News Scan for Aug 13, 2020

MDR-TB infections in Ohio
US gears up for flu vaccination
Severe COVID-19 risk factors

MDR-TB cases at Ohio food processing facility investigated

A case report today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report describes three cases of multidrug-resistant tuberculosis (MDR-TB) among workers at an Ohio food-processing facility.

Investigation into the three cases by the CDC and Ohio Department of Health (ODH) began in February 2019 after whole-genome sequencing revealed that MDR-TB isolates from the three patients were genetically identical. The index patient was born in one of the 30 countries identified by the World Health Organization as having a high prevalence of MDR-TB. According to the available work schedules, the second and third patients had worked for at least 54 days and 7 days, respectively, on the same food production line as the index patient. The third patient also worked in a second facility, but that facility had closed by the time of the investigation.

All three patients recovered, and no other cases of MDR-TB related to the patients were identified, but testing of 160 high-priority workplace contacts (out of 448) found that 59 (37%) had positive results on tuberculin skin tests or interferon-y release assay tests, both of which test for TB infection. That's higher than the estimated percentage of non–US-born people in the United States who have a positive tuberculin skin test (21%) or a positive interferon-y assay result (16%) and is an indication of workplace transmission, the investigators concluded. Among those with positive results, 19 (32%) began latent TB treatment.

The authors say the low level of TB testing and treatment for infection among contacts is a concern, and is likely related to difficulties in communication, perceived barriers to care, and mistrust of government authorities.

They write, "Public health agencies need to facilitate engagement with communities with higher rates of TB to build trust, which is important for successful disease investigations. Activities might include communicating in a culturally sensitive manner with community members, offering patients incentives for getting tested or treated, providing transportation to clinics, using mobile clinics, and conducting communitywide education efforts."

ODH is continuing to work with local partners to facilitate TB testing and latent TB treatment for contacts and monitor for new cases.
Aug 13 MMWR Notes from the Field


Flu vaccine makers boost production for upcoming flu season

The CDC said in a recent update to its flu vaccine information that vaccine makers expect to make about 194 to 198 million doses for the upcoming US flu season, up from 175 million doses for the previous season.

The CDC said that though it's not possible to say if flu will circulate alongside COVID-19, it is taking steps to maximize vaccination during the COVID-19 pandemic to reduce the risks of flu and reduce the overall burden on the healthcare system. In the Southern Hemisphere, the flu season hasn't started, which could be complicated by COVID-19 factors, including the possibility that physical distancing and other measures could be influencing flu circulation patterns.

The CDC has purchased an additional 2 million doses of pediatric vaccine and 9.5 million doses of adult flu vaccine and will target its outreach to groups that are at higher risks of flu complications.

Some settings, such as workplaces, may not offer vaccination this year due to social distancing challenges, and the CDC is working with health providers to develop contingency plans for vaccinating people while minimizing the risk of COVID-19 and other respiratory viruses. Earlier this summer, the CDC issued interim guidance for delivering immunization services during the COVID-19 pandemic.

The CDC has developed a test that public health labs can use to test for flu and COVID-19 at the same time to help health officials track how both diseases are spreading. However, the specialized test is for surveillance efforts and won't replace tests used in healthcare settings.

Two new vaccines will be available for the upcoming US flu season: a quadrivalent high-dose vaccine for adults ages 65 and older and an adjuvanted quadrivalent vaccine for seniors. Both are replacing trivalent versions.

In related developments, Sanofi announced on July 22 that it began shipping its first doses of flu vaccine to health providers, and GSK made a similar announcement on July 28. In addition, Astra Zeneca today announced that it has started shipping FluMist doses for the upcoming season.
Aug 7 CDC FAQ on 2020-2021 flu season
CDC interim guidance on immunization services
Jul 22 Sanofi press release
Jul 28 GSK press release


Study identifies key symptoms, risk factors associated with severe COVID-19

Researchers at one regional hospital in Maryland identified key risk factors for severe illness from COVID-19 (defined as intensive care unit [ICU] admission or death), and found diabetes and kidney disease were accurate predictors of serious outcomes. The study was published yesterday in PLoS One.

The study was conducted via a retrospective chart review of the first 117 patients hospitalized for COVID-19 from Mar 1 to Apr 12 at the Anne Arundel Medical Center in Parole, Maryland. Patients discharged or deceased within 1 day of arrival were not included in the study.

Of the 117 patients, the average age was 66, and the most common findings at admission were cough (82.1%), shortness of breath (78.6%), and fatigue (67.5%). Chest scans on 110 patients showed ground glass opacities in 58.1% of the scans. In-hospital mortality was 24.8%, and 30.8% of patients required ICU admission, while 29.1% required mechanical ventilation.

Patients who required ICU care or died from their infections, "were more likely to complain of increased sputum production (18.8% vs. 5.8%, P= .028), and had … more total comorbidities or risk factors (4.5 vs. 3.0, P = .001) and displayed higher rates of insulin-dependent diabetes mellitus (27.1% vs. 2.9%, P < .001), obstructive sleep apnea (16.7% vs. 4.3%, P = .049), atrial fibrillation (22.9% vs. 5.8%, P = .006), and chronic kidney disease (41.7% vs. 10.1%, P < .001)," the authors wrote.

Patients with severe symptoms were also older. The authors said their findings could be used to help identify patients at risk for severe COVID-19 upon hospital admission and to allocate resources.
Aug 12 PLoS One study

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