Heart inflammation found in athletes after mild, asymptomatic COVID-19

Four of 26 competitive athletes (15%) who had recovered from mild or asymptomatic COVID-19 had evidence suggestive of myocarditis, or inflammation of the heart muscle, on cardiac magnetic resonance (CMR) imaging, according to a research letter published today in JAMA Cardiology.

Researchers from The Ohio State University performed CMR, electrocardiography, and echocardiography and measured serum troponin I levels in all competitive athletes referred to the sports medicine clinic 11 to 53 days after testing positive for coronavirus to detect myocarditis, which would flag athletes before they returned to play that they might be at high risk for sudden cardiac death.

Twelve athletes (26.9%) reported having only mild symptoms during their COVID-19 infections, including sore throat, shortness of breath, muscle pain, and fever. The remainder were asymptomatic.

While no diagnostic ST/T wave changes were evident, and ventricular volumes and function and serum troponin I levels were normal in all athletes, four male athletes showed signs of myocardial edema (swelling) and injury on CMR. Two of them had signs of pericardial effusion, or an accumulation of excess fluid between the heart and its surrounding sac.

Eight athletes had gadolinium enhancement on CMR without T2 sequence elevation, suggesting myocarditis. Athletes with signs of myocarditis had prolonged T2 sequences compared with those without signs (59 vs 51 milliseconds), suggesting dysfunction.

Two of the four affected athletes had had only mild shortness of breath, and the remaining two reported no symptoms.

The authors noted that a July study in the same journal also demonstrated cardiac findings in a significant number of recovered COVID-19 patients. "While long-term follow-up and large studies including control populations are required to understand CMR changes in competitive athletes, CMR may provide an excellent risk-stratification assessment for myocarditis in athletes who have recovered from COVID-19 to guide safe competitive sports participation," they wrote.
Sep 11 JAMA Cardiol research letter

Swiss study finds lower aerobic capacity in soldiers with COVID-19

A study of Swiss Army personnel found reduced aerobic capacity in recruits with symptomatic COVID-19 1 to 2 months after diagnosis, Swiss and British researchers reported yesterday in Eurosurveillance.

The study looked at 199 recruits (median age 21 years) belonging to two companies heavily affected by a COVID-19 outbreak at a Swiss Army base in March and April. The participants were sorted by infection status into three groups: convalescent recruits with symptomatic COVID-19 (n = 68), asymptomatic recruits with evidence of viral infection (n = 77), and a naïve group without clinical symptoms or evidence of infection (n = 54). The researchers then compared the results of a fitness test—which included an endurance run—conducted a median of 45 days after COVID-19 diagnosis with the results of the same test conducted 3 months before the outbreak.

The comparison revealed that nearly 19% of the COVID-19 convalescents saw a decrease of more than 10% in maximal aerobic capacity (VO₂max), while VO₂max increased by more than 10% in 14% of the naïve recruits and 8% of the asymptomatic recruits. Prior to the outbreak, VO₂max was very similar between the three groups. Strength test results did not differ significantly before and after diagnosis.

The authors of the study note that while the data don't explain the pathophysiology behind the findings, reduced aerobic capacity is a hallmark of interstitial lung disease.

"This indicates the importance of further long-term follow-up studies to assess the extent and duration of the sequelae, as well as of infection prevention to avoid these long-term consequences," they wrote.
Sep 10 Eurosurveill study

Child-to-child SARS-CoV-2 spread rare in German schools, study finds

In another study yesterday in Eurosurveillance, German researchers report that child-to-child transmission of SARS-CoV-2, the virus that causes COVID-19, appeared very uncommon after schools and childcare facilities in the state of Baden-Wurttemberg reopened.

To gain a better understanding of SARS-CoV-2 transmission in schools and childcare facilities in Baden-Wurttemberg after they reopened in May, the researchers compiled and analyzed data from infected children (ages 0 to 19 years) who had been to those schools and childcare facilities from May 25 to Aug 5.

In total, 557 cases were reported during the study period (representing 17.9% of all 3,104 reported cases in the state), and information in school attendance was available for 453. Of these cases, 137 attended school or childcare facilities for at least 1 day in their infectious period, while 316 were at home during their entire infectious period.

More than 2,300 nasopharyngeal swabs were taken from the close contacts (teachers and students) of the 137 index cases, and from close contacts of secondary cases. Overall, 6 of the 137 index cases were found to have infected 11 additional pupils, and no secondary infections could be detected for the remaining cases, despite extensive contact tracing and swabbing of contacts. All remaining cases with information on school and childcare attendance were caused by other sources.

Based on these data, the researchers estimate one secondary case per roughly 25 infectious school days.

"Our investigation suggests that child-to-child transmission in schools and childcare facilities is uncommon and not the primary cause of SARS-CoV-2 infection in children," the authors of the study wrote.
Sep 10 Eurosurveill study

Report shows steep declines in antibiotic use on British poultry farms

A report this week from the British Poultry Council (BPC) shows steep reductions in antibiotic use in recent years.

According to the BPC's 2020 Antibiotic Stewardship Report, total antibiotic use on farms raising chickens, ducks, and turkeys fell by 76% from 2012 through 2019, and the use of critically important antibiotics—those also used in human medicine—declined by 97.3%. In 2019, the sector used 19.7 tons of antibiotics, which accounts for 9.3% of the total antibiotics licensed for use in food-producing animals in the United Kingdom.

The report noted that while 2019 saw a slight increase in antibiotic use due to disease challenges, the sector remains below industry-specified targets.

"The British poultry meat sector stands committed to upholding the UK’s position at the forefront of international efforts to keep antibiotics effective for future generations and tackling antimicrobial resistance," BPC Chief Executive Richard Griffiths said in a press release. "UK poultry meat producers have stopped all preventative treatments and the highest priority antibiotics that are critically important for humans are used only as a 'last resort' for chickens and turkeys."
Sep 8 BPC 2020 Antibiotic Stewardship Report
Sep 8 BPC press release

FDA grants orphan drug status for antibiotic peptide

Biotechnology platform company Peptilogics, of Pittsburgh, announced this week that the Food and Drug Administration (FDA) has granted Orphan Drug Designation for PLG0206, an antibiotic peptide, for the treatment of prosthetic joint infections (PJIs).

PLG0206 is a broad-spectrum cationic antibiotic peptide with a novel mechanism of action that kills bacterial cells by targeting and disrupting the bacterial membrane. It has demonstrated activity against pathogens identified as critical, urgent, or high-priority targets by the World Health Organization and the US Centers for Disease Control and Prevention, and addresses the biofilms and persistent pathogens that make PJIs difficult to treat.

Under the Orphan Drug Act, the FDA can grant Orphan Drug Designation to a drug or biological product that treats a rare disease or condition that affects fewer than 200,000 people in the United States, provided the drug and the disease or condition meet certain criteria. Orphan designation qualifies the sponsor of the drug for certain incentives, including a partial tax credit for clinical trial expenditure, waived user fees, and eligibility for 7 years of marketing exclusivity.

"PLG0206 is the first novel anti-infective to be granted Orphan Drug Designation, confirmation that we are advancing a meaningful therapy that can address an unmet medical need, beginning with PJI," Peptilogics Founder and CEO Jonathan Steckbeck, PhD, said in a press release.
Sep 9 Peptilogics press release

Five more sick in DRC's latest Ebola outbreak; total at 118 cases

A spurt of 5 new cases were reported in the Democratic Republic of the Congo (DRC) Equateur province outbreak, boosting the total to 118, the World Health Organization (WHO) African regional office said in an update on Twitter today.

No new deaths were reported, keeping the fatality count at 48.

The outbreak is the country's 11th involving Ebola and is occurring in the same area where the DRC's ninth outbreak took place in 2018, sickening 54 people and leading to 33 deaths.

Health officials are concerned about the new outbreak, as outbreak responders also grapple with COVID-19 amid scarce resources. In addition, illnesses are occurring across a broad area, some difficult to access, and some patients with confirmed infections have remained in the community, posing a high risk of further spread.
Sep 11 WHO African regional office tweet

Five countries report more polio cases

Five countries reported more polio cases over the last week, two in the Middle East and three in Africa, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).

In the Middle East, Afghanistan and Pakistan reported more wild poliovirus type 1 (WPV1) cases. Afghanistan reported 4 cases, 2 each in Kandahar and Zabul provinces, raising its total for the year to 44 cases. Pakistan reported 3 more WPV1 cases, 1 in Balochistan province and 2 in Punjab province, lifting its number for 2020 to 68.

The three African countries all reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases. Chad had 3 more cases, 2 in Logone Oriental province and 1 in Tandjile province, lifting its total for the year to 63 from two different outbreaks.

The DRC reported 15 more cases, including 13 in Equateur province where an Ebola outbreak is under way (see item above) and 1 each in Kinshasa and Mai Ndombe provinces, putting the country's 2020 total at 41. And finally, Sudan reported 8 more cVDPV2 cases in five different provinces, increasing its total for the year to 21. The GPEI said all are linked to the virus circulating in Chad.
Sep 10 GPEI update

H5N1, H5N6 avian flu outbreaks reported in Vietnamese poultry

Vietnam today reported avian flu outbreaks in poultry in two provinces involving two different highly pathogenic strains, H5N1 and H5N6, according to notifications to the World Organization for Animal Health (OIE).

The H5N1 outbreak began on Aug 26 in village birds in Tra Vinh province, located in the south. The virus killed 100 of 300 susceptible birds, and the survivors were destroyed to curb the spread of the virus. So far, the source of the virus isn't known. Vietnam reported its last H5N1 outbreak in June.

Meanwhile, Vietnamese animal health officials said H5N6 struck village birds in Hai Phong province in the north. The outbreak began on Aug 21, killing 350 of 6,171 birds. The remaining ones were culled as part of the outbreak response. The country reported its last H5N6 outbreak in July.
Sep 11 OIE report on H5N1 in Vietnam
Sep 11 OIE report on H5N6 in Vietnam