News Scan for Sep 17, 2020

High viral load and COVID-19 death
Eastern equine encephalitis in Indiana
Avian flu in Kazakhstan

High COVID-19 viral load in hospital patients tied to higher risk for death

High SARS-CoV-2 viral load at hospital admission may place patients with and without cancer at higher risk for death, a new multicenter observational study published in Cancer Cell suggests.

Researchers at Weill Cornell Medicine used surrogate markers to measure the viral load of SARS-CoV-2, which causes COVID-19, in 100 cancer patients and 2,914 patients without cancer admitted to one of three New York City hospitals from Mar 15 to May 14.

The in-hospital death rate was 38.8% in all patients with a high viral load, 24.1% among those with a medium viral load, and 15.3% among those with a low viral load (P < 0.001).

Similarly, cancer patients with a high viral load had the highest death rate (45.2%), while 28.0% of cancer patients with a medium load and 12.1% with a low load died (P = 0.008). Patients with hematologic cancers (affecting blood and blood-forming organs), especially those who had undergone chemotherapy or targeted treatments, had higher median viral loads than non-cancer patients. "We suspect that this finding may be from the underlying immunodeficiencies conferred by either the hematologic malignancies or the administered therapies, which may decrease the ability to inhibit proliferation of SARS-CoV-2," said co- author Lars Westblade, PhD, a pathologist at Weill Cornell Medicine, in a Cell Press news release.

High viral loads at admission were associated with increased age; underlying conditions such as congestive heart failure, diabetes, chronic kidney disease; and use of inhaled or oral steroids before hospitalization. Hispanic patients were less likely than those of other ethnicities to carry a high viral load at admission.

Cancer patients were more likely than patients without cancer to be white (42.0% vs 21.2%; P < 0.001), be former smokers (29.0% vs 16.5%; P = 0.001), have coronary artery disease (25.0% vs 14.8%; P = 0.004), and have congestive heart failure (14.0% vs 6.2%; P = 0.002). Proportions of cancer and non-cancer patients requiring oxygen support, intubation, and vasopressors (to regulate blood pressure) and who died in the hospital were similar.

"These findings highlight the critical role of viral load in SARS-Co-V pathogenesis and suggest that providing [viral load] value results to clinicians could serve as a valuable tool in the care of hospitalized patients with COVID-19," they wrote.
Sep 15 Cancer Cell study and news release


Eastern equine encephalitis case reported in Indiana

State health officials in Indiana this week reported a probable human case of eastern equine encephalitis (EEE) and the detection of the virus in horses in northern Indiana.

The Indiana State Department of Health (ISDH) identified the probable case in a LaPorte Country resident. Three horses in northern Indiana have also tested positive for the virus. Health officials are urging residents of northern Indiana to protect themselves from mosquito bites.

EEE is rare but can cause serious illness and death in people, with a fatality rate of around 33% or higher. Children under 15 and adults over 50 are at greatest risk of severe illness if infected.

"Eastern equine encephalitis virus disease is rare in humans but can cause permanent complications and even death," State Health Commissioner Kris Box, MD, said in a press release. "While all Hoosiers are at risk for mosquito-borne diseases, northern Indiana residents need to be especially vigilant right now."

Health officials recommend that people avoid being outdoors when mosquitoes are active, use an Environmental Protection Agency–approved insect repellent, cover exposed skin in places where mosquitoes are active, and eliminate mosquito breeding grounds from their property.
Sep 15 ISDH press release


High-path H5 avian flu outbreaks hit poultry in Kazakhstan

Animal health officials in Kazakhstan today reported seven highly pathogenic H5 avian flu outbreaks in poultry in the north near the Russian border, where several similar outbreaks were recently reported, according to a notification today from the World Organization for Animal Health (OIE).

The outbreaks began from Sep 11 to Sep 14, striking backyard and village poultry. The virus killed 1,763 of 67,794 susceptible birds, and response actions include movement restrictions, vaccination, and disinfection.

The report said the source of the virus is contact with wild birds and that the outbreaks mark the first appearance of the virus in Kazakhstan.

Russia recently reported a spate of H5 outbreaks, including some involving H5N8 in southwestern Siberia, which isn't far from Kazakhstan's outbreak area. UK veterinary officials have noted that similar outbreaks in Russia in the summer of 2016 heralded widespread H5N8 outbreaks in Europe that winter, and they urged poultry owners to remain vigilant.
Sep 17 OIE report on H5 in Kazakhstan
Sep 14 CIDRAP News scan "H5N8 avian flu strikes more poultry in Russia"

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