News Scan for Dec 08, 2020

COVID-19 in childcare workers
Binge drinking during COVID lockdown
Early promise for universal flu vaccine
Avian flu in Europe

Study suggests childcare workers not at higher risk for COVID-19

A large study of childcare providers in Pediatrics today found that childcare staff were not at higher risk for COVID-19 during the early months of the US pandemic.

Recent research suggests that children are unlikely to be the source of COVID-19 household outbreaks, but the role of children in the spread of SARS-CoV-2, the virus that causes COVID-19, has not been fully defined. A number of studies show low rates of pediatric SARS-CoV-2 infection and spread and mild symptoms in infected children. But other research shows that children shed virus at levels comparable to adults, suggesting that children could be a significant source of community transmission and leading to concerns about spread in childcare settings.

Researchers gathered email survey data from 57,335 self-identified childcare providers in all 50 states from May 22 to Jun 8, using national childcare association databases and state registries. Participants self-reported testing positive or being hospitalized for SARS-CoV-2 (427 cases), as well as their degree of exposure to childcare.

Nearly half of all childcare programs (48.6%) did not close or reopened during the study period. Programs that remained open were typically operating at lower capacity and with significant mitigation efforts—hand hygiene, surface disinfection, symptom screening, grouping children by age-group, and social distancing.

The study authors found no association between exposure to childcare and risk of contracting COVID-19 after adjusting for confounding variables (matched odds ratio, 0.94; 95% confidence interval [CI], 0.73 to 1.21). Home-based providers showed a higher risk of COVID-19 (OR, 1.59; 95% CI, 1.14 to 2.23) but did not show an association with childcare exposure. Risk of COVID-19 in childcare workers was strongly associated with high levels of community transmission, measured by county-level COVID-19 deaths (OR, 1.60; 95% CI, 1.19 to 2.15; P=0.002).  

Experts in a commentary in the same journal caution against extrapolating the study's conclusions to kindergarteners to 12th-graders. "Student, teacher, and classroom dynamics differ from child care settings in ways that meaningfully influence infection transmission," they noted. "The results from this study should give confidence to center-based child care providers that the risk of COVID-19 infection from young children is low when community transmission is low and multiple risk mitigation strategies are employed."
Dec 8 Pediatrics study
Dec 8 Pediatrics commentary


Every week of lockdown increased binge drinking odds by 19%, data show

The likelihood of binge drinking increased 19% every week during the US spring COVID-19 lockdown, according to a study published yesterday in the American Journal of Drug and Alcohol Abuse. The 1,982-person survey also revealed that the most predictive factors of increased drinking were pre-pandemic drinking habits and history of depression.

The researchers collected data from mid-March to mid-April, and binge drinking was defined as more than four drinks per occasion for women and more than five drinks per occasion for men.

Overall, increased alcohol consumption during the pandemic was 60% more likely for binge drinkers and 28% more likely for non-binge drinkers. If respondents reported a previous depression diagnosis and were currently experiencing depressive symptoms, they were 80% more likely to increase their drinking during lockdown—227% more likely if they were already binge drinkers. Living with children minimized odds of any drinking by 26%.

"We hope that public health and clinical experts consider these additional associations of the pandemic and develop programs and opportunities to overcome them," Sitara Weerakoon, MPH, first and corresponding study author, said in a University of Texas press release. "This may include increasing awareness and access to virtual counseling sessions and mental health services. Additionally, public health organizations should prioritize providing healthy alternatives for stress relief, such as virtual meetups and social activities."

Before the pandemic, binge drinkers said they drank a maximum of 6.5 drinks per occasion, and 31.1% practiced the same alcohol consumption during the pandemic's first wave. Non-binge drinkers had a 2.1-drink upper limit, and 55.8% of them said their intake did not change. Respondents were mostly affluent (75% had a household income of at least $80,000), had an average age of 42, and were predominantly white (89%).
Dec 7 Am J Drug Alcohol Abuse study
Dec 7 University of Texas press release


Universal flu vaccine found safe, immune-producing in phase 1 trial

Universal flu vaccine candidates created with chimeric hemagglutinin (cHA) produced a broad immune response for 1.5 years, reports a study yesterday in Nature Medicine. Traditional flu vaccines target the virus' head of hemagglutinin (HA), but some researchers hope that creating a vaccine that targets the less-frequently mutating stalk will provide longer and broader protection.

The researchers were able to sidestep issues of the virus's immunodominant head by using first H8 then H5 HA viral heads in their vaccination sequence, both with the same H1 HA stalk. Past studies have shown that by using the same stalk but different heads in vaccination regimens, subjects receive rising levels of immunity to the stalk itself. Most adults have already been primed at least once for the H1 stalk through previous exposure.

The placebo-controlled, phase 1 trial used three different intervention groups and two control groups of 18- to 39-year-old, healthy US adults. Variables included intranasal or intramuscular prescription, live-attenuated influenza virus vaccines (LAIVs) or inactivated influenza virus vaccines (IIVs), and the presence of an adjuvant.

All regimens included a booster of some kind on day 85. Out of 65 study participants, most adverse events were mild or moderate, with common effects across all intervention groups being headache, fatigue, and muscle soreness.

Using 1,280 stalk antibody area under the curve (AUC) levels as an acceptable level of immune response, the most promising long-term regimen was an intramuscular, adjuvanted IIV expressing cH8/1N1 on day 1 and a booster of adjuvanted cH5/1N1. Between 66.7% and 73.3% of participants still remained in this immune threshold considered to be protective between days 242 and 588, approximately 2.25-fold above baseline.

The other two regimens used LAIVs, and while the addition of an IIV booster vaccination produced long-term immune response in only 7.7% of recipients, 40.9% of those who received an IIV booster with an adjuvant had sufficient titer levels for immunity.
Dec 7 Nat Med study


H5N8 avian flu strikes more poultry, wild birds in Europe

Two countries—France and Poland—reported more highly pathogenic H5N8 avian flu outbreaks in poultry, and France and two other European countries reported more detections of the virus in wild birds, according to the latest notifications from the World Organization for Animal Health (OIE).

In France, the virus struck a duck farm during the open-air prefeeding phase in Landes department in the far southwest of the country. The event began on Dec 5, killing 400 of 6,000 birds. An investigation into the source of the virus is still under way, but the farm is near a wetland area where migratory birds stop.

Poland reported H5N8 at a layer farm in Pomorskie province in the northwestern part of the country. The outbreak started on Dec 3 and killed 6,000 of 176,871 chickens at the facility.

In wild bird reports, France reported H5N8 detections in waterfowl in Loire-Atlantique department in the northwest and Meurthe et Moselle department in the northeast. Slovenia reported more H5N8 in waterfowl, this time from Ljubljana, its capital and largest city. And the Netherlands reported three more outbreaks in waterfowl, two in South Holland province and one in Utrecht province.
Dec 8 OIE report on H5N8 in French poultry
Dec 8 OIE report on H5N8 in Polish poultry
Dec 8 OIE report on H5N8 in French wild birds
Dec 7 OIE report on H5N8 in Slovenia
Dec 7 OIE report on H5N8 in the Netherlands

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