News Scan for Dec 28, 2020

Hospital air contamination
Antibiotic stewardship in children
New polio cases in five countries
Yellow fever in Guinea
More CWD in Montana

Hospital air frequently contaminated with COVID-19, study finds

A study of hospital air contamination in JAMA Network Open last week found that 17.4% of air samples from environments near COVID-19 patients were positive for SARS-CoV-2 RNA, the virus that causes COVID-19, but only 8.6% contained viable virus.

Researchers reviewed 24 observational studies of air contamination in hospital settings from Jan 1 to Oct 27 with data on SARS-CoV-2 viral RNA positivity rates detected by reverse-transcription polymerase chain reaction (RT-PCR), viral culture, air ventilation systems, and distance from patients.

Overall, 82 of 471 air samples (17.4%) from close patient environments (within 5 meters) were positive for SARS-CoV-2 RNA, with no significant difference associated with distance from patients. The positivity rate in intensive care settings was 25.2% (27 of 107 samples) compared with 10.7% (39 of 364 samples) for non-intensive care units (P < .001).

Of a total of 81 viral cultures performed, 7 (8.6%) were positive, all from close patient settings. The authors note that this finding is consistent with studies of other respiratory viruses that are frequently found in the air around patients, but which rarely demonstrate the presence of viable viruses.

Public areas showed high viral loads, with 56.3% of hallway samples testing positive and a 33.3% public area positivity rate overall. High viral loads were also found in patient bathrooms (23.8% positivity rate), staff workstations (27.2%), and staff meeting rooms (19.2%).

"In an epidemic setting, public areas are often crowded, with both a high patient flow and high incidence of COVID-19," the authors wrote. "These factors have to be considered to control the transmission of COVID-19 between nonmasked HCPs in hospitals, especially staff rooms and lockers."

The study authors point to wide variability in the air sampling methods and poorly detailed climatic conditions such as temperature and humidity—that can affect the capacity for viral particles to remain suspended in air—as factors that limit the study's conclusions and call for further research.
Dec 23 JAMA Netw Open study


PIDS provides guidance for pediatric antibiotic stewardship programs

The Pediatric Infectious Diseases Society (PIDS) today published a policy statement in Pediatrics recommending and providing specific guidance for antibiotic stewardship programs (ASPs) for pediatric populations.

Antibiotics are the most common medications prescribed to children and are also frequently prescribed unnecessarily, and the risks associated with antibiotic overuse—including antibiotic resistance, Clostridioides difficile infections, and other adverse events—are just as significant in children as they are in adults. Yet while many US hospitals have adopted ASPs to promote judicious antibiotic use, the members of the PIDS Committee on Infectious Diseases note that differences in common infections, drug-specific considerations, and evidence surrounding treatment recommendations between children and adults mean that stewardship for pediatric populations requires specific guidance.

Their statement discusses the rationale for inpatient and outpatient pediatrics ASPs, the essential personnel, infrastructure, and activities required for effective stewardship in children, approaches to evaluating their effectiveness, and gaps in knowledge that require further investigation.

Among the recommendations are that pediatric ASPs should include specialists with both pediatric and stewardship expertise, that inpatient ASPs can use clinical guidelines, prior approval, and post-prescription review and feedback as core interventions, but can also use pharmacy-driven interventions. They also recommend that outpatient ASPs focus on judicious use of antibiotics for acute respiratory tract infections and emphasize use of the narrowest spectrum of antibiotics for the shortest duration of therapy.
Dec 28 Pediatrics policy statement


New polio cases reported across Asia, Africa

Five countries confirmed new wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) cases in the Global Polio Eradication Initiative's (GPEI) Dec 23 report.

The most cases were in Pakistan, with 1 WPV1 case in Balochistan province and 11 cVDPV2 cases in Sindh (6) and Balochistan (5). While the country's 83 WPV1 cases for the year are lower than 2019's 147, the year's total for cVDPV2 is already 121, whereas 2019 had 22.

In Africa, Burkina Faso had 6 cVDPV2 cases across Dedougou (3), Koudougou (2), and Kaya (1) provinces, in part due to the Jigawa outbreak in Nigeria and Savanes outbreak in Togo. Similarly, South Sudan's 10 cVDPV2 cases in Warrup (8), Upper Nile (1), and Lakes (1) provinces added to the  38 cases linked to the polio outbreak in Chad. South Sudan also found one positive cVDPV2 environmental sample in Central Equatoria province.

Chad had two cVDPV2 cases in Logone Oriental and Logone Occidental, and the risk for further cases across the Lake Chad subregion remains high.

Two countries reported positive environmental samples but no new cases. Afghanistan, which led the prior week's report totals with 54 cases of cVDPV2, reported 2 WPV1 and 23 cVDPV2 positive environmental samples across four provinces, including Helmand (8 cVDPV2) and Kandahar (7 cVDPV2). These two provinces had 33 cVDPV2 cases in the previous GPEI report. The country of Benin also reported 1 cVDPV2 positive environmental sample in Oueme.
Dec 23 GPEI weekly report


Yellow fever outbreak strikes children in northwest Guinea

A yellow fever outbreak centered in northwestern Guinea that began in early November and is focused among children has resulted in 52 suspected cases, 14 of them fatal, the World Health Organization (WHO) said in a Dec 23 announcement.

Of the 52 cases, 50 are from Koundara health district. Testing revealed that 8 samples from the district were positive for yellow fever. And of the cases from the district with known vaccination status 31 were in unvaccinated people.

Children aged 5 to 14 years  were the most affected age-group. Following the identification of the first three cases, health officials launched a vaccination campaign that reached about 3,000 children in the region.

The WHO said Guinea is a high-risk endemic country and current estimates suggest 40% vaccination coverage between 2016 and 2019, below the level needed to sustain population immunity. Coverage is very low in Koundara district at about 16%.

An entomological survey found the possibility of Aedes mosquito contact with the local population, along with factors to support sylvatic spillover from nonhuman primates to people.

Nationally, the risk is high, due to large numbers of cases in young children over a short time period, the WHO said, adding that the regional risk is moderate.
Dec 23 WHO statement


First CWD case reported on tribal land in Montana

A whitetail deer harvested by a tribe member on Blackfeet Nation land in Montana tested positive for chronic wasting disease (CWD), according to the Blackfeet Fish and Wildlife Department (BFWD). ProMED, who later reported the case, believes that this is the first instance of CWD on the reservation's 1.5 million acres.

The deer was harvested in the Meriwether Road area Nov 11, and the hunter voluntarily gave a sample to the Montana, Fish, Wildlife, and Parks department (MFWP). While the FWP already has three large regional zones designated as Priority Surveillance Areas in the state, it has no authority on tribal lands.

BFWD says it will work with MFWP, the US Animal and Plant Health Inspection Service, the Bureau of Indian Affairs, and other professionals to come up with a CWD management strategy and provide updates through its website, Facebook page, and local media. For now, tribal hunters can bring fresh or frozen cervid samples to the BFWD office for CWD testing. (MFWP regional offices stopped accepting samples Nov 29, the end of the state's hunting season, according to the BFWD report.)

CWD is a fatal neurological disease caused by misfolded prions that can be spread among cervidae species such as deer, elk, and moose through contact with infected body fluids, antler velvet, and environmental surfaces. Currently, no evidence for cervid-to-human transmission exists, but the Centers for Disease Control and Prevention) do not recommend eating any CWD-positive meat as a similar disease, bovine spongiform encephalopathy (a.k.a. mad cow disease), mutated to infect humans.
Dec 23 ProMED report
Dec 15 BFWD report



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