News Scan for Jan 21, 2021

News brief

CDC: Vaccine uptake in US kindergartners remained high in 2019-20

New data published today in Morbidity and Mortality Weekly Report (MMWR) show routine vaccine uptake among kindergarteners across the United States during the 2019-20 school year was high, approximately 95%—but the COVID-19 pandemic threatens to bring that number down.

The data came from a national assessment of vaccine coverage among incoming kindergartners reported to the Centers for Disease Control and Prevention (CDC) annually. Only 2.5% of kindergartners had an exemption from at least one vaccine during the 2019-20 school year.

For the school year, national coverage was 94.9% for diphtheria and tetanus toxoids, and acellular pertussis; 95.2% for measles, mumps, and rubella (MMR); and 94.8% for varicella vaccines. A total of 2.3% were not up to date for MMR and did not have a vaccine exemption. Both the exemption rate and vaccine uptake were similar to levels or the 2018-19 school year.

But the disruption of the pandemic will likely mean skipped routine doctor's visits, the authors said, and the transition to distance learning may mean parents opted out of the standard vaccination schedule.

"CDC expects that the COVID-19 pandemic has already reduced actual vaccination coverage of kindergarten-aged children through reduced appointment availability at providers' offices, parents delaying preventive health care visits, and other barriers to vaccination, and that those disruptions will reduce kindergarten vaccination coverage in the 2020–21 school year," the authors concluded. "In addition, schools in many states began the 2020–21 school year remotely and might not have enforced the usual vaccination policies."
Jan 22 MMWR study

Global flu detections remain mainly sporadic, mainly flu B

Flu activity across the globe remained at lower levels than expected for this time of year, though some countries in the Northern Hemisphere have reported sporadic cases of influenza A and B, the World Health Organization (WHO) said in its latest regular update, which roughly covers the last half of December and into the first days of January.

In its report, the WHO included caveats that COVID-19 measures are likely affecting the circulation of flu and that increased efforts have been under way to test for flu.

Haiti reported increased flu activity in the past few weeks, and some flu activity continues in West Africa. Countries in South Asia have reported sporadic cases.

Of nearly 201,000 respiratory specimens tested at WHO-affiliated labs from Dec 21 to Jan 3, only 409 were positive for flu. Of those, 70.4% were influenza B and 29.6% were influenza A. Of the subtyped influenza A samples, 54.3% were 2009 H1N1 viruses and 45.7% were H3N2.
Jan 20 WHO global flu update

COVID-19 Scan for Jan 21, 2021

News brief

RNA—but not live virus—found in corneas of deceased COVID patients

Six of 11 deceased patients—all but one of whom had COVID-19—had SARS-CoV-2 RNA in their corneas, but live virus was not detected, according to a study published today in JAMA Ophthalmology.

German researchers examined six female and five male deceased coronavirus patients who underwent autopsy from Mar 20 to May 14. One of the patients died of hemorrhagic shock, which was deemed unlikely to be related to COVID-19.

They detected genomic RNA of SARS-CoV-2, the virus that causes COVID-19, in 6 of the 11 (55%) corneal discs harvested and subgenomic RNA in 4 of those 6.

The researchers were unable to isolate the virus or detect it on immunohistology and thus couldn't ascertain infectivity of the virus, detect viral replication, or determine the presence of viral structural proteins in any of the corneas. Patients with corneas positive for the coronavirus, however, also had positive results on COVID-19 testing of other parts of the eye, including in 4 of 6 swab samples from the conjunctivitis, 1 of 3 from the aqueous humor, 3 of 5 from the vitreous humor, and 4 of 5 from the blood.

Conjunctival swab samples were positive for SARS-CoV-2 RNA in 5 of 11 cases, and 5 of 9 patients had postmortem evidence of the virus in their bloodstreams. Median time from death to autopsy was 2.7 days, and no preexisting eye conditions had been noted in any of the decedents' medical records.

The authors noted that current guidelines recommend avoiding transplant of corneas from donors who either had COVID-19 at the time of death or who had been recently exposed to the virus, because the infectivity of contaminated tissue posed to potential recipients is unknown. They said, though, that transmission of a donor disease to a corneal transplant recipient is rare.

"The potential of SARS-CoV-2 infection via a corneal transplant is low, but further research is warranted to assess the rate of SARS-CoV-2 transmission," the researchers wrote. "The low RNA loads in corneal samples suggest a low risk of infection through a corneal transplant.... Nevertheless, infection via a contaminated corneal graft cannot be fully excluded."
Jan 21 JAMA Ophthalmol study

Many patients skipped medical care early in pandemic, study finds

Almost 41% of US adults skipped some form of medical care during the first wave of the pandemic, according to a JAMA Open Network study published today.

People most often opted out of planned medical care because the related medical practice was closed (63.0%), they were worried about COVID-19 transmission (57.4%), or they had financial concerns related to the pandemic (14%).

The researchers surveyed 1,337 US adults as part of the second wave of the John Hopkins COVID-19 Civic Life and Public Health Survey. While 79.0% reported needing care from March to mid-July, 2020, 14.9% missed at least one prescription fill at a retail pharmacy, 58.3% missed an outpatient general medical appointment, 46.3% missed an outpatient general mental health appointment, 60.6% missed an elective surgery, and 51.4% said they did not receive care for a severe mental or physical issue that started after the pandemic. (Receiving telehealth did not count as forgoing medical care.)

Race, age, household income, employment status, and health insurance status appeared to affect outcomes. Some of the largest percentage-point gaps included missed prescriptions by Hispanic people vs white people (30% vs 10%) and non-working vs working people (39% vs 13%). Those who were on Medicaid also reported a higher frequency of missed prescriptions than those on commercial health insurance or Medicare (36% vs 10%).

"The findings of this survey study suggest that as the United States is experiencing another wave of surging SARS-CoV-2 infections, it will be important to track whether interventions to enhance health system safety provide the public with sufficient confidence to seek medical care," the researchers write.
Jan 21 JAMA Netw Open study

US suicide rates found stable during first COVID-19 wave

US suicide rates most likely did not increase during the first wave of the pandemic, according to two research letters published today in JAMA Network Open.

The first looked at nationwide internet searches related to suicide and reported 7.8 million fewer than expected. The other study focused on Massachusetts suicide rates during the stay-at-home period from March to May 2020 and found a 16% lower rate compared with 2019 (0.84 rate ratio; 95% confidence interval [CI], 0.64 to 1.00).

The internet study used data from the past decade to create a forecast for suicide-related searches before and after the declaration of a national emergency, looking at phrases such as "suicide" and "suicide note." (Past studies have linked increases in such searches to increased suicides.)

Queries with "suicide" decreased 22% (95% CI, 18% to 26%) in the 18 weeks after President Donald Trump announced a national emergency, and searches never surpassed the expected amount in any week. Three quarters of the related terms also showed decreases.

The only related searches that significantly increased were facts, such as "How many people commit suicide?" which had an 18% increase, or 13,000 more searches than expected (95% CI, 1% to 36%).

In the Massachusetts study, the researchers looked at the past 5 years of data from the Massachusetts Department of Health Registry of Vital Records and Statistics to create forecasts and comparisons. From March through May 2020, 0.67 suicides occurred per 100,000 person-months (95% CI, 0.56 to 0.79); the corresponding months in 2019 had 0.80 suicides per 100,000 person-months (95% CI, 0.68 to 0.93). Even with a more conservative assumption in pending cases, the incidence rate ratio between 2020 and 2019 was 0.94.

Both studies suggest that solidarity helped suicide rates remain stable. "In some cases, catastrophes are associated with increased social support and unify communities and are thereby associated with reduced suicidal outcomes (what experts call the 'pulling together' phenomenon)," write the researchers from the internet study. Both research groups, however, say suicides may increase as the pandemic continues.
Jan 21 JAMA Netw Open internet study
Jan 21 JAMA Netw Open Massachusetts study