News Scan for May 21, 2021

Child care COVID-19 outbreaks
Africa in-hospital COVID deaths
Backyard poultry Salmonella
Vaccine-derived polio in 4 nations
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Report: COVID-19 outbreaks affected 6% of DC child care facilities

While one in four Washington, DC, child care facilities reported at least one COVID-19 case from July to December 2020, only 5.8% had COVID-19 facility-associated outbreaks, according to yesterday's Morbidity & Mortality Weekly Report. A facility-associated outbreak was defined as two or more lab-confirmed cases at a child care site within 14 days.

Out of 469 child care facilities in DC, 112 (23.9%) submitted 269 COVID-19 reports to the DC Office of the State Superintendent of Education (85 reports were excluded because of missing, duplicated, or inaccurate information). Officials confirmed 319 cases, including 3 found through contact tracing.

Outbreaks occurred in 27 (5.8%) facilities and accounted for 48.9% of the total reported cases, but the researchers note that five sites made up 44.2% of the facility-associated cases. About one in five infections (21.3%) were in asymptomatic patients, with 63.2% of these found in children. Overall, teachers and staff made up 56.4% of patients.

Most cases (72.4%) were reported after Oct 27, which was when community cases began increasing, the researchers write. Data showed five close contacts per child care patient versus 1.2 per community patient.

Facilities were more likely to have an outbreak if they had people who received COVID-19 tests 3 or more days post–symptom onset (relative risk [RR], 2.03), had asymptomatic cases (RR, 2.10), or were in operation for 3 years or less (RR, 3.29). The researchers suggest that more experienced facilities may have had more resources or been better at implementing COVID mitigation measures such as cohorting.

"Similar to outbreaks reported in school settings, those associated with child care facilities, including outbreak-associated cases, remained low," the researchers write. "Implementation and maintenance of multiple prevention strategies, including vaccination, masking, physical distancing, cohorting, screening, and reporting, are important to reduce transmission of SARS-CoV-2 in child care facilities and to facilitate a timely public health response to prevent outbreaks."
May 20 MMWR study


Half of critical COVID-19 patients in African hospitals died, study says

Almost half of patients hospitalized with critical COVID-19 infections died in the hospital within 30 days across 10 African countries, according to a Lancet study today. The researchers say that, compared with the global average, this translates to 11 to 23 excess deaths per 100 patients.

The African COVID-19 Critical Care Outcomes Study (ACCCOS) looked at 3,140 patients in intensive care or high-care units in 64 hospitals in 10 African countries from May to December 2020.

Factors associated with 30-day in-hospital mortality included a sequential organ failure assessment score of 3 or higher at admission (odds ratio [OR], 3.66), chronic liver disease (OR, 3.48), delay in admission due to resource shortages (OR, 2.14), HIV/AIDS infection (OR, 1.91), and increasing age per year (OR, 1.03). Patients who needed respiratory support of any type or had cardiorespiratory arrest within 24 hours of admission had similar or higher odds of mortality.

The researchers found high rates of physician and nurse coverage, so they speculate that resource shortages as well as underused resources due to lack of training or machine breakdown may have affected mortality rate. For instance, dialysis was available in 39 of 57 sites yet only offered to 330 patients. Placing patients in the prone position, they write, should have been used for at least six times as many patients, and access to extracorporeal membrane oxygenation was 14 times lower than what it should have been. Additionally, half the patients died without receiving oxygen.

"This study has several strengths, including a large sample size, robust analyses, as well as having a multisite and prospective design," write Bruce J. Kirenga, MBChB, MMed, PhD, and Pauline Byakika-Kibwika, MBChB, MMed, PhD, in a commentary.

"However, the authors also recognise some limitations, including that the study was done in tertiary hospitals. Moreover, 23 (36%) of 64 hospitals were in South Africa and Egypt, which are better resourced countries compared with some other African countries; mortality is probably higher in lower-income African countries."
May 22  Lancet study and commentary


CDC confirms 163 Salmonella illnesses linked to backyard poultry

The Centers for Disease Control and Prevention (CDC) has confirmed 163 new Salmonella infections in 43 states that are linked to backyard poultry.

A total of 34 people have been hospitalized, but no deaths have been recorded. Case-patients range in age from less than 1 to 87 years, with a median age of 24. But a third of the cases occurred in children under the age of 5 years, the CDC said.

Of 92 patients interviewed, 81 (88%) reported contact with backyard poultry before falling ill.

"Interviews with sick people show that contact with backyard poultry is the likely source of the outbreaks," the agency said in a press release. "Backyard poultry can carry Salmonella germs even if they look healthy and clean. These germs can easily spread in areas where they live and roam."

Officials in Ohio who collected samples from a sick person's ducklings noted that whole-genome sequencing (WGS) showed that Salmonella serotype Hadar in duckling poop was closely related to bacteria from sick people. Investigators also used WGS to determine that about half of 125 sick people's samples showed resistant to one or antibiotic.

The CDC recommends that children younger than 5 not touch the birds (including chicks and ducklings) or anything in the area where the birds live and roam. Young children, the immunocompromised, and the elderly are most at risk for serious Salmonella infections.
May 20 CDC
May 20 CDC
press release


Four countries add more vaccine-derived polio cases

Four countries reported more vaccine-derived polio cases this week, two in Africa and two in the Middle East, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI). All involved circulating vaccine-derived poliovirus type 2 (cVDPV2).

In Africa, Mali reported a case in Koulikoro region in the country's southwest. The illness is counted in the 2020 total, which is now at 47. Nigeria also reported one new case, which involves a patient from Kebbi state in the country's northwest. The detection lifts the country's total this year to six.

Meanwhile Afghanistan reported 5 cVDPV2 cases in four different provinces, lifting its total for 2021 to 38. Also, Pakistan reported one case, which involved a patient from Balochistan, putting its total for the year at seven.
May 20 GPEI update

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