News Scan for Mar 16, 2022

High-path avian flu in Nebraska flock
;
COVID and small airways disease
;
Reduced vancomycin use in children

Avian flu appears in Nebraska backyard flock

Raising the number of states to report highly pathogenic avian flu in backyard flocks or commercial poultry this year to 15, federal and state officials today announced the first outbreak in Nebraska. In related developments, Missouri reported another outbreak in backyard poultry, and federal officials reported more H5 detections in wild birds, including the first in Ohio and Illinois.

In Nebraska, the virus struck backyard birds in Merrick County, which is in the east central part of the state, according to a statement from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

The Nebraska Department of Agriculture said the outbreak follows recent detections in wild birds, one from Lincoln that was announced on Mar 7, with similar cases that followed in wild geese from Cedar and Douglas counties.

Elsewhere, Missouri reported a fifth outbreak and its second in backyard birds. The latest outbreak occurred in Ralls County in the northeastern part of the state, and federal officials said there were 225 mixed species birds at the site.

Meanwhile, federal officials reported 18 more detections in wild birds, raising the total to 376. They include the first from Ohio, which involves H5N1 in a herring gull found dead in Erie County, and the first from Illinois, involving three Canadian geese found dead in Will County. Officials also reported more positive samples from wild birds at a Florida zoo and in more waterfowl in Nebraska and Missouri.
Mar 16 USDA APHIS statement
Mar 16 Missouri Department of Agriculture
statement
USDA APHIS
poultry outbreak page
Missouri Department of Agriculture
avian flu page
USDA APHIS wild bird
avian flu page

 

COVID of any severity may lead to long-term small airways disease

COVID-19 may lead to lasting disease of the small airways, regardless of infection severity, according to a single-center study published yesterday in Radiology.

Based on observations that many COVID-19 survivors later showed signs of chronic lung disease, University of Iowa researchers led the study of 100 adults who still had COVID-19 symptoms more than 30 days after diagnosis, or post-acute sequelae of COVID-19 (PASC). Participants, who were prospectively enrolled from June to December 2020, were compared with 106 matched healthy controls enrolled from March to August 2018.

The researchers analyzed symptoms, pulmonary function tests, and computed tomographic (CT) chest images and performed a quantitative CT analysis using machine learning. Among participants, the median age was 48 years, and 66% were women.

Of PASC patients, 67% were outpatients, 17% were hospitalized, and 16% were admitted to the intensive care unit (ICU). Among the hospitalized and ICU groups, the average percentage of total lung classified as ground glass opacities (GGO) (hazy gray regions of the lungs on CT) was 13.2% and 28.7%, respectively, and was greater than that among outpatients (3.7%).

The average percentage of total lung affected by air trapping (abnormal retention of air) was 25.4%, 34.6%, and 27.3% in outpatient, hospitalized, and ICU groups and 7.2% in controls. Air trapping was linked with the lung capacity ratio of residual volume to total lung capacity. Quantitative analysis of expiratory chest CT images revealed evidence of small airways disease.

"In survivors of COVID-19, small airways disease occurred independently of initial infection severity," the study authors wrote. "The long-term consequences are unknown."

"Something is going on in the distal [outer] airways related to either inflammation or fibrosis that is giving us a signal of air trapping," senior author Alejandro Comellas, MD, of the University of Iowa, said in a Radiological Society of North America press release.

"If a portion of patients continues to have small airways disease, then we need to think about the mechanisms behind it," he said. "It could be something related to inflammation that's reversible, or it may be something related to a scar that is irreversible, and then we need to look at ways to prevent further progression of the disease."
Mar 15 Radiology study
Mar 15 Radiological Society of North America
press release

 

Education, consensus tied to less pediatric vancomycin use

A quality-improvement (QI) initiative at a children's hospital was associated with a drastic reduction in vancomycin use in critically ill children, researchers reported yesterday in Pediatrics.

The QI project at Children's Hospital of Philadelphia involved three strategies implemented in the pediatric intensive care unit (PICU) over a 3-year period: 1) provider education; 2) creation of a consensus-based guideline for empiric vancomycin use; and 3) implementation of the guideline through clinical decision support tools.

The aim was to reduce overall days of therapy (DOT) of vancomycin, which is commonly used in children's hospitals but often unnecessarily, by at least 10% over the 3-year period. At the start of the project, vancomycin was the most commonly used antibiotic in the PICU.

In the baseline period prior to implementation of the QI project (July 2016 to June 2017), researchers analyzed 1,276 episodes of suspected bacterial infection and found 19 cases of bacteremia (1.5%) caused by organisms requiring vancomycin therapy, including 6 cases caused by methicillin-resistant Staphylococcus aureus (MRSA). Baseline use of vancomycin was 182 DOT per 1,000 patient-days.

During the 3-year QI project, vancomycin use fell by 40%, from 182 to 109 DOT per 1,000 patient-days. No MRSA bacteremias were missed with empiric therapy, and there was no increase in 30-day mortality or new or progressive respiratory, renal, or cardiovascular organ dysfunction.

The study authors credit education and consensus-building among key stakeholders as the biggest factors associated with reduced vancomycin use in the PICU, as the 40% reduction in vancomycin use occurred before the implementation of the clinical decision support tools.

"These findings are significant because they support the idea that focused education and stakeholder-engaged consensus guidelines can be effective strategies for improving antibiotic use in the PICU setting," they wrote. 
Mar 15 Pediatrics abstract

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