News Scan for Apr 15, 2022

COVID, upper airway infection in kids
Avian flu detected in Idaho flocks
US flu continues slow rise
Polio in Nigeria and Israel

Upper airway infections in kids with COVID-19 rose with Omicron surge

Rates of upper airway infections (UAIs) such as croup and bacterial tracheitis among pediatric COVID-19 patients, though low, rose after the Omicron variant became dominant in December 2021, with more than one fifth of hospitalized children with both conditions developing severe illness, estimates a study today in JAMA Pediatrics.

The University of Colorado–led US National COVID Cohort Collaborative analyzed its data and those from a National Institutes of Health–funded pediatric COVID-19 dashboard on 18,849 hospitalized COVID-19 patients 18 years and younger from Mar 1, 2020, to Dec 25, 2021 (before the emergence of Omicron) and after (Dec 26, 2021, to Feb 17, 2022).

Of the 18,849 children, 384 (2.0%) had UAIs, and 81 (21%) required invasive ventilation, the use of vasopressor drugs to raise blood pressure, or extracorporeal membrane oxygenation or died. Rates of UAIs in COVID-positive children rose from 1.5% to 4.1% after the emergence of Omicron, with 178 of 384 cases (46%) diagnosed during that time.

Pediatric patients with UAIs during Omicron were more likely than those diagnosed in the preceding Delta period to be younger and Hispanic and less likely to be given the corticosteroid dexamethasone or to become severely ill. The proportion of children with a complex chronic condition weren't significantly different during the two periods, at 36% (74 of 206) before Omicron and 22% (39 of 178) after.

While noncoronaviruses such as parainfluenza and respiratory syncytial virus most often cause UAI, coronaviruses are also commonly implicated, the study authors said. "Young children are especially vulnerable to UAI given their small and relatively collapsible airways," they wrote.

The researchers said that the study likely underestimated the concurrent COVID-19 and UAI cases amid Omicron because diagnostic codes for these conditions were available only for completed hospitalizations, meaning that children still hospitalized during the study period were not represented.

While the rate of coexisting COVID-19 and UAI in children wasn't strikingly high, the researchers said that severe UAI predisposes children to cardiac arrest from rapid-onset upper-airway obstruction.

"They may require therapies typically provided in intensive care units, including frequent administration of nebulized racemic epinephrine, helium-oxygen mixtures, and intubation," they wrote.
Apr 15 JAMA Pediatr research letter


High-path avian flu spreads to Idaho flocks

Federal animal health officials today reported the first highly pathogenic avian flu outbreaks in Idaho, signaling more westward spread of the virus.

In an announcement, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said tests have confirmed two outbreaks, both in backyard flocks. One is located in Caribou County in the southeast corner of the state, and the other is in Gooding County in south central Idaho.

In other developments, two Midwestern states—Minnesota and Wisconsin—reported more outbreaks in poultry. Minnesota reported 4 more outbreaks, raising its total to 38 and affecting 1.84 million birds. The latest outbreaks involved backyard birds in Benton County and turkey farms in three counties: Blue Earth, Otter Tail, and Waseca.

Officials from the Wisconsin Department of Agriculture, Trade and Consumer Protection (DATPC) yesterday reported three more outbreaks, including one in commercial poultry in Polk County in the western part of the state. The other two involved backyard flocks in Sheboygan County and Columbia County.

The outbreaks are part of ongoing Eurasian H5N1 activity and have now affected 27 states, leading to the loss of roughly 25.8 million birds.
Apr 15 USDA APHIS announcement
Minnesota Board of Animal Health avian flu outbreak page
Apr 14 Wisconsin DATCP press release


US flu activity and hospitalizations still on the rise

Flu activity rose again last week, up in most regions, but at the highest levels in the central and south central parts of the country, the US Centers for Disease Control and Prevention (CDC) said today in its latest weekly update.

Overall, the percentage of outpatient visits rose slightly again, from 1.9% to 2%, but is still below baseline. One state—New Mexico—reported high flu activity, another marker of clinic visits. Three reported moderate activity: Massachusetts, New York, and Oklahoma.

Of respiratory samples that tested at clinical labs, 8.4% were positive for flu. At public health labs, 100% of flu viruses detected were influenza A, and, of subtyped influenza A samples, all were the H3N2 strain.

Hospitalizations have been on the rise for 10 straight weeks, but are still at lower levels than the last four prepandemic flu seasons. Three more pediatric flu deaths were reported, raising the season's total to 19. All were related to H3N2.

The CDC noted that other respiratory viruses are also circulating and the contribution of flu varies by location.
Apr 15 CDC FluView update


More polio in Nigeria and Israel

In its latest weekly update, the Global Polio Eradication Initiative (GPEI) reported one more polio case, which is from Nigeria.

The case in Nigeria involves circulating vaccine-derived poliovirus type 2 and brings the country's total for the year to 22.

In other polio developments, the World Health Organization (WHO) posted an update on Israel's circulating vaccine-derived poliovirus type 3 outbreak. So far, seven cases have been confirmed, which include the index case and six asymptomatic children. Of the seven kids, one wasn't fully vaccinated and the other were unvaccinated.

Initial testing has detected two more cases, and confirmation testing is under way.

Immunization activities with inactivated polio vaccine and bivalent oral polio vaccine are also under way. They initially began in Jerusalem on Apr 4 and were extended to the rest of the country on Apr 13.
Apr 14 GPEI update
Apr 15 WHO update

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