Wastewater polio in second New York county points to wider circulation
Polio in New York state is circulating more widely than thought, with wastewater sampling revealing traces of the virus in a second county, the New York Department of Health (NYDH) announced yesterday.
Positive samples were detected from two geographic locations in June and July in Orange County, which is located north of the New York City metro area. Also, samples have been detected from July in wastewater in Rockland County, which is part of the metro area and where a confirmed case and positive June wastewater samples were reported earlier.
Sequencing done by the Centers for Disease Control and Prevention (CDC) on three wastewater samples from Rockland County and four wastewater samples from Rockland County show that they are genetically linked to the virus found in the Rockland County resident. The patient was reported earlier to be man who sought treatment for weakness and paralysis. Officials have also said that the man's samples are linked to Sabin-like type 2 isolated detected in environmental samples from Jerusalem and London, though the findings don't imply that that the man had traveled to either of the locations.
The health department said the findings in the two counties show evidence of local transmission.
Mary Bassett, MD, New York's health commissioner, said the single case detected is just the tip of the iceberg. "Based on earlier polio outbreaks, New Yorkers should know that for every one case of paralytic polio observed, there may be hundreds of other people infected," she said, urging adults and young children to get up to date with their polio immunizations.
Officials said the environmental findings don't implicate the Rockland County patient as the source of transmission and that an investigation continues into the origin of the virus.
Aug 4 NYDH statement
Aug 1 CIDRAP News scan
In other polio developments, one country reported a polio case this week, Pakistan with another wild poliovirus type 1 (WPV1) case. In its weekly update, the Global Polio Eradication Initiative (GPEI) said Pakistan's case is from Khyber Pakhtunkhwa, the same area where other recent cases were reported. The country has now reported 14 WPV1 cases this year.
Aug 4 GPEI update
Study: Stewardship program cut antibiotic prescribing by 20 percentage points
An antimicrobial stewardship program (ASP) was tied to a reduction in antibiotic prescriptions for specified non–COVID-19 upper respiratory infections (URIs) from 27.6% to 7.6% over 2 years, according to a study published today in Antimicrobial Stewardship & Healthcare Epidemiology (ASHE).
Researchers from Mayo Clinic Health System-Southwest Minnesota evaluated their ASP, which was designed to reduce antibiotic prescribing for URIs in family medicine, internal medicine, pediatrics, emergency medicine, and urgent care clinics from 27.6% in 2019 to less than 21.6% in 2021. The authors noted that antibiotic prescribing had already begun to drop in 2020, before ASP implementation.
Two urgent-care clinics with more than 300 URI visits per year and an antibiotic prescribing rate greater than 40% (high-priority) were targeted, while all family medicine, pediatric, and adolescent clinics were considered moderate priorities because they had antibiotic prescribing rates of 15% to 57% and only 100 to 300 annual URI visits.
In 2021, an ASP liaison was identified for each high-priority department to receive one-on-one education from the ASP pharmacist and monthly data reports on antibiotic prescribing for their area. Each moderate-priority department received quarterly data summaries.
From October 2020 to February 2021, all departments were given at least one presentation on ASP goals and resources, which included a slide set for provider education, a poster and symptom-management recommendations for patients, and an order panel in the electronic health record system with syndrome-specific guidelines.
As a result, antibiotic prescriptions for URIs fell from 27.6% in 2019 to 19.1% in 2020 and 7.6% in 2021.
The researchers noted that an estimated 44% of antibiotic prescriptions written for outpatients with URIs in the United States are inappropriate and that in 2020, the Joint Commission mandated that accredited institutions implement an outpatient ASP.
"Prioritization of specific departments or providers for ASP intervention based on rate of antibiotic prescribing and total number of encounters of interest may be advantageous in settings with limited ASP personnel," they wrote. "The creation of a provider-specific scoring tool for prioritizing ASP interventions directed toward individual providers may merit future investigation."
Aug 5 ASHE study
Studies investigate effectiveness of Pfizer COVID vaccine in teens, kids
JAMA Network Open has published a new study on Pfizer/BioNTech COVID-19 vaccine effectiveness in US teens, and the Centers for Disease Control and Prevention (CDC) and other US investigators conclude in a Clinical Infectious Diseases study that the vaccine protects against multisystem inflammatory syndrome in children (MIS-C) in children.
The JAMA Network Open study included 3,168 children ages 12 to 17 who had received two doses of the Pfizer vaccine (BNT162b2). The primary outcome was protection against Delta- and Omicron-related emergency department and urgent care encounters.
The authors found that the estimated effectiveness of two doses of BNT162b2 was highest against both the Delta (89%) and Omicron (73%) variants less than 2 months after vaccination but waned to 49% against Delta and 16% against Omicron at 6 months and beyond.
A third dose of BNT162b2 was associated with improved protection against Omicron (87% [95% confidence interval, 72% to 94%]) after a median of 19 days.
In the Clinical Infectious Diseases study, researchers showed that children ages 5 to 18 were protected against MIS-C after two doses of the Pfizer vaccine.
The study compared 304 MIS-C case-patients (280 [92%] unvaccinated) with 502 controls (346 [69%] unvaccinated). Vaccination was associated with a decrease in the likelihood of MIS-C during both the Delta and Omicron waves.
"Vaccination with two doses of BNT162b2 was associated with lower frequency of MIS-C compared to hospitalized SARS-CoV-2 negative controls," the authors concluded.
Aug 3 JAMA Netw Open study
Aug 4 Clin Infect Dis study
Spain reports pair of acute hepatitis deaths in children
Spain's health ministry has reported its first two deaths in children who had unexplained hepatitis, according to the Associated Press (AP).
Officials said 46 cases have been reported so far, including 3 kids who needed liver transplants. Of the three, two patients died. One was a 15-month-old baby who died in June and the other was a 6-year-old child who died in July.
So far, the cause of the unexplained cases hasn't been determined, but scientists suspect an adenovirus link, and two studies recently suggested a role for adenovirus-associated virus type 2, a "helper virus" that isn't known to cause disease on its own.
Aug 5 AP story
In related developments in the United States, the Centers for Disease Control and Prevention in its weekly update reported 3 more cases, bringing the nation's total to 357 from 43 states.
CDC update on acute hepatitis in children