News Scan for Apr 05, 2022

News brief

Study highlights economic impact of inappropriate antibiotic use

An analysis of antibiotic use for upper respiratory infections (URIs) in Ghana reveals the considerable economic impact of inappropriate prescribing can have on low-resource settings, researchers reported last week in Antimicrobial Resistance & Infection Control.

Using data from the ABACUS (AntiBiotic ACcess and USe) project, conducted from 2016 to 2019 to explore community antibiotic access and consumption in Africa and Asia, researchers from Ghana and the Netherlands conducted an economic impact analysis focusing on inappropriate antibiotic use for URIs in Ghana, where self-medication with antibiotics is widespread.

Their analysis focused on two inappropriate-use situations: (1) URIs treated with antibiotics, not according to guidelines, and (2) URIs that were not treated with antibiotics but should have been.

Healthcare costs related to inappropriate antibiotic use for URIs were estimated to be around $20 million US dollars annually, including $18 million for situation 1 and $2 million for situation 2. Combined travel costs and lost income due to travel were estimated to be around $44 million for situation 1 and $18 million for situation 2. Possible healthcare cost savings range from $2 million to $12 million for situation 1 and from $0.2 million to $1 million for situation 2.

"Understanding the economic consequences of community antibiotic consumption practices is crucial to mobilise key stakeholders and design sustainable strategies to improve antibiotic use," the study authors wrote. "This economic impact analysis supports this endeavour by providing baseline data to be used by future studies investigating the cost-effectiveness of such strategies."

They added, "In a broader sense, the study can serve as a starting point for other countries, especially LMICs [low- and middle-income countries], to conduct an economic analysis related to inappropriate antibiotic use."
Apr 1 Antimicrob Resist Infect Control study

Avian flu hits more Minnesota poultry as wild birds infected across US

The Minnesota Board of Animal Health (MBAH) reported 3 more highly pathogenic avian flu outbreaks on poultry farms, raising the state's total to 15.

All of the new outbreaks involve turkey producers. Officials reported the outbreaks in three previously unaffected counties—Becker in the west central part of the state and Dodge and LeSueur in the south. So far, outbreaks have been reported in 9 of Minnesota's 87 counties, and the events have led to the loss of more than 636,000 birds, mostly turkeys.

In related developments, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported 111 more avian flu detections from wild bird surveillance, including the first two detections in Minnesota. The virus was found in a bald eagle found dead in Dakota County near the Twin Cities and in a great horned owl found dead in Kandiyohi County in the central part of the state.

APHIS also reported several more detections in in Ohio, mostly results from live-bird testing in Ottawa County; in North Dakota, where many of the positives were in wild geese found dead in Foster County; and in South Dakota, where the results were mainly from hunter-harvested birds in Aurora County. So far, APHIS has reported 593 detections involving Eurasian H5 strains since the middle of January.
Apr 4 MBAH update
USDA APHIS wild bird detection page

CDC ends investigation into deadly Listeria outbreak tied to Dole salads

The Centers for Disease Control and Prevention (CDC) has declared its investigation into a Listeria outbreak linked to Dole packaged salads over, while adding 1 additional case and death, for a total of 18 infections and 3 deaths in the multistate outbreak.

The investigation originally took place in 2019 and 2020, but the agency did not have enough information to identify a source. In November 2021the CDC identified four more connected cases beginning in August of 2021, and trace-back information revealed the illnesses were likely connected to Dole packaged salads.

Of the 18 cases, 3 were from Ohio; Minnesota, Iowa, and Texas each reported 2 cases; and 10 other states reported a single case. The deaths were in Michigan, Ohio, and Wisconsin, the CDC said. Of 16 people with information available, all were hospitalized.

Illnesses started from Aug 16, 2014, to Jan 15, 2022.

"State and local public health officials interviewed people (or their family) about the foods they ate in the month before they got sick. Of the 10 people interviewed, 9 (90%) reported eating packaged salads. Of the three people who remembered a specific brand, two reported Dole and one reported Little Salad Bar," the CDC said.

In multiple samplings made this past fall, Dole found Listeria on equipment used to harvest iceberg lettuce at plants across the country. Dole has recalled products containing iceberg lettuce.
Apr 4 CDC report

MERS sickens Qatari traveler

Qatar's Ministry of Public Health (MOPH) reported a second MERS-CoV case in as many weeks, which involves an 85-year-old man who had been outside the country and was hospitalized upon his return.

In a statement, the ministry said the man had direct contact with camels and began having symptoms before he arrived in Qatar. It didn't note the man's recent travel destination.

On Mar 22, the MOPH reported the country's first MERS-CoV (Middle East respiratory syndrome coronavirus) case of the year. The patient is a man in his 50s who had contact with camels. No travel history was noted.

The latest case lifts Qatar's MERS-CoV total to 25 cases.

In a February update, the World Health Organization (WHO) said it has received reports of 2,585 cases, 890 of them fatal, since the first human cases were detected in 2021. The vast majority are from Saudi Arabia.
Apr 3 Qatar MOPH statement
Mar 28 CIDRAP News scan

COVID-19 Scan for Apr 05, 2022

News brief

Studies find long COVID symptoms, including joint pain, at 1 year

Two new studies detail long COVID symptoms, with one from France showing that 85% of patients who had symptoms 2 months after illness onset still had them at 1 year and some symptoms worsened, and one from China revealing that 12% of patients reported rheumatic symptoms at 1-year follow-up.

In the first study, researchers in Paris analyzed data from 968 adult COVID-19 participants in an ongoing prospective cohort study in France, including their responses to the online Long COVID Symptom Tool questionnaire about daily occurrence of 53 symptoms from December 2020 to October 2021. The data were published today in Nature Communications.

Of patients with symptoms 2 months after symptom onset, 85% still had them at 1 year. The prevalence of 27 symptoms such as a loss of taste or smell declined over time, while 18 symptoms (eg, shortness of breath) remained stable, and 8 (eg, abnormal sensations due to nerve damage) increased.

Symptoms had a greater effect on patients' lives starting at 6 months. "Our results are of importance to understand the natural history of post COVID-19 disease," the researchers concluded.
Apr 5 Nat Commun study

The second study, conducted by researchers in Harbin and Beijing, involved face-to-face interviews of 1,296 COVID-19 survivors 1 year after they were released from the hospital from Jan 7 to May 29, 2020. The findings were published yesterday in Open Forum Infectious Diseases.

Of the 1,296 patients, 12.3% still reported rheumatic symptoms at 1 year. The most common symptoms involved joints in the knee (38%), hand (25%), and shoulder (19%). The symptoms were independent of illness severity and corticosteroid therapy during the initial illness. Older age (odds ratio [OR], 1.22) and female sex (OR, 1.58) were risk factors for these symptoms.

"Our investigation showed a considerable proportion of rheumatic symptoms following COVID-19 in discharged patients, which highlights the need for continuing attention," the study authors wrote.
Apr 4 Open Forum Infect Dis study

COVID-19 sped up adoption of new clinical guidelines

A survey of 52 US hospitals—mostly academic medical centers—shows the COVID-19 pandemic drastically sped up the rate at which clinicians adopted new clinical treatment guidelines, shortening the duration from years to months. The study was published yesterday in JAMA Network Open.

The researchers looked at survey results from 52 hospitals in the Hospital Medicine Reengineering Network and how they treated COVID-19 patients from Dec 17, 2020, to Feb 10, 2021.

Over the course of 6 to 8 months, 94% to 100% of sites began recommending dexamethasone for patients requiring at least 4 liters (L) of oxygen, and 69% began recommending remdesivir for patients receiving mechanical ventilation. A total of 81% of hospitals surveyed began recommending dexamethasone for patients requiring 1 to 2 L of oxygen, and 67% began implementing awake proning (having patients lie face down).

The dexamethasone use was recommended following one randomized control trial. Previous analyses demonstrate it can take institutions as many as 17 years following one trial before use becomes standard practice. But the pandemic forced action, the authors said.

"Institutions favored treatment over not treatment, particularly when guidelines diverged from each other or from the underlying evidence, as exemplified by 69% to 81% of sites recommending remdesivir or dexamethasone, respectively, when evidence or guidelines conflicted," the authors wrote.
Apr 4 JAMA Netw Open study