News Scan for Apr 11, 2022

News brief

Study: Depression, loneliness increased for older adults during pandemic

Depression and loneliness have increased among older adults during the pandemic, prompting a need for more coordinated efforts to address the issue, according to a report on social isolation in older Canadians.

The report was conducted by researchers at Simon Fraser University's Gerontology Research Centre for the Federal/Provincial/Territorial Ministers Responsible for Seniors Forum and used data from participants enrolled in the Canadian Longitudinal Study on Aging (CLSA), a long-term study (at least 20 years) of 50,000 Canadians ages 45 to 85.  

Women reported a significant increase in loneliness during the pandemic, with those aged 65 to 74 experiencing a 67% increase in loneliness and a rise in depression from 19% prepandemic (2011 to 2015) to 23% in 2020. Women ages 75 to 84 reported a 37% increase in loneliness.

Men also saw a jump in loneliness by 45% in the 65-to-74 age-group and 33% in the 75-to-84 age-group.

The loneliness may be linked to limited time with family: More than 60% of women over age 65 said the pandemic separated them from family.

The authors of the report also emphasized that older Canadians were not a homogenous group: Lesbian, gay, bisexual, transgender, queer, and questioning and their allies (LGBTQA) experienced more depression in the pandemic, as did those living in rural areas.

More outreach and digital education should be done to connect older Canadians during the pandemic, the authors said. "Ensuring all Canadians have access to low-cost home internet and free internet in public spaces should be a priority," they said in a press release on the report.
Apr 11 social isolation report
Apr 11 Simon Fraser University press release


Age older than 5, high levels of ferritin tied to higher risk for severe MIS-C

Children older than 5 years and those with high concentrations of ferritin in the blood—an indicator of inflammation—were at highest risk for intensive care unit (ICU) admission for COVID-19–related multisystem inflammatory syndrome in children (MIS-C), finds a study today in the Canadian Medical Association Journal (CMAJ).

A team led by researchers at McGill University in Montreal conducted chart reviews of 232 MIS-C patients younger than 18 years admitted to 15 hospitals in Canada, Iran, and Costa Rica from Mar 1, 2020, to Mar 7, 2021. Average patient age was 5.8 years, 56.0% were boys, and 21.6% had underlying illnesses.

Among the 232 patients (106 confirmed and 126 probable), 31.5% were admitted to an ICU, but none died. About two-thirds (64.4%) required vasopressors to raise their blood pressure, with or without mechanical ventilation.

Children most at risk were those 13 to 17 years (46.2% vs 18.4% of those younger than 5; adjusted risk difference, 27.7%) and 6 to 12 years (43.6%; adjusted risk difference, 25.2%) and those with ferritin (a blood protein containing iron) concentrations higher than 500 micrograms per liter (μg/L; 18.4%), indicating inflammation.

The risk of ICU admission at Canadian hospitals was significantly higher for patients hospitalized from December 2020 to March 2021 than those hospitalized from March to May 2020 (adjusted risk difference 25.3%). Relative to patients hospitalized before Oct 31, 2020, those admitted later had higher rates of ICU admission (adjusted risk difference, 12.3%), cardiac involvement (30.9%), and abnormal blood clotting (90%).

The vast majority (89.2%) had gastrointestinal involvement, mostly abdominal pain. Of all patients, 76.4% with confirmed and 43.6% with probable MIS-C had cardiac involvement, 2.6% had acute kidney injury, and 51.7% had hepatitis.

The median length of hospital stay was 6 days, with 69.0% of patients released by day 7 and 84.9% released by day 10. An elevated initial ferritin level was tied to a longer stay.

"Further research is needed to evaluate long-term outcomes of MIS-C with and without treatment, as well as changes in MIS-C severity and short- and long-term outcomes with emerging variants of concern," the researchers concluded.
Apr 11 CMAJ study


H5N6 avian flu sickens 1 more person in China

China has reported another human H5N6 avian flu case, part of a small but steady stream of infections involving the strain.

In an Apr 9 statement, Hong Kong's Centre for Health Protection (CHP) said the patient is a 53-year-old woman from Jiangsu province who had visited a live-poultry market before her symptoms began on Mar 24. Two days later she was hospitalized, where she is listed in critical condition.

So far, China has reported 12 H5N6 cases this year. The country has now reported 76 such cases since the virus, known to circulate in poultry in a few Asian countries, was first detected in humans. Adults who have contact with poultry are the most affected group, and H5N6 infections are often severe or fatal.
Apr 9 Hong Kong CHP statement


Global flu continues slow rebound

After initially decreasing in January, global flu levels began increasing again in February and are still rising, mainly in the Northern Hemisphere, the World Health Organization (WHO) said in its latest global flu update, which covers the middle 2 weeks of March.

Europe's flu activity continues to increase, mainly due to the H3N2 strain. North America's flu patterns are also on the rise, but are still at lower levels than the most recent pre-COVID flu seasons. In China, where influenza B activity had been reported, activity is starting to decrease.

Some tropical parts of South America, Africa, and Southeast Asia are reporting H3N2 detections, while South Asian countries are reporting low levels of activity from 2009 H1N1 and influenza B strains.

Of respiratory samples that tested positive for flu at national flu labs in the middle of March, 88.8% were influenza A. Of the subtyped influenza A strains, 93.5% were H3N2. All of the characterized influenza B viruses belonged to the Victoria lineage.
Apr 4 WHO global flu update


DRC and Nigeria report new polio cases

Late last week the Global Polio Eradication Initiative (GPEI) reported new cases of polio in both the Democratic Republic of the Congo (DRC) and Nigeria.

Seven cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in the DRC, raising the number of 2022 cases to 16. Twenty-eight cases were recorded in 2021.

In Nigeria, six cases of cVDPV2 were reported across the country, bringing the 2022 total to 14. The number of 2021 cases was 415.
Apr 6 GPEI report

Stewardship / Resistance Scan for Apr 11, 2022

News brief

Study: Medicare outpatients frequently received antibiotics for COVID-19

A review of data on Medicare beneficiaries during the first year of the COVID-19 pandemic found that nearly a third of outpatient COVID-19 visits were linked to an antibiotic prescription, mainly for azithromycin, Centers for Disease Control and Prevention (CDC) researchers reported late last week in JAMA.

The analysis of Medicare carrier claims and data from the Medicare Part D prescription drug plan from April 2020 to April 2021 found that 29.6% of more than 1.1 million COVID-19 outpatient visits were associated with an antibiotic prescription. The rate of prescribing varied by month, with higher rates of prescribing occurring during a wave of COVID-19 cases in the winter of 2020-21 (range, 17.5% in May 2020 to 33.3% in October 2020). Prescribing was highest in the emergency department (33.9%), followed by telehealth (28.4%), urgent care (25.8%), and office visits (23.9%).

Azithromycin was the most frequently prescribed antibiotic (50.7% of cases), followed by doxycycline (13%), amoxicillin (9.4%), and levofloxacin (6.7%). Urgent care had the highest percentage of azithromycin prescriptions (60.1%), followed by telehealth (55.7%), office visits (55.1%), and ED (47.4%).

Differences were observed by age, sex, and location, with non-Hispanic White beneficiaries receiving antibiotics for COVID-19 more frequently (30.6%) than other racial and ethnic groups, including American Indian/Alaska Native (24.1%), Asian/Pacific Islander (26.5%), Black (23.2%), and Hispanic (28.8%) patients.

Despite some early studies that indicated azithromycin might benefit COVID-19 patients, subsequent randomized clinical trials demonstrated no benefit.

"These observations reinforce the importance of improving appropriate antibiotic prescribing in outpatient settings and avoiding unnecessary antibiotic use for viral infections such as COVID-19 in older adult populations," the CDC researchers wrote.
Apr 8 JAMA research letter


Stewardship linked to drop in fluoroquinolones for urinary tract infections

A multifaceted antimicrobial stewardship intervention at a community health system dramatically reduced fluoroquinolone prescribing for urinary tract infections (UTIs), researchers reported today in Infection Control & Hospital Epidemiology.

The intervention implemented at Lee Health, a large community health system in Florida, included development of an antimicrobial stewardship team to oversee the intervention, dissemination of a system-specific UTI treatment pathway with an emphasis on the use of non-fluoroquinolone antibiotics, and modification of the electronic health record to incorporate treatment recommendations. A fluoroquinolone stewardship dashboard was also created, and prescribers received monthly reports on the percentage of UTI visits for which fluoroquinolones were prescribed.

Originally implemented in four urgent care locations in April 2019, the intervention was extended to the system's 19 primary care clinics in August 2019.

Comparison of prescribing data from the 6-month post-intervention period (September 2019 to February 2020) with the pre-intervention period (September 2018 to February 2019) showed that the percentage of fluoroquinolone prescribing for UTIs fell from 17.6% pre-intervention to 3.0% post-intervention in the four urgent care clinics, and from 23.8% to 6.8% in the 19 primary care clinics. Percentages of any primary care clinic visits at which a fluoroquinolone was prescribed fell from 1.3% to 0.5%.

Sustained decreases in fluoroquinolone prescribing for UTIs were observed in a third assessment period compared with the pre-intervention period for both urgent (3%) and primary care (7%).

"Our initiative demonstrated that a multifaceted antimicrobial stewardship bundle had a significant and sustained impact on fluoroquinolone utilization in urgent care and primary care clinics," the study authors wrote. "Although the emphasis of our intervention was on UTI-related visits, the impact potentially extended beyond UTI visits, given the large decrease in total fluoroquinolone prescriptions, which was not completely accounted for by visits with UTI-related diagnosis codes."
Apr 11 Infect Control Hosp Epidemiol study

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