News Scan for Apr 20, 2022

News brief

Androgen suppression not tied to better COVID-19 outcomes in men

A randomized controlled trial found that suppressing androgen hormones in male COVID-19 patients hospitalized with the virus did not improve outcomes. The study was published yesterday in JAMA Network Open.

The data come from the Hormonal Intervention for the Treatment in Veterans With COVID-19 Requiring Hospitalization (HITCH) phase 2 trial, which was conducted at 14 Department of Veterans Affairs hospitals from Jul 22, 2020, to Apr 8, 2021. A total of 96 men were included in the phase 2 trial, which compared the efficacy of degarelix—a hormone-based chemotherapy used to treat prostate cancer—plus standard care to the effect of placebo plus standard care.

Degarelix has a rapid effect on circulating testosterone, reducing the hormone within 48 hours. Researchers hypothesized that medical castration would limit COVID-19 mortality. Mouse studies suggested medical castration reduced viral severity.

However, "There was no statistically significant difference between groups for the primary composite end point. At 15 days after randomization, 19 veterans (30.6%) in the degarelix group were either still hospitalized, had died, or required mechanical ventilation, compared with 9 veterans (26.5%) in the placebo group," the authors said.

The study was stopped for futility.

Eleven veterans (17.7%) in the degarelix group and 6 veterans (17.6%) in the placebo group died before discharge. Fifteen veterans (24.2%) in the degarelix group, compared with 7 veterans (20.6%) in the placebo group required mechanical ventilation.
Apr 19 JAMA Netw Open study

Five groups issue guidance for preventing catheter-related infections

Updated practical guidance from five large US healthcare organizations published yesterday in Infection Control and Hospital Epidemiology highlights practices for preventing central line–associated bloodstream infections (CLABSIs) in hospitals that include detailed infection-control steps in inserting catheters and a caution against the routine use of preventive antibiotics.

The recommendations come from efforts of more than 100 global experts. The guidance was produced by Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission.

The previous version was published in 2014.

"Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years, the rates of CLABSIs and several other healthcare-associated infections have substantially worsened during the COVID-19 pandemic, reversing years of progressive improvement," said Deborah Yokoe, MD, MPH, chair of SHEA's efforts to prevent healthcare-associated infections in acute-care hospitals, in a SHEA news release. "These infections seriously threaten patients' lives and recovery, and the rising rates are further evidence for the need to build more resilient systems of care."

Some highlights of the guidance include advice that the subclavian vein is now preferred for central venous catheter insertion in intensive care unit patients, and chlorhexidine-containing dressings are now considered an "essential practice" in patients older than 2 months. The experts recommend against using antimicrobial prophylaxis for short-term or tunneled catheter insertion or while catheters are in situ.
Apr 19 Infect Control Hosp Epidemiol guidance
Apr 19 SHEA news release

Israel examining 12 unexplained pediatric hepatitis cases

In the wake of unexplained hepatitis cases reported in young children by a number of countries, Israel's Ministry of Health (MOH) said yesterday on Twitter that a request for information to hospitals has turned up 12 cases in recent months.

It said the 12 cases that fit the definition and are under investigation are from two hospitals—Shaare Zedek Medical Center and Schneider Children's Medical Center.

The children are under the age of 5, came from various parts of the country, and aren't from any specific ethnic or religious group, according to the Jerusalem Post. Two involved transplants of liver lobes, which occurred a year ago.

Clusters of acute hepatitis in young kids, some of whom needed liver transplants, were reported recently by the United Kingdom, and since then similar cases have been reported in other countries, including the United States in Alabama. Scientists suspect an infectious cause. Adenovirus has been detected in several cases, and some had active or recent COVID-19 infections.
Apr 19 Israel MOH tweet
Apr 20 Jerusalem Post story
Apr 15 CIDRAP News story
Apr 19 CIDRAP News scan

Avian Flu Scan for Apr 20, 2022

News brief

Chinese man hospitalized with H5N6 avian flu infection

The H5N6 avian flu virus has sickened one more in China, a man from Sichuan province in the country's southwest, Hong Kong's Centre for Health Protection (CHP) said today.

The 56-year-old man's symptoms began on Mar 31, and he was hospitalized on Apr 4 where he is remains in serious condition. An investigation found that he had been exposed to live domestic poultry before he got sick.

So far, China has reported 13 H5N6 cases for the year, part of ongoing activity that saw a large spike in 2021. H5N6 is known to circulate in poultry in a handful of Asian countries, and infection in humans is often severe or fatal.

The virus was first detected in humans in 2014 and has so far infected 77 people in China. Laos is the only other country that has reported a human case.
Apr 20 CHP statement

Avian flu continues to hit wild birds, including raptors, in multiple states

Tests on wild birds found dead and in surveillance samples taken from hunter-harvested bird and live birds turned up 98 more positives for highly pathogenic H5 avian influenza, especially in Midwestern states, according to the latest update from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

Many of the latest positive samples were from North Dakota, much of it in wild geese found dead. Other Midwestern states reporting more avian flu in wild birds include Minnesota, South Dakota, Wisconsin, Missouri, and Illinois.

In the East, New Hampshire, Maine, Vermont, Ohio, and Tennessee reported more H5, mostly in waterfowl. In the West, Colorado and Montana reported more positives.

A number of the latest positives across several states included raptors, including bald eagles, hawks, and owls. The University of Minnesota Raptor Center said though waterfowl can carry and shed the virus without symptoms, other birds including chickens and raptors often get severe illness and die. It said the 2022 outbreak is unique due to very high levels of H5N1 circulating in wildlife.

So far, the center has sampled 90 raptors, of which 37 tested positive for highly pathogenic avian flu. Affected birds include great horned owls, bald eagles, red-tailed hawks, and a barred owl.

The Raptor Center has suspended public tours due to rising highly pathogenic flu cases and is urging people who live in high transmission areas to consider pausing the use of bird feeders and baths for the next few months as a way of preventing birds from gathering and the virus from spreading.
USDA APHIS wild bird avian flu detection page
University of Minnesota Raptor Center background page