News Scan for Apr 28, 2022

News brief

Wisconsin and California probe unexplained hepatitis cases, 1 fatal

The Wisconsin Department of Health Services (WDHS) in an alert to clinicians said it is investigating at least four unexplained hepatitis cases in children, including one who needed a liver transplant and one who died. Also, California officials said today that they are investigating seven cases

The WDHS said it launched the investigation following a report from Alabama of nine similar cases, of which all five sequenced samples showed a possible connection to adenovirus type 41. Two of the Alabama children required liver transplants. News of the California cases was reported by the San Francisco Chronicle, which cited the California Department of Health.

The developments brings the number of US states reporting similar cases to five, which also includes North Carolina and Illinois.

In an update last week, the World Health Organization (WHO) said as of Apr 21, it had received reports of at least 169 cases from 12 countries, mostly in Europe.

In a related development, the European Centre for Disease Prevention and Control (ECDC) posted a risk assessment on the hepatitis cases, noting that 111 cases have been reported from the United Kingdom, along with 55 from other European countries, 12 from Israel, 12 from the United States, and 1 from Japan. They note in most cases, children had gastrointestinal symptoms before the illness progressed to jaundice. The most common pathogens found were adenovirus and SARS-CoV-2.

So far, no common exposure has been found, but the leading hypothesis is a cofactor involving young kids with adenovirus infection, which may trigger a more severe infection. Subtyping testing on samples from 11 cases in the United Kingdom identified type 41F, which has also been identified in several US cases.
Apr 27 WDHS health alert
Apr 28 San Francisco Chronicle tweet
Apr 25 Illinois Department of Public Health announcement
Apr 21 Stat story on North Carolina investigation
Apr 15 Alabama Department of Public health statement
Apr 28 ECDC risk assessment


Six states report more avian flu outbreaks, poultry losses top 35 million

Six states reported more highly pathogenic avian influenza outbreaks in poultry, including Nebraska, where the virus struck a large layer farm housing 2.1 million birds, according to the latest notifications from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

Nebraska's outbreak, the state's seventh, occurred in Knox County, located in the northeast corner of the state. Elsewhere in the Midwest, three states reported more outbreaks, all involving backyard birds. They include Kansas (Republic County), Michigan (Saginaw County), and North Dakota (Richland County).

Elsewhere, Pennsylvania reported another large outbreak at a commercial farm in Lancaster County, the state's sixth. The latest outbreak struck a commercial broiler breeder farm housing 18,000 pullets. Also, Montana reported its fifth outbreak in backyard birds, this time in a Missoula County flock that had 40 birds.

The outbreaks, part of ongoing spread involving the Eurasian H5N1 strain, have hit poultry in 29 states and have now led to the loss of 35.5 million birds. The event is the nation's worst since 2015 when outbreaks, mostly from highly pathogenic H5N2, wiped out more than 50 million chickens and turkeys.
USDA APHIS poultry outbreak page

COVID-19 Scan for Apr 28, 2022

News brief

Modeling study shows geographical disparities in US COVID deaths

Using excess mortality data collected by the Centers for Disease Control and Prevention (CDC), researchers from Georgetown University found significant regional differences in mortality rates due to COVID-19, with a disproportionate number of virus deaths in Southern states.

Excess deaths were analyzed for the period between Jan 3, 2020, to Sep 26, 2021, with Northeast, Midwest, South, and West regions compared. Though the South only has 38% of the US population, that region has seen 48% of the nation's COVID-19 deaths since October of 2020.

Using the excess death data over that same time period, there were 895,693 excess deaths associated with COVID-19, 26% more than previously reported, the authors said. Since May 31, 2020, the South experienced COVID-19 mortality 26% higher than the national rate, whereas the Northeast's rate was 42% lower.

If every region had the same mortality rate as the Northeast, more than 316,234 COVID-19 deaths between May 31, 2020 and Sep 26, 2021 could have been avoided.

"Our study is the first to quantify avoidable deaths and confirm that both COVID-19 deaths and avoidable deaths disproportionately occurred in the South," said Michael Stoto, PhD, a corresponding author of the study in a press release.

The authors attribute these differences to lower vaccine uptake in the South in 2021, and fewer mitigation strategies, including masking, throughout the course of the pandemic.
Apr 28 PLoS One study
Apr 28 Georgetown University press release


Opera-led singing program eased breathlessness in long-COVID patients

An ongoing online UK program using singing techniques helped relieve post–COVID-19 mental wellbeing and persistent breathlessness, according to a randomized, controlled trial published yesterday in The Lancet Respiratory Medicine.

Led by Imperial College London researchers, the trial involved 150 adults who still had shortness of breath, with or without anxiety, 4 or more weeks after symptom onset (average, 320 days), referred from 51 UK long-COVID clinics from Apr 22 to May 25, 2021. Eighty-one percent of participants were women.

Patients were randomly assigned to either the 6-week English National Opera (ENO) Breathe program, which teaches breath retraining using singing methods (74 participants), or usual care (76). The program is led by professional ENO singers and features a one-on-one session, weekly group sessions, and the provision of online services. Participants don't need to have singing skills and start with lullabies.

Relative to usual care, ENO Breathe was tied to improved mental health composite (MHC)—but not physical health composite (PHC)—scores on the RAND 36-item short-form survey (MHC improvement, 2.42 vs 0.60). The 100-point Visual Analogue Scales showed a 10.48-point reduction in breathlessness.

An analysis focusing on participants who attended all ENO Breathe sessions showed that 40% saw a 5-point improvement in MHC, compared with 17% of usual-care participants. One ENO Breathe participant reported minor, short-term dizziness when using a computer for long periods.

In an Imperial College London press release, lead author Keir Phillip, MBChB, said that the results suggest that the use of arts-related interventions can relieve long-COVID symptoms in certain patients, particularly when provided alongside clinical services.

"Our study suggests that the improvements in symptoms experienced by participants, resulted from both practical breathing techniques learnt, but also the creative, humane, and positive way the programme is delivered," he said.

The study authors noted that 70 services in England have referred more than 1,000 participants to the program since its September 2020 inception.
Apr 27 Lancet Respir Med study
Apr 28 Imperial College London press release

This week's top reads