News Scan for Aug 04, 2021

News brief

Trial supports stopping antibiotics for RTIs when not needed

Discontinuing antibiotics for uncomplicated respiratory tract infections (RTIs) when a physician has determined that antibiotics aren't needed is a safe strategy for reducing unnecessary antibiotic use, according to the results of a randomized clinical trial published yesterday in Clinical Microbiology and Infection.

In the multi-center open-label trial, conducted in Spain, adults with RTIs who had been taking antibiotics for less than 3 days but were deemed by trial investigators to not need antibiotics were randomized 1:1 to either discontinue or continue antibiotic treatment. The primary outcome was duration of severe symptoms (the number of days scoring 5 or 6 on a 6-item Likert scale), and secondary outcomes included antibiotics taken, adverse events, patient satisfaction, and complications within 3 months.

A total of 467 patients were randomized to the two arms, and 409 were included in the final analysis. The mean duration of severe symptoms was 3.0 days for the patients assigned to the discontinuation arm and 2.8 days for those who continued antibiotic treatment (mean difference, 0.2 days; 95% confidence interval [CI], —0.1 to —0.4 days). The proportion of patients who continued taking antibiotics after the baseline visit was much lower in the discontinuation group (25.1% vs 90.1%).

Patients assigned to the continuation group had a higher risk of adverse events (relative risk [RR], 1.47; 95% CI, 0.80 to 2.71) but slightly higher levels of patient satisfaction and a lower need for further healthcare contact in the following 3 months (RR, 0.61; 95% CI, 0.28 to 1.37).

The investigators note that the results are in line with previous studies showing no differences in clinical outcomes between antibiotics and placebo for uncomplicated RTIs, and resemble those obtained with a delayed antibiotic prescribing strategy.

"Our results have shown that discontinuing an already initiated antibiotic treatment for uncomplicated RTI when the clinician considered that it was not indicated had no influence on the clinical outcomes of the patients," they wrote.
Aug 3 Clin Microbiol Infect study

Officials warn about Dominican Republic African swine fever outbreaks

The Dominican Republic recently reported two African swine fever (ASF) outbreaks in pigs, marking the country's first detection of the disease in nearly 40 years. AFS is spreading globally and destabilizing the pork market.

In a recent statement, the World Organization for Animal Health (OIE) called for urgent efforts to prevent the spread of the disease in the Americas. ASF, a viral hemorrhagic fever that has a nearly 100% mortality rate, has spread to 50 countries since 2018. Investigations are underway into how the virus entered the country, and measures are in place to curb further spread.

According to notifications from the OIE, two outbreaks occurred in backyard pigs, one in Monte Cristi province in the northwest that started on Jul 1 and one in Sanchez-Ramirez province in the central part of the country that began on Jul 14. Taken together, the virus killed 800 of 842 susceptible pigs, and the remaining ones were destroyed as part of the response measures.

The US Department of Agriculture (USDA) said its foreign animal disease diagnostic lab on Plum Island off the coast of New York has confirmed ASV in samples collected from the pigs through an existing cooperative agreement. It added that several safeguards are in place to prevent ASF from entering the United States, and federal officials are enhancing inspections on flights coming from the Dominican Republic to ensure that travelers don’t bring prohibited products into the country.

Officials are also ensuring that garbage from the incoming Dominican Republic flights are properly handled to prevent ASF transmission in the United States.
Jul 30 OIE statement
Jul 29 OIE statement on ASF in the Dominican Republic
Jul 28 USDA statement

Inovio launches phase 2 trial of MERS vaccine

Inovio, a Pennsylvania-based biotechnology company, today announced that the first doses have been given in a phase 2 trial of its MERS-CoV vaccine.

In a statement, it said the trial’s goal is to evaluate the safety, tolerability, and immunogenicity of INO-4700, which is a DNA product. The vaccine is administered with Inovio’s Cellectra 2000, a smart device that uses a brief electrical pulse to open small pores in the cell that allow plasmids to enter. The multicenter trial will include 500 healthy adults and is funded by the Coalition for Epidemic Preparedness (CEPI). The trial follows promising phase 1 results that were published in 2019.

Joseph Kim, PhD, Inovio’s chief executive officer and president, said, “We are pleased to collaborate with CEPI to combat one of the most virulent pathogens of the coronavirus family for which there is no approved vaccine.”

With support from CEPI, Inovio is developing two vaccines, one against Middle East respiratory syndrome coronavirus (MERS-CoV) and one against Lassa virus. The groups said they will make stockpiles of the vaccines available for emergency use following phase 2 testing. Currently, there are no licensed treatments or vaccine for MERS-CoV.
Aug 4 Inovio statement

COVID-19 Scan for Aug 04, 2021

News brief

Flu vaccine linked to less severe COVID-19

COVID-19 patients who had received the flu vaccine 6 months to 2 weeks prior to diagnosis were less likely to have sepsis, stroke, and—with some time constraints—deep vein thrombosis (DVTs) and admission to the intensive care unit (ICU) or emergency department (ED), according to a study yesterday in PLOS One.

The researchers used an electronic medical record network to match 37,377 COVID-19 patients who had received the flu vaccine with 37,377 of those who hadn't in January 2021, drawing from 56 healthcare organizations predominantly in the United States. Across 30, 60, 90, and 120 days after being diagnosed as having COVID-19, those who received the flu vaccine had lower occurrences of sepsis (risk ratio [RR], 1.36 to 1.45), stroke (RR, 1.45 to 1.58), and, for almost all time points, less likely to go to the ICU (RR, 1.17 to 1.20 for 30, 90, and 120 days, with day 60 approaching significance at 1.16).

From days 60 to 120, patients who had the flu vaccine also showed significantly less likelihood for DVTs (RR, 1.41 to 1.53) and, from days 90 to 120, significantly less likelihood of visiting the ED (RR, 1.20 to 1.58). Similar to previous studies, the researchers did not find any significance with mortality rates.

"In addition to guarding against a possible 'twindemic' of simultaneous outbreaks of influenza and SARS-CoV-2, the [number needed to vaccinate] trends observed within 30–120 days of SARS-CoV-2 diagnosis for sepsis, stroke, ICU admission, DVT, and ED visits further strengthen the case in favor of a protective effect of influenza vaccination," write the researchers.
Aug 3 PLOS One study

Study shows mRNA vaccines don’t trigger flares in rheumatic patients

A study today in Arthritis & Rheumatology shows the mRNA vaccines for COVID-19 do not routinely cause rheumatic and musculoskeletal diseases like arthritis to flare in patients after the two-dose vaccination, and if flares do occur, they are not severe.

The study was based on 1,377 patients with rheumatic and musculoskeletal diseases, including arthritis and lupus. The researchers measured symptoms within 7 days of each vaccine dose (D1 and D2), and 1 month after D2. Only 11% of participants reported a flare that required treatment after vaccination, none of which were severe.

Most patients experienced mild adverse reactions to the vaccines, including injection-site pain (D1, 87%; D2, 86%) and fatigue (D1, 60%; D2, 80%). For the 11% who experienced a flare, the event was associated with prior COVID-19 infection (incident risk ratio [IRR], 2.09; P = 0.02), flare in the 6 months preceding vaccination (IRR, 2.36; P < 0.001), and use of combination immunomodulatory therapy (IRR, 1.95; P < 0.001).

"This study highlights that most of our rheumatic patients tolerated the vaccine well with mostly having local reactions such as injection site pain, which was quite reassuring, but most importantly, we did not observe any severe flares of their underlying autoimmune disease," said co–senior author Julie J. Paik, MD, MHS, of Johns Hopkins University School of Medicine, in a press release from Wiley, which publishes the journal.
Aug 4 Arthritis Rheum study
Aug 4 Wiley press release