News Scan for Aug 22, 2022

News brief

Paxlovid tied to 45% lower risk of poor outcomes in vaccinated outpatients

Nonhospitalized, high-risk, vaccinated COVID-19 patients who received nirmatrelvir-ritonavir (NMV-r, or Paxlovid) saw a 45% drop in their relative risk of emergency department (ED) visits, hospitalization, and death by 30 days, suggests a study published late last week in Clinical Infectious Diseases.

A team led by Beth Israel Lahey Health researchers in Massachusetts retrospectively analyzed the outcomes of 2,260 nonhospitalized, high-risk adults who had been vaccinated against COVID-19 but had breakthrough infections at least 1 month later from Dec 1, 2021, to Apr 18, 2022. Half the patients had received Paxlovid within 5 days of diagnosis, and half received standard care.

A total of 89 patients (7.9%) who received Paxlovid had an all-cause ED visit, were hospitalized, or died within 30 days, compared with 163 controls (14.4%; odds ratio [OR], 0.5), translating to a 45% relative risk reduction. No deaths were reported among Paxlovid recipients, compared with 10 in controls.

The Paxlovid group also experienced fewer multisystem symptoms and complications such as lower respiratory tract infection, abnormal heart rhythms, and the need for radiologic testing.

"Our data strongly support the clinical effectiveness of NMV-r in vaccinated patients and the current NIH [National Institutes of Health] guidelines, listing this as the preferred therapy for mild-moderate Covid-19 in those at high risk of severe disease," the researchers wrote.

The authors noted that when rebound infections, which have been reported after 5 days of Paxlovid treatment, did occur, they still didn't negate its benefits. "Indeed, we found no late increase in complications among those with treatment compared to no treatment, although our study likely would have missed cases of transient or mild rebound occurring between 10 and 30 days after diagnosis," they wrote.
Aug 20 Clin Infect Dis study


Study highlights impact of stewardship steps in severely ill COVID patients

A study conducted at two hospitals in Thailand found that implementing a procalcitonin (PCT) and Clinical Pulmonary Infection Score (CPIS) was associated with reduced inappropriate antibiotic use, multidrug-resistant organisms (MDROs), and invasive fungal infections (IFIs) in severely-to-critically ill COVID-19 patients, researchers reported today in Infection Control & Hospital Epidemiology.

In the quasi-experimental study, conducted from March 2020 through February 2022, Thai and US researchers evaluated the role of PCT-CPIS in two hospitals in which severely-to-critically ill COVID-19 patients were treated in intensive care units. They compared inappropriate antibiotic use during the 1-year pre-implementation period (period 1: March 2020 through February 2021), when no antibiotic protocols were available for COVID-19 patients at either hospital, and the 1-year post-implementation period (period 2: March 2021 through February 2022).

During period 2, antibiotics were not initiated, or were discontinued on day 3, for patients with a CPIS score of less than 6 and PCT of less than 0.5 micrograms per liter (μg/L).

In total, 192 patients were included in period 1 and 214 in period 2. Their median age was 62 years, 52.0% were severely ill, and 23.6% were critically ill. Compared with period 1, overall inappropriate antibiotic use in period 2 fell significantly, from 63.5% to 31.3%, driven mainly by reduced inappropriate antibiotic use in severely-to-critically ill COVID-19 patients (80.8% in period 1 vs 39.1% in period 2). But it was not reduced among mildly-to-moderately ill COVID-19 patients (8.7% vs 7.5%).

In period 2, researchers also observed a significantly lower incidence of MDRO-IFIs (25% vs 16.8%) and MDR Acinetobacter baumannii (16.1% vs 9.3%), as well as significantly shorter antibiotic duration (7 days vs 0 days) and shorter hospitalizations (13 days vs 10 days). There was no difference in 30-day mortality between the two periods.

"Our findings suggest that the PCT-CPIS strategy could be beneficial to severely-to-critically ill COVID-19 patients," the authors concluded.
Aug 22 Infect Control Hosp Epidemiol abstract


Studies estimate health, cost-savings benefit of childhood vaccines

Today two studies in Pediatrics estimate that childhood immunization programs have prevented 24 million US cases of vaccine-preventable diseases in 1 year, and their $8.5 billion cost for kids born in 2017 paid for itself more than seven times over in healthcare savings.

The studies come as rates for routine childhood immunizations have dropped across the United States have declined since the pandemic limited in-office visits. To compound the problem, vaccine hesitancy and misinformation continue to grow across the country.

In the first study, the authors looked at historical records and public health data to update estimates of the reduction in overall and age-specific disease incidence associated with the routine childhood immunization programs, based on the 2017 to 2021 vaccination schedule.

They noted reductions of more than 90% in 10 common childhood illnesses after the introduction of vaccines, including diphtheria, Haemophilus influenzae type b, measles, mumps, pertussis, polio, rotavirus, rubella, tetanus, and varicella. Reduction of influenza, however, was only 17%, and hepatitis A was 87%, while hepatitis B was 86%.

All told, the reductions resulted in the prevention of 24 million cases of disease for the 2019 US population.

In the second study, a separate team used an economic model based on the 2017 US birth cohort to predict the cost savings of routine immunizations. By preventing 17 million cases of disease and 31,000 deaths, routine immunizations in this cohort was associated with a savings of $63.6 billion in disease-related costs. The total cost of childhood immunizations in that group was $8.5 billion.

In a commentary on the studies, two experts with the Maternal and Child Health Bureau of the US Health Resources and Services Administration write that the studies "provide strong confirmation of what pediatricians know well: vaccines prevent illness, vaccines save lives, and vaccines are beneficial to society. However, the impact of misinformation on vaccine hesitancy, pervasive inequities among marginalized communities, and the disruption of the COVID-19 pandemic on routine preventive care for children underscore the need for pediatricians to be actively involved in assuring a strong system for vaccine delivery and uptake."
Aug 22 Pediatrics incidence
Aug 22 Pediatrics cost
Aug 22 Pediatrics


Romaine on Wendy's sandwiches suspected as E coli outbreak source

In an update on an Escherichia coli O157:H7 outbreak linked to an unknown food source, the Centers for Disease Control and Prevention (CDC) late last week said many of the sick patients said they ate burgers or sandwiches containing romaine lettuce before they got sick.

The agency also reported 8 more cases and two more affected states, raising the outbreak total to 37 cases from Michigan, Ohio, Indiana, and Pennsylvania. Of patients with known information, 10 were hospitalized. The latest illness onset was Aug 8. Three patients in Michigan had hemolytic uremic syndrome (HUS), a potentially fatal kidney complication.

The CDC said so far an individual food source hasn't been confirmed and officials continue to analyze ingredients to see if there are any other foods that could be the source of the outbreak. Of 26 people who were interviewed, 22 reported eating at Wendy's the week before they became ill. Patients ate a variety of menu items, but romaine on burgers and sandwiches was the most common ingredient.

Officials said Wendy's is taking the precautionary step of removing romaine from its menu in the affected region. The CDC said the fast food chain uses a different type of romaine for its salads and that there is currently no evidence that romaine at grocery stores or served in other restaurants is linked to the outbreak.
Aug 19 CDC outbreak update
Aug 18 CIDRAP News

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