News Scan for Feb 08, 2021

News brief

DRC reports new Ebola case in earlier outbreak hot spot

The Democratic Republic of the Congo (DRC) yesterday announced a new Ebola case, its first since September, which involves a woman who died from her infection in Butembo, one of the main hot spots in the country's 10th outbreak that was centered in North Kivu and Ituri provinces.

In a statement yesterday, the World Health Organization (WHO) said the woman is the wife of an Ebola survivor who sought care at a local health center in Butembo, one of the biggest cities in North Kivu.

The previous North Kivu–centered outbreak—the world's second largest and the DCR's biggest—went on for 2 years before it was declared over in June 2020. The WHO said samples from the woman have been sent to Kinshasa for genetic sequence to see if the virus is linked to the earlier outbreak. Survivors can harbor the virus for long periods in "immune-protected" sites such as the testes and eyes, and similar sporadic cases in the wake of Ebola outbreaks have sometimes triggered resurgences.

So far, 70 of the woman's contacts have been identified, and disinfection of the sites that she visited is under way. The earlier North Kivu outbreak resulted in 3,481 cases, 2,299 of them fatal. A smaller outbreak that occurred in the western DRC soon after led to 150 cases and 55 deaths before it was declared over in the middle of November 2020.

At a media briefing, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said the WHO expects more cases to be reported, given that the woman had contact with several people while she was symptomatic. He added that vaccines have been sent to the country, along with a rapid response team.
Feb 7 WHO update

PAHO issues epidemiologic alert on Candida auris

The Pan American Health Organization (PAHO) late last week issued an alert on outbreaks of Candida auris in the Americas, noting an increase in cases of the multidrug-resistant yeast during the COVID-19 pandemic.

While several countries in the region have reported isolated cases or small outbreaks of C auris since 2012, four countries with no previous history of the pathogen (Brazil, Guatemala, Mexico, and Peru) reported cases during the last 6 months of 2020, with a hospital in Mexico reporting an outbreak involving 10 patients in an intensive care unit. In addition, Panama and Colombia reported 124 and 340 C auris cases, respectively, in 2020. Most cases have been reported in patients with COVID-19.

First identified in Japan in 2009, C auris spreads easily in healthcare settings, can cause serious invasive infections in immunocompromised patients, and has shown resistance to three major antifungal drug classes. Recent case reports, including an investigation of a C auris outbreak at a Florida hospital in July 2020, have linked COVID-related breakdowns in infection prevention and control to the spread of the pathogen in hospitals.

To prevent hospital outbreaks, the PAHO alert recommends that health services build capacity for early detection of patients with suspected C auris infections or colonization, isolate cases in single rooms when recommended, screen all patients on the same hospital ward, clean and disinfect the patient area and surfaces with disinfectant effective against C auris on a daily basis, and reinforce hand hygiene among healthcare workers.

PAHO also recommends that hospitals notify health authorities of any positive C auris isolates identified by validated methods.
Feb 6 PAHO epidemiologic alert

H5N8 avian flu strikes more poultry in Russia and the UK

Two countries in Europe—Russia and the United Kingdom—reported more highly pathogenic H5N8 avian flu outbreaks in poultry, according to the latest official notifications, including from the World Organization for Animal Health (OIE).

Russia's outbreak began on Jan 27 at a turkey farm in Rostov oblast in the country's southwest, killing 99473 of 213,881 susceptible birds, according to an OIE notification. Elsewhere, the UK Department for Environment, Food, and Rural Affairs (DEFRA) today reported H5N8 at a layer farm at a small farm near Redcar in North Yorkshire in the country's northeast. The UK has now reported 13 outbreaks in poultry this winter.

Meanwhile, several European countries reported more avian flu outbreaks in wild birds, mostly involving the H5N8 strain, but Switzerland reported an event involving H5N4, the second country in Europe behind Germany to report the strain in wild birds. Elsewhere, China reported another H5N8 detection in wild birds, which involved mandarin ducks found dead on Jan 29 at a nature park in Jiangsu province in the country's east.
Feb 5 OIE report on H5N8 in Russia
Feb 8 DEFRA report
Feb 5 OIE report on H5N4 in Swiss wild birds
Feb 8 OIE report on H5N8 in Chinese wild birds

COVID-19 Scan for Feb 08, 2021

News brief

Study: Pfizer’s mRNA vaccine neutralizes COVID-19 variants

A study today in Nature Medicine showed Pfizer's mRNA vaccine, the first vaccine approved in the United States for use against COVID-19, neutralized three variants of the virus, including the B117 strain first identified in the United Kingdom, and two new variants first confirmed in South Africa.

The mutations tested included the N501Y from the United Kingdom and South Africa, the 69/70-deletion + N501Y + D614G from United Kingdom; and E484K + N501Y + D614G from South Africa.

To conduct the study, University of Texas Medical Branch researchers engineered three COVID-19 viruses with the spike mutations from the variants. They then measured neutralization geometric mean titers (GMTs) against the variants in 20 samples of human sera from subjects who had been vaccinated with Pfizer's two-dose vaccine 2 to 4 weeks earlier.

GMTs were 0.81- to 1.46-fold of the GMTs of the original, wild type virus, against which Pfizer’s vaccine is 95% effective.

As seen in other studies, the neutralization GMT of the serum panel against the virus with three mutations from the South Africa variant (E484K + N501Y + D614G) was slightly lower than the neutralization GMTs against the N501Y virus or the virus with mutations from the UK variants, the authors wrote. But the difference was not great.

"The magnitude of the differences in neutralization GMTs against any of the mutant viruses in this study was small (0.81- to 1.41-fold), as compared to the greater than four-fold differences in hemagglutination-inhibition titers that have been used to signal potential need for a strain change in influenza vaccine," the authors concluded.

They suggested ongoing surveillance of variants.
Feb 8 Nat Med study

Novel antiviral interferon lambda may offer COVID-19 outpatient benefits

After adjusting for baseline viral load, COVID outpatients are more than four times more likely to have an undetectable viral load when treated with the experimental drug interferon lambda, according to a small study published late last week in The Lancet Respiratory Medicine.

Interferon lambda is an antiviral protein that uses multiple pathways to attack viruses. It is most active in the liver, lungs, and intestine.

The researchers treated 29 people with one 180-microgram injection of interferon lambda and 30 with a placebo from May 18 to Nov 4, 2020, in Toronto. At day 7, 82.8% of the intervention group had undetectable viral loads compared with 63.3% of the placebo group, resulting in an adjusted odds ratio of 4.12 (95% confidence interval [CI], 1.15 to 16.73). The results were more marked for those with a higher viral load of at least 10⁶: The intervention group was 8.16 times more likely to test negative (95% CI, 1.76 to 51.5).

Interferon lambda's effects were able to be seen starting on day 3 after injection, according to the researchers. Viral load decline was 0.81 log copies per milliliter greater in the treatment group vs the placebo group, which increased to a difference of 1.67 log copies by day 5 and 2.42 log copies by day 7.

"If we can decrease the virus level quickly, people are less likely to spread the infection to others and we may even be able to shorten the time required for self-isolation," says Jordan Feld, MD, MPH, lead author, in a University Health Network press release.

Both the intervention and placebo groups had similar side effects.
Feb 5 Lancet Respir Med study
Feb 5 UHN press release

Pandemic-related food security, lower income noted in poorer nations

International phone surveys across nine lower- and middle-income countries (LMICs) found that, during the COVID-19 pandemic, residents have experienced a median 70% income loss and 30% unemployment rate as well as food insecurity (a median 45% have skipped or reduced meals), difficulty accessing markets (31%), and limited healthcare (13%). The results were published in Science Advances late last week.

The researchers surveyed 16 subpopulations using pre-determined pools and randomized dialing in Burkina Faso, Ghana, Kenya, Rwanda, Sierra Leone, Bangladesh, Nepal, the Philippines, and Colombia, reaching more than 30,000 households. Kenya and Bangladesh made up more than 50% of the study cohort.

While the surveys took place from April through early June 2020, the researchers say that already in April, approximately 50% of those surveyed had begun rationing or skipping meals.

"Even in Colombia," the researchers write, "the country in our sample with the highest per capita GDP and thus potentially the greatest financial resources to cope with the crisis, the majority of respondents report drops in income (87%) and employment (49%), and an increase in food insecurity (59%)."

The researchers say looking at individual ranges is just as important as median figures to understand the pandemic's full impact. For instance, only 8% of Kenyan refugee households experienced income loss, but 69% of the country's rural households did. Median national or humanitarian aid was 11%, but subgroups ranged from no coverage to 49%. And despite reporting the highest rates of assistance (26%), 27% of Bangladesh's Rohingya refugees reported food insecurity.

"We find that the economic shock in these countries—where most people depend on casual labor to earn enough to feed their families—leads to deprivations that seem likely to generate excess future morbidity, mortality, and other adverse longer-term consequences," the researchers write, adding that children are particularly vulnerable to food insecurity, school closures, and inadequate healthcare.

In their discussion and in press releases, the researchers advocate for worldwide COVID vaccines, aid policies that don't spur additional COVID transmission risks, and "graduation programs" that can increase training and provide income during such times.
Feb 5 Sci Adv study
Feb 5 University of California Berkeley press release
Feb 5 Innovations for Poverty Action press release