Cases of kids with COVID-19 and croup rose amid Omicron surge

A new study shows that the proportion of children diagnosed as having COVID-19 and croup was significantly higher during the Omicron surge than in earlier waves dominated by other variants.

Croup is an upper airway infection generally affecting children. It causes swelling around the larynx, trachea, and bronchi, resulting in labored breathing and a "barking" cough.

Late last week in JAMA Network Open, researchers from Children's Minnesota reported on their study of 5,152 children aged 3 months to 8 years diagnosed as having croup related to COVID-19 from Jan 1, 2021, to Mar 26, 2022. The team used data from 43 US children's hospitals in the Pediatric Health Information System. Median patient age was 17 months, and 64.6% were boys.

The proportion of children with both infections was 10.9% in the Omicron era, up from 4.1% amid Alpha and other variants and 3.6% during Delta. The adjusted odds ratio (aOR) of hospitalization for infections caused by Alpha or other variants was 1.28 (95% confidence interval [CI], 0.97 to 1.70), while it was 0.92 (95% CI, 0.74 to 1.15) during Delta—figures not significantly different from that of the Omicron period.

Racemic epinephrine (RE) to reduce swelling was used less often during the Delta era (aOR, 0.73; 95% CI, 0.61 to 0.87) and didn't differ in periods dominated by Alpha or other variants (aOR, 1.03; 95% CI, 0.81 to 1.31) relative to the Omicron era, suggesting lower disease severity during Delta. Admissions to an intensive care unit (ICU) were similar across the time periods.

The authors noted that the overall ICU admission was lower than a rate reported before COVID-19, which they said could be related to limitations on ICU capacity or less-severe illness.

"Given that COVID-19 is likely to become endemic, our findings suggest that pediatric health systems should consider variation in SARS-CoV-2 phenotypes and their association with patient care," they concluded. "This may be especially true when other viral infections lead to surges in patient volume."
Jul 1 JAMA Netw Open research letter


Study: Convalescent plasma did not improve COVID-19 outcomes

Though widely given to severely ill patients hospitalized with COVID-19 during the pandemic, convalescent plasma did not improve the ability to survive or recover, according to a national clinical trial published today in Chest.

The study was led by researchers at Vanderbilt University, and it looked at the efficacy and safety of COVID-19 convalescent plasma therapy for adults hospitalized with moderate to severe COVID-19 within 2 weeks of symptom onset. The study enrolled 960 patients from 25 US hospitals who were administered plasma from someone who had survived COVID (482 patients) or a placebo (465 patients).

The goal of convalescent plasma use is for the patient to receive passive SARS-CoV-2 antibodies.

The two groups, however, saw little difference in outcome: At 28 days following treatment, 18.5% of patients in the convalescent plasma group and 17.2% of patients in the placebo group had died. The researchers also found that clinical status by day 14 of illness did not differ between the groups, nor did any of the 13 secondary efficacy outcomes that they measured.

"Providing passive immunity with convalescent plasma does not appear to benefit patients once their illness has progressed to the point of needing treatment in the hospital," said Todd Rice, MD, a senior author of the study, in a Vanderbilt press release. "Despite receiving convalescent plasma with a higher titer of neutralizing antibodies, the therapy did not help hospitalized patients."
Jul 5 Chest
Jul 5 Vanderbilt University
press release


DRC declared end of latest Ebola outbreak

The Democratic Republic of the Congo (DRC) declared the end of an Ebola outbreak in Equateur province, which was the third outbreak in the region since 2018 and marked the country's 14th outbreak, the World Health Organization (WHO) African regional office announced yesterday.

The event totaled four confirmed cases and one probable case, all of them fatal. Earlier investigation findings suggested the source was a new spillover of the virus from an animal host, rather than a resurgence sparked by lingering virus in a survivor. The outbreak began in the middle of April.

During the response, 2,104 people were vaccinated, including 302 contacts and 1,307 frontline workers, the WHO said. The outbreak was centered near Mbandaka, the provincial capital, where an ultra cold-chain freezer was installed to allow vaccine to be stored locally.

Matshidiso Moeti, MBBS, who directs the WHO's African regional office, said Africa is experiencing an increase in Ebola and other diseases that jump from animals. "We need to be ever more vigilant to ensure we catch cases quickly. This outbreak response shows that by bolstering preparedness, disease surveillance and swift detection, we can stay a step ahead."
Jul 4 WHO African regional office statement


Ice cream suspected as source in deadly multistate Listeria outbreak

Ice cream sold in Florida is suspected in a recently announced multistate Listeria outbreak that has sickened 23 people, 1 of them fatally, mostly involving people who live in or have traveled to Florida, the Centers for Disease Control and Prevention (CDC) said in a recent update.

Of 17 people who were interviewed about the foods they ate in the month before they got sick, 14 recalled eating ice cream. Of 13 who remembered the brand they ate, 6 reported eating Big Olaf Creamery brand or eating ice cream at locations that served the brand.

On Jul 1, the company—based in Sarasota—began contacting retail locations to recommend that they stop selling the companies products. It also urged consumers to throw out the products they have in their homes. According to the company's website, it delivers to most of Florida, serving ice cream parlors, senior homes, restaurants, fairs, and supermarkets.

Of the 23 cases, 12 involved Florida residents. Cases were also reported in nine other states. The patient who died is from Illinois. Five patients were pregnant women, one of whom miscarried.

Listeria monocytogenes can survive at very low temperatures and spread to other foods or surfaces. Pregnant women, elderly people, and those with weakened immune systems are at highest risk.
Jul 2 CDC outbreak update
Jul 1 CIDRAP News scan
Big Olaf Creamery website


H5N1 avian flu implicated in Maine seal deaths

Testing prompted by elevated deaths and illnesses in seals on the Maine coast has identified highly pathogenic H5N1 avian flu in four seal, National Oceanic Atmospheric Administration (NOAA) Fisheries said in a statement over the weekend. In June, its partner organization, Marine Mammals of Maine (MMM), started responding to an elevated number of stranded seals, most of them found dead.

The rate of seal strandings is about three times above normal for this time of the year. MMM said it has responded to 40 seal strandings, and NOAA Fisheries said that as of Jul 4, people have reported 71 seal strandings this year, about half of them harbor seals in Cumberland County.

Over the past year, H5N1 has been detected in other mammal species, including foxes, raising concerns about the zoonotic potential of the virus. Two human infections have been reported, both in people who had extensive contact with poultry.
Jul 3 NOAA Fisheries press release
MMM statement

In related developments, though avian flu outbreaks at commercial poultry farms have slowed in the warm-weather months, the virus continues to be detected in backyard poultry and in wild birds.

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported three more outbreaks in backyard birds. One struck a location in Utah's Salt Lake County, affecting 20 birds. Also, two were reported in Washington, one in King County, where 220 birds were held, and one in Kitsap County in a flock of 6 birds.

So far, the virus has led to the loss of more than 40 million poultry across 36 states.
USDA APHIS poultry outbreak updates

Stewardship / Resistance Scan for Jul 05, 2022

News brief

Study finds low rate of bacterial, fungal co-infections in US COVID patients

A study of US hospital data found that fewer than 10% of COVID-19 patients had bacterial or fungal co-infections, but they had a higher risk of antibiotic-resistant, healthcare-associated infections than flu patients, Centers for Disease Control and Prevention researchers reported late last week in Clinical Infectious Diseases.

Using patient and microbiologic data from the Premier Healthcare Database, researchers analyzed 206,465 inpatients diagnosed with COVID-19 from January 2020 through June 2o21 and 142,246 patients diagnosed with influenza-like illness (ILI) from January through June 2019. The proportion of patients with a bacterial or fungal culture obtained during hospitalization was similar in both groups (56.2% for COVID-19 and 60.4% for ILI). The percentage of discharges with a positive culture defined as community-onset (CO) was lower in COVID-19 patients than those with ILI (7% vs 10.4%), but the percentage of discharges with a positive culture identified as HO was higher (4.1% vs 2.4%).

Multivariable logistic models showed that COVID-19 patients had significantly lower odds than ILI patients of CO methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Pseudomonas aeruginosa (CRPA), or carbapenem-resistant Acinetobacter baumannii infections, but significantly higher odds of HO MRSA, CRPA, carbapenem-resistant Enterobacterales, and extended-spectrum beta-lactamase infections. Further analysis suggests the increased risk of antibiotic-resistant infections for COVID-19 patients is linked to longer hospital stays, critical care stay, receipt of invasive mechanical ventilation, and high rates of antibiotic exposure.

"Hospitals should continue to focus on infection control and antibiotic stewardship measures for patients with COVID-19 to prevent healthcare-associated infections, including antibiotic resistant pathogens," the study authors concluded.
Jul 2 Clin Infect Dis abstract


UK announces more funding for antibiotic development

The government of the United Kingdom last week announced an investment of more than $5 million to support development of new treatments to combat antimicrobial resistance (AMR).

The investment of £4.5 million ($5.3 million USD) from the UK government's Global AMR Innovation Fund (GAMRIF) will help the Global Antibiotic Research and Development Partnership (GARDP) develop antibiotics for drug-resistant infections that the World Health Organization has identified as the greatest threats to public health, including neonatal sepsis and hospital-acquired bacterial infections.

The funding, which brings the UK's total investment in GARDP to nearly £19 million ($22.6 million), will also support the development of zoliflodacin, a novel antibiotic for gonorrhea infections that GARDP is developing with Entasis Therapeutics.

"I am thrilled that the UK will be working in partnership with GARDP to deliver crucial research as part of GAMRIF's commitment to a One Health approach," Dame Sally Davies, UK Special Envoy on AMR, said in a press release from the UK's Department of Health and Social Care (DHSC). "Together we are leading efforts to combat AMR where the burden of infection is greatest, and we will use this investment to develop new treatments for drug-resistant infections to protect the world's most vulnerable."
Jun 30 DHSC press release


EU members vote to prohibit certain antibiotics from veterinary use

European Union (EU) member states have formally given their support to a list of antibiotics that will be prohibited from being sold for veterinary use.

The list of antibiotic classes, subclasses, and substances to be reserved for humans only is based on recommendations provided to the European Commission in May by the European Medicines Agency, the European Centre for Disease Prevention and Control, and the EU Food Safety Authority.  Antibiotic classes on the list include carbapenems (eg, meropenem), cephalosporin/beta-lactam inhibitor combinations (ceftolozane-tazobactam), siderophore cephalosporins (cefiderocol), monobactams (aztreonam), carboxypenicillins (piperacillin), glycopeptides (vancomycin), lipopeptides (daptomycin), oxazolidinones (linezolid), and glycylcyclines (tigecycline).

EU member states voted on the list yesterday.

"The list voted today, the first of its kind in the EU, and a landmark worldwide, is a major step forward in our One-Health policy approach to curb antimicrobial resistance," Stella Kyriakides, EU Commissioner for Health and Food Safety, said in a European Commission press release. "It is a prime example of how we address human, animal health and plant health together while at the same time also considering the importance of the environment."

The European Commission says it will formally adopt and publish the list in the coming weeks, and the ban will go into effect 6 months after publication.
Jul 4 European Commission press release

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