News Scan for Jul 27, 2022

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In COVID-19 survivors, subsequent vaccination tied to half the risk of reinfection

Completion of a primary COVID-19 vaccination series after recovery from infection was tied to half the risk of reinfection in the pre-Omicron variant era, according to a study published today in JAMA Network Open.

Brown University researchers led the retrospective study of statewide disease-surveillance data on more than 95,000 COVID-19 survivors—including long-term congregate-care (LTCC) residents and workers—in Rhode Island from Mar 1, 2020, to Dec 9, 2021. The survivors were aged 12 and older, and were unvaccinated at the time they tested positive for COVID-19. The main outcome was reinfection at least 90 days after the first positive test.

Receipt of two doses of an mRNA COVID-19 vaccine or one dose of a viral-vector vaccine was linked to protection against reinfection of 49% (95% confidence interval [CI], 27% to 65%) among 3,124 LTCC residents, 47% (95% CI, 19% to 65%) among 2,877 LTCC employees, and 62% (95% CI, 56% to 68%) in 94,516 members of the general population during periods dominated by the wild-type, Alpha, and Delta SARS-CoV-2 strains.

The odds of reinfection at 9 months among participants who remained unvaccinated after COVID-19 recovery were 13.0% (95% CI, 12.0% to 14.0%) among LTCC residents, 10.0% (95% CI, 8.8% to 11.5%) among LTCC workers, and 1.9% (95% CI, 1.8% to 2.0%) in the general population, after adjusting for confounding factors and varying infection rates over time.

The study authors said the results can inform COVID-19 vaccination guidelines, especially those relating to LTCC residents and staff. "Individuals who have recovered from COVID-19 and remain unvaccinated should be encouraged to complete vaccinations, as they are eligible, to reduce their risk of reinfection," they wrote.
Jul 27 JAMA Netw Open study


Study: Very short antibiotic course effective in pneumonia patients with normal oxygen levels

A study of patients hospitalized with pneumonia found that among those with normal oxygenation levels, an ultra-short course of antibiotics appeared to be as safe and effective as the standard course, researchers reported today in Clinical Infectious Diseases.

In the study, a team led by researchers from Harvard Medical School conducted a retrospective analysis of patients treated with antibiotics for possible pneumonia at four hospitals in Massachusetts from May 2017 through February 2021. They focused on a subset of patients with oxygen saturation levels of 95% or higher, which is associated with a lower probability of true infection, then compared those treated with a very short course of antibiotics (1 to 2 days) with those who received a standard course (5 to 8 days). The primary outcomes were hospital mortality and time-to-discharge. Secondary outcomes included readmissions, 30-day mortality, Clostridioides difficile infections, 30-day hospital-free days, and antibiotic-free days.

Among 39,752 patients treated for possible pneumonia, 10,012 had median oxygen saturation levels of 95% or higher without supplemental oxygen. Of these patients, 2,239 who received 1 to 2 days of antibiotics were propensity matched to 2,239 who received 5 to 8 days. There were no statistically significant differences in hospital mortality between the two groups (2.1% for short course vs 2.8% for standard course; subdistribution hazard ratio [SHR], 0.75; 95% confidence interval [CI], 0.51 to 1.09), but patients treated with 1 to 2 days of antibiotics were discharged sooner (6.1 days vs 6.6 days; SHR, 1.13; 95% CI, 1.07 to 1.19) and had more 30-day hospital-free days (23.1 vs 22.7; mean difference, 0.44; 95% CI, 0.09 to 0.78).

There were no significant differences in 30-day readmissions (16.0% vs 15.8%; odds ratio [OR], 1.01; 95% CI, 0.86 to 1.19), 30-day mortality (4.6% vs 5.1%; OR, 0.91; 95% CI, 0.69 to 1.19), or 90-day C difficile infections (1.3% vs 0.8%; OR, 1.67; 95% CI, 0.94 to

"This analysis suggests a potentially powerful strategy to help clinicians to easily identify a subset of patients with possible pneumonia in whom early discontinuation of antibiotics may be safe," the study authors wrote. They suggest the strategy merits testing in prospective randomized trials.
Jul 27 Clin Infect Dis abstract


Two more Marburg infections reported from Ghana

Two more Marburg fever cases have been reported in Ghana's outbreak, a World Health Organization (WHO) official said at a briefing today.

Ghana is experiencing its first Marburg fever outbreak, and the new cases—the wife and child of the index case—lift the total to four. Ibrahima Soce Fall, MD, the WHO's assistant director-general for emergency, said the child died and was infected by his mother, not the index case. Three people have died in the outbreak.

Soce Fall said the outbreak response is challenging, because the mother is at a prayer camp and the response team is still working to isolate her. He also said that though case numbers are still low, three regions are affected.

So far, at least 118 contacts have been identified and more than 40 are still in the risk period, Soce Fall said.

The virus that causes Marburg fever, which is similar to Ebola, is transmitted from fruit bats to people and can spread among humans through contact with body fluids.
Jul 27 WHO briefing


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