News Scan for Mar 07, 2022

News brief

COVID patients with heart defects may be at higher risk for severe disease

Hospitalized COVID-19 patients with congenital heart defects (CHDs) were more likely to be admitted to an intensive care unit (ICU), require invasive mechanical ventilation (IMV), and die than those without CHDs in the first 11 months of the pandemic, suggests a study published today in Circulation.

Congenital heart defects, the most common birth defect in the world, occurs when the heart or blood vessels near the heart don't develop normally in utero.

US Centers for Disease Control and Prevention (CDC) researchers mined claims data on hospitalized COVID-19 patients ages 1 to 64 years from March 2020 through January 2021 from the Premier Healthcare Database Special COVID-19 Release. Vaccination status data weren't included in the study.

Patients with and without CHD received care in the same hospitals, and the study accounted for differences in age, sex, race, health insurance type, and other high-risk conditions such as heart failure, pulmonary hypertension, Down syndrome, diabetes, and obesity.

Among 235,638 eligible patients, 421 (0.2%) had CHD, and 68.4% had one or more chronic illnesses, compared with 58.8% of the 235,217 patients without CHD.

More than half (53.9%) of CHD patients were admitted to an ICU (vs 42.6% of those without CHD), 24.0% needed IMV (vs 14.5%), and 11.2% died in the hospital (vs 6.9%). Those at greatest risk for severe illness were those who had CHD and an underlying illness, were 50 years and older, and were men.

Among CHD patients, 73% were older than 30 years, 61% were male, 55% were White, 19% were Hispanic, and 16% were Black.

In an American Heart Association (AHA) press release, lead study author Karrie Downing, MPH, a CDC epidemiologist, said the findings have clinical relevance.

"People with heart defects should be encouraged to receive the COVID-19 vaccines and boosters and to continue to practice additional preventive measures for COVID-19, such as mask-wearing and physical distancing," she said. "People with heart defects should also consult with their health care teams about additional steps to manage personal risks related to COVID-19."
Mar 7 Circulation research letter
Mar 7 AHA press release

Long COVID patients lose more quality-adjusted life days

A new study of 548 COVID-19 patients from the United Kingdom shows 17% reported physical symptoms at month 6—most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath—and 10% reported prolonged loss of function compared with pre-COVID levels. The study was published late last week in Clinical Infectious Diseases.

The prospective cohort study of non-hospitalized COVID-19 patients aged 12 to 85 years included 6 months of follow-up data conducted through health surveys. Patients were compared to SARS-CoV-2–negative controls, and the main outcome was quality-adjusted life days (QALDs).

The average age of COVID patients was 41 years, and 61.5% were women.

Loss of QALDs increased with patient age. "Generally, the health loss of cases increased by age from 7.2 (5.5, 9.0) QALDs in ages 12-24 years to 22.4 (14.6, 30.2) QALDs in ages 65+ years, and it was higher for cases who reported symptoms at month 6 (32.9, 95% CI: 24.5, 37.6) versus cases who did not report symptoms at month 6 (8.8, 95% CI: 5.8, 12.1)," the authors wrote.

On average, all patients lost 13.7 (95% confidence interval [CI], 9.7 to 17.7) QALDs, while those reporting symptoms at month 6 lost 32.9 (95% CI, 24.5 to 37.6) QALDs. More than half (52.7%) of COVID-19–positive patients missed work or school for a mean of 12 days.

The authors note that persistent symptoms of COVID after acute infection affect as many as 20% to 30% of cases at 1 month post-diagnosis, and at least 10% 3 months after diagnosis.
Mar 5 Clin Infect Dis study

Polio returns to Israel after 32-year absence

Israeli officials reported the nation's first polio case since 1989, involving an unvaccinated 4-year-old boy in Jerusalem.

It's not clear from media reports whether a vaccine-derived or wild-type virus caused the infection, but the Israeli Ministry of Health (MOH) said in a news release, "The source of the disease in this case [is] a polio virus that has undergone a change and may cause disease in those who are not vaccinated.".

An MOH official told Israel Hayom that the boy was experiencing weakness and in a condition that could deteriorate to paralysis. Neither the boy nor his family had been vaccinated against polio. Officials say hundreds or thousands of children might have been exposed to a mutated polio strain.

"The population vaccinated against polio is protected. But this could be significant for the unvaccinated population, and the recommendation is to get vaccinated. It's disturbing, mostly because this is a completely preventable disease," MOH officials said.

Head of Public Health Services Sharon Alroy-Preis, MD, MPH, MBA, stressed the importance of following vaccination programs to safeguard children from the disease, according to the Jerusalem Post. She recommended that the first polio vaccine dose be moved up to 6 weeks after birth and the second administered at 12 weeks after birth.

In 2013, evidence of poliovirus was detected in sewer systems across Israel, but no human cases were identified at that time, The Times of Israel reports. But the discovery led authorities to launch a mass vaccination campaign in children.
Mar 6 MOH news release
Mar 7 Israel Hayom story
Mar 7 Jerusalem Post story
Mar 7 Times of Israel report

Stewardship / Resistance Scan for Mar 07, 2022

News brief

Joint European report calls for more action on antimicrobial resistance

A new joint report on antimicrobial resistance (AMR) in European Union/European Economic Activity (EU/EEA) countries is calling for concerted action to address the problem from a One Health perspective.

The report from the European Centre for Disease Prevention and Control (ECDC), the European Food Safety Agency (EFSA), the European Medicines Agency (EMA), and the Organisation for Economic Co-operation and Development (OECD) notes that there have been encouraging trends in human and animal antibiotic use across Europe over the past decade. From 2011 through 2020, antibiotic consumption in humans in EU/EEA countries fell by 23%, while animal antibiotic consumption fell by 43% in 25 European nations with consistent reporting.

In addition, EU/EEA countries have made major strides in developing and implementing national AMR action plans.

Resistance to commonly used antibiotics in bacteria from food-producing animals, however, remains high (>20% to 50%) or very high (>50% to 70%), with significant variation across the continent, while resistance to critically important antibiotics in healthcare-associated pathogens continues to climb. And the declines in human and animal antibiotic use vary widely as well. In addition, the evidence that AMR can spread between humans, animals, and the environment continues to mount, and significant gaps remain in implementation of national AMR action plans.

"AMR cannot be contained within borders or regions, underlining the need for concerted action throughout the EU/EEA," the report states.

To continue making progress, the report urges EU/EEA countries to prioritize monitoring and evaluation of national action plan implementation, integrate and expand surveillance of drug-resistant bacteria in humans, animals, and the environment, and invest in antimicrobial stewardship and infection prevention and control programs.

The report also recommends that a forthcoming EU policy initiative to boost implementation of the EU One Health Action Plan against AMR should promote innovative economic models and incentives for new antibiotics, diagnostics, and vaccines; target antibiotic consumption in nursing homes; and establish a system to promote implementation of best practices to tackle AMR.
Mar 7 ECDC/EFSA/EMA/OECD joint report

Canadian hospital surveys show rise, stabilization of antimicrobial use

Point-prevalence surveys of sentinel acute-care hospitals in Canada suggest that antimicrobial use over a 15-year period stabilized following a sharp increase, Canadian researchers reported today in Infection Control & Hospital Epidemiology.

The surveys were conducted by the Canadian Nosocomial Infection Surveillance Program in 2002, 2009, and 2017 during a 24-hour period in February of each year to identify trends in antimicrobial use in acute care. Patients were eligible if they were admitted for 48 hours or more or if they had been admitted to the hospital within a month. Twenty-eight to 47 hospitals participated in each survey.

In 2002, 2,460 of 6,747 patients (36.5%) at surveyed hospitals received one or more antimicrobials. In 2009, the proportion of patients receiving one or more antimicrobial climbed to 3,566 of 8,902 patients (40.1%). In 2017, 3,936 of 9,929 patients (39.6%) received one or more antimicrobial. Overall, the prevalence of antimicrobial use increased 9.9% from 2002 to 2009 but remained stable (a 1.1% decrease) from 2009 to 2017. In a secondary analysis of the 18 hospitals that participated in all three surveys, the prevalence of antimicrobial use was similar to the primary analysis.

Among patients who received one or more antimicrobials, penicillin use increased 36.8% from 2002 to 2017 and third-generation cephalosporin use increased from 13.9% to 18.1%. Over the same period, fluoroquinolone use declined by 36.5% and clindamycin use decreased by 62.5%. Carbapenem use increased by 57.6% from 2002 to 2009, then by 4.8% from 2009 to 2017.

The authors say the stabilization of antimicrobial use coincided with an increased focus on antimicrobial stewardship in Canadian hospitals since the mid-2000s.

"Further studies are needed to examine the appropriateness of antimicrobial use, as part of a coordinated approach to prevent the emergence and spread of antimicrobial resistance," the authors write.
Mar 7 Infect Control Hosp Epidemiol study