Saudi Arabia reports fatal MERS case

Saudi Arabia's Ministry of Health (MOH) today reported a new MERS-CoV case, which involves a 36-year-old man who died from his infection.

The man was from Hafr Al-Batin in the country's northeast. An investigation found that the man had been exposed to camels. He wasn't a healthcare worker and isn't thought to have contracted MERS-CoV (Middle East respiratory syndrome coronavirus) from another person.

The case marks Saudi Arabia's eighth of the year. The World Health Organization (WHO) said in an April update that, since 2012 when virus was first detected in humans, it has received reports of 2,574 confirmed cases, at least 886 of them fatal.
May 6 Saudi MOH update


WHO establishes Hub for Pandemic and Epidemic Intelligence

In an effort to detect and respond to epidemic and potential pandemic threats more quickly, the WHO and Germany's government yesterday announced the establishment of a new global hub for gathering intelligence, as well as sharing and analyzing data for risk assessments.

Called the WHO Hub for Pandemic and Epidemic Intelligence, the center will be based in Berlin and will work with partners around the world from government, academia, and the private sector. In a statement, the WHO and Germany said the center will help public health officials and policy makers take rapid steps to prevent and respond to future disease threats.

Tedros Adhanom Ghebreyesus, PhD, the WHO's director-general, said a lesson from the COVID-19 pandemic is that the world needs more advanced data analysis to help guide public health decisions.

"This requires harnessing the potential of advanced technologies such as artificial intelligence, combining diverse data sources, and collaborating across multiple disciplines. Better data and better analytics will lead to better decisions," he said.
May 5 WHO/German government joint news release


Mali and Germany report more H5N1 avian flu in poultry

Mali reported another highly pathogenic H5N1 avian flu outbreak in poultry, and Germany reported four outbreaks involving the subtype, all in Lower Saxony state, according to the latest notifications from the World Organization for Animal Health (OIE).

Mali reported its first H5N1 outbreaks in the middle of April, and its latest event is located in one of the same areas—Koulikoro region. The latest outbreak struck a layer farm and began on Apr 9, killing 64,040 of 80,050 susceptible birds.

 Germany reported four H5N1 outbreaks with start dates ranging from Feb 23 through May 3. Three were farms housing either turkeys or layers, and one involved backyard birds. Taken together, the virus killed 517 of 22,171 birds.
Apr 30 OIE report on H5N1 in Mali
May 5 OIE report on H5N1 in Germany

COVID-19 Scan for May 06, 2021

News brief

Clotting, bleeding issues uncommon with AstraZeneca COVID-19 vaccine

The AstraZeneca-Oxford COVID-19 vaccine is associated with some increases in bleeding and clotting events, according to a BMJ study yesterday, but experts say the benefits outweigh the risks.

The researchers compared 28-day post-vaccination comorbidities in 291,264 Danish and Norwegian adults under 65 with the general population. Most (79.0%) were women, with a median age for all patients of 44 to 45. People who had experienced any adverse events in the past year were excluded.

The results show no association between arterial events and COVID vaccination, but the risk of venous thromboembolism was increased 1.97-fold, though to only 11 excess occurrences per 100,000 vaccinations. Cerebral venous thromboembolisms in particular increased 20.25-fold, resulting in 2.5 excess occurrences per 100,000 vaccinations. A BMJ editorial by Rafael Perera, DPhil, and John Fletcher, MB BChir, MPH, however, notes that COVID itself is associated with 4.3 excess brain blood clots per 100,000 infections.

Standardized morbidity ratios were slightly higher for thrombocytopenia or clotting disorders (1.52) as well as any bleeding (1.23). The researchers say increased surveillance could also be a factor.

Stratifying the data by age affected only venous thromboembolism occurrence (2.99 morbidity ratio in those younger than 45 vs 1.58). While vaccinated men had a 0.67 morbidity ratio for venous thromboembolism, overall the researchers say the data are not conclusive and that more studies are needed to understand populations that may have increased risks.

A BMJ blog post by Paul R. Hunter, MB ChB, MD, MBA, points out that some adverse events may have gone undetected due to the simplification of ICD-10 codes, which were used for data analysis, or because patients did not seek hospital care. Still, he, the researchers, and the editorial authors agree that the benefits of the AstraZeneca vaccine's outweigh the risks.

"Comparing vaccine adverse event rates to background population rates is appropriate for rare diseases, since most people are never exposed to the disease but are exposed to risk of adverse events if vaccinated. The situation is different in a pandemic," Perera and Fletcher write. "The choice we nearly all face is between eventual SARS-CoV-2 infection or vaccination. The Oxford-AstraZeneca vaccine is clearly a good choice, despite the likely risks found by Pottegård and colleagues."
May 5 BMJ study, editorial, and blog post

Lung abnormalities can persist a year post-COVID

Almost one in three patients' lungs exhibited a lower ability to diffuse gas into the bloodstream 1 year after hospital discharge following severe COVID-19, according to a study yesterday in The Lancet Respiratory Medicine.

The researchers looked at 83 healthy adults who were diagnosed as having severe COVID-19 pneumonia at a Wuhan University hospital in China. After enrollment in February and March 2020, the patients were followed up 3, 6, 9, and 12 months post-discharge. The study excluded patients who received intubation and mechanical ventilation in the hospital or who had a history of smoking or comorbidities.

In pulmonary function tests, the median diffusing capacity of the lungs for carbon monoxide (DLCO) was 77% of the predicted value at 3 months, 76% at 6 months, and 88% at 12 months; median forced vital capacity (FVC) was 92%, 92%, and 98% of predicted value, respectively. By 12 months, 27 (32.5%) still had impaired DLCO, and 9 (10.8%) had reduced FVC, a measure of breathing ability. Despite this, patients exhibited improved exercise and breathlessness symptoms.

Almost 80% of patients (65) showed residual computed tomography (CT) abnormalities 3 months after discharge, and after a year, 24.1% (20) did. High-resolution CT (HRCT) showed no evidence of established fibrosis or progressive interstitial changes. Overall, the researchers found significant differences in pulmonary function test parameters between patients with normal versus abnormal HRCT scores a year after discharge.

Female sex was associated with impaired DLCO (odds ratio [OR], 8.61; 95% confidence interval [CI], 2.83 to 26.2). Data also associated peak HRCT pneumonia scores with radiologic abnormalities (OR, 1.36; 95% CI, 1.13 to 1.62).

Piero L. Olliaro, MD, PhD, writes in a commentary, "The findings on lung function and how these are reflected in functional tests therefore apply to a selected population at the beginning of the pandemic and both presenting characteristics and case management have evolved since." Thus, he calls for more research to understand the long-term impact of COVID-19 on the lungs.
May 5 Lancet Resp Med study and commentary

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