News Scan for Nov 04, 2021

News brief

US hospitals saw healthcare-associated infections rise in 2020

A new report from the Centers for Disease Control and Prevention (CDC) shows that progress against healthcare-associated infections (HAIs), including those caused by antibiotic-resistant bacteria, took a step back in 2020.

The 2020 National and State Healthcare-Associated Infections Progress report shows that from 2019 to 2020, general acute care hospitals saw a 35% increase in the standardized infection ratio for ventilator-associated events, a 24% increase in central line-associated bloodstream infections (CLABSIs), and a 15% increase in hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Long-term acute care hospitals (ACHs) saw a 20% increase in MRSA bacteremia.

The CDC says the impact of the COVID-19 pandemic on US hospitals likely played a major role in these increases.

"For most HAIs in ACHs, the increases seen in 2020 present a strong contrast to the success in reducing these infections prior to the pandemic," the report states. "The COVID-19 pandemic created a perfect storm for HAIs in healthcare settings. Many hospitals faced extraordinary circumstances that may have reduced the implementation of standard infection prevention and control (IPC) practices."

On a positive note, the report also found a 11% decline in hospital-onset Clostridioides difficile infections at ACHs, along with a 9% decline in surgical site infections (SSIs) following hysterectomies and 5% decline in SSIs following colon surgery. In addition, ACHs in more than half the states are performing better than the 2015 national baseline in preventing CLABSIs, MRSA bacteremia, SSIs following surgeries, C difficile infections, and catheter-associated urinary tract infections.

The CDC says the report highlights the need for hospitals to continue to reinforce IPC practices in their facilities and regularly review HAI surveillance data to identify areas for improvement.
Oct 2021 CDC report

Minnesota asks hunters for CWD samples near North Dakota border

The Minnesota Department of Natural Resources (DNR) said yesterday that it is implementing voluntary chronic wasting disease (CWD) sampling for all deer harvested along the state's border with North Dakota during the current hunting season.

The move follows the identification of the first suspected CWD case in the area. Preliminary test results from a deer harvested near Climax, Minnesota, indicate a CWD infection, but confirmation of the initial result is not expected until next week, the DNR said in a press release.

"Thanks to this hunter's early discovery, we have the chance to act quickly and be proactive," said Seth Goreham, acting wildlife research manager for the DNR. "We're asking hunters to submit samples so we can determine the extent of CWD in the area and take steps to help control the spread."

The DNR said samples can be submitted at two self-service stations in the area.

CWD is a fatal prion disease that affects cervids like deer, elk, and moose. The disease was first detected in wild deer in the United States in 1981 and has now been detected in 26 states. So far, 118 cases have been documented in Minnesota's wild deer herd, most of them in the southeastern part of the state. Implications for human health are unknown.
Nov 3 DNR press release

ACIP makes recommendations on hep B, orthopoxvirus, Ebola vaccines

A day after its deliberations on the Pfizer-BioNTech COVID-19 vaccine for children, the vaccine advisory group for the CDC met yesterday and approved policy recommendations for three other vaccines. The vaccines target hepatitis B, orthopox viruses, and Ebola virus.

The Advisory Committee on Immunization Practices (ACIP) said the hepatitis B vaccine should be used in people ages 19 to 59 and in those ages 60 and older who are at higher risk. They also said it may be given in those ages 60 and older who don't have risk factors.

The orthopoxvirus recommendation related to the Bavarian Nordic vaccine against monkeypox and smallpox, which the Food and Drug Administration approved in 2019. In a five-part vote, the group recommended it as an alternative to the first-generation vaccine (ACAM2000), though its recommendation wasn't preferential. The policy measures also covered healthcare workers who administer ACAM, which contains live vaccinia virus, occupational risks involving more virulent variants, and booster doses.

And finally, ACIP recommended the VSV-EBOV vaccine for preexposure prophylaxis for health workers at special pathogens treatment centers and those who work at Laboratory Response Network facilities. Also, the group approved routine votes on childhood and adult immunization schedules.
Nov 3 ACIP agenda

COVID-19 Scan for Nov 04, 2021

News brief

US COVID vaccine rollout tied to fewer cases, hospital visits in older adults

The initial COVID-19 vaccine campaign in the United States was associated with fewer infections, emergency department (ED) visits, and hospitalizations among adults 65 and older, finds a study yesterday in The Lancet.

Researchers at the Centers for Disease Control and Prevention (CDC) analyzed population-based COVID-19 data reported to US federal agencies from Nov 1, 2020, to Apr 10, 2021. Starting in mid-December, healthcare workers were prioritized for vaccines, followed by adults 75 years and older, those aged 65 to 74, and those 16 to 64 at high-risk for poor COVID-19 outcomes.

COVID-19 vaccination was linked to a 53% reduction in infection among adults aged 65 to 74 years and a 62% reduction among those 75 years and older, relative to those aged 50 to 64. Similarly, ED visits decreased 61% in adults 65 to 74 and 77% in those 75 and older, relative to the younger age-group.

Hospitalizations fell 39% among adults aged 60 to 69 years, 60% in those 70 to 79 years, and 68% in those 80 and older, compared with the younger age-group. Likewise, COVID-19 deaths dropped a relative 41% among adults 65 to 74 years and 30% in those 75 and older, but the study authors said the impact of the vaccines on deaths was not clear.

"Although it is not possible to conclusively attribute these declines solely to vaccination given the ecological design of this analysis, these results suggest that the initial phases of the US COVID-19 vaccination programme led to a meaningful reduction in COVID-19 burden among US people aged 65 years and older, a group at high risk of severe outcomes from COVID-19," the researchers wrote.

In a commentary in the same journal, Justin Ortiz, MD, and Kathleen Neuzil, MD, MPH, both of the University of Maryland, said that it will be important to evaluate public health outcomes in diverse settings because of differences in circulation and the emergence of SARS-CoV-2 variants, vaccines and vaccination schedules, and the diversity of targeted populations.

"Future COVID-19 vaccine impact studies in the USA will need to be timely to keep pace with critical public health needs," they wrote. "Finally, as the largest vaccine roll-out in history expands even further, we must ensure that low-income and lower–middle-income countries are supported in their efforts to establish immunisation programme monitoring and evaluation to guide appropriate and context-specific decision making."
Nov 3 Lancet study and commentary

Study: Bamlanivimab protects against COVID-19 hospitalization in seniors

A new case-control study shows the monoclonal antibody bamlanivimab offered good protection against hospitalization in 1,257 adult US outpatients who were either 65 or older or obese. The study was published yesterday in Open Forum Infectious Disease.

The patients in the study sought treatment in the Mass General Brigham (MGB) health system, where a lottery system had been put in place for the monoclonal antibody therapy beginning in December 2020. This study was based on patients who entered the lottery from Dec 9, 2020 and Feb 25, 2021, and were 65 years and older and had a body mass index (BMI) of 35 or higher.

According to the researchers, patients who received bamlanivimab had a statistically significant, 68% reduction in the odds of hospitalization, and a statistically significant difference in the odds of death (odds ratio, [OR], 0.03; 95% confidence interval [CI], 0 to 0.25; P<0.01), compared with those who did not receive bamlanivimab.

Despite the promising results, bamlanivimab is no longer administered alone, only in combination with other monoclonal antibody therapies, per the Food and Drug Administration.

"Not withstanding these limitations, the study supports the effectiveness of monoclonal antibody therapy for Covid-19 under real world conditions in reducing the rate of hospitalization for adult patients with BMI ≥ 35 or age ≥ 65 and suggests that there may be a mortality benefit in this population," the authors concluded.
Nov 3 Open Forum Infect Dis study