Half of rheumatology patients report persistent symptoms after COVID-19

Over half of adults diagnosed as having a rheumatologic disease reported persistent COVID-19 symptoms at least a month after recovery from their infection, according to survey results presented late last week at the virtual American College of Rheumatology annual meeting.

A news release from the Hospital for Special Surgery in New York City described the study, in which researchers emailed surveys to 7,505 men and women 18 years and older who had been treated for rheumatologic conditions at the hospital from 2018 to 2020.

Among 2,572 survey respondents, nearly 56% who said they tested positive for COVID-19 reported symptoms lasting 1 month or more, including loss of taste or smell, muscle aches, and difficulty concentrating. Patients who smoked, took corticosteroids, or had a chronic condition such as diabetes or congestive heart failure were at particularly high risk for long-haul symptoms.

Only two patients reported pre-existing fibromyalgia, a condition that produces symptoms similar to those of long-haul COVID-19. "Our findings do not suggest that symptoms of fibromyalgia are being misinterpreted as long haul COVID in patients with rheumatic diseases, which is something that has been raised as a possibility," senior study author Lisa Mandl, MD, MPH, said in the release. 

Lead author Medha Barbhaiya, MD, MPH, said that understanding the long-term effects of COVID-19 in this population is critical. "For rheumatology patients, long-haul COVID may be particularly challenging, as these patients already have significant chronic health issues and warrants further investigation," she said.

The researchers plan to use the data in a longitudinal analysis to determine if lingering COVID-19 symptoms interact with or aggravate rheumatologic conditions.
Nov 6 Hospital for Special Surgery news release


Mandated sepsis bundle tied to increased antibiotic use, fewer deaths

A series of measures mandated by the Centers for Medicare and Medicaid Services (CMS) to improve sepsis care in US hospitals was associated with increased sepsis diagnosis and antibiotic use, but also with reduced mortality, researchers reported late last week in Clinical Infectious Diseases.

In their analysis of the Severe Sepsis and Septic Shock: Management Bundle (SEP-1) Core Measure, required at all US hospitals that receive CMS compensation as of October 2015, the researchers looked at antibiotic use among adult patients at 26 hospitals during the year before and the year after implementation (October 2014 through October 2016).

The SEP-1 bundle promotes early administration of effective antibiotic therapy in sepsis patients, but its impact on antibiotic use wasn't known. Sepsis diagnosis rates and all-cause mortality were also analyzed.

A total of 701,055 patient were included in the study, and more than 1.9 million antibiotic days of therapy (DOT) were administered during the study period. Antibiotic use and sepsis diagnosis increased 2% each month during the SEP-1 preparation period (October 2014 through September 2015) and remained elevated. Cumulatively, the rate of sepsis diagnosis increased 32.9% during the entire study period, and the mean monthly antibiotic DOT per 1,000 patient-days increased 24.4%.

The rate of all-cause mortality fell 5% each month during the SEP-1 preparation period, then declined by 2% each month during the SEP-1 implementation period (November 2015 through October 2016). Cumulatively, the monthly mean all-cause mortality per 1,000 patients declined 38.5% over the entire study period.

The study authors note that while it's plausible the decline in mortality was related to improved antibiotic therapy for sepsis patients, they did not observe changes in mortality in a subset of patients with suspected sepsis. Furthermore, the decline in mortality was out of proportion to the increased number of patients diagnosed as having sepsis and to the increase in antibiotic use.

"Our analysis does not demonstrate a causal association between implementation of SEP-1 and changes in antibacterial use or mortality, but strongly suggests that additional investigation into the value and potential adverse events of mandated antibiotic therapy is required," the authors wrote. "Any benefits provided by the prompt and broad application of antibacterial therapy for patients with suspected sepsis may be quickly outweighed by adverse events."
Nov 5 Clin Infect Dis abstract


Three Jamestown Canyon virus cases detected in New Hampshire

New Hampshire has reported three more Jamestown Canyon virus (JCV) cases, two in patients hospitalized with neurologic symptoms, according to the state's Department of Health and Human Services (DHHS).

The adults, who all recovered, live in Loudon, Pittsfield, and Rumney, New Hampshire, and were infected with JCV through mosquito bites.

"With these three JCV infections happening in early fall, it is important to remember the season of mosquitos is longer than just the summer months. Mosquitos can continue to transmit infections like Jamestown Canyon Virus until there is a mosquito-killing hard frost," said Benjamin Chan, MD, MPH, New Hampshire state epidemiologist, in a press release. "Residents and visitors of New Hampshire should take steps to avoid mosquito bites from the time the snow melts in the spring to the hard-frosts of fall."

Though most cases of JCV are mild, moderate to severe—and even fatal—cases of the disease have been reported. If symptoms occur, they are likely to include fever, muscle aches, headaches, and fatigue.

There are no vaccines or treatments for JCV at this time.
Nov 5 New Hampshire DHHS press release


Zika outbreak strikes third Indian state

A Zika outbreak has so far sickened nearly 90 people in India's Uttar Pradesh state, the third Indian state to be affected by the virus this year, according to Reuters, which cited local health authorities.

The latest outbreak is centered in the Uttar Pradesh city of Kanpur. So far, 89 illnesses have been detected, including 17 involving children. One of the patients is a pregnant woman, whose condition is being monitored. Cases in the city have been rising since late October.

In the middle of October, the World Health Organization (WHO) described two other recent Zika outbreaks in India, one in Kerala state and the other in Maharashtra. The outbreaks were the first for the two states, though India has reported Zika virus cases before.

A spate of outbreaks in other states in 2018 involved the Southeast Asian lineage, with no reports of microcephaly.
Nov 8 Reuters story
Oct 14 CIDRAP News scan


More H5N1 avian flu outbreak reported in Europe, South Korea

Highly pathogenic H5N1 avian influenza outbreaks in poultry are accelerating in Europe, with Poland among a handful of countries reporting new detections in poultry and wild birds, according to notifications from the World Organization for Animal Health (OIE).

Poland reported two outbreaks, one at a commercial farm in Lubusz province in the west that raises turkeys and geese and the other at a noncommercial farm in Silesian province in the south that houses multiple poultry species. The outbreaks in Poland are its first involving the subtype since 2008.

Also, the United Kingdom's Department for Environment, Food, and Rural Affairs (DEFRA) said high path H5N1 has been confirmed at a small backyard facility in Warwickshire County in the West Midlands region.

Other countries, mostly in Europe, reported more H5N1 detections in wild birds, according to the latest OIE report. They include the Czech Republic (mute swans in South Bohemian region), Ireland (peregrine falcon in Galway), the Netherlands (waterfowl in North Holland Province), and Sweden (wild goose in Skane County).

In October, European veterinary officials warned that the spread of H5N1 along migration routes could portend more outbreaks in the months ahead.

Elsewhere, South Korea reported two H5N1 outbreaks in wild birds, one in mandarin ducks and other species in North Jeolla province and the other in mandarin ducks in South Chungcheong province.
Nov 5 and 8 OIE reports on H5N1 poultry outbreaks in Poland (Lubusz and Silesian provinces)
Nov 8 UK DEFRA report
Nov 5 OIE reports on H5N1 wild birds in the Czech Republic, Ireland, the Netherlands, and Sweden
Nov 5 OIE report on H5N1 in wild birds in South Korea

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