22% of kids with COVID-19 or MIS-C had neurologic involvement in 2020-21
A study of US patients aged 0 to 20 years hospitalized for COVID-19 or multisystem inflammatory syndrome in children (MIS-C) in 2020 and 2021 shows that 22% had a neurologic condition, including 9% with life-threatening illness.
In the study, published yesterday in JAMA Neurology, a team led by Boston Children's Hospital researchers investigated rates of neurologic disorders in 2,168 children admitted to 55 hospitals in 31 states from Dec 15, 2020, to Dec 31, 2021, for COVID-19 (34%) or MIS-C (66%). Median patient age was 10.3 years, and 58% were male.
Of all patients, 22% had neurologic involvement, 9% of whom had life-threatening conditions, including 55% who had acute central nervous system (CNS) infections or acute disseminated encephalomyelitis (ADEM; damage to the protective covering of nerve fibers in the brain). The most common of these conditions were encephalitis (infection-related swelling of the brain) and stroke. Seven of 23 (30%) of these patients experienced severe outcomes.
Life-threatening neurologic disorders were more common during the Delta variant surge than in previous waves (64% vs 36%). Ten of 42 (24%) of patients with neurologic involvement were released from the hospital with new-onset neurologic conditions, and 8 (19%) died. Among patients with non–life-threatening neurologic involvement, 4% were released from the hospital with neurologic deficits, 90% had no neurologic disorders, and 5% died.
Relative to patients with no neurologic involvement, those with such a condition were older (median age, 12 vs 10 years) and more often had underlying neurologic disorders (107 of 476 [22%] vs 240 of 1,692 [14%]).
Of the 155 COVID-19 vaccine-eligible patients with neurologic involvement and confirmed vaccination status, 95% had received no doses, including 15 of 16 patients (94%) with life-threatening illness.
"SARS-CoV-2–related neurologic involvement in US children and adolescents hospitalized for COVID-19 or MIS-C persisted in 2021, and acute CNS infection/ADEM accounted for more of the reported life-threatening cases than in 2020," the researchers wrote. "COVID-19 vaccination is effective at preventing hospitalization for acute COVID-19 and MIS-C and may decrease associated neurologic complications."
Nov 7 JAMA Neurol study
Study: Cholesterol drug has no significant effect on COVID-19
After showing promise in early laboratory research, the cholesterol-lowering drug fenofibrate had no significant effect on COVID-19 outcomes in a multicenter international randomized controlled trial, where use of the drug did little to curb severity of disease or deaths. The study is published in Nature Metabolism.
The large study was performed by researchers from Penn Medicine, who sponsored the FERMIN trial at 26 collaborating institutions from North America, South America, Europe, and Western Asia.
Fenofibrate is a low-cost generic drug approved for use around the world, and works to lower fatty substances such as cholesterol and triglycerides in the blood. In previous lab studies, fenofibrate reduced viral replication by changing how cells handled fat.
To conduct the study, researchers enrolled 701 participants who reported COVID-19 symptoms in the previous 2 weeks. The study team assigned 351 patients to be treated with 145 milligrams of fenofibrate and 350 with a placebo.
Those in the intervention arm had no significant reductions in symptom severity up to 30 days following the trial. There was no significant effect on death from any cause. Importantly, these outcomes were seen in all countries and trial sites, and among all participants regardless of sex, age, comorbidities, and body mass index.
According to the study authors, there were 61 (17%) adverse events in the placebo arm compared with 46 (13%) in the fenofibrate arm, with slightly higher incidence of gastrointestinal side effects in the fenofibrate group.
In a press release, Jordana B. Cohen, MD, MSCE, a professor at Penn said, "Cellular effects of drugs observed in a petri dish system may fail to translate to beneficial effects in people with COVID-19 as a result of a wide range of potential phenomena in whole organisms. Our trial reinforces the importance of not equating laboratory efficacy with clinical efficacy in the setting of COVID-19."
Nov 7 Nat Metab study
Nov 7 Penn Medicine press release
USDA researchers say deer susceptible to scrapie, a relative of CWD
US Department of Agriculture (USDA) researchers in Ames, Iowa, published a new study showing white-tailed deer are susceptible to the prion that causes classical scrapie in sheep, and that differentiation from chronic wasting disease (CWD) may be difficult. The study is published in the Journal of Infectious Diseases.
To conduct the study, the researchers took five healthy white-tailed deer and inoculated them by a concurrent oral/intranasal exposure with the classical scrapie agent from sheep. Another six deer were inoculated oronasally with the classical scrapie agent from goats.
None of the animals inoculated with scrapie from goats showed signs of prion disease, but all the animals inoculated with the prion disease from sheep had clinical signs of infection, spongiform lesions, and widespread evidence of disease in neural and lymphoid tissues.
"This study suggests that potential transmission of scrapie to deer presents an ongoing risk to wild and captive white-tailed deer. Future studies will focus on whether white-tailed deer could serve as a reservoir of infectivity to scrapie susceptible sheep," the authors concluded.
While neither scrapie nor CWD have been documented in humans, another prion disease, called bovine spongiform encephalopathy (BSE, or "mad cow" disease) poses a threat to people who consume BSE-infected animals, and officials are concerned the same may happen with CWD.
Nov 8 J Infect Dis study
Cases and deaths rise in Uganda's Ebola outbreak
Over the past few days, Uganda has reported 5 more Ebola cases, along with 5 new deaths, according to the latest totals on the health ministry's website. The newest developments bring the number of lab-confirmed cases to 136 and the number of deaths in people with confirmed infections to 53 in the current outbreak.
The outbreak, first announced in September, involves the less common Sudan Ebola virus.
In other outbreak developments, the country's Cabinet has approved a health ministry plan to close schools early for the third-term holidays to curb the Ebola outbreak, according to the Daily Monitor.
Also, over the weekend, the government extended the 3-week lockdowns for two of the hardest hit districts, Mubende and Kassanda, according to Agence France-Presse (AFP). The lockdowns are slated to last another 3 weeks and include a night curfew, a ban on personal travel, and the closure of markets, bars, and churches.
Uganda health ministry Ebola page
Nov 8 Daily Monitor story on school measures
Nov 5 AFP story