News Scan for Sep 16, 2021

News brief

Pregnancy intentions lowered during early pandemic, study says

Almost half of New York women who had been trying to become pregnant before COVID-19 stopped trying during the first few months of the pandemic, according to survey results published in JAMA Network Open yesterday.

From Apr 20 to Aug 21, 2020, 1,179 women (mean age, 32.2 years) in New York City with at least one child responded to the survey. Before the pandemic began, about 16.2% had been thinking about becoming pregnant and 5.2% had been trying to become pregnant. By the time of the survey, 37.2% and 49.2% of each subgroup, respectively, said they had changed their mind (total, 101). Of the 30 who had stopped actively trying to become pregnant, 43.3% said they would resume after the pandemic resolved.

As for the 927 women who weren't planning on becoming pregnant prior to the pandemic, 4.5% were now considering it.

Those who stopped considering or attempting pregnancy were more likely to respond to the survey during outbreak peak (adjusted odds ratio [aOR], 2.04, but with a wild confidence interval).

Those considering pregnancy who had previously not been were significantly less likely to be Hispanic (aOR, 0.27), more likely to have fewer children at home (aOR, 0.62), and more likely to say they had COVID-19 (aOR, 2.70).

According to a New York University (NYU) press release, US birth data showed 300,000 fewer births in 2020 than expected, with a particular drop in November and December (eg, fewer conceptions at the beginning of the pandemic). Lead study author Linda Kahn, PhD, MPH, noted in the press release that delaying family planning could also result in higher risks for aging mothers and their children.

In a related commentary, Philip N. Cohen, PhD, writes, "In light of disparate impacts of COVID-19 itself and the social and economic fallout of the pandemic, research should concentrate on widening inequalities in fertility and family well-being, and their relationship to health disparities."
Sep 15 JAMA Netw Open study and commentary
Sep 15 NYU
press release


Comorbidities, older age associated with severe COVID in kids

Among US children 17 and under, COVID-19 hospitalization was associated with older age and chronic comorbidities, including obesity or type 2 diabetes, according to a study yesterday in the Journal of Hospital Medicine.

The researchers looked at 19,976 COVID-19 pediatric encounters from Apr 1 to Sep 30, 2020. About 79.7% were discharged from the emergency department (ED) and 20.3% were hospitalized. 

Factors associated with hospitalization were obesity or type 2 diabetes (aOR, 10.4), immunocompromised condition (aOR, 5.9), pulmonary disease (aOR, 5.3), cardiovascular disease (aOR, 5.0), asthma (aOR, 1.4), and private payer insurance (aOR, 1.16). While older children and adolescents were hospitalized at lower rates, the researchers note that those who were had a higher likelihood of severe illness.

"Given the recent, concerning increases in COVID cases nationwide and the fact that the vast majority of children remain unvaccinated and susceptible, these findings should be taken into account when considering preventive strategies in schools and planning vaccinations when available for children less than 12 years of age, " said lead author James Antoon, MD, PhD, in a press release by the Vanderbilt University Medical Center (VUMC).

Of those hospitalized, 79.3% had moderate illness, 11.3% had severe illness, and 9.4% had very severe illness. Overall, 21% of hospitalized patients needed intensive care unit admission. About 10.1% of the whole cohort sought healthcare for any cause within 30 days, with hospitalized children more likely to have a return visit than those discharged from the ED.
Sep 15 J Hosp Med study
Sep 15 VUMC
press release


Foods not previously implicated linked to foodborne illness in recent years

Twenty-eight novel outbreak-associated food vehicles, or foods that have not been implicated in past outbreaks, have emerged from 2007 to 2016, according to a study last week in Emerging Infectious Disease.

The researchers used the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System to look at 14,216 outbreaks with implicated foods, comparing outbreaks from 1973 to 2006 with those from 2007 to 2016. Their analysis found 28 novel outbreak-associated food vehicles, with the most common categories being fish (6 outbreaks), nuts (6), fruits (4), vegetables (3), and meats (3). One-third were imported, and two-thirds didn't need cooking after purchase.

Thirty-six of the outbreaks were linked to these novel food vehicles, which led to 1,294 illnesses, 263 hospitalizations, 14 deaths, and 17 recalls, according to the data. Salmonella and Shiga toxin–producing Escherichia coli were the most commonly associated cause of these novel food vehicles, accounting for 53% and 14% of the outbreaks, respectively.

"Compared with other outbreaks, those associated with novel food vehicles were more likely to involve illnesses in multiple states and food recalls and were larger in terms of cases, hospitalizations, and deaths," write the researchers. "Prevention efforts targeting novel foods cannot rely solely on consumer education but require industry preventive measures."
Sep 8 Emerg Infect Dis study


Alaska reports 2 more novel orthopox cases

Following the detection of two novel orthopox cases in Alaska's Fairbanks area in 2015 and 2020, the Alaska Department of Health and Social Services (ADSS) recently reported two more infections over the summer from the same area.

The previously identified orthopox, named Alaskapox virus, isn't related to other known orthopox viruses but causes similar symptoms, such as small lesions, swelling, fever, and fatigue, which resolve.

The two new unrelated cases were detected in July and August, both in people from the Fairbanks area. One is a young girl who had a lesion on the inside of her elbow, and the other is a middle-aged woman who had a lesion on her inner thigh.

Investigators found that neither patient had traveled outside Fairbanks in the 4 weeks before symptom onset. Both households had dogs and cats, and the cats were known to hunt small mammals. No specific source of the virus was found, but both patients had spent time outdoors in the summer. The woman had also spent significant time doing yardwork the week before her symptoms began.

Health officials note that all four patients who have experienced Alaskapox live in low-density housing areas in forested regions where small mammals are widespread. Three live in households with cats, a species known to be intermediate hosts for other orthopox viruses. Small-animal trapping in the Fairbanks area has also yielded Alaskapox virus.

Though the infections may be more common than initially thought, no human-to-human spread has been reported and all cases were identified in outpatient settings. So far the public health impact is limited, the report said.
Sep 9 ADHSS epidemiology bulletin


Nigeria confirms spike in monkeypox cases

Though Nigeria has reported sporadic monkeypox cases since 2017, so far this year health officials have confirmed three times more infections than in 2020, the World Health Organization (WHO) African regional office said yesterday in its weekly outbreaks and health emergencies report.

Nigeria's ongoing monkeypox activity has also come with sporadic cases exported to other countries, such as the one detected in a Texas traveler who returned from Nigeria in July.

The WHO said Nigeria reported a substantial increase in cases in August, registering a 50% increase compared with July. Nine new suspected cases were reported in August, and the six confirmed cases were from six different states, two of which reported their first cases since 2017 when the outbreak was first declared.
Sep 15 WHO African regional office weekly report


WHO: Urban settings raise plague transmission risk in Madagascar

In an update on Madagascar's latest pneumonic plague outbreak, the World Health Organization (WHO) African regional office said the risk of further spread is high because the epicenter in Itasy region is densely populated and is near the country's capital Antananarivo.

As of the end of August, the country had reported 30 suspected cases and 7 deaths, with a case-fatality rate of 23%.

The WHO also noted that traffic between the outbreak area and Antananarivo is intense. It said plague is endemic in Madagascar, with increased transmission typically seen between September and April. It warned that it expects more cases in the months ahead.

Though Madagascar has experience managing outbreaks, it is juggling other health challenges, including COVID-19 and a humanitarian situation in the country's south, the WHO said.

In 2019, the country battled a large outbreak that affected endemic and nonendemic areas, including large urban areas.
Sep 15 WHO African regional office weekly report

Stewardship / Resistance Scan for Sep 16, 2021

News brief

CDC launches antibiotic stewardship toolkit for healthcare payers

The Centers for Disease Control and Prevention (CDC) yesterday launched a toolkit to help healthcare payers support appropriate antibiotic use in outpatient settings.

The toolkit, developed in collaboration with the Pew Charitable Trusts and healthcare stakeholders and based on the CDC's Core Elements of Outpatient Antibiotic Use, identifies the activities that healthcare payers can implement to support outpatient antibiotic stewardship in primary care clinics and urgent care centers. Those activities include tracking and reporting antibiotic use within insurance networks, communicating commitment to stewardship to network members, implementing patient education campaigns, ensuring clinicians have access to current clinical guidelines, and conducting audit-and-feedback interventions for high-prescribing clinicians.

The CDC says healthcare payers—which include private health plans and Medicare and Medicaid—can play an important role in improving outpatient antibiotic use, because they have financial oversight in the provision of healthcare and are uniquely positioned to facilitate quality improvement measures.

Among the examples provided in the toolkit is an audit-and-feedback intervention conducted by Aetna over a 3-year period to target network clinicians who prescribed antibiotics to more than 50% of outpatients diagnosed as having acute bronchitis. The company sent more than 4,500 letters to clinicians from 2016 to 2019 and observed a 6% improvement in antibiotic prescribing for bronchitis over that period.

"All antibiotic use contributes to resistance, and most antibiotics in the US are given in outpatient settings—many of them inappropriately," David Hyun, MD, director of the Pew Charitable Trusts' antibiotic resistance project, said in a statement emailed to reporters. "Insurance companies can give providers the information they need to improve antibiotic stewardship, and the new toolkit from CDC gives them a roadmap."
Sep 15 CDC toolkit for healthcare payers


Transatlantic AMR task force lays out new 5-year plan

The Transatlantic Task Force on Antimicrobial Resistance (TATFAR) yesterday released a draft work plan identifying actions for continued collaboration over the next 5 years.

The plan is broken down into four key areas: appropriate antimicrobial use in human and veterinary medicine; surveillance and prevention of AMR; strategies to improve financial, access, research, and development of new antimicrobials, diagnostics, and alternative therapies; and actions to improve dissemination of information. The identified actions include consultation and regular exchanges of information among the TATFAR countries on actions that could help advance progress in those four key areas.

TATFAR was established in 2009 to bring together agencies and technical experts from the United States, Canada, the European Union, Norway, and the United Kingdom to collaborate and share best practices to strengthen domestic and global practices on appropriate antimicrobial use, prevention of healthcare-associated infections, and strategies for improving the pipeline of new antimicrobial drugs.
Sep 15 TATFAR draft work plan

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