Indonesia's health ministry reports polio case, announces vaccine drive

News brief

Indonesia's health ministry over the weekend reported a polio case in a child. On Twitter, the officials said one case of type 2 polio, presumably circulating vaccine-derived poliovirus type 2 (cVDP2), was found in Pidie regency in Aceh province. The government said it will launch an immunization drive for children up to ages 13 starting on Nov 28 in all areas of Aceh.

A local health department statement translated and posted by Avian Flu Diary, an infectious disease news blog, said acute flaccid paralysis was found on Nov 10 in a 7-year-old child who wasn't vaccinated.

In 2019, the country reported two cVDPV1 cases in Papua province.

The World Health Organization (WHO) said vaccine-derive polio infections are rare but can emerge in populations affected by immunization gaps.

In 2014, a WHO emergency committee declared a public health emergency of international concern (PHEIC) over ongoing polio activity. In October it met for the 33rd time to discuss the latest developments, and afterward it agreed that the situation still warrants a PHEIC, partly owing to the risk of international spread of cVDPV2 along with immunization gaps.

Earlier this year, cVDPV2 was found in a New York resident, along with wastewater detections, which suggest further local spread. Similar environmental detections were reported recently in London and Jerusalem.

Scientists start work on WHO priority pathogen list revisions

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The World Health Organization (WHO) today announced the launch of global scientific effort to update the list of priority pathogens, a list used to guide investments and research, especially for vaccines and treatments.

It said the process began on Nov 18 with a meeting of more than 300 scientists, who are examining evidence on 25 virus families and bacteria, as well as "Disease X," an unknown pathogen that could cause a serious international epidemic. The group will consider scientific criteria, as well as the potential socioeconomic, access, and equity impact.

The WHO published its first priority pathogen list in 2017, with the last assessment done in 2018. In the past few years, the WHO has also posted priority pathogen lists for antibiotic-resistant and fungal organisms.

Mike Ryan, MD, who heads the WHO's health emergencies program, said, "Without significant R&D investments prior to the COVID-19 pandemic, it would not have been possible to have safe and effective vaccines developed in record time."

The WHO said it expects to publish the revised priority pathogen list in the first quarter of 2023.

Candida auris cases rising in Europe, survey finds

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An epidemiologic survey conducted by the European Centre for Disease Prevention and Control (ECDC) in April 2022 shows Candida auris cases are rising across the continent, researchers reported last week in Eurosurveillance.

The survey shows a near doubling of C auris cases—and countries reporting them—from 2020 to 2021, from 335 reported by 8 countries in 2020 to 655 reported by 13 countries in 2021. In both years, most cases were reported by Spain (260 in 2020 and 331 in 2022) and Italy (49 in 2020 and 242 in 2021). Most of the cases (63.2%) reported in 2020 and 2021 involved colonization, while bloodstream and other type of infections accounted for 15.3% and 10.3% of cases, respectively.

Cases of the multidrug-resistant yeast reported in Europe in 2020 and 2021 were considerably higher than in previous years. Overall, 1,812 C auris cases have been reported by European Union/European Economic Activity (EU/EEA) countries since 2013. But prior to 2021, the number of cases was driven by a large outbreak in one country. Eleven EU/EEA countries had not detected any C auris cases until 2021.

From 2019 to 2021, five countries (Denmark, France, Germany, Greece, and Italy) reported 14 C auris outbreaks—defined as two or more cases with an epidemiologic link. At least two of the reported outbreaks (in Germany and Italy) involved COVID-19 patients or units dedicated to the care of COVID-19 patients. One country (Spain) reported regional endemicity.

The multidrug-resistant yeast, which spreads easily in healthcare settings and can cause severe and deadly infections in patients with compromised immune systems, was first discovered in 2009 in Japan. Since then, it has spread around the world.

"The reported interregional spread as well as regional endemicity in one country show that C. auris is in the process of establishing itself as a healthcare-associated pathogen in the EU/EEA, similar to other countries such as the United States," the authors  of the report wrote. "European-level surveillance therefore needs to improve with case definitions and standardised and regular case-based reporting."

The World Health Organization recently listed C auris as one of 19 fungal priority pathogens. 

Imaging spotlights brain changes 6 months after COVID-19

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A study using a special type of magnetic resonance imaging (MRI) has revealed brain changes in COVID-19 patients up to 6 months after recovery from their infections, according to findings to be presented at next week's Radiological Society of North America (RSNA) annual meeting in Chicago.

Researchers in India used susceptibility-weighted imaging to analyze the effects of COVID-19 on the brain among 46 COVID-19 survivors and 30 healthy controls within 6 months of recovery. The most commonly reported symptoms among COVID-19 patients were fatigue, trouble sleeping, problems with attention, and memory issues.

The MRI results showed significant changes in the brain linked with fatigue, insomnia, anxiety, depression, headaches, and cognitive problems in the COVID-19 patients compared with controls.

There were also differences in parts of the brain responsible for language production and comprehension, attention, motor inhibition and imagery, social cognitive processes, hormone-release signaling, sensory and motor signaling, and regulation of the sleep-wake cycle.

"Changes in susceptibility values of brain regions may be indicative of local compositional changes," study coauthor Sapna Mishra, a PhD candidate at the Indian Institute of Technology in Delhi, said in the RSNA news release. "Susceptibilities may reflect the presence of abnormal quantities of paramagnetic compounds, whereas lower susceptibility could be caused by abnormalities like calcification or lack of paramagnetic molecules containing iron."

The research team is now conducting a longitudinal study on the same patient cohort to determine whether the neurologic abnormalities persist longer. "The present findings are from the small temporal window," Mishra said. "However, the longitudinal time points across a couple of years will elucidate if there exists any permanent change."

CWD confirmed on another Wisconsin deer farm

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The Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) late last week announced that chronic wasting disease (CWD) has been detected on a deer farm in Lincoln County, which is located in the north central part of the state.

The positive result is from a 5-year-old white-tailed buck. The farm has been placed on quarantine while veterinarians from the DATCP and the US Department of Agriculture conduct an epidemiologic investigation.

The new detection marks the third this year at a Wisconsin deer farm. Last month, the DATCP reported a positive CWD finding at a deer farm in Vernon County, which is in southwestern Wisconsin. In February, officials confirmed CWD findings in two deer from a farm in Waukesha County that had been in quarantine following an investigation into CWD linked to a Eau Claire County ranch.

CWD can spread among cervids like deer, elk, and moose and is fatal. The prion disease spreads through contaminated environments, antler velvet, and body fluids and tissues.

The disease isn't known to infect humans, but some experts fear it could cause illness similar to another prion disease, bovine spongiform encephalophathy ("mad cow disease"). The Centers for Disease Control and Prevention (CDC) warns against eating meat from infected animals.

European survey shows need for more antibiotic knowledge

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A survey published last week by the European Commission shows fewer Europeans reported taking antibiotics in the past year than in previous years, but many are taking them for the wrong reasons, and lack of knowledge about antibiotics remains a problem.

The results of the Eurobarometer survey, conducted from Feb 21 to Mar 21, 2022, reveal that 23% of Europeans say they have taken oral antibiotics in the previous 9 to 12 months, down from 32% in a 2018 survey and the lowest recorded level since the survey was first conducted in 2009. But the proportion of respondents who reported taking antibiotics varied widely—from 15% in Sweden to 42% in Malta. Roughly 8% of respondents said they had taken antibiotics without a prescription.

In addition, more than 30% of respondents reported taking antibiotics for illnesses that don't require them, such as cold (11%), flu (12%), and COVID-19 (9%), while others took them for illnesses that require additional testing, like bronchitis (12%). More than half of respondents (53%) said they didn't have a test to find out the cause of their illness before they started taking antibiotics.

When quizzed on their knowledge about antibiotics, only 50% knew that antibiotics are ineffective against viruses, while 62% knew that antibiotics are ineffective against colds. Only 28% answered all four antibiotic knowledge questions correctly. More than 8 in 10 (82%) were aware that unnecessary use of antibiotics makes them less effective, and 67% knew that taking antibiotics can lead to side effects like diarrhea.

EU Commissioner for Health and Food Safety Stella Kyriakides said the survey results highlight one of the reasons antimicrobial resistance has emerged as a major public health crisis.

"Antibiotics kill bacteria, not viruses. Overusing antibiotics feeds the resistance of bacteria to our medicines," Kyriakides said in a press release. "The survey we present today shows why this risk exists."

The authors of the report say improving public awareness about antibiotics and antimicrobial resistance will be crucial in efforts to reduce antibiotic overuse and misuse, and that education campaigns need to target people who have incomplete knowledge.

Surveys show differing attitudes toward monkeypox vaccination

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Men who have sex with men (MSM) account for the vast majority of US monkeypox cases, and a new survey shows urban versus rural MSM have significantly different attitudes about vaccination and disease prevention. The survey results are published in The Journal of Rural Health.

The study participants were recruited in August of 2022 from the gay dating app Grindr. A total of 582 men answered questions about geographic location, experience with monkeypox infections, attitude surrounding vaccination, and sexual behavior.

Most of the participants were urban residents (71.8%) and 28.2% were rural, with 61.3% identifying as white, and 64.4% reporting having a bachelor's degree or higher. Over two-thirds of participants had oral sex (86.8%) and condomless anal sex (67.9%) with a nonprimary male sex partner in the past 6 months, the authors said, and 95.2% had heard of monkeypox.

More than three-quarters of the participants (77.1%) had not been vaccinated against monkeypox, but urban residents were less likely to believe that they were at risk for the virus compared to urban dwellers. Rural residents also reported more perceived barriers to accessing the vaccine.

In another new study based on a survey of mostly MSM British men, authors found vaccine acceptability to be very high (86%), but overall participants said they had low (34%) understanding of public health knowledge. That study was published in HIV Medicine.

The study was based on 1,932 survey respondents, 1,750 of whom identified as men, 88 as women, and 64 as gender non-conforming. The goal of the survey was to understand the public response to public health and media messaging during the monkeypox outbreak of 2022. A total of 80% of participants identified as gay, bisexual (12%), heterosexual (4%), and pansexual (2%).

Overall, 52% of respondents considered themselves at risk, 61% agreed that people with monkeypox should isolate for 21 days, 49% reported they would first attend a sexual health clinic if symptomatic, and 86% reported they would accept a vaccine.

Myocarditis after mRNA COVID vaccine risk real, but rare in young men

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A new large Canadian study shows a small but significant increased risk in myocarditis among young men who get mRNA COVID-19 vaccines, especially the second dose of the Moderna vaccine. The study is published in CMAJ (Canadian Medical Association Journal).

The study was based on outcome seen during the BC COVID-19 Cohort study, which included more than 10.2 million doses of mRNA vaccines administered to people 12 years and older from Dec 15, 2020, to Mar 10, 2022. Seven million were BNT162b2 (Pfizer-BioNTech) doses and 3.2 million were mRNA-1273 (Moderna) doses, and the authors examined cases of myocarditis, or inflammation of the heart muscle, which were identified 7-21 days after vaccination and required hospitalization.

The authors recorded 99 incident cases of myocarditis within 7 days, compared with 7 expected cases, and 141 cases within 21 days post-vaccination, compared with 20 expected cases. Overall, myocarditis was seen at a rate of 1.37 per 100,000 vaccine doses, compared with an expected rate of 0.39 per 100,000 people who were not vaccinated.

Males aged 18-29 were at the most risk of developing the condition, especially if they received the Moderna vaccine twice. Overall myocarditis rates among males in this age group were 2.97 per 100,000, which rose to 2.27 per 100,000 after the second dose. Among men ages 18 to 29 who received the Moderna vaccine, the rate was 22.9 per 100,000 doses.

In a press release, the authors said their findings "support the preferential use of the BNT162b2 (Pfizer-BioNTech) vaccine over the mRNA-1273 (Moderna) vaccine for people aged 18–29 years."

"Although observed rates of myocarditis were higher than expected, the benefits of vaccination against SARS-CoV-2 in reducing the severity of COVID-19, hospital admission, and deaths far outweigh the risk of developing myocarditis," the authors said.

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