Quick takes: TFAH preparedness report, mosquito-borne activity in the Americas, cholera situation worsens

News brief
  • The Trust for America's Health (TFAH), a nonprofit health advocacy group based in Washington, DC, today released its annual "Ready or Not" report, which measures states' capacity to respond to health emergencies and provide public health services. It also makes a host of recommendations based on the findings. Nationally, strengths included emergency expansions in healthcare and lab capacity; however, the report noted shortfalls in seasonal flu vaccination, public health system service gaps, and relatively low percentages of hospitals earning top patient safety scores. Several recommendations include investing $4.5 billion annually to bolster public health capacity.
  • The World Health Organization (WHO) today sounded an alarm about increasing geographic expansion of dengue and chikungunya activity in the Americas. In the southern part of the region, chikungunya cases have expanded beyond areas where the disease is typically reported. Dengue activity has been intense in the initial months of 2023 and is expected to get worse in the Southern Hemisphere due to weather conditions that fuel increases in mosquito populations.
  • The global cholera situation continues to deteriorate, with four new countries reporting outbreaks, raising the total to 24, the WHO said yesterday in a situation update that includes new developments since its last report on Feb 11. The new countries reporting outbreaks are South Africa, South Sudan, Tanzania, and Zimbabwe. The group said disease activity is spreading further into southeast Africa, and ongoing outbreaks in Malawi and Mozambique are at risk for worsening due to the impact of Cyclone Freddy in March. It said many outbreak countries are struggling with other outbreaks that strain health systems, as well as shortages of oral cholera vaccine. It said the global risk is very high.

Nirmatrelvir tied to 26% lower risk of long COVID, 47% lower risk of death

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The antiviral drug nirmatrelvir (one of the components of Paxlovid) lowered the risk of long COVID in patients who had at least one risk factor for severe illness, finds a study published today in JAMA Internal Medicine.

pink pills

Researchers from the VA St. Louis Health Care System and Washington University used the US Department of Veterans Affairs' healthcare databases to identify patients who tested positive for COVID-19 from January 3 to December 31, 2022, weren't hospitalized on the day of the test, and had at least one risk factor for severe infection.

The team compared long-COVID rates among the 35,717 patients who received oral nirmatrelvir within 5 days of testing positive with those of the 246,076 control patients who received no COVID-19 antiviral or antibody treatment during infection. Average age was 62 years, and 86.0% were men.

Preventing progression, persistent symptoms

Relative to the control group, nirmatrelvir was tied to a reduced risk of long COVID (relative risk [RR], 0.74; absolute risk reduction at 180 days [ARR, 4.51%), including a lower risk of 10 of 13 signs and symptoms involving the cardiovascular system (abnormal heart rhythms and ischemic heart disease), blood-clotting and hematologic disorders (pulmonary embolism and deep vein thrombosis), fatigue and malaise, acute kidney disease, muscle pain, neurologic system, and shortness of breath.

Nirmatrelvir was also linked to a reduced risk of death after acute infection (hazard ratio [HR], 0.53; ARR, 0.65%), and post-infection hospitalization (HR, 0.76; ARR, 1.72%). Nirmatrelvir was also associated with a lower risk of long COVID, regardless of vaccination status and history of infection.

"The totality of evidence suggests that improving the uptake and use of nirmatrelvir in the acute phase as a means of not only preventing progression to severe acute disease but also reducing the risk of post-acute adverse health outcomes may be beneficial," the authors wrote.

CDC says US TB incidence rose by 5% in 2022

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Preliminary data released today by the Centers for Disease Control and Prevention (CDC) show that US tuberculosis (TB) cases rose by 5% in 2022, with considerable increases in young children and certain racial and ethnic groups. But incidence remains lower than it was prior to the COVID-19 pandemic.

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In a paper published today in Morbidity and Mortality Weekly Report, CDC researchers said the uptick in TB cases comes after a sharp decline in 2020 that coincided with the pandemic, which contributed to delayed or missed diagnoses in the United States and other countries. With the decline, incidence of reported TB fell from 2.7 cases per 100,000 persons in 2019 to 2.2 in 2020. TB incidence then climbed to 2.4 in 2021.

With the 8,300 TB cases reported to the National Tuberculosis Surveillance System in 2022, incidence is now at 2.5 cases per 100,000. Of those cases, 73% occurred among non–US-born persons, compared with 72% in 2021.

Among 2,239 US-born TB patients, incidence was highest among non-Hispanic Native Hawaiian or Other Pacific Islander (NH/OPI) persons (6.6 cases per 100,000), American Indian or Alaska Native (AI/AN) persons (4.4), Asian persons (2.2), and Black persons (1.9). Compared with 2021, incidence increased 63% among Asians, 26% among NH/OPIs, 16% among AI/ANs, and 7% among Hispanics, a finding the CDC says reflects ongoing health disparities.

Among age groups, the largest increase in TB incidence compared with 2021 was among children aged 4 years and younger (28.8%) and adolescents and young adults aged 15 to 24 years (23.7%). People experiencing homelessness (4.8%) or residing in correctional facilities (3.5%) also saw increases in TB incidence in 2022.

"The message is loud and clear—TB is still here," Phillip LoBue, MD, director of CDC's Division of Tuberculosis Elimination, said in a press release. "Communities, providers, and public health partners must work together to make sure we are reaching the right people with testing and treatment, so we can prevent and stop the spread of TB."

Equatorial Guinea's Marburg virus outbreak expands

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Following several weeks of little new information on Equatorial Guinea's first Marburg virus outbreak, which began in January, the country is reporting more cases and more extensive transmission of the virus, according to an update yesterday from the World Health Organization (WHO).

Eight more confirmed cases have been reported, bringing the total to nine. Seven people among the nine confirmed cases have died from their infections. There are also 20 probable cases, all fatal.

Of the eight new confirmed cases, two are from Kie-Ntem province, four are from Litoral, and two are from Centro Sur. The WHO said the provinces are about 150 kilometers (93 miles) apart, suggesting wider transmission. It also said uncertain epidemiologic links in Centro Sur suggest potential undetected spread of the virus.

The group added that it has deployed experts to Equatorial Guinea to assist the nation's response and community engagement. Given that the country is grappling with the virus for the first time, its capacity needs to the strengthened, the WHO said.

The three affected provinces share borders with Cameroon and Gabon, and international crossings are frequent with porous borders. The WHO assessed the risk to Equatorial Guinea as very high, to the region as moderate, and to the globe as low.

Tanzania this week confirmed its first Marburg virus outbreak. Since 2021, four African countries have reported their first outbreaks involving the virus, which is similar to Ebola.

WHO: COVID activity up in 3 world regions

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In its latest global COVID-19 update, the World Health Organization (WHO) said patterns reflect a mixed picture in its tracking over the last 28 days, with infections rising in the Eastern Mediterranean, South East Asia, and European regions. However, at the global level, cases declined 31%, and deaths were down 46% compared with the previous 4-week period.

In the Eastern Mediterranean region, which is seeing the steepest rise, Iran, Kuwait, and Pakistan reported the highest proportional increases. In South East Asia, the increase is led by a large spike in India, which had a 251% increase over the reporting period. And in Europe, nearly half of countries reported rises, with the highest proportional increases in Kyrgyzstan, Armenia, and Ukraine. Also, Russia and Austria reported modest rises in new daily cases over the past 28 days.

In its variant update, the WHO said the proportion of the XBB.1.5 Omicron subvariant has risen to 37.7% globally, up from 29% in the last reporting period. It said XBB and related viruses are the only variants under monitoring that are rising, with the rest stable or decreasing.

White House to step down COVID response team

In other COVID developments, the White House will disband its COVID response team when the public health emergency winds down in May, the Washington Post reported yesterday, based on information from anonymous sources who have knowledge of international operations. An official said the move parallels the shift away from the emergency phase of the pandemic but that COVID-19 isn't over and is still an administration priority.

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