Almost 20% of people who were hospitalized for COVID-19 infections early in the pandemic still had signs of impairment with brain function 2 years after infection, finds a new study in Scientific Reports.

The study population came from Portugal, in a region hit hard by the first wave of the COVID-19 pandemic. Based on hospital admission episodes and SARS-CoV-2 infection status from March 2020 to February 2021, the authors identified four groups: group 1 (101) hospitalized for COVID-19 infections, group 2 (87) hospitalized but uninfected with COVID-19, group 3 (252) infected but not requiring hospitalization, and group 4 (258) uninfected and not hospitalized for any reason. 

Cognitive assessments were conducted in two parts 2 years after infection, a general screening using the Montreal Cognitive Assessment and a subsequent neuropsychological assessment conducted by one of four psychologists if the score of the general screening was low. Overall, verbal memory, visual memory, executive functions, language, and information processing speed and attention were evaluated.

ICU stay tied to increased cognitive impairment

The authors found that the prevalence of cognitive impairment at 2 years was 19.1%, 6.8%, 10.7%, and 3.2%, in groups 1, 2, 3, and 4, respectively. Notably, hospitalized patients (groups 1 and 2) more often had three or more impaired cognitive domains than the non-hospitalized participants (54.6% vs 19.4%).

Cognitive impairment was more than five times higher in group 1 (adjusted odds ratio, 5.39, 95% confidence interval, 1.54 to 18.92) than in group 2. Higher odds of cognitive impairment were linked to older age (58 years and older), a history of clinical anxiety, and lower levels of education.

Intensive care unit admission and hospitalization for 15 or more days was also associated with cognitive impairment. 

Infection with SARS-CoV-2 during the first year of the pandemic was associated with three to five times higher odds of cognitive impairment 2 years after infection

"Infection with SARS-CoV-2 during the first year of the pandemic was associated with three to five times higher odds of cognitive impairment 2 years after infection," the authors concluded. "Survivors of the disease may require special attention from clinical doctors to diagnose and treat cognitive impairment."

Only 35% to 40% of US pregnant women and parents of young children say they intend to fully vaccinate their child, per survey results from researchers at Emory University and the Centers for Disease Control and Prevention (CDC).

For the two surveys, published as a research letter this week in JAMA Network Open, the investigators recruited 174 pregnant women and 1,765 parents from a nationally representative panel in April 2024 to answer questions about their intent to have their child receive all recommended vaccines by 18 months.

"Many parents in the US choose to delay or refuse vaccines that are recommended for their child from birth to age 18 months," the study authors wrote. "Research is necessary to understand the value of intervening during pregnancy to proactively support parents with vaccination decisions before the birth of the child, as implementation of such interventions will require substantial engagement of health care professionals and entities outside of the pediatric care setting."

Vaccine refusal highest among parents

In total, 37.6% of pregnancies were first pregnancies. About half of respondents held a bachelor's degree or higher (49.4% of pregnant women and 45.1% of parents), and 77.6% and 79.5%, respectively, lived in urban areas.

Given the high decisional uncertainty during pregnancy about vaccinating children after birth, there may be value in intervening during pregnancy to proactively support families with childhood vaccination decisions.

Intent to vaccinate was similar among pregnant women and parents, at 35% to 40%. The proportion of respondents planning to refuse some or all vaccines was lowest among women pregnant for the first time (4%) and highest among parents (33%). Women in their first pregnancy were most uncertain about childhood vaccination (48%), while parents were the least unsure (4%).

"Given the high decisional uncertainty during pregnancy about vaccinating children after birth, there may be value in intervening during pregnancy to proactively support families with childhood vaccination decisions," the researchers wrote. 

"Future interventions should account for differences in uptake of seasonal (ie, COVID-19, influenza) vs routinely recommended vaccines," they added. "Future studies with longitudinal follow-up may shed further light on evolution of vaccination decisions from pregnancy to parenthood, and the effectiveness of intervening proactively during pregnancy."

• Hong Kong's Centre for Health Protection (CHP) yesterday warned about a chikungunya outbreak in China's Guangdong province that has so far sickened at least 478 people. Though no related cases have been reported in Hong Kong, the CHP said it is preparing for imported cases and urged people to eliminate mosquito-breeding sites and take steps to avoid mosquito bites. Guangdong province's outbreak is centered in the Shunde district of Foshan, which is on the Pearl River delta. The outbreak was triggered by imported cases. So far, all illnesses have been mild with symptoms that include fever and joint pain. Hong Kong averaged 11 imported chikungunya cases per year from 2016 to 2019 but has not recorded any since 2020.
• GSK today announced that the US Food and Drug Administration (FDA) has approved a prefilled syringe formulation of its recombinant shingles vaccine (Shingrix). Prefilled syringes make it easier for healthcare providers to immunize, because they don't need to reconstitute separate vials before administration. The existing version of the vaccine contains two vials—a lyophilized (powdered) antigen and a liquid adjuvant. Consistent with the earlier version, the vaccine is approved for adults ages 50 and older and those ages 18 and older who are at increased risk for shingles, which is caused by reactivation of varicella-zoster virus, the same one that causes chickenpox. Two doses are needed to complete the vaccine series.
• The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) this week confirmed 10 more H5N1 avian flu detections in wild and captive mammals, including two with recent sample collection dates—from a harbor seal in Lincoln County, Maine, and a domestic cat in Multnomah County, Oregon. The others were seven skunks from four Texas counties that have sample collection dates in February and March and a harbor seal from Suffolk County, Massachusetts, that was sampled in February.