News Scan for Apr 07, 2021

News brief

1 in 3 COVID survivors develop neurologic, psychological conditions

One in three COVID-19 survivors were diagnosed as having a neurologic or psychological condition within 6 months after their coronavirus diagnosis, according to a study yesterday in The Lancet Psychiatry. The researchers noted that disease severity was linked to higher risk.

Among 236,379 US COVID-19 patients, the researchers found that 33.6% of survivors developed a neurologic or psychological condition within 6 months after testing positive for coronavirus and that for 12.8%, it was their first such condition.

The most common psychiatric conditions were anxiety (17.4%) and mood disorders (13.7%), while neurologic conditions included ischemic stroke (2.1%), and dementia (0.7%). No significant association was found between COVID-19 and increased risk of parkinsonism or Guillain-Barre syndrome.

Severe COVID-19 was also associated with a higher prevalence of neurologic or psychological disorders. For instance, 38.7% of those who were hospitalized had a neurologic or psychological diagnosis, compared with 46.4% admitted to the intensive care unit (ICU) and 62.3% who had delirium at some point during their infection.

Similarly, less common conditions also occurred more often, with intracranial hemorrhage in 2.7% of ICU patients and 3.6% of patients with delirium (compared with 0.3% of nonhospitalized patients) and development of a psychotic disorder in 2.8% in ICU patients and 7.0% in patients with delirium (compared with 0.9% of nonhospitalized patients).

"Although almost all neurological and psychiatric outcomes were more frequent in patients with more severe COVID-19 than in those with mild disease, these psychiatric disorders might be more driven by general effects, including psychosocial aspects of infection, rather than a direct effect of COVID-19 on the brain," notes a commentary by Jonathan P. Rogers, MRCPsych, and Anthony S. David, MD, of University College London.

Compared with a matched cohort of people who had the flu or any respiratory infection, those who had COVID-19 were associated with a 44% and 16% increased risk, respectively (95% confidence interval, 1.40 to 1.47 and 1.14 to 1.17).

Overall, 80.4% of the cohort was not hospitalized, 19.6% was, 3.8% needed ICU treatment, and 2.6% developed encephalopathy. Patients were included if they were older than 10 years, infected with COVID-19 after Jan 20, 2020, and still alive on Dec 13, 2020.
Apr 6 Lancet Psychiatry study and commentary

Moderna COVID-19 vaccine antibodies persist for at least 6 months

Moderna's COVID vaccine (mRNA-1273) showed coronavirus antibody persistence 6 months after administration of the second 100-microgram dose, according to a letter to the editor in the New England Journal of Medicine yesterday.

Among 33 healthy adults who received the Moderna vaccine, antibody activity "remained high," ranging from 49,373 geometric mean end-point titers (GMTs) in those 71 years and older to 92,451 in those aged 18 to 55. Nearly all had detectable activity in pseudovirus neutralization assay tests, and in a more sensitive live-virus neutralization test, 50% inhibitory dilution GMTs were 406, 171, and 131 across age-groups 18 to 55, 56 to 70, and 71 and older, respectively.

The researchers estimated half-life for binding and neutralizing antibodies with models that assumed either a steady rate of decay or an exponential rate. For binding antibodies, the half-life 43 days after vaccination was 52 assuming steady decay or 109 days assuming an exponential rate, respectively. For neutralizing antibodies, the half-life for pseudovirus neutralization was 69 or 173 days, respectively, and, for live-virus neutralization, 68 or 202 days.

These results are in line with results from convalescent COVID-19 patients through 8 months after symptom onset, the authors note.

"Although the antibody titers and assays that best correlate with vaccine efficacy are not currently known," they continue, "antibodies that were elicited by mRNA-1273 persisted through 6 months after the second dose, as detected by three distinct serologic assays."
Apr 6 N Eng J Med letter

Final leafy greens E coli probe finds recurring issues related to cattle

The Food and Drug Administration (FDA) yesterday released its final investigation report into a 2020 Escherichia coli O157:H7 outbreak linked to leafy greens, which said cattle in the area was probably a contributing factor and persistent source of the pathogen.

The source of the outbreak was never linked to a specific farm or type of greens, and the Centers for Disease Control and Prevention (CDC) on Dec 22 concluded its probe, with 40 cases reported in 19 states. Half of the patients were hospitalized, but no deaths were reported.

In a statement, Frank Yiannas, MPH, the FDA's deputy commissioner for food policy and response, said the investigation sheds light on understanding E coli outbreaks tied to California's Central Coast growing region, especially those in the Salinas Valley and Santa Maria areas since 2017. He noted the preliminary findings released in January described the detection of the outbreak strain in a sample of cattle feces collected from a roadside about a mile uphill from a produce farm.

"This finding drew our attention once again to the role that cattle grazing on agricultural lands near leafy greens fields could have on increasing the risk of produce contamination, where contamination could be spread by water, wind or other means," he said.

An examination of outbreaks that seem to occur each fall since 2017 found three key recurring trends: the same E coli strain, the same region, and issues with activities on adjacent lands.

The FDA recommends that growers in the Central Coast consider the recurring E coli strain a reasonably foreseeable hazard, especially in the South Monterey County portion of the Salinas Valley. The agency also urged growers to identify where the recurring strain persists and how it's likely contaminating leafy greens.
Apr 6 FDA statement
Apr 6 FDA final inspection report
Dec 23, 2020, CIDRAP News scan

Stewardship / Resistance Scan for Apr 07, 2021

News brief

European health groups release antimicrobial resistance declaration

Health First Europe (HFE) and the European Patient Group on Antimicrobial Resistance (AMR Patient Group) today launched their 2021 Declaration on AMR.

The document aims to raise awareness among European citizens about the real-world impact of AMR and healthcare-associated infections (HAIs) and to encourage patients to speak out. It also lists a range of interventions that European Union (EU) policymakers and national governments should make to address AMR from a One Health perspective.

"Drug-resistant infections know no borders—they can easily cross from humans to animals and spread from one geographic location to another," the declaration states.

The groups call for EU policymakers and member states to increase awareness and understanding of AMR and HAIs among health professionals through communication, education, and training; establish clear governance arrangements at all levels to ensure leadership, accountability, and coordination around the issue; improve infection prevention and control measures in human and animal healthcare settings; create national targets for surveillance of antibiotic use in humans and animals; and implement antibiotic stewardship programs in primary and secondary care settings.

The document also recommends that governments invest in and promote medical technologies that prevent AMR and HAIs, promote equitable access to appropriate treatments, and support activities that raise public awareness of antibiotic resistance.

The groups are inviting other European patient associations to promote the declaration.
Apr 7 HFE-AMR Patient Group declaration on AMR

Antibiotic use is significantly lower on UK organic farms

A survey published yesterday by the UK-based Alliance to Save Our Antibiotics and the Soil Association indicates that antibiotic use on organic livestock farms in the United Kingdom is much lower than the national average for all livestock farming.

The survey, involving data from 248 organic farms certified by the Soil Association, found that overall antibiotic use in animals on those farms (7.46 milligrams per population correction unit [mg/pcu]) was four times lower than the national average of 31 mg/pcu. On organic dairy farms, the average was less than half the level found in a national survey of dairy farms (10.66 mg/pcu vs 22.5 mg/pcu), while organic beef farms used less than a third of the antibiotics found in a national survey of beef farms (7.22 mg/pcu vs 24.5 mg/pcu).

Significantly lower antibiotic use was also found on organic sheep (five times lower), pig (77 times lower), and poultry farms (six times lower in broiler chickens), but the small sample sizes for pig and poultry farms make those figures less reliable, the report notes. Antibiotic use varied widely among the farms in the survey.

Interviews with organic farmers revealed that organic rules on antibiotic use in livestock, good nutrition, a low-stress environment, breeding specifically for health traits, and minimizing the period when animals are kept indoors during the winter were among the factors that kept antibiotic use low on their farms.

"British farmers have voluntarily cut their antibiotic use by nearly 50% in the last five years, which is very welcome, but these findings show that much lower use could still be achieved," Alliance scientific adviser Cóilín Nunan said in a press release from the group. "Organic farming has stricter rules on antibiotics which do not permit routine use or preventative mass medication. If the government is serious about tackling the antibiotic-resistance crisis, it should immediately move to end these practices on all British livestock farms."
Apr 6 Alliance to Save Our Antibiotics survey
Apr 6 Alliance to Save Our Antibiotics press release

Stewardship intervention linked to reduced fluoroquinolone use

Cascade reporting at a Veterans Affairs (VA) medical center in Virginia was associated with a significant decline in ciprofloxacin consumption, researchers reported yesterday in Infection Control & Hospital Epidemiology.

Cascade reporting is a strategy of only reporting antimicrobial susceptibility results for secondary, broad-spectrum agents if an organism is resistant to primary, narrow-spectrum antibiotics. The strategy, which aims to reduce unnecessary use of broad-spectrum antibiotics, was implemented at the Hunter Homes McGuire VA Medical Center in 2018 to reduce inappropriate fluoroquinolone and carbapenem use. To determine the strategy's effectiveness, researchers collected antibiotic consumption data across eight inpatient units for the 12 months before and after implementation (April 2017 through March 2019).

An interrupted time series analysis showed that consumption of ciprofloxacin, a fluoroquinolone, fell by 2.16 days of therapy per 1,000 days present per month after implementation of cascade reporting, but no significant change in levofloxacin consumption was observed. Mean monthly meropenem consumption also declined, but the slope of consumption did not significantly change, a result the study authors suggest could reflect the hospital's restriction on meropenem use during the study period. No significant changes in hospital-onset Clostridioides difficile infection rates were observed.

"Cascade reporting is a valuable tool that ASPs [antibiotic stewardship programs] can deploy to encourage prescribers to select more narrow-spectrum antimicrobial agents," the authors wrote. "Further investigation is warranted to determine how cascade reporting strategies affect rates of C. difficile, antimicrobial resistance, and clinical outcomes."
Apr 6 Infect Control Hosp Epidemiol abstract