News Scan for Aug 25, 2022

News brief

Ebola vaccination launches in latest DRC outbreak area

Within days of confirming a new Ebola case in North Kivu province, medical teams in the Democratic Republic of the Congo (DRC) today launched an Ebola vaccination campaign in Beni, the area where the fatal case was reported.

On Twitter, the World Health Organization (WHO) said it provided 200 vaccine doses and is supporting the country's ring vaccination campaign.

In a separate statement, the WHO shared more details about the new case, which officials have said has been genetically linked to the virus that circulated during the region's large outbreak in 2018 to 2020. It said the 46-year-old woman who died from her infection on Aug 15 had underlying health conditions and had been hospitalized for 23 days. Samples were obtained just after she died, and her body was buried before the Ebola results were known. So far, it's not known if the woman had been vaccinated against Ebola.

So far, investigators have identified 134 hospital contacts and 9 family contacts.

The WHO said the risk to the DRC is high, with the threat to the region and the world moderate and low, respectively. It added that the Beni area is affected by insecurity, with frequent protests against security measures, adding challenges to the outbreak response.

The agency also said the DRC is juggling responses to other diseases, such as cholera, measles, polio, yellow fever, and monkeypox, putting further pressure on the healthcare system and resources.
Aug 25 WHO tweet
Aug 25 WHO statement

Study links recent azithromycin use with resistant gonorrhea infections

A study of patients at a sexual health clinic in Seattle found that recent treatment with azithromycin was associated with subsequent azithromycin-resistant gonococcal infections, researchers reported yesterday in Clinical Infectious Diseases.

To explore the relationship between individual-level azithromycin exposure for sexually transmitted infections and subsequent azithromycin resistance in people with Neisseria gonorrhoeae infections, researchers with the University of Washington and Public Health-Seattle & King County (PHSKC) analyzed data collected data on patients treated for gonorrhea at the PHSKC Sexual Health Clinic from 2012 through 2019. Azithromycin is one of the last two antibiotics recommended for treatment of uncomplicated gonorrhea, which has progressively developed resistance to all antibiotics used for its treatment, but azithromycin-resistant gonorrhea infections have been rising worldwide in recent years.

During the study period, 2,155 unique patients were diagnosed with 2,828 culture-positive gonorrhea infections, 156 (5.5%) of which were caused by azithromycin-resistant N gonorrhoeae. Of those 156 patients, 4 (2.6%) had received an azithromycin prescription in the 29 days prior to their gonorrhea diagnosis, and 37 (24%) had received azithromycin the prior 30 to 365 days.

After the researchers adjusted for clinical, demographic, and risk behavior characteristics, they found that an azithromycin-resistant N gonorrhoeae infection was strongly associated with receipt of azithromycin in the prior 29 days (adjusted odds ratio [aOR], 6.76; 95% confidence interval [CI], 1.76 to 25.90), but not with receipt of azithromycin in the prior 30 to 365 days.

The researchers also found that azithromycin minimum inhibitory concentration levels—a measurement of how much antibiotic is needed to prevent growth of bacteria—were associated with the number of azithromycin prescriptions in the prior 30 days.

The study authors say the findings suggest that the long half-life and persistence of subtherapeutic levels of azithromycin in people who've recently been exposed to the antibiotic may result in the selection of azithromycin-resistant gonorrhea strains.
Aug 24 Clin Infect Dis abstract

COVID-19 Scan for Aug 25, 2022

News brief

WHO: COVID deaths for 2022 pass 1 million worldwide

At a World Health Organization (WHO) briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said COVID-19 deaths for 2022 alone passed 1 million this week, as he pressed countries to do more to vaccinate all healthcare workers, older people, and others at highest risk. Since the pandemic began in early 2020, 6,472,848 deaths have been reported, according to the Johns Hopkins online dashboard.

Tedros said countries in Africa with the lowest rates are making progress with vaccine coverage, and many countries are making good strides in targeting high-priority groups. He said, howevere, that one third of the world is still unvaccinated, including two thirds of health workers and three quarters of older adults in low-income countries.

Tedros pushed countries at all income levels to vaccinate risk groups, ease access to life-saving therapies, continue testing and sequencing, and tailor COVID response measures.

In other global developments, Germany tightened its COVID measures ahead of fall and winter, including wearing N95 respirators for long-distance travel by plane, train, or bus, according to the Associated Press (AP).

In US developments, Food and Drug Administration (FDA) Commissioner Robert Califf, MD, said on Twitter the FDA will not hold advisory committee meetings to evaluate the bivalent boosters from Pfizer-BioNTech and Moderna that target the Omicron BA.4/BA.5 subvariants. He said following extensive deliberations in June when it voted to include an Omicron component, the committee has no new questions that warrant committee input.

He added that bivalent and multivalent vaccines are very common, and they are often updated without changing other ingredients. "FDA has extensive experience with reviewing strain changes in vaccines, as is done with the annual flu vaccine," he said.

The FDA is reviewing emergency use authorization submissions for the two boosters, and the Centers for Disease Control and Prevention (CDC) vaccine advisory panel is scheduled to discuss recommendations on Sep 1 and Sep 2.
Aug 25 Tedros speech
Johns Hopkins online dashboard
Aug 25 AP story
Robert Califf tweet

Older and unvaccinated adults hospitalized more during Omicron

Today in Morbidity and Mortality Weekly Report (MMWR) a study shows that, during the Omicron BA.2 variant surge in the spring of 2022, hospitalization rates increased more in senior (65 or older) Americans than in younger adults, and hospitalization rates among unvaccinated adults were more than triple those of vaccinated adults.

The study was based on hospital records that included patient age and vaccination status in 14 states from Jun 20, 2021, to May 31, 2022, when the Delta, Omicron BA.1, and Omicron BA.2 variants were the predominant strains of the virus. The Omicron BA.2 subvariant became dominant across the country during the week of Mar 20, 2022, and the study included hospitalizations through May 31, 2022.

The authors found that, among 8,266 patients, adults aged 65 years or greater accounted for 41.0%, 49.6% and 61.5% of hospitalizations during the Delta, BA.1, and BA.2 periods, respectively. Weekly hospitalization rates (hospitalizations per 100,000 population) among seniors quadrupled, from 6.9 (week ending April 2, 2022) to 27.6 (week ending May 28, 2022), during the BA.2 period, while hospital rates for adults ages 18 to 64 increased by 1.7-fold during the same period.

Compared with adults 18 to 49 years old, hospitalization rates among seniors were 3.9, 5.7, and 8.2 times higher in the Delta, BA.1, and BA.2 periods, respectively

Among all hospitalized adults during BA.2, 39.1% had received a primary vaccination series and one booster or additional dose, while 5.0% had received a primary series and at least two boosters or additional doses. Hospitalization rates in unvaccinated adults were 3.4 times higher than in vaccinated adults.

"Nearly all hospitalized adults had one or more underlying medical condition. Hospitalization rates continue to remain higher among unvaccinated adults than among adults who received a primary COVID-19 vaccination series and ≥1 booster or additional dose," the authors concluded.
Aug 25 MMWR study

Study: Two COVID-19 rapid tests accurately diagnose variant infections

Two COVID-19 rapid antigen tests produce accurate results for infections with the SARS-COV-2 pre-Delta, Delta, and Omicron strains, finds a study yesterday in JAMA Network Open.

University of Washington and University of Nevada researchers tested 797 adults who had symptoms characteristic of COVID-19 within the previous 5 days. They assessed the SCoV-2 Ag Detect Rapid Self-Test and BinaxNow COVID-19 Ag Card at multiple sites in King County, Washington.

Testing was done from Feb 17, 2021, to Jan 11, 2022. Average participant age was 37.3 years, 58.2% were women, and 52.9% were unvaccinated.

The researchers collected two nasal swab samples from each participant, testing one on site with the SCoV-2 test and sending one for polymerase chain reaction (PCR) testing, the gold standard for diagnostic accuracy. The team also evaluated test performance and analytical detection limit by spiking negative nasal swabs with live virus and testing dilutions using both the SCoV-2 and the BinaxNow test.

They found no significant differences in the analytical detection limit or diagnostic accuracy for any variant. The estimated detection limit for both rapid antigen tests was 50% or below the tissue culture infectious dose of 62.5, and the positive agreement of the ScoV-2 test was 81.2% (95% confidence interval [CI], 69.5% to 89.9%) to 90.7% (95% CI, 77.9% to 97.4%) in all periods. The negative percent agreement stayed high throughout the study period, with a cumulative diagnostic specificity of 99.8% (95% CI, 99.1% to 100%).

The authors noted that COVID-19 rapid antigen tests have not been universally accepted for diagnosis because of concerns about accuracy, particularly with mutated forms of the wild-type virus. They added that the tests, however, are now widely available and may facilitate testing in home and community settings, faster treatment, and appropriate isolation periods.

"Although more clinical studies are needed, the ongoing home-based rapid antigen testing programs may be an important intervention to reduce global SARS-CoV-2 transmission," the researchers concluded.
Aug 24 JAMA Netw Open study