News Scan for Nov 02, 2022

News brief

Meta-analysis suggests 14% hospitalization rate for monkeypox patients

A new study published in eClinicalMedicine analyzed 19 studies on monkeypox, which included 7,553 reported cases, among which there were 555 hospitalizations. The meta-analysis suggests monkeypox patients have a 14.1% hospitalization rate.

The authors included studies on monkeypox outbreaks from 1950 through 2022. In all 19 studies, 15 recorded deaths were noted — all in Africa. The median age of cases was 35 years (interquartile range 28 to 38, n = 2010) and 98% of case-patients were male. The case-hospitalization rate (CHR) was 14.1% (95% credible interval, 7.5% to 25.0%). The case-fatality rate (CFR) was calculated to be 0.3%.

"The results from pooled estimates suggest that there has been an attenuation of the case hospitalization rate from nearly 50% during pre-2017 outbreaks to 3.2–9.4% during the 2020 outbreak," the authors wrote.

Until the global outbreak of 2022, most studies on monkeypox have been small, and establishing CHRs and CFRs has been difficult. Researchers have known the Congo Basin clade of the virus, found mostly in Africa, is associated with a CFR of 10%, while the West African clade—the cause of the current outbreak—has a CFR of 3% to 6%.

The authors said the current outbreak will yield significantly lower CFRs, because cases are occurring in upper middle- to high-income countries, among young and middle-aged men who have sex with men who are most often otherwise healthy.

"As sustained human-to-human transmission has been observed and the number of cases grow, it will be important to quantify the morbidity and mortality of MPX infections and the potential for CHR and CFR to evolve," the authors concluded.
Oct 31 EClincalMedicine study

Chronic wasting disease confirmed in Wyoming elk

Chronic wasting disease (CWD)—which most often has affected deer in the United States but can cause disease in other members of the deer family—has been confirmed in two elk in Wyoming, state officials reported earlier this week.

In an Oct 31 news release, the Wyoming Game and Fish Department confirmed the presence of CWD in Elk Hunt Areas 47 and 49. The disease was detected in two bull elk that were harvested by hunters in those areas on Oct 12 and Oct 15.

Those two hunt areas are near Cody and are bordered by areas previously affected by CWD in elk. The disease was confirmed in Hunt Areas 34 in 2015 and 48 in 2017, both of which are to the east. In 2018 CWD was detected in Hunt Area 66 to the northwest, and in 2020 it was found in Hunt Area 45 to the north.

Wyoming Game and Fish officials said that last year they tested 6,947 CWD lymph node samples from deer and elk, mostly submitted by hunters, and continue to monitor for the disease.

At least 30 states have reported CWD cases to date. The disease is always fatal to animals. No human cases have been detected yet, but the Centers for Disease Control and Prevention warn people not to eat meat from CWD-infected animals.
Oct 31 Wyoming Game and Fish news release

Avian flu strikes more poultry in US, Europe

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported more highly pathogenic avian flu outbreaks in poultry in six states over the past few days, including on a commercial turkey farm in Minnesota.

Also, Iowa agriculture officials reported an outbreak at a layer farm, the state's first on a commercial farm since April.

Minnesota's outbreak occurred at a turkey farm in Swift County that houses 45,600 birds. Meanwhile, the Iowa Department of Agriculture and Land Stewardship (IDALS) reported an outbreak at a layer farm in Wright County in the north, which followed a recent detection in backyard birds in Dallas County in central Iowa.

Also, APHIS reported more backyard poultry outbreaks in Montana, New York, Oregon, Tennessee, and Florida.

In wild-bird developments, Louisiana wildlife officials reported H5N1 for the first time in wild birds, which involved a hunter-harvested blue-winged teal in the southwestern part of the state. At the national level, APHIS reported 251 more detections in wild birds, raising the total to 3,375. Most of the new detections were from hunter-harvested birds or live bird surveillance.

APHIS is now tracking H5N1 detections in mammals. So far, 78 detections have been reported, with the most recent samples reported from September involving red foxes in New York. The highest proportion of detections are in the upper Midwest in the Mississippi flyway area.
USDA APHIS poultry avian flu update page
Oct 31 IDALS statement
Oct 31 Louisiana Department of Wildlife and Fisheries statement
USDA APHIS wild bird avian flu update page
USDA APHIS mammal avian flu update page

In international developments, ongoing H5N1 outbreaks in the United Kingdom prompted a recent announcement from the Department for Environment, Food, and Rural Affairs (DEFRA) that poultry must be kept indoors starting on Nov 7. Also, Russia reported a new H5N1 outbreak, according to notifications from the World Organization for Animal Health (WOAH). Russia's outbreak occurred at a commercial farm housing 523,000 birds in Khabarovsk Krai in the far eastern region.
Oct 31 DEFRA announcement
Nov 2 WOAH report on H5N1 in Russia

COVID-19 Scan for Nov 02, 2022

News brief

Severe adverse events more likely in previously infected COVID vaccinees

Americans who received an mRNA COVID-19 vaccine after SARS-CoV-2 infection are more likely to experience severe systemic adverse events (AEs) than their never-infected counterparts, according to a study published yesterday in Vaccine.

Researchers from the US Centers for Disease Control and Prevention (CDC) used v-safe vaccine surveillance data and online follow-up surveys from 3,862 adults who reported severe systemic AEs after receiving their first dose from Dec 14, 2020, to May 16, 2021. Each participant was matched with three vaccinated controls who reported no AEs. Most (90.1% of participants and 94.8% of controls) didn't report testing positive for COVID-19 before vaccination.

Among previously infected participants, the likelihood of severe AEs was 2.4 (95% confidence interval [CI], 1.89 to 3.09) times higher after receipt of the Moderna vaccine and 1.5 (95% CI, 1.17 to 2.02) times higher after the Pfizer/BioNTech vaccine than that of their COVID-naïve peers.

A total of 0.5% of all study participants reported visiting an emergency department or being hospitalized for AEs after the second dose. The greatest risk was seen in Moderna recipients who had tested positive for COVID-19 30 or fewer days before receipt of dose 1 (adjusted odds ratio, 6.05 compared with controls). But most participants who had severe systemic AEs after the first dose didn't require medical care in the 7 days after the second dose.

"Vaccine providers can use these findings to counsel patients who had pre-vaccination SARS-CoV-2 infection histories, experienced severe systemic AEs following dose 1, and are considering not receiving additional mRNA COVID-19 vaccine doses," the researchers wrote.

The authors noted that clinical trials of the Moderna and Pfizer COVID-19 vaccines had excluded people with a history of confirmed infection, limiting the understanding of the risk of AEs in this population.

"COVID-19 vaccine studies that include participants with a history of SARS-CoV-2 infection and collect data on immunological responses to SARS-CoV-2 infection and vaccination at study entry and following primary series and booster vaccinations may inform the development of future COVID-19 vaccines and the policies for their use," they concluded.
Nov 1 Vaccine study

Increased COVID-19 knowledge in teens linked to better mental health

US teens who could correctly answer survey questions about COVID-19 reported lower stress, anxiety, and depression as well as less loneliness and fear of missing out, according to a study today in Journal of Child and Family Studies.

The study analyzed surveys given by Washington State University (WSU) researchers to 215 teens in July of 2020. The survey was made up of 18 true or false statements about COVID-19, including how the virus is spread: 21.9% got all the answers correct, while most teens answered at least 15 out of 18 correctly.

Teen participants were also asked about social media use and general well-being. Almost all —98.1% — of teens reported using social media, but those who used the platform less reported lower levels of anxiety

"Knowledge was a good thing. The teens who did better on our quiz tended to report lower depression, anxiety and stress—just across the board," corresponding author Chris Barry, PhD, a WSU psychology professor, said in a university press release. "This is a one-time snapshot, so we don't really know cause and effect, but one presumption is that having accurate information was connected to feeling a little bit more ease during that time."
Oct 19 J Child Fam Stud study
Nov 2 WSU press release

Global COVID-19 cases decline except in Americas and Western Pacific

At the global level, COVID-19 cases fell again last week, down 17% from the week before, the World Health Organization (WHO) said today in its latest weekly update. Cases were up 5%, however, in the Americas and the Western Pacific.

Deaths were down 5% overall, but levels rose in four regions: Africa, the Americas, Southeast Asia, and the Western Pacific.

In the Americas, countries reporting the highest proportional increases last week were Guatemala, Panama, and Peru. Chile and Brazil also reported notable rises of 21% and 22%, respectively. In the Western Pacific, New Zealand and Mongolia saw the biggest proportional rises. Japan's cases rose 21% compared to the previous week, and South Korea's were up 37%.

Regarding variant spread, the WHO said that for the week ending Oct 16, BA.2.75 prevalence rose from 2.9% to 3.7%, with BQ.1 lineages rising from 5.7% to 9.0%, and XBB rising from 1.0% to 1.5%. Also, the prevalence of BA.5 lineages with additional spike mutations increased from 19.5% to 21.0%. Levels of BA.4.6 held steady, at 4.1%.

Last week, the WHO's virus evolution advisory group weighed in on the latest Omicron variant changes and held off on designating XBB and BQ.1 sublineages as variants of concern. BQ.1 proportions are rising rapidly in Europe and the United States, and XBB levels are rising in parts of Asia.
Nov 2 WHO weekly COVID update