News Scan for Oct 06, 2021

News brief

WHO recommends malaria vaccine for kids in high-risk areas

The World Health Organization (WHO) today recommended the RTS,S malaria vaccine for children in sub-Saharan Africa and other areas of moderate and high Plasmodium falciparum malaria transmission. The recommendation paves the way for global health groups to make funding and vaccine rollout plans and for countries to decide whether to include vaccination in their malaria control programs.

Malaria is a leading cause of childhood illness and death in sub-Saharan Africa, and the WHO said more than 260,000 African children younger than 5 die from malaria each year. In a statement, WHO Director General Tedros Adhanom Ghebreyesus, PhD, said, "This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control."

The WHO based its recommendation on advice from two of its advisory groups, one on vaccines and the other on malaria, following promising vaccine pilot programs in Malawi, Kenya, and Ghana. The RTS,S vaccine is given on a four-dose schedule that begins at 5 months of age and continues through age 2.

The vaccine, from GlaxoSmithKline, has been 30 years in the making.
Oct 6 WHO statement

Study finds C difficile is prevalent outside of healthcare settings

A study presented last week at IDWeek 2021 suggests Clostridiodes difficile is more prevalent outside of the hospital than previously thought. And the soles of people's shoes may play a significant role in spread of the bacterium.

Researchers at the University of Houston analyzed environmental samples collected from public areas, healthcare settings, and shoe soles in 11 countries from 2014 through 2017 for the presence of C difficile, which causes severe diarrhea and is the leading cause of hospital-associated infections but is increasingly being reported in community settings. The aim was to examine the prevalence and the strain types of the bacterium in different settings.

Of the 11,986 unique isolates collected, 92% were from the United States, 1.7% were from Taiwan, and 1.6% were from India. Samples were categorized as being from outdoor environments (2,992 isolates), private residences (2,772), shoe soles (1,420), public buildings (1,104), and acute care settings (3,698). Worldwide C difficile sample positivity was 26% and was similar between US and non-US sampling sites.

In the United States, private residences (26.2%) and outdoor environments (24.1%) had the highest positivity rate compared with public buildings (17.2%). In a sub-analysis of 8,571 isolates collected in Texas, positivity rates were highest in outdoor samples (27%) and were similar between private residences (24%) and healthcare buildings (24%). The most prevalent C difficile ribotypes (RTs) overall were F014-020 (16.4%), F106 (14.9%), and FP310 (11%). Shoe soles had the highest positivity rate (45%), with similar RT distribution between shoe soles and environmental samples.

"The results of this study shift our understanding of C. diff, including where it is found, how it is transmitted, and who it affects," co-author Kevin Garey, PharmD, of the University of Houston College of Pharmacy, said in an IDWeek press release. "We can no longer think of C. diff as only existing in healthcare settings, and the population at risk is no longer just the very sick patient in the hospital. Identifying that person at risk anywhere in the world should become a priority regardless of whether the person is in a hospital or the community."

The study authors said removing shoes before entering a home or a common space could help reduce community spread.
Sep 30 IDWeek press release

APHIS announces $5.7 million in support for CWD programs

The US Department of Agriculture Animal and Plant Health Inspection Service (APHIS) recently announced $5.7 million in support for chronic wasting disease (CWD) management and response activities targeting wild and farmed cervids in 20 states, as well as in 8 tribes or tribal organizations.

Kevin Shea, JD, APHIS administrator, said in a press release, "These collaborative efforts will strengthen our ability to find and implement new solutions as part of our mission to safeguard agriculture and natural resources." APHIS said priority areas included improving management of affected farmed herds and wild cervid populations, improved management of affected area or premises, research on testing technology, and developing and conducting educational outreach.

The group received 64 proposals, and scientific and program panels worked with submitters to refine the scope of promising projects when needed.

In documents that detailed the breakdown of the funding, APHIS said about $2.5 million went to wild cervid management, $1.5 million to farmed cervid management, $1.22 million to farmed cervid research, and $300,000 to tribal wild cervid management.

CWD, a deadly prion disease that affects cervids, was first identified in North America in 1967 and has spread across much of the United States and Canada. No human CWD cases have been confirmed, but some experts fear that eating meat from CWD-affected animals could trigger an illness similar to bovine spongiform encephalopathy (mad cow disease), also caused by prions.
Oct 1 APHIS press release

MERS sickens Saudi man

Saudi Arabia's Ministry of Health (MOH) reported another MERS-CoV case—its 13th of the year.

Like the last three cases, the patient is from Riyadh and had contact with camels, according to an MOH statement. The 58-year-old man's illness is considered primary, meaning he isn't thought to have contracted the MERS-CoV (Middle East respiratory syndrome coronavirus) from another sick person.

In a mid-August update, the WHO said that, since 2012, it had received reports of 2,578 lab-confirmed MERS cases around the world, including at least 888 deaths. The vast majority are from Saudi Arabia.
Sep 29 Saudi MOH statement
Aug 17 WHO update

COVID-19 Scan for Oct 06, 2021

News brief

HHS: COVID vaccine saved 39,000 Medicare beneficiaries' lives

A US Department of Health and Human Services (HHS) analysis of Medicare data and county vaccination rates indicates that COVID-19 vaccinations administered from January until May 2021 were estimated to reduce COVID-19 infections by 265,000 and deaths by 39,000 among Medicare beneficiaries.

To conduct the study, HHS used Centers for Disease Control and Prevention (CDC) county-level COVID-19 vaccination rates for adults ages 18 to 64 and for those 65 years and older who were fully vaccinated to build a model that would determine how many cases, hospitalizations, and deaths were averted with full vaccination.

The study found an 11% to 12% decrease in weekly COVID-19 hospitalizations and deaths among Medicare beneficiaries for every 10% increase in county vaccination rates.

The study also suggested that 107,000 hospitalizations were avoided due to vaccination. These numbers represent an estimated 18% reduction in COVID-19 infections, 21% reduction in COVID-19 hospitalizations, and 22% reduction in COVID-19 deaths based on the number of potential COVID-19 outcomes of Medicare beneficiaries.

"This report reaffirms what we hear routinely from states: COVID-19 vaccines save lives, prevent hospitalizations, and reduce infection," said HHS Secretary Xavier Becerra in a press release.

The study authors conclude, "Vaccination rates have continued to rise over the summer, and with the surge in cases from the Delta variant, the importance of vaccination has likely grown substantially, given the Delta variant is more than twice as contagious as previous variants."
Oct 5 HHS study
Oct 5 HHS press release

Pandemic lockdowns affected cancer surgery globally, study says

Planned cancer surgery was delayed during the pandemic worldwide, with 15% of people putting off an operation during full COVID-19 lockdowns, according to a study yesterday in The Lancet Oncology.

The researchers looked at 20,006 adults at 466 hospitals and 61 countries who were planning on receiving surgery for the 15 most common solid cancer types during the COVID-19 pandemic. All were followed for a minimum of 12 weeks (until surgery or Aug 31, 2020), but even after a median of 23 weeks, 10.0% still hadn't had their surgery. All had at least one COVID-19–related reason, most commonly concern about infection risk to the patient (72.8%), and 15.3% reported at least one additional non-COVID reason.

Under light restrictions, 0.6% of patients didn’t have surgery, compared with 15.0% and 5.5% of people under full and moderate lockdowns, respectively (adjusted hazard ratios, 0.51 and 0.81, respectively). Almost 9 in 10 patients (88.7%) who didn't receive their surgery lived in areas with full lockdowns.

Overall, being in a low- or middle-income country (LMIC), having more frailty or comorbidities, and having locally advanced or nodal disease (or both) were all independently associated with increased risk of not receiving surgery. Of those who didn't receive surgeries, 22.6% were re-staged (reassessed for cancer spread), 8.9% progressed to unresectable disease, and 2.4% died.

Patients waiting for surgery in LMICs during full lockdowns were more likely to go without surgery than those under light restrictions (HR, 0.41). The researchers note that patients younger than 50 were more commonly from LMICs and were also less likely to receive their planned surgery.

"In order to prevent further harm during future lockdowns, we must make the systems around elective surgery more resilient—protecting elective surgery beds and operating theatre space, and properly resourcing 'surge' capacity for periods of high demand on the hospital, whether that is COVID, the flu or other public health emergencies," said co-lead author James Glasbey, MBBCh, in a University of Birmingham press release.
Oct 5 Lancet Oncol study
Oct 5 University of Birmingham press release

COVID-19 incidence may be higher in irritable bowel disease patients

COVID-19 incidence was 4.7 per 1,000 person-years among irritable bowel disease (IBD) patients compared with 2.8 in the general population, according to a population-based study published in PLOS One yesterday.

The researchers looked at COVID-19 patients admitted to the only two hospitals covering the South-Limburg region in the Netherlands from Feb 27, 2020, to Jan 4, 2021. The total population was 597,184 people, and 4,980 were estimated to have IBD. Twenty IBD patients (0.4%) and 1,425 of the general population (0.24%) were hospitalized due to COVID-19, leading to an incidence rate ratio of 1.68 (95% confidence interval [CI], 1.08 to 2.62, p = 0.019).

COVID-19 patients with IBD were more likely to be younger (median age, 63.0 years vs 72.0) and have a higher body mass index (BMI) (average, 24.4 vs 24.1 kg/m²), but both groups had similar rates of intensive care unit (ICU) admission (12.5% vs 15.7%, P = 1.00), mechanical ventilation (6.3% vs 11.2%, P = 1.00), and death (6.3% vs 21.8%, P = 0.22).

A post-hoc analysis found that BMI among ICU patients was significantly higher compared with non-ICU patients in both groups (mean, 25.8 vs 23.9), which the researchers say confirms that BMI as a risk factor for severe COVID-19.

"Interestingly, none of the IBD patients with severe COVID-19 were on biologicals when in fact a substantial proportion of IBD patients in our population currently use biologicals, in particular anti-tumour necrosis factor (TNF) agents such as infliximab and adalimumab," the researchers add. "All in all, although cases were limited, the observation of no anti-TNF users among the IBD patients with severe COVID-19 in the current study further substantiates the potential protective role of anti-TNF agents in the pathophysiology of COVID-19."
Oct 5 PLOS One study