Over the past 3 days, Cambodia has reported two more human H5N1 avian flu infections, raising it total for the year to seven cases, according to health ministry statements translated and posted by Avian Flu Diary, an infectious disease news blog.

On July 6, the ministry reported the first new case, which involves a 3-year-old boy from Takeo province in the southern part of the country. Initial symptoms included fever, cough, and breathing difficulty. The boy was hospitalized, and his condition is improving. An investigation found that 10 days earlier he had touched and held a chicken that had died in the village.

Both cousins exposed to dead poultry

Today the ministry reported a second case, involving a 5-year-old girl who is a cousin of the first patient and lived in the same home. The girl had a fever and is receiving treatment. Officials said her illness is mild. Investigators found that she had also touched the dead chicken.

So far, the clade isn't known, but other recent H5N1 illnesses in Cambodia were linked to the older 2.3.2.1c clade that circulates in poultry in some Asian countries, including Cambodia. It is different from the 2.3.4.4b clade affecting wild birds, poultry, and some mammals across several world regions. 

Cambodia has reported an uptick in human infections, with 13 reported since February 2023. The infections are often serious or fatal.

A secondary analysis of a randomized clinical trial found that a probiotic supplement had only a minor and transient effect on the gut microbiome composition of children during and after antibiotic treatment, researchers reported late last week in JAMA Network Open.

The trial, which involved 350 children and was conducted at three hospitals in the Netherlands and two in Poland, found that a multispecies probiotic given to participants within 24 hours of initiating antibiotics had no effect on antibiotic-associated diarrhea (AAD), but did reduce the overall risk of diarrhea during and for 7 days after antibiotic treatment compared with placebo. For the secondary analysis, to better understand the underlying protective mechanism of probiotics, the investigators collected stool samples from 88 children in the trial (44 from the probiotics group and 44 from the placebo group) at four predefined times and conducted microbiota analysis.

Minimal effect on bacterial diversity

The stool samples were collected and analyzed at inclusion in the trial, on the last day of antibiotic use, on the last day of the study intervention, and 1 month after the intervention. Alpha diversity did not significantly differ between the probiotic and placebo groups during the first three collection times, and Beta diversity was not significantly different at any of the collection times. Shannon diversity (mean, 3.56 vs 3.09) and inverse Simpson diversity (mean, 3.75 vs –1.31) indices were higher in the placebo group compares with the probiotic group 1 month after intervention.

While the analysis did find that three of five bacterial genera contained in the probiotic—Ligilactobacillus, Lactiplantibacillus, and Lactobacillus—were more abundant in children from the probiotic group than the placebo group during supplementation, the difference between the groups disappeared after 1 month. 

"It therefore remains debated whether probiotics have beneficial effects on antibiotic-induced microbiota composition aberrations," the study authors wrote. They add that future studies are needed to assess whether the observed transient effects on taxonomic composition and on diversity play any role in preventing AAD and other adverse effects from antibiotics.

A new meta-analysis of 48 observational studies that included 8,664,026 people reveals that pre-existing sleep disturbances are tied to an increased risk of COVID-19 infection and worse outcomes if infected. The study is published in eClinicalMedicine. 

Previous studies have shown that up to 50% of COVID-19 patients experience sleep disturbances, and sleep disturbances are linked to "daytime drowsiness, work burnout, and low spirits but also induce immune deficiency and systematic inflammation," the authors note.

For the purposes of this study, sleep disturbances included obstructive sleep apnea (OSA), insomnia, abnormal sleep duration (less than 6 hours or more than 9), night-shift work, and restless legs syndrome already documented before infection with COVID-19 

The studies analyzed had sample sizes ranging from 118 to 4.9 million and were conducted in 15 countries, including 19 studies based on US patients. 

Pre-existing sleep disturbances were tied to an increased risk of COVID-19 infection of 12% (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07 to 1.18), hospitalization of 25% (OR, 1.25; 95% CI, 1.15 to 1.36), death of 45% (OR, 1.45; 95% CI, 1.19 to 1.78), and long COVID of 36% (OR, 1.36; 95% CI, 1.17 to 1.57).

Findings differ by age, sex

Age and gender played a role in the findings, with men with sleep disturbances more likely to die from COVID than women with sleep disturbances. 

Young individuals with pre-existing sleep disturbances had a higher susceptibility and hospitalization for COVID-19 than those without.

"Young individuals with pre-existing sleep disturbances had a higher susceptibility and hospitalization for COVID-19 than those without. This finding further confirmed the compromised immune function induced by sleep disturbances," the authors wrote. "In old individuals, those with pre-existing sleep disturbances elevated the hospitalization and mortality of COVID-19 but did not increase the susceptibility compared with those without."