News Scan for May 06, 2020

News brief

Study describes C auris bloodstream infections in Colombian kids

In a study today in the Journal of the Pediatric Infectious Diseases Society, US and Colombian researchers report that nearly one-third of the pediatric invasive Candida bloodstream infections (BSIs) analyzed at two Colombian pediatric hospitals were caused by Candida auris.

Of the 110 pediatric BSIs caused by Candida species at the two hospitals from July 2014 through October 2017, the researchers found that 34 (31%) were caused by C auris, a multidrug-resistant fungus that has primarily been identified in hospitalized and immunocompromised adults and rarely among children. Twenty-one percent of the children were younger than 28 days, 47% were 1 year old and younger, and 32% were over 1 year old. Underlying conditions included preterm birth (26%), being malnourished (59%), cancer (3%), solid-organ transplant (3%), and kidney disease (3%). All patients had at least one indwelling device, and 82% had a central venous catheter.

Thirty-three of the children (97%) received specific antifungal treatment for C auris. Analysis of 13 isolates found that 7 (54%) were resistant to amphotericin-B, 2 (15%) were resistant to fluconazole, and 1 (8%) was resistant to anidulafungin. In-hospital mortality was 41%.

The authors of the study note that the two hospitals were part of a large C auris outbreak investigation in Colombia, and that environmental and patient sampling at the hospitals showed extensive C auris contamination. They suspect that the infections were acquired during hospitalization.

"Rapid and accurate identification of C. auris is needed to guide treatment decisions, as are infection-control measures to stop the spread of the organism," they write. "Pediatricians need to be vigilant for C. auris infections in pediatric populations."
May 6 J Pediatric Infect Dis Soc abstract

Measles spread to Burundi refugee camps triggers outbreak

The World Health Organization (WHO) today said a measles outbreak that began at a refugee camp in Burundi, under way since November 2019, has so far sickened 857 people from four of the country's districts.

The people at the refugee camps were from measles-affected parts of the Democratic Republic of the Congo (DRC). They first arrived at a transit camp in Cibitoke health district, then were sent to permanent camps in four other areas.

In the affected parts of Burundi, measles vaccination coverage is relatively high, but not in those arriving from the DRC. Pockets of undervaccinated people in Burundi are vulnerable to the disease, the WHO said. About 77% people affected were unvaccinated.

The outbreak in the Cibitoke health region is ongoing, but activity has declined in other areas. Burundi's health ministry had developed a comprehensive plan, which includes vaccinating targeted children ages 9 months to 14 years at the camps and strengthening surveillance. The outbreak poses a high risk to Burundi, partly owing to a lack of infrastructure, suboptimal vaccine coverage, and large population movements from the DRC, which is grappling with a large measles outbreak.
May 6 WHO notification

COVID-19 Scan for May 06, 2020

News brief

Study finds co-infection common in children with COVID-19

A study published today in Pediatrics shows Chinese children who contracted COVID-19 often presented with co-infections of other respiratory viruses.

The study involves 68 children with complete epidemiologic data, 95.5% of whom were household contacts of infected adults. Of the 44 who had symptoms, cough (32.4%) and fever (27.0%) were the most common. Thirty-four patients had nucleic acid testing results for common respiratory pathogens, and 19 (55.9%) of them showed co-infection with other pathogens other than SARS-CoV-2, the virus that causes COVID-19.

The full study involved 74 children. Among those, only 1 case of severe pneumonia was noted, while 20 children were fully asymptomatic, with another 10 classified as subclinical mild pneumonia patients.

The authors concluded that the clinical presentation of COVID-19 in children differed from adults.

"Among adult patients, fever (83.0%-98.6%) and cough (59.4%-82.0%) were the most common and predominant symptoms. Whereas fever and mild cough only accounted for 27.03% and 32.43%, respectively, of symptoms at disease onset and during hospitalization in our pediatric patients, a proportion much lower than that of adult patients," they said. "Additionally, fatigue, headache, nausea, and gastrointestinal symptoms were not common among infected children."
May 6 Pediatrics study

High stress detailed in health workers caring for patients in outbreaks

A meta-analysis of 25 studies that compared psychological outcomes of healthcare workers who had direct contact with infected patients during emerging virus outbreaks showed high levels of acute and long-term or posttraumatic stress and psychological distress.

Fifty-nine papers met the authors' inclusion criteria; 37 of them on SARS (severe acute respiratory syndrome), 8 on COVID-19, 7 on MERS (Middle East respiratory syndrome), 3 each on Ebola and pandemic H1N1 flu, and 1 was on H7N9 avian flu. Of the 38 studies comparing psychological outcomes of healthcare workers providing care to infected patients, 25 had data amenable to a pairwise meta-analysis comparing workers at high and low risk of exposure.

The authors found that, compared with lower-risk controls, staff providing direct patient care to infected patients had higher levels of acute posttraumatic stress (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.28 to 2.29) and psychological distress (OR, 1.74; 95% CI, 1.50 to 2.03).

Risk factors for psychological distress were youth, junior status, having dependent children, having an infected family member, long quarantine, lack of practical support, and stigma. Protective factors included clear communication, access to adequate personal protective equipment (PPE), adequate time off, and practical and psychological support.

In a commentary in the same journal, Jessica Gold, MD, MS, of Washington University in St. Louis said that the findings are concerning given the already-high rates of mental illness and substance use disorders in healthcare workers and high rates of suicide in physicians. She noted the effect of a lack of PPE on mental health.

"Such institutional betrayal—when trusted and powerful institutions act in ways that can harm those dependent on them for safety and wellbeing—compounds trauma," she wrote. "To mitigate this, organizations should support staff voices and efforts to obtain PPE when possible."
May 5 BMJ study and commentary

COVID-19 tracker app shows outbreak prediction possibilities

An early analysis of a COVID-19 symptom tracker phone app that launched in the middle of March suggests that it has the potential to predict spikes in outbreak activity, which could provide real-time data that can serve as an early warning. Researchers from Boston and London published their findings yesterday in Science.

The group launched the mobile app in the United Kingdom Mar 24 and in the United States 5 days later among several preexisting large epidemiology cohorts. The app also gathered data from healthcare workers, including on hazards related to protective equipment shortages.

Combinations of three or more symptoms often predicted positive tests for COVID-19. The symptoms included fatigue and cough, followed by diarrhea, fever, and loss of smell. When the investigators looked at a subset of users in southern Wales, they found that the app successfully predicted two spikes in the number of COVID-19 cases before they were detected by public health departments.

The team said structure of the study group will allow them to investigate the long-term outcomes of the disease. They noted that one limitation of the study is that it doesn't represent random population sampling.
May 5 Science abstract
May AAAS press release