A research letter yesterday in the New England Journal of Medicine documents vertical (mother-to-baby) transmission of Oropouche virus (OROV) in Brazil this summer.

The case resulted in the stillbirth of the baby, after the 40-year-old mother reported fever, chills, generalized muscle aches, and severe headache at 30 weeks' gestation.

The woman experienced light vaginal bleeding and decreased fetal movement in late July and early August. Ultrasound showed fetal demise, and Oropouche RNA was detected in several fetal samples, including the cerebrospinal fluid, placenta, and umbilical cord. 

Risk in women exposed to the virus

"The phylogenomic results confirm the link between this stillbirth and the ongoing OROV outbreak in Brazil," the authors wrote. "These findings emphasize the risks of OROV infection in pregnancy and the need to consider this infection in pregnant women with fever or other suggestive symptoms who live in or visit regions in which the virus is endemic or emerging," the report concluded."

These findings emphasize the risks of OROV infection in pregnancy 

The virus, spread by biting midge and some types of mosquitoes, has caused outbreaks this year in regions of Brazil that previously had not had cases, including Ceara, a Brazilian state that had been historically free from the disease, the authors said. 

A study conducted in Wales found increased mortality in women with Staphylococcus aureus bacteremia (SAB), with sepsis-related mortality identified as the underlying cause of the disparity, researchers reported yesterday in JAMA Network Open.

Using a database of anonymized, population-scale electronic health record data, researchers from Cardiff University examined data on all adults diagnosed as having SAB from April 2010 through March 2022. They compared all-cause mortality within 30 and 90 days among men and women using logistic regression adjusted for covariates, including age, hospital- or community-related SAB, methicillin resistance, and Charlson comorbidity index score.

The 7,515 adults with SAB identified for the study included 4,755 (63%) male patients and 2,760 (37%) female patients. Overall mortality at 30 days after SAB was 2,057 deaths (27%), including 1,262 among men (27%) and 795 among women (29%). Overall mortality at 90-day post-SAB mortality was 2,712 (36%), including 1,690 (36%) among men and 1,022 (37%) among women.

Further research into underlying factors is needed

In adjusted models, female sex was associated with both 30-day (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06 to 1.34) and 90-day (OR, 1.15; 95% CI, 1.03 to 1.29) mortality. Using an adjusted competing risks regression model for 30-day mortality, female sex was associated with SAB deaths due to sepsis (hazard ratio, 1.21; 95% CI, 1.02 to 1.44) but not with other causes (hazard ratio, 1.10; 95% CI, 0.99 to 1.23).

The study authors say the findings reaffirm the results of a systematic review and meta-analysis published in February in the same journal.

"Further research is necessary to investigate underlying pathophysiological, social, and health care–related factors that underpin sex-related mortality differences in SAB," they wrote. "Addressing these disparities could lead to more targeted therapies, improved survival rates, and more equitable health care outcomes for both sexes."

Drug supply chain disruptions led to significant shortages in the United States more often than in Canada from 2017 to 2021, a study today in JAMA suggests.

A University of Toronto–led research team used the IQVIA Multinational Integrated Data Analysis database to identify drug supply chain problems and shortages less than 6 months apart in the United States and Canada from 2017 to 2021. The IQVIA database contains information on 89% of US and 100% of Canadian drug purchases.

A shortage was defined as a decrease of at least 33% in monthly purchased standardized drug units within 1 year, relative to those in the 6 months before the report of supply chain issues to a US or Canadian reporting system.

International cooperation needed

A total of 104 drug supply chain issues occurred in both countries, and within 1 year, 49.0% (95% confidence interval [CI], 39.3% to 59.7%) were tied to significant drug shortages in the United States, compared with 34.0% (95% CI, 25.0% to 45.0%) in Canada (adjusted hazard ratio [aHR], 0.53; 95% CI, 0.36 to 0.79).

These findings inform ongoing policy development and highlight the need for international cooperation between countries to curb the effects of drug shortages and improve the resiliency of the supply chain for drugs.

The lower risk of drug shortages in Canada compared with the United States was consistent before (aHR, 0.47; 95% CI, 0.30 to 0.75) and after the COVID-19 pandemic (aHR, 0.31; 95% CI, 0.15 to 0.66). Combining reports of supply chain disruptions in both countries revealed that the shortage risk was double for sole-source drugs (adjusted HR, 2.58; 95% CI, 1.57 to 4.24) and nearly half for Canadian tier 3 drugs (adjusted HR, 0.56; 95% CI, 0.32 to 0.98).

"Drug-related reports of supply chain issues were 40% less likely to result in meaningful drug shortages in Canada compared with the US," the study authors wrote. "These findings inform ongoing policy development and highlight the need for international cooperation between countries to curb the effects of drug shortages and improve the resiliency of the supply chain for drugs."