China reports 3 more H9N2 avian flu infections

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Avian Influenza (Bird Flu)

China has reported three more H9N2 avian flu infections, all involving children, Hong Kong's Centre for Health Protection said today in its weekly avian flu update.

boy with poultry
Rusheng Yao / iStock

The infections raise the country's number of H9N2 infections this year to four and come just a week after the mainland reported its first case of the year, which involved a 6-year-old boy from Anhui province.

The children infected by the virus are from three different provinces. One is a 3-year-old boy from Guangxi province in southern China whose symptoms began on February 2, and another is an 11-year-old boy from Jiangxi province in the country's southeast who became ill on February 11. The third patient is a 3-year-old boy from southern China's Guangdong province who started having symptoms on February 17.

H9N2 infections are typically mild and affect children. The report didn't note the children's exposures, but most earlier illnesses involving the strain have been linked to contact with poultry or their environments. H9N2 is known to circulate in China and some other countries in Asia.

Officials describe dealing with outbreaks of mpox, hepatitis A, and meningococcal disease at the same time

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Hepatitis
Mpox
mpox vax
PeopleImages / iStock

In Florida in 2022, concurrent outbreaks of mpox, hepatitis A, and invasive meningococcal disease (IMD) were noted among men who have sex with men (MSM). A report on the outbreaks, published yesterday in Emerging Infectious Diseases, emphasizes the need to offer vaccination against these diseases among at-risk groups.

The authors explain that the global mpox outbreak arrived in Florida in the summer of 2022, amid ongoing outbreaks of IMD and hepatitis A, which began the previous year. Florida had the fourth-highest rates of mpox in the United States.

From November 1, 2021, to November 30, 2022, Florida health officials recorded 322 hepatitis A cases, of which 153 (48%) met the genotype outbreak case definition. Among the outbreak patients, 95% were male, 5% female, 74% MSM, and 21% had HIV. One death was noted.

Three outbreaks shared timeline

The Florida Department of Health tracked 71 IMD cases during the period, of those, 44 (62%) were classified as outbreak-associated. Among the outbreak patients, 72% were MSM, 34% had HIV, and 20% died.

By the end of November 2022, Florida had recorded 2,845 confirmed or probable mpox cases. Eighty-eight percent were among MSM, and all but 14% were acquired locally. Fifty-two percent of patients were HIV-positive.

The three outbreaks overlapped substantially: Hepatitis A peaked in late March of 2022, IMD in May and June, and mpox in August.

Vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among MSM.

"We did not identify any instances of the same person being part of both the hepatitis A and IMD outbreaks. However, among mpox cases, 4 patients were also part of the hepatitis A outbreak, and 3 others were part of the IMD outbreak," the authors conclude. "Vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among MSM, consistent with national guidelines and, where feasible, offered with other program services to the same at-risk population."

Stressing personal ownership may be key to COVID booster uptake

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COVID-19
Young woman receiving vaccine dose
VCU Capital News Service / Flickr cc

Adding the note "claim your dose" to texted reminders to get the latest COVID-19 booster increased uptake more than if the nudge just told patients the bivalent booster was available, researchers from Carnegie Mellon University and the University of California Los Angeles (UCLA) report.

Last week in Nature Human Behaviour, the researchers compared the result of the addition of the sentence "Claim your dose by making a vaccination appointment" to increase a sense of personal ownership with that of a vaccination reminder with only a link to an online scheduling tool.

The current study took previous research published in Nature in 2021 from hypothetical and prediction surveys and applied them to real-world settings by texting 314,824 UCLA patients 1 of 14 reminders to get a booster. A control group didn't receive a text.

The researchers extracted patients' vaccination records from the California Immunization Registry or electronic health records to verify whether they received a booster within 1 month of reminder receipt. The average participant age was 50 years, 42% were men, 49% were White, and 14% were Hispanic.

'Claim your dose' boosts coverage 2 percentage points

Compared with the 12.4% of patients who received a booster within 1 month, all but the "bundle booster and flu shot" reminder significantly increased uptake 0.73 percentage points, to 1.93 percentage points, and the "claim your dose" message improved uptake by 1.93 percentage points. 

While hypothetical surveys and self-reports are undoubtedly valuable for providing foundational evidence on the mechanisms of human behavior, our findings suggest that they may not always translate to complex real-world situations where various factors can affect behavior.

Silvia Saccardo, PhD

"Reminders and psychological ownership language increased booster uptake, replicating prior findings," the study authors wrote. "However, strategies deemed effective by prediction or intention surveys, such as encouraging the bundling of COVID-19 boosters and flu shots or addressing misconceptions, yielded no detectable benefits over simple reminders."

They said their results raise questions about the applicability of studies based on hypothetical or theoretical assumptions.

"While hypothetical surveys and self-reports are undoubtedly valuable for providing foundational evidence on the mechanisms of human behavior, our findings suggest that they may not always translate to complex real-world situations where various factors can affect behavior," lead author Silvia Saccardo, PhD, of Carnegie Mellon, said in a UCLA press release.

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