Compared with after a first COVID-19 illness, being re-infected with SARS-CoV-2, the virus that causes COVID, doubles the risk of later developing long COVID, or post-acute sequelae of COVID-19 (PASC) in children, teens, and young adults, according to a new preprint study posted on medRxiv.

The retrospective cohort study used data from the RECOVER consortium collected from 40 US children's hospitals from January 2022 through October 2023, when the Omicron variant was predominant. The study involved 465,717 patients 20 years old and younger with confirmed COVID-19 during the study period; the median age was 8 years. The study has not yet been peer-reviewed.

The population had a very low rate of long COVID, defined by the study authors as a diagnosis based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD10-CM) U09.9 diagnosis code of PASC. Only 208 patients were diagnosed as having the condition after their first SARS-CoV-2 infection, with 134 long-COVID patients identified after their second infection. The rate per million patients per 6 months was 903 after the first infection and 1,884 after the second infection.

Higher rate of long COVID plus many specific conditions

Compared with the first COVID-19 infection, a second infection was associated with twice the increased risk of a long-COVID diagnosis (relative risk [RR], 2.08; 95% confidence interval [CI], 1.68 to 2.59). The second infection was also tied to a 50% or greater increase in several specific long-COVID conditions, including myocarditis (RR, 3.60), changes in taste and smell (2.83), heart disease (1.96), acute kidney injury (1.90), generalized pain (1.70), arrhythmias (1.59), abnormal liver enzymes (1.56), and fatigue or malaise (1.50).

These findings emphasize the ongoing risk of PASC with reinfection, regardless of severity.

"These findings emphasize the ongoing risk of PASC with reinfection, regardless of severity, and suggest that the risk of PASC may be cumulative with each successive infection," the study authors write.

"Given that vaccination has been shown to reduce the risk of PASC, these findings underscore the importance of reinforcing public health efforts to promote vaccination among adolescents and younger children."

In a new cross-sectional analysis of 6,746 hospitalized adults aged 60 and older in 20 states, increased respiratory syncytial virus (RSV) vaccination was associated with being 75 years or older and having pulmonary disease. 

Vaccination was also associated with having at least grade 12 education or the General Educational Development equivalent. The study was published yesterday in JAMA Network Open. 

The authors assessed the patient characteristics associated with RSV vaccination among older adults hospitalized during the 2023-24 RSV season, the first year RSV vaccines were available. The cross-sectional study was conducted in 26 hospitals from October 2023 through April 2024.

The average patient age was 73 years, and 51.2% were female. In total, there were 700 RSV-vaccinated (10.4%) and 6,046 unvaccinated (89.6%) adults.

Being 75 years or older had an adjusted risk ratio (aRR) of 1.23 for RSV vaccination (95% confidence interval [CI], 1.10 to 1.38), which means a 23% higher rate of vaccination. Those with pulmonary disease had a 39% higher uptake (aRR, 1.39; 95% CI, 1.16 to 1.67), and those with compromised immune systems had a 30% higher rate (aRR, 1.30; 95% CI, 1.14 to 1.48).

Many don't know eligibility status 

The authors also interviewed RSV-negative adults included in the study about RSV knowledge. They found that 47.2% had not heard of RSV or were unsure, and 78.5% were unsure if they were eligible for RSV vaccine or thought they were not. Of note, 41.7% of unvaccinated patients reported being open to future RSV vaccination.

Knowledge of RSV disease and vaccine eligibility was lower among participants with less educational attainment .

"Knowledge of RSV disease and vaccine eligibility was lower among participants with less educational attainment and those residing in communities with high social vulnerability," the authors wrote.

he Centers for Disease Control and Prevention recommended RSV vaccination for adults 60 years or older in June 2023.

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported 15 more H5N1 avian flu detections in mammals, including domestic cats in four states.

The latest cats to test positive for the virus were from Kansas, Pennsylvania, Iowa, and Illinois. Sample collection dates range from March 19 through March 24. It's not clear if any of the cases are linked to exposure to contaminated raw food for cats.

Newly reported detections also include five skunks, three in New Mexico and two in Texas, two house mice in Iowa, an Arctic fox in Alaska, a red fox in New York, a raccoon in Kentucky, and a bobcat in Connecticut. 

 A few more confirmations in poultry, dairy cattle

Over the past 2 days, APHIS also confirmed two more outbreaks in poultry, one on a layer pullet farm in Indiana and the other involving a backyard flock in Maryland.

Also, APHIS confirmed one more detection in dairy cattle, a herd in California, raising the national total since March 2024 to 996, which includes 758 from California. 

CARB-X announced today that it has awarded biotechnology company ArrePath, of Princeton, New Jersey, $3.7 million to execute a Lead Optimization workplan for its first-in-class antibiotic targeting a clinically novel portion of pathogenic bacteria for treating complicated urinary tract infections caused by multidrug-resistant (MDR) Enterobacterales bacteria.

Using an artificial intelligence and machine-learning–enabled (AI/ML) approach, ArrePath has identified a series of inhibitors with a novel mechanism of action against a highly conserved but previously unexploited target in gram-negative bacteria.

Could act against vast majority of MDR Enterobacterales

If developed as hoped, ArrePath's novel antibiotic class will be active against the vast majority of MDR Enterobacterales infections, representing an important new tool in the fight against antimicrobial resistance. ArrePath's inhibitors have attributes that suggest they can be administered orally as well as by the intravenous (IV) route. This would allow hospitalized patients being treated via IV to switch to oral medicine when appropriate.

"CARB-X is excited to support ArrePath in advancing its new antibiotic targeting multidrug-resistant Enterobacterales," said Erin Duffy, PhD, chief of research and development with CARB-X. "This could significantly improve treatment options for complicated urinary tract infections, especially in outpatient and community settings."

This could significantly improve treatment options for complicated urinary tract infections.

"We are thrilled to have received this prestigious award from CARB-X, which not only provides external validation of our proprietary AI/ML platform but also allows us to rapidly advance a novel class of antibiotics that is so desperately needed for the treatment of multidrug-resistant gram-negative infections," said Kevin Krause, MBA, ArrePath president and CEO.