News Scan for Jun 10, 2020

News brief

Chronic wasting disease detected in Wisconsin ranch that lured wild deer

The Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) confirmed that two deer at Brush Ranch Outfitters, a Wisconsin game ranch that was previously charged with the unauthorized taking of live wild animals and failure to register deer, have chronic wasting disease (CWD), a fatal prion disease in cervids, which are members of the deer family.

Now the 1,600-acre Trempealeau County ranch, home to 505 cervids, is in quarantine. According to the Milwaukee Journal-Sentinel, Brush Ranch Outfitters paid $17,505 in civil forfeitures for illegal activity at and around its facility last year, including luring wild deer onto the ranch.

The detection comes after the Wisconsin Department of Natural Resources (DNR) announced earlier this month that the incidence of CWD in wild deer in the state rose 25% in the last year. A total of 1,334 samples deer tested positive for CWD in the last year, up from 1,061 during the previous hunting season, Wisconsin Public Radio reported last week.

According to the Wisconsin DNR, 56 of Wisconsin’s 72 counties have been affected by CWD. In 2019, 23 counties reported detections.

In related news, Minnesota has expanded deer feeding and attractant bans, following the detection of CWD in a wild deer in Dakota County in March. Beginning Jul 1, Minnesota's DNR will ban such activity in six Twin Cities–area counties: Dakota, Hennepin, Ramsey, Rice, Scott, and Washington.

"To prevent the spread of chronic wasting disease, it’s important to limit close contact among deer," said Michelle Carstensen, PhD, Minnesota DNR's wildlife health program supervisor, in a statement. "By keeping feed and attractants out of our backyards, Minnesotans can discourage the congregation of deer that spreads this deadly disease."
Jun 9 Wisconsin DATCP statement
Sep 28 Milwaukee Journal-Sentinel story
Jun 1 Wisconsin Public Radio story
Jun 5 Minnesota DNR statement

H5N8 avian flu strikes more poultry in Hungary

Hungarian veterinary officials reported six more highly pathogenic H5N8 outbreaks in poultry, part of sporadic similar detections over the past few months, according to a Jun 8 notification from the World Organization for Animal Health (OIE).

The outbreaks all occurred at farms in Bacs-Kiskun County in central Hungary. The events began between May 18 and Jun 4, killing 882 of 173,956 birds. The rest were culled to control the spread of the virus.

So far, the source of the virus isn't known, but health officials said wind, high humidity, and human contact are likely to be contributing factors.
Jun 8 OIE report on H5N8 in Hungary

COVID-19 Scan for Jun 10, 2020

News brief

Study highlights mode of COVID-19 household spread, coinfections in kids

A study of 68 children in China with COVID-19 reveals that 96% were household contacts of infected adults who had developed symptoms earlier, and 51% of those tested for common respiratory pathogens also had another type of infection.

The study, published today in Pediatrics, involved a retrospective review of electronic medical records of pediatric patients admitted to the Qingdao Women and Children's Hospital and Wuhan Children's Hospital from Jan 20 to Feb 27.

Nineteen of 34 patients who underwent nucleic acid testing were coinfected with one or more pathogens other than SARS-CoV-2, the virus that causes COVID-19, including Mycoplasma pneumoniae, respiratory syncytial virus, Epstein-Barr virus, cytomegalovirus, and influenza A and B.

One patient developed severe pneumonia, while 29 (39%) had mild pneumonia, 24 (32%) had acute respiratory tract infections, and 20 (27%) had no symptoms. The most common symptoms in 44 symptomatic patients were cough (32%) and fever (27%). C-reactive protein levels, indicating inflammation, were observed in 13 patients (18%).

Abnormal leukocyte counts were found in 23 (31%) of children, with 19 (26%) elevated and 4 (5%) reduced. Ten (14%) had abnormal lymphocyte counts, with 6 (8%) increased and 4 (5%) decreased. Leukocytes and lymphocytes are white blood cells involved in immune response.

Thirty-seven of 70 patients who underwent chest computed tomography (CT) (53%) had abnormal findings, 30 (81.1%) of whom had symptoms. Only nine 9 patients (12.2%) had characteristic COVID-19 findings on chest CT.

Eight of 10 children assessed showed prolonged fecal shedding of SARS-CoV-2 RNA on real-time reverse transcription polymerase chain reaction (RT-PCR). All patients recovered.

Because the children had different signs and symptoms from those typically seen in adults and coinfections were common, the authors said the study highlights the importance of screening for the novel coronavirus in this age-group.
Jun 10 Pediatrics study

Early antibiotics for COVID-19 found to have no impact on death, infections

A small study of COVID-19 patients treated at a community hospital in southern Switzerland found that early administration of antibiotics did not significantly impact mortality or hospital-acquired infections in critically ill patients, Swiss researchers reported in a letter to the Journal of Infection.

The retrospective study looked at 48 intensive care unit (ICU) patients who had COVID-19, 19 (40%) of whom received antibiotics before ICU admission because of suspected bacterial co-infection. In general, the characteristics of the patients in the antibiotic and non-antibiotic groups were similar, with cardiovascular disease more frequently observed in the non-antibiotic patients. The most frequently used antibiotic was amoxicillin-clavulanate.

Analysis of outcomes showed that mortality was similar between the two groups (24% without antibiotics vs 26% with antibiotics, P = 0.86) and that no difference was observed in the overall number of delayed hospital-acquired infections during ICU stay, though urinary tract infections were more frequently seen in the non-antibiotic patients, and candidemia cases appeared more often in the antibiotic group.

Although the low number of patients in the study did not allow the researchers to draw a firm conclusion from the results, they said the findings "call into question the utility of early treatment of a presumptive bacterial superinfection in COVID-19 patients."

"Large multi-centric studies are urgently needed to investigate the impact of early antibiotics therapy on mortality, subsequent healthcare associated infections and ICU complications (i.e., duration of mechanical ventilation)," they wrote.
Jun 4 J Infect letter

Most early COVID-19 treatment studies flawed, researchers find

Most registered clinical trials of potential treatments for COVID-19 under way as of late March will have limited value due to poor design, according to a study published yesterday in BMJ Open.

Researchers at Johns Hopkins University in Baltimore analyzed the 201 clinical trials for drugs or plasma to treat COVID-19 registered under ClinicalTrials.gov and the World Health Organization's (WHO's) international registry as of Mar 26. One-hundred (50%) were registered in China, and 78 (38%) were registered in the United States. Most studies in the US records were registered by international researchers. Overall, 126 (63%) of 201 were enrolling patient from China, 31 (15%) from Europe, and 14 (7%) from the United States.

Ninety-two (46%) of the studies involved different drugs and antibody-containing blood plasma.

A third of the studies lacked clinical end points to indicate success or failure, nearly half were underpowered to assess modest treatment benefits because they were designed to enroll fewer than 100 patients, two-thirds could have been affected by unconscious bias because the patients and physicians both knew who did and did not receive the treatment, and about a quarter lacked randomization.

Nearly all trials involved treatments already used for other diseases because they could be rapidly repurposed for the novel coronavirus owing to established safety profiles and regulatory approval. But the authors said that prescribing even approved drugs for other conditions, called "off-label" use, requires safety and effectiveness studies because they carry risks.

Lead author Hemalkumar Mehta, PhD, said in a university press release that the studies' weaknesses mean that they will likely produce only preliminary evidence: "Given the urgency of identifying definitive evidence on potential COVID-19 treatments, this is an instance where we wish we did not have to say 'further research is needed' because of basic trial design shortcomings and small trials," he said.
Jun 9 BMJ Open study and Johns Hopkins press release