News Scan for Nov 24, 2020

News brief

CWD slowly spreading in Montana and Virginia

Chronic wasting disease (CWD), a fatal neurologic prion disease that affects members of the deer family, was detected in two cervids in Montana and Virginia. In 2019, 144 cases of CWD were reported in Montana and 1 case was reported in Virginia.

The first, reported Nov 20 by the Montana Department of Livestock (MDOL), was from a Flathead County game farm and showed no CWD symptoms. It was the first CWD detection in the Flathead Valley.

All harvests from game farms are subject to mandatory CWD testing in the state, and upon discovery, the herd is subject to depopulation and post-mortem testing or quarantine for 5 years after the last known case.

"The herd in Flathead County has a good history of participating in the required surveillance program, so this case is probably the result of a new animal moving in on its own," says assistant state veterinary Tahnee Szymanski, DVM, in a Flathead Beacon story. "The other thing we know about CWD is that materials can get moved around, so it's possible a scavenger bird might have transported some infected prion materials onto the property.”

The other case involved a doe harvested during the archery season in October in Loudoun County, Virginia. While this is the first case reported in the county, the region is already included in the state's disease management area. The case was discovered after a hunter dropped off voluntary samples for the Department of Wildlife and Resources, and an Inside NoVa article urges hunters to similarly take advantage of either the testing drop sites or authorized taxidermists and processors.
Nov 20 MDOL press release
Nov 23 Flathead Beacon article
Nov 19 InsideNoVa article

More illnesses reported in leafy greens–related multistate E coli outbreak

In the second of three multistate Escherichia coli O157:H7 outbreaks announced this fall, the Centers for Disease Control and Prevention (CDC) said 16 more illnesses have been reported, bringing the total to 39 cases in 18 states.

So far, the CDC hasn't linked the outbreak to a particular food, but it said 22 sick people interviewed so far reported eating a variety of leafy greens, though no single brand or type of greens stands out.

The latest illness onset is Oct 23, and 62% of the patients are female. Of 30 people with available information, 19 were hospitalized, and 4 developed hemolytic uremic syndrome, a potentially fatal kidney complication. No deaths have been reported.
Nov 23 CDC outbreak update

In another food safety development, Dole Fresh Vegetables on Dec 21 recalled a limited number of cases over potential E coli contamination in two products: Dole Organic Romaine 3-Pack and Wild Harvest Organic Romaine Hearts. The affected products were harvested and packed 4 weeks ago and shouldn't be in stores, but consumers are advised to check their homes and discard any products matching the description.

No illnesses have been associated with the recall, but a sample of Dole Organic Romaine from a retail store tested positive for E coli in Michigan during routine sampling. So far, the finding hasn't been linked to any illnesses and is not associated with any strains involved in any of the ongoing outbreaks.
Nov 21 FDA recall notice

FDA clears baloxavir use for flu postexposure prophylaxis

The US Food and Drug Administration (FDA) has approved a new indication for the use of Roche's baloxavir marboxil (Xofluza) for influenza postexposure prophylaxis (prevention), Genentech, a member of the Roche group, announced yesterday.

The new indication covers people age 12 and older who had contact with someone with flu. The drug is the first single-dose medicine approved for that purpose. In July, researchers published a study in the New England Journal of Medicine that suggested the drug prevented flu in household contacts of infected patients.

Genentech also said it is exploring the antiviral as a possible treatment and prophylactic in children ages 1 to 12 years old. Xofluza was approved in the United States and Japan in 2018 as a single-dose oral treatment for uncomplicated flu, and the FDA also approved an indication for treatment of flu in patients at high risk for flu complications.
Nov 23 Genentech statement
Jul 9 CIDRAP News story "Study: Baloxavir prevents spread of flu to household members"

H5N8 avian flu strikes more birds in Europe, Japan

Six countries reported more highly pathogenic H5N8 avian flu outbreaks in poultry or wild birds, according to the latest notifications from the World Organization for Animal Health (OIE).

Five of the countries are in Europe. Belgium reported three detections in wild birds, which began from Nov 12 to Nov 18 at different locations in West Flanders province. Croatia reported an outbreak, its first involving the strain since 2017, at a turkey farm in Koprivnica-Krizevci County. It began on Nov 11, killing 4,315 birds, with the rest culled as part of the outbreak response.

Meanwhile, Germany reported more H5N8 outbreaks in both wild birds and poultry. The wild bird detection occurred on Nov 12 in North Rhine-Westphalia state. Two of the country's states reported more outbreaks in poultry, which included two in Schleswig-Holstein state and one in Lower Saxony state. Also, Sweden reported its first appearance of H5N8 in poultry since 2017, which occurred at a turkey farm in Skane county in the far south.

The United Kingdom also reported four more H5N8 detections in waterfowl found from Nov 5 to Nov 13 in nature parks in Devonshire, Northern Ireland, Lancashire, and Lincolnshire.

Finally, Japan reported two more outbreaks on poultry farms in Kagawa prefecture, an area affected by other recent outbreaks. The events began on Nov 14 at a broiler farm and a layer facility, killing 28 of 89,000 birds. The surviving birds were culled as part of the outbreak response.
Nov 22 OIE report on H5N8 in Belgium
Nov 21 OIE report on H5N8 in Croatia
Nov 18 OIE report on H5N8 in German wild birds
Nov 19 OIE report on H5N8 in German poultry
Nov 18 OIE report on H5N8 in German poultry
Nov 18 OIE report on H5N8 in German poultry
Nov 18 OIE report on H5N8 in Sweden
Nov 18 OIE report on H5N8 in the UK
Nov 19 OIE report on H5N8 in Japan

COVID-19 Scan for Nov 24, 2020

News brief

Poor outcomes noted for mechanically ventilated COVID-19 patients

A PLOS One study yesterday showed a 43% overall mortality rate for mechanically ventilated COVID-19 patients, with an even higher risk of death for patients of advanced age.

This study included 164 US COVID-19 patients who required invasive mechanical ventilation (IMV) within the Inova Health System in Virginia—five hospitals and a large tertiary care center—from Mar 5 to Apr 26, and followed patient outcomes to reassessment on Aug 19.

Health system hospitals were experiencing a high volume of COVID-19 patients at that time, but not a surge that outstripped their ability to provide critical care. Patient data collected via electronic medical records included demographics, comorbidities, laboratory values, respiratory treatments, and outcomes.

Of a total 1,023 COVID-19–positive admitted patients, 164 required IMV (16.0%). Overall, 42.7% of IMV patients had died by the Aug 19 reassessment. The researchers observed an 84.3% in-hospital mortality rate for patients older than age 70, but 67.4% of patients below age 70 survived to hospital discharge.

Deceased patients were older (median age 66 years vs 55, P < 0.0001) and had significantly higher laboratory values for two common blood tests—initial D-dimer and peak ferritin levels—compared with survivors. Younger age, non-white race, and treatment at a tertiary care center were all associated with lower mortality.

"Mortality of patients with COVID-19 requiring invasive mechanical ventilation is high, with particularly daunting mortality seen in patients of advanced age, even in a well-resourced health care system," the authors wrote.
Nov 23 PLOS One study

Pandemic stress caused by longer-term concerns, survey finds

A survey of 1,337 adult Americans found that their level of serious psychological distress went down from 14.2% in April to 13.0% in July, with worry about COVID-19 infection and finances topping the list, according to a research letter published yesterday in JAMA. Comparatively, in 2018, only 3.9% of adults reported serious psychological distress.

Stress was measured by the 24-point Kessler 6 scale, and the results showed the highest prevalence among adults who were aged 18 to 29 years in April (25.4% in April, 26.5% in July), those who earned less than $35,000 per year (20.2%, 21.2%), and Hispanics (17.9%, 19.2%). Of those who were classified as seriously distressed in July, 72% were already feeling that way back in April.

The most common stressors were concerns about getting COVID-19 (65.9%) or having the pandemic affect employment (65.1%) or finances (60.6%). Notably, 35% cited healthcare access as a stressor. Of those who were attending school or who had school-aged children, 69% said they were concerned about education, as well.

The researchers conclude, "High prevalence at both time points suggests that the pandemic's longer-term disruptions are important drivers of distress."
Nov 23 JAMA research letter