News Scan for Feb 01, 2021

News brief

Unemployment insurance, stimulus tied to less food insecurity

Unemployment insurance was tied to a food insecurity reduction of 4.3 percentage points and a reduction in the need to eat less because of financial constraints of 5.7 percentage points during the COVID-19 pandemic, according to a JAMA Network Open study published late last week.

The researchers looked at 1,119 Understanding Coronavirus in America survey respondents who lived in households with income less than $75,000 and who lost their job during the pandemic.

Overall, 37.1% of respondents reported food insecurity and 39.1% said they were eating less due to financial issues at least once during the survey's 15 waves. But unemployment insurance was associated with 35.0% and 47.9% relative reductions, respectively, or 4.3- and 5.7-percentage-point reductions, respectively (95% confidence interval [CI], 1.8 to 6.9 and 3.0 to 8.4).

Those who received the additional $600-a-week supplement provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act or had larger unemployment insurance payments saw greater reductions in food insecurity. No significant changes were associated with the one-time federal stimulus payment or Supplemental Nutrition Assistance Program payments, the researchers said.

The survey results showed that 69.2% of indigenous respondents, 52.5% of Hispanics, 42.2% of blacks, and 40.3% of Asians in this lower-income, unemployed subgroup had food insecurity compared with 26.9% of whites. Additionally, 46.1% of households with food insecurity had children versus 32.8% of households without children.

"The study by Raifman et al adds to our general understanding of unemployment insurance as not only a particularly important tool for blunting the effects of economic downturns but also a tool to promote better health outcomes," writes Elizabeth Rigby, PhD, in a commentary.

Study lead author Julia Raifman, ScD, adds in a Boston University press release, "There has long been a need to improve the proportion of people covered, the duration of coverage, and the amount of coverage in our unemployment insurance system. This paper speaks to the critical role that unemployment insurance can play in preventing people from facing food insecurity during a crisis."
Jan 29 JAMA Netw Open study
Jan 29 JAMA Netw Open commentary
Jan 29 Boston University press release

Pfizer COVID-19 vaccine likely effective against B117 variant, study shows

The Pfizer/BioNTech COVID-19 vaccine is likely effective against the B117 variant, according to 40 blood samples that were introduced to pseudoviruses of both the B117 and the original SARS-CoV-2 strains.

The study, published late last week in Science, found that, while the BNT162b2 vaccine was shown to be slightly less effective against the B117 strain, sufficient antibody activity existed for the vaccine to work.

The researchers used blood samples from 26 people aged 23 to 55 years and 14 people aged 57 to 73 years, all from German phase 1/2 clinical trials. All volunteers had received both vaccine doses at the recommended 21 days apart.

SARS-CoV-2 pseudoviruses were introduced either 7 or 21 days after the second dose, and then 50% neutralization assays were used to test the blood samples. The younger group showed 0.78 geometric mean ratio titers against B117 (95% CI, 0.68 to 0.89) compared with the original virus strain, and the older group showed 0.83 (95% CI, 0.65 to 1.1).

"Based on experience from studying antibody correlates of disease protection for influenza virus vaccines, a 20% reduced titer does not indicate a biologically significant change in neutralization activity," write the researchers. They add, however, that specific vaccine adaptations should be made to combat new strains.
Jan 29 Science study

WHO snapshot covers 4 most recent Saudi MERS cases

The World Health Organization (WHO) today posted an overview of four MERS-CoV cases reported from Saudi Arabia in the last 7 months of 2020, all of which were noted earlier by Saudi Arabia's Ministry of Health.

In a report that fleshes out more details, the WHO said one of the four cases was fatal. Two of the patients are from Riyadh, and the others are from Taif and Al Ahsa. All are men, ages 40 to 62, and all had underlying health conditions, three of them with diabetes.

No clusters were reported, and none of the patients were health workers or had reported contact with earlier cases. Three had contact with camels or exposure to camel milk.

The WHO emphasized that testing capacity for MERS-CoV (Middle East respiratory coronavirus) has been severely affected in many countries due to resources dedicated to COVID-19, which is also caused by a coronavirus. The agency said it expects additional MERS cases to be reported in the Middle East and that illnesses will likely be exported to other countries.

Since 2012 when the virus was first detected in humans, 2,566 lab-confirmed cases have been reported to the WHO, along with at least 882 deaths. Saudi Arabia has been by far the hardest-hit country.
Feb 1 WHO statement

Study shows oral HPV detected in 23% of newborns

New data published late last week in Emerging Infectious Diseases adds to the understanding of human papillomavirus (HPV) carriage in children, showing that HPV can be detected in 22.9% of newborns at birth, but prevalence drops to 8.7% at 3 years.

The data come from a longitudinal study of 331 Finnish children who participated in the Finnish Family HPV Study, which explored nonsexual and vertical transmission of HPV from mothers to babies. Women were enrolled at a minimum of 36 weeks into their pregnancy and were subsequently followed up for 6 years. Researchers conducted oral scrapings on children for HPV testing.

The researchers found 18 different HPV genotypes in the oral mucosa of the children tested, with HPV16 the most prevalent genotype, followed by HPV18, 6, 33, and 31.

The team noted that 22.9% of oral samples collected at birth were positive for HPV DNA,15 HPV types were identified (the most at any point), and the frequency of multiple-type infections was also the highest, at 3.7%. At the 36-month visit, only 8.7% of the oral samples were positive for HPV, and the researchers identified only 4 genotypes. By the 6-year visit, HPV prevalence rose again to 20.4%, and 8 HPV genotypes were identified.

Mode of delivery had no association with HPV carriage, but oral HPV persistence during the 6-year follow-up period was predicted by oral HPV infection and seroconversion to high-risk HPV of the mother during the follow-up period, the authors concluded.
Jan 29 Emerg Infect Dis study

H5N1 avian flu reported in Africa and India, H5N8 and H5N4 elsewhere

Among several new highly pathogenic avian flu developments, Mauritania reported an H5N1 outbreak in pelicans, not far from where H5N1 was recently reported in neighboring Senegal in poultry and wild birds, according to Reuters.

In other detections involving H5N1, India reported more H5N1 outbreaks, in poultry, according to notifications from the World Organization for Animal Health (OIE). One involved backyard birds in Chattisgarh state in the central part of the country and the other at a farm in Maharastra state in south-central India. Also, the country reported H5N1 in wild geese in Punjab state in the north.

Meanwhile, countries on two continents reported more H5N8 outbreaks in poultry, and Germany detected H5N4 for its first time in wild birds. South Korea reported 14 more H5N8 outbreaks in poultry, many at layer farms, in five provinces, mostly in Gyeonggi province. The outbreaks began from Jan 18 to Jan 28, and, taken together, the virus killed 1,993 of 2,241,110 poultry. India also reported more H5N8 in poultry in two states, Gujarat in the far west and Kerala in the far south.

In Europe, the United Kingdom reported an H5N8 outbreak at a game farm housing pheasants in Wales that began on Jan 24; so far, the source of the virus is unknown.

And finally, Germany reported its first appearance of H5N4, which involved a wild swan found dead on Jan 7 in Baden Wurttemberg state in the southwest.
Jan 31 Reuters story
Feb 1 OIE report on H5N1 in India's Chattisgarh state
Feb 1 OIE report on H5N1 in India's Maharastra state
Feb 1 OIE report on H5N1 in Indian wild birds
Jan 29 OIE report on H5N8 in South Korea
Feb 1 OIE report on H5N8 in India's Gujarat state
Feb 1 OIE report on H5N8 in India's Kerala state
Jan 29 OIE report on H5N8 in the United Kingdom
Jan 28 OIE report on H5N4 in German wild swan

Stewardship / Resistance Scan for Feb 01, 2021

News brief

CARB-X to fund development of electronic antibiotic susceptibility test

CARB-X announced today that it is awarding up to $2.5 million to Avails Medical of Menlo Park, California, to develop an electronic antibiotic susceptibility test (eAST).

The Avails eAST has 96 integrated electronic biosensors in a disposable lid that would fit onto widely available susceptibility testing panels and rapidly detect bacterial growth when immersed in positive blood culture samples. Company officials say the aim of the technology is to provide phenotypic results that can guide antibiotic therapy decisions within 4 hours. Current susceptibility testing methods take days to identify the most effective antibiotic treatments.

"Speed is a critical component of effectively diagnosing and treating serious antibiotic-resistant bacterial infections, including bloodstream infections," Erin Duffy, PhD, chief of research and development at CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), said in a CARB-X press release. "Every hour of delay in effective treatment increases the risk of complications and septic shock."

Avails Medical could receive up to $14.7 million in additional CARB-X funding if the project, which is currently in the feasibility development phase, successfully progresses to later phases.

Since its launch in 2016, CARB-X has awarded more than $278.5 million for projects focused exclusively on drug-resistant bacteria. There are currently 51 active projects in the CARB-X portfolio.
Feb 1 CARB-X press release

UK study: Flu vaccine linked to fewer amoxicillin prescriptions in seniors

Influenza vaccination was associated with reduced amoxicillin prescribing in a large cohort of UK seniors, according to a study published late last week in PLOS One.

To estimate the effects of the flu vaccine on amoxicillin prescribing in UK adults age 65 and over, researchers analyzed electronic health record data on 88,158 who turned 65 and received the vaccine in the year 2000 but had not received the vaccine the 2 previous years. They then matched the vaccinated patients 1:1 with unvaccinated patients based on a propensity score model.

The time to prescription of amoxicillin, which is frequently prescribed for respiratory illness and may serve as a proxy for flu diagnosis, in the year before and the year after vaccination was analyzed using the Prior Event Rate Ratio (PERR) Pairwise method to address bias from measured and unmeasured confounders.

Compared to the unvaccinated patients, those from the vaccinated group were more likely to be prescribed amoxicillin in the year prior to vaccination (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.83 to 1.98) and the year following vaccination (HR, 1.64; 95% CI, 1.58 to 1.71). But after adjusting for prior differences in the two groups using the PERR Pairwise method, the vaccinated group had a 14% lower risk of receiving amoxicillin (HR, 0.86; 95% CI, 0.81 to 0.92) after vaccination.

Subgroup analysis showed similar results for vaccinated adults 65 to 75 (HR, 0.87; 95% CI, 0.82 to 0.93) and those age 75 and over (HR, 0.84; 95% CI, 0.76 to 0.94).

"Antibiotic resistance is a growing healthcare problem, the consequences of which include longer healthcare stays and more expensive healthcare costs," the study authors wrote. "Our findings suggest that improving uptake of influenza vaccination in older patients can contribute to strategies to reduce antibiotic resistance."
Jan 29 PLOS One study

Review finds high mortality from ICU infections in lower-income countries

A review of literature on intensive care unit (ICU)-acquired infections suggests mortality is much higher in ICUs in low- and middle-income countries (LMICs) compared with higher-income countries, as is the level of antibiotic resistance, Dutch and Indonesian researchers reported late last week in Antimicrobial Resistance and Infection Control.

The scoping review of 51 articles on ICU-acquired infections in LMICs from 2005 to 2018 found average point-prevalence rate of 22.4 infected patients per 100 present, which is comparable to the 19.5% rate recorded in Western European countries in 2011 and 2012. But the overall ICU mortality in LMICs was 33.6% (varying from 14% to 70% across studies), compared with a 15.3% ICU mortality rate found in a European Union study conducted from 2008 through 2012 and a 18.2% ICU mortality rate found in a 2009 study of ICUs in 75 countries.

The reviewers also found that multidrug-resistant gram-negative species were the most prevalent group of pathogens in ICUs in LMICs, with Acinetobacter baumannii (24%), Pseudomonas aeruginosa (16%), and Klebsiella pneumoniae (15%) causing more than 50% of infections. By comparison, these three pathogens caused less than 25% of ICU infections in Western Europe in the same period.

The authors note that the findings are limited by the relatively few high-quality studies, most of them conducted in only a handful of countries.

"Many gaps in knowledge remain since most LMICs have not produced high quality reports," they wrote. "However, from the reported evidence it is clear that the rate of ICU-acquired infections is likely to be somewhat higher in LMICs compared to high income countries and that the ICU mortality rate is much higher."
Jan 29 Antimicrob Resist Infect Control study