News Scan for Aug 17, 2020

News brief

Ebola infects 2 more in DRC outbreak totaling 88 cases, with 36 deaths

Health officials in the Democratic Republic of the Congo (DRC) have reported 2 more Ebola cases in its Equateur province outbreak, lifting the total to 88, the World Health Organization (WHO) African regional office said on Twitter today.

The number of deaths held steady at 36.

It's not clear where the latest cases were detected, but the WHO has said the outbreak is concerning, because cases have been reported from a wide geographic region in the DRC.

Marking the DRC's 11th outbreak, the event was first detected in early June and is occurring in the same area as country's ninth outbreak in 2018, which lasted only a few months and sickened 54 people, with 33 deaths reported.
Aug 17 WHO African regional office tweet

Red cabbage suspected as source of bagged salad Cyclospora outbreak

Red cabbage grown in Florida may be the source of Cyclospora in a multistate outbreak tied to a bagged salad mix produced by Fresh Express, based on results from a new method developed by the Food and Drug Administration (FDA) for testing agricultural water for the parasite.

The outbreak was first reported in the middle of June, though health officials weren't sure which ingredient in the salad mix was contaminated. In an Aug 14 update, the FDA said trace-back investigations suggested the source was either iceberg lettuce grown in California or red cabbage grown in Florida.

Health officials saw a notable decline in cases after red cabbage sourcing shifted from Florida to other areas, providing a possible clue. Using the new method, environmental testing of canal water used for irrigation collected north and south of a farm yielded two positive samples. The farm was no longer growing red cabbage, so the product couldn't be sampled. The FDA said all samples collected from farms growing iceberg lettuce in California were negative.

The testing can't yet determine genetic typing, so investigators can't conclusively link samples from patients to the Cyclospora collected from the canal, the FDA noted, adding that it is working with Florida officials to further investigate the findings and that it will propose agricultural water revisions for the Produce Safety Rule.

In a related update, the Centers for Disease Control and Prevention (CDC) said 49 more illnesses have been reported, raising the outbreak total to 690 from 13 states. The latest illness onset was Jul 20. So far, 37 people have been hospitalized, and no deaths have been reported. A related outbreak in Canada has sickened at least 37 people in three provinces.
Aug 14 FDA update
Aug 14 CDC update
Jul 8 Public Health Agency of Canada notice

Information card boosts patient knowledge of antibiotics, UK study finds

Introduction of an "antibiotic information card" (AIC) for patients being discharged from the acute medical unit (ACU) of an English hospital significantly increased patient knowledge about antibiotic prescriptions but did not affect the readmission rate, UK researchers reported late last week in the American Journal of Infection Control.

The card was introduced in the ACU at William Harvey Hospital from November 2019 to January 2020 as part of an effort to improve patient compliance with antibiotic regimens. The ultimate aim was to reduce the 30-day readmission and reattendance rate due to the same infection by 75% in patients discharged from the AMU with antibiotics, and to increase patient understanding regarding their antibiotic prescription and treatment to 75% or higher, as assessed by a questionnaire completed 30 days after discharge.

Recent research has shown that 30-day emergency readmissions in English hospitals increased by 1.3% from 2013-14 to 2017-18, with infection-related conditions accounting for 59% of readmissions.

The researchers designed the AIC after collecting baseline data from AMU patients discharged with antibiotics, then provided it to 22 of 23 eligible patients in the first cycle of the intervention and conducted follow-up telephone surveys with those patients. There was no significant improvement in 30-day reattendance and readmission rates, but patient knowledge of their antibiotics increased from the baseline range of 14% to 71% to over 75%, with a range of 86% to 100%. In the second cycle of the intervention, which did not include on-ward support from medical students, only 1 of 23 eligible patients received the card, and patient knowledge of antibiotics ranged from 43% to 100%.

The authors of the study say the AIC is an easily sustainable intervention with minimal financial costs that could be replicated on other wards. But they acknowledge that more staff engagement will be needed to make sure every patient receives the card on discharge.

"Change is more likely to be successful and sustainable as a team effort, and so staff should be encouraged to continue to complete the AICs prior to a patient's discharge," the authors wrote.
Aug 15 Am J Infect Control abstract

COVID-19 Scan for Aug 17, 2020

News brief

COVID-19 patients with heart disease at risk for complications, death

A meta-analysis by Italian researchers published late last week in PLOS One shows that COVID-19 patients who have or are at risk for cardiovascular disease are more likely than others to develop cardiovascular complications and die from their infections.

Researchers analyzed data from 21 published observational studies involving 77,317 hospitalized COVID-19 patients in Asia, Europe, and the United States. At hospital admission, 12.9% of the patients had cardiovascular conditions, 36.1% had high blood pressure, 33.8% were obese, 19.5% had diabetes, and 10.7% were smokers. Of all patients, 11.7% had coronary artery disease, 9.4% had heart failure, and 5.3% had chronic obstructive pulmonary disease.

During hospitalization, 14.1% of coronavirus patients developed cardiovascular complications, the most common of which were abnormal heart rhythms or palpitations (18.4%), heart muscle injury (10.3%), chest pain (10.2%), and heart failure (2.0%).

Pre-existing cardiovascular diseases and risk factors were significantly associated with cardiovascular complications (P = 0.019). Advanced age (P < 0.001), pre-existing cardiovascular diseases or risk factors (P < 0.001), and cardiovascular complications (P = 0.038) were significantly linked to death.

The case-fatality rate was 9.6% (41.8% of intensive care unit [ICU] patients, 7.6% of non-ICU patients).

"Results of the present meta-analysis strongly suggest that COVID-19 fatality is influenced by cardiovascular pre-existing conditions and/or cardiovascular risk factors," the authors wrote. "These findings unveil additional prognostic elements that should be taken into account, in addition to age and gender, to influence the risk prognostication and clinical management of COVID-19 patients."
Aug 14 PLOS One study

Study highlights racial disparities in US COVID-19 hospitalizations

Blacks, Hispanics, Native Americans, and Alaskan Natives were overrepresented among COVID-19 hospitalizations in 12 US states, according to a research letter published today in JAMA Internal Medicine.

Researchers used the University of Minnesota COVID-19 Hospitalization Tracking Project to identify the 12 states that reported the ethnicities of 48,788 coronavirus patients hospitalized from Apr 30 to Jun 24.

Black hospitalized COVID-19 patients surpassed their representative proportion of the population in all 12 states. The disparity was most pronounced in Ohio (31.8% of hospitalizations vs 13.0% of population), Minnesota (24.9% vs 6.8%), Indiana (28.1% vs 9.8%), and Kansas (22.0% vs 6.1%).

In 10 of 11 states that reported hospitalizations of Hispanic coronavirus patients, the percentage of hospitalizations exceeded their representative proportion of the population. The disparity was most evident in Virginia (36.2% of hospitalizations vs 9.6% of population), Utah (35.3% vs 14.2%), and Rhode Island (33.0% vs 15.9%).

While coronavirus hospitalizations of Native American and Alaskan Natives were reported by only eight states, the disparity was significant in some. For instance, in Arizona, this subgroup accounted for only 4.0% of the population but made up 15.7% of the hospitalizations. In Utah, Native Americans and Alaskan Natives made up 0.9% of the population but accounted for 5.0% of hospitalizations.

Conversely, white patients made up a significantly smaller share of COVID-19 hospitalizations compared with their share of the population in all 12 states. For instance, white patients in Minnesota made up only 52.9% of coronavirus hospitalizations, although they made up 84.1% of the population.

Likewise, in 6 of 10 states that reported data for Asians, the proportion of hospitalizations was lower than their population representation. For example, in Massachusetts Asians made up 7.0% of the population but only 4.0% of coronavirus hospitalizations.

The authors said that their findings underscore the need for increased and consistent reporting of COVID-19 hospitalizations by all states to better identify and tackle disparities.

"A large body of research has identified racial/ethnic health disparities in the risk of infection associated with a higher prevalence of comorbidities, less access to health care, adverse economic conditions, and service-related occupations," they wrote. "The unique clinical, financial, and social implications of COVID-19 for racial/ethnic populations that are often systematically marginalized in society must be well understood to design and establish effective and equitable infrastructure solutions."
Aug 17 JAMA Intern Med research letter