India's health ministry yesterday reported a fatal Nipah virus case involving a 14-year-old boy from Kerala state, which has been the country's hot spot for the virus in recent years.

The boy from Mallapuram was hospitalized for acute encephalitis in Perinthalmanna before he was transferred to a facility in Kozhikode. Samples were sent for testing to the National Institute of Virology in Pune, which confirmed Nipah virus. 

Investigators are looking for related cases and conducting contact tracing, and a federal task force will be deployed to assist health officials in Kerala state. The ministry added that it has sent monoclonal antibody treatment for the boy based on a request from Kerala officials. Though the treatment arrived before the boy died, it could not be used due to his deteriorating medical condition.

Boy had eaten hog plum fruit from neighborhood

The top health official in Kerala state said the boy had eaten hog plum fruit from his neighborhood before he got sick and that the neighborhood harbors bats, according to the Hindustan Times. Health officials have identified 350 contacts, of which 101 are considered high risk.

Nipah virus is spread by fruit bats and can be spread person-to-person. People can also contract the virus from drinking palm sap or eating fruit contaminated with bat urine, droppings, or saliva. The disease has a high case-fatality rate, and currently there are no specific treatments or vaccine, though a clinical trial is underway in India and Bangladesh to assess a monoclonal antibody treatment. The trial, launched earlier this month, is supported by the Coalition for Epidemic Preparedness and Response.

An expert group led by the Centers for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, with support from Wellcome recently published an updated roadmap for developing medical countermeasures against Nipah virus.

Sewage sampling has turned up circulating variant type 2 poliovirus (cVDPV2) in two sites in the Gaza Strip, though no related paralysis cases have been detected, the Global Polio Eradication Initiative (GPEI) said in a July 19 statement.

Genetic analysis suggests the viruses from the two locations are related to each other, and are closely related to the variant circulating in Egypt in the last half of 2023. GPEI said the virus could have been introduced to Gaza as early as September 2023. 

The health ministry is conducting a risk assessment to assess how well the surveillance system is doing at detecting acute flaccid paralysis and wastewater sampling and to more clearly assess subnational immunity levels.

"The ongoing crisis continues to pose a significant challenge to the ability to implement full disease surveillance and outreach with immunization services," the group said, adding routine immunization rates in the occupied Palestinian territory were optimal before the conflict began in 2023. Polio vaccine coverage was estimated to be 99% in 2022, declining to 89% in 2023, according to the latest estimates from global health groups.

GPEI said only 16 of 36 hospitals are partly functional and only 45 of 105 primary health facilities are operational. "The impact on health system, insecurity, inaccessibility, population displacement, and shortages of medical supplies, coupled with poor quality of water and weakened sanitation, have contributed to reduced routine immunization rates and an increased risk of vaccine-preventable diseases, including polio, the group said.

The World Health Organization considers the risk of further spread within Gaza as high.

Hospitalized patients with COVID-19 who required intensive care unit (ICU) treatment were more likely to acquire infections than those hospitalized with influenza, according to a new study in Scientific Reports.

The study was based on outcomes seen among Swedish adults treated with invasive mechanical ventilation due to COVID-19 between January 2020 and March 2022 and those with flu between January 2015 and May 2023 at Sahlgrenska University Hospital.

In total, 480 participants were included in the final analysis, and 436 had COVID-19. The median age in both cohorts was 63 years.

Corticosteroid treatment linked to infections

During the first wave of the pandemic, the authors wrote, approximately 14% of patients hospitalized due to COVID-19 were admitted to the ICU, and compared to influenza, COVID-19 patients had longer ICU stays. Risk of infection also increased with length of ICU stay. 

The incidence rates of ICU-acquired infections were 31.6 per 1,000 and 9.9 per 1,000 ICU-days in the COVID-19 and influenza cohorts, respectively, the authors said. Infections were associated with corticosteroid treatment, which was given more frequently to COVID-19 patients. 

Secondary infections among ICU patients with COVID-19 are a common complication associated with a more complex course of disease.

"Secondary infections among ICU patients with COVID-19 are a common complication associated with a more complex course of disease," the authors concluded, finding that COVID-19 patients were more likely to have difficult-to-treat gram-negative infections.

Implementation of a Clostridioides difficile infection (CDI) intervention program at a university referral hospital in Spain was associated with improved management of CDI patients and less use of hospital resources, researchers reported last week in Open Forum Infectious Diseases.

The CDI intervention program implemented at the 900-bed hospital (Hospital A) provides real-time advice from an infectious disease specialist to each patient with a positive CDI test and promotes continuity of care by providing a phone number to contact the specialist. To assess the impact of the program, researchers compared the proportion of patients who were not treated with antibiotics, compliance with clinical guidelines, accessibility to new medications, use of hospital resources, and recurrence and mortality rates at Hospital A and another hospital in the same region without a CDI intervention program (Hospital B).

Avoiding unnecessary antibiotic treatment

During the study period, there were 295 CDI cases identified at Hospital A and 130 identified at Hospital B. At Hospital A, 19.3% of cases were identified as being colonized or having self-limited CDI and avoided unnecessary antibiotic treatment, compared with 11.5% at Hospital B. Hospital A also provided access to novel therapies more frequently (35.3% vs 13%) and adhered more closely to current guidelines (95.8% vs 71.3%) than Hospital B. 

Although mortality and recurrence rates did not show a statistically significant difference between the two hospitals, the absence of an intervention program at Hospital B was associated with greater odds of any admission due to recurrence (odds ratio [OR], 4.19; 95% confidence interval [CI], 1.09 to 16.05) and greater odds of visits to the emergency department due to CDI (OR, 8.74; 95% CI, 2.54 to 30.04).

The study authors say the findings suggest oversight of CDI patients by an infectious disease specialist may result in better outcomes and resource management.

"In this study, we observed a greater proportion of patients who did not receive antibiotics because they were evaluated as colonized, better adherence to clinical guidelines, easier access to novel therapies and a decrease in hospital resource utilization," they wrote.            

A study conducted in South Africa highlights the impact that COVID-19 lockdowns had on drug-resistant tuberculosis (DR-TB) diagnoses and incidence patterns. The findings were published late last week in Annals of Epidemiology.

For the study, a team of US and South African researchers compared the number, spatial distribution, and characteristics of DR-TB diagnoses in South Africa's KwaZulu-Natal province before and after the initial COVID-19 lockdown on March 26, 2020. Previous research has shown that the COVID-19 pandemic significantly impacted rates of TB case notifications worldwide, resulting in an 18% decline in the number of diagnoses reported in 2020 compared with 2019, and a 26% decline in South Africa. The decline has been attributed in part to disruptions to TB services and hesitancy among TB patients to visit healthcare facilities out of fear of contracting COVID-19.

Poverty linked to increased incidence

From October 2018 through February 2022, 693 individuals were diagnosed with DR-TB in the province. The rate of diagnosis per year was 274 prior to the initial lockdown and 155 after, corresponding to a 43% decrease in the notification rate. Analysis of detailed sociodemographic data of a subgroup of DR-TB cases showed that, compared with cases diagnosed before the lockdowns, cases diagnosed after were associated with worse living conditions. Specifically, they were less likely to have a fuel source for heating, piped water, a flush toilet, or own a phone. DR-TB cases diagnosed after the lockdowns also reported more adults living in their household compared with cases diagnosed prior to the lockdowns.

"These findings are similar to those found in a previous cohort study conducted in the region, and depict that indicators of poverty at both the individual and municipality level are associated with increased DR TB incidence, which may have worsened after the COVID-19 pandemic," the study authors wrote.

The authors suggest prevention strategies such as targeted active case finding, along with allocation of resources to at-risk regions, could be implemented in areas identified as at higher risk for DR-TB after the COVID-19 lockdowns.