News Scan for Nov 12, 2020

News brief

Measles deaths rise 50% worldwide since 2016, topping 200,000

The World Health Organization (WHO) said today that worldwide measles deaths climbed 50% from 2016 to 2019, to an estimated 207,500 fatalities in 2019 alone, and cases that year rose to 869,770—the highest total in 23 years.

After a steady decline in cases from 2010 to 2016, increases since then reflect a failure to vaccinate children on time with two doses of measles-containing vaccines (MCV1 and MCV2), the WHO said in a news release. A 95% vaccination coverage rate is needed to prevent outbreaks at the population level, but MCV1 has been globally stagnant at 84% to 85% for more than a decade while MCV2 is currently at 71%.

"The fact that measles outbreaks are occurring at the highest levels we've seen in a generation is unthinkable when we have a safe, cost-effective, and proven vaccine," said Elizabeth Cousens, PhD, president and CEO of the United Nations Foundation, in the release. "No child should die from a vaccine-preventable disease."

Experts are concerned that the COVID-19 pandemic will exacerbate the measles crisis because of disruptions in vaccination programs and other control efforts. Already, 26 countries have reported a pause in their measles vaccination campaigns. In an attempt to head off further global measles control failures, on Nov 6, WHO issued an emergency call to action to prioritize and fund measles and polio immunization programs.

"While health systems are strained by the COVID-19 pandemic, we must not allow our fight against one deadly disease to come at the expense of our fight against another," said Henrietta Fore, UNICEF executive director. "This means ensuring we have the resources to continue immunization campaigns for all vaccine-preventable diseases, even as we address the growing COVID-19 pandemic."
Nov 12 WHO news release

High-path avian flu outbreaks reported again in 3 European countries

Three European countries reported more highly pathogenic avian flu outbreaks, mostly involving H5N8 in wild birds, but with Germany reporting H5N5 in backyard poultry, according to notifications from the World Organization for Animal Health (OIE).

Germany's H5N5 outbreak in backyard chickens, geese, ducks, and pigeons began on Nov 8 in Mecklenburg-Vorpommern state in the northeast. The virus killed 24 of 167 birds, and the remaining ones were culled, except for the pigeons. The country also reported 22 more H5N8 outbreaks in wild birds, all from neighboring Schleswig-Holstein state in northern Germany. The events began from Nov 4 to Nov 7, killing 22 waterfowl.

Elsewhere, Denmark reported two H5N8 outbreaks in wild birds found dead on Nov 5 in Tonder County in the country's southwest near the border with Germany. Also, Ireland reported an H5N8 outbreak involving a peregrine falcon found sick on Oct 29 in Limerick. The bird died shortly afterward.
Nov 11 OIE report on H5N5 outbreak in German poultry
Nov 10 OIE report on H5N8 in German wild birds
Nov 10 OIE report H5N8 in Denmark
Nov 10 OIE report on H5N8 in Ireland

COVID-19 Scan for Nov 12, 2020

News brief

Mega study shows blacks, Asians have increased COVID-19 infection risk

A meta-analysis of 50 studies and 18,728,893 US and UK patients with COVID-19 found that black people were 2.02 times more likely and Asians 1.50 times more likely to be infected with COVID-19 compared with white people. The researchers also found that Hispanic people had a 1.77 adjusted risk ratio (RR), but none of the applicable studies had been peer reviewed.

In the study, published in EClinicalMedicine today, UK researchers screened more than 1,500 papers, choosing the final study collection and measuring for infection, admission to intensive care units (ICUs), and death. Of the patients, 77% were white, 8% were Hispanic; 7% Asian, and 3% black. Native Americans, mixed races/ethnicities, and other backgrounds were also tracked, but because of population size, the results were inconclusive.

In addition to the COVID-19 prevalence findings, the researchers noted that those of Asian ethnicity were also more likely to be admitted to an ICU (RR, 1.97) or die (1.22) compared with whites, but the ICU findings had not been peer-reviewed and the mortality rate was borderline statistically insignificant. Black people had a 1.10 RR of ICU admission and Hispanics a 1.16 RR; neither had an increased risk for mortality.

"Our findings suggest that the disproportionate impact of COVID-19 on Black and Asian communities is mainly attributable to increased risk of infection in these communities," says Dr. Manish Pareek, senior author, in a National Institute for Health Research news release. He added that living in larger multi-generational housing, having a lower socioeconomic status, and being employed as frontline workers might all play a role.
Nov 12 EClinicalMedicine study
Nov 12 National Institute for Health Research press release

A 60-day COVID-19 follow-up reveals health, financial struggles

A telephone survey of 488 Michigan residents who survived COVID-19 after hospitalization revealed that 159 (32.6%) still had symptoms, 92 (18.9%) reported new or worsening symptoms, and 58 (11.9%) said that they had more difficulty or were not able to complete daily living activities 60 days after hospital discharge.

Almost half (238, 48.8%) said they felt emotionally affected by the experience, with 28 (5.7%) seeking mental health care, according to the Annals of Internal Medicine study published yesterday.

Financially, 179 (36.7%) reported at least mild impact, while 47 (9.6%) reported that most or all of their savings had been used during their illness. Thirty-five (7.2%) said they were rationing food, heat, housing, or medications owing to financial strain. Of the 117 who were able to return to work, 30 (25.6%) said they had to have reduced or modified duties because of their health.

Patients surveyed were among 1,250 patients discharged from the hospital.

"These data confirm that the toll of COVID-19 extends well beyond hospitalization, a finding consistent with long-term sequelae from sepsis and other severe respiratory viral illnesses," the researchers write. "Collectively, these findings suggest that better models to support COVID-19 survivors are necessary."

Overall, the researchers analyzed chart data on 1,648 patients who were admitted in 38 Michigan hospitals for COVID-19 and discharged between Mar 16 and Jul 1. Of those, 398 (24.2%) died during hospitalization, but an additional 84 (6.7% of hospital survivors and 10.4% of ICU survivors) died within 60 days after discharge, giving a 60-day mortality rate of 29.2%. Additionally, 189 (15.4% of 1,250 hospital survivors) had to be readmitted.
Nov 11 Ann Intern Med research letter
Nov 11 Michigan Medicine press release

High death rate in patients with COVID-19 and Staph aureus bacteremia

Of 42 patients who were admitted to two New York City hospitals for COVID-19 and who developed Staphylococcus aureus bacteremia, 14-day and 30-day hospital mortality was 23 (54.8%) and 28 (66.7%), respectively. The study was published today in Open Forum Infectious Diseases.

If bacteremia onset was found four or more days after admission, the odds ratio for mortality was 11.9. Antibiotics were most often administered at the time of blood culture sampling, and the study did not find any significant outcome differences whether the S aureus was resistant to methicillin or not. The median time from blood culture to death was 7.9 days.

Using univariate logistic regression, the researchers found that every 1-point increase in the Pitt bacteremia score—which measures illness severity from 0 to 14 points—predicted a 44% and 56% increased risk of 14-day and 30-day mortality, respectively. The median score for patients who died vs survivors was 7.0 versus 3.0 and, for 30-day hospital mortality, it was 6.5 versus 2.0. While age was less of an indicator than Pitt bacteremia score, for every 1-year increase in age, the study found a 10% increased risk of 14-day mortality.

In another predictor measure, patients who received central venous catheters within 48 hours of testing positive on their blood cultures were 4.36 times more likely and 4.89 times more likely to experience 14-day and 30-day hospital mortality, respectively.

During the time of the study (Mar 1 through May 31), the 42 patients represented 1.57% out of 2,679 people hospitalized for COVID-19 at the two sites.
Nov 12 Open Forum Infect Dis study