Nursing home in states with COVID-19 vaccine mandates saw higher staff uptake
Nursing homes in US states with COVID-19 vaccine mandates for healthcare workers saw a 7 percentage-point increase in staff vaccine uptake over homes in non-mandate states during a 5-month period in 2021, with no worsening of worker shortages, finds a study published late last week in JAMA Health Forum.
The study, led by a researcher from the University of Rochester Medical Center in New York, used weekly National Healthcare Safety Network data on staff COVID-19 vaccination rates and worker shortages at nursing homes in 38 study-eligible states from Jun 6 to Nov 14, 2021.
The team chose this time window to avoid confounding from the federal nursing home mandate that was announced on Nov 4 and took effect Dec 6. Vaccination was considered at least one dose of the Pfizer/BioNTech, Moderna, or Johnson & Johnson COVID-19 vaccines.
Of the 38 states, 26 had no COVID-19 vaccine mandate for nursing home workers, while 8 had a mandate with no option to substitute with weekly COVID-19 tests, and 4 had a mandate with a test-out option.
At least 10 weeks after a mandate announcement, nursing homes in states with a mandate and no test-out option saw an increase in worker COVID-19 vaccination of 6.9 percentage points (95% confidence interval [CI], −0.1 to 13.9) over those in no-mandate states. Nursing homes in states with a mandate and test-out option saw a 3.1 percentage-point climb in vaccination (95% CI, 0.5 to 5.7) relative to those in no-mandate states. There were no reports of worsened staffing shortages.
Increases in COVID-19 vaccination rates in mandate states with no test-out option were greater in Republican-leaning counties than in Democrat-leaning counties (14.3 percentage points with no test-out option and 4.3 percentage points with test-out option), although Republican counties had lower baseline vaccination rates.
"These findings suggest that given the waning vaccine-induced immunity and low booster dose coverage among nursing home staff in many parts of the US, state mandates for booster doses may be warranted to improve and sustain vaccination coverage in nursing homes," the authors wrote.
Jul 29 JAMA Health Forum study
Tennessee clinicians describe cluster of babies hospitalized with parechovirus
In the wake of a recent warning from the US Centers for Disease Control and Prevention (CDC) about reports of parechovirus (PeV) infections in babies from many states, a team from Tennessee reported on a cluster of 23 babies admitted to a Tennessee children's hospital for PeV meningoencephalitis.
Writing in the most recent issue of Morbidity and Mortality Weekly Report (MMWR), the authors said the babies, ages 5 days to 3 months, were previously healthy and were admitted to the hospital between Apr 12 and May 24. Symptoms included fever, fussiness, and poor feeding. All got sick in community settings, except one preterm infant who started having symptoms in the neonatal intensive care unit (NICU). Sixteen babies had siblings or were exposed to other kids, and one went to daycare.
Four babies had severe disease and were admitted to the NICU. The mean hospital stay was 4.5 days. Of the group, 21 recovered without complications. One was scheduled for follow-up for possible hearing loss and hypercoagulation, and another had persistent seizures and is expected to experience severe developmental delays.
The hospital had introduced a multiple molecular panel in May 2018 to help detect pathogens in patients with suspected meningitis or encephalitis. Nineteen cases were detected over 5 months in 2018, probably reflecting a baseline of PeV central nervous system infections. Seven cases were detected from 2019 through 2021. The group wrote that the recent peak in infections might reflect relaxed COVID-19 measures, similar to patterns seen with other respiratory viruses.
They recommend that clinicians test for the virus when PeV is circulating, even in babies with normal cerebrospinal fluid parameters. And they said rapid detection with multiplex molecular panels can limit antibiotic administration and improve patient management.
Jul 29 MMWR Note from the Field
Jul 13 CIDRAP News scan
Polio samples in New York have genetic links to Israel and UK
Wastewater surveillance as part of the response to the recently identified polio case in New York's Rockland County has revealed positive samples from June in Rockland County, the New York State Department of Health (NYSDOH) said today.
State officials sent the wastewater samples to the Global Polio Laboratory Network for testing, which confirmed that the New York patient's samples are genetically linked to two Sabin-like type 2 isolates collected from Rockland County wastewater samples, as well as those from Jerusalem, Israel, and recently detected environmental samples from London. The health department said the findings don't imply that the patient in New York had traveled to Israel or the United Kingdom.
According to media reports, the Rockland County patient is a man who sought care for weakness and paralysis.
Health officials urged all New Yorkers who are unvaccinated or who haven't completed their immunization series to get vaccinated right away. They warned that unvaccinated people who live, work, go to school in, or visit Rockland County are at the highest exposure risk. Rockland County's polio vaccination rate of 60.5% in 2-year-olds is below the statewide average of 79.1%.
In 2018 and 2019, Rockland County experienced a large measles outbreak that resulted in 312 cases and was New York's largest since 1992.
Aug 1 NYSDOH statement
Jul 21 New York Times story
USDA to declare Salmonella an adulterant in breaded, stuffed raw chicken
The US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) today announced that it will declare Salmonella an adulterant in breaded and stuffed raw chicken products, which have been associated with as many as 14 foodborne illness outbreaks since 2018.
Sandra Eskin, JD, USDA deputy undersecretary for food safety, said, "Today’s announcement is an important moment in U.S. food safety because we are declaring Salmonella an adulterant in a raw poultry product." USDA officials said the step is part of broader efforts to reduce Salmonella infections linked to poultry.
Declaring Salmonella an adulterant will ensure that highly contaminated products aren't sold to consumers. Currently, federal guidelines don’t require a recall, because Salmonella isn't considered an adulterant in raw poultry. Salmonella in breaded and stuffed raw chicken products is a frequent problem, because consumers often don't realize that they are preparing a raw product and assume that the items are precooked.
Some items are labeled as microwavable, and due to variability in the ovens, undercooking can result. The USDA said efforts to improve labeling haven't been effective at reducing illnesses.
The USDA said it is proposing that the products be considered adulterated if they exceed a very low level of Salmonella contamination. The FSIS is proposing a limit of 1 colony-forming unit of Salmonella per gram of product. The agency is also seeking comments on whether a different adulteration level, such as zero tolerance of one limited to specific serotypes, would be more appropriate.
The USDA said it will publish a notice in the Federal Register in the fall seeking public comments.
Aug 1 USDA press release
