News Scan for Aug 02, 2021

News brief

MERS sickens one more in Saudi Arabia

Saudi Arabia reported a second MERS-CoV (Middle East respiratory syndrome coronavirus) case from Riyadh in the month of July, and, like the first case, involving a man who had contact with camels, according to notification from the country's ministry of health (MOH).

The patient is age 65, is not a health worker, and isn't thought to have contracted the virus from another sick person.

The new MERS-CoV case marks Saudi Arabia's eleventh case of the year. Earlier this summer, the World Health Organization (WHO) said in an update that it has received reports of 2,574 cases, at least 866 fatal, since the first human cases were identified in 2012. Most are from Saudi Arabia.
Jul 30 Saudi MOH statement

Study: More than half of US outpatient antibiotics not tied to visit, infection

More than half of ambulatory antibiotic use among privately insured US patients over a 2-year period was not linked to a clinician visit or an infection, researchers reported yesterday in Open Forum Infectious Diseases.

Using a database of privately insured US patients, researchers from Brigham and Women's Hospital, Harvard Medical School, and Northwestern University's Feinberg School of Medicine found that of 22.3 million outpatient antibiotic prescriptions issued from Apr 1, 2016, through Jun 1, 2018, 31% (6.9 million) were non–visit-based, and 22% (4.9 million) were associated with a clinician visit that did not involve an infection-related diagnosis. Compared with children, adults had over twice as high a proportion of antibiotic fills that were not visit-based (34% vs 16%) and had higher rates of non-infection-related prescriptions.

A comparison across clinician specialties showed that the highest non–visit-based prescribing rate was among medical/surgical specialists (38%), followed by internists (28%) and family practitioners (20%), and the lowest rates were among pediatricians (10%) and nurses (16%).

In multivariable modeling, non–visit-based prescribing was associated with increasing patient age, with the odds of a non–visit-based prescription increasing 1% for each year of age, and was less likely for patients in the South, patients with more baseline clinical visits, and those with chronic lung disease.

The study authors note that the findings are similar to a study they conducted using older Medicaid data, as well as smaller prior studies, which suggests that non–visit-based and non–infection-related prescribing remains a problem.

"Prescriptions issued and filled in the absence of an in-person visit or without documentation of an infection raise particular problems, since antibiotic stewardship interventions may not reach the prescribing clinician at the time when a decision is being made," they wrote.

They add that further analysis is needed to identify the clinical decision points at which stewardship interventions could make a difference.
Aug 1 Open Forum Infect Dis abstract

Missouri detects longhorned ticks, Maine reports another Powassan virus case

The Missouri Department of Agriculture (MDA) recently confirmed the state's first identification of an Asian longhorned tick, the sixteenth US state to detect the tick species.

The ticks—known for their prolific reproduction—are a threat to livestock and humans. A single female can produce as many as 1,000 offspring at a time without mating and can stress heavily infested animals. The tick was first found in the United States in 2017.

Media reports said Missouri's finding occurred in Greene County, located in the southwest corner of the state.

Asian longhorn ticks aren't known to have infected humans yet, but they are known to be aggressive biters.
Jul 27 MDA statement

In other tick developments, the Maine Centers for Disease Control (MCDC) recently reported the state's second Powassan virus case, which involves a Knox County resident who was sick in June.

The state reported its first case of the season in June, in a Waldo County resident who is recovering following hospitalization.

Knox County is in southern Maine and borders Waldo County, where the earlier case was found.

Powassan virus cases, spread by ticks, are rare. The United States averages about 25 cases each year. The illness can be severe, with symptoms ranging from headache to fever to encephalitis. There are no treatments for the infection.
Jul 26 MCDC statement
Jul 2 CIDRAP News scan

US reports 254 more Cyclospora cases, food links still under investigation

In a monthly update on domestic Cyclospora activity, the US Centers for Disease Control and Prevention (CDC) said 254 more cases have been reported, raising the national total to 462.

So far no specific food item has been identified. Cyclospora infections in people who haven't traveled out of the country typically rise in warmer months. Past outbreaks have been linked to fresh produce such as mesclun, basil, cilantro, and fresh raspberries.

Six more states have reported cases, raising the number affected to 28. So far, 41 people have been hospitalized, and no deaths have been reported. The latest illness onset is Jul 16.

Caused by a parasite called Cyclospora cayetanensis, the disease is caused by eating food or drinking water contaminated with feces. The hallmark of the illness is profuse diarrhea that can last weeks to months. In 2020, the nation reported 1,241 cases from 34 states, which included multiple outbreaks in clusters linked to different food items, including bagged salad.
Jul 29 CDC Cyclospora update

COVID-19 Scan for Aug 02, 2021

News brief

Age-groups tied to different frequent COVID-19 symptoms

Researchers found that different age-groups had different associations with various COVID-19 symptoms, according to a Lancet Digital Health study late last week. The study was evaluating an artificial intelligence (AI) model for early COVID-19 detection (1 to 3 days of symptom onset).

The researchers trained their AI model on 182,991 UK people who self-reported symptoms in the ZOE COVID Symptom Study app from Apr 20 to Oct 15, 2020, and then they tested it on 15,409 UK app participants from Oct 16 to Nov 30, 2020. Of the 18 symptoms included in the study, the researchers say the ones most associated with early COVID-19 infection were, in order from most to least relevant, loss of smell, chest pain, persistent cough, shortness of breath, abdominal pain, blisters on the feet, eye soreness, and unusual muscle pain.

The highest area under the receiver operating characteristic curve (AUC) that the model achieved was 0.80, with better sensitivity and specificity for older age-groups. AUC is one measure of the model's usefulness from 0 to 1.

Participants from 16 to 39 years of age showed higher COVID-19 associations with loss of smell, chest pain, and abdominal pain. Loss of smell, however, had less significance in those aged 60 to 79. For those 80 and above, it was not the most common indicator. Instead, chest pain, diarrhea, and sore throat were. Overall, men were more likely to report shortness of breath, fatigue, chills, and shivers, while women were more likely to report loss of smell, chest pain, and a persistent cough.

"Currently, in the UK, only a few symptoms are used to recommend self-isolation and further testing," said first author Liane dos Santos Canas, PhD, in a King's College London press release. "Using a larger number of symptoms and only after a few days of being unwell, using AI, we can better detect COVID-19 positive cases. We hope such a method is used to encourage more people to get tested as early as possible to minimise the risk of spread."
Jul 29 Lancet Digit Health study
Jul 30 King's College London press release

COVID vs excess deaths vary by country

The 2020 residual mortality rates (RMRs) were half positive and half negative across 35 countries, suggesting that COVID-19 deaths and excess mortality deaths were not comparable, according to a study today in Epidemiology & Infection.

The researchers looked at all deaths from 2015 to 2020 as well as COVID-attributed deaths in 2020, and they included covariates such as economic health, demographics, and government response stringency index. Taiwan and Canada had the highest positive RMR (ie, fewer excess deaths than reported COVID-19 deaths) and Bulgaria and Poland had the most negative (ie, more excess deaths than reported COVID-19 deaths). The researchers add that these countries had more than double the RMR magnitude than the next closest countries.

Overall, the correlation coefficient between excess mortality and COVID-19 mortality was 0.796 (95% confidence interval [CI], 0.629 to 0.892), 0.867 between excess mortality and RMR (95% CI, 0.750 to 0.931), and 0.388 between COVID-19 mortality and RMR (95% CI, 0.062 to 0.638).

RMR had no significant covariates, which the researchers say may be due to how both excess deaths and COVID-19 deaths were related to them. Plus, they write, their study did not look at disruption to health services or under- and over-reporting of COVID-19 deaths.

"In accordance with this survey, we found a high correlation coefficient between excess mortality and excess non–COVID-19 mortality i.e. RMR, suggesting that health system disruption, reduced health care demand, and health care resources diverted to COVID-19 patients could be some important determinants of RMR," add the researchers.

"Further data on cause-specific mortality is required to determine the extent to which residual mortality represents non–COVID-19 deaths and to explain differences between countries. Time series modelling of timing and stringency of lockdown measures on COVID-19 deaths are also necessary to assess the impact these have had in different countries," they conclude.
Aug 2 Epidemiol Infect study