News Scan for Aug 24, 2021

News brief

Two US Salmonella outbreaks linked to Italian-style meats

Two US outbreaks of Salmonella, one S Typhimurium and the other S Infantis, have been linked to Italian-style meats, although none are connected to a specific product or brand yet, according to a Centers for Disease Control and Prevention (CDC) investigation notice today.

A total of 36 people across 17 states are affected. The S Typhimurium outbreak began May 30 and has thus far affected 23, hospitalizing 9 patients, and the S. Infantis outbreak began May 9 and has thus far affected 13 people, hospitalizing 3 patients.

Fourteen out of 16 contacted patients in the S Typhimurium outbreak reported eating Italian-style meats such as prosciutto and salami, and all 8 contacted in the S Infantis outbreak reported the same.

Until a specific product is identified, CDC recommends that those at high risk for Salmonella (eg, those under 5 or above 65 years old) heat all Italian-style meats until they reach an internal temperature of 165° Fahrenheit or are steaming.

Whole-genome sequencing has shown that 19 of 20 available S Typhimurium samples have predicted resistance to ampicillin, and all have predicted resistance to chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline. None of the 12 available S Infantis samples have shown any predicted antibiotic resistance.
Aug 24 CDC notification

HPV vaccine tied to lower rates of vaccine virus strains but not others

A study in JAMA Network Open yesterday showed lower rates of vaccine strains of human papillomavirus (HPV) infections in vaccinated girls and young women in New York City but higher rates of some high-risk non-vaccine strains.

The large cohort study followed girls ages 13 to 21 who received the quadrivalent (four-strain) Gardasil vaccine over a 12-year period, from 2007 to 2019. A total of 1,453 participants were included, with a mean age of 18.2 years, and roughly half (694 participants) were vaccinated prior to their first sexual intercourse.

The age-adjusted cervical HPV detection of vaccine-related types (HPV-6, HPV-11, HPV-16, and HPV-18) were lower year over year, the authors said, while the prevalence of nonvaccine high-risk HPV types remained flat or higher. The largest effect sizes were observed among those who had been vaccinated before they became sexually active (adjusted odds ratio [aOR], 0.81; 95% CI, 0.67-0.98).

The age-adjusted estimates showed a lower prevalence of cervical vaccine types since introduction of the quadrivalent vaccine, from 9.1% (95% CI, 6.2%-11.9%) between 2008 and 2010 to 4.7% (95% CI, 1.2%-8.2%) between 2017 and 2019 in the overall cohort, and from 8.8% (95% CI, 1.1%-16.6%) to 1.7% (95% CI, 0%-3.7%) in the subcohort of girls vaccinated prior to having sexual intercourse.

However, the authors observed increasing rates of anal and cervical nonvaccine types, including high-risk HPV types 39, 51, 56, and 68, in study participants.

"Our study findings suggest that postvaccination rates of nonvaccine high-risk HPV types may be greater in some higher-risk groups. As such, surveillance with HPV testing should be considered," the authors concluded.
Aug 23 JAMA Netw Open study

Chinese farmer hospitalized in critical condition with bubonic plague

Health officials in China's Inner Mongolia region have reported a bubonic plague case, which involves a woman who works as a livestock farmer in Ordos, according to a statement today from Hong Kong's Centre for Health Protection (CHP).

Her symptoms began on Aug 14, and the infection was confirmed on Aug 21. The woman is hospitalized in critical condition. So far all of her contacts are asymptomatic and have tested negative.

Plague is mainly transmitted to humans through bites of infected fleas. Yersinia pestis, the bacterium that causes the disease, can also spread when cuts or breaks in the skin come into contact with body fluids or tissue from infected animals. Eating infected animals and inhaling respiratory droplets are other transmission modes.

Plague cases in the neighboring country of Mongolia were reported in 2019 after a man and his wife ate tainted marmot meat. The cases prompted a quarantine in Ulgii, the town where they lived.
Aug 24 CHP statement
May 7, 2019, CIDRAP News scan

COVID-19 Scan for Aug 24, 2021

News brief

More seniors may have become homebound during COVID-19, study says

The number of older adults who are homebound (leaving home once a week or less) increased in 2020 over the prior decade, according to a research letter yesterday in JAMA Internal Medicine. The researchers say that this could affect social, psychological, and physical needs because of factors such as physical distancing and caretaker or telehealth access.

The data used survey responses from the US National Health and Aging Trends Study from May 1, 2011, to Oct 31, 2020, which included 10,785 people 70 and older observed an average of 4.6 times. The prevalence of homebound adults ages 70 to 75 years more than doubled, from approximately 5.0% (1.6 million) from 2011 to 2019 to 13.0% (4.2 million) in 2020.

The population increase is most likely because of COVID-19 mitigations, according to the researchers. They note that in 2020, being homebound increased the most among Hispanic people (34.5% vs 12.6% to 17.2% in previous years), followed by Black people (22.6% vs 6.9% to 9.9%), and White people (10.1% vs 3.7% to 6.0%).

In 2020, non-White, homebound adults 70 and older were more likely to live with more people; for instance, 18.8% of White people lived with at least two other people, compared with 47.6% of Hispanics and 37.5% of Black people. About 44% of homebound White people lived alone. The researchers say that those who live alone may not be receiving adequate care, but conversely, those who live with others may have been at increased risk for SARS-CoV-2 exposure.

Also in 2020, 27.8% of all respondents did not have a cellphone, 50.8% did not have a computer, and more than half had not used email or texted (52.0%) or gone online (55.2%) in the last month. Not only could this affect social and psychological wellbeing during the pandemic, but the researchers suggest this could also affect access to digital services such as telehealth.
Aug 23 JAMA Intern Med study

Post-vaccination SARS-CoV-2 antibodies found in breast milk

After COVID-19 vaccination, 21 lactating healthcare workers showed significant increases in SARS-CoV-2 antibodies in their breast milk, according to a study published in Breastfeeding Medicine late last week.

The researchers recruited from the University of Florida health system from December 2020 to March 2021 and sampled blood and breast milk pre-vaccination, 16 to 30 days after the first dose, and 7 to 10 days after the second dose. All healthcare workers received either the Pfizer/BioNTech or Moderna vaccine.

Data showed that from pre-vaccination to after the second dose, SARS-CoV-2–specific immunoglobulin G (IgG) and immunoglobulin A (IgA) significantly increased in breast milk, with IgA positivity in 85% of 21 participants and IgG positivity in 100% of 10 participants. In blood, IgG seropositivity was found after the first and second doses, and IgA seropositivity significantly increased after full vaccination. For both IgA and IgG, data showed a positive link between breast milk and blood antibodies.

"We saw a robust antibody response in blood and breast milk after the second dose—about a hundred-fold increase compared with levels before vaccination," noted Lauren Stafford, a doctoral student working in the lab of senior author Joseph Larkin III, PhD, in a University of Florida press release.

The average age of the cohort was 34 years, and all but one participant was White. Three had a lower milk supply after the COVID-19 vaccination, but the study did not do a longer-term follow-up to see if the effect resolved. Future areas of research include understanding the effectiveness of breast milk antibodies, how long they linger, and if they can stimulate babies to create their own COVID-19 antibodies.
Aug 20 Breastfeed Med study
Aug 24 University of Florida press release