News Scan for Jul 14, 2021

News brief

More research needed on heavy impact of antibiotic resistance, report says

A Wellcome report yesterday says more research is needed on drug-resistant bacterial infections (DRIs), but current data indicate that DRIs can be more likely to occur—and have more serious ramifications—in people with health conditions like cancer or who have received extensive treatment such as surgery.

The authors did a rapid evidence assessment of studies related to DRIs and surgery (11), organ transplants (22), cancer (10), intensive care unit admission (11), diabetes (16), HIV (15), infants/children (8), immunodeficiency (7), liver and kidney disease (3), and physical trauma such as road accidents (5).

They found that DRIs, particularly antibiotic-resistant infections, are often more likely in those with health conditions, with some studies showing that certain conditions may increase likelihood of death or health complications. However, they note a lack of DRI-related research on not only the health conditions they included in the report but also many they wanted to include, such as strokes, asthma, and childbirth.

In a first-person anecdote by Lillian Sung, MD, PhD, of the Hospital for Sick Children in Toronto in the executive summary, she talked about how physicians have needed to use stronger treatments over the years, resulting in a cycle of increasing resistance and more side effects. And even with these mitigations, she writes, children can go from being fine to dying within 12 hours because of DRIs.

Another excerpt by Paul Turner, MBBS, PhD, director of the Cambodia Oxford Medical Research Unit, touches on concerns in lower- and middle-income countries: "If you lose the use of azithromycin in places like the US and UK, maybe it doesn't seem like a big deal," he writes. "Kids with an ear infection will be able to get another antibiotic. But if we lose azithromycin in places like Cambodia or Nepal or Pakistan because of drug resistance, there is no oral treatment left for typhoid. It's the last one left."

The Wellcome authors conclude, "The trends that were identified—of links between resistant infections and greater mortality risks, for example—were overwhelmingly negative, but urgent research is needed to understand the impact of [antimicrobial resistance] and to drive an immediate and ambitious policy response."
Jul 13 Wellcome report

H5N6 avian flu infection hospitalizes Chinese man

China has reported another human H5N6 avian flu infection, this time in a 55-year-old man who lives in Bazhong City in Sichuan province, according to a statement today from Hong Kong's Centre for Health Protection (CHP).

The man's symptoms began on Jun 30, and he was hospitalized on Jul 4, where he is listed in critical condition. An investigation found that he had contact with live domestic poultry before he got sick. Sichuan province is in southwest China.

Since 2014, China's mainland has reported 32 H5N6 cases, which are often severe or fatal.

China and other countries, mostly in Asia, have reported H5N6 avian flu outbreaks in poultry, but China and Laos are the only nations to report human cases.
Jul 14 CHP statement

Zendel developing live-attenuated TB vaccines for children, adults

The Spanish pharmaceutical company Zendel has partnered with IAVI to develop a live-attenuated (weakened) tuberculosis (TB) vaccine that, if successful, could provide long-lasting protection in infants, adolescents, and adults, according to an IAVI news release today.

The vaccine candidate, called MTBVAC, will complete a phase 2 trial in adults this year. A phase 3 trial of MTBVAC in newborns is scheduled to begin in several African countries later this year, as well.

The only TB vaccine in use is bacille Calmette-Guérin (BCG), which has limited effectiveness in preventing pulmonary TB in adults. That vaccine has been used for 100 years.

IAVI, an international nonprofit research organization focused on developing vaccines and antibodies against infectious and neglected diseases, said progress on COVID-19 vaccines this year should not place developing a new and effective TB vaccine on the back burner.

"The urgency of global COVID-19 vaccine rollout is deservedly receiving unprecedented attention. At the same time, this global focus on disease control is an opportunity to go the extra mile and try to stamp out TB, which, once COVID-19 recedes, will resume its position as the leading cause of infectious disease deaths globally," said Mark Feinberg, MD, PhD, president and CEO of IAVI.

Before COVID-19, TB was the most deadly infectious disease in the world, killing 1.4 million people a year.
Jul 14 IAVI press release

COVID-19 Scan for Jul 14, 2021

News brief

Bacterial infections found in higher-risk, hospitalized COVID-19 patients

Half of 399 hospitalized COVID-19 patients developed bacterial infections 48 or more hours after hospitalization, according to a PLOS One study yesterday. The bacterial superinfections were associated most strongly with lung disease, encephalopathy, mechanical ventilation, hospital stay of 8 or more days, and steroid treatment.

From March to August 2020, the researchers looked at hospitalized COVID-19 patients at two clinics in Medellín, Colombia, who had at least one of the following risk factors: age over 60 years, diabetes, heart disease, lung disease, immunosuppression, or poor prognostic factors (eg, low white blood cells). The cohort consisted of 58.9% men, and 41.9% of the total was over 59 years. The most common comorbidities were high blood pressure (41.6%), diabetes (23.8%), obesity (15.0%), and hypothyroidism (13%).

Overall, 198 (49.6%) had bacterial superinfections, which had to meet clinical, paraclinical, and radiologic criteria. Sixteen species were identified, the most common being Klebsiella (pneumoniae and oxytoca) and Staphylococcus aureus. Most patients received antibiotics for 1 week (62.7%, 60.3% as monotherapy). Ampicillin/sulbactam was the most common treatment (56.4%), but other frequent antibiotics were piperacillin/tazobactam (29.9%), meropenem (18.6%), ciprofloxacin (16.7%), and ceftriaxone (15.2%).

During hospitalization, 28.8% of patients were admitted to the intensive care unit, 26.6% needed mechanical ventilation, 20.8% suffered kidney failure, and 10.5% died. The researchers found no fungal superinfections.

Data showed that bacterial superinfection was 36% higher in those 60 and above, 42% higher in those with chronic lung disease, 58% higher in those who were immunosuppressed, and 38% higher in those with acute renal failure. After multivariate adjustment, associations with bacterial superinfection were lung disease, encephalopathy, mechanical ventilation, hospital stay of 8 or more days, and steroid treatment.

"These results are vital to identifying priority clinical groups, improving the care of simultaneous infections with COVID-19 in people with the risk factors exposed in the population studied, and identifying bacteria of public health interest," the researchers write.
Jul 13 PLOS One study

Study finds well-being gap between remote, in-person high school learning

High school students taking remote classes had lower social, emotional, and academic well-being survey scores compared with high schoolers who attended in person during the pandemic, according to an Educational Researcher study yesterday.

The researchers had given a 10-question survey to 6,576 high schoolers enrolled at Orange County public schools in Florida. Students first took the survey in February 2020 when they were in grades 8 through 11, and later the same students, then in 9th to 12th grade, took the survey in October 2020. The second survey occurred 1 to 2 months after 63.9% had chosen to continue remote learning for the 2020-21 school year and the remainder had chosen to attend in person.

The survey was scored on a 100-point scale, and in-person students had higher scores in all three categories, with the largest difference in social well-being (77.2 vs 74.8), compared with emotional (57.4 vs 55.7) and academic (78.4 vs 77.3) well-being. The well-being gap was notably larger among 10th through 12th graders versus 9th graders, although the gap was present across gender, race/ethnicity, and socioeconomic status.

The researchers note that students who attended school in person were more likely male, White, in the ninth grade, ineligible for free or reduced-price meals, or from an English-speaking home. Although they were also more likely to have lower grades, they had a higher probability of having better social well-being.

"As policymakers gear up for national tutoring and remediation programs—which we agree are urgent priorities—we must recognize that our nation's students are not just lagging as performers, they are suffering as people," said lead author Angela L. Duckworth, PhD, MSc, MA, in an American Educational Research Association (AERA) press release. "Meeting their intrinsic psychological needs—for social connection, for positive emotion, and authentic intellectual engagement—is a challenge that cannot wait."
Jul 13 Edu Research study
Jul 14 AERA press release