News Scan for Jul 28, 2021

News brief

Second lab-worker CJD case prompts lab moratorium in France

Five research institutions in France are under a 3-month moratorium on prion research after a retired lab worker who handled prions was diagnosed as having Creutzfeldt-Jakob disease (CJD), according to a report today in Science.

An investigation is under way to see whether the worker was exposed to prions on the job, and the diagnosis follows the 2019 CJD death of a French lab worker who contracted the illness after pricking her thumb while conducting an experiment with prion-infected mice.

CJD is an incurable and fatal brain disease triggered by the misfolding of proteins. Symptoms typically occur up to 10 years after exposure, resulting in rapid-onset dementia and death, often within months.

The moratorium affects nine labs at the five institutions and has the goals of exploring an infection link between the lab work and the second patient's illness and identifying more prevention measures.

The second patient is a woman who works at a National Research Institute for Agriculture, Food and Environment lab in Toulouse and is still alive. French officials learned of her infection last week, a scientist familiar with the situation told the journal. So far, it's not clear if the patient has classic CJD or variant CJD.
Jul 28 Science report

Oxford launches early clinical trial of plague vaccine

Oxford University this week announced the phase 1 trial launch of a vaccine against plague, based on the same adenovirus platform that researchers used to develop the AstraZeneca-Oxford COVID-19 vaccine.

The trial will take place in 40 healthy adults ages 18 to 55 and will assess safety and how well the vaccine triggers protective antibody and T-cell responses, Oxford said in a press release. Volunteers will be followed for 12 months.

Andrew Pollard, MD, who directs the Oxford Vaccine Group, said plague has threatened the world over several millennia, and even today, outbreaks continue to disrupt communities. "A new vaccine to prevent plague is important for them and for our health security," he said. Cases continue to be reported in Africa, Asia, and the United States. A 2017 outbreak in Madagascar resulted in 2,119 suspected cases and 171 deaths.

Christine Rollier, PhD, an associated professor with the Oxford Vaccine Group, said antibiotics can be used to treat plague, which is caused by Yersinia pestis, but many areas that experience outbreaks are in remote locations, and an effective vaccine would be useful for preventing infections in those settings.
Jul 26 Oxford University press release

Study: Nursing home intervention led to fewer antibiotics for UTIs

A tailored intervention implemented at nursing homes in Denmark reduced antibiotic prescriptions and unnecessary interventions for urinary tract infections (UTIs) without substantially increasing hospitalizations and mortality, Danish researchers reported last week in The Lancet Infectious Diseases.

In a cluster-randomized trial involving 22 nursing homes, 11 were randomized from June 1, 2017, to June 1, 2018, to receive interactive educational sessions on how to distinguish between a UTI and asymptomatic bacteriuria and evaluate non-specific symptoms, along with an algorithm to determine whether a UTI is likely. The remaining nursing homes continued standard UTI management.

While nursing home staff in Denmark (unskilled workers, nurses, healthcare assistants, and healthcare helpers) don't prescribe antibiotics, the theory behind the intervention was that diagnosis and treatment of UTIs are directly influenced by the staff's knowledge and communication skills.

The primary outcome of the trial was the number of antibiotic prescriptions for acute UTI per residents per days at risk in the intervention and control groups. Secondary outcomes included the appropriateness of antibiotic treatment for UTIs, all-cause hospitalizations, and all-cause mortality.

A total of 1,470 nursing home residents (765 in the intervention group and 705 in the control group) were analyzed for the primary endpoint. The number of prescriptions for UTI per resident was 134 per 84,035 days at risk in the intervention group, compared with 228 per 77,817 days at risk in the control group, for an unadjusted rate ratio (RR) of 0.51 (95% confidence interval [CI], 0.37 to 0.71) and an adjusted RR of 0.42 (95% CI, 0.31 to 0.57).

In terms of secondary outcomes, the risk of receiving appropriate antibiotic treatment (RR, 0.65; 95% CI, 0.41 to 1.06) and inappropriate (RR, 0.33; 95% CI, 0.23 to 0.49) treatment was lower in the intervention group. All-cause hospitalization increased in the intervention group (adjusted RR, 1.28; 95% CI, 0.95 to 1.74), but all-cause mortality was lower (adjusted RR, 0.91: 95% CI, 0.62 to 1.33).

"Our results imply that a broader range of health professionals should be engaged in antibiotic stewardship and that programmes should be tailored to address potential barriers to implementation and should focus on education, reflection, and a structured professional dialogue," the study authors wrote.
Jul 22 Lancet Infect Dis abstract

COVID-19 Scan for Jul 28, 2021

News brief

New metric shows COVID-19 reduced lifespan significantly

COVID-19 reduced lifespan by up to 9 years in parts of the United States, per a new "mean unfulfilled lifespan" (MUL) metric, according to a study published yesterday in PLOS One.

The MUL is a new indicator of the impact of mortality shocks, such as the novel coronavirus or other natural disaster, on peoples' lifespan.

In contrast to period life expectancy at birth (PLEB), the MUL is the difference between the average age at death for those who died in a given timeframe, and the average age these individuals would have been expected to reach, if there had not been a temporary shock to mortality rates, according to a Public Library of Science news release emailed to journalists.

Using the metric, the authors determined that the MUL for COVID-19 peaked during 7-day rolling average in 2020 at 6.43 years in Lombardy, Italy; at 8.91 years in New Jersey; and at 6.24 years in Mexico City.

"Mortality conditions are always changing, but when these changes are relatively steady, changes in PLEB remain interpretable as changes in individual longevity," the authors wrote. "When declines in PLEB are induced by a relatively rapid and likely temporary increase in mortality, such as currently experienced with the COVID-19 pandemic, however, they become hardly interpretable as indicators of changes in the individual lifespan."

The MUL, the authors said, will be a useful tool for COVID-19 and other pandemics in the future.
Jul 27 PLOS One study

Study: 40% still had COVID symptoms 1 to 6 months after hospital release

Forty percent of 290 COVID-19 survivors completing an Emory University survey 1 to 6 months after release from the hospital reported lingering symptoms such as fatigue, shortness of breath on exertion, and "mental fog."

The study, published yesterday in Open Forum Infectious Diseases, involved an emailed survey about persistent COVID-19 symptoms, acute illness severity, and quality of life to better quantify and characterize "long COVID."

Of the 209 patients, 39.7% said they still had symptoms, including fatigue (20.3%), shortness of breath on exertion (14.1%), mental fog (13.5%), and loss of smell (11.9%).

Common symptoms tied to reports of worse physical health included weakness, fatigue, muscle pain, depression, and mental fog. For those reporting that emotional issues were limiting their daily activities, the most common symptoms were irritability, depression, back pain, anxiety, and ear fullness.

Proportion of patients with lingering symptoms wasn't associated with time since acute illness (fewer than 90 days, 37.2% vs more than 90 days, 40.4%). Predictors of long-term symptoms included provider-reported moderate or severe illness (adjusted odds ratio [aOR], 3.24), female sex (aOR, 1.99), greater length of time since acute illness (aOR, 2.24), and middle age (aOR, 2.08). More than half of respondents said they had sought or planned to seek medical attention for their symptoms.

"Symptoms following acute COVID-19 are common and may be predicted by factors during the acute phase of illness," the study authors wrote. "Fatigue and neuropsychiatric symptoms figured prominently. Select symptoms seem to be particularly associated with perceptions of physical health following COVID-19 and warrant specific attention on future studies."

The researchers called for future research into the risk factors, mechanisms, duration, and subtypes of long COVID.
Jul 27 Open Forum Infect Dis study