Disrupted care, discrimination tied to less infant vaccination during COVID
US infants born early in the pandemic were less likely to receive routine childhood vaccinations if their mothers had perinatal care disruptions (those just before or after birth) or experienced discrimination during pregnancy, according to a prospective study today in JAMA Pediatrics.
Stony Brook University researchers analyzed data from 4,388 pregnant women 18 years and older across the country recruited from social media from Apr 25 to May 14, 2020. They completed a baseline survey and two follow-up surveys in July and October, at which time 1,107 infants were 3 to 5 months old.
Eighty-nine infants (8.0%) had incomplete vaccination uptake by 3 to 5 months, with 51 (4.6%) receiving some vaccinations and 38 (3.4%) receiving none. Analyses showed that incomplete vaccine uptake was tied to previously established maternal factors such as the number of times the woman has given birth, education level, health insurance status, and other factors related and unrelated to COVID-19, such as income loss, discrimination, receipt of prenatal telehealth care, and shorter post-delivery hospitalization.
A multivariate analysis identified some of the same key factors, such as prenatal telehealth care and shorter postpartum hospitalization, COVID-19–related income loss, and discrimination owing to race, gender, or body size. Infants whose mothers were more concerned about perinatal infection and more satisfied with their birth experience had a higher likelihood of complete vaccination status.
The study authors said that pandemic-related income loss could interfere with complete infant vaccination status by limiting access to or affordability of healthcare and that prenatal telehealth care and shorter post-delivery hospitalization may decrease opportunities for vaccine education.
The researchers called for policies and protocols that guarantee patient education about infant vaccination, particularly healthcare disruptions such as those caused by the pandemic.
"Since vaccination status in early infancy is overwhelmingly predictive of future up-to-date vaccination status, strategies to address perinatal care limitations and discrimination merit serious consideration by policy makers, health care organizations, and obstetric and pediatric clinicians," they wrote. "To promote infant vaccination, special attention should be given to vulnerable women who experienced financial loss or discrimination or had negative health care experiences."
Nov 22 JAMA Pediatr research letter
WHO urges vigilance against H5N6 avian flu after cases rise in people
The World Health Organization (WHO) said late last week that it's not clear whether highly pathogenic H5N6 avian flu viruses have enhanced potential for infecting people but urged countries to remain vigilant as human cases rise.
The WHO said in its risk assessment that 26 H5N6 human infections have been reported in 2021—25 in China and 1 in Laos—with 20 of the patients reporting illness onset after Jun 21. Almost all confirmed cases involved exposure to poultry, and most occurred in adults with a median age of 55 years. One child was infected. All sequenced viruses belonged to hemagglutinin genetic clade 2.3.4.4b, a group of viruses that have gradually become more prevalent in birds in China and neighboring countries over the past year.
The WHO said the rise in human H5N6 infections may reflect the spread of the viruses in poultry, along with increased diagnostic capacity and more awareness of respiratory illnesses, which is a direct outcome of the COVID-19 pandemic. But whether the H5N6 viruses have enhanced intrinsic zoonotic potential—a greater ability to transmit from animals to people—is unclear.
"Although genetic markers known to be associated with mammalian adaptation have been identified sporadically in individual cases following infection, these changes were not consistently present in environmental or poultry viruses and likely reflect intra-host mutations," the WHO said. "While the zoonotic threat remains elevated due to spread of the viruses in birds, based on evidence available so far, the overall pandemic risk is considered not significantly changed in comparison to previous years."
Minimizing the risk to people will depend on decreasing virus circulation in poultry, reducing the amount of virus in live bird markets and on farms, and mitigating exposure to infected birds, the agency said.
Nov 19 WHO risk assessment
OIE urges increased avian flu surveillance as poultry outbreaks expand
As countries enter the high-risk period for avian flu spread in birds, the World Organisation for Animal Health (OIE) recently recommended stepped-up surveillance and biosecurity efforts.
In a Nov 19 statement, the agency said that, since May, 41 countries have reported various highly pathogenic subtypes in poultry and wild birds, which pose a threat to food security and economic security.
Avian flu outbreaks show a seasonal pattern, which typically starts in October. However, nearly 16,000 detections have already been reported for the month, signaling an increased risk, the OIE said. It noted that an unprecedented number of subtypes are circulating, including H5N1, H5N3, H5N4, H5N5, H5N6 or H5N8. On rare occasions, the disease poses a human health threat, such as the spate of recent H5N6 cases in China, as noted above.
The OIE emphasized that it's critical for countries to notify it of outbreaks quickly to support the accurate and timely monitoring of virus spread.
Nov 19 OIE statement
In related developments, several countries reported new H5N1 outbreaks, including the Czech Republic (goose farm, South Bohemia region), Germany (turkey farm, North Rhine-Westphalia state), Ireland (turkey farm, Monaghan County), and Israel (turkey and duck farms, Hadarom, Hazafon, and Haifa districts), according to the most recent OIE outbreak notifications.
In Asia, Japan reported a wild bird H5 detection in Kagoshima province, and South Korea reported its sixth outbreak (duck farm, South Jeolla province), according to statements translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.
Also, the United Kingdom's Department for Environment, Food, and Rural Affairs (DEFRA) over the past few days reported five more H5N1 outbreaks. The highly pathogenic strain has been reported in Essex, Cheshire, and Cumbria, and pathogenicity tests are still under way regarding H5N1 detections in Norfolk and North Yorkshire.
Nov 19 OIE report on H5N1 in the Czech Republic
Nov 19 OIE report on H5N1 in Germany
Nov 22 OIE report on H5N1 in Ireland
Nov 18 OIE report on H5N1 in Israel
Nov 21 AFD post
Nov 21 DEFRA update
