News Scan for Nov 24, 2021

News brief

Study shows rising use of ceftazidime-avibactam for CRE infections

A large study of patients in Veterans Administration (VA) hospitals shows a significant increase in the use of ceftazidime-avibactam for carbapenem-resistant Enterobacterales (CRE) infections, US researchers reported today in Infection Control & Hospital Epidemiology.

Cefazidime-avibactam was approved by the Food and Drug Administration in 2015 and is now considered a primary option for CRE infections by the Infectious Diseases Society of America. To date, however, there have been no large national studies to evaluate prescribing trends in patients with confirmed CRE infections, who traditionally have been treated with polymyxins and the aminoglycoside antibiotic tigecycline.

The cross-sectional study of patients treated at 134 VA facilities from 2012 through 2018 identified 7,767 patients with positive CRE cultures, 65% of whom met the definition of receiving antibiotic treatment and were included in the cohort. Urine cultures were the major source (51.7%) of CRE, followed by respiratory (20.1%), blood (13.7%), and other cultures (14.5%). The frequency of bloodstream infection (BSI) CRE isolates increased over time, and the condition was more likely to be found in Black and Latino patients.

In patients with BSI and non-BSI CRE cultures, use of ceftazidime-avibactam increased significantly over time (by 154.0% and 433.0%, respectively), as did use of extended-spectrum cephalosporins (385.5% and 111.1%), while use of aminoglycosides (58.0% and 49.0%) and polymyxins (72.6% and 79.7%) fell significantly. In 2018, 54.1% of CRE BSI patients and 22.7% of CRE non-BSI patients received ceftazidime-avibactam.

"This large national cohort study of veterans with CRE showed an encouraging trend toward increased uptake and utilization of ceftazidime–avibactam for CRE, with decreased utilization of 'older' agents such as aminoglycosides and polymyxins," they write. "Future studies will need to assess uptake and utilization of other, more recently approved antibiotics targeting multidrug-resistant gram-negative bacteria."
Nov 24 Infect Control Hosp Epidemiol abstract

Low-path H5 avian flu turns up on Minnesota turkey farm

Routine testing in a Minnesota turkey flock turned up low-pathogenic H5 avian influenza, the Minnesota Board of Animal Health (MBAH) said yesterday in a statement. The affected farm is in Kandiyohi County, located about 90 miles west of Minneapolis.

The US Department of Agriculture (USDA) National Veterinary Services Laboratory in Ames, Iowa, confirmed the findings. The MBAH said the low-path H5 virus doesn't pose a health risk to the public and isn't the same one that caused highly pathogenic outbreaks in Midwestern poultry in 2015.

Beth Thompson, DVM, the state's veterinarian, said testing birds before they go to market is standard protocol for poultry in Minnesota, a step that ensures that healthy birds are sent to production and that diseases are identified early so producers can manage them.

The turkey flock is under quarantine, and surveillance is under way among backyard and commercial flocks within a 10-kilometer radius.

North American lineage low-pathogenic and highly pathogenic avian flu outbreaks occur in US poultry occasionally and pose a low threat to humans, according to the Centers for Disease Control and Prevention (CDC).

In the fall of 2018, low-pathogenic H5N2 was detected at eight Minnesota turkey farms in Kandiyohi and Stearns counties, according to the USDA. California this year has reported four low-path avian flu detections in domestic poultry, including two in October. All were related to spillovers from wildlife, according to the California Department of Food and Agriculture (CDFA).
Nov 23 MBAH statement
CDC avian flu background
USDA background
CDFA avian flu updates

WHO: Global flu activity rises slightly

Though global flu levels are still low, activity has increased slightly, with some regions showing a few signs of a return to pre-COVID patterns for this time of year, the World Health Organization (WHO) said in an update that covers the last week of October and the first week of November.

In Europe, flu levels are still low but appear similar to pre–COVID-19 levels for the reporting period in some countries. In North America, flu activity increased slightly but is still below the national threshold. Southern Asia also reported flu activity at levels seen in previous seasons.

The WHO also took note of South Africa's out-of-season flu rise and said several world regions are still reporting elevated respiratory syncytial virus (RSV) activity.

Of respiratory samples that tested positive for flu at national flu labs from Oct 25 to Nov 7, 54.6% were influenza B. Of subtyped influenza A viruses, 86.1% were the H3N2 strain.

The WHO included the caveat that flu patterns should be interpreted with caution, due to potential impacts from COVID-19 surveillance and public health measures.
Nov 22 WHO global flu update

WHO: Polio still public health emergency of international concern

During the WHO's 30th meeting of the polio emergency committee, the group agreed that the international polio situation still warrants a public health emergency of international concern (PHEIC), mainly due to cross-border spread of circulating vaccine-derived polioviruses (cVDPV) and the unpredictable situation of wild polio virus 1 (WPV1) transmission in Afghanistan.

Throughout 2021, WPV1 transmission has fallen to low levels, with no new cases reported since January 2021, when two WPV1 cases occurred, one each in Pakistan and Afghanistan. That compares with 129 WPV1 cases during the same period in 2020, the committee said. Despite this, both countries still have what the committee called a population of "persistently missed children" who have not been vaccinated against polio.

Currently cVDPV cases have been detected in 30 countries in Africa, Europe, and the Eastern Mediterranean region. Three new countries, Guinea Bissau, Mauritania, and Ukraine, have reported new cases of circulating vaccine derived poliovirus type 2 (cVDPV2) in 2021.

The number of cVDPV2 cases in 2021 is 420, of which 266 have occurred in Nigeria.

"The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC but concluded that there are still significant risks despite apparent progress made in the two endemic countries, and that the coming three months would be a critical period to monitor the situation there closely," the WHO said.
Nov 23 WHO statement

COVID-19 Scan for Nov 24, 2021

News brief

SARS-CoV-2 antibody levels predict COVID vaccine efficacy, study finds

SARS-CoV-2 antibody concentrations predict COVID-19 vaccine effectiveness, with higher levels correlating with greater protection, according to an ongoing US phase 3 clinical trial yesterday in Science.

A team led by researchers from Fred Hutchinson Cancer Research Center in Seattle evaluated 30,420 adult recipients of the Moderna mRNA COVID-19 vaccine at 99 centers for neutralizing and binding antibodies as correlates of risk for, and protection against, infection.

They measured the antibodies at the second vaccine dose and then again 4 weeks later. Concentrations were inversely associated with COVID-19 infection risk and directly tied to vaccine efficacy.

Vaccine effectiveness in vaccinees with 50% neutralizing antibody levels of 10, 100, and 1,000 international units per milliliter was 78% (95% confidence interval [CI], 54 to 89%), 91% (95% CI, 87% to 94%), and 96% (95% CI, 94% to 98%), respectively.

Based on antibody levels, the estimated risk of SARS-CoV-2 infection was roughly 10 times lower for vaccinees whose antibody concentrations were in the top 10% of values, relative to those with negative or undetectable values.

The results help define immune marker correlates of protection, or biomarkers to measure how much immunity is needed to prevent COVID-19 infection, the study authors said. Identifying and validating a correlate of protection would expedite vaccine research and regulatory approval for existing vaccines for new groups of people, modifications of vaccine regimens, and new vaccines, they added.

"Our findings that all evaluated binding and neutralizing antibody markers strongly inversely correlated with COVID-19 risk, and directly correlated with vaccine efficacy, adds evidence toward establishing an immune marker surrogate endpoint for mRNA COVID-19 vaccines," the researchers wrote.
Nov 23 Science study

Study: 1 in 5 people avoided healthcare during initial COVID-19 lockdown

A study yesterday in PLOS Medicine shows that up to 20% of people polled in the Netherlands avoided seeking healthcare during the initial months of the COVID-19 pandemic, even for serious health concerns.

The study is based on results from 5,656 participants of the Rotterdam Study, who answered questions on healthcare from April 2020 to July 2020. The study is an ongoing effort to assess chronic diseases in mid to late life.

One in five participants (20.2%) reported avoiding healthcare during the pandemic. Of those, 36.3% reported symptoms that warranted urgent care, including limb weakness (13.6%), heart palpitations (10.8%) and chest pain (10.2%). Adjusted odds ratios showed women were more likely to avoid care (1.58; 95% confidence interval [CI], 1.38 to 1.82), as were those with poor self-appreciated health (per-level decrease, 2.00; 95% CI, 1.80 to 2.22).

High rates of depression were also related to avoiding healthcare.

In a PLOS press release, senior author Silvan Licher said, "One in five avoided healthcare during COVID-19 lockdown, often with alarming symptoms like chest pain or limb weakness. Vulnerable citizens were mainly affected, emphasising the urgent need for targeted public education."
Nov 23 PLOS Medicine study
Nov 23 PLOS press release

Significant improvement noted in death rates of COVID-19 cancer patients

Research published today in JAMA Oncology finds lower estimated all-cause death rates among COVID-19–infected European cancer patients over time.

The study, by the OnCovid Study Group in Europe used data from a registry of adults with blood cancer or solid tumors diagnosed as having COVID-19 from 35 centers in six countries (Belgium, France, Germany, Italy, Spain, and the United Kingdom) from Feb 27, 2020, to Feb 14, 2021, before the emergence of the Delta (B1617.2) variant. Patients were, on average, 68 years old, and 52.8% were men.

The authors noted a significant time-dependent improvement in 14-day case-fatality rates, from 29.8% in February to March 2020, to 20.3% in April to June 2020, 12.5% in July to September 2020, 17.2% in October to December 2020, and 14.5% in January to February 2021.

In the first major European outbreak (February to June 2020), the 14-day case-fatality rate was 25.6%, compared with 16.2% in the second outbreak (July 2020 to February 2021). After adjustment for multiple factors, patients diagnosed as having COVID-19 in the first outbreak were at higher risk of death by 14 days (hazard ratio [HR], 1.85) and 3 months (HR, 1.28) than those diagnosed in the second outbreak.

The study authors said that the lower death rate over time may be linked to earlier COVID-19 diagnosis, better treatments, and changes in community SARS-CoV-2 transmission.

While the authors acknowledged the difficulty of direct measurement of the factors that may have contributed to the lower death rate among patients with cancer and COVID-19, they conclude, "This case series provides an important contemporary portrait of the evolving outcomes of COVID-19 in patients with cancer, highlighting the importance of widespread SARS-CoV-2 testing as a strategy to facilitate early diagnosis of COVID-19 and maintain the appropriate therapeutic pathway for patients with cancer despite the ongoing threat of an unresolved global pandemic."
Nov 24 JAMA Oncol study