News Scan for Oct 14, 2021

News brief

DRC confirms second Ebola case, per media report

A second Ebola case has been confirmed in the latest outbreak in the Democratic Republic of the Congo (DRC), a city health official from the city of Beni told Reuters.

The latest case involves a 42-year-old woman who tested positive yesterday, according to Michel Tosalisana, the health official from Beni, where a cluster of cases was recently reported. They include a 2-year-old boy, whose fatal illness was confirmed, and three suspected cases—the boy's neighbors—who died earlier after experiencing similar symptoms.

Beni was one of the epicenters in a large outbreak in North Kivu province that occurred from 2018 to 2020. The World Health Organization (WHO) has said that sporadic recurrent cases are expected, given Ebola persistence in some survivors and that animal species found in the DRC harbor the virus.

So far, it's not clear if the latest flare-up is linked to earlier human cases. North Kivu province experienced a smaller recurrence earlier this year that appeared to be linked to the large event, though the source of the outbreak was never found. Genetic sequencing is under way on samples from the boy who died, with results expected this week.

Yesterday, health officials launched an Ebola vaccination campaign in Beni targeting the boy's contacts and the contacts of those contacts.
Oct 14 Reuters story
Oct 11 CIDRAP News story
Oct 13 CIDRAP News scan

Zika outbreaks reported in 2 Indian states

The WHO today detailed Zika outbreaks in two Indian states, Kerala and Maharashtra, with no cases of microcephaly (undersized head in infants) or Guillain-Barre syndrome reported so far in either event.

Kerala state in in southwest India, and Maharashtra state is in the northwestern part of the country. The cases are the first for both states, though India has reported Zika virus before.

The first case in Kerala's outbreak was confirmed in early July, and is the state's first. The patient is a 24-year-old woman pregnant woman from Trivandrum district. Retrospective testing in 19 patients and staff who had similar symptoms in May revealed positive findings for 13 patients, hinting that the virus had been circulating in Kerala state since May.

Active case finding and passive surveillance involving 590 blood samples in July yielded 70 positive samples, all involving people who lived in or had visited Trivandrum district.

In late July, health officials from Maharashtra state reported the first lab-confirmed case in Belsar, a village in Pune district. The initial case involved a 50-year-old woman who tested positive for both Zika and chikungunya. Of 51 samples collected from village residents with suspected infections, 40 were negative, and results for the other 11 are pending.

The WHO said three Indian states had reported Zika cases in 2018: Gujarat, Madhya Pradesh, and Rajasthan. All involved the Southeast Asian lineage, and no microcephaly cases were associate with the country's earlier cases. The agency added that more outbreaks aren't surprising, given the wide distribution of the mosquito vector in the two states, though it's notable that this is the first time cases have been confirmed in the locations.
Oct 14 WHO statement

Officials detail yellow fever outbreak in Venezuela

A yellow fever outbreak near a rural city in northeastern Venezuela has resulted in seven cases, the WHO said yesterday, based on reports from the country's health officials.

The outbreak is centered south of the city of Maturin in Monagas state. Of 7 confirmed case-patients, 3 were asymptomatic and 4 had symptoms that began from Sep 20 to Sep 24. The initial case is in a young pregnant woman who was vaccinated, but the other 6 were unvaccinated. No deaths have been reported.

Since Aug 11, Venezuela has detected 10 yellow fever outbreaks (epizootics) involving monkeys, including 2 not far from Maturin.

The WHO said Venezuela is a high-risk country for yellow fever and vaccination coverage is suboptimal, posing a threat of onward transmission and virus amplification. It added that the increased number of human cases and epizootics is concerning due to the persistence of high viral circulation. Monagas state has a 67.7% yellow fever vaccine coverage, suggesting that the population remains at risk.

The outbreak is occurring against the complex healthcare backdrop of COVID-19–related disruptions on the healthcare system, including an extra burden on lab capacity.
Oct 13 WHO statement

COVID-19 Scan for Oct 14, 2021

News brief

Kids may serve as COVID-19 reservoirs for variants, study says

Using COVID-19 viral load and viral cultures from 110 children, researchers suggest that children may serve as reservoirs for COVID-19, furthering transmission and viral evolution.

The researchers created a prospective cohort of patients 21 years or younger who sought care at Massachusetts General Hospital or its urgent care clinics between April 2020 and 2021 (median age, 10 years). About 56% were boys, and 38% were Hispanic. Thirty-six children (33%) required hospitalization, of whom 18 required supplemental oxygen or respiratory support of any kind.

Thirty patients (27.3%) were asymptomatic, and they were more likely to be younger than those with mild disease. Those who were hospitalized with low oxygen levels were significantly older than those in both groups.

Asymptomatic children and those with mild disease had significantly higher viral loads than adults hospitalized with COVID-19 with comparable symptom duration, according to the study. No viral load difference was seen with hospitalized pediatric COVID-19 patients and hospitalized adults of similar illness duration. Adult patient data was derived from the Massachusetts General Hospital COVID-19 Biorepository from April to August 2020.

Of 126 pediatric respiratory samples, the researchers cultured live virus from 33, including eight taken from asymptomatic children. Higher viral load was predictive of live virus shedding but similar to viral load observation, age was not associated with viral culture results.

"Our results suggest that the low rates of transmission in settings such as schools and daycares cannot be attributed to low viral loads, low rates of viral shedding, or rapid clearance of virus in younger patient populations," the researchers write, asking policy makers to consider how mitigation efforts for vaccinated adults may affect children. "Our results additionally suggest that pediatric populations have the potential to serve as a community reservoir of actively replicating virus, with implications for both new waves of infection and the evolution of viral variants."

The researchers note that SARS-CoV-2 lineages reflected those in the community of the time: 57 samples from 54 children showed four Alpha (B117) variants, three Iota (B1526.2) variants, and no Delta (B1617.2) variants.
Oct 14 J Infect Dis study

Public-facing COVID experts receive harassment, death threats

In a Nature survey of 321 scientists who spoke out about COVID-19 to the media or on social media, about 42% said they had emotional or psychological distress afterward, 22% have received threats of physical or sexual violence, and 15% have received death threats.

The survey's results, which were included in a Nature news feature yesterday, also found that the more a scientist was attacked, the more they were likely to say their readiness to give future media interviews was affected.

Overall, more than two-thirds of researchers had a negative experience as a result of sharing their opinion or expertise. While the survey respondents were largely from the United Kingdom, Germany, and the United States, the results were similar to a smaller, 50-person survey the Australian Science Media Centre in Adelaide sent to researchers on its COVID-19 media lists in June.

The Nature feature was full of anecdotes of scientists receiving home phone calls, emails, suspicious mailed packages, and malicious tweets, as well as high profile examples, such as when a Belgian military sniper went on the run after stating he was going to target virologists.

According to epidemiologist Gideon Meyerowitz-Katz, MPH, a PhD candidate at the University of Wollongong in Australia, two major triggers are statements about vaccines and the unproven COVID-19 drug ivermectin. "It's anonymous people e-mailing from weird accounts saying 'I hope you die' or 'if you were near me I would shoot you,'" he said.

Two percent of survey respondents said they had experienced physical attacks after their public comment.

About 44% of survey respondents who had been harassed didn't tell their employer, but of those who did, almost 80% found their employer to be at least somewhat supportive (eg, setting up an email filter, identifying and warning harassers).

Help does not always come, however. For instance, Andrew Hill, MD, PhD, a pharmacologist at the University of Liverpool in England, complained to Twitter about the litany of abusive tweets directed toward him, including images of hanged corpses and coffins, but the company said they did not violate its terms of use.
Oct 13 Nature feature

Obesity linked to COVID-19 death, longer ICU stay

High body mass index (BMI) was independently associated with death and longer intensive care unit (ICU) stays for hospitalized COVID-19 patients, according to a study published yesterday in PLOS One.

The researchers looked at Sweden's nationwide ICU population from Mar 6 to Aug 30, 2020, and found 1,649 adults with COVID-19, of whom 78.3% were at least overweight (25 kilograms per square meter [kg/m²] or more). Besides having an overrepresentation of obese people compared with Sweden's general population (39% in the cohort), the study group also consisted of more men (74.4%). Mean age was 60.1 years.

Higher BMI was associated with the composite outcome of death during ICU stay or an ICU stay longer than 14 days in survivors, even after adjusting for age, sex, comorbidities, and illness severity (odds ratio [OR] per standard deviation increase, 1.30; 95% confidence interval [CI], 1.16 to 1.44). Those with a BMI of 35 kg/m²or higher (class 2 or 3 obesity) were at double the risk of the composite outcome, the researchers note.

"Based on our findings, we advocate that BMI is included in the severity scoring for patients with COVID-19 admitted to intensive care, and suggest that individuals with obesity should be more closely monitored when hospitalized for COVID-19," write the researchers.

"In a large prospective study [by Matthieu Schmidt, et al], 94% of all participating ICUs reported that the COVID-19 pandemic led to a need of extended number of ICU beds," they add. "Thus, the prolonged [length of stay] is an important factor not only for the individual patient but also as an important factor for health care, putting excess strain on ICUs during the COVID-19 outbreak."
Oct 13 PLOS One study