News Scan for Sep 06, 2022

News brief

Those with, without HIV have similar monkeypox outcomes, study finds

A new study from Germany shows no major differences in the clinical picture in those with or without HIV who contract monkeypox. The study, in HIV Medicine, was based on 546 monkeypox cases in Germany, which has one of the highest monkeypox case counts in Europe. The study is published in HIV Medicine.

All patients in the study were men who have sex with men (MSM), and 46.9% were living with HIV, mostly with a preserved immune system and viral suppression. In men without HIV, 42.5% were also taking HIV pre-exposure prophylaxis (PrEP) and 10.6% of MSM had no known HIV infection or PrEP use. The median age was 39.

The symptoms and presentation of the virus were similar in men both with and without HIV. No men died, and 4% required hospitalization.

Also, a study in The Lancet Child & Adolescent Health describes 16 pediatric cases of monkeypox in Spain; 4 patients were 4 years old or younger, and the other 12 were ages 13 to 17.

In three of the younger patients the transmission route was through household contact with their parents, and in one patient the transmission route was unknown. In the older group, nine patients were infected via an outbreak in a tattoo and piercing studio, and three contracted the disease during sexual contact.

None of the pediatric patients required hospitalization.

In other news, the US Centers for Disease Control and Prevention (CDC) late last week reported 497 more monkeypox cases, raising the national total to 19,962.
Sep 4 HIV Med study
Sep 1 Lancet Child Adolesc Health study
Sep 2 CDC update

Yellow fever cases increase in Africa, WHO says

Though yellow fever is endemic in Africa, the situation has intensified since the end of 2021, with 12 countries reporting probable or confirmed cases, the World Health Organization (WHO) said in a Sep 2 update. It added that ongoing complex transmission has led to 184 confirmed cases, 274 probable cases, and 21 deaths from Jan 1, 2021, to Aug 26, 2022.

Of nine countries that reported cases in 2021, six continue to report confirmed cases in 2022. One of the major hot spots is Ghana, which reported 33% of all confirmed cases. This year, Kenya and Uganda have been added to the list of countries reporting confirmed cases. Most cases involve people aged 30 or younger.

The WHO said more cases are expected as Africa enters the season when cases typically rise. It said the risk at the regional level is high, amid concerns about suboptimal immunization coverage in most of the affected countries. The WHO said routine childhood vaccination for yellow fever in 2021 was 47%, much lower than the 80% threshold needed to confer population immunity. Coverage in affected countries ranges from 7% in Kenya to 94% in Ghana.

Many countries experiencing yellow fever cases are grappling with other health threats and instability, which contributes to delays in diagnosis and surveillance. The WHO noted that the global risk is low and that no exported cases have been reported since January 2021.
Sep 2 WHO yellow fever update

WHO prequalifies GSK malaria vaccine

GSK today announced that the WHO has prequalified its RTS,S/AS01 (Mosquirix) vaccine, the first for a malaria vaccine and a key step that paves the way for the vaccine to distributed to countries that have moderate to high Plasmodium falciparum malaria transmission.

The WHO prequalification is mandatory for United Nations organizations such as UNICEF to buy vaccine in partnership with Gavi, the Vaccine Alliance. Prequalification is a rigorous regulatory process that assesses clinical, safety, and technical data to ensure that the vaccine meets preset standards and is appropriate for the target population.

Thomas Breuer, GSK's chief global health officer, said that so far more than 1 million children in Ghana, Kenya, and Malawi have had at least one dose of the vaccine, donated by GSK through the Malaria Vaccine Implementation Programme. He added that the WHO prequalification paves the way for more kids to benefit from the vaccine.

A WHO-led pilot program was first launched in Malawi in 2019, which showed that the vaccine was safe and feasible. In October 2021, the program was expanded to more moderate- and high-risk countries. The vaccine is given on a four-dose schedule that begins at 5 months and continues through age 2.
Sep 6 GSK statement

COVID-19 Scan for Sep 06, 2022

News brief

Study: Most COVID survivors had cardiac involvement nearly 1 year later

A study of 346 previously healthy COVID-19 survivors finds that 73% had cardiac signs and symptoms more than 3 months after infection, and 57% still had them at nearly 1 year.

In the study, published yesterday in Nature Medicine, a team led by University Hospital Frankfurt researchers in Germany measured blood biomarkers of heart injury and dysfunction and performed magnetic resonance imaging (MRI) on 346 COVID-19 survivors who had no previous heart disease or notable chronic conditions at a median of 109 and 329 days.

The first screening took place from April 2020 to October 2021. Average participant age was 43.3 years, and 52% were women. A total of 144 participants (42%) received mRNA COVID-19 vaccination from baseline to follow-up, but the effects of vaccination weren't systematically assessed.

At 109 days, 73% of participants noted cardiac symptoms such as shortness of breath during exertion (62%), palpitations (28%), chest pain (27%), and fainting (3%). Participants who had symptomatic COVID-19 infections had higher heart rates and signs of heart inflammation on MRI than asymptomatic patients, but structural heart disease and biomarkers of heart injury or dysfunction were rare in symptomatic patients.

Of all participants, 38% had mild cardiac symptoms, while 33% reported moderate symptoms, and 3% had severe symptoms that resulted in the inability to leave home owing to sudden general weakness, dizziness, and blackouts.

At a median of 329 days, 57% of participants reported cardiac symptoms, including 5% who developed new cardiac symptoms since baseline. Those reporting cardiac symptoms had more evidence of diffuse myocardial edema than those without cardiac symptoms. Women were significantly more likely than men to have lingering cardiac symptoms (67% vs 46%).

"Ongoing inflammatory cardiac involvement may, at least in part, explain the lingering cardiac symptoms in previously well individuals with mild initial COVID-19 illness," the researchers wrote.
Sep 5 Nat Med study

Mobile app detects COVID-19 infection in people's voices

A mobile smartphone app uses artificial intelligence (AI) to accurately detect COVID-19 infections in people's voices, according to research presented this week at the European Respiratory Society International Congress in Barcelona, Spain.

The developers of the app said the program detected infections with more accuracy than lateral flow or rapid antigen tests, and is cheaper than a polymerase chain reaction (PCR) test. The app was accurate in detecting infection 89% of the time.

"These promising results suggest that simple voice recordings and fine-tuned AI algorithms can potentially achieve high precision in determining which patients have COVID-19 infection," said Wafaa Aljbawi, a researcher at the Institute of Data Science, Maastricht University, the Netherlands, in a European Lung Foundation press release. "Such tests can be provided at no cost and are simple to interpret. Moreover, they enable remote, virtual testing and have a turnaround time of less than a minute."

The researchers used different artificial intelligence models to classify voices, patterns of speech, power, and variation over time in audio samples collected by the University of Cambridge, which included recordings from 4,352 healthy and non-healthy participants, 308 of whom had tested positive for COVID-19.

Participants provided several audio samples, which included coughing, reading a short sentence, and breathing deeply through the mouth.

The best performing model was called the Long-Short Term Memory (LSTM). Using that model, researchers were able to correctly identify true positives 89% of the times, and true negatives 83% of the time.

Lateral flow tests, or home rapid antigen tests, have a sensitivity of only 56%, Aljbawi said, which means more true positives may be missed.
Sep 4 European Lung Foundation press release

US BA.5 dominance still high; pharmacies begin receiving booster updates

The Omicron BA.5 SARS-CoV-2 subvariant predominance remained high last week, making up 88.6% of sequenced samples, down just a hair from 88.7% last week, the Centers for Disease Control and Prevention (CDC) said today in its latest update.

Meanwhile, over the past week the proportion of the BA.4.6 Omicron subvariant rose from 7.5% to 8.4% of samples. The proportions of BA.4.6 are still highest in the southern tier of Midwestern states, where it accounts for 17.8% of samples.

The 7-day average for new daily cases continues to decline, and at 77,316 is at its lowest level since early May, according to the Washington Post tracker, which said cases over the past week are down 12%, with a 9% decline in hospitalizations. Deaths remain steady.

In the wake of last week's emergency use approval of and recommendation for updated boosters from Moderna and Pfizer-BioNTech, two of the nation's major pharmacy chains—Walgreens and CVS—announced that customers can book online appointments as they begin receiving their supplies.

In international developments, the European Centre for Disease Prevention and Control (ECDC) and the European Medicine Agency (EMA) today issued guidance on the use of updated COVID boosters, which urges that people at higher risk of complications be prioritized, including those age 60 and older, those who have weakened immune systems, and people with underlying health conditions.

Elsewhere, cities in China are still battling rises in local COVID activity, with Shenzhen ending a brief lockdown and officials in Chengdu extending its lockdown, according to Reuters.
Sep 6 CDC variant proportions
Washington Post COVID tracker
Sep 2 Walgreens press release
Sep 2 CVS press release
Sep 5 Reuters story on China's COVID measures