News Scan for Sep 07, 2021

News brief

Pfizer COVID-19 vaccine 96% effective in pregnant women, study says

Results from an observational cohort study of pregnant women indicated a 96% vaccine effectiveness (VE) against COVID-19 infection and an 89% VE against hospitalization for the Pfizer/BioNTech vaccine in pregnant women, according to a study in Nature Medicine today.

The researchers matched 10,861 Israeli pregnant women who received the Pfizer vaccine with 10,861 who weren't from Dec 20, 2020, to Jun 3, 2021. All women were 16 and older (median age, 30 years), and 26%, 48%, and 26% of pregnancies were in the first, second, and third trimesters, respectively. Almost one in five women (18%) had at least one risk factor for severe COVID-19, most commonly obesity. Median follow-up was 77 days.

Data showed VE was 96% from days 7 to 56 after the second vaccine dose for any documented infection (95% confidence interval [CI], 89% to 100%). The vaccine had a 97% VE against infections with documented symptoms and an 89% VE against COVID-related hospitalizations. The researchers also looked at VE after the first dose, finding that, by days 21 to 27, it was 71% (95% CI, 22% to 94%) against COVID-19 infection.

Overall, 131 people in the vaccinated group contracted COVID-19, compared with 235 in the unvaccinated group (1.2% vs 2.2%), and only one unvaccinated woman had severe illness, compared with none in the vaccinated group.

The researchers write that the VE in their study group "is similar to the effectiveness estimated in the general population."
Sep 7 Nat Med study

US COVID vaccine rates suggest disparities

Across the nine largest US cities, neighborhoods with higher affluence and greater proportions of White and Asian people were associated with higher vaccination rates, according to a JAMA Health Forum research letter late last week.

The researchers looked at the metro areas of New York City, Los Angeles, Houston, Phoenix, Philadelphia, San Antonio, California, and Dallas, as well as the city of Chicago, from the start of the pandemic through Apr 13. The average vaccination rate across 1,127 neighborhoods was 42.3%, with the lowest quartile having a 27.6% uptake and the highest 59.7%.

Vaccination rates were higher in neighborhoods that had a greater proportion of White and Asian people and a lower proportion of Black and Hispanic people, as well as in neighborhoods with higher average incomes, lower poverty rates, and higher 4-year college completion rates.

Neighborhoods with high vaccination rates were associated with lower COVID-19 death rates, even though the researchers say they had a greater share of elderly people. Overall, a 10-percentage-point increase in COVID-19 vaccination rates was connected to 25 fewer COVID-19 deaths per 100,000 people.

"This study builds on reports of inequitable COVID-19 vaccination rates by race and ethnicity that were frequently based on incomplete demographic data from states as well as county-level analyses of early vaccination efforts that found comparatively small differences in vaccination rates by county social vulnerability index," the researchers write.

"The findings of the present study emphasize the opportunity and need for cities to address vaccination inequities in marginalized communities."
Sep 3 JAMA Health Forum study

Officials report Nipah virus case in Kerala, India

The southern state of Kerala, India, is continuing surveillance for a potential Nipah virus outbreak after a 12-year-old boy died from the virus on Sep 5, according to the Associated Press (AP) today. The state is currently battling the most COVID-19 infections in the country, reporting almost 20,000 infections on Monday out of India's daily total of 31,222.

Nipah virus is an infectious disease that, while rare, has no known cure or vaccine. Nipah can be spread through fruit bats, pigs, and human-to-human contact, and only supportive care can treat its symptoms of high fever, vomiting, and convulsions. The World Health Organization estimates that it has a 40% to 75% mortality rate.

The boy died in the city of Kozhikode, and health officials have begun contact tracing and isolating all close contacts. Today, 8 of 48 close contacts who are being monitored at a hospital have received negative diagnoses, according to the AP. However, the Times of India mentions that the investigation has 188 uncovered contacts thus far, with about 100 from one of the hospitals to which the boy was admitted.

More samples will be tested today, and officials are continuing to trace secondary contacts. The federal government also sent a team of experts who gave recommendations on surveillance and public health preparedness.

"The child started showing symptoms on August 27 and, considering the incubation period of the virus, the next one week is crucial," Kerala's Health Minister Veena George, MSc, told the Times of India.

Kerala's last outbreak was in 2018, when more than a dozen people died, but it also experienced one case in 2019.
Sep 7 AP article
Sep 6 Times of India article

Bovine spongiform encephalopathy detected in 2 Brazilian meat plants

Over the weekend Brazil suspended the exportation of beef to China after two bovine spongiform encephalopathy (BSE) cases, or "mad cow" disease, were detected in cattle at meat plants in Minas Gerais and Mato Grosso states.

These are the fourth and fifth cases of BSE detected in Brazilian cattle during 23 years of surveillance, according to the World Organization for Animal Health (OIE). The last case was detected in 2019.

"This case and the case reported in the State of Minas Gerais are isolated events, detected at dates close to each other. The specified risk materials were duly removed and destroyed," the OIE said in a report on the Mato Grosso case. "The meat and other products of this animal will not enter the food chain and do not represent a risk to ruminant populations."

According to Al Jazeera, Brazil is the biggest beef exporter in the world, with China as its largest customer.

BSE, a prion disease, was first identified in the United Kingdom in the 1980s. In rare cases, humans who consume meat from an animal with BSE can develop the fatal Creutzfeldt-Jakob disease.
Sep 4 OIE report on Matto Grosso case
Sep 4 OIE report on Minas Gerais case
Sep 5 Al Jazeera story

Botswana reports its first H5N1 avian flu outbreak in poultry

Botswana reported its first highly pathogenic H5N1 avian flu outbreak in poultry, the latest country in Africa to report the virus.

The outbreak began on Jul 23 and involved exotic poultry at a backyard location in Kgatleng district in the country's southeast, according to a notification yesterday from the World Organization for Animal Health (OIE).

The farmer had noticed deaths without previous illness symptoms. The H5N1 findings were confirmed on Aug 26. The virus killed 8 of 25 birds, and the rest were culled as part of the outbreak response. So far, the source of the virus isn't known.

Elsewhere, Togo reported another H5N1 outbreak, this time at a farm that housed layers and cockerels in Maritime region in the far south, according to a report from the OIE. The event began on Aug 16, killing 879 of 1,800 susceptible poultry. The rest were destroyed to curb the spread of the virus.

A handful of other African nations, including Togo, have reported sporadic H5N1 outbreaks over the past few months. Other affected countries include South Africa, Mali, and Niger.
Sep 6 OIE report on H5N1 in Botswana
Sep 6 OIE report on H5N1 in Togo

Stewardship / Resistance Scan for Sep 07, 2021

News brief

Study describes impact of XDR typhoid on young children

A new study by researchers in Pakistan details the impact and response to treatment among children diagnosed as having extensively drug-resistant (XDR) typhoid infections.

The study, published late last week in BMC Infectious Diseases, reviewed the records of 680 children who had culture-proven XDR Salmonella enterica serovar Typhi infections and were treated at a hospital in Karachi at any point from July 2017 to December 2018.

The World Health Organization estimates that there were 5,247 cases of XDR Salmonella Typhi—which is resistant to five classes of antibiotics—in Karachi from November 2016 to December 2019, but data on clinical features and response to treatment among children has been scarce. The estimated incidence of enteric fever in Pakistan is 413 cases per 100,000 population among children ages 2 to 4, and 573 cases/100,000 population in children ages 5 to 15.

The median age of the patients was 5, and 57.5% were boys. Of the 270 patients with recorded outcomes, 234 (86.7%) were cured within 14 days, while a delayed response to antibiotics was noted in 32 (11.9%). Four children died. Seventy-six children (29%) recovered after treatment with a combination of meropenem and azithromycin, 72% were successfully treated with azithromycin alone, and 15 (6%) responded to meropenem alone.

The study authors note that literature from other parts of Pakistan has also reported a higher frequency of infection among children aged 5 years or younger, which could be explained by the fact that children have lower immunity and require lower bacterial doses to develop infection.

"This study confirms that XDR S. Typhi is common in children under 5 years of age," they wrote. "We advocate increasing nationwide awareness about the consumption of safe water, antibiotic stewardship and immunisation practices of children."
Sep 3 BMC Infect Dis study

Indian surveillance report highlights rising carbapenem resistance

The latest antimicrobial resistance (AMR) surveillance data from India shows an increase in carbapenem-resistant Enterobacterales and a rise in fungal infections among hospitalized patients.

The 2020 report from the Indian Council of Medical Research (ICMR) Antimicrobial Resistance Research and Surveillance Network shows that Escherichia coli was the most commonly isolated bacterial pathogen among 65,561 isolates collected from tertiary care hospitals, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus.

Among the E coli isolates, susceptibility to imipenem was 72%, down from 86% in 2016 but up from 63% in 2019. K pneumoniae susceptibility fell from 65% in 2016 to 45% in 2020. The authors of the report say the lower susceptibility to imipenem is reflective of the increase in carbapenem use in India over the past two decades.

The ICMR also reported reduced susceptibility in A baumannii and P aeruginosa. Among A baumannii isolates, reduced susceptibility of 10% to 20% was observed against carbapenems, cephalosporins, monobactams, and beta-lactam/beta-lactamase inhibitor combinations. Only 40% of P aeruginosa isolates were susceptible to fluoroquinolones, and 60% to 70% were susceptible to carbapenems, cephalosporins, and aminoglycosides.

Among the increasing number of fungal infections observed in Indian hospitals, the ICMR reported that the multidrug-resistant yeast Candida auris was consistently isolated from regional hospitals across India. Most C auris isolates were resistant to fluconazole, and the incidence of echinocandin resistance is on the rise.

"Systematic collection, evaluation, and analysis of resistance data of specific pathogens for [the] last five years have highlighted that certain pathogens have become highly drug resistant and have become clinicians' dilemma," the report noted. "Aggressive action for prevention, containment, and treatment are needed at the national level."
Sep 2 ICMR surveillance report