Swiss data from 1918 flu pandemic show steep rise in low birth weight, stillbirth

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Pandemic Influenza

1918 pandemic Red Cross workers
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Echoing patterns observed amid COVID-19, historical data from a Swiss maternal hospital reveal a significant rise in low birth weight (LBW) and stillbirth during and after the 1918 flu pandemic, according to a study published yesterday in PLOS One.

University of Zurich researchers evaluated changes in birth weight, gestational age, and stillbirth rates at the Bern Maternity Hospital every 5 years from 1880 to 1900 and every year from 1914 to 1922. A total of 1,530 and 6,924 births were recorded before and during/after the flu pandemic, respectively.

The team used linear regression models to estimate the effect of birth year on birth weight and logistic regression models to estimate the effect of birth year and exposure to flu on premature birth, stillbirth, and LBW.

"It is estimated that nongenetic maternal and environmental factors account for 60–70% of the variation in birth weight," the authors wrote. "In contrast to adult height, birth weight is a more direct measure of nutritional status at the time of measurement (as it mirrors the inherited, biological and environmental influences over nine months of gestation)."

Double the risk of stillbirth in pandemic

Average birth weight increased slightly between the two periods (range, 3,058 grams (6.7 pounds) in 1895 to 3,172 grams (7.0 pounds) in 1921, but stillbirth rates fell markedly, ranging from 3.3% to 6.4% in 1914 to 1922, and preterm birth rates dropped to 13% to 16% in 1914. Infant sex, number of previous pregnancies, gestational age, and maternal age were significantly tied to birth weight during both periods.

This urges us to better prepare for future pandemics to mitigate their effects on maternal and neonatal health.

Compared with 1914, the odds of LBW rose significantly in 1918 (odds ratio [OR], 1.49) and 1919 (OR, 1.55). Mothers exposed to flu during pregnancy were at double the risk for stillbirth (OR, 2.27). The data on flu infection during pregnancy were imprecise and thus didn't allow individual-level conclusions.

"Pandemics are increasingly reported to negatively influence pregnancy outcomes," the study authors wrote. "This urges us to better prepare for future pandemics to mitigate their effects on maternal and neonatal health."

Fleming Fund to boost AMR surveillance in Africa, Asia

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Antimicrobial Stewardship

UK aid program the Fleming Fund announced today that it will provide up to £210 million ($267.5 million US) in funding to boost antimicrobial resistance (AMR) surveillance capacity in the countries where it's most needed.

The funding, which comes from the UK government's aid budget, will help upgrade 250 laboratories in 25 low-and middle-income countries (LMICs) in Asia and Africa where the threat and burden of AMR is the highest. New genome sequencing technology to help track the transmission of bacterial pathogens among humans, animals, and the environment will be included in the upgrade. The investment will also support 20,000 training sessions for laboratory staff, pharmacists, and hospital staff.

"I am proud and delighted that the UK's Fleming Fund will continue to create real impact to tackle AMR and build pandemic preparedness on the ground across the world, using data to drive action and catalyse investment," Dame Sally Davies, the UK Special Envoy on AMR, said in a Fleming Fund press release. "This world-leading investment in AMR laboratories, workforce and systems is a vital contribution to realise our vision of a world free of drug-resistant infection."

I am proud and delighted that the UK's Fleming Fund will continue to create real impact to tackle AMR and build pandemic preparedness on the ground across the world.

The Fleming Fund was established in 2015 to help LMICs in Africa and Asia generate, share, and use AMR data.

The announcement comes ahead of the G20 Health Minister's meeting, which will take place in Gandhinagar, India, on August 18 and 19. AMR is likely to be among the topics discussed at the meeting.

New York, Connecticut report fatal Vibrio cases

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Foodborne Disease
Vibrio bacteria
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The New York State Department of Health (NYSDOH) yesterday urged residents to take precautions following the Vibrio death of a patient from Suffolk County, as well as similar fatal cases reported recently from Connecticut.

In a statement, New York officials said the case is still under investigation to determine if the patient was exposed to water in New York or elsewhere. The NYSDOH urged health providers to consider Vibrio vulnificus when evaluating patients with severe wound infections or sepsis without or without wound infection. It also urged people with wounds to avoid swimming in warm sea water and people with weakened immune systems to avoid handling or eating raw seafood that could carry the bacteria.

In late July, the Connecticut State Department of Health warned residents about the risk of eating raw shellfish and exposure to salt or brackish water along Long Island Sound after reports of severe Vibrio cases. Since July 1, the state has received reports of three cases, one of them fatal. Patients were between 60 and 80 years old, and all were hospitalized.

Given our current heat wave, this may be a time to exercise particular caution in what you consume.

One patient had eaten raw oysters at a location in another state. The other two were exposed to salt or brackish water in Long Island Sound. Both had pre-existing open cuts or wounds or had sustained new wounds during their activities.

Manisha Juthani, MD, Connecticut's health commissioner, said in the hottest months of summer, bacteria are more likely to overgrow and contaminate raw shellfish. "Given our current heat wave, this may be a time to exercise particular caution in what you consume."

Connecticut recorded five cases in 2020, but none in 2021 or 2022. North Carolina reported three Vibrio deaths in July.

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