A study of more than 285,000 nonhospitalized US veterans who tested positive for COVID-19 in 2022 and early 2023 reveals low rates of prescribing of antivirals and monoclonal antibodies (mAbs), with a higher likelihood of treatment for Black, Hispanic, and older patients with more chronic conditions.

For the study, published yesterday in JAMA Network Open, a Veterans Affairs (VA)-led research team mined Veterans Health Administration (VHA) and linked Community Care and Medicare databases on the number of prescriptions each month for the antiviral medications nirmatrelvir-ritonavir (Paxlovid), molnupiravir (Lagevrio) and the mAbs sotrovimab (Xevudy) and bebtelovimab from January 2022 through January 2023.

Median age of the 285,710 enrollees was 63.1 years, 86.6% were men, 69.6% were White, 21.4% were Black, and 10.0% were Hispanic.

84% received no COVID treatment

Of all COVID-19 patients, 9.3% were prescribed nirmatrelvir-ritonavir, 3.2% were given molnupiravir, 1.7% received sotrovimab or bebtelovimab, and 83.8% received no treatment. The remaining 2.0% received other COVID-19 drugs such as remdesivir (1.8%) or other monoclonal antibodies (0.3%) and weren't included in the any-treatment or no-treatment groups.

The proportion of veterans receiving any COVID-19 treatment rose from 3.2% in January 2022 to 23.9% in August 2022 and then fell to 20.8% in January 2023. Veterans most likely to receive any treatment were older (adjusted odds ratio [aOR] for ages 65 to 74 vs 50 to 64 years, 1.18) and had a higher Charlson Comorbidity Index (CCI) score (aOR for CCI score of 6 or higher vs 0, 1.52).

A more recent decline has not been widely reported in nonveteran populations.

Black veterans were more likely than their White peers to be prescribed a COVID-19 drug (aOR, 1.06), and Hispanic veterans had greater odds of receiving treatment than their non-Hispanic counterparts (aOR, 1.06).

"Although trends in early uptake of COVID-19 pharmacotherapies within the VHA mirrored other settings, a more recent decline has not been widely reported in nonveteran populations," the study authors wrote. "These results suggest the need for continued support of infrastructure and education to facilitate treatment for individuals at highest risk of progression to severe COVID-19."

More than half of US dog owners surveyed mistrust routine vaccines for their pets, according to a new study in Vaccine.

Researchers from Massachusetts, Pennsylvania, and Colorado conducted the survey of 2,200 US adults from March 30 to April 10, 2023, in partnership with sampling firm YouGov. They found that a large share of dog owners consider vaccines administered to dogs to be unsafe (37%), ineffective (22%), or unnecessary (30%). And, in total, 53% of dog owners endorse at least one of these three positions.

'Spillover effect' from COVID

The authors say the findings demonstrate a COVID-19 vaccine "spillover effect"—that Americans who hold negative attitudes toward human vaccines are more likely to hold similar views toward immunizing their pets.

"The vaccine spillover effects that we document in our research underscore the importance of restoring trust in human vaccine safety and efficacy," says first author Matt Motta, PhD, an assistant professor of health law, policy, and management at Boston University (BU), in a BU School of Public Health news release.

"If non-vaccination were to become more common, our pets, vets, and even our friends and family risk coming into contact with vaccine-preventable diseases," he added.

Our pets, vets, and even our friends and family risk coming into contact with vaccine-preventable diseases.

Study coauthor Gabriella Motta, VMD, a Pennsylvania veterinarian and Matt's sister, says she encounters an unvaccinated animal or a vaccine-hesitant pet owner every day at her job.

"When a staff member is bitten by an animal, there is always concern for infection or trauma, but the seriousness of the situation escalates if the animal is unvaccinated or overdue for its rabies vaccine," she says. "The risk with the rabies vaccine is quite low—especially when compared to the risk of rabies infection, which is almost 100-percent lethal."

The Wisconsin Department of Agriculture,​​​​ Trade and Consumer Protection (DATCP) yesterday confirmed that a deer on a deer farm in Washburn County has tested positive for chronic wasting disease (CWD).

A 3-year-old doe tested positive. The 150-acre farm has been placed under quarantine while DATCP and US Department of Agriculture scientists conduct an epidemiologic investigation. Washburn County is located in northwestern Wisconsin.

The samples were confirmed positive for CWD by the National Veterinary Services Laboratories in Ames, Iowa. CWD is an always-fatal neurologic disease of deer, elk, and moose caused by an infectious protein called a prion that affects the animal's brain and nervous system and leads to erratic behavior and muscle wasting. Public health officials fear it might one day cross into people, similar to bovine spongiform encephalitis, or "mad cow" disease.

The most recent previous farm to test positive in Wisconsin was in late May in Sauk County in the southwestern part of the state. DATCP data show that 9 deer farms in the state are still operating after a CWD detection, and 17 were shut down after deer tested positive.

Three countries in two regions reported new polio cases this week, all of them involving vaccine-derived viruses, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

In Africa, Chad reported 4 cases involving circulating vaccine-derived poliovirus type 2 (cVDPV2), raising its total for the year to 29. The new infections were in Lac, Logone Oriental, and Logone Occidental regions.

Also, the Democratic Republic of the Congo reported 16 cVDPV2 cases, pushing its 2023 total to 81. The illnesses were mostly in Kasai Oriental province, but also in Tanganyika, Bas Uele, and Haut Lomami provinces. The country also reported 6 cases involving circulating vaccine-derived poliovirus type 1 (cVDPV1), bringing that total to 54 and the total of vaccine-derived cases to 135. Five of those cases were in Haut Katanga, and 1 was in Tanganyika.

In the Middle East, Yemen reported one cVDPV2 case, marking its first of the year. The patient is from Alhudiadah, and officials are planning a surveillance review to identify any gaps in case finding. Last year, Yemen reported 162 cVDPV2 cases.