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Weekly Digest: Testing and isolation strategies to significantly reduce novel coronavirus transmission; Study supports convalescent plasma as early treatment for severe COVID-19; Analysis finds 36% of UTIs in US nursing homes resistant to antibiotics.

Weekly Digest: Testing and isolation strategies to significantly reduce novel coronavirus transmission; Study supports convalescent plasma as early treatment for severe COVID-19; Analysis finds 36% of UTIs in US nursing homes resistant to antibiotics.

COVID-19

Testing and isolation strategies to reduce novel coronavirus transmission. A modeling study by the Imperial College COVID-19 Response team found that various testing and isolation strategies would have a significant impact on novel coronavirus transmission, but no strategy alone would reduce the effective reproduction number (R) below an epidemic threshold. Researchers found that self-isolation of all individuals with COVID-19-like symptoms would lead to a 47 percent reduction in R. Implementing PCR testing among symptomatic individuals would reduce the number of individuals needing to self-isolate, but may generate approximately 10 percent false-negative results. Weekly screenings of high-risk populations regardless of symptoms and comprehensive contact tracing could lead to an additional 23 and 26 percent reductions in transmission, respectively. [The Lancet Infectious Diseases]

Study supports convalescent plasma as early treatment for severe COVID-19. Preliminary results from an ongoing study of nearly 600 COVID-19 patients suggest that convalescent plasma therapy may be a safe and efficacious treatment for severe COVID-19. A total of 316 COVID-19 patients received a transfusion of convalescent plasma from donors who recovered from the virus, and were matched with 251 control patients. The interim analysis found that convalescent plasma therapy was tied to a significant reduction in 28-day mortality compared to the standard of care, specifically when the transfusion occurred within three days of hospital admission with high titers of anti-receptor binding domain IgG. [The American Journal of Pathology]

Inactivated COVID-19 vaccine proves safe and immunogenic in phase 1/2 trials in China. An inactivated COVID-19 vaccine proved safe and immunogenic in phase 1/2 trials in Henan Province, China, according to an interim analysis. Of the 320 individuals included in randomization, no serious adverse events were reported, and the vaccine candidate demonstrated immunogenicity across three dose-levels. Results support longer-term assessment of the candidate in phase 3 trials. [JAMA]

Diabetes and kidney disease identified as risk factors for severe COVID-19. A retrospective analysis of the first 117 COVID-19 cases at a hospital in Maryland identified diabetes and chronic kidney disease as significant risk factors for ICU admission and death. The analysis found that nearly 25 percent of the COVID-19 patients died, 30.8 percent were admitted to the ICU, and 29.1 percent required mechanical ventilation. Insulin-dependent diabetes mellitus, sputum production, chronic kidney disease, and the amount of supplemental oxygen required at admission were all significantly associated with higher odds of severe COVID-19 outcomes (OR=11.9, 6.7, 4.8, and 1.2 respectively). A model predicting increased risk of severe outcomes was developed to improve treatment decisions and resource allocation, thus resulting in improved outcomes among patients hospitalized with COVID-19. [PLOS ONE]

COVID-19 vaccine messaging needed in the US, survey finds. An online survey of nearly 700 US adults found that two-thirds would accept a COVID-19 vaccine if it is recommended to them, with males, older adults, Asians, and college degree holders more likely than others to accept the vaccine. Respondents who did not complete high school reported low uptake of the influenza vaccine (10 percent) and a high acceptance of a COVID-19 vaccine (60 percent), while unemployed respondents reported low uptake/acceptance of both vaccines. Black respondents reported the lowest acceptance rates of a COVID-19 vaccine compared to all other racial groups. Survey results highlight disparities in vaccine acceptance and emphasize the need for COVID-19 vaccine-acceptance messaging in the US. [EClinicalMedicine]

COVID-19-related inflammatory syndrome differs from Kawasaki disease. Researchers in London assessed the clinical and immunological characteristics of COVID-19-related multisystem inflammatory syndrome in children (MIS-C) in comparison to Kawasaki disease. The analysis found that nearly all of the 25 children with MIS-C included in the analysis had antibodies against the novel coronavirus or were likely exposed to it, suggesting that the syndrome is catalyzed by COVID-19. Characteristics observed in the MIS-C patients differed from those with Kawasaki disease, including older age (median 12.5 years vs. 1-3 years) and higher rates of gastrointestinal symptoms and heart muscle dysfunction. Further research is necessary to understand the distinct syndrome that is increasingly being reported amid the pandemic. [Nature Medicine, CIDRAP]

 

Drug Resistance and Global Health

Analysis finds 36% of UTIs in US nursing homes resistant to antibiotics. More than one-third of urinary tract infections (UTIs) in nursing homes are resistant to antibiotics, researchers from the US Centers for Disease Control and Prevention reported. In an analysis of 6,157 pathogens causing UTIs across 243 nursing homes, common isolates included Escherichia coli (41 percent), Proteus species (14 percent), and Klebsiella pneumoniae/oxytoca (13 percent). E. coli isolates were commonly resistant to fluoroquinolones (50 percent) and extended-spectrum cephalosporins (20 percent), and although rare, Staphylococcus aureus and Enterococcus faecium isolates had the highest rates of resistance (67 percent to methicillin and 60 percent to vancomycin). UTIs caused by Pseudomonas aeruginosa had the highest rates of multidrug resistance (11 percent). [Infection Control and Hospital Epidemiology]

ASP leads to reduced antimicrobial use and resistance in Qatar hospital. The implementation of an antimicrobial stewardship program (ASP) in a Qatar hospital in 2015 led to significant reductions in antimicrobial consumption and rates of multidrug-resistant Pseudomonas aeruginosa. The ASP consisted of a hospital-wide pre-authorization by infectious disease physicians of all broad-spectrum antibiotics. The program was tied to a 23.9 percent reduction in antimicrobial consumption and a significant decline in MDR P. aeruginosa from 9 percent in 2014 to 5.46 percent in 2017. [JAC-Antimicrobial Resistance]

Livestock-associated MRSA strain detected in milk in China. Researchers in China reported the emergence of a livestock-associated MRSA strain from milk in Shanghai. Two ST398 isolates were detected in bulk tank milk samples from two different farms and were closely related to hospital-associated MRSA ST398 strains. Findings emphasize the need for surveillance of livestock-associated MRSA in healthy cattle across China in an effort to prevent the spread of resistant pathogens. [Journal of Antimicrobial Chemotherapy]

School flu vaccine intervention indirectly benefits community health. An influenza vaccine intervention across nearly 100 primary schools in northern California was linked to school and community benefits, including significantly lower rates of flu-related hospitalizations and illness-related school absences. Districts that implemented the intervention between 2014 and 2018 saw significantly larger reductions in the incidence of influenza hospitalizations per 100,000 among non-elementary-school-aged individuals and adults 65 years and older compared to districts that did not. Larger reductions in rates of illness-related school absences per 100 school days during flu season were also observed in intervention districts in 2016-17 and 2017-18. [PLOS Medicine]