https://www.cidrap.umn.edu/avi...

1 in 5 US retail milk samples test positive for H5N1 avian flu fragments
Lisa Schnirring Today at 3:42 p.m.
Avian Influenza (Bird Flu)

A senior official from the US Food and Drug Administration (FDA) said today that its nationwide survey of retail milk has found remnants of H5N1 avian flu viruses in one in five samples, with the highest concentrations in regions where outbreaks in dairy cattle have been reported.

Donald Prater, DVM, acting director of the FDA Center for Food Safety and Applied Nutrition (CFSAN), shared the new findings with state health officials who took part in a scientific symposium on H5N1 hosted by the Association of State and Territorial Health Officials (ASTHO). The results come in the wake of earlier findings this week from more limited FDA sampling, along with similar findings from a smaller set of samples tested by a lab that's part of the National Institute of Allergy and Infectious Diseases Centers of Excellence for Influenza Research and Response (CEIRR) Network.

At today's ASTHO briefing, state health officials heard the latest investigation and research updates from federal health officials and had the opportunity to ask their own questions, everything from virus shedding in cow manure to pandemic preparedness.

FDA's long list of research questions
Prater reiterated that the FDA hasn't changed its assessment that the nation's milk supply remains safe. So far, early work on milk samples that were positive for H5N1 fragments haven't found any viable (potentially infectious) virus.

He said, however, that the FDA still has a long list of data gaps to fill, including identifying the risk of infection to humans via oral consumption and validating that existing pasteurization methods can inactivate H5N1.

Other data gaps include how long the virus survives in raw milk and the infectious dose of viruses. Though a major concern is retail milk, Prater also said the FDA needs to see if contamination is occurring in other products, such as cheese made from raw milk.

USDA continues to probe farm transmission patterns
Rosemary Sifford, DVM, deputy administrator for veterinary services and chief veterinarian with the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said the agency has now shared 260 genetic sequences with public databases, up from 239 earlier this week. Of those, only 1 had a mutation linked to mammalian adaptation.

She also said the B3.13 genome circulating in cattle was first seen in poultry in the middle of March in a Texas flock at a time when the virus was cropping up in some of the state's dairy farms. Sifford said investigators continue to look at how the virus is moving on farms and how it transmits among cattle.

Scientists are looking for the virus in other species, including feral pigs, and regular influenza surveillance is monitoring the situation in commercial pigs. Sifford said efforts are under way to gauge how long infected cows shed the virus and if shedding patterns are any different in asymptomatic animals.

When asked about on-farm transmission, she said scientists haven't observed significant shedding in cow feces. Meanwhile, sampling from the USDA's Food Safety and Inspection Service (FSIS) found the highest concentrations in milk and mammary tissue.

CDC notes cat infections, weighs risks
Centers for Disease Control and Prevention (CDC) officials shared more details from their epidemiologic investigations, including virus findings in other animals on affected dairy farms. Sonja Olsen, PhD, associate director for preparedness and response with the CDC's Influenza Division, said there were 6 H5N1 positive tests in cats from three states: 3 in Texas, 2 in New Mexico, and 1 in Ohio.

Also, there were 5 H5N1 detections in wild birds on the farms.

She said CDC a key question is the infection risk from exposure to milk and whether certain conditions, such as aerosolization, pose a higher risk.

Vivien Duggan, PhD, who heads the CDC's Influenza Division, said the interagency Flu Risk Management group, which formed 15 years ago, is meeting now to discuss prepandemic vaccines and diagnostics.

On the research front, the CDC is looking for any changes in the virus that would hamper the ability to use countermeasures, such as antiviral drugs and vaccines.

A key tool that the CDC uses to evaluate and prioritize resources is the Influenza Risk Assessment Tool (IRAT), in which its experts grade the virus using 10 data criteria. Duggan said the CDC is still gathering some data and that it will take some time to evaluate the virus and come up with a risk score. In its last assessment in July 2023, the agency scored the H5N1 clade 2.3.4.4b virus from a Spanish mink farm outbreak as slightly higher for some elements than a 2022 virus from the same clade from wild birds.

Latest on vaccines, other countermeasures
So far, research results have been promising for antiviral susceptibility. And for the two candidate vaccine viruses against the H5N1 2.3.4.4b clade, experiments using ferret antisera show good cross-reaction against the outbreak strain, she said.

When state officials asked what would trigger ramped up H5N1 vaccine production, Duggan said officials are watching for certain cues, such as change in mammalian transmission, better adaptation to human-to-human spread, and clusters of cases. "There's no formula, but we're all on the watch."

Health officials also heard from government countermeasure experts, who said they don't foresee any issues with the antiviral supply chain.

State health officials had several questions about where things stand with a candidate vaccine. David Boucher, PhD, director of infectious disease preparedness and response at the Department of Health and Human Services Administration for Strategic Preparedness, said there is a limited quantity of prefilled syringes and vials that are used for clinical trials, for example. He added that health officials are already looking at regulatory pathways to use the vaccine more widely, if needed.

He said the first wave of production, if needed, could provide several hundreds of thousands of vaccine doses, and the second tranche could amount to 10 million doses. "Any pivot from that would require additional resources," Boucher said. "If we need to pull any of those levers, we're willing to do so."

Partnering with established seasonal flu vaccine producers has the benefit of a licensed platform in place that can be easily adapted to include an H5N1 vaccine virus, but he acknowledged that a downside would be a potential disruption in seasonal flu vaccine production. "There are a lot of variables that go into making that decision."

Two safety and immunogenicity studies are already under way on candidate H5N1 vaccines, Boucher told the group.

https://www.cidrap.umn.edu/cov...

COVID may have eroded doctors' belief that they are obligated to treat infectious patients
Mary Van Beusekom, MS Today at 2:22 p.m.
COVID-19

A systematic review posted in Clinical Infectious Diseases reveals that, amid the COVID-19 pandemic, many physicians felt less ethically obligated to provide care to infectious-disease patients if they fear contracting the disease.

A Duke University–led team reviewed 155 published studies exploring treatment obligation and refusal, HIV/AIDS, COVID-19, and pandemics up to October 25, 2022.

"During pandemics, healthcare providers struggle with balancing obligations to self, family, and patients," the study authors wrote. "While HIV/AIDS seemed to settle this issue, coronavirus disease 2019 (COVID-19) rekindled debates regarding treatment refusal."

82% still endorsed an obligation to treat
The included studies examined ethical treatment obligations for patients with HIV/AIDS (72.2%), severe acute respiratory syndrome (SARS; 10.2%), COVID-19 (10.2%), Ebola (7.0%), and flu (7.0%).

Most articles (81.9%) argued for an obligation to treat these patients, while most papers (60.0%) that endorsed withholding treatment were on COVID-19, and HIV had the fewest papers advocating for treatment refusal (13.3%).

The most common reasons given for an obligation to treat were professionalism (55.5%), the social contract (45.3%), and the law (20.3%). The most common reason for advocating for withholding COVID-19 treatment was labor rights and worker protection (40%); labor rights were cited in only 17% to 19% for other infections.

For HIV care, labor rights was the least cited reason for treatment refusal (6.2%). A total of 26.7% of articles published during COVID-19 cited the risk of infection to physicians and their families, compared with 8.3% for flu and 6.3% for SARS.

"All the papers throughout history have shown that physicians broadly believed they should treat infectious disease patients," lead author Braylee Grisel, a fourth-year student at Duke University School of Medicine, said in a Duke press release. "We figured our study would show the same thing, so we were really surprised when we found that COVID-19 was so different than all these other outbreaks."

Consideration of vaccination status
The researchers said the COVID-19 pandemic may have altered the perceived social contract between physicians and patients, because it had several unique characteristics, including a shortage of resources (eg, personal protective equipment, hospital rooms, respirators, vaccines, treatments), broadly disseminated misinformation about the disease (eg, how the virus spreads, effective treatments, vaccine efficacy and safety), its highly contagious nature, and escalating abuse of staff by patients and their families.

Arguments were made based on reciprocity, medical triage, and personal responsibility to exclude patients who refused vaccines from consideration when ventilators and other resources were limited.
Senior author Krista Haines, DO, of Duke University, said, "Some of these results may be because we had the unique opportunity to evaluate changing ethics while the pandemic was actively ongoing, as COVID-19 was the first modern outbreak to put a significant number of frontline providers at personal risk in the United States due to its respiratory transmission."

Some papers discussed the consideration of COVID-19 vaccination status in treatment decisions. "Patients who refused vaccination were at a higher risk of complications while also putting other patients and providers at risk," the researchers wrote. "Arguments were made based on reciprocity, medical triage, and personal responsibility to exclude patients who refused vaccines from consideration when ventilators and other resources were limited."

The findings show how physicians are not immune from sociopolitical influences, Grisel said. "In future pandemics, we may need to become more aware of how the risks and outside pressures of an active pandemic influence willingness to provide care," she said. "Health care systems can learn how to mitigate these influences to ensure that hospitals are adequately staffed to meet patient needs."

The authors noted that the obligation to provide care was supported throughout the 20th and early 21st centuries. "Striking a balance between providing care, limiting patient discrimination, respecting provider autonomy, and protecting the healthcare workforce is crucial to adequately meet public needs during a global health crisis," they concluded.

https://www.cidrap.umn.edu/res...

Survey shows mostly positive attitudes toward RSV vaccine in pregnancy
Stephanie Soucheray, MA 58 minutes ago.
Respiratory Syncytial Virus (RSV)

If women perceive respiratory syncytial virus (RSV) to be a serious illness in infants, they are more likely to be willing to get vaccinated against respiratory syncytial virus in pregnancy, according to a new study based on the survey results of women who were pregnant or trying to become pregnant in the United States.

The study, published in Pediatrics, also showed that those with small children at home were also more likely to get vaccinated against RSV.

Almost all children contract RSV before age 2, with most cases mild, but in children 6 months and younger, infections frequently result in hospital or intensive care admission.

Last fall, the Food and Drug Administration approved an RSV vaccine for pregnant mothers. The current study was conducted before the RSVpreF (Abrysvo) vaccine was approved. Abrysvo is recommended to be given between 32 and 36 weeks of pregnancy.

40% said RSV serious, likely
A total of 1,528 participants were asked how serious they perceived RSV infections to be in infants, and how likely they thought it would be that their infant would contract RSV in his or her first 12 months of life.

Surveys were conducted from March 1 to March 20, 2023; 48% of study participants were planning to become pregnant, and 52% were currently pregnant.

Overall, 40% percent of respondents perceived that RSV illness among children is both serious and likely, 45% perceived RSV illness as serious but not likely, and 16% did not view RSV illness as serious.

Twenty percent said they had never heard of RSV, and 30% of respondents reported first hearing about RSV in 2022. Fifteen percent reported first hearing about it in 2021, and 36% reported hearing about it in 2020 or earlier.

Vaccination in past pregnancies linked to willingness
Study participants who had received Tdap or influenza vaccines in past pregnancies had significantly higher odds of being very likely to receive a future RSV vaccine during pregnancy, the authors said (odds ratio, 3.56; 95% confidence interval, 2.38 to 5.33).

"Among respondents who thought it was likely, as well as those who thought it was not likely, perceiving RSV illness in children as serious was associated with significantly higher odds of receiving a future RSV vaccine," the authors wrote.

Perceiving RSV illness in children as serious was associated with significantly higher odds of receiving a future RSV vaccine.
Respondents with the lowest predicted proportions of being very likely to receive a future RSV vaccine during pregnancy were those who thought RSV illness was not serious. Only 31% of respondents who said the virus was not serious said they would get the vaccine. In contrast, 63% of respondents who thought that RSV illness was both serious and likely reported they would be very likely to get vaccinated against RSV during pregnancy.

"Our findings clearly show that in order to increase RSV vaccination during pregnancy and spare infants from potentially severe infection, future parents need to be well informed about the serious risks RSV may pose to their child," said lead author Jennifer Saper, MD, MS, in a press release from Lurie Children's Hospital of Chicago.

https://www.cidrap.umn.edu/cov...

Impaired sense of smell still common 1 year after COVID-19
News brief Today at 3:09 p.m.
Stephanie Soucheray, MA
Topics COVID-19

Sense of smell—but not taste—was still impaired in some COVID patients at 1 year, according to a new study in JAMA Network Open.

The US-based cross-sectional study compared 340 people with and 434 without prior COVID-19, recruited from February 2020 to August 2023 from the social media website Reddit.

Researchers instructed participants to take the 53-item Waterless Empirical Taste Test (WETT) and 40-item University of Pennsylvania Smell Identification Test (UPSIT) to assess taste and smell function.

Loss of taste and smell was one of the first symptoms most commonly ascribed to COVID-19 infections, but few studies have looked at the loss after 1 year, or in infections caused by newer variants. Furthermore, only a handful of studies have been based on smell and taste tests.

Participants in the study had a mean time between testing and COVID-19 diagnosis of 395 days (95% confidence interval [CI], 363 to 425 days). The total WETT scores did not differ significantly between participants with and without a COVID-19 history, with both groups falling within normal ranges.

Almost a third with prior COVID had loss of smell
The UPSIT test assessing smell, however, showed that people with COVID-19 had mean scores that were significantly lower than those without a history of COVID (age- and sex-adjusted mean, 34.4 [95% CI, 33.9 to 34.9] compared to 35.9 [95% CI, 35.4 to 36.3], a 4.2% reduction.

Participants with a history of COVID-19 were more likely to experience some degree of smell loss compared with those without a history (30.3% vs 21.0%; odds ratio [OR], 1.64; 95% confidence interval [CI], 1.18 to 2.27). Moderate to severe loss of smell was likewise higher in those with previous COVID-19 (8.5% vs 2.8%; OR, 3.28; 95% CI, 1.65 to 6.53).

Reports that taste loss continues long after the initial infection probably are due in large part to the confusion between taste- and olfaction-dependent food flavor.
"Reports that taste loss continues long after the initial infection probably are due in large part to the confusion between taste- and olfaction-dependent food flavor," the authors explained. "Smell loss remained in nearly one-third of individuals with exposure, likely explaining taste complaints of many individuals with [long COVID]."

Three women contract HIV from dirty "vampire facials" at unlicensed spa

https://arstechnica.com/scienc...

Vampire facial.. what idiocy. And promoted by Paltrow and Kardashian. I confess not feeling too bad about someone stupid enough to buy that bullcrap.

20% of grocery store milk has traces of bird flu, suggesting wider outbreak
The milk is still considered safe, but disease experts are alarmed by the prevalence.

https://arstechnica.com/scienc...

I am sort of alarmed also.

The thread "Coronavirus Info Central (COVID19 Discussion)" in Sandbox forum

Long-COVID patients more likely to report psychiatric symptoms, cost barriers to therapy
Mary Van Beusekom, MS Today at 1:13 p.m.
COVID-19

A study in JAMA Network Open finds that while US adults with long COVID have a higher rate of psychiatric conditions such as depression and anxiety and are just as likely to receive treatment, many cite cost as a reason for not seeking care.

A team led by University of British Columbia researchers parsed data on 25,122 US adults with and without long COVID (or post-COVID condition [PCC]) from the 2022 National Health Interview Survey, a nationally representative interview-based survey, from October 2023 to February 2024.

The researchers used the Patient Health Questionnaire-8 to gauge depression symptoms and the General Anxiety Disorder-7 instrument to assess anxiety. Participants were considered treated if they received counseling or psychiatric medications for their symptoms. The median participant age was 46 years, half were women, and 3.4% were experiencing long COVID.

"The experiences of individuals who were unable to access care due to costs, stigma, or other reasons are important to consider when developing PCC-focused mental health supports," the researchers wrote. "Adults with mental illness frequently experience barriers to care and may be underserved—a problem that was exacerbated during the COVID-19 pandemic."

Similar rates of receiving treatment
Relative to participants without long COVID, those who had the condition were about twice as likely to experience depression (weighted prevalence [wPr], 16.8% vs 7.1%; adjusted odds ratio [aOR], 1.96), anxiety (wPr, 16.7% vs 6.3%; aOR, 2.21), sleep difficulties (wPr, 41.5% vs 22.7%; aOR 1.95), cognitive problems (wPr, 35.0% vs 19.5%; aOR, 2.04), and disabling fatigue (wPr, 4.0% vs 1.6%; aOR, 1.85).

People with PCC may have more difficulty paying for counseling or therapy due to lost employment wages and greater costs of managing complications from COVID-19, or they may experience challenges obtaining health plan authorization for these supports.
Having current long COVID was tied to female sex, White race, having multiple chronic conditions, and not having received a COVID-19 vaccine.

Of adults with depression or anxiety, those with long COVID (wPr, 28.2% vs 34.9%; aOR, 1.02) were similarly likely as those without the condition to not receive treatment in the previous year (wPr, 37.2% vs 23.3%; AOR, 2.05). But participants currently experiencing long COVID were twice as likely to report cost as a barrier to getting counseling (aOR, 2.12).

"People with PCC may have more difficulty paying for counseling or therapy due to lost employment wages and greater costs of managing complications from COVID-19, or they may experience challenges obtaining health plan authorization for these supports," the researchers wrote.

Screening may counter reluctance to seek care
The authors said that the US Department of Health and Human Services is helping healthcare systems create care pathways specific to long COVID.

"These pathways can integrate mental health services by, for example, incorporating routine mental health screening in follow-up for individuals recovering from COVID-19 and including mental health professionals in multidisciplinary PCC clinics," they wrote. "In contexts in which mental health services are sparse, telehealth and group-based programs could be leveraged."

But these programs should recognize that long-COVID patients with or without psychiatric conditions may hesitate to seek care.

"These individuals have described experiencing stigma and medical gaslighting from clinicians, sometimes being told that their physical symptoms are psychosomatic," they wrote. "Standardized screening strategies for psychiatric symptoms in PCC clinics may help normalize mental health assessments for this population."

https://www.cidrap.umn.edu/avi...

H5N1 avian flu infects Colorado dairy cows as global experts weigh in on virus changes
Lisa Schnirring 23 minutes ago.
Avian Influenza (Bird Flu)

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today reported the first H5N1 avian flu virus detection in Colorado's dairy cows, raising the number of affected states to nine.

Also today, the World Health Organization (WHO), the World Organization for Animal Health (WOAH), and the UN Food and Agriculture Organization (FAO) weighed in on recent H5N1 developments in the United States and abroad. They said evolving developments with the virus, including a novel reassortant detected in three Asian countries and a spillover from wild birds to dairy cows in the United States, requires real-time monitoring.

34 US herds now affected
The H5N1 detection in Colorado raises the number of herds known to be affected to 34. So far, there are no details on where the Colorado herd is located and how it may have been exposed to the virus.

Recent detections of H5N1 remnants in retail milk suggest that the virus in dairy cows may be more widespread than suggested by current animal testing.

Global concerns about virus evolution
The three global agencies raised concerns about genetic diversification of the H5N1 2.3.4.4b clade spreading in multiple world regions, as well as its ability to infect a broader range of species, with some species experiencing significant death rates, such as in sea mammals in South America.

As the virus infects more species, including a goat and dairy cows in the United States, the virus has more opportunities to generate new genotypes, which could cause different clinical pictures.

For example, the global experts said a novel H5N1 reassortant seen in poultry in Cambodia, Laos, and Vietnam over the past 2 years has now been detected in humans, one from Cambodia and the other from Vietnam. The virus contains surface proteins from an older H5N1 clade (2.3.2.1c) and internal genes from the more recent 2.3.4.4b H5N1 clade.

The WHO, WOAH, and FAO said the overall risk to humans remains low, and for people who have exposure to infected animals or their environments, the risk is low to moderate.

More Michigan poultry affected; new USDA updates
In other H5N1 developments:

Michigan reported another H5N1 outbreak in commercial poultry, this time at a turkey facility on Ottawa County that houses 104,000 birds, according to an update from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). Ottawa County is among the Michigan countries in which H5N1 was detected in a dairy herd.
USDA APHIS today announced a rule that would require electronic identification for certain cattle and bison moving between states. The agency said the move is designed to limit the impacts of animal disease outbreaks to certain regions and readily provide disease-free status in nonaffected regions. The rule, which requires visually and electronically readable ear tags, applies to all sexually intact cattle and bison 18 months of age or older, all dairy cattle, cattle and bison of any age used for rodeo or recreation events, and cattle or bison of any age used for shows or exhibitions.
Though H5N1 hasn't been detected in US beef cattle, Colombia announced restrictions on the import of US beef and beef products, the first country to do so, Reuters reported yesterday.
USDA APHIS posted new resources related to the H5N1 response, including a testing guide for labs conducting surveillance for influenza A in livestock and a document detailing requirements for H5N1 in livestock targeted to state animal health officials, veterinarians, and producers.

https://www.cidrap.umn.edu/ant...

Global, US data show high antibiotic use, rise in resistant infections during COVID
Chris Dall, MA Today at 2:39 p.m.
Antimicrobial Stewardship COVID-19

Two new studies highlight the impact that the COVID-19 pandemic has had on antibiotic use and resistance.

In one study, data gathered by researchers from the World Health Organization (WHO) confirms what previous research has shown—globally high rates of antibiotic use in COVID-19 patients despite low rates of suspected bacterial infections. In the other, a team led by researchers from the National Institutes of Health (NIH) found that rates of hospital-acquired, multidrug-resistant infections at US hospitals remain well above pre-pandemic levels.

Both studies are being presented at the upcoming European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global Congress in Barcelona, Spain.

Of patients with severe COVID, 81% got antibiotics
The WHO data, collected through the WHO Global Clinical Platform, shows that, among 592,898 COVID-19 patients hospitalized in 65 countries from January 2020 through March 2023, antibiotic use ranged from 83% in the WHO Eastern Mediterranean Region to 32.8% in the Western Pacific Region. Overall, three of four COVID-19 patients received antibiotics, despite the fact that antibiotics provide no benefit for the viral illness.

The highest rate of antibiotic use was seen among patients with severe or critical COVID-19, 81% of whom received antibiotics. But even in patients with mild or moderate COVID, antibiotics were commonly used, with rates as high 79% in the African Region. Empiric treatment was common, ranging from 55% in patients with mild/moderate COVID-19 to 69% in severe critical cases.

While antibiotic prescribing rates for COVID-19 declined over time in Europe and the Americas from the beginning of the pandemic through 2022, they increased in Africa.

Although frequent use of antibiotics in the early months of the pandemic—when hospitals were overwhelmed and few treatment options were available—has been well documented, the continued use of antibiotics for COVID well into the pandemic is concerning. The WHO says they're concerned that this extensive overuse of antibiotics is contributing to the "silent spread" of antimicrobial resistance (AMR).

Prescription of 'Watch' antibiotics as high as 94%
In another concerning finding, the data also show that antibiotics with an increased risk of promoting resistance—known as "Watch" antibiotics under the WHO's AWaRE (Access, Watch, and Reserve) classification system—were frequently prescribed for COVID-19 patients in the Eastern Mediterranean Region (93.8%), the Region of the Americas (90.8%), and the African Region (91.1%).

But, as has been found in previous studies, there is little reason to prescribe antibiotics for patients with COVID-19. Suspected bacterial co-infections—which might justify use of antibiotics in some cases—were reported in only a fraction (8%) of COVID-19 patients. Higher rates of bacterial co-infections were reported in the Region of the Americas (14.1%) and the Eastern Mediterranean Region (8.8%).

Unsurprisingly, antibiotics did not improve clinical outcomes for COVID-19 patients. In fact, an analysis of patients without suspected or confirmed bacterial infections found that patients with mild/moderate COVID-19 who received empiric antibiotic therapy had an 80% increased mortality risk (adjusted hazard ratio [aHR], 1.80; 95% confidence interval [CI], 1.36 to 2.38) compared with those didn't receive antibiotics.

Patients with severe/critical COVID-19 who received antibiotics had a 16% increased risk of death (aHR, 1.16; 95% CI, 1.08 to 2.84).

"When a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance. However, when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance," Silvia Bertagnolio, MD, WHO unit head for surveillance, evidence, and laboratory strengthening in the Division for AMR, said in a WHO press release.

"These data call for improvements in the rational use of antibiotics to minimize unnecessary negative consequences for patients and populations," she added.

Rise in resistant, hospital-acquired infections
Meanwhile, data collected from 120 US hospitals from January 2018 through December 2022 illustrate how AMR surged during the pandemic, driven largely by dramatic increases in hospital-acquired infections.

In the study, researchers examined all adult hospitalizations over the period for culture-confirmed infection by six pathogens: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum cephalosporin-resistant Enterobacterales (ECR), carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CR-PA). Hospital-acquired infections were defined as those that occurred after 3 days of hospitalization.

These data call for improvements in the rational use of antibiotics to minimize unnecessary negative consequences for patients and populations.
The researchers wanted to provide an update to a previous report by the Centers for Disease Control and Prevention (CDC). The report, published in 2022, showed alarming increases in the six pathogens at US hospitals during first year of the pandemic, resulting in a 15% overall increase in drug-resistant infections and deaths from 2019 through 2020.

The NIH-led study found the overall prevalence of AMR infections increased by 6.3% during the pandemic, driven mainly by hospital-acquired infections, which rose 32.4%, compared with a 1.4% increase in community-acquired infections. Among the hospital-acquired infections, the largest increases were seen for CRAB (a 160.0% increase), CRE (63.6%), CR-PA (54.5%), and ECR (50%). Conversely, community-acquired MRSA infections fell 10% during the pandemic, a result the researchers believe is linked to reduced social interactions.

Multiple factors at play
As with the CDC report, the researchers believe the surge in multidrug-resistant, hospital-acquired infections is likely the result of a combination of pandemic-related factors.

"It is likely that surges in severely ill COVID-19 patients during the pandemic corresponded with significant surges in antibiotic use and challenges following infection and prevention control protocols in strained hospitals," lead author Christina Yek, MBBCh, of the National Institute of Allergy and Infectious Diseases, said in an ESCMID press release. "In addition, hospitals may have experienced shortages of personal protective equipment, while treating sicker patients who were more likely to require the use of medical devices like ventilators, which would have added to the spread of antimicrobial-resistant infections."

Yek and her colleagues also found that the hospitals that saw the largest surges in severely ill COVID-19 patients had the largest increases in hospital-acquired AMR infections.

And while the overall prevalence of AMR infections in US hospitals returned to pre-pandemic levels (a 0.2% increase) by the end of 2022, hospital-acquired AMR infections remained 13% above baseline, largely because of continued increases in carbapenem-resistant gram-negative pathogens. From March to December 2022, CRE, CRAB, and CR-PA infections were 81%, 43%, and 38% above pre-pandemic levels.

Yek said the persistence of these infections is concerning.

"More action is needed to protect people, especially from difficult-to-treat hospital-acquired gram-negative infections that remain concerningly high," she said.

https://www.cidrap.umn.edu/cov...

US respiratory virus levels continue to decline as officials track shift in SARS-CoV-2 proportions
News brief Today at 1:44 p.m.
Lisa Schnirring
Topics COVID-19 Influenza, General Respiratory Syncytial Virus (RSV)

Respiratory virus activity continued to decline last week, and though COVID-19 indicators continue to decline, estimates of new variant proportions show some notable shifts in SARS-CoV-2, the Centers for Disease Control and Prevention (CDC) said in its weekly updates today.

SARS-CoV-2 micrograph
NIAID/Flickr cc
In its weekly snapshot for flu, COVID-19, and respiratory syncytial virus (RSV), the CDC said no states are reporting high activity. Only one—North Dakota—is reporting moderate activity.

Flu markers continue to tail off
Flu activity continues to decline, with levels below baselines in all but 1 of 10 regions. Region 1, which includes six northeastern states, is at its regional baseline, the CDC said in its weekly FluView update.

Test positivity declined, and all three seasonal flu viruses continue to circulate, with influenza A making up 62.7% of positive samples at public health laboratories.

Hospitalizations declined, and overall deaths held steady. The CDC received reports of 6 more pediatric flu deaths, raising the season's total to 148. The deaths occurred from November 2023 to early this month. Three were due to influenza A, and three were linked to influenza B.

COVID trends decline, despite rise in FLiRT proportions
In its latest COVID data updates, the CDC reported further declines in its severity markers (hospitalizations and deaths), as well as its early indicators (test positivity and emergency department visits). Wastewater SARS-CoV-2 detections, another early indicator, remained at the minimal level and are at their lowest level since July 2023.

In its variant proportion update today, the CDC reported an ongoing decline in JN.1 variant detections and a steady rise in its spinoffs that have two added spike mutations, nicknamed the FLiRT (F for L at position 456 and R for T at position 346). The most notable rise was for KP.2, which edged above JN.1 and is now at 24.9%. Also, the proportion of another FLiRT subtype, called KP.1.1, rose from 3.1% to 7.5% over the past 2 weeks.

So far it's not clear if the FLiRT subtypes will trigger another rise in COVID activity.

https://www.cidrap.umn.edu/foo...

USDA declares Salmonella an adulterant in raw breaded chicken products
News brief Today at 1:40 p.m.
Lisa Schnirring
Topics Foodborne Disease Salmonella

The US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) announced that it has finalized a policy to declare Salmonella an adulterant in raw breaded chicken products, which have been linked to 14 foodborne illness outbreaks that have sickened at least 200 people since 1998.

breaded stuffed chicken
Chip Sillesa/Flickr cc
In its statement, the USDA said Salmonella would be considered an adulterant in the products if it exceeds a certain microbiologic threshold.

The step is part of a plan the agency proposed in 2022 to reduce Salmonella contamination in raw poultry products. FSIS added that it will address contamination in other raw poultry products later this year.

USDA Secretary Tom Vilsack said the final determination marks the first time Salmonella has been declared an adulterant in a class of raw poultry products. "This policy change is important because it will allow us to stop the sale of these products when we find levels of Salmonella contamination that could make people sick," he said.

It will allow us to stop the sale of these products when we find levels of Salmonella contamination that could make people sick.
FSIS said it would carry out testing procedures on the raw incoming chicken component prior to stuffing and breading to ensure that producers are controlling Salmonella in the products. It said the rule will go into effect 12 months after it is published in the Federal Register.

Raw breaded products present unique challenges
Though the raw breaded chicken products make up less than 0.15% of the domestic chicken market, they account for about 5% of all chicken-related foodborne illness outbreaks.

The products are problematic for consumers because they appear pre-browned and cooked. They are often cooked from a frozen state, which increases the chance that the raw chicken component may not reach the internal temperature needed to kill the Salmonella.

https://www.cidrap.umn.edu/cov...

Study reveals promising results for abatacept for severe COVID
News brief Today at 1:32 p.m.
Stephanie Soucheray, MA
Topics COVID-19

A new study shows good results in patients with severe COVID-19 for abatacept, an anti-inflammatory immunomodulating drug used to treat psoriatic arthritis, according to findings published yesterday in JAMA Network Open.

The study was based on results seen among 395 hospitalized patients in the ACTIV-1 IM randomized clinical trial, designed to assess the efficacy of abatacept, which inhibits T-cell activation, reducing multiple inflammatory cytokines. A previous ACTIV-1 trial showed the drug decreased mortality in hospitalized patients with COVID-19, but optimal dosing of the drug based on body weight is still unknown, the authors said.

"Because increased body weight is a risk factor for severe COVID-19 and is associated with increased abatacept clearance (CL), it is possible that the pharmacokinetics of abatacept may be different in hospitalized patients with COVID-19," the authors said.

Increased doses linked to recovery
Abatacept was administered to enrolled participants on day 1 as a single 10-milligram (mg)-per-kilogram intravenous infusion, with a maximum dose of 1,000 mg. At least two blood samples were collected through day 28, with clinical outcomes also assessed over 4 weeks.

Over the course of the study, 320 patients (81.0%) recovered, 32 (8.1%) did not recover, and 43 (10.9%) died. Every 5,000-unit increase of abatacept was associated with a higher probability of recovery at day 28, with a hazard ratio of 2.63 (95% confidence interval [CI], 1.70 to 4.08).

Overall, participants with higher abatacept exposure had improved outcomes with fewer safety events. Increased levels of the drug were associated with lower odds of a composite safety event at 28 days (odds ratio, 0.46; 95% CI, 0.33 to 0.63).

A higher-dose abatacept regimen would be necessary for most patients to achieve the exposure that resulted in optimal benefit.
"A higher-dose abatacept regimen would be necessary for most patients to achieve the exposure that resulted in optimal benefit derived from this ACTIV-1 IM cohort," the authors concluded.

https://www.cidrap.umn.edu/cov...

Risk of uveitis recurrence higher in year after COVID vaccination
News brief Today at 11:07 a.m.
Mary Van Beusekom, MS
Topics COVID-19

The incidence of uveitis in the year after COVID-19 was 17% among nearly 474,000 Korean adults with a history of the inflammatory eye condition, according to a report in JAMA Ophthalmology.

Researchers at the Hanyang University College of Medicine in Seoul mined the Korean National Health Insurance Service and Korea Disease Control and Prevention Agency databases for information on 473,934 patients diagnosed as having uveitis from January 2015 to February 2021.

The patients had previously had uveitis and had received at least one dose of an mRNA (Pfizer/BioNTech or Moderna) or adenovirus vector–based (AstraZeneca or Johnson & Johnson) COVID-19 vaccine. The average patient age was 58.9 years, 51.3% were women, and none tested positive for COVID-19 during the study period.

Uveitis is a potentially serious inflammation of the eye's middle layer of tissue that can cause symptoms such as pain, redness, and blurry vision.

Risk was elevated or all 4 vaccines
The incidence of uveitis was 8.6% at 3 months, 12.5% at 6 months, and 16.8% at 1 year. The odds of uveitis were increased among recipients of all four vaccines, including Pfizer (hazard ratio [HR], 1.68), Moderna (HR, 1.51), AstraZeneca (HR, 1.60), and Johnson & Johnson (HR, 2.07). The risk was highest in the first 30 days after vaccination and peaked between the first and second doses (HR, 1.64).

These results emphasize the importance of vigilance and monitoring for uveitis in the context of vaccinations, including COVID-19 vaccinations, particularly in individuals with a history of uveitis.
"Although uveitis following vaccination is rare, our findings support an increased risk after COVID-19 vaccination, particularly in the early postvaccination period," the study authors wrote. "These results emphasize the importance of vigilance and monitoring for uveitis in the context of vaccinations, including COVID-19 vaccinations, particularly in individuals with a history of uveitis."

In a related commentary, Anika Kumar and Nisha Acharya, MD, said it's important to weigh the risk of uveitis with that of remaining unvaccinated against COVID-19. "Indeed, other investigations of postvaccine NIU [noninfectious uveitis] that similarly identified increased risks of NIU after vaccination noted that effect sizes were small and attributable risks were low; thus, the findings should not preclude individuals from receiving a vaccination," they wrote.

I think my dinner tonight was the stuffed raw chicken that article mentioned

sallyg said: I think my dinner tonight was the stuffed raw chicken that article mentioned

Uh oh!

Well, it's official - the Australian Technical Advisory Group on Immunisation (ATAGI) has fallen to the political spin around COVID-19. Despite COVID having a mortality rate around 1.5 times the flu and significantly greater risk of post-viral illness (which is cumulative, i.e. increases every time you catch COVID), the latest official advice for COVID-19 vaccines is actually weaker than that for Influenza!

https://www.health.gov.au/reso...
https://www.health.gov.au/reso...

Suffice to say I am disgusted at the irresponsible nature of this advice.

For those who don't have the time to go through it all, it can be summed up as:

ATAGI Influenza Clinical Advice Statement said:Annual vaccination is the most important way to prevent influenza and its complications. Influenza vaccination is recommended for all people aged ≥6 months.

ATAGI COVID-19 Clinical Advice Statement said:ATAGI recommends a dose of COVID-19 vaccine for adults aged ≥75 years every 6 months.

ATAGI recommends the following groups receive a dose of COVID-19 vaccine every 12 months, and can consider a dose every 6 months, based on a risk-benefit assessment:
• Adults aged 65—74 years
• Adults aged 18—64 years with severe immunocompromise

The following groups can consider a COVID-19 vaccine every 12 months, based on a risk-benefit assessment:
• All other adults aged 18—64 years
• Children and adolescents aged 5—<18 years with severe immunocompromise

Pathetic. It's bad enough that the uptake of the boosters has dropped with each one, but wording the official clinical advice so weakly basically means that very few are going to follow it up.

Australia is effectively setting itself up for a lot of long COVID by refusing to encourage people to keep up with their COVID vaccinations.

That's unfortunate, Joshua. As time goes by, they may change their recommendations as the health of so many strains the medical and social systems.