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News Scan for Aug 27, 2021

COVID-19 infection tied to much higher clot risk than vaccination

The risk of blood clots is higher following COVID-19 infection than after vaccination, researchers based at Oxford University reported today in BMJ.

Earlier this year, a number of countries identified rare thrombocytopenia and thromboembolic events in people who had received adenovirus-based vaccines, which resulted in pauses to investigate and modifications in vaccination policy. Following these investigations, vaccine advisory groups said the benefits of vaccination, on the whole, still outweighed the risk.

To look for patterns with thrombocytopenia and thromboembolic events after vaccination, the researchers examined data from the health records of 29 million people in England who received their first dose of the AstraZeneca-Oxford vaccine or the Pfizer-BioNTech vaccine. The group included 19.6 million who got the AstraZeneca vaccine, 9.5 million who received Pfizer, and 1.8 million who tested positive for SARS-CoV-2.

After the first dose of the AstraZeneca vaccine, they found an increased risk of thrombocytopenia, venous thromboembolism, and other rare thrombotic events, and after the first Pfizer dose they identified an increased risk of arterial thromboembolism and ischemic stroke. However, they found that the risks of these conditions were much higher in people from the same population who were infected with SARS-CoV-2. They also wrote that the blood clot risk persisted for a longer period of time in people who were infected.

Julia Hippisley-Cox, MD, a study coauthor at the University of Oxford, said in an Oxford press release, “People should be aware of these increased risks after Covid-19 vaccination and seek medical attention promptly if they develop symptoms, but also be aware that the risks are considerably higher and over longer periods of time if they become infected with SARS-CoV-2.”
Aug 27 BMJ study
Aug 27 Oxford press release

Kids with cancer have much higher risk of COVID-19 severity, study finds

One in five children with cancer and COVID-19, or 20%, experience severe illness compared with 1% to 6% in the general pediatric population, according to a Lancet Oncology study yesterday.

The researchers looked at 1,500 cancer or hematopoietic stem-cell transplantation patients 18 or younger hospitalized for COVID-19 from Apr 15, 2020, to Feb 1, 2021 (median age, 8 years). While most were in the Americas (56.7%), the cohort encompassed 45 countries. The most common cancer type was acute lymphoblastic leukemia or acute lymphoblastic lymphoma (49.1%) and then extracranial solid tumors (24.2%).

Of 1,319 patients who had 30-day follow-up, 67.4% were hospitalized and 3.8% died of COVID-related causes, compared with the 0.01% to 0.7% mortality rate among general pediatric COVID-19 infections. One in five (19.9%) of the cancer patients had severe or critical infections.

Severe or critical illness was associated with lower- or middle-income country status (odds ratio [OR], 5.8), upper-middle income country status (OR, 1.6), older age (15 to 18 years OR, 1.6), and intensive treatment (OR, 1.8). Severity was also linked with having an absolute lymphocyte count of 300 or fewer cells per cubic millimeter (cells/mm3; OR, 2.5) and absolute neutrophil count of 500 or fewer cells/mm3 (OR, 1.8), with the researchers noting that delaying myelosuppressive and lymphocyte-depleting therapy may be recommended during active COVID-19 infection.

About 56% of cancer therapies were modified among 1,092 patients, with lower likelihoods among patients in upper- or middle-income countries (OR, 0.5) or who had a primary diagnosis of other hematological issues (OR, 0.5). Higher likelihoods were tied to COVID-19 symptoms at presentation (OR, 1.8) or one or more comorbidities (OR, 1.6).

“As absolute lymphocyte count, absolute neutrophil count, and age are not significantly associated with treatment disruption in our models, our data suggest there might be opportunity to improve outcomes by tailoring treatment decisions to identified risk factors when provider decision making, rather than health system limitations, are driving disruptions,” the researchers write.
Aug 26 Lancet Oncol study


Multistate Salmonella outbreaks now linked to specific Italian meats

The Centers for Disease Control and Prevention (CDC) said yesterday that two outbreaks of Salmonella involving 36 cases in 17 states that it first reported earlier this week are now linked to a specific brand of Italian meat.

“Epidemiologic data show that Fratelli Beretta brand prepackaged Uncured Antipasto trays may be contaminated with Salmonella and may be making people sick,” the CDC said in an update. “Of the 25 people with information, 22 (88%) reported eating a variety of Italian-Style meats. Among 15 people who remembered the specific product or had shopper card records showing a purchase, 14 had Fratelli Beretta brand prepackaged Uncured Antipasto trays.”

The agency reported no new cases since it first warned about the outbreak on Aug 24. As of Aug 25, the outbreak includes at least 13 people infected with Salmonella Infantis and 23 with Salmonella Typhimurium, but the true number of sick people is likely much higher than the 36 total confirmed infections. The CDC has combined the two outbreaks into one investigation.

Illness-onset dates range from May 9 to Jul 27, and California (7), Arizona (5), and Illinois (4) have reported the most cases. Twelve people have been hospitalized, but no deaths are reported.

Although no food recall has yet been announced, the CDC update says, “CDC is advising people not to eat Fratelli Beretta brand prepackaged Uncured Antipasto trays with ‘best by’ dates on or before February 11, 2022. This does not include Italian-style meats sliced at a deli. The investigation is ongoing to determine if additional products are linked to illness.”
Aug 26 CDC update and news release
Aug 24 related
CIDRAP News scan

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