Half of hospitalized COVID patients developed complications, study finds
Half of patients hospitalized with severe COVID-19 across 302 UK hospitals developed one or more health complications within 28 days or discharge, according to a study yesterday in The Lancet.
The researchers looked at 73,197 adults 19 and older and found that 49.7% developed at least one complication while hospitalized with COVID-19 from Jan 17 to Aug 4, 2020. While 31.5% died, 43.5% of survivors had at least one complication. The most common were renal (24.3%), complex respiratory (18.4%), and systemic (16.3%), but cardiovascular (12.3%), neurologic (4.3%), and gastrointestinal or liver (0.8%) issues also occurred.
Patient mean age was 71.1 years, and 56.0% were male. About four in five (81.0%) had at least one comorbidity. Complications were associated more with sex (59.8% of men vs 39.9% of women) and age, occurring in 27% of those 19 to 29, 37% of those 30 to 39, 43% in those 40 to 49, and then from 50% to 54% in those 50 and older. The presence of any complication was linked with increased risk of death, and in survivors, complications were also associated with a worse ability for self-care.
Chinese pulmonologists Xiaoying Gu, PhD, and Bin Cao, PhD, writing in a related commentary, highlight that relative mortality risk was higher in younger patients with complications versus older patients with complications when compared with similarly aged patients who had no complications. But they note that the authors of the study did not assess statistical significance of this finding. They say the finding emphasizes the need to support younger patients who may be more likely to live longer with complications.
Overall, Gu and Cao state, “Comprehensively understanding the health effects of COVID-19 from its acute to chronic stages is important, not only for the preparation of further waves of the pandemic, but also for assessing the burden on health-care systems due to COVID-19 consequences.” They add that it would be interesting to understand the role that ethnicity might play.
Jul 15 Lancet study and commentary
Monkeypox confirmed in Texas traveler returning from Nigeria
The US Centers for Disease Control and Prevention (CDC) and health officials in Texas have confirmed a human monkeypox illness in a US resident who recently returned from Nigeria and is hospitalized in Dallas. Nigeria has been reporting monkeypox flare-ups since 2017.
Health officials are contacting airline passengers who were on two flights with the patient, one from Lagos to Atlanta that arrived on Jul 9 and one from Atlanta that arrived in Dallas on the same day. The CDC said the risk of virus spread by respiratory droplets was low on the flights, given that mask wearing was required because of the pandemic.
The Texas Department of Health and Human Services (TDHHS) said the patient, a Dallas County resident, is isolated in the hospital and that investigators have identified a few people who may have been exposed in Dallas. They are monitoring themselves, and officials said the illness doesn’t pose a risk to the general public. Dallas County officials, who are leading the investigation, said the patient is in stable condition.
Genetic testing revealed that the patient’s strain is related to monkeypox circulating in parts of West Africa, including Nigeria. Sporadic exported cases have been reported over the past few years, including three in a family cluster in the United Kingdom, which also had ties to Nigeria travel. The CDC said the Texas case isn’t related to any of the earlier exported cases.
The last monkeypox cases reported in the United States were part of a 2003 outbreak triggered by the virus jumping from imported African rodents to pet prairie dogs. There were 47 cases, 37 confirmed and 10 listed as probable, from five states. The event triggered an import ban on African rodents.
Jul 16 CDC statement
CDC monkeypox outbreak background
Jul 16 TDHHS statement
Jul 16 Dallas County statement
Multidrug-resistant organisms reduced in nursing home residents’ rooms
A multicomponent intervention implemented at nursing homes in Michigan significantly reduced the prevalence of multidrug-resistant organisms (MDROs) in residents’ rooms, according to the results of a randomized clinical trial reported today in JAMA Network Open.
Using a cluster-randomized trial design, researchers from the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System compared the presence of MDROs in patients and their room environments at 3 nursing homes that implemented the intervention with the MDRO presence at 3 control nursing homes. The intervention included enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning education and feedback, hand hygiene promotion, and healthcare workers’ education and feedback. Control nursing homes continued standard care practices.
Over 808 study visits, the researchers obtained 3,654 patient cultures and 5,606 environmental cultures. The intervention reduced the odds of MDRO prevalence in patients’ environments by 43% (adjusted odds ratio [aOR], 0.57; 95% confidence interval [CI], 0.35 to 0.94), but there was no statistically difference at the patient level before or after adjustment (aOR, 0.57; 95% CI, 0.29 to 1.14).
When adjusting for patient-level covariates, the intervention was not associated with significantly decreased time to new acquisition of methicillin-resistant Staphylococcus aureus (hazard ratio [HR], 0.20; 95% CI, 0.04 to 1.09), vancomycin-resistant Enterococci (HR, 0.84; 95% CI, 0.46 to 1.53), or resistant gram-negative bacilli (HR, 1.14; 95% CI, 0.73 to 1.78).
“By acknowledging that patients and their environments are dyads that readily transmit to one another, our results highlight how critical it is to study interventions that impact both patient colonization and environmental contamination,” the authors wrote. “Under this analysis, we can conclude that this intervention influences patients and their environment overall, thus reducing MDRO transmission potential within facilities.”
Jul 16 JAMA Netw Open study
CDC reports Salmonella tied to lettuce salad, other foodborne outbreaks
The Centers for Disease Control and Prevention (CDC) yesterday reported a two-state outbreak involving eight Salmonella cases linked to BrightFarms Sunny Crunch lettuce salad that was produced in Rochelle, Illinois. The cases are in Wisconsin and Illinois, and the salad was distributed in “at least” Illinois, Indiana, Iowa, and Wisconsin, the CDC said.
The outbreak strain is Salmonella Typhimurium. Sick people range in age from 31 to 61 years, with a median age of 46, and five are women. Illness-onset dates range from Jun 10 to 15. No hospitalizations or deaths were reported. The CDC is advising people not to eat, sell, or serve BrightFarms brand Sunny Crunch salad.
The agency said in a news release, “Interviews with ill people and traceback information show that BrightFarms brand Sunny Crunch salad may be contaminated with Salmonella and making people sick. At least five people ate or bought this product before getting sick.” All eight people reported eating leafy greens in the week before they got sick, and seven said they ate prepackaged salads.
In other food outbreak news, the CDC on Jul 14 announced that two people in Texas and one in Delaware were infected with Listeria in an outbreak tied to frozen, fully cooked chicken products, such as chicken strips and diced chicken, supplied by Tyson Foods. The products have been shipped nationwide, and brands include Tyson, Jet’s Pizza, Casey’s General Store, Marco’s Pizza, Little Caesars, and Circle K. The products have been recalled.
Finally, Food Safety News reports that the CDC is investigating an Escherichia coli O121 outbreak that has sickened 15 people in 11 states, but no other information is available, including the likely source of the pathogen.
Jul 15 CDC Salmonella outbreak notice and news release
Jul 13 CDC Listeria outbreak notice
Jul 16 Food Safety News story
More vaccine-derived polio cases reported in 3 countries
Nigeria, Senegal, and Tajikistan reported more polio cases this week, all involving circulating vaccine-derived poliovirus type 2 (cVDPV2), the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.
Nigeria reported 1 case, which involves a patient from Kebbi state in the northwest, lifting the total for 2021 to 22. Elsewhere in Africa, Senegal reported 2 cases, both in Diourbel region in the west, putting its total for the year at 11.
Tajikistan reported 1 case in Khatlon province in the southwest on the border with Afghanistan and Uzbekistan, which brings the country’s total so far this year to 16.
Jul 15 GPEI weekly update