CDC alerts providers about infectious diseases in Afghan evacuees
The US Centers for Disease Control and Prevention (CDC) yesterday sent a Health Alert Network notice to health providers warning that cases of measles and mumps have been detected in people recently evacuated from Afghanistan.
So far, 16 cases of measles and 4 cases of mumps have been reported among Afghan refugees and US citizens who were recently airlifted from Afghanistan. The CDC said continued vigilance is needed, and evacuees who are in the United States are required to receive the measles, mumps, and rubella (MMR) vaccine and complete a 21-day quarantine after vaccination at designated locations. Evacuation flights into the United States from other countries have been halted to allow for MMR vaccination and quarantine.
The CDC said it expects more measles spread among evacuees, given the low MMR vaccine coverage in Afghanistan and the close living quarters inherent in the evacuation process. It urged public health departments to continue to look for people with communicable diseases, isolate those with symptoms, and identify and monitor contacts.
The notice also urged health officials to monitor for other diseases. Besides measles and mumps, other infections have been found in evacuees, including chicken pox, tuberculosis, malaria, leishmaniasis, hepatitis A, and COVID-19.
Sep 20 CDC HAN notice
Antivirals underused in Canadian kids with flu, study says
About 41% of children 16 years or younger admitted to 12 Canadian hospitals for the flu received antivirals from the 2010-11 season to 2018-19 season, according to a study in Pediatrics today. Almost 73% received antibiotics even though lab-confirmed bacterial infections were only found in 6.7% patients.
The researchers looked at data from 7,545 patients (median age, 3 years) and found that antiviral use varied from 10.2% to 81.1% across sites and 19.9% to 59.6% across flu season. Increased likelihood factors included more recent flu season (highest adjusted odds ratio [aOR], 9.18 for 2018-19), presence of chronic health conditions (highest aOR, 4.81 for cancer), intensive care unit admission (aOR, 3.62), lab confirmation timing (highest aOR, 2.67 for pre-admission results), needed respiratory support (aOR, 1.57), or antibiotic treatment (aoR, 1.51).
Of the 41.3% patients who received antiviral agents, 99.9% received oseltamivir. About 81.7% received antivirals within 2 days of hospital admission, but initiation decreased in proportion as time lengthened from symptom onset to admission (e.g., less than 2 days was 48.3%, while greater than 4 days was 35%).
Seventy-two percent of patients received antibiotics during hospitalization, but only 6.7% of patients had lab-confirmed bacterial infections. The researchers say that 93% of patients had influenza test results available within 48 hours of admission.
“In this study, only a quarter of children presented within [the recommended antiviral] time interval; delayed presentation (ie, >48 hours) may have led some clinicians not to use antiviral agents,” write the researchers. “However, antiviral agents are recommended for all patients hospitalized for influenza, even if treatment is started >48 hours after onset of illness.”
“These findings suggest that integrating novel rapid and accurate molecular assays to emergency department diagnostic algorithms, especially for at-risk children being hospitalized, would facilitate early diagnosis and treatment.”
Sep 21 Pediatr study
Meningitis cases and deaths rise in DRC outbreak
A meningitis outbreak in the Democratic Republic of Congo (DRC), first reported earlier this month, has grown to 608 suspected cases and 161 deaths, the World Health Organization (WHO) said yesterday in an update. The latest report reflects a steady increase from the 269 cases and 129 deaths that were initially reported on Sep 8.
The area where the outbreak is occurring is in the northeastern DRC province of Tshopo, which is part of Africa’s “meningitis belt.” The epicenter is the province’s Banalia health zone.
So far, 12 cases are lab confirmed. Only a small portion of meningitis cases are confirmed each year. Further testing on samples reveals that the Neisseria meningitidis bacteria involved in the outbreak belongs to serogroup W. Antibiotic susceptibility testing revealed that it is susceptible to ceftriaxone.
Investigations so far have found that the outbreak began in early June in two mining areas in Banalia health zone, north of the provincial capital city of Kisangani. Local health officials have stepped up response actions, and an immunization campaign with a vaccine that contains the serogroup W antigen is being planned.
Tshopo province battled its last meningitis outbreak in 2009, which resulted in 214 cases and 18 deaths. The WHO said the risk of spread to other health zones and the provincial capital is high, with the regional risk moderate and the international threat low.
Sep 20 WHO outbreak update
Non-COVID excess deaths affected minorities, men more, study says
Since the COVID-19 pandemic began, minorities and men have accounted for 58% and 34% of the excess life years lost to non-COVID related deaths, according to a study published yesterday in the Proceedings of the National Academy of Science.
The researchers looked at US data from Mar 8 to Dec 31, 2020, and found that deaths were 17.3% higher than age-population-weighted mortality in the same interval from 2017 to 2019—an excess death count of 413,592. Of the life years lost due to excess mortality, 34.2% of men’s loss was not due to COVID-19 versus women’s 19.0%. About 32.3% of life years lost among Black or Hispanic people was not due to COVID-19 versus the 24.2% of White people’s life years lost. Overall, minorities represented 70% of non-COVID excess deaths and 58% of non-COVID excess life years lost in 2020.
People who were 45 to 75 years old and Black had greater non-COVID excess death rates. Compared with White people, Black men had a 4.7 ratio and women had an 8.5 ratio, and against Hispanic people, Black men and women had a 2.8 and 3.4 non-COVID excess death rate ratio, respectively. White people over the age of 75, on the other hand, had “substantial negative excess mortality” from non-COVID causes.
Age did not create a consistent gradient in non-COVID excess mortality except for minority women and Hispanic men.
“There is little doubt that some of the excess death we label ‘non–COVID-19’ are truly mismeasured COVID-19 deaths,” the researchers write. “However, the evidence above suggests that measurement error represents a small share of these excess deaths and, more importantly, does not explain the large racial/ethnic disparity in non–COVID-19 excess death rates.”
Sep 20 Proc Natl Acad Sci study