COVID-19 Scan for Jun 15, 2021

News brief

Deaths rose 17% in US assisted living residents during COVID-19

From January to August 2020, 17% more US assisted living residents died compared with the same months in 2019, and excess deaths hit 24% in the hardest-hit states, according to a JAMA Network Open research letter yesterday.

The researchers used Centers for Medicare & Medicaid Services, including Vital Status Data, from 2018 to 2020, to look at more than 422,000 facilities each year in 49 states and Washington, DC. (Minnesota was excluded because it licenses agencies, not physical locations.) Residents were mostly White (90%) or women (66%), and 48% were older than 85 years.

From Jan 1 to Aug 11, 2020, the all-cause mortality rate was an average of 2.30 deaths per 1,000 residents per week, compared with the corresponding months in 2019, which had 2.02 deaths per 1,000 residents per week (adjusted incidence risk ratio [aIRR], 1.17; 95% confidence interval [CI], 1.14 to 1.20).

An analysis of the 10 states with the greatest COVID-19 surges showed 24% higher mortality in 2020, with mortality incidence averaging 2.39 deaths per 1,000 residents per week, while in 2019, those 10 states had a composite 1.93 deaths per 1,000 residents per week (aIRR, 1.24; 95% CI, 1.19 to 1.30). Those states reached a 2020 peak at 4.49 deaths per 1,000 residents per week.

"These results suggest that assisted living residents experienced increased mortality during the COVID-19 pandemic consistent with increases observed among nursing home residents," the researchers write. "The increase in resident mortality we observed is likely an underestimate of the overall excess mortality during the pandemic given the lag in Vital Status data and the period studied."
Jun 14 JAMA Netw Open study

Booster vaccine raised antibody levels in some transplant recipients

Promising antibody levels in 30 organ transplant recipients who received a booster COVID-19 vaccine dose show that clinical trials may be beneficial to assess vaccine protection after an added dose, according to an Annals of Internal Medicine research letter yesterday.

The patients were originally vaccinated with two doses of either the Pfizer/BioNTech or Moderna COVID-19 vaccine, but after a median of 9 days, 24 had negative antibody titers and six had low titers. A third dose was administered a median of 67 days post–second vaccination from Mar 20 to May 10. Fifteen received the Johnson & Johnson vaccine, 9 Moderna, and 6 Pfizer. After a median of 14 days, all 6 with low titer levels hit high-positive levels. Of the 24 with negative levels, 6 converted to high-positive, 2 had low levels, and 16 were still negative.

Seven days after the third vaccination dose, 15 of 23 people reported moderate local reactions, and 1 person had severe arm pain. The most frequent systemic reaction was mild or moderate fatigue (14), and no one reported fever. One heart transplant recipient had antibody-mediated mild rejection 7 days after the third vaccination, but the researchers are not completely sure if this was related to the vaccine.

Patients were a median of 57 years, and most were women (56.7%) or White (96.7%). Twenty-five had maintenance immunosuppression, and 24 received corticosteroids. The median time between transplantation and the initial vaccination was 4.5 years. None had a history of COVID-19.

"We believe that these observations support the use of clinical trials to determine whether booster doses to prevent COVID-19 in transplant patients can be incorporated into clinical practice, as they have been for hepatitis B and influenza vaccination," conclude the researchers.
Jun 14 Ann Intern Med study

News Scan for Jun 15, 2021

News brief

H1N1v flu infects German teen who had swine exposure

Germany recently reported a human variant H1N1 (H1N1v) case involving a 17-year-old boy who works on a pig farm, according to a recent weekly communicable disease update from the European Centre for Disease Prevention and Control (ECDC).

The boy, from Mecklenburg-Western Pomerania state, began having flulike symptoms on Apr 18, and the virus was confirmed with genetic sequencing at the Robert Koch Institute as part of routine surveillance. The analysis revealed that the virus belongs to the Eurasian avian-like lineage of swine influenza A viruses.

When his respiratory symptoms began a few days after working at the pig farm he was isolated for a suspected COVID-19 infection. No other symptoms were reported in workers at the farm or in the patient's family.

Germany reported a similar H1N1v case in July 2020, which involved a 2-year-old boy who had recently visited a pig farm.
Jun 11 ECDC weekly report
Jul 20, 2020, CIDRAP News scan

Five polio vaccinators killed in Afghanistan

In the middle of a 4-day polio vaccination campaign targeting 9.9 million Afghan children, gunmen shot and killed at least five vaccinators and injured several others today in separate attacks in eastern Nangarhar province.

The Voice of America (VOA) reported that the vaccination campaign has been halted due to the violence. Afghanistan and neighboring Pakistan are the only two countries in the world where polio is endemic, but vaccinators have faced increasing violence in recent years. In March, the VOA said, three female anti-polio workers were gunned down in Jalalabad; the Islamic State eventually claimed responsibility for that attack.

The vaccination campaign was meant to jumpstart vaccination efforts that had been halted due to the COVID-19 pandemic. So far no groups have said they are responsible for the violence.

"Polio immunization campaigns are a vital and effective way to reach millions of children to protect them against polio. Depriving children from an assurance of a healthy life is inhumane," said Ramiz Alakbarov, United Nations secretary-general’s deputy special representative for Afghanistan, in a statement. "The United Nations strongly condemns all attacks on health workers anywhere."
Jun 15 VOA story
Jun 15 United Nations statement
Jun 14 CIDRAP News scan on polio campaign