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COVID-19 occasionally associated with serious childbirth complications
Pregnant women with COVID-19 are more likely to experience complications such as heart attacks or blood clots, though the absolute increased risk is small, according to a JAMA Internal Medicine research letter today.
These findings highlight the need for risk mitigations, the authors write, adding that pregnant women should also be included in COVID-19 vaccine and treatment trials.
Using hospital codes within the US Premier Healthcare Database, the researchers looked at 406,446 hospitalizations for childbirth between Apr 1 and Nov 23, 2020. Of these, the 6,380 (1.6%) pregnant women who had COVID-19 were more likely to experience myocardial infarction (heart attack; adjusted odds ratio [aOR], 30.89), thrombotic (clot-producing) events (4.47), preeclampsia (1.21), and preterm birth (1.17). Absolute values ranged from less than 1% (myocardial infarction, 0.1% vs 0.004%) to almost 9% (preeclampsia, 8.8% vs 6.8%).
Mortality rate for COVID-infected pregnant women was 0.1%, which the researchers extrapolated to 141 deaths per 100,000 as opposed to the 5.0 deaths projected for non-infected women.
“Although the absolute risk differences were small, in-hospital death, [venous thromboembolism], and preeclampsia were considerably higher among women who gave birth with COVID-19 than in those without COVID-19,” the author write.
COVID-19 infection was also associated with higher levels of care: 3.3% of pregnant women with COVID-19 were admitted to the intensive care unit (aOR, 6.47) and 1.3% needed mechanical ventilation (aOR, 23.70). Study data indicated that pregnant women with COVID were more likely to be younger (29.7% 24 years or under), black (17.6%) or Hispanic (42.6%), or experiencing diabetes (2.1%) or obesity (21.6%).
Jan 15 JAMA Intern Med study
Past COVID may give at least 83% protection against reinfection
While people who had COVID-19 infections may have protection against reinfection, viruses in their nasal and throat passages may still transmit the disease, according to a preprint paper outlining preliminary data on Public Health England’s (PHE’s) SARS-CoV-2 Immunity and Reinfection EvaluatioN (SIREN) study yesterday.
The study looked at 20,787 English healthcare workers from clinical and nonclinical roles from Jun 18 to Nov 24, 2020. Out of 6,614 workers who were placed in the COVID-19–positive cohort at time of recruitment, 42 developed possible and 2 developed probable reinfections, indicating an 83% protection rate (99% if the 42 possible reinfections were false).
The median interval between the participants’ alleged infections was more than 160 days, or a little over 5 months.
Possible infections were defined as either having two positive polymerase chain reaction (PCR) tests more than 90 days apart or a new PCR-positive test at least 4 weeks after testing positive for COVID antibodies, according to a BMJ news story. Probable infections needed quantitative serologic or supportive viral genomic data in addition to this. Study participants had PCR and antibody tests every 2 to 4 weeks.
While a months-long immunity response is promising, the authors caution that more research needs to be done to explore vaccine effects, the development of SARS-CoV-2 variants, and transmission ability versus immunity. For instance, they write, those with immunity may still be able to carry the virus in their nasal and throat passages.
“This study has given us the clearest picture to date of the nature of antibody protection against COVID-19 but it is critical people do not misunderstand these early findings,” Susan Hopkins, MB BCh, MSc, SIREN study leader, said in a PHE press release. “If you believe you already had the disease and are protected, you can be reassured it is highly unlikely you will develop severe infections but there is still a risk that you could acquire an infection and transmit to others.”
Jan 14 PHE press release
Jan 14 BMJ news
Study shows high-dose, standard flu vaccines equally safe in older adults
A study yesterday in JAMA Network Open compared the safety and short-term effects on quality of life in older adults who received either the trivalent adjuvanted inactivated influenza vaccine (aIIV3) or trivalent high-dose inactivated influenza vaccine (HD-IIV3), and found both are acceptable vaccine options for this patient population.
The randomized clinical trial included 757 adults 65 and older, with 378 receiving aIIV3 and 379 receiving HD-IIV3. The study included 420 women (55%) and 589 white participants (78%), with a median age of 72 for all patients.
According to the study authors, the proportion reporting moderate-to-severe injection-site pain, limiting or preventing activity, after aIIV3 (12 participants [3.2%]) (primary outcome) was noninferior compared with HD-IIV3 (22 participants [5.8%]) (difference −2.7%; 95% confidence interval, −5.8 to 0.4).
No vaccine-related serious adverse events occurred in either group, and the overall Health-Related Quality of Life (HRQOL) assessment scores were not clinically meaningful pre- and post-vaccination in either group.
“For older persons, any reaction that limits or prevents activities of daily living may have a substantial impact on quality of life,” the authors concluded. “In our study, we measured quality of life change from baseline to 2 days postvaccination using HRQOL instruments validated for older adults. We found no significant differences in the change of prevaccination vs postvaccination HRQOL scores between the aIIV3 and HD-IIV3 groups.”
Jan 14 JAMA Netw Open study
H5N6 and H9N2 avian flu cases reported in China
China reported one more human H5N6 avian flu case, in a 51-year-old man who works as a farmer near Chongqing, a city in the south-central part of the country, according to a recent avian flu update from the World Health Organization (WHO) Western Pacific regional office.
The man’s symptoms began on Dec 18, and the investigation found that he had been exposed to domestic poultry. He was hospitalized with severe pneumonia on Dec 28 and is listed in critical condition. His illness lifts the number of H5N6 cases in China since 2014 to 27.
China reported two earlier cases in 2020; the last case was reported in December from Hunan province.
H5N6 outbreaks have been reported in poultry in China and other countries in Asia, but so far illnesses in humans—which are often severe or fatal—have been reported only in China.
Also, China reported another H9N2 avian flu case in a 1-year-old boy from Guangdong province who had been exposed to domestic poultry. His mild symptoms began on Dec 28, and he was hospitalized the following day. No other illnesses in family members were detected. The WHO said China has reported 42 H9N2 cases since December 2015.
Sporadic H9N2 infections have been reported in China and other countries where H9N2 is endemic in poultry. So far children are the most affected group, and the virus in humans has not been linked to sustained transmission.
Jan 8 WHO update
Three countries report more polio cases
Three countries—Pakistan, Sudan, and Yemen—reported more polio cases last week, all involving vaccine-derived virus, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.
Pakistan reported 1 circulating vaccine-derived poliovirus type 2 (cVDPV2) case in Sindh province, which is included in its total for 2020, which is now 122 for cVDPV2.
Sudan reported 4 cVDPV2 cases in four states: Kassala, Khartoum, Blue Nile, and Red Sea. The new cases raise the country’s total for 2020 to 52. Also, Yemen reported 9 cases of circulating vaccine-derives poliovirus type 1 (cVDPV1) from Saadah, putting its 2020 total at 28.
Jan 14 GPEI update