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Pain associated with worse COVID-19 in sickle cell disease
A history of pain in sickle cell disease (SCD) patients—the disease’s most common complication—is associated with worse COVID-19 outcomes in children and adults, according to a Blood Advances study yesterday. SCD-related organ comorbidities were also related to worse COVID-19 outcomes in children.
The researchers looked at 750 international patients with COVID-19 and SCD from March 2020 to 2021. Almost half (48.5%) were children, median age 11, and the remaining were adults, median age 31. About 91% were Black and 7% were Latino.
Most had prior acute care visits for pain (55.5% children, 78.5% adults), and almost one in three had acute chest syndrome in the previous 3 years (29.4% children, 29.5% adults). The most common COVID-19 symptoms were pain (35.2% children, 67.4% adults) and acute chest syndrome (14.8% children, 29.5% adults), which made the researchers question if COVID infection triggered pain episodes.
Data showed that in children, their risk of severe COVID-19 increased with renal comorbidities (risk ratio [RR], 3.67), a history of pain (RR, 3.09), or heart or lung comorbidities (RR, 1.76), with the latter two conditions also connected with increased hospitalization risk (RRs, 2.15 and 1.61, respectively). In adults, the risk of COVID-19 severity increased with a history of pain (RR, 1.94).
Half of the patients were on hydroxyurea, a drug meant to reduce pain episode frequency, but the researchers did not find a link with COVID-19 hospitalization or severity. It was, however, associated with a lower risk of pain in adults.
“This study tells us that all individuals with sickle cell disease are not at equal levels of risk,” said study author Lana Mucalo, MD, of the Medical College of Wisconsin, in an American Society of Hematology (ASH) press release. “Patients with a history of pain, as well as individuals with coexisting organ conditions, need to be even more careful to avoid COVID-19 infection than those without any comorbidities.”
Jul 1 Blood Adv study
Jul 1 ASH press release
COVID risk from patient encounters appears low in emergency responders
COVID incidence for emergency medical service (EMS) workers was not affected by work encounters with a COVID-19 patient, according to an Emerging Infectious Diseases study yesterday.
The researchers looked at EMS responses in King County, Washington, from Feb 16 to Jul 31, 2020, and found that about 1% of all encounters were with a COVID-19 patient (1,115), of which about one in six needed an aerosol-generating procedure (AGP), the most common being nonrebreather masks. (Over the study period, EMS workers received COVID-related protocols, including personal protective equipment guidelines. For instance, anytime an AGP was performed, the workers needed to don N95 respirators.)
By the end of the study period, 30 workers had tested positive for COVID-19, with only one linked with a COVID-19 patient encounter within the patient’s incubation period(the patient had also needed at least one AGP). As for the other workers, 18 received positive diagnoses outside of their most recent COVID-19 patients’ incubation period, and 11 never encountered a COVID-19 patient through work. EMS worker incidence for COVID-19 infection acquired anywhere was 0.57 infections per 10,000 person-days, and no significant change of incidences were attributed to a COVID patient encounter or not.
“We observed that the large majority of COVID-19 illness was a consequence of encounters not with patients but in the community or occupational settings,” the researchers write. “These findings support efforts to screen workplaces for provider symptoms or initiate point-of-care provider testing to limit on-the-job exposure as well as to practice guideline-directed social distancing, masking, and hygiene recommendations outlined for the general public, acknowledging that vaccination may affect these directives.”
Overall, about 55% of the region’s first responders had contact with a COVID-19 patient, and while this includes patients beyond their transmission period, one third also didn’t display common symptoms. Across 8,582 person-days, 705 EMS workers performed at least one AGP on COVID-19 patients within their viral incubation period, and across 26,583 person-days, 1,389 workers treated a COVID-19 patient within their incubation period who did not need an AGP.
Jul 1 Emerg Infect Dis study
FDA announces plan to prevent Cyclospora-related foodborne disease
The Food and Drug Administration (FDA) yesterday published a new prevention, response, and research action plan to help the agency prevent Cyclospora contamination of foods, and respond quickly to outbreaks.
Cyclospora is a parasite that can cause intestinal illness in people when ingested. It was first identified in domestically grown herbs in the United States in 2018. Since then, infections have been rising, and there have been 6,000 domestically acquired cases of Cyclospora over the past 3 years.
“Given the emerging nature of Cyclospora contamination in domestic produce, a large number of action items in this plan are aimed at addressing knowledge gaps,” the FDA said. The FDA created a Cyclospora Task Force in 2019, and that group authored the new action plan. In a press release, the FDA said the plan is modeled after the Leafy Greens Shiga toxin–producing Escherichia coli (STEC) Action Plan.
The plan expands laboratory capacity across the FDA, state, foreign partners and academia to sample and test for Cyclospora, the FDA said. The FDA will also work with the Centers for Disease Control and Prevention to better understand the case distribution of cyclosporiasis across the country.
Jul 1 FDA plan and press release
Nigeria reports 10 more vaccine-derived polio cases
Only one country reported new polio cases this week: Nigeria, which reported 10 infections involving circulating vaccine-derived poliovirus type 2 (cVDPV2), according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).
Of its cases, 3 are in Jigawa state, 3 in Yobe, and 1 each in Borno, Kano, and Zamfara states, boosting the country’s total for the year to 21 cases.
Nigeria’s total for 2021 has already passed the 8 cases reported for all of 2020.
Jul 1 GPEI update
Maine confirms its first Powassan virus case of the year
Health officials in Maine this week reported the state’s first Powassan virus case of the year, which involves a resident of Waldo County, located in the east central part of the state.
In a statement, the Maine Department of Health and Human Services (MDHHS) said the person contracted the virus in Maine and is recovering after spending time in the hospital. The detection marks Maine’s ninth Powassan virus case since 2010.
Powassan virus is spread by ticks, and infections are rare, with the United States averaging about 25 cases a year. There is no treatment for the illness, which can be severe. Symptoms range from headache to fever to encephalitis.
Jun 29 MDHHS statement