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News Scan for May 25, 2021

Dentists may have fewer COVID-19 infections than other health workers

Monthly dentist surveys showed a cumulative infection rate of 2.6%, according to a study yesterday in the Journal of the American Dental Association (ADA). The researchers say these rates are lower than those in other health workers, such as physicians or emergency medical service professionals.

While 2,196 participants responded at least once from June to November 2020, only 785 answered all six surveys. Of the total cohort, most were male (59.2%), White (76.1%), in private practice (94.8%), or were general dentists (82.1%). Almost one in four (24.4%) had at least one medical condition associated with higher COVID-related risk, with the most common being obesity (7.6%) and asthma (7.3%). The median age was 52.6 years.

The amount of dentists working (93.0% to 98.1%), doing aerosol-generating procedures (92.8% to 98.4%), and receiving COVID-19 diagnosis tests (16.6% to 43.9%) all increased over the study period.

From the first survey to the last, reported contact with someone who had COVID-19 infection increased from 4.6% to 16.1% (875 total), and the survey responses said 49.1% of exposures were because of patients and 35.4% were because of coworkers. Overall, the cumulative infection rate was 2.6%, and the researchers estimated that monthly incidence rates were between 0.2% to 1.1%.

Personal protective equipment optimization declined over the study, with more dentists switching out masks or respirators between patients by the end (17.6% vs 25.5% or higher beginning in June 2020). The researchers say that this could be a sign of more supply. Almost all dentists (99.7% or higher per survey) said their workplace had some COVID-19 mitigations in place such as screening and disinfecting, and while teledentistry peaked in July (26.1%), by November it had declined (20.5%).

“This study shows high rates of pre-appointment screening of patients and appropriate infection control measures throughout the study period, demonstrating that adhering to very strict protocols for enhanced infection control helps protect their patients, their dental team and themselves,” said senior author Marcelo Araujo, DDS, MS, PhD, ADA Science and Research Institute CEO, in an ADA press release.
May 24 J Am Dent Assoc study
May 24 ADA
press release

 

Tocilizumab associated with less death in moderate-to-severe COVID-19

Tocilizumab was associated with a lower risk of death 90 days after treatment in COVID-19 patients with moderate-to-severe infection or pneumonia at the time of enrollment, particularly those with high C-reactive protein (CRP) levels, according to a JAMA Internal Medicine research letter yesterday. CRP is a marker of inflammation.

In the continuation of a previous JAMA Internal Medicine study that found an association between tocilizumab and reduced ventilation or death by day 14 (but not mortality by day 28), the researchers followed up with the 63 patients who received tocilizumab and the 67 in the control group. By day 90, 7 in the intervention group (11.1%) and 11 in the control group (16.4%) died (adjusted hazard ratio [aHR], 0.64; 95% confidence interval [CI], 0.25 to 0.65).

In the original study, researchers stratified data by CRP levels and found that patients most benefited from tocilizumab when they had CRP levels higher than 15.0 milligrams per deciliter. Of these patients, 18% who received tocilizumab needed ventilation or died versus 57% in the control group by day 14. Now by day 90, the researchers found that those with high CRP levels had a lower likelihood of mortality if they received tocilizumab compared with those who didn’t (aHR, 0.18; 95% CI, 0.04 to 0.89).

“This follow-up analysis suggests that tocilizumab may be considered for treating patients with moderate-to-severe COVID-19–associated pneumonia and high CRP levels,” write the researchers. “Further studies will help determine which patients with COVID-19–associated pneumonia would benefit the most from a combination of tocilizumab and dexamethasone.”
May 24 JAMA Intern Med study

In India, 47% of bacterial infections in COVID patients multidrug-resistant

A retrospective study of COVID-19 patients in India found a low prevalence of secondary bacterial or fungal infections, but gram-negative pathogens predominated, high rates of antibiotic resistance were observed, and mortality was high, Indian researchers reported yesterday in Infection and Drug Resistance.

Of the 17,534 COVID-19 patients admitted to the intensive care units and wards of 10 Indian hospitals from June to August 2020, 640 (3.6%) patients developed secondary bacterial infections (585/640, 91.4%) or fungal infections (35/640, 5.4%), with a range of 1.7% to 28% across hospitals. Among those patients, 78% acquired the infections in the hospitals (48 hours or more after admission), and the median number of days to develop an infection varied from 3 to 15 days.

Of the pathogens isolated from blood, respiratory specimens, and urine, 78.3% were gram-negative bacteria, and Klebsiella pneumoniae (29.3%) and Acinetobacter baumannii (21.1%) were the most commonly isolated pathogens. Candida spp were isolated from 6% of patients with secondary fungal infections, with 13 Candida auris (1.3%) isolates found.

Among the patients with secondary infections, 47.1% were infected with multidrug-resistant organisms. High levels of carbapenem resistance were detected in K pneumoniae (72.8%) and A baumannii (92.6%), and A baumannii isolates showed high resistance to nearly all antibiotics tested. Extremely drug-resistant K pneumonia and A baumannii accounted for nearly 50% of the gram-negative isolates. While overall mortality in COVID-19 patients in the 10 hospitals was 11.6%, mortality among patients with secondary infections was 56.7%.

The study authors say the prevalence of highly resistant pathogens, and the fact that most of the infections were hospital-acquired suggests poor infection control practices and irrational use of broad-spectrum antibiotics. Most of the antibiotics prescribed came from the World Health Organization’s “watch” (52.4%) and “reserve” (22.1%) categories.

“These data were captured when the COVID-19 cases were on the rise, and the findings suggest that a lot of overprescribing of antimicrobials happened during that time,” they wrote. “The practice of poor infection control and empirical over-use of broad-spectrum antimicrobials also provides fertile ground for future outbreaks with highly drug-resistant pathogens.”
May 24 Infect Drug Resist study

WHO advisors extend global polio emergency

The World Health Organization (WHO) polio emergency committee recently met for the 28th time to assess the latest developments and unanimously said that the global situation still warrants a public health emergency of international concern (PHEIC) under the International Health Regulations.

In a statement late last week, the WHO said the group met virtually on May 4 to review the latest data. The group typically meets every 3 months or more often as needed. Its last meeting was on Feb 1.

The group said activity from wild poliovirus type 1 in Pakistan and Afghanistan may have peaked in 2020, but it’s not clear if the situation will be sustained in Pakistan, and there are concerns about a doubling of cases in Afghanistan in the most recent period. Transmission persists in parts of both countries, with spread to previously polio-free areas.

Committee members also said Afghanistan and Pakistan are still vulnerable because of COVID-related interruptions in routine immunization and other prevention activities, but short-term COVID mitigation measures may have temporarily reduced transmission.

Members also aired concerns about the continued rapid spread of circulating vaccine-derived poliovirus type 2 (cVDPV2), with 2020 cases 254% higher than in 2019. The also noted numerous instances of cases exported to other countries, including from Sudan to Egypt, as well as from Afghanistan to Iran and Tajikistan. They concluded that the risk of international spread of both WPV1 and cVDPV2 is very high.
May 21 WHO statement

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