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Study notes small decline in preschool developmental milestones during pandemic
Stephanie Soucheray, MA Today at 3:29 p.m.
COVID-19

Today in JAMA Pediatrics, researchers from the Johns Hopkins Children's Center published a study demonstrating small declines in developmental milestones in children 5 years old and younger during the pandemic in the United States.

The authors of the study said the findings were reassuring for the short term but may mean behavioral and development pediatric care will be strained in the coming years.

"We found, overall, that while there are some changes, the sky is not falling, and that is a really important and reassuring finding," said Sarah Johnson, MD, PhD, the corresponding author of the study, in a press release from Johns Hopkins Medicine.

Researchers used results from the Comprehensive Health and Decision Information System (CHADIS) and the Ages and Stages Questionnaire-3 (ASQ-3), which assesses communication, gross motor, fine motor, problem-solving, and personal-social skills. ASQ-3 scores from a total of 50,205 children were included in the final study.

To capture the effects of the pandemic, researchers compared ASQ-3 results from 2018, 2020, and what they called an intrapandemic phase from 2020 through 2022. Caregivers completed developmental screening at US pediatric primary care practices participating in CHADIS.

No changes in motor skills
Pre- and post-pandemic, there were no significant changes in fine or gross motor skill domains. But the remaining three categories, communication, problem-solving, and personal-social skills, all saw a dip of single percentage points after 2020, suggesting that the pandemic's interruptions to childcare, work, and school left a mark on young children.

In total, mean score decreases were observed from 2018 to 2020-2022 in communication (−0.029; 95% confidence interval [CI], −0.041 to −0.017), problem-solving (−0.018; 95% CI, −0.030 to −0.006), and personal-social (−0.016; 95% CI, −0.028 to −0.004) areas.

Even in young infants aged 0 to 12 months, 2% to 3% declines in these three areas were observed, but caregiver concerns about children's behavior didn't rise in 2022 compared to 2018. Caregivers did, however, report worrying more about a child's well-being during the pandemic years (rate ratio, 1.088; 95% CI, 1.036 to 1.143).

The authors of the study said these findings have important implications for the country's pediatricians and nurse practitioners. "While changes in developmental screening scores were modest (2%-3%), nationwide, this could translate to more than 1500 additional recommended developmental referrals over baseline each month," they wrote.

It is important for us to continue to keep an eye on kids of all ages in terms of development.
"It is important for us to continue to keep an eye on kids of all ages in terms of development, so we can understand whether these changes have longer-term implications for children or if new challenges emerge as children age," said Johnson.

https://www.cidrap.umn.edu/cov...

State COVID policies didn't translate into fewer cases, deaths, study suggests
Mary Van Beusekom, MS Today at 2:03 p.m.
COVID-19

A research letter published today in JAMA Network Open suggests that US states and territories that had more policies aimed at reducing COVID-19 rates in nursing homes (NHs) and home healthcare agencies (HHAs) didn't necessarily have a lower burden of the disease.

The Columbia University–led research team used NH- and/or HHA-specific policies from state and territory government websites to identify 38 COVID-19 policies implemented from March 2020 to July 2022. They then linked the policy data with community-level and NH-specific COVID-19 cases and deaths to create a dataset and dashboard to help researchers and public health officials assess policy effectiveness.

"The COVID-19 pandemic disproportionately affected older persons, many of whom were served by home health care agencies (HHAs) and nursing homes (NHs)," the researchers wrote. "The extent to which state- and territory-level COVID-19 policies reinforced or expanded federal policies is unknown."

Fewer policies on HHAs than NHs
In total, 1,400 policies were identified in 50 states and 5 territories. Most (60.4%) included all health care settings, followed by NH-specific (34.7%), NH- and HHA-specific (3.1%), and HHA-specific (1.8%) policies.

The policies were aimed at preventing SARS-CoV-2 transmission (52.6%), expanding NH and/or HHA capacity (23.2%), easing administrative requirements (13.1%), reporting COVID-19 data (5.6%), and admitting and releasing patients (3.9%).

Future public health planning and pandemic responses should include adaptive and targeted policy interventions and should consider specific needs of all health care settings.
Having more state- and territory COVID-19 policies wasn't consistently tied to lower community- or NH-level disease burden, which the authors said suggests that policy effectiveness may depend on implementation and compliance.

"For example, on May 24, 2020, Montana, Hawaii, and Alaska had no COVID-19 deaths or policies, in contrast with North Carolina's moderate burden and several policies," the researchers wrote. "By January 12, 2021, New York had a severe COVID-19 burden and the greatest number of policies, while Pennsylvania, Montana, and Florida had a similar COVID-19 burden but fewer policies."

Less attention was paid to HHAs than NHs, even though both settings served high-risk older people. "This suggests a gap in public health planning, raising questions about resource allocation and prioritization among health care settings during pandemics," they wrote.

The researchers' dataset and dashboard provide a way to visualize efforts to mitigate public health crises, they said.

"Future public health planning and pandemic responses should include adaptive and targeted policy interventions and should consider specific needs of all health care settings," they concluded. "Dashboards have the potential to help formulate data-driven decision-making during public health crises."

https://www.cidrap.umn.edu/res...

Hospitalizations for RSV rose in 2021, 2022 for preschoolers
News brief Today at 2:21 p.m.
Stephanie Soucheray, MA
Topics Respiratory Syncytial Virus (RSV)

A study published late last week in JAMA Network Open finds that, among US preschoolers, the rate of respiratory syncytial virus (RSV) hospitalizations and intensive care unit (ICU) cases rose in 2021 and 2022 during the COVID-19 pandemic compared with 2015 to 2019, with the greatest increase in those 2 to 5 years old.

The retrospective cohort study included 924,061 children younger than 5 years diagnosed with RSV and bronchiolitis at 50 children's hospitals in 10 geographic regions across the United States.

Before the COVID-19 pandemic, RSV had a seasonal peak in North America, but in the winters of 2020 and 2021, there was a dip in cases as COVID mitigation efforts also reduced and altered transmission patterns of RSV. In 2021 and 2022, the virus appeared to peak early in several states and to cause more severe illness.

20% of hospitalized kids needed ICU care
The average age of participants was 8 months, 58.0% were male, and 37.7% were diagnosed with RSV, with 54.0% of those diagnosed with the virus needing hospitalization.

Hospitalization rates rose for all age-groups in 2021 and 2022 compared to the prepandemic period, with children aged 2 to 5 years 4.86 (95% confidence interval [CI], 4.75 to 4.98) times more likely to be hospitalized in 2022 than in 2015 to 2019. Infants aged 0 to 5 months were 1.77 (95% CI, 1.74 to 1.80) times as likely to be hospitalized.

RSV was also tied to more ICU use in the study, with a higher portion (19.7%) of kids with RSV admitted to ICUs than those with non-RSV bronchiolitis (8.6%).

The increased incidence of RSV among older children "has implications for newly available prevention strategies (eg, monoclonal antibodies), for which older children are not currently eligible," the authors concluded.

https://www.cidrap.umn.edu/pne...

Four findings may indicate clinical stability in kids hospitalized for pneumonia
News brief Today at 10:37 a.m.
Mary Van Beusekom, MS
Topics Pneumonia

Younger age, absence of vomiting, decreased breath sounds, and normal capillary refilling may indicate clinical stability and discharge readiness in children hospitalized with community-acquired pneumonia (CAP), suggests a study published in Pediatrics.

A team led by a Medical College of Wisconsin researcher collected time-to-clinical stability (TCS) data (temperature, heart rate [HR], respiratory rate [RR], and oxygenation) in 571 patients ages 3 months to 18 years hospitalized for CAP from July 2013 to December 2017.

CAP is one of the top five indications for hospitalization and antibiotic use in children, but while TCS data are well-defined for adults with CAP, only one study has assessed their use in children, the authors noted.

"Objective definitions of medical stability are necessary to optimize the care of children with CAP," they wrote. "Clear, objective definitions of medical stability guide when a patient is safe to be discharged from the hospital, when they can be switched from intravenous (IV) to oral antibiotics, length of the overall antibiotic course, and risk of adverse outcomes after discharge, including mortality or readmission."

Infants most likely to quickly reach stability
Of 571 children, 32.7% had at least one abnormal parameter at hospital release, 7% had two abnormal readings, and none had three or more. All four parameters were stable in 93% of infants at release, compared with 49% of patients aged 12 to 18 years.

TCS may decrease length of stay if implemented to guide discharge decisions.
RR was the least likely factor to reach stability at hospital release (65%), followed by HR (84%), temperature (95%), and oxygenation (97%).

The median TCS for each parameter was less than 24 hours, with younger age, absence of vomiting, diffusely decreased breath sounds, and normal capillary refilling tied to early hospital release. In total, 8.1% of patients revisited the emergency department; patients who didn't reach clinical stability weren't more likely to return.

"A TCS outcome consisting of physiologic variables may be useful for objectively assessing disease recovery and clinical readiness for discharge among children hospitalized with CAP," the researchers concluded. "TCS may decrease length of stay if implemented to guide discharge decisions."

https://www.cidrap.umn.edu/mis...

Quick takes: Psittacosis in Argentina, more counterfeit Botox reactions, US measles cases rise
News brief Today at 10:34 a.m.
Lisa Schnirring
Topics Misc Emerging Topics Measles Botulism

The cause of severe pneumonia cases reported in Argentina has been linked to a rise is psittacosis, a respiratory disease from a bacteria known to infect birds, the country's health ministry said an April 20 statement. The infections were mainly reported in the Buenos Aires metropolitan area. The ministry said no non-subtypable influenza A viruses were found, no were any unusual respiratory viruses. Cases of mycoplasma pneumonia and chlamydia pneumonia were found, but not in greater-than-expected numbers. In early March, the World Health Organization (WHO) posted an alert about an unexpected rise in psittacosis cases in five European countries.
Three more people have been hurt by reactions linked to counterfeit or mishandled Botox injections, raising the number to 22 in 11 states, the Centers for Disease Control and Prevention (CDC) said in an April 19 update. Two more states reported cases: California and Texas. Two more people were hospitalized, bringing that number to 11. Six people have been treated with botulism antitoxin. Of seven people tested for botulism, tests were negative for six and are pending for one.
Four more measles cases have been reported to the CDC, raising the national total to 125 from 18 jurisdictions, the CDC said in its latest weekly update. The number of outbreaks remained at seven, and 69% of the cases this year have been linked to outbreaks. Children younger than 5 years make up 46% of cases, with older children at 22% and adults at 32%. Of the illnesses reported, 54% of patients were hospitalized for isolation purposes or to manage disease complications.

Is There a Vaccine for H5N1 Influenza?
— And how quickly could it be deployed should it be needed?

https://www.medpagetoday.com/s...

crawgarden said: Is There a Vaccine for H5N1 Influenza?
— And how quickly could it be deployed should it be needed?

https://www.medpagetoday.com/s...

That's good news I wasn't expecting to see .

https://www.cidrap.umn.edu/avi...

Scientists find clues in early analysis of newly shared US H5N1 avian flu sequences
Lisa Schnirring 28 minutes ago.
Avian Influenza (Bird Flu)

With the public release of 239 recent H5N1 avian flu genetic sequences from US dairy cows and other animals, researchers have already roughly visualized the virus, but they still lack the collection dates and geographic information that would paint a clearer picture.

Meanwhile, the virus was confirmed in another dairy herd in Idaho, raising the number of H5N1 detections to 33, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said in its update yesterday.

Virus may have circulated undetected for months
Michael Worobey, DPhil, head of the ecology and evolutionary biology department at the University of Arizona at Tucson, on Twitter (X) today detailed the work of an international group of virus evolution and genomic experts who quickly combed through the sequences to identify the DNA, RNA, and protein arrangements of the virus and how the different sequences might be related to each other.

Analysis of the hemagglutinin, neuraminidase, and internal genes hints that the virus hasn't changed much from its introduction into cattle in late 2023 or 2024, he said. The virus could have jumped to cattle once, but the information from the sequences can't rule out multiple introductions, Worobey added.

Having collection dates and geographic data with each sequence is crucial for pinpointing when the virus began circulating in dairy cows, along with how and where it is spreading, he said.

There's a strong possibility that the virus has been circulating undetected for months, even before a mysterious illness began affecting dairy cows in February, Worobey said. "This reveals massive gaps in our pathogen and surveillance system."

More evidence of cow-to-cow spread
Commenting on the group's work, Sam Scarpino, PhD, director of artificial intelligence and life sciences at Northeastern University, on X said the genome data strengthen the evidence for cow-to-cow transmission. "This means we need much wider testing of dairy and beef cattle (including testing of asymptomatic cows) to determine how widespread the infections are."

Scarpino said so far, the early analysis shows no obvious changes that would increase the human-to-human transmission risk, but he added that it will take time to fully analyze all the genomes. And though the USDA was slow to post the data, he praised the international science community's speed in mobilizing to analyze what the department shared.

https://www.cidrap.umn.edu/cov...

National COVID-19 guidelines vary widely, often promote ineffective treatments
Stephanie Soucheray, MA 47 minutes ago.
COVID-19

A comparative analysis yesterday in BMJ Global Health shows that national clinical guidelines for treating COVID-19 vary significantly around the world, and nearly every national guideline (NG) recommends at least one COVID-19 treatment proven not to work.

The authors considered the gold standard for clinical guidelines to be the World Health Organization's (WHO's) 2022 updated guidelines—the 11th version of the WHO guideline.

They looked at NGs for 109 of the 194 WHO member states after the summer of 2022. Of the 85 countries not included in the final analysis, 9 did not have any NGs.

Regionally, Europe had the most countries with easily identifiable guidelines (69.8%), followed by Africa (53.2%). A country's ministry of health published 73.4% of guidelines, while 12.8% of the guidelines were published by a national disease organization.

The 11th WHO guidelines recommend that clinicians categorize disease severity as non-severe, severe, and critical. However, 84.4% of reviewed NGs defined COVID-19 severity differently from the WHO, and 6.4% of the guidelines did not define severity at all.

Just 10 countries (9.2%) had NGs that published severity definitions comparable to the WHO.

Steroids most widely recommended
The WHO guidelines recommend 10 therapeutics or medications, but NGs recommended 1 to 22 therapeutics. The therapies recommended in NGs were graded in 25 (23.8%) of the guidelines assessed. Most (77%; 84) guidelines did not include an assessment of the strength of the therapeutic recommendation.

"The most commonly recommended drugs were corticosteroids; 92% (100/109) of the NGs featured corticosteroids, and 80% (88/109) recommended corticosteroids for the same disease severity as did the WHO," the authors wrote.

Corticosteroids were not recommended in severe disease in nearly 10% of guidelines, however, despite strong evidence of their benefit.

Several countries, especially those in poorer regions, in 2022 continued to recommend treatments that had been disproven and were not recommended by the WHO, including chloroquine, lopinavir–ritonavir, azithromycin, vitamins, and zinc.

Why do NGs differ so much in their treatment guidance for such a widespread and potentially serious infection when all have access to the same information?
"Why do NGs differ so much in their treatment guidance for such a widespread and potentially serious infection when all have access to the same information?" the authors wrote. "Apart from the prohibitive cost of some medications for low-resource settings, we do not have a satisfactory explanation."

https://www.cidrap.umn.edu/cov...

Survey: Already-isolated older adults fared better than socially connected peers early in COVID pandemic
Mary Van Beusekom, MS Today at 12:57 p.m.
COVID-19

Older adults who were already isolated before the COVID-19 pandemic experienced less of a shock to their well-being than their more socially connected peers, concludes a UK analysis published yesterday in PNAS.

University College London researchers surveyed 4,636 isolated and nonisolated adults aged 50 or older from the English Longitudinal Study of Ageing about quality of life, loneliness, health behaviors, financial concerns, and internet use in June and July 2020 (early pandemic) and November and December 2020 (later pandemic) compared with 2018 and 2019.

The average participant age was 66.8 years, and all were living in private households. Isolated adults were more likely than nonisolated participants to be men, live alone, have a limiting chronic medical condition, have less educational attainment, work, and be of lower socioeconomic status.

Social isolation was defined in terms of social life (partnership status, contact with family and friends, and participation in organizations).

"Social isolation has been recognized as a public health problem, given its associations with increased risks of mortality, and an array of physical and mental health conditions," the study authors noted. "This problem was of particular concern during the COVID-19 pandemic, when lockdowns and social distancing restrictions were imposed worldwide."

Nonisolated adults increased internet use
Before the pandemic, isolated participants reported lower life satisfaction, quality of life, and physical and mental health than their more socially connected counterparts.

From before to during the pandemic, isolated participants (29% of the total) reported smaller decreases in life satisfaction and quality of life and a lesser rise in loneliness than their more connected counterparts. The isolated group showed greater drops in smoking and physical activity and were more likely to continue worrying about their future finances.

Isolated adults didn't change their use of the internet, while their nonisolated peers reported increased use. Both groups reported no change in general health and sleep quality, increased depression and anxiety, and decreased expectations of future financial problems.

Established coping strategies may have eased disruptions
Isolated participants "may have even been better placed to cope and adapt, potentially via existing routines and arrangements that supported their isolated lives (e.g., delivery of groceries and medication)," the authors wrote.

Although isolated older adults generally show poorer outcomes than their socially connected counterparts, they were somewhat protected during the pandemic on some fronts.
"It is likely that the nonisolated group experienced a greater disruption in their habitual routines and rhythms, including missing meaningful social events and gatherings, which possibly eroded their sense of meaning and significance."

Social isolation can be mitigated by building age-friendly communities that enable in-person interactions, implementing community projects that facilitate social engagement, providing information and communication technology training to improve digital skills and attitudes, and removing financial barriers to internet use, they added.

"Although isolated older adults generally show poorer outcomes than their socially connected counterparts, they were somewhat protected during the pandemic on some fronts," the researchers wrote. "Such insight can be useful in targeting social isolation interventions toward a better allocation of resources, besides informing future policies on isolation, quarantine, and so

https://www.cidrap.umn.edu/mea...

West Virginia reports first measles case in 15 years
News brief Today at 2:12 p.m.
Lisa Schnirring
Topics Measles

The West Virginia Department of Health yesterday announced the state's first measles case since 2009, which involves a patient from Monongalia County who was unvaccinated and had recently traveled internationally.

Officials said an investigation and contact tracing are under way.

The case is part of a global and national rise in measles activity this year. In its latest update, the US Centers for Disease Control and Prevention (CDC) said it has received reports of 125 cases this year from 18 jurisdictions, up sharply from 2023.

England's measles cases highest in a decade
The UK Health Security Agency (HSA) said today that measles cases in England are at their highest level in a decade, and it urged people to ensure that they and their loved ones are up to date with the measles, mumps, and rubella (MMR) immunization.

We know some communities in London have very low MMR vaccination rates.
In the latest surveillance update, Vanessa Saliba, an HSA consultant epidemiologist, said numbers are rising across the country, especially in London in recent weeks. "We know some communities in London have very low MMR vaccination rates," she said. "Measles is extremely infectious and it only takes one case to get into these communities for this disease to spread rapidly, especially in schools and nurseries."

https://www.cidrap.umn.edu/avi...

Contaminated meat likely source of avian flu that killed bush dogs in UK zoo, preprint suggests
News brief Today at 1:48 p.m.
Mary Van Beusekom, MS
Topics Avian Influenza (Bird Flu)

A study on the preprint server bioRxiv details the deaths of 10 of 15 bush dogs from H5N1 highly pathogenic avian influenza A virus (HPAIV) at a UK zoo in November 2022, with consumption of contaminated meat the most likely source of infection.

Researchers from the Animal and Plant Health Agency in England analyzed the clinical records and tissues of the 10 animals, 4 of which were found dead and 6 that were euthanized.

The bush dogs died over 9 days, with some showing signs of neurologic illness. Bush dogs are a near-threatened species of wild dogs found in Central and South America. The study has not yet been peer-reviewed.

Caution urged in feeding wild birds to captive carnivores
Genomic analyses revealed the cause of death as clade 2.3.4.4b H5N1 HPAIV, and histopathologic findings revealed severe acute systemic infection characterized by inflamed blood vessels and tissue death and inflammation in the liver, brain, lung, and adrenal glands.

As well as impacting upon commercial and wild avian species, the virus has also infected mammalian species more than ever observed previously.
In the absence of evidence of other routes of exposure, the source of infection is thought to be frozen shot wild birds or game fed to the bush dogs, although the animals could have eaten sick wild birds that landed in their enclosure, the authors said.

"Clearly the feeding of wild shot birds to captive carnivores whilst infection pressure is high in wild birds should be discouraged in line with similar recommendations given to keepers of birds of prey, or in alternative, a rigorous risk assessment should be carried out before any carcass is fed to any of these animals," they wrote.

The authors noted that Europe has experienced unusual outbreaks of H5N1 since fall 2021, including several mass-casualty events in farmed and wild animals such as marine mammals. People have also been affected, although human-to-human transmission hasn't been demonstrated.

"As well as impacting upon commercial and wild avian species, the virus has also infected mammalian species more than ever observed previously," they wrote.

Q&A on Reducing COVID-19 Risk for Elderly, Immunocompromised

https://www.factcheck.org/2024...

Remnants of Bird Flu Virus Found in Pasteurized Milk, FDA Says

https://www.medpagetoday.com/i...

Questions and Answers Regarding Milk Safety During Highly Pathogenic Avian Influenza (HPAI) Outbreaks

https://www.fda.gov/food/milk-...

crawgarden said: Remnants of Bird Flu Virus Found in Pasteurized Milk, FDA Says

https://www.medpagetoday.com/i...

Questions and Answers Regarding Milk Safety During Highly Pathogenic Avian Influenza (HPAI) Outbreaks

https://www.fda.gov/food/milk-...

Oh, well, yes, because this is what was missing in our lives.

crawgarden said: Remnants of Bird Flu Virus Found in Pasteurized Milk, FDA Says

https://www.medpagetoday.com/i...

Questions and Answers Regarding Milk Safety During Highly Pathogenic Avian Influenza (HPAI) Outbreaks

https://www.fda.gov/food/milk-...

That's why milk is pasteurized. I expect tests would turn up a lot of killed organisms in pasteurized milk. That's why it's so much safer than raw milk.

To me, what it may indicate is that the virus is more widespread among dairy herds than anyone realized or suspected. Since it's likely spread via wild bird populations, it could well be found in beef cattle feedlots as well. I'm guessing any situation where a lot of cattle are in close quarters being fed cattle feed with a high content of grain (think northern winters) which will also attract a variety of wild bird populations as well. Range fed cattle probably are not as susceptible, but it's probably worth looking at animal populations which are fed grain in concentrated areas. I would extrapolate from seeing this that locations to feed deer for the hunting season and exotic game ranches where free roaming is limited and a lot of supplemental feed is put out that will also attract bird populations might also be at risk for becoming infected with the virus. I'm sure experts in government, universities and animal health have thought of those things and are likely following up or planning to follow up with some tests at some point. Hope so.

USDA orders H5N1 testing of some dairy cows to limit spread of bird flu

https://www.statnews.com/2024/...

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US orders testing for certain dairy cows after H5N1 avian flu remnants found in retail milk
Lisa Schnirring Today at 1:15 p.m.
Avian Influenza (Bird Flu)

A day after the Food and Drug Administration (FDA) announced that H5N1 avian flu fragments have been found in retail milk samples, the US Department of Agriculture (USDA) today announced that lactating dairy cows must be tested before interstate transport.

The movement of dairy cows, some of which aren't showing disease symptoms, from already affected states such as Texas has been a source of H5N1 spread to dairy herds in states such as Idaho and Michigan. Also, the identification of virus fragments in finished milk suggests that the virus may be more widespread in dairy cows than currently known.

Wider cow testing to help fill data gaps
At a Department of Health and Human Services (HHS) media briefing today, Michael Watson, PhD, administrator of the USDA Animal and Plant Health Inspection Service (APHIS) said the new testing order—which will increase information available to the USDA—also requires labs to report the H5N1 test findings to federal officials. Positive cows must be held for 30 days before they are moved.

Watson said he expects the testing will help shed light on the extent of virus circulation in asymptomatic cows and fill other information gaps.

For now, the National Animal Health Laboratory Network, which has 50 labs, has enough capacity and materials for testing and can conduct tens of thousands of tests per day, he added, noting that testing takes about 1 to 3 days. Scientists are developing a field test that producers can use on farms.

We continue to ask for producer cooperation to ensure the confidence of Americans and to keep Americans safe.
Watson said so far there are no changes to the virus circulating in cows that would make it more transmissible to humans and that the risk to the public remains low.

Watson shared a few new details about the situation in cows, including that one sample from a cow in Kansas showed a genetic shift that suggests adaptation. And though cows sickened by H5N1 have shown little to no mortality, lung samples from a culled dairy cow yielded H5N1.

"We continue to ask for producer cooperation to ensure the confidence of Americans and to keep Americans safe," he said.

FDA expands probe of virus fragments in retail milk
Donald Prater, DVM, acting director of the FDA Center for Food Safety and Applied Nutrition (CFSAN), emphasized that despite test findings released yesterday, the nation's milk supply remains safe.

Though health officials feel confident that current pasteurization processes inactivate H5N1, based on what's known in the scientific literature about flu viruses and other pathogens, testing is under way to gauge the specific impacts of H5N1 in milk and other dairy products such as cream.

He also noted that heat inactivation processes for eggs, which involve lower temperatures than pasteurization, has been successful in preventing the spread of H5N1 from food to people.

Prater said the FDA is conducting tests on milk samples that yielded H5N1 fragments to assess if the products contain live virus, which would pose a larger threat. Those test methods take more time and involve egg inoculation and cell culture.

Monitoring human health, assessing countermeasures
Federal health officials today noted that the virus remnants were found in tests by the FDA and in a smaller number of milk samples tested by scientists with the National Institute for Allergy and Infectious Diseases (NIAID) Centers of Excellence for Influenza Research and Response (CEIRR) Network.

When pressed to share details on the geographic location of the positive milk samples, Prater said the FDA is conducting a nationwide survey and will release the results in the days ahead.

A senior official with the Centers for Disease Control and Prevention (CDC) told reporters that 44 people exposed to infected cattle have been tested, and so far, just one person has tested positive, the previously mentioned patient from Texas.

He added that the CDC's foodborne illness division hasn't detected any concerning activity linked to milk and that surveillance activity, including in areas near affected farms, has shown no unusual trends.

Regarding preparedness, Dawn O'Connell, JD, assistant secretary for preparedness and response at HHS, said states can request personal protective equipment (PPE) from the federal government to supplement their own stockpiles. She added that the federal government has millions of doses of antivirals in the Strategic National Stockpile. The CDC recently said its testing found that the virus is susceptible to currently approved neuraminidase inhibitors.

There's not currently a need to ramp up [vaccine production].
Two candidate virus vaccine strains against H5N1 developed earlier by the CDC appear to be well matched to the circulating strain, and she said hundreds of thousands of doses could be made in a matter of a week.

O'Connell said the HHS has issued a request for proposals from mRNA vaccine manufacturers in case a vaccine is needed. However, she said the risk from H5N1 to humans remains low. "There's not currently a need to ramp up."

https://www.cidrap.umn.edu/cov...

Data: Optimal initiation of Paxlovid in hospitalized COVID patients is 3 to 5 days
Mary Van Beusekom, MS Today at 11:03 a.m.
COVID-19

Taking the SARS-CoV-2 antiviral drug nirmatrelvir-ritonavir (Paxlovid) 3 to 5 days after COVID-19 symptom onset—not earlier or later—may result in the greatest reduction in viral loads, viral transmission, and viral rebound in hospitalized patients, a University of Hong Kong–led study finds.

For the study, posted by eLife, which publishes peer-reviewed preprints, the investigators fitted a mathematical model of in vivo Omicron variant behavior to electronic medical record data from 208 patients hospitalized with mild to moderate COVID-19 in Hong Kong from January to May 2022. The Omicron BA.2 variant was dominant during the study period.

Half of the patients received Paxlovid, and the other half were given no antiviral therapy. Participants were aged 8 to 103 years.

Low uptake despite efficacy
The study authors noted that despite the availability of antivirals within 5 miles of home for 90% of Americans through the US Test-to-Treat program, US uptake has been relatively low, with only 11% of COVID-19 patients prescribed the drugs during the study period. Paxlovid is prescribed for patients at high risk for severe disease.

"The low uptake may stem from slow rollouts in some areas, complex eligibility requirements, testing, and potential drug interactions, as well as concerns about viral rebounds following Paxlovid treatment," they wrote.

In Hong Kong, under 40% of COVID-19 patients older than 60 years had been prescribed Paxlovid by late July 2022.

"Low rates of antiviral uptake may stem from misinformation, lack of access, and the rising proportion of cases that opt for at-home rapid tests and do not seek healthcare," the researchers wrote. "Telemedicine and online healthcare services can accelerate and expand access to antivirals, but may not reach some of the older populations in Hong Kong."

Optimal use could avert over 90% of viral replication
In total, 62% of Paxlovid recipients started the drug 3 to 5 days after symptom onset. When the drug was started 3 days after symptom onset, the odds of post-treatment viral rebound was low (17%), with a 12% lower risk of transmission among non-rebound patients. The findings suggest that Paxlovid can prevent over 90% of viral replication if it is given at the optimal time, the study authors said.

But if Paxlovid is initiated before 3 days, the risk of viral rebound is significantly increased with no improvement in infectiousness, with a 74% chance of viral rebound if started the day after symptom onset. And starting the drug after 5 days of symptom emergence lowers the drug's ability to stem peak viral shedding (0% reduction at 10 days).

The development of global distribution programs that provide rapid and equitable access to antivirals could enhance our ability to combat COVID-19 as the virus and the landscape of immunity continues to evolve.
"Our findings indicate that broader global access to Paxlovid, coupled with appropriately timed treatment, can mitigate the severity and transmission of SARS-CoV-2," the researchers concluded.

Giving Paxlovid to more patients may help quell future pandemic waves without the need for socioeconomically expensive lockdowns, lead author Zhanwei Du, PhD, of the World Health Organization (WHO) Collaborating Center for Infectious Disease Epidemiology and Control at the University of Hong Kong, said in an eLife press release. "However, to get the most out of these drugs, we first need to understand the optimal timing for taking them and to encourage their wider distribution and uptake," he said.

The researchers, however, caution that their data didn't consider the potential emergence of Paxlovid resistance, which would require further research before the antiviral could be deployed more broadly.

"The development of global distribution programs that provide rapid and equitable access to antivirals could enhance our ability to combat COVID-19 as the virus and the landscape of immunity continues to evolve," they concluded.

https://www.cidrap.umn.edu/cov...

Teen vaccination cut COVID-19 cases by 37% in California, new data show
News brief Today at 1:47 p.m.
Stephanie Soucheray, MA
Topics COVID-19

JAMA Network Open has published a new study showing that, from April 1, 2020, to February 27, 2023, in California, an estimated 146,210 COVID-19 cases were averted by vaccination in teens aged 12 to 15 years, representing a 37% reduction.

Researchers also estimated that 230,134 cases were averted in kids aged 5 to 11 years, a 24% reduction.

The study looked at COVID-19 infections in post-vaccination evaluation periods consisting of 141 days (June 10 to October 29, 2021) for adolescents aged 12 to 15 years, 199 days (November 29, 2021 to June 17, 2022) for children aged 5 to 11 years, and 225 days (July 17, 2022, to February 27, 2023) for those aged 6 to 59 months, according to study authors.

Biggest reduction in teens
From April 2020 to February 2023, California recorded 3,913,063 pediatric COVID-19 cases and 12,740 hospitalizations. During those times, statewide vaccine coverage reached 53.5% among adolescents aged 12 to 15 years, 34.8% among children aged 5 to 11 years, and 7.9% among those aged 6 to 59 months.

The biggest reduction attributed to vaccination occurred with older kids, and there was no evidence of reductions in COVID-19 cases statewide among children aged 6 to 59 months (estimated averted cases, −259; 95% prediction interval, −1,938 to 1,019).

Though there was no evidence in case reduction in the youngest kids, vaccination prevented an estimated 168 hospitalizations among children aged 6 to 59 months during the 225-day evaluation period.

These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations.
"These results support the use of COVID-19 vaccines to reduce COVID-19 incidence and hospitalization in pediatric populations," the authors concluded.