News Scan for Aug 26, 2022

Study: US C difficile prevalence fell during COVID-19 pandemic

The prevalence of Clostridioides difficile infection (CDI) in the United States declined during the COVID-19 pandemic, but inpatient mortality and treatment costs were higher, according to a paper published yesterday in Open Forum Infectious Diseases.

Using data from the Premier Healthcare Database, researchers with the University of Texas and Texas A&M compared CDI prevalence and inpatient outcomes in the pre-COVID (April 2019 to March 2020) and COVID (April 2020 to March 2021) periods. Overall, a total of 25,991 inpatients and outpatients with a laboratory-confirmed CDI diagnosis were included in the analysis. The investigators analyzed data on 22,130 unique patients, who were predominantly older (median age, 68 years), female (57.5%), and White (79.5%).

CDI prevalence significantly decreased from the pre-COVID to the COVID period (12.2 CDI cases per 10,000 encounters vs 8.9 per 10,000), driven primarily by a reduction in inpatient CDI prevalence (57.8 per 10,000 vs 49.4 per 10,000), though outpatient CDI prevalence fell as well (2.2 per 10,000 vs 1.5 per 10,000). But an interrupted time series analysis found no significant difference in the rate ratio (RR) from the pre-COVID to the COVID period for all encounters (RR, 1.04; 95% CI, 0.90 to 1.20) or inpatient encounters (RR, 1.08; 95% CI, 0.98 to 1.19).

Patient costs increased by an average of approximately $2,000 from the pre-COVID to the COVID period. Among inpatients only, all-cause mortality increased from 5.5% in the pre-COVID period to 7.4% in the COVID period. Costs and mortality were higher for those with severe CDI.

The study authors say the similar rate of decline in the pre-COVID and COVID period is an indication that CDI prevalence was falling before the pandemic. But better adherence to infection control practice in hospitals (eg, improved hand hygiene, donning of personal protective equipment) and new practices in outpatient settings (eg, masking, social distancing) during the pandemic may have helped further limit CDI transmission.

“Further studies are needed to identify the specific factors that contributed to changes in CDI prevalence and health outcomes, such that targeted interventions can be maintained or created in the future to prevent and treat CDI effectively,” they concluded.
Aug 25 Open Forum Infect Dis abstract

CDC: 47 more E coli cases linked to fast food sandwiches

The Centers for Disease Control and Prevention (CDC) said yesterday that 47 more cases of Escherichia coli have been linked to Wendy’s sandwiches, bringing the outbreak total to 84 illnesses in four states.

No deaths have been recorded, but 38 people have required hospitalization. Eight people in Michigan sickened in this outbreak have developed a potentially fatal type of kidney failure called hemolytic uremic syndrome.

Though no food source for the pathogen has been identified, earlier this week, Wendy’s removed romaine lettuce from sandwiches. According to the CDC, “Many sick people reported eating sandwiches with romaine lettuce at Wendy’s restaurants in Indiana, Michigan, Ohio, and Pennsylvania before getting sick.”

Wendy’s uses a different type of romaine lettuce for salads, the CDC said. At the time, the CDC does not advise avoiding Wendy’s restaurants or romaine lettuce.

Michigan has the most cases, with 53, followed by Ohio (23), Indiana (6), and Pennsylvania (2). Illness onset dates range from Jul 26 to Aug 9.

Of 62 people who have been interviewed in the outbreak, 52 (84%) said they ate at a Wendy’s restaurant in the week prior to illness, and 15 of 17 people with detailed information on what they ate reported eating sandwiches or burgers with romaine lettuce.
Aug 25 CDC update

H1N2v flu reported in Ohio fairgoer

The CDC today reported a variant H1N2 (H1N2v) flu infection in an Ohio resident who attended an agricultural fair, bringing the season’s variant flu total to five cases.

In its weekly flu update, the CDC said the patient is younger than 18 years old, wasn’t hospitalized, and has recovered. The investigation found that the child had attended the agricultural fair on his or her illness-onset day.

No other illnesses were found in the patient’s household contacts, and no human-to-human illnesses linked to the patient have been identified.

Last week, the CDC reported another H1N2v case involving a child in Oregon who had not been around pigs or an agricultural fair. Earlier this summer it reported three H3N2v cases in people who attended the same agricultural fair in West Virginia, where they had contact with pigs or swine environments.
Aug 26 CDC FluView report

Florida reports local dengue case in Collier County

The Florida Department of Health yesterday reported a local dengue infection in Collier County, which covers the Naples area. A local media report quoting a health department official said the case is Collier County’s first in more than 20 years.

In an advisory announcing the case, Florida Health warned residents about an increase in mosquito activity and of the potential for more dengue infections. It urged people to drain standing water and to cover skin with clothing or insect repellent.

Florida has reported five other local dengue cases this year, all in people who became sick in June and July in Miami-Dade County, according to Florida Health’s latest weekly arbovirus surveillance bulletin.
Aug 25 Florida Health advisory
Aug 25 Naples Daily News story
Aug 20 Florida Health arbovirus surveillance bulletin

Four countries add to polio totals

Four countries reported more polio cases this week, including Mozambique, which reported another wild poliovirus type 1 (WPV1) case, according to the latest update from the Global Polio Eradication Initiative (GPEI).

In May, Mozambique recorded its first WPV1 case in 30 years. This week it reported a case from Tete, raising its total for the year to five. The GPEI said the reporting of the new cases within a short time span signals that intensified surveillance efforts in the affected province are working.

The three other countries reported more circulating vaccine-derived poliovirus type 2 cases (cVDPV2). Chad reported 5 more cases across three provinces, lifting its total for the year to 14. Somalia reported 1 more case, from middle Juba, putting its total for the year at 3.

Also, Yemen reported 10 more cases in five provinces, bringing its cVDPV2 number for the year to 92, up sharply from the 66 cases it reported last year.
Aug 25 GPEI update