The Perfect Enemy | News Scan for Jul 26, 2022
August 11, 2022

News Scan for Jul 26, 2022

COVID vaccine and myocarditis in kids
European AMR data
AAV2 acute hepatitis link
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Study: COVID vaccine doesn’t raise risk of myopericarditis in kids aged 5 to 11

The risk of myocarditis and/or pericarditis was not significantly different among children ages 5 to 11 years after COVID-19 vaccination from that of unvaccinated children and much lower than that among children aged 12 to 17, finds a prospective study in Denmark published today in Pediatrics.

A team led by Copenhagen University Hospital researchers estimated the risk of myopericarditis (inflammation of the heart muscle and/or the membrane surrounding the heart) among 433,484 vaccinated and unvaccinated children aged 5 to 11.

A total of 208,088 (48%) of the children had received at least one dose of COVID-19 vaccine from Nov 25, 2021, when the Pfizer/BioNTech vaccine was approved for this age-group in Denmark, and Feb 1, 2022. Follow-up was 1 month.

Among the vaccinated group, a previously healthy 11-year-old boy developed mild myocarditis and was hospitalized for 1 day with chest pain, shortness of breath, and elevated troponin levels 14 days after receiving his first vaccine dose. He tested negative for COVID-19.

The risk of myopericarditis was 4.8 (95% confidence interval [CI], 0.1 to 26.8) per 1 million vaccinated children aged 5 to 11 years, significantly lower than that of vaccinated children aged 12 to 17 (57.4; 95% CI, 32.1 to 94.7 per 1 million).

Relative to the background incidence of myopericarditis, the risk after COVID-19 vaccination among 5- to 11-year-olds was 4.6 (95% CI, 0.1 to 156.1), not statistically different from that of those aged 12 to 17 (3.3; 95% CI, 1.4 to 8.1). Thus, the lower risk in the younger age-group may reflect an overall lower risk of developing the condition, the authors said.

“In addition, SARS-CoV-2-associated myopericarditis seems to be an extremely rare condition in children since (1) no such cases, independent of multisystem inflammatory system in children, has to our knowledge been reported in individuals aged 5 to 11 years and (2) a population-based nationwide study identified no cases of isolated SARS-CoV-2-associated myocarditis in children and adolescents during the first 1.5 years of the pandemic in Denmark,” they wrote.
Jul 26 Pediatrics study

European surveillance data show rise in carbapenem-resistant E coli, Klebsiella

New antimicrobial resistance (AMR) surveillance data from Europe shows concerning trends among the most common causes of clinical bacterial infections.

The 2020 European Antimicrobial Resistance Surveillance Network (EARS-Net) report, which includes data on eight bacterial species (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter species, Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecalis, and Enterococcus faecium) from 29 European Union/European Economic Activity (EU/EEA) countries, showed either significantly decreasing trends or no significant trends in population-weighted AMR percentages for most bacterial species-antibiotic combinations. But the situation varied by bacterial species, antibiotic class, and region.

In particular, invasive E coli and K pneumoniae isolates exhibited rising resistance to carbapenem antibiotics, with almost a quarter of EU/EEA countries reporting carbapenem-resistance percentages above 10% in K pneumoniae. In addition, more than half (54%) of the E coli isolates, and more than a third (38%) of K pneumoniae isolates, were resistant to at least one antibiotic under surveillance, and combined resistance to several antibiotics in both pathogens was a frequent occurrence.

The EARS-Net report noted that infections caused by resistant E coli proportionally contribute most to the burden of AMR in Europe, both in the number of cases and attributable deaths, while carbapenem-resistant K pneumoniae is associated with high mortality and is causing an increasing number of hospital outbreaks.

“This underlines the need for continuous close monitoring and greater efforts to respond efficiently to this public health threat,” the report states.

The data also show that despite some declines, AMR among Acinetobacter and P aeruginosa—both considered critical-priority pathogens by the World Health Organization—remains high, particularly in southern and eastern Europe, while the percentage of vancomycin-resistant E faecium isolates rose from 11.6% in 2016 to 16.8% in 2020.

As in previous years, AMR patterns varied widely among European countries but often with a north-to-south and east-to-west gradient. In general, the lowest AMR percentages were reported by northern European countries, and the highest by countries in southern and eastern Europe.
Jun 25 2o20 EARS-Net surveillance report

Studies ID possible AAV2 link to acute hepatitis cases in kids

Two preprint studies from the United Kingdom suggest a potential cause that may explain the recent puzzling acute hepatitis cases in children, some of whom needed liver transplants.

Both studies suggest a role for adeno-associated virus 2 (AAV2), which can’t replicate in sick people itself but as a “helper virus” can accompany infections with adenoviruses.

Both studies appear on medRxiv, a preprint server. One is from a group at the University of Glasgow and the other is from researchers at Great Ormond Street Hospital in London.

In the Glasgow study, researchers found AAV2 in liver and blood in all 9 cases, and in the London study, the group found the virus in 16 of 17 cases. AAV2 was also found alongside herpes virus in a smaller number of patients.

Earlier investigations leaned toward an adenovirus link but said a cofactor may be involved and that other possibilities were still being considered, such as a role for COVID-19 or a toxin exposure. Globally, about 1,010 cases have been reported from 35 countries.

Both studies ruled COVID-19 out as a direct cause and both compared sick children with healthy controls. The groups said it’s still not clear what led to the spike in acute hepatitis cases in children, but noted that adenovirus infections may have peaked after a lockdown period due to changes in virus circulation and immune protection.

In a press release from the University of Glasgow, Sofia Morfopoulou, PhD, a computational statistician with the London group, said the study findings raise several interesting questions. “International collaborations to further investigate and elucidate the role of AAV2 and co-infecting viruses in paediatric unexplained hepatitis in patients from different countries are now needed,” she said.
Jul 25 University of Glasgow press release
Jul 19 University of Glasgow
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Jul 24 Greater Ormond Street Hospital
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