News scan for Sep 30, 2021

ECMO patients appeared to have higher mortality during 2020

Critically ill COVID-19 patients who received extracorporeal membrane oxygenation (ECMO) in late 2020 had a higher death rate than those who received it in the first semester, according to a study published yesterday in The Lancet.

Researchers examined 4,812 COVID-19 patients aged 16 and older who received ECMO in 2020 at 349 sites and 41 countries. Using May 1, 2020, as an arbitrary marker for the publication of the COVID-specific guidelines for ECMO, patients were divided into three groups: those who received ECMO until May 1, those who received l ECMO after that date and those who received it after May 1 who were also in hospitals that only offered COVID-19-related ECMO after May 1 (“late adopters”).

Patients who started ECMO on or before May 1, 2020 had a 90-day in-hospital mortality rate of 36.9%, while 51.9% of those who started ECMO after died. . In addition, people treated in late adoption centers had a mortality rate of 58.9%. Centers with more experience in ECMO (at least nine patients up to May 1) appeared to have better results than those with less experience (risk-adjusted mortality rate, 0.56).

“The selection of the right patient at the right time is guided by clinical principles and experience, as well as availability, which could perversely delay the onset of ECMO,” writes Alain Vuylsteke, MD, in a commentary. related. “In the report by Barbaro and colleagues, no one knows whether some patients survived despite the ECMO they did not need, or whether some died simply because of the ECMO, or what happened to them. those who have been denied ECMO – this is still the conundrum to be clarified before we decide whether ECMO is worth using or not. “

“ECMO cannot be blamed for the increased mortality; it is simply a tool and clinicians have yet to figure out when to use it for the greatest benefit,” concludes Vuylsteke.
Sep 29 Lancet to study and remark

COVID vaccination linked to low hospitalization and death in Scotland

Less than 0.05% of Scots at least partially vaccinated against COVID-19 have been hospitalized or died from the virus, according to a large population-based study examining data from December 8, 2020 to April 18, 2021.

The results, published yesterday in The Lancet, showed that out of 2,572,008 Scots, 883 required hospitalization related to COVID-19 and 541 died from COVID-19 infection after the first dose of the Pfizer / BioNTech vaccine (32.7 %) or AstraZeneca / Oxford (67.3%). The median follow-up after the first vaccination was 55 days, and of the 27.0% of people who received a second dose during the study period, the median follow-up after the second dose was 19 days.

A higher risk was associated with being 80 years of age or older compared to those aged 18 to 64 (adjusted relative risk [aRR], 4.75), having five or more comorbidities (aRR, 4.24), having been hospitalized during the previous 4 weeks (aRR, 3.00) or exercising a high-risk occupation (aRR, 2.14). Those who were residents in a nursing home (aRR, 1.63), socio-economically disadvantaged (most disadvantaged versus least quintile, aRR, 1.57), male (aRR, 1.27), or a ex-smokers compared to non-smokers (aRR, 1.18) also had higher risks.

On the flip side, the researchers note, having COVID-19 before vaccination was protective (aRR, 0.40). Those with a longer interval between the two doses also appeared to have a lower risk (the UK extended vaccine dose intervals to 8 to 12 weeks to maximize supply).

“Restricting booster doses to populations most at risk for severe disease will maximize the benefits of booster doses, with minimized effect on global vaccine distribution,” write Eyal Lehsem, MD, and others in a commentary. related.

“The results reported by Agrawal and his colleagues make it possible to identify and prioritize populations at risk to be taken into account for reinforcement. settings where vaccine availability is limited. ”
Sep 29 Lancet to study and remark

Study Shows Wearable Biosensors Can Predict Infections Like Flu, Common Cold

A portable biosensor can predict when a person is infected with common viruses, including a cold or the flu, even before the person experiences symptoms, according to a study conducted yesterday in JAMA network open.

The challenge study collected data on 31 participants inoculated with H1N1 influenza and 18 participants inoculated with rhinovirus. A wearable device, called an E4 bracelet manufactured by Empatica, Inc, measured heart rate, skin temperature, electrodermal activity, and movement. It accurately detected 92% of H1N1 infections and 88% of rhinovirus infections.

The sensors were able to detect the infection 24 hours before the onset of symptoms 90% of the time for H1N1 and 89% of the time for rhinovirus.

This is the first demonstration that wearable devices could detect infections before symptoms appear, the authors said, which would allow users to monitor themselves more quickly for disease and prevent the spread of infections. to others.

“This study shows that it is possible to use portable data to predict infection status and infection severity 12 to 36 hours before symptoms appear, with most of our models achieving accuracy greater than 80% “, the authors concluded. “Presymptomatic detection of respiratory viral infection and prediction of infection severity may allow better allocation of medical resources, early quarantine, and more effective prophylactic measures.”

They add that the technology may hold promise for COVID-19.
Sep 29 JAMA Netw Open to study

China reports 2 more cases of avian influenza H5N6, 1 fatal

The H5N6 bird flu virus has sickened two more people in China, including one deadly, as the number of cases in the country continues to rise this year, the Center for Health Protection said today ( CHP) from Hong Kong.

The first case concerns a 55-year-old man from Guilin city in southern China’s Guangxi province. He is from the same city as another case announced yesterday. His symptoms started on August 23 and he was hospitalized on August 30, where his condition is listed as severe. An investigation revealed that he may have been exhibited in a live poultry market before he fell ill.

The second case concerns a 72-year-old man from the southwestern provincial city of Chongqing. His symptoms started on September 16 and he was hospitalized 3 days later, where he died of his infection. The CHP said he had contact with poultry before his symptoms began.

China has now reported 23 cases of H5N6 for the year, bringing its total since the virus was first detected in 2014 to 47. H5N6 is known to circulate in poultry, especially in a handful of Asian countries. However, so far only China and Laos have reported human infections, which are often severe or fatal.
Sep 30 CHP declaration

Louisiana announces MDC test incentive for hunters and taxidermists

The Louisiana Department of Wildlife and Fisheries (LDWF) announced on September 17 that deer hunters and taxidermists in the state who submit deer for chronic wasting disease (CWD) sampling will be enrolled in a lottery for $ 1,000 and $ 500 gift cards, respectively.

The event will take place during the 2021-22 deer season, and samples must come from mature males harvested in the state. Participants can contact local LDWF offices to submit samples, and hunters must record the date and parish of harvest on the carcass tag. Additionally, hunters must confirm the harvest within 72 hours by phone or online through the LDWF website.

CWD is a fatal prion disease that affects the deer family, which includes deer, moose and elk. It can be spread through contact with infected body fluids from living or deceased animals and contaminated environments. The LDWF says that while no deer have been reported with CWD in the state, Texas, Arkansas and Mississippi have all identified positive cases.
Sep 17 LDWF Press release

Rabies kills Illinois man who refused vaccination

The Illinois Department of Public Health (IDPH) this week reported its first case of human rabies since 1954, involving a Lake County man in the 1980s who woke up with a bat on his neck in mid-August.

Animal health authorities captured the bat and it tested positive for rabies. The patient was encouraged to start preventive (prophylactic) treatment for post-exposure rabies, but declined. A month later, the man began to experience symptoms of rabies, including neck pain, headaches, and other neurological issues. Lake County is in the northeast corner of Illinois, north of Chicago.

He died of his infection and people who came in contact with the man’s secretions were assessed and received prophylactic treatment as needed.

Mark Pfister, executive director of the Lake County Health Department, said in an IDPH statement that once symptoms appear, the disease is almost always fatal, making it vital that those at risk receive treatment as soon as possible.

Rabies post-exposure prophylaxis consists of a dose of human rabies immunoglobulin and rabies vaccine given on the day of exposure, followed by doses of the vaccine on days 3, 7 and 14, according to the Centers for Disease Control and Prevention. (CDC).
Sep 28 IDPH declaration
CDC context