CDC-led study finds major racial disparities in MIS-C incidence
A surveillance study of US children during the first wave of the pandemic found that multisystem inflammatory syndrome in children (MIS-C) was a rare complication associated with SARS-CoV-2 infection, but incidence was significantly higher in non-White racial and ethnic groups, US researchers reported yesterday in JAMA Network Open.
Using enhanced surveillance data collected from seven states (Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York, and Pennsylvania) from April through June 2020, a team led by researchers from the Centers for Disease Control and Prevention (CDC) COVID-19 Response Team found that 248 people under age 21 with MIS-C were reported, with the most in New Jersey. The median age range at onset was 8, and 53.6% of the cases were male.
Overall incidence of MIS-C during the study period was 5.1 persons per 1,000,000 person-months. Compared with White persons, incidence was about ninefold higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26; 95% confidence interval [CI], 6.15 to 13.93) and Hispanic or Latino persons (aIRR, 8.92; 95% CI, 6.0 to 13.26), and nearly threefold higher among Asian of Pacific Islanders (aIRR, 2.94; 95% CI, 1.49 to 5.92).
MIS-C incidence was 316 per 1,000,000 SARS-CoV-2 infections and was also higher among Black (aIRR, 5.62; 95% CI, 3.68 to 8.60), Hispanic or Latino (aIRR, 4.26; 95% CI, 2.85 to 6.38), and Asian or Pacific Islander persons (aIRR, 2.88; 95% CI, 1.42 to 5.38) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger and children aged 6 to 10 years.
“Our findings of higher incidence among younger children and among Hispanic or Latino, Black, and Asian or Pacific Islander persons emphasize a need for further study of risk factors for MIS-C,” the study authors wrote.
Jun 10 JAMA Netw Open study
Most severe COVID patient autopsies showed muscle inflammation
In autopsies of 43 hospitalized COVID patients and 11 patients hospitalized for other health issues in Germany, those with COVID-19 were associated with more skeletal muscle inflammation, according to a study today in JAMA Neurology.
The researchers looked at cryopreserved quadriceps, deltoids, lungs, and heart tissues in people who died from March 2020 to February 2021. Of those who had COVID-19, the median age was 72, 72.1% were men, and COVID-19 infection was the primary cause of death in 83.7%. Those without COVID infection had a median age of 71, and 63.6% were men. All but one in the COVID-19 group had at least one concurrent medical issue, but none had a history of primary myopathy, or disease affecting muscle tissue.
Overall, 60.4% of COVID-19 patients had some sort of muscle inflammation, with more severe inflammation associated with those who were chronically ill with COVID-19 (30 or more days post-symptom onset) and then seroconverted. Patients with COVID-19 had skeletal muscles with higher overall pathology scores (average, 3.4 vs 1.5) and inflammation scores (average, 3.5 vs 1.0) compared with those without, and their natural killer cell levels were higher (median, 8 vs 3 per 10 high-power fields).
While SARS-CoV-2 RNA was found in some muscles of COVID-19 patients, the researchers say there was no evidence for direct viral infection and that its presence is most likely explained by circulating viral RNA.
“Most individuals with severe COVID-19 showed signs of myositis ranging from mild to severe. Inflammation of skeletal muscles was associated with the duration of illness and was more pronounced than cardiac inflammation,” write the researchers. “This suggests that SARS-CoV-2 may be associated with a postinfectious, immune-mediated myopathy.”
Jun 11 JAMA Neurol study
Two monkeypox cases confirmed in United Kingdom
Two monkeypox patients were identified in the United Kingdom at the end of May, one traveling from Nigeria and the other who was quarantining with the first patient upon arrival, the World Health Organization (WHO) said today. The WHO adds that the public health risk for monkeypox in the United Kingdom is low.
The index patient arrived in the United Kingdom on May 8 prior to living and working in Delta state, Nigeria. After arrival, the person quarantined because of COVID-19 protocols and developed a facial rash beginning on May 10.
The patient continued to quarantine for another 10 days and then looked for medical care on May 23 and received a confirmed diagnosis of West African clade monkeypox virus on May 25. One family member who was in quarantine with the index patient developed a similar rash May 29 and had confirmatory lab results on May 31. Both are stable and recovering, the WHO reports.
Contact tracing spanning 21 days after the patients’ last exposure found that no close contact had traveled outside of the United Kingdom, and officials alerted Nigerian health officials. Post-exposure vaccination was not offered to the patients.
Monkeypox is transmitted by contact and droplet exposure. Incubation usually lasts 6 to 13 days, and the infection is often self-limiting, resolving within 14 to 21 days. The WHO says the disease is endemic in parts of West and Central Africa (eg, Democratic Republic of the Congo’s October 2020 outbreak).
The WHO says the new cases raise the UK total to six, including three imported from Nigeria in 2018 and 2019.
Jun 11 WHO news release
WHO weighs in on China’s recent H10N3 avian flu case
The WHO yesterday shared more details about China’s recent H10N3 avian flu case, the first known illness of its kind in a human. Earlier this month, China had reported the illness, which involves a 41-year-old man.
In a statement, the WHO said the man is from the city of Zhenjiang in Jiangsu province on China’s east-central coast. His symptoms—nausea and fever—began on Apr 23. He was admitted to an intensive care unit on Apr 28, and he is currently listed in stable condition.
An investigation found no clear history of exposure to poultry, and no H10N3 had been detected in local poultry. No related infections were found in any of the man’s contacts. Genetic analysis found that the virus is avian in origin. Further genetic analysis is under way to assess if the virus that infected the man is closely related to earlier avian H10N3 viruses.
Chinese officials consider that the case represents incidental transmission from birds to humans.
The WHO said rare H10 infections have been found in Australia, Egypt, and China, and targeted surveillance in birds has found H10N3, but the extent of transmission is unclear. Human infections with avian flu viruses, including H10 strains, are usually linked to contact with birds, and sporadic infections are likely to continue, the WHO said. So far, it doesn’t appear that H10 viruses have the capacity for sustained human-to-human transmission, so the likelihood of spread is low, the agency added.
Jun 10 WHO statement
Jun 1 CIDRAP News scan
GPEI launches new polio campaign as 2 nations report more cases
The Global Polio Eradication Initiative (GPEI) yesterday launched a new eradication strategy after pausing door-to-door campaigns for 4 month last year to curb the spread of COVID-19.
“With this new Strategy, the GPEI has clearly outlined how to overcome the final barriers to securing a polio-free world and improve the health and wellbeing of communities for generations to come,” said Tedros Adhanom Ghebreyesus, PhD, director-general of the WHO, in a WHPO news release. “Polio eradication is at a pivotal moment. It is important we capitalize on the momentum of the new Strategy and make history together by ending this disease.”
The campaign comes as GPEI reported that both Afghanistan and Burkina Faso had new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2), and the WHO declared a polio outbreak in the Philippines over.
In announcing the new initiative, GPEI said the COVID-19 pandemic halted progress toward polio eradication, resulting in an increase in polio cases. Last year, 1,226 cases of all forms of polio were recorded, compared with only 138 in 2018, GPEI said. The group contributed up to 30,000 program staff and over $100 million in polio resources to support pandemic response in almost 50 countries.
Meanwhile, in Afghanistan, 1 case of cVDPV2 was recorded in Badghis this week, bringing the number of 2021 cases to 40. Last year Afghanistan reported 308 cVDPV2 cases. Burkina Faso recorded its second cVDPV2 case of the year; in 2020, the African nation had 62 cases.
And after polio re-emerged in the Philippines in September of 2019, the country is once again polio-free. No cases have been detected for 16 months, and the country completed a massive vaccination campaign that included 30 million doses of oral polio vaccine, the Associate Press reported.
Jun 10 WHO news release
Jun 11 GPEI update
Jun 11 Associated Press story