Naval Medical Center Portsmouth (NMCP) COVID-19 Literature Report
#100: Friday, 19 August 2022
Prepared By: Tracy C. Shields, MSIS, AHIP (Ms.; she/her) <tracy.c.shields2.civ@ mail.mil>
Naval Medical Center Portsmouth; Library Services, Reference Medical Librarian
Purpose: These reports, which were published twice a week then biweekly from March 2020
until August 2022, were curated collections of current research, special reports, and news
regarding the COVID-19 pandemic that may be of interest to medical providers, leadership, and
decision makers. All reports are available online at https://nmcp.libguides.com/covidreport.
Archived reports are also available through the Medical Heritage Library and BUMED's Office of
Medical History collection at archive.org.
Disclaimer: | am not a medical professional. This document is current as of the date noted
above. While | make every effort to find and summarize available data, | cannot cover
everything in the literature on COVID-19. Due to the rapid evolution of the literature, | will not
update past reports when new information arises; for retracted papers specific to COVID-19,
see the list of retracted papers from Retraction Watch.
TABLE OF CONTENTS
An End Has a Start..... 2 Pregnancy and Postpartum Period..... 14
The Big Picture..... 3 Pediatric Population..... 17
COVID-19 Vaccines..... 4 Other Infectious Diseases and Public
a8 . Health Threats ..... 23
Transmission, Exposure, and Surveillance . — es
.6 Special Topic: Monkeypox..... 25
Treatments and Management..... 8 References..... 29
Long COVID and Other Post-Infectious
Findings..... 11
NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
An End Has a Start
Reflecting on the NMCP COVID-19 Literature Reports
The novel coronavirus cases caught my attention early. On 21 January 2020, | asked my fellow
medical librarian colleagues on social media about it: "#medlibs: Do you pull together resources
(articles, websites, etc) for your patrons on emerging or newsworthy medical topics? For
example, new coronovirus [sic] outbreak in China, major new studies. Do you have demand for
that sort of thing?"
Only a few people responded and no one really discussed it. Still, my gut told me there was
something there, so | set up some literature alerts and kept an eye out for notable news items.
In my role as a medical librarian, | had done something similar for 2009 H1N1 pandemic, the
2015 Zika virus outbreak, and other health threats. | assumed it would be more for my personal
interest and maybe a few providers might ask for information.
Soon after the World Health Organization declared the novel coronavirus outbreak a pandemic
on 11 March 2020, the library's immediate leadership approached me about putting together
something that could be disseminated to leaders and decision makers. My initial interest and
monitoring morphed into these reports; it was a relatively easy transition.
The first report went out on Tuesday, 31 March 2020 and was only 8 pages (which seemed
ridiculously long at the time). Already there were over 165,000 cases of COVID-19 in the United
States and the pandemic was barely underway. | thought | would do these reports for a short
time — maybe a few months at best — and we would adjust to a new "normal". | was too
optimistic by far, even in my pessimism. The reports would span weeks, then months, then
years.
Now, two and half years later, this is the last NUCP COVID-19 Literature Report. | compiled the
reports, sent to my leadership, and really never knew if anyone read them, if they mattered or
made a difference. | kept at it though, and in doing so became an "expert" at covid literature.
There are things | wish | didn't know about this disease and pandemic, things | wish | had never
seen or read, and so many things | wish had been done differently.
In many ways ending this project is a relief, but it is also bittersweet. This project has consumed
untold hours of my professional life and given me a front-row seat to documenting the covid
pandemic. It has been a depressing yet invigorating learning experience. It's time | focused on
other efforts.
The covid pandemic continues as there are new, emerging, and ongoing threats to public
health: monkeypox; polio; Langya virus; climate change and its impact on human health and
infectious diseases. | will monitor those events as well — and hope there will not be a need for
another set of reports like these.
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
The Big Picture
News in Brief
"CDC unveils streamlined COVID-19 guidance" (CIDRAP).
"A 'staggering' number of people couldn't get care during the pandemic, poll finds" (NPR).
CDC
"In an effort to address its missteps during Covid, CDC plans an 'ambitious' agency overhaul"
(STAT).
"CDC, under fire, lays out plan to become more nimble and accountable" (WP).
Beyond COVID
"Abortion bans complicate access to drugs for cancer, arthritis, even ulcers" (WP).
Journal Articles
MMWR: Summary of Guidance for Minimizing the Impact of COVID-19 on Individual Persons,
Communities, and Health Care Systems — United States, August 2022 (19 August 2022)
"What is already known about this topic? High levels of immunity and availability of
effective COVID-19 prevention and management tools have reduced the risk for medically
significant illness and death.
What is added by this report? To prevent medically significant COVID-19 illness and death,
persons must understand their risk, take steps to protect themselves and others with
vaccines, therapeutics, and nonpharmaceutical interventions when needed, receive testing
and wear masks when exposed, receive testing if symptomatic, and isolate for 25 days if
infected.
What are the implications for public health practice? Medically significant illness, death, and
health care system strain can be reduced through vaccination and therapeutics to prevent
severe illness, complemented by use of multiple prevention methods to reduce exposure
risk and an emphasis on protecting persons at high risk for severe illness."
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
COVID-19 Vaccines
News in Brief
"Pending regulatory approval, Pfizer/BioNTech's Omicron-specific COVID vaccine could be ready
to roll out as soon as October, BioNTech announced" (Medpage; see also: BioNTech press
release).
"What's behind the FDA's controversial strategy for evaluating new COVID boosters" (NPR).
"A complicated fall vaccine campaign: Updated Covid boosters, flu shots, and how to time the
jabs" (STAT).
Journal Articles
Cell Rep Med: Multiple BCG vaccinations for prevention of COVID-19 and other infectious
diseases in Type 1 diabetes (15 August 2022)
"There is a need for safe and effective platform vaccines to protect against COVID-19 and
other infectious diseases. In this randomized, double-blinded, placebo-controlled Phase 2/3
trial, we evaluate the safety and efficacy of multi-dose Bacillus Calmette-Guerin (BCG)
vaccine for prevention of COVID-19 and other infectious disease in a COVID-19-
unvaccinated, at-risk-community-based cohort. The at-risk population are adults with type 1
diabetes. We enrolled 144 subjects and randomized 96 to BCG and 48 to placebo. There
were no drop-outs over the 15-month trial. A cumulative incidence of 12.5% of placebo-
treated and 1% of BCG-treated participants meets criteria for confirmed COVID-19, yielding
an efficacy of 92%. The BCG group also displays fewer infectious disease symptoms and
lesser severity, and fewer infectious disease events per patient, including COVID-19. There
were no BCG-related systemic adverse events. BCG’s broad-based infection protection
suggests that it may provide platform protection against new SARS-CoV-2 variants and
other pathogens."
JAMA Netw Open: Health Care Utilization in the 6 Months Following SARS-CoV-2 Infection (12
August 2022)
"Question: Is SARS-CoV-2 associated with health care utilization 6 months after the acute
stage of infection?
Findings: In this cohort study of 127 859 patients with positive SARS-CoV-2 test results
matched to 127 859 patients with negative SARS-CoV-2 test results, health care utilization
was elevated in patients with positive SARS-CoV-2 results 6 months after the acute
infection. Other than COVID-19 and infectious disease sequelae, the most notable post—
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
COVID-19 conditions associated with elevated health care utilization over 6 months
included alopecia (hair loss), bronchitis, pulmonary embolism or deep vein thrombosis, and
dyspnea.
Meaning: These findings suggest that health care systems should consider long-term
strategic resource allocation in response to the expected elevated health care utilization
experienced by patients with SARS-CoV-2 infection for at least 6 months following the acute
stage of infection."
JAMA Ophthalmol: COVID-19 Vaccination Rates Among US Adults With Vision or Hearing
Disabilities (11 August 2022)
"Question: What is the prevalence of COVID-19 vaccination among US adults with vision or
hearing disabilities?
Findings: In this cross-sectional study of 916 085 participants, adults with blindness were
less likely to initiate COVID-19 vaccination compared with adults with little to no vision
impairment. Adults with deafness were also less likely to initiate the COVID-19 vaccination
compared with adults with little to no hearing impairment.
Meaning: The findings suggest that, compared with adults without vision or hearing
impairment, COVID-19 vaccination rates were lower among adults with vision or hearing
disabilities, and additional research may be needed to monitor COVID-19 vaccination
disparities among this population."
JAMA Netw Open: Durability of Heterologous and Homologous COVID-19 Vaccine Boosts (10
August 2022)
"Question: What is the durability of humoral and cellular immune responses in individuals
who originally received the BNT162b2 vaccine and were boosted with Ad26.COV2.S or
BNT162b2?
Findings: In this cohort study of 68 adults, both Ad26.COV2.S and BNT162b2 were
associated with increased humoral and cellular immune responses. Boosting with
Ad26.COV2.S was associated with durable antibody and T-cell responses for at least 4
months.
Meaning: A heterologous mix-and-match vaccine strategy was associated with durable
antibody and T-cell responses against the SARS-CoV-2 Omicron variant."
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
Vaccine: COVID-19 vaccine hesitancy cannot fully explain disparities in vaccination coverage
across the contiguous United States (08 August 2022)
"Vaccine hesitancy has been identified as a major obstacle preventing comprehensive
coverage against the COVID-19 pandemic. However, few studies have analyzed the
association between ex-ante vaccine hesitancy and ex-post vaccination coverage.
This study leveraged one-year county-level data across the contiguous United States to
examine whether the prospective vaccine hesitancy eventually translates into differential
vaccination rates, and whether vaccine hesitancy can explain socioeconomic, racial, and
partisan disparities in vaccine uptake. A set of structural equation modeling was fitted with
vaccine hesitancy and vaccination rate as endogenous variables, controlling for various
potential confounders.
The results demonstrated a significant negative link between vaccine hesitancy and
vaccination rate, with the difference between the two continuously widening over time.
Counties with higher socioeconomic statuses, more Asian and Hispanic populations, more
elderly residents, greater health insurance coverage, and more Democrats presented lower
vaccine hesitancy and higher vaccination rates. However, underlying determinants of
vaccination coverage and vaccine hesitancy were divergent regarding their different
associations with exogenous variables. Mediation analysis further demonstrated that
indirect effects from exogenous variables to vaccination coverage via vaccine hesitancy only
partially explained corresponding total effects, challenging the popular narrative that
portrays vaccine hesitancy as a root cause of disparities in vaccination.
Our study highlights the need of well-funded, targeted, and ongoing initiatives to reduce
persisting vaccination inequities."
Transmission, Exposure, and Surveillance
News in Brief
"How much virus does a person with COVID exhale? New research has answers" (Nature).
Opinion: "PCR testing can help clarify confusion over Covid-19 rebound and isolation" (STAT).
"When you have covid, here's how you know you are no longer contagious" (WP).
"Tens of thousands of people exposed to bat coronaviruses each year" (Nature).
"How many animal species have caught COVID? First global tracker has (partial) answers"
(NPR).
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
Journal Articles
JAMA Netw Open: Awareness of SARS-CoV-2 Omicron Variant Infection Among Adults With
Recent COVID-19 Seropositivity (17 August 2022)
"Question: What proportion of individuals who recently contracted the SARS-CoV-2
Omicron variant were aware of their infectious status?
Findings: In this cohort study of 210 adults with evidence of seroconversion during a
regional Omicron variant surge, 56% reported being unaware of any recent Omicron variant
infection.
Meaning: Findings of this study suggest that low rates of Omicron variant infection
awareness may be a key contributor to rapid transmission of the virus within communities."
JAMA Netw Open: Risk of SARS-CoV-2 Acquisition in Health Care Workers According to
Cumulative Patient Exposure and Preferred Mask Type (15 August 2022)
"In this follow-up study, we analyzed the SARS-CoV-2 risk for HCWs depending on
cumulative exposure to patients with COVID-19 and assessed whether this risk can be
modulated by the use of respirator compared with surgical masks....
In this study, SARS-CoV-2 positivity in HCWs was associated with cumulative COVID-19
patient exposure. The odds of being SARS-CoV-2—positive were reduced by more than 40%
in individuals using respirators irrespective of cumulative exposure, even after adjusting for
multiple work- and nonwork-related covariables."
MMWR: COVID-19 Self-Test Data: Challenges and Opportunities — United States, October 31,
2021—June 11, 2022 (12 August 2022)
"What is already known about this topic? COVID-19 self-test use has increased but reporting
of results is not required.
What is added by this report? During October 31, 2021—June 11, 2022, 10.7 million test
results were voluntarily reported by users of four manufacturers’ self-tests; during that
period, 361.9 million laboratory-based and point-of-care test results were reported.
Completeness of reporting demographic variables and trends in percent positivity were
similar across test types.
What are the implications for public health practice? Self-tests are a valuable risk-reduction
tool that can guide individual actions, but they currently offer limited utility in enhancing
public health surveillance. Laboratory-based and point-of-care test result data, in
combination with other COVID-19 surveillance information, continue to provide strong
situational awareness."
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
Treatments and Management
News in Brief
"COVID rebound is surprisingly common — even without Paxlovid" (Nature).
Journal Articles
JAMA Intern Med: Clinical and Genetic Risk Factors for Acute Incident Venous
Thromboembolism in Ambulatory Patients With COVID-19 (18 August 2022)
"Question: What is the 30-day acute risk of venous thromboembolism (VTE) among
ambulatory patients with COVID-19, and what are the clinical and genetic risk factors
predisposing them to developing post—COVID-19 VTE?
Findings: In this retrospective cohort study of 18 818 outpatients with COVID-19 and 93 179
propensity score—matched noninfected participants, a higher VTE incidence was observed in
the former (hazard ratio, 21.42); however, this risk was considerably attenuated among the
fully vaccinated, after breakthrough infection. Older age, male sex, obesity, no vaccination
or partial vaccination, and inherited thrombophilia were independent risk factors for
COVID-19-—associated VTE.
Meaning: The results of this study suggest that ambulatory patients with COVID-19, either
vaccinated or not, present a clinically relevant increased risk of incident VTE during the
acute phase, with the risk pronounced by factors of older age, male sex, obesity, incomplete
vaccination, and factor V Leiden thrombophilia."
JAMA Netw Open: Institutional Surgical Response and Associated Volume Trends Throughout
the COVID-19 Pandemic and Postvaccination Recovery Period (18 August 2022)
"Question: How did surgical volumes change with respect to subspecialty and patient acuity
during the COVID-19 pandemic, and did they recover after the peak and vaccine release
periods?
Findings: In this cohort study, a retrospective analysis of 129 956 records of weekly surgical
procedures from January 6, 2019, to December 31, 2021, revealed that the overall volume
did not fully recover to pre—COVID-19 levels well into 2021. Recovery rates were
inconsistent across surgical subspecialties and case classes.
Meaning: Further research and hospital-level changes are needed to address the backlog of
surgical services and muted recovery of surgical procedures to pre—COVID-19 volumes."
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
NEJM: Randomized Trial of Metformin, lvermectin, and Fluvoxamine for Covid-19 (18 August
2022)
"BACKGROUND: Early treatment to prevent severe coronavirus disease 2019 (Covid-19) is
an important component of the comprehensive response to the severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) pandemic.
METHODS: In this phase 3, double-blind, randomized, placebo-controlled trial, we used a 2-
by-3 factorial design to test the effectiveness of three repurposed drugs — metformin,
ivermectin, and fluvoxamine — in preventing serious SARS-CoV-2 infection in
nonhospitalized adults who had been enrolled within 3 days after a confirmed diagnosis of
infection and less than 7 days after the onset of symptoms. The patients were between the
ages of 30 and 85 years, and all had either overweight or obesity. The primary composite
end point was hypoxemia (<93% oxygen saturation on home oximetry), emergency
department visit, hospitalization, or death. All analyses used controls who had undergone
concurrent randomization and were adjusted for SARS-CoV-2 vaccination and receipt of
other trial medications.
RESULTS: A total of 1431 patients underwent randomization; of these patients, 1323 were
included in the primary analysis. The median age of the patients was 46 years; 56% were
female (6% of whom were pregnant), and 52% had been vaccinated. The adjusted odds
ratio for a primary event was 0.84 (95% confidence interval [Cl], 0.66 to 1.09; P=0.19) with
metformin, 1.05 (95% Cl, 0.76 to 1.45; P=0.78) with ivermectin, and 0.94 (95% Cl, 0.66 to
1.36; P=0.75) with fluvoxamine. In prespecified secondary analyses, the adjusted odds ratio
for emergency department visit, hospitalization, or death was 0.58 (95% Cl, 0.35 to 0.94)
with metformin, 1.39 (95% Cl, 0.72 to 2.69) with ivermectin, and 1.17 (95% Cl, 0.57 to 2.40)
with fluvoxamine. The adjusted odds ratio for hospitalization or death was 0.47 (95% Cl,
0.20 to 1.11) with metformin, 0.73 (95% Cl, 0.19 to 2.77) with ivermectin, and 1.11 (95% Cl,
0.33 to 3.76) with fluvoxamine.
CONCLUSIONS: None of the three medications that were evaluated prevented the
occurrence of hypoxemia, an emergency department visit, hospitalization, or death
associated with Covid-19."
JAMA: Association of COVID-19 vs Influenza With Risk of Arterial and Venous Thrombotic Events
Among Hospitalized Patients (16 August 2022)
"Question: Is the 90-day incidence of arterial thromboembolism and venous
thromboembolism higher in patients hospitalized with COVID-19 vs in patients hospitalized
with influenza?
Findings: In this retrospective cohort study that included 93 906 patients, hospitalization
with COVID-19 before vaccine availability and during vaccine availability was significantly
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NMCP COVID-19 Literature Report #100: Friday, 19 August 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
associated with higher 90-day risk of venous thromboembolism (adjusted hazard ratios,
1.60 and 1.89, respectively) vs hospitalization with influenza in 2018-2019, but there was no
significant difference in the risk of arterial thromboembolism among those hospitalized with
COVID-19 during either period (adjusted hazard ratios, 1.04 and 1.07) vs those hospitalized
with influenza.
Meaning: Hospitalization with COVID-19 both before and during vaccine availability was
significantly associated with a higher risk of venous thromboembolism, but not arterial
thromboembolism, vs hospitalization with influenza in 2018-2019."
Emerg infect Dis: Rapid Increase in Suspected SARS-CoV-2 Reinfections, Clark County, Nevada,
USA, December 2021 (15 August 2022)
"Genetic differences between SARS-CoV-2 variants raise concerns about reinfection. Public
health authorities monitored the incidence of suspected reinfection in Clark County,
Nevada, USA, during March 2020-March 2022. Suspected reinfections, defined as a second
positive PCR test collected >90 days after an initial positive test, were monitored through an
electronic disease surveillance system.
We calculated the proportion of all new cases per week that were suspected reinfections
and rates per 1,000 previously infected persons by demographic groups. The rate of
suspected reinfection remained <2.7% until December 2021, then increased to =11%,
corresponding with local Omicron variant detection. Reinfection rates were higher among
adults 18-50 years of age, women, and minority groups, especially persons identifying as
American Indian/Alaska Native. Suspected reinfection became more common in Clark
County after introduction of the Omicron variant, and some demographic groups are
disproportionately affected. Public health surveillance could clarify the SARS-CoV-2
reinfection burden in communities."
JAMA Netw Open: Virologic Efficacy of Casirivimab and Imdevimab COVID-19 Antibody
Combination in Outpatients With SARS-CoV-2 Infection: A Phase 2 Dose-Ranging Randomized
Clinical Trial (15 August 2022)
"Question: Can casirivimab and imdevimab effectively reduce the viral load of SARS-CoV-2
with lower doses and a subcutaneous route of administration?
Findings: In this phase 2 randomized clinical trial of outpatients with SARS-CoV-2, all
casirivimab and imdevimab doses and routes of administration showed statistically
significant and comparable reductions in viral load through day 7 vs placebo in those who
were seronegative at baseline.
Meaning: These findings, combined with the results from additional studies examining
clinical efficacy, justify lowering the dose of casirivimab and imdevimab from 2400 mg to
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
1200 mg and suggest that subcutaneous administration is a viable alternative to
intravenous administration."
Clin Infect Dis: Readmissions, post-discharge mortality and sustained recovery among patients
admitted to hospital with COVID-19 (08 August 2022)
"Background: Many interventional in-patient COVID-19 trials assess primary outcomes
through day 28 post-randomization. Since a proportion of patients experience protracted
disease or relapse, such follow-up period may not fully capture the course of the disease,
even when randomization occurs a few days after hospitalization.
Methods: Among adults hospitalized with COVID-19 in Eastern Denmark from March 18,
2020 - January 12, 2021 we assessed: all-cause mortality, recovery and sustained recovery
90 days after admission, and readmission and all-cause mortality 90 days after discharge.
Recovery was defined as hospital discharge and sustained recovery as recovery and alive
without readmissions for 14 consecutive days.
Results: Among 3,386 patients included in the study 2,796 (82.6%) reached recovery and
2,600 (77.0%) achieved sustained recovery. Of those discharged from hospital, 556 (19.9%)
were readmitted, and 289 (10.3%) died. Overall, the median time to recovery was 6 days
(Interquartile range (IQR), 3-10), and 19 days (IQR, 11-33) among patients in intensive care
in the first two days of admission.
Conclusions: Post-discharge readmission and mortality rates were substantial. Therefore,
sustained recovery should be favored to recovery outcomes in clinical COVID-19 trials. A 28-
day follow-up period may be too short the critically ill."
Long COVID and Other Post-Infectious Findings
News in Brief
"Long-COVID treatments: why the world is still waiting" (Nature).
"It's not just long COVID — Society has been underestimating the long-term consequences of
viruses, bacterial infections, and parasites for ages" (Atlantic).
"Risk of 'brain fog' and other conditions persists up to two years after Covid infection" (STAT).
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Journal Articles
Lancet Psychiatry: Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an
analysis of 2-year retrospective cohort studies including 1 284 437 patients (17 August 2022)
"Background: COVID-19 is associated with increased risks of neurological and psychiatric
sequelae in the weeks and months thereafter. How long these risks remain, whether they
affect children and adults similarly, and whether SARS-CoV-2 variants differ in their risk
profiles remains unclear.
Methods: In this analysis of 2-year retrospective cohort studies, we extracted data from the
TriNetX electronic health records network, an international network of de-identified data
from health-care records of approximately 89 million patients collected from hospital,
primary care, and specialist providers (mostly from the USA, but also from Australia, the UK,
Spain, Bulgaria, India, Malaysia, and Taiwan). A cohort of patients of any age with COVID-19
diagnosed between Jan 20, 2020, and April 13, 2022, was identified and propensity-score
matched (1:1) to a contemporaneous cohort of patients with any other respiratory
infection. Matching was done on the basis of demographic factors, risk factors for COVID-19
and severe COVID-19 illness, and vaccination status. Analyses were stratified by age group
(age <18 years [children], 18-64 years [adults], and 265 years [older adults]) and date of
diagnosis. We assessed the risks of 14 neurological and psychiatric diagnoses after SARS-
CoV-2 infection and compared these risks with the matched comparator cohort. The 2-year
risk trajectories were represented by time-varying hazard ratios (HRs) and summarised
using the 6-month constant HRs (representing the risks in the earlier phase of follow-up,
which have not yet been well characterised in children), the risk horizon for each outcome
(ie, the time at which the HR returns to 1), and the time to equal incidence in the two
cohorts. We also estimated how many people died after a neurological or psychiatric
diagnosis during follow-up in each age group. Finally, we compared matched cohorts of
patients diagnosed with COVID-19 directly before and after the emergence of the alpha
(B.1.1.7), delta (B.1.617.2), and omicron (B.1.1.529) variants.
Findings: We identified 1 487 712 patients with a recorded diagnosis of COVID-19 during the
study period, of whom 1 284 437 (185 748 children, 856 588 adults, and 242 101 older
adults; overall mean age 42-5 years [SD 21-9]; 741 806 [57-8%] were female and 542 192
[42:2%] were male) were adequately matched with an equal number of patients with
another respiratory infection. The risk trajectories of outcomes after SARS-CoV-2 infection
in the whole cohort differed substantially. While most outcomes had HRs significantly
greater than 1 after 6 months (with the exception of encephalitis; Guillain-Barré syndrome;
nerve, nerve root, and plexus disorder; and parkinsonism), their risk horizons and time to
equal incidence varied greatly. Risks of the common psychiatric disorders returned to
baseline after 1-2 months (mood disorders at 43 days, anxiety disorders at 58 days) and
subsequently reached an equal overall incidence to the matched comparison group (mood
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disorders at 457 days, anxiety disorders at 417 days). By contrast, risks of cognitive deficit
(known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still
increased at the end of the 2-year follow-up period. Post-COVID-19 risk trajectories differed
in children compared with adults: in the 6 months after SARS-CoV-2 infection, children were
not at an increased risk of mood (HR 1:02 [95% Cl 0:94-1:10) or anxiety (1-00 [0-94—1-06])
disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial
haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic
disorders, and epilepsy or seizures (HRs ranging from 1-20 [1:09-1:33] to 2:16 [1:46—3-19]).
Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time
to equal incidence (491 days). A sizeable proportion of older adults who received a
neurological or psychiatric diagnosis, in either cohort, subsequently died, especially those
diagnosed with dementia or epilepsy or seizures. Risk profiles were similar just before
versus just after the emergence of the alpha variant (n=47 675 in each cohort). Just after (vs
just before) the emergence of the delta variant (n=44 835 in each cohort), increased risks of
ischaemic stroke, epilepsy or seizures, cognitive deficit, insomnia, and anxiety disorders
were observed, compounded by an increased death rate. With omicron (n=39 845 in each
cohort), there was a lower death rate than just before emergence of the variant, but the
risks of neurological and psychiatric outcomes remained similar.
Interpretation: This analysis of 2-year retrospective cohort studies of individuals diagnosed
with COVID-19 showed that the increased incidence of mood and anxiety disorders was
transient, with no overall excess of these diagnoses compared with other respiratory
infections. In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia,
and epilepsy or seizures persisted throughout. The differing trajectories suggest a different
pathogenesis for these outcomes. Children have a more benign overall profile of psychiatric
risk than do adults and older adults, but their sustained higher risk of some diagnoses is of
concern. The fact that neurological and psychiatric outcomes were similar during the delta
and omicron waves indicates that the burden on the health-care system might continue
even with variants that are less severe in other respects. Our findings are relevant to
understanding individual-level and population-level risks of neurological and psychiatric
disorders after SARS-CoV-2 infection and can help inform our responses to them."
Clin Infect Dis: Symptom burden and immune dynamics 6 to 18 months following mild SARS-
CoV-2 infection -a case-control study (12 August 2022)
"Background: The burden and duration of persistent symptoms after non-severe COVID-19
remains uncertain. This study aimed to assess post-infection symptom trajectories in home-
isolated COVID-19 cases compared to age- and time-period matched seronegative controls,
and investigate immunological correlates of long COVID.
Methods: A prospective case-control study conducted between February 28th and April 4th
2020 included home-isolated COVID-19 cases followed for 12 (n = 233) to 18 (n = 149)
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months, and 189 age-matched SARS-CoV-2 naive controls. We collected clinical data at
baseline, 6, 12 and 18 months post-infection, and blood samples at 2, 4, 6 and 12 months
for analysis of SARS-CoV-2 specific humoral and cellular responses.
Results: Overall, 46% (108/233) had persisting symptoms 12 months after COVID-19.
Compared to controls, adult cases had a high risk of fatigue (27% excess risk, gender and
comorbidity adjusted odds ratio [aOR] 5.86, 95% confidence interval [Cl]3.27-10.5), memory
problems (21% excess risk, aOR 7.42, Cl 3.51-15.67), concentration problems (20% excess
risk, aOR 8.88, Cl 3.88-20.35), and dyspnea (10% excess risk, aOR 2.66, Cl 1.22-5.79). The
prevalence of memory problems increased overall from 6 to 18 months (excess risk 11.5%,
Cl 1.5, 21.5, p = 0.024) and among women (excess risk 18.7%, Cl 4.4, 32.9, p = 0.010).
Longitudinal spike IgG was significantly associated with dyspnea at 12 months. The spike-
specific clonal CD4 + TCRB depth was significantly associated with both dyspnea and
number of symptoms at 12 months.
Conclusions: This study documents a high burden of persisting symptoms after mild COVID-
19, and suggest that infection induced SARS-CoV-2 specific immune responses may
influence long-term symptoms."
Pregnancy and Postpartum Period
Journal Articles
Clin Infect Dis: SARS-CoV-2 testing and detection during peripartum hospitalizations among a
multi-center cohort of pregnant persons, March 2020—February 2021 (12 August 2022)
"Background: Identifying SARS-CoV-2 infections during peripartum hospitalizations is
important to guide care, implement prevention measures, and understand infection
burden.
Methods: This cross-sectional analysis used electronic health record data from
hospitalizations during which pregnancies ended (peripartum hospitalizations) among a
cohort of pregnant persons at 3 U.S. integrated healthcare networks (Sites 1-3). Maternal
demographic, medical encounter, SARS-CoV-2 testing, and pregnancy and neonatal
outcome information was extracted for persons with estimated delivery and pregnancy end
dates during March 2020-February 2021 and 21 prenatal care record. Site-stratified
multivariable logistic regression was used to identify factors associated with testing and
compare pregnancy and neonatal outcomes among persons tested.
Results: Among 17,858 pregnant persons, 10,863 (60.8%) had peripartum SARS-CoV-2
testing; 222/10,683 (2.0%) had positive results. Testing prevalence varied by site and was
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lower during March-May 2020. Factors associated with higher peripartum SARS-CoV-2
testing odds were Asian race (adjusted odds ratio [aOR]: 1.36; 95% Cl: 1.03-1.79; referent:
White) (Site 1), Hispanic or Latina ethnicity (aOR: 1.33; 95% Cl: 1.08-1.64) (Site 2),
peripartum Medicaid coverage (aOR: 1.33; 95% Cl: 1.06-1.66) (Site 1), and preterm
hospitalization (aOR: 1.69; 95% Cl: 1.19-2.39 [Site 1]; aOR: 1.39; 95% Cl: 1.03-1.88 [Site 2]).
Conclusions: Findings highlight potential disparities in SARS-CoV-2 peripartum testing by
demographic and pregnancy characteristics. Testing practice variations should be
considered when interpreting studies relying on convenience samples of pregnant persons
testing positive for SARS-CoV-2. Efforts to address testing differences between groups could
improve equitable testing practices and care for pregnant persons with SARS-CoV-2
infections."
JAMA Netw Open: Comparison of Severe Maternal Morbidities Associated With Delivery During
Periods of Circulation of Specific SARS-CoV-2 Variants (12 August 2022)
"Question: Does the association between SARS-CoV-2 infection and severe maternal
morbidity (SMM), including nonrespiratory complications, vary by viral strain?
Findings: In this retrospective cohort study of 3129 patients with SARS-CoV-2 infection and
12 504 patients without infection giving birth in a large US health system between March
2020 and January 2022, the risk of SMM associated with SARS-CoV-2 infection was
significantly higher during the phase of the pandemic when the Delta variant was
predominant (July 2021-November 2021). This association was also noted specifically for
both respiratory and nonrespiratory SMM.
Meaning: These findings highlight the importance of the prevention of SARS-CoV-2 infection
in pregnant individuals and the consideration of infection as a risk factor for adverse
peripartum maternal outcomes."
JAMA Netw Open: Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-
19 Pandemic (12 August 2022)
"Question: Was the COVID-19 pandemic associated with changes in pregnancy-related
outcomes?
Findings: In a cohort of more than 1.6 million pregnant patients across 463 US hospitals, the
number of live births decreased by 5.2% during the COVID-19 pandemic (March 2020 to
April 2021) compared with the 14 months prior. While live-birth outcomes and mode of
delivery remained stable, small but significant increases in pregnancy-related complications
and maternal death during delivery hospitalization were observed.
Meaning: In this study, the COVID-19 pandemic was associated with increases in pregnancy-
related complications and maternal deaths during delivery hospitalization."
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Lancet Infect Dis: Safety of COVID-19 vaccines in pregnancy: a Canadian National Vaccine Safety
(CANVAS) network cohort study (11 August 2022)
"Background: Pregnant individuals have been receiving COVID-19 vaccines following pre-
authorisation clinical trials in non-pregnant people. This study aimed to determine the
frequency and nature of significant health events among pregnant females after COVID-19
vaccination, compared with unvaccinated pregnant controls and vaccinated non-pregnant
individuals.
Methods: We did an observational cohort study, set in seven Canadian provinces and
territories including Ontario, Quebec, British Columbia, Alberta, Nova Scotia, Yukon, and
Prince Edward Island. Eligibility criteria for vaccinated individuals were a first dose of a
COVID-19 vaccine within the previous 7 days; an active email address and telephone
number; ability to communicate in English or French; and residence in the aforementioned
provinces or territories. Study participants were pregnant and non-pregnant females aged
15-49 years. Individuals were able to participate as controls if they were unvaccinated and
fulfilled the other criteria. Data were collected primarily by self-reported survey after both
vaccine doses, with telephone follow-up for those reporting any medically attended event.
Participants reported significant health events (new or worsening of a health event
sufficient to cause work or school absenteeism, medical consultation, or prevent daily
activities) occurring within 7 days of vaccination or within the past 7 days for unvaccinated
individuals. We employed multivariable logistic regression to examine significant health
events associated with MRNA vaccines, adjusting for age group, previous SARS-CoV-2
infection, and trimester, as appropriate.
Findings: As of Nov 4, 2021, 191 360 women aged 15-49 years with known pregnancy status
had completed the first vaccine dose survey and 94 937 had completed the second dose
survey. 180 388 received one dose and 94 262 received a second dose of an mRNA vaccine,
with 5597 pregnant participants receiving dose one and 3108 receiving dose two, and 174
765 non-pregnant participants receiving dose one and 91 131 receiving dose two. Of 6179
included unvaccinated control participants, 339 were pregnant and 5840 were not
pregnant. Overall, 226 (4-0%) of 5597 vaccinated pregnant females reported a significant
health event after dose one of an mRNA vaccine, and 227 (7:3%) of 3108 after dose two,
compared with 11 (3-2%) of 339 pregnant unvaccinated females. Pregnant vaccinated
females had an increased odds of a significant health event within 7 days of the vaccine
after dose two of mRNA-1273 (adjusted odds ratio [aOR] 4-4 [95% Cl 2-4-8-3]) compared
with pregnant unvaccinated controls within the past 7 days, but not after dose one of
mRNA-1273 or any dose of BNT162b2. Pregnant vaccinated females had decreased odds of
a significant health event compared with non-pregnant vaccinated females after both dose
one (aOR 0:63 [95% Cl 0-55-0-72]) and dose two (aOR 0:62 [0:54-0-71]) of any MRNA
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vaccination. There were no significant differences in any analyses when restricted to events
which led to medical attention.
Interpretation: COVID-19 mRNA vaccines have a good safety profile in pregnancy. These
data can be used to appropriately inform pregnant people regarding reactogenicity of
COVID-19 vaccines during pregnancy, and should be considered alongside effectiveness and
immunogenicity data to make appropriate recommendations about best use of COVID-19
vaccines in pregnancy."
Pediatric Population
News in Brief
"Should parents delay kids' second COVID vaccine? Here's what the research says" (Nature).
Journal Articles
Vaccines and Boosters
MMWR: Safety Monitoring of Pfizer-BioNTech COVID-19 Vaccine Booster Doses Among
Children Aged 5-11 Years — United States, May 17—July 31, 2022 (19 August 2022)
"What is already known about this topic? A Pfizer-BioNTech COVID-19 vaccine booster dose
is recommended for children aged 5—11 years; approximately 657,302 third doses were
administered to children in this age group during May—July 2022.
What is added by this report? Among children aged 5—11 years, local and systemic reactions
were reported to v-safe with similar frequency after doses 2 and 3; specific reactions
differed in severity. Vaccine administration errors were the most common events reported
to the Vaccine Adverse Event Reporting System. No reports of myocarditis or death after
receipt of dose 3 were received.
What are the implications for public health practice? Among children aged 5—11 years,
serious adverse events after dose 3 are rare. Additional provider education might prevent
vaccine administration errors."
JAMA Netw Open: Long-term Effectiveness Associated With the BNT162b2 Vaccine Against
SARS-CoV-2 Infection Among Adolescents in South Korea (17 August 2022)
"Our results suggest that after vaccination with BNT162b2, the effectiveness of the vaccine
against SARS-CoV-2 infection among adolescents waned over time, with limited protection
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observed 30 to 59 days after administration of a second dose of the vaccine. Regardless, our
findings suggest an association between the BNT162b2 vaccine and sustained effectiveness
against critical SARS-CoV-2 infection, as reported previously."
NEJM: Effectiveness of BNT162b2 Vaccine against Omicron in Children 5 to 11 Years of Age (11
August 2022)
"Background: Since it was first identified in early November 2021, the B.1.1.529 (omicron)
variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread quickly
and replaced the B.1.617.2 (delta) variant as the dominant variant in many countries. Data
on the real-world effectiveness of vaccines against the omicron variant in children are
lacking.
Methods: In a study conducted from January 21, 2022, through April 8, 2022, when the
omicron variant was spreading rapidly, we analyzed data on children in Singapore who were
5 to 11 years of age. We assessed the incidences of all reported SARS-CoV-2 infections
(confirmed on polymerase-chain-reaction [PCR] assay, rapid antigen testing, or both), SARS-
CoV-2 infections confirmed on PCR assay, and coronavirus disease 2019 (Covid-19)-related
hospitalizations among unvaccinated, partially vaccinated (21 day after the first dose of
vaccine and up to 6 days after the second dose), and fully vaccinated children (27 days after
the second dose). Poisson regression was used to estimate vaccine effectiveness from the
incidence rate ratio of outcomes.
Results: A total of 255,936 children were included in the analysis. Among unvaccinated
children, the crude incidence rates of all reported SARS-CoV-2 infections, PCR-confirmed
SARS-CoV-2 infections, and Covid-19-related hospitalizations were 3303.5, 473.8, and 30.0
per 1 million person-days, respectively. Among partially vaccinated children, vaccine
effectiveness was 13.6% (95% confidence interval [Cl], 11.7 to 15.5) against all SARS-CoV-2
infections, 24.3% (95% Cl, 19.5 to 28.9) against PCR-confirmed SARS-CoV-2 infection, and
42.3% (95% Cl, 24.9 to 55.7) against Covid-19-related hospitalization; in fully vaccinated
children, vaccine effectiveness was 36.8% (95% Cl, 35.3 to 38.2), 65.3% (95% Cl, 62.0 to
68.3), and 82.7% (95% Cl, 74.8 to 88.2), respectively.
Conclusions: During a period when the omicron variant was predominant, BNT162b2
vaccination reduced the risks of SARS-CoV-2 infection and Covid-19-related hospitalization
among children 5 to 11 years of age."
Lancet: Vaccine effectiveness of two-dose BNT162b2 against symptomatic and severe COVID-19
among adolescents in Brazil and Scotland over time: a test-negative case-control study (08
August 2022)
"Background: Little is known about vaccine effectiveness over time among adolescents,
especially against the SARS-CoV-2 omicron (B.1.1.529) variant. This study assessed the
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associations between time since two-dose vaccination with BNT162b2 and the occurrence
of symptomatic SARS-CoV-2 infection and severe COVID-19 among adolescents in Brazil and
Scotland.
Methods: We did test-negative, case-control studies in adolescents aged 12-17 years with
COVID-19-related symptoms in Brazil and Scotland. We linked records of SARS-CoV-2 RT-
PCR and antigen tests to national vaccination and clinical records. We excluded tests from
individuals who did not have symptoms, were vaccinated before the start of the national
vaccination programme, received vaccines other than BNT162b2 or a SARS-CoV-2 booster
dose of any kind, or had an interval between their first and second dose of fewer than 21
days. Additionally, we excluded negative SARS-CoV-2 tests recorded within 14 days of a
previous negative test, negative tests recorded within 7 days after a positive test, any test
done within 90 days after a positive test, and tests with missing sex and location
information. Cases (SARS-CoV-2 test-positive adolescents) and controls (test-negative
adolescents) were drawn from a sample of individuals in whom tests were collected within
10 days of symptom onset. We estimated the adjusted odds ratio and vaccine effectiveness
against symptomatic COVID-19 for both countries and against severe COVID-19
(hospitalisation or death) for Brazil across fortnightly periods.
Findings: We analysed 503 776 tests from 2 948 538 adolescents in Brazil between Sept 2,
2021, and April 19, 2022, and 127 168 tests from 404 673 adolescents in Scotland between
Aug 6, 2021, and April 19, 2022. Vaccine effectiveness peaked at 14-27 days after the
second dose in both countries during both waves, and was significantly lower against
symptomatic infection during the omicron-dominant period in Brazil (64-7% [95% Cl 63-0-
66-3]) and in Scotland (82:6% [80-6-84-5]), than it was in the delta-dominant period (80:7%
[95% Cl 77-8-83-3] in Brazil and 92:8% [85-7-96-4] in Scotland). Vaccine efficacy started to
decline from 27 days after the second dose for both countries, reducing to 5-9% (95% Cl 2:2-
9-4) in Brazil and 50-6% (42-7-57-4) in Scotland at 98 days or more during the omicron-
dominant period. In Brazil, protection against severe disease remained above 80% from 28
days after the second dose and was 82:7% (95% Cl 68-8-90:4) at 98 days or more after
receiving the second dose.
Interpretation: We found waning vaccine protection of BNT162b2 against symptomatic
COVID-19 infection among adolescents in Brazil and Scotland from 27 days after the second
dose. However, protection against severe COVID-19 outcomes remained high at 98 days or
more after the second dose in the omicron-dominant period. Booster doses for adolescents
need to be considered."
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COVID Complications
Pediatrics: Health Impairments in Children and Adolescents After Hospitalization for Acute
COVID-19 or MIS-C (11 August 2022)
"Objective: To evaluate risk factors for post-discharge sequelae in children and adolescents
after hospitalization for acute COVID-19 or multisystem inflammatory syndrome in children
(MIS-C).
Methods: Multicenter prospective observational cohort study conducted in 25 US pediatric
hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or
MIS-C with follow-up 2-4 months after admission. We assessed readmissions, caregiver-
reported persistent symptoms or activity impairment, and new morbidities identified by the
Functional Status Scale. Multivariable regression was used to calculate adjusted risk ratios
(aRR).
Results: Of 358 eligible patients, 2-4 month survey data were available for 119/155 (76.8%)
with acute COVID-19 and 160/203 (78.8%) with MIS-C. Thirteen (11%) patients with acute
COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute
COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%)
patients with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For
patients with acute COVID-19, persistent symptoms (aRR, 1.29[95% Cl, 1.04-1.59]) and
activity impairment (aRR, 1.37[95% Cl, 1.06-1.78]) were associated with more organs
systems involved. Patients with MIS-C and pre-existing respiratory conditions more
frequently had persistent symptoms (aRR, 3.09[95% Cl, 1.55-6.14]) and those with obesity
more frequently had activity impairment (aRR, 2.52[95% Cl, 1.35-4.69]). New morbidities
were infrequent (9% COVID-19 and 1% MIS-C).
Conclusions: Over one in four children hospitalized with acute COVID-19 or MIS-C
experienced persistent symptoms or activity impairment for at least 2 months. Patients with
MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery."
Pediatrics: COVID-19 and Acute Neurologic Complications in Children (11 August 2022)
"Background: Little is known about the epidemiology and outcomes of neurologic
complications associated with COVID-19 in children.
Methods: We performed a cross-sectional study of children 2 months to <18 years with
COVID-19 discharged from 52 children's hospitals from March 2020-March 2022. Neurologic
complications were defined as encephalopathy, encephalitis, aseptic meningitis, febrile
seizure, non-febrile seizure, brain abscess and bacterial meningitis, Reye's syndrome, and
cerebral infarction. We assessed length of stay (LOS), intensive care unit (ICU) admission,
30-day readmissions, deaths, and hospital costs. We used multivariable logistic regression
to identify factors associated with neurologic complications.
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Results: Of 15,137 children hospitalized with COVID-19, 1060 (7.0%) had a concurrent
diagnosis of a neurologic complication. The most frequent neurologic complications were
febrile seizures (3.9%), non-febrile seizures (2.3%) and encephalopathy (2.2%). Hospital LOS,
ICU admission, ICU LOS, 30-day readmissions, deaths, and hospital costs were higher in
children with neurologic complications compared to those without complications. Factors
associated with lower odds of neurologic complications included: younger age (aOR 0.97,
95% Cl 0.96, 0.98), occurrence during Delta variant predominant time period (aOR 0.71,
95% Cl 0.57, 0.87), presence of a non-neurologic complex chronic condition (CCC) (aOR
0.80, 95% Cl 0.69, 0.94). Presence of a neurologic CCC was associated with a higher odds of
neurologic complication (aOR 4.14, 95% Cl 3.48, 4.92).
Conclusions: Neurologic complications are common in children hospitalized with COVID-19
and are associated with worse hospital outcomes. Our findings emphasize the importance
of COVID-19 immunization in children, especially in high-risk populations, such as those with
neurologic co-morbidity."
Beyond COVID
NEJM: A Case Series of Children with Acute Hepatitis and Human Adenovirus Infection (18
August 2022)
"Background: Human adenoviruses typically cause self-limited respiratory, gastrointestinal,
and conjunctival infections in healthy children. In late 2021 and early 2022, several
previously healthy children were identified with acute hepatitis and human adenovirus
viremia.
Methods: We used International Classification of Diseases, 10th Revision, codes to identify
all children (<18 years of age) with hepatitis who were admitted to Children's of Alabama
hospital between October 1, 2021, and February 28, 2022; those with acute hepatitis who
also tested positive for human adenovirus by whole-blood quantitative polymerase chain
reaction (PCR) were included in our case series. Demographic, clinical, laboratory, and
treatment data were obtained from medical records. Residual blood specimens were sent
for diagnostic confirmation and human adenovirus typing.
Results: A total of 15 children were identified with acute hepatitis - 6 (40%) who had
hepatitis with an identified cause and 9 (60%) who had hepatitis without a known cause.
Eight (89%) of the patients with hepatitis of unknown cause tested positive for human
adenovirus. These 8 patients plus 1 additional patient referred to this facility for follow-up
were included in this case series (median age, 2 years 11 months; age range, 1 year 1 month
to 6 years 5 months). Liver biopsies indicated mild-to-moderate active hepatitis in 6
children, some with and some without cholestasis, but did not show evidence of human
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adenovirus on immunohistochemical examination or electron microscopy. PCR testing of
liver tissue for human adenovirus was positive in 3 children (50%). Sequencing of specimens
from 5 children showed three distinct human adenovirus type 41 hexon variants. Two
children underwent liver transplantation; all the others recovered with supportive care.
Conclusions: Human adenovirus viremia was present in the majority of children with acute
hepatitis of unknown cause admitted to Children's of Alabama from October 1, 2021, to
February 28, 2022, but whether human adenovirus was causative remains unclear.
Sequencing results suggest that if human adenovirus was causative, this was not an
outbreak driven by a single strain."
NEJM: Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause (18 August 2022)
"Background: Since January 2022, there has been an increase in reports of cases of acute
hepatitis of unknown cause in children. Although cases have been reported across multiple
continents, most have been reported in the United Kingdom. Investigations are ongoing to
identify the causative agent or agents.
Methods: We conducted a retrospective study involving children referred to a single
pediatric liver-transplantation center in the United Kingdom between January 1 and April
11, 2022. These children were 10 years of age or younger and had hepatitis that met the
case definition of the U.K. Health Security Agency for confirmed acute hepatitis that was not
hepatitis A through E and did not have a metabolic, inherited or genetic, congenital, or
mechanical cause, in the context of a serum aminotransferase level greater than 500 IU per
liter. We reviewed medical records and documented demographic characteristics, clinical
features, and results of liver biochemical, serologic, and molecular tests for hepatotropic
and other viruses, as well as radiologic and clinical outcomes. The outcomes were classified
as an improving condition, liver transplantation, or death.
Results: A total of 44 children had hepatitis that met the confirmed case definition, and
most were previously healthy. The median age was 4 years (range, 1 to 7). Common
presenting features were jaundice (in 93% of the children), vomiting (in 54%), and diarrhea
(in 32%). Among the 30 patients who underwent molecular testing for human adenovirus,
27 (90%) were positive. Fulminant liver failure developed in 6 patients (14%), all of whom
received a liver transplant. None of the patients died. All the children, including the 6 who
received liver transplants, were discharged home.
Conclusions: In this series involving 44 young children with acute hepatitis of uncertain
cause, human adenovirus was isolated in most of the children, but its role in the
pathogenesis of this illness has not been established."
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Other Infectious Diseases and Public Health Threats
News in Brief
"A rapidly spreading E. coli outbreak in Michigan and Ohio is raising health alarms" (NPR).
"New Langya virus that may have spilled over from animals infects dozens" (WP; see also: NEJM
study, noted below).
"As of 8 August, the United Republic of Tanzania has reported 20 cases of leptospirosis in two
districts in Lindi Region, including three deaths" (WHO).
"Zimbabwe blames measles surge on sect gatherings after 80 children die" (Reuters).
"Major test of first possible Lyme vaccine in 20 years begins" (AP).
Polio
"Wastewater monitoring identifies polioviruses in New York City" (STAT).
"New York Health Department says hundreds of people may be infected with polio virus" (CBS).
"CDC sends team to New York to investigate polio case" (ABC).
Journal Articles
MMWR: Public Health Response to a Case of Paralytic Poliomyelitis in an Unvaccinated Person
and Detection of Poliovirus in Wastewater — New York, June—August 2022 (19 August 2022)
"What is already known about this topic? Sustained poliovirus transmission has been
eliminated from the United States for approximately 40 years; vaccines are highly effective
in preventing paralysis after exposure.
What is added by this report? In June 2022, poliovirus was confirmed in an unvaccinated
immunocompetent adult resident of New York hospitalized with flaccid lower limb
weakness. Vaccine-derived poliovirus type 2 was isolated from the patient and identified
from wastewater samples in two neighboring New York counties.
What are the implications for public health practice? Unvaccinated persons in the United
States remain at risk for paralytic poliomyelitis if they are exposed to either wild or vaccine-
derived poliovirus; all persons in the United States should stay up to date on recommended
poliovirus vaccination."
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Nat Clim Change: Over half of known human pathogenic diseases can be aggravated by climate
change (08 August 2022)
"It is relatively well accepted that climate change can affect human pathogenic diseases;
however, the full extent of this risk remains poorly quantified. Here we carried out a
systematic search for empirical examples about the impacts of ten climatic hazards sensitive
to greenhouse gas (GHG) emissions on each known human pathogenic disease. We found
that 58% (that is, 218 out of 375) of infectious diseases confronted by humanity worldwide
have been at some point aggravated by climatic hazards; 16% were at times diminished.
Empirical cases revealed 1,006 unique pathways in which climatic hazards, via different
transmission types, led to pathogenic diseases. The human pathogenic diseases and
transmission pathways aggravated by climatic hazards are too numerous for comprehensive
societal adaptations, highlighting the urgent need to work at the source of the problem:
reducing GHG emissions."
NEJM: A Zoonotic Henipavirus in Febrile Patients in China (04 August 2022)
summary from CIDRAP: "Chinese researchers who were conducting routine surveillance in
people with fevers who had recent contact with animals have identified Langya henipavirus
(LayV), a distinct henipavirus and relative of Hendra and Nipah viruses, in a throat swab of
one patient. In correspondence last week to the New England Journal of Medicine, they said
their investigation turned up 35 suspected acute infections in Shandong and Henan
provinces. The surveillance for potential zoonotic infections took place in three hospitals,
two in Henan province and one in Shandong province, between Apr 2018 and Aug 2021.
The first patient was a 53-year-old woman who sought care at one of the hospitals in
December 2018. Patients' symptoms were mainly mild and included fever, fatigue, cough,
loss of appetite, myalgia, nausea, and headache. However, a few had more serious illness
that included pneumonia and abnormalities in liver and kidney function.
When the researchers investigated potential animal sources, they found serologic evidence
of exposure in a few goats and dogs. Of 25 wildlife species they tested, LayV was mainly
found in shrews, suggesting that the species might harbor the virus.
They found no evidence of human-to-human spread or common exposures among patients,
which they said suggests infections in humans may be sporadic. They concluded that the
newly identified henipavirus, which is most closely related to Mojiang henipavirus detected
in southern China, warrants more investigation to better understand human infections."
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Special Topic: Monkeypox
News in Brief
"Monkeypox: experts give virus variants new names" (WHO).
"WHO vows nothing 'ridiculous' as public submits ideas to rename monkeypox" (Reuters).
Vaccines
"Bavarian Nordic A/S, the only company with an approved vaccine for monkeypox, said it's no
longer certain it can meet demand and is talking to multiple production partners as cases rise
across the world" (Bloomberg).
"FDA authorizes emergency use of JYNNEOS vaccine to increase vaccine supply" (FDA).
"The chaotic monkeypox vaccine pipeline is leaving everyone short — A Danish company that's
the sole producer of the only approved vaccine has sold nearly all its supplies to the US, and it
won't be making new doses until 2023" (Wired).
"Fractional monkeypox vaccine dosing comes under scrutiny" (CIDRAP).
"Monkeypox vaccine not ‘a silver bullet,| WHO says, as breakthrough cases emerge" (ABC).
Transmission and Surveillance
"What scientists know — and don't know — about how monkeypox spreads" (STAT).
"World ignored monkeypox threats, including signs of sexual transmission" (WP).
"COVID sewage surveillance labs join the hunt for monkeypox" (NPR).
"New data from several states show racial disparities in monkeypox infections" (STAT).
Webinars and Other Events
WHAT: Monkeypox: The State of the Science
American Public Health Association and the National Academy of Medicine
"A panel of experts will discuss the current state of the science of monkeypox,
the disease epidemiology as we understand it today, available and emergent
prevention options, critical research questions we need to answer, and what we
should consider and plan for as we respond to this public health emergency."
WHEN: Thursday 18 August 2022, 1500-1630 ET
(recording and transcript will be available on site following event)
LINK: https://nam.edu/event/monkeypox-the-state-of-the-science
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WHAT:
WHEN:
LINK:
CDC and FDA Update: Interim Clinical Considerations for Monkeypox Vaccination
CDC Clinician Outreach and Communication Activity (COCA)
"The U.S. Food and Drug Administration (FDA) has issued an emergency use
authorization (EUA) for the JYNNEOS vaccine. The EUA allows healthcare
providers to administer the vaccine by intradermal injection for individuals 18
years of age and older who are at high risk for monkeypox infection, which will
result in up to a five-fold increase in the total number of doses available for use.
In addition, the Centers for Disease Control and Prevention (CDC) has released
Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines
during the 2022 U.S. Monkeypox Outbreak that provides guidance for using the
alternative (intradermal) regimen, as well as the standard (subcutaneous)
regimen for JYNNEOS vaccine.
During this COCA Call, presenters from FDA and CDC will provide updates on
FDA's EUA of the JYNNEOS vaccine and CDC's Interim Clinical Considerations for
using the JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Monkeypox
Outbreak. Presenters will also provide training on how to administer the
vaccines using the interim clinical considerations."
Recorded Thursday 11 August 2022, 1500-1600 ET
(recording, transcript, and call materials available on site)
https://emergency.cdc.gov/coca/calls/2022/callinfo 081122.as
Journal Articles
Ann Intern Med: Detection of Monkeypox Virus in Anorectal Swabs From Asymptomatic Men
Who Have Sex With Men in a Sexually Transmitted Infection Screening Program in Paris, France
(16 August 2022)
"Objective: To assess the presence of MPXV in anorectal samples among asymptomatic
MSM routinely tested for bacterial sexually transmitted infections (2).
Methods and Findings: We retrospectively performed testing for MPXV on all anorectal
swabs that were collected in our center as part of a screening program for Neisseria
gonorrhoeae and Chlamydia trachomatis.... Of the 187 asymptomatic participants who
tested negative for MPXV, 3 presented to our clinic more than 3 weeks after the initial
MPXV-negative anal swab with symptoms suggestive of MPXV infection and tested
positive."
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Emerg Infect Dis: Human Monkeypox without Viral Prodrome or Sexual Exposure, California,
USA, 2022 (15 August 2022)
"We report human monkeypox in a man who returned to the United States from the United
Kingdom and reported no sexual contact. He had vesicular and pustular skin lesions but no
anogenital involvement. The potential modes of transmission may have implications for the
risk of spread and for epidemic control."
MMWR: Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May
17-July 22, 2022 (12 August 2022)
"What is already known about this topic? A global monkeypox outbreak began in 2022.
What is added by this report? Among U.S. monkeypox cases with available data, 99%
occurred in men, 94% of whom reported recent male-to-male sexual or close intimate
contact; racial and ethnic minority groups appear to be disproportionately affected. Clinical
presentations differed from typical monkeypox, with fewer persons experiencing prodrome
and more experiencing genital rashes.
What are the implications for public health practice? Public health efforts should prioritize
gay, bisexual, and other men who have sex with men, who are currently disproportionately
affected, for prevention and testing, address equity, and minimize stigma, while maintaining
vigilance for transmission in other populations. Clinicians should test persons with rash
consistent with monkeypox, regardless of whether the rash is disseminated or was
preceded by prodrome."
MMWR: Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV
Infection — United States, August 2022 (12 August 2022)
"What is already known about this topic? A multinational monkeypox outbreak
disproportionately affecting men who have sex with men, including persons with HIV
infection, is ongoing worldwide.
What is added by this report? CDC has developed clinical considerations for prevention and
treatment of monkeypox in persons with HIV infection, including pre-exposure and
postexposure prophylaxis with JYNNEOS vaccine, treatment with tecovirimat, and infection
control.
What are the implications for public health practice? Persons with advanced HIV might be
at increased risk for severe monkeypox. Postexposure prophylaxis and antiviral treatments
are available for persons with HIV infection. Prompt diagnosis and treatment and enhanced
prevention efforts might reduce the risk for severe outcomes."
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Emerg Infect Dis: Environmental Persistence of Monkeypox Virus on Surfaces in Household of
Person with Travel-Associated Infection, Dallas, Texas, USA, 2021 (11 August 2022)
"In July 2021, we conducted environmental sampling at the residence of a person in Dallas,
Texas, USA, who had travel-associated human West African monkeypox virus (MPXV-WA).
Targeted environmental swab sampling was conducted 15 days after the person who had
monkeypox left the household. Results indicate extensive MPXV-WA DNA contamination,
and viable virus from 7 samples was successfully isolated in cell culture. There was no
statistical difference (p = 0.94) between MPXV-WA PCR positivity of porous (9/10, 90%) vs.
nonporous (19/21, 90.5%) surfaces, but there was a significant difference (p<0.01) between
viable virus detected in cultures of porous (6/10, 60%) vs. nonporous (1/21, 5%) surfaces.
These findings indicate that porous surfaces (e.g., bedding, clothing) may pose more of a
MPXV exposure risk than nonporous surfaces (e.g., metal, plastic). Viable MPXV was
detected on household surfaces after at least 15 days. However, low titers (<102 PFU)
indicate a limited potential for indirect transmission."
Lancet: Evidence of human-to-dog transmission of monkeypox virus (10 August 2022)
"Whether domesticated cats and dogs could be a vector for monkeypox virus is unknown.
Here we describe the first case of a dog with confirmed monkeypox virus infection that
might have been acquired through human transmission."
Lancet: Clinical presentation and virological assessment of confirmed human monkeypox virus
cases in Spain: a prospective observational cohort study (08 August 2022)
"Background: In May, 2022, several European countries reported autochthonous cases of
monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We
aimed to investigate clinical and virological characteristics of cases of human monkeypox in
Spain.
Methods: This multicentre, prospective, observational cohort study was done in three
sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients
with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were
offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected
by means of interviews conducted by dermatologists or specialists in sexually transmitted
infections and were recorded using a standard case report form. Outcomes assessed in all
participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV
status, exposure to Someone with monkeypox, travel, mass gathering attendance, risk
factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first
presentation, virological results at multiple body sites, co-infection with other sexually
transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical
outcomes were followed up until July 13, 2022.
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Findings: 181 patients had a confirmed monkeypox diagnosis and were enrolled in the
study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men
(MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age
was 37:0 years (IQR 31:0—42-0). 32 (18%) patients reported previous smallpox vaccination,
72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per wL, and
31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median
incubation was 7-0 days (IQR 5-0—10:0). All participants presented with skin lesions; 141
(78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral
region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a
proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight
(4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180
swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral
load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value
23 [SD 4] vs 32 [6], absolute difference 9 [95% Cl 8-10]; p<0-0001). 108 (65%) of 166 MSM
reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with
proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% Cl 19-44];
p<0-0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute
difference 34% [28-62]; p<0-0001) more frequently than MSM who did not engage in anal-
receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive
sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7-
13).
Interpretation: In our cohort, monkeypox caused genital, perianal, and oral lesions and
complications including proctitis and tonsillitis. Because of the variability of presentations,
clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed
the highest viral loads, which, combined with the history of sexual exposure and the
distribution of lesions, suggests close contact is probably the dominant transmission route
in the current outbreak."
References
Journal Articles
Ann Intern Med: Ferré VM, Bachelard A, Zaidi M, Armand-Lefevre L, Descamps D, Charpentier
C, Ghosn J. Detection of Monkeypox Virus in Anorectal Swabs From Asymptomatic Men Who
Have Sex With Men in a Sexually Transmitted Infection Screening Program in Paris, France. Ann
Intern Med. 2022 Aug 16. doi: 10.7326/M22-2183. Epub ahead of print. PMID: 35969863. Link:
https://www.acpjournals.org/doi/10.7326/M22-2183
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Cell Rep Med: Faustman DL, Lee A, Hostetter ER, et al. Multiple BCG vaccinations for prevention
of COVID-19 and other infectious diseases in Type 1 diabetes. Cell Rep Med. Published: August
15, 2022 DOI: https://doi.org/10.1016/j.xcrm.2022.100728 Link: https://www.cell.com/cell-
reports-medicine/fulltext/S2666-3791(22)00271-3
Clin Infect Dis: Delahoy MJ, Munoz F, Li K, Arriola CS, Bond NL, Daugherty M, Ferber J, Ferguson
N, Hadden L, Henderson JT, Irving SA, Juergens M, Kancharla V, Greenberg M, Odouli R, Newes-
Adeyi G, Nicholson EG, Reichle L, Sanyang M, Snead M, Dawood FS, Naleway AL. SARS-CoV-2
testing and detection during peripartum hospitalizations among a multi-center cohort of
pregnant persons, March 2020-February 2021. Clin Infect Dis. 2022 Aug 12:ciac657. doi:
10.1093/cid/ciac657. Epub ahead of print. PMID: 35959949; PMCID: PMC9384720. Link:
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac657/6663759
Clin Infect Dis: Fjelltveit EB, Blomberg B, Kuwelker K, Zhou F, Onyango TB, Brokstad KA, Elyanow
R, Kaplan IM, Téndel C, Mohn KGI, Ozgiimiis T, Cox RJ, Langeland N; Bergen COVID-19 Research
Group. Symptom burden and immune dynamics 6 to 18 months following mild SARS-CoV-2
infection -a case-control study. Clin Infect Dis. 2022 Aug 12:ciac655. doi: 10.1093/cid/ciac655.
Epub ahead of print. PMID: 35959897. Link: https://academic.oup.com/cid/advance-
article/doi/10.1093/cid/ciac655/6663664
Clin Infect Dis: Moestrup KS, Reekie J, Zucco AG, Jensen T@, Jensen JUS, Wiese L, Ostrowski SR,
Niemann CU, MacPherson C, Lundgren J, Helleberg M. Readmissions, post-discharge mortality
and sustained recovery among patients admitted to hospital with COVID-19. Clin Infect Dis.
2022 Aug 8:ciac639. doi: 10.1093/cid/ciac639. Epub ahead of print. PMID: 35938291; PMCID:
PMC9384687.Link: https://academic.oup.com/cid/advance-
article/doi/10.1093/cid/ciac639/6658187
Emerg Infect Dis: Karan A, Styczynski AR, Huang CH, Sahoo MK, Srinivasan K, Pinsky BA, et al.
Human monkeypox without viral prodrome or sexual exposure, California, USA, 2022. Emerg
Infect Dis. 2022 Oct [15 August 2022]. https://doi.org/10.3201/eid2810.221191 Link:
https://wwwnc.cdc.gov/eid/article/28/10/22-1191 article
Emerg Infect Dis: Morgan CN, Whitehill F, Doty JB, Schulte J, Matheny A, Stringer J, et al.
Environmental persistence of monkeypox virus on surfaces in household of person with travel-
associated infection, Dallas, Texas, USA, 2021. Emerg Infect Dis. 2022 Oct [date cited].
https://doi.org/10.3201/eid2810.221047 Link: https://wwwnc.cdc.gov/eid/article/28/10/22-
1047 article
Emerg Infect Dis: Ruff J, Zhang Y, Kappel M, Rathi S, Watkins K, Zhang L, Lockett C. Rapid
Increase in Suspected SARS-CoV-2 Reinfections, Clark County, Nevada, USA, December 2021.
Emerg Infect Dis. 2022 Aug 15;28(10). doi: 10.3201/eid2810.221045. Epub ahead of print.
PMID: 35969420. Link: https://wwwnc.cdc.gov/eid/article/28/10/22-1045 article
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JAMA: Lo Re V 3rd, Dutcher SK, Connolly JG, Perez-Vilar S, Carbonari DM, DeFor TA, Djibo DA,
Harrington LB, Hou L, Hennessy S, Hubbard RA, Kempner ME, Kuntz JL, McMahill-Walraven CN,
Mosley J, Pawloski PA, Petrone AB, Pishko AM, Driscoll MR, Steiner CA, Zhou Y, Cocoros NM.
Association of COVID-19 vs Influenza With Risk of Arterial and Venous Thrombotic Events
Among Hospitalized Patients. JAMA. 2022 Aug 16;328(7):637-651. doi:
10.1001/jama.2022.13072. PMID: 35972486. Link:
https://jamanetwork.com/journals/jama/fullarticle/2 795268
JAMA Intern Med: Xie J, Prats-Uribe A, Feng Q, Wang Y, Gill D, Paredes R, Prieto-Alhambra D.
Clinical and Genetic Risk Factors for Acute Incident Venous Thromboembolism in Ambulatory
Patients With COVID-19. JAMA Intern Med. 2022 Aug 18. doi:
10.1001/jamainternmed.2022.3858. Epub ahead of print. PMID: 35980616. Link:
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2 795466
JAMA Netw Open: Dorr T, Haller S, Muller MF, Friedl A, Vuichard D, Kahlert CR, Kohler P. Risk of
SARS-CoV-2 Acquisition in Health Care Workers According to Cumulative Patient Exposure and
Preferred Mask Type. JAMA Netw Open. 2022 Aug 1;5(8):e2226816. doi:
10.1001/jamanetworkopen.2022.26816. PMID: 35969403. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795150
JAMA Netw Open: Ghoshal S, Rigney G, Cheng D, Brumit R, Gee MS, Hodin RA, Lillemoe KD,
Levine WC, Succi MD. Institutional Surgical Response and Associated Volume Trends
Throughout the COVID-19 Pandemic and Postvaccination Recovery Period. JAMA Netw Open.
2022 Aug 1;5(8):e2227443. doi: 10.1001/jamanetworkopen.2022.27443. PMID: 35980636. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2 795296
JAMA Netw Open: Joung SY, Ebinger JE, Sun N, Liu Y, Wu M, Tang AB, Prostko JC, Frias EC,
Stewart JL, Sobhani K, Cheng S. Awareness of SARS-CoV-2 Omicron Variant Infection Among
Adults With Recent COVID-19 Seropositivity. JAMA Netw Open. 2022 Aug 1;5(8):e2227241. doi:
10.1001/jamanetworkopen.2022.27241. PMID: 35976645. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795246
JAMA Netw Open: Kim J, Choe YJ, Lee H, Choi EH, Jang EJ, Kim RK, Park YJ. Long-term
Effectiveness Associated With the BNT162b2 Vaccine Against SARS-CoV-2 Infection Among
Adolescents in South Korea. JAMA Netw Open. 2022 Aug 1;5(8):e2227205. doi:
10.1001/jamanetworkopen.2022.27205. PMID: 35976652. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795253
JAMA Netw Open: Molina RL, Tsai TC, Dai D, Soto M, Rosenthal N, Orav EJ, Figueroa JF.
Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic. JAMA
Netw Open. 2022 Aug 1;5(8):e2226531. doi: 10.1001/jamanetworkopen.2022.26531. PMID:
35960517. Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795158
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JAMA Netw Open: Mupanomunda M, Fakih MG, Miller C, Ottenbacher A, Winegar AL, Roberts
P, Kimathi M, Gianopoulos JG, Cahill AG, Cacchione JG, Fogel RI, Aloia TA, Masoudi FA.
Comparison of Severe Maternal Morbidities Associated With Delivery During Periods of
Circulation of Specific SARS-CoV-2 Variants. JAMA Netw Open. 2022 Aug 1;5(8):e2226436. doi:
10.1001/jamanetworkopen.2022.26436. PMID: 35960519. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795160
JAMA Netw Open: Portal-Celhay C, Forleo-Neto E, Eagan W, Musser BJ, Davis JD, Turner KC,
Norton T, Hooper AT, Hamilton JD, Pan C, Mahmood A, Baum A, Kyratsous CA, Kim Y, Parrino J,
Kampman W, Roque-Guerrero L, Stoici R, Fatakia A, Soo Y, Geba GP, Kowal B, DiCioccio AT,
Stahl N, Lipsich L, Braunstein N, Herman GA, Yancopoulos GD, Weinreich DM; COVID-19 Phase 2
Dose-Ranging Study Team. Virologic Efficacy of Casirivimab and Imdevimab COVID-19 Antibody
Combination in Outpatients With SARS-CoV-2 Infection: A Phase 2 Dose-Ranging Randomized
Clinical Trial. JAMA Netw Open. 2022 Aug 1;5(8):e2225411. doi:
10.1001/jamanetworkopen.2022.25411. PMID: 35969402. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795149
JAMA Netw Open: Tan CS, Collier AY, Yu J, Liu J, Chandrashekar A, McMahan K, Jacob-Dolan C,
He X, Roy V, Hauser BM, Munt JE, Mallory ML, Mattocks M, Powers JM, Meganck RM, Rowe M,
Hemond R, Bondzie EA, Jaegle KH, Baric RS, Schmidt AG, Alter G, Le Gars M, Sadoff J, Barouch
DH. Durability of Heterologous and Homologous COVID-19 Vaccine Boosts. JAMA Netw Open.
2022 Aug 1;5(8):e2226335. doi: 10.1001/jamanetworkopen.2022.26335. PMID: 35947380. Link:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794985
JAMA Netw Open: Tartof SY, Malden DE, Liu IA, Sy LS, Lewin BJ, Williams JTB, Hambidge SJ,
Alpern JD, Daley MF, Nelson JC, McClure D, Zerbo O, Henninger ML, Fuller C, Weintraub E,
Saydah S, Qian L. Health Care Utilization in the 6 Months Following SARS-CoV-2 Infection. JAMA
Netw Open. 2022 Aug 1;5(8):e2225657. doi: 10.1001/jamanetworkopen.2022.25657. PMID:
35960522. Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795163
JAMA Ophthalmol: Turner K, Nguyen OT, Alishahi Tabriz A, Islam JY, Hong YR. COVID-19
Vaccination Rates Among US Adults With Vision or Hearing Disabilities. JAMA Ophthalmol. 2022
Aug 11. doi: 10.1001/jamaophthalmol.2022.3041. Epub ahead of print. PMID: 35951319. Link:
https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2795317
Lancet: Florentino PTV, Millington T, Cerqueira-Silva T, Robertson C, de Araujo Oliveira V, Junior
JBS, Alves FJO, Penna GO, Vital Katikireddi S, Boaventura VS, Werneck GL, Pearce N, McCowan
C, Sullivan C, Agrawal U, Grange Z, Ritchie LD, Simpson CR, Sheikh A, Barreto ML, Rudan |,
Barral-Netto M, Paixao ES. Vaccine effectiveness of two-dose BNT162b2 against symptomatic
and severe COVID-19 among adolescents in Brazil and Scotland over time: a test-negative case-
control study. Lancet Infect Dis. 2022 Aug 8:51473-3099(22)00451-0. doi: 10.1016/S1473-
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3099(22)00451-0. Epub ahead of print. PMID: 35952702; PMCID: PMC9359673. Link:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00451-0/fulltext
Lancet: Seang S, Burrel S, Todesco E, Leducq V, Monsel G, Le Pluart D, Cordevant C, Pourcher V,
Palich R. Evidence of human-to-dog transmission of monkeypox virus. Lancet. 2022 Aug
10:S0140-6736(22)01487-8. doi: 10.1016/S0140-6736(22)01487-8. Epub ahead of print. PMID:
35963267. Link: https://www.thelancet.com/journals/lancet/article/PIISO140-6736(22)01487-
8/fulltext
Lancet: Tarin-Vicente EJ, Alemany A, Agud-Dios M, et al. Clinical presentation and virological
assessment of confirmed human monkeypox virus cases in Spain: a prospective observational
cohort study. Lancet. 2022 Aug 8:S0140-6736(22)01436-2. doi: 10.1016/S0140-6736(22)01436-
2. Epub ahead of print. PMID: 35952705.Link:
https://www.thelancet.com/journals/lancet/article/PIISO140-6736(22)01436-2/fulltext
Lancet Infect Dis: Sadarangani M, Soe P, Shulha HP, Valiquette L, Vanderkooi OG, Kellner JD,
Muller MP, Top KA, Isenor JE, McGeer A, Irvine M, De Serres G, Marty K, Bettinger JA; Canadian
Immunization Research Network. Safety of COVID-19 vaccines in pregnancy: a Canadian
National Vaccine Safety (CANVAS) network cohort study. Lancet Infect Dis. 2022 Aug 11:51473-
3099(22)00426-1. doi: 10.1016/S1473-3099(22)00426-1. Epub ahead of print. PMID: 35964614.
Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00426-1/fulltext
Lancet Psychiatry: Taquet M, Sillett R, Zhu L, et al. Neurological and psychiatric risk trajectories
after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including
1 284 437 patients. Lancet Psychiatry. Published: August 17, 2022 DOI:
https://doi.org/10.1016/S2215-0366(22)00260-7 Link:
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext
MMWR: Hause AM, Baggs J, Marquez P, et al. Safety Monitoring of Pfizer-BioNTech COVID-19
Vaccine Booster Doses Among Children Aged 5-11 Years — United States, May 17—July 31,
2022. MMWR Morb Mortal Wkly Rep 2022;71:1047—-1051. DOI:
http://dx.doi.org/10.15585/mmwr.mm7133a3 Link:
https://www.cdc.gov/mmwr/volumes/71/wr/mm7133a3.htm
MMWR: Link-Gelles R, Lutterloh E, Schnabel Ruppert P, et al. Public Health Response to a Case
of Paralytic Poliomyelitis in an Unvaccinated Person and Detection of Poliovirus in Wastewater
— New York, June-August 2022. MMWR Morb Mortal Wkly Rep. ePub: 16 August 2022. DOI:
http://dx.doi.org/10.15585/mmwr.mm7133ez2 Link:
https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e2.htm
MMWR: Massetti GM, Jackson BR, Brooks JT, et al. Summary of Guidance for Minimizing the
Impact of COVID-19 on Individual Persons, Communities, and Health Care Systems — United
States, August 2022. MMWR Morb Mortal Wkly Rep. ePub: 11 August 2022. DOI:
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http://dx.doi.org/10.15585/mmwr.mm7133e!1 Link:
https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e1.htm
MMWR: O'Shea J, Filardo TD, Morris SB, Weiser J, Petersen B, Brooks JT. Interim Guidance for
Prevention and Treatment of Monkeypox in Persons with HIV Infection — United States, August
2022. MMWR Morb Mortal Wkly Rep 2022;71:1023-1028. DOI:
http://dx.doi.org/10.15585/mmwr.mm7132e4 Link:
https://www.cdc.gov/mmwr/volumes/71/wr/mm7132e4.htm
MMWR: Philpott D, Hughes CM, Alroy KA, et al. Epidemiologic and Clinical Characteristics of
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Potter JL, Ingram LA, Kelly D, Lu X, Ayers-Millsap S, Willeford WG, Rassaei N, Bhatnagar J,
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News in Brief
ABC: ABC News. Mary Kekatos. CDC sends team to New York to investigate polio case (08
August 2022). Link: https:
case/story?id=88095468
ABC: ABC News. Arielle Mitropoulos. Monkeypox vaccine not ‘a silver bullet,’ WHO says, as
breakthrough cases emerge (17 August 2022). Link:
https://abcnews.go.com/Health/monkeypox-vaccine-silver-bullet-breakthrough-cases-
emerge/story?id=88510794
AP: Associated Press. Lauran Neergaard and Shelby Lum. Major test of first possible Lyme
vaccine in 20 years begins (08 August 2022). Link: https://apnews.com/article/science-health-
ticks-73fab8e29f3e2243c2db5bc33b3265e1
Atlantic: The Atlantic. Hank Balfour and William Hoffman. It's Not Just Long COVID (12 August
2022). Link: https://www.theatlantic.com/ideas/archive/2022/08/long-covid-monovirus-
ebv/671080/
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
Bloomberg: Bloomberg News. Christian Wienberg and Madison Muller. Monkeypox Vaccine
Maker Seeks Partners in Race to Meet Demand (17 August 2022). Link:
certain-it-can-meet-demand
CBS: CBS News. Sophie Reardon. New York Health Department says hundreds of people may be
infected with polio virus (05 August 2022). Link: https://www.cbsnews.com/news/polio-virus-
hundreds-of-infections-possible-new-york-health-department/
CIDRAP: Center for Infectious Disease Research and Policy. Lisa Schnirring. CDC unveils
streamlined COVID-19 guidance (11 August 2022). Link: https://www.cidrap.umn.edu/news-
perspective/2022/08/cdc-unveils-streamlined-covid-19-guidance
CIDRAP: Center for Infectious Disease Research and Policy. Stephanie Soucheray. Fractional
monkeypox vaccine dosing comes under scrutiny (11 August 2022). Link:
dosing-comes-under-scrutiny
FDA: US Food & Drug Administration. FDA Authorizes Emergency Use of JYNNEOS Vaccine to
Increase Vaccine Supply (09 August 2022) Link: https://www.fda.gov/news-events/press-
announcements/monkeypox-update-fda-authorizes-emergency-use-jynneos-vaccine-increase-
vaccine-supply
Medpage: Medpage Today. Amanda D'Ambrosio. States vs Masks; Lyme Vax Trial Begins;
Weapons Stockpile in Hospital Closet (09 August 2022). Link:
https://www.medpagetoday.com/infectiousdisease/covid19/100126
Nature: Nature. Ewen Callaway. COVID rebound is surprisingly common — even without
Paxlovid (11 August 2022). Link: https://www.nature.com/articles/d41586-022-02121-z
Nature: Nature. Shannon Hall. Should parents delay kids' second COVID vaccine? Here's what the
research says (16 August 2022). Link: https://www.nature.com/articles/d41586-022-02159-z
Nature: Nature. Heidi Ledford. Long-COVID treatments: why the world is still waiting (09 August
2022). Link: https://www.nature.com/articles/d41586-022-02140-w
Nature: Nature. Smriti Mallapaty. Tens of thousands of people exposed to bat coronaviruses
each year (09 August 2022). Link: https://www.nature.com/articles/d41586-022-02153-5
Nature: Nature. McKenzie Prillaman. How much virus does a person with COVID exhale? New
research has answers (17 August 2022). Link: https://www.nature.com/articles/d41586-022-
02202-z
NPR: National Public Radio. Max Barnhart. How many animal species have caught COVID? First
global tracker has (partial) answers (05 August 2022). Link:
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Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
https://www.npr.org/sections/goatsandsoda/2022/08/05/111435 7154/how-many-animal-
species-have-caught-covid-first-global-tracker-has-partial-answe
NPR: National Public Radio. Rhitu Chatterjee. A 'staggering' number of people couldn't get care
during the pandemic, poll finds (08 August 2022). Link: https://www.npr.org/sections/health-
shots/2022/08/08/1116264151/poll-1-in-5-seriously-ill-black-americans-had-a-hard-time-
getting-medical-care
NPR: National Public Radio. Wynne Davis. A rapidly spreading E. coli outbreak in Michigan and
Ohio is raising health alarms (18 August 2022). Link:
https://www.npr.org/2022/08/18/1118141019/e-coli-outbreak-michigan-ohio
NPR: National Public Radio. Mark Kreidler. COVID sewage surveillance labs join the hunt for
monkeypox (08 August 2022). Link: https://www.npr.org/sections/health-
shots/2022/08/08/1115455190/covid-sewage-surveillance-labs-join-the-hunt-for-monkeypox
NPR: National Public Radio. Rob Stein. What's behind the FDA's controversial strategy for
evaluating new COVID boosters (18 August 2022). Link: https://www.npr.org/sections/health-
shots/2022/08/18/1117778748/whats-behind-the-fdas-controversial-strategy-for-evaluating-
new-covid-boosters
Reuters: Reuters. Zimbabwe blames measles surge on sect gatherings after 80 children die (15
August 2022). Link: https://www.reuters.com/business/healthcare-pharmaceuticals/zimbabwe-
blames-measles-surge-sect-gatherings-after-80-children-die-2022-08-14
Reuters: Reuters. Emma Farge and Jennifer Rigby. WHO vows nothing 'ridiculous' as public
submits ideas to rename monkeypox (16 August 2022). Link:
public-submits-ideas-rename-monkeypox-2022-08-16/
STAT: STATnews. Helen Branswell. Wastewater monitoring identifies polioviruses in New York
City (12 August 2022). Link: https://www.statnews.com/2022/08/12/polio-virus-new-york-city/
STAT: STATnews. Helen Branswell. In an effort to address its missteps during Covid, CDC plans
an 'ambitious' agency overhaul (17 August 2022). Link:
https://www.statnews.com/2022/08/17/cdc-ambitious-overhaul-covid-missteps
STAT: STATnews. Elizabeth Cooney. Risk of 'brain fog' and other conditions persists up to two
years after Covid infection (17 August 2022). Link: https://www.statnews.com/2022/08/17/risk-
of-brain-fog-and-other-conditions-persists-up-to-two-years-after-covid-infection
STAT: STATnews. Robert B. Darnell. PCR testing can help clarify confusion over Covid-19
rebound and isolation (10 August 2022). Link: https://www.statnews.com/2022/08/10/pcr-
testing-help-clarify-confusion-covid-19-rebound-and-isolation
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STAT: STATnews. Andrew Joseph. A complicated fall vaccine campaign: Updated Covid
boosters, flu shots, and how to time the jabs (16 August 2022). Link:
https://www.statnews.com/2022/08/16/a-complicated-fall-vaccine-campaign-updated-covid-
boosters-flu-shots-and-how-to-time-the-jabs/
STAT: STATnews. Usha Lee McFarling, Katherine Gilyard, and Akila Muthukumar. New data from
several states show racial disparities in monkeypox infections (11 August 2022). Link:
https://www.statnews.com/2022/08/11/new-data-from-several-states-show-racial-disparities-
in-monkeypox-infections/
STAT: STATnews. Megan Molteni. What scientists know — and don't know — about how
monkeypox spreads (10 August 2022). Link: https://www.statnews.com/2022/08/10/what-
scientists-know-and-dont-know-about-how-monkeypox-spreads/
WHO: World Health Organization. Monkeypox: experts give virus variants new names (12
August 2022). Link: https:
virus-variants-new-names
WHO: World Health Organization. Leptospirosis - United Republic of Tanzania (12 August 2022).
Link: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON403
Wired: Wired. Grace Browne. The Chaotic Monkeypox Vaccine Pipeline Is Leaving Everyone
Short (08 August 2022). Link: https://www.wired.com/story/monkeypox-vaccine-supply-chain
WP: Washington Post. Amy Cheng. New Langya virus that may have spilled over from animals
infects dozens (10 August 2022). Link:
https://www.washingtonpost.com/health/2022/08/10/langya-virus-china-shrews-henipavirus
WP: Washington Post. Mark Johnson. World ignored monkeypox threats, including signs of
sexual transmission (12 August 2022). Link:
https://www.washingtonpost.com/health/2022/08/12/monkeypox-virus-origins-nigeria-sexual-
transmission/
WP: Washington Post. Katie Shepherd and Frances Stead Sellers. Abortion bans complicate
access to drugs for cancer, arthritis, even ulcers (08 August 2022). Link:
https://www.washingtonpost.com/health/2022/08/08/abortion-bans-methotrexate-
mifepristone-rheumatoid-arthritis/
WP: Washington Post. Lena H. Sun and Joel Achenbach. When you have covid, here's how you
know you are no longer contagious (updated 11 August 2022). Link:
https://www.washingtonpost.com/health/2022/08/01/covid-contagious-period-isolation
WP: Washington Post. Lena H. Sun and Dan Diamond. CDC, under fire, lays out plan to become
more nimble and accountable (17 August 2022). Link:
https://www.washingtonpost.com/health/2022/08/17/walensky-revamp-cdc-culture-covid
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