Saskia v. Popescu, PhD, MPH, MA, CIC

Syphilis Surge—Are We Neglecting Other Infectious Diseases?

During times of an outbreak and especially during a pandemic, all resources get thrown at responding to the issue. It’s natural though, to throw every resource—all but the kitchen sink—at an outbreak or emergent situation. The challenge then becomes, avoiding neglect of all the other health issues we’re facing. This isn’t the first time though, that we’ve seen other diseases surge as a result of all efforts focused on one and the impact to a health care and public health infrastructure. In response to the 2014-2016 Ebola virus outbreak in West Africa, there was a significant 

 services that exacerbated malaria, HIV/AIDS, and tuberculosis.

Now, as we near a year and a half of COVID-19, we’re starting to see impacts to 

. Syphilis is 1 that has been starting to rear its head. 2000 numbers left us with promise of near eradication, but since 2015, cases have risen by 74%. This trend though has been worrying public health officials more as congenital syphilis rates soared from 2012 to 2019.

In Fresno, congenital syphilis spiked 900% in 2018. Erica Pan, MD, MPH, 

It’s been a really long, hard year responding to this pandemic, but people have really acknowledged and realized the impact of divesting in public health infrastructure. I hope that a lot of the resources that we hope to bring to bear in the longer term after this pandemic will benefit STDs as well.” This serves as a critical reminder that in the midst of a pandemic, we need to be able to step back to see the full health care picture.

J&J Vaccine Pause Shouldn’t Instill Fear

This week was busy with the news of the single-dose Johnson & Johnson (J&J) vaccine and requested pause on distribution to investigate 6 blood clotting cases. Instantaneously, the news took off and began to instill fears about the safety of the vaccine. First, this recommended pause is an indicator of a vaccine safety system via the Food and Drug Administration(FDA) and the Centers for Disease Control and Prevention (CDC) is working. This surveillance and transparency are vital for vaccine safety and overall public trust in vaccination efforts. As virologist Angela Rasmussen, PhD, noted: “Approximately 1.5 million doses of the Johnson & Johnson vaccine have been administered to women under the age of 50, so if the risk is high only for that group, the incidence is around 1 in 250,000. Pregnancy, using hormonal contraceptives, and smoking all are associated with a much higher risk of this form of blood clotting than even crude estimates of the vaccine-related risk for clotting. The odds of having a blood clotting disorder as a result of having Covid-19 is much higher, affecting as many as 

. This means that if you received this vaccine and you are under 50, the odds are in your favor.”

The next Advisory Committee on Immunization Practices (ACIP) 

 to review data will be on Friday, April 23, which will be a likely deciding session for future recommendations and distribution. During this time though, it’s important to continue discuss vaccine safety, efficacy, and how the regulatory process is built around ensuring transparency and safety for individuals.

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The number of syphilis cases in 2000 raised hopes that it could be eradicated, but since 2015 cases have risen 74%. 

Hot Topics in Infection Prevention: Syphilis Surges, While J&J Vaccine on Pause

Things are a bit precarious right now with COVID-19 cases rising in some areas and a race to vaccinate as many as possible. Over 167 million doses have been administered, with 62 million people fully vaccinated within the United States. Of the total population, this accounts for 18.8%, which is a very exciting milestone. Many of the vaccine manufacturers are working to ramp up production as well as 

Effectiveness of mRNA COVID-19 Vaccines in Preventing Infection

One of the big questions we’ve had since the announcement of efficacious vaccines is—will this protect against infection as well as disease? While they are effective against severe disease and hospitalization, what about asymptomatic infection? This continued question is not easy to answer but one that we’re increasingly coming up against.

 (MMWR) assessed both the Pfizer and Moderna vaccines against SARS-CoV-2 infection in health care workers, first responders, and essential workers.

Coined the HERS-RECOVER study, this longitudinal cohort was across 8 locations in the United States that performed surveillance in vaccinated individuals for not only symptoms, but participants also “self-collected a midturbinate nasal swab weekly, regardless of COVID-19–associated illness symptom status and collected an additional nasal swab and saliva specimen at the onset of COVID-19–associated illness.” Investigators noted that “among 5077 participants, those with laboratory documentation of SARS-CoV-2 infection before enrollment starting in July 2020 (608) or identified as part of longitudinal surveillance up until the first day of vaccine administration (240) were excluded. Another 279 were excluded because of low participation (i.e., failed to complete surveillance for ≥20% of study weeks and did not contribute COVID-19–associated illness specimens). Overall, 3950 participants in the vaccine effectiveness analytic sample were analyzed.”

The participants included physicians, nurses, health care personnel, and 62% were female. 75% of the participants received at least one dose during the study period and overall, 5.2% were diagnosed with SARS-CoV-2 infection via RT-PCR.

“During the 116,657 person-days when participants were unvaccinated, 161 PCR-confirmed infections were identified (incidence rate = 1.38/1,000 person-days). During the 13 days after first-dose or second-dose vaccination when immune status was considered indeterminate (67,483 person-days), 33 PCR-confirmed infections were identified and excluded from the outcome. Two sources of partially immunized person-days were reported.”

After studying these frontline responders for 13 weeks across the 8 locations, these 3950 participants helped shed some important insight into protection against infection. Under these real-world conditions, those fully vaccinated had 90% protection against infection regardless of symptoms and even partial immunization yielded 80% protection against infection. More research will be needed, but this is a very promising beginning.

CDC SARS-CoV-2 Fomite Transmission Update

This week the Centers for Disease Control and Prevention (CDC) released a new scientific update on surface transmission and indoor community environments. The topic of “over cleaning” and “hygiene theater” has been used a lot in recent months as we learn more that fomite transmission is possible, but generally lower risk. From the infection prevention and epidemiologist perspective, it’s important to note that when dealing with a novel respiratory pathogen, we treat it like previous ones—fomite transmission is possible and more common in influenza, RSV, and was a concern during previous coronavirus outbreaks.

Hygiene theater and the focus on over cleaning did become an issue as people were bleaching groceries and quarantining mail, but the bigger concern is now how we communicate this. It’s still important to clean and disinfect and use hand hygiene. The CDC reiterates that “people can be infected with SARS-CoV-2 through contact with surfaces. However, based on available epidemiological data and studies of environmental transmission factors, surface transmission is not the main route by which SARS-CoV-2 spreads, and the risk is considered to be low. The principal mode by which people are infected with SARS-CoV-2 is through 

exposure to respiratory droplets carrying infectious virus

.” Cleaning and disinfection are still recommended within 24 hours after an infectious person has been present in an indoor community. The CDC also reiterated that source control (masking) is a great way to avoid contamination, just like hand hygiene and other efforts to avoid bioburden.

Those fully vaccinated had 90% protection against infection regardless of symptoms and even partial immunization yielded 80% protection against infection.

Hot Topics in Infection Prevention: Vaccines Block COVID-19 Infection

Some weeks are busier than others in the world of infection prevention and global health. The United States sits on a precarious position as we race to vaccinate as many as possible to combat the growing case counts and hospitalizations. It’s a worrisome sign when Rochelle Walensky, MD, the director of the Centers for Disease Control and Prevention (CDC), pleads with 

people to maintain vigilance in COVID-19 prevention efforts. More and more the goal of passing the finish line is used, but the truth is that we keep having to push back this line with our rush to reopen and return to “normal.” From a global health and infection prevention perspective, “normal” is what got us here—a state of poor preparedness, underfunded health departments, and neglected hospital preparedness for a pandemic. There are several things though, that we should keep a close eye on that will likely come in up infection prevention rounds.

 that their COVID-19 vaccine has shown preliminary efficacy and safety in children aged 12-15 years.While more data is being collected, analyzed, and many are calling for antibody results, this is an exciting bit of news. A timeline for distribution though could be prior to the next school year. The current Pfizer vaccine is already available for those aged 16 years and older, so this new insight would expand the vaccine eligibility and hopefully decrease transmission as older children appear to have more similar transmission dynamics as adults. Overall, this will be a welcome advancement in COVID-19 response, especially in the face of novel variants and an increasing need for school re-openings.

The World Health Organization (WHO) just released its 

 on possible origins of the virus that causes COVID-19. Within the report, there is a review of several hypotheses, with a strong emphasis on epidemiology, sample collection, and a need for further analysis. The topic of an origin and concerns around lab origins were discussed within the report, which has a strong epidemiological section. Not all were satisfied with the report though, as 

 by Kai Kuperschmidt—“Produced by an international team of scientists after a carefully negotiated visit to China, where COVID-19 was first recognized, the report concludes that the likeliest start of the pandemic was a bat coronavirus that infected another, unidentified animal and then moved on to humans. That’s long been the favored hypothesis of many virologists, but the team convened by the World Health Organization (WHO) reports little fresh evidence to support it, and members acknowledge several other scenarios, including an accidental release from a lab, remain possible. The report does, however, lay out plenty of next steps. ‘We still don’t know where the virus came from, but there’s a clear plan to continue investigating,’ says virologist Angela Rasmussen of Georgetown University, who was on the WHO team.”

While there is a bigger need for multi-lateral review and continued efforts, the truth is that the source of the pandemic does not change the poor response from so many countries, including the United States. Considering that the United States 

 over 61,240 cases yesterday (March 31) and reported 875 deaths, I think we can safely say that understanding the origin is critical, but not the most immediate concern we have. For infection prevention efforts, this is a welcome reminder that regardless of source, a virus could have pandemic potential and that continued readiness is critical.

From a global health and infection prevention perspective, “normal” is what got us here—a state of poor preparedness, underfunded health departments, and neglected hospital preparedness for a pandemic.

Hot Topics in Infection Prevention: Vaccine for Youngsters and WHO Report 

The past few weeks, despite being over a year into the coronavirus disease 2019 (COVID-19) pandemic, have seemed particularly exhausting. The promise of growing vaccination rates has been challenged by concerns for third surges in Europe and worry that we could see that in the United States as states rapidly reopen. Throughout much of the news, from concern for the 

 from the Ebola outbreak in Guinea, there were two stories that felt particularly impacting to the infection prevention world. The first was the big news last week that the Centers for Disease Control and Prevention (CDC) updated school guidance to reflect a smaller physical distancing requirement. The other is the increasing topic of vaccine passports and what they might mean moving forward.

. A new guidance for schools reopening for in-person lessons, recommended that students in elementary, middle, and high school, should be three feet apart. This is of course a change from the six-foot physical distancing rule and for middle school and high school students, is OK if community transmission is not at a high level. When adults (teachers and staff) are interacting with students, they need to maintain six feet.

These new recommendations though, emphasize that universal masking is occurring, as well as attention to cleaning/disinfection, ventilation, and hand hygiene among other things. The CDC emphasizes that this guidance was shared based on several studies that have shown schools can reduce the physical distancing aspect of school guidance with other intervention strategies in place as “evidence from several studies suggests that children and adolescents may be less commonly infected with SARS-CoV-2 than adults.” The 

 “although children can be infected with SARS-CoV-2, can get sick from COVID-19, and can spread the virus to others, less than 10% of COVID-19 cases in the United States have been among children and adolescents aged 5–17 years.” The heavy burden on schools to reopen with distancing has increasingly become an issue as it often prevents fully reopening full classrooms, which is complex topic and one that carries with it a lot of nuance. For infection preventionists (IPs) though, this update likely will drive questions around if we’ll be seeing similar guidance in adults or workplaces. It’s important to emphasize that this is specific to children due to epidemiological trends and a risk-matched approach with older children, but in all cases, all other interventions are required to be in place.

The second hot topic right now is in relation to 

. Also known as vaccine passes, certificates, or even “green passes.” Many countries are employing or considering them for not only travel and quarantine purposes, but there is also a potential some employers might travel vaccination status. While this isn’t new to health care workers, the larger conversations around use of vaccination status to drive larger policies is one that carries with it a lot of complexities and conversations. From equity to legal and even operational challenges, vaccine passports and what they mean require larger conversations. Currently, CDC guidance still requires those vaccinated individuals to continue following infection prevention measures, like masking, when at work. As we learn more about sterilizing immunity and the prevention of asymptomatic infection, these recommendations could change, but with the growing conversation around vaccine passports, it’s important we work with staff to discuss the importance of continued infection prevention efforts.

The heavy burden on schools to reopen with distancing has increasingly become an issue as it often prevents fully reopening full classrooms, which is complex topic and one that carries with it a lot of nuance.

Saskia v. Popescu, PhD, MPH, MA, CIC

Articles

Hot Topics in Infection Prevention: Syphilis Surges, While J&J Vaccine on Pause

Hot Topics in Infection Prevention: Vaccines Block COVID-19 Infection

Hot Topics in Infection Prevention: Vaccine for Youngsters and WHO Report

Hot Topics: School Distancing and Vaccination Passports