News Scan for Apr 29, 2021

CDC: 2020 Sturgis Motorcycle Rally a COVID-19 super-spreader event

The August 2020 Sturgis Motorcycle Rally in South Dakota spread COVID-19 across the country, resulting in at least 649 infections—including transmission to household and workplace contacts—over the next 6 weeks, according to a study today in Clinical Infectious Diseases.

In the study, researchers from the Centers for Disease Control and Prevention (CDC) analyzed data and phone interview results from 39 state, county, and city health departments involving COVID-19 patients who had either traveled to Meade County in August 2020 or attended the rally from Aug 7 to 16.

The event attracted about 462,000 people from 61% of US counties, who participated in outdoor and indoor activities. No state, county, or city face covering requirements were in effect, the state had few business restrictions, and attendees were observed ignoring physical distancing recommendations.

While nine jurisdictions reported no coronavirus cases, 30 reported at least one rally-related COVID-19 infection during that period. A total of 463 primary lab-confirmed cases were reported within 2 weeks of the rally, and another 186 were identified among secondary or tertiary contacts in 17 jurisdictions.

From Aug 1 to Sept 15, the 14-day coronavirus testing volume in Meade County rose 199%, and the positivity rate climbed from 5% to 8%. Most patients (86%) had symptoms at testing or case investigation. Among the 463 primary COVID-19 patients, 3.7% were hospitalized and 1 died.

South Dakota and the bordering states of Minnesota, Montana, North Dakota, Nebraska, and Wyoming recorded 56% of all infections. Minnesota authorities traced rally-related infections to one third of the state’s counties.

Of the 463 patients with primary infections, 60% were men and 84% were White. Slightly more than half of infections were in people 40 to 59 years old, while 16% were in those 60 or older.

The authors noted that the number of cases—140 per 100,000 attendees—is likely an underestimate because rally goers with no symptoms or mild illness may not have sought testing or reported attending the event, and health department resources to identify and interview contacts may have been limited.
Apr
29 Clin Infect Dis study

 

Severe diabetes linked to worse COVID-19 outcomes

A study that included 17,687 people with diabetes and confirmed COVID-19 identified key diabetic risk factors that are linked to severe COVID-19 outcomes, including high blood glucose (blood sugar) levels and treatment with insulin. The study was published yesterday in Diabetologia.

The meta-analysis is based on 22 studies and was conducted by researchers at the German Diabetes Center (Deutsches Diabetes-Zentrum, or DDZ). As in the general population, increasing age and being male was associated with worse COVID-19 outcomes: Men with diabetes were 28% more likely to die from COVID-19 than diabetic women were, and people with diabetes aged over 65 with diabetes were more than three times more likely to die than younger patients were.

In five studies, patients currently using insulin were found to be 75% more likely to die from infections than their non-insulin–using peers were. High glucose levels at the time of hospital admission were associated with increased risk of death, but the findings came from only two studies. Patients with blood glucose levels greater than 11 millimoles per liter (mmol/L) at admission had an 8.6 times increased risk of death compared with those with glucose levels less than 6 mmol/L.

People who used metformin to control their diabetes, however, were 50% less likely to die from COVID-19 than those not using metformin. The authors suggest this may be because patients who use metformin to control blood sugar levels have less severe diabetes.

“These results will help to classify individuals with diabetes even better in order to improve their therapy and mitigate the course,” said senior author and DDZ Scientific Director Michael Roden, MD, in a news release from the center.
Apr 28 Diabetologia study
Apr 29 DDZ
press release

 

Study suggests link between prenatal, early antibiotics and eczema

A large cohort study conducted in Sweden suggests antibiotic use in prenatal and early postnatal life may be linked to increased risk of eczema (atopic dermatitis) in children, researchers reported today in JAMA Network Open.

In a nationwide, prospective cohort study, a team lead by researchers from Sweden’s Karolinska Institutet examined data on mother-child pairs from Sweden’s Medical Birth Register, looking at children born from Mar 1, 2006, through Dec 31, 2010, to determine whether maternal exposure to antibiotics during pregnancy and childhood exposure to antibiotics during the first year of life were associated with the risk of eczema, which causes skin inflammation. The hypothesis is that disturbances to the gut microbiome that may result from exposure to antibiotics utero and in early life could be among the environmental factors linked to the condition, but previous studies have produced inconsistent results.

Among the 722,767 children identified in the study, 153,407 were exposed to antibiotics in utero and 172,405 were exposed during the first year of life.

In a multivariable-adjusted analysis, antibiotic use at any time during pregnancy was associated with a 10% higher rate of eczema (adjusted hazard ratio [aHR], 1.10; 95% confidence interval [CI], 1.09 to 1.12). However, when the researchers further explored this association using sibling control participants to adjust for familial factors, no association between prenatal antibiotic exposure and atopic dermatitis was observed (aHR, 0.96; 95% CI, 0.92 to 1.00).

Multivariable-adjusted analysis showed that the use of antibiotics during the first year of life was associated with a 52% increased risk of eczema (aHR, 1.52; 95% CI, 1.50 to 1.55). The sibling-control analysis found a 24% increased risk (aHR, 1.24; 95% CI, 1.20 to 1.29).

In a commentary on the study, Ayman Grada, MD, of Boston University, and Christopher Bunick, MD, PhD, of Yale, write, “These collective findings strongly warrant additional investigation to explore the impact of antibiotics in [atopic dermatitis] and other inflammatory diseases. … It is important to avoid painting narrow-spectrum and broad-spectrum antibiotics with the same brush because narrow-spectrum and targeted antibiotics are among the main ways physicians will practice antibiotic stewardship in the future.”
Apr 29 JAMA Netw Open study
Apr 29 JAMA Netw Open commentary

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