Surge of strep A infections, including more dangerous invasive type, has affected Denmark since late 2022, especially in the elderly
**Note: the release below is from the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023, Copenhagen, 15-18 April). Please credit the conference if you use this story**
During the 2022-2023 winter season Denmark experienced a surge in infections caused by group A streptococci (GAS), including the more dangerous, invasive types of infections (iGAS). Incidence of iGAS is highest among the elderly, but the largest relative increase from previous seasons was seen among children. The study is being presented to the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023, Copenhagen, 15-18 April), by Thor Bech Johannesen and Steen Hoffmann, Statens Serum Institut, Copenhagen, Denmark, and colleagues.
Following the implementation of lockdown measures to prevent spread of COVID-19 in March 2020, the number of invasive infections caused by GAS, including more dangerous invasive types (iGAS), decreased. However, during November 2022, an increasing number of these infections occurred in all regions of Denmark, with incidence rates reaching three times the pre-lockdown levels in January-March 2023. While there is no policy on mandatory reporting of GAS infection in Denmark, clinical microbiology laboratories nationwide submit isolates of iGAS to Statens Serum Institut (SSI) for further characterization on a voluntary basis.
Since 2018 approximately 90% of all iGAS cases in Denmark have been submitted to SSI for whole genome sequencing (WGS). For the period 2018 through March 2023, the authors extracted these WGS data and all records from the Danish Microbiology Database (MiBa) with culture-proven GAS and iGAS (invasive GAS being defined as GAS isolated from an anatomical region that should be sterile). Repeated specimens from the same patient of either GAS or iGAS within a 30-day-period were excluded. Potential date of death was collected from the Danish Civil Registration System.
Incidence of GAS as well as iGAS decreased notably following the restrictions in March 2020. The incidence of both remained at low levels until October 2022 and then dramatically increased in December 2022, peaking between January and March 2023 (Figure 1). The incidence of iGAS was highest in the age groups 65-84 years (4.0/100,000) and 85+ years (5.2/100,000) (Figure 2). Fatalities from iGAS in absolute numbers have also increased, but the case fatality rates for all age groups were similar to previous seasons (approximately 15% overall, and 30% in those aged 85 years and older – rates in children are low and vary due to low absolute numbers).
The strains ST28 emm1 (also known as M1) and ST36 emm12, which have both been virtually absent since April 2020, accounted for 53% and 28%, respectively, of iGAS infections in 2023. A new subvariant of M1 emerged in 2022 and has become the dominant subvariant in 2023, accounting for 30% of all iGAS cases (Figure 3). In addition to a distinct core genome, this variant is characterised by its acquisition of a bacteriophage carrying the virulence factor SpeC, a known key exotoxin. From initial analyses, the novel M1 subvariant does not appear to be significantly more virulent than other M1 variants circulating in Denmark, however, M1 variants in general are more likely to cause invasive disease, and iGAS patients infected with M1 variants are more often in need of intensive care. No significant difference was found in mortality rates for individual variants.
The authors conclude: “Since December 2022, the incidence of iGAS-cases in Denmark has been unusually high, partly driven by the emergence of a new M1 subvariant, which has been responsible for 30% of iGAS cases in 2023. Although a large proportion of the variants currently circulating in Denmark have a high capacity for virulence, we estimate that the current surge is largely due to extensive community spread, possibly combined with a low level of immunity in the general population following two years of extraordinarily low incidence rates.”
Thor Bech Johannesen, Statens Serum Institut, Copenhagen, Denmark. T) +45 51 53 85 02 E) email@example.com
Steen Hoffmann, Statens Serum Institut, Copenhagen, Denmark. E) firstname.lastname@example.org
Alternative contact Tony Kirby in the ECCMID Media Centre. T) +44 7834 385827 E) email@example.com
The authors declare no conflicts of interest.
This press release is based on abstract 6915 (Late breaker LB119) at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) annual meeting. The material has been peer reviewed by the congress selection committee. The research has been not yet been submitted to a medical journal for publication.
Note the data here updates the abstract so no abstract provided.
Article Publication Date
The authors declare no conflict of interest
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COVID-19's 'long tail' analyzed at European rheumatology congress – The Science Board
Studies on long-COVID patients with inflammatory rheumatic diseases (iRD) are scarce and largely inconclusive. Nor is it known whether correctly classifying patients with iRD as long-COVID cases is complicated by persistent symptoms that could be attributed to either disease.
The researchers sought to compare the risk of developing long COVID after Omicron infection in iRD patients enrolled in a prospective cohort study, with age- and sex-matched healthy controls.
As per World Health Organization (WHO) guidelines, long-COVID participants reported persistent symptoms lasting at least eight weeks, within three months of confirmed SARS-CoV-2 infection onset, unexplainable by alternative diagnoses.
Of the 1,974 iRD participating patients and 733 controls, 24% and 30% respectively had an Omicron infection. Questionnaires revealed that more iRD patients than controls fulfilled long COVID criteria — 21% versus 13%, respectively.
Post-hoc modeling showed that higher body mass index and severity in the acute infection phase were significantly associated with a higher risk of developing long COVID. Fatigue and loss of fitness were the most commonly reported long COVID symptoms in both groups; long-COVID recovery time was similar.
More iRD patients than controls with no history of COVID-19 reported symptoms also observed in long COVID, perhaps due to clinical manifestations of underlying rheumatic diseases.
Other researchers presented data from a prospective cohort study — called “COVID 19: A pandemic with a long tail” — that included immune-mediated inflammatory disease (IMID) patients on immunosuppressive therapies. They examined whether post-vaccination anti-spike antibody levels could predict breakthrough infection and COVID-19 outcomes.
A large cohort of 1,051 patients provided post-vaccination samples and responded to follow-up questionnaires after three vaccines. Immunosuppressive medication included tumor necrosis factor inhibitors, methotrexate, interleukin inhibitors, janus kinase inhibitors, and vedolizumab. Hospital records, the Norwegian Patient Registry, and the Norwegian Death Cause Registry provided additional information.
Results showed that while half the patients reported COVID-19, few had life-threatening illness. Patients with the highest post-vaccination anti-spike levels had a lower risk of COVID-19 infection, supporting the benefits of repeated vaccination in IMID patients on immunosuppressive therapies. Comorbidities or ulcerative colitis increased the risk of breakthrough infections.
Researchers concluded that low antibody levels do not greatly increase severe COVID-19 risks, and emphasized positive prognoses for vaccinated IMID patients with Omicron infections.
Other researchers have reported on the safety of COVID-19 vaccines during pregnancy and breastfeeding in women with autoimmune diseases. This international study sought to answer questions about COVID-19 vaccination uptake in people with autoimmune diseases.
Overall, 40 pregnant and 52 breastfeeding patients with autoimmune diseases were identified, with vaccination rates of 100% and 96.2%, respectively. Adverse events were reported more frequently by pregnant patients, but at rates similar to pregnant healthy controls. No differences were observed between breastfeeding patients and healthy controls.
Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients. Disease flares were managed with glucocorticoids; one in five women required initiation or changes in their immunosuppressive treatment.
Researchers hope that these indications of COVID-19 vaccination safety during the antenatal period in women with autoimmune disease will strengthen physician-patient communication and overcome vaccine hesitancy.
“The benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of adverse events and disease flares,” Dr. Laura Andreoli, University of Brescia rheumatology professor, said in a statement.
Copyright © 2023 scienceboard.net
COVID-19's shifting impact: the changing relationship between infections and severe outcomes – News-Medical.Net
A recent study published in the PLOS Biology Journal explored the dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalization (IHR) and fatality (IFR) ratios in England over 23 months.
Study: Dynamics of SARS-CoV-2 infection hospitalisation and infection fatality ratios over 23 months in England. Image Credit: AlexanderSteamaze/Shutterstock.com
SARS-CoV-2 has globally increased morbidity and mortality rates. England witnessed a massive surge in hospitalizations and deaths after SARS-CoV-2 Alpha emerged.
Consequently, a national lockdown was imposed in January 2021 to curb social contact, with the concurrent implementation of a mass vaccination program.
As a result, coronavirus disease 2019 (COVID-19) cases, hospitalizations, and deaths declined sharply in early 2021. Restrictions were gradually eased after March 2021, and the pandemic re-entered a growth phase with the emergence of the SARS-CoV-2 Delta in April 2021.
All domestic restrictions were removed in July 2021, with society reopening to an extent unseen since the start of the pandemic.
Restrictions were not since re-introduced at a large scale, even when the prevalence was high late in 2021 and during the Omicron waves.
Evaluating the trends between infection levels and hospitalization rates can help inform public health agencies and governments to implement proportionate and appropriate restrictions. When IHR and IFR are accurate, severe outcomes could be forecast over the short term.
The study and findings
In the present study, researchers explored the dynamics of SARS-CoV-2 IHR and IFR in England over 23 months. They used data from the real-time assessment of community transmission (REACT)-1 study that conducted 19 cycles of surveys from May 2020 to March 2022. Persons aged five or older were contacted for participation and sent a self-administered swab test.
Data on COVID-19 cases, hospitalizations, deaths, and vaccinations were accessed from an official government website. The time lag from swab positivity to the occurrence of severe outcomes declined throughout the study.
There was a time lag of 19 days to hospitalization and 26 days to death during REACT-1 cycles 1-7 (May 1 to December 3, 2020).
During cycles 14-19 (September 9, 2021, to March 31, 2022), time lags were shorter at seven days to hospitalization and 18 days to death. Contrastingly, time lags were extremely long during cycles 8-13 (December 30, 2020, to July 12, 2021) at 24 days to hospitalization and 40 days to death. The IHR and IFR were estimated to be 2.6% and 0.67%, respectively, during cycles 1-7.
IHR was 0.76%, and IFR was 0.09% during cycles 14-19. The IHR and IFR were far lower for participants aged 64 or younger than those aged 65 or above during cycles 1-7 and 14-19.
The team compared the average IFRs and IHRs over four-week intervals to a baseline period (May 1 to November 11, 2020).
The average IFR was 1.68 and 1.31 times greater than the baseline in late November 2020 and January 2021, when SARS-CoV-2 Alpha accounted for 15% and 86% of cases, respectively. The average IHR and IFR reduced to 0.51 and 0.25 of baseline in April 2021, when 47% of the population had received at least one vaccine dose.
The average IHR and IFR were 0.84 and 0.43 of baseline in June-July 2021, respectively, when the Delta variant accounted for 99% of infections and 50% of the population had been double vaccinated.
IHR and IFR showed a steady decline from September 2021 and were sharply reduced in December 2021, when the proportion of booster vaccine recipients increased.
The mean IHR was 0.62%, and the average IFR was 0.06% by March 2022, when the Omicron variant caused over 99% of cases. The time lag between swab positivity and daily case numbers varied throughout the study and was three days, -7 days, and one day during cycles 1-7, 8-13, and 14-19, respectively.
The case ascertainment rate, defined as the proportion of cases identified with a positive test through mass testing, was 36.1% overall and varied throughout the study.
It increased from around 20% in July 2020 to 30% during August-December 2020, with a sharp surge between May and July 2021 and a steep decline between December 2021 and March 2022.
The researchers illustrated the temporal relationship between community prevalence of SARS-CoV-2 infection and severe outcomes.
They estimated SARS-CoV-2 IHR, IFR, and case ascertainment rates by assessing the differences in the swab positivity estimates and the time lag of COVID-19 cases, hospitalizations, and deaths.
The findings revealed a decline in SARS-CoV-2 infection severity over time in England. Community-based studies like REACT-1 can provide unbiased temporal estimates of infection levels, allowing for rapid detection of IHR or IFR changes.
Appropriate interventions can be implemented with early warnings when they are highly effective.
5 Ways to Take a Break at Work (In Less Than 60 Seconds) – Outside
No one needs to tell you that work is a source of stress. But the workplace—and its unrelenting deadlines, meetings, politics, and frustrations—has become the leading stressor for Americans. According to a recent review of data, 83 percent of workers in the United States suffer from work-related stress. Among that group, 25 percent report that work is their number one complaint.
While work stress takes a toll in numerous ways in our everyday lives, perhaps the largest toll is on mental well-being. Recently Calm, the mental health brand, asked users what difficult moments prompted them to use the app. Facing challenges at work was the most common response.
Eradicating workplace stress obviously isn’t an option. That leaves everyone in need of different ways to handle that stress better. The answer may seem too obvious.
“Taking a mental health break can take you out of the monotony—or chaos—of your day and bring you back to the present, allowing you to re-enter your work day less stressed and more focused, increasing your productivity in a calm and sustainable way,” says Madeline Lucas, a New York-based therapist at Real, a mental health therapy platform.
Easier said than done. If you think you’re too busy to take a break, feel guilty slipping away during work hours, or don’t want your co-workers to think you’re unproductive, you’re not alone. Those are the top three reasons why workers don’t take a break during the day for their mental health, according to a Calm Business report.
But finding even 60 seconds to be present with yourself and your surroundings can help you feel more centered, says Jay Shetty, a life coach, host of the On Purpose podcast, best-selling author, and chief purpose officer at Calm.
When Do You Need to Take a Break at Work?
It may seem like you would know when you need to take a break. But that’s not necessarily the case. “Taking breaks at work is not intuitive,” Shetty says. “We haven’t been trained on when to take breaks or how to do them, so most people just skip them and take their stress into the next task or meeting.”
There are actually classic signs of needing to take a mental health break. Lucas explains, “Are you, for instance, having difficulty focusing or completing a task, becoming easily distracted by other thoughts or activities, or even noticing a dull numbness if you’ve been on your computer too long?”
You might also notice that you’re more irritated, annoyed, or resentful toward your coworkers and tasks than usual. Even feeling constantly fatigued can indicate you need to step away from the screen. Check in with yourself throughout the day—or even the hour.
5 Ways to Take a Break at Work (In Less Than 60 Seconds)
How long you take a break is up to you. The more time you can devote to your mental health, the better. Although any amount of time for a break is better than none. Even 60 seconds.
The duration of your break might also depend on your manager or your workplace. “No one will probably notice if you take one minute for a few deep breaths before a meeting,” Shetty says.
If, however, you intend to take a longer break, you might want to communicate your need for that.
The most important thing to remember is, as Shetty says, “a short break is better than no break.” Here are five to try.
1. Stretch Your Neck
Settle yourself comfortably in your chair, close your eyes or soften your gaze, and release your shoulders away from your ears. Lower your chin toward your chest and slowly roll your head from side to side. As you do this, breathe deeply. Repeat at least two to three times, Lucas says. Releasing tight muscles in your neck can activate the vagus nerve, which in turn kicks in your parasympathetic nervous system, which lessens physical and mental tension.
2. Practice the Three Ws
This refers to “walk, water, and window,” a practice that Shetty created. First, take a walk, which has stress-reducing benefits. Bonus points if you can be outside. But even just walking into another room or down the hallway can help, he says.
Next, drink some water. “Five cups of water per day lowers the risk of anxiety,” he says. This, by the way, comes from a recent study in the World Journal of Psychiatry.
The last one is looking into the distance through a window. Not only will you give your mind a well-needed break, you’ll also reduce eye strain, he says. Follow the 20-20-20 rule from the American Optometric Association: Every 20 minutes, take a 20-second break and look at something 20 feet away.
3. Slow Your Breathing
Turning your attention to your breath is one of the most time-tested and science-backed ways to give your body and mind a break. Slowing your breath causes your heart rate to lessen, your blood pressure to lower, and your mind to quiet. And it can start to take effect in just a few seconds. Although focusing on your breath won’t eradicate the source of your stress, it can modulate how you show up to it.
Inhale for a count of four and exhale for a count of four. Or as you breathe in, say “inhale” in your head, and say “exhale” as you breathe out. You could also use a specific mantra that matches your inhale and exhale. One option sometimes used in yoga is “so hum,” which means “I am that” in Sanskrit; say “so” to yourself as you inhale and “hum” as you exhale.
4. Tap it out
Using your fingertips, lightly tap across your chest, then down each arm and back up to your chest. Take long, slow breaths as you do so. “This can awaken your system and reground you in the present moment,” Lucas says.
How, exactly? “Tapping is another way you can activate the parasympathetic nervous system to signal messages of safety, calm and relaxation to the brain,” she says. Science supports this.
5. Give (and Receive) Some TLC
Although silly pet videos can soothe your nervous system by making you laugh, research indicates that the real deal is even more effective. Engaging with a cat or dog for 10 minutes can significantly lower levels of the stress hormone cortisol. Can’t take a break for that long? Finding one minute to play with your fur baby isn’t going to make you feel worse.
COVID-19's 'long tail' analyzed at European rheumatology congress – The Science Board
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