Bulletin Today
A new study published in PLoS One suggests that the influenza vaccine may help safeguard individuals against COVID-19.
The retrospective cohort analysis found that patients with COVID-19 who had been vaccinated against influenza were less likely to visit an emergency department and be admitted to the ICU.
The researchers believe the findings indicate that influenza vaccine may reduce the risks of stroke, sepsis, and deep vein thrombosis (DVT) in patients with COVID-19.
Devinder Singh, MD, lead study author and professor of clinical surgery at the University of Miami Miller School of Medicine, and colleagues focused on patient records from the United States, the United Kingdom, Germany, Italy, Israel, and Singapore. The team screened electronic health records on the TriNetX research database of more than 70 million patients to identify 2 groups of 37,377 patients who were matched for factors that could influence their risk of susceptibility to severe COVID-19, such as gender; ethnicity; smoking; and chronic diseases like diabetes, obesity, and chronic obstructive pulmonary disease.
Members of the first study group received the influenza vaccine 2 weeks and 6 months prior to being diagnosed with COVID-19. Those in the second group also had a positive COVID-19 diagnosis, but were not vaccinated against influenza. The incidence of 15 adverse outcomes—including sepsis, stroke, DVT, and pulmonary embolism—was compared between the 2 groups within 30, 60, 90, and 120 days of testing positive for COVID-19.
Individuals who had not been vaccinated against influenza were up to 20% more likely to have been admitted to the ICU. In addition, they were up to 58% more likely to visit the emergency department, up to 45% more likely to develop sepsis, up to 58% more likely to have a stroke, and up to 40% more likely to develop DVT.
The researchers say the findings strongly indicate the influenza vaccine may prevent against several severe effects of COVID-19, and they urge people to receive their annual influenza vaccine in addition to COVID-19 vaccines.
Tocilizumab in short supply due to pandemic
Some individuals with rheumatoid arthritis (RA) are treated with a monthly infusion of the biologic tocilizumab (Actemra—Genentech). However, the drug is now in short supply because of the surge in COVID-19 cases.
In June 2021, FDA gave tocilizumab its emergency use authorization to treat hospitalized COVID-19 patients. This monoclonal antibody can help reduce inflammation by blocking a protein called IL-6, which causes RA-related damage. That same pathway plays a role in alleviating serious symptoms in people with severe COVID-19.
Genentech estimates that demand for the drug increased by more than 400% beyond pre-COVID-19 levels in just 2 weeks. When RA patients go without the medication, even for 1 month, they can experience debilitating flare-ups. Genentech said additional supplies of the drug should be available by fall, and a subcutaneous injectable form of tocilizumab that has not been authorized to treat COVID-19 is still available for RA patients.
Poll finds high trust in pharmacists, nurses, and doctors
A new poll shows that most Americans have high levels of trust in physicians, nurses, and pharmacists. The poll, from the University of Chicago Harris School of Public Policy and the Associated Press-NORC Center for Public Affairs Research, found that at least 7 in 10 Americans believe doctors, nurses, and pharmacists will do the right thing for them and their families most of the time.
The high levels of trust for these health care professionals included Democrats and Republicans; men and women; and white, Black, and Hispanic Americans.
“Public health officials should really look to doctors, nurses, and pharmacists to be the megaphone to deliver the message of the importance of getting vaccinated,” said Michelle Strollo, a senior vice president in NORC’s Health Research Group.
The survey, which was conducted in June 2021, involved more than 1,000 adults using a sample drawn from NORC’s probability-based AmeriSpeak Panel.
Patients on high doses of opioid analgesics risk overdose when tapering, study finds
A new study published in JAMA reveals that patients who take substantial amounts of opioid analgesics over the long term are at a greater risk of experiencing a mental health crisis or an overdose when they taper their dose.
The researchers examined a database of more than 113,000 patients prescribed higher doses of opioid analgesics between 2008 and 2019—an average of about 50 morphine milligram equivalents per day—for at least 1 year. They used this information to identify patients who tapered their dose, which researchers defined as reducing it by at least 15% over a 60-day period.
Researchers found that the group of patients who tapered their dose experienced a 68% increase in overdoses and twice the number of mental health crises compared with patients who stayed on their typical dose of medication.
Those risks were more pronounced among patients whose original doses were higher and who reduced their doses more quickly.
“Clinicians and patients must carefully weigh risks and benefits of both opioid continuation and tapering in decisions regarding ongoing opioid therapy,” the study authors write. “The risks associated with opioid tapering warrant further exploration to inform clinical guidelines regarding patient selection for tapering, optimal rates of dose reduction, and how best to monitor and support patients during periods of dose transition.”
Although these findings raise questions about potential harms of tapering, they noted that interpretation is limited by the observational study design.
What might this flu season have in store?
Influenza cases and deaths in the United States and worldwide dropped to unprecedented lows between October 3, 2020, and July 24, 2021, according to CDC data. In a typical season, 75 to 150 children die of influenza in the United States, noted pediatric infectious disease specialist Paul Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, in a recent JAMA article. Last influenza season, he said, 1 child was reported to have died.
Except for a few places, such as western Africa, influenza “was essentially nowhere” last season, said virologist Richard Webby, PhD, of St. Jude Children’s Research Hospital, in the same article.
Several what-ifs will determine the upcoming season’s magnitude: the COVID-19 pandemic’s severity this fall and winter, the extent to which SARS-CoV-2 mitigation measures continue to be used, and how well vaccines are matched to circulating influenza viruses.
The unexpected decline of influenza cases during the COVID-19 pandemic “certainly showed that many of the social-distancing things we were doing were very effective,” said Vanderbilt University School of Medicine infectious disease professor William Schaffner, MD. Schaffner also cited the halt of international travel and closing of schools, which kept children at home and away from each other.
Influenza vaccine manufacturers project they will deliver 188 million to 200 million doses in the United States for the upcoming influenza season. GlaxoSmithKline recently announced that it expects to distribute 50 million doses of its influenza vaccine in the United States, more than in any previous season.