One more Ebola case reported in newest DRC outbreak

One more case has been reported in the latest outbreak in the Democratic Republic of the Congo (DRC), raising the total to 24, the World Health Organization (WHO) African regional office said today on Twitter.

No details about the patient were available, but the WHO said that, of the 24 cases reported as of Jun 23 in the Equateur province outbreak, 21 are confirmed and 3 are listed as probable. No new deaths were reported, keeping the total at 13.

In the larger outbreak centered in North Kivu and Ituri provinces, health officials added 7 earlier probable cases, raising the outbreak total to 3,470, with 2,268 deaths, according to a WHO situation report yesterday. The latest patients’ illness onset dates range from March 2019 to November 2019.

The outbreak, which has been under way for nearly 2 years, has almost passed two incubation periods with no new cases, and at a WHO media briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said the DRC government is expected to formally announce the end of the outbreak tomorrow.
Jun 24 WHO African regional office tweet
Jun 23 WHO Ebola situation report
WHO online Ebola dashboard


Gout drug colchicine shows promise in hospitalized COVID-19 patients

A study published today in JAMA Network Open has found that hospitalized COVID-19 patients who received the anti-inflammatory drug colchicine had a lower rate of clinical deterioration and required mechanical ventilation 2 days later than those who did not.

In the open-label, clinical trial, researchers randomly assigned 105 COVID-19 patients in 16 Greek hospitals to receive either colchicine or standard care alone from Apr 3 to 27. Colchicine was given as a 1.5-milligram (mg) loading dose followed by 0.5 mg after 60 minutes and then 0.5 mg twice daily.

Sixty-one of 105 patients (58.1%) were men, and median age was 64 years. Rates of time to maximum high-sensitivity troponin level (indicating heart injury), time until C-reactive protein more than tripled its upper reference limit (indicating inflammation), and time to clinical deterioration by 2 points on a 7-grade scale (indicating death or the need for mechanical ventilation) was 1.8% in the colchicine group (1 of 55 patients) and 14.0% in the standard care group (7/50 patients) (odds ratio, 0.11; 95% confidence interval [CI], 0.01 to 0.96; P = .02).

Mean event-free survival time was 20.7 days in the colchicine group, versus 18.6 days the in the control group. Adverse event rates were similar in the two groups, except for diarrhea, which was more common in the colchicine group than in the standard care group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003).

“In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration,” the authors wrote. “There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels.”

The researchers cautioned that factors other than those evaluated in the study could have influenced the results and that the trial was underpowered to detect differences in rare adverse events. Colchicine has been used primarily to treat gout, but some studies have shown a benefit in patients with cardiovascular disease, they noted.
Jun 24 JAMA Netw Open study


COVID-19 patients with cancer at higher risk of hospitalization, death

Among 423 COVID-19 patients at a New York City cancer center, 40% were hospitalized, 20% developed severe respiratory illness, 11% required high-flow oxygen, 9% required mechanical ventilation, and 12% died within 30 days, according to a research letter published today in Nature Medicine.

Researchers studied the characteristics of symptomatic COVID-19 patients at Memorial Sloan Kettering Cancer Center from Mar 10 to Apr 7 to weigh the competing safety interests of continuing cancer treatment and lowering exposure to the novel coronavirus. Risk factors for severe illness and hospitalization were age older than 65 years, receipt of immune checkpoint inhibitor (ICI) cancer drugs, non-white race, heart disease, high blood pressure, and chronic kidney disease. Chemotherapy, metastatic cancer, and major surgery did not appear to increase risk.

The case-fatality rate for patients needing intensive care was 35% (17 of 48 patients). All seven pediatric patients had only mild illness without complications.

Most patients were older than 60 years, and the most common malignancies included breast (86 patients [20%]), colorectal (37, 9%), and lung (35, 8%) cancer. The most common blood cancer was lymphoma (48, 11%), and 238 of 423 patients (56%) had metastatic solid tumors.

Of 423 patients infected with SARS-CoV-2, the virus that causes COVID-19, 248 (59%) had at least one underlying illness, including diabetes, high blood pressure, chronic kidney disease, and heart disease. Cough (82%) and fever (78%) were the most common symptoms, followed by shortness of breath (44%) and diarrhea (26%).

The link between ICIs and coronavirus outbreaks needs further study in tumor-specific groups, the authors said. “Until further evidence is available, it is prudent not to alter treatment decisions but to consider increased vigilance with SARS CoV-2 testing in patients initiating or continuing treatment with ICIs, irrespective of symptoms,” they wrote.
Jun 24 Nat Med research letter

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