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National Academies: Expand US The new OIG report found that during The effectiveness of hybrid immunity
Wastewater Disease Surveillance the first year of the pandemic, bimonthly against hospital admission or severe dis-
Continued development of and investment COVID-19 or likely COVID-19 diagnosis rates ease was 97% at 12 months compared with
in a national wastewater infectious disease among Medicare beneficiaries peaked at 75% after infection alone. Effectiveness
surveillance system could help improve pub- 75% or higher at 1358 nursing homes nation- against reinfection was 42% for hybrid
lic health responses to the ongoing COVID-19 wide. “For-profit nursing homes made up immunity and 25% for previous infection
pandemic and future infectious disease a disproportionate percentage of these at 12 months.
outbreaks, according to a report from the homes,” the report’s authors wrote. The re- The findings, published in The Lancet In-
National Academies of Sciences, Engineer- sult was mortality close to 20%, or about fectious Diseases, suggest that people with
ing, and Medicine. double that in facilities with lower diagno- hybrid immunity may not need COVID-19
Launched by the US Centers for Disease sis rates. vaccine booster doses as soon as people who
Control and Prevention in 2020, the Na- The report recommends examining and are vaccinated but have never been in-
tional Wastewater Surveillance System revising as necessary nurse staffing require- fected, the authors noted. “Producing esti-
detects SARS-CoV-2 infection biomarkers, ments; improving how surveys identify in- mates of protection for vaccines targeting
such as DNA or RNA, in municipal sewer sys- fection control risks; and providing more new variants will be crucial for COVID-19 vac-
tems. It can detect changing pathogen lev- oversight and technical assistance to homes cination policy and decision-making bod-
els and identify new variants, supplement- found to be at high infection risk. ies,” the authors wrote.
ing reporting from clinical laboratory tests, Published Online: February 1, 2023. Published Online: February 1, 2023.
which has declined as at-home testing has doi:10.1001/jama.2023.0740 doi:10.1001/jama.2023.0743
risen, according to the report.
The report recommends detailed steps Agent Slows Glioblastoma Tumors New Report on Mpox Cases
for developing a surveillance system that is in Mice by Blocking Fat Metabolism Leading Up to 2022 Global Outbreak
flexible, equitable, sustainable, integrated, An investigational drug slowed glioblas- From January 1, 2022, through January 27,
and actionable while addressing ethical and toma tumor growth in a mouse model, re- 2023, more than 85 000 confirmed hu-
privacy concerns. searchers reported in Science Translational man mpox (monkeypox) cases in 110 coun-
Published Online: February 1, 2023. Medicine. tries and 86 deaths were reported to the
doi:10.1001/jama.2023.0739 The agent, called YTX-7739, interferes World Health Organization.
with the ability of glioblastoma stem-like cells Leading up to the global outbreak, from
High COVID-19 Rates Prompt Call to convert saturated fatty acids to monoun- 2018 through 2021, human mpox cases were
for Better Nursing Home Protections saturated fatty acids, the authors noted. confirmed in 6 African countries, according
Better nursing home protections are needed Toxic saturated fats then accumulate, kill- to a Morbidity and Mortality Weekly Report
for future health emergencies, says a data ing cells and preventing tumor growth. (MMWR). More than 18 000 suspected
brief from the US Department of Health The experimental drug also may in- cases were reported in the Democratic
and Human Services Office of Inspector crease sensitivity to temozolomide chemo- Republic of the Congo.
General (OIG). therapy for some forms of glioblastoma, Eight cases were identified in 4 coun-
a difficult-to-treat cancer. In studies of mice tries outside Africa after travel from Nigeria
with a highly aggressive patient-derived in the years preceding the global outbreak.
glioblastoma, combining the 2 agents hin- In Nigeria, “clinicians noticed atypical pre-
dered tumor growth more and extended sur- sentation that included lesions first appear-
vival compared with either alone. ing on the genitals and the absence of a fe-
Published Online: February 1, 2023. brile prodrome,” the MMWR authors wrote.
doi:10.1001/jama.2023.0741 As of late 2022, the report noted, more
than 100 000 people had enrolled in educa-
Hybrid Immunity More Protective tionalcoursesaboutmpoxofferedbytheWHO
Than Prior SARS-CoV-2 Infection Alone for clinicians and public health providers.
A recent systematic review of studies found Published Online: February 1, 2023.
that people who have been vaccinated doi:10.1001/jama.2023.0744
against COVID-19 and have had a previous
SARS-CoV-2 infection, known as having hy- Nearly 500 000 in UK May Have
brid immunity, have better protection Missed Blood Pressure Drugs
against the Omicron variant than those with An estimated 491 000 fewer people
iStock.com/FG Trade
only a previous infection. than expected began antihypertensive

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 News & Analysis

medications in the UK between March more prevalent, and longer duration of

2020 and July 2021 during the COVID-19 vasopressor treatment than patients in the
pandemic. The decline, reported in Nature liberal fluid group. In the restricted fluid
Medicine, could result in more than 13 000 group, 109 patients, or 14%, died from any
additional cardiovascular disease events, cause before discharge home by day 90,
including nearly 2300 myocardial infarc- which was not significantly different from
tions and 3500 strokes, should these the 116 patient deaths, or 14.9%, in the lib-
patients remain untreated over their life- eral fluid group. Adverse event rates also
times, the authors predicted. were similar between the 2 groups.
On average, about 27 000 fewer pa- Published Online: February 1, 2023.
tients were prescribed antihypertensive doi:10.1001/jama.2023.0747
drugs and nearly 17 000 fewer were pre-
scribed lipid-lowering medications each Newly Discovered Host-Cell Factor
month compared with the same months in Could Be a COVID-19 Treatment Target
2019. The study examined 1.32 billion dei- The discovery of a molecular factor that
dentified records of medication dispensing helps many types of coronaviruses invade
collected in England, Scotland, and Wales be- iStock.com/bymuratdeniz host cells could lead to COVID-19 treat-
tween April 2018 and July 2021. ments that retain effectiveness as SAR-
Identifying and treating missed pa- group improved slightly more in a measure CoV-2 mutates, according to a study in
tients could reduce cardiovascular events, of knee function in sports and recreation at Proceedings of the National Academy
the authors wrote. the end of treatment and at 6 months, and of Sciences.
Published Online: February 1, 2023. in an overall quality-of-life measure at 12 The study found that an enzyme, phos-
doi:10.1001/jama.2023.0745 months. The findings appeared in the Annals phorylated C-terminal domain (CTD)–
of Internal Medicine. interacting factor 1 (PCIF1), helps the SARS-
Both High- and Low-Dose Exercise CoV-2 virus enter lung cells by stabilizing the
Published Online: February 1, 2023.
Therapy Help Knee Osteoarthritis doi:10.1001/jama.2023.0746 activity of spike enzymes that attach to an-
For patients with pain and decreased knee giotensin-converting enzyme 2 receptors on
function from osteoarthritis, high-dose ex- Vasopressors or High-Volume IV Fluids the host cell surface. “[O]nce SARS-CoV-2
ercise therapy is not superior to low-dose Both Effective for Sepsis has opened the door to a cell, PCIF1 helps
therapy for most outcomes, according to the Patients with sepsis-induced hypotension re- keep the door open,” the study’s senior au-
results of a randomized trial. suscitated in the first 24 hours with lower vol- thor Tariq Rana, PhD, of the UC San Diego
ConductedatsitesinSwedenandNorway, umes of intravenous fluid and greater vaso- School of Medicine, said in a news release.
the study involved 189 patients who re- pressor use were about as likely to survive as Unlike spike proteins targeted by most
ceived exercise therapy 3 times weekly for 12 patients treated with higher intravenous fluid current COVID-19 therapies, the PCIF1 cell–
weeks. The high-dose group did 11 exercises volumes prioritized over vasopressors. The host factor is preserved across SARS-CoV-2
for 70 to 90 minutes while the low-dose trial results, reported in the New England variants and even other coronaviruses. This
group did 5 exercises for 20 to 30 minutes. Journal of Medicine, contradicted the initial makes it a promising target for future thera-
In both groups, scores improved signifi- hypothesis that a restricted fluid strategy pies, the study authors said.
cantly on standardized measures of knee- would reduce mortality. − Howard Larkin
related pain, other symptoms, activities of In the 60-center superiority trial involv- Published Online: February 1, 2023.
daily living, and quality of life at the end of ing 1563 patients, the 782 patients in the doi:10.1001/jama.2023.0748
treatment and at 6 and 12 months after treat- restricted fluid group received a median Note: Source references are available through
ment. However, patients in the high-dose 2134 mL less intravenous fluid, and earlier, embedded hyperlinks in the article text online.

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