Morbidity and Mortality Weekly Report (MMWR)

Mortalité cardiovasculaire des 20-49 ans aux USA 🇺🇸 (CDC)... C-A GUSTAVE

▻https://threadreaderapp.com/thread/1693270068820344843

1/12
Je voudrais profiter du thread cité 🔽 pour clarifier un point qui est trop souvent caricaturé par les « rassuristes » ou les « sophistes du tout ou rien ».
Ci-dessous vous avez les données de mortalité cardiovasculaire des 20-49 ans aux USA 🇺🇸 (CDC)...

https://pbs.twimg.com/media/F35t_XfXgAA07u7.jpg

2/12
On peut dire ce qu’on veut à propos de la « bénignité » de la covid, les données épidémio sont têtues :
son émergence est associée à une nette cassure ↗️↗️ de cette mortalité chez des gens pourtant présentés comme « non vulnérables » dans les narratifs dominants...
3/12
Vous pouvez également voir que cette ↗️↗️ n’a rien à voir avec la vaccination, puisqu’elle apparaît AVANT, et ↘️ APRÉS, mais sans revenir au niveau pré-pandémique.
De plus, en prévision des commentaires habituels, je vous renvoie d’emblée à l’étude suivante...
4/12
Sur >4 MILLIONS de patients suivis sur 12 mois, tous NON-vaccinés, l’issue clinique la fortement ↗️ au décours d’une infection par SARS-CoV-2 est... la myocardite !...

▻https://twitter.com/IanCopeland5/status/1626576433920212992?s=20

5/12
Apparemment, l’info est peu connue, pourtant elle est documentée depuis début 2021.
Le CDC retrouvait un risque de myocardite 16x plus élevé chez les personnes avec un antécédent de covid, et très loin devant le sur-risque associé à la vaccination
Association Between COVID-19 and Myocarditis...
Viral infections are a common cause of myocarditis. Some studies have indicated an association between COVID-19 and myocarditis.
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm
6/12
Que disent les rassuristes/sophistes face à de tels threads ?
« ah le retour des histériques », « agitateurs de peurs », « covido-dingo », « ça y est on va tous mourir 🤪 »... et j’en passe.
La question n’est pas là du tout, et c’est justement là toute la tartuferie de leur propos
7/12
Reprenez ce graphe 🔽
Regardez l’écart entre le niveau pré-pandémique et la nouvelle médiane induite par la pandémie.
Cet écart c’est le « nouveau normal » qui va imposer des réajustement socio-économiques majeurs... Image
8/12
Cet écart, c’est une morbi-mortalité qu’on n’avait pas avant, et qui va perdurer désormais avec la persistence du virus et des cycles de réinfections.
Ce sont donc des dépenses de santé en plus, une charge supplémentaire sur le système de santé...
9/12
Ce sont également des difficultés individuelles supplémentaires (une myocardite virale peut finir en insuffisance cardiaque et donc en invalidité). Ce sont également bien plus d’arrêts maladies « nouveaux » par rapport à l’avant-pandémie...
10/12
Bref, et là ce n’est qu’un exemple parmi tous les équilibres épidémio-démographiques qui vont être réajustés par le « vivre avec » associé à l’abandon de toute mesure de prévention des infections.
Il ne s’agit pas de dire « on va tous mourir », c’est plus que ridicule...
11/12
Il s’agit simplement de vous rappeler que ce graphe vous montre que c’est facile de détourner le regard du danger, mais ça n’élimine pas le danger.
Son impact va imposer des réajustement socio-économiques, et c’est peu probable qu’ils vous plaisent.
12/12
Comme toujours, ce n’est pas de l’alarmisme, c’est juste un thread de plus pour nous remettre tous collectivement face à nos responsabilités.
Comme veut l’adage, on récolte ce qu’on sème.

Seroprevalence of infection-induced SARS-CoV2 antibodies
▻https://www.cdc.gov/mmwr/volumes/71/wr/mm7117e3.htm

https://www.cdc.gov/mmwr/volumes/71/wr/figures/mm7117e3-F.gif

As of February 2022, approximately 75% of children and adolescents had serologic evidence of previous infection with SARS-CoV-2, with approximately one third becoming newly seropositive since December 2021. The greatest increases in seroprevalence during September 2021–February 2022, occurred in the age groups with the lowest vaccination coverage; the proportion of the U.S. population fully vaccinated by April 2022 increased with age (5–11, 28%; 12–17, 59%; 18–49, 69%; 50–64, 80%; and ≥65 years, 90%). Lower seroprevalence among adults aged ≥65 years, who are at greater risk for severe illness from #COVID-19, might also be related to the increased use of additional precautions with increasing age.

Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection [11 fév. 2022]
▻https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm?s_cid=mm7106e1_w

https://www.cdc.gov/mmwr/volumes/71/wr/social-media/mm7106e1_MaskingEffectiveness_IMAGE_04Feb22_1200x675_1.jpg

These data from real-world settings reinforce the importance of consistently wearing face masks or respirators to reduce the risk of acquisition of SARS-CoV-2 infection among the general public in indoor community settings.

These findings are consistent with existing research demonstrating that face masks or respirators effectively filter viruses in laboratory settings and with ecological studies showing reductions in SARS-CoV-2 incidence associated with community-level masking requirements.

#covid-19 #masques #ffp2

Eric Billy résume la conclusion d’un rapport du CDC :
▻https://twitter.com/EricBillyFR/status/1481533184277979139

La vaccination anti-COVID réduit de 91% le risque de PIMS chez les 12-18 ans.

Le taux de décès chez les enfants touchés par un PIMS post infection est de 1%. il y en a déjà plusieurs centaines en France (plutôt chez 0-9 ans non vaccinés)

Le rapport du CDC :
▻https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e1.htm

Association Between K–12 School Mask Policies and School-Associated COVID-19 Outbreaks — Maricopa and Pima Counties, Arizona, July–August 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e1.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7039e1_MaskingvsOutbreaksK-12_IMAGE_24Sept21_Social_1200x627.jpg?_=01901

A school was considered to have a mask requirement if all persons, regardless of vaccination status, were required to wear a mask indoors in school. An early mask requirement was one that was in place when the school year began, and a late mask requirement was one that was implemented any time after school began.

[…]

[…] the odds of a school-associated #COVID-19 outbreak were 3.5 times higher in schools with no mask requirement than in those with a mask requirement implemented at the time school started.

#masques #écoles #enfants

Hospitalizations Associated with #COVID-19 Among Children and Adolescents — COVID-NET, 14 States, March 1, 2020–August 14, 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7036e2.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7036e2_HospitalizationsChildren_IMAGE_3Sept21_1200x627.jpg?_=18706

Comme chez l’adulte le #variant #delta est plus transmissible chez l’#enfant

What is added by this report?

Weekly COVID-19–associated hospitalization rates among children and adolescents rose nearly five-fold during late June–mid-August 2021, coinciding with increased circulation of the highly transmissible SARS-CoV-2 Delta variant. The proportions of hospitalized children and adolescents with severe disease were similar before and during the period of Delta predominance.

Par ailleurs comme chez l’adulte les adolescents vaccinés sont beaucoup moins souvent hospitalisés que les non-vaccinés

Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents.

#SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status — Los Angeles County, California, May 1–July 25, 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e5.htm

5 fois moins d’infection et 29 fois moins d’hospitalisation chez les vaccinés.

Concerne essentiellement le #variant #delta

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/21_322041-AC_MMWR-graphic_LA-investigators_Get-Vaccinated-FINAL1200x627-medium.jpg

Efforts to increase #COVID-19 #vaccination, in coordination with other prevention strategies, are critical to preventing COVID-19–related hospitalizations and deaths.

Reduced Risk of #Reinfection with #SARS-CoV-2 After #COVID-19 #Vaccination — Kentucky, May–June 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7032e1_ReinfectionVaccinationStatus_IMAGE_6Aug21_1200x627.jpg

Summary

What is already known about this topic?

Reinfection with human coronaviruses, including SARS-CoV-2, the virus that causes COVID-19, has been documented. Currently, limited evidence concerning the protection afforded by vaccination against reinfection with SARS-CoV-2 is available.

What is added by this report?

Among Kentucky residents infected with SARS-CoV-2 in 2020, vaccination status of those reinfected during May–June 2021 was compared with that of residents who were not reinfected. In this case-control study, being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated.

What are the implications for public health practice?

To reduce their likelihood for future infection, all eligible persons should be offered COVID-19 vaccine, even those with previous SARS-CoV-2 infection.

Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm

Among the 469 cases in Massachusetts residents, 346 (74%) occurred in persons who were fully vaccinated; of these, 301 (87%) were male, with a median age of 42 years. Vaccine products received by persons experiencing breakthrough infections were Pfizer-BioNTech (159; 46%), Moderna (131; 38%), and Janssen (56; 16%); among fully vaccinated persons in the Massachusetts general population, 56% had received Pfizer-BioNTech, 38% had received Moderna, and 7% had received Janssen vaccine products. Among persons with breakthrough infection, 274 (79%) reported signs or symptoms, with the most common being cough, headache, sore throat, myalgia, and fever. Among fully vaccinated symptomatic persons, the median interval from completion of ≥14 days after the final vaccine dose to symptom onset was 86 days (range = 6–178 days). Among persons with breakthrough infection, four (1.2%) were hospitalized, and no deaths were reported. Real-time RT-PCR Ct values in specimens from 127 fully vaccinated patients (median = 22.77) were similar to those among 84 patients who were unvaccinated, not fully vaccinated, or whose vaccination status was unknown (median = 21.54) (Figure 2).

Mask Use and #Ventilation Improvements to Reduce #COVID-19 Incidence in Elementary Schools — Georgia, November 16–December 11, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e1.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7021e1_MitigationGASchools_IMAGE_21May21_1200x627.jpg

COVID-19 incidence was 37% lower in schools that required teachers and staff members to use masks and 39% lower in schools that improved ventilation. Ventilation strategies associated with lower school incidence included dilution methods alone (35% lower incidence) or in combination with #filtration methods (48% lower incidence).

Par contre...
▻https://twitter.com/zeynep/status/1395764679918641152

“And once again, unlike the benefits associated with mitigations based on #aerosol dominance, masks and ventilation, the two costly mitigations in schools based on theories of droplet prominence, barriers and desk-spacing, were not associated with a real reduction of COVID risk.”

https://pbs.twimg.com/media/E16_1pQWEAYtzS4?format=jpg&name=large#.jpg

#aérosols #masques #enfants #écoles

Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against #COVID-19 Among Hospitalized Adults Aged ≥65 Years — United States, January–March 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7018e1.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7018e1_EffectivenessOlderAdults_IMAGE_28Apr21_1200x627.jpg

Évaluation de l’efficacité des #vaccins à ARN chez les sujets de 65 ans et plus.

In a multistate network of U.S. hospitals during January–March 2021, receipt of Pfizer-BioNTech or Moderna COVID-19 vaccines was 94% effective against COVID-19 hospitalization among fully vaccinated adults and 64% effective among partially vaccinated adults aged ≥65 years.

Mais, entre autres faiblesses de l’étude énumérées par les auteurs mêmes, les intervalles de confiance sont très larges.

Matériel et Méthode :

Case-patients were those who received one or more positive test results for SARS-CoV-2. Patients meeting eligibility criteria who received negative SARS-CoV-2 RT-PCR test results served as controls.

A standard approach to postmarketing VE [vaccine effectiveness ] evaluation involves the test-negative design in which vaccine performance is assessed by comparing the odds of antecedent vaccination among case-patients with acute laboratory-confirmed COVID-19 and control-patients without acute COVID-19 (6).

[The] final analysis includ[ed] 187 case-patients and 230 controls, [...] median age was 73 years for case-patients and controls.

COVID-19 Outbreak Associated with a SARS-CoV-2 R.1 Lineage Variant in a Skilled Nursing Facility After Vaccination Program — Kentucky, March 2021 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7017e2.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7017e2_KentuckySNFPostvaccination_IMAGE_21April21_1200x627.jpg

Pendant un cluster du à un #variant du #SARS-CoV-2 les résidents vaccinés (Pfizer) d’une maison de retraite ont été 3 fois moins infectés et quand ils l’ont été ont développé des formes moins graves, asymptomatiques le plus souvent.

Summary

What is already known about this topic?

#COVID-19 vaccines have demonstrated high efficacy in clinical trials. Limited data are available on effectiveness in skilled nursing facilities (SNFs) and against emerging variants.

What is added by this report?

In a COVID-19 outbreak at a Kentucky SNF involving a newly introduced variant to the region, unvaccinated residents and health care personnel (HCP) had 3.0 and 4.1 times the risk of infection as did vaccinated residents and HCP. Vaccine was 86.5% protective against symptomatic illness among residents and 87.1% protective among HCP.

What are the implications for public health practice?

#Vaccination of SNF residents and HCP is essential to reduce the risk for symptomatic COVID-19, as is continued focus on infection prevention and control practices.

#vaccins

Estimated SARS-CoV-2 Seroprevalence Among Persons Aged <18 Years — Mississippi, May–September 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7009a4.htm

Chez les moins de 18 ans le nombre de sujets séropositifs au #sars-cov2 est beaucoup plus important que celui des sujets PCR positif.

Summary

What is already known about the topic?

Serosurveys estimating prior SARS-CoV-2 infections in the United States have focused on adults; little is known about seroprevalence among young persons.

What is added by this report?

Serologic testing of residual blood specimens collected during May–September 2020, from 1,603 persons aged <18 years suggested that approximately 113,842 (16.3%) of 698,420 young persons in Mississippi might have been infected with SARS-CoV-2 by mid-September 2020, and only 8,993 confirmed and probable COVID-19 cases among young persons had been reported to the Mississippi State Department of Health by August 31.

What are the implications for public health practice?

Serosurveys including pediatric age groups help estimate cumulative disease incidence and frequency of undiagnosed cases of COVID-19 among young persons to guide prevention efforts.

#séroprévalence #prévalence #enfants

Suspected Recurrent #SARS-CoV-2 Infections Among Residents of a Skilled Nursing Facility During a Second COVID-19 Outbreak — Kentucky, July–November 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7008a3.htm

The finding that all five patients with recurrent #COVID-19 had either asymptomatic or mildly symptomatic courses during their first infections is noteworthy, suggesting the possibility that asymptomatic or mildly symptomatic initial infections do not produce a sufficiently robust immune response to prevent #reinfection.

#COVID-19 Outbreak Among Attendees of an Exercise Facility — Chicago, Illinois, August–September 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7009e2.htm

https://www.cdc.gov/mmwr/volumes/70/wr/social-media/mm7009e2_ExerciseFacilityChicago_IMAGE_24Feb21_1200x627.jpg

Assessment of Day-7 Postexposure Testing of Asymptomatic Contacts of #COVID-19 Patients to Evaluate Early Release from Quarantine — Vermont, May–November 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/70/wr/mm7001a3.htm

Seulement 3% des sujets contact ont eu un #PCR #sars-cov2 positif à J7,

1,26% des sujets #contact #asymptomatiques étaient positifs à J7

Aucun des négatifs à J7 ne s’est déclaré positif dans les 7 jours suivant.

977 (44.9%) of these contacts had a specimen collected for testing on day 7. Among these, 34 (3%) had test results that were positive, 940 (96%) had results that were negative, and three (<1%) had results that were indeterminate (Table). Among the 34 contacts who received a positive SARS-CoV-2 PCR test result on day 7 after exposure, 12 (35%) were asymptomatic. The remaining 22 contacts with positive test results were symptomatic at the time of testing; approximately one half had developed symptoms on days 4–7 after exposure. Among the 940 contacts who received negative test results on specimens collected on day 7 after exposure, 154 (16%) had a subsequent test within the next 7 days (i.e., days 8–14); among these, 152 (99%) had tests that remained negative, and two (1%) had results that were indeterminate.

Implications of Shortened Quarantine Among Household Contacts of Index Patients with Confirmed #SARS-CoV-2 Infection — Tennessee and Wisconsin, April–September 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm695152a1.htm

Au sein des foyers familiaux, 19% des cas secondaires (PCR positif) n’apparaissent que 7 jours après l’apparition des symptômes du cas (supposé) source.

Summary

What is already known about this topic?

After exposure to COVID-19, a 14-day quarantine period can prevent further spread but might be challenging to maintain.

What is added by this report?

Among persons exposed to COVID-19 in the household who were asymptomatic and had negative laboratory test results through 7 days after symptom onset in the index patient, 19% experienced symptoms or received positive test results in the following week.

What are the implications for public health practice?

A shorter quarantine after household exposure to COVID-19 might be easier to adhere to but poses some risk for onward transmission. Persons released from quarantine before 14 days should continue to avoid close contact and wear masks when around others until 14 days after their last exposure.

[...]

The findings in this report are subject to at least five limitations. First, the index patient’s illness onset date was used as a proxy for last exposure. This might not have been the actual date of last exposure, affecting calculations on timing of positive specimens and symptom onset. Second, chains of transmission are challenging to recreate with observational studies; however, the main findings were robust in several sensitivity analyses designed to account for possible misclassification of secondary infections. Third, household contacts were assumed to have acquired infection from the index patient; however, the possibility that some infections might have been introduced from the community cannot be excluded. Fourth, a highly sensitive assay was used to detect SARS-CoV-2 nucleic acids; in some settings, however, this type of testing might not be available or yield timely results. Finally, these findings might not be directly translatable to use of point-of-care assays, which yield more rapid results but with lower sensitivity.

Performance of an Antigen-Based Test for Asymptomatic and Symptomatic #SARS-CoV-2 Testing at Two University Campuses — Wisconsin, September–October 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm695152a3.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm695152a3_RapidAntigenTestResultsCOVID19_IMAGE_01Jan21_1200x627.jpg

Summary

What is already known about this topic?

Antigen tests for SARS-CoV-2 are inexpensive and can return results within 15 minutes, but test performance data in asymptomatic and symptomatic persons are limited.

What is added by this report?

Compared with real-time reverse transcription–polymerase chain reaction (RT-PCR) testing, the Sofia antigen test had a sensitivity of 80.0% and specificity of 98.9% among symptomatic persons; accuracy was lower (sensitivity 41.2% and specificity 98.4%) when used for screening of asymptomatic persons.

What are the implications for public health practice?

To account for reduced antigen test accuracy, confirmatory testing with a nucleic acid amplification test (e.g., RT-PCR) should be considered after negative antigen test results in symptomatic persons and positive antigen test results in asymptomatic persons.

Cependant,

Ct values for specimens with false-negative antigen results were significantly higher compared with antigen- and real-time RT-PCR-positive specimens (mean N1 Ct = 32.3 versus 23.7; p<0.01).

Decline in #SARS-CoV-2 Antibodies After Mild Infection Among Frontline Health Care Personnel in a Multistate Hospital Network — 12 States, April–August 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6947a2.htm

Deuxième dosage des anticorps 60 jours après la mise en evidence d’une séropositivité (▻https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470460) chez des sujets qui avaient développé une forme légère de la maladie.

Summary

What is already known about this topic?

Most persons develop virus-specific antibodies to SARS-CoV-2 after infection; however, the timeline of antibody decline over time is uncertain.

What is added by this report?

Among 156 frontline health care personnel who had positive SARS-CoV-2 antibody test results in spring 2020, 94% experienced a decline at repeat testing approximately 60 days later, and 28% seroreverted to below the threshold of positivity. Participants with higher initial antibody responses were more likely to have antibodies detected at the follow-up test than were those who had a lower initial antibody response.

What are the implications for public health practice?

SARS-CoV-2 antibodies decline over weeks following acute infection. Negative SARS-CoV-2 serologic results do not exclude previous infection , which has significant impacts on how serologic studies are interpreted.

[...]

... misclassification of antibody status was possible; however, this was considered to be unlikely because of the high sensitivity and specificity of the ELISA.

These antibody declines might not equate to loss of protective immunity or increased risk for #reinfection; this was not assessed in this study.

[...]

Whether decay in these antibodies increases risk for reinfection and disease remains unanswered.

#anticorps #immunité

Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate — Kansas, June 1–August 23, 2020 | MMWR
▻https://www.cdc.gov/mmwr/volumes/69/wr/mm6947e2.htm

https://www.cdc.gov/mmwr/volumes/69/wr/social-media/mm6947e2_KSMaskMandateCOVID19_IMAGE_20Nov20_1200x627.jpg

#masques