Hot Topics in Infection Prevention and Control: Beginning 2023

It is the week after several major holidays, and so many people took off work and/or were traveling. More and more, though, we have heard accounts of people traveling, and within a day or two, feeling run down and testing positive for COVID-19. In perhaps the first “real” holiday season in this post-pandemic (can we call it that?) world, what else can we expect with so much travel, so little masking, and a general disinterest in anything infection prevention because it reminds the public of COVID-19.

But infection prevention never ceases, so here are some hot topics as we begin 2023.

COVID-19

Cases in the United States may be plateauing, with the last 2 weeks showing a 5% increase in cases, which was less than the week before. Test positivity within the US is 13%, and hospitalizations are up 9%. For the most part, it seems that cases are stable and holding, which is a good sign. The worry, though, is that with holidays like Christmas and New Year’s Day, travel, and all the time in between, these numbers will steeply rise.

Last winter, during the Omicron surge, the peak was in January. Globally, the week before Christmas 2022, “the WHO received reports of more than 3.7 million cases, similar to the week before. However, regional patterns reflect a mixed picture in the lead-up to the Christmas holidays. Cases were up 18% in the Americas compared to the previous week, with cases up 8% in the Western Pacific region. For deaths, more than 10,400 were reported to the WHO last week, with levels decreasing or stable in all world regions, except for the Western Pacific.”

Clostridioides difficile in Pediatric Patients

A recent article was published regarding predictors of hospital-onset Clostridioides difficile infections in children with antibiotic-associated diarrhea. Given this influenza season and the numbers of Respiratory syncytial virus (RSV), it’s a good time to brush up on antibiotic use and what may give us a leg up on C difficile precautions. In the “retrospective case-control study included patients aged [more than or equal to] 2-18 years with AAD who underwent C difficile polymerase chain reaction testing [more than] 3 days after hospital admission. Patients with hospital-onset [C difficile infections (CDI)] were selected as cases and matched with the control patients without CDI. Independent predictors for CDI identified and combined into the prediction score included abdominal pain (adjusted odds ratio [95% confidence interval]: 7.940 [3.254-19.374]), hospitalization for [more than or equal to] 14 days before the onset of diarrhea, antibiotic use for [more than or equal to] 10 days before the onset of diarrhea, receipt of meropenem, and clindamycin.”

A Take on The Influenza Narrative

There’s been much debate around why this RSV and influenza season have been so severe – is it the new disregard for masks and mass travel or socializing after 3 years of a pandemic? The efficacy of masks and attention to infection prevention and control efforts that saved us from them for the past few years and now have been tossed aside, perhaps. Or is there an immunity debt? This last topic has increasingly come up, and yet it is becoming more controversial. This notion is that the lack of respiratory viruses spread in the previous few years due to pandemic mitigation means that people’s immune systems are at a bit of a disadvantage in fighting off those more common bugs. Seems legit right? Well, many individuals are now pushing back – an interesting debate, no?

Per CIDRAP, “Danuta Skowronski, MD, the epidemiology lead for influenza and emerging respiratory pathogens at the British Columbia Centre for Disease Control, said she's not yet convinced this year's flu season will be more deadly or lead to a greater number of hospitalizations than typical years. And as for immunity debt, Skowronski said she finds the idea unclear and ultimately unhelpful. ‘The piper must be paid at some point in nature; kids will get sick, and it has nothing to do with a more compromised immune system,’ Skowronski said. ‘It is the cohort effect, the accumulated residual cohort effect, especially [among] older children and teens, who have richer social networks.’ Skowronski explained that, with more potential hosts, unmasked and in social contact with each other, we should expect more cases of all respiratory illnesses. ‘Even without change in immunological status, an absolute increase in the number of hosts will mean there will be a greater number of severe cases,’ she said.”