Neutralizing antibodies generally persist after 6 months in children who had been infected with 

, according to new late-breaking data presented at 

A longitudinal assessment of pediatric patients treated for COVID-19 at Seattle’s Children Hospital between April 2020 and January 2021 found that virus-neutralizing antibodies remained detectable in most children 24 weeks after infection.

Presented by Lauren E. Gentles, a graduate student at Fred Hutchinson Cancer Research Center, the findings complement the ongoing understanding of natural SARS-CoV-2 immunity history in children.

Gentles and colleagues sought to examine convalescent sera through 6 months following SARS-CoV-2 infection in children, to observe changes in neutralization potency and nucleocapsid (N) protein-binding. Their population included 32 children, 27 of whom had no underlying immunocompromised state, and 25 of such children who had symptomatic COVID-19.

Investigators observed 10 children with a greater than 2-fold decrease in neutralization titers between weeks 4 and 24; 12 had a decreased less than 2-fold; 5 had neutralization titers that increased more than 2-fold over time. Of these 27 children, only 1 did not have detectable SARS-CoV-2 neutralizing activity at 24 weeks.

 during IDWeek, Gentle discussed the team’s findings and their implication for pediatric SARS-CoV-2 antibody progression.

Videos

A new study from IDWeek showed most observed children previously infected with SARS-CoV-2 retained antibodies over 6 months.

Understanding Long-Term Pediatric SARS-CoV-2 Antibodies

 is not only a long sought-after measure of HIV control in the infectious disease community—it’s a now tangible opportunity that would alter both diagnostics and care.

 Raphael J. Landovitz, MD, MSc, of the UCLA Center for Clinical AIDS Research & Education, reviewed his own presentation on the current status and promising developments of long-acting PrEP.

Most notably, he reviewed injectable cabotegravir, for which new data from this year shows “high levels of protective efficacy…across populations” including cisgender men who have sex with men, transgender women, and cisgender women in sub-Saharan Africa.

Landovitz also discussed the observed “profound antiviral efficacy” observed with cabotegravir that suppresses viral replication and makes PrEP breakthrough infections more difficult to identify.

“I suspect that this isn’t going to be something that’s unique to long-acting cabotegravir and is really going to push the field diagnostically as we look forward to monthly oral islatravir, the islatravir implant, and subcutaneous lenacapavir,” Landovitz said.

An expert reviews cabotegravir, islatravir, lenacapavir, and what other promising agents that could redefine long-term HIV prevention.

Long-Acting Injectable PrEP for HIV Risk

The release of the Infectious Diseases Society of America’s 2017 guideline update for 

 treatment recommended the use of either vancomycin or fidaxomicin for first-line use therapy.

Although it is yet to be determined if this update 

 recurrence, these therapies will not always successfully treat the bacterium. And as such, clinicians are looking for other therapeutics to alleviate the pain and suffering of their patients.

Ferring Pharmaceuticals and Rebiotix, a Ferring Company, announced this week it was 

 on it investigational biotherapeutic, RBX2660. Some of the highlights from the studies included:

RBX2660 significantly increased gut bacteria associated with health and decreased gut bacteria associated with CDI pathology;

And analysis of phase 3 data showed bile acid compositions shifted significantly from primary to secondary bile acid predominance after treatment.

Teena Chopra, MD, MPH, professor of Medicine, Division of Infectious Disease, Wayne State University School of Medicine, has reviewed the data and sees RBX2660's promise as an emerging therapy for rCDI.

 spoke to Chopra who offered insights on the various studies and her clinical perspective on looking at this potential therapy in the treatment of 

A clinician provides an overview of the data on the microbiota-based live biotherapeutic, RBX2660, which in phase 3 studies has shown safety and reduction in recurrent C difficile infection (rCDI).

Ferring's Investigational Therapy RBX2660 Demonstrates Another Potential Offering for C Diff Treatment

Diagnostic stewardship is defined as the appropriate use of laboratory testing to guide patient management, including treatment, in order to optimize clinical outcomes and limit the spread of antimicrobial resistance.

In part, this collaboration allows for laboratory professionals and clinicians to work together to identify the right technologies to enable efficient diagnosis and begin the appropriate treatment for patients. The emergence of rapid testing diagnostics is a means to enable this stewardship.

Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, assistant professor of pharmacy practice at Loma Linda University School of Pharmacy, has been involved in research looking at ways to increase diagnostic stewardship and the importance associated in clinical care with this initiative. According to Abdul-Mutakabbir, behind diagnostic stewardship is understanding what are the most valuable diagnostics for individual medical centers and hospitals to have and also having key stakeholders serving as champions for this type of stewardship within these institutions to identify these diagnostics and aid in other aspects such as reading results and acting upon them. 

 spoke with Abdul-Mutakabbir about some of her diagnostic stewardship research, specific technologies associated with it, and her insights on some of her presentations that will appear at this year’s IDWeek.

1. Patel R, Fang FC. Diagnostic Stewardship: Opportunity for a Laboratory-Infectious Diseases Partnership. 

 2018 Aug 16;67(5):799-801. doi: 10.1093/cid/ciy077. PMID: 29547995; PMCID: PMC6093996.

This type of stewardship is a means of reducing unnecessary testing, getting the appropriate diagnosis more efficiently, and getting patients the appropriate therapy in a timely manner. 

Diagnostic Stewardship: Appropriate Testing Leads to Efficient Diagnosis, Timely Therapy 

A 3-day regimen of intravenous (IV) antiviral therapy remdesivir (Veklury) provided an 87% reduction in risk of hospitalization or death related to 

versus placebo after 28 days, according to new late-breaking data presented at 

Presented by study author Joshua A. Hill, MD, Assistant Professor at the Fred Hutchinson Cancer Research Center, University of Washington, the findings from the Gilead-funded phase 3, randomized, double-blind, placebo-controlled provided new insights into one of the earliest investigated therapies for severe COVID-19—and the first granted full Biologics License Application (BLA) approval by the US Food and Drug Administration (FDA) earlier this year.

Hill and colleagues sought to compare a 3-day regimen of remdesivir added to standard care to placebo plus standard care in non-hospitalized patients with COVID-19 deemed to be at high risk of the virus.

A total of 562 patients were randomized 1:1 to either IV remdesivir (n = 279; 200 mg on day 1, then 100 mg on days 2-3) or placebo (n = 283). Investigators sought a primary efficacy endpoint of composite COVID-19 hospitalization or all-cause mortality by day 28 and a primary safety endpoint of proportion of patients with treatment-emergent adverse events. The team controlled for baseline stratification factors when using Cox proportional hazards models to interpret comparative therapy efficacy.

The phase 3 trial was terminated early due to “administrative reasons in light of the evolving pandemic.”

A majority (52%) of patients were male; 44% were Hispanic/Latino and 30% were ≥60 years old. Common comorbidities in the high-risk patients with COVID-19 included diabetes (62%), obesity (56%), and hypertension (48%).

Remdesivir was associated with an 87% reduction in composite COVID-19 hospitalization or all-cause death versus placebo by day 28 (HR, 0.13; 95% CI, 0.03 – 0.59; 

 = .008). The antiviral was also associated with an 81% risk reduction for COVID-19 associated medically attended visits or all-cause death by day 28 versus placebo (HR, 0.19; 95% CI, 0.07 – 0.56; 

 = .002). Investigators observed no patient deaths in either treatment arm by day 28.

Treatment-emergent adverse events were similar across the treatment arms, with nausea (11%), headache (6%), and diarrhea (4%) occurring most frequently in patients treated with remdesivir.

 during IDWeek 2021, Hill discussed further details surrounding the findings, and how they impact the current clinical interpretation and utility of remdesivir versus COVID-19.

“We’ve seen variable results in the in-patient hospitalization remdesivir data, but really the key takeaways that I think we’ve seen emerge from data are earlier initiation with antiviral therapy is better and associated with better efficacy and outcomes, and that’s just expanded by this study,” Hill said. “Now we’re intervening the earliest—within 7 days of symptom onset and not yet hospitalized—and now we’re really seeing a strong effect.”

Hear the rest of Hill’s takeaways in the video above.

The study author of the late-breaking IDWeek findings discusses what the new data mean for using the antiviral to reduce COVID-19 burden.

Early 3-Day Remdesivir Regimen Reduces COVID-19 Hospitalization, Death by 87%

Since the first iteration of IDWeek’s COVID-19 Chasing the Sun program during last year’s annual meeting, key topics surrounding the pandemic have significantly evolved.

No subject may be more pertinent this year than that addressed by Cecilia Gounder, MD, ScM, in her presentation on COVID-19 reinfection and post-vaccination breakthrough infections. As the US struggles to contain the virus in post-vaccine rollout stages, many experts and worried members of the general public have returned to the definitions of vaccine efficacy: are we exercising their absolute benefit? Should we be expecting more from mRNA vaccines?

, Gounder, from the New York University School of Medicine, reviewed the progression of vaccines since last year to this current inflection point.

As she explained, mRNA vaccines from Pfizer-BioNTech and Moderna progressed from rapid and clinically successful development, to emergency authorization and tiered public rollout, then to early real-world evidence showing robust benefit in preventing symptomatic and/or severe COVID-19. That observation, Gounder noted, incentivized the lifting of masking guidance for fully-vaccinated people in May—though the decision was supported by only a couple month’s data.

“So if you think about it—if you reframe that finding in terms of what we know about immune response to vaccination and infection—we know that you have a spike in neutralizing antibodies very soon after infection or vaccination,” Gounder said. “Simultaneously, you’re developing a memory cell response. And as those antibodies wane over time, your immune response really becomes dependent on that memory cell response.”

When neutralizing antibodies wane, upfront infection protection is not as significant as that observed early after vaccination. It is “to be expected” that breakthrough infections—such as those beginning at scale greater in July—occur in vaccinated persons.

“Then, many of us began to wonder what this all means for vaccine effectiveness and the durability of vaccinated responses,” Gounder explained. “That has really led us to the debate we’re having today about boosters.”

An expert explains the science of vaccine- and infection-induced immunity, and how it informs the timeline of COVID-19 outbreaks this year.

COVID-19 Breakthrough Infections: How We Got Here

 has been a community-based medical care organization focusing on equitable, accessible health care, supportive services, and research and education for 50 years. Fenway focuses on LGBTQIA+ people, BIPOC individuals, and other underserved communities. The organization’s, Fenway Institute, is hosting its 7th annual 

Advancing Excellence in Transgender Health conference

 later this week. The virtual meeting is for both providers and members of the transgender community.

The conference is designed to train health care teams in providing responsive and confident gender-affirmative health care, grounded in research evidence and best clinical practices. Clinicians are not trained in medical school to understand the unique health challenges for transgender and gender-diverse patients as well as how to engage in dialogue in conversations about health with these patients, explained Alex Keuroghlian, MD, MPH, director of Education and Training Programs, The Fenway Institute.

“Gender-affirming care is not something that’s part of the standard curriculum typically for members of health care teams…it is not something we learn in our formative training,” Keuroghlian stated.

Keuroghlian has organized the educational program for the conference and says there is a robust schedule of sessions that will include a number of areas related to transgender and gender-diverse health as well as infectious disease-related topics including HIV and 

Sessions are led by expert faculty specialized in gender-diverse focused research and patient care. The featured keynote speaker is Rachel Levine, MD, Assistant Secretary for Health at the US Department of Health and Human Services. The preconference is on September 30, and the conference runs October 1 to October 3. For people who are interested in attending, they can register 

 spoke with Keuroghlian recently about the importance of the upcoming conference, understanding the unique challenges associated with medical care for the transgender community, and offers insights and resources for providers to consider accessing for conversations they may have with their transgender patients.

The Fenway Institute is hosting its upcoming Advancing Excellence in Transgender Health conference. The program will include education on transgender medical care as well as how clinicians and people within this community can interact and the former can understand the latter’s needs when it comes to preventative and acute care. 

Understanding the Medical Needs Associated With Transgender Health 

With the different modes of transmission and the variability in their incidence rates, infectious disease outbreaks can be difficult to manage once they appear. 

The introduction of COVID-19 reaffirmed how quickly an infectious disease can take hold and how dangerous a viral pathogen can be to a larger, global population.

Ebola, on the other hand, has had very bad regional outbreaks in various countries within Africa. And while its mode of transmission is different (through body fluids), the fear it could spread to other areas in the world remains intense due to the disease’s harmful effects and potential mortality. Ebola’s 

 according to the World Health Organization, but there is also great variability with rates ranging from 25% to 90% from past individual outbreaks. 

is a mysterious fungal infection and not much is fully known for why outbreaks appear. It remains highly contagious in health care settings and is often multidrug resistant. Similar to Ebola, the mortality rates for 

 vary greatly according to Jeffrey Rybak, PharmD, PhD, instructor, Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital.

Outside of a smattering of cases in Europe and the US, Ebola outbreaks have remained on the African continent. Conversely, 

 has had outbreaks in several continents occurring simultaneously, according to Rybak.

In the second installment of an interview with 

Rybak discusses outbreaks across different geographic locations including one where there was a high incidence rate of COVID-19, 

 mortality rates, and whether it has enough durability that will provide it with a sense of permanency and therefore remain a concern in public health for years to come.

The emergence of this fungal infection remains mysterious as the world experiences more outbreaks. 

Considering Candida Auris Outbreak Behavior

Welcome to our series, 1 Big Question, which asks 1 question to the medical community and we get their feedback on an important infectious disease topic.

In this episode, our 1 Big Question is: One of the more interesting treatment areas within C diff is fecal microbiota transplants. What is your take on this potentially being used as a therapy in patients with recurrent c diff?

We interviewed, Sahil Khanna, MBBS, MS, is a Professor of Medicine in the Division of Gastroenterology and Hepatology at Mayo Clinic, Glenn Tillotson, PhD, FIDSA, FCCP, GST Micro LLC, and Anurag Malani, MD, infectious diseases specialist, St. Joseph Hospital, and a fellow of Infectious Diseases Society of America (IDSA).

Check out our video to hear their insights.

With fecal microbiota transplants (FMT) becoming a potential emerging therapy for these patients, here are some aspects to consider when treating.

Clinical Considerations for FMT for Recurrent Clostridioides Difficile 

In early July, control of COVID-19 seemed to be trending in the right direction including vaccinations increasing, caseloads going down and a sense the pandemic might become somewhat under control.

Pfizer began advocating for booster doses in early July

, officials from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) told Pfizer officials that relevant data supporting a COVID-19 booster dose remained inconclusive.

By August, the Delta surge which had torn through the United Kingdom and India earlier in the year, was now in the United States and creating havoc as caseloads went up, including hospitalizations, increases in mortality, and the emergence of breakthrough infections. This very acute surge was perplexing to public health officials as well as the general public, especially to those who were vaccinated.

Addressing the Shifting Vaccination Policy

Just weeks before, the FDA and CDC did not see the utility of a booster dose. Then in August, the Biden Administration began publicly advocating for a booster dose months after the second dose of the vaccine. Initially, it was 8 months and then there were reports it has decreased to 6 months after the second dose.

And for those who are already vaccinated, booster doses will likely be available for some people this fall and winter including the immunosuppressed, people 65 years and older, and health care workers. Last week, the Vaccines and Related Biologic Products Advisory Committee (VRBPAC) decided 

 to vote on an Emergency Use Authorization (EUA) for a booster dose for people 65 years and older and those deemed high risk of COVID-19. That vote passed unanimously in favor of those two groups being eligible for the booster dose. In addition, they created a poll question during the meeting addressing health care workers (HCW) and that also passed unanimously in favor of HCWs being eligible for boosters. 

This shift in health care policy came largely from 

, which saw a COVID-19 surge of its own this year, leading to more hospitalizations and higher mortality rates. That country decided upon a booster strategy to bring down incidence rates. 

It is important to note, VRBPAC members at the September 17 meeting, discussed their reservations to recommending an approval for booster doses for the Pfizer-BioNTech COVID-19 vaccines for everyone 16 years and older, and a large part of their reasoning was due to the fact there was very limited data to demonstrate the need in the United States to give everyone a third dose.

In the background behind the Delta surge and the discussion on boosters, is the impending flu season. Last year it did not develop into a large concern due to all the restrictions related to COVID-19. The influenza season was the lowest it had been in years.

However, in 2021, with many restrictions lifted, people vaccinated, and life getting back to normal, there will be more person-to-person interactions and the possibility of more people getting influenza. With this possibility comes one of the concerns public health officials have had: “the twindemic.” This is a phenomenon where providers and the public are battling COVD-19 and influenza simultaneously.

As the southern hemisphere goes through their influenza season now, indications thus far show it has been a mild season there. 

 remains very low at < 10% positivity of tested specimens.

Still, with the unpredictability of this seasonal virus and the pandemic virus and taking into consideration the risk of these viruses individually or combined, getting vaccinated should be part of everyone's care plan.

Although decisions and guidance by public health agencies are evolving depending on the latest data released from studies, in the meantime, there are vaccination health care recommendations that can be followed now.

 spoke with William Schaffner, MD, medical director for the National Foundation for Infectious Diseases (NFID), professor of Preventive Medicine in the Department of Health Policy, and professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, who offered some guidance in terms of vaccinations, the potential of the twindemic, and the timing of booster and influenza vaccines.

With the Delta cases surging in recent weeks, and the upcoming flu season almost upon us, here is a glimpse of what providers and the public can expect when both viruses are circulating.