News & Analysis
Medical News in Brief
National Academies: Expand US
Wastewater Disease Surveillance
Continued development of and investment
in a national wastewater infectious disease
surveillance system could help improve pub-
lic health responses to the ongoing COVID-19
pandemic and future infectious disease
outbreaks, according to a report from the
National Academies of Sciences, Engineer-
ing, and Medicine.
Launched by the US Centers for Disease
Control and Prevention in 2020, the Na-
tional Wastewater Surveillance System
detects SARS-CoV-2 infection biomarkers,
such as DNA or RNA, in municipal sewer sys-
tems. It can detect changing pathogen lev-
els and identify new variants, supplement-
ing reporting from clinical laboratory tests,
which has declined as at-home testing has
risen, according to the report.
The report recommends detailed steps
for developing a surveillance system that is
flexible, equitable, sustainable, integrated,
and actionable while addressing ethical and
privacy concerns.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0739
High COVID-19 Rates Prompt Call
for Better Nursing Home Protections
Better nursing home protections are needed
for future health emergencies, says a data
brief from the US Department of Health
and Human Services Office of Inspector
General (OIG).
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The new OIG report found that during
the first year of the pandemic, bimonthly
COVID-19 or likely COVID-19 diagnosis rates
among Medicare beneficiaries peaked at
75% or higher at 1358 nursing homes nation-
wide. “For-profit nursing homes made up
a disproportionate percentage of these
homes,” the report’s authors wrote. The re-
sult was mortality close to 20%, or about
double that in facilities with lower diagno-
sis rates.
The report recommends examining and
revising as necessary nurse staffing require-
ments; improving how surveys identify in-
fection control risks; and providing more
oversight and technical assistance to homes
found to be at high infection risk.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0740
Agent Slows Glioblastoma Tumors
in Mice by Blocking Fat Metabolism
An investigational drug slowed glioblas-
toma tumor growth in a mouse model, re-
searchers reported in Science Translational
Medicine.
The agent, called YTX-7739, interferes
with the ability of glioblastoma stem-like cells
to convert saturated fatty acids to monoun-
saturated fatty acids, the authors noted.
Toxic saturated fats then accumulate, kill-
ing cells and preventing tumor growth.
The experimental drug also may in-
crease sensitivity to temozolomide chemo-
therapy for some forms of glioblastoma,
a difficult-to-treat cancer. In studies of mice
with a highly aggressive patient-derived
glioblastoma, combining the 2 agents hin-
dered tumor growth more and extended sur-
vival compared with either alone.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0741
Hybrid Immunity More Protective
Than Prior SARS-CoV-2 Infection Alone
A recent systematic review of studies found
that people who have been vaccinated
against COVID-19 and have had a previous
SARS-CoV-2 infection, known as having hy-
brid immunity, have better protection
against the Omicron variant than those with
only a previous infection.
(Reprinted) JAMA February 21, 2023 Volume 329, Number 7
The effectiveness of hybrid immunity
against hospital admission or severe dis-
ease was 97% at 12 months compared with
75% after infection alone. Effectiveness
against reinfection was 42% for hybrid
immunity and 25% for previous infection
at 12 months.
The findings, published in The Lancet In-
fectious Diseases, suggest that people with
hybrid immunity may not need COVID-19
vaccine booster doses as soon as people who
are vaccinated but have never been in-
fected, the authors noted. “Producing esti-
mates of protection for vaccines targeting
new variants will be crucial for COVID-19 vac-
cination policy and decision-making bod-
ies,” the authors wrote.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0743
New Report on Mpox Cases
Leading Up to 2022 Global Outbreak
From January 1, 2022, through January 27,
2023, more than 85 000 confirmed hu-
man mpox (monkeypox) cases in 110 coun-
tries and 86 deaths were reported to the
World Health Organization.
Leading up to the global outbreak, from
2018 through 2021, human mpox cases were
confirmed in 6 African countries, according
to a Morbidity and Mortality Weekly Report
(MMWR). More than 18 000 suspected
cases were reported in the Democratic
Republic of the Congo.
Eight cases were identified in 4 coun-
tries outside Africa after travel from Nigeria
in the years preceding the global outbreak.
In Nigeria, “clinicians noticed atypical pre-
sentation that included lesions first appear-
ing on the genitals and the absence of a fe-
brile prodrome,” the MMWR authors wrote.
As of late 2022, the report noted, more
than 100 000 people had enrolled in educa-
tionalcoursesaboutmpoxofferedbytheWHO
for clinicians and public health providers.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0744
Nearly 500 000 in UK May Have
Missed Blood Pressure Drugs
An estimated 491 000 fewer people
than expected began antihypertensive
531
 News & Analysis
medications in the UK between March
2020 and July 2021 during the COVID-19
pandemic. The decline, reported in Nature
Medicine, could result in more than 13 000
additional cardiovascular disease events,
including nearly 2300 myocardial infarc-
tions and 3500 strokes, should these
patients remain untreated over their life-
times, the authors predicted.
On average, about 27 000 fewer pa-
tients were prescribed antihypertensive
drugs and nearly 17 000 fewer were pre-
scribed lipid-lowering medications each
month compared with the same months in
2019. The study examined 1.32 billion dei-
dentified records of medication dispensing
collected in England, Scotland, and Wales be-
tween April 2018 and July 2021.
Identifying and treating missed pa-
tients could reduce cardiovascular events,
the authors wrote.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0745
Both High- and Low-Dose Exercise
Therapy Help Knee Osteoarthritis
For patients with pain and decreased knee
function from osteoarthritis, high-dose ex-
ercise therapy is not superior to low-dose
therapy for most outcomes, according to the
results of a randomized trial.
ConductedatsitesinSwedenandNorway,
the study involved 189 patients who re-
ceived exercise therapy 3 times weekly for 12
weeks. The high-dose group did 11 exercises
for 70 to 90 minutes while the low-dose
group did 5 exercises for 20 to 30 minutes.
In both groups, scores improved signifi-
cantly on standardized measures of knee-
related pain, other symptoms, activities of
daily living, and quality of life at the end of
treatment and at 6 and 12 months after treat-
ment. However, patients in the high-dose
532 JAMA February 21, 2023 Volume 329, Number 7 (Reprinted)
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group improved slightly more in a measure
of knee function in sports and recreation at
the end of treatment and at 6 months, and
in an overall quality-of-life measure at 12
months. The findings appeared in the Annals
of Internal Medicine.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0746
Vasopressors or High-Volume IV Fluids
Both Effective for Sepsis
Patients with sepsis-induced hypotension re-
suscitated in the first 24 hours with lower vol-
umes of intravenous fluid and greater vaso-
pressor use were about as likely to survive as
patients treated with higher intravenous fluid
volumes prioritized over vasopressors. The
trial results, reported in the New England
Journal of Medicine, contradicted the initial
hypothesis that a restricted fluid strategy
would reduce mortality.
In the 60-center superiority trial involv-
ing 1563 patients, the 782 patients in the
restricted fluid group received a median
2134 mL less intravenous fluid, and earlier,
more prevalent, and longer duration of
vasopressor treatment than patients in the
liberal fluid group. In the restricted fluid
group, 109 patients, or 14%, died from any
cause before discharge home by day 90,
which was not significantly different from
the 116 patient deaths, or 14.9%, in the lib-
eral fluid group. Adverse event rates also
were similar between the 2 groups.
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0747
Newly Discovered Host-Cell Factor
Could Be a COVID-19 Treatment Target
The discovery of a molecular factor that
helps many types of coronaviruses invade
host cells could lead to COVID-19 treat-
ments that retain effectiveness as SAR-
CoV-2 mutates, according to a study in
Proceedings of the National Academy
of Sciences.
The study found that an enzyme, phos-
phorylated C-terminal domain (CTD)–
interacting factor 1 (PCIF1), helps the SARS-
CoV-2 virus enter lung cells by stabilizing the
activity of spike enzymes that attach to an-
giotensin-converting enzyme 2 receptors on
the host cell surface. “[O]nce SARS-CoV-2
has opened the door to a cell, PCIF1 helps
keep the door open,” the study’s senior au-
thor Tariq Rana, PhD, of the UC San Diego
School of Medicine, said in a news release.
Unlike spike proteins targeted by most
current COVID-19 therapies, the PCIF1 cell–
host factor is preserved across SARS-CoV-2
variants and even other coronaviruses. This
makes it a promising target for future thera-
pies, the study authors said.
− Howard Larkin
Published Online: February 1, 2023.
doi:10.1001/jama.2023.0748
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