Reports detail pediatric eye injuries related to hand sanitizer

As the pandemic has made hand sanitizer ubiquitous, perhaps it was inevitable that clinicians would report sanitizer-related eye injuries in children. Two brief studies published yesterday in JAMA Ophthalmology look into this topic, with the first finding a sevenfold year-to-year increase in sanitizer/eye exposure in French children from April to August, and the second looking at two cases of toxic keratopathy (cornea injury).

Overall, less chemical eye splatter cases were reported to the French Poison Control Centers from April to August 2020 than in the same months the year prior (2,336 [2.2% of pediatric calls] vs 2,553 [4.2%]), according to the first study. Cases in which the affected child was exposed to hand sanitizer, however, rose from 1.3% to 9.9%. The frequency of these cases occurring in public locations also increased, both year-to-year (0 to 63) and from May to August 2020 (16.4% to 52.4%).

During the pandemic months, 16 children were admitted to eye hospitals for hand sanitizer exposure, compared with 1 child in 2019. Two of the 16 needed amniotic membrane transplants.

The other study catalogued the symptoms and treatments of two cases of toxic keratopathy after accidental eye exposure to hand sanitizer. One case was in a 4-year-old who tried to use a sanitizer dispenser from a shop’s floor stand; symptoms included lack of blood flow in the eye and a large epithelial defect.

The other case was in a 5-year-old who was experiencing a congested eye and surface cell death in the cornea. After treatment, which in both cases included moxifloxacin and carboxymethyl cellulose drops, the first injury resolved in 2 weeks and the second in 5 days.

“With the current widespread use of hand sanitizer in public places, it is not unexpected that young children would be drawn to these dispensers, many of which appear to be inadvertently designed to facilitate contact between the hand sanitizer and young eyes,” writes Kathryn Colby, MD, PhD, in a commentary on both studies. She recommends increased awareness and education, cautionary signage, and possible redesigns, such as the use of shorter hand sanitizer dispensers for children.
Jan 21 JAMA Ophthalmol French study
Jan 21 JAMA Ophthalmol case studies
Jan 21 JAMA Ophthalmol commentary

Phase 1 data show Bharat Biotech’s COVID vaccine safe, immunogenic

Phase 1 results from Bharat Biotech’s BBV152 COVID-19 vaccine shows it is safe and immune-producing, according to a study published in The Lancet Infectious Diseases yesterday. The adjuvanted vaccine is made with an inactivated whole virus and was stored between 35.6°F and 46.4°F, which could be an advantage over other vaccines that require very low storage temperatures.

Across 11 sites in India, 300 healthy 18- to 55-year-olds received two doses 2 weeks apart in July of 3 micrograms (µg) of the vaccine adjuvanted with receptor 7/8 agonist molecule adsorbed to alum (Algel-IMDG), 6 µg with Algel-IMDG, or 6 µg with Algel. An additional 75 received a control with Algel. Adjuvants boost the body’s immune response.

Solicited local and systemic adverse reactions were reported in 17.0%, 21.0%, 14.0%, and 13.3%, respectively. All were mild or moderate, and the most common adverse events reported in the intervention groups were injection site pain (5.0%), headache (3.7%), and fever (3.0%).

Seroconversions rates 2 weeks after the second dose were highest in the Algel-IMDG groups, with 87.9% seroconverting in the low-dose and 91.9% in the high-dose group. CD4+ and CD8+ T-cell responses were also found in a subgroup of 16 Algel-IMDG recipients. As for the Algal group, 82.8% seroconverted, and less than 0.5% CD4+ and CD8+ T-cell responses were found. 

“Despite these favourable phase 1 results, concerns linger regarding the potential for an inactivated whole-virus vaccine to elicit antibody-dependent enhancement of infection or vaccine-associated enhanced respiratory disease upon SARS-CoV-2 infection,” writes Christina A. Rostad, MD, and Evan J. Anderson, MD, in a Lancet commentary. “We will wait with cautious optimism on this vaccine candidate poised to bolster worldwide equitable access to COVID-19 prevention.”

Phase 2 results will focus on two doses of either 3 or 6 µg of the vaccine with Algel-IMDG.  The researchers noted that while they were on an accelerated timeline for phase 1 because of the pandemic’s severity, in phase 2, they will administer at least some doses on a 4-week schedule.
Jan 21 Lancet Infect Dis study
Jan 21 Lancet Infect Dis commentary

Five countries report more polio cases

Five countries reported more polio cases this week, all due to circulating vaccine-derived poliovirus type 2 (cVDPV2), according the latest weekly update from the Global Polio Eradication Initiative (GPEI).

In the Middle East, Afghanistan reported 15 cVDPV2 cases in seven provinces, with Hilmand reporting 5, which lifts the total for 2020 to 255.

In Africa, Burkina Faso reported 1 case in Dedougou, raising its total for the previous year to 56 from two different outbreaks. Chad reported 4 new cases in three regions: Mayo Kebbi Ouest, Mandoul, and Hadjer Lamis. The country now has 98 cases from three different outbreaks for 2020.

Elsewhere in Africa, Guinea reported 3 cases, 2 in Nzerekore and 1 in Conakry, bringing its total to 39. And Sudan reported 4 more illnesses from three different provinces: South Kordofan, North Kordofan, and North Darfur. The country now has 56 cases for its 2020 total.
Jan 21 GPEI update

H5N8 avian flu hits many French duck farms, expands in Europe’s wild birds

France’s duck farms in the foie gras production region in the southwest continue to be hit hard by highly pathogenic H5N8 avian flu outbreaks, with 123 more events reported, according to the latest notification from the World Organization for Animal Health (OIE).

The latest outbreaks began from Dec 28 to Jan 18, all involving farms, most of them producing ducks. The majority of the outbreaks struck farms in Landes department, but they were also reported in others in the same part of France, including Pyrenees-Atlantiques, Gers, and Hautes-Pyrenees.

Among all of the events, the virus killed 16,423 of 553,372 susceptible birds, and the survivors were culled to curb the spread of the virus.

In other avian flu developments, several European countries reported more H5N8 detections in wild birds, including the Czech Republic, Spain, Italy, Norway, and Germany, according to OIE reports. Also, Denmark reported H5N5 in wild birds, and Belgium and Romania reported H5 in wild birds.
Jan 22 OIE report on H5N8 in France
OIE outbreak page