The Texas Department of State Health Services (TDSHS) today reported 34 more measles cases in an outbreak centered in the South Plains area in the western part of the state, raising the total since late January to 124.

The newest cases include the first of the outbreak from Dallam and Martin counties, pushing the state's number of affected counties to nine. Most of the latest measles confirmations, however, are from Gaines County, where the outbreak began in the local Mennonite community.

Eighteen people have been hospitalized. Five patients were vaccinated, and the rest were either unvaccinated or have unknown immunization statuses.

Tracking exposures in San Marcos, San Antonio

Earlier this week, the TDSHS and local health officials said they are tracking exposures in San Marcos and San Antonio, after a patient from Gaines County who was later diagnosed as having measles visited the area, including two universities.

Also, the New Mexico Department of Health is investigating an outbreak in Lea County, which borders Gaines County, that has so far sickened nine people. 

Cambodia's health ministry today reported a fatal H5N1 avian flu infection in a 2-year-old boy, marking the country's second case of 2025.

The ministry posted a statement on its Facebook page, which was translated and posted by Avian Flu Diary, an infectious disease news blog. The boy, who died today after his family brought him to the hospital, was from Prey Veng province in the southeast. The National Institute for Public Health confirmed the H5N1 findings.

Contact with sick chickens

The boy's household had 15 chickens, some of which were sick. The child had slept and played near the chicken coop.

The boy's H5N1 infection is Cambodia’s 18th since early 2023, half of which were fatal. The most recent case involved a 28-year-old man from Kampong Cham province in central Cambodia. He died in January following exposure and after possibly consuming sick poultry. The report did not note the clade.

Some of Cambodia's recent human cases have been linked to a new reassortant that includes internal genes from the newer 2.3.4.4b clade. The older 2.3.2.1c clade still circulates in Cambodian poultry, with sporadic infection reported in people. 

In new findings regarding the recent detection of the D1.1 H5N1 avian flu genotype in Nevada dairy cattle, an international team of virologists today reported that the jump from birds to dairy cattle may have occurred in early December, more than a month before quarantines were placed on two affected farms following detection through the national milk testing stem. 

The investigators published an analysis of viruses from four D1.1 bovine cases from a Nevada herd on Virological, an online hub for prepublication data designed to assist with public health activities and research. The study has not yet been peer-reviewed.

The four cattle D1.1 genomes were shared by the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). The team said their analysis suggests all four came from a single herd, and they said more studies are needed to gauge the diversity of D1.1 in cattle.

Detection of the virus in Nevada cows supports the key role of the National Milk Testing Strategy, but quarantining all possibly-contributing herds when a milk silo tests positive could make it more effective, the team said. "Considering the currently widespread nature of H5N1 in the United States, frequent on-site testing, including of individual herds, may be necessary for timely and maximally effective control measures for bovine H5N1 outbreaks," they wrote.

USDA confirms detections in live markets in 2 states

In other H5N1 developments, APHIS today reported confirmations in poultry from live-bird markets in Pennsylvania and New Jersey. The detection from Pennsylvania is from Philadelphia County and the one from New Jersey is from Union County.

A study of primary care patients and providers in five European countries found that antibiotic prescriptions for common respiratory infections (RTI), even those caused by viruses, are often prolonged, European researchers reported today in JAC-Antimicrobial Resistance.

For the study, researchers examined data on consecutive patients presenting with RTI symptoms at general practices and out-of-hours services in France, Greece, Lithuania, Poland, and Spain during two winter periods (February to April 2022 and 2023). The data were from a before-and-after study conducted to enhance antibiotic prescribing in primary care settings. Clinicians in the study recorded patient age, gender, RTI diagnosis, type of antibiotic prescribed, and treatment duration.

Of the 11,270 RTI cases registered by 196 clinicians (133 in general practice and 63 in out-0f-hours services), antibiotics were prescribed in 3,835 cases (34.0%). The highest prescribing rates were observed for pneumonia (85.0%), acute otitis media (82.9%), acute exacerbations of chronic obstructive pulmonary disease (77.9%), acute rhinosinusitis (67.8%), and acute pharyngotonsillitis (63.7%). The prescribing rate ranged from 51.5% in Greece to 27.5% in Spain. 

The mean antibiotic course duration was 7.52 days. Antibiotic courses were significantly longer for pneumonia, COVID-19 infection, and pharyngotonsillitis (8.01, 8.00, and 7.74 days, respectively) and lowest for predominantly viral infections such as the common cold and flu infection, laryngitis, and acute bronchitis (6.32, 6.48, and 6.98 days, respectively). The mean duration was longest in Greece (8.54 days) and shortest in France (6.53 days). A total of 26.7% of the courses were prescribed for 10 days or longer. 

Unnecessary antibiotic exposure for self-limiting, mostly viral infections

The study authors note that while 8 days of antibiotics for pneumonia exceeds the 5-day regimen recommended by the latest guidelines, the bigger concern is that patients with self-limiting and predominantly viral RTIs received nearly 7 days of antibiotics.

"Not only are these extended courses unnecessary, but they also subject individuals to prolonged therapy, carrying potential deleterious effects," they wrote. "It is crucial to restrict antibiotic exposure, particularly for these self-limiting and predominantly viral RTIs, to mitigate AMR and minimize adverse effects."

A survey of US pediatric antimicrobial stewardship programs (ASPs) found that most have made progress in meeting Centers for Disease Control and Prevention (CDC) requirements since 2018, but many report insufficient resources and a lack of diversity in the workforce, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

In 2017, The Joint Commission and the Centers for Medicare and Medicaid Services required that US hospitals have an ASP. A survey of US children's hospitals conducted a year later showed that 94% had ASPs. To investigate changes in US pediatric ASPs since that survey, a team led by researchers from Boston Children's Hospital distributed a two-part survey to 82 US pediatric ASPs. 

Part I of the survey asked ASP leaders about hospital demographics, ASP funding, and program choices related to the CDC's 2019 Core Elements of Hospital Antibiotic Stewardship Programs. Part II asked ASP team members to anonymously self-identify race, ethnicity, gender identity, training, and duration of ASP experience. 

Most ASPs meet CDC core elements

Of the 62 ASPs that responded to the survey, 61 (98%) indicated they had a formal ASP, 55 (88%) identified themselves as multidisciplinary (ie, made up of pharmacists, physicians, and members from other disciplines), and 40 (65%) were co-led by an ASP physician and pharmacist. In addition, 60 (97%) reported having dedicated inpatient physician full-time equivalents (FTEs), and 57 (92%) reported having dedicated inpatient pharmacist FTEs. The median program age was 10 years.

Among all ASPs, 49 (79%) performed at least some preauthorization, 58 (94%) reported some use of audit and feedback, 59 (95%) had developed two or more evidence-based guidelines on antibiotic use, and 60 (97%) performed ASP activities in inpatient settings. However, only 31 ASPs (50%) engaged in outpatient stewardship, and only 11 (36%) had FTEs for any role in outpatient stewardship. And 35 programs (58%) reported inadequate financial resources for staffing from hospital leadership. 

Of the 125 ASP professionals who completed the second part of the survey, 71% self-reported as White, 15% as Asian, and 3% as Black.

The study authors say they hope the results will spur studies on how stewardship funding and activities relate to outcomes.

A systematic review of five studies concludes that, even after successful tuberculosis (TB) treatment, children and teens experience substantial respiratory impairment, with 40% to 65% having abnormal lung function and those younger than 10 years showing reduced height and weight and lower quality of life.

McGill University researchers in Canada led the review, published in eClinical Medicine. The team reviewed studies published from January 2004 to December 2024 involving children aged 0 to 19 years who completed TB treatment and had at least one related impairment or disability. 

After identifying 117 potential studies, only 5—all published in 2023 and 2024 in South Africa or The Gambia—met the inclusion criteria, because over 80% excluded children.

"Tuberculosis remains a significant global health challenge, affecting over 10 million people annually, including more than 1 million children under 15 years of age," the researchers wrote. "Tuberculosis-associated respiratory impairment and disability, also known as post-tuberculosis lung disease, results from the complex interplay of bacterial, host, and environmental factors." 

TB effects differ in adults, children

After TB treatment, children younger than 5 years had diminished respiratory capacity. Of those aged 5 to 10 years, about 40% had abnormal lung function post-treatment, rising to 65% in those older than 10. Disability was common, with 35% to 50% of all children experiencing respiratory symptoms (eg, wheezing, cough) and children younger than 10 years displaying reduced physical growth and lower quality of life.

Even after successful tuberculosis treatment, children and adolescents can experience respiratory impairments and disability that may reduce their quality of life, ability to participate in activities, and growth potential.

"Even after successful tuberculosis treatment, children and adolescents can experience respiratory impairments and disability that may reduce their quality of life, ability to participate in activities, and growth potential," they wrote. "The epidemiology and clinical manifestations of these impairments vary by age, reflecting distinct biological and behavioural differences."

The researchers call for future TB research involving children. "Given the differences in the spectrum of tuberculosis disease, lung development, and underlying comorbidity differences between children, adolescents, and adults, age-disaggregated data are essential to fully understand the long-term impact of tuberculosis on respiratory health throughout the life course," they concluded.