The Centers for Disease Control and Prevention (CDC) yesterday issued its second malaria alert of the season, which includes new information about locally acquired infections, including one in Maryland that was caused by the mosquito-borne parasite linked to the most severe form of the disease.

Maryland's case, first reported on August 18 in a resident of the National Capital Region, involved Plasmodium falciparum, which can rapidly result in severe disease and death if not quickly diagnosed and treated. In contrast, the earlier locally acquired malaria cases in Florida and Texas involved Plasmodium vivax.

Florida has reported seven cases this summer, and Texas has reported just one case. No new cases for either state have been reported since the middle of July.

Raising awareness for clinicians

Given the rapid deterioration that can occur in people infected with P falciparum, the CDC urged clinicians to routinely consider malaria as a cause of fever in patients who have a history of international travel and in those with unexplained fever, regardless of travel history. It emphasized that malaria is a medical emergency and should be treated accordingly.

So far all of the US patients who had locally acquired infections were treated, with their conditions improving. Surveillance for additional cases in all three states, along with stepped-up mosquito control efforts, will continue.

For most Americans, the risk for locally malaria cases is low, but the threat is higher in areas where Anopheles mosquitoes survive over most of the year and in areas with larger numbers of people who travel internationally.

A new report from the European Centre for Disease Prevention and Control (ECDC) shows tuberculosis (TB) cases fell across the continent in 2021, but progress toward reaching TB reduction goals remains slow.

The report, published yesterday, shows that the 30 countries of the European Union/European Economic Area (EU/EEA) reported a total of 33,527 TB cases in 2021, for a notification rate of 7.4 cases per 100,000 population. That continues a downward trend observed since 2002.

But country-specific TB notification rates ranged widely, from 1.9 per 100,000 population in Iceland and Greece to 41.6 in Romania, which accounted for nearly 25% of all cases in 2021. In addition, the ECDC said the decline could reflect the continuing impact of the COVID-19 pandemic, which affected TB clinical services and surveillance around the world, resulting in fewer diagnoses.

The ECDC noted that rifampicin resistance/multidrug resistance (RR/MDR) was reported in 4.2% of 16,544 TB cases that received drug susceptibility testing, and that extensive drug resistance (XDR) was reported for 54.4% of 742 MDR-TB cases that underwent second-line drug susceptibility testing. That's up from 45.1% in 2020.

Challenges in achieving TB elimination

The ECDC also noted that, despite the decline in TB notifications, the EU/EEA is still not on track to meet the United Nations Sustainable Development Goal of 2.4 cases TB per 100,000 population by 2030, which would be an 80% reduction from the 2015 TB notification rate.

EU/EEA countries also need to improve on the treatment success rate, which was 71.7% in 2021, well below the World Health Organization (WHO) target rate of 85%.

Despite ongoing progress toward reaching the goals set by the United Nations and WHO, countries continue to face several challenges in achieving elimination.

"If the continued decline in TB incidence also observed during 2021 was real and not solely an artefact of the COVID-19 pandemic, this report indicates that despite ongoing progress toward reaching the goals set by the United Nations and WHO, countries continue to face several challenges in achieving elimination," the ECDC wrote. "Additional resources will be required to accelerate progress towards achieving these goals and to counteract any increase in TB cases resulting from the impact of the COVID-19 pandemic on TB services."

A pediatric hospital system wasted 58,607 antibiotic doses worth more than $230,000, including drugs in limited US supply, in 2 years, finds a study today in Infection Control & Hospital Epidemiology.

A team led by Emory University researchers calculated the number of wasted antibiotic doses dispensed at Children's Healthcare of Atlanta from January 1, 2020, to December 31, 2021. The system has three hospitals with more than 600 beds.

Wasted antibiotics were defined as unused doses returned to the pharmacy and unable to be reassigned. Such drugs include those in intravenous (IV) solutions and doses based on patient weight.

8 of 10 wasted drugs in shortage

During the study, 58,607 antibiotic doses ordered for 17,319 patients were wasted, for an average of 80 daily doses and 169 doses per 1,000 patient-days. Nearly all (99.4%) of the doses were either IV or suspension solutions and the syringes needed to deliver them; the remaining doses were tablets.

A total of 23% of doses were ordered on the first or second day of hospitalization, and 36% were ordered on the day of hospital release. Ten antibiotics made up 77% of the wasted doses, led by ampicillin (13%), clindamycin (13%), and cefazolin (9%). Eight of the 10 most-wasted antibiotics were currently in shortage or were in shortage in the past 3 years.

General pediatric prescriptions made up 41% of doses, followed by critical care (9%), hematology/oncology (8%), and surgery (6%). Total weight of the wasted doses, syringes, and carrier fluid was 2,508 kilograms (5,529 pounds).

The amount of waste is high, partially avoidable, with no contribution to improving patient outcomes.

Estimated cost of the waste was $255,503. The syringes and normal saline totaled $14,570 and $7,805, respectively, and the antibiotics cost $233,128. The five most expensive drugs wasted per milligram, totaling $36,541, were tigecycline (5 doses), ceftaroline (84), ceftazidime-avibactam (30), ertapenem (16), and IV sulfamethoxazole-trimethoprim (163).

"The amount of waste is high, partially avoidable, with no contribution to improving patient outcomes," the authors wrote. "High-priority targets to use antibiotic resources wisely include empiric optimization to minimize drug changes within 24 hours of admission and planning around the time of discharge."

The Coalition for Epidemic Preparedness Innovations (CEPI) and the University of Oxford have committed $80 million to the development of a vaccine targeting "Disease X," or unknown pathogens with the potential to cause pandemics.

The money will be used to work on vaccine prototypes against viral families most at risk for becoming pathogens that threaten human health at the pandemic scale.

"This is a ground-breaking commitment from CEPI to provide momentum that will drive the critical research that we need to be better prepared for future pandemics," said Sir Andrew Pollard, PhD, director of the Oxford Vaccine Group, in a CEPI press release. "Building on our extensive experience in vaccine development over the past 30 years and world-leading response to COVID-19 with the Oxford-AstraZeneca vaccine, we will strive with CEPI to secure the safety of future generations against the ongoing threats from the microbial world."

This is a ground-breaking commitment from CEPI to provide momentum that will drive the critical research that we need to be better prepared for future pandemics.

CEPI cited the example of COVID-19, climate change, and globalization as signs that an outbreak from Disease X is inevitable, and the world must be prepared to react swiftly with vaccination. CEPI has previously stated that the goal is to develop vaccines against an emerging pathogen within 100 days.

"CEPI's strategic partnership with the University of Oxford will make a vital contribution to our work to drive forward the 100 Days Mission," Richard Hatchett, MD, CEO of CEPI, said. "The partnership enables CEPI to deploy Oxford's ChAdOx technology—one of only a handful of proven rapid response vaccine platforms in the world."

China has reported H9 avian flu, likely H9N2, in a 4-year-old girl from Sichuan province, Hong Kong's Centre for Health Protection said in its weekly update.

The girl's symptoms began on August 7, and the report did not say how she was exposed to the virus. Sichuan province is in southwestern China.

If the infection is confirmed as H9N2, it will be China's first since late June. The country has reported four such cases over the past 6 months.

The virus circulates in poultry in some Asian countries. Illnesses in humans are usually mild and are more likely to be reported in children, especially those who have contact with domestic poultry or their environments.