In updates yesterday and today, the Finnish Food Authority reported eight more H5N1 avian flu outbreaks on fur farms, raising the total to 20. All are from the earlier affected regions.

Most of the farms house blue foxes, but one raises minks, another has raccoon dogs, and others have mixed-breed foxes.

The outbreaks began in the middle of July, and officials have said the animals likely contracted the virus from wild birds. Finland has reported several H5N1 detections in wild birds over the summer months. The events on the fur farms have heightened growing concerns about more frequent H5N1 detections in mammals and bolstered close monitoring for any genetic changes that would allow the virus to more easily infect humans.

United States, Netherlands report H5N1 detections in poultry

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported an outbreak in poultry at a live market in New York, the first poultry event since the middle of May. The outbreak occurred in Kings County, which covers Brooklyn, and the market had 660 birds.

Since November 2022, APHIS has reported eight outbreaks at live poultry markets from three states, mostly in New York at facilities in Kings and Queens counties.

Elsewhere, the Netherlands reported an outbreak at a poultry farm, its first since May, according to a notification from the World Organization for Animal Health (WOAH). The outbreak began on July 24 at a free-range layer farm in village in Flevoland province, located in the central part of the country. The virus killed 100 of 10,968 birds, and the remaining chickens were culled as part of the outbreak response.

The World Health Organization (WHO) has added four drugs for treating infectious diseases to its updated list of essential medicines.

The newly added medications include pretomanid, an antibiotic that's included in the WHO-recommended, 6-month regimens for multidrug-resistant tuberculosis (TB). The other drugs in the regimens—bedaquiline, linezolid, and moxifloxacin—are also on the essential medicines list.

TB Alliance CEO Mel Spigelman, MD, said the designation is important because many countries use the essential medicines list to prioritize the medicines used in their national health systems.

"With this listing, the novel six-month regimens receive a further endorsement on the path to providing improved outcomes for all eligible patients, replacing older, toxic, and often ineffective combinations that required up to 18 months of treatment – sometimes longer," Spigelman said in a statement.

Also added to the essential medicines list is ceftolozane-tazobactam, an antibiotic-beta-lactamase inhibitor combination for treating infections caused by carbapenem-resistant Pseudomonas aeruginosa, which is on the WHO's Priority Pathogens list. The drug was added to the "reserve" antibiotic group, which includes antibiotics that should only be used for infections with limited or no treatment options, and is considered an important part of the strategy for limiting the spread of carbapenem resistance.

The other anti-infectives added to the list are ravidasvir, which is used in combination with sofosbuvir for treating chronic hepatitis C infection in adults, and monoclonal antibodies for Ebola virus disease.

Today in Morbidity and Mortality Weekly Report, authors from the US Centers for Disease Control and Prevention (CDC) describe alpha-gal syndrome (AGS), a growing tick bite-associated allergy to mammal meat and milk.

The condition can be life-threatening and is characterized by a hypersensitivity to the sugar molecule galactose-alpha-1,3-galactose (alpha-gal). Cases are increasing across the country along with the number of tests performed and suspected AGS cases. The number of persons who received positive test results jumped from 13,371 in 2017 to 18,885 in 2021.

But despite growing incidence, in a survey of 1,500 US healthcare providers (HCPs), 42% said they had never heard of the condition. Among those who had heard of the condition, 35% said they were not confident in their ability to diagnose the allergy, and only 55 clinicians (6%) said they had treated 5 or more alpha-gal patients.

The condition is primarily associated with the bite of the lone star tick (Ambylomma americanum) in the United States, with most cases recorded in the South and Midwest.

Allergic symptoms develop within 2 hours of eating something containing alpha-gal and range from mild (rash) to severe (anaphylaxis).

"More than one half of the respondents (502; 58%) correctly identified topics on which to counsel AGS patients, such as tick bite prevention, eliminating red meat from their diet, exercising caution when receiving new medications and vaccines, and recognizing and managing anaphylaxis," the authors said.

More clinician education is needed, the authors concluded. "The lack of HCP knowledge of AGS is likely to lead to undertesting, further hampering knowledge of the national prevalence of AGS," they said.