A report yesterday in the New England Journal of Medicine details detection of highly pathogenic H5N1 avian flu virus in wastewater from 10 Texas cities during the same time period the virus was detected in Texas cattle herds.

The study was conducted by researchers primarily from the University of Texas Health Science Center at Houston (UTHealth Houston) and Baylor College of Medicine. Before March 2024, H5N1 had not been detected in 1,337 wastewater samples analyzed by the team, a press release from UTHealth Houston said. 

From March 4 to July 15 of this year, H5N1 was detected as part of the virome (collection of viruses present in wastewater sample) in 10 of 10 cities, 22 of 23 sites (96%), and 100 of 399 samples (25%). 

"The abundance of H5N1 sequences identified has not correlated with influenza-related hospitalizations, which declined in Texas during the spring of 2024," the authors wrote. 

Overall risk still low 

Texas was the first state this year to confirm an H5N1 case, which involved an agricultural worker on March 28. The case-patient, who presented with conjunctivitis, among other mild symptoms, was exposed to symptomatic cattle. Since that detection, 13 other human US cases have been recorded, and all patients have made recoveries. 

"The widespread detection of influenza A(H5N1) virus in wastewater from 10 U.S. cities is troubling," the authors concluded. "Although the exact origin of the signal is currently unknown, the lack of clinical burden along with genomic information suggests multiple animal sources."

The lack of clinical burden along with genomic information suggests multiple animal sources.

Despite the findings, the risk to human health without direct contact with infected cattle like remains low, the authors said. 

Emergent BioSolutions today announced that the Biomedical Advanced Research and Development Authority (BARDA), part of the US Department of Health and Human Services, has awarded the company a research and development option worth $41.9 million to its existing contract to further the development and scale-up of its monoclonal antibody treatment for Ebola virus infection.

The 10-year contract for the drug known as Ebanga (ansuvimab-zykl or mAb114) was initially awarded by BARDA in August 2023. 

According to a company statement, the contract option will cover drug substance engineering and scale-up process validation, long-term stability, and commercial readiness in support of its ongoing program for Ebanga. The US Food and Drug Administration (FDA) approved the drug, given as a single infusion, in December 2020 for the treatment of Ebola Zaire virus disease. 

The BARDA activities are part of plan to deploy treatments that can be deployed in outbreaks. The drug was initially developed by Ridgeback Biotherapeutics with support from BARDA. Ridgeback and Emergent signed an agreement that allows Emergent to make and distribute the drug in the United States and Canada.

The Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) are calling for world leaders to take "robust action" to mitigate the impact of antimicrobial resistance (AMR).

In a joint white paper published yesterday in CMI Communications, IDSA and ESCMID experts urged world leaders attending the upcoming United Nations (UN) High-Level Meeting on AMR to adopt a political declaration with "bold targets and practical steps" to accelerate progress against drug-resistant bacteria across the human, animal, agricultural, and environmental sectors. 

"To truly propel consequential, sustainable progress against AMR, the UN political declaration must include bold targets and be accompanied by robust financing," the groups wrote. "We urge all participants to agree on a global commitment to scale up action commensurate with the present threat of AMR, with the aim to reduce the global deaths caused by AMR by 10 percent by 2030."

Targets on antibiotic use, infection control

Among the targets recommended by IDSA/ESCMID to achieve that goal is for 70% of all antibiotic use globally to be from the group of antibiotics that the World Health Organization (WHO) defines as Access antibiotics—first- and second-line antibiotics with a narrow spectrum of activity that offer high therapeutic value with lower potential for resistance. They also call for a 30% reduction in the quantity of antibiotics used in the agri-food system.

To prevent the infections that drive global use of antibiotics, the groups say world leaders should set a goal of reaching 14 million children globally with essential immunization services, commit to scaling up implementation of the WHO's infection prevention and control guidelines to ensure that all nations have the core components in place, and improve access to clean water, sanitation, and hygiene.

We urge all participants to agree on a global commitment to scale up action commensurate with the present threat of AMR, with the aim to reduce the global deaths caused by AMR by 10 percent by 2030.

Other recommendations include rebuilding the antimicrobial drug pipeline, with a focus on developing a sustainable innovation ecosystem that can deliver drugs that target multidrug-resistant bacteria, strengthening and scaling up global AMR surveillance systems, and establishing an independent scientific panel for AMR mitigation.

"We strongly encourage them to work with our societies to help provide the scientific basis to guide this important work," they wrote.