The number of cases in a measles outbreak centered in Gaines County, Texas, has jumped to 24, as health officials in New Mexico investigate a case—the state’s first of the year—in neighboring Lea County.

The Texas State Department of Health Services (TSDHS) said yesterday that the 24 patients, up from 6 reported on February 5, had symptom onsets within the last 2 weeks. All of the patients are unvaccinated and are residents of Gaines County. Sixteen of the patients are school-age children, and two are adults ages 18 and older.

Nine patients have been hospitalized, and health officials are bracing for more cases. “Due to the highly contagious nature of this disease, additional cases are likely to occur in Gaines County and the surrounding communities,” the TSDHS said, adding that it is working with the South Plains Public Health District and Lubbock Public Health to investigate the outbreak.

New Mexico reports illness in unvaccinated teen

Meanwhile, the New Mexico Department of Health (NMDH) yesterday issued an alert about potential measles exposure at a hospital emergency department and school gymnasium in Lovington due to a confirmed infection in an unvaccinated Lea County teenager.

NMDH officials said Lea County borders Gaines County in Texas, however they added that the Lea County youth had no recent travel or exposure to any affected patients in the Texas outbreak.

The case marks New Mexico’s first measles case of 2025. The state recorded two cases in 2024, which were its first since 2021. 

Miranda Durham, MD, chief medical officer for the NMDH, said in a statement that it’s important for people to get up-to-date with their vaccine doses. “Measles can spread easily, whether you're in Lea County or elsewhere in the state, if you're not current on the measles-mumps-rubella (MMR) vaccine,” she said. 

In an update on Oropouche virus activity, the Pan American Health Organization (PAHO) yesterday said in the first four weeks of the year, 3,765 cases have already been reported from six Americas countries, most of them from Brazil. Other countries reporting local cases include Panama, Peru, Cuba, and Guyana, as well as an imported case from Canada.

PAHO also provided an overview of activity in 2024, during which the region reported 16,239 cases from 11 countries and 1 territory. Brazil was the hardest hit country, followed by Peru, Cuba, and Bolivia. Of countries reported importingcases, the United States reported 108, all involving travel to Cuba.

The Americas region reported four deaths, three from Brazil.

Brazil confirms 5 vertical transmission instances, probes several others

Health officials in Brazil confirmed five instances of Oropouche transmission from mothers to their fetuses, resulting in four fetal deaths and one congenital abnormality. Investigations are still underway into 22 fetal deaths, 5 miscarriages, and 4 congenital anomaly cases.

Oropouche virus is spread to humans through the bite of certain midge species and possibly by some Culex mosquitoes. The illness causes febrile symptoms similar to dengue and in rare instances can lead to meningitis or encephalitis.

 In 2024, the virus spread beyond typically affected areas to new regions and countries, with rising reports of poor outcomes following transmission from pregnant women to their fetuses.

“The current outbreak highlights the need to strengthen epidemiological and entomological surveillance measures, as well as to reinforce preventive measures aimed at the population,” PAHO said. It also encouraged countries to report any unusual events related to the disease, including deaths and poor pregnancy outcomes.

A study of Veterans Affairs (VA) hospitals found that collaboration between antimicrobial stewardship physicians and pharmacists and use of local antibiotic prescribing guidelines were associated with less antibiotic use at discharge, researchers reported today in Infection Control & Hospital Epidemiology.          

Using data from the Veterans Health Administration, researchers from the Iowa City VA Health Care System evaluated post-discharge oral antibiotic prescribing at 123 VA hospitals from May 2020 to May 2021 with a risk-adjusted metric that categorized hospitals into three groups: high-performing (less frequent prescribing of antibiotics at discharge and shorter antibiotic courses), low-performing (more frequent antibiotic prescribing at discharge and longer antibiotic courses), and intermediate-performing. They then used responses from a mandatory antibiotic stewardship survey to determine the association between hospital characteristics and performance.

Stewardship processes critical to performance

Of the 396,909 patient admissions across the 123 hospitals, 17.2% received post-discharge antibiotics, with a median duration of 6 days. Based on the risk-adjusted metric, 37 hospitals (30.1%) were high-performing, 22 (17.9%) were low-performing, and 64 (52%) were intermediate-performing. The two stewardship processes associated with metric performance were more frequent interactions between stewardship champions (70.3% vs. 22.7% at high- and low-performing sites, respectively) and education of inpatient providers on stewardship principles within the past year (97.3% vs 77.3% at high- and low-performing sites, respectively).

A multinomial logistic regression model found that low-performing hospitals were less likely than high-performing hospitals to report interactions between their stewardship physician and stewardship pharmacist every day or several times per week (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03 to 0.55), and use local antibiotic prescribing guidelines for common infections (OR, 0.21; 95% CI, 0.05 to 0.93). 

The study authors note that both components are recommended in the Centers for Disease Control and Prevention's Core Elements for Hospital-Based Stewardship Programs.

"Physician engagement likely provides credibility to initiatives to reduce antibiotic overuse at discharge, while local guidelines provide an easy reference for determining duration of therapy," they wrote. "While there may be many ways to reduce antibiotic overuse at this transition of care, these two features seem to be important strategies for success."`

Sixty hunter-harvested deer and four elk in 10 more eastern Nebraska counties tested positive for chronic wasting disease (CWD) during the 2024 hunting season, an increase of over 50% from 2023 that likely reflects a 42% rise in deer tested, according to tallies posted on Outdoor Nebraska.

Nebraska conducts CWD surveillance in four to seven regions each year, rotating to a different part of the state each season. 

Disease detected in 73% of counties

CWD was first identified in Nebraska in 2000 in Kimball County. Since 1997, the Nebraska Game and Parks Commission (NGPC) has tested more than 58,000 deer and 400 elk, with 1,347 deer and 23 elk testing positive for the fatal neurodegenerative disease. So far, CWD has been detected in free-ranging deer and elk in 68 of 93 counties (73%).

Thirty of 600 deer tested were positive for CWD in 2023. In 2024, NGPC tested 1,419 hunter-harvested deer samples at check stations in the Missouri, Elkhorn, Loup East, Wahoo, Blue Northwest, and Blue Southeast deer-management units.

So far, CWD has been detected in free-ranging deer and elk in 68 of 93 counties (73%).

The 60 deer and four elk that tested positive for CWD in 2024 were found in 10 previously CWD-negative counties: Antelope, Butler, Greeley, Jefferson, Madison, Merrick, Platte, Richardson, Seward, and York. Thus far, no population declines have been attributed to the disease.

CWD is a disease of cervids such as deer and elk caused by prions, infectious proteins that trigger abnormal folding in normal proteins, especially in the central nervous system. Infected animals shed CWD prions in body fluids, which can spread to other cervids through direct contact or the environment. 

Although no CWD cases have been detected in people, the US Centers for Disease Control and Prevention recommends against eating infected animals and advises taking precautions when handling carcasses.