Report describes MDR-TB outbreak in Kansas, neighboring state

News brief

Investigators say a rare outbreak of multidrug-resistant tuberculosis (MDR-TB) in a social network in Kansas provides a "cautionary tale" for areas with low TB incidence.

The outbreak, described today in Morbidity and Mortality Weekly Report, involved 13 people in Kansas and one in a neighboring state and was initially identified in a hospitalized infant in Kansas in November 2021. Resistance to the four drugs that constitute first-line TB therapy was confirmed by DNA sequencing and drug-susceptibility tests. Investigation by public health officials identified four additional members in the infant's household with MDR-TB.

pulmonary TB

In January 2022, an infant from a second household in the same apartment complex was hospitalized with TB, and culture-based testing identified the same drug susceptibility pattern as the first household. MDR-TB infection was then detected in the child's mother and four additional household members. Further investigation revealed the families in the two households had extensive social contact and shared a car to commute to the same workplace.

Additional cases were subsequently identified in two households in a different neighborhood that were connected to the first two households, and in a child in a neighboring state who had connections with the second household. Nine cases of latent TB infection were also identified in the four Kansas households.

Outbreak may have begun with overseas infection

To date, 13 of the 14 individuals with MDR-TB have completed treatment, and one declined treatment. The nine individuals with latent TB have also completed treatment. The patients will be examined every 6 months for more than 2 years after treatment completion.

Investigators say that while identifying a source of the outbreak is difficult, it's plausible that it may have begun with a non–US-born adult in one of the first two households who had been infected overseas and went untreated, leading to further transmission. MDR-TB cases in the United States tend to be detected among non—US-born individuals. Only 77 cases were identified in the United States in 2021.

"This outbreak is also a cautionary tale, reminding other low TB incidence jurisdictions that sustained declines in TB incidence are not assured," they wrote.

Meningococcal group B vaccine associated with reduced gonorrhea incidence

News brief

Chris Dall, MA

A study conducted at two universities in Oregon suggests meningococcal group B vaccine (MBV) may offer protection against gonorrhea infection, researchers reported today in JAMA Network Open.

In the study, researchers with the Oregon Public Health Division analyzed gonorrhea incidence among more than 30,000 students ages 18 to 29 at the University of Oregon and Oregon State University who received one or more doses of MBV following group B meningococcal outbreaks on the two campuses in 2015 and 2016.

young adult vaccination — Alex Raths / iStock

The study was prompted by a 2017 report by New Zealand researchers that showed MBV appeared to reduce gonorrhea incidence, with an estimated vaccine effectiveness of 31%, and successful follow-up studies that replicated the finding. Those studies found that outer membrane vesicle (OMV)-based MBVs target OMVs that are common to both Neisseria meningitidis and Neisseria gonorrhoeae, which are genetically similar.

The study population included 15,760 recipients of one or more OMV-based MBV (54% female, median age 19.3 years) and 15,212 recipients of one or more non–OMV-based MBV (56% female, median age 19.4 years). Fifty-three percent of non–OMV-based MBV recipients received more than one dose, compared with 57% of OMV-based MBV recipients.

Further investigation warranted

Overall, 24 gonorrhea cases were reported in OMV-based MBV recipients versus 44 cases in non–OMV-based MBV recipients. The analysis estimated that the OMV-based MBV was 47% effective in preventing gonorrhea among recipients aged 18 to 29. Among those aged 18 to 19, the OMV-based MBV was 59% effective. Vaccine effectiveness was 11% for recipients of two or more doses versus one dose.

Further investigation of OMV-based vaccination technology may be warranted.

"Given the global burden of gonorrhea, further investigation of OMV-based vaccination technology may be warranted," the study authors wrote.

The study limitations include the low number of gonorrhea cases, the likelihood of students graduating and leaving the disease-reporting area, and shifts in gonorrhea risk over time.

Limited data suggest rising global COVID-19 activity

News brief

Lisa Schnirring

Though case reporting doesn't accurately reflect COVID-19 activity because of decreased testing and reporting, the number reported over the past month increased by 63%, with increased cases reported in three regions, the World Health Organization (WHO) said in its latest weekly update yesterday.

During an online Q and A session today, Maria Van Kerkhove, PhD, the WHO's technical lead for COVID, said the latest update is the WHO's final weekly report as it transitions to monthly reporting.

Europe, the Western Pacific, and the Eastern Mediterranean regions all noted rises in infections. No reporting data were available from the Americas. Deaths were up in one region, the Eastern Mediterranean.

Over the past month, only 44% of countries reported any cases to the WHO, a proportion that has been declining since the middle of 2022. Of reporting countries, some of those with upward trends include Iran, Belgium, Ireland, the United Kingdom, and South Korea.

Of the 19 countries that regularly report data on hospitalization for COVID, eight reported increases of 20% or more compared to the previous month: Bangladesh, Ireland, Greece, Kyrgyzstan, the United States, Malta, Mexico, and the Netherlands. Of 17 countries that regularly report intensive care unit admissions, 6 reported increases of 20% or more: Ireland, Malta, Singapore, Latvia, Greece, and the Netherlands.

The WHO's variant tracking shows that XBB.1.16 and EG.5 are the most common variants of interest, and EG.5 is the only one showing an increase. The agency said the potential impact of BA.2.86 mutations is currently undergoing careful assessment, and so far no deaths have been reported in any patients infected with the variant.