Study describes global prevalence of reported penicillin allergy

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systematic review and meta-analysis finds that the global prevalence of reported penicillin allergy (PenA) is nearly 10%, though much of the data come from high-income countries (HICs), researchers reported late last week in the Journal of Infection.

Led by researchers from Imperial College London, the review team analyzed 174 studies from 28 countries. Of those studies, 92% were from HICs, with 72% conducted in the United States (95 studies), United Kingdom (18), and Australia (18). In the 124 full-text, peer-reviewed studies included in the meta-analysis, worldwide prevalence of PenA was 9.4%. Prevalence in HICs (9.9%) was more than twice that of middle-income countries (4.4%).

Only one study was published from low- and middle-income countries (LMICs), and none from low-income countries (LICs), with little data from Africa and much of Asia and South America.

"This highlights an unmet need to broaden epidemiological analysis in under-represented regions," the study authors wrote.

The authors also noted that most of the studies were conducted in secondary care settings, with only 16 conducted in primary care.

Many with PenA are mislabeled

The findings are noteworthy because research has shown that 95% of people labeled as having PenA are mislabeled and can tolerate penicillins, which are the preferred first-line antibiotics for over 95% of infections, according to the World Health Organization (WHO). Patients with PenA often receive broader-spectrum antibiotics that can promote antimicrobial resistance and are associated with increased risk of adverse events.

Given that the WHO has endorsed antibiotic allergy assessment as an important antimicrobial stewardship activity, the authors say more research is needed on penicillin allergy labels in LMICs and LICs.

Kansas tuberculosis outbreak now largest in US

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TB x-ray
Tonpor Kasa / iStock

Editor's note: This story was updated at 6:35PM on January 27 with comments from a KDHE spokesperson.

A tuberculosis (TB) outbreak in Kansas City has become the largest documented TB outbreak on record in the United States.

Data on the outbreak from the Kansas Department of Health and Environment (KDHE) show that 67 active TB cases and 79 latent cases have been reported since the beginning of 2024 in Wyandotte and Johnson counties, which are part of the greater Kansas City area. Most of the cases have been in Wyandotte County. KDHE says it has been working with local health departments in response to the outbreak and is following guidance from the Centers for Disease Control and Prevention (CDC) to ensure patients are receiving proper treatment.

"The current Kansas City, Kan. Metro tuberculosis (TB) outbreak is the largest documented outbreak in U.S. history, presently (since the 1950’s, when the Centers for Disease Control and Prevention (CDC) started monitoring and reporting TB cases)," KDHE communications director Jill Bronaugh told CIDRAP News in an email. "This outbreak is still ongoing, which means that there could be more cases."

Bronaugh said KDHE reported 79 active and 213 latent TB cases in 2024, adding that those cases are still provisional and are being reviewed by the CDC for confirmation. Two TB deaths in 2024 are associated with the outbreak.

"While there is a very low risk of infection to the general public in these communities, KDHE is working to ensure that patients are receiving appropriate treatment, which will limit the ability to spread this disease and prevent additional cases from occurring," Bronaugh said.

Rising incidence of TB in the United States

In September 2023, KDHE researchers published a case report in the CDC's Morbidity and Mortality Weekly Report on an outbreak of multidrug-resistant (MDR)-TB in Kansas City that involved 13 people. They noted that 37 to 43 TB cases were reported annually in Kansas from 2019 through 2021. That number rose to 52 cases in 2022, driven in part by the MDR-TB outbreak.

The outbreak comes amid rising TB incidence in the United States. According to CDC data, 9,633 TB cases were reported in the United States in 2023—the highest case count since 2013. It was the third straight year of increases in US TB case counts, and the incidence rate of 2.9 cases per 100,000 persons represented a 15% increase from 2022. Most cases were in people born outside the United States.

The most recent global TB report from the World Health Organization (WHO) shows 8.2 million people were diagnosed with TB in 2023, the highest number recorded by WHO since it began global TB monitoring in 1995.

FDA aims to tackle berry-linked foodborne illness with new strategy

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Strawberries
Emily Mills / Flickr cc

The US Food and Drug Administration (FDA) has rolled out a strategy to help prevent outbreaks of enteric (intestinal) viruses such as hepatitis A and norovirus linked to fresh and frozen berries.

"While no enteric virus outbreaks associated with domestic berries have been reported in 35 years, there have been reported outbreaks linked to imported fresh and frozen berries," the FDA said in a news release.

Contamination can result from lapses in food-safety systems and prevention methods and can be prevented through proper hygienic practices among field workers, management of sanitary facilities, measures to prevent cross-contamination of fruit in the field and processing, and monitoring virus carriage in farm and facility workers, the FDA said. 

Collaboration between regulators, the global berry industry, and other interest holders has been critical for the development of this strategy.

Conrad Choiniere, PhD

The consistent use of sanitary controls is essential, because people can harbor and shed enteric viruses yet not have symptoms.

Compliance, research, and vaccination

Developed through analysis of outbreaks, historical data, and consultations with food safety experts, the strategy outlines steps for the FDA, industry, and other groups to take to:

  • Promote compliance with FDA food safety requirements.
  • Urge the berry industry to identify and ensure consistent application of processes for effective pre- and post-harvest sanitary practices for domestic and global operations, including promoting the use of root-cause analysis when failures occur.
  • Broaden scientific knowledge about the viability, persistence, detection, and mitigation of viruses in berries, pre- and post-harvest settings, and agricultural water sources.
  • Add incentives for industry and governments to encourage worker vaccination.
  • Foster research into better methods of detecting and characterizing enteric viruses in different sample types and linking contamination sources with advanced laboratory methods.

"Collaboration between regulators, the global berry industry, and other interest holders has been critical for the development of this strategy," Conrad Choiniere, PhD, director of the Office of Microbiological Food Safety at the FDA’s Human Food Program, said in the release.

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