In a new update on a multistate Salmonella outbreak linked to backyard poultry—first announced in May—the Centers for Disease Control and Prevention (CDC) reported 86 more illnesses and 9 more affected states, raising the national total to 195 cases from 38 states.

Initially, outbreak involved five Salmonella serotypes: Altona, Indiana, Infantis, Mbandaka, and Typhimurium. The CDC said two more have been implicated in the illnesses—Cerro and Johannesburg. 

Of information based on 136 patients, 50 were hospitalized. No deaths have been reported. Just over 40% of patients are younger than 5 years old. The latest illness onset is May 30. The CDC warned that the outbreak total is likely much higher and that illnesses probably aren't limited to the states with known cases, given that most people aren't tested and recover without medical care.

Of 45 people with information available, 36 had bought or obtained poultry before they became ill. People got the birds from multiple retail stores and directly from hatcheries.

Samples from shipping boxes matched patient strains

Investigators from Minnesota, Ohio, and Utah collected samples from inside boxes used to ship the poultry from hatcheries to retail stores, which included box liner and bedding. Whole-genome sequencing (WGS) found that Salmonella Altona, Cerro, and Mbandaka in the samples matched strains from some of the sick patients.

WGS analysis of 176 patient samples and 13 environmental samples found no predicted resistance, but 14 patient samples had predicted resistance to one or more antibiotics: amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftiofur, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline.

Backyard poultry have been tied to several other Salmonella outbreaks over the past several years. The CDC urged poultry owners to take precautions, such as washing hands with soap and water after touching backyard poultry and supervising children around backyard poultry, especially young ones who are more likely to get sick.

The World Health Organization (WHO) last week launched an effort to strengthen global diagnostic capacity and support access to safe, affordable, and quality-assured diagnostics.

In a policy brief, the WHO said the Antimicrobial Resistance (AMR) Diagnostic Initiative aims to "bring diagnostics to the forefront" of the global response to antimicrobial resistance, help countries strengthen microbiology laboratory capacity, support antimicrobial stewardship and infection prevention and control, enhance routine surveillance, and achieve equitable access to quality testing for common bacterial and fungal pathogens and associated AMR.

The initiative was developed by the WHO to help World Health Assembly member states address commitments made in 2023 to strengthen diagnostic capacity. The agency notes that for nearly half the global population, access to reliable and timely laboratory test results is severely limited, with only 1% to 2% of clinical laboratories in sub-Saharan countries undertaking bacteriology testing. Mycology testing is even more limited. 

"Appropriate and rapid diagnosis of bacterial and fungal infections and associated resistance is of paramount importance for guiding appropriate clinical management and rational selection of antimicrobial therapy, monitoring infections and treatment response, and carrying out antimicrobial stewardship initiatives, infection prevention and control measures, investigating outbreaks and emerging threats, and monitoring the burden of antimicrobial resistance," the WHO said. 

"Without equitable access to quality-assured diagnostics and laboratory services, antimicrobial resistance will be allowed to spread silently within and across countries," it added.

Building blocks

The ability to provide essential bacteriology and mycology laboratory services is hindered by a shortage of clinical microbiologists and lab technicians, the high cost of supplies and equipment, and inadequate infrastructure, the agency said.

To overcome these challenges and strengthen global diagnostic and laboratory capacity, the policy brief lays out four "building blocks" for the initiative. These include a strategic and operational framework to set standards and provide implementation guidance; standardized assessment tools for monitoring and reporting bacteriology and mycology laboratory services capacity at national and global levels; a global AMR laboratory network that includes laboratories designated by the WHO for bacteriology, mycology, and susceptibility testing at national, supranational, and specialized levels; and research and innovation in AMR diagnostics.

Infants born to mothers with active hepatitis C virus (HCV) infection are more likely to be screened for the virus, but pediatric HCV infections are likely going undetected in the many unscreened babies, finds a new study in the Journal of the Pediatric Infectious Diseases Society. 

University of Pittsburgh researchers used maternal HCV status to estimate the likelihood of screening infants born from 2015 to 2019 at a large academic hospital.

"Only 30% (range 8.6%–53.1%) of children born to women with HCV infection are screened," the authors noted. "This is due to multiple factors, such as loss to follow-up, poor communication between healthcare providers, and electronic health record (EHR) gaps."

Babies of infected moms 2.5 more likely to be screened

Mothers were tested for HCV infection 4.4 months before delivery, on average. Of 503 HCV-exposed infants, 260 (52%) were born to actively infected women, 137 (27%) to previously infected mothers, and 106 (21%) to those with probable infection. 

A total of 385 babies (77%) had an order for HCV screening, of which 262 (68%) were tested. Most completed screenings (58%) were of infants of actively infected mothers, 49% to mothers with probable infection, and 43% to those previously infected. Pediatric HCV infection ranged from 1.7% to 7.7%. 

Screening children exposed to perinatal HCV is crucial to ensure timely identification and treatment of infected children.

Infants of actively infected mothers were 2.5 times more likely to be screened than those of previously infected women; there was no difference for infants of women with probable infections.

Active maternal HCV infection, smoking, and documentation of viral exposure or clinic visit after 18 months were tied to orders for pediatric screening. Earlier birth year, premature birth, and residence with nonbiologic parents at 18 months were linked to screening completion.

Probable or active maternal infection, ongoing substance use, lack of a maternal anxiety diagnosis, residence with nonbiologic parents or clinic visit at 18 months, and documentation of maternal viral load were associated with infant infection.

"Screening children exposed to perinatal HCV is crucial to ensure timely identification and treatment of infected children," the researchers wrote.

A 2-year-old white-tailed doe in a second Sutton County, Texas, deer-breeding facility has tested positive for chronic wasting disease (CWD), the Texas Parks and Wildlife Department (TPWD) announced late last week.

The infection was found during mandatory postmortem CWD surveillance testing. Sutton County is located in west central Texas.

The first Sutton County case was discovered in a deer-breeding facility in May 2023. That case was detected in a 4-year-old white-tailed buck tested for CWD before transfer to a registered release site.

A continuing threat to cervids

Since the first Texas CWD detection in 2012, the fatal neurologic disease has been found in captive and free-ranging cervids such as deer, mule deer, red deer, and elk, the TPWD said.

CWD, which is caused by misfolded proteins called prions, poses an ongoing threat to cervids because it can spread from animal to animal and through environmental contamination. The disease isn't known to infect humans, but officials recommend not eating meat from a sick animal and using precautions when field-dressing or butchering cervids.