Study supports more selective use of preventive antibiotics for cataract surgery

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Cataract surgery
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A longitudinal cohort study found that the use of a disinfectant combined with selective preventive antibiotics during cataract surgery may be as effective as routine antibiotics for preventing postoperative endophthalmitis, Dutch researchers reported yesterday in JAMA Ophthalmology.

The study examined incidence data from Rotterdam Eye Hospital (REH), where clinicians since 2016 have adhered to a regimen of preoperative disinfection with 1% povidone combined with intracameral antibiotic prophylaxis only after complicated cataract surgery to prevent endophthalmitis, a serious inflammatory eye condition caused by infection. While the standard regimen for preventing endophthalmitis over the past few decades has been 5% povidone combined with routine intracameral antibiotics (ICA), questions have been raised about widespread use of routine antibiotics in patients undergoing the most performed surgical procedure in the world.

The researchers found that postoperative endophthalmitis incidence after 58,598 cataract procedures conducted at REH from 2016 through 2022 was 0.000, which was the same level found in a literature search of 37 studies examining postoperative endophthalmitis incidence with the standard regimen.

No substantial difference in postoperative endophthalmitis

"The REH data show that a low level of postoperative endophthalmitis was associated with 1% povidone iodine disinfection in combination with selective prophylactic antibiotic use and that postoperative endophthalmitis incidence did not substantially differ from routine antibiotic use," the study authors wrote.

They add that limiting antibiotic prophylaxis to complicated cataract surgery may be preferable to routinely exposing large numbers of patients to prophylactic antibiotics.

An accompanying commentary by French and Australian experts, however, questions whether selective use of ICA could lead to potentially avoidable cases of endophthalmitis in uncomplicated cataract surgery.

"This case series may raise more questions as to whether selective use of ICA might be equally effective when used routinely and that further assessment of this possibility probably would be worthwhile," the authors wrote.

US preparedness & response agency offers H5N1 avian flu resources

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The US Administration for Strategic Preparedness & Response (ASPR) today laid out its response to H5N1 avian flu infections affecting US cattle and poultry, as Iowa confirmed another highly pathogenic avian flu outbreak in poultry.

Protective equipment available for farmers, others

ASPR, part of the Department of Health and Human Services, said it is "monitoring the situation closely and making resources available to support state, local, tribal, and territorial partners." ASPR has personal protective equipment (PPE) and antiviral drugs available in the Strategic National Stockpile (SNS), as well as antiviral drugs like oseltamivir (Tamiflu) and materials for vaccines should human-to-human transmission occur. So far, just three H5N1 cases in people have been confirmed in the United States in 2024. 

The SNS includes a large inventory of PPE available to protect healthcare workers. ASPR is also offering face shields, gloves, N95 respirators, elastomeric half-mask respirators, and goggles for farm workers or others who interact with infected cattle or other animals.

"ASPR's mission is to help the country prepare for, respond to, and recover from public health emergencies and disasters," the agency said. "The SNS contributes to this mission as the nation's largest repository of emergency medical supplies. While many states hold large supplies of PPE in state-held stockpiles, if those stockpiles of PPE are depleted or unavailable, federal supplies managed by SNS may be requested."

Third outbreak in Iowa poultry this year

Yesterday the Iowa Department of Agriculture and Land Stewardship reported an outbreak of highly pathogenic avian influenza (HPAI) in a commercial turkey flock in Sac County. This is Iowa's third confirmation of HPAI in poultry flocks in 2024. Sac County is in the west-central part of the state.

In response to the outbreak, Gov. Kim Reynolds authorized a disaster proclamation for Sac County effective for 1 month. The proclamation allows state resources to assist with tracking and monitoring, rapid detection, containment, disposal, and disinfection.

CDC data show uptick in COVID-19 cases, low flu activity

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The latest data from the Centers for Disease Control and Prevention (CDC) today indicate that COVID-19 activity continues to rise across the country, albeit at low levels.

COVID illustration
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According to the CDC's COVID Data Tracker, test positivity was 6.6% for the week ending June 15, up 1.2% from the previous week. Emergency department visits for COVID-19 were up 14.7% from the previous week and now stand at 0.7%. In its weekly snapshot of respiratory viral illnesses, the CDC said COVID infections are growing or likely growing in 39 states and territories and stable or uncertain in 10 states and territories.

The agency's two severity indicators—hospitalizations and deaths—also show notable upticks. Hospitalizations through June 1 are up 25% from the previous week, while deaths are up 16.7%. But hospitalization and death rates remain low overall, however, compared with peak periods of the pandemic.

Data from the CDC's National Wastewater Surveillance System show that COVID wastewater levels nationally are low, but several states in the West are reporting high viral activity, and six states—Alaska, Hawaii, New Mexico, Missouri, Florida, and Connecticut—are reporting very high activity. The latest data from WastewaterSCAN, a national wastewater monitoring system based at Stanford University in partnership with Emory University, suggest COVID wastewater levels are high nationally.

Shifting variants

The uptick appears to be driven by increases in the KP.3, KP.2, and LB.1 variants, which now account for 71.4% of sequenced samples, up from 61% the previous week, according to today's variant proportion update. All three variants are offshoots of the JN.1 lineage and carry key mutations in the spike protein that could help them evade antibodies.

"KP.3 and LB.1 are projected to continue increasing as proportions of the variants that cause COVID-19," the CDC said.

Meanwhile, seasonal flu activity remains low, the CDC said in its weekly FluView report. But the agency noted that three additional influenza-associated pediatric deaths that occurred during the 2023-24 season were reported during the week ending June 15, bringing the total number of pediatric deaths for the season to 178. That compares with 185 deaths in the 2022-23 season.

CDC closes investigation into Salmonella outbreak tied to basil after 36 cases

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fresh basil

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The Centers for Disease Control and Prevention (CDC) this week declared an end to its investigation of  a Salmonella outbreak linked to fresh organic basil after 36 cases were reported. 

Four people required hospitalization, but there were no confirmed deaths in the outbreak, which saw cases reported in 14 states. Seven people were sickened in Florida, six in Minnesota, and five in Massachusetts, with a number states reporting smaller outbreaks. 

When the outbreak was first announced in April, 12 people in seven states had become ill, many after eating fresh basil sold at Trader Joe's grocery stores. The organic basil was sold by Infinite Herbs of Miami, which completed a voluntary recall. Trader Joe's pulled the product from its shelves and stopped shipments of the basil on April 12. 

Implicated basil no longer for sale 

The CDC said illnesses started on dates ranging from February 11, 2024, to May 26, 2024. The average age of case-patients was 39, with people ages 1 to 78 sickened. Seventy-eight percent were female.

"State and local public health officials interviewed people about the foods they ate in the week before they got sick. Of the 24 people interviewed, 18 (75%) reported eating basil," the CDC said. 

Recalled basil is no longer available for sale, and the use-by dates have passed, the CDC said.

In related news, US federal officials are investigating a new outbreak of Salmonella Typhimurium with at least 47 illnesses, but the source of the pathogen is unknown, according to Food Safety News.

Quick Takes: Mpox in South Africa, measles in Kenya, polio in 3 countries

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  • South Africa has identified 6 new cases of mpox, bringing the country's total cases reported since late May to 13, South Africa's Department of Health reported today. The new cases are in Gauteng and Western Cape provinces. Two deaths so far have been reported in the outbreak, which involves the clade 2 virus responsible for global spread. The department also said it had received a batch of the antiviral drug tecovirimat (Tpoxx) for treating patients who experience severe health complications.
  • A measles outbreak that began in Kenya in December 2023 has now reached 1,536 cases and 11 deaths, according to the latest outbreak report from the World Health Organization African Region. Children under the age of 5 have been the hardest hit by the outbreak, with 563 cases, followed by the 15-and-older group (386 cases). Of the reported measles case-patients, 34% were unvaccinated, 6% had received two doses of the measles containing vaccine, 14% had received one dose, and 46% had unknown vaccination status. Kenya's Ministry of Health says it plans to implement a vaccination campaign in affected areas.
  • Three countries reported new polio cases this week, the Global Polio Eradication Initiative said in its latest update. Afghanistan reported 1 case of wild poliovirus type 1 (WPV1) in Hilmand province, bringing the total number of cases reported this year to 6. Nigeria reported 3 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, for a total of 30 this year, and South Sudan reported 1 cVDPV2 case, bringing the country's total this year to 6.

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