The New Jersey Department of Health (NJDOH) said yesterday that is investigating a rise in Legionnaires' disease cases from Middlesex County and neighboring Union County.

In a statement, it said since August 3, 21 cases have been reported from Middlesex County, and 20 cases have been reported from Union County. No deaths have been reported. The two counties each averaged about six to eight Legionnaires' disease cases from August to October.

Middlesex County, with New Brunswick as its county seat, is part of the New York metropolitan area. Union County on its northern border includes Elizabethtown as its county seat.

NJDOH said it is working with local health departments to investigate the cases and identify potential infection sources. So far, no common exposure among the confirmed cases has been identified.

Kaitlan Baston, MD, NJDOH's acting health commissioner, said in the statement that early diagnosis is key to treating the disease. "Although the risk of contracting Legionnaires' disease if you live in or have recently visited Middlesex or Union counties remains low, individuals who develop pneumonia-like respiratory symptoms should visit their health care provider immediately to be evaluated," she said.

Infections are caused by exposure to Legionella bacteria, and past outbreaks have been linked to plumbing systems that can harbor the organism. Sources can include cooling towers, whirlpool spas, hot tubs, humidifiers, hot water tanks, and condensers of large air conditioning systems.

Symptoms can mimic other respiratory diseases such as COVID and flu. Older or middle-aged people, as well as smokers and those with chronic health conditions, are at higher risk of contracting Legionnaires' disease.

Today in Morbidity and Mortality Weekly Report, researchers published two studies on COVID-19 and flu vaccine coverage among US healthcare personnel (HCP), with one finding higher flu vaccine than COVID-19 vaccine uptake in 2023, and one suggesting that hospital workers were less likely to be vaccinated against flu during the 2020-21 and 2022-23 flu seasons than before the pandemic.

Both studies are from the same Centers for Disease Control and Prevention (CDC) research groups. The authors noted that the Advisory Committee on Immunization Practices recommends annual flu vaccination for HCP and up-to-date COVID-19 vaccination for everyone aged 6 months and older.

Up-to-date COVID vaccine uptake only 17% at hospitals

For the first study, the researchers analyzed healthcare facilities' reports of HCP vaccination against flu and COVID-19 from the CDC's National Healthcare Safety Network (NHSN) for January to June 2023. The NHSN defined up-to-date COVID-19 vaccination as receipt of one dose of a bivalent mRNA vaccine or completion of a primary series within the past 2 months.

Flu vaccine uptake was 81.0% among HCP at hospitals and 47.1% among those working at nursing homes. Up-to-date COVID-19 vaccination coverage was 17.2% among hospital HCP and 22.8% among nursing-home HCP.

There is a need to promote evidence-based strategies to improve vaccination coverage among HCP.

"There is a need to promote evidence-based strategies to improve vaccination coverage among HCP," the study authors wrote. "Tailored strategies might also be useful to reach all HCP with recommended vaccines and protect them and their patients from vaccine-preventable respiratory diseases."

Flu vaccine coverage fell amid pandemic

For the other study, the investigators used NHSN data to identify changes in flu vaccination among HCP in hospitals before and during the pandemic.

HCP flu vaccination rose before the pandemic, from 88.6% in the 2017-18 season to 90.7% in 2019-20. But amid the pandemic, the proportion of HCP vaccinated against flu fell to 85.9% in 2020–2021 and 81.1% in 2022-23.

"Additional efforts are needed to implement evidence-based strategies to increase vaccination coverage among HCP and to identify factors associated with recent declines in influenza vaccination coverage," the researchers wrote.

Mild COVID-19 infections can cause a loss of tase and smell, but a study today in JAMA Otolaryngology - Head & Neck Surgery suggests that almost all cases resolve within 3 years of initial infection.

In the small cohort study, 88 patients with loss of smell and taste were compared to 88 controls. All participants had tested positive for SARS-CoV-2 infection by polymerase chain reaction during March and April of 2020 in Trieste, Italy, and were enrolled in the study from March to June 2021.

The prevalence of self-reported smell or taste dysfunction was 64.8% (57/88), 31.8% (28/88), 20.5% (18/88), and 15.9% (17/88), during the acute phase of COVID-19, at 1-year, 2-year, and 3-year follow-up, respectively, the authors noted. If participants were age 50 or younger at the time of enrollment, they were less likely to report long-lasting loss of taste or smell.

By year 3, there were no statistically significant excess of olfactory dysfunction (OD) between cases and controls (13.6% vs 10.2%; absolute difference, 3.4%; 95% confidence interval, −7.3% to 14.1%).

Patients with PCC [post COVID condition] exhibiting chemosensory alterations should be reassured that a recovery of olfaction appears to continue over 3 years after initial infection."

"At the 3-year study endpoint, OD was comparable between both groups," the authors wrote. "Patients with PCC [post COVID condition] exhibiting chemosensory alterations should be reassured that a recovery of olfaction appears to continue over 3 years after initial infection."

The British Standards Institution (BSI) announced today that drugmakers Sandoz and Teva have become the first companies to be certified as meeting an international standard for responsible antibiotic manufacturing.

The Minimized Risk of Antimicrobial Resistance (AMR) certification, developed by BSI in collaboration with the AMR Industry Alliance, provides third-party independent verification that the concentration of antibiotic waste released into the environments by companies that manufacture antibiotics and their raw ingredients is below a threshold that could promote AMR in the environment. The threshold was established in a globally applicable responsible antibiotic manufacturing standard published in 2022.

Concerns about AMR in the environment

The certification attests to the fact that the companies are taking the necessary steps to control waste streams containing antibiotic active pharmaceutical ingredients. The Sandoz manufacturing site in Kundl, Austria, was the first to complete the assessment process. Annual surveillance will be conducted to ensure the standard is being maintained.

Controlling waste discharge of antibiotics from manufacturing can help retain the long-term effectiveness of antibiotics to treat infections, keeping medicine effective, boosting patient safety, and supporting a cleaner ecosystem.

BSI and the AMR Industry Alliance developed the certification to address concerns that discharge of antibiotics from manufacturing sites is contributing to the development and transmission of drug-resistant pathogens in the environment.

"Controlling waste discharge of antibiotics from manufacturing can help retain the long-term effectiveness of antibiotics to treat infections, keeping medicine effective, boosting patient safety, and supporting a cleaner ecosystem," Courtney Soulsby, global director of healthcare at BSI, said in a press release. "It's fantastic to see Sandoz and TEVA achieve certification, making clear their commitment to ensuring antibiotic manufacturing meets the best available scientific and environmental standards."