The Texas Department of State Health Services (TDSHS) today reported eight more measles cases since its last update on May 9, including the first two from Dallas that are linked to the large outbreak in West Texas.

Also, the TDSHS said cases in the Dallas area now linked to the large outbreak centered in Gaines County are from Collin and Rockwall counties. Collin County is just northeast of Dallas and is home to Plano, and Rockwall County is about 32 miles northeast of Dallas. 

Last week, officials said they removed Garza and Lynn counties from the list of active transmission counties, because two incubation periods have passed since the last patients were infectious.

The new cases reported today lift the Texas outbreak total to 717 from 32 counties. The state has also reported 15 cases in various counties that aren't part of the West Texas outbreak.

Houston wastewater sampling showed early warning

In other Texas measles developments, a research team based at Baylor College of Medicine described how they detected the measles virus in Houston wastewater samples before illnesses were detected in two travelers. They reported their findings in the American Journal of Public Health.

The wastewater surveillance program, which also involved the Houston Health Department and researchers from two other universities, detected measles in samples collected on January 7 from two Houston water treatment facilities, well before investigations confirmed two measles infections in travelers on January 17. The travelers lived in the same area serviced by the water treatment plants.

Researchers said that, for comparison, 821 wastewater samples from the same area were negative in monitoring over the 31 previous months.

New recommendations from the National Academies of Sciences, Engineering, and Medicine are asking scientists to dive into available evidence in an effort to investigate treatments to ease the fatigue, pain, and "brain fog" that affect 10% to 20% of people long term after contracting Lyme disease.

The recommendations for people living with Lyme infection–associated chronic illness (IACI) are published in a 252-page report.

"There is an urgent need to identify and develop safe and effective treatments for Lyme IACI that can restore functionality and quality of life, and it is possible for that work to start now," said Kent Kester, MD, chair of the committee that wrote the report and executive director of vaccine research and development at the Coalition for Epidemic Preparedness Innovations (CEPI), in a National Academies press release. "People living with this condition deserve to have information that allows them to both make informed decisions about their own health and to have safe and effective treatments available to them."

People living with this condition deserve to have information that allows them to both make informed decisions about their own health and to have safe and effective treatments available to them.

Lyme IACI share symptoms common to other IACIs such as long COVID and myalgic encephalomyelitis/chronic fatigue syndrome. But the authors of the report note that only six randomized clinical trials for Lyme IACI have been conducted in the past 20 years.

Five of those trials studied antibiotics, and one studied yoga. None of the six trials showed benefit in terms of symptom alleviation.

Patient-centered research 

In order to guide future trials, the authors of the report suggest that researchers focus on asking patients what symptoms are most bothersome to them, and trials should be focused on finding relief of the most common symptoms. 

The authors also said future research must use biobanks for data collection.

"While continuing research into the triggers and mechanisms responsible for the development of Lyme IACI is essential, the urgent need for effective interventions requires an enhanced focus on developing therapies to treat those symptoms most debilitating and important to people living with Lyme IACI," the authors wrote.

A new study in the Journal of Occupational and Environmental Medicine suggests significant work productivity losses in people living with long-COVID symptoms for 2 or more years. 

The findings come from adult respondents to an online survey incorporating the Valuation of Lost Productivity questionnaire given to residents of British Columbia, Canada. All participants had a SARS-CoV-2 infection confirmed via polymerase chain reaction testing 1 to 2 years prior to the survey. 

The median time between infection and survey completion was 28 months. Participants with ongoing long-COVID symptoms were more likely to be female, older, White, unvaccinated before infection, and have had a severe initial COVID-19 illness, the authors wrote.

33 hours lost every month

Among 906 participants, 165 (18.7%) reported long-COVID symptoms. The 165 people with long COVID reported greater total productivity loss than other COVID-19 survivors (adjusted mean difference, 99.2 hours per 3 months; 95% confidence interval, 44.9 to 167.5 hours).

This equals about 33 lost hours of productivity each month—or about 8 hours per week.

Overall, participants with ongoing long-COVID symptoms were much more likely to report any productivity loss in the preceding 3 months compared to those without ongoing long-COVID symptoms (74.9% vs. 47.1%). Similarly, 72.9% of those with long COVID compared to 39.4% without reported work performance impairment in the preceding 7 days of the survey.

On average, among those with long COVID symptoms, the amount of time loss was nearly 100 hours .

"On average, among those with long COVID symptoms, the amount of time loss was nearly 100 hours (equivalent to 2.7 weeks of full-time work) more over 3 months and almost 15% greater work performance impairment per week," the authors concluded. 

They added that the productivity loss described in the study is comparable to the burden associated with chronic migraine, multiple sclerosis, and rheumatoid arthritis. 

A study involving nearly 27,000 pregnancies suggests that women infected with COVID-19 before or during pregnancy are at two to three times the risk for miscarriage before 20 weeks' gestation.

The University of Texas–led analysis used electronic health records to evaluate the relationship between COVID-19 and miscarriage, ectopic pregnancy, and preterm delivery from 2019 to 2023. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, rendering it unviable.

"In early pregnancy and the periconception period, SARS-CoV-2 infection may disrupt the complex immunology of pregnancy, which shifts between the temporary immunosuppression necessary for implantation and fetal tolerance and the proinflammatory response which helps to prevent infections in mid-pregnancy," the researchers wrote. 

The findings were published late last week in BMC Medicine.

Results underscore need for vaccination

Among the 25,058 pregnancies in the Southeast Texas Pregnancy and COVID Cohort, 8.3% ended in miscarriage or abortion, 6.0% of which were further classified as miscarriages, 1.5% as ectopic pregnancies, 51.7% as live births, 0.6% as stillbirths, and 37.9% as deliveries, which can mean either a live birth or stillbirth. Seventeen women died, with five due to any cause and two due to COVID-19 complications around the time of childbirth.

These findings highlight the importance of COVID-19 vaccination and post-COVID management for pregnant people and those planning a pregnancy.

Among the 22,610 singleton pregnancies with gestational age at delivery after 20 weeks, 76.7% were classified by term, with 16.7% preterm (before 37 weeks' gestation). 

The overall risk of miscarriage was 6.3%. Multivariable models tied both mild and moderate-to-severe pre-pregnancy COVID-19 to miscarriage (adjusted odds ratio [aOR], 2.48 and 2.81, respectively). It also linked mild and moderate-to-severe first-trimester infection to miscarriage (aOR, 2.31 and 2.45, respectively).

Risk factors for miscarriage were increasing age, Black or Hispanic ethnicity, and more chronic conditions.

Univariate models linked COVID-19 to miscarriage, and infections 31 to 180, 181 to 365, and more than 365 days before pregnancy had similar effect sizes as no COVID-19 before pregnancy (crude odds ratio, 2.33, 2.32, and 2.75, respectively).

"These findings highlight the importance of COVID-19 vaccination and post-COVID management for pregnant people and those planning a pregnancy," the authors wrote.

The US Centers for Disease Control and Prevention (CDC) is warning people planning to travel to the Region of the Indian Ocean to practice enhanced precautions against chikungunya.

The Level 2 travel notice comes in response to chikungunya outbreaks in Mauritius, Mayotte, Reunion, Somalia, and Sri Lanka. It urges travelers visiting the area to use insect repellent and wear long sleeves and pants to protect against mosquitoes, which spread the virus, and recommends vaccination. The CDC says pregnant women should reconsider travel to the area.

Spread by Aedes aegypti and Aedes albopictus mosquitoes, chikungunya causes fever, severe joint pain, rash, and fatigue. While most cases are self-limited, the disease can affect neurologic and cardiovascular systems, leading to poor outcomes, including death. Yesterday the World Health Organization said Reunion island has had more than 47,500 confirmed chikungunya cases, 12 deaths, and more than 170,000 consultations for suspected chikungunya, while Mayotte has detected its first locally transmitted cases in 19 years.

Although there are two Food and Drug Administration (FDA)-approved chikungunya vaccines, the FDA and CDC last week recommended a pause in the use of Valneva's live-attenuated vaccine (Ixchiq) in people ages 60 and older. The pause was ordered while the agencies investigate five hospitalizations for cardiac or neurologic events in older people after receiving Ixchiq.

A study of positive blood cultures over a 5-year period found that antimicrobial resistance (AMR) was associated with a 10% relative increase in the risk of death among patients with bacteremia, Canadian researchers reported today in Clinical Infectious Diseases.

Using linked microbiologic data from 114 hospital, community, and public health laboratories in Ontario, a team led by researchers from the University of Toronto and Public Health Ontario developed a cohort of patients with positive blood cultures from 2017 through 2021. They focused their analysis on pathogens responsible for at least 150 bloodstream infections and at least 20 associated deaths, and selected antibiotics for which susceptibility results were reported in at least 10% of episodes, with a resistance proportion from 1% to 99%. The primary outcome was 30-day mortality.

A total of 83,962 bacteremia episodes caused by 30 pathogens were identified, with 11 eligible pathogen-antibiotic combinations. Overall 30-day mortality was 17.1%. The most common pathogens were Escherichia coli (30.8%), Staphylococcus aureus (17.6%), and Klebsiella spp. (10.0%). The average patient age was 70 years, and 54.9% were male.

Larger impact for commonly used antibiotics

Across the 110 pathogen-antibiotic combinations studied, any resistance was associated with a 47% increased risk of 30-day mortality (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.32 to 1.65) in unadjusted analyses. But after adjusting for age, sex, healthcare exposures, comorbidities, and co-resistance, the increased risk of 30-day mortality was 10% (HR, 1.10; 95% CI, 1.07 to 1.16). The risk was 18% higher for resistance to antibiotics commonly used for empiric treatment (HR, 1.18; 95% CI, 1.10 to 1.26).

Attributable mortality due to AMR over the study period was 896 deaths, or 1.2 per 100,000 population per year.

"These results suggest that treatment adequacy could be an important mechanism leading to AMR-associated mortality, and that the mortality burden will increase if resistance rates to our most common treatment agents increase," the study authors wrote. "Ongoing surveillance and global collaboration is needed to better document and limit the impacts of antimicrobial resistance."