The Public Health Agency of Canada (PHAC) has published a new list of the drug-resistant bacteria that pose the greatest health threat to Canadians.

The 2025 Antimicrobial Resistance (AMR) Priority Pathogen list, published yesterday in PLOS One, was developed by AMR experts from PHAC and the Canadian AMR Surveillance System (CARSS) using nationally representative surveillance data from 2017 through 2022 and nine prioritization criteria that reflect the country's public health priorities. Prioritization criteria included incidence, trend (change in the proportion of resistant cases), mode of transmission, morbidity, mortality, treatability, and equity, which was newly added to the list to reflect level of exposure to resistant bacteria and barriers to treatment.

Of the 68 pathogens initially identified as AMR threats, 29 were selected for full evaluation. The Tier 1 group, defined as high-priority pathogens based on their scores, includes carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), carbapenem-resistant Acinetobacter (CRA), drug-resistant gonorrhea, Candida auris, and extended-spectrum beta-lactamase–producing Enterobacterales. 

"High rankings for CRE, CRPA, and CRA were primarily driven by treatability challenges, with limited or absent treatment options, including barriers to access, and the more severe disease outcomes associated with these infections," the authors wrote.

The medium-priority group (Tier 2) includes methicillin-resistant Staphylococcus aureus, drug-resistant Streptococcus pneumoniae, drug-resistant Shigella, and vancomycin-resistant Enterococcus. Pathogens in the Tier 3 group (medium to low priority) include Clostridioides difficile, drug-resistant Salmonella, and multidrug-resistant tuberculosis, and Tier 4 (low priority) includes drug-resistant Campylobacter and drug-resistant Helicobacter pylori.

A 'more inclusive' assessment of AMR threats

The authors say a key finding is that 45% of the assessed AMR pathogens disproportionately affect populations experiencing "social or economic marginalization and structural barriers to health," such as sex workers, men who have sex with men, the homeless, and refugees or migrants from conflict or disaster-affected regions.

"By explicitly integrating health equity as a prioritization criterion for the first time, this exercise allowed for a more inclusive and contextually grounded assessment of AMR threats in Canada," they wrote. "Rather than relying solely on traditional metrics such as incidence or mortality, this approach recognizes that vulnerability to AMR is shaped by broader social determinants of health."

Four people from four geographically distinct areas of Bangladesh have died of Nipah virus infections this year, the World Health Organization (WHO) announced today.

The unrelated cases, which occurred between January 1 and August 29, include a child who died in August, outside of the country's usual Nipah virus season (December to April), and three adults (two men and one woman) with a history of consuming raw palm sap, a known risk. The child, a boy, wasn't known to have consumed raw palm sap, and his exposure is under investigation. 

The deaths occurred in Barisal, Dhaka, and Rajshahi divisions in the Bhola, Faridpur, and Pabna districts, respectively. Last year, five fatal Nipah cases were reported in the country.

Risk of international spread low 

Since Bangladesh experienced its first Nipah virus outbreak in 2001, human cases have been identified nearly every year, the WHO said. Of the 347 people with documented infections since 2001, 71.7% have died. 

WHO assesses the overall public health risk posed by NiV [Nipah virus] at the national and regional levels to be moderate; the risk of international disease spread is considered low.

"The Ministry of Health and Family Welfare in Bangladesh has implemented several public health measures with support from WHO," the statement said. "WHO assesses the overall public health risk posed by NiV [Nipah virus] at the national and regional levels to be moderate; the risk of international disease spread is considered low."

No drugs or vaccines against the virus are available, and treatment of severe respiratory and neurologic complications consists of intensive supportive care.

Nipah is transmitted from animals such as fruit bats and pigs to people, from person to person through close contact, and through food contaminated with the saliva, urine, and waste of infected animals. Nipah virus infection, which can cause severe illness and death in both people and animals, primarily causes outbreaks in South and South East Asia.

Infected people initially develop symptoms such as fever, headaches, muscle pain, vomiting, and a sore throat. In severe cases, dizziness, drowsiness, altered consciousness, and neurologic signs can occur, indicating acute encephalitis (brain inflammation). Atypical pneumonia and severe respiratory problems sometimes develop, and encephalitis, seizures, and coma may ensue within 24 to 48 hours.

Over the past week, health officials in in the Democratic Republic of the Congo (DRC) have confirmed two more Ebola virus cases and reported seven more deaths, raising the total to 38 confirmed cases and 23 deaths, a top official from the Africa Centres for Disease Control and Prevention (Africa CDC) said today.  Ten deaths were reported earlier in people with suspected infections.

At a weekly briefing today, Yap Boum, PhD, MPH, deputy incident manager for Africa CDC's mpox response, said 23 people are currently under medical care, 17 with confirmed infection and 6 with suspected illnesses. Males make up 52% of cases, and children account for 44%. 

Cases are concentrated in six areas of Bulape health zone in Kasai province, which he said is a sign of control but also requires vigilance.

Boum said more than 1,000 contacts have been identified, with a case-to-contact ratio of 1:20, which he said is a sign of good progress with surveillance. Healthcare workers have vaccinated 613 people, including 68 medical colleagues, a group vulnerable to the virus, which spreads through infected body fluids.

Treatment center expands; WHO launches appeal

In other developments, the Ebola treatment center in Bulape has expanded from 21 to 34 beds. Boum said the main priorities are to continue identifying contacts, beef up cross-border surveillance, and scale up community engagement.

The head of the World Health Organization (WHO) also addressed the DRC’s latest Ebola outbreak at a briefing today on global health issues. Tedros Adhanom Ghebreyesus, PhD, congratulated the DRC on its leadership in responding to the outbreak declaration 2 weeks ago. “Years of investment and experience are paying off,” he said.

He added that 14 people have received treatment with the monoclonal antibody MAb114 (ansuvimab-zykl, also known as Ebanga). Earlier this week, two patients were discharged from treatment.

Following earlier deployment of medical equipment and experts, Tedros said the WHO is also launching an appeal for $21 million to help the DRC scale up its response to the Ebola outbreak.