The latest Quinnipiac University poll finds only one third (33%) of surveyed US adults approve of the job US Secretary of Health and Human Services Robert F. Kennedy Jr. is doing and that 67% support school-based vaccine requirements.

Kennedy's approval has dropped from a June 11 poll, which showed 38% approved of the job he was doing. Only 17% of those polled in the current survey said they were very confident in medical information from Kennedy. Twenty-two percent said they were somewhat confident, 11% said they were not so confident, and 46% were not confident at all. 

The poll surveyed 1,276 registered voters nationwide from September 18 to 21 and has a margin of error of plus or minus 3.3 percentage points.

Republicans split on school vaccines

Democrats (91%) and independent voters (70%) were overwhelmingly in favor of vaccine requirements for children attending public schools. Republicans were split on the issue; 44% supported mandates and 46% opposed them. 

Overall, 79% of respondents say the United States is in a "political crisis," including most Democrats (90%), Independents (84%), and Republicans (60%). 

A study led by researchers at the University of California, San Francisco identified pervasive gaps in tuberculosis (TB) testing and treatment for non–US-born adults at US community health centers.

The retrospective cohort study, published yesterday in Open Forum Infectious Diseases, analyzed individual-level demographic and TB clinical data on non–US-born adults who sought care at 12 community clinics from June to December 2019. Over 70% of people with TB in the United States were born or lived outside of the country in settings with a high incidence of TB, with over 90% of these diagnoses attributed to reactivation of asymptomatic or latent TB infection (LTBI) acquired before immigration. The aim of the study was to characterize the LTBI "care cascade" (screening, testing, and treatment) in the community healthcare clinics where immigrants typically receive primary care.

"Systematic reviews have highlighted large gaps in TB infection testing and treatment for persons migrating from high to low-TB incidence settings with a wide range of barriers to guideline-directed care," the study authors wrote. "However, there are limited data on the gaps in care for non-U.S.-born persons from geographically diverse primary care clinics in the U.S."

Only 1 in 3 tested for TB

A total of 8,460 non–US-born adults were included in the analysis, with a median of 702 per site. Of those included, 2,765 (33%) had at least one TB infection test ordered, 2,572 had valid results for at least one test, and 1,022 had at least one positive result. 

Among the 1,022 with a positive test, 787 (77%) were diagnosed as having a TB infection, of whom 377 (48%) were offered preventive treatment at the seven clinics that provided on-site LTBI treatment. Of the 173 patients who were treated at those clinics, 141 (82%) completed treatment. Another 190 patients were referred to an outside clinic, with no follow-up recorded.

The authors say research is needed to identify strategies that could increase TB preventive care in populations who face a disproportionate burden of disease.

"Integrated and person-centered approaches to addressing access, implementation and quality barriers along the entire cascade have the greatest potential to improve outcomes," they wrote.

The first serologic survey of animals in southern France reveals that Crimean-Congo hemorrhagic fever virus (CCHFV), which is fatal in up to 40% of people, has been circulating among cattle and wildlife for years, with antibodies against the tickborne virus identified in over 2% of samples.

Researchers in Montpellier, France, used enzyme-linked immunosorbent assays (ELISA) and pseudo-plaque reduction neutralization tests (PPRNT) to detect CCHFV antibodies in blood samples from 8,609 cattle and 2,182 wild animals (eg, wild boars, red deer) from 2008 to 2022.

One of the deadliest viruses, CCHFV recently expanded into Western Europe via Hyalomma ticks carried by migratory birds. It was already circulating in Africa, the Balkans, the Middle East, and Asia. There is no vaccine or antiviral drug for the illness.

The findings were published yesterday in PLOS One.

Risk factors for infection

In total, 2.04% of cattle and 2.25% of wild animals tested positive for CCHFV antibodies, with higher rates seen in the Pyrenees-Orientales and Hautes-Pyrenees regions along the Spanish border.

These findings reveal spatial clusters of CCHFV circulation and suggest the existence of enzootic [continual] transmission cycles involving local tick vectors and animal hosts.

Risk factors that influenced seropositivity in cattle were older age and living in a natural open habitat, while male sex and geographic location affected wildlife seroprevalence.

"These findings reveal spatial clusters of CCHFV circulation and suggest the existence of enzootic [continual] transmission cycles involving local tick vectors and animal hosts," the authors wrote. "These findings highlight the importance of environmental and anthropogenic factors in shaping the dynamics of CCHFV transmission."

"It also raises questions about the role of additional tick vectors, such as Hyalomma lusitanicum, in the transmission cycle," they added. The team called for continued surveillance and integrated approaches to monitor zoonotic pathogens.

In related news, the University of California-Riverside has received a 5-year, $3.4 million grant from the National Institutes of Health to detect CCHFV antibodies in survivors in Kazakhstan, Turkey, and Uganda. The team will also explore how the immune system attacks the virus and will work to develop monoclonal antibody treatments against different strains.

• The Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) today announced that highly pathogenic H5N1 avian flu has been detected in commercial poultry in Jefferson County, in the southeast, east of Madison. The agency is working with the US Department of Agriculture (USDA) on a joint incident response and said the birds will be culled. It added that the Wisconsin Department of Health Services and Jefferson County Public Health are monitoring exposed farm workers. The DATCP's poultry outbreak page says the Jefferson County farm has more than 3 million birds and the outbreak is the state's first since April. The finding is part of a recent rise in poultry outbreaks in a handful of Midwestern states.
• The New Mexico Department of Health yesterday reported its second plague case of the year, which involves a 77-year-old man from Bernalillo County, home to Albuquerque. The man was hospitalized and has now been discharged. The state said it averages about two plague infections a year. The disease, caused by Yersinia pestis, is spread by rodents, which can transmit the bacteria to humans through infected fleas. Symptoms in people include sudden fever onset, chills, headache, weakness, and often swollen, painful lymph nodes.
• The UK Health Security Agency (HSA) today announced the opening of a new Moderna Innovation and Technology Centre in Harwell that has the capacity to make up to 250 million mRNA vaccine doses in a year in the event of a pandemic. In a statement, the HSA also said the country has established a $66.7 million (£50 million) fund to bring more research and development investments to the country and that Moderna is investing more than $1.3 billion (£1 billion) in a partnership with the United Kingdom over the next 10 years to discover new therapies, create jobs, and bolster pandemic preparedness.