After 2 days with no new Marburg virus cases, Rwanda’s health ministry today reported three new infections and one more death from the disease, raising the outbreak total to 61 cases, 14 of them fatal.

The ministry said all new cases reported since its initial announcement have been within a hospital cluster in Kigali and their contacts. Thirty one people remain in isolation and treatment, and 16 people have recovered from their illnesses.

Vaccination using an experimental Marburg vaccine from the Sabin Vaccine Institute launched last weekend, and 501 people at high risk have now been immunized.

WHO weighs in on outbreak developments, travel advisories

In a related development, the World Health Organization (WHO) posted an update on Rwanda’s update, its first, noting that the vast majority of cases are from three districts within Kigali. All new cases confirmed in the past week are associated with two hospital clusters in Kigali, the country’s capital.

So far, more than 700 contacts have been identified and are under monitoring. The contact who is known to have traveled to Germany is still being monitored by local health officials, and a contact who traveled to Belgium has completed the 21-day monitoring period.

Separately, the WHO issued a statement yesterday that said travel and trade restrictions are ineffective for controlling the ongoing Marburg outbreak in Rwanda, and can hurt affected countries and discourage countries from rapidly sharing data. It noted that several countries have introduced travel-related measures, including temporarily discouraging travel to Rwanda. The United States recently upgraded its travel advisory for Rwanda, recommending against nonessential travel, and announced that health screening for inbound travelers from Rwanda will begin on October 14.

COVID activity in the United States continues to decline, and seasonal flu markers show no upticks, according to the latest respiratory disease updates today from the US Centers for Disease Control and Prevention.

For COVID, test positivity has declined to 7.7% nationally, but is a little higher in the Western region that includes the Dakotas, Montana, Wyoming, Colorado, and Utah. Emergency department visits for COVID continue to decline. Hospitalizations remain on a downward trend. Deaths also declined, though CDC provisional data show 424 people died from their COVID infections last week.

CDC SARS-CoV-2 detections drop to low level

CDC wastewater detections have now declined to low, with levels in the West a bit higher than other regions. Tracking from WastewaterSCAN, a national wastewater monitoring system based at Stanford University in partnership with Emory University, shows that SARS-CoV-2 detections are at the medium level nationally, with a 3-week downward trend. The South is now at the low level. 

For flu, activity is still at the low level, and of the few viruses reported by public health labs last week, 55.8% were the 2009 H1N1 strain and 42.2% were H3N2, the CDC in its latest weekly FluView report.

The Environmental Protection Agency (EPA) this week finalized its framework for expanding federal collaboration on the review of antibacterial and antifungal pesticides.

The framework establishes a process through which the EPA will consider expert input from other federal agencies when evaluating whether use of antibacterial or antifungal pesticides may result in the development or spread of antibacterial or antifungal resistance. It was developed in coordination with the Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA).

Farmers use antibacterial and antifungal pesticides to treat crop diseases such as apple scab, citrus greening, fire blight, and gray mold. But there is concern that widespread use of these pesticides, which share characteristics or modes of action with antibiotics and antifungals used in human and animal medicine, could promote the development of resistance to those drugs, potentially reducing their effectiveness.

Balancing risks, benefits

The EPA says the framework is designed to recognize the benefits of these pesticides to agriculture while minimizing their impact on human and animal health and considering the issue through a One Health approach.

"This framework will strengthen the shared goals of EPA, HHS, USDA, and the White House in protecting relevant human and animal drugs while ensuring growers can continue to have access to important tools to protect their crops from fungal and bacterial diseases," Ed Messina, JD, director of EPA’s Office of Pesticide Programs, said in an agency press release.

For people with chronic diseases, an electronic nudge increased influenza vaccination compared to usual care, researchers reported in a new study published in JAMA.

During the 2022 to 2023 influenza season in Denmark, only 40.7% of patients with diabetes and 44.6% of patients with heart failure obtained vaccination, the authors said. In an effort to increase uptake, the study authors designed six electronic letters to be sent to patients emphasizing benefits of vaccination. 

In total, 299,881 Danish patients aged 18 to 64 years with chronic diseases were included in the study. The main outcome was receipt of seasonal flu vaccine by January 2024.

Influenza vaccination rates were higher among those receiving any intervention letter (39.6%) compared to the standard care of no letter (27.9%). A letter emphasizing the benefits of vaccination for cardiac health was most effective, with 39.8% vaccinated compared to 27.9% in standard care.

The results of this study suggest that simple, scalable, and cost-efficient electronic letter strategies may have substantial public health implications.

"The results of this study suggest that simple, scalable, and cost-efficient electronic letter strategies may have substantial public health implications," the authors concluded. 

Four countries have new polio cases this week, including Pakistan with four more wild poliovirus type 1 (WPV1) cases and Angola, Nigeria, and South Sudan with vaccine-derived cases, according to the weekly report from the Global Polio Eradication Initiative (GPEI).

Also noted in the report, Spain has its first positive environmental sample, from Barcelona, and French Guiana has multiple positive environmental samples. 

Pakistan now has 28 cases of WPV1 this year. The new cases all experienced paralysis onset in September, and were located in Balochistan, Khyber Pakhtunkhwa, and Sindh provinces.

In Angola, the new detection of a circulating vaccine-derived poliovirus type 2 (cVDPV2) case raises the year’s total to seven. Nigeria now has 61 cVDPV2 cases for 2024 after this week’s four cases, and South Sudan now has nine. 

First environmental sample detected in Spain 

Two countries reported environmental samples of vaccine-derived polio for the first time this week.

"One cVDPV2-positive environmental sample has been reported this week, from the Barcelona metropolitan area, Catalonia, with collection in September," the GPEI said. "This is the first time cVDPV2 has been reported in Spain."

This is the first time cVDPV2 has been reported in Spain.

Similarly, French Guianareported three circulating vaccine-derived poliovirus type 3-positive environmental samples collected in Cayenne province in May, June, and August.