Health officials in three more states—Illinois, Arizona, and Virginia—announced steps to ease access to updated COVID-19 vaccines in light of barriers and confusion linked to recent federal policy changes and recommendations.

Illinois Governor JB Pritzker today signed an executive order to protect vaccine access during the upcoming respiratory virus season. It allows providers in pharmacies and clinical settings to administer COVID and other vaccines recommended by Illinois Department of Public Health (IDPH) in consultation with its Immunization Advisory Committee.

IDPH Director Sameer Vohra, MD, JD, said in a news release, "With confusing and conflicting guidelines from the federal government, the Executive Order ensures Illinois residents have the credible, transparent, and science-based guidance they need."

Protecting 'health care freedom'

And yesterday Arizona Governor Katie Hobbs announced that she has signed an executive order that directs the health department and board of pharmacy to make vaccines, including the updated COVID vaccines, broadly accessible and available to state residents who want them. The step also allows the Arizona Department of Health Services to issue a standing order that allows pharmacists and healthcare providers to administer vaccines without a prescription in accordance with nationally recognized clinical guidance.

"We are taking action to protect the health care freedom of Arizonans," Hobbs said. "With this Executive Order, we are following the science and ensuring that Arizonans have access to vaccines to keep themselves and their families."

Also, the Virginia Department of Health yesterday announced that State Health Commissioner Karen Shelton, MD, has signed a new statewide standing order that allows pharmacists to administer the updated COVID vaccines without a prescription to people ages 65 and older and those ages 18 to 64 years old who have at least one underlying medical condition. 

"We realize this has been top of mind for many Virginians in the past several days," she said, "and we are resolved to increase access to the updated formulation of the COVID-19 vaccine to all eligible Virginians."

Other states have taken other similar recent actions, including Pennsylvania, Colorado, Massachusetts, Minnesota, New York, and New Jersey.

The Los Angles County Department of Public Health (LADPH) yesterday urged residents to make sure family members are protected from measles following the death of a school-age child who was infected with the virus during infancy and developed a rare complication from the disease called subacute sclerosing panencephalitis (SSPE). Health officials said SSPE is typically fatal in people who were infected with measles during early life. 

The warning comes amid a growing US measles outbreak and during a record year for case since the United States achieved measles elimination status in 2000.

The LADPH said the child originally had measles before he or she was eligible to receive the vaccine. The first dose is typically given between 12 and 25 months.

SSPE is a progressive brain disorder that is a late complication from measles, typically surfacing 2 to 10 years after the initial infection and after the patient has seemingly recovered. Death typically occurs about 3 years after SSPE is diagnosed. There is no cure, and the LADPH said the condition affects an estimated 1 in 10,000 people with measles, but the risk is thought to be much higher—at 1 in 600—in those who had measles as infants. 

Muntu Davis, MD, MPH, the county's public health officer, said the death is a painful reminder of how dangerous measles can be for the most vulnerable people. "Infants too young to be vaccinated rely on all of us to help protect them through community immunity. Vaccination is not just about protecting yourself—it's about protecting your family, your neighbors, and especially children who are too young to be vaccinated."

Georgia announces measles case

In related news, the Georgia Department of Public Health today announced another measles case, which involves an unvaccinated Fulton County resident who has no known history of international travel. The patient is no longer infectious, but may have exposed others from September 2 to September 11. 

Some of the exposure locations include Georgia State University, a restaurant on multiple days, and soccer games and practices. 

A new study by US and Indian researchers indicates that improving knowledge about appropriate antibiotic use among healthcare providers in India and other low- and middle-income countries may not be enough to reduce inappropriate prescribing, researchers reported this week in Science Advances.

The two-part study, conducted in two Indian states (Karnataka and Bihar), involved a survey of 2,282 private healthcare providers and anonymized standardized patient (SP) visits using paid actors. 

The surveys measured knowledge about appropriate antibiotic prescribing using a vignette that described a case of viral child diarrhea with no indications of a bacterial infection. The SP visits with the providers presented the same scenario described in the vignettes. The providers included doctors with MBBS degrees, traditional-medicine practitioners, rural medicine providers, and pharmacists.

The survey results showed that 50% of the providers said they would prescribe antibiotics when presented with the vignette, a finding the study authors say indicates a substantial "know gap" and room for improvement in knowledge. But the SP visits revealed that even among the 50% of providers who appropriately said they would not prescribe antibiotics, 62% still prescribed antibiotics to SPs who described the same scenario as the vignette. The authors call this the "know-do" gap.

"The know gap and know-do gap was large among all provider types, but both the know gap and know-do gap were largest among providers with the least amount of training (rural medical providers and pharmacy workers)," they wrote.

Providers influenced by patient preferences

Further analysis of the results found that correct knowledge was only loosely associated with appropriate antibiotic prescribing and that antibiotic prescribing was more sensitive to patients' expressed preferences. 

When SPs expressed a preference for oral rehydration salts, providers with correct knowledge were 20% less likely to prescribe antibiotics, compared with only a 5% reduction when SPs expressed no preference. Financial incentives had little impact on the know-do gap.

"Future work should design and test interventions to change provider perceptions that patients want antibiotics to reduce the know-do gap as such efforts have the potential to reduce inappropriate antibiotics prescribing and subsequent antibiotic resistance," the authors concluded.

• Local spread of mosquito-borne diseases continue to accelerate in parts of Europe, with France this week reporting 82 more chikungunya cases, raising its total to 383, along with 2 more dengue cases, bringing that total to 21, the European Centres for Disease Prevention and Control (ECDC) said today in its weekly communicable disease update. Italy reported 60 more locally acquired chikungunya cases, raising its total to 167, but officials noted no new local dengue cases. In another development, two probable local Plasmodium falciparum malaria cases were confirmed in Greece, along with another with an undetermined place and mode of infection. The probable local cases involve two migrants and are epidemiologically linked. Their suspected infection location is a rural village in central Greece. The other case involves a migrant from a non-endemic country in North Africa who arrived on a Greek island in June before moving to a migrant facility in Attica. The patient's symptoms began in late July.
• Three countries—Chad, Nigeria, and Somalia—reported new polio cases this week, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI). All involve vaccine-derived types. Chad reported 2 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases in patients with late July illness onsets, raising its total for the year to 18. The country also reported a circulating vaccine-derived poliovirus type 3 (cVDPV3) case with a July onset, its second such case of 2025. Nigeria reported 4 cVDPV2 cases, 1 with a May paralysis onset and 3 with onsets in July, pushing its total to 28. Somalia reported one new cVDPV2 case with a June paralysis onset, putting its total at eight.
• In the latest H5N1 avian flu developments, more outbreaks in poultry have been confirmed in two states, part of a late-summer uptick in activity, according to the latest notifications from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). South Dakota has two more outbreaks, one at a turkey farm in Jerauld County and the other at a facility in Spink County. The virus also struck a producer in Liberty County, Montana, that has 5,800 birds. Meanwhile, the Maryland Department of Agriculture announced a presumed positive involving a backyard flock in Anne Arundel County, marking the state's third detection of 2025.