An investigation into an occupational mpox infection in a California physician found multiple possibilities for transmission, including contact with contaminated surfaces. Investigators from the Centers for Disease Control and Prevention and their partners in California detailed their findings yesterday in a letter in Emerging Infectious Diseases.

They note that many mpox infections have been reported in healthcare workers, but only a few were due to occupational exposure.

The 40-year-old woman's symptoms began in August with muscle aches, fatigue, and headache. Over the next week, she developed small raised lesions along with fever and sore throat, and a swab sample was positive for mpox. She was received a 2-week course of tecovirimat (Tpoxx) and recovered with no complications.

An investigation revealed that she works at two clinics that mainly serve LGBTQ+ patients and those with HIV. The doctor regularly sees patients with mpox, and during those visits, she wears full personal protective equipment (PPE). However, during her incubation she met with two patients with suspected infections, during which she wore a surgical mask and gloves. When she learned that the patients had suspected mpox symptoms, in both instances she left the exam room and donned PPE before swabbing the patients' lesions.

Samples from both patients were positive for mpox. A review of 159 other patients she saw during her incubation period found that three were tested for mpox. One was positive, but the patient's lesions had healed before the exam date.

As part of the investigation, researchers made a site visit to a clinic. They said the doctor's mpox infection could have been acquired through inadvertent contamination during specimen collection, contact with contaminated environmental surfaces in the exam room or bathroom, or skin contamination during glove doffing.

Annual funding for tuberculosis (TB) research reached $1 billion worldwide for the first time in 2021, a milestone that nonetheless remains far short of what's needed, according to a report today from the Stop TB Partnership and Treatment Action Group (TAG).

The $1 billion committed for research into new drugs, diagnostics, and vaccines for TB in 2021 is roughly three times the amount raised in 2005, when TAG first began tracking TB research and development (R&D) funding. But it's only half the annual amount that countries committed to raising at the United Nations (UN) High-Level Meeting on TB in 2018. The funding is aimed at achieving the UN and World Health Organization (WHO) goal of eliminating TB as a global health threat by 2030.

Stop TB Partnership and TAG also say that after years of severe underinvestment and in the wake of COVID-19 pandemic-related disruptions to TB services, the annual amount needed for TB R&D has risen.

$5 billion a year needed

"We're proud that two decades of activism and scientific advances have led to this unprecedented level of funding for TB research," TAG Executive Director Mark Harrington said in a press release. "But we remain disappointed at the pandemic inequity that holds back progress on TB diagnosis, prevention, and treatment. This number must grow to US$5 billion per year."

That figure comes from a July report by Stop TB Partnership, which estimated that a total of $40 billion ($5 billion per year) would be needed for research into drugs, diagnostics, and vaccines from 2023 to 2030 to eliminate TB as a public health threat. The report estimated that hitting the funding target would help reduce TB cases by 80% and deaths by 90% by 2030, compared with 2015 levels.

The largest individual funder of TB research in 2021 was the US National Institutes of Health, which contributed $354 million, up from $339 million in 2020. Overall, the US government contributed $416 million. 

A recent report from the WHO found that, in the wake of pandemic-related disruptions to essential TB services, global TB cases rose in 2021—the first increase seen in nearly two decades.

Americans with attention-deficit hyperactivity disorder (ADHD) are struggling to find good alternatives to the stimulant Adderall, which has been in short supply this fall and will likely not be back in stock until early next year.

About 6 million US children aged 3 to 17 years have been diagnosed as having ADHD, and 62% take a medication to help them focus and control their behavior, according to the Centers for Disease Control and Prevention. The estimated prevalence of ADHD among college students is 11.6%; among adults, the prevalence is 4.4%.

The US Food and Drug Administration (FDA) announced the shortage of Adderall in October: "FDA is in frequent communication with all manufacturers of amphetamine mixed salts [Adderall], and one of those companies, Teva, is experiencing ongoing intermittent manufacturing delays. Other manufacturers continue to produce amphetamine mixed salts, but there is not sufficient supply to continue to meet U.S. market demand through those producers."

Pharmacies, though, had begun reporting shortages of Adderall over the summer, when 64% reported difficulty obtaining the drug. Teva, the leading manufacturer of Adderall for the US market, blamed the shortage on intermittent manufacturing delays due to ongoing worker shortages, according to the Wall Street Journal.

Increased demand

Demand has also been rising for Adderall, with an increase of nearly 20% in 2021 over 2020. Getting a prescription also became easier in 2020, when the US government eased rules to allow Adderall prescribing during telehealth visits.

Adderall is a controlled substance and therefore highly regulated by the US government, and the Drug Enforcement Administration (DEA) maintains strict rules on maximum production to avoid patient abuse of the drug. The DEA is unlikely to raise those limits in 2023, DrugWatch reports.

While awaiting a resupply, patients and parents should talk with their healthcare provider about alternative ADHD drugs such as Ritalin, Concerta, and Strattera, Nidhi Kumar, MD, of Saint Peter's Healthcare System in New Jersey, told CBS News.

Amid an unprecedented increase in global cholera activity, eight infections in travelers returning from affected areas have been reported in the United States, the Centers for Disease Control and Prevention (CDC) said in an email to clinicians yesterday.

The patients were returning from Pakistan, Iraq, and Bangladesh. The CDC says 25 countries are currently experiencing active cholera transmission.

Though cholera infections are rare and community transmission in the United States is unlikely, the CDC urged providers to obtain a travel history when they evaluate patients who have acute onset of watery diarrhea. It also recommends obtaining a stool sample for testing and promptly starting treatment.

The agency also urged clinicians to brush up on how to diagnose and treat cholera, pointing to CDC resources. And officials recommended that pharmacies and medical facilities have ample supplies of rehydration products. The notice also covered recommendations for labs, state health officials, and the public.

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today announced the first highly pathogenic avian flu outbreak in Alabama poultry, part of expanding spread of the Eurasian H5N1 strain that has been circulating in US birds since the first of the year.

The outbreak in Alabama struck a backyard flock in Lawrence County, which is in the northwestern part of the state. The detection lifts the number of states that have reported outbreaks in poultry to 47. So far, the events have led to the loss of a record 52.7 million birds.

H5N1 has previously reported in wild birds from Alabama, most recently in several black vultures found dead in Montgomery County, located in the central part of the state.