In its latest weekly update today, the US Centers for Disease Control and Prevention (CDC) reported 30 more measles cases, putting the national total at 1,544, a record high since the United States eliminated the disease in 2000.

Two more outbreaks were reported, bringing the total to 42. The CDC said 86% of cases are linked to outbreaks, and 92% of patients are unvaccinated or have an unknown vaccination status. The number of affected jurisdictions remained the same, at 42. 

So far, 21 cases have been reported in international visitors.

Minnesota cases surge, another from Chicago suburbs

In related developments, the Minnesota Department of Health today reported 10 more measles cases, pushing the state’s total for the year to 18. All involve unvaccinated people. 

Seven of the cases are within families that had recent domestic travel and three unrelated cases were linked to international travel. 

Jessica Hancock-Allen, NP, MPH, director of the infectious disease division at MDH, said in a statement, “We are encouraging families to be aware of symptoms of measles, particularly the rash, and call their health care provider if they notice a rash—especially if their child is unvaccinated and has been exposed to someone with measles or has travelled recently. We are also reminding our health care provider partners to think about measles and ask about travel—domestic or international—and possible exposures if a patient has any symptoms of measles.” 

Meanwhile, Cook County Public Health yesterday confirmed its third case, a suburban Cook County adult whose vaccination status is unknown. Health officials said the patient likely contracted the virus from the county’s last reported case, which it announced on September 16. That patient was a 4-year-old child who traveled internationally and may have exposed people at O’Hare International Airport.

Regarding the new case, the health department said exposure may have occurred at an Aldi grocery store in Crestwood on the evening of September 24.

Valneva today reported strong antibody persistence for Ixchiq, its live-attenuated vaccine against chikungunya, a virus spread by mosquitoes.

In a press release, the company said data from 254 healthy adults suggested that 95% retained an antibody response above the seroresponse threshold for 4 years after a single dose. Antibody persistence in adults age 65 and older was similar to that for younger adults, which held for geometric mean titers and seroresponse rates.

Juan Carlos Jaramillo, MD, Valneva’s chief medical officer, said the company is encouraged by the data showing durable protection with just a single dose.  “Whether you are a traveler, live in an endemic area, or face an outbreak situation, the prospect of long-term protection from a mosquito-borne disease with a single vaccination is highly valuable, especially in low- and middle-income countries where vaccine access is often limited.”  

Valneva added that the trial will track antibody persistence up to 10 years after vaccination.

No new safety concerns reported

The trial, funded by the Coalition for Epidemic Preparedness (CEPI) and the European Union’s (EU) Horizon Europe program, also looked at long-term safety data for up to 2 years and found no adverse events of special interest from the earlier trial or any new-onset severe adverse events from when participants enrolled in the study.

Following reports of severe adverse events in seniors and those with underlying health conditions earlier this year, the European Medicines Agency temporarily paused use of the vaccine in those groups in May, but in July reversed the pause after a thorough review. The US Food and Drug Administration, however, suspended Valneva’s license for the vaccine.

A study conducted at a community hospital in New Jersey highlights the excess costs associated with recurrent Clostridioides difficile infection (CDI), researchers reported this week in Infection Control & Hospital Epidemiology.

The retrospective study of patient medical records by clinicians at AtlantiCare Regional Medical Center included patients who had three or more inpatient admissions due to CDI from January 2017 through December 2020. Although few studies have looked at the net economic impact of treating recurrent-CDI patients at the hospital level, healthcare costs for recurrent cases are notably higher than they are for an initial CDI case.

CDI is the most common cause of hospital-associated diarrhea, affecting more than 500,000 Americans annually. An initial episode is a known risk factor for recurrence. An estimated 25% to 30% of patients with an initial CDI case experience a recurrence, and 50% to 65% of patients with one recurrence experience subsequent cases. 

Net loss of more than $2 million 

Among the 29 patients included in the analysis (median age, 58.9 years; 55% female), there were 108 admissions, 1,006 inpatient hospital days, and 74 days in the intensive care unit over the study period. Patients had a median of three admissions, with a median length of stay of 7 days. Total hospitalization costs were estimated to be $3,352,400, and the estimated reimbursement received by the hospital was $1,119,043.

"Thus, we estimated that the community teaching hospital had a net loss of $2,232,997 over the 4-year period due to CDI-related hospitalizations," the study authors wrote. "This translates to a net loss per patient of approximately $77,000 over the 4-year study period."

The authors add that their analysis may underestimate the true financial losses incurred, since they assumed full reimbursement, and that may not always be the case.

They concluded, "Our findings indicate that there is an ongoing cycle of CDI admissions among a subset of patients who experience CDI, which poses a substantial economic impact on the hospital."

Today, Morbidity and Mortality Weekly Report published updated guidance from the US Centers for Disease Control and Prevention (CDC) on postexposure prophylaxis (prevention) and treatment of the rare but potentially serious tickborne disease tularemia.

The recommendations are aimed at healthcare providers caring for patients with naturally occurring infections or, in the case of bioterrorist deployment of the pathogen, working with preparedness experts and public health authorities to prepare their clinics, hospitals, and communities.

Tularemia is caused by the gram-negative bacteria Francisella tularensis, which spreads through bites from ticks, deer flies, and mosquitoes. Infections occur naturally in the Northern Hemisphere, with up to 300 cases in the United States each year. But because only a small amount of pathogen is required for infection, tularemia is classified as a bioterrorism agent that could sicken thousands of people.

Intentional release of the pathogen would require public health agencies, first responders, and clinicians to make rapid decisions. "To mitigate the effects of a bioterrorism attack, the US government stockpiles medical countermeasures, and the 21st Century Cures Act mandates development of evidence-based guidelines for their use," the authors wrote.

First-line treatments, group-specific recommendations

To create the guidelines, the CDC conducted systematic literature reviews on human tularemia cases through 2023, analyzed surveillance data, compiled outbreak reports and case series, gathered animal data, and consulted with experts.

In the wake of a bioterrorism attack, initial treatment with two distinct effective antimicrobial classes is recommended because of the risk for engineered antimicrobial resistance.

Key departures from the 2001 guidelines include use of a prophylaxis and treatment framework and designation of fluoroquinolone antibiotics (ciprofloxacin and levofloxacin) and doxycycline as first-line treatments for outbreaks. 

Other changes include identification of third-tier treatments if first-line and alternative antimicrobials are unavailable or contraindicated, and guidance for newborns, breastfeeding infants, lactating mothers, patients with weakened immune systems, and older people.

The recommendations don't include information on dispensing treatments, diagnostic testing, triage, or adjunct therapies. 

"In the wake of a bioterrorism attack, initial treatment with two distinct effective antimicrobial classes is recommended because of the risk for engineered antimicrobial resistance," the authors wrote.

• The Mississippi State Department of Health (MSDH) this week reported a pertussis (whopping cough) death in an infant younger than 2 months old who was too young to be vaccinated. Officials said the state has recorded 115 pertussis cases this year, sharply higher than the 49 cases reported in 2024. With the latest infant pertussis death, Mississippi has now reported three since 2008. Pertussis activity remains elevated in the United States, following a post-COVID pandemic peak in 2024, according to the US Centers for Disease Control and Prevention (CDC). Babies ages 1 year and younger are at highest risk for severe disease and complications.
• In New York, Madison County Public Health on September 22 announced that it was investigating a confirmed Eastern equine encephalitis (EEE) illness in a county resident. The 79-year-old man died from his infection, a local media outlet reported yesterday, adding that his death was central New York’s first from EEE case since 2015. EEE is a rare mosquito-borne viral disease that is sometimes fatal and can cause long-term neurologic problems. The CDC as of yesterday had reported three cases from three states—Maine, New York, and South Carolina—this year, all of which involved neuroinvasive disease.
• The CDC on September 26 issued a level 2 (practice enhanced precautions) travel notice for a chikungunya outbreak in Cuba. Health officials urged travelers to take steps to prevent mosquito bites and to be vaccinated if visiting an outbreak area. They also urged pregnant women to reconsider travel to affected areas, especially if close to the delivery date, due to the risk of contracting the virus and passing it to the baby. Cibercuba, an Cuban expat media outlet based in Spain, reported that Matanzas province is experiencing an alarming rise in suspected dengue and chikungunya infections.