Minnesota has reported two more highly pathogenic avian influenza outbreaks at commercial turkey farms, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). One is at a facility in Redwood County that houses 18,500 birds and the other is a farm in Steele County that has 48,100 birds.

Since avian influenza activity began ramping up again in early October, Minnesota has reported at least 12 outbreaks on turkey farms spanning 7 counties. Minnesota has also reported a large outbreak at a layer farm that led to the loss of nearly 1 million birds.

Elsewhere, two states reported new outbreaks in backyard poultry flocks, including Colorado, which reported an event in Montrose County, and North Dakota, where the virus hit a location in Mcintosh County. The H5N1 outbreaks, which began in February 2022, have led to the loss of a record 61.60 million birds across 47 states.

Outbreaks in the Netherlands and Hungary

Following two new outbreaks in poultry in two different provinces, the first since July, the Netherlands reinstated many of its poultry restrictions, according to an agriculture ministry statement translated and posted by Avian Flu Diary, an infectious disease news blog.

Elsewhere, Hungary also reported a second new outbreak in poultry, this time involving a farm in Bacs-Kiskun County, according to a notification from the World Organization for Animal Health.

The pace of flu detections in the last half of October rose in parts of Asia, the United States, and some tropical countries, the World Health Organization (WHO) said in its latest global flu update.

In East Asia, flu levels rose in China and South Korea, while levels remained elevated in Southeast Asia, with rises reported from Laos and Thailand. Southern Asia's activity rose, mainly fueled by increased detections in Iran.

In the WHO's European region, flu remained low or at baseline in all countries except for Slovakia and Israel. And in the Americas, flu activity rose slightly in the Caribbean, with rising levels in parts of the United States.

Elsewhere, a few other countries reported rises, including Ecuador and Ethiopia.

Of respiratory samples that were positive for flu at national labs during the last half of October, 86% were influenza A, and of subtyped influenza A samples, 67.4% were H3N2 and 32.6% were 2009 H1N1.

The TB Alliance announced yesterday that Indian pharmaceutical company Macleods will start manufacturing an essential component of the shorter, all-oral drug regimen for drug-resistant tuberculosis (DR-TB).

Under a licensing agreement with the non-profit TB Alliance, Macleods will be able to supply 135 low- and middle-income countries (LMICs) with pretomanid, which is part of the 6-month BPaL (bedaquiline, pretomanid, and linezolid) regimen used with or without moxifloxacin (BPaLM). Macleods will supply the drug to those countries through the Stop TB Partnership's Global Drug Facility. Pretomanid was developed by TB Alliance and approved by the Food and Drug Administration in 2019.

The BPaL and BPALM regimens are recommended by the World Health Organization (WHO) for treating DR-TB. Previous treatments lasted 9 to 18 months and included multiple pills and injectable drugs, many of them with toxic side effects. But accessibility remains an issue, particularly in LMICs. According to a recent WHO report, only 40% of the estimated 410,000 patients who developed DR-TB in 2022 were started on one of those regimens.

"Macleods' pretomanid product will create an additional source of pretomanid for countries, thereby making the BPaL regimen even more accessible," Sandeep Juneja, MBA, Senior Vice President of Market Access at TB Alliance, said in a press release.

"Curing drug-resistant TB faster and with fewer pills will help people overcome one of the most difficult-to-treat infections on our planet," added Macleods CEO Vijay Agarwal.

Researchers from the Centers for Disease Control and Prevention and other US institutions have created an mpox severity scoring system that they say could help clinicians track disease progression and response to treatment and guide researchers in identifying risk factors for severe illness and assessing the effectiveness of therapeutics.

Their evaluation of the MPOX-SSS scoring system was published yesterday in the Journal of Infectious Diseases.

Scores matched clinical observations

The team developed MPOX-SSS during the 2022 multicountry clade IIb mpox outbreak based on seven variables: number of active lesions, anatomic lesion involvement, presence of merged lesions, presence of bacterial superinfection, mucosal involvement, level of care, and need for painkillers.

The researchers then piloted MPOX-SSS through a chart review of 200 mpox patients from June to August 2023 at a single New York City center. The median participant age was 34 years, 99% were men, 96% were men who have sex with men, 38% were Hispanic, 28% were Black, 49% had HIV, 28% were taking HIV preventive drugs, and 57% of patients were taking the antiviral tecovirimat (Tpoxx).

The team tested the association between the scoring system's severity measure and proxy measures expected to correlate with severity, including Tpoxx prescription, CD4 count (indicator of immune function in HIV patients), and treatment after 3 days of illness.

The scoring system's simplicity and ease of use make it suitable for diverse clinical settings, including both resource-limited and well-resourced environments.

MPOX-SSS scores could be calculated retrospectively for 172 patients (86%). Missing data that precluded scoring were lesion number (13%) and presence of merged lesions (7%).

MPOX-SSS produced higher severity scores in Tpoxx recipients, those treated more than 3 days after symptom onset, and those with low CD4 counts. Serial scores matched clinical observations, and MPOX-SSS demonstrated good discrimination, identified changes over time, and generated higher scores in the expected groups.

"The scoring system's simplicity and ease of use make it suitable for diverse clinical settings, including both resource-limited and well-resourced environments," the authors wrote. "Future research is needed to validate the MPOX-SSS in larger, diverse patient populations as well as in circumstances where illness is caused by infection with virus strains other than Clade IIb."