A 32-year-old man who is the son of a man who died from a confirmed Nipah virus infection in India's Kerala state has tested positive in preliminary hospital testing, Onmanorama News reported today, which appears to lift the current outbreak total to five. 

The man had accompanied his 58-year-old father, who died from his infection and appears to represent the fourth case, to the hospital. He was on the contact list and began having symptoms while under observation.

The outbreak is occurring in an area of Kerala state that has reported Nipah virus cases before. Besides the father and son, earlier outbreak patients include a 42-year-old woman from Malappuram district, an 18-year-old woman from Malappuram district who died from her illness, and a 38-year-old woman from Palakkad district.

Nipah virus is spread by fruit bats and can be transmitted between people. The virus can also be contracted by drinking palm sap or eating fruit contaminated with bat urine, droppings, or saliva. Nipah illness has a high case-fatality rate, and there are no specific treatments or vaccine, though trials are under way. 

Human trials to launch for 2 vaccines

In other Nipah developments, Gavi yesterday in an update on Nipah virus vaccine development said human trials for two candidate vaccines will soon launch in Bangladesh, one of the countries to report ongoing sporadic human cases. 

One is the ChAdOx1 NipahB vaccine developed at the University of Oxford that recently received the European Medicines Agency's PRIority MEdicines (PRIME) designation to accelerate regulatory approval. The vaccine’s development was funded by the Coalition for Epidemic Preparedness Innovations (CEPI). The other is PHV02 vaccine, a live, attenuated, recombinant vesicular stomatitis virus (rVSV) vector that expresses the glycoprotein of the Nipah virus (Bangladesh strain), which is also supported by CEPI and will soon enter a phase 2 trial.

A new review published in JAMA Network Open describes how often ethics are incorporated in infectious diseases international clinical practice guidelines (CPGL) and finds planning and actual consideration of ethical issues in infectious disease CPGL are limited.

To perform the analysis, the authors conducted a systematic search for CPGL specific to infectious diseases published between January 2021 and December 2023 in three guideline databases, most from high-income countries. 

The authors of the study reviewed 115 CPGL and found only 32 (27.8%) dedicated a section or paragraph to ethical considerations. Only a single CPGL mentioned issues of gender balance policies in authorship.

Affordability most often addressed

Costs of diagnostics and treatment affordability were mentioned in 53 guidelines analyzed, while 41 guidelines mention cost or benefit centered on the patient. Access to care was addressed in 50 of the guidelines, but allocation of resources was addressed in only 35 of the guidelinesanalyzed. 

The most common ethical issues addressed were related to justice (including affordability and access to care).

“Less than a third of CPGL dedicated a section or paragraph to ethical considerations, and only half of guidelines addressed minority populations,” the authors wrote. “The most common ethical issues addressed were related to justice (including affordability and access to care).”

The authors said more planning for and attention to ethical considerations is crucial. 

“Complex ethical issues apply to the field of infectious diseases because of disproportionate disease burdens in vulnerable populations and the public health risks related to the spread of infection,” they wrote.

Allowing nursing-home visitors was safe for residents during the COVID-19 pandemic—even during community case surges and before vaccine availability, concludes a study published yesterday in the American Journal of Infection Control.

An Emory University–led research team analyzed and modeled weekly data on visitor policies, resident COVID-19 infections, and community case rates from 677 Ohio nursing homes from November 1, 2020, to January 3, 2021.

"Nursing home residents were particularly vulnerable to COVID-19 with over 100,000 COVID-19 related deaths reported in 2020," the authors wrote. "As a response, in March of 2020 the Center for Medicare and Medicaid Services recommended, and most states issued, bans on outside visitors to nursing homes." 

Ohio was the only state that collected facility-level visitation data after ending its visitor ban on October 29, 2020.

Role of infection-control measures

In total, 226 to 327 nursing homes allowed visitors during any week of the study period, 316 to 448 banned visitors, 207 always allowed visitors, and 289 always prohibited them. 

Allowing visitors in the context of adequate personal protective equipment and social distancing was safe, even in a period with large increases in community infection rates and before vaccine rollouts.

Among nursing homes that permitted visitors in a week in 2020, the proportion with a new COVID-19 case rose from 9.5% the week of November 1 to 49.3% the week of December 6. A similar increase was seen among nursing homes that forbade visitors. Except for the first 2 weeks of the study, there were no differences in infection rates between the two facility types. 

Marginal models suggested that visitors weren't linked to the unadjusted rates or adjusted odds of new infection among residents (odds ratio, 0.92). 

Several factors may have influenced the findings, including partial resident immunity from COVID-19 infection early in the pandemic and the strict infection-prevention measures that may have been in place when allowing visitors, the researchers said.

"Allowing visitors in the context of adequate personal protective equipment and social distancing was safe, even in a period with large increases in community infection rates and before vaccine rollouts," they wrote.

• In its latest weekly update today, the US Centers for Disease Control and Prevention (CDC) today reported 21 more measles cases, bringing the national total since the first of the year to 1,309 cases in 40 states. Two more outbreaks were reported, putting the total at 29 for the year, up dramatically from all of 2024, when 16 outbreaks were confirmed. So far, 88% of the nation's cases have been linked to outbreaks, and 92% of people infected with the virus this year were unvaccinated or have an unknown vaccination status. Last week, the United States passed the post-elimination record number of cases set in 2019. Many of the cases earlier in the year were linked to a large outbreak in West Texas, but since then there have been numerous smaller outbreaks in undervaccinated populations as well as sporadic travel-related cases.
• Quest Diagnostics yesterday announced the launch of a new diagnostic test for Oropouche virus, a disease primarily spread by biting midges and some mosquito species that has spread in parts of the Americas, including the Caribbean. In the United States, several infections have been reported in people exposed during travel to Oropouche outbreak areas. In a statement, the company said the polymerase chain reaction (PCR) test will be available with a prescription by the end of the month and that its advanced lab in San Juan Capistrano, California, will perform the test. Serology testing will be available by the end of the quarter.
• The US Department of Agriculture (USDA) yesterday announced new measures to reduce foodborne illnesses. USDA Secretary Brooke Rollins announced the measures during the opening of the new Midwestern Food Safety Laboratory in St Louis. Some of the steps include quicker and broader Listeria testing, updating training and tools for Food Safety Inspection Service (FSIS) inspectors, reopening stakeholder discussion on strategies to reduce Salmonella illnesses, strengthening state partnerships, and empowering the FSIS inspectors to take compliance actions.