In an update on Oropouche virus activity, the Pan American Health Organization (PAHO) yesterday said in the first four weeks of the year, 3,765 cases have already been reported from six Americas countries, most of them from Brazil. Other countries reporting local cases include Panama, Peru, Cuba, and Guyana, as well as an imported case from Canada.

PAHO also provided an overview of activity in 2024, during which the region reported 16,239 cases from 11 countries and 1 territory. Brazil was the hardest hit country, followed by Peru, Cuba, and Bolivia. Of countries reported importingcases, the United States reported 108, all involving travel to Cuba.

The Americas region reported four deaths, three from Brazil.

Brazil confirms 5 vertical transmission instances, probes several others

Health officials in Brazil confirmed five instances of Oropouche transmission from mothers to their fetuses, resulting in four fetal deaths and one congenital abnormality. Investigations are still underway into 22 fetal deaths, 5 miscarriages, and 4 congenital anomaly cases.

Oropouche virus is spread to humans through the bite of certain midge species and possibly by some Culex mosquitoes. The illness causes febrile symptoms similar to dengue and in rare instances can lead to meningitis or encephalitis.

 In 2024, the virus spread beyond typically affected areas to new regions and countries, with rising reports of poor outcomes following transmission from pregnant women to their fetuses.

“The current outbreak highlights the need to strengthen epidemiological and entomological surveillance measures, as well as to reinforce preventive measures aimed at the population,” PAHO said. It also encouraged countries to report any unusual events related to the disease, including deaths and poor pregnancy outcomes.

Three of the world's largest philanthropic organizations yesterday announced the launch of a new $50 million effort to boost discovery of new antibiotics for gram-negative bacteria.

Launched jointly by the Bill & Melinda Gates Foundation, the Novo Nordisk Foundation, and Wellcome, the Gram-Negative Antibiotic Discovery Innovator (Gr-ADI) will focus on discovery of direct-acting small-molecule antibiotics with broad-spectrum activity against Enterobacteriaceae, with Klebsiella spp. selected as the pathogen to be used in all proposed project. The program aims to address the lack of novel antibiotics for gram-negative bacteria and the public health threat posed by antimicrobial resistance (AMR).

Data sharing and collaboration

According to a news release, Gr-ADI will function as a consortium whereby multiple funders, research institutions, and industry partners share data and work collectively.

"New drugs are critical to preventing needless deaths from the superbugs created by AMR," said Trevor Mundel, PhD, president of global health at the Gates Foundation. "An unconventional model of drug discovery and development—driven by innovative approaches and cross-organisation collaboration— could be the key to unlocking the pipeline of antibiotics that can be used to target drug-resistant pathogens."

"Through the Gr-ADI program, grant recipients will not only focus on their individual projects but will also become integral members of a consortium dedicated to data sharing, with a focus on specific gram-negative bacteria," said Marianne Holm, MD, PhD, vice president of infectious diseases at the Novo Nordisk Foundation.

Projects funded by Gr-ADI will be selected through a request for proposals. Projects with a duration of up to 3 years and maximum requested budget of $5 million are eligible for funding.

A study of Veterans Affairs (VA) hospitals found that collaboration between antimicrobial stewardship physicians and pharmacists and use of local antibiotic prescribing guidelines were associated with less antibiotic use at discharge, researchers reported today in Infection Control & Hospital Epidemiology.          

Using data from the Veterans Health Administration, researchers from the Iowa City VA Health Care System evaluated post-discharge oral antibiotic prescribing at 123 VA hospitals from May 2020 to May 2021 with a risk-adjusted metric that categorized hospitals into three groups: high-performing (less frequent prescribing of antibiotics at discharge and shorter antibiotic courses), low-performing (more frequent antibiotic prescribing at discharge and longer antibiotic courses), and intermediate-performing. They then used responses from a mandatory antibiotic stewardship survey to determine the association between hospital characteristics and performance.

Stewardship processes critical to performance

Of the 396,909 patient admissions across the 123 hospitals, 17.2% received post-discharge antibiotics, with a median duration of 6 days. Based on the risk-adjusted metric, 37 hospitals (30.1%) were high-performing, 22 (17.9%) were low-performing, and 64 (52%) were intermediate-performing. The two stewardship processes associated with metric performance were more frequent interactions between stewardship champions (70.3% vs. 22.7% at high- and low-performing sites, respectively) and education of inpatient providers on stewardship principles within the past year (97.3% vs 77.3% at high- and low-performing sites, respectively).

A multinomial logistic regression model found that low-performing hospitals were less likely than high-performing hospitals to report interactions between their stewardship physician and stewardship pharmacist every day or several times per week (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03 to 0.55), and use local antibiotic prescribing guidelines for common infections (OR, 0.21; 95% CI, 0.05 to 0.93). 

The study authors note that both components are recommended in the Centers for Disease Control and Prevention's Core Elements for Hospital-Based Stewardship Programs.

"Physician engagement likely provides credibility to initiatives to reduce antibiotic overuse at discharge, while local guidelines provide an easy reference for determining duration of therapy," they wrote. "While there may be many ways to reduce antibiotic overuse at this transition of care, these two features seem to be important strategies for success."`

Sixty hunter-harvested deer and four elk in 10 more eastern Nebraska counties tested positive for chronic wasting disease (CWD) during the 2024 hunting season, an increase of over 50% from 2023 that likely reflects a 42% rise in deer tested, according to tallies posted on Outdoor Nebraska.

Nebraska conducts CWD surveillance in four to seven regions each year, rotating to a different part of the state each season. 

Disease detected in 73% of counties

CWD was first identified in Nebraska in 2000 in Kimball County. Since 1997, the Nebraska Game and Parks Commission (NGPC) has tested more than 58,000 deer and 400 elk, with 1,347 deer and 23 elk testing positive for the fatal neurodegenerative disease. So far, CWD has been detected in free-ranging deer and elk in 68 of 93 counties (73%).

Thirty of 600 deer tested were positive for CWD in 2023. In 2024, NGPC tested 1,419 hunter-harvested deer samples at check stations in the Missouri, Elkhorn, Loup East, Wahoo, Blue Northwest, and Blue Southeast deer-management units.

So far, CWD has been detected in free-ranging deer and elk in 68 of 93 counties (73%).

The 60 deer and four elk that tested positive for CWD in 2024 were found in 10 previously CWD-negative counties: Antelope, Butler, Greeley, Jefferson, Madison, Merrick, Platte, Richardson, Seward, and York. Thus far, no population declines have been attributed to the disease.

CWD is a disease of cervids such as deer and elk caused by prions, infectious proteins that trigger abnormal folding in normal proteins, especially in the central nervous system. Infected animals shed CWD prions in body fluids, which can spread to other cervids through direct contact or the environment. 

Although no CWD cases have been detected in people, the US Centers for Disease Control and Prevention recommends against eating infected animals and advises taking precautions when handling carcasses.