Officials track measles exposures at airports in Colorado, Montana

News brief

Health officials in Colorado and Montana confirmed new measles cases and warned about potential exposure at airports, one in Denver and the other in Bozeman, Montana.

The Colorado Department of Public Health and Environment yesterday reported a second recent case in Mesa County, home of Grand Junction. The patient is an adult whose vaccination status is unknown who may have had a common exposure with a Mesa County case reported last week.

Officials also warned the public about possible measles exposure at Denver International Airport on August 12, which is related to a confirmed case in an out-of-state traveler.

It is important for everyone to stay up to date on their vaccinations.

Rachel Herlihy, MD, MPH, deputy chief medical officer and state epidemiologist, said in a statement that the incident serves as a reminder that travel in crowded public spaces, such as airports, increases the risk of exposure to various communicable diseases. "It is important for everyone to stay up to date on their vaccinations, especially before traveling, to protect themselves and others."

Potential exposure at Bozeman airport

Meanwhile, the health department in Gallatin County, Montana, said it was notified of measles exposure on August 15 that occurred on August 12 at Bozeman Yellowstone International Airport involving a person who is not a resident of Gallatin County. It urged people who were potentially exposed to monitor for symptoms through September 2.

Also, Lewis and Clark Public Health, representing a county that includes Helena, confirmed a measles infection, the county's first in decades. The patient is a minor who, according to the child's parents, had previously received one dose of measles, mumps, and rubella vaccine.

Officials said the family followed diagnosis and treatment protocols and there is no evidence of transmission or any public exposure sites. Another unimmunized household member is quarantined at home and remains asymptomatic.

Study shows high rate of antibiotic use in hospital-at-home patients

News brief

Chris Dall, MA

A study by Mayo Clinic researchers found a high prevalence of antibiotic use among hospital-at-home (HaH) patients. The findings were published today in Infection Control & Hospital Epidemiology.

For the retrospective study, the researchers analyzed use of antimicrobials (antibiotics, antifungals, and antivirals) in Mayo Clinic's Advanced Care at Home program, which provides inpatient home care for patients in Arizona, Florida, and northwestern Wisconsin, from January 2023 through December 2024.

Among the benefits of HaH compared with traditional hospitalization are reduced healthcare costs, reduced hospital readmissions, and improved quality of life. The researchers note that while infections are a common HaH admitting diagnosis, HaH antimicrobial use in the United States has not been well characterized.

Over the study period, 2,398 (79.6%) of 3,012 adult HaH patients received a systemic antimicrobial, with antibiotics accounting for 585.6 days of therapy (DOT) per 1,000 days-present and antivirals and antifungals contributing 56.9 DOT and 29.4 DOT per 1,000 days-present, respectively. Three quarters (74.6%) of HaH patients received at least one antibiotic, 10.6% received an antiviral, and 4.7% received an antifungal. The monthly proportion of patients receiving an antibiotic increased by 0.18% per month, while antifungal use decreased by 0.05% per month. There was no significant change in antiviral use.

Respiratory viruses were the most prevalent indication for antibiotic use (33.9% of all patients receiving an antibiotic), followed by urinary tract infections (30.5%). Ceftriaxone was the most frequently administered antibiotic (32.7% of patients), followed by cefepime (15.4%) and piperacillin-tazobactam (12.5%). Among patients who received an antibiotic, 89.6% were administered at least one intravenous dose.

Opportunities for stewardship

The study authors say the high prevalence of antibiotic use observed in the study warrants further investigation into antimicrobial stewardship (AMS) opportunities in HaH settings.

"As HaH programs continue to expand, integrating AMS will be essential to optimize patient outcomes, reduce the burden of antimicrobial resistance, and ensure the sustainability of this innovative care model," the study authors wrote.

Non-White Lyme disease patients more likely to be in late stages at diagnosis

News brief

Mary Van Beusekom, MS

Lyme disease rash on Black and White skin — CDC

Non-White US Lyme disease patients with Medicaid or Medicare coverage were more likely than their White peers to be female, hospitalized at diagnosis, diagnosed outside of primary care and the summer months, and to have disseminated disease (more widespread in the body), per a new study by Pfizer scientists co-developing a vaccine against the tick-borne infection with Valneva.

From 2016 to 2021, the researchers analyzed claims-based data from 15 Lyme-prevalent states and Washington, DC, on Medicaid beneficiaries 18 years and younger and 19 and older and Medicare fee-for-service beneficiaries younger than 65 and 65 and older.

The findings were published yesterday in Emerging Infectious Diseases.

Highest rates of disseminated disease in Black participants

Medicaid data identified 33,776 infections in children and 30,935 cases in adults. Medicare data identified 12,911 cases in beneficiaries 65 years or younger and 90,913 in older adults. Most infections were in White people (range, 85.0% in adult Medicaid beneficiaries to 96.6% in older Medicare recipients).

Patients with later-stage manifestations are more likely to be hospitalized and to have persistent symptoms after treatment than patients diagnosed with early, localized manifestations.

Lyme disease incidence was highest among White participants of all age and beneficiary groups, followed by Native Americans, with the lowest rates among Black participants. But disseminated disease was more common among non-White participants, especially among both groups of Medicaid recipients (prevalence ratio [PR], 1.77 for younger and 1.57 for older patients).

The highest rates of disseminated disease were in older Black Medicare beneficiaries (42.7%) and pediatric Black Medicaid beneficiaries (39.1%).

Higher rates of disseminated disease among non-White people may be partially due to difficulty recognizing the characteristic rash on darker skin, which can lead to misdiagnosis or delayed or missed diagnoses. "Other factors, including differential risk behaviors and knowledge, likely create and perpetuate the differences in Lyme disease diagnoses," the researchers wrote.

Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted to humans by the bite of infected Ixodes (black-legged or deer) ticks.

"Although all manifestations are treatable with recommended antimicrobial drugs, patients with later-stage manifestations are more likely to be hospitalized and to have persistent symptoms after treatment than patients diagnosed with early, localized manifestations," the authors concluded.