Post-treatment lesions in mpox patients likely less severe than initial presentation

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Mpox lesionToday in Morbidity and Mortality Weekly Report, researchers from the NYC Department of Health and Mental Hygiene describe nine cases of new skin or mucosal lesions in patients with mpox who had recently completed the 14-day tecovirimat (Tpoxx) treatment course.

The authors said the nine cases may mean that post-treatment lesions are more common than previously thought. Patients' median age was 33 years, eight were men, one was a transgender woman, and five were HIV-positive. None had been vaccinated against mpox before contracting the virus.

All patients reported beginning treatment with the antiviral within 9 days of symptom onset and completing the recommended 14-day course with self-reported full adherence.

New lesions an average 13 days after treatment

Patients developed post-treatment lesions an average of 13 days after finishing their antiviral treatment course, and in eight of the patients the lesions were classified as less severe than those on initial presentation.

"Among six patients for whom orthopoxvirus testing of posttreatment lesions was conducted, one received a positive result," the authors said, which suggests post-treatment lesions do not likely need to be treated with a repeat course of tecovirimat.

The authors hypothesize that post-treatment lesions may be a recurrence of the virus, but viral loads are likely too low for detection.

Tecovirimat was restarted for two patients, for 1 and 2 weeks, respectively.  Both had a full resolution of symptoms. Among the other seven patients, six had a resolution of symptoms and one was lost to follow-up.

The authors hypothesize that post-treatment lesions may be a recurrence of the virus, but viral loads are likely too low for detection. More research is needed, they conclude.

US lawmakers re-introduce antibiotic development legislation

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US Capitol and blossoms
Architect of the Capitol / Flickr cc

A bipartisan group of US senators and representatives today reintroduced a bill to boost the antibiotic development market.

The Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, which was introduced in 2020 and 2021 but never received a vote despite bipartisan support, would establish a subscription-style payment model for new antibiotics. Under the model, companies that develop innovative new antibiotics for drug-resistant infections would receive contracts from the federal government valued between $750 million and $3 billion to make the antibiotics available at no charge for patients covered by federal health insurance programs.

The bill would also require companies to support appropriate use of the new antibiotics and conduct post-marketing studies. A committee made up of doctors, patients, outside experts, and representatives of federal agencies would develop guidance on infections and pathogens to target and on the favored characteristics of potential treatments.

Weak antibiotic pipeline

The aim of the legislation is to address the broken market for new antibiotics by de-linking companies' profits from the volume of antibiotics sold. Advocates say this is necessary because antibiotics are expensive to develop but don't generate much revenue for companies, since they are only used for short periods and need to be used judiciously to maintain their effectiveness.

The financial challenges of antibiotic development have discouraged investment and led many pharmaceutical companies to drop their antibiotic programs, resulting in a weak pipeline of new products at a time when antibiotic resistance is growing.

Our bill would incentivize the development of new innovative antibiotics and focus on educating health care providers.

The bill is cosponsored by US senators Michael Bennet (D-Col.) and Todd Young (R-Ind.), along with US representatives Scott Peters (D-Calif.), Drew Ferguson (R-Ga.), Mike Levin (D-Calif.), and Jake LaTurner (R-Kan.).

"Market failures have resulted in a lack of needed research and development in this field which is a threat to public health," Young said in a press release. "Our bill would incentivize the development of new innovative antibiotics and focus on educating health care providers on how to avoid overuse or misuse of these life-saving medications in order to slow the emergence of antibiotic-resistant pathogens."

VA infectious threat project tied to less staff burnout, fewer COVID cases

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Stressed healthcare workerA serious infectious threat response initiative (SITRI) at the US Veterans Affairs (VA) North Texas Health Care System (VANTHCS) was associated with reduced staff burnout during COVID-19 without increased healthcare-associated infections (HAIs), according to a study yesterday in the American Journal of Infection Control.

The VA's infection prevention and control (IPC) team implemented the SITRI after an Ebola epidemic led the Veterans Health Administration in 2015 to require preparation for emerging pathogens. Staff developed an algorithm to facilitate communications and safe care of infected patients.

After SARS-CoV-2 emerged in early 2020, the IPC team identified issues such as staff anxiety, lack of COVID-19 knowledge, and shortages of personal protective equipment and tests. Staff adapted the SITRI to better support workers, facilitate daily operations, and maintain infection-prevention protocols.

The SITRI became a 24/7 call service staffed by infection preventionists and a hospital epidemiologist who was also an infectious disease physician. The preventionists also conducted COVID-19 surveillance, data abstraction, exposure management, and public health reporting.

Weekly SITRI calls, COVID cases linked

The SITRI received 3,816 staff calls from January 2020 to March 2021. The number of weekly calls and the average census of COVID-19 hospitalizations were correlated.

Staff reported a lower burden of exhaustion in 2020 and 2021 than in 2019, but compassion fatigue rose gradually from 2019 to 2021.

Rates of central line‚Äďassociated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus, and Clostridioides difficile infections declined or stayed the same, which the authors said could be because SITRI allowed the IPC to maintain surveillance, audits, and feedback.

During the early months of the COVID-19 pandemic, healthcare facilities lacked essential infection prevention resources and information, and staff anxiety was incredibly high.

The SITRI cost $360,000 from March 2020 to May 2021 based on IPC overtime pay for covering the SITRI line.

"During the early months of the COVID-19 pandemic, healthcare facilities lacked essential infection prevention resources and information, and staff anxiety was incredibly high," lead author Madhuri Sopirala, MD, MPH, said in an Association for Professionals in Infection Control news release. "Our evaluation shows that the VANTHCS' SITRI provided support and services that contributed meaningfully to patient safety and staff well-being during this time."

Mpox cases rise in a few Asian countries; Pakistan reports first case

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Though weekly mpox cases continue to decline at the global level, activity is rising in the Western Pacific due to local transmission in Japan, South Korea, and China, the World Health Organization (WHO) said today in its latest biweekly update.

In another new development, Pakistan reported its first case, bringing the number of countries reporting infections to 111. The WHO said Pakistan's case, reported Apr 21, involves a person who traveled from Saudi Arabia.

Since the WHO's last report on Apr 13, 183 new cases were reported, along with 14 more deaths. The newly reported deaths were in Mexico, the United States, Brazil, and Panama, and they bring the fatality count to 130.

In the Western Pacific, Japan reported 28 new cases, South Korea 17, and China 16. The WHO noted that a lack of cases from Africa over the past weeks reflects disruptions in reporting.

Nigeria battling meningitis and diphtheria outbreaks

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The World Health Organization (WHO) today detailed two outbreaks in Nigeria, one involving meningitis and the other diphtheria. The country is juggling several health challenges, which is complicated by a humanitarian emergency and insecurity in the northeast.

Nigeria's meningitis outbreak began in October 2022, and, as of April 16, 1,686 suspected cases have been reported, 124 of them fatal, with the case-fatality rate at 7%. Though cases have been reported in 22 of Nigeria's 36 states, 74% have been reported from Jigawa state in the north, which borders an area of Niger where meningitis activity has also been under way since October 2022.

Of 481 cerebrospinal fluid samples tested, 247 were positive for bacterial infection, 91% yielding Neisseria meningitidis serogroup C. Meanwhile, 13 cases involved Streptococcus pneumoniae and 1 involved Haemophilus influenzae.

The WHO said northern Nigeria is part of Africa's meningitis belt. It said several bacteria can cause the disease, but N meningitidis is most likely to fuel large outbreaks. Meningococcal meningitis spreads through respiratory droplets and respiratory secretions, often from asymptomatic carriers. Outbreaks follow a seasonal pattern, with highest levels during the dry season, with a peak between March and April.

Suboptimal diphtheria vaccine coverage in conflict areas

In a separate statement, the WHO said Nigeria is experiencing a diphtheria outbreak that began in December 2022 and is its biggest outbreak involving the disease since 2011. So far this year, the country has reported 557 confirmed cases in 21 of its 36 states, with 73 deaths reported, for a case-fatality rate of 13%.

The outbreak peaked in January, and the death rate has declined owing to increased access to diphtheria antitoxin.

The disease is highly contagious and spreads through direct contact and respiratory droplets. Unvaccinated children are at highest risk. The WHO noted that third-dose vaccine coverage in Nigeria is suboptimal, especially in the northeast, where conflict is an obstacle to vaccination efforts.

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