WHO reports mpox decline in most regions, but more deaths

News brief

In an update covering the past 2 weeks, the World Health Organization (WHO) said today that it has received reports of 323 new mpox cases and 11 more deaths.

Cases are slowly declining in most regions but with no clear downward trend in Africa, where the virus spreads with a mixed pattern of both human-to-human and zoonotic spillovers. Outside of Africa, countries continue to report sporadic cases and small clusters.

The Americas region reported the vast majority of the new cases over the past 3 weeks—408 of 442—with the Western Pacific reporting a rise over the same period with the addition of more cases from Japan and Taiwan. The WHO said epidemic curves show that Europe is headed toward the end of its outbreak, with levels declining more slowly in the Americas.

The new cases and deaths push the global totals to 86,496 and 111, respectively.

Of the 11 more deaths, 10 were in the Americas, including 5 in Peru, 4 in the United States, and 1 in Costa Rica. The only death reported outside of the Americas was from Belgium.

The new cases and deaths push the global totals to 86,496 and 111, respectively, from 110 countries.

The WHO declared a public health emergency for mpox in July 2022 following a surge in human-to-human cases, mainly in men who have sex with men, outside of areas in Africa where the virus has persistently infected humans due to ongoing zoonotic events. In February 2023, the WHO announced it was keeping the public health emergency of international concern in place for mpox due to sustained activity in some countries, along with gaps in detection and delayed reporting.

Electronic medical record notification tied to reduced C diff testing, incidence

News brief

Chris Dall, MA

C difficile bacteria An intervention to reduce unnecessary Clostridioides difficile testing was associated with a decline in healthcare-facility–onset C difficile infection (HCFO-CDI) across a five-hospital health system, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

The intervention implemented at Henry Ford Health in Michigan was a "hard stop" in the electronic medical record that automatically appeared when clinicians ordered C difficile toxin testing. The message notified clinicians that C difficile testing was not permitted for patients who had received promotility agents for gastrointestinal issues within the previous 48 hours. It also noted when testing was considered inappropriate. The aim of the intervention was to restrict C difficile testing—which can lead to unnecessary treatment—to patients with no alternative cause for diarrhea.

To evaluate the impact of the hard stop, researchers at Henry Ford Health compared C difficile test order rates, CDI rates, and the standardized infection ratio (SIR) during the pre-intervention period (January 2018 to February 2019) and the intervention period (April 2020 to March 2022). The test order rate per 1,000 patient-days fell from 126.5 in the pre-intervention period to 90.6 in the intervention period (a 28% reduction), while CDI rates fell from 3.54 per 1,000 patient-days to 1.48 (a 58% reduction). The SIR also declined 33%, falling from 0.521 to 0.347.

Incorporating this strategy into best practices ... can significantly reduce HCFO-CDI rates.

Of the 289 overrides of the hard-stop notification by an expert reviewer, 248 tests were performed and 26 (11%) were positive.

The authors say the findings indicate diagnostic stewardship is an effective strategy for reducing inappropriate C difficile testing in inpatient settings.

"Incorporating this strategy into best practices, such as provider education, handwashing, and contact isolation, can significantly reduce HCFO-CDI rates," they wrote.