Following a meeting of the World Health Organization (WHO) emergency committee on the mpox upsurge in Africa last week, the group’s director-general today accepted the committee’s recommendation that the situation still warrants a public health emergency of international concern (PHEIC) under International Health Regulations. 

The WHO first declared the PHEIC for the escalating situation in Africa in August 2024, and its meeting last week was the fourth to discuss the latest developments in the outbreaks, which now affect 25 countries in Africa, with recent outbreaks in West Africa, including a large one in Sierra Leone.

The emergency committee also tweaked its temporary recommendations that apply to, but are not limited to, countries experiencing sustained transmission and those with clusters of cases or sporadic clade 1b travel-related cases.

The Africa Centres for Disease Prevention and Control in August 2024 also declared the region’s first public health emergency of continental concern, and its emergency committee has also been reviewing the latest developments and possible new response recommendations.

States continue to report a flurry of new measles cases, with the nation on track to reach a new record number of cases since the disease was eliminated in the United States in 2000.

In California, health officials in Yolo County on June 6 confirmed a measles case in a resident of West Sacramento, marking California’s 13^th case of the year. The patient is an adult with an unknown vaccination status whose source of infection is still under investigation. The patient had not traveled internationally but may have been exposed during air travel to a state without a known outbreak or may have contracted measles locally. 

Officials noted that measles was recently detected in Sacramento wastewater, once in May and once in June. “An investigation into the source of the earlier detections is ongoing and it remains possible that another unknown individual with measles was present in the area,” Yolo County said in its statement.

On June 7, the Los Angeles County Department of Health said it is investigating a measles case in a resident who had recently traveled internationally. The case was linked to multiple exposure sites, which include Costco and Walmart stores.

Elsewhere, two counties in Michigan reported measles cases, including an Allegan County resident linked to exposure sites in Kent County as well as a Macomb County resident who is linked to exposures at multiple medical offices in Rochester Hills, according to a local media report.

Alabama probes suspected measles case

The Alabama Department of Public Health said it is investigating a suspected measles case in an unvaccinated person who is not yet eligible for vaccination. In a statement, it said the investigation is underway in Lee County, located in the east central part of the state.

In other developments, the Oklahoma State Department of Health on June 6 reported one more measles case, raising the state’s total to 19, which include 16 confirmed illnesses and 3 suspected infections.

National Institutes of Health (NIH) scientists from all 27 of its institutes and centers sent the NIH’s new leader Jay Bhattacharya, MD, PhD, a letter today that said newly introduced policies undermine the agency’s mission, waste public resources, and harm the health of Americans and others across the globe.

The 4-page document is titled the Bethesda Declaration, modeled after Bhattacharya’s Great Barrington Declaration, which in 2020 spelled out views from scientists who believed the COVID-19 lockdowns and other measures were excessive. The group sent the letter to Bhattacharya, Health and Human Services Secretary Robert F. Kennedy Jr., and certain members of Congress and posted it publicly on the Stand Up for Science website.

The document was signed by name by 92 NIH researchers, program directors, branch chiefs, and scientific review officers. Another 250 signed the letter anonymously, according to the Associated Press (AP). 

Shared commitment to academic freedom and dissent

Letter signatories said they appreciated the commitments Bhattacharya made to academic freedom and support for dissent at his confirmation hearing and in other forums since then. Then they detailed their concerns about the Trump administration’s actions under his leadership, which they said have politicized research, scrapping nearly finished studies and interrupting study participant treatment.

Also, the group objected to interruptions in global collaboration, undermining of peer review, a blanket 15% limit on indirect research costs, and the firing of essential NIH staff.

In response, Bhattacharya said on X today that dissent in science is productive, but he said the Bethesda Declaration has fundamental misconceptions about recent NIH policy decisions, some of which he said are designed to remove ideological narratives that he says clouds the science. He also said global partnerships require more transparency about who is doing the work and that the peer review directives are misunderstood. He also added that staffing levels will evolve with changes in NIH priorities.

A study of US pediatric outpatient prescriptions over a 10-year period found that flu and respiratory syncytial virus (RSV) are associated with meaningful proportions of pediatric antibiotic prescribing, researchers reported last week in the Journal of Infectious Diseases.

In an analysis of data from a large commercial insurance database, researchers from the University of California-Berkeley and the University of Alabama at Birmingham examined medical visits and outpatient pharmacy prescriptions in children aged 0 to 17 years from 2008 and 2018. 

The primary outcome was the incidence and attributable fractions of antibiotic prescriptions associated with RSV and influenza. While both viruses are known to be common causes of acute respiratory infections (ARIs) in children, data on their role in outpatient pediatric antibiotic prescribing are limited.

During the study period, more than 21.5 million outpatient antibiotic prescriptions were dispensed, two-thirds (66.8%) of which were associated with an ARI diagnosis. Using negative binomial regression models, the researchers estimated that 6.3% (95% confidence interval [CI], 5.2% to 7.3%) of all antibiotic prescriptions were associated with RSV and 3.4% (95% CI, 3.1% to 3.8%) were associated with flu. These estimates translated to 72.6 RSV-associated and 40.0 flu-associated antibiotic prescriptions per 1,000 children annually. 

More antibiotics prescribed in peak RSV, flu years

Both estimates varied widely across study years, with RSV-associated antibiotic prescribing exceeding 10% in peak RSV years and flu-associated prescribing exceeding 20% in peak flu years. 

RSV-associated antibiotic prescription incidence was highest among children aged 5 years and under and linked to pneumonia, bronchiolitis, and acute otitis media (ear infection) diagnoses, while flu-associated antibiotic prescriptions were highest among children over 5 years and more commonly linked with viral upper respiratory infection and bronchitis diagnoses.

The study authors say the findings support vaccination and other measures to reduce RSV and influenza in children.

"Beyond disease burden reductions, immunization against these pathogens may reduce antibiotic use, an important step in mitigating antibiotic resistance," they wrote.