Argentina has reported a significant rise in cases and deaths from invasive group A streptococcal disease, prompting an alert yesterday from Pan American Health Organization (PAHO) that urged countries in the region to enhance their surveillance for related illnesses.

As of November 6, Argentina had reported 487 cases, 78 of them fatal. About half of the cases and more than one third of the deaths involved children younger than 16 years. The country's latest total is 643 cases and 93 deaths.

Officials have issued an epidemiologic bulletin about a M1UK strain and a hypervirulent M1 sublineage. They are also stepping up surveillance for noninvasive Streptococcus pyogenes, including mild cases, to further characterize the frequency and distribution of the disease and its different genetic lineages.

PAHO notes that Argentina's developments follow an increase in invasive group A strep and scarlet fever cases in Europe in 2022 and reports of similar cases in Uruguay during the same period.

Along with increased surveillance, PAHO urged countries to also conduct genomic surveillance and to ensure early diagnosis and treatment of affected patients.

The Centers for Disease Control and Prevention (CDC) recently unveiled new wastewater data tracking dashboard to make it easier to track local and national trends, even by variant. Wastewater tracking is one of the early indicators health officials use to gauge the activity of SARS-CoV-2 and other viruses.

Called the National Wastewater Surveillance Program, the main page says that, nationally, wastewater viral activity of COVID is high.

On Twitter (X), Niall Brennan, MPP, senior adviser to the CDC's director, said the makeover was done over a 4-week period by a team informally called "Poo's Clues." He added that the goal was to reimagine how to present the data and improve the visualizations, which were previously underwhelming.

Mpox viruses also tracked

Wastewater tracking users can now see national trends in 1-year, 6-month, and 45-day increments and examine regional and local trends. The new portal also has maps showing wastewater viral activity levels and shows shifts in variants over time.

"It was fun and fast paced and my thanks to the incredible team at CDC who willingly ripped up the rule book in the process of making this incredible resource more accessible to a wider audience. Much more to come!," Brennan said.

Amy Kirby, PhD, MPH, a microbiologist and epidemiologist who is part of the CDC team, pointed out on Twitter that the dashboard also includes mpox wastewater tracking.

A new study based on British birth outcomes shows placental presence of Streptococcus agalactiae (known as group B Streptococcus, or GBS) is linked to double or triple the risk of neonatal intensive care unit (NICU) admission, roughly 10 times greater than previous estimates.

Group B strep is a common bacterium found in the genital tract of roughly 20% of pregnant women. Previous research has identified GBS in the placenta of around 5% of women before labor.

US women receiving prenatal care are routinely screened for the bacterium, and antibiotics are recommended for use in labor to avoid passing on the pathogen to the infant, but widespread screening is not as common in the United Kingdom.

Findings may change UK screening guidelines

In the study, published today in Nature Microbiology, researchers looked at the presence of GBS and admission to the NICU, using data from a previous study of 436 infants born at term, and a second cohort of 925 pregnancies.

The researchers found that 1 in 200 babies were admitted with sepsis associated with GBS, much higher than expected. Of 436 infants born at term, 7 out of 30 (23.3%) with placental GBS DNA and 34 of 406 (8.4%) without placental GBS DNA were admitted to the NICU (odds ratio, 3.3; 95% confidence interval, 1.3 to 7.8.)

Significantly more newborns are admitted to the neonatal unit as a result of GBS-related sepsis than was previously thought.

"In the UK, we've traditionally not screened mothers for GBS, but our findings—that significantly more newborns are admitted to the neonatal unit as a result of GBS-related sepsis than was previously thought—profoundly changes the risk/benefit balance of universal screening," said author Francesca Gaccioli, MD, from the University of Cambridge, in a university press release on the study.

The authors of the study then analyzed umbilical cord serum in infants who suffered sepsis and positive placental GBS DNA, and found levels of four pro-inflammatory cytokines were signifianctly raised, suggesting the GBS caused a cytokine storm.

"We conclude that GBS causes about ten times the number of cases of neonatal morbidity than is currently recognized and that this morbidity is associated with bacterial invasion of the placenta and extreme activation of the fetal innate immune system before birth," the authors concluded.

A report released this week by the Canadian government shows a small decline in veterinary antimicrobial sales in 2022.

Data from the Veterinary Antimicrobial Sales Reporting (VASR) system show that overall sales of all antimicrobials for animals fell by 2.4% from 2021 to 2022, with a 1.7% decrease in the quantity of antimicrobials sold in milligrams per population correction unit (mg/PCUCA) for production animals (food-producing animals and horses) and a 3.8% decrease in the quantity sold for cats and dogs.

The report also shows that veterinary antimicrobials sales in mg/PCUCA have fallen by 11% since 2018, when Health Canada began implementing regulatory and policy changes to promote prudent use of antimicrobials in animals. But the quantity of antimicrobials sold since 2019 has remained fairly stable. That mirrors trends observed in the United States, where veterinary antimicrobial sales fell significantly following policy changes implemented in 2017 but have since plateaued.

Increased use in pigs, aquaculture

Antimicrobial sales for pigs and aquaculture rose by 15% and 74%, respectively, while sales for cattle and poultry declined by 11% and 34%, respectively. The bulk of veterinary antimicrobials sold in 2022 were intended for use in pigs.

Category 1 antimicrobials, which are considered of very high importance for human medicine, represented less than 1% of the antimicrobials sold for use in animals in 2022, a figure similar to 2021. Category 2 antimicrobials (high importance for human medicine) represented 30% of total sales, down from 33% in 2021.