A new survey released by the Peggy Lillis Foundation suggests most Americans are unfamiliar with Clostridioides difficile infection (CDI), and key knowledge gaps about the infection remain. But awareness is growing.

The survey, conducted by YouGov among 1,000 US adults, found that 54% of respondents were "not at all familiar" with CDI, a bacterial infection that causes an estimated 500,000 illnesses and 30,000 deaths in the United States each year. The findings represent a 6-percentage-point increase from a 2021 survey commissioned by the foundation, which found that 60% of Americans had no awareness of CDI.

Similarly, the number of respondents who said they were "somewhat" familiar with CDI rose from 14% to 19%, while the percentage who said they were "a little" familiar stayed essentially the same: 18% previously versus 19% in the new poll. The poll's margin of error is plus or minus 3.5 percentage points.

"We're encouraged by the steady growth in awareness we're seeing," Peggy Lillis Foundation Executive Director Christian John Lillis said in a press release emailed to journalists. "Every percentage point increase demonstrates the impact of our efforts to educate the American public about C. diff. Awareness is the first step to prevention, and these results show that our work and efforts are making a measurable difference." 

Peggy Lillis died of CDI in April 2010 at the age of 56.

Most don't know antibiotic use is primary cause

But three quarters of respondents who said they had some knowledge of CDI did not identify antibiotic use as the primary cause, including 40% of respondents who had experience with CDI as a healthcare professional and 30% of those who had been diagnosed as having CDI at some point in their lives. According to the US Centers for Disease Control and Prevention, people are 7 to 10 times more likely to get CDI while taking an antibiotic and during the month after.

In addition, only 7% of respondents were able to identify other risk factors, such as a recent stay in a healthcare setting, a weakened immune system, or a previous C difficile infection.

The foundation plans to use the results to plan the next phase of its advocacy and education efforts.

"We view this poll not just as a snapshot of current awareness, but as a roadmap for where we need to focus our efforts next," said Lillis.

A study led by researchers at the University of California, San Francisco identified pervasive gaps in tuberculosis (TB) testing and treatment for non–US-born adults at US community health centers.

The retrospective cohort study, published yesterday in Open Forum Infectious Diseases, analyzed individual-level demographic and TB clinical data on non–US-born adults who sought care at 12 community clinics from June to December 2019. Over 70% of people with TB in the United States were born or lived outside of the country in settings with a high incidence of TB, with over 90% of these diagnoses attributed to reactivation of asymptomatic or latent TB infection (LTBI) acquired before immigration. The aim of the study was to characterize the LTBI "care cascade" (screening, testing, and treatment) in the community healthcare clinics where immigrants typically receive primary care.

"Systematic reviews have highlighted large gaps in TB infection testing and treatment for persons migrating from high to low-TB incidence settings with a wide range of barriers to guideline-directed care," the study authors wrote. "However, there are limited data on the gaps in care for non-U.S.-born persons from geographically diverse primary care clinics in the U.S."

Only 1 in 3 tested for TB

A total of 8,460 non–US-born adults were included in the analysis, with a median of 702 per site. Of those included, 2,765 (33%) had at least one TB infection test ordered, 2,572 had valid results for at least one test, and 1,022 had at least one positive result. 

Among the 1,022 with a positive test, 787 (77%) were diagnosed as having a TB infection, of whom 377 (48%) were offered preventive treatment at the seven clinics that provided on-site LTBI treatment. Of the 173 patients who were treated at those clinics, 141 (82%) completed treatment. Another 190 patients were referred to an outside clinic, with no follow-up recorded.

The authors say research is needed to identify strategies that could increase TB preventive care in populations who face a disproportionate burden of disease.

"Integrated and person-centered approaches to addressing access, implementation and quality barriers along the entire cascade have the greatest potential to improve outcomes," they wrote.

The first serologic survey of animals in southern France reveals that Crimean-Congo hemorrhagic fever virus (CCHFV), which is fatal in up to 40% of people, has been circulating among cattle and wildlife for years, with antibodies against the tickborne virus identified in over 2% of samples.

Researchers in Montpellier, France, used enzyme-linked immunosorbent assays (ELISA) and pseudo-plaque reduction neutralization tests (PPRNT) to detect CCHFV antibodies in blood samples from 8,609 cattle and 2,182 wild animals (eg, wild boars, red deer) from 2008 to 2022.

One of the deadliest viruses, CCHFV recently expanded into Western Europe via Hyalomma ticks carried by migratory birds. It was already circulating in Africa, the Balkans, the Middle East, and Asia. There is no vaccine or antiviral drug for the illness.

The findings were published yesterday in PLOS One.

Risk factors for infection

In total, 2.04% of cattle and 2.25% of wild animals tested positive for CCHFV antibodies, with higher rates seen in the Pyrenees-Orientales and Hautes-Pyrenees regions along the Spanish border.

These findings reveal spatial clusters of CCHFV circulation and suggest the existence of enzootic [continual] transmission cycles involving local tick vectors and animal hosts.

Risk factors that influenced seropositivity in cattle were older age and living in a natural open habitat, while male sex and geographic location affected wildlife seroprevalence.

"These findings reveal spatial clusters of CCHFV circulation and suggest the existence of enzootic [continual] transmission cycles involving local tick vectors and animal hosts," the authors wrote. "These findings highlight the importance of environmental and anthropogenic factors in shaping the dynamics of CCHFV transmission."

"It also raises questions about the role of additional tick vectors, such as Hyalomma lusitanicum, in the transmission cycle," they added. The team called for continued surveillance and integrated approaches to monitor zoonotic pathogens.

In related news, the University of California-Riverside has received a 5-year, $3.4 million grant from the National Institutes of Health to detect CCHFV antibodies in survivors in Kazakhstan, Turkey, and Uganda. The team will also explore how the immune system attacks the virus and will work to develop monoclonal antibody treatments against different strains.

• The Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) today announced that highly pathogenic H5N1 avian flu has been detected in commercial poultry in Jefferson County, in the southeast, east of Madison. The agency is working with the US Department of Agriculture (USDA) on a joint incident response and said the birds will be culled. It added that the Wisconsin Department of Health Services and Jefferson County Public Health are monitoring exposed farm workers. The DATCP's poultry outbreak page says the Jefferson County farm has more than 3 million birds and the outbreak is the state's first since April. The finding is part of a recent rise in poultry outbreaks in a handful of Midwestern states.
• The New Mexico Department of Health yesterday reported its second plague case of the year, which involves a 77-year-old man from Bernalillo County, home to Albuquerque. The man was hospitalized and has now been discharged. The state said it averages about two plague infections a year. The disease, caused by Yersinia pestis, is spread by rodents, which can transmit the bacteria to humans through infected fleas. Symptoms in people include sudden fever onset, chills, headache, weakness, and often swollen, painful lymph nodes.
• The UK Health Security Agency (HSA) today announced the opening of a new Moderna Innovation and Technology Centre in Harwell that has the capacity to make up to 250 million mRNA vaccine doses in a year in the event of a pandemic. In a statement, the HSA also said the country has established a $66.7 million (£50 million) fund to bring more research and development investments to the country and that Moderna is investing more than $1.3 billion (£1 billion) in a partnership with the United Kingdom over the next 10 years to discover new therapies, create jobs, and bolster pandemic preparedness.