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.

On Friday, Kentucky announced two pertussis deaths in infants over the past 6 months, and neither the infants nor their mothers had been vaccinated against the highly contagious bacterial infection also known as whooping cough. 

According to the Kentucky Department for Public Health (KDPH), these are the first whooping cough deaths in the state since 2018.

Anyone can get whooping cough, but infants are at greatest risk for life-threatening illness

“Anyone can get whooping cough, but infants are at greatest risk for life-threatening illness,” said KDPH Commissioner Steven Stack, MD, in a press statement. “Fortunately, when vaccinations are administered to pregnant women, it provides protection to both the mother and the baby." 

Whooping cough activity on the rise 

All infants are recommended to get the pertussis vaccine series starting at 2 months of age, and pregnant women should receive it in every pregnancy. Children receive another immunization before kindergarten, at age 12, and every 10 years in adulthood. 

According to Kentucky officials, whopping cough is on the rise in the state, with 543 cases reported in in 2024, the highest number of cases since 2012. So far this year, 247 cases of whooping cough have been reported.

Data from a survey of Kentucky school children doing the 2024-25 school year shows that 86% of kindergarteners and 85% of seventh graders are up to date on their required pertussis immunizations.

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.