The Virginia Department of Wildlife Resources (DWR) late last week reported the first chronic wasting disease detection in Carroll County, located in the southwestern part of the state.

The deer was an adult male that was legally harvested near the town of Dugspur. The carcass was brought to a taxidermist in October, and the DWR obtained a sample as part of proactive surveillance, according to a December 15 statement. Carroll County is already part of disease management area (DMA) 3, given that CWD was confirmed in neighboring Montgomery County in 2020.

CWD less common in southwestern Virginia

Of 181 positive detections in Virginia since 2009, only 11 were from DMA 3. The detection of CWD in Carroll County has prompted stepped-up testing in neighboring Wythe County.

Virginia has been closely monitoring CWD prevalence since 2002. Earlier detections had occurred the northwestern part of the state, where two other DMAs are designated.

CWD is a progressive neurologic disease that is fatal in cervids, including deer. The prion disease is similar to bovine spongiform encephalopathy ("mad cow" disease.) So far, no infections have been found in humans, but health officials urge people to have their deer tested, avoid eating meat from contaminated animals, and use precautions when field-dressing or butchering animals.

The DRW said it appreciates the support of taxidermists, processors, and hunters who assist with surveillance efforts. "This assistance is critical to the success of the ongoing statewide CWD monitoring, surveillance, and prevention efforts."

The World Health Organization (WHO) announced late last week that the gangrenous disease noma has been added to its official list of neglected tropical diseases (NTDs).

Also known as gangrenous stomatitis or cancrum oris, noma is a rapidly progressive bacterial infection of the face and mouth. It begins as inflammation of the gums, and, if not treated early with antibiotics, spreads quickly to destroy facial tissue and bone, frequently leading to death or severe disfigurement. Diagnosis and treatment in the early stages of the infection can lead to proper wound healing.

The official request to have noma added to the NTD list was submitted to the WHO in January on behalf of 32 member states.

More than a disease

Primarily found in sub-Saharan Africa, noma mainly affects malnourished children between the ages of 2 and 6 years. Poor oral hygiene, malnutrition, weakened immune systems, and extreme poverty are among the risk factors.

"Noma is more than a disease, it is a social marker of extreme poverty and malnutrition, affecting the most vulnerable populations," WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in a press release. "By classifying noma as a neglected tropical disease, we are shining a light on a condition that has afflicted marginalized communities for centuries."

Current efforts to control the disease in endemic areas are often managed by oral health programs. The WHO says recognition of noma as an NTD aims to boost those efforts through multisectoral and multipronged approaches, amplifying global awareness of the disease, and stimulating research and funding.

"We are committed to working with affected countries and communities to address the drivers of noma, and alleviate the suffering it causes," Tedros said.

By classifying noma as a neglected tropical disease, we are shining a light on a condition that has afflicted marginalized communities for centuries.

A survey of US healthcare providers found that those who more commonly treat sexually transmitted infections (STIs) are more likely to prescribe prophylactic (preventive) doxycycline for STI prevention, Centers for Disease Control and Prevention (CDC) researchers reported late last week in Emerging Infectious Diseases.

The analysis of survey responses from a sample of 1,504 US healthcare providers (30.4% family physicians, 36.2% internists, 16.7% obstetricians/gynecologists, and 16.7% nurse practitioners/physician assistants) showed that providers whose practice includes 10% or more STI care were more than 2.5 times more likely to have used doxycycline prophylactically for STI prevention than non-STI providers (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 2.20 to 3.48). STI providers were more than 50% more likely (aOR, 1.54; 95% CI, 1.24 to 1.89) to agree that the benefits of prescribing prophylactic doxycycline for patients who are at high risk for STIs outweigh the possibility of increasing antimicrobial resistance (AMR).

STI providers were no more likely than non–STI providers to agree that they had seen an increase in AMR among their patients over the past 5 years (aOR, 1.00; 95% CI, 0.81 to 1.23) or that the prophylactic use of doxycycline contributes to AMR (aOR, 1.09; 95% CI, 0.88 to 1.35).

Forthcoming CDC guidelines weigh risks, benefits

The CDC is currently working on guidelines for who should be eligible for doxycycline post-exposure prophylaxis, or doxy-PEP, which involves taking a dose of doxycycline within 72 hours of unprotected sex. A trial conducted at sexual health clinics in San Francisco and Seattle found that, among a cohort of men who have sex with men (MSM) and transgender women, the intervention reduced incidence of chlamydia by 88%, syphilis by 87%, and gonorrhea by 55%.

Concern about the impact that doxy-PEP could have on AMR is among the issues that the CDC is weighing. Trial investigators say they didn't see marked changes in AMR at 12 months follow-up but note that resistance will need to be monitored.

"Additional education on this topic for providers who routinely treat STIs and for providers who routinely prescribe doxycycline will help minimize any potential AMR threats," the CDC researchers wrote.

The effectiveness of unregulated botanical blacklegged-tick repellants and killers varies widely, with some offering minimal protection against bites and the pathogens they transmit to humans, according to a Centers for Disease Control and Prevention (CDC) study.

Published last week in Emerging Infectious Diseases, the study summarized the evidence on products used in the United States and their efficacy compared with that of products registered with the Environmental Protection Agency (EPA) as safe and effective. The bite of the blacklegged, or deer, tick (Ixodes scapularis) can cause Lyme disease, ehrlichiosis, and other diseases.

The author, Lars Eisen, PhD, noted that while the availability of unregulated anti-tick products, many based on botanical oils, is proliferating, assessments of such products are limited. These products are EPA-exempt because their active and inactive ingredients are considered to pose limited risk to human health or the environment when applied to skin, clothing, or vegetation.

"Evaluations of minimum risk tick repellents have typically focused on individual active ingredients rather than formulated products, which often combine multiple active ingredients," he wrote.

Repellent effect much shorter with botanicals

Some products killed blacklegged ticks at rates similar to chemical pesticides, while others had little effect. In addition, different products based on the same active ingredients (eg, rosemary oil) varied considerably in their tick-killing ability.

Evaluations of minimum risk tick repellents have typically focused on individual active ingredients rather than formulated products, which often combine multiple active ingredients.

One study that compared the ability to repel ticks in the United States among 19 minimum-risk active ingredients showed that total protection ranged from under 10 minutes (eg, castor oil) to less than 1 hour (eg, citronella oil) and 1 or 2 hours (eg, cinnamon oil), compared with the entire 6-hour observation period with the chemical DEET.

"Consumers should be aware that effectiveness to kill and repel ticks can differ among unregulated minimum risk products," Eisen wrote. "There also is a need to better understand the reasons why members of the public choose to use EPA-registered versus minimum risk 25(b) exempt tick toxicant and repellent products, based on perceptions about effectiveness and safety for humans, pets, and the environment."