Both South Carolina and Utah confirmed new measles cases in unvaccinated residents. 

South Carolina officials said this is the state’s third measles case this year, and the patient, who lives in the Upstate region, was unvaccinated and had no prior immunity from measles exposure.

They did have a recent international trip to a country with an ongoing measles outbreak and were not contagious while traveling

“They do not have a specific, known exposure to someone with measles, but they did have a recent international trip to a country with an ongoing measles outbreak and were not contagious while traveling,” officials said. 

No school exposure in Utah

Utah's Grand County has reported its first measles case of the year, in an unvaccinated person younger than 18 years old who was exposed to someone with measles outside the county. According a Facebook post by the Southeast Utah Health Department, there was no school exposure related to this case.

So far this year there have been 19 measles cases reported in Utah.

In last week’s update, the Centers for Disease Control and Prevention said 1,431 confirmed measles cases have been reported in the United States since the beginning of the year.

The World Health Organization (WHO) on September 5 released more details about a new Ebola virus outbreak in the Democratic Republic of the Congo (DRC), including that two of the healthcare workers who cared for the index patient—a 34-year-old pregnant woman who died from her infection—developed similar symptoms and also died. The index patient was at 34 weeks gestation and died on August 25 from multi-organ failure. 

Of the 28 suspected cases recorded as of September 4 in Kasai province, 15 deaths were reported, with 4 health workers among the patients who died. Patients listed as suspected cases are from three areas of Bulape health zone and from Mweka health zone. Eighty percent of the patients are ages 15 years and older. Among samples collected from five suspected patients and one probable death that were sent for testing to the National Public Health Laboratory (INRB) in Kinshasa, and all were positive for Ebola. 

The DRC health ministry said that, according to its latest data, 32 cases and 15 deaths have been reported in the outbreak zone. Officials held an outbreak coordination meeting with technical and financial partners to chart a response plan with a $45 million price tag that will begin with mobilizing partners, establishing monitoring and evaluation, and conducting scientific research on the virus reservoir. 

New zoonotic spillover, but source still under investigation

Whole-genome sequencing suggests that the virus represents a new zoonotic spillover and is not directly linked to earlier outbreaks in the area in 2008 and 2008-2009.

The WHO said the outbreak's location is not far from Tshikapa, the capital of Kasai province, as well as the border between the DRC and Angola. Though the affected area is hard to reach, population movements between different parts of the province are frequent, especially between Bulape and the provincial capital.

So far, the source of the outbreak hasn't been identified, and the illness onset date and the history of health visits of the index patient hasn't been determined, which the WHO said increases the likelihood of ongoing community transmission. It assessed the health risk as high for the DRC, moderate for Africa, and low at the global level.

A quality improvement intervention implemented at two urgent care centers in an integrated healthcare system was associated with increased adoption of 5-day antibiotic durations for common outpatient infections, researchers reported today in Open Forum Infectious Diseases.

The Take 5 campaign, implemented at Denver Health in December 2019, is a multifaceted antibiotic stewardship intervention to promote adherence to institutional guidance for 5-day antibiotic durations for skin infections, urinary tract infections, sinusitis (sinus infection), otitis media (earache), pneumonia, and chronic obstructive pulmonary disease (COPD) exacerbations. To assess its performance, researchers from Denver Health examined urgent care visits from January 2017 through December 2023, calculating the proportion of antibiotic prescriptions for the pre-specified infections that were 5 days or less before and after the intervention was implemented.

Over the study period, the investigators documented 32,352 visits for the pre-specified infections where an antibiotic was prescribed—14,698 before the intervention and 17,654 during the intervention. While there was a significant increasing trend in the proportion of prescriptions for 5 days or less prior to the intervention, there was an estimated 10.7% increase in prescriptions for 5 days or less immediately after the intervention started, followed by an increase of 0.18% per month over the course of the intervention.

"Therefore, the intervention had a strong immediate effect and was associated with sustained increases in five-day durations of therapy over time," the study authors wrote.

An effective stewardship approach

The aggregate proportion of prescriptions for 5 days or less rose from 57.5% pre-intervention to 82.9% after implementation. Subgroup analysis by infection type found an immediate effect of the intervention on prescriptions for sinusitis, cellulitis or skin abscess, acute cystitis, and COPD exacerbation. Rates of new antibiotic prescriptions and hospitalizations within 14 days were similar between the periods.

The authors say the campaign resulted in 6,000 fewer antibiotic-days dispensed per year, a more than 20% decline. 

"Promoting use of the shortest effective duration of therapy for infections where antibiotics are indicated or may be indicated appears to be an effective antibiotic stewardship approach in the urgent care setting and may complement efforts to prevent unnecessary antibiotic prescriptions for acute respiratory infections," they concluded.