Three states have reported new measles cases over the past few days, including Kansas, with four more cases, all linked to an outbreak in the southwestern part of the state. 

In a July 9 update, the Kansas Department of Health and Environment upped the state's total to 87 cases, of which 84 are linked to the outbreak. The outbreak that began in January was initially tied to the large outbreak in West Texas. So far, outbreak-related cases have been reported in nine counties in Kansas, but five have gone 42 days with no new cases.

Elsewhere, North Dakota Health and Human Services reported one more case, boosting the state's total to 35 and marking the state's first since late May. Health officials noted potential exposures at a gas station in Valley City and at two locations in Willison. A local media report, citing the health department, said the case is in Williams County and that the patient is unvaccinated and had traveled out of state.

The New Jersey Department of Health yesterday confirmed a case in an Ocean County resident, though limited information is available and the state isn't ' experiencing an outbreak. Health officials are working with their local partners on contact tracing and notifying people who may have been exposed.

The new cases are part of a national surge fueled by multiple factors, including a large outbreak in West Texas, illnesses related to international travel, and a growing number of unvaccinated people. This week the nation reached a new post-elimination high of 1,288 cases. 

An increase in uptake of routine childhood vaccines among US children over 15 years was associated with a decrease in antibiotic prescriptions and antibiotic-treated sinus infections, according to an ecological study published today in Antimicrobial Stewardship & Healthcare Epidemiology.

Using de-identified commercial claims data, researchers from Merck and Analysis Group Inc. analyzed uptake of four pediatric vaccines recommended by the Centers for Disease Control and Prevention for children aged 5 years and younger: the 7- or 13-valent pneumococcal conjugate vaccine, Haemophilus influenzae type b (Hib) vaccine, diphtheria-tetanus-acellular pertussis (DTaP) vaccine, and influenza vaccine. Vaccination status was assessed annually from 2000 through 2019, and children were categorized based on receipt of all 4 vaccines, 1 to 3 vaccines, or no vaccines. 

The primary outcomes were antibiotic prescriptions for any reasons and five respiratory tract infections that commonly result in antibiotic prescriptions: otitis media (ear infection), pharyngitis, pneumonia, sinusitis, and viral respiratory infections. 

Antibiotic prescriptions nearly cut in half

Data from 6.7 million children showed that vaccine uptake more than doubled over the study period, from 32.5% of children receiving one dose of the four vaccines in 2004 (the first year all 4 vaccines were recommended) to 66.8% in 2019. The proportion of unvaccinated children fell from 8.4% in 2004 to 2.5% in 2019. At the same time, overall antibiotic prescriptions decreased from 1.89 to 1.01 per person-year from 2000 through 2019, and the rate of overall antibiotic prescriptions decreased by 46.6%. The greatest reduction in comparison to 2000 was seen in macrolides (73.3%) and broad-spectrum antibiotics (57%). 

Antibiotic-treated respiratory tract infections declined from 2.43 to 1.61 episodes per person-year, with the largest decreases in sinusitis (64.7%) and pharyngitis (39.8%). The incidence of overall antibiotic-treated respiratory tract infections decreased by 33.8% in 2019 compared with 2000.

"Although causality cannot be inferred due to the ecological study design, the observed trends are consistent with the notion that reducing vaccine-preventable diseases may decrease antibiotic use," the study authors wrote. "While various factors besides vaccination may also play a role, future prospective cohort studies using longitudinal patient-level data are warranted to validate this association."

• Though H5N1 avian flu detections in US dairy cattle have tailed off over the past few months, sporadic positives continue to be reported, including a new detection in a herd from California, the state's first since early June, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) confirmed today. The new positive from California raises the national total to 1,075 herds in 17 states.
• Wastewater detections of SARS-CoV-2 crept up from very low to the low level last week, the US Centers for Disease Control and Prevention (CDC) reported today. Though virus activity remains low across the nation this summer, the region with the highest levels continues to shift and is now the West. In the previous week it was the South.
• Pakistan reported another wild poliovirus type 1 (WPV 1) infection last week, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI). The patient, from North Waziristan in Khyber Pakhtunkhwa province, had a June 10 paralysis onset. Pakistan, one of the two countries with endemic WPV1 activity, has now reported 14 cases this year. Afghanistan, the other endemic country, reported three more environmental detections of WPV1. They were collected in May in Kandahar, Uruzgan, and Hilmand provinces.