The Texas Department of State Health Services (TDSHS) today reported 19 more cases since its last update on May 2, lifting the state’s total to 702 cases.

As the country’s biggest measles hot spot, the state has reported outbreak-linked cases from 29 counties, mainly in west Texas. So far 91 people have been hospitalized, reflecting an increase of 2 since the last report. Of the 702 cases, 672 involved unvaccinated people or whose immunization status was unknown.

Texas, like several other states, also continues to report a spate of other measles illnesses not linked to the main outbreak. The state has recorded 16 such cases.

Other states have reported measles cases linked to the Texas outbreak, and today Oklahoma reported one more infection, raising its total to 17, which includes three probable cases.

New cases in Illinois, North Dakota, and Missouri

Elsewhere, three Midwestern states reported new cases. The Illinois Department of Public Health reported two more cases, bringing its total to six, all in adults. The two new cases involved patients from southern Illinois. One patient is from the Franklin-Williamson bi-county area, which, with three cases in people who know each socially, meets the federal definition of an outbreak.

After reporting its first measles case since 2011, the North Dakota Department of Health and Human Services has reported three more cases, lifting its total to four. The three patients are all unvaccinated people who are close contacts of the first case, health officials said.

Also, the Missouri Department of Health and Senior Services today reported a confirmed case involving an adult resident of New Madrid County who likely had limited exposure to others while infectious. Officials said the case isn’t linked to a prior case or prior exposures reported in Missouri.

Danish drugmaker Bavarian Nordic announced today that the US government has placed a $144 million order for a freeze-dried version of its mpox vaccine, which can also be used to prevent smallpox.

The freeze-dried formulation of the Jynneos vaccine was approved by the US Food and Drug Administration (FDA) in March. It will be easier to store and transport, and has a longer shelf life, than the liquid-frozen formulation that Bavarian Nordic has been supplying to the US government since 2010. The company ramped up production of Jynneos in response to the mpox outbreak that began in 2022. 

Jynneos was first approved by the FDA in 2019 and is one of two FDA-approved vaccines for the prevention of smallpox and mpox.

The options exercised under Bavarian Nordic's existing contract with the Biomedical Advanced Research and Development Authority (BARDA), which was awarded in 2017, are valued at $143.6 million and will support manufacturing and supply of freeze-dried Jynneos starting in 2026.

"We applaud the U.S. government’s steadfast commitment to improving national health security through the exercise of these options," Bavarian Nordic President and CEO Paul Chaplin, PhD, said in a company press release. "The freeze-dried vaccine, with its improved shelf life, provides a significant contribution to securing the long-term availability of countermeasures to protect U.S citizens against life-threatening diseases."

A new analysis of existing literature in Annals of Internal Medicine suggests patients prescribed antivirals for nonsevere influenza infections have no reduction in risk of hospital admission or mortality. There is some evidence, however, that antivirals can reduce symptom duration. 

Included in the analysis were 73 randomized control trials, of which 40 reviewed oseltamivir (Tamiflu).

Across all studies, influenza-related mortality or hospital admission was rare, seen in less than 2 and 21 patients per 1,000, respectively. No antiviral reduced the risk of these events.

Time to symptom resolution, however, dropped in patients taking antivirals, but the effect was small: 0.75 days in oseltamivir groups, and 1.02 days in patients treated with baloxavir (Xofluza). 

More resistance seen with Xofluza

Also of note, trials with oseltamivir had more treatment-related adverse events (AEs) than standard care or placebo. The antiviral baloxavir did not increase treatment-related AEs, but resistance developed in 9.97% of those treated. 

 Influenza vaccinations must remain the first line of defense.

In an attached commentary on the analysis by researchers at the Mayo Clinic, the authors write, “Baloxavir is probably more effective and better tolerated than other available anti-viral drugs but should not be expected to reduce influenza-related hospitalization or death. Influenza vaccinations must remain the first line of defense.”

Today in Emerging Microbes & Infections, researchers at Weill Cornell Medicine–Qatar present a systematic review of 35 studies on new-onset diabetes after COVID-19 infection, estimating an incidence of 1.37%.

The researchers mined databases to identify and analyze studies from around the world on COVID-related type 1 or type 2 diabetes published up to October 2023. The studies included a total of 4.4 million COVID-19 patients of all ages, and 47.7% were male.

Vast majority of cases were type 2

Of the 4.4 million COVID-19 patients, 60,189 (1.37%) had new-onset diabetes (0.84% type 2, 0.017% type 1). The type of diabetes wasn't available for 28 studies (0.51% of cases). 

A multidisciplinary approach involving endocrinologists, primary care physicians, and infectious disease specialists should be implemented in the management of post-COVID patients.

Factors associated with incident diabetes were SARS-CoV-2 variant type, severity of infection, underlying medical conditions, demographic factors, and vaccination status. The risk of diabetes rose over time, with the highest rates seen at 3 to 12 months post-infection.

The study authors noted that the real-world incidence could be higher because many studies reported cases of new-onset diabetes only for patients who returned to the hospital for readmission or follow up. 

"However, this rate is still higher than the estimated rate of new onset diabetes in a general population," they wrote. "For example, among adults aged 18 years or older in the USA, the crude estimates for 2021 were 1.2 million new cases of diabetes (0.59%)."

The exact causes of post-COVID diabetes are unclear, the researchers said: "The mechanisms behind COVID-19-induced diabetes may include direct damage of the pancreatic beta cells, inflammation, insulin resistance, and autoimmune responses."

They recommended that healthcare providers monitor COVID-19 survivors for signs of new-onset diabetes, particularly those with risk factors such as hospitalization, intensive care unit admission, severe infection, pre-existing metabolic disorders, and COVID-19 variants associated with higher risks.

"A multidisciplinary approach involving endocrinologists, primary care physicians, and infectious disease specialists should be implemented in the management of post-COVID patients to address both the acute and long-term complications, including metabolic changes and risk of diabetes," they added.