During the first 3 years of the pandemic, at least 255 healthcare workers (HCWs) around the world were attacked, 18 were killed, 147 were injured, and 86 facilities were damaged, finds a report published last week in Health Security.

Led by researchers in the Netherlands, the study extracted data on global COVID-related attacks against HCWs from the Safeguarding Health in Conflict Coalition database from January 2020 to January 2023. The team included incidents related to COVID-19 public health measures or interference with COVID-19 care, including attacks related to conflict.

"During the COVID-19 pandemic, violence targeting healthcare reportedly increased," the researchers wrote. "Attacks against healthcare can severely hamper the public health response during a pandemic."

Likely an undercount

During the study period, 255 COVID-19-related attacks on HCWs were reported, with 18 killed and 147 injured, in addition to damage to 86 facilities. Attacks were most common at the beginning of the pandemic and primarily consisted of "stigma-related" attacks on HCWs. 

The findings of this study emphasize the importance of public education campaigns, improved coordination between healthcare organizations and law enforcement, and the possible need to bolster the security of medical facilities and health workers.

Incidents in 2021 included those against vaccination campaigns and conflict-related attacks that interfered with COVID-19 care. Such incidents were reported in heterogeneous contexts throughout the pandemic.

"Due to underreporting, the data presented are a minimum estimate of the actual magnitude of violence," the study authors wrote. "The findings of this study emphasize the importance of public education campaigns, improved coordination between healthcare organizations and law enforcement, and the possible need to bolster the security of medical facilities and health workers."

Southern Hemisphere flu activity is winding down, and data show that the 2024 season was similar to the region’s earlier flu seasons, a reminder that the virus can cause significant public health impact, the US Centers for Disease Control and Prevention (CDC) said in an overview yesterday.

Though it's important to consider Southern Hemisphere flu activity ahead of the upcoming US flu season, the CDC emphasized that patterns there don't always predict how the season will unfold in the United States. Differences in predominant flu viruses and population immunity can contribute to regional variations, it added.

Mix of subregional flu patterns

In the Southern Hemisphere, flu activity this season varied by virus strain, severity, and timing. In South America, H3N2 was the main strain, and Argentina, Chile, and Uruguay had an early start to their seasons. Chile's activity was very high, and Chile, Ecuador, and Uruguay had high levels of severe disease.

In contrast, H1N1 was dominant in the African region, with Zambia reporting an early start to the season and very high levels of illness and severe disease. Activity continues—now mostly from influenza B—in South Africa and Zambia.

H3N2 was predominant in the Oceania region. The timing of Australia's season was similar to pre-COVID years and similar to its 2023 flu season. Flu activity reached the moderate level and has been decreasing in recent weeks, though several areas are seeing upward trends.

The Southern Hemisphere's flu season typically runs from April through September, but it can sometimes extend into October or November, the CDC said.

"Vaccination remains the best defense against flu and even if vaccination does not prevent the risk of flu entirely, it can help reduce the severity of flu illness in people who get flu despite being vaccinated," the CDC said "In the United States, September and October are generally good times to be vaccinated against flu."

Data collected from hospitals in South Africa's third most populous province highlight the patients who are bearing the burden of rising rates of carbapenem-resistant Enterobacterales (CRE) in the country, researchers reported yesterday in PLOS One.

Using routine clinical and laboratory datasets, researchers from Stellenbosch University analyzed all CRE episodes (including clinical episodes and carriage) at hospitals in Western Cape province from 2016 through 2020. With CRE becoming an increasing problem at hospitals across the country but little local data on it, they wanted to describe the epidemiology of CRE carriage and infection, examine patient demographics and resistance phenotypes, and identify factors associated with mortality.

A total of 2,242 CRE episodes (70.5% clinical episodes and 29.5% carriage) were identified over the study period. Among the 2,281 CRE isolates identified, the most common species were Klebsiella spp (72.1%), Enterobacter cloacae (15.1%), and Escherichia coli (5.5%). Affected patients were mostly male (52%) and had a median age of 31 years. Most CRE episodes occurred in hospitalized patients (93%) and were recorded in central hospitals (70%).

The proportions of CRE isolates that were non-susceptible to imipenem and meropenem were 77.6% and 74.6%, respectively, and resistance to other beta-lactam antibiotics exceeded 98%. 

Factors associated with death

Among the 2,109 CRE episodes with available outcome data, 20.4% of patients died; crude in-hospital mortality rates were significantly higher for CRE clinical episodes (26.9%) than for CRE carriage episodes (6.4%). 

Factors that showed a statistically significant association with in-hospital mortality were female sex (adjusted odds ratio [aOR], 1.40; 95% confidence interval [CI], 1.09 to 1.56)], adult patients (aOR, 1.76; 95% CI, 1.20 to 2.57), CRE isolation from a sterile specimen (aOR, 0.41; 95% CI, 0.32 to 0.53), and more than 3 days between hospital admission and specimen collection (aOR, 1.56; 95% CI, 1.11 to 2.18).

"It is important to identify these factors to improve patient outcomes, to guide treatment strategies, enhance infection prevention and control (IPC) measures and to address the broader public health and economic implications of CRE infections," the study authors wrote. "This ultimately impacts the greater fight against [antimicrobial resistance] and the improvement of health care."