Over the past 3 days, Cambodia has reported two more human H5N1 avian flu infections, raising it total for the year to seven cases, according to health ministry statements translated and posted by Avian Flu Diary, an infectious disease news blog.

On July 6, the ministry reported the first new case, which involves a 3-year-old boy from Takeo province in the southern part of the country. Initial symptoms included fever, cough, and breathing difficulty. The boy was hospitalized, and his condition is improving. An investigation found that 10 days earlier he had touched and held a chicken that had died in the village.

Both cousins exposed to dead poultry

Today the ministry reported a second case, involving a 5-year-old girl who is a cousin of the first patient and lived in the same home. The girl had a fever and is receiving treatment. Officials said her illness is mild. Investigators found that she had also touched the dead chicken.

So far, the clade isn't known, but other recent H5N1 illnesses in Cambodia were linked to the older 2.3.2.1c clade that circulates in poultry in some Asian countries, including Cambodia. It is different from the 2.3.4.4b clade affecting wild birds, poultry, and some mammals across several world regions. 

Cambodia has reported an uptick in human infections, with 13 reported since February 2023. The infections are often serious or fatal.

The Public Health Agency of Canada (PHAC) last week reported an increase in antimicrobial-resistant gonococcal (AMR-GC) infections, including a near doubling of cases showing resistance or decreased susceptibility to two different antimicrobials.

The Enhanced Surveillance of Antimicrobial-Resistant Gonorrhea (ESAG) report summarizes data on 3,377 gonorrhea cases submitted for analysis in four Canadian provinces (Alberta, Manitoba, Novia Scotia, and the Northwest Territories) from 2018 through 2021. Most patients (80.2%) were male, of which an average of 55.5% were among men who have sex with men (MSM). 

From 2018 through 2020, the prevalence of AMR-GC (as indicated by resistance to at least one antibiotic) was stable, but it increased from 69.3% in 2020 to 77.4% in 2021, while GC cultures demonstrating resistance or decreased susceptibility to two different antimicrobials rose from 24.8% to 44.5%. In 2021, the AMR-GC burden was highest among MSM (85.2% of isolated cultures were resistant to at least one antimicrobial), followed by heterosexual men (73.5%) and women (66.7%). 

Recommended regimen remains effective

Of tested antimicrobials, resistance to ciprofloxacin was most prevalent, rising from 46.6% of cases in 2020 to 63.1% in 2021. Resistance to ciprofloxacin and tetracycline was high among all sexual behavior groups but highest among MSM. But no cases demonstrating combined resistance to azithromycin and ceftriaxone or cefixime (the gonorrhea treatment regimens recommended by PHAC) were reported. Decreased susceptibility to ceftriaxone or cefixime was detected in one case each in 2018, 2020, and 2021, and in three cases in 2019.

Fourteen cases were reported by public health authorities as treatment failures, but none demonstrated resistance or decreased susceptibility to prescribed treatment regimens.

PHAC says that, as gonorrhea cases rise across Canada and resistance continues to evolve, it's hoping to recruit additional ESAG sites to collect more representative data.

"The continuous monitoring of AMR-GC patterns via surveillance is of paramount importance to ensure the effectiveness of the recommended antimicrobials to treat GC infection," the agency said. "ESAG can play an important role in assessing and monitoring the effectiveness of GC treatment options and for the success of Canadian initiatives to combat AMR-GC."

A new meta-analysis of 48 observational studies that included 8,664,026 people reveals that pre-existing sleep disturbances are tied to an increased risk of COVID-19 infection and worse outcomes if infected. The study is published in eClinicalMedicine. 

Previous studies have shown that up to 50% of COVID-19 patients experience sleep disturbances, and sleep disturbances are linked to "daytime drowsiness, work burnout, and low spirits but also induce immune deficiency and systematic inflammation," the authors note.

For the purposes of this study, sleep disturbances included obstructive sleep apnea (OSA), insomnia, abnormal sleep duration (less than 6 hours or more than 9), night-shift work, and restless legs syndrome already documented before infection with COVID-19 

The studies analyzed had sample sizes ranging from 118 to 4.9 million and were conducted in 15 countries, including 19 studies based on US patients. 

Pre-existing sleep disturbances were tied to an increased risk of COVID-19 infection of 12% (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07 to 1.18), hospitalization of 25% (OR, 1.25; 95% CI, 1.15 to 1.36), death of 45% (OR, 1.45; 95% CI, 1.19 to 1.78), and long COVID of 36% (OR, 1.36; 95% CI, 1.17 to 1.57).

Findings differ by age, sex

Age and gender played a role in the findings, with men with sleep disturbances more likely to die from COVID than women with sleep disturbances. 

Young individuals with pre-existing sleep disturbances had a higher susceptibility and hospitalization for COVID-19 than those without.

"Young individuals with pre-existing sleep disturbances had a higher susceptibility and hospitalization for COVID-19 than those without. This finding further confirmed the compromised immune function induced by sleep disturbances," the authors wrote. "In old individuals, those with pre-existing sleep disturbances elevated the hospitalization and mortality of COVID-19 but did not increase the susceptibility compared with those without."