For the second time this year, India has reported a fatal Nipah virus case, this time involving a 24-year-old student, a local health official told Reuters.

The man’s symptoms began on September 4, and he died 5 days later, according to a district health official from Malappuram, which has been one of the country’s hot spots for Nipah and where the country’s earlier case this year was detected. 

India’s National Institute of Virology confirmed the finding on September 9. Investigators have determined that the man came from Bengaluru, the capital of Karnataka state, and so far, they have identified 151 contacts for monitoring.

Five people with symptoms have been sampled, and testing is under way. So far, it’s not clear how the patient was exposed to the virus.

Earlier cases this year from India and Bangladesh

The country reported its last Nipah case in July. That case involved a 14-year-old boy who got sick and died after eating hog plum fruit from his neighborhood.  The virus is spread by fruit bats and can pass from person-to-person. Earlier this year, Bangladesh reported two infections, both fatal and both from Dhaka.

People can also contract the virus from drinking palm sap or eating fruit contaminated with bat urine, droppings, or saliva. The disease has a high case-fatality rate, and currently there are no specific treatments or vaccines. Nipah virus is classified as a priority disease for countermeasure research and development.

Implementation of an ambulatory antibiotic stewardship program (ASP) intervention at a network of hospitals and clinics cut unnecessary antibiotic prescribing for upper respiratory infections (URIs) by 50% without diminishing patient satisfaction, researchers reported today in Infection Control & Hospital Epidemiology.

The multifaceted ambulatory ASP intervention, implemented across Mayo Clinic facilities in Minnesota, Wisconsin, Arizona, and Florida in July 2020, aimed to reduce antibiotic use for tier 3 URI syndromes, which are defined as URIs for which antibiotics should never be prescribed. In a study published in 2023, Mayo Clinic researchers reported the intervention was associated with 48.4% relative reduction in the antibiotic prescribing rate for tier 3 URI encounters.

In this study, Mayo Clinic researchers analyzed data from patients who completed surveys with six questions assessing patient satisfaction pre- and post-implementation. Participants in both cohorts were aged 19 to 65 years, predominantly female, and had received care from either a physician or an advanced practice provider. 

No difference in patient satisfaction

Overall, a total of 75,874 tier 3 primary care encounters occurred during the pre- and post-implementation periods. Among the 2,956 survey participants (1,715 from the pre- and 1,241 from the post-implementation cohorts), tier 3 antibiotic prescribing decreased from 28.3% pre- to 14.1% post-implementation (a 50% relative reduction). 

When the researchers compared the survey responses of the pre- versus post-implementation cohorts, they found no statistically significant changes for any of the six survey questions or their associated means. For the first question ("Likelihood of you recommending our practice to others"), antibiotic prescribing was associated with statistically significant higher mean satisfaction scores in the overall and pre-implementation cohorts, but the researchers say the difference in mean score was small and may not be meaningfully different.

The researchers say that while the survey respondents represent only a small subset of the overall tier 3 encounters during the study, and the responses may skew toward patients with stronger opinions, the findings are still noteworthy.

"Programmatic efforts to reduce inappropriate antibiotic prescribing should not be dissuaded by concerns over reduced patient satisfaction, although empowering providers with tools to educate patients and provide non-antibiotic value are paramount," they concluded.

A University of Pittsburgh–led study estimates that psychiatric inpatients—especially those on the geriatric unit—with COVID-infected roommates were at much higher risk of infection than those exposed to contagious patients housed elsewhere in the unit from 2020 to 2023.

For the study, published late last week in the American Journal of Infection Control, the researchers compared the risk of SARS-CoV-2 transmission in six units of a US psychiatric hospital among patients with an infectious roommate with that of those with an infectious unit mate from July 2020 to August 2023.

The hospital placed patients with COVID-19 diagnoses in a separate unit that used negative air pressure and required staff to wear N95 respirators. Patients with known SARS-CoV-2 exposure were housed in a separate unit, and new patients were either placed in an individual room or with an unexposed roommate. In all units, physical distancing and universal masking were required until March 2023.

"Patients cared for in psychiatric facilities may have complex psychiatric diagnoses and coexisting medical conditions that are risk factors for severe SARS-CoV-2 infection and complications of infection, and may lack the ability to adhere to masking, social distancing, and other mitigation strategies," the authors noted. 

Geriatric-unit patients at 6 times the risk

The analysis included 40 and 387 roommate and unit mate exposures, respectively. The COVID-19 infection rate was 10.05% overall, 24.4% for exposed roommates, and 9.3% for exposed unit mates. Average exposure time was 1.84 days.

Cohorting contagious and exposed individuals and avoiding multi-bedded rooms may successfully mitigate COVID-19 transmission risk during psychiatric care.

Patients who shared a room with a contagious roommate were 3.14 more likely than those with an infected unit mate to test positive for COVID-19. Patients exposed to a sick roommate or unit mate in the geriatric psychiatric unit were 6.38 times more likely to become infected. Group therapy wasn't associated with viral transmission.

"Cohorting contagious and exposed individuals and avoiding multi-bedded rooms may successfully mitigate COVID-19 transmission risk during psychiatric care," the researchers wrote. "Group therapy may continue to be offered with appropriate mitigation measures due to the minimal contribution to transmission that group therapy offers."

• The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed four more H5N1 avian influenza outbreaks in diary herds, two in Texas and one each in California and Idaho. The new confirmations push the nation’s total to 207 herds from 14 states. California, the most recently affected state, now has eight outbreaks.
• The Taliban has suspended polio vaccination campaigns in Afghanistan, the Associated Press (AP) reported today, based on United Nations sources. The group relayed its decision to UN officials just before a September vaccine drive was to begin. It’s not clear why the group suspended the campaign. Afghanistan is one of two countries where wild poliovirus type 1 (WPV1) is still endemic. The country, along with neighboring Pakistan, has reported a rise in WPV1 cases this year, and Pakistan has recently reported more attacks on polio vaccination teams, some of them deadly.