Maryland health officials yesterday warned that a Maryland resident with a confirmed case of measles may have exposed people to the highly contagious virus at Washington Dulles International Airport and a local healthcare facility.

In a news release yesterday, the Maryland Department of Health confirmed a positive case of measles in a Howard County resident who recently traveled internationally. Department officials said anyone who was at Terminal A at Washington Dulles on March 5 from 4:00 pm to 9:00 pm or Johns Hopkins Howard County Medical Center Pediatric Emergency Department on March 7 from 3:30 pm to 7:30 pm may have been exposed to the virus. 

"People, especially those not vaccinated or otherwise immune to measles, who were at any of these locations during the possible exposure times should monitor themselves for any early symptoms of measles for 21 days after the potential exposure," department officials said.

Official US case count: 222

On March 7, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network advisory urging healthcare professionals to ensure that all patients without other evidence of measles immunity, especially those planning international travel, are up to date on the MMR vaccine. In its most recent update on the same day, the CDC confirmed 222 US measles cases so far this year.

The Maryland case is the first measles case in that state this year. Maryland experienced one case each in 2024 and 2023, and none from 2020 through 2022.

A new study involving Norwegian nurses links sleep debt and night work to an increased risk of the common cold, with sleep debt also linked to vulnerability to pneumonia/bronchitis, sinusitis, and gastrointestinal infection.

Researchers at Haukeland University Hospital in Bergen examined the association among sleep duration, lack of sleep, shift work, and self-reported infections among 1,335 Norwegian nurses. The average participant age was 41.9 years, and 90.4% were women. The data were derived from the spring 2018 Survey of Shift work, Sleep and Health study.

"Approximately 25% of all employed individuals worldwide are engaged in shift work," the investigators wrote. "While around-the-clock work is crucial for maintaining the functioning of essential services, shift and night work also bring forth diverse health consequences for the workers."

The findings were published yesterday in Chronobiology International. 

Severe sleep debt tied to almost 4 times risk of pneumonia

Relative to adequate sleep, sleep debt (1 to 2 hours or more than 2 hours, respectively) was associated in a dose-dependent manner with an increased risk of the common cold (adjusted odds ratios [aORs], 1.33 and 2.32), pneumonia/bronchitis (aORs, 2.29 and 3.88), sinusitis (aORs, 2.08 and 2.58), and gastrointestinal infection (aORs, 1.45 and 2.45).

Brazil has reported its first clade 1b mpox case, per a notice from the national Health Ministry. 

According to media reports, the patient is a 29 year-old woman from Sao Paulo, whose relative had recently returned from travel to the Democratic Republic of the Congo (DRC). Currently the DRC is in the middle of a large mpox outbreak, with thousands of cases caused by clade 1b, a more transmissible strain of the virus. 

So far this year Brazil has reported 52 cases of mpox, but all were clade 2, the strain that caused a global outbreak of the virus in 2022 and 2023, primarily among men who have sex with men. 

Health Ministry officials said there are no other clade 1b cases in Brazil at this time. 

Grant for single-dose vaccine 

In related news, Tonix Pharmaceuticals today announced that it has received a US Department of Defense grant to support the development of a single-dose vaccine against mpox and smallpox. A grant from the Medical CBRN Defense Consortium will support the development of TNX-801, a recombinant live horsepox virus vaccine.

"TNX-801 offers an appealing target product profile, requiring just a single dose for durable, long-term protection, with favorable shipping and storage requirements. With a significant global unmet need, TNX-801 is in a strong position to make a potential impact towards preventing mpox and controlling mpox epidemics," said Seth Lederman, MD, the president and CEO of Tonix, in a press release from the company. 

The vaccine has performed well in animal challenges with mpox clade 1 infections, the company said.

A study of patients who received fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) at six US hospitals identifies the biggest risk factors for subsequent antibiotic use, researchers reported late last week in Open Forum Infectious Diseases.

The study, led by researchers with the University of Minnesota, was a secondary analysis of a prospective cohort study of patients who received FMT for rCDI from July 2019 through November 23, 2023. 

FMT involves the transfer of stool from healthy donors to help restore the gut microbiome of patients with rCDI, which occurs in roughly 20% of CDI patients after an initial infection and becomes more of a risk with each subsequent episode. Although FMT has been shown to be effective as an rCDI treatment and is endorsed by several medical societies for managing rCDI, the researchers wanted to investigate non-CDI antibiotic exposure in the patients within 2 months of FMT, as that could disrupt the restoration of the gut microbiome and contribute to recurrence.

The analysis included 448 patients from the original study. Of those patients, 82 (19%) were immunocompromised, 147 (34%) had been previously hospitalized for CDI, and 49 (11%) were exposed to non-CDI antibiotics within 2 months of FMT. The most commonly reported reasons for non-CDI antibiotic administration were urinary tract infections, respiratory tract infections, and procedural prophylaxis.

A 'potentially modifiable' risk factor

Risk factors for non-CDI antibiotics within 2 months of FMT included immunocompromised status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1 to 4.4), more than three non-CDI antibiotic courses pre-FMT (OR, 3.1; 95% CI, 1.4 to 6.8), and prior hospitalization for CDI (OR, 2.0; 95% CI, 1.1 to 3.8).

The study authors say the findings highlight the importance of appropriate and judicious antibiotic use post-FMT.

"Unlike other risk factors for CDI recurrence, the administration of non-CDI antibiotics post FMT is a potentially modifiable risk factor," the study authors wrote. "Assessment of these risk factors along with understanding the initial triggering event for CDI can help develop a comprehensive plan to prevent subsequent CDI episodes."

In an update on March 8 the World Health Organization (WHO) shared new details about a second cluster of cases—three confirmed and two probable—in Uganda’s Ebola Sudan outbreak, which have raised concerns about undetected transmission and have led to ramped up surveillance.

All of the cases have links to a 4-year-old child, reported as the tenth case, whose confirmed death from the virus occurred on February 25. The WHO’s African regional office last week reported that the boy’s mother had died of an acute illness after delivering a baby in the hospital. The baby also died. Neither were tested, and both fatal illnesses were recorded as probable cases. The report notes that the mother and baby were from Ntoroko district in the west of the country, not far from the Democratic Republic of the Congo (DRC) border.

Unsupervised burial in 3 recent deaths

The WHO said the mother was pregnant when her symptoms began on January 22. She died on February 6, and her newborn child died on February 12. “The three deaths did not have a supervised burial,” the WHO said.

The eleventh confirmed case involves a woman who had contact with the boy, and the twelfth is a woman who had contact with his mother. Both are admitted to Ebola treatment centers.

As of March 2, 192 new contacts have been identified and are under monitoring in connection to the second cluster of cases. The contacts are from Kampala and Wakiso district in the east of the country around the capital city of Kampala, while others are from Ntoroko district in the west.

The outbreak marks Uganda’s sixth Ebola Sudan outbreak. Currently, the case fatality rate is 29%, which is lower than the 41% to 70% levels seen in earlier outbreaks.