The United Kingdom today reported its first imported clade 1b mpox case, a patient who recently traveled to countries in Africa that are experiencing infection in community settings.

In a statement, the UK’s Health Security Agency (HSA) said the case was detected in London and that the patient has been transferred to the Royal Free Hospital’s High Consequence Infectious Diseases unit.

Susan Hopkins, MB BCh, chief medical advisor at the HSA, said, “The risk to the UK population remains low, and we are working rapidly to trace close contacts and reduce the risk of any potential spread. In accordance with established protocols, investigations are underway to learn how the individual acquired the infection and to assess whether there are any further associated cases.”

The UK is the fifth country to report an imported case of clade 1b monkeypox, alongside Sweden, Thailand, Germany, and India.

Different than clade 2 strain spreading globally, the novel clade 1b virus was detected amid a large outbreak in the Democratic Republic of the Congo (DRC) in April and is circulating alongside other clades and in Uganda.

Bavarian Nordic launches mpox trial in children, WHO adds more tests to EUL list

In other mpox developments, Bavarian Nordic announced yesterday that the first patients have been vaccinated in a clinical trial to assess the safety and immunogenicity of the Jynneos vaccine in children ages 2 to 11 years old. The trial is expected to enroll 460 participants, mainly in the DRC but with some sites to be included from Uganda.

Meanwhile, the World Health Organization (WHO) said today that it has added two more mpox PCR tests to its emergency use listing. They include Xpert Mpox from Cephid, which can be used on GeneXpert systems and deliver a result in 40 minutes. The other is the cobas MPXV assay, developed by Roche for use on cobas 6800/8800 systems. The test can detect both mpox clades and deliver a result in less than 2 hours.

A study of two different strategies for optimizing antibiotic therapy in intensive care unit (ICU) patients with pneumonia found that both provided high rates of appropriateness in empiric antibiotic selection, but one was better at reducing antibiotic overuse, researchers reported today in Open Forum Infectious Diseases.

In the study, researchers from the University of Michigan and the University of Kansas compared two strategies for selecting empirical antibiotic treatment in patients with hospital-acquired and ventilator-associated pneumonia (HAP/VAP) caused by gram-negative bacteria, which is a common infection in intensive care units and associated with high morbidity and mortality. Guidelines recommend administering two antipseudomonal agents, but they lack clear guidance on which antibiotics to use. 

One strategy is to develop local antibiograms based on common pathogens and use the results to inform treatment strategies. The other is to base treatment on patient-specific risk factors, such as previous antibiotic use. 

To compare the two, the researchers spent one period (2021) collecting respiratory cultures and reviewing patient charts from ICU patients at a tertiary care hospital in Michigan to develop optimal empiric antibiotic regimens based on local antibiograms and a risk factor-based algorithm. In the second period (2022), they hypothetically applied the strategies to patients to compare rates of appropriate therapy and antibiotic overuse.

Risk factor–based approach offers advantages

The analysis found that risk factor–based regimens had a higher appropriateness rate compared to regimens derived from antibiograms (89.9% vs 83.7%). Additionally, applying antibiogram-based regimens resulted in a higher prevalence of antibiotic overuse than a patient-specific risk factor–based approach (69.8% vs. 40.3%), with excess overuse driven by a higher frequency of unnecessary use of combination therapy. 

"Both patient-specific risk factors and unit-specific combination antibiogram approaches were useful and can be applied in empiric antibiotic selection," the study authors wrote. "However, the patient-specific risk factor-based approach offers higher rate of appropriateness therapy and advantages in reducing the overuse of combination agents."

Amid unprecedented flooding across several parts of the country, South Sudan has declared a cholera outbreak, with 50 suspected cases reported so far, the World Health Organization (WHO) said today.

The outbreak’s location is Renk County in northern South Sudan, a border area where refugees are fleeing armed conflict in neighboring Sudan, the WHO said.

Flooding has affected more than 81,000 people and has displaced more than 46,000 in Upper Nile state, which includes Renk County.

South Sudan has activated a cholera task force, and the WHO said it is working closely with health officials to provide support, including the establishment of two cholera treatment units. The WHO also said it has deployed two rapid response teams and has delivered 12 metric tons of emergency kits, enough to treat 74,000 people.

Cholera activity and outbreaks have been on the rise since 2021, driven by complex factors that include population displacements and natural disasters. In a recent report, the WHO said cases this year are down from 2023 numbers, but deaths have more than doubled.