Some countries continue to report high COVID-19 burdens, based on markers that include cases, hospitalizations, and deaths, the World Health Organization (WHO) said today in its latest weekly update. The agency has said tracking COVID trends remains challenging, since a declining number of countries regularly report cases, with hospitalizations and deaths becoming more reliable indicators.

At the regional level, Africa reported a rise in COVID deaths, though fatalities have been at a relatively low baseline.

Of 19 countries that regularly report hospitalizations, 2 reported rises of 20% or more during the current 28-day reporting period: Bangladesh and Malta. Of 16 countries that regularly report intensive care unit (ICU) admissions, 2 reported rises of 20% or more, Lithuania and Mexico.

In its variant proportion update, the WHO said Omicron XBB.1.5 levels continue to decline steadily, falling from 30.1% to 16.3% of sequences over the past month. Meanwhile, XBB.1.16 levels continue to rise, up from 18.1% to 21.2% over the reporting period. The WHO said proportions vary by region, with XBB.1.5 dominant in the Americas and XBB.1.16 most common in Europe, Southeast Asia, and the Western Pacific.

Of the other subvariants that the WHO monitors, only three increased: XBB, XBB.1.9.2, and XBB.2.3.

A case report published yesterday in Emerging Infectious Diseases highlights the increased risk of multidrug-resistant (MDR) organism transmission and infection posed by the conflict in Ukraine.

The report describes the analysis of blood and surveillance cultures from a service member from Ukraine who suffered multiple traumatic injuries, including full-thickness burns. After transfer to a US military hospital in Germany, doctors obtained blood, urine, respiratory, and peri-rectal surveillance cultures from the patient, which grew Acinetobacter baumannii, Enterococcus faecium, Klebsiella pneumoniae, and three distinct strains of Pseudomonas aeruginosa. The gram-negative pathogens were nonsusceptible to most antibiotics tested, while the E faecium isolate was nonsusceptible to vancomycin.

Whole-genome sequencing identified an array of antibiotic resistance genes, including multiple carbapenemase and extended-spectrum beta-lactamase genes.

The study is one of several in recent months that have described MDR infections among soldiers and hospitalized patients in Ukraine since the Russian invasion in February 2022. The study authors note that European healthcare networks now consider prior hospitalization in Ukraine to be a critical risk factor for colonization with MDR organisms.

Healthcare practitioners treating citizens of Ukraine need to be cognizant of the increased risk for MDR organism transmission and infection.

"Gaps in such services as infection control, caused by limited resources and personnel, are exacerbating the transmission of MDR organisms in Ukraine," researchers from Walter Reed Army Institute of Medical Research and Landstuhl Regional Medical Center wrote. "Healthcare practitioners treating citizens of Ukraine need to be cognizant of the increased risk for MDR organism transmission and infection imposed by the conflict in Ukraine and implement appropriate infection control measures to mitigate their spread." 

A study conducted at four hospitals in Kenya found that antibiotic use, invasive devices, and several days of hospitalization were significantly associated with carriage of multidrug-resistant bacteria, researchers reported yesterday in Clinical Infectious Diseases.

For the study, a team of US and Kenyan researchers collected and analyzed stool samples from randomized patients at one urban and three rural hospitals in Kenya from January 2019 to March 2020. Their aim was to evaluate the potential risk factors for colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE), which commonly precedes infection for many patients.

"These bacteria can cause untreatable infections," lead author Sylvia Omulo, PhD, MPH, of Washington State University, said in a university press release. "We have to use surveillance to make sure we understand what causes these bacteria to colonize and, later, resist certain antibiotics."

Analysis of 840 stool samples revealed that 66% and 11% of patients harbored an ESCrE and/or CRE isolate, respectively. Seventy-six percent of patients had received one or more antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%) and metronidazole (28%).

The risk factors for colonization identified in this study—limiting the use of invasive devices, judicious use of antibiotics, and reducing the transmission risk—are similar to those associated with nosocomial infections.

In the logistic regression models that controlled for ceftriaxone use as a potential risk factor, ESCrE colonization odds were higher among patients hospitalized for 3 or more days (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.60 to 3.37), intubated patients (OR, 1.73; 95% CI, 1.03 to 2.91), and people with HIV (OR, 1.70; 95% CI, 1.03 to 2.8). CRE colonization odds were higher among patients receiving ceftriaxone (OR, 2.23; 95% CI, 1.14 to 4.38) and for every additional day of antibiotic use (OR, 1.08; 95% CI, 1.03 to 1.13).

"In conclusion, the risk factors for colonization identified in this study—limiting the use of invasive devices, judicious use of antibiotics, and reducing the transmission risk—are similar to those associated with nosocomial infections," the study authors wrote. "This emphasizes not only the importance of infection prevention and control activities but also the utility of colonization data—rather than data on nosocomial infections—in evaluating the effectiveness of hospital interventions."

A month after Oklahoma reported its first case of chronic wasting disease (CWD) in a wild deer, another white-tailed deer has tested positive, this time in Woodward County.

Earlier this week, the Oklahoma Department of Wildlife Conservation (ODWC) said a landowner reported the wild deer behaving abnormally on his property about 15 miles east of Woodward.

The state's first case of CWD in a wild deer was identified in Texas County, in the Oklahoma Panhandle. Woodward County is located east of Texas County, in the northwestern part of the state and just east of the Panhandle. Identification of the first case prompted the ODWC and the Oklahoma Department of Agriculture, Food and Forestry to activate the next stage of their CWD response strategy.

We will be ... implementing surveillance efforts and steps to monitor and slow the potential spread of this disease.

"We will be working through our response plan implementing surveillance efforts and steps to monitor and slow the potential spread of this disease," Jerry Shaw, ODWC wildlife programs supervisor, said in a statement. "Our ultimate goal is to ensure healthy and well-managed deer with as little impact to either the resource or our constituents as possible."

State reported CWD in captive elk in 1998

CWD is a fatal neurodegenerative disease caused by infectious prions, or misfolded proteins, that affects cervids such as deer, elk, and moose. The disease creates cavities in the brain that resemble those of sponges. While CWD isn't known to infect humans, some experts fear it could jump species. 

The ODWC said it has been monitoring hunter-harvested deer and elk, as well as road-killed deer, for CWD since 1999, processing tissue samples from more than 10,000 wild deer and elk.

The ODWC said it will continue monitoring for CWD and release more information, including how deer and elk hunters can help with detection and mitigation, as hunting seasons approach. It will also distribute more guidelines or management plans, if necessary, to further protect Oklahoma's cervids.

In 1998, the ODWC confirmed CWD in a captive elk herd in Oklahoma County that had been imported from Montana.

• A UNICEF and World Health Organization (WHO) analysis of gender inequalities related to issues with household drinking water, sanitation, and hygiene found that women and girls bear the biggest burdens, which can affect their safety and education. The report looked at trends from 2000 to 2022 and found that females are twice as likely as males to be responsible for fetching household water, detracting from play, learning, and safety. Also, females were more likely to feel unsafe using a toilet outside the home and disproportionately felt the impact of hygiene gaps, such as limited ability to safely and privately manage their periods.
• The US Centers for Disease Control and Prevention reported 24 more mpox cases over the past week, according to an update yesterday. Health officials have braced for a potential spike in cases with increased social gatherings over the summer, but so far, the 7-day average for new daily cases remains low. The new cases raise the national total since early 2022 to 30,555. No new deaths were reported, keeping the fatality count at 43.
• Denmark's pertussis cases have shown a spike since May, according to a statement from the country's Statens Serum Institut, translated and posted by Avian Flu Diary, an infectious disease news blog. Health officials said about 80 to 100 cases are detected each month, but cases rose to 104 in May and at least 284 in June. They said that, as with other respiratory diseases, pertussis cases were low during and right after pandemic restrictions were in place, that pertussis levels rise every 3 to 5 years, and that it's too early to say if cases will remain at epidemic levels.