Maternal syphilis rates in the United States tripled from 2016 to 2022, according to new Centers for Disease Control and Prevention (CDC) data published this week.

During the 6-years analysis, maternal infections rose 222%, reaching 280.4 per 100,000 births in 2022.

The increase was seen across all ages and ethnicities, but syphilis rates were highest in mothers who were American Indian and Alaska Native, younger than age 25, and had no prenatal care. Among American Indian and Alaska Natives, rates rose 783%, from 159.7 to 1,410.5 per 100,000 births in 2016 and 2022, respectively.

South Dakota saw biggest jump in incidence

In 2022, the state with the highest incidence was South Dakota (762.6 per 100,000 births), and the lowest incidence was in Maine (45.8 per 100,000 births). In addition to South Dakota, New Mexico, Colorado, Mississippi, Montana, and Alaska also saw a 400% increase in rates.

The biggest risk factor for maternal infection was receiving no or late prenatal care. The largest increases occurred for mothers with no prenatal care (298%, from 262.5 to 1,044.0 per 100,000 births), followed by mothers who began care in the third trimester (244%, from 167.4 to 576.1), and mothers who began care in the second trimester (240%, from 134.3 to 456.9), the CDC said.

After reaching historic lows in 2000 and 2001, rates of primary and secondary syphilis in the overall U.S. population have increased.

"After reaching historic lows in 2000 and 2001, rates of primary and secondary syphilis in the overall U.S. population have increased nearly every year through 2022," the report said. "Congenital syphilis can cause adverse pregnancy outcomes such as fetal and neonatal death, low birthweight, preterm birth, and brain and nerve disorders."

A study presented yesterday at the Society for Maternal-Fetal Medicine's (SMFM) annual conference shows that giving an oral dose of azithromycin to pregnant women who deliver vaginally is a cost-saving way to reduce maternal sepsis, death, and infection.

The study builds on findings from the Azithromycin Prevention in Labor Use Study (A-Plus), which found that women in seven low- and middle-income countries (LMICs) who received an oral dose of azithromycin before a planned vaginal delivery had a 33% reduced risk of maternal sepsis or death compared with those who received placebo. That study, presented at last year's conference and published in the New England Journal of Medicine, involved more than 29,000 pregnant women in Bangladesh, the Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia.

Sepsis causes an estimated 10% of maternal deaths worldwide, but the rate in LMICs is twice that of wealthier nations. To see if the intervention would be cost-effective in the low-resource settings where maternal sepsis is a significant burden, a team of US researchers used data from A-Plus to estimate the cost per case of maternal sepsis or death averted and the incremental cost after accounting for cost savings from reduced healthcare use.

Significant cost saving

The researchers found that, for every 100,000 pregnancies, an oral dose of azithromycin prevented 1,592 cases of maternal sepsis, death, or infection and 249 maternal hospitalizations, at a cost of 91 cents per pregnancy. The overall cost savings was $32,661 per 100,000 pregnancies.

The study's lead author says the data could help ministries of health in LMICs decide how to allocate scarce resources.

"Sepsis remains a leading cause of maternal death globally, and the burden is greatest in low-resource settings," Jackie Peterson, MD, of the University of North Carolina at Chapel Hill School of Medicine, said in an SMFM press release. "It's a big deal to have an effective therapy for maternal sepsis that is also cost-saving to implement in a low-resource setting."

CARB-X announced today that it is awarding researchers at Harvard University $1.2 million to develop oral antibiotics for antibiotic-resistant lower respiratory tract and skin and other soft-tissue infections (SSTIs).

The award to the Andrew G Myers Research Group at the Harvard Department of Chemistry and Chemical Biology will support the development of oral lincosamide antibiotics that have been synthetically enhanced to overcome bacterial defense mechanisms.

"The award from CARB-X will allow us to profile several promising antimicrobial leads in studies to define their potential to advance into preclinical development, or further guide chemical optimization," Andrew Myers, PhD, Amory Houghton Professor of Chemistry at Harvard, said in a CARB-X (Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) press release. "This advancement in research in antibiotics has the exciting potential to combat drug-resistant bacteria, with promise of major impact on global health."

Rising resistance, lack of oral options

Lower respiratory tract infections were the fourth leading cause of death globally in 2019, according to the World Health Organization, causing an estimated 2.6 million deaths. SSTIs account for 31% of all healthcare-associated infections. The bacteria that cause these infections are growing increasingly resistant to first-line antibiotics, particularly in lower-resource settings.

Erin Duffy, PhD, CARB-X's head of research and development, noted that more than 70% of the antibiotics launched since 2010 lack an oral option.

"Oral antibiotics enable patients to be treated at home, which can reduce healthcare costs and increase access globally, including in low- and middle-income countries where the burden of antimicrobial resistance is highest," she said.

The project is the fifth to receive funding under CARB-X's 2022-23 funding call.

An investigation into a Legionnaire's disease outbreak in Grand Rapids, Minnesota, found that the municipal water system is the likely source, the Minnesota Department of Health (MDH) announced yesterday.

Fourteen cases have been reported since April 2023, all involving adults. Eleven patients were hospitalized, but no deaths were reported. The epidemiologic investigation found that the municipal water supply was the only common exposure among the patients. Meanwhile, the lab investigation found that water samples from two buildings were positive for Legionella bacteria and that Legionella from the two buildings were highly related to each other and to the bacteria from patient respiratory samples.

Grand Rapids, in northeastern Minnesota, has a population of about 11,000.

Chlorination wasn't required for city water system

Tom Hogan, who directs the MDH's environmental health division, said officials are working with the local water utility to determine how to address the situation. Grand Rapids is one of a few cities in Minnesota that doesn't chlorinate its water. "This is because some systems that draw water from groundwater sources, such as community wells, are not required to add disinfectants," the MDH said.

Julie Kennedy, general manager of Grand Rapids Public Utilities, said the main priority is developing a plan to disinfect and flush areas of the water system. She added that officials are considering adding a chlorination system, which can be a complex process for a previously unchlorinated system to avoid any additional safety, health, or distribution complications.

Legionnaire's disease—a serious type of pneumonia—can occur when people inhale water droplets containing Legionella, which is commonly found in natural and manmade aquatic environments. The MDH said people sickened in the Grand Rapids outbreak likely contracted the bacteria from water mist from fixtures in buildings, such as showers or faucets.

The World Health Organization (WHO) today added more details to China's recent report of a woman who died following a coinfection with H3N2 seasonal flu and H10N5 avian flu. The case marked the first known human illness involving H10N5.

The woman, in her sixties, worked as a farmer in Anhui province and had underlying health conditions. Her respiratory illness symptoms began on November 30, 2023, and she was hospitalized on December 2. When her condition worsened, she was transferred to a facility in Zhejiang province on December 7, where she died on December 16. On January 22, authorities in Zhejiang isolated H3N2 and H10N5 from her respiratory samples, which were confirmed on January 26 by the Chinese Center for Disease Control and Prevention.

Duck meat samples yielded H10N5

Investigators found that the woman had not been vaccinated against seasonal flu. A few days before her symptoms began, she was exposed to live poultry when she bought a duck. Lab testing on duck meat from the woman's refrigerator found H10N5 in seven samples. The woman did not have contact with pigs or other mammals. Environmental samples from her home were negative.

Monitoring of the woman's contacts in both provinces found no related cases. Agriculture authorities conducted a trace-back investigation of the ducks and have culled birds and disinfected affected areas.

More research needed to gauge H10N5 in animals

The WHO said H10 strains are occasionally detected in wild birds, poultry, and mammals in different parts of the world. They are low-pathogenic viruses that don't require reporting, so their prevalence is unknown. H10N5 had been isolated from pigs in China's Hubei province.

More research is needed to gauge the epidemiology of H10N5 in animal populations, the WHO said, adding that, so far, avian H10 viruses haven't acquired the ability to spread from person to person.

• The National Institutes of Health (NIH) is investing $515 million more in funding over the next 4 years to study long COVID, Director Monica Bertagnolli, MD, announced today. The support is in addition to the $1.15 billion Congress appropriated in 2021 to launch the Researching COVID to Enhance Recovery (RECOVER) Initiative. She said the added funding will focus on clinical trials of new interventions; better understanding of how SARS-CoV-2 affects each part of the body, with an eye on diagnosis and treatment; investigating the recovery trajectory, including how it affects underlying chronic illnesses; and maintaining support for research infrastructure.
• The US Centers for Disease Control and Prevention (CDC) is in the process of revising its guidance for isolation after testing positive for COVID-19 to better align it with current recommendations for flu and respiratory syncytial virus (RSV), the Washington Post reported today, citing agency officials and an expert who is familiar with the discussions. Currently, the CDC recommends a 5-day isolation period after testing positive for COVID. The new recommendations are expected to use clinical symptoms to guide isolation, such as being fever-free for 24 hours without help from fever-reducing medication.
• The CDC yesterday weighed in on the recent detections of four new human H5N1 avian flu infection this year in Cambodia, noting that all of the patients had been exposed to sick poultry and that there is no sign of human-to-human spread. Three of the patients are children, one of whom died. The CDC outlined a few extra details beyond what was included in earlier reports. It noted that the third and fourth case-patients were siblings but lived in different households. Dead poultry were brought from the household of the fourth patient to that of the third patient, exposing both siblings. Genetic sequencing has identified the older H5N1 clade (2.3.2.1c) in two of the cases, and sequencing of the fourth case is under way. The CDC said more sporadic infections in humans can be expected in people with direct or close unprotected exposure to sick or dead poultry.