The Texas Department of Health and Human Services (TDHHS) recently reported a locally acquired malaria infection, its first since 1994, which follows two similar cases reported in Florida.

The patient is a Texas resident from Cameron County who spent time working outdoors and has no history of travel outside Texas or the United States, the TDHHS said in a statement. State and local health officials are following up and working to determine if others were exposed. Cameron County is on the southern tip of Texas on the Gulf of Mexico coast. It also borders Mexico.

Health officials urged clinicians to routinely obtain a travel history and ask about time spent outdoors in people with flulike symptoms, body ache, headache, nausea, or vomiting. They also urged the public to take steps to avoid mosquito bites and to prevent mosquito-breeding sites, such as dumping standing water.

A moderate or severe COVID-19 infection may be a risk factor for chronic pain, according to a study published late last week in PLOS One.

Researchers from Upstate Medical University in New York led the analysis of data from 15,335 adult respondents to the 2021 National Health Interview Survey. They aimed to compare the odds of having chronic pain in the past 3 months among COVID-19 survivors who had no, mild, moderate, or severe symptoms during their infections and never-infected control participants.

"Chronic pain is associated with an increase in depression, anxiety, and sleep disturbance," the researchers wrote. "It can impact daily living activities, reduce social engagement, and impact the ability to contribute to the workforce."

26% of patients with non-mild cases report frequent pain

Of all participants, 76.7% reported never having been infected with COVID-19, 10.7% had no or mild symptoms, and 12.6% had moderate or severe cases. Respondents reporting no or infrequent pain made up 80.3% of the sample, while 19.7% said they had chronic pain.

Chronic pain was more prevalent in the moderate or severe group relative to the never-infected group (25.5% vs 19.4%). Both the adjusted model (odds ratio [OR], 1.28) and matched model (OR, 1.45) showed a higher likelihood of pain for those with moderate or severe COVID-19 than for the uninfected group.

Participants with no or mild symptoms were less likely to report pain in the previous 3 months than the COVID-naïve group (OR, 0.81). Adjusted probabilities show that chronic pain was roughly 4 percentage points more likely among those with more symptoms during infection than among the never-infected group (20% vs 16%).

"A moderate/highly symptomatic COVID-19 infection may be a new risk factor for chronic pain," the authors wrote. "As the absolute number of severe COVID-19 infections continues to rise, overall prevalence of chronic pain may also increase. While knowledge continues to unfold on long-haul symptoms, prevention of severe infections remains essential."

A moderate/highly symptomatic COVID-19 infection may be a new risk factor for chronic pain.

In a new update, the World Health Organization (WHO) notes 41 new mpox cases in the Western Pacific, Americas, and Africa. Beginning in July, the WHO said it will be publishing new situation updates monthly.

"Virus transmission continues at a low pace in several countries, and the main epidemiological and clinical characteristics of cases are stable over time," the WHO said. "Nineteen countries are reporting cases."

Since January of 2022, a total of 87,972 laboratory-confirmed cases of mpox, including 147 deaths, have been reported to the WHO by 112 countries. Reported weekly cases declined by 42% in week 24 (June 12 through June 18), with 41 cases reported to the WHO, compared with 71 cases in week 23 (June 5 through June 11).

Israel reports first case of 2023

In related news, Israel has reported its first mpox case of the year, in a man who had been vaccinated against the virus. Last year, the country tallied 262 mpox cases. The man had recently traveled to Portugal, news reports said.

In its report, the WHO also updated guidance on infections in pregnant women, saying they should avoid all close contact with mpox patients who have active infections, and use condoms for 12 weeks. If infected, pregnant women should continue all prenatal care. According to the WHO, 58 mpox patients were reported to be pregnant or recently pregnant in the mpox global surveillance data since January 2022.

The WHO said decisions to breastfeed should be made on a case-by-case basis.

• Cyclospora infections acquired in the United States typically rise in the summer months, but the increase began in April, which is earlier than usual, the Centers for Disease Control and Prevention (CDC) said in a recent update. Typically, cases start rising in May, and it's too soon to say if there's a change in seasonality, the agency added. So far, 210 cyclosporiasis cases have been reported in 22 states, and 30 people have been hospitalized and no deaths have been reported. A common food source has yet to be identified. Past outbreaks were linked to fresh produce, such as cilantro, basil, snow peas, and raspberries. Earlier this year, federal officials were part of an investigation into 20 illnesses in Alabama and Georgia. Though investigators found a link to imported raw broccoli, they weren't able to identify a specific source or producer, and the outbreak appears to be over.
• Two more Americans have died in a fungal meningitis outbreak linked to spinal anesthesia administered at Mexican cosmetic surgery clinics, bringing the total to six, the CDC said in a recent update. Also, tests have confirmed the fungus in spinal tap samples from three more people, bringing the total to nine. The CDC's update lists 16 suspected cases, meaning people whose symptoms suggest the infection but whose lab results aren't known, and 10 probable cases, meaning spinal tap testing shows evidence of meningitis.
• With flu at low seasonal levels in the United States, the CDC on June 23 said it is watching activity in the Southern Hemisphere flu season, and so far there is no clear pattern, with a mixed picture that varies by country. Some nations, such as Chile, experienced an early start to the flu season, while others, such as Australia and Argentina, are having a typical flu season, with South Africa's activity listed as moderate. Though Mexico isn't in the Southern Hemisphere, it has experienced abnormally high activity in May and June. The CDC said Southern Hemisphere activity doesn't always predict what will happen in the Northern Hemisphere, but monitoring patterns can be helpful for preparedness. The main virus is 2009 H1N1, but some countries are reporting circulation of the H3N2 strain and the influenza B Victoria lineage.