Compared to last year at this time, global cholera cases have declined 31%, but deaths are 34% higher, the World Health Organization (WHO) said today in its latest update, which includes data received in July.

For July, 17 countries reported nearly 52,000 cases, along with 223 deaths. Four WHO regions reported cases, with the Eastern Mediterranean region hit hardest, followed by the African region. 

Since late July, Nepal has reported new cholera clusters from several districts. 

Cholera vaccine shortage persists

The WHO said the response to the outbreaks is still hampered by a shortage of oral cholera vaccine, with 105 million doses requested by 18 countries since January 2023, nearly double the 55 million doses produced over that period.

The WHO said the global risk is still very high and is considered a grade 3 emergency. It added that transmission dynamics are increasingly complex, reflecting factors that cross county borders, such as population mobility, natural disasters, and climate change.

Antibiotics given to pregnant women prior to cesarean section have limited effects on infant gut microbiome composition, researchers reported yesterday in Cell Host & Microbe.

In a randomized trial conducted in the Netherlands, investigators found that antibiotics given prior to incision to prevent maternal infections and neonatal sepsis subtly affected bacterial strain variability and antibiotic resistance gene abundance in infants. But feeding mode had a much bigger impact on infant microbial composition.

Administering antibiotics 20 minutes before incision is widely recommend and has been found to reduce maternal risk of infection, but few studies have looked at the impact on the infant gut microbiome.

"We decided to conduct this study because it addresses a significant clinical question with possibly profound implications for infant health," first and corresponding author Trishla Sinha, MD, of University Medical Center Groningen, said in a press release from Cell Press. "Mothers often ask whether the antibiotics they take influence their child, and this study can provide assurance that they have only small effects on infant gut microbiome."

Feeding mode had larger impact on gut microbiome composition

For the trial, investigators enrolled 28 mother-infant pairs, assigning 12 of the mothers to receive antibiotics before skin incision and 16 to receive them after the umbilical cord was clamped—a practice that was common prior to 2015 in part to avoid exposing newborns to antibiotics. The World Health Organization recommended in 2015 that antibiotics be administered before the incision.

Analysis of 172 infant fecal microbiome samples collected at eight time points after birth, along with data from 79 infants in two similar trials, found no statistically significant differences in the two groups in terms of bacterial diversity and species richness. Differences at the bacterial strain level and in the load of antibiotic resistance genes in infants born to mothers who had received antibiotics prior to incision were very small.

Mothers often ask whether the antibiotics they take influence their child, and this study can provide assurance that they have only small effects on infant gut microbiome.

Feeding mode explained 12% of the variation in infant gut microbiome composition and also had a profound effect on the babies' bile acid composition.

The investigators say the findings need to be validated in larger-scale and long-term studies, and further research is needed on the long-term health implications for pregnant women and infants.

The New York State Department of Health (NYSDH) is telling healthcare providers to discontinue the use of ciprofloxacin in people who've had contact with patients diagnosed as having bacterial meningitis.

Ciprofloxacin is among the antibiotics that have been recommended for post-exposure prophylaxis (PEP) to prevent illness in contacts of people with invasive meningococcal disease, a rare but severe infection caused by Neisseria meningitidis. But in a health advisory notification yesterday, department officials said they've been finding an increase in ciprofloxacin-resistant strains of N meningitidis over the past 18 months.

"Providers should instead use rifampin or ceftriaxone, as they remain a first-line treatment option," State Health Commissioner James McDonald, MD, MPH. said in a press release. "Importantly, the treatment recommendations have not changed—it's vital to begin antibiotic treatment promptly when invasive meningococcal disease is suspected."

Resistance levels close to CDC threshold 

According to the notification, 4 of 20 N meningitidis isolates (20%) collected from invasive meningococcal disease patients in New York but outside of New York City in 2023 were resistant to ciprofloxacin. In New York City, 6 (17%) of 35 isolates collected from patients from July 23, 2023, to July 22, 2024, were resistant. The Centers for Disease Control and Prevention recommends discontinuing ciprofloxacin PEP when at least 2 patients and 20% of patients in a local catchment area have resistant strains.

The NYSDH said azithromycin may also be used as an alternative option for PEP.

Invasive meningococcal disease can cause swelling of the brain, bloodstream infections, and joint infections, and is fatal in 10% to 15% of cases. Roughly 30 cases occur each year in New York state.