Low-level mpox transmission continues in many parts of the world, with Africa, Europe, and the Americas reporting the largest portion of recent cases, the World Health Organization (WHO) said in a monthly situation update yesterday, which covers cases reported in March.

Adding a caveat that a decline in surveillance may underestimate infections, the WHO said 466 new cases, 3 of them fatal, were reported in March. In Africa, the Democratic Republic of the Congo (DRC)—experiencing an outbreak of a novel clade 1 virus—reported the most cases.

Ten countries reported case rises in March, with the Republic of Congo reporting the largest rise in Africa. Other hot spots were the United Kingdom, Puerto Rico in the United States, and Vietnam.

The WHO said the risk is high for the DRC's general population and moderate for countries that have historically reported mpox infections and for men who have sex with men, gender-diverse people, and sex workers. The general population risk for countries that haven't experienced earlier outbreaks is low.

Over the past 6 months, monthly cases have fluctuated between 400 and 1,000 cases, with most reported in the Americas, Europe, and Africa. Though sexual encounters are the most common mode of transmission, patterns in Africa are more diverse and include the zoonotic route.

Advisers discuss mpox vaccine issues

WHO vaccine advisers met in March, and they said populations to consider for vaccination include adults and children in geographic areas with documented exposure risks, people with multiple sexual contacts, health workers with repeated exposure, and known contacts of infected people. 

The group called for strong measures to promote mpox and vaccine research in Africa, along with equitable access to vaccines. The committee expects to release its final recommendations on mpox  immunization in May.

A laboratory- and population-based surveillance study conducted in nine states found a low incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) infections, but most isolates carried a carbapenemase gene and had limited treatment options, researchers reported this week in the American Journal of Infection Control.

Using data collected through the Emerging Infections Program's Multi-site Gram-negative Surveillance Initiative (MuGSI) from January 1 through December 31, 2019, researchers from the Centers for Disease Control and Prevention analyzed 136 CRAB cases in 125 patients. The crude incidence rate was 0.70 cases per 100,000 population.

Of the 66 CRAB isolates submitted for further analysis, 37 (56.1%) were from men, 36 (54.6%) were from Black or African American patients, 50% were collected from outpatient settings, and the median age of patients was 63.5 years. Whole-genome sequencing found that 48 isolates (72.7%) harbored an acquired carbapenemase gene, mainly bla_OXA-23 or bla_OXA-24/40. One isolate harbored bla_NDM. The isolates were resistant to many first-line antibiotics used to treat CRAB infections, with 50 (75.8%) defined as difficult to treat (DTR). Of the 11 case-patients who died, 9 had isolates that met the DTR definition.

Cefiderocol, which was approved by the Food and Drug Administration in 2019, had the most in vitro activity against the CRAB isolates among the 19 antibiotics tested.

Defining the landscape of CRAB

The study authors say the detailed clinical and microbiologic data allow for a deeper understanding of the epidemiology of CRAB across the spectrum of healthcare.

"This surveillance activity has demonstrated its value in helping to define the landscape of CRAB by providing a unique view of the molecular epidemiology of CRAB in the U.S., reinforcing the importance of tracking emerging and potentially transmissible resistance in A. baumannii complex to help inform and evaluate infection prevention and control strategies," they wrote.

At least 12 people in California and Washington state have been sickened and 7 people hospitalized in an Escherichia coli O157 outbreak traced to Gibson Farms organic walnuts that are sold in 19 states, the Centers for Disease Control and Prevention (CDC) said in a food safety alert yesterday.

Two patients developed hemolytic uremic syndrome, a serious and potentially fatal kidney condition. The CDC said in a news release, "Almost all sick people purchased organic walnuts from bulk bins in food co-ops or natural food stores in California and Washington." Two people bought bulk walnuts from the same store.

Company recalls bulk walnuts

In a recall notice yesterday, the Food and Drug Administration (FDA) said Gibson Farms has voluntarily recalled the implicated walnuts. "Gibson Farms Organic Light Halves and Pieces shelled walnuts were sold in bulk boxes in Net Wt. 25 lbs quantities and can be identified by lot 3325-043 & 3341-501 with expiration dates 5/21/25 & 6/7/25."

The agency added, "A full investigation is currently under way to determine the potential source of the contamination."

The CDC said the nuts were distributed to natural food and co-op stores in Alaska, Arkansas, Arizona, California, Colorado, Hawaii, Idaho, Kansas, Louisiana, Montana, Nebraska, New Mexico, Nevada, Oregon, South Dakota, Texas, Utah, Washington, and West Virginia. The FDA has posted a list of stores that sold the walnuts.

Gibson Farms, Inc, is headquartered in Hollister, California.

First patient fell ill on February 1

The 12 patients—6 in California and 6 in Washington—range in age from 6 to 84 years, with a median age of 57. Eight are female. Of 10 patients who reported racial information, 9 are White and 1 is Black.

Illness-onset dates range from February 1 to April 4. No deaths have been reported.

"The true number of sick people in this outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses," the CDC said.