COVID-19 activity remains elevated across most of the United States, but some regions of the country are seeing some declines, as the proportion of KP.3.1.1 variant continues to rise, the Centers for Disease Control and Prevention (CDC) said today in its latest updates.

Nationally, wastewater detections of SARS-CoV-2 are at the very high level for the second straight week. The highest levels are still in the West and South, followed by the Midwest and the Northeast. The CDC's latest update, however, shows downward trends from high levels in the South and Midwest. 

For respiratory virus activity in general, the nation's levels are low, with most illnesses caused by COVID, with flu and respiratory syncytial virus (RSV) levels still low, the CDC said in its latest snapshot. It noted an upward trend for RSV, though.

COVID indicators show that the burden is highest in people ages 65 and older and in children younger than 2 years old.

KP.3.1.1 variant continues to rise

The proportion of KP.3.1.1 variant continues to rise, the CDC said in its latest variant proportion estimates. KP.3.1.1, one of many JN.1 offshoots, is thought to more easily evade immunity from earlier infection and vaccination. The variant now makes up 36.8% of sequences, up from 22.8% in the previous 2 weeks.

Among the CDC's other metrics, test positivity rose slightly last week and is at 18.1% nationally, but was highest in Texas and surrounding states. Emergency department visits for COVID declined a bit from the previous week, but are still at the moderate level in parts of the South.

Hospitalization levels are declining from an early-August peak. Deaths from COVID continue to rise, however, up 18.7% from the previous week. 

UK health officials are warning of a rise in cases of ceftriaxone-resistant gonorrhea.

In a report released yesterday, the UK Health Security Agency (UKHSA) said 15 cases of infection with ceftriaxone-resistant Neisseria gonorrhoeae were detected in England from June 2022 to May 2024, including 5 that were extensively drug-resistant (XDR). A total of 31 ceftriaxone-resistant gonorrhea cases, 7 of them XDR, have been reported in England since 2015.

Ceftriaxone is the first-line recommended antibiotic for gonorrhea infections in England and most countries. But it's the last remaining effective treatment option for the N gonorrhoeae bacterium, which has developed resistance to every class of antibiotic used to treat it, and ceftriaxone-resistant strains have been spreading, particularly in parts of Asia.

Concerns about wider spread

All case-patients have been heterosexual men, mostly in their 20s, and most have acquired the infection abroad. While transmission within England has been limited, UKHSA officials say they're concerned about the potential for wider spread as gonorrhea cases rise. The 85,223 gonorrhea cases reported in England in 2023 is the most annual cases in the country since officials began keeping records in 1918.

"Gonorrhoea is becoming increasingly resistant to antibiotics, risking the possibility of it becoming untreatable in the future," UKHSA consultant microbiologist Helen Fifer said in a news release. "Untreated gonorrhoea can lead to serious health issues, including pelvic inflammatory disease and infertility."

Fifer added that the best defense against gonorrhea is to use condoms.

UKHSA sent a clinical alert to sexual health clinics advising them to culture gonococcal isolates, perform test-of-cure, and to refer all ceftriaxone-resistant strains or potential treatment failures to UKHSA.

Gonorrhoea is becoming increasingly resistant to antibiotics, risking the possibility of it becoming untreatable in the future.

A new study indicates more than 4 billion people in low- and middle-income countries (LMICs) lack access to safe drinking water, Swiss researchers reported yesterday in Science.

Combining household surveys and earth observation data (including satellite, airborne, and land-based data) with geospatial modelling techniques, a team led by researchers from the Swiss Federal Institute of Aquatic Science and Technology estimated that only 33% of the total population of 135 LMIC's used a safely managed drinking water service (SMDWS) in 2020, leaving approximately 4.4 billion without access to safe drinking water. That's more than twice the number of people estimated to lack access to safe drinking water in a 2020 by the World Health Organization and the United Nations (UN) Children's Fund Joint Monitoring Programme for Water Supply, Sanitation and Hygiene.

The lowest national rates of SMDWS use were in sub-Saharan Africa. The study estimates that, in 12 countries in the region, less than 10% of the population used SMDWS in 2020.

Safe drinking water a 'basic human right'

The study also found that access to safe drinking water in LMICs is primarily limited by fecal contamination, which affects nearly half the population in those countries and is indicated by Escherichia coli contamination in the primary drinking water source. 

"Detection of fecal contamination in drinking water is concerning, as ingestion of fecal pathogens is a major driver of diarrheal disease, one of the leading causes of under-five child mortality globally," the study authors wrote.

The authors note that access to safe drinking water is recognized as a basic human right and plays a core role in the UN's 2030 Agenda for Sustainable Development. They add that drawing attention to the many regions lacking safe water could "inform the mobilization and effective allocation of financial resources and human capacity" to address the issue.

"By filling crucial data gaps, our results point toward a substantial underestimation of the number of people whose basic human rights to safe drinking water are not being met and provide information on which subcomponents may be limiting use of SMDWS regionally," they wrote.

A new study in JAMA Network Open shows that state COVID-19 vaccine mandates for healthcare workers (HCWs) issued in 17 states in 2021 were associated with increased vaccine uptake.

The authors found that states with vaccines mandates had a nearly 4% increase in vaccination rates compared with non-mandate states, with even bigger gains in states with no test-out options. 

The study included 31,142 HCWs sampled across 45 states, including 16 states with vaccine mandates issued in mid-2021. The outcomes measured were increases in the proportions of vaccinated HCWs and those who completed or intended to complete the vaccination series 2 weeks after mandate announcement relative to baseline proportions of 88% and 86% vaccinated HCWs, respectively.

Test-out option tied to higher uptake

The authors found a mandate-associated 3.46 percentage point (pp) (95% confidence interval [CI], 0.29 to 6.63 pp) increase in the proportion of HCWs ever vaccinated against COVID-19 and a 3.64 pp (95% CI, 0.72 to 6.57 pp) increase in the proportion that completed or intended to complete the primary vaccination series 2 weeks after a mandate announcement in states with mandates. 

A stratified analysis showed that, in states with a no test-out option and among HCWs aged 25 to 49 years, vaccination increased 3.32% to 7.09% compared to baseline proportions. There were no significant uptake increases in states that offered both vaccine mandates and a test-out option. 

In an editorial on the study, John B. Lynch, MD, PhD, of the University of Washington in Seattle, said vaccine mandates are often unpopular and can be politicized, so understanding just how much benefit they yield is important for policy makers. 

Researchers are gaining more information on the specific tools that can be used for employer vaccine mandate policies, including not having a test-out option.

"Importantly, researchers are gaining more information on the specific tools that can be used for employer vaccine mandate policies, including not having a test-out option," he said.