Though US flu activity continues to increase slightly in children, overall levels remain low nationally, as do COVID markers, the Centers for Disease Control and Prevention (CDC) said today in its respiratory disease updates.

Percent positivity for flu has trended upward over the past few weeks but is still low, at 1.6% at clinical labs, where nearly 93% of detections are influenza A. Meanwhile, emergency department visits for flu increased slightly among children and adolescents. 

No new pediatric flu deaths were reported, keeping the season's total at one. One death was reported for the 2023-24 season, which occurred in a child who died in May, bringing the number for last season to 205. 

COVID activity continues to decline in most areas, the CDC said in its weekly respiratory virus snapshot. 

"Across the nation, COVID-19 infections are predicted to decline in some states, and grow slowly from a low level in others," the agency said. Wastewater detections are still at the low level and are highest in the Midwest. WastewaterSCAN, a national wastewater monitoring system based at Stanford University in partnership with Emory University, said yesterday that SARS-CoV-2 detections remain low, with no significant trend up or down over the past 3 weeks.

RSV picks up more steam; more Mycoplasma and pertussis

In other respiratory illness tracking, the CDC said respiratory syncytial virus (RSV) activity is elevated and continues to increase in the East and South and is trending upward in the Central region, especially in young children. Also, infections caused by Mycoplasma pneumoniae ("walking pneumonia") continue to rise in the younger age-groups.

For pertussis (whooping cough), the CDC recently reported that illness patterns have returned to pre–COVID-19-pandemic levels. For the week ending November 9, preliminary data show that more than five times as many cases have been reported this year than last year. 

Three countries reported more polio cases this week: Pakistan had three more wild poliovirus type 1 (WPV1) cases, Nigeria noted seven more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, and Chad confirmed two cVDPV2 cases, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

Pakistan is one of two countries where WPV1 is still endemic. The country's latest patients all had paralysis onsets in October. They are from three different provinces, Sindh, Balochistan, and Khyber Pakhtunkhwa. The cases, part of a sharp rise in cases this year, boost Pakistan's 2024 total to 48.

In Africa, Nigeria’s cVDPV2 patients had paralysis onsets in September and hail from five different states: Katsina, Jigawa, Yobe, Sokoto, and Kogi. The illnesses put the country's total for 2024 at 80. Chad's 2 cases are in Wadi Fira and Chari Baguirmi regions, also with onset of paralysis in September. They bring Chad's total cVDPV2 cases this year to 15.

Repatriation among factors fueling polio rises in endemic countries

Pakistan's forced repatriation of roughly 730,000 undocumented Afghani residents back to their home country is a factor behind setbacks in polio eradication in Pakistan and Afghanistan, Hamid Jafari, MD, who directs polio eradication activities for the World Health Organization Eastern Mediterranean regional office, said this week at a virtual meeting hosted by the GPEI, according to Voice of America. He said the virus moved with massive unpredictable population movements across borders and within the countries. 

Other factors include polio vaccination barriers in militant areas, vaccine hesitancy, and community boycotts. The report said antigovernment militants have violently attacked polio vaccination teams over suspicions of spying.  

New data from the UK Health Security Agency (HSA) show that the number of serious antibiotic-resistant infections last year in England surpassed pre–COVID-19-pandemic levels.

The English Surveillance of Antibiotic Prescribing and Utilisation Report (ESPAUR) shows there were an estimated 66,730 serious antibiotic-resistant infections in England in 2023, compared with 62,314 in 2019. The increase was largely due to an uptick in antibiotic-resistant Escherichia coli, which was responsible for an estimated 68% of drug-resistant bacteremia cases. 

Resistance to multiple classes of antibiotics in cases of E coli bacteremia also increased compared with 2019, and resistance to most classes of antibiotics increased in Klebsiella pneumoniae as well. The rates of reported carbapenemase-producing organisms from all sample types more than doubled from 2021 (4.7 per 100,000) to 2023 (10.1 per 100,000).

Widening disparities

The ESPAUR data also reveal that people living in the most economically and socially deprived areas of England were 42.6% more likely to have an antibiotic-resistant infections than those living in the least deprived areas. That's up from 29.6% in 2019. Ethnic disparities were found as well, with the highest proportion of resistant infections reported in Asian or Asian-British ethnic groups (39.4%).

"Increasingly the first antibiotics that patients receive aren't effective at tackling their infections," HSA Chief Executive Professor Dame Jenny Harries said in a press release. "That's not just an inconvenience—it means they are at greater risk of developing a severe infection and sepsis. Our declining ability to treat and prevent infections is having an increasing impact, particularly on our poorest communities."

Antibiotic use in England also rose in 2023, increasing by 2.4% compared with 2022 and returning to 2019 levels after dropping during the COVID-19 pandemic. The UK AMR National Action Plan has set a target of reducing total antibiotic in people by 5% from the 2019 baseline.

Our declining ability to treat and prevent infections is having an increasing impact, particularly on our poorest communities.