This pooled analysis examines the diagnostic accuracy of the updated Pediatric Emergency Care Applied Research Network prediction rule in identifying febrile infants 28 days or younger with bacteremia...

This systematic review and meta-analysis quantify the relative importance of risk conditions for adult IPD. Understanding how these risk conditions interact in cases of multimorbidity remains an impor...

Cases of a mosquito-borne virus that causes crippling disabilities are surging worldwide. Experts are working out how many people are affected in Kenya and Tanzania.

More data are required to contextualize disease burden attributable to respiratory viral infections (RVIs) in hematology/oncology patients, including vaccine-preventable RVIs (eg, influenza, respiratory syncytial virus [RSV]) and other RVIs for which vaccines/therapeutics are not presently available (eg, human metapneumovirus [HMPV] or human parainfluenza virus [HPIV]).MethodsA retrospective cohort study included all adult patients hospitalized for RVI with diagnoses based on multiplex polymerase chain reaction testing from 2018 to 2024 in a large Singaporean cancer center. Severity was defined as a composite of multiple individual severe events (oxygen usage, intensive care unit [ICU] or high-dependency [HD] admission, and all-cause mortality events). Patients were followed up from admission until discharge or up to 1 month. The comparative severity of RSV and other non–vaccine-preventable RVIs (eg, HMPV/HPIV), versus seasonal influenza, was evaluated using multivariate logistic regression.ResultsIn total, 1823 patients hospitalized with RVIs were included; 24.0% had influenza (n = 437); 12.9% had RSV (n = 235), and the remainder had other RVIs (eg, HMPV [n = 128] and HPIV [n = 204]). A third (29.4% [536 of 1823]) had severe infection (defined as requirement for oxygen, ICU/HD admission, or death within 1 month); 26.9% (491 of 1823) required oxygen, 6.9% (126 of 1823) required ICU/HD admission, and 14.8% (269 of 1823) died. Other RVIs (eg, RSV, HMPV, or adenovirus) were more severe overall, compared with influenza (adjusted odds ratios [aORs] for RSV, HMPV, and adenovirus, 1.94 [95% confidence interval (CI), 1.33–2.83], 1.77 [1.12–2.80], and 2.19 [1.33–3.63], respectively). Patients hospitalized with RSV had increased odds for ICU/HD admission (aOR, 2.41 [95% CI, 1.22–4.77]) and all-cause mortality events at 1 month (2.42 [1.42–4.12]), compared with seasonal influenza. Older age (aOR, 1.30 [95% CI, 1.03–1.64]), comorbid conditions (1.50 [1.18–1.90]), coinfections (1.70 [1.21–2.38]), and nosocomial transmission (1.53 [1.20–1.94]) were associated with greater severity.ConclusionsRSV was more severe than influenza in hospitalized patients with cancer, but higher odds of severity were also observed for other RVIs (HMPV and adenovirus), underlining the need for new vaccines and therapeutics. Given the significant morbidity/mortality rates associated with nosocomial RVI, infection prevention is crucial in preventing outbreaks in this immunocompromised population.

ABSTRACTThe resurgence of whooping cough in regions utilizing acellular pertussis vaccines underscores emerging public health challenges. Here, we characterized 178 Bordetella pertussis isolates collected from patients across all age groups in Shanghai (2018–2024) to assess genomic evolution and antibiotic susceptibility. Macrolide resistance to erythromycin, azithromycin, and clarithromycin escalated from ≤50% (pre-2020) to nearly 100% (post-2020), mechanistically linked to the 23S rRNA A2047G mutation. Genome-based analysis identified a genotype MT28-ptxP3-MRBP rapidly dominated post-2020, exhibiting significantly higher prevalence in adults than in other age groups. Phylogenetic analysis of 178 Shanghai and 1,596 global genomes revealed two major lineages corresponding to ptxP1 and ptxP3 alleles. MT28-ptxP3-MRBP cluster was identified in France, Japan, and the United States in 2024, indicating potential cross-border transmission. These findings advocate for integrated surveillance spanning all ages and international borders to contain the global spread of macrolide-resistant B. pertussis.IMPORTANCEIn recent years, despite high coverage of acellular pertussis vaccines in China, pertussis cases have increased substantially. Drawing on 178 Bordetella pertussis isolates obtained through age-inclusive active surveillance in Shanghai (2018–2024), we found that macrolide resistance rose from ≤50% before 2020 to nearly 100% thereafter, with all resistant isolates harboring the 23S rRNA A2047G mutation. A resistant MT28-ptxP3 lineage became dominant after 2020 (61.7%) and was disproportionately represented among older age groups; the primary affected population shifted from children ≤36 months toward those aged 37 months to 18 years. Incorporating NCBI public genome data, we further observed that this resistant lineage is not confined locally, suggesting a risk of cross-border spread. These findings provide an early warning of the expansion of macrolide-resistant pertussis and underscore the need for age-inclusive, cross-regional genomic surveillance and re-evaluation of diagnostic workflows, antimicrobial stewardship, and immunization strategies.

AbstractThis publication represents the first part of an update to the clinical practice guideline on the diagnosis and management of group A streptococcal (Streptococcus pyogenes or GAS) pharyngitis, developed by the Infectious Diseases Society of America (IDSA). Diagnosis of GAS pharyngitis by clinician judgement alone is unreliable, and unselective testing incurs cost and inconvenience for individuals at low risk of having GAS infection. Clinical scoring systems have been used to quantify the probability of a positive GAS throat culture based on standardized criteria such as the presence of fever; tonsillar enlargement or exudate; tender and enlarged anterior cervical lymph nodes; and the absence of cough. The goal of this paper is to determine whether a scoring system should be used to decide which patients should have a diagnostic test performed by rapid antigen detection test (RADT), molecular methods, and/or throat culture. We performed a systematic review of randomized and non-randomized studies that compared the use of a clinical scoring system to clinician judgement alone in predicting the outcome of a throat culture. Evidence from studies in children and adults suggests the diagnostic accuracy of a clinical scoring system is comparable to or slightly higher than clinician judgement alone. However, the studies are limited due to small size, lack of uniformity in outcome measures, and incomplete data. The consensus of the panel is that the balance of benefits and harms favors use of a clinical scoring system as part of the evaluation of patients with sore throat. The principal utility of using a scoring system is to identify patients with low probability of GAS pharyngitis and to reduce unnecessary testing.

A third dose of measles, mumps, and rubella vaccine (MMR3) may be administered in outbreak and nonoutbreak settings. However, data on long-term immunogenicity to the mumps component of MMR are limited. We examined durability of mumps antibody response among adults up to 11 years after receipt of MMR3.MethodsPersons who received MMR3 at ages 18–28 years had sera collected before (baseline), 1 month, 1, 5, and 9–11 years after vaccination. Mumps antibodies were assessed by plaque reduction neutralization, immunoassay (EIA), and immunoglobulin G (IgG) avidity. Neutralizing antibodies were assessed against the vaccine strain (Genotype A) and a wild-type virus from Genotype G. Participants with neutralizing antibody titers <31 for Genotype A and <8 for Genotype G, and with EIA index values <1.10 were considered potentially susceptible.ResultsAmong participants with data for all visits after MMR3 (40%, n = 262/655), susceptibility based on Genotype A titers increased from 15.7% (41/262) at baseline to 30.5% (80/262) 9–11 years after vaccination while susceptibility based on Genotype G titers remained relatively stable (30.2%–24.2%). The proportion of participants seronegative for mumps IgG by EIA increased from 0% (0/255) at baseline to 7.5% (19/255) 9–11 years after vaccination. The avidity index increased from 52% to 67% through Year 5 (P < .0001).ConclusionsBy 9–11 years after receipt of MMR3, many participants had mumps antibody levels that predicted susceptibility to infection, comparable to those observed before receipt of MMR3. The antibody titers to Genotype G remained consistently lower than the titers to the vaccine strain.

AbstractThe American Thoracic Society recently released updated community-acquired pneumonia (CAP) guidelines. The Infectious Diseases Society of America (IDSA) agreed with 8 of the 10 recommendations in the guidelines but declined to endorse the guidelines because they include recommendations for use of antibiotics in outpatients with comorbidities and inpatients with nonsevere CAP who test positive for respiratory viruses. It is noted in the guidelines that bacterial coinfections are common and that delaying antibiotics may be harmful. IDSA notes, however, that nondiscriminatory use of antibiotics for patients with CAP and positive viral assays confers more risks than benefits. Most patients do not have bacterial coinfections, and briefly withholding antibiotics for patients with nonsevere illness to clarify the diagnosis is safe. In this era of precision medicine, IDSA instead recommends individualized, dynamic decision-making that takes into account each patient´s evolving trajectory, severity of illness and balance of clinical features for and against coinfection.

Bacterial vaginosis (BV) was long considered not to be a sexually transmitted infection, and treatment was only for women to bear. That was the convention at least until Catriona Bradshaw and her team at the Melbourne Sexual Health Centre published their groundbreaking clinical trial results earlier this year, demonstrating that treating male partners of women with BV prevented recurrence in those women [1]. In this episode of Communicable, hosts Angela Huttner and Annie Joseph welcome back Bradshaw to discuss her trial’s design, results, and clinical implications—with some guidelines already updated to include male partners in BV treatment regimens [2,3]. The conversation also explores the complexities of BV diagnosis, the challenges of trial execution in general, and future research directions.This episode was edited by Kathryn Hostettler and peer reviewed by Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania. It was released on 16 June 2025.Declaration of competing interestThe authors declare that they have no conflicts of interest.Related podcast episodes•Communicable episode 29: Bacterial vaginosis & male partners https://share.transistor.fm/s/3de4f5c3.•Communicable episode 19: ‘Super gonorrhoea’ & other sexually transmitted infections https://share.transistor.fm/s/c1f6f9ea; DOI: https://doi.org/10.1016/j.cmicom.2025.105090.Further reading•Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Med. 2005;2:e298. DOI: https://doi.org/10.1371/journal.pmed.0020298.•Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 2007;369:643–56. DOI: https://doi.org/10.1016/S0140-6736(07)60312-2.•Bukusi E, Katherine KT, Rosemary N, Craig RC, Noel W, Robert C, et al. Topical penile microbicide use by men to prevent recurrent bacterial vaginosis in sex partners: A randomized clinical trial. Sex Transm Dis. 2011;38:483–9. DOI: https://doi.org/10.1097/OLQ.0b013e318214b82d.•Cohen CR, Wierzbicki MR, French AL, Morris S, Newmann S, Reno H, et al. Randomized trial of Lactin-V to prevent recurrence of bacterial vaginosis. N Engl J Med. 2020;382:1906–15. DOI: https://doi.org/10.1056/NEJMoa1915254.•Gray RH, Kigozi G, Serwadda D, Makumbi F, Nalugoda F, Watya S, et al. The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda. Am J Obstet Gynecol. 2009;200:42.e1–7. DOI: https://doi.org/10.1016/j.ajog.2008.07.069.•King AJ, Phillips TR, Plummer EL, Wild N, Fairley CK, Chow EPF, et al. Getting everyone on board to break the cycle of bacterial vaginosis (BV) recurrence: A qualitative study of partner treatment for BV. Patient. 2025;18:279–90. DOI: https://doi.org/10.1007/s40271-025-00731-z.•Mehta S, Zhao D, Green SJ, Agingu W, Otieno F, Bhaumik R, et al. The microbiome composition of a man's penis predicts incident bacterial vaginosis in his female sex partner with high accuracy. Front Cell Infect Microbiol. 2020;10:433. DOI: https://doi.org/10.3389/fcimb.2020.00433.•Muzny CA, Taylor CM, Swords WE, Tamhane A, Chattopadhyay D, Cerca N, et al. An updated conceptual model on the pathogenesis of bacterial vaginosis. J Infect Dis. 2019;220:1399–405. DOI: https://doi.org/10.1093/infdis/jiz342.•Yockey LJ, Hussain FA, Bergerat A, Reissis A, Worrall D, Xu J, et al. Screening and characterization of vaginal fluid donations for vaginal microbiota transplantation. Sci Rep. 2022;12:17948. DOI: https://doi.org/10.1038/s41598-022-22873-y.•Plummer EL, Vodstrcil LA, Doyle M, Danielewski JA, Murray GL, Fehler G, et al. A prospective, open-label pilot study of concurrent male partner treatment for bacterial vaginosis. mBio. 2021;12:e0232321. DOI: https://doi.org/10.1128/mBio.02323-21.•Plummer EL, Vodstrcil LA, Danielewski JA, Murray GL, Fairley CK, Garland SM, et al. Combined oral and topical antimicrobial therapy for male partners of women with bacterial vaginosis: Acceptability, tolerability and impact on the genital microbiota of couples - A pilot study. PLoS One. 2018;13:e0190199. DOI: https://doi.org/10.1371/journal.pone.0190199.•Vodstrcil LA, Muzny CA, Plummer EL, Sobel JD, Bradshaw CS. Bacterial vaginosis: Drivers of recurrence and challenges and opportunities in partner treatment. BMC Med. 2021;19:194. DOI: https://doi.org/10.1186/s12916-021-02077-3.•Wawer MJ, Makumbi F, Kigozi G, Serwadda D, Watya S, Nalugoda F, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: A randomised controlled trial. Lancet. 2009;374:229–37. DOI: https://doi.org/10.1016/S0140-6736(09)60998-3.

The health department told a state official the outbreak may be linked to a gym.

Smallpox played a pivotal role throughout the American Revolution, but the record remains ambiguous about whether British officers weaponized refugees to sow pestilence in the Continental Army.