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This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 19 - 25 November 2023 and includes updates on human infection with influenza A(H1N2)v, influenza A(H5N1), an overview of respiratory virus epidemiology in the EU/EEA, respiratory infections due to Mycoplasma pneumoniae in the EU/EEA, HIV/AIDS surveillance 2023 (2022 data), West Nile virus, SARS-CoV-2 variant classification, and poliomyelitis.

At least 450 patients at Mass General Brigham, Salem Hospital, near Boston are at risk of HIV and hepatitis infection, according to a lawsuit claiming negligent intravenous medication administration. Medscape Medical News…

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 19 - 25 November 2023 and includes updates on human infection with influenza A(H1N2)v, influenza A(H5N1), an overview of respiratory virus epidemiology in the EU/EEA, respiratory infections due to Mycoplasma pneumoniae in the EU/EEA, HIV/AIDS surveillance 2023 (2022 data), West Nile virus, SARS-CoV-2 variant classification, and poliomyelitis.

Europe\'s advances in HIV prevention strategies, including PrEP and long-acting retrovirals, bring hope amidst persistent access challenges and disparities. Medscape Medical News…

BackgroundThe global distribution of HIV-1 subtypes is evolving, which is reflected in the Swedish HIV cohort. The subtype HIV-1A6, which may be prone to developing resistance to cabotegravir, is the most common subtype in Ukraine. AimWe aimed to examine trends in HIV-1 subtype distribution in Sweden, with a special focus on HIV-1A6, and to describe the virology, demography and treatment of Ukrainian people living with HIV (PLWH) who migrated to Sweden in 2022. MethodsData about PLWH in Sweden are included in a national database (InfCareHIV). We used the online tool COMET to establish HIV-1 subtypes and the Stanford database to define drug resistance mutations. We investigated the relation between virological characteristics and demographic data. ResultsThe early epidemic was predominated by HIV-1 subtype B infections in people born in Sweden. After 1990, the majority of new PLWH in Sweden were PLWH migrating to Sweden, resulting in an increasingly diverse epidemic. In 2022, HIV-1A6 had become the sixth most common subtype in Sweden and 98 of the 431 new PLWH that were registered in Sweden came from Ukraine. We detected HIV RNA in plasma of 32 Ukrainian patients (34%), of whom 17 were previously undiagnosed, 10 had interrupted therapy and five were previously diagnosed but not treated. We found HIV-1A6 in 23 of 24 sequenced patients. ConclusionThe molecular HIV epidemiology in Sweden continues to diversify and PLWH unaware of their HIV status and predominance of HIV-1A6 should be considered when arranging care directed at PLWH from Ukraine. …

Following Russia’s invasion in 2022, over 4.1 million Ukrainians sought refuge in the EU/EEA. We assessed how this impacted HIV case reporting by EU/EEA countries. Ukrainian refugees constituted 10.2% (n = 2,338) of all 2022 HIV diagnoses, a 10-fold increase from 2021. Of these, 9.3% (n = 217) were new diagnoses, 58.5% (n = 1,368) were previously identified; 32.2% had unknown status. Displacement of Ukrainians has partly contributed to increasing HIV diagnoses in EU/EEA countries in 2022, highlighting the importance of prevention, testing and care. …

This report describes higher proportions of deaths among children younger than 5 with HIV receiving antiretroviral treatment (ART) compared with older children and adults with HIV receiving ART.

Simple 2 is the first test approved by the FDA that uses a sample collected at home to test for an STD, other than tests for HIV. WebMD Health News…

BackgroundThe earliest recognised infections by the SARS-CoV-2 Omicron variant (Pango lineage B.1.1.529) in Belgium and Switzerland suggested a connection to an international water polo tournament, held 12–14 November 2021 in Brno, Czechia. AimTo study the arrival and subsequent spread of the Omicron variant in Belgium and Switzerland, and understand the overall importance of this international sporting event on the number of infections in the two countries. MethodsWe performed intensive forward and backward contact tracing in both countries, supplemented by phylogenetic investigations using virus sequences of the suspected infection chain archived in public databases. ResultsThrough contact tracing, we identified two and one infected athletes of the Belgian and Swiss water polo teams, respectively, and subsequently also three athletes from Germany. In Belgium and Switzerland, four and three secondary infections, and three and one confirmed tertiary infections were identified. Phylogenetic investigation demonstrated that this sporting event played a role as the source of infection, but without a direct link with infections from South Africa and not as a superspreading event; the virus was found to already be circulating at that time in the countries involved. ConclusionThe SARS-CoV-2 Omicron variant started to circulate in Europe several weeks before its identification in South Africa on 24 November 2021. Accordingly, it can be assumed that travel restrictions are usually implemented too late to prevent the spread of newly detected SARS-CoV-2 variants to other regions. Phylogenetic analysis may modify the perception of an apparently clear result of intensive contact tracing. …

HIV can take an emotional toll on patients whether it was diagnosed days ago or decades before, but the issues patients must contend with have changed over time. Medscape Medical News…

The monthly to bimonthly injectable regimens help overcome challenges that some patients face with daily pills. Medscape Medical News…

Preexposure prophylaxis is highly effective in preventing HIV and yet uptake can be low among women, report researchers who say mobile technologies can help. Medscape Medical News…

The infrastructure in cities provides unique opportunities to eliminate HIV. Since 2014, the HIV Transmission Elimination AMsterdam Initiative, a consortium involved in HIV prevention and care, has employed an integrated approach to curb HIV incidence in Amsterdam. This effort contributed to the 95% decline in estimated newly acquired infections and the 79% decline in observed new HIV diagnoses in Amsterdam from 2010 to 2022. In 2022, Amsterdam reached and exceeded the 95–95–95 UNAIDS treatment cascade goals (98–95%-96%). …

Kun 38 mænd, der har sex med mænd (MSM), der er enten født eller smittet i Danmark, blev anmeldt som hiv-positive i 2022. Det er samme tal som året før, og forebyggelsesindsatsen vurderes at være lykkedes.

Primary care clinicians can provide optimal preventive care for patients at risk of contracting HIV. Medscape Medical News…

Two new antiretrovirals have been approved by the US Food and Drug Administration since the US Preventive Services Task Force\'s last report, which now includes new options. Medscape Medical News…

Recruitment stopped on the phase 3 trial of the once-daily oral drug islatravir in combination with doravirine, but the study of the investigational new option for HIV continued for the full 48 weeks. Medscape Medical News…

Globally, significant progress has been made, with 86% of people knowing their HIV status. However, new infections persist at a rate that has not dropped as fast as possible. Medscape Medical News…

People living with HIV who are diagnosed and treated early, and take their medication as prescribed, can expect to have the same health and life expectancy as their HIV-negative counterparts. WebMD Health News…

Final data from the REPRIEVE trial show pitavastatin therapy is associated with a significantly lower risk of cardiovascular events than placebo as evidence grows for statins in primary prevention. Medscape Medical News…

Is it time to add the antibiotic doxycycline post exposure for more STIs? Doxy-PEP use is a clinical controversy that will be debated at the upcoming International AIDS Society Conference. Medscape Medical News…

Read clinically focused news coverage of key developments from IAS 2023 Medscape HIV/AIDS…

BackgroundArthropod vectors such as ticks, mosquitoes, sandflies and biting midges are of public and veterinary health significance because of the pathogens they can transmit. Understanding their distributions is a key means of assessing risk. VectorNet maps their distribution in the EU and surrounding areas. AimWe aim to describe the methodology underlying VectorNet maps, encourage standardisation and evaluate output. Methods: Vector distribution and surveillance activity data have been collected since 2010 from a combination of literature searches, field-survey data by entomologist volunteers via a network facilitated for each participating country and expert validation. Data were collated by VectorNet members and extensively validated during data entry and mapping processes. ResultsAs of 2021, the VectorNet archive consisted of ca 475,000 records relating to > 330 species. Maps for 42 species are routinely produced online at subnational administrative unit resolution. On VectorNet maps, there are relatively few areas where surveillance has been recorded but there are no distribution data. Comparison with other continental databases, namely the Global Biodiversity Information Facility and VectorBase show that VectorNet has 5–10 times as many records overall, although three species are better represented in the other databases. In addition, VectorNet maps show where species are absent. VectorNet’s impact as assessed by citations (ca 60 per year) and web statistics (58,000 views) is substantial and its maps are widely used as reference material by professionals and the public. ConclusionVectorNet maps are the pre-eminent source of rigorously validated arthropod vector maps for Europe and its surrounding areas. …

Researchers are now examining the connection between HIV and menopause – and the virus\'s impact on a woman\'s health can be significant. WebMD Health News…

This report describes an increase in meningococcal disease cases among people with HIV during 2022 compared to previous years.

Several countries in the European Union (EU) and European Economic Area (EEA) established and/or scaled up HIV pre-exposure prophylaxis (PrEP) programmes between 2016 and 2023. Data on PrEP programmes’ performance and effectiveness in reaching those most in need will be needed to assess regional progress in the roll-out of PrEP. However, there is a lack of commonly defined indicators for routine monitoring to allow for minimum comparability. We propose a harmonised PrEP monitoring approach for the EU/EEA, based on a systematic and evidence-informed consensus-building process involving a broad and multidisciplinary expert panel. We present a set of indicators, structured along relevant steps of an adapted PrEP care continuum, and offer a prioritisation based on the degree of consensus among the expert panel. We distinguish between ‘core’ indicators deemed essential for any PrEP programme in the EU/EEA, vs ‘supplementary’ and ‘optional’ indicators that provide meaningful data, yet where experts evaluated their feasibility for data collection and reporting as very context-dependent. By combining a standardised approach with strategic opportunities for adaptation and complementary research, this monitoring framework will contribute to assess the impact of PrEP on the HIV epidemic in Europe. …

Leishmaniasis -- BrazilIntroduction: Human visceral leishmaniasis (VL) is a zoonosis of great importance to public health due to its epidemiological diversity, with emphasis on the possibility of aggravation by coinfection with the human immunodeficiency virus (HIV).Objective: The aim was to study the epidemiological characteristics of VL cases associated with HIV coinfection in Pará. Methods. Reported cases of VL from January 2006 to December 2016 were investigated. A descriptive epidemiological method related…

This report describes how the CDC adapted smallpox preparedness systems and HIV prevention programs to respond to 2022-2023 mpox cases.

A test for HIV, hepatitis B, and hepatitis C that uses a single dried blood spot could increase testing for these viruses in high-risk and challenging settings, new data show. Medscape Medical News…

Fewer women are giving birth to newborns with HIV, but the success does not extend to some communities. Medscape Medical News…

De nyeste tal fra Statens Serum Institut viser, at der ikke blev fundet nogen hiv-positive bloddonorer i bloddonorscreeningen i 2019 og kun ganske få tilfælde af hepatitis B og C.

The ruling applies nationwide, and public health experts were quick to criticize the decision. WebMD Health News…

An individualised blood donor selection policy was implemented in the United Kingdom from summer 2021. We have investigated the impact of this policy by comparing the extent of undeclared use of HIV pre-exposure or post-exposure prophylaxis (PrEP/PEP) before and after this change. The rate of PrEP usage in syphilis-positive male blood donors has not changed since individualised donor assessment was implemented but provides continuing evidence of undisclosed PrEP use which may be associated with current or past higher-risk sexual behaviours.…

Three quarters of US adults have never tested for HIV. Why are we still behind the 8 ball? Medscape Medical News…

This report describes the worldwide progress of eliminating HIV as a global public health threat through the use of antiretroviral therapy.

BackgroundEpidemiological and immunovirological features of people living with HIV (PLWH) can vary by sex.AimTo investigate, particularly according to sex, characteristics of PLWH who consulted a tertiary hospital in Barcelona, Spain, in 1982–2020.MethodsPLWH, still in active follow-up in 2020 were retrospectively analysed by sex, age at diagnosis, age at data extraction (December 2020), birth place, CD4+ cell counts, and virological failure.ResultsIn total, 5,377 PLWH (comprising 828 women; 15%) were included. HIV diagnoses in women appeared to decrease from the 1990s, representing 7.4% (61/828) of new diagnoses in 2015–2020. From 1997, proportions of new HIV diagnoses from patients born in Latin America seemed to increase; moreover, for women born outside of Spain, the median age at diagnosis appeared to become younger than for those born in Spain, with significant differences observed in 2005–2009 and 2010–2014 (31 vs 39 years (p = 0.001), and 32 vs 42 years (p < 0.001) respectively), but not in 2015–2020 (35 vs 42 years; p = 0.254). Among women, proportions of late diagnoses (CD4+ cells/mm3 < 350) were higher than men (significantly in 2015–2020: 62% (32/52) vs 46% (300/656); p = 0.030). Initially, virological failure rates were higher in women than men, but they were similar in 2015–2020 (12% (6/52) vs 8% (55/659); p = 0.431). Women ≥ 50 years old represented 68% (564/828) of women actively followed up in 2020.ConclusionsWomen still have higher rates of late HIV diagnoses than men. Among currently-followed-up women, ≥ 50 year-olds, who need age-adapted care represent a high percentage. Stratifying PLWH by sex matters for HIV prevention and control interventions.…

This report describes the identification of HIV cluster among Hispanic or Latino gay, bisexual, and other men who have sex with men in Atlanta.

This report describes efforts to reduce female-to-male transmission of HIV through CDC supported voluntary male circumcision programs.

BackgroundLateral flow antigen-detection rapid diagnostic tests (Ag-RDTs) for viral infections constitute a fast, cheap and reliable alternative to nucleic acid amplification tests (NAATs). Whereas leftover material from NAATs can be employed for genomic analysis of positive samples, there is a paucity of information on whether viral genetic characterisation can be achieved from archived Ag-RDTs.AimTo evaluate the possibility of retrieving leftover material of several viruses from a range of Ag-RDTs, for molecular genetic analysis.MethodsArchived Ag-RDTs which had been stored for up to 3 months at room temperature were used to extract viral nucleic acids for subsequent RT-qPCR, Sanger sequencing and Nanopore whole genome sequencing. The effects of brands of Ag-RDT and of various ways to prepare Ag-RDT material were evaluated.ResultsSARS-CoV-2 nucleic acids were successfully extracted and sequenced from nine different brands of Ag-RDTs for SARS-CoV-2, and for five of these, after storage for 3 months at room temperature. The approach also worked for Ag-RDTs for influenza virus (n = 3 brands), as well as for rotavirus and adenovirus 40/41 (n = 1 brand). The buffer of the Ag-RDT had an important influence on viral RNA yield from the test strip and the efficiency of subsequent sequencing.ConclusionOur finding that the test strip in Ag-RDTs is suited to preserve viral genomic material, even for several months at room temperature, and therefore can serve as source material for genetic characterisation could help improve global coverage of genomic surveillance for SARS-CoV-2 as well as for other viruses.…

BackgroundHerpes zoster (HZ) affects 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age and the presence of immunocompromising conditions. In Spain, vaccination guidelines were recently updated to include the recommendation of the new recombinant zoster vaccine (RZV) for certain risk groups.AimTo describe the epidemiology of HZ-related hospitalisations in Spain in order to prioritise vaccination recommendations and define a baseline to monitor the effectiveness of vaccination policies.MethodsRetrospective study using the National Health System’s Hospital Discharge Records Database, including all HZ-related hospitalisations from 1998 to 2018.ResultsThe 65,401 HZ-related hospitalisations, corresponded to an annual mean hospitalisation rate of 6.75 per 100,000 population. There was an increasing trend of HZ hospitalisations over the study period. This rate was higher in males and older age groups, particularly over 65 years. Comorbidities with higher risk of readmission were leukaemia/lymphoma (RR 2.4; 95% CI: 2.3–2.6) and solid malignant neoplasm (RR 2.2; 95% CI: 2.1–2.4). Comorbidities associated with higher risk of mortality were leukaemia/lymphoma (RR 2.9; 95% CI: 2.7–3.2), solid malignant neoplasm (RR 2.9; 95% CI: 2.7–3.1) and HIV infection (RR 2.2; 95% CI: 1.8–2.7).ConclusionOf all patients hospitalised with HZ, those with greater risk of mortality or readmission belonged to the groups prioritised by the current vaccination recommendations of the Spanish Ministry of Health. Our study provided relevant information on clinical aspects of HZ and established the base for future assessments of vaccination policies.…

Postexposure prophylaxis with doxycycline has been shown to significantly reduce the risk of STIs in men and transgender women. Now a study looks at its efficacy in cisgender women taking HIV PrEP. Medscape Medical News…

"It shows it's not impossible -- it's just very difficult -- to remove HIV from the body." WebMD Health News…

Read clinically focused news coverage of key developments from CROI 2023 Medscape HIV/AIDS…

Other Animal Disease -- New ZealandMore than 3000 beehives had to be destroyed in the year to May 2022, as the honey industry responded to record high cases of American Foulbrood disease (AFB).American Foulbrood weakens and kills honey bee colonies and once they become infected they never recover.New Zealand has been trying to eliminate AFB since 1998 and as part of the industry's national pest management strategy, infected hives have to be burned.The National American Foulbrood Pest Management Plan's compliance…

Undiagnosed -- Saudi ArabiaRegarding PRO/AH/EDR> Undiagnosed deaths, camel - Saudi Arabia: (RI) RFI Archive Number: http://promedmail.org/post/20230126.8707979, published 26 Jan 2023:The animal health authority was notified of a number of deaths in a camel herd in the central region. A total of 4 deaths in a single camel herd were detected and the investigation is consistent with acute feed-related poisoning. Samples were collected for the feed and the suspected feed was sorghum.-- communicated by:Abdullah…

The proposed guidance would evaluate all potential donors on the basis of their individual risks of HIV infection. Medscape Medical News…

This report describes an increase in people with HIV infection receiving PEPFAR-supported antiretroviral therapy in Uganda.

"It's obviously disappointing," Anthony Fauci, MD, told MSNBC, noting that other areas of HIV treatment research are promising. "I don't think that people should give up on the field of the HIV vaccine." WebMD Health News…

The study involves the largest analysis of survival in KS patients “since the advent of antiretroviral therapy for HIV in 2008,” according to the authors. MDedge News…

Cases of late HIV might be averted if multi-prong strategies are implemented, including redefining the category for better monitoring. Medscape Medical News…