Worldwide measles resurgence and international travel pose risk to US. As of May 10, 2019, there have been 839 measles cases across 23 US states, according to the US Centers for Disease Control and Prevention (CDC). In March 2019, there were over 1,500 cases across 22 European countries; France, Lithuania, Poland, and Romania had the highest case counts of 295, 248, 219, and 188 cases, respectively, according to the European Centre for Disease Prevention and Control (ECDC). A new spatial risk analysis that assessed the impact of international travel on measles resurgence in the US found that four factors—measles incidence at travel origin, international air travel volume in US counties, non-medical vaccine exemption rates, and county population— correctly identified US counties at higher risk of measles outbreaks. [CDC, ECDC, Lancet]

Global burden of pediatric asthma incidence attributable to NO2 pollution. Each year, an estimated four million new pediatric asthma cases are attributable to NO2 pollution worldwide, according to an analysis of country- and age-specific asthma incidence rates from the Institute for Health Metrics and Evaluation for 194 countries. N02 pollution-related asthma cases account for 13 percent of global asthma incidence. Sixty-four percent of these cases occur in urban centers. Andean Latin America, high-income North America, and high-income Asia Pacific had the greatest burdens of new asthma cases associated with NO2 exposure with incidence rates of 340, 310, and 300 cases per 100,000 people per year, respectively. [Lancet Planetary Health]

Under-5 mortality in India. In 2015, there were over 25 million livebirths and over 1.2 million under-5 deaths in India, the largest number globally. The under-5 mortality rate was 47.81 per 1,000 livebirths, and 57.9 percent of these deaths occurred in neonates. Child mortality rates ranged from 9.7 to 73.1 deaths per 1,000 livebirths in Goa and Assam, respectively. Nationwide, the leading causes of under-5 deaths were pre-term birth complications (27.5 percent), pneumonia (15.9 percent), and intrapartum-related events (11.6 percent). [Lancet Global Health]

Exposure to zoonotic malaria parasite in northern Malaysia. Between September and December 2015, researchers interviewed over 10,000 individuals from 180 villages in the Kudat, Kota Marudu, Pitas, and Ranau districts in northern Sabah, Malaysia to measure prevalence of serological exposure to the zoonotic malaria parasite Plasmodium knowlesi and to assess associated risk factors. About five percent of surveyed participants were seropositive for P. knowlesi. Risk factors for exposure to the parasite included male sex, contact with macaques, forest fragmentation, and raised house construction. Residing at higher elevations and using insecticide reduced risk of exposure to P. knowlesi. [Lancet Planetary Health]

Antimicrobial resistance patterns of urine culture specimens from nursing homes. Over 6,500 urine cultures were collected before and during a two-year antimicrobial stewardship intervention program in 27 nursing homes in North Carolina. Overall, 68 percent of the cultures were positive for potentially pathogenic bacteria, most commonly Escherichia coli (38 percent), Proteus species (13 percent), and Klebsiella pneumoniae (12 percent). There were significant reductions in the number of urine culture and positive culture rates during the intervention period. Nitrofurantoin resistance among E. coli and ciprofloxacin resistance among Proteus species decreased during the intervention period while carbapenem resistance and multi-drug resistance increased for Proteus species. [ICHE]

Perspective of Pakistani physicians towards AMR stewardship programs. Researchers conducted qualitative face-to-face and telephonic interviews with 22 physicians working in seven tertiary public hospitals in Punjab, Pakistan to assess physicians’ views of antimicrobial stewardship programs (ASP). The majority of participants noted that antimicrobial resistance (AMR) is an emerging public health threat that requires immediate attention. The absence of appropriate diagnostic facilities, presence of unlicensed practitioners, patient’s non-compliance with antibiotic therapy, and sale of antibiotics without a prescription were cited as causes of AMR while inadequate resources, poor healthcare facilities, and insufficiently trained medical staff were identified as major barriers to ASP implementation in Pakistan. [IJE]

CDC launches education module for Rocky Mountain Spotted Fever. In 2017, there were a record-setting 6,248 cases of Rocky Mountain Spotted Fever (RMSF) in the US, according to the US Centers for Disease Control and Prevention (CDC), but fewer than one percent of cases had sufficient laboratory confirmation. In response, the CDC developed a web-based education module to help healthcare providers identify, diagnose, and treat RMSF, a tickborne illness that is fatal in about one of five cases. [CDC]

Eye images and social norms messages do not improve healthcare provider hand hygiene adherence. Researchers placed placards depicting an image of eyes, a social norms message, or control placards near soap and alcohol-based handwash dispensers on a medical-surgical unit and progressive care unit. Placards were alternated every 10 days, and hand hygiene adherence rates among 166 nurses and certified nursing assistants were assessed electronically using the CenTrak Hand Hygiene Compliance Solution. Before the intervention, hand hygiene adherence was 70 percent, and there was no significant increase in adherence rates during the four-month intervention period. [ICHE]

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