Can the Kidney Microbiome Influence Stone Formation?

Is urine sterile? Investigating the urobiome

Normal bacteria levels in urine are very low, but they are rarely zero. Despite this, the urobiome – microbiome of different organs in the urinary tract including the bladder and kidneys – has been a controversial topic since its discovery in human urine less than 15 years ago.

First author and urologist José Agudelo, MD, had personally seen bacteria in the kidneys of his patients in the decade he spent treating patients in Venezuela. However, he explains that these observations and previous studies of a kidney microbiome gave compelling evidence but left enough room for doubt.

First author and urologist José Agudelo, MD, who has extensive experience in urinary stone disease, explains that previous indirect findings of a kidney microbiome gave compelling evidence but left room for doubt.

Bacterial communities need to meet three criteria to be considered a true microbiome: stability, consistency and reproducibility and being metabolically active. The team’s methods demonstrated each of these aspects for bacteria found in the urinary tract. Their research also showed that bacteria living in the urinary tract were not only there because of disease, since they found them in the urinary tract of people without evidence of urologic disease.

Other studies had shown that two species Drs. Miller and Agudelo had identified, E. coli and Lactobacillus crispatus, had been associated with the presence and absence of kidney stones, respectively. The researchers asked if the metabolic activity of their newly discovered microbial community played a role in kidney stone formation.

Low levels of Lactobacillus in urine, kidneys, are normal and prevent kidney stone formation

To see whether the kidney microbiome could influence stone formation, the researchers grew bacteria using a special chamber that mimics the movement of urine in our kidneys. They then added the “raw ingredients” of kidney stones, oxalate and calcium, to see what happened.

Several large, stone-like crystal structures formed in chambers growing E. coli. Chemical and X-ray analyses revealed these structures were indistinguishable from human kidney stones. No stones formed in the chambers growing Lactobacillus in this way. Growing the two bacteria together resulted in very small crystal structures that were structurally and chemically different from kidney stones, indicating that Lactobacillus somehow blocks E. coli’s ability to form kidney stones.

In preclinical models, the team also saw that antibiotic overuse shifted the balance of the kidney microbiome away from the healthy Lactobacillus towards the stone-forming E. coli. They believe their findings, taken together, may explain why individuals on long-term antibiotic courses are more prone to developing kidney stones.

“Antibiotics are one of – if not the – most miraculous inventions of the modern age, but they do not come without consequences,” Dr. MIller says. “Our findings about how antibiotics impact the renal microbiome and stone formation give us a critical piece of the puzzle we need to combat these consequences.”

Implications for kidney stones and other diseases

Dr. Agudelo says his team’s findings suggest that different bacteria produce pro- and anti- kidney stone molecules, which he wants to use in new therapeutic and diagnostic techniques. He is already working to understand which bacterial metabolites influence stone formation, and how.

“If the kidney microbiome can influence kidney stones, it can likely influence other kidney diseases as well,” Dr. Miller adds. “We are already looking at microbial signatures for other kidney diseases and have even submitted a grant to investigate how certain genetic variants influence the renal microbiome and kidney disease risk in different ethnicities.”

Website: International Conference on Infectious Diseases

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6 Tips for Patients to Avoid Healthcare-Associated Infections

Follow these 6 tips to help you and your loved ones prevent HAIs:

1. Speak Up and Ask Questions
Advocate for yourself and your loved ones by talking with the healthcare professionals caring for you. When a specific treatment is recommended, such as an IV or urinary catheter, ask why it is needed, what the risks are, and when it can be removed. Write down your questions in advance to help remember details. You should feel empowered to ask questions and share any concerns.

2. Keep Your Hands Clean
Make sure that everyone around you, including healthcare professionals, caregivers, and visitors, clean their hands with soap and water or with alcohol-based hand sanitizers when they enter or leave your room and just before touching you or your devices, dressings, or equipment. If you do not see a healthcare professional clean their hands, simply remind them to “please clean your hands, thank you.” If everyone routinely washed their hands, countless deaths could be prevented. This video shows the right (and wrong) way to wash your hands: How to Wash Your Hands (nfid.org).

3. Be Antibiotics Aware
Antibiotics do not treat respiratory infections caused by viruses, like colds, flu, and COVID-19. Never demand an antibiotic if it isn’t prescribed. When antibiotics aren’t needed, they won’t help you, and the side effects can be harmful. Even when they are needed, antibiotics can still cause side effects and contribute to antimicrobial resistance. Talk with a healthcare professional about the best treatment for your illness.

4. Recognize the Signs and Symptoms of an Infection
Learn how to recognize early symptoms of an infection, such as a fever. If you have recently had surgery, look out for redness, pain, or drainage where the incision was made in your skin, without touching the site directly. Never touch IV lines. Keep cuts and wounds clean and covered until healed. If you had a urinary catheter, look for signs of a urinary infection, such as pain or burning when urinating. Talk with a healthcare professional about what signs and symptoms you should look for and what to do to ensure prompt and proper treatment if you do get an infection. If an infection isn’t stopped, it can cause sepsis, a life-threatening medical emergency. Healthcare professionals should immediately evaluate and treat people who might have sepsis.

5. Stay Up to Date on All Recommended Vaccines
Staying up to date on all recommended vaccines can help you stay healthy, avoiding the need for health care in the first place. Everyone ages 6 months and older should get an annual flu vaccine and stay up to date with their COVID-19 vaccines. Talk with a healthcare professional about other vaccines you may need.

6. Don’t be a Dreaded Spreader
Don’t share your germs when visiting someone in a hospital, nursing home, or other healthcare facility. Do not visit a healthcare facility if you don’t feel well. Wash your hands often. Stay home when sick and use precautions, such as wearing a mask where and when required. Masks can help reduce the spread of some germs.

Website: International Conference on Infectious Diseases

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liver cancer

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. This type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:Losing weight without trying

• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
• White, chalky stools

When to see a doctor

Make an appointment with your doctor if you experience any signs or symptoms that worry you.
Causes

Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Sometimes the cause of liver cancer is known, such as with chronic hepatitis infections. But sometimes liver cancer happens in people with no underlying diseases and it's not clear what causes it.

Risk factors

Factors that increase the risk of primary liver cancer include:

• Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
• Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
• Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson's disease.
• Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don't have diabetes.
• Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
• Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops, such as grains and nuts, can become contaminated with aflatoxins, which can end up in foods made of these products.
• Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.

Prevention

Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.

Get vaccinated against hepatitis B

You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C

No vaccine for hepatitis C exists, but you can reduce your risk of infection.

• Know the health status of any sexual partner. Don't engage in unprotected sex unless you're certain your partner isn't infected with HBV, HCV or any other sexually transmitted infection. If you don't know the health status of your partner, use a condom every time you have sexual intercourse.
• Don't use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn't an option for you, make sure any needle you use is sterile, and don't share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
• Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don't take your questions seriously, take that as a sign that the facility isn't right for you.

Seek treatment for hepatitis B or C infection

Treatments are available for hepatitis B and hepatitis C infections. Research shows that treatment can reduce the risk of liver cancer.
Ask your doctor about liver cancer screening 

For the general population, screening for liver cancer hasn't been proved to reduce the risk of dying of liver cancer, and it isn't generally recommended. People with conditions that increase the risk of liver cancer might consider screening, such as people who have:

• Hepatitis B infection
• Hepatitis C infection
• Liver cirrhosis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves a blood test and an abdominal ultrasound exam every six months.

Website: International Conference on Infectious Diseases

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Health ministry urges caution as flu cases rise nationwide

Japan is grappling with a sharp rise in seasonal influenza cases, prompting health authorities to urge people to take heightened precautions as the year-end holiday period approaches.

Data that the health ministry released Friday highlights a troubling spike in infections. From Dec. 9 to 15, there were 94,259 cases of the flu reported across some 5,000 hospitals and clinics nationwide.

This brings the estimated total of cases nationwide to 718,000, more than double the figure recorded the previous week.

The national average of reported cases per medical institution jumped to 19.06, up from 9.03 the week before. All 47 prefectures saw increases, with Oita leading, at 37.22 cases per medical facility, followed by Fukuoka at 35.40, Kagoshima at 29.00, Ehime at 28.90, and Saga at 28.55.

Oita and Fukuoka surpassed the warning threshold of 30 cases per institution, while 40 prefectures exceeded the alert level of 10.

Tokyo has also seen a steep rise in infections, recording 17.36 cases per medical facility as of Dec. 15, a sharp increase from 8.19 the prior week. This figure breaches the city’s advisory threshold of 10, signaling a high likelihood of a large-scale outbreak within the next four weeks.

The flu has even reached the Imperial Household. Princess Aiko contracted the virus and is expected to remain absent from official duties until at least Friday, the Imperial Household Agency announced Monday.

Outbreaks in schools and care facilities are intensifying, with cluster outbreaks doubling to 211 in Tokyo from Dec. 9 to 15 compared to the week before. Nationwide, 2,759 schools and other institutions implemented partial or full closures from Dec. 9 to 15, also twice the previous week’s total.

Hospitalizations have risen in tandem, with 1,316 patients nationwide admitted for influenza during the same period, up from 628. Of these, 58 required intensive care, up from 43.

The rise in hospitalizations has prompted concerns among officials about potential burdens on the health care system, as the flu outbreak comes in combination with a rise in COVID-19 cases.

“We predict high case counts this season because people were less exposed to the flu virus during the pandemic and so lack immunity,” Tadashi Ishida, head of the influenza panel at the Japanese Association for Infectious Diseases, told NHK.

Dr. Norio Sugaya, an honorary adviser at Keiyu Hospital, noted a return to prepandemic flu patterns.

“Before COVID-19, flu cases typically surpassed alert thresholds in late December and peaked in January,” he said in an interview with the Asahi Shimbun, adding that stringent COVID-19 measures between December 2020 and spring 2022 largely suppressed influenza outbreaks.

In contrast, flu cases began surging unusually early in September 2023, with waves of infection continuing into May 2024. During this period, an estimated 18 million people — 1.8 times the usual number — were infected.

With restrictions now lifted, both Ishida and Sugaya expect cases to peak in January, consistent with current ministry and prefectural data.

In response to the outbreak, health officials are urging the public to adopt rigorous preventive measures, including regular handwashing, use of hand sanitizers, and practicing proper cough etiquette.

Vaccination also remains the most effective way to prevent severe flu symptoms, particularly among vulnerable groups.

Website: International Conference on Infectious Diseases

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About One Health

One Health is a collaborative, multi sectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.

What is One Health?

One Health is an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment. One Health is not new, but it has become more important in recent years. This is because many factors have changed interactions between people, animals, plants, and our environment.

• Human populations are growing and expanding into new geographic areas. As a result, more people live in close contact with wild and domestic animals, both livestock and pets. Animals play an important role in our lives, whether for food, fiber, livelihoods, travel, sport, education, or companionship. Close contact with animals and their environments provides more opportunities for diseases to pass between animals and people.
• The earth has experienced changes in climate and land use, such as deforestation and intensive farming practices. Disruptions in environmental conditions and habitats can provide new opportunities for diseases to pass to animals.
• The movement of people, animals, and animal products has increased from international travel and trade. As a result, diseases can spread quickly across borders and around the globe.

These changes have led to the spread of existing or known (endemic) and new or emerging zoonotic diseases, which are diseases that can spread between animals and people. Every year, millions of people and animals around the world are affected by zoonotic diseases. Examples of zoonotic diseases include:

• Rabies
• Salmonella infection
• West Nile virus infection
• Q Fever (Coxiella burnetii)
• Anthrax
• Brucellosis
• Lyme disease
• Ringworm
• Ebola

Similar to humans, animals are also at risk of getting sick from some diseases and environmental hazards. Because of this, they can sometimes serve as early warning signs of potential human illness. For example, birds often die of West Nile virus before people in the same area get sick with West Nile virus infection.

What are common One Health issues?

One Health issues include emerging, re-emerging, and endemic zoonotic diseases, neglected tropical diseases, vector-borne diseases, antimicrobial resistance, food safety and food security, environmental contamination, climate change and other health threats shared by people, animals, and the environment. For example:

• Antimicrobial-resistant germs can quickly spread through communities, the food supply, healthcare facilities, and the environment (soil, water), making it harder to treat certain infections in animals and people.
• Vector-borne diseases are on the rise with warmer temperatures and expanded mosquito and tick habitats.
• Diseases in food animals can threaten supplies, livelihoods, and economies.
• The human-animal bond can help improve mental well-being.
• Contamination of water used for drinking, recreation, and more can make people and animals sick.

Even the fields of chronic disease, mental health, injury, occupational health, and noncommunicable diseases can benefit from the One Health approach involving collaboration across disciplines and sectors.

How does the One Health approach work?

One Health is gaining recognition in the United States and globally as an effective way to fight health issues at the human-animal-environment interface, including zoonotic diseases. CDC uses the One Health approach by involving experts in human, animal, environmental health, and other relevant disciplines and sectors in monitoring and controlling public health threats and to learn about how diseases spread among people, animals, plants, and the environment.

Successful public health interventions require the cooperation of human, animal, and environmental health partners. Professionals in human health (doctors, nurses, public health practitioners, epidemiologists), animal health (veterinarians, paraprofessionals, agricultural workers), environment (ecologists, wildlife experts), and other areas of expertise need to communicate, collaborate on, and coordinate activities. Other relevant players in the One Health approach could include law enforcement, policymakers, agriculture, communities, and even pet owners. No one person, organization, or sector can address issues at the animal-human-environment interface alone.

The One Health approach can:

• Prevent outbreaks of zoonotic disease in animals and people.
• Improve food safety and security.
• Reduce antimicrobial-resistant infections and improve human and animal health.
• Protect global health security.
• Protect biodiversity and conservation.

Website: International Conference on Infectious Diseases

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Statement on the antigen composition of COVID-19 vaccines

Key points

SARS-CoV-2 continues to circulate and evolve with important genetic and antigenic evolution of the spike protein.
The objective of an update to COVID-19 vaccine antigen composition is to enhance vaccine-induced immune responses to circulating SARS-CoV-2 variants.
As the virus is expected to continue to evolve from JN.1, the TAG-CO-VAC advises the use of a monovalent JN.1 lineage as the antigen in future formulations of COVID-19 vaccines.
In accordance with WHO SAGE policy, vaccination programmes should continue to use any of the WHO emergency-use listed or prequalified COVID-19 vaccines and vaccination should not be delayed in anticipation of access to vaccines with an updated composition.

Evidence reviewed

The published and unpublished evidence reviewed by the TAG-CO-VAC included: (1) SARS-CoV-2 genetic evolution with support from the WHO Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE); (2) Antigenic characterization of previous and emerging SARS-CoV-2 variants using virus neutralization tests with animal antisera or human sera and further analysis of antigenic relationships using antigenic cartography; (3) Immunogenicity data on the breadth of neutralizing antibody responses elicited by currently approved vaccine antigens against circulating SARS-CoV-2 variants using animal and human sera, including modelling data; (4) Vaccine effectiveness estimates (VE) of currently approved vaccines during periods of circulation of XBB.1 and JN.1 lineages; (5) Preliminary immunogenicity data on immune responses following infection with circulating SARS-CoV-2 variants; and (6) Preliminary preclinical and clinical immunogenicity data on the performance of candidate vaccines with updated antigens shared confidentially by vaccine manufacturers with TAG-CO-VAC. Further details on the publicly available data reviewed by the TAG-CO-VAC can be found in the accompanying data annex. Unpublished and/or confidential data reviewed by the TAG-CO-VAC are not shown.

Summary of available evidence

• SARS-CoV-2 continues to circulate and evolve; there are genetic changes in important regions of the spike protein of SARS-CoV-2.
• As of April 2024, nearly all (>94%) SARS-CoV-2 genetic sequences in publicly available databases are derived from JN.1, and these variants continue to displace existing XBB lineage variants (e.g. EG.5). This displacement indicates greater fitness of JN.1 derived variants as compared to other circulating SARS-CoV-2 variants in the human population.
• Several JN.1 derived variants (e.g. JN.1.13.1, JN.1.11.1, KP.2) have independently evolved changes in the spike protein at epitopes involving amino acid residues 346 and/or 456. Substitutions at these amino acid residues have been identified in previous SARS-CoV-2 variants (e.g. R346T in BQ.1 and XBB; F456L in EG.5 and HK.3) and are within epitopes known to be targeted by neutralizing antibodies.
• Given the displacement of XBB lineage variants by JN.1 derived variants, it is likely that, in the near-term, circulating SARS-CoV-2 variants will be derived from JN.1.
• In immunologically naïve animal and human sera, XBB.1.5 and JN.1 are antigenically distinct SARS-CoV-2 variants. In non-naïve animals and humans, post-monovalent XBB.1.5 vaccination sera, with or without recent prior infection, neutralize XBB.1.5 and its derivatives including EG.5, HK.3, HV.1, as well as BA.2.86 and JN.1. However, neutralization titres against JN.1 in published and unpublished studies were typically lower (2-5-fold) than those against the homologous XBB.1.5 immunizing antigen. There are further reductions in cross neutralization of JN.1 variants with F456L and/or R346T substitutions.
• Secondary analysis of published immunogenicity data demonstrates that an additional vaccine dose with an updated vaccine antigen results in an average 40% increase in neutralizing antibodies to that variant as compared to vaccines with a previous vaccine antigen. Using statistical modeling, the predicted additional effectiveness of a vaccine dose with an updated vaccine antigen may be approximately 23-33% against severe disease as compared to a previous vaccine antigen and 11-25% against symptomatic disease.

Recommendations for COVID-19 vaccine antigen composition

As of April 2024, nearly all circulating SARS-CoV-2 variants reported in publicly available databases are JN.1 derived variants. As virus evolution is expected to continue from JN.1, future formulations of COVID-19 vaccines should aim to induce enhanced neutralizing antibody responses to JN.1 and its descendent lineages. One approach recommended by TAG-CO-VAC is the use of a monovalent JN.1 lineage (GenBank: PP298019, GISAID: EPI_ISL_18872762) antigen in vaccines.

The continued use of the current monovalent XBB.1.5 formulation will offer protection given the neutralizing antibody responses to early JN.1 descendent lineages, and the evidence from early rVE studies against JN.1. However, it is expected that the ability for XBB.1.5 vaccination to protect against symptomatic disease may be less robust as SARS-CoV-2 evolution continues from JN.1. Other formulations and/or platforms that achieve robust neutralizing antibody responses against currently circulating variants, particularly JN.1 descendent lineages, can also be considered.

In accordance with WHO SAGE policy, vaccination programmes should continue to use any of the WHO emergency-use listed or prequalified COVID-19 vaccines and vaccination should not be delayed in anticipation of access to vaccines with an updated composition. WHO stresses the importance of access to and equity in the use of all available COVID-19 vaccines.
Further data requirements and considerations

Given the limitations of the evidence upon which the recommendations above are derived and the anticipated continued evolution of the virus, the TAG-CO-VAC strongly encourages generation of data on immune responses and clinical endpoints (i.e. VE) on the performance of all currently approved COVID-19 vaccines against emerging SARS-CoV-2 variants, and candidate vaccines with an updated antigen over time.

As previously stated, the TAG-CO-VAC continues to encourage the further development of vaccines that may improve protection against infection and reduce transmission of SARS-CoV-2.

Website: International Conference on Infectious Diseases

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‘Virus hunter' reveals why many might be feeling sick right now

COVID, norovirus, whooping cough, bird flu, dengue fever -- there is no shortage of viruses making headlines in the U.S. right now.

But why does it seem like so many are getting sick lately?

We spoke to "virus hunter" Mary Rodgers, an associate research fellow at Abbott, about what's circulating right now and why.

Rodgers monitors viruses around the world to track any changes or mutations that could become concerning.

"They're constantly moving and changing and mutating, and we know that they can do this at any moment so we can never let our guard down," Rodgers said. "We have to be faster and we have to work together with partners around the world to keep an eye on them."

According to Rodgers, it's a particularly virus-heavy time -- and it could soon worsen.

"We can't necessarily rank which one is the scariest per se, but we need to really be prepared for everything that's circulating, especially the respiratory pathogens, because we're in the sort of respiratory season where things like RSV, flu, COVID and even strep throat are spreading in some places more than others," she said. "And as we have holiday travel coming up, that could change. Hot spots can then become the entire country potentially that are seeing spikes in all of these different respiratory pathogens."

Recently, health officials have warned about spikes in whooping cough, particularly in young children, with levels reaching numbers not seen in 20 years in Illinois.

Just this month, Chicago has seen "several small outbreaks" of suspected norovirus cases, according to a spokesperson for the Chicago Department of Public Health.

In addition to the many respiratory viruses circulating, one of the current viruses being tracked by virus hunters like Rodgers is bird flu.

"We certainly have been keeping an eye on H5N1, which is avian influenza, in particular in the U.S. because we're seeing more and more human cases lately," Rodgers said. "These are primarily in people who are at risk because they're interacting with livestock ,and livestock are currently the reservoir or the place that you're most likely to find avian influenza, as you'd expect, because it's a virus that primarily affects animals and birds. But that could always change. And so that's why we have to keep an eye on it as people get cases. They've been mild, which is good news, but that could always change."

The Centers for Disease Control and Prevention confirmed the first severe illness in a person with bird flu on Wednesday. A patient was hospitalized in Louisiana, marking the "first instance of severe illness linked to the virus in the United States."

Since April 2024, there have been 61 human cases of bird flu reported in the U.S., according to the CDC.

"We've learned one thing through COVID and that is that we can't assume anything," Rodgers said. "So it's really important to have an active view and proactively be looking at how these viruses are changing so that we can respond. We know that every outbreak is different and it's really important that we're all staying as healthy as possible so that we can be prepared for whatever's coming next."

When it comes to COVID-19, Rodgers said the XEC variant remains the dominant variant in the U.S.

"We've continued to see COVID evolving, and that's to be expected, actually," Rodgers said. "As people's immune responses develop to one strain, the virus is motivated to change so it can escape from those immune responses. And that's what we're seeing today. We're certainly keeping an eye on those changes so that we can make sure that tests are working and the sequences are out there to update the vaccines to be able to keep pace with those changes that happen in the virus. But from what we're seeing circulating today and the growing predominant strain for COVID is XEC, which is something we're keeping an eye on. But we also know that what the WHO analysis has shown is that this is a low risk to the public. It's not particularly more dangerous than other COVID strains, but it is changing. So we need to keep an eye on it."

While the symptoms for COVID remain unchanged so far, they can mimic the early signs of a myriad of other viruses.

"The symptoms to keep an eye out for, particularly if you're concerned you may have been exposed to COVID, would be the usual symptoms that were seen in past waves. So something like a fever or a cough or a very sore throat, those are the early warning signs that someone should get a test or check to see if they have COVID," Rodgers said. "But the thing is, a lot of these other pathogens have the same initial symptoms, so it's really hard to tell if someone might have COVID versus flu just based on symptoms alone. So you kind of have to check in with your health care provider to see what they would recommend. But obviously, testing is going to give you the definitive answer so that you'll know whether or not your family has COVID or flu, which all kind of start with the same fever, sore throat, runny nose and a test is really key in those kinds of situations."

Website: International Conference on Infectious Diseases

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Yellow Fever Vaccine Information for Healthcare Providers

• Yellow fever vaccine is recommended for persons aged ≥9 months traveling to or living in areas of South America and Africa with a risk of yellow fever.
• Because serious adverse events occur, clinicians should vaccinate only persons at risk for exposure to yellow fever virus or require proof of vaccination for country entry.
• To mitigate the risk of serious adverse events, clinicians should observe the contraindications and consider the precautions to vaccination before administering vaccine.

Yellow fever vaccine recommendations

Yellow fever vaccine is recommended for people aged 9 months or older who are traveling to or living in areas at risk for yellow fever virus transmission in South America and Africa. Yellow fever vaccine may be required for entry into certain countries. Yellow fever vaccination requirements and recommendations for specific countries are available on the CDC Travelers' Health page.

Serious adverse events can occur following yellow fever vaccination. Therefore, persons should only be vaccinated if they are at risk of exposure to yellow fever virus or require proof of vaccination for country entry.

To minimize the risk of serious adverse events, healthcare providers should carefully observe the contraindications and consider the precautions about vaccination prior to vaccine administration (see below). A medical waiver can be given for persons with a precaution about or contraindication to vaccination. More information about medical waivers is available on the CDC Travelers' Health website.

For more information about the use of yellow fever vaccine in travelers or laboratory workers, see the Advisory Committee on Immunization Practice (ACIP) recommendations.

This vaccine is administered only at designated vaccination centers. For healthcare professionals who want to learn more about yellow fever disease and vaccine, a training module is available.

Yellow fever vaccine virus has been transmitted through blood transfusion and solid organ transplantation. Healthcare providers who administer yellow fever vaccine should inform patients of the need to defer blood donation for at least 2 weeks after receiving the vaccine.

Booster doses of the vaccine

In February 2015, the CDC Advisory Committee on Immunization Practices (ACIP) approved a new recommendation that a single dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers. The updated recommendations also identify specific groups of travelers who should receive additional doses and others for whom additional doses may be considered including:

• Woman who were pregnant when first vaccinated
• Persons who received a hematopoietic stem cell transplant following their last dose of yellow fever vaccine
• Persons who are HIV-infected
• Travelers who received yellow fever vaccine at least 10 years previously and who will be in a higher-risk setting based on season, location, activities, and duration of their travel
• Laboratory workers who routinely handle wild-type yellow fever virus

The official ACIP recommendations were published on June 19, 2015 (see Advisory Committee on Immunization Practice (ACIP) recommendations. All current ACIP yellow fever vaccine recommendations can be found on the ACIP website.

Because of the change to International Health Regulations no longer requiring booster doses, a completed International Certificate of Vaccination or Prophylaxis is now valid for the lifetime of the vaccinee. For more information on completing the International Certificate of Vaccination or Prophylaxis, visit the most recent version of CDC Yellow Book: Health Information for International Travel.

Contraindications

• Allergy to a vaccine component
• Aged younger than 6 months
• Symptomatic HIV infection or CD4+ T-lymphocytes <200/mm3 (<15% of total in children aged <6 years)
• Thymus disorder associated with abnormal immune function
• Primary immunodeficiencies
• Malignant neoplasms
• Transplantation
• Immunosuppressive and immunomodulatory therapies

Precautions

• Age 6 to 8 months
• Age 60 years or older
• Asymptomatic HIV infection and CD4+ T-lymphocytes 200 to 499/mm3 (15-24% of total in children younger than 6 years old)
• Pregnancy
• Breastfeeding

Coadministration with other vaccines

Inactivated vaccines

Inactivated vaccines can be administered either simultaneously or at any time before or after yellow fever vaccination.

Live attenuated viral vaccines

Generally, yellow fever vaccine can be given at the same time as other live viral vaccines. If simultaneous administration is not possible, wait 30 days between vaccinations, because the immune response to a live viral vaccine could be impaired if it is administered within 30 days of another live viral vaccine.

There are several studies on the immunogenicity of yellow fever and measle-containing vaccines when coadministered or separated at different intervals. Although coadministration typically results in similar seroconversion rates compared to administered at least 4 weeks apart, the concentration of antibodies in the blood seen following coadministration is lower for all components other than measles. These findings suggest that it is best to give yellow fever and MMR (measles, mumps, and rubella) vaccines 30 days apart. However, coadministration of yellow fever and MMR vaccines is acceptable to ensure travelers are vaccinated before departure.

Live attenuated bacterial vaccines

Limited data suggest oral typhoid vaccine (Ty21a) and oral cholera vaccine (CVD103-HgR) can be administered simultaneously or at any interval before or after yellow fever vaccine.


Website: International Conference on Infectious Diseases

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How Long Does Stomach Flu (Viral Gastroenteritis) Last?

• Many viruses cause gastroenteritis, commonly known as stomach flu.
• Depending on the type of virus, the length of your illness will vary but should not last long. You can expect to start feeling like your usual self again within a few days.
• Contact a healthcare provider if your symptoms don't go away or you have other health concerns like dehydration.

What Is Stomach Flu?

The stomach flu, or viral gastroenteritis, is a type of intestinal infection that presents with mostly GI symptoms. It may be caused by a number of viruses but not influenza viruses as the term "stomach flu" 

Viral gastroenteritis is also a self-limiting disease. In other words, you will likely recover on your own without treatment.5 With a stomach virus, your immune system is busy trying to help you feel normal. Those types of diseases might resolve spontaneously.

Symptoms

People may experience the following signs of the stomach flu within four to 48 hours of viral exposure:

• Abdominal cramps or pain
• Fever—which isn't always a symptom
• Nausea or vomiting
• Watery diarrhea

Dehydration

Staying hydrated is essential if you have viral gastroenteritis. Dehydration happens if you lose too many fluids from diarrhea, fever, and vomiting. Drinking enough fluids while you have the stomach flu may be difficult, increasing your risk of dehydration.

Dehydration symptoms include:

• Extreme thirst
• Dry mouth and skin
• Sweating and urinating less than usual
• Urine that has a dark color
• Fatigue
• Feeling dizzy

Some people with a stomach bug develop mild dehydration symptoms, which may prolong your illness. Other times, dehydration can be life-threatening.

Seek immediate medical attention if you develop severe symptoms like:

• Breathing quickly
• Fainting
• Feeling confused
• Not urinating
• Rapid heartbeat
• Shock

How Long Does It Last?

There's a good chance your symptoms will go away rather quickly if you have a healthy immune system. Some people with the stomach flu might not even develop symptoms.

What Can Prolong Symptoms?

You may need more time to recover if you have a weak immune system. A weak immune system may have a harder time fighting a stomach virus than usual. Stomach flu symptoms may last longer than average, and you might have a high risk for complications.

Talk to a healthcare provider if you develop viral gastroenteritis and have:

• Autoimmune conditions (e.g., lupus and rheumatoid arthritis)
• Immunodeficiency syndromes
• Inflammatory bowel disease (IBD)
• Kidney disease
• Metabolic diseases (e.g., diabetes)
• Structural heart disease

How Long Am I Contagious?

Viral gastroenteritis is highly contagious and spreads from person to person through stool and vomit. Norovirus is contagious as long as you are sick and for up to two weeks afterward.

Preparing food and drinks, shaking hands, and touching objects and surfaces with unwashed hands after using the bathroom easily spreads a stomach bug. The virus may become airborne if you vomit. Norovirus might live for months on objects and surfaces.

Stomach Flu Remedies

Viral gastroenteritis typically resolves on its own. Still, there are some things you can do to feel better and possibly reduce your symptoms. Below are some tips to help you recover if you have a stomach bug:

• Eat small amounts of bland food: Not eating does not help alleviate symptoms. Instead, try eating small servings of bananas, bread, cereal, plain yogurt, and vegetables. Replenishing your nutrients is essential if you have diarrhea and vomiting.
• Stay hydrated: Drinking plenty of fluids helps prevent dehydration. Sip on electrolyte replacement solutions, Gatorade, or water every 30–60 minutes. Do not drink broth, fruit juice, gelatin, or soda if you have a stomach bug. Those fluids might worsen diarrhea.
• Take medicine: Antibiotics do not work for viral infections like the stomach flu. Instead, you might use over-the-counter (OTC) medicines like Imodium (loperamide) or Pepto-Bismol (bismuth subsalicylate). Talk to a healthcare provider if you have bloody or severe diarrhea before taking medicine.

Website: International Conference on Infectious Diseases

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Tickborne Disease

These free continuing education activities provide information to healthcare providers on Lyme disease, RMSF, ehrlichiosis, anaplasmosis, and viral tickborne disease cases in the United States.

Ehrlichiosis and Anaplasmosis Continuing Education

This free continuing education activity provides information to healthcare providers on the assessment, evaluation, and clinical implications of ehrlichiosis and anaplasmosis cases in the United States.

Improving Care for Patients with Prolonged Symptoms and Concerns about Lyme Disease: A Clinician Toolkit

This online toolkit provides educational resources for physicians and other health care professionals to help care for patients with prolonged symptoms and concerns about Lyme disease. The toolkit gathers:

• Best practices and guidance from CDC, medical professional societies including American Academy of Neurology (AAN), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Rheumatology (ACR), Infectious Diseases Society of America (IDSA), and practicing clinicians
• Resources for patients and health care professionals
• Interviews with experts
• A CME module
• Video examples of health care professionals who care for complex patients

Viral Tickborne Disease Continuing Education

This free continuing education activity provides information to healthcare providers about tickborne viral diseases endemic to the United States (Powassan, Colorado tick fever, Heartland, and Bourbon viruses). Information on the epidemiology, diagnosis, treatment, and prevention of these diseases is covered during this one-hour interactive course.

Tick-Borne Encephalitis (TBE) Vaccine Continuing Education

This free continuing education activity for healthcare providers describes TBE vaccine recommendations for U.S. travelers and laboratory workers. Healthcare providers can use these guidelines to discuss the risks and benefits of TBE vaccination when they consult with people traveling abroad or with laboratory workers at potential risk for exposure to TBE virus.

Website: International Conference on Infectious Diseases

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