Microregistrar Infection Newsletter · Thursday 22 October 2026
Nigeria confirms the Bundibugyo strain in its imported Ebola case and reports that the patient is deteriorating; the FCDO updates its Nigeria travel advice, but UKHSA’s HCID list doesn’t yet mention Nigeria.
The NCDC says three molecular tests confirmed Bundibugyo virus in the Abuja patient, and that her condition has deteriorated. One official told AFP she is in multi-organ failure, although the health minister told the BBC she was “stable” and “improving”. There are still 44 contacts, most of them healthcare workers, and none is reported to have symptoms. The NCDC held its first incident-management meeting on 21 Oct. Kenya still has 9 cases in one cluster, with 8 patients stable. Its first quarantined contacts can go home from 25 Oct.
In the UK, the FCDO added Ebola information to its Nigeria travel advice on 21 Oct (18:00 BST). UKHSA’s HCID country-specific risk list is still dated 15 Oct and has nothing on Nigeria. For a febrile traveller from Nigeria, Uganda, Kenya or DRC, take a full travel, transit and healthcare-exposure history, and assess VHF risk using the official statements. There are no new official DRC figures in the window: SitRep 158 (9,637 cases, 4,646 deaths) is still the latest.
Check before quoting: accounts of the Nigeria case conflict. Arrival is given as 3 Oct (WHO AFRO, NCDC via Al Jazeera, an aviation official via Vanguard) or 5 Oct (NCDC via Punch). Symptom onset is 6 Oct (Africa CDC) or 7 Oct (WHO AFRO). Her nationality and the route (holiday in Kampala via Addis Ababa, or business in eastern DRC) also differ, and her clinical condition is reported both ways. There’s no WHO Disease Outbreak News yet.
Counted from today’s digest. The twelve journal items come from CID, OFID (three), JAC (two), AAC (three), AJIC, J Infect and Lancet Infect Dis. Links are unique content links across the issue, not counting our two website links. The 44 contacts are from the Nigerian ministry and WHO AFRO. Gaps are the items in the Coverage gaps list; reports that simply haven’t been published yet are listed separately.
Also today
The other headlines from today’s issue. Each one links through to the full summary. UK flu/COVID-19, measles and Salmonella figures are unchanged; week 43 flu/COVID-19 is due today at 14:00, after the window closes.
Nigeria: Bundibugyo confirmed; patient reportedly worse
NCDC confirmed the strain; 44 contacts (mostly HCWs), none symptomatic; incident action plan being finalised.
Clinical status and timeline conflict between sources.
Kenya: 9 cases, 8 stable
Single cluster; 134 of 135 contacts traced; first quarantined contacts released from 25 Oct if well.
From the ministry update, as reported in the press.
FCDO updates Nigeria advice; HCID list unchanged
FCDO Health page now covers Ebola (21 Oct); UKHSA HCID list still dated 15 Oct and has no Nigeria entry.
DRC: no new official figures
SitRep 158 (9,637 cases / 4,646 deaths, data to 19 Oct) is still the latest; the ECDC page hasn’t changed since 20 Oct.
One press report gives 4,550 deaths to 18 Oct, against the official 4,602.
Immunosuppression in 16.9% of BSI episodes
Southern Sweden, 2013–2023: more E. faecium and Pseudomonas; 30-day mortality 17.9% vs 12.5%.
When can a tetracycline result support doxycycline?
A review: tet(K)/tet(L) efflux may spare doxycycline; tet(M)/tet(O) ribosomal protection usually doesn’t.
What we could not confirm
The Nigeria timeline, the patient’s condition and her travel route all conflict between sources. Kenya’s figures are press-reported. No new DRC SitRep was found and the ECDC page hasn’t updated. The CDC HAN archive didn’t load. Several journal items are title-only, and the Crossref sweep may miss items that are indexed late.
Microregistrar Moodle update
No new entries. We read the Microregistrar moodlecloud sheet (Index tab, “Whats new?”) directly at about 07:52 BST. The newest entries are still the two from 19 Oct, which were first listed in the 20 Oct issue (the 21 Oct issue didn’t check Moodle). They’re shown below for reference only.
MRSA (updated)
Already reported: refreshed teaching item on meticillin-resistant Staphylococcus aureus.
PVL Staph aureus (updated)
Already reported: refreshed item on Panton–Valentine leukocidin-producing S. aureus.
The full list is in the Microregistrar moodlecloud sheet ›
Watched pages
We check nine pages every morning for anything new, compared with what we saw last time (checked 22 Oct 2026 ~07:55 BST; 9 of 9 checked). After our relevance filter, three pages have something new: the UKHSA regional hepatitis C reports, two JAC papers and a J Infect paper on Spiroplasma.
Health Protection Report (UKHSA)
No changeThe collection is still dated 6 May 2026, and nothing new appeared in the UKHSA GOV.UK feed.
UK SMI News (RCPath)
No changeThe SMI news page still returns 404. The consultations page lists only B 6, Investigation of whooping cough, open until 26 Oct. Consultations ›
RCPath Examinations
No changeThe landing page loaded. We didn’t open the dated sub-pages (news and dates).
Green Book
No changeThe collection was last changed on 11 Jun 2025 (gonorrhoea chapter), checked directly through the GOV.UK content API.
UKHSA organisation page (GOV.UK)
NewRegional hepatitis C annual reports for East of England, Yorkshire and Humber, North East, South East, West Midlands, East Midlands and North West (21 Oct ~09:00). The rest is corporate: the safeguarding report and a Health Security Campus assessment. Example: East of England ›
NICE published guidance
No changeNo infection guidance. The 20–21 Oct items are HTG784 (lung perfusion) and TA1202 (trastuzumab deruxtecan).
Journal of Antimicrobial Chemotherapy
NewTwo items: tetracycline cross-susceptibility and doxycycline, and INSTI exposure with hepatic steatosis (see Journals).
Journal of Infection
NewHuman spiroplasmosis, a newly recognised tick-associated febrile illness (title only; see Journals).
Journal of Hospital Infection
No changeNo new items in the Crossref sweep.
Agencies & guidance
Today’s main developments are the Nigeria strain confirmation and the patient’s worsening condition, Kenya’s update and the FCDO’s Nigeria travel advice. There’s no new UKHSA surveillance, MHRA alert, WHO Disease Outbreak News, ECDC update or DRC SitRep in the window.
Guidance changes
No new UK guidance in the window; two consultations still open
Nothing new from UKHSA, the Green Book, NICE or UK SMI between 21 Oct 08:10 and this morning.
- UK SMI B 6, Investigation of whooping cough: open until 26 Oct 2026 (forwarded by Mail Sorter on 19 Oct). Feedback goes through the RCPath survey form linked from the consultation page.
- UKAP: HIV viral load clearance and monitoring for healthcare workers living with HIV who perform EPPs. Closes 8 Nov 2026. UKHSA’s 21 Oct stakeholder cascade flagged it again.
- Still current: MHRA DSI/2026/014 (echinocandins with CRRT) and the IXCHIQ withdrawal (20 Oct).
UKHSA / MHRA / England
FCDO Nigeria travel advice updated for Ebola (21 Oct 18:00 BST); UKHSA HCID list still not updated
FCDO’s Health page now notes the 20 Oct confirmation and contact tracing. Travellers arriving in Nigeria from countries with Ebola transmission must complete the online Nigeria Health Declaration Form and may face thermal screening. The UKHSA HCID country-specific risk page was last changed on 15 Oct (Kenya).
Action: for febrile returners, take a full travel and transit history (including Kampala, Addis Ababa and Abuja) and any healthcare exposure, especially in Abuja private facilities. Assess VHF risk using the official statements until the HCID page is updated.
Week 42 still the latest
No new report in the window. Week 43 is due 22 Oct at 14:00. UKHSA’s 21 Oct cascade summarises week 42 as flu and COVID-19 low, with RSV rising to baseline levels.
England: no new release
Last updated 15 Oct.
S. Enteritidis: still week 41
No week 42 release yet. The 21 Oct cascade flagged the FSA egg recall again (10 Oct): S. Enteritidis in eggs from one Ukrainian supplier, a strain linked to 36 cases in England in 2026 but not to the outbreak strains.
Still week 41
Last added 15 Oct; no newer week.
Regional hepatitis C annual reports published
Seven English regions published annual HCV epidemiology reports on 21 Oct. We didn’t extract any figures. MHRA has no new infection-relevant drug safety update or device alert in the window (the latest are IXCHIQ on 20 Oct and the field safety notice round-ups on 19 Oct).
ECDC
Page still dated 20 Oct 15:00 at ~07:52 BST, 22 Oct
- DRC 9,552 cases / 4,602 deaths (data to 18 Oct); Kenya 8 cases (as of 20 Oct). Nigeria isn’t mentioned.
- ECDC’s modelling still puts the risk of importation into the EU/EEA as very low. Its modelling doesn’t cover returning healthcare workers.
No new Communicable Disease Threats Report (week 42 is the latest; week 43 is expected around 23 Oct). Eurosurveillance’s latest issue is still 31(41), 15 Oct, and the 22 Oct issue wasn’t out at compile time.
Global — Ebola (Bundibugyo)
Nigeria: Bundibugyo confirmed; patient deteriorating; incident action plan being finalised (21 Oct)
- Official (WHO AFRO / UN News): symptom onset on 7 Oct, four days after arrival. She sought care at a private Abuja facility on 11 Oct and was confirmed on 20 Oct. 44 contacts are being monitored, IPC is being stepped up at the facility, and NCDC has activated its incident management system. WHO recommends no travel or trade restrictions.
- NCDC (as reported in the press): three molecular tests confirmed Bundibugyo, and “the patient’s condition has deteriorated”. Most contacts are healthcare workers; others include her husband and passengers on the Uganda–Nigeria flight. The first incident-management meeting took place on 21 Oct.
- Conflicting accounts: the health minister told the BBC she is a 42-year-old who spent two and a half weeks in Kampala with a two-hour Addis Ababa stopover, and that she is “stable” and “improving”. Africa CDC gives onset as 6 Oct, after care at two private hospitals. Uganda’s ministry says she transited Uganda after business in eastern DRC, and it has asked Nigeria for her records. Vanguard cites flight ET333 arriving 3 Oct; Punch quotes NCDC giving 5 Oct.
Check before quoting: the clinical status, dates, nationality and route are press-reported and conflict between sources. There’s no WHO Disease Outbreak News yet.
WHO AFRO › · UN News › · FMoH statement › · BBC › · Al Jazeera › · Punch › · Vanguard › · State House ›
DRC: SitRep 158 still the latest (9,637 confirmed / 4,646 deaths, data to 19 Oct)
- We found no SitRep 159 in the window. The archive at ebola-tracker.org lists SitRep 158 as the newest.
- Doesn’t add up: ABC News gives 4,550 deaths to 18 Oct, but the official SitRep 157 and ECDC figure is 4,602. A secondary daily briefing (loew-beer.at, 21 Oct) lists Ituri at 6,996, against ECDC’s 6,960, and counts 20 cumulative cases in Uganda.
Check before quoting: use INSP, WHO or ECDC figures. The summaries above are secondary.
Kenya: 9 confirmed cases, 1 death; 8 patients stable (21 Oct update)
- Every case belongs to the single known cluster, with no evidence of spread beyond it.
- 134 of 135 contacts (99.3%) are traced and quarantined. Those in quarantine since 6 Oct can go home from 25 Oct if they have no symptoms after 21 days.
- PPE and diagnostic kits have gone to 12 very high-risk and 16 high-risk counties, and there’s a dedicated lab at the Kenyatta National Hospital Infectious Disease Unit.
Press-reported: Health CS Duale’s update as reported by the media. ECDC still lists 8 cases.
WHO
No Disease Outbreak News on Nigeria or Kenya
The DON API still has MERS-CoV in Saudi Arabia (15 Oct) as the latest; the last Ebola DON was on 8 Oct. WHO’s Nigeria statement is through AFRO and UN News (see above).
CDC / US
Still no Ebola notice for Nigeria
The current notices are Level 4 (Ituri/Nord-Kivu), Level 3 (Haut-Uélé/Tshopo) and Kenya (19 Oct). Yellow fever notices for Colombia and Ghana are dated 16 Oct.
HAN archive did not load
The page returned only its header: curl was blocked with 403 and WebFetch gave no notice list. The last known HAN is CDCHAN-00533 (10 Sep).
Still the 15 Oct issue
The next weekly issue is expected later on 22 Oct (US time).
4,410 US cases (as of 15 Oct)
The page was updated on 16 Oct and shows 3 deaths. The next update is due Thursday.
No new ahead-of-print items since 19 Oct
The African swine fever and Shamonda virus items were covered on 21 Oct.
Journals
New since the 21 Oct issue (online 21–22 Oct), from a Crossref sweep of all 19 watched titles. There were no new infection items in this window for Lancet Microbe, NEJM, JID (one HIV-PAH case-control study, out of scope), IJID (two items, not listed), ICHE (an erratum only), J Hosp Infect, CMI, ARIC or JCM. Eurosurveillance has no new issue yet.
Clinical Infectious Diseases
Holistic composite endpoints with strategic analyses for Gram-negative bloodstream infection trials
Title only; no abstract in Crossref. A methods paper on trial endpoints (for example DOOR-type approaches).
Open Forum Infectious Diseases
Aetiology and outcomes of bloodstream infection by type of immunosuppression (southern Sweden, 2013–2023)
8,058 of 47,552 BSI episodes (16.9%) had underlying immunosuppression, rising by about 1.9% a year. Immunosuppression was associated with E. faecium (OR 3.16), Pseudomonas (OR 2.51) and intrinsic cephalosporin resistance (OR 1.45). 30-day mortality was 17.9% vs 12.5% (OR 1.54).
Takeaway: empirical cover for immunocompromised patients with BSI should consider enterococci and Pseudomonas.
Severe yellow fever outside the endemic zone: Colombian Andean outbreak ICU cohort (Ibagué, 2025)
61 RT-PCR-confirmed adults; 22 died (36.1%). Non-survivors had worse coagulation, liver and kidney markers and more shock, AKI, ARDS, DIC and bleeding. 10 (16.4%) reported previous vaccination (self-reported).
Takeaway: CDC’s Colombia yellow fever notice (16 Oct) is relevant. Check vaccination for travellers to the Andean regions, not only to the classic endemic zones.
Q fever hospitalisations in Italy, 2014–2023: under-recognition and a Sardinian hotspot
428 hospitalisations (0.07 per 100,000 person-years) with a CFR of 2.4%; pneumonia was the most common concurrent diagnosis. Sardinia’s rate was 0.55, which the authors call “7-fold” the national rate (the ratio is about 7.9). Risk rose 12% per 10 cattle/km².
Journal of Antimicrobial Chemotherapy
Cross-susceptibility among tetracyclines in Gram-positive infection: EUCAST/CLSI guidance and doxycycline
A narrative review. Cross-susceptibility isn’t uniform: efflux (tet(K), tet(L)) may spare doxycycline and minocycline, while ribosomal protection (tet(M), tet(O)) usually reduces susceptibility across the class. Interpretation depends on the organism, method and breakpoint, and the clinical evidence is strongest for selected staphylococcal infections.
Takeaway: before you extrapolate a tetracycline result to oral doxycycline step-down, check your lab’s EUCAST surrogate rules.
Cumulative integrase-inhibitor exposure and severe hepatic steatosis in people with HIV (Italy)
265 patients assessed by VCTE: 49% had S2–S3 steatosis and 28.5% had S3. S3 was independently associated with cumulative INSTI exposure (aOR 1.19 per year), BMI, daily alcohol and LDL. Viral suppression was associated with lower liver stiffness. This is a cross-sectional, single-centre study.
Antimicrobial Agents and Chemotherapy
Tebipenem and ceftibuten with novel oral β-lactamase inhibitors against 57 acquired β-lactamases
Tested in recombinant E. coli. Xeruborbactam restored activity against most metallo-β-lactamase producers, which avibactam and ledaborbactam did not. Tebipenem–xeruborbactam had the broadest spectrum. This is in vitro work only.
Carbapenemase-producing E. coli and K. pneumoniae in Lima, Peru (2020–2022)
320 isolates: NDM 69%, KPC 16.9%, OXA-48-like 4.6%; 11 K. pneumoniae carried both NDM and KPC. All isolates were MDR, but aztreonam–avibactam and cefiderocol were active against every isolate tested. This is the first report of NDM-5 in Peru (E. coli ST167); K. pneumoniae ST147 carried NDM-1.
Takeaway: relevant when screening and choosing empirical therapy for patients transferred from Peruvian hospitals.
Rifampicin-resistant MRSE implant-associated infection: ceftaroline plus daptomycin
In a murine tissue-cage model, daptomycin plus ceftaroline gave the highest cure rates, including against clinical rifampicin-resistant strains, though efficacy fell at higher inocula. rpoB mutations carried a fitness cost, and one mutant formed more biofilm.
American Journal of Infection Control
CHG-impregnated caps to reduce dialysis catheter-associated BSI, neonates to adults (single-centre QI)
Title only; no abstract retrieved.
Journal of Infection
Human spiroplasmosis: clinical characterisation of a newly recognised tick-associated febrile illness
Title only; no abstract retrieved. Worth reading for travel and tick-exposure differentials.
The Lancet Infectious Diseases
African countries’ efforts to interrupt polio outbreaks
Title only (news or comment).
On X
A light weekday check: three searches covering agency accounts, Ebola and AMR/IPC terms, 21 Oct 08:10 to 22 Oct ~07:55 BST. Individual posts aren’t linked except for official accounts.
Nigeria Ebola dominated. NCDC (@NCDCgov) posted about its first incident-management meeting and the incident action plan, plus symptom advice. Press accounts focused on the patient’s worsening condition, questions about airport screening and the 12-day gap before she was tested, and Uganda’s statement that it hasn’t established she was infected there.
Kenya: the ministry (@MOH_Kenya) posted community-engagement and reporting messages, with nothing new on case numbers. WHO’s posts were mostly measles vaccination and a Bundibugyo explainer video.
AMR/lab: the NCTC (UKHSA) has announced five new UKHSA-PACE AMR panels of 145 Gram-negative isolates for research. Discussion of the first patient treated with AI-designed phage (covered yesterday) continued, with no outcome data. International Infection Prevention Week posts ran through the day.
Unverified: the NCTC panel announcement and all the press-derived claims are from X and haven’t been checked against a primary page. UKHSA’s own X account had no infection alert in the window.
What we could not confirm
We want you to know exactly where today’s issue has limits, so here are the 7 gaps we couldn’t close, plus the reports that simply weren’t out yet.
| Source | Issue |
|---|---|
| Nigeria | Clinical status (“stable/improving” vs “deteriorated/multi-organ failure”), arrival date (3 vs 5 Oct), onset (6 vs 7 Oct), nationality and route all conflict between sources. There’s no WHO DON yet and we found no NCDC situation report. |
| DRC | We found no SitRep 159. The ECDC page hasn’t updated since 20 Oct 15:00. A press report gives 4,550 deaths against the official 4,602, and secondary briefings use different provincial totals. |
| Kenya | The 21 Oct figures come from the ministry update as reported in the press. ECDC still lists 8 cases. |
| UK pages | The RCPath SMI news page returns 404 (we used the consultations page). For RCPath exams we checked only the landing page. UKHSA’s regional hepatitis C reports were noted but not read for figures. |
| CDC | The HAN archive didn’t load (curl 403; WebFetch returned only the page header). |
| Journals | Crossref sweep only, and indexing can lag. CID, AJIC, J Infect and Lancet Infect Dis items are title-only; NEJM and JAMA had no infection research in the window. |
| X | A light check only. The NCTC AMR panel item and the press claims weren’t verified against primary pages. |
Not out yet
- UKHSA: week 43 flu/COVID-19 (due 22 Oct 14:00), week 42 Salmonella, measles and outbreaks under monitoring; an HCID page update for Nigeria.
- ECDC: Ebola page update; CDTR week 43 (~23 Oct); Eurosurveillance (22 Oct).
- WHO / DRC: Disease Outbreak News on Nigeria and Kenya; INSP SitRep 159.
- CDC: next MMWR and measles update (22 Oct, US time).
Sources
What we checked for this issue. Every link in the issue was retrieved during this run.
- Watched pages (9 of 9 checked, 22 Oct ~07:55 BST)
- Microregistrar moodlecloud Google Sheet (Index tab), read directly through the Sheets connector
- UKHSA on GOV.UK (search API and content API): organisation feed, HCID country-specific risk list, flu/COVID-19, measles, Salmonella, outbreaks under monitoring, Health Protection Report, UKAP consultation; FCDO Nigeria travel advice
- MHRA: Drug Safety Update and drug and device alerts (GOV.UK search API)
- RCPath: UK SMI consultations page, SMI news page (404) and examinations landing page; Green Book collection; NICE published guidance
- Mail (microregistrar2021@gmail.com, read only): the UKHSA stakeholder cascade of 21 Oct and the UKHSA Global Hazards weekly bulletin, each item filed under its matching section. No Mail Sorter forwards were found in the window
- ECDC: Ebola page, news feed, CDTR, Eurosurveillance
- Nigeria: FMoH statement, WHO AFRO, UN News, State House, BBC, Al Jazeera, Punch, Vanguard
- Kenya: Tuko, Radio Generation; DRC: ebola-tracker.org SitRep archive, ABC News
- WHO Disease Outbreak News (API)
- CDC: travel notices, HAN (did not load), MMWR RSS, measles, EID ahead of print
- Journal sweep (Crossref, online 21–22 Oct): Lancet Infect Dis, Lancet Microbe, NEJM, JAMA, CID, JID, OFID, IJID, ICHE, AJIC, JAC, JAC-AMR, J Hosp Infect, J Infect, CMI, ARIC, AAC, JCM, Eurosurveillance
- X: three searches (agency accounts, Ebola, AMR/IPC terms)