Microregistrar Infection Newsletter · Tuesday 27 October 2026
Measles: missed diagnoses in about 7% of US cases (ICHE), as Pennsylvania passes 1,360 cases and a Washington report shows how fast control limited importations.
A case-crossover study in Infection Control & Hospital Epidemiology (Arakkal, Miller, Cavanaugh, Herwaldt; online 26 Oct) looked at 4,651 measles cases in US MarketScan data from 2001 to 2023. It estimated 381 missed opportunities to diagnose in the two weeks before diagnosis: about 6.9% of patients had at least one, mostly in outpatient settings (81%). The mean delay was 4.05 days, and 1.7% waited a week or longer. Delays were more likely in children under 2 and in patients who were prescribed antibiotics.
The context makes this a front-line IPC issue. As reported by FluTrackers, the Pennsylvania Department of Health says 1,360 cases have been confirmed across 44 counties this year. A Public Health Alerts report in NEJM Evidence (with CIDRAP) describes five importations into Washington State in January. They led to 26 cases (24 unvaccinated, none admitted), and the authors say isolation and quarantine compliance helped keep it at that. A same-day ICHE systematic review found that germicidal UV has older evidence for reducing airborne spread of measles and chickenpox, but no robust trial evidence.
Check before quoting: the ICHE figures come from the Crossref abstract; we haven’t read the full text. The Pennsylvania total is secondary (FluTrackers relaying a DOH statement, consistent with CIDRAP’s “topped 1,300”). There’s no UK change: UKHSA measles data are still at 15 Oct (next release 12 Nov).
Counted from today’s digest. The Crossref sweep (online 26–27 Oct) found nine new infection items; yesterday’s OFID babesiosis paper isn’t counted again, and JAMA’s eight new items weren’t infection-related. The NEJM Evidence measles report was found through X. Links are unique content links across the issue, not counting our two website links. The UKHSA item is the updated East of England HIV spotlight; other UKHSA entries were release-calendar announcements only.
Also today
The other headlines from today’s issue. Each card links to its source and to the full summary.
Kenya reports a second Ebola death; Nigeria’s index patient flown to Switzerland
A 65-year-old relative of Kenya’s index patient died in quarantine care. There are no new cases, seven patients are in isolation and the first contacts have completed 21 days (CIDRAP).
Critical appraisal questions oral–IV equivalence claims in infective endocarditis
Siraj and Hollnagel (online 26 Oct). Relevant to POET-style step-down decisions; abstract not yet indexed.
Germicidal UV for indoor respiratory infection: systematic review
40 studies from 1940 to 2025, only 4 RCTs. Benefit is suggested for measles and chickenpox, other effects are uncertain, and there was no excess eye or skin irritation.
Septic surgery unit ASP: drug costs down 25%, more oral switches
A Hungarian before–after study. DDDs rose 23% while duration and costs fell; 30-day mortality was unchanged.
H5N1 in Danish (~27,000 birds) and German (~1,200) poultry
WOAH reports relayed by FluTrackers; Hong Kong has suspended poultry imports from Slagelse, Denmark. Secondary.
Elizabethkingia added to Microregistrar Moodle
The first new entry since 23 Oct, dated 26 Oct in the “Whats new?” list.
What we could not confirm
The Pennsylvania measles total (secondary). The ICHE and OFID papers beyond their Crossref abstracts; the OFID endocarditis appraisal has no abstract yet. The Kenya and Nigeria Ebola updates come via CIDRAP, and the DRC totals (9,964 cases, 4,841 deaths) are CIDRAP citing CDC; there’s been no new WHO DON. European H5N1 and US screwworm reports are secondary. RCPath still lists the B 6 consultation as open, although its end date (26 Oct) has passed. CDC HAN is still unreachable, and ECDC’s week 43 CDTR isn’t on the archive.
Microregistrar Moodle update
One new entry. We read the Microregistrar moodlecloud sheet (Index tab, “Whats new?”) directly at about 07:50 GMT. Since the 26 Oct issue, one row dated 26 Oct has been added above the two 23 Oct entries.
Elizabethkingia
The new top row in “Whats new?”. The sheet gives only the title; we haven’t opened the Moodle page itself. Moodle ›
Interactive HYN – Anthrax; Interactive HYN – PVL Staph aureus
These remain the next entries down; we reported them on 24 Oct. Sheet ›
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 27 Oct 2026 ~07:50 GMT). All nine were reached, and two have something new.
UK SMI News (RCPath)
No changeThe page still lists B 6, Investigation of whooping cough under “Open consultations”, but its stated end date (26 Oct) has passed. No new UK SMI documents are listed. Consultations ›
RCPath Examinations
No changeThe page still says autumn 2026 FRCPath, Certificate and Diploma applications are closed. Examinations ›
Green Book
No changeNo chapter updated in the window; the last change was the hepatitis A chapter on 22 Oct. Green Book ›
UKHSA organisation page (GOV.UK)
NewThe East of England HIV annual data spotlight was updated on 26 Oct, and a women’s prisons health needs toolkit was published. Release dates were confirmed for HCAI monthly data (4 Nov) and the ICU bloodstream infection annual report (26 Nov). HIV spotlight ›
NICE published guidance
No changeThe listing loaded; the newest items are still dated 23 Oct, none infection-related. NICE published ›
Journal of Antimicrobial Chemotherapy
NewTwo pieces of correspondence (online 26 Oct). One comments on the NHS England AMS specialist capability framework (Delphi); the other is the authors’ right-to-reply on the multicentre study of acute kidney injury in S. aureus bacteraemia. AMS framework letter › · SAB AKI reply ›
Agencies & guidance
UKHSA published one infection item, an updated regional HIV report. MHRA, ECDC and WHO DON had nothing new on infection, and the CDC travel notice list is unchanged. Most of today’s outbreak news comes from CIDRAP and official accounts.
Guidance changes
No UKHSA, MHRA or Green Book infection guidance change
The last infection guidance change is still UKHSA’s influenza antiviral update (23 Oct). MHRA’s Monday items were a Drug Safety Update for #MedSafetyWeek (2–8 Nov; Yellow Card website and app changes) and a Class 2 recall of Xeal Pharma clopidogrel oral liquids. Neither is infection-specific. The HCID country-specific risk page was last updated on 22 Oct.
UKHSA / MHRA / England
HIV: East of England annual data spotlight updated
UKHSA updated its East of England annual HIV epidemiology report collection on 26 Oct. We haven’t extracted the figures.
HCAI and respiratory release dates confirmed
These are announcements, not data. Flu/COVmin-2026-10-27-19 week 44 report: Thu 29 Oct. MRSA, MSSA, Gram-negative bacteraemia and C. difficile monthly data: 4 Nov. ICU bloodstream infection annual report (FY 2025–26): 26 Nov. Measles data are still at 15 Oct. No in-window Mail Sorter forwards.
ECDC / Europe
Nothing new from ECDC
ECDC’s newest item is still the Kenya/Nigeria Ebola threat assessment (23 Oct), which rates the risk to EU/EEA travellers as low. The week 43 CDTR still isn’t on the archive; the latest there is week 42.
H5N1 in domestic poultry
WOAH reports (relayed by FluTrackers) give about 27,000 birds affected in Denmark and about 1,200 in Germany. Hong Kong CHP has suspended poultry meat imports from Slagelse Municipality, Denmark.
Secondary; we haven’t checked these against WAHIS.
@FluTrackers (Denmark) › · @FluTrackers (Germany) › · @FluTrackers (Hong Kong) ›
Global
Kenya: second death and first contacts released; Nigeria’s index patient flown to Switzerland
- Kenya (CIDRAP, 26 Oct): a 65-year-old woman, a close relative of the index patient, died under quarantine in a Nairobi infectious disease unit, 10 days after symptom onset. There are no new cases. Seven patients are in isolation (9 cases in total, 2 deaths). Of the index patient’s 135 contacts, 118 were quarantined, and the first contacts to complete 21 days were released over the weekend.
- Nigeria: the index patient, a 42-year-old Ugandan woman, was evacuated to Switzerland in stable condition with her asymptomatic husband. Nigeria is monitoring 52 contacts. Africa CDC is investigating where she was infected, because her itinerary showed no travel to the DRC. Both index patients passed through Entebbe airport on 3 Oct, which Africa CDC suggests may be where transmission happened.
- DRC: Dr Tedros says the last two patients have been discharged from the Mongbwalu (Ituri) ETC, with no new positives there for five days. FluTrackers relays a report that the Ania health centre in Ituri has closed after about 15 infections, including in health workers (secondary). CIDRAP, citing CDC, gives 9,964 cases and 4,841 deaths (CFR about 48.6%).
There’s been no new WHO DON since DON622 (23 Oct). The DRC totals are CDC figures via CIDRAP, not WHO.
WHO scales up its cholera and trauma response in Yemen
WHO EMRO says that between 12 and 20 Oct it delivered cholera supplies to eight treatment centres in Aden, Abyan and Al-Dhale’e. It also supported measles–rubella vaccination for 200 children under five at Al-Ferdaws camp. No case numbers were given.
WHO
No new Disease Outbreak News in the window
The latest is still DON622 (Ebola, 23 Oct).
Support for people in isolation or quarantine
Dr Tedros welcomed Nigeria’s commitment to give incentives to people who need to isolate or quarantine. This confirms the stipend we reported yesterday from an X summary, though the amount still hasn’t been confirmed.
CDC / US
Pennsylvania 1,360 cases; Washington importations held to 26
Pennsylvania DOH reports 1,360 confirmed cases in 44 counties in 2026 (via FluTrackers). CIDRAP says Pennsylvania accounts for nearly 30% of US cases, which fits its 4,588 national total (about 29.6%). Washington State’s five January importations, four of them linked to South Carolina, produced 2 + 14 + 2 + 1 + 7 = 26 cases (NEJM Evidence Public Health Alerts).
New World screwworm: four more animals; CDC pages unchanged
FluTrackers relays USDA reports of New World screwworm in 3 cattle and 1 sheep in newly affected counties of Texas and New Mexico (secondary). The CDC travel notice list is identical to yesterday’s, the HAN archive returned an error again, and EID’s newest early-release items are still dated 19–23 Oct.
@FluTrackers (NWS) › · Travel notices › · EID early release ›
Journals
New since the 26 Oct issue (online 26–27 Oct), from a Crossref sweep of the 19 watched titles, plus the NEJM Evidence measles report found through X. JAMA’s eight new items weren’t infection-related. The other titles had nothing new.
Infection Control & Hospital Epidemiology
Estimating the incidence and duration of diagnostic delays for measles
Arakkal AT, Miller AC, Cavanaugh JE, Herwaldt LA and colleagues. A case-crossover study using MarketScan (2001–2023) with 4,651 measles cases. 426 patients (9.2%) had measles-compatible visits in the prior two weeks, giving an estimated 381 missed opportunities (95% CI 330–440). About 6.9% of patients had at least one, with a mean delay of 4.05 days (median 2.94), and 81% of delays were in outpatient care. Children under 2 and patients prescribed antibiotics were more likely to be delayed.
Takeaway: in febrile rash illness, an antibiotic prescription may be a marker of a missed measles diagnosis. Isolate early and ask about vaccination status and travel.
Germicidal ultraviolet to reduce transmission of respiratory infections indoors
Higerd-Rusli GP, Blatchley ER and colleagues. 57 reports covering 40 studies (30 non-randomised, 4 RCTs). Older studies suggest GUV reduces measles and chickenpox; the evidence for undifferentiated respiratory illness is mixed, and two RCTs were inconclusive or modest. There was no excess eye or skin irritation in 16 studies. 89% of studies were non-randomised, so no meta-analysis was done.
Workroom contact networks and respiratory infection risk
Hanson AW and colleagues used proximity badges in two physician workrooms. The smaller room (112.6 sq ft) had more contacts and a higher simulated risk of secondary infection than the larger one (208.7 sq ft), despite similar occupancy (2.3 vs 2.7).
Open Forum Infectious Diseases
Reconsidering claims of equivalence between oral and IV antibiotics for infective endocarditis
Siraj DS, Hollnagel F (online 26 Oct). A critical appraisal of the evidence behind oral step-down. Crossref has no abstract yet, so we can’t summarise the conclusions.
Risk factors for ARB colonisation among community adults in Bangladesh (ARCH)
768 adults in Dhaka. Using a public tap was associated with ESCrE (aOR 11.24, 95% CI 1.28–98.6) and MRSA colonisation (aOR 2.38), and bottled or jarred water with MRSA (aOR 5.5). The authors call the estimates imprecise.
Gender-affirming hormone therapy and PrEP: bidirectional effects
Blumenthal J, Gianella S and colleagues. After 12 weeks of daily FTC/TDF, PrEP concentrations were similar with and without GAHT, and hormone levels weren’t affected by PrEP.
JAC, ARIC and NEJM Evidence
Multidisciplinary ASP in a 24-bed septic surgery unit
Biró A and colleagues, a before–after study in Hungary (2022–23 vs 2023–24). Procurement costs fell 25.1%, mean therapy duration fell from 5.68 to 5.30 days and oral use rose from 20.0% to 28.9%. Glycopeptide-resistant Gram-positive cocci fell 87% and methicillin-resistant staphylococci 74%, alongside stronger barrier precautions. 30-day mortality was 10.0% before and 9.0% after (p = 0.545).
DDDs rose 23% while costs and duration fell. The authors attribute this to an “administrative expansion” in DDD metrics, so read the consumption data with care.
AMS specialist capability framework; SAB AKI right-to-reply
Two letters published online on 26 Oct, with no abstracts. One is a comment on the NHS England AMS specialist capability framework (Abdelsalam-Elshenawy R). The other is a reply by Sinkeler FS, Brüggemann RJ and colleagues on their multicentre study of acute kidney injury in S. aureus bacteraemia.
Domestic measles importations in Washington State, January 2026
Washington DOH and CDC authors describe five importations that led to 26 cases (24 unvaccinated, 2 unknown; none admitted). One index case went to a school and a healthcare facility while infectious, leading to six more cases.
On X
Tuesday light check: two account searches and one post lookup (26 Oct 08:10 to 27 Oct ~07:50 GMT). Each item links to the post we read.
Measles: CIDRAP and NEJM Evidence on the Washington importations report. @CIDRAP › @NEJMEvidence › Pennsylvania at 1,360 cases. @FluTrackers ›
Ebola: CIDRAP on Kenya’s second death. @CIDRAP › Dr Tedros on the Mongbwalu discharges, @DrTedros › on Nigeria’s isolation incentives, @DrTedros › and on meeting MSF about the DRC response. @DrTedros (MSF) › Kenya MoH’s myth-busting and hotline messaging. @MOH_Kenya ›
AMR / stewardship: ESCMID is promoting an onsite AMS and infection control course (part of its AMS Certificate Programme). @ESCMID ›
Outbreaks / zoonoses: H5N1 in Denmark and Germany, FluTrackers › New World screwworm in Texas and New Mexico, FluTrackers › and Yemen cholera supplies. @WHOEMRO › CIDRAP on a US study of flu vaccine uptake in pregnancy. @CIDRAP ›
Unverified: the Pennsylvania total, Ania health centre closure, European H5N1 flock sizes and screwworm counts weren’t checked against primary sources. We found no UKHSA, ECDC or RCPath posts 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 |
|---|---|
| Lead (measles) | The ICHE figures come from the Crossref abstract, not the full text. The Pennsylvania figure of 1,360 is FluTrackers relaying a state DOH announcement; we haven’t seen the DOH release itself. |
| OFID endocarditis | No abstract indexed yet, so we’ve given only the title and authors. We can’t say what the appraisal concludes. |
| Ebola | The Kenya and Nigeria details are from CIDRAP. The DRC totals (9,964 cases, 4,841 deaths) are CDC figures quoted by CIDRAP, and the Ania closure is secondary. There’s been no new WHO DON or situation report. |
| RCPath | The UK SMI B 6 consultation is still listed under “Open consultations” although its end date (26 Oct) has passed. We couldn’t confirm whether it has been extended. |
| Zoonoses | The H5N1 reports (Denmark, Germany, Hong Kong) and the US screwworm counts are FluTrackers relays and weren’t checked against WAHIS or USDA. |
| CDC / ECDC | The CDC HAN archive returned an error page. ECDC’s week 43 CDTR is still not on the archive (latest week 42). |
| Journals | Crossref sweep only, and indexing can lag; Elsevier titles (CMI, JHI, J Infect, IJID, AJIC) often index late. |
Not out yet
- UKHSA: flu/COVmin-2026-10-27-19 surveillance week 44 (Thursday 29 Oct, 14:00); HCAI monthly data (4 Nov); measles (12 Nov); ICU bloodstream infection annual report (26 Nov).
- ECDC: CDTR week 43 (overdue) and week 44 (Friday 30 Oct).
- WHO: the revised Ebola rapid risk assessment; the next DON and AFRO situation report.
- CDC: 2026 AR Threats Report (trailed for this week); MMWR (Thursday 29 Oct).
- AMR: IPEA information sessions on 27 and 29 Oct; ESCMID AMR Action Subcommittee applications close 31 Oct; Africa CDC ministerial Ebola meeting on 28 Oct.
- MHRA: #MedSafetyWeek runs 2–8 Nov.
Sources
What we checked for this issue. Every link in the issue was retrieved and checked during this run.
- Watched pages (9 of 9 checked, 27 Oct ~07:50 GMT)
- Microregistrar moodlecloud Google Sheet (Index tab), read directly through the Sheets connector
- UKHSA, MHRA and DHSC on GOV.UK (search API); Green Book, HCID country risk, Health Protection Report and measles (content API); UKHSA statistics announcements
- RCPath UK SMI consultations, UK SMI and Examinations pages; NICE published guidance
- Mail (microregistrar2021@gmail.com, read only): no infection emails or Mail Sorter forwards in the window
- ECDC: news feed and CDTR archive
- WHO Disease Outbreak News (API)
- CDC: travel notices (unchanged), HAN (error), EID early release
- CIDRAP news articles (Kenya Ebola; Washington measles)
- Journal sweep (Crossref, online 26–27 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; EID and MMWR checked separately
- X (Tuesday light check): two account searches and one post lookup. Live microregistrar.com/newsletter/ checked (26 Oct issue is the current baseline)