Microregistrar Infection Newsletter · Friday 30 October 2026
TB notifications in England held level in 2025 at 5,449, but UKHSA says they need to fall further as the deprivation gap widens.
UKHSA’s annual data, published on 29 Oct, show 5,449 TB notifications in England in 2025 (9.26 per 100,000), level with 5,485 in 2024 (9.36 per 100,000). That follows rises from 4,380 in 2022 and 4,831 in 2023. Provisional data for the first three quarters of 2026 suggest notifications are down 8.2% on the same period of 2025.
The pattern hasn’t changed: 82.3% of notifications were in people born outside the UK, and London had the highest rate (20.2 per 100,000). The deprivation gap grew. In the most deprived 10% of areas the rate rose from 14.5 per 100,000 in 2019 to 17.5 in 2024 and 19.4 in 2025, and people there were 6.9 times more likely to be diagnosed than those in the least deprived areas. MDR-TB was 2.1% (2.2% in 2024). A new TB National Action Plan is being developed; until then, the current plan still applies.
Check before quoting: all figures are from the UKHSA press release. We haven’t read the full ‘Tuberculosis in England: 2026 report’, and the 2026 figures are provisional.
Counted from today’s digest. The Crossref sweep (online 29–30 Oct) found 14 infection-relevant items (CID 6, OFID 4, AAC 2, ICHE 1, JCM 1); none of JAMA’s 10 items were infection-related. Links are unique content links across the issue, not counting our two website links. The seven agency items are UKHSA’s annual TB data, the week 43 winter virus surveillance, HPR 20(10), outbreaks under monitoring (week 43), prenatal pertussis vaccine coverage (April to June 2026) and the updated Ebola and Marburg case locations page, plus ECDC’s first preparedness assessments. MHRA’s two recalls in the window weren’t infection-related, and there was no new WHO DON.
Also today
The other headlines from today’s issue. Each card links to its source and to the full summary.
78 cases linked to a Salmonella strain found in Ukrainian eggs
WGS matched S. Enteritidis t5.8998 from one Ukrainian producer’s eggs to 78 confirmed cases (76 England, 2 Wales), dating from Dec 2024 to Sep 2026.
RSV starting to rise; flu and COVID-19 low
Week 43: RSV positivity rose to 1.5% (from 0.9%), with admissions at 0.52 per 100,000. Flu positivity was stable at 6.6%, and COVID-19 fell to 8.3%.
Cyclospora: 135 UK cases linked to travel to Mexico
135 UK cases from 30 Apr to 29 Sep; 92.6% of those with travel data had been to Mexico, mostly the Riviera Maya. Onsets peaked in June and July.
Prenatal pertussis coverage 72.3% for April to June 2026
That’s up 1.1 percentage points on the same quarter last year. Coverage ranged from 65.3% in London to 81.0% in the South West.
UKHSA: 10,060 confirmed cases in DRC; UK risk low
UKHSA’s week 43 outbreaks report (data to 25–26 Oct) counts 10,060 confirmed cases and 4,887 confirmed deaths in the DRC, and 9 cases and 2 deaths in Kenya.
Half of follow-up blood cultures in SAB may be unnecessary
Across 2,499 episodes in three Dutch hospitals, 50.6% of follow-up sets met at least one stewardship criterion, and culturing continued after clearance in 45.3%.
Histoplasma and HSV modules added to Microregistrar Moodle
Three rows dated 29 Oct now top “Whats new?”: Histoplasma, Histoplasma interactive, and Interactive module – HSV.
What we could not confirm
The TB figures come from UKHSA’s press release; we haven’t read the full 2026 TB report. In HPR 20(10), we read the Salmonella, cyclospora, HFMD and norovirus articles but not the MMR or coverage reports. The HPR counts 40 t5.8998 cases in 2026 (England and Wales), whereas the 28 Oct cascade said 36 cases in England in 2026, so the figures don’t match directly. Ebola: there’s no new WHO DON since DON622, and CIDRAP published no new Ebola update in the window. US measles, Morocco diphtheria and avian flu items are FluTrackers relays. CDC HAN is still blocked, and ECDC’s week 43 and 44 CDTRs aren’t on the archive.
Microregistrar Moodle update
Three new entries. We read the Microregistrar moodlecloud sheet (Index tab, “Whats new?”) directly this morning (30 Oct). Since the 29 Oct issue, three rows dated 29 Oct have been added above the 2026 UKHSA flu guideline entry we reported yesterday.
Histoplasma
The new top row in “Whats new?”. The sheet gives only the title; we haven’t opened the Moodle page itself. Moodle ›
Histoplasma interactive
An interactive companion to the Histoplasma entry, listed second. Sheet ›
Interactive module – HSV
Listed third, above yesterday’s flu guideline row. Sheet ›
2026 UKHSA Flu guideline
Now the fourth entry down; we reported it on 29 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 on the morning of 30 Oct 2026). All nine were reached, and three have something new (one of them, NICE, with nothing infection-related).
Health Protection Report (UKHSA)
NewHPR 20(10) published on 29 Oct. It covers Salmonella Enteritidis t5.8998 in Ukrainian eggs, a cyclosporiasis update, rising HFMD in young children, strengthened norovirus surveillance, MMR infection reports, and vaccine coverage (childhood, the MenB young adults programme and maternal pertussis). HPR volume 20 ›
UK SMI News (RCPath)
No changeStill “There are currently no open consultations.” No new UK SMI documents are listed. Consultations ›
RCPath Examinations
No changeUnchanged since yesterday; autumn 2026 FRCPath, Certificate and Diploma applications remain closed. Examinations ›
Green Book
No changeNo chapter changes in the window. Yesterday’s meningococcal chapter 22 update is the latest; the collection page itself is unchanged. Green Book ›
UKHSA organisation page (GOV.UK)
NewNew annual TB data, outbreaks under monitoring week 43 (BVD, CCHF, Shamonda virus), the weekly winter virus surveillance, prenatal pertussis coverage, and the Ebola and Marburg case locations page (Nigeria, map and footnote updated). The HCID country risk page hasn’t changed since 22 Oct. TB › · Ebola locations › · HCID risk ›
NICE published guidance
NewOne new item: TA1205 (maralixibat for cholestatic pruritus in Alagille syndrome, 29 Oct). It isn’t infection-related. NICE published ›
Journal of Antimicrobial Chemotherapy
No changeNo new items in the Crossref sweep (online 29–30 Oct). JAC advance articles ›
Agencies & guidance
UKHSA published annual TB data, HPR 20(10), weekly winter virus surveillance and prenatal pertussis coverage. Its week 43 outbreaks report updates Ebola and CCHF. ECDC reported its first round of preparedness assessments. There was no new WHO DON. In the US, early-season flu hospitalisations are the highest since 2010–11.
Guidance changes
TB in England: level in 2025, falling in 2026, inequalities widening
England had 5,449 TB notifications in 2025 (9.26 per 100,000), compared with 5,485 in 2024 (9.36). Provisional data for the first three quarters of 2026 show an 8.2% fall. 82.3% of cases were in people born outside the UK (82% in 2024), and London’s rate was 20.2 per 100,000. In the most deprived decile the rate was 19.4 per 100,000 (14.5 in 2019), 6.9 times that of the least deprived areas. 2.1% of notifications were MDR-TB (2.2% in 2024). UKHSA is developing a new TB National Action Plan and reminds the public that a productive cough lasting more than three weeks can be TB.
For ID, respiratory and microbiology teams: think of TB in people with a prolonged cough from high-incidence countries and deprived areas, especially while respiratory virus testing dominates winter workups. Keep MDR-TB testing pathways in place (about 1 in 50 notifications).
UKHSA news › · TB in England 2026 report › · Quarterly reports ›
Salmonella Enteritidis t5.8998 in Ukrainian eggs; cyclospora; norovirus typing
Salmonella: UKHSA tested nearly 3,000 imported eggs as part of the S. Enteritidis outbreak investigation (main outbreak strain t5.9411). Three pooled samples from a single Ukrainian producer grew S. Enteritidis, and on 8 Oct WGS confirmed strain t5.8998. That strain isn’t closely related to the outbreak strain but is linked to 78 confirmed human cases (40 in 2026; 76 in England, 2 in Wales; 42% of the England cases in London; median age 30). Only 4% reported travel, and one restaurant outbreak in June involved 6 cases. Cyclospora: 135 cases in UK travellers (81 England, 43 Scotland, 11 Wales) from 30 Apr to 29 Sep and 88 of the 95 with travel information had been to Mexico; onsets peaked in June (49) and July (47). Norovirus: dual typing is now in routine use, and GII.4[P16] is the most common type so far this season. HFMD: GP consultations rose in September, mainly in children aged 1–4.
The 28 Oct cascade (reported yesterday) linked the same egg strain to 36 cases in England in 2026. The HPR’s 40 cases in 2026 covers England and Wales, with data as of 13 Oct, so the two figures aren’t directly comparable.
UKHSA / MHRA / England
RSV rising from baseline; flu and COVID-19 low
For 19–25 Oct: flu positivity 6.6% (6.4% the week before), with hospitalisations 2.47 per 100,000. COVID-19 positivity fell to 8.3% (from 8.8%), with hospitalisations 2.76 per 100,000. RSV positivity rose to 1.5% (from 0.9%), and admissions to 0.52 per 100,000 (from 0.31). Norovirus lab reports were 39.0% below the five-season average, and HNORS outbreak data are unavailable because the system is offline.
Prenatal pertussis coverage, April to June 2026
Coverage was 72.1% in April, 72.4% in May and 72.5% in June: 72.3% for the quarter, 1.1 percentage points higher than a year earlier. Regionally it ranged from 65.3% in London to 81.0% in the South West. HPR 20(10) also reports on the time-limited MenB young adults programme and provisional childhood coverage.
CCHF in Afghanistan and Mauritania; Shamonda virus in France
Afghanistan reported 220 suspected CCHF cases and 5 deaths in September, 15.2% more than August’s 191 cases (220/191 checks). That brings the 2026 total to 1,669 cases and 71 deaths. Mauritania reported a second fatal case in Trarza (UKHSA spells it ‘Traza’). UKHSA added the first documented human Shamonda virus infection (an immunosuppressed patient in Lyon who died; probably midge-borne), which we reported last week, and assesses the UK risk as very low.
No infection-related MHRA alerts; UKHSA syndromic summary
MHRA issued two Class 2 medicines recalls on 29 Oct (lercanidipine and Mynzepli); neither is an anti-infective. The UKHSA syndromic surveillance email (29 Oct, week 43) said most acute respiratory infection indicators were stable. There were no Mail Sorter forwards in the window.
ECDC / Europe
First public health emergency preparedness assessments
ECDC reports that the first cycle of Public Health Emergency Preparedness Assessments (PHEPAs) across Europe found strong commitment to emergency preparedness but several recurring challenges. We read only ECDC’s summary, not the country reports.
CDTR still at week 42; H5N1 trade measures
ECDC’s weekly threats archive still shows week 42 as the latest. FluTrackers relays a Hong Kong CHP suspension of poultry imports from areas of Denmark and the Netherlands because of H5N1.
Secondary (FluTrackers relay); not checked against CHP.
Global
UKHSA week 43: 10,060 confirmed cases in the DRC; UK risk remains low
- DRC (UKHSA, data to 25 Oct): 10,060 confirmed cases and 4,887 confirmed deaths across 66 health zones in 8 provinces. That’s 508 cases and 285 deaths more than the previous UKHSA report. Ituri had 7,211 cases (3,370 deaths), North Kivu 2,309 (1,293) and Haut-Uele 436 (190). Of 482 deaths reported from 6 to 20 Oct, 307 (64%) were in the community.
- Kenya: 9 confirmed cases and 2 deaths as of 26 Oct. Nigeria: 1 case, medically evacuated to Switzerland, with 53 contacts followed up. Uganda’s outbreak ended on 27 Aug (20 cases, 2 deaths). UKHSA updated the Nigeria entry on its case locations page on 29 Oct.
- UK: no imported cases; UKHSA assesses the risk to the UK population as low. Press coverage of Africa CDC’s warning that the outbreak could reach the UK continued, and the Science Media Centre published expert reaction.
- Region (secondary): the Central African Republic has tightened controls at its border with the DRC, and media report thousands of children orphaned in eastern DRC.
UKHSA describes the 10,060 (to 25 Oct) as confirmed cases. Yesterday’s issue cited CIDRAP’s 10,141 confirmed, so the sources and cut-off dates differ. Ituri plus North Kivu plus Haut-Uele = 9,956, and the other five provinces make up the rest. There’s still no new WHO DON since DON622, and CIDRAP published no Ebola update in the window.
UKHSA OUM › · Case locations › · @SMC_London › · @FluTrackers (CAR) ›
Morocco diphtheria; H5N6 in Vietnamese ducks; severe paediatric flu in Hong Kong
Morocco reports 25 suspected diphtheria cases after a child’s death. Vietnam reports H5N6 in ducks. Hong Kong CHP reported a severe paediatric influenza A(H1) case.
Press and government reports relayed by FluTrackers; not verified.
@FluTrackers (Morocco) › · @FluTrackers (Vietnam) › · @FluTrackers (Hong Kong) ›
WHO
No new Disease Outbreak News in the window
The latest is still DON622 (Ebola, 23 Oct).
Tanzania trains frontline staff in Ebola IPC
WHO Tanzania reports Ebola infection prevention and control training for healthcare workers as part of readiness.
CDC / US
Highest mid-October flu hospitalisations since 2010–11
Experts quoted by CIDRAP cite nearly 5,000 lab-confirmed flu hospitalisations in the week ending 17 Oct (CDC data), the highest rate for mid-October since 2010–11. Early cases appear to be driven by an H1N1 variant that the vaccine may only partly match. Separately, CDC’s outlook expects a moderate flu season, a COVID-19 peak similar to or lower than last year, and RSV close to last year’s levels.
Hospitalisation figures are as reported by CIDRAP; we didn’t check them against FluView. The CDC outlook was read only via CDC’s post.
Relevance to the UK: UK flu is still low (6.6% positivity), but an early H1N1-driven season elsewhere supports pushing vaccine uptake before November.
Measles: Kentucky tops 200, Minnesota’s highest in 36 years; H5N1 in Washington cattle
Kentucky’s outbreak has doubled in two weeks to more than 200 confirmed cases, and Minnesota has its highest measles total in 36 years. USDA reports 3 more H5N1 dairy herds in Yakima, Washington, bringing the state total to 30. New World screwworm reached Arizona and was found in a cat in New Mexico for the first time; the US total of 71 is unchanged from yesterday.
Measles and H5N1 figures are FluTrackers relays and weren’t verified.
@FluTrackers (Kentucky) › · @FluTrackers (Minnesota) › · @FluTrackers (H5N1) › · CIDRAP (screwworm) ›
Raw milk use rising; US vaccine policy roundup
A Cornell preprint (via CIDRAP) found that 15% of more than 1,000 US adults surveyed had drunk raw milk in the past six months. CIDRAP’s fortnightly vaccine policy update covers a misused Cleveland Clinic flu vaccine preprint, a personalised melanoma vaccine milestone and a new vaccine injury centre.
No new EID items; travel notices unchanged
EID early release has nothing new since 27 Oct, and the CDC travel notice list is unchanged. The HAN archive was blocked again (Access Denied).
Journals
New since the 29 Oct issue (online 29–30 Oct), from a Crossref sweep of the 19 watched titles. We summarise 10 of the 14 infection items; the rest are a schistosomiasis enteropathy study, a CID editorial, an MAC pharmacokinetic study and a JCM photo quiz. JID, JAC, the Lancet titles, NEJM and the Elsevier titles had nothing new, and none of JAMA’s items were infection-related.
Clinical Infectious Diseases
2023 Duke criteria: more sensitive, but ‘possible IE’ stays at about a third
Stavropoulou E, Padrutt M, Siedentop B and colleagues. A retrospective study at two Swiss university hospitals (2014–2025) of 3,448 suspected IE episodes with guideline-concordant imaging; 1,302 (38%) were adjudicated as IE. ‘Possible’ IE made up 29% (2015 Duke-ESC), 33% (2023 Duke-ISCVID) and 29% (2023 Duke-ESC). Sensitivity rose from 63% to 74% (ISCVID) and 71% (ESC 2023). Specificity fell from 72% to 59% and 66%.
Takeaway: the newer criteria pick up more IE at the cost of specificity. Endocarditis team adjudication is still needed for the grey zone.
Governance framework for LLM-based HAI surveillance
Vicentini C, Ramondetti L, Citta D and colleagues. From an ECDC-funded feasibility project on HA-BSI surveillance in Italian hospitals: a privacy-by-design framework with on-site de-identification and tiered LLM deployment. LLMs extract information only, and a deterministic rule-based algorithm applies the ECDC definitions.
Autochthonous acute Chagas disease in the US
Fu C, Nguyen D, Hamer S and colleagues describe a Texas infant with fulminant myocarditis whose home surroundings had T. cruzi-infected vectors and animals. A companion piece by Reifler K and Hamer D covers acute Chagas from probable oral ingestion, which carries a high risk of severe disease (no abstract available).
Open Forum Infectious Diseases
Follow-up blood cultures in S. aureus bacteraemia often exceed guidance
Van Bommel I, Plantinga N, Van Mourik M and colleagues. Three Dutch hospitals, 2014–2024: 2,499 SAB episodes in 2,400 patients and 21,014 blood culture sets, 12,701 (60.4%) of them during follow-up. 64.0% of follow-up intervals involved daily culturing, culturing continued after clearance in 903 of 1,993 episodes (45.3%), and 6,432 of 12,701 follow-up sets (50.6%) met at least one stewardship criterion.
Takeaway: for most SAB patients, two sets every 2 days until clearance is enough. Intensify only when clinically indicated, for example in endocarditis.
Clindamycin and cefdinir linked to dental infection treatment failure
Harven L, Eid K, Ellena K and colleagues. 12,365 Michigan outpatients: 75.6% received penicillins and 19.1% clindamycin. Of 594 evaluated for failure, it was most common with clindamycin (11.3%). Clindamycin (OR 6.2) and cefdinir (OR 9.9) were independent risk factors. 21.4% of patients given alternatives had no documented allergy.
Only 41% of US flu outpatients got antivirals
Patel P, Serman E, Block J and colleagues (PCORnet, 1.26 million outpatients, 2022–2025). Antivirals were prescribed for 41% overall and 44% of those at higher risk of complications. Delayed care-seeking may contribute.
Infection-associated chronic conditions
A perspective on infection-associated chronic conditions and illnesses (title only; we didn’t read an abstract).
ICHE and AAC
Pathogen-reduction drugs for CRE colonisation: an agent-based model
Singh B, Lutgring J, Wolford H and colleagues (CDC). At baseline there were 27.4 CRE colonisations per 10,000 patient-days. Treating only clinically detected carriers (25% drug effectiveness) cut incidence by 1.2%. With 75% effectiveness plus 100% all-admission screening, it fell by 38.5%. The drug is hypothetical.
Minocycline plus metronidazole for macrolide-resistant M. genitalium
Htaik K, Vodstrcil L, Plummer E and colleagues (Melbourne). A 14-day course cured 80.9% (212/262). Cure rates were similar with doxycycline pre-treatment (82.3%) and without it (77.8%, p=0.387). Cure was higher in cervicovaginal than urethral infection, and it was comparable to moxifloxacin in their setting.
On X
Friday light check: three searches, covering agency accounts, outbreak relays and UK infection topics (29 Oct 08:10 GMT to the morning of 30 Oct). Each item links to the post we read.
UKHSA: the #UKHSAVirusWatch thread on week 43 flu, COVID-19 and RSV positivity, @UKHSA › and a video featuring Ruth McCabe. @UKHSA ›
Raw milk: CIDRAP on rising raw milk consumption. @CIDRAP ›
Ebola: the Science Media Centre collected expert reaction to Africa CDC’s warning that the outbreak could reach the UK. @SMC_London ›
Influenza (US): CIDRAP on the highest mid-October flu hospitalisation rate since 2010–11, @CIDRAP › and CDC’s new epidemic trend website for COVID-19, flu and RSV. @CDCgov ›
IDWeek: CIDRAP’s postcards from IDWeek, where ID specialists say they remain committed to improving care. CIDRAP ›
Unverified: US measles and H5N1 counts, and the Morocco diphtheria and Vietnam H5N6 items weren’t checked against primary sources. We found no ECDC posts in the window, and we left out Ebola conspiracy posts.
What we could not confirm
We want you to know exactly where today’s issue has limits, so here are the 9 gaps we couldn’t close, plus the reports that simply weren’t out yet.
| Source | Issue |
|---|---|
| Lead (TB in England) | All figures are from UKHSA’s press release. We didn’t open the full ‘Tuberculosis in England: 2026 report’ or its data tables, and the 2026 quarter 1–3 fall is provisional. |
| HPR 20(10) | We read the Salmonella, cyclospora, HFMD and norovirus articles, but not the MMR infection report or the childhood and MenB coverage reports. The t5.8998 case counts (40 in 2026, England and Wales, data to 13 Oct) don’t directly match the cascade’s 36 in England in 2026. |
| Ebola | UKHSA’s data run to 25–26 Oct. There’s no new WHO DON or situation report, and we found no CIDRAP Ebola article in the window. The CAR border and orphan items are media reports via FluTrackers. |
| Journals | Crossref abstracts only. The CID oral-ingestion Chagas piece and the OFID perspective have no abstract. JID, JAC and the Elsevier titles (CMI, JHI, J Infect, IJID, AJIC) returned nothing, possibly because of indexing lag. |
| US influenza | The hospitalisation figures are as reported by CIDRAP and weren’t checked against FluView. The CDC outlook was read only through CDC’s X post. |
| Outbreak relays | US measles (Kentucky, Minnesota), H5N1 in Washington cattle, Hong Kong (H1 and import bans), Vietnam H5N6 and Morocco diphtheria are secondary and weren’t verified. |
| CDC / ECDC | The CDC HAN archive returned Access Denied. ECDC’s CDTR archive still shows week 42 (weeks 43 and 44 are missing), and ECDC’s all-items RSS returned a ‘Page not found’ page. We didn’t check the 29 Oct MMWR. |
| ECDC preparedness | We read only the RSS summary of the PHEPA news item; the full ECDC page didn’t render in our fetch. |
| Mail Sorter / mailbox | No Mail Sorter forwards arrived. The only infection email in the window was UKHSA’s week 43 syndromic surveillance summary (29 Oct), filed under UKHSA above. A low-quality X post about Legionella at a Kent flat block was left out as unverifiable. |
Not out yet
- UKHSA: week 45 flu/COVID-19 surveillance report (data to week 44, announced 30 Oct); HCAI monthly data (4 Nov); measles (12 Nov); ICU bloodstream infection annual report (26 Nov). Cold-health alerting starts on 1 Nov.
- ECDC: CDTR weeks 43 and 44 (overdue).
- WHO: the revised Ebola rapid risk assessment; the next DON and AFRO situation report.
- CDC: MMWR of 29 Oct not checked; the Ebola travel attestation starts on 3 Nov.
- AMR: ESCMID AMR Action Subcommittee applications close on 31 Oct; Faculty of Public Health AMR leadership webinar on 23 Nov.
- 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 on the morning of 30 Oct)
- 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, outbreaks under monitoring, TB, winter surveillance, prenatal pertussis and Ebola case locations (content API)
- RCPath UK SMI consultations, UK SMI and Examinations pages; NICE published guidance
- Mail (microregistrar2021@gmail.com, read only): UKHSA syndromic surveillance summary of 29 Oct; no Mail Sorter forwards in the window
- ECDC: news feed and CDTR archive
- WHO Disease Outbreak News (API)
- CDC: travel notices (unchanged), HAN (blocked), EID early release (nothing new)
- CIDRAP per-topic feeds (Ebola, measles, avian flu, antimicrobial stewardship, influenza, HAI, COVID-19, pertussis, mpox, C. auris) and the CIDRAP front page; in-window articles only
- Journal sweep (Crossref, online 29–30 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 checked separately
- X (Friday light check): three searches