Microregistrar Infection Newsletter · Thursday 5 November 2026
Maternal Tdap linked to lower infant anti-PCV antibodies for most serotypes — but no carriage data yet.
UKHSA published a rapid systematic review on 4 Nov (09:30 GMT) on the effect of maternal pertussis vaccination on pneumococcal carriage in infants. Seven studies met inclusion (search to 4 June 2026). An IPD meta-analysis of PCV13-vaccinated infants (n between 565 and 613 across four studies) found significantly lower anti-PCV antibody after maternal Tdap versus no maternal Tdap for 12 of 13 vaccine serotypes, and significantly fewer infants reached the ≥0.35 µg/mL threshold for 5 of 13 serotypes (5, 6B, 9V, 19A, 23F).
No included study reported nasopharyngeal carriage of vaccine or non-vaccine serotypes, so the title question is unanswered by direct evidence. Certainty was mostly low to very low (GRADE). The review follows yesterday’s Green Book chapter 25 revision (Down syndrome risk group; PPV23-to-PCV20 switch) and matters for how maternal Tdap and infant PCV schedules interact.
Check before quoting: figures are from the UKHSA PDF main messages. Evidence is limited to PCV10/PCV13 and heterogeneous schedules; the authors say firm conclusions are difficult. Ebola was eligible to lead (last Ebola lead 24 Oct) but there was no new primary Ebola tally in the window.
Counted from today’s digest. The 5 agency/outbreak items are the maternal Tdap review, HCAI monthly to September 2026, Brigg H5N1 (AIV 2026/23), ECDC EU Reference Laboratories news, and the Pennsylvania measles-associated death (PA DOH primary; CIDRAP secondary). MHRA’s FSN list and the CMO annual report aren’t counted as infection guidance. Journal Watch is interim (4 medRxiv preprints) because PubMed was down at the Journal Watch deadline.
Also today
The other headlines from today’s issue. Each card links to its source and to the full summary.
Klebsiella bacteraemia up 9.7% in September; HOHA up 22.8%
UKHSA’s monthly mandatory data for September 2026: 1,395 Klebsiella spp. bacteraemias (+9.7% vs September previous year); hospital-onset healthcare-associated cases 420 (+22.8%). CDI overall 1,572 (+5.5%). UKHSA is consulting on stopping the monthly commentary.
Pennsylvania confirms sixth measles-associated death
An unvaccinated Jefferson County resident died — the county’s second. PA DOH: 1,467 confirmed cases in 45 counties; Franklin County coroner case still not confirmed as measles-associated.
HPAI H5N1 confirmed near Brigg, North Lincolnshire
AIV 2026/23 on a commercial poultry premises (4 Nov). 3 km protection and 10 km surveillance zones; flock to be culled. England season H5N1 count now 2.
>1 in 4 US adults report misrepresenting symptoms for antibiotics
CIDRAP on two JAMA Network Open surveys: 28% of 959 adults and 27% of 236 caregivers said they had exaggerated or invented symptoms to obtain antibiotics.
Metformin within 6 days of COVID linked to 53% less long COVID/death
Observational target-trial emulation (n=248 vs 248); weighted incidence 4.0% vs 8.5%. Authors call for trial replication (via CIDRAP).
S. capitis/NRCS-A and S. saprophyticus added 4 Nov
Two new “Whats new?” rows on the Moodle sheet, displacing the 31 Oct diphtheria interactive from the top.
What we could not confirm
The lead rests on the UKHSA PDF main messages; we didn’t re-extract every GRADE table. PA measles deaths: DOH confirms 6; Franklin County coroner case is not in that tally. CDC’s last cited national death count (via CIDRAP, data to 30 Oct) was 3 and lags states. No new WHO DON (still DON622). ECDC CDTR still week 42. CDC HAN remains blocked. Journal Watch is interim — only 4 medRxiv preprints, PubMed/Europe PMC down at their deadline. A FluTrackers claim of a British healthcare worker with Ebola evacuated to the UK is unverified and not used as fact.
Microregistrar Moodle update
Read from the MoodleCloud Google Sheet Index tab (“Whats new?” column) on the morning of 5 Nov. Two entries dated 4/11/2026 are new since yesterday’s issue.
Staphylococcus capitis and NRCS-A
Top row in “Whats new?”. Neonatal ICU clone / NRCS-A teaching resource (title as on the sheet). Moodle › · Sheet ›
Staphylococcus saprophyticus
C. diphtheriae & C. ulcerans Interactive
Still listed; we reported it on 1 Nov. Now below the two 4 Nov entries. Moodle ›
Greenbook vaccine part 1 revision
Unchanged since yesterday. Moodle ›
Watched pages
Nine standing pages checked on the morning of 5 Nov. Two showed a material infection update inside the window (HCAI monthly landing/trends; bird-flu England situation). Green Book pneumococcal was yesterday’s lead and is unchanged today.
HCAI monthly data: September 2025–September 2026 tables and trends bulletin first published 4 Nov 09:30 GMT. Landing › · Trends ›
Bird flu (England): Brigg AIV 2026/23 added; page updated 4 Nov 19:59 GMT. Situation › · Brigg case ›
Green Book collection / ch25: no further change after 3 Nov 08:37 GMT (yesterday’s lead). Collection › · Chapter 25 ›
HCID country risk: still last changed 22 Oct (Kenya, Nigeria, United States). HCID ›
UK SMI consultations: B 6 (whooping cough) listed closed (12–26 Oct); no new open consultation. Consultations ›
UK SMI / Examinations / NICE published guidance: no new infection SMI, exam notice or ID/AMS/IPC NICE guideline spotted in the window. UK SMI › · Exams › · NICE ›
Measles collection / HPR vol 20: no new England epi or HPR issue in the window. Measles › · HPR ›
Flu/COVID surveillance: latest published still week 44 (29 Oct); week 45 announced for 5 Nov 14:00. Collection › · Week 45 announcement ›
Agencies & guidance
UKHSA, MHRA, DEFRA/APHA, ECDC, WHO, CDC and CIDRAP items inside the window. Each card links to the primary page we used.
UKHSA / England
Maternal pertussis vaccination and infant pneumococcal responses: rapid systematic review
Published 4 Nov 2026 09:30 GMT. Seven studies; IPD meta-analysis of PCV13 infants (n 565–613) found lower anti-PCV antibody for 12/13 serotypes after maternal Tdap, and fewer infants at ≥0.35 µg/mL for 5/13 serotypes. No study reported carriage. Certainty mostly low–very low.
PDF main messages also note evidence limited to PCV10/PCV13 and heterogeneous schedules.
Mandatory HCAI monthly data: September 2026
Overall vs same month previous year: E. coli 3,837 (−0.7%); Klebsiella spp. 1,395 (+9.7%), HOHA 420 (+22.8%); P. aeruginosa 413 (−9.8%); MRSA 94 (+5.6%), COHA 13 vs 8 (+62.5% — small n); MSSA 1,148 (+3.9%); CDI 1,572 (+5.5%), COCA 480 (+15.1%).
UKHSA invites feedback on a proposal to stop the monthly commentary while keeping the tables.
Bird flu near Brigg, North Lincolnshire (AIV 2026/23)
Confirmed 4 Nov: HPAI H5N1 on commercial poultry near Brigg. 3 km protection and 10 km surveillance zones; poultry to be culled. England 2026–27 season H5N1 count on the situation page: 2 (plus Scotland H5N1 1). UK no longer free from HPAI under WOAH rules.
Field Safety Notices 26–30 October 2026 (listed 4 Nov)
Routine FSN round-up published for information. Includes Beckman Coulter Access HIV Ag/Ab Combo Calibrator (manufacturer FSN dated 23 Oct). No new infection medicine safety alert in the window.
ECDC
EU Reference Laboratories for Public Health — European Laboratory Day
News item 5 Nov 07:51 GMT (08:51 CET). Marks European Laboratory Day; emphasises EURL-PH roles in reference diagnostics, EQA, training and outbreak support, citing recent Ebola and Andes virus/hantavirus examples. No new case counts. Companion guide published the same day.
CDTR archive still week 42 (10–16 October)
Weeks 43 and 44 remain missing from the weekly threats archive — same gap as yesterday.
WHO / global outbreaks
No new Disease Outbreak News (still DON622, 23 Oct)
API top item remains Bundibugyo Ebola in DRC, Kenya and Nigeria. No revised rapid risk assessment retrieved in this window.
PA DOH confirms sixth measles-associated death
Unvaccinated Jefferson County resident; county’s second measles-associated death. Statewide: 1,467 confirmed cases in 45 counties, 283 hospitalisations, 34 newly confirmed since 2 Nov. Deaths by county: Jefferson 2, Lancaster 3, Mifflin 1. Franklin County coroner case not confirmed by DOH.
CIDRAP (secondary)
Symptom misrepresentation to obtain antibiotics
Two JAMA Network Open surveys: 28% of 959 adults and 27% of 236 caregivers reported ever exaggerating or inventing symptoms to get antibiotics. Younger respondents and those who feel clinicians dismiss symptoms were more likely; few regretted it.
Metformin soon after COVID and long COVID/death
Target-trial emulation: metformin within 6 days of diagnosis associated with 53% relative reduction in long COVID or death over 6 months (weighted incidence 4.0% vs 8.5%; n=248 per arm). Observational; authors want trial confirmation.
Journals
New since the 4 Nov issue: our picks from a Crossref sweep of the watched titles (online 4–5 Nov) and EID ahead-of-print dated 4 Nov, followed by today’s interim Journal Watch file (4 medRxiv preprints — PubMed and Europe PMC were down at their deadline). Lancet Infect Dis, Lancet Microbe, NEJM, CID, IJID, AJIC, J Hosp Infect, J Infect, CMI, AAC and Eurosurveillance had nothing new matching infection filters in Crossref for the window; JAMA had no infection items. Yesterday’s CHG bathing ICHE paper is not repeated.
Our picks
Probenecid plus beta-lactams for skin and soft tissue infection: systematic review
Nine studies. Reviews whether probenecid-boosted oral beta-lactams could spare IV therapy, or allow less frequent narrow-spectrum IV dosing (e.g. cefazolin) in ambulatory SSTI. Abstract notes up to 50% of hospital SSTI presentations have already failed oral therapy.
International AMS improvement programme in hospitals serving deprived populations
Mixed-methods evaluation of the Antimicrobial Stewardship Disparities Programme across six centres (Botswana, Kenya, Lebanon, Mexico, Pakistan, USA), mapped to GAMSAS accreditation standards.
PK/PD strategies to optimise antifungal therapy and limit resistance
Review of triazoles, polyenes, echinocandins and flucytosine PK/PD indices, resistance mechanisms (including C. auris) and how exposure targets may improve efficacy.
Expanding NHSN CPT codes improves capture of paediatric cardiac procedures
Adding 62 paediatric CPT codes raised validation-period sensitivity for Society of Thoracic Surgeons index procedures from 77.0% to 97.4%.
Infection control link nurses in nursing homes: multimethod study
How link-nurse roles are enacted in nursing-home IPC programmes (title/Crossref; abstract not returned by Crossref for this DOI).
Isoniazid-resistant tuberculosis: a forgotten diagnostic and treatment need
Commentary/perspective title from Crossref; no abstract in the API response.
Early remdesivir in immunocompromised patients hospitalised with COVID-19
Target-trial emulation (~400 US hospitals). Assesses whether remdesivir within 2 days of admission reduces 14- and 28-day in-hospital mortality vs later or never, in immunocompromised patients aged ≥12 years (May 2020–Dec 2023).
Invasive candidiasis across six Mexican tertiary hospitals, 2021–2024
574 IC episodes; non-albicans 64.5%. Bayesian WISCA used to estimate empiric regimen coverage; 30-day mortality primary outcome.
Sputum vs oropharyngeal swab for viruses in non-COVID CAP
Among 229 hospitalised adults with paired specimens, multiplex PCR detected respiratory viruses in 65% of sputum vs 39% of oropharyngeal swabs.
CSP malaria vaccine (FMP013/ALFQ): antibody quality and protection
Phase 1 challenge trial (n=29 malaria-naïve adults) of nearly full-length soluble P. falciparum CSP in ALFQ; protection associated with antibody quality across standard, delayed and delayed-fractional schedules.
EID ahead of print (4 Nov)
Monkeypox virus seroprevalence among adults, Kenya roadside clinics, 2025
Early-release title; AoP dated 4 Nov 2026.
Livestock-associated MSSA bacteraemia, Denmark, 2007–2023
Early-release title; AoP dated 4 Nov 2026.
Indirect healthcare-associated canine sporotrichosis (S. brasiliensis), Argentina
Early-release title; AoP dated 4 Nov 2026.
Serologic evidence of avian influenza virus exposure in livestock, Egypt, 2024–2026
Early-release title; AoP dated 4 Nov 2026.
Journal Watch top 10
Credited to Microregistrar Journal Watch (interim file of 5 Nov 2026). PubMed E-utilities returned HTTP 500 and Europe PMC HTTP 503 at their 06:45 deadline, so only four medRxiv infectious-disease preprints first posted 4 Nov were saved. Preprints are not peer reviewed. Notes restate abstracts; this isn’t clinical advice. None of these DOIs appear in recent issues. Coverage gap: full top 10 missing until PubMed recovers.
Cross-reactive antibody and T-cell responses to Bundibugyo after Zaire ebolavirus vaccination/infection
Licensed ZEBOV vaccine recipients and Ebola survivors showed Bundibugyo-cross-reactive T-cell and binding-antibody responses; strongest in survivors (authors).
Preprint › · via Journal Watch
Single-reaction pan-lineage Lassa RT-PCR accuracy in two Nigerian laboratories
Against RealStar two-reaction kit in 300 plasma samples: PANDAA LASV 98.6% sensitivity, 99.4% specificity, 99.0% accuracy; three discords at high Ct.
Preprint › · via Journal Watch
Multilevel framework for RSV monoclonal antibodies in daycare and households
US-informed simulation: infant RSV mAb gives only modest indirect protection to toddlers, depending on contacts and coverage.
Preprint › · via Journal Watch
VaccineScout: guiding composition and valency of SARS-CoV-2 vaccine updates
Analysed >14 million genomes (2021–2025); supports annual updates; tool’s strain picks matched FDA choices or tracked closer to future variants (authors).
Preprint › · via Journal Watch
On X
Thursday light check: agency and society accounts (UKHSA, ECDC, WHO, WHO/AFRO, CDC, MHRA, CIDRAP, IDSA, ESCMID) and FluTrackers posts on Ebola, H5N1, measles, mpox and related pathogens, from 4 Nov 08:10 GMT to this morning. Each item links to the post we read.
Agencies and societies
WHO: Bundibugyo Ebola toll and vaccine/treatment support @WHO ›; media briefing with Tedros @WHO ›; >10,000 cases / 5,000 deaths in DRC with new hotspots @WHO ›; Ervebo trial plus recommendation to add Bundibugyo-specific candidates @WHO ›; influenza and COVID-19 protection for health workers @WHO ›
WHO/AFRO: expert groups recommend adding ChAdOx1 and Moderna mRNA-1469 to the Tumaini Ebola trial. @WHOAFRO ›
CIDRAP: Pennsylvania measles death @CIDRAP ›; metformin / long COVID @CIDRAP ›; antibiotic symptom misrepresentation @CIDRAP ›; Osterholm Update preview @CIDRAP ›
ESCMID: WAAW webinar Part 2 today 16:00 CET. @ESCMID ›
No posts from UKHSA, ECDC, CDC or MHRA in the light-search window.
Outbreaks (relays)
Ebola: FluTrackers relay of a British healthcare worker evacuated from DRC to the UK @FluTrackers › — unverified; we found no UKHSA/NHS/WHO confirmation in this run. North Kivu school cases and Bas-Uélé relays also unverified.
H5N1: Washington cattle B3.13 @FluTrackers ›; California backyard flock @FluTrackers ›; Germany/Austria WOAH relays — all unverified here.
Unverified: FluTrackers items were not checked against primary government sources in this light run, apart from stories we already have from PA DOH, DEFRA/APHA or CIDRAP.
What we could not confirm
We want you to know exactly where today’s issue has limits, so here are the 13 gaps we couldn’t close, plus the reports that weren’t out yet.
| Source | Issue |
|---|---|
| Lead (maternal Tdap review) | Taken from the UKHSA PDF main messages and GOV.UK landing page. We didn’t re-audit every GRADE table or Annexe. No carriage outcomes in the included studies. |
| HCAI monthly | September 2026 figures from the trends bulletin. MRSA COHA +62.5% is on small counts (13 vs 8). Commentary-stop survey is open; we didn’t analyse the ODS tables cell-by-cell. |
| Measles (US) | PA DOH confirms 6 associated deaths; Franklin County coroner case excluded. CDC national death tally last cited via CIDRAP (data to 30 Oct) was 3 and lags states. US case total 4,852 is as of 30 Oct. |
| Ebola | No new WHO DON or CIDRAP dedicated Ebola article in the window. Yesterday’s CFR inconsistency (51.6% vs 51.5% vs earlier 48.8%) is unresolved. FluTrackers UK HCW evacuation claim is unverified. |
| H5N1 | Brigg is primary DEFRA/APHA. US/EU FluTrackers avian items are relays. |
| Journal Watch | Interim only: 4 medRxiv preprints. PubMed HTTP 500 and Europe PMC HTTP 503 at the Journal Watch deadline; full top 10 missing. Preprints are not peer reviewed. |
| Journals | Based on Crossref abstracts/titles. ARIC and JCM items had empty abstracts. EID notes are title-only. OUP/ASM/Elsevier pages often 403 to automated fetches; DOIs were confirmed via Crossref. |
| X (light) | Thursday light check (2 searches). Relay accounts are secondary. |
| CDC | HAN archive Access Denied again. No new November-dated infection travel notice spotted. |
| ECDC | CDTR still week 42; weeks 43–44 missing. ecdc_all.rss returned HTML. |
| WHO | No new DON since DON622 (23 Oct). |
| Mail Sorter | No Mail Sorter forwards in the window. UKHSA GovDelivery cascade and Global Hazards bulletin arrived; cascade items used only where primary GOV.UK pages confirmed them. |
| Watched pages | Quick check; NICE/RCPath showed no new infection guidance. Green Book unchanged after yesterday. |
Not out yet
- UKHSA: week 45 flu/COVID-19 report (announced for 5 Nov 14:00) announcement ›; HCAI monthly data to October 2026 announcement ›; outbreaks-under-monitoring beyond week 43 collection ›; next England measles epi update.
- ECDC: CDTR weeks 43 and 44 (overdue).
- WHO: next DON; revised Ebola rapid risk assessment; AFRO situation report.
- CDC: HAN (blocked to us); statements on California clade I mpox and reconciled measles deaths.
- Journal Watch: full top 10 once PubMed recovers (interim file has 4 preprints only).
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 5 Nov)
- Microregistrar moodlecloud Google Sheet (Index tab), read directly through the Sheets connector
- UKHSA, MHRA, DHSC and DEFRA/APHA on GOV.UK (search API and content API); HCAI trends bulletin; maternal Tdap rapid review PDF; bird-flu situation and Brigg case page; HCID country risk; Health Protection Report; measles and Green Book pages
- RCPath UK SMI consultations, UK SMI and Examinations pages; NICE published guidance
- Mail (microregistrar2021@gmail.com, read only): no Mail Sorter forwards; UKHSA stakeholder cascade and Global Hazards Weekly Bulletin (4 Nov)
- ECDC: news feed (EU Reference Laboratories) and CDTR archive
- WHO Disease Outbreak News (API)
- CDC: travel notices, HAN (blocked), EID ahead-of-print RSS (4 new on 4 Nov)
- Pennsylvania Department of Health measles newsroom (primary for PA death count)
- CIDRAP per-topic feeds (Ebola, measles, avian flu, antimicrobial stewardship, influenza, HAI, COVID-19, pertussis, mpox, C. auris): 3 in-window items (measles, metformin, antibiotic surveys)
- Journal sweep (Crossref, online 4–5 Nov): 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
- Microregistrar Journal Watch interim top file, 5 Nov 2026 (4 medRxiv preprints)
- X (Thursday light check): searches over 4–5 Nov