Microregistrar Infection Newsletter · Friday 23 October 2026
UKHSA adds Nigeria to its HCID country-specific risk list as Nigeria’s minister says the Abuja Ebola patient is improving; the official DRC count passes 9,700 confirmed cases.
At 15:30 BST on 22 Oct UKHSA updated its HCID country-specific risk list (Kenya, Nigeria and the United States) and its Ebola and Marburg case-locations page, where Nigeria is now added. Nigeria is listed for Ebola as “limited local transmission (associated with a case import)”, with an imported case in 2026. In Abuja, health minister Muhammad Ali Pate said on 22 Oct that the patient’s laboratory results show “significant improvement”. That differs from yesterday’s report that she was deteriorating. High-risk contacts are in quarantine, and there’s still no evidence of community transmission. WHO says it wasn’t told of any travel other than to Uganda, and the source of infection is still unknown.
ECDC’s 22 Oct update gives the DRC 9,704 confirmed cases and 4,687 deaths (data to 20 Oct). Kenya still has 9 cases in a single cluster, and on Day 17 it reported no new cases. Elsewhere in the UK, the Green Book hepatitis A chapter and the immunoglobulin handbook were updated for a change in the HNIG product UKHSA issues for community PEP. The chikungunya guidance no longer mentions IXCHIQ. Week 42 Salmonella, norovirus and flu/COVID-19 data were all published in the window.
Check before quoting: the Nigeria patient’s clinical status still conflicts. The minister and WHO say she is improving, against yesterday’s report of deterioration and multi-organ failure. Her travel route is also still disputed: Africa CDC says she didn’t go to DRC, while Uganda’s ministry says she did. There’s no WHO Disease Outbreak News on Nigeria yet.
Counted from today’s digest. The seventeen journal items come from Eurosurveillance (four), CID (five), JAC (three), JAC-AMR (two), OFID (two) and AAC (one). Links are unique content links across the issue, not counting our two website links. The DRC figure is from ECDC (data to 20 Oct). 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. The UK flu/COVID-19 report (week 42 data) was published on 22 Oct at 14:00: flu is stable at baseline (6.3% positivity) and COVID-19 is low (8.9%).
UKHSA adds Nigeria to the HCID list
Kenya, Nigeria and US entries updated 22 Oct 15:30 BST; Nigeria also added to the Ebola case-locations page.
Abuja patient “improving”, says minister
Lab results show “significant improvement”; high-risk contacts in quarantine; no community spread reported.
Press-reported; this conflicts with yesterday’s deterioration reports.
DRC 9,704 cases / 4,687 deaths
ECDC, data to 20 Oct. Kenya: 9 cases, no new cases on Day 17; UKHSA reports 134 of 135 contacts traced.
New HNIG product for hepatitis A PEP
The Green Book chapter and the immunoglobulin handbook were updated on 22 Oct for a change in the UKHSA-issued HNIG product.
We didn’t extract the product name; check the chapter.
First human Shamonda virus infection: fatal encephalitis
A French allogeneic HSCT recipient; SHAV-EU1 was found in CSF. ECDC and WHO are monitoring.
Updated UK OPAT good practice recommendations
Five new recommendations (self-administration, hard-to-reach groups, education, complex oral monitoring, equity) and two amended ones.
What we could not confirm
The Nigeria patient’s condition and travel route still conflict, and the reports are press-based. We couldn’t see what changed in the HCID entry for the United States. We didn’t extract the name of the new HNIG product. The CDC HAN archive, NICE listings and the CDC measles update didn’t load or weren’t updated. Several journal items are title-only.
Microregistrar Moodle update
One new entry. We read the Microregistrar moodlecloud sheet (Index tab, “Whats new?”) directly at about 07:52 BST. The 22 Oct issue reported nothing newer than the two 19 Oct entries.
Interactive: Conjunctivitis
New interactive teaching item on conjunctivitis. This is the sheet entry only; we didn’t open the Moodle page.
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 23 Oct 2026 ~07:55 BST). We checked 7 of the 9; RCPath Examinations and NICE weren’t reached. Three pages have something new: the Green Book (hepatitis A), UKHSA (the HCID update and weekly surveillance) and JAC (OPAT).
Health Protection Report (UKHSA)
No changeThe collection is still dated 6 May 2026.
UK SMI News (RCPath)
No changeThe consultations page still lists only B 6, Investigation of whooping cough, open 12–26 Oct, so it closes on Monday. Consultations ›
RCPath Examinations
Not checkedWe didn’t reach this page in this run (see Gaps).
Green Book
NewHepatitis A chapter updated 22 Oct 11:36 BST for a change in the HNIG product used for community PEP. The collection page itself is unchanged (11 Jun 2025). Hepatitis A chapter ›
UKHSA organisation page (GOV.UK)
NewHCID list and Ebola case locations (Nigeria added), outbreaks under monitoring week 42, flu/COVID-19, Salmonella week 42, norovirus, NOIDs week 42, chikungunya guidance and the immunoglobulin handbook. HCID list ›
NICE published guidance
Not checkedThe listing returned 403 to curl, so we couldn’t check it (see Gaps).
Journal of Antimicrobial Chemotherapy
NewFour items, including the updated UK OPAT good practice recommendations (see Journals).
Journal of Infection
No changeNo new items in the Crossref sweep.
Journal of Hospital Infection
No changeNo new items in the Crossref sweep.
Agencies & guidance
The main developments today are UKHSA’s HCID and Ebola page updates for Nigeria, a change to the hepatitis A HNIG product, and the weekly UK surveillance releases. On Ebola, Nigeria’s patient is reported to be improving and ECDC has new DRC figures. There’s no new MHRA infection alert and no WHO Disease Outbreak News in the window.
Guidance changes
Hepatitis A: change of HNIG product for community post-exposure prophylaxis
UKHSA updated the Green Book hepatitis A chapter (11:36 BST) and the immunoglobulin handbook (“Hepatitis A immunoglobulin”, 12:14 BST) to reflect a change in the human normal immunoglobulin (HNIG) product it procures and issues for community hepatitis A PEP. The chikungunya guidance (13:31 BST) now has IXCHIQ removed from its prevention section, following the MHRA withdrawal on 20 Oct.
Action: before you next issue HNIG for hepatitis A contacts, check the product, dose and route in the updated chapter and handbook. We didn’t extract the details.
- Still open: UK SMI B 6, Investigation of whooping cough (closes 26 Oct), and the UKAP consultation on healthcare workers living with HIV (closes 8 Nov).
Green Book hepatitis A › · Immunoglobulin handbook › · Chikungunya guidance › · UK SMI consultations › · UKAP consultation ›
UKHSA / MHRA / England
HCID country-specific risk list updated for Kenya, Nigeria and the United States (22 Oct 15:30 BST)
Nigeria’s Ebola entry now reads “(b) Limited local transmission (associated with a case import)”, 2014, with an imported case in 2026. Kenya shows the same category for 2026. The Ebola and Marburg case-locations page has updated Kenya details, a new map and footnote, and Nigeria added. The change note doesn’t say what changed for the United States; the entry lists A(H5N1) zoonotic transmission and plague in 2026.
Action: treat travellers from Nigeria (Abuja), Kenya (Nairobi), DRC and Uganda under the VHF risk assessment, and take a full travel, transit and healthcare-exposure history.
Week 42 added: BVD update, a new US A(H5N1) case, Junin and MERS
Data to 20 Oct: DRC 9,552 cases / 4,602 deaths (to 18 Oct), with Wapinda (Nord-Ubangi) the latest affected zone; Kenya 9 cases; Nigeria 1. The new signal is a human A(H5N1) case in Yakima County, Washington, in a person exposed to dairy cattle (mild, isolating). There are also updates on Argentine haemorrhagic fever and MERS-CoV. The risk to the UK population from BVD is assessed as low.
Week 42 data: flu stable at baseline, COVID-19 low
Flu positivity 6.3% (6.2% the week before) and hospitalisations 1.94/100,000 (1.81). COVID-19 positivity 8.9% (8.8%) and hospitalisations 2.64/100,000 (2.48). RSV positivity 0.9%, with admissions at 0.33/100,000 (0.23). Norovirus has decreased slightly but is within expected levels (week 43 report, 09:30).
UKHSA summary › · Flu/COVID-19 reports › · Norovirus reports ›
S. Enteritidis egg-associated clusters: 17 more cases
Data to 20 Oct. t5.9411: 449 (+10; 56 in the past 4 weeks; 78 of 293 admitted; 1 death). t0.24068: 201 (+7). t5.9765: 44 (+0).
NOIDs week 42 out; measles unchanged; no new MHRA infection alert
The notifiable diseases (causative agents) week 42 data was published at 13:01; we didn’t extract figures. Measles is still at the 15 Oct update. MHRA’s only new item in the window is an update to its COVID-19 test validation approved-products list; there’s no new infection-related alert or DSU.
ECDC
DRC 9,704 cases / 4,687 deaths; Kenya 9; Nigeria now included
- DRC data to 20 Oct across eight provinces. Kenya: 9 cases, the last confirmed on 19 Oct and reported on 20 Oct. Nigeria: onset on 7 Oct, care sought on 11 Oct, positive on 20 Oct, with 44 contacts.
- The likelihood of infection for EU/EEA travellers to affected areas is low, and for EU/EEA residents very low.
Also on 22 Oct: ECDC news on the first human Shamonda virus infection (France; see Journals), and a respiratory season briefing. The week 43 CDTR wasn’t published at compile time. Eurosurveillance 31(42) is out (see Journals).
ECDC 22 Oct update › · ECDC Shamonda › · Respiratory season › · CDTR ›
Global — Ebola (Bundibugyo)
Minister says the patient is improving; WHO says it was told of travel to Uganda only (22 Oct)
- Minister Pate (Daily Post, TVC): “laboratory results show significant improvement. There is a possibility that she will recover fully”. High-risk contacts are quarantined in a facility, and there’s no evidence of community transmission.
- WHO (Reuters via CNBC Africa; AFP): she arrived in Abuja on 3 Oct after time in Uganda from 16 Sep. Her biochemical markers are improving. The source of infection is unknown, and the investigation includes which Abuja facilities she visited in the 48 hours before admission. WHO calls the continental outbreak “complex”.
- Africa CDC (Channels, AFP): she is Ugandan-born and based in Abuja, and did not go to DRC. Africa CDC is asking her to disclose any DRC travel or contacts, and is looking at whether she could have had contact at the airport with Kenya’s first case, who also left Uganda on 3 Oct.
Check before quoting: this is press-reported. Her status conflicts with yesterday’s “deteriorated/multi-organ failure” reports, and Uganda’s claim of DRC travel is still unresolved. There’s no WHO DON.
Daily Post › · TVC News › · CNBC Africa (Reuters) › · AFP › · Channels TV ›
DRC: 9,704 confirmed / 4,687 deaths (data to 20 Oct)
- ECDC and the CDC situation summary (as of 21 Oct) agree. The CDC gives a total of 9,735 cases and 4,690 deaths, including Kenya (9/1), Nigeria (1/0), Uganda (20 confirmed + 1 probable) and France (1).
- UN News (22 Oct): the Nigeria patient’s onset was 7 Oct and sequencing is under way. Kenya’s Amoth says 100% of 135 contacts are accounted for.
- Doesn’t add up: a secondary daily briefing (loew-beer.at, 22 Oct) gives 4,649 deaths to 18 Oct, against 4,646 in SitRep 158.
Check before quoting: use the INSP, WHO or ECDC figures. We found no INSP SitRep 159.
Kenya: no new cases; 14 samples negative in 24 h (22 Oct)
All nine cases are in one cluster with no community spread. The ministry says the first contacts will soon return home.
From the Kenya MoH on X (an official account).
WHO
No new Disease Outbreak News
The DON API still has MERS-CoV in Saudi Arabia (15 Oct) as the latest. There’s nothing yet on Nigeria, Kenya or Shamonda. On 22 Oct WHO posted on X that it is in contact with France about the first human Shamonda case.
CDC / US
NTM infections after cosmetic surgery in Mexico (US, Apr–Sep 2025)
This Notes from the Field item came out in the 22 Oct MMWR (18:00 BST); we have the title only.
Takeaway: consider NTM in wound infections after cosmetic surgery abroad.
Ebola situation page updated 22 Oct; travel notices unchanged
The CDC reports no US cases and a low risk. Its DRC Level 4 and Level 3 notices (from August) are unchanged, as are the yellow fever notices for Colombia and Ghana. We saw no Nigeria notice.
HAN archive did not load
Our request was blocked (403), so we couldn’t check for new HAN notices.
Still 4,410 cases (as of 15 Oct)
The page we retrieved is still dated 16 Oct, with 3 deaths. The expected Thursday update wasn’t visible (the page may have been cached).
Ahead of print: Orientia tsutsugamushi isolated from bat-associated chiggers, Japan
Posted 22 Oct at 05:00 BST, just before the window opened; it wasn’t in yesterday’s issue. Title only.
Journals
New since the 22 Oct issue (online 22–23 Oct), from a Crossref sweep of the 19 watched titles plus the Eurosurveillance 31(42) contents page. There were no new infection items for Lancet Infect Dis, Lancet Microbe, NEJM, IJID, J Hosp Infect, J Infect, CMI, ARIC or JCM. ICHE had an erratum only and JID one EBV-LPD paper (not listed). JAMA had a correspondence exchange on COVID-19 antiviral guidelines (not listed).
Eurosurveillance 31(42), 22 Oct
Fatal encephalitis caused by Shamonda virus Europe 1 (SHAV-EU1) in a severely immunocompromised patient, France, 2026
This is the first reported human SHAV-EU1 infection. Encephalitis developed one month after allogeneic HSCT. Metatranscriptomics detected the virus in CSF and RT-PCR confirmed it. CNS biopsies had high viral loads, and the virus was found in serum, respiratory and stool samples for at least two months before the encephalitis began.
Takeaway: consider unbiased metagenomics in encephalitis of unknown cause after transplant, particularly where there are livestock or vector exposures.
West Nile virus repeatedly detected in Aedes caspius during an early season, northern Italy, 2026
WNV lineage 2 was found in six of seven archived Ae. caspius pools from three sites in Lombardy, with >99.94% nucleotide identity to human sequences from the same period.
Gentamicin and antibiotic use in Norwegian hospitals: 35 point-prevalence surveys, 2015–2023
Title only.
Andes virus reaches Europe: clinical challenges, diagnostic gaps and preparedness, 2026
A narrative review; title only.
Journal of Antimicrobial Chemotherapy
Updated UK good practice recommendations for OPAT
The update was based on a systematic review, expert consensus and consultation. There are five new recommendations: self-administration, OPAT in hard-to-reach groups, patient education, monitoring protocols for complex oral antimicrobials and new parenteral routes, and equitable provision. Two are amended: thromboprophylaxis, and early collaboration with vascular access teams.
Takeaway: check your local OPAT SOPs against these, particularly the monitoring of complex oral regimens.
Cutibacterium acnes and dalbavancin: gradient test vs agar dilution
217 isolates (117 from arthroplasty tissue). By agar dilution, dalbavancin MIC50/90 were 0.03/0.06 mg/L, against vancomycin 0.5/0.5. The gradient test gave 0.004/0.008 mg/L. The authors say the gradient test may not be reliable for this combination.
Doesn’t add up: the abstract calls the difference “3-fold”, but 0.03 vs 0.004 mg/L is about 7.5-fold, or roughly three doubling dilutions.
A practical guide to structured data processing for AMR surveillance
A standardised workflow developed using two neonatal infection surveillance databases. Methods paper.
JAC-Antimicrobial Resistance
blaNDM outbreak across UK healthcare sites in Merseyside: multi-species plasmids and K. pneumoniae ST101
A rise in NDM was detected in 2023. The outbreak involved six Enterobacterales species and 28 STs. K. pneumoniae ST101 was the only major clonal expansion (18 of 21 isolates). NDM-1 spread between species on an IncHI2/IncHI2A plasmid (82% of NDM-1 isolates).
Takeaway: plasmid-level surveillance and linked data across trusts are needed when patients move between healthcare systems.
Doesn’t add up: the title says seven healthcare sites but the conclusion says eight healthcare settings.
GP antibiotic prescribing in Belgium, 2014–2023, and GP workforce demographics
Nationwide reimbursement data linked to GP age and sex. We didn’t extract the findings.
Clinical Infectious Diseases
Gonorrhoea: ciprofloxacin resistance-guided therapy, and a strategy to slow ceftriaxone resistance
The ARLG is running a multicentre study of NAATs that predict ciprofloxacin susceptibility from gyrA codon 91, to support FDA submissions; a consensus paper covers diagnostics, regulation, guidelines and reimbursement. A companion piece, “A strategy to slow resistance of gonococci to ceftriaxone”, is title only.
Also in CID
- Geographic differences among tetanus cases in the US, 2009–2023: incidence by jurisdiction ranged from 0 to 0.20 per million.
- Disseminated NTM disease in NEMO and IκBα defects (a review).
- Availability of IV artesunate for severe malaria (title only).
Open Forum Infectious Diseases
Late-onset invasive aspergillosis 22 months after starting acalabrutinib in CLL (two cases)
One proven case (brain abscess and pneumonia) and one probable (brain and lung). Both stopped the BTK inhibitor and one survived.
Takeaway: the IFI risk persists with prolonged BTK-inhibitor therapy, so keep a low threshold for investigating CNS or lung lesions.
Natural immunity to Klebsiella pneumoniae O1 in mothers and infants in Malawi
Anti-O1 IgG and functional immunity were higher in mothers than in their infants. Relevant to maternal vaccine development.
Antimicrobial Agents and Chemotherapy
OSUAB-0284, a preclinical anti-staphylococcal type II topoisomerase inhibitor
Balanced inhibition of gyrase and topoisomerase IV, with an MIC90 of 0.25 µg/mL across 100 clinical S. aureus isolates and a very low resistance frequency. Preclinical only.
On X
A light weekday check: two searches (agency accounts, and AMR/IPC/emerging terms), 22 Oct 08:10 to 23 Oct ~07:50 BST. Individual posts aren’t linked except for official accounts.
Ebola: Kenya’s ministry (@MOH_Kenya) posted its Day 17 update (no new cases, 14 samples negative), symptom-reporting messages (call 719) and anti-stigma messages. NCDC (@NCDCgov) posted an explainer on how Ebola spreads. WHO shared a Bunia survivor-clinic story.
Shamonda: WHO (@WHO) posted about the first documented human Shamonda virus infection, in France. This was the most-engaged infection post in the window.
UK: @UKHSA posted its #UKHSAVirusWatch figures (flu 6.3%, COVID-19 8.9%). AMR/IPC: US local TV widely shared a press-release story on how Candida auris survives antifungal treatment (we didn’t verify the source paper), and JID flagged a commentary on Galleria models and fluconazole for C. auris. International Infection Prevention Week posts ran through the day.
Unverified: the C. auris story wasn’t checked against a primary paper. Official posts are cross-checked in Agencies.
What we could not confirm
We want you to know exactly where today’s issue has limits, so here are the 8 gaps we couldn’t close, plus the reports that simply weren’t out yet.
| Source | Issue |
|---|---|
| Nigeria | The clinical status (“improving” from the minister and WHO, against yesterday’s “deteriorated”) and the DRC travel question (Africa CDC says no, Uganda says yes) are unresolved. Everything is press-reported, and there’s no NCDC situation report or WHO DON. |
| UKHSA HCID | The change note says the United States entry was updated but doesn’t say how. We couldn’t tell what changed. |
| Green Book / HNIG | The hepatitis A chapter and immunoglobulin handbook changes were noted from the change notes only. We didn’t extract the new product name, dose or route. |
| DRC | No INSP SitRep 159 was found. A secondary briefing’s death count (4,649) differs from SitRep 158 (4,646). |
| UK pages | The NICE listing returned 403 and RCPath Examinations wasn’t checked. The NOIDs week 42 and norovirus figures weren’t extracted. |
| CDC | The HAN archive returned 403. The measles page still shows 16 Oct, so the Thursday update wasn’t visible. The MMWR NTM item is title only. |
| Journals | Crossref sweep only, and indexing can lag. Several CID, Eurosurveillance and JAC-AMR items are title-only or weren’t extracted. Two abstracts contain internal inconsistencies (flagged). |
| Mail / X | No Mail Sorter forwards were found in the window. The X check was light, and the C. auris press story wasn’t verified. |
Not out yet
- ECDC: CDTR week 43 (expected 23 Oct).
- WHO / DRC: Disease Outbreak News on Nigeria, Kenya or Shamonda; INSP SitRep 159.
- UKHSA: measles update; any further HCID or NaTHNaC changes.
- CDC: measles update (it may have been cached); any Nigeria travel notice.
Sources
What we checked for this issue. Every link in the issue was retrieved during this run.
- Watched pages (7 of 9 checked, 23 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): HCID country-specific risk list, Ebola/Marburg case locations, outbreaks under monitoring week 42, flu/COVID-19, norovirus, Salmonella week 42, NOIDs, measles, chikungunya, Health Protection Report, UKAP consultation
- Green Book (hepatitis A chapter and collection) and the immunoglobulin handbook
- MHRA (GOV.UK search API); RCPath UK SMI consultations page; NICE (403)
- Mail (microregistrar2021@gmail.com, read only): 7 messages since 22 Oct, including the UKHSA syndromic surveillance summary and ECDC Highlights. No Mail Sorter forwards were found in the window
- ECDC: Ebola page and 22 Oct epidemiological update, news feed (Shamonda, respiratory season), CDTR, Eurosurveillance 31(42)
- Nigeria: Daily Post, TVC News, CNBC Africa (Reuters), AFP, Channels TV; UN News; Kenya MoH on X
- WHO Disease Outbreak News (API); CDC: Ebola situation summary, travel notices, HAN (403), MMWR RSS, measles, EID ahead of print; loew-beer.at secondary briefing
- Journal sweep (Crossref, online 22–23 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: two searches (agency accounts; AMR/IPC/emerging terms)