Microregistrar Infection Newsletter · Wednesday 28 October 2026
CDC’s 2026 AR Threats Report: 9.7 million drug-resistant infections and 50,800 US deaths a year, with Candida auris top of the urgent list.
CDC released the 2026 update to its Antimicrobial Resistance Threats Report on 27 Oct. As reported by CIDRAP, 19 drug-resistant bacteria and fungi cause an estimated 9.7 million infections and 50,800 deaths in the US each year (2023 data). Infections that commonly occur in hospital patients account for more than 42,000 deaths and over $12 billion in costs. The 2019 report gave 2.8 million infections and 35,000 deaths, but CDC says data sources and methods have changed substantially and the two reports should not be compared directly.
Four pathogens are rated urgent, 13 serious and 2 concerning, with a watch list of six more. C. auris heads the urgent list: 4,523 infections in 2023, a 10-fold rise from 2019. CRE caused 14,878 cases, 67% of them community-onset (some with recent healthcare exposure), and drug-resistant gonorrhoea is also urgent. For UK and EU labs, a same-day Journal of Clinical Microbiology review maps six C. auris clades across 82 countries, with more than 84,000 cumulative cases to December 2025.
Check before quoting: the figures come from CIDRAP’s report on the CDC release; the CDC report pages on cdc.gov returned 403 to our checker, though the AR data portal loaded. Carbapenem-resistant Acinetobacter as the fourth urgent threat, and the C. auris resistance percentages circulating on X, come from secondary posts, not CIDRAP. The report covers the US only; there’s no UK equivalent in the window.
Counted from today’s digest. The Crossref sweep (online 27–28 Oct) found 29 new infection items, 18 of them in JCM; JAMA’s five and NEJM’s one new items weren’t infection-related, and a JAC-AMR correction isn’t counted. Links are unique content links across the issue, not counting our two website links. The four agency items are UKHSA’s updated prisons respiratory illness guidance and Nipah page, MHRA’s Strep A vaccine research and ECDC’s Ebola deployment.
Also today
The other headlines from today’s issue. Each card links to its source and to the full summary.
Acute respiratory illness guidance for prisons and secure estates updated
Added measures on isolation, ventilation, IPC, visiting, contact restrictions and outbreak control in places of detention, plus IPC and outbreak updates for the children and young people secure estate.
DRC outbreak passes 10,000 cases; ECDC sends experts to Nigeria
CIDRAP reports 10,060 cases in the DRC. In Kenya, 20 contacts finished 21 days and 98 remain in quarantine. ECDC still rates the EU/EEA risk as very low.
Antibiotic spectrum days versus days of therapy as C. difficile risk factors
A two-centre Japanese cohort of 3,073 patients (186 CDI) compares DASC with DOT to separate duration from spectrum intensity.
Antenatal STI screening did not reduce preterm birth or low birthweight
Philani Ndiphile trial, South Africa (n = 2,247). Composite outcome 22.9% (once) and 20.6% (twice) vs 23.2% with syndromic care; RRs 0.99 and 0.89, CIs crossing 1.
MHRA research on a needle-free Strep A vaccine
A GMMA-based Strep A carbohydrate vaccine given by the nose or under the tongue produced mucosal and systemic responses in mice (with the GSK Vaccines Institute). Preclinical only.
BBV risk in dialysis unit added to Microregistrar Moodle
“BBV risk in dialysis unit – test and management”, dated 28 Oct, is the new top row in “Whats new?”.
What we could not confirm
The AR Threats Report figures come via CIDRAP; the cdc.gov report pages blocked our checker, and the fourth urgent pathogen (carbapenem-resistant Acinetobacter) is from secondary posts. Ebola totals (10,060 DRC cases) are CIDRAP, and the DRC daily report (96 new confirmed cases, 46 deaths) is FluTrackers relaying the DRC government; there’s no new WHO DON. Journal items are Crossref abstracts only. Avian flu, screwworm, Bangladesh measles deaths and DRC prison cholera are secondary. CDC HAN is still blocked, and ECDC’s week 43 CDTR is still missing.
Microregistrar Moodle update
One new entry. We read the Microregistrar moodlecloud sheet (Index tab, “Whats new?”) directly at about 07:55 GMT. Since the 27 Oct issue, one row dated 28 Oct has been added above the 26 Oct Elizabethkingia entry.
BBV risk in dialysis unit – test and management
The new top row in “Whats new?”. The sheet gives only the title; we haven’t opened the Moodle page itself. Moodle ›
Elizabethkingia
Now the next entry down; we reported it on 27 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 28 Oct 2026 ~07:55 GMT). All nine were reached, and three have something new.
Health Protection Report (UKHSA)
No changeNo new HPR issue; the collection pages still show their May/June 2026 update dates. HPR ›
UK SMI News (RCPath)
NewThe consultations page now says “There are currently no open consultations.” B 6, Investigation of whooping cough (12–26 Oct) is listed as a closed consultation draft, alongside B 63. 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)
NewUpdated acute respiratory illness guidance for prisons and secure estates, a disclaimer added to the Nipah virus biological principles page, and an updated Brucella Reference Unit collection (all 27 Oct). Prisons ARI › · Nipah › · BRU ›
NICE published guidance
No changeTwo technology appraisals were published on 27 Oct (olezarsen TA1203 and plozasiran TA1204, both for familial chylomicronaemia syndrome); neither is infection-related. NICE published ›
Journal of Antimicrobial Chemotherapy
NewThree items (online 27 Oct): cefiderocol against Burkholderia from people with CF, novel triazoles for histoplasmosis, and a viewpoint saying molecular detection is not diagnosis. Cefiderocol › · Histoplasmosis › · Viewpoint ›
Agencies & guidance
UKHSA updated its prisons respiratory illness guidance, MHRA published Strep A vaccine research and ECDC is deploying Ebola experts to Nigeria. WHO DON had nothing new. The main US item is CDC’s AR Threats Report.
Guidance changes
Acute respiratory illness (including flu and COVID-19) in prisons and the children and young people secure estate
UKHSA updated the guidance for prisons and other prescribed places of detention (PPDs) with more on isolation, ventilation, IPC, visiting, contact restrictions and outbreak control. The CYPSE guidance adds IPC and outbreak control considerations, informed by WHO guidance. The previous revision added RSV vaccination and the updated PPD outbreak management guidance. There was no Green Book or MHRA infection guidance change, and the HCID country-specific risk page was last updated on 22 Oct.
For IPC teams covering prisons: check local outbreak plans against the updated isolation and ventilation sections before winter.
UKHSA / MHRA / England
Needle-free Strep A vaccine “within reach”
MHRA scientists, working with the GSK Vaccines Institute for Global Health, used GMMA (outer membrane vesicles) as carrier and adjuvant for the Strep A carbohydrate. Given intranasally or sublingually, it produced mucosal and systemic immune responses in a mouse model (Human Vaccines & Immunotherapeutics, October 2026). There is no licensed Strep A vaccine. MHRA’s October Safety Roundup was also published; we found nothing infection-specific in its listing.
Nipah and Brucella pages updated; data releases ahead
UKHSA added a disclaimer to “Nipah virus (NiV): biological principles” and updated the Brucella Reference Unit collection (27 Oct). Coming up: flu/COVID-19 week 44 report (Thu 29 Oct), HCAI monthly data (4 Nov) and measles (12 Nov; data still at 15 Oct). No in-window Mail Sorter forwards or UKHSA bulletins in the mailbox.
ECDC / Europe
ECDC deploys experts to Nigeria
A team led by ECDC’s senior epidemic intelligence expert went to Nigeria this week to support the EU Delegation in Abuja, with help offered on surveillance, contact tracing, IPC and preparedness. ECDC rates the likelihood of infection for Europeans in affected areas of Kenya and Nigeria as low, and the overall EU/EEA risk as very low. The week 43 CDTR still isn’t on the archive; the latest is week 42.
H5N1 on a laying farm in Groningen
Bird flu was detected at a laying poultry farm in Lutjegast (Westerkwartier). Hong Kong has extended poultry import suspensions to areas of Denmark and the US. ESCMID’s weekly Epi Alert also notes France’s first human Shamonda virus case (ECDC, 22 Oct) and widespread West Nile virus in Europe.
Secondary (FluTrackers relays); not checked against WAHIS.
@FluTrackers (Netherlands) › · @FluTrackers (Hong Kong) › · @ESCMID Epi Alert ›
Global
DRC passes 10,000 cases; Kenya releases 20 more contacts
- DRC (CIDRAP, 27 Oct): 10,060 cases, which CIDRAP calls the fastest-growing Ebola outbreak in history: compared with West Africa 2014–16, it has at least three times the cases and deaths since it was declared on 15 May. The DRC government’s daily report for 25 Oct (via FluTrackers) gives 96 new confirmed cases, 46 new deaths and a CFR of 48.6%. This fits the rise from the 9,964 (CDC via CIDRAP) we reported yesterday: 9,964 + 96 = 10,060. The sources differ, though.
- Kenya: nine cases and two deaths. 20 contacts were released after 21 days and 98 remain in quarantine (20 + 98 = 118, matching the 118 quarantined that we reported yesterday). Africa CDC has praised Kenya’s response.
- Nigeria / Switzerland: ECDC is sending experts to investigate how the Nigerian case was infected. The Swiss government confirmed that the case and a close contact are being treated in Switzerland.
There’s been no new WHO DON since DON622 (23 Oct). The daily DRC figures are a FluTrackers relay of the DRC government report.
CIDRAP › · @FluTrackers (DRC daily) › · @FluTrackers (Switzerland) › · @FluTrackers (Africa CDC) ›
GBD 2023: measles in under-5s up 40% since 2020; pertussis 18.9 million cases
Two Nature Medicine GBD analyses (via CIDRAP). Measles in children under 5 rose about 40% from 2020 to 2023 (15.6 million cases, 118,000 deaths), and about 23.7 million infants missed their first dose. Pertussis caused 18.9 million cases and 115,000 deaths in 2023. Incidence was up 102.6% on 2020, though wide uncertainty intervals and a return to pre-pandemic levels explain much of this.
Cholera in a DRC prison; dengue and measles deaths in South Asia
Nine cholera cases at Walikale Central Prison, North Kivu. Bangladesh dengue deaths reached 400, and press reports put measles-linked child deaths since March at 1,240. Sri Lanka has 81 dengue deaths and Peru nearly 79,000 dengue cases.
All press reports relayed by FluTrackers; not verified.
@FluTrackers (DRC cholera) › · @FluTrackers (Bangladesh) › · @FluTrackers (Sri Lanka) ›
WHO
No new Disease Outbreak News in the window
The latest is still DON622 (Ebola, 23 Oct).
Revised Ebola rapid risk assessment still awaited
We found no revised WHO rapid risk assessment or new AFRO situation report in the window. ECDC’s assessment (23 Oct) remains the latest European risk statement.
CDC / US
19 resistant pathogens: 9.7 million infections and 50,800 deaths a year
- Overall (2023 data): 4 urgent, 13 serious and 2 concerning threats, plus a six-pathogen watch list. Hospital-associated infections account for more than 42,000 deaths and over $12 billion in costs.
- C. auris: 4,523 infections in 2023, 10 times the 2019 number; fatal in 29–62% of cases (Chiller, quoted by CIDRAP).
- CRE: 14,878 cases in 2023, 67% community-onset. A September 2025 CDC study found hospital CRE incidence rose 18% from 2019 to 2023.
- Gonorrhoea: drug-resistant N. gonorrhoeae is also urgent. Secondary posts name carbapenem-resistant Acinetobacter as the fourth.
CDC says 2019 and 2026 estimates aren’t directly comparable (2.8 million to 9.7 million partly reflects new methods and data).
H5N1 in Washington cattle triples; screwworm spreads
Washington State H5N1 dairy herd detections rose from 9 to 27 in a week, all but one in Yakima County (CIDRAP). New World screwworm detections in New Mexico and Texas reached 15 in October. FluTrackers relays USDA: 66 animals infected in the US to date and a ninth human death in Mexico.
CIDRAP › · @FluTrackers (US NWS) › · @FluTrackers (Mexico) ›
Five new EID early-release items; travel notices unchanged
EID posted Oropouche fever in Havana (2024), Mayaro virus in Peru, Yezo virus reservoirs in Hokkaido, animal-contact illness estimates for 7 US pathogens, and canine distemper virus in primates. The CDC travel notice list is unchanged, and the HAN archive was blocked again.
Journals
New since the 27 Oct issue (online 27–28 Oct), from a Crossref sweep of the 19 watched titles. We summarise the most relevant 14 of 29 infection items; the rest are JCM taxonomy updates, correspondence and lab method papers. The other titles had nothing new.
Clinical Infectious Diseases
Antenatal STI screening to reduce preterm birth or low birthweight (Philani Ndiphile)
Medina-Marino A, Babalola C, Mdingi M and colleagues. A three-arm trial in South Africa randomised 2,247 pregnant women before 27 weeks to one-time screening and treatment for chlamydia, gonorrhoea and trichomonas (with test of cure), screening repeated at 30–34 weeks, or syndromic management. Among 1,910 live births, the composite of preterm birth or low birthweight occurred in 22.9% (RR 0.99, 95% CI 0.81–1.21) and 20.6% (RR 0.89, 0.72–1.09) vs 23.2%.
Takeaway: screening didn’t significantly improve birth outcomes in this trial; the case for antenatal STI screening rests on other benefits.
National trends in drug use-associated infective endocarditis, 2016–2022
Christine P, Fabricant S, Appa A and colleagues. An estimated 118,190 US DUA-IE admissions, peaking in 2020 (18,735) and falling to 15,345 in 2022. The opioid-only share fell from 49.4% to 39.9% as stimulant involvement grew. An accompanying editorial discusses the changing epidemiology.
Managing HIV in primary care with Project ECHO
Haddad M, Bifulco L, Ashley K. Describes a tele-mentoring model for HIV care in primary care; no abstract indexed. A reply on mixed models was also published.
Infection Control & Hospital Epidemiology
Days of antibiotic spectrum coverage vs days of therapy as risk factors for CDI
Yagi Y, Maeda M, Mori N and colleagues. A retrospective cohort at two Japanese tertiary hospitals (2016–2024): 3,073 patients tested for CDI after systemic antibiotics, 186 with CDI. It separates length of therapy from combination intensity (DOT/LOT) and models continuous risk with spline curves and propensity matching. The abstract on Crossref was truncated before the main estimates, so we don’t give effect sizes.
Journal of Antimicrobial Chemotherapy
Cefiderocol against Burkholderia cepacia complex and B. gladioli from CF patients
Mojica M, Zeiser E, Becka S and colleagues. 150 US CF isolates were tested by iron-depleted broth microdilution and agar dilution and compared with historical MICs for 16 agents, with blaPenA expression studies.
Posaconazole or isavuconazole for histoplasmosis
Concha Fuentes C and colleagues. Six patients in Barcelona (2017–2022), including people with HIV and CLL, with disseminated, localised and chronic cavitary disease, given posaconazole 300 mg or isavuconazole 200 mg daily, mostly as step-down. Very small case series.
Beyond the panel: molecular detection is not diagnosis
Fihman V, Jacquier H, Razazi K. The authors argue that antibiotic decisions should stay clinical. Sample quality, colonisation, contamination, off-panel pathogens and prior antibiotics all limit how syndromic PCR results can be read, and outcome benefits depend on stewardship integration.
Journal of Clinical Microbiology
Global diversification and regional spread of Candidozyma (Candida) auris clades
Kamau E. A minireview: C. auris has spread to 82 countries, with more than 84,000 cumulative colonisation and infection cases to December 2025, and six clades (I–VI). Clades I and III are the most widespread outbreak lineages. US isolates from 2013–2022 were clade I 56.0%, III 29.4%, IV 14.1% and II 0.5%. Covers the UK and EU/EEA among other regions.
QIAstat-Dx Meningitis/Encephalitis Panel: multicentre evaluation
Farnsworth C, Ren P, González-López J and colleagues. 1,667 CSF samples at 13 sites in Europe and the US, compared with conventional methods including BioFire ME. Pathogens were detected in 7.5% of prospective samples.
Aspergillus ddPCR in breath condensate and BAL in haematological malignancy
Bitterman R and colleagues. A prospective study of 203 patients (26 with probable or proven IA). Exhaled breath condensate ddPCR performed poorly (AUC 0.55).
Updated CDC influenza A(H3) subtyping assay detects subclade K
Shu B and colleagues redesigned the H3 reverse primer after mutations threatened sensitivity. The LoD was about 101.7–102.1 EID50/mL, and performance improved for contemporary viruses.
MeMed BV score to guide blood cultures in the ED
Sundaram M and colleagues looked at whether the TRAIL/IP-10/CRP score can help decide on blood cultures and separate bacterial from viral infection, compared with standard markers and WCC.
JID and OFID
IL-6 blockade with clazakizumab in severe COVID-19
Stoddart L and colleagues. Samples from a pre-vaccine-era RCT show a myeloid activation signature and type 2 cytokine response, which were decoupled in non-survivors.
Preferences for an electronic partner notification system
Mosurkal S and colleagues. Discrete choice experiments among 126 notifiers and 174 recipients (MSM and transgender women) to inform a Massachusetts ePN platform.
On X
Wednesday light check: two searches, one of key accounts and one on AMR, C. auris and UK measles (27 Oct 08:10 to 28 Oct ~07:50 GMT). Each item links to the post we read.
AMR: CDC’s AR Threats Report dominated. CIDRAP, @CIDRAP › ASM, @ASMicrobiology › a stewardship summary, @ABsteward › and a pharmacist’s thread on C. auris resistance (secondary figures). @LordAlirezaF ›
Ebola: CIDRAP quick takes on 10,000+ cases, @CIDRAP › and the DRC daily report relay. @FluTrackers ›
Vaccines: CIDRAP on global pertussis burden, @CIDRAP › rabies PEP completion through community pharmacies (AJIC), @CIDRAP › and the gut microbiome and post-vaccination fever. @CIDRAP ›
UK / Europe: UKHSA’s seasonal tick and Lyme disease awareness post, @UKHSA › and ESCMID’s weekly Epi Alert. @ESCMID ›
Unverified: the C. auris resistance percentages, the fourth urgent pathogen, screwworm and avian flu counts, and the South Asia death tolls weren’t checked against primary sources. We found no UK measles 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 (CDC AR Threats) | The figures come from CIDRAP’s report. The cdc.gov report and press release pages returned 403 to our checker, so we linked the CDC AR data portal instead. CIDRAP names C. auris, CRE and gonorrhoea as urgent; carbapenem-resistant Acinetobacter as the fourth is from secondary posts. |
| Ebola | The 10,060 DRC total is CIDRAP. The DRC daily figures (96 new cases, 46 deaths) are a FluTrackers relay. There’s no new WHO DON or situation report. |
| Journals | Crossref abstracts only, and some were truncated (ICHE CDI). Crossref indexing can lag, and Elsevier titles (CMI, JHI, J Infect, IJID, AJIC) often index late; the AJIC rabies paper was found only through CIDRAP. |
| Zoonoses / outbreaks | H5N1 (Netherlands, US, Hong Kong), screwworm counts, DRC prison cholera and the Bangladesh, Sri Lanka and Peru figures are FluTrackers relays of press or official reports and weren’t verified. |
| CDC / ECDC | The CDC HAN archive returned Access Denied. ECDC’s week 43 CDTR is still not on the archive (latest week 42). MMWR wasn’t checked (next issue Thursday). |
| MHRA | We didn’t open the October Safety Roundup in full; the Strep A vaccine work is preclinical (mouse) and we haven’t read the paper. |
| Mail Sorter / mailbox | No Mail Sorter forwards arrived and the mailbox had no infection bulletins in the window (latest UKHSA syndromic summary 22 Oct). We can’t rule out bulletins sent to other addresses. |
Not out yet
- UKHSA: flu/COVID-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: MMWR (Thursday 29 Oct).
- AMR: IPEA information session on 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, 28 Oct ~07:55 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)
- RCPath UK SMI consultations, UK SMI and Examinations pages; NICE published guidance
- Mail (microregistrar2021@gmail.com, read only) and the bot inbox: 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 (blocked), EID early release, AR Threats data portal
- CIDRAP per-topic feeds (Ebola, measles, avian flu, antimicrobial stewardship, influenza, HAI, COVID-19, pertussis, mpox, C. auris); in-window articles only
- Journal sweep (Crossref, online 27–28 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 (Wednesday light check): two searches. Live microregistrar.com/newsletter/ checked