June '26 Infectious Diseases Update

Article of the Month (Editors' Choice) 

Person-to-Person Transmission of Hantavirus

By Kami Kim, M.D.

• In May 2026, a cluster of severe acute respiratory infections (SARI) in passengers on a cruise ship originating in Argentina was reported. The first symptomatic patient became ill two days after the ship left port, and to date 10 cases have been documented with 3 deaths. Genome sequencing of clinical samples have confirmed presence of Andes orthohantavirus (ANDV). A single zoonotic exposure followed by person-to-person spread is suspected.
• Martinez et al. (N Engl J Med 2020;383:2230) published a molecular epidemiological study of person-to-person transmission of ANDV in Chubut Province, Argentina in 2018-19 involving 34 confirmed infections and 11 deaths.
• ANDV is the only hantavirus known to be transmitted person-to-person, albeit in a low proportion of cases (Lancet Infect Dis 2024;24:775). Most hantavirus infections are acquired by inhalation of rodent saliva, urine or feces. Viral genome sequence analysis of isolates from the 2018-19 outbreak showed a high degree of sequence conservation consistent with a single introduction from a zoonotic rodent reservoir.
• In the 2018-19 outbreak described by Martinez et al., three symptomatic individuals acted as “super-spreaders” at crowded social events and were responsible for transmission of 21 of 33 secondary cases (64%).
• Transmission was ascribed to inhalation of droplets or aerosolized virions. Mean interval from symptom onset in a primary case to symptom onset in a secondary case was 23 ±7 days with an incubation period of 9-40 days.
• High viral titers, compromised liver function, and thrombocytopenia in combination with attendance at social gatherings or extensive close contact were associated with a higher likelihood of transmission.

Antimicrobial Stewardship

• Knowledge and Skills for Stewardship
  • The Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and the Society of Infectious Diseases pharmacists have released updated recommendations for the knowledge and skills needed to lead antimicrobial stewardship (AMS) programs.
  • The document provides suggestions and priorities for basic, intermediate, and advanced skills for leaders in acute care, outpatient, and long-term care settings. Knowledge and skills are further broken down into clinical infectious diseases, interventions, and program building and leadership.
  • AMS teams are encouraged to partner with other hospital programs such as infection prevention and control and/or microbiology to share resources and collaborate on performance measures. AMS programs may encounter barriers, and strategies for overcoming these barriers are provided.
  • AMS leaders could consider using the gap analysis tool from the supplementary materials to identify opportunities based on current program structure and future goals. Antimicrob Steward Healthc Epidemiol. 2026 May 11;6(1):e130. doi:
    10.1017/ash.2026.10344.
    

New Drug Approvals

• Bulevirtide-gmod (Hepcludex): for treatment of chronic hepatitis D virus (HDV) infection in adults without cirrhosis or with compensated cirrhosis. Bulevirtide is a synthetic 47-amino acid lipopeptide that inhibits HDV infection by binding to the HDV receptor sodium taurocholate co-transporting polypeptide (NTCP) on the plasma membrane of hepatocytes, blocking HDV attachment to NTCP. The usual dose is 8.5 mg administered subcutaneously once daily.
• Cefepime-zidebactam (Zaynich): for treatment of adults with complicated UTI, including pyelonephritis, caused by susceptible strains of E. coli, K. pneumoniae, P. mirabilis, E. cloacae complex, and P. aeruginosa. Cefepime-zidebactam is the combination of cefepime, a 4th-generation cephalosporin, and zidebactam, a beta-lactamase inhibitor and non-beta-lactam antibacterial. It demonstrates in vitro activity against Enterobacterales isolates confirmed to contain Ambler Class A (e.g., KPCs), Class B (e.g., NDM, VIM, IMP), Class C (e.g., CMY), and Class D (e.g., OXA-48-like) beta-lactamases. The usual dose is 3 gm IV (over 1 hr) q8h. Doses are expressed as the sum of cefepime and zidebactam (2:1 ratio).
• Ensitrelvir (Xocova): for post-exposure prophylaxis (PEP) of COVID-19 in adults and adolescents ≥12 years of age following contact with an individual who has COVID-19. Ensitrelvir is an inhibitor of the SARS-CoV-2 main protease (M^pro), also referred to as 3C-like protease (3CL^pro) or nonstructural protein 5 (nsp5) protease. The usual dose, beginning ASAP and within 72 hours following contact with an infected individual, is 375 mg po on day 1 followed by 125 mg q24h on days 2-5. Ensiltrevir is a substrate and inhibitor of CYP3A and multiple transporters, so drug interactions are an issue. It is available in 125 mg tablets.

New or Updated Guidelines

• British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal infection: 2025 update (Lancet Infect Dis 2026;26:e217). This is an update of the 2015 best practice guidance.
• The Fifth Mexican consensus on the diagnosis and treatment of Helicobacter pylori infection (Rev Gastroenterol Mex [Engl Ed] 2026;91:89). This is an update of the 2018 consensus. PDF available.
• British Association of Sexual Health and HIV (BASHH) national guideline on the management of non-gonococcal urethritis (NGU), 2026 (Int J STD AIDS 2026;37:690). This is an update of the 2015/2018 guideline. PDF available.

Antimicrobial Shortages (US)

• New shortages:
  • None
• Resolved shortages:
  • Nitrofurantoin oral suspension (20 May 2026)
  • Penicillin VK, all oral formulations (8 May 2026)
• Antimicrobial drugs recently discontinued: 
  • None
• Antimicrobial drugs or vaccines in continued reduced supply or unavailable due to increased demand, manufacturing delays, product discontinuation by a specific manufacturer, or unspecified reasons: 
  • Antibacterial drugs:
    • Aminoglycosides:
      
      • Gentamicin injection (22 Feb 2021)
    • Cephalosporins:
      • Cefazolin injection (4 Jun 2018)
      • Cefotaxime injection (10 Jun 2015)
        
        • FDA is allowing temporary importation of product from SteriMax in Canada, in conjunction with Provepharm Life Solutions and its distributor Direct Success.
    • Fluoroquinolones:
      
      • Levofloxacin injection in D5W (29 May 2024)
      • Levofloxacin oral solution, 25 mg/mL (15 Sep 2023)
      • Moxifloxacin injection (13 Jan 2026)
      • Moxifloxacin 400 mg tablets (6 Dec 2023)
    • Glycopeptides, glycolipopeptides, lipopeptides:
      
      • Vancomycin injection (1 Jun 2015)
    • Lincosamides:
      • Clindamycin phosphate injection (25 Jun 2015)
    • Macrolides, azalides:
      • Azithromycin injection (6 Jan 2026)
      • Azithromycin oral suspension, 1 gm packets (20 Nov 2024)
      • Erythromycin lactobionate injection (21 Apr 2025)
    • Miscellaneous
      • Bacitracin ophthalmic ointment 500 units/gm (12 Sep 2024)
      • Benzylpenicilloyl polylysine [Pre-pen] (19 Mar 2026)
      • Chloramphenicol injection (9 Oct 2023)
      • Neomycin and Polymyxin B sulfates GU irrigant (25 Jun 2023)
      • Rifaximin 200 mg tablets (11 Apr 2024)
    • Oxazolidinones:
      • Linezolid injection (16 Oct 2024)
    • Penicillins:
      • Amoxicillin, all oral formulations (18 Oct 2022)
      • Amoxicillin-clavulanate, all oral formulations (17 Nov 2022)
      • Dicloxacillin 250 mg, 500 mg capsules (18 Aug 2021)
      • Oxacillin injection (4 Nov 2025)
      • Penicillin G benzathine injection (1 Feb 2023) Availability update
        
        • Temporary importation of Extencilline from France
        • Temporary importation of Lentocilin from Portugal
      • Penicillin G benzathine/Penicillin G procaine (31 Mar 2023) Availability update
  • Antifungal drugs: 
    
    • Amphotericin B Lipid Complex (5 Aug 2022)
    • Ibrexafungerp 150 mg tablets (3 Dec 2024)
  • Antimycobacterial drugs: 
    
    • No current shortages
  • Antiparasitic drugs:
    
    • Nitazoxanide oral susp 100 mg/5 mL (15 Feb 2024)
  • Antiviral drugs: 
    
    • Acyclovir injection (16 Dec 2025)
    • Oseltamivir, all formulations (1 Nov 2022)
    • Peginterferon alfa-2a (Pegasys) (8 Jan 2025)
    • Ribavirin for inhalation solution (23 May 2023)
• For more information including estimated resupply dates, see ASHP Drug Shortages website.
• Data shown are current as of 8 June 2026.