Early Release

Perspective

• Global Health’s Evolution and Search for Identity
  K. M. De Cock View Abstract

  Despite earlier attempts to define global health, the discipline’s boundaries are unclear, its priorities defined more by funding from high-income countries from the Global North than by global health trends. Governance and resource allocation are challenged by movements such as decolonizing global health. Inherent contradictions within global health derive from its historical evolution from tropical medicine and international health, as well as recent trends in infectious diseases. Demographic, socioeconomic, and epidemiologic transitions, including the rise in noncommunicable diseases, have eroded the concept of a binary world of developed and developing countries. Competitive tension has emerged between aspirations for global health security and health equity. Dominant principles should focus on vulnerable populations, transnational challenges such as migration and climate change, appropriate prevention and care, and epidemic preparedness and response capacity. As the 2030 target date for the United Nations Sustainable Development Goals approaches, reconceptualization of global health is required, or the discipline risks losing identity and relevance.

Synopses

• Medscape CME Activity
  Rickettsia sibirica mongolitimonae Infections in Spain and Case Review of the Literature
  S. Santibáñez et al. View Abstract

  Rickettsia sibirica mongolitimonae is an emerging cause of tickborne rickettsiosis. Since the bacterium was first documented as a human pathogen in 1996, a total of 69 patients with this infection have been reported in the literature. Because of the rising rate of R. sibirica mongolitimonae infection cases, we evaluated the epidemiologic and clinical features of 29 patients who had R. sibirica mongolitimonae infections confirmed during 2007–2024 at the Center for Rickettsiosis and Arthropod-Borne Diseases, the reference laboratory of San Pedro University Hospital–Center for Biomedical Research of La Rioja, Logroño, Spain. We also reviewed all cases published in the literature during 1996–2024, evaluating features of 94 cases of R. sibirica mongolitimonae infection (89 in Europe, 4 in Africa, and 1 in Asia). Clinicians should consider R. sibirica mongolitimonae as a potential causative agent of rickettsiosis, and doxycycline should be administered promptly to avoid clinical complications.

• Systematic Review of Avian Influenza Virus Infection and Outcomes during Pregnancy
  R. Purcell et al. View Abstract

  Human cases of avian influenza A(H5N2) and A(H5N1) viruses associated with outbreaks in birds and mammals are increasing globally, raising concerns about the possibility of a future avian influenza pandemic. We conducted a systematic review examining 30 reported cases of avian influenza in pregnant women. We found high mortality rates for mothers (90.0%, 27/30) and their babies (86.7%, 26/30) when women were infected with avian influenza virus during pregnancy. Despite being a high-risk population and having worse health outcomes across multiple pandemics, pregnant women are often excluded from vaccine trials. However, as the risk for a new pandemic increases and human vaccines against avian influenza are developed, early inclusion of pregnant women in clinical trials can inform the risk–benefit analysis for both the mother and their newborn infant. Early inclusion of pregnant women in public health vaccination programs is vital for protecting this high-risk population.

• The Rise of Mpox in a Post-Smallpox World
  J. H. McQuiston et al. View Abstract

  Reports of mpox are rising in Africa where the disease is endemic and in new countries where the disease has not been previously seen. The 2022 global outbreak of clade II mpox and an ongoing outbreak of the more lethal clade I mpox highlight the pandemic potential for monkeypox virus. Waning population immunity after the cessation of routine immunization for smallpox plays a key role in the changing epidemiologic patterns of mpox. Sustained human-to-human transmission of mpox is occurring widely in the context of insufficient population immunity, fueling genetic mutations that affect the accuracy of some diagnostic tests and that could lead to changing virulence. Additional research should address complex challenges for control of mpox, including improved diagnostics and medical countermeasures. The availability of vaccines should be expanded not only for outbreak response but also for broader routine use for persons in mpox-endemic countries.

• Medscape CME Activity
  Pneumococcal Septic Arthritis among Adults, France, 2010–2018
  F. Hamdad et al. View Abstract

  Streptococcus pneumoniae infection is considered an uncommon cause of arthritis in adults. To determine the clinical and microbiological characteristics of pneumococcal septic arthritis, we retrospectively studied a large series of cases among adult patients during the 2010–2018 conjugate vaccine era in France. We identified 110 patients (56 women, 54 men; mean age 65 years), and cases included 82 native joint infections and 28 prosthetic joint infections. Most commonly affected were the knee (50/110) and hip (25/110). Concomitant pneumococcal infections were found in 37.2% (38/102) and bacteremia in 57.3% (55/96) of patients, and underlying conditions were noted for 81.4% (83/102). Mortality rate was 9.4% (8/85). The proportion of strains not susceptible to penicillin was 29.1% (32/110). Of the 55 serotyped strains, 31 (56.4%) were covered by standard pneumococcal vaccines; however, several nonvaccine serotypes (mainly 23B, 24F, and 15A) had emerged, for which susceptibility to β-lactams was low.

• Meningococcal C Disease Outbreak Caused by Multidrug-Resistant Neisseria meningitidis, Fiji
  A. Strobel et al. View Abstract

  We describe an outbreak of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup C in Fiji. We created surveillance case definitions and collected data by using standard investigation forms. Bacterial identification, antimicrobial susceptibility testing, and PCR were performed in Fiji. Molecular testing was conducted at the Microbiological Diagnostic Unit in Melbourne, Victoria, Australia. During January 2016–December 2018, a total of 96 confirmed or probable IMD cases were reported. Of case-patients, 61.5% (59/96) were male and 38.5% (37) female, 84.4% (81) were indigenous people of Fiji, and 70.8% (68) were children <15 years of age. Annual incidence increased from 1.8/100,000 population in 2016 to 5.2/100,000 population in 2018. Serogroup C multilocus serotype 4821 that is resistant to ciprofloxacin was prevalent (62.1%, 41/66). Public health measures, which included targeted mass vaccination with monovalent meningitis C vaccine, were effective in controlling the outbreak. We observed a rapid decline in meningitis C cases in subsequent years.

• Cluster of Legionellosis Cases Associated with Manufacturing Process, South Carolina, USA, 2022
  H. M. Mohamed et al. View Abstract

  Evolving technology and the development of new devices that can aerosolize water present a risk for new sources of Legionella bacteria growth and spread within industrial settings. We investigated a cluster of legionellosis among employees of a manufacturing facility in South Carolina, USA, and found 2 unique equipment sources of Legionella bacteria. The cluster of cases took place during August–November 2022; a total of 34 cases of legionellosis, including 15 hospitalizations and 2 deaths, were reported. Legionella pneumophila was isolated from 3 devices: 2 water jet cutters and 1 floor scrubber. L. pneumophila sequence type 36 was identified in environmental isolates and 1 patient specimen, indicating that those devices were the likely source of infection. Remediation was ultimately achieved through the development and implementation of a device-specific water management program. Manufacturing facilities that use aerosol-generating devices should consider maintaining updated Legionella water management programs to prevent Legionella bacterial infections.

Research

• Ongoing Evolution of Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2023–2024
  A. M. Hassan et al. View Abstract

  Middle East respiratory syndrome coronavirus (MERS-CoV) circulates in dromedary camels in the Arabian Peninsula and occasionally causes spillover infections in humans. MERS-CoV diversity is poorly understood because of the lack of sampling during the COVID-19 pandemic. We collected 558 swab samples from dromedary camels in Saudi Arabia during November 2023–January 2024. We found 39% were positive for MERS-CoV RNA by reverse transcription PCR. We sequenced 42 MERS-CoVs and 7 human 229E-related coronaviruses from camel swab samples by using high-throughput sequencing. Sequences from both viruses formed monophyletic clades apical to recently available genomes. MERS-CoV sequences were most similar to B5 lineage sequences and harbored unique genetic features, including novel amino acid polymorphisms in the spike protein. Further characterization will be required to understand their effects. MERS-CoV spillover into humans poses considerable public health concerns. Our findings indicate surveillance and phenotypic studies are needed to identify and monitor MERS-CoV pandemic potential.

• Social Contact Patterns and Age Mixing before and during COVID-19 Pandemic, Greece, January 2020–October 2021
  V. Engeli et al. View Abstract

  We collected social contact data in Greece to measure contact patterns before (January 2020) and during the COVID-19 pandemic (March 2020–October 2021) and assess the effects of social distancing over time. During lockdowns, mean daily contacts decreased to 2.8–5.9 (mean prepandemic 20.4). Persons >65 years of age retained the fewest contacts during the pandemic (2.1–4.1). Compared with the first lockdown (March–April 2020), the second lockdown (November–December 2020) and third lockdown (April 2021) showed higher numbers of contacts (incidence rate ratio 1.50 [95% CI 1.27–1.76] in second lockdown and 2.19 [95% CI 1.86–2.58] in third lockdown). In 2021, an increase in contacts was apparent, which persisted during the April 2021 lockdown among persons 18–64 years of age. Our study provides evidence of the waning observance of physical distancing. Effective risk communication alongside targeted social distancing could offer alternatives to repeated lockdowns.

• Trichuriasis in Human Patients from Côte d’Ivoire Caused by Novel Species Trichuris incognita with Low Sensitivity to Albendazole/Ivermectin Combination Treatment
  A. Venkatesan et al. View Abstract

  Albendazole/ivermectin combination therapy is a promising alternative to benzimidazole monotherapy alone for Trichuris trichiura control. We used fecal DNA metabarcoding to genetically characterize Trichuris spp. populations in patient samples from Côte d’Ivoire showing lower (egg reduction rate <70%) albendazole/ivermectin sensitivity than those from Laos and Tanzania (egg reduction rates >98%). Internal transcribed spacer (ITS) 1 and ITS2 metabarcoding revealed the entire detected Côte d'Ivoire Trichuris population was phylogenetically distinct from T. trichiura found in Laos and Tanzania and was more closely related to T. suis. Mitochondrial genome sequencing of 8 adult Trichuris worms from Côte d’Ivoire confirmed their species-level differentiation. Sequences from human patients in Cameroon and Uganda and 3 captive nonhuman primates suggest this novel species, T. incognita, is distributed beyond Côte d'Ivoire and has zoonotic potential. Continued surveillance by using fecal DNA metabarcoding will be needed to determine Trichuris spp. geographic distribution and control strategies.

• Cefiderocol Resistance Conferred by Plasmid-Located Ferric Citrate Transport System in Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae
  R. Polani et al. View Abstract

  Cefiderocol (FDC), a siderophore-cephalosporin conjugate, is the newest option for treating infection with carbapenem-resistant gram-negative bacteria. We identified a novel mechanism contributing to decreased FDC susceptibility in Klebsiella pneumoniae clinical isolates. The mechanism involves 2 coresident plasmids: pKpQIL, carrying variants of bla_KPC carbapenemase gene, and pKPN, carrying the ferric citrate transport (FEC) system. We observed increasing FDC MICs in an Escherichia coli model system carrying different natural pKpQIL plasmids, encoding different K. pneumoniae carbapenemase variants, in combination with a conjugative low copy number vector carrying the fec gene cluster from pKPN. We observed transcriptional repression of fiu, cirA, fepA, and fhuA siderophore receptor genes in bla_KPC–fec–E. coli cells treated with ferric citrate. Screening of 27,793 K. pneumoniae whole-genome sequences revealed that the fec cluster occurs frequently in some globally distributed different K. pneumoniae carbapenemase–producing K. pneumoniae clones (sequence types 258, 14, 45, and 512), contributing to reduced FDC susceptibility.

• Surveillance Strategy in Duck Flocks Vaccinated against Highly Pathogenic Avian Influenza Virus
  S. Planchand et al. View Abstract

  Since 2016, epizootics of highly pathogenic avian influenza (HPAI) virus have threatened the poultry sector in Europe. Because conventional prevention and control measures alone were insufficient in some contexts, the European Commission authorized poultry vaccination in 2023. Subsequently, France launched a nationwide duck vaccination campaign combined with a comprehensive surveillance plan. We used a mathematical model to simulate the transmission of HPAI viruses in vaccinated duck flocks and assess the effectiveness of a wide range of surveillance strategies. Sampling and testing dead ducks every week (enhanced passive surveillance) was the most sensitive (≈90%) and the most timely strategy. Active surveillance through monthly testing of a cross-sectional sample of live ducks was the least sensitive and timely strategy. Thus, we advise focusing HPAI surveillance efforts on enhanced passive surveillance and reducing active surveillance of live ducks.

• Social Contact Patterns in Rural and Urban Settings, Mozambique, 2021–2022
  M. C. Kiti et al. View Abstract

  Few sources have reported empirical social contact data from resource-poor settings. To address this shortfall, we recruited 1,363 participants from rural and urban areas of Mozambique during the COVID-19 pandemic, determining age, sex, and relation to the contact for each person. Participants reported a mean of 8.3 (95% CI 8.0–8.6) contacts per person. The mean contact rates were higher in the rural site compared with the urban site (9.8 vs 6.8; p<0.01). Using mathematical models, we noted higher vaccine effects in the rural site when comparing empirical (32%) with synthetic (29%) contact matrices and lower corresponding vaccine effects in the urban site (32% vs 35%). Those effects were prominent in younger (0–9 years) and older (≥60 years) persons. Our work highlights the importance of empirical data, showing differences in contact rates and patterns between rural and urban sites in Mozambique and their nonnegligible effects in modeling potential effects of vaccine interventions.

• Population-Based Study of Emergence and Spread of–Escherichia coli Producing OXA-48–Like Carbapenemases, Israel, 2007–2023
  E. Temkin et al. View Abstract

  Escherichia coli producing OXA-48–like carbapenemases (OXA-EC) is considered a high-risk pathogen spread primarily in the community in low- and middle-income countries and nosocomially in high-income countries. We investigated the emergence and spread of OXA-EC in Israel, a high-income country with strong carbapenemase-directed infection control in healthcare institutions, by conducting a population-based study using data and isolates from the national surveillance system. A total of 3,510 incident cases of OXA-EC occurred during 2007–2023. During 2016–2023, annual cases rose from 41 to 1,524 and nonnosocomial cases rose from 39% to 57%. Sixty-three sequenced isolates belonged to 20 sequence types (STs) and had 3 bla_OXA alleles (bla_OXA-244, bla_OXA-48, and bla_OXA-181); 71% were chromosomally encoded, and 29% were plasmid-encoded. Nosocomially and non–nosocomially acquired isolates belonged to the same STs and alleles. Most outbreaks involved multiple STs and could only partially be explained by plasmid dissemination. Measures for confronting OXA-EC might need reconsideration.

• Neisseria meningitidis Serogroup Y Sequence Type 1466 and Urogenital Infections
  S. J. van Hal et al. View Abstract

  Neisseria meningitidis is a common commensal bacterium of the nasopharynx that can cause invasive meningococcal disease (IMD). In comparison, N. gonorrhoeae is always a pathogen usually limited to mucosal sites. However, increased evidence for overlapping clinical syndromes is emerging. We compared N. meningitidis samples from a urogenital outbreak in Australia with sequences from the United States and other countries. We conducted phylogenetic analyses to assess relatedness and examine for genomic changes associated with meningococcal adaptation; we collated a total of 255 serogroup Y (MenY), sequence type (ST) 1466 isolate assemblies. Most urogenital isolates originated from Australia; those isolates formed a distinct clade, most closely related genomically to recent US IMD isolates. No specific genomic changes suggested niche adaptation or associated clinical manifestations. The MenY ST1466 N. meningitidis isolates circulating in Australia and the United States are capable of causing both urethritis and invasive meningococcal disease.

Dispatches

• Case Reports of Human Monkeypox Virus Infections, Uganda, 2024
  N. Bbosa et al. View Abstract

  Mpox is a zoonotic disease caused by the monkeypox virus. We report on human mpox cases in Uganda identified by PCR and confirmed by deep sequencing. Phylogenetic analysis revealed clustering with other clade Ib sequences associated with recent outbreaks in the Democratic Republic of the Congo.

• Fatal Case of Crimean-Congo Hemorrhagic Fever, Portugal, 2024
  L. Zé-Zé et al. View Abstract

  We report a fatal case of Crimean-Congo hemorrhagic fever in Portugal. An 83-year-old man, initially suspected of having Mediterranean spotted fever, was later confirmed to have Crimean-Congo hemorrhagic fever by the detection of viral genome in the patient's serum and the presence of specific IgM antibodies.

• Detection and Genomic Characterization of Novel Mammarenavirus in European Hedgehogs, Italy
  B. Di Martino et al. View Abstract

  Mammarenaviruses are noteworthy zoonotic pathogens, and the main reservoirs are rodent species. We report the detection of a novel mammarenavirus in 6/183 (3.3%) in necropsied European hedgehogs (Erinaceus europaeus) collected in Italy. The whole-genome sequence obtained for 4 strains reveaed a marked genetic diversity but a monophyletic origin.

• Influenza A(H5N1) Virus Clade 2.3.2.1a in Traveler Returning to Australia from India, 2024
  Y. Deng et al. View Abstract

  We report highly pathogenic avian influenza A(H5N1) virus clade 2.3.2.1a in a child traveler returning to Australia from India. The virus was a previously unreported reassortant consisting of clade 2.3.2.1a, 2.3.4.4b, and wild bird low pathogenicity avian influenza gene segments. These findings highlight surveillance gaps in South Asia.

• Clonal Complex 398 Methicillin-Resistant Staphylococcus aureus Producing Panton-Valentine Leukocidin, Czech Republic, 2023
  K. Brodíková et al. View Abstract

  To trace evolution of Panton-Valentine leucocidin–positive clonal complex 398 methicillin-resistant Staphylococcus aureus (MRSA) in the Czech Republic, we tested 103 MRSA isolates from humans. Five (4.9%) were Panton-Valentine leucocidin–positive clonal complex 398, sequence types 1232 and 9181. Spread to the Czech Republic may result from travel to or from other countries.

• Domestic Cat Hepadnavirus Infection in Iberian Lynxes
  G. Diakoudi et al. View Abstract

  We conducted a survey for domestic cat hepadnavirus, an analog of human hepatitis B virus, in the endangered felid species Iberian lynx. Results revealed specific antibodies in 32.3% of serum samples and DNA in 0.5% of available liver samples. Phylogenetically, the virus segregated apart from other Europe strains of the virus.

• Detection of Prions in Wild Pigs (Sus scrofa) from Areas with Reported Chronic Wasting Disease Cases, United States
  P. Soto et al. View Abstract

  Using a prion amplification assay, we identified prions in tissues from wild pigs (Sus scrofa) living in areas of the United States with variable chronic wasting disease (CWD) epidemiology. Our findings indicate that scavenging swine could play a role in disseminating CWD and could therefore influence its epidemiology, geographic distribution, and interspecies spread.

• Invasive Group B Streptococcus Infections Caused by Hypervirulent Clone of S. agalactiae Sequence Type 283, Hong Kong, China, 2021
  C. Li et al. View Abstract

  During September–October 2021, group B Streptococcus bloodstream infections surged among patients hospitalized in Hong Kong. Of 95 cases, 57 were caused by the hypervirulent strain sequence type 283, which at the time was also found in freshwater fish and wet market environments and thus poses a transmission threat.

• Toxigenic Corynebacterium diphtheriae Infections in Low-Risk Patients, Switzerland, 2023
  P. Urwyler et al. View Abstract

  We report a cluster of infections with genetically related toxigenic Corynebacterium diphtheriae linked to an outbreak among asylum seekers in Switzerland that subsequently affected patients without known exposure. This discovery highlights the importance of rapid, interdisciplinary outbreak investigations and regular vaccination status assessment, especially in elderly populations with waning immunity.

Research Letters

• Equine Encephalomyelitis Outbreak, Uruguay, 2023–2024
  S. Frabasile et al. View Abstract

  We report the genomic analysis from early equine cases of the Western equine encephalitis virus outbreak during 2023–2024 in Uruguay. Sequences are related to a viral isolate from an outbreak in 1958 in Argentina. A viral origin from South America or continuous enzootic circulation with infrequent spillover is possible.

• Cocirculation of 4 Dengue Virus Serotypes, Putumayo Amazon Basin, 2023–2024
  J. van der Ende et al. View Abstract

  Latin America is experiencing an unprecedented dengue outbreak, causing an increased health burden. We document the cocirculation of dengue viruses 1–4 in Putumayo, a remote, underserved region at the border between Ecuador and Colombia. Dengue circulation in this largely unexplored territory represents a threat to public health in Putumayo and neighboring areas.

• Low IgG Seroconversion among Persons Vaccinated against Measles, Republic of Congo
  Y. Mavoungou et al. View Abstract

  We report a low (38.7%; p<0.0001) level of IgG seroconversion in patients who were positive for measles virus IgM in the Republic of Congo, despite a history of vaccination. Considering this country’s recurring measles epidemics, more effective immunization strategies, including vaccine delivery methods, are needed to prevent measles outbreaks.

• Fatal Mixed Plasmodium Infection in Traveler Returning to Colombia from Comoros Islands, 2024
  L. J. Medina-Lozano et al. View Abstract

  During 2014–2022, only Plasmodium falciparum malaria cases were reported in the Comoro Islands. We report a fatal case of mixed Plasmodium malaria infection in a traveler returning from the Comoros to Colombia in 2024, highlighting the need to strengthen laboratory detection and identification of Plasmodium spp. in sub-Saharan Africa.

• Identification and Characterization of Vancomycin-Resistant Staphylococcus aureus CC45/USA600, North Carolina, USA, 2021
  J. K. MacFarquhar et al. View Abstract

  Vancomycin-resistant Staphylococcus aureus (VRSA) is a rare but serious public health concern. We describe a VRSA case in North Carolina, USA. The isolate from the case belonged to the USA600 lineage and clonal complex 45. No transmission was identified. Confirmed VRSA cases should include a thorough investigation and public health response.

• Evidence of Influenza A(H5N1) Spillover Infections in Horses, Mongolia
  B. Damdinjav et al. View Abstract

  Recent outbreaks of influenza A(H5N1) have affected many mammal species. We report serologic evidence of H5N1 virus infection in horses in Mongolia. Because H3N8 equine influenza virus is endemic in many countries, horses should be monitored to prevent reassortment between equine and avian influenza viruses with unknown consequences.

• Spread of Antifungal-Resistant Trichophyton indotineae, United Kingdom, 2017–2024
  A. Abdolrasouli et al. View Abstract

  We describe 157 cases of Trichophyton indotineae infection in the United Kingdom, mostly in patients linked to southern Asia. T. indotineae is spreading in the United Kingdom and accounts for 38% of dermatophyte isolates referred to the UK National Mycology Reference Laboratory. Clinicians should suspect T. indotineae in tinea corporis cases.

• Salmonella enterica Serovar Abony Outbreak Caused by Clone of Reference Strain WDCM 00029, Chile, 2024
  A. Piña-Iturbe et al. View Abstract

  A Salmonella enterica serovar Abony outbreak occurred during January–April 2024 in Chile. Genomic evidence indicated that the outbreak strain was a clone of reference strain WDCM 00029, which is routinely used in microbiological quality control tests. When rare or unreported serovars cause human infections, clinicians and health authorities should request strain characterization.

• Replication Restriction of Influenza A(H5N1) Clade 2.3.4.4b Viruses by Human Immune Factor, 2023–2024
  J. Ankerhold et al. View Abstract

  We show that human myxovirus resistance protein 1 (MxA) suppresses replication of highly pathogenic avian influenza A(H5N1) viruses isolated from mammals in vitro and in MxA-transgenic mice. However, H5N1 can evade MxA restriction through replacement of individual viral polymerase complex components from a human-adapted MxA-resistant strain in vitro.

• Endogenous Endophthalmitis Caused by Prototheca Microalga in Birman Cat, Spain
  L. Jimenez-Ramos et al. View Abstract

  We identified Prototheca spp. microalga in ocular samples of a cat in Spain with nontreatable endogenous endophthalmitis. Within 2 years, the eye lesions progressively worsened and neurologic signs appeared, suggesting systemic spread of the infection. On multitarget sequence analysis, the feline pathogen could not be assigned to any known Prototheca species.

Letters

• Case Report of Leprosy in Central Florida, USA, 2022
  A. B. Auyeung et al.
• Oropouche Virus Genome in Semen and Other Body Fluids from Traveler
  Z. Iglói et al.

Books and Media

• Hansen’s Disease: A Complete Clinical Guide
  R. Hussein

Online Reports

• Research and Development of Medical Countermeasures for Emerging Infectious Diseases, China, 1990–2022
  J. Ma et al. View Abstract

  Since the severe acute respiratory syndrome outbreak in 2003, China has invested substantial efforts in promoting scientific and technological advances for medical countermeasures against high-threat pathogens. The examination of China’s landscape identifies progress and gaps in research and development (R&D) and also highlights management and regulatory issues that should be of concern to other countries. Our study examined the current state of R&D of medical countermeasures in China during 1990–2022. The findings showed a robust and diversified pipeline responding quickly to disease outbreaks and policy changes. However, proactive and highly innovative candidates are limited, and a large proportion of vaccines and drugs stagnate at the early development stage. A paradigm shift involving a preemptive R&D agenda and persistent investment, innovative technology development, and accelerated research translation is urgently needed to prepare for the next pandemic.

• A Step Forward in Hypervirulent Klebsiella pneumoniae Diagnostics
  T. A. Russo et al. View Abstract

  Hypervirulent Klebsiella pneumoniae (hvKp) can cause life-threatening infections in healthy community members. HvKp Infections often involve multiple sites, some of which are unusual for classical K. pneumoniae (cKp) infections, such as the central nervous system, eyes, and fascia. The acquisition of antimicrobial resistance by hvKp has resulted in concerns of an emerging superbug. This concern is magnified by increasing geographic dissemination and healthcare associated infections. Currently, diagnostic testing to differentiate hvKp from cKp is lacking, causing challenges for clinical care, surveillance, and research. Although imperfect, the detection of all 5 of the biomarkers iucA, iroB, peg-344, rmpA, and rmpA2 is the most accurate and pragmatic means to identify hvKp. We propose a working definition for hvKp that will enhance accuracy for diagnosis and surveillance, which will aid in preventing the spread of hvKp.

• Development and Implementation of a Public Health Event Management System, Nigeria, 2018–2024
  J. Elston et al. View Abstract

  Event management systems (EMS) are key tools for epidemic intelligence, integrating surveillance signals and incident response, although international standards to inform development are lacking. We describe the Nigeria Centre for Disease Control and Prevention (NCDC) SITAware, a software capable of operating with low internet bandwidth to generate notifications, reports, and spatiotemporal dashboards and provide event-level data for real-time accountability and postevent learning. SITAware was enabled by local institutional ownership, co-created at low cost, and integrated into existing workflows. In 2022, SITAware was used to manage ≈300 incidents, and NCDC implemented it subnationally. NCDC’s experience may inform EMS development and implementation in similar settings.

About the Cover

• Flying Firemen and Underwater Croquet
  R. Tucker et al.

Synopses

• National Surveillance of Human Ehrlichiosis Caused by Ehrlichia ewingii, United States, 2013–2021
  S. N. Adams et al.
• Two Human Cases of Fatal Meningoencephalitis Associated with Potosi and Lone Star Viruses, United States, 2020–2023
  C. Y. Chiu et al.

Research

• Short-lived Neutralizing Antibody Responses to Monkeypox Virus in Smallpox Vaccine–Naive Persons after JYNNEOS Vaccination
  K. Phipps et al.

Dispatches

• Reemergence of Echinococcus granulosus Infections after 2004 Termination of Control Program in Magallanes Region, Chile
  C. A. Alvarez Rojas and J. Alvarez
• Infection by Tick-Borne Bacterium Candidatus Midichloria Associated with First Trimester Pregnancy Loss, Tennessee, USA
  J. Newman et al.
• Seoul Orthohantavirus Infection and Subsequent Guillain-Barré Syndrome in Traveler Returning from Kenya, 2022
  T. M. Lepage et al.
• East African Origin of SAT2 Topotype XIV Foot-and-Mouth Disease Virus Outbreaks, Western Asia, 2023
  A. Di Nardo et al.
• Borrelia spielmanii–Associated Neuroborreliosis in Patient Receiving Rituximab, Belgium
  T. Carette et al.
• Acute Q Fever Patients Requiring Intensive Care Unit Support in Tropical Australia, 2015–2023
  C. Price et al.
• Two Human Infections with Diverse Europe 1 Crimean–Congo Hemorrhagic Fever Virus Strains, North Macedonia, 2024
  D. Jakimovski et al.

Research Letters

• Detection of Mycoplasma phocimorsus in Woman with Tendinous Panaritium after Cat Scratch, Denmark
  A. Skafte-Holm et al.
• Venezuelan Equine Encephalitis Virus Infection in Nonhuman Primate, Guatemala, 2023
  K. Wendy et al.
• Sin Nombre Virus as an Unlikely Reverse Zoonotic Threat
  J. Prévost et al.
• Acute Encephalopathy Associated with Human Adenovirus Type 14 Infection in 7-Year-Old Girl, Japan
  S. Mizuno et al.
• Zika Virus Infection in Pregnant Traveler Returning to Denmark from Phuket, Thailand, 2024
  I. C. Rubin et al.
• Burkholderia pseudomallei Sequence Type 46 Transmission from Asia to Australia
  E. M. Meumann et al.
• Ixodes scapularis Tick Parasitizing Dog in Dawson County, Montana, USA, 2023
  P. E. Stewart et al.

Books and Media

• Ending Epidemics: A History of Escape from Contagion
  C. Partin
• 2000 Years of Pandemics: Past, Present, and Future, 1st Edition
  N. M. M’ikanatha and K. Hamilton

Research

• Mycobacterium nebraskense Isolated from Patients in Connecticut and Oregon, USA
  M. L. Metersky et al.

Research Letters

• Neurosarcocystosis in Patient with HIV-Induced Immunodeficiency
  T. Skarpengland et al.
• Fluoroquinolone Resistance in Drug-Resistant Tuberculosis, Kharkiv, Ukraine, 2019–2023
  O. Konstantynovska et al.