Early Release

Synopses

• Neoehrlichiosis Causing Hemolytic Anemia in Patients Treated with Rituximab, Norway
  M. Paulson et al.
• Epidemiology and Risk Factors of Amoebic Meningoencephalitis, Kerala, India, 2025
  H. Sivanandan et al.
• Investigation of Mycobacterium abscessus Cluster in Hospital, Maryland, USA, 2024
  S. Ludmer et al. View Abstract

  Mycobacterium abscessus infections are frequently drug resistant and can cause severe disease, particularly among vulnerable populations in healthcare settings. In June 2024, a cluster of M. abscessus infection cases was reported at a hospital in Maryland, USA. An investigation involving hospital infection prevention staff, the Maryland Department of Health, the Centers for Disease Control and Prevention, and the Wadsworth Laboratory of the New York State Department of Health included initiation of mitigation efforts such as tap water use restrictions, point-of-use water filters, hospitalwide water flushing, and staff education regarding sink safety. Whole-genome sequencing of patient and environmental isolates, coupled with epidemiologic data, revealed a strong association (0–24 single-nucleotide polymorphism differences) between environmental and patient samples, indicating that infections were likely a result of patient exposure to M. abscessus. Ensuring initiation of mitigation initiatives likely prevented additional patient infections. Although effective in this investigation, not all mitigation strategies are equal or sustainable.

Research

• Improved Case Detection of Flea-Borne Typhus through Polymerase Chain Reaction Testing, Los Angeles County, California, 2022–2024
  A. Sanosyan et al.
• Dual PCR-Sanger Sequencing Assay for Simultaneous sqle-Based Identification and Resistance Detection in Trichophyton Species
  N. Abou-Chakra et al.
• The impact of considering post-tuberculosis consequences on the effectiveness and cost-effectiveness of tuberculosis prevention among new immigrants to Canada: a modeling study
  A. Ainiwaer et al.
• Clustering and Source Association of Clinical and Nonclinical Listeria monocytogenes Isolates, New York, USA, 2000–2021
  H. Samut et al.
• Reemergence of Scrub Typhus Associated with Leptotrombidium akamushi Mites and Karp-like Orientia tsutsugamushi Genotype Bacteria, Japan, 2024
  M. Ogawa et al.
• Experimental Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Alpacas, 2026
  J. Schön et al.

Dispatches

• Chronic Elbow Nodules Caused by Fomitiporella Fungus in Immunocompetent Patients, United States
  G. S. Tansarli et al.
• Serologic Evidence of Hantavirus Exposure in Humans, Italy, 2004–2018
  G. Faolotto et al. View Abstract

  Rodentborne hantaviruses and lymphocytic choriomeningitis virus (LCMV) circulate in northern Italy but are rarely diagnosed. We tested samples collected from 371 patients during 2004–2018 and detected LCMV IgG in 2.7% of samples and hantavirus IgG in 7.3%. Puumala virus–neutralizing antibodies were confirmed in 10 cases, indicating unrecognized local hantavirus circulation.

• Seroprevalence of Influenza A(H5N1) Virus in Domestic Cats at Epicenter of Dairy Cattle Outbreaks, California, USA, 2024–2026
  I. G. Bemis et al. View Abstract

  We conducted a serologic study of domestic cats near the epicenter of the dairy cattle outbreaks of influenza A(H5N1) in California, USA. Three of the 12 cats sampled within 2 km of farms had neutralizing antibodies against H5N1 virus. Proximity to dairy farms was a statistically significant risk factor for seropositivity.

• Genetically Distinct African Swine Fever Virus Genotype II Variant in Wild Boar, Spain, 2025–2026
  C. Gallardo et al.
• Genomic and Epidemiologic Insights into Ongoing Measles Outbreak, Israel, 2025–2026
  E. Bucris et al. View Abstract

  An ongoing measles outbreak in Israel, involving ≈3,200 cases and 16 deaths, threatens the country’s measles elimination status and reflects declining vaccination rates observed globally and within Israel. Epidemiologic investigations supported by sequencing suggest that a single importation triggered the outbreak, underscoring the critical role of rapid genomic surveillance in outbreak control.

• Case Report and Retrospective Review of Acanthamoeba Encephalitis and Chronic Lymphocytic Leukemia
  M. Persico et al.
• Wickerhamomyces anomalus Pseudo-Outbreak Associated with Medical Lubricating Gel, South Africa, 2022–2024
  C. Maluleka et al.
• Global Spread of Trichophyton indotineae Tracked by Mass Spectrometry Identification Network, 2022–2025
  A. Jabet et al.

Research Letters

• Locally-Acquired Pulmonary Coccidioidomycosis Linked to Maritime Shipping Containers, Taiwan, 2025
  A. C. Huang et al.
• Rickettsia massiliae infection in a peri-urban area, Spain, 2023
  J. Martín-Trueba et al.
• Outbreak of Brazilian spotted fever, Southeastern Brazil, 2018
  J. Brasil et al.
• Southern Tick–Associated Rash Illness in Pediatric Patient, New York, USA, 2025
  A. S. Handel et al. View Abstract

  Southern tick–associated rash illness (STARI) is a tickborne disease of unknown etiology characterized by an erythema migrans–like skin lesion. We report a STARI case in New York in a child after an Amblyomma americanum tick bite; we detected Borrelia lonestari, a disputed cause of STARI, in the tick.

• Autochthonous Canine Pythiosis Linked with Freshwater Exposure, Italy, 2021–2024
  A. Peano et al.
• Powassan Virus in Ixodes scapularis Populations, Illinois, United States, 2025
  A. Marguccio et al.
• Pediatric Tuberculosis Care Outcomes in a Tertiary Care Center, France, 2014–2024
  D. Franco et al.
• Emergence of Oropouche virus in Venezuela, 2025
  L. Rodríguez et al.

Letters

• Pulmonary Histoplasmosis, Taiwan, 1997–2024
  T. Kao et al.
• Pulmonary Histoplasmosis, Taiwan, 1997–2024
  C. Liang et al.
• Plausible Source Cases for Recent Mycobacterium tuberculosis Transmission, United States, 2018-2022
  R. Zubairi

Synopsis

• Meta-analysis of Maternal and Fetal Outcomes of Crimean-Congo Hemorrhagic Fever during Pregnancy
  B. Donk et al.

Research

• Wastewater Surveillance to Track a Resurgent Outbreak of Measles, Ontario, Canada, 2025
  R. Corchis-Scott et al.
• Human Myiasis Resulting from Reemergence of Cochliomyia hominivorax Screwworm, Mexico, 2025–2026
  O. Delgado-Cuellar et al. View Abstract

  After its elimination from Mexico in 2003, myiasis caused by New World screwworm (NWS), Cochliomyia hominivorax, has recently reemerged as a public and animal health concern. We conducted a retrospective study of human New World screwworm myiasis cases reported through Mexico’s national surveillance system during April 13, 2025–March 14, 2026. Of 204 cases in official surveillance summaries, 202 had sufficient information for case-level clinical and epidemiologic analysis. Cases were concentrated in southern Mexico, particularly Chiapas, followed by Yucatán, Oaxaca, and Quintana Roo. Most (71.8%) cases occurred in men; mean patient age was 61.1 years. Lower limbs (55.0%) were the most frequently reported anatomic location, and 76.7% of patients had >1 concurrent condition. Six deaths were reported among patients with NWS myiasis; at the time of reporting, 1 death was attributed directly to NWS myiasis. Our findings support proactive clinical detection and integrated One Health surveillance along the expected northward spread of NWS.

• Meta-Analysis of Asymptomatic Monkeypox Virus Prevalence in Nonendemic Regions, 2022–2024
  K. J. MacCuish et al.
• Detection of Anaplasma capra in patients with suspected Crimean-Congo Hemorrhagic Fever in Türkiye, 2022: Clinical evidence and genotyping
  K. Altay et al.
• Persistent Bartonella quintana Infection in Macaques at Primate Research Institute, Japan
  Y. Nomura et al.
• Genomic Epidemiology of Salmonella Hadar Strain Linked to Poultry-Associated Salmonellosis Outbreaks, United States
  L. Xiaoli et al.

Dispatches

• Emergence of Divergent H5N1 (Clade 2.3.4.4b) in Central Park in São Paulo, Brazil, 2025
  J. de Araujo et al.
• Emergence of Rabies in Cape Fur Seals, South Africa
  C. Ngoepe et al. View Abstract

  Rabies was diagnosed in Cape fur seals by using direct fluorescent antibody testing in South Africa, 2024. We investigated the origin of rabies virus in this species. Phylogenetic analysis revealed virus introduction from jackals into seals, followed by sustained viral transmission within the seal population and spillover into a domestic dog.

• Emergence of Macrolide-Resistant Bordetella pertussis in Peru
  E. Juscamayta-López et al.
• Mpox Virus in Healthcare Settings, Sierra Leone, June 2025
  M. Jaba et al.
• Emergence of Genotype 2.3.1 Multidrug-Resistant Salmonella enterica Serotype Typhi Strain, West Africa, 2021–2025
  E. Njamkepo et al.

Research Letter

• Highly pathogenic avian influenza virus subtype 5 in Brazilian cetaceans: implications for surveillance in threatened species Influenza A Virus in Cetaceans from Brazil
  A. S. Melgarejo et al.

In Memoriam

• In Memoriam: The Enduring Influence of Nancy J. Cox (1948–2026)
  D. B. Jernigan et al.

• Implementation and Early Outcomes of Laboratory Proficiency Testing Program for National Wastewater Surveillance System, USA, 2024
  H. Dutcher et al.
• Mpox Surveillance in Wastewater, North Carolina, USA, October 2023–May 2025
  N. L. Snyder et al.
• Targeted Wastewater Surveillance during the World Athletics Championship, Oregon, USA, 2022
  R. Falender et al. View Abstract

  Targeted wastewater surveillance during the 18th World Athletics Championships in Eugene, Oregon, USA, in 2022 detected influenza A virus, SARS-CoV-2, and hepatitis A virus. Poliovirus detections were inconclusive. Influenza B, hepatitis E, and measles viruses and Middle East respiratory syndrome coronavirus were not detected. Wastewater surveillance augments traditional surveillance to mitigate risks associated with large multinational gatherings.

• Wastewater Respiratory Virus Surveillance in Remote Community, Alaska, 2022–2024
  B. Lefferts et al.
• Correlations between Wastewater Concentrations of Influenza A and Respiratory Syncytial Viruses and Clinical Laboratory Testing and Hospitalization Data, California
  E. Burnor et al.
• Temporal Alignment of Wastewater-based Signals with Clinical Indicators of Respiratory Illness in Post-Pandemic Texas
  K. Bi et al.
• A Multi-Partner Effort to Launch and Sustain Wastewater Surveillance, United States
  J. Yoder et al. View Abstract

  The National Wastewater Surveillance System represents a groundbreaking initiative aimed at enhancing public health surveillance for infectious diseases through wastewater analyses. We have outlined current and planned collaborative efforts between the Centers for Disease Control and Prevention and key partners, including academic institutions, utilities, jurisdictions, and public health partner networks, to develop, implement, and sustain wastewater surveillance for infectious diseases to inform public health activities. By addressing critical challenges in assay development, community and clinician engagement, governance structures, public health ethics, data system development and integration, and innovation fostering, those partnerships lay the groundwork for a robust public health surveillance framework. Establishing this novel public health surveillance capability required developing new partnerships and skills, incorporating basic principles of public health surveillance, validating assays, and envisioning a system to meet current and future public health challenges. This capability will foster improved public health responses nationwide.

• Evaluation of Detection Methods for Wastewater Surveillance of Antimicrobial-Resistant Bacteria from Healthcare Facilities
  E. Warren et al. View Abstract

  Carbapenem resistance in bacteria is an urgent public health threat. Wastewater surveillance could support antimicrobial resistance monitoring at long-term care facilities. We assessed feasibility of wastewater sampling at such facilities for carbapenemase genes (bla_KPC, bla_VIM, bla_OXA-48-like, bla_NDM, and bla_IMP) detected by quantitative PCR or GeneXpert Carba-R (Cepheid, https://www.cepheid.com) over 16 months and compared those findings with those for clinical infections. The bla_KPC, bla_OXA-48-like, and bla_VIM genes were routinely detected in composite wastewater samples, passive samples, and sewer biofilm swab specimens. Wastewater and sewer biofilm resistomes differed, but both contained bla_KPC, bla_VIM, and bla_IMP. Wastewater surveillance for carbapenemases shows promise, but few clinical infections during the study period and contributions from sewer biofilms complicate correlations between wastewater measurements and clinical incidence, underscoring the need for further research.

• Building National Wastewater Surveillance for Infectious Diseases in the United States
  J. S. Yoder et al.
• Implications of Wastewater Surveillance for Clinical Care among Infectious Disease Physicians, United States, 2024
  S. L. Jones et al. View Abstract

  We analyzed 192 responses from a 2024 survey of Emerging Infections Network members in the United States regarding how wastewater surveillance can affect clinical practice. Four themes emerged: situational awareness, patient counseling, infection control, and diagnostic support. Enhanced collaboration between public health officials and clinicians might optimize utility of such surveillance in clinical practice.

• Exploration of Public Perceptions of Wastewater Surveillance, United States, June 2024
  J. T. Moore et al. View Abstract

  Community wastewater surveillance (WS) is a valuable tool for informing public health action, but its effects on individual health behaviors relies on public understanding and awareness. We analyzed 2,024 free text responses from a national survey on perceptions of WS conducted during June 19–23, 2024, to gain insights into public perceptions of WS. Primary themes among 1,181 detailed responses included varying levels of trust in government and authorities, the need for more information about the effectiveness and accuracy of monitoring, desire to understand public health implications, and the need for more education and communication. Those findings could help inform community engagement strategies as WS continues to evolve.

• Early-Season Detection of Influenza A(H3N2) Subclade K in Wastewater, Colorado, USA, 2025–2026
  M. C. Hetherington-Rauth et al. View Abstract

  We assessed the value of wastewater sequencing for monitoring influenza circulation in Colorado, USA, focusing on the emergence of influenza A(H3N2) subclade K. We detected subclade K in wastewater 31 days before clinical detection. Our results demonstrated that wastewater sequencing can provide real-time situational awareness for public health officials.