Early Release

Synopsis

• Western Equine Encephalitis Virus in Blood Donors during Outbreak, Argentina, 2023–2024
  S. Blanco et al.

Research

• Virulence of Burkholderia pseudomallei Strains from Western Hemisphere and Africa in Mice
  C. P. Klimko et al. View Abstract

  Melioidosis, caused by Burkholderia pseudomallei, is an emerging disease in the United States and was declared endemic to the Gulf Coast region in 2022. Melioidosis has been sporadically reported in the American continents, the Caribbean, and more recently in Africa. We conducted lethal dose analyses in BALB/c and C57BL/6 mice exposed to small particle aerosols of B. pseudomallei strains from the Western Hemisphere and Africa. Those isolates exhibit a variety of virulence patterns, including rapidly-lethal disease and delayed onset of fatal disease. We found that the isolates we tested grew similarly in culture but displayed major differences in biofilm formation. Our data contribute to the growing knowledge of geographically distinct B. pseudomallei isolates and aid in ensuring that medical countermeasures in development are effective against a diverse collection of bacterial strains.

• Use of Salmonella enterica Serovar Typhi Hemolysin E and Lipopolysaccharide IgA to Identify Enteric Fever Cases, South Asia
  J. C. Seidman et al. View Abstract

  Existing methods to identify patients infected with Salmonella enterica serovar Typhi or Paratyphi are not adequately accurate, affordable, or efficient. We evaluated the performance of antibodies to Salmonella Typhi hemolysin E (HlyE) and lipopolysaccharide (LPS) in Bangladesh, Nepal, and Pakistan for enteric fever case identification. We measured plasma concentrations of HlyE and LPS IgA in blood culture–confirmed enteric fever case-patients and in febrile controls with laboratory-confirmed alternative etiologies. Combining LPS and HlyE IgA discriminated enteric fever cases from other febrile illnesses with an area under the receiver operating characteristic curve (AUC) of 0.93 (specificity 86% at a fixed 90% sensitivity). LPS IgA alone performed nearly as well (AUC 0.92). In children <5 years of age, the combined biomarkers outperformed either biomarker alone (AUC 0.96 vs. 0.94 for HlyE, 0.93 for LPS). Our findings support use of HlyE and LPS IgA–based assays for enteric fever diagnosis in endemic settings.

• Qualitative Risk Assessment of Infectious Agents Associated with Canine Importation into Canada, 2023–2024
  V. Leung et al. View Abstract

  Dog importation into Canada has grown substantially since the early 2010s, and concerns have been raised regarding the potential introduction of infectious agents. We conducted a qualitative risk assessment of infectious agents associated with canine importation into Canada. We adapted international risk assessment methodologies coupled with an expert consultation. We estimated likelihood of entry, likelihood of canine exposure, and magnitude of impact of exposure to individual canines and the canine population for all hazards (n = 53). We also completed estimates for likelihood of human exposure and magnitude of impact of exposure on individual humans and the human population for zoonotic hazards (n = 33). Hazards were commonly ranked moderate or high for likelihood of entry and exposure estimates. Magnitude of impact of exposure estimates were assessed at much lower levels, indicating more restricted health impacts. Our study provides a foundation for future risk mitigation, including caregiver education, veterinary assessments, and importation regulations.

• Rapid Expansion of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Genotype D1.1 Virus across Flyway Regions, North America, Fall 2024
  M. Scotch et al. View Abstract

  Highly pathogenic avian influenza clade 2.3.4.4b virus continues to circulate in North America and has caused severe human disease. That clade includes genotype D1.1, which became dominant in birds in late 2024. Recent phylodynamic reconstructions place D1.1 emergence in mid-2024 but differ on its inferred origin and early dissemination pathways. We combined targeted surveillance of wild birds in Arizona with publicly available US clade 2.3.4.4b hemagglutinin sequences to estimate when D1.1 genotype emerged and to infer its diffusion among the 4 major US flyways. Phylodynamic analyses showed transitions concentrated among adjacent flyways regions, consistent with stepwise dissemination during fall 2024 and limited support for long-distance Pacific–Atlantic exchange. The Pacific Flyway showed patterns consistent with an early source and the Central Flyway with a secondary hub linked to onward spread. Our findings support coordinated genomic surveillance across adjacent flyways to reduce detection delays and improve situational awareness during rapid viral expansion.

• Detection of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Genotype D1.2 Virus in Swine after Experimental Inoculation
  H. Seger et al. View Abstract

  Highly pathogenic avian influenza H5NX clade 2.3.4.4b viruses continue to circulate globally. Reintroduction of Eurasian lineage viruses into North America and reassortment with endemic low pathogenicity strains have resulted in new genotypes, including D1.2. To assess pathogenicity and cellular tropism, we intranasally inoculated genotype D1.2 virus into pigs. We isolated virus from nasal secretions from most inoculated animals for multiple days. At 5 days postinoculation, PCR and immunohistochemistry detected virus in musculoskeletal, respiratory, digestive, lymphatic, and nervous systems and isolates from meat juice. At 35 days postinoculation, we detected viral antigen and low levels of RNA in the brain of an animal with lesions consistent with a viral etiology and found viral antigen in the ethmoid of 2 animals. Consistent detection in nasal swab specimens, combined with subclinical respiratory infection, systemic distribution, and protracted detection of clade 2.3.4.4b virus in swine, suggest identifying infection in commercial swine without overt respiratory signs could be difficult.

• Association of Medically Attended Infections in Infancy with Long-Term Weight Gain and Obesity among Children, Southern California, USA
  Z. W. Taylor and J. C. Lin
• Occupationally Exposed and General Population Antibody Profiles to Influenza A Viruses Circulating in Swine as Indication of Zoonotic Risk
  C. A. Snyder et al. View Abstract

  Persons with occupational exposure to swine might be at disproportionate risk for zoonotic swine influenza A virus. To evaluate human antibody responses, we tested serum or plasma from swine veterinarian, farm employee, and general population cohorts by hemagglutination inhibition assays against representative swine and human seasonal influenza vaccine strains. We analyzed hemagglutination inhibition data by antigenic cartography to assess strain relationships and reproduction number modeling to evaluate pandemic potential using age-stratified immunity profiles. Occupationally exposed groups had lower human seasonal vaccine uptake (45.5% vs. 70%) and lower odds of seropositivity to several H1 and H3 strains from swine than did general population cohorts. One swine strain exhibited significant antigenic drift (3.62 antigenic units) from its nearest vaccine strain. Multiple strains required lower reproduction number thresholds for pandemic spread (1.09–1.35) than recorded pandemic strains (1.46–1.80), demonstrating that population immunity gaps heighten zoonotic risk to circulating swine H1 and H3 strains.

• Epidemiologic, Entomologic, and Virologic Findings during Reemergence of Western Equine Encephalitis Virus, Argentina
  L. Spinsanti et al. View Abstract

  During November 2023–April 2024, a total of 1,543 horses with neurologic disease from rural areas in 17 provinces of Argentina were reported to national animal health authorities. Nested reverse transcription PCR, quantitative real-time reverse transcription PCR, and sequencing of equine brain necropsies confirmed western equine encephalitis virus (WEEV) infection in 23 horses and 1 sheep. Phylogenetic analyses identified a lineage previously detected in Argentina in 1957, overlapping areas affected during the 1980s epizootics. Overall, we aspirated 1,362 female mosquitoes (12 species) from 1 of the most affected areas; Aedes (Ochlerotatus) albifasciatus (70.1%) and Ae. (Ochlerotatus) scapularis (26.8%) mosquitoes were the most abundant species. Three of 27 mosquito pools (n = 1,089 mosquitoes) were identified as WEEV positive (2 Ae. albifasciatus, 1 Ae. scapularis). Increased rainfall, agricultural expansion, vector proliferation, and low vaccination coverage were likely key factors contributing to the reemergence of WEEV.

Dispatches

• Camel Prion Disease, Tataouine, Tunisia, 2019–2021
  A. Amara et al. View Abstract

  We report 6 cases of camel prion disease in dromedaries in Tunisia, confirming widespread occurrence in North Africa. Affected animals showed neurologic signs and scrape prion protein accumulation in brain and lymphoid tissues. These findings highlight the importance of active surveillance and investigation of the epidemiology, transmission, and public health implications.

• Filovirus Surveillance in Communities Bordering Equatorial Guinea, Marburg Outbreak, Cameroon, 2023
  J. Ramassamy et al. View Abstract

  After the 2023 Equatorial Guinea Marburg virus (MARV) outbreak, surveillance of 181 persons in southern Cameroon detected MARV antibodies in 3 persons and Ebola virus antibodies in 7. Testing of 289 captured bats, including 158 Rousettus aegyptiacus bats, did not detect MARV RNA. Enhanced surveillance for regional filovirus spillover risks is warranted.

• Isolation of Infectious Highly Pathogenic Avian Influenza A(H5N1) Virus from Fetal Bovine Serum, United States, 2025
  A. R. Rebelo et al. View Abstract

  In February 2025, we detected highly pathogenic avian influenza virus A(H5N1) clade 2.3.4.4b virus in a fetal bovine serum lot during routine adventitious agent testing. Sequencing confirmed H5N1 genotype B3.13 virus. We found low viral loads in additional samples from the same lot. Heating at 56°C for 30 minutes completely inactivated the virus.

• Detection of Dengue Virus in Aedes aegypti Mosquitoes, Dubai, United Arab Emirates
  N. Nowotny et al. View Abstract

  We performed a 1-year mosquito survey in Dubai, United Arab Emirates, after a dengue virus outbreak in 2024. We collected 1,598 Aedes aegypti mosquitoes and detected dengue virus in 5 pools of <20 mosquitoes. Our findings underscore the importance of sustained vector surveillance for dengue virus in arid urban environments.

• Detection of Congenital Syphilis via Digital PCR and Next-Generation Sequencing, Colombia
  A. M. Bossa-Castro et al. View Abstract

  We describe congenital syphilis in a newborn whose mother had secondary syphilis diagnosed during pregnancy and received a single penicillin dose. Molecular methods detected an extremely low Treponema pallidum load in the mother but higher load in the neonate. Our findings support use of molecular methods for detecting vertical T. pallidum transmission.

• Human Cases of Borrelia miyamotoi Disease, Slovenia, 2025
  P. Bogovič et al. View Abstract

  We identified human Borrelia miyamotoi infections in Slovenia in 2 of 337 adults with undifferentiated fever tested positive by metagenomic sequencing and PCR. Both patients reported recent local tick bites. The illness was mild and self-limited. Our findings underscore the need to consider this pathogen in evaluating fever after tick bite.

• Outbreak of Salmonella enterica Serovar Reading Linked to Dried Bovine Meat, New South Wales, Australia, 2023
  E. Kerr et al. View Abstract

  An outbreak of Salmonella enterica serovar Reading in Sydney, New South Wales, Australia, was linked to a restaurant and meat products purchased from South Asian grocery stores. Salmonella Reading was isolated from dried bovine meat products obtained from the restaurant and traced to an unlicensed meat processor and manufacturer of dried meat products.

• Outbreak of Hepatitis A Linked to Frozen Blueberries, the Netherlands, 2024–2025
  I. Friesema et al. View Abstract

  Twenty-four patients in the Netherlands who became ill during November 2024–February 2025 were part of a hepatitis A virus genotype IA cluster. Consumption data combined with detection of RNA of the hepatitis A outbreak strain in a food product pointed toward frozen blueberries from a specific supermarket chain as the source.

• Case-Fatality Risk of Norovirus, England, 2022–2025
  M. L. Tang et al. View Abstract

  Norovirus incidence increased in England during 2022–2025, when GII.17 replaced GII.4 as the dominant genotype. By using nationally linked norovirus testing and fatality data, we found age and care setting, but not genotype, were associated with case-fatality risk. Increased incidence might reflect changes in transmissibility or population immunity.

• Emergent Vibrio parahaemolyticus Gastroenteritis Outbreaks, New Zealand, 2019–2022
  S. Jefferies et al. View Abstract

  We report the Trans-Pacific expansion of Vibrio parahaemolyticus pandemic clone sequence type 36 and emergence of sequence type 50 in Oceania, causing seafoodborne outbreaks in New Zealand. Unusual features of the outbreaks included diversity of the seafood sources and pathogenic strains and timing, occurring in both winter and summer seasons.

Research Letters

• Novel Parvovirus in Pigs Associated with Exophthalmos and Erythema, the Netherlands
  T. J. Tobias et al. View Abstract

  We report an outbreak of infections with a novel protoparvovirus on several commercial farms in the Netherlands and associations with a clinical syndrome in pigs characterized by exophthalmos and erythema. Evidence of involvement of this virus, highly similar to a vulpine parvovirus, was substantiated by long-read sequencing and in situ hybridization techniques.

• Hepatitis A Outbreak in Skilled Nursing Facility, Los Angeles County, California, USA, 2025
  M. T. Yazdi et al. View Abstract

  We investigated an outbreak of 5 hepatitis A cases among skilled nursing facility residents in Los Angeles County, California, USA, including 3 who were vaccinated after exposure. Our results suggest that persons in congregate living facilities should receive both the vaccine and immune globulin after hepatitis A exposure to mitigate further transmission.

• Antibodies Cross-Reactive with Bundibugyo Virus in Ferrets Vaccinated with Ebola Virus Vaccine
  J. Wight et al. View Abstract

  Banked serum samples from ferrets previously immunized with the Ebola virus vaccine revealed a prominent but limited humoral immune response that cross-reacted with Bundibugyo virus. The supporting immunogenicity data we report may help guide the ongoing response to the current outbreak of Bundibugyo virus in the Democratic Republic of the Congo.

• Human Lactococcus garvieae Bloodstream Infection Complicated by Spondylodiscitis, Germany
  P. Schulz et al. View Abstract

  Lactococcus garvieae bloodstream infection in a woman in Germany resulted in spondylodiscitis and bioprosthetic mitral valve endocarditis. Six weeks of ceftriaxone followed by 10 days of doxycycline led to sustained clinical and microbiological resolution. This case highlights the need for thorough diagnostic testing and individualized, shared decision-making in infective endocarditis cases.

• Antimicrobial Resistance in Extragenital Neisseria gonorrhoeae Infections, US Military Centers, 2022–2024
  J. L. Dombach et al. View Abstract

  We analyzed antimicrobial resistance markers in 189 Neisseria gonorrhoeae patient encounters from 2 US military medical centers. Co-occurring resistance-associated markers were common; we detected plasmid-mediated β-lactamase in extragenital sites. Our findings highlight the importance of anatomic site–specific surveillance and, potentially, molecular antimicrobial resistance detection to guide screening and treatment strategies.

• Surveillance of Ticks and Tickborne Borrelia, Ehrlichia, and Rickettsia spp., Texas, USA, 2014–2021
  Y. Zhang et al. View Abstract

  We report the temporal and geographic distribution of ticks and tickborne Borrelia, Ehrlichia, and Rickettsia spp. bacteria in Texas, USA, 2014–2021, updating the previous 2008–2014 passive surveillance report. We identified 9 tick species and an overall prevalence of tested bacterial species of 26.0%, predominantly Rickettsia amblyommatis.

• Kudoa septempunctata Parasite–Associated Foodborne Disease Outbreaks, South Korea, 2015–2024
  S. Kim and B. Chun

Letters

• Tuberculosis after TB Preventive Therapy in Persons Living with HIV Initiating Antiretroviral Therapy, Mozambique
  L. Templin et al.
• Detection of bla_OXA-23–Positive Proteus mirabilis Isolate, United States, 2024
  G. Orazi et al.
• Tuberculosis after TB Preventive Therapy in Persons Living with HIV Initiating Antiretroviral Therapy, Mozambique
  Q. Chen
• Doxycycline Resistance and 16S rRNA Mutations in Treponema pallidum
  M. A. Beale et al.
• Doxycycline Resistance and 16S rRNA Mutations in Treponema pallidum (Response)
  G. S. Long and V. R. Duvvuri

Another Dimension

• My Long Road Back to Life
  C. Möbius-Friedmann and P. Schulz View Abstract

  A patient recounts her experience of surviving zoonotic endocarditis caused by the rare bacterial pathogen Lactococcus garvieae. She reflects on the potentially life-changing medical decisions she faced and the physical and emotional challenges of recovery. Her story highlights resilience, adaptation, and the gradual journey back to everyday normality.

Books and Media

• The Formula for Better Health
  D. M. Brett-Major

Etymologia

• Helicobacter pylori
  H. Santos-Dutra et al.
• Lactococcus garvieae
  C. Partin

Correction

• Correction: Vol. 32, No. 2

About the Cover

• Seeing Patterns—from Glass Art to Public Health
  L. Mitchell and E. Belay

Synopsis

• Neoehrlichiosis Causing Hemolytic Anemia in Patients Treated with Rituximab, Norway
  M. Paulson et al.

Research

• Improved Case Detection of Flea-Borne Typhus through Polymerase Chain Reaction Testing, Los Angeles County, California, 2022–2024
  A. Sanosyan 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.

• Serologic Evidence of Hantavirus Exposure in Humans, Italy, 2004–2018
  G. Faolotto 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.
• Autochthonous Canine Pythiosis Linked with Freshwater Exposure, Italy, 2021–2024
  A. Peano et al.

Research

• Wastewater Surveillance to Track a Resurgent Outbreak of Measles, Ontario, Canada, 2025
  R. Corchis-Scott et al.

Dispatch

• Emergence of Divergent H5N1 (Clade 2.3.4.4b) in Central Park in São Paulo, Brazil, 2025
  J. de Araujo 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.
• Evaluation of Detection Methods for Wastewater Surveillance of Antimicrobial-Resistant Bacteria from Healthcare Facilities
  E. Warren et al.
• A MultiPartner Effort to Launch and Sustain Wastewater Surveillance in the United States
  J. Yoder et al.
• Early-Season Detection of Influenza A(H3N2) Subclade K in Wastewater, Colorado, USA, 2025–26
  M. C. Hetherington-Rauth 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.
• Exploration of Public Perceptions of Wastewater Surveillance, United States, June 2024
  J. T. Moore et al.
• Temporal Alignment of Wastewater-based Signals with Clinical Indicators of Respiratory Illness in Post-Pandemic Texas
  K. Bi et al.