Early Release

Synopsis

• Life-Threatening SARS-CoV-2–Associated Encephalopathy and Multiorgan Failure in Children, Asia and Oceania, 2022–2024
  M. Kasai et al. View Abstract

  SARS-CoV-2 infections in children occasionally manifest with severe neurologic signs. We report a case series of life-threatening encephalopathy associated with SARS-CoV-2 in 25 children in Australia, Japan, Singapore, and Taiwan during February 2022–January 2024. All children had severe encephalopathy develop, characterized by rapidly progressive cerebral edema, conditions known as acute shock with encephalopathy and multiorgan failure or acute fulminant cerebral edema. Among the 25 patients, 22 (88%) eventually died; 11 (44%) children died within 24 hours of hospitalization. In addition, 18 (72%) had illness manifest with shock, and 14 (56%) had multiorgan failure develop within 6 hours of neurologic onset. Serum concentrations of cytokines/chemokines including interleukin 6 and tumor necrosis factor-α were significantly higher within 24 hours of onset than for controls. SARS-CoV-2–associated encephalopathy cases such as those described here represent an emerging neurologic crisis with high mortality rate resulting from rapidly progressive brain edema and multiorgan failure.

Research

• Predictors of Fatal Outcomes among Pediatric Patients Hospitalized for Rocky Mountain Spotted Fever, Sonora, Mexico, 2004–2024
  S. Bellman et al. View Abstract

  The tickborne disease Rocky Mountain spotted fever (RMSF) remains life-threatening among children in northern Mexico. We retrospectively investigated 500 pediatric RMSF patients hospitalized in Sonora during 2004–2024. We analyzed clinical, laboratory, and sociodemographic data to identify predictors of fatality by using descriptive statistics and multivariable logistic regression. We found that the overall case-fatality rate was 19.8%, decreasing over time from 31.4% (2004–2013) to 14.5% (2014–2024). Fatal outcomes were associated with delayed doxycycline treatment (>5 days after symptom onset), older age, Indigenous background, and abnormal laboratory markers. Among survivors, 16% had life-altering sequelae, including amputations and neurologic deficits. Cases occurred year-round, predominantly in urban settings. Timely doxycycline administration remains a critical factor in reducing mortality rates. Vulnerable populations, including persons living in poverty, children >10 years of age, and Indigenous communities, require targeted interventions. Strengthening early diagnosis and understanding mechanisms underlying severe disease and death could improve RMSF outcomes in endemic regions.

• Leptotrombidium imphalum as Vector for Scrub Typhus in Human Settlements, India, 2022–2023
  C. S. Devamani et al.
• Pathogenesis of Pulmonary Complications in Fatal Yellow Fever, Brazil, 2017–2019
  A. N. Duarte-Neto et al.
• Assessing Dengue Transmission Risk in Travelers Using Routine Surveillance Data
  K. Rysava et al.

Dispatches

• Retail Milk Monitoring of Influenza A(H5N1) in Dairy Cattle, United States, 2024–2025
  N. N. Tarbuck et al. View Abstract

  US retail milk monitoring during April 13–May 3, 2024, identified influenza A(H5N1) viral RNA in 36% of retail milk samples, indicating widespread undetected infections in US dairy cows. After federal initiatives, reported infections more closely aligned with findings in retail milk during December 27, 2024–January 29, 2025, reflecting improved detection and control.

• Genomic Analysis of Doxycycline Resistance–Associated 16S rRNA Mutations in Treponema pallidum Subspecies pallidum
  G. S. Long et al. View Abstract

  We inspected 16S rRNA sequences of 784 publicly available Treponema pallidum subspecies pallidum genomes and 17 new T. pallidum subsp. pallidum genomes from Canada for putative mutations associated with doxycycline resistance. Variants were detected in 9 non-Canada genomes. These findings establish a global genomic baseline for monitoring doxycycline resistance in syphilis.

• Donor-Derived West Nile Virus Infection in Kidney Recipients, France
  A. Truffot et al.
• Characteristics and Transmission Dynamics of Global Travel-Related Mpox Cases Caused by Clade Ib Monkeypox Virus
  H. Laurenson-Schafer et al. View Abstract

  We examined 89 travel-related clade Ib monkeypox virus cases detected in 33 countries during August 2024–July 2025. Most cases were among men; about one third led to secondary transmission. Secondary transmission risk was highest among sexual, then household, contacts. Those groups should be the focus of response strategies and interventions.

• Measles Outbreak Driven by Nosocomial Transmission, Armenia, February–July 2023
  K. Palayan et al. View Abstract

  During March–July 2023, we investigated a measles outbreak in Armenia. Of 287 patients, 130 were <5 years of age and 215 (75%) were unvaccinated. Among 3 transmission chains involving 183 cases, 70% of patients were exposed in healthcare facilities. To minimize nosocomial transmission, measles vaccination should be encouraged among healthcare workers.

• Desulfovibrio Bacteremia in Patients with Abdominal Infections, Japan, 2020–2025
  N. Watanabe et al. View Abstract

  We reviewed 8 episodes of Desulfovibrio bacteremia in Japan (2020–2025) and confirmed 4 species by 16S rRNA gene and whole-genome sequencing. We detected β-lactamase genes in 2 D. desulfuricans (bla_DES-1-like), 1 D. falkowii (bla_MUN-1), and 2 D. fairfieldensis (bla_CfiA-like). Mass spectometry failed to identify D. falkowii or D. legallii.

• Neospora caninum Infections in Marine Mammals Stranding in Northeastern Pacific Ocean
  S. A. Raverty et al.
• Multiplex PCR to Differentiate Monkeypox Virus Clades
  C. T. Williams et al. View Abstract

  We designed a multiplex quantitative PCR to differentiate monkeypox virus clades. For clinical samples collected in the United Kingdom and Nigeria, sensitivity was 78% (95% CI 67.67%–86.14%) and specificity 94% (95% CI 80.84%–99.30%); for samples with cycle thresholds <35, sensitivity was 98% (95% CI 91.72%–99.96%) and specificity 94% (95% CI 80.84%–99.30%).

• Effectiveness of RSV Vaccines against RSV-Associated Thromboembolic Events
  R. E. Wiegand et al. View Abstract

  We evaluated effectiveness of respiratory syncytial virus (RSV) vaccines against RSV-associated thromboembolic events among community-dwelling Medicare fee-for-service beneficiaries >65 years of age in the United States enrolled during October 1, 2023–March 30, 2024. RSV vaccines protected against RSV-associated thromboembolic events (effectiveness 79% [95% CI 74%–83%]) in the same season as vaccine receipt.

• Avian Influenza A(H9N2) Virus Transmission across Chicken Production and Distribution Networks, Vietnam
  M. Hennessey et al. View Abstract

  In northern Vietnam, during March 2021–March 2022, prevalence of influenza A(H9N2) in chickens was higher in distribution facilities than on farms and varied between facility types. Phylogenetic analysis indicated extensive viral mixing along networks of chicken production and distribution, highlighting a need for risk mitigation across the entire network.

• Case of Legionella pneumophila Serogroup 1 Infection Linked to a Water Flosser
  C. Slekovec et al.
• Temporal Clustering of Mycoplasma pneumoniae–Associated Encephalitis and Stroke in South Korea, 2024
  S. H. Song et al.
• Autochthonous Rat Lungworm Angiostrongylus cantonensis Infections in Accidental and Definitive Hosts, San Diego, California, USA
  S. Nakagun et al. View Abstract

  The rat lungworm, Angiostrongylus cantonensis, is an emerging veterinary and public health concern. We describe A. cantonensis infections in a zoo-housed parma wallaby and free-ranging Virginia opossums and roof rats in San Diego, California, USA. Angiostrongyliasis should be considered in central nervous system disease in humans and animals in this region.

Research Letters

• Airport Malaria Cluster in Certified Malaria-Free Country, Libya, 2024
  A. M. Alarbi et al.
• Severe Respiratory Diphtheria-Like Illness Caused by Toxigenic Corynebacterium ulcerans
  R. Helleren et al. View Abstract

  We report a possible zoonotic case of severe diphtheria-like respiratory illness in Norway caused by a previously unreported toxigenic Corynebacterium ulcerans sequence type. This case highlights C. ulcerans as an emerging pathogen that can cause life-threatening disease. Clinicians should be aware of C. ulcerans infection, even in regions where diphtheria is rare.

• Monkeypox Virus Antibodies in Healthy Persons after Vaccination, United Kingdom
  V. H. Sheridan et al.
• Invasive Pneumococcal Disease among Childbearing-Age Women, United States, 2007–2023
  N. Prasad et al. View Abstract

  US data on invasive pneumococcal disease incidence among pregnant and postpartum women are limited. We estimated incidence in those groups using population-based surveillance. Compared with nonpregnant women of childbearing age, incidence was similar for pregnant women but 3.5 times higher for postpartum women. Our findings could inform pneumococcal vaccine recommendations.

• Multicenter Serologic Investigation of Influenza D Virus in Cats and Dogs, Europe, 2015–2024
  C. Trombetta et al. View Abstract

  We conducted a multicenter study in Europe (France, Italy, and Ukraine) to assess the seroprevalence of influenza D virus (IDV) in domestic cats and dogs. Serum samples from France (2015–2018) and Italy (2023–2024) showed no IDV positivity. In Ukraine, 2.46% of dogs and 0.85% of cats tested IDV-positive in 2024.

• Acute Severe Hepatitis B Virus Infection in Previously Vaccinated Patient during Acalabrutinib Treatment
  L. Rojek et al. View Abstract

  We describe acute severe hepatitis B virus (HBV) infection with liver failure requiring transplantation in a patient in Poland treated with acalabrutinib. The patient was fully vaccinated against HBV and had adequate HBV antibody titers and no HBV exposure documented before therapy. Differential diagnoses for jaundice should consider HBV in patients receiving acalabrutunib.

• Vaccine-like African Swine Fever Virus Strain in Domestic Pigs, Thailand, 2024
  T. Nguyen et al.

Emerging Infection Networks Letter

• Candida auris Testing by the Antimicrobial Resistance Laboratory Network, United States, 2022–2023
  J. E. Laury et al. View Abstract

  During 2022–2023, the Antimicrobial Resistance Laboratory Network tested 8,033 Candida auris clinical isolates in the United States. Overall, 95% of isolates were fluconazole resistant, 15% amphotericin B resistant, and 1% echinocandin resistant. Laboratory capacity for C. auris identification and antifungal susceptibility testing is essential to address this emerging public health threat.

Etymologia

• Mumps [muhmps]
  S. Mohan and A. Khan

Correction

• Correction: Vol. 32, No. 1

About the Cover

• Yellow Fever in Buenos Aires
  T. Chorba

Synopsis

• Stenotrophomonas maltophilia Bloodstream Infection Outbreak in Acute Care Hospital, California, United States, 2022–2023
  S. M. Khan et al.

Research

• Environmental and Phylogenetic Investigations of Aspergillus flavus Outbreak Linked to Contaminated Building Materials, Denmark, 2025
  A. Gewecke et al.
• Lymphocytic Choriomeningitis Virus Seroprevalence among Urban Pregnant Women and Newborn Infants, Philadelphia, USA, 2021
  D. D. Flannery et al.
• Genetically Similar High-Risk Strains of Carbapenemase-Producing Enterobacterales in Humans and Companion Animals, United States
  L. Xiaoli et al.
• Accelerated Increase in Candidozyma (Candida) auris Bloodstream Infections during COVID-19 Pandemic, South Africa
  H. Ismail et al.
• Strongyloides Genetic Diversity among Humans, Dogs, and Nonhuman Primates, Central African Republic, 2016–2022
  E. Nosková et al.
• Projected Effects of Global Tuberculosis Epidemiology on Mycobacterium tuberculosis Prevalence and Immunoreactivity, 2024–2050
  M. Machado et al.
• Seroincidence Rate of Typhoidal Salmonella in Children, Kenya, 2017–2018
  A. Khan et al.
• Blastomyces antigen testing in urine for active case identification during a blastomycosis outbreak
  A. W. O’Connor et al.

Policy Review

• Rethinking Leptospirosis Prevention, the Philippines
  R. V. Labana

Dispatches

• Rapid Interventions to Limit Outbreak of Invasive Streptococcus pneumoniae in Correctional Facility, North Carolina, USA, 2024
  C. D. Gowler et al.
• Emerging Endemic Area for Blastomycosis, New York, USA, 2000–2024
  L. E. Ramirez et al.
• Tuberculosis in Persons Living with HIV Initiating Antiretroviral Therapy after TB Preventive Therapy, Mozambique, 2021–2024
  L. Templin et al.
• Optimal specimens and lesions for mpox diagnosis using real-time polymerase chain reaction in Korea: a retrospective observational study
  D. Kim et al.

Research Letters

• Detecting Influenza A(H5N1) Viruses through Severe Acute Respiratory Infection Surveillance, Cambodia
  W. W. Davis et al. View Abstract

  Of 19 human cases of avian influenza A(H5N1) virus infection detected during January 2023–March 2025 in Cambodia, 12 (63%) were detected directly by surveillance for severe acute respiratory infection (SARI) or indirectly by testing ill close contacts. SARI surveillance can supplement other surveillance sources for identifying H5N1 cases.

• Oestrus ovis Nasal Myiasis with Pupation in Human Host, Greece, October 2025
  I. P. Kioulos
• Costs of Extrapulmonary Nontuberculous Mycobacterial Disease, Denmark, 2005–2017
  V. Dahl et al.
• Crimean-Congo Hemorrhagic Fever Virus Seroprevalence among Hunter-Gatherers, Northeastern DRC
  D. M. Kasumba et al.

Online Report

• New 2030 Global Target for Histoplasmosis
  A. C. Pasqualotto et al.