Early Release

Perspective

• Reassortment of High Pathogenicity Avian Influenza as a Driver for Zoonotic Spillover, Asia
  A. Byrne et al.

Synopses

• Meta-analysis of Maternal and Fetal Outcomes of Crimean-Congo Hemorrhagic Fever during Pregnancy
  B. Donk et al.
• Early Action Review of Detection, Notification, and Response Timeliness during Cross-Border Bundibugyo Virus Disease Outbreak, Uganda, 2026
  J. Kayiwa et al.
• Systematic Review and Meta-analysis of Group B Streptococcus Rectovaginal Colonization Rates and Serotype Distribution in Pregnant Women, Asia-Pacific Region, 2014–2025
  Z. Toh 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.
• Molecular Epidemiology and Evolution of Swine Influenza A Viruses in Vietnam, 2020 to 2024
  N. Bui et al.
• Multisectoral Emergence of Multidrug-Resistant Campylobacter coli ST-10042 Lineage, Europe, 2018–2025
  M. Azevedo et al.
• Isothermal Detection of Influenza D using Reverse Transcription Loop-Mediated Isothermal Amplification
  C. dos Santos et al.
• Experimental Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Alpacas, 2026
  J. Schön et al.
• Multiple Introductions and Cross-Sector Transmission of Salmonella enterica Serovar Infantis Carrying bla_CTX-M-65 Gene, South Korea, 2022–2024
  E. Shin 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.
• Transmission Characteristics and Superspreading Potential of Andes Virus Human-to-Human Transmission
  Z. Guo et al.
• Emergence of Plasmodium malariae and Co-endemicity of 3 Plasmodium Species Parasites, Khanh Hoa Province, Vietnam, 2023–2025
  T. Võ et al.
• Fatal Infection with Dengue Virus and Avian Orthoavulavirus 1 in Traveler from Saudi Arabia, 2025
  M. Salmona et al.
• Clinical Characterization of Invasive Meningococcal Disease Outbreak, Uzbekistan, 2026
  B. B. Rakhimov et al.
• Detection of Highly Pathogenic Avian Influenza A(H5N1) Virus in Cat and Rats during Outbreak in Backyard Poultry, United States, 2025
  S. M. Storms et al.
• Chlamydia psittaci Meningitis, Chile, 2023
  Y. I. Pinos Garcia et al.

Research Letters

• 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.
• Age Differences in Pertussis Epidemics, New South Wales, Australia, 2015 and 2024
  E. F. Madden et al.
• Evaluation of Trichodysplasia Spinulosa Polyomavirus in Skin Biopsies
  I. M. Espinal et al.
• Transmissibility and Case Fatality of Bundibugyo Virus Estimated from First Outbreak, Uganda, 2007
  B. de Padua and A. R. Akhmetzhanov
• Cocirculation of Human Mpox Clade 1b with Varicella-Zoster Virus, Uganda
  N. Bbosa et al.
• Human Infection with Japanese Encephalitis Virus Genotype V, China, 2025
  W. Zou et al.

In Memoriam

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

Dispatch

• Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Camels, Kazakhstan, 2025
  A. Kydyrmanov et al.

Research Letter

• Community Transmission of Pneumonic Plague, Fenoarivobe, Madagascar 2022
  L. Randrianasolo et al.

Dispatch

• Scrub Typhus Masquerading as Typhoid Fever in Patient with Myelodysplastic Syndrome, China, 2025
  Y. Li et al.

• Implementation and Early Outcomes of Laboratory Proficiency Testing Program for National Wastewater Surveillance System, United States, 2024
  H. Dutcher et al. View Abstract

  Underlying the core goals of the Centers for Disease Control and Prevention National Wastewater Surveillance System (NWSS) in the United States is the need for robust and reliable pathogen data. The rapid build-out of the NWSS network and participation of many laboratories with varying expertise in environmental molecular methods has resulted in a lack of method standardization and poor data comparability. Proficiency testing is a powerful strategy to address this challenge. We describe preliminary outcomes from 2 proficiency testing rounds with 38 total participating laboratories, where reported respiratory virus concentrations from replicate samples spanned roughly 2 orders of magnitude; the program identified key opportunities for improvement. Although still in its infancy, this program proved an effective tool for quantifying variability across the network, offering preliminary insights on method performance, and improving data quality through laboratory support. Our results suggest that wastewater proficiency testing for disease surveillance will improve data quality and strengthen the NWSS.

• Public Understanding of Wastewater Surveillance, United States, August 2025
  R. H. Soelaeman et al. View Abstract

  We examined public understanding of wastewater surveillance (WS) data and perceptions of its importance by using a nationwide cross-sectional survey. Approximately half of participants were aware of WS, and 79.0% responded that WS information about viruses was important, highlighting the need for community engagement about WS use and value.

• Wastewater Respiratory Virus Surveillance in Remote Community, Alaska, USA, 2022–2024
  B. Lefferts et al. View Abstract

  Wastewater surveillance (WS) is underused in rural communities. We evaluated WS performance in the remote, subarctic, mostly Indigenous, community of Bethel, Alaska, USA, during October 2022–May 2024. Wastewater was collected >3 times weekly and underwent on-site PCR testing for SARS-CoV-2, respiratory syncytial virus (RSV), and influenza A and B viruses. We compared WS virus detection with local clinical data by using results from 318 wastewater samples and 7,392 clinical tests. We detected SARS-CoV-2 in 265 (83.3%) wastewater samples, influenza A virus in 128 (40.3%), RSV in 78 (24.5%), and influenza B virus in 29 (9.1%). Wastewater signals correlated with clinical results for influenza B virus (Spearman ρ = 0.85), influenza A virus (ρ = 0.62), RSV (ρ = 0.60), and SARS-CoV-2 (ρ = 0.59), providing corroborating data that informed the timing of seasonal respiratory virus immunization campaigns. Our findings show that WS is feasible and useful for disease surveillance in rural Alaska.

• Monkeypox Virus Surveillance in Wastewater, North Carolina, USA, October 2023–May 2025
  N. L. Snyder et al. View Abstract

  In September 2023, the North Carolina Department of Health and Human Services identified a new case of mpox clade II 5 months after the last previous report. To assess possible unrecognized transmission, nonvariola orthopoxvirus testing was implemented at select wastewater sites. During October 29, 2023–May 2025, a total of 801 samples were collected across 16 treatment plants serving ≈2 million residents. We analyzed wastewater detections (n = 47) and clinical cases (n = 45) using a +17-day window. Overall sensitivity of identifying the presence of >1 temporally aligned mpox case within a sewershed was 10.6% (95% CI 6.5%–16.7%); specificity was 95.1% (95% CI 93.2%–96.5%), positive predictive value was 31.9% (95% CI 20.4%–46.2%), and negative predictive value was 83.2% (95% CI 80.3%–85.7%). Restricting detections above the limit of detection reduced sensitivity but increased specificity. Overall, wastewater surveillance showed low sensitivity but provided complementary awareness for public health response.

• 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.

• 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.

• Correlations between Wastewater Concentrations of Influenza A and Respiratory Syncytial Viruses and Clinical Laboratory Testing and Hospitalization Data, California, USA
  E. Burnor et al. View Abstract

  We evaluated correlations between influenza A virus and respiratory syncytial virus (RSV) wastewater concentrations in California, USA, and 3 clinical laboratory–based disease surveillance datasets: sentinel laboratory surveillance, mandatory electronic laboratory reporting data, and laboratory-confirmed influenza hospitalizations. We evaluated data from 10 counties and 18 wastewater treatment plants in California during July 2022–March 2024. We observed strong, positive, and statistically significant correlations between individual sewershed-level wastewater concentrations and county-aggregated wastewater concentrations of influenza A and RSV and clinical laboratory–based surveillance datasets (median Kendall τ 0.62 [range 0.40–0.78]; p<0.05). A lead–lag analysis did not show consistent evidence of wastewater leading other surveillance datasets across all counties and wastewater treatment plants (influenza A –16 to 22 days; RSV –8 to 35 days). Wastewater surveillance can augment other disease surveillance modalities and improve situational awareness of influenza A and RSV transmission in communities.

• Temporal Alignment of Wastewater Signals with Clinical Indicators of Respiratory Illness Postpandemic, Texas, USA
  K. Bi et al. View Abstract

  In the COVID-19 postpandemic era, declining clinical testing for SARS-CoV-2 has led to the exploration of complementary early detection methods. We evaluated metagenomic wastewater-based epidemiology (WBE) in Texas, USA, by comparing viral signals with the National Syndromic Surveillance Program tracked emergency department visits and Texas All-Payer Claims Database insurance claims across several Texas counties during 2022–2024. By analyzing SARS-CoV-2, influenza, and respiratory syncytial virus, we found moderate-to-strong temporal correlations between wastewater and clinical indicators. Influenza showed the most stable associations (r<0.98), whereas SARS-CoV-2 signals generally preceded clinical metrics. Respiratory syncytial virus exhibited higher geographic and temporal heterogeneity, reflecting differences in clinical data capture. Despite sampling frequency and geographic alignment challenges, metagenomic WBE consistently tracked community trends. Our findings suggest WBE can offer valuable situational awareness and a resilient complement to clinical surveillance, supporting public health preparedness in an evolving respiratory disease landscape.

• Laboratory assessment of wastewater as a surveillance tool for West Nile virus
  J. Spring et al.
• Correlation of Norovirus in Wastewater with Gastroenteritis-Related Hospitalizations, New York, USA, 2022–2024
  O. F. Nwabor et al.