Fazal A, Reinhart K, Huang S
… +8 more, Kniss K, Olson SM, Dugan VG, Ellington S, Budd AP, Reed C, Uyeki TM, Garg S
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 40014654
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In late January 2025, CDC received anecdotal reports of children with influenza-associated acute necrotizing encephalopathy (ANE), a severe form of influenza-associated encephalopathy or encephalitis (IAE), including sev...In late January 2025, CDC received anecdotal reports of children with influenza-associated acute necrotizing encephalopathy (ANE), a severe form of influenza-associated encephalopathy or encephalitis (IAE), including several fatal cases. In response, CDC examined trends in the proportions of cases with IAE among influenza-associated pediatric deaths reported during the 2010-11 through 2024-25 influenza seasons, including demographic and clinical characteristics of identified cases. CDC contacted state health departments to ascertain whether any pediatric influenza-associated deaths with IAE reported this season also had a diagnosis of ANE. Among 1,840 pediatric influenza-associated deaths during the 2010-11 through 2024-25 influenza seasons, 166 (9%) had IAE, ranging from 0% (2020-21 season) to 14% (2011-12 season); preliminary data for the 2024-25 season (through February 8, 2025) indicate that nine of 68 (13%) had IAE. Across seasons, the median age of patients with fatal IAE was 6 years; 54% had no underlying medical conditions, and only 20% had received influenza vaccination. Because no dedicated national surveillance for IAE or ANE exists, it is unknown if the numbers of cases this season vary from expected numbers. Health care providers should consider IAE in children with acute febrile illness and neurologic signs or symptoms lasting >24 hours. Evaluation should include testing for influenza and other viruses and neuroimaging; clinical management should include early antiviral treatment for suspected or confirmed influenza and supportive critical care management as needed. Influenza vaccination is recommended for all eligible persons aged ≥6 months as long as influenza viruses are circulating.
Gargano JW, Stefanos R, Dahl RM
… +17 more, Castilho JL, Bostick EA, Niccolai LM, Park IU, Blankenship S, Brackney MM, Chan K, Delikat EL, Ehlers S, Barrera KG, Kurtz R, Meek JI, Whitney E, Vigar M, Unger ER, Markowitz LE, HPV-IMPACT Working Group
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 40014651
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In 2006, human papillomavirus (HPV) vaccine was first recommended in the United States to prevent cancers and other diseases caused by HPV; vaccination coverage increased steadily through 2021, and increasing numbers of...In 2006, human papillomavirus (HPV) vaccine was first recommended in the United States to prevent cancers and other diseases caused by HPV; vaccination coverage increased steadily through 2021, and increasing numbers of young women had received HPV vaccine as children or adolescents. Since 2008, CDC has monitored incidence of precancerous lesions (cervical intraepithelial neoplasia [CIN] grades 2-3 and adenocarcinoma in situ [AIS], collectively CIN2+), which are detected through cervical cancer screening and can be used as an intermediate outcome for monitoring vaccination impact, via the five-site Human Papillomavirus Vaccine Impact Monitoring Project. This analysis describes trends in incidence of CIN2+ and CIN3+ (i.e., CIN grade 3 and AIS) lesions during 2008-2022. Among women aged 20-24 years who were screened for cervical cancer, rates during 2008-2022 decreased for CIN2+ by 79%, and for CIN3+ by 80%. In the same period, CIN3+ rates among screened women aged 25-29 years decreased by 37%. These data are consistent with considerable impact of HPV vaccination for preventing cervical precancers among women in the age groups most likely to have been vaccinated, and support existing recommendations to vaccinate children at the routinely recommended ages as a cancer prevention measure.
Falender R, Radniecki TS, Kelly C
… +5 more, Cieslak P, Mickle D, Hall H, Scholz R, Sutton M
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 40014649
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Wastewater surveillance is an important tool in the surveillance of emerging pathogens and has been leveraged during the highly pathogenic avian influenza (HPAI) A(H5N1) virus outbreak in cattle and poultry in the United...Wastewater surveillance is an important tool in the surveillance of emerging pathogens and has been leveraged during the highly pathogenic avian influenza (HPAI) A(H5N1) virus outbreak in cattle and poultry in the United States. Interpretation of avian influenza A(H5) subtype detections in wastewater requires an understanding of human and animal contributors to the sewershed because current testing does not distinguish between human and animal sources. Potential animal contributors include wild birds, farms with poultry or dairy cattle outbreaks, and dairy processing facilities. Retrospective analysis of 551 influenza A virus-positive wastewater surveillance samples from 20 sites in Oregon during September 15, 2021-July 11, 2024, revealed 21 avian influenza A(H5) subtype detections across 12 communities. Avian influenza A(H5) subtype detections in wastewater began approximately 6 weeks before Oregon's first HPAI outbreak in domestic poultry, 7 weeks before Oregon's first avian influenza A(H5) detection in wild birds, and 2 years before the first HPAI A(H5N1) outbreak in dairy cattle in the United States (Oregon has not detected HPAI A(H5N1) in dairy cattle or milk). No association was found between detection of avian influenza A(H5) in a community's wastewater and history of an HPAI A(H5) outbreak among poultry in the county or presence of dairy processing facilities or dairy farms within the sewershed. Avian influenza A(H5) was detected most frequently in two communities with important wild bird habitats. Animal inputs, including from wild birds, should be considered when interpreting avian influenza A(H5) subtype detections in wastewater.
Link-Gelles R, Chickery S, Webber A
… +53 more, Ong TC, Rowley EAK, DeSilva MB, Dascomb K, Irving SA, Klein NP, Grannis SJ, Barron MA, Reese SE, McEvoy C, Sheffield T, Naleway AL, Zerbo O, Rogerson C, Self WH, Zhu Y, Lauring AS, Martin ET, Peltan ID, Ginde AA, Mohr NM, Gibbs KW, Hager DN, Prekker ME, Mohamed A, Johnson N, Steingrub JS, Khan A, Felzer JR, Duggal A, Wilson JG, Qadir N, Mallow C, Kwon JH, Columbus C, Vaughn IA, Safdar B, Mosier JM, Harris ES, Chappell JD, Halasa N, Johnson C, Natarajan K, Lewis NM, Ellington S, Reeves EL, DeCuir J, McMorrow M, Paden CR, Payne AB, Dawood FS, Surie D, CDC COVID-19 Vaccine Effectiveness Collaborators
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 40014628
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COVID-19 vaccination averted approximately 68,000 hospitalizations during the 2023-24 respiratory season. In June 2024, CDC and the Advisory Committee on Immunization Practices (ACIP) recommended that all persons aged ≥6...COVID-19 vaccination averted approximately 68,000 hospitalizations during the 2023-24 respiratory season. In June 2024, CDC and the Advisory Committee on Immunization Practices (ACIP) recommended that all persons aged ≥6 months receive a 2024-2025 COVID-19 vaccine, which targets Omicron JN.1 and JN.1-derived sublineages. Interim effectiveness of 2024-2025 COVID-19 vaccines was estimated against COVID-19-associated emergency department (ED) or urgent care (UC) visits during September 2024-January 2025 among adults aged ≥18 years in one CDC-funded vaccine effectiveness (VE) network, against COVID-19-associated hospitalization in immunocompetent adults aged ≥65 years in two networks, and against COVID-19-associated hospitalization among adults aged ≥65 years with immunocompromising conditions in one network. Among adults aged ≥18 years, VE against COVID-19-associated ED/UC visits was 33% (95% CI = 28%-38%) during the first 7-119 days after vaccination. Among immunocompetent adults aged ≥65 years from two CDC networks, VE estimates against COVID-19-associated hospitalization were 45% (95% CI = 36%-53%) and 46% (95% CI = 26%-60%) during the first 7-119 days after vaccination. Among adults aged ≥65 years with immunocompromising conditions in one network, VE was 40% (95% CI = 21%-54%) during the first 7-119 days after vaccination. These findings demonstrate that vaccination with a 2024-2025 COVID-19 vaccine dose provides additional protection against COVID-19-associated ED/UC encounters and hospitalizations compared with not receiving a 2024-2025 dose and support current CDC and ACIP recommendations that all persons aged ≥6 months receive a 2024-2025 COVID-19 vaccine dose.
Naraharisetti R, Weinberg M, Stoddard B
… +12 more, Stobierski MG, Dodd KA, Wineland N, Beal M, Morse J, Hatter S, Sledge D, Youatt K, Coyle J, McFadden J, Uyeki TM, Durand LO
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 39977383
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Highly pathogenic avian influenza (HPAI) A(H5N1) virus, clade 2.3.4.4b, genotype B3.13 infection has been documented in cats on U.S. dairy cattle farms. In May 2024, the detection of HPAI A(H5N1) virus infection in two c...Highly pathogenic avian influenza (HPAI) A(H5N1) virus, clade 2.3.4.4b, genotype B3.13 infection has been documented in cats on U.S. dairy cattle farms. In May 2024, the detection of HPAI A(H5N1) virus infection in two cats that were reported to be exclusively indoor, and that had respiratory and neurologic illness in different households, prompted an investigation by the Michigan Department of Health and Human Services and Mid-Michigan District Health Department (MDHHS/MMDHD). The cats' owners and household members were interviewed and offered testing for influenza A(H5) virus. The owner of one cat worked on a dairy farm but declined A(H5) testing; three other household members received negative A(H5) test results. The owner of the other cat lived alone and worked on multiple dairy farms transporting unpasteurized milk; this worker also reported getting splashed in the face and eyes by unpasteurized milk but declined A(H5) testing. Both workers were employed in a county known by MDHHS/MMDHD to have HPAI A(H5N1) virus, clade 2.3.4.4b, genotype B3.13-positive dairy cattle. In states with confirmed HPAI A(H5N1) in livestock, veterinary care can be aided if veterinarians obtain household members' occupational information, especially when evaluating cats with signs of respiratory or neurologic illness. If occupational exposure to HPAI A(H5N1)-infected livestock is identified among cat owners, and their companion cats are suspected to have HPAI A(H5N1) virus infection, it is important that veterinarians contact state and federal public health and animal health officials to collaborate on joint One Health investigations and testing to protect human and animal health.
Ware-Gilmore F, Rodriguez DM, Ryff Mph K
… +12 more, Torres JM, Velez MP, Torres-Toro CT, Santiago GA, Rivera A, Madewell ZJ, Maldonado Y, Cardona-Gerena I, Brown GC, Adams LE, Paz-Bailey G, Marzán-Rodriguez M
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 39977371
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Dengue, a mosquitoborne viral infection, is a public health threat in Puerto Rico, where multiple dengue virus (DENV) serotypes circulate. Dengue causes an acute febrile illness that can progress to severe disease or dea...Dengue, a mosquitoborne viral infection, is a public health threat in Puerto Rico, where multiple dengue virus (DENV) serotypes circulate. Dengue causes an acute febrile illness that can progress to severe disease or death. The last outbreak declared by the Puerto Rico Department of Health occurred during 2013. In January 2024, the number of dengue cases in Puerto Rico surpassed the epidemic threshold and remained elevated, prompting the Puerto Rico Department of Health to declare a public health emergency in March 2024. In collaboration with CDC, a dengue outbreak response was initiated to monitor the outbreak and implement vector-control measures alongside public health campaigns to raise awareness about increasing dengue case numbers and strategies to prevent mosquito bites. During 2024, a total of 6,291 confirmed dengue cases were reported; the highest numbers of cases were reported in the municipalities of San Juan (1,200; 17.3%), Carolina (354; 5.1%), and Rincón (252; 3.6%). DENV serotype 3 predominated, accounting for 59.2% of cases with known serotype. Approximately one half of ill patients (52.3%) required hospitalization, with the highest percentages of hospitalizations (33.9%) and severe dengue cases (28.4%) occurring among persons aged 10-19 years. Overall, severe dengue was identified in 4.2% of cases, with 11 reported fatalities (0.2%). Transmission remains elevated in multiple regions, underscoring the need for tailored public health measures, including vaccination among eligible populations, vector management, community outreach, and provider education to facilitate improved outcomes. To reduce the risk for mosquito bites, residents of and visitors to Puerto Rico should consider using repellents, wearing protective clothing, and staying in places with door and window screens.
Levy V, Branzuela A, Hsieh K
… +16 more, Getabecha S, Berumen R, Saadeh K, Snyder RE, Marek G, Dodson D, Newman A, Hacker JK, Kath C, Minhaj FS, Gigante CM, Gearhart S, Kallen A, Hutson CL, Jacobson K, Clade I Mpox Response Team
MMWR Morb Mortal Wkly Rep
· 2025 Feb · PMID 39946302
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A clade I monkeypox virus (MPXV) outbreak is ongoing in the Democratic Republic of the Congo; travel-associated clade I MPXV infections have been reported in non-African countries. In November 2024, San Mateo County Heal...A clade I monkeypox virus (MPXV) outbreak is ongoing in the Democratic Republic of the Congo; travel-associated clade I MPXV infections have been reported in non-African countries. In November 2024, San Mateo County Health in California identified an electronic laboratory report of polymerase chain reaction results suggestive of clade I MPXV infection in a male traveler who had recently returned from East Africa. After conferring with the California Department of Public Health (CDPH), a county health department worker visited the patient that same day at his home and obtained skin pustule swab specimens for expedited clade I MPXV testing. Clade I MPXV was confirmed the following day by the CDPH Viral and Rickettsial Disease Laboratory. This was the first reported clade I MPXV infection in the Americas. Among 83 identified contacts, five received JYNNEOS vaccine as postexposure prophylaxis. All contacts were monitored for 21 days; no secondary cases were identified. Patients with mpox-compatible lesions or clinical features should receive MPXV testing, and health care providers should immediately notify public health authorities of suspected clade I MPXV infections (e.g., mpox manifestations and travel history to an area with ongoing clade I MPXV transmission) or upon receiving a nonvariola orthopoxvirus DNA detected, clade II MPXV DNA undetectable test result to trigger additional testing and facilitate the rapid implementation of transmission-based precautions and other preventive public health interventions.
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39820474
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At its October 2024 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Immunization Schedule for Adults Ages 19 Years or Older, United States, 2025. The schedule supports health ca...At its October 2024 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Immunization Schedule for Adults Ages 19 Years or Older, United States, 2025. The schedule supports health care providers, as well as public health and other professionals, by providing a consolidated summary of current ACIP recommendations for adult vaccination. The 2025 schedule includes several updates to the cover page, tables, notes, and appendix. The addendum remains part of the schedule and will be used to summarize new or updated ACIP recommendations that occur before the next annual schedule update. Health care providers are strongly encouraged to use all parts of the schedule (the cover page, tables, notes, appendix, and addendum) together when making recommendations for individual patients. The 2025 adult immunization schedule can be found on the CDC website (https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html).
Papa A, Barile JP, Jia H
… +2 more, Thompson WW, Guerin RJ
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39819886
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Health care workers experience substantial chronic stress, burnout, and mental distress, and the COVID-19 pandemic might have exacerbated these conditions. To identify ways to improve mental health care-seeking among thi...Health care workers experience substantial chronic stress, burnout, and mental distress, and the COVID-19 pandemic might have exacerbated these conditions. To identify ways to improve mental health care-seeking among this population, mental health symptoms, care-seeking, and self-reported barriers to seeking mental health care among U.S. health care providers during the pandemic were studied. During September 2022-May 2023, 2,603 primary care physicians, pediatricians, nurse practitioners, and physician assistants participated in a national Internet panel survey. Approximately one half (45.4%) of participants reported that they did not need mental health care, and only one in five (20.3%) had sought care. One quarter (25.6%) of providers reported mental distress severe enough to meet diagnostic criteria for psychopathology. Among these providers, only 38% reported seeking care; 20.1% indicated that they did not need care, despite severe symptoms. The average number of years in practice was lower for providers reporting care-seeking. Providers who identified as female were also more likely to report care-seeking. The most frequently reported barriers to care-seeking included difficulty getting time off from work, cost of care, and concerns about confidentiality. Increased pandemic-related work stressors were associated with increased symptom severity, but support from work supervisors mitigated these effects. Organizational human resources practices, supervisor training on managing employee stress, and public health messaging to normalize mental health care-seeking and its effects on licensing might help address gaps in provider care-seeking and improve patient outcomes.
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39819853
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At its October 2024 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Immunization Schedule for Child and Adolescent Ages 18 Years or Younger, United States, 2025. The schedule su...At its October 2024 meeting, the Advisory Committee on Immunization Practices* (ACIP) approved the Recommended Immunization Schedule for Child and Adolescent Ages 18 Years or Younger, United States, 2025. The schedule supports health care providers, as well as public health and other professionals, by providing a consolidated summary of current ACIP recommendations for vaccinating children and adolescents. The 2025 schedule includes several updates to the cover page, tables, notes, and appendix. The addendum remains part of the schedule and will be used to summarize new or updated ACIP recommendations that occur before the next annual schedule update. Health care providers are strongly encouraged to use all parts of the schedule (the cover page, tables, notes, appendix, and addendum) together when making recommendations for individual patients. The 2025 child and adolescent immunization schedule can be found on the CDC website (https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html).
Shi DS, Charles M, Beaucham C
… +5 more, Walker S, Alarcon W, Brueck SE, Chiu SK, Somerville N
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39774068
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Workers in electronics waste and lamp recycling facilities are at risk of exposure to elemental mercury through inhalation of mercury vapor and mercury-containing dust. Employers at an electronics waste and lamp recyclin...Workers in electronics waste and lamp recycling facilities are at risk of exposure to elemental mercury through inhalation of mercury vapor and mercury-containing dust. Employers at an electronics waste and lamp recycling facility in Ohio that crushes mercury-containing lamps expressed concerns about mercury exposure from work processes and requested a health hazard evaluation by CDC's National Institute for Occupational Safety and Health (NIOSH). In April 2023, NIOSH conducted a multidisciplinary investigation to assess elemental and inorganic mercury exposures, including epidemiologic, environmental, and ventilation assessments. Results indicated that mercury vapor was detected throughout the facility, with six of 14 workers having elevated urine mercury levels. These workers had a median job tenure of 8 months; four did not speak English, and five reported symptoms consistent with mercury toxicity, such as metallic or bitter taste, difficulty thinking, and changes in personality. Recommendations included improving the ventilation system, changing work practices to reduce mercury exposure, and providing training and communication tailored to the worker. As the electronic waste recycling industry continues to grow, it is important for employers to evaluate mercury exposure and safeguard employees using a hierarchy of controls. Health departments should consider monitoring occupational mercury exposure in recycling facilities, and clinicians should be aware of the potential for mercury toxicity among workers in these settings.
Kobayashi M, Leidner AJ, Gierke R
… +8 more, Xing W, Accorsi E, Moro P, Kamboj M, Kuchel GA, Schechter R, Loehr J, Cohen AL
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39773952
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Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19-64 years with risk condit...Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown. Options included either 20-valent PCV (PCV20; Prevnar20; Wyeth Pharmaceuticals) or 21-valent PCV (PCV21; CAPVAXIVE; Merck Sharp & Dohme) alone or 15-valent PCV (PCV15; VAXNEUVANCE; Merck Sharp & Dohme) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23; Merck Sharp & Dohme). There are additional recommendations for use of PCV20 or PCV21 for adults who started their pneumococcal vaccination series with 13-valent PCV (PCV13; Prevnar13; Wyeth Pharmaceuticals). The ACIP Pneumococcal Vaccines Work Group employed the Evidence to Recommendations framework to guide its deliberations on expanding the age-based PCV recommendation to include adults aged 50-64 years. On October 23, 2024, ACIP recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years. Recommendations for PCVs among adults aged 19-49 years with risk conditions and PCV13-vaccinated adults have not changed from previous recommendations. This report summarizes evidence considered for these recommendations and provides updated clinical guidance for use of PCV.
Walker HL, Roland M, Dudley S
… +12 more, Komatsu K, Weiss J, Dillard J, Lin HI, Rust L, Plummer T, Berg R, Everett S, Chang A, Yeh M, Daniel J, Brady S
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39773926
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Rich SN, Hinckley AF, Earley A
… +3 more, Petersen JM, Mead PS, Kugeler KJ
MMWR Morb Mortal Wkly Rep
· 2025 Jan · PMID 39736154
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Tularemia is a rare nationally notifiable zoonosis, caused by the tier-1 select agent Francisella tularensis, that has been reported from all U.S. states except Hawaii. Clinical manifestations typically include fever and...Tularemia is a rare nationally notifiable zoonosis, caused by the tier-1 select agent Francisella tularensis, that has been reported from all U.S. states except Hawaii. Clinical manifestations typically include fever and localized symptoms that vary by route of infection. The case fatality rate of tularemia is typically <2% but can be higher depending on clinical manifestation and infecting strain. Tularemia is treatable with antibiotics. During 2011-2022, a total of 47 states reported 2,462 tularemia cases, but four central states (Arkansas, Kansas, Missouri, and Oklahoma) accounted for 50% of all reported cases. Incidence was highest among children aged 5-9 years (0.083 per 100,000 population) and adult males aged 65-84 years (range = 0.133-0.161). Incidence among American Indian or Alaska Native persons (0.260) was approximately five times that among White persons (0.057). The average annual incidence of tularemia in the United States during 2011-2022 (0.064) was 56% higher than that reported during 2001-2010 (0.041), largely resulting from increased reporting of probable cases. These findings might reflect an actual increase in human infection or improved case detection amid changes in commercially available laboratory tests during this period. Reducing tularemia incidence will require tailored prevention education; mitigating morbidity and mortality will require health care provider education, particularly among providers serving tribal populations, regarding early and accurate diagnosis and treatment.