Building the Future of Biodefense
Biothreat intelligence to deter and detect natural, accidental, deliberate and novel biological agents.
ADVISORY
The Maldives reports elevated dengue activity, with an increase in imported cases among European travelers
03/20/2026
Maldives
Recommendation: Dengue is endemic in the Maldives, with cases typically highest during the rainy season (April-September). Organizations in the Maldives should reduce mosquito populations at their facilities by eliminating standing water. Employees can take steps to prevent mosquito bites by wearing protective clothing and using insect repellent, and eliminating standing water near their homes.
Situation: The Maldives recorded higher-than-typical dengue incidence since March 2025, with a substantial increase from December 2025 to January 2026 (411 to 646 cases). In previous years, 74 cases were reported in the Maldives in January 2025 and 139 cases in January 2024. ECDC reported at least 46 imported dengue cases so far this year in individuals from 4 European countries who recently traveled to the Maldives. Imported cases in travelers can be a proxy indicator of the ongoing transmission when case data is limited. [Confidence: Very High]
ADVISORY
Chicago reports high respiratory syncytial virus activity
03/20/2026
Illinois, Cook County
Recommendation: Respiratory syncytial virus (RSV) and other respiratory illnesses are expected to impact employee absenteeism due to illness or caregiving duties. Organizations in Chicago, Illinois, should provide flexible work schedules to support employees making vaccine appointments for themselves or family members.
Situation: Health officials reported that RSV activity in Chicago increased from Moderate to High levels and is above typical seasonal levels. Wastewater viral activity levels are currently Very High. Emergency department visits and hospitalizations are also elevated, especially among children ages 0-4, where visit rates are more than 3 times higher than the same time last year. The weekly test positivity increased from 7.2% to 8.7%, and 2 pediatric deaths were reported this season. Healthcare providers were advised to continue RSV immunization for eligible infants < 8 months of age and high-risk infants ages 8–19 months. [Confidence: Very High]
WATCH
Elevated measles activity in Japan, including an outbreak at a restaurant in Tokyo
03/19/2026
Japan, TokyoJapan
Recommendation: Organizations in Tokyo, Japan, should inform employees about the measles exposure location and provide flexible work schedules to support employees in making vaccine appointments for themselves or family members. Measles is highly contagious and can quickly spread among unvaccinated individuals in a work environment.
Situation: Tokyo reported a measles outbreak of 9 cases this week, all among employees at the same workplace, an unidentified restaurant in Shinjuku Ward. None of the cases reported any international travel, suggesting ongoing community transmission. Separately, another measles case was reported in Tokyo last week, who may have exposed the public at LIXIL Showroom Tokyo on 3/7. Exposed individuals should monitor for measles symptoms (7-21 days from exposure). Tokyo reported 34 measles cases so far this year, with transmission hotspots noted in workplaces and schools. In the first 3 months of 2026, Tokyo reached the same number of cases reported in all of 2025. Nationally, 100 measles cases were reported in 2026 so far, higher than the number of cases for the same period in 2020 to 2025. [Confidence: Very High]
WATCH
Latvia reports a measles outbreak
03/19/2026
Latvia
Recommendation: Organizations in Latvia should provide flexible work schedules to support employees in making vaccine appointments for themselves or family members. Measles is highly contagious and can quickly spread among unvaccinated individuals in a work environment.
Situation: Latvia health officials reported a measles outbreak of 14 cases (7 laboratory-confirmed and 7 clinically confirmed), all of which are epidemiologically linked. 13 were in children, and 1 was an adult. Over 1,000 contacts were identified across schools, families, public events, and international transport, highlighting the potential for wider spread. Specific exposure locations were not provided. Latvia assessed the risk of further spread of infection, especially among unvaccinated individuals, as High. Earlier this week, Latvia reported a measles case linked to attendance at a Liutauras Viktorinas wellness event in Riga, with subsequent travel to Turkey (see PHC alert 3/17). It is currently unclear whether the newly reported cases are connected to this earlier case or exposure locations. [Confidence: Very High]
ADVISORY
Measles virus detection in wastewater in Kauaʻi County, Hawaii
03/18/2026
Hawaii, Kauai County
Recommendation: Organizations in Kauaʻi County, Hawaii, should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Measles is highly contagious and can quickly spread among unvaccinated individuals in a work environment.
Situation: Hawaiian health officials reported a measles virus detection in wastewater from Kauaʻi County. The sample was collected on 2/25 at a site in East Kauaʻi County, and officials were notified of the result on 3/16. The detection suggests that at least 1 individual in the community or traveling through the community around that time was infectious with measles. A recent confirmed measles case reported on 3/7, in a visitor who traveled on Oʻahu and Hawaiʻi Islands, is unrelated to Kauaʻi’s wastewater detection based on the case timeline and itinerary, according to health officials (see PHC alert 3/9). [Confidence: Very High]
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