Organizations in Sonora, Mexico, 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. Sonora, Mexico, reported 21 measles cases so far this year, all imported or related to imported cases. 19 of the cases are associated with a cluster i...read moren Cajeme of migrant farmers originally from Chihuahua, where there is an ongoing measles outbreak (see PHC alert 5/22). Health officials reported a measles death in a 1-year-old child associated with the cluster this week. The child was malnourished and unvaccinated. Officials stated that Sonora remains free of local measles transmission. [Confidence: Very High]

Informational update only. Lithuania's 2024-25 flu season officially ended the week of May 12-18 after a long, active season. The highest flu incidence rate of 1910.5 cases per ...read more100,000 people was recorded at the end of Jan, surpassing previous seasons. Hospitalizations were higher than in previous seasons, and a record high of 75 flu-related deaths were recorded (the previous record was 27 deaths in 2023–2024). The increase in cases and deaths is attributed to improved diagnostics, with rapid flu tests introduced in healthcare facilities in October 2024. Health officials still recommend good hygiene, ventilation indoors, cleaning surfaces, and consulting a doctor if symptoms develop. [Confidence: Very High]

Organizations in the US should not sell or serve whole cucumbers grown by Bedner Growers Inc. and distributed by Fresh Start Produce Inc. between 4/29 and 5/9 while a multi-state outbreak investigation is ongoing. Anyone with whole cucumbers at their workplace or home who can’t tell where they are from should dispose of them. Whole cucumbers grown by Bedner Growers Inc. and distributed by Fresh Start Produce Inc. were linked to a US multistate outbreak of Salmonella that be...read moregan on 4/29 and has continued to 5/19, with 26 cases and 9 hospitalizations linked to the outbreak across 15 states. The number of cases associated with the outbreak is likely much higher, and may not be limited to just the states with known illnesses. Cases reported buying and eating cucumbers from various locations, including grocery stores, restaurants, hospitals, and cruise ships. [Confidence: Very High]

Brazil exported $10 billion of chicken meat in 2024, comprising 35% of global trade. The country is one of the main poultry meat importers into the European Union. The primary impact of highly pathogenic avian influenza (HPAI) outbreaks in commercial flocks is increased cost of eggs or poultry products when outbreaks become more widespread. Organizations sensitive to egg and poultry prices in Brazil should contingency plan for price volatility. PHC recommends that continuity plans be reviewed and updated in preparation for high-consequence infectious disease threats. The European Commission announced an import ban on poultry and meat products from Brazil due to the detection of highly pathogenic avian influenza in ...read morea commercial poultry facility. The ban applies to all poultry from Brazil, as EU regulations require exporters to be free from avian influenza. No timeline for lifting the ban was given. Other countries also imposed bans (see PHC alerts 5/19 and 5/16). Brazil's Agriculture Ministry implemented measures to contain and eradicate the outbreak and restore exports. [Confidence: Very High]

COVID-19 is highly contagious and can be spread in the workplace and schools, leading to worker absenteeism due to illness or caregiving duties. Organizations in China should advise employees to proactively protect themselves against respiratory illnesses by wearing masks, practicing hand hygiene, avoiding crowded areas, and getting vaccinated. Organizations should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. In the most recent data covering April, China reported an upward trend in COVID-19 test positivity, though the overall epidemic situation of respirato...read morery diseases remains low. Test positivity increased from 7.5% to 16.2% for outpatient COVID-19 tests from the end of March to the start of May, and from 3.3% to 6.3% for hospitalized severe acute respiratory infection cases. Test positivity was higher in southern provinces than northern provinces. Other countries in the region reported similar increases in COVID-19 activity recently. [Confidence: Very High]

Cases of hantavirus are rare, but not unexpected in Nevada. Organizations in Washoe County should take measures to ensure rodent-free facilities. Rodent droppings should be cleaned with bleach; wet the soiled area with bleach before wiping up droppings to limit infectious aerosol generation. Employees should always wear gloves and N95 (or equivalent) masks when handling rodents or their droppings. Nevada confirmed a hantavirus case in a woman in her 90s from Washoe County, who is currently hospitalized. It is believed that the exposure occurred ...read morethrough inhalation or direct contact with rodent droppings, urine, or nesting materials disturbed during carpentry work in her home in the weeks before the onset of symptoms. This is the 1st case of hantavirus in Washoe County since Aug 2023. [Confidence: Very High]

Dengue outbreaks have become increasingly common and severe in the Seychelles in recent years. Organizations in Seychelles should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can reduce infection risk by wearing clothing that covers skin, using mosquito repellents, and emptying standing water. Media sources reported a rise in dengue cases in the Seychelles, with 16 cases in Mahe and 36 in Praslin. 6 cases were hospitalized, and no deaths have been reported so far. [Confidence: Very High]

Brazil exported $10 billion of chicken meat in 2024, comprising 35% of global trade. The primary impact of highly pathogenic avian influenza (HPAI) outbreaks in commercial flocks is increased cost of eggs or poultry products when outbreaks become more widespread. Organizations sensitive to egg and poultry prices in Brazil should contingency plan for price volatility. PHC recommends that continuity plans be reviewed and updated in preparation for high-consequence infectious disease threats. Brazil reported its 1st detection of HPAI at a commercial poultry breeding farm in Rio Grande do Sul. Containment and eradication measures were implem...read moreented following the detection. Officials stated that the risk of human infection is low. The number of birds affected was not provided. Media sources reported that China implemented a country-wide trade ban for 60 days due to the detection, while Japan, the United Arab Emirates, and Saudi Arabia would activate state-specific bans. [Confidence: Very High]

Organizations with employees in or traveling to Colombia should check the country's yellow fever vaccination requirements before traveling within the country to avoid delays. Enhanced screening at health checkpoints may lead to travel delays. Organizations should provide flexible work schedules to support employees who need to get vaccinated at least 10 days before any travel. Officials announced that yellow fever vaccination is required before travel to high-risk areas in Colombia. Vaccination must occur at least 10 days be...read morefore the trip. Media sources reported that authorities established mandatory health checkpoints on driving and river routes, and individuals will need to provide proof of vaccination before purchasing tickets at land transportation terminals and digital platforms. All transportation companies will need to certify that personnel are vaccinated. As of 5/12, 87 yellow fever cases, including 39 deaths, were reported in Colombia so far since early 2024, with most in Tolima. See PHC alerts on 4/25 and 4/17 for earlier info. [Confidence: Very High]

Saskatchewan, Canada, reports sporadic anthrax cases and outbreaks in animals, with the last outbreak reported in 2022 in bison. Anthrax cases tend to garner media attention, but cases in a more rural, agricultural region do not pose a threat to organizations. Saskatchewan Agriculture confirmed anthrax as the cause of death in cattle on 5/13 in the Rural Municipality (RM) of Paynton No. 470. Officials urged ...read moreproducers to stay vigilant for signs of anthrax in animals, ensure annual animal vaccinations, and exercise caution when handling deceased or possibly infected animals. No human cases have been identified. [Confidence: Very High]

Middle Eastern respiratory syndrome coronavirus (MERS-CoV) cases have typically been detected annually in Saudi Arabia since 2012, though case numbers have remained at very low levels since 2019. Most human cases occur after contact with a camel, but human-to-human transmission can occur. Past outbreaks occurred after importation to other areas and in healthcare facilities. Employees residing in or traveling to Saudi Arabia should be encouraged to avoid contact with camels, drinking raw camel milk, and eating undercooked camel meat. Saudi Arabia reported 9 MERS-CoV cases from March to April, including 2 deaths. Cases were reported from Riyadh (8) and Hail (1). Among the cases, the...read morere was a cluster of 7 cases in Riyadh that comprised 6 healthcare workers caring for the initially infected patient. The case from Hail was the only case to report contact, direct or indirect, with camels. The WHO stated that the global and regional risk assessment remains moderate, with detection of additional cases expected in countries where the virus is circulating in camels. [Confidence: Very High]

Informational update only. Employees should consult a doctor about chikungunya and vaccination risks before traveling. The FDA and CDC recommended a pause in the use of IXCHIQ (Chikungunya Vaccine, Live) for individuals aged 60 and older while they investigate reports ...read moreof serious adverse events, including neurologic and cardiac issues, among those who received the vaccine. As of 5/7, 17 serious adverse events, including 2 deaths, were reported globally in individuals aged 62 to 89 who received the vaccine, with 6 cases from the US. France previously revised its recommendation for the IXCHIQ vaccine in older adults following reports of adverse events, including 1 death (see PHC alert 4/30). [Confidence: Very High]

In November 2024, the US was alerted to the first animal case of New World Screwworm (NWS) in Mexico since its eradication in the 1970s. Recent animal cases reported in Central America in the last 2 years, and now Mexico, have raised concerns about its spread northward. NWS, which was eradicated in the U.S. in the 1960s, primarily affects livestock but can also impact pets, wildlife, and occasionally humans. NWS fly larvae can cause serious and often deadly damage to an animal. Reintroduction of NWS in the U.S. could lead to commercial financial losses, trade restrictions, and costly eradication efforts. Organizations reliant on Mexican meat and dairy production should have a contingency plan for possible price volatility. The US Department of Agriculture announced an immediate suspension of live cattle, horse, and bison imports through US ports of entry along the southe...read morern border. This decision comes in response to the ongoing and rapid spread of NWS in Mexico. The suspension will be reviewed monthly and remain in place until significant containment progress is made. The US and Mexico are maintaining regular communication regarding containment and eradication efforts. In April 2025, Mexico also reported 2 human cases of NWS in people who live in rural communities. [Confidence: Very High]

Whooping cough (also known as pertussis) is highly contagious and can be deadly; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Organizations in Florida should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Florida reported 37 new whooping cough cases in the most recent week of data, totaling 505 cases so far this year. Cases are over 4 times higher compa...read morered to this time last year (104 cases). Several other states have reported elevated whooping cough activity (see PHC alerts on 5/5, 5/2, 4/29). Nationally, 10,062 cases were reported, nearly 2 times higher compared to this time last year (5,212). The US is returning to pre-pandemic patterns with more than 10,000 whooping cough cases reported annually. [Confidence: Very High]

Organizations in New York 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. New York reported 4 new measles cases in Orange and Ontario Counties, totaling 7 cases this year. 3 new measles cases were confirmed in Orange County ...read morechildren who recently traveled internationally. No exposures outside of immediate family are known to have occurred. Health officials also reported a probable measles case in Ontario County from March in a resident who was exposed outside the US and had isolated at home while contagious. Health officials advised the public to review their vaccination status and to get vaccinated. Children aged 6 months and older can receive a dose of the MMR vaccine early. [Confidence: Very High]

Informational update only. Organizations should follow the recommendations provided in the PHC analysis on 1/10 and 2/13, including lowering barriers to seasonal flu vaccines for their employees. The CDC's Influenza Risk Assessment Tool (IRAT) evaluates the potential pandemic risk of novel influenza A viruses. The latest assessment reviewed two...read more recent clade 2.3.4.4b avian influenza A(H5N1) viruses: a B3.13 genotype virus and a D1.1 genotype virus. Both viruses scored as "moderate risk" for emergence and public health impact. The IRAT does not assess immediate public health risk or predict future pandemics. The current H5N1 bird flu situation continues to be mostly an animal health issue, and human risk remains low. [Confidence: Very High]

Whooping cough (also known as pertussis) is highly contagious and can be deadly; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Organizations in Mexico should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Mexico reported 835 confirmed cases of whooping cough so far this year, including 49 deaths. All deaths were in children under the age of 1 who were u...read morenvaccinated, and most were in children under the age of 6 months. In the first 4 months of 2025, Mexico approached the 2019 annual total of cases (874). See PHC alerts on 4/14 and 3/4 for earlier info. [Confidence: Very High]

Human anthrax cases are rare in Thailand, though the disease is more commonly detected in neighboring countries of Vietnam, Laos, and Myanmar. Organizations should caution employees working in or traveling to Thailand to avoid consuming meat from dead or improperly slaughtered cattle. Travel from Thailand to Laos could be delayed at inspection checkpoints. Thai officials confirmed an anthrax outbreak in Mukdahan Province, near the Laos border, with 3 human confirmed cases, including 1 death, and 98 peopl...read moree still under observation. In response, Laos issued a nationwide directive to immediately suspend the import and transit of animals and animal products from Thailand. This includes cattle, buffalo, horses, pigs, sheep, and goats. All border checkpoints will enforce strict inspections, disinfect vehicles, and enhance livestock monitoring. The restriction will remain until the outbreak is contained. See PHC alert 5/2 for an earlier update. [Confidence: Very High]

Influenza-related deaths are a reminder that the illness can be severe or fatal. Organizations should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The United States reported 216 influenza-associated pediatric deaths for the 2024-25 season in the most recent week of data, the 2nd highest number of...read more pediatric deaths since the 2009-10 season (288 deaths). Experts suggest that the number of deaths is likely underreported due to delayed data compilation and may continue to rise after the influenza season comes to a close. This season was declared to be a high severity season across all age groups, but activity is on the decline nationally. [Confidence: Very High]

During Tonga's intermittent dengue outbreaks, organizations should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can reduce infection risk by wearing clothing covering skin, using mosquito repellants, and emptying standing water. Tonga reported 22 new dengue cases on 5/5, totaling 647 cases since the outbreak started, with most cases from Vava'u (301), Tongatapu (286), 'Eua (58...read more), and Haapai (2). A 3rd dengue-related death was reported in an 8-year-old boy from Tongatapu, while 6 cases are currently hospitalized in stable condition. Cases continue to be reported at lower numbers since the peak in early March. See PHC alerts on 4/30, 4/15, 4/2, 3/26, and 3/12 for earlier info. [Confidence: Very High]

Organizations with employees traveling to Ecuador should check the country's yellow fever vaccination and entry documentation requirements before travel to avoid delays. Organizations should provide flexible work schedules to support employees who need to get vaccinated at least 10 days before departure. Starting on 5/12, residents from or travelers who spent >10 days in Peru, Colombia, Bolivia, and Brazil must show an International Certificate of Vacc...read moreination against yellow fever upon entering Ecuador. Additionally, Ecuadorians or residents without a vaccination history traveling to high-risk areas in the Ecuadorian Amazon (Sucumbíos, Orellana, Napo, Pastaza, Morona Santiago, and Zamora Chinchipe) must get vaccinated 10 days before travel. Officials advised planning trips in advance to ensure a valid international vaccination certificate. [Confidence: Very High]

Locust swarms are not uncommon in Australia and are most prevalent after rainfalls. Locusts can have a devastating impact on agriculture, particularly in regions where large swarms invade crops, leading to economic losses, pesticide and control costs, and disrupting seasonal planting. Media sources reported that locusts are destroying pastures and crops, particularly affecting grass for cattle herds, after recent flooding in Queensl...read moreand. The Department of Primary Industries stated properties in the Central Highlands, Isaac, and Barcaldine council areas reported locust activity in the past six weeks. Agriculture officials say that the situation could grow to plague proportions, pending certain precipitation and vegetation conditions. The management of locusts in Queensland is primarily the responsibility of landowners as part of their general biosecurity obligation. [Confidence: Very High]

Due to an anthrax outbreak, organizations in eastern Democratic Republic of Congo (DRC) and Kabale, Uganda, should caution employees to avoid contact with animals in the region, ensure any water from nearby sources is boiled before consumption, and not to consume meat obtained from sick animals or animals that died suddenly. The US State Department lists the DRC under a Level 4: Do Not Travel advisory and Uganda as a Level 3: Reconsider Travel advisory. Health officials in the DRC, supported by the World Health Organization (WHO), are ramping up efforts to control an anthrax outbreak in North Kivu Pro...read morevince, with 16 suspected and 1 confirmed human case. 1 death was reported. So far, the outbreak has impacted 4 health zones around Lake Edward, along the border of the DRC and Uganda, and is linked to 7 cases in Uganda’s Kabale District. Response efforts, including surveillance, investigation, medical treatment, and livestock vaccination, are ongoing. WHO is facilitating cross-border coordination between the DRC and Uganda to enhance the outbreak response. See PHC alerts 4/30, 4/28, and 4/09. [Confidence: Very High]

The primary impact of highly pathogenic avian influenza (HPAI) outbreaks in commercial flocks is increased cost of eggs or poultry products when outbreaks become more widespread. Organizations sensitive to egg and poultry prices should contingency plan for price volatility. PHC recommends that continuity plans be reviewed and updated in preparation for high-consequence infectious disease threats. South Dakota detected HPAI in a commercial table egg layer facility in Aurora County, affecting 700,000 birds. This was the 2nd HPAI detection in the ...read morestate in April after over 33,000 birds were culled in Beadle County (see PHC alert on 4/10). [Confidence: Very High]

Employers can support employees in obtaining mpox vaccinations by providing flexible work schedules. Information on the availability of mpox vaccines and treatment can also be included in employee wellness communication. Sierra Leone continues to see a surge of new mpox cases, with a total of 1,052 confirmed cases and 9 deaths since the start of the outbreak in Jan 202...read more5. Cases were reported in 10 of 16 districts so far, with most occurring in the Western Urban and Western Rural Districts. Clade 2b was previously sequenced from cases. See PHC alerts on 4/28, 3/27, 3/13, 2/3, and 1/14 for earlier info. [Confidence: Very High]

No human-to-human spread of highly pathogenic avian influenza (HPAI) H5N1 has been identified. Organizations should follow the recommendations provided in the PHC analysis on 2/13 and 1/10, including lowering barriers to seasonal flu vaccines for their employees. Idaho reported 15 new confirmed HPAI detections in cattle herds on 4/30. Detections in the state are on the rise, with 40 detections in the past 30 da...read moreys. 57 facilities are currently under quarantine in Cassia, Gooding, Jerome, and Twin Falls Counties. Since the outbreak in dairy cattle started in March 2024, Idaho reported the 2nd most HPAI detections in dairy herds per state, after California (765 affected herds). Detections slowed in California and nationally in recent months, but the spike in Idaho may indicate a changing trend. The US has detected HPAI in 1,047 cattle herds in 17 states. [Confidence: Very High]

Organizations in Buenos Aires, Argentina, should encourage employees to seek treatment if they develop gastrointestinal symptoms. Organizations should ensure access to clean water, and employees should avoid consuming undercooked food. Argentina reported an outbreak of febrile and gastrointestinal symptoms affecting 10 people from Buenos Aires, with 2 cases testing positive for Salmo...read morenella typhi (typhoid fever). One person died. The outbreak, which began in March, continues into April. Health officials are tracing close contacts and potential contamination sources, including testing water supplies from a building where some cases may have been exposed. [Confidence: Very High]

Whooping cough (also known as pertussis) is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Organizations in Virginia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Virginia reported 207 cases of whooping cough this year, up from 78 cases at this time last year. Cases are affecting all age groups. In 2024, 778 cas...read morees were reported, compared to 130 in 2023. The increase in whooping cough cases is attributed to declining vaccination rates and waning natural immunity. Health officials advised the public to review their vaccination status and to get vaccinated. [Confidence: Very High]

Deaths from influenza are a reminder that the illness can be severe or fatal. Organizations in Alberta, Canada, should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Alberta reported 193 influenza deaths, 3,316 hospitalizations, and 275 intensive care admissions during the 2024-2025 season so far. This season's inf...read moreluenza death toll was the highest in the past 16 years. Of the hospitalizations, 75% were in individuals aged 50 and older. While weekly case counts are falling, 172 people remain hospitalized, with 9 in intensive care. Declining flu vaccination rates likely contributed to the severe season, dropping to 21% from 37% during the COVID-19 pandemic and 31% in the pre-pandemic 2018-19 season. Health officials also noted increased circulation of both H1N1 and H3N2 strains, with H3N2 particularly affecting older adults. [Confidence: Very High]

Organizations in Indiana with employees working outdoors in grassy or wooded areas should remind them that tick bite prevention is important for minimizing exposure risk. Indiana reported a fatal case of ehrlichiosis in a Floyd County resident this month. Ehrlichiosis is a tick-borne bacterial infection, causing symptom...read mores such as fever, chills, headache, and muscle aches. Health officials advised the public to prevent tick bites and reduce the risk of ehrlichiosis and other tick-borne diseases by using insect repellent and carefully checking and removing ticks from clothing, gear, pets, and skin. [Confidence: Very High]

The polio vaccine is more than 99% effective in preventing poliovirus infection. The US State Department lists Afghanistan under a Level 4: Do Not Travel advisory. Afghanistan reported its 2nd wild poliovirus type 1 (WPV1) case of 2025 last week. The case was detected in Hilmand. A WPV1-positive environmental sample was also reported in Kandahar. [Confidence: Very High]

Organizations in Nassau County, New York, that used Jersey Mike’s Subs for catering or event services may wish to notify employees of this hepatitis A exposure. Employees who ate food at the restaurant and are not vaccinated against hepatitis A or who experience gastrointestinal symptoms should consult with a healthcare provider. Nassau County health officials confirmed a hepatitis A case in a restaurant worker at Jersey Mike’s Subs in Oceanside. Those who ate or drank at the...read more restaurant from 4/5-4/19 may have been exposed and should monitor for hepatitis A symptoms for the next 50 days from their exposure date. The hepatitis A vaccine is over 95% effective in preventing disease in people who have received two shots. Postexposure vaccination is also available up to 14 days after exposure. [Confidence: Very High]

Plague occurs in wildlife throughout areas of the western US, but human and pet cases are rare. Avoiding contact with wildlife is a best practice for organizations with employees who work outside. New Mexico confirmed the 1st animal plague case in Santa Fe County for 2025, involving a dog. Pets can contract the plague from infected flea bites or...read more by eating infected animals. Humans can also get it through flea bites or direct contact with infected animals. No human cases were reported. With prompt diagnosis and treatment, the risk of death in both people and pets is significantly reduced. [Confidence: Very High]

Yellow fever is endemic in the Amazon regions of South America, though this year, cases have spread outside of traditionally endemic areas. Employees traveling to yellow fever-risk areas in the Americas should consult their healthcare provider at least 10 days before departure about the vaccine. Organizations should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Employees can prevent mosquito bites by wearing protective clothing and using insect repellent. The Pan American Health Organization (PAHO) issued another yellow fever health alert (see PHC alert 3/28). So far this year, 189 confirmed human cases...read more of yellow fever were reported, of which 74 cases were fatal. 4 countries reported cases: Brazil (102 cases, 41 deaths), Colombia (53 cases, 21 deaths), Peru (32 cases, 11 deaths), and Bolivia (2 cases, 1 death). Cases are declining in Brazil, but remain elevated in Colombia. This alert follows the US CDC's updated travel advisory for South America and Colombia's recent declaration of a state of emergency (PHC alert 4/17 and 4/15). The Ministry of Health in Ecuador also reported its 1st yellow fever case this year in Zamora Chinchipe. [Confidence: Very High]

Invasive meningococcal disease (IMD) cases have increased in Australia, but annual cases remain below pre-pandemic levels. Organizations with employees traveling to or working in Australia should provide flexible work schedules to allow for vaccination of themselves or family members if not already vaccinated. Western Australia reported 4 new IMD cases in the past week, totaling 5 cases in 2025 so far. At least 3 cases were serogroup B. 2 cases were children...read more in the same household, and the other 2 adult cases were unrelated to each other or other cases. In 2024, the state reported 13 IMD cases, including 1 death. Health officials stated that the MenACWY vaccine is available to all children starting at 12 months for free, while Aboriginal children can access the vaccine at 6 weeks old, given the higher rate of disease in this population. A catch-up program is available for children aged 15-19 years for free as well. [Confidence: Very High]

The civil unrest and limited healthcare infrastructure in Afghanistan will increase the risk of infectious disease outbreaks, including the potential for cross-border spread into neighboring countries. The US State Department lists Afghanistan under a Level 4: Do Not Travel advisory. The World Health Organization reported 31,818 suspected measles cases and 208 deaths in Afghanistan so far this year. There has been a steady increase...read more in cases since the beginning of 2025, and cases are higher than the 3-year average (2022-2024). Additionally, a total of 71 suspected cases and 2 deaths of Crimean-Congo hemorrhagic fever (CCHF) were reported. Cases of CCHF have remained stable since the start of 2025. Additional updates on other diseases can be found in the source link. [Confidence: Very High]

For informational purposes only. Organizations in Nevada should review their workplace policies to protect workers from heat-related illnesses. This includes reviewing and preparing for compliance with Nevada's new heat regulation before enforcement begins. The Nevada Occupational Safety and Health Administration (Nevada OSHA) announced it will fully enforce the state's new Heat Regulation starting 4/29. ...read moreBusinesses with over 10 employees must conduct a job hazard analysis, create a written safety program that includes water, rest breaks, cooling methods, and emergency procedures, and train workers to recognize and prevent heat illness. This regulation aims to protect workers as temperatures rise across Nevada. [Confidence: Very High]

Employers can support employees in obtaining mpox vaccinations by providing flexible work schedules. Information on the availability of mpox vaccines and treatment can also be included in employee wellness communication. The Africa CDC reported 2 new mpox cases in Malawi in the past week, totaling 4 confirmed cases in Lilongwe and Mangochi Districts. The 4 individuals ...read moredid not report recent travel history, suggesting ongoing undetected local transmission. Clade 1b was sequenced from cases. See PHC alert 4/21 for earlier info. [Confidence: Very High]

The polio vaccine is more than 99% effective in preventing poliovirus infection. Travelers to Pakistan should verify their polio vaccination status before travel. Pakistan reported 1 new case of wild poliovirus in an individual from District Torghar, Khyber Pakhtunkhwa. This is the 2nd case from Khyber Pakhtunkh...read morewa and the 7th case for Pakistan. Pakistan is currently conducting a polio vaccination campaign from 4/21 to 4/27, aiming to reach 45.4 million children under the age of 5. See PHC alerts 4/15, 3/3, 2/28, 2/24, and 2/13 for earlier info. [Confidence: Very High]

Zimbabwe is prone to cholera outbreaks, particularly due to the lack of water and sanitation infrastructure. Organizations in Zimbabwe should ensure access to clean, potable water for drinking and washing, and encourage employees to seek treatment if they develop gastrointestinal symptoms. Zimbabwe media sources confirmed a cholera outbreak in Gwanda District, Matabeleland South Province, after 3 cases and 1 death were reported. The poor...read more water, sanitation, and hygiene conditions in the district likely contributed to the local transmission, with importation of the disease unlikely. The province typically reports sporadic and seasonal cholera outbreaks, though a widespread cholera outbreak is ongoing in several provinces across Zimbabwe (see PHC alerts 3/20 & 3/17). [Confidence: Very High]

Informational update only. Media sources reported that a Quebec health department spokesperson announced the end of the measles outbreak after 32 days without new cases since 3/...read more18. Quebec reported 40 measles cases linked to the outbreak that started in Dec 2024, with 32 cases reported in the Laurentians region north of Montreal. As of 4/23, Quebec's website lists the outbreak as still active. [Confidence: Very High]