For information only. Mpox has been declared a Public Health Emergency of International Concern twice in recent years (2022 and 2024). The more recent declaration was made for the more severe clade 1b strain. Children make up ~ 60% of clade I mpox cases; vaccinating children should help slow transmission. The World Health Organization has authorized the first mpox vaccine for children. It will be used as a single dose in children over 1 year of age. Chi...read moreldren are particularly susceptible to mpox; successful vaccination will protect children from severe disease and should help to control this public health emergency. [Confidence: Very High]

PHC will monitor the event and provide updates as needed. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. California identified a possible H5N1 avian influenza case in a child with mild upper respiratory symptoms. The child has no known exposure to animals...read more. All of California's 27 confirmed H5N1 avian influenza cases had direct contact with infected dairy cows. See PHC alert 11/15 for earlier info about H5N1 in CA. [Confidence: Very High]

Given California's proactive testing, the detection of additional H5N1 cases in dairy workers is not unexpected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. Fresno County reported a case of H5N1 avian influenza in a Fresno County resident who had contact with infected cattle at a dairy farm in the Central ...read moreValley. This case is the 1st in Fresno County, and 24th in California. No human-to-human spread of H5N1 has been detected. [Confidence: Very High]

The death of an infant from measles is Vietnam's 5th measles death this year and serves as a reminder that measles can be a severe disease. Businesses in Dong Nai, Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. People traveling to Dong Nai should check their measles vaccination status. An infant in Dong Nai, Vietnam died from measles amidst a measles outbreak in the province, with 1,893 cases this year. See PHC alerts 11/18 and 10/31 for earlier info about measles in Dong Nai. [Confidence: Very High]

Whooping cough is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in San Diego County, CA should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. San Diego County is encouraging residents to stay up-to-date with whooping cough vaccination as this year's 547 cases to date already exceed 2023's to...read moretal of 329 cases. The most affected age group is 11–17-year-olds, indicating the greatest impact to business is likely caregiving-related absenteeism. [Confidence: Very High]

H5N1 exposure to the public may attract media attention, but the risk in this instance is very low. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. Last week, Hawai'i announced its first ever detection of H5N1 avian influenza. Prior to symptoms, some of the birds in the affected flock were present...read more at the Mililani Pet Fair held on Nov 2. Since the birds were not yet sick, the transmission risk is very low, but participants at the fair who later experienced conjunctivitis or flu-like symptoms should contact their healthcare provider. [Confidence: Very High]

Informational update. A single case of mpox in a traveler does not pose a significant risk to business. PHC will continue to monitor the situation and provide updates as needed. See PHC mpox critical threat for more information about the growing mpox clade 1b situation. California reported the US's 1st case of mpox clade 1 in a traveler with recent travel to areas where clade 1 mpox has been circulating in Central and...read more Eastern Africa. Health authorities are conducting contact tracing. The exact clade has yet not been identified, but is likely to be the deadlier and more transmissible clade 1b that has been imported to other countries this year. [Confidence: Very High]

The detection of an H5N1 case in a poultry worker on an affected farm is not unexpected. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. Oregon reported its 1st human H5N1 case, in a farm worker from Clackamas County who had exposure to infected birds (see PHC alert 10/25 about the H5N1...read more outbreak on this farm). The case had mild symptoms and has since recovered. This is not the same H5N1 strain that has been circulating among dairy cattle and workers, and close contacts of this Oregon case have not developed symptoms. [Confidence: Very High]

Given California's proactive testing, the detection of additional H5N1 cases in dairy workers is not unexpected. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. Madera County, CA reported 2 human cases (1 confirmed and 1 presumptive) of H5N1 in workers with exposure to infected dairy cows. These are Madera County's 1st H5N1 human cases and CA's 22nd and 23rd. [Confidence: Very High]

The continuing expansion of mpox 1b is concerning, but these cases do not change the recommendations for businesses. Businesses 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. Update on the mpox cases reported in Zambia (PHC alert 10/11) and Zimbabwe (PHC alert 10/15): All of the cases were the more severe mpox clade 1b and ...read moretravel-related. Zimbabwe reported two cases: one with travel history to South Africa and one with travel history to Tanzania. No details on the travel history fo Zambia's case have been shared. [Confidence: Very High]

Communicable disease cases often rise when school resumes after a break. Both whooping cough and chickenpox can easily spread in school settings and can lead to worker absenteeism due to caregiving for sick family members, temporary school closures, or exclusion of unvaccinated children for 21 days after an exposure. Businesses should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Clark County, Washington reported a surge in two communicable diseases since the start of the school year 2 months ago. 168 whooping cough cases have ...read morebeen identified in the last 2 months, totaling 406 this year, the highest county in WA. 50 chickenpox cases have been reported this year, with 23 tied to outbreaks in 3 schools. [Confidence: Very High]

Eastern equine encephalitis (EEE) risk in Michigan decreases as temperatures drop, but the recent discovery of an infected bird is a reminder that businesses should eliminate standing water until mosquito season is over (when nighttime temperatures are consistently below freezing). EEE can cause severe neurological complications in humans. The Marquette County Health Department urged residents of Michigan's Upper Peninsula to continue avoiding mosquito bites after a bird recently tested ...read morepositive for EEE. EEE has a high fatality rate and can cause permanent neurologic damage to survivors. Climate change has led to longer mosquito seasons and delayed freezing temperatures, requiring the extension of mosquito precautions into later fall. [Confidence: Very High]

Measles is highly contagious and can quickly spread among unvaccinated individuals in a work environment. Businesses in Italy should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Italy reported 33 measles cases in Oct, totaling 935 cases in 2024. Cases began increasing in Dec 2023 and peaked in April (181 cases), but monthly cases still approach 2023's annual total (46 cases). [Confidence: Very High]

The confirmation of H5N1 in the earlier reported case does not change the current risk to business. PHC will update recommendations if the public health investigation produces relevant information. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. Canada's National Microbiology Laboratory confirmed the previously presumptive avian influenza infection in a teenager is due to the H5N1 strain circu...read morelating in commercial poultry flocks in British Columbia's Fraser Valley. See PHC alert 11/12 for earlier information. [Confidence: Very High]

Hawaii has been the only state without confirmed H5N1. PHC will monitor the event and provide updates as needed. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. Hawaii officials reported detection of H5 avian flu from a wastewater sample collected from O'ahu earlier this month as part of routine surveillance. ...read moreThis is HI's 1st H5 identification. Wastewater testing cannot determine if the sample was H5N1, or if the source was human or an animal. An investigation is underway. [Confidence: Very High]

Whooping cough is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in Washington should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Spokane County, Washington health officials declared a whooping cough outbreak. 123 cases have been identified this year, marking the County's 3rd hig...read morehest annual total since 2005. Only 2019 (178 cases) and 2012 (198 cases) had higher cases. Across the state, whooping cough is surging (see PHC alert 11/8). [Confidence: Very High]

Influenza-related worker absenteeism can be due to employee illness or caregiving duties. Businesses in Taiwan can support employees in obtaining seasonal flu vaccinations by providing flexible work schedules. Information on the availability of vaccines can also be included in employee wellness communication. Taiwan reported 202 severe flu cases and 26 deaths this season, the highest in the same time period in a decade. All 26 deaths occurred in individuals...read more who had not received the seasonal flu vaccine this year. Health authorities are advising citizens to get vaccinated. [Confidence: Very High]

South Korea's first whooping cough death serves as a reminder that whooping cough can be deadly. Whooping cough is also highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in South Korea should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. South Korea reported its 1st ever whooping cough death since whooping cough-related mortality surveillance began in 2011. South Korea has reported rec...read moreord-breaking whooping cough cases this year (30,332 cases and 1 death). Health officials urged vaccination, especially for pregnant women, household members of infants, and caregivers. See PHC alert 10/4 for earlier info about whooping cough in South Korea. [Confidence: Very High]

The growing measles outbreaks in Vietnam warrant greater attention from enterprise businesses. While Ho Chi Minh City has the largest outbreak, Hanoi’s cases continue. Businesses in Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Hanoi reported 16 new measles cases in the last week, the highest weekly total since the outbreak's start. Hanoi has reported 62 measles cases across ...read more22 districts this year. Last week's cases occurred in Chuong My (4), Dong Da (2), Hoang Mai (2), Ha Dong (2), Nam Tu Liem (2), Hoai Duc (1), Quoc Oai (1), Phuc Tho (1), and Thanh Xuan (1). [Confidence: Very High]

PHC will monitor the event and provide updates as needed. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. Canada’s 1st presumptive locally acquired human H5 avian influenza case is a teenager from the Fraser Health Region of British Columbia. The provinc...read moreial health officer stated the case is in critical condition and has no known connection to farms or poultry. Health authorities are investigating and identifying contacts; no other cases have been detected. BC recently detected H5N1 in 22 commercial poultry flocks in Fraser Valley. [Confidence: Very High]

California's proactive testing is expected to detect additional H5N1 cases in dairy herds. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. California has confirmed H5N1 avian influenza in 259 dairy herds in California since the start of the avian influenza outbreak in cattle, up from 233 ...read moreherds as of 11/4. See PHC alerts from 11/4, 10/28, 10/22, 10/10, and 10/8 for information about earlier H5N1 detections in California herds. [Confidence: Very High]

Whooping cough is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in Washington state should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. As PHC warned last month (see alert 10/11), Washington state has had a surge of whooping cough cases this year. Cases have continued to increase, with...read more 377 new cases in the last 4 weeks and 1,193 total, now the highest annual cases in over 10 years. Clark (434) and King (151) counties have the highest cases. [Confidence: Very High]

Eastern Equine Encephalitis (EEE) risk in Maine is now lower, but mosquito activity often continues in early Nov due to climate change pushing back the year's first frost. EEE can cause severe neurological complications in humans, and mosquito bite prevention is critical even as risk decreases. Businesses should reduce mosquito habitats by eliminating sources of standing water. Employees working outside can prevent mosquito bites by wearing protective clothing and using insect repellent. Penobscot County, Maine reported a human case of eastern equine encephalitis (EEE), the state's 1st case since 2015. The case developed symptoms in ea...read morerly Oct. A single mosquito pool in Penobscot County tested positive for EEE in Aug. [Confidence: Very High]

For information only. The finding that 7% of tested dairy workers had evidence of past H5N1 infection is concerning and adds urgency to preventing coinfection of H5N1 and seasonal flu. Businesses should follow the recommendations provided in the PHC analysis from October 22. Businesses should lower barriers to seasonal flu vaccines for their employees. In a study, CDC detected a 7% H5N1 infection rate in certain dairy workers. As seasonal flu season commences, this finding raises the probability of a...read more farm worker being coinfected with H5N1 and seasonal flu, which increases the opportunities for H5N1 to gain the ability to transmit from person to person. Additionally, CDC recommended: (1) increased testing (2) wider Tamiflu use in those most likely to have simultaneous infection with H5N1 and seasonal flu (e.g., dairy and poultry workers), and (3) expanded PPE. [Confidence: Very High]

Detection of a second H5N1-infected pig from a non-commercial backyard farming operation does not pose an immediate threat to enterprise business. Influenza infections in pigs are closely monitored because pigs can serve as a “mixing vessel” for flu viruses to gain genetic changes that impact human infection. PHC will update risk assessments as appropriate. Businesses should follow the recommendations provided in the PHC analysis from October 22. Businesses should lower barriers to seasonal flu vaccines for their employees. Update on USDA investigation into an H5N1-infected pig in Oregon: the two pending tests on pigs at the affected farm confirmed one of the pigs to be i...read morenfected with H5N1. Genetic testing indicated that the pigs' H5N1 strain matches the strain identified in the affected farm's poultry and wild birds in the area, and is not the same strain currently circulating in dairy cattle. No human cases were identified at this farm. See PHC alert 10/30 for info about the 1st H5N1-infected pig. [Confidence: Very High]

The immediate threat to business is unchanged, but rising human cases increases the potential for the virus to evolve. Businesses should lower barriers to seasonal flu vaccines for their employees. Businesses should follow the recommendations provided in the PHC analysis from October 22. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Washington confirmed 2 more human H5N1 avian influenza cases in poultry workers, totaling 11 confirmed cases. Confirmatory testing is pending for 3 pr...read moreobable cases among other poultry workers. Additional H5N1 infection in poultry workers is expected, especially in those who may have helped cull infected poultry. [Confidence: Very High]

California's proactive testing is expected to detect additional human H5N1 cases. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. California reported its 21st human case of H5N1 avian influenza and another probable case in workers with exposure to cattle. The CDC confirmed 46 hum...read morean H5N1 cases. As flu season begins, the potential for co-infection of H5N1 and a seasonal flu is concerning. [Confidence: Very High]

Vietnam has reported measles outbreaks in several provinces this year. While Ho Chi Minh City has the largest outbreak, Nghe An's smaller outbreaks also warrant attention. Businesses in Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Nghe An, Vietnam implemented a measles vaccination campaign that runs through the end of Nov due to an increase in provincial cases. 53 cases occurred...read more in sporadic locations across the province from Jan - June, followed by an increase in cases from July - Oct (192) with outbreaks identified in Vinh City, Hung Nguyen, and Nghi Loc. [Confidence: Very High]

Informational update. Household spread of the more transmissible mpox clade 1b is to be expected and does not pose a significant risk to business. PHC will continue to monitor the situation and provide updates as needed. See PHC mpox critical threat for more information about the growing mpox clade 1b situation. The United Kingdom identified one new case of the deadlier mpox clade 1b in a household member of the case reported in London last week, totaling 4 cases in the same household tied to this situation. [Confidence: Very High]

For information only. Hong Kong regularly imposes importation restrictions in response to H5N1 outbreaks, potentially leading to economic losses in the affected areas. See PHC analysis on 10/22 for more information and guidance on the dairy-related H5N1 avian influenza outbreaks. Hong Kong halted importation of poultry meat and products, and eggs from H5N1-affected areas of the US and Canada (Clackamas County, OR; Kings County...read more, CA; Cache County, UT; Willner No. 253, Saskatchewan). See PHC alert from 10/1 for information on other banned importation areas in the United States. [Confidence: Very High]

Businesses can reduce barriers to mpox vaccination for at-risk employees by preparing guidance on vaccine coverage and reimbursement under company-provided health insurance policies including upcoming changes in coverage on Jan 1. Mpox vaccine access in the US has been hindered by affordability issues since the vaccine became commercially available earlier this year, increasing ...read morefrom free to $300 per dose ($600 for the 2-dose series). Most private US insurance companies do not currently cover the cost, but will cover it starting Jan 1. [Confidence: Very High]

Whooping cough is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in Michigan should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Michigan has reported 941 confirmed/probable whooping cough cases as of 11/2, the highest since 2014 which had 1,424 cases. Whooping cough outbreaks a...read morere cyclic, generally occurring every 2-5 years. The lingering cough and illness can lead to prolonged caregiving-related absenteeism. [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. Businesses with healthcare workers in this area should be aware of these episodes of violence and caution employees to maintain high situational awareness for personal safety. Balochistan province reported Pakistan's 46th wild poliovirus type 1 (WPV1) case from Killa Saifullah district, the 2nd case from this district and th...read moree 23rd from Balochistan. Balochistan has the most cases this year amid vaccination campaign challenges caused by protests and violence. Last week, 9 people were killed in a bombing targeting a polio vaccination drive in Mastung. [Confidence: Very High]

This first detection of H5 avian influenza in Los Angeles County wastewater does not pose an immediate threat to business. PHC will provide updated guidance as warranted. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The LA County Department is working to identify the sources of H5 avian influenza detected for the first time at a wastewater sampling site. The count...read morey is working with dairy and meat processing sites as part of the investigation; wild birds are also a potential source. [Confidence: Very High]

California's proactive testing is expected to detect additional human H5N1 cases. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. California reported the 17th, 18th, 19th human cases of H5N1 avian influenza on 11/1 and the 20th case on 11/4; all workers had exposure to cattle. Th...read moreere have been 44 total human cases of H5N1 avian influenza reported in the US. As flu season begins, the potential for co-infection of H5N1 and a seasonal flu is concerning. [Confidence: Very High]

Informational update. A few, isolated cases of mpox do not pose a significant risk to business. PHC will continue to monitor the situation and provide updates as needed. See PHC mpox critical threat for more information about the growing mpox clade 1b situation. The United Kingdom reported 2 additional cases of mpox clade 1b in household members of the case reported in London last week. Mpox clade 1b is the mo...read morere severe type that emerged earlier this year while the less severe mpox clade 2 type spread globally in 2022. [Confidence: Very High]

Additional H5N1 infection in poultry workers culling birds is expected. The immediate threat to business is unchanged, but rising human cases increases the potential for the virus to evolve. Businesses should lower barriers to seasonal flu vaccines for their employees. Businesses should follow the recommendations provided in the PHC analysis from October 22. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Washington confirmed 3 more human H5N1 avian influenza cases in poultry workers, totaling 9 confirmed cases. Confirmatory testing is pending for 3 probable cases among other poultry workers. [Confidence: Very High]

Malaria is endemic in Ethiopia, but cases are surging in an already record high year. High cases are expected to continue during the remainder of the fall malaria season. Businesses in Ethiopia should continue to eradicate mosquito habitats by eliminating sources of standing water and applying effective insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, and eliminating standing water near their homes. Ethiopia’s 7.3M malaria cases this year are higher than the past 7 years, with outbreaks beyond the normal seasons. Every week in 2024, cases exceed...read moreed previous years. An off-season surge in the summer saw weekly case counts of 200-300k, leading into the traditional malaria season of September to December. The return of 300K weekly cases suggests the rest of the fall malaria season will continue to be high. Cases are concentrated in western regions and overlap with areas experiencing violent conflict. [Confidence: Very High]

Businesses in Los Angeles County, California can support mosquito control measures at their facilities by eliminating standing water. Employees living in or visiting the area should eliminate sources of standing water around their property and prevent mosquito bites by wearing protective clothing and using insect repellent. Businesses in Baldwin Park should be especially proactive. LA County reported 2 new cases of locally acquired dengue, totaling 11 cases this year. One case was reported from a new area, Hollywood Hills, while ...read morethe other case originated from Baldwin Park, where 6 earlier cases were reported. All 11 cases had initial symptoms in August and September. See PHC alerts from 10/24, 10/17, 10/3, 9/26, and 9/20 for information on earlier cases in LA County. [Confidence: Very High]

Businesses in New South Wales, Australia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. New South Wales, Australia's record-breaking 2024 whooping cough cases continue, with 2,709 cases identified in Oct. 18,376 cases have been identified...read more in 2024, higher than any other year on record (previous highest annual total was 13,188 in 2011). See PHC alert 10/1 for more info. [Confidence: Very High]

Businesses in New Brunswick, Canada should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. New Brunswick, Canada reported 2 new measles cases, both close contacts of a case identified in Oct (see PHC Alert 10/25). Additional potential cases ...read moreare under investigation. Measles vaccination clinics are scheduled for this weekend. [Confidence: Very High]

It is unsurprising that mandatory surveillance detected H5N1 at multiple dairies in Cache County, Utah. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. 8 commercial dairies in Cache County, Utah have detected H5N1 avian influenza in cattle after the earlier detection of the dairy-related H5N1 strain i...read moren commercial poultry in the same county (PHC alert 10/15). Utah initiated mandatory surveillance for H5N1 in all Cache County dairies after the poultry outbreak (PHC alert 10/24). A quarantine has been instituted restricting movement of dairy cows at infected facilities with an exemption for slaughter. [Confidence: Very High]

Informational update only. Increased testing is likely to detect avian influenza in more dairy herds but aids in targeted use of biosecurity measures to limit further spread. Businesses should continue to follow the recommendations provided in the PHC analysis on Oct 22. The USDA will begin a nationwide bulk milk testing program starting in early Nov. Bulk testing of milk for H5N1 has previously been conducted in CA an...read mored CO, and was used for brucellosis detection in the past. Bulk testing helps identify undetected virus circulation so that biosecurity measures can be implemented to limit spread. [Confidence: Very High]

Detection of H5N1 in a pig from a non-commercial backyard farming operation does not pose an immediate threat to enterprise business. Influenza infections in pigs are closely monitored because pigs can serve as a “mixing vessel” for flu viruses to gain genetic changes that impact human infection. PHC will update risk assessments as appropriate. Businesses should follow the recommendations provided in the PHC analysis from October 22. Businesses should lower barriers to seasonal flu vaccines for their employees. The USDA has reported the 1st pig H5N1 avian influenza case in the US from a backyard farming operation with mixed livestock (poultry, pigs, goats, sh...read moreeep) in Crook County, Oregon. This is also the 1st detection of H5N1 in poultry in Crook County. The backyard farm has been quarantined and all swine euthanized. Out of 5 pigs tested for H5N1, 1 tested positive, 2 tested negative, and 2 have tests pending. Initial genetic testing of the H5N1 virus found in poultry on the farm does not show any mutations that would increase transmissibility to humans. [Confidence: Very High]

Informational update. A single case of mpox in a traveler does not pose a significant risk to business. PHC will continue to monitor the situation and provide updates as needed. See PHC mpox critical threat for more information about the growing mpox clade 1b situation. The UK reported the 1st case of mpox clade 1b in a traveler who recently returned from African countries with community cases of mpox clade 1b. The in...read moredividual was diagnosed after visiting a London emergency department on 10/27. Health authorities are conducting contact tracing. Mpox clade 1b is the more severe type that emerged earlier this year. The less severe mpox clade 2 spread globally in 2022. [Confidence: Very High]

H5N1 infection in poultry workers culling birds is rare but not unexpected; the threat to business is unchanged. Businesses should lower barriers to seasonal flu vaccines for their employees. Businesses should follow the recommendations provided in the PHC analysis from October 22. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Washington state confirmed a 6th human case of H5N1. Two additional suspected cases have confirmatory tests pending. See PHC alerts from 10/28, 10/25, and 10/21 for more information on these cases in poultry workers. [Confidence: Very High]

Businesses in New Jersey should inform employees about possible measles exposures and provide flexible work schedules to support employees making vaccine appointments for themselves or family members. New Jersey reported 4 additional confirmed measles cases; all were close contacts of the Monmouth County case reported earlier in October. State and l...read moreocal health officials are identifying and notifying people who might have been exposed. The initial case attended the International Longshoreman Association Strike at the Elizabeth Chassis Depot all day on 1-3 October. See PHC Alert on 10/15 for other exposures to the public. [Confidence: Very High]

This respiratory season is off to a worse start compared to last year and appears to be partly driven by an increase in COVID-19. Businesses can support employees in obtaining seasonal influenza, COVID-19, and other respiratory illness vaccinations by providing flexible work schedules. Medical consults for acute respiratory illnesses are on the rise in Hungary. While increases in medical consults appear to be driven by COVID-19, as s...read moreuggested by regional wastewater and negative flu tests, already more Hungarians are seeking care for influenza-like illness compared to prior years. [Confidence: Very High]

Businesses in Iowa should be aware of the reported death and be prepared to answer employees' questions and respond to fear. Lassa Fever can only be transmitted by close contact. Public health officials are working to identify anyone who had close contact with the individual for monitoring. An Iowa resident died from suspected Lassa Fever after returning from recent travel to West Africa. Lassa Fever is endemic in West Africa. The individ...read moreual was reportedly not symptomatic while traveling. Therefore, the risk to the public is low. [Confidence: Very High]

Informational update. The revisions to the recommendations now include many working-age adults as part of the target population for the pneumococcal vaccine. The vaccine can prevent long-term illness and costly hospital stays. Businesses in the US should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The CDC updated its recommendation for the pneumococcal vaccine. The CDC now recommends that adults receive the pneumococcal vaccine at 50 instead of ...read more65. The pneumococcal vaccine protects against infections from Streptococcus pneumoniae in the lungs, brain, bloodstream, and sinuses. Older adults and young children are more likely to experience severe disease. [Confidence: Very High]

Given California's proactive testing, the detection of additional H5N1 cases in dairy workers and herds is not unexpected. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. California has reported a new human H5N1 avian influenza case in an individual with animal exposure, the state's 16th reported case. Additionally, 178 dairies have been confirmed infected in Central California. [Confidence: Very High]

Informational update. Businesses in the United States should continue to promote COVID-19 vaccination for employees by providing flexible work schedules. PHC recommends that those without medical contraindications receive the COVID-19 vaccine in consultation with their healthcare provider. The CDC recommended that individuals 65 years or older and people with moderate to severely compromised immune systems receive a 2nd dose of the updat...read moreed 2024-2025 COVID-19 vaccines, which were released in August, 6 months after the initial dose. Individuals with moderately or severely weakened immune systems may receive 3 or more doses of the vaccine. [Confidence: Very High]

H5N1 infection in poultry workers culling birds is rare but not unexpected; the threat to business is unchanged. Businesses should lower barriers to seasonal flu vaccines for their employees. Businesses should follow the recommendations provided in the PHC analysis from October 22. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Washington State reported 4 additional human cases of H5N1 avian influenza for a total of 8 cases; 2 cases have been confirmed by the CDC. [Confidence: Very High]

Whooping cough is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in Alaska should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Alaska's record-breaking whooping cough outbreak continues, with the current 435 cases now surpassing all years since reporting began in 2010 (previou...read mores high was 356 cases in 2012). See PHC alerts 9/12, 9/10, and 8/28 for more info about Alaska's whooping cough outbreak. [Confidence: Very High]

Informational update. See PHC Marburg analysis 9/30. Businesses with staff in Rwanda should ensure their emergency plans are up to date for high consequence outbreaks. Enhanced screening for Marburg at airports, including rerouting of US flights from Rwanda, may lead to travel delays. Business travelers should expect evolving public health measures. PHC will monitor the event and provide updates as needed. Rwanda reported the 64th Marburg virus case in a close contact at the site of the index case. The new case does not represent community transmission. 64 cases and 15 deaths have been reported. [Confidence: Very High]

Whooping cough is highly contagious; a single case in the workplace can infect 15 others. The average worker absenteeism for whooping cough is 6 days. Businesses in Ireland should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Ireland has confirmed 402 whooping cough cases this year with an additional 112 suspected cases. Ireland hasn't seen whooping cough cases this high si...read morence 2012 (458 cases). Whooping cough is a cyclical disease, peaking every 3 to 5 years, but this increase in cases surpasses recent outbreaks. [Confidence: Very High]

Identification of the dairy-associated strain of H5N1 in poultry outbreaks can signal undetected H5N1-infected dairy herds in states that have not reported infected cattle. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. On 10/15 USDA reported an avian influenza outbreak at a large commercial egg operation in Cache County. PHC warned that if genetic analysis identified...read more the dairy-related version of H5N1, it could indicate Utah had undetected H5N1-infected dairy herds. The dairy strain was subsequently identified, and Utah initiated mandatory testing for avian influenza in all dairies in Cache County. [Confidence: Very High]

Informational update. See PHC Marburg analysis 9/30. Businesses with staff in Rwanda should ensure their emergency plans are up to date for high consequence outbreaks. Screening for Marburg at airports is increasing, including rerouting of US flights from Rwanda, which may lead to travel delays. Business travelers should expect evolving public health measures. PHC will monitor the event and provide updates as needed. After 8 days with no new cases, Rwanda reported a new Marburg virus case in a health professional who has been treating Marburg virus patients since t...read morehe start of the outbreak. The new case does not represent community transmission. 63 cases and 15 deaths have been reported. [Confidence: Very High]

Given California's proactive testing, the detection of additional H5N1 cases in dairy workers is not unexpected. No human-to-human spread of H5N1 has been detected. Businesses should continue to follow the recommendations provided in the PHC analysis on Oct 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. California reported 1 new human H5N1 avian influenza case in a dairy worker, totaling 15 this year. Only animal-to-human transmission has been recorde...read mored in California, but additional human cases provide new opportunities for the virus to acquire genetic changes. As flu season begins, the potential for co-infection of H5N1 and a seasonal flu is concerning. See PHC alerts from 10/22, 10/18, 10/15, 10/11, and 10/9 for more details about earlier human H5N1 cases in dairy workers. [Confidence: Very High]

Businesses whose operations are sensitive to the price of milk should increase their uncertainty level around cost projections as the full impact of H5N1 infections on dairy herds develops. Multiple media reports have cited Keith Poulsen, avian influenza researcher and Director of the Wisconsin Veterinary Diagnostic Laboratory, as asserti...read moreng the mortality rate of California herds may be 15% - 20%, compared to the previously reported 2% in other states. The severe summer heat may be a factor. The reported 60-70% drop in milk production is also higher than previous estimates. Too little time has passed to know if infected cows will return to normal production for their next cycle. One source notes that younger cows are more impacted, which translates to the greatest financial impact since young cows have only just begun to produce milk. In combination, these factors could lead to significant losses to dairy farmers and volatility in milk and dairy product prices. [Confidence: Moderate]

Businesses 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. See PHC mpox critical threat for more information about the growing mpox clade 1b situation. Uganda reported a surge of 113 mpox cases since October 2nd. The first cases this year were in July, and the rapid acceleration of cases now totals 16...read more4. Half of all cases recorded in October were in Kampala (57). Kampala’s current surge is not related to the prison cases identified earlier in October; those cases are in other districts. Uganda's Ministry of Health did not report the clade, but Uganda reported clade 1b cases earlier in the summer. PHC will continue to monitor the situation and provide updates. [Confidence: Very High]

Given California's proactive testing, the detection of additional H5N1 cases in dairy workers is not unexpected. No human-to-human spread of H5N1 has been detected. Businesses should follow the recommendations provided in the PHC analysis on October 22, including lowering barriers to seasonal flu vaccines for their employees. The CDC is offering free seasonal influenza vaccines to farmworkers in high-risk states. Merced County Department of Public Health has reported the county's first human H5N1 case in a dairy worker at a farm with infected cattle. The worker...read more's contacts have been notified and are being monitored for symptoms. This case is the 14th in California. See PHC alerts on 10/21 and 10/18 for information on other recent human H5N1 cases in the state. [Confidence: Very High]

Detection of an imported case of mpox in Europe will generate media attention, but the current risk to enterprise business remains low. 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. Germany reported its 1st ever mpox clade 1b case in an individual who had traveled abroad. Health authorities have stated that risk to the public is l...read moreow as transmission requires close contact, but they are continuing to monitor the situation. See PHC mpox critical threat for more information about the growing mpox clade 1b situation. [Confidence: Very High]