PHC Global Alerts
The US is planning to screen for Marburg at select airports, which may lead to travel delays for travelers entering the country. Business travelers should expect evolving public health measures. For information on the Marburg outbreak see the PHC analysis from 9/30. The United States is finalizing plans to redirect travelers from Rwanda to select US airports for additional public health entry screening. The CDC ha...read mores suggested that travelers planning to visit Rwanda reconsider their plans amid the growing outbreak. [Confidence: Very High]
Detection of highly pathogenic avian influenza in more dairy herds is not unexpected. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. 26 more H5N1-infected dairy herds were identified in California, bringing the total to 82 infected herds. Pasteurization inactivates the H5N1 virus, m...read moreaking pasteurized milk and milk products safe to consume. No sustained human-to-human spread of H5N1 has been detected. See PHC alerts from 10/3, 10/1, and 9/24 for more information. [Confidence: Very High]
The impact of Europe's bluetongue outbreak is being felt first in the wholesale market, with supermarket prices expected to rise once fixed-price contracts expire. PHC recommends businesses that purchase food products or provide food services should plan for these rising costs to persist. Bluetongue serotype 3 has been spreading through Europe. This serotype has higher fatality rates than previous strains in Europe, and the economic imp...read moreacts are mounting. See PHC analysis from 9/5 (Economic Impact Expected from Bluetongue Virus (BTV) Outbreak in Europe) for more information. [Confidence: Very High]
Employers can support at-risk 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. PHC will continue to monitor the emerging clade 1b mpox outbreak and update business recommendations as needed. The Democratic Republic of the Congo (DRC) has begun a mass mpox vaccination program to address the growing mpox outbreak, which has spread to all pro...read morevinces of the country. The vaccination campaign will start in Goma, the capital of North Kivu province. Last week, 2,490 cases were reported (365 confirmed, 26 deaths) with the DRC and Burundi accounting for nearly 95% of all cases. Africa has reported 34,297 suspected cases of mpox in 2024 (6,806 confirmed, 866 deaths). [Confidence: Very High]
Given the numerous dairy herd outbreaks in California, the detection of positive dairy workers is not unexpected. No human-to-human spread of H5N1 has been detected, 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. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. California is investigating a 3rd possible case of H5N1 avian influenza case in a Central Valley dairy worker with no known connection to the prior 2 ...read morehuman cases in California (see PHC alert 10/3). Samples have been sent to CDC for confirmatory testing. [Confidence: Very High]
Businesses in San Diego 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 the Escondido area should be especially proactive. San Diego County reported the 1st case of locally-acquired dengue in an Escondido resident. In response, County Vector Control is conducting mosquito control spraying in Escondido. [Confidence: Very High]
Employers can support at-risk 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. Ghana reported an mpox case in the Western North region, the country's 1st mpox case this year. The clade has not yet been identified. 25 close contac...read morets are being monitored. Ghana identified 8 mpox cases in 2023 and 120 in 2022. [Confidence: Very High]
Businesses in Minnesota should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The measles outbreak within the greater Minneapolis and St. Paul region of Minnesota continues with 1 new case identified in the last week, totaling 5...read more2 linked to the outbreak. The new case was identified in Anoka. Minnesota has reported 59 measles cases this year. See PHC alerts 9/18, 9/9 and 8/29 for more info. [Confidence: Very High]
Eastern equine encephalitis (EEE) can cause severe neurological complications in humans, and mosquito bite prevention is critical. Media attention around this case may lead to employee questions about outdoor safety. Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. New Hampshire reported a 5th case of eastern equine encephalitis (EEE) resulting in the death of a Danville resident. As temperatures drop, the risk o...read moref transmission from an infected mosquito decreases, but consistent cold temperatures are required before dropping prevention measures. This is the 2nd EEE death reported in NH this year; no EEE deaths had been reported for NH since 2014. See PHC alerts from 10/1, 9/18, 8/29, and 8/27 for more information. [Confidence: Very High]
Given the numerous dairy herd outbreaks in California, the detection of two positive dairy workers is not unexpected. No human-to-human spread of H5N1 has been detected, but additional human cases provide the virus new opportunities to acquire genetic changes. As flu season begins, the potential for co-infection of H5N1 and a seasonal flu is concerning. Contacts of the cases are being monitored. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. CDC tests have confirmed H5 avian influenza in 2 California dairy workers: a suspected case that the California Department of Public Health (CDPH) had...read more previously announced (see earlier PHC alert 10/3) and a previously unreported individual. Both cases had mild symptoms, did not report respiratory symptoms, and were not hospitalized. [Confidence: Very High]
Evidence of previously undetected H5N1 infections among dairy workers means that other cases likely occurred/are occurring. No human-to-human spread of H5N1 has been detected. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. California is investigating a possible case of H5N1 avian influenza case in a Central Valley dairy worker who handled H5N1-infected cattle. The prelim...read moreinary test was positive for H5N1, and samples have been sent to CDC for confirmatory testing. The person's only symptom was conjunctivitis. 4 other US cases have been linked to the dairy industry since April (PHC alerts from 8/2, 7/5, and 5/30). [Confidence: Very High]
Though tularemia occurs in wildlife throughout Nebraska, human cases are rare. Tularemia can be spread by ticks, or handling or mowing over infected animals. Businesses in Nebraska with employees working outdoors should encourage tick bite prevention and avoiding contact with wildlife, including removing dead rodents from the area before mowing. Nebraska reported an increase in tularemia cases, with 18 cases so far in 2024 compared to a 5-year average annual total of 11 cases per year. There i...read mores also an increasing trend in cases, with 7 of the 18 cases identified in Sept compared to a previous average of 1 case each year in Sept. Half of the cases are tied to inhalation of tularemia, usually associated with contact with infected animals or contaminated surfaces. [Confidence: Very High]
Businesses in Israel should inform employees about the possible measles exposures and provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Israel reported 2 measles cases in the Haifa region in unvaccinated individuals. One case visited Ramat Hanassi Maccabi Clinic (9/18), Maccabi Clinic ...read more(9/19, 9/21), and Bnei Zion Hospital (9/21, 9/22). Historically, most measles cases in Israel are imported, but small clusters have occurred among unvaccinated groups following imported cases. [Confidence: Very High]
Businesses should aggressively reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can reduce their risk by wearing clothing covering skin, using mosquito repellants, using window screens and mosquito nets impregnated with insect repellants, and anti-mosquito coils and vaporizers. Italy has reported a record 130 locally-acquired dengue cases in 2024 (130) compared to 42 in the same time period in 2023. The 2024 cases are spread ...read moreacross 5 regions, with most identified in Marche with Fano as the epicenter (102). The government stated Marche saw a 93% drop in cases last week based on date of initial illness, but the total confirmed case count doubled, suggesting the agency may be working through a backlog of lab tests. Pending clarification on transmission trends, businesses should continue mosquito mitigation efforts. 4 other regions reported locally-acquired dengue cases: Emilia-Romagna (19), Lombardy (6), Veneto (1), and Tuscany (1). See PHC alert from 9/13 for more info. [Confidence: Very High]
See PHC Marburg analysis 9/30. Businesses with staff in Rwanda should ensure their emergency plans are up to date for high consequence outbreaks. Businesses with a presence in East and Central Africa should anticipate movement restrictions and other mitigation measures. PHC will monitor the event and provide updates as needed. Update to Rwanda's first ever Marburg outbreak (see PHC alerts from 10/2, 9/30, 9/27): 37 cases and 11 deaths have been confirmed making this the 3rd largest Marburg outbreak ever recorded. [Confidence: Very High]
Businesses in Mozambique should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Mozambique's measles outbreak which started in July has expanded to 2 new provinces: Nampula and Zambezia. 546 cases have been reported across 5 provi...read morences: Cabo Delgado (350), Niassa (68), Zambezia (46), Nampula (41), and Sofala (41). Mozambique implemented a catch-up immunization campaign earlier this month (see PHC alert 9/13 for details); that campaign is being extended into the newly affected provinces. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in Ho Chi Minh City, Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. People traveling to Ho Chi Minh, Vietnam should check their measles vaccination status. Update to Ho Chi Minh, Vietnam's measles outbreak: cases remain very high, with 111 new cases reported in the past week, totaling 846 cases in 2024. D...read moreistricts with the highest cases include Binh Chanh, Binh Tan, and Hoc Mon. See PHC alerts 9/26, 9/19, 9/4, 8/26 and 8/12 for earlier info about measles in Ho Chi Minh. [Confidence: Very High]
See PHC Marburg analysis 9/30. Businesses with staff in Rwanda should ensure their emergency plans are up to date for high consequence outbreaks. Businesses with a presence in East and Central Africa should anticipate movement restrictions and other mitigation measures. PHC will monitor the event and provide updates as needed. Update to Rwanda's Marburg outbreak (see PHC alerts from 9/30, 9/27): 29 cases and 10 deaths have been confirmed. Separately, WHO reported that a cont...read moreact traveled to Belgium but remained healthy, completing the 21-day monitoring period. The contact did not present with any symptoms and is not a risk to public health. [Confidence: Very High]
This rapidly growing outbreak in New South Wales warrants greater attention from enterprise businesses in this area. 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 Australia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. New South Wales, Australia's 2024 whooping cough cases (15,368) are now higher than any previously recorded (previous highest annual total was 13,188 ...read morein 2011). Activity is growing, with two-thirds of this year's cases (9,762) identified in the last 2 months. [Confidence: Very High]
This rapidly growing outbreak in Queensland warrants greater attention from enterprise businesses in this area. 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 Australia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Queensland, Australia reported 9,489 cases of whooping cough, the highest case count ever recorded. So far, 31,891 cases have been reported in Austral...read moreia with cases already surpassing the case counts from 2011, the previous highest year (28,273 cases). See PHC alert from 8/23 for more information. [Confidence: Very High]
Detection of highly pathogenic avian influenza in more dairy herds in multiple states is not unexpected. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. 3 more H5N1-infected dairy herds were identified in California and 1 H5N1-infected dairy herd in Idaho, totaling 44 infected herds (CA) and 33 infecte...read mored herds (ID) since the outbreak began. No human cases have been identified in these cattle outbreaks. Pasteurization inactivates the H5N1 virus, making pasteurized milk and milk products safe to consume. No sustained human-to-human spread of H5N1 has been detected. [Confidence: Very High]
Businesses with employees in impacted areas should consider including health-related items in their communications including directions to boil contaminated water for at least 1 minute, information on how the company health insurance handles replacement of lost medications, and warning about flood hazards like infections in cuts from submerged metal and mold. U.S. Department of Health and Human Services has declared Public Health Emergencies in Florida, Georgia, and North Carolina. The PHE declarations are ...read moreseparate from the emergency declarations issued by the White House for Florida, Alabama, Georgia, North Carolina, and Tennessee. The PHE declarations give the Centers for Medicare & Medicaid Services’ (CMS) health care providers and suppliers greater flexibility in meeting emergency health needs of Medicare and Medicaid beneficiaries. [Confidence: Very High]
Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can reduce their risk by wearing clothing covering skin, using mosquito repellants, using window screens and mosquito nets impregnated with insect repellants, and anti-mosquito coils and vaporizers. Mexico's 2024 dengue cases (64,815) are nearly 3 times higher than the same period in 2023 (23,241) and has already beaten the total number of cases i...read moren 2023 (56,333). Dengue is widespread across Mexico but states of particular interest with large cities or tourist attractions such as Baja California Sur (Cabo San Lucas), Quintana Roo (Cancun, Isla Mujeres), Nuevo Leon (Monterrey), and Yucatan (Chichen Itza) are reporting epidemic levels of dengue. See PHC alert from 9/12 for more information. [Confidence: Very High]
Businesses may want to share information on the availability of free COVID tests in employee wellness communications. Free tests can be obtained via COVIDTests.gov. The US is offering another round of 4 free at-home, rapid COVID-19 tests per household. The US has periodically mare free at-home covid tests availabl...read moree since 2022. PHC reports when new rounds of free covid-19 tests become available. (see PHC alert 8/26). [Confidence: Very High]
See PHC Marburg analysis 9/30. Businesses with staff in Rwanda should ensure their emergency plans are up to date for high consequence outbreaks. Businesses with a presence in East and Central Africa should anticipate movement restrictions and other mitigation measures. PHC will monitor the event and provide updates as needed. Update to Rwanda's Marburg outbreak: only 4 days after reporting the outbreak (see PHC alert 9/27), 26 cases and 8 deaths have been confirmed. Cases h...read moreave been identified in 7 of Rwanda's 30 districts. Marburg disease is highly contagious and causes severe disease with a high fatality rate (88%). [Confidence: Very High]
Symptomatic contacts of an H5N1 clade 2.3.4.4b avian flu case in an individual without known exposure to animals is a concerning new development. Follow up testing will help determine if human-to-human transmission may have occurred. Businesses do not currently need to change their posture regarding H5N1 influenza. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Update to the recent human H5N1 avian flu case in Missouri (see PHC alerts 9/23, 9/16, 9/13 and 9/6): respiratory symptoms have been reported in 4 add...read moreitional health care workers who were exposed to the avian influenza H5N1 clade 2.3.4.4b case after respiratory droplet precautions were put into place. Of the 6 healthcare workers exposed, 1 tested negative for H5N1 through PCR while the others' antibody test results are pending. Missouri has reported no confirmed human-to-human transmission. See PHC Highly Pathogenic Avian Influenza (HPAI) H5N1 critical threat for more information. [Confidence: Very High]
Businesses with staff in Rwanda should ensure their emergency plans are up to date for high consequence outbreaks. Businesses with a presence in East and Central Africa should anticipate movement restrictions and other mitigation measures. PHC will monitor the event and provide updates as needed. Rwanda reported an unspecified number of confirmed cases of Marburg viral hemorrhagic fever disease in multiple hospitals. These are the first cases e...read morever in the country. Media has reported the deaths of multiple health workers. Marburg disease is highly contagious, and causes high fever, severe headache, vomiting, and hemorrhaging with a high fatality rate (50%). [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. Australia reported a recent surge in clade II mpox cases, with 616 new cases identified between July - Sept 25, totaling 724 cases in 2024. Most cases...read more are in New South Wales (374) and Victoria (187). The current mpox surge is larger than any prior mpox outbreak in Australia. [Confidence: Very High]
Businesses in Italy should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Italy has already reported a quadrupling of measles cases in 2024, with 864 cases so far this year (through 8/31) compared to 2023's annual total of 4...read more4 cases. 53 cases were identified in Aug, with most cases in Lombardy (10), Campania (7), Lazio (6), Sicily (6). [Confidence: Very High]
Detection of highly pathogenic avian influenza in more dairy herds is not unexpected, though this is the largest number of infected herds in a state at one time. California produces about 20% of the US milk supply. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. 6 more H5N1-infected dairy herds were identified in California, totaling 42 infected herds in Sept. No human cases have been identified in these cattl...read moree outbreaks. Pasteurization inactivates the H5N1 virus, making pasteurized milk and milk products safe to consume. No sustained human-to-human spread of H5N1 has been detected. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in Ho Chi Minh City, Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. People traveling to Ho Chi Minh, Vietnam should check their measles vaccination status. Update to Ho Chi Minh, Vietnam's measles outbreak: cases remain very high, with 96 new cases reported in the past week, totaling 743 cases in 2024. Di...read morestricts with the highest cases include Binh Chanh, Binh Tan, and Hoc Mon. See PHC alerts 9/19, 9/4, 8/26 and 8/12 for earlier info about measles in Ho Chi Minh. [Confidence: Very High]
Dengue is endemic in Saint Lucia, but cases are much higher this year than usual. Businesses should reduce mosquito populations at their facilities by eliminating standing water, even in relatively dry months. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, and eliminating standing water near their homes. Saint Lucia declared a dengue outbreak due to rising cases. So far, 205 cases have been reported, with almost half of 2024's cases identified in Aug (...read more96) and Sept's cases remaining high (72 so far). Most cases have occurred in the northern regions, including Castries and Gros Islet. [Confidence: Very High]
This rapidly growing outbreak in Dong Nai province warrants greater attention from enterprise businesses in this area. Businesses in Dong Nai should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Dong Nai, Vietnam has implemented a vaccination catch-up campaign to address rising measles cases in the province. So far, 262 cases have been reporte...read mored this year across 11 districts and cities, compared to only 1 case identified during the same period in the province in 2023. Current vaccination rates are 83.9% for children under 2 years, far below the target rate of 95%. [Confidence: Very High]
Businesses in Germany should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Germany reported 18,245 whooping cough cases as of Sept 25, 2024, the highest annual cases recorded since data reporting began in 2001; the previous h...read moreighest annual total was 2017 (16,323). Cases have been higher than usual all year, but began surging in mid-May and have remained high. Classes resumed in late Aug, increasing the risk of transmission. [Confidence: Very High]
West Nile virus (WNV) is endemic in Spain, with most cases in rural and southern regions. This WNV death in Seville is a reminder the WNV can be deadly and circulate in urban areas. Businesses should reduce mosquito populations at their facilities by eliminating standing water, even in relatively dry months. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, and eliminating standing water near their homes. Spain reported a human death from West Nile virus (WNV) in a Seville resident, the country's 8th WNV death but the 1st death identified in an urban ar...read moreea. Previous WNV cases and deaths have been reported in rural regions of Andalucia. See PHC alert 9/17 for info about earlier WNV cases in Spain. [Confidence: Very High]
Businesses in Scotland should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Scotland's whooping cough outbreak is now its largest in the past 10 years. 432 new cases have been identified in the past 30 days. 2024 has had 6,660...read more cases and 1 death through 9/16. Cases peaked in July, but Aug and Sept's monthly totals remain higher than annual totals during the past 10 years. [Confidence: Very High]
This rapidly growing outbreak in the Dublin and Northeast region warrants greater attention from enterprise businesses in this area. Businesses in Ireland should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Ireland reported 2 new confirmed and 24 suspected measles cases in the last week, totaling 121 confirmed cases this year. One of the new cases is in t...read morehe Dublin and Northeast region, where cases have been rising since May (47 cases total). Neither of the recent cases are linked to known outbreaks, indicating widespread community transmission. See PHC alerts 9/16 and 9/12 for more info about measles in Ireland. [Confidence: Very High]
Dengue is endemic in Tamil Nadu, but cases are much higher than expected and the upcoming monsoon will further increase risk. Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. Tamil Nadu, India reported its highest dengue cases in 7 years, with 14,000 cases and 7 deaths so far this year. Dengue risk remains high with the northeast monsoon expected next week. [Confidence: Very High]
EEE can cause severe neurological complications in humans, and mosquito bite prevention is critical. Media attention around this death may lead to employee questions about outdoor safety. Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. New York declared an imminent threat to public health after the state's 1st 2024 human case from eastern equine encephalitis (EEE) died (see PHC alert...read more 9/23 about identification of the case). The declaration is in effect 9/23 - 10/30 and provides resources to local public health to aid in mosquito bite prevention, including spraying and providing repellent at state parks. [Confidence: Very High]
Businesses in Dak Lak, Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Dak Lak, Vietnam's measles outbreak continues, with 21 cases identified in the last week. 136 cases have been reported in 14 of the province's 15 dist...read morericts, with Buon Ma Thuot city reporting the most cases (74). The province did not report any measles cases from 2021 - 2023. Local hospitals continue to be challenged by the patient surge (see PHC alert 9/17). [Confidence: Very High]
If confirmed by government sources, this reported case indicates that 2 new countries have the deadlier clade Ib mpox strain. Employers can support at-risk 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 situation. Widespread media sources have reported that India has identified its 1st case of deadlier clade Ib mpox. The case had recently traveled from the Unite...read mored Arab Emirates (UAE) and was identified at a Kerala airport (see PHC alert 9/19). The UAE has not identified any clade Ib mpox cases. [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 3 wild poliovirus type 1 (WPV1) cases in the last week, including Khyber Pakhtunkhwa's 1st case this year. 21 polio cases have been reported in Pakistan this year. [Confidence: Very High]
Detection of highly pathogenic avian influenza in more dairy herds is not unexpected, though this is the largest number of infected herds in a state at one time. California produces about 20% of the US milk supply. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. 18 more H5N1-infected dairy herds were identified in California, totaling 31 infected herds in Sept. No human cases have been identified in these catt...read morele outbreaks. Pasteurization inactivates the H5N1 virus, making pasteurized milk and milk products safe to consume. No sustained human-to-human spread of H5N1 has been detected. [Confidence: Very High]
Businesses in Aswan, Egypt should ensure they have access to clean water in the event the outbreak expands into cities/population centers. Businesses in Egypt can advise ill employees to seek medical care if gastrointestinal symptoms appear. This outbreak of severe gastrointestinal disease is under investigation to determine the cause of illness. PHC monitors reports of severe unknown illnesses; PHC will communicate any actionable developments. Aswan, Egypt reported an outbreak of gastrointestinal illness, with 480 hospitalized cases. Most cases are in Abu Al-Rish and Daraw villages. The publ...read moreic water was tested and found to be safe; an investigation is underway to identify a contaminated water source. [Confidence: Very High]
EEE can cause severe neurological complications in humans, and mosquito bite prevention is critical. Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. Ulster County, New York reported the state's 1st human eastern equine encephalitis (EEE) case since 2015. Ulster County reported an equine EEE case in...read more Aug and Rensselaer County, NY detected 2 EEE cases in emus earlier this month. [Confidence: Very High]
Symptomatic close contacts of an H5N1 clade 2.3.4.4b avian flu case in an individual without known exposure to animals is a concerning new development. Follow up testing could help determine if human-to-human transmission may have occurred. Businesses do not currently need to change their posture regarding H5N1 influenza. PHC will continue to monitor and will communicate updated risk assessments as appropriate. Update to the recent human H5N1 avian flu case in Missouri (see PHC alerts 9/16, 9/13 and 9/6): a second close contact was identified, consisting of a...read more healthcare worker who developed symptoms, but was never tested. Health officials are considering conducting follow up testing to determine if the close contacts may have evidence of previous H5N1 infection. CDC can only assist with an invitation from the state. [Confidence: Very High]
Businesses in Israel with employees working outdoors in grassy or wooded areas should remind them that tick bite prevention is important for minimizing exposure risk. Wearing long-sleeve shirts, pants, and boots can help prevent tick bites, and light-colored clothing can make it easier to spot ticks. Israel reported its 1st ever cases of Crimean-Congo hemorrhagic fever (CCHF) in cattle. Infected cattle were identified during a Veterinary Institute ...read moretesting program. About a third of herds tested were positive, with cases identified in Golan Heights, Jezreel Valley, and the Menashe Mountains. No human case of CCHF has been reported in Israel. [Confidence: Very High]
Businesses should reduce mosquito populations at their facilities by eliminating standing water, even in relatively dry months. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, and eliminating standing water near their homes. PHC has been reporting on Israel's record-breaking West Nile virus (WNV) outbreak since June, but a recent comment from the Minister of Health has dra...read morewn media attention. In the last 4 days, 9 new cases and 1 death have been identified, totaling 913 cases and 70 deaths in 2024. Israel's 2024 WNV cases (913) now exceed all WNV cases across Europe combined (744 cases and 51 deaths). See PHC analysis on 7/2 and alerts 9/16, 9/6, 8/20, 8/7, 7/29, 7/12, 7/10, and 6/28 for more info. [Confidence: Very High]
Businesses in the Courtenay, British Colombia area should refer employees to the health alert about this possible exposure and provide flexible work schedules to employees needing to get themselves or their family members vaccinated. Courtenay, British Columbia reported a case of Hepatitis A in a Dairy Queen employee. Hepatitis A is spread through contaminated food and water. Hepat...read moreitis A vaccine is over 95% effective in preventing disease in people who have received two shots. A single shot of the hepatitis A vaccine can help prevent hepatitis A if given within 14 days of exposure. [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 the Baldwin Park area should be especially proactive. Baldwin Park, California has reported 2 more dengue cases in residents with no history of travel in the same area as the dengue case confirmed earlier this month (see PHC alert 9/10). [Confidence: Very High]
The detection of highly pathogenic avian influenza in more dairy herds is not unexpected. California produces about 20% of the US milk supply. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Pasteurization inactivates the H5N1 virus, making pasteurized milk and milk products safe to consume. No sustained human-to-human spread of H5N1 has been detected. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. Six dairy herds in California tested positive for highly pathogenic avian influenza (HPAI) H5N1, totaling 17 dairy herd outbreaks in the state. No human cases have been identified in this current outbreak. [Confidence: Very High]
Indonesia's peak dengue season starts in Nov. Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. Dengue is a year-round threat in Indonesia, and the 186,324 cases to date are already the second highest number since 1968 (2016 was the worst with 20...read more3,936 cases). The dengue cycle in Indonesia has also shortened so that epidemics occur approximately every < 3 years instead of 10 years. As climate change causes more intense El Nino events, dengue cases increase in Indonesia. [Confidence: Very High]
The polio vaccine is more than 99% effective in preventing poliovirus infection. Travelers to Ghana should verify their polio vaccination status before travel. Ghana declared a public health emergency after identifying vaccine derived polio virus type 2 (cVDPV2) in a wastewater sample collected in Koforidua w...read moreithin Eastern Region. Ghana last detected polio in wastewater samples in 2020. Its last human polio case was in 2008. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in Ho Chi Minh City, Vietnam should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. People traveling to Ho Chi Minh, Vietnam should check their measles vaccination status. Update to Ho Chi Minh, Vietnam's measles outbreak: cases remain very high, with 102 new cases reported in the past week, totaling 776 cases in 2024. C...read moreases have been identified in 9 new schools this past week and 30 additional schools are still monitoring close contacts after identifying an infected student(s). 55 schools in Ho Chi Minh have had cases this year. See PHC alerts 9/4, 8/26 and 8/12 for more info. [Confidence: Very High]
Businesses in England should provide flexible work schedules to support employees making vaccine appointments, and should remind employees to consider including pediatric vaccine appointments in their back-to-school tasks. Pediatric vaccinations can reduce employee absenteeism for caregiving duties. England's whooping cough outbreak has now surpassed all previous annual case totals since 2011, with 12,200 cases and 9 deaths through 8/31. Cases pe...read moreaked in May, but remain very high and are expected to rise again following the start of the school year earlier this month. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in Minnesota should strongly encourage employees to be aware of their and family members' vaccination status, and provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The measles outbreak within the greater Minneapolis and St. Paul region of Minnesota continues with 11 new cases in September, totaling 51 linked to t...read morehe outbreak. One of the new cases attends a Minneapolis public school. Minnesota has reported 58 measles cases this year. See PHC alerts 9/9 and 8/29 for more info. [Confidence: Very High]
This potential bioviolence incident should not impact enterprise business directly; however, this situation illustrates the importance of being prepared for this type of event due to the risk of copy cat actions against companies. Businesses should have a plan for handling suspicious mail. The FBI is investigating threatening letters containing an unknown substance sent to election officials in at least 6 states. So far, none of the substances have been hazardous. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in the greater Dublin, Ireland area should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Dublin, Ireland reported 4 new confirmed measles cases in the last 2 days, totaling 46 cases for the region and 119 for the country this year. Ireland...read more's 2024's measles cases are already 28-fold higher than 2023's 4 cases. None of the cases identified in the last week are linked to known outbreaks, indicating widespread community transmission in the greater Dublin area. See PHC alerts 9/16 and 9/12 for more info. [Confidence: Very High]
Informational update only. Massachusetts tested its 95 licensed dairy herds for H5N1 and tests confirmed all were negative. MA is the 1st state to proactively test all herds for H5N1. [Confidence: Very High]
This situation warrants greater attention from enterprise businesses in the area. Nipah virus is severe and often deadly. Mitigation measures in the affected area are likely to cause business disruptions, including potential loss of revenue due to decreased open hours. Businesses should anticipate employee absenteeism for caregiving duties. Businesses in Kerala, India should advise employees to not consume raw juice or raw fruit that has been left in the open. Kerala, India implemented mitigation measures after confirming Nipah death. Public gatherings are prohibited, and universal masking is required within...read more a 3km radius of the 5 affected wards in Malappuram district. Theaters, schools, churches, and childcare centers in the containment zones are closed, and stores have a 7pm curfew while the investigation is underway. All Mawlid-related activities have been cancelled. 126 close contacts with high-risk exposures are being monitored. See PHC alert 9/16. [Confidence: Very High]
Compared to other respiratory illnesses, COVID-19 will have a bigger impact on worker absenteeism due to employee illness or caregiving duties. To mitigate this, businesses should continue to promote COVID-19 vaccination for employees. PHC recommends that those without medical contraindications receive the COVID-19 vaccine in consultation with their healthcare provider. A new COVID variant (XEC) may become the dominant strain during the US's upcoming fall/winter wave. XEC, a combination of KS.1.1 and KP.3.3 Omicron va...read moreriants, was first identified in Germany in June, and has since spread to 27 countries. Fall 2024 COVID vaccines should protect against severe illness for any of the currently circulating strains. [Confidence: Very High]
This record-breaking outbreak warrants greater attention from enterprise businesses in the area as the new semester begins, increasing the risk of disease spread. Businesses in South Korea should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. South Korea reported a record breaking whooping cough outbreak, with more cases in 2024 (27,787) than in any previous year (annual average of 140). So...read moreuth Korea's cases peaked in July, but still remain very high with 937 cases so far in Sept. [Confidence: Very High]
Informational update only. Multiple states have reported H5N1 avian flu outbreaks in dairy herds. Increased surveillance for avian flu is likely to identify additional infected herds and farms. Two dairy herds in Texas tested positive for highly pathogenic avian influenza (HPAI) H5N1, totaling 26 dairy herd outbreaks in the state. TX's last i...read morenfected dairy herd was in Aug. No human cases have been identified in this current outbreak. [Confidence: Very High]
Informational update only. Multiple states have reported H5N1 avian flu outbreaks in dairy herds. Increased surveillance for avian flu is likely to identify additional infected herds and farms. A dairy herd in Idaho tested positive for highly pathogenic avian influenza (HPAI) H5N1, the state's 34th dairy herd outbreak. ID's last infected dair...read morey herd was in Aug. No human cases have been identified in this current outbreak. [Confidence: Very High]
Businesses in Sweden should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Sweden reported 32 measles cases in 2024, higher than cases during the same time period for each of the past 5 years. Measles activity has been increasing since June with most cases tied to international travel. [Confidence: Very High]
See PHC mpox critical threat for more information about the growing mpox situation. 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. Uganda reported 10 cases of mpox, reportedly clade 1b. Uganda's Ministry of Health did not report the clade, but national and international news agencies have reported all 10 cases to be clade 1b. [Confidence: Very High]
The detection of an H5N1 clade 2.3.4.4b avian flu case in an individual without known exposure to animals is a concerning new development. Businesses do not currently need to change their posture regarding H5N1 influenza. PHC will continue to monitor and will communicate updated risk assessments as appropriate. CDC reported that the recent human avian flu case in Missouri (see PHC alerts 9/13 and 9/6) was confirmed to be H5N1 clade 2.3.4.4b, closely related t...read moreo the strain that has been infecting dairy cows. The case had a household contact who became symptomatic on the same day as the case but was never tested. [Confidence: Very High]
Informational update only. See PHC mpox critical threat for more information about the growing mpox situation. 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. Burundi reported a rapid rise in mpox cases due to its outbreak of the deadlier clade Ib that started in late July. 1,489 suspected cases have been id...read moreentified across 30 of Burundi's 49 health districts. See PHC alerts 9/4, 8/16 and 7/29 about Burundi's mpox outbreak. [Confidence: Very High]
Employees and travelers to countries with active mpox outbreaks or to countries with enhanced screening procedures should expect increased delays at ports of entry. 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. India implemented mandatory temperature screening for international travelers at airports and a 21-day isolation for mpox cases. These policy changes ...read morewere made after India reported an imported clade II mpox case last week (See PHC alert 9/9). [Confidence: Very High]
Unlike West Nile virus, eastern equine encephalitis (EEE) infection is often highly severe with frequent neurological complications. Businesses should proactively implement mosquito prevention to prevent this disease by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. Ottawa, Canada reported a human case of eastern equine encephalitis (EEE), the city's 1st ever confirmed case and the 1st case in Ontario since 2022. Ottawa reported an equine case of EEE in Aug. [Confidence: Very High]
The detection of an H5 avian influenza case in a patient without known exposure to animals is a concerning new development. Businesses do not currently need to change their posture regarding H5N1 influenza. PHC will continue to monitor and will communicate updated risk assessments as appropriate. CDC reported that the recent H5 human case in Missouri (see PHC alert 9/6) had no clear exposure source. The case was deemed a "one off" with no increased risk of other human cases tied to this situation. [Confidence: Very High]
The detection of highly pathogenic avian influenza in another dairy herd is not unexpected. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. California identified H5N1 avian flu in 2 more dairy herds, totaling 5 infected herds this week and 8 in CA this year. No human cases have been detect...read moreed associated with the California outbreak and no human-to-human spread of H5N1 has been detected. California produces about 20% of the US milk supply. Pasteurization inactivates the H5N1 virus, making pasteurized milk and milk products safe to consume. [Confidence: Very High]
Informational update only. See PHC mpox critical threat for more information about the growing mpox situation. 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. Marrakech, Morocco reports 1st case of mpox, which is the 1st case in North Africa since the most recent mpox clade 1b outbreak was declared in mid-Au...read moregust. Neither clade information nor the case's travel history/possible exposure source were provided. [Confidence: Very High]
See PHC analysis on 8/15 for more information about the growing mpox situation. 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. Africa CDC reported that the deadlier mpox clade Ib continues to spread, with 26,500 cases and 724 deaths identified since Jan. Cases are increasing, ...read morewith 15% of 2024's cases (3,160) and deaths (107) reported in the last week alone. [Confidence: Very High]
The detection of highly pathogenic avian influenza in another dairy herd is not unexpected. California produces about 20% of the US milk supply. The continued spread of H5N1 throughout the US increases the risk of volatility in milk prices; businesses that purchase milk and dairy products should maintain low confidence in cost projections. Pasteurization inactivates the H5N1 virus, making pasteurized milk and milk products safe to consume. No human-to-human spread of H5N1 has been detected. Businesses should continue to follow the recommendations provided in the PHC analysis on April 26. California identified H5N1 avian flu in 3 dairy herds in Central Valley, totaling 6 infected dairy herds in the state this year. No human cases have been detected associated with this outbreak. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in Ireland should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Ireland's 2024 measles cases (113) are now 28-fold higher than 2023's annual total (4). Ireland reported 7 new measles cases in the last 4 days, with ...read morean additional 22 suspected cases. 18 measles outbreaks have occurred in Ireland in 2024, including 2 new recent outbreaks in the Dublin/Midlands and Cork/Kerry areas. Many cases are not linked to known outbreaks, indicating likely widespread community transmission. [Confidence: Very High]
Businesses that used the involved restaurant for catering or event services should contact employees who may be affected. Food service establishments should remind sick workers to stay home and not return to work for 48 hours if infected. Paid sick leave can help reduce the risk of an outbreak. Employers should remind employees to wash their hands with soap and water after using the bathroom and before eating or handling food. Other enterprise businesses can avoid shigellosis outbreaks by encouraging sick people to stay home. Humboldt County, California has closed the Elks Lodge for 2 weeks due to a shigella outbreak involving 6 confirmed and 61 probable cases. The closure ...read morewas implemented after finding that some food service employees had continued to work while ill even after the outbreak was identified. It will stay closed through 9/25. [Confidence: Very High]
Eastern equine encephalitis (EEE) can result in severe neurological complications in humans, and mosquito bite prevention is critical. Businesses should reduce mosquito habitats by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. Providence County, Rhode Island reports human case of eastern equine encephalitis (EEE), the state's 1st case this year. RI also reported a 2nd probab...read morele human case of West Nile virus (WNV). Citizens were urged to use mosquito bite prevention. [Confidence: Very High]
For information only. PHC will monitor and report updates as needed. Update to outbreak of unknown illness in Kachchh district in Gujarat, India: a new death was reported, totaling 15 deaths in 5 days. Preliminary testi...read moreng has ruled out H1N1 and swine flu, Crimean-Congo fever, malaria, and dengue; additional tests are pending. See PHC alert 9/9 for info about earlier cases. [Confidence: Moderate]
Businesses in Newfoundland and Labrador, Canada can share information on the vaccination expansion in employee wellness communications. Businesses should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Newfoundland and Labrador, Canada reported expanding whooping cough booster vaccination to include 8th graders after identifying rising cases this year. 230 cases were identified in 2024 compared to previous annual totals (5). [Confidence: Very High]
Compared to other respiratory illnesses, COVID-19 will have a bigger impact on worker absenteeism due to employee illness or caregiving duties. To mitigate this, businesses should continue to promote COVID-19 vaccination for employees. PHC recommends that those without medical contraindications receive the COVID-19 vaccine in consultation with their healthcare provider. A new study reported that COVID-19 causes more severe and longer lasting symptoms than other respiratory illnesses. Multiple viral illnesses can lead ...read moreto prolonged symptoms, with long COVID found to last longer than for other diseases. [Confidence: Very High]
This rapidly growing outbreak warrants greater attention from enterprise businesses in this area. Businesses in Minnesota should strongly encourage employees to be aware of their and family members' vaccination status, and provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Update to Minneapolis and St. Paul, Minnesota's measles outbreak: 2 new cases were identified in the past 24 hours, totaling 42 linked cases. MN has i...read moredentified 48 measles cases in 2024. See PHC alerts from 9/9 and 8/29 for more info. [Confidence: Very High]
Unlike West Nile virus, EEE infection is often highly severe with frequent neurological complications. The EEE risk remains high for communities in several counties. Businesses should proactively implement mosquito prevention to prevent this disease by eliminating sources of standing water and applying insecticides to outdoor water storage containers. Employees can prevent mosquito bites by wearing protective clothing, using insect repellent, anti-mosquito coils and vaporizers, and eliminating standing water near their homes. Middlesex County, Massachusetts reported a human case of eastern equine encephalitis (EEE), the state's 4th case this year. See PHC alert 9/6 about MA's previous EEE cases. [Confidence: Very High]
Businesses in affected areas with employees who work outdoors should consider temporarily reassigning the workers to indoor activities when feasible. Businesses should also ensure employees have access to clean water and encourage them to seek medical care if they develop symptoms. Orange County, California issued an alert warning about wildfire-related health risks. Smoke from nearby wildfires has drifted into areas of Orange Co...read moreunty. Individuals are urged to limit unnecessary time outside in affected areas. [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. California reported its 1st case of locally acquired dengue in 2024 in Los Angeles County. Only 2 locally acquired dengue cases have been previously identified in CA, both in Los Angeles County during 2023. [Confidence: Very High]
Businesses in Latvia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Vidzeme, Latvia reported a diphtheria outbreak with 4 linked cases identified in the past week. All of the cases were unvaccinated. An investigation is underway to identify potential close contacts. [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. Islamabad, Pakistan reported its 1st human polio case in 16 years, Pakistan's 17th case this year. The case has wild poliovirus type 1 (WPV1), which w...read moreas also detected in sewage samples from 13 districts in Pakistan last week (see PHC alert 9/6). [Confidence: Very High]
Employers who bought or served eggs branded as "Milo's Poultry Farms" or "Tony's Fresh Market" should dispose of any remaining eggs regardless of the expiration date. All potentially impacted employees should be encouraged to seek care if gastrointestinal symptoms develop. A salmonella outbreak linked to eggs branded as "Milo's Poultry Farms" and "Tony's Fresh Market" has caused 65 cases and 24 hospitalizations in 9 stat...read morees (California, Colorado, Illinois, Iowa, Michigan, Minnesota, Utah, Virginia, Wisconsin) with the majority of people becoming sick in Wisconsin and Illinois. Eggs were sold to stores and restaurants in Illinois, Michigan and Wisconsin. [Confidence: Very High]
Businesses in Thailand should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Businesses with employees traveling to Thailand should recommend they check their vaccination status before travel. Thailand reported 2,144 confirmed measles cases and 5 deaths in 2024, its highest annual total since 2019. Measles cases have been rising since Feb 20...read more24 with cases identified in 20 of its 76 provinces. Pattani province has reported the most cases (1,263) and lowest vaccination rates (50%) in 2024. [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. India reported a case of mpox clade II in an individual who had recently traveled to an area with an active mpox outbreak. India has not identified any cases of clade Ib mpox that recently emerged. [Confidence: Very High]
