PHC Global Alerts
Employers, especially those near Stuttgart, should inform employees about the ongoing outbreak and instruct those who attended the festival and are experiencing gastrointestinal symptoms to not report to work until 24 hours after symptoms subside. Food handlers should not return to work until 48 hours after symptoms subside. More than 800 individuals have contracted norovirus at the Stuttgart spring festival. So far, the outbreak has been connected with the Göckelesmaier ...read moremarquee. Testing suggests the outbreak was not connected to food or drinks served within the tent, and person-to-person transmission is suspected. The festival remains open and will run through May. [Confidence: Very High]
Businesses in Mayotte should ensure they have access to clean water and encourage them to seek treatment if they develop symptoms. Enterprise businesses with employees operating outside should try to acquire bottled water for distribution to employees. Mayotte reported their first ever cases of locally spread cholera (3), with 13 cases total identified in 2024. The 3 locally spread cases in Mayotte a...read morell reside in different households. Nearby Comoros has been experiencing a recent cholera outbreak, which increases the risk of continued locally spread cholera in Mayotte. A large portion of the population does not have running water, and over 80% are below the poverty line. The potential for spread is concerning. See PHC alerts on 4/12, 4/24, and 4/26 for info about Comoros' cholera outbreak. [Confidence: Very High]
For information only. Powassan virus disease remains a rare disease, but this case is a reminder that climate change is leading to less predictable tick emergence and a broader geographic range for some diseases. Sharon, MA reported their first ever case of Powassan, a rare tick-borne disease. Powassan virus occurs mostly in the Northeast and Great Lakes region...read more of the U.S. and in eastern Canada, but is rare. On average, fewer than 30 cases of Powassan virus disease occur each year in the US. Infection resembles meningitis illness and can be severe. There is no vaccine or treatment. Tick bite prevention is important for minimizing risk of exposure. [Confidence: Very High]
Imported cases can start chains of transmission if local mosquitoes bite the infected person. Businesses in the UK can support mosquito control measures at their facilities by eliminating standing water. Employees living in or visiting areas with high malaria rates should prevent mosquito bites by wearing protective clothing and using insect repellent. The UK reported an increase in imported malaria cases, with 2,004 cases identified in 2023, the first time rates have been this high in over 20 years....read more Individuals are encouraged to take mosquito control measures during upcoming spring and summer travel and seek care right away if they become ill. Malaria was present in southern England in the early 1900s, and the mosquito vector remains present in the UK. [Confidence: Very High]
Businesses in West Virginia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Update to measles case in West Virginia: 150 - 200 close contacts across West Virginia and Pennsylvania have been identified and are being monitored. ...read moreThis was West Virginia's first measles case in 15 years. PHC will continue to monitor the situation and report updates as needed. [Confidence: Very High]
Informational advisory only. Though Hawai'i typically has low numbers of pertussis cases, this new whooping cough case is likely due to local spread. Enterprise businesses are not expected to experience widespread absenteeism. Hawaiʻi reported a new whooping cough case, the 11th between March - April 2024. The case has not traveled recently and is not tied to previously identified cases, giving evidence of local spread on the island. [Confidence: Very High]
Receiving a flu shot reduces both the risk of contracting influenza and the likelihood of developing severe illness. PHC strongly recommends annual flu shot in consultation with a healthcare provider, especially for those at high risk of severe illness, such as being elderly, pregnant women, and those with underlying conditions. As flu season starts in Australia, local businesses should expect heightened absenteeism. Australia's New South Wales released a health alert encouraging flu vaccination after seeing an early rise in cases for the season. 4,700 flu cases we...read morere identified in the last four weeks, a 16% increase compared to the same time period in 2023. [Confidence: Very High]
France is increasingly hospitable to the mosquitoes that carry dengue. Imported cases can start chains of transmission if local mosquitoes bite the infected person. Businesses in France can support mosquito control measures at their facilities by eliminating standing water. Employees living in or visiting areas with high dengue rates, including the French West Indies should prevent mosquito bites by wearing protective clothing and using insect repellent. France reported an unprecedented number of imported dengue cases in 2024. So far, 1,679 cases have been identified in 2024 compared to only 131 cases ...read morein the same period in 2023. Most imported cases (60%) are tied to travel from the French West Indies, which has been experiencing a dengue outbreak since mid-2023. [Confidence: Very High]
Businesses in Vermont should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Vermont is reporting a measles case among individuals exposed to measles through their participation in a program with international visitors. A total...read more of 26 people in that program were exposed to a measles case earlier this month (see PHC alert 4/15 for more info). Other program participants are still being monitored for illness. PHC will continue to monitor and provide any relevant updates. [Confidence: Very High]
Businesses in the Netherlands should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Convening of the outbreak management team reflects the increasing risk related to measles in the Netherlands. Employees with unvaccinated children may have extended absenteeism due to infection or post-exposure quarantine. The Netherlands' high number of measles cases continues, with 8 new cases occurring in so far April and 64 total for 2024. An Outbreak Management Team...read more (OMT) was assembled to address the situation and develop a response plan, only the third OMT in the last ten years. The OMT recommended childcare attendance exclusions for siblings of measles cases to last through 21 days. See PHC 4/5 analysis and 4/4 alert for more info. [Confidence: Very High]
Businesses in West Virginia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. West Virginia reported their first measles case since 2009 in a Monongalia County resident who had traveled recently. The individual visited a local h...read moreospital, but details about potential public exposures have not yet been released. West Virginia's measles vaccination rate for children is 95.6%, right at the target 95% rate. PHC will continue to monitor the situation and report updates as needed. [Confidence: Very High]
Businesses in the greater Indianapolis area should inform employees about the possible measles exposure and provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Marion County, IN reports possible measles exposure at the Indianapolis Children's Museum related to an out-of-town visitor. The case visited the muse...read moreum on April 8 for a solar eclipse viewing event. No measles cases have been identified in Marion County residents in 2024. [Confidence: Very High]
Businesses in Samoa 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. The Samoa Ministry of Health has declared a dengue outbreak after reporting increasing cases. 216 cases have occurred between Nov 2023 to April 14, 20...read more24, with 81 of the cases occurring in April. The Ministry of Health is urging individuals to implement mosquito control measures. [Confidence: Very High]
Businesses in Quebec should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Quebec, Canada reported 3 new measles cases in the past week. In total, 46 cases have occurred in Quebec in 2024, with most cases occurring in Montrea...read morel (18) and Montérégie (11). The new cases visited several public places, including two outpatient medical centers (CLSC de Côte-des-Neiges and ELNA Pediatrics). [Confidence: Very High]
Leptospirosis is getting media attention, but should not impact enterprise business. Businesses in NYC should take measures to ensure rodent-free facilities. Any rodent urine should be cleaned with bleach; wet the soiled area with bleach before wiping up. Employees should always wear gloves when handling rodents or their urine. NYC reported a high number of leptospirosis cases so far in 2024, with 6 cases identified. In comparison, NYC averaged only 3-4 cases a year between 2...read more001 - 2022, though in 2023, they had 24 cases. Leptospirosis is more common in dogs in NYC than humans; a canine vaccine that covers several serovars is available. Leptospirosis can be severe but is treatable. Infection is caused by exposure to water, soil, or food containing animal urine and is usually associated with outdoor activities in tropical areas. [Confidence: Very High]
Businesses in Czechia may experience increased worker absenteeism due to family caregiving needs, and should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Czechia's worst whooping cough outbreak in at least 64 years continues, with 1,494 new cases reported in the past week. This is the highest number of ...read morecases in a single week since the outbreak started. See PHC analysis 3/20 and alerts 3/7, 4/3, and 4/9 for more info. [Confidence: Very High]
Businesses in Peru 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. Peru's health ministry estimates 117 dengue deaths have occurred this year among an estimated 135,000 cases. This is triple the number of deaths obser...read moreved over the same period last year, leading the ministry to approve large-scale fumigation campaigns aimed at containing the virus. [Confidence: Very High]
Businesses in Costa Rica should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The US Embassy issued an alert regarding whooping cough in Costa Rica. Costa Rica's Ministry of Health is investigating a whooping cough outbreak in the Tibas region. [Confidence: Very High]
Businesses in Brazil can support dengue prevention by eliminating standing water at their facilities to reduce mosquito populations. Employees living in or visiting the area should prevent mosquito bites by wearing protective clothing and using insect repellent. Brazil's record-breaking dengue outbreak now has ~3 million probable cases. Dengue-related deaths in 2024 are nearly triple those seen in 2023. Prelim...read moreinary data suggest that rates may be starting to decline but, due to substantial reporting delays, further data is necessary to confirm this. [Confidence: Very High]
Dengue is endemic in the US Virgin Islands, but higher than normal cases are expected this year due to the many dengue outbreaks occurring across Central and South America. Businesses in the US Virgin Islands or with employees traveling there should advise them to take steps to prevent mosquito bites by wearing protective clothing, using insect repellent, and eliminating standing water near their homes. US Virgin Islands (VI) reported 3 cases of dengue in 2024 and encouraged citizens to seek treatment if they develop symptoms. Though case rates in US ...read moreVI are still low, a rise in dengue cases is anticipated following nearby Puerto Rico's record high 549 cases already this year. [Confidence: Very High]
Businesses with employees traveling to Argentina should encourage them to bring insect repellent with them. Employees visiting the area should prevent mosquito bites by wearing protective clothing and using insect repellent. Argentina reported that many regions, including Buenos Aires, are experiencing shortages of insect repellent due to increased demand related to ongoin...read moreg high dengue infection rates. Authorities are temporarily allowing importation of insect repellent and are working to increase repellent production locally. [Confidence: Very High]
Businesses in Chicago should inform employees about the possible measles exposure and provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Chicago reported one new measles case, totaling 58 so far. Cases tied to this outbreak have started to taper, but another surge is possible due to mea...read moresles' sometimes lengthy incubation period. The newest case visited a pharmacy and grocery store. [Confidence: Very High]
Informational update only. Human cases are rare; the risk of an outbreak is extremely low based on historic behavior. Employees in or traveling to Vietnam should avoid live-animal markets and not have contact with or consume diseased poultry. Vietnam reported their first human case of H9N2 avian influenza. The case had no known contact with poultry, but lived next to an individual who raise...read mores poultry for sale. H9N2 avian influenza has been detected in birds in Vietnam. It is a low virulence strain and usually causes only mild symptoms. [Confidence: Very High]
Media contain conflicting reports about the powder-laced letters sent last week, but some media claim forensics did find anthrax spores. An anthrax bioterrorism incident in Pakistan should not impact enterprise business directly; however, this situation illustrates the importance of being prepared for this type of event. Businesses should have a plan for how to handle suspicious mail. Update to the Pakistan incident involving threatening letters containing a suspicious white powder: some media sources claim anthrax spores were confi...read morermed in the powder. Ten additional threatening letters were found on Friday, bringing the total number of suspicious letters to 18. Anthrax usually does not spread person-to-person. Authorities are still investigating. [Confidence: Moderate]
Businesses in CA should take measures to ensure rodent-free facilities. Any rodent droppings should be cleaned with bleach; wet the soiled area with bleach before wiping up droppings to limit infectious aerosol generation. Employees should always wear gloves and N95 (or equivalent) masks when handling rodents or their droppings. Sierra County, CA reports the death of a resident from hantavirus, the first case in the region since 2003 and the first case in CA this year. Hantavi...read morerus is spread by the droppings (urine and feces) of rodents and can cause severe illness. [Confidence: Very High]
This incident illustrates the potential impact of a norovirus outbreak on a business, even in a healthcare setting. Food service establishments should remind sick workers to stay home and not return to work for 48 hours after symptoms stop. Paid sick leave can help reduce the risk of a food establishment-associated 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 norovirus outbreaks by encouraging sick people to stay home. St Richard's Hospital in West Sussex reported closing multiple wards and restricting visitors due to a norovirus outbreak. [Confidence: Very High]
Businesses in the Netherlands should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The Netherlands is experiencing increasing measles rates in 2024, with 37 new cases in March and 51 cases total for the year. There were only 7 measle...read mores cases in the Netherlands for all of 2023. Measles vaccination rates in the Netherlands are 88.8%, below the target of 95%. [Confidence: Very High]
Businesses in Czechia should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. The whooping cough outbreak in Czechia continues, with 5,297 cases total in 2024, of which 1,077 occurred just in the last week. This is the most case...read mores in a calendar year since 1960. PHC warned the situation in Czechia was continuing to worsen, despite the Health Minister saying the situation was "under control." See PHC analysis 3/20 and alert 3/7 for more info. [Confidence: Very High]
Anthrax garners headlines, especially when potential bioterrorism is involved, but a potential anthrax incident in Pakistan should not impact enterprise business. Anthrax usually does not spread person-to-person. Pakistan reported that eight judges received threatening letters with a white powder suspected of being anthrax. Authorities are investigating the let...read moreters; white powder hoaxes are common. Anthrax was last used in a bioterrorism attack in 2001, infecting 22 and killing 5. [Confidence: Very High]
Informational update included due to recent H5N1 cases in cattle and a human in Texas. The risk of human disease remains low, but avian flu outbreaks in poultry can have a financial impact on businesses in the food industry and can also increase the price of consumer chicken. Texas reported avian influenza H5N1 in a commercial poultry flock in a facility owned by the largest US egg producer. This comes just one day after H5...read moreN1 was identified in a farmer with exposure to infected cows. H5N1 influenza is typically spread between birds (both domestic and wild) and can occasionally spread from birds to other animals and humans, but human-to-human transmission is extremely rare. The type of H5N1 identified in the Texas poultry is the same that has been causing mass die-offs of birds around the world; it is different from the H5N1 that has caused human fatalities in the past. [Confidence: Very High]
Informational update only. Businesses may want to remind their employees to avoid consuming raw milk as it may contain harmful pathogens. Texas reported a human case of avian influenza H5N1, the second case in the US since 2022. The case developed conjunctivitis after contact with dairy ...read morecows presumed to be infected with avian influenza. H5N1 influenza is typically spread between birds (both domestic and wild) and can occasionally spread from birds to other animals and humans, but human-to-human transmission is extremely rare. The type of H5N1 identified in the cattle is the same that has been causing mass die-offs of birds around the world; it is different from the H5N1 that has caused human fatalities in the past. [Confidence: Very High]
Businesses with employees traveling to Pakistan should verify their polio vaccination status before travel. Pakistan reported that sewage samples from Sukkur, Chaman, and Karachi Central have tested positive for wild poliovirus type 1. No new human cases of ...read morepolio have been identified since the two prior cases in 2024. Finding poliovirus in sewage samples indicates that an individual(s) is shedding virus, which could pose a transmission risk in the community. Wastewater data helps identify areas at the highest risk for polio spread and should be targeted for vaccination efforts. See PHC alert on Jan 10 for more info. [Confidence: Very High]
The measles outbreak in Chicago continues to expand. Businesses in Chicago should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Chicago's measles outbreak continues, with 11 new cases since the last report, including the first case in a Cook County suburban resident. The County...read more resident was exposed to measles while at the Pilsen shelter, the epicenter of this outbreak. [Confidence: Very High]
The measles outbreak in Canada has worsened. Businesses in Canada should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Travelers to Quebec should ensure they are up to date on their measles vaccination. Canada reported 10 new measles cases during the past week, totaling 36 cases for 2024. Most of the new cases (9) occurred in Quebec. See PHC analysis on Measles in Montreal 3/14 for our early warning. [Confidence: Very High]
Businesses in China should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. China reported a large increase in whooping cough cases, with 32,380 cases identified in Jan and Feb 2024 compared to 1,421 cases in the same period l...read moreast year. Vaccination rates are high in China, with 99% of children immunized. The increase in cases is tied to a return to normal social activity. [Confidence: Very High]
Businesses in Spain should provide flexible work schedules to support employees making vaccine appointments for themselves or family members. Spain reported increasing numbers of whooping cough cases, with 1,077 cases in the past week. In total, 5,242 whooping cough cases have been identifie...read mored so far this year. About half of the current cases occurred in the Catalonia region. [Confidence: Very High]
Flexible work schedules should be made available to employees needing to get themselves or their family members vaccinated. Portugal reported an outbreak of Hepatitis A, with 43 cases occurring in 2024. The outbreak is linked to men who have sex with men. Cases may stay ele...read morevated this spring due to travel and Pride events. The hepatitis A vaccine is over 95% effective in preventing disease in people who have received two shots. A single hepatitis A vaccine can help prevent hepatitis A if given within 14 days of exposure. [Confidence: Very High]
