On May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity,† 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact,§ 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity,¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex with men (MSM); transgender, nonbinary, and gender-diverse persons; racial and ethnic minority groups; and persons who are immunocompromised, including persons with advanced HIV infection or newly diagnosed HIV infection.
Leptospirosis, an acute bacterial zoonotic disease, is endemic in Puerto Rico. Infection in approximately 10%-15% of patients with clinical disease progresses to severe, potentially fatal illness. Increased incidence has been associated with flooding in endemic areas around the world. In 2022, Hurricane Fiona, a Category 1 hurricane, made landfall and inundated Puerto Rico with heavy rainfall and severe flooding, increasing the risk for a leptospirosis outbreak. In response, the Puerto Rico Department of Health (PRDH) changed guidelines to make leptospirosis cases reportable within 24 hours, centralized the case investigation management system, and provided training and messaging to health care providers. To evaluate changes in risk for leptospirosis after Hurricane Fiona to that before the storm, the increase in cases was quantified, and patient characteristics and geographic distribution were compared. During the 15 weeks after Hurricane Fiona, 156 patients experienced signs and symptoms of leptospirosis and had a specimen with a positive laboratory result reported to PRDH. The mean weekly number of cases during this period was 10.4, which is 3.6 as high as the weekly number of cases during the previous 37 weeks (2.9). After Hurricane Fiona, the proportion of cases indicating exposure to potentially contaminated water increased from 11% to 35%, and the number of persons receiving testing increased; these factors likely led to the resulting overall surge in reported cases. Robust surveillance combined with outreach to health care providers after flooding events can improve leptospirosis case identification, inform clinicians considering early initiation of treatment, and guide public messaging to avoid wading, swimming, or any contact with potentially contaminated floodwaters.
Purpose: Ulcerative colitis (UC) patients diagnosed with Clostridium difficile (C. difficile) in hospital have worse outcomes; however, the majority of studies have only evaluated the influence of in-hospital diagnosis of C. difficile. The aims of this study were to determine whether: 1) UC patients diagnosed with C. difficile infections in-hospital and up to 90 days prior to admission were more likely to have an emergent colectomy; and 2) whether C. difficile increased the risk of postoperative complications following colectomy. Methods: Population-based surveillance was conducted in the Calgary Health Zone between January 1, 2000 and December 31, 2009 to identify all adults (≥ 18 years) admitted to hospital for an UC flare (n=481). In addition, the Calgary Laboratory Services (CLS) laboratory provided all C. difficile toxin tests ordered within 90 days of hospital admission (n=123). UC patients admitted to hospital for flare who responded to medical management (n=295) and were discharged from hospital were compared to UC patients who failed medical management and required an in-hospital emergent colectomy (n=186). Secondly, the records of patients undergoing emergency colectomy were reviewed to assess for the occurrence of various postoperative complications stratified as any complication and infectious. Multivariate logistic regression analysis was performed to examine the association between C. difficile infection and: 1) emergent colectomy versus medically responsive UC flare; and 2) postoperative complications (any and infectious). Results: Patients diagnosed with C. difficile 90 days before or during hospitalization (n=18) were at higher risk for having a colectomy when compared to patients who were C. difficile negative (OR= 2.87; 95% CI: 1.03-8.03) after adjusting for age, sex, corticosteroid use in hospital and disease extent. UC patients who underwent emergent colectomy and were diagnosed with C. difficile prior to surgery were not at a statistically higher risk of developing postoperative complications in general (OR=3.48; 95% CI: 0.93-13). However, preoperative C. difficile infection increased the risk of specified infectious complications (OR=4.56; 95% CI: 1.07-18.34) in the postoperative period. Conclusion: UC patients were significantly less likely to be medically responsive and hence, required a colectomy when they were diagnosed with a C. difficile infections in-hospital or within 90 days of admission. Moreover, UC patients who had concomitant C. difficile, preoperatively were at a higher risk of infectious complications following colectomy.
Anthrax is a rare but serious infectious zoonotic disease caused by the spore-forming bacterium Bacillus anthracis.In North America, animal outbreaks typically occur during summer in hot, dry weather (1).Rare cases among humans usually follow direct contact with or processing of anthrax-infected animals or contanimated animal products such as hides, hair, or wool (1,2).In early 2024, an unusual case of confirmed cutaneous anthrax* acquired during the winter in a geographic region with enzootic anthrax occurred, and an investigation was undertaken.This activity was reviewed by CDC,
Background Brucellosis is widespread in Ethiopia with variable reported prevalence depending on the geographical area, husbandry practices and animal species. However, there is limited information on the disease prevalence amongst pastoral communities, whose life is intricately linked with their livestock. Methodology We conducted an integrated human-animal brucellosis sero-surveillance study in two adjacent pastoral regions, Afar and Somali region (SRS). This cross-sectional study included 13 woredas (districts) and 650 households. Blood samples were collected from people and livestock species (cattle, camel, goats and sheep). Sera were analyzed with C-ELISA for camels and shoats (sheep and goats), with I-ELISA for cattle and IgG ELISA for humans. Descriptive and inferential statistics analyses were performed. Results A total of 5469 sera were tested by ELISA. Prevalence of livestock was 9.0% in Afar and 8.6% in SRS (ranging from 0.6 to 20.2% at woreda level). In humans, prevalence was 48.3% in Afar and 34.9% in SRS (ranging from 0.0 to 74.5% at woreda level). 68.4% of all households in Afar and 57.5% of households in SRS had at least one animal reactor. Overall, 4.1% of animals had a history of abortion. The proportion of animals with abortion history was higher in seropositive animals than in seronegative animals. Risk factor analysis showed that female animals were significantly at higher risk of being reactors ( p = 0.013). Among the species, cattle had the least risk of being reactors ( p = 0.014). In humans, there was a clear regional association of disease prevalence ( p = 0.002). The older the people, the highest the odds of being seropositive. Conclusion Brucellosis is widespread in humans and animals in pastoral communities of Afar and SRS with the existence of geographical hotspots. No clear association was seen between human and particular livestock species prevalence, hence there was no indication as whether B . abortus or B . melitensis are circulating in these areas, which warrants further molecular research prior to embarking on a national control programs. Such programs will need to be tailored to the pastoral context.
Since August 2017, CDC has confirmed three cases of brucellosis attributed to Brucella abortus cattle vaccine strain RB51. Each case was associated with consumption of domestically acquired unpasteurized (raw) milk products.
