{"databaseConfigured":true,"generatedAt":"2026-05-11T17:00:27.282Z","totalEvents":50,"latestPublishedAt":"2026-05-08T18:00:00.000Z","riskCounts":{"elevated-watch":21,"high-attention":22,"watch":7},"source":{"name":"WHO Disease Outbreak News","publisher":"World Health Organization","url":"https://www.who.int/emergencies/disease-outbreak-news","updateCadence":"Daily Vercel Cron ingestion at 03:00 UTC"},"events":[{"id":"2026-DON600","title":"Hantavirus cluster linked to cruise ship travel, Multi-country","disease":"Hantavirus cluster linked to cruise ship travel","locations":["Multi-country"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON600","summary":"On 2 May 2026, a cluster of passengers with severe respiratory illness aboard a cruise ship was reported to the World Health Organization (WHO). At that time, according to the ship operator, 147 passengers and crew were onboard, and 34 passengers and crew had previously disembarked. Since the last Disease Outbreak News published on 4 May, three of the suspected cases were confirmed, and one additional confirmed case was reported. As of 8 May, a total of eight cases, including three deaths (case fatality ratio 38%), have been reported. Six cases have been laboratory-confirmed as hantavirus infections, with all identified as Andes virus (ANDV). Through the International Health Regulations (2005) (IHR) channel, National IHR Focal Points (NFPs) have all been informed and are supporting international contact tracing. WHO assesses the risk to the global population posed by this event as low and will continue to monitor the epidemiological situation and update the risk assessment. The risk for passengers and crew on the ship is considered moderate.","overview":"On 2 May 2026, WHO received notification from the National IHR Focal Point of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom) regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard a Dutch-flagged cruise ship. Since the last Disease Outbreak News was published on 4 May, three of the suspected cases were confirmed, and one additional confirmed case was reported. As of 8 May, a total of eight cases (six confirmed and two probable cases), including three deaths (two confirmed and one probable), case fatality ratio 38%, have been reported. All six laboratory-confirmed cases were identified as Andes virus through virus specific polymerase chain reaction (PCR) or sequencing. Two medical evacuation flights, from Cabo Verde, carrying two symptomatic confirmed patients and one previously suspected case landed in the Netherlands on 6 and 7 May. As of 8 May, four patients are currently hospitalised, one in intensive care in Johannesburg, South Africa, two in different hospitals in the Netherlands and the other in Zurich, Switzerland. The previously suspected case was transferred directly to Germany, where she was tested, and both PCR and serology tests were negative for Andes virus, she is therefore no longer considered to be a case. Contact tracing of passengers who disembarked in St Helena is ongoing; passengers have been contacted and advised to self-monitor for symptoms. Additionally, passengers who travelled on the same flight from St Helena to South Africa with one of the cases who was subsequently confirmed, have been contacted. On 6 May, the ship left Cabo Verde, heading to the Canary Islands, Spain where disembarkation is planned. Further investigations into the potential exposure of the first case and the source of the outbreak are ongoing in collaboration with authorities in Argentina and Chile. The outbreak is being managed through a coordinated international response, including in-depth epidemiological investigations, case isolation and clinical management, medical evacuations, laboratory testing and international contact tracing and monitoring. Summary of confirmed and probable cases: Case 1: An adult male who boarded the ship on 1 April, after more than three months of travel in Argentina, Chile, and Uruguay. Developed symptoms on 6 April and died onboard on 11 April. No microbiological tests were performed. He is considered a probable case. Case 2: An adult female, who was a close contact of case 1, who travelled and boarded the ship with him, went ashore at Saint Helena on 24 April with gastrointestinal symptoms. She subsequently deteriorated on a flight to Johannesburg, South Africa, on 25 April. She died on 26 April in a Johannesburg clinic. On 4 May, she was subsequently confirmed by PCR testing with hantavirus infection. Case 3: An adult male who developed symptoms on 24 April. He was disembarked and medically evacuated from Ascension Island on 27 April and is currently hospitalised in an Intensive Care Unit (ICU) in Johannesburg, South Africa. PCR testing confirmed hantavirus infection on 2 May, and Andes virus was confirmed through sequencing. Case 4: An adult female, with onset of symptoms (fever and general malaise) on 28 April, later presenting with pneumonia, died on 2 May. A post-mortem sample was collected and sent to the Netherlands with the evacuated patients, where it was confirmed to be Andes virus. Case 5: An adult male, working as the ship doctor, reported onset of symptoms on 30 April, including fever, fatigue, muscle pain, and mild respiratory symptoms. His samples confirmed PCR positivity for Andes virus on 6 May. The case was medically evacuated to the Netherlands on 6 May and is currently stable in isolation. Case 6: An adult male, working as a ship guide. Onset of symptoms was reported on 27 April with mild respiratory and gastrointestinal symptoms. Laboratory samples confirmed PCR positivity for Andes virus on 6 May. The case was medically evacuated to the Netherlands on 7 May and is currently stable in isolation. Case 7: An adult male, who disembarked in St Helena on 22 April and flew back to Switzerland on 27-28 April, through South Africa and Qatar. He started experiencing symptoms on 1 May after arrival in Switzerland, where he immediately self-isolated and reported to local public health authorities. He is currently hospitalised and in isolation in Switzerland. His samples confirmed PCR positivity for Andes virus on 5 May. [1] Case 8: An adult male, who disembarked in Tristan da Cunha on 14 April. Onset of symptoms was reported on 28 April with diarrhoea and two days later with fever. He is currently stable and in isolation. He is currently a probable case until laboratory confirmation. One case previously reported as suspected has now been reclassified as a non-case after testing negative for Andes virus through PCR and serology. Nevetheless, monitoring continues until the end of their incubation period from last exposure. Table 1. Distribution of reported Andes hantavirus cases by case status and outcome, as of 8 May 2026 Operational outbreak case definitions Suspected case : anyone who shared or visited a conveyance where there has been a confirmed or probable ANDV case AND with acute (or history of) symptoms compatible with ANDV infection, including fever (38&deg;C or above), myalgia, chills, acute gastrointestinal (e.g. nausea, vomiting, diarrhoea, abdominal pain) or acute respiratory (e.g. cough, shortness of breath, chest pain, difficulty breathing) symptoms. Probable case : a person with signs and symptoms of a suspected case that has been evaluated by a health professional AND a known epidemiological link with a confirmed or probable ANDV case AND for which laboratory tests have not been conducted. Confirmed case : a person with laboratory confirmation of ANDV through RT-PCR or serology testing. Non-case*: a suspected or probable case who tests negative for ANDV by RT-PCR or serology. *Non-cases who develop symptoms compatible with the suspected case definition after a negative test and within the maximum incubation period after last exposure to a probable or confirmed case should be retested and reclassified as appropriate. Figure 1. Epidemiological curve of Andes hantavirus cases reported to WHO as of 8 May 2026, 17:00. Based on currently available information, the working hypothesis is that case 1 most probably acquired the infection prior to boarding through environmental exposure during activities he conducted in Argentina. Investigations are ongoing to assess the full itinerary of his activities and possible exposure factors. Current evidence points to subsequent human-to-human transmission onboard (Figure 1), given documented epidemiological links of some of the subsequent cases with case 1 during his illness, and the timing of their symptom onset, which clusters around the most likely incubation periods previously documented for ANDV. However, ongoing epidemiological and sequencing investigations will help better understand the epidemiological links between cases and their most likely exposure.","assessment":"WHO currently assesses the public health risk related to the cruise ship as moderate, and at the Global level as low for the following reasons: The disease can have a high case fatality ratio, reaching 40-50%, particularly among elderly individuals and those with co-morbidities. The average age of passengers on board the ship is 65 years old. Andes virus has demonstrated limited human-to-human transmission in previous outbreaks, typically occurring among close contacts and within household settings, generally requiring prolonged close exposure. Transmission can usually be contained through early detection, isolation of cases, clinical management, and contact tracing. However, the ship environment presents an increased risk due to close living quarters, shared indoor spaces, prolonged exposure, and frequent interpersonal interactions, all of which may facilitate transmission. Investigations on the travel history and potential exposures of the first case in the Southern Cone subregion of the Americas are ongoing and suggest possible exposure to rodents during bird watching activities. Viral sequencing analyses are also ongoing and will compare the ANDV strain associated with this outbreak with strains circulating in Argentina, Chile and Uruguay, where the disease is enzootic. Additional cases may occur among individuals exposed before implementation of containment measures. However, the current response, including rapid isolation of any new suspect cases and the monitoring of contacts, is expected to limit the risk of further spread. As there is no specific antiviral treatment for HPS, suspected cases require prompt transfer to an adequately equipped emergency department or intensive care unit, where available, for close monitoring and supportive management to improve chances of recovery. Consequently, rapid transfer to a mainland healthcare facility is required, which may be challenging under the current conditions. More detailed epidemiological, clinical and laboratory investigations are required to inform further iterations of this risk assessment.","advice":"WHO advises that States Parties involved in this event continue public health coordination and management efforts on board conveyances and in countries where cases and/or contacts are present or will be returning to. This includes contact tracing and monitoring detection, investigation, reporting of suspected cases, laboratory testing of suspected cases, case management, infection prevention and control measures, and clear and transparent communication to affected individuals and the general public. In the context of the current outbreak, people on board the affected ship and flights should practice frequent hand hygiene, monitor any early symptoms, including headache, dizziness, chills, fever, myalgia, and gastrointestinal problems, such as nausea, vomiting, diarrhoea, and abdominal pain, for 42 days after last potential exposure. Should any early symptoms or sudden onset of respiratory distress occur, people should immediately inform health authorities and self-isolate until medical evaluation is conducted. If respiratory symptoms are present, people should practice respiratory etiquette and wear a respirator. A precautionary approach should be applied to contact identification, classification, tracing and follow-up, particularly for persons exposed on board of the ship or during travel. Contacts should be classified according to exposure risk, considering the intensity and duration of exposure, proximity to the case, exposure to enclosed or shared spaces, and use of personal protective equipment. High-risk contacts may include cabin mates, intimate partners, persons with prolonged close indoor exposure, healthcare workers with unprotected exposure, and individuals handling contaminated materials or body fluids without appropriate personal protective equipment. Given the documented transmission of ADNV in past outbreaks stemmed from close, prolonged contact, that infectiousness peaks in the early phase of illness, and that pre-symptomatic transmission cannot be entirely ruled out, as a precautionary principle , WHO recommends for active monitoring and home or facility quarantine of high-risk contacts for 42 days following last exposure. Current evidence does not support routine laboratory testing of contacts for outbreak control (or public health response) or the quarantine of low-risk contacts; low-risk contacts should undertake passive self-monitoring and seek medical evaluation if symptoms occur. Recommendations are dynamic and will be adapted as more evidence emerges. Contact investigations should use available information sources, including interviews, passenger manifests, seating arrangements and activity logs, to improve completeness of contact identification. Early recognition of suspected cases, prompt isolation, and consistent adherence to recommended infection prevention and control measures remain essential to protect healthcare personnel, other passengers and crew members. In healthcare environments, standard precautions* should be applied for all patients, including hand hygiene, environmental cleaning and waste management. In addition to standard precautions, transmission-based precautions should be implemented for management of suspect or confirmed cases. For aerosol-generating procedures, airborne precautions should be used. [5] When HPS is suspected, patients should be promptly transferred to an emergency department or intensive care unit for close monitoring and supportive management. Initial management should include supportive care with antipyretics and analgesics as needed. For confirmed hantavirus, antibiotics are not routinely indicated. However, before a definitive diagnosis is established (and bacterial infection is a diagnostic possibility), or if superadded bacterial infection is suspected, empiric broad-spectrum antibiotics may be appropriate. Clinical management relies primarily on careful fluid administration, hemodynamic monitoring, and respiratory support. Given the rapid progression of HCPS, close monitoring and early transfer to ICU are critical for more severe cases. Mechanical ventilation, meticulous volume control, and vasopressors may be required. For severe cardiopulmonary insufficiency, extracorporeal mechanical oxygenation may be lifesaving. In severe cases of renal dysfunction, dialysis may be required. Although ribavirin has shown efficacy against hantavirus haemorrhagic fever with renal syndrome, it has not demonstrated effectiveness for HCPS and is not licensed for either treatment or prophylaxis of hantavirus pulmonary syndrome. At present, there is no specific antiviral treatment approved for HCPS; a number of existing drugs have antiviral activity in laboratory studies but not yet demonstrated in human disease. Public health awareness efforts should focus on improving early detection, ensuring timely treatment, and reducing exposure risks. Preventive measures should address occupational and ecotourism-related exposures, emphasize infection prevention and control measures, and include rodent control strategies. Most routine tourism activities carry little or no risk of exposure to rodents or their excreta. Risk communication and community engagement (RCCE) interventions should prioritize transparent, timely, and culturally appropriate communications to raise awareness of hantavirus transmission risks&mdash;particularly. RCCE strategies should support coordinated, timely and aligned evidence based information to ensure concerned people receive clear, consistent and actionable information and explanations of the public health measures. Operational measures should integrate RCCE activities through the whole event. The implementation of integrated environmental management strategies aimed at reducing rodent populations is also recommended. *Standard precautions refer to a set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. These practices aim to protect both healthcare professionals and patients and include hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of sharps materials, safe injection practices, use of sterile instruments and equipment and cleaning of hospital environments and the environment. Adapted from &ldquo;Standard precautions for the prevention and control of infections: aide-memoire&rdquo;- WHO, 2022. Available at https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1 WHO advises against the application of any travel or trade restrictions based on the current information available on this event.","publishedAt":"2026-05-08T18:00:00.000Z","lastModified":"2026-05-10T10:26:21.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON600","response":"Authorities from States Parties involved in the management of the event to date &ndash; Argentina, Cabo Verde, Chile, Germany, the Netherlands, South Africa, Spain, Switzerland, and the United Kingdom &ndash; WHO, and partners have initiated coordinated response measures including: Ongoing engagement between WHO and the National IHR Focal Points of Argentina, Cabo Verde, Chile, Germany, the Netherlands, South Africa, Spain, Switzerland and the United Kingdom, to ensure timely information sharing and coordination of response actions. International contact tracing involving partners is ongoing. Passengers onboard have been advised to practice physical distancing and remain in their cabins where possible, while on the cruise ship. One expert from WHO and one from the European Centre for Disease Prevention and Control (ECDC) are on board the ship for the provision of public health advice to passengers during the journey. Epidemiological investigations are underway to determine the source of exposure. WHO shared information about the event, technical guidance on the management of hantavirus on board the ship, a technical note for the disembarkation and onward management of passengers and crew, information on the management of contacts of Andes virus cases, its rapid risk assessment of the associated public health risk, case investigation forms and details on primers and probes for Andes virus detection with National IHR Focal Points globally through its secure Event Information Site for IHR NFPs to support States Parties in responding to the event. The National IHR Focal Points of countries with cases have shared passenger and crew lists with the National IHR Focal Points of the respective countries, according to each person&rsquo;s nationality. IHR NFP international contact tracing efforts are ongoing for conveyances. The National IHR Focal Point of Argentina requested information, which has been provided, on the first two cases to reconstruct their travel itinerary in the Southern Cone subregion of the Americas and assess any potential exposure to hantavirus. They also shared the National Hantavirus Epidemiological Circular: Update epidemiological Surveillance and Management Standards on Hantavirus. In line with the Working Arrangement between the WHO Emergency Medical Team (EMT) Secretariat and the EU Emergency Response Coordination Centre (ERCC), the EMT Secretariat has launched formal discussions to support the clinical management and medical evacuation of symptomatic passengers. EU Health Task Force (EUHTF) has also been activated for support. Logistic support has been provided, including sample collection items. WHO supported the shipment of samples to the Institut Pasteur de Dakar, Senegal. Laboratory testing and confirmation of hantavirus infection have been conducted at the National Institute for Communicable Diseases (NICD) of South Africa. Identification of Andes virus was performed through genomic sequencing at NICD and virus-specific PCR at Geneva University Hospitals, Switzerland. WHO supported collaboration across laboratories to ensure further timely testing, involving laboratories in Senegal, the United Kingdom, the Netherlands and Argentina. Further testing is currently on-going including serology, sequencing and metagenomics. WHO has developed guidance documents in support of countries affected by the event, including covering management of the event on the ship, investigation of cases, disembarkation and management of returning passengers and crew members. Risk communication coordination and support are being provided to ensure sharing of regular, timely and evidence-based information. WHO has activated three-level coordination and is supporting national authorities in implementing risk-based, evidence-informed public health measures in accordance with the provisions of the IHR and related WHO technical guidance documents.","epidemiology":"Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a zoonotic, viral respiratory disease caused by hantaviruses of the genus Orthohantavirus , family Hantaviridae , order Bunyavirales . More than 20 viral species have been identified within this genus. In the Americas, Sin Nombre virus is the predominant cause of HPS in North America, while Orthohantavirus andesense is responsible for most cases in South America. Hantaviruses found in Europe and Asia are known to cause haemorrhagic fever with renal syndrome (HFRS), which primarily affects the kidneys and blood vessels. Human-to-human transmission has not been documented in this part of the world. Human Hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of infected rodents or by touching contaminated surfaces. Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present, and opportunities for exposure are greater. HPS is characterized by headache, dizziness, chills, fever, myalgia, and gastrointestinal symptoms, such as nausea, vomiting, diarrhoea, and abdominal pain, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from 1-6 weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure. Hantavirus infections are relatively uncommon globally. In 2025, in the Region of the Americas, eight countries reported 229 cases and 59 deaths with a CFR of 25.7%. [2] In the European Region, 1885 hantavirus infections were reported in 2023 (0.4 per 100 000), marking the lowest rate observed between 2019 and 2023. [3] In East Asia, particularly China and the Republic of Korea, hantavirus haemorrhagic fever with renal syndrome (HFRS) continues to account for many thousands of cases annually, although incidence has declined in recent decades. Hantavirus infections are associated with a case fatality rate of <1&ndash;15% in Asia and Europe and up to 50% in the Americas. While there are no licensed treatment nor vaccines for hantavirus infections, early supportive care and immediate referral to a facility with a complete ICU can improve survival. Environmental and ecological factors affecting rodent populations can influence disease trends seasonally. Since hantavirus reservoirs are sylvatic rodents, transmission can occur when people come into contact with rodent habitats. Although uncommon, limited human‑to‑human transmission of HPS due to Andes virus has been reported in community settings involving close and prolonged contact. Secondary infections among healthcare workers have been previously documented in healthcare facilities, though remain rare. Secondary transmission appears most likely during the early phase of illness, when the virus is more transmissible. [4] Currently, little evidence is available due to the scarcity of hantavirus outbreak related to human-to-human transmission.","formattedDate":"2026-05-08T21:31:10Z","matchedSignals":["cross-border signal","transmission concern","severity signal","response escalation"]}},{"id":"2026-DON599","title":"Hantavirus cluster linked to cruise ship travel, Multi-country","disease":"Hantavirus cluster linked to cruise ship travel","locations":["Multi-country"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON599","summary":"On 2 May 2026, a cluster of passengers with severe respiratory illness aboard a cruise ship was reported to the World Health Organization. The ship is carrying 147 passengers and crew. As of 4 May 2026, seven cases (two laboratory confirmed cases of hantavirus and five suspected cases) have been identified, including three deaths, one critically ill patient and three individuals reporting mild symptoms. Illness onset occurred between 6 and 28 April 2026 and was characterized by fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock. Further investigations are ongoing. The outbreak is being managed through coordinated international response, and includes in-depth investigations, case isolation and care, medical evacuation and laboratory investigations. Human hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of infected rodents. It is a rare but severe disease that can be deadly. Although uncommon, limited human to human transmission has been reported in previous outbreaks of Andes virus (a specific species of hantavirus). WHO currently assesses the risk to the global population from this event as low and will continue to monitor the epidemiological situation and update the risk assessment.","overview":"On 2 May 2026, WHO received notification from the National International Health Regulations (2005) (IHR) Focal Point of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom) regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard a Dutch-flagged cruise ship. On 2 May 2026, laboratory testing conducted in South Africa confirmed hantavirus infection in one patient who is critically ill and in intensive care. On 3 May, one additional death was reported. A further three suspected cases remain on board. As of 4 May, a total of seven (two confirmed and five suspected) cases, including three deaths, have been reported. The vessel departed Ushuaia, Argentina, on 1 April 2026 and followed an itinerary across the South Atlantic, with multiple stops in remote and ecologically diverse regions, including mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena, and Ascension Island. The extent of passenger contact with local wildlife during the voyage, or prior to boarding in Ushuaia remains undetermined. The vessel carries a total of 147 individuals, including 88 passengers and 59 crew members. Onboard passengers and crew represent 23 nationalities. As of 4 May 2026, the vessel is moored off the coast of Cabo Verde. Summary of cases: Case 1: An adult male developed symptoms of fever, headache, and mild diarrhoea on 6 April 2026 while on board the ship. By 11 April, the case developed respiratory distress and died on board on the same day. No microbiological tests were performed. The body of the passenger was removed from the vessel to Saint Helena (a British Overseas Territory) on 24 April. Case 2: An adult female, who was a close contact of case 1, went ashore at Saint Helena on 24 April 2026 with gastrointestinal symptoms. She subsequently deteriorated during a flight to Johannesburg, South Africa, on 25 April. She later died upon arrival at the emergency department on 26 April. On 4 May, the case was subsequently confirmed by PCR with hantavirus infection. Contact tracing for passengers on the flight has been initiated. Cases 1 and 2, had travelled in South America, including Argentina, before they boarded the cruise ship on 1 April 2026. Case 3: An adult male presented to the ship's doctor on 24 April 2026 with febrile illness, shortness of breath and signs of pneumonia. On 26 April, his condition worsened. He was medically evacuated from Ascension to South Africa on 27 April, where he is currently hospitalised in an Intensive Care Unit (ICU). Laboratory testing on an extensive respiratory pathogen panel was negative; however, polymerase chain reaction (PCR) testing confirmed hantavirus infection on 2 May 2026. Serology, sequencing and metagenomics are ongoing. Case 4: An adult female, with presentation of pneumonia, died on 2 May 2026. The onset of symptoms was on 28 April, with fever and a general feeling of being unwell. Three suspected cases have reported high fever and/or gastrointestinal symptoms and remain on board. Medical teams in Cabo Verde are evaluating the patients and collecting additional specimens for testing.","assessment":"Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a zoonotic, viral respiratory disease caused by hantaviruses of the genus Orthohantavirus , family Hantaviridae , order Bunyavirales . More than 20 viral species have been identified within this genus. In the Americas, Sin Nombre virus is the predominant cause of HPS in North America, while Orthohantavirus andesense is responsible for most cases in South America. Human Hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of infected rodents or by touching contaminated surfaces. Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present, and opportunities for exposure are greater. HPS is characterized by headache, dizziness, chills, fever, myalgia, and gastrointestinal problems, such as nausea, vomiting, diarrhoea, and abdominal pain, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from 2-4 weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure. Hantavirus infections are relatively uncommon globally. In 2025 (as of epidemiological week 47), in the Region of the Americas, eight countries reported 229 cases and 59 deaths with a CFR of 25.7%. [1] In the European Region, 1885 hantavirus infection reported in 2023 (0.4 per 100,000), marking the lowest rate observed between 2019 and 2023. [2] In East Asia, particularly China and the Republic of Korea, Hantavirus haemorrhagic fever with renal syndrome (HFRS) continues to account for many thousands of cases annually, although incidence has declined in recent decades. Hantavirus infections are associated with a case fatality rate of <1&ndash;15% in Asia and Europe and up to 50% in the Americas. While there are no specific treatment nor vaccines for hantavirus infections, early supportive care and immediate referral to a facility with a complete ICU can improve survival. Environmental and ecological factors affecting rodent populations can influence disease trends seasonally. Since hantavirus reservoirs are sylvatic rodents, transmission can occur when people come into contact with rodent habitats. Although uncommon, limited human‑to‑human transmission of HPS due to Andes virus has been reported in community settings involving close and prolonged contact. Secondary infections among healthcare workers have been previously documented in healthcare facilities, though remain rare. WHO currently assesses the risk to the global population from this event as low and will continue to monitor the epidemiological situation and update the risk assessment as more information becomes available.","advice":"WHO advises that States Parties involved in this event continue efforts in detection, investigation, reporting, case management, infection control, and public health management on board, including ship sanitation measures, in close coordination with the conveyance operator, to prevent and control infections caused by hantaviruses. In the context of the current outbreak, passengers and crew members should practice frequent hand hygiene, remain vigilant of Hantavirus symptoms and undertake active symptom monitoring for 45 days. Crew must ensure adequate environmental cleaning (avoiding dry sweeping) and ventilation in the ship. Passengers and crew members experiencing symptoms should inform medical professionals on board and self-isolate. If respiratory symptoms are present to practice respiratory etiquette and wear a medical mask. Vigilance among travellers, crew, including those involved in implementing ship sanitation measures, or other personnel returning from areas where hantavirus is known to be present, as well as on conveyances engaged in eco-tourism on a journey from and through those areas, is essential. Early recognition of suspected cases, prompt isolation, and consistent adherence to recommended infection prevention and control measures remain essential to protect healthcare personnel. Diagnosis of HPS is with serologic testing for IgM or rising titres of IgG antibodies using enzyme-linked immunoassay (ELISA) or with reverse transcriptase polymerase chain reaction (RT&ndash;PCR) to detect viral RNA. In healthcare environments, standard precautions* should be applied for all patients, including hand hygiene, environmental cleaning and safe handling of blood and body fluids. In addition to standard precautions, transmission-based precautions should be implemented for management of suspect or confirmed cases. Standard precautions combined with transmission-based precautions during close contact are considered sufficient. For aerosol-generating procedures, airborne precautions should be used. [3] When HPS is suspected, patients should be promptly transferred to an emergency department or intensive care unit for close monitoring and supportive management. Initial management should include supportive care with antipyretics and analgesics as needed. For confirmed hantavirus, antibiotics are not routinely indicated. However, before a definitive diagnosis is established (and bacterial infection is a diagnostic possibility), or if superadded bacterial infection is suspected, empiric broad-spectrum antibiotics may be appropriate. Clinical management relies primarily on careful fluid administration, hemodynamic monitoring, and respiratory support. Given the rapid progression of HCPS, close monitoring and early transfer to ICU are critical for more severe cases. Mechanical ventilation, meticulous volume control, and vasopressors may be required. For severe cardiopulmonary insufficiency, extracorporeal mechanical oxygenation may be lifesaving. In severe cases of renal dysfunction, dialysis may be required. Although ribavirin has shown efficacy against hantavirus haemorrhagic fever with renal syndrome, it has not demonstrated effectiveness for HCPS and is not licensed for either treatment or prophylaxis of hantavirus pulmonary syndrome. At present, there is no specific antiviral treatment approved for HCPS. Public health awareness efforts should focus on improving early detection, ensuring timely treatment, and reducing exposure risks. Preventive measures should address occupational and ecotourism-related exposures, emphasize standard and transmission-based infection prevention and control practices, and include rodent control strategies. Most routine tourism activities carry little or no risk of exposure to rodents or their excreta. The potential for human-to-human transmission should be considered in areas where Andes and potentially other South American hantaviruses are endemic. Individuals engaging in outdoor activities where endemic transmission is known, such as visiting rural areas, camping or hiking, should take precautions to minimise potential exposure to infectious materials. Risk communication and community engagement interventions should prioritize transparent, timely, and culturally appropriate communication to raise awareness of hantavirus transmission risks&mdash;particularly exposure to rodent excreta in endemic areas&mdash;and promote practical preventive behaviours such as safe food storage, avoiding contact with rodents, wet-cleaning methods (no dry sweeping), and proper ventilation. Community engagement strategies should involve local leaders and workers in high-risk occupations to co-develop and disseminate tailored messages, address misinformation, and reinforce early care seeking. Surveillance for HPS should be integrated into a comprehensive national surveillance system and include clinical, laboratory, and environmental components. The implementation of integrated environmental management strategies aimed at reducing rodent populations is also recommended. *Standard precautions refer to a set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. These practices aim to protect both healthcare professionals and patients and include hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of sharps materials, safe injection practices, use of sterile instruments and equipment and cleaning of hospital environments and the environment. Adapted from &ldquo;Standard precautions for the prevention and control of infections: aide-memoire&rdquo;- WHO, 2022. Available at https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1 WHO advises against the application of any travel or trade restrictions based on the current information available on this event.","publishedAt":"2026-05-04T18:00:00.000Z","lastModified":"2026-05-05T18:30:34.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON599","response":"Authorities from States Parties involved in the management of the event to date &ndash; Cabo Verde, the Netherlands, Spain, South Africa and the United Kingdom - have initiated coordinated response measures including: Ongoing engagement between WHO and the National IHR Focal Points of Cabo Verde, the Netherlands, South Africa, Spain and the United Kingdom, to ensure timely information sharing and coordination of response actions. WHO shared information about the events with National IHR Focal Points globally. Passengers onboard have been advised to practice maximal physical distancing and remain in their cabins where possible. Epidemiological investigations are underway to determine the source of exposure. The National IHR Focal Point of Argentina shared the passenger and crew lists with the National IHR Focal Points of the respective countries, according to each person&rsquo;s nationality. In line with the Working Arrangement between the WHO Emergency Medical Team (EMT) Secretariat and the EU Emergency Response Coordination Centre (ERCC ) , the EMT Secretariat has launched formal discussions to support the clinical management and medical evacuation of symptomatic passengers. Logistic support has been provided, including sample collection items. Laboratory testing and confirmation of hantavirus infection have been conducted at the National Institute for Communicable Diseases (NICD) of South Africa. Serology, sequencing and metagenomics are ongoing. Additional laboratory samples from symptomatic passengers are being sent, with WHO support, to the Institut Pasteur de Dakar, Senegal, for testing. WHO has activated three-level coordination and is supporting national authorities in implementing risk-based, evidence-informed public health measures in accordance with the provisions of the IHR and related WHO technical guidance documents.","epidemiology":"","formattedDate":"2026-05-04T21:48:22Z","matchedSignals":["cross-border signal","transmission concern","severity signal","response escalation"]}},{"id":"2026-DON598","title":"Measles - Bangladesh","disease":"Measles","locations":["Bangladesh"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON598","summary":"On 4 April 2026, the National International Health Regulations (IHR) Focal Point for Bangladesh notified WHO of a nationwide increase in measles cases, geographically affecting 58 out of 64 districts across all eight divisions in Bangladesh. A total of 19 161 suspected measles cases and 2897 laboratory-confirmed measles cases have been reported between 15 March and 14 April 2026, including 166 measles related deaths (CFR 0.9%). The majority (79%) of the reported cases are children aged under 5 years. A targeted measles-rubella (MR) vaccination campaign started on 5 April, and various outbreak response measures are ongoing including strengthening nationwide surveillance and epidemiological analysis to enhance case detection and reporting. Based on currently available information, WHO assesses the risk at the national level as high due to ongoing transmission across multiple divisions, the large number of susceptible children, documented immunity gaps, and the occurrence of suspected measles-related deaths.","overview":"On 4 April 2026, the National IHR Focal Point of Bangladesh notified WHO of a significant increase in measles cases, driven by sustained domestic transmission. Since January 2026, Bangladesh has experienced a marked increase in measles cases. Geographically, cases have been reported across all eight divisions, in 58 out of 64 districts (91% of districts), indicating widespread transmission nationally. Since 15 March 2026 and as of 14 April, a total of 19 161 suspected measles cases and 2973 laboratory-confirmed measles cases have been reported. Moreover, 166 suspected measles-related deaths (CFR 0.9%) and 30 confirmed measles-related deaths (CFR= 1.1%) have been recorded. A total of 12 318 hospital admissions and 9772 hospital discharges have also been reported. The highest cumulative burden of suspected measles cases since 15 March 2026 has been reported in Dhaka (8263 cases), Rajshahi (3747 cases), Chattogram (2514 cases), and Khulna (1568 cases). In Dhaka, cases are concentrated in densely populated informal settlements, including Demra, Jatrabari, Kamrangirchar, Korail, Mirpur, and Tejgaon industrial and slum clusters. (HEOC, DGHS, 15 April 2026). Children aged under 5 years account for the majority of reported cases (79%), including children aged under 2 years (66%) and infants aged under 9 months (33%). A total of 166 suspected deaths have been reported (CFR 1%), mainly among unvaccinated children aged under 2 years.","assessment":"Measles is a highly contagious viral disease that affects susceptible individuals of all ages and remains one of the leading causes of death among young children globally. Measles can cause serious illness in at-risk groups, including children under 5 years of age, those who are malnourished especially those with vitamin A deficiency and people with weakened immune systems. Measles complications include hearing loss, diarrhoea, pneumonia and blindness. Severe complications of measles include encephalitis, brain damage, and death. The current outbreak in Bangladesh is occurring in the context of suboptimal population immunity. A substantial proportion of cases occurred among children who were either unvaccinated or had received only one dose of measles-containing vaccine. In addition, some children were infected before reaching the age of eligibility for vaccination at 9 months. Most cases (91%) occurred among children aged 1 to 14 years, indicating substantial immunity gaps in this age group. Before this outbreak, Bangladesh had made substantial progress towards measles elimination. Reported coverage with the first dose of measles-containing vaccine increased considerably between 2000 (89% - WUENIC) and 2016 (118% - WUENIC), while coverage with the second dose also improved between its nationwide introduction in 2012 (22% - WUENIC) and 2024 (121% - WUENIC). During the same period, confirmed measles incidence declined sharply. However, recent declines in MR1 and MR2 coverage due to nationwide stockout of MR vaccine between 2024-2025, combined with routine immunization gaps and the absence of regular nationwide supplementary measles-rubella campaigns since 2020, have increased the number of susceptible children and contributed to the current outbreak. The risk at the national level is assessed as high due to ongoing transmission across multiple divisions, the large number of susceptible children, documented immunity gaps, and the occurrence of suspected measles-related deaths. The concentration of cases among unvaccinated and under-vaccinated children including infants too young to be vaccinated, raises concern for continued uninterrupted transmission and severe disease outcomes. Overall, the outbreak suggests a reversal from Bangladesh&rsquo;s previous progress towards measles elimination and highlights increasing vulnerability to sustained transmission. Continued spread is likely unless urgent measures are implemented to strengthen surveillance, rapidly detect and respond to cases, and close immunity gaps through high-quality vaccination activities. There are considerable risks of cross-border spread, facilitated by cross-border population movement, with major urban centres such as Dhaka, Chattogram, Sylhet, and Cox&rsquo;s Bazar being important international travel and transit hubs increasing the likelihood of national and international spread, particularly among unvaccinated or inadequately vaccinated travelers. Measles is endemic across the South-East Asia region. The risk is assessed as high at regional level. Bangladesh shares extensive land borders with India and Myanmar, and population mobility across these borders may facilitate continued transmission. In Myanmar there is a considerable number of unvaccinated/zero dose children. With ongoing conflict and humanitarian crisis, surveillance and response capacities are limited. India, despite achieving high vaccination coverage, has reported a rise in case count over the past six months. Cities with high incidence such as Jashore and Chapainawabganj (an identified hotspot) share busy land crossings with India, thereby increasing the risk of introduction across the border. Despite Bangladesh&rsquo;s progress towards measles elimination the current outbreak highlights the vulnerability of the population and underscores the fragility of immunization gains. The risk at the global level is assessed as moderate due to high levels of population mobility, combined with ongoing widespread measles transmission and immunity gaps.","advice":"WHO recommends maintaining sustained homogeneous coverage of at least 95% with the first and second doses of the MCV vaccine in all municipalities and strengthening integrated epidemiological surveillance of measles and rubella to achieve timely detection of all suspected cases in public, private, and social security healthcare facilities. WHO recommends strengthening epidemiological surveillance in high-traffic border areas to rapidly detect and respond to highly suspected measles cases. Providing a rapid response to imported measles cases to avoid the re-establishment of endemic transmission through the activation of rapid response teams trained for this purpose and by implementing national rapid response protocols when there are imported cases. Once a rapid response team has been activated, continued coordination between the national, sub-national, and local levels must be ensured, with permanent and fluid communication channels between all levels. During outbreaks, it is recommended to establish adequate hospital case management to avoid nosocomial transmission, with appropriate referral of patients to isolation rooms (for any level of care) and avoiding contact with other patients in waiting rooms and/or other hospital rooms. WHO recommends vaccination of at-risk populations (without proof of vaccination or immunity against measles and rubella), such as healthcare workers, persons working in tourism and transportation (hotels, airports, border crossings, mass transportation, and others), and international travelers. Implementing a plan to immunize migrant populations in high-traffic border areas, prioritizing those considered at-risk, including both migrants and residents, in these municipalities increases vaccination coverage to increase population immunity. In all settings, consideration should be given to providing susceptible contacts with post-exposure prophylaxis (PEP), including a dose of MCV or normal human immunoglobulin (NHIG) (if available) for those at risk and in whom the vaccine is contraindicated. In well-resourced settings, MCV should be provided to susceptible contacts within 3 days. For contacts for whom vaccination is contraindicated or is not possible within 3 days post-exposure, consideration can be given to providing NHIG up to 6 days post-exposure. Infants, pregnant women, and the immunocompromised should be prioritized. WHO recommends maintaining a stock of the MR and/or measles, mumps, rubella (MMR) vaccine, and syringes/supplies for control actions of imported cases. Facilitating access to vaccination services according to the national scheme to those from other countries or people from the same country who perform temporary activities in countries with ongoing outbreaks; displaced populations; indigenous populations, or other vulnerable populations. WHO does not recommend any restriction on travel and trade based on the information available on the current outbreak.","publishedAt":"2026-04-23T12:58:07.000Z","lastModified":"2026-04-23T13:14:43.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON598","response":"A nationwide measles-rubella (MR) vaccination campaign was approved by the National Immunization Technical Advisory Group (NITAG) on 30 March 2026, targeting children aged 6&ndash;59 months (with expanded coverage for 6&ndash;8 months), and started on 5 April in 30 upazilas (sub-districts) of 18 priority districts. A nationwide campaign commenced on 20 April. Vitamin A campaign was held throughout the country on 15 March 2025. During this outbreak response, Vitamin A supplementation is provided to all suspected and confirmed measles cases as an essential component of standard treatment and case management. District Rapid Response Teams (RRTs) have been activated, and vaccine procurement fast-tracked by the Ministry of Health. Other outbreak response actions include strengthening routine immunization to prevent further spread of the outbreak, enhancing hospital preparedness, ensuring availability of vitamin A, strengthening isolation capacity, and reinforcing infection prevention and control measures. Strengthening nationwide surveillance and epidemiological analysis, is also ongoing including measures to improve case detection and reporting. Trainings are being conducted at health facilities to improve case detection and reporting, and weekly situation reports produced to support evidence-based decision-making. National and divisional guidelines have been issued to guide response activities, including vaccination, clinical management, infection prevention and control, patient care pathways, and procurement.","epidemiology":"Measles is a highly contagious acute viral disease which affects individuals of all ages and remains one of the leading causes of death among young children globally. The mode of transmission is airborne or via droplets from the nose, mouth, or throat of infected persons. Initial symptoms, which usually appear 10-14 days (range 7-23 days) after infection, include high fever, usually accompanied by a runny nose, bloodshot eyes, cough and tiny white spots inside the mouth. The rash usually appears 10-14 days after exposure and spreads from the head to the trunk to the lower extremities. A person is infectious from four days before up to four days after the appearance of the rash. There is no specific antiviral treatment for measles, and most people recover within 2-3 weeks. Measles is usually a mild or moderately severe disease. However, measles can lead to complications such as pneumonia, diarrhoea, secondary ear infection, inflammation of the brain (encephalitis), blindness, and death. Postinfectious encephalitis can occur in about one in every 1000 reported cases. About two or three deaths may occur for every 1000 reported cases. Vaccination with measles containing vaccine is safe and effective, providing protection against measles and its complications for all eligible populations. WHO recommends two doses of Measles Containing Vaccine (MCV) to be provided through the routine immunization schedule. Strong routine immunization systems are therefore critical foundations for achieving and sustaining high levels of population immunity to vaccine preventable diseases such as measles. WHO further recommends the conduct of Supplementary Immunization Activities (SIAs) or mass immunization campaigns as an effective strategy for delivering vaccination to children who may have been missed by routine services. In protecting vulnerable populations against measles, mass vaccination campaigns can rapidly improve population immunity by reducing the number of susceptible individuals in the population.","formattedDate":"2026-04-23T13:14:13Z","matchedSignals":["transmission concern","severity signal","WHO high-risk wording","response escalation","cross-border signal"]}},{"id":"2026-DON597","title":"Avian Influenza A(H9N2) - Italy","disease":"Avian Influenza A(H9N2)","locations":["Italy"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON597","summary":"On 21 March 2026, the National International Health Regulations (IHR) Focal Point for Italy notified the World Health Organization (WHO) of the identification of a human case of avian influenza A(H9) in an adult male returning from Senegal. Next generation sequencing confirmed Influenza A(H9N2). According to epidemiological investigations, the patient had no known history of exposure to poultry or any person with similar symptoms prior to the onset of symptoms. Authorities in Italy have implemented a series of measures aimed at monitoring, preventing and controlling the situation. According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. This is the first imported human case of avian Influenza A(H9N2) reported in the European Region. Based on currently available information, WHO assesses the current risk to the general population posed by A(H9N2) viruses as low but continues to monitor these viruses and the situation globally.","overview":"On 21 March 2026, the National IHR Focal Point for Italy notified WHO of the identification of a human case of avian influenza A(H9) in an adult male. The patient had been in Senegal for more than six months and traveled to Italy in mid-March. Upon arrival, he visited the emergency department with a fever and a persistent cough. On 16 March, a bronchoalveolar lavage specimen was collected, which showed a positive Mycobacterium tuberculosis result, as well as detection of un-subtypeable influenza A virus. The patient was placed in a negative-pressure isolation room with airborne precautions. He was treated with antitubercular medication and antiviral oseltamivir. By 9 April, his condition was stable and improving. On 20 March, a regional reference laboratory identified the A(H9) subtype, and on 21 March, next-generation sequencing confirmed influenza A(H9N2). Initial genetic findings suggest the infection was likely acquired from an avian source linked to Senegal. Additional samples have been sent to Italy&rsquo;s National Influenza Center, where further characterization confirmed virus subtype Influenza A(H9N2), with close genetic similarity to strains previously identified in poultry in Senegal. No direct exposure to animals, wildlife or rural environments was identified. There was also no reported contact with symptomatic or confirmed human cases. Further epidemiological investigations on the source of exposure are ongoing. Contacts identified in Senegal were asymptomatic. All identified and traced contacts in Italy have tested negative for influenza and completed the period of active monitoring for the onset of symptoms and the quarantine required by national guidelines. They also received oseltamivir as a preventive measure.","assessment":"Most reported human cases of A(H9N2) virus infection have been linked to exposure to infected poultry or contaminated environments, with the majority of cases experiencing mild clinical illness. Sporadic human cases following exposure to infected birds or contaminated environments can be expected since the virus remains enzootic in poultry populations. Avian influenza A(H9N2) viruses have been detected in poultry and environmental samples collected at live bird markets in Senegal and authorities in the country reported a human case of infection with an A(H9N2) virus in 2020. Current epidemiological and virological evidence indicates that none of the characterized influenza A(H9N2) viruses thus far have acquired the ability for sustained transmission among humans. Thus, the likelihood of sustained human-to-human spread is low at this time. Infected individuals traveling internationally from affected areas may be identified in another country during or after arrival. However, if this were to occur, further community-level spread is considered unlikely. The risk assessment would be revisited if and when further epidemiological and virological information becomes available.","advice":"This case does not change the current WHO recommendations on public health measures and surveillance of influenza. The public should avoid contact with high-risk environments such as live animal markets/farms or surfaces that might be contaminated by poultry feces. Respiratory protection is highly recommended for those handling live or dead (including slaughtering) poultry in occupational or backyard-farming settings. Good hand hygiene, i.e. frequent washing of hands or the use of alcohol-based hand sanitizer is recommended. WHO does not recommend any specific additional measures for travelers. Under Article 6 of the IHR, all human infections caused by a new subtype of influenza virus are notifiable. The case definition for notification of human influenza infection caused by a new subtype under the IHR is provided here . State Parties to the IHR are required to immediately notify WHO of any laboratory-confirmed case of a human infection caused by such an influenza A virus. WHO advises against the application of any travel or trade restrictions based on the current information available on this event.","publishedAt":"2026-04-10T13:51:44.000Z","lastModified":"2026-04-10T14:03:22.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON597","response":"Contact tracing procedures have been initiated, and relevant authorities in Italy, as well as internationally (National IHR Focal Point for Senegal, WHO, and European Centre for Disease Prevention and Control (ECDC)) have been informed through IHR channels. Once avian influenza was suspected, the response moved quickly from hospital-level management to regional laboratory confirmation and national coordination. Additionally, the regional surveillance system was notified, integrated within the One Health avian influenza reporting framework.","epidemiology":"Animal influenza viruses normally circulate in animals but can also infect people. Infections in humans have primarily been acquired through direct contact with infected animals or through indirect contact with contaminated environments. Depending on the original host, influenza A viruses can be classified as avian influenza, swine influenza, or other types of animal influenza viruses. Avian influenza virus infections in humans may cause diseases ranging from mild upper respiratory tract infection to more severe diseases and can be fatal. Conjunctivitis, gastrointestinal symptoms, encephalitis and encephalopathy have also been reported. Laboratory tests are required to diagnose human infection with influenza. WHO periodically updates technical guidance protocols for the detection of zoonotic influenza using molecular methods. Human infections with influenza A(H9) viruses have been reported from countries in Africa and Asia, where these viruses are also detected in poultry. The majority of cases of human avian influenza A(H9N2) infection have been reported from China. This is the first imported human case of avian Influenza A(H9N2) virus infection reported in the European Region.","formattedDate":"2026-04-10T14:03:01Z","matchedSignals":["transmission concern","novel or unusual signal","response escalation"]}},{"id":"2026-DON596","title":"International food safety event: Infant formula and products containing arachidonic acid oil contaminated with cereulide toxin - Multi-country","disease":"International food safety event: Infant formula and products containing arachidonic acid oil contaminated with cereulide toxin","locations":["Multi-country"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON596","summary":"Multi-country recalls of infant formula and other products have been initiated after cereulide toxin, was detected in batches of multiple internationally distributed brands. Investigations have identified arachidonic acid (ARA) oil, used as an ingredient in the implicated products, as the source of contamination. However, the full root cause analysis and complete traceability of all affected batches remains under investigation. Contaminated formulae, nutritional products, and oil mixes have been distributed to 99 countries and territories across six WHO Regions, with the first product recalls initiated on 10 December 2025. Between 1 January and 25 February 2026, 144 suspected and confirmed cases were reported across ten countries in three WHO Regions, with investigations ongoing. Based on the available information, WHO assesses the overall public health risk as moderate due to the vulnerability of the affected population (infants), the ongoing uncertainty regarding the full extent of distribution and exposure, and remaining gaps in case detection and root cause information.","overview":"Since 10 December 2025, and as of 25 February 2026, 99 countries and territories have been identified as having received batches of infant formula products subject to recall due to contamination with cereulide toxin. During this period, 144 suspected and confirmed cases were reported across 10 countries. The epidemiological investigations and product‑traceback activities remain ongoing in many countries. The case definitions in use by the International Food Safety Authorities Network (INFOSAN) are currently: Suspect case: A person presenting symptoms of cereulide intoxication with a history of consumption of the recalled product, without laboratory confirmation in a clinical sample. Confirmed case: A person presenting symptoms of cereulide intoxication with a history of consumption of recalled product, with laboratory confirmation in a clinical sample. Health authorities are actively searching for cases and conducting laboratory testing of human specimens and infant formula products. However, case definitions used may differ from those established by INFOSAN, such as those established by the European Centre for Disease Prevention and Control, creating challenges with comparability of reported case numbers. Since this is not a routinely tested contaminant or condition, diagnostic challenges and limited surveillance capacity are hindering Member States&rsquo; ability to identify confirmed cases. One country has laboratory confirmed cases linked to the contaminated products (Belgium). The limited case numbers appearing in multiple, geographically separated areas is consistent with sporadic exposures to contaminated products that were widely distributed. ​Precautionary recalls have been issued across all countries and territories where products were distributed. These measures aim to prevent further exposures, although the speed and completeness of product recall and withdrawal vary by location according to various factors including inspection and enforcement capacities.","assessment":"WHO assesses the overall public health risk associated with this event to be Moderate. This assessment is based on the information currently available and reflects the wide international distribution of contaminated products, ongoing uncertainties regarding the full extent of contaminated product distribution, case detection, and root cause of contamination, and the vulnerability of infants and young children to dehydration and electrolyte imbalance from with vomiting illness associated with cereulide toxin ingestion. Several considerations contribute to this assessment: Cereulide is a thermostable emetic toxin that can cause acute vomiting and rapid dehydration particularly in very young infants which can have severe consequences if untreated; mild or self-limiting cases are likely to go unreported, especially in settings with limited healthcare access or diagnostic capacities. The extent of the contaminated ARA oil distribution remains uncertain, as complete traceability from the original implicated manufacturer has not been provided to WHO. Secondary distribution through commercial supply chains has further complicated efforts to identify all affected products. Additional investigation is required to determine the source and extent of the cereulide contamination. The international spread of contaminated products has already disrupted trade and supply chains across at least 99 countries and territories, with the possibility of further recalls if additional affected batches or product categories are identified. These recalls, while essential for public health protection, have created a risk of localized shortage of infant formula, particularly in settings where reliance on specific products is high, despite manufacturers&rsquo; efforts to increase production of unaffected products. A residual risk of exposure persists while investigations and traceability efforts continue, as competent authorities manage evolving distribution information and update risk communication measures. Mild clinical presentations can resemble common childhood illnesses, laboratory capacity for cereulide testing in contaminated products or human samples varies widely, and variations in case definitions across countries complicate consistent reporting and may delay detection. Although limited numbers of suspected and confirmed cases have been reported to date, without continued investment in surveillance for toxin‑related events, strengthened laboratory networks, training of health‑care providers, and clear communication on recalls and safe alternatives, delays in detection and response could lead to preventable morbidity in infants.","advice":"Based on the information available, WHO recommends Member States to maintain epidemiological surveillance, enhance readiness of laboratory capacity for cereulide testing of suspected contaminated products and in clinical samples of suspected cases, and facilitate effective implementation of recalls and withdrawals, as needed. WHO advises Member States to: Identify, trace, and withdraw all affected products from the market. Verify the effectiveness of recalls at retail and distribution levels and ensure that affected products are not available for sale, including online sales. Conduct sampling and laboratory testing of suspect products and human specimens. Strengthen requirements for traceability across the supply chain and food recalls. Enhance inspection and oversight of facilities producing or handling ingredients used in infant nutrition. Share relevant information through established international information-sharing mechanisms, including INFOSAN. Issue targeted alerts to consumers, caregivers, health workers, and retailers, while providing clear guidance on identifying and disposing of affected products. Promote breastfeeding and address barriers to accessing safe alternative nutrition. Encourage early presentation to health facilities for infants with sudden vomiting. Reinforce guidance on dehydration management and red-flag symptoms, while supporting availability of tools for safe clinical management of affected infants. WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.","publishedAt":"2026-03-13T19:00:00.000Z","lastModified":"2026-03-13T16:05:23.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON596","response":"WHO Response: Since 7 January 2026, when distribution of the products was confirmed to extend beyond the European Union, WHO, through the INFOSAN Secretariat, has been contacting INFOSAN Emergency Contact Points in the countries and territories identified as affected to notify them of recalled products exported to their markets and to support information exchange and coordinated response. Communication within the European Union has been managed through the European Rapid Alert System for Food and Feed (RASFF), with close coordination between INFOSAN and RASFF. Response measures in affected countries and territories: Recalls and communication campaigns have been carried out in many countries and territories where contaminated products were distributed, preventing further exposures despite variable implementation of recall and withdrawal measures. Active case-finding and laboratory confirmation efforts are ongoing in affected countries and territories, with most countries and territories reporting no linked illnesses to date.","epidemiology":"Cereulide is a heat-stable toxin produced by certain strains of Bacillus cereus , a Gram-positive, spore-forming bacterium ubiquitous in soil, dust, and food production environments. The primary hazard in this event is suspected to have occurred during the production of ARA oils used in infant formula, although a root cause analysis has not yet been provided to WHO. Cereulide is not contagious; illness occurs only when a person ingests the toxin, such as through consumption of contaminated products. The toxin withstands cooking temperatures (stable up to 121&deg;C) and common pasteurization, persisting in finished products. Symptoms manifest rapidly, typically within 0.5&ndash;6 hours post-ingestion, and usually present as acute gastrointestinal symptoms (nausea, vomiting, abdominal pain) with risk of rapid dehydration and electrolyte imbalance which can be particularly severe in infants due to their physiological vulnerability and limited reserves. The toxin has a very low symptomatic dose threshold and remains fully active despite gastric conditions, contributing to its clinical potency. For babies who rely entirely on formula, repeated feedings can increase the amount of toxin consumed, and using contaminated formula for rehydration can worsen illness. The absence of specific antidotes or targeted therapies places greater emphasis on supportive clinical care, effective risk communication to caregivers and health workers, and robust coordination between food safety and public health authorities. Where there is limited access to health care and where there may be delays in care seeking, rapid dehydration and electrolyte imbalance in infants may be fatal. As of 25 February 2026, the following countries have notified suspected cases: Austria (9), Brazil (5), China, Hong Kong SAR, (1), Czechia (4), France (11), Italy (1), Singapore (3), Spain (41), and the United Kingdom of Great Britain and Northern Ireland (61). In other countries, including Denmark (32) and the Netherlands (221) the number of suspected cases is based on self-reporting and is therefore not comparable with the INFOSAN case definition. To date, Belgium is the only country with laboratory‑confirmed cases, reporting eight confirmed intoxications linked to the implicated products.","formattedDate":"2026-03-13T16:05:10Z","matchedSignals":["cross-border signal"]}},{"id":"2026-DON595","title":"Mpox: recombinant virus with genomic elements of clades Ib and IIb – Global situation","disease":"Mpox: recombinant virus with genomic elements of clades Ib and IIb","locations":["Global situation"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON595","summary":"Recombination of monkeypox virus (MPXV) strains has been documented in recent months, with two cases of a recombinant strain comprising clade Ib and IIb MPXV reported. Recombination is a known natural process that can occur when two related viruses infecting the same individual exchange genetic material, producing a new virus. The first case was detected in the United Kingdom of Great Britain and Northern Ireland (hereafter “United Kingdom”), with travel history to a country in South-East Asia, and the second in India, with travel history to a country in the Arabian Peninsula. Detailed analysis of the virus genomes shows that the two individuals fell ill several weeks apart with the same recombinant strain, suggesting that there may be further cases than are currently reported. Both cases had similar clinical presentation to that observed for other clades. Neither patient experienced severe outcomes. Contact tracing for both cases in the reporting countries has been completed; no secondary cases were detected. Based on available information, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.","overview":"In December 2025, the United Kingdom detected the first reported case of a clade Ib/IIb MPXV recombinant strain.​ 5 ​ After classification of this case and posting in a public database as a novel MPXV recombinant strain, a case of mpox detected in India in September 2025 was retrospectively reclassified as a closely-related recombinant strain based on sequencing data. To date, these are the only known cases of this recombinant virus. Case detected in the United Kingdom of Great Britain and Northern Ireland The case was identified following testing of a vesicular swab from a traveler who had returned from a country in the Asia Pacific region in October 2025. During laboratory confirmation, the virus was initially typed as clade Ib MPXV by qPCR. Subsequent whole genome sequencing revealed that the MPXV strain identified was distinct from other known clade Ib MPXV strains with phylogenetic analysis indicating that the genome had regions similar to both clade Ib and clade IIb MPXV reference sequences, suggesting that it is an inter-clade recombinant. To confirm this unusual finding, sequencing was repeated on the original extract from the primary sample, a fresh extract from the same primary sample, a second swab collected from the patient at the same time, and a cultured isolate derived from the initial swab. This repeat sequencing yielded identical viral genome sequences from the two clinical swabs and the cultured isolate, supporting the initial findings of a new recombinant strain, and showing that it can replicate and presents potential for onward transmission. This strain is a recombinant MPXV, containing genetic elements from both clade Ib and clade IIb MPXV. A small number of contacts were identified and followed up in the United Kingdom; none developed any clinical features of mpox. Health worker contacts had worn full personal protective equipment (PPE) during provision of medical care to the patient. The authorities of the United Kingdom continue to investigate the significance of this recombinant MPXV strain through phenotypic characterization studies. Case detected in India On 13 January 2026, the National IHR Focal Point (NFP) of India notified WHO of a mpox case with an inter‑clade recombinant MPXV which was, upon whole-genome sequencing, found to have genomic elements of clades Ib and IIb MPXV. The recombinant virus was found in samples from a man with mpox who had presented for care in September 2025. The patient had reported recent travel from a country in the Arabian Peninsula, where he resides as an overseas worker. He developed symptoms on 1 September 2025, while still abroad. After his return to India, real‑time PCR confirmed MPXV infection on 11 September 2025. Clade differentiation PCR performed on 15 September 2025 initially identified this virus as clade II MPXV. Initial genomic sequencing analysis suggested features consistent with clade IIb MPXV. However, following the update of the global Nextclade database on 16 December 2025, which included the recombinant clade Ib/IIb MPXV strain reported by the United Kingdom, the virus from the patient in India was reclassified as belonging to the recombinant strain. Recombination analysis demonstrated mosaic patterns containing genomic regions derived from both parent clades. Following the initial diagnosis, the patient was hospitalized, did not experience any medical complications, and fully recovered, testing negative for MPXV on 29 September 2025. The case reported no close contacts in India, and no known secondary cases were identified following this introduction of the recombinant clade Ib/IIb MPXV in India. Full or near‑full genome retrieval (>99%) from both the sample and a sample-derived virus isolate enabled phylogenetic analysis showing >99.9% similarity to the recombinant strain detected in the United Kingdom. A total of 34 recombinant tracts were observed in the sequence reported by India, while 28 recombinant tracts were observed in the sequence reported by the United Kingdom; 16 recombinant tracts were common to both strains. This case in India therefore represents the earliest known detection of this recombinant strain globally, having preceded the event reported in the United Kingdom. Consistent with the case reported in the United Kingdom, clinical presentation was consistent with cases due to clade I or clade II MPXV (non-recombinant MPXV) infection.","assessment":"Mpox outbreaks must be considered in their local context, with meaningful involvement of affected communities, to ensure an in-depth understanding of the epidemiology, modes of transmission, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control. Multiple strains of MPXV are circulating through interconnected sexual networks across many countries and settings. Co-infection with different strains, that could lead to emergence of recombinant virus strains, while rare, can be expected. The case in India was infected with the same recombinant Ib/IIb MPXV strain detected in the United Kingdom. Symptom onset in the case reported in India occurred more than two months earlier than the case in the United Kingdom, and the great degree of similarity between their sequences suggests a common evolutionary history. This information has two important implications: i) the origin of the recombinant strain remains unknown; and ii) transmission of this recombinant virus already involves at least four countries in three WHO regions, and is therefore likely to be more widespread than currently documented. For the cases in the United Kingdom and India, the initial clade differentiation PCR results indicated clade Ib and IIb MPXV, respectively. Thus, clade differentiation PCR assays alone may not reliably identify recombinant MPXV strains, and genomic sequencing is likely to be required for their detection. Due to the small number of cases found to date, conclusions about transmissibility or clinical characterization of mpox due to recombinant strains would be premature, and it remains essential to maintain vigilance regarding this development. In light of the limited information available on this recombinant MPXV strain, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors. All countries should remain alert to the possibility of MPXV genetic recombination. The public health risk posed by any newly detected recombinant strain should be assessed on a case-by-case basis, considering available epidemiological, clinical and genomic information.","advice":"Based on the information available, WHO recommends maintaining epidemiological surveillance, laboratory and genomic sequencing capacity for mpox, case management, infection prevention and control (IPC) measures, vaccination for people at risk, locally relevant risk communication and community engagement, and public health guidance for mpox. All recommendations are made in the context of ongoing transmission of clades Ib and IIb MPXV in key populations at risk in all WHO regions, including undetected or pre- and asymptomatic infections, as well as unreported cases. They additionally apply to settings where clades Ia and IIa MPXV continue to spread through a mix of zoonotic and human-to-human contact. There is likely to be wider circulation of this emerging recombinant strain of MPXV since at least September 2025 than reflected by the two cases documented and linked to four countries in three WHO regions. WHO advises Member States to: maintain mpox surveillance and rapid reporting, including prompt IHR notification of any unusual events and imported cases in line with the WHO Standing Recommendations issued under the IHR (2005) and extended to August 2026; continue to carry out genomic sequencing of all laboratory specimens from confirmed cases in early outbreak settings, and a representative sample of at least 10% of laboratory specimens from confirmed cases in settings experiencing community transmission, as per WHO guidance; carry out targeted sample characterization for specific situations of interest, especially for cases who report recent travel to locations with clade I MPXV circulation or to locations which provide opportunities for sex tourism, prioritizing sequencing for cases in key populations at risk and for imported, unusual, or severe cases, and sharing sequences rapidly in public databases; ensure quality case management and robust IPC practices and strengthen vaccination strategies, including ensuring access to mpox vaccines for key populations at risk; continue to advance integration of HIV/STI and mpox health services to ensure early HIV testing and care for any person with suspected or confirmed mpox and rapid initiation or resumption of antiretroviral therapy in people living with HIV as needed for any person with mpox; strive to eliminate human-to-human transmission of mpox where MPXV circulation remains low and ensure the maintenance of capacity for prompt outbreak response; continue to provide information to travelers who may be at risk. WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.","publishedAt":"2026-02-14T19:00:00.000Z","lastModified":"2026-02-14T17:54:34.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON595","response":"WHO Response: WHO maintains global mpox surveillance and continues to provide response guidance and support for all countries, including access to diagnostics and vaccines through multi-partner coordination including through the Access and Allocation Mechanism for mpox. WHO and partners are establishing the longer-term International Coordinating Group for mpox vaccine provision (ICG) to further accelerate timely outbreak response and ensure sustainable support for the future. Furthermore, WHO continues to evaluate available rapid diagnostic tests for field use. Response measures in the United Kingdom: The United Kingdom Health Security Agency (UKHSA) continues to work closely with the National Health Service England, public health agencies in Scotland, Wales and Northern Ireland, and is monitoring the situation in the United Kingdom and undertaking public health actions in accordance with the Mpox control: UK strategy 2025 to 2026 . Public health information was made available to health care providers and the public. Contact tracing was completed in line with national guidance. Contacts were given appropriate health advice, offered vaccination, and monitored for symptoms. All suspected mpox cases in the UK are tested using Orthopoxvirus-generic, MPXV-generic, and MPXV-specific PCR as primary testing, with clade differentiation assays performed on any positive samples. All samples identified as clade Ib, and selected samples identified as clade IIb cases undergo whole genome sequencing through Illumina-based workflows. Response measures in India: Public health measures, including contact tracing and monitoring, were implemented to prevent onward transmission. No secondary case was detected. All suspected mpox cases in India are tested using Orthopoxvirus‑generic and MPXV‑specific PCR with clade differentiation assays. Positive cases undergo whole genome sequencing through Illumina‑based workflows.","epidemiology":"Mpox is an infectious disease caused by the MPXV, which is part of the genus Orthopoxvirus , that includes the variola virus, the causative agent for smallpox. There are two known clades of MPXV: clade I (previously called the Congo Basin clade), which includes subclades Ia and Ib; and clade II (previously called the West Africa clade), which includes subclades IIa and clade IIb. Subclades Ia and Ib were defined after the emergence of subclade Ib in the South Kivu province of the Democratic Republic of the Congo in 2023, and subclade Ia encompasses all other strains of clade I that are not Ib.​ As reported here, there have also been two cases of the clade Ib/IIb recombinant strain, detected in the UK and in India. Mpox spreads among humans through direct close physical contact with an infected person, including sexual contact. Transmission can also occur through indirect contact (with contaminated materials), through infectious respiratory particles in limited cases, and from mother to child (vertical transmission).​ Historically mpox was primarily characterized by zoonotic transmission, with outbreaks occurring in tropical rainforest regions of East, Central and West Africa, and occasional exportation of cases to other areas. In the context of zoonotic transmission, which continues to occur in historically endemic areas, MPXV is transmitted to humans through direct contact with infected wild animals (e.g., through hunting, trapping, or petting), and possibly through processing and consuming infected wild game or their body parts and fluids. To date, animal-to-human transmission has always been documented in or linked to known endemic regions of Africa. All other outbreaks in Africa or in other parts of the world are to date presumed to be due to human-to-human transmission, until proven otherwise. Symptoms of mpox in humans include swollen lymph nodes, fever, and a skin rash and/or mucosal lesions that may initially resemble those of other illnesses such as chickenpox (caused by the varicella virus), or sexually transmitted infections such as herpes or syphilis if the rash or lesions appear in the genital or anal region. The ongoing global outbreak has shown that mpox can also present with few lesions, and asymptomatic infection can occur.​ The contribution of pre- and asymptomatic infection to transmission remains poorly understood.","formattedDate":"2026-02-14T14:07:30Z","matchedSignals":["cross-border signal","transmission concern","novel or unusual signal","response escalation"]}},{"id":"2026-DON594","title":"Nipah virus infection - Bangladesh","disease":"Nipah virus infection","locations":["Bangladesh"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON594","summary":"On 3 February 2026, the International Health Regulations National Focal Point (IHR NFP) for Bangladesh notified WHO of one confirmed case of Nipah virus (NiV) infection in Rajshahi Division. The patient developed fever and neurological symptoms on 21 January. Nipah virus infection was laboratory-confirmed on 29 January. The patient reported no travel history but had a history of consuming raw date palm sap. All 35 contact-persons are being monitored and have tested negative for NiV and no further cases have been detected to date. Bangladesh regularly has small NiV outbreaks, with cases reported at different times of the year, though outbreaks tend to occur between December and April corresponding with the harvesting and consumption of date palm sap. The Ministry of Health and Family Welfare in Bangladesh has implemented several public health measures. WHO assesses the overall public health risk posed by NiV to be low at the national, the regional and global level. The risk of international disease spread is considered low.","overview":"On 3 February 2026, the Bangladesh IHR NFP notified WHO of one confirmed case of NiV infection that occurred in Rajshahi Division, northwestern Bangladesh. The case was confirmed by Polymerase Chain Reaction (PCR) and Enzyme-Linked Immunosorbent Assay (ELISA) testing on 29 January 2026. The patient is female, aged between 40-50 years, residing in Naogaon District, Rajshahi Division. She developed symptoms consistent with NiV infection on 21 January, including fever, headache, muscle cramps, loss of appetite (anorexia), weakness, and vomiting, followed by hypersalivation, disorientation, and convulsion. On 27 January, she became unconscious and was referred by a local physician to a tertiary hospital. She was admitted on 28 January, and the Nipah surveillance team collected throat swabs and blood samples. The patient died the same day. The patient reported repeated consumption of raw date palm sap between 5 and 20 January 2026. Following the confirmed diagnosis, an outbreak investigation team, including One Health stakeholders, started investigations on 30 January. A total of 35 contact persons has been identified, including three household contact persons 14 community contact persons and 18 hospital contact persons. Samples were collected from six symptomatic contact persons, including three from household, two from communities and one from hospital. All six samples tested negative for NiV infection by PCR and anti-Nipah IgM antibody detection by ELISA. As of 3 February, no additional cases have been identified. Contact persons are under monitoring. Bangladesh reported its first case of NiV infection in 2001. Since then, human infections have been reported almost every year. In 2025, four laboratory-confirmed fatal cases were reported from Bangladesh.","assessment":"Nipah virus is a zoonotic pathogen with a high death rate and no licensed vaccine or treatment, though early supportive treatment can save lives. Its reservoirs are fruit bats or flying foxes (bats of the Pteropus genus), which are distributed in the coastal regions and on several islands in the Indian ocean, India, south-east Asia and Oceania. The virus can be transmitted to humans from wild and domestic animals. Secondary human-to-human transmissions are also possible. Cases of Nipah virus infection were first reported in 1998 and since then have been reported in Bangladesh, India, Malaysia, Philippines and Singapore. The virus is present in Bangladesh, while NiV cases are reported throughout the year, outbreaks tend to occur between December and April corresponding with the harvesting and consumption of date palm sap. Clusters of cases are mainly reported in the country&rsquo;s central and northwest districts. To date, since 2001 Bangladesh has documented 348 NiV disease cases, including 250 deaths, corresponding to an overall case fatality rate of 72%. Nearly half of these cases (n=162) were primary cases with a confirmed history of consuming raw date palm sap or tari (fermented date palm sap), while 29% resulted from direct person-to-person transmission. Most cases detected in Bangladesh were reported through December to April, suggesting a seasonal pattern. Based on the current available information, WHO assesses the overall public health risk posed by NiV at the national level to be low due to the following reasons: The case fatality rate from NiV infection is high. There are currently no specific drugs or vaccines available for NiV infection, although WHO has identified Nipah as a priority disease for research under WHO Research and Development Blueprint. Intensive supportive care is recommended for the treatment of severe respiratory and neurologic complications. The initial signs and symptoms of NiV infection are non-specific, and the diagnosis is often not suspected at the time of presentation. This can delay timely diagnosis and create challenges in outbreak detection, effective and timely infection control measures, and outbreak response activities. Fruit bats ( Pteropus spp .), as a natural reservoir of the Nipah virus, are present in Bangladesh and repeated spillover of the virus from its reservoir to the human population has been demonstrated. Despite ongoing efforts at risk communication and community engagement to address awareness, there is continued consumption of raw date palm sap by the community. However, the yearly number of NiV cases reported in Bangladesh remains under 10 since 2016, with exception in 2023 when 14 cases were reported. Although human-to-human transmission has been reported in previous outbreaks, it has been less frequent in recent years. In addition, strong public health measures are in place to detect and control outbreaks, including a hospital-based systematic human NiV infection surveillance system which has been established since 2006, the utilization of the National Rapid Response Team (NRRT) at the central level and the Rapid Response Team (RRT) at the district level and the capacity to rapidly test samples. Bangladesh borders India and Myanmar, and WHO assesses the risk at the regional level to be low. While there have not been any instances of cross-border transmission by humans previously, the risk remains, given shared ecological corridor for the virus's natural host Pteropus bats in Bangladesh and India. However, Bangladesh has strong capacities and experience of controlling previous NiV outbreaks. WHO assesses the risk at the global level to be low, as there have been no previous confirmed cases outside Bangladesh, India, Malaysia, Philippines and Singapore.","advice":"In the absence of a licensed vaccine or specific therapeutic treatment for Nipah virus disease, reducing or preventing infection in people relies on raising awareness of the risk factors. This includes providing guidance on and reinforcing risk communication messages about the measures that people can take to reduce exposure to the Nipah virus. Case management should focus on delivering timely supportive care, supported by an effective laboratory system and adequate infection prevention and control measures in health facilities. Intensive supportive care is recommended for treatment of severe respiratory and neurologic complications. Public health educational messages should focus on: Reducing the risk of bat-to-human transmission Efforts to prevent transmission should first focus on decreasing bat access to date palm sap and other fresh food products. Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of bat bites should be discarded. Areas where bats are known to roost should be avoided. Reducing the risk of human-to-human transmission Close unprotected physical contact with NiV-infected people should be avoided. Regular hand washing should be carried out after caring for or visiting sick people along other preventive measures. People experiencing Nipah-like symptoms should be referred to a health facility, as early supportive care is key in the absence of treatment. Contact tracing and monitoring are also key to mitigate human-to-human transmission. Controlling infection in health care settings Health and care workers caring for patients with suspected or confirmed infection, or handling specimens from them, should always implement standard precautions for infection prevention and control at all times, for all patients. When caring for patients with suspected or confirmed NiV, WHO advises the use of contact and droplet precautions including a well-fitting medical mask, eye protection, a fluid-resistant gown, and examination gloves. Airborne precautions should be implemented during aerosol-generating procedures, including placing the patient in an airborne-infection isolation room and the use of a fit-tested filtering facepiece respirator instead of a medical mask. Suspected or confirmed cases of NiV should be placed in a single-patient room. For family members and caregivers visiting patients with suspected or confirmed Nipah virus, similar precautions should be applied. Samples taken from people and animals with suspected NiV infection should be handled by trained staff working in suitably equipped laboratories. Based on the currently available information, WHO does not recommend any travel and/or trade restrictions.","publishedAt":"2026-02-06T19:00:00.000Z","lastModified":"2026-02-10T16:05:50.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON594","response":"Several public health measures have been implemented by local authorities, including: On 30 January 2026, the Ministry of Health and Family Welfare (MoHFW), in collaboration with relevant sectors, initiated an outbreak investigation using a coordinated One Health approach. Active contact tracing was implemented to identify and monitor exposed individuals. Preparations were undertaken to conduct an advocacy meeting involving Civil Surgeons, Upazila Health Officers, Hospital Directors, and Superintendents from Nipah-endemic districts. Community awareness programmes are being planned with the involvement of field-level health workers. Audio-visual health education materials on NiV infection are being developed for point-of-entry staff and travellers. The support provided by WHO includes: WHO is monitoring the situation closely, in coordination with the national and sub-national health authorities. WHO facilitated IHR event communication to notify the case.","epidemiology":"NiV infection is a zoonotic disease transmitted to humans through infected animals (such as bats), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. Fruit bats, also known as flying foxes, ( Pteropus species) are the natural hosts for the virus. The incubation period ranges from 3 to 14 days. In some rare cases, incubation of up to 45 days has been reported. Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests. The main tests used are RT-PCR from bodily fluids and antibody detection via ELISA. Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis (brain swelling). Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours. Further information about NiV infection can be found here . The CFR in previous outbreaks across Bangladesh, India, Malaysia, Philippines and Singapore ranged from 40% to 75%, depending on local capabilities for early detection and clinical management. There are currently no licensed medicines or vaccines specific for NiV infection. Early intensive supportive care is recommended to treat severe respiratory and neurologic complications. Henipavirus nipahense (or Nipah virus) is considered a priority pathogen for the acceleration of medical countermeasures to respond to epidemics and pandemics as part of the WHO R&D Blueprint for Epidemics.","formattedDate":"2026-02-06T21:43:10Z","matchedSignals":["transmission concern","severity signal","response escalation"]}},{"id":"2026-DON593","title":"Nipah virus disease - India","disease":"Nipah virus disease","locations":["India"],"riskLevel":"watch","signalClass":"WHO outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON593","summary":"On 26 January 2026, the National IHR Focal Point for India notified WHO of two laboratory‑confirmed cases of Nipah virus (NiV) infection in West Bengal State. Both are healthcare workers at the same private hospital in Barasat (North 24 Parganas district). NiV infection was confirmed at the National Institute of Virology in Pune on 13 January. One case remains on mechanical ventilation as of 21 January, the other case experienced severe neurological illness but has since improved. Authorities have identified and tested over 190 contacts, who all tested negative for NiV with support from a mobile BSL‑3 laboratory deployed by the National Institute of Virology, Pune. No further cases have been detected to date. This event represents the third NiV infection outbreak reported in West Bengal (previous outbreaks reported in Siliguri in 2001 and Nadia in 2007). Enhanced surveillance and infection prevention and control (IPC) measures are in place while investigations into the source of exposure are ongoing. NiV infection is a serious but rare zoonotic disease transmitted to humans through infected animals (such as bats), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. There are currently no licensed medicines or vaccines for NiV infection, however early supportive care can improve survival. WHO assesses the risk posed by Nipah to be moderate at the sub-national level, and low at the national, the regional and global levels.","overview":"On 26 January 2026, the India IHR NFP notified WHO of two confirmed NiV infection cases that occurred in West Bengal State. Preliminary laboratory testing suggested NiV infection, and confirmation was received from the National Institute of Virology, Pune on 13 January 2026. The cases were confirmed through Reverse Transcription Polymerase Chain Reaction (RT-PCR) and Enzyme-Linked Immunosorbent Assay (ELISA) testing. The first case is a female nurse and the second case is a male nurse. Both cases were between 20 &ndash; 30 years old, from Barasat, North 24 Parganas district. Both cases developed symptoms typical of severe NiV infection in late December 2025 and were admitted to hospital in early January 2026. As of 21 January 2026, the second case showed clinical improvement, while the first case remained under critical care. Following the two confirmed cases, Indian health authorities identified and tested over 190 contact persons, including health and care workers and community contacts. All samples from contact persons tested negative for NiV. The Indian National Centre for Disease Control, announced on 27 January that no further confirmed cases have been detected in West Bengal from December 2025 to date.","assessment":"Nipah virus ( Henipavirus nipahense ) is a rare zoonotic pathogen with a high CFR (40-75%) and no licensed vaccine or treatment. Its reservoirs are fruit bats or flying foxes (bats in the Pteropus genus), which are distributed in the coastal regions and on several islands in the Indian ocean, India, south-east Asia and Oceania. The virus can be transmitted to humans from wild and domestic animals, however, as the disease can be transmitted by domesticated animals, secondary human-to-human transmissions are also possible. Cases of Nipah virus infection were first reported in 1998 and since then have been reported in Bangladesh, India, Malaysia, Philippines and Singapore. The virus is present in India, with seasonal outbreaks linked to bat activities and cultural practices such as the consumption of raw date palm sap. Seasonal outbreaks occur between December and May, coinciding with the harvesting of date palm sap. This event represents the third Nipah outbreak reported in West Bengal, while multiple Nipah outbreaks were also documented in Kerala since 2018. In West Bengal, previous outbreaks occurred in 2001 (Siliguri) and 2007 (Nadia district). Based on the current available information, WHO assesses the overall public health risk posed by NiV at the sub-national level to be moderate, taking into consideration no availability of specific drugs or vaccines for NiV infection and the difficulty of early diagnosis. Although sensitive and specific laboratory methods exist, the symptoms during the first phase are not specific and could potentially delay a timely diagnosis, outbreak detection and response. In addition, fruit bats ( Pteropus spp .) are the natural reservoir of NiV, and they are present in India and repeated spillover of the virus from its reservoir to the human population has been demonstrated. Human-to-human transmission has been documented in previous outbreaks, mostly reported in health-care settings and among family and caregivers of sick people through close contact with bodily fluids. Implementation of adequate infection prevention and control measures in health care facilities is critical to mitigate health care associated infection. The yearly number of NiV infection cases reported in India has remained relatively low since 2001, except for 2001, when 66 cases were reported and 2018 when 18 cases were reported. Over the past 5 years, a dozen confirmed cases were reported in India, all in Kerala State. Strong public health measures are implemented in India to detect and control outbreaks, including established NiV surveillance, and the availability of Rapid Response Teams (RRT) at both the Central and State levels, along with the capacity to rapidly test samples. For neighbouring countries, WHO assesses the public health risk posed by NiV at the regional level to be low. There have been no reports of cross‑border transmission, and the current outbreak remains geographically limited. Nevertheless, the risk of disease occurrence persists due to the shared ecological corridor of fruit bats and the history of human cases previously reported in the region. India has demonstrated strong capacity and experience in managing past NiV outbreaks. WHO assesses the public health risk posed by NiV at the global level to be low, as there has been no confirmed spread of cases outside India.","advice":"In the absence of a licensed vaccine or specific therapeutic treatment for Nipah virus disease, reducing or preventing infection in people relies on raising awareness of the risk factors. This includes providing guidance on and reinforcing risk communication messages about the measures that people can take to reduce exposure to the Nipah virus. This is also important in the context of mass gatherings, where attendees come from different countries and may be unfamiliar with disease and its mode of transmission, as well as actions they can take to protect themselves. and case management should focus on delivering timely supportive care, supported by an effective laboratory system and adequate infection prevention and control measures in health facilities. Intensive supportive care is recommended for treatment of severe respiratory and neurologic complications. Public health educational messages should focus on: Reducing the risk of bat-to-human transmission Efforts to prevent transmission should first focus on decreasing bat access to date palm sap and other fresh food products. Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of bat bites should be discarded. Areas where bats are known to roost should be avoided. Reducing the risk of human-to-human transmission. Close unprotected physical contact with NiV-infected people should be avoided. Regular hand washing should be carried out after caring for or visiting sick people along other preventive measures. People experiencing Nipah-like symptoms should be referred to a health facility, as early supportive care is key in the absence of treatment. Contact tracing and monitoring are also key to mitigate human-to-human transmission. Controlling infection in health care settings Health and care workers caring for patients with suspected or confirmed infection, or handling specimens from them, should always implement standard precautions for infection prevention and control at all times, for all patients. When caring for patients with suspected or confirmed NiV, WHO advises the use of contact and droplet precautions including a well-fitting medical mask, eye protection, a fluid-resistant gown, and examination gloves. Airborne precautions should be implemented during aerosol-generating procedures, including placing the patient in an airborne-infection isolation room and the use of a fit-tested filtering facepiece respirator instead of a medical mask. Suspected or confirmed cases of NiV should be placed in a single-patient room. For family members and caregivers visiting patients with suspected or confirmed Nipah virus, similar precautions should be applied. Samples taken from people and animals with suspected NiV infection should be handled by trained staff working in suitably equipped laboratories. Based on the currently available information, WHO does not recommend any travel and/or trade restrictions.","publishedAt":"2026-01-30T19:00:00.000Z","lastModified":"2026-02-11T08:14:47.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON593","response":"Several public health measures have been implemented by local authorities, including: The Government of India, in close coordination with the Government of West Bengal, initiated prompt and comprehensive public health measures in accordance with established protocols. Investigations were conducted in collaboration with other sectors through a One Health coordinated approach. Contact tracing has been carried out around the identified cases, with continuous follow-up. Surveillance efforts have been strengthened and enhanced to ensure early case detection. Health education and awareness campaigns, including community engagement and advocacy, are ongoing. Clinicians have been sensitized and alerted to NiV. Infection prevention and control has been strengthened at health-care settings. Prompt sample collection, transportation, and testing were conducted at the reference laboratory teams. The support provided by WHO includes: Providing event communication support at national and international levels, including the submission of an official IHR notification. Monitoring of the evolving outbreak situation, especially during the ongoing Nipah season, including support for assessment of epidemiological patterns, risk factors, and geographic spread.","epidemiology":"NiV infection is a zoonotic disease transmitted to humans through infected animals (such as bats), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. Fruit bats or flying foxes ( Pteropus species) are the natural hosts for the virus. The incubation period ranges from 3 to 14 days. In some rare cases incubation of up to 45 days has been reported. Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests. The main tests used are RT-PCR from bodily fluids and antibody detection via ELISA. Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis (brain swelling). Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours. Further information about NiV infection can be found here . The case fatality ratio (CFR) in outbreaks across Bangladesh, India, Malaysia, and Singapore range from 40% to 75%, depending on local capabilities for early detection and clinical management. There are currently no licensed medicines or vaccines specific for NiV infection. Intensive supportive care is recommended to treat severe respiratory and neurologic complications. Henipavirus nipahense (Nipah virus) is considered a priority pathogen for the acceleration of medical countermeasures (MCMs) to respond to epidemics and pandemics as part of the WHO R&D Blueprint for Epidemics.","formattedDate":"2026-01-30T16:32:57Z","matchedSignals":["transmission concern","response escalation"]}},{"id":"2026-DON592","title":"Marburg virus disease- Ethiopia","disease":"Marburg virus disease- Ethiopia","locations":[],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON592","summary":"On 26 January 2026, the Ministry of Health of Ethiopia declared the end of the Marburg virus disease (MVD) outbreak. This declaration came after two consecutive incubation periods (a total of 42 days) since the last person confirmed with MVD died and was given a safe and dignified burial, in accordance with WHO recommendations on 14 December 2025. As of 25 January 2026, a cumulative total of 19 cases, including 14 confirmed (including nine deaths) and five probable cases (all deaths), were reported. A total of 857 contacts listed for monitoring all had completed their 21-day follow-up as of 25 January 2026. WHO, through its country office and partners, provided technical, operational and financial support to the government to contain this outbreak.","overview":"On 14 November 2025, after the laboratory confirmation of suspected viral hemorrhagic fever (VHF) cases in Jinka town, South Ethiopia Regional State, Ethiopia, the Ministry of Health of Ethiopia declared an outbreak of Marburg Virus Disease (MVD). Molecular testing conducted by the National Reference Laboratory at the Ethiopian Public Health Institute (EPHI) identified Marburg virus (MARV) in patient samples. This was the first time Ethiopia was reporting a MVD outbreak . The first known case was an adult from Jinka town who developed symptoms on 23 October. The patient presented to the General Hospital the following day with vomiting, loss of appetite, and abdominal cramps. As of 25 January 2026, a cumulative total of 14 confirmed cases, including nine deaths (Case Fatality Rate (CFR) 64.3%) and five probable cases, all of whom had died, were reported by the Ministry of Health from Jinka, Malle and Dasench woredas in South Ethiopia Region and Hawassa in Sidama Region. As of 25 January 2026, a total of 857 contacts were listed who completed 21 days of follow-up, 760 from the South Ethiopia Region and 97 from the Sidama Region. As of 5 January 2026, 3800 samples were tested for the virus. On 26 January 2026, after two consecutive incubation periods (a total of 42 days), without a new confirmed case reported, after the last confirmed case died and was given a safe and dignified burial, on 14 December 2025, the Ministry of Health of Ethiopia declared the end of the MVD outbreak, as per WHO recommendations. Figure 1: Map of districts reporting confirmed and probable Marburg virus disease cases in Ethiopia, as of 25 January 2026","assessment":"This was the first-ever confirmed MVD outbreak reported in Ethiopia. Based on the outbreak investigation and surveillance activities during the response, which included contact tracing, alert management, active case search, and mortality surveillance, no additional cases have been reported during the 42-day countdown period, as per WHO recommendations. However, there remains a risk of re-emergence of MVD following the declaration of the end of the outbreak, with potential spillovers from interactions with the animal reservoir. Risk communication and community engagement activities will continue to provide timely and accurate information, monitor and address community feedback and rumours, while supporting efforts to reduce stigma toward individuals affected by the outbreak.","advice":"WHO encourages maintaining early detection and care capacities in addition to sustaining the ability to quickly respond after the outbreak ends. This is to make sure that if the disease re-emerges, health authorities can detect it immediately, prevent the disease from spreading again, and ultimately save lives. Raising awareness of risk factors for MVD and protective measures that individuals can take is an effective way to reduce human transmission. WHO advises the following risk reduction measures as an effective way to reduce MVD transmission in healthcare facilities and in communities: Reducing the risk of bat-to-human transmission arising from prolonged exposure to mines or caves inhabited by fruit bat colonies. People visiting or working in mines or caves inhabited by fruit bat colonies should wear gloves and other appropriate protective clothing (including masks). Capabilities for early detection of MVD patients should be maintained over time in settings at risk of the disease. Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with MVD patients should be avoided. Patients suspected or confirmed for MVD should be isolated in a designated treatment centre for early care and to avoid transmission at home. Communities affected by MVD, along with health authorities, should ensure that the population is well informed, both about the nature of the disease itself and about necessary outbreak containment measures. Outbreak containment measures include safe and dignified burial of the deceased, identifying people who may have been in contact with someone infected with MVD and monitoring their health for 21 days and providing care to the confirmed patient. Any sick people with symptoms matching MVD should be referred to a health facility with adequate capacity. Critical infection prevention and control measures should be implemented and/or strengthened in all health care facilities, per WHO&rsquo;s Infection prevention and control guideline for Ebola and Marburg disease . Health workers caring for patients with confirmed or suspected MVD should apply transmission-based precautions in addition to: standard precautions , including appropriate use of PPE and hand hygiene according to the WHO 5 moments to avoid contact with patient&rsquo;s blood and other body fluids and with contaminated surfaces and objects. Waste generated in healthcare facilities must be safely segregated, collected, transported, stored, treated and finally disposed. Follow the national guidelines, rules and regulations for safe waste disposal or follow the WHO&rsquo;s guidelines on safe waste management . Patient-care activities should be undertaken in a clean and hygienic environment that facilitates practices related to the prevention and control of health-care-associated infections (HAIs) as outlined in Essential environmental health standards in health care . Safe water, adequate sanitation and hygiene infrastructure and services should be provided in healthcare facilities. For details on recommendations and improvement, follow the WASH FIT implementation Package WHO encourages countries to implement a comprehensive care programme to support people who have recovered from MVD with any subsequent sequelae and to enable them to access body fluid testing and to mitigate the risk of transmission through infected body fluids by adequate practices. Based on the current risk assessment, WHO advises against any travel and trade restrictions with Ethiopia.","publishedAt":"2026-01-26T19:00:00.000Z","lastModified":"2026-01-26T17:03:04.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2026-DON592","response":"Local and national health authorities in Ethiopia implemented the following public health measures: A National Taskforce established at the Ministry of Health to provide strategic guidance, make decisions and mobilize resources. A costed national three-month response plan developed and launched by the MoH/EPHI The MoH regularly disseminated information on the MVD outbreak to the public and key partners. Public Health Emergency Operational Centres were activated at national and regional levels, with incident management structures established to coordinate the response. The Ministry of Health, in collaboration with EPHI and regional health offices, conducted integrated surveillance and response activities, including at priority points of entry (PoEs) and points of control (PoCs). Community surveillance, contact tracing, house-to-house visits, and medical service delivery were enhanced. Two hospitals designated as treatment centres, with dedicated health workers deployed to manage cases. Laboratory capacities were strengthened both at national level and through the deployment of a mobile laboratory in Jinka for timely confirmation. Field assessments conducted by a rapid response team (RRT). Risk Communication and Community Engagement (RCCE) teams disseminated MVD prevention messages, conducted community dialogues, developed activity plans for targeted community interventions, monitored social media to address misinformation, and assessed trusted communication channels to enhance public awareness and engage local networks and influencers. WHO, through its country office and partners, provided technical, operational and financial support to the government to contain this outbreak. These include: WHO provided policy, technical and operational support across all response pillars, including on PoE surveillance, laboratory, case management, IPC, safe and dignified burial, RCCE, logistics and cross-border coordination. Provided emergency supplies including testing kits, VHF kits, treatment centre modules. Deployed technical experts to provide operational support across all response pillars. Provided technical support for capacity building and supervision on surveillance, integrated case management and IPC activities. Continued providing technical and strategic support for the transition plan, including the integration of the MVD response into essential health services. Supported the Regional Health Bureau (RHB) with community-based active case searching and mortality surveillance across various clusters. Provided technical and programmatic support to the RHB for the development and implementation of the Survivors Program.","epidemiology":"Marburg virus disease (MVD) is a severe disease caused by either of two closely related viruses, Marburg virus and Ravn virus. MVD has a high case fatality rate, ranging from 24% to 88% from previous outbreaks. The CFR can be lowered with early supportive patient care. The virus is initially transmitted to humans from fruit bats ( Rousettus aegyptiacus ) and then spreads among people through direct contact with bodily fluids, contaminated surfaces, or infected materials. Healthcare workers, caregivers, and individuals involved in burial practices are particularly at risk when appropriate infection, prevention and control measures are not in place. MVD symptoms typically begin abruptly after an incubation period of two to 21 days and include high fever, severe headache, malaise, muscle aches, and progressive gastrointestinal symptoms such as diarrhea and vomiting. In severe cases, patients may experience bleeding from multiple sites and die from shock and organ failure within a week of symptom onset. There are no approved treatment or vaccines for MVD, although early supportive care improves survival. Some candidate vaccines and therapeutics are currently under investigation. Nineteen outbreaks of MVD have previously been reported globally. The most recent outbreak was reported from the Republic of Tanzania between January and March 2025. Additional countries that have reported outbreaks of MVD in the African Region include Angola, the Democratic Republic of the Congo, Equatorial Guinea, Ghana, Guinea, Kenya, Rwanda, South Africa, and Uganda.","formattedDate":"2026-01-26T17:02:50Z","matchedSignals":["transmission concern","severity signal","response escalation"]}},{"id":"2025-DON591","title":"Middle East respiratory syndrome coronavirus - Global update","disease":"Middle East respiratory syndrome coronavirus","locations":["Global update"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON591","summary":"Since the beginning of 2025 and as of 21 December 2025, a total of 19 cases of Middle East respiratory syndrome coronavirus (MERS- CoV), including four deaths have been reported to WHO globally. Of the 19 cases, 17 were reported by the Kingdom of Saudi Arabia (KSA), and two were reported from France. Between 4 June and 21 December 2025, the Ministry of Health (MoH) of KSA reported a total of seven cases of MERS-CoV infection, including two deaths. In addition, at the beginning of December 2025, the National IHR Focal Point (IHR NFP) for France also reported two MERS-CoV travel – associated cases; involving individuals with recent travel to countries in the Arabian Peninsula. The notification of these latest cases does not change the overall risk assessment, which remains moderate at both the global and regional levels. These cases show that the virus continues to pose a threat in countries where it is circulating in dromedary camels, with regular spillover into the human population. WHO recommends implementation of targeted infection, prevention and control (IPC) measures to prevent the spread of health care-associated infections of MERS-CoV and onward human transmission.","overview":"Since the first report of MERS-CoV in the KSA and Jordan in 2012, a total 2635 laboratory-confirmed cases of MERS-CoV infection, with 964 associated deaths (Case Fatality Ratio (CFR) of 37%), have been reported to WHO from 27 countries, across all six WHO regions (Figure 1). The majority of cases (84%; n=2224), have been reported from the KSA (Figure 2). Since the beginning of 2025 and as of 21 December, a total of 19 cases have been reported to WHO. Overall, 17 cases were reported in the KSA from five regions named: Riyadh (n=10), Taif (n=3), Najran (n=2), Hail (n=1), and Hafr Al-Batin City (n=1) (Figure 3). In addition, two travel associated cases of MERS-CoV infection have been reported in France, with likely exposure occurring during recent travel in the Arabian Peninsula (Figure 3). This disease outbreak news report focuses on the recent nine cases of MERS-CoV infection reported between 4 June - 21 December 2025: seven cases from the KSA and the two imported cases to France. The details of cases reported earlier in 2025 can be referred to in the previously published disease outbreak news on 13 March 2025 and 12 May 2025 . Between 4 June and 21 December 2025, the MoH of the KSA reported a total of seven cases of MERS CoV infection. The cases were reported from three regions: Najran (2), Riyadh (3), and Taif (2). No epidemiological links were identified between the seven cases. In addition, between 2 and 3 of December 2025, the IHR NFP for France reported two cases of MERS &ndash; CoV with recent travel to the Arabian Peninsula during the month of November. Follow-up has been completed for all contacts and no secondary infections have been identified or reported. From September 2012, France has recorded a total of four laboratory-confirmed cases of MERS-CoV infection, including one death: two cases were reported in 2013, and the latest two cases in December 2025. All cases had been travelers exposed in the Arabian Peninsula and returning back to France. For additional details please see Table 1. Figure 1: Epidemic curve of MERS-CoV infections (2635) and deaths (964) reported globally between 2012-2025 Figure 2: Epidemic curve of MERS-CoV infections (2224) and deaths (868) reported in KSA between 2012-2025 Figure 3. Geographical distribution of MERS-CoV infections between 1 January and 21 December 2025 (n=19). Table 1: MERS-CoV cases reported by KSA and France between 4 June and 21 December 2025","assessment":"As of 21 December 2025, a total of 2635 laboratory-confirmed cases of MERS-CoV infection have been reported globally to WHO, with 964 associated deaths. The majority of these cases have occurred in countries on the Arabian Peninsula, including 2224 cases with 868 related deaths (CFR 39%) reported from the KSA. A notable outbreak outside the Middle East occurred in the Republic of Korea, in May 2015, during which 186 laboratory-confirmed cases (185 in the Republic of Korea and 1 in China) and 38 deaths were reported. However, the index case in that outbreak had a history of travel to the Middle East. Three limited healthcare-related clusters have recently been reported from the KSA, two in 2024 comprised of three and two cases each, and one in 2025 comprised of 7 cases; the previous cluster before that had been observed in May 2020, also in the KSA. Extensive contact tracing was applied in the 2025 cluster, which lead to detection of four asymptomatic and two mild cases, who fully recovered. Despite these recent clusters, zoonotic spillover remains an important mode of human infection, leading to isolated cases and limited onwards transmission between humans. Global total cases reflect laboratory-confirmed cases reported to WHO under IHR (2005) or directly by Ministries of Health from Member States. These figures may underestimate the true number of cases if some were not reported to WHO, as they may be missed by current surveillance systems and not be tested for MERS-CoV &ndash; either due to similar clinical presentation as other circulating respiratory diseases or because infected individuals remained asymptomatic or had only mild disease. The total number of deaths includes those officially reported to WHO through follow-up with affected Member States. The notification of these new cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (for example, consumption of raw camel milk, camel urine, or eating meat that has not been properly cooked), or in a healthcare setting. Due to the similarity of symptoms with other respiratory diseases that are widely circulating, like influenza or COVID-19, detection and diagnosis of MERS cases may be delayed, especially in unaffected countries, and provide an opportunity for onward human-to-human transmission to go undetected. WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information. No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.","advice":"Surveillance: Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections, with the inclusion of MERS-CoV into the testing algorithm where warranted, and to carefully review any unusual patterns. Clinical Management The incubation period is typically 2-15 days (median 5 days), although prolonged incubation periods have been reported in the immunocompromised. Although mild disease does occur, clinicians should be aware that symptoms may frequently progress rapidly non-specific signs of upper respiratory tract infection, cough and breathlessness, to respiratory failure and cardiovascular collapse. [3] MERS-CoV infection should be managed supportively with respiratory support titrated to the needs of the patient; there is a wide spectrum of severity, with many patients requiring mechanical ventilation. The largest clinical trial in MERS compared a combination of lopinavir&ndash;ritonavir and interferon &beta;-1b with placebo (95 patients). [4] Active treatment caused lower 90-day mortality in hospitalized patients with laboratory-confirmed MERS (90-day mortality of 48% and 29% respectively). Further analysis suggested a positive effect only in patients treated within 7 days of symptom onset. Although there is increasing use of corticosteroids for some respiratory conditions (specifically in COVID-19 and some other forms of pneumonia), their use in MERS-CoV is of uncertain benefit, and harms relating to their immunomodulatory effects may be significant; more data are needed. The use of convalescent plasma has not been proven, although has been used in a limited number of patients in a non-trial setting. While antibiotics have been used in severe disease to presumptively treat concurrent bacterial infection, there are no controlled data on efficacy. A retrospective analysis of 349 MERS patients examined macrolide antibiotic therapy. No difference in 90-day mortality was found in the 136 patients receiving macrolides compated with those who did not . [5] Infection prevention and control: Human-to-human transmission of MERS-CoV in healthcare settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing timely IPC measures. IPC measures are therefore critical to prevent the spread of MERS-CoV in healthcare facilities and onwards in the community. Healthcare workers should always apply standard precautions consistently with all patients and perform risk assessments at every interaction in healthcare settings to determine the necessary protection measures. For patients with suspected MERS-CoV infection that require hospitalization, place patient in an adequately ventilated single room away from other patient care areas. In addition to standard precautions. Droplet and contact precautions should be implemented when providing care to patients with symptoms of acute respiratory infection who are suspects of any respiratory disease, including probable or confirmed cases of MERS-CoV infection. [6,7] Droplet and contact precautions should be maintained until the patient is no longer symptomatic (for at least 24 hours) and has two upper respiratory (URT) swabs (taken 24hrs apart) test negative in RT-PCR or according to local guidance. Additionally, airborne precautions should be applied when performing aerosol generating procedures or in settings where aerosol generating procedures are conducted. Early identification, case management and prompt isolation of suspected respiratory infected patients and cases, quarantine of contacts, together with appropriate IPC measures in health care settings, including improving ventilation in enclosed spaces and public health awareness can prevent the spread of human-to-human transmission of MERS-CoV. Public health and social measures: MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and immunosuppression. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating. General hygiene measures, such as regular hand hygiene before and after touching animals or animal products and avoiding contact with sick animals, should be adhered to. In addition, hygiene practices should be observed including the five keys to safer food should be followed when dealing with food items of camels; people should avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked. WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions.","publishedAt":"2025-12-24T05:38:07.000Z","lastModified":"2026-01-06T10:00:01.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON591","response":"WHO is supporting Member States in strengthening preparedness and response. Activities in the Kingdom of Saudi Arabia include; Strengthened surveillance with immediate notification of all suspected and confirmed cases. Strict implementation of infection prevention and control transmission-based precautions (Contact and Droplet precautions) in healthcare facilities for suspect or confirmed patients, and airborne precautions for patients undergoing aerosol-generating procedures. Identification of health and care worker contacts and perform risk assessment of their exposure, considering the timely identification of symptomatic patients, implementation of IPC measures, and correct utilization of PPE while treating patients, Exposed health and care workers are followed up for 14 days to monitor symptoms. If they develop symptoms, they are to be removed from working with patients until tested and symptoms are fully resolved. Patients exposed to MERS-CoV in the healthcare setting must be tested to determine their ability to continue working with patients without further transmission, which could potentially lead to outbreaks in the healthcare facility. Identification of all potential community contacts and active follow-up to monitor symptoms for 14 days. All community acquired cases are investigated for having direct or indirect contact with camels or their products. Cases linked to camel exposures are notified to the National Center for Prevention and Control of Plants, Pests, and Animal Diseases (Weqaa) to investigate potential camel sources. Camels identified as a presumed source are quarantined and tested for MERS-CoV, and if live virus is detected, the quarantine period will be extended until live virus is no longer detected in camel. Activities in France include; On 4 December 2025, MoH France published information regarding the two imported cases of MERS-CoV in the country ( link ). Genomic sequencing was conducted from the first case and reported as being the same lineage that is circulating in the Arabian Peninsula. Further laboratory analyses are ongoing. Contact tracing was initiated as soon as the first case was detected for the monitoring and surveillance of fellow travellers and co-exposed individuals, high-risk contacts, and hospital contacts. It was completed in week 51 and no additional cases among the travellers have been reported, nor any secondary cases as of 19 December 2025. Asymptomatic co-exposed individuals and at-risk contacts located in France were offered a full testing protocol (nasopharyngeal swab, sputum, rectal swab and serology) on a voluntary basis up to 29 days after their last exposure, even if they did not exhibit any symptoms.","epidemiology":"Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). The case fatality ratio (CFR) among confirmed cases is around 37%. The CFR is calculated based solely on laboratory-confirmed infections and may overestimate the actual mortality rate since milder cases often go undetected or unreported. Humans can contract MERS-CoV through multiple transmission pathways; the primary route being through direct or indirect contact with dromedary camels, which serve as the virus&rsquo;s natural host and primary zoonotic reservoir. Additionally, human-to-human transmission can occur via infectious respiratory particles primarily in close-contact situations and can also occur through direct or indirect contact; this is especially prominent in health-care settings. Human-to-human transmission of the virus has occurred in health care facilities in several countries, including transmission from patients to health care providers and transmission between patients before MERS-CoV was diagnosed. It is not always possible to identify patients with MERS‐CoV early or without testing because symptoms and other clinical features may be non‐specific. Outside these environments, there has been limited documented human-to-human transmission. MERS can present with no symptoms (asymptomatic), mild symptoms (including mild respiratory issues), or severe illness leading to acute respiratory distress and death. Common symptoms include fever, cough, and breathing difficulties, with pneumonia frequently observed, though not always present. Some patients also experience gastrointestinal symptoms such as diarrhoea. Severe cases may require intensive care, including mechanical ventilation. Those at higher risk of severe outcomes include older adults, individuals with weakened immune systems, and those with chronic conditions like diabetes, kidney disease, cancer, or lung disorders. The number of MERS-CoV infections reported to WHO substantially declined since the beginning of the COVID-19 pandemic. Initially, this was likely the result of epidemiological surveillance for SARS-CoV-2 being prioritized. Similar clinical pictures of both diseases may have resulted in reduced testing and detection of MERS-CoV infections. However, the MoH of the KSA has been working to improve testing capacities for better detection of MERS-CoV since the easing of the COVID-19 pandemic, with MERS-CoV included into sentinel surveillance testing algorithms since the second quarter of 2023, for samples that test negative for both influenza and SARS-CoV-2. In addition, recommended IPC measures (e.g., mask-wearing, hand hygiene, physical distancing, improving ventilation) and public health and social measures in the community to reduce SARS-CoV-2 transmission, (stay-at-home orders, reduced mobility) also likely reduced onward human-to-human transmission of respiratory infections including MERS-CoV. Potential cross-protection conferred from infection with or vaccination against SARS-CoV-2 and any reduction in MERS-CoV infection or disease severity and vice versa has been hypothesized but requires further investigation. [1,2]","formattedDate":"2025-12-24T09:19:23Z","matchedSignals":["cross-border signal","transmission concern","novel or unusual signal","severity signal","response escalation"]}},{"id":"2025-DON586","title":"Seasonal influenza - Global situation","disease":"Seasonal influenza","locations":["Global situation"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON586","summary":"Seasonal influenza (‘the flu’) is an acute respiratory infection caused by influenza viruses that circulate globally and year-round. It can cause illness ranging from mild to severe, sometimes resulting in hospitalization or death. Seasonal influenza activity has increased globally in recent months, with an increased proportion of seasonal influenza A(H3N2) viruses being detected. This rise coincides with the onset of winter in the northern hemisphere and an increase in acute respiratory infections caused by influenza and other respiratory viruses typically observed at this time of year. Although global activity remains within expected seasonal ranges, early increases and higher activity than typical at this time of year have been observed in some regions. Seasonal influenza viruses, including A(H3N2) viruses, continually evolve over time. Since August 2025, there has been a rapid increase of A(H3N2) J.2.4.1 alias K subclade viruses detected from several countries based on available genetic sequence data. These subclade K viruses have several changes from related A(H3N2) viruses. Current epidemiological data do not indicate an increase in disease severity, although this subclade marks a notable evolution in influenza A(H3N2) viruses. Early estimates suggest that the influenza vaccine continues to provide protection against hospital attendance in both children and adults, even though its effectiveness against clinical disease during the current season remains uncertain. Vaccines remain essential, especially for people at high risk of influenza complications and their care givers. Even if there are some genetic differences between the circulating influenza viruses and the strains included in the vaccines, the seasonal influenza vaccine may still provide protection against drifted viruses and the other virus strains included in the vaccine. Vaccination is still expected to protect against severe illness and remains one of the most effective public health measures. WHO continues to monitor global influenza activity and influenza viruses, supports countries in surveillance capacity and updates guidance as needed.","overview":"Globally, influenza activity has increased since October 2025 with influenza A viruses predominant among the viruses detected globally. In many northern hemisphere countries, acute respiratory infection levels increase at this time of year. These increases are typically caused by seasonal epidemics of respiratory pathogens such as influenza, respiratory syncytial virus (RSV) and other common respiratory viruses. The exact timing of the onset, the duration, magnitude and the severity of each epidemic might vary by location, influenced by multiple factors such as type of circulating viruses (including influenza and other respiratory pathogens), relative population immunity and environmental conditions. In the northern hemisphere, some countries have reported early starts to the influenza season. In other countries, influenza activity is starting to increase, but has not yet reached the epidemic threshold. In the southern hemisphere, some countries have had unusually long seasons compared to previous years, with virus activity remaining higher than usual in recent months. Global influenza surveillance and monitoring is conducted through the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of over 160 institutions in 131 Member States. GISRS is tasked with conducting year-round surveillance and monitoring of influenza viruses and serving as the global alert mechanism for the emergence of novel influenza viruses and other respiratory pathogens with pandemic potential. In the northern hemisphere temperate and sub-tropical countries, areas and territories, influenza activity was generally low from June to August 2025. Activity gradually increased in September and continued to increase through November 2025. Influenza A viruses, especially A(H3N2) viruses, predominated during this period (Fig. 1). In the southern hemisphere temperate and sub-tropical countries, areas and territories, influenza activity generally decreased from June 2025 and remained low through August. However, a slight increase has been observed since September. Influenza A(H1N1)pdm09 viruses predominated in June and July; however, A(H3N2) viruses have predominated since September (Fig. 2). In tropical areas, there has been sustained influenza activity from June through November. Influenza A(H1N1)pdm09 viruses predominated through July. Since then, the proportion of influenza A(H3N2) viruses among reported detections has increased and has become predominant since the end of September (Fig. 3). Figure 1. Virus detections by subtype reported to FluNet, from 1 June to 30 November 2025 for the northern hemisphere temperate and sub-tropical countries, areas and territories. Source: GISRS: https://worldhealthorg.shinyapps.io/flunetchart/ Figure 2. Virus detections by subtype reported to FluNet, from 1 June to 30 November 2025, for the southern hemisphere temperate and sub-tropical countries, areas and territories. Source: GISRS: https://worldhealthorg.shinyapps.io/flunetchart/ Figure 3. Virus detections by subtype reported to FluNet, from 1 June to 30 November 2025, for tropical countries, areas and territories. Source: GISRS: https://worldhealthorg.shinyapps.io/flunetchart/ Genetic characteristics of recent seasonal influenza viruses Influenza A(H1N1)pdm09 and influenza B/Victoria lineage viruses continue to circulate in all regions albeit at low levels. Influenza A(H3N2) viruses Based on genetic sequence data available in GISAID , a mixture of A(H3N2) haemagglutinin (HA) clades and subclades are currently circulating globally; however, there has been a recent and rapid rise in a particular subclade of A(H3N2), J.2.4.1 (alias subclade K Nextclade / Nextstrain nomenclature). A(H3N2) subclade K viruses have genetically drifted from related J.2.4 viruses and have several amino acid changes in their HA in comparison. Detections of subclade K viruses are increasing in many parts of the world, with the exception, to date, of South America. Subclade K viruses were particularly evident from August 2025 in Australia and New Zealand and have now been detected in more than 34 countries over the last 6 months. Figure 4. Influenza A(H3N2) percent positivity reported for epidemiological week 48 (24 to 30 November) 2025 Source: GISRS: https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenza-surveillance-outputs Overview of seasonal influenza by WHO Region African region Influenza detections in the WHO African Region overall increased in October with influenza A(H3N2) predominant. The timing and predominant virus varied by zone. In the western part of the region, influenza detections increased in September and October with A(H3N2) predominant since October. All seasonal subtypes have been detected continuously in the middle and eastern parts of the region. Influenza activity peaked in May 2025 in South Africa with almost exclusively A(H3N2) detections; in recent weeks influenza activity has increased slightly but remained low. Eastern Mediterranean Region While influenza activity in the WHO Eastern Mediterranean Region overall increased in October with A(H3N2) viruses predominant, there were variations by zone. In countries in the northern part of the region, influenza detections increased in October with influenza A(H1N1)pdm09 predominant and lesser proportions of influenza A(H3N2) and B virus detections reported. In the Arabian Peninsula, influenza detections also increased in October but with influenza A(H3N2) viruses predominant. European Region As of 21 November 2025, reported rates of influenza-like illness (ILI) and/or acute respiratory infection (ARI) in primary care were at baseline levels for most countries and areas of the WHO European Region. However, detections were increasing and regionally pooled test percent positivity in primary care sentinel surveillance rose above 10% in weeks 45 and 46 (ending on 15 November), marking the start of the 2025/26 influenza season for the European Region. This was approximately four weeks earlier than the median, but not out of the ordinary, with epidemiological trends similar to those observed in the 2022/23 influenza season. Influenza activity was variable between countries, with those in the west of the Region generally seeing earlier increases of influenza indicators compared to others. Influenza admissions, detections, and percent positivity in hospital surveillance were also increasing from inter-seasonal levels, with a higher proportion aged 65 years or older. A majority of influenza detections from sentinel and non-sentinel primary care and hospital surveillance systems were A(H3N2) viruses. Region of the Americas During the 2025 southern hemisphere season in the Americas, influenza transmission exceeded the seasonal threshold in mid-March, remaining mostly at low to moderate levels. Circulation was driven by influenza A(H1N1)pdm09, reaching a peak positivity of 19%. Activity then declined to low levels until the end of August, when an increase in circulation was observed, associated with influenza A(H3N2) in Brazil and Chile. As of beginning of November, Chile remains at moderate levels of influenza A(H3N2) transmission, without evidence of increased severity or rises in outpatient consultations. As of 4 November 2025, subclade K had not been detected in South America. In the northern hemisphere countries of the Americas, during week 45 of 2025, seasonal influenza circulation remained low, with influenza A(H1N1)pdm09 predominating in the Caribbean and Central America. In North America, influenza activity&mdash;although still low&mdash;was increasing, mainly driven by influenza A virus detections. While most detections in Mexico were influenza A(H1N1)pdm09, a predominance of influenza A(H3N2) has been observed in the United States and Canada, with growing detections of the A(H3N2) subclade K. South-East Asia Region Influenza detections in the South-East Asia Region started increasing from June, peaked in August and since then have generally remained low with some exceptions. During the 2025 till November, the proportion of Influenza A among all influenza viruses tested positive was 66% Influenza A(H3N2) was the predominant sub-type (43%) in transmission followed by A(H1N1)pdm09 (~20%). In Thailand, influenza detections of predominantly A(H3N2) increased in October and November. Influenza A(H3N2) detections also increased since July in Bangladesh and October in Sri Lanka. While the region has seen an increase in Influenza A(H3N2), 22 sequences of subclade K have been reported in GISAID from Nepal (1), India (4) and Thailand (17) as of 30 November. Western Pacific Region Since the beginning of October 2025, influenza seasonal activity has increased in the Western Pacific Region. In some countries, including Japan and the Republic of Korea, the onset of the typical seasonal influenza activity period started earlier than in previous years. As of 9 November 2025, influenza positivity ranged from 8% to 56% in the northern hemisphere countries. In southern hemisphere countries, influenza activity shows mixed trends; positivity has declined in Australia, remains high in New Zealand and is rapidly increasing in Fiji. The elevated influenza activity in New Zealand and Fiji is unusual for this time of the year. The predominant circulating influenza subtype is influenza A(H3N2), marking a shift from A(H1N1)pdm09, which predominated during the 2024-2025 northern hemisphere winter season. The increases in influenza have predominantly been driven by the expansion of A(H3N2) subclade K, which represents 89% of sequences submitted to GISAID from the Western Pacific Region (as of 21 November 2025).","assessment":"Seasonal influenza activity has increased globally in recent months, and influenza A(H3N2) viruses are predominant. This rise coincides with the onset of winter in the northern hemisphere. Epidemics and outbreaks of seasonal influenza and other circulating respiratory viruses can place significant pressure on healthcare systems. Although global activity remains within expected seasonal ranges, early increases and higher activity than typical at this time of year have been observed in some regions. Seasonal influenza could place significant pressure on healthcare systems even in non-temperate countries. Genetically drifted influenza A(H3N2) viruses, known as subclade K viruses, have been detected in many countries. While data on how well the vaccine works against clinical disease this season are still limited, vaccination is still expected to protect against severe illness and remains one of the most effective public health measures.","advice":"Surveillance Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of year-round global surveillance to detect and monitor virological, epidemiological and clinical changes associated with emerging or circulating influenza viruses that may affect human health and timely virus sharing for risk assessment. Countries are encouraged to remain vigilant to the threat of influenza viruses and review any unusual epidemiological patterns. WHO advises Member States to maintain surveillance for respiratory pathogens through an integrated approach, considering country context, priorities, resources and capacities. WHO has published guidance on integrated respiratory virus surveillance. WHO has also updated guidance on assessing influenza epidemic and pandemic severity , including the impact on healthcare facilities. Clinical management and prophylaxis Clinical care for seasonal influenza focuses on identifying illness severity, assessing risk of progression, and linking to definitive care. Most cases are mild and self-limiting, but severe disease, marked by respiratory distress, sepsis, acute respiratory distress syndrome or multi-organ failure, requires urgent supportive care and often hospitalization. Clinical management of influenza involves high-quality supportive care&mdash;oxygen therapy, monitoring, hydration and respiratory support&mdash;and is foundational to improving outcomes, especially in severe cases. Diagnostic testing should support rapid decision-making: nucleic acid amplification test (NAAT) is conditionally recommended for confirmation of suspected disease in severely unwell patients, while either NAAT or digital immunoassay may be used for non-severe cases, depending on context and resource availability. Testing should be performed early with the aim of identifying people in need of treatment and linking them to care, including antivirals where indicated. Patients at high risk of progressing to severe disease are likely to benefit from antiviral to reduce their chance of admission to hospital. High-risk groups include adults &ge;65 years, those with immunocompromising conditions, chronic cardiovascular, neurological or respiratory disease; malignancy, pregnancy and diabetes further elevate risk. Individuals &ge;85 years or those with multiple risk factors are considered extremely high risk and might be considered for antiviral prophylaxis if exposed to influenza. Infection prevention and control measures in health-care settings Seasonal influenza is known to cause health care-associated infection outbreaks, in particular in long-term care facilities. WHO advises the use of syndromic screening at all entry points to health-care settings and as part of daily inpatient assessment to ensure that patients with suspected or confirmed infections that are transmissible in health-care settings, including influenza, are identified as soon as possible and that appropriate transmission-based precautions are implemented. WHO advises the use of droplet precautions when caring for patients with suspected or confirmed influenza. This includes appropriate patient placement (isolation) of suspected or confirmed cases, and the use of a medical mask by all health and care workers and visitors when caring for patients with suspected or confirmed influenza. Appropriate risk assessment for additional personal protective equipment (e.g. eye protection, filtering facepiece respirators, gown, gloves) should be performed by health and care workers when caring for patients with influenza. Increased risk of influenza transmission may occur instances where care activities or patient symptoms are likely to generate splashes or sprays of blood, body fluids, secretions and excretions onto mucosa of eyes, nose or mouth; or if in close contact with a patient with respiratory symptoms (e.g. coughing/sneezing) and sprays of secretions may reach the mucosa of eyes, nose or mouth directly, or indirectly via contaminated hands. When performing an aerosol-generating procedure on patients with suspected or confirmed influenza, patient placement in an airborne infection isolation room as well as airborne and contact precautions with eye protection are advised. Vaccination Vaccination is the best way to prevent influenza disease. Safe and effective vaccines have been used for more than 60 years. Influenza viruses are constantly changing, so the composition of the seasonal influenza vaccine is regularly updated to contain viruses that are more related to those circulating. WHO, through the Global Influenza Programme and GISRS, in collaboration with partners, continuously monitors influenza viruses and activity globally and recommends seasonal influenza vaccine compositions in February and September for the following northern and southern hemisphere influenza seasons, respectively. WHO recommends annual vaccination for high-risk groups, including health and care workers. People should ideally get vaccinated just before the influenza season begins for the most effective coverage, although getting vaccinated at any time during the influenza season can still help prevent flu infections. While the effectiveness of the vaccine may vary across seasons and risk groups, it reduces disease severity and lowers the chance of complications and death. Vaccination is especially important for people at high risk of influenza complications and their caregivers. Genetic changes or drift can occur in the circulating influenza viruses before or during the influenza season, including during the time between vaccine strain selection and the influenza season. Even if there are some genetic differences between the circulating influenza viruses and the strains that are included in the vaccines, the seasonal influenza vaccine may still provide protection against drifted viruses. Current vaccines include three influenza viruses: influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B/Victoria lineage viruses. Therefore, circulation of a drifted virus does not always result in seasonal influenza vaccines being less effective in offering protection against influenza associated illness. As of now, it remains unclear how the vaccine will protect against clinical disease during this current season. However, early vaccine effectiveness estimates show the current vaccine is 70 to 75% effective at preventing hospital attendance in children aged 2 to 17 years and 30 to 40% effective in adults. [1] ,[2] Public health and social measures in the community The implementation of appropriate and proportionate public health and social measures (PHSM) is an essential component in the overall response to seasonal influenza epidemics. Measures such as performing hand hygiene, respiratory hygiene and cough etiquette as well as voluntary self-isolation and mask wearing of individuals who are symptomatic or have tested positive for influenza viruses can reduce transmission of influenza viruses. Countries should consider developing a plan to scale up additional PHSM in the event of high or extraordinarily high epidemics. Risk communication and community engagement Member States should consider to update and strengthen their risk communication and community engagement (RCCE) strategy integrating respiratory viruses. Enhanced risk communication and community engagement approach support empowerment of individuals to make informed decisions, countering misinformation, and community-led protection strategies. Clear, regular, evidence-based, culturally acceptable and context adapted RCCE approaches are essential for building and maintaining trust with the concerned and affected populations to ensure adoption of interventions, practices and behaviours. For RCCE efforts to be successful, it is vital that national policies for RCCE incorporate community engagement and feedback mechanisms that acknowledge and address contextual challenges faced by different population groups, particularly those made most vulnerable. The integration of RCCE approaches to promote vaccination against influenza is also recommended. WHO does not recommend any restriction on travel to or trade with the countries named in this report, based on the information available on the current event.","publishedAt":"2025-12-10T19:00:00.000Z","lastModified":"2025-12-10T19:55:04.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON586","response":"WHO is enhancing national, regional, and global capacities for influenza preparedness and response, including: continuous global monitoring of influenza viruses and disease activity; issuing seasonal influenza vaccine composition recommendations for both hemispheres; providing technical guidance to Member States on vaccine selection and campaign timing; supporting countries in developing prevention and control strategies; enhancing diagnostic capabilities and laboratory networks; monitoring vaccine effectiveness and susceptibility to approved antivirals; supporting disease surveillance and outbreak response activities; promoting increased vaccine coverage among high-risk groups; facilitating research and development of new therapeutics and countermeasures; and enhancing risk communication for the onset of the influenza season.","epidemiology":"Seasonal influenza (the flu) is an acute respiratory infection caused by influenza viruses that circulate globally and year-round. In temperate regions, seasonal influenza typically peaks during the winter months, whereas in tropical areas, influenza viruses can circulate year-round with seasonality and intensity that varies across countries. There are four types of influenza viruses, types A, B, C and D. Influenza A and B viruses circulate and cause seasonal epidemics of disease: Influenza A viruses are further classified into subtypes according to the combinations of the proteins on the surface of the virus. Currently circulating in humans are subtype A(H1N1) and A(H3N2) influenza viruses. Influenza B viruses are not classified into subtypes but can be broken down into lineages. Influenza type B viruses belong to either B/Yamagata or B/Victoria lineage. Influenza spreads easily between people when they cough or sneeze. Influenza disease can cause illness ranging from mild to severe, sometimes resulting in hospitalization or death. While most individuals recover within a week without need for medical care, influenza can lead to serious complication including death, especially among high-risk groups such as young children, the elderly, pregnant women and those with underlying conditions. Health and care workers are at high risk of acquiring influenza virus infection due to increased exposure to the patients, and of further spreading particularly to vulnerable individuals.","formattedDate":"2025-12-10T19:54:36Z","matchedSignals":["cross-border signal","novel or unusual signal","severity signal","WHO high-risk wording","response escalation"]}},{"id":"2025-DON587","title":"Broader transmission of mpox due to clade Ib MPXV – Global situation","disease":"Broader transmission of mpox due to clade Ib MPXV","locations":["Global situation"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON587","summary":"The purpose of this report is to raise awareness about the local transmission of clade Ib monkeypox virus (MPXV) among men who have sex with men (MSM) in countries previously unaffected or to date reporting only cases linked to travel. This report summarizes recent epidemiological developments, response activities, and the associated global public health risk. The second declaration of a public health emergency of international concern (PHEIC) for mpox was lifted on 5 September 2025. As both MPXV clades I and II and their subclades continue to circulate globally, leading to substantial outbreaks in African countries, WHO continues to advise emergency preparedness and response activities. Multiple modes of transmission underlie ongoing virus circulation, with sexual contact remaining the primary amplifier of transmission in most settings. Since 5 September 2025, several countries across four of six WHO regions have confirmed clade Ib MPXV infection in individuals with no recent travel reported (WHO African Region, Region of the Americas, the European Region and the Western Pacific Region), most of which are being detected among men who have sex with men, suggesting local transmission, particularly given that infections often manifest with few or no symptoms (paucisymptomatic or asymptomatic cases) leading to undetected onward transmission. Overall, the surveillance data in most countries is sufficient to detect and respond effectively to mpox outbreaks. However, thorough epidemiological investigation, contact tracing and implementation of public health interventions to control spread remain challenging. Mpox is known to resolve on its own over two to four weeks in most cases. However, timely access to quality healthcare is essential to identify, prevent and manage secondary bacterial infections and other complications. Individuals living with immune suppressive conditions remain at high risk of more severe mpox disease and death, most notably people living with undetected and/or untreated, uncontrolled human immunodeficiency virus (HIV) infection. Men who have sex with men with new and/or multiple partners remain at increased risk of clade Ib and also IIb MPXV infection. WHO assesses the public health risk posed by clade Ib MPXV to men who have sex with men as moderate and the risk to the general population as low in most countries.","overview":"Since the lifting of the second PHEIC for mpox on 5 September 2025, and as of 24 November 2025, 43 new confirmed cases of clade Ib MPXV have been reported across six WHO regions outside areas where sustained community transmission of this virus strain has been occurring. In four of these regions (Region of the Americas, South-East Asia Region, European Region and the Western Pacific Region), 24 cases had reported no recent international travel, suggesting local transmission. Based on this, Italy, Malaysia, the Netherlands, Portugal, Spain, and the United States of America are now considered to be experiencing community transmission of clade Ib MPXV. In addition, travel-related cases continue to be reported in many countries. Among the 43 cases, half (22) were documented among men who have sex with men, while other cases were linked to travel to countries with known community transmission of clade Ib, or secondary to travel-related cases (household contacts and/or sexual partners). This report provides an overview of these recent cases of mpox confirmed to be due to clade Ib MPXV, by WHO region and country, summarizing key available epidemiological information, followed by WHO&rsquo;s rapid risk assessment and public health advice. Summary of reported mpox due to clade Ib MPXV in WHO Regions and countries from 5 September to 24 November 2025 WHO African Region Since the lifting of the PHEIC on 5 September 2025 and as of 24 November 2025, one country, Namibia, has reported clade Ib MPXV cases for the first time. Community transmission persists in Burundi, the Democratic Republic of the Congo, Kenya, Malawi, Mozambique, Republic of Congo, Rwanda, South Africa, the United Republic of Tanzania, Uganda, and Zambia. Namibia Namibia notified WHO of one probable and two confirmed cases of mpox due to clade Ib MPXV. The index (probable) case linked to travel within the African Region and the two confirmed cases were his household contacts. No further cases have been reported following detection of this cluster. These are the first cases of mpox reported in the country. WHO Region of the Americas Two countries in the WHO Americas Region have reported a total of four confirmed cases of mpox due to clade Ib MPXV. One case detected in Canada had recently travelled, while three cases in the United States of America had no recent travel history or known epidemiological links to travellers. Canada Canada notified WHO of one confirmed mpox case due to clade Ib MPXV in an adult male with recent travel outside of the country and reporting no sexual partners after returning to Canada. The case received counselling on preventing further transmission. United States of America The United States of America reported three unrelated cases of mpox due to clade Ib MPXV in Long Beach (one case) and Los Angeles (two cases) counties, California. All three occurred among men who have sex with men, none of whom had a history of recent international travel or known exposure to mpox cases. None of the individuals had a previous MPXV infection or prior orthopoxvirus vaccination, and one case was immunocompromised. All three individuals were hospitalized, received standard medical care, and have fully recovered. Prior to the lifting of the PHEIC, the United States of America had reported six cases of mpox due to clade Ib MPXV, all linked to travel. Public health authorities conducted contact tracing among household, healthcare-facility and social contacts. No additional cases of mpox due to clade Ib MPXV have been detected to date. Public health investigations suggest ongoing community transmission of clade Ib MPXV among men who have sex with men and their social networks in southern California. Viral genomic sequencing data indicate that the three California cases may be linked to a previously reported case in the country in August 2025. WHO South-East Asia Region From 5 September to 24 November 2025, five cases of mpox due to clade Ib MPXV have been reported in the WHO South-East Asia Region, all in Thailand. All cases had a recent history of international travel and three self-identified as men who have sex with men. Thailand Thailand notified WHO of five new cases of mpox cases due to clade Ib MPXV. The cases included four males, three of whom self-identified as men who have sex with men, and one female. Travel histories indicate associations with recent travel to the United Arab Emirates, Oman, and the Russian Federation, where exposure to infection is likely to have occurred. Prior to 5 September, Thailand had reported five cases of mpox due to clade Ib MPXV, all of which were associated with international travel. WHO Eastern Mediterranean Region Three countries in the WHO Eastern Mediterranean Region, Egypt, Lebanon and Qatar have reported six cases of mpox. Although the clade was not documented in Egypt and Lebanon, two cases attributed to clade Ib MPXV were reported in Qatar. Qatar Qatar notified WHO of two cases of mpox due to clade Ib MPXV. One adult male and one adult female, linked to travel within the Eastern Mediterranean Region. Prior to this period, Qatar had reported three cases of mpox due to clade Ib MPXV, all of which were associated with international travel. WHO European Region Countries in the WHO European Region have reported a total of 27 mpox cases due to clade Ib MPXV. Of these, 18 cases were classified as autochthonous, with no relevant history of recent international travel, suggesting undetected community transmission (Italy, the Netherlands, Portugal, and Spain). Two cases (reported from Belgium and the United Kingdom) were related to travel within Europe and five cases to travel outside of Europe (East Africa, Uganda, United Arab Emirates), either to or from countries experiencing community transmission of clade Ib MPXV but also to or from countries where no community transmission has been reported, including Angola, the United Arab Emirates, and Viet Nam. Furthermore, at least 15 of the 27 cases, and 14 of the 18 locally acquired cases occurred among individuals who self-identified as men who have sex with men. Belgium Belgium reported to WHO one case of mpox due to clade Ib MPXV with recent travel to the Netherlands. This individual reported having had multiple sexual contacts with other men while in the Netherlands. Prior to 5 September, Belgium had reported six mpox cases caused by clade Ib MPXV, all linked to travel. France France notified WHO of one case of mpox due to clade Ib MPXV in an adult male traveller who had returned from East Africa. Prior to this period, France had reported three cases of mpox due to clade Ib MPXV, all linked to travel. Germany Germany notified WHO of three cases of mpox due to clade Ib MPXV. All three cases had a recent history of international travel: one, an adult male who had travelled to Angola, another an adult female who had travelled to Uganda, and the third, an adult male who had travelled to Viet Nam. Uganda has community transmission of clade Ib and Viet Nam has not previously reported cases of this subclade. Prior to 5 September, Germany had reported 12 mpox cases due to clade Ib MPXV, most of which were linked to travel. Greece Greece notified WHO of its first case of mpox due to clade Ib MPXV, in an adult male with a recent history of travel to the United Arab Emirates before arriving in Greece. Ireland Ireland reported two cases linked to a small cluster which was reported before 5 September 2025. The index case had history of recent travel outside Europe. The first locally acquired case was a child (<5 years) who contracted clade Ib MPXV through household transmission, and the second a healthcare worker who had cared for one of the earlier cluster cases. No additional cases have been identified following this localized clade Ib cluster. Prior to this period, Ireland had reported one confirmed case of mpox due to clade Ib MPXV, which was linked to a traveller who was a probable case and part of that same cluster. Italy Italy notified WHO of two cases of mpox due to clade Ib MPXV in adult males who had no history of recent international travel or known contact with mpox cases. There was no epidemiological link between these cases. Epidemiological investigations and contact tracing were conducted, and no additional cases were identified. The identification of these cases of mpox due to clade Ib MPXV in Italy, without any links to travel, suggests local community transmission of clade Ib MPXV in the country. Prior to this period, Italy had reported one case of mpox due to clade Ib MPXV, linked to travel the United Republic of Tanzania. The Netherlands The Netherlands has reported nine cases of mpox due to clade Ib MPXV, all without relevant history of recent travel. These are the first such cases of mpox reported in the country. Eight cases were reported among individuals who identify as men who have sex with men. Of these, six individuals reported visiting the same highly frequented sex-on-premises venue. These cases suggest local community transmission of clade Ib MPXV in the country. Prior to the 5 September, the Netherlands had not reported any cases of mpox due to clade Ib MPXV. Portugal Portugal notified WHO of its first confirmed case of mpox case due to clade Ib MPXV. The case is an adult male with no history of recent international travel, with an inconsistent exposure context, and no known link to a case. There were no identified contacts, and the case was provided with guidance on home isolation, suspension of all sexual contact, and adherence to hygiene measures until full lesion resolution. Subsequently, the case ceased communication with health authorities. In Portugal, outbreak prevention and control measures are still ongoing at national and subnational levels. Reinforcement of clinical, laboratory and epidemiological detection, as well as engagement with civil society and the most at-risk communities promoting vaccination, has been in place. No further cases of mpox due to clade Ib have been detected in Portugal. The identification of this case of mpox due to clade Ib MPXV in Portugal, without any link to travel, and although no other cases have been detected, suggests local community transmission of clade Ib MPXV in the country. Spain Spain reported six cases of mpox due to clade Ib MPXV in individuals with no recent history of international travel or known contact with mpox cases. Two additional I MPXV cases were reported without further subclade information. These are the first cases of mpox due to clade Ib MPXV reported in the country. All cases were among individuals who identify as men who have sex with men. The identification of cases of mpox due to clade Ib MPXV in Spain, without any link to travel, suggests local community transmission of clade Ib MPXV in the country. The United Kingdom of Great Britain and Northern Ireland The United Kingdom notified WHO of one case of mpox due to clade Ib MPXV with travel history within Europe. This patient was a man who reported having sex with other men. Prior to this case, the United Kingdom had reported 18 clade Ib cases, most of whom reported direct or indirect links to travel to countries where clade Ib MPXV is circulating. WHO Western Pacific Region From 5 September to 24 November 2025, three cases of mpox due to clade Ib MPXV have been reported in the WHO Western Pacific Region: one each in Australia, Japan, and Malaysia. Australia Australia notified WHO of one case of mpox due to clade Ib MPXV in an adult male who reported recent travel to China and to the Philippines, where he was most likely infected. The Philippines have not reported any cases of mpox due to clade Ib MPXV. Prior to 5 September, three cases of mpox due to clade Ib MPXV, all linked to travel, had been reported in Australia. Japan Japan notified WHO of its first case of mpox due to clade Ib MPXV in adult female who reported recent travel to Africa, where she was most likely exposed to the virus. Malaysia Malaysia notified WHO of its first case of mpox due to clade Ib MPXV in an adult male, who self-identified as a man who has sex with men. He had no history of recent international travel nor any link to a known case. The person reported sexual contact with at least one individual during the three weeks prior to symptom onset. Contact tracing identified 15 household and healthcare contacts who underwent monitoring and no additional cases followed. The identification of this case of mpox due to clade Ib MPXV in Malaysia, without any link to travel, suggests local transmission of clade Ib MPXV in the country. Table 1. Summary of mpox due to clade Ib MPXV, by country, 5 September to 24 November 2025. *One additional case is not yet confirmed; therefore, it is not included in the table. **Two additional cases of mpox due to clade I MPXV among MSM, with no recent travel, did not have subclade information available","assessment":"In light of the epidemiological developments presented above and confirmation of community transmission of clade Ib MPXV in all WHO regions, WHO assesses the public health risk posed by clade Ib MPXV as moderate for men who have sex with men with new and/or multiple partners, and the risk to the general population as low. The rationale for this assessment is outlined below. When timely and good quality care is available, mpox generally causes a mild to moderate disease characterized by systemic symptoms and localized skin and/or mucosal lesions. However, secondary bacterial infections and other complications can lead to severe illness and death. In most settings, the proportion of cases where death occurs (case fatality ratio) is below 1%. Risk factors for severe disease and death include immunosuppression from any cause, such as uncontrolled HIV, younger age (0-4 years) and pregnancy. In recent years, people living with untreated or uncontrolled HIV have experienced the highest burden of mpox-related mortality. In African countries, deaths have also occurred among young children, pregnant women and their unborn or newborn infants, and individuals with other immunocompromising conditions. WHO has twice declared a PHEIC for mpox in recent years. The first, in 2022, was linked to a multi-country outbreak of clade IIb MPXV spreading through sexual networks across all regions of the world, primarily among men who have sex with men who have more than one partner. Transmission beyond this group during the global outbreak remained very limited, and was brought under control in the second half of 2023, with low-level sporadic transmission persisting in the same population, likely due to mild, undetected or subclinical transmission through sexual contact. The second PHEIC for mpox was declared in 2024 due to the rising number of mpox cases reported in Africa and the spread of the newly identified clade Ib MPXV across several African countries, most of which were affected by mpox for the first time and noted both sexual and non-sexual contact transmission. These outbreaks have led to sustained community transmission of this strain in several countries primarily in Central and East Africa. In many settings, transmission was initially driven by heterosexual contact among people with multiple casual sexual partners in linked sexual networks which included but were not limited to sex workers, followed by secondary spread within households. In most of these settings, virus circulation persists through both recognized and cryptic (undetected or unreported) transmission. The locally acquired cases of mpox due to clade Ib MPXV described above in individuals in multiple countries and WHO regions suggest that undetected transmission of this subclade is occurring independently in these settings. This transmission is likely accelerated due to some infections with no or minimal symptoms (asymptomatic or paucisymptomatic cases), leading to further onward transmission, predominantly through sexual contact. This hypothesis is supported by the rising proportion of clade Ib MPXV cases among men who have sex with men. It is likely that clade Ib MPXV will continue to spread, and that community transmission will become established in more countries, primarily mediated by sexual contact in extended sexual networks. Men who have sex with men, particularly those with a high number of casual sexual contacts, remain at increased risk of mpox, including clade Ib MPXV infection. Currently, immunity to mpox in this population is a result of vaccination efforts since 2022 in some countries and immunity conferred by exposure to mpox during the clade IIb MPXV outbreak. However, many countries were not able to offer mpox vaccination, access was constrained in some countries where vaccine was available, and many individuals received an incomplete course of vaccination. In addition, since the peak of vaccination activities in late 2022, new cohorts of young individuals have entered the sexually active population. These individuals are more likely to be immunologically na&iuml;ve having neither had previous infection nor been reached by vaccination activities. Furthermore, available data on vaccine effectiveness, uncertainty around the duration of protection against mpox following vaccination or prior infection, uncertainty regarding cross-clade protection of prior immunity during outbreaks with ongoing virus strain evolution, together with emerging data on waning humoral immunity over time, all limit confidence that those vaccinated or infected in 2022 and 2023 continue to retain protective immunity. Furthermore, of all cases reported by the countries noted here from 5 September to 24 November, only half were among men who have sex with men, suggesting continuing risk in other groups. All cases reported here are clinically stable and in isolation or recovered from the disease. The known contacts for most of them were followed up for 21 days to ensure early recognition of symptoms and diagnosis. The clinical risk for these cases and their contacts is low, notably if they have been vaccinated and are not immunocompromised. Data from the global outbreak related to clade IIb, and the multiple importations of clade Ib MPXV in the last year, suggests that transmission of mpox outside sexual networks has been relatively limited in most high-income settings. In this context, the risk of community transmission of mpox across different population groups is still considered to be low. However, given the large outbreaks and extensive community transmission of clade Ib MPXV in Africa affecting different populations, including children, together with associated outbreaks in many countries, it remains critical to maintain vigilance in all regions, and most notably for population groups at higher risk of sexual transmission. While affected countries have developed the capacity to detect and respond effectively to mpox outbreaks, in-depth epidemiological investigation and contact tracing remain challenging. Individuals with mpox are often reluctant to disclose their exposure history or current sexual contacts, which hinders full mapping of transmission chains and raises the likelihood of undetected onward spread. Prompt isolation of cases, identification and monitoring of reported contacts, and timely administration of post‑exposure vaccination to at-risk contacts, ideally within four days of exposure, all help to reduce the immediate risk of secondary cases. However, given that sexual transmission of clade Ib is now occurring in many countries, the risk is high that clade Ib MPXV will continue to spread in newly affected countries and to other countries around the world. In light of these recent developments, WHO assesses the public health risk posed by clade Ib MPXV for men who have sex with men with new and/or multiple partners as moderate and to the general population as low. The risk for men is justified by the higher risk of exposure in this population, and the prevalence of advanced HIV infection in this group in many contexts compared to the general population. The higher risk is mitigated by residual protective benefit of previous natural infection and/or prophylactic vaccination in this group in some areas. The extent to which immunity in the group could indirectly benefit younger individuals or those not previously vaccinated or exposed is not known and will continue to diminish over time if access to vaccines is not sustained. All mpox outbreaks, including individual locally acquired cases, should be assessed in their local context to better understand the epidemiology, transmission patterns, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control. Regardless of geographic area, epidemiological context, gender identity or sexual behaviour, an individual&rsquo;s risk largely depends on factors such as exposure risk and immune status.","advice":"Community transmission of clade Ib MPXV is occurring in many countries within and beyond Africa. WHO strongly advises that countries continue to follow the Standing Recommendations issued in 2023 and extended through 20 August 2026, particularly concerning the epidemiological surveillance of mpox and the strengthening of laboratory diagnostic capacities in line with WHO guidance, together with all other elements of response including risk communication and community engagement and ensuring access to mpox vaccine for people at risk. Countries must have, or arrange access to, diagnostic capacities to detect both MPXV clades and subclades. Public health authorities are strongly encouraged to ensure access to genomic sequencing capacity for virus clade identification for new cases and clusters of cases as part of comprehensive prevention and response measures. The WHO Strategic framework for enhancing prevention and control of mpox (2024&ndash;2027) outlines a road map to prevent and control outbreaks characterized by human-to-human transmission in every context, advance mpox research and access to countermeasures, and minimize zoonotic transmission where relevant in some African countries. Countries and communities are strongly encouraged to enhance preparedness, foster community ownership, widen access to vaccination for people at risk, and ensure cross-border coordination, especially in regions with mobile and vulnerable populations. In terms of risk communication, community engagement and infodemic management (RCCE-IM), countries are encouraged to: continue to engage closely with communities who may be at risk, such as men who have sex with men, sex workers and other groups at risk, to promote uptake of protective measures; expand outreach to include diaspora populations from and travellers to countries where mpox is currently circulating, including public health advice at points of entry; ensure that all communication and interventions are delivered in a stigma-free, respectful and inclusive manner, avoiding messaging that reinforces negative stereotypes or discrimination. Mpox vaccines formulated with vaccinia virus provide protection against mpox. WHO recommends vaccination against mpox in the context of an outbreak for people most at risk of exposure to mpox and for preventive use for laboratory personnel working with orthopoxviruses, in line with recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and the WHO position paper on mpox vaccines. Two vaccines currently in use for mpox are recommended. MVA-BN (non-replicating vaccine) has been prequalified by WHO and broadly used in outbreak response and LC16m8 (minimally replicating vaccine) has received a WHO emergency use listing (EUL) and is used in Japan and the DRC and has also been used in Colombia. LC16 is contraindicated for use in pregnancy, immunocompromised individuals, and those suffering from a proliferative skin condition. WHO recommends a vaccination for people at risk or where relevant in geographic areas at risk to interrupt transmission. National authorities are encouraged, as a temporary outbreak response measure, to administer MVA-BN vaccine via intradermal injection at one fifth of the dose normally administered subcutaneously (also known as fractional dosing) to protect individuals at risk of exposure and facilitate reaching four to five times as many people. Intradermal vaccination with MVA-BN has been shown to be effective and safe. Anyone with a clinical or laboratory-confirmed diagnosis of mpox should follow the instructions of local health authorities, including isolation in a health facility or at home for the duration of the infectious period. Persons with mpox should avoid travel, including local and international travel, unless the reason for travel is to seek medical care, until they do not present any mpox symptoms and the scabs have fallen off and a fresh layer of skin has formed underneath. Contacts of a confirmed case are asked to limit their movements (and to abstain from sexual relations) for 21 days, the maximum incubation and monitoring period for the appearance of possible symptoms. WHO strongly recommends implementation of optimized clinical care for patients with mpox, to reduce the risk of medical complications and long-term sequelae and improve health outcomes. Mpox disproportionally affects people living with HIV, with a higher risk of severe disease, hospitalization or death in people with advanced HIV disease. WHO strongly recommends early HIV testing for all patients with suspected or confirmed mpox and rapid initiation of antiretroviral therapy (ART) in people living with untreated HIV who are diagnosed with mpox. Health authorities at all levels should provide travellers with information to protect themselves and others before, during and after travel to mpox-affected countries or attending events or gatherings where mpox may present a risk. WHO does not recommend any restriction on travel to or trade with the countries named in this report. For additional information on WHO public health advice to reduce the risk of mpox please see the resources listed below in the further information section.","publishedAt":"2025-12-05T19:00:00.000Z","lastModified":"2025-12-07T11:20:03.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON587","response":"WHO maintains global mpox surveillance and continues to provide response guidance for all countries and support to access diagnostics and vaccines through multi-partner coordination. WHO and partners have established the International Coordinating Group for mpox vaccine provision (ICG) to further accelerate timely outbreak response and ensure sustainable support for the future. Furthermore, WHO continues to evaluate available rapid diagnostic tests for field use. Public health response measures taken in the affected WHO Regions include: WHO African Region A continental mpox response is ongoing in the region, including all main response pillars . Surveillance activities continue, and most countries have mpox diagnostic capacity in place Sixteen countries have received mpox vaccines and are vaccinating people at risk to contain the outbreaks. WHO Region of the Americas WHO supports Member States with surveillance, preparedness, and outbreak response in activities for mpox in affected countries. WHO provides information through situation reports and the mpox dashboard. Vaccines remain available to countries through the PAHO Revolving Fund. The response is focused on communication and engagement of at-risk communities, timely detection of cases and treatment of patients, laboratory confirmation, surveillance, and containment of transmission chains, securing access to critical health supplies and protection of health workers. WHO South-East Asia Region WHO provides weekly briefings and technical guidance to Member States to enhance preparedness, including laboratory diagnostics and access to medical countermeasures (MCM). Access to MCM is facilitated through allocation and supply chain coordination for diagnostics and support to regulatory preparedness through a regional regulatory network. WHO provides guidance on clinical management and infection prevention and control to strengthen capacity for safe and scalable care. A collaborative surveillance mechanism for early detection and reporting includes coordination between HIV/STI and emergency programmes. Support includes genomic sequencing, reagent supply, training, and bioinformatics to improve regional capacity. Community protection and communication strategies are being scaled up, with targeted outreach to high-risk groups, social listening, rumour tracking, and regional adaptation of messaging, alongside efforts to improve genomic sequencing capacity and regulatory preparedness for diagnostics. WHO Eastern Mediterranean Region WHO continues to support coordination, reporting, and information sharing between countries through the IHR mechanism. WHO continues advocating with national stakeholders to integrate mpox prevention and care in routine STI services. WHO supports countries to access mpox diagnostics services through facilitating procurement and distribution of kits. WHO works closely with national health authorities to strengthen surveillance and ensure inclusion of mpox in lists of diseases for routine surveillance. WHO European Region WHO and the European Centre for Disease Prevention and Control (ECDC) have asked all Member States to report mpox due to clade I MPXV through official International Health Regulations (IHR) and/or surveillance mechanisms. WHO has conducted modelling to better understand drivers of mpox transmission in the region. ECDC published a threat assessment brief following the detection of local transmission of clade Ib MPXV in the EU/EEA. A Risk Communication, Community Engagement, and Infodemic Management package for health workers and travel advice has been shared with Member States through IHR focal points. Questions and answers documents on mpox have been updated. WHO and ECDC are planning a community briefing on the situation to understand community perceptions. WHO Western Pacific Region Following notification of a locally acquired case due to clade Ib in the Region, and exportation of clade Ib from the Region, WHO has been working with national authorities on epidemiological investigation, contact follow-up up and assessment of potential transmission settings and continues to monitor for additional cases and offer cross-border support. WHO continues to support countries with surveillance, preparedness, and investigation of suspected mpox events, including rapid risk assessments, technical advice on case management and IPC, and verification of event information through IHR channels. WHO provides targeted support to strengthen diagnostic capacity, including guidance on clinical sampling, access to PCR testing for clade I and clade II MPXV, and coordination with national laboratories to increase genomic sequencing capability for clade and subclade identification. WHO is working to integrate mpox preparedness within services for HIV and sexually transmitted infections, promoting early HIV testing and prompt antiretroviral therapy (ART) initiation for any person with mpox, in line with WHO guidance for clinical care and infection prevention and control. WHO supports clinical readiness through regional webinars, technical exchanges, and Communities of Practice, enabling countries to access updated clinical management guidance, peer support, and context-specific tools for managing suspected and confirmed cases. Risk communication and community engagement activities focus on social listening, information, education and communication (IEC) material production and close collaboration with health workers and key population networks, including men who have sex with men, sex workers, and community-based organizations, to strengthen awareness of symptoms, promote early care seeking, and reduce stigma associated with mpox. WHO continues to assist countries in reviewing and strengthening national preparedness measures, including support for intra-action reviews and integration of mpox within all-hazards emergency preparedness and response frameworks.","epidemiology":"Mpox is an infectious disease caused by the MPXV, divided into two clades, clade I (including subclades Ia and Ib), and clade II (including subclades IIa and IIb. Historically associated with zoonotic transmission in tropical rainforest regions of East, Central and West Africa, mpox has in recent years predominantly spread through human-to-human transmission and has rapidly emerged across all WHO regions. Subclades Ia and Ib have been following the emergence of clade Ib in South Kivu province of the Democratic Republic of the Congo in 2023. Clade Ia is currently considered to encompass all other strains of Clade I that are not Ib. Clade IIb continues to circulate in all WHO regions since 2022. The virus is primarily transmitted through close physical contact with a person who has mpox, through sexual contact or other forms of direct skin-to-skin contact, for example from parent to child. Other documented routes include indirect contact with contaminated materials, occasionally non-physical contact such as close-range inhalation of infectious respiratory particles, and vertical transmission from mother-to-child during pregnancy or childbirth. In historically endemic areas transmission can also occur from animals to humans through contact with live animals or consumption of contaminated bushmeat. Emerging evidence indicates that exposure to MPXV can result from subclinical infection in another person and silent shedding of the virus, particularly in genital and anal secretions, which can facilitate further transmission during sexual contact. Mpox causes signs and symptoms which usually begin within 3-7 days of exposure and can start as soon as one or rarely up to 21 days later. Symptoms typically last for two to four weeks but may last longer in someone with a weakened immune system, for example as a result of advanced untreated HIV infection. Fever, muscle aches and sore throat may appear first, followed by an evolving skin rash and/or mucosal lesions, or appearance of such lesions may precede systemic symptoms. Lymphadenopathy (swollen lymph nodes) is also a typical feature of mpox, present in most cases. Transmission through sexual contact has been observed to lead to the appearance sometimes of only genital lesions. Children, pregnant women and people with weak immune systems, most commonly due to advanced HIV infection, are at risk of developing complications and dying of mpox. Laboratory testing is necessary to confirm mpox, particularly for the first cases in an outbreak or new geographic area. The primary diagnostic test for MPXV infection is polymerase chain reaction (PCR). The best diagnostic specimens are taken directly from lesion material &ndash; on skin or mucosae, such as lesion fluid or crusts &ndash; collected by vigorous swabbing. In the absence of skin or mucosal lesions, testing can be done on oropharyngeal, anal or rectal swabs. However, while a positive result of oropharyngeal, anal or rectal sample confirms mpox, a negative result is not enough to rule out MPXV infection. Testing of blood is not recommended as any viremia is usually brief and individuals can test negative just a few days after infection. Serology does not distinguish between different orthopoxviruses and is therefore restricted to reference laboratories where antibody detection methods may be applied for retrospective case classification or in special studies. Treatment is based primarily on managing clinical symptoms, ensuring skin care, eye care, reducing pain, and preventing and managing secondary bacterial infections and other complications. Where available through clinical studies or emergency access protocols, specific antiviral medications may also be used in the treatment of mpox, particularly for severe cases or individuals at higher risk of complications. Vaccines for use to prevent mpox are available to all countries. WHO recommends use of MVA-BN (non-replicating) or LC16m8 (minimally replicating) vaccine as indicated, or ACAM2000 (replicating) vaccine based on an individual risk-benefit assessment when the others are not available. In the context of an outbreak, vaccination is recommended by WHO for individuals at high risk of exposure to mpox, such as sex workers; gay, bisexual or other men who have sex with men; or other individuals with multiple sexual partners; health workers and frontline workers, contacts of known mpox cases, and other affected groups in a geographically defined area or community (based on local epidemiology).","formattedDate":"2025-12-05T17:52:36Z","matchedSignals":["PHEIC language","cross-border signal","transmission concern","severity signal","WHO high-risk wording","response escalation"]}},{"id":"2025-DON590","title":"Avian Influenza A(H5N5)- United States of America","disease":"Avian Influenza A(H5N5)- United States of America","locations":[],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON590","summary":"On 15 November 2025, WHO was notified of the 71st confirmed human case with influenza A(H5) since early 2024 in the United States of America— the first human case reported in the United States of America since February 2025. On 20 November, U.S. Centers for Disease Control and Prevention (CDC) laboratory sequencing verified the virus as influenza A(H5N5), representing the first globally reported human case caused by an influenza A(H5N5) virus. The investigation by health authorities in the United States of America is ongoing. Contact tracing identified no further cases amongst contacts, and there is currently no evidence of human-to-human transmission. Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect and monitor virological (including genomics), epidemiological and clinical changes associated with emerging or circulating influenza viruses that may affect human health and timely virus sharing for risk assessment. Based on available information, the WHO currently assesses the overall public health risk posed by A(H5) viruses as low. However, for individuals with occupational risk of exposure, the risk of infection is considered low to moderate.","overview":"On 15 November 2025, WHO was notified of a confirmed human infection with influenza A(H5) in the United States of America&mdash;the first reported in the country since February 2025 and the 71st since early 2024. On 20 November, CDC laboratory sequencing verified the virus as influenza A(H5N5), representing the first human case of this subtype reported globally. The patient was an adult with underlying medical conditions residing in Washington State. The patient developed symptoms including fever during the week ending 25 October 2025. During the week ending 8 November 2025, the patient was hospitalized with a serious illness and subsequently died on 21 November. Respiratory specimens collected at the healthcare facility tested positive for influenza A virus by RT-PCR and were presumptive positive for influenza A(H5) at the University of Washington. The specimens were sent to the Washington State Public Health Laboratory, where influenza A(H5) was confirmed using the CDC influenza A(H5) assay. The sample was received at the CDC on 19 November. Sequencing conducted at the University of Washington and at the CDC indicated this was an influenza A(H5N5) virus belonging to the H5 haemagglutinin (HA) clade 2.3.4.4b [1] . Public health investigation revealed that the patient kept backyard poultry and domestic birds. Additional epidemiological investigations are under way and include active monitoring of anyone who was in close contact with the patient.","assessment":"Human infections with avian influenza A(H5) viruses are considered unusual, as A(H5) viruses remain primarily avian influenza viruses. However, in rare cases, individuals exposed to infected animals or contaminated environments can become infected with A(H5) viruses. Influenza A(H5N5) viruses are detected in birds, including wild birds and domestic poultry, and sometimes in non-human mammals. When avian influenza viruses circulate in poultry populations, there is an inherent risk of human infection through exposure to infected birds or contaminated environments. As such, sporadic human cases are expected. The case had underlying conditions and subsequently died. The investigation by health authorities in the United States of America is ongoing and included contact tracing which identified no further cases amongst contacts, and there is currently no evidence of human-to-human transmission. This is the 71 st confirmed human case of A(H5) in the United States of America since early 2024, and the first since February 2025. To date, no human-to-human transmission has been identified in any of the A(H5) cases reported in the United States of America. From a global perspective, while a few events with limited human-to-human transmission of zoonotic influenza A(H5) have been described between 1997 and 2007, sustained human-to-human transmission has not been detected to date. Based on available information, the WHO currently assesses the overall public health risk posed by A(H5) viruses as low. However, for individuals with occupational risk of exposure, the risk of infection is considered low to moderate. The risk assessment will be updated as needed, based on any new epidemiological or virological information related to this event.","advice":"This event does not change the current WHO recommendations on public health measures and surveillance of influenza. Given the current situation of influenza viruses at the human-animal-environmental interface, WHO does not recommend special traveler screening at points of entry or any restrictions. Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect and monitor virological (including genomics), epidemiological and clinical changes associated with emerging or circulating influenza viruses that may affect human health and timely virus sharing for risk assessment. When humans have been exposed to an influenza A virus outbreak in domestic poultry, wild birds, or other animals or when a human case of infection is identified, enhanced surveillance of potentially exposed human populations becomes necessary. This surveillance should consider the healthcare-seeking behaviour of the population and may include a range of active and passive approaches, such as enhanced surveillance in influenza-like illness (ILI)/severe acute respiratory infection (SARI) systems, active screening in hospitals, and among groups at higher occupational risk of exposure. It should also consider other sources, such as traditional healers, private practitioners, and private diagnostic laboratories. Given the observed widespread occurrence of avian influenza in poultry, wild birds and some wild and domestic mammals, the public should avoid contact with any sick or dead animals. Individuals should report deceased birds and mammals or request their removal by contacting local wildlife or veterinary authorities. Eggs, poultry meat, and other poultry products should be properly cooked and handled during food preparation. Due to potential health risks, consumption of raw milk should be avoided. WHO advises consuming pasteurized milk and if pasteurized milk is not available, heating raw milk until it boils makes it safer for consumption. In the case of a confirmed or suspected human infection caused by a novel influenza A virus with pandemic potential, including avian influenza viruses, early clinical management, a thorough epidemiologic investigation of animal exposure history, travel, and contact tracing should be conducted even while awaiting the confirmatory laboratory results. The epidemiologic investigation should also include early identification of unusual events that could signal person-to-person transmission of the novel virus. Clinical samples collected from confirmed or suspected cases should be tested and sent to a WHO Collaborating Center [3] for further characterization. Additional samples should be collected from animals, the environment or any foods suspected to be sources of infection. WHO advises travelers to countries with known animal influenza outbreaks to avoid farms, live animal markets, areas where animals may be slaughtered and contact with any surfaces potentially contaminated by animal feces. Travelers should also wash their hands frequently with soap and water and should follow good food safety and good food hygiene practices. If infected individuals from affected areas travel internationally, their infection may be detected either during travel or upon arrival. However, further community level spread is considered unlikely, as this virus has not yet acquired the ability to transmit easily among humans. Poultry workers should take additional health precautions as they are at higher risk of exposure to avian influenza and other zoonotic diseases due to their close contact with birds and potentially contaminated environments. Farm workers who have direct or close contact with animals or materials infected or contaminated with avian influenza A(H5) virus, should wear appropriate personal protective equipment (PPE) to minimize their risk of exposure. All human infections caused by a novel influenza A virus subtype are notifiable under the International Health Regulations (IHR,2005) and State Parties to the IHR are required to immediately notify WHO within 24 hours of any laboratory-confirmed case of a recent human infection caused by an influenza A virus due to the potential to cause a pandemic. Evidence of illness is not required for this report. WHO has updated the influenza A(H5) confirmed case definition on the WHO website . Currently, there are no readily available vaccines against influenza A(H5) virus for humans. Candidate vaccine viruses for pandemic preparedness have been selected against several A(H5) clades. Existing seasonal influenza vaccines are unlikely to provide protection to against avian influenza A(H5) viruses, based on currently available data. Close monitoring of the epidemiological situation and serological investigations are essential for assessing risk and adjusting risk management measures as needed.. WHO does not recommend any restriction on travel to or trade with the United States of America, based on the information available on the current event.","publishedAt":"2025-12-05T16:36:27.000Z","lastModified":"2025-12-05T17:06:44.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON590","response":"The CDC and State public health officials have initiated several public health response measures: Public health officials are conducting surveillance in the area, that included additional case investigations and contact tracing. Since March 2024, at least 30,100 people have been monitored, and at least 1260 have been tested after exposure to infected animals in the USA. The CDC conducts enhanced routine surveillance to detect and monitor influenza activity, including infections caused by novel influenza viruses such as avian influenza A(H5). The CDC recommends that state and local public health departments monitor individuals exposed to birds or other animals (including livestock) suspected of being infected with avian influenza A viruses for the onset of signs and symptoms for up to 10 days after their last exposure. Individuals who develop signs or symptoms of respiratory illness and/or conjunctivitis should be tested for influenza. The CDC has issued recommendations for the public to avoid unprotected contact with sick or dead animals, including wild birds, poultry, other domestic fowl, and other wild or domestic animals, as well as animal droppings, litter, or materials contaminated by birds or other animals suspected of being infected with the influenza A(H5) virus. The CDC has interim recommendations for prevention, monitoring, and public health investigations of avian influenza A(H5) virus infections in people. The CDC has also updated recommendations for occupational protection and the use of personal protective equipment (PPE).","epidemiology":"Animal influenza viruses typically circulate within animal populations, but some have the potential to infect humans. Human infections are predominantly acquired through direct contact with infected animals or exposure to contaminated environments. Based on the original host species, influenza A viruses can be categorized such as avian influenza, swine influenza, and other animal-origin influenza subtypes. Human infection with avian influenza viruses may result in a spectrum of illness, ranging from mild upper respiratory tract symptoms to severe, life-threatening conditions. Clinical manifestations may include conjunctivitis, respiratory, gastrointestinal symptoms, encephalitis (brain swelling), and encephalopathy (brain damage). In some cases, asymptomatic infections with the virus have been reported in individuals with known exposure to infected animals and environments. A definitive diagnosis of human avian influenza infection requires laboratory confirmation. WHO regularly updates its technical guidance on the detection of zoonotic influenza, utilizing molecular diagnostic methods such as RT-PCR. Clinical evidence indicates that certain antiviral agents, particularly neuraminidase inhibitors (e.g., oseltamivir, zanamivir), have been shown to shorten the duration of viral replication and improve patient outcomes in some cases. This antiviral agent should be administered within 48 hours of symptom onset. High pathogenicity avian influenza A(H5) clade 2.3.4.4b A(H5N5) viruses have been detected in North America in wild birds and wild mammals since at least 2023. [2] This is the first laboratory-confirmed human infection with an influenza A(H5N5) virus in the United States of America and reported globally.","formattedDate":"2025-12-05T17:06:31Z","matchedSignals":["transmission concern","novel or unusual signal","severity signal","response escalation"]}},{"id":"2025-DON589","title":"Ebola virus disease – Democratic Republic of the Congo","disease":"Ebola virus disease","locations":["Democratic Republic of the Congo"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON589","summary":"On 1 December 2025, the Ministry of Health (MoH) of the Democratic Republic of the Congo (DRC) declared the end of the Ebola virus disease (EVD) outbreak which had been declared on 4 September 2025. The end was declared after two consecutive incubation periods (a total of 42 days) since the last person confirmed with EVD tested negative for the virus and was discharged on 19 October 2025. A total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), were reported from six health areas in Bulape Health Zone, Kasai Province. WHO and partners provided technical, operational and financial support to the government to contain the outbreak. This is the country’s 16th outbreak of Ebola. Although the outbreak has been declared over, health authorities are maintaining surveillance to rapidly identify and respond to any re-emergence. Risk communication and community engagement activities will continue to provide accurate information, monitor and address community feedback and rumours, and support efforts to reduce stigma toward individuals affected by the outbreak.","overview":"The EVD outbreak in the Democratic Republic of the Congo (DRC) was declared on 4 September 2025. As of 30 November 2025, a total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), have been reported from six health areas (Bambalaie, Bulape, Bulape Com, Dikolo, Ingongo and Mpianga) in Bulape Health Zone, Kasai Province. Since the last confirmed case reported on 25 September 2025, no new confirmed EVD cases have been reported. There have been five cases among health workers (four nurses and one laboratory technician), three of whom have died. The epicentres of the outbreak have been localised in Dikolo (26 cases, 15 deaths) and Bulape (24 cases, 22 deaths) health areas, which together account for 78.1% of the total cases reported and 82.2% of all deaths. The outbreak initially involved nosocomial transmission and a high-transmission funeral gathering, with high mortality among young children. As of 12 October 2025, a total of 572 contacts were followed up. On 1 December 2025, the Ministry of Health declared the end of the outbreak. This declaration came after two consecutive incubation periods (42 days) since the last person confirmed with EVD tested negative for the virus and was discharged on 19 October 2025, as per WHO recommendations. Figure 1. Map of confirmed and probable cases and deaths of Ebola virus disease, Bulape Health Zone, Kasai province, Democratic Republic of the Congo, as of 30 November 2025 Figure 2: Epidemic curve of confirmed and probable Ebola virus disease cases in Bulape Health Zone, Kasai province, Democratic Republic of the Congo, as of 30 November 2025","assessment":"The current outbreak constitutes the 16 th Ebola disease occurrence in the DRC since 1976. The last outbreak was reported from North Kivu in 2022. This outbreak occurred in difficult, hard to reach areas with limited existing infrastructure. A future outbreak is not unexpected given that EVD is endemic in the country. Ebola virus is enzootic and a resurgence from viral persistence in survivors has been described in recent epidemics. Re-emergence of EVD is a major public health concern in the Democratic Republic of the Congo; gaps remain in the country's capacity to recover, prepare for, and respond to outbreaks. The country is facing several outbreaks, including mpox, cholera, and measles. In addition, the country is experiencing a long-term economic and political crisis. The country's resources and capacity to effectively respond to the outbreak were therefore limited. The epicentre of the outbreak was in proximity with the Angolan border (approximately 100 to 200 kilometres, depending on the nearest border crossing point). Although the affected district is a hard-to-reach rural area relatively far from the two main urban centres of Mbuji Mayi and Kananga, population movements between different parts of the province are frequent, especially between Bulape and Tshikapa. The outbreak has most likely originated from a new zoonotic spillover and led to sustained human-to-human transmission. Infections and deaths among healthcare workers were reported, which raised the risk of nosocomial amplification and further spread within health facilities. The outbreak is declared over, as of 30 November 2025, with no new cases reported for 42 consecutive days.","advice":"Coordination Outbreak control requires a coordinated, multi-sectoral approach. Key interventions include clinical care, surveillance, laboratory services, IPC/WASH, safe burials, and community engagement. Collaboration with neighbouring countries is essential for joint investigations, harmonized reporting, and real-time data sharing. Maintaining collaborative relationships with survivor associations while monitoring survivors is a priority to mitigate any potential risks. Surveillance and Laboratory Surveillance must be strengthened at community level, health facilities, and points of entry/points of crossing. Suspected cases should be promptly identified, tested, and isolated. Laboratory capacity must support timely diagnosis and confirmation of cases. Contact tracing and monitoring of survivors are essential to prevent further transmission. Case Management To reduce EVD mortality, early diagnosis and initiation of supportive care are essential. WHO-recommended treatments include Inmazeb&reg; (3-antibody combination) and Ebanga&reg; (single antibody). Ebola treatment centres must ensure biosecurity, IPC, and allow direct patient observation in red zones. WHO and partners&rsquo; innovative solutions should be utilized to ensure safe and effective care delivery. Vaccination The Ervebo vaccine is recommended for ring vaccination during EVD outbreaks caused by EBOV. Target groups include contacts, potential contacts of confirmed/suspected cases, and frontline workers. Risk Communication and Community Engagement (RCCE) Enhanced RCCE interventions should be maintained where possible to ensure communities know the signs of Ebola, understand the importance of reporting symptoms quickly and remain aware of available health services. Community engagement and feedback systems should be maintained to quickly detect concerns, rumours or changes in community perceptions that could signal any emerging risk or resurgence. Work should continue to support stigma-reduction and survivor reintegration, working with local leaders, survivor groups, and health workers to promote positive narratives and prevent discrimination against returning patients and their families. Infection Prevention and Control / Water, Sanitation and Hygiene (IPC/WASH) Health workers caring for patients with confirmed or suspected Ebola should apply transmission-based precautions in addition to standard precautions, including PPE as per WHO's Infection prevention and control guideline for Ebola and Marburg disease and hand hygiene according to the WHO 5 moments . National guidelines should be followed on rules and regulations for safe waste disposal or WHO&rsquo;s guidelines on safe waste management Healthcare facilities should maintain clean environments with safe water, sanitation, and hygiene infrastructure as outlined in Essential environmental health standards in health care . Safe water, adequate sanitation and hygiene infrastructure and services should be provided in healthcare facilities. For details on recommendations and improvement, follow the WASH FIT implementation Package . Preparedness and readiness Bordering countries should enhance readiness for early detection, isolation, and treatment. Strengthen surveillance, laboratory capacity, and coordination mechanisms. Ensure healthcare facilities are equipped, and staff are trained in IPC/WASH and case management. WHO advises against any restrictions on travel and/or trade to the Democratic Republic of the Congo based on available information for the outbreak.","publishedAt":"2025-12-01T19:00:00.000Z","lastModified":"2025-12-02T08:59:30.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON589","response":"Health authorities, with support from WHO and partners, implemented public health measures, including but not limited to the following: Coordination The Ministry of Health (MoH) coordinated the outbreak response with WHO and partners, while the Incident Management Team in Bulape Health Zone oversaw field operations. A high-level national delegation led by the Minister of Health visited Kasai Province to assess response activities, reaffirm government commitment, and inaugurate a newly constructed Ebola Treatment Centre. WHO deployed 112 experts and frontline responders to support the national authorities to swiftly scale up and sustain the response. A regional strategic preparedness and response plan was developed and disseminated to guide efforts in surveillance, case management, diagnostics, vaccination, IPC, community engagement, and operational readiness. WHO launched a US$21 million appeal to scale up response operations, supported by contributions from partners. Surveillance Surveillance activities were scaled up in Bulape and nearby areas, and more than 100 alerts were investigated. Community health workers were trained to support community-based surveillance using simplified case definitions. Congolese Red Cross volunteers were engaged in reporting community deaths and supporting surveillance efforts, while mortality surveillance was initiated in health facilities Surveillance, health screening and risk communication were reinforced at points of entry and points of control, including border crossings, with sensitization of staff at points of entry to detect and manage suspected cases. Border communities were integrated into early warning systems and the national surveillance network. WHO deployed epidemiologists in Bulape and supports the 90-day heightened surveillance period following the declaration of the end of the outbreak. Laboratory MoH and partners strengthened laboratory capacities and deployed a mobile laboratory to reduce turnaround time for laboratory results. MoH performed full genome sequencing on the sample of the first confirmed case and findings indicate the outbreak was most likely the result of a spillover event from a zoonotic reservoir. Case management MoH, with support from WHO and partners, set up an Ebola treatment centre in Bulape Case management strategy was scaled up to ensure sufficient capacities to provide care for all probable and confirmed cases in all hotspots. Surge teams and partners supported clinical care. Patients received monoclonal antibody treatment. WHO experts supported case management, essential health services, and survivor program implementation. Vaccination A total of 47 577 individuals were vaccinated with the rVSV&Delta;G-ZEBOV-GP (Ervebo) Ebola vaccine in Bulape, Bulambae, and Mweka Health Zones. A ring vaccination strategy implemented, targeting contacts, potential contacts, and high-risk healthcare/frontline workers, complemented by geographic targeting in hotspots. Ultra cold chain equipment installed in Kananga, Mweka and Tshikapa to support vaccine storage and distribution. Infection prevention and control Infection prevention and control (IPC) response coordination mechanism activated, including the IPC ring around cases, which included cleaning and disinfection of sites where confirmed cases passed through. Recommendations provided to health workers, district leaders, and the public to strengthen detection of suspected cases and implement appropriate IPC measures. Supervision and support provided to Bulape General Hospital, Ebola treatment centre , and four health centres. Risk Communication and Community Engagement An integrated community engagement approach was implemented, enabling the Risk Communication and Community Engagement (RCCE) team to work alongside other response pillars to facilitate safe access to affected communities and strengthen acceptance of response activities such as community surveillance, contact tracing and vaccination. Tailored risk communication messages were developed and disseminated widely, promoting protective behaviours and timely care- seeking, while sustained and evolving engagement with religious leaders, teachers, traditional healers and other trusted influencers helped build trust and community cooperation. WHO provided technical guidance and on the ground expertise to conduct a rapid community assessment to better understand the knowledge, perceptions, experiences, needs and bottom-up solutions of local communities affected by the EVD outbreak. These findings are being used to inform appropriate and localized public health measures for community protection. Community health volunteers were trained and supported, expanding local capacity for community outreach and engagement. Operations Support and Logistics WHO and partners established a temporary airbridge to accelerate delivery of supplies and personnel to affected areas. WHO delivered over 150 tonnes of medical supplies and equipment to protect health workers and communities. Additional logistics include an epi-shuttle, generator, motorbikes, mattresses, and food for patients. The coordination with partners enabled rapid access to remote health zones. Preparedness and readiness Eight of nine neighbouring countries completed readiness assessments DRC&rsquo;s high-risk provinces were supported in planning. Capacity building conducted on readiness in five health zones Prevention of Sexual Exploitation, Abuse and Harassment Prevention of sexual exploitation, abuse, and harassment (PRSEAH) integrated into response activities through responder briefings, community sensitization, and risk analysis. Individuals from three churches and responders/community members were oriented on PRSEAH and reporting mechanisms. PRSEAH focal points identified in collaboration with the Bulape Health Zone authorities. Posters with PRSEAH principles and reporting information were displayed in health centres and offices.","epidemiology":"Ebola virus disease is a severe disease caused by the Ebola virus (EBOV). The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission by direct contact with bodily fluids, organs, or contaminated surfaces and materials. The incubation period, the time between infection with the virus and the onset of symptoms, ranges from 2 to 21 days, but typically is 7&ndash;11 days. People are not infectious during the incubation period; they become contagious with early symptoms; therefore, transmission risk begins at the onset of clinical signs and increases with disease severity. Case fatality ratios ranging from 25% to 90% have been reported in previous outbreaks. The disease is characterized by an acute onset of fever with non-specific symptoms/signs (e.g., abdominal pain, anorexia, fatigue, malaise, myalgia, sore throat) usually followed several days later by nausea, vomiting, diarrhoea, and occasionally a variable rash. Severe illness may include haemorrhagic manifestations (e.g., bleeding), encephalopathy, shock/hypotension, multi-organ failure, and spontaneous abortion in infected pregnant women. Individuals who recover may experience prolonged sequelae (e.g., arthralgia, neurocognitive dysfunction, uveitis, sometimes followed by cataract formation), and clinical and subclinical persistent infection may occur in immune-privileged compartments (e.g., central nervous system, eyes, testes). Family members, health and care providers, and participants in burial ceremonies with direct contact with the deceased are at particular risk.","formattedDate":"2025-12-01T13:57:19Z","matchedSignals":["transmission concern","severity signal","response escalation"]}},{"id":"DON588","title":"Diphtheria - African Region (AFRO)","disease":"Diphtheria","locations":["African Region (AFRO)"],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/DON588","summary":"From 1 January to 2 November 2025, a total of 20 412 suspected diphtheria cases, including 1 252 deaths (an average case fatality ratio [CFR] - 6 %) have been reported across eight Member States in the WHO African Region (Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria, and South Africa). Several of these countries have been experiencing ongoing outbreaks since 2023. Children and young adults represent the majority of the cases, with females accounting for a slightly greater proportion. Case confirmation and management remain constrained. Laboratory confirmation remains low due to shortages of diagnostic supplies and limited testing capacity. At the same time, the global shortage of diphtheria antitoxin (DAT), and uneven clinical capacity to provide this essential treatment, pose significant challenges for effective case management. Diphtheria is a vaccine-preventable bacterial disease which can lead to severe systemic complications, including myocarditis, kidney failure, and neurological damage. Many of the affected countries are fragile, conflict-affected or have system vulnerabilities where health systems are overstretched, routine services are disrupted and access to essential services is limited. These settings are characterized by high population mobility, and crowded living conditions, especially among displaced populations. WHO continues to work across all levels of the organization to identify and implement the most appropriate mechanisms to support affected countries and mitigate the impact of the outbreaks. Given this context, the regional public health risk is assessed as high due to the potential for further geographic expansion of outbreaks, high case fatality rates, insufficient resources for outbreak control, and limited surveillance and laboratory systems. At the global level, the public health risk is considered low, as most countries outside the African Region have established immunization programs and adequate surveillance systems.","overview":"In 2025, from 1 January to 2 November, a total of 20 412 suspected diphtheria cases, including 1 252 deaths (an average case fatality ratio [CFR] &ndash; 6.1 %) have been reported across eight Member States in the WHO African Region (Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria, and South Africa). Of these suspected cases, 9 864 (48.3%) cases have been confirmed through laboratory testing, epidemiological linkage, or clinical diagnosis. Laboratory confirmation was conducted for 5.7% (n = 1 177) of the suspected cases. Women, children aged 5&ndash;18 years, and young adults under 30 years are the most affected, confirming that the immunity gap extends well beyond early childhood. The situation has further deteriorated in Mali, Mauritania, and Niger, in recent weeks, with increasing case numbers and geographic spread of the outbreaks reported in these countries. The resurgence of diphtheria across multiple countries in the WHO African Region constitutes a serious public health concern which led to its grading as a grade 2 emergency under the Emergency Response Framework of WHO. Timely case detection, coordinated response, and clinical management remain critical to limiting transmission and reducing the high fatality rates observed in recent outbreaks. However, response efforts are being hampered by a global shortage of DAT and limited laboratory diagnostic capacity. Effective outbreak control requires comprehensive, multi-sectoral action across all response pillars including emergency coordination, laboratory confirmation, enhanced surveillance and case finding, clinical management with life-saving DAT and appropriate antibiotics (in accordance with WHO guidelines), infection prevention and control (IPC). Sustained vaccination efforts, coupled with risk communication and community engagement (RCCE) are essential to interrupt transmission and protect high-risk populations. In addition, preventing the recurrence of diphtheria outbreaks in the African Region will require strengthened health systems, particularly through robust routine immunization coverage. Summary of individual country situations from 1 January to 2 November 2025 Algeria Algeria reported a diphtheria outbreak in October 2025 in Skikda province, with 13 suspected cases and two deaths (CFR 15%). Eight of the suspected cases were laboratory-confirmed, and none of the confirmed cases had received diphtheria vaccination. The outbreak affected both children and adults, with males accounting for 62.5% of confirmed cases. A previous outbreak in southern Algeria, reported in 2024, involved over 900 suspected cases and 119 deaths (CFR 13%). According to WHO/UNICEF estimates of national immunization coverage (WUENIC) for 2024, Algeria has high national immunization coverage (98% for the first Diphtheria-Tetanus toxoid-Pertussis [DTP] dose and 92% for the third), however geopolitical instability in neighboring countries has led to mass displacement into southern Algeria, where vaccination coverage among refugees is low. The lack of data since May 2025 and limited information sharing are key challenges to assessing the full scope of the outbreak. Chad From 1 January to 2 November 2025, Chad reported 4 462 suspected diphtheria cases and 47 deaths (CFR 1.1%), with only four laboratory-confirmed cases. The significant amount of suspected diphtheria cases compared to the limited number of laboratory-confirmed cases highlights the challenge in the country to obtain a laboratory-confirmed diagnosis. The outbreak affects 27 out of 215 health districts across 7 of 23 provincial health delegations, with active transmission ongoing in three regions. Most cases are among children aged 3&ndash;13 years, and vaccination status is unknown for the vast majority. Chad faces a complex humanitarian crisis marked by conflict, displacement, and food insecurity. The country hosts over 1.4 million refugees, including more than 870 000 Sudanese refugees and 300 000 Chadian returnees. The health system is overwhelmed, and multiple infectious disease outbreaks, including yellow fever, measles, cholera, and hepatitis E, are occurring simultaneously. WHO, UNICEF, and MSF are supporting response efforts, but challenges include delayed reporting, insufficient case management kits, and logistical constraints. A request has been submitted to Gavi for vaccine supply and operational funding for mass immunization campaigns. According to WUENIC, the DTP coverage in 2024 was 84% for the first dose and 68% for the third dose. Guinea Guinea has experienced a resurgence of diphtheria since June 2025, with 476 suspected cases and 123 deaths. The CFR among the suspected cases is 25.8%, the highest among affected countries. The outbreak has affected four of 38 prefectures (11%), with human-to-human transmission concentrated in the Kankan region, particularly in Siguiri district, which accounts for over 80% of reported cases and fatalities. Laboratory confirmation remains limited, with only 70 cases confirmed. The outbreak follows a major event in 2023 that affected multiple regions and led to over 4 500 suspected cases. Guinea&rsquo;s response is hampered by delayed presentation to health facilities, and insufficient resources for clinical management and community engagement. The outbreak is occurring in gold mining areas with high population mobility, increasing transmission risk. According to WUENIC in Guinea for 2024, the immunization coverage remains low (77% for the first DTP dose and 63% for the third), and urgent needs include DAT supply, improved clinical pathways, and expanded vaccination efforts. Mali From 1 January to 2 November 2025, Mali has reported 430 suspected diphtheria cases and 29 deaths (CFR 6.7%), with 46 laboratory-confirmed cases. The outbreak has affected seven out of 11 regions (64%), including the capital city Bamako, with the number of affected districts increasing from three to 30 out of 75 in less than six weeks, representing a rapid geographic expansion. Mali is experiencing a complex humanitarian crisis driven by conflict, climate related disruptions, and limited access to basic services. In 2025, 6.4 million people required humanitarian assistance. Displacement and restricted access to healthcare have contributed to low immunization coverage among vulnerable populations. According to WUENIC in 2024, estimates show 91% coverage for the first DTP dose and 82% for the third. Challenges include underreporting, limited availability of DAT, and logistical constraints. The outbreak response is hindered by concurrent emergencies and overstretched health services. Mauritania From 1 January to 2 November 2025, Mauritania has reported 849 suspected cases of diphtheria and 33 deaths (CFR 4%), with 318 confirmed cases. After an initial delay, the outbreak was officially declared on 25 September 2025 and has rapidly expanded across 11 out of 53 departments (21%). An upsurge of cases has been observed since late September. The most affected age groups are children and adolescents aged 5&ndash;19 years, and women account for 60% of suspected cases. Only 10% of cases have documented vaccination history. Mauritania hosts the largest refugee camp for Malians, with over 118 000 refugees, mostly women and children. The outbreak coincides with a Rift Valley fever outbreak in some of the same regions. Response efforts are challenged by limited resource mobilization, weak active case finding, and insufficient community sensitization. Reactive vaccination campaigns have been initiated, but gaps remain in funding, logistics, and healthcare worker training. According to WUENIC in 2024, the immunization coverage is relatively high (95% for the first DTP dose and 86% for the third), but subnational disparities persist. Niger From 1 January to 2 November 2025, Niger has reported 1 926 suspected diphtheria cases and 122 deaths CFR (6.3%), with 765 laboratory-confirmed cases. The outbreak has affected 34 out of 72 health districts (47%) across eight regions, with most cases concentrated in Agadez, Diffa and Zinder. Compared to 2024, there have been fewer reported cases and deaths, but transmission remains active. Niger is facing a protracted humanitarian crisis driven by insecurity, climate related disruptions, economic pressures, and displacement. An estimated 2.6 million people require humanitarian assistance. According to WUENIC in 2024, the immunization coverage is relatively high (95% for the first DTP dose and 86% for the third), but recent outbreaks highlight gaps in vaccine access and delivery. A vaccination campaign in September 2025 achieved high coverage, and a second round is planned. Challenges include limited diagnostic and treatment capacity, insufficient vaccine quantities, low public awareness, and funding constraints. Nigeria Nigeria continues to report the highest number of diphtheria cases in the African Region. From 1 January to 2 November 2025, 12 150 suspected cases have been reported, with 8 587 confirmed and 884 deaths (CFR 7.2%). Confirmed cases have been reported from 240 Local Government Areas across 30 states. Most cases are clinically compatible, with only 3% confirmed by laboratory testing. The outbreak has disproportionately affected children and adolescents, with low vaccination coverage contributing to the spread. In Nigeria more than 2 million children are under-immunized, including those with zero-doses, highlighting the high risk of further spread. Reactive campaigns have been conducted in Imo, Kaduna and Lagos, targeting health workers and priority populations. The outbreak overlaps with areas targeted by the Big Catch-up initiative. Challenges include delayed laboratory confirmation, poor IPC practices, limited information, education and communication materials, and vaccine shortages. Discussions with Gavi are ongoing to secure additional support. According to WUENIC in 2024, the estimates show 71% coverage for the first DTP dose and 67% for the third. South Africa From 1 January to 26 October 2025, South Africa has reported 106 diphtheria cases, including 66 laboratory-confirmed respiratory cases, two laboratory-confirmed cutaneous cases, one probable respiratory case, and 37 asymptomatic carriers. The outbreak has affected 5 of 9 provinces (55%), highlighting the involvement of multiple provinces. Most cases and carriers are from the Western Cape, with additional clusters in Limpopo, Gauteng, KwaZulu-Natal, and Mpumalanga. CFR among probable and confirmed respiratory diphtheria cases was 18% (12/67). Most respiratory cases occurred in adults aged 18 years and older. Clusters have been documented among vulnerable populations, including individuals in correctional facilities. According to WUENIC in 2024, the immunization coverage remains below 80% in most provinces (76% for the first DTP dose and 74% for the third), and immunity gaps are widening. The outbreak response is challenged by competing priorities, limited human resources, and limited global supply of diphtheria antitoxin. Detailed case investigations and in-depth risk assessments are needed to guide targeted interventions. Geographical distribution of diphtheria outbreaks in the WHO African Region, January 2025 until 2 November 2025 Table 1. Summary of reported ongoing diphtheria outbreaks in the WHO African region, January &ndash; 2 November 2025 Table 2. Summary of vaccination coverage by diphtheria-affected country (WUENIC, 2024)","assessment":"Diphtheria is a major public health problem in the African region despite substantial efforts on immunization activities over the past three decades. Between 2000 and 2024, 75 789 diphtheria suspected cases were reported in the Region with the majority being reported from 2023 to 2024. In 2023-2024, Algeria, Chad, Gabon, Guinea, Mali, Mauritania, Niger, Nigeria and South Africa reported resurgence of diphtheria outbreaks with approximately 57 000 suspected cases and 2000 deaths (CFR of 3.5%) recorded. The countries most affected were Guinea, Niger and Nigeria. Most cases reported were children under fifteen years and female. Over 50% of suspected cases were non-vaccinated or with unknown vaccination status. Since the beginning of 2025 and as of 2 November 2025, eight countries in the Region have reported a total of 20 412 suspected diphtheria cases, including 1 252 deaths (with an average case fatality ratio [CFR] of 6%). Most cases are among children and young adults, with women slightly more affected than men. Laboratory confirmation remains low due to shortages of diagnostic supplies and limited testing capacity. The global shortage of DAT, and a variable clinical capacity to provide this essential treatment, poses an additional challenge to effective case management. Many of the affected countries are fragile, conflict-affected or have system vulnerabilities where health systems are overstretched, routine services are disrupted and access to essential services is limited. These settings are characterized by low routine immunization coverage, high population mobility, and crowded living conditions, especially among displaced populations. The resurgence of diphtheria in these countries is further compounded by disruptions caused by the COVID-19 pandemic, which led to significant declines in vaccine uptake and widened immunity gaps. At the regional level, the public health risk is assessed as high due to the potential for further geographic expansion of outbreaks, high fatality rates, insufficient resources for outbreak control, and weak surveillance and laboratory systems. The humanitarian context in several affected countries, including Chad, Mali, Niger, and Nigeria, increases the likelihood of sustained transmission and complicates response efforts. At the global level, the public health risk is considered low. Most countries outside the African Region have established immunization programs and adequate surveillance systems. However, the possibility of international spread through travel cannot be ruled out, particularly if susceptible individuals are exposed. Strengthened global surveillance and risk communication are therefore essential to mitigate this risk. The confidence in the available information is assessed as moderate. While data collection and reporting have improved in some countries, gaps remain in laboratory confirmation, case classification, and timely sharing of epidemiological updates.","advice":"Diphtheria is a vaccine-preventable bacterial disease caused by Corynebacterium diphtheriae . It primarily affects the upper respiratory tract and can produce a toxin that leads to severe systemic complications, including myocarditis, kidney failure, and neurological damage. The disease spreads via close contact with respiratory secretions or skin lesions. Areas with low immunization coverage, overcrowding and limited access to healthcare services are at higher risk of increased transmission and may experience outbreaks Considering the ongoing diphtheria outbreaks in the WHO African Region, WHO encourages Member States to strengthen preparedness and response capacities. This includes enhancing surveillance systems to improve case detection and reporting, expanding laboratory capacity for timely confirmation of cases, and improving clinical management and infection prevention and control. Supplementary immunization activities should be prioritized to close immunity gaps, particularly among children/adolescents and displaced populations. Community engagement and risk communication efforts must be intensified to raise awareness, promote health-seeking behavior, and ensure adherence to control measures. WHO also recommends the establishment of contingency stockpiles of diphtheria antitoxin, antibiotics, and laboratory supplies at regional hubs in Dakar and Nairobi. These stockpiles will enable rapid deployment of essential materials to the affected countries when needed. Regional and global advocacy efforts should be strengthened to mobilize funding and political support for outbreak response. WHO will continue to support Member States through technical assistance, resource mobilization, and coordination with partners. WHO will continue to work across all levels of the organization to identify and implement appropriate mechanisms to support affected countries and mitigate the impact of the outbreaks. WHO does not recommend any restriction on travel to or trade with the countries named in this report, based on the information available on the current event.","publishedAt":"2025-11-21T19:00:00.000Z","lastModified":"2025-11-22T09:03:37.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"DON588","response":"WHO, together with its partners, continues to support national authorities in responding to ongoing diphtheria outbreaks across affected countries. Assistance focuses on both technical and operational needs. At the country level, the scope of response operations varies according to available capacities, but core interventions remain consistent. These include enhanced surveillance through active case finding and timely reporting; adequate clinical management, including the appropriate use of antitoxin and antibiotics; risk communication and community engagement to improve public awareness and encourage care-seeking; and capacity-building efforts such as training and dissemination of evidence-based guidelines. Country-specific actions and priority needs differ, ranging from strengthening surveillance and coordination to scaling up vaccination, laboratory capacity, and medical supplies. Despite these efforts, multiple challenges continue to hinder the effectiveness of outbreak control. Competing health priorities have contributed to long-standing immunity gaps, reflected in persistently low vaccination coverage, especially in fragile settings. Similarly, case management capacity is also limited due to scarcity of diphtheria antitoxin and late presentation of patients, resulting in high case fatality rates, especially in vulnerable, marginalized and hard-to-reach populations. In some settings, surveillance systems remain fragile, resulting in delayed detection and incomplete reporting. Limited laboratory capacity further complicates the response, with shortages of diagnostic supplies, weak specimen transport systems, and restricted technical expertise leading to delayed confirmation and underestimation of outbreak magnitude.","epidemiology":"Diphtheria is a severe infectious disease caused by the gram-positive bacterium Corynebacterium diphtheriae or, less commonly, toxigenic strains of other Corynebacterium species. Infection may lead to respiratory disease, cutaneous disease, or an asymptomatic carrier state. The primary mode of transmission rests on close contact with infectious material from respiratory secretions or from skin lesions. The only known reservoir for C. diphtheriae are humans. As a result, asymptomatic carriers play a critical role in infection transmission. Immunity (either via natural infection or vaccine induced) provides protective immunity against the disease but does not prevent carriage. The disease can affect all age groups; however, unvaccinated or partially vaccinated individuals, including children, are most at risk. Respiratory diphtheria typically presents two to five days after exposure with sore throat, malaise, cervical lymphadenopathy, and low-grade fever. Oropharyngeal involvement is most common, but infection may extend to the nasopharynx, larynx, and tracheobronchial tree. Characteristic findings include adherent gray pseudomembranes on the respiratory tract mucosa that often bleed when removed. Severe cases can result in airway obstruction with neck swelling, hoarseness, stridor, or palatal paralysis. Toxin-mediated complications from toxigenic strains may include myocarditis, neurologic deficits, and kidney injury. Cutaneous diphtheria presents as chronic, nonhealing sores or shallow ulcers covered by a dirty gray membrane, though the appearance is non-specific. In addition to supportive care, treatment is based on the appropriate administration of DAT and antibiotics (azithromycin or penicillin). Full primary series and required booster doses. DAT administration against diphtheria has been effective in reducing the deaths and illness from diphtheria dramatically. Diphtheria is fatal in 5 to 10% of cases, with a higher mortality rate in young children. However, in settings with poor access to DAT, the CFR can be as high as 40%.","formattedDate":"2025-11-21T18:29:27Z","matchedSignals":["transmission concern","novel or unusual signal","severity signal","WHO high-risk wording","cross-border signal"]}},{"id":"2025-DON585","title":"Marburg virus disease- Ethiopia","disease":"Marburg virus disease- Ethiopia","locations":[],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON585","summary":"On 12 November 2025, WHO noted a press release from the Ethiopian Ministry of Health (MoH), and the Ethiopian Public Health Institute (EPHI), announcing suspected viral hemorrhagic viral fever (VHF) in Jinka town, South Ethiopia Regional State, Ethiopia. On 14 November 2025, the Ministry of Health of Ethiopia confirmed that the cases previously reported as suspected VHF were Marburg virus disease (MVD). Molecular testing conducted by the National Reference Laboratory at EPHI identified Marburg virus (MARV) in patient samples. As of 20 November 2025, 33 laboratory tests have been conducted, of which six confirmed cases, including three deaths, have been reported. Of the six confirmed cases, three are currently alive and on treatment. In addition to the lab-confirmed cases, a further three epidemiologically linked cases could not be tested; all three are deceased and recorded as probable cases. A total of 206 contacts have been identified, and contacts are under active follow-up. The number of contacts will continue to change as the response evolves. The source of the infection has not yet been identified. This marks the first confirmed outbreak of MVD in the country. Initial investigation by the one health team in Ethiopia show the presence of the natural host of the virus, fruit bats, in the area. MVD is a severe, often fatal illness, transmitted from bats to humans, and clinically similar to Ebola virus diseases. The disease has a case fatality ratio of up to 88%, but it can be much lower with good and early patient care. Under the leadership of the MoH, WHO is working alongside the Ethiopian response teams to enhance coordination, surveillance (including outbreak investigation, contact tracing, and alert management), case management, infection prevention and control measures, laboratory capacity, risk communication and community engagement. WHO assesses the public health risk posed by the outbreak as high at the national level, moderate at the regional level and low at the global level. Ethiopia is facing concurrent emergencies and multiple disease outbreaks, including of cholera, measles, dengue, which results in stretched health capacity.","overview":"As of 20 November 2025, 33 laboratory tests have been conducted, of which six confirmed cases, including three deaths, have been reported. Of the six confirmed cases, three are currently alive and on treatment. In addition to the lab-confirmed cases, a further three epidemiologically linked cases could not be tested; all three are deceased and recorded as probable cases. A total of 206 contacts have been identified, and contacts are under active follow-up. The number of contacts will continue to change as the response evolves. Clinically, patients have presented with high-grade fever, headache, vomiting, abdominal pain, and watery or bloody diarrhoea. Haemorrhagic manifestations, including nose bleeding and vomiting blood were observed in five cases, consistent with multi-organ failure. As this is the first time Ethiopia is reporting MVD, WHO recommends that samples be shared with a reference laboratory for inter-laboratory comparison. Figure 1: Map of Ethiopia showing location of Jinka town","assessment":"This is the first confirmed MVD outbreak in Ethiopia. The public health risk posed by the MVD outbreak is assessed as high at the national level due to several concerning factors: The outbreak involves six laboratory-confirmed cases; there have been a total of six deaths and there are three confirmed cases under treatment. All deaths involved unsupervised burials, posing a risk of potential additional community transmission. The presence of healthcare workers among the confirmed cases suggests potential occupational exposure risks within health facilities. Although investigations are ongoing, information on the source of the outbreak, geographical extent and epidemiology is limited. Although no international transmission has been confirmed to date, the potential risk for spread remains. The affected area, Jinka, while distant from Ethiopia&rsquo;s capital or major international airports, is connected by road transportation networks, including to neighbouring Kenya and South Sudan. Therefore, the public health risk posed by this event is assessed as moderate at the regional level. It is considered low at the global level.","advice":"Human-to-human transmission of Marburg virus is primarily associated with direct contact with the blood and/or other bodily fluids of infected people. Strengthening and reinforcing IPC measures is essential to prevent further transmission and reduce the likelihood of amplification. WHO advises the following risk reduction measures to be taken as an effective way to reduce MVD transmission to control the outbreak. Prevention: Protective measures individuals should take to reduce human exposure to the virus include: Reduce the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids including blood, feces and vomit. Close physical contact with MVD patients should be avoided. Persons with symptoms compatible with MVD should immediately seek care in health facilities, and patients suspected or confirmed to have MVD should be isolated in a designated treatment centre for early care and to avoid transmission at home. Community and family members should avoid caring for symptomatic individuals at home and avoid touching bodies of people deceased with MVD symptoms. They should avoid touching other potentially contaminated items and surfaces. Reduce the risk of bat-to-human transmission arising from prolonged exposure to mines, caves or dwellings inhabited by fruit bat colonies. During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks). During outbreaks, all animal products (blood and meat) should be thoroughly cooked before consumption. Coordination: Multisectoral coordination and pillar meetings at all levels and sharing of detailed situation reports is encouraged. Involvement of different stakeholders and partners in preparedness and response activities is also encouraged. To ensure an effective and sustained response, resource mobilization efforts within the government and with partners are recommended. Risk communication and community engagement: Raising public awareness and engaging with communities are important for successfully controlling MVD outbreaks. This includes raising awareness of symptoms, risk factors for infection, protective measures and the importance of seeking immediate care at a health facility. Sensitive and supportive information about safe and dignified burials is also crucial. This awareness should be increased through targeted campaigns and direct work with communities. Special attention should be given to high-risk groups, such as traditional healers, clergy, and community leaders, who may inadvertently facilitate disease spread, and who are important sources of information for the community. Misinformation and rumours should be addressed to foster trust and promote early symptom reporting. Surveillance: Active case detection, contact tracing, and alert management across affected and neighbouring regions should be intensified. Community-based surveillance systems should be strengthened to promptly identify and report new cases, particularly in high-risk areas. Close monitoring of healthcare workers, family members and individuals who have had contact with suspected cases or other high-exposure settings should be ensured. Surveillance capacities should also be intensified at relevant points of entry and borders to reduce the risk of further spread, including internationally. Infection prevention and control (IPC) measures: Critical infection prevention and control measures should be implemented and/or strengthened in all health care facilities, per WHO&rsquo;s Infection prevention and control guideline for Ebola and Marburg disease , which highlighted the importance of the rapid implementation of the IPC ring approach, including but not limited to IPC rapid assessment, decontamination of health facilities and households and early detection and identification of the cases through the screening and isolation of the suspected cases to minimize the transmission risk. Patients meeting the case definition for suspected MVD should be treated with appropriate precautions for MVD, regardless of whether the clinical suspicion suggests a more common ailment with similar symptoms, such as malaria. Health workers caring for patients with confirmed or suspected MVD should apply transmission-based precautions in addition to standard precautions , including appropriate use of personal protective equipment (PPE) and hand hygiene according to the WHO 5 moments , to avoid contact with patient&rsquo;s blood and other body fluids and with contaminated surfaces and objects. Waste generated in healthcare facilities must be safely segregated, safely collected, transported, stored, treated and finally disposed. Follow the national guidelines, rules and regulations for safe waste disposal or follow the WHO&rsquo;s guidelines on safe waste management . Patient-care activities should be undertaken in a clean and hygienic environment that facilitates practices related to the prevention and control of health-care-associated infections (HAIs) as outlined in Essential environmental health standards in health care. Safe water, adequate sanitation and hygiene infrastructure and services should be provided in healthcare facilities. For details on recommendations and improvement, follow the WASH FIT implementation Package . Laboratory testing: The processing and analysis of samples should be expedited, with results promptly shared with responders and clinicians to guide patient management, containment strategies and broader response efforts. This includes genomic sequencing on positive samples. International referral of samples to a regional reference laboratory should be considered for inter-laboratory comparison. Laboratory workers handling specimens from patients suspected or confirmed to be infected with MARV should receive refresher training on laboratory biosafety; this includes taking appropriate precautions when drawing blood for a malaria rapid diagnostic test or other test not specific for MARV. Evaluation of candidate medical countermeasures: There are no licensed vaccines or therapeutics against MVD. Several candidate vaccines are in the pipeline and outbreaks offer an opportunity to assess their efficacy and safety. There are protocols available and a network of experts in filoviruses ready to support national researchers. Safe and dignified burials: Safe and dignified burial protocols should be implemented for persons who have died to minimize community exposure. Additional training and equipment for healthcare workers and burial teams should be provided to ensure safe management of MVD-related fatalities. Thorough community engagement is required to ensure that affected communities are empowered to adhere to the protocols. Case management and mental health and psychosocial support: Designated treatment centers should ensure adequate level of care for confirmed patients to improve the chance of survival. Isolation and treatment facilities should be adequately equipped to ensure the safety and efficacy of patient care, while simultaneously preventing the spread of the disease. Supportive care such as rehydration, symptom management, and psychological support for patients and their families is essential to improving survival rates and mitigating the outbreak's impact. Border health and cross-border coordination: Surveillance capacities should be strengthened at relevant at-risk points of entry, onboard conveyances, and in border regions to prevent further spread, including internationally. Cases, contacts and individuals in affected areas who present signs and symptoms compatible with case definition should be advised not to travel, in line with WHO&rsquo;s border health and points of entry technical guidance for filovirus disease outbreaks. Collaboration with neighbouring countries should be enhanced to harmonize reporting mechanisms, conduct joint investigations, and share critical data in real-time. Countries at-risk of potential spread should enhance readiness activities to enable early case detection, isolation and treatment. Based on the current risk assessment, WHO advises against any travel and trade restrictions with Ethiopia.","publishedAt":"2025-11-21T16:00:11.000Z","lastModified":"2025-11-21T16:34:20.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON585","response":"Local and national health authorities in Ethiopia have implemented the following public health measures: A National Taskforce has been established at the Ministry of Health to provide strategic guidance, make decisions and mobilize resources. A costed national three-month response plan has been developed and launched by the MoH/EPHI. The MoH is regularly providing information on the MVD outbreak to the general public and partners. Emergency Operational Centres (EOCs) have been activated at national and regional levels, with incident management structures established to coordinate the response. Daily coordination meetings are ongoing at the national and subnational EOCs. The Ministry of Health, in collaboration with EPHI and regional health offices, is conducting integrated surveillance and response activities. Community surveillance, contact tracing, house-to-house visits, and medical service delivery are being enhanced. Two hospitals have been designated as treatment centres, with dedicated health workers deployed to manage cases. Field assessments are being conducted by a rapid response team (RRT). One RRT was deployed to Jinka to conduct contact tracing and epidemiological investigation while a second team is strengthening infection prevention and control (IPC) in health facilities managing suspected cases. Risk Communication and Community Engagement (RCCE) teams are disseminating MVD prevention messages, developing activity plans for targeted interventions, monitoring social media to address misinformation, and assessing trusted communication channels to enhance public awareness.","epidemiology":"Marburg virus disease (MVD) is a severe hemorrhagic fever caused by either of two closely related viruses, Marburg virus and Ravn virus, which are closely related to the Ebola viruses. MVD has a high case fatality rate, ranging from 24% to 88% from previous outbreaks The case fatality rate can be lowered with good and early patient care. The virus is initially transmitted to humans from fruit bats ( Rousettus aegyptiacus ) and then spreads among people through direct contact with bodily fluids, contaminated surfaces, or infected materials. Healthcare workers, caregivers, and individuals involved in burial practices are particularly at risk when infection prevention and control measures are not in place. MVD symptoms typically begin abruptly after an incubation period of two to 21 days and include high fever, severe headache, malaise, muscle aches, and progressive gastrointestinal symptoms such as diarrhea and vomiting. In severe cases, patients may experience bleeding from multiple sites and die from shock and organ failure within a week of symptom onset. There are no approved treatment or vaccines for MVD, although supportive treatment and early supportive care improves survival. Some candidate vaccines and therapeutics are currently under investigation. Nineteen outbreaks of MVD have previously been reported globally. The most recent outbreak was reported from the Republic of Tanzania between January and March 2025. Additional countries that have reported outbreaks of MVD in the African Region include Angola, the Democratic Republic of the Congo, Equatorial Guinea, Ghana, Guinea, Kenya, Rwanda, South Africa, and Uganda.","formattedDate":"2025-11-21T16:33:57Z","matchedSignals":["transmission concern","severity signal","WHO high-risk wording","response escalation"]}},{"id":"2025-DON584","title":"Rift Valley fever- Mauritania and Senegal","disease":"Rift Valley fever- Mauritania and Senegal","locations":[],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON584","summary":"Between 20 September and 30 October 2025, a total of 404 confirmed human cases of Rift Valley fever (RVF), including 42 deaths, were reported by national health authorities in two West African countries: Mauritania and Senegal. RVF is a zoonotic disease, which mainly affects animals, but can also infect humans. The majority of human infections result from contact with the blood or organs of infected animals, but human infections have also resulted from the bites of infected mosquitoes. To date, no human-to-human transmission of RVF has been documented. While RVF often leads to severe illness in animals, its impact in humans varies, ranging from mild flu-like symptoms to severe hemorrhagic fever that can be fatal. RVF is endemic in both countries, where recurrent outbreaks have been previously reported in both livestock and humans. The risk of further spread remains high, especially with environmental conditions favorable to the proliferation of mosquitoes, periods of heavy rains and increased mosquito activity, as well as movements of livestock within country and towards Mali and Gambia for grazing and trade. The response to RVF outbreaks requires a One Health approach, based on enhanced collaboration between the human health, animal health and environmental sectors, in both countries and at the regional level. WHO, in collaboration with the World Organization for Animal Health (WOAH), and the Food and Agriculture Organization of the United Nations (FAO), currently assesses the overall risk as high at the national levels, moderate at the regional level and low at the global level.","overview":"Mauritania Human cases: Between 27 September and 30 October 2025, a total of 46 confirmed human cases of RVF, including 14 associated deaths (case fatality ratio: 30%), were reported in eleven districts from thirteen regions (wilayas), three of which share international borders: Assaba (bordering Mali to the south), Brakna and Trarza (both bordering Senegal along the Senegal River). Out of a total of 190 samples tested, 46 were positive, i.e. a positivity rate of 24.2%. Animal cases: On 30 October 2025, the Mauritanian Ministry of Animal Resources reported a total of 62 animal outbreaks, with 235 positive samples out of 1106 collected and tested. The first animal cases, involving goats and dromedaries, were reported in August 2025. A total of 235 animal cases, including 71 deaths (two in camels and 14 in goats), have been reported in Aioun (Hodh El Gharbi region) and Timbedra (Hodh Ech Chargui region), both located in the southeast near the border with Mali, as well as in Maghta Lahjar (Brakna region) in the center of the country. In the Brakna region, 46 animal cases and 55 deaths have been reported to WOAH. Affected species include sheep, goats, dromedaries and cattle. RVF is endemic in Mauritania. The last major outbreak occurred in 2022, with 47 confirmed human cases, including 23 deaths (case fatality ratio 49%), mainly affecting pastoralists in nine of the fifteen regions. During this outbreak, cattle, camels and small ruminants were also affected, with positivity rates in animals approaching 21.2%. Senegal Human cases: Between 20 September and 30 October 2025, the Republic of Senegal reported a total of 358 confirmed human cases of RVF, including 28 deaths (case fatality rate: 7.8%). The cases were recorded in 22 health districts from eight administrative regions, with the vast majority (78%) reported in the Saint-Louis region. Additional cases have been reported in Dakar (nine cases), Fatick (12 cases), Kaolack (13 cases), Louga (18 cases), Matam (23 cases), Thi&egrave;s (2 cases) and Tambacounda (2 cases). The affected districts in the Saint-Louis region, namely Dagana (32 cases), Pete (9 cases), Podor (32 cases), Richard-Toll (133 cases) and Saint-Louis (73 cases), are all located along the northern border with Mauritania, close to the Senegal River. Animal cases: Animal infections have been detected in the same areas as human cases. On 23 September 2025, authorities collected 1122 blood samples and four abortion samples from small ruminant herds in the affected villages. Laboratory analyses confirmed 36 positive samples from six herds. As of 29 October 2025, a total of 160 confirmed animal cases of RVF have been reported in sheep, goats and cattle in seven regions of Senegal: Dakar, Fatick, Louga, Matam, Saint-Louis, Tambacounda and Thi&egrave;s. In addition, 640 animal abortions were reported in three regions. As of 22 October 2025, the country has notified WOAH of 26 RVF outbreaks, affecting a total of 59 animals, including two deaths. RVF is endemic in Senegal, with previous outbreaks affecting both human and animal populations. The last confirmed human case prior to this outbreak was reported in January 2025 in Touba, Diourbel region, while the last human case in the Saint-Louis region was in 2022. Figure 1. Geographic distribution of confirmed human RVF cases (404) and deaths (n=42) in Mauritania and Senegal, September 20 to 30 October 2025.","assessment":"The current outbreak of RVF in Senegal and Mauritania is unusual in its scale and severity, although both countries are endemic for the disease. It affects several districts in international border areas, particularly along the Senegal River, increasing the risk of inter-regional transmission due to animal movements. In Mauritania, RVF has been confirmed in eastern regions bordering Mali, raising concerns about potential regional spread beyond the Senegal River Basin through livestock movements. A high proportion of severe human cases have been reported, potentially reflecting gaps in case detection and limitation in optimized clinical management. In Senegal, approximately 11% of confirmed human cases have presented with hemorrhagic symptoms, of which 20 have resulted in death. The situation is particularly concerning in Mauritania, where the case fatality rate has reached 30% indicating heightened severity. As a result, the public health risk is assessed as high at the national level, moderate at the regional level and low at the global level. The risk to animal health is considered high at the national level, moderate at the regional level and low at the global level. WHO, in collaboration with FAO and WOAH, has carried out a joint rapid risk assessment, which will be revised as new information becomes available.","advice":"RVF is a viral zoonotic disease primarily transmitted by mosquitoes, with transmission dynamics influenced by environmental factors (rainfall and floodings), which predominantly affects domestic animals such as cattle, sheep, camels and goats. Human cases usually occur in the vicinity of animal outbreaks, in areas with favorable conditions for mosquito transmission. The majority of human infections result from direct or indirect contact with the blood or organs of infected animals. Care should be taken when handling sick or dead animals, patients, or biological materials. It is recommended that a One Health approach be applied, integrating animal, human and environmental health efforts into all RVF prevention and control activities. During outbreaks, countries need to strengthen their capacity to detect human cases early and ensure adequate patient care. Public awareness campaigns on the risks of RVF transmission and protective measures are essential to reduce infection and mortality rates. Preventive measures for the public should focus on: Reducing the risk of animal-to-human transmission through safe livestock handling and slaughter practices. Maintaining good hand hygiene, including wearing gloves and protective equipment when handling sick animals or infected tissues, or during slaughter. Avoiding unsafe consumption of fresh blood, raw milk or animal tissue. In regions where epizootics are reported, all animal products (blood, meat, milk) must be thoroughly cooked before consumption. Preventing mosquito bites through vector control measures, including eliminating breeding sites, using insecticide-treated nets and repellents when possible, wearing long, light-colored clothing, and avoiding outdoor activities during peak mosquito activity hours. Preventive measures at healthcare facilities should focus on : Although human-to-human transmission of Rift Valley fever (RVF) has never been documented, health care workers caring for suspected or confirmed cases should follow standard precautions when providing care or handling biological samples. Measures at the animal level should include: Considerations for restricting or banning livestock movement to help mitigate the risk of virus spread between infected and non-infected areas. Routine livestock vaccination before outbreaks to prevent epizootics. Vaccination should not be initiated once an outbreak has begun as use of multi-dose vials and reused needles/syringes could inadvertently contribute to virus spread. WHO does not recommend any travel or trade restrictions to or from Mauritania and Senegal or affected regions based on the current information.","publishedAt":"2025-11-05T15:07:26.000Z","lastModified":"2025-11-05T15:38:21.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON584","response":"In both countries, multidisciplinary rapid response teams, comprising personnel from the ministries of health and veterinary services at both national and subnational levels, have been deployed to conduct thorough investigations and implement outbreak response measures. These efforts are being conducted in coordination with local authorities, ministries of agriculture and livestock, and partners, including WHO, FAO and WOAH. In Senegal, as part of the response to the RVF outbreak, regional coordination teams have been set up in each affected region, using a One Health approach, with the designation of regional incident managers. A national response coordination unit has also set up a national incident management system, based on the same One Health framework. WHO is providing support to Mauritania and Senegal, and is undertaking the following actions: Supporting countries in accelerating the rolling out of key priority interventions accordingly to their national plans: risk communication and community engagement (RCCE), deployment of SURGE and rapid response teams, briefing of clinicians, procurement and distribution of supplies, improved understanding of transmission dynamics. Supporting surveillance activities and expanding diagnostic capacities at district level (including trainings) in human and animal health sectors, to minimize delayed detection, underreporting, and reliance on central PCR confirmation. Organizing targeted training for health worker, community health workers and community-based animal health workers on RVF awareness and preventive measures, zoonotic and vector risks, case recognition and management as well as community engagement best practices. Improving capacities for clinical care for severe patients through training, provision of supplies, and surge capacity as required. Scaling up RCCE efforts significantly to focus on meaningful engagement with the most affected groups (e.g. herders, slaughterhouse workers) to raise awareness of transmission risks, preventive measures, care pathways, and access to trustworthy information. Procuring and distributing medical, IPC and laboratory supplies based on country needs. Continuing investigation of transmission patterns, including examination of malaria circulation as well dual mapping of the human and animal outbreaks. Supporting digital data management and production of updated, high-quality sitreps. Scaling up vector-control activities, for RVF but also importantly against malaria and dengue. Continuing partner coordination efforts with FAO, WOAH and other key operational partners and sectors. FAO and WOAH are undertaking the following in support of national authorities: Providing personal protective equipment (PPE) for veterinary laboratories. Providing operational support on the ground to strengthen response activities in affected areas. Supporting countries with technical expertise and monitoring the animal situation in Senegal, Mauritania and in neighbouring countries. Supporting community engagement by disseminating targeted messages to communities with exposure to livestock.","epidemiology":"Rift Valley fever (RVF) is a viral zoonotic disease primarily affecting domestic animals in sub-Saharan Africa, including cattle, sheep, goats and camels. Human infection may occur through bites from infected mosquitoes, however the majority of cases result from direct contact with the blood, tissues or organs of infected animals. Occupational groups at highest risk include livestock breeders, farmers, slaughterhouse workers and veterinarians. Humans can become infected by consuming unpasteurized or undercooked milk from infected animals. To date, no human-to-human transmission of RVF has been documented. While RVF often leads to severe illness in animals, its impact in humans varies, ranging from mild flu-like symptoms to severe hemorrhagic fever that can be fatal. The majority of the infected individuals experience no symptoms or only mild illness, characterized by fever, general weakness, lower back pain and dizziness. However, a small percentage of patients (about 2%) progress to a severe form of the disease, which may manifest in one or more of the following three clinical presentations: ocular form (involving inflammation of the eye), meningoencephalitis (inflammation of the brain), and hemorrhagic form (bleeding).","formattedDate":"2025-11-05T15:38:08Z","matchedSignals":["transmission concern","novel or unusual signal","severity signal","WHO high-risk wording"]}},{"id":"2025-DON581","title":"Chikungunya virus disease- Global situation","disease":"Chikungunya virus disease- Global situation","locations":[],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON581","summary":"In 2025, a resurgence of chikungunya virus (CHIKV) disease was noted in a number of countries, including some that had not reported substantial case numbers in recent years. Between 1 January and 30 September 2025, a total of 445 271 suspected and confirmed CHIKV disease cases and 155 deaths were reported globally from 40 countries, including autochthonous and travel imported cases. Some WHO Regions are experiencing significant increases in case numbers compared to 2024, although others are currently reporting lower case numbers. This uneven distribution of cases across regions makes it challenging to characterize the situation as a global rise, however, given the ongoing outbreaks reported globally in 2025, the potential for further spread remains significant. CHIKV disease can be introduced into new areas by infected travelers and local transmission may be established if there is the presence of Aedes mosquito and a susceptible population. The risk is heightened by limited population immunity in previously unaffected areas, favorable environmental conditions for vector breeding, gaps in surveillance and diagnostic capacity, and increased human mobility and trade. Strengthening disease surveillance, enhancing vector surveillance and control, and improving public health preparedness are essential to mitigate the risk of further transmission. Prior to 2025, current or previous autochthonous transmission of CHIKV has been reported from 119 countries and territories. A total of 27 countries and territories across six WHO regions have established competent populations of Aedes aegypti mosquitoes but have not yet reported autochthonous CHIKV transmission. Additional countries have established populations of Aedes albopictus mosquitoes, which can also transmit CHIKV, and in which transmission efficiency is enhanced for CHIKV lineages with the E1 226V mutation. The presence of these vectors poses a continuous threat of chikungunya introduction and spread in previously unaffected areas. Increased CHIKV transmission is driven by multiple factors that include the expanded geographic distribution of Aedes mosquitoes related to transportation in conveyances and climate change, unplanned urbanization, poor water management, and weakened vector surveillance and control. CHIKV disease typically causes high population attack rates. In smaller settings such as islands, the transmission dynamics can be temporarily interrupted once a proportion of the population becomes infected and subsequently immune. In larger populations however, where enough individuals remain immunologically susceptible, transmission can persist over time, leading to sustained outbreaks. These outbreaks often place a significant burden on healthcare systems due to the number of affected individuals. Countries differ in their ability to detect and report chikungunya and other vector-borne diseases, with many outbreaks identified only retrospectively, hindering effective public health responses. Early detection of cases, particularly in persons at risk for severe CHIKV disease, and timely access to appropriate medical care are essential for minimizing clinical complications and reducing mortality. The variation in distribution of cases across regions highlights the importance of continued investment in surveillance, preparedness, and response capacities to address evolving regional dynamics. WHO continues to call on all countries to strengthen their healthcare and laboratory systems to enable rapid detection, timely reporting, and effective response to chikungunya outbreaks.","overview":"Global overview Globally as of December 2024, current or previous autochthonous transmission of CHIKV had been reported from 119 countries and territories across six WHO regions. In addition, 27 countries and territories had evidence of established and competent Aedes aegypti and Aedes albopictus vector populations but had not yet documented autochthonous CHIKV transmission. Per available data from January to September 2025, 263 592 suspected and 181 679 confirmed CHIKV disease cases and 155 CHIKV disease-related deaths have been reported globally. While certain WHO Regions are reporting lower case numbers compared to 2024, others are experiencing marked increases. This heterogeneity in regional trends complicates the interpretation of a global increase. Instead, the data suggest localized resurgence or emergence in specific geographic areas. The region of the Americas has reported the highest number of cases followed by the European region (comprised of cases reported predominantly from French Overseas Departments in the Indian Ocean). Table 1: Number of suspected and confirmed CHIKV disease cases and deaths by region in 2025, as of September 2025. *Note: the date of last report varies by country Figure 1: Geographical distribution of CHIKV disease cases as reported to WHO or Publicly shared by Ministries of Health from January to September 2025 Regional overview African region As of September 2025, a total of 2197 suspected and 108 confirmed CHIKV disease cases have been reported from four countries: Comoros, Kenya, Mauritius, and Senegal with Mauritius recording the highest number of cases. In Comoros, between 1 January to 31 May 2025 (epi week 1 and epi week 22), a total of four confirmed cases have been reported, while Senegal reported seven confirmed cases. In Mauritius, a total of 1583 cases have been reported between 15 March to 4 August 2025 (epi week 12 to epi week 32), including 1543 local and 40 imported cases. There have been no reported deaths. In Kenya, a chikungunya outbreak was confirmed in Mombasa County as of 8 June 2025 (epi week 23). By 6 July 2025 (epi week 27), a total of 614 cases had been recorded, including 97 laboratory-confirmed cases. Since then, no further cases have been reported. No chikungunya-related deaths have been recorded to date. Eastern Mediterranean Region As of September 2025, a total of 1596 suspected, and 67 confirmed CHIKV disease cases have been reported from Pakistan and Somalia. In Pakistan, CHIKV disease cases in 2025 have been reported at rates similar to those in 2024. A notable increase occurred between 4 May to 21 June 2025 (epi weeks 19 to 25), with 101 to 121 suspected CHIKV disease cases reported per week during this period. In Somalia, a chikungunya outbreak has been confirmed in Sool region, with 488 suspected cases reported between January and June 2025. Eight out of 10 samples tested were laboratory-confirmed for chikungunya. Somalia has also recorded imported travel related cases. European Region As of 15 September 2025, two European countries&mdash;France and Italy&mdash;have reported locally acquired cases of CHIKV disease. France has recorded 479 cases distributed across 54 clusters, with 40 clusters currently active. Italy has reported 205 locally acquired cases distributed across four clusters of which three clusters are currently active. A total of 56 456 CHIKV disease cases, and 40 deaths, have been reported from four countries in the European region in 2025. In France, the increased incidence of CHIKV outbreaks in 2025 represent a deviation from observed patterns in previous years . In 2024, only one CHIKV disease case was reported. The larger number of chikungunya cases this year, along with their early onset, are linked to an epidemic in La R&eacute;union and the broader Indian Ocean region, driven by a viral strain that is highly adapted to the Aedes albopictus mosquito. In the French overseas department of La R&eacute;union, a total of 54 517 confirmed cases and 40 deaths have been reported in 2025 (as of 14 September). There has been a steady decline in new cases since 26 April (epi week 17) indicating that the outbreak is waning. This marks the first autochthonous transmission of chikungunya on the island since 2014. In Mayotte, following two imported cases from La R&eacute;union, the first locally acquired CHIKV disease case was confirmed in March 2025. As of 18 September 2025, a total of 1255 locally acquired cases, including 39 hospitalizations, have been reported . The transmission receded since August with only a few cases reported per week on average. Region of the Americas As of 20 September 2025, CHIKV disease transmission continues across the Americas in line with expected seasonal patterns. A total of 228 591 suspected cases have been reported from 14 countries, including 100 329 confirmed cases and 115 deaths. In Bolivia, a total of 5372 CHIKV disease cases have been reported, 73% of which are laboratory confirmed, along with four deaths. The outbreak primarily affected the department of Santa Cruz with 99% of cases (n=3905, including four deaths). Additionally, cases were reported in the departments of Beni, Chuquisaca, Cochabamba, Pando, and Tarija. Brazil accounts for nearly 96% of all reported cases and deaths in the region, with 96 159 confirmed cases and 111 deaths. In Cuba, between 1 January to 20 September, 34 cases of chikungunya were reported, all confirmed by laboratory by RT-PCR test, in the provinces of Guantanamo, La Habana, Matanzas, Pinar del Rio and Santiago de Cuba. Public health interventions have been implemented. South- East Asia Region As of early September 2025, over 34 628 CHIKV disease cases, both suspected and confirmed, have been reported in the WHO South-East Asia region, primarily from India and Bangladesh. In India, between 1 January and 31 March 2025, a total of 30 876 suspected cases and 1741 confirmed cases were reported. The states reporting the highest number of confirmed cases were Maharashtra, Karnataka and Tamil Nadu. In Bangladesh, the Institute of Epidemiology, Disease Control and Research between reported a total of 732 suspected CHIKV disease cases in Dhaka city between 1 January and 31 August 2025. Of these, 400 cases were laboratory-confirmed by RT-PCR. In Sri Lanka, a total of 151 confirmed CHIKV disease cases were reported from sentinel sites in Colombo, Gampaha and Kandy between 1 January 2025 and the second week of March 2025. According to the Epidemiology Unit Division situation report, dated 31 August 2025, the CHIKV disease cases continued to increase and peaked in June 2025. Over half of the reported cases were from the Western Province, with Colombo District alone reporting 33%. The most affected age group was 41&ndash;60 years (36.4%), although an increasing trend was noted among children. In Thailand, a total of 1128 CHIKV disease cases were reported between 1 January and 14 September 2025. Bueng Kan (142), Chiang Mai (411), and Loei (125) are the provinces reporting the most cases. The age distribution of cases is: 0-4 years 2%, 5-9 years 3%, 10-14 years 6%, 15-19 years 4%, 20-29 years 9%, 30-39 years 17%, 40-49 years 17%, 50-59 years 16%, &ge; 60 years 26%. Western Pacific Region A total of 21 299 CHIKV disease cases including four countries reporting imported cases, with no deaths, have been reported from 16 countries and areas in the Western Pacific region in 2025. Of these, five countries reported local transmission, six reported imported cases, and five reported no cases during the year. In China (excluding Hong Kong SAR, Macao SAR, and Taiwan, China), as of 27 September 2025, a total of 16 452 locally transmitted cases has been reported in Guangdong Province. All cases were laboratory-confirmed. This represents the largest documented chikungunya outbreak to date in China. The cases have been reported in 21 cities, mainly in Foshan City (10032), Jiangmen City (5209), Guangzhou City (590), Shenzhen City (128), Zhanjiang City (112), Zhuhai City (60), and Zhongshan City (54). Additionally, during 1-21 September, Guangxi Zhuang Autonomous Region reported 297 local and associated cases; Fujian Province reported 124 local and associated cases; and some other provinces (such as Hunan, Sichuan, and Hainan provinces) also reported a few local cases. According to the data as of 16 August 2025, among all locally reported cases nationwide, the age distribution is: 0-5 years 3.1 %, 6-17 years 13.6 %, 18-45 years 37.0 %, 46-60 years 23.3 %, 61-74 years 15.2 %, and &ge;75 years 7.8 %. Up to now, all reported cases have been mild, with no severe cases or deaths. In Indonesia, as of 31 July 2025, a total of 3608 confirmed CHIKV disease cases across 19 provinces have been reported, compared to 1399 confirmed cases reported during the same period in 2024. No chikungunya-related deaths have been recorded to date. The risk of future increases persists, particularly during the transition from the rainy to the dry season, with heightened concern in the most populous and frequently visited provinces: West Java, Central Java, East Java, and Banten. The Ministry of Health of Indonesia has strengthened detection and reporting through its Early Warning Alert and Response System (EWARS) and has implemented response measures in high-risk areas. In Malaysia, as of 2 August 2025, a total of 40 CHIKV disease cases have been reported in 2025, compared to the 63 cases reported during the same period in 2024. No chikungunya-related deaths have been recorded to date. During the current reporting year, three chikungunya clusters were reported. Case investigation, integrated vector management, community engagement, and multisectoral collaboration efforts were implemented. All outbreaks were successfully contained within two weeks of detection, indicating an effective public health response and outbreak management. In Philippines, as of 16 August 2025, a total of 628 CHIKV disease cases have been reported, a 78% decrease from 2886 cases reported in the same period in 2024. The national trend has been fluctuating, with 46 cases reported from 20 July to 2 August 2025, which is 10% lower than the 51 cases reported two weeks prior (6 to 19 July 2025). Cases ranged from 1 to 87 years old, with a median age of 33. Females accounted for 66% of cases (414 out of 628). There was one death reported (CFR: 0.16%). Local health authorities have investigated areas with clustering of cases to determine risk factors and implement vector control activities In Singapore, as of 20 September 2025, 25 cases of CHIKV disease cases have been reported, compared to 12 cases reported during the same period in 2024. The majority of the cases were individuals with recent travel to chikungunya-affected areas. No chikungunya-related deaths and no sustained local transmission have been reported. The Communicable Diseases Agency Singapore continues to monitor the situation closely and provides ongoing guidance on prevention and control measures, particularly focusing on vector control to limit further transmission.","assessment":"CHIKV disease is an Aedes- borne disease widely distributed in tropical and subtropical regions. While the overall fatality rate is low, severe disease can occur, especially in vulnerable populations such as infants, the elderly, and those with pre-existing conditions. Chikungunya can be introduced to new areas by viremic travelers and generate local transmission in the presence of competent vectors, an immunologically susceptible population and favorable environmental conditions. Factors associated with increased CHIKV transmission include: broader geographic range of Aedes mosquitoes associated with transport of immature stages in goods and vessels, and expansion of conducive mosquito habitats due to climate change and periodic extreme events, with increased potential for chikungunya transmission in previously unaffected areas; unplanned urbanization and poor water management contribute to vector reproduction and persistent transmission cycles; low coverage or lack of sustainability of the vector control programs. political instability and conflict in countries at risk, such as Somalia, Sudan, and Yemen face exacerbated public health challenges include disruption of healthcare infrastructure hampering case detection and outbreak response; increased travel to and from endemic regions introducing cases into areas with established populations of competent mosquito vectors and favorable environmental conditions. The public health impact of the outbreaks depends on several factors, including the ability to detect chikungunya transmission, overall capacities for a coordinated public health response and clinical management, and the proportion of the population immunologically susceptible to CHIKV infection (i.e., people not previously infected with CHIKV). Young children, elderly individuals, and those with pre-existing health conditions such as diabetes, hypertension, and cardiovascular diseases are at higher risk of developing severe disease. Additionally, people living in areas with high mosquito populations and inadequate vector control measures are at greater risk of being infected. Effective public health strategies such as vector surveillance and control, and community education, are crucial in reducing the risk infection for susceptible individuals and preventing outbreaks. In some areas, there is a lack of medical facilities with limited geographical access, making it difficult for people to access basic health care. Other challenges can be stockouts of several essential supplies for prevention and control, lack of reagents and consumables for laboratory diagnosis, and need for re-training field teams and health workers. Given the ongoing outbreaks reported globally in 2025, the potential for further spread remains significant. Although some WHO Regions are currently reporting lower case numbers compared to 2024, others are experiencing a resurgence with significant increases in case numbers, furthermore some countries are seeing an emergence of chikungunya in previously unaffected populations. This uneven distribution of cases across regions makes it challenging to characterize the situation as a global rise but rather substantial increases in particular geographical areas. Further, the potential for geographic spread remains substantial given that chikungunya can be introduced into new areas by infected travelers where local transmission may be established in the presence of Aedes mosquito and a susceptible population. The risk is heightened by limited population immunity in previously unaffected areas, favorable environmental conditions for vector breeding, gaps in surveillance and diagnostic capacity, and increased human mobility and trade. Strengthening surveillance, enhancing vector surveillance and control, and improving public health preparedness are essential to mitigate the risk of further transmission.","advice":"WHO encourages countries to develop and maintain the capacity to detect and confirm cases, manage patients, and implement social communication strategies to gain community support to reduce the presence of the mosquito vectors. This includes training and alerting healthcare workers on case detection and potential complications, identifying risk groups for severe disease, ensuring appropriate clinical management, and following up on cases to prevent deaths. Targeted integrated vector surveillance and control measures are essential to reduce transmission rates. Strengthening health care capacity: Chikungunya can cause large outbreaks with high attack rates, affecting one-third to three-quarters of immunologically susceptible populations with the potential to cause heavy burdens on healthcare systems. Early detection of severe disease progression and access to proper medical attention are key to addressing clinical complications and reducing mortality, particularly among people at higher risk of severe disease (associated factors include age >65 years and <1 year, comorbidities, pregnant women specially in the third trimester due to vertical transmission during birth, which leads to neonatal chikungunya, with several complications such as encephalitis, hepatitis, and myocarditis). Countries vary in their capacity to detect and report chikungunya and other vector-borne diseases, and outbreaks are often reported retrospectively, meaning real-time epidemiological data necessary for public health response is lacking. WHO reiterates to all countries the importance of strengthening their healthcare capacity to rapidly detect and report chikungunya and other vector-borne diseases to understand real-time epidemiological data necessary for public health response. It is important to include measures for appropriate clinical detection and management as well as preparing health services for surges in case counts. Strengthening surveillance: Enhanced surveillance and epidemiologic investigations are essential to more accurately determine the incidence and trends of CHIKV infection. Current surveillance systems often prioritize dengue over other Aedes- borne arboviruses, leading to frequent clinical misdiagnosis and misreporting of CHIKV as dengue. Strengthening surveillance capacity will support more effective risk communication and guide targeted vector control strategies. Ongoing, close monitoring of the regional situation is also critical, along with active cross-border coordination and information sharing, given the potential for transmission in neighboring countries. Laboratory confirmation: Although many countries have acquired the capacity to perform RT-PCR testing in recent years, the availability of reagents for chikungunya testing is limited and costs may be prohibitive. Serology is generally cheaper and more accessible but, in some regions, serological tests can cross-react with other alphaviruses and produce false positive test results. Prevention and control: Prevention efforts are highly focused on surveillance and control of predominantly day-biting Aedes mosquitoes. For protection against mosquito bites, clothing that minimizes skin exposure to mosquitoes indoors and outdoors is advised. Window and door screens should be used to prevent mosquitoes from entering homes. Repellents can be applied to exposed skin or clothing in strict accordance with product label instructions. Avoidance of mosquito bites offers the best protection against CHIKV infection. Patients suspected of having CHIKV infection should avoid getting mosquito bites during the first week of illness to prevent further transmission to mosquitoes, that may in turn infect other people. The main method to reduce transmission of CHIKV is through control of the mosquito vectors and reduction of mosquito breeding sites. This requires mobilization of communities, who are critical in reducing mosquito breeding sites through emptying and cleaning containers that contain water on a weekly basis, disposing of waste, and supporting local mosquito control programmes. During outbreaks, intensified vector control activities targeting adult mosquitoes and larvae are a priority to interrupt the CHIKV transmission cycle. This may also be performed by health authorities as an emergency measure to control the mosquito population. Insecticide-treated mosquito nets should be used against day-biting mosquitoes by persons who sleep during the daytime, for example young children, sick patients or older people. No measures related to international traffic and trade are warranted at this time.","publishedAt":"2025-10-03T11:25:30.000Z","lastModified":"2025-11-18T17:18:35.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON581","response":"Overview of public health response in WHO Regions WHO is supporting Member States in strengthening preparedness and response to arbovirus epidemics and pandemics, in alignment with the pillars of the Global Arbovirus Initiative , the Global Strategic Preparedness, Readiness and Response Plan , and the 5Cs of WHO&rsquo;s global architecture for Strengthening health emergency prevention, preparedness, response and resilience (HEPR). WHO has undertaken the following actions: Issued an alert at the UN Geneva Press Briefing in July 2025 regarding the rapid global spread of chikungunya. African region In 2025, WHO and partners supported countries reporting chikungunya in the WHO African Region to respond to this outbreak. While sporadic transmission was reported in four countries, the most significant impact was observed in Mauritius and Kenya, where comprehensive response operations have been implemented. Mauritius: Surveillance has been strengthened to detect new cases early and monitor transmission trends. Vector control measures have been implemented including larval source reduction, household spraying, and fogging. Community engagement activities have been implemented through awareness campaigns promoting personal protection, household vector control, and early care-seeking. A Rapid Risk Assessment was conducted with WHO support to guide response actions. Kenya: A national response plan was developed, and an Incident Management System team was established for coordination. The Ministry of Health issued advisories to coastal counties, including Mombasa, to reinforce surveillance and clinical case management. Vector control activities were implemented including treating 2198 mosquito breeding sites with larvicide, fogging in 306 villages, and spraying 218 houses. Community sensitization activities were conducted which reached 780 people, and insecticide-treated nets were distributed to vulnerable groups. Eastern Mediterranean region In response to the chikungunya outbreaks, WHO EMRO is taking the following actions: A webinar to provide an orientation for national health authorities, public health professionals, and relevant stakeholders, offering a comprehensive overview of chikungunya epidemiology and outbreak prevention and control is planned. An online training session for Somalia on case management was conducted. Technical support is being provided to review national multisectoral arboviral response plans in affected countries, ensuring alignment with WHO-recommended strategies, integrated vector management, case management protocols, laboratory preparedness, and risk communication approaches. European region In response to the chikungunya situation in La R&eacute;union and Mayotte, authorities activated the corresponding levels of the Organisation de la R&eacute;ponse de S&eacute;curit&eacute; Civile (ORSEC) arbovirus plan. Enhanced surveillance, began on 1 May 2025, is being carried out at the local level (traps, individual reporting by citizens, etc.). This surveillance should enable the detection of new mosquito species. It is accompanied by health interventions around detected cases, whether imported or indigenous, particularly during periods of enhanced surveillance. Door-to-door surveys are being carried out for enhanced entomological and epidemiological investigations and active search for clinically suggestive cases; Vector control treatments in the affected area are being carried out (adulticide mosquito control treatments within a 300-metre radius of the case) ; Awareness is being increased among healthcare professionals in the sector and local authorities; The Ministry of Health published several press releases specifying the actions planned by the health authorities and best practices for vector control for the general population, and regularly posts updates on its social media accounts. Safety measures for products of human origin are implemented in accordance with the recommendations of the High Council for Public Health, including a 28-day deferral for donors of labile blood products and the introduction of viral genomic diagnosis. Posters and prevention messages targeting travellers are currently displayed on aircraft (for flights between mainland France and R&eacute;union, as well as to the French West Indies and French Guiana) and in airport terminals to raise awareness. In Italy, in the regions affected by local transmission events, all the control measures set out in the National Plan for the Prevention, Surveillance and Response to Arboviral Diseases have been implemented, including the immediate activation of epidemiological and entomological surveillance, the adoption of vector control interventions, population protection measures, and the safeguarding of transfusion and transplant safety. Region of the Americas PAHO has undertaken the following actions: Issued an Epidemiological alert on chikungunya in the Americas Region on 28 August 2025 regarding the rapid global spread of chikungunya. Provides advice and technical support to prevent and control chikungunya on the basis of the Integrated Management Strategy for Arboviral Disease Prevention and Control, adopted by PAHO/WHO Member States in 2016 (CD55.R6). Support is being provided for the implementation of an integrated epidemiological surveillance system model for dengue, chikungunya and Zika. This model integrates epidemiological, clinical, laboratory and entomological surveillance to generate standardized and timely information for decision-making. Technical support is being provided to implement a collaborative surveillance strategy for arboviral diseases, operationalized through virtual collaboration spaces (VCS). Through the VCS, countries and PAHO collaborate in the real-time analysis of their epidemiological, clinical, laboratory and entomological data, as well as the generation of automated reports and bulletins. National capacities are being strengthened for clinical diagnosis and case management of dengue, chikungunya, and Zika in the Region through the implementation of technical documents and clinical guidelines, virtual continuous training strategy that includes distance-based self-learning courses, and the establishment of national networks of clinical experts in arboviral diseases. Developed several initiatives to improve entomological surveillance systems, as well as the monitoring and management of resistance to insecticides used in public health. In August 2025, a workshop was held on updating the Integrated Management Strategy for the Prevention and Control of Arboviral Diseases (IMS-Arbovirus) and the roadmap for the implementation, monitoring, and evaluation of the IMS-Arbovirus in countries and territories of the Americas for the period 2026&ndash;2030. Public health laboratories are being supported in the implementation of RT-PCR testing and serology (IgM) interpretation (technical cooperation, training, provision of key reagents) and of genomic surveillance for chikungunya monitoring and characterization. Entomo-virological surveillance guidelines are currently being implemented to enable early detection and assessment. A new operational model for Aedes control is being developed and is currently in the implementation phase in the Americas Region. Vector-control activities are being strengthened in affected countries. South-East Asia Region WHO SEARO is supporting Member States by undertaking the following actions: Continuing to monitor the situation and raise awareness of chikungunya and other arboviruses in the region. Enhancing vector control for Aedes mosquitos to better control chikungunya and other arbovirus, strengthening community engagement. Advocacy and planning for integrated arbovirus surveillance&mdash;covering dengue, chikungunya, and Zika&mdash;are underway to generate stronger evidence for informed decision-making. The implementation of guidelines on the clinical management of chikungunya is actively being promoted. Western Pacific Region The WHO Regional Office for the Western Pacific has implemented the following measures: Shared the global situation and technical guidelines with Member States in the Western Pacific Region to support chikungunya preparedness and response. These include: (1) WHO Chikungunya Outbreak Toolbox , (2) WHO Guidelines for Clinical Management of Arboviral Diseases (Dengue, Chikungunya, Zika, and Yellow Fever) &ndash; 4 July 2025 , and (3) Policy Considerations for Strengthening Preparedness and Response to Arbovirus Epidemics and Pandemics &ndash; 16 July 2025 Requested Member States in the WPR to provide updates on the chikungunya situation in their respective countries for risk assessment. Conducted a Community of Practice (CoP) session on 14 August 2025 to share updates and best practices with Member States. In response to the chikungunya outbreaks, Member States have implemented response measures based on the evolving chikungunya situation at national and subnational levels: National and local health authorities have been conducting field investigations in areas with case clustering and outbreaks to assess transmission dynamics, inform decision-making, and coordinate multisectoral response efforts in the affected areas. Medical care is being provided to affected individuals, including hospitalization or home isolation for laboratory-confirmed cases, ensuring appropriate clinical management and reducing transmission risk. Surveillance systems have been strengthened to enable early detection, laboratory confirmation, and timely reporting of cases. Enhanced monitoring in healthcare facilities is supporting rapid identification and response to potential clusters and importation risks. Targeted vector control interventions are being implemented in high-risk areas, including environmental cleanup to eliminate breeding sites, larviciding, and adult mosquito control through fogging operations. Innovative approaches such as drone-assisted spraying are also being utilized. Community health workers are mobilized for door-to-door inspections and public education campaigns to promote source reduction and personal protection. Authorities are maintaining regular communication with the public to share updates, promote preventive measures, and address concerns.","epidemiology":"Chikungunya is a mosquito-borne viral disease caused by the CHIKV, an RNA virus in the alphavirus genus of the family Togaviridae . CHIKV is transmitted by infected female mosquitoes, most commonly Aedes aegypti and Aedes albopictus , which can also transmit dengue and Zika viruses. These mosquitoes bite primarily during daylight hours and Aedes aegypti feeds both indoors and outdoors, whereas Aedes albopictus feeds primarily outdoors. They lay eggs in manmade and natural containers with standing water. When an uninfected mosquito feeds on a person who has CHIKV circulating in their bloodstream, the mosquito can ingest the virus. Over a period of about 10 days (range: 7-12 days), the virus replicates in the mosquito and enters its salivary glands. Once this occurs, the mosquito becomes capable of transmitting the virus to a new human host through a subsequent bite. In the newly infected individual, the virus begins to replicate and reaches high concentrations in the blood, enabling further transmission to other mosquitos and perpetuating the transmission cycle. In symptomatic patients, CHIKV disease onset is typically 4&ndash;8 days (range 2&ndash;12 days) after the bite of an infected mosquito. Disease is characterized by an abrupt onset of fever, frequently accompanied by severe joint pain. The joint pain is often debilitating and usually lasts for a few days but may be prolonged, lasting for weeks, months or even years. Other common signs and symptoms include joint swelling, muscle pain, headache, nausea, fatigue and rash. Since these symptoms overlap with other infections, including those with dengue and Zika viruses, cases can be misdiagnosed. In the absence of significant joint pain, symptoms in infected individuals are usually mild and the infection may go unrecognized. Most patients recover fully from the infection; however, occasional cases of eye, heart, and neurological complications have been reported with CHIKV infections. Patients at extremes of the age spectrum are at higher risk for severe disease including newborns infected during delivery to infected mothers or bitten by infected mosquitoes in the weeks after birth, and older people, particularly those with underlying medical conditions. Patients with severe disease require hospitalization because of the risk of organ damage and death. Once an individual is recovered, available evidence suggests they are likely to be immune from future chikungunya infections. CHIKV may be detected directly in blood samples collected during the first week of illness using molecular tests such as reverse transcriptase&ndash;polymerase chain reaction (RT&ndash;PCR), and after the first week of illness using serologic tests to detect antibodies produced in response to CHIKV infection. Clinical management includes managing fever and joint pain with anti-pyretic, analgesics, maintaining adequate hydration by consuming sufficient fluids and ensuring general rest. There is no specific antiviral drug treatment for CHIKV infections. Paracetamol or acetaminophen are recommended for pain relief and reducing fever until dengue infections are ruled out, as non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding. There are currently two chikungunya vaccines that have received regulatory approvals and/or have been recommended for use in populations at risk in several countries, but the vaccines are not yet widely available nor in widespread use. WHO and external expert advisors are reviewing vaccine trial and post-marketing data in the context of global chikungunya epidemiology to inform possible recommendations for use.","formattedDate":"2025-10-03T13:08:06Z","matchedSignals":["cross-border signal","severity signal"]}},{"id":"2025-DON582","title":"Nipah virus infection - Bangladesh","disease":"Nipah virus infection","locations":["Bangladesh"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON582","summary":"Between 1 January and 29 August 2025, the International Health Regulations National Focal Point (IHR NFP) for Bangladesh notified WHO of four confirmed fatal Nipah virus (NiV) infection cases, temporally unrelated, reported from four different districts across three separated geographical divisions (Barisal, Dhaka, and Rajshahi) in Bangladesh. NiV infection is a zoonotic disease transmitted to humans through infected animals (such as bats or pigs), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. Fruit bats or flying foxes (Pteropus species) are the natural hosts for the virus. Human NiV infection is an epidemic-prone disease that can cause severe disease in humans and animals, with a high mortality rate, and outbreaks primarily occurring in South and South-East Asia. Since the first recognized outbreak in Bangladesh in 2001, human infections have been detected almost every year. To date, Bangladesh has documented 347 NiV cases through its Nipah surveillance system established to detect and respond to outbreaks promptly, with a case fatality rate of 71.7% There are currently no specific drugs or vaccines for NiV infection; intensive supportive care is recommended to treat severe respiratory and neurologic complications. Public health efforts should focus on raising awareness of risk factors, promoting preventive measures to reduce exposure to the virus, and on early case detection supported by adequate intensive supportive care. The Ministry of Health and Family Welfare in Bangladesh has implemented several public health measures with support from WHO. WHO assesses the overall public health risk posed by NiV at the national and regional levels to be moderate; the risk of international disease spread is considered low.","overview":"Between 1 January and 29 August 2025, the Bangladesh IHR NFP notified WHO of four confirmed fatal Nipah virus (NiV) infection cases that occurred at different times from four separate districts across three different divisions (Barisal, Dhaka, and Rajshahi) of Bangladesh. All cases were confirmed through Reverse Transcription Polymerase Chain Reaction (PCR) and Enzyme-Linked Immunosorbent Assay (ELISA) testing, and no epidemiological links were reported to have been identified between the cases. The first case was a young adult woman from Pabna district, Rajshahi division, with symptom onset on 25 January. She was admitted to a community hospital on 26 January and referred to another hospital the next day. She died on 28 January, and laboratory confirmation of NiV was received on 29 January. A total of 96 contacts were reported to be identified, and all tested negative for NiV. The second case was an adult man from Bhola district, Barisal division, who developed symptoms on 13 February and was admitted to hospital on 19 February. He was transferred to another hospital the next day and died on 22 February. NiV infection was confirmed on 21 February. A total of 71 contacts were reportedly identified, and all tested negative for NiV. The third case was an adult man from Faridpur district, Dhaka division, with symptom onset on 17 February. He was admitted to hospital on 25 February and died the same day. NiV infection was confirmed on 26 February. A total of 66 contacts were identified, and all tested negative for NiV. The fourth case was a male child from Naogaon district, Rajshahi division, with symptom onset on 3 August. He was admitted to a hospital on 8 August and moved to the intensive care unit the following day. He died on 14 August. Samples collected on 10 August tested positive for NiV on 22 August. An outbreak investigation team was deployed the same day. A total of 72 contacts were identified, and samples from 11 symptomatic contacts were collected. Six tested negative, while the results for the remaining are awaited. This case was reported outside the typical season (December to April). The first three cases had a history of consuming raw palm sap. However, the fourth case had no history of consuming raw palm sap, and the likely source/s of infection remain under investigation. None of the cases appears to be linked to each other. Fruit bats, the known reservoir for NiV, are present in the affected regions. Since the report of the first case in 2001, human infections have been reported almost every year, with case fatality ratios (CFR) varying between 25% (in 2009) and 100% (in 2024). In 2024, five laboratory-confirmed fatal cases of NiV were reported from Bangladesh (Figure 1, Figure 2). Figure 1. Annual number of reported Nipah virus cases and deaths, 1 January 2001 &ndash; 9 September 2025, Bangladesh. Source: Institute of Epidemiology, Disease Control and Research, Bangladesh. https://iedcr.portal.gov.bd/site/page/d5c87d45-b8cf-4a96-9f94-7170e017c9ce/- Figure 2. Distribution of Nipah cases in Bangladesh, 2001-2025, as of 14 August 2025","assessment":"Nipah virus (Henipavirus nipahense) is a zoonotic pathogen with a high CFR (40-75%) and no licensed vaccine or treatment. Its reservoirs are fruit bats or flying foxes (bats in the Pteropus genus), which are distributed in the coastal regions and on several islands in the Indian ocean, India, south-east Asia and Oceania. The virus can be transmitted to humans from wild and domestic animals. So far, outbreaks have only been reported in Asia; however, as the disease can be transmitted by domesticated animals and secondary human-to-human transmissions are also possible, it has considerable epidemic or pandemic potential. The disease is endemic in Bangladesh, with seasonal outbreaks linked to bat activities and cultural practices such as the consumption of raw date palm sap. Seasonal outbreaks occur between December and May, coinciding with the harvesting of date palm sap. To date, Bangladesh has documented 347 NiV disease cases, with a case fatality rate of 71.7%. Nearly half of these cases (n=162) were primary cases with a confirmed history of consuming raw date palm sap (DPS) or tari (fermented date palm sap), while 29% resulted from direct person-to-person transmission. In 2025 to date, four fatal cases of NiV infection have been reported in Bangladesh; however, none of them appear to be linked to each other. While three of the cases presented a seasonal pattern, clustered during the first two months of 2025, the fourth case presented outside of the usual season, with no history of consuming raw date palm sap, and the possible source of infection remains unknown. Based on the current available information, WHO assesses the overall public health risk posed by NiV at the national level to be moderate , taking into consideration the high case fatality rate, no availability of specific drugs or vaccines for NiV infection and the difficulty of early diagnosis. Although sensitive and specific laboratory methods exist, the symptoms during the first phase are not specific and could potentially delay a timely diagnosis, outbreak detection and response. In addition, fruit bats ( Pteropus spp .) are the natural reservoir of NiV, and they are present in Bangladesh and repeated spillover of the virus from its reservoir to the human population has been demonstrated. Despite ongoing efforts at risk communication and community engagement to raise awareness, there is continued consumption of raw date palm sap in the community. People infected with NiV may remain asymptomatic. Although human-to-human transmission has been reported in previous outbreaks, it has been less frequent in recent years. The yearly number of NiV infection cases reported in Bangladesh has remained under 10 since 2016, except for 2023, when 13 cases were reported. Strong public health measures are implemented in Bangladesh to detect and control outbreaks, including sentinel NiV surveillance, established since 2006, and the availability of Rapid Response Team (RRT) at both the central and district levels, along with the capacity to rapidly test samples. For neighbouring countries &ndash; India and Myanmar - WHO assesses the public health risk posed by NiV at the regional level to be moderate. While there has not been any report of previous cross-border transmission, the risk of spread still remains, given the shared ecological corridor of fruit bats and the occurrence among domestic animals and human cases previously reported in both countries. India has demonstrated capacity and experience in controlling previous NiV outbreaks. WHO assesses the public health risk posed by NiV at the global level to be low, as there have been no confirmed spread of cases outside Bangladesh.","advice":"In the absence of a licensed vaccine or specific therapeutic treatment for Nipah virus disease, the only way to reduce or prevent infection in people is by raising awareness of the risk factors. This includes providing guidance on measures that people can take to reduce exposure to the Nipah virus, and case management should focus on delivering timely supportive care, supported by an effective laboratory system. Intensive supportive care is recommended for treatment of severe respiratory and neurologic complications. Public health educational messages should focus on: Reducing the risk of bat-to-human transmission Efforts to prevent transmission should first focus on decreasing bat access to date palm sap and other fresh food products. Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of bat bites should be discarded. Areas where bats are known to roost should be avoided. Reducing the risk of human-to-human transmission. Close unprotected physical contact with NiV-infected people should be avoided. Regular hand washing should be carried out after caring for or visiting sick people. Protective measures include guidelines to limit the spread of the disease both in households and hospitals (use of protective equipment, isolation, and safe contact with medical staff). The options to prevent secondary transmissions are active case finding, contact tracing, isolation and quarantine of cases and their contacts. Controlling infection in health care settings Health and care workers caring for patients with suspected or confirmed infection, or handling specimens from them, should implement standard precautions for infection prevention and control at all times. As health care-associated infections and occupational infections of Nipah virus have been reported, in health-care settings, contact and droplet precautions should be used in addition to standard precautions, including the use of single-rooms for isolation. Airborne precautions are required in addition to contact precautions during aerosol-generating procedures. Enhanced environmental controls in health-care settings are advised, including twice daily environmental cleaning and disinfection of all surfaces in the patient care area of patients with suspected or confirmed NiV infection, and to ensure inpatient care areas meet or exceed the minimum ventilation rate of at least 60 litres per second per patient. Samples taken from people and animals with suspected NiV infection should be handled by trained staff working in suitably equipped laboratories. Based on the currently available information, WHO does not recommend any travel and/or trade restrictions.","publishedAt":"2025-09-18T18:00:00.000Z","lastModified":"2025-09-18T09:57:25.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON582","response":"Several public health measures have been implemented by local authorities, including: The Ministry of Health and Family Welfare has conducted investigations in collaboration with other sectors through a One Health coordinated approach. Contact tracing has been carried out around the identified cases, with continuous follow-up. Surveillance effort has been strengthened and extended beyond the regular active and passive surveillance to ensure early case detection. Health education and awareness campaigns, including community engagement and advocacy, are ongoing under the supervision of civil surgeons (the head of the district health systems). Nipah information leaflets have been distributed in endemic areas as part of risk communication efforts. Clinicians have been sensitized and alerted to NiV. Prompt sample collection, transportation, and testing were conducted at the reference laboratories. The support provided by WHO: Provided event communication support at national and international levels, including the timely submission of an official IHR notification to WHO. Closely followed up on NiV infection field investigations to support robust data collection and effective contact tracing. Supported case management, including infection prevention and control measures at household and health facility levels to prevent secondary cases. Monitoring of the evolving outbreak situation, especially during the ongoing Nipah season, including support for data compilation, assessment of epidemiological patterns, risk factors, and geographic spread. Provided technical support to the government in developing public health messaging for the prevention and control of the outbreak.","epidemiology":"Nipah virus infection is a zoonotic disease transmitted to humans through infected animals (such as bats or pigs), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. Fruit bats or flying foxes ( Pteropus species) are the natural hosts for the virus. The incubation period ranges from 4 to 14 days. However, an incubation period of up to 45 days has once been reported. Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests. The main tests used are RT-PCR from bodily fluids and antibody detection via ELISA. Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis (brain swelling). Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours. Further information about NiV infection can be found here . The CFR in outbreaks across Bangladesh, India, Malaysia, and Singapore range from 40% to 75%, depending on local capabilities for early detection and clinical management. There are currently no drugs or vaccines specific for NiV infection. Intensive supportive care is recommended to treat severe respiratory and neurologic complications. Henipavirus nipahense (Nipah virus) is considered a priority pathogen for the acceleration of medical countermeasures (MCMs) to respond to epidemics and pandemics as part of the WHO R&D Blueprint for Epidemics. [1]","formattedDate":"2025-09-18T09:38:38Z","matchedSignals":["transmission concern","novel or unusual signal","severity signal","response escalation"]}},{"id":"2025-DON580","title":"Ebola virus disease – Democratic Republic of the Congo","disease":"Ebola virus disease","locations":["Democratic Republic of the Congo"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON580","summary":"On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of Ebola virus disease (EVD) in the Bulape Health Zone, Kasai Province, DRC. The first known index case was a pregnant woman who presented at Bulape General Reference Hospital on 20 August 2025 with symptoms of high fever, bloody diarrhoea, haemorrhage and extreme weakness. She died on 25 August from multiple organ failure. On 4 September 2025, following confirmatory laboratory testing, the Ministry of Health declared an outbreak of EVD. Ebola virus disease is a serious, often fatal illness in humans. The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission. As of 4 September 2025, 28 suspected cases, including 15 deaths (case fatality ratio (CFR): 54%), have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone. Among the deaths, four are health-care workers. About 80% of the suspected cases are aged 15 years and older. Six samples were collected from five suspected cases and one probable death from Bulape health zone and arrived on 3 September at the National Public Health Laboratory (INRB) in Kinshasa for confirmation testing. All five samples tested positive for Ebola virus (EBOV) through GeneXpert and Polymerase Chain Reaction (PCR) assays on 3 September 2025. The Ministry of Health, with support from WHO and partners, is implementing public health response measures to contain the outbreak. WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level.","overview":"On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of EVD in the Bulape Health Zone, Kasai Province, DRC. The first known suspected index case was admitted to the Bulape General Reference Hospital on 20 August 2025. The patient was a pregnant woman at 34-weeks of gestation who presented with symptoms of fever, bloody diarrhoea, haemorrhage, vomiting, asthenia, followed by multiple organ failure. She died on 25 August 2025. Two of the health-care workers that had initially been in contact with this first case also developed similar symptoms and died. As of 4 September 2025, a total of 28 suspected cases, including 15 deaths, of which four are health-care workers (case fatality ratio (CFR): 54%) have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone. About 80% of the suspected cases are aged 15 years and older. Five blood samples from five suspected cases and a naso-pharyngeal swab from a probable death were collected from the three health areas and shipped to the National Public Health Laboratory (INRB) in Kinshasa for testing. On 3 September 2025, the laboratory testing conducted at INRB confirmed Ebola virus (EBOV) [1] through GeneXpert and Polymerase Chain Reaction (PCR) assays. The results obtained from whole genome sequencing suggest that the outbreak is a new zoonotic spillover event and is not directly linked to the 2007 Luebo or 2008/2009 Mweka EVD outbreaks. [2] Figure 1. Map of suspected cases and deaths of Ebola virus disease by health zone, as of 4 September 2025","assessment":"This is the 16 th EVD outbreak in the DRC since 1976. The current outbreak occurs after almost three years without a confirmed EVD outbreak in the country. The last EVD outbreak in the country was declared on 15 August 2022 in Beni city, North Kivu province, with one single case reported who later died, and the MoH declared the end of the outbreak on 27 September 2022. In the Bulape district, the epicentre of the current outbreak, the last EVD outbreak was recorded in 2007. This outbreak is occurring in a complex epidemiological and humanitarian context. The country is facing several outbreaks, including mpox, cholera, and measles. In addition, the country is experiencing a long-term economic and political crisis. The country's resources and capacity to effectively respond to the current outbreak are therefore limited. The epicentre of this outbreak is in the proximity of the Tshikapa city, the capital city of the Kasai province, and the Angolan border (approximately 100 to 200 kilometres, depending on the nearest border crossing point). Although the affected district is a hard-to-reach rural area relatively far from the two main urban centres of Mbuji Mayi and Kananga, population movements between different parts of the province are frequent, especially between Bulape and Tshikapa. In addition, epidemiological investigations are ongoing with transmission chains, and the source of the outbreak has not yet been identified; therefore, additional infected people cannot be ruled out. The date of symptom onset for the first case is not yet known, as well as the therapeutic itinerary prior to health facility consultation, which further increases the likelihood of an ongoing community transmission with further risk of spread to other health districts. WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level.","advice":"Effective outbreak control relies on the application of a set of interventions, namely clinical management, IPC & Water, sanitation and hygiene (WASH), surveillance and contact tracing, good laboratory service, safe and dignified burials, community engagement, and social mobilization. The Ebola virus can persist in some body fluids of people who have recovered from EVD. In a limited number of cases, secondary transmissions resulting from exposure to the body fluids of people who have recovered from EVD have been documented. Therefore, maintaining collaborative relationships with survivor associations while monitoring survivors is a priority to mitigate any potential risks. Early diagnosis and initiation of optimized supportive clinical care can reduce mortality from EVD. In addition, monoclonal antibodies active against a 3-antibody combination of atoltivimab, maftivimab and odesivimab [Inmazeb&reg;] or a single antibody ansuvimab [Ebanga&reg;]. Ebola treatment centres should be designed and managed to ensure safe care is provided with appropriate biosecurity and infection prevention and control intervention, and allow optimized care, allowing direct visualization of patients in the red zone as much as possible. WHO and partners have worked to develop these innovative solutions. There is a need to strengthen surveillance and other response activities, including at relevant points of entry and borders, to contain the possibility of exponential spread. Cases, contacts and individuals in affected areas who present signs and symptoms compatible with case definitions should be considered suspects and cared for and treated in designated treatment facilities with appropriate biosecurity, infection prevention and control and be offered testing in a timely fashion and advised not to travel. Collaboration with neighbouring countries should be enhanced to harmonize reporting mechanisms, conduct joint investigations, and share critical data in real time. Surrounding countries should enhance readiness activities to enable early case detection, isolation and treatment. Critical infection prevention and control measures should be implemented and/or strengthened in all health care facilities, per WHO's Infection prevention and control guideline for Ebola and Marburg disease . Health workers caring for patients with confirmed or suspected Ebola should apply transmission-based precautions in addition to standard precautions , including appropriate use of PPE and hand hygiene according to the WHO 5 moments to avoid contact with patients&rsquo; blood and other body fluids, and with contaminated surfaces and objects. Waste generated in health-care facilities must be safely segregated, safely collected, transported, stored, treated and finally disposed. National guidelines should be followed on rules and regulations for safe waste disposal or WHO&rsquo;s guidelines on safe waste management . Patient-care activities should be undertaken in a clean and hygienic environment that facilitates practices related to the prevention and control of health-care-associated infections, as outlined in Essential environmental health standards in health care . Safe water, adequate sanitation and hygiene infrastructure and services should be provided in healthcare facilities. For details on recommendations and improvement, follow the WASH FIT implementation Package . In accordance with the recommendations of the Strategic Advisory Group of Experts on immunization, the Ervebo vaccine is recommended during an EVD outbreak due to EBOV for ring vaccination, for contacts and potential contacts of confirmed/suspected EVD cases, as well as for frontline workers. A global stockpile has been established and is being coordinated by the International Coordination Group for vaccine procurement. WHO advises against any restrictions on travel and/or trade to the Democratic Republic of the Congo based on available information for the current outbreak.","publishedAt":"2025-09-05T18:00:00.000Z","lastModified":"2025-09-16T14:56:11.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON580","response":"Health authorities are implementing public health measures, including but not limited to the following: A crisis committee was activated at both the local and provincial levels. Risk communication and active surveillance activities are ongoing. All cases are isolated, and Infection Prevention and Control (IPC) measures have been implemented. Patients are receiving intravenous medication. Contact isolation and tracing are continuing. Investigations are ongoing. WHO is supporting the national authorities, including through: Risk assessment and investigation. Providing operational, financial and technical support to the Ministry of Health to ensure swift response. Provision of essential supplies (Personal Protective Equipment (PPE), medical supplies and infrastructures support) The approved Ervebo vaccine is available with a stock of 2000 doses located in Kinshasa expected to be shipped shortly to the affected area, to vaccinate contacts of confirmed or suspected cases, frontline and health workers.","epidemiology":"Ebola virus disease is a severe disease caused by the Ebola virus (EBOV). The virus belongs to the species Orthoebolavirus Zairense . The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission by direct contact with bodily fluids, organs, or contaminated surfaces and materials. The incubation period, the time between infection with the virus and the onset of symptoms, ranges from 2 to 21 days, but typically is 7&ndash;11 days. People are not infectious during the incubation period; they become contagious with early symptoms, therefore, transmission risk begins at the onset of clinical signs and increases with disease severity. The average case fatality ratio is 50%; case fatality ratios ranging from 25% to 90% have been reported in previous outbreaks. The disease is characterised by an acute onset of fever with non-specific symptoms/signs (e.g., abdominal pain, anorexia, fatigue, malaise, myalgia, sore throat) usually followed several days later by nausea, vomiting, diarrhoea, and occasionally a variable rash. Severe illness may include haemorrhagic manifestations (e.g., bleeding), encephalopathy, shock/hypotension, multi-organ failure, and spontaneous abortion in infected pregnant women. Individuals who recover may experience prolonged sequelae (e.g., arthralgia, neurocognitive dysfunction, uveitis, sometimes followed by cataract formation), and clinical and subclinical persistent infection may occur in immune-privileged compartments (e.g., central nervous system, eyes, testes). Family members, health and care providers, and participants in burial ceremonies with direct contact with the deceased are at particular risk.","formattedDate":"2025-09-05T15:56:22Z","matchedSignals":["transmission concern","severity signal","response escalation"]}},{"id":"2025-DON579","title":"Cholera – Multi-country with a focus on countries experiencing current surges","disease":"Cholera","locations":["Multi-country with a focus on countries experiencing current surges"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON579","summary":"The global cholera situation continues to deteriorate, driven by conflict and poverty, posing a significant public health challenge across multiple WHO regions. Between 1 January and 17 August 2025, a total of 409 222 cholera/Acute Watery Diarrhoea (AWD) cases and 4738 deaths were reported globally, from 31 countries, with six of the 31 countries reporting case fatality rates above 1%, indicating serious gaps in case management and delayed access to care. Cholera is resurging in a number of countries, including some that had not reported substantial case numbers in years, like Chad and the Republic of Congo, while other countries, such as the Democratic Republic of the Congo, South Sudan, and Sudan, are experiencing outbreaks that are continuing from 2024, with significant geographic expansion. This complicates containment efforts and strains fragile health systems. Conflict, mass displacement, disasters from natural hazards, and climate change have intensified outbreaks, particularly in rural and flood-affected areas, where poor infrastructure and limited healthcare access delay treatment. These cross-border factors have made cholera outbreaks increasingly complex and harder to control. Safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to ending this cholera emergency and preventing future ones. Given the scale, severity, and interconnected nature of these outbreaks, the risk of further spread within and between countries is considered very high. Without urgent and coordinated public health measures, based on strengthened surveillance, improved case management, WASH interventions, vaccination campaigns, and cross-border collaboration, cholera transmission is likely to expand across countries. WHO collaborates with the Ministries of Health, partners and stakeholders in affected countries. WHO supports countries in all pillars of cholera control, including strengthening epidemiological surveillance, reinforcing laboratory capacity, improving access to and quality of treatment, implementing appropriate WASH and IPC practices, promoting community engagement in cholera prevention and control and facilitating OCV access and campaign implementation. On 26 August, the Africa CDC and WHO launched the Continental Cholera Emergency Preparedness and Response Plan for Africa 1.0, alongside a joint Incident Management Team. This initiative follows the commitment of African Heads of State and Government, who have elevated cholera to a continental priority through their recent high-level Call to Action, pledging to control and eliminate outbreaks by 2030.","overview":"In 2025, the global cholera situation continues to pose a significant public health challenge across multiple regions. Between 1 January and 17 August 2025, a total of 409 222 cholera/AWD cases and 4738 deaths were reported globally, from 31 countries. [1] During the same period in 2024, 510 638 cases and 3248 deaths were reported from 28 countries, representing a 20% decrease in cases, but a 46% increase in deaths. In 2025, the Eastern Mediterranean Region recorded the highest number of cholera/AWD cases (230 991 cases, six countries), followed by the African Region (172 750 cases, 23 countries), the South-East Asia Region (2985 cholera/AWD cases, five countries), and the Region of the Americas (2496 cases, one country). Cholera-related deaths were highest in the African Region (3763 deaths, CFR 2.2 %), followed by the Eastern Mediterranean Region (943 deaths, CFR 0.4%), the Region of the Americas (31 deaths, CFR 1.2%), and the South-East Asia Region (One death, CFR 0.03%). Meanwhile, the European and Western Pacific regions have not reported any outbreaks. Cholera is resurging in a number of countries, with some that had not reported substantial case numbers in years, including Chad and the Republic of the Congo, while others, including the Democratic Republic of the Congo (DRC), South Sudan, and Sudan, are experiencing outbreaks that are continuing from 2024, with significant geographic expansion. The spread into previously unaffected areas is complicating containment efforts and straining fragile health systems. These trends reveal deep systemic weaknesses in health systems, Water, Hygiene, and Sanitation (WASH), and disease surveillance systems, especially in countries facing humanitarian crises. Cross-border transmission is occurring, underscoring the urgent need for stronger surveillance, timely reporting, and coordinated response across international borders. The disease burden remains high, particularly in the following countries currently experiencing acute outbreaks: Chad, DRC, the Republic of the Congo, South Sudan, and Sudan. These countries continue to report high transmission rates, case fatality rates, and experience significant challenges in outbreak control and access to care. However, differences in case definitions and reporting systems have been observed across countries and regions, which may affect the comparability of data and the interpretation of trends. Therefore, given these complexities, the data presented here likely underestimates the true burden of cholera and should be interpreted with caution. Figure 1 . The global cholera and acute watery diarrhoea (AWD) cases per 100 000 population, 1 January to 17 August 2025 * * Afghanistan and Myanmar report AWD cases. Figure 2 . Number of cholera cases by epidemiological week of reporting, as of 17 August 2025. Data source: WHO Figure 3. Cholera cases by epidemiological week of reporting (Chad, Republic of the Congo, DRC, South Sudan and Sudan) available as of 17 August 2025. Data source: WHO Overview of selected countries Cholera is resurging in a number of countries, including some that have not reported cases in years; the countries highlighted in this report continue to report high transmission rates, case fatality rates, and experience significant challenges in outbreak control and access to care. For a more detailed overview of cholera globally, please refer to the regularly produced global cholera situation report . Chad On 24 July 2025, Chad officially confirmed a cholera outbreak, following the report of the first suspected case on 13 July from Dougui Camp in Chokoyane health district, located in Ouadda&iuml; province along the border with Sudan. Between 13 July and 19 August, the country reported a total of 776 cholera cases, including 53 deaths, resulting in a case fatality rate (CFR) of 6.8%. Of these deaths, 27 occurred in the community, highlighting gaps in timely access to care. Laboratory confirmation has been obtained for 32 cases through culture testing. As of 19 August, suspected cholera cases have been reported from two provinces (Ouadda&iuml; and Sila) and six health districts: Abdi, Adr&eacute;, Amleyouna, Chokoyane, Farchana and Hadjer Hadid. Among these, Chokoyane is the most affected, accounting for 541 cases and 25 deaths, with a district-specific CFR of 4.6%. Republic of the Congo Between 23 June and 17 August 2025, the Republic of the Congo reported a total of 457 suspected cholera cases and 35 deaths, resulting in a CFR of 7.7 %. The outbreak, which began in the Brazzaville district, has been spreading to districts along the Congo River. Brazzaville has recorded a CFR of 4.8 % (269 cases; 13 deaths), while Congo-Oubangui has experienced a significantly higher CFR of 11.7 % (188 cases; 22 deaths). The most affected age group is 15 to 24 years, accounting for 19% of all reported cases. Democratic Republic of the Congo From 1 January to 10 August 2025, the Democratic Republic of the Congo has reported a total of 46 800 cholera cases and 1362 deaths, resulting in a CFR of 2.9%. Cholera cases have been reported in 16 out of the country&rsquo;s 26 provinces, with Kwango being the most recently affected as of week 31. During week 32, the country recorded 1887 new cases and 84 deaths, representing a 4.8% and 1.2 % decrease compared to the previous week, respectively. In the past four weeks, 57.4% of all cases have been concentrated in Kinshasa, North-Kivu, South-Kivu and Tshopo provinces. Kinshasa alone has reported 1781 cases and 136 deaths, with a notably high CFR of 8%. In week 31, Kinshasa recorded 126 cases and five deaths, with a weekly CFR of 4%. This shows a declining trend compared with the previous weeks. South Sudan From 1 January to 17 August 2025, South Sudan has reported a total of 71 825 suspected cholera cases and 1194 deaths, resulting in a CFR of 1.7 %. The outbreak has affected 55 of 80 counties across eight states and three administrative areas, demonstrating widespread transmission throughout the country. During the most recent reporting month, from 21 July to 17 August 2025, 2472 cases and 36 deaths were recorded nationwide. Between 14 July to 13 August 2025, approximately 74% of the cases reported were concentrated in Unity State, the Abyei Administrative Area, and Central Equatoria. Unity State reported 1562 cases and 10 deaths, Abyei recorded 988 cases and two deaths, while Central Equatoria registered 244 cases and two deaths. Sudan Between 1 January and 11 August 2025, Sudan has reported a total of 48 768 cholera and acute watery diarrhoea cases, along with 1094 deaths, resulting in a CFR of 2.2 %. The outbreak has affected all 18 states, with the majority of cases, 72 % reported from Khartoum (22 225 cases), North Kordofan (7394 cases), and White Nile (5622 cases). Cholera has also been confirmed in all five Darfur states, where both cases and deaths are rising. New areas, including border localities near Chad, have recently reported cases, indicating expanding transmission. The reported cholera burden varies significantly across the Darfur states. In the northern state, 3687 cases and 26 deaths have been reported, with a CFR of 0.7 %. The southern state has recorded 1589 cases and 66 deaths, resulting in a higher CFR of 4.2 %. The central state has reported 682 cases and nine deaths (CFR 1.3 %), while the eastern state has seen 517 cases and 26 deaths, with a notably high CFR of 5%. The western state has reported 17 cases with no associated deaths. There are identified gaps in the surveillance system in Darfur, which may lead to delayed reporting from some areas and no reports in others.","assessment":"As of 17 August 2025, cholera outbreaks continue to escalate across multiple countries, with seven of the 31 countries now reporting case fatality rates above 1%, indicating serious gaps in case management and delayed access to care. Among these, four countries&mdash;Chad, the Democratic Republic of the Congo (DRC), South Sudan, and Sudan&mdash;are currently classified as being in a major outbreak due to the severity and scale of their outbreaks. All countries highlighted in this report are facing multiple and similar challenges to control the ongoing outbreaks, underscoring the urgent need for public health interventions and international support. Cholera outbreaks have been recurrent in several areas of the Democratic Republic of the Congo and South Sudan over the past years. In contrast, Chad and the Republic of the Congo have not reported large-scale outbreaks in recent years. This limited exposure has contributed to low levels of awareness regarding cholera prevention and treatment among both communities and health-care providers, which can contribute to late detection of cases and late care seeking. Access to affected populations continues to be severely constrained by challenging geography, including outbreaks occurring in remote and hard-to-reach areas such as the Democratic Republic of the Congo and the Republic of the Congo. In Chad, South Sudan, and Sudan, access is further impeded by seasonal flooding and poor road infrastructure, limiting the mobility of both national and international health workers and the timely delivery of essential medical supplies. These geographic and infrastructural barriers are also hindering the implementation of community programmes, including the decentralization of treatment services. As a result, delays in accessing care are contributing to elevated case fatality rates. The Republic of the Congo and Chad are currently reporting the highest CFRs at 7.7% and 6.8%, respectively. Nearly 50% of reported deaths occur within communities before patients reach health facilities. Insecurity, population displacement, and the ongoing refugee crisis&mdash;particularly in Chad, South Sudan, and Sudan&mdash;are compounding these challenges. In these settings, CFRs consistently exceed the 1% threshold, underscoring the impact of restricted access to care. In conflict-affected areas, including parts of Sudan and eastern DRC, insecurity and displacement continue to obstruct surveillance activities and limit the ability to accurately assess the scope of the outbreaks. Cross-border population movement, particularly in areas with porous borders and high mobility, further exacerbates the risk of regional spread. Many of these countries share borders and experience frequent migration due to trade, displacement, and conflict, increasing the likelihood of cholera transmission across national boundaries. Inadequate access to clean water and sanitation remains a common denominator across all affected countries, leaving communities highly vulnerable to cholera outbreaks. Seasonal factors such as heavy rains and flooding further amplify this risk by contaminating water sources and facilitating rapid transmission. These systemic barriers, coupled with overstretched response capacities, are contributing to high case fatality. There is an urgent need to decentralize treatment services, strengthen surveillance systems, and improve access to lifesaving care to reduce preventable deaths and mitigate the impact of ongoing outbreaks. Given the scale, severity, and interconnected nature of these outbreaks, the risk of further spread within and between countries is considered very high. Without urgent and coordinated public health measures, including improved case management, WASH interventions, vaccination campaigns, and cross-border collaboration, cholera transmission is likely to expand across countries.","advice":"Leadership and coordination Response to cholera outbreaks requires strong multi-sectoral, multi-partner coordination, ensuring epidemiological data is available to guide coordinated responses across case detection, RCCE, WASH, case management, OCV administration and prevention of further spread. Coordination mechanisms should build on existing mechanisms where available and should be implemented at both national and sub-national levels. Epidemiological Surveillance and Laboratory WHO supports the national surveillance systems with the deployment of rapid response teams and assistance for data reporting and analysis. WHO supports diagnostics through the provision of rapid diagnostic test kits, training of clinical staff on sample collection and the use of RDTs, training of laboratory diagnosticians, the development and dissemination of recommendations and tools and provision of materials for laboratory diagnostics. To strengthen early detection of cases and the monitoring of cholera outbreaks, WHO recommends: Deployment of rapid response teams Integrate health facility-based surveillance, community-based surveillance and event-based surveillance while also integrating epidemiological data with test results Regularly evaluate surveillance systems and use results to strengthen Use standard recommended definitions of suspected cholera cases and of acute watery diarrhoea Use of rapid diagnostic tests for the early detection of suspected or probable cholera outbreaks Systematically record standard case-based data on suspected cholera cases detected by health-facility-based surveillance Perform routine analysis of key morbidity and mortality indicators (CFR -health facility-deaths and community deaths) at administrative or health zone levels to orient response activities to target the most affected populations. Strengthening laboratory capacity to confirm cholera outbreaks and monitor antimicrobial resistance Data sharing and joint intervention planning between neighbouring countries, especially in regions with high cross-border movement, is important to prevent further geographic spread and control importation of cases and or existing outbreaks. Case Management In order to improve cholera case management, it is advised to use treatment protocols and clinical materials, and to ensure staff at CTCs, CTUs, and ORPs receive proper training and supervision. Multiple countries are reporting high CFR and a high proportion of deaths occurring in communities. To reduce cholera deaths, WHO recommends: Working with RCCE colleagues to promote awareness of cholera, including the importance of early initiation of ORS and rapidly seeking treatment if symptoms occur Ensuring early access to treatment through implementation of community-based treatment strategies, including oral rehydration points and distribution of ORS via Community Health Workers Reinforce or set up referral mechanisms, including transport from the community and outpatient community structures to inpatient facilities Setting up dedicated cholera treatment structures &ndash; these may be integrated into existing health-care facilities or be set up as independent structures Training staff to recognize and treat patients with suspected cholera Ensure adequate supplies for patient treatment Infection Prevention and Control (IPC)/Water, Hygiene, and Sanitation (WASH) WHO recommends strengthening WASH and IPC measures in health-care facilities through regular evaluations, staff training, provision of essential supplies, and proper implementation of protocols to reduce transmission. Priority WASH and IPC activities include: Improving WASH in healthcare facilities - adequate quantity and quality of water, availability of toilets Ensuring at least minimum infection prevention and control measures are implemented in health-care facilities, and especially cholera treatment facilities Provision of safe drinking water Water quality monitoring Safe excreta disposal Distribution of WASH kits in affected communities Promotion of protective hygiene practices Risk Communication and Community Engagement Risk communication and Community Engagement colleagues work across all response pillars, supporting information exchange between affected populations and public health responders. WHO recommends: Community promotion of early care seeking, Promotion of preventive hygiene measures &ndash; hand and food hygiene Supporting implementation and OCV campaigns Developing social listening to understand the concerns and any misinformation circulating in affected communities so they can be addressed Engagement of communities on the protection of water sources Vaccination Oral Cholera Vaccine campaigns are an important tool to control cholera outbreaks when used alongside improvements in water and sanitation. OCV protects affected communities and reduces the impact of the outbreak when timely implemented and reduces the risk and extent of outbreak spread. Single-dose strategies for reactive vaccination are currently in effect. Preventive vaccination campaigns have been suspended since late 2022, and the vaccine shortfall has now stalled reactive vaccination efforts as well. WHO recommends: Fostering the preparedness and the definition of vaccination strategies for outbreak response Submission of a timely and targeted ICG request for reactive vaccination campaign Strong risk communication to inform communities about campaigns, enhance demand, maximise uptake and build trust around vaccine safety and efficacy Integration of RRCE into vaccination plans Readiness and timely implementation of vaccination campaigns Fostering sound evaluation and impact assessment of reactive vaccination campaigns WHO does not recommend travel or trade restrictions to and from the cholera outbreak-affected countries.","publishedAt":"2025-08-29T18:00:00.000Z","lastModified":"2025-08-29T14:12:24.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON579","response":"WHO collaborates closely with Ministries of Health and partners to coordinate cholera response efforts, strengthen surveillance systems, and support diagnostics, case management, and vaccination campaigns. This includes deploying rapid response teams, providing training and supplies for clinical and laboratory staff, supporting WASH and IPC measures in health facilities, and facilitating access to Oral Cholera Vaccines (OCV) through the International Coordinating Group (ICG) mechanism. WHO and partners also promote integrated risk communication and community engagement to support cholera-affected countries through information sharing, training, and development of integrated RCCE plans and tools. In addition, WHO encourages countries to use the Global Task Force on Cholera Control (GTFCC) tools to improve surveillance and guide targeted interventions. On 26 August, the Africa CDC and WHO launched the Continental Cholera Emergency Preparedness and Response Plan for Africa 1.0, alongside a joint Incident Management Team. This initiative follows the commitment of African Heads of State and Government, who have elevated cholera to a continental priority through their recent high-level Call to Action, pledging to control and eliminate outbreaks by 2030. Overview of public health response in selected countries Chad Coordination: WHO is working closely with the Ministry of Health and international partners to coordinate response efforts. Cross-border collaboration with Sudan is being supported to address shared challenges. Epidemiological Surveillance and Laboratory: Daily surveillance updates and sharing of epidemiological situation with all partners. Active case finding in Dougi and Hadjer Hadid camps. Donation of rapid diagnostic tests (RDTs) and reinforcement of the laboratory for culture confirmation of V. cholerae to reduce the need to transport samples to N&rsquo;Djamena. Case Management: Patient care and prevention efforts continue in affected districts, with hospitalization, isolation, and set-up of initial five cholera treatment centres in Ouddai. Supplies: Prepositioning of cholera kits for preparedness in yet to be affected districts, donation of treatment materials (peripheral, central and community kits) to affected districts. Infection Prevention and Control /Water, Hygiene, and Sanitation: Critical gaps remain, particularly in areas where water access is below emergency standards and WASH funding is limited. Partners are urged to prioritize WASH in future funding proposals to address waterborne disease risks effectively. Risk Communication and Community Engagement: Awareness campaigns are ongoing to promote hand hygiene, latrine use, early care seeking and food safety. RCCE partners are supporting integrated communication strategies. Vaccination: The ICG approved a request from the Government of Chad for 870 000 doses for eastern Chad. An additional 250 000 doses were approved as prepositioning stock. Doses will arrive in the country on 29 August, and the campaign will be implemented shortly afterwards. Preparedness and Readiness: Anticipating potential spread of the disease, the country is working with partners on preparedness in areas not yet affected. WHO prepositioned cholera kits in at-risk districts. Democratic Republic of the Congo: Coordination: WHO has deployed multidisciplinary teams to Kinshasa to support technical response and coordination. A cross-border coordination meeting with the Republic of the Congo was held on 29 July, with another meeting in planning. Epidemiological Surveillance and Laboratory: Technical support provided for cleaning and analysing surveillance data. Training sessions held on the use of cholera rapid diagnostic tests in selected health zones. Case Management: Evaluations conducted in cholera treatment centres; medicines and supplies distributed to affected provinces. Hundreds of health technicians and community health workers were trained to support cholera response, including pre-referral care and household distribution of ORS and Aquatabs. Infection Prevention and Control /Water, Hygiene, and Sanitation : WASH efforts are ongoing, with WHO providing logistical support and coordination to improve hygiene infrastructure and water quality in affected areas. Risk Communication and Community Engagement: Mapping of vulnerable population and mass outreach activities reached over three million people across multiple provinces. Alerts received via call centre and interactive media broadcasts were conducted to promote cholera prevention. Briefings held for community teams and civil society members on communication, infodemic management, and cholera response strategies. Vaccination: Since the beginning of the year, three vaccination campaigns have been implemented and targeted 8.6 million people living in 23 health districts of seven provinces. The most recent campaign started on 19 August and targeted 3.7 million people in the city of Kinshasa. A fourth request was approved by ICG to target an additional 2.2 million people in three Provinces of the country. The vaccines are planned to arrive in several lots between 22 and 29 August. Republic of the Congo Coordination: WHO has deployed 33 experts, including epidemiologists, case management experts, RCCE and logisticians. Cross-border coordination with DRC is active. Epidemiological Surveillance and Laboratory: Training of 80 community volunteers in Mossaka and Mbamou and provision of 200 cholera RDTs and Yoro and Brazzaville ports. Delivery of 9.5 tonnes of medicines and cholera kits. Case Management: Briefing of 172 health workers on case management and IPC, installation of three treatment tents and construction of cholera treatment centres in Mbamou and Mossaka. Infection Prevention and Control /Water, Hygiene, and Sanitation: Training on standard precautions and biomedical waste management. Retraining of 22 health workers on standard precautions and chlorination of water at Mossaka base hospital. Establishment of a water supply circuit in Lissanga treatment unit. Risk Communication and Community Engagement: Awareness raising conducted for 6023 people, including 318 households. Provision of support to community and religious leaders and distribution of 3000 posters to the Ministry of Health Vaccination: An OCV request targeting five health zones was approved by ICG members. South Sudan Coordination: WHO is coordinating with the Ministry of Health (MoH) and partners to manage the outbreak. Epidemiological Surveillance and Laboratory: WHO is supporting the MoH on routine analysis of reported cases to understand drivers of the outbreak and provision of feedback to the states and counties WHO supported the government on the cholera testing algorithm, where sample collection and weekly testing from confirmed locations (3-5 samples) happen. Case Management: WHO oversees the ongoing mapping of functional Oral Rehydration Points (ORPs), Cholera Treatment Centers (CTCs) and Cholera Treatment Units (CTUs), within the country. In addition, supported training of health-care providers on case management and community-based volunteers on community case management, provision of supplies to cholera treatment facilities, supported the set-up of oral rehydration points and improvements of cholera treatment facilities. Infection Prevention and Control /Water, Hygiene, and Sanitation: WASH interventions are being implemented with WHO support, focusing on hygiene promotion, safe water access, and sanitation improvements. Vaccination: Since the beginning of this outbreak, over 10 million OCV doses have been approved and delivered; campaigns have been completed across multiple regions with high uptake in several counties. Post-campaign evaluations are underway. Sudan Coordination: WHO and partners are exploring ways to support cholera response efforts in Sudan and Chad, through technical assistance and potential deployments. Infection Prevention and Control/Water, Hygiene, and Sanitation: WASH interventions are being implemented with WHO support, focusing on hygiene promotion, safe water access, and sanitation improvements. Vaccination: Since the beginning of the outbreak, 17 requests have been approved through the ICG mechanisms, targeting 25 million people.","epidemiology":"Cholera is an acute diarrheal infection caused by consuming food or water contaminated with the bacterium Vibrio cholerae . It is primarily associated with poor sanitation and limited access to safe water. The disease can cause severe acute watery diarrhoea, resulting in significant morbidity and mortality. The speed of spread depends on exposure levels, population vulnerability, and environmental conditions. Cholera affects both children and adults and can be fatal if left untreated. However, cholera is easily treatable, with most cases successfully managed through prompt administration of Oral Rehydration Solution (ORS). The incubation period ranges from 12 hours to five days after consuming contaminated food or water. While most infected individuals remain asymptomatic, they can still shed the bacteria in faeces for up to 10 days, potentially spreading the infection to others. Among symptomatic cases, most experience mild to moderate illness, while a smaller proportion develop severe diarrhoea and vomiting, which can lead to life-threatening dehydration. Humanitarian crises and disasters from natural hazards, such as floods, heighten the risk of cholera transmission by disrupting water and sanitation systems and forcing populations into overcrowded, unsanitary conditions. Controlling cholera outbreaks requires a multisectoral approach, combining surveillance, WASH interventions, adequate case management, social mobilization, community engagement and risk communication and oral cholera vaccination.","formattedDate":"2025-08-29T09:00:18Z","matchedSignals":["cross-border signal","severity signal"]}},{"id":"2025-DON578","title":"Circulating vaccine-derived poliovirus type 1- Israel","disease":"Circulating vaccine-derived poliovirus type 1- Israel","locations":[],"riskLevel":"high-attention","signalClass":"Potential international public-health emergency","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON578","summary":"On 4 August 2025, Israel notified WHO of a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak. Between February and July 2025, nine genetically linked virus isolates were found in environmental samples from seven sites, mainly in Jerusalem and the Central Region. No human cases of paralytic polio have been reported. Israel discontinued routine use of the bivalent oral polio vaccine in March 2025 but continues using inactivated polio vaccine (IPV) as part of the country’s routine immunization schedule. WHO and partners of the Global Polio Eradication Initiative are supporting national and subnational authorities. WHO assesses the risk of international spread of this cVDPV1 outbreak in Israel as low, due to strong overall immunity, surveillance, and response systems. However, the virus is circulating in under-vaccinated, vaccine-sceptic communities with ties to similar groups abroad, posing a potential risk for further spread.","overview":"On 4 August 2025, WHO received an International Health Regulations notification from the IHR National Focal Point (NFP) for Israel reporting the declaration of a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak in the country. Between February and July 2025, nine genetically related VDPV1 isolates were detected in environmental samples collected from seven sampling sites, four of which are geographically non-overlapping in the Jerusalem district and Central Region. Laboratory analyses and whole-genome sequencing (WGS) indicate that these viruses are genetically linked to each other and to multiple Sabin-like viruses isolated from environmental samples since October 2024. As of 8 August 2025, cVDPV1 has been detected only in environmental samples, with no paralytic cases reported at this stage. However current evidence supports classification of this event as an outbreak of cVDPV1 with sustained community transmission. Prior to this outbreak a Sabin-like type 1 virus (SL1), related to SL1 viruses detected in environmental surveillance, was the cause of an acute flaccid paralysis (AFP) case in an unvaccinated 17-year-old male from Jerusalem that was reported on 23 December 2024 and classified as vaccine-associated paralytic poliomyelitis (VAPP). Israel discontinued routine use of the bivalent oral polio vaccine (bOPV) in March 2025 but continues to administer four doses of inactivated polio vaccine (IPV) as part of the routine immunization schedule up to 12 months of age. The WHO/UNICEF Estimates of National Immunization Coverage for three doses of IPV in 2024 was 98%. However, vaccination coverage in Jerusalem is notably lower and below WHO&rsquo;s recommended coverage threshold, which is necessary to maintain sufficient population immunity and prevent poliovirus transmission.","assessment":"The international spread of poliovirus was declared a Public Health Emergency of International Concern (PHEIC) by the Director-General of the WHO on 5 May 2014, and most recently, the PHEIC declaration was extended on 28 July 2025. The outbreaks of cVDPV in Israel are covered by the original PHEIC declaration. There is a high level of vaccination coverage and a robust surveillance system in Israel, however, the risk of further spread in the country is likely to be moderate as immunization gaps persist in known high-risk areas/population groups. Local health authorities are conducting field, epidemiological and virological investigations to better understand the situation and the likely risk of spread. Israel discontinued the use of bOPV in March 2025. The routine immunization schedule includes four doses of IPV-containing vaccine until the age of 12 months and a fifth dose during the second year of primary school. In 2024, a total of 11 cVDPV1 cases were reported, ten in the Democratic Republic of the Congo and one in Mozambique. Despite no cVDPV1 case detection for the past 10 months, continued low routine immunization and IPV coverage in several countries and associated immunity gap, indicate continued risk of cVDPV1 emergence. WHO currently assesses the risk of international spread associated with this cVDPV1 detection as low due to high overall population immunity, robust poliovirus surveillance, and response capacity. However, the potential for spread exists, taking into account the fact that circulation is likely occurring in the vaccine-sceptic under vaccinated communities with known close ties to similar communities in other countries. An example of this being the 2022-2023 multi-country circulation of cVDPV2 in the UK, USA, Canada and Israel.","advice":"The polio vaccine, given multiple times, can protect a child for life. WHO advises that every country should seek to achieve and maintain high levels of coverage with polio vaccine in support of the global commitment to eradicate polio. WHO recommends that all those who travel to or live in polio-affected areas should be fully vaccinated against polio in compliance with the national schedule. Population pockets with low immunity against polio should be prioritised for targeted interventions to boost immunity and reduce the risk of sustained transmission and spread. It is important that all countries, in particular those with frequent travel and contact with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction. As per the advice of the Emergency Committee convened under the International Health Regulations (2005) , efforts to limit the international spread of poliovirus remain a PHEIC. Countries affected by poliovirus transmission are subject to Temporary Recommendations . To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency, consider vaccination of all international travellers, ensure such travellers are provided with an international certificate of vaccination, restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination, intensify cross-border efforts to substantially increase vaccination coverage of travellers, and intensify efforts to increase routine immunization coverage. Any country subject to the temporary recommendation maintains the measures described above until the following criteria have been met: At least six months have passed without new infections; and There is documentation of the full application of high-quality eradication activities in all infected and high-risk areas. In the absence of such documentation, the measures should be maintained until the state meets the above assessment criteria for being no longer infected. The latest epidemiological information on cVDPVs is updated on a weekly basis . WHO does not recommend any travel and/or trade restrictions to Israel based on the current information available for this event.","publishedAt":"2025-08-20T16:06:59.000Z","lastModified":"2025-08-20T16:37:18.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON578","response":"Enhanced AFP and environmental surveillance to detect further transmission are ongoing. Under the Ministry of Health, a multi-disciplinary emergency response team (ERT) was established to support the control of outbreaks of cVDPV3 in 2022 followed by cVDPV2 in 2023 and this ERT continues to operate for this current cVDPV1 outbreak. Investigations are ongoing to assess the scale of local circulation and the necessary responses where relevant. Partners of the Global Polio Eradication Initiative, including the WHO European Regional Office, are supporting national and subnational authorities. Targeted immunization campaigns with IPV have been ongoing since 2022, focusing on under-immunized communities. These campaigns are currently being intensified alongside measles vaccination efforts to maximize coverage. To enhance vaccine acceptance, the campaigns are supported by tailored, community-specific communication strategies. Community- sensitive communication strategies are being developed with tailored messages to reduce the vaccine hesitancy and increase uptake.","epidemiology":"Polio is a highly infectious disease that largely affects children under five years of age, causing permanent paralysis (approximately 1 in 200 infections) or death (2-10% of those paralyzed). The virus is transmitted from person-to-person, mainly through the fecal-oral route or, less frequently, by contaminated water or food. The virus multiplies in the intestine, from where it can invade the nervous system and cause paralysis. The incubation period is usually 7-10 days but can range from 4-35 days. Up to 90% of those infected are either asymptomatic or experience mild symptoms and the disease usually goes unrecognized. Vaccine-derived poliovirus is a well-documented strain of poliovirus mutated from the strain originally contained in OPV. OPV contains a live, weakened form of poliovirus that replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. On rare occasions, when replicating in the gastrointestinal tract, OPV strains can genetically change and may spread in communities that are not fully vaccinated against polio, especially in areas where there is poor hygiene, poor sanitation, or overcrowding. The lower the population's immunity, the longer vaccine-derived poliovirus survives and the more genetic changes it undergoes. In very rare instances, the vaccine-derived virus can genetically change into a form that can cause paralysis as does the wild poliovirus &ndash; this is what is known as a vaccine-derived poliovirus (VDPV). The detection of VDPV in at least two different sources and at least two months apart, that are genetically linked, showing evidence of transmission in the community, is classified as cVDPV. Similar to wild poliovirus, cVDPVs can be of three types (1,2 or 3), the current outbreak in Israel is due to cVDPV1.","formattedDate":"2025-08-20T16:36:57Z","matchedSignals":["PHEIC language","cross-border signal","response escalation"]}},{"id":"2025-DON577","title":"Nipah Virus Infection - India","disease":"Nipah Virus Infection","locations":["India"],"riskLevel":"elevated-watch","signalClass":"Cross-border or severe outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON577","summary":"Between 17 May and 12 July 2025, the Information and Public Relations Department, Government of Kerala informed through a series of official press releases about four confirmed cases, including two deaths, due to Nipah virus (NiV) infection in two districts of Kerala State. NiV infection is a bat-borne disease transmitted to humans through infected animals (such as bats or pigs), contaminated food or, less commonly, through close contact with infected individuals. Since 1998 NiV outbreaks have been reported in Bangladesh, India, Malaysia, the Philippines, and Singapore. In India, NiV infections have occurred multiple times since 2001 with outbreaks in West Bengal State in 2001 and 2007, and in Kerala State regularly since 2018. Since 2018, Kerala has reported a total of nine NiV outbreaks. While the state has a strong healthcare system and improved infection control measures since 2023, it is advisable to maintain strong preparedness and surveillance efforts while ensuring continued care for patients. At the same time, States that may be at risk should be encouraged to continue strengthen their detection systems and response capacities. With no licensed vaccine or treatment available, public health efforts should focus on raising awareness of risk factors and promoting preventive measures to reduce exposure to the virus, and on early case detection supported by adequate intensive supportive care. Currently, the risk of international disease spread is considered low. There is no evidence of human-to-human transmission of NiV internationally in this event.","overview":"Between 17 May and 12 July 2025, the Information and Public Relations Department, Government of Kerala through a series of official press releases informed about four confirmed NiV cases, including two deaths, due to NiV infection from two districts of Kerala State. Of the four cases, two were reported from Malappuram and two from Palakkad district. This marks the first-ever outbreak in Palakkad District. Of the four cases, one case was reported in May (with symptom onset in April) and three in July with symptom onset June (two cases), and July (one case). The first patient was an adult woman from Malappuram district with symptom onset on 25 April. The patient was admitted in critical condition to a local hospital in Malappuram with fever, cough, and respiratory distress due to worsening of symptoms. She was transferred to intensive care on 2 May due to acute encephalitis syndrome. Samples were collected and tested positive for NiV at Calicut Medical College on 6 May. Confirmatory testing was conducted by the National Institute of Virology, Pune, and results confirmed on 8 May. The second patient, also an adult woman from Malappuram district developed symptoms on 23 June and died on 1 July. She visited multiple healthcare facilities, before being transferred to a government medical facility, where clinical suspicion of NiV led to sample collection and laboratory testing. The third patient is an adult woman from Palakkad district who developed symptoms on 25 June. She sought care at several healthcare facilities, before being admitted to a multi-specialty hospital, where she remains in critical condition on ventilator support. This is the first confirmed NiV case in Palakkad district. The fourth case was an adult male also from Palakkad district, who developed symptoms on 6 July 2025. He sought initial medical care on the same day, was admitted to a private hospital on 10 July, and transferred to a multi-specialty hospital on 11 July. On 12 July, he died and was confirmed with NiV infection. This is the second confirmed case in Palakkad district. The sources of infection of the cases remain under investigation. None of these cases appear to be linked to each other, suggesting independent spillover events from the natural reservoir. A significant presence of fruit bats, the known reservoir for NiV has been observed in the affected areas.","assessment":"As of July 2025, a total of nine NiV outbreaks have been reported in Kerala State. Recent case numbers reported in Kerala State are consistent with trends observed in previous years and are therefore not entirely unexpected. However, they continue to highlight a localized risk associated with NiV in that area. At this time, the overall risk to the broader national and regional population remains low. The first outbreak was reported in 2018 (23 cases including confirmed and probable; CFR: 91%), followed by subsequent outbreaks in 2019 (a single case who survived), 2021 (one case; CFR: 100%), 2023 (six cases including two deaths; CFR: 33%), 2024 (two cases; CFR 100%), and 2025. So far in 2025, four confirmed cases of NiV, have been reported, all from Kerala State, with the symptom onset in April (one case), June (two cases) and July (one case). These recurrent spillover events highlight the ongoing risk of NiV in Kerala. In addition, studies indicated that fruit bats tested positive for NiV antibodies in several other Indian states, suggesting that NiV infection may potentially emerge in other States. Kerala State has a robust healthcare system. While nosocomial transmission was confirmed during the 2023 outbreak, the Infection Prevention and Control (IPC), and waste management practices have since been strengthened and audited. The sources of infection for the 2025 cases are yet to be confirmed.","advice":"In the absence of a vaccine or licensed treatment available for NiV disease, the only way to reduce or prevent infection in people is by raising awareness of the risk factors and supporting people with measures they can take to reduce exposure to the virus. Case management should focus on the delivery of timely, supportive care and be supported by a good laboratory system. Intensive supportive care is recommended to treat severe respiratory and neurologic complications. Public health educational messages should focus on: Reducing the risk of bat-to-human transmission Efforts to prevent transmission should first focus on decreasing bat access to date palm sap and other fresh food products. Freshly collected date palm juice should be boiled, and fruits should be thoroughly washed and peeled before consumption. Fruits with signs of bat bites should be discarded. Areas where bats are known to roost should be avoided. Reducing the risk of human-to-human transmission. Close unprotected physical contact with NiV-infected people should be avoided. Regular hand washing should be carried out after caring for or visiting sick people. Controlling infection in health care settings Health-care workers caring for patients with suspected or confirmed infection, or handling specimens from them, should implement standard infection control precautions at all times. As human-to-human transmission has been reported, in particular in health-care settings, contact and droplet precautions should be used in addition to standard precautions. Airborne precautions may be required in certain circumstances. Samples taken from people and animals with suspected NiV infection should be handled by trained staff working in suitably equipped laboratories. WHO does not recommend any travel and/or trade restrictions toward India based on the currently available information.","publishedAt":"2025-08-06T10:48:42.000Z","lastModified":"2025-08-06T12:13:22.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON577","response":"Several public health measures have been implemented by local authorities including: The Kerala state health minister chaired an emergency meeting to assess the situation and confirmed that preventive measures have been strengthened in accordance with the established NiV protocol. As of 17 July, contact tracing is intensively implemented. A total of 723 individuals have been identified as contacts of confirmed Nipah virus (NiV) cases across several districts: Palakkad (394), Malappuram (212), Kozhikode (114), Ernakulam (2), and Thrissur (1). Based on an in-depth investigation, Kerala health authorities have released route maps for the movement of three confirmed NiV cases reported in July, to trace potential community exposures. Alerts have been issued by health authorities in Kozhikode, Malappuram, and Palakkad districts. In response, 26 special teams were deployed to carry out contact tracing, monitor symptoms among contacts and inform the public. Additionally, a special alert has been issued to hospitals in Kannur, Kozhikode, Malappuram, Palakkad, Thrissur and Wayanad districts, instructing them to remain vigilant and promptly report any suspected cases with NiV symptoms. The public has been advised to avoid non-essential visits to healthcare facilities to minimize the risk of transmission. WHO is closely coordinating with the National Centre for Disease Control on One Health and capacity building for high threat pathogens including NiV.","epidemiology":"NiV infection is a bat-borne zoonotic disease transmitted to humans through infected animals (such as bats or pigs), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person (although less common). Fruit bats or flying foxes (Pteropus species) are the natural hosts for the virus. The incubation period ranges on average from 4 to 14 days. However, an incubation period of up to 45 days has been reported once. Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests. The main tests used are Reverse Transcription Polymerase Chain Reaction (RT-PCR) from bodily fluids and antibody detection via enzyme-linked immunosorbent assay (ELISA). Symptoms range from acute respiratory infection and fatal encephalitis. Further information about NiV infection can be found here . The case-fatality rates in outbreaks across Bangladesh, India, Malaysia, and Singapore typically range from 40% to 100%, depending on local capabilities for early detection and clinical management. Although candidate products are in development, there are no licensed vaccines or therapeutics available for the prevention or treatment of NiV infection.","formattedDate":"2025-08-06T11:33:56Z","matchedSignals":["transmission concern","severity signal"]}},{"id":"2025-DON576","title":"Rabies - Timor-Leste","disease":"Rabies","locations":["Timor-Leste"],"riskLevel":"watch","signalClass":"WHO outbreak signal","url":"https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON576","summary":"On 17 May 2025, the Timor-Leste government reported to the World Health Organization (WHO) a fatal human case of rabies from Ermera Municipality. Between May and mid-June 2025, Timor-Leste confirmed four human rabies deaths in the municipalities of Bobonaro (n=2), Ermera (n=1) and Oecusse (n=1). All cases involved individuals exposed to dogs' bites months prior to symptom onset, with rabies virus confirmed via Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing. Since March 2024, a total of 106 animal rabies cases—mostly in dogs—have been reported, and over 1400 dog bites or scratches have occurred, with a total of six fatalities. Access to and completion of post-exposure prophylaxis remains limited. The spread of rabies into non-border areas like Ermera signals a growing public health concern. The public health response is ongoing and includes vaccination of dogs, risk communication, training of healthcare workers on Post-Exposure Prophylaxis (PEP) and case management, active surveillance, and ensuring the availability of rabies vaccines and human rabies immunoglobulin. Based on the current available information, the WHO assesses the risk posed by this event as high at the national level, moderate at the regional level, and low at the global level.","overview":"As of 17 June 2025, a total of four human rabies deaths have been confirmed in Timor-Leste in 2025. These cases occurred in the municipalities of Bobonaro (n=2), Ermera (n=1), and Oecusse (n=1). On 17 May 2025, the Timor-Leste Ministry of Health (MoH) confirmed a fatal human case of rabies in an adult male from Ermera Municipality. The person was bitten by a dog in March 2025 and developed symptoms including hydrophobia, photophobia, aggressiveness, convulsions, and hallucinations. On 15 May, the individual sought medical care and was transferred to a national hospital. Rabies infection was confirmed the same day by RT-PCR testing at the National Health Laboratory (NHL) in Timor-Leste, using a saliva sample collected before death. On 30 May 2025, a second fatal case of rabies was confirmed in an adult male from Oecusse Municipality. The person had been bitten by a dog in June 2024 and developed symptoms including hydrophobia and photophobia. The individual presented to a regional hospital on 27 May 2025. Rabies infection was confirmed on 29 May by RT-PCR testing at the NHL. On 13 June 2025, a third fatal case was confirmed in an adult male from Bobonaro Municipality. The person had been bitten by a dog approximately 2&ndash;3 months prior to symptom onset and developed symptoms including hydrophobia and difficulty swallowing. On 12 June, the individual sought medical care and was transferred to a national hospital in Dili. A saliva sample collected before death tested positive for rabies by RT-PCR at the NHL. On 17 June 2025, a fourth fatal case was confirmed in a female child from Bobonaro Municipality. The child had been bitten by a dog approximately two months prior to symptom onset and developed symptoms including hydrophobia, insomnia, hallucinations, hyperactivity, difficulty swallowing, and convulsions. On 12 June, the child was taken to medical care. A saliva sample tested positive for rabies by RT-PCR at the NHL on 13 June. On 14 June 2025, the child was transferred to a national hospital. Prior to this, two additional fatal human rabies cases were reported in 2024, bringing the total number of confirmed human rabies deaths since the emergence of the disease in 2024 to six. In March 2024, the first confirmed animal cases of rabies (in dogs) were reported in Oecusse Municipality. As of 1 June 2025, a total of 106 animal rabies cases have been confirmed in Timor-Leste. Of these, 103 (97%) were in dogs, two in goats (in Bobonaro and Oecusse), and one in swine (in Bobonaro). Oecusse Municipality is an enclave of Timor-Leste located within Indonesia&rsquo;s East Nusa Tenggara province (NTT), where rabies is endemic and human cases are frequently reported. Both fatal human rabies cases reported in 2024 occurred in Oecusse. However, in 2025, one human case was reported in Ermera, an inland municipality that does not border Indonesia. This suggests that rabies may be spreading beyond border areas, highlighting the need to expand surveillance, monitor the movement of infected dogs, post-exposure prophylaxis (PEP), dog vaccination, education and awareness raising, and address the risk of undetected transmission in the country&rsquo;s interior regions. Between March 2024 and 15 June 2025, a total of 1445 dog scratches and bites were reported in Timor-Leste. Of these, 41% were classified as WHO category III exposures . Only 18% of category III exposures received rabies immunoglobulin. Although 66% of all bite victims began PEP, most did not complete the full course.","assessment":"Rabies is a vaccine-preventable, neglected zoonotic disease caused by a neurotropic virus of the Genus Lyssavirus , and it is transmissible to all mammals. Populations of the orders Carnivora and Chiroptera are considered to be the main reservoir hosts and, by the same order, the most common source of exposure of humans to the rabies virus. In up to 99% of cases of rabies in humans, domestic dogs (pets and stray dogs) are responsible for rabies virus transmission to humans. The transmission of rabies is through saliva, usually through bites and non-bites (scratches or licks on open skin/mucosa). The rabies virus is not transmitted through intact skin. Post-exposure prophylaxis is the emergency response to a rabies exposure and consists of extensive washing with water and soap for at least 15 minutes and local treatment of the wound as soon as possible after a suspected exposure; a course ofeffective rabies vaccine that meets WHO standards; and the administration of rabies immunoglobulin or monoclonal antibodies into the wound, if eligible. WHO assesses the risk posed by this event as high at the national level, moderate at the regional level, and low at the global level due to the following: The country was previously classified as &ldquo;rabies free&rdquo; and reported the first cases in 2024. In 2025, several fatal human cases of rabies have been reported within a short period of time across multiple municipalities. As such, experiences and awareness of community and health care workers on rabies is likely limited. Overall, health workers have limited knowledge about rabies case management, and dog bite and scratch case management. In 2024, dog vaccination coverage in NTT province, Indonesia was only 5.5% and dog vaccine coverage in Indonesia in 2022, was 24%, while 70% coverage is needed as the main technical control measure. Vaccination efforts in Timor-Leste have so far focused on high-risk municipalities; however, expanding these efforts to other areas remains challenging due to limited resources. Timor-Leste has a significant population of stray and unvaccinated dogs including in the areas bordering Indonesia. Previously there was no stock of human rabies vaccines in the government health facilities. WHO Country Office Timor-Leste has procured 6000 rabies vaccines doses and 1000 vials of rabies immunoglobulin, and distributed them to the health facilities. Not all humans bitten by a suspected rabid animal (mainly dogs) are receiving adequate and timely PEP, due to several reasons. NTT province in Indonesia shares land borders with Timor-Leste, and control measures to limit the movement of animals, particularly unvaccinated dogs, across these borders is challenging due to the terrain and extent of the land border. The confirmation of a human rabies case in Ermera Municipality &ndash; an inland non-border district &ndash; signals potential wider geographic spread within Timor-Leste and suggests gaps in surveillance and vaccination coverage beyond previously known high-risk areas.","advice":"Although a highly effective animal vaccine has been available for over a century, rabies remains enzootic in over 150 countries and territories, mainly in Asia and Africa. Rabies is included in WHO&rsquo;s 2021&ndash;2030 Roadmap for the Global Control of Neglected Tropical Diseases, which sets regional, progressive targets for the elimination of targeted diseases. As a zoonotic disease, it requires close cross-sectoral coordination at the national, regional and global levels. The key to implementing effective rabies elimination programs is to engage with local communities, start small, catalyze long-term investment through stimulus packages, ensure the ownership of governments, demonstrate success and cost-effectiveness, and scale up quickly. Rabies elimination is feasible and achievable if this goal is prioritized and financially and politically supported. Risk Communication and Community Engagement (RCCE) Raising awareness of rabies disease through engaging communities and empowering people is a cornerstone of response to rabies. RCCE activities should include an understanding of how to prevent rabies in animals, when to suspect rabies, and what to do in case of exposure. Individuals should adequately wash any wounds with soap and copious amounts of water for 15 minutes as a key important first aid measure and to seek early treatment whenever they are exposed to a rabid animal. Education on dog behaviour and bite prevention for both children and adults is an essential extension of rabies vaccination programs and can decrease both the incidence of human rabies and the financial burden of treating dog bites. Immunization of persons Very effective rabies vaccines and rabies immunoglobulins are available to immunize people after suspected exposure to rabies (post-exposure prophylaxis). Appropriate wound management and prompt access to quality-assured PEP is almost 100% effective in preventing human rabies deaths. Pre-exposure prophylaxis (PrEP) is recommended for people in certain high-risk occupations (such as laboratory workers handling live rabies and rabies-related viruses) and people whose professional or personal activities might lead to direct contact with bats or other mammals that may be infected with rabies (such as animal disease control staff and wildlife rangers). PrEP might also be indicated for outdoor travellers and people living in remote, highly rabies-endemic areas with limited local access to rabies biologics. Exposed individuals with PrEP still need booster vaccination; however, abridged regimens apply, and human rabies immunoglobulin (RIG) is not needed. Exposure risk and indications for PEP Depending on the severity of exposure, administration of a full PEP course is recommended as follows: Source: https://www.who.int/news-room/fact-sheets/detail/rabies Mass dog vaccination As dogs are the source of more than 95% of human rabies cases, the control and elimination of rabies in dogs prevents rabies at its source. Vaccinating dogs, including puppies, is the most cost-effective strategy for preventing rabies in people, and reduces the need for PEP. Mass dog vaccination with high quality and safe vaccines, aiming at 70% coverage over consecutive years in endemic areas interrupts rabies virus (RABV) transmission at its animal source and saves human lives. This event does not interfere with travel and trade. Travellers must be made aware of the risk of contracting rabies while travelling to areas considered at higher risk, such as border areas with Indonesia.","publishedAt":"2025-07-24T18:00:00.000Z","lastModified":"2025-07-24T15:43:56.000Z","sourceId":"who-disease-outbreak-news","metadata":{"donId":"2025-DON576","response":"The Timor-Leste MoH has taken the following public health response actions: On 16 June, a press conference was held to raise community awareness, advising citizens to vaccinate their dogs, avoid contact with wild animals, observe if there are any changes in dog behaviour, report dog bite incidents for immediate treatment and rabies vaccination. Recently, a dedicated rabies risk communication and community engagement (RCCE) strategy for Timor-Leste has been developed with support from the Australian government and public health communications specialists. Several RCCE materials including flyers (for adults and children), magazine features, animation videos, podcast recordings and social media content featuring prominent and respected Timorese influencers have been developed jointly by the Ministry of Agriculture, Livestock, Fisheries and Forestry (MALFF), MoH and WHO to raise awareness about rabies, nationally. Supported by the school health focal point in the WHO country office (WCO), rabies brochures were distributed among school children in high-risk areas. The Government of Timor-Leste has revived the National Task Force on Rabies and adopted a One Health approach, involving the MoH, the MALFF and other stakeholders to undertake joint planning and response to rabies. A national rabies prevention campaign will be launched, increasing rabies vaccine availability and enhancing human and animal health surveillance, including the vaccination of dogs. PEP, including wound washing, anti-rabies vaccine, and human rabies immunoglobulin (RIG) for passive immunization is currently available in government health facilities. However, as dog bite cases continue to occur and spread to neighbouring municipalities, there is an urgent need for additional stockpile requests. The National Strategic Plan to Eliminate Rabies in Timor-Leste has been developed with the support of WHO, WOAH, and Australian Aid.","epidemiology":"Rabies is a vaccine-preventable, zoonotic, viral disease affecting the central nervous system. Once clinical symptoms appear, rabies is nearly 100% fatal. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet rabies can affect both domestic and wild animals. It spreads to people and animals via saliva, usually through bites, scratches or direct contact with mucosa (e.g. eyes, mouth or open wounds). Children between the ages of 5 and 14 years are frequent victims. Direct human-to-human transmission has never been documented; however, it has occurred from infected organ/tissue donors to transplant recipients. The incubation period for rabies is typically 2&ndash;3 months but may vary from 1 week to 1 year, depending on factors such as the location of virus entry and the viral load. Initial symptoms of rabies include generic signs like fever, pain and unusual or unexplained tingling, pricking, or burning sensations at the wound site. As the virus moves to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops. Clinical rabies in people can be managed but very rarely cured, and not without severe neurological deficits. Rabies deaths occur mainly in those who cannot immediately access effective PEP. According to the Union Against Rabies Forum (launched by FAO, WHO and WOAH), globally, every nine minutes, one person dies from rabies. Almost half of them are children. People can be protected against rabies through a series of vaccines given to individuals as pre-exposure prophylaxis (PrEP). Following an exposure, individuals still need a post-exposure booster vaccination, although with a shortened regimen compared to post-exposure prophylaxis (PEP). PEP is the emergency response to a rabies exposure. This prevents the virus from entering the central nervous system, which would invariably result in death. Current diagnostic tools are not suitable for detecting rabies infection before the onset of clinical symptoms. Unless the rabies-specific signs of hydrophobia or aerophobia are present, or a reliable history of contact with a suspected or confirmed rabid animal is available, clinical diagnosis is difficult. Human rabies can be confirmed, both whilst alive and post-mortem, by various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, or saliva).","formattedDate":"2025-07-24T15:43:44Z","matchedSignals":["severity signal"]}}]}