Healthbeat

NYC public health system braces for federal grant cuts under proposed OMB revision

2026-07-30T22:30:44+00:00

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New York City’s public health system is bracing for possible funding cuts from a federal budget rule change the Trump administration is considering.

A proposed revision from the Office of Management and Budget would give the Trump administration broad discretion over how federal grants are awarded, managed, and terminated. Currently, such grants can’t be canceled without cause, but the new OMB rule would permit termination with minimal explanation or opportunities for appeal.

Though a range of federal agencies could be potential targets of the revisions, known as “Uniform Guidance,” the city’s Department of Health and Mental Hygiene and community-based health centers are particularly vulnerable.

Health officials say about $500 million, or 20% percent of the city’s budget for the Health Department, comes from the federal government. This money is earmarked for emergency preparedness and disease surveillance.

The Health Department has already been a mark. Last year, the Trump administration tried to withhold funding across the United States, including some $100 million earmarked for the city’s Health Department, but a coalition of attorneys general sued. A federal judge halted the effort for now.

“It would not necessarily completely disrupt what they’re doing, but it would maybe destabilize the core functions of the Health Department,” Dr. Oni Blackstock, a primary care physician based in New York City who specializes in HIV treatment, said of the proposed rule.

Blackstock is also the founder and executive director of Health Justice, a consulting firm that aims to promote equity initiatives in healthcare and public health. She previously was an assistant commissioner at the New York City Health Department, leading the city’s response to the HIV epidemic.

The OMB changes could be far-reaching, from the states to counties nationwide. According to the National Association of Counties, a nonprofit group advocating for county government across the United States, the proposed rule is the “most significant overhaul of federal grants regulations in more than a decade.” County programs such as transportation, public safety, housing, and disaster recovery could be affected.

According to the department, “OMB is proposing revisions that would improve transparency, accountability, and oversight for Federal awards across the Federal Government.”

A spokesperson could not be reached for further comment.

Russell Vought, the OMB director, is one of the main architects of Project 2025, the 900-page blueprint that articulated a broad conservative vision for the second Trump administration.

The final version of the rule could take effect on Oct. 1. Until then, the OMB is required to consider every public comment it has received since the rule was announced in late May and address or respond to substantive critiques. The agency received nearly 500,000 comments until the comment period ended on July 13.

The topic of the Trump administration possibly withholding funding from the city’s Health Department has come up before. At a March budget hearing, City Council Health Committee Chair Lynn Schulman asked about contingency plans.

“We are currently in active discussions with (the city’s) OMB, with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities,” Health Commissioner Dr. Alister Martin said at the March hearing. “We will assess and make decisions around what will protect New Yorkers’ health and safety the best.”

A Health Department spokesperson didn’t respond to questions about plans for potential cuts.

Blackstock says the proposed OMB rule could target Health Department funding for outbreak responses, HIV prevention, substance use services, emergency preparedness, and chronic disease prevention.

“All of these programs receive federal dollars through discretionary cooperative agreements,” she said.

In the past, the Centers for Disease Control and Prevention or the U.S. Health Resources and Services Administration would evaluate grant applications, but now political appointees will be making key decisions, she said.

“They’re going to be using their own independent judgment and lack of knowledge and expertise to decide whether these discretionary federal awards are granted,” Blackstock said.

Dr. Oni Blackstock

Community-based groups that receive federal funds could also be affected. That means the pot of money will grow smaller, and nonprofits have cut back on hiring, reduced services, postponed raises, and resorted to layoffs. Nonprofits are also looking at ways to forge alliances and share resources.

A preview of the abrupt withdrawal of federal funding played out earlier this year. Community nonprofits working on substance abuse issues experienced the sudden loss of funding — and ensuing chaos — in January when an agency in the Department of Human and Health Services suddenly revoked roughly $2 billion in funding, only to restore the money the following day because of bipartisan lobbying.

Given that the Trump administration has issued executive orders that target health care services for groups serving LGBTQ+ communities, some nonprofits may decide to pass on federal support.

“If it’s a trans-led organization, they may be discouraged from actually applying for any federal funding because they don’t want to be a target of this administration and have their funds withdrawn,” Blackstock said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Exclusive data: More than 74,000 older adults seek measles immunity tests amid U.S. outbreaks

2026-07-29T20:40:13+00:00

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Measles was surging in West Texas as Nancy Churnin eagerly awaited the birth of two grandchildren. She was sure she had been vaccinated decades ago, but she wanted to confirm she was still protected.

She didn’t want to risk spreading the highly contagious disease to vulnerable newborns, so she got a simple blood test last year.

“I wanted to double-check my immunity,” said Churnin, a children’s book author who lives in Plano, Texas, near Dallas.

Churnin is among more than 74,000 U.S. adults over age 50 who have received blood tests checking their measles antibody status from January 2025 through March of this year, according to an exclusive analysis of medical records data conducted in response to questions from Healthbeat.

The rates of older adults seeking measles immunity tests spiked across the country during last year’s West Texas measles outbreak and again earlier this year as South Carolina’s measles outbreak became the nation’s largest in decades, according to the analysis by a research team at Truveta, a healthcare data and analytics company that receives patient care data from major health systems that serve about one in three U.S. residents.

Truveta’s research team said its analysis suggests that public awareness of high-profile local measles outbreaks might be influencing more people across the country to seek the immunity tests, which are called titer tests.

Nina Masters, the principal applied research scientist at Truveta who led the analysis, said she was struck by the spikes in titer testing during outbreaks because historically, the standard recommendation has been to just vaccinate people who don’t have proof of immunity.

“To me, that suggests outbreaks are influencing healthcare-seeking behavior and reflects growing concern among Americans who want to understand their immunity status and protect themselves and their loved ones amid rising measles activity,” said Masters, a former Centers for Disease Control and Prevention epidemiologist who has deployed to multiple measles outbreaks.

As the U.S. this month broke last year’s record number of measles cases, people who are infected are increasingly exposing others to the virus in a wide range of public settings from schools and churches to restaurants, stores, and airports. The virus spreads through the air and can linger in a room for two hours after the infectious person has left, putting anybody who goes through the area at risk if they lack immunity.

The result is large numbers of people need to quarantine at home for up to 21 days if they are not vaccinated against measles or cannot provide proof of their immunity through previous vaccination or illness.

“We think it’s important for people to know their immunity status,” said Dr. Emma Doran of the North Carolina Department of Health and Human Services, which recommends titer tests as one of the ways people can check their immunity before they are exposed.

Titer tests can be particularly helpful for older adults who were vaccinated against measles long before electronic medical records and state immunization registries and no longer have their paper vaccination records. The measles vaccine provides lifelong immunity for most people. Two doses of the combination measles-mumps-ruebella shot is 97% effective against measles, and one dose is 93% effective.

“There is a good chunk of the population there that, unfortunately, if somebody didn’t hold on to that paper, they don’t have it,” said Doran, who is the medical director of the department’s Vaccine Preventable and Respiratory Diseases Medical Consultation Unit.

Immunity tests spiked in U.S. during Texas, South Carolina outbreaks

The new data on titer testing provides a window into one of the many ways the return of measles in the United States is impacting people’s lives. The disease was declared eliminated from the country in 2000. In November, an international public health body will review whether the disease has once again become endemic to the United States.

During 2025 — as a major measles outbreak was underway in West Texas — more than 62,000 older adults across the country went to doctors’ offices to get measles titer tests, the Truveta analysis found.

The surge in testing was dramatic, and not just in Texas.

Nationwide, adults 50 and older received measles immunity testing last year at nearly seven times the rate they had in recent years. From 2021 through 2024, a typical month saw about 50 people get tested for measles immunity for every 100,000 adults who had an outpatient doctors’ visit. But in 2025, that figure reached nearly 341 tests per 100,000 adults.

The rate of titer testing within the state of Texas was particularly high, peaking at 627 tests per 100,000. But even when data from Texas was excluded, the data for the rest of the United States still showed a spike in testing at nearly 309 tests per 100,000.

A similar pattern played out during the first three months of this year, when more than 12,000 U.S. adults over 50 received titer tests as the South Carolina measles outbreak became the nation’s largest in 35 years. The analysis showed an even larger spike in testing rates in 2019, when measles outbreaks also fueled an earlier record number of cases.

The analysis involved an examination of electronic health record data from nearly 30 million patients over 50 who had outpatient visits from January 2018 through March. The data is provided to Truveta by the company’s health system members. The researchers looked at data for older adults to try to focus on those seeking the tests long after childhood vaccination or illness, as well as to reduce the inclusion of routine prenatal testing.

Truveta conducted the analysis after Healthbeat asked the company whether its data could provide any information about whether more people were seeking titer tests amid the recent measles outbreaks.

While the data does not say why the individuals received measles titer tests, Masters and her research team said the spikes in titer testing during outbreaks likely reflect a combination of patient concern, vigilance by healthcare providers, exposure-related evaluations, and adult uncertainty about immunization status. Media coverage might also play a role.

There could be many reasons why an adult might want to check their immunity amid increased spread of measles, the researchers said. They include grandparents seeking to confirm they are protected before visiting infant grandchildren, as well as adults who are worried about the risk of living in or traveling to an outbreak area.

Before her grandson, Ezra, was born last year, Nancy Churnin of Plano, Texas, had her blood tested to make sure she was immune to measles. She didn't want to put him at any risk. Churnin was surprised to discover she wasn't immune, prompting her to get an additional dose of MMR vaccine.

Protecting her newborn grandbabies was Nancy Churnin’s motivation in getting a measles titer test last year before they were born. The babies’ parents were also seeking to safeguard their infants against infectious diseases.

“Anybody who wanted to see the baby was on notice: Get all your shots or we can’t let you around the baby unless you’re fully, fully vaccinated,” recalled Churnin.

When Churnin’s titer test result came back, she was surprised to learn she was not immune to measles. She was certain she had been vaccinated as a child, but she was born in 1957 and she has no access to her records, and her parents aren’t around to ask. After the test, she got vaccinated.

“I was very, very glad I got the test. I’m very, very glad I got immunized,” Churnin said. “I don’t want to do anything to endanger those babies, anybody’s babies.”

Should you get a titer test? Cost, doctors’ views shape decisions.

Most older adults are likely to be protected against measles either because they were vaccinated as children or had the disease before vaccines became available.

Adults born before 1957 are officially presumed to be immune to measles because they were likely infected when they were children, according to the Centers for Disease Control and Prevention. Vaccines against measles have been available in the United States since the early 1960s, with an improved version of the vaccine distributed since 1968.

Should those who can’t find their vaccination records ask their doctors for titer tests?

The CDC recommends that adults born during or after 1957 who can’t find their immunization records get the MMR vaccine. But the CDC guidance also says they can get a measles titer test to determine if they need the vaccine. “There is no harm in getting another dose of MMR vaccine if an individual may already be immune,” the CDC says.

There are several factors to consider in whether to do a titer test or just get another MMR shot, experts said.

Dr. Margot Savoy, chief medical officer of the American Academy of Family Physicians, told Healthbeat that it’s not common for patients to ask for a titer test unless they work in a healthcare field where the test is required.

“The question that they normally ask is: How do I know if I’m protected?” she said.

“For most family physicians, and most physicians in general, their answer would be, I don’t know that I would draw titers on most people. If we’re at all worried that you might not be protected, we would just give you another MMR” vaccine, she said.

Savoy said the time and cost of getting a titer test is not worth it for the average patient, because the test may show the person needs to get vaccinated anyway.

Unlike the MMR vaccine, which is routinely covered by insurance plans without patient cost-sharing, there are no requirements for insurance coverage of titer tests, although insurers can choose to cover them. In addition to getting the tests through a doctor’s office, many direct-to-consumer labs and walk-in clinics also will do the tests without a prescription, but the costs can range from $40 to $150 or more.

Individual patients may weigh the costs and benefits differently when deciding between just getting an MMR shot or getting tested, said Doran.

“I think there’s no one-size-fits-all approach for whether to do an MMR vaccine if you don’t have the records or whether to get a titer first,” she said.

Editor’s note: This story has been updated to reflect that, as of late July, there have been more measles cases in 2026 than in all of 2025.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

A preventable tragedy: What my sister’s death taught me about public health

2026-06-24T12:03:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

This year marks the 15th anniversary of my sister’s death from rabies.

In 2010, my sister Ivy bought a home in Sumter, South Carolina, and eagerly began rehabilitating it. Soon, she noticed bats finding their way into her enclosed back porch and main living areas.

Aware that bats can carry rabies, she called the local Animal Control office in 2011 to express her concerns. Instead of health advice, she received a warning: She was told bats are protected, and killing them could land her in jail. No one advised her to seek a medical assessment or contact the health department to protect herself and her son.

Months later, Ivy developed flu-like symptoms. What followed was a harrowing journey of confusion and misdiagnoses before a neurologist finally ordered a rabies test. By the time we had an answer, it was too late. Rabies is 100% preventable before symptoms appear, but there is little that can be done once a patient becomes symptomatic.

Ivy Durant, sister of Tonji Durant.

I recently retired as an epidemiologist for the Centers for Disease Control and Prevention, having spent my career in domestic and global health. Yet, sitting in that intensive care unit, my professional background could not save my sister. Her death illuminated critical systemic gaps in how we communicate public health risks at the local level.

Seven out of every 10 deaths from rabies in people are linked to bats, and rabid bats can be found in every state except Hawaii. A public health survey conducted in Sumter County after Ivy’s death found 3.5% of respondents had bats either living in their home or entering the home. And while respondents generally knew that bats can transmit rabies, they had limited knowledge of the risks or how to protect themselves.

The mistakes surrounding Ivy’s death were born of institutional silos and poor communication:

Disconnected agencies: Animal Control and the local health department were located across the street from one another at the time, yet they did not collaborate on communicating community risks.
Information gaps: The local health department lacked the resources it needed to provide citizens with practical information regarding the fatal risks of bats in sleeping quarters or how to address bats if they’re there. Today there are more resources available online, but they remain challenging to navigate and apply locally. Recent cuts to the CDC also likely limit capacity for expertise, testing, and engagement, which are especially important for complex conditions like rabies.
Diagnostic delays: Because human rabies cases are incredibly rare, the disease was not on the hospital’s radar, delaying crucial decisions regarding her comfort and care.

My mother feels our family was robbed, and she is right. Ivy did not have to die. To prevent this from happening to another family, we must fundamentally shift our public health approach.

Break down government silos: Agencies must communicate. If Animal Control is aware of bat activity or other exposure risks, it must work closely with public health officials so citizens are immediately informed of health risks, not just legal liabilities.
Engage trusted community leaders: We need to return to grassroots strategies. We must engage community-based organizations and trusted local voices to communicate risks and empower residents.
Apply global lessons domestically: Having worked in global health, I know the immense value of the community-building strategies we use overseas. We must rebuild local partnerships, applying the lessons we’ve learned globally to our domestic programs. Whether for maternal health, HIV, malaria, vaccine-preventable diseases, or One Health initiatives that recognize the connections between human and animal health, community-based strategies are at the heart of successful prevention programs.
Prioritize proactive engagement: Ivy’s laboratory and medication bills (excluding her clinical care) for just her final two weeks of life were roughly a quarter of a million dollars in 2011. Today, that’s approximately a half-million dollars. We must invest in a system based on coordinated prevention and not wait until a crisis hits.

One life lost to a fully preventable disease is one life too many. In the last year and a half, we’ve seen significant cuts to public health funding and infrastructure. Without protecting public health investments, declining engagement and resources are inevitable, and we run the risk of repeating past public health mistakes.

Tonji Durant is a retired CDC scientist. She now advocates for stronger health systems and coordinated public health communication to prevent tragedies like her sister Ivy’s death. Tonji is a member of the Southern Alliance for Public Health Leadership, whose work focuses on empowering public health professionals across the South.

RFK Jr. orders hantavirus cruise passenger to remain in secure facility, overrules federal medical review

2026-06-16T23:36:02+00:00

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The order from Health and Human Services Secretary Robert F. Kennedy Jr. was slipped under Angela Perryman’s door Monday afternoon inside the secure National Quarantine Unit in Nebraska. This is where she and other former cruise ship passengers have been held since last month because of possible exposure to a dangerous type of hantavirus.

The order signed by Kennedy requires Perryman to stay inside the locked Nebraska facility through June 21, the end of the 42-day quarantine period — even though an HHS-appointed medical review determined last week that Perryman could safely finish her quarantine at home in Florida.

“It has nothing to do with public health at all,” Perryman told Healthbeat Monday evening. “They’re using administrative orders to detain American citizens with no judicial oversight.”

HHS officials did not answer Healthbeat’s questions about the reasons behind Kennedy’s order and why it appears to contradict the findings of the federal government’s own medical review of her detention.

A copy of the order, provided to Healthbeat by Perryman, only says generally that he finds that requirements for federal quarantine continue to be met.

The day after this article was published, HHS said in an emailed statement: “In the absence of proper home monitoring by state authorities, the Administration’s quarantine order is necessary to ensure both Ms. Perryman’s and her community’s wellbeing.”

HHS did not address the detailed findings in the medical review that said the monitoring would be appropriate and protective.

What began as a medical evacuation of Americans from a deadly outbreak aboard an international nature adventure cruise has raised increasing concerns from some public health and legal experts about whether the U.S. government has failed to properly balance protecting public health with ensuring people are quarantined in the least restrictive setting that is safe.

Neither Perryman nor any of the 17 other U.S. passengers who were sent to the Nebraska quarantine facility after leaving the M/V Hondius cruise ship have shown any signs of infection with Andes virus. This type of hantavirus typically spreads through contact with South American rodents, but also is the only hantavirus known to have the potential to spread from person to person.

Of the nearly 150 passengers and crew who were aboard the M/V Hondius, there have been 13 cases of Andes virus, including three deaths, according to the World Health Organization.

Person-to-person spread of Andes virus is “relatively rare and generally associated with prolonged close contact” with a person who is sick, the Centers for Disease Control and Prevention has said in its interim emergency guidance for the public health management of people who have been exposed.

Angela Perryman, pictured during the nature cruise that landed her in federal quarantine.

Recently, HHS has allowed some passengers to leave the facility and finish their quarantines at home – but often under requirements that state and local health departments ensure 24/7 monitoring.

But while Perryman’s home state of Florida is willing to supervise her quarantine at home, it won’t agree to 24/7 monitoring.

“At this time the assessment of the Florida Department of Health is that it is not necessary to implement the federal conditions of 24/7 continuous surveillance and twice daily in-person monitoring of the individual at their residence,” according to a May 28 letter Florida Surgeon General Joseph Ladopo sent to Dr. David Fitter, the hantavirus response incident manager at the Centers for Disease Control and Prevention.

Perryman provided a copy of the letter to Healthbeat.

As part of her quarantine appeals through a federal administrative process, Perryman requested a medical review of the necessity of the terms of her federal quarantine order.

According to the June 11 medical review report, an HHS-appointed official from the CDC recommended that Perryman be allowed to finish her quarantine at home in Florida.

“The disagreement between CDC and Florida over the appropriate monitoring conditions forms a central dispute in this medical review,” wrote Dr. Michael Bell, the appointed quarantine medical reviewer, who is the director of the CDC Division of Healthcare Quality and Promotion.

Bell noted in the report he was not previously involved with the quarantine orders in Perryman’s case.

After reviewing the evidence in the case, Bell said that it was his professional judgment that “less restrictive alternatives would adequately serve to protect public health.”

Bell noted that Florida health officials had proposed once-daily telehealth monitoring with remote temperature checks and symptom assessments. He said these conditions – along with a pre-arranged plan for an appropriate hospital to care for Perryman if she experienced symptoms – would be sufficient to protect public health.

“This is a reasonable and efficient approach that is consistent with the level of transmission risk associated with Andes virus infection,” wrote Bell.

Perryman, who has been appealing her continued detention in Nebraska for several weeks, had her hopes buoyed by Bell’s medical review. But then she received no information indicating anyone was arranging her transfer to Florida.

She said Kennedy’s order on Monday – essentially rejecting the medical review’s recommendations and upholding the current quarantine order – means she’s stuck at the Nebraska quarantine facility until the 42-day quarantine period ends on June 21.

Perryman said she thinks she’s being retaliated against for publicly criticizing how HHS has handled the quarantines.

“A non-physician just overrode the physician medical reviewer,” she said, emphasizing that Kennedy is not a doctor.

Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University, called Kennedy’s order “a shocking disregard for both science and personal freedom.”

“It’s a flagrant violation of due process and should be immediately challenged in the courts,” Gostin said on the social media platform X.

Appealing federal quarantine orders isn’t an easy process, Perryman said she and her attorneys have found. Numerous bureaucratic hurdles first have to be cleared within the federal government’s administrative process before you can seek a court’s review.

“They’ve managed to run the clock down and deny me my Fifth Amendment rights,” she said. “We followed the procedure set forth in the regulation, we complied with the law, and they did not.”

Editor’s note: This article has been updated to include a comment that the U.S. Department of Health and Human Services provided the day after publication.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine: 5 passengers sent to home quarantine, 13 remain in Nebraska facility

2026-06-01T23:21:17+00:00

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Five passengers from the hantavirus cruise ship have been allowed to leave a secure quarantine facility in Nebraska and continue being monitored at home, but 13 others remain at the secure facility, the U.S. Department of Health and Human Services told Healthbeat on Monday.

At least two of those released to home quarantine on Monday will be under around-the-clock monitoring and have been put under an official quarantine order, New York officials said.

Multiple media outlets have reported that federal officials had wanted to require that state health departments ensure a police officer or public health worker was stationed 24/7 outside each of the individuals’ homes. That is an unusual step that may stigmatize people who have shown no signs of infection.

Officials at HHS and the Centers for Disease Control and Prevention did not answer questions about why some passengers are being allowed to leave the facility after 21 days of a 42-day quarantine or why others are remaining inside a secure, institutionalized setting. Nor have they provided any public health or scientific basis for how potential risks from former passengers of the M/V Hondius are being managed.

The lack of transparency and inconsistency in the federal government’s approach to managing potential public health risks in the wake of a deadly outbreak of Andes hantavirus is drawing concern from legal experts and public health officials.

Testing so far has not found any of the U.S. passengers being held in quarantine to be infected with the virus.

“The administration is being quite secretive and arbitrary in its use of quarantine powers,” said Lawrence Gostin, the founding O’Neill Chair in Global Health Law at Georgetown University.

“Quarantining a person is a massive infringement of civil liberties and must be done using a clear and science-based process,” Gostin said Monday. “I do not think the administration is acting in a transparent or rational fashion.”

The 18 U.S. passengers from the cruise ship were evacuated last month to the National Quarantine Unit at the University of Nebraska Medical Center in Omaha after three people who had been aboard an international nature cruise died from severe respiratory illness caused by an unusual type of hantavirus that has the potential for “limited” spread between people.

So far, health officials in multiple countries have identified 10 additional cases of Andes hantavirus among people who were among the nearly 150 passengers and crew aboard the ship, according to the World Health Organization’s latest update on May 28.

It’s unclear what the terms and conditions are for the five U.S. passengers who on Monday were allowed to leave the Nebraska facility, and whether federal health officials have issued any new or renewed federal quarantine orders to force any of the other passengers to remain in the facility.

Neither HHS nor the CDC would say. Officials at the University of Nebraska Medical Center also did not answer questions from Healthbeat.

“All five remain symptom-free and have met public health criteria to safely continue monitoring outside the NQU,” HHS said in an email to Healthbeat. The department did not respond to questions about what those criteria were.

Health workers in hazmat suits board the Dutch polar expedition cruise ship MV Hondius at a dock in Rotterdam. So far there have been 10 cases of the Andes hantavirus worldwide among about 150 passengers and crew. (Photo by Nicolas Economou/NurPhoto via Getty Images)

The five people being released to home quarantine will not travel on any commercial flights, HHS said. The department said “appropriate biocontainment measures are in place during transport,” but no details were released.

Once these five people are home, HHS said that state health departments will continue “daily symptom monitoring, maintain 24/7 oversight, and provide guidance throughout the remainder of the 42-day monitoring period.”

HHS officials did not answer questions about how the monitoring and oversight would be carried out.

“CDC encourages the public to support the people and families affected by this situation,” HHS said. “Public health monitoring is a precautionary measure that helps safeguard the health of potentially exposed individuals and protect communities.”

Two of the passengers beginning home quarantine have returned to their private residences in undisclosed locations outside of New York City, Dr. James McDonald, New York state health commissioner, said in a statement Monday afternoon. He said they will remain under “around-the-clock surveillance” and under a quarantine order.

A third New York passenger has chosen to complete the remaining 21 days of their quarantine in Nebraska, McDonald said.

Another Hondius passenger who has chosen to stay at the Nebraska facility is Jake Rosmarin, an Instagram content creator who switched from documenting sightseeing aboard the ship to documenting his time in quarantine.

“This whole experience has totally traumatized me,” Rosmarin said in a video posted Sunday to his Instagram account explaining why he’s choosing to stay at the National Quarantine Unit. “I’m afraid to leave this room until I know that I will not get sick. I do not want to leave here until I know that there is a 0% chance of me getting sick, a 0% chance of me risking my family and friends getting sick, or the general public getting sick.”

He said he also wants to be at a facility that can quickly treat him should he develop any symptoms of Andes virus before the quarantine period ends.

Rosmarin said the process that federal officials have set up to allow some Hondius passengers to leave the facility is complex and involves federal, state, and local authorities.

“The media is making it out to be much simpler than it actually is logistically to get people home to self isolate,” he said. “It is a really complicated process, and there’s a lot of factions that have to agree upon us going home to make that work.”

HHS noted that no cases of Andes virus have been confirmed in the United States. The risk to the public remains low, officials said.

The Andes virus is typically spread by rodents in South America, but has in some cases been able to spread from one infected person to another, according to the CDC. But this person-to-person spread usually requires close contact, such as having direct physical contact with the sick person, spending “prolonged” time in close or enclosed spaces, or being exposed to the infected person’s body fluids.

It can take between four and 42 days from when a person is exposed to the virus to when they start showing symptoms, such as fatigue, fever, achy muscles. People who are infected can become seriously ill with Hantavirus Pulmonary Syndrome. There is no specific treatment or vaccine. For those who are sickened, medical care focuses on managing symptoms.

Last month, the CDC issued federal quarantine orders to two of the 18 people being monitored at the Nebraska facility. Those orders were based on a disease list that does not include hantavirus.

The passengers had initially been “requested” to stay at the facility for testing and monitoring through May 31. When two of them began making arrangements to leave and quarantine at home, the CDC issued two federal quarantine orders against them, requiring that they stay in the facility.

CDC and HHS officials did not answer Healthbeat’s questions about the status of these quarantine orders.

Jennifer Nuzzo, an epidemiology professor and director of the Pandemic Center at Brown University School of Public Health, called the approach to managing the U.S. passengers’ risk unusual and concerning.

“Every American should be concerned about the somewhat quixotic and a bit arbitrary approach that they have taken in dealing with these passengers,” Nuzzo said.

Nuzzo noted that some passengers who disembarked the Hondius cruise ship after the first passengers died but before health officials were aware of an outbreak, have been allowed to quarantine at home since their return to the United States.

“To tell some passengers you can’t leave Nebraska, and to tell other passengers it’s okay to be home, that doesn’t make any sense. There’s no public health rationale for that,” she said.

She also questioned why the federal quarantine orders were issued last month to two of the patients who sought to quarantine at home.

“I have not heard a single assertion that these patients don’t want to quarantine,” Nuzzo said.

“The general public health practice, the ethical practice, the historical practice is we impose measures by the least restrictive means necessary,” Nuzzo said. “Quarantining in facilities is not typical, and only done under extreme cases, usually because someone has refused to comply with other measures.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Hantavirus cruise ship quarantine orders are based on a disease list that doesn’t include hantavirus

2026-05-22T02:34:45+00:00

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The deadly hantavirus that has killed three passengers from a cruise ship does not appear on a key list that gives the Centers for Disease Control and Prevention its expansive detention powers, a public health law expert told Healthbeat. That means the federal quarantine orders the agency is using to detain two exposed passengers could face legal challenges.

At issue: Federal regulations only allow the CDC to quarantine people for specific “quarantinable communicable diseases” that are on a list created through presidential executive orders. The list includes a wide range of dangerous diseases: viral hemorrhagic fevers, infectious tuberculosis, measles, severe acute respiratory syndromes, and flu that can cause a pandemic.

However, no type of hantavirus is on this list.

The list can only be updated by presidential executive order, and President Donald Trump has not issued an order to add the deadly Andes hantavirus that has prompted worldwide concern.

Until this week, federal officials had requested, but not mandated, that 18 U.S. passengers from the M/V Hondius cruise ship undergo medical screening and observation at a Nebraska quarantine facility through May 31, which would be the 21st day of their monitoring period.

On Tuesday the CDC announced that it had issued federal quarantine orders to two of the passengers at the Nebraska facility, requiring that they stay until the monitoring period is over.

One of the passengers being held in Nebraska, Angela Perryman, has spoken publicly about receiving a quarantine order after making plans to leave the facility to continue voluntarily quarantining on her own. Perryman could not be reached.

James Hodge, Jr., director of the Center for Public Health Law & Policy at Arizona State University, told Healthbeat that he’s seen a copy of the CDC’s quarantine order. Federal health officials are using a broader category of disease placed on the list more than a decade ago to justify detaining the two passengers.

“Here’s what they’ve done: They are classifying hantavirus, the Andes strain, as a severe acute respiratory syndrome condition,” Hodge said. “That is a listed condition for which the CDC can actually quarantine.”

The Andes hantavirus, which is usually spread through contact with urine or droppings from rodents, can cause severe pulmonary symptoms. It is the only hantavirus that can also spread from person to person.

Hodge said he’s spoken to some medical experts who think it’s legitimate to classify the Andes hantavirus as a type of severe acute respiratory syndrome, but he noted that’s not typically how the term is applied.

“That’s going to be a real question,” Hodge said, “and it might be one for which we do see that quarantine order being significantly challenged.”

Officials at the CDC and the U.S. Department of Health and Human Services did not respond to questions from Healthbeat on Thursday.

Hodge said the CDC’s quarantine orders are relying on a July 2014 executive order issued by President Barack Obama that updated the list of quarantinable diseases to include a broadly defined category of “severe acute respiratory syndromes.”

The executive order defines these syndromes as “diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.”

The order specifies that this definition does not apply to influenza.

It’s unclear whether the executive order was intended to apply to diseases such as those caused by the Andes strain of hantavirus, which has shown the ability to spread from person to person for many years.

The Obama executive order was issued amid heightened concerns about outbreaks of MERS – Middle East respiratory syndrome – coronavirus.

Obama’s order amended an April 2003 executive order issued by President George W. Bush that added “Severe Acute Respiratory Syndrome (SARS)” to the quarantinable list. The SARS coronavirus emerged in China in 2002 and spread to 28 countries before the outbreak ended in 2003.

Given the broadly written definition of severe acute respiratory syndromes in the Obama order, Hodge said the CDC is seeking to make the case that the Andes hantavirus qualifies as a quarantinable disease.

But he said the passengers subject to this week’s quarantine orders also have the potential to make several arguments if they choose to challenge the orders in court, including that the virus wasn’t specified as a quarantinable disease. “I would be saying, you’ve never previously called hantavirus Andes strain a severe acute respiratory condition,” he said.

Hodge added that any uncertainty could be ended with an executive order adding the Andes virus to the quarantinable list. “President Trump could issue that order in the next five minutes and we’d be done here,” he said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Inside the largest U.S. measles outbreak in decades: Records reveal spread in vaccine-hesitant community

2026-05-19T09:00:00+00:00

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Case #1 in what would become the largest U.S. measles outbreak in decades was a parent in South Carolina’s Upstate Region near Spartanburg.

The next seven people to fall ill were all children. Three of them were being cared for at home – limiting their ability to spread the highly contagious measles virus to others.

But the children who became Cases 5, 6, 7, and 8 were infectious while they mingled with other children at school and in daycare, according to internal records obtained by Healthbeat from the South Carolina Department of Public Health.

By the second week of the outbreak, the number of known infections had grown to 12. The internal records, obtained under the state’s public records law, reveal all of them lived in just four households.

At the center of the nearly seven-month South Carolina measles outbreak – from beginning to end – was a close-knit, vaccine-hesitant Ukrainian- and Russian-speaking community in and around Spartanburg County, according to South Carolina state health officials.

By the time the outbreak was declared over on April 27, the handful of cases that were first identified among a couple of families in October 2025 had resulted in 997 documented measles infections.

How the South Carolina measles outbreak began

A breakdown of the first eight cases:

South Carolina DPH estimates about 90% of these outbreak cases were among members of the area’s Ukrainian- and Russian-speaking community, which has around 15,000 people in Spartanburg County, the department said in emailed responses to Healthbeat’s questions.

“This community was at the center of the outbreak for its whole course,” said the department, which did not grant an interview.

The South Carolina outbreak is the latest example of a trend the Centers for Disease Control and Prevention has documented for decades: Nearly all large U.S. measles outbreaks since 2000 – when the country attained measles-free status – have involved various types of close-knit groups with low vaccination rates.

As measles makes a major comeback across the country, a Healthbeat examination of the challenges encountered controlling the South Carolina outbreak highlights the need for public health officials to understand the specific and sometimes differing reasons for vaccine hesitancy within individual groups.

It also illustrates the importance of identifying at-risk pockets of unvaccinated people and building trusted relationships before outbreaks happen. All are complex tasks made more difficult amid heightened public distrust in the wake of the Covid-19 pandemic and during a time of cuts to public health staffing and funding.

“Waiting for infectious disease to start spreading is too late. It is significantly more effective to prevent an outbreak than to contain it,” said Dr. Eliza Varadi, a Russian-speaking pediatrician in Charleston, S.C.

“Even in a state where most people are vaccinated, those small pockets, that’s where diseases will spread,” said Varadi, the immunization representative for the South Carolina chapter of the American Academy of Pediatrics, who worked with DPH officials during the outbreak and provided advice on culturally sensitive outreach and education.

Close-knit groups have fueled U.S. measles outbreaks since 2000

South Carolina’s outbreak is a case study in how years of declining immunization rates – especially among children obtaining religious and non-medical exemptions from school vaccination requirements – is making localized communities of various types across the country vulnerable to the spread of infectious diseases, according to Varadi and other health experts.

Dr. Satish Pillai, the CDC’s incident manager for the 2025-26 national measles response, noted the role of close-knit groups in “nearly all” measles outbreaks with more than 50 cases since 2000 during a presentation to local public health officials earlier this month.

Outbreak was concentrated in a close-knit community

From October 2025 through March 2026, the outbreak caused 997 known measles infections in and near Spartanburg County. State health officials estimate about 90% were members of the area’s Ukrainian- and Russian-speaking community.

These outbreaks include those that have occurred in New York during 2018-19 largely in an Orthodox Jewish community; in Washington state in 2019 among a Ukrainian- and Russian-speaking community; in central Ohio in 2022 primarily among children of Somali descent; in Chicago during 2024 within a shelter for migrants who were mostly from Venezuela; in Minnesota in 2024 where a Somali community was disproportionately impacted; and in West Texas in 2025 among a rural Mennonite community.

In recent months, Pillai noted, the types of close-knit groups driving measles outbreaks has been evolving. Large outbreaks this year have occurred on the campus of Ave Maria University in Florida and at a federal detention facility in Texas.

“Having large college outbreaks and large detention facility outbreaks at these levels are unprecedented since 2000,” Pillai said.

Meanwhile, lower vaccination rates throughout communities have begun allowing outbreaks that begin in close-knit communities to start spreading widely across populations, as has happened in the ongoing outbreak in Utah, he said.

Schools, families, churches contributed to virus spread in S.C.

South Carolina DPH officials told Healthbeat they do not know the infection source that led to the initial cases in the state’s measles outbreak. They said this indicates unrecognized spread of the virus was already occurring by the time cases started being reported to public health.

Measles poses a significant outbreak threat for unvaccinated, socially, and geographically connected people because it is so contagious and spreads through the air, where it can linger for up to two hours in enclosed spaces.

Families drive early infections

By Oct. 15, state investigators had identified 12 outbreak cases. All were members of just four households.

To prevent ongoing transmission of measles within communities, 95% of people need to be fully vaccinated against the disease, according to the CDC.

Some of the earliest cases in the South Carolina outbreak last October involved Global Academy of South Carolina. The Spartanburg County public charter school was founded by educators from Ukraine whose “passion to help families of immigrants” have prompted them to open tuition-free schools in California, Florida, and most recently South Carolina, according to the schools’ websites.

When the outbreak started, Global Academy’s student body had one of South Carolina’s lowest levels of vaccination coverage: Only 21% of its students were up-to-date on their school vaccinations during the 2025-26 school year, state data show. Even fewer of the school’s students – just 17% – were fully vaccinated during the previous school year.

Only 21% of the students at Global Academy in Spartanburg County were up-to-date on their school vaccinations during the 2025-26 school year, state data show.

Officials with Global Academy of South Carolina, its board of directors, and founders have either declined to be interviewed, did not respond to interview requests, or could not be reached during and after the outbreak.

As the measles cases continued to spread within households, some of those infected were unvaccinated children and teens who unknowingly brought measles into other schools – exposing scores more students who also weren’t vaccinated.

“We know that some schools with a high percentage of children from Ukrainian- or Russian-speaking families have been impacted and a number of public exposures have been reported in churches attended by these community members,” DPH said in response to Healthbeat’s questions.

In low-vaccination communities, one person can expose dozens

Because the initial symptoms of measles – such as a cough, runny nose, red eyes, and fever – can appear like those of a common cold or the flu, people can spread the disease before they know they have it. They are contagious beginning four days before the tell-tale measles rash appears on their face and body.

Further complicating public health efforts to control the virus’ spread is that there can be a significant lag time from when someone is exposed to the virus and when they start feeling ill. Symptoms often develop seven to 14 days after exposure, but it can sometimes take up to 21 days.

Internal South Carolina state health department records obtained by Healthbeat provide a window into how a single contagious person can expose dozens.

How measles can spread

How Case #44 in South Carolina’s outbreak exposed 66* close contacts to the virus who were unvaccinated or lacked immunity through previous infection.

*One individual was both a household member and Lyman Elementary School student.

Outbreak Case #44, identified by state health officials in mid November, exposed 66 close contacts to measles who were unvaccinated or lacked immunity to the virus through previous infection. They included three household members, four patients at a doctor’s office, 58 individuals at Lyman Elementary School (including one of the household members), and two school bus riders from D.R. Hill Middle School, according to an email update from DPH to the South Carolina governor’s office on Nov. 17.

As state public health officials investigated outbreak Case #45, they identified an initial 61 close contacts who had been exposed and weren’t protected against measles. They included four household members and 57 individuals from Boiling Springs Middle School. The person, while infectious, also attended a church with about 250 people in its congregation, according to DPH emails to the governor’s office on Nov. 19 and 20 that do not name the church, but say notification letters in multiple languages were provided for distribution.

As the outbreak continued, infected people participated in services and other activities at several Slavic churches, where services are held in the Russian or Ukrainian languages, including Slavic evangelical and Pentecostal churches.

At one of these churches, the Way of Truth Church in Inman, S.C., a person who was infectious attended on the evening of Nov. 7 and morning of Nov. 9, exposing others who weren’t vaccinated. Over the weeks that followed, at least 30 infections were linked to the church.

Of the 14 newly identified measles cases announced on Dec. 2 by state health officials, eight were people exposed at Way of Truth Church. Over the next week, 16 more people fell ill with measles from exposures at the church. Five more cases linked to the church were announced on Dec. 16, plus one more on Dec. 19.

During late December and into January, state health investigators tracing the movements of people recently diagnosed with measles identified additional exposures that had occurred at several other Slavic churches, including Tabernacle of Salvation Church, Ark of Salvation Church, and Slavic Pentecostal Church of Spartanburg. Church leaders could not be reached or did not respond to Healthbeat’s interview requests during and after the outbreak.

Slavic churches unwilling to host vaccination events during outbreak

Varadi, the state American Academy of Pediatrics representative who worked with South Carolina DPH during the outbreak, told Healthbeat that vaccine hesitancy within the membership of some Spartanburg-area churches was a key challenge in stopping the outbreak.

“The center of the outbreak was not the entire Russian-speaking or Ukrainian-speaking community. It was a small subset that may have been related to specific churches,” Varadi told Healthbeat.

“It’s not that the church leadership was discouraging vaccinations, they just were not encouraging,” Varadi said. “We wish that there would have been a better partnership to work together to encourage vaccination.”

DPH officials, who told Healthbeat that Varadi provided them with “valuable insights and assistance,” acknowledged that no church from within the area’s Ukrainian- or Russian-speaking community agreed to host a vaccination event during the outbreak.

“As is often the case, church leaders made decisions about whether to interact with DPH based largely on the wishes and feelings of their congregations,” the department said in its written responses to Healthbeat’s questions. “While some were willing to discuss outreach and education opportunities, others were not. Importantly, none were forced to meet with DPH to discuss any of these topics.”

Tabernacle of Salvation Church in Spartanburg, South Carolina, was among several Slavic churches that had measles exposure incidents during the outbreak.

One of the close-knit community’s “prominent churches” did voluntarily agree to meet with DPH leadership during the outbreak, the department said, “and that conversation was informative.” DPH declined to name the church.

From the beginning of the outbreak, DPH officials in press briefings emphasized the importance of vaccination in stopping the outbreak. They separately made information about measles available in the Ukrainian and Russian languages on the DPH website and to churches and other groups.

Two doses of the measles-mumps-rubella (MMR) vaccine are 97% effective in protecting against measles, and even one dose is 93% effective, according to the CDC.

While the Ukrainian- and Russian-speaking community remained a vaccination challenge, by January – as the outbreak spiked – the department started seeing wider increases in measles vaccination across Spartanburg County and the state. This increase, combined with the large number of people who became immune to measles through illness, helped end the outbreak, they said.

Dr. Brannon Traxler, the South Carolina DPH’s deputy director and chief medical officer, in response to Healthbeat’s questions during the department’s last media briefing on the outbreak on April 27, said it is important to understand the community’s history and reasons for being hesitant about vaccines.

“We recognize and appreciate there is history there that didn’t occur in South Carolina, often even before they came to the United States, that has led to very legitimate fears of government and of government health,” said Traxler, who last week was named the department’s acting director. “They have a reason to have the doubts that they do.”

How the South Carolina measles outbreak grew from 5 to 997 cases

Traxler did not elaborate. DPH, in response to Healthbeat’s questions, declined to discuss the reasons public health workers have been given by community members for not vaccinating their families against measles.

“Those reasons are theirs to communicate, not ours,” DPH said by email. “Our role in every communication was to provide the best factual information possible with which families could make informed decisions.”

Vaccination programs and government trust have a complicated history in Ukraine and Russia.

The more distant history includes the former Soviet Union’s mandatory and coercive national immunization programs and ongoing vaccine hesitancy and concerns about vaccine safety.

There also was a history in former Soviet republics of some measles vaccines having lower levels of effectiveness in preventing outbreaks that has been attributed to poor manufacturing quality control and improper vaccine storage and handling practices.

While the Russian Federation is estimated by the World Health Organization and UNICEF to have had high levels of measles vaccination coverage for many years, that has not been the case in Ukraine.

In Ukraine, the country’s vaccination coverage dropped dramatically after the high-profile death in 2008 of a Ukrainian teenager, an event later determined to be unrelated to being vaccinated against measles as part of a large immunization campaign.

According to the WHO, 95% of children in Ukraine in 2008 were fully vaccinated against measles. But by 2016, just 42% were protected with one dose of measles vaccine and 31% with two doses. And during 2017-19, the country experienced a measles epidemic that resulted in more than 115,000 reported cases.

Since then vaccination coverage has increased. As of 2024, about 91% of 1-year-old Ukrainian children and about 83% of 6-year-olds were vaccinated against measles, according to information released by UNICEF Ukraine last year.

In South Carolina, DPH officials said members of the Ukrainian- and Russian-speaking community cooperated with the department’s recommendations for isolating and quarantining at home to prevent spreading measles to others.

Quarantines, which could last up to 21 days, had a significant impact on these families’ daily lives, education, and finances, with children having to stay out of school and adults missing work.

DPH said its community health workers, when asked, helped these families identify social service resources, including for food and utility support

Community members are key to building trust in public health

Public health officials at the Washington State Department of Health found themselves facing similar challenges in 2019, following a measles outbreak among a Ukrainian- and Russian-speaking community.

“We didn’t have a lot of connection with that community or a lot of resources for them in their language,” said Danielle Koenig, the department’s health promotion supervisor.

In the wake of the outbreak, Koenig helped secure a CDC grant that for six years funded a project to better understand the needs of the community, build trust, and provide health resources. The grant ended last summer.

The South Carolina Department of Public Health had disappointing turnouts for its mobile vaccination clinics during the outbreak. Churches serving the Ukrainian- and Russian-speaking community at the center of the outbreak declined to host vaccination events, the department said.

The department found that a cornerstone of building trust is partnering with leaders and organizations from the impacted community, listening and responding to their needs – and also hiring members of the community – like Vadim Gaynaliy – to help lead the outreach.

Gaynaliy, a health educator at the department who speaks Ukrainian and Russian and is from a large Ukrainian community in northeast Portland, said his background and those of others involved in the project provided insights into the community’s values and how it functions.

“We’re not even talking about a single community here. There’s obvious political tensions between Russian and Ukrainian communities, there’s different religions and denominations. So we try to address them as different communities who will have different needs,” Gaynaliy told Healthbeat.

The project resulted in the creation of the Nashi Immigrants Health Board – now an independent nonprofit organization run by and for the Ukrainian- and Russian-speaking community that provides a range of resources and support programs beyond just information about vaccination.

“Trust is the biggest ingredient,” said Tamara Cyhan Cunitz, the board’s co-founder, executive director, and a registered nurse and educator whose relatives came to the United States after escaping the Soviet Union during World War II. “People who are from a cultural community will pay attention and connect better with someone who knows their culture and language.”

S.C. gets 5 months of funding to launch outreach project

The huge measles outbreak in the Spartanburg area is finally over, but the area remains at risk of future outbreaks because it continues to have large pockets of people who are not vaccinated against the disease – including in the Ukrainian- and Russian-speaking community.

To help address this, DPH told Healthbeat it is beginning a new partnership with two nonprofit public health organizations to hire community health workers to do education and outreach in two or three areas within Spartanburg County that face higher risks from measles and other vaccine-preventable diseases.

The CDC Foundation, a nonprofit organization that supports the CDC and public health, has agreed to provide five months of funding for the project, the groups said.

“The idea is to reach the specific Slavic community, that from a health department perspective, they have had struggles with reaching over the years and to really make inroads around vaccines and vaccine education,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, which is one of the project’s partners. “Doing this work outside of a crisis is really, really important.”

Terri Jowers, executive director of the South Carolina Community Health Workers Association, the project’s other nonprofit partner, said the project plans to hire three community health workers, with two of them coming from within the Russian- and Ukrainian-speaking community.

Jowers said the project will develop training for this soon-to-be hired team on how to better engage with communities through conversations about why they are hesitant or concerned about vaccines, what they have heard, and ways to work together to find sources they trust to figure out the facts. The training will also be made available to other community health workers in Spartanburg County and across the state, she said.

“The goal is to really start training people by the end of June so that community health workers feel more comfortable having these conversations,” she said.

Five months is not a lot of time to build trust and Jowers said she is hoping that the project will be able to identify additional funding for a year beyond the initial grant. “You have to build those trusted relationships,” she said.

The CDC Foundation, which told Healthbeat it is providing more than $100,000 for the project, said that trusted messengers are critical. The foundation said the project’s limited timeframe is based on funding availability. “If additional funding becomes available, we would consider extending the timing,” it said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Why the hantavirus cruise is getting so much attention – and how much to worry

2026-05-14T11:00:00+00:00

Hello from Nairobi.

This week’s report is heavy on the ongoing hantavirus outbreak. I’m fascinated by this story. Not because the virus itself looks like it will become a global emergency (I strongly believe it won’t), but because the story around it has taken on a force of its own. We’ll also cover Indonesia’s push to eliminate a type of cancer, fake rumors of shrinking genitals in central Africa, and the spiraling health crisis in Cuba.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight five of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The hantavirus outbreak … breaks out of health news

Last week, I wrote about the hantavirus outbreak as a marginal item. An interesting story, but not quite a major event.

Since then, I’ve been gobsmacked by how far this story has traveled. Not only are most major media outlets covering the outbreak from dozens of angles and follow-ups, but it’s moved well beyond the usual lane of global health stories into full zeitgeist-meme territory.

The outbreak is clearly catching the broader public’s attention, eliciting no small amount of fear and anxiety… so what gives? Was I wrong to dismiss it?

Disease breakdown: Hantavirus is a family of rare viruses usually carried by rodents. People typically get infected by breathing in particles from infected rodent urine, droppings, or saliva. The strain at play here is Andes virus, one of the few hantaviruses known to spread from person to person, as seen in South American outbreaks going back decades. It can cause severe respiratory illness, with symptoms appearing up to 42 days after exposure. There is no specific treatment or vaccine, so care is mostly supportive.

First off, I won’t argue that the story isn’t captivating. It has all the ingredients of a thriller movie: a rare and deadly disease. A cruise ship unable to reach port. Wealthy, international passengers who had already disembarked and scattered across the globe. The ongoing scramble to contain and quarantine.

And yet, even with all of this, the World Health Organization and national public health agencies globally have been in full-on reassurance mode.

Despite the attention, you can’t find serious global health professionals in panic over this outbreak. Not only has the WHO said that it “assesses the risk to the global population posed by this event as low,” but even for the people stuck on the actual cruise(!), “the risk for passengers and crew on the ship is considered moderate.”

It’s worth taking a big step back here, to break down what actually makes an infectious disease objectively frightening in an outbreak. And why this ain’t it.

(Fair warning: What follows is my own aggressive oversimplification, but a sound and useful one.)

Let’s imagine a mad scientist had created a disease-making box with four dials that control how “scary” an outbreak gets. And the way you tweak those settings will determine whether your virus, bacteria, or parasite is a local headache or a global nightmare. Those dials are:

Deadliness: What are the straight odds this disease kills you?
Existing medical defenses: Do we already have vaccines, treatments, or diagnostics that can fight the illness, or blunt the damage?
Infection window: When and how long will someone spread this disease? Are apparently healthy people passing it around for days, is it just a brief affair that requires someone to be visibly ill?
Finally, contagiousness: How easily does the infection spread? Are we looking at something that hangs in the air for hours like measles, or does it require close contact with infected fluids or tissues, like Ebola?

Now, if the Andes virus came out of our imaginary disease-making box, here’s where our objective fear dials would be set.

On deadliness, the dial is set to… “nightmare”! We’re looking at a fatality rate around 40%. No, not the deadliest disease we know of, but let’s not split hairs. Nobody sane would ever willingly risk those odds.

On medical defenses, the dial is also set to “maximum fear.” There is no specific treatment and no vaccine currently available for this virus, so care is mainly supportive.

Ok, so we’re off to a terrible start.

But the infection window setting is mixed. The bad news is that symptoms can appear as late as 42 days after exposure. That long incubation period means infected people can travel far before anyone knows they are infected, potentially seeding new clusters. But (!) there’s a crucial caveat: People are not contagious that whole time. In fact, the evidence we have suggests that people with the Andes virus are infectious only once they are visibly sick. So we’re setting this dial down to “mild alarm.”

This all brings us to the most important dial: contagiousness. And this one is set way down to “low-grade unease.” Ultimately, this is the big reason health officials are cautious, but not sounding alarms. Yes, the Andes virus is unusual among hantaviruses because it can spread from person-to-person. But the word “can” is doing a lot of work.

As Ion Genomics has reported, the virus does not appear to be some strange new mutant. So, as in older outbreaks, person-to-person spread is largely limited to close contact with a sick person, including direct physical contact, for prolonged periods of time in an enclosed space, or exposure to body fluids. (You can see why a cruise ship is the perfect incubator.) Simply put, it just does not appear to move easily through casual contact.

That’s reassuring, because this type of spread is laggardly enough that competent public health responses can typically move faster than the virus. If officials can identify contacts, monitor them, isolate anyone who gets sick and quarantine people at highest risk, there is a very high likelihood of containing this outbreak. Yes, that containment still requires vigilance, real work, and potentially more deaths. After all, this virus spreads and creeps in ways that do not quash instantly. But “quashing” is nevertheless where we’re headed.

Admittedly, Andes virus sounds terrifying. And for the unlucky people who get sick, it absolutely is. But scary as a disease is not the same thing as scary as an outbreak.

And so, my big takeaway here: The objective risk and threat of this outbreak is incommensurate with the news coverage it has received.

Now, I’m not wagging my finger at the coverage. People are interested, and I get why. But don’t mistake the amount of coverage, or the, uh, “cinematic focus” of it, for a measure of how concerned you should be.

As a threat, this hantavirus is not obviously more alarming than, say, Nipah virus: a comparably deadly infection with similar dynamics, which causes recurring outbreaks every few years in South Asia… all without a fraction of the spotlight.

What the hantavirus panic gets right

To gut-check that read, I reached out to Dr. Ronald Nahass, a clinical professor of medicine and president of the Infectious Diseases Society of America.

He agreed with the assessment that the epidemiology here does not justify outsized worry, but argued the outbreak still revealed something real. “A public health fire drill,” as he put it, and one that showed how important clear communication still is.

First off, we spoke about why this, of all outbreaks, has captured so much attention given the reality of the disease dynamics. My imperfect theory has been that the outbreak mirrors a lot of the media dynamics of a celebrity death. Deaths of course happen every day, but certain deaths break through because the person or circumstances make them feel unusually vivid and close. And this story has vividness in spades. After all, “cruise from hell” is narratively almost too good.

Also, at a certain point, public interest starts feeding on itself. The more coverage a story gets, the more it signals that this is something worth paying attention to, and so the more people want to hear about it.

Nahass broadly agreed that the narrative setting was doing a lot of work (granted, neither of us are media theorists) but he added another factor I had underweighted: the memory of Covid.

Nahass likened the event to a kind of public “PTSD” from the early days of the last pandemic. With a ship at sea, passengers trapped in uncertainty, people dying from a transmissible disease, “that is extraordinarily similar to some of the stories we heard during the Covid outbreak, and so obviously that brings back those images,” he said. “And so we all feel that.”

Still, his greater point was this: Put aside the science for a moment, public health is about people, and the public’s reaction and interest should matter as much as the underlying epidemiology. If people are worried this could be Covid 2.0, meet them where they are.

Sure, he said, “the biology doesn’t necessarily rise to the level of a SARS virus or a novel influenza virus.” But the anxiety is real, and that “emotional toll, or anxiety toll,” he said, and the practical questions people have about what this means for them, well, that’s more than enough to make the focus worthwhile.

And there’s a clear upside. This response is an opportunity for public health organizations to build trust, he said, and to show what a competent outbreak response actually looks like before the next real crisis arrives.

Now … as for how this moment has initially been met, Nahass was blunt enough to assign grades. He gave the WHO decent marks, especially given that no single country, and not even the WHO, had clear authority over a ship at sea. “I’d give them a B, or maybe a B-minus,” he said.

His assessment of the U.S. Centers for Disease Control and Prevention was harsher: “The CDC certainly gets a failing grade. They were absent,” he said, noting that it took the organization almost a week to put out a public response, and to Nahass, that silence fit a larger problem. Behind the scenes, the United States was missing from the kind of global outbreak response it once helped lead.

In the end, Nahass framed the ongoing hantavirus outbreak as “a public health fire drill,” one that showed how much that we still have not learned from the last pandemic. “God forbid this had been something more transmissible,” he said, noting that “we had potential vectors across the United States before we knew what it was.”

Nahass thinks the United States’ takeaway should be a wake-up call about the cost of pulling back from global health, such as departing the WHO. “We’re all interconnected,” he said, “we have to be able to respond to these kinds of events globally.”

As for the rest of the world, I think this “fire drill” is also a useful warning at a moment when the WHO’s global pandemic treaty is still sitting unfinished, as we’ve covered extensively.

Because next time might not be another drill.

Fake rumors of shrinking genitals… no laughing matter!

We’ve gone long on hantavirus coverage, so I’ll be brief with the other stories of the week.

Reuters covered a story about a fake disease conspiracy theory in the Democratic Republic of Congo that has become a real public health crisis.

Last year, rumors of a mysterious illness causing men’s genitals to shrink spread through social media, local outlets, and churches in a province in the center of the country. The rumors elicited “angry mobs [which] attacked and killed four health workers conducting vaccination research,” among other damage and deaths. “In all, at least 17 killings related to the atrophy rumor have been reported,” although Reuters could not independently verify all of them.

The story is grotesque (enough so that I’m not even attempting the obvious jokes), with a broader, painfully familiar warning. Misinformation is not background noise in public health. And it can create new dangers of its own, turning ignorance or confusion into fear and violence, directed at the very people trying to deliver much needed health care.

Cuba: an ‘epidemic of flies, rats, [and] waste’

The Guardian has a depressing follow-up on Cuba’s deepening health crisis, which we’ve reported on before.

As a U.S. oil blockade chokes off fuel supplies, the capital city of Havana has been forced to cut back on trash collection, leaving waste piling up across the city and residents burning trash in the streets. One resident described it as “an epidemic of flies, rats, waste, and foul odors.”

The piece tracks the obvious health risks of all that uncollected and burning waste: toxic smoke, vermin, flies, and gastrointestinal diseases. One Havana doctor told The Guardian, “at the hospital, we’ve seen an increase in hygiene-related illnesses and gastrointestinal issues.”

Less obvious, but just as worrying, trash heaps can collect rainwater in discarded plastic and other debris, causing fears of rising “mosquito-borne illnesses, with the Aedes aegypti [mosquito] species proliferating." That mosquito is one of the primary vectors for many infectious diseases, like dengue, Zika, chikungunya, and yellow fever.

It’s a rough story, and Cuba’s crisis has many causes. But right now, the U.S. fuel blockade is plainly a driving force, enough so that two members of Congress wrote in The New York Times this week after visiting the island, calling for the blockade to end for medical and humanitarian reasons, even while acknowledging the failures of the Cuban government.

Indonesia’s shot at curing [a type of] cancer

We’ll finish today with an inspiring piece in Think Global Health on Indonesia’s push to eliminate cervical cancer, a disease that still kills more than 20,000 women there each year.

This cancer is unique because it’s a form of the disease where most cases are caused directly by a virus. In this case, the human papillomavirus, or HPV.

In countries like Indonesia, HPV is responsible for an estimated “94% of cervical cancer deaths.” So screening and vaccination efforts against this virus are dramatically effective at cutting cancer deaths.

The hard part, as always, is reaching the people you most need. Indonesia’s “285 million people are spread across 17,500 islands,” with a third of the government’s districts classified as remote. So the story here is ultimately about whether an ambitious national health program can reach people on the outskirts of the country.

– William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Why it’s so hard to get better drugs for neglected diseases

2026-05-07T11:00:00+00:00

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Hello from Nairobi.

The weekend brought in a bit of natural chaos: rains torrential enough to bring down trees near my home, and marauding Sykes’ monkeys in numbers sufficient to convince me I may never eat the soursops growing in my back yard. (I have long since given up on the mangoes.)

This week we’ve got a proper hodgepodge. A story on why it’s still so hard to get better drugs to people with neglected diseases, even after real medical advances. A damning investigation into an AI-driven health insurance system. Updates on both the widening health toll of conflicts in the Middle East, and the stall in a global pandemic treaty, and, finally, a rare virus trapped on a quarantined cruise ship.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The neglected disease trap for better drugs

We’ll start with a story out in Nature that cleanly captures the maddening challenge to treat and cure some of the world’s most neglected diseases.

Enter our hero: moxidectin.

It’s a drug that’s both safe and proven since 2018 as a dramatic improvement for preventing and treating two widespread parasitic diseases (river blindness and elephantiasis).

The problem for moxidectin? The uptake has been an uphill battle.

Disease breakdown: River blindness, also known as onchocerciasis, is a parasitic disease that’s spread by biting blackflies, which breed in rapidly flowing rivers. The nightmarish parasites grow in the skin and eyes, which cause intense itching, scarring, and lesions that can lead to permanent blindness. There are an estimated 20 million cases of this disease, almost entirely on the African continent, and 250 million people require preventive treatment.
Disease breakdown: Elephantiasis is another terrifying parasitic disease, this one spread by mosquitoes. It can cause extreme swelling in limbs or other tissues (commonly in the breasts and genitals) and skin thickening. Hence the name, which is Greek-derived for “elephant-like disease.” There are an estimated 51 million cases of this disease across the equatorial world, and over 650 million people require preventive treatment.

To be clear, moxidectin’s efficacy is not in question.

For river blindness, clinical trials have shown that it lasts longer in the body and appears to clear parasites “86%” more effectively than the current treatment, an anti-parasite drug called ivermectin. The same is true for elephantiasis. In one small trial referenced in the article, the drug cleared parasites in about 95% of patients, compared with 32% for existing treatments.

The drug itself also has a unique backstory. It was invented in the ‘80s for livestock use, but it wasn’t until last decade that it jumped the expensive hoops for human clinical trials.

Those decades of lag is largely because there’s not a lot of commercial incentive for pharmaceutical companies to invest in something like moxidectin. (Even if the World Health Organization says nearly 900 million total people can use it!) After all, its target market is mostly the very poorest people in the world. And for both diseases, other treatments already exist, even if moxidectin appears to work better.

Instead, it took the altruistic efforts of an organization called Medicines Development for Global Health, a non-profit pharmaceutical company that focuses on neglected diseases, to run the trial gauntlet. And they made history doing so.

As the article outlines, this “development, regulatory approval, and [rollout] without involvement of a commercial pharmaceutical partner…” was “a first-of-its-kind achievement for a non-profit company.”

Where are we now?

While moxidectin was finally approved for river blindness in 2018, its first real-world rollout is only now underway in Ghana, “where around 120,000 people received the new treatment last year.”

Part of the delay is pure regulatory bureaucracy. Countries and the WHO still have to review the data and issue guidance. Part of it is also logistical. After all, someone has to manufacture, buy, and distribute the stuff.

But the cruelest delay is, again, financial: Ivermectin, the older and weaker drug, is donated for free by the pharma company Merck. Moxidectin’s nonprofit maker can offer it at a reduced cost, but not for free. So, as you might imagine, competing with a free pill… makes for a hard sell, especially in an era of tightening budgets.

What’s my takeaway? I said this at the top, but this is a maddening story. The layers of systems built around neglected diseases, even in the face of medical advancements, still seem almost designed to make success as hard as possible.

Still, if there is a silver lining, it’s that there are organizations like Medicines Development for Global Health nevertheless trying to exploit the various cracks in that broken system to get better drugs, slowly, into people’s hands.

Stalled pandemic negotiations, part 2

A month ago, we covered the stalled global pandemic treaty, and noted the sticking point to progress: “one final, unresolved section known as Pathogen Access and Benefit Sharing. Basically an agreement on how countries will share bacteria/virus samples of the next pandemic, and how medicines and tests developed from those samples will be distributed.”

The issue basically being that: Poorer countries are being asked to quickly share samples, but they want guarantees that they won’t be last in line for the vaccines, tests, and treatments made from them… like, uh, they were last time.

Well, Reuters is reporting that WHO member states have now even further extended talks on this same unresolved section, “casting doubt on when a pandemic treaty adopted last year can ‌come into effect.”

To be clear, until these final negotiations finish, there is no active treaty (even though the unfinished treaty was technically signed in 2025).

It’s a terrible limbo of inaction. If another pandemic were to emerge tomorrow, we’d still be at the same place we were in early 2020: no settled rulebook on how we work together as a global community, and (assuredly) plenty of consternation to go around.

What’s to be done? I came across a useful essay by three global health law experts, published almost exactly one year ago. And their argument, today, is all the more salient: This final, unresolved section is buckling because it’s trying to solve two extremely hard problems at once.

“Pathogen and data sharing [and] pharmaceutical supply and distribution… both are vital activities that would be more effectively addressed separately,” they write. But, (and here’s my favorite quote from the essay) “exactly why member states think they can resolve the most contentious issues of the preceding three years simply because it is in a separate annex… is rather baffling.”

Ultimately, their sharper point is that these negotiations are being asked to do too much political work. Because the fight isn’t really about technical details anymore, it’s about trust.

The world needs countries to share dangerous pathogens quickly. And poorer countries need some assurance that they won’t once again help create lifesaving tools they can’t access. But both of these issues may be easier to solve if they are not forced into the same all-or-nothing negotiation.

The takeaway? Break up the negotiations!

Counting global conflict’s health toll

There are two data-heavy stories worth your time this week on the widening fallout from conflicts in the Middle East.

First up, Reuters reports that attacks on health care workers and health facilities are rising globally, with the recent Middle East conflicts driving a clear jump.

By the numbers: Before the outbreak of fighting in Iran and Lebanon, the WHO said “attacks globally on such facilities and staff averaged about 3.7 per day.” But that has now risen to an average of 4.3 attacks per day.

“This is clearly showing that health care is the target,” Altaf Musani, the WHO’s director of emergency health, told Reuters

And that’s not even the bleakest figure in the story!

Here are several more: Since March, Lebanon alone has seen 149 attacks on health care, according to the WHO. Gaza is down to just one fully functioning hospital. In Sudan, only half of hospitals are fully operational. As Musani put it, where “health care is needed most, it is being attacked.”

Meanwhile, The Guardian has a figure-filled story on how the blockade in the Strait of Hormuz has disrupted the global supply chain for humanitarian aid.

To be clear, only part of the issue is food and medicine that’s directly stuck in the strait. For example, how the International Rescue Committee told The Guardian that $130,000 worth of supplies for 20,000 people in Sudan is still stranded in Dubai.

Rather, the big killer is fuel shortages and rising prices, which are in full swing. Like in Nigeria and Ethiopia, where “government oil rations meant the emergency relief body [the International Rescue Committee] was having to limit generator use in its health clinics.”

Save the Children also estimates that every $5 increase in the price of a barrel of oil is costing the charity an additional “$340,000 a month” in shipping, fuel, food, and medical supplies. And if oil stays around $100 a barrel through 2026, that could mean an extra $27 million in costs this year.

In response, humanitarian leaders are calling for a humanitarian corridor through the Strait of Hormuz to freely move food and medical supplies, alongside fuel to address these humanitarian crises. (Which is, let’s be real, an extremely unlikely resolution.)

This is clearly an ongoing story, and one we’ll keep watching.

HealthInsuranceGPT

Sorry, but it’s dealer’s choice for this next one. (When a global health story lands in Nairobi, I’m going to cover it!) The Guardian just published a damning investigation on Kenya’s new national health insurance program.

In short: That program is based on an “AI system used to predict how much Kenyans can afford to pay for access to health care,” but which has “systemically driven up costs for the poor.”

(If you’re tempted to skip this because you’re not especially invested in one country’s health insurance system, fair enough. But you can read this as a broader, cautionary tale about handing off messy human decisions to opaque artificial intelligence systems.)

According to the report, the 2-year-old AI system has been, from the start, “systematically overcharging the poorest Kenyans … while undercharging the wealthiest by underestimating their incomes.”

The core issue is that the “system is structured on a decades-old World Bank bugbear: proxy means testing,” which is “a way of estimating the incomes of the poor based on their possessions and other life circumstances, such as how many children they have or whether they live alone.”

In practice, “this has meant deploying government volunteers … across the country to register their roofing materials, livestock, and children – and feeding those details into an opaque algorithm to decide how much they earn and how much they must pay.”

The end result, according to the reporting, is a widespread mess of misclassification: with “critically ill people who cannot get treatment,” and families “facing a sum of between 10% and 20% of meager incomes.”

“People are dying, people are suffering,” said one of the officials registering families under the system in Nairobi.

Ultimately, The Guardian reports that there is “not a single reason” for these inaccuracies. “Poverty is a fluid category – and using factors such as an iron roof or a pit toilet to estimate a family’s wealth is an intrinsically imprecise undertaking.”

There is one last point worth noting: As development economist Stephen Kidd told The Guardian, failures like this don’t just get numbers wrong and cost lives, they also reduce public faith in government services. “It feels like a lottery,” he said. “The lottery is not a great way of building trust.”

The Hantavirus cruise

I’ll leave you with a story I initially dismissed as too small, but which I’ve come across enough times in enough outlets that I just have to flag.

The BBC reports that a Dutch-operated cruise ship (the MV Hondius) was moored off Cape Verde after a suspected hantavirus outbreak killed three people and left another passenger seriously ill. The ship was sailing from Argentina to the Canary Islands.

In port, two more cases were confirmed. On Wednesday, the ship departed Cape Verde was heading to Spain’s Canary Islands with nearly 150 people on board, the Associated Press reported.

Disease breakdown: Hantavirus is a family of rare viruses usually carried by rodents. People typically get infected by breathing in particles from infected rodent urine, droppings, or saliva. It can cause severe respiratory illness, with symptoms appearing one to eight weeks after exposure. (A lag that can allow cases to silently accumulate.) Human-to-human spread is rare, but has been documented with the Andes virus in South America. There is no specific treatment or vaccine, so care is mostly supportive.

One source at the WHO told the BBC that in this case, some person-to-person spread may have happened among close contacts sharing cabins, but the first infection could also have come from rodents before the ship left Argentina, or during one of its stops.

Still, there’s more questions than answers as of yet.

(Only modestly related here, but this news reminds me of a story I wrote about 12 years ago for Popular Mechanics. I was helping at my father’s automotive shop and we found rats living in a Porsche’s cabin air filter. A Centers for Disease Control and Prevention ecologist told me that was “an ideal way to spread an airborne virus,” since the car’s vents were blowing particles from rodent droppings or urine straight into an unlucky customer’s face.)

Anyhow… a rare virus, a stranded cruise ship, several deaths, and no clear answer yet on where the outbreak began?

Fine. It gets the closing slot!

I’ll see you next week,

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How the South Carolina measles outbreak grew from 5 to 997 cases

2026-04-27T23:55:10+00:00

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The South Carolina measles outbreak is one of the largest in the United States in decades.

It started with just five known cases in October, but by January exploded to 847 – becoming larger than last year’s deadly outbreak in Texas. By mid March, the outbreak had further grown to 997 known cases.

Along the way, hundreds of additional people in South Carolina – many of them children at schools with low vaccination rates – have had to stay in home quarantine for up to 21 days because they aren’t immunized and have been exposed to contagious people.

South Carolina’s state epidemiologist, Dr. Linda Bell, has said there also were likely many more people who weren’t in quarantine, but should have been. They were unaware they had been exposed during the normal course of their lives: Going to work, school, and church, shopping for groceries, dining in restaurants, and visiting museums.

Measles spreads through the air and can linger in a room for two hours after an infectious person has left. The people who are spreading the disease often don’t know they have it: They are contagious for four days before they develop the virus’ hallmark rash.

A Healthbeat review of the outbreak’s history provides a detailed timeline of how the South Carolina Department of Public Health worked to trace and contain new infections. For a while, the outbreak smoldered with few new cases. Then the holiday season supercharged the spread in January.

The South Carolina outbreak was declared over on April 27.

Here is how it happened.

October 2, 2025 - South Carolina announces measles outbreak

Total outbreak cases: 5.

The South Carolina Department of Public Health announces it has confirmed a measles outbreak in the Upstate region, the northwest part of the state that includes Spartanburg County. During 2025, the state had only identified three earlier measles cases: two in July and one in early September – and those were linked to exposures during international travel, plus one close contact of a traveler who became infected. “We now have identified five cases in a little more than a week,” Bell said. “This sharp uptick in cases and the unknown source of two of the recent cases indicates unrecognized community spread.”

October 7, 2025 - Two schools have early outbreak cases

Total outbreak cases: 7. New cases: 2.

Two additional cases of measles are identified in Spartanburg County, raising to seven outbreak cases that had been reported since Sept. 25. None have an identified source, state health officials said, “suggesting that measles is circulating in the community.” Two schools – Global Academy of South Carolina, a public charter school where state data show only 21% of students had all their school vaccinations, and Fairforest Elementary, a public school where 82% of students were up-to-date on their school shots – are locations with confirmed measles cases. Health officials identified 153 unvaccinated students at the two schools who were exposed and at risk of measles infection, resulting in their required exclusion from classes until the 21-day period of potential disease transmission was over. The school exclusion periods were over on Oct. 21 for the Global Academy students, and on Oct. 22 for the Fairforest students.

Vaccination coverage of 95% is needed in local communities to stop the spread of measles. Across Spartanburg County, the state health department estimates that just 90% of school-age children are fully vaccinated. Rates at some schools are even lower, state data show.

Global Academy of South Carolina, a public charter school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

October 9, 2025 - A child in Greenville County has measles

Total outbreak cases: 8*. New cases: 1.

State health officials announce another case of measles, a child in Greenville County, which borders the west side of Spartanburg County. While it was not immediately clear whether the child’s illness was related to the Spartanburg County outbreak, health officials eventually included the case in the outbreak count. “What this case tells us is that there is active, unrecognized community transmission of measles occurring in the Upstate, which makes it vital to ensure that the public have received their measles vaccinations,” the state health department said. The department would later identify the Crunch Fitness gym at 1332 S. Pleasantburg Dr. in Greenville as the source of the child’s exposure on Sept. 30.

(*) Total case count includes this Greenville County child, whose measles case was later determined to be an outbreak case on Oct. 21.

October 13, 2025 – Quarantines appear to be working

Outbreak investigators from the state health department are optimistic about their efforts to control the spread of measles at Global Academy of South Carolina and Fairforest Elementary, according to internal health department records obtained by Healthbeat. “The quarantine of students from Global Academy and Fairforest Elementary appears to be working. The recent confirmed cases in those exposure groups did not lead to additional case investigations because they were already in quarantine,” according to an Oct. 13 email obtained by Healthbeat that the state health department sent to staff in the governor’s office.

October 14, 2025 - School exposures result in more cases

Total outbreak cases: 13*. New cases: 5.

Five new measles infections are confirmed among unvaccinated students who were already in quarantine at home because of previously reported school exposures. The department previously identified exposures at Global Academy of South Carolina and Fairforest Elementary. “Because they were quarantining before they became infectious, no additional exposures occurred with these new cases,” state health officials said. The state health department announces the next day that it will be sending its mobile measles vaccination unit to hold five events at four locations in Spartanburg County – including churches, a community center, and a library.

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 17, 2025 - Three cases among contacts in quarantine

Total outbreak cases: 16*. New cases: 3.

Three new cases are identified among close contacts of people with measles who were already in quarantine at home. State health officials said the new cases show how early quarantine after an identified exposure “is highly effective in preventing community spread.”

(*) Total case count includes a Greenville County child whose measles infection was announced on Oct. 9 as being under investigation, and was later determined to be an outbreak case on Oct. 21.

October 21, 2025 - Four new cases in Spartanburg County

Total outbreak cases: 20. New cases 4.

Two new cases are confirmed among close contacts of people already in home quarantine. And two additional measles cases are identified in association with a business in Spartanburg that had “no public exposures,” health officials said. They also announce that the Greenville County child exposed at a gym whose case was announced on Oct. 9 is now being considered an outbreak case “due to ongoing unrecognized community transmission.”

October 24, 2025 - Two more sickened with measles

Total outbreak cases: 22. New cases 2.

Two new measles cases are confirmed in Spartanburg County; both are linked to close contacts of people with measles who had been in quarantine at home, state health officials announced.

October 28, 2025 - Mobile clinics give 24 shots as more fall ill

Total outbreak cases: 30. New cases: 8.

As state health officials announce eight new measles cases in Spartanburg County among close contacts of people already in home quarantine, they continue to send their mobile vaccination clinic to offer free measles shots at more locations. Multiple vaccination events have been offered in the community since Oct. 16, but only 24 vaccines have been administered: 19 to adults and five to children, state health officials said.

October 31, 2025 - State emphasizes isolation, quarantine

Total outbreak cases: 34. New cases: 4.

Four new measles infections were confirmed in Spartanburg County. All were linked to close contacts of previously known cases. “No public exposures have been identified from these cases,” state health officials said. “We continue to rely on isolation and quarantine measures for those who have been exposed and are unvaccinated to prevent the spread of measles in the community to contain this outbreak.” The state health department added that its “additional response” to the outbreak “is to encourage protection with the measles-mumps-rubella (MMR) vaccine for those who are not immune.” With free mobile vaccination clinics ongoing, just 28 doses of MMR vaccine – 23 to adults and five to children – have been administered since the outreach events began on Oct. 16.

November 4, 2025 – No new cases as holiday season looms

Total outbreak cases: 34. New cases: 0.

No new measles cases were identified by health officials since the previous Friday. Yet they cautioned that 34 people were still in quarantine because they were unvaccinated and had been exposed to someone who was contagious. The latest end date for those in quarantine to no longer be at risk of developing measles is Nov. 24. “We are reminding people that travel for the upcoming holidays increases the risk of exposures greatly for those traveling and for those accepting visitors,” the state health department said. “Consider getting vaccinated now to prevent measles from disrupting your holiday plans.”

November 7, 2025 – Another case confirmed, more expected

Total outbreak cases: 35. New cases: 1.

State health officials announce they have identified one new measles case and are still investigating how many people may have been exposed to the virus by this person. “We also expect more cases to come in the days ahead from exposed family members of known previous cases,” the state health department said, noting that there are 31 people in quarantine.

November 10, 2025 – Restaurant mistakenly flagged for exposure

While investigating the ongoing outbreak, state health officials put out a press release saying a person who was infectious with measles was at the Kanpai of Tokyo restaurant at 2300 Winchester Pl. in Spartanburg on Nov. 2 from 3 to 6 p.m.; they urged anyone who believes they were exposed – particularly those without immunity – to contact their health care providers. But a mistake was made, and the health department said it had been given the wrong date: The person actually dined at the restaurant in late October – at a time when they weren’t infectious.

“Our business went down for a good two months. We lost sales, we lost wages,” general manager Nick Nakincheng told Healthbeat. “People thought we closed, and then people were just scared to even come at all.” Business is finally returning, he said in January. But the state health department, while acknowledging the error to the Post and Courier in December, still had not corrected its press release as of Jan. 26. The department declined to answer Healthbeat’s questions about the error or explain why the press release remained posted on its website without correction – even though it had corrected at least one other outbreak press release. After Healthbeat published this timeline, the department added a correction to its Kanpai of Tokyo press release.

The general manager of Kanpai of Tokyo said the Spartanburg restaurant lost business after the state health department publicly warned in November 2025 that an infectious person had dined there. It later turned out that outbreak investigators were given a wrong date – and the person wasn’t contagious when they were at the restaurant.

November 12, 2025 – Eight new measles cases identified

Total outbreak cases: 43. New cases: 8.

Of the eight new measles cases announced by state officials, six were household members of known cases who were in quarantine. But the source of the infection for the other two cases, who were people from the same household, is unclear. “The unidentified source of the two new cases reinforces our concern about potential ongoing community transmission,” the state health department said.

November 14, 2025 – One new measles case

Total outbreak cases: 44. New cases 1.

Just one new measles case has been identified since the state’s last update and the extent of others exposed to the person is still under investigation, state health officials said; 18 people are currently in quarantine because of outbreak exposures.

November 18, 2025 – More cases, more public exposures

Total outbreak cases: 49. New cases: 5.

While two of the five new cases are household members of known measles cases in quarantine, the source of the infection of the other three people is unknown, state health officials said. “The initial investigation of contacts of the new cases has determined potential exposures in public settings. Additional information will be provided once more details are obtained,” the department said, noting that 84 people are in quarantine and that direct contacts and facilities that have been impacted are being notified about the potential exposures.

November 21, 2025 – School, church, airport exposures

Total outbreak cases: 52. New cases: 3.

State health officials announce the confirmation of three new measles cases – and that as a result of contact tracing by health workers, there are now 137 people in quarantine because they are unvaccinated and have been exposed, plus one person in isolation because of infection. Many of these people are from schools in Spartanburg County: 57 are from Lyman Elementary School (where 89% of students were up-to-date on school vaccines); 55 are from Boiling Springs Middle School; and one attends D.R. Hill Middle School (where 88% of students were up-to-date on vaccines). Health officials also warned that an employee at the Greenville-Spartanburg International Airport who was infected with measles may have exposed airport visitors between 9 a.m. and 7 p.m. on Nov. 10 and 11. They also said an infectious person attended the Way of Truth Church in Inman, S.C., which is in Spartanburg County, from 7 to 11 p.m. on Nov. 7 and from 10 a.m. to 2 p.m. on Nov. 9.

State health officials linked multiple outbreak cases to exposures that occurred at the Way of Truth Church in Inman, S.C., which is in Spartanburg County.

November 25, 2025 – Public exposure at county treasurer’s office

Total outbreak cases 55. New cases: 3.

On the Tuesday before Thanksgiving, the state health department announces they have identified three additional measles cases. Two of the people are household members of known cases. The source of the third person’s infection is still being investigated. Meanwhile, the department warns of another public exposure location: An infectious person was at the Spartanburg County Treasurer’s Office on Nov. 17 and 18 during the hours the office was open.

November 28, 2025 – Public exposure event at Costco

Total outbreak cases: 62. New cases: 7.

Of the seven new measles cases announced, six were household members of known cases who were in quarantine, and one was a person exposed in a school setting who also was in quarantine. Total people currently in quarantine: 144; six in isolation. State health officials also warn there was a potential measles exposure event at a Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18 between 9:30 a.m. and 1 p.m.

As the outbreak grew, state health officials warned of infectious people potentially exposing others while shopping at a range of retail stores. One incident occurred at the Costco store and tire center at 211 W. Blackstock Rd. in Spartanburg on Nov. 18, 2025.

December 2, 2025 - More school exposures, 14 new cases

Total outbreak cases: 76. New cases: 14.

Eight of the 14 new measles cases announced by state health officials were the result of the previously reported exposure at the Way of Truth Church in Inman. Three of the new cases were exposed in a school setting, and the other three are still under investigation. Based on public health investigations of the new cases, the public was alerted that four Spartanburg County schools were the sites of additional measles exposures, requiring dozens of unvaccinated students to be excluded from school and quarantined. The schools involved: Hendrix Elementary School, where state data show 87% of students are up-to-date on school vaccines (40 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (13 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (5 students in quarantine); and Tyger River Elementary School, where 89% of students are up-to-date on vaccines (17 students in quarantine).

December 5, 2025 – Measles quarantines hit more schools

Total outbreak cases: 84. New cases: 8.

Eight new measles cases are announced by state health officials, but the number of people in quarantine and at risk of developing measles has jumped to 281. Based on public health investigations of the new cases, the public was alerted to new measles exposures at four additional Spartanburg County schools: Fairforest Elementary School, where 82% of students were up-to-date on their school vaccines (44 students in quarantine); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (61 students in quarantine); Fairforest Middle School, where 90% of students are up-to-date on vaccines (fewer than 5 students in quarantine); Dorman Freshman Campus, where 93% of students are up-to-date on vaccines (15 students in quarantine). This is the second round of quarantines at Fairforest Elementary, which was one of the earliest sites of known measles cases in early October.

December 9, 2025 – Earlier church exposure fuels new infections

Total outbreak cases: 111. New cases: 27.

Of the 27 new measles cases announced, 16 resulted from previously reported exposure incidents in November at Way of Truth Church in Inman. Eight of the new infections were among household members of known cases. One infection was from a school exposure, one had an unknown source, and one was from an exposure in a health care setting. State health officials said the new cases have resulted in additional public exposures at Inman Intermediate School, where state data show 83% of students were up-to-date on vaccines (43 students in quarantine). Officials continue to encourage those who may have been exposed to measles to alert their health care provider in advance of going to their office, so that measures can be taken to protect against additional exposures.

December 12, 2025 – More than 300 in quarantine, 15 new cases

Total outbreak cases: 126. New cases: 15.

As state health officials investigate the contacts of 15 new measles cases, they identified two more Spartanburg County schools where public exposures have occurred: Campobello Gramling School, where state data show 80% of students are up-to-date on school vaccines (67 students in quarantine), and Boiling Springs Elementary School, where 80% of students are up-to-date on vaccines (16 students in quarantine). Overall, 303 people are in quarantine, many of them students at 11 schools. The large number in quarantine is a potential warning sign of the magnitude of future measles cases because there is a lag time between when people are exposed and when they start feeling sick – typically seven to 10 days, but sometimes as long as 21 days.

Of the 15 new cases, 13 involved exposures within households with known measles cases; one infection involved a neighborhood contact; and the source of one is unknown and under investigation.

Boiling Springs Elementary, a public school operated by Spartanburg County School District Two, is among several schools in South Carolina’s Upstate region that have had multiple rounds of quarantines.

December 16, 2025 - Nine new cases, another school exposure

Total outbreak cases: 135. New cases: 9.

Of the nine new measles cases announced, five were the result of a previously reported exposure at Way of Truth Church in Inman. Three cases involved known household exposures and one involved a neighborhood contact. Investigations of the new cases identified an additional Spartanburg County school with public exposures: Berry Shoals Elementary School, where 93% of students are up-to-date on school vaccines (44 students in quarantine).

December 19, 2025 – Another school with measles exposures

Total outbreak cases: 144. New cases: 9.

State health officials announce nine new measles cases: Four were infections of household members of known cases; one was from a previously identified school exposure; one was from a previously identified exposure at Way of Truth Church in Inman; and the source of three infections is unknown. Contact investigations for the new cases identified an additional school where measles exposures have occurred: New Prospect Elementary School in Inman, where 82% of students are up-to-date on school vaccines (56 students in quarantine).

December 23, 2025 – Nine new measles cases identified

Total outbreak cases: 153. New cases: 9.

Of the nine new cases announced, five resulted from household exposures to known cases; two involved a previously known school exposure; the source of one is unknown; and another is still being investigated.

December 26, 2025 – Three new measles cases identified

Total outbreak cases: 156. New cases: 3.

Amid the holiday season, three new measles cases were reported between Tuesday and Friday. All were the result of a previously reported school exposure, state officials said. There are 252 people in quarantine and three in isolation. The latest end date for those in quarantine is Jan. 15.

December 29, 2025 – School contact tracing delayed by holidays, resistance

Although it was not made public at the time, internal health department records later obtained by Healthbeat under South Carolina’s public records law show how efforts to quickly quarantine schoolchildren exposed to measles before winter break were hampered by school closures, as well as resistance from one school. With students continuing to fall ill with measles in late December, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff and others who had been exposed before the two-week break. The schools where state records show contact-tracing delays occurred included: Global Academy of South Carolina, Sugar Ridge Elementary, Boiling Springs Elementary, and Jesse S. Bobo Elementary. The result: During this critical period in the outbreak, as cases were rising and more people were socializing and traveling, public health officials were not able to warn potentially infected people they needed to quarantine at home.

“Our inability to get contact information for potentially exposed students and notify those families resulted in some people being out and about in the community without knowing that they were infectious,” Bell would later tell Healthbeat. “The consequences being new cases due to additional exposures from people who would have otherwise been in quarantine had we been able to make contact.” At one school that health officials were able to reach by email on Dec. 29 – Westgate Christian School in Spartanburg – the principal refused to provide required information about students who had been exposed to measles. “We will not provide personal details and immunization status information for the students in our school,” the principal replied the next day. After state health officials sent Westgate a “final notice” letter in early January that threatened enforcement actions and potential fines, the school provided the information.

December 30, 2025 – As cases rise, 3 hospitalized from measles

Total outbreak cases: 176. New cases: 20.

Since Friday, state health officials identified 20 new measles cases and learned of three people – including adults and children – who required hospitalization because of complications from the disease. Citing patient privacy, health officials would not provide additional details about the hospitalized cases. The measles virus can cause serious complications such as pneumonia, brain inflammation, risks of premature births for pregnant mothers and it also can weaken a person’s immune system. Of the new cases, seven involved household exposures, five involved a previously known school exposure, two involved a church exposure, and one resulted from an exposure at either school or church, the state health department said.

January 2, 2026 – Nine more measles cases identified

Total outbreak cases: 185. New cases: 9.

Of the nine new cases detected, four were household exposures of known measles cases; one involved a previously reported school exposure; one case is still being investigated; and the source of three cases is unknown. The number of people in quarantine because they lack immunity and have been exposed: 223; three are in isolation for infections.

January 3, 2026 – Exposures at Best Buy, restaurant, library

The state health department announces that a person who did not know they were infectious with measles visited multiple public locations during the previous week. On Dec. 24, they visited the Nose Dive Restaurant, a gastropub at 116 S. Main St. in Greenville, then went to a Best Buy store at 1125 Woodruff Rd. in Greenville. A few days later, on Dec. 27, they attended an afternoon planetarium show about solar superstorms at the Spartanburg County Public Libraries headquarters library in downtown Spartanburg, which in October opened a new planetarium learning center with a 135-seat domed theater. Todd Stephens, the county’s librarian, said a public health official called him the day before the state’s press release went out and let him know someone with measles had been in the library’s theater a week earlier. “We have a response plan on Covid. We don’t have a document like that for this,” Stephens told Healthbeat. “But I can say we applied some of those principles that we’ve learned.” He said he’s not received any calls or concerns from library patrons about the potential exposure and he is not aware of anyone becoming infected.

A person who didn’t know they were infectious with measles attended an afternoon show in the Spartanburg County Libraries 135-seat domed planetarium theater on Dec. 27, 2025 in downtown Spartanburg, according to state health officials.

January 5, 2026 – S.C. outbreak exposes other states

People infected in South Carolina’s outbreak have exposed others while traveling, including at sites in Kentucky, North Carolina, Texas, Georgia, and New Mexico, according to a Jan. 5 memo the South Carolina Department of Public Health sent to staff at the South Carolina governor’s office. “The three latter sites are all associated with one case,” said the memo, which Healthbeat obtained with a public records request. “We sent an exposure notifications [sic] to all U.S. jurisdictions regarding the potential for exposure at the out-of-state-sites.”

January 6, 2026 – Public exposures at more schools, churches

Total outbreak cases: 211. New cases: 26.

Among the 26 new cases identified by state health officials, 19 involved exposures in households with known cases and at schools with previously announced exposures. Four of the new infections resulted from an exposure at church. One case has an unknown source, and two are still being investigated. Another 144 people without immunity are in quarantine because of exposures. Investigations of recent cases identified multiple locations of public exposures. Nine students are in quarantine at two Spartanburg County schools where these exposures occurred: Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines. It was the second time during the outbreak that students at Boiling Springs Elementary had to be quarantined; the previous quarantines were in December. Churches where public exposures occurred, health officials said, included: Tabernacle of Salvation Church, Slavic Pentecostal Church of Spartanburg, Ark of Salvation Church, and the Unitarian Universalist Church of Spartanburg.

January 7, 2026 - Health alert sent to providers, facilities

The state department of public health sent out a statewide alert to all health care providers and facilities about the importance of having “heightened awareness” for measles and providing advice on the recommended measures for the use of masks and rapid isolation of people suspected of having measles infections to protect others in health care settings from being exposed.

January 9, 2026 – Measles cases spike with 99 new infections

Total outbreak cases: 310. New cases: 99.

Between Tuesday and Friday this week, state health officials identified 99 new cases of measles. They said another 200 people were in quarantine because of exposures. Dr. Linda Bell, the state epidemiologist, warned it was becoming increasingly difficult to identify likely sources of infection because of the increasing number of public exposure sites. “The number of those in quarantine does not reflect the number actually exposed,” Bell said. “An increasing number of public exposure sites are being identified with likely hundreds more people exposed who are not aware they should be in quarantine if they are not immune to measles.” The department flags one new public exposure site: Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Jesse S. Bobo Elementary School, a public school in Spartanburg County School District Six, had a measles exposure incident that state health officials announced on Jan. 9, 2026.

January 12, 2026 – Measles exposures at BMW, Michelin plants

Although not publicly known at the time, internal South Carolina Department of Public Health records obtained by Healthbeat show that large manufacturing plants for BMW and Michelin in Spartanburg were the sites of measles exposure incidents in January. While the health department alerted staff at the South Carolina governor’s office about the plant exposures in a Jan. 12 email, these exposures at large, prominent manufacturing plants weren’t publicly announced. When Healthbeat later revealed the exposures, BMW said it kept its workforce informed about measles cases at the plant and that the company was providing on-site access to vaccinations. Michelin declined to answer questions about what actions it took.

January 13, 2026 - Surge continues with 124 new measles cases

Total outbreak cases: 434. New cases: 124.

Health officials announce another surge in cases, with 124 new infections identified in recent days. They said another 409 people are in isolation because they were exposed and lacked vaccination or immunity from previous infection; 17 were in isolation. Investigators have learned of more than 30 public locations where infectious people have potentially exposed others to measles in recent days, Bell said. Besides schools, these locations have included churches, restaurants, and many health care settings, she said. But the department is only naming locations where details about exposure dates and times are available to allow the public to take informed actions, she said.

Adding to concerns: Health officials learned that a person who didn’t know they were infectious had visited the South Carolina State Museum in Columbia – the state’s capital city, which is about 95 miles southeast of the outbreak area in Spartanburg County. No measles cases have been identified outside the Upstate region, officials said. “Circulation of the measles virus is increasing in numerous community settings in the Upstate, and the risk of infection to those who are not immune to measles by vaccination or previous disease is increasing,” Bell said. “This includes people who may be traveling to the upstate region. So [the Department of Public Health] strongly encourages those who are not protected to consider getting vaccinated now to protect against unexpected exposures, against illness, and possible complications.”

January 15, 2026 – S.C. residents spark Washington, N.C. cases

The Snohomish County Health Department in Washington state announces that an infectious family from South Carolina who was visiting the area two weeks ago is now connected to three new measles cases among local children. The three cases are considered an outbreak and a sign the virus is spreading in the community, the department said. The South Carolina family members, one adult and two children, were infectious while visiting multiple locations in Everett, Marysville, and Mukilteo – including schools – from Dec. 27, 2025 through Jan. 1, 2026. They also flew through Seattle-Tacoma International Airport. “We are hoping to contain it, but unfortunately there have been a number of exposure sites already and there are likely more cases in the community that we do not know about yet,” said Dr. James Lewis, the Snohomish County health officer.

In North Carolina, state health officials announce that the South Carolina outbreak is connected to two cases of measles in unvaccinated siblings Buncombe County, N.C.

January 16, 2026 – Schools hit with repeated quarantines

Total outbreak cases: 558. New cases: 124.

Another 124 new measles cases are announced by state health officials; 531 people are in quarantine; and 85 are in isolation. The outbreak continues to be centered around Spartanburg County, they said.

Based on investigations of the newest cases, health officials said public exposures have occurred at nine schools: Holly Springs-Motlow Elementary, where state data show 80% of students are up-to-date on school vaccines (53 students in quarantine); Campobello Gramling School, where 80% of students are up-to-date on vaccines (46 students in quarantine – and the school’s second round of quarantines); Crestview Elementary, where 90% of students are up-to-date on vaccines (22 students in quarantine); Libertas Academy, where 74% of students are up-to-date on their vaccines (15 students in quarantine); Fairforest Elementary, where 82% of students were up-to-date on their school vaccines (14 students in quarantine – and the third round of quarantines at this school); Berry Shoals Elementary, where 93% of students are up-to-date on school vaccines (14 students in quarantine – and the school’s second round of quarantines); Oakland Elementary, where 83% of students are up-to-date on vaccines (6 students in quarantine); Mabry Middle School, where 81% of students are up-to-date on vaccines (6 students in quarantine – and the school’s second round of quarantines); and Landrum High School, where 94% of students are up-to-date on vaccines (5 students in quarantine).

Additional public exposures occurred during certain hours at: Walmart at 203 Cedar Springs Rd. in Spartanburg on Jan. 3; Wash Depot at 2177 S. Pine St. in Spartanburg on Jan. 3 and 4; and at Bintime Spartanburg at 445 S. Blackstock Rd. in Spartanburg on Jan. 7.

Fairforest Elementary, a public school in Spartanburg, S.C., was one of two schools that had some of the earliest confirmed cases of measles linked to the outbreak.

January 20, 2026 – Exposures at schools, Clemson University

Total outbreak cases: 646. New cases: 88.

“As we continue to watch this daily surge in cases, DPH strongly encourages those who are not protected to take advantage of the opportunity to get protected,” Dr. Linda Bell, the state epidemiologist, says at a press briefing about the outbreak numbers released on Jan. 20.

In recent days, state health officials identified 88 new measles cases. They said 538 people are in quarantine and 33 in isolation. Bell said that since the outbreak began,10 people, including adults and children, have required hospitalization for measles complications.

Through investigations of the latest cases, health officials have identified six additional schools where public exposures have recently occurred: Starr Elementary, where 96% of students are up-to-date on school vaccines (17 students in quarantine); Global Academy of South Carolina, where 21% of students are up-to-date on vaccines (13 students in quarantine – and this school’s second round of quarantines); Boiling Springs High School, where 92% of students are up-to-date on vaccines (11 students in quarantine); Chapman High School, where 87% of students are up-to-date on vaccines (fewer than 5 students in quarantine – this is the school’s second round of quarantines); Boiling Springs Elementary (students in quarantine to be determined – this is the school’s third round of quarantines); Rainbow Lake Middle School, where 82% of students were up-to-date on vaccines (quarantine numbers still being determined – this is the school’s second round of quarantines).

Public exposures have also been identified at Clemson University (where 34 students were in quarantine) and Anderson University (where 50 students were in quarantine). While both universities are in South Carolina’s Upstate region, they are in counties west and southwest of the Spartanburg County area where the outbreak has been centered.

Additional public measles exposures were announced as occurring during certain hours at two grocery stores: a Publix at 2153 E. Main St. in Duncan on Jan. 16; and a Food Lion at 11153 Asheville Hwy. in Inman on Jan. 11 and 12.

January 23, 2026 – Cases reach 700, plus 485 in quarantine

Total outbreak cases: 700. New cases: 54.

The number of known cases in South Carolina’s measles outbreak is approaching the total cases in the huge Texas outbreak last year. When the Texas outbreak was declared over in August 2025, the state health department had confirmed 762 measles cases since late January 2025. Two school-age children died and 99 people required hospitalization. The South Carolina Department of Public Health announces it has identified 54 new measles cases in the Upstate region – raising the total outbreak cases to 700. There are an additional 485 people in quarantine and 10 people are in isolation, the department said. Since the outbreak began, 12 people have required hospitalization.

Case investigations have identified additional public exposures at multiple schools: Cooley Springs-Fingerville Elementary, where 77% of students are up-to-date on their school vaccines (22 students in quarantine); Cannons Elementary, where 95% of students are up-to-date on vaccines (8 students in quarantine); Abner Creek Middle School, where 89% of students are up-to-date on vaccines (the number of students being quarantined is still being determined); Mayo Elementary, where 89% of students are up-to-date on vaccines (student quarantines still being determined); and Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines (student quarantines still being determined, this is the second round of quarantines at this school).

Additional public exposure locations occurred during certain hours at: Anytime Fitness at 3621 Boiling Springs Rd. in Boiling Springs on Jan. 13; the U.S. Post Office at 504 Pennsylvania Ave. in Greer on Jan. 13; Goodwill at 1333 W. Wade Hampton Blvd. in Greer on Jan. 13; and Aldi at 1560 W. Floyd Baker Blvd. in Gaffney on Jan. 17.

January 27, 2026 – S.C. outbreak exceeds Texas outbreak

Total outbreak cases: 789. New cases: 89.

State health officials announce they have confirmed 89 new measles cases, and that there are 557 people in quarantine and 20 in isolation. Outbreak investigators also have identified more public measles exposures that have occurred at several schools: Dorman High, where 96% of students are up-to-date on school vaccines; Inman Intermediate, where students have previously been quarantined and 83% of students are up-to-date on vaccines; and New Prospect Elementary in Inman, where students have previously been quarantined and where 82% of students are up-to-date. The state health department said the number of students that need to quarantine at each of these schools is still being determined. The newly identified cases raise the South Carolina outbreak’s total to 789 – surpassing the number sickened in the deadly Texas outbreak last year. In Texas, 762 cases of measles were confirmed in an outbreak that began in late January 2025 and was declared over in August 2025.

January 30, 2026 – Surge puts 443 in quarantine

Total outbreak cases: 847. New cases: 58.

Numbers released by the state health department show 58 new measles cases have been identified. There are 443 people in quarantine who have been exposed, who lack immunity, and who are at risk of developing the disease in the coming days and weeks. Twenty people are in isolation because of illness. Public health investigators have identified a school and a fast food restaurant with recent public exposures because of the presence of an infectious person. Health officials are still determining how many students need to be quarantined and excluded from class at the school, Lyman Elementary, where state records show 89% of students are up-to-date on school vaccines. The school was involved in a previous exposure situation announced on Nov. 21. The other public exposure event involves a Burger King restaurant at 6196 US-221 in Roebuck, S.C., that occurred on Jan. 28 between 11:30 a.m. and 2:30 p.m.

February 3, 2026 – Fewer infections – but one in Sumter County

Total outbreak cases: 876. New cases: 29.

The state health department announces 29 new cases of measles in the ongoing outbreak in South Carolina’s Upstate region, in and near Spartanburg County. They also said a measles case has been confirmed in a resident of Sumter County – which is located in South Carolina’s Pee Dee Region, southeast from where the outbreak has been occurring. “At this point in the investigation, it is not yet clear whether this new case is linked to the Upstate outbreak centered around Spartanburg County or if the case may have been exposed where measles is occurring in other locations,” the department said. The department said public exposures to measles have occurred during certain specific hours at three locations in Sumter, S.C.: Mariachis Mexican Restaurant at 1072 Broad St. on Jan. 23; Food Lion at 5700 Broad Street Ext. on Jan. 24; and the Walmart Neighborhood Market at 343 Pinewood Rd. on Jan. 25. The health department said there are currently 354 people in quarantine who have been exposed to measles and lack vaccination or immunity; 22 people are ill and in isolation.

February 6, 2026 – Vaccination is up significantly

Total outbreak cases: 920. New cases: 44

State health officials announce 44 new measles cases, plus another 277 people who are in quarantine because they were exposed and are unvaccinated or lack immunity from prior infection; eight people are in isolation because of illness. They also announce new locations of public exposure incidents during certain specific time periods at a Social Security Administration office at 145 N. Church St. in Spartanburg on Jan. 29; Boost Mobile at 1515 Asheville Hwy. in Spartanburg on Jan. 29; Rick Erwin’s Level 10 Restaurant at 225 W. Main St. in Spartanburg on Jan. 29; and the Target store at 6025 Wade Hampton Blvd. in Taylors on Jan. 30.

During a media call earlier in the week, Bell said state health officials are encouraged by increases in measles vaccination during January. In Spartanburg County, the number of measles vaccines given last month was up 162% over January 2025, an increase of more than 1,000 doses, she said. Statewide, measles vaccination was up 72%, with about 7,000 more doses given across South Carolina last month than were administered in January 2025. “So far, this is the best month for measles vaccination during this outbreak,” Bell said.

While complications from measles aren’t reportable to state health officials, Bell said the department has learned of some serious complications among 19 people – children and adults – who have been hospitalized since the outbreak began in October. “Some of these complications include measles encephalitis, or inflammation of the brain in children, and pneumonia.”

In addition, Bell said, several pregnant women were exposed to measles and required administration of immune globulin to protect against the high risk of complications measles poses to pregnant women and their newborns. Bell declined to provide additional details about the exposures of the pregnant women. Earlier in the week, Healthbeat revealed a measles exposure incident had occurred on a labor and delivery unit at Prisma Health Greer Memorial Hospital.

February 10, 2026 – Fewer new cases, but one in Lancaster County

Total outbreak cases: 933. New cases: 13

Just 13 new measles cases are announced in the state health department’s update; 235 people are in quarantine because of exposures, and six are in isolation because of illness. The department noted that a measles infection has been confirmed in a resident of Lancaster County; the source of the person’s exposure is still under investigation. The outbreak has not previously had any cases in Lancaster County, which is in north-central South Carolina. Two schools in Spartanburg County have been the sites of recent public exposures: Libertas Academy, where 74% of students are up-to-date on their school vaccines (nine individuals in quarantine); and Inman Intermediate, 83% of students are up-to-date on vaccines (fewer than five individuals in quarantine). People also remain in quarantine from an earlier public exposure at Lyman Elementary School, where 89% of students are up-to-date on vaccines (23 individuals remain in quarantine).

February 13, 2026 – Concerns linger about undetected cases

Total outbreak cases: 950. New cases: 17

The number of new measles cases announced today continues to be well below the numbers during the January surge. The state health department said 17 new cases of measles have been identified and there are another 186 people in quarantine because of exposures; nine people are in isolation because of illness. The recent identification of measles cases in Lancaster and Sumter counties – with no identified source of exposure – indicate that unrecognized transmission of measles is occurring in the community, Bell told reporters this week. “That can result in more and more transmission if we don’t stay on top of those cases, find out where that transmission is occurring, and implement our disease control measures,” Bell said. The outbreak continues to be centered in Spartanburg County, she said, and about 95% of those who have been infected are unvaccinated. The department announced three locations where public exposures have occurred recently during defined time periods: Children’s Medical Center, 841 S. Buncombe Rd. in Greer, all day on Feb. 4 and 6; Itto Ramen Bar, 1807 Poinsett Hwy. in Greenville, on Feb. 5 from 12:30 p.m. to 3:30 p.m.; and HomeGoods, 1125 Woodruff Rd. in Greenville, on Feb. 5 from 10 a.m. to 12:45 p.m.

February 17, 2026 – Most new infections involve known cases

Total outbreak cases: 962. New cases: 12.

State health officials announce 12 new cases and said there are an additional 127 people in quarantine because of exposures; eight people are in isolation because of symptoms. “The majority of cases are close contacts of known cases,” the state health department said. “However, the number of public exposure sites indicates that measles is circulating in the community, increasing the risk of exposure and the risk of infection for those who are not immune due to vaccination or natural infection.” The department said it is aware of 20 hospitalizations, involving children and adults, since the start of the outbreak. Libertas Academy has been the site of a recent public exposure event (17 individuals in quarantine). This school, where 74% of students are up-to-date on their school vaccines, has had previous exposure events, state records show. The department also announced a public exposure event occurred at Walmart – Powdersville, 11410 Anderson Rd. in Greenville on Feb. 8 from 4 to 8 p.m.

February 20, 2026 – Church, school, community college exposures

Total outbreak cases: 973. New cases: 11.

Health officials announce the identification of 11 new measles cases, and say there are 105 people in quarantine because of exposure and seven in isolation because of illness. “We are seeing a slowing, but it is too soon for us to say when this will end,” Bell said this week. “The concern is that we can see ongoing, smoldering transmission that can be introduced into other communities. The measles virus can find susceptible people wherever.”

While the number of new cases announced continues to be low, state health officials warn that public exposures have occurred recently at multiple locations in Spartanburg County. The exposure locations include Mabry Middle School in Inman, where 81% of students are up-to-date on vaccines and exposures have occurred previously. Other sites: Tabernacle of Salvation Slavic Church, 150 Outlet Rd. in Spartanburg, on Feb. 15 from 10 a.m. to 1 p.m.; Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 11 from 6:30 to 10 p.m .; Spartanburg Community College - Giles Campus, 107 Community College Dr. in Spartanburg, on Feb. 17 from 9:30 a.m. to 7:30 p.m.; Costco, 211 W. Blackstock Rd., Spartanburg, on Feb. 17 from 12 to 3 p.m.

February 24, 2026 – Just 6 new cases

Total outbreak cases: 979. New cases: 6.

Just six new cases of measles are announced by state health officials, plus 91 others who are in quarantine for exposures; one person is in isolation because of illness. The latest end date for those in quarantine is March 15. The newest cases have resulted in outbreak investigators identifying public exposures at Willow Creek Gathers Homeschool Co-op, where 17 individuals are in quarantine, the state health department said. Although South Carolina requires immediate reporting of cases of measles or suspected measles to the health department, the state doesn’t specifically require reporting about whether these cases were hospitalized or had complications. Over the course of the outbreak, the health department says it has learned about 21 people, children and adults, who have been hospitalized.

Since the outbreak began, the South Carolina Department of Public Health has used its mobile clinic to offer free measles-mumps-rubella vaccines in the Spartanburg County area.

February 27, 2026 – Hopes for earlier end to outbreak

Total outbreak cases: 985. New cases: 6.

Since Tuesday, state health officials say they have identified six new measles cases. There are 61 people in quarantine because of exposures; two people are in isolation for illness. The latest end date for people currently in quarantine and who may develop the disease is March 20. “We’re encouraged with the downward trend, particularly in the last two weeks,” Bell, the state epidemiologist, said this week. It’s possible that the outbreak may even end earlier than projected, she said. But the risk of another surge remains because of low vaccination coverage. The department said that based on the recent cases, investigators have identified public exposures that have recently occurred at Sugar Ridge Elementary, where 78% of students are up-to-date on vaccines. Fewer than five individuals from the school are in quarantine, officials said. This is the third round of quarantines for the school, health department records show. Another public exposure incident occurred at Costco - Spartanburg at 211 W. Blackstock Rd. on Feb. 22 from 2 to 6 p.m. It’s the third known measles exposure incident at the store, with the others occurring on Feb. 17 and Nov. 18, according to health department reports. State health officials said their mobile health unit will hold another measles vaccination clinic next week.

March 3, 2026 - Increased vaccination is helping slow outbreak, state says

Total outbreak cases: 990. New cases: 5.

The number of new cases reported to the state health department remains low: Just five new cases since Friday, health officials announced. There are 52 people in quarantine because of exposures and four in isolation because of illness. The latest end date for those in quarantine is March 27. The state health department also said there was a public measles exposure incident at Westgate Baptist Church, 1990 Old Reidville Rd. in Spartanburg, on Feb. 22 from 10:45 a.m. to 4 p.m. This church also had a measles exposure incident on Feb. 11. “We saw another strong increase in measles vaccination uptake during the month of February, which is encouraging,” Bell said at a media briefing this week. “Compared to February of 2025, there was a 133% increase in measles vaccination in Spartanburg County, with around 900 additional doses given,” she said. Statewide, there was a 70% increase in measles vaccination, with an additional 7,000 doses given. “This increase in vaccination is one of the reasons why this outbreak is slowing,” Bell said. “But given the surge in cases we saw following the Christmas holidays, we remain concerned that another surge could occur following spring break, when many people can be traveling and participating in more social activities.”

March 6, 2026 – Just one new case as outbreak cost reaches $1.6 million

Total outbreak cases: 991. New cases: 1.

Just one new measles case is announced by state health officials in their Friday update. There are 52 people in quarantine because of exposures and three in isolation because of illness. The latest end date for those in quarantine is March 27. Meanwhile, state health officials told Healthbeat this week that the public health response to the outbreak has cost taxpayers $1.6 million so far. Most of that has been personnel costs, including for contact tracing and other activities to combat the outbreak, the department said.

Of the 991 outbreak cases, most have been children and teens: 260 are younger than 5; 637 are ages 5-17; 86 are age 18 or older; and the age is unknown for eight cases. Almost all who have been infected have been unvaccinated or only partially vaccinated: 925 were unvaccinated; 19 had only one one dose of the recommended two-dose MMR vaccine; 26 were fully vaccinated with two doses of MMR; and the vaccination status was unknown for 21 cases.

March 10, 2026 – Slow trickle of cases continues

Total outbreak cases: 993. New cases: 2.

State health officials announce just two new measles cases have been identified since Friday; 42 people are in quarantine because of exposures; 2 are in isolation because of illness. The latest end date for those keeping watch for signs of illness while in quarantine is April 2. “We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said this week. The department doesn’t want to have measles cases surge during the upcoming spring break period. Bell said the department has asked all schools in the Upstate region to identify a point of contact who will be available when schools are closed over spring break to provide student contact information if it’s needed for measles exposure investigations. Healthbeat previously revealed how outbreak investigations were hampered and quarantines were delayed during school winter break because health officials couldn’t quickly get contact information from several schools.

March 13, 2026 – Three new cases

Total outbreak cases: 996. New cases: 3.

State officials announce three new measles cases, and that the number of people in quarantine because of exposures is down to 30. Four people are in isolation because of illness. The latest quarantine end date is April 2. Of the outbreak’s 996 cases, 993 have been in Spartanburg County and 36 have been in neighboring Greenville County. A handful of additional cases have been in three other nearby counties in South Carolina’s Upstate region: eight in Anderson County, six in Pickens County, and fewer than five in Cherokee County. Two additional counties in other parts of the state also have a small number of cases: Lancaster County, in the state’s Midlands region, and Sumter County in the Pee Dee region each have fewer than five cases, according to state data.

March 17, 2026 – ‘We are not letting our guard down’

Total outbreak cases: 997. New cases: 1.

State officials announce one new measles case and say there are only eight people in quarantine for exposures and none in isolation because of illness. The latest end date for those in quarantine is April 2. “We are not letting our guard down. It is too early to say that we will not see any more cases,” Bell said this week. She said it’s important that health care providers remain vigilant and continue to suspect measles when they see illnesses with a fever and rash. “That gives us the opportunity to immediately place people in isolation, to place their contacts in quarantine, if necessary,” she said. “If we let our guard down too early, then we just put ourselves in the position of allowing more disease to spread if we are not paying careful attention.” Before South Carolina can declare the outbreak over, there must be two incubation cycles – or 42 days – with no new cases, Bell said. In the meantime, spring break for many schools in the Spartanburg area is scheduled for early April, and state officials remain concerned that travel and socializing during the school break period could result in more measles cases.

March 20, 2026 – No new measles cases since Tuesday

Total outbreak cases: 997. New cases: 0.

State health officials, in their Friday update, announced no new measles cases had been identified since Tuesday. The last time there were zero new cases in one of their twice-weekly outbreak updates was more than four months ago on Nov. 4. There are two people in quarantine because of exposures. Their last date in quarantine is March 28.

March 24, 2026 – Again, no new measles cases

Total outbreak cases: 997. New cases: 0.

For the second update in a row, state health officials in their Tuesday update said no new measles cases had been identified. Two people remain in quarantine because of exposures, with a latest quarantine end date of March 28. Nobody is in isolation because of illness. It will take 42 consecutive days with no new cases – two incubation cycles of the virus – to determine that the outbreak’s transmission chain has been broken, the health department said. If the no cases trend continues, the last day of the outbreak will be April 26.

March 27, 2026 – No new cases, only one person in quarantine

Total outbreak cases: 997. New cases: 0.

South Carolina health officials announce they continue to detect no new measles cases. Just one person remains in quarantine because they lack immunity and were exposed – and that person is almost out of danger. Their quarantine ends March 28. One question lingers: Are there still some measles cases that aren’t being detected and reported? A report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, said it was likely measles cases in the outbreak were going unreported, Healthbeat reported.

While Bell told Healthbeat she remains concerned about unrecognized cases, if they exist, the department doesn’t think there are a lot of them. “Our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” she said. Before the outbreak can be declared over, a period of 42 days – two incubation cycles for the virus – must pass without any more measles cases. If that happens, the last day of the outbreak would be April 26.

March 31, 2026 – No new cases and nobody in quarantine

Total outbreak cases: 997. New cases: 0.

With no new cases reported again and also nobody in quarantine, the countdown to the end of the outbreak continues. The outbreak can’t be declared over until two incubation cycles of 21 days each have passed without any new cases. If that happens, the last day of the outbreak would be April 26, state health officials have said.

April 3, 2026 – Still no new cases

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak remains underway as state health officials again announce no new cases.

April 7, 2026 – Still no new cases as DPH scales back public updates

Total outbreak cases: 997. New cases: 0.

The countdown to an April 26 last day of the outbreak continues as state health officials again announce no new cases. Unless a new measles case is identified, the South Carolina Department of Public Health said it will reduce the frequency of its Wednesday media briefings to every other week. While Tuesday outbreak data updates will continue, Friday updates will be discontinued, the department said. “If a new case is reported, DPH will immediately notify the media and resume briefings and updates as appropriate,” the department said.

April 27, 2026 – DPH declares the outbreak over, risks remain

Total outbreak cases: 997.

After 42 days passed without any new outbreak cases, the South Carolina Department of Public Health declared the outbreak to be over.

“Though we reached nearly 1,000 cases, we are grateful that, by and large, it remained confined to one county and did not spread statewide, as was always our concern and fear,” Dr. Brannon Traxler, the department’s deputy director and chief medical officer, said at a news conference.

Traxler said there are three main reasons state health officials think the outbreak has ended: the large number of people infected, widespread community cooperation with quarantine and isolation, and increased vaccination against measles in recent months.

While this record-breaking outbreak is over, Traxler said conditions remain for another measles outbreak in the future, brought into the state through travel.

“If we don’t continue to see increases in vaccination, I’m worried that we could see another large – maybe not this large, but hopefully not – but another large outbreak in a community where it gets introduced from someone who had traveled.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

South Carolina’s measles outbreak is over: 7 things to know about largest U.S. outbreak in decades

2026-04-27T23:49:47+00:00

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Officials at the South Carolina Department of Public Health declared their record-breaking measles outbreak to be over on Monday after no new cases emerged during the past 42 days.

Here are seven things to know about the largest U.S. measles outbreak in more than 35 years:

Most people who got infected weren’t vaccinated

Of the 997 measles cases documented in the outbreak, 932 patients were unvaccinated, 19 had an unknown vaccination status, and 20 were only partially vaccinated with only one dose of the two-dose MMR (measles-mumps-rubella) vaccine, according to the department’s data.

Just 26 people were fully vaccinated with two doses of MMR vaccine. Two doses of the vaccine is about 97% effective in providing protection against measles infections; one dose is about 93% effective, according to the Centers for Disease Control and Prevention.

Infections, increased vaccination credited in stopping outbreak

The 997 people sickened with measles developed immunity to the disease, Traxler said. “Though that carried with it, of course, the risk of severe illness, a weakened immune system and the potential for devastating complications even years from now,” she said.

Another important factor in stopping the spread of the virus, she said, was that the “vast majority” of people who were infected or exposed followed public health instructions to stay home and avoid infecting others.

Lastly, thousands of people got vaccinated. In Spartanburg County, she said, an additional 3,788 doses of MMR vaccine were administered during the six months of the outbreak compared with the previous year.

“In particular, January and February were record months for MMR vaccination in the state,” she said.

Risks for future measles outbreaks continue in South Carolina

This outbreak may be over, but outbreak risks remain in Spartanburg County and across the state. Traxler noted that pockets of people who are not protected against measles remain in many communities.

“We’re going to continue to see sporadic cases that are going to be travel-associated most likely,” Traxler said, noting the goal is to keep one of these travel cases from sparking a larger outbreak.

State’s $2.1 million cost is only part of the outbreak’s bill

The department estimates that the outbreak response cost the state of South Carolina $2.1 million. But that was just the costs the department could calculate for staff time, vaccination costs, and other direct expenses.

It doesn’t include all of the costs to the health care system, schools, businesses, and beyond, she said. “What were the economic impacts to the state of parents who had to miss work?” she asked. It’s not part of that number.

Outbreak began with 5 cases, centered in Spartanburg County

The outbreak was first identified in early October, with just five cases. For weeks the virus seemed to spread slowly – then the holiday season began.

On the Tuesday before Thanksgiving, the state had logged 55 measles cases. By Dec. 12, there were 126 cases – and more than 300 people in quarantine, Healthbeat’s timeline of the outbreak shows.

By mid January – after the December holidays and multiple public exposures at schools and churches – the outbreak surged, with more than 100 new measles cases being identified every few days. By Jan. 20, the department had documented 646 cases. Cases slowed during February and March.

The last time the state announced a new case in the outbreak was on March 17, the day the case total reached 997.

Before the measles outbreak could be declared over, there needed to be two incubation cycles – or 42 days – without any new cases.

Winter break school closures delayed investigations, quarantines

During the critical December holiday period – before the outbreak surged – South Carolina health officials were hampered in their efforts to control measles exposures because of winter break school closures, Healthbeat reported earlier this year.

Internal department records, obtained by Healthbeat, revealed how outbreak investigators were delayed in their efforts to quickly quarantine schoolchildren exposed to measles right before the two-week winter break period began. Because schools were closed, outbreak investigators couldn’t reach anyone at multiple Spartanburg schools to get contact information for classmates, staff, and others who had been exposed to infected people.

To prevent similar communications gaps during the recent spring break period, the department contacted schools across the state’s 11-county Upstate region to identify a person who would be available to provide attendance and contact information during the spring break closures of schools and administrative offices.

Department’s response, lessons learned to be evaluated

“The outbreak is over, but our work to understand and prevent measles and future outbreaks is not,” Traxler said. “A thorough after-action review and analysis is being started. We believe our outbreak response team did a tremendous job under really unprecedented conditions. But there are always things that we can learn from and improve on in our future with future responses, and we are committed to doing so.”

One of the things the department did well, she said, was urging members of the health care community to be pro-active in immediately reporting any suspected measles case – even before any test results come back. That early heads-up, she said, allowed the department to immediately start educating the patient about the need to isolate and begin earlier contact tracing.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

Rutgers dean argues public health circles need to better understand humans’ role in outbreaks

2026-04-21T18:35:29+00:00

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Public health has long focused on the biology of pathogens — how viruses spread, how vaccines save lives, and how treatments can prevent disease — but Perry Halkitis believes the field should take a closer look at the role that humans play in public health.

Such is the focus of his new book: Humanizing Public Health: How Disease-Centered Approaches Have Failed Us.

Halkitis has served as the dean of the Rutgers School of Public Health since 2017. Prior to that he worked as a professor at the Center for Health, Identity, Behavior and Prevention Studies at New York University; the center has since moved to Rutgers, which he still leads. Halkitis conducted research on HIV/AIDS, drug abuse, and mental health. He is also an epidemiologist, applied statistician, and public health psychologist.

His academic area of expertise is people who have been infected and affected by HIV — a topic he explored in an earlier book, The AIDS Generation. It may come as no surprise that Halkitis saw parallels between the AIDS epidemic and the Covid pandemic and felt compelled to write his latest book on the need for a public health sector that puts humans front and center.

In a conversation with Healthbeat, Halkitis, 63, a New York City native who lives in Manhattan, discussed how public health might “humanize” itself, how the LGBTQ community can serve as a model for tackling public health challenges, the importance of public health influencers, and the reality that five tequila shots might compromise our better judgment.

This interview has been edited and condensed for clarity and length.

Your new public health book has just come out. Can you tell us about it?

It talks about the need for us to understand public health with humans at the center of all diseases. It means that we have to show humanity to each other as members of communities, and it means that we have to attend to the human elements of disease, i.e. people’s emotions or psychological states, their identities — all the things that make people people — and stop treating people like they’re laboratory rats running around mazes.

The book interweaves a story around HIV and Covid, mpox, Ebola, and the 1918 flu — everything from the history of pandemics and diseases that shows that human beings are a problem, for lack of a better term.

Human beings make irrational decisions that seem rational to some of them. They make decisions based on what feels good.

Spurred by Harlem Legionnaires’ disease outbreak, new rules for NYC cooling tower testing to take effect

I remember sitting in a room with a bunch of really prominent researchers, and I was just a new guy. They were talking about the model they were going to develop — the model was if we gave people confidence in using condoms, they would use condoms.

The little young Perry said, ‘not if they’ve had five tequila shots.’ That, for me, summarizes what this book is about, which is, yes, those models work if people are making decisions based on reason and logic.

Public health depends on those models, but people do not make decisions based on reason and logic, and therefore the models are tenuous at best. You need to create emotion-based models in order to change people’s behavior.

Ultimately, if you’re trying to enhance the people’s empathy and altruism, you have to show that there’s a benefit in there for them too.

Public health leaders are trying to get their messaging out, but they’re up against some powerful forces, the mighty algorithm being the latest. How can public health leaders push back against that?

There’s two answers to that question. If you go back and check on all the major networks that had been presenting information during Covid, it was mostly by medical doctors. It wasn’t public health people. That’s public health’s fault.

Number one: We should have demanded that they should have been talking to us, because we know how to talk to people. Number two: We need to be training our students how to use these tools to be able to be effective leaders.

Which means that we need to be engaging with social media companies, to have them come in and train our students just like we train students to do statistics, epidemiology, policy analysis and outbreak investigation. We need to teach them how to be able to message to the top communities that they work with through social media.

The simple answer is that we need to teach people to be public health influencers, and we’re not doing that. At Rutgers, we are trying to do that, we’re changing our curriculum to address this very issue, because our students are telling us, ‘I need these tools to become a public health influencer.’

Your ‘humanizing’ title also seems to be acknowledging that artificial intelligence is in the room, no?

You can bet you can use AI in effective ways to tailor messages. What’s going to work for a 70- year-old or a 50-year-old is going to be different from an 18-year-old. When I say ‘humanizing,’ I’d say use all the tools at your disposal, including industry, which includes AI. And develop those messages that are humanistic, or tell me how to say [certain things].

There’s a new administration in New York City, and public health is being broadly linked to an affordability agenda. What are your thoughts on that approach?

Affordability is a very, very, very, very important characteristic of health disparities, a very important driver of health disparities that we see in New York City. Case in point: If you look at the HIV map in New York City, you will see a lot of people infected in Chelsea, a lot of people infected in the south Bronx and central Brooklyn.

If you put it next to it a map of where people are dying of AIDS, they’re not going to see people dying in Chelsea. But they are dying in central Brooklyn and south Bronx. What’s that about? That’s about affordability and access. It’s about access to care. It’s about access to services, affordability of medications, affordability of good food, affordability to see the best doctors. I agree 100%.

Are there any public health issues in the city that keep you up at night, or that are overlooked?

Obviously homelessness, because we see it everywhere. People are sick. They’re on the street. During this hard winter we had, which was the first rough one in a long time, people were just out there.

What also keeps me up at night is the next viral outbreak. One of the things I write about in the book is you want a model of something that works really well in a population that comes together. Look at what happened in response to mpox. We got that under control.

I do worry about bird flu and a mutating H1N5. I worry about a new clade of mpox. I worry about measles outbreaks now, because [New Yorkers] are not just staying confined in the city.

Greater New York is going to see its share of visitors — more than a million, it’s expected — when the region hosts the World Cup. In light of the dramatic changes to the Centers for Disease Control and Prevention and the World Health Organization, which have traditionally been responsible for disease surveillance, what are your thoughts on how all these local agencies might be able to handle these duties?

I have every confidence that the city will stay on top of it. When people ask where to go for information right now, [I don’t send them] to the CDC site. It’s all garbage. [I send them to] the [New York State Department of Health], which is doing a really good job. It remains a reliable source and a vigilant organization that is very much on the pulse of what’s going on with health issues and is very good about communicating in effective ways about that.

New Jersey is okay, too. They have a pretty good health care system and a public health care system there.

It’s the rest of the country I’m worried about. We’re going to have to be even more on alert in the next few months than before.

Anything else you want to add?

The gay population can serve as a model of how a community comes together and cares for each other. That, to me, is about altruism and care and concern. Maybe it’s because we’re all traumatized for 45 years of AIDS. The thought of Covid, the thought of something else destroying our lives, [compels us to] rally. There is a lesson that hasn’t been played up enough.

This story was updated to clarify that the Center for Health, Identity, Behavior and Prevention Studies is at Rutgers.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Spurred by Harlem Legionnaires’ disease outbreak, new rules for NYC cooling tower testing to take effect

2026-04-10T23:45:03+00:00

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New York City property owners with working cooling towers — the cylinder rooftop structures spiking the city’s skyline — will soon be required to step up their testing for the Legionella bacterium.

It’s the city’s latest effort to prevent outbreaks of Legionnaires’ disease, which killed at least seven people in Harlem last summer.

A spokesman for the New York City Department of Health and Mental Hygiene said Friday the new cooling tower regulations go into effect on May 8 citywide. The rules were published in the City Record, a database of records and notices that includes public hearings and agendas, on Wednesday, and registered tower operators were notified. Property owners will also face higher fines for noncompliance.

The final rules were shared with all elected officials and community boards citywide Thursday.

The new regulations come after the City Council in October approved legislation to ramp up requirements for testing building cooling towers for Legionella microbes. In the past, cooling tower operators were required to conduct Legionella sampling every 90 days.

Building owners will now need to test for the presence of Legionella at least every month when the cooling towers are in use, which is generally during warmer weather months. The bill further requires that all such testing be performed by, or under the supervision of, a “qualified” professional.

Legionnaires’ disease is a severe form of pneumonia caused by the Legionella bacterium. It spreads through airborne water droplets, not by drinking water or through person-to-person spread. Many of the outbreaks in New York City are caused by water vapor spewing from rooftop cooling towers.

Harlem has high risk factors for Legionnaires’ disease

Central Harlem was the center of a Legionnaires’ outbreak last summer in which health officials say at least seven people died and more than 100 were sickened, many of them hospitalized. The outbreak was linked to contaminated cooling towers at several locations, including Harlem Hospital, which also had an outbreak in 2021. In that case, health officials determined the facility had not properly managed one of its cooling towers in accordance with local law.

Last month, Gothamist reported that Harlem Hospital ignored its own cooling tower maintenance plan in the weeks before last year’s outbreak when it failed to conduct rapid, weekly tests for Legionella.

New York City Legionnaires’ disease outbreak: Cooling towers, regulations, and lessons from 2015

In a separate Harlem case, two residents in one of the city’s largest residential complexes were diagnosed with Legionnaires’ disease, prompting local health officials in January to open an investigation.

Residents were advised to take baths or sponge baths instead of showers so that they wouldn’t breath in contaminated mist.

Harlem is particularly vulnerable to Legionnaires’ outbreaks, because of its high density of tall buildings with cooling towers, and the concentration of chronic disease — a risk factor for Legionnaires’ — in Upper Manhattan and the Bronx. The health department has also cited historic disinvestment and structural racism as factors.

Legionnaires’ disease tends to emerge more frequently in neighborhoods with older populations and higher rates of poverty, according to health officials. From 2019 to 2022, the city’s highest annual Legionnaires’ disease rates were concentrated in parts of Harlem and the Bronx. Among residents with Legionnaires’ disease in that period, more than 90% had at least one chronic medical condition, and more than 50% were previous or current smokers.

In what seemed like an odd anomaly to Harlem residents, city health inspectors in February found two tenants with Legionnaires’ disease in an apartment building on the Upper East Side.

“I started to believe that Legionella only knew Black and brown neighborhoods,” Marquis Harrison, chair of Manhattan’s Community Board 10 in Harlem, said March 31 on a panel with city health officials hosted by the CUNY Graduate School of Public Health & Health Policy. “We only saw it in the South Bronx and in Harlem, and only communities of color. We were having these outbreaks. … Maybe it doesn’t just exist in our neighborhoods.”

Preliminary budget includes more inspectors

The city held public hearings after last summer’s outbreak.

Health officials testified last September that they needed more inspectors to strengthen oversight and enforcement and hiring has begun. Speaking about the preliminary budget before the City Council’s Health Committee on March 20, health officials said that when fully staffed, the department will have about 56 scientists and water ecologists to oversee work related to the inspections. The city has some 6,000 cooling towers.

“The additional staffing that we got will enable us to conduct the annual inspection and any follow-up that’s needed of every cooling tower in the city, which, as you know, has been our goal,” said Corinne Schiff, deputy commissioner of the environmental health division in the health department.

The preliminary budget plan notes that the health department is devoting more money toward community outreach, cooling tower inspections, disease surveillance and laboratory testing. In the budget hearing, chief financial officer and deputy commissioner Aaron Anderson said $9 million will go toward surveillance and testing in the fiscal year 2027, along with 50 employees. Another $2.5 million will be devoted to the cooling tower inspections and 28 employees, and community outreach efforts will receive $1.1 million and 15 employees.

The outbreak has prompted lawsuits against the city and the construction firms involved in maintaining the cooling towers, with the backing of civil rights lawyer Ben Crump and the Rev. Al Sharpton. In his lawsuit, Crump alleged that the city failed to learn that water towers were unregistered or went uninspected. He also argued that the official death toll was an undercount.

The seven people who died last summer have not been publicly identified.

Harrison said their names may have been lost in the confusion surrounding the summer outbreak.

“It’s very sad for us, because the community couldn’t send their condolences or even celebrate their lives,” Harrison told Healthbeat on Friday, adding that he would renew his request to learn more about the people who died.

At the March budget hearing, City Council Health Committee Chair Lynn Schulman asked Schiff if the health department required further help.

“Do you need additional resources to prevent future outbreaks?”

“The program is to promote compliance with the rigorous requirements that New York City has, and as we discussed in the fall, that is designed as a prevention measure,” Schiff said. “We can’t commit that nothing bad will ever happen again.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

AI could help save lives by easing delivery of treatments that we know work

2026-04-10T11:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

According to tech leaders, artificial intelligence will be transformative for our health. AI could give us “the next 50-100 years of biological progress in 5-10 years,” declared Dario Amodei, CEO of Anthropic. “Maybe with 10 gigawatts of compute, AI can figure out how to cure cancer,” enthused Sam Altman, CEO of OpenAI.

Back in the clinic, our enthusiasm is more guarded. Part of it is the checkered history of health technology, too often extracting humanism in medicine for the pursuit of profits. Another hesitation is because so often, in the real world, the problem is not discovery but delivery. Cures that don’t reach the patients most in need; prevention that never makes it into practice. But what if AI could actually help us change that?

Take one of my longtime patients, whom I recently saw on his 45th birthday. We commiserated about the travails of middle age (I’m also turning 45 this year), and celebrated some progress he had made with his mental health in the last few months. And — with colon cancer affecting more young patients — I recommended a colonoscopy.

He acquiesced to a stool test, which screened positive, but declined the follow-up colonoscopy that might save his life. When I reached him to understand why, I learned that he had lost his job and his health coverage, and felt he had bigger fish to fry. “I’m feeling fine, doc” he said to me. His reassurance just reinforced my own powerlessness to reassure him.

My patient is far from alone: Roughly half of Americans with a positive stool test don’t complete follow-up within six months, despite the proven benefits of early detection and treatment.

This yawning gap repeats itself across American medicine. Less than half of patients with high blood pressure are on an effective regimen for it. Only about a third of patients who qualify for the medicines that could cure them of hepatitis C receive them. Fewer than 1 in 5 patients who would benefit from therapies like buprenorphine for opioid addiction get treated.

Even as we discover more effective treatments, we fail to deliver them to those most in need.

AI can help patients get through complex process to care

The discovery-delivery gap is not new. Three decades ago, health care pioneer Don Berwick highlighted “the gap between what we know and what we do.” But we now have a realistic opportunity to fix this failure, by thoughtfully harnessing AI to save lives.

Take my patient’s positive screen for colon cancer. Several steps are required after the stool test: notifying the patient, arranging scheduling, ensuring coverage, explaining the bowel prep. Sometimes the prep isn’t adequate, and we send patients back to square one.

The complexity of this process explains why many health systems employ patient navigators, and why people with greater means seek out concierge care to cut through the thicket. Artificial intelligence could help scale this kind of personalized, persistent engagement. Imagine a system that calls my patient in his native language, helps schedule his colonoscopy, and answers questions about the bowel prep. Nurses and social workers can focus their precious time on more complicated cases, like helping my patient enroll in Medicaid.

A test for AI apps is whether they enrich the human relationships at the heart of exceptional care. Too often, health technology has eroded relationships: reducing eye contact, depersonalizing interactions, making medicine transactional. Patients become less inclined to trust recommendations. In this environment, trusted intermediaries like community health workers become more important, not less, and technology must work for them.

Human relationships have always been a key to bridging innovations, like vaccines and cures, with implementation. The United States tamed tuberculosis, for example, through painstaking efforts to find and monitor cases in the community and provide subsequent support for completing treatment regimens.

AI can help cures reach patients who need them

Today we have a chance to eliminate modern scourges like hepatitis C, thanks to new therapies like curative antivirals. Hepatitis C is an insidious disease: Tens of thousands of Americans each year progress toward cirrhosis, their eyes yellowing and toxins clouding their minds as the liver fails. Yet a simple 8- to 12-week course of pills can eliminate the virus from the body. AI could help ensure that such breakthroughs actually reach patients.

Casefinding is especially important when people can transmit infection without knowing they are infected. Yet our tools for identifying these “silent carriers” are often blunt. Today, the national recommendation for hepatitis C is to screen every American between 18 and 79 at least once with a blood test. By contrast, a machine-learning algorithm tested in Israel was 100 times more efficient: yielding one diagnosis for every 10 tests instead of one for every thousand.

A similar opportunity exists for HIV prevention. As powerful new tools like the long-acting injection lenacapavir emerge, AI could help ensure that protection reaches those at highest risk.

Eliminating diseases like HIV and hepatitis C, just as we did for smallpox and polio, is within our reach — though it will take more than just technology.

What AI can’t do is solve our all too human problems, like the fact that high prices preclude broad access to some of our most consequential breakthroughs, from antivirals for hepatitis C, to the $28,000-a-year lenacapavir, to the new GLP-1 medications for diabetes and obesity. For this, we will have to work through our messy human systems to forge a better path.

Mere mortals have done it before. In Louisiana, a so-called “Netflix model” facilitated expanded access to hepatitis C medicines for a flat subscription fee. And the Congressional Budget Office estimated that a national subscription model for hepatitis C would save the federal government approximately $6.6 billion over 10 years, in part due to costs averted from hospitalizations and intensive care that would otherwise be borne by Medicare. We can save lives and money.

My patient ended up completing his colonoscopy after our social worker helped find health coverage he could afford. They found a small polyp that was precancerous, and he and I both breathed sighs of relief. But he’s due for another colonoscopy in five years. I hope we can make a century of medical progress by then. At the least, we can make it easier for patients like him to receive the care we already know saves lives.

Dr. Dave A. Chokshi is a physician at Bellevue Hospital and Sternberg Family Professor at the City College of New York. Previously, he served as health commissioner of New York City.

Where measles is spreading in the U.S.: Outbreaks fuel infections in states coast to coast

2026-04-09T21:27:09+00:00

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Measles infections continue to spread across the United States, largely fueled by outbreaks – large and small – in multiple states

Since January, there have been more than 1,670 confirmed cases of measles nationwide, with most states reporting at least one case to the Centers for Disease Control and Prevention.

States with 10 or more confirmed cases of measles since January include: Arizona, California, Colorado, Florida, Minnesota, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, Texas, Utah, Virginia, and Washington state, according to federal, state, and local data.

But health officials in multiple states have told Healthbeat they are concerned measles cases are going unreported because there are people who aren’t seeking diagnosis and treatment. They also are worried that recent spring break travel may contribute to more people falling ill with measles in the next few weeks. It can take two to three weeks for symptoms to appear after a person is infected.

The good news: South Carolina, the site of the largest U.S. measles outbreak in decades with 997 cases, hasn’t had a reported measles infection in more than three weeks and will be declared over if that trend continues through April 26.

The bad news: Utah’s outbreak – now the largest, still-growing outbreak in the country – is approaching 600 known cases.

The CDC defines an outbreak as three or more related cases. Here’s what to know about six places where measles has been spreading:

Utah: The largest outbreak that is still growing

Utah’s large outbreak, like others, began with just a handful of cases that started being identified last June. A few were in Utah County, around Provo. Others were in a rural area in the southwest corner of the state – where the virus continued to gain traction, becoming the focus of the outbreak throughout last year.

By the end of 2025, 197 people had been diagnosed with measles largely in that one corner of the state. Then in recent months the outbreak surged statewide. Since January, another 386 people have been diagnosed, bringing the outbreak’s total to 583 reported cases as of this week. At least 47 people have been hospitalized.

Dr. Leisha Nolen, Utah’s state epidemiologist, said the number of cases known to public health officials is an undercount. “I can say confidently that we are missing cases,” she said.

But it’s difficult to say how many.

In some communities that are particularly distrustful of government and public health, as few as 1 in 10 cases may go unreported, she said. Cases in remote rural communities, with limited access to health care, may also have higher rates of underreporting, while more cases may get counted in cities with easier access to doctors and hospitals.

One thing is clear: Utah’s outbreak is continuing to grow. In the last three weeks, state health officials have learned of 121 new cases.

“In the beginning of our outbreak, we did have mostly communities along the southwest border with Arizona affected, and we were really trying to contain it in that area and prevent spread,” Nolen said. “But as you know, people move around.”

A state high school wrestling championship in mid February contributed to the spread of the disease, health officials said. The state’s TriCounty Health District in northeast Utah, with 59 reported cases, has been particularly hard hit in recent weeks following the event.

Kirk Benge, TriCounty Health director, said the region’s outbreak has been centered around the city of Vernal, which is known as “Dinosaurland” because of the area’s rich deposits of dinosaur fossils and nearby Dinosaur National Monument.

“We started with quite a large number of cases in a school,” Benge said. “Now we’re seeing the household spread that comes from all of those cases started in a school setting.”

There are encouraging signs the outbreak in the Vernal area may be slowing, he said.

“We saw week over week doubling there for a little while, and I think it plateaued here this last week, and it may be declining right now. So hopefully that trend continues,” Benge said.

He said that since the local outbreak began, large numbers of parents are seeking vaccines for their children and the number of vaccines administered is up 500% over the same period last year.

“I think we have a lot more just hesitant people who have been confused by mixed messages on social media,” Benge said. This kind of vaccine hesitancy is different than the staunch opposition to vaccination found in some other communities in the state, he said.

Still, many other parts of the TriCounty area remain vulnerable to measles outbreaks because of low vaccination rates – something the county’s board of health warned in a December 2024 open letter to the community that cited an increase from 4.8% to 11.9% of local parents seeking to exempt their children from school vaccines. “We want all residents to understand that individual decisions regarding vaccination impact us collectively,” the letter said.

To prevent outbreaks of measles, 95% of people in a community need to be vaccinated against the disease.

Arizona: Measles outbreak from 2025 continues to grow

A measles outbreak has been underway in Mohave County, along the Arizona-Utah border, since August 2025.

Last year the county had 214 cases. This year, at least 61 cases have been reported, state data show. Officials with the Mohave County Department of Public Health did not respond to an interview request.

Oregon: ‘Worrisome’ infections without obvious source

There have been just 13 measles cases reported across the state of Oregon as of April 3. While not technically an outbreak, Dr. Dean Sidelinger, the state’s epidemiologist, is concerned about hidden spread of the virus.

While the source of some of Oregon’s known measles cases can be traced to travel to another state with an outbreak, disease investigators haven’t found a source for most of the cases.

“That’s very worrisome to us in public health, because that indicates a level of spread in the community that we’re not detecting,” Sidelinger told Healthbeat.

The state’s wastewater testing has also been intermittently detecting measles in areas that don’t correlate with where cases are being reported, he said.

While Sidelinger said 9 out of 10 parents in Oregon have chosen to fully vaccinate their children, the state has localized communities where there are concentrations of unvaccinated people.

“Many of our communities, not just in Oregon, but across the country, who have lower vaccination rates, often have various reasons for that. But some are in more close knit, often faith-based communities that don’t typically seek health care, or maybe have a little bit more of a mistrust or distrust of government,” he said. “We worry that if it gets into one of these communities that it could spread fairly quickly.”

Florida: Cases continue in county with university outbreak

A measles outbreak linked to Ave Maria University in southwest Florida’s Collier County has grown to 106 confirmed and probable cases through April 4, the most recent data available on the state health department’s website. Statewide, there have been 144 measles cases reported since January, including a handful of cases in Broward, Pinellas and Hillsborough counties, the data show.

In recent weeks, spring break travel has resulted in a surge of travelers prompting concerns about the potential for further spread of the virus. The state health department and Ave Maria University didn’t respond to interview requests.

North Dakota: Two outbreaks since February

Since March 23 there have been six cases of measles reported in Ransom County, North Dakota, a largely agricultural area in the southeastern part of the state with a population of about 5,600 people. One person has been hospitalized, according to state data.

Officials at North Dakota Health and Human Services issued a press release on April 1 about the first Ransom County case, saying that the person “likely acquired the infection within the state” and that the case was not linked to a measles outbreak in Pembina County.

A spokesperson for the department said staff were out of the office and unavailable to answer questions about the current status of the outbreaks and efforts to control the spread of the disease.

The outbreak in Pembina County, which is in North Dakota’s northeast corner, involves 23 cases reported in February and March, according to the state’s online data. Four of these people were hospitalized.

A total of 32 cases have been reported across the state since January.

California: An outbreak sparked by travel to South Carolina

In recent months the Sacramento, California region has been experiencing a measles outbreak that was sparked by an unvaccinated toddler who had recently visited South Carolina’s outbreak area.

The toddler’s illness was reported to Sacramento County health officials in late February, then nearby Placer County identified three more measles cases in siblings from a different household who had been exposed to the toddler, according to the California Department of Public Health.

Additional cases have continued to be identified in both counties.

This week, Sacramento County announced that two additional measles cases have been reported. Both are unvaccinated children, raising the county’s number of confirmed cases to five.

“These five confirmed Sacramento County measles cases in recent weeks show the disease is circulating in Sacramento County,” the county health department said in an announcement about the cases. “The overall risk to the general public remains low but residents, especially those who aren’t vaccinated against measles or whose vaccination status is unknown, should be hyper-aware and take steps to protect themselves and others.”

In Placer County, where there have been eight confirmed measles cases, officials also are concerned that measles is spreading in the community. “Nearly all of the measles cases thus far have some association with homeschool enrichment programs in the region, either directly or through family members,” the county health department said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

The next U.S. aid disruption: HIV, malaria drugs for Africa and Asia

2026-04-09T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

We had a lovely, long Easter weekend. (Both Good Friday and the Monday after Easter are national holidays here.) And later this week, I’m planning on driving some visiting family upcountry to the foothills of Mount Kenya, where we’ll see the last two northern white rhinos in the world.

This week’s stories cover some (déjà vu triggering) disruptions to U.S. medical aid, the rollout of a promising HIV prevention drug, the growing damage that war is inflicting on Iran’s health system, among a few other stories.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

A proposal for more U.S. medical aid disruption

The United States is preparing a major, disruptive overhaul in how it delivers HIV and malaria aid, Reuters reports. The proposed changes represent an “upheaval likely to cause more medicine shortages” and risk “a second dislocation of life-saving services in just over a year,” across Africa and Asia.

Some background: For the last 10 years, the United States has routed a fairly astonishing volume of medical supplies through one large program called the Global Health Supply Chain Program – Procurement and Supply Management, which is run by the for-profit company Chemonix. Just how much? Between 2016 and 2024, that program “delivered a total of more than $5 billion of HIV and malaria products to 90 countries,” making the United States by far the largest funder of these tests and medicines worldwide.

But, according to the Reuters investigation, State Department leadership has asked “staff in 17 African countries and Haiti in an email [on March 31] to cease implementing the supply program by May 30.”

The program will theoretically be replaced by new systems set up under “bilateral agreements with other countries” and private distributors, which would have to be negotiated extremely quickly.

All told, the month-and-a-half timeline is raising concerns about “immediate risks to service continuity if the transition is rushed or incomplete,” with potential shortages of HIV drugs, malaria treatments, and other basic health supplies that millions of people rely on. As the article outlines, ordering and shipping medical supplies to remote clinics can take many months.

The directive “did not lay out a clear transition plan, instead asking each U.S. country office to set out how it would implement the handover, and to inform Washington of any risks or need for more time.”

I reached out to a senior, overseas State Department official with direct knowledge of the program, who agreed to speak on background to provide context.

My source confirmed the broader uncertainty around the transition. To their knowledge, even basic guidance on the proposed upheaval (including the email referenced in the Reuters report) has not yet circulated across all countries served by the program.

They echoed the strong concerns in the Reuters report that such a severe and rapid disruption could leave patients without lifesaving medicines. But what I found most interesting is that they noted that even if the United States ultimately shifts medical procurement to the international organization the Global Fund (an option that we reported on last week) simply purchasing medical supplies is only part of the coming challenge.

What remains dramatically unclear is the rest of the supply chain: warehousing, logistics, and actually getting drugs into clinics.

At the risk of getting too in-the-weeds: These risks may be especially acute in countries where the State Department did not inherit parallel supply systems from the now-defunct U.S. Agency for International Development that could temporarily absorb the shock. (In other words, some countries have backup systems to keep medicines flowing. Others do not.)

My takeaway: It’s still unclear how much of this proposal will actually move forward, or whether the State Department may walk back the plan or timeline. I’ll be following this story closely.

Is there enough of this game-changing HIV prevention drug?

Late last year, a new injectable drug to prevent HIV infection called lenacapavir began rolling out in several African countries. The drug has generated enormous excitement because a single injection protects people for about six months, and it provided close to perfect protection in clinical trials.

But that early rollout is already raising questions. In Eswatini, which received the drug first and has the world’s highest rate of HIV, clinics are already running through their tiny initial shipments, The Guardian reports.

One clinic only “received 130 doses.” Nationally, only a few thousand people have started the drug so far. (Keep in mind, a quarter-million people in Eswatini are HIV+). As one source in the story put it, “The coverage so far has been very, very, very low. But my impression is that interest is extremely high.”

The story raises an obvious question, and also had me wondering if this goes beyond one country: Is lenacapavir’s wider rollout already being hampered by supply limits? To ask, I reached out to Mitchel Warren, executive director of the AIDS Vaccine Advocacy Coalition, who we last spoke to about lenacapavir in October.

To start, Warren told me to pump the brakes. It is still early days. While “the initial deliveries are quite small to each country … it is actually too early to tell about the actual supply constraints (if any),” he said.

Warren noted that countries like Kenya, Nigeria, and Zimbabwe only just received their first shipments last month. “So we don’t yet know that demand is truly outstripping supply – yet.”

Still, Warren said the bigger picture for HIV prevention is far from reassuring amid the broader pullback in global health aid.

As he put it: “This continues to be a moment of cruelest irony – our best opportunity in HIV prevention coming at the worst time politically and economically.” While there is enormous potential for this new drug, “the foundational programs [which would deliver it] have been severely curtailed, and in some cases entirely decimated.”

Warren also left me with one note that’s often missing from lenacapavir coverage. HIV prevention, he says, “has always been more than a product — it is a program.” And without outreach, testing, and health systems that bring people back every six months, even a “miracle drug” (as the Guardian piece put it) won’t stop the epidemic.

Iran’s civilian health system under fire

For the third week in a row, we’re returning to the Iran war. Granted, it’s been evolving on a fairly volatile timeline, so much of what we know will likely change in the coming days.

Early Wednesday, a fragile cease-fire was holding after U.S. threats to attack Iranian power plants, bridges, and other civilian infrastructure if Iran did not reopen the Strait of Hormuz. Iran had threatened similar retaliation to neighboring countries. Under international law, these are war crimes, and the potential consequences for civilian health and survival could be enormous.

To some extent, that damage is already underway. Al Jazeera reports that U.S. and Israeli strikes have already hit major parts of Iran’s health system. This includes a psychiatric hospital, a pharmaceutical company, and the Pasteur Institute of Iran, “the oldest and most prestigious research and public health center in Iran,” which has “played a central role in fighting endemic diseases such as smallpox and cholera.”

The World Health Organization says it has verified “over 20 attacks on health care in Iran,” resulting in “at least nine deaths,” including an infectious diseases health worker and a member of the Iranian Red Crescent.

More broadly, WHO Director-General Tedros Adhanom Ghebreyesus warned that “the conflict in Iran, and the region, is impacting the delivery of health services and the safety of health workers, patients, and civilians present at health facilities.”

Argentina: easier monopolies for medicines?

After pulling out of the WHO last month, Argentina has made another significant policy shift. The government has scrapped guidelines that limited which medicines could qualify for pharmaceutical patents, according to an essay in Health Policy Watch by leaders in the affordable-medicines advocacy arm of Doctors Without Borders.

Put simply, the essay argues that Argentina has essentially made it easier for pharmaceutical companies to stretch out monopolies by re-patenting small tweaks to existing drugs. (Imagine a company simply rejiggering a new dose of an existing drug, and then re-patenting it just as the original patent was about to expire.)

Ultimately, these patent extensions push generic competitors out of the market for longer, and keep prices much higher. As an example, the authors reference a hepatitis C treatment that dropped from “$147,000 to $120 per person” once generics were allowed to compete.

You may be asking: Why is this (admittedly niche) policy shift for a single country worth covering?

Well, the authors argue that Argentina’s previous “more disciplined system” of patent rules showed how governments could apply strict standards, while still rewarding real innovation. By rolling those rules back, they warn, Argentina risks weakening a model other countries have looked to when trying to limit pharmaceutical monopolies.

As for my takeaway? This story touches on a tension I run into constantly covering global health. Alongside government-funded R&D, private companies are our greatest engine of drug innovation. The big question is how and where we should draw the line between incentivizing companies to invent lifesaving medicines … and demanding those medicines remain affordable once they exist.

Honestly, I’m reluctant to even, say, cast drug patents as a “necessary evil.” As uncomfortable as they are, monopolies ultimately allow companies to recoup the enormous cost of developing new medicines. And there’s nothing shameful in that. When there’s no profit to be made (as we see constantly with the entire field of “neglected tropical diseases”), the results often fall between grim and hopeless.

Human greed is a powerful force! Companies should see value in investing in the medicines we all rely on. But keeping that greed in check is just as important, and I think Argentina is failing in the latter to serve the former.

A ‘mysterious skin disease’ in Pakistan

We’ll finish on a small but worrying report out of Pakistan that’s worth flagging. At least nine children have died in the country’s southeast Sindh province from what officials have described as a “mysterious skin disease,” though the cause has not yet been identified, Pakistan Today reports.

On Monday, “samples from eight affected children had been sent to Karachi [the capital of the province] for testing,” but results have not yet been released.

It’s too early to know what this actually is, although the big worry is a novel outbreak. Local officials have suggested possibilities including chickenpox or mpox. (Although additional reporting suggests that while mpox has been detected in some of the cases, health officials say it was not the direct cause of the deaths.)

With no diagnosis yet and only local reporting so far, this may ultimately turn out to be a familiar disease rather than something new. Still, unexplained childhood deaths are always worth watching closely, and I’ll keep an eye out for further reporting.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

How smoking fell to lowest level ever and other public health wins

2026-04-08T11:00:00+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a global nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

I often write about what’s not working in public health. This week, I want to focus on a few recent studies that show what is working in public health — from reducing tobacco use to preventing one of the world’s deadliest killers — and put it in the context of how we think about interventions to avert illness and death in large populations.

What interventions work best in public health?

When we are trying to improve the health of a population, we try to choose interventions that benefit the largest number of people for the longest amount of time with the least amount of effort required on a daily basis.

In a framework first promulgated by former Centers for Disease Control and Prevention Director Tom Frieden, the most effective interventions address the socioeconomic factors that have the largest impact on health and longevity, such as poverty, education, and housing. The second most effective are interventions that change the default context for how people make healthy decisions, e.g., clean water, safe food, smoke-free places, and seatbelt mandates. These work because the healthy choice becomes automatic.

Third most effective are long-lasting protective interventions, such as vaccines or colonoscopies, that confer durable protection from a single encounter with the health system. Fourth most effective are ongoing clinical interventions, such as medications to treat blood pressure or HIV. And, fifth, the least effective in a population, is counseling and education about health: telling people to eat better, exercise more, stop smoking. Trying to talk one person into changing their behavior is hard. Trying to talk millions of people into changing their behavior is even harder and often fails.

Even though we have a hierarchy of what works best in public health, each of these types of interventions has value, as shown by multiple recent studies.

Changing the context: Tobacco use at a historic low

Cigarette smoking just fell to its lowest recorded level in U.S. history. A study published this month in NEJM Evidence, using 2023 and 2024 National Health Interview Survey data, found that cigarette smoking among U.S. adults dropped from 10.8% to 9.9%, the first time it has ever reached single digits. Tobacco kills roughly 480,000 Americans each year. If this trajectory holds, the United States could meet the Healthy People 2030 target of 6.1% before the decade ends.

What drove this decline? While many people probably think it was because of better education about smoking’s harms, most of the gains in tobacco control came from years of investment in changing the default context: High tobacco taxes and comprehensive smoke-free laws that made smoking expensive to start and disruptive to continue.

Unfortunately, this progress is not guaranteed to sustain. The current administration has had virtually nothing to say about tobacco and even eliminated the CDC’s Office on Smoking and Health. Congress is trying to restore it, and so I remain hopeful that the United States will continue to drive tobacco use down.

Worth noting is that e-cigarette use has not declined and sits at 7% among adults, with rates among young adults running significantly higher than cigarette smoking. And we still do not know what the long-term consequences of vaping will be.

Long-lasting protective interventions: Flu vaccine still worth getting

Vaccines are among the most cost-effective tools in all of public health. Some, like measles or polio vaccines, are delivered in the first few years of life and protect people for decades. Others, like flu vaccines, work differently: Because the virus mutates rapidly, the vaccine has to be redesigned each year, and protection is partial rather than complete.

The CDC just published data showing both the benefits and challenges of getting a flu shot every year. The dominant circulating strain this year (influenza A[H3N2] subclade K) emerged after this season’s flu vaccine was already selected, a mismatch that predictably lowered effectiveness. Among children and adolescents, vaccine effectiveness against outpatient visits ranged from 38% to 41% and, among adults, 22% to 34%.

While those numbers are much lower than I would like, one of the most important axioms of public health is that a small number multiplied by a very big number is a big number. Even partial protection against a disease that infects tens of millions of people means that tens of thousands of people did not end up in a hospital from the flu. For example, during the 2022-23 flu season, when overall flu vaccine effectiveness was also just 30%, flu vaccines still prevented an estimated 71,000 hospitalizations and 4,300 deaths in the United States.

Clinical interventions: DoxyPEP and tuberculosis

While medical care is often seen as the most important part of health, it is often less effective than other public health interventions, because it requires accessing a clinic, getting the right diagnosis, and maintaining adherence to treatment. Public health’s primary role in medical care is making sure that people who need it most complete these steps.

Syphilis rates in the United States have been rising sharply for a decade. In 2023, King County, Washington began actively promoting doxyPEP: prescribing a single dose of the antibiotic doxycycline that patients can take within 72 hours of unprotected sex to prevent bacterial sexually transmitted infections. The intervention is recommended for men who have sex with men and transgender women who have sex with men, the populations at highest risk.

A study published last week in Clinical Infectious Diseases assessed the two years after doxyPEP was introduced in King County. Syphilis cases fell by 52.3% overall, an absolute reduction of more than 3,000 cases. Cases fell among cisgender women as well, likely through an indirect effect: As transmission declined in high-risk groups, it declined in their broader sexual networks, too.

The CDC also just released its provisional tuberculosis data for 2025. Cases declined slightly from 10,395 to 10,260, a 1% drop. Cases had been increasing for four straight years, a reversal of the CDC’s long-standing progress toward eliminating domestic TB transmission.

TB demands more from the health system than almost any other infectious disease, because it requires specialized testing and prolonged treatment. Diagnosis is often delayed, because the symptoms are burdensome but not debilitating, and most cases occur in immigrants and other groups that have limited access to high-quality medical care. Treatment requires months of strict adherence to multiple antibiotics. For this reason, most TB care is either provided directly by public health agencies or monitored closely by them.

I am worried that the United States will not be able to sustain this decline. Much of the progress against TB elimination in the United States has come from sustained investment in domestic public health services and in global TB control, both of which have been cut dramatically in the past year.

What these findings have in common

Tobacco control, flu vaccination, doxyPEP, and TB treatment sit at different levels of the public health hierarchy of interventions, but they share a common feature: None of them happened spontaneously. They required sustained government investment, functioning public health agencies, and the political will to keep at it year after year even when the gains seem small and the benefits invisible to the naked eye.

Until next week,

Jay

Dr. Jay K. Varma, who is recognized globally for his leadership in the prevention and control of infectious disease, writes about public health for Healthbeat. He has guided epidemic responses, developed policies, and implemented programs that have saved lives across Asia, Africa, and the United States. He is based in New York. Contact Jay at jvarma@healthbeat.org.

Michigan measles outbreak shows high cost of stopping even a small number of infections from spreading

2026-04-03T22:40:20+00:00

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The small measles outbreak that health officials are combating in Michigan began last month with an unvaccinated young woman returning home from visiting Florida, a state where there have been more than 140 cases this year.

Her first symptoms around March 7 seemed like a cold. By the time the telltale measles rash appeared a few days later, she had exposed her family and scores of other people in public settings, according to health officials in Washtenaw County, near Detroit.

The Michigan outbreak is one of 17 new outbreaks nationwide reported to the Centers for Disease Control and Prevention since January. There have been 1,671 confirmed cases of measles reported this year across 32 states, according to CDC data.

Most of this year’s cases – 94% – have involved outbreaks. Some – like those in Texas and Florida – involve more than 100 infections. In a few, cases have surged into the hundreds, as is the case in the outbreak in Utah, which is still growing, and the outbreak in South Carolina, which appears to be ending.

Many of the outbreaks are small – just a few cases. But as public health officials in Washtenaw County, Michigan, are learning, the resources required to keep them that way can be enormous.

Staffing costs for managing a handful of measles cases: $45,000

“We’re still at seven cases,” Beth Ann Hamilton, communications coordinator for the Washtenaw County Health Department, told Healthbeat this week. “We’re definitely not out of the woods yet.”

Meanwhile, another measles case announced Thursday in neighboring Monroe County has state health officials concerned that measles may be silently spreading in the community. No definitive link has been established to the cases in Washtenaw County, but the timing and location of the new case are concerning, officials at the state health department said.

Because of this risk, the Michigan Department of Health and Human Services is recommending young children receive their first measles shot early – at 6 months to 11 months of age.

Yet even with just a handful of known measles cases, the containment workload is already taking its toll.

Spring break travel risks spread of measles across U.S.

At the Washtenaw County Health Department, measles control is taking priority over many other health department services as staff have been needed to help track down and counsel hundreds of exposed people, test them for immunity to measles when they don’t have vaccination records, and monitor those in quarantine.

“Seven cases may not seem like a lot, but it is, and it’s hundreds and hundreds of contacts that our staff have to follow up on and monitor,” Jimena Loveluck, the department’s health officer, told the Washtenaw County Board of Health on March 27.

“We’re not able to get other work done,” she said. “We just don’t have the capacity to respond and then continue all our regular level of services. The expense also is tremendous.”

Exposures have occurred at a popular mall in Ann Arbor, a community college, hospital, urgent care clinics, several stores, and a restaurant.

Investigating and managing the exposures of just the initial three or four cases cost $45,000 in staff time, Ruth Kraut, the department’s deputy health officer, told the board. Other health department staff noted that $100,000 in funding from the state to help with the outbreak had been largely spent.

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Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
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“It’s been a huge effort,” Dr. Juan Luis Marquez, the department’s medical director, told the board. “We get lists of students or patients or whatnot. We don’t have much information to go by other than their name and date of birth. So that basically means our team of nurses and other folks calling everybody to verify their immunization status.”

Because two doses of measles-mumps-rubella vaccine is 97% effective at preventing the disease, public health officials are mostly trying to identify those who aren’t protected so they can be advised to quarantine at home and not spread the disease to others.

But people often don’t remember whether they’ve been vaccinated or don’t have access to their immunization records, Marquez said. So then they need to come to the health department clinic to have a blood test to check to see if they have measles immunity from past vaccination or infection.

The result is that the health department’s clinic is largely focused on measles and vaccine response, he said, and communicable disease efforts are being limited to measles and other high-risk cases.

Like forest fires, measles outbreaks are ‘sending out sparks’

A significant challenge for public health officials is that it’s difficult to know which small measles outbreaks can be quickly and easily contained, and which ones will spread to hundreds of people.

Dr. William Moss, a professor at the Johns Hopkins Bloomberg School of Public Health and director of the school’s International Vaccine Access Center, compared the measles landscape across the United States to a map of forest fires.

“You’ve got these bigger outbreaks, they’re kind of sending out sparks,” Moss said. “If that spark lands in a county or a community with high vaccine coverage, you don’t get much spread. And so you see one of these small outbreaks. But if it does land in a community with a large number of individuals who are under vaccinated or unvaccinated, then you get these larger outbreaks.”

It would be helpful to overlay measles cases onto maps with detailed vaccination coverage data, he said. But sources of vaccination data are limited and fragmented, and while school vaccination data can be helpful, it doesn’t include information about adults in the community.

“We and many other groups have been trying to develop ways to predict or forecast, as best we can, where the hotspots are. It’s just very difficult with measles,” Moss said.

Moss said that to know how easily measles will spread requires having detailed information about the coverage levels of vaccination and immunity within very localized communities where people socialize. But such data isn’t readily available, he said.

The places Moss and his team are watching closely are those where cases have been increasing the most in the past few weeks. That includes Hudspeth County, Texas, where the Johns Hopkins U.S. Measles Tracker has tallied 31 cases in recent weeks, and several counties in Utah, which is in the midst of a surge in its outbreak. Many of the cases in Hudspeth County, Texas involve a federal detention facility.

Since it began last year, Utah’s measles outbreak has sickened 559 people, 362 since January. South Carolina’s measles outbreak, the largest in the United States in decades, has had 997 known cases since October – more than 660 of them since January.

The good news: South Carolina health officials haven’t had a measles case reported to them in more than two weeks. If that trend continues for 42 consecutive days – which is two incubation cycles for the measles virus – that outbreak will be declared over after April 26.

As of early March, the South Carolina Department of Public Health told Healthbeat it had spent $1.6 million on its response to the outbreak.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

No new measles cases in South Carolina for a week, but CDC outbreak models warn about underreporting

2026-03-27T09:00:00+00:00

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For the first time since South Carolina’s record-breaking measles outbreak began last fall, the state has gone a full week without health officials learning of any new cases.

It’s an encouraging sign that the outbreak – which has 997 documented cases – may be nearing its end. However a report from outbreak modelers at the Centers for Disease Control and Prevention, completed earlier this month, raises questions about how many measles infections have been going unreported.

“There are likely some undocumented cases of measles in the affected region, raising the risk of spread to other populations in the region or nearby regions,” according to the March 3 risk assessment from the CDC’s Center for Forecasting and Outbreak Analytics.

@healthbeatnews
Is South Carolina’s record-breaking measles outbreak nearing its end? ⁠ ⁠ The state has gone more than two weeks without health officials learning of any new cases, but questions remain about how many measles infections have been going unreported. ⁠ ⁠ Healthbeat’s Alison Young breaks down what needs to happen before the outbreak can be declared over. ⁠ ⁠ 🔗 Check out our timeline of South Carolina's outbreak — and stay up-to-date with developments in outbreaks across the country — at Healthbeat.org. #measles #southcarolina #publichealth #outbreak
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The assessment says the extent of this underreporting is among several key uncertainties in predicting the future of the largest U.S. measles outbreak in decades.

Before the outbreak can be declared over, there must be a period of 42 days with no new cases – an important sign that chains of transmission of the virus have been broken. The last day of the outbreak would be April 26 if no more cases are reported, Dr. Linda Bell, South Carolina’s state epidemiologist, said Wednesday.

“We remain concerned about the possibility of unrecognized measles transmission, and we remain vigilant in monitoring any potential cases and spread,” Bell said.

State health officials worry spring break travel will spread measles as infections rise across the U.S.

Bell noted that the CDC’s modeling report was completed three weeks ago.

“Since that time, our measles case reports have continued to decline, our surveillance systems indicate this trend reflects a true decrease and not people avoiding health care,” Bell told Healthbeat.

Tests of wastewater in the outbreak area are not detecting measles, nor is there any sign from people going to emergency departments for measles-like symptoms, she said.

CDC officials did not grant interviews, and the agency’s written statements did not answer Healthbeat’s questions about information in the agency’s measles outbreak forecast report for South Carolina.

Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership, said he thinks the state health department is using the best data it has available in its announcements last Friday and again Tuesday that no new measles cases had been reported.

“I think it’s very unlikely we’re at zero,” Thorpe said. “One of the really challenging, frustrating things about measles is that there absolutely can be cases we don’t catch, mild cases in particular.”

The last time South Carolina’s health department reported zero measles cases was on Tuesday, Nov. 4, when the outbreak had just 34 cases. But by Friday, Nov. 7, a case was reported, department records show. State health officials provide case number updates only on Tuesdays and Fridays.

Thorpe said he continues to be concerned about the upcoming spring break travel period increasing measles cases in the area. Many schools in Spartanburg County, where the outbreak is centered, are scheduled to be off for spring break during April 6-10.

It’s a concern Bell has previously expressed as well. South Carolina’s outbreak surged after the winter holiday break period.

‘Inconsistent’ or ‘sub-optimal’ compliance with isolation, quarantine

Outbreak modeling teams at the CDC have produced three “outbreak scenario” assessments for the South Carolina measles outbreak, the first on Jan. 2, plus two updates on Jan. 20 and March 3.

“Throughout the outbreak, our assessment consistently indicated that a larger outbreak, lasting at least six months, with some spread beyond the affected community, is the most likely outcome,” the agency’s outbreak modelers said in a March 6 web post that detailed their assessments.

The South Carolina outbreak was first identified in early October with five known cases.

As of early March, the CDC modelers said positive signs for the outbreak were that the rate of new cases was declining and that there were zero or minimal cases “outside of the affected community in the affected region” and that exposure settings affecting the “general population” had become limited or infrequent. Another positive sign: The number of households, schools, churches, and health care facilities with ongoing measles transmission was limited – a significant improvement from mid- to late January when the outbreak surged.

But in addition to concerns about the likelihood of some underreporting of measles cases, the CDC modelers also wrote that compliance with stay-at-home recommendations by infected and exposed people was “sub-optimal or inconsistent,” and that there had only been low to moderate immunization with the measles-mumps-rubella (MMR) vaccine among unvaccinated people in the area.

“Currently, there is no evidence that unvaccinated residents of the affected region are receiving MMR vaccine in high enough numbers to substantially reduce transmission,” the CDC report said.

How the South Carolina measles outbreak grew from 5 to 997 cases

However, Bell, who is leading South Carolina’s outbreak response, credits increased measles vaccination in recent months as a key reason the number of new measles cases being identified has slowed to a trickle throughout March and to zero reported in the past week. She said that in addition to people who got vaccinated, it is important to also consider that the nearly 1,000 people sickened with measles in the outbreak also acquired protective immunity to the virus through their infections. “That is a very risky way to get immunity,” she said.

“I should also add that our disease containment strategies, our investigation of cases while they’re infectious, and making sure that people remain in isolation, and making sure that people have guidance about being in quarantine, also contributes to preventing ongoing transmission in communities,” Bell said.

CDC forecasts note ‘close-knit’ low-vaccination community

The CDC modelers noted that Spartanburg County, where the outbreak has been concentrated, “is home to a large, close-knit community of about 15,000 people with low vaccination coverage,” and that in schools countywide, just 88.9% of students are vaccinated against measles, compared to a statewide average of 93.7%.

To stop measles from spreading within communities, 95% of the population needs to be vaccinated.

Neither the CDC nor South Carolina’s state health department would identify the “close-knit” community referenced in the CDC outbreak modeling assessments. However state health officials have previously acknowledged outbreak cases and multiple exposure incidents at Slavic-language churches whose members speak Ukrainian and Russian, as well as schools serving students from those communities.

Vaccine hesitancy among Ukrainian and Russian-speaking communities in the United States has been fueled in part by historic distrust of the former Soviet government and its health system, health officials in other states have found.

The CDC’s outbreak assessment updated on March 3 says that the “size of close-knit communities with low vaccination coverage” in the outbreak area, as well as their level of connection to other similar communities across South Carolina is a key uncertainty in predicting the outbreak’s future path.

The assessment notes that much is unknown about the extent of measles vaccination coverage in the region, “particularly among close-knit, under-vaccinated communities.” Use of school vaccination data can be used to help estimate community-wide immunization rates, the report said, but rates vary widely in the region.

Some of South Carolina’s earliest known outbreak cases and exposures involved Global Academy of South Carolina, a public charter school in Spartanburg whose founders are Ukrainian immigrants. Only 21% of Global Academy’s students were up-to-date on their school vaccinations, according to state data.

The Way of Truth Church in Inman, S.C., was identified as the location of a measles exposure incident in early November.

One church, Way of Truth Church in Inman, S.C., was identified as the location of an outbreak exposure incident in early November that resulted in at least 30 measles infections during the weeks that followed, according to state outbreak updates. Over the Christmas holiday period, multiple Slavic churches were associated with measles cases and exposure incidents, according to state outbreak updates. School and church officials have declined or not responded to past interview requests.

‘Intrusion into your life’ when families seek care for measles

Another key uncertainty impacting the future of the outbreak, according to the CDC outbreak modelers, is how quickly people who are experiencing measles symptoms or who have been exposed get tested and seek health care.

The report says “avoidance of testing or health care could give the impression that transmission is slowing when that is not the case.”

The CDC outbreak modelers are not alone in their concern about underreporting of measles cases in the South Carolina outbreak.

Dr. Robin LaCroix, a pediatric infectious disease specialist with Prisma Health, one of the major health systems treating measles cases in South Carolina’s Upstate outbreak area, said earlier this month that underreporting is a “big concern.” LaCroix noted the potential “intrusion” of public health investigations after health care providers notify health officials, as required, about measles cases.

“I think that we have captured only a fraction of the people who have become infected with measles because if you were not ill enough to seek medical care, you are never captured in the numbers that are reported, “ LaCroix told the Why Should I Trust You podcast.

“When you began to see what happened when you sought medical care – you had a call from the DPH, who wanted to know everywhere you had been for the four days before you became ill, or your child became ill, and there was a lot of intrusion into your life and activities related to that,” said LaCroix.

In addition, she said, an infected child’s school also would get reported to public health and other unvaccinated children who were exposed would be sent home for 21 days of quarantine.

“There were big community consequences around coming forward that my child has measles, and so then you open yourself up for again some ostracization within the community, that you caused us to have to send all of our children home. So I do think that there is an underreporting,” LaCroix said.

Prisma Health spokesperson Tammie Epps said LaCroix was unavailable for an interview with Healthbeat.

While Bell said she remains concerned that there may be some unrecognized measles cases, if they are out there and aren’t seeking medical care, she doesn’t think there are currently many because there are no signs of them in wastewater testing and other surveillance systems.

“We don’t see indications there are large numbers of unrecognized measles cases because people are self-isolating,” she said.

“No surveillance system captures 100% of cases,” Bell said, “but with a highly infectious disease like measles, if ongoing transmission were occurring from many unreported cases, it is more likely to be detected by at least one of these means in addition to provider reporting.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

How the Iran war is disrupting the world’s medicine supplies

2026-03-26T11:00:00+00:00

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Hello from Nairobi.

This week we start with a reminder that the world’s conflicts rarely stay confined to the map. The Iran war is scrambling medical supply chains globally, because the Persian Gulf is not just an energy chokepoint but a critical transit hub for pharmaceuticals.

That said … we’re feeling the energy squeeze, too! Rumors of fuel rationing started circulating in Nairobi early this week, which was enough to send me out late at night to fill up my tank just in case.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The Iran war is a drug shipping fiasco

The starkest warning yet of how the Iran war could scramble global health comes from this must-read analysis in Think Global Health. The short version: The war is choking the movement of medicines around the world.

To be clear, it’s not that the Persian Gulf countries (like Saudi Arabia, Qatar, and the United Arab Emirates) are major drug producers. They’re not. It’s that these countries form “a critical pharmaceutical transit hub,” where drugs and their basic ingredients from India, Europe, and China routinely pass before heading to Africa, Asia, and the United States.

For reference, this is a region whose “pharmaceutical industry is worth $23.7 billion,” but where roughly 80% of that trade depends on medicines or pharmaceutical ingredients passing through.

And right now both ways these medicines largely transit, the sea shipping lane in the Strait of Hormuz and the Persian Gulf’s giant cargo airports, are badly disrupted. Shipping has dropped “90% below pre-war levels,” while air cargo capacity has fallen by “79% in the Gulf region.”

Where will the shocks be felt first?

I reached out to one of the authors, Prashant Yadav at the Council on Foreign Relations, who is a leading expert on global health care supply chains to ask.

Right now the biggest risk is cold-chain medicines, which he writes are “vaccines, insulin, biologics, and cancer therapies” with “short shelf lives” that have to move quickly and stay within a tight temperature range; largely “between 2°C and 8°C,” 35-46°F.

Most cold-chain medicines move by air cargo, Yadav told me, and airlines cannot simply add new capacity overnight if those routes stay disrupted. Even over the medium term, “I don’t think European airlines, or the two major African ones that have stepped in, will enhance their cargo carrying capacity by buying new planes just because this may continue for a few more months,” he said.

When shipments of these drugs are held up, those medicines can spoil. And even when they don’t, delays multiply. As the article notes, cargo carriers “need a week and a half to catch up for every week that air shipments are suspended.”

Also at risk is helium supplies, a gas that is “an essential input for cooling the magnetic resonance imaging (MRI) machines used worldwide for [over 95 million] medical scans,” each year. Qatar alone produces a third of the world’s helium. And the threat is not just constraints from the transit fiasco, but physical damage to the industry, including Iran’s March 18 attack on a major helium production site in Qatar.

Yadav believes we will ultimately see some “supply impact for MRI helium,” but exactly how severe it may become is too hard to untangle right now. Much will depend on how long Qatar’s production remains offline and how exactly limited supplies are allocated between industries, like semiconductor manufacturing (which is an enormous use for the gas).

Perhaps unexpectedly, the war has also put medical research under threat. Yadav’s article describes how the Gulf region was in the middle of a clinical trial boom, driven by “the area’s high chronic-disease prevalence and its lenient regulations allowing for fast-tracked trials,” and that supply chain chaos could interrupt ongoing trials.

The good news is that, for now, "short-term risks of drug shortages are low in most countries,” Yadav writes. But that’s because of “inventory buffers” that governments and pharmaceutical companies keep around the world. But those cushions are temporary. If shipping and air freight disruptions drag on, shortages will eventually work their way through the system.

I also asked Yadav whether the war could trigger a price squeeze for medicines made with petroleum products, which is more than you might think. “Most of our medicines have some kind of a chemical precursor, and a very significant portion of those chemical precursors are petrochemical derivatives,” he said. (For example, acetaminophen and ibuprofen are made using an oil-based chemical called propylene.)

But Yadav says, for now, that’s not a major concern. The petrochemical ingredients in something like a pill of ibuprofen only make up only around 5% of the cost, with the rest tied up in processing and manufacturing.

But other cost implications are coming fast. A combination of rerouted flights, rising air-cargo rates, and surging insurance premiums for ships mean that moving medicines are more expensive everywhere. And at least one supply chain logistics firm says that, “consumers could see drug costs affected within four to six weeks.”

Yadav’s article ends with a clear policy warning. Governments may need to temporarily loosen certain import regulations so medicines can move through alternate routes. Longer term, he says the world needs something bigger: a standing G20 coordination system that tracks where medicines are stuck and helps countries respond before shortages hit.

A rare campus outbreak

The UK is facing an outbreak of meningococcal disease among university students in Kent, which is in England’s southeast. It has already killed two people, the BBC reports. The outbreak has drawn serious attention in British media, because while the disease is rare, it strikes with a fairly shocking speed and quickly becomes deadly.

Disease breakdown: Meningococcal disease is an illness caused by a bacteria called Neisseria meningitidis. It spreads through respiratory droplets, similar to Covid, and often starts with flu-like symptoms, followed by patients developing a distinct red and purple rash. It is largely preventable through vaccination, and can be treated with antibiotics, although it can leave survivors with permanent disabilities. Confusingly, outbreaks are sometimes referred to more broadly as “meningitis” in mass media, which is a condition that refers to the often-deadly inflammation of the tissues surrounding the brain and spinal cord.

A Scientific American report on the situation framed the outbreak as a reminder of why vaccination programs matter. William Schaffner, an infectious disease physician at Vanderbilt University Medical Center, told Scientific American that “this outbreak is a very unusual event,” and underscored “how routine, comprehensive vaccination has had a profound effect on really dramatically reducing the occurrence of what was once an extreme, ordinarily feared infection.”

Reading that, my immediate question was if the UK outbreak might portend something broader: like a smaller equivalent of the measles resurgence, where slipping vaccination coverage is allowing outbreaks to return?

Ultimately, that seems unlikely. The Kent outbreak was caused by a rarer strain of meningococcal disease known as strain B. While many children are routinely vaccinated against it, vaccine boosters for strain B are often offered only selectively in places like the UK and United States because cases are so uncommon. That means the gap that appears on college campuses is usually not missed shots but fading protection as immunity wanes over time.

I also reached out to Schaffner directly, who told me that “the outbreak in Kent does not portend similar outbreaks elsewhere.” He emphasized that the disease holds “very little risk to the general public for two reasons,” he said. First, because it needs close, repeated contact to spread. The illness spreads “most readily amongst semi-confined populations such as university students” who share classrooms, dorms, and nightlife, he said. (The epicenter of this spread is believed to have been a bar).

Second, containment is relatively straightforward. In Kent, “the public health response has been brisk and comprehensive,” he said, with health officials quickly giving antibiotics to people who may have been exposed.

Vaccine side effects (... good ones!)

A senior infectious disease reporter I follow, Helen Branswell, just published an interesting article in STAT News that sits somewhere between op-ed and straight news. She walks readers through vaccine by vaccine to explain a simple but often overlooked point: Immunization programs rarely benefit just one person against one pathogen.

Pure speculation on my part, but I’m imagining this story originated as a sort of professional self-care for a veteran health reporter. After watching the maddening vaccine debate circle the bowl of conspiracy-land too many times, maybe you just need to reset the conversation. Anyhow, I’m here for it!

I won’t walk through the whole list here, but three examples really jumped out to me:

Rubella vaccination in kids has essentially eliminated a once-devastating birth defect in mothers that left many babies “deaf, blind, or with developmental delays.”

The meningitis vaccine has helped decimate gonorrhea infections, with surprising studies suggesting the shot offers about a “30% to 40%” spillover protection against the sexually transmitted infection.

And Human Papillomavirus vaccination has turned into what one expert called “one of the most elegant herd immunity stories that we have” in public health, reducing several cancer rates broadly… even in men who were never the original targets of the vaccine program.

Argentina, out of the WHO

Argentina has finally made good on its year-old promise to withdraw from the World Health Organization, Al Jazeera reports. It is the second country to ever do so, after the United States. It may sound symbolic, but the move cuts off Argentina from the United Nations agency which (as we’ve covered extensively) “monitors health trends, tracks disease, promotes health care access, and trains medical providers.”

So why’d they do it?

Argentina’s President Javier Milei has framed the move as a matter of national “sovereignty,” criticizing the WHO’s “health advice during the Covid-19 pandemic,” and saying Argentina will pursue “international cooperation in health through bilateral agreements” instead.

Do those arguments sound familiar? They should, as both the criticisms and the shift toward bilateral deals echo the exact complaints and policies we’ve heard from the Trump administration. So, it’s clearly Argentina’s model.

Not to quibble, but it’s worth noting one key point: The WHO does not control countries’ health policies, and its Covid-19 recommendations were never strong-armed on Argentina. It is an advisory body. (Just ask Sweden, or Argentina’s neighbor Uruguay).

My takeaway? Ultimately, unless this move somehow triggers further exits, I’m not seeing it as a dramatic new fracture in global health cooperation. It’s another aftershock of far-right domestic politics that have been spilling into health policy since 2025.

Secret jungle medical school

Let’s finish this week with a remarkable story from The Guardian, which followed a group of nursing students in Myanmar who just graduated from a “secret jungle school” of medicine built during the country’s civil war.

The background: After the military coup in 2021 destroyed large parts of the public health system, an underground network of clinics emerged. This “parallel secret health system” surfaced to treat injured pro-democracy fighters and “those who cannot risk government-controlled hospitals or who live in the vast areas of the country which are outside the regime’s control.”

Eventually, the effort expanded beyond treating patients to training the next generation of nurses. One nursing teacher “contacted colleagues in the U.K., and together nurses in Myanmar and Britain arranged video masterclasses,” for a full curriculum.

All told, “dozens of international academics recorded lectures for the 58 modules needed to cover Myanmar’s curriculum, and “the Phoenix Bachelor of Nursing Science” degree was born.

The article describes how lectures were “smuggled on memory sticks across the country,” and how the students completed their training under extraordinary conditions: like studying in remote classrooms while dodging drone surveillance and airstrikes. As one organizer put it, “safety is never guaranteed.” Another described bombs landing “right next to the classroom.”

It’s a powerful read, and the new graduates say the program represents something larger than medical training. “The name Phoenix itself is powerful for us. It symbolizes rising from the ashes of the destruction the coup has caused … We are the living proof that education and hope cannot be extinguished by violence.”

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

NYC health department submits budget plan while bracing for potential federal funding cuts

2026-03-20T19:24:50+00:00

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The New York City Department of Health and Mental Hygiene is bracing for a potentially significant loss in federal funding as the agency submits its preliminary 2027 budget.

Almost a quarter of the health department’s $2.51 billion budget comes from the federal government, making it vulnerable to cuts from the Trump administration. The department’s federal funding mostly supports disease control and emergency preparedness.

With a projected shortfall of $5.4 billion over the next two years, the full municipal budget proposal is to take effect July 1 after negotiations and revisions with the City Council.

In testimony before the City Council’s Health Committee, Health Commissioner Dr. Alister Martin said Thursday the department was preparing for potential cuts, noting that the Trump administration had tried to slash more than $11 billion nationwide in public health funding last year, with some $100 million earmarked for the city’s health department. After a coalition of attorneys general led by New York AG Letitia James sued, a federal judge issued a temporary halt on the efforts to block the funding.

“We must brace for possible future cuts,” Martin told the committee. “We are enduring coordinated and large-scale attacks on public health, and we do not foresee them letting up soon.”

When City Council Health Committee Chair Lynn Schulman asked Martin about the health department’s “contingency plan,” Martin said conversations were underway.

“We are closely monitoring the situation,” Martin said. “We are currently in active discussions with [the Office of Management and Budget], with the law department in the mayor’s office, to come up with plans if there are cuts to specific activities. We will assess and make decisions around what will protect New Yorkers’ health and safety.”

NYC launched a $1M campaign to promote vaccination. Here’s what it gets right, and where it misses.

It was the first budget hearing for Martin since he began the job Feb. 23, with him and chief financial officer and deputy commissioner Aaron Anderson facing questions about the preliminary financial plan for fiscal years 2026-2030. About $1 billion of that proposed fiscal 2027 budget of $2.51 billion comes from a city tax levy. The remaining support comes from a mix of federal, state, and other funding.

The health department’s projected fiscal 2027 budget represents 1.9% of the city’s proposed $128.9 billion fiscal 2027 budget. The department’s budget consists of public health, mental health, and the office of the chief medical examiner.

The proposal includes funding for child care site inspections that will be required as part of Mayor Zohran Mamdani’s campaign pledge to provide universal child care across the city. Funding is also earmarked for outreach and education for early intervention services for children with learning disabilities and a new public health laboratory.

Budget highlights include support for children

Here are four key areas presented in the preliminary budget documents.

Early intervention. The program helps children under age 3 who have learning disabilities and may require extra support. The preliminary plan includes an additional $78.5 million of city funding in fiscal 2026 for the program, growing to $93 million in fiscal 2027, $108.7 million in fiscal 2028, $125.6 million in fiscal 2029, and $143.9 million in fiscal 2030 for existing early Intervention services.

2-K inspections and early intervention connection. The preliminary plan includes an additional $1.6 million of city funding in fiscal 2027, $2.3 million in fiscal 2028, and $2.9 million in fiscal 2029 and 2030 to enhance the 2-K centers’ ability to screen for disabilities in children. The plan also includes 10 positions to support mandated inspections and 6 for early intervention services.

Child care regulation and monitoring. The preliminary plan includes an additional $5.4 million of city funding starting in fiscal 2026 to expand 3-K child care facility regulation and monitoring with 59 inspectors and 3 staff for after-school services.

New public health laboratory. The preliminary plan includes an additional $7.7 million of city and state funding in fiscal 2026, $16.8 million in fiscal 2027, $15.8 million in fiscal 2028, $16.3 million in fiscal 2029, and $16.8 million in fiscal 2030 for operating costs for a new, state-of-the-art public health laboratory in Harlem that will focus on environmental health issues, as well as funding five positions, including the facility director and IT technicians and managers. The lab is due to be completed this year.

The city is expected to see the restoration of $60 million in core public health services as part of a state funding package from an original $90 million that was cut in 2019 under former Gov. Andrew Cuomo. Schulman, a vocal advocate for the restoration of what’s referred to as Article 6 of the Public Health Law, asked what programs and services might be restored with the new funding.

Schulman suggested that the city do “something publicly” to show Gov. Kathy Hochul how the Article 6 funding was used.

Citing the upheaval at the Centers for Disease Control and Prevention, Schulman asked about the status of federally funded positions at the health department. Anderson said there are 14 such positions and that none of them had been eliminated or furloughed.

The proposed fiscal 2027 budget for disease prevention and treatment is $36.7 million less than the amount allocated in fiscal year 2026, according to documents submitted to the City Council. This includes $26.2 million less for fighting communicable diseases, $1.7 million less for sexually transmitted infection programs, and $1.1 million less for a tuberculosis control program.

The funding difference, the documents noted, are concerning given the recent rise in communicable disease cases like tuberculosis and HIV. The reduced funding could limit the department’s ability to conduct disease surveillance, testing and case management.

Mamdani appoints deputy mayor for community safety

The Thursday hearing coincided with Mamdani announcing at City Hall that he had appointed longtime advocate Renita Francois to serve as the city’s first deputy mayor for community safety. Mamdani said he had signed an executive order to set up an office overseeing that portfolio.

Most recently, Francois served as chief strategy officer and chief program officer at Beyond Impact, a nonprofit that supports social justice issues. She also had a leadership role in a neighborhood safety program under former Mayor Bill de Blasio.

The new community safety office was a central part of Mamdani’s campaign last year. Modeled after similar programs around the United States, the office of community safety aims to accommodate people who are experiencing mental health episodes by sending medical professionals in addition to law enforcement.

With cheers from the rotunda audible from the chambers, Council Member Tiffany Cabán asked if the health department was “involved in the planning for the office.”

Cabán also asked:

“As of now, have you identified any mental hygiene programs that are going to be transferred into that office?”

“We’re still in conversations with City Hall and OMB about what the future will look like, and I’m eager to talk to and build a relationship with the new deputy mayor,” Martin said.

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

Spring break 2026: Travel season risks spread of measles across U.S., state officials tell Healthbeat

2026-03-19T09:00:00+00:00

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The spring break travel season is underway, with tens of thousands of people every day clogging U.S. airports in their quest for sun, surf, theme parks, big city excitement, and other getaways.

It’s a scene that worries public health officials amid another bad year for measles across the country – and the potential for increased spread of the highly contagious disease during this busy travel period.

“It feels like whack-a-mole right now,” said Scott Thorpe, executive director of the Southern Alliance for Public Health Leadership. “Just as the numbers are dying down in South Carolina, you see this big jump in cases in Utah. Then you see cases starting to pop up in other places across the South.”

State health department officials in multiple states – including California, Utah, Colorado, Georgia, and South Carolina – told Healthbeat they are concerned about spring break travel and the potential for measles to spread within and between states.

Driving those concerns: Spring break is happening with the United States on a trajectory to exceed last year’s record-breaking number of measles infections – the worst since 1992.

This year the Centers for Disease Control and Prevention has already logged 1,362 confirmed cases of measles across the country through mid-March, mostly among unvaccinated children and teens. In less than three months, that’s more than half of the 2,284 measles cases confirmed during all of last year.

Since January, there have been at least 14 new measles outbreaks identified across the country, including in Florida, California, Washington state, Texas, and Colorado. These are in addition to ongoing outbreaks that began last year in South Carolina, Utah, and Arizona. Across the country, 30 states have reported at least one measles case this year, CDC data show.

Measles, which is one of the most contagious viruses for humans, is transmitted through the air when an infected person breathes or coughs. The virus can linger in a room for up to two hours.

The disease is preventable with vaccination. Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Most of those being infected with measles aren’t immunized. Nationwide, about 92% were unvaccinated or had an unknown vaccination status, according to CDC data.

“As vaccination rates have just broadly declined across all these communities, it’s just incredibly hard to stop. And that’s just going to get worse,” Thorpe said. “Short of something crazy happening, we’re absolutely going to blow through what our numbers were for last year.”

The contribution of spring break exposures to these national measles case counts won’t be known for several weeks.

After a susceptible person is exposed to the virus, it can take one to three weeks for them to start falling ill with initial symptoms that may seem like a cold or the flu. By the time the hallmark measles rash appears, they will have been infectious for four days – potentially spreading the virus to even more people.

“Everybody’s on high alert,” said Pat Endsley, president-elect of the National Association of School Nurses.

Top spring break destination Florida is No. 3 for measles

Dr. Rana Alissa, president of the Florida chapter of the American Academy of Pediatrics, told Healthbeat she’s very concerned about the potential for spring break travel to spread measles infections – especially in her home state, which already has measles cases in several communities, plus a large outbreak linked to a university.

Florida – with 116 confirmed measles cases since January – ranks No. 3 in the nation for 2026, behind South Carolina and Utah, which continue to battle outbreaks that began last year, according to the latest CDC data.

“Everyone wants to come to Florida,” Alissa said. “It’s always crowded. Orlando is going to be crazy, Daytona Beach, Clearwater, Miami.”

With these crowds comes an increased risk that some of the people are carrying measles. “It is very scary,” said Alissa, who is advising unvaccinated infants and children, as well as people with weakened immune systems, to avoid crowded areas because of the risk of measles.

Besides a fever and rash, measles can cause serious and sometimes life-threatening complications, including pneumonia and dangerous swelling of the brain, as well as “immune amnesia,” which increases a person’s susceptibility to other diseases in the future. Pregnant women and their babies are also at increased risk of complications from measles.

In addition to being a top state for measles this year, Florida is a perennial spring break hot spot. Cities throughout the state continue to be among the nation’s top spring break destinations, according to 2026 booking data from AAA and Booking.com.

At Tampa International Airport, the spring break travel surge is underway, with about 75,000 to 80,000 passengers a day expected through April 13. The biggest travel day, the airport predicts, will be this coming Sunday, when 90,000 travelers are expected to pass through the airport.

In Orlando, airport officials expect this week to bring some of their highest passenger volumes of the spring break period, with nearly 212,000 passengers arriving and departing last Sunday, plus another 205,000 passengers on Monday.

Florida health department won’t discuss large measles outbreak

Officials with the Florida Department of Health did not answer questions from Healthbeat since March 6 about the risks posed by spring break travel to and from the state, and what kinds of measles prevention and control activities the department is performing.

The department’s top official, Florida Surgeon General Joseph Ladapo, last fall announced plans to end all school-age vaccine requirements in the state, a move that has faced resistance in the legislature. In 2024, during a measles outbreak at a South Florida elementary school, Ladapo sent a letter to parents allowing them to keep sending their unvaccinated children to class, despite their risk of infection.

Most of Florida’s measles cases this year are part of a large outbreak linked to Ave Maria University in southwest Florida’s Collier County, about 35 miles northeast of Naples. At least 98 confirmed and suspected measles cases have been diagnosed in the county through March 7, according to state health department data. Five of those cases were reported during the first week of March, the data indicate.

Despite repeated requests, officials at the Catholic university did not respond to Healthbeat’s questions, including about the current status of the outbreak and any actions being taken to address the potential health impact of the school’s Easter break, scheduled for April 2-6.

Florida’s health department also wouldn’t discuss the university’s outbreak or answer Healthbeat’s questions about other locations in the state where ongoing spread of measles may be occurring, and how many people statewide are in quarantine because of measles exposures. While such information – which doesn’t involve identifying specific patients – is routinely made public in other states, the Florida health department’s media relations team said it was unable to discuss ongoing epidemiological investigations because of state confidentiality statutes.

The department’s data show at least 12 other Florida counties have reported confirmed or probable measles cases since January. They include the Tampa-St. Petersburg area, where six cases have been diagnosed in Pinellas County, and two more in Hillsborough County. In the Jacksonville area, Duval County has reported six cases; in the Pensacola area, Escambia County has identified five cases; and in South Florida, two cases have been diagnosed in Broward County and one in Miami-Dade County .

Concerns about measles extend beyond spring break hot spots

In response to interview requests and questions about rising U.S. measles cases and spring break travel sent earlier this month to the CDC, a spokesperson for the U.S. Department of Health and Human Services emphasized the risk of measles being imported from other countries.

“The risk of measles remains low for most of the United States due to high population-level immunity from MMR vaccination,” press secretary Emily Hilliard said in an email Tuesday night to Healthbeat. “That said, anyone who is not protected against measles is at risk if exposed. Since measles is common in many countries, unvaccinated travelers can bring measles to the United States at any time, and it can spread to other people who are not protected against measles.”

Hilliard said the CDC is supplying technical support and funding to states dealing with outbreaks and that vaccination is the best protection, “especially if you plan to travel internationally or to a place with a measles outbreak.”

While international travel can play a role in U.S. measles cases, according to CDC data, only nine of the 1,362 confirmed U.S. measles cases since January involved international visitors; last year just 25 of the 2,284 confirmed cases were international visitors. In both years, most of the measles cases across the country have involved outbreaks where the virus has spread from person to person within U.S. communities with low vaccination rates, such as those that have occurred in South Carolina, Texas, Arizona, New Mexico and other states.

As a growing number of states are already dealing with measles cases this year, officials at several state health departments expressed concerns about the risks posed by spring break travel.

This year California has had three outbreaks of measles – the first outbreaks in the state since 2020. Some of these California cases are linked to an unvaccinated toddler who had recently traveled to a measles outbreak area in South Carolina.

As of Monday, California has had 29 confirmed cases of measles; two have been hospitalized, according to the California Department of Public Health.

“International or domestic travel during spring break carries a risk of transmitting measles to Californians,” the department said in an email. “CDPH continues to closely monitor measles and to work with medical and public health partners to limit its spread during and after the spring break travel season.”

Georgia Department of Public Health spokesperson Nancy Nydam Shirek said that while people who are not immunized against measles are at high risk any time they are exposed to the virus, “that risk increases if they visit crowded tourist destinations, travel through airports, or go to areas with ongoing measles outbreaks.”

Two doses of the measles-mumps-rubella shot are 97% effective in preventing measles; one dose is 93% effective.

Two cases of measles have been reported this year in Georgia. One involved a baby too young to be routinely vaccinated who became infected during international travel. State health officials said they don’t know how the other case, a resident of Bryan County near Savannah, became infected and they cannot rule out unrecognized spread of the virus within the state, Healthbeat reported earlier this month.

In Utah, the spring break travel surge comes at a precarious time in the state’s measles outbreak, which began last year and has resulted in 443 reported infections as of Tuesday.

“What is concerning to me is we are seeing spread of this disease through our entire state,” Dr. Leisha Nolen, Utah’s state epidemiologist, said at a media briefing earlier this month. “For a while it was really limited to the southern part of the state, but it is now expanding, and we are having people diagnosed in every part of our state. And these are not just mild infections.”

Measles infections in Utah have resulted in more than 120 people going to emergency rooms, 31 needing to be admitted overnight, and three needing treatment in an intensive care unit, she said.

While the disease has spread in a variety of settings, Utah officials said cases involving school activities are noteworthy.

“We have definitely seen people get infected with measles from wrestling events, from dance-drill teams and from basketball. So we really encourage people to protect their children,” she said. “The measles vaccine is the best thing to protect your child. It is how we can stop this infection.”

In Colorado, where as of Monday 11 cases of measles have been identified along with multiple locations where infectious people potentially exposed others, state health officials said they are working to raise public awareness through media campaigns and provider webinars. The department also is doing direct outreach to families whose children are overdue for their MMR vaccines. In 2025 and 2026, this outreach resulted in 48% of the contacted families getting their children immunized, the department said.

South Carolina shows how holiday breaks can fuel outbreaks

“Measles is spread very easily to anyone who is susceptible,” said Dr. Linda Bell, state epidemiologist in South Carolina, where officials worry spring break travel could reignite an outbreak that has sickened nearly 1,000 people since last fall.

The outbreak has slowed to a trickle in recent weeks. After months of tracking cases, quarantining exposed people, and urging vaccination, the state health department announced Tuesday just one new measles case, bringing the total to four cases identified in the past week.

“The risk of spread is increased by the number of people exposed,” Bell said, “so things like air travel and people visiting tourist attractions during holiday breaks are a concern.”

It’s a risk South Carolina officials watched play out in mid-January, when measles cases surged to hundreds of cases a week after the winter holiday break period where gatherings with families and friends fueled the spread of the disease – not only within South Carolina, but to other states. The department’s measles control efforts were further hampered because outbreak investigators couldn’t get contact information from schools during winter break closures, delaying the quarantine of exposed students, an issue the department is trying to fix for spring break.

As infected South Carolina residents traveled the country during the winter break period, internal health department records show they exposed others to measles at travel convenience stores in Georgia and Florida, at a hotel and a youth conference in Kentucky, and at a hospital and a hotel in Florida, Healthbeat revealed last month.

Many schools in Spartanburg County, the epicenter of South Carolina’s outbreak, are scheduled to close for spring break the week of April 6-10.

State officials remain concerned there could be another surge in cases.

“It is far too early for us to let our guard down,” Bell said Wednesday. “We will see what happens with spring break.”

The problem is there are still many more unvaccinated people in South Carolina and across the country for the virus to infect.

To stop measles from spreading within local communities, 95% of the population needs to be vaccinated. But in most states, statewide vaccination rates among kindergartners have fallen below that “herd immunity” level, according to CDC data. And even where vaccination rates may seem high on a statewide or countywide level, pockets of unvaccinated children and adults within localized communities can still fuel outbreaks, experts said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

How ICE and hospitals are failing at infection control

2026-03-18T12:26:06+00:00

Public health, explained: Sign up to receive Dr. Jay K. Varma’s reports in your inbox a day early.

Hello and welcome to Healthbeat’s weekly report on stories shaping public health in the United States.

I am Dr. Jay K. Varma, a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a national nonprofit focused on economic mobility and well-being for vulnerable communities. Views expressed here are my own.

In the past week, I have been alarmed by the number of infectious disease outbreaks occurring at Immigration and Customs Enforcement detention facilities while the Trump administration is planning to expand their size even more.

It is not just ICE that is failing in infection control: A new survey reveals hospitals are under-investing as well. And we have interesting new data on a topic I covered a few weeks ago — longevity, or the science of living larger — and a further reminder that medications and tests are less important than who and what we surround ourselves with.

Infectious diseases spreading at ICE detention facilities

Elected officials in Maryland recently sent a letter to the U.S. General Services Administration raising alarm about Legionella bacteria detected in the water systems of the George H. Fallon Federal Building in downtown Baltimore.

Legionella is a waterborne bacteria that causes a severe pneumonia (known as Legionnaires’ disease) when contaminated water vapor is inhaled. It thrives in poorly maintained plumbing and ventilation systems and can be fatal, particularly for older adults and immunocompromised individuals, as happened in a large 2025 New York City Legionnaires disease outbreak.

The Fallon building houses an ICE regional office and detention holding rooms. According to the letter from two U.S. senators and seven House members, testing in November found Legionella bacteria in the building’s water system and contamination persists despite hyperchlorination treatment.

The lawmakers report that detainees are being held in overcrowded conditions for far longer than temporary holding rooms are designed to accommodate and that insufficient action is being taken to prevent an outbreak.

Unfortunately, Legionella is only the latest dangerous respiratory pathogen found at ICE facilities nationwide.

In early March, ICE confirmed that there have been, at least, 14 cases of measles at its largest detention facility: Camp East Montana, a tent city located on the Fort Bliss Army base in El Paso, Texas. An additional 112 people have been either quarantined or isolated. Four additional cases have also been diagnosed in the surrounding El Paso community.

Tuberculosis cases have been reported at ICE facilities in Alaska, California, Arizona, Colorado, Washington, and New York over the past year. Just like measles, TB spreads through the air, and outbreaks occur in precisely the conditions ICE facilities create: crowding, poor ventilation, and incomplete screening and testing.

Federal standards require that people be screened for TB within 12 hours of intake, but government investigators have found that is not always happening. Detainees with positive screening are often moved to solitary confinement, but these rooms lack the air filtration and ventilation needed to keep measles virus or TB bacteria from spreading outside a single room.

None of this should be a surprise. A 2021 study in JAMA documented over 2,600 cases of influenza, chickenpox, and mumps between 2017 and 2020 at 22 ICE facilities, including one with a varicella (chickenpox) outbreak that ran for 33 consecutive months. Another study published last October analyzed data about 20 ICE facilities from 2019 to 2023, and found 2,035 influenza cases, 486 hepatitis A cases, and 252 mumps cases across 128 separate outbreaks.

The authors’ recommendations were fairly basic: Reduce crowding, vaccinate detainees and staff against preventable infections, and improve infection control, such as air filtration and ventilation.

As ICE has dramatically expanded detention from roughly 39,000 detainees at the end of the Biden administration to more than 75,000 today, the conditions for outbreaks have worsened proportionally. Crowding intensifies transmission risk, and interfacility transfers seed infections across the system.

The administration is now planning to build even larger facilities. ICE’s “Detention Reengineering Initiative” calls for consolidating hundreds of facilities into approximately 34 regional mega-centers. One is planned for Social Circle, Georgia‚ a small city that would see its population nearly triple. The facility is projected to hold between 7,500 and 10,000 detainees for stays of roughly 60 days.

As the size of these facilities grows, the possibility of further illness and death from infectious diseases grows dramatically. Will ICE learn the lessons from the past few years about preventing measles, TB, and other respiratory infections in their facilities? I’m not, ahem, holding my breath.

Infection control also lagging in hospitals

Any indoor setting that brings a large number of people together in close proximity can lead to an infectious disease outbreak. Hospitals are particularly risky, because they bring two populations close together: people who have a high likelihood of already having an infectious disease and people who are highly susceptible, due to immune suppression or other issues, of becoming severely ill if they are exposed to an infectious disease. This is why federal and state regulations require hospitals to invest in infection control personnel, systems, and equipment.

Unfortunately, a new survey published in February by Infection Control Today reveals how badly hospitals continue to fall short. Infection preventionists are specialized professionals who track and stop pathogen transmission inside health care facilities. The survey found they are overwhelmed with problems to address, while simultaneously lacking the resources and authority to address those problems. According to one respondent, “Without investment, [hospital leaders] will only see the consequences when the patient impacts are already significant, and the costs are high.”

As with ICE facilities, the solutions are not complicated: increased staffing, increased authority and stature of infection prevention staff within leadership, and modernized technology to improve detection and response. Hospital-acquired infections cost the health care system billions annually, many times more than what prevention costs. Infection prevention in facilities, as in the broader community, needs to be framed as an investment, rather than a cost.

Your frenemies may be killing you

A few weeks back, I wrote about challenges with the field of longevity, but I wish I had been able to highlight a study that was just published in the Proceedings of the National Academy of Sciences. We all know toxic relationships - a colleague who undermines you or a family member who keeps score and makes your life worse. But is it possible they are also making you die sooner?

That is the intriguing hypothesis that a research team at New York University set out to test. Using a representative sample of more than 2,300 adults in Indiana, they studied what they called “hasslers”: people in your close social network who “occasionally or often” caused problems or made their life difficult in some way. Nearly 60% of people had at least one.

To measure aging, the researchers used DNA methylation, tiny chemical changes in the genome that accumulate predictably over a lifetime and may be read as a biological clock. Each additional hassler was associated with approximately 1.5% faster biological aging per year, the equivalent of roughly nine months of added biological age. People with more hasslers also had worse self-rated health, more anxiety and depression, and greater rates of cardiovascular disease and diabetes.

One finding I found particularly striking was that the most damaging relationships were not the purely hostile ones, but ambivalent ones, i.e., people who provide both support and stress. It’s easy to identify and exit entirely negative relationships. The ambivalent ones keep you close, keep you invested, and keep the stress going.

While I have some doubts about whether the biochemical changes measured in this study truly measure aging, I am inclined to believe these results, because health — whether it’s preventing infections or living longer — depends far less on medications and tests than on factors outside our body: air, water, food, and the people in our lives.

Until next week,

Jay

South Carolina wants to avoid a spring break measles outbreak surge, enlists school help during closures

2026-03-12T21:28:16+00:00

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Amid concerns that spring break could reignite South Carolina’s measles outbreak, state health officials are trying to avoid a repeat of the communication gaps that delayed measles exposure investigations when schools were closed for winter break.

Healthbeat revealed last month that the South Carolina Department of Public Health was hamstrung in late December in its efforts to quickly warn and quarantine students and staff who had been exposed to measles. The problem: Schools were closed over winter break and they had nobody available to provide contact information to outbreak investigators.

The result was that people who were unaware they were infectious continued to interact with others in the community during the busy winter holiday season. In the weeks that followed, cases of measles surged dramatically and the South Carolina outbreak became one of the largest in decades.

“We are concerned that we may see another surge in cases,” Dr. Linda Bell, South Carolina’s state epidemiologist said. “So we have actually been in contact with schools to work with them more closely, to make sure that we have points of contact.”

Bell said Thursday that the department has sent letters to schools in South Carolina’s 11-county Upstate region asking them to identify a person who will be available during the spring break vacation period – when schools and administrative offices are closed – who can provide school attendance and contact information if it is needed for measles exposure investigations.

Here's how the S.C. measles outbreak grew after the holidays

“We’ve been receiving steady responses from the schools for those points of contact,” she said.

The health department said late Thursday that the letters, which requested contact information by March 10, were sent to all public school superintendents in the Upstate region. Only 11 of the 23 superintendents had supplied contacts as of Thursday. “DPH has previously established contacts at private and charter schools that have been impacted by the outbreak,” the department said.

Of the 993 measles cases recorded since the outbreak was identified in October, 936 have been in Spartanburg County and most of the others in nearby Upstate counties, according to state data. Almost all of those who have been infected were unvaccinated and most have been school-age children and teens.

In recent weeks, the number of new measles cases being reported to the department has slowed to a trickle. On Monday, the health department said just two new cases had been identified since Friday.

In Spartanburg County, spring break is scheduled for April 6-10 for many schools, but dates vary throughout the state.

“We’re very encouraged by the decline in cases, but we won’t be able to declare this outbreak over until we’re certain that measles transmission has ended,” Bell said. School holiday break periods pose an increased risk for the spread of measles because they often involve people traveling and socializing more.

The winter holiday break was a time of significant spreading of measles in the Spartanburg area.

Between early October – when the outbreak began – and Dec. 22, when Spartanburg County schools closed for winter break, there had been a total of 144 measles cases during the nearly three-month period. Then, in just the three weeks after schools reopened in January, there were more than 500 new cases of measles, state data show.

When Healthbeat asked South Carolina’s health department last month why it hadn’t reached out to schools to have contacts in place before winter break, the department said: “DPH cannot direct school employees to come to work to assist with outbreak investigations.”

Bell on Thursday said the new outreach to schools is an example of the department incorporating lessons learned into its outbreak response. “DPH has made the ability to communicate with school officials who have access to the information needed for case investigation a priority ahead of the upcoming spring break,” she said.

Measles is highly contagious and spreads through the air when an infected person breathes, coughs, or sneezes. The virus can linger in a room for up to two hours after an infectious person has left. Because a person is infectious for four days before the telltale measles rash appears, and initial symptoms may seem like a cold, many people spread the disease before they know they have it.

While two doses of the measles-mumps-rubella vaccine is 97% effective in preventing measles, those who are unvaccinated are at high risk of infection if they are exposed.

Christian school refused to share student information

Based on internal health department records, Healthbeat reported last month that during winter break there were delays quarantining people who had been exposed to measles – just prior to the holiday recess – at three public schools and one private Christian school.

In most cases, the schools were closed and didn’t have anyone available to provide information.

But when outbreak investigators reached Westgate Christian School in Spartanburg, the principal refused to provide information required to ensure those at risk of spreading the disease knew of the need to stay in quarantine, according to a health department warning letter to the school that Healthbeat recently obtained under South Carolina’s public records law.

According to the Jan. 9 letter, Westgate Christian School Principal Gail Grab responded to requests for information about exposed students by sending an email on Dec. 30 that said in part: “We will not provide personal details and immunization status information for the students in our school.”

Then when Grab sent outbreak investigators a list of exposed students on Dec. 31, the only names on it were the siblings of the person who had measles.

The department’s “final warning” letter on Jan. 9 gave the school until 1 p.m. the next day to provide the required information about all students who were had contact with the person with measles or the department would issue a public health order, under which the school could face fines of $1,000 per day for each exposed student’s name left off the list.

“Your continued failure to comply with this lawful demand has significantly impeded DPH’s ability to conduct mandatory case investigation, contact tracing, and quarantine monitoring,” the letter said. “This lack of cooperation places quarantined students, school staff, and the families of your students at increased and unnecessary risk of measles exposure, a highly contagious and serious disease.”

The school did comply before the deadline, Bell said.

Grab did not respond to requests for an interview on Wednesday. Pastor James Wooten, Westgate Christian’s president, replied Wednesday to emailed questions about the letter by saying he was traveling. He previously told Healthbeat that the school thought it had provided all necessary information on Dec. 31. He did not previously disclose that the school’s principal had sent an email refusing to provide required information.

Plans unclear at schools with past delayed measles investigations

Officials at the other three schools where state investigations of measles exposure incidents were delayed during winter break did not answer Healthbeat’s questions Wednesday and Thursday about any changes they have made for the upcoming spring break period.

Mark Robertson, principal at Global Academy of South Carolina, a public charter school where state records show only 21% of students are up-to-date with school immunizations, said he had no comment.

A vaccination rate of 95% is needed in communities to stop the spread of measles.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

Cynthia Robinson, a spokesperson for Spartanburg County School District 6, did not respond to emails and calls on Wednesday and Thursday. Delays investigating measles cases over winter break occurred at the district’s Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on vaccines.

Other schools that had delayed measles exposure investigations over winter break were in Spartanburg County School District 2: Sugar Ridge Elementary, where state data show 78% of students are up-to-date on vaccines, and Boiling Springs Elementary, where 80% of students are up-to-date on vaccines, also had delays investigating measles exposures during winter break, Healthbeat previously reported.

Adrian Acosta, a District 2 spokesperson, did not answer Healthbeat’s questions about what the district will do differently during spring break to avoid the winter break problems providing health officials with measles contact tracing information.

Acosta first sent a statement saying a district nurse supervisor is available 24/7. Then when asked if this person will be available during the spring break vacation period, Acosta emailed another statement saying school administrators are “always on the job.” Acosta added: “If an administrator knows they will be out of touch or unreachable, then it is expected that they have a communication plan in place.”

But Acosta did not respond to questions about what the district will do differently during spring break to prevent a recurrence of the delays.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Source of Georgia measles case remains a mystery as people who were exposed continue quarantine

2026-03-05T19:25:28+00:00

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How and where an unvaccinated Georgia resident recently became infected with measles remains unknown and multiple unvaccinated people continue to be in quarantine because they are at risk of developing the disease, according to the state’s health department.

It is unknown whether the person – a resident of Bryan County, near Savannah – became infected in Georgia through undetected measles spreading within the state, or if the infection occurred during recent travel to Washington, D.C., the Georgia Department of Public Health said Thursday in response to questions from Healthbeat.

“We cannot definitively determine whether the individual was infected in Georgia or during travel, but there is no record of exposure to a known case of measles,” said department spokesperson Nancy Nydam Shirek.

The District of Columbia has reported no confirmed cases of measles through Feb. 26, according to the Centers for Disease Control and Prevention. While the D.C. health department has issued alerts about infectious visitors potentially exposing others to measles at events in the nation’s capital, the Georgia person didn’t attend any of those kinds of gatherings, Nydam Shirek said.

Here's how the South Carolina measles outbreak grew

Nationwide, the United States is on track to have another record year of measles cases. During 2025, there were 2,281 confirmed measles cases across the country, according to the CDC. In just the first two months of this year, the CDC has confirmed 1,136 measles cases.

While infectious, state health investigators determined that the Bryan County resident exposed “several dozen” other people in Georgia to the highly contagious measles virus. Most were protected against the disease with up-to-date vaccinations. However, “fewer than 20” were not vaccinated against measles and are in quarantine or under active monitoring, Nydam Shirek said.

While it usually takes about seven to 14 days after exposure for an infected person to start showing symptoms of measles, it can take as long as 21 days. The incubation period for those exposed to the Bryan County person ends on March 15, Nydam Shirek said.

“To date, there are no reported cases of secondary measles infection,” she said.

The department has not announced any locations of public places where the infected person exposed others to the virus. According to media reports, officials at Bryan County Schools last month notified parents that the infectious person was at Bryan County Middle High School on Feb. 13. The district’s spokesperson, Melissa Roberts, did not respond to Healthbeat’s questions on Wednesday and Thursday.

Nydam Shirek said the state health department does not issue public notifications about school exposure incidents. “When there is a school exposure, the communication comes from the school, not DPH,” she said. In other states, such as South Carolina, which is experiencing a major outbreak, the health department also alerts the public about school exposures.

There were no other public locations, such as restaurants or stores, where exposures occurred, Nydam Shirek said, and all people who were exposed have been notified.

So far this year, Georgia has identified one other measles case. It involved a baby who was too young to be routinely vaccinated against measles who became infected during international travel, state health officials said in January.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

South Carolina has spent $1.6 million to combat its huge measles outbreak – and it’s not over yet

2026-03-04T23:49:23+00:00

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South Carolina has spent an estimated $1.6 million so far on public health efforts to combat its huge measles outbreak, according to information the state’s health department provided to Healthbeat on Wednesday.

The outbreak, which began with just five known cases in October, surged in January following the winter holidays, and has slowed in recent weeks. The total number of people infected in the outbreak, which is centered around Spartanburg County, reached 990 this week.

Most of the estimated $1.6 million spent so far on the outbreak response has been for personnel, the South Carolina Department of Public Health said in response to Healthbeat’s questions.

As the outbreak grew, the number of staff assigned to work full-time on the outbreak grew to as many as 90 people, said Dr. Linda Bell, the state epidemiologist.

Most of these staff, Bell said, have been involved in doing investigations of individual measles cases and tracing their contacts to help identify and quarantine those at risk of infection and further spread of the disease.

S.C. measles cases surged after holiday school closures delayed outbreak investigations

Funding for some of the outbreak’s public health costs has come from the Centers for Disease Control and Prevention, through an immunizations cooperative agreement, which helps with outbreak response activities, the South Carolina DPH said. Additional funding has come from a H5N1 Public Health Crisis Response Cooperative Agreement, which funds influenza and other public health emergency preparedness and response, the department said, as well as some other state and federal funds.

Although the number of new measles cases being detected each week has dropped significantly, the outbreak continues. The department said that final costs will be calculated once the outbreak is over.

But the threat the outbreak could surge again remains – especially with the potential for the virus to spread during the upcoming spring break travel period, Bell said.

“We remain concerned and must be mindful of the fact that we can see cases increase again from the low number that we’re seeing now,” she said. In recent weeks, the outbreak has slowed to about 10 new cases a week amid increases in measles vaccination in the Spartanburg County area and across the state.

The increased travel during school spring break raises the potential for the kind of increased spread of measles that South Carolina experienced over schools’ winter break period. “In the two consecutive weeks following the Christmas holidays, we had over 200 cases reported in each of those weeks,” Bell said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48.

How milder winters are luring mosquitoes – and the diseases they carry – beyond the ‘tropics’

2026-02-26T12:00:00+00:00

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Hello from Nairobi.

This week’s news is heavy on drug trials and some groundbreaking scientific research – two subjects I try to cover cautiously, because scientists, research institutions, and others have incentives to hype early findings. Anyhow, in global health terms, it is a good issue to be grappling with. It means there wasn’t some new outbreak I had to research.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Mainland Europe: a mosquito’s tropical getaway?

There’s a whole rogues gallery of tropical, mosquito-borne diseases that have long been relegated to the warmer and poorer parts of the world. For example: malaria, dengue, Zika, and chikungunya virus.

But global warming and roving mosquitos are rapidly blowing up the traditional boundaries of what counts as “tropical.” A new study in the journal Royal Society Interface finds that many of these diseases can now be transmitted by mosquitoes across most of southern and central Europe, The Guardian reports.

To be clear, the study isn’t just a speculative forecast. For some of these diseases, the shift has already happened.

Take chikungunya. “Up until last year, France had recorded 30-odd cases of chikungunya over the last 10 years or so. [In 2025], they had over 800,” said Steven White, one of the scientists at the UK Centre for Ecology and Hydrology that was behind the new study.

Disease breakdown: Chikungunya (a particular focus of the new study) is a virus first identified in Tanzania in the 1950s. Its name means “that which bends up,” a nod to the symptomatic contortions caused by terrible joint pain and fever. Although there’s no cure, death is rare, with fewer than 1 in 1,000 perishing from the illness. The real cost is in long-term pain: chronic arthritis that can last for months or years.

One of the study’s most unsettling findings for chikungunya was that the virus can incubate inside the increasingly invasive Asian tiger mosquito at much lower temperatures than previously believed. Specifically, “the study found the cut-off temperature for transmission is 13 degrees C - 14 degrees C,” or about 55 to 57 degrees F.

That dramatically expands the map of where outbreaks are possible, “meaning infections can occur for more than six months of the year in Spain, Portugal, Italy, and Greece, and for three to five months of the year in Belgium, France, Germany, Switzerland, and a dozen other European countries.”

What’s the takeaway?

First, it’s increasingly hard to see the northern spread of these tropical diseases (across North America, too) as anything but inevitable. As winters grow milder and warm seasons stretch longer, the conditions that allow these viruses to circulate are expanding … and exponentially!

I reached out to Flavia Riccardo, an independent infectious diseases researcher at the Italian National Institute of Health. She shared a recent study she co-authored that adds an important nuance. For now, the main risk is not these viruses becoming permanently established in Europe. It is infected travelers bringing them in during mosquito season, and triggering local outbreaks that can flare out of control.

My second takeaway is this: If there’s a morbid upside, it may be that once these diseases begin affecting wealthier countries, they could finally attract the sustained research funding and political urgency they need.

Guinea-Bissau stomps out a controversial vaccine trial

Last week, I mentioned in passing that World Health Organization Director-General Tedros Ghebreyesus publicly condemned a controversial U.S.-funded vaccine study on infants in the West African nation of Guinea-Bissau. Now, the country has shut it down, Reuters reports.

Guinea-Bissau’s foreign minister ultimately said, “It’s not going to happen, period,” after scientists, health bodies, and U.S. lawmakers raised alarms.

The trial, backed by the U.S. Centers for Disease Control and Prevention, would have tested the timing of the hepatitis B vaccine in newborns. Some “critics had said it was being used to test theories linking vaccines to autism,” and others (including the WHO chief) decried it as unethical because only half of infants would receive the life-saving shot at birth.

The threat here is clear: “90% of babies exposed to hepatitis B at birth or in their first year of life develop a chronic infection, and 15% to 25% of these die early of related liver failure or cancer as a result.”

To be perfectly fair to the researchers, “under the [proposed] trial, half the infants would receive [the vaccine] at birth,” and “the remainder at 6 weeks,” which is when infants normally receive the vaccine in the formal health care system in Guinea-Bissau. So the researchers hadn’t planned on taking anything away from vulnerable infants. The African nation “plans to introduce the dose at birth only in 2028.”

Still, at 6 weeks, “many infants whose mothers have hepatitis B are already infected,” and as I wrote last week: It is just hard to imagine a similar trial within the United States surviving legal/ethical challenges.

Magic mushrooms go mainstream

Magic mushrooms are having a bit of a clinical moment.

Compass Pathways, a British pharmaceutical company, announced that its synthetic psilocybin (which is the psychoactive chemical found in magic mushrooms) treatment hit its “major goals” in a large, late-stage trial for hard-to-treat depression, Reuters reports.

The report says that the company now plans to meet with the U.S. Food and Drug Administration and could seek approval for the treatment as early as 2027. (Keep in mind, this would be the first approved psychedelic therapy cleared in the United States.)

What’s my takeaway? Before we all start penciling psychedelics into the next generation of antidepressants, I’d strongly recommend reading this thoughtful essay published in STAT last week.

Erica Rex, a writer who participated in an early magic mushroom trial, warns that the rush to commercialize psychedelics is stripping away the therapy, community, and careful supervision that made those early studies feel safe and transformative. She argues that the drug alone is not the treatment. And profit incentives may directly clash with the slow, human elements that made psychedelic therapy work for her.

A ‘clock’ for Alzheimer’s symptoms

A new study published in the research journal Nature Medicine suggests we may soon be able to do something Alzheimer’s researchers have long dreamed of: Detect Alzheimer’s disease early and estimate when symptoms will begin, the Washington Post reports.

The study describes how to use blood draws to “build a ‘clock’ for Alzheimer’s disease that could roughly predict when symptoms will develop.” The core of the work revolves around tracking the levels of “one specific protein, called p-tau217,” in the blood.

This protein is important, because it is a hallmark sign that Alzheimer’s has started. More specifically, it shows that “clumps of misfolded proteins called amyloid plaques [have] begun to build up in the brain.”

Now just measuring that protein in blood draws isn’t enough on its own.

The bloodwork data has to be fed into a computer model that contains information about the patient, such as their age, which is then used to “forecast symptom onset within a margin of three to four years.”

So, yeah… it’s a wide error range. And practically speaking, this kind of prediction isn’t precise enough yet to guide individual treatment decisions.

But (and here’s the important part!) it could matter enormously for the potential, future use of novel drugs. That’s because two big Alzheimer’s studies underway are testing if newly developed “anti-amyloid” drugs can slow or prevent the disease if they’re given early enough.

If those drugs truly work best early, then knowing when “early” begins would be incredibly important.

The quest for a universal vaccine

I want to tread very, very carefully here. This next story is genuinely fascinating, but I’ve covered enough “breakthroughs” to know how easy it is to get carried away. The bigger the claim, the more skepticism we should hold.

The journal Science has just published a paper describing a provocative new approach to developing a “universal vaccine,” the BBC reports. That is, a vaccine that doesn’t just target one virus, but puts the entire immune system on high alert against many.

The paper is not theoretical. Stanford University scientists developed a nasal spray vaccine that they tested on mice against infections that attack the lungs. The end result was a “three-month effect” in which the mice’s immune systems were in a “heightened state of readiness” that “led to a 100- to -1,000-fold reduction in viruses getting through the lungs and into the body.”

This included effective immunity against a medley of cold and flu viruses, among other would-be invaders.

That is big news! So what’s the actual science here? To understand it, it helps to step back and look at what traditional vaccines are actually designed to do.

Traditional vaccines all use different strategies to teach the immune system to recognize a specific virus or bacteria. This is done by either by exposing the body to a weakened, dead, or fragmented germ … or by delivering instructions for the body to make a harmless piece of it (this last one is the new mRNA method, developed during the Covid-19 pandemic.)

This even newer approach is totally different. Instead of teaching the immune system to identify attackers, the vaccine artificially mimics the signals “immune cells [use to] communicate with each other” in the midst of an infection. Normally, when an infection begins, immune cells send out chemical signals that trigger a system-wide defensive response. And when on high alert, immune cells become more active and better able to contain invading viruses or bacteria.

This vaccine recreated that early alarm. It did this by introducing a molecule that flips the sensors inside some immune cells, pushing them into that heightened state of readiness.

Yes, it absolutely does sound like an incredible breakthrough. So … let’s move on to my beloved caveats.

First: This has not been tested in humans. It worked on mice, which is not nothing, but many, many fascinating mouse studies have failed to translate into people.

Second: The researchers now have to run the clinical trial gauntlet. That starts with Phase 1 trial to test safety, Phase 2 to figure out dosing and immune response, and Phase 3 to see whether it actually works in large numbers of people. Historically, only about 10% of drugs that start these trials end as an approved drug. Most are found to be unsafe or ineffective. Even at Phase 3, roughly half still fail.

Still, it’s promising.

I’ll see you next week!

William

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Huge S.C. measles outbreak slows, fueling cautious optimism it may end earlier than predicted

2026-02-25T21:56:44+00:00

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South Carolina’s huge measles outbreak has slowed significantly in recent weeks, raising hopes among health officials that the disease’s spread might end sooner than expected, the state’s epidemiologist said Wednesday.

Since Feb. 17, the South Carolina Department of Public Health has documented 17 new measles cases. That’s far fewer than the 100 or more new cases being identified every few days during mid-January, when the outbreak spiked following the winter holidays.

“We’re encouraged with the downward trend, particularly in the last two weeks,” said Dr. Linda Bell, who has been leading the state’s response since the outbreak was identified in October with an initial five cases.

Since then, 979 people – mostly school-age children – have been sickened with measles. All but 52 of the cases have been in Spartanburg County; about 95% have been among people who were not vaccinated.

“No one should underestimate the hard work and long hours that front-line, often entry level epidemiologists have put into this response, and [who] are largely responsible for this downward trend that is actually occurring a bit earlier than previously projected,” Bell said.

Earlier in the outbreak, Bell said that modeling had suggested the outbreak might last for as long as six months.

“The case counts per week now are really down to the level that we were seeing at the beginning of December,” she said. “We are now 22 weeks into this and we hope, with that continued downward trend, in parallel to the hope that vaccination coverage will increase, will help us end this sooner than was originally projected.”

Bell said the department has asked the Centers for Disease Control and Prevention to assist the department in the coming weeks to do studies to help learn from the outbreak, including studies that examine chains of transmission and the costs associated with the public health response to the outbreak, as well as health care costs.

Officials remain concerned, however, that the outbreak has the potential to spike yet again. “This is not over yet. It’s not nearly over yet,” Bell said. “It is these pockets of under-vaccinated people who remain susceptible. That ongoing susceptibility in our population may continue to fuel ongoing spread.”

To stop measles outbreaks from spreading in localized communities, at least 95% of people need to be vaccinated. But in Spartanburg County, state health officials have said measles vaccination rates for school children across the county are just 90% – and they are even lower within some individual schools and communities.

“Many of the schools in Spartanburg County have some of the lowest vaccination coverage rates in the state,” Bell said. “So all of those are contributing to the reason that the outbreak has been focused in Spartanburg County, because of higher risk there, because of lower coverage.”

This is also a likely contributing factor for why measles cases identified recently in a few other South Carolina counties haven’t spread widely in those locations, Bell said. Of the 979 cases in the South Carolina outbreak, 927 involve people in Spartanburg County.

“Even if we are only seeing a dozen or so cases per week, the risk we can surge remains,” Bell said.

Bell noted that schools will be going on spring break in the coming weeks, bringing with it the risk of people who have been exposed to measles becoming infectious and spreading the disease to others at tourist attractions and while traveling. “This is a great concern,” she said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

S.C. measles cases surged after holiday school closures delayed outbreak investigations

2026-02-17T10:00:00+00:00

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South Carolina’s state health department faced a significant problem in the critical weeks before the state’s measles outbreak surged in January.

As schoolchildren continued to fall ill with measles in late December, outbreak investigators needed help from schools to get contact information for the classmates, staff, and others who had been exposed. They needed to be warned quickly so they wouldn’t spread the virus to others if they were infected.

But schools were closed for their two-week winter break. Nobody was available at most schools to provide the information health officials needed, according to South Carolina’s state epidemiologist and records obtained by Healthbeat.

This communication gap between the South Carolina Department of Public Health and schools in Spartanburg County – the outbreak’s epicenter – resulted in delays quarantining people who were at risk of unknowingly spreading the highly contagious disease. An infected person is contagious beginning four days before the tell-tale measles rash appears.

At the same time, the state health department was grappling with its own holiday staffing challenges, according to the internal DPH outbreak reports that Healthbeat obtained under South Carolina’s public records law.

While the number of measles cases grew in December, the number of DPH staff assigned to combat the outbreak dropped. The internal DPH reports repeatedly note concerns about holiday staffing, workloads, burnout, the availability of backup staffing, and “limited support due to workforce reduction in April 2025.”

Only after New Year’s Eve did outbreak staffing begin to increase significantly, records show.

Dr. Linda Bell, the state epidemiologist who is leading South Carolina’s outbreak response, said that despite challenges, public health staff “worked diligently throughout the holidays.”

“DPH made many efforts to reach impacted schools over the holidays with limited success because the schools were closed,” Bell said in written responses to Healthbeat’s questions.

By early January, the South Carolina measles outbreak surged to become one of the largest in the United States in decades.

“It’s impossible to know exactly what impact school closures and the resulting delays had on the spike in cases,” Bell told Healthbeat.

However, the delays hampered one of the department’s key strategies for slowing the virus’ spread: Rapid identification and home quarantine of exposed children and adults who were at risk of developing and further spreading the disease because they aren’t vaccinated.

This occurred during a time of increased socializing over the holidays, she noted.

It usually takes a week to 12 days, and sometimes as long as three weeks, for people infected with measles to start showing symptoms. The virus spreads through the air when a contagious person breathes, sneezes, or coughs.

Before Spartanburg County schools closed for winter break on Dec. 22, the state health department had logged 144 measles cases since the outbreak began in early October, state data show. In the three weeks after schools reopened during the week of Jan. 5, outbreak investigators were chasing after more than 500 new cases of measles.

The outbreak continues to grow, reaching 950 confirmed cases in South Carolina as of last week, a tally that doesn’t include cases sparked in other states.

School officials with Spartanburg County’s District 2 and District 6, whose elementary schools were among those with delayed exposure investigations during winter break, have declined repeated requests from Healthbeat for interviews or information about their procedures for providing time-sensitive public health information during extended school break closures.

Both districts have had multiple measles exposure incidents in their schools since the outbreak began last fall, requiring dozens of students to be excluded from class due to quarantines.

What happened in South Carolina is a cautionary tale for health departments and schools across the United States – especially as measles makes a resurgence amid declining vaccination rates. So far this year, at least 24 states have reported measles cases to the Centers for Disease Control and Prevention.

In the coming weeks, schools across the country will be closing again for spring break.

“I just want to emphasize how normal Spartanburg is,” said Scott Thorpe, executive director of the nonprofit Southern Alliance for Public Health Leadership, noting that the pockets of low vaccination rates that have fueled the South Carolina measles outbreak are also common in other communities. “I hope that everybody is really preparing for this, because I don’t think it’s going anywhere anytime soon.”

With some communities having multiple school districts plus numerous private schools, Thorpe said that strengthening lines of communication between public health and schools takes time. “To try to figure out how to interact successfully in all these circumstances, in a crisis situation, is really hard,” he said.

School nurses, staff often not paid to work over breaks

Pat Endsley, president-elect of the National Association of School Nurses, said school breaks can pose a special challenge for health departments doing infectious disease contact tracing because school nurses and other staff often aren’t being paid to work during those periods – and they may even be traveling out of town.

With every state operating differently, Endsley said she’s not aware of any national best practice for addressing school contact tracing for measles during extended school break periods. A lot of the best practices were written specifically to address the emergence of the Covid-19 pandemic, she said.

“The gold standard would be to have some kind of person who is at the school, who’s not going anywhere, who could have access to information,” said Endsley, who served as a school nurse in Maine for 23 years and now teaches full time.

“Maybe that’s something that would come out of South Carolina, or Texas, or these other places with measles,” she said. “Based on this information, we could develop some exemplars of communication.”

How the South Carolina measles outbreak grew from 5 to over 900 cases

In at least some communities, health departments have found ways to ensure measles exposure investigations aren’t thwarted by school breaks.

Health officials battling another large measles outbreak along the Utah-Arizona border said they had no difficulties reaching impacted schools over the recent winter break.

“Our epidemiologists report that contact tracing and other issues involving students ran uninterrupted over the winter holidays, mainly due to frequent communication with an established point of contact with our largest school district,” said David Heaton, a spokesperson for the Southwest Utah Public Health Department. The school contact was available to help over the holidays, Heaton said.

Dani Lagana, a spokesperson for the Mohave County Department of Public Health in Arizona, said the department’s measles response activities are not dependent on school calendars.

“Effective contact tracing in school-associated cases relies on established communication protocols and coordination between public health and education partners,” Lagana said by email. “Health departments routinely plan for coverage during holidays and breaks to ensure appropriate notification and follow-up when needed.”

It’s unclear why – before winter break closures began – similar arrangements weren’t put in place between the South Carolina DPH and schools in Spartanburg County.

“DPH cannot direct school employees to come to work to assist with outbreak investigations,” the South Carolina department said in an emailed statement to Healthbeat.

The department said it has contact lists for school administrators, but these administrators may not have access to the detailed information outbreak investigators need when schools are closed.

“Comparisons of response activities from one jurisdiction to the next should be made with caution,” the state health department said. “Each jurisdiction has unique circumstances including differences between centralized vs. autonomous county public health agencies.”

Winter break delays in investigations of measles exposures occurred at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In South Carolina, public health activities are centralized and provided by state DPH employees at offices across the state. Arizona and Utah, have multiple local health departments covering a single county or multi-county region, in addition to state health departments.

Healthbeat asked each of Spartanburg County’s seven public school districts whether they had any policies or procedures that would specifically enable rapid sharing of student contact information during holiday breaks with public health officials who are trying to control infectious disease outbreaks. None of the districts provided answers to these questions.

Schools play an important role in helping public health investigators quickly determine which students, teachers, staff, and visitors may have been exposed to the infected individual. Not only does measles spread through the air, the virus can linger in a room for two hours after the contagious person has left.

School staff can provide health investigators detailed information about the movements of an infected student – and who was around them while they were contagious – by going through class schedules and rosters of those participating in extracurricular activities and riding on school buses. They also know which students lack immunity to measles because school records show which ones have exemptions from vaccine requirements for medical or religious reasons.

Rapid notification of at-risk individuals is critical, health officials say, so they know to quarantine at home and watch for early signs of measles that might otherwise be mistaken for a cold or the flu. In the four days before measles’ hallmark rash appears – and the person is already contagious – their earliest symptoms are typically a fever, cough, runny nose, and red, watery eyes.

“I definitely can see the issue that DPH had during winter break with schools closed two to three weeks, and no way to do that school notification, contact trace, get information from nurses,” said Dawn MacAdams, president of the South Carolina Association of School Nurses. “But then you run into: nurses don’t get paid during that time.”

MacAdams said that during Covid, school nurses faced overwhelming workloads and long hours helping with contact tracing without being paid for the extra work. “Nurses were working Christmas Eve, Christmas Day, New Year’s because the numbers were exploding and the guidance was changing,” she said.

MacAdams said she’s not sure what the solution is for ensuring timely contact tracing of school-associated measles exposures when schools are closed.

“That’s a really good question to think about with DPH on what are the things we can do,” she said. “Most spring breaks are somewhere the first or second week of April this year. So we’re going to be in another desert of the availability of school personnel to provide information.”

Records show quarantine delays at five Spartanburg schools

Internal South Carolina DPH reports show there were delays during winter break notifying and quarantining people who had been exposed to measles at three public schools, one public charter school, and one private Christian school.

For the exposure incidents at these schools, the department’s internal daily outbreak summary reports during winter break repeatedly listed that health officials were reaching out to the facilities or that the status of quarantine actions were still “TBD” – or to be determined.

It’s unclear how many exposed students and staff weren’t contacted quickly because these schools were closed. “Parsing out all those we were working to reach, whether students or others, during that time when cases were surging is not possible,” Bell said.

Measles investigation and quarantine delays occurred at Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines.

One of the schools where winter break investigation and quarantine delays occurred is Global Academy of South Carolina, a public charter school where only 21% of students are up-to-date on required school vaccines, including the measles, mumps and rubella shot. To prevent measles outbreaks, 95% coverage is needed.

It took Global Academy until Jan. 9 to provide outbreak investigators with a requested “line list” detailing the names and contact information for exposed students and staff, the DPH documents obtained by Healthbeat show. The school’s winter break was Dec. 22-Jan. 2.

“Global Academy finally provided a line list yesterday, and we are going through it,” a DPH official said in a Jan. 10 email updating the South Carolina governor’s office on the outbreak response.

The school’s principal, Mark Robertson, did not answer Healthbeat’s questions and told a reporter to contact DPH.

Global Academy was one of the first two schools to have confirmed measles cases when the outbreak began in early October. The school has had repeated rounds of students being quarantined and excluded from class.

Other schools that had delayed winter break investigations of measles exposure incidents included large public elementary schools in Spartanburg County School Districts 2 and 6, the records show. Throughout the outbreak, the district’s schools have had exposure incidents requiring students to quarantine, state records show.

In District 2, winter break delays occurred in investigations of exposures at Sugar Ridge Elementary, where state data show 78% of students are up-to-date on school vaccines, and at Boiling Springs Elementary, where 80% of students are up-to-date on vaccines.

In District 6, the delays also occurred at Jesse S. Bobo Elementary School, where state data show 94% of students are up-to-date on school vaccines.

Officials with both districts have declined repeated requests from Healthbeat since Jan. 9 for interviews or answers to specific questions about the outbreak’s impact on student health, as well as the circumstances surrounding the exposure investigation delays over the winter break.

Health officials’ efforts to get complete exposure contact information from one school were so protracted coming out of the winter break that they were preparing to issue a formal public health order to force compliance. The school says it promptly provided information.

Maternity unit, BMW plant among groups exposed in South Carolina measles outbreak, records reveal

In January, the state health department issued a “final notice letter” to Westgate Christian School in Spartanburg because of the school’s continued “noncompliance,” Healthbeat reported earlier this month. The school was closed for its Christmas break from the afternoon of Dec. 19 through Jan. 2.

Outbreak investigators had been asking for contact information for exposed students and staff since Dec. 29, Bell said. A list that the school provided on New Year’s Eve was deemed “insufficient.”

When Westgate Christian’s break was over and the requested information still hadn’t been provided, Bell said the department issued a “final notice” to the school on Jan. 9. The letter warned that if the information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.”

The issue was resolved the next day when the school provided the requested information, Bell said.

Pastor James Wooten, Westgate Christian’s president, said that until the school’s administrator received the “final notice” email – at 5 p.m. on Friday, Jan. 9 – she thought the health department had been provided everything it needed on Dec. 31.

“Other than a thank you acknowledging receipt, she received no further correspondence or request for information until the final notice warning,” Wooten told Healthbeat last week. School officials wonder why, if outbreak investigators needed more information, “they didn’t simply reply to the email and request it,” Wooten said.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

NYC infectious disease experts prep for World Cup as ‘huge global migration event’ with 1.2M visitors

2026-02-13T18:39:37+00:00

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Health care professionals at the nation’s oldest hospital in New York City have been quietly preparing for an influx of soccer fans to come watch the 2026 FIFA World Cup this summer.

Such a large increase in visitors from around the world also raises the risk of imported infectious diseases – including “high-consequence” ones, or special pathogens that have high mortality rates, like Ebola or the Marburg virus.

That’s why doctors, nurses and others at NYC Health + Hospitals/Bellevue Hospital have been practicing elaborate drills that include actor patients and even chartered and commercial airplanes. As part of that broader preparation effort, some 500 health care professionals working at hospitals near the main World Cup venue in New Jersey have received training to ensure they’re ready to treat what comes.

“We’re training a lot,” said Dr. Vikramjit Mukherjee, an intensive care physician who is chief of critical care and the special pathogens program at Bellevue. “Through June, we’re going to the hospitals next to the MetLife stadium, where people will be more prone to present with symptoms, and making sure their front-end capabilities are ready.”

MetLife Stadium in East Rutherford, New Jersey, a venue that holds 82,500 spectators, will host eight World Cup matches starting June 13, including the championship on July 19. Greater New York is expected to see more than 1.2 million visitors this summer for the tournament, as the United States expects up to 10 million. Sixteen major cities, and a few smaller ones, across North America will host matches.

Big crowds will gather. A watch party in Central Park is expected to draw some 250,000 viewers. A separate party is scheduled for Liberty State Park in Jersey City.

Public health leaders see this year’s World Cup, billed as the largest tournament in world history, as the world’s largest temporary migration into the United States’ most densely populated urban corridor. They are planning accordingly.

“We’re looking at it as if it’s a huge global migration event,” Mukherjee said while giving Healthbeat a tour of Bellevue, including its biocontainment lab and tuberculosis ward. “The whole health care system in New York City will be a bit on alert for all of these events.”

Bellevue Hospital leads outbreak preparedness

The New York City health care system has experience with an influx of international visitors and potential pathogens. Greater New York has three international airports that are among the busiest in the world, and the city has been on the front line of recent disease outbreaks as they near or encroach upon the United States. The oldest hospital in the United States and one of the largest, Bellevue has had years to prepare.

In October 2014, the hospital received a bit of fame for treating New York City’s only confirmed Ebola patient. Dr. Craig Spencer had been treating Ebola patients in Guinea when he contracted the fatal disease and later entered Bellevue (his discharge is captured in a photo hanging on a hospital wall).

“Because of what we’ve seen in the last few years — Ebola, Covid, and mpox — we feel that we will be the ones who will be affected first for the next outbreak, and therefore have an additional responsibility of keeping prepared,” Mukherjee said.

Central to preparation has been simulated exercises that bring together different agencies working in different time zones and across international borders. Repeated drills help spot deficiencies.

Last summer, Bellevue health care professionals and others participated in a four-day exercise that required transporting by air a group of pretend patients with a high-consequence infectious disease from Toronto, a World Cup host city, to LaGuardia Airport in New York. The pretend patients were then taken to Bellevue for treatment. The exercise aimed to test workers’ ability to handle a portable biocontainment unit — a device used to isolate and transport patients with highly contagious diseases.

“That was the biggest drill we’ve done, because that involved local, state, federal, and international partners,” said Noel Alicea, a spokesman for Bellevue.

New York City Mayor Zohran Mamdani named a former campaign manager to the new post of “World Cup Czar,” but it is unclear whether the position has public health responsibilities.

“Maya Handa will use this innovative role to oversee the Mamdani administration’s inter-agency work to host the FIFA 2026 World Cup and ensure the historic event benefits the city’s residents and economy,” the city said in announcing the role.

Cities have stronger role in preparedness

The World Cup games are also certain to test local public health workers’ ability to coordinate with the federal government. Because the Trump administration has overhauled the U.S. Centers for Disease Control and Prevention and withdrawn from the World Health Organization, both of which have historically played a major role with disease surveillance, state and local governments have taken on additional responsibilities preparing for the World Cup. They are expected to do the same once the matches begin.

This week, the New York State Department of Health announced that it was joining a WHO global network of public health institutions, governments, academic agencies, and labs that aims to coordinate responses to public health threats. New York City, California, and Illinois have also joined.

For its part, the White House created a FIFA task force, led by Andrew Giuliani, the son of former New York City Mayor Rudy Giuliani. Reporting to the Department of Homeland Security, Andrew Giuliani is “spearheading the federal government’s extensive efforts to ensure that the largest World Cup in history will also be the safest,” according to the task force’s website.

Asked how Bellevue was preparing for the World Cup in light of the significant federal changes, Mukherjee said:

“We are trying to paint the picture that this is essential to U.S. biosecurity, which has great bipartisan support, and we recognize that at the end of the day our biggest asset are our health care workers, and if we cannot keep them safe, the entire health care system infrastructure falls through.

“So our priority — our laser focus — is toward making sure our health care workers are safe as they go into relatively dangerous zones of high-consequence, infectious diseases. And that’s what we advocate for in D.C. That’s what we teach and train every day at the front lines.”

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

NYC health department joins global network after U.S. pulls out of WHO

2026-02-05T20:15:29+00:00

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The New York City Department of Health and Mental Hygiene announced Thursday it has joined a World Health Organization network that works on disease outbreaks and other public health emergencies around the world. The city said it was the first U.S. municipality to do so.

The decision to join WHO’s Global Outbreak Alert and Response Network is the latest example of a government agency in the United States seeking to work with the WHO following the Trump administration’s withdrawal from the organization in January, coupled with deep cuts to the U.S. Centers for Disease Control and Prevention. California Gov. Gavin Newsom announced last month that his state was joining the network; on Tuesday, Illinois Gov. JB Pritzker announced his state would join.

The WHO group is an international public health network that brings together more than 300 public health institutions, governments, academic centers, laboratories, and response organizations. Their aim is to rapidly detect and respond to public health threats and emergencies. To this end, the different entities receive direct access to early-warning alerts and outbreak intelligence, along with training and exercises.

New NYC health commissioner is ER doctor with policy degree: ‘Not a traditional pick’

The membership will likely prove essential this summer when the United States, along with Mexico and Canada, hosts the 2026 FIFA World Cup. Matches will take place in major cities throughout North America, culminating with a final in July at MetLife Stadium in East Rutherford, New Jersey. Greater New York alone is expecting more than a million visitors. For its part, the White House has created a World Cup task force, led by Andrew Giuliani, son of former New York City Mayor Rudy Giuliani, that is housed at the U.S. Department of Homeland Security.

Public health experts say the Trump administration’s retreat from the WHO will make the world – and the United States – more vulnerable to disease outbreaks and other public health threats. The United States has long been a key player in containing outbreaks in other parts of the world that might otherwise show up at the U.S. borders. The United States was the WHO’s single largest donor, with contributions fluctuating, donating $1.2 billion during the 2022-23 biennium.

In an interview with Healthbeat last week, New York State Health Commissioner James McDonald said the state was also looking into joining the WHO network.

McDonald said the U.S. withdrawal from the WHO would undermine global immunization efforts, which would bring illness as a result. A healthier world means a healthier New York state and United States.

“One of my big concerns is by pulling out of the World Health Organization and by underfunding CDC, what risk are we inviting in the United States?” McDonald said. “Because people get in planes and travel, and you are literally 12 hours away from the biggest surprise ever. I don’t understand why we’re willing to live in this period of ignorance."

Trenton Daniel is a reporter covering public health in New York for Healthbeat. Contact Trenton at tdaniel@healthbeat.org or on the messaging app Signal at trentondaniel.88.

When conspiracy theories dictate global vaccine policy

2026-02-05T12:00:00+00:00

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Hello from Nairobi.

The realities of public health hit home for me this weekend. My daughter just started pre-K, a touching milestone I was repeatedly warned would bring more illness into our home. (I took this to mean perpetual sniffles.) Instead, after about a week, she shared a lovely bout of norovirus with me.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Vaccine conspiracies as global health policy

Gavi, the global organization that finances and distributes vaccines in poorer countries, finds itself in a funding standoff with the United States, Reuters reports.

For reference, “the U.S. previously contributed around 13% of Gavi’s funding,” and still has outstanding funds owed to the organization from the Biden era.

The issue at hand?

You might assume this is tied to America’s broader reworking of the global health budget, but… it is not. Instead, the Trump administration has told the global vaccine group “to phase out shots containing thimerosal as a condition of providing the group with funding.”

If you (like me) have made it this far in your life without needing to know what thimerosal is, let me present you with the disappointing news: It is a benign preservative at the center of several vaccine/autism conspiracy theories.

I reached out to Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, and one of the world’s foremost experts on vaccine development and vaccine misinformation to get his take.

He cautioned against “sanewashing” conspiracy claims or even detailing them next to mainstream vaccine science, which creates a “false equivalency,” as if both sides deserve equal weight.

“The thimerosal/autism link was debunked many years ago through both large epidemiological studies and even nonhuman primate neurodevelopment studies,” Hotez said, with the overwhelming fatigue of somebody who has explained this several hundred times before. “Many of these false links were popularized by [U.S. Health and Human Services Secretary Robert F. Kennedy Jr.’s] discredited 2005 article published in Rolling Stone and Salon magazines, since retracted by the editors.” As for the ultimate impact on Gavi, it remains to be seen whether the administration follows through, or whether Gavi decides to cave to the anti-science demand.

But “it’s tragic for the world’s children that now their access to vaccines and immunizations could be imperiled by this kind of pseudoscience,” Hotez said.

We’re winning the worm war

Guinea worm disease is on the verge of eradication, with just 10 infections reported worldwide last year, the Washington Post reports.

Disease breakdown: Guinea worm (also known as Dracunculiasis) is a parasite that spreads through drinking contaminated water, or eating infected animals. I’ll spare you the gory details (because this one is a true stomach turner), but it forms a terrible worm-filled blister. Though not lethal, at its peak in the 1980s, it was endemic across 20 countries and infected about 3.5 million people per year. Four decades later, there is still no treatment beyond pain meds.

The global effort to eliminate the disease has been led by the Carter Center since the 1980s. Last year’s total caseload is a drop from 15 cases in 2024 and consists of “four human cases … reported in Chad, four in Ethiopia, and two in South Sudan.”

The organization reports that the global aid pullback “has not stopped the Guinea worm program at ground level.”

What’s particularly incredible about the ongoing elimination project is that there is no vaccine or cure for guinea worm. This global effort’s success is largely the byproduct of sustained, committed gruntwork, with decades of programs to “educate the public, train volunteers, and distribute water filters in affected areas.”

I have two takeaways: First, we are clearly winning this war against the worm. If Guinea worm cases reach zero, it would be only the second human disease ever eradicated, after smallpox. (That said, I’m still hopeful we’ll first eliminate polio before the decade is out.)

Second, the last mile will be the hardest. Unlike polio or smallpox, Guinea worm also has animal hosts. Officials say the grunt work must continue, even after zero human cases. The disease can bounce back unless animal transmission (including dogs, domestic cats, and freshwater fish) is stopped, too.

Still, if Guinea worm fades into history, the credit belongs to the community health workers and volunteers who kept at the slow, quiet work for decades, moving village by village.

ChatDNA

Last week I was admittedly a bit flippant about a story on artificial intelligence helping pharma companies speed up the “unsexy” side of drug trials. Well, this week brings a more humbling piece on AI’s promise in driving real medical advancement.

Smithsonian magazine reports that researchers at Google DeepMind have unveiled a new artificial intelligence tool called AlphaGenome.

The tool leverages what AI does best (processing and learning from enormous datasets) to crunch the full book of our DNA. Essentially, it’s meant to help scientists predict how the parts of DNA we still cannot fully explain help tell our cells what to make, and when and how to make it.

The piece has a world-class explainer on the fundamental science:

“DNA is made of four different units called nucleotides: adenine (A), cytosine (C), guanine (G), and thymine (T). These letters pair up and act as an instruction manual for cells, yet only 2% of human DNA tells our cells how to build proteins, the building blocks of life. The remaining genetic code was long dismissed as “junk DNA,” but now, scientists know it plays an important role in regulating gene activation. Certain variants and mutations in the genome can lead to disease — and AlphaGenome’s goal is to predict what those changes are.”

So what’s the promise? The designers of the AlphaGenome believe the tool “can help experts develop new genetic therapies and ways to diagnose rare diseases.” Especially by pointing human researchers toward complex genetic links that are hard to spot on their own. Best of all: “The new resource is freely available to other researchers, who can modify the program based on their own needs.”

The tool has limitations, of course, including issues predicting the impact of DNA regions that influence each other at a great distance (meaning the segments are several hundred thousand letters away).

Still, I will be looping back in the coming months. As Pushmeet Kohli, vice president of science at Google DeepMind, put it: “I think we are at the start of a new era of scientific progress, and AI is going to enable a number of different breakthroughs.”

I have to admit … I believe it.

We. Declare. ‘Water bankruptcy!’

The United Nations says the world has entered a new kind of water crisis, one it calls “global water bankruptcy,” Health Policy Watch reports. That means rivers, lakes, and underground sources that once bounced back after droughts or heavy use are being drained faster than they can recover.

Perhaps the starkest example is the Aral sea in central Asia. In the late ’80s it was still the world’s fourth-largest lake. Today it barely exists.

Not to lay it on thick, but the report hits you with some staggering facts:

“More than half of the world’s large lakes have lost water since the early 1990s, over 30% of glacier mass since 1970 has disappeared in certain regions, while about 410 million hectares of natural wetlands — a land mass nearly equal to that of the European Union — have been destroyed over the past five decades.”

And the human impact?

Today about “4 billion people — nearly two-thirds of the global population — face severe water scarcity for at least one month every year.” The report particularly points to farmers in dry regions who pump groundwater for irrigation year after year, a practice that physically cannot continue indefinitely.

What’s my takeaway?

I find these reports largely overwhelming, because the solutions are not mysterious. National governments across the world need to act to protect water sources, manage them better, and plan for scarcity. Will they? Not anytime soon.

Tangent here, but I’m reading What We Can Know by Ian McEwan, which is set in a future Britain after a climate collapse. In the book, historians look back on our current era as a period they call “The Derangement,” when people had clear knowledge of climate change but failed to act at the needed scale.

With this report it is, uh … uncomfortably on the nose.

Mosquitoes keep moving

I’m leaving you this week on a story with a somewhat fascinating twist.

Chile is on high alert after finding an Aedes aegypti mosquito in the capital of Santiago, reports El Mercurio, the country’s largest newspaper.

Why is this such bad news? The mosquito, which is still absent from large parts of the country, is known as a major vector for a host of highly transmissible diseases including dengue, chikungunya, Zika, and yellow fever. Enough so that it’s commonly called the “dengue mosquito” or “yellow fever mosquito.” It also particularly thrives in cities, breeding in locations like flower vases, plastic bottles, gutters, and even old tires.

As we reported in October, this is an insect that sticks around. “Once Aedes aegypti mosquitoes establish themselves in an area warm enough for them to survive the winter, it becomes extremely difficult to eliminate them,” Dr. Marietjie Venter, an animal-borne virus expert, told me last year.

Granted, this is not the first time the mosquito has appeared in Chile. But as climate change makes the country increasingly habitable for it, health officials are worried sightings this year could signal the mosquito establishing a foothold … and introducing a perpetual risk of terrible tropical diseases. It would not take much. After all, as Chile’s head of health emergencies, Ester Alywin, warned on Friday, “a single female mosquito can lay up to 1,500 eggs in her lifetime.”

What’s the twist?

The singular mosquito was identified by eye by an airport staff member at a warehouse in Santiago International, then caught and then sent for analysis at a public laboratory.

Readers, I’ve searched for more detail on how staff could possibly be trained well enough to recognize and capture a single, specific mosquito (!) rather than just swatting it … but I’ve come up empty. Apparently, someone took their annual public health briefings seriously.

Anyhow, you’re my hero of the week, anonymous Chilean airport warehouse worker.

I’ll see you next week.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Maternity unit, BMW plant among groups exposed in South Carolina measles outbreak, records reveal

2026-02-02T10:00:00+00:00

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In South Carolina’s surging measles outbreak, infectious people have exposed others to the virus in the labor and delivery unit of a hospital – where babies are at high risk of infection, as well as in the workplaces of some of the region’s major employers, including manufacturing plants for BMW and Michelin.

Internal records obtained by Healthbeat from the South Carolina Department of Public Health’s outbreak response reveal more about the scope of the outbreak’s impact within the state and across the country than has been previously made public.

The documents, obtained under South Carolina’s public records law, also show the state’s outbreak has resulted in measles exposure incidents in public locations in several other states. They include infectious people from South Carolina who attended a large youth conference in Kentucky, went to a hospital in Florida, and visited busy travel convenience stores in Georgia and Texas.

How the South Carolina measles outbreak grew from 5 to 847 cases

Within South Carolina, the department’s internal outbreak reports, as well as emails updating the state’s governor’s office, reveal numerous measles exposure events inside health care facilities. Many have involved urgent care clinics. Others have occurred when infectious people exposed others to the virus at hospitals and pediatrics practices.

The reports note the challenges state health department officials have faced trying to stop one of the largest measles outbreaks in decades, including making sure those in quarantine understand they need to stay at home and away from others, and dealing with some schools that have been slow to cooperate with outbreak investigations. The records reveal the department issued a final notice last month to a private Christian school, warning that it was about to face enforcement action for failing to fully share information about exposed students.

After initially growing slowly since the outbreak was identified on Oct. 2 with just five cases, the number of measles cases exploded in January, nearing 850 confirmed infections by the end of the month. For now, the outbreak is mostly in and near Spartanburg County, in the northwest part of South Carolina, where it’s being fueled by clusters of unvaccinated children and adults.

South Carolina travelers expose people in other states

While health officials in Washington state, North Carolina, and California have announced recent measles cases in their states that are linked to the South Carolina outbreak, the documents obtained by Healthbeat list additional states and locations where infectious people who are part of the outbreak have traveled.

According to the South Carolina DPH’s internal briefing reports for its director, there were exposure incidents during December and January involving contagious South Carolina residents who traveled to Kentucky, where exposures occurred at a “Large NYE Youth Conference” and also at a Hyatt Place hotel; in Georgia at a Love’s travel center; in Texas at a Buc-ee’s travel center; and in Florida at an Embassy Suites hotel.

In addition, there was a potential public exposure at a hospital in Florida, according to a Dec. 29 email from the South Carolina health department to the South Carolina’s governor’s office. The email did not include the hospital’s name or location.

The other reports released to Healthbeat provide little information about the circumstances of the public exposure sites or whether anyone became infected. In most cases, the reports only list the names of sites of public exposures that have occurred in the previous 21 days – which is the maximum period of time it can take for a person to develop symptoms after being exposed to measles.

The South Carolina DPH told Healthbeat its staff was not able to quickly provide more details about the locations listed in the records. Officials with Hyatt, Love’s, Buc-ee’s, and Embassy Suites’ operator Hilton did not answer Healthbeat’s questions about the exposure incidents listed in the reports.

A spokesperson for the Texas Department of State Health Services said it had not been notified of a measles exposure incident at a Buc-ee’s there during this time period. Officials at the Florida Department of Health did not respond to questions from Healthbeat seeking more information about the hospital and Embassy Suites exposures there.

It’s also unclear exactly where or when the “Large NYE Youth Conference” occurred in Kentucky. The South Carolina DPH said it doesn’t have specific details of the event. Officials at the Kentucky Department for Public Health did not answer Healthbeat’s questions about the conference or the separate exposure incident at a Hyatt Place hotel, which appears to have resulted in the infection of a Kentucky resident.

Last month, the local health department in Lexington-Fayette County, Kentucky, issued a measles alert saying an “unvaccinated, out-of-state traveler” stayed at the Hyatt Place in Hamburg, Kentucky, from Dec. 31 through Jan. 2, and also visited a Panera in Hamburg on Jan. 1. No mention was made of the South Carolina outbreak.

An unvaccinated Kentucky resident who was exposed to this “out-of-state traveler” later tested positive for the disease, the Kentucky DPH announced on Jan. 15. A department spokesperson did not answer Healthbeat’s questions about whether the Hamburg exposures and measles infection are linked to the South Carolina outbreak.

Exposures include hospitals, a maternity unit, urgent care centers

Within South Carolina, the state health department’s internal outbreak reports reveal more measles exposure locations than just the schools and stores, restaurants, businesses, and others that have been publicly shared in the information released to the public.

South Carolina state epidemiologist Dr. Linda Bell, in emailed comments to Healthbeat, said the state only notifies the public of the locations of measles exposure incidents when the department knows the specific date and time the exposure occurred, and when it cannot notify all those who have been directly exposed to the infectious person.

In recent weeks, Bell has spoken at media briefings about health care facilities – without naming names – as a place where measles exposures and infections have been occurring.

“We have seen transmission associated with exposures in health care settings,” Bell said during a Jan. 28 briefing. She said the department continues to encourage health care facilities to put masks on people who arrive with symptoms of respiratory illness, which can be early symptoms of measles, and isolate them from waiting areas where other people might be exposed.

Bell said health facilities also should make sure their workers – including administrative and intake staff – are vaccinated. “We are having to track a number of workers across disciplines and health care settings who have been exposed,” Bell said.

As U.S. is poised to lose measles-free status, RFK Jr.’s new CDC deputy downplays its significance

State health officials and members of the medical community have been urging that anyone who may have measles call before visiting health facilities, so that arrangements can be made to safely provide assessment and care – such as through a remote telemedicine appointment, an after-hours office visit, or admission to a special hospital isolation unit.

The newly released documents detail the names of hospitals, urgent care clinics, and some practice locations where infectious people have exposed others to measles.

Two of the major health systems serving the South Carolina Upstate region at the center of the outbreak – Spartanburg Regional Healthcare System and Prisma Health – have had multiple incidents where infectious people went into their facilities and exposed others to measles in the December through January period, the state health department’s records show.

One of the listed exposure incidents occurred in the labor and delivery unit at Prisma Health Greer Memorial Hospital, which is located between Spartanburg and Greenville. A spokesperson for Prisma would not answer questions about the incident or whether any infections were associated with it.

Measles is especially dangerous to babies, who are too young to be vaccinated, according to the Centers for Disease Control and Prevention. The virus spreads through the air and infectious particles can remain in a room for two hours after the infected person has left the area.

“Exposure to measles in a labor and delivery unit is highly concerning because measles is extremely contagious and poses serious risks to both pregnant people and those who may not be fully protected against measles,” said Dr. Michael Warren, chief medical and health officer for the March of Dimes, who previously served as the associate administrator of the federal Health Resources and Services Administration’s maternal and child health bureau.

While not commenting on the specific incident in South Carolina, Warren told Healthbeat that the ability of the measles virus to linger in the air for hours increases the likelihood of exposures occurring in that kind of a health care setting. The Birthplace at Greer Memorial Hospital has 10 labor, delivery, recovery and postpartum and recovery rooms, according to a promotional video on its website.

“Labor and delivery units care for multiple patients, with pregnant and postpartum women, newborns, and health care workers in close proximity, so even a single measles exposure can lead to rapid spread if not identified and managed quickly,” Warren said. He added that because newborns and pregnant people can’t receive the measles vaccine, those who are exposed may need special treatment with immunoglobulin, a substance that helps fight infections.

In addition to the exposure incident at Greer Memorial Hospital, other Prisma Health facilities that are listed in the records as sites of public measles exposures include: Greenville Memorial Hospital and its emergency department; Prisma Health Pediatrics in Greer; Prisma Health Urgent Care locations in Boiling Springs and Greenville; and Prisma Pediatrics - Spartanburg.

A South Carolina Department of Public Health nurse holds a box containing vaccine for a mobile clinic in Spartanburg County. Two doses of the vaccine is 97% effective at protecting against infection with measles, according to the Centers for Disease Control and Prevention.

Prisma Health did not answer questions about whether it is aware of any measles infections occurring in association with exposure incidents in its facilities. In a brief emailed statement, a spokesperson for the system noted that measles is highly contagious and that people can spread the virus before they are diagnosed.

“Prisma Health has taken extensive proactive measures during the measles outbreak to protect patients, visitors, and team members, including visitor restrictions, enhanced masking policies, additional precautions, and broad patient and community education,” the statement said.

Spartanburg Regional Healthcare System also wouldn’t answer questions about the specific exposure incidents inside its facilities and whether any have resulted in infections. Among the system’s facilities noted in the records for exposures: Spartanburg Regional Medical Center, Spartanburg Regional ER, and Pelham Medical Center.

In an emailed statement, the system said it has taken several actions to address the risks of measles exposure in its facilities. They include signs posted at Medical Group of the Carolinas practices to inform patients about the signs and symptoms of measles and instructing them to stay in their vehicles, call the practice’s phone number, and wear a mask. Masks are being required in all of the system’s emergency rooms and immediate care centers. “Associates and providers also are taking airborne precautions – such as wearing masks – when evaluating patients who might have measles,” the system said.

Measles enters BMW, Michelin manufacturing plants

Beyond health care facilities, the documents also show exposures at some major employers in the Spartanburg area that have not been included in the information the state health department has released publicly.

The most prominent of the employers listed in the records are BMW and Michelin.

BMW Manufacturing employs more than 12,000 people at BMW Group Plant Spartanburg, which assembles BMW sports activity vehicles and coupes on what the company describes as its 10 million-square-foot campus. Michelin has had a major tire manufacturing presence in the Spartanburg area for decades.

The state health department flagged the exposures at the BMW and Michelin plants to the state’s governor’s office in a Jan. 12 email with outbreak updates.

In a statement to Healthbeat, BMW said: “The Plant Spartanburg workforce has been informed about the measles cases at the plant. We are following guidance from the South Carolina Department of Public Health and are in regular communication with our teams regarding recommended health protocols.”

The BMW statement said it is providing measles vaccinations onsite and that the company is sharing updates and resources with employees. “We will continue to monitor the situation closely and encourage anyone who is unvaccinated or uncertain about their vaccination status to contact their health care provider promptly,” the company said.

A spokesperson for Michelin declined to answer questions about its exposure and what actions the company is taking in response.

Outbreak investigators face challenges at some schools

Since the South Carolina outbreak began in October, hundreds of students in the Spartanburg area have needed to quarantine at home – and stay out of classes – because they have been exposed to someone who was contagious with measles.

While many schools have helped the state health department’s outbreak investigators identify which students have been exposed and need to be quarantined because they are not fully vaccinated or lack immunity from prior infection, the records obtained by Healthbeat show that others have been slow to provide information.

As measles exploded, officials in Texas looked to CDC scientists. Under Trump, no one answered.

In one case, the health department got to the point of threatening enforcement action.

Last month, the South Carolina DPH issued a final warning to Westgate Christian School in Spartanburg that it was about to be served with a public health order and face possible penalties because of its failure to comply with an outbreak investigation, according to the records and additional information Bell provided in response to Healthbeat’s questions.

“Being able to identify and notify staff and students who may have been exposed and are at risk for measles is very important to our efforts to limit the spread of measles to the greatest degree possible,” Bell said. “In order to do so, we require lists from the school of those who may be at risk. Schools that don’t provide the full information needed to contact those at risk within 48 hours are considered noncompliant.”

According to Bell, on Dec. 29 the state health department provided a formal, written request to Westgate seeking contact information for students identified as close contacts of a person with measles. The list that the school provided on Dec. 31 was “insufficient,” Bell said.

Bell said the department issued a final notice to the school on Jan. 9, warning that if the requested information wasn’t received by 1 p.m. on Jan. 10, the department “would issue a Public Health Order pursuant to S.C. Code § 44-1-140 compelling compliance.” Under its authority to collect information to address threats to public health, she said the department can take enforcement actions including fines and other legal actions when organizations fail to comply.

Bell said the school provided the required information on Jan. 10, resolving the issue.

Pastor James Wooten, who is listed as the school’s president, told Healthbeat that the school drew the warning because of “some confusion.” The school is a ministry of Westgate Baptist Church. Wooten said that the final notice was unexpected and that the school thought it had provided the health department with the requested information.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

What the U.S. leaving the WHO means for health in America and the world

2026-01-29T12:00:00+00:00

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Hello from Nairobi.

Over the weekend, I had the pleasure of seeing Mahmood Mamdani launch his new book, Slow Poison, here in the city. The book traces Ugandan history, particularly the bizarre and violent reign of Idi Amin and the long rule of Yoweri Museveni (who entered his fourth decade in power in sham elections held just this month.) It’s a great read. Mamdani is one of East Africa’s most respected political scholars and, in a curious bit of trivia, he’s also the father of Zohran Mamdani, New York City’s new mayor.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

U.S. pulls out of the WHO

The United States officially pulled out of the World Health Organization on Thursday, making good on the Trump administration’s yearlong pledge, Al Jazeera reports. (One complicating factor not in the Al Jazeera coverage: The United States still owes WHO roughly $260 million … money it’s unlikely to pony up.)

As a reminder, the WHO is the United Nations body that coordinates global disease surveillance, sets health standards, and helps countries respond to outbreaks.

Is the U.S. pullout mostly symbolic, or will it reshape global health in real ways? I reached out to Gavin Yamey, director of the Center for Policy Impact in Global Health at Duke University, to discuss.

Yamey is exceptionally clear: The pullout will “have major consequences for both the United States and the WHO itself.”

On the American side, “the U.S. has shot itself in the foot,” he says. “It has now made itself much more vulnerable to disaster and devastation when the next epidemic or pandemic hits. Outbreaks don’t respect national borders,” and now “the country will no longer have access to crucial data about emerging health threats.”

For context, before the exit, “if there was an overseas outbreak, the [U.S. Centers for Disease Control and Prevention] would play a critical role in the scientific discussions and deliberations convened by WHO on the status of the outbreak, the risk of spread, and the best way to contain and control the outbreak. Now, having left the WHO, the U.S. will be excluded from these crucial conversations,” blunting its ability to track fast-moving outbreaks and advise at home in real time, Yamey says.

On the WHO side, Yamey says the loss is twofold. The WHO is losing “some of the finest expertise in the world” at the CDC, but the deeper blow is financial. “The U.S. was the single largest donor to the WHO,” he says. Without American dollars, “the organization will be weakened in its ability to carry out its critical activities. And there is no other body on the planet that does, or can do, what the WHO does. There’s no other body that has the same global reach, representation, legitimacy, and ability to convene experts and determine best scientific practice. Its activities are the bedrock of global health,” he says. “By weakening the WHO, the U.S. has made the world less safe — which in turn makes the U.S. less safe.”

(I promised you, after last week’s optimistic report, we were in for a heavy dose of reality.)

But Yamey also wanted to make one other point explicit, especially for American readers: The United States is leaving WHO after weakening its own public health system. He says that Robert F. Kennedy Jr., the U.S. secretary of Health and Human Services, “arguably one of the world’s most extreme and dangerous anti-vaccine activists and conspiracy theorists … has spent the last year dismantling the U.S. federal public health system and its vaccination systems. He has fired hundreds of critically important federal public health workers, massively weakened the CDC, interfered with the CDC’s science-based guidance, and rolled back vaccination, even as vaccine-preventable diseases are returning.”

His takeaway?

“Even without exiting the WHO, the U.S. has over the past year greatly weakened its own domestic capacity to deal with health threats, and leaving the WHO makes a bad situation immeasurably worse,” Yamey said.

A Nipah virus outbreak

India is facing an outbreak of deadly Nipah virus in the eastern state of West Bengal, which borders Bangladesh, the Global Times reports. Authorities have quarantined nearly 100 people and confirmed five cases, including infections among health care workers at a hospital near Kolkata.

Disease breakdown: Nipah virus is an animal-borne disease that typically originates in fruit bats and can either spread directly, through proxy animals such as pigs, or through close contact with an infected person’s bodily fluids. There is no treatment or vaccine. It can cause fever, muscle pain, and respiratory distress, which often moves to a deadly inflammation of the brain. In past outbreaks, 40% to 75% of those who contracted the disease died.

The outbreak has spooked several countries in the neighborhood across South and Southeast Asia. This includes Thailand, which has begun “screening air passengers arriving from India for possible Nipah virus infection;” Nepal, which “heightened nationwide alertness to prevent the possible entry of the Nipah virus;” and China, which is “strengthen[ing] quarantine and control measures for people entering China from India.”

Some context: Nipah is a scary disease, but it’s not new. It was identified in the late ’90s, and the virus has surfaced repeatedly over the past decades. In Bangladesh, for example, small spillover events appear “almost every year,” according to the WHO, and usually involve only a handful of cases.

The takeaway? The travel screening and alerts across South and Southeast Asia are not panic moves. They are the global health system clicking into gear. Nipah is highly deadly and so carefully treated and monitored … but history suggests outbreaks like this are usually stopped before they spread far.

Neither screw nor worm; still horrible

OK, fair warning: This next one is fairly gross.

As Healthbeat reported earlier this month, North America is experiencing a resurgence of a flesh-eating fly larva known as the New World screwworm. (Despite the name … it is not a worm.) The situation is dire enough that the United States Department of Agriculture has announced $100 million for “innovative projects” to fight the parasite.

The parasite is the larval stage of a blowfly that burrows into open wounds and feeds on living tissue. It was once endemic across much of the southern and southwest United States, Mexico, and Central America. It was largely eradicated from the ’60s through the late ’90s. Before that, the screwworm caused massive losses in livestock (the big threat) and, on rare occasions, infected humans.

How was it killed off? The eradication relied largely on a suite of partially U.S.-funded programs that released millions of sterile male flies to crash the wild populations. It worked so well that the insect all but disappeared … until now. The parasite has crept back through Central America and has reached as far north as about 70 miles below the U.S.-Mexico border.

Why is it back?

We lapsed in the sterile fly release program, essentially. According to a report published in September by the American Veterinary Medical Association, the Covid-19 pandemic disrupted sterile fly production in Panama, reducing the releases that normally keep wild screwworm populations in check. (The report also notes that the closure of U.S. and Mexican fly factories in previous decades left current control efforts with basically just the Panamanian facility.)

For the sake of all of our nightmares … let’s get these facilities up and running again.

A million missing midwives

The world is facing a shortage of nearly 1 million midwives across 181 countries, The Guardian reports. This data come from a new study in the science journal Women and Birth.

No surprise here, but the medical care shortage is not evenly spread. Nearly half of the global gap is in Africa, with large midwife shortages also concentrated in the Eastern Mediterranean and parts of the Americas. The report notes that the problem is not just a lack of training, but “a failure in many countries to employ trained midwives where they were needed.”

Why does this matter? Beyond childbirth, midwives handle much of the frontline work in pregnancy and postpartum care across much of the developing world. When they are absent, the researchers warn, preventable complications and deaths rise quickly.

The study does offer a small silver lining. It estimates a modest reduction in the roughly million-person gap by 2030 as more midwives are trained each year. The problem is that population growth in the hardest-hit regions largely keeps pace with those gains. Even under the researchers’ most optimistic scenarios, hundreds of thousands of midwives will still be missing, well into next decade.

What’s the takeaway? It’s hard to pick one. Obviously, this is a complicated amalgam of training and medical staffing issues across very different countries. Still, one conclusion is that this is a solvable problem the world is choosing to tolerate, even though midwives remain one of the most cost-effective ways to keep mothers and babies alive.

AI: Revolutionizing the ‘unsexy’ parts of drug development?

Artificial intelligence has yet to tackle the core of drug development: actually discovering new, breakthrough medicines. (To be fair to AI, it’s been busy with more important work, like producing goofy songs about Chimpanzees and Borsht.)

But AI is quietly speeding up some of the more banal parts of the drug R&D process.

According to a Reuters report from the JP Morgan Healthcare Conference, drugmakers are using AI to recruit patients for clinical trials, pick trial sites, and draft regulatory paperwork. This “unsexy stuff,” as the Israel-based Teva Pharmaceutical Industries CEO Richard Francis put it, is shaving weeks off slow and expensive work, and is where AI “makes a difference,” in the industry today, he says.

One interesting vignette from the article: Novartis said it used AI to cut a four- to six-week site-selection process for a massive heart-drug trial down to a single two-hour meeting. (Which, let’s be real, maybe says more about their corporate meeting culture than the power of AI.)

Of course, it’s still an open question of how much (or if!) these incremental time savings will actually translate into faster drug approvals or lower costs for patients.

I’ll see you next week.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Blood supply shortage, Legionnaires’ disease in Harlem, a cold snap, and respiratory viruses

2026-01-23T15:39:12+00:00

This article originally appeared at Your Local Epidemiologist New York. Sign up for the YLE NY newsletter here. Public health, explained: Sign up to receive Healthbeat’s free New York City newsletter here.

This is a packed week for New York health news. From an urgent call for blood donations and Legionnaires’ disease cases in Harlem, to a Code Blue warning for freezing temperatures and the ongoing virus season, here’s your New York Dose.New York is facing a blood supply shortage. Your donation matters.

The American Red Cross and regional partners, including the New York Blood Center, are raising the flag that the local blood supply is critically low, with donations down to nearly 40% below hospital demand in parts of the state. Types O (the universal donor type), A‑, and B‑ are especially needed.

Why this matters

Hospital care — including emergency trauma response, childbirth, surgeries, cancer treatment, and chronic disease management like for sickle cell anemia — depends on a steady blood supply. National data show someone in the United States needs blood every 2 seconds, and nearly 29,000 pints are required daily. If hospitals don’t have enough blood on hand, clinicians may need to make hard decisions about who gets blood transfusions and who has to wait.

The challenge with having enough blood on hand is that it’s perishable —red blood cells last 42 days and platelets only five days. Winter holidays, bad weather, and a more severe flu season this year are resulting in fewer blood donations and cancelled blood drives. Even without these seasonal challenges, only about 3% of age‑eligible Americans donate blood each year.

How can we improve this system?

Addressing blood shortages requires innovation as well as better infrastructure. Strategies being explored to be less reliant on the limited donor supply include:

Blood substitutes designed to temporarily carry oxygen when donated blood isn’t available. But these substitutes can’t replace blood entirely — they don’t clot, lack immune functions, and aren’t widely available.
Lab-grown red blood cells show promise, especially for rare blood types. They are in the early stages of trials, but scaling the technology and science to meet hospital demand will be a big challenge.
Advances in medical procedures that require less blood, and better inventory systems that reduce waste and expiration, will reduce the amount of blood needed.

Despite innovations and improvements, community blood donations remain the backbone of the blood supply and are essential to hospitals.

What you can do now

Schedule a donation appointment through the Red Cross, New York Blood Center, or other local blood centers.
Encourage family and friends to donate — one donation can help up to three people.
Regular, year‑round donations help prevent seasonal shortages.

You can make a huge difference — donating blood literally saves lives.

Legionnaires’ disease under investigation in Harlem residential complex

City health officials are investigating two cases of Legionnaires’ disease at 3333 Broadway in Harlem, one of New York City’s largest residential buildings, home to about 10,000 people. Both cases occurred in the past year and were not fatal. Clusters like this raise concerns about water system exposure — especially following last summer’s Harlem outbreak that sickened more than 100 and killed seven (which I covered here).

While tests are being run, the building’s management and public health agencies have advised residents who are at higher risk for Legionnaires’ disease — those who are 50 and older, people with compromised immune systems or chronic diseases like diabetes or asthma, or who smoke — to do the following:

Use cold water for drinking and bathing.
Take baths or sponge baths instead of showers to avoid breathing in mist.
Boil water if hot water is needed.

If you live or work in the affected building and develop flu-like symptoms, contact a health care provider and mention this exposure. Early antibiotic treatment greatly improves outcomes.

What this means and why it matters

Even with only two cases, this situation raises several big issues:

It’s not surprising the residents are scared and upset. Seven people died in last year’s Harlem outbreak. Asking residents to take cold baths and avoid showers during a January cold snap is not realistic, especially in a building where many are older or have chronic illnesses. The communication and assistance for affected residents are lacking.
This is a health equity issue. Harlem has some of the highest rates of asthma, diabetes, and poverty in New York City, all of which increase Legionnaires’ risk. Communities here deserve rapid, culturally responsive public health action, not lagging testing and unattainable guidance. The city should prioritize better and faster Legionella inspections in Harlem and the surrounding areas, in particular.
There are policy gaps. While New York City requires regular Legionella testing for cooling towers, there is no law requiring routine testing of building plumbing systems (e.g., hot-water plumbing and domestic taps), even in large residential buildings like this one. Building water systems can be a source of Legionella, and in New York City, buildings aren’t tested for the bacteria until after two cases occur in the same building within a year. It’s important to note, though, that most big outbreaks in New York City have been linked to cooling towers.

A bill at the New York City Council (Intro. 434) would require large residential buildings to implement Legionella testing and water management plans for domestic water systems, but it has stalled. I’ll be paying attention to see if it picks up momentum again — I think that increased testing of large residential buildings has the potential to reduce the risk of these Legionnaires’ clusters.

Cold temps this weekend and a Code Blue

A strong cold snap is in the forecast this weekend, bringing “feels like” temperatures close to 0°F across New York and in New York City this weekend. Extreme cold can cause real health risks — from hypothermia and frostbite to worsening of chronic heart and lung disease, especially among older adults and people experiencing homelessness.

Tips to stay safe

Keep children and pets inside when temperatures drop.
Check in on older neighbors and people with chronic health conditions.
If you use a space heater, make sure to follow the manufacturer’s guidance to avoid fire hazards.

Code Blue

A Code Blue Weather Emergency notice is issued in New York City when the temperature drops below freezing (32°F or lower) between 4 p.m. and 8 a.m. — which will be the case this weekend. No one will be denied shelter in New York City during a Code Blue. Should you see a vulnerable person out in the cold, call 311, and an outreach team will be dispatched to offer assistance.

The ripple effects of ICE in communities

It’s heart-wrenching to watch communities live in fear — families unsure if they’ll be able to safely pick up their kids from school, loved ones waiting anxiously for family members to come home.

Immigration and Customs Enforcement raids and activity have increased across the United States, including here in New York. A new ICE processing and detention facility is slated to open just 50 miles north of New York City, a large facility opened last year in Newark, New Jersey, and ICE continues to hold contracts with several upstate county jails.

I wrote about the ripple effects of ICE enforcement on communities’ health and well-being last year, and it’s just as relevant today. The impacts go far beyond immigration policy. They reach deep into the health, safety, and stability of families and neighborhoods. But there are ways we can support each other — neighbors, educators, and clinicians play a huge role in mitigating harmful health effects. I cover ways we can support families and communities carrying the burden in the piece here.

Infectious disease ‘weather report’

Flu: The good news is that flu has decreased for the past couple of weeks in New York. The bad news is that this has still been a really bad flu year. In the first week of January, we saw the highest number of flu hospitalizations in a single week ever recorded in New York. In New Jersey, a young child died of a flu infection last week.

Flu cases in New York City.

I’ve been hearing a lot of chatter about the flu vaccine this year and questions about whether it was a good match. Although the circulating flu strain (subclade K) emerged after the vaccine formula was selected, effectiveness data from Europe in the fall showed that the vaccine still offered meaningful protection against hospitalization, even with the circulation of subclade k, with estimates of 70%–75% effectiveness in children and 30%–40% in adults.

RSV: RSV cases in New York are holding steady, but the good news is that emergency department visits are declining, which means less pressure on clinics and hospitals. This has been a milder RSV season in New York.

RSV cases in New York City.

Covid: Covid slightly increased in New York the past week, but overall the burden remains low. In New York City, only a very small percentage of hospitalizations are due to Covid — it isn’t a major driver of severe illness right now.

Covid cases in New York City.

No change to child vaccine schedule in New York

In case you missed it, the Northeast Public Health Collaborative announced that it is continuing to recommend the American Academy of Pediatrics’ Recommended Child and Adolescent Immunization Schedule, despite changes to the federal vaccine schedule (YLE founder Katelyn Jetelina covered those changes here).

Bottom line

You’re all caught up on New York health news. Stay warm, and see you next week!

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health advocate. She specializes in infectious diseases, outbreak response, and emerging health threats. She has led multiple outbreak investigations at the California Department of Public Health and served as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Donnelly is also an epidemiologist at Biobot Analytics, where she works at the forefront of wastewater-based disease surveillance.

What’s going well: Marburg virus winding down. A cheap malaria defense. The future of antibiotics.

2026-01-22T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week’s news has an unexpected but welcome throughline: optimism! From effective outbreak control to promising new research, we have a few stories that suggest key parts of the global health system are still functioning well, even under strain. (For the disappointed masochists out there, don’t worry. I’ll likely be back with some bummer news next week.)

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Marburg virus: Not too early to celebrate

We’ve been covering how Ethiopia is faring during its first-ever outbreak of Marburg virus, an Ebola-like hemorrhagic disease with no vaccine.

How this outbreak unfolds matters beyond this one country and one disease. For me, it’s the second real test after last year’s Ebola flare-up in the Democratic Republic of the Congo of whether the international order still has the muscle to contain deadly outbreaks in an era of austerity.

Oddly, there has been very little sustained reporting on how the outbreak is actually progressing. (And, mea culpa, my cynic’s heart usually assumes no news means bad news!) So as I promised last week, I’ve followed up. I reached out to International Medical Corps, one of the organizations leading the Marburg fight, and spoke with Lawrence Mutharia, its country director for Ethiopia. What’s the state of play?

An unambiguous success.

“We are now at day 36 with no confirmed new cases,” Mutharia told me on Monday. He reports that the focus has shifted from an active response to making sure systems are in place if the virus resurfaces, “while waiting for the outbreak to be officially declared as over.”

This outcome was not guaranteed. The virus hit the outskirts of Jinka, a remote, under-resourced area with no prior experience handling a disease this lethal. I’ve hesitated to describe that reality too vividly in past updates, partly to avoid sliding into lazy stereotypes or misleading ideas about what “rural Africa” looks like. But the truth is that the communities surrounding Jinka follow culturally and socially traditional ways of life, with Indigenous conceptions of medicine that are far removed from modern biomedical practice. Without putting too fine a point on it: I have attended only one meeting in my life where participants arrived in full body paint, scarification, and feathered headdresses. It was in Jinka.

You could imagine this could be a tough setting for an outbreak response built on community cooperation with foreign medical guidance.

Nevertheless, Mutharia says that early, effective outreach to local communities was actually one of the response’s key strengths. That, a rapid influx of funding, early deployment of medical teams, and clear leadership from Ethiopia’s federal Ministry of Health. “Timely and coordinated efforts are crucial” for stopping fast-moving outbreaks like Marburg, he noted, and in this case they were deployed close to a best-case scenario.

Perhaps more importantly, and beating another one of my nagging fears, Mutharia told me that donor support for the response was “quite adequate.” That support included, to their credit, rapid funding from the U.S. State Department. Given the tightening of purse strings globally and America’s pullback last year, this was all the more striking. As Mutharia put it, “we are currently in a situation of trying to do more with less.”

My takeaway?

First, you have to applaud the responders to this crisis. And taken together with last year’s Ebola response in the DRC, this outbreak offers clear proof that the international community has lost neither the will nor the ability to respond to serious global health risks. For viruses like Marburg and Ebola (truly nightmare diseases) each day of delay makes them exponentially harder and more expensive to contain. At least for now, that lesson has not been unlearned.

Who controls Europe’s medicines?

Two stories out this week focus on Europe’s drug supply problem. (No, not the Ibiza kind.)

First, the Financial Times is reporting that U.S. pharmaceutical companies are openly threatening to withhold new medicines from Europe if governments refuse to pay higher prices.

Speaking at the JPMorgan health care conference, Pfizer CEO Albert Bourla framed the choice starkly: “When [we] do the math, shall we reduce the U.S. price to France’s level or stop supplying France? We [will] stop supplying France.” Other executives said they were considering delaying or skipping European launches altogether as they try to offset revenue lost from Trump-era price cuts in the United States.

At the same time, on Tuesday the European Parliament moved to shore up Europe’s pharmaceutical defenses. Lawmakers adopted proposals to rebuild manufacturing capacity inside the European Union and coordinate national stockpiles. Ultimately, the EU is pushing a “Buy European” approach that prioritizes security of supply and production within the bloc.

The takeaway? Europe is caught in a squeeze. Drugmakers are signaling they are willing to use access as leverage to raise prices, just as European lawmakers are trying to reduce their dependence on those same companies.

How the economics and politics will play out next is unclear, so I’ll be following up on this story.

Antibiotic optimism (with caveats)

A lot of modern medicine rests on a very fragile assumption that our antibiotics will keep working … and, uh, we know they won’t.

Drug-resistant infections kill millions of people globally each year, and new antibiotics are not being developed fast enough to keep up with the spread of resistance. (A large part of the issue is that antibiotics rarely recoup their R&D costs. In fact, biotech companies that specialize in them have a bad track record of going bust.)

But in an essay in the Washington Post, biochemist and antibiotic researcher Andre Hudson argues that the future may be a hopeful one. His case for optimism rests on the idea that (putting aside our laggardly development of new drugs) other scientific advancements may catch up to the threat.

He makes four main points: First, faster and more precise diagnostics are increasingly reducing unnecessary antibiotic use. Second, antibiotics are no longer the only tool in town. Hudson outlines how researchers are developing alternatives, including genetically engineered viruses (!) that hunt bacteria and gene-targeting tools to “disable resistance genes” in bacteria.

Third and fourth, Hudson finds hope in a clearer understanding of how resistance moves through entire systems, and in policy solutions meant to fix the economics behind antibiotic development. (Being frank here: This is where I feel the optimism is less earned.)

On the systems side, Hudson argues that drug resistance is finally being understood as more than a hospital problem. Antibiotics move through farms, food, wastewater, and trade, and that matters. But understanding the problem is not the same as controlling it. On policy, he points to ideas meant to fix the broken economics of antibiotics, including draft U.S. legislation that would pay companies for having lifesaving drugs available rather than selling more of them. It is a sensible fix. It has also been stuck in Congress for three years.

Still, a hopeful take!

American dollars … revisited?

Two stories out this week clarify what last year’s U.S. pullback in global health funding really amounted to, and what may come next this year.

The damage? All told, in 2025 the United States (still the world’s largest funder of global health) slashed its spending by roughly 66%, according to new end-of-year estimates reported in Think Global Health. It took months for this picture to come into focus, and “the cuts are bigger than we expected, not less,” said Joseph Dieleman, who leads financing tracking at the Institute for Health Metrics and Evaluation, a research group that analyzes health spending worldwide.

We’ve reported extensively on earlier data of the pullback, but it’s worth reading this article, particularly for the data visualization on where the cuts landed.

Looking forward, things are murkier … which is better than bad.

Devex is reporting that a draft, bipartisan foreign assistance bill for 2026 would allocate $9.4 billion for global health. That is still well below recent highs (down a quarter from the $12.4 billion in 2024) but far more than many expected after last year’s upheaval. The bill preserves core funding for HIV, malaria, tuberculosis, and polio, and includes unexpected support for the vaccine funding organization GAVI, alongside family planning money, and dollars for several U.N. agencies the administration had tried to zero out.

One takeaway is that this is a signal that the U.S. government is not ready to walk away from global health. Another is that the bill exposes a sharp divide between the majority Republican Congress and the Trump administration on global health funding.

Mitchell Warren, executive director of the HIV nonprofit AVAC (and a friend of the Checkup!) raises the most trenchant questions in the article: “Will both houses of Congress approve the bill? Will the president sign it? And, perhaps more importantly, will the president actually spend congressional appropriations and accept at last that it is Congress, and not him, who has the power of the purse?” he said.

What do these two stories mean together? “Bottom line is that while most programs have been gutted, most of the budgets are being preserved. Where and how those funds get spent remains to be seen,” Dieleman told me.

A ‘dirt cheap’ malaria defense

We’re going all in on optimism today, so why not end on a high note?

A clever new study suggests malaria prevention may already be woven into daily life, The Guardian reports. Researchers found that treating baby-carrying cloth wraps with insecticide cut malaria cases in infants by roughly two-thirds in parts of western Uganda.

The idea is brilliant. In many communities, babies spend much of the day tied to their mothers’ backs in cloth wraps. (I can’t stress enough just how ubiquitous this is in East Africa.) Treating those wraps with permethrin, the same insecticide used in bed nets, adds protection during hours when nets are not in use.

Anecdotal, but as one mother told the researchers: “I’ve had five children. This is the first one that I’ve carried in a treated wrap, and it’s the first time I’ve had a child who has not had malaria.”

The best part? “It’s dirt cheap,” reports one of the researchers.

As mosquitoes increasingly bite outdoors and earlier in the evening, treated wraps could help close one of malaria prevention’s most stubborn gaps. They won’t replace bed nets or vaccines, but they add protection exactly where infants already are, in a way that fits seamlessly into daily life.

I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Consolidation may be the answer to more austere global health funding

2026-01-15T13:43:48+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

It’s a new year and I’m happy to be back home, where the vanilla orchids in my garden are blooming. (They’re beautiful, but won’t form beans unless I get on a ladder and pollinate them by hand!) This week’s report ranges from a big proposal to remake global health institutions to a very concrete, “cynical” decision shaping health care in a humanitarian disaster.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Big structural reforms (try not to get too excited!)

Looking ahead to 2026, there are zero signs that last year’s global health cuts will revert. If anything, deeper reductions this year look like the more likely scenario.

And that leads us to the central challenge facing global health right now: Unless the goal is to just do less with less, this winter of austerity is a moment for the largest organizations in global health to reform. Either by slimming/changing their structures, or tightening their mandates. (As we’ve reported, the Global Polio Eradication Initiative deserves credit for being among the first to grapple seriously with this in practice.)

With that in mind, our first story this week is an essay in Think Global Health by Muhammad Ali Pate, Nigeria’s minister of health; Donald Kaberuka, the African Union’s top financing official; and Peter Piot, the former director of UNAIDS. Together, they argue that global health’s largest institutions should make changes that would have seemed unthinkable just a year ago.

Their proposal is deliberately severe.

At the center is a serious overhaul of institutions with overlapping mandates. The authors argue that GAVI and The Global Fund (the two biggest international funding organizations in global health outside the World Health Organization) should be merged into a single entity, writing that “financing institutions should form a holding company with a single governance and secretariat.” Under this model, that body could also absorb various other smaller organizations, including the “Pandemic Fund, Unitaid, and the Global Drug Facility for TB.”

The consolidation would not stop there. Other “single-disease entities that were created at the start of the millennium — such as Roll Back Malaria and Stop TB” could be folded in as offices under the same structure, or potentially into WHO itself. Ultimately, it’s hard to argue with their logic that in a world of shrinking budgets, funding parallel institutions built for an era of expansion is increasingly hard to justify.

Cost cutting is explicitly part of their vision, and the authors note an initial target: “The expensive Geneva presence should be minimized.” (It’s worth noting that Geneva is one of the most expensive cities in the world to house and support international staff.)

To gauge how this idea is landing among policy insiders, I reached out to Pete Baker, deputy director of global health policy and policy fellow at the Center for Global Development, a leading think tank tackling these ideas. Baker welcomed the proposal. “This is an important contribution to the current global health reform debate,” he told me, adding that consolidation could do more than cut costs. In his view, “one institution with a broader mandate could improve efficiency and be better at building health systems.”

But Baker is also clear-eyed about the obstacles. “However, this kind of merger will be very time consuming,” and cautioned that because we are talking about massive staffing redundancy, “each organization’s board and secretariat may resist it.” (I am reading this as a massive understatement.)

He leaves us with a set of open questions that will hang over global health reform throughout the year: “This will also consume a huge amount of effort from global health leaders. Will it be worth it?” he asks. “Or will it be easier to close existing institutions, and set up a new financing mechanism? One that is aligned to the multilateral development banks, broadly supports health system development, funds on-budget and backcountry priorities — and crucially — also provides loans as well as grants as countries get wealthier?”

A ‘cynical’ ban of health aid groups in Gaza

Let’s turn to what, despite a ceasefire, is still one of the world’s worst man-made humanitarian disasters: Gaza.

Israel has moved to ban dozens of international aid organizations from Gaza, which the British Medical Journal reports will sharply reduce an already abysmal state of medical care.

Under new registration rules, NGOs must hand over personal information on Palestinian staff to Israeli authorities or lose their ability to operate. Groups including Doctors Without Borders, Oxfam, and the Norwegian Refugee Council say the requirements put workers at risk and violate humanitarian principles. Israel argues the measures are necessary to prevent armed groups from infiltrating aid operations, an accusation the organizations strongly deny.

The potential impact of the bans is severe. “Overall, around 60% of Gaza’s field hospitals are run or supported by such international non-governmental organizations,” and Doctors Without Borders alone backs about a fifth of hospital beds and a third of births.

This is in the context where “more than 500 humanitarian workers [and] at least 1,700 health workers have been killed” in Gaza since October 2023, making demands for staff lists especially fraught.

Doctors Without Borders calls the policy a “cynical and calculated” move that could leave Palestinians without lifesaving care, at a moment when winter conditions, flooding, and aid restrictions are already proving deadly. Taken together with Israel’s earlier ban on UNRWA (the U.N. agency for Palestinian refugees), the decision signals a further, deadly contraction of humanitarian space in Gaza.

I reached out to Elisabeth Mahase, who reported the story, to ask how she sees this move in the context of years of grim news for Gaza’s health system. She emphasized that “considering how inadequate the health care capacity already is compared to the need, any loss in this space will have a devastating impact on Gazans. Palestinians in Gaza desperately need more aid and more health care, not less,” Mahase said.

Burning plastic indoors is surprisingly common

A new study has put numbers on a historically under-reported health risk: burning plastic inside the home for heat or cooking. One in three people in poor urban communities have seen it, and one in six say they have done it, The Guardian reports.

As you probably know: Burning plastic releases a noxious mix of pollutants, including “dioxins, furans, and heavy metals.” These are all chemical classes linked to respiratory disease, heart problems, cancer, and developmental harm.

Researchers have also found these toxins in soil and food near burn sites, raising concerns about longer-term contamination of local food chains. No real surprise here, but the practice is most common where waste collection is weak, and cleaner fuels are unaffordable or unavailable.

What’s the takeaway? The authors argue this is a major blindspot in global health and environmental policy. (On a personal level, I agree. I’ve seen a lot of burning plastic in my decade on the African continent, but even I find this rather surprising. What I’ve seen is usually outside, and done as a way to dispose of trash.)

Household plastic burning rarely shows up in official pollution data, yet plastic waste is expected to nearly triple by 2060. Without investment in basic waste services, cleaner cooking options, and public awareness, this is a health threat that will keep growing.

More funding for Marburg?

The European Union has announced $1.4 million in new funding for the ongoing outbreak of Marburg virus in Jinka, southern Ethiopia (a city I last visited in 2022 for work.) The new funding will be split among the WHO and two of the biggest organizations working on the ground: the International Medical Corps and the Red Cross.

Disease breakdown: Marburg virus is a high-fatality fever that is similar to Ebola, and often leads to hemorrhaging and organ failure. Untreated, about 9 in 10 people who contract the disease will die. The disease exists endemically in bats, allowing it to spread and occasionally spill over into humans. While this ongoing epidemic is Ethiopia’s first record of the disease, the WHO says the strain matches those seen in past regional flare-ups. There is, unfortunately, no vaccine.

What makes this announcement notable, and a little odd, is the timing. Just last week, the Ethiopian Ministry of Health announced the country had gone 21 days without a new Marburg case, essentially putting the outbreak halfway to epidemic control. That’s the kind of milestone that is usually announced, or at least echoed, by the WHO. Yet an International Medical Corps briefing Friday painted a very different picture, describing a ramping up of the response effort in Jinka.

This matters because, like the Democratic Republic of the Congo’s Ebola outbreak last year, Marburg in Ethiopia is shaping up to be an early test of how well the world can control one of its deadliest viruses in an era of global health austerity. Right now, the funding announcements and official signals don’t fully line up. It’s unclear whether they reflect caution and bureaucratic lag, or if there’s genuine concern that the outbreak is not as contained as it appears. I’ll be following up with independent reporting next week to try to sort out which story is closer to the truth.

Parenthood only needed this 13% tax

Let’s end this week’s report with a story that I’m sharing because, well, it just gets stranger the longer you sit with it. As Reuters reports, China has scrapped “a three decade-old tax exemption on contraceptive drugs and devices … to spur a flagging birth rate.”

Condoms and contraceptive pills are now subject to a 13% tax. Of course, this is not China’s first attempt to centrally engineer fertility decisions, though it may be one of the more delicate nudges. (The country, after all, enforced the one-child policy from 1980 to 2015.)

Yes, this move is just one of several recent efforts aimed at pushing China’s birth rates upward. But … I just can’t fathom how a 13% tax is really meant to nudge would-be parents in the direction of a newborn! A 130% price hike? Maybe at the margins. A 1,300% increase? Sure, I could see that.

But as a parent whose child just entered pre-K this week, let me say: Kids are incomparably expensive to a one-time tax. They’re more of an uncancelable subscription service that has a very aggressive pricing model.

Condoms in China are already extremely cheap by global standards, costing just a few cents at the low end (yes, I looked up a Chinese condom industry report.) So… I’d like to meet the person staring at a half-cent price increase and thinking, “Well, that settles it. Let’s just have the baby.”

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

‘Aha’ moment in public health: Building relationships before the next outbreak

2026-01-06T14:39:35+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 18 at Powerhouse Arena bookstore in Brooklyn. Watch the full show here. Sign up to receive Healthbeat’s free New York newsletter here.

In July 2015, I stood in front of a packed auditorium in the South Bronx. People were wedged shoulder to shoulder on folding chairs. Another hundred or so crowded the hallway outside, many trying to squeeze in.

I came there to talk about facts. They came there to talk about injustice. That was the night I learned that relationships always come first, and facts come second.

The town hall was organized by the Bronx Borough president to discuss a large outbreak of Legionnaires’ Disease. Legionnaires’ disease is a severe pneumonia caused by bacteria that grow in water. One common source is cooling towers. They sit on rooftops and release a mist that can carry bacteria hundreds of yards through the air. This outbreak had already sickened dozens of people in the South Bronx, and the numbers were rising each day.

I sat in the front of the room. I felt prepared.

I was wearing my favorite suit. Charcoal gray, the J. Crew Ludlow type, similar to the ones our new mayor wears. Sure, it was not the most appropriate choice for a hot summer day. But it was appropriate for my goal that evening: to project credibility, authority, and trust.

I also carried the tools of the public health trade. Maps. Figures. And, most important, the confidence that the best epidemiologists, microbiologists, and environmental health experts in the city had gathered the data, crunched the numbers, and used this to contain the threat. I believed that if I explained the data clearly enough, people would leave reassured.

That is not what happened.

I started the way the Centers for Disease Control and Prevention had trained me. First, describe the disease, its cause, how it spreads, and how it gets treated. Next, describe the investigation. I showed a map of cases and explained that the pattern pointed to something that had been in the air. I told the room that we had identified several contaminated cooling towers, that one of them was the most likely source of the outbreak, and that we had ordered the contaminated towers cleaned.

The air was now safe to breathe.

When I stopped talking, I scanned the room. People’s heads shook from side to side in disagreement. They turned to their neighbors and scowled. Hands shot up. People shouted over one another.

I felt confused. Had I not explained the facts clearly enough? Maybe I should just repeat it with a little different phrasing?

A woman’s voice rose from the back. She spoke sharply and forcefully, and it stopped everyone else from talking, “Why is the outbreak only happening in the Bronx? Why is it always happening here. In our community.”

I felt the power rush out of my suit. It was now constricting me. My palms were sweating, and my black leather shoes were weighing me down.

I had not come prepared to answer that question.

When I get flustered, I don’t stop to think. Or to listen. I just start talking. And then talk some more.

I kept repeating that the air was safe, that the water was safe, that we had fixed the problem. Those were the facts. But the facts weren’t quelling anyone’s anger.

This is the moment that stays with me. That moment when I realized the facts are not enough.

By the time I got to that town hall, I was confident we had found and cleaned the most likely source of the outbreak: a cooling tower on top of a boutique hotel near where we were speaking that night. So, when I said the air was safe, I meant it.

When they heard me say that, they heard something very different.

They heard government saying, “Just calm down. No need to get all worked up.”

They heard a system that had failed to protect them in the past now asking them to trust that this time was different. They heard the long history of neglect that shaped their daily lives well before this outbreak started.

In this community, where chronic disease, environmental pollution, violence, and racism are fixtures of daily life, this outbreak felt like yet another insult. Yet another unfair injury.

Why does this always happen here?

Why is our neighborhood the one that always suffers?

Why should we believe you now?

I came to talk about pathogens and probabilities. They came to talk about fairness and dignity. They wanted to know whether their lives truly counted as much as everyone else’s.

I realized that I had walked into that room thinking my job was to lower fear by explaining risk. What I had not understood, until that night, was that my job was to feel their outrage and connect with them at an emotional level.

The anger in that room was not fundamentally about risks or the facts of the case. It was about the relationship between the city government and this community and their outrage at the way they had been treated in this relationship.

Outrage is shaped as much by history as it is by acute hazards. Communities react to threats based on the stress they already carry, the inequities they already endure, and the ways institutions have treated them long before the first person became sick in this outbreak.

What I learned that night is simple but often overlooked: If you want people to trust you in a crisis, get to know them before the crisis.

As public health officials, we cannot focus only technical excellence. We must focus equally on our relationships with people and communities.

If we wait until an outbreak to learn how people live, what they love, what they fear, and how government has failed them in the past, then we will be speaking past them at the exact moment we need to be speaking with them.

In public health, relationships come first, and facts come second.

Dr. Jay K. Varma is a special contributor to Healthbeat, sharing his expertise from a long career in public health. As a physician and epidemiologist, he is an expert in the prevention and control of infectious diseases who has served as a public health official in New York City.

Screwworm threat returns to U.S.: Why it matters

2026-01-05T14:29:14+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In 2025, the United States faced a series of reminders that the security of our food supply depends on public health systems that are largely invisible to the general population. Poultry and dairy production were disrupted by H5N1 avian influenza and infant formula by botulism contamination. Less visible was a parasite that once terrified American ranchers: the New World screwworm.

The resurgence of screwworm highlights the fragility of infectious disease control and the importance of sustained government cooperation across different sectors and across international borders.

What screwworm is and why it matters

The New World screwworm is caused by the larvae of a blowfly called Cochliomyia hominivorax. The adult fly targets warm-blooded animals, most often cattle, and lays its eggs in open wounds. These wounds can be large, such as those caused by branding or dehorning, or barely visible, such as a tick bite or an abrasion.

Within hours, the eggs hatch, and the larvae burrow into the flesh and feed aggressively on living tissue. (This is what distinguishes screwworm from other maggots, which eat decaying or dead tissue.) As the larvae grow, the wound expands, attracting more flies, which deposit even more eggs. The larvae cause severe pain, tissue destruction, secondary infections, and often death of the animal.

After several days, mature larvae drop to the ground, pupate in the soil, and emerge as adult flies ready to repeat the cycle on another cow. Under warm conditions, the entire process can take only a few weeks. In a herd setting, infestations can spread rapidly, devastating entire herds of cattle.

Before eradication, screwworm caused hundreds of millions of dollars in financial losses each year in the United States. Ranchers spent enormous time and money on treatment and prevention. The parasite also occasionally infected wildlife, pets, and some humans.

How screwworm was controlled in the 20th century

Beginning in the mid 20th century, U.S. scientists developed a special technique to stop screwworm reproduction. The “sterile insect technique” involved breeding millions of male screwworm flies in specialized facilities, sterilizing them with radiation, and releasing them into the wild. Because female screwworm flies mate only once, they produce no offspring after they mate with a sterile male fly. Over time, the screwworm population dies off.

Using this approach, screwworm was eliminated from the United States by the mid 1960s. The program then moved south, in collaboration with Mexico and Central American countries. By the early 2000s, screwworm had been pushed as far south of the United States as Panama. Every week, sterile flies were released to prevent northward spread from endemic regions in South America, creating a biological barrier to screwworm making its way into the United States.

This screwworm control program remains one of the most successful examples of international disease control in the Americas. To maintain it, however, requires constant effort to produce sterile flies and conduct surveillance for breakthrough infections.

Why the screwworm threat has returned

For decades, screwworm was largely absent from the United States and Mexico. That changed in 2023, when outbreaks began spreading northward through Central America and into southern Mexico. The reasons are still being investigated, but likely include interruptions in sterile fly production during the Covid pandemic, increased movement of cattle and people, and the sheer difficulty of maintaining surveillance across remote terrain.

In August, the United States confirmed its first human screwworm case in decades. The patient, a Maryland resident, had recently traveled to El Salvador and returned with larvae embedded in living tissue. The infection was treated successfully, and there was no evidence that infection was either acquired locally or transmitted onward.

While the risk to Americans of this case was low, it was considered an important warning sign. Because they are so rare, even one human screwworm infection suggests widespread prevalence in animals.

The economic stakes are particularly worrisome. Cattle herd sizes in the United States are near historic lows due to drought and rising costs. In response to the screwworm threat, the United States halted cattle imports from Mexico in 2025. Prolonged disruption could drive prices higher, an important problem because the average American consumes 60 pounds of beef each year.

What is being done to stop the New World Screwworm outbreak?

The United States and Mexico have begun to rebuild the capacity that previously stopped screwworm transmission in both countries. Sterile insect production in Panama has been expanded to release roughly 100 million flies per week. Facilities in southern Mexico are being renovated to produce tens of millions more, and the U.S. Department of Agriculture is working on additional dispersal capacity in Texas.

These efforts are expensive and slow. Experts estimate that several hundred million sterile flies per week may be needed to re-establish the barrier that once existed. At the same time, workforce reductions and loss of institutional memory are making it harder for the U.S. government to respond quickly.

New tools are also emerging. Last month, the Food and Drug Administration conditionally approved a topical antiparasitic drug for cattle that can help prevent or treat screwworm infestations. While this drug gives cattle farmers another option, there are challenges with using it; it is prescription only, has withdrawal periods, and cannot be used in all cattle.

Why this matters beyond screwworm

The return of screwworm illustrates broader lessons about public health and food security. When they work, public health protections are invisible, and, when they fail, the consequences are difficult and expensive.

Particularly with food security, these protections must embrace a One Health model, in which human, animal, and environmental sectors work in partnership. And, finally, at a time when the United States has dramatically cut its global health workforce, screwworm offers an important example about why such work remains essential.

Dr. Jay K. Varma is a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

ByHeart baby formula recall: What to know about 4 new developments

2025-12-19T23:30:03+00:00

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It’s been six weeks since ByHeart Inc. began recalling its popular organic baby formula amid a nationwide outbreak of infant botulism – and nearly two years since children started becoming infected across the country.

Here are four things to know about the latest developments in the outbreak investigation and formula recall.

Some good news: No new cases of sick infants discovered in the past week

The U.S. Food and Drug Administration announced this week that the identification of new infant botulism cases linked to ByHeart infant formula has slowed, with none identified during the past week.

The number of infants known to have been sickened in the outbreak remains at 51 – and all of them required hospitalization. The infants live in 19 states. There have been no deaths.

The most recent date a child started showing signs of illness was Dec. 1, according to the FDA.

The lack of new cases is an encouraging sign. ByHeart did an initial, limited recall of its formula products on Nov. 8, followed by a recall of all of its products on Nov. 11.

But it can take up to 30 days after an infant ingests botulism spores for the bacteria to start growing in the child’s immature gut and produce a toxin that causes symptoms, such as constipation, poor eating, loss of head control, difficulty swallowing and breathing, and potentially respiratory arrest. And ByHeart formula remained on the shelves of some stores for weeks after the recall. (More on this below.)

Some bad news: The discovery that babies started being sickened two years ago

Until recently, federal health officials had said the earliest outbreak illnesses began in August. But they’ve now identified children who were fed ByHeart formula who were hospitalized with infant botulism as far back as December 2023.

The Centers for Disease Control and Prevention has expanded its outbreak case definition to include any infant with botulism who was exposed to ByHeart baby formula at any time since the product first went on the market in March 2022.

Initially, investigators were focused only on infants sickened since Aug. 1, 2025. When they looked at earlier infant botulism cases, they identified 10 additional children who consumed ByHeart products and fell ill from December 2023 through July 2025. Those cases are included in the 51 total outbreak cases.

While no cases have been identified before December 2023, the investigation is ongoing, and the FDA said it “cannot rule out the possibility that contamination might have affected all ByHeart formula products.”

Federal officials and ByHeart say they are still investigating how botulism bacteria spores got into ByHeart formula.

FDA issues warning letters to retailers that kept selling recalled ByHeart formula

Retailers across the country continued to sell ByHeart infant formula for weeks after the recall began on Nov. 8 and was expanded to include all products on Nov. 11.

State and local food safety officials along with FDA inspectors performed more than 4,000 spot-checks of retail stores across the country to ensure recalled ByHeart’s formula was no longer being sold. Yet they continued to find ByHeart products on store shelves at more than 175 locations in 36 states, the FDA said.

However, those checks of retail stores, Healthbeat reported last month, were slowed by FDA delays in sharing ByHeart product distribution lists with state and local officials.

The FDA says it hasn’t received any reports of recalled ByHeart formula still being on store shelves since Nov. 26.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered ByHeart single-serve “anywhere pack” sticks on a shelf with a promotional “Sale!” sign offering a $2 discount more than a week after all of the company’s products were recalled because of botulism risks.

This week the FDA called on food industry officials across the country to improve their compliance with protecting the public from recalled products.

The FDA also announced it sent formal warning letters on Dec. 12 to corporate officials at Target, Walmart, Kroger, and Albertsons Companies for failing to remove ByHeart products from their store shelves.

At a Target store in Arkansas, state inspectors on Nov. 20 discovered a promotional “Sale!” sign offering a $2 discount off recalled ByHeart single-serve “anywhere pack” sticks from Nov. 16 to Nov. 22, according to the FDA’s warning letter to the company.

Investigators found recalled ByHeart formula on Target store shelves across 20 states from Nov. 12 to Nov. 20, the FDA’s letter said.

Workers at Target stores – as well as those at Walmart stores in 21 states, Kroger stores in 10 states, Albertsons Companies’ stores operated under various names in 11 states – gave state and local inspectors a variety of explanations for the presence of ByHeart formula in stores after the recalls were launched, the letters say.

Explanations included that store associates weren’t aware of the recall and that there was confusion over which specific lots were recalled. Workers also told investigators that there were failures to remove all of the recalled products from shelves and that stocking of shelves occurred when recalled products arrived after the recall notification, the warning letters say.

The four companies have 15 days to respond to the FDA warning letters with steps they are taking to address violations or provide information supporting why they believe they haven’t violated the law.

In a statement to Healthbeat, Walmart said: “We take all reports of inaction seriously and will respond to the letter.” The company said it “moved swiftly” to issue a sales restriction and remove the product from its stores and online platform.

Albertsons Companies said they have procedures to address product recalls and that ByHeart products have been removed from their stores. Target and Kroger did not immediately respond to Healthbeat’s requests for comment on their warning letters.

Food safety groups call for botulism testing, investigation of recall delays

The ByHeart formula recall and outbreak has “exposed dangerous deficiencies” in the nation’s food inspection and regulatory systems, according to a letter sent to the heads of the FDA, CDC and Department of Health and Human Services by the Safe Food Coalition, whose members are national food safety advocacy groups.

The five-page letter calls for a range of reforms to strengthen food safety inspections and regulations and improve the speed of recalls. It also urges fully funding food safety work and illness surveillance systems at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.

Citing Healthbeat’s reporting, the coalition is calling for the FDA to investigate bureaucratic delays in releasing to state food safety regulators the names of retailers that received ByHeart’s recalled products. It’s a lengthy process “that can and must be streamlined not just with respect to recall communication, but for all communication with state regulators,” the Dec. 8 letter said.

The Safe Food Coalition letter, among its many recommendations, also calls for the FDA to declare contamination with Clostridium botulinum to be a hazard that requires prevention and must be addressed in manufacturers’ food safety plans. And it urges the FDA to conduct a nationwide sampling program to test infant formula for this type of bacteria, which causes infant botulism.

“I think it’s critically important that the agency go out there in the field and do a survey of all the infant formula out there to reassure consumers and to understand whether this is a broader problem,” Sarah Sorscher, director of regulatory affairs at the Center for Science in the Public Interest, told Healthbeat.

Other groups in the Safe Food Coalition that signed the letter include the Center for Food Safety, Consumer Federation of America, Consumer Reports, Government Accountability Project, the Institute for Food Safety and Nutrition Security at George Washington University, and Stop Foodborne Illness.

Federal officials have not yet replied to the coalition’s letter. “HHS is in receipt of the letter and will respond directly to the requestors,” HHS said Friday in an email to Healthbeat.

“FDA acted quickly to protect the public, issuing multiple warnings alongside the firm’s initial and expanded recall,” HHS said in its email.

The FDA has previously not responded to Healthbeat’s questions about delays in sharing ByHeart’s product distribution lists with local and state food safety regulators.

HHS said Friday that the FDA began conducting its own recall effectiveness checks “at the corporate level of large retailers” on Nov. 10 – two days after ByHeart announced its initial recall of two batches of formula.

The FDA didn’t receive ByHeart’s product distribution lists from the company until Nov. 12, the day after the company expanded the recall to all products, HHS said. The list was shared the same day with a subset of state food safety regulators who had information-sharing agreements on file with the FDA, the HHS said.

HHS acknowledged that the FDA had to go through a process to obtain exceptions for local and state regulators that lacked information agreements and “where such sharing of commercial confidential information would be otherwise prohibited under the Trade Secrets Act.”

Healthbeat reported last month that according to the Association of Food and Drug Officials – whose members are state and local regulators – the FDA didn’t start fully sharing ByHeart’s product distribution lists with all state and local officials until a teleconference held at 6 p.m. on Nov. 14 – nearly a week after the formula was linked to the outbreak and the company had launched its initial recall on Nov. 8.

HHS did not say how many states had information sharing agreements with FDA that allowed them to receive the distribution lists on Nov. 12. The department only said a “majority” of the 50 states and the District of Columbia have the agreements.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

Vaccine panel’s hepatitis B vote signals further turbulence for immunization policy, public trust

2025-12-12T14:36:10+00:00

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When Su Wang was in medical school, she donated blood. That’s when she learned she was infected with hepatitis B, a virus that attacks the liver and can lead to cancer and death decades later.

“I was 18, healthy, in college,” she said. “And suddenly I had a chronic illness I didn’t even know about.”

Born in Florida in 1975, Wang grew up before the hepatitis B vaccine was routinely given to newborns. For years, she assumed she had been infected by her mother, only to discover later that both her parents were negative. “It turns out my grandparents, who cared for me after birth, probably passed it to me,” she said. “That’s how easy this virus spreads — not from some exotic risk factor, just family.”

Today, Wang is the medical director for viral hepatitis programs at RWJBarnabas Health in New Jersey. Her story now sits at the center of a historic turning point in public health.

On Dec. 5, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted to end the universal U.S. recommendation for the newborn dose of the hepatitis B vaccine, instead adopting a policy urging individual-based decision-making.

Under the new approach, only infants born to mothers who test positive for hepatitis B will automatically receive a dose of the vaccine and hepatitis B antibodies shortly after birth. For everyone else, if the parents choose to vaccinate, the birth dose can be delayed until 2 months of age.

All the committee members were appointed by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime anti-vaccine activist. In an 8-to-3 vote, the panel decided that since most pregnant women now receive hepatitis B testing, administering the vaccine at birth should be reserved for infants whose mothers test positive. They framed the shift as a way to reduce interventions deemed unnecessary, align vaccination with test results, and give parents more control over timing. Supporters of the decision described it as a move toward parental choice rather than a reflection of changing epidemiology.

Vaccine panel drops recommendation that all newborns get hepatitis B shot

But to many clinicians and epidemiologists, the change represents a dangerous rollback that could reverse three decades of progress toward eliminating a disease that still infects as many as 2.4 million Americans and kills tens of thousands each year. They see echoes of the 1980s, when risk-based vaccination left entire generations unprotected, and worry the country is about to repeat that mistake.

Moreover, the panel’s move on hepatitis B — in the face of overwhelming data that show the birth dose is effective and safe — portends further upheaval for the nation’s childhood vaccine schedule, a cornerstone of public health.

“They’re not just trying to change one vaccine,” said Angela Rasmussen, a virologist and an editor of the scientific journal Vaccine. “They’re trying to dismantle how vaccine policy is made.”

Department of Health and Human Services spokesperson Emily Hilliard responded: “ACIP reviews all evidence presented and issues recommendations based on evidence and sound judgment to best protect America’s children.”

The authors of a new independent review by the Vaccine Integrity Project, which evaluated more than 400 studies and reports, warned in a public comment that delaying the birth dose “would reduce protection for infants and increase the risk of avoidable HBV infections, undermining decades of progress” toward eliminating the hepatitis B virus. The review was led by researchers at the University of Minnesota’s Center for Infectious Disease Research and Policy, which created the Vaccine Integrity Project in response to what it regards as Trump administration actions that “put the federal vaccine landscape at risk,” and it was vetted by outside experts.

“We fought hard for that universal birth dose because targeted approaches missed too many babies,” Wang said. “We know what happens when you wait.”

What’s unfolding now is not just a technical policy update but a fundamental test of the systems meant to protect the most vulnerable. The debate turns on a few critical questions — whether testing is reliable enough to replace universal safeguards, how infectious hepatitis B truly is, why past strategies failed, and what the CDC’s internal shake-ups mean for vaccine policy writ large.

Why universal vaccination was created

Hepatitis B testing sits at the center of the new ACIP recommendation, but even the CDC acknowledges that testing alone can’t guarantee protection. Pregnant women may test negative if the virus was acquired late in pregnancy or during the “window period,” before hepatitis B surface antigens become detectable. False negatives happen. No testing system, no matter how well designed, can catch every infection. That’s why universal vaccination was created in the first place.

If a mother’s status is unknown at delivery, hospitals are supposed to give the newborn a hepatitis B vaccine within 12 hours, adding hepatitis B antibodies for premature infants or if the mother later tests positive. But in real clinical settings, these safeguards routinely break down. Results take time. Nurses miss or misread labs. Pharmacies delay deliveries. Documentation gets lost.

“Every step you add increases the chance that something falls through the cracks,” Wang said. “Delaying the vaccine just adds another.”

ACIP’s vote shows how that logic is being challenged.

RFK Jr. wants to delay the hepatitis B vaccine. Here’s what parents need to know.

Some committee members suggested dropping the third hepatitis B shot if antibody levels look high after the second.

But Brian McMahon, a liver disease specialist who has spent decades treating hepatitis B, told the panelists that the data doesn’t support that idea. “Only maybe 20% to 30%” of infants have an adequate antibody level after the first dose, he said.

“You need two doses to really reach a high level of protection,” he said, with the third shot giving a stronger, longer-lasting response.

He said the overall message coming from the committee seemed designed to “discourage the birth dose.”

“They’re making it more and more difficult,” McMahon said.

In a second vote, ACIP also encouraged parents and clinicians to order post-vaccine serology tests — blood tests that measure protective antibody levels — after the second or third dose. The tests, ACIP said, should be covered by insurance.

Hepatitis B is more infectious than HIV or hepatitis C

Hepatitis B can survive on toothbrushes, razors, and household surfaces for a week. It spreads not just from mother to child but also through ordinary family contact: shared items, open sores, small blood exposures. In the 1980s, researchers found that about half of infections in American children came not from mothers but from other household members.

That’s why state health departments continue to insist that every newborn be vaccinated within 24 hours of delivery, regardless of maternal status. “Delaying vaccination misses a crucial period of potential exposure,” a New York advisory warned this year. The vaccine, it noted, is 80% to 100% effective when given on time.

The Vaccine Integrity Project report underscores the stakes. Since the universal birth dose was introduced in 1991, pediatric hepatitis B infections in the United States have dropped by more than 99%. A 2024 CDC analysis estimated that the current schedule has prevented more than 6 million hepatitis B infections and nearly 1 million hospitalizations.

The benefits are lifelong. Infants vaccinated at birth are shielded not just from hepatitis B but also from the liver failure and cancer it can cause decades later. Yet because the disease unfolds slowly, the consequences of policy shifts may not surface for 20 or 30 years.

Trieu Pham, a California physician, doesn’t need to imagine those consequences. Born in Vietnam in 1976, he probably contracted the virus at birth. “If the vaccine had existed then, I wouldn’t have gone through what I did,” he said. Diagnosed in his 20s, he developed cirrhosis by 40. At 47, he was coughing blood from ruptured esophageal veins. Eventually, he required a liver transplant to survive.

“You live with this constant fatigue and fear,” he said. “And the saddest part is it was preventable.”

His three children, all vaccinated within hours of birth, are free of hepatitis B. “That’s the difference a day can make,” Pham said.

Data show the universal strategy is most effective

In 1982, ACIP recommended the new hepatitis B vaccine only for adults at high risk: health care workers, injection drug users, and men who have sex with men. But by the late 1980s, it was clear that risk-based vaccination couldn’t contain transmission. Many newly infected adults didn’t fit any defined risk group. Identifying high-risk people proved imperfect, stigmatizing, and ultimately ineffective.

Meanwhile, infants infected during or shortly after birth had a 90% chance of developing chronic infection, compared with less than 5% in adults. Yet public health officials repeated the same targeted strategy, this time with newborns. In 1988, the CDC recommended universal prenatal screening and linked an infant’s vaccination to the mother’s test result, again basing protection on a risk marker instead of vaccinating all infants.

As before, it failed. Many infected mothers weren’t correctly identified. Some were never tested, some were tested too early, and others had results that were misread or never communicated. Too many infants slipped through the cracks, proof that another targeted approach couldn’t reliably protect them.

In 1991, the CDC issued its landmark guidance recommending that all infants, regardless of their mother’s infection status, receive a hepatitis B vaccine at birth, followed by two additional doses in infancy. By 2005, the policy was fully embedded in the routine immunization schedule, then reaffirmed in 2018. This evolution was based on data showing that a universal strategy, rather than a targeted one, was the most effective in preventing infections.

U.S. stands alone in abandoning birth dose

The CDC’s new hepatitis B policy rests on the premise that moving the decision to parents will strengthen trust in the vaccine system. Supporters frame it as an empowerment shift — a way to give families more control.

In 1999, when it was last recommended to postpone the first dose of hepatitis B vaccine for infants born to uninfected mothers, vaccination rates also dropped among infants born to those who were infected.

“Opt-in policies sound patient-centered,” Wang said, “but in practice they’re inequitable. They leave behind the very families who need protection most” — the ones most likely to miss prenatal care and testing, have infections that go undetected or arise after testing, or slip through gaps in hospital care, as well as infants who can be exposed and infected by other caregivers and household members.

Those are often immigrant families, including from Asian and Pacific Islander communities in which hepatitis B remains endemic. “We already underdiagnose and undertreat these populations,” Wang said. “This change would deepen that gap.”

The United States is now the only country to abandon a universal hepatitis B birth dose recommendation. Though it will take decades to gather outcomes data, some researchers predict that delaying the first dose of hepatitis B vaccine to 2 months of age could result in over 1,400 preventable infections and about 300 cases of liver cancer per year.

“We don’t get to choose what we inherit,” Wang said. “But we do get to choose what we pass on.”

This story originally published at KFF Health News, Healthbeat’s national reporting partner.

Kenya signs first U.S. aid deal – but can it afford to pay its share?

2025-12-11T12:00:00+00:00

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Hello from Nairobi.

Last weekend I went to an ugly-sweater holiday party at the start of the dry season and learned something important about hubris. There is hot, there is very hot, and then there is “woolen knitwear in equatorial sun.” I will choose differently next time.

What’s new this week? Some big moves on American foreign aid, plus we’ve hit the point in the year when the consequences of the past 12 months are starting to show up in the data. Some of what follows is tough reading, but I promise we will end on something light.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Kenya signs the first ‘America First’ health deal

Allow me start this week’s opening story with a short rewind on what happened this year to America’s aid bureaucracy. (Bear with me, the background really does matter.)

Earlier this year, the Trump administration shut down America’s foreign aid agency, the United States Agency for International Development. While most American aid programs ended with it, about 17% of USAID’s former contracts survived. These included some (though not all) lifesaving global health programs. By July, those programs were all transferred to the State Department, which has been quietly rehiring former USAID staff as temporary contractors to keep them running. Still, for months the ultimate fate of that remaining health aid was anybody’s guess.

Finally, in September, the State Department announced a new plan for American health aid moving forward, which was presented under the banner of “America First.” The heart of the new approach would be country-by-country deals. But the announcement left huge questions about actual funding and long-term commitments unanswered.

Still with me? This brings us to the latest news.

The United States finally signed the first of those global deals here in Kenya last week, Health Policy Watch reports. The agreement promises “$1.6 billion over the next five years,” for priorities like malaria control and disease surveillance, and hinges on Kenya committing to raise its own health spending by $850 million. Moving forward, American officials say as many as 49 more agreements could follow in Africa alone.

There has been some hubbub in Kenya about one clause in the deal, which requires the Kenyan government to share health surveillance data with the United States for 25 years, including providing U.S. businesses with genetic data. (I initially didn’t read this as a nefarious data grab, but instead as Washington trying to patch the disease reporting gap it opened when it pulled out of the World Health Organization.)

Meanwhile, Secretary of State Marco Rubio praised the agreement’s new approach by saying, “We are not going to spend billions of dollars funding the NGO industrial complex while close and important partners like Kenya either have no role to play or have very little influence over how health care money is being spent.” It’s worth noting: That framing is flat-out inaccurate, since USAID historically co-designed Kenya’s health programs with the Kenyan government, and routed much of its funding through local Kenyan organizations.

This all gets to my bigger question: How much is actually different in practice, once you sift past the rhetoric? I reached out to John Kuehnle, my old colleague who actually ran America’s health programs for USAID in Kenya from 2020 to 2024, to ask. (Today Kuehnle is the CEO of the American NGO Partners for World Health).

Kuehnle welcomes the effort to persuade Kenya to invest more of its own money, which he says mirrors what USAID and the Centers for Disease Control and Prevention had pushed for years. But he warns that “the challenge that we always had was that we knew that even if we got the Kenyan government to agree to increase spending over time, fiscally that would be very difficult for them to actually do. I don’t think that has changed,” he said. (It’s worth noting that the agreement is, uh, non-binding.)

“I think that the Kenyan government signed this agreement out of desperation to guarantee funding for the next five years, and buy time in the hopes that their financial situation improves, or that there is a regime change in the U.S. that is open to renegotiating [the agreement] when it ends,” Kuehnle said.

As the agreement rolls out, Kuehnle points to a few key signals to watch.

For one, “the U.S. government currently does not have enough staff in Kenya to manage an [agreement] like this. Keep an eye on ... the amount of funding that actually moves.” And perhaps most importantly, Kuehnle raised the specter of the c-word that had constrained many of USAID’s earlier attempts to route money more directly through governments like Kenya’s: corruption. “I think many Kenyans outside of the Kenyan government do not believe that their government can be trusted to manage funds directly,” he said.

Preventable childhood deaths are increasing

For the first time in 25 years, childhood deaths from preventable diseases are rising globally, TIME magazine reports. (This is according to University of Washington researchers in the Gates Foundation’s annual report on global health.) All told, an additional 200,000 children under 5 are expected to die in 2025, bringing the total to about 4.8 million. (Disclosure: The Gates Foundation is a funder of Healthbeat).

To be clear, these are deaths that could have been entirely avoided “with vaccines or other [existing] treatments.” In the report (which can be downloaded here) Bill Gates himself puts this compound tragedy fairly succinctly: “There’s something especially devastating about a child dying of a disease we know how to prevent.”

Regular readers of the Global Health Checkup probably won’t be surprised by what is being fingered as the primary driver of this reversal: “significant cuts to spending in global health from the world’s largest donors.”

What’s the takeaway?

For one, it’s worth noting that the report largely presents this year’s rise in deaths as a short-term bump rather than a lasting reversal. Even without reversing the global cuts, the projections show child deaths falling again in most future scenarios, even as soon as next year. At the same time, the report warns that child survival is now more fragile than before, and that progress against preventable diseases can be increasingly pushed off course by shocks like conflict, climate disruption… or a further drop in funding.

Malaria is on an ominous path

The World Health Organization just published its yearly report on the global state of malaria, Euronews reports. (One note up front: Like the tuberculosis data we covered three weeks ago, WHO’s reporting speed is glacial, so the “2025” report only describes 2024.)

How was last year? Ominous.

Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether.

Even before this year’s aid cuts, malaria cases ticked up in 2024 over 3%, reaching an estimated 282 million total cases. Deaths also rose upward to 610,000 in 2024, with the majority being young children in “11 African countries.”

Malaria is one of the rare tropical diseases with a well-funded advocacy community and decades of scientific focus, so it’s worth asking, why we were losing ground last year?

There are really two answers, according to the WHO. One is rising resistance to malaria drugs and insecticides, and the other is a familiar foe, climate change, which is giving various mosquito species more places to survive and more months each year to spread the parasite.

My takeaway: Looking “forward” to this past year, malaria is the disease I’m most worried about on the continent I call home. That’s because malaria moves fast (the incubation period is tiny), and once you let off the brakes, or conditions shift, cases can explode. As we covered in early October, in places like Cameroon, aid agencies are already saying the clock has rolled back 20 years due to the aid pullback. If we were already losing ground, the worst may still be ahead.

Exit ebola, enter cholera

It’s been a week of whiplash in the Democratic Republic of the Congo. As we reported last week, the country announced the end of the Ebola outbreak on Dec. 1. But UNICEF, the U.N. Children’s agency, just confirmed that DRC is now contending with its worst cholera outbreak in 25 years, Reuters reports.

Just by the numbers, there’s been more than 64,000 cases and roughly 1,888 deaths since the start of the year. But one, smaller line hit me particularly hard: “In one case, a quarter of the children in a Kinshasa orphanage … died days after the disease swept through.”

Disease breakdown: Cholera is a bacterial infection that infects up to 4 million people each year. Because it largely spreads through water contaminated with feces, it thrives in humanitarian disasters or anywhere else that basic sanitation has broken down. Cholera’s horror is its speed. It causes sudden, violent diarrhea that can empty the body so quickly that stools turn a pale, milky white. Without treatment, cholera can kill in a matter of hours.

The conditions driving this disaster are painfully familiar: “Only 43% of people in Congo have access to at least basic water services [like basic plumbing or just treated water], the lowest rate in Africa, and just 15% use basic sanitation,” like toilets or sanitized latrines. Combine that with ongoing conflict, displacement, overcrowding, and crumbling infrastructure, and cholera is spreading through many communities with ease. Unsurprisingly, UNICEF is calling for “more funding” to help contain the crisis, which is unlikely to come unless it is diverted from elsewhere.

The takeaway: It is encouraging to see what the world can do when it focuses on a threat like Ebola. But if that focus is built on rerouting and draining support from other crises, and if the plan for this cholera outbreak also just moves money from one emergency to the next … it’s hard to celebrate a system that’s only moving the danger around.

Expert advice from Scandinavians on winter darkness

Admittedly some tough news in today’s report, so let’s end with something light. With the solstice around the corner, the Associated Press published a story that sums up advice from Nordic health professionals on coping with winter darkness.

As far as I could tell, the advice seemed sound: You should get morning light, keep your routines, stay social, and lean into winter. That said, there’s a famous adage in journalism on the importance of verifying whatever anyone tells you, even from trusted sources: It’s “if your mother says she loves you, check it out.”

So I passed on the article to three close Scandinavian friends of mine for, uh, let’s call it fact checking. I asked them to be unvarnished, and boy were they!

Generally, my Nords concurred with the AP. Ragnar, a Norwegian-Swede, stressed just how central the cultural value of coziness (“hygge”) really is for managing the enduring dark, along with a steady drumbeat of holiday festivals and “small cozy moments and traditions,” he said. Although … he noted that a certain triumvirate of important and traditional Scandinavian winter staples was entirely missing in the AP story. That’s alcohol, caffeine, and salty Christmas food. But “I’m not sure if these are the best tips to put into a global health newsletter,” he acknowledged.

Miriam, a Swede, challenged the central premise of the article. “I’m not sure we, as a population, know how to deal with the winter darkness,” she said. “Yeah, we do a lot of things, but also a lot of people just go depressed.”

But my favorite takeaways came from Théo (also Swedish) who wrote to me from Kuala Lumpur, Malaysia. “My best remedy for managing Nordic winters is not living there,” he said.

He also took umbrage with one particular line in the AP story. “The saying ‘there’s no such thing as bad weather — only bad clothing’ is a scam invented to force preschool kids to play outside even in the rain and freezing cold,” he said, channeling what sounded like a long-held grievance. “Ice on the sidewalk and horizontal rain mixed with snow 100 % qualifies as bad weather.”

I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Vaccine panel drops recommendation that all newborns get hepatitis B shot

2025-12-05T20:33:43+00:00

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A longstanding recommendation that all babies be vaccinated at birth against hepatitis B was abandoned in a divided vote Friday by a federal advisory panel at the Centers for Disease Control and Prevention.

Members of the committee who voted in favor of the change hailed it as supporting informed vaccine choice by parents, who they say have been abandoned and marginalized by pediatricians when refusing or delaying immunizations.

“True choice has not been existing in practice,” said committee member Hillary Blackburn, a doctor of pharmacy. “No child should lose their medical home because their parents are engaging in the very individually based decision making we’re encouraging.”

Those who voted against the change said parents always have the final say in what vaccines their children receive, and that the new recommendations lacked scientific evidence and will result in children suffering needless infections and serious liver damage.

“We know that three doses given according to the existing schedule are safe and effective in preventing hepatitis B,” said Dr. Cody Meissner, a professor of pediatrics at Dartmouth’s Geisel School of Medicine. “We are doing harm by changing this wording, and I vote no.”

All of the committee’s members were chosen by Health and Human Services Secretary Robert F. Kennedy Jr., who has long been critical of vaccine safety. Kennedy dismissed the panel’s previous members during the summer, then fired Trump administration CDC Director Susan Monarez for what she told Congress was her refusal to rubber stamp future recommendations of the committee.

The CDC Advisory Committee for Immunization Practices voted 8-3 that women who test negative for the hepatitis B virus should consult with health care providers to “decide when or if“ their child should be vaccinated against the virus, with any initial dose “suggested” to be administered “no earlier than 2 months of age.”

The committee did not change the current recommendation that a birth-dose of the vaccine be given to infants born to women who test positive for the hepatitis B virus.

U.S. Sen. Bill Cassidy, the Republican chairman of the Senate Health Education, Labor, and Pensions Committee urged acting CDC Director Jim O’Neill to not sign the recommendations and maintain the current standards.

“As a liver doctor who has treated patients with hepatitis B for decades, this change to the vaccine schedule is a mistake,” Cassidy, whose vote was instrumental in Kennedy’s confirmation as HHS secretary, said on the social media platform X.

“The hepatitis B vaccine is safe and effective. The birth dose is a recommendation, NOT a mandate,” Cassidy said, noting that before the birth dose was recommended, 20,000 newborns a year were infected with hepatitis B. “Now, it’s fewer than 20. Ending the recommendation for newborns makes it more likely the number of cases will begin to increase again. This makes America sicker.”

The committee makes recommendations to the CDC director, who can accept or reject them. O’Neill is a deputy secretary at HHS in addition to serving as acting CDC director. CDC and HHS did not immediately respond to questions from Healthbeat about O’Neill’s timeframe for making a decision on the recommendations.

Major medical and public health associations – including the American Academy of Pediatrics, the American Medical Association, the Infectious Diseases Society of America and the National Association of City and County Health Officials – had urged the committee not to change the recommendation that all babies receive the birth dose.

The American Academy of Pediatrics has said it is not going to change its recommendation to pediatricians that all babies should receive a first dose of hepatitis B vaccine shortly after they are born.

The associations noted that babies born to mothers who test negative for hepatitis B virus remain at risk of infection early in life from families, caregivers, and other close contacts who may be infected but often do not know it.

The hepatitis B virus is highly contagious and spreads through contact with blood and body fluids. It can cause severe liver damage and cancer. The virus can spread from person to person through sharing of personal items such as razors, toothbrushes, and nail clippers, as well as through sexual contact and use of unsterile needles.

Universal infant and childhood vaccination against hepatitis B, recommended since 1991, has reduced by 99% the number of reported cases among U.S. children, adolescents, and young adults.

“Recommendations are not mandates,” Dr. Flor Muñoz, representing the Infectious Disease Society of America at Friday’s meeting, told the committee as it prepared to vote. “The issue of consent is not being solved with these changes … 30 years of information regarding the safety and efficacy of these vaccines are very strong to continue to support the existing recommendation.”

Committee members Meissner and Dr. Joseph Hibbeln, a psychiatrist and neuroscientist, objected throughout the meeting to what they said was a lack of evidence supporting the new recommendations. No data were presented to the committee to support recommending a two-month delay before babies born to hepatitis B negative moms get their first vaccine, they said.

“We have no basis for saying that. That’s been kind of pulled out of the air,” Meissner said.

“I am hopeful that pediatricians will continue to administer the birth dose within the first 24 hours of delivery and before discharge from the hospital. I think to follow any other course is not in the interest of the infant,” Meissner said.

Added Hibbeln: “This specific point is the reason why we tabled this issue for three months to more fully discuss it. However, we have still not had any information or science presented or discussed with regards to this issue of [giving the first dose of hepatitis B vaccine ] before or after 2 months of age. This is unconscionable.”

The committee also voted to recommend parents consider antibody testing to evaluate the hepatitis B vaccine’s effectiveness before getting subsequent doses. The vote passed with six members in favor, four opposed, and one abstaining.

This blood testing, the recommendation says, should be used to determine whether adequate protection against hepatitis B has been achieved. The recommendation says the cost of the testing should be covered by insurance.

Hibbeln objected to this testing recommendation being added to what had been a changing series of proposed recommendations shared with the committee with little time for advance consideration. “This fourth iteration of votes in 96 hours is still incredibly problematic,” he said.

“There is an absolutely novel concept being put forth here to vote, that a serology test should be offered” after the first dose, he said. “There has been no data presented that this plan would actually work.”

Dr. Raymond Pollak, a transplant immunobiologist, expressed similar concerns. “We have no data whether monitoring serology actually implies immunity,” he said.

Dr. Kirk Milhoan, a pediatric cardiologist who recently was appointed the committee’s chairman, said the tests could help parents decide how many vaccines their child needs.

“I would be very happy if we were to vote to simply recommend that this needs to be studied. That would also serve the purpose,” said Milhoan, noting “there is a paucity of data.”

But none of the committee’s members made a motion to do this.

This story has been updated with more details from Friday’s meeting.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

New York state to require insurers to cover inhalers. NYC life expectancy rises.

2025-12-05T20:00:00+00:00

There’s a lot to cover and celebrate this week in New York public health. From improving New York City’s life expectancy to a new state law ensuring inhaler coverage, public health and policy are quietly working behind the scenes. But there’s still plenty of work ahead. Let’s jump in.

Insurance has to pay for inhalers in NY

No one should struggle to breathe because they can’t afford it, but that’s been the reality for many New Yorkers with asthma. The cost of inhalers varies widely, from $35 with insurance to over $500 if uninsured, and depending on the type (e.g., daily preventative vs. emergency relief inhaler). Starting in 2027, though, that reality will shift for many. Last week, Gov. Kathy Hochul signed into law a bill that will require state-regulated health plans — including those on the Affordable Care Act marketplace — to cover the cost of asthma inhalers fully.

Why this matters

Nearly 2 million New Yorkers (about 10% of the state) live with asthma. In New York City, the problem is even greater, especially in neighborhoods with higher pollution levels due to heavy traffic and industrial zoning. In the Bronx, for example, the neighborhood of Mott Haven has become known as “Asthma Alley” because of its concerningly high rates of childhood asthma.

Mott Haven has nearly double the rate of asthma-related emergency room visits for kids 5-17 years old (266.2 per 10,000) compared to city averages (143.7 per 10,000). And these are some of the highest asthma-related emergency room visit rates in the country. (For comparison, the national average asthma-related emergency room visit rate is 36.6 per 10,000 for kids aged 0-18.)

New York City asthma emergency department visits (ages 5-17) in 2023 by community district.

Access to free inhalers is more than a convenience — it’s a lifeline. This is especially true for low-income families living in neighborhoods with high air pollution, who are least likely to afford consistent care. Mott Haven is one of these neighborhoods: a community with many families earning low incomes, surrounded by three major highways and industrial warehouses, resulting in higher air pollution.

While this new law is a major step forward for health equity, it’s still a band-aid: It doesn’t address why asthma rates are so high in the first place. Until we tackle the upstream causes, like air pollution, housing quality, and environmental justice, New Yorkers will continue to need more inhalers.

The state has taken similar steps to make treatments accessible for other chronic conditions, such as capping insulin costs under state-regulated plans. Though this piecemeal approach raises a bigger question: Is the best solution to pass drug-by-drug legislation? Do we need individual bills for every lifesaving medication New Yorkers depend on, and that many families struggle to pay for? This approach is reactive, and many experts argue that broader reforms may be more effective at addressing the underlying root drivers of high drug pricing.

New York City just beat its own health goal, 5 years early

In 2023, the city launched HealthyNYC following a dramatic drop in life-expectancy — from 82.6 years in 2019 to 78 years in 2020, mainly due to the Covid-19 pandemic. The initiative aims to raise life expectancy to 83 years by 2030. But according to new data released last week, we’ve already passed that goal: Life expectancy in New York City is now 83.2 years — the highest in our city’s history since we began tracking.

What drove this change?

Covid-19 deaths dropped by over 90% from 2021 to last year. This alone added years back to New Yorkers’ lives. Other leading causes of death, like heart disease, diabetes, suicide, and homicide, also declined.

But not every number went in the right direction. Deaths from screenable cancers (think breast, colorectal, cervical) rose slightly — up 0.7%. These are cancers we can often catch early or prevent through routine screening, yet outcomes worsened last year in the city.

Additionally, major health inequities persist:

Screenable cancer deaths are still highest among non-Hispanic Black New Yorkers, and especially men.
Heart and diabetes-related deaths are most common in non-Hispanic Black communities.
Homicide and overdose rates disproportionately affect Black and Hispanic communities.

What’s working?

Some of the programs helping to improve life expectancy include:

The Public Health Corps, connecting high-risk communities to care.
Citywide media campaigns and vaccine outreach.
Distribution of 300,000+ naloxone kits and harm reduction services.
New investments in opioid treatment programs like Relay.
Doula and nurse home visiting programs for 20,000+ families.
Action centers focusing on neighborhoods with the highest premature death rates.

With the HealthyNYC initiative codified into law, these efforts won’t disappear with a new mayor or budget cycle — the city will keep working on improving these metrics. But these successes aren’t the finish line. There’s still a big question: How do we not just live longer, but live better? Some city leaders say the next chapter should focus on healthspan — the years of life spent in good health — not just lifespan. It’s also crucial that we continue to double down on closing health inequities across neighborhoods and populations.

Infectious disease ‘weather report’

Flu: Flu continues to increase quickly. The most recent data show that cases and hospitalizations in the state have increased by 117% and 99%, respectively. In New York City, emergency department visits for the flu rose by 142%.

Hospitalizations of respiratory viruses in New York.

RSV: Also increasing across the state and in New York City, mostly in kids under 4. Statewide, hospitalizations increased by 21%, while emergency department visits in New York City went up by 71%.

Covid-19: Cases and hospitalizations are holding steady at low levels in both the city and across the state.

The New York state wastewater program recently launched a helpful update to its dashboard. They now color-code sites by whether they are increasing, decreasing, or stable for Covid-19.

Right now, most sites across the state have either stable or decreasing Covid-19 wastewater values. Sixteen sites, though, are reporting increases, with the largest spikes seen in Seneca and Tioga.

HIV diagnoses have gone up in NYC

A new report shows that last year, 1,791 people were diagnosed with HIV in New York City, up 5.4% compared with 2023. And huge inequities remain: 86% of people newly diagnosed with HIV were Black or Latino/a, and 91% of newly diagnosed women were Black or Latina. Among people newly diagnosed with known transmission category, 65% were men who have sex with men, 82% of whom were Black or Latino.

Upstate updates

If you are looking forward to ice fishing this winter, make sure to check the conditions of the ice before you go out. A minimum of three to four inches of solid ice is the general rule for safety. For more information and to learn about specific fish species in ice fishing, check out the New York Department of Environmental Conservation page.
A raccoon tested positive for rabies in Deansboro. This is a reminder to avoid touching wildlife. If you see any acting strangely (acting mad, shy, getting unusually close, or drooling or foaming at the mouth), stay away, and call your local animal control officer for help. (Find contact information on your city’s website).
Monroe County launched MonroeAlert, an emergency notifications system for residents to get alerts about critical situations in their community. Residents can sign up to receive alerts via text message, email, phone call, or mobile app about emerging issues like severe weather, public safety incidents, travel restrictions, and shelter information.

Bottom line

New York is making real progress, from adding years to our lives to making breathing a little easier for those with asthma. But equity and prevention must stay front and center. Our communities should strive to live better, in addition to living longer.

Love,

Your NY Epi

How an ‘aha’ moment at age 10 led to a career in science and public health

2025-12-02T15:11:53+00:00

This story was part of Healthbeat’s live storytelling event, “Aha Moments in Public Health,” held Nov. 3 at Manuel’s Tavern in Atlanta. Watch the full show here. Sign up to receive Healthbeat’s free Atlanta newsletter here.

I was a career scientist at the Centers for Disease Control and Prevention for nine years, and a public health professional for over 20 years. I’ve had many “aha” moments over the years.

My first “aha” moment was when I was 10 years old. I was sitting on the couch with my grandmother watching a movie, as we did every time I visited. I saw helicopters, people in uniform, and lots of action. The thing that stood out for me was being curious about what a “BSL” was. I saw BSL 1, BSL 2, BSL 3, and so on. This was the opening of the movie “Outbreak.”

If you don’t know, BSL stands for Biosafety Level, with 1 being the lowest.

I was a curious kid, always questioning things and discovering answers to the world. You can imagine how much my parents loved hearing from me constantly!

Some may have watched that movie and thought they wanted to be Dustin Hoffman, the virologist investigating the outbreak. I always wanted to be Rene Russo. Why? Because she was the one who practiced public health and science in the movie the most.

My “aha” was learning that I didn’t want to be the person who knew how government or knowledge was controlled and dispensed, but rather the person who was on the ground with the people it affected. Rene Russo embodied the sacrifices and the leadership that changed the entire outcome of the film. At 10 years old, I wrote an “essay” … if you can even call it that … about how I wanted to be a scientist, and it propelled me on a linear track to achieving that goal.

My second “aha” was becoming a scientist. I realized I didn’t really know much about how to do this job. I was thankful for career scientists and mentors who guided me through the process. If you would have told me it would take a decade to understand the science, and then another decade to understand how I fit into the science, I don’t know if I would have continued on my path. So I had another “aha”: that we don’t have to know it all. Part of public health is constantly learning, and I appreciated that so much when that came to be for me.

My third “aha” was learning that as a civil servant, and one who dedicated their life to saving others, that I would never give up or halt in my efforts. The job is neverending. And so to relate back to my favorite movie “Outbreak,” my second was “The NeverEnding Story.”

Many of us can likely relate to this … who didn’t want a Falcor in their life? But the impact of that movie in the scene with the horse, Artax, is in the Swamp of Sadness. We remember that scene because it was the sensation of leaving your most beloved thing behind. That, in many ways, is what it feels like to be dismissed from duty at the CDC in public health professions.

With all that said, I continue to question, to be curious, to investigate, analyze, and report on my life, assisting others who need information, and to support the wider communities who rely on our strongest efforts. Because who am I without everyone else, and with the sadness of our professions being attacked … we persevere.

Thank you, and with solidarity,

I’m Brandon Kenemer.

Brandon Kenemer is an associate director for informatics focused on data science, surveillance, communications, and bioinformatics at the Centers for Disease Control and Prevention. Previously, he worked in psychology, behavioral health, and nursing care.

Who in the world will get access to new weight-loss pills?

2025-11-13T12:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

This week’s stories zigzag across global health: money chasing weight loss, the heartbreak behind a potential Ebola victory, governments stuck on repeat, and scientists quietly pushing the boundaries of what medicine can conquer. Still, think I’m missing something big? Email me!

With that, as we say in Swahili: karibu katika habari — welcome to the news.

The risk of slimmer margins

An economic gold rush is rippling through global health, and it’s powered by GLP-1 weight-loss drugs.

In just the past week, Reuters reports that pharma giant Eli Lilly’s injectable GLP-1 weight-loss drug Mounjaro became India’s top-selling drug, overtaking antibiotics that have long dominated the market. At the same time, the corporation announced a new, $3 billion plant in the Netherlands to mass-produce a new pill form of the drug, a sign that the market is expected to grow significantly faster than existing factories can keep up. (The Financial Times has an excellent story on the scientific and economic race to make these new pills; I have a syndicated, non-paywalled link here.)

Background: GLP-1 drugs like Mounjaro, Wegovy, and Ozempic mimic a natural hormone that regulates blood sugar and appetite. Essentially, the medicine signals fullness to your brain and slows down digestion. The “GLP-1” name is an abbreviation for the molecule it mimics, which was originally developed as a treatment for diabetes.

My big question here: Is this a zero-sum boom?

Global health aid is shrinking, so as factories ramp up to make billions of GLP-1 pills, are they pulling resources away from other essential medicines? I reached out to Prashant Yadav at the Council on Foreign Relations, who is one of the foremost authorities on global drug manufacturing.

There is indeed a drug-shortage risk, says Yadav, albeit a narrow one. To understand why this is, first you have to know two things about GLP-1 drugs, and what makes the pills different from injectables.

First: Unlike say, aspirin, GLP-1 drugs don’t just require cooking up inert chemicals in a lab. Instead, as part of their manufacturing process, they involve corralling living creatures. In particular, coaxing a genetically tweaked beer yeast — yes, this is true! — to produce molecules. Importantly, this is also how insulin is made.

Second: The pills require a lot more of the active compound than the injection. About three to four times more, says Yadav. The reason why isn’t complicated … it’s basically because your gut destroys most of what you swallow.

Combine these factors, and you could get a classic market squeeze: limited manufacturing capacity chasing the highest profit margin. “This shift could ultimately put pressure on the global insulin supply, particularly in developing countries,” Yadav says.

But Yadav says I’m missing the bigger issue. Shortages are not a sure thing, but the fight over who gets access to these drugs is already here. About two-thirds of the world’s 1 billion obese adults live outside the developed world, and Yadav says the real question is whether or how people in “India, Mexico, Nigeria, South Africa, the Philippines, and other countries” with sizable obese populations will get these same medicines.

And as the new pills are deployed, that’s where to watch.

A window into the Ebola outbreak

We’ve been following the Ebola outbreak in the Democratic Republic of the Congo, where just a few days after our last check-in, the World Health Organization declared that responders discharged a (potentially) final patient.

That restarted the official countdown (42 days, which is twice the incubation period of the virus) for the outbreak to be declared over. Materially, not much has changed since our last update, which Dr. Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health, called “promising and precarious.” Promising, because the speed and effectiveness of the response bucked the worst-case fears that we’d lost the money and muscle to contain such a crisis. And precarious because, as I wrote then, we’re relying on a new world of “reactive, one-off appeals that pull resources from other crises” rather than steady support.

Why the update? Because The Guardian just published a deeply reported snapshot of what that response looked like up close, largely told through one man’s story. The piece is worth the full read: For me, it transformed an abstract story about case counts and funding gaps into a vivid, human window into the outbreak.

I’ll try not to ruin the story, but it follows Bope Mpona Héritier, an Ebola survivor from the remote village of Bulape who “lost his wife, daughter and mother” before realizing he was infected, too. Inside his isolation tent, Héritier remembers, “there were three other patients. I watched them all die, one by one.”

It’s heartbreaking, of course. But what stood out most was how the story reveals what responders actually mean when they talk about the challenges of vaccinating, tracing, and operating in “hard to reach” areas … and how that same isolation became a quiet blessing in slowing the spread. “It took some of us four days to reach Bulape from the capital, Kinshasa, because we had to cross forests,” recalls Chiara Montaldo of Médecins Sans Frontières. (For reference: These locations are only about 430 miles apart, about the same distance between Chicago and Atlanta, or Paris and Berlin). And “we had to bring everything from outside, including medicines, materials for building tents, and water decontamination supplies.”

The price tag to preempt the next pandemic

I don’t know about you, but I loathe talking about the Covid-19 pandemic. For me, the topic dredges memories of isolation and social distancing, anxiety, and those mean little nasal swabs … and ultimately still getting walloped by the virus three times. (Honestly, I usually try to change the subject when it comes up.)

So I find it a little odd that this next story — which starts with the upsetting news that scientists estimate there’s roughly a 50-50 chance the world will face another global pandemic in the next 25 years — is actually rather empowering.

Writing in Vox, Stephanie Psaki, who served as the first U.S. coordinator for global health security under the Biden administration, argues that the next pandemic isn’t by any means inevitable. In fact, “scientific and medical advances have made it possible to detect, treat, and stop the pathogens most likely to sweep across continents and cause widespread death” in perpetuity within the next 10 years, she says.

Psaki does not float this flippantly. In a long but impressively methodical essay, she lays out exactly what’s needed over the next decade: The steps to reduce the odds of a virus ever jumping from animals to humans. Then how to build the kind of global surveillance and rapid diagnostic capacity that can catch outbreaks early. And how we can use existing tech to develop vaccine and drug platforms that can be tailored to a new pathogen within weeks.

What makes Psaki’s argument so striking is its practicality and specificity. She even gives a price tag.

“Conservatively … $30 billion annually” over a decade could be enough, she writes, “to take the top pandemic threats off the table.”

Bangladesh’s annual dengue lesson, still unlearned

Bangladesh is months into a crisis of dengue virus, one that health experts warned in October was “worsening rapidly with infections and deaths climbing sharply across the country.” They cautioned the disease could spiral if urgent and coordinated mosquito control efforts were not launched. That spiral now appears to be happening, the WHO reports.

Disease breakdown: Dengue is a millennia-old mosquito-born virus that’s sometimes called “break-bone fever” for the intense joint and muscle pain it causes. Although it has a very low fatality rate (less than 1%), it spreads quickly through mosquitoes that thrive in cities. That makes it extremely difficult to wall off and allows outbreaks to balloon to millions of cases.

To put today’s crisis in perspective: Dengue cases in Bangladesh are tracking close to the country’s devastating 2022 and 2024 outbreaks, which were the second and third worst years on record. It’s still not nearly as catastrophic as the record-setting 2023 epidemic (which had four times more cases than any other year on record) but hospitals are once again overwhelmed as the virus spreads beyond the capital city Dhaka into rural districts.

The question: Why is this happening again?

You can place part of the blame on warmer temperatures and heavier monsoon rains, which are both intensified by climate change and are expanding the mosquito breeding seasons. You can also lay blame on newly endemic mosquito species. But in an absolutely blistering op-ed in Bangladesh’s independent newspaper New Age, political columnist M.A. Hossain argues the real cause isn’t nature, it’s political negligence.

He accuses local authorities of repeating the same cycle of inaction every year: slow mosquito control, poor drainage, and a lack of political accountability until the crisis peaks. His essay lands less as commentary and more as an open-handed scolding.

In his words, “mosquitoes have become symbols of our administrative failure.” Hossain writes that despite years of warnings, “city authorities act only when the situation turns dire,” and that the government’s seasonal clean-up drives have become “a yearly ritual of denial and blame.”

His conclusion: “Dengue has not defeated us. We have defeated ourselves by refusing to learn.”

Immune system, meet self-control

We’ll end the week with something genuinely promising. The Associated Press just published a pair of powerful stories on autoimmune diseases: the broad, 100+ family of poorly understood conditions caused when the body begins attacking itself. That family includes lupus, type-1 diabetes, multiple sclerosis, and rheumatoid arthritis. Like the Ebola coverage earlier, the AP reporting really zooms in on the lived experience of people navigating those illnesses.

Why is this hopeful? Because, as New York University Langone rheumatologist Dr. Amit Saxena put it, “this is probably the most exciting time that we’ve ever had to be in autoimmunity” research.

As the story reports, researchers are using new tools and “discoveries from cancer research and the Covid-19 pandemic” vaccines to decoding the wiring “behind these debilitating illnesses.” While some treatments are moving faster than others, researchers are increasingly uncovering links between diseases once thought unrelated and testing new ways to bolster the immune system.

One such experimental treatment retrains immune cells instead of merely suppressing them, and is called CAR-T therapy. How it works is wild: Researchers extract a patient’s immune cells, splice the cells’ DNA to add a new gene that helps them recognize a specific threat, and then infuse them back into the body by the millions. “The first lupus patient was treated in Germany [with CAR-T therapy] in March 2021 and remains in drug-free remission, the researchers said last month.”

I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Monkey escape is latest safety breach involving Tulane research facility

2025-10-31T17:45:51+00:00

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The crash of a truckload of research monkeys this week in Mississippi is the latest safety breach involving a national primate research center run by Tulane University.

The Tulane National Biomedical Research Center in Covington, La., drew national media attention in 2015 when a deadly foreign-strain of bacteria – that poses a significant public health threat in other countries – escaped one of the center’s high-containment laboratories.

That incident, which I reported on at the time for USA Today and further investigated for a recent book on the risks posed by lab accidents, is one of several biosafety lapses that have occurred over the years at the research facility. Until it was renamed this month, the center was called the Tulane National Primate Research Center.

A Tulane spokesperson said the center’s safety history has nothing to do with Tuesday’s truck crash that resulted in the escape of some of the 21 rhesus macaques that were being transported from the university’s facility to an undisclosed destination.

“This incident is completely unrelated to the other issues you mention,” Tulane spokesman Mike Strecker said Friday in a text message to Healthbeat, noting the animals were not owned or transported by the center. “The primates in this week’s tragic accident were not carrying any diseases and had received recent checkups confirming that they were pathogen-free.”

Here are four things to know about some of the Tulane research center’s past biosafety breaches, which are detailed in a full chapter about the facility in my book, “Pandora’s Gamble: Lab Leaks, Pandemics, and a World at Risk.”

Deadly bacteria escaped Tulane center’s lab in 2014

In late 2014, two rhesus macaques – part of the Tulane center’s massive monkey breeding operation that involved about 4,000 animals kept in outdoor cages – became ill. Tests ultimately revealed they were infected with a lab-strain of a dangerous bacterium called Burkholderia pseudomallei.

The monkeys, as breeding stock, had never been used in any experiments. Their outdoor cages were on the other side of the center’s 500-acre compound, far from the secure and federally regulated biosafety level 3 lab where scientists had been using this specific strain of bacteria.

The strain, called 1026b, was not one that could be found naturally in the United States. It had been isolated from a rice farmer in Thailand who became infected in 1993.

Burkholderia pseudomallei causes a disease called melioidosis that can be fatal in people and animals. The disease, which is spread through contact with bacteria-contaminated water or soil, as well as by breathing contaminated dust or water droplets, is difficult to diagnose. The bacteria is often studied because of its potential to be used as a biological weapon and the need to develop treatments against the disease.

The bacterium is rarely found in the United States, but poses a significant public health risk in parts of the world with tropical climates where it is common, especially Southeast Asia and northern Australia.

The bacteria’s release from the center’s secure lab worried local, state, and federal officials because Burkholderia pseudomallei bacteria, which can cause fatal infections in people, lives and grows in warm, moist soil.

These conditions were present in the dirt and grass floored cages where the sick monkeys had been living – raising concerns about the potential for contamination of the wider environment in that part of Louisiana.

CDC investigators blamed sloppy lab practices for bacteria release

Lab regulators from the Centers for Disease Control and Prevention announced in March 2015 that the federal investigation concluded the most likely cause of the bacteria getting out of Tulane’s secure lab involved the organism hitching a ride to the monkeys on contaminated worker clothing.

Federal inspectors determined that workers routinely entered the secure lab without wearing appropriate personal protective gear, increasing the risk of unknowingly carrying bacteria out of the lab or becoming infected. The monkeys, the CDC said, may have become infected either in their outdoor cages or in an on-site veterinary clinic where they went for routine care and treatments.

“CDC has found no evidence to date to suggest the organism was released into the surrounding environment, and therefore it’s unlikely there is any threat to the general population,” the agency told the public.

USDA investigators privately warned of risk to Louisiana’s environment

Investigators for another federal agency, however, saw the situation differently.

According to a copy of a 58-page risk assessment, obtained for “Pandora’s Gamble” through public records requests, investigators from the U.S. Department of Agriculture saw several plausible ways the bacteria could have escaped the facility’s labs.

They concluded, however, that contaminated laboratory wastewater was the most likely way the bacteria escaped the lab and infected monkeys in the outdoor breeding colony. The USDA report found evidence that Tulane was lax in its decontamination of potentially infectious wastewater going back years – a particularly significant issue for a bacteria that lives in water and soil.

The serious biosafety breaches cited in the USDA risk assessment included the way lab workers at the Tulane center failed to decontaminate – with bleach or heat – the blood and body fluids from animals used in experiments with Burkholderia pseudomallei.

Instead, the report said, infected monkeys were “exsanguinated” – draining the blood from their bodies – “directly into the sink during the course of euthanasia and that fluids were not retained for any contact period with disinfectant before entering the drain.”

These fluids from infected monkeys then flowed into the primate center’s on-site wastewater settling ponds, the report said, noting the ponds were near the outdoor breeding colony. The USDA team noted that the nearby Bogue Falaya River, where the center’s wastewater was discharged, “is within the optimal temperature range for B. pseudomallei April through October.”

CDC inspectors privately also had concerns about the facility’s workers not properly disinfecting blood and tissue waste from infected monkeys before sending the potentially infectious materials down the drain.

“This observation raises serious concerns regarding environmental contamination due to improper decontamination of infectious fluids,” they wrote in a March 2015 inspection report marked “Sensitive But Unclassified” that I obtained for the book under the Freedom of Information Act.

In the wake of the monkey infections and regulatory concerns, Tulane officials have said that hundreds of tests have been done of the environment, wildlife, monkeys, and lab workers and that none have detected the presence of Burkholderia pseudomallei.

In response to the 2015 monkey infection incident, Tulane told me for the book that the center had “improved our biosafety program which is widely regarded as a model program for other institutions throughout the country.”

More lab wastewater safety lapses occurred in 2017

Records show that in October 2017, the USDA notified the Tulane center it could face up to $600,000 in fines for multiple violations of the Agricultural Bioterrorism Protection Act of 2002 for issues related to its release of Burkholderia pseudomallei.

The department eventually let Tulane settle the violations by paying about $39,000.

Despite safety concerns about the potential of the facility’s wastewater to release pathogens into the environment, records show that in November 2017 built-up sewage sludge was pulled out of the facility’s wastewater treatment plant that serves laboratories, then spread across the ground in an area on the primate center’s property where the debris from monkey cages was routinely dumped.

Tulane’s safety officials didn’t learn about the sludge spreading until a month after it happened, and they didn’t notify state environmental regulators until October 2018, records show.

During that gap, Tulane hired an outside expert to test soil at the dump site for the presence of Burkholderia pseudomallei and also the bacteria that cause anthrax. Both had been studied in the center’s labs, and both had the potential to contaminate the environment if they were present.

The tests did not detect the presence of these pathogens, and in correspondence with Louisiana environmental regulators, Tulane officials said they “believe that the land application of the sludge did not have an adverse effect on the environment, did not pose a threat to public health, and did not cause an emergency condition.”

In 2021, Tulane officials sought funding from the National Institutes of Health to improve systems at the research facility, including installing a system to sterilize biohazardous liquid lab waste.

“Effluent decontamination capabilities are desperately needed and will be realized through installation of the proposed effluent decontamination system,” Tulane wrote in its application, which was funded.

A spokesperson for the university told me for the book that the request involved equipment needed for future growth into new research areas and that the center’s existing programs were in compliance with waste treatment rules.

Questions remain about monkeys that escaped in Mississippi this week

In the wake of Tuesday’s truck crash on Interstate 59 in Mississippi, which resulted in some monkeys escaping and others being killed, Tulane officials have released little information about why the animals were being moved or where they were going.

The Jasper County, Mississippi, sheriff’s department initially announced on Facebook that the monkeys were aggressive, carried “hepatitis C, herpes, and COVID,” and that handling them required the use of personal protective equipment, based on what the department said the truck’s driver told local law enforcement.

The sheriff’s department later posted a short statement from Tulane, which said that the research center provides primates to other research organizations, and the monkeys involved in the crash “belong to another entity and are not infectious.” But that organization was not identified.

In text messages to Healthbeat on Friday, Tulane spokesman Strecker said it is the university’s understanding that 13 of the monkeys recovered from the crash site remain in the possession of their owner and have arrived at their original destination.

Local law enforcement has acknowledged that some of the 21 rhesus macaques monkeys that were being transported were killed by officers after the crash. Three monkeys were still on the loose as of midday Friday, according to the Mississippi Department of Wildlife, Fisheries, and Parks, whose officers are involved in the search.

Strecker said that the transport of research animals is common and usually involves contracts that prevent the disclosure of information “both for the safety of the animals and to protect the parties’ proprietary information.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

A public health horror story: If the zombies arrive on Halloween, will the CDC be there to respond?

2025-10-27T17:01:48+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

In 2011, the Centers for Disease Control and Prevention decided it wasn’t enough to keep humans alive. It was also going to make sure the dead stayed that way.

The CDC’s Office of Public Health Preparedness and Response published a graphic novel called “Preparedness 101: Zombie Pandemic.” In this story, a fictional couple watch news reports of a mysterious pathogen spreading across the United States. The pathogen turns out to be a virus that turns people into zombies, and the CDC leads an effective national response. The story was meant to teach Americans about the importance of being prepared for health emergencies and the role of CDC in responding.

Unfortunately, as we approach Halloween 2025, I am more fearful of what’s happening to CDC than I am of ghosts and vampires. If the zombie outbreak from “Preparedness 101” happened this Halloween, the outcome would be far worse.

Patients rush to emergency departments with first signs of zombie illness

In CDC’s graphic novel, a couple, Julie and Todd, see news reports about a strange illness emerging in the Southeast. People are stumbling into emergency departments, confused and feverish, then suddenly becoming violent. The first nurse is bitten before anyone realizes an outbreak has started.

In this scenario, astute clinicians would have called state health departments, and they would have immediately called the CDC – a seamless network for early detection of new health threats. Syndromic surveillance systems supported by the CDC would immediately detect a surge in emergency department visits for an unusual combination of symptoms.

Today, in a change from previous administrations, CDC staff are prohibited during the government shutdown from even speaking with state health officials. Even if the federal government were open, I suspect there would be insufficient staffing to assess the situation adequately. In the early stages of a zombie attack, CDC requires epidemiologists from across the agency to collaborate on assessing an event.

As with any unexplained cluster of illness, the CDC must consider the possibility that the zombie illness could be caused by a non-infectious agent, such as radiation, industrial chemicals, or naturally occurring toxins, but CDC’s environmental health and toxic substances programs have been gutted.

State and CDC laboratories work to identify the cause of zombie illness

CDC’s graphic novel shows scientists in lab coats analyzing specimens, sequencing the virus, mapping its spread, and tracing its origins – just as happened with SARS, influenza H1N1, and Covid-19 over the past 25 years.

Today, state laboratories that would previously have been responsible for collecting specimens to send to the CDC are struggling with staffing after their CDC grants have been cut. Many CDC labs have been closed, and microbiologists fired, including from CDC’s premier laboratory training program, the Laboratory Leadership Service. Epidemic Intelligence Service officers — the “disease detectives” who deploy during outbreaks — have been fired then rehired twice in the past year, and at least two state requests for their assistance (“Epi-Aids”) have been declined by the CDC. All of this would add up to delays in identifying a zombie virus and understanding how to prevent its spread.

CDC coordinates a national response to zombie illness

In the CDC’s graphic novel, as the infection spreads, the CDC Emergency Operations Center hums with activity. Federal, state, and local agencies coordinate messaging and logistics. Scientists brief elected officials and the media calmly. The CDC recommends that people lock themselves down at home until we know more about how the virus is spreading.

Today, it’s unclear how the chain of command would operate at the CDC during a national emergency. After his appointment, Health and Human Services Secretary Robert F. Kennedy Jr. eliminated the CDC staff who work on intergovernmental coordination and communication, arguing that all health-related communications, operations, and policy should reside within HHS headquarters, not the expert agencies within HHS.

In 2025, we’ve seen what this means for outbreak response: Amid an ongoing nationwide outbreak of measles that threatens the country’s measles elimination status, there have been zero CDC press conferences and only one health alert issued to medical providers. During the current shutdown, the CDC’s most authoritative outlet for written communication, the Morbidity and Mortality Weekly Report, has stopped publication, and multiple editors and staff have been fired.

Even if the CDC were permitted to speak during a zombie outbreak, it’s highly unlikely the CDC would instruct people to stay at home or even advise exposed persons to quarantine. One of the most strident critiques of the CDC by the current HHS secretary, National Institutes of Health director, Food and Drug Administration director, and the current acting CDC director are that the CDC should not have told people to stay at home during the peak of the Covid pandemic and that public health agencies should not restrict people’s freedom of movement. Would they do the same in a zombie outbreak?

CDC develops a vaccine and supports mass vaccination sites

In the graphic novel, CDC scientists rapidly identify the cause of zombie illness: Z5N1, a mutated flu virus. They quickly design, validate, and produce a vaccine. Staff from HHS and the CDC’s Strategic National Stockpile work in tandem. Trucks roll, planes fly, and CDC staff work with states to establish mass vaccination sites within “safe zones.”

Today, that image of coordinated national response to a health emergency seems as fictional as zombies themselves. The president and HHS secretary have repeatedly questioned the safety of vaccines, funding has been cut for vaccine research at the NIH (including the mRNA platform that would most likely be used if a new virus emerges), CDC vaccine experts have quit because of political interference, and, during the most recent October layoffs, multiple personnel responsible for health emergency response were fired. Several states have established a new public health alliance, arguing that they can no longer rely on the CDC.

Surviving an epidemic of zombie virus or other viruses

In the CDC’s graphic novel, Julie and Todd survive. They make it to a shelter, receive the vaccine, and wake up to find it was all a dream. The message of their dream was simple: If you prepare for all hazards, you can survive a hurricane, flood, pandemic, and even a zombie apocalypse.

The systems that made the CDC the hero of the zombie apocalypse graphic novel, as well as movies and TV shows, are being dismantled. For many public health experts, the horror of this Halloween is realizing that, in a fight against a zombie virus, the virus might win.

Disease sleuths piece together clues in unusual malaria case in Washington state

2025-10-27T11:00:00+00:00

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When public health investigators received a report this summer about a woman hospitalized with malaria who lived east of Tacoma, Wash., the case didn’t seem unusual.

Even though malaria was officially eliminated from the United States decades ago, every year about 2,000 people travel to places where the disease is common and bring it back with them.

All it takes is a bite from an infected mosquito to inject the malaria parasites into the skin.

So when the Tacoma-Pierce County Health Department received an official notifiable disease report on Aug. 4 about the woman’s malaria diagnosis, it triggered a routine investigation.

In the beginning it was just another of the 20-70 malaria cases reported in Washington state each year, and among the thousands of reports for a wide array of other diseases and conditions that health departments across the state track and investigate.

“The vast majority of people who are diagnosed with malaria in the United States have traveled to a malaria endemic setting,” Dr. James Miller, the department’s health officer, told Healthbeat. “By the time they’re diagnosed, they’re back in the U.S.”

It usually takes seven to 30 days from the time the person is infected until they start getting sick with fever, chills, sweating and other flu-like symptoms. Without quick treatment, the infection can become life-threatening.

Dr. James Miller, health officer for the Tacoma-Pierce County Health department, says he was initially skeptical a local mosquito bite could have caused a woman's malaria infection.

Each person whose malaria case is reported to the department gets interviewed by public health staff.

The department’s health investigators expected to learn that the woman had traveled to one of more than 80 countries where malaria infections routinely occur. Worldwide, there were about 263 million new malaria cases in 2013, according to the World Health Organization, and about two-thirds of them occurred in about a dozen African countries.

Yet the woman in Washington state hadn’t traveled anywhere she could have become infected.

“That’s what made this case unusual,” Miller said.

Reports of locally acquired malaria are rare in the U.S.

It raised the question: Could the Pierce County woman have somehow become infected with malaria in the local community?

That seemed implausible. There had never been a case of locally acquired malaria documented in Washington state, he said.

While rare, there had been sporadic reports of local infections in other parts of the United States over the years.

In 2023, health departments in Florida, Maryland, Texas, and Arkansas identified 10 people whose malaria infections were attributed to mosquito bites in those four states. Before this unusual series of small malaria outbreaks, it had been 20 years since a locally acquired malaria case had been identified in the United States.

So Miller was skeptical that a local mosquito bite was how the woman in Pierce County, Wash., had been infected.

“Initially I thought we’ll probably find some other explanation here,” he said.

New research raises concerns about local malaria infections in U.S.

Before joining the local health department, Miller had been a regional medical officer for the state’s health department, and he had also served as an epidemic intelligence officer – a disease detective – for the Centers for Disease Control and Prevention.

Often in public health investigations, he said, additional interviews and other probing will result in an explanation that makes sense. “So I think that was my first thought, that we would find another explanation,” he said.

After consulting with zoonotic disease specialists at the Washington State Department of Health and additional experts in the CDC’s malaria branch, Miller and his team started digging deeper.

“The first step was to do a more detailed Interview with the patient and their family,” he said. “Not just recent international travel, but exploring their lifetime international travel history, also looking at recent domestic travel, looking at things like outdoor activities, as well as any other potential sources of infection.”

There can be rare scenarios where people can become infected with malaria without a mosquito being involved, Miller said.

Could the woman have been infected with malaria through a transfusion, despite precautions blood banks take to prevent that from happening? Or could she have been exposed to malaria-contaminated blood through unsterilized medical equipment or perhaps by getting a tattoo in unsterile conditions?

“Again, very rare, but obviously local transmission of malaria is also rare. So we explore all the possibilities,” Miller said.

“There are rare cases where someone can have traveled to a malaria-endemic setting years prior and then not develop malaria until later,” he said. “But in this case, we didn’t identify any relevant travel for the patient, even in the more distant past.”

Investigators also didn’t identify any medical procedures or other potential blood exposures that could explain her infection.

Miller said his skepticism about a local mosquito causing the infection faded after the team’s in-depth interview with the patient and her family.

“Even though it seems very unlikely, we have to really be thinking that this could be transmission within Washington,” Miller said.

Investigators went from skeptical to warning the public

On Aug. 6, the department put out a press release alerting the public that they were investigating a possible locally acquired case of malaria.

The most likely cause of the woman’s infection, the release said, was a local mosquito biting someone who was infected with a travel-associated case of malaria, then spreading the infection to the Pierce County woman.

Malaria is caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people.

The department emphasized that the risk to the public was “very low,” that malaria does not spread directly from person to person, and that the best way to protect against malaria was to prevent mosquito bites and to talk with a health care provider about taking anti-malaria medications if traveling to countries where the disease is more common.

An alert also was sent to the area’s health care providers to be on the lookout for malaria infections, even in people who had not traveled abroad. “Without a relevant travel history, people wouldn’t be suspecting malaria in a place like Washington,” Miller said.

Meanwhile, the Tacoma-Pierce County public health team worked with the state health department and CDC to examine recent emergency department data. The records were analyzed looking for people with possible malaria symptoms who may not have been diagnosed with the disease in the recent past and going forward. No additional malaria cases were identified, Miller said.

Mosquitoes were trapped at the patient’s house and at other nearby locations.

Investigators wanted to determine whether the specific type of mosquito that’s capable of spreading malaria – the Anopheles mosquito – was present in the area. Some Anopheles mosquitoes were captured, but testing showed none of these individual mosquitoes was infected with the malaria parasite, Miller said.

The local health investigators went back and reviewed the cases of other people in the county who had been diagnosed recently with travel-related malaria infections, just to see if there was anything that was overlooked in those earlier investigations, Miller said.

They also went back to the Pierce County woman’s family and took a closer look at their travel and illness histories, in case one of them had been an initial malaria case.

But neither of these efforts produced additional clues, Miller said.

In labs at the CDC, scientists did molecular testing on samples of the malaria parasites that infected the Pierce County woman, then compared the findings with the genetic makeup of the parasites involved in the county’s other recent travel-related malaria cases.

These lab results indicated parasites in the county’s recent malaria cases weren’t similar enough to suggest any connection, Miller said.

“So where that leaves us is that in the absence of any other explanation, we think the most likely scenario is that this person did acquire a mosquito bite either here in Pierce County or potentially in a neighboring county,” Miller said.

The investigation’s findings suggest that this Pierce County woman is the state’s first known locally acquired malaria infection.

But there is no way to know exactly how her infection occurred.

One possibility, Miller said, is that a mosquito with malaria could have somehow been brought into the United States, perhaps on a plane.

The CDC’s testing of the malaria parasites that infected the woman indicate that they are most likely from sub-Saharan Africa, Miller said.

Another possibility, he said, is that there may have been a person in the area who had malaria, but their infection didn’t receive medical attention, and therefore wasn’t reported to public health officials. Miller noted that people who have lived in areas where malaria infections are common can have some level of immunity and may have a less severe case of the disease.

“And then a mosquito would have had to bite that person and then bite the person with locally acquired malaria,” Miller said.

But there is no way to know for sure. “We don’t have any confirmation or ability to say for sure about any of those scenarios,” he said.

Miller said the rapid investigation of this malaria case highlights the way the nation’s public health system should work, with local, state and federal agencies, sharing resources and expertise.

“In this situation, fortunately, the patient recovered. We didn’t identify any other cases. But of course, you don’t know that at the beginning of an investigation,” Miller said. “So it’s important to have a public health system that’s ready to ramp up quickly and to work together effectively to do an investigation.”

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

‘Going down the drain’: Atlanta global health work imperiled by U.S. aid cuts

2025-10-20T19:09:56+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

Sudden cuts to U.S. global health aid this year have hit Atlanta-based international nonprofits hard, spurring layoffs of close to 1,000 workers, and imperiling their mission to help millions of people access food and life-saving health services.

A program that trained thousands of health and nutrition workers in Bangladesh is “going down the drain,” said Joyce Sepenoo, senior director of global health programs at CARE. Programs that are helping countries like Uganda nearly eliminate river blindness have lost funding, said Dr. Kashef Ijaz of The Carter Center.

They are among leaders of four Atlanta global health organizations affected by cuts implemented by the Trump administration since taking office in January.

The suddenness of cuts to the U.S. Agency for International Development caused far more disruption than was necessary, said Dr. Patrick O’Carroll, president and CEO of The Task Force for Global Health.

“Many countries said, ‘If you told us this was going to happen, and you gave us five years to do that, we could have done a pretty good job, and it’s really in our interest to do so’,” O’Carroll said. “But this happened so suddenly.”

In March, U.S. Secretary of State Marco Rubio said the government was canceling 83% of the programs at USAID. “The 5,200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” Rubio said in a March post on X.

Atlanta’s global health leaders disagree.

Tropical diseases like trachoma, a bacterial eye infection, or even malaria could come back here if they are not well-controlled overseas, Ijaz said.

Reducing diseases globally is good for America’s security, too, Ijaz said, because it helps improve economies and political stability in other countries.

Here’s a rundown of where things stand at five large global health organizations based in Atlanta.

CARE: Aid to 18.4M people terminated

Cooperative for Assistance and Relief Everywhere was founded in 1945 in the wake of World War II to put together food and life-saving items for people in war-torn Europe: care packages. Since then, it has dramatically expanded its scope to a range of humanitarian projects around the world and moved its headquarters to Atlanta in 1993.

CARE lost $165 million in direct federal funding – mostly from USAID, since the start of the year, said spokesperson Michael de Vulpillieres. The organization received a total of just over $903 million in revenue for the year ending June 30, 2024, according to its financial statements.

Global Health Checkup: A promising moment in Ebola outbreak, early flu surge, and a rise in life expectancy

The loss of funds resulted in layoffs: 850 full-time workers cut from a total workforce of about 7,400. Most of those positions were in other countries, but 110 U.S.-based workers also lost their jobs. Contract positions have also been cut, de Vulpillieres said.

All told, 46 programs in 30 countries that reached an estimated 18.4 million people have been terminated, he said.

Those include:

health programs and food distribution programs in Sudan, where “a protracted famine is taking hold,” according to the World Food Programme
health and nutrition services to mothers and children in Bangladesh
health programs in the eastern part of the Democratic Republic of Congo
Programs to provide services to survivors of violence in Honduras and Guatemala

“Our program in Bangladesh trained and invested in over 50,000 workers, and it’s all going down the drain,” Sepenoo said during an Oct. 4 panel discussion at the Decatur Book Festival. “The world is coming to a place where we all need to shout on top of our voices and say we are so connected that the impact of these things in one country affect all of us.”

Carter Center helps fill gaps in U.S. aid

The Carter Center receives only about 9% of its funding from the federal government, so it hasn’t been hit as hard as others, Ijaz said. There have been no layoffs in its health programs.

Still, Ijaz is worried about how countries like Uganda, which is very close to eliminating river blindness, and Ethiopia, which has the highest burden of trachoma in the world, will continue to make progress because other nonprofits working there have lost significant funding.

“If you miss one mass drug administration for prevention of trachoma in a population at risk, you basically put the program back two years,” Ijaz said. As in many countries, the effort in Ethiopia relies on drugs donated from pharmaceutical company Pfizer. Those could expire if they are not administered on schedule.

“All those gains which were made, they can be reversed,” Ijaz said. The Carter Center is trying to help “meet the moment” by drawing on its own resources to fill the gap left by U.S. aid cuts, including providing $5 million to partner organizations for trachoma elimination in Mozambique, which is close to eliminating the disease, and continuing its own work in Ethiopia.

“We want to reach the finish line and finish the job, and this is our contribution, in this larger ecosystem of partnerships, collaboration and relationship, to fill in those gaps,” Ijaz said.

The Task Force for Global Health finds workarounds for some programs

The Task Force for Global Health is the “world’s longest-running pharmaco-philanthropy,” O’Carroll said during the book festival panel. Much of the organization’s work focuses on managing drug donations from pharmaceutical companies for diseases like river blindness and trachoma to countries around the world.

The Task Force, founded in 1984 and headquartered in Decatur, has had to lay off staff, spokesperson Jessica Wurst said, though she declined to say how many people. It also lost funding for a USAID-funded neglected tropical disease program in early 2025 aimed to improve how sub-Saharan governments and organizations prevent and treat diseases like river blindness.

The $45 million award involved a partnership with the Kwame Nkrumah University of Science and Technology in Ghana and an African research network, according to a 2024 news release.

The Task Force’s partners have found workarounds in the short-term, Wurst said. Pfizer donates the medication for trachoma, and nongovernmental organization partners stepped in to ensure that drugs were distributed before they expired.

Still, Wurst said, that’s only a short-term solution, and the organization is concerned about next year because about 40% of the areas that need the trachoma drugs were funded by the U.S. government.

Other funding streams have remained intact, Wurst said. Those include efforts to support national programs to dramatically reduce intestinal worm infections in several countries, including Bangladesh and Malawi, work on polio eradication in the remaining countries where outbreaks persist, and providing support for viral hepatitis elimination.

Merck and GSK donate drugs for lymphatic filariasis and river blindness, and so far none of those drugs have expired, Wurst said. Countries that lost USAID funding are “pursuing alternative solutions to sustain progress toward elimination.”

In the United States, The Task Force is watching what Congress will do to the U.S. foreign aid budget. “Some cuts that have been proposed would diminish our country’s ability to prevent future pandemics, manage outbreaks, and maintain the infrastructure of health systems across the globe,” Wurst said. “These losses weaken global capacity to fight diseases that continue to threaten lives worldwide and jeopardize American safety.”

Atlanta’s public health ‘anchor’: the CDC

O’Carroll likened the Centers for Disease Control and Prevention to the “anchor store” in a mall because it is the cornerstone of Atlanta’s global health work.

The agency has been rocked by multiple rounds of layoffs this year, most recently on Oct. 10. The CDC formerly had offices in more than 60 countries, according to its website.

Funding for malaria prevention was canceled, and 27 workers in sub-Saharan Africa were recalled to the United States earlier this year, Politico reported. Staffers who focused on global HIV and TB in the Global Health Center were terminated in April.

After the United States withdrew from the World Health Organization in January under an executive order from President Donald Trump, CDC staffers were instructed to stop communicating with the organization.

Trump’s proposed fiscal year 2026 budget would, if approved, cut funding for the CDC’s Global Health Center by more than half, from $693 million to $293 million, according to the CDC Data Project.

“CDC is funded by U.S. tax dollars to protect the health of Americans, but there is no way to protect the health of Americans and turn a blind eye to global health,” O’Carroll said.

The CDC Foundation is an independent nonprofit created in 1995 to fill “gaps in what CDC could do,” Brandon Talley, chief program and foundation officer, said at the book festival. The foundation has domestic and international programs and has worked in more than 100 countries.

Federal funding cuts have primarily impacted the foundation’s domestic work, said Amy Tolchinsky, associate vice president for communications.

The organization received Covid-19 supplemental funding from the federal government that was not renewed. It was using that money to support state and local public health agencies in hiring CDC Foundation staff members to work on local health needs, so when the funding ended, 90 staffers were laid off.

The foundation also laid off 32 additional people who work in the United States due to a decrease in other federal funds, Tolchinsky said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

New research raises concerns about local malaria infections in U.S.

2025-10-17T15:52:26+00:00

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An unusual series of small U.S. malaria outbreaks – attributed to mosquito bites occurring in Florida, Maryland, Texas, and Arkansas in 2023 – illustrates what may be an increasing risk of the disease transmitting locally in the future, according to new research from local and federal public health investigators.

Their paper, published this month in the journal JAMA Network Open, comes as health officials in New Jersey and Washington state are investigating the potential that two people may have been infected with malaria this summer in those states. Neither had traveled to international destinations recently.

Malaria was largely eliminated in the United States more than 70 years ago and health officials say the risk of contracting the disease in this country remains low.

The greatest risk involves international travel to countries where the disease is widespread. Such travel is the source of most of the 2,000 malaria cases in the United States each year, according to the Centers for Disease Control and Prevention.

Yet the local U.S. malaria outbreaks in 2023 and sporadic locally transmitted cases over the decades illustrate the potential for malaria infections to occur from mosquito exposures across the United States.

That’s because when malaria-infected travelers return to or arrive in the United States and are bitten by local mosquitoes, the disease can spread in U.S. communities. More than a dozen states – including Georgia and New York – are where most of these imported malaria cases have been identified.

Here’s what you need to know.

What is malaria?

Malaria is a serious, but treatable, disease caused by a parasite that is transmitted by a specific type of mosquito, called the Anopheles. To spread the disease, mosquitoes must first bite a person who already has a malaria infection, then go on to bite other people. The disease does not spread from person to person like the cold or flu.

Initial symptoms – which typically occur seven to 30 days after infection – can include fever, chills, headache, muscle aches, and fatigue. If not quickly treated, the disease can become fatal, causing kidney failure, seizures, and coma, according to the CDC.

How often do malaria cases occur in the U.S.?

Local transmission of malaria in the United States was largely eliminated by 1951 because of intensive public health efforts dating back to 1914 that included drainage projects and the spraying of mosquito-killing pesticides.

The Centers for Disease Control and Prevention, which began in 1946 as the Communicable Disease Center, traces its history to an earlier World War II malaria-control agency that worked to protect troops at military training bases in Southern states as well as U.S. territories. The historic challenges eliminating malaria in the Southeast is a big part of why the CDC is based in Atlanta.

Captured in 1954, this historic image depicts a view of what was the Centers for Disease Control and Prevention, formerly known as the Communicable Disease Center, Newton Field Station, located on the Ichauway Plantation in Newton, Georgia. This wooden structure was known as the Mossy Pond tower, used to trap insects.

Malaria was considered eliminated from the United States by the early 1950s and the World Health Organization certified the United States as malaria-free in 1970.

These days, malaria cases in the United States are usually the result of infections that occurred during international travel. Each year there are about 2,000 travel-related malaria cases reported to the CDC, and on average during 2007-22 there were nearly seven deaths per year.

On occasion, however, the public health teams that investigate each U.S. malaria case cannot find any connection to international travel, raising the possibility that the infection occurred here in the United States.

For example, in August 2002, when two teenagers in northern Virginia became infected locally, public health investigators concluded the source of their infections was “probably the bite of an infective mosquito that had acquired the parasite by biting a malaria-infected person in the general vicinity.” The teens lived about a half mile apart from each other, but the 19-year-old who became infected had made numerous visits to friends who lived across the street from the 15-year-old who became infected.

How unusual were the domestic outbreaks of malaria in 2023?

Over the past 50 years, the CDC says that malaria that has been transmitted locally in the United States has resulted in more than 150 cases and more than 60 limited outbreaks.

Yet after 2003, no U.S.-acquired malaria infections from local mosquito bites were detected for 20 years. That ended in 2023, according to an examination of the 2023 cases by local, state and federal health officials published this month in JAMA Network Open.

From May through September 2023, 10 people across four states were sickened with fevers and other malaria symptoms, nine of them seeking treatment from emergency departments, and one from primary care.

After a 20-year absence of documented local malaria infections, it was “unexpected” to have so many cases spread across multiple states in one summer, the researchers wrote.

Seven of the people lived in Sarasota County, Florida, and the other three lived in Cameron County, Texas; Saline County, Ark; and the National Capital Region of Maryland. All were treated with antimalarial medications and recovered.

None had recent international travel that could explain their malaria exposures, the team found, and none had risk factors for blood-borne transmission, such as transfusions, tattoos, or needle-sharing practices.

The public health investigators found that in the weeks before these people became ill, all had a history of spending time outdoors at night – the time when Anopheles mosquitoes pose the greatest risk. Two of the infected people had worked outdoors overnight, three reported being homeless, and the rest said they had been involved in other types of outdoor nighttime activities.

Genetic and other testing determined that the cases in Florida, Arkansas, and Texas involved malaria strains associated with Central or South American parasites, the paper says. The Florida cases appeared to share a common source, the testing indicated.

But the Arkansas and Texas cases were not genetically related to each other nor were they related to the Florida cases. The infection in the Maryland case had a genetic signature consistent with African malaria parasites.

Hundreds of mosquitoes were collected and tested in the four states in the areas near where the infected patients lived. Three Anopheles mosquitoes captured over three nights in May 2023 from the same swamp in Sarasota County, Florida indicated a recent blood meal from a person infected with malaria. Evidence of malaria was not detected in any of the other mosquitoes collected as part of the investigation.

A spokesperson for the Florida Department of Health in Sarasota County said no one was available to discuss the 2023 cases.

What caused these outbreaks?

The research team noted that there were likely many factors that contributed to the U.S. malaria outbreaks in 2023. It’s suspected that the risk of local transmission of malaria has increased along with the increase in the number of malaria cases being imported to the United States through international travel.

After the Covid-19 pandemic, as “as international travel rebounded, preliminary 2023 data suggested a record high of 2,205 imported malaria cases,” the researchers said.

While most U.S. states report at least one travel-related case of malaria each year, 75% of these infected travelers in 2022 were located in 13 states. Three of the four states involved in the 2023 outbreaks were among the top states with imported cases of malaria.

Other top states for imported malaria cases in 2022 included Georgia, New York, Pennsylvania, Ohio, Virginia, Minnesota, and Virginia.

Prior to the 2023 locally acquired malaria cases, the new paper notes that the last outbreak of locally transmitted malaria occurred in 2003 in Palm Beach County, Florida, that involved eight cases.

What lessons can we take from the 2023 malaria outbreaks?

While the research team said sustained malaria transmission within the United States is unlikely, they warned that a variety of factors may increase the risk of future cases that are locally acquired in U.S. communities.

Those factors include continued increases in international travel and migration, and that rising temperatures increase the potential for mosquito exposures.

The researchers noted that there were several challenges to identifying these locally transmitted malaria outbreaks because doctors may not consider malaria as a possible diagnosis when people haven’t had recent international travel.

“Although all patients were eventually diagnosed and treated appropriately, several experienced delayed diagnosis and health care access barriers,” the paper notes.

In addition, they said, more research is needed about the prevalence and patterns of Anopheles mosquitoes in the United States. Other species are prioritized because they more commonly spread disease in this country.

“There is no national surveillance system for Anopheles species,” they wrote. And they noted that local capabilities to perform resource-intensive mosquito control efforts vary by jurisdiction.

“This case underscores common challenges in malaria diagnosis, including differentiation from babesiosis and other diseases, and potential for sporadic locally acquired malaria cases in the United States,” said Amanda Hils, a spokesperson for the Maryland Department of Health, whose investigators were co-authors of the paper. “It also highlights the need for coordinated efforts among public health officials, clinicians, laboratories, and the public to prevent, detect, investigate, and respond to such cases.”

What’s known so far about this summer’s New Jersey and Washington malaria cases?

In New Jersey, state health officials announced in August that they were working with the CDC to investigate a possible locally acquired malaria infection in a resident of Morris County, which is about 30 miles northwest of New York City.

The infected resident had no history of international travel, state health officials said. They noted the possibility the person became infected in New Jersey and said they were working to reduce potential public risks through local mosquito control activities.

If the New Jersey case is confirmed as being a locally acquired infection, it would be the first in the state since 1998, officials there said.

“The investigation to determine a potential source of the case is ongoing and is awaiting investigational testing at CDC,” Dalya Ewais, communications director for the New Jersey Department of Health, told Healthbeat on Thursday. “This testing takes time and may or may not provide definitive information.”

Ewais said the department’s trapping and testing of mosquitoes did not identify any that carried malaria parasites. The department also is not aware of any additional cases of suspected locally acquired malaria in the state, beyond the one in Morris County, she said.

“Risk of non-travel-related malaria to the general public in New Jersey remains low,” she said.

In Washington, the Tacoma-Pierce County Health Department announced earlier this summer that a woman in East Pierce County, who had not traveled recently, was diagnosed with malaria on Aug. 2.

The county health department, which has been working with the Washington State Department of Health and the CDC to investigate how the woman became infected, said it did not have an update to provide about the investigation at this time. The department as previously noted it’s “possible she was recently infected with malaria in Washington.”

If confirmed, the department said it would be the first known locally acquired case of malaria in Washington.

The CDC, which is part of the ongoing federal government shutdown, did not respond to a request for information about the New Jersey and Washington malaria cases.

What can U.S. residents do to reduce their risk of malaria?

Because mosquitoes can spread a variety of diseases besides malaria – including the viruses that cause West Nile virus, dengue and Zika – the CDC recommends protecting against mosquito bites. Some tips for doing this include using proven insect repellants that are registered with the U.S. Environmental Protection Agency, wearing loose-fitting clothing with long sleeves and pants, using screens on windows and doors, and eliminating or treating standing water outdoors where mosquitoes breed.

The biggest risk of being infected with malaria comes with international travel. Most of the approximately 2,000 cases of malaria diagnosed in the United States each year involve people returning home after trips to countries where malaria is common.

For U.S. cases where the country of infection was known in 2019, the CDC says 93% acquired malaria in Africa; 4% in Asia; 2% in the Caribbean, South America and Central America; and less than 1% in Oceania and the Middle East. When these infections occurred among U.S. civilians, 76% were traveling to visit friends or relatives.

Before going to countries where malaria is endemic, the CDC advises travelers to consult with health care providers about their risk factors and whether they should be taking an anti-malaria medication to prevent infection during their trip. The CDC maintains a list of health risks by international destination and guidance for health care providers who advise and treat travelers.

CDC officials note that even people who may have once had some immunity to malaria because they previously lived in a country where the disease is widespread can quickly lose that immunity. They are also urged to take preventative actions to avoid infection.

Preventing malaria infections during international travel reduces the risk of bringing the parasites back to the United States, where mosquito bites on returning home have the potential to spread the disease in this country.

Where in the world does malaria pose the greatest risk?

Worldwide there were an estimated 263 million malaria cases and 597,000 deaths in 83 countries during 2023, according to the WHO.

About two-thirds of these malaria cases and deaths occurred in 11 African countries: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, United Republic of Tanzania and Uganda. And the African region as a whole accounted for an estimated 94% of malaria cases, according to the WHO.

But malaria endemic countries are found around the world. Outside of Africa they include Bolivia, Brazil, Colombia, Haiti, Indonesia, Iran, Myanmar, Pakistan, Panama, Papua New Guinea, and Peru.

The United States is among 44 countries and one territory that have been certified as malaria-free by the WHO.

Alison Young is Healthbeat’s senior national reporter. You can reach her at ayoung@healthbeat.org or through the messaging app Signal at alisonyoungreports.48

A promising moment in Ebola outbreak, early flu surge, and a rise in life expectancy

2025-10-16T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Nairobi.

The sun is shining, and the jacarandas are shedding a purple rain of flowers all along my street. This week, I’m thrilled to share the news that the Global Health Checkup will now be available a day early, every Wednesday, to email subscribers.

You can sign up here.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Ebola update: signs of containment

We’ve been following the worrying Ebola outbreak in the Democratic Republic of the Congo. Our focus has been on how the World Health Organization, alongside partners like the Red Cross and Doctors Without Borders, have scrambled to contain the disease amid severe funding shortfalls. I want to know: Does the world still have the muscle to manage major health emergencies now that the U.S. Agency for International Development (defunct) and the U.S. Centers for Disease Control and Prevention (hobbled) are no longer footing most of the bill, as was true for past epidemics?

In my last update on Oct. 2, I noted that the WHO was sounding some fairly dire alarms: International donors had pledged less than a fourth of what was needed, and the outbreak had already “overwhelmed” health facilities at the epicenter of the crisis. Worrying signs, all.

So it’s a welcome bit of whiplash that the WHO now reports a “potential control of transmission,” which means that 10 days have passed without any newly reported Ebola cases, the Associated Press reports.

I’ll admit, after my last update I found this news surprising, and a good reason to check my priors! Could this be a sign that the American pullback is less crippling to global health than many feared? To get perspective, I reached out again to Dr. Paul Spiegel, director of the Johns Hopkins Center for Humanitarian Health.

To start, Spiegel called the WHO’s report “encouraging,” although “it’s important to interpret it cautiously,” he said. “Ebola’s incubation period can extend up to 21 days, so a 10-day period without new cases suggests progress, but not definitive containment.”

(I also reached out to the Red Cross, and Fatou Mwaluke, a health coordinator in Kinshasa, tempered any rush to celebrate: “Surveillance teams are actively monitoring nearly 2,000 contacts, and several suspected cases remain under laboratory investigation,” she said, reminding me to avoid the temptation of conflating “delays in reporting and testing” with concrete success.)

Still, Spiegel says the progress “likely reflects effective surveillance, isolation, and community engagement,” all of which are vital but expensive to sustain in such a remote region. To me, this sounds like tentative proof that the WHO and partners like the Red Cross managed to rally new resources after sounding the alarm. And more importantly, that there may be still enough committed actors out there willing to step up, at least for this outbreak.

As for the broader takeaway for global health? Spiegel sees this moment as both promising and precarious. It may indicate “growing resilience” and “diversified global health partnerships,” in a post-American largesse world, but he noted “a structural vulnerability” in how the world pays for emergencies like this. After all, how secure can the system be if it depends on reactive, one-off appeals that pull resources from other crises rather than building lasting capacity?

In short: a promising pause, but not yet victory.

The early-bird flu

Time magazine reports that influenza is breaking tradition, spreading earlier than its usual season across Asia. (Worldwide, the flu is largely seasonal because the virus spreads more easily in cool, dry air, and when people spend more time indoors and close together.)

In Japan, officials declared a nationwide flu epidemic after cases skyrocketed five weeks earlier than usual. Schools and child care centers closed, and 60% of Japanese prefectures saw rising flu counts. “But it’s not just Japan. Flu cases have risen in recent weeks in other countries across the continent, including Singapore, Thailand, and India.”

It’s a long article, but the takeaway comes right at the top: The “surge of influenza cases … has led some medical experts to warn that getting sick more easily throughout the year may be the new reality.”

What’s driving the shift? Experts point to two converging pressures, with plenty of nerdy disagreement on which is the main cause. The first pressure is genetic: the slow evolutionary drift in flu viruses that help them adapt and circulate when there’s a new opportunity. Basically, the virus is evolving. The second pressure is climate change, where shifts in rainfall, increased indoor crowding during extreme weather, and changing seasonal habits in tropical regions may all be eroding the old boundaries of “flu season.”

I know what you’re thinking: If only there were a simple, once-a-year shot that could help prevent all this … oh wait.

Rift Valley Fever outbreak in Senegal

Senegal has confirmed over 100 cases and 17 deaths from an outbreak of Rift Valley Fever, in what officials are calling the “country’s worst in decades,” Africa News reports.

Disease breakdown: Rift Valley Fever is a centuries-old virus, best understood as a livestock disease that occasionally spills over into humans. It primarily affects herding animals, including cattle, goats, sheep, and camels. It spreads through mosquitos (or, occasionally, animal slaughter) and is largely isolated to Africa, the Arabian Peninsula, and some islands in the Indian Ocean. While the majority of cases in humans present as symptomless or as a flu-like fever, it can occasionally lead to coma, loss of vision, or fatal hemorrhaging.

What’s behind the outbreak? Officials are blaming “climate change … for creating ideal breeding conditions for mosquitoes,” with unusually heavy downpours in Northern Senegal followed by intense heat.

At first glance, this might sound like a fairly local story. But there’s more at stake here than meets the eye. The disease is a test for regional cooperation, as it threatens a rough triangle between northern Senegal, Mauritania, and Mali. For context, this is a dramatically underdeveloped region where herders, livestock, and trade routes constantly cross borders. (Underdeveloped may even be an understatement … Mauritania has been described to me as Earth’s own Tatooine.)

It’s an epidemic that’s worth watching closely. There’s an effective vaccine for livestock, but paying for it and deploying it across remote, nomadic, and resource-limited regions is another matter entirely. Like the Ebola story, this one could become a test of how well these national and regional health systems can respond during the global health funding crunch.

Thankfully, there is a bit of luck at play here. Over the weekend, Senegalese scientists confirmed that the current virus is nearly genetically identical to previous outbreaks, so the existing vaccines should work.

An uneven rise in life expectancy

It was a big weekend for the spreadsheet crowd. The Global Burden of Disease report came out, which is the most important recurring study in global health. It is basically the master dataset on what’s killing, sickening, and disabling people around the world, and why. (I imagine that epidemiologists view it publishing like the Coachella lineup dropping.)

The study is a mammoth effort, based on a network of over 16,500 scientists and more than 300,000 data sources. And this year’s edition offers the first true snapshot of health in a fully post-pandemic world. Some of the starkest findings come from the Americas.

According to El País, while global life expectancy has rebounded to record highs (76 years for women and 71 for men) across North and South America, deaths among people in their 20s and 30s have risen much more sharply. These deaths are largely driven by suicide, drug use, and alcoholism, which the researchers call “muertes por desesperación,” or “deaths of despair.”

The biggest increases were observed in the United States, Canada, Mexico, and Brazil, where deaths in the 25-to-29 age group have risen almost 32%, and 50% among people in their 30s (!).

What’s the takeaway? A little humility, to start. There are clearly political and social forces behind these numbers, but I’m internalizing this as a reminder: Progress in public health doesn’t move in a straight line. Even in the world’s wealthiest countries, as science pushes life expectancy higher, and infectious diseases retreat, social fractures and mental health crises are cutting lives short.

From health policy to ideology police

For decades, U.S. global health funding has come with political strings attached. The best known is officially called the “Mexico City Policy.” Under Republican presidents, it bars foreign NGOs that receive U.S. funding from offering, promoting, or even mentioning abortion services … even if they use their own money to do so. (Within USAID, we use to call it the “global gag rule.”)

In practice, it has historically forced clinics in dozens of countries to choose between keeping U.S. financial support or providing comprehensive reproductive health care. The rule is a kind of foreign-policy pendulum I watched swing back and forth during my time at USAID, rescinded under Democratic presidents and reinstated under Republicans, disrupting programs every few years.

Now, the Trump administration is reportedly pushing to extend this model beyond abortion, The Guardian reports. According to Politico, countries, UN agencies, and NGOs are being told to drop all diversity, equity, and inclusion programs or risk losing all funding. If implemented, it would mark the first time the United States has used its global health purse not just to restrict services, but to police ideology itself.

The takeaway? The potential consequences are enormous. As one source told The Guardian: “It risks causing real human suffering, undermining global health, and destabilizing decades of partnerships and progress.”

I’ll see you all next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Global Health Checkup: Chikungunya hits home, malaria’s comeback, and a vaccine for elephants

2025-10-09T11:00:00+00:00

Public health, explained: Sign up to receive Healthbeat’s Global Checkup in your inbox a day early.

Hello from Lagos.

I’m in Nigeria this week for a conference with a British development project I’m working with. It’s my first time here, and I can confirm that the food is fiery, the traffic is legendary, and people dress to impress. Even more exciting: Lagos is to Afrobeat music what Nashville is to country music (the warm, pulsating heart), so I’m hoping to hear some live before I fly out.

The traffic in Abuja, Nigeria, was better than in Lagos, but of an entirely different species.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Chikungunya: from the tropics to Times Square

This week a team of epidemiologists mapped the growing reach of chikungunya virus in the science journal BMJ Global Health, which now threatens up to 35 million people worldwide, The Times of India reports.

Disease breakdown: Chikungunya is a virus first identified in Tanzania in the 1950s and is spread by mosquitoes. Its name means “that which bends up,” a nod to the symptomatic contortions caused by terrible joint pain and fever. Although there’s no cure, death is rare, with fewer than 1 in 1,000 perishing from the illness. The real cost is in long-term pain: chronic arthritis that can last for months or years.

If you’ve never heard of this disease, that’s likely because most cases of chikungunya remain in India, Brazil, and Indonesia. But the virus is increasingly spreading beyond the tropics. China is now seeing its worst outbreak on record, while Italy and France are fighting surges of their own. And last week, a Long Island woman tested positive despite not having traveled abroad. If confirmed, that would be the first local transmission in New York.

What’s going on here? I spoke with Dr. Marietjie Venter, an animal-borne virus researcher at the University of the Witwatersrand, in South Africa. We talked about why chikungunya is spreading, and what this means.

She said the main issue at play is that mosquitoes are moving. The Asian tiger mosquito (Aedes albopictus) and the yellow fever mosquito (Aedes aegypti) are the main carriers of the disease. Both have expanded their range dramatically, surviving in places once thought too cold. This comes as humans unwittingly ferry mosquito species across continents and (uh, wittingly) warm the global climate.

“At this stage, chikungunya is really about long-term management rather than eradication,” Venter said. “Once Aedes aegypti or Aedes albopictus mosquitoes establish themselves in an area warm enough for them to survive the winter, it becomes extremely difficult to eliminate them.”

Venter also says that unless we stop warming the planet, today’s situation shouldn’t be seen as a high-water mark for chikungunya, but the new normal. And just as outbreaks are spreading through southern Italy and France, the same could soon happen across the southern United States, where both invasive mosquito species have taken hold. “It’s not something to panic about, but it is something to be aware of,” she said.

Malaria’s comeback in Cameroon

Reuters has a report this week on the death of a 9-month-old boy in northern Cameroon. He’s one of a growing number of malaria fatalities that local officials and aid workers are directly linking to the U.S. pullback in foreign assistance. The story is heartbreaking but straightforward:

“Before the cuts, Mohamat might have been diagnosed earlier by one of more than 2,000 U.S.-funded community health workers who would travel over rough dirt roads to reach the region’s remotest villages … [but] nearly all of the U.S.-funded community health workers are now out of service.”

The core issue is that the Trump administration has cut funding for America’s malaria-fighting program, the President’s Malaria Initiative, by nearly half from recent levels of about $800 million a year. This program once paid the stipends and supplied the drugs for the community health workers reaching families like Mohamat’s. In the story, officials warn that northern Cameroon’s malaria fatality rate may have already erased a decade of progress. It’s worth noting that although U.S. funding cuts triggered this crisis, Cameroon’s government (which earns billions from oil and other exports, but ranks as one of the most corrupt in the world) has failed to step up and provide these basic medical services.

As I wrote two weeks ago, the U.S. government insists its new “America First” health strategy will still reduce malaria cases and deaths, but it doesn’t say how. Ultimately strategies, goals, and promises mean little if the math doesn’t work. For perspective, from 2010 to 2023, the United States contributed roughly 37% of all global malaria funding, according to the World Health Organization. Halving that support while promising the same outcome — without explaining how — seems like magical thinking.

Something’s in the air

We tend to think of air pollution risk in terms of lung damage, like asthma or lung cancer. But The Guardian reports that a new global review of studies across 11 countries has found a strong link between long-term exposure to polluted air and an increased risk of “frailty” in middle and older age. The researchers define “frailty” as a clinical state marked by reduced strength, slowness, and a lower ability to recover from illness.

Context: The type of study here matters a lot. Health reporting has long struggled with how to cover single studies, which can sometimes overstate results or show false findings. That’s not necessarily because of fraud or bad science, but simply because when thousands of studies are run, a few will produce statistical outliers that look exciting by chance alone. It’s how you end up with whiplash headlines: “Coffee/chocolate/wine linked to cancer,” and “Coffee/chocolate/wine shown to prevent cancer.” You know the ones I mean.

But this isn’t a single study. This new review is a “meta-analysis,” meaning it’s a synthesis of data from dozens of studies. That gives it more statistical weight and helps pin down patterns that would be impossible to prove on a case-by-case basis, but hold up across different populations.

What’s the takeaway? The correlation was relevant for developing and richer countries alike, even wealthy countries like the UK. “Since frailty can be reversible,” one independent researcher notes, reducing pollution now isn’t just about preventing disease, it’s about preserving quality of life, “extend[ing] years of independence, and eas[ing] the strain on health and social services,” for millions globally.

Growing drug-resistant infections in newborns

Australian researchers are sounding the alarm on a disturbing rise in drug-resistant infections in newborns across South and Southeast Asia, Newsweek reports. In many cases, standard antibiotics fail, leaving doctors scrambling to treat babies with dwindling options. The story highlights hospitals in India, Bangladesh, and Nepal where “neonatal sepsis” (essentially blood poisoning) is caused by resistant bacteria.

The report links several drivers: overuse of broad-spectrum antibiotics (some given even in advance of any illness), weak infection control in hospitals, and a lack of diagnostic labs to guide medication decisions. In one hospital, a newborn unit saw a strain of bacteria (Klebsiella pneumoniae) resistant to a class of last-resort antibiotics. These infections quickly escalate in fragile newborns whose immune systems barely exist.

What’s the takeaway? “Antibiotic resistance spreads across borders,” one researcher warned. While chikungunya or malaria might never touch most readers directly, drug-resistant infections are increasingly likely to. Once resistance takes hold, there’s no rewinding it, and slowing it down will require serious global cooperation and accountability. Moving forward also means another kind of investment, the researchers say. “With so few new drug candidates in the pipeline, we need a significant investment in antibiotic development.”

Finally, some good elephant news

It’s welcome (if not a bit Dr. Seussian) news this week: Scientists in the UK have trailed the first vaccine in elephants, the BBC reports. The vaccine protects the animals from a deadly virus, called elephant endotheliotropic herpesvirus. The illness is reportedly the largest disease risk for Asian elephants, enough so that “seven baby elephants have died of it over the last decade,” at the Chester Zoo in the UK, where the drug trials took place on six individuals.

Last year, a Houston Zoo elephant received an experimental version of a similar vaccine, which is based on the mRNA vaccine advancements that led to the Covid vaccines. But this marks the first proper trial. (Now, you can almost hear the voiceover: “Ask your zookeeper if Tuskaris is right for you.”)

In all seriousness, this is a rare piece of hopeful science, and not just for a species under siege. Just as mRNA vaccines this decade pushed the boundaries of how quickly we can design and test human vaccines, this work shows how far those advances are spreading — to new tools and new species. It’s also a small but meaningful step toward using modern medicine to help endangered animals fight their own battles to survive.

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

Are STIs truly declining, or is our data just not very good? What the 2024 CDC STI report really shows

2025-10-07T17:56:45+00:00

Dr. Jay K. Varma is a special contributor to Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Amid the disturbing news about public health in the United States, there may be some good news about sexually transmitted infections. On Sept. 24, the Centers for Disease Control and Prevention quietly reported that the combined total of the three nationally reportable STIs — chlamydia, gonorrhea, and syphilis — declined in 2024.

Is the United States finally making progress in improving sexual health? While reported cases have indeed declined, the data have some important limitations, and the data on syphilis show worrisome trends in how we detect, track, and treat infectious diseases.

CDC STI surveillance report shows decline in cases

The CDC tracks and reports annually on chlamydia, gonorrhea, and syphilis because they are the most common bacterial sexually transmitted infections and the ones most strongly associated with long-term illness and reproductive harm, including pelvic inflammatory disease, infertility, and chronic pelvic pain in women and epididymitis and infertility in men.

Syphilis can lead to neurologic and cardiovascular complications years after initial infection and can infect a developing fetus, resulting in stillbirth, neonatal death, or lifelong disability. These infections also serve as sentinel markers of inadequate access to testing and treatment for vulnerable populations.

According to the CDC’s Sexually Transmitted Infections Surveillance, 2024 (Provisional) report, the overall total number of reported STIs — chlamydia, gonorrhea, and syphilis combined — declined 9% percent from 2023 to 2024, marking the third consecutive annual decrease and the first sustained multi-year decrease in a decade.

Major findings include:

Chlamydia, the most common reportable infection, declined 8% in 2024.
Gonorrhea dropped 10%, the third consecutive year of decline.
Primary and secondary syphilis, the infectious stages of the disease, fell 22% after years of steady increase.
Congenital syphilis rose 1.6% from 2023, reaching nearly 4,000 reported cases in 2024 and marking the 12th year in a row that cases have risen.
Despite the declines, the absolute total of reported STIs (2.25 million cases) remains 13% higher than 2014.

What is driving the decline in reported STI cases?

There are several plausible explanations for the decline in reported cases.

First is the impact of HIV pre-exposure prophylaxis (PrEP) programs. Patients taking PrEP are required by their providers to get tested and treated for STIs every three months. As PrEP use has expanded among men who have sex with men, transgender women, and other people in sexual networks with high STI transmission, so too has testing and treatment for STIs.

Second is the impact of doxycycline post-exposure prophylaxis (DoxyPEP). DoxyPEP involves taking a single 200 mg dose of doxycycline within 72 hours after sex to prevent bacterial STIs. Studies have shown it can reduce syphilis and chlamydia infections by about 70% and gonorrhea by 50% in men who have sex with men and transgender women. It is possible that widespread adoption in high transmission sexual networks is helping reduce transmission.

A third possibility is that antibiotic use for other reasons — for example, increased prescriptions for respiratory infections during Covid-19 surges or the past year’s wave of influenza and RSV — may have had a collateral effect on bacterial STIs. While this would not be a desirable reason given the risks of antibiotic resistance, it could partially explain short-term declines.

Finally, declines in gonorrhea could reflect indirect protection from vaccines. The meningococcal B vaccine, which targets Neisseria meningitidis, has shown cross-protection against Neisseria gonorrhoeae. Broader use of this vaccine in college-age and high-risk adults might be contributing to fewer gonorrhea infections.

Is it possible the decline in STI rates is not real?

While there are plausible reasons for declines in STI cases, we need to be cautious about drawing any conclusions about the impact of testing, treatment, and vaccines.

First, the national data is not complete. The CDC released only national-level information for 2024 because of ongoing updates to its surveillance systems. More worrisome is that the CDC’s transition to its new One CDC Data Platform began in 2022, which coincides with the first of these three consecutive years of decline. The agency acknowledges that the new system has delayed or limited reporting from many states.

Second, the data that were released lack important data elements. Detailed data by state, race, ethnicity, age, and sexual behavior were withheld. These analyses often reveal disparities and local surges that national averages can obscure. Without them, we cannot know whether declines are widespread or concentrated in a few regions or populations. Because the federal government has recently revised CDC data systems — changing “gender” to “sex,” discontinuing data collection about transgender people, and reducing analyses by race and ethnicity — the next round of surveillance may provide less visibility into who is being affected and where disparities are widening.

Finally, we lack information about STI testing rates. Surveillance only counts the number of positive test results. A decline in positive test results could simply reflect fewer being tested for STIs. Many local health departments have cut sexual health clinic hours and staff. Private clinicians may be ordering fewer screening tests because of competing demands or changing insurance coverage. Without knowing how many people were tested, we cannot determine whether incidence truly declined or whether we are just missing more infections.

Do the trends in syphilis cases tell the real story?

Looking at the data on syphilis in more detail helps provide insight into what might and what might not be working with STI control. Nearly all of the reduction in reported syphilis cases occurred among men. Primary and secondary syphilis among men dropped by 9,600 cases, a 24% decline from 2023 to 2024. Among women, the decrease was much smaller — about 1,900 cases, or 14% — indicating that heterosexual transmission remains far less controlled. This pattern most likely reflects the effects of biomedical prevention among MSM — DoxyPEP and more frequent screening among people taking PrEP.

In fact, the data show that early non-primary, non-secondary syphilis — an indicator of recent infections that were not diagnosed — increased among women by nearly 8% in 2024. This is a warning sign that transmission in heterosexual networks continues to increase, even as symptomatic disease declines among men. Because these early infections often go unnoticed, they can progress to infectious stages or lead to congenital syphilis during pregnancy.

The rise in congenital syphilis, which is infection passed to a fetus during pregnancy, is the most worrisome indicator. Despite an overall 9% decline in total reported syphilis cases, congenital syphilis rose 1.6% to nearly 4,000 reported cases, the 12th consecutive annual increase. Compared to 2014, congenital syphilis is now nearly 700% higher. That divergence between adult and congenital disease means fewer pregnant women are being screened or treated in time to prevent infection of their babies. Each congenital case requires multiple breakdowns in our health system: undiagnosed syphilis in men, untraced female partners, missed screening during pregnancy, and failure to treat during pregnancy.

What the 2024 CDC STI surveillance data can and cannot tell us

While CDC surveillance reports are essential for understanding national trends, they are inherently retrospective. Case reports take time to collect, verify, and analyze. By the time data reach the public, they describe events that occurred months or even years earlier. Surveillance is like our rear-view mirror of public health. It’s not what is happening in front of us right now or what’s further down the road.

The declines in chlamydia, gonorrhea, and early-stage syphilis may represent progress in some populations, particularly men who have access to biomedical prevention. But the same data reveal widening gaps for women and infants and an ongoing breakdown in our systems to prevent high-consequence infections, such as syphilis.

Welcome to the Global Checkup: 5 health stories from around the world

2025-09-25T20:01:21+00:00

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Hello and welcome to the Global Health Checkup, Healthbeat’s new weekly report highlighting five of the week’s most important stories in public health from around the world. My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya.

We’re launching this report at Healthbeat.org – and soon as a newsletter; sign up here – with a few goals.

First, to cut through the dense world of disease outbreaks and global health policy to pull out what truly matters and why. Unless you’re steeped in the field, it’s easy to find this space repetitive or incomprehensible. To help, I’ll be bringing in experts to help us digest the news.

We want to help people understand how global health connects us all. When you strip away the jargon, you’re left with a story that everyone can care about. It’s about how humanity wrestles with our oldest agonies: sickness, survival, death, and care. As we saw in the last global pandemic, what happens in one place doesn’t always stay there. Outbreaks, shortages, and breakthroughs tend to ripple outward.

Second, to put it all in context. I’m a science and health journalist by training, but I spent the last 8 1/2 years as the head of communications for the U.S. Agency for International Development in Rwanda, Ethiopia, and Kenya. With the dissolution of America’s foreign aid agency and the broader retreat of global health funding from the world’s wealthier nations, I want to understand what the pullback really means. But I also want to resist catastrophizing, check my priors, and highlight the brilliant people across the developing world who are working to make their societies healthier, with or without outsiders’ help.

With that, as we say in Kenya: karibu katika habari — welcome to the news!

Ebola returns to Central Africa

The Democratic Republic of the Congo is facing the first outbreak of Ebola in three years, Al Jazeera reports. The United Nations confirmed 48 cases and 31 fatalities on Sept. 18.

Disease breakdown: Ebola is a virus in the family of the deadly “hemorrhagic fevers.” It’s a disease that first occurred in 1976 and is contracted through infected animals, blood, or other bodily fluid. Because symptoms often end in organ failure and internal/external bleeding, the average fatality rate is around 50%. Ebola is a nightmare disease in all but one very important way: It moves slowly, because it requires direct contact with infected people or contaminated objects to spread.

The World Health Organization and other international partners have rushed in “more than 14 tons of essential medical equipment and supplies and [deployed] 48 experts.” Importantly, these supplies include a relatively new vaccine — approved in 2019 — and an antibody therapy — approved in 2020.

Will this be enough? I spoke with Dr. Paul Spiegel, the director of Johns Hopkins’ Center for Humanitarian Health, for his takeaway on this story and others.

Spiegel said the WHO has “done a good job so far, but the key is to watch how the outbreak response expands,” especially when it comes to the expensive, time-consuming task of contact tracing. “My biggest concern is that the WHO’s capacity has been decimated because of funding shortfalls, particularly the U.S. reduction in funding,” as has the U.S. Centers for Disease Control and Prevention, “which has historically been a major player in past [Ebola] outbreaks.”

We’ll be watching not just how this outbreak unfolds, but what it reveals about the world’s capacity to control epidemics.

Malnutrition deaths rising in South Sudan

In South Sudan hunger is worsening at an alarming rate. As is universally true, when hunger or famine hits, it is children who disproportionately suffer. The Associated Press reports that “about 2.3 million children under 5 in South Sudan now require treatment for acute malnutrition.” One source in the AP story reports that nearly a quarter of “children admitted for malnutrition [in the capital city’s] largest children’s hospital have died of hunger.”

What’s to blame? Conflict, corruption and climate change are factors, but the country has been especially vulnerable to the global retreat of foreign aid. Here’s an excerpt:

“Critics say years of aid dependence have exposed South Sudan. The government allocates just 1.3% of its budget to health — far below the 15% target set by the World Health Organization, according to a recent UNICEF report. Meanwhile, 80% of the health care system is funded by foreign donors.”

The AP cites closed malnutrition centers, layoffs for nutrition-focused medical workers, and dangerously low stocks of the therapeutic food (called RUTF) that are given to children on the brink of death. The crisis comes from two directions: Trump administration cuts to global malnutrition programs, and NATO allies shifting aid funds toward military budgets.

Spiegel said that unlike the acute crisis of Ebola, “what we are seeing is an exacerbation of some very long-term trends in South Sudan.” He concurs that partly at issue is the government of South Sudan’s failure to allocate funds to their health sector (despite their oil revenue.) But he notes that even a more willing and able government wouldn’t be able to match the “magnitude of the reduction in nutrition funding so quickly,” he says.

Coupled with severe flooding and a political crisis (particularly the ongoing trial of the vice president) that threatens to send the country into a severe phase of conflict and civil war, “this is an extremely serious situation that threatens to become much worse. Although it may not be hugely surprising, the scope of what is happening is horrifying.”

UNAIDS proposal: closure by 2026

Reuters reports that the United Nations may shutter its HIV/AIDS agency as it faces funding shortfalls. A draft plan from the U.N. Secretary-General calls for UNAIDS to “sunset” by the end of 2026, with its work folded into the wider UN system. The agency had already mapped out a transition with a 55% staff cut and possible closure after 2027. This new plan would accelerate that timeline.

What does this mean? Let’s turn to Eswatini in southern Africa, which has the highest rate of HIV among adults in the world.

The Times of Eswatini — the small landlocked country’s main daily — reported a stark reaction from the head of the Eswatini government body that coordinates non-governmental organizations: “I am beyond shocked myself at the fact,” Thembinkosi Dlamini said. In Eswatini, UNAIDS isn’t just a provider of technical support, he said. It underpins community testing campaigns and helps people stick to life-saving HIV treatment. Without it, he warned, new infections in Eswatini could climb again.

His appeal was for the government to begin budgeting to absorb some of UNAIDS’ functions. “We cannot rely on donors, especially at a time like this,” he said.

America first. Global health … after?

The U.S. State Department has unveiled a 36-page strategy that reframes U.S. engagement on global health under President Donald Trump’s “America First” agenda. This comes after the Trump administration has made a U.S. withdrawal from the WHO, a roughly 70% cut to U.S. global health spending (more than $9 billion), and the shuttering of USAID. An analysis by Think Global Health breaks down the document.

Let’s start with the good news: The strategy “emphasizes a continued commitment to the ambitious goals that have been set over the past decades for HIV/AIDS, malaria, polio, and TB,” Think Global Health reports.

How will the U.S. accomplish these ambitious goals after a 70% funding cut? The new plan offers no clear explanation of how (or if) those goals could be met beyond vows of “efficiency,” cuts to non-frontline work, foreign country “co-investment” to fill the gap, and some ominous silence on other longstanding U.S. commitments.

Which leads us to the bad news:

“The plan is silent on whether the United States will continue to support historically bipartisan investments in routine childhood immunization, nutrition, maternal and child health, family planning (aside from abortion), and pandemic preparedness (beyond surveillance and outbreak response)... [and] is also silent on [helping] low- and middle-income countries to manufacture vaccines, diagnostic tests, and countermeasures locally.”

The takeaway: Without a credible plan to backfill cuts, the strategy is less a roadmap to hit global targets for diseases like malaria or HIV, and more of a pivot that risks hollowing out other commitments.

More mosquitos, less problems?

The Independent reports that Brazil has just opened the largest biofactory in the world for producing mosquitoes purposely infected with a bacteria called Wolbachia. This human-friendly bacteria blocks the transmission of a suite of diseases from mosquitoes, including dengue, Zika, and chikungunya. Dengue is the main target of this effort.

Disease breakdown: Dengue is a millennia-old mosquito-borne virus that’s sometimes called “break-bone fever” for the intense joint and muscle pain it causes. Although it has a very low fatality rate (less than 1%), it spreads quickly through mosquitoes that thrive in cities. That makes it extremely difficult to wall off and allows outbreaks to balloon to millions of cases — hence the need for inventive solutions.

Each week, the factory can churn out over 100 million mosquito eggs carrying the bacteria. After the mosquitoes are grown, “public health officials release laboratory-bred mosquitoes infected with Wolbachia to breed with local mosquito populations,” to pass on the virus-blocking ability.

The way this is actually rolled out sounds like it was designed by a cartoon supervillain:

“Cars laden with infected mosquitoes will pass through dengue hotspots and release the insects with the push of a button.”

In all seriousness, Brazil’s health ministry estimates the program could protect up to 140 million people over the next few years, and could provide a model for other countries facing current surges in dengue, like Bangladesh.

Thank you for reading. I’ll see you next week!

William Herkewitz is a reporter covering global public health for Healthbeat. He is based in Nairobi. Contact William at wherkewitz@healthbeat.org.

7 things to know about New York City’s Legionnaires’ disease outbreak

2025-08-22T13:28:51+00:00

Due to the large, ongoing Legionnaires’ disease outbreak in New York City, we’re taking a closer look at the illness and its biology this week. While the outbreak data shared is specific to New York City, much of this information can apply to outbreaks elsewhere. For our readers outside of New York City, know that we’ll be back with state-level updates next week. Let’s dive in.

While the Legionnaires’ outbreak in New York City’s Central Harlem has slowed, it hasn’t stopped. As of Thursday, there have been 109 cases, with 9 currently hospitalized and 5 deaths. The affected ZIP codes include 10027, 10030, 10035, 10037, and 10039.

The most recent case developed symptoms on Aug. 12, which means we’re likely closer to the end of the outbreak. That’s good news. It means that mitigation efforts (like identifying and cleaning contaminated cooling towers) are working.

New York City Legionnaires’ disease outbreak: Cooling towers, regulations, and lessons from 2015

But we’re not entirely out of the woods — we still might have some cases trickling in. People who may have been exposed before the cooling towers were cleaned could still get sick several days after their exposure.

What does this mean for you? We still need to stay alert, especially if you are someone at higher risk for severe illness (more below).

Since the outbreak began, I’ve gotten a lot of questions about Legionella (the bacteria) and Legionnaires’ disease (the illness it causes). Here are your top seven questions answered.

1. What are the symptoms, and who is most at risk?

Symptoms usually start 2–10 days after exposure and can include:

Cough
Fever
Chills
Shortness of breath
Muscle aches
Diarrhea

Most healthy people exposed won’t get sick. Those at highest risk are adults over age 50, smokers, and people with chronic lung disease, diabetes, cancer, or weakened immune systems.

2. Can I get Legionnaires’ disease from drinking water?

No.

Legionnaires’ disease is caused by breathing in tiny water droplets containing Legionella bacteria. Water doesn’t enter the lungs when drinking unless someone chokes and accidentally inhales it.
Stomach acid also likely kills Legionella bacteria if swallowed, so drinking water (even if contaminated) won’t cause illness.

On top of all this, outbreaks in New York City are typically caused by cooling towers, which are on different plumbing systems than residential water, meaning drinking water will not be contaminated.

3. If it’s in the air, why don’t more people get sick?

The bacteria have to be inhaled in a concentrated enough dose to cause illness. Many people breathe in small amounts without getting sick because their immune systems clear the bacteria.

But older adults, people who smoke, and people with chronic lung disease (including asthma) or weakened immune systems are much more likely to develop severe pneumonia. For example, I don’t have any of the risk factors for severe Legionnaires’ disease, so I felt comfortable going on a run through Central Harlem during the outbreak. If I had asthma, I would have found a different area to run in.

4. If it affects the lungs, why can’t it spread from person to person?

In New York City, Legionnaires’ disease almost always comes from cooling towers (though elsewhere in the United States, outbreaks have been linked to sources like hot tubs). Unlike the viruses that cause Covid-19 or flu, Legionella bacteria don’t spread easily between people— only one person-to-person case has ever been documented worldwide.

Residents question health officials about why Harlem is a Legionnaires’ hotspot

The reason lies in the biology of the Legionella bacteria.

After someone inhales contaminated water droplets, the bacteria travel deep into the lungs and infect alveolar macrophages, a type of immune cell.
Legionella mostly stays put in the lung immune cells — it doesn’t colonize the throat or nose, and you don’t find it in mucus or saliva. This is different from the viruses that cause Covid-19 and flu, which replicate in the upper airways and are spread through coughing, sneezing, or even talking.

This is also reflected in the way people are tested for Legionnaire’s disease: Clinicians often need a lower respiratory sample because infections are typically deep in the lungs. In contrast, to diagnose Covid or the flu, a simple nose or throat swab usually works.

5. What is being done to control the outbreak?

New York City has some of the most intensive and sensitive Legionella monitoring in the world, and was the first city in the world to have a cooling tower inspection program. Every day, special software scans health data across the city for clusters of pneumonia-like symptoms. If a pattern is detected, the health department springs into action: Inspectors test cooling towers for Legionella, and any tower that tests positive must be cleaned, disinfected, and retested by the building owner. The goal is to stop ongoing exposure and prevent future cases.

6. Why wouldn’t a health department share the building addresses of the affected cooling towers?

The health department’s decision on whether to release specific addresses is based on a balance of risk vs. public benefit, and how far along the investigation is (e.g., if there are more cooling towers to test). For the recent Central Harlem outbreak, eventually the city did release information on the buildings with positive tests.

Knowing the address of a contaminated cooling tower shouldn’t really change how you act. That’s because Legionella bacteria from cooling towers can travel long distances in the air, sometimes up to several miles.

The health department likely worries that releasing an address can create a false sense of security. Someone might think, “I’m a few blocks away, so I’m safe,” when that’s not how this bacteria behaves. Risk doesn’t scale linearly with proximity, and public health decisions aim to protect everyone, not just those near a known source.

Instead, health departments focus on identifying and remediating the source quickly, which is the most effective way to reduce risk to the public.

7. What do I need to do?

If you live or work in a ZIP code with a Legionnaires’ disease cluster and develop symptoms, call your doctor right away.

If you have any of the risk factors (age 50 or older, smoke or used to smoke, have a chronic lung condition like COPD or asthma, or are immune-compromised), be on alert for any symptoms and seek medical care right away if you develop any. Also, reduce time in the area of the outbreak (which I know is hard) and spend less time outdoors. For anyone else without risk factors and with no symptoms, I don’t think you need to worry.

Bottom line

Legionnaires’ disease spreads through airborne water droplets, not by drinking water or through person-to-person spread. During outbreaks, spread is slowed by identifying and cleaning contaminated cooling towers. If you live or work in ZIP codes affected by a Legionnaires’ outbreak and develop flu-like symptoms, contact your doctor right away, especially if you are over 50 years old, have chronic lung conditions, smoke, or are immunocompromised.

Love,

Your NY Epi

New York City Legionnaires’ disease outbreak: Cooling towers, regulations, and lessons from 2015

2025-08-20T16:57:46+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

New York City is experiencing its second-largest outbreak of Legionnaires’ disease linked to contaminated cooling towers. More than 100 people have been diagnosed, and five have died. For me, this outbreak is an unfortunate reminder of the summer of 2015, when I served as incident manager for the city’s largest outbreak, which sickened 138 people and killed 16.

That outbreak, traced to a cooling tower at a hotel in the South Bronx, forced the city to address a problem that had long been suspected but never adequately addressed: the role of buildings in spreading Legionella bacteria through the air.

What is Legionnaires’ disease?

Legionnaires’ disease is a severe form of pneumonia caused by Legionella bacteria. Infected people often develop symptoms of a respiratory infection, such as cough, fever, and shortness of breath, and can be cured with antibiotic treatment. Infection can be lethal, however, in people over 50 years old, smokers, and those with chronic illnesses. Many infected people are never diagnosed, because it requires clinicians to order special laboratory testing of respiratory specimens or urine for Legionella. People with Legionnaires’ disease cannot spread it to other people.

How are cooling towers linked to Legionnaires’ disease?

People get infected with Legionella by breathing in small droplets of water contaminated with the Legionella bacteria. These droplets most often come from devices that use water and generate a mist, such as hot tubs or improperly maintained plumbing systems in settings with vulnerable populations, including hospitals and nursing homes.

Another major source is cooling towers, which are usually placed on rooftops of large buildings. Air-conditioning systems generate waste heat, which is absorbed by water in the building’s cooling system. This heated water is pumped into the cooling tower and sprayed into the air. As some of the water evaporates, it carries heat away, creating a mist that is released into the environment.

Residents question health officials about why Harlem is a Legionnaires’ hotspot

Legionella bacteria can grow on the inside surfaces of pipes and tanks in the cooling tower. From there, these bacteria can be expelled into the air along with the mist and carried long distances, exposing thousands of people who walk on the streets in the area near the cooling tower or who breathe in the mist through their windows. The only way to prevent Legionella bacteria from growing and spreading through the air is to maintain and disinfect cooling towers consistently and correctly.

2015 South Bronx Legionnaires outbreak prompted legislation

By the time we detected the 2015 outbreak, dozens of people had been hospitalized. Our investigation eventually tested more than 50 cooling towers in the neighborhood. We found two towers with the same strain as patients, but a specialized form of laboratory testing — known as whole-genome sequencing — confirmed that a cooling tower on top of a new hotel was the primary source.

The outbreak centered in one of New York’s poorest neighborhoods, where residents already suffered disproportionately from chronic illnesses that made them more vulnerable. In total, 138 people were sickened and 16 died, making it the largest Legionnaires’ disease outbreak in the city’s history and the second-largest ever reported in the United States.

For years, experts had warned that cooling towers were a likely source of recurrent Legionnaires’ outbreaks. Cases occur sporadically every year, and most are never linked to a specific source. That is because proving the source of a human infection requires more than just finding Legionella in the environment. Investigators need a DNA fingerprint of the bacteria, obtained through laboratory methods such as pulsed-field gel electrophoresis or whole-genome sequencing, to show that the strain that infected a patient matches the strain from a cooling tower.

Even with these tools, the process can be time-consuming and not always definitive, since Legionella is widespread in natural and built environments. This scientific complexity is one reason outbreaks from cooling towers often go unrecognized until many people become ill in a specific geographic area.

As with most public safety measures, it takes a crisis — like a plane crash or a deadly outbreak — to spur changes. In the wake of the 2015 outbreak, New York’s City Council passed cooling tower regulations for Legionnaires’ disease. The law required every building with a cooling tower to register it with the Health Department, test it quarterly, and remediate it if Legionella were detected. The New York City cooling tower law also funded inspectors at the Health Department to ensure that building owners’ complied.

Did New York City’s regulations for cooling towers work?

Within the first year, the Health Department had inspected nearly 80% of towers, forcing remediation of contamination that would previously have gone undetected. While the number of Legionnaires’ cases has fluctuated, no large outbreaks occurred until now.

During the peak of the Covid pandemic, city government diverted resources to the emergency response, and routine inspections fell. Since then, staffing at the City Health Department, similar to other health agencies across the country, has not fully recovered. Reporters found that the number of cooling tower inspections this year is at the lowest level since the program began.

After the latest outbreak was detected, the Health Department reported that 11 cooling towers in the area tested positive for Legionella. Of these 11, four are operated by the city, and two are for health services (Harlem Hospital and a Health Department sexual health clinic).

In public health, proving causation — that X program directly caused Y benefit — is always difficult. We know that keeping cooling towers free of Legionella will decrease the amount of Legionella spreading through the air. We know that outbreaks were increasing in New York City before the 2015 outbreak and then declined after the cooling tower inspection program started. And we know that, after inspections declined in 2025, another large, lethal outbreak has occurred.

Infections may be inevitable, but outbreaks are a choice

The lesson from the 2025 Legionnaires’ disease outbreak in New York City is one that everyone in public health knows: Regulations do not enforce themselves. They require sustained investment in government personnel to ensure people comply with regulations. The Covid pandemic has sparked a strong backlash against government authority, and austerity budgets are now starving public health agencies. Infections may be inevitable, but outbreaks are a choice.

‘Global work on a local level’: DeKalb gets new tuberculosis clinic

2025-07-17T22:52:30+00:00

Public health, explained: Sign up to receive Healthbeat’s free Atlanta newsletter here.

DeKalb County has the highest rate of tuberculosis cases in Georgia. Next week, it’s opening a new clinic to help test for the disease and treat it.

The clinic at the county’s Richardson Health Center on Winn Way is in a renovated space on the ground floor. It features eight treatment rooms, along with a separate entrance and negative pressure technology to prevent the spread of the contagious bacterial infection. A new radiology suite has a digital imaging system for X-rays.

Last year, DeKalb reported 52 cases of TB (a rate of 6.8 per 100,000 in 2023) while neighboring Gwinnett and Fulton reported 35 and 26 respectively, according to a surveillance report from the state Department of Public Health.

Part of the reason for DeKalb’s high rate of TB is the demographic make-up of the county, said Dr. Alawode Oladele, the supervising physician and laboratory director for infectious diseases and refugee health at DeKalb Public Health.

“It has to do with the diversity of the county and the fact that a lot of folks who are here, who are not U.S. born, come from what we call high TB-burden countries,” Oladele said, referring to nations with high TB rates.

People who were born abroad make up about 73% of the county’s TB cases, he said. Most came from Mexico, India, Guatemala, or Vietnam, according to the state DPH’s 2023 surveillance report.

DeKalb Public Health's new tuberculosis clinic features a separate entrance to prevent the spread of the bacterial infection.

Refugees and immigrants are typically screened for TB before they enter the United States. Oladele said most of DeKalb’s cases are in undocumented migrants or immigrants who have been here for awhile from high-burden countries.

The other 27% of DeKalb’s cases come from people born in the United States, Oladele said, affecting people from all walks of life.

17 tuberculosis workers laid off in DeKalb

Oladele has spent the past 28 years working on TB in DeKalb. He was born in Nigeria and came to Atlanta to study medicine at Morehouse School of Medicine and Emory University.

“I would watch people die from TB [in Nigeria], and it’s sad, because we have the capacity to prevent those deaths, right? But we didn’t have access,” Oladele said.

He sees his work in DeKalb as “an opportunity to do global work on a local level,” noting that the World Health Organization last year deemed TB the top infectious cause of death in the world, with about 1.25 million deaths in 2023.

Oladele said treating TB and stopping its spread is very resource intensive. In some cases, staff members must supervise patients taking their drugs daily, typically for four to six months. Contact tracing can be complicated, especially among undocumented communities and those who lack trust in the government and medical workers.

DeKalb County funded the new clinic, but recent cuts to public health funding have introduced new constraints. Oladele said 17 of the more than 20 people who worked on TB contact tracing and ensuring people took their medications in DeKalb were recently let go by the state after the federal government “clawed back” Covid relief funding to state health departments.

“Without the funding, without the resources, we’re handcuffed, and it limits our ability to do the work,” Oladele said.

Global funding for tuberculosis prevention and treatment decreased in 2023 and “remains far below target,” according to the WHO.

The U.S. Agency for International Development, the country’s main foreign aid agency, until this year led global TB eradication efforts. But the Trump administration has dissolved USAID.

President Donald Trump’s proposed budget for next year would, if approved, decrease support for global TB work from this year’s $406 million to $228 million.

“It’s been amply demonstrated that investments by the U.S. government in strengthening global TB prevention and control have direct benefit to our country,” said Carmen Marsit, a professor at Emory University’s School of Public Health. “It is really crucial that, just as diseases know no borders, our efforts don’t stop at our border.”

While tuberculosis numbers were on the way down prior to Covid, cases have since ticked back up, globally, nationally, and in DeKalb, Oladele said.

The Centers for Disease Control and Prevention reported that national tuberculosis rates increased three years in a row, from 2020 to 2023.

What is tuberculosis?

TB is an infectious bacterial disease that primarily affects the lungs but can infect other parts of the body. The bacteria can stay in a person’s body for years or even decades without making them sick or being transmissible to other people, in what is called latent TB.

But if a person’s immune system can no longer control the infection, latent TB can develop into active TB, which can lead to sickness or even death, especially if left untreated. TB germs can spread through the air when a person with active TB coughs, speaks, or sings. In comparison to highly transmissible diseases like measles, TB typically requires prolonged, close contact to spread.

DeKalb Public Health's new tuberculosis clinic includes negative air pressure technology to prevent the spread of the bacterial disease.

In the United States, those at higher risk of disease exposure include people who live in certain congregate settings like homeless shelters or prisons, as well as people traveling from countries where TB is common, according to the CDC. People at risk of developing the disease, if infected, include those with immune systems that are weakened due to medications, or conditions like cancer or HIV/AIDS.

In its primary stage, TB manifests with flu-like symptoms, like a low fever, tiredness and cough. Active TB disease can result in coughing up blood or mucus, chest pain, fever, and chills, among other symptoms.

The disease is treated through the use of antibiotics, and a patient is typically required to take daily medications over many months.

Globally, rising numbers of drug-resistant TB complicate the work of controlling this disease. Drug-resistant TB doesn’t respond to common medications and requires more complex treatment. The WHO describes multidrug-resistant TB as a public health crisis, noting that worldwide, only about 2 in 5 people with drug-resistant TB accessed the treatment in 2023.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

How AI can make infectious disease surveillance smarter, faster, and more useful

2025-07-01T11:00:00+00:00

This is a guest essay for Healthbeat. Public health, explained: Sign up to receive Healthbeat’s free national newsletter here.

Public health agencies are under pressure to move faster, detect threats earlier, and make better decisions, even as their funding is cut and their authority reduced. While most public health agencies will have to do less with less, artificial intelligence systems provide an opportunity to maintain and possibly improve performance in one critical area: infectious disease surveillance.

When I led infectious disease programs for the New York City Health Department, I saw how even the best-resourced health departments rely on inefficient, error-prone systems. Disease surveillance often requires personnel to manually review lab reports, call health care providers, and write and revise code to clean, analyze, and visualize data.

AI has improved performance in industries where data are abundant and decisions need to be fast and accurate, such as finance and logistics. Public health surveillance systems are essentially large repositories of data about a community’s health. The same tools that improve performance in other fields can help health agencies save time, improve accuracy, and act faster.

What is disease surveillance and why does it matter?

Surveillance is how governments monitor the incidence and overall burden of disease in a population over time, detect outbreaks, inform policies, and assess whether prevention and control programs are working. Each state maintains a list of “notifiable” diseases that health care providers and laboratories are legally mandated to report.

With infectious diseases, most reporting occurs through laboratory-based surveillance. The system is supposed to work like this: A patient has symptoms and visits a health care provider, the provider collects a specimen from the patient and sends it to a clinical laboratory, the laboratory performs tests to identify a potential pathogen, then the laboratory reports that data to a state or local health agency. This is how health agencies collect data about everything from salmonella to HIV to Covid-19.

Monitoring laboratory-confirmed cases, in this way, gives public health agencies the confidence that they are investigating cases of public health importance, not just people with symptoms of a disease that is less relevant to public health.

Here’s how artificial intelligence could improve public health

Health agencies ideally receive these reports electronically through systems that use standardized digital formatting and vocabulary. But many reports still come by fax or phone. More importantly, regardless of whether data are transmitted digitally or analog, duplicate records must be adjudicated, errors corrected, and missing information (often about patient demographics and exposures) filled in.

AI can improve how data get collected and reported

Labs generate huge volumes of data. While some lab instruments automatically generate data in a format that can be readily reported to health agencies, technicians often must interpret and record results in another electronic system, and labs or health departments must process that data into a standardized format to merge them with disease surveillance databases.

AI-powered natural language processing can scan free-text lab reports and extract useful data: which pathogen was detected, which test was used, when it was done, what the result was, and what identifiable and reportable information is there about the patient (e.g., name, date of birth, home address, gender, race, ethnicity). That information can be automatically formatted to meet public health reporting requirements.

AI can also monitor data flowing from laboratory instruments and detect when a reportable disease appears. It can then automate the steps needed to report that infection without requiring a person to notice it, look it up, and enter data into a system manually.

Another major problem is compliance with reporting. Staff turnover, new software, or new instruments can result in cases not being reported. Health departments often discover these problems only after reviewing trends (e.g., why has this lab not reported any diseases in the past quarter?), then staff spend time reviewing data, contacting labs, and sometimes issuing official warnings. AI “agents” operated by health departments could continuously monitor reporting trends by facility, flag unusual drops in reporting, issue reminder emails, and even conduct calls to the laboratory facility – with a human supervising the system, but not necessarily conducting the activities.

AI can help clean and connect the data

At a health agency, epidemiologists must merge surveillance data from many different sources, e.g., labs, hospitals, outpatient offices, and other facilities. AI algorithms help accelerate and improve identification and resolution of duplicates. Two reports might refer to the same patient but have different names or dates. Or one patient might have multiple test results for the same infection. AI can learn to match and consolidate these records, improving the accuracy of matching over time.

Most lab reports contain just a few pieces of information: name, age, sex, address, and the name of the doctor and facility that ordered the test. But to understand disease burden and identify outbreaks, public health investigators need much more: When did symptoms start? What was the patient exposed to? Did they travel? Were they hospitalized?

To get these details, epidemiologists must call patients or providers and search other agency databases. That takes time, staff, and effort. AI tools and agents can help by automating some of these processes. AI agents could send links to patients’ mobile phones or email for online surveys or chatbot interviews and, as they evolve, even interview patients by voice. If legally permitted in a state, AI agents can connect to hospital records, immunization registries, or death certificates to fill in missing demographic and outcome data.

AI can make sense of the data faster

One of the most promising uses of AI is to improve the analysis, visualization, and communication of surveillance data.

In well-resourced health agencies, epidemiologists run models to “nowcast” and “forecast” diseases. Most county health departments in the United States, however, lack epidemiologists with these skills. AI tools can be built to automate these processes, including merging surveillance data with other locally available databases, such as from emergency rooms, 911 calls, and/or pharmacy sales to estimate current and future incidence, depending on different interventions.

AI can also write custom summaries of the data for different audiences. Most surveillance reports are dense and difficult to read, written by epidemiologists for a broad audience that covers experts and lay persons. Generative AI tools can create summaries that are tailored for different technical levels and perspectives, such as policymakers, journalists, health care providers, or the public.

Privacy and security still matter

While surveillance data is generally exempt from federal health privacy laws like HIPAA, it is still governed by strict state and local laws.

AI tools used for public health surveillance must be designed to operate within these legal frameworks. They should not store or use identifiable information for training purposes. They must limit access to authorized personnel. And they should be run in secure, closed electronic environments.

AI may also help allow more data transparency while preserving confidentiality. One reason health agencies hesitate to release detailed surveillance data is the risk that individuals could be identified. AI tools could help automatically de-identify records and test whether patients can be re-identified once datasets are made public.

What’s next

For AI to have an immediate impact, public health agencies need tools that are validated for data processing and analysis and can be easily adapted to the needs of epidemiologists. Partnerships between public health experts, AI developers, and policymakers will be essential to ensure these systems are incorporated and improve the speed, quality, and usability of public health surveillance systems, while maintaining robust security and privacy controls.

Dr. Jay K. Varmais a physician and epidemiologist. An expert in the prevention and control of infectious diseases, he has led epidemic responses, developed global and national policies, and implemented large-scale programs that saved hundreds of thousands of lives in Asia, Africa, and the United States.

Why is the CDC located in Atlanta and not D.C.? History tied to Coca-Cola and mosquitoes

2025-05-15T16:26:06+00:00

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The Centers for Disease Control and Prevention has deep roots in Atlanta and plays an important role in making the city a public health center. Why is the CDC there when most federal agencies are in the Washington, D.C., area?

As with many things in Atlanta, the answer involves Coca-Cola — and mosquitoes. Coca-Cola chairman Robert W. Woodruff purchased land in Baker County, Georgia, for quail hunting about 100 years ago.

Malaria plagued the South then in a way that’s hard for us to imagine now. One early CDC administrator said a lumber company in north Florida needed a 700-person workforce to ensure 300 were healthy enough to work during malaria season. Half the workforce was ill at any one time, and everyone had to plan for malaria season.

“This was expected as a way of life,” said epidemiologist and early CDC administrator Melvin Goodwin, according to an account in the journal Southern Spaces. The disease was a health and economic burden in Georgia.

Woodruff worked with Emory University to set up treatment centers and a field station at Ichauway Plantation in 1939. The state’s malariologist (yes, that used to be a job), Dr. Justin Andrews, helped run it.

During World War II, malaria became a military concern, as troops traveling overseas fell ill. The federal government established the Malaria Control in War Areas program in Atlanta, run by Andrews. That morphed into the Communicable Disease Center in 1946.

Woodruff provided the funds for Emory to purchase about 15 acres of land near the university, former Board of Trustees chairman Ben Johnson told Healthbeat earlier this year. Emory, in turn, donated the land for the CDC’s first headquarters.

This image from 1954 shows the Mossy Pond tower on the Ichauway Plantation in Newton, Georgia. The wooden structure was used to trap insects.

According to one account, a phone call from Woodruff to his hunting buddy President Dwight Eisenhower may have helped garner the federal funds to build the CDC’s first headquarters.

By 1951, malaria was eliminated from the United States, and the CDC steadily expanded its focus to many public health topics, including rabies, tuberculosis, and other infectious diseases, according to an official timeline. Notably, the CDC early on had its own production facilities to develop films for public health training.

Flash forward seven decades, and the CDC has two sprawling campuses, the original one near Emory and another in Chamblee. But today’s federal government is seeking to shrink the agency through funding cuts and layoffs.

The agency started with just 400 employees and grew to around 13,000 employees by last year, with just over 10,000 of those based in Georgia. Earlier this year, the agency laid off about 2,400 employees and is undergoing a reorganization under President Donald Trump.

Ichauway Plantation has become the Jones Center at Ichauway, a conservation center that also hosts graduate students from Emory, the University of Georgia, and other Southern universities conducting research about the environment.

And while malaria is no longer a significant public health threat in the United States, controlling mosquitoes and the illnesses they carry, like West Nile virus, is still an important part of local public health work.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

Tuberculosis is on the rise in NYC. Here’s why — and what to know about the disease.

2025-04-25T11:00:00+00:00

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Since a surge of tuberculosis in the 1990s, New York City has made significant progress in controlling the spread of the world’s leading infectious disease killer. But in recent years, cases in the city have started to tick up again.

In 2023, the city reported 684 confirmed TB cases, a 28% increase from 2022 and the highest number of confirmed cases since 2011, according to data from the New York City Department of Health and Mental Hygiene. Last year, the numbers rose again, to 839 confirmed cases, according to recent data from the agency.

That increase is concerning, said Dr. Barun Mathema, an associate professor of epidemiology at the Columbia University Mailman School of Public Health. While TB is an infectious disease, spread through the air, it is socially complex, he said, and is closely linked to a community’s health and well-being.

Controlling TB is resource- and time-intensive, involving contact tracing and ensuring adherence to long courses of treatment. But it also requires tackling social issues that contribute to the disease prevalence, like access to housing, employment, and food. When public health infrastructure falters or loses resources, experts say, TB can start to re-emerge.

Here’s what to know about TB and why cases have been on the rise in recent years.

What is tuberculosis?

TB is an infectious bacterial disease that primarily affects the lungs but can spread to other parts of the body. The bacteria can stay in a person’s body for years or even decades without making them sick or being transmissible to other people, in what is called latent TB.

In the United States, those at higher risk of disease exposure include people who live in certain congregate settings like homeless shelters or prisons, as well as people traveling from countries where TB is common, according to the Centers for Disease Control and Prevention. People at risk of developing the disease, if infected, include those with immune systems that are weakened due to medications, or conditions like cancer or HIV/AIDS.

How is tuberculosis treated?

The disease is treated through the use of antibiotics, and a patient is typically required to take daily medications over many months.

“Treatment adherence is something of a problem,” said Dr. Don Des Jarlais, a professor of epidemiology at the NYU School of Global Public Health. “Health departments try to have outreach workers who visit people who have TB to remind them to take their medication.”

In New York City, every person with active TB is assigned a case manager who educates the patient and ensures attendance at medical appointments, said Dr. Joseph Burzynski, assistant commissioner for the city Health Department’s Bureau of Tuberculosis Control. Contact tracers also work to track down other people who might have been exposed and get them tested.

“The case manager makes sure that the patient goes all the way from testing through treatment, makes sure that the patient has access to the medications, and takes their medication every day — all the way to the end of treatment,” Burzynski said.

The Health Department runs three TB clinics, which provide low- to no-cost testing and treatment for the disease. The medical services offered are confidential, and do not require health insurance or revealing one’s immigration status.

Globally, a growing issue of drug-resistant TB complicates the work of controlling this disease. Drug-resistant TB doesn’t respond to common medications and requires more complex treatment. The World Health Organization describes multidrug-resistant TB as a public health crisis, noting that worldwide, only about 2 in 5 people with drug-resistant TB accessed the treatment in 2023.

Although TB is preventable and curable, about 8.2 million people were newly diagnosed with TB in 2023, the highest number since global monitoring began in the 1990s, and 1.25 million people died from the disease that year, according to the WHO.

City brought down tuberculosis surge in 1990s

In the late 1980s and early 1990s, New York City saw an explosion of TB cases, driven by a confluence of health and social issues, including the HIV/AIDS epidemic, homelessness, and substance use.

From 1984 to 1992, the number of TB cases in the city rose 139%, according to data from the Health Department. For a few years in the early 1990s, the city recorded more than 3,500 TB cases annually.

“Back in the ’90s, the big problem was really HIV infection making people much more susceptible to TB, and a fair number of them died from TB because of their weakened immune system,” said Des Jarlais, who at the time worked to expand TB testing at syringe exchange programs in the city.

In addition to the HIV/AIDS epidemic, an increase in people coming to New York and disinvestment in public health resources in the late 1980s helped create the conditions for TB cases to spike in the city, Burzynski said.

“We had a very small program, and part of the success in the response at that time was a major reinvestment in public health, and particularly in TB control,” he said. “We got a huge amount of money with additional staff, increased case management capabilities, and increased public health laboratory capabilities.”

The number of TB cases in the city has fallen dramatically since then, with a 83% decrease from 1992 to 2013. Experts attribute that decline to the city’s creation of a robust TB control program, as well as to successful efforts to control HIV.

But eventually, TB started to re-emerge. From 2013 to 2023, the city recorded an 18% increase in TB cases, including a 28% increase from 2022 to 2023.

Between 2023 and 2024, the rate of TB in the city rose from 7.8 to 9.5 per 100,000 people. Last year’s data show that 18 neighborhoods have TB rates higher than the citywide rate, especially in the Bronx and Queens.

Why have tuberculosis cases increased?

There isn’t one explanation for why TB cases have started to rise again, but there are multiple contributing factors, experts say.

The recent low of 444 confirmed TB cases in 2020 reflects, in part, the impact of Covid-19. The pandemic limited TB control work, as New Yorkers avoided medical care, and case management and contact tracing became more difficult, Burzynski said.

“Now that things have reopened up, there are more people coming into New York City, more people coming here from places with high rates of TB,” he said.

In recent years, New York City has experienced a surge in migration, but that doesn’t fully explain the increase in TB. In 2024, among non-U.S. born people, the average number of years in the United States at the time of TB diagnosis was 12 years, according to city data.

TB cases also closely track the public health cycle of investment during crises and disinvestment when crises wane, experts say.

In recent years, the city’s TB division has struggled with staffing shortages. The division continues to face vacancies among case managers, contact tracers, and epidemiologists, Burzynski said.

In fiscal year 2024, agency positions budgeted for TB prevention and treatment had a 16% vacancy rate, a small improvement on the 20% vacancy rate the prior year, Crain’s reported last year.

With more robust funding, the Health Department would be better positioned to quickly respond to new TB cases, Dr. Michelle Morse, the Health Department’s acting commissioner, has previously told Healthbeat.

NYC loses millions in state aid for public health services each year. City leaders want the money back.

Dramatic federal health policy decisions have also impacted the city’s TB control work. Earlier this year, seven employees of the CDC who worked at the Health Department, including on TB case management, outreach, surveillance and data collection, were terminated amid mass layoffs at the federal agency. And the $100 million in federal funding cuts that the city Health Department faces will likely impact its ability to track and respond to infectious diseases.

“We are hoping that we will have continued investment in public health resources to be able to do our work, because as cases go up, if there’s disinvestment, we’ll be less able to perform the work that’s really important for TB control,” Burzynski said.

Since New York City has historically been such a leader in TB control, Mathema, the Columbia epidemiologist, said it’s “particularly disheartening” to see cases start to rise again.

“The numbers are the numbers,” he said. “I hope that it’s a bit of a call to our policy makers to turn the ship around.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

NYC Health Department warns of hepatitis A case at Manhattan restaurant

2025-02-14T16:56:54+00:00

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Recent diners at a Lebanese restaurant in Manhattan may have been exposed to the highly contagious hepatitis A virus, the New York City Department of Health and Mental Hygiene announced on Friday.

The Health Department was recently notified of a case of hepatitis A, an inflammation of the liver, in a food handler at ilili Restaurant at 236 Fifth Ave. in the Flatiron District, according to the agency. No other cases of illness have been identified.

The Health Department advises anyone who dined at or ordered takeout from the restaurant between Jan. 31 and Feb. 9 to get a hepatitis A vaccination, if not already vaccinated. New Yorkers seeking a vaccine can contact their health care provider, search for a vaccine provider on the NYC Health Map, or reach out to NYC Health + Hospitals, the municipal health system.

“We are urging these restaurant patrons to consult with their providers and get the hepatitis A vaccine as a precautionary measure,” Dr. Michelle Morse, the acting health commissioner, said in a statement. “If people experience symptoms like yellowing of eyes and skin, fatigue, abdominal pain, nausea, and diarrhea, they should see a doctor immediately, especially if you have not had two doses of the hepatitis A vaccine.”

Additionally, the Health Department encourages anyone who ate the restaurant’s food between Jan. 17 and Feb. 9 to monitor for symptoms of the virus for seven weeks following their meal. Other New Yorkers should stay up-to-date on vaccination recommendations, and to thoroughly wash their hands to limit disease spread, Morse said.

In a statement on Facebook on Friday, ilili said the restaurant learned on Wednesday that a kitchen employee had tested positive for hepatitis A. The restaurant said it was working with the Health Department, had repeatedly deep-cleaned its kitchen and will ensure that staff has access to free testing and vaccination.

The hepatitis A virus is spread through close person-to-person contact or by eating contaminated food or drink. The virus usually causes a mild, short-term illness, according to the U.S. Centers for Disease Control and Prevention. Those infected may feel sick for a few weeks or months, but typically do not have lasting liver damage. However, in rare cases, the virus can cause liver failure or death — outcomes that are more common in older people or in those with chronic liver disease or other serious health issues.

Symptoms of hepatitis A usually appear two to seven weeks after exposure and can include dark urine, diarrhea, fatigue, fever, joint pain, loss of appetite, nausea and jaundice, according to the CDC. Some infections are asymptomatic.

The best way to prevent a hepatitis A infection is through vaccination, which confers long-term immunity, according to public health authorities. The CDC recommends vaccination against hepatitis A for all children ages 12 to 23 months, all children between the ages of 2 and 18 years who are unvaccinated, and all people who have increased risk factors for the disease.

The chef Philippe Massoud opened ilili about two decades ago. In 2008, The New York Times described the upscale restaurant as “probably the most ambitious Middle Eastern restaurant, in terms of scale and décor, in New York.” On Friday, the restaurant was promoting a $155 per person four-course prix fixe menu for Valentine’s Day.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Syphilis outbreak should be treated as public health emergency, tribes say

2024-10-30T09:00:00+00:00

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Natalie Holt sees reminders nearly everywhere of the serious toll a years-long syphilis outbreak has taken in South Dakota. Scrambling to tamp down the spread of the devastating disease, public health officials are blasting messages to South Dakotans on billboards and television, urging people to get tested.

Holt works in Aberdeen, a city of about 28,000 surrounded by a sea of prairie, as a physician and the chief medical officer for the Great Plains Area Indian Health Service, one of 12 regional divisions of the federal agency responsible for providing health care to Native Americans and Alaska Natives in the United States.

The response to this public health issue, she said, is not so different from the coronavirus pandemic — federal, state, local, and tribal groups need to “divide and conquer” as they work to test and treat residents. But they are tasked with responding to this crisis with fewer resources because federal officials haven’t declared it a public health emergency.

Resurgence of congenital syphilis signals ‘urgent need’ for testing, treatment in NY

Those public pleas for testing are part of health officials’ efforts to halt the outbreak that has disproportionately hurt Native Americans in the Great Plains and Southwest.

According to the Great Plains Tribal Epidemiology Center, syphilis rates among Native Americans in their region soared by 1,865% from 2020 to 2022 — over 10 times the 154% increase seen nationally during the same period. The tribal epidemiology center’s region spans Iowa, Nebraska, North Dakota, and South Dakota. The epidemiology center also found that 1 in 40 Native American and Alaska Native babies born in the region in 2022 had a syphilis infection.

The rise in infections accelerated in 2021, pinching public health leaders in the area between the coronavirus pandemic and the explosive spread of syphilis.

Three years later, the outbreak continues — new infections so far this year are 10 times those recorded in some entire years before the upsurge began. And tribal health leaders say their calls for federal officials to declare a public health emergency have gone unheeded.

HHS urged to declare public health emergency

Pleas for help from local and regional tribal health leaders like Meghan Curry O’Connell, the chief public health officer for the Great Plains Tribal Leaders’ Health Board and a citizen of the Cherokee Nation, preceded a September letter from the National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for health care for U.S. tribes, to publicly urge the federal Health and Human Services Department to declare a public health emergency. Tribal leaders said they need federal resources, including public health workers, access to data and national stockpile supplies, and funding.

According to data from the South Dakota Department of Health, 577 cases of syphilis have been documented this year in the state. Of those, 430 were among Native American people — making up 75% of the state’s syphilis cases, whereas the group accounts for just 9% of the population.

The numbers can be hard to process, O’Connell said.

“It’s completely preventable and curable, so something has gone horribly wrong that this has occurred,” she said.

The Great Plains Tribal Leaders’ Health Board first called on HHS to declare a public health emergency in February, but O’Connell said the federal agency sent a letter in response outlining some resources and training it has steered toward the outbreak. It stopped short of declaring an emergency or providing the substantial resources the board requested. The board’s now months-old plea for resources was like the recent one from the National Indian Health Board.

“We know how to address this, but we do need extra support and resources in order to do it,” she said.

Tribal leaders say they need more help

Syphilis is a sexually transmitted infection that can result in life-threatening damage to the heart, brain, and other organs if left untreated. Women infected while pregnant can pass the disease to their babies. Those infections in newborns, called congenital syphilis, kill dozens of babies each year and can lead to devastating health effects in others.

Holt said the IHS facilities she oversees have averaged more than 1,300 tests for syphilis monthly. She said a recent decline in new cases detected each month — down from 92 in January to 29 in September — may be a sign that things are improving. But a lot of damage has been done during the past few years.

Cases of congenital syphilis across the country have more than tripled in recent years, according to the Centers for Disease Control and Prevention. In 2022, 3,700 cases were reported — the most in a single year since 1994.

The highest rate of reported primary and secondary syphilis cases in 2022 was among the non-Hispanic American Indian or Alaska Native people, with 67 cases per 100,000, according to CDC data.

O’Connell and other tribal leaders said they don’t have the resources needed to keep pace with the outbreak.

Chief William Smith, vice president of Alaska’s Valdez Native Tribe and chairperson of the National Indian Health Board, told HHS in the organization’s letter that tribal health systems need greater federal investment, so the system can better respond to public health threats.

Rafael Benavides, deputy assistant secretary for public affairs for the federal Health and Human Services, said the agency has received the letter sent in early September and will respond directly to the authors.

“HHS is committed to addressing the urgent syphilis crisis in American Indian and Alaska Native communities and supporting tribal leaders’ efforts to mobilize and raise awareness to address this important public health crisis,” he said.

Federal officials from the health department and the CDC have formed task forces and hosted workshops for tribes on how to address the outbreak. But tribal leaders insist a public health emergency declaration is needed more than anything else.

Holt said that while new cases seem to be declining, officials continue to fight further spread with what resources they have. But obstacles remain, such as persuading people without symptoms to get tested for syphilis. To make this easier, appointments are not required. When people pick up medications at a pharmacy, they receive flyers about syphilis and information about where and when to get tested.

Despite this “full court press” approach, Holt said, officials know there are people who do not seek health care often and may fall through the cracks.

O’Connell said the ongoing outbreak is a perfect example of why staffing, funding, data access, and other resources need to be in place before an emergency develops, allowing public health agencies to respond immediately.

“Our requests have been specific to this outbreak, but really, they’re needed as a foundation for whatever comes next,” she said. “Because something will come next.”

Jazmin Orozco Rodriguez is a reporter for KFF Health News, Healthbeat’s national reporting partner.

Resurgence of congenital syphilis signals ‘urgent need’ for testing, treatment

2024-10-22T16:22:17+00:00

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Public health officials in New York are urgently promoting syphilis testing and treatment, alarmed that a preventable sexually transmitted infection once close to eradication has returned.

They are especially concerned about a resurgence of congenital syphilis, which is passed from a pregnant person to a baby. Congenital syphilis can result in miscarriage, stillbirth, prematurity and infant death, and babies born with the infection can have deformed bones, severe anemia, brain and nerve problems, and other issues.

In recent years, congenital syphilis cases have increased significantly nationwide, rising from 334 cases reported in 2012 to 3,761 in 2022, according to data from the Centers for Disease Control and Prevention. The CDC reported 231 stillbirths and 51 infant deaths in 2022.

Those outcomes are particularly distressing, experts say, because congenital syphilis is preventable and can be treated relatively easily, with a form of penicillin. But cases can emerge when pregnant people aren’t tested for syphilis at key intervals, or if they don’t have access to prenatal care.

Funding for the CDC’s prevention programs for sexually transmitted infections has been relatively flat over the past two decades, and recently, some local health departments across the country have faced steep cuts in their budgets for prevention efforts.

“We are all very concerned, as clinicians, about the increases in congenital syphilis, and syphilis in general, across the United States,” said Dr. Rodney Wright, vice chair of obstetrics at Montefiore Medical Center in the Bronx. “It’s not just a problem here in New York. It’s a problem across the entire nation.”

Congenital syphilis rates are highest in parts of the Southwest, the Midwest, and the South. Native American communities have been hit particularly hard. But even in New York, which has among the lowest rates of congenital syphilis in the country, mounting cases have raised alarms.

New York is just above the national average for rates of primary and secondary syphilis — the most infectious stages of the disease — which can result in congenital cases.

Preliminary data for 2023 show about 70 congenital syphilis diagnoses in New York state, a 204% increase over the past decade, Joseph Kerwin, director of the AIDS Institute at the New York State Department of Health, said during a meeting of the New York State AIDS Advisory Council in September.

“This is the first time in this century that New York state has seen a number rise to this level,” Kerwin said of the cases.

This year, New York is on track to see at least the same number of congenital syphilis cases as last year, said Rachel Malloy, director of the Office of Sexual Health and Epidemiology at the AIDS Institute.

“Compared to the rest of the country, New York state rates are actually lower, which speaks to the magnitude of the issue, because the rates in New York state are high,” Malloy said.

Surge in primary and secondary syphilis drives congenital cases

When the CDC began tracking syphilis cases in the 1940s, the agency regularly recorded hundreds of thousands of total cases each year nationwide.

But by 2000, total syphilis cases had dropped to 31,618 — and just 5,979 cases of primary and secondary syphilis. That year, the rate of primary and secondary syphilis fell to its lowest point since reporting began in 1941 (2.1 cases per 100,000 people).

That data point reflected a significant achievement in the country’s fight to eliminate syphilis, which is often called “the great imitator” due to its frustratingly wide range of symptoms. At its primary stage, the infection is easy to miss, often appearing as a single, painless sore. By the secondary stage, symptoms can include a skin rash, sores, fever, muscle aches and hair loss. Left untreated, syphilis can damage the brain, heart, and other organs, and the infection can be fatal.

“We were on the verge of eliminating syphilis altogether about 20 years ago, 25 years ago,” said Preeti Pathela, executive director of the Sexually Transmitted Infections Program in the Bureau of Hepatitis, HIV, and STI at the New York City Department of Health and Mental Hygiene. “We’ve seen a rise in adult syphilis since that time.”

By 2022, the total number of syphilis cases nationwide had surged to more than 200,000. Primary and secondary syphilis cases increased to more than 59,000 (17.7 cases per 100,000 people). Over the decades, rates of primary and secondary syphilis among women have increased, a key driver of congenital cases.

In New York City, the Health Department reported a 35% increase from 2021 to 2022 in primary and secondary syphilis cases among women — primarily among Black and Latina women — but little change among men. The agency reported 19 cases of congenital syphilis across the city in 2022 — and 16 cases in just the first half of 2023, according to the agency’s preliminary data.

“It is clear that there’s been a dramatic increase here,” Pathela said.

Earlier this year, the Health Department released an advisory for health care providers warning of “alarming rates” of primary and secondary syphilis and congenital syphilis in the city, “signaling an urgent need for increased screening and appropriate treatment.”

“There has been, for a long time, a real misconception about risk, both in the community, but also among health care providers, that you don’t need to screen or test if someone doesn’t report individual risk behaviors, or sexual behaviors that might put them at risk of acquiring syphilis,” Pathela said.

For many sexually active people, living in a community with a high rate of syphilis poses a significant risk factor for acquiring the infection, she said. In 2022, the Bronx had the highest rate of primary and secondary syphilis among women ages 15 to 44 (22.5 cases per 100,000 people), followed by Brooklyn (11.4 cases per 100,000 people).

“The disproportionate burden of primary and secondary syphilis among Black and Latina and young females often reflects the impact of structural racism,” Pathela added. “That prevents many people of color from accessing care, and especially affordable care.”

Experts urge expanding syphilis testing, treatment

The United States has reduced surges of congenital syphilis cases before — most recently in the 1990s — and experts say it can be done again.

The solution is clear, they say: closing gaps in testing and treatment. In 2022, lack of timely testing and adequate treatment contributed to almost 90% of congenital syphilis cases across the country, according to the CDC.

“The biggest part of addressing this issue is making sure people are tested and treated,” Wright, the Montefiore physician, said. “I think there may have been a bit of complacency about syphilis for a number of years.”

This poster was created by the New York State Department of Health in the 1930s.

In New York, a new state requirement went into effect this spring which mandates a syphilis test during the third trimester of pregnancy, in addition to screening at first exam and delivery. (New York City has required third trimester syphilis testing since 2019.)

A state strategic planning group is poised to release a series of recommendations to guide New York’s efforts to reduce and eliminate congenital syphilis. And state and city officials have ramped up warnings to health providers, who may have little firsthand experience with congenital syphilis.

Over the course of his 25 year career, Wright said, congenital syphilis cases were rare — but have increased in recent years.

During the September AIDS Advisory Council meeting, he described a recent case that resulted in a neonatal death. The pregnant person, he said, had tested negative at the beginning of pregnancy but had not reached the point of third trimester testing.

The late identification of syphilis during pregnancy has been a major missed opportunity in nationwide and state prevention efforts, officials say.

Malloy, of the AIDS Institute, stressed the importance of determining the pregnancy status of any individual of reproductive capacity diagnosed with syphilis — and expanding access to prenatal care for pregnant people.

Disrupting networks of transmission is key, too. While reviewing congenital syphilis cases in the city and state, Wright noticed that in some cases, partners who were not tested or declined treatment reinfected the pregnant person.

“That drives home the point of partner notification and encouraging partner testing and treatment,” he said.

The state employs contact tracers and case investigators who follow up with people newly diagnosed with STIs and maintains a call line for providers working on congenital syphilis cases, Malloy noted.

New York City’s STI Disease Intervention Specialists work to find people who need STI treatment and help notify partners. In 2022, they conducted more than 14,000 case investigations based on positive syphilis laboratory tests. The Health Department also identified 196 cases of congenital syphilis, estimating that it averted 91% of potential cases.

“I am hopeful,” Malloy said. “We have seen syphilis and congenital syphilis go down before. I want to see it go down, and I want to see it stay down. And I do think that if we act now and act together, we will get those numbers down.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Mosquitoes linger as fall arrives

2024-10-09T11:00:00+00:00

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As the leaves change, we say goodbye to summer, but at least one thing remains for a couple more weeks — mosquitoes.

Yes, mosquitoes are annoying, but they can also pose serious health risks for New Yorkers. It’s worth grabbing mosquito spray for a couple more weeks.

Here’s what’s going on with mosquitoes in New York (state and city) and especially the two diseases making the news.

New York state reports human case of EEE

This is the first case in the state since 2015. The case was identified in Ulster County and the patient died.

Eastern Equine Encephalitis is a virus transmitted by the bite of a certain species of mosquito. Thankfully, most people infected with EEE won’t have any symptoms. But for those who develop symptoms, the illness can be severe and involve inflammation of the brain (encephalitis) and spinal cord (meningitis).

About one-third of people who develop severe illness die.
There is no specific treatment available.
People over the age 50 or younger than 15 are at greatest risk.

EEE rare in New York, but may be more active this year

Since 1971, only 12 human cases have been identified in the state, including the most recent one. Of these patients, seven died. A human case of EEE is a significant event.

There are some signs that this year might be worse than recent years. Typically, two or three New York counties detect EEE annually by testing mosquitoes, horses, and birds. This year, though, 14 counties have detected it all across the state. And this isn’t because there is more testing this year; the level of testing is similar to last year.

Counties in solid blue have detected EEE mosquitoes, with Ulster County detecting positive mosquitoes and a human case. Striped blue counties are testing mosquitoes for EEE but have not detected it. Data from the New York state mosquito activity report

West Nile virus is circulating in New York City and state

West Nile virus is also a disease spread by some mosquitoes and is more common than EEE.

So far, 42 human cases have been detected in New York state (excluding New York City) and 35 cases in New York City. Compared to the past few years, this has been a normal year.

West Nile virus cases in New York state, excluding New York City.

WNV has been detected in most of the New York counties that are testing for it. On the map below, solid light or dark orange and brown counties have had WNV detections in humans, mosquitoes, horses, or birds.

Counties where humans, mosquitoes, horses, or birds have tested positive for West Nile virus (solid light or dark orange and brown).

If we zoom in on New York City, we are also in the average range of WNV human cases. Over the past 10 years, the total number of annual cases has ranged from 6 to 46.

West Nile virus cases in New York City.

WNV-positive mosquitoes are almost everywhere in the city. Below, regions in blue are where West Nile virus has been detected in the past two weeks (light blue) and earlier this season (dark blue).

The number of WNV cases in the city is similar to the rest of the state (35 vs. 42) for two reasons:

The high population density in the city — more people are there to get bitten.
There is a lot of WNV activity. When adjusting for population size, Richmond (Staten Island) and Queens counties have some of the highest WNV case rates in the state.

Most people infected with WNV will not have symptoms or will have very mild illness. However, those over 60 years old or with immunocompromising conditions are at higher risk for severe illness, which can include inflammation of the brain (encephalitis) and spinal cord (meningitis), or muscle weakness or paralysis (acute flaccid paralysis).

What is being done to prevent more human cases?

A lot!

First, public health departments randomly test mosquitoes. Mosquitoes are collected in traps, identified in the lab, and tested in groups (for efficiency). We’ve been doing this for decades, and although imperfect, it gives us a good view of risk.

With consistent positives (in mosquitoes or humans), vector control units will then go to these areas and spray mosquito repellent in mass. Several factors go into the decision to spray:

Mosquito density and species
Persistence of the virus
Time of year
Proximity to human populations

While mosquito spraying is safe for humans and pets, if spraying is happening in your neighborhood and you have asthma or other respiratory conditions, it’s a good idea to try and stay inside during the spraying time.

There are no mosquito spraying events scheduled for New York City in the near future. You can check for schedule updates here. For spraying events in other areas of New York state, check with your local public health or mosquito control departments.

On top of ongoing mosquito control, New York state health commissioners issued a Declaration of Imminent Threat to Public Health in response to the Ulster County EEE case. This move:

Frees up additional state resources to go toward reducing mosquito-borne diseases, including more public outreach and strengthening public health surveillance to detect human cases and positive mosquitoes
Increases mosquito spraying throughout the state to reduce the adult mosquito population
Provides free insect repellent to visitors at New York state parks and campgrounds

When will the mosquitoes leave?

Mosquitoes can only transmit these diseases when it’s warm. Once average temperatures drop to around 60°F, mosquito biology makes transmission much more difficult. It likely won’t be that cool consistently in New York until late October or early November, so until that happens, we should all be diligent about protecting ourselves from mosquitoes.

To avoid contracting WNV or EEE, the best thing you can do is avoid mosquito bites:

Wear EPA approved mosquito repellent when outside and especially during peak-mosquito activity time: dawn and dusk.
Avoid being outside when mosquitoes are most active (the morning and evening) — but this can be really hard.
Dump standing water (think flower/plant saucers, buckets, fountains, toys that have been sitting outside, etc.) to eliminate mosquito habitats.

Bottom line

We are still in mosquito season. Because mosquitoes can carry some nasty diseases, keep that mosquito spray close for a few more weeks!.

Love,

Your Local Epidemiologist

Dr. Marisa Donnelly, a senior epidemiologist with wastewater monitoring company Biobot Analytics, has worked in applied public health for over a decade, specializing in infectious diseases and emerging public health threats. She holds a PhD in epidemiology and has led multiple outbreak investigations, including at the California Department of Public Health and as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Marisa has conducted research in Peru, focusing on dengue and Zika viruses and the mosquitoes that spread them. She is Healthbeat’s contributing epidemiologist for New York in partnership with Your Local Epidemiologist, a Healthbeat supporter. She lives in New York City. Marisa can be reached at mdonnelly@healthbeat.org.

Legionnaires’ disease case reported at Manhattan federal building with contaminated water

2024-09-27T23:00:00+00:00

This article is a collaboration with THE CITY.

A public agency with offices at 26 Federal Plaza notified the General Services Administration of a case of Legionnaires’ disease among one of its employees recently, THE CITY and Healthbeat have learned.

The reported case of Legionnaires’ disease, a severe form of pneumonia, comes less than three weeks after GSA found the bacteria that can cause the disease in water throughout the building, which houses immigration court and federal law enforcement offices. Most people exposed to Legionella bacteria do not become sick, but exposure can lead to Legionnaires’ disease, which can be serious or even fatal.

GSA, which operates the building, alerted tenant agencies in an email Monday that an individual connected to 26 Federal Plaza had tested positive for Legionnaires’ disease.“No direct connection has been made between this report and the water quality in the building,” a GSA representative said in the email, which was provided to THE CITY and Healthbeat by a worker in the building.

“It’s important to note that due to its natural prevalence, there are many potential sources of exposure to Legionella in the community or even from home water systems,” Deborah Croft, a GSA spokesperson, said in a statement.

GSA is “pursuing a corrective action plan” with a water management company, according to the email sent to tenants on Monday. The agency is offering bottled water to agencies in the building and started routine flushing of water tanks and pipes on Sept. 13. GSA also began routine flushing of all drinking water outlets and showers on Monday and installed filters on all shower heads last week, according to the email.

“This is an alert, an alarm, but I don’t think there’s a need to panic,” said Chuanwu Xi, a professor of environmental health sciences and of global public health at the University of Michigan School of Public Health who has researched the growth of Legionella bacteria.

Most healthy people exposed to Legionella bacteria do not get sick, according to the Centers for Disease Control and Prevention. Those at increased risk of developing Legionnaires’ disease include current or former smokers, people who are at least 50 years old, or those with cancer, chronic lung disease, diabetes, kidney failure, liver failure, and weakened immune systems. Legionnaires’ disease often requires hospitalization; the disease carries a case fatality rate of about 10%, according to the CDC.

The disease has previously proven deadly in apartment complexes and nursing homes in the New York City region. Earlier this month, three people who tested positive for Legionnaires’ disease died at an Albany assisted living home. In February, THE CITY reported on the death of a public housing resident in Brooklyn due to Legionnaires’ disease.

From 2010 to 2022, the New York City Department of Health and Mental Hygiene has reported more than 150 cases of Legionnaires’ disease each year, with a peak of 656 cases in 2018, according to a health department report.

Legionnaires’ disease can be easily resolved if caught early and treated with antibiotics, but can become severe if it goes undetected, said Dr. Waleed Javaid, a professor of medicine at the Icahn School of Medicine at Mount Sinai and a director of infection prevention.

With the reported case of Legionnaires’ disease at 26 Federal Plaza, Javaid cautioned against panic, emphasizing that more information is needed to understand the extent of the issue. He advised people concerned about their exposure to Legionella to follow public health guidance in the building and keep an eye out for symptoms, including respiratory illness, fevers and confusion.

“Any kind of respiratory illness I have, I should go and get myself checked,” Javaid said.

If a patient tests positive for Legionnaires’ disease, their health care provider must report the case to the city health department. If two or more people who are associated with the same building test positive for Legionnaires’ disease within 12 months of each other, the Health Department will conduct an evaluation of the building.

Patrick Gallahue, a city health department spokesperson, said in a statement that the department follows CDC guidance on building evaluations and can “offer guidance to private landlords who are looking into their own buildings.”

Anyone with flu-like symptoms, fever, cough, or difficulty breathing should seek immediate medical attention, Gallahue added.

In early September, GSA alerted tenants that water testing in the building during late August had found Legionella bacteria in dozens of locations within the complex, including kitchens, locker room showers, drinking fountains and daycare sinks, THE CITY and Healthbeat reported earlier this month. The agency said the testing was part of a “proactive water quality management program” at thousands of the facilities it runs.

On Sept. 9, signs posted at the buildings’ entrances alerted workers and visitors to the presence of Legionella bacteria, but several employees interviewed by THE CITY were unaware of the issue.

GSA — which owns 1,600 federal buildings and leases space in more than 6,500 buildings nationwide — has dealt with issues involving Legionella bacteria in recent years. Last year, the agency’s Office of Inspector General released a memo highlighting elevated levels of the bacteria in multiple GSA-controlled buildings and inadequate testing for Legionella in GSA-operated child-care centers.

Legionella bacteria occurs naturally in lakes and streams and does not usually pose a risk to human health unless it enters a building’s water system and multiplies, driven by stagnant water and warm temperatures. People can become sick by inhaling water droplets containing the bacteria. The bacteria can be especially dangerous in health-care facilities and residential buildings, where it can spread through shower heads, faucets, cooling towers, hot water tanks and plumbing systems.

Growth of the bacteria has become an increasing issue in the United States, largely due to aging infrastructure, Xi said.

“We have aging buildings, and that makes it a little more difficult to manage, and the complexity of the plumbing system contributes to the elevated growth of Legionella in the system,” he said.

Flushing the water system often clears away Legionella growth, and if the bacteria persists, the building management should consider disinfecting the system and flushing it again, he added.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org. Rachel Kahn is an intern at THE CITY, a non-profit newsroom that serves the people of New York through independent journalism.

First person to develop EEE in New York in nearly a decade has died, state says

2024-09-23T23:17:18+00:00

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The first person to be diagnosed with eastern equine encephalitis in New York state in nearly a decade has died, Gov. Kathy Hochul’s office announced Monday.

The human case of the rare and often fatal mosquito-borne disease was confirmed in Ulster County on Friday. The Ulster County Department of Health is investigating the case, which is the first in the state since 2015.

State Health Commissioner Dr. James V. McDonald issued a Declaration of an Imminent Threat to Public Health on Monday, prompted by the discovery of EEE in multiple counties and the recent human case of the disease. The declaration, which runs through Nov. 30, enables the expanded use of state resources to address the mosquito-borne illness.

“Eastern equine encephalitis is different this year,” McDonald said in a statement. “While we normally see these mosquitoes in two to three counties each year, this year they have been in 15 counties so far, and scattered all over New York state. This life-threatening mosquito-borne disease has no commercially available human vaccine and must be taken seriously.”

Hochul offered her condolences to the family of the victim, who was not identified, in a statement and emphasized the measures her administration has taken to reduce the spread of EEE.

In addition to ongoing mosquito spraying, New York is making insect repellent available at state parks, posting signage about EEE in parks, campgrounds and trailheads, and working with local health departments to limit park hours during peak periods of mosquito activity, according to a press release.

At least 10 other human cases of EEE, across six states, have been reported in the United States this year, according to the Centers for Disease Control and Prevention. Massachusetts has reported four human cases; other cases have been reported in Vermont, New Hampshire, Rhode Island, New Jersey, and Wisconsin.

Only a handful of human cases of EEE have been reported in New York state since 1971. This year, 18 cases of the infection have been identified in horses across 12 counties in New York state, according to the Hochul administration. A case of EEE in a horse in Ulster County was confirmed in August.

EEE is spread through the bite of a mosquito infected with the virus to mammals, including horses and humans. Most people bitten by an infected mosquito do not develop symptoms, though severe cases can involve a sudden headache, high fever, chills, and vomiting. The illness can lead to disorientation, seizures, encephalitis, and coma.

There is no commercially available treatment or human vaccine for EEE. About a third of patients who develop EEE die, and many who survive experience neurological impairment, according to the state Health Department.

The risk of developing EEE is highest from late July through September, and people over the age of 50 and younger than 15 are the most vulnerable to developing severe disease.

The state Health Department urges residents to protect against mosquito bites, including by wearing long sleeves, pants and socks when outside, using insect repellent, securing screens in windows and doors, and eliminating standing water.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org .

Legionella found in dozens of locations in Manhattan federal building

2024-09-09T23:00:00+00:00

This article is a collaboration with THE CITY.

Water testing at a major federal building in Lower Manhattan that houses immigration court and federal law enforcement offices has found bacteria that can cause Legionnaires’ disease in dozens of locations, THE CITY and Healthbeat have learned.

The U.S. General Services Administration, which operates the building, found Legionella in the water at 81 locations at 26 Federal Plaza, according to documents obtained by THE CITY. Legionella is a bacteria that can cause the disease, a severe form of pneumonia.

The water quality tests were conducted between August 23 and 25, according to an email sent Sunday night from building staff to members of the Department of Justice, which has offices in the building. The results found Legionella in water sources all over the building, including in kitchens, locker room showers, drinking fountains and daycare sinks. The test also found elevated levels of copper in two separate rooms and elevated levels of lead in a lactation room faucet.

Signs announcing the results of the water tests greeted people as they entered the building at the visitors’ and employee entrances on Monday: “Legionella has been detected in the drinking water system — normal use may continue.”

An employee who works on the eighth floor found out about the presence of Legionella only after a building cleaner showed him a picture of one of the posted notices on Monday afternoon.

“One of our contractors came up to me and said, ‘Do you know anything about this?’” he recalled. The employee, who requested anonymity because his job doesn’t allow him to speak to the media, hadn’t received any communication from the building staff about the issue.

He then asked another coworker, but they hadn’t heard anything either. “I am very unhappy that we didn’t get an email about this,” he told THE CITY. “I’m drinking water that I brought!”

More than a dozen employees who spoke with a reporter outside the building on Monday were unaware of the Legionella, and hadn’t noticed the signs the building had posted.

Water in the building at 26 Federal Plaza in New York City was found to have bacteria that can cause Legionnaires’ disease. (Ben Fractenberg / THE CITY)

The 41-story complex at 26 Federal Plaza is home to a number of prominent federal agencies, like the Department of Homeland Security, the New York branch of the Federal Bureau of Investigation, and the U.S. Court of International Trade and Immigration Court.

Dr. Waleed Javaid, a professor of medicine at the Icahn School of Medicine at Mount Sinai and a director of infection prevention and control, stressed that the presence of Legionella alone should not be too alarming, unless people begin getting sick.

For workers in and visitors to a building where Legionella has been detected, the risk of developing Legionnaires’ disease is likely low, he said. Still, he encouraged people to follow posted guidance and reach out to their health care providers if they are concerned or develop symptoms.

“If they’ve been exposed, the exposure itself wouldn’t really cause them to get Legionnaires’ unless the Legionella bacteria gets into their lungs, or if they have some preexisting condition that causes them to get the illness,” he said. “If they develop pneumonia, a respiratory illness, that’s when I’d start getting concerned.”

A GSA spokesperson said in a statement there are “no known active public health case investigations” of Legionnaires’ disease linked to the water supply at 26 Federal Plaza. This year, as part of a “proactive water quality management program,” the agency is testing the drinking water at thousands of the facilities it oversees.

The agency has begun the “flushing of all point-of-use outlets and hot water tanks, equipment evaluation to ensure proper functionality and cleaning or replacement where necessary, and reviewing operations, such as temperature set points and chemical characteristics of incoming water to the building.”

Pattern of contamination

This is not the first time in recent years that the federal agency overseeing the government’s workplaces has found Legionella bacteria in its buildings.

A memo released last September by the GSA’s Office of Inspector General reported that since that July, elevated levels of the bacteria had been detected in the water at six GSA-controlled buildings across the country, including in New York, Nebraska, Illinois, Utah and Michigan.

In New York, elevated levels of Legionella were detected at the Lewiston Bridge Land Port of Entry, at the U.S-Canada border.

In the memo, an assistant inspector general urged the Public Buildings Service, a division of GSA that oversees workplaces for civilian federal agencies, to take “immediate action to address the risk of Legionella contamination in water systems” across buildings owned and leased by GSA.

The problem dates back even further, according to the inspector general. In September 2022, that office had alerted the Public Buildings Service that it did “not effectively test for water contamination, including Legionella” in GSA-operated child-care centers. The memo noted that the elevated Legionella levels detected in 2023 coincided with reduced building occupancy, which can lead to water stagnation — a favorable condition for bacterial growth.

At 26 Federal Plaza, Legionella was found in five distinct locations in a room that served as a daycare center. It was also found in a sink on an early childhood learning floor, and in five places in four different classrooms.

The inspector general memo noted that the Public Buildings Service’s approach to Legionella testing was “not comprehensive or consistent” and urged the division to improve its testing requirements and tighten its oversight of its properties. In January, a GSA official highlighted expanded water testing efforts in its buildings.

The agency manages a massive portfolio of real estate. GSA owns 1,600 federal buildings and leases space in more than 6,500 buildings across the country, according to the memo.

Deadly risk for some

Most healthy people exposed to Legionella bacteria do not get sick, according to the Centers for Disease Control and Prevention. Current or former smokers, people 50 years or older, and people with cancer, chronic lung disease, diabetes, kidney failure, liver failure and a weakened immune system are at increased risk of developing Legionnaires’ disease.

Symptoms can include a cough, fever, headaches, muscle aches and shortness of breath. The disease can be successfully treated with antibiotics, though it can require hospitalization. About one in 10 people with Legionnaires’ disease die due to complications, according to the CDC.

The likelihood of becoming sick from Legionella is higher in places where people stay for longer periods of time, including apartment buildings and hospitals, Dr. Javaid said.

“If you’re just going there or you’re working there, the risk is exceedingly low, but not zero,” he said. “There is always a risk that you can acquire bacteria like this from working in a place that may have Legionella there.”

The bacteria occurs naturally in lakes and streams, and doesn’t typically pose a risk unless it enters a building’s water system and multiplies there, where stagnant water and warm temperatures can lead to bacterial growth.

People can become sick by inhaling water droplets containing the bacteria, including from showerheads, hot tubs, and centralized air-cooling systems. Legionella isn’t typically a concern in drinking water, although in rare cases, someone can become infected if they accidentally swallow water containing the bacteria that ends up in their lungs, according to the CDC.

From 2019 to 2023, there were more than 4,000 cases of illness caused by Legionella, including Legionnaires’ disease and a milder condition called Pontiac fever, in New York state, according to the state Department of Health. In 2021, New York reported more cases of those illnesses than any other state.

Clusters of Legionnaires’ disease have also emerged in New York City Housing Authority developments in recent years. In February, THE CITY reported the death of a NYCHA resident from the disease.

The number of Legionnaires’ disease cases has fluctuated in New York City from 2010 to 2022, with a peak of more than 600 cases in 2018, according to a city health department report.

The bacteria can be particularly dangerous in health-care facilities. Last week, officials announced the deaths of three people who tested positive for Legionnaires’ disease amid an outbreak of cases at an assisted living home in Albany. In 2022, five people died from the disease at a Manhattan nursing home.

The building at 26 Federal Plaza has rooms designated for “healthcare,” “health unit” and “health center,” according to the documents obtained by THE CITY and Healthbeat. Legionella was found in six of them.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org. Rachel Kahn is an intern at THE CITY, a non-profit newsroom that serves the people of New York through independent journalism.

West Nile virus a ‘moderate concern’ in Atlanta, with 7 cases reported

2024-09-09T19:27:26+00:00

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An increase in West Nile virus cases in Georgia – from two in August to seven last week – has spurred concern, as county health departments take steps to control mosquitoes, which spread the disease.

Nationwide, 377 cases have been reported this year, according to data from the U.S. Centers for Disease Control and Prevention.

“There’s clearly high risk circulating in the environment among the mosquitoes here … When there’s a cluster of cases, the likelihood for additional cases is higher than an average year,” said Emory University infectious disease expert Dr. Matthew Collins, who considers the disease a “moderate concern” in metro Atlanta.

Collins urged people to take precautions against mosquito bites, but said there’s no reason to panic.

“Driving in Atlanta is probably much higher risk than getting West Nile in Atlanta,” Collins said.

Two human cases of the virus have been identified in Fulton County, with one each in DeKalb, Cherokee, Hall, Richmond, and Chatham counties as of Sept. 3, according to the CDC.

Of the seven, four cases have been the more serious “neuroinvasive” type, which can affect a patient’s brain or spinal cord and lead to confusion, severe headache or loss of consciousness.

Officials doing West Nile virus surveillance

The Georgia Department of Public Health tracks West Nile virus by identifying birds, horses, and mosquitoes that test positive, which helps determine the areas where people are most at risk, spokesperson Nancy Nydam said.

Local public health departments focus on preventing mosquito breeding, but each county uses a slightly different approach.

In DeKalb County, public officials do not spray for mosquitoes but rather use larvicide. That is environmentally friendly and prevents mosquito larvae from becoming biting adults, spokesperson Eric Nickens said.

Photos help East Point show community’s challenges, but also joys

In Fulton County, if West Nile virus is detected in mosquitoes, officials will visit all residents within a quarter-mile of the area to urge precautions. Fulton uses insecticide spraying and larvicide to try to control mosquitoes, spokesperson Darryl Carver said.

“In Georgia, mosquito season lasts into October and sometimes into November, depending on weather conditions. As long as mosquitoes are active, and we know [West Nile virus] is circulating, elevated risk exists,” Nydam said.

Virus goes from birds to mosquitoes

West Nile is spread to humans by mosquitoes, typically Culex mosquitoes that become infected when they bite infected birds. The mosquitoes can then transmit the disease to people, horses, and other mammals, according to the CDC.

People are “dead-end hosts,” according to the CDC. An infected human will not pass the disease on to a mosquito if bitten. However, the disease can be transmitted from one human to another through blood transfusion or organ transplantation, as well as from mothers to babies through pregnancy, delivery or breastfeeding.

West Nile virus was first identified in the United States in New York City in 1999. It is named after the West Nile region of Uganda, where it was originally discovered in 1937.

The spread of West Nile is likely affected by climate change, Collins said. But it’s difficult to draw a direct line between increased temperatures and increased incidence of the disease. Rather, there are “multiple factors” that include the location of bird and mosquito populations, temperature and rain.

Severe cases of West Nile virus are rare

Many people infected with West Nile virus feel no or mild symptoms, and those cases are likely to go unreported, Collins said. Other people may have more moderate symptoms like rash, fever, headache, an upset stomach or diarrhea that will last for a few days and then subside.

West Nile virus cases reported in New York City

The “neuroinvasive” forms, which can cause paralysis, are rarer and more likely to develop in elderly people or those with other health conditions, Collins said.

About two-thirds of cases reported so far this year — 255 of 377 — have been neuroinvasive, according to CDC data. Four of Georgia’s cases have been neuroinvasive.

Testing for the disease is “not great,” Collins said. A simple blood draw can show evidence of past infection but may not indicate infection at the time of the test.

The most definitive diagnosis comes from testing spinal fluid obtained through a lumbar puncture, he said.

Strongest defense: Avoid mosquito bites

There is no commercially available vaccine or treatment for West Nile virus, beyond supportive care, which could include attempting to cool the body in the case of very high fever and breathing support if needed.

Preventing mosquito bites is the strongest line of defense, Collins and the state Department of Public Health emphasized.

Steps people to prevent bites include:

Limiting exposure at dusk and dawn, when mosquitoes are more likely to bite
Wearing longer-sleeved clothes and pants to reduce skin exposure
Using insect repellent with the chemical DEET
Ensuring that doors, windows and screens are tightly closed so that mosquitoes cannot come indoors
Emptying containers, including outdoor pools and buckets, that contain standing water where mosquitoes can breed.

Insect repellents with the chemical DEET are safe, Collins said.

Rebecca Grapevine is a reporter covering public health in Atlanta for Healthbeat. Contact Rebecca at rgrapevine@healthbeat.org.

West Nile virus: What you need to know about the mosquito-borne illness

2024-08-26T19:01:12+00:00

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Human cases of West Nile virus have been reported throughout the United States this year. The virus, which is primarily spread through the bite of an infected mosquito, typically leads to asymptomatic or mild disease. In rare cases, however, the disease can be severe or even fatal.

Dr. Anthony Fauci, one of America’s most prominent infectious disease experts, was recently infected with the virus. The former director of the National Institute of Allergy and Infectious Diseases was hospitalized with a case of West Nile virus this month and is recovering at home, the New York Times reported.

Here’s what you need to know about the virus.

What is West Nile virus?

West Nile virus is the leading cause of mosquito-borne disease in the continental United States, according to the Centers for Disease Control and Prevention.

The virus is primarily transmitted to humans when mosquitoes feed on infected birds and then bite people. In very rare cases, West Nile virus is transmitted from person to person through blood transfusion and organ transplantation, or from a mother to her baby, according to the CDC.

There are no vaccines to prevent West Nile virus, and there is no treatment for it, although health care providers can help relieve patients’ symptoms.

Most West Nile infections are asymptomatic. About 1 in 5 people who are infected develop West Nile fever, the mild form of the disease, according to the CDC. Other symptoms can include headaches, weakness, muscle aches, joint stiffness, gastrointestinal issues, and rashes.

About 1 in 150 infected people develop a more severe form of the disease, West Nile neuroinvasive disease, according to the CDC. People 60 years and older or those with weakened immune systems are at increased risk for the neuroinvasive disease, which can include encephalitis, meningitis and acute flaccid paralysis (severe muscle weakness), and can be fatal.

Where is West Nile virus circulating?

At least 216 cases of West Nile virus disease in humans have been reported in 31 states this year as of of Aug. 20, according to the CDC. Of those cases, 142 have been cases of West Nile virus neuroinvasive disease.

Nationwide, Texas leads the count of West Nile virus human disease cases, with 37 cases as of Aug. 20. About 20 states have reported a handful of cases.

The New York City Department of Health and Mental Hygiene reported the city’s first human cases of West Nile virus last week. As of Monday, the Health Department has reported six cases of West Nile neuroinvasive disease and one case of West Nile fever. The Health Department has also reported three cases of West Nile virus among blood donors.

The number of mosquito pools — groups of up to 50 mosquitoes that the Health Department traps and tests — has more than doubled in the past month, to 1,413 positive pools across the five boroughs. The city appears on its way to surpassing its record high number of West Nile virus detections — 1,555 positive pools reported in 2022.

Georgia has reported two cases of West Nile virus disease in humans so far this year.

What can you do to prevent West Nile virus?

The best way to prevent West Nile virus is to avoid getting mosquito bites.

The CDC recommends using insect repellent, wearing long-sleeved shirts and pants, using screens on windows and doors and eliminating standing water, which can become breeding grounds for mosquitoes.

In New York City, August and September are the peak periods of activity for mosquitoes with West Nile virus.

During the summer, the Health Department sprays pesticides in neighborhoods throughout the city to reduce mosquito activity. Residents can reference the city’s pesticide spraying schedule online.

Property owners in the city are responsible for removing standing water, and violations in public and private locations can be reported to 311 from April through October.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

New York City reports year's first human cases of West Nile virus

Mosquito season: West Nile virus shows up early, travelers bring dengue

New York City reports the year’s first human cases of West Nile virus

2024-08-19T21:53:23+00:00

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The New York City Department of Health and Mental Hygiene reported the year’s first human cases of West Nile virus, in four city residents, on Monday.

One person was diagnosed with West Nile fever and three others were hospitalized with West Nile neuroinvasive disease — a rare and serious condition — beginning in late July, the Health Department said. The four people with West Nile virus disease live in Manhattan and Queens.

The virus was also detected in the blood donations of three city residents, and the Health Department is investigating two possible cases of West Nile virus disease in the Bronx.

Health commissioner Dr. Ashwin Vasan said in a statement that the department continues to treat marshy areas and conduct mosquito spraying. Vasan also emphasized measures residents can take to keep themselves safe.

“Using an EPA-registered insect repellent is one very important tool, especially when outside at dusk and dawn, when the types of mosquitoes that transmit West Nile virus are most active,” he said. “You can also stop mosquitoes from laying eggs and reproducing in the water by emptying outdoor containers that hold water or calling 311 if you see standing water that you cannot empty.”

August and September are the peak periods of activity for mosquitoes with West Nile virus in New York City.

Mosquito pools — groups of up to 50 mosquitoes that the Health Department traps and tests — that are positive for West Nile virus have been reported in all five boroughs. This summer, the Health Department first detected the virus in the city’s mosquito population on June 5, the earliest identification on record.

The Health Department reported a total of 1,286 positive mosquito pools across the city as of Friday, a significant jump from the 703 positive pools reported in late July. At this point last summer, the city had reported 569 positive pools, according to the Health Department.

The New York State Department of Health reported the first statewide human case of West Nile virus earlier this month, in Suffolk County on Long Island.

Mosquito season: West Nile virus shows up early; travelers bring dengue

The vast majority of West Nile infections are asymptomatic. West Nile fever, the mild form of the disease, is characterized by headaches, weakness, muscle aches, joint stiffness, gastrointestinal issues, and rashes.

Less than 1% of infections result in West Nile neuroinvasive disease, the severe form of the disease. People 60 years and older or those with weakened immune systems are at increased risk for the neuroinvasive disease, which can include encephalitis, meningitis and acute flaccid paralysis (severe muscle weakness), and can be fatal.

Every year, New York City sees significant fluctuations in its annual West Nile virus cases, but climate change may lead to increased mosquito activity, Dr. Yesim Tozan, an assistant professor of global and environmental health at the NYU School of Global Public Health, told Healthbeat earlier this month.

In 2022, New York City hit a record high of 1,555 positive mosquito pools and 36 diagnoses of West Nile neuroinvasive disease. Last year, the Health Department reported 1,146 positive mosquito pools and 31 cases of West Nile neuroinvasive disease.

Over the past decade, an average of 17 city residents have been diagnosed with West Nile neuroinvasive disease per year, with a median age of 62 years and a case fatality rate of 10%, according to the Health Department.

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.

Mosquito season: West Nile virus shows up early; travelers bring dengue

2024-08-08T16:04:08+00:00

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The New York City Health Department has identified West Nile virus in mosquitoes throughout the city, and there’s growing concern about cases of dengue, another mosquito-borne disease, among travelers returning to New York.

There have been no confirmed human infections of West Nile virus in the city or state as of late July, but the city Health Department has reported 703 positive results in mosquito pools across all five boroughs.

In 2022, the city hit a record high of 1,555 positive mosquito pools and 36 diagnoses of West Nile neuroinvasive disease. Last year, the Health Department reported 1,146 positive mosquito pools and 31 cases of West Nile neuroinvasive disease.

The vast majority of West Nile virus infections are subclinical or asymptomatic, according to the Health Department. Symptoms of West Nile fever, or mild disease, include headache, weakness, muscle aches and joint stiffness, gastrointestinal issues and a rash. Less than 1% of infections lead to West Nile neuroinvasive disease, which includes encephalitis, meningitis, or acute flaccid paralysis (severe muscle weakness), and can be fatal.

This summer, the Health Department first detected West Nile virus in the city’s mosquito population on June 5, the earliest identification on record, according to an advisory. But early detection doesn’t necessarily mean a worse year for outbreaks, said Dr. Nicholas DeFelice, an associate professor of environmental medicine and climate science at the Icahn School of Medicine at Mount Sinai, whose research focuses on forecasting diseases including West Nile.

“Every year is different. There’s a lot of moving parts to it, and a lot of things that need to line up well for spillover events to occur,” DeFelice said, referring to the cross-species transmission of the virus.

In New York City, mosquitoes with West Nile virus are present from July through October, with peak activity in August and September. This month marks a “critical point” in the transmission cycle of the virus, when it’s most important to wear mosquito repellent, DeFelice said.

“During this time of the year, the thing that you can do is wear bug spray when you go out,” he said. “Dawn and dusk is when the mosquito that transmits West Nile bites.”

The Health Department also encourages New Yorkers to eliminate standing water around their homes, which can become breeding grounds for mosquitoes.

Climate change may increase risk

The first cases of West Nile virus in the United States were identified in New York City in the summer of 1999, when Dr. Deborah Asnis, an infectious disease specialist in Queens, alerted the city health department about strange symptoms in two of her patients. As the outbreak spread in the city, seven people died and dozens of others fell sick.

In the 25 years since, New York has seen significant fluctuations in annual West Nile virus cases. But climate change could lead to increased mosquito activity, particularly given the city’s temperate climate, said Dr. Yesim Tozan, an assistant professor of global and environmental health at the NYU School of Global Public Health, who researches infectious disease prevention and control.

Climate change increases the risk of human exposure to the virus, as warmer temperatures accelerate mosquito development, biting rates, and disease incubation periods, according to the U.S. Environmental Protection Agency.

Still, it’s hard to know precisely how climate change will shape the transmission of mosquito-borne diseases, DeFelice said. While warmer, wetter conditions might encourage transmission, extreme heat waves could also kill off mosquito populations, he said.

Tozan stressed the importance of collective responsibility when it comes to mitigating outbreaks, from the city’s pesticide-spraying efforts to New Yorkers using bug spray and eliminating standing water.

“There are various points, in this big, complex cycle that is embedded in the environment, where we could go and do things to decrease this transmission force,” she said.

New York, Florida lead dengue count

The United States is also facing an increase in dengue cases among travelers returning from countries where the mosquito-borne viral disease is endemic. Outbreaks of dengue frequently occur in the Caribbean, Central America, South America, Southeast Asia and the Pacific Islands. Earlier this year, Puerto Rico declared a public health emergency after recording a rapid rise in dengue cases.

New York and Florida lead the dengue case count among the 50 states, according to data from the U.S. Centers for Disease Control and Prevention. All of New York’s cases are from returning travelers, not local transmission.

Travelers to countries where dengue is endemic should inform themselves about the risk before departure and take care to protect against mosquito bites while visiting, Tozan said. Swift diagnosis and treatment of the disease is key, she added. Symptoms of dengue may include a fever, aches and pains, nausea, and a rash, according to the CDC. Severe cases can be life-threatening.

In a June alert about the increased risk of dengue among travelers, the Health Department noted that a local outbreak was unlikely. Aedes aegypti, the type of mosquito that primarily transmits dengue, is not typically found in the city, although Aedes albopictus, a close relative, is.

There remains a chance that a viral disease like dengue could start to spread locally, particularly if ideal conditions for rain, temperature and infectious reservoirs are met, Tozan said.

“It is a real possibility,” she said. “It’s just that it may not necessarily cause very big outbreaks, but it will jump around through these chance encounters.”

Eliza Fawcett is a reporter covering public health in New York City for Healthbeat. Contact Eliza at efawcett@healthbeat.org.