![\"Hantavirus](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/hantavirus-outbreak-epi-curvef3430263-0740-4ff3-95eb-5a3e950a0092.png?sfvrsn=80f4e86b_3\" "\\"Hantavirus")
Authorities from States Parties managing cases and/or contacts, WHO, and partners have initiated coordinated response measures, including:
[1] Preliminary analysis of Orthohantavirus andesense virus sequences from a cruise-ship related cluster, May 2026. https://virological.org/t/preliminary-analysis-of-orthohantavirus-andesense-virus-sequences-from-a-cruise-ship-related-cluster-may-2026/1029
[2] “Super-Spreaders” and Person-to-Person Transmission of Andes Virus in Argentina | New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa2009040
[3] Padula PJ, Edelstein A, Miguel SD, López NM, Rossi CM, Rabinovich RD. Hantavirus pulmonary syndrome outbreak in Argentina: molecular evidence for person-to-person transmission of Andes virus. Virology. 1998 Feb 15;241(2):323-30. doi: 10.1006/viro.1997.8976. PMID: 9499807. https://pubmed.ncbi.nlm.nih.gov/9499807/
[4] Dietl CA, Wernly JA, Pett SB, et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome. The Journal of Thoracic and Cardiovascular Surgery. 2008;135(3):579-584. doi:10.1016/j.jtcvs.2007.11.020.
Citable reference: World Health Organization (28 May 2026). Disease Outbreak News. Hantavirus outbreak linked to cruise ship travel, Multi-locations. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON604
","Summary":"This is the fourth Disease Outbreak News report on the Andes hantavirus outbreak linked to cruise ship travel, following the notification to the World Health Organization (WHO) on 2 May 2026 of severe respiratory illness cases aboard M/V Hondius, a cruise ship. Since the last DON was published on 13 May, three additional confirmed cases were reported, from Canada, the Netherlands, and Spain. The previously reported inconclusive case from the United States of America was subsequently determined to be negative following further laboratory testing and has been removed from the total case count. All cases to date have been passengers or crew members on the ship. As of 27 May, a total of 13 cases, including three deaths, have been reported (case fatality ratio 23%). Eleven cases have been laboratory-confirmed for Andes virus (ANDV) infection, and two are probable cases. Given the long incubation period of up to six weeks, it is not unexpected that cases continue to be reported until the end of the six weeks since last exposure. \r\n\r\nThrough the International Health Regulations (2005) (IHR) channels, National IHR Focal Points (NFPs) have all been informed and are supporting international contact tracing and monitoring efforts. WHO has assessed the risk posed by this event to the global population as low and will continue to monitor the epidemiological situation and update the risk assessment as needed. ","PublicationDateAndTime":"2026-05-28T18:00:00Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Hantavirus outbreak linked to cruise ship travel, Multi-locations","Epidemiology":"Hantavirus disease is a zoonotic viral disease caused by hantaviruses of the genus Orthohantavirus, family Hantaviridae, order Bunyavirales. More than 20 viral species have been identified within this genus.
Human hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of certain species of (specific) infected rodents, or by touching contaminated surfaces. Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present, and opportunities for exposure are greater.
Human-to-human transmission has currently only been reported for hantavirus pulmonary syndrome (HPS) associated with Andes virus infection. Andes virus (ANDV) is endemic in South America, with confirmed circulation and human cases reported primarily in Argentina and Chile, and additional cases and related strains identified in Uruguay, southern Brazil, and Paraguay.
Andes virus transmission between humans
Based on the available information and the existing observations of the current outbreak, limited human-to-human transmission of ANDV is known to occur. However, no large-scale human-to-human outbreaks have been observed historically,[2] suggesting a low probability of transmission per contact. ANDV circulates in specific species of rodents in the Americas, and there have been many sporadic cases reported in Argentina and Chile that have not led to onward transmission.[3] Clusters of human cases have been reported in multiple past outbreaks and have been typically associated with close and prolonged interactions, often in shared indoor environments such as households. The largest reported outbreak of ANDV was reported in Argentina in 2018-2019,[2] where high viral titres in combination with attendance at large social gatherings or extensive contacts among people were associated with higher transmission. While the available evidence suggests that there are multiple modes of transmission that occur with ANDV, the probability of onward transmission between humans remains low.
In this recent outbreak of ANDV infection reported on a cruise ship, human-to-human transmission has also occurred. Considering the ongoing epidemiological studies and environmental sampling after the disembarkation of all passengers from MV Hondius, the exact mode(s) through which human-to-human transmission occurred and their relative contributions are yet to be fully understood.
Therefore, at present, WHO is operating under the assumption that ANDV transmission:
The virus does not exhibit transmission dynamics consistent with highly transmissible airborne pathogens (such as measles).
This information is up to date as of 27 May 2026. It will be updated as new evidence becomes available and the understanding of transmission evolves.
Using data from the previously documented human-to-human outbreaks in Argentina [2] and the 13 cases so far recorded from the cruise ship outbreak, WHO estimates that the mean incubation period is 22 days, corresponding to a probability of safe release from quarantine of 96% at 42 days, reducing to 91% at 35 days. This reaffirms WHO’s recommendation of 42 days of quarantine for high-risk contacts and self-monitoring for low-risk contacts.
Using case incidence data from the ANDV outbreak associated with the cruise ship, the effective reproduction number (Rt) for this outbreak as of 22 May is estimated to be 0.7, where anything less than 1.0 indicates that the spread of disease is declining.
","OverrideTitle":"Hantavirus outbreak linked to cruise ship travel, Multi-locations","Advice":"WHO advises States Parties involved in this event to continue coordinated public health management efforts related to the management of cases and contacts associated with the affected ship and flights, as well as in countries where cases and/or contacts have been identified. WHO has advised and continues to advise a precautionary approach for management of the outbreak related to the ship, with focus on total containment to minimize the onward risk of transmission to other persons. This strategic decision is guided by:
At this time, WHO does not recommend any changes to routine activities for the general public. People who were on board the affected ship, or who have had close contact with a confirmed case, should follow national health advice. Guidance may be updated as further evidence becomes available.
Recommendations remain dynamic and will be updated as additional epidemiological and laboratory evidence, including genetic sequencing data, becomes available.
Coordination
Surveillance
Laboratory
Case management
Infection Prevention and Control
Risk Communication and Community Engagement (RCCE)
Based on the current information available on this event, WHO advises against the application of any travel or trade restrictions beyond the restriction of movement of identified high-risk contacts.
*Standard precautions refer to a set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. These practices aim to protect both healthcare professionals and patients and include hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of sharps materials, safe injection practices, use of sterile instruments and equipment and cleaning of hospital environments and the environment. Adapted from “Standard precautions for the prevention and control of infections: aide-memoire”- WHO, 2022. Available at https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1
","Assessment":"WHO continues to assess the risk for passengers and crew who were onboard the cruise ship as moderate, as individuals exposed prior to the implementation of control measures may still develop illness during the incubation period and should therefore be closely monitored.
The risk at the global level is assessed as low for the following reasons:
For the general public, including people not exposed on board the ship or through close contact with a confirmed case, the overall probability of infection remains low. Current evidence indicates that human-to-human transmission occurs through close and prolonged contact, and can be effectively limited through early detection, isolation of cases, and contact tracing.
","Overview":"On 2 May 2026, WHO received notification from the IHR NFP of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom) regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard the Netherlands-flagged cruise ship M/V Hondius.
As of 27 May, a total of 13 cases (eleven confirmed and two probable cases), including three deaths (two confirmed and one probable), have been reported. Since the last Disease Outbreak News was published on 13 May, three additional confirmed cases have been reported among passengers or crew members, one each from Canada, the Netherlands, and Spain. The case in Canada developed symptoms during contact follow-up, whereas the cases in the Netherlands and Spain were identified through routine weekly testing of high-risk contacts during follow-up. The previously reported inconclusive case from the United States of America was subsequently determined to be negative following further laboratory testing and has been removed from the total count on 15 May. All confirmed cases are among people who travelled onboard the M/V Hondius.
Figure 1. Epidemiological curve of Andes hantavirus cases (n = 13) reported to WHO as of 27 May 2026, 17:00.
Based on currently available information, the working hypothesis is that the first case acquired the infection prior to boarding the cruise, through exposure on land. Investigations are ongoing to elucidate the potential circumstances of exposure and the source of the outbreak, in collaboration with authorities in Argentina and Chile, however, the time between the individual’s visit to Chile and the onset of symptoms exceeds the maximum incubation period. Therefore, based on the information currently available, exposure in Chile can be ruled out. Current evidence suggests subsequent human-to-human transmission onboard the ship. This is also supported by a preliminary analysis of the sequences, which show a near-identical sequence from different cases.[1]
This outbreak is being managed through a coordinated international response. This includes comprehensive epidemiological investigations, case isolation and clinical management, medical evacuations, laboratory testing, and international contact tracing, as well as quarantine and monitoring measures. Recommendations are subject to change as new epidemiological and laboratory evidence becomes available, including findings from genetic sequencing.
Follow-up and contact tracing for all contacts of hantavirus cases linked to the cruise ship is ongoing. This includes passengers who disembarked in Saint Helena, United Kingdom, on 24 April; Ascension, United Kingdom, on 27 April; Praia, Cabo Verde, on 6 May; and Tenerife, Spain, on 10 and 11 May, the remaining 25 crew members and the two healthcare workers from the Netherlands who disembarked in the Netherlands on 18 May and 23 May. Passengers who travelled on flights who may have had exposure to subsequently confirmed cases have been identified and contacted.
High-risk contacts are being quarantined and monitored by local health authorities either in their respective countries or in the ship’s flag country, the Netherlands, or third countries (Table 1). As of 22 May 2026, more than 600 contacts, including 53% high-risk and 47% low-risk contacts, have been identified across 32 countries, territories and areas, and are either under close monitoring or self-monitoring in line with the updated guidance on management of contacts of Andes virus (ANDV) cases from the MV Hondius cruise ship published on 17 May.
Table 1. Contacts being traced for the Andes hantavirus outbreak on a cruise ship reported to WHO as of 25 May 2026, 17:00.
![\"Hantavrius](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/hantavrius-contacts.png?sfvrsn=d4f49938_3\" "\\"Hantavrius")
Health authorities in DRC, in collaboration with WHO and partners are implementing public health measures, including but not limited to the following:
Coordination
Surveillance
Case Management
Laboratory
Risk Communication and Community Engagement (RCCE)
WHO and partners have developed a shared RCCE message repository to harmonize risk communication content
Infection Prevention and Control (IPC)
Operational support and Logistics
Border Health, Travel and Mass Gatherings
Health authorities in Uganda, in collaboration with WHO and partners, are implementing public health measures, including but not limited to the following:
Coordination
Surveillance and Laboratory
Case Management
Laboratory
Risk Communication and Community Engagement (RCCE)
Infection Prevention and Control (IPC)
Corrigendum: This Disease Outbreak News was revised on 25 May 2026 to correct the year of the last Sudan ebolavirus in Uganda and the distance between Bunia HZ and Uganda.
Corrigendum: This Disease Outbreak News was revised on 26 May 2026 to amend the declaration date of the public health emergency of international concern (PHEIC) to 17 May 2026
","Summary":"On 15 May 2026, the Ministry of Public Health, Hygiene and Social Welfare, Democratic Republic of the Congo (DRC), and the Ministry of Health of Uganda declared an outbreak of Ebola Disease following the confirmation of Bundibugyo virus disease (BVD) in both countries.\r\nOn 17 May 2026, the World Health Organization (WHO) Director-General determined that the Ebola disease caused by Bundibugyo virus in DRC and Uganda constitutes a public health emergency of international concern (PHEIC), as defined in the provisions of IHR.\r\nOn 19 May 2026, the Director-General of WHO convened the first meeting of the IHR Emergency Committee, and temporary recommendations were issued to State Parties.\r\nAs of 21 May, 746 suspected cases and 176 deaths among suspected cases were reported in DRC. So far 85 confirmed cases, including two in Uganda, and ten deaths, with one in Uganda, among confirmed cases were reported across both countries. In DRC, transmission is concentrated in Ituri, North Kivu and South Kivu provinces, with challenges in contact follow-up, insecure conditions, and inadequate isolation and referral systems complicating response efforts. Uganda has reported two imported cases with no confirmed local transmission. An American national who was working in DRC has also been confirmed positive and transferred to Germany for care.\r\nNational authorities, in collaboration with WHO and partners, are implementing response measures including deployment of rapid response teams, delivery of medical supplies, strengthened surveillance, laboratory confirmation, infection prevention and control assessments, the set-up of safe and optimized treatment centers, and community engagement.","PublicationDateAndTime":"2026-05-21T22:00:47Z","TitleSuffix":"","UseOverrideTitle":false,"Title":"Ebola disease caused by Bundibugyo virus \u2013 Democratic Republic of the Congo","Epidemiology":"Bundibugyo virus disease (BVD) is a severe and often fatal form of Ebola disease caused by the Bundibugyo virus, one of the Orthoebolavirus species. It is a zoonotic disease, with fruit bats suspected to be the natural reservoir. Human infection occurs through close contact with the blood or secretions of infected wildlife, such as bats or non-human primates, and subsequently spreads from person to person through direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals or contaminated surfaces or items. Transmission is particularly amplified in health-care settings when infection prevention and control (IPC) measures are inadequate, and during unsafe burial practices involving direct contact with the deceased.
The incubation period for BVD ranges from 2 to 21 days, and individuals are usually not infectious until symptom onset. Early symptoms are non-specific, including fever, fatigue, muscle pain, headache, and sore throat, which complicates clinical diagnosis and can delay detection. These progress to gastrointestinal symptoms, organ dysfunction, and in some cases haemorrhagic manifestations. Case fatality rates in the past two BVD outbreaks, reported in Uganda and in DRC in 2007 and 2012, have ranged from approximately 30% to 50%.
Differentiating BVD from other endemic febrile illnesses such as malaria is challenging without laboratory confirmation using PCR or antigen/antibody-based assays. Control relies on rapid case identification, isolation and care, contact tracing, safe burials, and strong community engagement, as no approved vaccines or specific treatments currently exist for BVD.
","OverrideTitle":"","Advice":"On 19 May 2026, the Director-General of WHO convened the first meeting of the IHR Emergency Committee who issued the following temporary recommendations on 22 May 2026 to State Parties:
For countries with documented detection of Bundibugyo virus (the Democratic Republic of the Congo and Uganda)
Coordination and high-level engagement
Risk communication and community engagement
Surveillance and laboratory
Infection prevention and control in health facilities and in the context of care
Patient referral pathway and access to safe and optimized intensive care
Safe and dignified burials
Operations, supplies and logistics
Border health, international travel and mass-gathering events
Research and development of medical countermeasures
For countries with land borders adjoining countries with documented Bundibugyo virus disease
In the presence of a BVD case, temporary recommendations for State Parties States Parties with documented BDBV detection apply.
For all other countries
In the presence of a BVD case, temporary recommendations for States Parties with documented BDBV detection apply.
Regular Information products on the outbreak of BVD in DRC
On 17 May 2026, WHO Director-General, after having consulted the States Parties where the event is known to be currently occurring, determined that the Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda constitutes a public health emergency of international concern (PHEIC), as per the provisions of the IHR.
This is the 17th Ebola disease outbreak in the DRC since 1976. The last Ebola disease outbreak in the country was an outbreak and Ebola virus disease which was declared on 4 September 2025 with total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), reported from six health areas in Bulape Health Zone, Kasai Province. The end of outbreak was declared on 1 December 2025. The last BVD outbreak was reported on 17 August 2012 by the DRC Ministry of Health in Province Orientale. A total of 59 cases, 38 confirmed and 21 probable cases, including 34 deaths were reported. The outbreak was declared over on 26 November 2012 by the MOH. In Uganda, the last outbreak reported was an outbreak of Sudan ebolavirus in 2025. The last BVD outbreak was recorded in the country in 2007.
This outbreak is occurring in a complex epidemiological and humanitarian context. A critical four-week detection gap between the onset of symptoms of the presumed index case (25 April 2026) and the laboratory confirmation of the outbreak (14 May 2025) suggests a low clinical index of suspicion among healthcare providers. This is compounded by the presence of co-circulating arboviruses and influenza-like illnesses, masking the initial index of suspicion for Ebola disease and exacerbating community transmission. Furthermore, the infection and death of four healthcare workers within a four-day span at Mongbwalu General Referral Hospital underscores critical breaches in IPC protocols. A large number of community deaths has been reported potentially associated with unsafe burial practices.
Ongoing conflict in Ituri province restricts the movement of surveillance teams, limits the deployment of Rapid Response Teams, and hinders the secure transport of laboratory samples. Contact tracing is challenging due to difficult access and highly mobile populations, increasing the risk of high-risk contacts being lost to follow up or never identified
Ituri’s role as a commercial and migratory hub increases the risk of regional exportation. The proximity to Uganda and South Sudan increases the risk of cross-border transmission if PoE screening and cross border coordination and information sharing are not immediately reinforced. On 15 May 2026, the Ministry of Health of Uganda reported an imported case of BVD.
Humanitarian needs in the area are dire. Ituri has 273 403 displaced people, with a total of 1.9 million people in need according to the Humanitarian Response Plan 2026 for DRC. From January to March 2026, 32 600 newly displaced and 30 200 returnees were recorded. The province recorded 5800 protection incidents and 11 incidents against humanitarian actors.
Unlike Ebola virus disease, there is no licensed vaccine or specific therapeutics against BDBV. Research and development activities are activated to coordinate efforts to advance potential candidate medical countermeasures. Response and outbreak control relies entirely on a range of interventions and public health measures that will need to be thoroughly implemented, including supportive care, early detection, adequate IPC, rigorous contact tracing, safe burials, and community engagement.
WHO assessed the risk of the outbreak of BVD to be very high at the national level in DRC, high at the regional level, and low at the global level.
","Overview":"On 15 May 2026, the Ministry of Public Health, Hygiene and Social Welfare of Democratic Republic of the Congo (DRC) officially declared the 17th Ebola disease outbreak following the laboratory confirmation of Bundibugyo virus disease (BVD) in eight samples. Concurrently, on 15 May 2026, the Ministry of Health of Uganda confirmed an outbreak of BVD following the identification of an imported case from DRC.
On 17 May 2026, the WHO Director-General, after having consulted the States Parties where the event is known to be currently occurring, determined that the Ebola disease caused by Bundibugyo virus in DRC and Uganda constitutes a public health emergency of international concern (PHEIC), as defined in the provisions of International Health Regulation (IHR)
Since the last Disease Outbreak News was published on 16 May 2026, the number of suspected and confirmed cases has increased rapidly in DRC, with geographical expansion into North Kivu and South Kivu. In total, 746 suspected cases, including 176 deaths among suspected cases have been reported from DRC as of 21 May 2026; and 85 confirmed cases (two in Uganda), including ten deaths (one in Uganda) (CFR 12%) have been reported from both countries.
Figure 1. Distribution of suspected and confirmed cases of Bundibugyo virus disease in Democratic Republic of Congo and Uganda, as of 21 May 2026
![\"\"](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/map1.jpg?sfvrsn=a47ecee3_3\" "\\"Figure")
Democratic Republic of the Congo
As of 21 May 2026, a total of 83 confirmed cases including nine deaths (CFR 11%); and 746 suspected cases including 176 deaths have been reported from 15 health zones (HZ) in Ituri, North Kivu and South Kivu Provinces, DRC. Four health worker deaths have been reported to date. Epidemiological and laboratory investigations are ongoing to reclassify all suspected cases and deaths reported in DRC.
The most affected HZ are Mongbwalu, Rwampara and Bunia, which all account for 96% of suspected cases and 79% of confirmed cases.
As of 21 May, 1603 contacts have been listed in Ituri province and one contact became a suspected case. However, follow-up remains weak due to insecurity and movement restrictions. The follow-up rate as of 21 May is 21%. On 21 May, 84 new alerts were reported, and 77 alerts were investigated, all of which were validated.
An American national, who was working in DRC as a surgeon, has also been identified as a confirmed case. Exposure is thought to have occurred during a medical procedure on 11 May. Onset of symptoms was reported on 16 May and laboratory confirmation was received on 20 May. The case is currently at a High-Level isolation unit in Berlin, Germany undergoing treatment.
Figure 2 Risk mapping of Health Zones in DRC as of 21 May 2026
![\"\"](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/map2.jpg?sfvrsn=ac399fe9_3\" "\\"Figure")
Response efforts continue to face a number of challenges, including:
It is currently thought that the event originated in the Mongbwalu HZ, DRC, a high-traffic mining area, with cases subsequently migrating to Rwampara and Bunia to seek medical care. Ituri province borders South Sudan and Uganda with Bunia HZ being less than 40km from Uganda. A full epidemiological investigation and trace back exercise is ongoing.
Ituri’s role as a commercial and migratory hub and proximity to Uganda and South Sudan increases the risk of regional exportation and cross-border transmission.
Uganda
As of 20 May 2026, a total of two confirmed cases including one death have been reported in Kampala, Uganda. Both cases were imported from the DRC. The first case was admitted to a private hospital on 11 May and died on 14 May. The transfer of the body to DRC was completed the same day. The second case was confirmed on 16 May in Kampala, in an individual returning from DRC with no apparent links to the first case. The case is currently admitted in Uganda at the Mulago Isolation Treatment Unit. At the time of reporting, no local transmission has been identified in Uganda.
As of 18 May, a total of 127 contacts, linked to both confirmed imported cases, have been identified and under follow-up. These include close household contacts and hospital contacts where the cases were hospitalized.
Exposure risks are associated with healthcare settings and cross-border movements. Eighteen alerts were reported on 18 May and investigated. Four active cross-border exposure clusters identified in Ntoroko District are under investigation.
","DonId":"2026-DON603","Provider":"dynamicProvider372"},{"Id":"dfc49ad5-c3b6-41ca-a2d6-f51092ff8b33","LastModified":"2026-05-26T16:32:37Z","PublicationDate":"2026-05-17T09:35:15Z","DateCreated":"2026-05-17T09:35:15Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON602","ItemDefaultUrl":"/2026-DON602","Response":"Health authorities in DRC are implementing public health measures, including but not limited to the following:
Coordination
Surveillance and Laboratory
Risk Communication and Community Engagement (RCCE)
Infection Prevention and Control (IPC)
Logistics
Health authorities in Uganda are implementing public health measures, including but not limited to the following:
WHO is supporting the national authorities, including through:
Citable reference: World Health Organization (17 May 2026). Disease Outbreak News; Bundibugyo Virus Disease, Democratic Republic of the Congo (The) and Uganda. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON602
Corrigendum: This Disease Outbreak News was revised on 26 May 2026 to amend the declaration date of the public health emergency of international concern (PHEIC) to 17 May 2026.
","Summary":"On 5 May 2026, the World Health Organization (WHO) was alerted of a high-mortality outbreak of unknown illness in Mongbwalu Health Zone, Ituri Province, Democratic Republic of the Congo (DRC), including deaths among health workers. \r\nOn 14 May 2026, the Institut national de recherche biom\u00e9dicale (INRB) Kinshasa analyzed 13 blood samples from Rwampara Health Zone, Ituri Province. Laboratory analysis confirmed Bundibugyo virus disease (BVD) in eight of these samples on 15 May, a species of Ebola.\r\nThe case fatality rates in the past two BVD outbreaks have ranged from 30% to 50%. Unlike Ebola virus disease, there is no licensed vaccine or specific therapeutics against Bundibugyo virus, though early supportive care is lifesaving. \r\nOn 15 May 2026, the Ministry of Public Health, Hygiene and Social Welfare, DRC, officially declared the 17th Ebola Disease outbreak in DRC. Concurrently, the Uganda Ministry of Health confirmed an outbreak of BVD following the identification of one imported case from DRC, a Congolese man who died in the capital city of Kampala. \r\nOn 17 May 2026, WHO Director-General, after having consulted the States Parties where the event is known to be currently occurring, determined that the Ebola disease caused by Bundibugyo virus in DRC and Uganda constitutes a public health emergency of international concern (PHEIC), as defined in the provisions of IHR.\r\nResponse measures include deployment of rapid response teams, delivery of medical supplies, strengthened surveillance, laboratory confirmation, infection prevention and control assessments, the set-up of safe treatment centers, and community engagement. WHO is supporting the coordination of the response, case management, and cross-border preparedness. WHO advice has been issued to countries.","PublicationDateAndTime":"2026-05-16T22:00:00Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo & Uganda","Epidemiology":"Bundibugyo virus disease (BVD) is a severe and often fatal form of Ebola disease caused by the Bundibugyo virus, one of the Orthoebolavirus species. It is a zoonotic disease, with fruit bats suspected to be the natural reservoir. Human infection occurs through close contact with the blood or secretions of infected wildlife, such as bats or non-human primates, and subsequently spreads from person to person through direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals or contaminated surfaces. Transmission is particularly amplified in health-care settings when infection prevention and control (IPC) measures are inadequate, and during unsafe burial practices involving direct contact with the deceased.
The incubation period for BVD ranges from 2 to 21 days, and individuals are usually not infectious until symptom onset. Early symptoms are non-specific, including fever, fatigue, muscle pain, headache, and sore throat, which complicates clinical diagnosis and can delay detection. These progress to gastrointestinal symptoms, organ dysfunction, and in some cases haemorrhagic manifestations. Case fatality rates in the past two BVD outbreaks, reported in Uganda and in DRC in 2007 and 2012, have ranged from approximately 30% to 50%.
Differentiating BVD from other endemic febrile illnesses such as malaria is challenging without laboratory confirmation using PCR or antigen/antibody-based assays. Control relies on rapid case identification, isolation and care, contact tracing, safe burials, and strong community engagement, as no approved vaccines or specific treatments currently exist for BVD.
","OverrideTitle":"Ebola disease caused by Bundibugyo virus, Democratic Republic of the Congo & Uganda","Advice":"For countries where the event is occurring (the Democratic Republic of the Congo and Uganda)
Coordination and high-level engagement
Risk communication and community engagement
Surveillance and laboratory
Infection prevention and control in health facilities and in the context of care
Patients’ referral pathway and access to safe and optimized intensive care.
Research and development of medical countermeasures
Border health, travels and mass-gathering events
Safe and dignified burials
Operations, supplies and logistics
For countries with land borders adjoining countries with documented Bundibugyo virus disease
For all other countries
On 17 May 2026, WHO Director-General, after having consulted the States Parties where the event is known to be currently occurring, determined that the Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda constitutes a public health emergency of international concern (PHEIC), as per the provisions of the IHR. Temporary recommendations for State Parties will be issued. In the meantime, WHO issued advice to countries, as stated below.
This is the 17th Ebola disease outbreak in the DRC since 1976. The last Ebola disease outbreak in the country was declared on 4 September 2025 with total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), reported from six health areas in Bulape Health Zone, Kasai Province. The end of outbreak was declared on 1 December 2025. The last BVD outbreak was reported on 17 August 2012 by the DRC Ministry of Health in Province Orientale. A total of 59 cases, 38 confirmed and 21 probable cases, including 34 deaths were reported. The outbreak was declared over on 26 November 2012 by the MOH.
This outbreak is occurring in a complex epidemiological and humanitarian context. A critical four-week detection gap between the onset of symptoms of the presumed index case (25 April 2026) and the laboratory confirmation of the outbreak (14 May 2025) suggests a low clinical index of suspicion among healthcare providers. This is compounded by the presence of co-circulating arboviruses and influenza-like illnesses, masking the initial index of suspicion for Ebola disease and exacerbating community transmission. Furthermore, the infection and death of four healthcare workers within a four-day span at Mongbwalu General Referral Hospital underscores critical breaches in IPC protocols. A large number of community deaths has been reported potentially associated with unsafe burial practices.
Ongoing conflict in Ituri province restricts the movement of surveillance teams, limits the deployment of Rapid Response Teams, and hinders the secure transport of laboratory samples. Contact tracing is challenging due to difficult access and highly mobile populations, increasing the risk of high-risk contacts being lost to follow up or never identified.
Ituri’s role as a commercial and migratory hub increases the risk of regional exportation. The proximity to Uganda and South Sudan increases the risk of cross-border transmission if PoE screening and cross border coordination and information sharing are not immediately reinforced. On 15 May 2026, the Ministry of Health of Uganda reported an imported case of BVD.
Humanitarian needs in the area are dire. Ituri has 273 403 displaced people, with a total of 1.9 million people in need according to the Humanitarian Response Plan 2026 for DRC. From January to March 2026, 32 600 newly displaced and 30 200 returnees were recorded. The province recorded 5800 protection incidents and 11 incidents against humanitarian actors.
Unlike Ebola virus disease, there is no licensed vaccine or specific therapeutics against BDBV. Research and development activities are activated to coordinate efforts to advance potential candidate medical countermeasures. Response and outbreak control relies entirely on a range of interventions and public health measures that will need to be thoroughly implemented, including supportive care, early detection, adequate IPC, rigorous contact tracing, safe burials, and community engagement.
","Overview":"On 5 May 2026, WHO received an alert regarding an unknown illness with high mortality reported in Mongbwalu Health Zone, Ituri Province, including four health workers who died within four days. Following an in-depth investigation by the rapid response team in Mongbwalu and Rwampara health zones (HZ) on 13 May, the outbreak was subsequently confirmed as Bundibugyo virus disease (BVD) due to Bundibugyo virus (BDBV) (Orthoebolavirus bundibugyoense, species) on 15 May.
On 15 May 2026, the Ministry of Public Health, Hygiene and Social Welfare officially declared the 17th Ebola Disease outbreak in the DRC, occurring in Rwampara, Mongwalu and Bunia HZ.
The first currently known suspected case, a health worker, reported onset of symptoms including fever, hemorrhaging, vomiting and intense malaise on 24 April 2026. The case died at a medical centre in Bunia.
As of 15 May, a total of 246 suspected cases and 80 deaths (four deaths among confirmed cases) have been reported from three HZ: Rwampara (six health areas affected), Mongbwalu (three health areas affected), and Bunia . Twenty four suspected cases are currently in isolation facilities across the three HZ. In addition, unusual clusters of community deaths with symptoms compatible with Bundibugyo virus disease (BVD) are being investigated across other HZ in Ituri and North Kivu.
A further case reported on 16 May, an individual returning from Ituri to Kinshasa, has tested NEGATIVE for Bundibugyo virus on confirmatory testing by the Institut National de la Recherche Biomédicale (INRB) of DRC, and is therefore not considered a confirmed case.
Most of the suspected cases are between 20 and 39 years old, with females accounting for over 60%, suggesting significant risks associated with household and caregiver transmission.
Initial testing of 20 samples collected in Rwampara HZ and analysed at the Provincial Public Health Laboratory in Bunia using standard Ebola Xpert were negative for Ebola virus. Samples were sent to INRB for further analysis, of which eight samples analysed were confirmed as Orthoebolavirus by polymerase chain reaction (PCR) on 15 May. Genomic sequencing confirmed the virus species as Bundibugyo virus (BDBV).
As of 15 May, 65 contacts have been listed, with 15 identified as high-risk. However, follow-up remains weak due to insecurity and movement restrictions. Several listed contacts became symptomatic and died before they could be isolated.
On 15 May 2026, the Ministry of Health of Uganda confirmed an outbreak of BVD following the identification of an imported case from the DRC. The case is an elderly man who was admitted to a private hospital on 11 May with severe symptoms and died on 14 May. The post-mortem transfer of the body to DRC was completed the same day. A clinical sample collected when the case was admitted on 11 May was tested at the Central Emergency Surveillance and Response Support Laboratory, Wandegeya, and was confirmed as Bundibugyo virus on 15 May 2026. A second imported case was confirmed on 16 May in Kampala, in an individual returning from DRC with no apparent links to the first case. At the time of reporting, no local transmission has been identified in Uganda.
On 17 May 2026, the Director-General of WHO, after having consulted the States Parties where the event is known to be currently occurring as defined in the provisions of the International Health Regulations (2005) (IHR), determined that the Ebola disease caused by Bundibugyo virus in DRC and Uganda constitutes a PHEIC.
It is currently thought that the event originated in the Mongbwalu HZ, DRC, a high-traffic mining area, with cases subsequently migrating to Rwampara and Bunia to seek medical care. Ituri province borders South Sudan and Uganda (and Bunia HZ is less than 500km from Uganda). A full epidemiological investigation and trace back exercise is ongoing.
Ituri’s role as a commercial and migratory hub and proximity to Uganda and South Sudan increases the risk of regional exportation and cross-border transmission.
Figure 1. Health Zones affected by Bundibugyo virus disease in Democratic Republic of Congo, as of 16 May 2026
![\"Map_Ebola](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/map_ebola-disease-caused-by-bundibugyo-virus_drc-(2).png?sfvrsn=db9a40db_3\" "\\"Map_Ebola")
Authorities from States Parties managing cases and/or contacts, WHO, and partners have initiated coordinated response measures, including:
[1] Preliminary analysis of Orthohantavirus andesense virus sequences from a cruise-ship related cluster, May 2026. https://virological.org/t/preliminary-analysis-of-orthohantavirus-andesense-virus-sequences-from-a-cruise-ship-related-cluster-may-2026/1029
[2] Pan American Health Organization / World Health Organization (PAHO/WHO). Epidemiological Alert Hantavirus Pulmonary Syndrome (HPS). https://www.paho.org/en/documents/epidemiological-alert-hantavirus-pulmonary-syndrome-americas-region-19-december-2025
[3] Hantavirus infection - Annual Epidemiological Report for 2023. https://www.ecdc.europa.eu/en/publications-data/hantavirus-infection-annual-epidemiological-report-2023
[4] WHO Director-General's opening remarks at the media briefing on hantavirus – 12 May 2026. https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing-on-hantavirus---12-may-2026
[5] Dietl CA, Wernly JA, Pett SB, et al. Extracorporeal membrane oxygenation support improves survival of patients with severe Hantavirus cardiopulmonary syndrome. The Journal of Thoracic and Cardiovascular Surgery. 2008;135(3):579-584. doi:10.1016/j.jtcvs.2007.11.020.
Citable reference: World Health Organization (13 May 2026). Disease Outbreak News. Hantavirus cluster linked to cruise ship travel, Multi-country. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON601
","Summary":"This is the third Disease Outbreak News report on the hantavirus cluster, following the notification to the World Health Organization (WHO) on 2 May 2026 of severe respiratory illness cases aboard MV Hondius, a cruise ship. Since the last DON was published on 8 May, two additional confirmed cases were reported from France and Spain. In addition, there is one inconclusive result for a case in the United States of America. All were passengers on the ship. As of 13 May, a total of 11 cases, including three deaths, have been reported (case fatality ratio 27%). Eight cases were laboratory-confirmed for Andes virus (ANDV) infection, two are probable, and one case remains inconclusive and undergoing further testing. Through the International Health Regulations (2005) (IHR) channels, National IHR Focal Points (NFPs) have all been informed and are supporting international contact tracing efforts. WHO has assessed the risk posed by this event to the global population as low and will continue to monitor the epidemiological situation and update the risk assessment as needed. ","PublicationDateAndTime":"2026-05-13T18:00:00Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Hantavirus cluster linked to cruise ship travel, Multi-country","Epidemiology":"
Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a zoonotic, viral respiratory disease caused by hantaviruses of the genus Orthohantavirus, family Hantaviridae, order Bunyavirales. More than 20 viral species have been identified within this genus.
Hantaviruses are associated with two major distinct clinical syndromes in humans: HPS predominantly reported in the Americas, and hemorrhagic fever with renal syndrome (HFRS), mainly reported in Europe and Asia. However, human-to-human transmission has only been reported for HPS associated with Andes virus infection. Andes virus is endemic in South America, with confirmed circulation and human cases reported primarily in Argentina and Chile, and additional cases and related strains identified in Uruguay, southern Brazil, and Paraguay.
Human Hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of infected rodents or by touching contaminated surfaces. Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present, and opportunities for exposure are greater.
HPS is characterized by headache, dizziness, chills, fever, myalgia, and gastrointestinal symptoms, such as nausea, vomiting, diarrhoea, and abdominal pain, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from 1-6 weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure.
Hantavirus infections are relatively uncommon globally. In 2025, in the Region of the Americas, eight countries reported HPS, 229 cases and 59 deaths with a CFR of 25.7%.[2] HPS is not reported in other parts of the world. In the European Region, 1885 hantavirus infections causing HFRS were reported in 2023 (0.4 per 100 000), marking the lowest rate observed between 2019 and 2023.[3] In East Asia, particularly China and the Republic of Korea, HFRS continues to record thousands of cases annually, although incidence has declined in recent decades.
The overall CFR for HPS can be as high as 50%. While there are no licensed treatment nor vaccines for hantavirus infections, early supportive care and immediate referral to a facility with a complete ICU can improve survival.
Environmental and ecological factors affecting rodent populations can influence disease trends seasonally. Since hantavirus reservoirs are sylvatic rodents, transmission can occur when people come into contact with rodent habitats.
Although uncommon, limited human\u2011to\u2011human transmission of HPS due to Andes virus has been reported in community settings involving close and prolonged contact. Secondary infections among healthcare workers have been previously documented in healthcare facilities, though remain rare. Secondary transmission appears most likely during the early phase of illness, when the virus is more transmissible. Currently, little evidence is available due to the scarcity of hantavirus outbreak related to human-to-human transmission.
WHO advises that States Parties involved in this event continue public health coordination and management efforts related to the ship and relevant flights, and in countries where cases and/or contacts are present or will be returning to. Based on information available and ongoing epidemiological, clinical and environmental investigations, and applying the precautionary principle, this includes contact tracing and monitoring, detection, investigation, reporting of suspected cases, laboratory testing of suspected cases, case management, infection prevention and control measures, and clear and transparent communication to affected individuals and the general public.
Outside the context of the ship, high-risk contacts may include intimate partners, household members and persons with prolonged close indoor exposure, healthcare workers with unprotected exposure, and individuals handling contaminated materials or body fluids without appropriate personal protective equipment, outlined in the interim guidance published on 8 May.
Given that infectiousness peaks in the early phase of illness, and that pre-symptomatic transmission cannot be entirely ruled out, as a precautionary principle, WHO recommends active monitoring and home or facility quarantine of high-risk contacts for 42 days following last exposure. Current evidence does not support routine laboratory testing of contacts for outbreak control nor the quarantine of low-risk contacts; low-risk contacts should undertake passive self-monitoring and seek medical evaluation if symptoms occur. Recommendations are dynamic and will be adapted as more evidence emerges.
Contact investigations should use available information sources, including interviews, passenger manifests, seating arrangements and activity logs, to improve completeness of contact identification.
Early recognition of suspected cases, prompt isolation, and consistent adherence to recommended infection prevention and control measures remain essential to protect healthcare personnel, other passengers and crew members.
In healthcare settings:
When HPS is suspected, patients should be promptly transferred to an emergency department or intensive care unit for close monitoring and supportive management. Initial management should include supportive care with antipyretics and analgesics as needed. For confirmed hantavirus, antibiotics are not routinely indicated. However, before a definitive diagnosis is established (and bacterial infection is a diagnostic possibility), or if secondary bacterial infection is suspected, empiric broad-spectrum antibiotics may be appropriate. Clinical management relies primarily on careful fluid administration, hemodynamic monitoring, and respiratory support. Given the rapid progression of HPS, close monitoring and early transfer to ICU are critical for more severe cases. Mechanical ventilation, judicious fluid management, and vasopressors may be required. For severe cardiopulmonary insufficiency, extracorporeal membrane oxygenation may be lifesaving.[5] In severe cases of renal dysfunction, dialysis may be required.
Although ribavirin has shown efficacy against hantavirus haemorrhagic fever with renal syndrome, it has not demonstrated effectiveness for HPS and is not licensed for either treatment or prophylaxis of hantavirus pulmonary syndrome. At present, there is no specific antiviral treatment approved for HPS; a number of existing drugs have antiviral activity in laboratory studies but not yet demonstrated in human disease.
Public health awareness efforts should focus on improving early detection, ensuring timely treatment, and reducing exposure risks. Preventive measures should address occupational and ecotourism-related exposures, emphasize infection prevention and control measures, and include rodent control strategies. Most routine tourism activities carry little or no risk of exposure to rodents or their excreta.
Risk communication and community engagement (RCCE) interventions should prioritize transparent, timely, and culturally appropriate communication to raise awareness of hantavirus transmission risks. RCCE strategies should support coordinated, timely and aligned evidence-based information to ensure concerned people receive clear, consistent and actionable information, including explanations of the public health measures being implemented. RCCE activities should explicitly address public concerns regarding transmissibility, severity, and international travel, and clarify what actions are and are not necessary for different population groups. Operational measures should integrate RCCE activities throughout all phases of the event. The implementation of integrated environmental management strategies aimed at reducing rodent populations is also recommended.
At this time, WHO does not recommend any changes to routine activities for the general public. People who were on board the affected ship, or who have had close contact with a confirmed case, should follow the specific monitoring and public health advice outlined above. Guidance may be updated as further evidence becomes available.
Based on the current information available on this event, WHO advises against the application of any travel or trade restrictions beyond the restriction of movement of identified high-risk contacts.
*Standard precautions refer to a set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. These practices aim to protect both healthcare professionals and patients and include hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of sharps materials, safe injection practices, use of sterile instruments and equipment and cleaning of hospital environments and the environment. Adapted from “Standard precautions for the prevention and control of infections: aide-memoire”- WHO, 2022. Available at https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1
","Assessment":"WHO currently assesses the public health risk for those who were onboard the cruise ship as moderate, and at the Global level as low for the following reasons:
For the general public, including people not exposed on board the ship or through close contact with a confirmed case, the overall probability of infection remains low. Current evidence indicates that transmission occurs through close and prolonged contact, and can be effectively limited through early detection, isolation of cases, and contact tracing.
More detailed epidemiological, clinical and laboratory investigations are required to inform further iterations of this risk assessment. ","Overview":"On 2 May 2026, WHO received notification from the IHR NFP of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom) regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard the Dutch-flagged cruise ship MV Hondius.
As of 13 May, a total of 11 cases (eight confirmed, one inconclusive and two probable cases), including three deaths (two confirmed and one probable), have been reported. Since the last Disease Outbreak News was published on 8 May, two additional confirmed cases and one inconclusive case have been reported among passengers. These are one confirmed case from France, who became symptomatic during repatriation, one confirmed case from Spain, tested upon arrival following repatriation but currently well and asymptomatic, and one case considered inconclusive. The latter was repatriated to the United States of America, is currently asymptomatic with inconclusive laboratory results (one positive and one negative result from two different laboratories), and is being retested. The individual was sampled due to high-risk exposure to confirmed cases on board. All laboratory-confirmed cases are confirmed for ANDV infection. All were passengers onboard the MV Hondius.
Figure 1. Epidemiological curve of Andes hantavirus cases (n = 11) reported to WHO as of 13 May 2026, 17:00.
![\"Hantavirus](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/hantavirus-outbreak-epi-curve.png?sfvrsn=1153a701_3\" "\\"Hantavirus")
Based on currently available information, the working hypothesis is that the first case acquired the infection prior to boarding the cruise, through exposure on land. Investigations are ongoing to elucidate the potential circumstances of exposure and the source of the outbreak, in collaboration with authorities in Argentina and Chile. Current evidence suggests subsequent human-to-human transmission onboard the ship. This is also supported by a preliminary analysis of the sequences, which show a close, near-identical sequenced from different cases.[1]
The outbreak is being managed through a coordinated international response, including in-depth epidemiological investigations, case isolation and clinical management, medical evacuations, laboratory testing and international contact tracing, quarantining and monitoring. Recommendations may be updated as additional epidemiological and laboratory evidence, including genetic sequencing data, becomes available.
Follow-up and contact tracing for all contacts of hantavirus cases linked to the cruise ship is ongoing. This includes passengers who disembarked in Saint Helena, United Kingdom, on 24 April; Praia, Cabo Verde, on 6 May; and Tenerife, Spain, on 10 and 11 May. Passengers who travelled on flights who may have had exposure to subsequently confirmed cases have been identified and contacted. Contacts are being monitored by local health authorities in their respective countries.
On 10 May, the ship arrived in the Canary Islands, Spain, where disembarkation began. Passengers and most of the crew were repatriated from the Canary Islands to their respective residence countries or transit points via specially arranged non-commercial flights, with WHO and partners supporting the disembarkation process. The ship left the Canary Islands on 11 May and is sailing to the Netherlands, with 25 crew members remaining on board, along with two Dutch health and care workers to conduct their health monitoring and provide any healthcare that may be necessary. ","DonId":"2026-DON601","Provider":"dynamicProvider372"},{"Id":"f6d5a10e-d6a4-4156-a203-4845ea2f878a","LastModified":"2026-05-10T10:26:21Z","PublicationDate":"2026-05-08T21:31:10Z","DateCreated":"2026-05-08T21:31:11Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON600","ItemDefaultUrl":"/2026-DON600","Response":"Authorities from States Parties involved in the management of the event to date – Argentina, Cabo Verde, Chile, Germany, the Netherlands, South Africa, Spain, Switzerland, and the United Kingdom – WHO, and partners have initiated coordinated response measures including:
[1] Complete sequence of Orthohantavirus andesense virus: Swiss resident 2026. https://virological.org/t/complete-sequence-of-orthohantavirus-andesense-virus-swiss-resident-2026/1023
[2] Pan American Health Organization / World Health Organization (PAHO/WHO). Epidemiological Alert Hantavirus Pulmonary Syndrome (HPS). https://www.paho.org/en/documents/epidemiological-alert-hantavirus-pulmonary-syndrome-americas-region-19-december-2025
[3] Hantavirus infection - Annual Epidemiological Report for 2023. https://www.ecdc.europa.eu/en/publications-data/hantavirus-infection-annual-epidemiological-report-2023
[4] WHO fact sheet. https://www.who.int/news-room/fact-sheets/detail/hantavirus
[5] Standard precautions for the prevention and control of infections: aide-memoire. https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1
Citable reference: World Health Organization (8 May 2026). Disease Outbreak\r\nNews. Hantavirus cluster linked to cruise ship travel, Multi-country. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON600
Corrigendum: The Disease Outbreak News was revised on 9 May 2026 to enhance clarity on potential exposure, advice for low-risk contacts, respiratory etiquette,and note additional information sharing by NFPs.
","Summary":"On 2 May 2026, a cluster of passengers with severe respiratory illness aboard a cruise ship was reported to the World Health Organization (WHO). At that time, according to the ship operator, 147 passengers and crew were onboard, and 34 passengers and crew had previously disembarked. Since the last Disease Outbreak News published on 4 May, three of the suspected cases were confirmed, and one additional confirmed case was reported. As of 8 May, a total of eight cases, including three deaths (case fatality ratio 38%), have been reported. Six cases have been laboratory-confirmed as hantavirus infections, with all identified as Andes virus (ANDV). Through the International Health Regulations (2005) (IHR) channel, National IHR Focal Points (NFPs) have all been informed and are supporting international contact tracing. WHO assesses the risk to the global population posed by this event as low and will continue to monitor the epidemiological situation and update the risk assessment. The risk for passengers and crew on the ship is considered moderate.","PublicationDateAndTime":"2026-05-08T18:00:00Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Hantavirus cluster linked to cruise ship travel, Multi-country","Epidemiology":"Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a zoonotic, viral respiratory disease caused by hantaviruses of the genus Orthohantavirus, family Hantaviridae, order Bunyavirales. More than 20 viral species have been identified within this genus. In the Americas, Sin Nombre virus is the predominant cause of HPS in North America, while Orthohantavirus andesense is responsible for most cases in South America.
Hantaviruses found in Europe and Asia are known to cause haemorrhagic fever with renal syndrome (HFRS), which primarily affects the kidneys and blood vessels. Human-to-human transmission has not been documented in this part of the world.
Human Hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of infected rodents or by touching contaminated surfaces. Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present, and opportunities for exposure are greater. HPS is characterized by headache, dizziness, chills, fever, myalgia, and gastrointestinal symptoms, such as nausea, vomiting, diarrhoea, and abdominal pain, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from 1-6 weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure.
Hantavirus infections are relatively uncommon globally. In 2025, in the Region of the Americas, eight countries reported 229 cases and 59 deaths with a CFR of 25.7%.[2] In the European Region, 1885 hantavirus infections were reported in 2023 (0.4 per 100 000), marking the lowest rate observed between 2019 and 2023.[3] In East Asia, particularly China and the Republic of Korea, hantavirus haemorrhagic fever with renal syndrome (HFRS) continues to account for many thousands of cases annually, although incidence has declined in recent decades.
Hantavirus infections are associated with a case fatality rate of <1–15% in Asia and Europe and up to 50% in the Americas. While there are no licensed treatment nor vaccines for hantavirus infections, early supportive care and immediate referral to a facility with a complete ICU can improve survival.
Environmental and ecological factors affecting rodent populations can influence disease trends seasonally. Since hantavirus reservoirs are sylvatic rodents, transmission can occur when people come into contact with rodent habitats.
Although uncommon, limited human\u2011to\u2011human transmission of HPS due to Andes virus has been reported in community settings involving close and prolonged contact. Secondary infections among healthcare workers have been previously documented in healthcare facilities, though remain rare. Secondary transmission appears most likely during the early phase of illness, when the virus is more transmissible.[4] Currently, little evidence is available due to the scarcity of hantavirus outbreak related to human-to-human transmission.
","OverrideTitle":"Hantavirus cluster linked to cruise ship travel, Multi-country","Advice":"WHO advises that States Parties involved in this event continue public health coordination and management efforts on board conveyances and in countries where cases and/or contacts are present or will be returning to.
This includes contact tracing and monitoring detection, investigation, reporting of suspected cases, laboratory testing of suspected cases, case management, infection prevention and control measures, and clear and transparent communication to affected individuals and the general public.
In the context of the current outbreak, people on board the affected ship and flights should practice frequent hand hygiene, monitor any early symptoms, including headache, dizziness, chills, fever, myalgia, and gastrointestinal problems, such as nausea, vomiting, diarrhoea, and abdominal pain, for 42 days after last potential exposure. Should any early symptoms or sudden onset of respiratory distress occur, people should immediately inform health authorities and self-isolate until medical evaluation is conducted. If respiratory symptoms are present, people should practice respiratory etiquette and wear a respirator.
A precautionary approach should be applied to contact identification, classification, tracing and follow-up, particularly for persons exposed on board of the ship or during travel. Contacts should be classified according to exposure risk, considering the intensity and duration of exposure, proximity to the case, exposure to enclosed or shared spaces, and use of personal protective equipment.
High-risk contacts may include cabin mates, intimate partners, persons with prolonged close indoor exposure, healthcare workers with unprotected exposure, and individuals handling contaminated materials or body fluids without appropriate personal protective equipment.
Given the documented transmission of ADNV in past outbreaks stemmed from close, prolonged contact, that infectiousness peaks in the early phase of illness, and that pre-symptomatic transmission cannot be entirely ruled out, as a precautionary principle, WHO recommends for active monitoring and home or facility quarantine of high-risk contacts for 42 days following last exposure. Current evidence does not support routine laboratory testing of contacts for outbreak control (or public health response) or the quarantine of low-risk contacts; low-risk contacts should undertake passive self-monitoring and seek medical evaluation if symptoms occur. Recommendations are dynamic and will be adapted as more evidence emerges.
Contact investigations should use available information sources, including interviews, passenger manifests, seating arrangements and activity logs, to improve completeness of contact identification.
Early recognition of suspected cases, prompt isolation, and consistent adherence to recommended infection prevention and control measures remain essential to protect healthcare personnel, other passengers and crew members.
In healthcare environments, standard precautions* should be applied for all patients, including hand hygiene, environmental cleaning and waste management. In addition to standard precautions, transmission-based precautions should be implemented for management of suspect or confirmed cases. For aerosol-generating procedures, airborne precautions should be used. [5]
When HPS is suspected, patients should be promptly transferred to an emergency department or intensive care unit for close monitoring and supportive management.
Initial management should include supportive care with antipyretics and analgesics as needed. For confirmed hantavirus, antibiotics are not routinely indicated. However, before a definitive diagnosis is established (and bacterial infection is a diagnostic possibility), or if superadded bacterial infection is suspected, empiric broad-spectrum antibiotics may be appropriate. Clinical management relies primarily on careful fluid administration, hemodynamic monitoring, and respiratory support. Given the rapid progression of HCPS, close monitoring and early transfer to ICU are critical for more severe cases. Mechanical ventilation, meticulous volume control, and vasopressors may be required. For severe cardiopulmonary insufficiency, extracorporeal mechanical oxygenation may be lifesaving. In severe cases of renal dysfunction, dialysis may be required.
Although ribavirin has shown efficacy against hantavirus haemorrhagic fever with renal syndrome, it has not demonstrated effectiveness for HCPS and is not licensed for either treatment or prophylaxis of hantavirus pulmonary syndrome. At present, there is no specific antiviral treatment approved for HCPS; a number of existing drugs have antiviral activity in laboratory studies but not yet demonstrated in human disease.
Public health awareness efforts should focus on improving early detection, ensuring timely treatment, and reducing exposure risks. Preventive measures should address occupational and ecotourism-related exposures, emphasize infection prevention and control measures, and include rodent control strategies. Most routine tourism activities carry little or no risk of exposure to rodents or their excreta.
Risk communication and community engagement (RCCE) interventions should prioritize transparent, timely, and culturally appropriate communications to raise awareness of hantavirus transmission risks—particularly. RCCE strategies should support coordinated, timely and aligned evidence based information to ensure concerned people receive clear, consistent and actionable information and explanations of the public health measures. Operational measures should integrate RCCE activities through the whole event. The implementation of integrated environmental management strategies aimed at reducing rodent populations is also recommended.
*Standard precautions refer to a set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. These practices aim to protect both healthcare professionals and patients and include hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of sharps materials, safe injection practices, use of sterile instruments and equipment and cleaning of hospital environments and the environment. Adapted from “Standard precautions for the prevention and control of infections: aide-memoire”- WHO, 2022. Available at https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1
WHO advises against the application of any travel or trade restrictions based on the current information available on this event.
","Assessment":"WHO currently assesses the public health risk related to the cruise ship as moderate, and at the Global level as low for the following reasons:
More detailed epidemiological, clinical and laboratory investigations are required to inform further iterations of this risk assessment.
","Overview":"On 2 May 2026, WHO received notification from the National IHR Focal Point of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom) regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard a Dutch-flagged cruise ship.
Since the last Disease Outbreak News was published on 4 May, three of the suspected cases were confirmed, and one additional confirmed case was reported. As of 8 May, a total of eight cases (six confirmed and two probable cases), including three deaths (two confirmed and one probable), case fatality ratio 38%, have been reported. All six laboratory-confirmed cases were identified as Andes virus through virus specific polymerase chain reaction (PCR) or sequencing.
Two medical evacuation flights, from Cabo Verde, carrying two symptomatic confirmed patients and one previously suspected case landed in the Netherlands on 6 and 7 May. As of 8 May, four patients are currently hospitalised, one in intensive care in Johannesburg, South Africa, two in different hospitals in the Netherlands and the other in Zurich, Switzerland. The previously suspected case was transferred directly to Germany, where she was tested, and both PCR and serology tests were negative for Andes virus, she is therefore no longer considered to be a case.
Contact tracing of passengers who disembarked in St Helena is ongoing; passengers have been contacted and advised to self-monitor for symptoms. Additionally, passengers who travelled on the same flight from St Helena to South Africa with one of the cases who was subsequently confirmed, have been contacted.
On 6 May, the ship left Cabo Verde, heading to the Canary Islands, Spain where disembarkation is planned.
Further investigations into the potential exposure of the first case and the source of the outbreak are ongoing in collaboration with authorities in Argentina and Chile. The outbreak is being managed through a coordinated international response, including in-depth epidemiological investigations, case isolation and clinical management, medical evacuations, laboratory testing and international contact tracing and monitoring.
Summary of confirmed and probable cases:
Case 1: An adult male who boarded the ship on 1 April, after more than three months of travel in Argentina, Chile, and Uruguay. Developed symptoms on 6 April and died onboard on 11 April. No microbiological tests were performed. He is considered a probable case.
Case 2: An adult female, who was a close contact of case 1, who travelled and boarded the ship with him, went ashore at Saint Helena on 24 April with gastrointestinal symptoms. She subsequently deteriorated on a flight to Johannesburg, South Africa, on 25 April. She died on 26 April in a Johannesburg clinic. On 4 May, she was subsequently confirmed by PCR testing with hantavirus infection.
Case 3: An adult male who developed symptoms on 24 April. He was disembarked and medically evacuated from Ascension Island on 27 April and is currently hospitalised in an Intensive Care Unit (ICU) in Johannesburg, South Africa. PCR testing confirmed hantavirus infection on 2 May, and Andes virus was confirmed through sequencing.
Case 4: An adult female, with onset of symptoms (fever and general malaise) on 28 April, later presenting with pneumonia, died on 2 May. A post-mortem sample was collected and sent to the Netherlands with the evacuated patients, where it was confirmed to be Andes virus.
Case 5: An adult male, working as the ship doctor, reported onset of symptoms on 30 April, including fever, fatigue, muscle pain, and mild respiratory symptoms. His samples confirmed PCR positivity for Andes virus on 6 May. The case was medically evacuated to the Netherlands on 6 May and is currently stable in isolation.
Case 6: An adult male, working as a ship guide. Onset of symptoms was reported on 27 April with mild respiratory and gastrointestinal symptoms. Laboratory samples confirmed PCR positivity for Andes virus on 6 May. The case was medically evacuated to the Netherlands on 7 May and is currently stable in isolation.
Case 7: An adult male, who disembarked in St Helena on 22 April and flew back to Switzerland on 27-28 April, through South Africa and Qatar. He started experiencing symptoms on 1 May after arrival in Switzerland, where he immediately self-isolated and reported to local public health authorities. He is currently hospitalised and in isolation in Switzerland. His samples confirmed PCR positivity for Andes virus on 5 May.[1]
Case 8: An adult male, who disembarked in Tristan da Cunha on 14 April. Onset of symptoms was reported on 28 April with diarrhoea and two days later with fever. He is currently stable and in isolation. He is currently a probable case until laboratory confirmation.
One case previously reported as suspected has now been reclassified as a non-case after testing negative for Andes virus through PCR and serology. Nevetheless, monitoring continues until the end of their incubation period from last exposure.
Table 1. Distribution of reported Andes hantavirus cases by case status and outcome, as of 8 May 2026
![\"Hantavirus_table\"](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/hantavirus_table.png?sfvrsn=18c15f9_3\" "\\"Hantavirus_table\\"")
Operational outbreak case definitions
Suspected case: anyone who shared or visited a conveyance where there has been a confirmed or probable ANDV case AND with acute (or history of) symptoms compatible with ANDV infection, including fever (38°C or above), myalgia, chills, acute gastrointestinal (e.g. nausea, vomiting, diarrhoea, abdominal pain) or acute respiratory (e.g. cough, shortness of breath, chest pain, difficulty breathing) symptoms.
Probable case: a person with signs and symptoms of a suspected case that has been evaluated by a health professional AND a known epidemiological link with a confirmed or probable ANDV case AND for which laboratory tests have not been conducted.
Confirmed case: a person with laboratory confirmation of ANDV through RT-PCR or serology testing.
Non-case*: a suspected or probable case who tests negative for ANDV by RT-PCR or serology.
*Non-cases who develop symptoms compatible with the suspected case definition after a negative test and within the maximum incubation period after last exposure to a probable or confirmed case should be retested and reclassified as appropriate.
Figure 1. Epidemiological curve of Andes hantavirus cases reported to WHO as of 8 May 2026, 17:00.
![\"Hantavirus](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/hantavirus_epi-curve-2026.png?sfvrsn=c7b50055_4\" "\\"Hantavirus_Epi")
Based on currently available information, the working hypothesis is that case 1 most probably acquired the infection prior to boarding through environmental exposure during activities he conducted in Argentina. Investigations are ongoing to assess the full itinerary of his activities and possible exposure factors. Current evidence points to subsequent human-to-human transmission onboard (Figure 1), given documented epidemiological links of some of the subsequent cases with case 1 during his illness, and the timing of their symptom onset, which clusters around the most likely incubation periods previously documented for ANDV. However, ongoing epidemiological and sequencing investigations will help better understand the epidemiological links between cases and their most likely exposure.
","DonId":"2026-DON600","Provider":"dynamicProvider372"},{"Id":"daf6528b-00a6-41f6-9b3c-7122cc3f6cac","LastModified":"2026-05-05T18:30:34Z","PublicationDate":"2026-05-04T21:48:22Z","DateCreated":"2026-05-04T21:48:23Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON599","ItemDefaultUrl":"/2026-DON599","Response":"Authorities from States Parties involved in the management of the event to date – Cabo Verde, the Netherlands, Spain, South Africa and the United Kingdom - have initiated coordinated response measures including:
[1] Pan American Health Organization / World Health Organization (PAHO/WHO). Epidemiological Alert Hantavirus Pulmonary Syndrome (HPS). https://www.paho.org/en/documents/epidemiological-alert-hantavirus-pulmonary-syndrome-americas-region-19-december-2025
[2] Hantavirus infection - Annual Epidemiological Report for 2023. https://www.ecdc.europa.eu/en/publications-data/hantavirus-infection-annual-epidemiological-report-2023
[3] Standard precautions for the prevention and control of infections: aide-memoire. https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1
Citable reference: World Health Organization (4 May 2026). Disease Outbreak News. Hantavirus cluster linked to cruise ship travel- Multi-country. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON599
Corrigendum: The Disease Outbreak News was updated on 5 May 2026 to include an additional statement to enhance clarity on infection prevention and control (IPC) measures.
WHO advises that States Parties involved in this event continue efforts in detection, investigation, reporting, case management, infection control, and public health management on board, including ship sanitation measures, in close coordination with the conveyance operator, to prevent and control infections caused by hantaviruses.
In the context of the current outbreak, passengers and crew members should practice frequent hand hygiene, remain vigilant of Hantavirus symptoms and undertake active symptom monitoring for 45 days. Crew must ensure adequate environmental cleaning (avoiding dry sweeping) and ventilation in the ship. Passengers and crew members experiencing symptoms should inform medical professionals on board and self-isolate. If respiratory symptoms are present to practice respiratory etiquette and wear a medical mask.
Vigilance among travellers, crew, including those involved in implementing ship sanitation measures, or other personnel returning from areas where hantavirus is known to be present, as well as on conveyances engaged in eco-tourism on a journey from and through those areas, is essential.
Early recognition of suspected cases, prompt isolation, and consistent adherence to recommended infection prevention and control measures remain essential to protect healthcare personnel.
Diagnosis of HPS is with serologic testing for IgM or rising titres of IgG antibodies using enzyme-linked immunoassay (ELISA) or with reverse transcriptase polymerase chain reaction (RT–PCR) to detect viral RNA.
In healthcare environments, standard precautions* should be applied for all patients, including hand hygiene, environmental cleaning and safe handling of blood and body fluids. In addition to standard precautions, transmission-based precautions should be implemented for management of suspect or confirmed cases. Standard precautions combined with transmission-based precautions during close contact are considered sufficient. For aerosol-generating procedures, airborne precautions should be used. [3]
When HPS is suspected, patients should be promptly transferred to an emergency department or intensive care unit for close monitoring and supportive management.
Initial management should include supportive care with antipyretics and analgesics as needed. For confirmed hantavirus, antibiotics are not routinely indicated. However, before a definitive diagnosis is established (and bacterial infection is a diagnostic possibility), or if superadded bacterial infection is suspected, empiric broad-spectrum antibiotics may be appropriate. Clinical management relies primarily on careful fluid administration, hemodynamic monitoring, and respiratory support. Given the rapid progression of HCPS, close monitoring and early transfer to ICU are critical for more severe cases. Mechanical ventilation, meticulous volume control, and vasopressors may be required. For severe cardiopulmonary insufficiency, extracorporeal mechanical oxygenation may be lifesaving. In severe cases of renal dysfunction, dialysis may be required.
Although ribavirin has shown efficacy against hantavirus haemorrhagic fever with renal syndrome, it has not demonstrated effectiveness for HCPS and is not licensed for either treatment or prophylaxis of hantavirus pulmonary syndrome. At present, there is no specific antiviral treatment approved for HCPS.
Public health awareness efforts should focus on improving early detection, ensuring timely treatment, and reducing exposure risks. Preventive measures should address occupational and ecotourism-related exposures, emphasize standard and transmission-based infection prevention and control practices, and include rodent control strategies. Most routine tourism activities carry little or no risk of exposure to rodents or their excreta.
The potential for human-to-human transmission should be considered in areas where Andes and potentially other South American hantaviruses are endemic.
Individuals engaging in outdoor activities where endemic transmission is known, such as visiting rural areas, camping or hiking, should take precautions to minimise potential exposure to infectious materials.
Risk communication and community engagement interventions should prioritize transparent, timely, and culturally appropriate communication to raise awareness of hantavirus transmission risks—particularly exposure to rodent excreta in endemic areas—and promote practical preventive behaviours such as safe food storage, avoiding contact with rodents, wet-cleaning methods (no dry sweeping), and proper ventilation. Community engagement strategies should involve local leaders and workers in high-risk occupations to co-develop and disseminate tailored messages, address misinformation, and reinforce early care seeking.
Surveillance for HPS should be integrated into a comprehensive national surveillance system and include clinical, laboratory, and environmental components. The implementation of integrated environmental management strategies aimed at reducing rodent populations is also recommended.
*Standard precautions refer to a set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. These practices aim to protect both healthcare professionals and patients and include hand hygiene, use of personal protective equipment, respiratory hygiene and cough etiquette, safe handling of sharps materials, safe injection practices, use of sterile instruments and equipment and cleaning of hospital environments and the environment. Adapted from “Standard precautions for the prevention and control of infections: aide-memoire”- WHO, 2022. Available at https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.1
WHO advises against the application of any travel or trade restrictions based on the current information available on this event.
","Assessment":"Hantavirus cardiopulmonary syndrome (HCPS), also known as hantavirus pulmonary syndrome (HPS), is a zoonotic, viral respiratory disease caused by hantaviruses of the genus Orthohantavirus, family Hantaviridae, order Bunyavirales. More than 20 viral species have been identified within this genus. In the Americas, Sin Nombre virus is the predominant cause of HPS in North America, while Orthohantavirus andesense is responsible for most cases in South America.
Human Hantavirus infection is primarily acquired through contact with the urine, faeces, or saliva of infected rodents or by touching contaminated surfaces. Exposure typically occurs during activities such as cleaning buildings with rodent infestations, though it may also occur during routine activities in heavily infested areas. Human cases are most commonly reported in rural settings, such as forests, fields, and farms, where rodents are present, and opportunities for exposure are greater. HPS is characterized by headache, dizziness, chills, fever, myalgia, and gastrointestinal problems, such as nausea, vomiting, diarrhoea, and abdominal pain, followed by sudden onset of respiratory distress and hypotension. Symptoms of HPS typically occur from 2-4 weeks after initial exposure to the virus. However, symptoms may appear as early as one week and as late as eight weeks following exposure.
Hantavirus infections are relatively uncommon globally. In 2025 (as of epidemiological week 47), in the Region of the Americas, eight countries reported 229 cases and 59 deaths with a CFR of 25.7%. [1] In the European Region, 1885 hantavirus infection reported in 2023 (0.4 per 100,000), marking the lowest rate observed between 2019 and 2023.[2] In East Asia, particularly China and the Republic of Korea, Hantavirus haemorrhagic fever with renal syndrome (HFRS) continues to account for many thousands of cases annually, although incidence has declined in recent decades.
Hantavirus infections are associated with a case fatality rate of <1–15% in Asia and Europe and up to 50% in the Americas. While there are no specific treatment nor vaccines for hantavirus infections, early supportive care and immediate referral to a facility with a complete ICU can improve survival.
Environmental and ecological factors affecting rodent populations can influence disease trends seasonally. Since hantavirus reservoirs are sylvatic rodents, transmission can occur when people come into contact with rodent habitats.
Although uncommon, limited human\u2011to\u2011human transmission of HPS due to Andes virus has been reported in community settings involving close and prolonged contact. Secondary infections among healthcare workers have been previously documented in healthcare facilities, though remain rare.
WHO currently assesses the risk to the global population from this event as low and will continue to monitor the epidemiological situation and update the risk assessment as more information becomes available.
","Overview":"On 2 May 2026, WHO received notification from the National International Health Regulations (2005) (IHR) Focal Point of the United Kingdom of Great Britain and Northern Ireland (hereafter referred to as the United Kingdom) regarding a cluster of severe acute respiratory illness, including two deaths and one critically ill passenger, aboard a Dutch-flagged cruise ship. On 2 May 2026, laboratory testing conducted in South Africa confirmed hantavirus infection in one patient who is critically ill and in intensive care. On 3 May, one additional death was reported. A further three suspected cases remain on board. As of 4 May, a total of seven (two confirmed and five suspected) cases, including three deaths, have been reported.
The vessel departed Ushuaia, Argentina, on 1 April 2026 and followed an itinerary across the South Atlantic, with multiple stops in remote and ecologically diverse regions, including mainland Antarctica, South Georgia, Nightingale Island, Tristan da Cunha, Saint Helena, and Ascension Island. The extent of passenger contact with local wildlife during the voyage, or prior to boarding in Ushuaia remains undetermined. The vessel carries a total of 147 individuals, including 88 passengers and 59 crew members. Onboard passengers and crew represent 23 nationalities. As of 4 May 2026, the vessel is moored off the coast of Cabo Verde.
Summary of cases:
Case 1: An adult male developed symptoms of fever, headache, and mild diarrhoea on 6 April 2026 while on board the ship. By 11 April, the case developed respiratory distress and died on board on the same day. No microbiological tests were performed. The body of the passenger was removed from the vessel to Saint Helena (a British Overseas Territory) on 24 April.
Case 2: An adult female, who was a close contact of case 1, went ashore at Saint Helena on 24 April 2026 with gastrointestinal symptoms. She subsequently deteriorated during a flight to Johannesburg, South Africa, on 25 April. She later died upon arrival at the emergency department on 26 April. On 4 May, the case was subsequently confirmed by PCR with hantavirus infection. Contact tracing for passengers on the flight has been initiated.
Cases 1 and 2, had travelled in South America, including Argentina, before they boarded the cruise ship on 1 April 2026.
Case 3: An adult male presented to the ship's doctor on 24 April 2026 with febrile illness, shortness of breath and signs of pneumonia. On 26 April, his condition worsened. He was medically evacuated from Ascension to South Africa on 27 April, where he is currently hospitalised in an Intensive Care Unit (ICU). Laboratory testing on an extensive respiratory pathogen panel was negative; however, polymerase chain reaction (PCR) testing confirmed hantavirus infection on 2 May 2026. Serology, sequencing and metagenomics are ongoing.
Case 4: An adult female, with presentation of pneumonia, died on 2 May 2026. The onset of symptoms was on 28 April, with fever and a general feeling of being unwell.
Three suspected cases have reported high fever and/or gastrointestinal symptoms and remain on board. Medical teams in Cabo Verde are evaluating the patients and collecting additional specimens for testing.","DonId":"2026-DON599","Provider":"dynamicProvider372"},{"Id":"a0884e79-da88-4907-ae66-c73b4b4a7636","LastModified":"2026-04-23T13:14:43Z","PublicationDate":"2026-04-23T13:14:13Z","DateCreated":"2026-04-23T13:14:43Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON598","ItemDefaultUrl":"/2026-DON598","Response":"A nationwide measles-rubella (MR) vaccination campaign was approved by the National Immunization Technical Advisory Group (NITAG) on 30 March 2026, targeting children aged 6–59 months (with expanded coverage for 6–8 months), and started on 5 April in 30 upazilas (sub-districts) of 18 priority districts. A nationwide campaign commenced on 20 April.
Vitamin A campaign was held throughout the country on 15 March 2025. During this outbreak response, Vitamin A supplementation is provided to all suspected and confirmed measles cases as an essential component of standard treatment and case management.
District Rapid Response Teams (RRTs) have been activated, and vaccine procurement fast-tracked by the Ministry of Health. Other outbreak response actions include strengthening routine immunization to prevent further spread of the outbreak, enhancing hospital preparedness, ensuring availability of vitamin A, strengthening isolation capacity, and reinforcing infection prevention and control measures.
Strengthening nationwide surveillance and epidemiological analysis, is also ongoing including measures to improve case detection and reporting. Trainings are being conducted at health facilities to improve case detection and reporting, and weekly situation reports produced to support evidence-based decision-making.
National and divisional guidelines have been issued to guide response activities, including vaccination, clinical management, infection prevention and control, patient care pathways, and procurement.
","FurtherInformation":"Citable reference: World Health Organization (23 April 2026). Disease Outbreak News: Measles in Bangladesh. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON598
","Summary":"On 4 April 2026, the National International Health Regulations (IHR) Focal Point for Bangladesh notified WHO of a nationwide increase in measles cases, geographically affecting 58 out of 64 districts across all eight divisions in Bangladesh. A total of 19 161 suspected measles cases and 2897 laboratory-confirmed measles cases have been reported between 15 March and 14 April 2026, including 166 measles related deaths (CFR 0.9%). The majority (79%) of the reported cases are children aged under 5 years. A targeted measles-rubella (MR) vaccination campaign started on 5 April, and various outbreak response measures are ongoing including strengthening nationwide surveillance and epidemiological analysis to enhance case detection and reporting. Based on currently available information, WHO assesses the risk at the national level as high due to ongoing transmission across multiple divisions, the large number of susceptible children, documented immunity gaps, and the occurrence of suspected measles-related deaths.","PublicationDateAndTime":"2026-04-23T12:58:07Z","TitleSuffix":"","UseOverrideTitle":false,"Title":"Measles - Bangladesh","Epidemiology":"Measles is a highly contagious acute viral disease which affects individuals of all ages and remains one of the leading causes of death among young children globally. The mode of transmission is airborne or via droplets from the nose, mouth, or throat of infected persons.
Initial symptoms, which usually appear 10-14 days (range 7-23 days) after infection, include high fever, usually accompanied by a runny nose, bloodshot eyes, cough and tiny white spots inside the mouth. The rash usually appears 10-14 days after exposure and spreads from the head to the trunk to the lower extremities. A person is infectious from four days before up to four days after the appearance of the rash. There is no specific antiviral treatment for measles, and most people recover within 2-3 weeks.
Measles is usually a mild or moderately severe disease. However, measles can lead to complications such as pneumonia, diarrhoea, secondary ear infection, inflammation of the brain (encephalitis), blindness, and death. Postinfectious encephalitis can occur in about one in every 1000 reported cases. About two or three deaths may occur for every 1000 reported cases.
Vaccination with measles containing vaccine is safe and effective, providing protection against measles and its complications for all eligible populations. WHO recommends two doses of Measles Containing Vaccine (MCV) to be provided through the routine immunization schedule. Strong routine immunization systems are therefore critical foundations for achieving and sustaining high levels of population immunity to vaccine preventable diseases such as measles.
WHO further recommends the conduct of Supplementary Immunization Activities (SIAs) or mass immunization campaigns as an effective strategy for delivering vaccination to children who may have been missed by routine services. In protecting vulnerable populations against measles, mass vaccination campaigns can rapidly improve population immunity by reducing the number of susceptible individuals in the population.
WHO recommends maintaining sustained homogeneous coverage of at least 95% with the first and second doses of the MCV vaccine in all municipalities and strengthening integrated epidemiological surveillance of measles and rubella to achieve timely detection of all suspected cases in public, private, and social security healthcare facilities.
WHO recommends strengthening epidemiological surveillance in high-traffic border areas to rapidly detect and respond to highly suspected measles cases. Providing a rapid response to imported measles cases to avoid the re-establishment of endemic transmission through the activation of rapid response teams trained for this purpose and by implementing national rapid response protocols when there are imported cases. Once a rapid response team has been activated, continued coordination between the national, sub-national, and local levels must be ensured, with permanent and fluid communication channels between all levels. During outbreaks, it is recommended to establish adequate hospital case management to avoid nosocomial transmission, with appropriate referral of patients to isolation rooms (for any level of care) and avoiding contact with other patients in waiting rooms and/or other hospital rooms.
WHO recommends vaccination of at-risk populations (without proof of vaccination or immunity against measles and rubella), such as healthcare workers, persons working in tourism and transportation (hotels, airports, border crossings, mass transportation, and others), and international travelers. Implementing a plan to immunize migrant populations in high-traffic border areas, prioritizing those considered at-risk, including both migrants and residents, in these municipalities increases vaccination coverage to increase population immunity.
In all settings, consideration should be given to providing susceptible contacts with post-exposure prophylaxis (PEP), including a dose of MCV or normal human immunoglobulin (NHIG) (if available) for those at risk and in whom the vaccine is contraindicated. In well-resourced settings, MCV should be provided to susceptible contacts within 3 days. For contacts for whom vaccination is contraindicated or is not possible within 3 days post-exposure, consideration can be given to providing NHIG up to 6 days post-exposure. Infants, pregnant women, and the immunocompromised should be prioritized.
WHO recommends maintaining a stock of the MR and/or measles, mumps, rubella (MMR) vaccine, and syringes/supplies for control actions of imported cases. Facilitating access to vaccination services according to the national scheme to those from other countries or people from the same country who perform temporary activities in countries with ongoing outbreaks; displaced populations; indigenous populations, or other vulnerable populations.
WHO does not recommend any restriction on travel and trade based on the information available on the current outbreak.\u202f
Measles is a highly contagious viral disease that affects susceptible individuals of all ages and remains one of the leading causes of death among young children globally. Measles can cause serious illness in at-risk groups, including children under 5 years of age, those who are malnourished especially those with vitamin A deficiency and people with weakened immune systems. Measles complications include hearing loss, diarrhoea, pneumonia and blindness. Severe complications of measles include encephalitis, brain damage, and death.
The current outbreak in Bangladesh is occurring in the context of suboptimal population immunity. A substantial proportion of cases occurred among children who were either unvaccinated or had received only one dose of measles-containing vaccine. In addition, some children were infected before reaching the age of eligibility for vaccination at 9 months. Most cases (91%) occurred among children aged 1 to 14 years, indicating substantial immunity gaps in this age group.
Before this outbreak, Bangladesh had made substantial progress towards measles elimination. Reported coverage with the first dose of measles-containing vaccine increased considerably between 2000 (89% - WUENIC) and 2016 (118% - WUENIC), while coverage with the second dose also improved between its nationwide introduction in 2012 (22% - WUENIC) and 2024 (121% - WUENIC). During the same period, confirmed measles incidence declined sharply. However, recent declines in MR1 and MR2 coverage due to nationwide stockout of MR vaccine between 2024-2025, combined with routine immunization gaps and the absence of regular nationwide supplementary measles-rubella campaigns since 2020, have increased the number of susceptible children and contributed to the current outbreak.
The risk at the national level is assessed as high due to ongoing transmission across multiple divisions, the large number of susceptible children, documented immunity gaps, and the occurrence of suspected measles-related deaths. The concentration of cases among unvaccinated and under-vaccinated children including infants too young to be vaccinated, raises concern for continued uninterrupted transmission and severe disease outcomes.
Overall, the outbreak suggests a reversal from Bangladesh’s previous progress towards measles elimination and highlights increasing vulnerability to sustained transmission. Continued spread is likely unless urgent measures are implemented to strengthen surveillance, rapidly detect and respond to cases, and close immunity gaps through high-quality vaccination activities.
There are considerable risks of cross-border spread, facilitated by cross-border population movement, with major urban centres such as Dhaka, Chattogram, Sylhet, and Cox’s Bazar being important international travel and transit hubs increasing the likelihood of national and international spread, particularly among unvaccinated or inadequately vaccinated travelers.
Measles is endemic across the South-East Asia region. The risk is assessed as high at regional level.
Bangladesh shares extensive land borders with India and Myanmar, and population mobility across these borders may facilitate continued transmission. In Myanmar there is a considerable number of unvaccinated/zero dose children. With ongoing conflict and humanitarian crisis, surveillance and response capacities are limited. India, despite achieving high vaccination coverage, has reported a rise in case count over the past six months. Cities with high incidence such as Jashore and Chapainawabganj (an identified hotspot) share busy land crossings with India, thereby increasing the risk of introduction across the border. Despite Bangladesh’s progress towards measles elimination the current outbreak highlights the vulnerability of the population and underscores the fragility of immunization gains.
The risk at the global level is assessed as moderate due to high levels of population mobility, combined with ongoing widespread measles transmission and immunity gaps.
On 4 April 2026, the National IHR Focal Point of Bangladesh notified WHO of a significant increase in measles cases, driven by sustained domestic transmission. Since January 2026, Bangladesh has experienced a marked increase in measles cases. Geographically, cases have been reported across all eight divisions, in 58 out of 64 districts (91% of districts), indicating widespread transmission nationally.
Since 15 March 2026 and as of 14 April, a total of 19 161 suspected measles cases and 2973 laboratory-confirmed measles cases have been reported. Moreover, 166 suspected measles-related deaths (CFR 0.9%) and 30 confirmed measles-related deaths (CFR= 1.1%) have been recorded. A total of 12 318 hospital admissions and 9772 hospital discharges have also been reported.
The highest cumulative burden of suspected measles cases since 15 March 2026 has been reported in Dhaka (8263 cases), Rajshahi (3747 cases), Chattogram (2514 cases), and Khulna (1568 cases). In Dhaka, cases are concentrated in densely populated informal settlements, including Demra, Jatrabari, Kamrangirchar, Korail, Mirpur, and Tejgaon industrial and slum clusters. (HEOC, DGHS, 15 April 2026).
Children aged under 5 years account for the majority of reported cases (79%), including children aged under 2 years (66%) and infants aged under 9 months (33%). A total of 166 suspected deaths have been reported (CFR 1%), mainly among unvaccinated children aged under 2 years.
","DonId":"2026-DON598","Provider":"dynamicProvider372"},{"Id":"a4502f7e-b680-4414-ab38-bce40aa09246","LastModified":"2026-04-10T14:03:22Z","PublicationDate":"2026-04-10T14:03:01Z","DateCreated":"2026-04-10T14:03:22Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON597","ItemDefaultUrl":"/2026-DON597","Response":"Contact tracing procedures have been initiated, and relevant authorities in Italy, as well as internationally (National IHR Focal Point for Senegal, WHO, and European Centre for Disease Prevention and Control (ECDC)) have been informed through IHR channels. Once avian influenza was suspected, the response moved quickly from hospital-level management to regional laboratory confirmation and national coordination. Additionally, the regional surveillance system was notified, integrated within the One Health avian influenza reporting framework.
","FurtherInformation":"Animal influenza viruses normally circulate in animals but can also infect people. Infections in humans have primarily been acquired through direct contact with infected animals or through indirect contact with contaminated environments. Depending on the original host, influenza A viruses can be classified as avian influenza, swine influenza, or other types of animal influenza viruses.
Avian influenza virus infections in humans may cause diseases ranging from mild upper respiratory tract infection to more severe diseases and can be fatal. Conjunctivitis, gastrointestinal symptoms, encephalitis and encephalopathy have also been reported.
Laboratory tests are required to diagnose human infection with influenza. WHO periodically updates technical guidance protocols for the detection of zoonotic influenza using molecular methods.
Human infections with influenza A(H9) viruses have been reported from countries in Africa and Asia, where these viruses are also detected in poultry. The majority of cases of human avian influenza A(H9N2) infection have been reported from China. This is the first imported human case of avian Influenza A(H9N2) virus infection reported in the European Region.
This case does not change the current WHO recommendations on public health measures and surveillance of influenza.
The public should avoid contact with high-risk environments such as live animal markets/farms or surfaces that might be contaminated by poultry feces. Respiratory protection is highly recommended for those handling live or dead (including slaughtering) poultry in occupational or backyard-farming settings. Good hand hygiene, i.e. frequent washing of hands or the use of alcohol-based hand sanitizer is recommended. WHO does not recommend any specific additional measures for travelers.
Under Article 6 of the IHR, all human infections caused by a new subtype of influenza virus are notifiable. The case definition for notification of human influenza infection caused by a new subtype under the IHR is provided here. State Parties to the IHR are required to immediately notify WHO of any laboratory-confirmed case of a human infection caused by such an influenza A virus.
WHO advises against the application of any travel or trade restrictions based on the current information available on this event.
","Assessment":"Most reported human cases of A(H9N2) virus infection have been linked to exposure to infected poultry or contaminated environments, with the majority of cases experiencing mild clinical illness. Sporadic human cases following exposure to infected birds or contaminated environments can be expected since the virus remains enzootic in poultry populations. Avian influenza A(H9N2) viruses have been detected in poultry and environmental samples collected at live bird markets in Senegal and authorities in the country reported a human case of infection with an A(H9N2) virus in 2020.
Current epidemiological and virological evidence indicates that none of the characterized influenza A(H9N2) viruses thus far have acquired the ability for sustained transmission among humans. Thus, the likelihood of sustained human-to-human spread is low at this time. Infected individuals traveling internationally from affected areas may be identified in another country during or after arrival. However, if this were to occur, further community-level spread is considered unlikely. The risk assessment would be revisited if and when further epidemiological and virological information becomes available.
","Overview":"On 21 March 2026, the National IHR Focal Point for Italy notified WHO of the identification of a human case of avian influenza A(H9) in an adult male.
The patient had been in Senegal for more than six months and traveled to Italy in mid-March. Upon arrival, he visited the emergency department with a fever and a persistent cough.
On 16 March, a bronchoalveolar lavage specimen was collected, which showed a positive Mycobacterium tuberculosis result, as well as detection of un-subtypeable influenza A virus. The patient was placed in a negative-pressure isolation room with airborne precautions. He was treated with antitubercular medication and antiviral oseltamivir. By 9 April, his condition was stable and improving.
On 20 March, a regional reference laboratory identified the A(H9) subtype, and on 21 March, next-generation sequencing confirmed influenza A(H9N2). Initial genetic findings suggest the infection was likely acquired from an avian source linked to Senegal. Additional samples have been sent to Italy’s National Influenza Center, where further characterization confirmed virus subtype Influenza A(H9N2), with close genetic similarity to strains previously identified in poultry in Senegal.
No direct exposure to animals, wildlife or rural environments was identified. There was also no reported contact with symptomatic or confirmed human cases. Further epidemiological investigations on the source of exposure are ongoing.
Contacts identified in Senegal were asymptomatic. All identified and traced contacts in Italy have tested negative for influenza and completed the period of active monitoring for the onset of symptoms and the quarantine required by national guidelines. They also received oseltamivir as a preventive measure.
","DonId":"2026-DON597","Provider":"dynamicProvider372"},{"Id":"f76a3c74-7987-43d9-9072-cc1d9230a4cf","LastModified":"2026-03-13T16:05:23Z","PublicationDate":"2026-03-13T16:05:10Z","DateCreated":"2026-03-13T16:05:23Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON596","ItemDefaultUrl":"/2026-DON596","Response":"European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA). Multi-country foodborne event caused by cereulide in infant formula products. 19 February 2026. Available from: https://www.ecdc.europa.eu/en/publications-data/multi-country-foodborne-event-caused-cereulide-infant-formula-products
European Food Safety Authority (EFSA). EFSA provides rapid risk assessment on cereulide in infant formula. EFSA; 1 February 2026.
https://www.efsa.europa.eu/en/news/efsa-provides-rapid-risk-assessment-cereulide-infant-formula
European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 31 January–6 February 2026 (Week 6). ECDC; 12 February 2026.
European Food Safety Authority (EFSA). Precautionary global recall of infant nutrition products following detection of Bacillus cereus. EFSA; 27 January 2026.
European Centre for Disease Prevention and Control (ECDC). Precautionary global recall of infant nutrition products following detection of Bacillus cereus. ECDC; 27 January 2026.
European Centre for Disease Prevention and Control. European outbreak case definition: cereulide contamination of infant formula products (EpiPulse event 2025-FWD-00107). Stockholm: ECDC; 2026.
https://www.ecdc.europa.eu/sites/default/files/documents/Case%20definition%20cereulide%20event.pdf
World Health Organization. Strengthening surveillance of and response to foodborne diseases. WHO; 11 December 2025.
https://www.who.int/publications/i/item/9789240118188
Austrian Agency for Health and Food Safety (AGES). Update: Information on cereulide in infant formula. AGES; 1 February 2026.
https://www.ages.at/en/news/detail/update-information-zu-cereulid-in-saeuglingsnahrung
Citable reference: World Health Organization (13 March 2026). Disease Outbreak News; Recall of internationally distributed infant formula and products containing ARA oil due to contamination with cereulide toxin. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON596
Cereulide is a heat-stable toxin produced by certain strains of Bacillus cereus, a Gram-positive, spore-forming bacterium ubiquitous in soil, dust, and food production environments. The primary hazard in this event is suspected to have occurred during the production of ARA oils used in infant formula, although a root cause analysis has not yet been provided to WHO.
Cereulide is not contagious; illness occurs only when a person ingests the toxin, such as through consumption of contaminated products. The toxin withstands cooking temperatures (stable up to 121°C) and common pasteurization, persisting in finished products. Symptoms manifest rapidly, typically within 0.5–6 hours post-ingestion, and usually present as acute gastrointestinal symptoms (nausea, vomiting, abdominal pain) with risk of rapid dehydration and electrolyte imbalance which can be particularly severe in infants due to their physiological vulnerability and limited reserves. The toxin has a very low symptomatic dose threshold and remains fully active despite gastric conditions, contributing to its clinical potency. For babies who rely entirely on formula, repeated feedings can increase the amount of toxin consumed, and using contaminated formula for rehydration can worsen illness.
The absence of specific antidotes or targeted therapies places greater emphasis on supportive clinical care, effective risk communication to caregivers and health workers, and robust coordination between food safety and public health authorities. Where there is limited access to health care and where there may be delays in care seeking, rapid dehydration and electrolyte imbalance in infants may be fatal.
As of 25 February 2026, the following countries have notified suspected cases: Austria (9), Brazil (5), China, Hong Kong SAR, (1), Czechia (4), France (11), Italy (1), Singapore (3), Spain (41), and the United Kingdom of Great Britain and Northern Ireland (61). In other countries, including Denmark (32) and the Netherlands (221) the number of suspected cases is based on self-reporting and is therefore not comparable with the INFOSAN case definition. To date, Belgium is the only country with laboratory\u2011confirmed cases, reporting eight confirmed intoxications linked to the implicated products.
","OverrideTitle":"International food safety event: Infant formula and products containing arachidonic acid oil contaminated with cereulide toxin - Multi-country","Advice":"Based on the information available, WHO recommends Member States to maintain epidemiological surveillance, enhance readiness of laboratory capacity for cereulide testing of suspected contaminated products and in clinical samples of suspected cases, and facilitate effective implementation of recalls and withdrawals, as needed.
WHO advises Member States to:
WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.
","Assessment":"WHO assesses the overall public health risk associated with this event to be Moderate. This assessment is based on the information currently available and reflects the wide international distribution of contaminated products, ongoing uncertainties regarding the full extent of contaminated product distribution, case detection, and root cause of contamination, and the vulnerability of infants and young children to dehydration and electrolyte imbalance from with vomiting illness associated with cereulide toxin ingestion.
Several considerations contribute to this assessment:
The international spread of contaminated products has already disrupted trade and supply chains across at least 99 countries and territories, with the possibility of further recalls if additional affected batches or product categories are identified. These recalls, while essential for public health protection, have created a risk of localized shortage of infant formula, particularly in settings where reliance on specific products is high, despite manufacturers’ efforts to increase production of unaffected products. A residual risk of exposure persists while investigations and traceability efforts continue, as competent authorities manage evolving distribution information and update risk communication measures.
Mild clinical presentations can resemble common childhood illnesses, laboratory capacity for cereulide testing in contaminated products or human samples varies widely, and variations in case definitions across countries complicate consistent reporting and may delay detection.
Although limited numbers of suspected and confirmed cases have been reported to date, without continued investment in surveillance for toxin\u2011related events, strengthened laboratory networks, training of health\u2011care providers, and clear communication on recalls and safe alternatives, delays in detection and response could lead to preventable morbidity in infants.
","Overview":"Since 10 December 2025, and as of 25 February 2026, 99 countries and territories have been identified as having received batches of infant formula products subject to recall due to contamination with cereulide toxin. During this period, 144 suspected and confirmed cases were reported across 10 countries. The epidemiological investigations and product\u2011traceback activities remain ongoing in many countries.
The case definitions in use by the International Food Safety Authorities Network (INFOSAN) are currently:
Suspect case: A person presenting symptoms of cereulide intoxication with a history of consumption of the recalled product, without laboratory confirmation in a clinical sample.
Confirmed case: A person presenting symptoms of cereulide intoxication with a history of consumption of recalled product, with laboratory confirmation in a clinical sample.
Health authorities are actively searching for cases and conducting laboratory testing of human specimens and infant formula products. However, case definitions used may differ from those established by INFOSAN, such as those established by the European Centre for Disease Prevention and Control, creating challenges with comparability of reported case numbers.
Since this is not a routinely tested contaminant or condition, diagnostic challenges and limited surveillance capacity are hindering Member States’ ability to identify confirmed cases. One country has laboratory confirmed cases linked to the contaminated products (Belgium).
The limited case numbers appearing in multiple, geographically separated areas is consistent with sporadic exposures to contaminated products that were widely distributed.
\u200bPrecautionary recalls have been issued across all countries and territories where products were distributed. These measures aim to prevent further exposures, although the speed and completeness of product recall and withdrawal vary by location according to various factors including inspection and enforcement capacities.
","DonId":"2026-DON596","Provider":"dynamicProvider372"},{"Id":"52a263de-c5a6-4ba1-b710-dfb5fe46e025","LastModified":"2026-02-14T17:54:34Z","PublicationDate":"2026-02-14T14:07:30Z","DateCreated":"2026-02-14T14:07:30Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON595","ItemDefaultUrl":"/2026-DON595","Response":"WHO Response:
WHO maintains global mpox surveillance and continues to provide response guidance and support for all countries, including access to diagnostics and vaccines through multi-partner coordination including through the Access and Allocation Mechanism for mpox. WHO and partners are establishing the longer-term International Coordinating Group for mpox vaccine provision (ICG) to further accelerate timely outbreak response and ensure sustainable support for the future. Furthermore, WHO continues to evaluate available rapid diagnostic tests for field use.
Response measures in the United Kingdom:
The United Kingdom Health Security Agency (UKHSA) continues to work closely with the National Health Service England, public health agencies in Scotland, Wales and Northern Ireland, and is monitoring the situation in the United Kingdom and undertaking public health actions in accordance with the Mpox control: UK strategy 2025 to 2026 .
Public health information was made available to health care providers and the public. Contact tracing was completed in line with national guidance. Contacts were given appropriate health advice, offered vaccination, and monitored for symptoms.
All suspected mpox cases in the UK are tested using Orthopoxvirus-generic, MPXV-generic, and MPXV-specific PCR as primary testing, with clade differentiation assays performed on any positive samples. All samples identified as clade Ib, and selected samples identified as clade IIb cases undergo whole genome sequencing through Illumina-based workflows.
Response measures in India:
Public health measures, including contact tracing and monitoring, were implemented to prevent onward transmission. No secondary case was detected.
All suspected mpox cases in India are tested using Orthopoxvirus\u2011generic and MPXV\u2011specific PCR with clade differentiation assays. Positive cases undergo whole genome sequencing through Illumina\u2011based workflows.
","FurtherInformation":"Citable reference: World Health Organization (14 February 2026). Disease Outbreak News; Mpox: recombinant virus with genomic elements of clades Ib and IIb – Global. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON595
","Summary":"Recombination of monkeypox virus (MPXV) strains has been documented in recent months, with two cases of a recombinant strain comprising clade Ib and IIb MPXV reported. Recombination is a known natural process that can occur when two related viruses infecting the same individual exchange genetic material, producing a new virus. \r\nThe first case was detected in the United Kingdom of Great Britain and Northern Ireland (hereafter \u201cUnited Kingdom\u201d), with travel history to a country in South-East Asia, and the second in India, with travel history to a country in the Arabian Peninsula. Detailed analysis of the virus genomes shows that the two individuals fell ill several weeks apart with the same recombinant strain, suggesting that there may be further cases than are currently reported.\r\n\r\nBoth cases had similar clinical presentation to that observed for other clades. Neither patient experienced severe outcomes. Contact tracing for both cases in the reporting countries has been completed; no secondary cases were detected. \r\nBased on available information, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.","PublicationDateAndTime":"2026-02-14T19:00:00Z","TitleSuffix":"","UseOverrideTitle":false,"Title":"Mpox: recombinant virus with genomic elements of clades Ib and IIb \u2013 Global situation","Epidemiology":"Mpox is an infectious disease caused by the MPXV, which is part of the genus Orthopoxvirus, that includes the variola virus, the causative agent for smallpox. There are two known clades of MPXV: clade I (previously called the Congo Basin clade), which includes subclades Ia and Ib; and clade II (previously called the West Africa clade), which includes subclades IIa and clade IIb. Subclades Ia and Ib were defined after the emergence of subclade Ib in the South Kivu province of the Democratic Republic of the Congo in 2023, and subclade Ia encompasses all other strains of clade I that are not Ib.\u200b As reported here, there have also been two cases of the clade Ib/IIb recombinant strain, detected in the UK and in India.
Mpox spreads among humans through direct close physical contact with an infected person, including sexual contact. Transmission can also occur through indirect contact (with contaminated materials), through infectious respiratory particles in limited cases, and from mother to child (vertical transmission).\u200b Historically mpox was primarily characterized by zoonotic transmission, with outbreaks occurring in tropical rainforest regions of East, Central and West Africa, and occasional exportation of cases to other areas. In the context of zoonotic transmission, which continues to occur in historically endemic areas, MPXV is transmitted to humans through direct contact with infected wild animals (e.g., through hunting, trapping, or petting), and possibly through processing and consuming infected wild game or their body parts and fluids. To date, animal-to-human transmission has always been documented in or linked to known endemic regions of Africa. All other outbreaks in Africa or in other parts of the world are to date presumed to be due to human-to-human transmission, until proven otherwise. Symptoms of mpox in humans include swollen lymph nodes, fever, and a skin rash and/or mucosal lesions that may initially resemble those of other illnesses such as chickenpox (caused by the varicella virus), or sexually transmitted infections such as herpes or syphilis if the rash or lesions appear in the genital or anal region. The ongoing global outbreak has shown that mpox can also present with few lesions, and asymptomatic infection can occur.\u200b The contribution of pre- and asymptomatic infection to transmission remains poorly understood.
","OverrideTitle":"","Advice":"Based on the information available, WHO recommends maintaining epidemiological surveillance, laboratory and genomic sequencing capacity for mpox, case management, infection prevention and control (IPC) measures, vaccination for people at risk, locally relevant risk communication and community engagement, and public health guidance for mpox.
All recommendations are made in the context of ongoing transmission of clades Ib and IIb MPXV in key populations at risk in all WHO regions, including undetected or pre- and asymptomatic infections, as well as unreported cases. They additionally apply to settings where clades Ia and IIa MPXV continue to spread through a mix of zoonotic and human-to-human contact. There is likely to be wider circulation of this emerging recombinant strain of MPXV since at least September 2025 than reflected by the two cases documented and linked to four countries in three WHO regions.
WHO advises Member States to:
WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.
","Assessment":"Mpox outbreaks must be considered in their local context, with meaningful involvement of affected communities, to ensure an in-depth understanding of the epidemiology, modes of transmission, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control.
Multiple strains of MPXV are circulating through interconnected sexual networks across many countries and settings. Co-infection with different strains, that could lead to emergence of recombinant virus strains, while rare, can be expected. The case in India was infected with the same recombinant Ib/IIb MPXV strain detected in the United Kingdom. Symptom onset in the case reported in India occurred more than two months earlier than the case in the United Kingdom, and the great degree of similarity between their sequences suggests a common evolutionary history. This information has two important implications: i) the origin of the recombinant strain remains unknown; and ii) transmission of this recombinant virus already involves at least four countries in three WHO regions, and is therefore likely to be more widespread than currently documented.
For the cases in the United Kingdom and India, the initial clade differentiation PCR results indicated clade Ib and IIb MPXV, respectively. Thus, clade differentiation PCR assays alone may not reliably identify recombinant MPXV strains, and genomic sequencing is likely to be required for their detection.
Due to the small number of cases found to date, conclusions about transmissibility or clinical characterization of mpox due to recombinant strains would be premature, and it remains essential to maintain vigilance regarding this development.
In light of the limited information available on this recombinant MPXV strain, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.
All countries should remain alert to the possibility of MPXV genetic recombination. The public health risk posed by any newly detected recombinant strain should be assessed on a case-by-case basis, considering available epidemiological, clinical and genomic information.
","Overview":"In December 2025, the United Kingdom detected the first reported case of a clade Ib/IIb MPXV recombinant strain.\u200b5\u200b After classification of this case and posting in a public database as a novel MPXV recombinant strain, a case of mpox detected in India in September 2025 was retrospectively reclassified as a closely-related recombinant strain based on sequencing data. To date, these are the only known cases of this recombinant virus.
Case detected in the United Kingdom of Great Britain and Northern Ireland
The case was identified following testing of a vesicular swab from a traveler who had returned from a country in the Asia Pacific region in October 2025. During laboratory confirmation, the virus was initially typed as clade Ib MPXV by qPCR. Subsequent whole genome sequencing revealed that the MPXV strain identified was distinct from other known clade Ib MPXV strains with phylogenetic analysis indicating that the genome had regions similar to both clade Ib and clade IIb MPXV reference sequences, suggesting that it is an inter-clade recombinant. To confirm this unusual finding, sequencing was repeated on the original extract from the primary sample, a fresh extract from the same primary sample, a second swab collected from the patient at the same time, and a cultured isolate derived from the initial swab. This repeat sequencing yielded identical viral genome sequences from the two clinical swabs and the cultured isolate, supporting the initial findings of a new recombinant strain, and showing that it can replicate and presents potential for onward transmission. This strain is a recombinant MPXV, containing genetic elements from both clade Ib and clade IIb MPXV. A small number of contacts were identified and followed up in the United Kingdom; none developed any clinical features of mpox. Health worker contacts had worn full personal protective equipment (PPE) during provision of medical care to the patient. The authorities of the United Kingdom continue to investigate the significance of this recombinant MPXV strain through phenotypic characterization studies.
Case detected in India
On 13 January 2026, the National IHR Focal Point (NFP) of India notified WHO of a mpox case with an inter\u2011clade recombinant MPXV which was, upon whole-genome sequencing, found to have genomic elements of clades Ib and IIb MPXV.
The recombinant virus was found in samples from a man with mpox who had presented for care in September 2025. The patient had reported recent travel from a country in the Arabian Peninsula, where he resides as an overseas worker.
He developed symptoms on 1 September 2025, while still abroad. After his return to India, real\u2011time PCR confirmed MPXV infection on 11 September 2025. Clade differentiation PCR performed on 15 September 2025 initially identified this virus as clade II MPXV. Initial genomic sequencing analysis suggested features consistent with clade IIb MPXV. However, following the update of the global Nextclade database on 16 December 2025, which included the recombinant clade Ib/IIb MPXV strain reported by the United Kingdom, the virus from the patient in India was reclassified as belonging to the recombinant strain. Recombination analysis demonstrated mosaic patterns containing genomic regions derived from both parent clades.
Following the initial diagnosis, the patient was hospitalized, did not experience any medical complications, and fully recovered, testing negative for MPXV on 29 September 2025. The case reported no close contacts in India, and no known secondary cases were identified following this introduction of the recombinant clade Ib/IIb MPXV in India.
Full or near\u2011full genome retrieval (>99%) from both the sample and a sample-derived virus isolate enabled phylogenetic analysis showing >99.9% similarity to the recombinant strain detected in the United Kingdom. A total of 34 recombinant tracts were observed in the sequence reported by India, while 28 recombinant tracts were observed in the sequence reported by the United Kingdom; 16 recombinant tracts were common to both strains. This case in India therefore represents the earliest known detection of this recombinant strain globally, having preceded the event reported in the United Kingdom.
Consistent with the case reported in the United Kingdom, clinical presentation was consistent with cases due to clade I or clade II MPXV (non-recombinant MPXV) infection.
","DonId":"2026-DON595","Provider":"dynamicProvider372"},{"Id":"d6231257-b960-4355-b365-e527415c41e3","LastModified":"2026-02-10T16:05:50Z","PublicationDate":"2026-02-06T21:43:10Z","DateCreated":"2026-02-06T21:43:10Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON594","ItemDefaultUrl":"/2026-DON594","Response":"Several public health measures have been implemented by local authorities, including:
The support provided by WHO includes:
Citable reference: World Health Organization (6 February 2026). Disease Outbreak News: Nipah virus infection in Bangladesh. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON594
NiV infection is a zoonotic disease transmitted to humans through infected animals (such as bats), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. Fruit bats, also known as flying foxes, (Pteropus species) are the natural hosts for the virus.
The incubation period ranges from 3 to 14 days. In some rare cases, incubation of up to 45 days has been reported. Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests. The main tests used are RT-PCR from bodily fluids and antibody detection via ELISA.
Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis (brain swelling).
Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.
Further information about NiV infection can be found\u202fhere.
The CFR in previous outbreaks across Bangladesh, India, Malaysia, Philippines and Singapore ranged from 40% to 75%, depending on local capabilities for early detection and clinical management. There are currently no licensed medicines or vaccines specific for NiV infection. Early intensive supportive care is recommended to treat severe respiratory and neurologic complications. Henipavirus nipahense (or Nipah virus) is considered a priority pathogen for the acceleration of medical countermeasures to respond to epidemics and pandemics as part of the WHO R&D Blueprint for Epidemics.
In the absence of a licensed vaccine or specific therapeutic treatment for Nipah virus disease, reducing or preventing infection in people relies on raising awareness of the risk factors. This includes providing guidance on and reinforcing risk communication messages about the measures that people can take to reduce exposure to the Nipah virus. Case management should focus on delivering timely supportive care, supported by an effective laboratory system and adequate infection prevention and control measures in health facilities. Intensive supportive care is recommended for treatment of severe respiratory and neurologic complications.
Public health educational messages should focus on:
Reducing the risk of bat-to-human transmission
Reducing the risk of human-to-human transmission
Controlling infection in health care settings
Based on the currently available information,\u202fWHO does not recommend any travel and/or trade restrictions.
","Assessment":"Nipah virus is a zoonotic pathogen with a high death rate and no licensed vaccine or treatment, though early supportive treatment can save lives. Its reservoirs are fruit bats or flying foxes (bats of the Pteropus genus), which are distributed in the coastal regions and on several islands in the Indian ocean, India, south-east Asia and Oceania. The virus can be transmitted to humans from wild and domestic animals. Secondary human-to-human transmissions are also possible. Cases of Nipah virus infection were first reported in 1998 and since then have been reported in Bangladesh, India, Malaysia, Philippines and Singapore. The virus is present in Bangladesh, while NiV cases are reported throughout the year, outbreaks tend to occur between December and April corresponding with the harvesting and consumption of date palm sap. Clusters of cases are mainly reported in the country’s central and northwest districts.
To date, since 2001 Bangladesh has documented 348 NiV disease cases, including 250 deaths, corresponding to an overall case fatality rate of 72%. Nearly half of these cases (n=162) were primary cases with a confirmed history of consuming raw date palm sap or tari (fermented date palm sap), while 29% resulted from direct person-to-person transmission. Most cases detected in Bangladesh were reported through December to April, suggesting a seasonal pattern. Based on the current available information, WHO assesses the overall public health risk posed by NiV at the national level to be low due to the following reasons:
Bangladesh borders India and Myanmar, and WHO assesses the risk at the regional level to be low. While there have not been any instances of cross-border transmission by humans previously, the risk remains, given shared ecological corridor for the virus's natural host Pteropus bats in Bangladesh and India. However, Bangladesh has strong capacities and experience of controlling previous NiV outbreaks.
WHO assesses the risk at the global level to be low, as there have been no previous confirmed cases outside Bangladesh, India, Malaysia, Philippines and Singapore.
","Overview":"On 3 February 2026, the Bangladesh IHR NFP notified WHO of one confirmed case of NiV infection that occurred in Rajshahi Division, northwestern Bangladesh. The case was confirmed by Polymerase Chain Reaction (PCR) and Enzyme-Linked Immunosorbent Assay (ELISA) testing on 29 January 2026.
The patient is female, aged between 40-50 years, residing in Naogaon District, Rajshahi Division. She developed symptoms consistent with NiV infection on 21 January, including fever, headache, muscle cramps, loss of appetite (anorexia), weakness, and vomiting, followed by hypersalivation, disorientation, and convulsion. On 27 January, she became unconscious and was referred by a local physician to a tertiary hospital. She was admitted on 28 January, and the Nipah surveillance team collected throat swabs and blood samples. The patient died the same day.
The patient reported repeated consumption of raw date palm sap between 5 and 20 January 2026. Following the confirmed diagnosis, an outbreak investigation team, including One Health stakeholders, started investigations on 30 January.
A total of 35 contact persons has been identified, including three household contact persons 14 community contact persons and 18 hospital contact persons. Samples were collected from six symptomatic contact persons, including three from household, two from communities and one from hospital. All six samples tested negative for NiV infection by PCR and anti-Nipah IgM antibody detection by ELISA. As of 3 February, no additional cases have been identified. Contact persons are under monitoring.
Bangladesh reported its first case of NiV infection in 2001. Since then, human infections have been reported almost every year. In 2025, four laboratory-confirmed fatal cases were reported from Bangladesh.
","DonId":"2026-DON594","Provider":"dynamicProvider372"},{"Id":"d010ef65-ce68-4180-a614-c67d6f2fcbbb","LastModified":"2026-02-11T08:14:47Z","PublicationDate":"2026-01-30T16:32:57Z","DateCreated":"2026-01-30T16:32:57Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON593","ItemDefaultUrl":"/2026-DON593","Response":"Several public health measures have been implemented by local authorities, including:
The support provided by WHO includes:
Citable reference: World Health Organization (30 January 2026). Disease Outbreak News: Nipah virus infection in India. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON593
Erratum: The Disease Outbreak News was revised on 31 January 2026. The total number of outbreaks reported in India and in Kerala was removed while discussions are ongoing with national authorities to align the number of outbreaks reported to WHO.
","Summary":"On 26 January 2026, the National IHR Focal Point for India notified WHO of two laboratory\u2011confirmed cases of Nipah virus (NiV) infection in West Bengal State. Both are healthcare workers at the same private hospital in Barasat (North 24 Parganas district). NiV infection was confirmed at the National Institute of Virology in Pune on 13 January. One case remains on mechanical ventilation as of 21 January, the other case experienced severe neurological illness but has since improved. \r\n\r\nAuthorities have identified and tested over 190 contacts, who all tested negative for NiV with support from a mobile BSL\u20113 laboratory deployed by the National Institute of Virology, Pune. No further cases have been detected to date.\r\n\r\nThis event represents the third NiV infection outbreak reported in West Bengal (previous outbreaks reported in Siliguri in 2001 and Nadia in 2007). Enhanced surveillance and infection prevention and control (IPC) measures are in place while investigations into the source of exposure are ongoing. \r\n\r\nNiV infection is a serious but rare zoonotic disease transmitted to humans through infected animals (such as bats), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. There are currently no licensed medicines or vaccines for NiV infection, however early supportive care can improve survival. \r\n\r\nWHO assesses the risk posed by Nipah to be moderate at the sub-national level, and low at the national, the regional and global levels. ","PublicationDateAndTime":"2026-01-30T19:00:00Z","TitleSuffix":"","UseOverrideTitle":false,"Title":"Nipah virus disease - India","Epidemiology":"NiV infection is a zoonotic disease transmitted to humans through infected animals (such as bats), or food contaminated with saliva, urine, and excreta of infected animals. It can also be transmitted directly from person to person through close contact with an infected person. Fruit bats or flying foxes (Pteropus species) are the natural hosts for the virus.
The incubation period ranges from 3 to 14 days. In some rare cases incubation of up to 45 days has been reported. Laboratory diagnosis of a patient with a clinical history of NiV infection can be made during the acute and convalescent phases of the disease by using a combination of tests. The main tests used are RT-PCR from bodily fluids and antibody detection via ELISA.
Human infections range from asymptomatic infection to acute respiratory infection (mild, severe), and fatal encephalitis (brain swelling).
Infected people initially develop symptoms including fever, headaches, myalgia (muscle pain), vomiting and sore throat. This can be followed by dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis. Some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.
Further information about NiV infection can be found here.
The case fatality ratio (CFR) in outbreaks across Bangladesh, India, Malaysia, and Singapore range from 40% to 75%, depending on local capabilities for early detection and clinical management. There are currently no licensed medicines or vaccines specific for NiV infection. Intensive supportive care is recommended to treat severe respiratory and neurologic complications. Henipavirus nipahense (Nipah virus) is considered a priority pathogen for the acceleration of medical countermeasures (MCMs) to respond to epidemics and pandemics as part of the WHO R&D Blueprint for Epidemics.
","OverrideTitle":"","Advice":"In the absence of a licensed vaccine or specific therapeutic treatment for Nipah virus disease, reducing or preventing infection in people relies on raising awareness of the risk factors. This includes providing guidance on and reinforcing risk communication messages about the measures that people can take to reduce exposure to the Nipah virus. This is also important in the context of mass gatherings, where attendees come from different countries and may be unfamiliar with disease and its mode of transmission, as well as actions they can take to protect themselves. and case management should focus on delivering timely supportive care, supported by an effective laboratory system and adequate infection prevention and control measures in health facilities. Intensive supportive care is recommended for treatment of severe respiratory and neurologic complications.
Public health educational messages should focus on:
Reducing the risk of bat-to-human transmission
Reducing the risk of human-to-human transmission.
Controlling infection in health care settings
Based on the currently available information, WHO does not recommend any travel and/or trade restrictions.
","Assessment":"Nipah virus (Henipavirus nipahense) is a rare zoonotic pathogen with a high CFR (40-75%) and no licensed vaccine or treatment. Its reservoirs are fruit bats or flying foxes (bats in the Pteropus genus), which are distributed in the coastal regions and on several islands in the Indian ocean, India, south-east Asia and Oceania. The virus can be transmitted to humans from wild and domestic animals, however, as the disease can be transmitted by domesticated animals, secondary human-to-human transmissions are also possible. Cases of Nipah virus infection were first reported in 1998 and since then have been reported in Bangladesh, India, Malaysia, Philippines and Singapore. The virus is present in India, with seasonal outbreaks linked to bat activities and cultural practices such as the consumption of raw date palm sap. Seasonal outbreaks occur between December and May, coinciding with the harvesting of date palm sap.
This event represents the third Nipah outbreak reported in West Bengal, while multiple Nipah outbreaks were also documented in Kerala since 2018. In West Bengal, previous outbreaks occurred in 2001 (Siliguri) and 2007 (Nadia district). Based on the current available information, WHO assesses the overall public health risk posed by NiV at the sub-national level to be moderate, taking into consideration no availability of specific drugs or vaccines for NiV infection and the difficulty of early diagnosis. Although sensitive and specific laboratory methods exist, the symptoms during the first phase are not specific and could potentially delay a timely diagnosis, outbreak detection and response. In addition, fruit bats (Pteropus spp.) are the natural reservoir of NiV, and they are present in India and repeated spillover of the virus from its reservoir to the human population has been demonstrated.
Human-to-human transmission has been documented in previous outbreaks, mostly reported in health-care settings and among family and caregivers of sick people through close contact with bodily fluids. Implementation of adequate infection prevention and control measures in health care facilities is critical to mitigate health care associated infection.
The yearly number of NiV infection cases reported in India has remained relatively low since 2001, except for 2001, when 66 cases were reported and 2018 when 18 cases were reported. Over the past 5 years, a dozen confirmed cases were reported in India, all in Kerala State. Strong public health measures are implemented in India to detect and control outbreaks, including established NiV surveillance, and the availability of Rapid Response Teams (RRT) at both the Central and State levels, along with the capacity to rapidly test samples.
For neighbouring countries, WHO assesses the public health risk posed by NiV at the regional level to be low. There have been no reports of cross\u2011border transmission, and the current outbreak remains geographically limited. Nevertheless, the risk of disease occurrence persists due to the shared ecological corridor of fruit bats and the history of human cases previously reported in the region. India has demonstrated strong capacity and experience in managing past NiV outbreaks.
WHO assesses the public health risk posed by NiV at the global level to be low, as there has been no confirmed spread of cases outside India.
","Overview":"On 26 January 2026, the India IHR NFP notified WHO of two confirmed NiV infection cases that occurred in West Bengal State. Preliminary laboratory testing suggested NiV infection, and confirmation was received from the National Institute of Virology, Pune on 13 January 2026.
The cases were confirmed through Reverse Transcription Polymerase Chain Reaction (RT-PCR) and Enzyme-Linked Immunosorbent Assay (ELISA) testing.
The first case is a female nurse and the second case is a male nurse. Both cases were between 20 – 30 years old, from Barasat, North 24 Parganas district. Both cases developed symptoms typical of severe NiV infection in late December 2025 and were admitted to hospital in early January 2026. As of 21 January 2026, the second case showed clinical improvement, while the first case remained under critical care.
Following the two confirmed cases, Indian health authorities identified and tested over 190 contact persons, including health and care workers and community contacts. All samples from contact persons tested negative for NiV.
The Indian National Centre for Disease Control, announced on 27 January that no further confirmed cases have been detected in West Bengal from December 2025 to date.
","DonId":"2026-DON593","Provider":"dynamicProvider372"},{"Id":"555e13f3-7aa5-445b-83eb-36e2f050a55c","LastModified":"2026-01-26T17:03:04Z","PublicationDate":"2026-01-26T17:02:50Z","DateCreated":"2026-01-26T17:03:04Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2026-DON592","ItemDefaultUrl":"/2026-DON592","Response":"Local and national health authorities in Ethiopia implemented the following public health measures:
WHO, through its country office and partners, provided technical, operational and financial support to the government to contain this outbreak. These include:
Marburg virus disease (MVD) is a severe disease caused by either of two closely related viruses, Marburg virus and Ravn virus. MVD has a high case fatality rate, ranging from 24% to 88% from previous outbreaks. The CFR can be lowered with early supportive patient care. The virus is initially transmitted to humans from fruit bats (Rousettus aegyptiacus) and then spreads among people through direct contact with bodily fluids, contaminated surfaces, or infected materials. Healthcare workers, caregivers, and individuals involved in burial practices are particularly at risk when appropriate infection, prevention and control measures are not in place.
MVD symptoms typically begin abruptly after an incubation period of two to 21 days and include high fever, severe headache, malaise, muscle aches, and progressive gastrointestinal symptoms such as diarrhea and vomiting. In severe cases, patients may experience bleeding from multiple sites and die from shock and organ failure within a week of symptom onset.
There are no approved treatment or vaccines for MVD, although early supportive care improves survival. Some candidate vaccines and therapeutics are currently under investigation.
Nineteen outbreaks of MVD have previously been reported globally. The most recent outbreak was reported from the Republic of Tanzania between January and March 2025. Additional countries that have reported outbreaks of MVD in the African Region include Angola, the Democratic Republic of the Congo, Equatorial Guinea, Ghana, Guinea, Kenya, Rwanda, South Africa, and Uganda.
","OverrideTitle":"","Advice":"WHO encourages maintaining early detection and care capacities in addition to sustaining the ability to quickly respond after the outbreak ends. This is to make sure that if the disease re-emerges, health authorities can detect it immediately, prevent the disease from spreading again, and ultimately save lives.
Raising awareness of risk factors for MVD and protective measures that individuals can take is an effective way to reduce human transmission. WHO advises the following risk reduction measures as an effective way to reduce MVD transmission in healthcare facilities and in communities:
Based on the current risk assessment, WHO advises against any travel and trade restrictions with Ethiopia.
","Assessment":"This was the first-ever confirmed MVD outbreak reported in Ethiopia. Based on the outbreak investigation and surveillance activities during the response, which included contact tracing, alert management, active case search, and mortality surveillance, no additional cases have been reported during the 42-day countdown period, as per WHO recommendations. However, there remains a risk of re-emergence of MVD following the declaration of the end of the outbreak, with potential spillovers from interactions with the animal reservoir.
Risk communication and community engagement activities will continue to provide timely and accurate information, monitor and address community feedback and rumours, while supporting efforts to reduce stigma toward individuals affected by the outbreak.
","Overview":"On 14 November 2025, after the laboratory confirmation of suspected viral hemorrhagic fever (VHF) cases in Jinka town, South Ethiopia Regional State, Ethiopia, the Ministry of Health of Ethiopia declared an outbreak of Marburg Virus Disease (MVD). Molecular testing conducted by the National Reference Laboratory at the Ethiopian Public Health Institute (EPHI) identified Marburg virus (MARV) in patient samples. This was the first time Ethiopia was reporting a MVD outbreak.
The first known case was an adult from Jinka town who developed symptoms on 23 October. The patient presented to the General Hospital the following day with vomiting, loss of appetite, and abdominal cramps. As of 25 January 2026, a cumulative total of 14 confirmed cases, including nine deaths (Case Fatality Rate (CFR) 64.3%) and five probable cases, all of whom had died, were reported by the Ministry of Health from Jinka, Malle and Dasench woredas in South Ethiopia Region and Hawassa in Sidama Region.
As of 25 January 2026, a total of 857 contacts were listed who completed 21 days of follow-up, 760 from the South Ethiopia Region and 97 from the Sidama Region. As of 5 January 2026, 3800 samples were tested for the virus.
On 26 January 2026, after two consecutive incubation periods (a total of 42 days), without a new confirmed case reported, after the last confirmed case died and was given a safe and dignified burial, on 14 December 2025, the Ministry of Health of Ethiopia declared the end of the MVD outbreak, as per WHO recommendations.
Figure 1: Map of districts reporting confirmed and probable Marburg virus disease cases in Ethiopia, as of 25 January 2026
![\"Map](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/map-for-marburg-virus-disease-in-ethiopia.png?sfvrsn=15b744e9_3\" "\\"Map")
","DonId":"2026-DON592","Provider":"dynamicProvider372"},{"Id":"0fc174d2-cdc3-4d5d-afed-4df595977a02","LastModified":"2026-01-06T10:00:01Z","PublicationDate":"2025-12-24T09:19:23Z","DateCreated":"2025-12-24T09:19:23Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2025-DON591","ItemDefaultUrl":"/2025-DON591","Response":"
WHO is supporting Member States in strengthening preparedness and response.
Activities in the Kingdom of Saudi Arabia include;
Activities in France include;
References:
[1] AlKhalifah, J. M., Seddiq, W., Alshehri, M. A., Alhetheel, A., Albarrag, A., Meo, S. A., Al-Tawfiq, J. A., & Barry, M. (2023). Impact of MERS-CoV and SARS-CoV-2 Viral Infection on Immunoglobulin-IgG Cross-Reactivity. Vaccines, 11(3), 552. https://doi.org/10.3390/vaccines11030552
[2] Zedan, H. T., Smatti, M. K., Thomas, S., Nasrallah, G. K., Afifi, N. M., Hssain, A. A., Abu Raddad, L. J., Coyle, P. V., Grivel, J. C., Almaslamani, M. A., Althani, A. A., & Yassine, H. M. (2023). Assessment of Broadly Reactive Responses in Patients With MERS-CoV Infection and SARS-CoV-2 Vaccination. JAMA network open, 6(6), e2319222. https://doi.org/10.1001/jamanetworkopen.2023.19222
[3] Middle East respiratory syndrome, Memish, Ziad A et al. The Lancet, Volume 395, Issue 10229, 1063 – 1077
[4] Arabi, Y. M., Asiri, A. Y., Assiri, A. M., Balkhy, H. H., Al Bshabshe, A., Al Jeraisy, M., Mandourah, Y., Azzam, M. H. A., Bin Eshaq, A. M., Al Johani, S., Al Harbi, S., Jokhdar, H. A. A., Deeb, A. M., Memish, Z. A., Jose, J., Ghazal, S., Al Faraj, S., Al Mekhlafi, G. A., Sherbeeni, N. M., Elzein, F. E., … Saudi Critical Care Trials Group (2020). Interferon Beta-1b and Lopinavir-Ritonavir for Middle East Respiratory Syndrome. The New England journal of medicine, 383(17), 1645–1656. https://doi.org/10.1056/NEJMoa2015294
[5] Macrolides in critically ill patients with Middle East Respiratory Syndrome, Arabi, Yaseen M. et al., International Journal of Infectious Diseases, Volume 81, 184 - 190
[6] Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Available at https://www.who.int/publications/i/item/10665-174652
[7] Transmission-based precautions for the prevention and control of infections: aide-memoire. Available at: https://www.who.int/publications/i/item/WHO-UHL-IHS-IPC-2022.2
Citable reference: World Health Organization (24 December 2025). Disease Outbreak News; Middle East respiratory syndrome coronavirus - Global update. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON591
","Summary":"Since the beginning of 2025 and as of 21 December 2025, a total of 19 cases of Middle East respiratory syndrome coronavirus (MERS- CoV), including four deaths have been reported to WHO globally. Of the 19 cases, 17 were reported by the Kingdom of Saudi Arabia (KSA), and two were reported from France.\r\nBetween 4 June and 21 December 2025, the Ministry of Health (MoH) of KSA reported a total of seven cases of MERS-CoV infection, including two deaths. In addition, at the beginning of December 2025, the National IHR Focal Point (IHR NFP) for France also reported two MERS-CoV travel \u2013 associated cases; involving individuals with recent travel to countries in the Arabian Peninsula.\r\nThe notification of these latest cases does not change the overall risk assessment, which remains moderate at both the global and regional levels. These cases show that the virus continues to pose a threat in countries where it is circulating in dromedary camels, with regular spillover into the human population. WHO recommends implementation of targeted infection, prevention and control (IPC) measures to prevent the spread of health care-associated infections of MERS-CoV and onward human transmission.","PublicationDateAndTime":"2025-12-24T05:38:07Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Middle East respiratory syndrome coronavirus - Global update","Epidemiology":"Middle East respiratory syndrome (MERS) is a respiratory illness caused by a coronavirus (MERS-CoV). The case fatality ratio (CFR) among confirmed cases is around 37%. The CFR is calculated based solely on laboratory-confirmed infections and may overestimate the actual mortality rate since milder cases often go undetected or unreported.
Humans can contract MERS-CoV through multiple transmission pathways; the primary route being through direct or indirect contact with dromedary camels, which serve as the virus’s natural host and primary zoonotic reservoir. Additionally, human-to-human transmission can occur via infectious respiratory particles primarily in close-contact situations and can also occur through direct or indirect contact; this is especially prominent in health-care settings. Human-to-human transmission of the virus has occurred in health care facilities in several countries, including transmission from patients to health care providers and transmission between patients before MERS-CoV was diagnosed. It is not always possible to identify patients with MERS\u2010CoV early or without testing because symptoms and other clinical features may be non\u2010specific. Outside these environments, there has been limited documented human-to-human transmission.
MERS can present with no symptoms (asymptomatic), mild symptoms (including mild respiratory issues), or severe illness leading to acute respiratory distress and death. Common symptoms include fever, cough, and breathing difficulties, with pneumonia frequently observed, though not always present. Some patients also experience gastrointestinal symptoms such as diarrhoea. Severe cases may require intensive care, including mechanical ventilation. Those at higher risk of severe outcomes include older adults, individuals with weakened immune systems, and those with chronic conditions like diabetes, kidney disease, cancer, or lung disorders.
The number of MERS-CoV infections reported to WHO substantially declined since the beginning of the COVID-19 pandemic. Initially, this was likely the result of epidemiological surveillance for SARS-CoV-2 being prioritized. Similar clinical pictures of both diseases may have resulted in reduced testing and detection of MERS-CoV infections. However, the MoH of the KSA has been working to improve testing capacities for better detection of MERS-CoV since the easing of the COVID-19 pandemic, with MERS-CoV included into sentinel surveillance testing algorithms since the second quarter of 2023, for samples that test negative for both influenza and SARS-CoV-2. In addition, recommended IPC measures (e.g., mask-wearing, hand hygiene, physical distancing, improving ventilation) and public health and social measures in the community to reduce SARS-CoV-2 transmission, (stay-at-home orders, reduced mobility) also likely reduced onward human-to-human transmission of respiratory infections including MERS-CoV. Potential cross-protection conferred from infection with or vaccination against SARS-CoV-2 and any reduction in MERS-CoV infection or disease severity and vice versa has been hypothesized but requires further investigation. [1,2]
","OverrideTitle":"Middle East respiratory syndrome coronavirus - Global update","Advice":"Surveillance:
Based on the current situation and available information, WHO re-emphasizes the importance of strong surveillance by all Member States for acute respiratory infections, with the inclusion of MERS-CoV into the testing algorithm where warranted, and to carefully review any unusual patterns.
Clinical Management
The incubation period is typically 2-15 days (median 5 days), although prolonged incubation periods have been reported in the immunocompromised. Although mild disease does occur, clinicians should be aware that symptoms may frequently progress rapidly non-specific signs of upper respiratory tract infection, cough and breathlessness, to respiratory failure and cardiovascular collapse.[3]MERS-CoV infection should be managed supportively with respiratory support titrated to the needs of the patient; there is a wide spectrum of severity, with many patients requiring mechanical ventilation.
The largest clinical trial in MERS compared a combination of lopinavir–ritonavir and interferon β-1b with placebo (95 patients).[4] Active treatment caused lower 90-day mortality in hospitalized patients with laboratory-confirmed MERS (90-day mortality of 48% and 29% respectively). Further analysis suggested a positive effect only in patients treated within 7 days of symptom onset. Although there is increasing use of corticosteroids for some respiratory conditions (specifically in COVID-19 and some other forms of pneumonia), their use in MERS-CoV is of uncertain benefit, and harms relating to their immunomodulatory effects may be significant; more data are needed. The use of convalescent plasma has not been proven, although has been used in a limited number of patients in a non-trial setting. While antibiotics have been used in severe disease to presumptively treat concurrent bacterial infection, there are no controlled data on efficacy. A retrospective analysis of 349 MERS patients examined macrolide antibiotic therapy. No difference in 90-day mortality was found in the 136 patients receiving macrolides compated with those who did not.[5]Infection prevention and control:
Human-to-human transmission of MERS-CoV in healthcare settings has been associated with delays in recognizing the early symptoms of MERS-CoV infection, slow triage of suspected cases and delays in implementing timely IPC measures. IPC measures are therefore critical to prevent the spread of MERS-CoV in healthcare facilities and onwards in the community. Healthcare workers should always apply standard precautions consistently with all patients and perform risk assessments at every interaction in healthcare settings to determine the necessary protection measures. For patients with suspected MERS-CoV infection that require hospitalization, place patient in an adequately ventilated single room away from other patient care areas. In addition to standard precautions. Droplet and contact precautions should be implemented when providing care to patients with symptoms of acute respiratory infection who are suspects of any respiratory disease, including probable or confirmed cases of MERS-CoV infection.[6,7]
Droplet and contact precautions should be maintained until the patient is no longer symptomatic (for at least 24 hours) and has two upper respiratory (URT) swabs (taken 24hrs apart) test negative in RT-PCR or according to local guidance. Additionally, airborne precautions should be applied when performing aerosol generating procedures or in settings where aerosol generating procedures are conducted. Early identification, case management and prompt isolation of suspected respiratory infected patients and cases, quarantine of contacts, together with appropriate IPC measures in health care settings, including improving ventilation in enclosed spaces and public health awareness can prevent the spread of human-to-human transmission of MERS-CoV.
Public health and social measures:
MERS-CoV appears to cause more severe disease in people with underlying chronic medical conditions such as diabetes, renal failure, chronic lung disease, and immunosuppression. Therefore, people with these underlying medical conditions should avoid close contact with animals, particularly dromedaries, when visiting farms, markets, or barn areas where the virus may be circulating.
General hygiene measures, such as regular hand hygiene before and after touching animals or animal products and avoiding contact with sick animals, should be adhered to.
In addition, hygiene practices should be observed including the five keys to safer food should be followed when dealing with food items of camels; people should avoid drinking raw camel milk or camel urine or eating meat that has not been properly cooked.
WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions.
","Assessment":"As of 21 December 2025, a total of 2635 laboratory-confirmed cases of MERS-CoV infection have been reported globally to WHO, with 964 associated deaths. The majority of these cases have occurred in countries on the Arabian Peninsula, including 2224 cases with 868 related deaths (CFR 39%) reported from the KSA.
A notable outbreak outside the Middle East occurred in the Republic of Korea, in May 2015, during which 186 laboratory-confirmed cases (185 in the Republic of Korea and 1 in China) and 38 deaths were reported. However, the index case in that outbreak had a history of travel to the Middle East.
Three limited healthcare-related clusters have recently been reported from the KSA, two in 2024 comprised of three and two cases each, and one in 2025 comprised of 7 cases; the previous cluster before that had been observed in May 2020, also in the KSA. Extensive contact tracing was applied in the 2025 cluster, which lead to detection of four asymptomatic and two mild cases, who fully recovered. Despite these recent clusters, zoonotic spillover remains an important mode of human infection, leading to isolated cases and limited onwards transmission between humans.
Global total cases reflect laboratory-confirmed cases reported to WHO under IHR (2005) or directly by Ministries of Health from Member States. These figures may underestimate the true number of cases if some were not reported to WHO, as they may be missed by current surveillance systems and not be tested for MERS-CoV – either due to similar clinical presentation as other circulating respiratory diseases or because infected individuals remained asymptomatic or had only mild disease. The total number of deaths includes those officially reported to WHO through follow-up with affected Member States.
The notification of these new cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or their products (for example, consumption of raw camel milk, camel urine, or eating meat that has not been properly cooked), or in a healthcare setting. Due to the similarity of symptoms with other respiratory diseases that are widely circulating, like influenza or COVID-19, detection and diagnosis of MERS cases may be delayed, especially in unaffected countries, and provide an opportunity for onward human-to-human transmission to go undetected. WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information.
No vaccine or specific treatment is currently available, although several MERS-CoV-specific vaccines and therapeutics are in development. Treatment remains supportive, focusing on managing symptoms based on the severity of the illness.
","Overview":"Since the first report of MERS-CoV in the KSA and Jordan in 2012, a total 2635 laboratory-confirmed cases of MERS-CoV infection, with 964 associated deaths (Case Fatality Ratio (CFR) of 37%), have been reported to WHO from 27 countries, across all six WHO regions (Figure 1). The majority of cases (84%; n=2224), have been reported from the KSA (Figure 2). Since the beginning of 2025 and as of 21 December, a total of 19 cases have been reported to WHO. Overall, 17 cases were reported in the KSA from five regions named: Riyadh (n=10), Taif (n=3), Najran (n=2), Hail (n=1), and Hafr Al-Batin City (n=1) (Figure 3). In addition, two travel associated cases of MERS-CoV infection have been reported in France, with likely exposure occurring during recent travel in the Arabian Peninsula (Figure 3).
This disease outbreak news report focuses on the recent nine cases of MERS-CoV infection reported between 4 June - 21 December 2025: seven cases from the KSA and the two imported cases to France. The details of cases reported earlier in 2025 can be referred to in the previously published disease outbreak news on 13 March 2025 and 12 May 2025.
Between 4 June and 21 December 2025, the MoH of the KSA reported a total of seven cases of MERS CoV infection. The cases were reported from three regions: Najran (2), Riyadh (3), and Taif (2). No epidemiological links were identified between the seven cases. In addition, between 2 and 3 of December 2025, the IHR NFP for France reported two cases of MERS – CoV with recent travel to the Arabian Peninsula during the month of November.
Follow-up has been completed for all contacts and no secondary infections have been identified or reported. From September 2012, France has recorded a total of four laboratory-confirmed cases of MERS-CoV infection, including one death: two cases were reported in 2013, and the latest two cases in December 2025. All cases had been travelers exposed in the Arabian Peninsula and returning back to France.
For additional details please see Table 1.
Figure 1: Epidemic curve of MERS-CoV infections (2635) and deaths (964) reported globally between 2012-2025
![\"MERS-CoV](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/mers-cov-number-of-cases-and-deaths-global.jpg?sfvrsn=d482fa73_3\" "\\"MERS-CoV")
Figure 2: Epidemic curve of MERS-CoV infections (2224) and deaths (868) reported in KSA between 2012-2025
![\"MERS-CoV](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/mers-cov-number-of-cases-and-deaths-ksa.jpg?sfvrsn=bf2f9eb7_4\" "\\"MERS-CoV")
Figure 3. Geographical distribution of MERS-CoV infections between 1 January and 21 December 2025 (n=19).
![\"MERS-CoV](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/mers-cov-geographic-distribution-of-cases.jpg?sfvrsn=c611599d_3\" "\\"MERS-CoV")
Table 1: MERS-CoV cases reported by KSA and France between 4 June and 21 December 2025
![\"MERS-CoV](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/mers-cov-cases-reported-in-the-ksa-and-france.jpg?sfvrsn=deaf9121_3\" "\\"MERS-CoV")
WHO is enhancing national, regional, and global capacities for influenza preparedness and response, including:
[1] World Health Organization. Weekly epidemiological record. Geneva: World Health Organization; 2024 [cited 2025 Nov 25];97(19):233–248. Available from: https://www.who.int/publications/i/item/who-wer9719
[2] World Health Organization. WHO recommendations on influenza vaccine composition. Geneva: World Health Organization; 2025 Feb [cited 2025 Nov 25]. Available from: https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations
Citable reference: World Health Organization (10 December 2025). Disease Outbreak News; Seasonal influenza -Global situation. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON586
","Summary":"Seasonal influenza (\u2018the flu\u2019) is an acute respiratory infection caused by influenza viruses that circulate globally and year-round. It can cause illness ranging from mild to severe, sometimes resulting in hospitalization or death. Seasonal influenza activity has increased globally in recent months, with an increased proportion of seasonal influenza A(H3N2) viruses being detected. This rise coincides with the onset of winter in the northern hemisphere and an increase in acute respiratory infections caused by influenza and other respiratory viruses typically observed at this time of year. Although global activity remains within expected seasonal ranges, early increases and higher activity than typical at this time of year have been observed in some regions.\r\nSeasonal influenza viruses, including A(H3N2) viruses, continually evolve over time. Since August 2025, there has been a rapid increase of A(H3N2) J.2.4.1 alias K subclade viruses detected from several countries based on available genetic sequence data. These subclade K viruses have several changes from related A(H3N2) viruses. Current epidemiological data do not indicate an increase in disease severity, although this subclade marks a notable evolution in influenza A(H3N2) viruses.\r\nEarly estimates suggest that the influenza vaccine continues to provide protection against hospital attendance in both children and adults, even though its effectiveness against clinical disease during the current season remains uncertain. Vaccines remain essential, especially for people at high risk of influenza complications and their care givers. Even if there are some genetic differences between the circulating influenza viruses and the strains included in the vaccines, the seasonal influenza vaccine may still provide protection against drifted viruses and the other virus strains included in the vaccine. Vaccination is still expected to protect against severe illness and remains one of the most effective public health measures. \r\nWHO continues to monitor global influenza activity and influenza viruses, supports countries in surveillance capacity and updates guidance as needed. ","PublicationDateAndTime":"2025-12-10T19:00:00Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Seasonal influenza - Global situation","Epidemiology":"Seasonal influenza (the flu) is an acute respiratory infection caused by influenza viruses that circulate globally and year-round. In temperate regions, seasonal influenza typically peaks during the winter months, whereas in tropical areas, influenza viruses can circulate year-round with seasonality and intensity that varies across countries.
There are four types of influenza viruses, types A, B, C and D. Influenza A and B viruses circulate and cause seasonal epidemics of disease:
Influenza spreads easily between people when they cough or sneeze. Influenza disease can cause illness ranging from mild to severe, sometimes resulting in hospitalization or death. While most individuals recover within a week without need for medical care, influenza can lead to serious complication including death, especially among high-risk groups such as young children, the elderly, pregnant women and those with underlying conditions. Health and care workers are at high risk of acquiring influenza virus infection due to increased exposure to the patients, and of further spreading particularly to vulnerable individuals.
","OverrideTitle":"Seasonal influenza - Global situation","Advice":"Surveillance
Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of year-round global surveillance to detect and monitor virological, epidemiological and clinical changes associated with emerging or circulating influenza viruses that may affect human health and timely virus sharing for risk assessment. Countries are encouraged to remain vigilant to the threat of influenza viruses and review any unusual epidemiological patterns.
WHO advises Member States to maintain surveillance for respiratory pathogens through an integrated approach, considering country context, priorities, resources and capacities. WHO has published guidance on integrated respiratory virus surveillance. WHO has also updated guidance on assessing influenza epidemic and pandemic severity, including the impact on healthcare facilities.
Clinical management and prophylaxis
Clinical care for seasonal influenza focuses on identifying illness severity, assessing risk of progression, and linking to definitive care. Most cases are mild and self-limiting, but severe disease, marked by respiratory distress, sepsis, acute respiratory distress syndrome or multi-organ failure, requires urgent supportive care and often hospitalization. Clinical management of influenza involves high-quality supportive care—oxygen therapy, monitoring, hydration and respiratory support—and is foundational to improving outcomes, especially in severe cases.
Diagnostic testing should support rapid decision-making: nucleic acid amplification test (NAAT) is conditionally recommended for confirmation of suspected disease in severely unwell patients, while either NAAT or digital immunoassay may be used for non-severe cases, depending on context and resource availability. Testing should be performed early with the aim of identifying people in need of treatment and linking them to care, including antivirals where indicated.
Patients at high risk of progressing to severe disease are likely to benefit from antiviral to reduce their chance of admission to hospital. High-risk groups include adults ≥65 years, those with immunocompromising conditions, chronic cardiovascular, neurological or respiratory disease; malignancy, pregnancy and diabetes further elevate risk. Individuals ≥85 years or those with multiple risk factors are considered extremely high risk and might be considered for antiviral prophylaxis if exposed to influenza.
Infection prevention and control measures in health-care settings
Seasonal influenza is known to cause health care-associated infection outbreaks, in particular in long-term care facilities. WHO advises the use of syndromic screening at all entry points to health-care settings and as part of daily inpatient assessment to ensure that patients with suspected or confirmed infections that are transmissible in health-care settings, including influenza, are identified as soon as possible and that appropriate transmission-based precautions are implemented. WHO advises the use of droplet precautions when caring for patients with suspected or confirmed influenza. This includes appropriate patient placement (isolation) of suspected or confirmed cases, and the use of a medical mask by all health and care workers and visitors when caring for patients with suspected or confirmed influenza.
Appropriate risk assessment for additional personal protective equipment (e.g. eye protection, filtering facepiece respirators, gown, gloves) should be performed by health and care workers when caring for patients with influenza. Increased risk of influenza transmission may occur instances where care activities or patient symptoms are likely to generate splashes or sprays of blood, body fluids, secretions and excretions onto mucosa of eyes, nose or mouth; or if in close contact with a patient with respiratory symptoms (e.g. coughing/sneezing) and sprays of secretions may reach the mucosa of eyes, nose or mouth directly, or indirectly via contaminated hands. When performing an aerosol-generating procedure on patients with suspected or confirmed influenza, patient placement in an airborne infection isolation room as well as airborne and contact precautions with eye protection are advised.
Vaccination
Vaccination is the best way to prevent influenza disease. Safe and effective vaccines have been used for more than 60 years. Influenza viruses are constantly changing, so the composition of the seasonal influenza vaccine is regularly updated to contain viruses that are more related to those circulating. WHO, through the Global Influenza Programme and GISRS, in collaboration with partners, continuously monitors influenza viruses and activity globally and recommends seasonal influenza vaccine compositions in February and September for the following northern and southern hemisphere influenza seasons, respectively.
WHO recommends annual vaccination for high-risk groups, including health and care workers. People should ideally get vaccinated just before the influenza season begins for the most effective coverage, although getting vaccinated at any time during the influenza season can still help prevent flu infections. While the effectiveness of the vaccine may vary across seasons and risk groups, it reduces disease severity and lowers the chance of complications and death. Vaccination is especially important for people at high risk of influenza complications and their caregivers.
Genetic changes or drift can occur in the circulating influenza viruses before or during the influenza season, including during the time between vaccine strain selection and the influenza season. Even if there are some genetic differences between the circulating influenza viruses and the strains that are included in the vaccines, the seasonal influenza vaccine may still provide protection against drifted viruses. Current vaccines include three influenza viruses: influenza A(H1N1)pdm09, influenza A(H3N2) and influenza B/Victoria lineage viruses. Therefore, circulation of a drifted virus does not always result in seasonal influenza vaccines being less effective in offering protection against influenza associated illness.
As of now, it remains unclear how the vaccine will protect against clinical disease during this current season. However, early vaccine effectiveness estimates show the current vaccine is 70 to 75% effective at preventing hospital attendance in children aged 2 to 17 years and 30 to 40% effective in adults.[1],[2]
Public health and social measures in the community
The implementation of appropriate and proportionate public health and social measures (PHSM) is an essential component in the overall response to seasonal influenza epidemics. Measures such as performing hand hygiene, respiratory hygiene and cough etiquette as well as voluntary self-isolation and mask wearing of individuals who are symptomatic or have tested positive for influenza viruses can reduce transmission of influenza viruses. Countries should consider developing a plan to scale up additional PHSM in the event of high or extraordinarily high epidemics.
Risk communication and community engagement
Member States should consider to update and strengthen their risk communication and community engagement (RCCE) strategy integrating respiratory viruses. Enhanced risk communication and community engagement approach support empowerment of individuals to make informed decisions, countering misinformation, and community-led protection strategies.
Clear, regular, evidence-based, culturally acceptable and context adapted RCCE approaches are essential for building and maintaining trust with the concerned and affected populations to ensure adoption of interventions, practices and behaviours. For RCCE efforts to be successful, it is vital that national policies for RCCE incorporate community engagement and feedback mechanisms that acknowledge and address contextual challenges faced by different population groups, particularly those made most vulnerable. The integration of RCCE approaches to promote vaccination against influenza is also recommended.
WHO does not recommend any restriction on travel to or trade with the countries named in this report, based on the information available on the current event.
","Assessment":"Seasonal\r\ninfluenza activity has increased globally in recent months, and influenza\r\nA(H3N2) viruses are predominant. This rise coincides with the onset of winter\r\nin the northern hemisphere. Epidemics and outbreaks of seasonal influenza and\r\nother circulating respiratory viruses can place significant pressure on\r\nhealthcare systems. Although global\r\nactivity remains within expected seasonal ranges, early increases and higher\r\nactivity than typical at this time of year have been observed in some regions. Seasonal\r\ninfluenza could place significant pressure on healthcare systems even in\r\nnon-temperate countries. Genetically drifted influenza A(H3N2) viruses, known\r\nas subclade K viruses, have been detected in many countries. While data on how\r\nwell the vaccine works against clinical disease this season are still limited,\r\nvaccination is still expected to protect against severe illness and remains one\r\nof the most effective public health measures.
Globally, influenza activity has increased since October 2025 with influenza A viruses predominant among the viruses detected globally.
In many northern hemisphere countries, acute respiratory infection levels increase at this time of year. These increases are typically caused by seasonal epidemics of respiratory pathogens such as influenza, respiratory syncytial virus (RSV) and other common respiratory viruses. The exact timing of the onset, the duration, magnitude and the severity of each epidemic might vary by location, influenced by multiple factors such as type of circulating viruses (including influenza and other respiratory pathogens), relative population immunity and environmental conditions.
In the northern hemisphere, some countries have reported early starts to the influenza season. In other countries, influenza activity is starting to increase, but has not yet reached the epidemic threshold.
In the southern hemisphere, some countries have had unusually long seasons compared to previous years, with virus activity remaining higher than usual in recent months.
Global influenza surveillance and monitoring is conducted through the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of over 160 institutions in 131 Member States. GISRS is tasked with conducting year-round surveillance and monitoring of influenza viruses and serving as the global alert mechanism for the emergence of novel influenza viruses and other respiratory pathogens with pandemic potential.
In the northern hemisphere temperate and sub-tropical countries, areas and territories, influenza activity was generally low from June to August 2025. Activity gradually increased in September and continued to increase through November 2025. Influenza A viruses, especially A(H3N2) viruses, predominated during this period (Fig. 1).
In the southern hemisphere temperate and sub-tropical countries, areas and territories, influenza activity generally decreased from June 2025 and remained low through August. However, a slight increase has been observed since September. Influenza A(H1N1)pdm09 viruses predominated in June and July; however, A(H3N2) viruses have predominated since September (Fig. 2).
In tropical areas, there has been sustained influenza activity from June through November. Influenza A(H1N1)pdm09 viruses predominated through July. Since then, the proportion of influenza A(H3N2) viruses among reported detections has increased and has become predominant since the end of September (Fig. 3).
Figure 1. Virus detections by subtype reported to FluNet, from 1 June to 30 November 2025 for the northern hemisphere temperate and sub-tropical countries, areas and territories.
![\"FluNet_northern](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/flunet_northern-hemisphere.png?sfvrsn=23302bc6_4\" "\\"FluNet_northern")
Source: GISRS: https://worldhealthorg.shinyapps.io/flunetchart/
Figure 2. Virus detections by subtype reported to FluNet, from 1 June to 30 November 2025, for the southern hemisphere temperate and sub-tropical countries, areas and territories.
![\"FluNet_southern](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/flunet_southern-hemisphere.png?sfvrsn=449e965b_3\" "\\"FluNet_southern")
Source: GISRS: https://worldhealthorg.shinyapps.io/flunetchart/
Figure 3. Virus detections by subtype reported to FluNet, from 1 June to 30 November 2025, for tropical countries, areas and territories.
![\"FluNet_tropical](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/flunet_tropical-countries--areas-and-territories.png?sfvrsn=b966692a_4\" "\\"FluNet_tropical")
Source: GISRS: https://worldhealthorg.shinyapps.io/flunetchart/
Genetic characteristics of recent seasonal influenza viruses
Influenza A(H1N1)pdm09 and influenza B/Victoria lineage viruses continue to circulate in all regions albeit at low levels.
Influenza A(H3N2) viruses
Based on genetic sequence data available in GISAID, a mixture of A(H3N2) haemagglutinin (HA) clades and subclades are currently circulating globally; however, there has been a recent and rapid rise in a particular subclade of A(H3N2), J.2.4.1 (alias subclade K Nextclade/Nextstrain nomenclature). A(H3N2) subclade K viruses have genetically drifted from related J.2.4 viruses and have several amino acid changes in their HA in comparison. Detections of subclade K viruses are increasing in many parts of the world, with the exception, to date, of South America. Subclade K viruses were particularly evident from August 2025 in Australia and New Zealand and have now been detected in more than 34 countries over the last 6 months.
Figure 4. Influenza A(H3N2) percent positivity reported for epidemiological week 48 (24 to 30 November) 2025
![\"FluNet_Influenza](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/flunet_influenza-a(h3n2).png?sfvrsn=464463f3_3\" "\\"FluNet_Influenza")
Source: GISRS: https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenza-surveillance-outputs
Overview of seasonal influenza by WHO Region
African region
Influenza detections in the WHO African Region overall increased in October with influenza A(H3N2) predominant. The timing and predominant virus varied by zone. In the western part of the region, influenza detections increased in September and October with A(H3N2) predominant since October. All seasonal subtypes have been detected continuously in the middle and eastern parts of the region. Influenza activity peaked in May 2025 in South Africa with almost exclusively A(H3N2) detections; in recent weeks influenza activity has increased slightly but remained low.
Eastern Mediterranean Region
While influenza activity in the WHO Eastern Mediterranean Region overall increased in October with A(H3N2) viruses predominant, there were variations by zone. In countries in the northern part of the region, influenza detections increased in October with influenza A(H1N1)pdm09 predominant and lesser proportions of influenza A(H3N2) and B virus detections reported. In the Arabian Peninsula, influenza detections also increased in October but with influenza A(H3N2) viruses predominant.
European Region
As of 21 November 2025, reported rates of influenza-like illness (ILI) and/or acute respiratory infection (ARI) in primary care were at baseline levels for most countries and areas of the WHO European Region. However, detections were increasing and regionally pooled test percent positivity in primary care sentinel surveillance rose above 10% in weeks 45 and 46 (ending on 15 November), marking the start of the 2025/26 influenza season for the European Region. This was approximately four weeks earlier than the median, but not out of the ordinary, with epidemiological trends similar to those observed in the 2022/23 influenza season.
Influenza activity was variable between countries, with those in the west of the Region generally seeing earlier increases of influenza indicators compared to others. Influenza admissions, detections, and percent positivity in hospital surveillance were also increasing from inter-seasonal levels, with a higher proportion aged 65 years or older. A majority of influenza detections from sentinel and non-sentinel primary care and hospital surveillance systems were A(H3N2) viruses.
Region of the Americas
During the 2025 southern hemisphere season in the Americas, influenza transmission exceeded the seasonal threshold in mid-March, remaining mostly at low to moderate levels. Circulation was driven by influenza A(H1N1)pdm09, reaching a peak positivity of 19%. Activity then declined to low levels until the end of August, when an increase in circulation was observed, associated with influenza A(H3N2) in Brazil and Chile. As of beginning of November, Chile remains at moderate levels of influenza A(H3N2) transmission, without evidence of increased severity or rises in outpatient consultations. As of 4 November 2025, subclade K had not been detected in South America.
In the northern hemisphere countries of the Americas, during week 45 of 2025, seasonal influenza circulation remained low, with influenza A(H1N1)pdm09 predominating in the Caribbean and Central America. In North America, influenza activity—although still low—was increasing, mainly driven by influenza A virus detections. While most detections in Mexico were influenza A(H1N1)pdm09, a predominance of influenza A(H3N2) has been observed in the United States and Canada, with growing detections of the A(H3N2) subclade K.
South-East Asia Region
Influenza detections in the South-East Asia Region started increasing from June, peaked in August and since then have generally remained low with some exceptions. During the 2025 till November, the proportion of Influenza A among all influenza viruses tested positive was 66% Influenza A(H3N2) was the predominant sub-type (43%) in transmission followed by A(H1N1)pdm09 (~20%). In Thailand, influenza detections of predominantly A(H3N2) increased in October and November. Influenza A(H3N2) detections also increased since July in Bangladesh and October in Sri Lanka. While the region has seen an increase in Influenza A(H3N2), 22 sequences of subclade K have been reported in GISAID from Nepal (1), India (4) and Thailand (17) as of 30 November.
Western Pacific Region
Since the beginning of October 2025, influenza seasonal activity has increased in the Western Pacific Region. In some countries, including Japan and the Republic of Korea, the onset of the typical seasonal influenza activity period started earlier than in previous years. As of 9 November 2025, influenza positivity ranged from 8% to 56% in the northern hemisphere countries. In southern hemisphere countries, influenza activity shows mixed trends; positivity has declined in Australia, remains high in New Zealand and is rapidly increasing in Fiji. The elevated influenza activity in New Zealand and Fiji is unusual for this time of the year.
The predominant circulating influenza subtype is influenza A(H3N2), marking a shift from A(H1N1)pdm09, which predominated during the 2024-2025 northern hemisphere winter season. The increases in influenza have predominantly been driven by the expansion of A(H3N2) subclade K, which represents 89% of sequences submitted to GISAID from the Western Pacific Region (as of 21 November 2025).
","DonId":"2025-DON586","Provider":"dynamicProvider372"},{"Id":"f15969ab-d67f-4380-b32b-98b301dcb5ad","LastModified":"2025-12-07T11:20:03Z","PublicationDate":"2025-12-05T17:52:36Z","DateCreated":"2025-12-05T17:52:36Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2025-DON587","ItemDefaultUrl":"/2025-DON587","Response":"WHO maintains global mpox surveillance and continues to provide response guidance for all countries and support to access diagnostics and vaccines through multi-partner coordination. WHO and partners have established the International Coordinating Group for mpox vaccine provision (ICG) to further accelerate timely outbreak response and ensure sustainable support for the future. Furthermore, WHO continues to evaluate available rapid diagnostic tests for field use.
Public health response measures taken in the affected WHO Regions include:
Citable reference: World Health Organization (5 December 2025). Disease Outbreak News; Broader transmission of clade Ib mpox - Global situation. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON587
","Summary":"The purpose of this report is to raise awareness about the local transmission of clade Ib monkeypox virus (MPXV) among men who have sex with men (MSM) in countries previously unaffected or to date reporting only cases linked to travel. This report summarizes recent epidemiological developments, response activities, and the associated global public health risk.\r\n\r\nThe second declaration of a public health emergency of international concern (PHEIC) for mpox was lifted on 5 September 2025. As both MPXV clades I and II and their subclades continue to circulate globally, leading to substantial outbreaks in African countries, WHO continues to advise emergency preparedness and response activities. Multiple modes of transmission underlie ongoing virus circulation, with sexual contact remaining the primary amplifier of transmission in most settings.\r\n\r\nSince 5 September 2025, several countries across four of six WHO regions have confirmed clade Ib MPXV infection in individuals with no recent travel reported (WHO African Region, Region of the Americas, the European Region and the Western Pacific Region), most of which are being detected among men who have sex with men, suggesting local transmission, particularly given that infections often manifest with few or no symptoms (paucisymptomatic or asymptomatic cases) leading to undetected onward transmission. \r\n\r\nOverall, the surveillance data in most countries is sufficient to detect and respond effectively to mpox outbreaks. However, thorough epidemiological investigation, contact tracing and implementation of public health interventions to control spread remain challenging. Mpox is known to resolve on its own over two to four weeks in most cases. However, timely access to quality healthcare is essential to identify, prevent and manage secondary bacterial infections and other complications. Individuals living with immune suppressive conditions remain at high risk of more severe mpox disease and death, most notably people living with undetected and/or untreated, uncontrolled human immunodeficiency virus (HIV) infection. Men who have sex with men with new and/or multiple partners remain at increased risk of clade Ib and also IIb MPXV infection. WHO assesses the public health risk posed by clade Ib MPXV to men who have sex with men as moderate and the risk to the general population as low in most countries.\r\n","PublicationDateAndTime":"2025-12-05T19:00:00Z","TitleSuffix":"","UseOverrideTitle":true,"Title":"Broader transmission of mpox due to clade Ib MPXV \u2013 Global situation","Epidemiology":"Mpox is an infectious disease caused by the MPXV, divided into two clades, clade I (including subclades Ia and Ib), and clade II (including subclades IIa and IIb. Historically associated with zoonotic transmission in tropical rainforest regions of East, Central and West Africa, mpox has in recent years predominantly spread through human-to-human transmission and has rapidly emerged across all WHO regions. Subclades Ia and Ib have been following the emergence of clade Ib in South Kivu province of the Democratic Republic of the Congo in 2023. Clade Ia is currently considered to encompass all other strains of Clade I that are not Ib. Clade IIb continues to circulate in all WHO regions since 2022.
The virus is primarily transmitted through close physical contact with a person who has mpox, through sexual contact or other forms of direct skin-to-skin contact, for example from parent to child. Other documented routes include indirect contact with contaminated materials, occasionally non-physical contact such as close-range inhalation of infectious respiratory particles, and vertical transmission from mother-to-child during pregnancy or childbirth. In historically endemic areas transmission can also occur from animals to humans through contact with live animals or consumption of contaminated bushmeat. Emerging evidence indicates that exposure to MPXV can result from subclinical infection in another person and silent shedding of the virus, particularly in genital and anal secretions, which can facilitate further transmission during sexual contact.
Mpox causes signs and symptoms which usually begin within 3-7 days of exposure and can start as soon as one or rarely up to 21 days later. Symptoms typically last for two to four weeks but may last longer in someone with a weakened immune system, for example as a result of advanced untreated HIV infection. Fever, muscle aches and sore throat may appear first, followed by an evolving skin rash and/or mucosal lesions, or appearance of such lesions may precede systemic symptoms. Lymphadenopathy (swollen lymph nodes) is also a typical feature of mpox, present in most cases. Transmission through sexual contact has been observed to lead to the appearance sometimes of only genital lesions. Children, pregnant women and people with weak immune systems, most commonly due to advanced HIV infection, are at risk of developing complications and dying of mpox.
Laboratory testing is necessary to confirm mpox, particularly for the first cases in an outbreak or new geographic area. The primary diagnostic test for MPXV infection is polymerase chain reaction (PCR). The best diagnostic specimens are taken directly from lesion material – on skin or mucosae, such as lesion fluid or crusts – collected by vigorous swabbing. In the absence of skin or mucosal lesions, testing can be done on oropharyngeal, anal or rectal swabs. However, while a positive result of oropharyngeal, anal or rectal sample confirms mpox, a negative result is not enough to rule out MPXV infection. Testing of blood is not recommended as any viremia is usually brief and individuals can test negative just a few days after infection. Serology does not distinguish between different orthopoxviruses and is therefore restricted to reference laboratories where antibody detection methods may be applied for retrospective case classification or in special studies.
Treatment is based primarily on managing clinical symptoms, ensuring skin care, eye care, reducing pain, and preventing and managing secondary bacterial infections and other complications. Where available through clinical studies or emergency access protocols, specific antiviral medications may also be used in the treatment of mpox, particularly for severe cases or individuals at higher risk of complications.
Vaccines for use to prevent mpox are available to all countries. WHO recommends use of MVA-BN (non-replicating) or LC16m8 (minimally replicating) vaccine as indicated, or ACAM2000 (replicating) vaccine based on an individual risk-benefit assessment when the others are not available. In the context of an outbreak, vaccination is recommended by WHO for individuals at high risk of exposure to mpox, such as sex workers; gay, bisexual or other men who have sex with men; or other individuals with multiple sexual partners; health workers and frontline workers, contacts of known mpox cases, and other affected groups in a geographically defined area or community (based on local epidemiology).
","OverrideTitle":"Broader transmission of mpox due to clade Ib MPXV \u2013 Global situation","Advice":"Community transmission of clade Ib MPXV is occurring in many countries within and beyond Africa. WHO strongly advises that countries continue to follow the Standing Recommendations issued in 2023 and extended through 20 August 2026, particularly concerning the epidemiological surveillance of mpox and the strengthening of laboratory diagnostic capacities in line with WHO guidance, together with all other elements of response including risk communication and community engagement and ensuring access to mpox vaccine for people at risk. Countries must have, or arrange access to, diagnostic capacities to detect both MPXV clades and subclades. Public health authorities are strongly encouraged to ensure access to genomic sequencing capacity for virus clade identification for new cases and clusters of cases as part of comprehensive prevention and response measures.
The WHO Strategic framework for enhancing prevention and control of mpox (2024–2027) outlines a road map to prevent and control outbreaks characterized by human-to-human transmission in every context, advance mpox research and access to countermeasures, and minimize zoonotic transmission where relevant in some African countries.
Countries and communities are strongly encouraged to enhance preparedness, foster community ownership, widen access to vaccination for people at risk, and ensure cross-border coordination, especially in regions with mobile and vulnerable populations. In terms of risk communication, community engagement and infodemic management (RCCE-IM), countries are encouraged to:\u202f\u202f
Mpox vaccines formulated with vaccinia virus provide protection against mpox. WHO recommends vaccination against mpox in the context of an outbreak for people most at risk of exposure to mpox and for preventive use for laboratory personnel working with orthopoxviruses, in line with recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and the WHO position paper on mpox vaccines. Two vaccines currently in use for mpox are recommended. MVA-BN (non-replicating vaccine) has been prequalified by WHO and broadly used in outbreak response and LC16m8 (minimally replicating vaccine) has received a WHO emergency use listing (EUL) and is used in Japan and the DRC and has also been used in Colombia. LC16 is contraindicated for use in pregnancy, immunocompromised individuals, and those suffering from a proliferative skin condition. WHO recommends a vaccination for people at risk or where relevant in geographic areas at risk to interrupt transmission. National authorities are encouraged, as a temporary outbreak response measure, to administer MVA-BN vaccine via intradermal injection at one fifth of the dose normally administered subcutaneously (also known as fractional dosing) to protect individuals at risk of exposure and facilitate reaching four to five times as many people. Intradermal vaccination with MVA-BN has been shown to be effective and safe.
Anyone with a clinical or laboratory-confirmed diagnosis of mpox should follow the instructions of local health authorities, including isolation in a health facility or at home for the duration of the infectious period. Persons with mpox should avoid travel, including local and international travel, unless the reason for travel is to seek medical care, until they do not present any mpox symptoms and the scabs have fallen off and a fresh layer of skin has formed underneath.\u202f Contacts of a confirmed case are asked to limit their movements (and to abstain from sexual relations) for 21 days, the maximum incubation and monitoring period for the appearance of possible symptoms.
WHO strongly recommends implementation of optimized clinical care for patients with mpox, to reduce the risk of medical complications and long-term sequelae and improve health outcomes. Mpox disproportionally affects people living with HIV, with a higher risk of severe disease, hospitalization or death in people with advanced HIV disease. WHO strongly recommends early HIV testing for all patients with suspected or confirmed mpox and rapid initiation of antiretroviral therapy (ART) in people living with untreated HIV who are diagnosed with mpox.
Health authorities at all levels should provide travellers with information to protect themselves and others before, during and after travel to mpox-affected countries or attending events or gatherings where mpox may present a risk. WHO does not recommend any restriction on travel to or trade with the countries named in this report.
For additional information on WHO public health advice to reduce the risk of mpox please see the resources listed below in the further information section.
In light of the epidemiological developments presented above and confirmation of community transmission of clade Ib MPXV in all WHO regions, WHO assesses the public health risk posed by clade Ib MPXV as moderate for men who have sex with men with new and/or multiple partners, and the risk to the general population as low.
The rationale for this assessment is outlined below.
When timely and good quality care is available, mpox generally causes a mild to moderate disease characterized by systemic symptoms and localized skin and/or mucosal lesions. However, secondary bacterial infections and other complications can lead to severe illness and death. In most settings, the proportion of cases where death occurs (case fatality ratio) is below 1%. Risk factors for severe disease and death include immunosuppression from any cause, such as uncontrolled HIV, younger age (0-4 years) and pregnancy. In recent years, people living with untreated or uncontrolled HIV have experienced the highest burden of mpox-related mortality. In African countries, deaths have also occurred among young children, pregnant women and their unborn or newborn infants, and individuals with other immunocompromising conditions.
WHO has twice declared a PHEIC for mpox in recent years. The first, in 2022, was linked to a multi-country outbreak of clade IIb MPXV spreading through sexual networks across all regions of the world, primarily among men who have sex with men who have more than one partner. Transmission beyond this group during the global outbreak remained very limited, and was brought under control in the second half of 2023, with low-level sporadic transmission persisting in the same population, likely due to mild, undetected or subclinical transmission through sexual contact.
The second PHEIC for mpox was declared in 2024 due to the rising number of mpox cases reported in Africa and the spread of the newly identified clade Ib MPXV across several African countries, most of which were affected by mpox for the first time and noted both sexual and non-sexual contact transmission. These outbreaks have led to sustained community transmission of this strain in several countries primarily in Central and East Africa. In many settings, transmission was initially driven by heterosexual contact among people with multiple casual sexual partners in linked sexual networks which included but were not limited to sex workers, followed by secondary spread within households. In most of these settings, virus circulation persists through both recognized and cryptic (undetected or unreported) transmission.
The locally acquired cases of mpox due to clade Ib MPXV described above in individuals in multiple countries and WHO regions suggest that undetected transmission of this subclade is occurring independently in these settings. This transmission is likely accelerated due to some infections with no or minimal symptoms (asymptomatic or paucisymptomatic cases), leading to further onward transmission, predominantly through sexual contact. This hypothesis is supported by the rising proportion of clade Ib MPXV cases among men who have sex with men. It is likely that clade Ib MPXV will continue to spread, and that community transmission will become established in more countries, primarily mediated by sexual contact in extended sexual networks. Men who have sex with men, particularly those with a high number of casual sexual contacts, remain at increased risk of mpox, including clade Ib MPXV infection. Currently, immunity to mpox in this population is a result of vaccination efforts since 2022 in some countries and immunity conferred by exposure to mpox during the clade IIb MPXV outbreak. However, many countries were not able to offer mpox vaccination, access was constrained in some countries where vaccine was available, and many individuals received an incomplete course of vaccination. In addition, since the peak of vaccination activities in late 2022, new cohorts of young individuals have entered the sexually active population. These individuals are more likely to be immunologically naïve having neither had previous infection nor been reached by vaccination activities. Furthermore, available data on vaccine effectiveness, uncertainty around the duration of protection against mpox following vaccination or prior infection, uncertainty regarding cross-clade protection of prior immunity during outbreaks with ongoing virus strain evolution, together with emerging data on waning humoral immunity over time, all limit confidence that those vaccinated or infected in 2022 and 2023 continue to retain protective immunity. Furthermore, of all cases reported by the countries noted here from 5 September to 24 November, only half were among men who have sex with men, suggesting continuing risk in other groups.
All cases reported here are clinically stable and in isolation or recovered from the disease. The known contacts for most of them were followed up for 21 days to ensure early recognition of symptoms and diagnosis. The clinical risk for these cases and their contacts is low, notably if they have been vaccinated and are not immunocompromised.
Data from the global outbreak related to clade IIb, and the multiple importations of clade Ib MPXV in the last year, suggests that transmission of mpox outside sexual networks has been relatively limited in most high-income settings. In this context, the risk of community transmission of mpox across different population groups is still considered to be low. However, given the large outbreaks and extensive community transmission of clade Ib MPXV in Africa affecting different populations, including children, together with associated outbreaks in many countries, it remains critical to maintain vigilance in all regions, and most notably for population groups at higher risk of sexual transmission.
While affected countries have developed the capacity to detect and respond effectively to mpox outbreaks, in-depth epidemiological investigation and contact tracing remain challenging. Individuals with mpox are often reluctant to disclose their exposure history or current sexual contacts, which hinders full mapping of transmission chains and raises the likelihood of undetected onward spread. Prompt isolation of cases, identification and monitoring of reported contacts, and timely administration of post\u2011exposure vaccination to at-risk contacts, ideally within four days of exposure, all help to reduce the immediate risk of secondary cases. However, given that sexual transmission of clade Ib is now occurring in many countries, the risk is high that clade Ib MPXV will continue to spread in newly affected countries and to other countries around the world.
In light of these recent developments, WHO assesses the public health risk posed by clade Ib MPXV for men who have sex with men with new and/or multiple partners as moderate and to the general population as low. The risk for men is justified by the higher risk of exposure in this population, and the prevalence of advanced HIV infection in this group in many contexts compared to the general population. The higher risk is mitigated by residual protective benefit of previous natural infection and/or prophylactic vaccination in this group in some areas. The extent to which immunity in the group could indirectly benefit younger individuals or those not previously vaccinated or exposed is not known and will continue to diminish over time if access to vaccines is not sustained.
All mpox outbreaks, including individual locally acquired cases, should be assessed in their local context to better understand the epidemiology, transmission patterns, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control. Regardless of geographic area, epidemiological context, gender identity or sexual behaviour, an individual’s risk largely depends on factors such as exposure risk and immune status.
","Overview":"Since the lifting of the second PHEIC for mpox on 5 September 2025, and as of 24 November 2025, 43 new confirmed cases of clade Ib MPXV have been reported across six WHO regions outside areas where sustained community transmission of this virus strain has been occurring. In four of these regions (Region of the Americas, South-East Asia Region, European Region and the Western Pacific Region), 24 cases had reported no recent international travel, suggesting local transmission. Based on this, Italy, Malaysia, the Netherlands, Portugal, Spain, and the United States of America are now considered to be experiencing community transmission of clade Ib MPXV. In addition, travel-related cases continue to be reported in many countries.
Among the 43 cases, half (22) were documented among men who have sex with men, while other cases were linked to travel to countries with known community transmission of clade Ib, or secondary to travel-related cases (household contacts and/or sexual partners).
This report provides an overview of these recent cases of mpox confirmed to be due to clade Ib MPXV, by WHO region and country, summarizing key available epidemiological information, followed by WHO’s rapid risk assessment and public health advice.
Since the lifting of the PHEIC on 5 September 2025 and as of 24 November 2025, one country, Namibia, has reported clade Ib MPXV cases for the first time. Community transmission persists in Burundi, the Democratic Republic of the Congo, Kenya, Malawi, Mozambique, Republic of Congo, Rwanda, South Africa, the United Republic of Tanzania, Uganda, and Zambia.
Namibia notified WHO of one probable and two confirmed cases of mpox due to clade Ib MPXV. The index (probable) case linked to travel within the African Region and the two confirmed cases were his household contacts. No further cases have been reported following detection of this cluster.
These are the first cases of mpox reported in the country.
Two countries in the WHO Americas Region have reported a total of four confirmed cases of mpox due to clade Ib MPXV. One case detected in Canada had recently travelled, while three cases in the United States of America had no recent travel history or known epidemiological links to travellers.
Canada notified WHO of one confirmed mpox case due to clade Ib MPXV in an adult male with recent travel outside of the country and reporting no sexual partners after returning to Canada. The case received counselling on preventing further transmission.
The United States of America reported three unrelated cases of mpox due to clade Ib MPXV in Long Beach (one case) and Los Angeles (two cases) counties, California. All three occurred among men who have sex with men, none of whom had a history of recent international travel or known exposure to mpox cases. None of the individuals had a previous MPXV infection or prior orthopoxvirus vaccination, and one case was immunocompromised. All three individuals were hospitalized, received standard medical care, and have fully recovered. Prior to the lifting of the PHEIC, the United States of America had reported six cases of mpox due to clade Ib MPXV, all linked to travel.
Public health authorities conducted contact tracing among household, healthcare-facility and social contacts. No additional cases of mpox due to clade Ib MPXV have been detected to date. Public health investigations suggest ongoing community transmission of clade Ib MPXV among men who have sex with men and their social networks in southern California. Viral genomic sequencing data indicate that the three California cases may be linked to a previously reported case in the country in August 2025.
From 5 September to 24 November 2025, five cases of mpox due to clade Ib MPXV have been reported in the WHO South-East Asia Region, all in Thailand. All cases had a recent history of international travel and three self-identified as men who have sex with men.
Thailand notified WHO of five new cases of mpox cases due to clade Ib MPXV. The cases included four males, three of whom self-identified as men who have sex with men, and one female. Travel histories indicate associations with recent travel to the United Arab Emirates, Oman, and the Russian Federation, where exposure to infection is likely to have occurred. Prior to 5 September, Thailand had reported five cases of mpox due to clade Ib MPXV, all of which were associated with international travel.
Three countries in the WHO Eastern Mediterranean Region, Egypt, Lebanon and Qatar have reported six cases of mpox. Although the clade was not documented in Egypt and Lebanon, two cases attributed to clade Ib MPXV were reported in Qatar.
Qatar notified WHO of two cases of mpox due to clade Ib MPXV. One adult male and one adult female, linked to travel within the Eastern Mediterranean Region. Prior to this period, Qatar had reported three cases of mpox due to clade Ib MPXV, all of which were associated with international travel.
Countries in the WHO European Region have reported a total of 27 mpox cases due to clade Ib MPXV. Of these, 18 cases were classified as autochthonous, with no relevant history of recent international travel, suggesting undetected community transmission (Italy, the Netherlands, Portugal, and Spain). Two cases (reported from Belgium and the United Kingdom) were related to travel within Europe and five cases to travel outside of Europe (East Africa, Uganda, United Arab Emirates), either to or from countries experiencing community transmission of clade Ib MPXV but also to or from countries where no community transmission has been reported, including Angola, the United Arab Emirates, and Viet Nam. Furthermore, at least 15 of the 27 cases, and 14 of the 18 locally acquired cases occurred among individuals who self-identified as men who have sex with men.
Belgium reported to WHO one case of mpox due to clade Ib MPXV with recent travel to the Netherlands. This individual reported having had multiple sexual contacts with other men while in the Netherlands. Prior to 5 September, Belgium had reported six mpox cases caused by clade Ib MPXV, all linked to travel.
France notified WHO of one case of mpox due to clade Ib MPXV in an adult male traveller who had returned from East Africa. Prior to this period, France had reported three cases of mpox due to clade Ib MPXV, all linked to travel.
Germany notified WHO of three cases of mpox due to clade Ib MPXV. All three cases had a recent history of international travel: one, an adult male who had travelled to Angola, another an adult female who had travelled to Uganda, and the third, an adult male who had travelled to Viet Nam. Uganda has community transmission of clade Ib and Viet Nam has not previously reported cases of this subclade. Prior to 5 September, Germany had reported 12 mpox cases due to clade Ib MPXV, most of which were linked to travel.
Greece notified WHO of its first case of mpox due to clade Ib MPXV, in an adult male with a recent history of travel to the United Arab Emirates before arriving in Greece.
Ireland reported two cases linked to a small cluster which was reported before 5 September 2025. The index case had history of recent travel outside Europe. The first locally acquired case was a child (<5 years) who contracted clade Ib MPXV through household transmission, and the second a healthcare worker who had cared for one of the earlier cluster cases. No additional cases have been identified following this localized clade Ib cluster. Prior to this period, Ireland had reported one confirmed case of mpox due to clade Ib MPXV, which was linked to a traveller who was a probable case and part of that same cluster.
Italy notified WHO of two cases of mpox due to clade Ib MPXV in adult males who had no history of recent international travel or known contact with mpox cases. There was no epidemiological link between these cases. Epidemiological investigations and contact tracing were conducted, and no additional cases were identified.
The identification of these cases of mpox due to clade Ib MPXV in Italy, without any links to travel, suggests local community transmission of clade Ib MPXV in the country. Prior to this period, Italy had reported one case of mpox due to clade Ib MPXV, linked to travel the United Republic of Tanzania.
The Netherlands has reported nine cases of mpox due to clade Ib MPXV, all without relevant history of recent travel. These are the first such cases of mpox reported in the country. Eight cases were reported among individuals who identify as men who have sex with men. Of these, six individuals reported visiting the same highly frequented sex-on-premises venue. These cases suggest local community transmission of clade Ib MPXV in the country. Prior to the 5 September, the Netherlands had not reported any cases of mpox due to clade Ib MPXV.
Portugal notified WHO of its first confirmed case of mpox case due to clade Ib MPXV. The case is an adult male with no history of recent international travel, with an inconsistent exposure context, and no known link to a case. There were no identified contacts, and the case was provided with guidance on home isolation, suspension of all sexual contact, and adherence to hygiene measures until full lesion resolution. Subsequently, the case ceased communication with health authorities.
In Portugal, outbreak prevention and control measures are still ongoing at national and subnational levels. Reinforcement of clinical, laboratory and epidemiological detection, as well as engagement with civil society and the most at-risk communities promoting vaccination, has been in place. No further cases of mpox due to clade Ib have been detected in Portugal.
The identification of this case of mpox due to clade Ib MPXV in Portugal, without any link to travel, and although no other cases have been detected, suggests local community transmission of clade Ib MPXV in the country.
Spain reported six cases of mpox due to clade Ib MPXV in individuals with no recent history of international travel or known contact with mpox cases. Two additional I MPXV cases were reported without further subclade information. These are the first cases of mpox due to clade Ib MPXV reported in the country. All cases were among individuals who identify as men who have sex with men. The identification of cases of mpox due to clade Ib MPXV in Spain, without any link to travel, suggests local community transmission of clade Ib MPXV in the country.
The United Kingdom notified WHO of one case of mpox due to clade Ib MPXV with travel history within Europe. This patient was a man who reported having sex with other men. Prior to this case, the United Kingdom had reported 18 clade Ib cases, most of whom reported direct or indirect links to travel to countries where clade Ib MPXV is circulating.
From 5 September to 24 November 2025, three cases of mpox due to clade Ib MPXV have been reported in the WHO Western Pacific Region: one each in Australia, Japan, and Malaysia.
Australia notified WHO of one case of mpox due to clade Ib MPXV in an adult male who reported recent travel to China and to the Philippines, where he was most likely infected. The Philippines have not reported any cases of mpox due to clade Ib MPXV. Prior to 5 September, three cases of mpox due to clade Ib MPXV, all linked to travel, had been reported in Australia.
Japan notified WHO of its first case of mpox due to clade Ib MPXV in adult female who reported recent travel to Africa, where she was most likely exposed to the virus.
Malaysia notified WHO of its first case of mpox due to clade Ib MPXV in an adult male, who self-identified as a man who has sex with men. He had no history of recent international travel nor any link to a known case. The person reported sexual contact with at least one individual during the three weeks prior to symptom onset. Contact tracing identified 15 household and healthcare contacts who underwent monitoring and no additional cases followed. The identification of this case of mpox due to clade Ib MPXV in Malaysia, without any link to travel, suggests local transmission of clade Ib MPXV in the country.
![\"Table](\"https://cdn.who.int/media/images/default-source/emergencies-and-disasters/table-1.-summary-of-mpox-due-to-clade-ib-mpxv--by-country--5-september-to-24-november-2025.png?sfvrsn=10d75cdb_1\" "\\"Table")
*One additional case is not yet confirmed; therefore, it is not included in the table.
**Two additional cases of mpox due to clade I MPXV among MSM, with no recent travel, did not have subclade information available
","DonId":"2025-DON587","Provider":"dynamicProvider372"},{"Id":"92731816-3909-4b16-bd67-3bb7f8220ae9","LastModified":"2025-12-05T17:06:44Z","PublicationDate":"2025-12-05T17:06:31Z","DateCreated":"2025-12-05T17:06:44Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2025-DON590","ItemDefaultUrl":"/2025-DON590","Response":"The CDC and State public health officials have initiated several public health response measures:
[1]Lam TT, Davis CT, WHO/WOAH/FAO H5 Evolution Working Group. Nomenclature updates to the hemagglutinin gene clade designations resulting from the continued evolution of high pathogenicity avian influenza A(H5) virus clades 2.3.2.1c and 2.3.4.4. bioRxiv. 2025 Nov 23;2025.11.23.690055. doi:10.1101/2025.11.23.690055.
[2]Erdelyan CNG, Kandeil A, Signore AV, et al. Multiple transatlantic incursions of highly pathogenic avian influenza clade 2.3.4.4b A(H5N5) virus into North America and spillover to mammals. Cell Rep. 2024 Jul 23;43(7):114479. doi:10.1016/j.celrep.2024.114479. Epub 2024 Jul 13. PMID:39003741; PMCID:PMC11305400
[3] World Health Organization. WHO Collaborating Centres and Essential Regulatory Laboratories in the Global Influenza Surveillance and Response System (GISRS) [Internet]. Geneva: WHO; 2025. Available from: https://www.who.int/initiatives/global-influenza-surveillance-and-response-system/who-collaboration-center-erl
Citable reference: World Health Organization (5 December 2025). Disease Outbreak News; Avian Influenza A(H5N5)- United States of America. Available at: https://www/who.int/emergencies/disease-outbreak-news/item/2025-DON590
Animal influenza viruses typically circulate within animal populations, but some have the potential to infect humans. Human infections are predominantly acquired through direct contact with infected animals or exposure to contaminated environments. Based on the original host species, influenza A viruses can be categorized such as avian influenza, swine influenza, and other animal-origin influenza subtypes.
Human infection with avian influenza viruses may result in a spectrum of illness, ranging from mild upper respiratory tract symptoms to severe, life-threatening conditions. Clinical manifestations may include conjunctivitis, respiratory, gastrointestinal symptoms, encephalitis (brain swelling), and encephalopathy (brain damage). In some cases, asymptomatic infections with the virus have been reported in individuals with known exposure to infected animals and environments.
A definitive diagnosis of human avian influenza infection requires laboratory confirmation. WHO regularly updates its technical guidance on the detection of zoonotic influenza, utilizing molecular diagnostic methods such as RT-PCR. Clinical evidence indicates that certain antiviral agents, particularly neuraminidase inhibitors (e.g., oseltamivir, zanamivir), have been shown to shorten the duration of viral replication and improve patient outcomes in some cases. This antiviral agent should be administered within 48 hours of symptom onset.
High pathogenicity avian influenza A(H5) clade 2.3.4.4b A(H5N5) viruses have been detected in North America in wild birds and wild mammals since at least 2023.[2] This is the first laboratory-confirmed human infection with an influenza A(H5N5) virus in the United States of America and reported globally.
","OverrideTitle":"","Advice":"This event does not change the current WHO recommendations on public health measures and surveillance of influenza.
Given the current situation of influenza viruses at the human-animal-environmental interface, WHO does not recommend special traveler screening at points of entry or any restrictions.
Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect and monitor virological (including genomics), epidemiological and clinical changes associated with emerging or circulating influenza viruses that may affect human health and timely virus sharing for risk assessment.
When humans have been exposed to an influenza A virus outbreak in domestic poultry, wild birds, or other animals or when a human case of infection is identified, enhanced surveillance of potentially exposed human populations becomes necessary. This surveillance should consider the healthcare-seeking behaviour of the population and may include a range of active and passive approaches, such as enhanced surveillance in influenza-like illness (ILI)/severe acute respiratory infection (SARI) systems, active screening in hospitals, and among groups at higher occupational risk of exposure. It should also consider other sources, such as traditional healers, private practitioners, and private diagnostic laboratories.
Given the observed widespread occurrence of avian influenza in poultry, wild birds and some wild and domestic mammals, the public should avoid contact with any sick or dead animals. Individuals should report deceased birds and mammals or request their removal by contacting local wildlife or veterinary authorities. Eggs, poultry meat, and other poultry products should be properly cooked and handled during food preparation. Due to potential health risks, consumption of raw milk should be avoided. WHO advises consuming pasteurized milk and if pasteurized milk is not available, heating raw milk until it boils makes it safer for consumption.
In the case of a confirmed or suspected human infection caused by a novel influenza A virus with pandemic potential, including avian influenza viruses, early clinical management, a thorough epidemiologic investigation of animal exposure history, travel, and contact tracing should be conducted even while awaiting the confirmatory laboratory results. The epidemiologic investigation should also include early identification of unusual events that could signal person-to-person transmission of the novel virus. Clinical samples collected from confirmed or suspected cases should be tested and sent to a WHO Collaborating Center[3] for further characterization. Additional samples should be collected from animals, the environment or any foods suspected to be sources of infection.
WHO advises travelers to countries with known animal influenza outbreaks to avoid farms, live animal markets, areas where animals may be slaughtered and contact with any surfaces potentially contaminated by animal feces. Travelers should also wash their hands frequently with soap and water and should follow good food safety and good food hygiene practices. If infected individuals from affected areas travel internationally, their infection may be detected either during travel or upon arrival. However, further community level spread is considered unlikely, as this virus has not yet acquired the ability to transmit easily among humans.
Poultry workers should take additional health precautions as they are at higher risk of exposure to avian influenza and other zoonotic diseases due to their close contact with birds and potentially contaminated environments. Farm workers who have direct or close contact with animals or materials infected or contaminated with avian influenza A(H5) virus, should wear appropriate personal protective equipment (PPE) to minimize their risk of exposure.
All human infections caused by a novel influenza A virus subtype are notifiable under the International Health Regulations (IHR,2005) and State Parties to the IHR are required to immediately notify WHO within 24 hours of any laboratory-confirmed case of a recent human infection caused by an influenza A virus due to the potential to cause a pandemic. Evidence of illness is not required for this report. WHO has updated the influenza A(H5) confirmed case definition on the WHO website.
Currently, there are no readily available vaccines against influenza A(H5) virus for humans. Candidate vaccine viruses for pandemic preparedness have been selected against several A(H5) clades. Existing seasonal influenza vaccines are unlikely to provide protection to against avian influenza A(H5) viruses, based on currently available data. Close monitoring of the epidemiological situation and serological investigations are essential for assessing risk and adjusting risk management measures as needed..
WHO does not recommend any restriction on travel to or trade with the United States of America, based on the information available on the current event.
","Assessment":"Human infections with avian influenza A(H5) viruses are considered unusual, as A(H5) viruses remain primarily avian influenza viruses. However, in rare cases, individuals exposed to infected animals or contaminated environments can become infected with A(H5) viruses. Influenza A(H5N5) viruses are detected in birds, including wild birds and domestic poultry, and sometimes in non-human mammals. When avian influenza viruses circulate in poultry populations, there is an inherent risk of human infection through exposure to infected birds or contaminated environments. As such, sporadic human cases are expected. The case had underlying conditions and subsequently died. The investigation by health authorities in the United States of America is ongoing and included contact tracing which identified no further cases amongst contacts, and there is currently no evidence of human-to-human transmission.
This is the 71st confirmed human case of A(H5) in the United States of America since early 2024, and the first since February 2025. To date, no human-to-human transmission has been identified in any of the A(H5) cases reported in the United States of America. From a global perspective, while a few events with limited human-to-human transmission of zoonotic influenza A(H5) have been described between 1997 and 2007, sustained human-to-human transmission has not been detected to date.
Based on available information, the WHO currently assesses the overall public health risk posed by A(H5) viruses as low. However, for individuals with occupational risk of exposure, the risk of infection is considered low to moderate.
The risk assessment will be updated as needed, based on any new epidemiological or virological information related to this event.
","Overview":"On 15 November 2025, WHO was notified of a confirmed human infection with influenza A(H5) in the United States of America—the first reported in the country since February 2025 and the 71st since early 2024. On 20 November, CDC laboratory sequencing verified the virus as influenza A(H5N5), representing the first human case of this subtype reported globally. The patient was an adult with underlying medical conditions residing in Washington State. The patient developed symptoms including fever during the week ending 25 October 2025. During the week ending 8 November 2025, the patient was hospitalized with a serious illness and subsequently died on 21 November.
Respiratory specimens collected at the healthcare facility tested positive for influenza A virus by RT-PCR and were presumptive positive for influenza A(H5) at the University of Washington. The specimens were sent to the Washington State Public Health Laboratory, where influenza A(H5) was confirmed using the CDC influenza A(H5) assay. The sample was received at the CDC on 19 November. Sequencing conducted at the University of Washington and at the CDC indicated this was an influenza A(H5N5) virus belonging to the H5 haemagglutinin (HA) clade 2.3.4.4b[1].
Public health investigation revealed that the patient kept backyard poultry and domestic birds. Additional epidemiological investigations are under way and include active monitoring of anyone who was in close contact with the patient.
","DonId":"2025-DON590","Provider":"dynamicProvider372"},{"Id":"bac6e717-f63e-496f-ae44-65f072fa75e6","LastModified":"2025-12-02T08:59:30Z","PublicationDate":"2025-12-01T13:57:19Z","DateCreated":"2025-12-01T13:57:20Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2025-DON589","ItemDefaultUrl":"/2025-DON589","Response":"Health authorities, with support from WHO and partners, implemented public health measures, including but not limited to the following:
Coordination
Surveillance
Laboratory
Case management
Vaccination
Infection prevention and control
Risk Communication and Community Engagement
Operations Support and Logistics
Preparedness and readiness
Prevention of Sexual Exploitation, Abuse and Harassment
Citable reference: World Health Organization (1 December 2025). Disease Outbreak News; Ebola virus disease in the Democratic Republic of the Congo. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON589
","Summary":"On 1 December 2025, the Ministry of Health (MoH) of the Democratic Republic of the Congo (DRC) declared the end of the Ebola virus disease (EVD) outbreak which had been declared on 4 September 2025. The end was declared after two consecutive incubation periods (a total of 42 days) since the last person confirmed with EVD tested negative for the virus and was discharged on 19 October 2025. A total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), were reported from six health areas in Bulape Health Zone, Kasai Province. WHO and partners provided technical, operational and financial support to the government to contain the outbreak. This is the country\u2019s 16th outbreak of Ebola. \r\nAlthough the outbreak has been declared over, health authorities are maintaining surveillance to rapidly identify and respond to any re-emergence. Risk communication and community engagement activities will continue to provide accurate information, monitor and address community feedback and rumours, and support efforts to reduce stigma toward individuals affected by the outbreak. ","PublicationDateAndTime":"2025-12-01T19:00:00Z","TitleSuffix":"","UseOverrideTitle":false,"Title":"Ebola virus disease \u2013 Democratic Republic of the Congo","Epidemiology":"Ebola virus disease is a severe disease caused by the Ebola virus (EBOV). The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission by direct contact with bodily fluids, organs, or contaminated surfaces and materials.
The incubation period, the time between infection with the virus and the onset of symptoms, ranges from 2 to 21 days, but typically is 7–11 days. People are not infectious during the incubation period; they become contagious with early symptoms; therefore, transmission risk begins at the onset of clinical signs and increases with disease severity.
Case fatality ratios ranging from 25% to 90% have been reported in previous outbreaks. The disease is characterized by an acute onset of fever with non-specific symptoms/signs (e.g., abdominal pain, anorexia, fatigue, malaise, myalgia, sore throat) usually followed several days later by nausea, vomiting, diarrhoea, and occasionally a variable rash. Severe illness may include haemorrhagic manifestations (e.g., bleeding), encephalopathy, shock/hypotension, multi-organ failure, and spontaneous abortion in infected pregnant women. Individuals who recover may experience prolonged sequelae (e.g., arthralgia, neurocognitive dysfunction, uveitis, sometimes followed by cataract formation), and clinical and subclinical persistent infection may occur in immune-privileged compartments (e.g., central nervous system, eyes, testes). Family members, health and care providers, and participants in burial ceremonies with direct contact with the deceased are at particular risk.
","OverrideTitle":"","Advice":"Coordination
Surveillance and Laboratory
Case Management
Vaccination
Risk Communication and Community Engagement (RCCE)
Infection Prevention and Control / Water, Sanitation and Hygiene (IPC/WASH)
Preparedness and readiness
WHO advises against any restrictions on travel and/or trade to the Democratic Republic of the Congo based on available information for the outbreak.
","Assessment":"The current outbreak constitutes the 16th Ebola disease occurrence in the DRC since 1976. The last outbreak was reported from North Kivu in 2022.
This outbreak occurred in difficult, hard to reach areas with limited existing infrastructure. A future outbreak is not unexpected given that EVD is endemic in the country. Ebola virus is enzootic and a resurgence from viral persistence in survivors has been described in recent epidemics. Re-emergence of EVD is a major public health concern in the Democratic Republic of the Congo; gaps remain in the country's capacity to recover, prepare for, and respond to outbreaks. The country is facing several outbreaks, including mpox, cholera, and measles. In addition, the country is experiencing a long-term economic and political crisis. The country's resources and capacity to effectively respond to the outbreak were therefore limited.
The epicentre of the outbreak was in proximity with the Angolan border (approximately 100 to 200 kilometres, depending on the nearest border crossing point). Although the affected district is a hard-to-reach rural area relatively far from the two main urban centres of Mbuji Mayi and Kananga, population movements between different parts of the province are frequent, especially between Bulape and Tshikapa.
The outbreak has most likely originated from a new zoonotic spillover and led to sustained human-to-human transmission. Infections and deaths among healthcare workers were reported, which raised the risk of nosocomial amplification and further spread within health facilities.
The outbreak is declared over, as of 30 November 2025, with no new cases reported for 42 consecutive days.
","Overview":"The EVD outbreak in the Democratic Republic of the Congo (DRC) was declared on 4 September 2025. As of 30 November 2025, a total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), have been reported from six health areas (Bambalaie, Bulape, Bulape Com, Dikolo, Ingongo and Mpianga) in Bulape Health Zone, Kasai Province. Since the last confirmed case reported on 25 September 2025, no new confirmed EVD cases have been reported.
There have been five cases among health workers (four nurses and one laboratory technician), three of whom have died. The epicentres of the outbreak have been localised in Dikolo (26 cases, 15 deaths) and Bulape (24 cases, 22 deaths) health areas, which together account for 78.1% of the total cases reported and 82.2% of all deaths. The outbreak initially involved nosocomial transmission and a high-transmission funeral gathering, with high mortality among young children. As of 12 October 2025, a total of 572 contacts were followed up.
On 1 December 2025, the Ministry of Health declared the end of the outbreak. This declaration came after two consecutive incubation periods (42 days) since the last person confirmed with EVD tested negative for the virus and was discharged on 19 October 2025, as per WHO recommendations.
Figure 1. Map of confirmed and probable cases and deaths of Ebola virus disease, Bulape Health Zone, Kasai province, Democratic Republic of the Congo, as of 30 November 2025
![\"Map](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/map-evd-drc.png?sfvrsn=ba19d8b0_3\" "\\"Map")
Figure 2: Epidemic curve of confirmed and probable Ebola virus disease cases in Bulape Health Zone, Kasai province, Democratic Republic of the Congo, as of 30 November 2025
![\"EVD-DRC_epi](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/evd-drc_epi-curve.png?sfvrsn=1fc74c47_4\" "\\"EVD-DRC_epi")
WHO, together with its partners, continues to support national authorities in responding to ongoing diphtheria outbreaks across affected countries. Assistance focuses on both technical and operational needs.
At the country level, the scope of response operations varies according to available capacities, but core interventions remain consistent. These include enhanced surveillance through active case finding and timely reporting; adequate clinical management, including the appropriate use of antitoxin and antibiotics; risk communication and community engagement to improve public awareness and encourage care-seeking; and capacity-building efforts such as training and dissemination of evidence-based guidelines. Country-specific actions and priority needs differ, ranging from strengthening surveillance and coordination to scaling up vaccination, laboratory capacity, and medical supplies.
Despite these efforts, multiple challenges continue to hinder the effectiveness of outbreak control. Competing health priorities have contributed to long-standing immunity gaps, reflected in persistently low vaccination coverage, especially in fragile settings. Similarly, case management capacity is also limited due to scarcity of diphtheria antitoxin and late presentation of patients, resulting in high case fatality rates, especially in vulnerable, marginalized and hard-to-reach populations. In some settings, surveillance systems remain fragile, resulting in delayed detection and incomplete reporting. Limited laboratory capacity further complicates the response, with shortages of diagnostic supplies, weak specimen transport systems, and restricted technical expertise leading to delayed confirmation and underestimation of outbreak magnitude.
","FurtherInformation":"Citable reference: World Health Organization (21 November 2025). Disease Outbreak News; Diphtheria in the African Region. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON588
Diphtheria is a severe infectious disease caused by the gram-positive bacterium Corynebacterium diphtheriae or, less commonly, toxigenic strains of other Corynebacterium species. Infection may lead to respiratory disease, cutaneous disease, or an asymptomatic carrier state. The primary mode of transmission rests on close contact with infectious material from respiratory secretions or from skin lesions. The only known reservoir for C. diphtheriae are humans. As a result, asymptomatic carriers play a critical role in infection transmission. Immunity (either via natural infection or vaccine induced) provides protective immunity against the disease but does not prevent carriage. The disease can affect all age groups; however, unvaccinated or partially vaccinated individuals, including children, are most at risk.
Respiratory diphtheria typically presents two to five days after exposure with sore throat, malaise, cervical lymphadenopathy, and low-grade fever. Oropharyngeal involvement is most common, but infection may extend to the nasopharynx, larynx, and tracheobronchial tree. Characteristic findings include adherent gray pseudomembranes on the respiratory tract mucosa that often bleed when removed. Severe cases can result in airway obstruction with neck swelling, hoarseness, stridor, or palatal paralysis. Toxin-mediated complications from toxigenic strains may include myocarditis, neurologic deficits, and kidney injury. Cutaneous diphtheria presents as chronic, nonhealing sores or shallow ulcers covered by a dirty gray membrane, though the appearance is non-specific.
In addition to supportive care, treatment is based on the appropriate administration of DAT and antibiotics (azithromycin or penicillin).
Full primary series and required booster doses. DAT administration against diphtheria has been effective in reducing the deaths and illness from diphtheria dramatically. Diphtheria is fatal in 5 to 10% of cases, with a higher mortality rate in young children. However, in settings with poor access to DAT, the CFR can be as high as 40%.
","OverrideTitle":"Diphtheria - African Region (AFRO)","Advice":"Diphtheria is a vaccine-preventable bacterial disease caused by Corynebacterium diphtheriae. It primarily affects the upper respiratory tract and can produce a toxin that leads to severe systemic complications, including myocarditis, kidney failure, and neurological damage. The disease spreads via close contact with respiratory secretions or skin lesions. Areas with low immunization coverage, overcrowding and limited access to healthcare services are at higher risk of increased transmission and may experience outbreaks
Considering the ongoing diphtheria outbreaks in the WHO African Region, WHO encourages Member States to strengthen preparedness and response capacities. This includes enhancing surveillance systems to improve case detection and reporting, expanding laboratory capacity for timely confirmation of cases, and improving clinical management and infection prevention and control. Supplementary immunization activities should be prioritized to close immunity gaps, particularly among children/adolescents and displaced populations. Community engagement and risk communication efforts must be intensified to raise awareness, promote health-seeking behavior, and ensure adherence to control measures.
WHO also recommends the establishment of contingency stockpiles of diphtheria antitoxin, antibiotics, and laboratory supplies at regional hubs in Dakar and Nairobi. These stockpiles will enable rapid deployment of essential materials to the affected countries when needed.
Regional and global advocacy efforts should be strengthened to mobilize funding and political support for outbreak response. WHO will continue to support Member States through technical assistance, resource mobilization, and coordination with partners.
WHO will continue to work across all levels of the organization to identify and implement appropriate mechanisms to support affected countries and mitigate the impact of the outbreaks.
WHO does not recommend any restriction on travel to or trade with the countries named in this report, based on the information available on the current event.\u202f
Diphtheria is a major public health problem in the African region despite substantial efforts on immunization activities over the past three decades. Between 2000 and 2024, 75 789 diphtheria suspected cases were reported in the Region with the majority being reported from 2023 to 2024. In 2023-2024, Algeria, Chad, Gabon, Guinea, Mali, Mauritania, Niger, Nigeria and South Africa reported resurgence of diphtheria outbreaks with approximately 57 000 suspected cases and 2000 deaths (CFR of 3.5%) recorded. The countries most affected were Guinea, Niger and Nigeria. Most cases reported were children under fifteen years and female. Over 50% of suspected cases were non-vaccinated or with unknown vaccination status.
Since the beginning of 2025 and as of 2 November 2025, eight countries in the Region have reported a total of 20 412 suspected diphtheria cases, including 1 252 deaths (with an average case fatality ratio [CFR] of 6%). Most cases are among children and young adults, with women slightly more affected than men. Laboratory confirmation remains low due to shortages of diagnostic supplies and limited testing capacity. The global shortage of DAT, and a variable clinical capacity to provide this essential treatment, poses an additional challenge to effective case management.
Many of the affected countries are fragile, conflict-affected or have system vulnerabilities where health systems are overstretched, routine services are disrupted and access to essential services is limited. These settings are characterized by low routine immunization coverage, high population mobility, and crowded living conditions, especially among displaced populations. The resurgence of diphtheria in these countries is further compounded by disruptions caused by the COVID-19 pandemic, which led to significant declines in vaccine uptake and widened immunity gaps.
At the regional level, the public health risk is assessed as high due to the potential for further geographic expansion of outbreaks, high fatality rates, insufficient resources for outbreak control, and weak surveillance and laboratory systems. The humanitarian context in several affected countries, including Chad, Mali, Niger, and Nigeria, increases the likelihood of sustained transmission and complicates response efforts.
At the global level, the public health risk is considered low. Most countries outside the African Region have established immunization programs and adequate surveillance systems. However, the possibility of international spread through travel cannot be ruled out, particularly if susceptible individuals are exposed. Strengthened global surveillance and risk communication are therefore essential to mitigate this risk.
The confidence in the available information is assessed as moderate. While data collection and reporting have improved in some countries, gaps remain in laboratory confirmation, case classification, and timely sharing of epidemiological updates.
In 2025, from 1 January to 2 November, a total of 20 412 suspected diphtheria cases, including 1 252 deaths (an average case fatality ratio [CFR] – 6.1 %) have been reported across eight Member States in the WHO African Region (Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria, and South Africa). Of these suspected cases, 9 864 (48.3%) cases have been confirmed through laboratory testing, epidemiological linkage, or clinical diagnosis. Laboratory confirmation was conducted for 5.7% (n = 1 177) of the suspected cases.
Women, children aged 5–18 years, and young adults under 30 years are the most affected, confirming that the immunity gap extends well beyond early childhood. The situation has further deteriorated in Mali, Mauritania, and Niger, in recent weeks, with increasing case numbers and geographic spread of the outbreaks reported in these countries.
The resurgence of diphtheria across multiple countries in the WHO African Region constitutes a serious public health concern which led to its grading as a grade 2 emergency under the Emergency Response Framework of WHO. Timely case detection, coordinated response, and clinical management remain critical to limiting transmission and reducing the high fatality rates observed in recent outbreaks. However, response efforts are being hampered by a global shortage of DAT and limited laboratory diagnostic capacity.
Effective outbreak control requires comprehensive, multi-sectoral action across all response pillars including emergency coordination, laboratory confirmation, enhanced surveillance and case finding, clinical management with life-saving DAT and appropriate antibiotics (in accordance with WHO guidelines), infection prevention and control (IPC). Sustained vaccination efforts, coupled with risk communication and community engagement (RCCE) are essential to interrupt transmission and protect high-risk populations. In addition, preventing the recurrence of diphtheria outbreaks in the African Region will require strengthened health systems, particularly through robust routine immunization coverage.
Summary of individual country situations from 1 January to 2 November 2025
Algeria
Algeria reported a diphtheria outbreak in October 2025 in Skikda province, with 13 suspected cases and two deaths (CFR 15%). Eight of the suspected cases were laboratory-confirmed, and none of the confirmed cases had received diphtheria vaccination. The outbreak affected both children and adults, with males accounting for 62.5% of confirmed cases. A previous outbreak in southern Algeria, reported in 2024, involved over 900 suspected cases and 119 deaths (CFR 13%). According to WHO/UNICEF estimates of national immunization coverage (WUENIC) for 2024, Algeria has high national immunization coverage (98% for the first Diphtheria-Tetanus toxoid-Pertussis [DTP] dose and 92% for the third), however geopolitical instability in neighboring countries has led to mass displacement into southern Algeria, where vaccination coverage among refugees is low. The lack of data since May 2025 and limited information sharing are key challenges to assessing the full scope of the outbreak.
Chad
From 1 January to 2 November 2025, Chad reported 4 462 suspected diphtheria cases and 47 deaths (CFR 1.1%), with only four laboratory-confirmed cases. The significant amount of suspected diphtheria cases compared to the limited number of laboratory-confirmed cases highlights the challenge in the country to obtain a laboratory-confirmed diagnosis. The outbreak affects 27 out of 215 health districts across 7 of 23 provincial health delegations, with active transmission ongoing in three regions. Most cases are among children aged 3–13 years, and vaccination status is unknown for the vast majority. Chad faces a complex humanitarian crisis marked by conflict, displacement, and food insecurity. The country hosts over 1.4 million refugees, including more than 870 000 Sudanese refugees and 300 000 Chadian returnees. The health system is overwhelmed, and multiple infectious disease outbreaks, including yellow fever, measles, cholera, and hepatitis E, are occurring simultaneously. WHO, UNICEF, and MSF are supporting response efforts, but challenges include delayed reporting, insufficient case management kits, and logistical constraints. A request has been submitted to Gavi for vaccine supply and operational funding for mass immunization campaigns. According to WUENIC, the DTP coverage in 2024 was 84% for the first dose and 68% for the third dose.
Guinea
Guinea has experienced a resurgence of diphtheria since June 2025, with 476 suspected cases and 123 deaths. The CFR among the suspected cases is 25.8%, the highest among affected countries. The outbreak has affected four of 38 prefectures (11%), with human-to-human transmission concentrated in the Kankan region, particularly in Siguiri district, which accounts for over 80% of reported cases and fatalities. Laboratory confirmation remains limited, with only 70 cases confirmed. The outbreak follows a major event in 2023 that affected multiple regions and led to over 4 500 suspected cases. Guinea’s response is hampered by delayed presentation to health facilities, and insufficient resources for clinical management and community engagement. The outbreak is occurring in gold mining areas with high population mobility, increasing transmission risk. According to WUENIC in Guinea for 2024, the immunization coverage remains low (77% for the first DTP dose and 63% for the third), and urgent needs include DAT supply, improved clinical pathways, and expanded vaccination efforts.
Mali
From 1 January to 2 November 2025, Mali has reported 430 suspected diphtheria cases and 29 deaths (CFR 6.7%), with 46 laboratory-confirmed cases. The outbreak has affected seven out of 11 regions (64%), including the capital city Bamako, with the number of affected districts increasing from three to 30 out of 75 in less than six weeks, representing a rapid geographic expansion. Mali is experiencing a complex humanitarian crisis driven by conflict, climate related disruptions, and limited access to basic services. In 2025, 6.4 million people required humanitarian assistance. Displacement and restricted access to healthcare have contributed to low immunization coverage among vulnerable populations. According to WUENIC in 2024, estimates show 91% coverage for the first DTP dose and 82% for the third. Challenges include underreporting, limited availability of DAT, and logistical constraints. The outbreak response is hindered by concurrent emergencies and overstretched health services.
Mauritania
From 1 January to 2 November 2025, Mauritania has reported 849 suspected cases of diphtheria and 33 deaths (CFR 4%), with 318 confirmed cases. After an initial delay, the outbreak was officially declared on 25 September 2025 and has rapidly expanded across 11 out of 53 departments (21%). An upsurge of cases has been observed since late September. The most affected age groups are children and adolescents aged 5–19 years, and women account for 60% of suspected cases. Only 10% of cases have documented vaccination history. Mauritania hosts the largest refugee camp for Malians, with over 118 000 refugees, mostly women and children. The outbreak coincides with a Rift Valley fever outbreak in some of the same regions. Response efforts are challenged by limited resource mobilization, weak active case finding, and insufficient community sensitization. Reactive vaccination campaigns have been initiated, but gaps remain in funding, logistics, and healthcare worker training. According to WUENIC in 2024, the immunization coverage is relatively high (95% for the first DTP dose and 86% for the third), but subnational disparities persist.
Niger
From 1 January to 2 November 2025, Niger has reported 1 926 suspected diphtheria cases and 122 deaths CFR (6.3%), with 765 laboratory-confirmed cases. The outbreak has affected 34 out of 72 health districts (47%) across eight regions, with most cases concentrated in Agadez, Diffa and Zinder. Compared to 2024, there have been fewer reported cases and deaths, but transmission remains active. Niger is facing a protracted humanitarian crisis driven by insecurity, climate related disruptions, economic pressures, and displacement. An estimated 2.6 million people require humanitarian assistance. According to WUENIC in 2024, the immunization coverage is relatively high (95% for the first DTP dose and 86% for the third), but recent outbreaks highlight gaps in vaccine access and delivery. A vaccination campaign in September 2025 achieved high coverage, and a second round is planned. Challenges include limited diagnostic and treatment capacity, insufficient vaccine quantities, low public awareness, and funding constraints.
Nigeria
Nigeria continues to report the highest number of diphtheria cases in the African Region. From 1 January to 2 November 2025, 12 150 suspected cases have been reported, with 8 587 confirmed and 884 deaths (CFR 7.2%). Confirmed cases have been reported from 240 Local Government Areas across 30 states. Most cases are clinically compatible, with only 3% confirmed by laboratory testing. The outbreak has disproportionately affected children and adolescents, with low vaccination coverage contributing to the spread. In Nigeria more than 2 million children are under-immunized, including those with zero-doses, highlighting the high risk of further spread. Reactive campaigns have been conducted in Imo, Kaduna and Lagos, targeting health workers and priority populations. The outbreak overlaps with areas targeted by the Big Catch-up initiative. Challenges include delayed laboratory confirmation, poor IPC practices, limited information, education and communication materials, and vaccine shortages. Discussions with Gavi are ongoing to secure additional support. According to WUENIC in 2024, the estimates show 71% coverage for the first DTP dose and 67% for the third.
South Africa
From 1 January to 26 October 2025, South Africa has reported 106 diphtheria cases, including 66 laboratory-confirmed respiratory cases, two laboratory-confirmed cutaneous cases, one probable respiratory case, and 37 asymptomatic carriers. The outbreak has affected 5 of 9 provinces (55%), highlighting the involvement of multiple provinces. Most cases and carriers are from the Western Cape, with additional clusters in Limpopo, Gauteng, KwaZulu-Natal, and Mpumalanga. CFR among probable and confirmed respiratory diphtheria cases was 18% (12/67). Most respiratory cases occurred in adults aged 18 years and older. Clusters have been documented among vulnerable populations, including individuals in correctional facilities. According to WUENIC in 2024, the immunization coverage remains below 80% in most provinces (76% for the first DTP dose and 74% for the third), and immunity gaps are widening. The outbreak response is challenged by competing priorities, limited human resources, and limited global supply of diphtheria antitoxin. Detailed case investigations and in-depth risk assessments are needed to guide targeted interventions.
Geographical distribution of diphtheria outbreaks in the WHO African Region, January 2025 until 2 November 2025
![\"Map](\"https://cdn.who.int/media/images/default-source/emergencies-and-disasters/map---diphtheria.jpg?sfvrsn=57f5364e_1\" "\\"Map")
Table 1. Summary of reported ongoing diphtheria outbreaks in the WHO African region, January – 2 November 2025
![\"Diphtheria](\"https://cdn.who.int/media/images/default-source/emergencies-and-disasters/table-1.-diphtheria.jpg?sfvrsn=28342c1_1\" "\\"Table") |
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Table 2. Summary of vaccination coverage by diphtheria-affected country (WUENIC, 2024) \u202f
![\"Diphtheria](\"https://cdn.who.int/media/images/default-source/emergencies-and-disasters/table-2.-diphtheria.jpg?sfvrsn=75f46a7d_1\" "\\"Table")
","DonId":"DON588","Provider":"dynamicProvider372"},{"Id":"78353ac3-ac5f-41c6-8d9d-61017609c263","LastModified":"2025-11-21T16:34:20Z","PublicationDate":"2025-11-21T16:33:57Z","DateCreated":"2025-11-21T16:34:20Z","IncludeInSitemap":true,"SystemSourceKey":null,"UrlName":"2025-DON585","ItemDefaultUrl":"/2025-DON585","Response":"Local and national health authorities in Ethiopia have implemented the following public health measures:
Citable reference: World Health Organization (21 November 2025). Disease Outbreak News; Marburg virus disease in Ethiopia. Available at: https://www/who.int/emergencies/disease-outbreak-news/item/2025-DON585
Marburg virus disease (MVD) is a severe hemorrhagic fever caused by either of two closely related viruses, Marburg virus and Ravn virus, which are closely related to the Ebola viruses. MVD has a high case fatality rate, ranging from 24% to 88% from previous outbreaks The case fatality rate can be lowered with good and early patient care. The virus is initially transmitted to humans from fruit bats (Rousettus aegyptiacus) and then spreads among people through direct contact with bodily fluids, contaminated surfaces, or infected materials. Healthcare workers, caregivers, and individuals involved in burial practices are particularly at risk when infection prevention and control measures are not in place.
MVD symptoms typically begin abruptly after an incubation period of two to 21 days and include high fever, severe headache, malaise, muscle aches, and progressive gastrointestinal symptoms such as diarrhea and vomiting. In severe cases, patients may experience bleeding from multiple sites and die from shock and organ failure within a week of symptom onset.
There are no approved treatment or vaccines for MVD, although supportive treatment and early supportive care improves survival. Some candidate vaccines and therapeutics are currently under investigation.
Nineteen outbreaks of MVD have previously been reported globally. The most recent outbreak was reported from the Republic of Tanzania between January and March 2025. Additional countries that have reported outbreaks of MVD in the African Region include Angola, the Democratic Republic of the Congo, Equatorial Guinea, Ghana, Guinea, Kenya, Rwanda, South Africa, and Uganda.
","OverrideTitle":"","Advice":"Human-to-human transmission of Marburg virus is primarily associated with direct contact with the blood and/or other bodily fluids of infected people. Strengthening and reinforcing IPC measures is essential to prevent further transmission and reduce the likelihood of amplification.
WHO advises the following risk reduction measures to be taken as an effective way to reduce MVD transmission to control the outbreak.
Prevention: Protective measures individuals should take to reduce human exposure to the virus include:
Coordination: Multisectoral coordination and pillar meetings at all levels and sharing of detailed situation reports is encouraged. Involvement of different stakeholders and partners in preparedness and response activities is also encouraged. To ensure an effective and sustained response, resource mobilization efforts within the government and with partners are recommended.
Risk communication and community engagement: Raising public awareness and engaging with communities are important for successfully controlling MVD outbreaks. This includes raising awareness of symptoms, risk factors for infection, protective measures and the importance of seeking immediate care at a health facility. Sensitive and supportive information about safe and dignified burials is also crucial. This awareness should be increased through targeted campaigns and direct work with communities. Special attention should be given to high-risk groups, such as traditional healers, clergy, and community leaders, who may inadvertently facilitate disease spread, and who are important sources of information for the community. Misinformation and rumours should be addressed to foster trust and promote early symptom reporting.
Surveillance: Active case detection, contact tracing, and alert management across affected and neighbouring regions should be intensified. Community-based surveillance systems should be strengthened to promptly identify and report new cases, particularly in high-risk areas. Close monitoring of healthcare workers, family members and individuals who have had contact with suspected cases or other high-exposure settings should be ensured. Surveillance capacities should also be intensified at relevant points of entry and borders to reduce the risk of further spread, including internationally.
Infection prevention and control (IPC) measures:
Laboratory testing: The processing and analysis of samples should be expedited, with results promptly shared with responders and clinicians to guide patient management, containment strategies and broader response efforts. This includes genomic sequencing on positive samples. International referral of samples to a regional reference laboratory should be considered for inter-laboratory comparison. Laboratory workers handling specimens from patients suspected or confirmed to be infected with MARV should receive refresher training on laboratory biosafety; this includes taking appropriate precautions when drawing blood for a malaria rapid diagnostic test or other test not specific for MARV.
Evaluation of candidate medical countermeasures: There are no licensed vaccines or therapeutics against MVD. Several candidate vaccines are in the pipeline and outbreaks offer an opportunity to assess their efficacy and safety. There are protocols available and a network of experts in filoviruses ready to support national researchers.
Safe and dignified burials: Safe and dignified burial protocols should be implemented for persons who have died to minimize community exposure. Additional training and equipment for healthcare workers and burial teams should be provided to ensure safe management of MVD-related fatalities. Thorough community engagement is required to ensure that affected communities are empowered to adhere to the protocols.
Case management and mental health and psychosocial support: Designated treatment centers should ensure adequate level of care for confirmed patients to improve the chance of survival. Isolation and treatment facilities should be adequately equipped to ensure the safety and efficacy of patient care, while simultaneously preventing the spread of the disease. Supportive care such as rehydration, symptom management, and psychological support for patients and their families is essential to improving survival rates and mitigating the outbreak's impact.
Border health and cross-border coordination: Surveillance capacities should be strengthened at relevant at-risk points of entry, onboard conveyances, and in border regions to prevent further spread, including internationally. Cases, contacts and individuals in affected areas who present signs and symptoms compatible with case definition should be advised not to travel, in line with WHO’s border health and points of entry technical guidance for filovirus disease outbreaks. Collaboration with neighbouring countries should be enhanced to harmonize reporting mechanisms, conduct joint investigations, and share critical data in real-time. Countries at-risk of potential spread should enhance readiness activities to enable early case detection, isolation and treatment.
Based on the current risk assessment, WHO advises against any travel and trade restrictions with Ethiopia.
","Assessment":"This is the first confirmed MVD outbreak in Ethiopia. The public health risk posed by the MVD outbreak is assessed as high at the national level due to several concerning factors:
Although no international transmission has been confirmed to date, the potential risk for spread remains. The affected area, Jinka, while distant from Ethiopia’s capital or major international airports, is connected by road transportation networks, including to neighbouring Kenya and South Sudan. Therefore, the public health risk posed by this event is assessed as moderate at the regional level. It is considered low at the global level.
As of 20 November 2025, 33 laboratory tests have been conducted, of which six confirmed cases, including three deaths, have been reported. Of the six confirmed cases, three are currently alive and on treatment. In addition to the lab-confirmed cases, a further three epidemiologically linked cases could not be tested; all three are deceased and recorded as probable cases. A total of 206 contacts have been identified, and contacts are under active follow-up. The number of contacts will continue to change as the response evolves.
Clinically, patients have presented with high-grade fever, headache, vomiting, abdominal pain, and watery or bloody diarrhoea. Haemorrhagic manifestations, including nose bleeding and vomiting blood were observed in five cases, consistent with multi-organ failure.
As this is the first time Ethiopia is reporting MVD, WHO recommends that samples be shared with a reference laboratory for inter-laboratory comparison.
Figure 1: Map of Ethiopia showing location of Jinka town
![\"MVD](\"https://cdn.who.int/media/images/default-source/products/disease-outbreak-news/mvd-in-ethiopia.jpg?sfvrsn=e861d6ce_3\" "\\"MVD")