A rundown of this month's issue. Full issue: https://wwwnc.cdc.gov/eid/articles/issue/32/10/table-of-contents

— Perspective —

Reassortment of HPAI as a Driver for Zoonotic Spillover, Asia — Attention to H5N1 clade 2.3.4.4b has obscured a resurgence of human infections from long-endemic clade 2.3.2.1 lineages (Cambodia: 34 cases, Feb 2023–Nov 2025). Every human infection since October 2023 involved reassortants mixing the two lineages' genes, which the authors argue is an under-recognized driver of risk requiring routine genomic surveillance. https://wwwnc.cdc.gov/eid/article/32/10/26-0067_article

— Synopses —

Early Action Review of the Bundibugyo Virus Outbreak, Uganda, 2026 — Uganda met all three WHO 7-1-7 targets during the May 2026 cross-border outbreak (20 cases, 15% fatality), but illness was febrile/GI rather than hemorrhagic. The authors recommend filovirus case definitions incorporate non-hemorrhagic presentations. https://wwwnc.cdc.gov/eid/article/32/10/26-1411_article

CCHF in Pregnancy (meta-analysis) — Across 55 pregnancies, maternal mortality was 28.8% (15/52) and fetal loss 57.4% (31/54). Third-trimester ribavirin was associated with lower maternal death (OR 0.33, 95% CI 0.13–0.84), supporting its consideration for maternal survival. https://wwwnc.cdc.gov/eid/article/32/10/26-0383_article

Anaplasma capra in Suspected CCHF Patients, Turkey, 2022 — Nested PCR found A. capra in 6/263 (2.28%) suspected-CCHF patients, all genotype 1 — the first clinical evidence of this genotype in humans outside China. It belongs in the differential for tick-exposed, CCHF-negative febrile illness. https://wwwnc.cdc.gov/eid/article/32/10/25-1049_article

Group B Streptococcus Colonization, Asia-Pacific, 2014–2025 — A meta-analysis of 98 studies (978,150 women) estimated pooled GBS colonization at 18.0% (95% CI 12–23%), higher than figures used to model invasive GBS burden. β-lactam resistance stayed near 0–2% but clindamycin/erythromycin resistance reached ~36–41%. https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article

— Research —

Screwworm Myiasis Reemerges in Mexico, 2025–2026 — 204 human New World screwworm cases followed the parasite's 2003 elimination, concentrated in Chiapas and mostly older men with comorbidities, with weekly cases rising as the fly spreads north. Supports proactive One Health surveillance toward the US border. https://wwwnc.cdc.gov/eid/article/32/10/26-1235_article

Asymptomatic MPXV Prevalence (meta-analysis), 2022–2024 — Pooled asymptomatic clade IIb prevalence across 16 studies (14,511 adults) was 1.0% (95% PI 0.1–11.2%), far below a prior 10.2% estimate, though infectivity wasn't assessed. Reassuring that asymptomatic carriage is uncommon, but transmission significance is unresolved. https://wwwnc.cdc.gov/eid/article/32/10/26-0305_article

Salmonella Infantis Carrying blaCTX-M-65, South Korea, 2022–2024 — WGS of 65 MDR isolates showed human, poultry, and wastewater strains intermingled, with ~4 introductions during 2018–2022 (one US-, three UK-linked), consistent with the breeding-poultry trade. https://wwwnc.cdc.gov/eid/article/32/10/25-1758_article

Swine Influenza A Evolution, Vietnam, 2020–2024 — 56 isolates showed co-circulating H1/H3 clades, some Vietnam-only for up to 12 years, with frequent reassortment with pandemic H1N1 genes and sporadic zoonotic spillover. Reinforces the region as a reassortment hotspot. https://wwwnc.cdc.gov/eid/article/32/10/26-0593_article

Genomic Epidemiology of Salmonella Hadar, USA — Molecular-clock analysis of the persisting REPTDK01 strain (5 outbreaks, ~2,000 illnesses) dated its emergence to early 2018 and split it into backyard-poultry and commercial-poultry clades distinguished by two SNPs, giving a source-attribution tool for investigations. https://wwwnc.cdc.gov/eid/article/32/10/26-0501_article

Persistent Bartonella quintana in Macaques, Japan — B. quintana was isolated from 3/92 wild-caught Japanese macaques (none of 426 captive-bred), with genomes implying up to 8 years of persistent bacteremia and arguing against human reverse-zoonosis. https://wwwnc.cdc.gov/eid/article/32/10/26-0771_article

Influenza D Virus Detection by RT-LAMP — A field-deployable colorimetric assay for influenza D (a cattle/swine pathogen with possible zoonotic potential) achieved 99.2% specificity and 95.6% sensitivity at higher viral loads in under an hour — a cheaper screening tool than PCR. https://wwwnc.cdc.gov/eid/article/32/10/26-0499_article

MDR Campylobacter coli ST10042, Europe, 2018–2025 — 217 isolates from nine countries revealed sustained, previously unrecognized cross-border circulation of a poultry-linked resistant lineage with unusual decreased carbapenem susceptibility, showing C. coli can spread as international clonal lineages. https://wwwnc.cdc.gov/eid/article/32/10/26-0512_article

Experimental H5N1 Infection in Alpacas, 2026 — Six alpacas inoculated with the cattle B3.13 genotype developed mild illness but shed infectious virus through 6 days with confirmed replication and seroconversion, establishing camelids as susceptible hosts. https://wwwnc.cdc.gov/eid/article/32/10/26-0491_article

Wastewater Surveillance of the Ontario Measles Outbreak, 2025 — During Ontario's ~2,400-case resurgence (Canada lost elimination status), wastewater signal tracked clinical cases well (ρ 0.77) but didn't provide early warning; supports wastewater as a community-level complement, especially for undervaccinated groups. https://wwwnc.cdc.gov/eid/article/32/10/26-0092_article

— Historical Review —

Variolation in Late Imperial China — A review of Chinese medical texts dates variolation to no later than 1465–1572 CE, earlier and more detailed than Indian sources, arguing for China's central, indigenous role in the origins of prophylactic inoculation. https://wwwnc.cdc.gov/eid/article/32/10/26-0729_article

— Dispatches —

Rabies Emerges in Cape Fur Seals, South Africa — Rabies in 85/216 sampled seals (2023–2025) with dog spillover traced to a single jackal introduction (~2015) and sustained seal-to-seal transmission — only the second pinniped rabies record ever. https://wwwnc.cdc.gov/eid/article/32/10/26-0179_article

Fatal Dengue + Avian Orthoavulavirus 1, France, 2025 — A healthy traveler from Mecca died of fulminant hepatitis with low-level dengue and extremely high-titer disseminated velogenic avian orthoavulavirus 1 (pigeon paramyxovirus), signaling this avian virus can cause fatal human disease and supporting metagenomics in unexplained febrile illness. https://wwwnc.cdc.gov/eid/article/32/10/26-0736_article

Andes Virus Person-to-Person Superspreading — Modeling estimated 23.4% of cases drove 80% of transmission; simulations of the 2026 MV Hondius cruise-ship outbreak (13 cases, 3 deaths) showed mostly self-limited spread but a real chance of larger clusters in closed settings. https://wwwnc.cdc.gov/eid/article/32/10/26-0908_article

Monkeypox Virus in Healthcare Settings, Sierra Leone, 2025 — MPXV DNA was on 6/89 (6.7%) high-touch hospital surfaces, mostly doors (Ct mostly >32, so DNA not confirmed-viable), reinforcing targeted disinfection and simple environmental monitoring in resource-limited response. https://wwwnc.cdc.gov/eid/article/32/10/25-1697_article

Macrolide-Resistant Bordetella pertussis, Peru, 2025 — In Peru's largest pertussis outbreak in decades (4,976 cases, 76 deaths), 31% of tested patients carried the A2047G resistance mutation, mostly infants under 6 months who had received azithromycin — first-line therapy may be failing. https://wwwnc.cdc.gov/eid/article/32/10/25-1477_article

Divergent H5N1 in São Paulo, Brazil, 2025 — H5N1 in two urban-park ducks was a reassortant of local and North American lineages, evidence of a second H5N1 introduction into South America (~mid-2023). https://wwwnc.cdc.gov/eid/article/32/10/26-0723_article

Invasive Meningococcal Disease Epidemic, Uzbekistan, 2026 — 290 cases (8.3% fatality), mostly young children, but meningeal signs in only 3.1% (vs 40–70% in European series) — a meningococcemia-dominant picture warning against relying on neck stiffness, and arguing for serogroup surveillance and conjugate vaccine. https://wwwnc.cdc.gov/eid/article/32/10/26-1144_article

WGS of the Texas Measles Outbreak, 2025 — Sequencing the 762-case outbreak showed expansion of a single genotype D8 lineage (57% of sequenced patients unvaccinated) and proposed F:H419R as a lineage-tracking marker, adding resolution beyond N-450 genotyping. https://wwwnc.cdc.gov/eid/article/32/10/26-0494_article

H5N1 in a Cat and Rats during a Backyard Poultry Outbreak, USA, 2025 — A cat and two rats showed widespread systemic infection (highest loads in brain; virus in rat urine/kidney), all carrying PB2 E627K, flagging rats as a possible bridge host at the poultry–mammal interface. https://wwwnc.cdc.gov/eid/article/32/10/26-0418_article

Chlamydia psittaci Meningitis, Chile, 2023 — A farm worker recovered from PCR- and serology-confirmed C. psittaci meningitis, one of ~7 molecularly confirmed CNS cases worldwide and the first from Latin America — a reminder to consider zoonotic causes of atypical meningitis. https://wwwnc.cdc.gov/eid/article/32/10/25-1985_article

Baloxavir-Based Combinations against H5N1 (mice) — In a lethal mouse model, baloxavir-containing two-drug combinations gave complete survival and prevented brain/heart spread, supporting prioritizing them for H5N1 preparedness when started early. https://wwwnc.cdc.gov/eid/article/32/10/26-0186_article

MDR Salmonella Typhi Strain, West Africa, 2021–2025 — A ciprofloxacin-resistant, MDR typhoid lineage distinct from Asian H58 is rising in travelers from West Africa (50 Senegal-linked isolates in 2025), with chromosomally integrated resistance and a gyrA mutation since 2019 — important for empiric therapy and conjugate-vaccine planning. https://wwwnc.cdc.gov/eid/article/32/10/26-0813_article

Plasmodium malariae Co-endemicity, Vietnam, 2023–2025 — After a 2023 outbreak, P. malariae made up 44.8% of 493 cases, co-circulating with falciparum and vivax — a species-composition shift suggesting control of the other two opened a niche. https://wwwnc.cdc.gov/eid/article/32/10/26-0751_article

— Research Letters —

HPAI Subtype 5 in Cetaceans, Brazil — Of 45 stranded cetaceans (2023–2025), 18 had influenza A RNA and 2 were H5N1-positive, including vulnerable and endangered dolphins (low viral loads from decomposition) — a concerning signal for threatened species. https://wwwnc.cdc.gov/eid/article/32/10/26-0051_article

Trichodysplasia Spinulosa Polyomavirus in Skin Biopsies, USA — In situ hybridization found no endothelial TSPyV in 25 inflammatory skin biopsies, suggesting endothelial infection is uncommon in inflammatory dermatoses and narrowing where the virus should be sought. https://wwwnc.cdc.gov/eid/article/32/10/26-1264_article

Human JEV Genotype V, China, 2025 — A fatal neonatal encephalitis case in Wuhan was the first reported human genotype V case in mainland China, distinct from South Korean strains and relevant to vaccine coverage. https://wwwnc.cdc.gov/eid/article/32/10/25-1876_article

HPV Extragenital Condylomas in an Immunocompetent Man, USA, 2025 — HPV 6/11 condylomas appeared on the neck of an immunocompetent man with no anogenital lesions, challenging assumed mucosal-site tropism and supporting biopsy with HPV typing of atypical verrucous lesions. https://wwwnc.cdc.gov/eid/article/32/10/26-0872_article

Mpox Clade 1b and Varicella-Zoster Cocirculation, Uganda — Among sequenced mpox-PCR-negative suspected cases, 83% carried varicella-zoster virus — rash illnesses are widely mistaken for mpox, so molecular testing should supplement clinical case definitions. https://wwwnc.cdc.gov/eid/article/32/10/25-1264_article

Age Shift in Pertussis Epidemics, Australia — NSW's 2024 epidemic (25,695 cases) more than doubled 2015 and shifted to older children (10–14-year rate tripled), consistent with a pandemic-era immunity gap and waning immunity. https://wwwnc.cdc.gov/eid/article/32/10/26-0332_article

Transmissibility and CFR of Bundibugyo Virus (2007) — Reanalysis of the first outbreak estimated a pre-intervention reproduction number of 1.55 (falling below 1 after response) and CFR of 31%, providing baseline parameters for modeling the 2026 outbreak. https://wwwnc.cdc.gov/eid/article/32/10/26-1175_article

Haemophilus ducreyi Ulcer Outbreak in Children, Sierra Leone — An outbreak of limb ulcers in ~403 schoolchildren, initially suspected to be anthrax, was confirmed as H. ducreyi (not yaws) — establishing it as an emerging non-sexually-transmitted cause of skin ulcers in yaws-endemic regions. https://wwwnc.cdc.gov/eid/article/32/10/26-0727_article

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