Kava (Piper methysticum), a central nervous system depressant derived from a plant in the pepper family native to the Pacific Islands, is traditionally consumed in religious, cultural, political, and social ceremonies. In the United States, kava emerged in the late 1990s and has experienced renewed growth and product diversification since the 2010s, with increasing availability of concentrated extracts and ready-to-drink beverages. These commercial products are commonly marketed as healthy alternatives to alcohol, sold near college campuses, and increasingly being combined with kratom, a psychoactive botanical with opioid-like effects, raising safety concerns. Data on kava-related use during January 2000-December 2025 that resulted in a report to the National Poison Data System (i.e., kava exposure report) were analyzed to assess trends by users' demographic characteristics, exposure type, and outcomes. Kava-related exposure reports declined sharply after a 2002 Food and Drug Administration advisory on kava-associated severe liver injury but have risen steadily since 2011, reaching 203 reported exposures in 2025. Reports primarily involved adults aged ≥20 years, but demographic characteristics have changed over time. During 2000-2001, reports primarily involved females and included more children aged ≤12 years, whereas exposure reports since 2013 have predominantly involved men; reports involving children have been rare. Since 2017, reports involving combined use of kava and kratom have increased, reaching 30% (61) of all kava reports in 2025. These increases have coincided with higher rates of serious reported clinical outcomes in recent years (32% in 2025 compared with 12% in 2000). These data indicate a resurgence of overall kava exposure reports to poison centers, as well as an increase in kratom-related kava reports, which has coincided with higher rates of serious clinical outcomes. The findings in this report suggest the need for enhanced surveillance for, clinical awareness of, and public education regarding commercial products containing kava.
Kratom, the leaves of a tropical evergreen tree (Mitragyna speciosa), is traditionally consumed in Southeast Asia for pain relief, mood enhancement, and to relieve symptoms of opioid withdrawal. Kratom contains psychoactive compounds that interact with opioid receptors and is widely available in various forms in the United States. Its evolution from natural leaf to high-potency alkaloid products has raised concerns about toxicity. Data on kratom-related use that resulted in a report to the National Poison Data System (NPDS) (i.e., kratom exposure report) during 2015-2025 were analyzed to assess trends by exposure report type, demographic characteristics of persons exposed, and outcomes. During the past 11 years, poison centers received a total of 14,449 kratom exposure reports; the record high 3,434 reports in 2025 represent an increase of approximately 1,200% compared with the 258 reports in 2015. Most reports involved males and young adults aged 20-39 years, but reports among adults aged 40-59 years increased most sharply, with rates nearly overlapping with those among young adults by 2025. Although single-substance exposure reports accounted for most reports (62%), multiple-substance reports occurred at higher rates (range = 467-5,442 per 1 million multiple-substance drug exposure reports versus 388-4,045 per 1 million single-substance drug exposure reports), were associated with more hospitalizations (44%-56% versus 24%-29% annually) and serious (life threatening, pronounced, prolonged, or systemic) outcomes (57%-66% versus 41%-49% annually), and accounted for the vast majority of kratom-associated deaths during the study period (184 of 233; 79%). NPDS data indicate that kratom-related reports to poison centers are increasing and expanding among demographic groups, underscoring the value of ongoing surveillance to identify high-risk patterns of kratom use and guide strategies to reduce risks from multiple-substance exposure reports.
Physical activity has numerous health benefits, including for women of reproductive age (18-44 years), among whom it can prevent chronic disease, including osteoporosis, and improve maternal health. Understanding the prevalence of leisure-time physical activity among different sociodemographic groups of women of reproductive age can help guide public health interventions and messaging. Data from the 2022 and 2024 National Health Interview Survey were used to examine the prevalences of self-reported leisure-time physical activity and meeting recommendations in the Physical Activity Guidelines for Americans, 2nd edition, among 10,981 women aged 18-44 years by race and ethnicity, age, and educational attainment. Overall, an estimated 25.1% of women aged 18-44 years reported leisure time activity meeting recommendations for both aerobic and muscle-strengthening physical activity, 27.1% reported leisure time activity meeting only the aerobic activity recommendation, and 6.1% reported leisure time activity meeting only the muscle-strengthening activity recommendation. An estimated 47.2% of women reported leisure-time physical activity insufficient to meet either recommendation (including those reporting no leisure time physical activity). Prevalences of reported aerobic and muscle-strengthening physical activity varied by race and ethnicity, age, and educational attainment: higher percentages of younger women (women aged 18-24 years), non-Hispanic White (White) women, and women with higher levels of educational attainment met both recommendations than did older women (women aged 30-34 or 40-44 years), women who are not White, and those with less educational attainment. Given the benefits of physical activity for maternal, physical, and mental health, addressing possible population-specific barriers to physical activity among women of reproductive age could be an important strategy for improving health outcomes.
The National Immunization Survey-Child monitors coverage with recommended routine childhood vaccines. For data collected in survey year 2024, which include children born in 2021 and 2022, the household response rate (23.4%) and availability of adequate provider data for children with completed interviews (51.4%) were comparable to those from earlier survey years. For most vaccines, coverage by age 24 months was similar among children born in 2021 and 2022 and those born in 2019 and 2020. Declines in coverage of 1-2 percentage points were observed for the primary series of Haemophilus influenzae type b conjugate vaccine, the birth dose of hepatitis B vaccine, ≥4 doses of pneumococcal conjugate vaccine, and rotavirus vaccine. Coverage with ≥2 doses of influenza vaccine by age 24 months decreased from 61.0% among children born during 2019-2020 to 53.5% among those born during 2021-2022. Coverage was lower among Vaccines for Children (VFC) program-eligible children than among those who were not VFC-eligible and differed substantially by jurisdiction. Compared with non-Hispanic White children, coverage with many vaccines was lower among non-Hispanic Black or African American and Hispanic or Latino children; coverage was highest among non-Hispanic Asian children. Coverage was also lower among children living in poverty and those living in more rural areas. Maintaining high levels of vaccination and improving coverage among groups and in areas in which rates have declined could help protect children from vaccine-preventable morbidity and mortality. The Community Preventive Services Task Force recommends several interventions to increase vaccination, including standing orders for vaccination, immunization information systems, and vaccination programs in organized child care centers and in Special Supplemental Nutrition Program for Woman, Infants, and Children settings. Other factors demonstrated to be effective include strong provider recommendations, targeted messages from credible and trusted sources, and increased participation in the VFC program.
The Advisory Committee on Immunization Practices (ACIP) recommends that all health care personnel (HCP) receive an annual influenza vaccination to reduce the risk for influenza and influenza-related morbidity and mortality among themselves and their patients. For the 2024-25 respiratory virus season, ACIP also recommended that all HCP be vaccinated against COVID-19. During March 26-April 17, 2025, CDC conducted a nonprobability opt-in internet panel survey of 2,650 U.S. HCP to estimate influenza and COVID-19 vaccination coverage during the 2024-25 respiratory virus season. Overall, 76.3% of HCP reported having received an influenza vaccine and 40.2% reported receiving the 2024-25 COVID-19 vaccine. Influenza vaccination coverage was highest among pharmacists (94.6%), physicians (92.6%), and HCP who worked in hospital settings (88.3%). COVID-19 vaccination coverage was highest among physicians (46.7%), assistants or aides (46.7%), and HCP who worked in long-term care and home health care settings (44.5%). Both influenza and COVID-19 vaccination coverage rates were highest among HCP whose employer required or recommended the vaccines or offered them on-site. A multipronged approach, including educating HCP about benefits of vaccination and implementing workplace strategies (such as employer vaccination recommendations or offering on-site vaccination) might improve vaccination coverage and reduce influenza- and COVID-19-related morbidity among HCP.
Violence is a major cause of morbidity and mortality among young adults in low- and middle-income countries. Men aged 18-24 years (young men) account for the majority of victims and perpetrators of many types of interpersonal violence. Childhood experiences, such as exposure to emotional, physical, or sexual violence or witnessing violence in their homes or communities, might increase risk for perpetration of violence in adulthood. Data from eight Violence Against Children and Youth Surveys conducted in low- and middle-income countries during 2018-2023 were analyzed to assess prevalence of physical and sexual violence perpetration by young men and associations of these events with their exposure to violence during childhood. Lifetime prevalence of physical or sexual violence perpetration among young men was common in all countries and ranged from 12.4% in Eswatini to 44.9% in Côte d'Ivoire. Physical violence victimization or witnessing violence in the household or community before age 18 years was associated with increased odds of violence perpetration among young men in all eight countries after adjusting for demographic covariates and childhood adversity indicators. Efforts to prevent exposure to violence during childhood, a pivotal developmental period, might reduce perpetration of violence by young men and create safer and more secure homes and communities.
The SARS-CoV-2 variant BA.3.2 was first identified in South Africa on November 22, 2024. BA.3.2 has approximately 70-75 substitutions and deletions in the gene sequence of the spike protein relative to JN.1 and its descendant, LP.8.1, the antigens used in the 2025-26 COVID-19 vaccines. CDC is using a multimodal SARS-CoV-2 genomic surveillance approach to monitor the emergence and spread of BA.3.2 and other SARS-CoV-2 variants internationally and within the United States. The first U.S. BA.3.2 detection occurred on June 27, 2025, through CDC's Traveler-Based Genomic Surveillance program in a participant traveling to the United States from the Netherlands. The first U.S. detection of BA.3.2 in a clinical specimen collected from a patient was reported on January 5, 2026. As of February 11, 2026, BA.3.2 had been detected in voluntarily self-collected nasal swabs from four U.S. travelers, clinical samples from five patients, three airplane wastewater samples, and 132 wastewater surveillance samples from 25 states. BA.3.2 has been reported by at least 23 countries. SARS-CoV-2 continues to cause substantial morbidity and mortality worldwide. BA.3.2 mutations in the spike protein have the potential to reduce protection from a previous infection or vaccination. Continued genomic surveillance is needed to track SARS-CoV-2 evolution and determine its potential effect on public health.
Kaposi sarcoma-associated herpesvirus (KSHV) infection is the cause of Kaposi sarcoma (KS), certain lymphoproliferative disorders, and the inflammatory condition Kaposi sarcoma-associated herpesvirus inflammatory cytokine syndrome (KICS). In solid organ transplant recipients, KSHV-related complications can result from reactivation of latent infection, new posttransplant infection, or transmission of virus from the transplanted organ. However, testing of donors and recipients is not routinely performed. During January 2021-September 2025, after transplantation of 185 organs into 153 recipients, 46 deceased donors were identified whose transplanted organs were suspected of having transmitted KSHV, approximately five times the number of such donors (nine) reported during 2016-2020. As of February 2026, a posttransplantation KSHV infection has been identified among 74 (48%) of these 153 transplant recipients. Among the 74 recipients with KSHV infection, 45 (61%) developed KS; 10 (14%) of these recipients with KS also developed a lymphoproliferative disorder (multicentric Castleman disease [eight], posttransplant lymphoproliferative disorder [one], and primary effusion lymphoma [one]) and six (8%) developed KICS; four (5%) recipients developed a lymphoproliferative disorder alone (primary effusion lymphoma [one] and posttransplant lymphoproliferative disorder [three]); and one (1%) developed KICS alone. To date, 25 (16%) of the 153 transplant recipients have died. Most donors and recipients were HIV-negative, and nonmedical drug use was common among donors. Clinicians should maintain a high index of suspicion for KSHV in transplant recipients, particularly when donors have risk factors including nonmedical drug use, or when another recipient from the same donor is found to be infected. Development and implementation of effective testing strategies and timely reporting could guide clinical management, reduce risk for KSHV-related complications, and improve transplant safety.
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Nursing home residents and health care personnel (HCP) are at increased risk for exposure to influenza; in addition, residents of nursing homes who acquire influenza are at increased risk for severe disease. The Advisory Committee on Immunization Practices recommends routine annual seasonal influenza vaccination for persons without contraindications, including HCP and those at increased risk for severe influenza. Nursing homes report influenza vaccination among residents and HCP to CDC's National Healthcare Safety Network. This report describes influenza vaccination coverage among nursing home residents and HCP working in nursing homes during the 2024-25 influenza season (October 1, 2024-March 31, 2025). At the end of the 2024-25 influenza season, influenza vaccination coverage was 61.3% among nursing home residents and 42.1% among HCP who work in nursing homes; coverage among HCP varied by employment type. This study is the first comprehensive, national assessment of influenza vaccination coverage among nursing home residents and HCP who work in nursing homes in the United States. Monitoring of influenza vaccination coverage in this population at high risk for influenza exposure and severe influenza disease, along with implementation of a combination of influenza vaccination, administration of influenza antiviral medications, and other recommended practices to control the spread and severity of influenza in nursing home settings, can help protect nursing home residents and HCP against severe influenza-associated outcomes.
Respiratory viruses are common causes of upper and lower respiratory tract illness and can also result in hospitalization and death. CDC conducts national surveillance using multiple systems to monitor ongoing and seasonal changes in the activity of selected respiratory viruses. This report summarizes U.S. trends in endemic respiratory virus activity during July 2024-June 2025. For SARS-CoV-2 and respiratory syncytial virus (RSV), national and regional trends; population-based hospitalization rates; vital records death counts; and preliminary estimates of associated illnesses, outpatient visits, hospitalizations, and deaths are described, as well as genetic characterization of circulating SARS-CoV-2 viruses. Some viruses, including SARS-CoV-2, showed bimodal peaks in positive laboratory test results, whereas others, including RSV and influenza viruses, were characterized by a single peak. The highest COVID-19-associated hospitalization rates were reported among adults aged ≥75 years (932.6 per 100,000 persons), infants aged <6 months (285.6), and adults aged 65-74 years (274.4). RSV-associated hospitalization rates were highest among infants aged <12 months (1,116.7 per 100,000; 95% CI = 1,078.4-1,157.9), children aged 12-23 months (770.6; 95% CI = 743.1-800.3), and adults aged ≥75 years (426.9; 95% CI = 366.6-510.8). COVID-19 was associated with an estimated 290,000-450,000 hospitalizations and 34,000-53,000 deaths; RSV was associated with 190,000-350,000 hospitalizations and 10,000-23,000 deaths. All circulating SARS-CoV-2 lineages were Omicron JN.1 descendants. Staying up to date with recommended COVID-19, RSV, and influenza vaccinations remains important to reducing the risk for severe disease caused by these viruses.
In late spring 2024, CDC was alerted to an outbreak of poisoning potentially associated with eating Diamond Shruumz microdosing chocolate bars. Diamond Shruumz microdosing chocolate bars are edible products designed so that small doses of mushroom-derived psychoactive compounds and other psychoactive ingredients can be eaten in a presectioned serving. In response to this alert, CDC and the Food and Drug Administration coordinated a nationwide outbreak investigation to characterize the potential poisonings associated with eating Diamond Shruumz microdosing chocolate bars. A case of poisoning was defined as an illness with moderate or major clinical effects (i.e., symptoms) as defined by America's Poison Centers in a person who ate any Diamond Shruumz product or another mushroom-containing chocolate product during January-October 2024. In total, 180 cases were reported in 34 states. Among these, 73 persons were hospitalized, including 38 persons who required intensive care unit (ICU) admission, 29 who required endotracheal intubation, and two deaths. Eating Diamond Shruumz chocolate bars was associated with higher odds of hospitalization (odds ratio [OR] = 3.29; 95% CI = 1.51-7.40), ICU admission (OR = 6.30; 95% CI = 2.17-22.6), seizures (OR = 8.45; 95% CI = 3.00-27.9), and endotracheal intubation (OR = 8.04; 95% CI = 2.24-44.2), compared with eating other mushroom-containing chocolate products. Eating larger amounts of Diamond Shruumz chocolate bars was associated with an increased likelihood of hospitalization, ICU admission, and endotracheal intubation (p-value for trend tests [p-trend] = 0.023, 0.004, and <0.001, respectively). Diamond Shruumz products were recalled, and the public was advised not to eat, sell, or serve any Diamond Shruumz products and to discard any Diamond Shruumz products previously purchased. Testing of some Diamond Shruumz products identified substances present in psychoactive mushrooms, including muscimol, psilocin (a Schedule I controlled substance), kavalactones, and other substances in some, but not all, tested products. Consumers should be aware of the poisoning risk associated with eating Diamond Shruumz products and other mushroom-containing microdosing chocolate products due to variability in ingredient composition, the absence of standardized regulatory oversight for sampling and testing finished products, and the potential toxicity of compounds intended to produce psychoactive effects.
In January 2025, CDC received several reports of deaths among children aged <18 years with a severe form of influenza-associated encephalopathy (IAE) termed acute necrotizing encephalopathy (ANE). Because no national surveillance for IAE currently exists, CDC requested notification of U.S. pediatric IAE cases from clinicians and health departments during the 2024-25 influenza season, a high-severity season with a record number of pediatric influenza-associated deaths. Among 192 reports of suspected IAE submitted to CDC, 109 (57%) were categorized as IAE, 37 (34%) of which were subcategorized as ANE, and 72 (66%) as other IAE; 82 reports did not meet IAE criteria and were categorized as other influenza-associated neurologic disease. The median age of children with IAE was 5 years and 55% were previously healthy, 74% were admitted to an intensive care unit, and 19% died; 41% of children with ANE died. Only 16% of children with IAE who were vaccination-eligible had received the 2024-25 influenza vaccine. Health care providers should consider IAE in children with encephalopathy or altered level of consciousness and a recent or current febrile illness when influenza viruses are circulating. Annual influenza vaccination is recommended for all children aged ≥6 months to prevent influenza and associated complications, potentially including severe neurologic disease such as IAE and ANE.
Meningococcal disease is a serious bacterial infection caused by Neisseria meningitidis. Serogroups B, C, W, and Y cause the majority of cases of this disease in the United States. These serogroups are targeted by different meningococcal vaccines available in the United States. Two quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate vaccines (MenACWY) (MenACWY-CRM [Menveo, GSK] and MenACWY-TT [MenQuadfi, Sanofi Pasteur]) and two serogroup B meningococcal vaccines (MenB) (MenB-4C [Bexsero, GSK] and MenB-FHbp [Trumenba, Pfizer]) are licensed for use in the United States and recommended by CDC's Advisory Committee on Immunization Practices (ACIP). Indications for MenACWY and MenB vaccination have not changed since indications for their use were published in 2020. A pentavalent (serogroups A, B, C, W, and Y) meningococcal vaccine (MenABCWY) (MenACWY-TT/MenB-FHbp [Penbraya, Pfizer]) has been licensed and recommended for use since October 2023. On February 14, 2025, the Food and Drug Administration licensed a second pentavalent MenABCWY vaccine (MenACWY-CRM/MenB-4C [Penmenvy, GSK]) for prevention of invasive disease caused by N. meningitidis serogroups A, B, C, W, and Y in persons aged 10-25 years, the same indication for which MenACWY-TT/MenB-FHbp is licensed. On April 16, 2025, ACIP recommended that MenACWY-CRM/MenB-4C may be used when both MenACWY and MenB are indicated at the same visit for 1) healthy persons aged 16-23 years (routine schedule) when shared clinical decision-making favors administration of MenB vaccine and 2) persons aged ≥10 years who are at increased risk for meningococcal disease (e.g., because of persistent complement deficiencies, complement inhibitor use, or functional or anatomic asplenia). Different manufacturers' serogroup B-targeting vaccines are not interchangeable; therefore, when MenACWY-CRM/MenB-4C is used, MenB-4C should be used for the other MenB doses. This report summarizes evidence considered for these recommendations and provides clinical guidance for the use of MenACWY-CRM/MenB-4C.
Dracunculiasis (Guinea worm disease), caused by the parasite Dracunculus medinensis, is acquired by drinking water containing small water fleas infected with D. medinensis larvae or eating inadequately cooked aquatic animals. Efforts to eradicate D. medinensis, including the Guinea Worm Eradication Program (GWEP), began at CDC in 1980. In 1986, with an estimated 3.5 million cases in 20 African and Asian countries, the World Health Assembly called for dracunculiasis elimination in specific geographic areas; this goal was later expanded to global eradication. GWEP has been led by The Carter Center since 1986 and is supported by countries with endemic dracunculiasis, CDC, the World Health Organization, UNICEF, and other partners. During 1986-2023, human dracunculiasis cases decreased by >99%, from an estimated 3.5 million to 14 worldwide. Since 2012, environmental contamination from infected animals has posed a new challenge to eradication, as have ongoing civil unrest and insecurity in some areas. As of June 2025, indigenous dracunculiasis transmission was occurring in six countries (Angola, Cameroon, Chad, Ethiopia, Mali, and South Sudan). Fifteen human cases and 664 animal infections were reported in 2024, including 299 canine infections in Cameroon and 234 in Chad; during January-June 2025, one human case and 550 animal infections were reported. Animal infections and public health personnel's impeded access to the population due to civil unrest and insecurity in Mali, South Sudan, and Sudan threaten the near-term possibility of disease eradication. Nevertheless, countries and partners appear poised to reach zero human cases soon.
Seasonal influenza vaccination provides important protection from influenza illness and associated potential complications. Monitoring seasonal influenza vaccine effectiveness (VE) in Southern Hemisphere countries can apprise health authorities in Northern Hemisphere countries about the potential protection provided from vaccination. Using data from influenza-like illness (ILI) and severe acute respiratory infection (SARI) sentinel surveillance networks in eight Southern Hemisphere countries, investigators estimated interim VE against influenza-associated outpatient visits and hospitalization using a test-negative case-control study design. During March-September 2025, Australia and South Africa identified 2,122 patients with ILI; Argentina, Australia, Brazil, Chile, New Zealand, Paraguay, and Uruguay identified 42,752 patients with SARI. Overall, 21.3% of patients with ILI and 15.9% of patients with SARI were vaccinated against influenza. Adjusted VE against influenza-associated outpatient visits and hospitalization was 50.4% and 49.7%, respectively, for any influenza virus, and 45.4% and 46.1%, respectively, for influenza A viruses. Adjusted VE against hospitalization with the predominant influenza subtype, A(H1N1)pdm09, was 41.6%. These interim estimates suggest that vaccination reduced medically attended influenza-associated illness by approximately one half in eight Southern Hemisphere countries. Health authorities should prioritize vaccination of all eligible persons ≥6 months to reduce incidence of influenza disease.
Incidence of coccidioidomycosis (Valley fever), a fungal infection caused by inhalation of Coccidioides species spores, has increased substantially across the southwestern United States in association with increasing aridity, warming temperatures, and precipitation volatility. Arizona and California report >95% of U.S. coccidioidomycosis cases, and incidence in Arizona has increased statewide. Patterns within Arizona's distinct climatological regions have not been characterized, especially in regions outside the known zone of persistently high levels of disease occurrence (hyperendemicity) in the southwest Sonoran Desert region. In this study, surveillance data reported to the Arizona Department of Health Services since 2005 were used to calculate coccidioidomycosis incidence within six ecological regions. During 2005-2022, annual incidence approximately doubled in Arizona, with >95% of cases reported from the Sonoran Desert region. Although the Plateaus and Mojave Desert regions (in the northern parts of the state) reported <1.5% of Arizona cases during this period, these regions experienced the highest relative increases in incidence from the 2005-2007 period to the 2020-2022 period. During 2020-2022, coccidioidomycosis incidence in the Plateaus region was 6.61 times the incidence during 2005-2007 (95% CI = 4.22-10.30), and in the Mojave Desert region, incidence was 4.50 times that during 2005-2007 (95% CI = 3.45-5.89). The Plateau and Mojave regions also reported the highest relative increases in incidence from the 2014-2016 period to the 2020-2022 period. Large relative incidence increases in northern regions, including cooler and wetter regions generally considered less suitable for Coccidioides species establishment and transmission, necessitate targeted public health messaging in these areas and support ongoing investigation into the causes of these increases.
Cosmetic botulinum neurotoxin (BoNT) can be used to temporarily diminish facial wrinkles (1); however, injection for this purpose occasionally results in localized paralytic effects, even when BoNT that is approved by the Food and Drug Administration (FDA) and purchased from authorized sources is administered by licensed and trained medical professionals. Rarely, improperly procured or administered BoNT can lead to severe illness. During May-June 2025, hospital clinicians and health departments in New York, Texas, and Wisconsin each alerted CDC about a person in their jurisdiction who experienced severe illness after self-injecting cosmetic BoNT that was purchased online.* None of the three patients met their state's requirements for purchasing or administering BoNT; no link was reported among the patients. This report describes the patients' characteristics, treatment, and outcomes. This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.†.
In September 2024, the ninth documented case of welder's anthrax was identified in a previously healthy male welder, aged 18 years, from Louisiana, who was hospitalized with pneumonia and respiratory failure requiring intubation and mechanical ventilation. Welder's anthrax is a recently described life-threatening pneumonia caused by infection with anthrax toxin-producing Bacillus cereus group bacteria; risk factors for infection are not well-understood. Eight previous cases (six fatal) were reported among welders or metalworkers from Louisiana and Texas. A coordinated state and federal response facilitated use of the anthrax antitoxin obiltoxaximab (Anthim), which was administered in combination with recommended multidrug antimicrobial therapy for inhalation anthrax, including bactericidal agents and protein synthesis inhibitors. The patient's clinical condition improved rapidly after administration of obiltoxaximab and antimicrobials and drainage of a pleural effusion. He was discharged with a tailored antibiotic regimen after a 26-day hospitalization; all of his pulmonary symptoms had resolved by his 3-month follow-up visit. An environmental investigation identified anthrax toxin genes in 28 (11.4%) of 245 soil and nonporous surface samples collected from the patient's worksite; however, this investigation did not clearly identify host or occupational factors that contributed to his illness. Enhanced workplace safety protocols and improved engineering and administrative controls could minimize exposure to dust and welding fumes and potentially decrease environmental exposure to infectious disease agents among metalworkers. Welder's anthrax should be considered in the differential diagnosis of pneumonia among welders and metalworkers, particularly those who live in or have worked in the southern United States. Health care providers should consult with CDC as soon as welder's anthrax is suspected to facilitate release of anthrax countermeasures, including antitoxins such as obiltoxaximab, as adjunctive therapy.
Human rabies cases are rare in the United States; most result from domestic wildlife exposure. U.S. residents can acquire rabies abroad, typically through contact with dogs in areas where dog-maintained rabies is endemic. In November 2024, a man from Haiti was admitted to a Kentucky hospital with an 8-day history of progressive lower extremity pain and weakness. Soon after admission, he experienced hypersalivation, dysphagia, agitation, and eventually, respiratory failure requiring invasive mechanical ventilation. Ten days after admission, he was transferred to a referral hospital in Ohio, where his condition further deteriorated. Despite early consideration of rabies in the differential diagnosis, testing was delayed until late in the clinical course while other diagnostic possibilities were pursued. Rabies testing was initiated on the 29th hospital day and was confirmed 5 days later; the patient died that day. Phylogenetic analysis of the nucleoprotein gene supported acquisition of a dog-maintained rabies virus variant in Haiti. In total, 709 possible contacts during the patient's infectious period underwent risk assessment; 60 (8%) were recommended to receive rabies postexposure prophylaxis (PEP) because of exposure to saliva. Before the patient's rabies diagnosis, standard precautions were used inconsistently during his care; among 60 persons recommended to receive PEP, 52 (88%) were health care workers. Earlier rabies diagnosis and regular adherence to standard infection control precautions, recommended for all patient care, might have reduced health care-associated exposures. This case underscores the importance of early public health consultation upon clinical suspicion of rabies and universal adherence to standard precautions.