Antimicrobial Stewardship

Ebola

HCV / Hepatitis

Blood-Borne Diseases

Coronavirus / COVID

E. Coli

Food Safety

Listeria

Salmonella

Food Borne Infection / Food Safety

Candida auris

Fungal Infections

C. Difficile

H. Pylori

Norovirus

Gastrointestinal Infections

Healthcare Associated Infections (HAI)

Antibiotics

Immunizations

Vaccines

Prevention

Community-Acquired Pneumonia 

Influenza

Measles

Respiratory Infections

HIV / AIDS

PrEP

Sexually Transmitted Diseases

MRSA

Skin & Soft Tissue Diseases

Lyme Disease

ZIKA

Zoonotic & Vector-Borne Diseases

News

Media

Medical World News

Podcasts

Videos

Insights

Peer Exchange

Media Day

News Network

Roundtables

Conference

Conference Coverage

Conference Listing

Publication

CME/CE

Partners

Resources

Interactive Tools

Special Projects

Contribute

Case Studies

Writers and Mentors

Subscribe

Contagion® is a news resource for infectious disease specialists and practitioners, aiding identification, diagnosis, treatment and prevention.

About Us

Advertise

Editorial

Contact Us

Do Not Sell My Information

Privacy

Terms & Conditions

Contagion Live | Infectious Disease News & Expert Insights

Facebook

LinkedIn

Spotlight

Bench to Bedside With SIDP

C. difficile 

Clinical Corner

Hepatitis

RSV: A New Era in Prevention

Clinical

COVID-19

Climate Change

Covid Vaccine Race

Food-Borne Infections

Healthcare-Associated Infections

Respiratory Diseases

Respiratory Syncytial Virus (RSV)

Video Series

Peers and Perspectives

1rem

Authors

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

A measles outbreak in 3 states continues to grow and there are a smattering of cases in various parts of the country. The Centers for Disease Control and Prevention (CDC) reports that as of last Thursday, March 13, there were 301 cases of measles in the United States including the following jurisdictions: Alaska, California, Florida, Georgia, Kentucky, Maryland, New Jersey, New Mexico, New York City, New York State, Pennsylvania, Rhode Island, Texas, Vermont, and Washington.

CDC reports that of all the cases nationwide, 95% of individuals were considered unvaccinated or unknown, 3% had 1 MMR vaccine dose, and 2% had 2 MMR doses.

The largest number of cases are in Texas where the state’s health department is reporting 259 cases with 34 hospitalizations, and 1 death. Of the cases, 257 of them have been classified as unvaccinated/unknown, zero cases with 1 dose of the vaccine, and 2 cases in people with 2 plus vaccines.

According to the state’s health officials, the unvaccinated/unknown category includes people with no documented doses of measles vaccine more than 14 days before symptom onset.

They also reported on existing cases, and after securing more information into the details of cases, health officials said 3 cases previously classified as vaccinated were not vaccinated cases. And 2 of those cases got their vaccine doses 1 to 2 days before their symptoms started, after they had been exposed to the virus.

They point out that it takes the body about 14 days after vaccination to develop immunity to measles, so people aren’t considered vaccinated until that 14-day period has passed.

In New Mexico, there has been 35 cases of measles in the state as of last Friday. Of those cases, 28 of them have been classified as unvaccinated, 2 cases had at least 1 dose of the vaccine, and 5 cases were in people with unknown vaccine status.

There has been 1 death there in an unvaccinated individual.

In Oklahoma, they reported 4 probable cases of measles as of last Friday. All the individuals were unvaccinated.

A new analysis by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) reported there was 127,350 measles cases in the European Region in 2024, which doubles the amount of cases reported for 2023 and the highest number since 1997.

Children under 5 accounted for more than 40% of reported cases in the region—comprising 53 countries in Europe and central Asia. More than half of the reported cases required hospitalization. A total of 38 deaths have been reported, based on preliminary data.

“Measles cases across Europe and central Asia have soared over the past 2 years—pointing to gaps in immunization coverage,” Regina De Dominicis, UNICEF Regional Director for Europe and Central Asia, said in a statement. “To protect children from this deadly and debilitating disease, we need urgent government action including sustained investment in healthcare workers.”

The report did not offer insights on this year’s cases, but public health officials are concerned about the incidence trends.

“Measles is back, and it’s a wake-up call. Without high vaccination rates, there is no health security. As we shape our new regional health strategy for Europe and central Asia, we cannot afford to lose ground. Every country must step up efforts to reach under-vaccinated communities,” Dr Hans Henri P. Kluge, WHO Regional Director for Europe, said in a statement. “The measles virus never rests—and neither can we.”


References
1. Measles Cases and Outbreaks. CDC. March 14, 2025. Accessed March 17, 2025.


https://www.cdc.gov/measles/data-research/index.html


2. Measles Outbreak. Texas Department of State Health Services press release. March 14, 2025. Accessed March 17, 2025.


https://www.dshs.texas.gov/news-alerts/measles-outbreak


3.2025 Measles Outbreak Guidance. NMDOH. March 14, 2025. Accessed March 17, 2025.


https://www.nmhealth.org/news/alert/2025/2/?view=2177


4. OSDH Reports Additional Measles Cases. OSDH press release. March 14, 2025. Accessed March 17, 2025.


https://oklahoma.gov/health/news---events/newsroom/2025/osdh-reports-additional-measles-cases.html


5. European Region reports highest number of measles cases in more than 25 years – UNICEF, WHO/Europe. WHO press release. March 13, 2025. Accessed March 17, 2025.


https://www.who.int/europe/news/item/13-03-2025-european-region-reports-highest-number-of-measles-cases-in-more-than-25-years---unicef--who-europe

Cases in the US continue to increase, and a new analysis shows 2024 was the highest year for measles cases in Europe in 25 years.

Measles Update: Week of March 17, 2025

As of March 20, the Centers for Disease Control and Prevention (CDC) is reporting that there are now 378 cases of measles in the US, with 4 states experiencing outbreaks including Texas, New Mexico, Oklahoma, and Kansas. Cases run across 18 jurisdictions, and 17% of these cases (64 people) have been hospitalized in 2025.



In terms of the ages of the individuals hospitalized, here is the breakdown:


In terms of mortality, there is 1 confirmed death from measles and 1 death that is under investigation.

Looking at the vaccination status for all the cases, 95% are unvaccinated or unknown, 3% of cases have had 1 dose of the measles, mumps, and rubella (MMR) vaccine, and 2% of cases have had 2 MMR doses.



Here is an update on the 4 states dealing with outbreaks: 



 As of March 25, there are 327 cases in the state with 40 hospitalizations. Of the cases, 325 of them are unvaccinated.

This outbreak is still increasing since last week’s numbers were reported.



As of March 25, there are 43 confirmed cases in the state, with 2 hospitalizations.

 There has been a slight increase in the outbreak since last week.



 As of March 25, there are 9 cases with zero hospitalizations. All 9 cases were considered in the unvaccinated/unknown category. 

 As of last Friday, March 21, the state confirmed there is 10 cases. All of the confirmed cases are ages 0-17, and 9 of them were unvaccinated.



The outbreak has been seen in 3 neighboring counties in the southwest part of Kansas with Grant, Stevens, and Morton counties reporting cases.



“Due to the highly contagious nature of measles, additional cases are likely to occur in the outbreak area in Kansas and in surrounding counties, especially among those that are unvaccinated,” The Kansas Department of Health and Environment wrote on its site.

Although not confirmed, social media is reporting there is as many of 23 cases in the state as of today, March 26.

Unrelated to these aforementioned outbreaks, a person infected with measles took an Amtrak train, the Northeast Regional 175, that was part of the Boston to Washington DC route from 7:30pm to 1:30pm back on March 19, according to the Washington DC Department of Health. The announcement does not say where the infected person boarded the train, but it says the person did enter Union Station in DC between 11pm and 1:30am on that date and then went to MedStar Urgent Care in Adams Morgan, in Washington on March 22, between 7:00pm-11:00pm. 

The DC Department of Health says people who were in those locations and might have been exposed and are not immune should contact their health care provider or DC Health at 844-493-2652 for more guidance.


References
1. Measles Cases and Outbreaks. CDC. March 21, 2025. Accessed March 26, 2025.



2.Measles Outbreak. Texas Department of State Health Services press release. March 25, 2025. Accessed March 26, 2025.



3.2025 Measles Outbreak Guidance. NMDOH. March 25, 2025. Accessed March 26, 2025.



4.Measles. Oklahoma State Department of Health. March 25, 2025. Accessed March 26, 2025.
https://oklahoma.gov/health/health-education/acute-disease-service/rash-illness/measles.html
5. Increase of Measles Cases in Kansas and Updated MMR Vaccination Recommendation. Kansas Department of Health and Environment.
6. Health Officials Investigating Possible Measles Exposures in DC. Washington DC Department of Health. March 25, 2025. Accessed March 26, 2025.
https://dchealth.dc.gov/release/health-officials-investigating-possible-measles-exposures-dc

Kansas now has an outbreak with at least 10 confirmed cases with an expectation from the state's health officials that there will be more. 

Measles Outbreak Expands to 4 States

Amidst looming funding cuts coming from the US federal government to international vaccine programs, as well as misinformation, population growth, and humanitarian crises, the World Health Organization (WHO), UNICEF, and Gavi have publicly stated these factors could lead to millions of children, adolescents, and adults being at an increased risk for vaccine-preventable diseases.

A recent WHO rapid stock take with 108 country offices of WHO—mostly in low- and lower-middle-income countries—shows that nearly half of those countries are facing moderate to severe disruptions to vaccination campaigns, routine immunization and access to supplies due to reduced donor funding. Disease surveillance, including for vaccine-preventable diseases, is also impacted in more than half of the countries surveyed.

In March, the US State Department detailed its planned cuts to foreign aid, and as part of that, it decided to cancel its over $1 billion grant to Gavi.

 The organization is a public-private partnership that helps vaccinate more than half the world’s children against some of the deadliest diseases. Gavi brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Gates Foundation, and other private sector partners.

“Vaccines have saved more than 150 million lives over the past five decades,” WHO Director-General, Tedros Adhanom Ghebreyesus, PhD, said in a statement. “Funding cuts to global health have put these hard-won gains in jeopardy. Outbreaks of vaccine-preventable diseases are increasing around the world, putting lives at risk and exposing countries to increased costs in treating diseases and responding to outbreaks. Countries with limited resources must invest in the highest-impact interventions – and that includes vaccines.”

According to Gavi, its vaccine programs have immunized 1.1 billion children through routine programs; prevented an estimated 18.8 million future deaths. In addition, 1.9 billion vaccinations have been administered through preventative campaigns and $250 billion in economic benefits have been estimated for participating countries.

The US is one of the 3 largest governmental donors to Gavi, along with the United Kingdom and Norway.

This loss of funding will greatly impact global vaccination efforts.

A Resurgence of Measles and Pertussis (Whooping Cough)

Globally, measles cases reached an estimated 10.3 million in 2023, a 20% increase compared to 2022, according to WHO.

 The agencies warn that this upward trend likely continued into 2024 and 2025, as outbreaks have intensified around the world. In the past 12 months, 138 countries have reported measles cases, with 61 experiencing large or disruptive outbreaks—the highest number observed in any 12-month period since 2019.

reported there were 884 cases of measles in the US as of April 25. In 2024, there were 285 cases reported, and in 2023, 59 cases. This suggest higher number of families choosing not to vaccinate their children, which is a large majority of the cases. Of the 2025 cases, 820 (93 percent) are linked to 11 outbreaks, compared to 69 percent outbreak-associated cases in 2024.

In 2024, the burden is especially worse in a few select countries In Europe. 35,212 measles cases were reported across the European Union (EU)/ European Economic Area (EEA). This up substantially.

Whooping cough is another example of a vaccine-preventable disease seeing large increases in the US. In 2024, there were 35,435 cases of whooping cough.

 This is the highest number since 2012 when there were 48,277 cases.

 Last year, 10 people died—6 of them were under 1 year of age.

Through the first 3 months of this year, the US has reported 6600 cases of whooping cough, more than 4 times the number at the same point last year and 25 times as many as had been reported at the same point in 2023. And if the current trend continues, the country will be on course for the highest number of infections since vaccination was introduced in 1948.

References
1. Increases in vaccine-preventable disease outbreaks threaten years of progress, warn WHO, UNICEF, Gavi. WHO. April 24, 2025. Accessed April 29, 2025. 
https://www.who.int/news/item/24-04-2025-increases-in-vaccine-preventable-disease-outbreaks-threaten-years-of-progress--warn-who--unicef--gavi
2. Gavi supports Côte d'Ivoire's largest HPV vaccination campaign targeting over 3 million girls. Gavi. April 7, 2025. Accessed April 29, 2025.


https://www.gavi.org/news/media-room/gavi-supports-cote-ivoires-largest-hpv-vaccination-campaign


3. Gavi’s Impact. Gavi. Accessed April 29, 2025.
https://www.gavi.org/
4. Abene S. As US Measles Cases Rise to 884, the ECDC Reports Over 35,000 Infections in 2024. 

. April 29, 2025. Accessed April 29, 2025.


https://www.contagionlive.com/view/as-us-measles-cases-rise-to-884-ecdc-reports-over-35-000-infections-in-2024


5. 2024 Provisional Pertussis Surveillance Report. CDC. Accessed April 29, 2025.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.cdc.gov/pertussis/media/pdfs/2025/01/pertuss-surv-report-2024_PROVISIONAL-508.pdf
6. Pertussis Cases by Year (1922-2023) CDC. April 24, 2025 Accessed April 29, 2025.


https://www.cdc.gov/pertussis/php/surveillance/pertussis-cases-by-year.html


7. Dyer O. Whooping cough: Cases soar in US. 

. 2025;389:r704. Published 2025 Apr 8. doi:10.1136/bmj.r704



The agencies are calling for sustained investments in immunization efforts in the midst of increasing case numbers rising for diseases such as whooping cough, measles, and others.  



WHO, UNICEF, Gavi Warn of Global Increases of Vaccine-Preventable Diseases 

This week, Pennsylvania has been added to the list of states with a measles outbreak. Two more cases were diagnosed recently in Erie County, Pa which is in the western part of the state. There have been 5 confirmed cases reported in this county since late March. According to health officials, none of the cases required hospitalization.

Nationally, as of April 10, there are 712 confirmed cases of measles in the US, which are being reported across 25 jurisdictions: Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Indiana, Kansas, Kentucky, Maryland, Michigan, Minnesota, New Jersey, New Mexico, New York City, New York State, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, and Washington.

 According to CDC, 93% of the confirmed cases (660 of 712) are outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated.

CDC reports that 11% of cases (79 of 712) have been hospitalized. The federal agency segmented the hospitalizations by age:




CDC reports there have been 7 outbreaks.

 States with the highest recorded counts include Texas (561 cases as of 4/15),

Texas health officials say there was an increase of 20 cases in just a few days, since their April 11 update.

Fewer than 25 of the confirmed cases, are estimated to be actively infectious since their rash onset date was less than a week ago. Patients are infectious 4 days prior to and 4 days after rash onset. Officials say 58 patients have been hospitalized and there have been 2 deaths of school-aged children—who were not vaccinated.


The 2025 outbreaks have seen more cases overall compared to last year. In 2024, there were a total of 285 measles cases that were reported by 33 jurisdictions: Arizona, California, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, New York City, New York State, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin, and West Virginia.

There were 16 outbreaks (defined as 3 or more related cases) reported in 2024, and 69% of cases (198 of 285) are outbreak-associated. For comparison, 4 outbreaks were reported during 2023 and 49% of cases (29 of 59) were outbreak-associated.

References
1. Bruce D. Erie County declares measles outbreak with two new cases. What it means. 

. April 14, 2025. Accessed April 16, 2025.
https://www.goerie.com/story/news/healthcare/2025/04/14/erie-county-measles-outbreak-two-more-cases-confirmed/83079749007/
2. Measles Cases and Outbreaks. CDC. April 11, 2025. Accessed April 16, 2025.



3. Measles Outbreak – April 15, 2025. Texas Department of State Health Services press release. April 15, 2025. Accessed April 16, 2025.


https://www.dshs.texas.gov/news-alerts/measles-outbreak-2025


4. 2025 Measles Outbreak Guidance. NMDOH. April 15, 2025. Accessed April 16, 2025.



5. Measles data. Kansas Department of Health and Environment. April 9, 2025. Accessed April 16, 2025.

https://www.kdhe.ks.gov/2314/Measles-Data


6. Measles. Oklahoma State Department of Health. April 15, 2025. Accessed April 16, 2025
7. Health Director Urges Parents to Ensure Children Are Vaccinated Against Measles as ODH Confirms Outbreak in Ohio. March 26, 2025. Accessed April 16, 2025.
https://odh.ohio.gov/media-center/odh-news-releases/odh-confirms-measles-outbreak-032625



The Centers for Disease Control and Prevention (CDC) says there are now 7 outbreaks. 

Kelly R. Reveles, PharmD, PhD, BCPS

Articles

Latest Updated Articles