MMWR. Morbidity and mortality weekly report最新文献

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.

Zika virus infection is transmitted to humans primarily through the bite of infected Aedes species mosquitoes. Although most Zika virus disease cases are mild or asymptomatic, severe neurologic complications can occur. Infection during pregnancy can result in severe congenital anomalies. In Bangladesh, Zika virus was first detected in an archived specimen from 2014; subsequently, five cases of Zika virus disease were identified in 2023. In September 2024, in response to identification of a confirmed Zika virus disease case in Bangladesh's capital, Dhaka, in a woman aged 29 years who was initially thought to have dengue, the Institute of Epidemiology, Disease Control and Research (IEDCR) launched an outbreak investigation. After IEDCR notification to hospitals, five additional Zika virus disease cases were identified in four patients evaluated at three Dhaka hospitals and in a household contact of one of these patients. Another four Zika virus disease cases were identified through Zika virus testing of patients referred to IEDCR during a concurrent chikungunya outbreak. In total, 10 confirmed cases of Zika virus disease were detected in and around Dhaka during September-December 2024 in patients with no history of international travel. None of the patients was pregnant, and all recovered without hospitalization or complications. An entomological investigation detected Zika virus RNA in Aedes species mosquitoes in Dhaka. This investigation suggests sporadic Zika virus transmission occurs in Dhaka. Integrated testing and surveillance for arboviral diseases might improve detection of Zika virus disease and support clinical management in areas where transmission of multiple arboviral diseases occurs. Prevention of these infections through vector control and use of personal protective measures should also be emphasized.

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.

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.

Respiratory syncytial virus (RSV) is a leading cause of intensive care unit (ICU) admission and respiratory failure among infants (children aged <1 year) in the United States. In August 2023, CDC's Advisory Committee on Immunization Practices recommended nirsevimab, a long-acting monoclonal antibody, to protect against RSV-associated lower respiratory tract infection among all infants aged <8 months born during or entering their first RSV season. Following licensure, nirsevimab effectiveness has been demonstrated against RSV-associated infant hospitalization, but evidence regarding effectiveness against RSV-associated critical illness is limited. In a 27-hospital case-control investigation, nirsevimab effectiveness against both RSV-associated infant ICU admission and acute respiratory failure (illness requiring continuous positive airway pressure, bilevel positive airway pressure, or invasive mechanical ventilation) after hospital admission was evaluated during December 1, 2024-April 15, 2025. Among 457 case-patients who received a positive RSV test result and 302 control patients who received a negative RSV test result admitted to an ICU with respiratory symptoms, 14% and 45%, respectively, had received nirsevimab ≥7 days before symptom onset. Nirsevimab was 80% effective (95% CI = 70%-86%) against RSV-associated ICU admission and 83% effective (95% CI = 74%-90%) against acute respiratory failure when received a median of 52 days (IQR = 32-89 days) and 50 days (IQR = 32-86 days) before onset for each respective endpoint. These estimates support the recommendation for use of nirsevimab as a prevention strategy to protect infants against severe outcomes from RSV infection.

This report updates the 2024-25 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States. Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have a contraindication to vaccination. Multiple formulations of the trivalent inactivated influenza vaccines (IIV3s), trivalent recombinant influenza vaccine (RIV3), and trivalent live attenuated influenza vaccine (LAIV3) are expected to be available for the 2025-26 influenza season. Updates for the 2025-26 season include 1) antigenic composition of 2025-26 U.S. seasonal influenza vaccines, 2) Food and Drug Administration (FDA) approval of FluMist (LAIV3) for self-administration or caregiver administration, 3) FDA approval of a change in age indication for Flublok (RIV3) from ≥18 years to ≥9 years, and 4) a new ACIP recommendation that children aged ≤18 years, pregnant women, and all adults receive seasonal influenza vaccines only in single-dose formulations that are free of thimerosal as a preservative. A comprehensive summary of recommendations, including those discussed in this report, as well as previous recommendations concerning topics not addressed in this report and that remain unchanged for the 2025-26 season, is available at Influenza | ACIP Recommendations for Vaccination. Additional background information also is available at Prevention and Control of Seasonal Influenza with Vaccines.

Before the introduction of universal respiratory syncytial virus (RSV) immunization recommendations for infants, RSV was the leading cause of hospitalization among infants in the United States. Since 2023, CDC's Advisory Committee on Immunization Practices (ACIP) has recommended that all infants be protected against RSV-associated lower respiratory tract infection (LRTI) through either 1) maternal RSV vaccination during pregnancy (Abrysvo, Pfizer) or 2) administration of nirsevimab (Beyfortus, Sanofi and AstraZeneca), a long-acting RSV monoclonal antibody, to the infant. In June 2025, the Food and Drug Administration licensed clesrovimab (Enflonsia, Merck), a second long-acting RSV monoclonal antibody, for prevention of RSV-associated LRTI in infants. Since September 2024, the ACIP Maternal/Pediatric RSV Work Group has reviewed evidence regarding the safety and efficacy of clesrovimab use in infants. On June 26, 2025, ACIP recommended clesrovimab as a second long-acting monoclonal antibody product that could be used as an alternative to nirsevimab for prevention of RSV-associated LRTI among infants aged <8 months who are born during or entering their first RSV season and who are not protected through maternal RSV vaccination. All infants should be protected against RSV-associated LRTI through use of one of these three products (i.e., maternal RSV vaccination or administration of nirsevimab or clesrovimab to the infant). No one product is preferred; the choice should be guided by parent preference, product availability, and timing of the infant's birth relative to the RSV season.

Drug overdose deaths involving stimulants have increased in the United States since 2011. This report describes characteristics of stimulant-involved overdose deaths during January 2021-June 2024 using CDC's State Unintentional Drug Overdose Reporting System data and trends by drug and race and ethnicity during 2018-2023 using CDC's National Vital Statistics System data. Overall, 59.0% of overdose deaths involved stimulants, 43.1% co-involved stimulants and opioids, and 15.9% involved stimulants and no opioids during January 2021-June 2024. Persons who died of overdoses involving stimulants and no opioids were older (aged ≥45 years; 66.5% versus 44.2%) and more frequently had a history of cardiovascular disease (38.7% versus 21.2%) than those who died of overdoses involving stimulants and opioids. Stimulant-involved overdose death rates increased from 2018 to 2023 (cocaine: 4.5 per 100,000 population to 8.6; psychostimulants with abuse potential, primarily methamphetamine: 3.9 to 10.4). Increases were largest for psychostimulants among non-Hispanic American Indian or Alaska Native persons (11.0 in 2018 to 32.9 in 2023) and cocaine among non-Hispanic Black or African American persons (9.1 to 24.3), driven by deaths co-involving stimulants and opioids. Increases in stimulant-involved deaths suggest the need for expanded access to evidence-based stimulant use disorder treatments, evaluation of medication-based treatments for stimulant use disorder and treatments for co-occurring substance use disorders, and engagement of persons who use stimulants and who might be missed by opioid-focused prevention efforts.