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PubMed1991

Epidemic keratoconjunctivitis at a U.S. military base: Republic of the Philippines.

Between August 1988 and January 1989, 2,603 cases of acute conjunctivitis occurred at Clark Air Base in the Philippines. Clinical features of the disease were consistent with epidemic keratoconjunctivitis. Adenovirus types 19 and 8, as well as enteroviruses, were isolated from conjunctival swabs. Approximately 18% of 9,167 active duty personnel were affected. In an attempt to contain the outbreak, active cases were isolated from the workplace, resulting in 9,038 personnel-days lost. Military preparedness was significantly impacted. A case-control study revealed multiple risk factors for acquisition of the disease.

Adenovirus Infections, Human↗

PubMed2026

Bundibugyo at the border: The 2026 Ebola outbreak and the case for pre-emptive countermeasure equity.

The 2026 Ebola outbreak caused by Bundibugyo ebolavirus in the Democratic Republic of the Congo and Uganda exposes a persistent structural flaw in global health security: preparedness remains overwhelmingly reactive and pathogen-specific. Despite the $518 million Africa CDC-WHO joint continental plan, no licensed BDBV vaccine or therapeutic is available; a 21-day (three-week) detection delay and cross-border transmission expose inadequate inter-epidemic investment in non-Zaire ebolavirus countermeasures. We argue for sustained, ring-fenced financing, institutionalised cross-border coordination, species-inclusive diagnostics, and real-time genomic data sharing to move African Ebola preparedness from reactive to pre-emptive.

Hemorrhagic Fever, Ebola↗

PubMed2026

Global molecular and serological evidence of dengue and chikungunya infection: a systematic review and meta-analysis of 158,608 tested participants.

INTRODUCTION: Dengue virus (DENV) and chikungunya virus (CHIKV) are Aedes-borne arboviruses with overlapping clinical manifestations, shared vectors, and substantial diagnostic challenges in co-endemic settings. This systematic review and meta-analysis synthesized published evidence on molecular detection, serological positivity, and DENV-CHIKV dual positivity/co-infection in human clinical, surveillance, and community-based study populations. CONTENT: Following PRISMA 2020 guidance, five bibliographic databases (PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and Google Scholar) and supplementary grey-literature/preprint sources were searched for English-language studies published from 1 January 1980 to 31 December 2024. No prospective PROSPERO or OSF protocol registration was available. Eligible records reported extractable numerators and denominators for DENV and/or CHIKV in humans using recognized molecular or serological assays. A total of 196 studies comprising 158,608 tested or suspected participants were included in the extraction table. The pooled CHIKV estimate was 14.0 % (95 % CI: 12.0-16.4; I2=97.5 %), with molecular and serological estimates of 9.8 and 15.7 %, respectively. The pooled DENV estimate was 13.8 % (95 % CI: 10.9-17.3; I2=99.0 %), with molecular and serological estimates of 13.1 % (95 % CI: 7.9-21.0) and 14.3 % (95 % CI: 10.2-19.8), respectively. DENV-CHIKV dual positivity/co-infection was 52.9 % (95 % CI: 48.7-57.1) among studies that tested and reported both outcomes. Country-level estimates varied widely and should be interpreted as summaries of available studies rather than nationally representative burden estimates. Funnel-plot asymmetry was statistically significant in DENV analyses but not in the overall CHIKV analysis. SUMMARY: Available evidence indicates extensive but highly heterogeneous DENV and CHIKV positivity across selected clinical and surveillance populations. The pooled estimates should be interpreted cautiously because of substantial between-study heterogeneity, diagnostic variability, outbreak-period sampling, and uneven geographic representation. OUTLOOK: The findings support integrated arboviral surveillance, multiplex diagnostics, and vector-control preparedness in co-endemic regions.

Humans↗

PubMed1985

Defense against nuclear weapons: a decision analysis.

Response to the public health threat posed by nuclear weapons is a medical imperative. The United States, in contrast to other nations, has chosen a course that assures maximal casualties in the event of a nuclear attack, on the theory that prevention of the attack is incompatible with preventive measures against its consequences, such as blast injuries and radiation sickness. A decision analysis approach clarifies the risks and benefits of a change to a strategy of preparedness.

Civil Defense↗

PubMed2026

Nipah virus in the era of global connectivity: molecular evolution, transmission risk, and preparedness strategies.

Nipah virus (NiV) is a highly pathogenic zoonotic RNA virus belonging to the genus Henipavirus within the family Paramyxoviridae, representing a continuing global health concern due to its high case fatality rate and potential for epidemic expansion in the era of increasing international connectivity. The virus demonstrates strong evolutionary adaptability driven by the absence of proofreading mechanisms during RNA replication, enabling genetic diversification that may influence host range, virulence, and transmission dynamics. Molecular pathogenesis of NiV is primarily mediated through interaction of viral glycoproteins with ephrin-B2 and ephrin-B3 receptors, facilitating host cell entry, endothelial damage, and neuroinvasion. Immune evasion facilitated by the action of accessory proteins encoded by the P gene (P, V, W, and C) acts to suppress innate antiviral immunity through the inhibition of interferon induction and JAK/STAT signaling. Human-to-human transmission of Nipah virus remains limited, with epidemiological evidence indicating basic reproduction numbers generally below unity; however, respiratory involvement and healthcare-associated exposure may enhance cluster outbreaks. Global travel, ecological disruption, and fragmented surveillance systems contribute to spillover risk, particularly in South and Southeast Asia where fruit bats of the genus Pteropus serve as natural reservoirs. Despite advances in vaccine technology, including subunit, viral vector, mRNA-based platforms, and monoclonal antibody therapies, no licensed prophylactic or therapeutic agent is currently available for human use. Global preparedness remains challenged by the scarcity of high-containment biosafety facilities, limited research funding, and absence of integrated One Health surveillance networks. Ethical considerations surrounding wildlife population control further complicate disease mitigation strategies. Emerging genomic surveillance, artificial intelligence-assisted predictive modeling, and regional data-sharing frameworks are essential for early detection and response. Strengthening molecular research on viral-host interactions and transmission determinants will be critical for preventing future Nipah virus outbreaks in an increasingly interconnected world.

Genomic surveillance↗

PubMed2025

Oropouche Virus Importation in Southern Brazil and Emerging Concern Calling for Enhanced Public Health Surveillance.

Oropouche virus (OROV), an arthropod-borne virus transmitted by Culicoides paraensis, is an endemic arbovirus that historically circulates mostly in the Amazon basin. Between 2022 and 2024, it reemerged as a more widespread public health concern in South America. We conducted a pooled-sample molecular surveillance study to understand the prevalence of Oropouche fever in Brazil's southernmost state. Over 18 months, we analyzed 4060 samples to monitor the virus emergence in the Rio Grande do Sul state. We detected the first human case of OROV in the state, and our phylogenetic reconstruction indicated a travel-related introduction from the Amazon region into Rio Grande do Sul. Despite the absence of local transmission, the invasion of Culicoides paraensis and enzootic circulation of the OROV in Rio Grande do Sul highlight the risk of Oropouche fever outbreaks in the region. We demonstrated that pooled-sample surveillance effectively monitors virus introduction during periods of low endemic circulation, serving as an essential active surveillance tool for the timely detection of virus emergence and enhancing public health preparedness. The multiple introductions of distinct OROV lineages into southern Brazil underscore the importance of genomic surveillance and public health strategies to monitor and mitigate arbovirus spread in the region.

Brazil↗

PubMed1976

[Robert Koch's unpublished and unfinished experiments on sheep-pox (author's transl)].

The archives of the Robert Koch Institute include a casket with preparations and handwritten notes by Robert Koch (Fig. 1). He made these preparations during his time as a rural doctor between October of 1878 and September of 1880. They refer to an outbreak of sheep-pox at Rackwitz, a place near his practice at Wollstein (Fig. 2). This work has not been published; we know of it from one of Robert Koch's private letters (11). To reconstruct his working scheme and reasoning, we consulted particularly his reports on rinderpest experiments which he began in 1896 (6). The preparations from this casket which had been stained with Bismarck brown (according to Weigert) date back to a period when Robert Koch developed the foundations of bacteriology and they are evidence of his preparedness to accept new operational procedures (1, 2, 3). Thus, we have to assume that these preparations were to serve as evidence of a bacteriological etiology of sheep-pox. A wrong conclusion as to associations between the superinfection present and etiology of the disease (7) was ruled out by maintaining his own postulate. Simultaneously with this preparation work, Robert Koch performed animal experiments (11). His experience from these studies was utilized later on in his rinderpest experiments (6). On account of his confrontation with viral disease - which had its starting point in his unpublished work on sheep-pox - Robert Koch stated his postulate to be valid in the same manner as if bacteriological etiology had been demonstrated (4,6). The importance of these preparations is also seen in the interpretation of viral tissue damage, i.e. increase of macrophages and plasma cells with subsequent necrosis (9) characteristic of vira infection (Figs. 3, 4).

Animals↗

PubMed2027

Nanopore Sequencing for Chikungunya Virus: Principles and Application.

Nanopore sequencing is transforming viral genomics through real-time, portable, long-read analysis of RNA and DNA. Unlike traditional short-read platforms, it detects nucleotide sequences by measuring ionic current changes as nucleic acids pass through nanoscale pores, enabling direct single-molecule sequencing and base modification detection. Its simplicity, flexibility, and capacity for ultra-long reads make it ideal for resolving complex genomic regions, structural variants, and full viral genomes. These advantages have accelerated its use in pathogen surveillance and outbreak response, especially in resource-limited settings. For chikungunya virus (CHIKV), nanopore sequencing allows rapid, culture-independent recovery of complete genomes from clinical and vector samples, enabling real-time tracking of viral diversity, evolution, and spread. Experiences from Ebola, Zika, and COVID-19 have demonstrated the power of portable sequencing, now applied to CHIKV monitoring. Advances in tools such as Guppy, Dorado, Minimap2, and Medaka enhance read quality, consensus accuracy, and downstream analyses. Despite challenges in basecalling and error correction, robust quality control pipelines ensure reliable results. Ongoing improvements in chemistry, flow cell design, and machine learning will further enhance fidelity and throughput, establishing nanopore sequencing as a cornerstone of CHIKV genomic surveillance and epidemic preparedness.

Chikungunya virus↗

PubMed1992

Venezuelan equine encephalomyelitis and African horse sickness. Current status and review.

The arthropod-borne virus (arbovirus) diseases of livestock have worldwide impact. The prevention of an introduction of an exotic disease and the control of one subsequent to an introduction will require the attention, cooperation, and support of the livestock industry, regulatory agencies, and researchers. The most effective protection of our livestock industries is to prevent the introduction of an exotic disease agent. This implies complete restriction of animal imports and exports. However, "zero risk" is an unacceptable option in today's world of internationally integrated and interdependent agriculture. Scientifically sound and factually based regulatory decisions must be combined with continued vigilance and preparedness, as well as appropriately directed surveillance and research, to protect the world agricultural marketplace. Two exotic arbovirus diseases that are of current concern to the livestock industries and regulatory officials of the North American and Caribbean Basin countries are VEE and AHS. Devastating epizootics of VEE in equines have occurred frequently in the Western Hemisphere, but no recent epizootic activity has been documented. Naturally occurring foci of sylvatic, equine nonpathogenic VEE virus subtypes, however, do exist in the tropical countries of the hemisphere. The relationship of these sylvatic virus foci to the origin of equine virulent epizootic VEE virus subtypes is unknown. AHS epizootics had been confined to Africa, the Middle East, and the Indian subcontinent until recent outbreaks in 1966 and 1987-1990 in Spain. With the recurrence of AHS in Spain for the past four years, concern about the possible introduction into potential vector species and equines in the Western Hemisphere has increased. This review addresses the current VEE and AHS virus activity and the potential for outbreaks in the Western Hemisphere.

African Horse Sickness↗

PubMed2026

Reconstructing the early spatial spread of pandemic respiratory viruses in the United States.

Understanding the geographic spread of emerging respiratory viruses is critical for pandemic preparedness, yet the early spatiotemporal dynamics of the 2009 H1N1 pandemic influenza and severe acute respiratory syndrome coronavirus 2 in the United States remain unclear. While mobility and genomic data have revealed important aspects of pandemic spatial spread, several key questions remain: Did the two pandemics follow similar spatial transmission routes? How rapidly did they spread across the United States? What role did stochastic processes play in early spatial transmission? To address these questions, we integrated high-resolution disease data with a robust, data-efficient inference framework combining air travel, commuting flows, and pathogen superspreading potentials to reconstruct their spatial spread across US metropolitan areas. The two pandemics exhibited distinct transmission pathways across locations; however, both pandemics established local circulation in most metropolitan areas within weeks, driven by several shared transmission hubs. Early spatial spread was more strongly associated with air travel than with commuting, though stochastic dynamics introduced substantial uncertainty in transmission routes, creating challenges for timely detection and control. Simulations indicate that broad wastewater surveillance coverage beyond top transmission hubs coupled with effective infection control may slow initial spatial expansion. Our findings highlight the rapid, stochastic spread of pandemic respiratory pathogens and the difficulties of early outbreak containment.

Humans↗