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China Travel Requirements & Vaccinations

China is a country in East Asia that is officially known as the People’s Republic of China. With a population of almost 1.5 billion, it is the world’s most populated country. Its Pacific coastline spans more than 9,000 miles and is banked by the Bohai, Yellow, East China and South China seas. The primary language spoken is Mandarin.

China’s diverse landscape ranges from deserts in the north, subtropical forests in the south, plains and grasslands in the interior, and mountainous regions along the borders of South and Central Asia. The diverse terrain leads to widely varied climates depending on where you are in the country. China is home to the Yangtze and Yellow Rivers, two of the longest rivers in the world.

China offers a wide variety of attractions and sightseeing opportunities, including:

• Religious sites and ancient architectures including the Great Wall of China
• Parks, zoos, museums and gardens
• Picturesque coastlines and beaches
• Diverse wildlife and plant life

Recommended Vaccinations for China Travel

• Hepatitis A
• Japanese Encephalitis

*Rabies vaccination is typically only recommended for very high risk travelers given that it is completely preventable if medical attention is received within 7 – 10 days of an animal bite.

Travelers may also be advised to ensure they have received the routine vaccinations listed below. Some adults may need to receive a booster for some of these diseases:

• Measles, mumps and rubella (MMR)
• Tdap (tetanus, diphtheria and pertussis)

Older adults or those with certain medical conditions may also want to ask about being vaccinated for shingles and/or pneumonia.

This information is not intended to replace the advice of a travel medicine professional. Not all of the vaccines listed here will be necessary for every individual.

Talk to the experts at UH Roe Green Center for Travel Medicine & Global Health to determine how each member of your family can obtain maximum protection against illness, disease and injury while traveling, based on age, health, medical history and travel itinerary.

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Update April 12, 2024

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Travel Advisory April 12, 2024

Mainland china, hong kong & macau - see summaries.

Updated due to new national security legislation in the Hong Kong Special Administrative Region.

Summary:  Reconsider travel to Mainland China due to the arbitrary enforcement of local laws, including in relation to exit bans, and the risk of wrongful detentions.

Exercise increased caution when traveling to the Hong Kong Special Administrative Region (SAR) due to the arbitrary enforcement of local laws .

Reconsider travel to the Macau Special Administrative Region (SAR) due to a limited ability to provide emergency consular services . Exercise increased caution when traveling to the Macau SAR due to the arbitrary enforcement of local laws .

See specific risks and conditions in each jurisdiction . 

Embassy Messages

View Alerts and Messages Archive

Quick Facts

Recommend consult with travel clinic

Max RMB 20,000

Embassies and Consulates

U.S. Embassy Beijing No. 55 An Jia Lou Road Chaoyang District, Beijing 100600 Telephone: +86 10-8531-4000 Emergency After-Hours Telephone: +86 10-8531-4000 Fax: +86 10-8531-3300 Email: [email protected] This consular district includes Beijing, Tianjin, Gansu, Hebei, Inner Mongolia, Ningxia, Qinghai, Shaanxi, Shandong, Shanxi, Xinjiang, Chongqing, Guizhou, Sichuan, Yunnan, and Tibet.

U.S. Consulate General Hong Kong & Macau 26 Garden Road Central, Hong Kong Telephone:  +852 2841-2211, +852 2841-2225, +852 2841-2323   Emergency After-Hours Telephone:  +852 2523-9011   Fax:  +852 2845-4845 Email:   [email protected]   This consular district includes the Hong Kong and Macau Special Administrative Regions (SARs).

U.S. Consulate General Guangzhou No. 43 Hua Jiu Road Zhujiang New Town Tianhe District, Guangzhou 510623 Telephone: +86 20-3814-5775 Emergency After-Hours Telephone: +86 10-8531-4000 Fax: +86 20-3814-5572 Email:   [email protected]  This consular district includes Fujian, Guangdong, Guangxi, and Hainan.

U.S. Consulate General Shanghai No. 1469 Huai Hai Zhong Road Xuhui District, Shanghai 200041 Telephone: +86 21-8011-2400  Emergency After-Hours Telephone: +86 10-8531-4000  Fax: +86 21-6148-8266  Email:   [email protected]  This consular district includes Shanghai, Anhui, Jiangsu, and Zhejiang.

U.S. Consulate General Shenyang No. 52 14th Wei Road Heping District, Shenyang 110003 Telephone: +86 24-2322-1198  Emergency After-Hours Telephone: +86 10-8531-4000 Fax: +86 24-8610-6904  Email:  [email protected]  This consular district includes Heilongjiang, Jilin, and Liaoning.

U.S. Consulate General Wuhan No. 396 Xin Hua Road Wuhan Minsheng Bank Building Jianghan District, Wuhan 430015 Telephone: +86 27-8563 2800  Emergency After-Hours Telephone: +86 10-8531-4000  Fax:  +86 27-5949 6496 Email:  [email protected] This consular district includes Henan, Hubei, Hunan, and Jiangxi.

Destination Description

See the U.S. Department of State’s Fact Sheet on the People's Republic of China for information on U.S.-China relations. 

Entry, Exit and Visa Requirements

Entry & Exit:

• Obtain a visa prior to arrival in the People’s Republic of China (PRC) and have a passport with at least six months' validity remaining. The lack of either will result in a fine and immediate deportation upon arrival.
• Apply for a ten-year multiple entry visa, useful for repeated travel, or trips to the Hong Kong or Macau Special Administrative Regions (SARs) with returns to mainland China.
• If you plan to work in the PRC, be sure to obtain the correct visa. Working in the PRC is not permissible on a student or tourist visa, and may result in detention, criminal charges, imprisonment, and deportation.
• You must have a valid visa to exit the PRC and you must leave the PRC before the expiration of the listed duration of stay.
• Do not travel to the PRC if you have a warrant for your arrest in the United States.

Lack of a visa, having an expired visa, or overstaying your visa will result in detention and/or fines.

• Apply for a visa extension from the local  Entry-Exit Bureau  before attempting to leave the PRC. Do not expect your request to be expedited, so apply ahead of time.
• Staying in the PRC on an expired visa may lead to a fine, imprisonment, and deportation.
• Visit the website of the  Embassy of the People’s Republic of China in the United States of America  for current visa information as well as information on the PRC’s immigration and nationality laws.

The Tibet Autonomous Region (TAR): The TAR requires special permits for tourist travel, most often obtained through a travel agent in the PRC. If you do enter a restricted area without the requisite permit, you could be fined, taken into custody, and deported for illegal entry. To learn more about specific entry requirements for the TAR or other restricted areas, check with the  Embassy of the People’s Republic of China in the United States of America . The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the PRC. Transiting the PRC:

• When transiting certain international airports, you may stay in mainland China without a PRC visa. However, this “visa-free travel” permit is only valid for the city of arrival and does not allow you to visit other cities in the PRC.
• The duration of allowed stay and how broadly you may travel varies by region.
• Transiting without a visa requires a valid passport with at least six months of remaining validity, a visa for your onward destination (if necessary), and an onward ticket from the same location.
• You must inform your airline upon check-in and get an endorsement stamp at the immigration desk before leaving the airport.
• Consult the  Embassy of the People’s Republic of China in the United States of America  for a current list of eligible airports and more detailed guidance.
• PRC border officials have the authority to deny foreign travelers’ entry to the PRC without warning or explanation. The U.S. Embassy and Consulates General cannot intervene on your behalf if denied entry to the PRC.

During Your Stay: 

• Failure to register your stay within 24 hours of arrival in the PRC could result in fines and deportation. You can register with hotel staff or the local police station. 
• Local regulations require foreigners to carry valid passports and PRC visas or residence permits at all times.
• Entry and exit requirements are strictly enforced, as are restrictions on activities allowed by any particular visa class.
• Police, school administrators, transportation officials, and hotel staff may check your visa to make sure you have not overstayed. If you overstay your visa’s duration of stay, you may be denied service by hotels, airports, and train stations, as well as face fines and detention.
• If you encounter problems in the Tibet Autonomous Region, the U.S. government has limited ability to provide assistance because the PRC government does not usually authorize U.S. government personnel to travel there, even to provide consular assistance to U.S. citizens.

Dual Nationality: The PRC government does not recognize dual nationality.  If you are a dual national of the United States and the PRC, or otherwise have ethnic or historical ties to the PRC, it is possible that PRC authorities will assert that you are a PRC citizen, limit your ability to access certain consular services, and, if you are detained, deny your access to U.S. consular officials. Because the PRC government does not recognize dual citizenship, dual U.S.-PRC citizens may face a number of hurdles when seeking public benefits in the PRC. U.S. citizens who are also citizens of the PRC may experience difficulty in accessing benefits in the PRC, such as enrollment in public schools, treatment at public hospitals and clinics, or obtaining PRC identity and citizenship documents, such as passports. U.S.-PRC dual citizens must navigate conflicting aspects of PRC nationality, which the PRC government may inconsistently apply.

If you are a naturalized U.S. citizen or have a possible claim to PRC citizenship, and you are traveling to the PRC, inform yourself about PRC nationality law and practices relating to determination and loss of PRC citizenship. PRC authorities generally consider a child born in the PRC to at least one PRC-national parent to be a PRC citizen, even if the child was issued a U.S. passport at the time of birth. If you have or had a claim to PRC citizenship and your child is born in the PRC, prior to departing the PRC with your child, you may wish to contact the local Public Security Bureau and/or Entry-Exit Bureau for information on obtaining a travel document. If you have or had a claim to PRC citizenship and your child is born in the United States, please contact the Embassy of the People’s Republic of China in the United States of America for specific information on the documentation requirements to bring your child to the PRC.

Find information on  dual nationality ,  prevention of international child abduction , and  customs regulations  on our websites.

Safety and Security

For most visitors, the PRC remains a very safe country. Traffic accidents are the most common safety concern for U.S. citizens. Training, capability, and responsiveness of PRC authorities vary by region and even by city. The U.S. Embassy and Consulates General have no law enforcement authority and may not represent U.S. citizens in either criminal or civil legal matters.

To ensure your safety and security in the PRC, you should:

• Take routine safety precautions.
• Pay attention to surroundings.
• Report any concerns to the local police.
• Call “110,”  the local equivalent to “911”. English services are often available, but you should not expect English services in remote parts of the PRC.

Violent crime is not common in the PRC, however:

• While sanctioned demonstrations must be approved by PRC authorities, they can turn violent.
• Domestic unrest and terrorism can occur.
• Business disputes between U.S. citizens and PRC-national business partners can sometimes result in physical confrontation, detainment, or coercion. Go straight to the police if you feel threatened or relocate to a public place.

Be alert to criminal schemes, such as:

• “Tourist Tea” Scams: PRC nationals invite visitors out to tea and leave them with an exorbitant bill.
• Phone Scams:  Callers pose as police officers and request a funds transfer to resolve an identity theft or money laundering investigation. In these cases, DO NOT WIRE any money. If you receive any suspicious calls or requests, contact the local Public Security Bureau to verify the caller’s identity.
• “Unlicensed or Unapproved Cabs”:  Taxi and ridesharing services in China are generally licensed by authorities. Be cautious when using taxi or ridesharing services that are not accessible through mobile applications. If you use the locally approved taxi service, insist that the driver use the meter, and get a receipt. Have the name of your destination written in Chinese characters and ask the driver to remove the bags from the trunk before you get out of the taxi and before you pay.
• Counterfeit Currency:  Although counterfeit currency has been a concern in the PRC the past, making purchases in cash is increasingly less common as most vendors prefer payments through local mobile payment apps. When you need cash, use only ATMs at trusted financial institutions, and carry a variety of denominations as vendors may have limited cash on hand as change.

Be alert to criminal schemes, such as internet, phone scams, dating scams, as well as financial scams. If you already have been victim of a scam, catalogue as many details as possible, including names, telephone and bank numbers, and email and IP addresses; file a police report, and inform the U.S. Embassy or nearest U.S. Consulate General. See the  U.S. Department of State's  and the  U.S. Federal Bureau of Investigation (FBI)'s  pages for information on scams. Victims of Crime:  Report crimes to the local police and contact the U.S. Embassy or nearest Consulate General. U.S. citizen victims of sexual assault can contact the local police and should contact the U.S. Embassy or nearest U.S. Consulate General.

Remember that local authorities are responsible for investigating and prosecuting the crime. See our webpage on  help for U.S. victims of crime overseas .

We can: 

• Help you find appropriate medical care.
• Assist you in reporting a crime to the police.
• Contact relatives or friends with your written consent.
• Provide general information regarding the victim’s role during the local investigation and following its conclusion.
• Provide a list of local attorneys.
• Provide our information on  victim’s compensation programs in the United States .
• Provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution.
• Help you find accommodation and arrange flights home.
• Replace a stolen or lost passport.

Lost or Stolen Passports:  If your passport is stolen, you must apply for both a new passport at the U.S. Embassy or nearest U.S. Consulate General and a new PRC visa. File a police report at the nearest police station right away. You may also be directed to file a report at the local Exit-Entry Bureau .

Domestic Violence:  U.S. citizen victims of domestic violence may contact the U.S. Embassy or nearest U.S. Consulate General for assistance. Domestic violence in the PRC is rarely recognized as a crime.

Tourism:  The tourism industry is unevenly regulated, and safety inspections for equipment and facilities do not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and staff may not be trained or certified either by the PRC government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in/near major cities. First responders are generally unable to access areas outside of major cities to provide urgent medical treatment. U.S. citizens are encouraged to purchase medical evacuation insurance . 

Local Laws & Special Circumstances

Criminal Penalties:   You are subject to local laws. If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned.

Some laws are also prosecutable in the United States, regardless of local law. See  crimes against minors abroad  and the U.S. Department of Justice  website.

Arrest Notification: If you are arrested or detained, ask police or prison officials to notify the U.S. Embassy or nearest U.S. Consulate General immediately.

• PRC authorities must notify a U.S. consular officer within four days; however, this does not always occur in a timely manner.
• A consular officer may be the only authorized visitor during your initial detention period.
• Bail is rarely granted.
• Detention may last many months before a trial.
• The U.S. Embassy or nearest U.S. Consulate General is unable to represent you in a legal matter.
• Travelers to the PRC should enroll in the State Department’s  Smart Traveler Enrollment Program (STEP)  and you may wish to have someone contact the U.S. Embassy or nearest U.S. Consulate General if you are detained.
• Please see the section on DUAL NATIONALITY for the limits on consular notification and access to dual nationals.
• See U.S. Department of State’s  webpage  for further information.

The PRC legal system can be opaque and the interpretation and enforcement of local laws arbitrary. The judiciary does not enjoy independence from political influence. U.S. citizens traveling or residing in the PRC should be aware of varying levels of scrutiny to which they will be subject from local law enforcement and state security. 

Certain provisions of the Criminal Law of the People’s Republic of China, such as “social order” crimes (Article 293) and crimes involving “endangering state security” and “state secrets” (Article 102 to 113), are ill-defined and can be interpreted by the authorities arbitrarily and situationally. Information that may be common knowledge in other countries could be considered a “state secret” in the PRC, and information can be designated a “state secret” retroactively. Drug and Alcohol Enforcement:

PRC law-enforcement authorities have little tolerance for illegal drugs, including marijuana. Penalties for possessing, using, or trafficking illegal drugs in the PRC are severe, and convicted offenders can expect long jail sentences, heavy fines, or the death penalty. Police regularly conduct unannounced drug tests on people suspected of drug use and have been known to enter a bar or nightclub and subject all patrons to immediate drug testing. Police may force you to provide a urine, blood, or hair follicle sample on short notice. A positive finding, even if the drug was legal elsewhere or consumed prior to arriving in the PRC, can lead to immediate detention, fines, deportation, and/or a ban from re-entering the PRC.

The PRC also has strict laws against driving under the influence of alcohol that can lead to immediate detention on a criminal charge.

Assisted Reproductive Technology:  In vitro fertilization (IVF) is widely and legally practiced. PRC law, however, strictly forbids surrogacy, and surrogacy contracts will not be considered valid. The use of reproductive technology for medical research and profit is strictly controlled. Contracts and Commercial Disputes:  Before entering into a commercial or employment contract in the PRC, have it reviewed by legal counsel both in the United States and in the PRC. The  U.S. International Trade Administration  can assist you in identifying and vetting business contacts and opportunities but may not intervene in contract disputes. Many U.S. citizens have reported difficulty getting their contracts enforced by PRC courts or being forced out of profitable joint-ventures without opportunity to secure legal recourse in the PRC. Counterfeit Goods:  Do not buy counterfeit or pirated goods. Bootlegs are illegal in the United States, and you may also be breaking local law by purchasing them.

Cruise Ship Passengers:  Click here for  safety information and travel advice .

Digital Payments: The PRC has transitioned to almost a predominantly cashless society. Some mobile phone applications offer a digital payment solution for individuals visiting the PRC on a temporary or long-term basis. Often, payment is made through an individual using their mobile phone to scan a vendor or business’s QR code. The number of locations accepting foreign credit cards has decreased in recent years. Visitors to the PRC should research whether the locations they are visiting will accept foreign credit cards and familiarize themselves with mobile digital payment options prior to traveling to the PRC.

Earthquakes:  Earthquakes occur throughout the PRC. Check here for information about preparing for a crisis or disaster overseas.

English/Secondary School Teachers:  English teachers in the PRC frequently report employment disputes which can result in questioning by local authorities, termination, lost wages, confiscation of passports, forced eviction from housing, and even threats of violence.

Exit Bans:  Business disputes, court orders to pay a settlement, or government investigations into both criminal and civil issues may result in an exit ban which will prohibit your departure from the PRC until the issue is resolved. Even individuals and their family members who are not directly involved, or even aware of these proceedings, can be subject to an exit ban. Additionally, some local businesspeople who feel that they have been wronged by a foreign business partner may hire "debt collectors” to harass, intimidate, and sometimes physically detain foreign business partners or family members in hopes of collecting the debt. The U.S. Embassy or nearest U.S. Consulate General can provide a list of local attorneys who serve U.S. clients but are otherwise unable to intervene in civil cases. Local law enforcement authorities are generally unwilling to become involved in what they consider private business matters and may not provide the individual who has been barred from leaving the PRC with any written notice of the exit ban.

Faith-Based Travelers:   See our following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Reports
• Country Reports on Human Rights Practices
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad

LGBTQI+ Travelers:  Same sex marriages are not legally recognized in the PRC and local authorities will not provide marriage certificates to same-sex couples. There are no civil rights laws that prohibit discrimination or harassment based on sexual orientation or gender identity, though homosexuality has been decriminalized. Prejudices and discrimination still exist in many parts of the country. There are growing LGBTQI+ communities in some of the largest cities in the PRC and violence against LGBTQI+ individuals in the PRC is relatively rare. See  Section 6 of our Human Rights Practices in the Human Rights Report for the People's Republic of China  and read our  LGBTQI+ Travel Information page .

Non-Governmental Organizations (NGOs):  In January 2017, the PRC implemented a law regulating the operations of foreign NGOs in the PRC. NGOs and their employees should ensure they are complying with all relevant statutory requirements, particularly if working in sensitive areas or fields. Additionally, the PRC government announced sanctions on five U.S.-based NGOs in December 2019.

North Korea:  Do not travel to the Democratic People’s Republic of Korea (North Korea) due to the serious risk of arrest and long-term detention of U.S. nationals. For further information, consult the  North Korea International Travel Information page  and the  North Korea Travel Advisory .

Political and Religious Activity:  Participating in unauthorized political or religious activities, including participating in public protests or sending private electronic messages critical of the government   may result in detention and PRC government-imposed restrictions on future travel to the PRC. Although the PRC constitution permits freedom of religious belief, it does not permit freedom of religious practice and government officials are increasing pressure on domestic religious activities. The U.S. Mission to the PRC has observed an increase in the number of U.S. citizens being interrogated, detained, and/or forced to leave the country in connection with real or perceived religious proselytization. U.S. citizens have been detained and/or expelled for distributing religious literature, including Bibles, or engaging in unauthorized religious meetings. If you bring religious literature with you, local law dictates that it be a “reasonable amount” for your personal use. If you attempt to bring larger quantities, the literature will likely be confiscated and you may be fined, detained, or deported. Social Insurance:  The PRC has a social insurance system to which foreigners who work in the PRC must contribute. When you sign an employment contract, you must apply for a social insurance number, and it is important that your employer work with you to comply with the regulations. Please check the official website for updated information. Social Media:  Social media accounts are widely monitored in the PRC. Local authorities may use information they deem critical, controversial, or that might involve illegal activity against both the poster of the material and the host of the social media forum under local law. Individuals have also been held responsible for the content that others place within social media spaces they control, such as the comments section under a post or within a group chat that an individual controls.

Special Scrutiny of Foreign Citizens:  On occasion, U.S. citizens visiting or resident in the PRC have been interrogated or detained for reasons said to be related to “state security.” In such circumstances, you could face arrest, detention, or an exit ban prohibiting your departure from the PRC for a prolonged period. Dual U.S.-PRC nationals and U.S. citizens of Chinese heritage may be at a higher risk of facing such special scrutiny. Information about  dual nationality  can be found on our website. Students: See our  U.S. Students Abroad  page and  FBI travel tips .

Surveillance and Monitoring:  Security personnel carefully watch foreign visitors and may place you under surveillance. Hotel rooms (including meeting rooms), offices, cars, taxis, telephones, internet usage, ​digital payments, and fax machines may be monitored onsite or remotely, and personal possessions in hotel rooms, including computers, may be searched without your consent or knowledge. Security personnel have been known to detain and deport U.S. citizens sending private electronic messages critical of the PRC government. Transferring Money to/from the PRC:  The regulatory environment in the PRC includes tightening capital outflow controls that can severely impact one’s ability to move money out of the country. Wire transfers may only be available to those who have an active bank account in the PRC. Ask your local bank location in the PRC for more information. The U.S. Department of State may be able to help transfer funds to a destitute U.S citizen overseas through our office in Washington, D.C., to a U.S. Embassy or U.S. Consulate General abroad. More information on this option is available  here .

Travelers Who Require Accessibility Assistance:  U.S. citizens with mobility disabilities may face challenges while traveling in the PRC. Sidewalks often do not have curb cuts and many streets can be crossed only via pedestrian bridges or underpasses accessible by staircase. Assistive technologies for blind people and those with other vision disabilities are unreliable, and access to elevators in public buildings can be restricted. In major cities, public restrooms in places visited by tourists usually have a least one accessible toilet. See  Persons with Disabilities in the Human Rights Report for the People's Republic of China (2022) .

Typhoons:  The southeast coast of the PRC is subject to strong typhoons and tropical storms, usually from July through September. For current information, please consult the Joint Typhoon Warning Center in Honolulu  and the  National Weather Service's Central Pacific Hurricane Center . Women Travelers: If you are a woman traveling abroad, please review our travel tips for  Women Travelers .

Xinjiang Uyghur Autonomous Region:  Extraordinary security measures are in place through the region. Authorities may impose curfews and restrictions on short notice. They may also engage in invasive surveillance techniques against individuals. Expect significant travel delays, avoid gatherings and demonstrations, always carry ID, and follow the instructions of local authorities. Travelers with ethnic ties to the region may experience special restrictions, discrimination, and even arbitrary detention.

COVID-19 Entry Requirements: There are COVID-related entry requirements in place for U.S. citizens.

• As of May 3, 2023, a negative COVID-19 PCR test or rapid antigen test (home tests are acceptable) within 48 hours of boarding is required for entry. Test results must be self-declared through a Health Declaration Form or through the China Customs smartphone app. Airlines will not check test results anymore. For more information, please see this notice .
• No proof of vaccination against COVID-19 is required for entry.
• There is no quarantine period for travelers upon arrival.

COVID-19 Testing: U.S. citizens can obtain a COVID-19 test at most hospitals and clinics in the PRC. They can choose between PCR and antigen tests, which are both available. The cost of the test is about $17 U.S. dollars, but it may vary depending on the location. The test fee is not covered by the host government and must be paid by the U.S. citizen. Test results are usually returned within 12 to 24 hours by email, text, or an update to the local COVID-19 monitoring app. For more information, please see this notice .

COVID-19 Vaccines:  Certain COVID-19 vaccines are available for U.S. citizens to receive in the PRC.

• The PRC government has conditionally authorized several vaccines that are currently available to foreigners residing in the PRC. The two most commonly available, Sinopharm and Sinovac, have not yet received approval by the Food and Drug Administration (FDA) of the United States. Sinopharm and Sinovac have received approval for emergency use by the World Health Organization (WHO). Please contact your local health authorities for more information.
• Visit the FDA's website to  learn more about FDA-approved vaccines  in the United States.

Quality of Care:  The standards of medical care in the PRC are not equivalent to those in the United States. Even in private hospitals or public hospitals with well-equipped wards, English-speaking patients frequently encounter difficulty due to cultural, language, and regulatory differences. Rural areas have rudimentary facilities and inadequate staffing. Additionally, Rh-negative blood may be difficult to obtain; the blood type of the general Asian populace is Rh positive. Payment and Insurance:  Ambulances in the PRC are often slow to arrive, and most do not have sophisticated medical equipment or trained responders. Cash payment for services is often required prior to treatment, including emergency cases. Travelers will be asked to post a deposit prior to admission to cover the expected cost of treatment. Hospitals in major cities may accept credit cards. The U.S. Embassy and Consulates General in the PRC maintain lists of local  English-speaking doctors and hospitals . Use of Medicare/Medicaid in the PRC:  Be aware that U.S. Medicare/Medicaid does not apply overseas. Hospitals and doctors in the PRC often do not accept U.S. health insurance.

Medical Insurance:  Make sure your health insurance plan provides coverage overseas. Most care providers overseas only accept cash payments. See our webpage for more information on insurance coverage overseas. Visit the U.S. Centers for Disease Control and Prevention (CDC) for more information on type of insurance you should consider before you travel overseas.

We strongly recommend supplemental insurance to cover medical evacuation.

Medication:  If traveling with prescription medication, check with the  Embassy of the People’s Republic of China in the United States of America  to ensure the medication is legal in the PRC. Carry prescription medication in original packaging, along with the prescription. Many commonly used U.S. drugs and medications are not available in the PRC, and counterfeit, low-quality knockoffs are prevalent. If you try to have medications sent to you from outside the PRC, you may have problems getting them released by PRC Customs authorities and/or you may have to pay high customs duties. Air Quality:  Air pollution is a significant problem in many locations. Visit AirNow Department of State for information on air quality at U.S. Embassies and Consulates. The PRC’s  Ministry of Ecology and Environment  also provides its own air quality data for cities throughout the PRC. Most roads and towns in Tibet, Qinghai, parts of Xinjiang, and western Sichuan are situated at altitudes over 10,000 feet. Take appropriate precautions to prepare for and be alert to altitude sickness. Disease:  The following diseases are prevalent:

• Hepatitis A
• Hepatitis B
• Tuberculosis
• Sexually transmitted infections (e.g., syphilis)

Vaccinations: Be up to date on all routine vaccinations recommended by the CDC. The CDC traveler’s health site for the PRC provides vaccine recommendations specific to travel within the PRC.

For further health information :

• World Health Organization (WHO)
• U.S. Centers for Disease Control and Prevention (CDC)

Travel and Transportation

Road Conditions and Safety:  Traffic safety is generally poor, and driving can be dangerous, though rules, regulations, and conditions vary greatly throughout the PRC.

Traffic can be chaotic and largely unregulated and the rate of accidents, including fatal accidents, is among the highest in the world. Motorcycle and bicycle accidents are frequent and often deadly. Pedestrians do not have the right of way, and you should show extreme caution when walking in traffic, even in marked crosswalks. Child safety seats are not widely available.

Traffic Laws:

• You may not drive in the PRC using a U.S. or international driver’s license.
• You can apply for a PRC driver’s license if you have a resident permit.
• If you are involved in a traffic accident, stay calm and call and wait for the police.
• If there are no injuries and damage is minimal, the parties often come to agreement on the spot.
• Unresolved disputes are handled by the courts.
• In cases involving injuries, the driver determined at fault is responsible for the injured person’s medical costs. Sometimes, the police may hold your passport until the other parties are satisfied with the compensation they receive.

Please refer to our  Road Safety page  for more information. Also, please review the Law of the People's Republic of China on Road Traffic Safety .

Public Transportation:  Public transportation, including subways, trains, and buses, generally has a positive safety record and is widely available in major cities, although individuals on crowded buses and subways can be targeted by pickpockets. Aviation Safety Oversight:   The U.S. Federal Aviation Administration (FAA) has assessed the PRC government’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the PRC’s air carrier operations. Further information may be found on the  FAA’s Safety Assessment Page .

Maritime Travel:  Mariners planning travel to the PRC should check for U.S. maritime advisories and alerts at the U.S. Department of Transportation (DOT) Maritime Security Communications with Industry (MSCI) web portal. Information may also be posted to the U.S. Coast Guard Homeport website , and the U.S. National Geospatial-Intelligence Agency (NGA) Navigational Warnings website .

The Commandant of the Coast Guard is unable to determine if effective anti-terrorism measures are in place in PRC ports as required by 46 U.S. Code § 70108.

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in  China . For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

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CDC in China

CDC has collaborated with the Government of China and China-based partners for over 40 years, addressing public health priorities that affect the U.S., China, and the world. CDC has enjoyed successful collaborations on a wide range of topics including preventing birth defects, nutrition, chronic diseases, and communicable diseases like HIV, influenza, and TB, as well as more general efforts to strengthen global health security through training field epidemiologists and support for publication of public health information. Throughout the COVID-19 global pandemic, US CDC and China CDC engaged in a series of ongoing technical briefings to share scientific updates.

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CDC Impact in China

Countries that have strong and resilient public health systems can quickly prevent, detect, and respond to infectious disease threats before they become epidemics. With a population of over 1.4 billion and 50% of the world’s livestock, China’s ecology poses a risk for emerging, re-emerging, and novel diseases that could threaten China, the U.S., and the rest of the world. The world’s growing network of air travel routes dramatically increases the risk for infections to spread rapidly, including infections that may lead to pandemics, such as COVID-19, that result in disruption of global trade, illness, or death.

CDC supports China’s development of efficient systems that can address disease outbreaks at their source. As China’s domestic public health capacity has grown, CDC and the China Center for Disease Control, known as China CDC, have collaborated in supporting global public health efforts. In addition, CDC collaborates with China CDC to advance the “one health” approach, recognizing that the health of people is connected to the health of animals and the environment. This approach aims to reduce human disease burden due to brucellosis, rabies, and other zoonotic diseases.

Experts from CDC and China CDC helped establish Africa CDC

CDC and China CDC coordinated efforts to support the 2014-2016 West Africa Ebola outbreak

Global health security investments and decades of global cooperation and support for outbreak response have built a strong foundation upon which to fight the coronavirus pandemic. During the COVID-19 pandemic, CDC and China CDC convened regular virtual technical exchange meetings to discuss various topics, including serological testing, vaccine preparedness, the epidemiology of outbreak clusters in China, vaccine efficacy and safety, and vaccine hesitancy in the U.S. and China.

FETP strengthens the capacity of the public health workforce to detect, respond, and control disease outbreaks at the source. Participants learn to gather critical data, analyze evidence, and turn it into fact-based recommendations. Since 2004, CDC has worked with the Chinese Field Epidemiology Training Program (CFETP), a two-year program designed to train China’s future disease detectives and public health leaders. CDC also helped start specialized training tracks in non-communicable diseases and tuberculosis. With technical collaboration from CDC, Intermediate and Front Line FETP programs were established to support underserved provinces in remote areas where populations may be at increased risk for novel infections.

Over 350 residents from 18 cohorts  have completed training. Many graduates serve as  program mentors and hold key positions  across China’s public health agencies

Residents have conducted more than 2,000 outbreak investigations as part of their training

CFETP was accredited by TEPHINET  (Training Programs in Epidemiology and Public Health Interventions Network) Global Accrediting Body in 2019

Influenza viruses change constantly and require continued vigilance. For over 20 years, CDC has supported the Chinese national influenza laboratory to strengthen monitoring for seasonal and novel influenza cases and viruses. CDC works in close partnership with the China CDC’s National Influenza Epidemiology, Virology, and Pandemic Preparedness Centers, China’s provincial and local CDCs, hospitals, and academic institutions. CDC maintains close ties with U.S. and China influenza experts to provide support for key activities. These include:

• Conducting research to estimate disease burden and vaccine effectiveness among populations at greatest risk (including young children, older adults and pregnant women).
• Promoting influenza vaccination policy development and coverage.
• Supporting novel virus risk assessments.
• Establishing influenza pandemic preparedness in China.

With the establishment of the Chinese National Influenza Surveillance Network, China now has advanced capabilities to monitor and assess the risk of influenza viruses circulating in the country

China has increased capacity to collect evidence about influenza disease burden and vaccine effectiveness , and to share data with the international community

Over the last 30 years, China has significantly redueced the burden of TB . However,  the country still has the third highest numbers of TB and multidrug resistant (MDR) TB cases in the world. To address this public health problem of global significance, CDC supports China CDC to implement collaborative projects designed to provide scalable models to strengthen TB prevention and control nationally. The priority areas include the following:

• Infection control – reducing the risk of TB transmission in health care facilities, especially among medical staff and other health care professionals.
• Surveillance – increasing the accuracy and utility of the national TB surveillance system to ensure data can be used to inform policy.
• Laboratory and quality assurance – improving the timeliness and accuracy of TB case diagnosis through laboratory management and quality assurance training including for people with MDR-TB.

Research findings have led to clear policies and updated guidelines on TB infection control across health facilities in China

To reduce under-reporting, the  national TB control guidelines  address completeness of reporting and data quality in the national TB surveillance system at all levels of health facilities

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• Population: > 1.4 billion
• Per capita income: > $15,320
• Life expectancy: F 79 / M 75 years
• Infant mortality rate: 9/1,000 live births

Sources: World Bank 2020, Population Reference Bureau 2020

• Ischemic heart disease
• Chronic obstructive pulmonary disease (COPD)
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Source: GBD Compare 2019

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CDC urges Americans to "reconsider" travel to China over COVID surge, will require tests

By Alexander Tin

Updated on: December 28, 2022 / 7:50 PM EST / CBS News

Travelers from China will need to test negative for COVID-19 before boarding flights to the U.S. starting next week, the Centers for Disease Control and Prevention announced Wednesday. The testing requirement will apply to travelers from mainland China, Hong Kong and Macau, and covers all passengers regardless of their nationality or vaccination status, the CDC said. 

Americans should also "reconsider travel to China, Hong Kong, and Macau," the CDC now urges. In a  travel alert  published Wednesday, the agency cited "reports that the healthcare system is overwhelmed," along with the risk of new variants.

Beyond masking while traveling in places like airports or planes, the CDC also recommends that Americans visiting China wear masks while indoors in public.

The moves come amid a record wave of infections in China since it relaxed its "zero COVID" policy in early December. The Chinese government has also begun to ease travel restrictions that were imposed years ago, early in the COVID-19 pandemic.

"CDC is announcing this step to slow the spread of COVID-19 in the United States during the surge in COVID-19 cases in the [People's Republic of China] given the lack of adequate and transparent epidemiological and viral genomic sequence data being reported from the PRC," the CDC said in a statement .

Beginning Jan. 5, airlines will be required to collect proof of a negative COVID-19 test from all passengers ages 2 and older before they can board flights out of China into the U.S.  Both lab-based PCR tests as well as antigen self-tests will be accepted, as long as they are overseen by a health care provider.

Travelers on connecting flights will also be required to provide proof of a negative test. 

People traveling to the U.S. through South Korea's Incheon International Airport, Canada's Toronto Pearson International Airport, and Canada's Vancouver International Airport will be required to test negative if they have been in China over the last 10 days.

"These three transit hubs cover the overwhelming majority of passengers with travel originating in the PRC and the Special Administrative Regions. We will continue to monitor travel patterns, adjust our approach as needed, and keep Americans informed in a timely manner," the CDC said.

Federal health authorities have not required negative COVID-19 tests from any international visitors since the requirement was scrapped in June . The U.S. continues to require that all foreign travelers prove they are fully vaccinated with the primary series of a COVID-19 vaccine.

Officials said Wednesday that they were waiting until next week to impose the measure to allow for airlines to implement the revived requirements.

"It does take some effort by the airlines to update their data systems to put this all in place. And so we have to make this announcement today, but it will take time to implement the program," a federal health official told reporters at a briefing.

Officials first acknowledged Tuesday that they were weighing the move, pointing to similar measures put in place on China by Japan  and other countries. They also cited China's own rules for arriving international travelers, which continue to require Americans and other foreign visitors to test negative.

"We've always believed that for all countries, COVID response measures need to be science-based and proportionate without affecting normal people-to-people exchange," China's foreign ministry spokesperson Wang Wenbin told reporters Wednesday ahead of the U.S. announcement.

Concern over COVID variants

In addition to the new requirement, the CDC said it is moving to expand its current variant surveillance efforts to two new international airports in Los Angeles and Seattle.

The agency has already been tracking variants over the past few months spotted in voluntary tests collected from arriving international travelers. Wastewater collected from some aircraft bathrooms are also now being tested for variants, the CDC says .

A total of some 290 weekly flights from China and nearby countries will be covered by the program once expanded, the CDC said. 

"We have very limited information in public databases about variants that are circulating in China presently. In the past few months, only about a hundred sequences have been uploaded," said the federal health official. 

They cited the threat the virus could pose as it infects a vast swath of "immunologically naive" people in China.

"What we're concerned about is a new variant that may emerge actually in China, with so many people in China being infected in a short period of time, there is a chance or probability that a new variant will emerge," said the official.

Scientists have voiced frustration over sparse variant sequencing released from China amid the country's current wave of infections, aside from a handful of travelers. 

All of the current variants circulating in China are descendants of Omicron, Chinese state media have reported , quoting their country's health officials, with BA.5.2 and BF.7 dominating infections in the country. 

What to know about the BF.7 variant

First spotted earlier this year, these two strains have made up a fraction of circulating virus in the U.S. to date. Instead, the CDC's estimates rank the BQ.1, BQ.1.1, and XBB strains as far outpacing them around the country.

Infections linked to XBB has surged across the Northeast in recent weeks, climbing to more than half of new infections across the region. Ahead of Christmas, federal data shows hospitalizations reaching some of the highest rates since last February in the Northeast.

Scientists believe a descendant dubbed XBB.1.5 is behind the renewed surge, with immune evasive mutations that appear to bind well to human cells. 

• Centers for Disease Control and Prevention

Alexander Tin is a digital reporter for CBS News based in the Washington, D.C. bureau. He covers the Biden administration's public health agencies, including the federal response to infectious disease outbreaks like COVID-19.

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White House Explains COVID Restrictions on Travelers from China

• By Paris Huang

As China has relaxed its zero-COVID policy and made it much easier for travelers to come and go, a surge of infections has prompted some countries, including the United States, to impose new testing requirements for anyone arriving from China.

Each Chinese traveler boarding a flight from mainland China, Hong Kong or Macau must present a negative COVID-19 test taken no more than two days prior. Beijing has pushed back on the increased screening, even though each foreign traveler entering China must also present a negative COVID-19 test.

VOA Mandarin White House Correspondent Paris Huang spoke with Dr. Nahid Bhadelia, senior adviser for the White House COVID Response Team, about the newly implemented COVID restrictions on travelers from China. The interview has been edited for length and clarity.

VOA: When we talk about the newly implemented COVID-19 restrictions on travelers from China, what type of test results will be accepted? Does it have to be from a reputable company like Abbott, with a QR code or lab or doctor’s note, or simply a photo of the test kit?

Dr. Nahid Bhadelia: What's required is a viral test that looks for current infections. It can be a nucleic acid amplification test such as a PCR or a rapid antigen test, as long as it's testing to see if you might currently be infected. And what passengers are required to do is to present the test results, which includes a certain amount of information: the sample collection date, the name of the entity or the lab that conducted the test, passenger information and the type of test that was used. Passengers can also use self-tests if they have a component which includes telehealth services associated with a manufacturer, which includes real time video and audio supervision. So, for example, when I've traveled globally in the past, I would do the self-test with the proctored telehealth service. I would then receive a test result in my email which I can then either take with me to the airport, or upload if the airline allows that beforehand. And there's a whole list of the accepted tests available and accepted by the Centers for Disease Control and Prevention on their website.

VOA: So it has to be from a third party or a certified company providing that result? It cannot be just a photocopy or a photo of the test kit?

Bhadelia: Not a photo of the test kit. It has to be a test result that has the data that is required for the airlines to determine whether the test was conducted within the right timeframe by an entity who might be able to provide supervision on how the test was done.

VOA: Who will be checking those certificates? How will the Transportation Security Administration authenticate a legitimate test result and how will they identify a counterfeit test result?

Bhadelia: I think the important part is that airlines here will be looking for the test results to have that necessary information and they'll make a determination when, for example, a translation is required. So this is an important point if you're traveling and the test results that you have are in another language. You may want to call the airline beforehand just to ensure that it has information that you need to be able to be accepted for travel.

VOA: When the travelers land here at the airport in the United States, will the TSA ask them to produce the test results for a second verification?

Bhadelia: We ask that passengers keep their tests. They may or may not be asked, but that's not a requirement. But they should hold on to that test result during their travel.

VOA: What is the punishment if someone has fake test results? Anything beyond denial of entry?

Bhadelia: The CDC order mentions that activities such as providing inaccurate or misleading information to the government can be subject to criminal offense charges.

VOA: How do you trace someone traveling to United States through a third country, especially if they stay there for a couple of days before coming to the United States?

Bhadelia: This is important and it can be confusing for passengers. One of the things that the order requires is that if you are in one of the designated airports as a stopover before you come to the U.S., and you have been in either mainland China, Hong Kong or Macau, that you are going to get a test. And then in those designated airports, you will also be required to present a test that you've done before traveling the United States.

The three airports that are designated are Vancouver International Airport, Toronto Pearson Airport and Incheon Airport in South Korea. At those three airports you will also be required as someone who may have traveled to mainland China, Hong Kong or Macau to present a negative test.

VOA: What happens if the traveler produced a negative test result when entering the United States, but then tested positive? What's the next step?

Bhadelia: The big goal here is to identify patients or travelers who may be positive so we're able to slow the appearance of new cases, the genomic data for which we don't have enough background on.

If you do test positive after arriving, you should isolate at home and keep distance from others in your household, provide good ventilation in your home, follow all the good practices the CDC provides for isolation of patients who may be positive.

Here's an important part. You may qualify if you are a high-risk patient for treatment with oral antiviral medications that we know can help reduce severe disease or hospitalizations. So one of the other things that we ask patients to do is just to call your health care provider to make sure that you test yourself to see if you're eligible for those antivirals. Or if you don't have one, look at covid.gov, which can direct you to places where you might be able to get access to treatment.

VOA: Will foreigners still be able to get the health care they need?

Bhadelia: For visitors here in the U.S., I think it’s going to depend on your hotel’s proximity clinics, your national insurance and other factors. But yes, absolutely. Anybody who's sick should be able to seek care.

VOA: Can travelers from China get new mRNA vaccines? Would you recommend that they get the latest boosters here?

Bhadelia: Yeah, CDC recommends that everybody stays updated with vaccinations. We know that it helps reduce severe illness, hospitalization and, God forbid, death. And anybody who's interested in getting a vaccination when you arrive in the U.S., you can check vaccines.gov. And again, if you want to access tests, you can also look at covid.gov. It's the same thing with treatment. Anybody who's seeking medical care can look for more information available on those sites.

VOA: Who is paying for the treatment, vaccines and test kits? Taxpayers or travelers?

Bhadelia: Well, I think the way to look at this is that every positive case that we identify and isolate is allowing us to ensure that more community transmission is not occurring. And so it is actually in the interest of the greater global good to ensure that anybody who requires a test is tested, and if they identify themselves as positive, that they're able to isolate.

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CDC Advises U.S. Travelers to 'Reconsider Travel' to China Following January Quarantine Lift

The CDC has also implemented a COVID-19 testing policy for travelers entering the U.S. from China starting Jan. 5.

The Centers for Disease Control and Prevention (CDC) is advising American travelers to "reconsider travel" to China as the country is slated drop its strict quarantine policy on Jan. 8.

Along with the agency's advice to American travelers, released on Wednesday, the CDC will also require individuals from China to take a COVID-19 test no more than 48 hours ahead of their arrival to the U.S.

The requirement will begin on Jan. 5 and applies to travelers from China, Hong Kong, and Macau — except those under two years old — regardless of their vaccination status.

The alert and testing requirement for incoming travelers comes days after China's National Health Commission announced it will remove its quarantine requirement for incoming passengers next month, the Associated Press reported . The change would reverse its long-standing policy forcing all incoming travelers to quarantine for five days at a hotel, followed by three days at home.

Hong Kong will also scrap nearly all of its COVID-19 protocols, its tourism board shared with Travel + Leisure.

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The CDC's precaution comes as China is still seeing a surge in COVID-19 cases, as well as concerns of the People's Republic of China (PRC)'s lack of transparency when it comes to cases.

"Reduced testing and case reporting in the PRC and minimal sharing of viral genomic sequence data could delay the identification of new variants of concern if they arise," the CDC wrote in a news release shared on Wednesday.

When it comes to U.S. travelers making their way to China, options for flights may not be as readily available as in the past. For instance, Reuters reported this week that United Airlines — which offers four flights weekly between San Francisco and Shanghai — is "evaluating the market demand and operating environment to determine when to resume additional flight operations to mainland China."

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Travelers from China no longer need to show proof of negative COVID test, CDC says

A requirement that travelers to the U.S. from China present a negative COVID-19 test before boarding their flights expired last Friday after more than two months as cases in China have fallen.

Following other countries like Italy and Japan, the restrictions were put in place on Dec. 28 and took effect Jan. 5 amid a surge in infections in China after the nation sharply eased pandemic restrictions and as U.S. health officials expressed concerns that their Chinese counterparts were not being truthful to the world about the true number of infections and deaths.

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The requirement from the U.S. Centers for Disease Control and Prevention expired for flights leaving after 3 p.m. EST last Friday.

Learn more: Best travel insurance

The U.S. decision to lift restrictions comes at a moment when U.S.-China relations are strained. Biden ordered a Chinese spy balloon shot down last month after it traversed the continental United States. The Biden administration has also publicized U.S. intelligence findings that raise concern Beijing is considering  providing Russia weaponry for its war on Ukraine.

Why was the order lifted?

In a news release  Friday, the CDC said epidemiologic data showed there is no longer a surge in COVID-19 cases in China, and the agency determined that requirements are no longer necessary. The agency also identified no variants of concern from China.

According to the World Health Organization, daily cases peaked at 7 million during the surge in late December and leveled off to 20,000 or so cases a day between Jan. 24 and Feb. 21.

What happens now that there are no requirements? 

Passengers flying to the U.S. from China, Hong Kong, Macau and designated airports will no longer be required to show a negative COVID-19 test no more than two days before their flight or proof of recovery from COVID-19 before boarding. 

The designated airports include Incheon International Airport (ICN) in Seoul, Republic of Korea; Toronto Pearson International Airport (YYZ) in Canada; and Vancouver International Airport (YVR) in Canada.

The testing applied to anyone 2 years and older, including U.S. citizens.

There also were  health screening procedures at airports where travelers have their temperature taken.

What is the current travel advisory for Americans in China?

The same day the requirements were lifted by the CDC, the State Department reissued China a Level 3 Travel Advisory  with updates to COVID-19 information . The advisory urges Americans to "reconsider travel," citing health risks, wrongful detention and other potential risks. 

Regarding COVID-19, the agency said it doesn't "provide or coordinate direct medical care to private U.S. citizens abroad. U.S. citizens overseas may receive PRC-approved COVID vaccine doses where they are eligible."

The Chinese government has not authorized the use of commonly available COVID-19 vaccines in mainland China, such as Moderna and Pfizer/BioNTech. There are 13 Chinese-made vaccines, but not all have been approved by the FDA. 

Travelers in mainland China may can face additional testing requirements to attend events or enter facilities. People may also run into law enforcement "arbitrarily enforcing local laws," including exit bans, and they become aware of this only when trying to leave China.  

On the CDC website , there are no travel health notices for China. The agency recommends people be up to date with all COVID-19 vaccines, among others, before traveling to China and taking the same health and safety precautions as they would in other places.

Contributing: Zeke Miller and Aamer Madhani, The Associated Press

Kathleen Wong is a travel reporter based in Hawaii. You can reach her at [email protected]

CDC tightens COVID measures for passengers from China

gpointstudio/iStock

The Centers for Disease Control and Prevention (CDC) today announced a COVID-19 testing requirement for passengers arriving from China, Hong Kong, and Macau to slow the spread of the virus in the United States due to lack of clarity about China's surge.

Amid media reports and video footage of overwhelmed health and mortuary services in China, the United States and other countries are stepping up restrictions on travelers from China, partly to track any potential new SARS-CoV-2 variants.

In its statement today, the CDC said it based its decision on the lack of adequate and transparent epidemiological and viral genomic sequence data from China. "These data are critical to monitor the case surge effectively and decrease the chance for entry of a novel variant of concern," the agency said, adding that it would monitor the situation and adjust its approach as needed.

CDC ups both testing and genomic surveillance

Beginning on Jan 5, all passengers ages 2 and older originating from China are required to test no more than 2 days before departure and show a negative test result to the airline before departure. The requirement applies to all airline passengers coming from China regardless of nationality or vaccination status.

The requirement also applies to people flying into the United States from international airports in Seoul, Toronto, and Vancouver who have been in China in the last 10 days.

Also, the CDC said it is expanding its traveler-based genomic surveillance, a voluntary swabbing program that is designed to help fill gaps in SARS-CoV-2 surveillance. The CDC added Los Angeles and Seattle airports to the program, bringing the number to seven. It also expands the number of weekly flights covered to 500, including 290 from China, from at least 30 countries.

Extent of Chinese surge unclear

Several of China's major cities were battling COVID flare-ups before the country scrapped its "zero COVID" measures. The unwinding of the restrictions seems to have intensified those outbreaks, but the nation's health officials have also signaled changes in reporting, including for deaths, that muddle the scale of the current surge.

Experts have also raised concerns about China's lack of transparency about genetic changes in the circulating viruses—key information needed to help the global community prepare for future surges.

Flurry of enhanced screening announcements

Yesterday, Japan—grappling with its own COVID surge—announced that it would test all passengers arriving from China, with those testing positive required to isolate at designated facilities for 7 days, according to the Japan Times . Officials also announced that they would limit the number of flights from China.

Japan's health ministry today reported a record daily high for COVID deaths, with 415 fatalities reported, according to Reuters . The country is also approaching record daily highs for new cases, with 216,219 reported today.

Other countries and jurisdictions are also tightening restrictions on travelers from China. Taiwan's government today said it would start testing people arriving from China starting on Jan 1 and that the government would sequence viruses from positive tests to look for any new SARS-CoV-2 variants.

Elsewhere, Italy's health minister today announced COVID rapid antigen testing and sequencing for all travelers coming from China, according to Reuters , which said the airport in Milan had already started screening people arriving from Beijing and Shanghai on Dec 26.

Editorial note: This story was revised to include the CDC's late-breaking announcement.

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USDA to test ground beef for traces of H5N1 avian flu virus as more poultry outbreaks reported

Dairy cows make up about 7% of US beef production.

Reasons cited for accepting the option of refusing treatment included unreasonable risk to physicians and their families and labor rights and worker protection.

US orders testing for certain dairy cows after H5N1 avian flu remnants found in retail milk

The USDA says that lactating dairy cows must be tested before interstate transport.

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January 21 coronavirus news

By Ben Westcott , Adam Renton, Sharon Braithwaite, Eliza Mackintosh , Ed Upright, Zamira Rahim and Caitlin Hu , CNN

China announces travel restrictions to curb coronavirus ahead of Lunar New Year 

From CNN's Beijing bureau

China’s National Health Commission (NHC) has announced a series of domestic travel restrictions to curb the spread of Covid-19 as the country prepares for mass movement of people to celebrate Lunar New Year. 

Millions of Chinese migrant workers who plan to travel back to the countryside are now required to present a negative Covid test result within seven days of departure.

They include:

• People from medium- or high-risk areas
• Quarantine center staff
• Cold chain food industry workers
• Transportation workers

People from medium- or high-risk areas are being discouraged from traveling altogether during the holiday. 

Those who do travel and have a negative test result will not have to quarantine on arrival. They will be required to monitor their health with daily temperature and symptoms checks, and undergo two other tests on the seventh and 14th day after arrival. 

The new measures will come into effect from January 28 and last until March 8. 

Beijing tightens Covid-19 restrictions as one neighborhood goes into lockdown

From CNN’s Beijing bureau

All residents in Beijing’s Daxing district have not been allowed to leave the area since Wednesday because of a rising number of Covid-19 cases, according to local officials. 

People wishing to leave the district need to provide a negative Covid-19 test taken within three days, a district notice announced. 

More than 24,000 residents around the infection hotspot in Daxing have also been asked to stay at home until further notice.

Daxing district has reported 11 confirmed cases since Sunday, according to the city’s health commission.

Schools and education facilities across Beijing will need to complete all in-person learning by Saturday, and kindergartens have been shut from today. Meanwhile, University and college students are being discouraged from leaving Beijing unless absolutely necessary. 

New cases: China’s National Health Commission reported 144 new Covid-19 cases across the country on Wednesday, including 18 imported infections. Among the 126 locally transmitted cases, 68 were reported in Heilongjiang, 33 in Jilin, 20 in Hebei, two in Beijing, two in Shanxi and one in Shandong. 

Additionally, 113 asymptomatic infections were reported nationwide, 16 of which were imported. China counts asymptomatic cases separately.

Biden reverses Trump's decision to leave WHO

From CNN's Kylie Atwood

The White House released US President Joe Biden's letter reversing the Trump administration's decision to leave the World Health Organization after the new US leader was sworn in on Wednesday.

US re-engagement: US diplomats around the world have already been notified of changes they must make as they conduct American diplomacy after Biden signed a series of executive orders tonight.   

The first department wide memo sent by Acting Secretary of State Dan Smith instructed all US diplomats to re-engage with WHO and halt any staff drawdown at the UN health agency, according to the memo reviewed by CNN. 

The memo was sent shortly after Biden signed a series of executive orders, including one to reverse former President Donald Trump’s decision to withdraw from WHO. 

“The United States will re-engage with the World Health Organization (WHO), and resume regular engagement of US government personnel with the organization. The United States also reverses its decision to recall US government personnel from secondments to WHO,” Smith wrote on Wednesday evening.

The US had been in the process of withdrawing staff at WHO in the final months of the Trump administration. That withdrawal will now be halted and reversed. 

White House press secretary outlines Covid parameters for Biden administration

From CNN's Kevin Liptak and Jason Hoffman 

The White House will require daily testing for coronavirus and N95 masks for staffers in a bid to model good pandemic behavior, according to press secretary Jen Psaki.

She said the new rules also include stringent requirements on social distancing.

Psaki said President Joe Biden "has asked us also to be models to the American people" -- a contrast to the previous administration, which largely ignored government mask and social distancing recommendations.

Psaki also said the administration will resume regular briefings with public health officials in addition to the daily White House press briefings. 

“We'll have more to share with you in the next few days, hopefully before the weekend, but what we plan to do is not just return these daily briefings … but also to return briefings with our health officials and public health officials,” Psaki said at her first White House briefing. “We want to do those regularly, in a dependable way with data shared with all of you and with the public, so that they can also track progress we're making on getting the pandemic under control.” 

Psaki said that the White House will combat misinformation by giving accurate information to the American people “even when it is hard to hear.”

The Trump administration had briefings with health officials regularly last spring when the coronavirus pandemic initially took hold, however those briefings were often not entirely focused on the pandemic as then-President Donald Trump led them awry.

Those regular briefings ended in April after Trump suggested injecting disinfectant could be a cure for coronavirus.  

Studies suggest vaccinated people protected from new Covid-19 variants

From CNN's Maggie Fox

New research out this week provides reassuring evidence that people vaccinated against coronavirus will be protected against emerging new variants of the virus.

Two teams tested two of the new variants against blood taken from people who had received the full two-course dose of either the Moderna or the Pfizer vaccine.

While the mutations in the new variants of the virus -- one first seen in Britain, and another first identified in South Africa -- did allow them to evade some of the immunity induced by vaccination, it was far from a complete escape, the two teams reported separately.

A team led by Dr. Michel Nussenzweig of the Rockefeller University tested plasma taken from 20 people who got two doses of either the Pfizer/BioNTech or Moderna vaccine as part of clinical trials.

They found the vaccines produced strong antibody responses, as well as cells that keep producing new antibodies for months or years.

"We measured their antibody responses to the wild-type virus. Then we took their plasmas and measured them against the variants," Nussenzweig told CNN.

Wild-type virus is the catchall name for virus generally circulating that is not changed enough to be designated a variant.

Different mutations in the viruses did allow some escape from some types of antibodies, but the bodies of the volunteers threw an army of different types of antibodies at the viruses, the team r eported in a pre-print study -- not peer reviewed -- published online.

"When you start putting all these mixtures of antibodies together, what it means is that together they can take care of the variants," Nussenzweig said. Even though they had a reduced effect, overall the response was so overwhelming that it should not matter, he said.

Eventually, the vaccines should be updated -- but the new mRNA vaccines made by Pfizer and Moderna can be changed very quickly. "Should the vaccines be tweaked?" he asked. "Probably -- but that doesn't mean that they won't be effective."

Read the full story:

Biden's first executive order will require masks on federal property

President Joe Biden, who plans to make the coronavirus pandemic his top priority, will begin his presidency by asking Americans to wear masks for 100 days and requiring their use on federal property.

His first executive order, the "100 Days Masking Challenge," will symbolize the administration's sharp turn from the Trump era by emphasizing recommendations by public health experts. A president cannot tell states or cities what to do, but a federal mandate will affect federal offices and federal lands and will urge states to do the same.

"This executive action will direct the agencies to take action to require compliance with CDC guidance on mask wearing and physical distancing in federal buildings, on federal lands and by federal employees and contractors," said Biden counselor Jeff Zients, who will be the administration's Covid-19 response coordinator. "And the president will call on governors, public health officials, mayors, business leaders and others to implement masking, physical distancing and other public measures to control COVID-19," Zients added. "This is not a political statement. This is about the health of our families, and economic recovery of our country."

States appeal for more coronavirus vaccine doses as the US death toll moves past 400,000

From CNN's Madeline Holcombe, Jason Hanna and Maggie Fox

As state leaders clamored for more Covid-19 vaccine doses, Joe Biden became President on Wednesday with an eye toward changing approaches to the pandemic that has  claimed more than 400,000 lives  in the US.

Some state officials say they  aren't seeing as many doses  as the federal government reports distributing and the demand for the vaccine is  outpacing the supply . Georgia, for example, reports adequate staff, volunteers and infrastructure but not enough doses.

Biden, meanwhile, has signaled he intends to alter the federal government's approach to the pandemic and public health in several ways, and one of his first acts as President, a few hours after his inauguration, was to sign an  executive order mandating masks on federal property .

He also intends to restore a previously disbanded National Security Council office that would focus on pandemic preparedness and to stop the previous administration's process of withdrawing from the World Health Organization,  one of his aides has said .

Dr. Rochelle Walensky, the new director of the Centers for Disease Control and Prevention, said the agency is conducting a comprehensive review of all existing Covid-19 guidance. "The toll that the Covid-19 pandemic has had on America is truly heartbreaking," she said.

Biden took office just a day after the country  surpassed 400,000 recorded deaths for the pandemic .

Across the country, hospitalizations and daily new cases and deaths have been dipping, though experts have warned that more-transmissible virus variants, including one first seen in the UK,  could send cases surging again :

Officials call for more vaccine doses as the US death toll passes 400,000

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Coronavirus Updates

Cdc says travel is safe for fully vaccinated people, but opposes nonessential trips.

Rachel Treisman

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing. Angus Mordant/Bloomberg via Getty Images hide caption

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing.

The Centers for Disease Control and Prevention has updated its domestic travel guidance for fully vaccinated people, lifting certain testing and self-quarantine requirements and recommending precautions like wearing a mask and avoiding crowds. But health officials continue to discourage nonessential travel, citing a sustained rise in cases and hospitalizations.

The CDC updated its website on Friday to reflect the latest scientific evidence, writing that "people who are fully vaccinated with an FDA-authorized vaccine can travel safely within the United States."

The announcement comes less than a month after the CDC first released updated guidance about gatherings for fully vaccinated people, which it described as a "first step" toward returning to everyday activities.

Air Travel Is Opening Up Again, But That Doesn't Mean The Pandemic Is Over

The CDC considers someone fully vaccinated two weeks after they receive the last dose of vaccine. Those individuals will no longer need to get tested before or after travel unless their destination requires it, and do not need to self-quarantine upon return.

The new guidance means, for example, that fully vaccinated grandparents can fly to visit their healthy grandkids without getting a COVID-19 test or self-quarantining as long as they follow other recommended measures while traveling, according to CDC Director Rochelle Walensky.

Those measures include wearing a mask over their nose and mouth, staying 6 feet from others and washing their hands frequently. Masks are required on all planes traveling into, within or out of the U.S., under an executive order issued by President Biden.

But Walensky, speaking at a White House COVID-19 Response Team briefing on Friday, nonetheless discouraged all nonessential travel, citing a continued increase in the seven-day average of cases and hospitalizations.

"While we believe that fully vaccinated people can travel at low risk to themselves, CDC is not recommending travel at this time due to the rising number of cases," Walensky said.

CDC Director Fears 'Impending Doom' If U.S. Opens Too Quickly

She said that while vaccinated people can do more things safely, most Americans are not yet fully vaccinated. Those who are not must have a negative test 1-3 days before they travel under CDC guidance. They must either get tested 3-5 days after they return and self-quarantine for 7 days, or self-quarantine for 10 days with no test.

Walensky said on Monday that there is more travel occurring now than throughout the pandemic, including the winter holidays. She acknowledged that people have been looking to get away over spring break or take advantage of what they perceive as a "relative paucity in cases," and she said the country was seeing an uptick in cases as a result.

"The thing that's different this time is that we actually have it in our power to be done with the scale of the vaccination," she said. "And that will be so much slower if we have another surge to deal with as well."

The U.S. is already seeing an uptick in domestic travel, and many Americans are looking to book trips in the coming months in what experts described to NPR as a sign of "clear pent up demand for travel."

As the country's supply of COVID-19 doses has grown, so has Biden's goal for the number of shots in arms during his first 100 days, doubling the target to 200 million by the end of this month. Many states have already expanded eligibility to all adults or are set to do so in the coming weeks, well ahead of the president's May 1 deadline.

According to NPR's vaccine tracker , 16.9% of the U.S. population is fully vaccinated, and 30% has had at least one dose. Researchers estimate that 70% to 85% of the country would need to have immunity for COVID-19 to stop spreading through communities.

International travel restrictions remain

The CDC is not lifting travel restrictions barring the entry of most non-U.S. citizens from places including China, Brazil, South Africa and parts of Europe. It will continue to require airline passengers entering the U.S. to get a test within three days of their departure and show proof of a negative result before boarding.

The travel industry has been pushing for some of these restrictions to end. A group of 26 organizations sent a letter to White House COVID-19 czar Jeffrey Zients urging the federal government "to partner with us to develop, by May 1, 2021, a risk-based, data-driven roadmap to rescind inbound international travel restrictions."

While Some Spring Breakers Swarm Beaches, Many Stay Home, Dreaming Of Summer Travel

"To be clear, at this time, we do not support removal or easing of core public health protections, such as the universal mask mandate, inbound international testing requirement, physical distancing or other measures that have made travel safer and reduced transmission of the virus," they wrote. "However, the data and science demonstrate that the right public health measures are now in place to effectively mitigate risk and allow for the safe removal of entry restrictions."

Travel and tourism have taken a considerable hit because of the pandemic with industry groups noting that overseas travel to the U.S. declined by 81% in 2020, causing billions of dollars in losses. Without lifting international travel bans, the U.S. Travel Association estimates that some 1.1 million American jobs will not be restored and billions in spending will be lost by the end of the year.

"Fortunately, enough progress has been made on the health front that a rebound for domestic leisure travel looks possible this year, but that alone won't get the job done," Roger Dow, the association's president and CEO, said in a statement . "A full travel recovery will depend on reopening international markets, and we must also contend with the challenge of reviving business travel."

Fauci Expects Surge In Vaccinations To Keep A 4th Coronavirus Wave At Bay

• Centers for Disease Control and Prevention
• COVID-19 vaccine

Articles from Emerging Infectious Diseases

Volume 30, Number 5—May 2024

[PDF - 14.66 MB - 228 pages]

Research Letters

About the cover.

Crimean-Congo hemorrhagic fever (CCHF), caused by CCHF virus, is a tickborne disease that can cause a range of illness outcomes, from asymptomatic infection to fatal viral hemorrhagic fever; the disease has been described in >30 countries. We conducted a literature review to provide an overview of the virology, pathogenesis, and pathology of CCHF for clinicians. The virus life cycle and molecular interactions are complex and not fully described. Although pathogenesis and immunobiology are not yet fully understood, it is clear that multiple processes contribute to viral entry, replication, and pathological damage. Limited autopsy reports describe multiorgan involvement with extravasation and hemorrhages. Advanced understanding of CCHF virus pathogenesis and immunology will improve patient care and accelerate the development of medical countermeasures for CCHF.

Crimean-Congo hemorrhagic fever (CCHF) is a tickborne infection that can range from asymptomatic to fatal and has been described in >30 countries. Early identification and isolation of patients with suspected or confirmed CCHF and the use of appropriate prevention and control measures are essential for preventing human-to-human transmission. Here, we provide an overview of the epidemiology, clinical features, and prevention and control of CCHF. CCHF poses a continued public health threat given its wide geographic distribution, potential to spread to new regions, propensity for genetic variability, and potential for severe and fatal illness, in addition to the limited medical countermeasures for prophylaxis and treatment. A high index of suspicion, comprehensive travel and epidemiologic history, and clinical evaluation are essential for prompt diagnosis. Infection control measures can be effective in reducing the risk for transmission but require correct and consistent application.

Crimean-Congo hemorrhagic fever virus (CCHFV) is the most geographically widespread tickborne viral infection worldwide and has a fatality rate of up to 62%. Despite its widespread range and high fatality rate, no vaccines or treatments are currently approved by regulatory agencies in the United States or Europe. Supportive treatment remains the standard of care, but the use of antiviral medications developed for other viral infections have been considered. We reviewed published literature to summarize the main aspects of CCHFV infection in humans. We provide an overview of diagnostic testing and management and medical countermeasures, including investigational vaccines and limited therapeutics. CCHFV continues to pose a public health threat because of its wide geographic distribution, potential to spread to new regions, propensity for genetic variability, potential for severe and fatal illness, and limited medical countermeasures for prophylaxis and treatment. Clinicians should become familiar with available diagnostic and management tools for CCHFV infections in humans.

Jamestown Canyon virus (JCV) is a mosquitoborne orthobunyavirus in the California serogroup that circulates throughout Canada and the United States. Most JCV exposures result in asymptomatic infection or a mild febrile illness, but JCV can also cause neurologic diseases, such as meningitis and encephalitis. We describe a case series of confirmed JCV-mediated neuroinvasive disease among persons from the provinces of British Columbia, Alberta, Quebec, and Nova Scotia, Canada, during 2011–2016. We highlight the case definitions, epidemiology, unique features and clinical manifestations, disease seasonality, and outcomes for those cases. Two of the patients (from Quebec and Nova Scotia) might have acquired JCV infections during travel to the northeastern region of the United States. This case series collectively demonstrates JCV’s wide distribution and indicates the need for increased awareness of JCV as the underlying cause of meningitis/meningoencephalitis during mosquito season.

We analyzed hospital discharge records of patients with coccidioidomycosis-related codes from the International Classification of Diseases, 10th revision, Clinical Modification, to estimate the prevalence of hospital visits associated with the disease in Texas, USA. Using Texas Health Care Information Collection data for 2016–2021, we investigated the demographic characteristics and geographic distribution of the affected population, assessed prevalence of hospital visits for coccidioidomycosis, and examined how prevalence varied by demographic and geographic factors. In Texas, 709 coccidioidomycosis-related inpatient and outpatient hospital visits occurred in 2021; prevalence was 3.17 cases per 100,000 total hospital visits in 2020. Geographic location, patient sex, and race/ethnicity were associated with increases in coccidioidomycosis-related hospital visits; male, non-Hispanic Black, and Hispanic patients had the highest prevalence of coccidioidomycosis compared with other groups. Increased surveillance and healthcare provider education and outreach are needed to ensure timely and accurate diagnosis and treatment of coccidioidomycosis in Texas and elsewhere.

High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018–2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having > 1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.

Understanding SARS-CoV-2 infection in populations at increased risk for poor health is critical to reducing disease. We describe the epidemiology of SARS-CoV-2 infection in Kakuma Refugee Camp Complex, Kenya. We performed descriptive analyses of SARS-CoV-2 infection in the camp and surrounding community during March 16, 2020‒December 31, 2021. We identified cases in accordance with national guidelines.We estimated fatality ratios and attack rates over time using locally weighted scatterplot smoothing for refugees, host community members, and national population. Of the 18,864 SARS-CoV-2 tests performed, 1,024 were positive, collected from 664 refugees and 360 host community members. Attack rates were 325.0/100,000 population (CFR 2.9%) for refugees,150.2/100,000 population (CFR 1.11%) for community, and 628.8/100,000 population (CFR 1.83%) nationwide. During 2020–2021, refugees experienced a lower attack rate but higher CFR than the national population, underscoring the need to prioritize SARS-CoV-2 mitigation measures, including vaccination.

Considering patient room shortages and prevalence of other communicable diseases, reassessing the isolation of patients with Clostridioides difficile infection (CDI) is imperative. We conducted a retrospective study to investigate the secondary CDI transmission rate in a hospital in South Korea, where patients with CDI were not isolated. Using data from a real-time locating system and electronic medical records, we investigated patients who had both direct and indirect contact with CDI index patients. The primary outcome was secondary CDI transmission, identified by whole-genome sequencing. Among 909 direct and 2,711 indirect contact cases, 2 instances of secondary transmission were observed (2 [0.05%] of 3,620 cases), 1 transmission via direct contact and 1 via environmental sources. A low level of direct contact (113 minutes) was required for secondary CDI transmission. Our findings support the adoption of exhaustive standard preventive measures, including environmental decontamination, rather than contact isolation of CDI patients in nonoutbreak settings.

During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November–December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%–72%; 601/875) and was 92% (95% CI 89%–94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.

We investigated clinically suspected measles cases that had discrepant real-time reverse transcription PCR (rRT-PCR) and measles-specific IgM test results to determine diagnoses. We performed rRT-PCR and measles-specific IgM testing on samples from 541 suspected measles cases. Of the 24 IgM-positive and rRT-PCR­–negative cases, 20 were among children who received a measles-containing vaccine within the previous 6 months; most had low IgG relative avidity indexes (RAIs). The other 4 cases were among adults who had an unknown previous measles history, unknown vaccination status, and high RAIs. We detected viral nucleic acid for viruses other than measles in 15 (62.5%) of the 24 cases with discrepant rRT-PCR and IgM test results. Measles vaccination, measles history, and contact history should be considered in suspected measles cases with discrepant rRT-PCR and IgM test results. If in doubt, measles IgG avidity and PCR testing for other febrile exanthematous viruses can help confirm or refute the diagnosis.

To determine the kinetics of hepatitis E virus (HEV) in asymptomatic persons and to evaluate viral load doubling time and half-life, we retrospectively tested samples retained from 32 HEV RNA-positive asymptomatic blood donors in Germany. Close-meshed monitoring of viral load and seroconversion in intervals of ≈4 days provided more information about the kinetics of asymptomatic HEV infections. We determined that a typical median infection began with PCR-detectable viremia at 36 days and a maximum viral load of 2.0 × 10 4 IU/mL. Viremia doubled in 2.4 days and had a half-life of 1.6 days. HEV IgM started to rise on about day 33 and peaked on day 36; IgG started to rise on about day 32 and peaked on day 53 . Although HEV IgG titers remained stable, IgM titers became undetectable in 40% of donors. Knowledge of the dynamics of HEV viremia is useful for assessing the risk for transfusion-transmitted hepatitis E.

We evaluated Q fever prevalence in blood donors and assessed the epidemiologic features of the disease in Israel in 2021. We tested serum samples for Coxeilla burnetii phase I and II IgG using immunofluorescent assay, defining a result of > 200 as seropositive. We compared geographic and demographic data. We included 1,473 participants; 188 (12.7%) were seropositive. The calculated sex- and age-adjusted national seroprevalence was 13.9% (95% CI 12.2%–15.7%). Male sex and age were independently associated with seropositivity (odds ratio [OR] 1.6, 95% CI 1.1–2.2; p = 0.005 for male sex; OR 1.2, 95% CI 1.01–1.03; p<0.001 for age). Residence in the coastal plain was independently associated with seropositivity for Q fever (OR 1.6, 95% CI 1.2–2.3; p<0.001); residence in rural and farming regions was not. Q fever is highly prevalent in Israel. The unexpected spatial distribution in the nonrural coastal plain suggests an unrecognized mode of transmission.

During December 11, 2020–March 29, 2022, the US government delivered ≈700 million doses of COVID-19 vaccine to vaccination sites, resulting in vaccination of ≈75% of US adults during that period. We evaluated accessibility of vaccination sites. Sites were accessible by walking within 15 minutes by 46.6% of persons, 30 minutes by 74.8%, 45 minutes by 82.8%, and 60 minutes by 86.7%. When limited to populations in counties with high social vulnerability, accessibility by walking was 55.3%, 81.1%, 86.7%, and 89.4%, respectively. By driving, lowest accessibility was 96.5% at 15 minutes. For urban/rural categories, the 15-minute walking accessibility between noncore and large central metropolitan areas ranged from 27.2% to 65.1%; driving accessibility was 79.9% to 99.5%. By 30 minutes driving accessibility for all urban/rural categories was >95.9%. Walking time variations across jurisdictions and between urban/rural areas indicate that potential gains could have been made by improving walkability or making transportation more readily available.

We estimated COVID-19 transmission potential and case burden by variant type in Alberta, British Columbia, and Ontario, Canada, during January 23, 2020–January 27, 2022; we also estimated the effectiveness of public health interventions to reduce transmission. We estimated time-varying reproduction number (R t ) over 7-day sliding windows and nonoverlapping time-windows determined by timing of policy changes. We calculated incidence rate ratios (IRRs) for each variant and compared rates to determine differences in burden among provinces. R t corresponding with emergence of the Delta variant increased in all 3 provinces; British Columbia had the largest increase, 43.85% (95% credible interval [CrI] 40.71%–46.84%). Across the study period, IRR was highest for Omicron (8.74 [95% CrI 8.71–8.77]) and burden highest in Alberta (IRR 1.80 [95% CrI 1.79–1.81]). Initiating public health interventions was associated with lower R t and relaxing restrictions and emergence of new variants associated with increases in R t .

We conducted a large surveillance study among members of an integrated healthcare delivery system in Pacific Northwest of the United States to estimate medical costs attributable to medically attended acute gastroenteritis (MAAGE) on the day care was sought and during 30-day follow-up. We used multivariable regression to compare costs of MAAGE and non-MAAGE cases matched on age, gender, and index time. Differences accounted for confounders, including race, ethnicity, and history of chronic underlying conditions. Analyses included 73,140 MAAGE episodes from adults and 18,617 from children who were Kaiser Permanente Northwest members during 2014–2016. Total costs were higher for MAAGE cases relative to non-MAAGE comparators as were costs on the day care was sought and costs during follow-up. Costs of MAAGE are substantial relative to the cost of usual-care medical services, and much of the burden accrues during short-term follow-up.

We investigated links between antimicrobial resistance in community-onset bacteremia and 1-year bacteremia recurrence by using the clinical data warehouse of Europe’s largest university hospital group in France. We included adult patients hospitalized with an incident community-onset Staphylococcus aureus , Escherichia coli , or Klebsiella spp. bacteremia during 2017–2019. We assessed risk factors of 1-year recurrence using Fine–Gray regression models. Of the 3,617 patients included, 291 (8.0%) had > 1 recurrence episode. Third-generation cephalosporin (3GC)-resistance was significantly associated with increased recurrence risk after incident Klebsiella spp. (hazard ratio 3.91 [95% CI 2.32–6.59]) or E. coli (hazard ratio 2.35 [95% CI 1.50–3.68]) bacteremia. Methicillin resistance in S. aureus bacteremia had no effect on recurrence risk. Although several underlying conditions and infection sources increased recurrence risk, 3GC-resistant Klebsiella spp. was associated with the greatest increase. These results demonstrate a new facet to illness induced by 3GC-resistant Klebsiella spp. and E. coli in the community setting.

We conducted a cross-sectional study in wild boar and extensively managed Iberian pig populations in a hotspot area of Crimean-Congo hemorrhagic fever virus (CCHFV) in Spain. We tested for antibodies against CCHFV by using 2 ELISAs in parallel. We assessed the presence of CCHFV RNA by means of reverse transcription quantitative PCR protocol, which detects all genotypes. A total of 113 (21.8%) of 518 suids sampled showed antibodies against CCHFV by ELISA. By species, 106 (39.7%) of 267 wild boars and 7 (2.8%) of 251 Iberian pigs analyzed were seropositive. Of the 231 Iberian pigs and 231 wild boars analyzed, none tested positive for CCHFV RNA. These findings indicate high CCHFV exposure in wild boar populations in endemic areas and confirm the susceptibility of extensively reared pigs to CCHFV, even though they may only play a limited role in the enzootic cycle.

African swine fever virus (ASFV) genotype II is endemic to Vietnam. We detected recombinant ASFV genotypes I and II (rASFV I/II) strains in domestic pigs from 6 northern provinces in Vietnam. The introduction of rASFV I/II strains could complicate ongoing ASFV control measures in the region.

In a representative sample of female children and adolescents in Germany, Toxoplasma gondii seroprevalence was 6.3% (95% CI 4.7%–8.0%). With each year of life, the chance of being seropositive increased by 1.2, indicating a strong force of infection. Social status and municipality size were found to be associated with seropositivity.

We describe the detection of Paranannizziopsis sp. fungus in a wild population of vipers in Europe. Fungal infections were severe, and 1 animal likely died from infection. Surveillance efforts are needed to better understand the threat of this pathogen to snake conservation.

We evaluated the in vitro effects of lyophilization for 2 vesicular stomatitis virus–based vaccines by using 3 stabilizing formulations and demonstrated protective immunity of lyophilized/reconstituted vaccine in guinea pigs. Lyophilization increased stability of the vaccines, but specific vesicular stomatitis virus–based vaccines will each require extensive analysis to optimize stabilizing formulations.

We report a cluster of serogroup B invasive meningococcal disease identified via genomic surveillance in older adults in England and describe the public health responses. Genomic surveillance is critical for supporting public health investigations and detecting the growing threat of serogroup B Neisseria meningitidis infections in older adults.

We detected Mayaro virus (MAYV) in 3.4% (28/822) of febrile patients tested during 2018–2021 from Roraima State, Brazil. We also isolated MAYV strains and confirmed that these cases were caused by genotype D. Improved surveillance is needed to better determine the burden of MAYV in the Amazon Region.

Across 133 confirmed mpox zoonotic index cases reported during 1970–2021 in Africa, cases occurred year-round near the equator, where climate is consistent. However, in tropical regions of the northern hemisphere under a dry/wet season cycle, cases occurred seasonally. Our findings further support the seasonality of mpox zoonotic transmission risk.

We investigated molecular evolution and spatiotemporal dynamics of atypical Legionella pneumophila serogroup 1 sequence type 1905 and determined its long-term persistence and linkage to human disease in dispersed locations, far beyond the large 2014 outbreak epicenter in Portugal. Our finding highlights the need for public health interventions to prevent further disease spread.

Norovirus is a major cause of acute gastroenteritis; GII.4 is the predominant strain in humans. Recently, 2 new GII.4 variants, Hong Kong 2019 and San Francisco 2017, were reported. Characterization using GII.4 monoclonal antibodies and serum demonstrated different antigenic profiles for the new variants compared with historical variants.

Cruise ships carrying COVID-19–vaccinated populations applied near-identical nonpharmaceutical measures during July–November 2021; passenger masking was not applied on 2 ships. Infection risk for masked passengers was 14.58 times lower than for unmasked passengers and 19.61 times lower than in the community. Unmasked passengers’ risk was slightly lower than community risk.

During a 2023 outbreak of Mycoplasma pneumoniae –associated community-acquired pneumonia among children in northern Vietnam, we analyzed M. pneumoniae isolated from nasopharyngeal samples. In almost half (6 of 13) of samples tested, we found known A2063G mutations (macrolide resistance) and a novel C2353T variant on the 23S rRNA gene.

We report the detection of Crimean-Congo hemorrhagic fever virus (CCHFV) in Corsica, France. We identified CCHFV African genotype I in ticks collected from cattle at 2 different sites in southeastern and central-western Corsica, indicating an established CCHFV circulation. Healthcare professionals and at-risk groups should be alerted to CCHFV circulation in Corsica.

In Latin America, rabies virus has persisted in a cycle between Desmodus rotundus vampire bats and cattle, potentially enhanced by deforestation. We modeled bovine rabies virus outbreaks in Costa Rica relative to land-use indicators and found spatial-temporal relationships among rabies virus outbreaks with deforestation as a predictor.

With the use of metagenomic next-generation sequencing, patients diagnosed with Whipple pneumonia are being increasingly correctly diagnosed. We report a series of 3 cases in China that showed a novel pattern of movable infiltrates and upper lung micronodules. After treatment, the 3 patients recovered, and lung infiltrates resolved.

Dogs are known to be susceptible to influenza A viruses, although information on influenza D virus (IDV) is limited. We investigated the seroprevalence of IDV in 426 dogs in the Apulia region of Italy during 2016 and 2023. A total of 14 samples were positive for IDV antibodies, suggesting exposure to IDV in dogs.

We report the detection of OXA-181 carbapenemase in an azithromycin-resistant Shigella spp. bacteria in an immunocompromised patient. The emergence of OXA-181 in Shigella spp. bacteria raises concerns about the global dissemination of carbapenem resistance in Enterobacterales and its implications for the treatment of infections caused by Shigella bacteria.

Although a vaccine against SARS-CoV-2 Omicron-XBB.1.5 variant is available worldwide and recent infection is protective, the lack of recorded infection data highlights the need to assess variant-specific antibody neutralization levels. We analyzed IgG levels against receptor-binding domain–specific SARS-CoV-2 ancestral strain as a correlate for high neutralizing titers against XBB variants.

We describe a feline sporotrichosis cluster and zoonotic transmission between one of the affected cats and a technician at a veterinary clinic in Kansas, USA. Increased awareness of sporotrichosis and the potential for zoonotic transmission could help veterinary professionals manage feline cases and take precautions to prevent human acquisition.

We report a clinical isolate of Burkholderia thailandensis 2022DZh obtained from a patient with an infected wound in southwest China. Genomic analysis indicates that this isolate clusters with B. thailandensis BPM, a human isolate from Chongqing, China. We recommend enhancing monitoring and surveillance for B. thailandensis infection in both humans and livestock.

To determine changes in Bordetella pertussis and B. parapertussis detection rates, we analyzed 1.43 million respiratory multiplex PCR test results from US facilities from 2019 through mid-2023. From mid-2022 through mid-2023, Bordetella spp. detection increased 8.5-fold; 95% of detections were B. parapertussis. While B. parapertussis rates increased, B. pertussis rates decreased.

We report a case of Sphingobium yanoikuyae bacteremia in an 89-year-old patient in Japan. No standard antimicrobial regimen has been established for S. yanoikuyae infections. However, ceftriaxone and ceftazidime treatments were effective in this case. Increased antimicrobial susceptibility data are needed to establish appropriate treatments for S. yanoikuyae .

Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 30, Number 6—June 2024

Perspective.

• Decolonization and Pathogen Reduction to Prevent Antimicrobial Resistance and Healthcare-Associated Infections M. R. Mangalea et al.
• Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France C. Vignals et al.
• An Electronic Health Record–Based Algorithm for Respiratory Virus–like Illness N. M. Cocoros et al.
• Severe Human Parainfluenza Virus Community- and Healthcare-Acquired Pneumonia in Adults at Tertiary Hospital in Seoul, South Korea, 2010–2019 J. H. Park et al.
• SARS-CoV-2 Disease Severity in Children during Pre-Delta, Delta, and Omicron Periods, Colorado L. Bankers et al.
• Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine Against Invasive Pneumococcal Disease in Follow-Up Study, Denmark K. Nielsen et al.
• Chest Radiograph Screening for Detection of Subclinical Tuberculosis in Asymptomatic Household Contacts, Peru Q. Tan et al.
• Outbreak of Highly Pathogenic Avian Influenza Virus H5N1 in Seals in the St. Lawrence Estuary, Quebec, Canada S. Lair et al.
• Carbapenem-Resistant and Extended-Spectrum β-Lactamase–Producing Enterobacterales Cases among Children, United States, 2016–2020 H. N. Grome et al.
• Antibodies to H5N1 Influenza A Virus in Retrieving Hunting Dogs, Washington State, USA J. D. Brown et al.

We characterized the evolution and molecular characteristics of avian influenza A(H7N9) viruses isolated in China during 2021–2023. We systematically analyzed the 10-year evolution of the hemagglutinin gene to determine the evolutionary branch. Our results showed recent antigenic drift, providing crucial clues for updating the H7N9 vaccine and disease prevention and control.

• Burkholderia semiarida as Cause of Recurrent Pulmonary Infection in Immunocompetent Patient, China D. Kuang et al.
• SARS-CoV-2 in Captive Nonhuman Primates, Spain, 2020–2023 D. Cano-Terriza et al.
• Infection- and Vaccine-Induced SARS-CoV-2 Seroprevalence in Persons 0–101 Years of Age, Japan, 2023 R. Kinoshita et al.
• Zoonotic Ancylostoma ceylanicum Infection in Coyotes from the Guanacaste Conservation Area, Costa Rica, 2021 P. A. Zendejas-Heredia et al.
• Detection of Encephalitozoon cuniculi in Cerebrospinal Fluid from Immunocompetent Patients, Czech Republic B. Sak et al.
• Emergence of Group B Streptococcus Disease in Pigs and Porcupines, Italy C. Garbarino et al.
• Molecular Identification of Fonsecaea monophora , Novel Agent of Fungal Brain Abscess S. Gourav et al.

During May–July 2023, a cluster of 7 patients at local hospitals in Florida, USA, received a diagnosis of Plasmodium vivax malaria. Whole-genome sequencing of the organism from 4 patients and phylogenetic analysis with worldwide representative P. vivax genomes indicated probable single parasite introduction from Central/South America.

Because novel SARS-CoV-2 variants continue to emerge, immunogenicity of XBB.1.5 monovalent vaccines against live clinical isolates needs to be evaluated. We report boosting of IgG (2.1×), IgA (1.5×), and total IgG/A/M (1.7×) targeting the spike receptor-binding domain and neutralizing titers against WA1 (2.2×), XBB.1.5 (7.4×), EG.5.1 (10.5×), and JN.1 (4.7×) variants.

Using the GISAID EpiCoV database, we identified 256 COVID-19 patients in Japan during March 31–December 31, 2023, who had mutations in the SARS-CoV-2 nonstructural protein 5 conferring ensitrelvir resistance. Ongoing genomic surveillance is required to monitor emergence of SARS-CoV-2 mutations that are resistant to anticoronaviral drugs.

• Novel Avian Influenza A(H5N6) in Wild Birds, South Korea, 2023 A. Cho et al.

Volume 30, Number 7—July 2024

We report highly pathogenic avian influenza A(H5N1) virus in dairy cattle and cats in Kansas and Texas, United States, which reflects the continued spread of clade 2.3.4.4b viruses that entered the country in late 2021. Infected cattle experienced nonspecific illness, reduced feed intake and rumination, and an abrupt drop in milk production, but fatal systemic influenza infection developed in domestic cats fed raw (unpasteurized) colostrum and milk from affected cows. Cow-to-cow transmission appears to have occurred because infections were observed in cattle on Michigan, Idaho, and Ohio farms where avian influenza virus–infected cows were transported. Although the US Food and Drug Administration has indicated the commercial milk supply remains safe, the detection of influenza virus in unpasteurized bovine milk is a concern because of potential cross-species transmission. Continued surveillance of highly pathogenic avian influenza viruses in domestic production animals is needed to prevent cross-species and mammal-to-mammal transmission.

• Borrelia miyamotoi -associated Acute Meningoencephalitis, Minnesota, United States J. M. Kubiak et al.

Research Letter

• Pasteurella bettyae Infections in Men Who Have Sex With Men, France A. Li et al.

Medscape, LLC is pleased to provide online continuing medical education (CME) for selected journal articles, allowing clinicians the opportunity to earn CME credit. In support of improving patient care, these activities have been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. CME credit is available for one year after publication.

Active CME Articles

During October 2021–June 2023, a total of 392 cases of acute hepatitis of unknown etiology in children in the United States were reported to Centers for Disease Control and Prevention as part of national surveillance. We describe demographic and clinical characteristics, including potential involvement of adenovirus in development of acute hepatitis, of 8 fatally ill children who met reporting criteria. The children had diverse courses of illness. Two children were immunocompromised when initially brought for care. Four children tested positive for adenovirus in multiple specimen types, including 2 for whom typing was completed. One adenovirus-positive child had no known underlying conditions, supporting a potential relationship between adenovirus and acute hepatitis in previously healthy children. Our findings emphasize the importance of continued investigation to determine the mechanism of liver injury and appropriate treatment. Testing for adenovirus in similar cases could elucidate the role of the virus.

In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March–­June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.

Disseminated leishmaniasis (DL) is an emergent severe disease manifesting with multiple lesions. To determine the relationship between immune response and clinical and therapeutic outcomes, we studied 101 DL and 101 cutaneous leishmaniasis (CL) cases and determined cytokines and chemokines in supernatants of mononuclear cells stimulated with leishmania antigen. Patients were treated with meglumine antimoniate (20 mg/kg) for 20 days (CL) or 30 days (DL); 19 DL patients were instead treated with amphotericin B, miltefosine, or miltefosine and meglumine antimoniate. High levels of chemokine ligand 9 were associated with more severe DL. The cure rate for meglumine antimoniate was low for both DL (44%) and CL (60%), but healing time was longer in DL (p = 0.003). The lowest cure rate (22%) was found in DL patients with >100 lesions. However, meglumine antimoniate/miltefosine treatment cured all DL patients who received it; therefore, that combination should be considered as first choice therapy.

Streptococcus suis , a zoonotic bacterial pathogen circulated through swine, can cause severe infections in humans. Because human S. suis infections are not notifiable in most countries, incidence is underestimated. We aimed to increase insight into the molecular epidemiology of human S. suis infections in Europe. To procure data, we surveyed 7 reference laboratories and performed a systematic review of the scientific literature. We identified 236 cases of human S. suis infection from those sources and an additional 87 by scanning gray literature. We performed whole-genome sequencing to type 46 zoonotic S. suis isolates and combined them with 28 publicly available genomes in a core-genome phylogeny. Clonal complex (CC) 1 isolates accounted for 87% of typed human infections; CC20, CC25, CC87, and CC94 also caused infections. Emergence of diverse zoonotic clades and notable severity of illness in humans support classifying S. suis infection as a notifiable condition.

During January–August 2021, the Community Prevalence of SARS-CoV-2 Study used time/location sampling to recruit a cross-sectional, population-based cohort to estimate SARS-CoV-2 seroprevalence and nasal swab sample PCR positivity across 15 US communities. Survey-weighted estimates of SARS-CoV-2 infection and vaccine willingness among participants at each site were compared within demographic groups by using linear regression models with inverse variance weighting. Among 22,284 persons > 2 months of age and older, median prevalence of infection (prior, active, or both) was 12.9% across sites and similar across age groups. Within each site, average prevalence of infection was 3 percentage points higher for Black than White persons and average vaccine willingness was 10 percentage points lower for Black than White persons and 7 percentage points lower for Black persons than for persons in other racial groups. The higher prevalence of SARS-CoV-2 infection among groups with lower vaccine willingness highlights the disparate effect of COVID-19 and its complications.

Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002­–­­2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death.

Using whole-genome sequencing, we characterized Escherichia coli strains causing early-onset sepsis (EOS) in 32 neonatal cases from a 2019–2021 prospective multicenter study in France and compared them to E. coli strains collected from vaginal swab specimens from women in third-trimester gestation. We observed no major differences in phylogenetic groups or virulence profiles between the 2 collections. However, sequence type (ST) analysis showed the presence of 6/32 (19%) ST1193 strains causing EOS, the same frequency as in the highly virulent clonal group ST95. Three ST1193 strains caused meningitis, and 3 harbored extended-spectrum β-lactamase. No ST1193 strains were isolated from vaginal swab specimens. Emerging ST1193 appears to be highly prevalent, virulent, and antimicrobial resistant in neonates. However, the physiopathology of EOS caused by ST1193 has not yet been elucidated. Clinicians should be aware of the possible presence of E. coli ST1193 in prenatal and neonatal contexts and provide appropriate monitoring and treatment.

We describe detection of the previously rarely reported gram-positive bacterium Auritidibacter ignavus in 3 cases of chronic ear infections in Germany. In all 3 cases, the patients had refractory otorrhea. Although their additional symptoms varied, all patients had an ear canal stenosis and A. ignavus detected in microbiologic swab specimens. A correct identification of A. ignavus in the clinical microbiology laboratory is hampered by the inability to identify it by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Also, the bacterium might easily be overlooked because of its morphologic similarity to bacterial species of the resident skin flora. We conclude that a high index of suspicion is warranted to identify A. ignavus and that it should be particularly considered in patients with chronic external otitis who do not respond clinically to quinolone ear drop therapy.

We reviewed invasive Nocardia infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were N. nova complex in Minnesota (33.4%), N. cyriacigeorgica in Arizona (41.4%), and N. brasiliensis in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. N. farcinica (20.7%) and N. cyriacigeorgica (19.5%) were the most common isolates among transplant recipients and N. cyriacigeorgica (38.0%), N. nova complex (23.7%), and N. farcinica (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites.

We collected stool from school-age children from 352 households living in the Black Belt region of Alabama, USA, where sanitation infrastructure is lacking. We used quantitative reverse transcription PCR to measure key pathogens in stool that may be associated with water and sanitation, as an indicator of exposure. We detected genes associated with > 1 targets in 26% of specimens, most frequently Clostridioides difficile (6.6%), atypical enteropathogenic Escherichia coli (6.1%), and enteroaggregative E. coli (3.9%). We used generalized estimating equations to assess reported risk factors for detecting > 1 pathogen in stool. We found no association between lack of sanitation and pathogen detection (adjusted risk ratio 0.95 [95% CI 0.55–1.7]) compared with specimens from children served by sewerage. However, we did observe an increased risk for pathogen detection among children living in homes with well water (adjusted risk ratio 1.7 [95% CI 1.1–2.5]) over those reporting water utility service.

Campylobacter fetus accounts for 1% of Campylobacter spp. infections, but prevalence of bacteremia and risk for death are high. To determine clinical features of C. fetus infections and risks for death, we conducted a retrospective observational study of all adult inpatients with a confirmed C. fetus infection in Nord Franche-Comté Hospital, Trevenans, France, during January 2000–December 2021. Among 991 patients with isolated Campylobacter spp. strains, we identified 39 (4%) with culture-positive C. fetus infections, of which 33 had complete records and underwent further analysis; 21 had documented bacteremia and 12 did not. Secondary localizations were reported for 7 (33%) patients with C. fetus bacteremia, of which 5 exhibited a predilection for vascular infections (including 3 with mycotic aneurysm). Another 7 (33%) patients with C. fetus bacteremia died within 30 days. Significant risk factors associated with death within 30 days were dyspnea, quick sequential organ failure assessment score > 2 at admission, and septic shock.

Group A Streptococcus (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. We discuss 20 additional cases of pediatric primary peritonitis caused by GAS among patients at Starship Children’s Hospital, Auckland, New Zealand, during 2010–2022. We compare identified cases of GAS primary peritonitis to cases described in the existing pediatric literature. As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen.

In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (<37 weeks), and having very low birthweight (<1,500 g) than those without CS. Mean length of hospital stay (14.5 days vs. 3.8 days) and mean charges ($56,802 vs. $13,945) were also higher for infants with CS than for those without. To address escalation of CS, Mississippi should invest in comprehensive prenatal care and early treatment of vulnerable populations.

Ongoing surveillance after pneumococcal conjugate vaccination (PCV) deployment is essential to inform policy decisions and monitor serotype replacement. We report serotype and disease severity trends in 3,719 adults hospitalized for pneumococcal disease in Bristol and Bath, United Kingdom, during 2006–2022. Of those cases, 1,686 were invasive pneumococcal disease (IPD); 1,501 (89.0%) had a known serotype. IPD decreased during the early COVID-19 pandemic but during 2022 gradually returned to prepandemic levels. Disease severity changed throughout this period: CURB65 severity scores and inpatient deaths decreased and ICU admissions increased. PCV7 and PCV13 serotype IPD decreased from 2006–2009 to 2021–2022. However, residual PCV13 serotype IPD remained, representing 21.7% of 2021–2022 cases, indicating that major adult PCV serotype disease still occurs despite 17 years of pediatric PCV use. Percentages of serotype 3 and 8 IPD increased, and 19F and 19A reemerged. In 2020–2022, a total of 68.2% IPD cases were potentially covered by PCV20.

Borrelia miyamotoi , transmitted by Ixodes spp. ticks, was recognized as an agent of hard tick relapsing fever in the United States in 2013. Nine state health departments in the Northeast and Midwest have conducted public health surveillance for this emerging condition by using a shared, working surveillance case definition. During 2013–2019, a total of 300 cases were identified through surveillance; 166 (55%) were classified as confirmed and 134 (45%) as possible. Median age of case-patients was 52 years (range 1–86 years); 52% were male. Most cases (70%) occurred during June–September, with a peak in August. Fever and headache were common symptoms; 28% of case-patients reported recurring fevers, 55% had arthralgia, and 16% had a rash. Thirteen percent of patients were hospitalized, and no deaths were reported. Ongoing surveillance will improve understanding of the incidence and clinical severity of this emerging disease.

During 2006–2021, Canada had 55 laboratory-confirmed outbreaks of foodborne botulism, involving 67 cases. The mean annual incidence was 0.01 case/100,000 population. Foodborne botulism in Indigenous communities accounted for 46% of all cases, which is down from 85% of all cases during 1990–2005. Among all cases, 52% were caused by botulinum neurotoxin type E, but types A (24%), B (16%), F (3%), and AB (1%) also occurred; 3% were caused by undetermined serotypes. Four outbreaks resulted from commercial products, including a 2006 international outbreak caused by carrot juice. Hospital data indicated that 78% of patients were transferred to special care units and 70% required mechanical ventilation; 7 deaths were reported. Botulinum neurotoxin type A was associated with much longer hospital stays and more time spent in special care than types B or E. Foodborne botulism often is misdiagnosed. Increased clinician awareness can improve diagnosis, which can aid epidemiologic investigations and patient treatment.

Corynebacterium ulcerans is a closely related bacterium to the diphtheria bacterium C. diphtheriae , and some C. ulcerans strains produce toxins that are similar to diphtheria toxin. C. ulcerans is widely distributed in the environment and is considered one of the most harmful pathogens to livestock and wildlife. Infection with C. ulcerans can cause respiratory or nonrespiratory symptoms in patients. Recently, the microorganism has been increasingly recognized as an emerging zoonotic agent of diphtheria-like illness in Japan. To clarify the overall clinical characteristics, treatment-related factors, and outcomes of C. ulcerans infection, we analyzed 34 cases of C. ulcerans that occurred in Japan during 2001–2020. During 2010–2020, the incidence rate of C. ulcerans infection increased markedly, and the overall mortality rate was 5.9%. It is recommended that adults be vaccinated with diphtheria toxoid vaccine to prevent the spread of this infection.

Mycolicibacterium neoaurum is a rapidly growing mycobacterium and an emerging cause of human infections. M. neoaurum infections are uncommon but likely underreported, and our understanding of the disease spectrum and optimum management is incomplete. We summarize demographic and clinical characteristics of a case of catheter-related M. neoaurum bacteremia in a child with leukemia and those of 36 previously reported episodes of M. neoaurum infection. Most infections occurred in young to middle-aged adults with serious underlying medical conditions and commonly involved medical devices. Overall, infections were not associated with severe illness or death. In contrast to other mycobacteria species, M. neoaurum was generally susceptible to multiple antimicrobial drugs and responded promptly to treatment, and infections were associated with good outcomes after relatively short therapy duration and device removal. Delays in identification and susceptibility testing were common. We recommend using combination antimicrobial drug therapy and removal of infected devices to eradicate infection.

We retrospectively reviewed consecutive cases of mucormycosis reported from a tertiary-care center in India to determine the clinical and mycologic characteristics of emerging Rhizopus homothallicus fungus. The objectives were ascertaining the proportion of R. homothallicus infection and the 30-day mortality rate in rhino-orbital mucormycosis attributable to R. homothallicus compared with R. arrhizus. R. homothallicus accounted for 43 (6.8%) of the 631 cases of mucormycosis. R. homothallicus infection was independently associated with better survival (odds ratio [OR] 0.08 [95% CI 0.02–0.36]; p = 0.001) than for R. arrhizus infection (4/41 [9.8%] vs. 104/266 [39.1%]) after adjusting for age, intracranial involvement, and surgery. We also performed antifungal-susceptibility testing, which indicated a low range of MICs for R. homothallicus against the commonly used antifungals (amphotericin B [0.03–16], itraconazole [0.03–16], posaconazole [0.03–8], and isavuconazole [0.03–16]). 18S gene sequencing and amplified length polymorphism analysis revealed distinct clustering of R. homothallicus .

Zoonotic outbreaks of sporotrichosis are increasing in Brazil. We examined and described the emergence of cat-transmitted sporotrichosis (CTS) caused by the fungal pathogen Sporothrix brasiliensis . We calculated incidence and mapped geographic distribution of cases in Curitiba, Brazil, by reviewing medical records from 216 sporotrichosis cases diagnosed during 2011–May 2022. Proven sporotrichosis was established in 84 (39%) patients and probable sporotrichosis in 132 (61%). Incidence increased from 0.3 cases/100,000 outpatient visit-years in 2011 to 21.4 cases/100,000 outpatient visit-years in 2021; of the 216 cases, 58% (n = 126) were diagnosed during 2019–2021. The main clinical form of sporotrichosis was lymphocutaneous (63%), followed by localized cutaneous (24%), ocular (10%), multisite infections (3%), and cutaneous disseminated (<0.5%). Since the first report of CTS in Curitiba in 2011, sporotrichosis has increased substantially, indicating continuous disease transmission. Clinician and public awareness of CTS and efforts to prevent transmission are needed.

Babesiosis is a globally distributed parasitic infection caused by intraerythrocytic protozoa. The full spectrum of neurologic symptoms, the underlying neuropathophysiology, and neurologic risk factors are poorly understood. Our study sought to describe the type and frequency of neurologic complications of babesiosis in a group of hospitalized patients and assess risk factors that might predispose patients to neurologic complications. We reviewed medical records of adult patients who were admitted to Yale-New Haven Hospital, New Haven, Connecticut, USA, during January 2011–October 2021 with laboratory-confirmed babesiosis. More than half of the 163 patients experienced > 1 neurologic symptoms during their hospital admissions. The most frequent symptoms were headache, confusion/delirium, and impaired consciousness. Neurologic symptoms were associated with high-grade parasitemia, renal failure, and history of diabetes mellitus. Clinicians working in endemic areas should recognize the range of symptoms associated with babesiosis, including neurologic.

Tularemia is a zoonotic infection caused by Francisella tularensis . Its most typical manifestations in humans are ulceroglandular and glandular; infections in prosthetic joints are rare. We report 3 cases of F. tularensis subspecies holarctica –related prosthetic joint infection that occurred in France during 2016–2019. We also reviewed relevant literature and found only 5 other cases of Francisella -related prosthetic joint infections worldwide, which we summarized. Among those 8 patients, clinical symptoms appeared 7 days to 19 years after the joint placement and were nonspecific to tularemia. Although positive cultures are typically obtained in only 10% of tularemia cases, strains grew in all 8 of the patients. F. tularensis was initially identified in 2 patients by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; molecular methods were used for 6 patients. Surgical treatment in conjunction with long-term antimicrobial treatment resulted in favorable outcomes; no relapses were seen after 6 months of follow-up.

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