WHO Disease Outbreak News

Between 17 May and 12 July 2025, the Information and Public Relations Department, Government of Kerala through a series of official press releases informed about four confirmed NiV cases, including two deaths, due to NiV infection from two districts of Kerala State. Of the four cases, two were reported from Malappuram and two from Palakkad district. This marks the first-ever outbreak in Palakkad District. Of the four cases, one case was reported in May (with symptom onset in April) and three in July with symptom onset June (two cases), and July (one case). The first patient was an adult woman from Malappuram district with symptom onset on 25 April. The patient was admitted in critical condition to a local hospital in Malappuram with fever, cough, and respiratory distress due to worsening of symptoms. She was transferred to intensive care on 2 May due to acute encephalitis syndrome. Samples were collected and tested positive for NiV at Calicut Medical College on 6 May. Confirmatory testing was conducted by the National Institute of Virology, Pune, and results confirmed on 8 May. The second patient, also an adult woman from Malappuram district developed symptoms on 23 June and died on 1 July. She visited multiple healthcare facilities, before being transferred to a government medical facility, where clinical suspicion of NiV led to sample collection and laboratory testing. The third patient is an adult woman from Palakkad district who developed symptoms on 25 June. She sought care at several healthcare facilities, before being admitted to a multi-specialty hospital, where she remains in critical condition on ventilator support. This is the first confirmed NiV case in Palakkad district. The fourth case was an adult male also from Palakkad district, who developed symptoms on 6 July 2025. He sought initial medical care on the same day, was admitted to a private hospital on 10 July, and transferred to a multi-specialty hospital on 11 July. On 12 July, he died and was confirmed with NiV infection. This is the second confirmed case in Palakkad district. The sources of infection of the cases remain under investigation. None of these cases appear to be linked to each other, suggesting independent spillover events from the natural reservoir. A significant presence of fruit bats, the known reservoir for NiV has been observed in the affected areas.

As of 17 June 2025, a total of four human rabies deaths have been confirmed in Timor-Leste in 2025. These cases occurred in the municipalities of Bobonaro (n=2), Ermera (n=1), and Oecusse (n=1). On 17 May 2025, the Timor-Leste Ministry of Health (MoH) confirmed a fatal human case of rabies in an adult male from Ermera Municipality. The person was bitten by a dog in March 2025 and developed symptoms including hydrophobia, photophobia, aggressiveness, convulsions, and hallucinations. On 15 May, the individual sought medical care and was transferred to a national hospital. Rabies infection was confirmed the same day by RT-PCR testing at the National Health Laboratory (NHL) in Timor-Leste, using a saliva sample collected before death. On 30 May 2025, a second fatal case of rabies was confirmed in an adult male from Oecusse Municipality. The person had been bitten by a dog in June 2024 and developed symptoms including hydrophobia and photophobia. The individual presented to a regional hospital on 27 May 2025. Rabies infection was confirmed on 29 May by RT-PCR testing at the NHL. On 13 June 2025, a third fatal case was confirmed in an adult male from Bobonaro Municipality. The person had been bitten by a dog approximately 2–3 months prior to symptom onset and developed symptoms including hydrophobia and difficulty swallowing. On 12 June, the individual sought medical care and was transferred to a national hospital in Dili. A saliva sample collected before death tested positive for rabies by RT-PCR at the NHL. On 17 June 2025, a fourth fatal case was confirmed in a female child from Bobonaro Municipality. The child had been bitten by a dog approximately two months prior to symptom onset and developed symptoms including hydrophobia, insomnia, hallucinations, hyperactivity, difficulty swallowing, and convulsions. On 12 June, the child was taken to medical care. A saliva sample tested positive for rabies by RT-PCR at the NHL on 13 June. On 14 June 2025, the child was transferred to a national hospital. Prior to this, two additional fatal human rabies cases were reported in 2024, bringing the total number of confirmed human rabies deaths since the emergence of the disease in 2024 to six. In March 2024, the first confirmed animal cases of rabies (in dogs) were reported in Oecusse Municipality. As of 1 June 2025, a total of 106 animal rabies cases have been confirmed in Timor-Leste. Of these, 103 (97%) were in dogs, two in goats (in Bobonaro and Oecusse), and one in swine (in Bobonaro). Oecusse Municipality is an enclave of Timor-Leste located within Indonesia’s East Nusa Tenggara province (NTT), where rabies is endemic and human cases are frequently reported. Both fatal human rabies cases reported in 2024 occurred in Oecusse. However, in 2025, one human case was reported in Ermera, an inland municipality that does not border Indonesia. This suggests that rabies may be spreading beyond border areas, highlighting the need to expand surveillance, monitor the movement of infected dogs, post-exposure prophylaxis (PEP), dog vaccination, education and awareness raising, and address the risk of undetected transmission in the country’s interior regions. Between March 2024 and 15 June 2025, a total of 1445 dog scratches and bites were reported in Timor-Leste. Of these, 41% were classified as WHO category III exposures. Only 18% of category III exposures received rabies immunoglobulin. Although 66% of all bite victims began PEP, most did not complete the full course.

Between 1 January and 1 July 2025, the National IHR Focal Point (NFP) of the Kingdom of Cambodia notified WHO of 11 laboratory-confirmed case of human infection with avian influenza A(H5N1) virus (clade 2.3.2.1e- formerly classified as 2.3.2.1c; from cases where virus sequences are available to date) including six deaths [CFR: 54%]. These cases are reported from the provinces of Siem Reap (4), Takeo (2), Kampong Cham (1), Kampong Speu (1), Kratie (1), Prey Veng (1), Svay Rieng (1). Of the total cases reported in 2025, seven cases were reported in June 2025. Males account for 63% of the cases. Of the 11 cases, three cases were reported in less than five-year-olds, two cases were between the age of 5 and 18 years and six cases were reported in the age group 18-65 years. All cases had exposure – handling or culling - of sick poultry, often kept in backyards. Avian influenza A(H5N1) was detected for the first time in Cambodia in December 2003, initially affecting wild birds. Between 2014 and 2022, there were no reports of human infection with A(H5N1) viruses. However, the re-emergence of human infections with A(H5N1) viruses in Cambodia was reported in February 2023. Since this re-emergence, Cambodia has reported 27 cases of laboratory confirmed human infection with avian influenza A(H5N1) including 12 fatalities (CFR 44%). The cases have been reported from eight provinces: Kampong Cham (1), Kampong Speu (1), Kampot (3), Kratie (3), Prey Veng (6), Svay Rieng (4), Siem Reap (5), Takeo (4). Figure 1: Epicurve of Avian Influenza A (H5N1) cases reported in Cambodia by year from 2003- 1 July 2025 Figure 2: Geographic distribution of Avian Influenza A (H5N1) cases reported in Cambodia from 1 January – 1 July 2025. Table 1: Details of Avian Influenza A (H5N1) cases reported in Cambodia between 1 January- 1 July 2025

Between 1 May and 4 May 2025, the Thailand IHR NFP notified WHO of four confirmed cases of cutaneous anthrax, including one death. The age range of the confirmed cases is 36 years to 58 years, comprising of three males and one female. The cases were identified in Mukdahan Province, located near the border with Lao People's Democratic Republic, separated by the Mekong River. All cases are epidemiologically linked to slaughtering of cows. The first cow was slaughtered on 12 April 2025, during a merit-making event, and its meat was distributed among villagers. A second cow was slaughtered on 28 April 2025. Exposure to meat or contact during the slaughtering process of these animals is believed to be the source of infection for all confirmed cases. The first case, presented with a skin rash on his right hand, which progressed to a clearly visible lesion by 24 April. Initially hospitalized, he was transferred to a referral hospital on 27 April due to worsening clinical symptoms, including a darkening lesion on the hand, swollen right axillary lymph nodes, dizziness, and convulsions. He subsequently died on the same day as a result of disease complications. The other three cases presented with pustular and vesicular lesions and were hospitalized. As of 28 May 2025, the three cases have completed a 10-day course of levofloxacin and doxycycline and have been discharged from hospital. Blood and wound samples from the four cases were collected between 28 April and 1 May and were sent to the Department of Medical Sciences (DMSC) and Bamrasnaradura Institute for laboratory testing. B. anthracis was confirmed by RT-PCR in all four patients. Screening of at-risk individuals was conducted across three villages, identifying two additional suspected cases who presented with diarrhea and fever. However, the samples tested negative for B. anthracis. A total of 636 individuals were identified as at risk and monitored till 10 May 2025. Among them, 28 people were directly involved in the slaughter of cattle, while others consumed raw beef. Public health authorities initiated post-exposure prophylaxis for at-risk individuals by administering doxycycline for a duration of seven days. On 28 May, the Ministry of Public Health announced the fifth confirmed case in Mukdahan province, associated with the slaughtering of cows. The clinical status of the most recent reported fifth case is unknown at the time of reporting. This is the first reported anthrax-related death in Thailand since 1994. According to the Division of Epidemiology, the most recent anthrax cases prior to this event occurred in 2000 (15 cases and no deaths in Phichit and Phitsanulok provinces) and in 2017 (two cases and no deaths in Tak province linked to handling a goat carcass imported from Myanmar).

There has been an increase in SARS-CoV-2 activity globally, based on SARS-CoV-2 data reported to the Global Influenza Surveillance and Response System (GISRS) from sentinel surveillance sites. As of 11 May 2025, the test positivity rate is 11% across 73 reporting countries, areas and territories. This level matches the peak observed in July 2024 (12% from 99 countries) and marks a rise from 2% reported by 110 countries back in mid-February 2025 (Figure 1). The increase in test positivity rate is mainly being driven by countries in the Eastern Mediterranean Region, the South-East Asia Region, and the Western Pacific Region. Countries in the African Region, European Region, and the Region of the Americas are currently reporting low levels of SARS-CoV-2 activity with percent positivity from sentinel or systematic virological surveillance sites ranging from 2% to 3%. However, some areas—particularly in the Caribbean and Andean subregions in the Region of the Americas showed increasing trends of SARS-CoV-2 test positivity as of 11 May. Publicly available wastewater monitoring data from countries in the European Region and the Northern America subregion remain low and, at present, do not indicate any upward trend in SARS-CoV-2 activity as of 11 May 2025. The reporting of COVID-19 associated hospitalizations, Intensive Care Unit (ICU) admissions, and deaths is very limited from the countries in the Eastern Mediterranean Region, the South-East Asia Region, and the Western Pacific Region and does not allow for evaluation of the impact on health systems by WHO. Figure 1. SARS-CoV-2 tested specimens and percent positive reported from sentinel sites to eGISRS from countries, areas and territories from January 2023 to May 2025* *Most recent week’s data may be incomplete. Source: Global Influenza Programme SARS-CoV-2 Variant Evolution and Circulation SARS-CoV-2 continues to evolve, and between January and May 2025, there were shifts in global SARS-CoV-2 variant dynamics. At the beginning of the year, the most prevalent variant tracked by WHO at the global level was XEC, followed by KP.3.1.1. In February, circulation of XEC began to decline while that of LP.8.1 increased, with the latter becoming the most detected variant in mid-March. Since mid-April, the circulation of LP.8.1 has been slightly declining as NB.1.8.1 is increasingly being detected. Figure 2. SARS-CoV-2 Variants of Interest and Variants Under Monitoring proportions from January 2025 to May 2025. Source: GISAID and CoV-SPECTRUM The most recently designated variant under monitoring (VUM) is NB.1.8.1, which is a descendent lineage of XDV.1.5.1, in turn a descendent of JN.1, with the earliest sample collected on 22 January 2025. In comparison to the currently dominant SARS-CoV-2 variant, LP.8.1, NB.1.8.1 has the following additional spike mutations: T22N, F59S, G184S, A435S, V445H, and T478I. Spike mutations at position 445 have been shown to enhance binding affinity to hACE2 receptor, which could increase the variant’s transmissibility; mutations at position 435 have been shown to modestly reduce the neutralization potency of class 1 and class 1/4 antibodies; mutations at position 478 have been shown to enhance the evasion of Class 1/2 antibodies.[2] As of 18 May 2025, 518 NB.1.8.1 sequences were submitted to GISAID from 22 countries, representing 10.7% of the globally available sequences in epidemiological week (EW) 17 of 2025 (21 to 27 April 2025). While the percentage remains low, this presents a significant rise from 2.5% four weeks prior in EW14 of 2025 (31 March to 6 April 2025). Between EW14 and EW17 of 2025, increased circulation of NB.1.8.1 was detected in all three WHO regions that are consistently sharing SARS-CoV-2 sequences, i.e. from 8.9% to 11.7% for the Western Pacific region, from 1.6% to 4.9% for the region of the Americas, and from 1.0% to 6.0% for the European region. There are only 5 NB.1.8.1 sequences from the South-East Asia Region, and none from the African Region or the Eastern Mediterranean Region. COVID-19 Vaccination Update From the latest available global data covering the period between 1 January and 30 September 2024, overall COVID-19 vaccine uptake among high-risk groups remains low, with significant disparities across regions and income levels. Among older adults[3], just 1.68% were reported as having received a dose so far in 2024 up to 30 September 2024 across 75 reporting Member States, and among health and care workers, uptake stood at 0.96% across 54 reporting Member States. An estimated 39.2 million individuals, across 90 reporting Member States covering 31% of the global population, had received a dose in 2024 through 30 September 2024, including 14.8 million in the third quarter. Uptake was notably higher in the Region of the Americas and the European Region, with older adult coverage reaching 5.1% in the European Region and 3.6% in the Region of the Americas compared to less than 0.5% in other regions. A similar disparity was observed when comparing countries by income level. High and upper middle-income countries (HIC/UMIC) reported higher vaccine uptake among older adults with 4.3% and 1.2% respectively, compared to less than 0.5% in low-income countries (LIC) and lower middle-income countries (LMIC). Similar patterns were seen among health and care workers, with uptake in the Region of the Americas (2.8%) far exceeding the less than 0.5% seen in other regions. Among income groups, UMICs reported 2.1% coverage, compared to just 0.3% in LICs and 0.1% in LMICs. Complete vaccination data for 2024 is being collected now and will be released in mid-July 2025. Currently approved COVID-19 vaccines continue to provide protection against severe disease and death. To ensure approved vaccines remain effective, the WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) continues to monitor and review the impact of SARS-CoV-2 evolution on the performance of available vaccines. In May 2025, TAG-CO-VAC advised that monovalent vaccines targeting the JN.1 or KP.2 lineages remain appropriate. They also noted that vaccines targeting the LP.8.1 lineage can be considered as a suitable alternative. Vaccination should not be delayed. However, in anticipation of access to latest variant-containing vaccines, there is a greater benefit in ensuring that persons at high risk of developing severe COVID-19 receive a dose of any available vaccine as compared to delaying vaccination. Overview of selected WHO regions Eastern Mediterranean Region In the Eastern Mediterranean Region, sentinel surveillance data have been reported from 12 countries via test positivity rates from sentinel sites in 2025. The test positivity rate increased from 4% in EW13 to 17% in EW17 and then declined to 15% in EW19. Following lower circulation in the first ten weeks of 2025, a sharp upward trend surpassed the levels of last year (11% in EW17 2024). Across the region, recent reports of increases in circulation have been observed in five countries to date, including Egypt, Kuwait, Oman, Saudi Arabia, United Arab Emirates and Pakistan. Figure 3. SARS-CoV-2 tested specimens reported from sentinel sites to eGISRS from countries, areas and territories in the Eastern Mediterranean Region for 2024 and 2025* *Most recent week’s data may be incomplete. Source: Global Influenza Programme South-East Asia Region In the South-East Asia Region, sentinel surveillance data have been reported by eight countries in 2025. Since the beginning of April, the test positivity rate increased from 0.5% in EW15 to 5% in EW19. Although at a lower level, a similar upward trend was observed during the same period in 2024, with rates rising from 4% in EW15 to 6% in EW19, and further to 10% by EW24. The recent increases are observed in the Maldives and Thailand. As per published national reports, a rise in COVID-19 case detections was observed in India [4] in EW20 and Thailand [5] between EW16 to EW20. Figure 4. SARS-CoV-2 tested specimens reported from sentinel sites to eGISRS from countries, areas and territories in the South-East Asia Region for 2024 and 2025* *Most recent week’s data may be incomplete. Source: Global Influenza Programme Western Pacific Region In the Western Pacific Region, sentinel surveillance data have been reported by ten countries and areas via test positivity rates from sentinel sites in 2025. In the past month, the test positivity rate increased from 5% in EW14 to 11% in EW19. Following lower circulation in the first ten weeks of the year, a sharp upwards trend reached similar levels as last year (10% in EW18 2024). The recent increases have been observed in four countries and areas to date: Cambodia, China, Hong Kong SAR and Singapore. Figure 5. SARS-CoV-2 tested specimens reported from sentinel sites to eGISRS from countries, areas and territories in the Western Pacific Region for 2024 and 2025* *Most recent week’s data may be incomplete. Source: Global Influenza Programme

On 9 May 2025, the IHR NFP for Papua New Guinea (PNG) notified WHO of the detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) from stool specimens of two healthy children from Lae city, Morobe province, Papua New Guinea (PNG). Stool samples from 25 healthy children were collected on 10 April 2025 as part of an in-depth epidemiological investigation in the catchment area of the Environmental Surveillance (ES) site, which reported cVDPV2 on 4 April 2025. On 8 May, the WHO Polio Regional Reference Laboratory in Australia, the Victorian Infectious Diseases Reference Laboratory (VIDRL) confirmed that two of these children tested positive for poliovirus type 2. The children who tested positive for the poliovirus are from two separate villages within the ES catchment area in Lae city and were asymptomatic at the time of sample collection. All isolates were classified as cVDPV2 and were genetically linked to the environmental sample detected on 4 April 2025. Genetic sequencing revealed 18-19 nucleotide differences from the Sabin 2 vaccine strain. All isolates are closely related to each other and genetically linked to the INO-PAP-2 emergence that previously caused an outbreak in Indonesia. The detection of circulating type 2 poliovirus is classified as a “polio outbreak”, in accordance with the Global Polio Eradication Initiative (GPEI) Standard Operating Procedures for responding to a poliovirus Event or Outbreak. In Papua New Guinea, vaccination coverage is low, which may facilitate the spread of cVDPV2. As of 2024, national vaccination coverage for the third dose of oral polio vaccine (OPV3) was 44%. In Morobe province, where the virus is currently detected, coverage with bivalent OPV (bOPV) remained below 40% over the past five years, ranging from 28-37%. Coverage for the first dose of inactivated polio vaccine (IPV1) has remained between 52-54%. However, Lae city has higher coverage, with 73% for bOPV and 90% for IPV1.

Between 29 December 2024 and 26 April 2025 (with data for Ecuador as of 2 May 2025), a total of 212 confirmed human cases of yellow fever, including 85 deaths (CFR 40%), have been reported to WHO by five countries in the Region of the Americas. The cases were reported from the following countries: Plurinational State of Bolivia (three cases, including one death (CFR 33%)); Brazil (110 cases, including 44 deaths (CFR 40%)); Colombia (60 cases, including 24 deaths (CFR 40%)); Ecuador (four fatal cases (CFR 100%)) and Peru (35 cases, 12 deaths (CFR 34%)) (Figure 1). In 2024, human cases of yellow fever were reported mainly across the Amazon region of Bolivia, Brazil, Colombia, Guyana, and Peru. In 2025, however, cases have been detected mainly in areas outside the Amazon region, including in the state of São Paulo, Brazil and the Tolima department, Colombia. The 212 confirmed yellow fever cases reported so far in 2025 in the Americas represent a threefold increase compared to the 61 confirmed cases reported in 2024. Figure 1. Confirmed human cases of yellow fever by country and epidemiological week of onset of symptoms in the Region of the Americas, as of 26 April 2025 * (n= 212) Note: *Data on the number of confirmed cases of yellow fever in Ecuador are current as of 2 May 2025. Source: Adapted from data provided by countries or published by national Ministries of Health. Figure 2: Geographical distribution of confirmed human cases of yellow fever by year, Region of the Americas, 2023-2025, as of 26 April 2025 Source: Adapted from data provided by countries or published by national Ministries of Health. Overview by countries Bolivia (Plurinational State of) Since the beginning of 2025, Bolivia has reported three confirmed human cases of yellow fever, including one fatal case (CFR 33%), as of 26 April 2025. The cases were reported in the departments of Beni (one case), La Paz (one fatal case), and Tarija (one case). The fatal case had no history of yellow fever vaccination, whereas the other two cases reported having been vaccinated. All three cases were confirmed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) testing and had a history of entering forested areas. Additionally, an epizootic event (death of non-human primates) was confirmed in the municipality of San Buenaventura in the department of La Paz. Brazil Since the beginning of 2025, Brazil reported 110 confirmed human cases of yellow fever, including 44 fatal cases (CFR 40%), as of 26 April 2025. Cases were reported in the states of Minas Gerais (10 cases, including five deaths), Pará (44 cases, including seven deaths), São Paulo (55 cases, including 31 deaths), and Tocantins (one fatal case). The majority of cases (95 cases; 89.6 %) were male, with ages ranging from 10 to 75 years. Symptom onset occurred between 2 January and 2 April 2025. Only one case had a documented history of yellow fever vaccination. All cases reported exposure to wild and/or forested areas, either through occupational or recreational activities. Colombia Since the beginning of the yellow fever outbreak in early 2024 through 26 April 2025, a total of 83 confirmed yellow fever cases, including 37 deaths, have been reported in Colombia. In 2025, a total of 60 confirmed cases of yellow fever were reported, including 24 deaths, as of 26 April 2025. The cases were residents of the following departments: Caldas (one fatal case), Cauca (one fatal case), Guaviare (one fatal case), Meta (two fatal cases), Putumayo (three cases, including one death), and Tolima (52 cases, including 18 deaths). The cases ranged in age from 2 to 83 years, with onset of symptoms between 6 January and 18 April 2025. All cases had a history of exposure to areas classified as at risk for yellow fever, defined by the country. Only two of the confirmed cases had a documented history of yellow fever vaccination. As of 29 April 2025, 29 yellow fever epizootics in non-human primates have been reported, including 27 in the department of Tolima and two in the department of Huila. Ecuador Since the beginning of 2025 and as of 2 May, four confirmed fatal cases of yellow fever have been reported, from the provinces of Morona Santiago (one fatal case) and Zamora Chinchipe (three fatal cases). The cases ranged in age from 25 to 55 years, with onset of symptoms between 16 March and 2 May 2025. All four cases had a history of exposure in wild and/or forested areas, due to occupational activities, and were confirmed by RT-PCR. Peru Since the beginning of 2025, 35 confirmed cases of yellow fever, including 12 deaths, were reported in the Departments of Amazonas (22 cases, including seven deaths), Huánuco (one fatal case), Junín (three cases), Loreto (two cases, including one death) and San Martin (seven cases, including three deaths), as of 26 April 2025. Of the confirmed cases, 31 (88.6%) were male, with ages ranging from 6 to 57 years, and date of onset of symptoms between 15 January and 12 April 2025. All cases had a history of exposure in wild and/or forested areas, due to agricultural work activities, and 71.8% of the cases had no history of vaccination against yellow fever.

Since late 2023, Morocco has been experiencing a widespread measles outbreak. The first cases were reported in limited provinces of the Souss Massa region in central Morocco, before spreading to additional provinces within the region during the first quarter of 2024, and subsequently to other regions of the country. From 1 October 2023 through 13 April 2025, more than 25 000 suspected measles cases were reported from all 12 regions, 13 706 of which were laboratory-confirmed cases and 184 people died. During the week ending 27 April 2025, Morocco reported 995 suspected measles cases, representing an incidence rate of 2.7 per 100,000 population. While a national peak incidence was recorded in week 4 of 2025 (week ending 25 January), a declining trend in case numbers has been observed for ten consecutive weeks, starting from week 5 of 2025. The distribution of cases by gender has been nearly equal, with 50.7% of cases among males and 49.3% among females. From 1 January 2024 to 28 February 2025, 68% of cases occurred among individuals under the age of 18, and 49% of all cases were reported in unvaccinated individuals. Genomic characterization of measles virus specimens collected during the 2024–2025 outbreak revealed exclusive circulation of genotype B3, which is common in many parts of Africa and has been associated with outbreaks globally. One isolated case was associated with genotype D8 and likely indicates a sporadic importation, with no evidence of sustained local transmission. The measles vaccine was introduced into Morocco’s national immunization schedule in 1987 as a single dose, and a second dose was added in 2014. It is administered in two doses: the first at 9 months of age, and the second between 15 and 18 months. According to WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), Morocco has reported coverage with two doses of measles-containing vaccine (MCV2) above the 95% threshold required to achieve the elimination goal. However, this threshold was not achieved in the last three years.

Between 1 March and 21 April 2025, the Ministry of Health (MoH) of the Kingdom of Saudi Arabia (KSA) reported nine cases of MERS-CoV infection. The cases were reported from the Hail (1) and Riyadh (8) regions of Saudi Arabia (Figure 1). Of the reported cases, five were male and four were female. Among these cases, a cluster of seven was identified in Riyadh, including six health and care workers who acquired a nosocomial infection from one single infected patient they had cared for. Of the six health and care workers, four remained asymptomatic, while two developed mild, nonspecific symptoms including myalgia, fatigue, nausea and vomiting (Table 1). Laboratory confirmation of the cases was performed by real-time polymerase chain reaction (RT-PCR) between 1 March 2025 and 16 April 2025. Of the cases, only one had indirect contact with camels and is not a part of the reported cluster. The rest of the patients had no known history of contact with camels or camel products. Since the first report of MERS-CoV in KSA in 2012, a total 2627 laboratory-confirmed cases of MERS-CoV infection, with 946 associated deaths (Case Fatality Rate or CFR of 36%), have been reported to WHO from 27 countries, across all six WHO regions. The majority of cases (2218; 84%), have been reported from KSA, including these newly reported cases (Figure 2). Since 2019, no human MERS-CoV infections have been reported from countries outside the Middle East. Figure 1. Geographical distribution of MERS-CoV infections between 1 March and 21 April 2025 by city and region, KSA (n=9).Table 1: MERS-CoV cases reported by KSA between 1 March and 21 April 2025 Figure 2: Epidemic curve of MERS-CoV infections (n=2218) and deaths (n=865) reported in KSA between 2012-2025*

La Réunion, France In August 2024, the regional health authority (Agence régionale de santé, ARS) of La Réunion, France, reported three locally transmitted chikungunya cases. Cumulatively, from the start of the outbreak in August 2024 through 4 May 2025, over 47 500 confirmed cases of chikungunya and more than 170 000 consultations for suspected chikungunya have been reported on the island. The surge in cases was observed from early 2025 with weekly case counts increasing from 30 at the end of 2024 to 4000 during the week of 10-16 March 2025 (epidemiological week 11), indicating more than a 100-fold increase. The overall clinical presentation of the illness was generally mild; however, from 1 January to 4 May, 340 hospitalizations have been reported. Almost half (43%) of hospitalized patients were adults over 65 years old and approximately 25% were children under six months old. Over 95% of hospitalized patients had at least one risk factor for severe disease including comorbidity, age-group (over 65 years and infants) or pregnancy. Additionally, 74 pregnant women and 48 infants under six months were hospitalized for short-term monitoring (2-3 days). To date, 66 severe cases (defined as those with at least one organ failure) have been reported. These included 36 adults over 65 years of age with comorbidities, 7 people under 65 years of age with comorbidities and 23 infants under 3 months of age. Over the course of the outbreak, 12 deaths that occurred between 9 March and 27 April (Epi weeks 11-17) in people over 70 years of age with comorbidities were classified as linked to chikungunya, and additional twenty-eight deaths are currently under investigation for chikungunya, including one neonatal death. The cumulative number of cases continues to increase, with the southern municipalities being the most affected by the virus, particularly Le Tampon. To date, all the municipalities have reported cases. The previous large outbreak in La Reunion occurred in 2005-2006 with estimated total cases ranging between from 244 000 to over 300 000. In March 2025, imported cases as a result of travelers who had visited La Réunion were reported in Mayotte (2), Wallis and Futuna (1) and Martinique (1). Figure 1: Epidemiological curve of the number of confirmed chikungunya cases in La Reunion between 1 January and 27 April 2025 by week of symptom onset Mayotte, France As of 4 May 2025, a total of 116 chikungunya cases have been reported by ARS Mayotte, France, including 29 imported cases, 57 locally acquired cases, and 30 cases under investigation. The first imported case was identified on 5 March in the Northeast of the Island, followed by further cases reported across multiple communes. This marks the first locally transmitted chikungunya cases since the 2005–2006 outbreak, which had resulted in approximately 7300 cases. One hospitalization has been reported, with no deaths to date.