Infectious Disease Roundup: 1/26/2025

An overview of infectious disease outbreaks in the United States and globally. January 26th, 2025: Tuberculosis, Norovirus, Chronic Wasting Disease, H5N1, Marburg Virus, et al.

Special Note: As of this writing, the United States Health and Human Services is still under a communications embargo. Agencies such as the CDC, NIH, FDA and 10 others remain unable to communicate to the public, though some reports are still being published. Read more about the 13 agencies under HHS here.

Currently, only a few reports regarding infectious diseases have been posted by the CDC since last week. For example, the CDC did publish a snapshot of Respiratory Virus Activity Levels on January 24th, indicating that medically attended cases of respiratory viral illness remain high.

However, that the data is from January 18th, 2024, which does not represent new data from last week.

Last week’s MMWR report remains unpublished, a first in 60 years of uninterrupted weekly publishing.

Four unnamed sources have indicated to a major media outlet that all scientific research is grinding to a halt inside of the NIH as scientists are no longer able to order reagents and supplies for their experiments.

Yesterday, I personally confirmed this, second hand, with prior NIH employees still in immediate contact with their colleagues. One direct contact at the NIH told me this morning that internally it is a “disaster” and that no one is completely clear about what is happening.

Currently, all NIH grant peer review meetings that score and approve grant funding (i.e. study sections) for scientific and medical research as well as small business, student, professor, university, and clinical trial grants (among others) have been canceled without an indication of when they may restart or be rescheduled. These research grants fund the vast majority of research and scientific education in the United States. The NIH funds disease research including research in Cancer, Heart Disease, Autoimmune Disease, Genetic Disorders, Diabetes and Metabolic Disorders, and Infectious Diseases among others.

Please consider writing to and calling your congressional representatives regarding this unprecedented disruption to medical and scientific research and the immediate threat to public health that may arise from these closures and communications embargos.

Infectious Disease Outbreaks In The United States

Tuberculosis

The ongoing outbreak of tuberculosis in the Kansas City, Kansas metro area is now the largest in recorded history in the United States. Tuberculosis (TB) is an infectious disease caused by bacteria called Mycobacterium tuberculosis. TB is the leading cause of death from a single infectious agent worldwide, despite being preventable and often curable.

Kansas public health officials have reported 67 active cases and 79 latent infections in the Kansas City, Kansas metro area. Most cases (60) have been in Wyandotte County, with 7 of the active confirmed cases in Johnson county. More about the most recent infections can be found here. County officials expect that more cases will be found in coming months.

Several other states are contending with or have had TB outbreaks over the last year. Per the most recent data published by the CDC (2023 final TB Surveillance Report), here are the states with the highest incidence rates of TB:

Although TB infection rates in the United States were in steady decline with a steep drop in 2020 (likely due to social distancing and mask wearing), incidence rates rapidly rose above pre-pandemic levels in 2023 (CDC data). Although 2024 final numbers have not been published, it is likely that rates have continued to increase based on several outbreaks reported by state health departments.

In the United States, there are an estimated 13 million people living with latent TB and 1 in 10 will convert to active, contagious TB. Qiagen’s VP and Head of Global Health, Marc Destito, recently published a call to action saying that their testing and surveillance has identified recent outbreaks in Alabama, Virginia, Arizona, New York, Minnesota, and Canada. Per the World Health Organization, tuberculosis is rising globally.

Untreated TB can be deadly. People can be tested for latent TB, and it can be treated. Latent (inactive) TB can become active at any time. Disruption of immune system function or becoming immunocompromised significantly increases the risk of developing active TB. It is possible that SARS-CoV-2 disruption of immune system function may increase the rate of TB activation and spread in untreated populations.

Although cases are on the rise in the United States, rates remain low (WHO data) relative to the rest of the world where an estimated 25% of the population is infected with latent TB. Note that drug resistant TB is on the rise. Here is the CDC’s flier on assessing personal TB risk and how treatment works.

Per the CDC 2024 Yellowbook on Tuberculosis: “TB transmission occurs when a patient with a contagious form of the infection coughs, spreading bacilli through the air. People can acquire bovine TB (caused by M. bovis) by consuming unpasteurized dairy products from infected cattle.” Avoiding prolonged exposure to anyone who has active TB, wearing a mask, washing your hands, and avoiding contact with wet or dry phlegm can all reduce chances of acquiring TB.

Norovirus

Norovirus levels continue to remain high in wastewater readings across the United States, higher than any time in the last 3 years.

Norovirus wastewater levels per wastewaterscan.org as of 1.26.2025.

The CDC recorded outbreaks through December 2024 corroborate wastewater data and show a multi-year high in the number of reported norovirus outbreaks.

Norovirus spreads easily, especially in high-traffic areas such as bathrooms or in close quarters (college dorms, nursing homes, households). Per the CDC, here are some common ways that norovirus spreads: “Food, water, or objects that are contaminated with norovirus are placed on surfaces. Tiny drops of vomit from a person with norovirus spray through the air, landing on surfaces or entering another person's mouth. A person with norovirus has diarrhea that splatters onto surfaces.”

Alcohol-based hand sanitizer DOES NOT kill norovirus. Bleach, peroxide, and hypochlorous acid-based cleaners eliminate norovirus.

Washing your hands with warm soap and water for at least 20 seconds is recommended by the CDC as the best way to reduce chances of becoming infected. Food services workers should be sure to wash their hands with soap and water before starting work to help reduce the spread of norovirus.

Chronic Wasting Disease

Georgia has just become the 36th state to confirm the presence of Chronic Wasting Disease (CWD) in its deer population. The positive case was discovered by random testing of a 2.5-year-old white-tailed deer taken from private property in Lanier County.

CWD is a prion-based disease with no cure. Similar to Mad Cow Disease, another prion disease, it is caused by a mis-folded protein that when consumed (or even inhaled) attacks the nervous system, causing death months to years after exposure. Cooking does not reduce the infectiousness of prions, and they are difficult to clean from surfaces.

About 350 cases of the prion-caused incurable Crutzfeilds-Jacobs Disease (CJD) are diagnosed each year in the United States, and roughly 70% of patients die within a year.

There is no definitive transmission link between cervids and humans, and this report from The National Deer Association states that no increased rate of infection is seen in hunters. However, their report also shows that rates of CJD diagnosis have been steadily increasing, even when age-adjusted. (CDJ typically appears between the age of 60 and 65).

Recently, two men who were regular deer hunters from the same hunting lodge died in short succession from prion disease, the strongest link to consuming infected meat to date. Finally, CJD in 3 unusually young patients who consumed elk and venison was detailed in this JAMA case study. Though the three patients had no other risk factors for CJD - but all consumed elk or venison - the study authors concluded they could not report a definitive link. Given the epidemiology of CJD (typical onset is between 60 and 65) and lack of risk factors, these cases that developed spontaneously in three people in their 20s indicates a potential smoking gun that should continue to be investigated.

The CDC recommends that hunters have local Game Management test cervids (deer, elk, or moose) taken from areas known to have CWD and to not eat the meat of animals that test positive for CWD. It is also recommended that hunters know the signs of CWD in an animal and report sick animals to the nearest Game Management Office. Animals that do not show obvious signs of illness may still be infected with CWD. Read more about recommendations for hunters and the positive case in Georgia here.

CIRAP (Center for Infectious Disease Research and Policy) of the University of Minnesota published a 102 page report on CWD Spillover Preparedness and Response (2025). Here are the conclusions and recommendations which can be found on page 91 of the PDF linked here.

CWD was first detected in Colorado and began to spread rapidly to other states in the early 2000s. CWD is now present in 36 States and 3 Canadian provinces. It has also been detected in South Korea, Norway, Sweden, and Finland. I remember exactly where I was (still a grad student) sitting in the window seat of a flight to a conference in Colorado when I first read about how CWD had begun to spread out of control to other states.

The United States Geological Survey (USGS.gov) has mapped and tracked the spread of CWD for several decades. Below are CWD surveillance maps from the last 20 years; 2005, 2010, 2015, 2020, and 2025.

2005

2010

2015

2020

2025

H5N1 Bird Flu

The Health Alert Network, a critical communication portal for alerting physicians and medical staff around the United States remains inactive. The last alert from HAN indicated that hospitals should accelerate subtyping of Influenza A infections to more rapidly identify potential H5N1 infection in the population. The alert is still available online here.

This indicates a shared concern that H5N1 is very close to a human-to-human transmission event, and rapid identification and mitigation of this will be critical. Both hospitalized North American cases, one in BC, Canada and one Louisiana showed that the virus developed the capability to transmit human to human, though no secondary infections were reported.

No significant updates have occurred regarding H5N1 since my update two days ago which can be found here.

I discussed the increase in egg prices and potential shortages being long-lived over a month ago on TikTok. We now have several reporters in the financial sector picking up on this. More can be read about this on Business Insider, The New York Times, and CNN.

If you decide to start a backyard flock to combat ongoing high egg prices be sure to familiarize yourself with how to protect them from being infected with H5N1 from wild birds or new birds you may bring into the flock. Familiarize yourself with ways to protect yourself from infection, some of which include using PPE when handling your birds and cleaning their enclosures. My prior report on this (here) has an infographic showing how H5N1 can spread from birds to humans. For a deep dive on H5N1, go to my write up on everything you need to know to date about H5N1 (here).

SARS-CoV-2

SARS-CoV-2 levels remain lower than prior years’ surges on average though some areas of the United States such as the upper Midwest and Northeast show very high levels of SARS-CoV-2 in the wastewater (leading indicator). SARS-CoV-2 infections do appear to be trending upwards. (data below from wastewaterscan.org).

CDC’s Last COVID-19 Update for the United States

The last Nowcast Data from the CDC’s Genomic Surveillance report did not show an emergence of any new or highly differentiated variants indicating that the currently available SARS-CoV-2 vaccine should be a good match for the variants that are currently in circulation.

CDC’s Last COVID-19 Variant Proportion Data Update for the United States

If the CDC’s Genomic Surveillance across the United States and of incoming travelers does not come back online soon, I will seek out alternative resources. It is not expected that a major shift will have occurred within the past week.

Global Disease Outbreaks:

Chapare hemorrhagic fever confirmed in Bolivia

Per a WHO report published 1/20/2025, an adult male farmer aged 50-60 years old has died and was confirmed to have Chapare virus (CHAPV) which behaves much like other hemorrhagic fevers (Ebola, Marburg for example) and has a 60% case fatality rate. The virus was first identified in 2003 in Bolivia and has been associated with five documented outbreaks. Human-to-human transmission can occur though it is relatively rare. As of January 13th, 2025, no other cases have emerged. Risk to public health in the United States remains very low.

Polio

New polio cases in Pakistan and the Democratic Republic of Congo (DRC) were reported this week. The cases in Pakistan were of wild-type poliovirus type 1 (WPV1) and the case reported in DRC was a vaccine-derived case. More information on these outbreaks can be found in the weekly report from the Global Polio Eradication Initiative (GPEI). Note that the United States has not used the live-attenuated Polio vaccine since 2000, and it was rapidly phased out starting in the late 1990s. The current polio vaccines given in the United States have no risk of spillover.

The most recent Eurosurveillance report indicates continued circulation of vaccine-derived poliovirus in wastewater samples in several European countries including the UK, Poland, Germany, Finland, and Spain. The Eurosurveillance detection report can be found here.

In countries where polio is in circulation such as Pakistan, it is routine for adults to receive polio boosters and the CDC recommends a polio booster if traveling to a country where the poliovirus is in circulation.

Marburg Virus

No new updates on the Marburg Virus outbreak in Tanzania have been reported. CDC posted a Level 1 Travel Health Notice for Tanzania and is recommending people practice usual precautions if traveling to Tanzania.

Please see my prior update for latest news: here.

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