Problem/Condition:Sub-Saharan Africa and South Asia have the highest rates of stillbirths and rates of death among children aged <5 years, with many countries in those regions unlikely to meet the 2030 goal of ending preventable deaths among newborns and children aged <5 years. Conventional mortality surveillance (determining cause of death through interviews with family members or caregivers [i.e., verbal autopsy] and vital registration) in areas with high mortality often lacks laboratory confirmation of causes and incompletely identifies maternal contributors and comorbid conditions, providing information that is insufficiently specific to guide prevention efforts. Period Covered:December 2016-December 2024. Description of System:The Child Health and Mortality Prevention Surveillance (CHAMPS) network generates standardized, laboratory-confirmed data on causes and preventability of deaths among neonates, infants, and children aged <5 years and stillbirths in areas with high mortality. During 2016-2024, CHAMPS operated in seven countries (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) through population-defined catchment areas. Eligibility required residence in a CHAMPS catchment area for ≥4 months before death or, for children aged <4 months, since birth. Deaths were investigated using a standardized postmortem approach that included minimally invasive tissue sampling (MITS), laboratory investigations (conventional and molecular microbiology and histopathology), interviews with family members or caregivers (i.e., verbal autopsy), and pediatric and maternal clinical record abstraction. Multidisciplinary determination of cause-of-death (DeCoDe) panels integrated evidence to assign causes (including multiple causes per death) and assess preventability. Results:During 2016-2024, a total of 18,784 eligible deaths were identified; families consented to CHAMPS enrollment for 15,612 (83.1%) of these deaths. MITS was completed for 9,415 deaths and DeCoDe was completed for 8,500 (90.3% of MITS-investigated deaths); a total of 3,199 (37.6%) were stillbirths; 3,230 (38.0%) were neonatal deaths; and 2,071 (24.4%) were deaths of infants (aged 28 days to <12 months) and children (aged ≥12 to <60 months). Stillbirths were predominantly attributed to perinatal asphyxia or hypoxia (79.1%), often with maternal hypertensive disorders, placental abnormalities, chorioamnionitis, and other medical conditions (e.g., diabetes). Neonatal deaths involved preterm complications (39.7%); asphyxia or hypoxia (37.7%), which often is linked to maternal and intrapartum care; and sepsis (36.5%), commonly resulting from infection with Klebsiella pneumoniae and Acinetobacter baumannii. Among infants and children, leading causes of death included lower respiratory infections (37.4%), sepsis (36.9%), malnutrition (27.3%), malaria (22.1%), and diarrheal disease (17.3%). Multiple conditions in the causal chain were common among neonates (44.3% with two or more conditions) and infants and children (67.9% with two or more conditions). Postmortem anthropometry indicated high levels of moderate or severe undernutrition among infants and children; among those with available measurements, nonmutually exclusive anthropometric indicators included underweight (61.3%), wasting (61.3%), and stunting (43.0%), according to the World Health Organization's Child Growth Standards. Among neonatal, infant, and child deaths (excluding stillbirths), infection contributed to 3,146 (59.3%) deaths. Among neonatal, infant, and child deaths with one or more pathogens identified in the causal chain (n = 2,749), 44.5% were polymicrobial, with gram-negative bacteria predominating. Main maternal conditions, most commonly placental complications and hypertensive disorders of pregnancy, were assigned for 71.1% of stillbirths and 58.2% of neonatal deaths. Of 7,558 deaths with a preventability assessment, 6,103 (80.7%) were considered preventable or possibly preventable through improvements in already available maternal, newborn, and child health interventions; primary opportunities included strengthened antenatal care, obstetric management, and infection control. Interpretation:CHAMPS complements conventional mortality surveillance by providing standardized, laboratory-confirmed, postmortem evidence on causes and preventability of stillbirths and of deaths among neonates, infants, and children aged <5 years across areas with high mortality. Findings demonstrate that preventable infections, suboptimal antenatal care, intrapartum complications, preterm birth, and malnutrition account for most deaths and also involve maternal and health care system factors. The predominance of infections caused by gram-negative bacteria highlights the need to strengthen infection prevention and control and to develop preventive tools, including vaccines. Public Health Action:Four of every five deaths were potentially preventable with timely implementation of established maternal, newborn, and child health interventions. CHAMPS demonstrates that high-precision postmortem MITS is feasible in resource-constrained settings and provides data critical to improve maternal and child health planning, practice, and policy. Certain components of CHAMPS (e.g., standardized MITS training, targeted diagnostics, and multidisciplinary review) could be adapted to strengthen routine surveillance and mortality review systems where feasible.
Problem/Condition:Candida auris is an emerging yeast that is frequently resistant to antifungal drugs. C. auris can cause invasive infections associated with high mortality and can colonize patients asymptomatically, which facilitates transmission in health care settings. Since it was first reported in the United States in 2016, C. auris has been identified in multiple states, with increasing numbers of cases reported annually. Monitoring national trends in cases identified through clinical testing and screening for colonization is critical to guide infection prevention and control efforts. Period Covered:2022-2024. Description of System:State and jurisdictional health departments voluntarily report clinical and screening C. auris cases to CDC using standardized case definitions of the Council of State and Territorial Epidemiologists. Clinical cases are defined as detection of C. auris from specimens collected for diagnostic purposes; screening cases are defined as detection from colonization screening swabs. Cases were reported to CDC through the Research Electronic Data Capture (REDCap) or Data Collation and Integration for Public Health Event Response (DCIPHER) platforms. Data included patient age and sex, case type, specimen type (for clinical cases), health care facility type, Antimicrobial Resistance Laboratory Network geographic region, and specimen collection date. Analyses were descriptive and limited to cases with specimens collected during 2022-2024. Results:During 2022-2024, a total of 13,507 clinical C. auris cases were reported to CDC, increasing from 2,882 in 2022 to 4,428 in 2023 and 6,197 in 2024, with smaller annual percentage increases over time (53.7% from 2022 to 2023 and 39.9% from 2023 to 2024). Most clinical cases occurred among adults aged ≥45 years (87.8%) and among males (61.0%). The most common specimen types among all clinical cases were urine (31.5%) and blood (30.2%); by year, the proportion of blood as the specimen type was 34.4% in 2022, 30.2% in 2023, and 25.6% in 2024. Most clinical cases were identified through specimens collected in acute care hospitals (76.6%) and long-term acute care hospitals (17.8%).During the same period, a total of 27,853 screening cases were reported to CDC, increasing from 6,226 in 2022 to 9,195 in 2023 and 12,432 in 2024. Screening cases most frequently occurred among adults aged ≥45 years (90.0%) and males (57.9%). Among cases with known facility type, the proportion of specimens collected in acute care hospitals increased from 24.7% in 2022 to 50.7% in 2024, whereas the proportion of specimens collected in long-term acute care hospitals decreased from 56.1% to 35.7% during the same period. Interpretation:The number of clinical and screening C. auris cases reported to CDC increased during 2022-2024, indicating ongoing transmission in U.S. health care settings. Although annual percentage increases in clinical cases declined over time, absolute case counts reported to CDC continued to rise. The increasing proportion of screening cases with specimens collected in acute care hospitals might reflect increased use of screening in acute care hospitals, including screening at admission. Public Health Action:Because of increases in the number of reported C. auris cases, sustained infection prevention and control efforts in health care facilities, including adherence to transmission-based precautions, environmental disinfection with agents effective against C. auris, and communication of C. auris status during patient transfers remain essential to preventing clinical infections and colonization. Because this pathogen is frequently resistant to antifungal drugs, continued investment in laboratory capacity and surveillance, including antifungal susceptibility testing and screening of patients at high risk for C. auris infection, can support timely detection and guide prevention strategies. Ongoing public health coordination at federal, state, and local levels is critical to limit further spread and to address emerging antifungal drug resistance.
Problem/Condition:Marine toxins cause most of the noninfectious outbreaks reported to CDC's Foodborne Disease Outbreak Surveillance System (FDOSS) each year. Certain marine toxins are produced by algae that accumulate in aquatic animals through the food chain, whereas others appear as a result of improper food storage and are therefore preventable. Overgrowths of toxin-producing algae (harmful algal blooms) have occurred on both U.S. coasts; the historical geographic range for some species (e.g., Gambierdiscus in tropical and subtropical regions) have expanded. Marine toxins that cause foodborne illness are tasteless, odorless, resistant to cooking or freezing, and can produce a complex variety of gastrointestinal, neurologic, and neuropsychologic symptoms. Among persons with severe illness resulting from ingestion of marine toxins, cardiovascular and respiratory manifestations can result in hospitalization and death. Analyzing these outbreaks provides insight into their incidence, severity, and key characteristics, which can be used to guide food safety and foodborne illness prevention efforts. Period Covered:2011-2023. Description of System:Via FDOSS, CDC collects data on foodborne disease outbreaks from local, state, and territorial health departments in the United States. Foodborne disease outbreaks are defined as two or more cases of similar illness associated with a common food exposure; outbreak etiologies and food sources can be reported as confirmed or suspected. Since 2009, health departments have voluntarily reported foodborne disease outbreaks to FDOSS through CDC's web-based National Outbreak Reporting System. Results:During 2011-2023, a total of 402 foodborne disease outbreaks caused by marine toxins were reported to FDOSS. These outbreaks resulted in 1,280 illnesses, 96 hospitalizations, and one death. The national rate of these reported outbreaks was 1.2 outbreaks per 1 million population. Outbreaks were reported by 32 states; Washington, DC; and Puerto Rico. Hawaii (25.3 outbreaks per 1 million population), Puerto Rico (16.5), Florida (6.3), and Alaska (5.4) had the highest reported rates. A food source was identified in 396 (99%) outbreaks, of which 379 (96%) implicated fish. Among 313 outbreak investigations in which the food importation status was known, 219 (70%) of the implicated foods were not imported. Of the 377 outbreaks in which a single location of food preparation was identified, private homes were reported in 193 (51%) outbreaks and sit-down dining restaurants were reported in 130 (34%) outbreaks.Nearly all outbreak reports (95%) implicated scombroid toxin (192 outbreaks, 597 illnesses, and six hospitalizations) or ciguatoxin (189 outbreaks, 619 illnesses, and 67 hospitalizations). For the 192 scombroid toxin outbreaks, the jurisdictions reporting the highest number of outbreaks were New York (43 [22%]), Florida (38 [20%]), California (23 [12%]), and Hawaii (18 [9%]). Of the 189 scombroid toxin outbreak reports with a reported food source, the majority (76%) implicated tuna. Of the 131 scombroid toxin outbreak reports with information on importation status, 70 (53%) implicated imported foods. Of the 181 scombroid toxin outbreak reports with a single location of food preparation, sit-down dining restaurants were identified in 104 (57%) outbreaks.Of the 189 ciguatoxin outbreaks, Florida reported 88 (47%) outbreaks, Puerto Rico reported 55 (29%), and Hawaii reported 18 (10%). Of the 187 ciguatoxin outbreak reports with a reported food source, 58 (31%) implicated barracuda, 25 (13%) implicated grouper, and 22 (12%) implicated amberjack. The majority (87%) of the 164 ciguatoxin outbreak reports with a known importation status reported foods that were domestically caught. Of the 178 ciguatoxin outbreak reports with a single location of food preparation, private homes were identified in 142 (80%) outbreaks.Shellfish-associated toxins caused 13 outbreaks, including paralytic shellfish poisoning in six (46%) outbreaks, neurotoxic shellfish poisoning in four (31%) outbreaks, and amnesic shellfish poisoning, diarrhetic shellfish poisoning, and unknown shellfish poisoning each associated with one (8%) outbreak. These outbreaks resulted in 40 illnesses and nine hospitalizations. Florida reported five (38%) of these 13 outbreaks and Alaska reported four (31%). Of the 13 total shellfish-associated outbreaks, mussels were implicated in four outbreaks (31%), sea snails in four (31%), and clams in three (23%). None of these outbreak investigations implicated imported shellfish. Of the 11 shellfish-associated toxin outbreaks with a reported single food preparation location, private homes were identified in eight (73%) outbreaks. Interpretation:Characterizing marine toxin outbreaks reported to FDOSS can guide opportunities for prevention. Scombroid toxin and ciguatoxin caused the most reported outbreaks, illnesses, and hospitalizations of all marine toxins, indicating they are important targets for public health intervention. More than half of scombroid toxin outbreaks were caused by imported fish and fish prepared in sit-down dining restaurants. Most ciguatoxin outbreaks were caused by reef fish, fish that were not imported, and fish prepared in private homes. Outbreaks attributed to shellfish-associated toxins were caused by shellfish that were not imported and were prepared in private homes. Outbreaks caused by ciguatoxin and those associated with shellfish-associated toxins were predominantly reported by jurisdictions where toxin-producing algal species are endemic and often implicated recreationally caught fish and shellfish. Geographic expansion, increasing frequency, and increasing intensity of harmful algal blooms in U.S. coastal waters might increase the presence of ciguatoxin and shellfish-associated toxins in aquatic animals. The varying characteristics of outbreaks caused by marine toxins highlight the need for tailored prevention measures that account for both environmental conditions and consumer behaviors. Public Health Action:The findings in this report can be used by public health practitioners to guide food safety prevention efforts and raise awareness about marine toxins and associated illnesses. Prevention of outbreaks resulting from scombroid toxin from both imported and domestic fish involves maintaining temperature control of seafood below 40°F (4.4°C) from catch to consumption. Understanding the needs and practices of recreational harvesters could help public health officials craft targeted communications about safer practices for harvest location and affected aquatic species. Reducing the harvesting of reef fish and shellfish from high-risk areas, especially during and immediately after harmful algal blooms, might prevent illnesses from these toxins.
Problem/Condition: Brucellosis is a zoonotic disease caused by bacteria of the Brucella genus, and humans can acquire the disease from infected animals or their by-products. This report on U.S. brucellosis cases is the first since the adoption of the 2010 Council of State and Territorial Epidemiologists' (CSTE) brucellosis case definition. Period Covered: 2010-2024. Description of System: Data from the National Notifiable Diseases Surveillance System (NNDSS), information from supplemental case report forms (CRFs), and data from analyses of clinical specimen testing by CDC during 2010-2024 were analyzed. The 2010 CSTE brucellosis case definition was used to determine case status using supplemental CRFs submitted for cases reported through NNDSS. Results: During 2010-2024, a total of 1,796 confirmed and probable cases of brucellosis were reported to CDC through NNDSS. A total of 878 of 1,796 (49%) cases also had a supplemental CRF submitted. Of these, 503 (57%) cases met the 2010 CSTE brucellosis confirmed or probable case definition on the basis of clinical and laboratory data submitted on the supplemental CRF; 383 cases (76%) were confirmed and 120 (24%) were probable. Among persons with brucellosis cases meeting the CSTE definition, 308 (61%) reported any travel, and of those, 245 (80%) reported only international travel during the 6 months before symptom onset. The most frequently reported exposures among persons with international travel were consumption of unpasteurized dairy products or undercooked meat (n = 195 [73%]). Among persons without international travel, the most frequently reported exposures were animal contact (n = 116 [62%]), particularly skinning and slaughtering wild animals (n = 47 [41%]) and hunting wild animals (n = 46 [40%]). Interpretation: The lack of adequate clinical or laboratory data led to the exclusion of nearly half of the supplemental CRFs from this analysis. However, the following recognized exposures to Brucella were identified in cases with adequate information: 1) consumption of unpasteurized dairy products or undercooked meat, particularly those produced outside the United States or meat from wild animals, and 2) animal contact, especially skinning and slaughtering of wild animals. Findings suggest ongoing public health messaging to reduce exposures from unpasteurized dairy products and undercooked meat, and to promote safe field dressing practices among hunters. For hunters and other persons who skin or slaughter wild animals, safe field dressing practices might help reduce infection risk. Public Health Action: Increasing brucellosis awareness among populations at risk for infection, health care providers, and public health officials will strengthen prevention and surveillance efforts and ultimately improve patient outcomes.
Problem/Condition:Tetanus is a serious but vaccine-preventable disease caused by the toxin produced by germinated spores of Clostridium tetani bacteria. Despite substantial declines in incidence resulting from immunization, cases continue to occur, particularly among unvaccinated and undervaccinated populations. Period Covered:2009-2023. Description of System:The National Notifiable Diseases Surveillance System uses national surveillance to identify cases of tetanus using the Council of State and Territorial Epidemiologists' tetanus case definition. Tetanus cases identified through clinical diagnosis are reported to CDC by state health departments. Detailed tetanus-specific case information is requested, which includes tetanus toxoid-containing vaccine (TTCV) vaccination history, wound history, medical care before tetanus disease onset, and the clinical course of illness, including death. Results:During 2009-2023, a total of 402 tetanus cases and 37 associated deaths were reported from 47 states and the District of Columbia, with a mean annual tetanus incidence of 0.08 cases and 0.008 deaths per 1 million population. More than half (62.2%) of all reported tetanus cases occurred in males. Incidence was higher among males than females for all persons aged <65 years and higher among women than men for adults aged ≥80 years. Women aged ≥80 years had the highest overall tetanus incidence (0.27 cases per 1 million population). The overall case-fatality rate among persons with tetanus with known vital status was 12.4% (37 of 299), with deaths predominantly affecting older adults. A total of 45.0% of persons with tetanus who had a substantial wound sought medical care before disease onset. Among patients with wounds eligible for tetanus post-exposure prophylaxis, 2.3% received tetanus immune globulin (TIG) and 26% received TTCV per recommendations. Among persons whose vaccination history was known, a substantial proportion (43.9%) had not received any TTCV doses, highlighting substantial gaps in coverage. Interpretation:Despite being preventable through vaccination, tetanus continues to occur among persons of all age groups in the United States. Overall, males have higher incidence compared with females; the highest incidence is among older women. Approximately 1 in 10 persons who develop tetanus will die, with the highest mortality and case-fatality rates among older adults. Public Health Action:Multiple efforts might reduce the incidence of tetanus, including clinicians' assessing for and offering routine tetanus vaccination for children and decennial tetanus boosters for adults. In addition, persons with significant wounds should seek timely medical care, and clinicians should provide recommended wound care, including identifying tetanus-prone wounds and the need for and administration of TTCV and TIG. Because C. tetani is ubiquitous in the environment, continued surveillance and vaccination efforts are crucial to monitor trends, identify opportunities to prevent tetanus cases, and reduce tetanus incidence in the United States.
