In the United States, cannabis is the most commonly used drug that is illegal under federal law*; in 2024, an estimated 64.2 million persons aged ≥12 years used cannabis (1). Frequent cannabis use is associated with various adverse health effects, including memory impairment, cannabis hyperemesis syndrome, chronic psychosis disorders, and cannabis use disorder (i.e., cannabis use leading to clinically significant impairment or distress) (2,3). Although cannabis alone rarely causes fatal overdoses (2), detection on postmortem toxicology testing among overdose deaths might help identify populations at high risk for other adverse health consequences (e.g., substance use disorders), including death, and help guide tailored prevention efforts. It is not known how often cannabis is detected among overdose deaths and whether detection varies by age.
Data from the 2025 National Immunization Survey-Teen for 18,692 adolescents aged 13-17 years were analyzed to assess trends in adolescent vaccination coverage. The 2025 CDC Child and Adolescent Immunization Schedule (updated July 2, 2025) recommended routine vaccination of persons aged 11-12 years with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine (which may be started at age 9 years). In 2025, coverage with ≥1 dose of Tdap and ≥1 dose of MenACWY decreased compared with 2024 but remained approximately 90%. HPV vaccination coverage (≥1 dose and up to date with HPV vaccination series) did not increase for the fourth consecutive year and remained lower than coverage with ≥1 dose of Tdap and ≥1 dose of MenACWY. Differences in vaccination coverage between nonmetropolitan statistical areas (mostly rural) and metropolitan statistical areas (mostly urban) persisted in 2025: coverage with ≥1 dose of HPV vaccine was 12.0 percentage points lower among adolescents living in mostly rural areas than among those living in mostly urban areas. Vaccination coverage varied by jurisdiction, with the largest variation observed for HPV vaccine. To ensure that adolescents are up to date, providers can review adolescent vaccination records, discuss recommended vaccines with families, and during all clinical encounters, administer all recommended vaccines that are due.
Since the onset of a global outbreak of monkeypox virus (MPXV) infections in 2022, cases have declined substantially in the United States; however, ongoing low-level transmission has persisted. To assess trends in cases of MPXV infection in the United States during 2024-2025, investigators analyzed data from the One CDC Data Platform and the National Notifiable Diseases Surveillance System. In 2024, a total of 2,803 cases of MPXV infection were reported in the United States, including one travel-associated clade Ib case. In 2025, a total of 2,519 cases were reported, including 10 clade Ib cases. The number of reported cases of MPXV infection during September-October 2025 was double that during the same period in 2024, although cases returned to background levels by the end of December 2025. Demographic characteristics of patients with MPXV infections, including distributions by sex, race and ethnicity, sexual orientation, lesion location, and age, were similar to those reported in previous years. Among 860 patients with complete information, the odds of hospitalization among those who were unvaccinated were 9.73 times those who were fully vaccinated when controlling for age group and HIV status. Encouraging completion of the recommended 2-dose vaccination series for persons at risk for MPXV exposure, including travelers to specific countries with ongoing clade I or clade II transmission, could reduce the risk for severe illness and hospitalization. Continued routine surveillance remains important to limiting future spread, monitoring changes in viral evolution, and focusing vaccination efforts on affected areas.
Southern Appalachia is a region where Lyme disease is emerging but not yet considered endemic. In response to local concerns about increased numbers of tickborne disease cases, researchers collected ticks monthly at 22 residential properties in the town of Biltmore Forest, North Carolina. During November 2024-August 2025, a total of 373 ticks were collected, 287 (76.9%) of which were blacklegged ticks (Ixodes scapularis). Among these, 19 of 48 adult Ix. scapularis (39.6%) tested positive for Borrelia burgdorferi sensu stricto, the bacterium that causes Lyme disease. Borrelia miyamotoi and Anaplasma phagocytophilum were also identified in collected Ix. scapularis ticks, suggesting an expansion of the geographic range of these ticks and pathogens. These findings illustrate the evolving epidemiology of tickborne infection risk and the need for enhanced tick surveillance in southern Appalachia.
On May 14, 2025, a county-level Chinese Center for Disease Control and Prevention (China CDC) in southwestern China received a report of the sudden death of four employees of a small workshop for ceremonial papermaking, which was operating without required safety and environmental approvals. The first person who died was a woman who lost consciousness while cleaning a wastewater tank. During the next 20 minutes, three of the woman's family members, also employees, entered the tank to attempt to rescue her. All four persons, including the workshop operator's wife, the workshop operator's son, the workshop operator, and the workshop operator's daughter, died. The county China CDC launched an immediate investigation, and the Intermediate Chinese Field Epidemiology Training Program and provincial and city China CDC staff members conducted a joint, on-site investigation that included identification of cases, analysis of the gas composition, and interviews of residents of the town and physicians to identify the cause of the apparent toxic exposure. Analyses revealed that levels of the highly toxic gases hydrogen sulfide, hydrogen fluoride, and phosphine were several times higher than the maximum allowable concentrations. Clinical signs among the decedents were consistent with poisoning by these gases. Lack of personal protective equipment in a confined space and the presence of toxic gases likely led to the multiple exposures and delayed response by rescue services. Although working in confined spaces with toxic gases is a known exposure risk, these exposures continue to be reported in China and have included deaths in the papermaking industry. These deaths highlight the importance of effective regulations for papermaking workshops and administrative controls, improved supervision, and education for workers.
Cannabis hyperemesis syndrome (CHS) is a condition characterized by cyclical nausea and vomiting and is associated with frequent cannabis use. Data from CDC's National Syndromic Surveillance Program were analyzed to examine trends in CHS-involved emergency department (ED) visits before and after implementation of a new, CHS-specific International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code on October 1, 2025. Monthly CHS-involved ED visits per 10,000 all-cause visits were assessed overall and by demographic characteristics. During January 2023-May 2026, a total of 199,565 ED visits involved CHS. During January 2023-September 2025, the proportion of ED visits that involved CHS remained mostly steady. In the first month after implementation of the new diagnostic code, the proportion of CHS-involved ED visits increased from 3.35 per 10,000 ED visits in September 2025 (preimplementation) to 11.26 per 10,000 ED visits in October 2025 (postimplementation). During the first 8 months after implementation of the new code (October 2025-May 2026), average monthly proportions of CHS-involved ED visits were 3.7 times as high as the monthly average during January 2023-September 2025. Higher proportions of CHS-involved ED visits were observed among persons aged 15-24 years and females, with more pronounced impacts among some demographic groups after code implementation. The abrupt, sustained increase might partly reflect improved recognition and coding of CHS rather than a true rise in incidence. These findings highlight a likely underestimated impact of CHS, suggesting the need to strengthen education about the risks associated with frequent cannabis use, expand ongoing surveillance efforts, and improve clinical recognition of CHS through continuing medical education and implementation of routine cannabis use assessment in ED settings.
Rubella is the leading cause of vaccine-preventable birth defects. Rubella virus infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). Vaccination is the primary method for preventing rubella and CRS, and a single dose of rubella-containing vaccine (RCV) provides lifelong protection. In 2024, the World Health Organization recommended introduction of RCV in all countries. Achieving rubella elimination is a priority of the Immunization Agenda 2030. This report summarizes global progress toward elimination of rubella and CRS during 2012-2024. During this period, the number of countries that introduced RCV increased from 132 of 194 (68%) to 179 (92%), and global coverage with the first routinely scheduled dose of RCV rose from 39% to 73%. The number of reported rubella cases declined by 66%, from 94,277 in 2012 to 31,593 in 2024, with large outbreaks increasingly concentrated in fewer countries and geographic shifts observed as vaccine introductions advanced. Modeled estimates suggest that CRS cases declined by approximately 70% during the same period. Since 2012 when accelerated rubella control activities began, 117 of 194 (60%) countries have verified elimination of endemic rubella virus transmission. Despite this, in 2024, approximately 21 million infants aged 12-23 months lived in the 15 countries that had not introduced RCV. Although substantial progress has been made, achieving and sustaining rubella and CRS elimination will require RCV introduction in all the remaining countries and continued commitment from all countries to strengthen immunization and surveillance systems.
Disseminated gonococcal infection (DGI) is a rare but serious complication of Neisseria gonorrhoeae infection that can result in severe illness or death. In April 2024, the Alaska Section of Epidemiology (SOE) identified an increase in suspected DGI cases in Anchorage, Alaska, prompting enhanced surveillance. The state's gonorrhea surveillance system and electronic health records were used to review all likely and verified DGI cases reported to SOE during January 2023-December 2024. Thirty-five DGI cases were identified, accounting for 0.35% (eight of 2,289) of all gonorrhea cases in 2023 and 1.3% (27 of 2,079) in 2024. The median patient age was 36 years, 51% of patients were male, and 37% had a documented substance use disorder. Overall, 21 (60%) patients experienced septic arthritis, and three (9%) patients developed endocarditis; 28 (80%) patients lacked mucosal symptoms. No deaths were reported. Eighteen available isolates collected during 2020-2024, including 14 from cases reported during 2023 and 2024, underwent antimicrobial susceptibility testing and whole-genome sequencing. Laboratory analyses identified a cluster of highly related isolates with a novel multilocus sequence type (MLST-18036) and markers of increased virulence; however, no resistance to first-line therapy (ceftriaxone) was detected. Clinicians should maintain a high index of suspicion for DGI in patients at risk for gonococcal infection, even in the absence of mucosal symptoms. Prompt diagnosis and treatment, prompt case reporting, and robust partner services are critical to preventing transmission and reducing DGI morbidity.
In February 2026, two travel-associated cases of measles were reported to the Wisconsin Department of Health Services (WDHS). Public health investigations for each case included wastewater (sewage) surveillance for wild-type measles, which was first implemented by the WDHS Wastewater Monitoring Program in June 2025. The virus from one case, caused by measles genotype D8, was detected by a wastewater surveillance assay before the case was identified by local health authorities, leading to public health notifications and action. Measles virus from the second case, caused by measles genotype B3, was not detected by the assay. Additional analysis of the measles wastewater assay, which is among the most widely used assays in the United States, revealed that the assay was not able to detect an internationally circulating variant of the measles B3 genotype. Two alternative assays confirmed that measles virus was present and detectable in the wastewater. The assay developers designed and released a modified assay that incorporated an additional probe that could detect the B3 variant. These cases demonstrate the potential benefit of wastewater surveillance in detecting wild-type measles virus from a single case, while also highlighting the importance of regularly monitoring wastewater assays with respect to available genomic data. These activities should be supported by up-to-date libraries of publicly available whole-genome sequencing data.
Legionellosis is a bacterial disease caused by inhalation or aspiration of Legionella bacteria; Legionnaires disease is a type of legionellosis characterized by illness with pneumonia. During November 2024, the U.S. Virgin Islands (USVI) Department of Health (VIDOH) was notified of two confirmed Legionnaires disease cases among travelers to two different hotels on St. Croix Island. VIDOH investigated to determine exposure sources and prevent additional cases. Two additional legionellosis cases were identified. The four patients with cases were aged 53-73 years; two patients were hospitalized and none died. At hotel A, L. pneumophila was detected in three of 21 (14%) environmental samples. VIDOH required hotel A to close one guest room, remediate, and retest. At hotel B, L. pneumophila was detected in 22 of 40 (55%) samples. VIDOH required hotel B to cease hotel operations until remediation and retesting were completed. L. pneumophila was isolated from shower samples at both hotels, in the cistern and cold water system at hotel A, and in cold and hot water systems at hotel B. The two USVI outbreaks underscore the importance of reporting legionellosis among returned travelers to facilitate local public health investigations and prevent additional cases. In addition, in tropical climates, cold water systems operate at temperatures favorable for Legionella growth (77°F-113°F [25°C-45°C]), highlighting the importance of effective water management programs and water system disinfection to prevent disease spread.
Alpha-gal syndrome (AGS) is an emerging, noninfectious tickborne disease characterized by an allergic reaction to galactose-α-1,3-galactose (alpha-gal), an oligosaccharide found in red (mammalian) meat and other mammalian products such as dairy and gelatin. As of 2022, AGS was estimated to affect up to 450,000 persons in the United States (1). Anaphylactic AGS reactions can be fatal, and AGS allergic reactions encompass a range of symptoms including urticaria, angioedema, wheezing, and gastrointestinal distress. AGS is primarily managed through an avoidance diet. The U.S. geographic distribution of AGS is closely associated with the range of the lone star tick (Amblyomma americanum); bites from this tick introduce alpha-gal through its saliva, which can trigger the allergy. Diagnosis of AGS requires both the presence of clinically compatible symptoms and the detection of serologic immunoglobulin E (IgE) antibodies against alpha-gal. Persons can have alpha-gal-specific IgE antibodies without clinical symptoms. The proportion of persons in the United States who are seropositive for alpha-gal IgE is unknown. To better understand the distribution and seroprevalence of alpha-gal IgE among U.S. adults, 3,000 serum samples collected during November 2024-April 2025 from blood donors living in 10 states were tested for the presence of alpha-gal IgE antibodies. States previously reported to have high numbers of suspected AGS cases were found to have correspondingly high seroprevalences. Among the 10 states, the highest estimated seroprevalences among persons aged ≥16 years were detected in Arkansas (31.2%) and Missouri (26.0%). These findings can guide the development of surveillance systems for AGS and help identify regions at increased risk.
Suicide is a substantial public health problem. In 2024, approximately 49,000 persons died by suicide in the United States, and an estimated 2.9 million persons aged ≥12 years reported having attempted suicide. Emergency department (ED) visits for suspected suicide attempts among adolescents increased during 2020-2021, then decreased in 2022; reports based on more recent data, including ED visits for suicide attempts among older age groups, are lacking. National Syndromic Surveillance Program data were examined overall and by sex and age group to identify changes in ED visits for suspected suicide attempts. During 2021-2025, numbers of ED visits for suspected suicide attempts and proportions of those visits among all ED visits for any reason (visit proportions) were highest among adolescents aged 12-17 years compared with other age groups and were higher among females than among males. Compared with 2021, overall visit proportions in 2025 declined 7.0%, with the largest decreases occurring among adolescents aged 12-17 years (20.8% decline) and females (10.7% decline). Visit proportions increased among adults in age groups ≥26 years (range = 1.4%-15.2%). These findings highlight the need for suicide prevention in all groups, particularly in those with high or increasing proportions of suicide attempts. Timely monitoring of suicide-related data and a comprehensive approach that both prevents suicidal behavior by addressing multiple risk and protective factors and also supports those who have attempted suicide are critical for saving lives.
On May 15, 2026, the ministries of health in the Democratic Republic of the Congo and Uganda declared outbreaks of Bundibugyo virus disease (BVD), a type of Ebola disease. In response to reports of high numbers of suspected cases and deaths in the affected countries, CDC assessed the risk posed by the BVD outbreak to the U.S. population during the next 3 months. This analysis used a standardized risk assessment approach that included epidemiologic data from the ongoing outbreak and historical data from previous Ebola outbreaks; the overall risk was determined by taking into account independent assessments of the likelihood of infection and the impact of infection. The assessment found that the overall risk to the U.S. population posed by the current BVD outbreak during the next 3 months is low, based on the extremely low likelihood of transmission, despite the high impact that potential infection could have and the resources that would be required to respond to the outbreak. Limitations to this assessment included uncertainties around the epidemiology of BVD as well as the current and future scope and geographic spread of the outbreak. CDC continues to monitor factors that could change this risk assessment.
In mid-October 2024, the New York State Department of Health (NYSDOH) was notified of two cases of Legionnaires disease in persons who stayed at the same short-term vacation rental property and had both used the rental property's hot tub. The diagnoses were confirmed by urine antigen tests, and NYSDOH successfully isolated Legionella pneumophila serogroup 1 from the sputum of one patient. Local health department staff members collected three samples from three sinks and two samples from two showers to assess the rental property's potable water system, which was supplied by a private well. Three samples were also collected from the rental property's hot tub. Whole genome sequencing of isolates from the hot tub samples and the sputum specimen were closely related, suggesting that the hot tub was the likely source of exposure. Hot tubs create aerosols and typically maintain water temperatures of approximately 100°F-104°F (38°C-40°C). This temperature is within the most favorable range for Legionella growth and also accelerates the decay of disinfectants. Guidance from NYSDOH and CDC regarding proper operation, disinfection, and remediation of hot tubs was provided to the rental property owner. NYSDOH recommended that the owner close the hot tub until proper remediation was performed and postremediation samples without detection of any Legionella bacteria were collected by NYSDOH staff members. The rental property owner did not initially comply with NYSDOH recommendations, and a public nuisance law was used to ensure that proper measures were taken to disinfect the hot tub before use by future guests. Activities to raise awareness among short-term rental and vacation rental property owners regarding the risks associated with an improperly managed hot tub are needed to decrease the likelihood that rental property hot tubs are in a condition that is conducive to Legionella growth and reduce the risk for Legionnaires disease associated with vacation rental stays. Travelers staying in vacation rental properties should be aware that use of hot tubs might pose a risk for Legionnaires disease and exercise caution when using hot tubs, particularly those travelers with underlying medical conditions.
