The 2026 Ebola outbreak caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda has prompted European countries and the United States to revise measures for travellers, healthcare workers and humanitarian personnel returning from affected areas. We compare current procedures and protocols with those implemented during the 2013–2016 Ebola outbreak. Despite some national differences, policies have largely converged towards risk-based management, early case detection, rapid isolation, exposure-based monitoring and healthcare preparedness, rather than routine border screening.

Introduction:West Nile virus (WNV) infection represents an emerging health concern in Southern Europe. Although most infections are asymptomatic, a small proportion progress to WNV neuroinvasive disease (WNND), occasionally complicated by cardiac involvement. Data describing critically ill patients with WNND and cardiac involvement requiring intensive care (ICU) are limited. Methods:We conducted a two-month observational case-series of consecutive adult patients with confirmed WNND admitted to the ICUs of two tertiary hospitals in Lazio region, Italy from July 1 to September 1, 2025. Clinical, laboratory, imaging, and outcome data were collected, with particular focus on neurological and cardiac manifestations. Results:Among 197 patients with confirmed WNV infection, 64 (32%) had WNND, of whom 12 (6.1%) required ICU admission. These 12 patients were subsequently enrolled in the study. The median age was 76.5 years (IQR 70-83), and 75% were male. The most common symptoms were fever, myalgia, and gastrointestinal complaints, followed by confusion, limb weakness, and psychomotor slowing. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (median 135 cells/mm3), elevated protein (median 126 mg/dL), and normal glucose. Brain MRI revealed T2/FLAIR hyperintensities in the thalami and brainstem in most cases, 2 patients had normal imaging. Four patients had cardiac involvement; two fulfilled criteria for suspected myocarditis and one was diagnosed with Takotsubo syndrome, based on new left ventricular dysfunction, elevated troponin, and diffuse hypokinesis not confined to a coronary territory. Five patients (41.7%) died within 30 days of admission. Non-survivors were older (median 83 years) and had more comorbidities. Survivors showed higher inflammatory markers. Conclusion:WNND remains a life-threatening condition requiring multi-disciplinary critical care. Cardiac involvement, including suspected myocarditis, was observed in a substantial proportion of critically ill WNND patients and occurred more frequently among non-survivors in this cohort. Although descriptive, these findings highlight the importance of early neuro-cardiac assessment and comprehensive supportive management to optimize outcomes in severe WNND.

The mitigation measures adopted to reduce the spread of COVID-19 have not only impacted the transmission of respiratory infections but also other infectious diseases. In this study, we explored the effect of the pandemic on the epidemiology of Central Nervous System (CNS) infections by conducting a retrospective analysis of diagnostic data obtained from cerebrospinal fluids (CSFs) collected before, during, and after the pandemic from patients with acute-suspected neuro-infectious syndrome. The samples were analyzed using a meningitis/encephalitis molecular syndromic panel. A total of 4203 CSFs were split into three groups: pre-pandemic (August 2018–February 2020), pandemic (March 2020–March 2022) and post-pandemic (April 2022–March 2024). Each pathogen was statistically assessed individually, comparing one group vs. another. Results showed that viral pathogens were the most frequently detected across all groups; however, Streptococcus pneumoniae was the single most identified pathogen. Comparison of the pre-pandemic and pandemic groups by statistical analysis showed a significant reduction in neuro-infections caused by enterovirus, S. pneumoniae and N. meningitidis, while the other pathogens were not affected. In conclusion, a reduction in CNS infections caused by respiratory and close-contact-transmitted pathogens, including both viral and bacterial agents, was observed during the period when COVID-19 containment measures were in effect.

In 2025, Rome hosted the Catholic Jubilee, recording over 33 million cumulative pilgrim attendances while simultaneously facing the death of Pope Francis, the election of Pope Leo XIV, and a regional West Nile Virus (WNV) outbreak. This commentary describes the Lazio Region’s preparedness strategy, based on adapting an existing Hub-and-Spoke infectious diseases network integrating surveillance with Regional Service for Epidemiology, Surveillance and Control of Infectious Diseases (SERESMI) laboratory support, telemedicine, and clinical management. Preparatory measures included an additional Hub, updated syndromic pathways, multidisciplinary coordination, and enhanced surveillance. Emergency department visits increased by 14.8%, while the proportion of infectious syndromes remained stable. This experience highlights the potential value of strengthening existing healthcare networks for mass gathering preparedness.

BACKGROUND:Zoonotic spillover events with pandemic potential are increasingly associated with environmental change, ecosystem disruption, and intensified human-animal interactions. Although the specific origin and timing of future pandemics remain uncertain, there is a clear need to complement traditional preparedness strategies with approaches that support earlier anticipation and prevention. OBJECTIVES:This study aims to propose a conceptual approach to reframe pandemic preparedness toward proactive surveillance and spillover prevention. METHODS:We introduce a tachyon-inspired conceptual approach, using a thought experiment based on hypothetical faster-than-light particles to illustrate anticipatory observation of pandemic emergence. The framework is informed by interdisciplinary literature on emerging infectious diseases, One Health surveillance, predictive epidemiology, and public-health preparedness. RESULTS:The proposed approach highlights the importance of proactive, integrated surveillance systems that combine human, animal, and environmental data. Key elements include the use of advanced analytical tools such as neural networks, early characterization of population risk profiles, strengthened public-health infrastructure, coordinated governance, adaptable financial resources, and a resilient healthcare workforce. The integration of animal welfare considerations, translational research, and planetary health principles is emphasized as central to reducing spillover risk. CONCLUSIONS:Tachyon-inspired thinking offers a conceptual tool to support a shift from reactive pandemic response toward proactive anticipation and prevention. Embedding integrated surveillance and One Health principles into public-health systems may enhance early detection capacity and contribute to mitigating the impact of future pandemics.

OBJECTIVES:Post-exposure prophylaxis (PEP) remains underutilised and real-world data on its role within prevention pathways are limited. We aimed to describe PEP use following sexual exposure and to identify predictors of linkage to prevention services within three months in a real-world clinical setting. METHODS:We conducted a retrospective observational study of PEP prescriptions following sexual exposure at the HIV Voluntary Counselling and Testing site of the National Institute for Infectious Diseases in Rome. Data included demographics, exposure, prior PEP/PrEP use, and follow-up through March 31, 2025. Mixed-effect logistic regression identified predictors of linkage to prevention services within three months. RESULTS:A total of 1366 PEP prescriptions were issued to 1188 individuals from January 2019 - December 2024. In 85.1% of the occasions, users were assigned male at birth and in 80.5% Italian-born. The most common exposures included receptive anal intercourse (35.3%), insertive anal intercourse (26.5%), insertive vaginal intercourse (11.2%), and sexual assault (8.5%). Prior PEP and PrEP were reported in 16.7% and 4.7% of the occasions, respectively. Follow-up was recommended in all; PrEP was advised in 46.1% occasions and initiated in 17.4%. Overall, users returned for follow-up in 46.5% of the cases. Multivariable analysis (n = 871) showed that active PrEP recommendation and age ≥35 years were positively associated with reattendance, while foreign birth and prior PEP were negatively associated. Nine persons (0.7%) were tested HIV positive; two at baseline and seven after PEP, suggesting missed opportunities for timely prevention. CONCLUSIONS:This large-scale analysis from an Italian setting highlights the role of PEP as an entry point into HIV prevention pathways, while confirming gaps in linkage to ongoing preventive care. The Italian context, characterised by a high proportion of late HIV diagnoses and ongoing PrEP implementation, underscores the importance of strengthening prevention strategies. Structured follow-up and facilitated linkage to PrEP, when appropriate, may help maximise its preventive impact.

BVD is a severe filoviral haemorrhagic fever caused by the Bundibugyo virus (BDBV), for which outbreak-related evidence remains limited compared with that available for Zaire ebolavirus. This perspective summarizes current evidence on transmission dynamics, presymptomatic infectiousness, post-recovery viral persistence and the duration of infectiousness, distinguishing BDBV-specific data from evidence extrapolated from other orthoebolaviruses. Available epidemiological data from the 2007-2008 outbreak in Uganda indicate that BDBV transmission occurs primarily through direct contact with the blood or body fluids of symptomatic or deceased individuals, with the handling of corpses representing a significant risk factor (adjusted odds ratio 3.83; 95% confidence interval 1.78-8.23). The average incubation period is 6.3 days, and prolonged chains of transmission were documented in household and healthcare settings. No documented human cases of pre-symptomatic transmission have been reported, however, the limited number of documented outbreaks precludes excluding this possibility, and experimental animal data support its biological plausibility. No BDBV-specific data are available regarding viral persistence and duration of infectiousness. Consequently, current recommendations rely largely on evidence derived from other orthoebolaviruses. Viral RNA may persist after recovery in immunoprivileged sites, particularly in semen, with rare but documented episodes of delayed transmission. The ongoing outbreak highlights the need for BDBV-specific studies to strengthen the evidence base underpinning public health recommendations.

Legionnaires’ disease (LD) is an atypical pneumonia sustained by Legionella bacteria. The epidemiological LD scenario in the urban area of Rome (Italy) is unique, moving from facing the COVID-19 pandemic, first capital city in Europe, to the preparation of the 2025 Catholic Jubilee, starting on from December 24, 2024. To provide key determinants for risk assessment in the setting of public health and clinical preparedness activities, we analysed data on LD cases collected from Regional Lazio Surveillance Systems during the 2017-2024 interval period. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Data were collected from two surveillance system databases available at SERESMI/Lazio Region Unit, according to national and regional regulations: 1) a notifiable ID disease system, named SIMI (Sistema Informativo delle Malattie Infettive, i.e. Infectious Disease Information System) from 1994 to 2019, replaced by PREMAL since January, 01st 2020. 2) a special surveillance system, managed at national level by Istituto Superiore di Sanità (National Institute of Health), collecting additional data on NID of special public health interest/concern (Vaccination preventable diseases, diseases under elimination plan, disease characterized by multisector prevention and control measures). Authors had no access to information that could identify individual participants during or after data collection. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes

The coronavirus disease 2019 (COVID-19) emergency has represented a profound upheaval in the dynamics of infectious diseases transmission worldwide. This phenomenon has been at least in part driven by the introduction of non-pharmaceutical interventions (NPIs), implemented to counteract viral transmission. Our study aimed to assess the magnitude and the features of the impact of the COVID-19 pandemic on the incidence of notifiable infectious diseases (NIDs) in the Lazio region, Italy. Data on NIDs in the Lazio Region with symptom onset date included in the time interval from 1 January 2017 to 31 December 2023 were collected from different surveillance system databases available at SERESMI/Lazio Region Unit and classified into five categories based on the main transmission route of the disease. Descriptive statistics were performed and interrupted time series (ITS) analysis was used to assess the effect of the COVID-19 pandemic and subsequent recovery period on monthly NIDs cases. Immediately after the start of the COVID-19 pandemic, a significant, sharp and immediate reduction in monthly cases was recorded for all NIDs (-86.73

PURPOSE:In 2023-2024, measles cases progressively increased in Europe. Multiple outbreaks were reported and viral strains with three-nucleotide mutations potentially compromising diagnostic testing were identified. We analyzed the first cases of measles reported in Lazio (Central Italy) from September 2023 to March 2024, combining molecular characterization and phylogenetic analysis with epidemiological investigation to identify transmission chains and evaluate the sensitivity of PCR tests adopted on circulating viral strains. METHODS:We tested samples collected through routine measles and rubella surveillance for IgM, IgG and Real-Time PCR. We sequenced positive samples with higher viral titers using an amplicon-based whole-genome next-generation sequencing (WG-NGS) approach and performed mutational and phylogenetic analysis. Furthermore, we tested the sensitivity of the PCR molecular diagnostic assay adopted in our laboratory to identify the mutated strains. RESULTS:Of the 39 suspected cases, 28 were confirmed. Endemic cases were 82%; of these, 78% were sporadic at epidemiological investigation. From 21 high-titer samples, we obtained 14 strains belonging to the D8 genotype. Phylogenetic analysis identified four distinct clusters: three associating 50% of sporadic cases, and one confirming the epidemiological investigation. Several mutational patterns were identified, one of which had three nucleotide mutations potentially affecting the diagnostic test. However, our routine diagnostic PCR tests are able to detect mutated strains at different dilutions. CONCLUSION:Our results demonstrate that WG-NGS can be used to distinguish transmission chains and identify infection clusters to improve surveillance activity and enable the implementation of more targeted control measures, highlighting the importance of integrated epidemiological and genomic surveillance.

Scabies represents a global health issue and in 2017 was added to the World Health Organization's list of neglected tropical diseases. In European and Middle Eastern countries, cases are sporadic while recent surveillance data have pointed out an increasing incidence among vulnerable populations. Regional cases for Lazio, Italy, reported from 2017 to 2023 to the national infectious disease surveillance system were analyzed. In Lazio, just after the coronavirus disease 2019 (COVID-19) pandemic onset, a significant and immediate reduction in the incidence of scabies was recorded (- 79.6%) followed by a progressive and relevant increase (143.4% from 2020 to 2021, 142.3% from 2021 to 2022 and 170.3% from 2022 to 2023). Consistently, the number of scabies outbreaks, after a decrease following the first COVID-19 wave, has progressively increased over time, mainly due to the occurrence of outbreaks in long term facilities (750% from 2020 to 2023). The increased incidence may also be driven by the "pseudo-resistance" phenomenon (under dosed/early-discontinued treatment, suboptimal adherence, reduced drug bioavailability), but also by reduced in-vitro susceptibility to the mainly used scabicides. The rapidly evolving epidemiology of scabies in our country, as documented also in other regions, calls for a comprehensive approach to effectively address the problem.

In July–18 August 2025, 171 autochthonous cases with West Nile virus (WNV) infection were confirmed in Lazio, Italy: four asymptomatic blood donors, 110 with WNV fever, 57 with neuroinvasive syndrome and nine deaths. WNV lineage 2 was detected in two neuroinvasive cases. Infection with WNV was confirmed in 28 horses, five crows and a Culex pipiens pool. We present the preliminary epidemiological and phylogenetic analysis of the outbreak and the public health measures taken within a One Health approach.

To address the growing frequency, extension, and size of local arboviral outbreaks in Europe we retrospectively analyzed dengue and chikungunya transmission in Italy from 2006 to 2023. We applied generalized additive models to the records of travel-related cases to highlight the spatiotemporal patterns of disease importation, calculated reproduction numbers for six local outbreaks based on autochthonous case data and mapped current transmission risks by applying a computational model that integrates human density, entomological, and climate data. Outbreak locations appear driven by case importation, which is notably higher for dengue - especially from June to October - rather than local transmission risks. Although reporting delays and favorable temperatures allowed onward transmission for several generations from mid-August to mid-November, upon outbreak detection control of transmission was achieved within 15 days. In high-risk areas, significantly longer epidemic risks were found for chikungunya (over 4 months). However, considering observed importation trends, increasingly frequent local dengue outbreaks are expected. Case detection should be prioritized focusing on areas, and in times, where environmental and climate conditions are permissive, regardless of prior outbreaks.

Dengue, a mosquito-borne disease caused by the dengue virus (DENV), is constantly expanding worldwide. We investigated the presence and persistence of DENV RNA in the bloodstream and other body fluids to describe the viral kinetics in the human host. We longitudinally collected serum (n = 118), plasma (n = 110), whole blood (n = 90), urine (n = 118), oral swabs (n = 68), saliva (n = 42), semen (n = 23), and vaginal fluids (n = 49) from 42 DENV patients. We measured DENV RNA for a median of 28 (range 1-63) days from symptom onset (DSO). We estimated the probability of viral detection applying a generalized linear model, and the duration of viremia using Monte Carlo-Markov Chain approach. In the bloodstream, the highest rate of positivity, levels of DENV RNA, and persistence were observed in whole blood. The estimated probability of a positive test dropped below 5% after 12.5, 20.7, and 35.4 DSO for plasma, serum, and whole blood, respectively. The average duration of viremia was estimated to be 19.9 DSO. Saliva and oral swabs showed 76.2% and 58.8% of DENV RNA positivity during the first week of symptoms while the longest persistence was observed in urine (39 DSO). DENV was revealed in 20% cervicovaginal (up to 11 DSO) and 30% seminal (up to 35 DSO) fluids. Whole blood represents the preferential specimen for dengue molecular detection and the correct estimation of viremia duration which have clear implications for onward transmission and public health countermeasures. Blood, urine, and oral samples can be assayed according to time from disease onset, severity, and screening purposes.

To determine whether patient-to-doctor transmission of measles occurred in an emergency department (ED) despite isolation precautions and full personal protective equipment (PPE) during the COVID-19 pandemic, an epidemiological and molecular investigation was carried out following the identification of two subsequent cases. The N fragment was used to identify the closest whole measles genome present in the GenBank nr database and, subsequently, this was used as a reference for the reconstruction of the entire MeV sequence in the two cases studied. Seven measles-susceptible healthcare workers were on duty the day of admission of the patient, wearing full PPE. The infected doctor neither visited the patient nor entered the isolation room. The patient wore a facial respirator. No breaches in infection control procedures, or other cases among contacts, patients and healthcare workers were identified. Molecular analysis provided evidence of patient-to-worker transmission: the two B3 genome sequences showed only one mutation and no sequences of other countries were identified as phylogenetically related. Isolation precautions and full PPE were widely implemented in the ED during the COVID-19 pandemic; however, this did not prevent nosocomial transmission of measles. Vaccination of healthcare workers and enhanced ventilation should complement other preventive measures to protect workers and patients.

This is a retrospective observational study including all COVID-19 patients admitted at our Institute throughout three successive pandemic waves, from January 2021 to June 2023. The main in-hospital outcomes (clinical progression [CP], defined as admission to Intensive Care Unit [ICU]/death, and death within 28 days) were compared among participants unvaccinated (NV), fully vaccinated (FV), with one (FV&B1) and two (FV&B2) booster doses. Vaccinated participants were stratified into recently and waned FV/FV&B1/FV&B2, depending on the time elapsed from last dose (≤ and >120 days, respectively). There were 4488 participants: 2224 NV, 674 FV, 1207 FV&B1, and 383 FV&B2. Within 28 days, there were 604 ICU admissions, 396 deaths, and 737 CP. After adjusting for the main confounders, the risk of both in-hospital outcomes was reduced in vaccinated individuals, especially in those who received the booster dose (approximately by 36% for FV and >50% for FV&B1 and FV&B2 compared to NV). Similarly, after restricting the analysis to vaccinated participants only, we observed a risk reduction of approximately 40% for FV&B1 and 50% for FV&B2, compared to FV, regardless of the distance since the last dose. Our data confirm the vaccine’s effectiveness in preventing severe COVID-19 and support the efforts to increase the uptake of booster doses, mainly among older and frailer individuals, still at a greater risk of clinical progression.

Dengue virus (DENV) has been expanding its range to temperate areas that are not usually affected, where the spread of vectors has been facilitated by global trade and climate change. In Europe, there have been many cases of DENV imported from other regions in the past few years, leading to local outbreaks of DENV among people without travel history. Here we describe the epidemiological and molecular investigations of three transmission events locally acquired DENV infections caused by serotypes 1, 2 and 3, respectively, in the Latium Region from August to November 2023. Next-generation or Sanger sequencing was used to obtain the whole genomes, or the complete E-gene of the viruses, respectively. The structure of the DENV-1 and DENV-3 sequences was analysed to identify amino acid changes that were not found in the closest related sequences. The major cluster was supported by DENV-1 (originated in South America), with 42 autochthonous infections almost occurring in the eastern area of Rome, probably due to a single introduction followed by local sustained transmission. Seven DENV-1 subclusters have been identified by mutational and phylogenetic analysis. Structural analysis indicated changes whose meaning can be explained by the adaptation of the virus to human hosts and vectors and their interactions with antibodies and cell receptors.