Marburg virus disease – Ethiopia
On 12 November 2025, authorities in Ethiopia reported suspected viral hemorrhagic fever in Jinka, South Ethiopia Regional State; by 14 November the cases were confirmed as Marburg virus disease (MVD). As of 20 November, six laboratory-confirmed cases (three deaths) and three additional probable deaths were identified. A total of 206 contacts are under active follow-up, and investigations show the presence of the natural bat reservoir in the area. Marburg virus, a filovirus related to Ebola, has a high case-fatality ratio and no licensed vaccines or specific treatments. This is the country’s first confirmed MVD outbreak; the risk is assessed as high at national level, moderate regionally, and low globally.
Seasonal Influenza A(H3N2) subclade K – Global
Increasing detection of A(H3N2) subclade K has prompted a threat assessment for the EU/EEA, where early-season influenza activity is rising. In the Western Pacific Region, Japan and the Republic of Korea are experiencing an earlier-than-usual onset of seasonal influenza. These observations suggest a shift toward earlier transmission in multiple regions and underscore the importance of vaccination and strengthened surveillance.
Diphtheria – African Region (AFRO)
From 1 January to 2 November 2025, the African Region reported 20,412 suspected diphtheria cases, including 1,252 deaths (CFR ~6%) across eight Member States: Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria and South Africa. Children and young adults bear the majority of cases, with females slightly more affected. Key operational challenges include limited laboratory confirmation (only 5.7% of suspected cases confirmed), global shortages of diphtheria antitoxin (DAT), and weak immunization coverage in fragile and humanitarian-affected settings.The regional public health risk is assessed as high, while the global risk remains low depending on vaccine coverage.
Antimicrobial resistance (AMR), Europe, ECDC annual surveillance report:
Invasive isolates are increasing, led by Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae. A persistent north-to-south and west-to-east gradient shows much higher resistance in southern and eastern Europe. High resistance to third-generation cephalosporins and carbapenems in K. pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. severely threatens treatment options. Gram-negative pathogens now dominate the AMR burden, while hypervirulent, carbapenem-resistant K. pneumoniae and multidrug-resistant Candidozyma auris are emerging threats.
Ethiopia has confirmed its first outbreak of Marburg virus disease, with six cases and three deaths identified by 20 November 2025 and over 200 contacts under follow-up; the national risk is assessed as high. Globally, seasonal influenza A(H3N2) continues to circulate more widely, with early-season activity in Europe and an unusually early onset in Japan and the Republic of Korea, indicating a shift toward earlier influenza transmission. In the WHO African Region, diphtheria remains a major concern, with over 20,000 suspected cases and a 6% case-fatality ratio, amplified by limited laboratory confirmation, antitoxin shortages, and low immunization coverage. Meanwhile in Europe, antimicrobial resistance continues to intensify, with invasive isolates rising—particularly E. coli, S. aureus, K. pneumoniae and S. pneumoniae—and persistently high resistance levels in southern and eastern countries; carbapenem-resistant gram-negative pathogens and emerging threats such as hypervirulent K. pneumoniae and multidrug-resistant Candidozyma auris further limit treatment options.
The ESCMID-AUMC Epi Alert, a strategic collaboration between the ESCMID Emerging Infections Subcommittee and the Center of Tropical Medicine and Travel Medicine of Amsterdam University Medical Center (AUMC) that integrates expertise and resources to advance emerging infectious diseases surveillance and intelligence sharing. This collaboration integrates ESCMID's extensive international network and emerging infections expertise with AUMC's proven surveillance capabilities, led by Dr. Abraham Goorhuis and the AUMC team.
The Epi Alert aims for weekly publication, with frequency adapted to emerging threats. The briefings are curated by infectious disease specialists prioritising data from trusted sources (WHO, ECDC, CDC, ProMED) based on potential impact, geographic region and urgency/relevancy to clinical practice. It aims to provide concise summaries for busy healthcare professionals with direct links for further investigation and transparency.
This integrated collaboration represents a significant milestone in ESCMID's commitment to emerging infections preparedness, strengthening our collective capacity to detect, analyse, and respond to infectious disease threats through international cooperation.
Disclaimer: The information in this epi-alert is a weekly summary of the information that is available on the internet, mainly the websites of WHO, ECDC, CDC, and others. For this summary, we consider issues that are most relevant to the ESCMID members involved in clinical patient care. Therefore, this report is not comprehensive, but we strive to include all major global issues in this report on a weekly basis.
The recent re-emergence of avian influenza (H5N1) in parts of Asia, including isolated human cases in Cambodia and India, highlights the need for continued vigilance. While sustained human-to-human transmission has not been observed, the current situation warrants close monitoring. Strengthening surveillance, improving poultry vaccination strategies, and promoting regional One Health collaborations can support risk assessment and management, including early containment efforts.
Since the previous update on 5 May 2025, and as of 12 May 2025, nine new MERS-CoV cases—including two deaths—have been reported by health authorities in Saudi Arabia, bringing the total number of cases this year to ten.
Seven of the recent cases were part of the same cluster in Riyadh, including one patient with no history of contact with camels and six healthcare workers who acquired nosocomial infections from that patient in early May.
The risk of sustained human-to-human transmission in Europe remains very low. However, the current MERS-CoV situation is concerning, as this rise in cases comes just two weeks ahead of the Mecca pilgrimage—a period typically associated with high international travel.
Since April 2012, and as of 12 May 2025, a total of 2,638 confirmed MERS cases—including 957 deaths—have been reported globally.
A Marburg virus disease (MVD) outbreak is evolving in Rwanda, East Africa. As of 7 October 2024, over 40 confirmed MVD cases have been reported, mainly in healthcare facilities in Kigali, with many healthcare workers affected. This outbreak represents a spread from known endemic areas to urban settings, including nosocomial transmission in Kigali hospitals. While outbreaks are typically limited to remote areas, this one spans across Rwanda, with potential for satellite cases and further spread. No vaccines or treatments are currently available.
This compilation includes the latest news, publications, and resources, covering recent developments such as vaccine distribution in Africa and WHO policy updates. It provides links to '2022-2024 Mpox Outbreak: Global Trends,' which features interactive dashboards and epidemiological data. This update offers a brief overview of the developments of the mpox situation for healthcare professionals, researchers, and policymakers.
As of August 2024, the world is facing a significant mpox outbreak, primarily affecting countries in Central and East Africa, particularly the Democratic Republic of the Congo (DRC) and neighbouring countries, with cases reported across several regions. The outbreak is characterised by the sustained human-to-human transmission of the clade I monkeypox virus (MPXV).
This ESCMID EIS mpox commentary provides up-to-date, evidence-based information on mpox (formerly known as monkeypox) for healthcare professionals, researchers, and public health officials.
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