Thought Leadership

Whooping Cough Is Surging in the U.S.: What You Need to Know

The United States is facing a sharp and deeply concerning resurgence of pertussis, better known as whooping cough, a vaccine-preventable illness that was once nearly eliminated thanks to robust public health efforts.

Published May 5, 2025

Image courtesy of 9nong via stock.adobe.com.

By Syra Madad, DHSc, MSc, MCP, CHEP, Public Health Editor-at-Large
Boghuma K. Titanji, MD PhD, Infectious Diseases Physician-Scientist and Assistant Professor of Medicine, Emory University School of Medicine

To date in 2025, the Centers for Disease Control and Prevention (CDC) has reported over 8,000 cases of whooping cough, a more than two-fold increase from the same time last year. At the current rate, the nation could see up to 70,000 cases by year’s end, more than doubling last year’s total. If this trajectory continues, the United States may experience the highest number of infections since the introduction of the pertussis vaccine in 1948.

What Is Whooping Cough?

Whooping cough is a highly contagious respiratory illness caused by Bordetella pertussis. It spreads through respiratory droplets when an infected person coughs, sneezes, or breathes near others. Symptoms begin like a common cold, runny nose, low-grade fever, and mild cough but progress to violent coughing fits that can last for weeks. The characteristic “whoop” occurs as the patient gasps for air between spasms. In severe cases, the force of repeated coughing can lead to rib fractures, which may then result in lung collapse, or pneumothorax, a potentially life-threatening complication.

For infants and young children, pertussis can be life-threatening. Complications include pneumonia, seizures, encephalopathy, and even death. Health officials have reported three recent pediatric deaths linked to whooping cough, two infants in Louisiana and a child under 5 in Washington state who died in late 2024. Infants under one year of age face the highest risk of severe illness and death, as their immune systems are not yet fully developed, and this group consistently accounts for the highest rates of reported pertussis cases.

Why Are Cases Rising?

Several converging factors are driving this resurgence:

Declining Vaccination Rates: In 2024, the CDC reported that less than 93% of kindergarteners were vaccinated against pertussis, falling from 95% in 2019.
Vaccine Hesitancy and Misinformation: The rise in anti-vaccine sentiment has had a measurable impact on immunization rates. This includes increasing vaccine exemptions and a decline in timely childhood vaccinations. Social media disinformation, politicization of vaccines, and public figures promoting skepticism have all contributed to declining coverage, fueling the resurgence of pertussis.
Waning Immunity: The acellular pertussis vaccine introduced in the 1990s was designed to reduce side effects like fever and injection site reactions. However, it is less durable than the older whole-cell vaccine, with immunity diminishing over time.
Genetic Mutation of the Pathogen: Emerging evidence indicates that Bordetella pertussis is evolving in ways that may affect vaccine effectiveness. Studies from CDC surveillance and genetic sequencing are ongoing to understand the implications of these changes.

Treatment and Prevention

There is no treatment that effectively halts the hallmark coughing fits once they begin. The clinical manifestations of the disease are mediated by bacterial toxins which damage the delicate hairlike structures (cilia) on the cells that line our airways. The main function of cilia on respiratory tract cells, is to help with clearing mucus. Once the damage is done, administering antibiotics for treatment does not reverse it, nor does it speed up the recovery and repair of these cells. Antibiotics such as azithromycin are instead used to reduce transmission by eradicating the bacteria from the nasopharynx–prevention through timely vaccination remains the most effective tool.

The Vaccine: Safe, Effective, and Critically Underused

Pertussis vaccines have been in use for decades, are well studied, and significantly reduce the severity of illness and prevent hospitalizations and deaths. CDC-recommended vaccination and booster timing includes:

Vaccine	Target Group	Doses	Booster Needed
DTaP	Infants and children	2, 4, 6 months	Boosters at 15-18 months and 4-6 years
Tdap	Preteens and teens	Age 11 or 12	Every 10 years
Tdap	Pregnant individuals	Each pregnancy (27–36 weeks)	Protects infant via maternal antibodies
Tdap	Adults	If not previously vaccinated	Every 10 years thereafter
Tdap	Adults in close contact with infants under 1 year	One dose	To reduce risk of transmission to vulnerable infants

While no vaccine is perfect, vaccinated individuals are far less likely to experience life-threatening complications.

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Containing Ebola in a Shifting World

A conversation with Uganda’s outbreak commander as the African nation deals with the ramifications of the 2025 Sudan Ebola outbreak.

Published April 10, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

This transmission electron microscopic (TEM) image revealed some of the ultrastructural morphology displayed by an Ebola virus virion. Image courtesy of Dr. Frederick Murphy via CDC.

In a world confronted with a growing tide of infectious disease threats, the 2025 Sudan virus outbreak in Uganda serves as a stark reminder that epidemic intelligence must evolve from being reactive to anticipatory.

Increased human encroachment into wildlife habitats, and shifting global health funding landscapes, means that diseases like Ebola, once considered rare and geographically isolated, are emerging with greater frequency and unpredictability.

To better understand the shifting dynamics of this outbreak and its implications for the future of global health security, I spoke with Henry Kyobe Bosa, PhD, Uganda’s National Incident Commander for Epidemics. A distinguished public health leader, Colonel in the Uganda People’s Defense Forces, and seasoned epidemiologist, Dr. Kyobe has led responses to some of the most complex health emergencies in the region, including Uganda’s COVID-19 response and the current Sudan Ebola outbreak.

In this timely and sobering conversation, Dr. Kyobe shares firsthand insights into the evolving trajectory of this year’s Ebola outbreak, the innovations and tools Uganda is using to contain it, and the global lessons we must heed. Dr. Kyobe’s remarks have been lightly edited for clarity and length.

As Uganda’s National Ebola Incident Commander, can you walk us through the current state of the Sudan virus outbreak from its initial detection to the most urgent challenges your response teams are facing today?

The 2025 Sudan virus outbreak in Uganda is a unique phenomenon. Unlike all previous outbreaks (n=7), this one was first identified in the capital, Kampala, a metropolitan city of over 6 million inhabitants, with complex transnational and national travel routes. This created initial challenges, as the index case, a 34-year-old male nurse working in a children’s ward at the national referral hospital, was diagnosed with Ebola only after death.

Prior to his passing, he had seeded two clusters: an extended family cluster (involving his mother, brother, son, and housemaid), and a hospital cluster (three healthcare workers from a private facility where he had sought care).

Since then, another cluster, again a family cluster has emerged. Apart from a temporal relationship that suggests either a point source or common source transmission, there is no epidemiological link between the two transmission chains.

These two chains, though involving relatively few cases, quickly spread to three of Uganda’s ten cities, spanning from the eastern district of Mbale to the western district of Ntoroko, with contacts identified in over 15 districts. This early spread posed a significant threat of rapid outbreak expansion.

This all occurred amid an ongoing mpox outbreak, Uganda is currently the second most burdened country for mpox globally and at a time when the U.S. was revising funding support to many health systems in the country, some of which play complementary roles in Ebola response.

As of now, it has been over 10 days since the last confirmed case tested negative for Sudan virus and was discharged. The overall response infrastructure remains in place and will continue until after 42 days (two incubation cycles) before transitioning to another phase of optimum control. We are keenly monitoring and looking forward to this milestone.

Given that this is Uganda’s sixth outbreak of Sudan virus since 2000, what have these recurrent episodes taught us about the nature of Ebola and its persistence in animal reservoirs? Are these outbreaks becoming more frequent or harder to contain and if so, why?

The 2000 Sudan virus outbreak remains the largest in Uganda and the third largest Ebola virus outbreak globally. Since then, successive outbreaks have occurred in different regions of Uganda. Notably, no two successive outbreaks have originated from the same location, not even this one.

As with previous outbreaks, the natural reservoir of Sudan virus, the possible presence of transient hosts, and the mechanisms of spillover remain elusive. What is clear so far is that the virus continues to resurface under unpredictable conditions.

Many people associate Ebola with terrifying headlines from past outbreaks. For someone reading this from New York or Los Angeles, why should they care about an Ebola outbreak happening thousands of miles away in Uganda?

Ebola is a highly infectious disease with high mortality among those infected. We saw this in the 1970s and more recently, 11 years ago in West Africa, where over 11,000 people died in three countries in just two years, with nearly 24,000 total cases. The outbreaks also devastated the economies of those countries.

Any suboptimal response to Ebola anywhere is a threat to global health security. It increases the likelihood of disruptions to international trade and travel.

The negative impacts of Ebola have not changed much since the virus was first identified 50 years ago. What has changed, however, with successive outbreaks, is the growing efficiency of outbreak response. While traditional tools like contact tracing, quarantine, and movement restrictions remain important, new advancements have helped us slow transmission and reduce outbreak size. For instance, in this current outbreak, the rVSV ring vaccination trial was launched just four days after the outbreak was declared.

While there are currently no Ebola cases outside of Uganda, what should healthcare systems in the United States be doing right now to prepare for potential importation of cases? What’s your message to frontline clinicians and emergency managers across the U.S.?

The risk of cross-border transmission beyond Uganda is currently remote. We have identified all known contacts, placed them in institutional quarantine, and added them to no-fly lists in accordance with International Health Regulations guidelines to protect other countries.

That said, individuals presenting with persistent febrile illness, with or without hemorrhagic manifestations and recent travel from Africa should be evaluated for possible viral hemorrhagic fevers, not just Sudan virus.

As someone who led Uganda’s response to both COVID-19 and now this Ebola outbreak, what do you believe are the core lessons we must carry forward to build resilient, community-trusted public health systems both in Africa and globally?

For a long time, we’ve relied on traditional public health tools. They’ve been effective, but also costly for populations and often associated with prolonged outbreaks. We must increasingly rely on newer and more effective tools.

Today, we can use cellphone data to collect temporal geospatial information to understand individuals’ movements and interactions and identify contacts.

In this outbreak, we deployed remdesivir in real-time because we had a balanced stock from the 2022 outbreak, effectively a stockpile. We probably would not have saved all 10 patients who arrived alive at treatment centers without this stock. Stockpiling essential commodities is critical.

Modernizing surveillance systems and ensuring they are appropriately linked to effective laboratory networks is critical. In the current outbreak, an existing mortality surveillance system detected the outbreak just in time, as it had already spread to three cities and several districts. This early detection was timely; had we missed this case, the outbreak could have grown exponentially.

There’s a lot of mistrust in public health around the world right now, especially after COVID. How are you working with communities in Uganda to build trust, fight misinformation, and encourage people to seek care early?

Misinformation takes many forms. The most valuable asset a public health worker can have is the trust of the community they serve.

The best way to maintain that trust is to be reliable.

We must be truthful, reliable, and consistent even when evidence changes in the face of new information. Our public health predecessors succeeded because they remained honest.

To fight misinformation, we must get ahead of the curve and provide correct information in real time. Only then can we progressively rebuild public trust.

What does success look like to you in this outbreak response, not just in stopping the virus, but in what we build afterward?

Success means being able to document best practices from this outbreak and learning from the mistakes of the past.

Want to be part of an impactful network of scientists across the globe? Join the Academy’s International Science Reserve.

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Understanding Hantavirus and How to Stay Safe

Hantavirus pulmonary syndrome, or HPS, has been in the news lately following the death of Betsy Arakawa, wife of actor Gene Hackman. But what is HPS?

Published March 12, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP and Waleed Javaid, MD, MBA, MS, FACP, FIDSA
Academy Contributors

Hantavirus pulmonary syndrome is spread through contact with rodents. Image courtesy of Art Johnson via stock.adobe.com.

The recent passing of Betsy Arakawa, wife of actor Gene Hackman, due to hantavirus pulmonary syndrome (HPS), has brought this rare but serious disease into public focus. Hantaviruses are a family of viruses primarily transmitted to humans through contact with infected rodent excreta, particularly urine, droppings, or saliva. In the United States, the deer mouse (Peromyscus maniculatus) is a common carrier.

HPS typically begins with nonspecific, flu-like symptoms such as fever, fatigue, and muscle aches. As the disease progresses, patients may experience coughing and shortness of breath due to fluid accumulation in the lungs. The mortality rate for HPS is approximately 35%. There is no specific treatment or vaccine for hantavirus infections; therefore, prevention, early recognition and supportive medical care are crucial.

More than 800 Cases Since 1993

Since the Centers for Disease Control and Prevention (CDC) began tracking hantavirus infections in 1993, a total of 864 cases have been reported in the United States through 2022. The majority of these cases have occurred in the western states, particularly in the Four Corners region, where Arizona, Colorado, New Mexico, and Utah converge. Notably, New Mexico has reported the highest number of cases, with 122, followed by Colorado with 119 cases. This distribution underscores the importance of heightened awareness and preventive measures in these areas to mitigate the risk of hantavirus exposure.

In New York State, hantavirus cases are exceedingly rare. Since surveillance began in 1993, there have been five identified cases. Notably, a case reported in 2017 involved a Long Island woman who contracted the New York orthohantavirus, leading to severe respiratory failure and cerebral complications. Ultimately, the patient required surgical intervention and was asymptomatic after one year of treatment.

Minimizing Risk

To minimize the risk of hantavirus exposure, individuals should:

Control rodents both inside and outside the home, as this is the best way to prevent hantavirus.
Remove and secure trash around the home and workplace to limit rodent access.
Seal holes and gaps in homes to prevent rodent entry.
Call a professional exterminator if the infestation is severe.
Store food in rodent-proof containers to reduce the likelihood of attracting rodents.
Dispose of dead rodents properly by using gloves, placing the animal in a double plastic bag, and discarding it in the trash—avoiding direct handling.
Use gloves, a mask, and disinfectants when cleaning areas contaminated by rodent droppings. Avoid actions that can aerosolize the virus, such as sweeping or vacuuming.
When cleaning rodent droppings, wet them down first with a 10% bleach solution and wear gloves to minimize exposure risk.
Avoid contact with rodents and rodent burrows when spending time outdoors in areas where hantavirus may be present.

While hantavirus infections remain rare, the tragic death of Betsy Arakawa underscores the importance of awareness and preventive measures, especially in areas where human-rodent interactions are more likely.

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About Waleed Javaid, MD, MBA, MS, FACP, FIDSA, FSHEA

Dr. Waleed Javaid is Professor of Medicine and Hospital Epidemiologist at the Icahn School of Medicine at Mount Sinai.

Then Along Came the Second Trump Administration

Academy President and CEO Nicholas B. Dirks highlights some of the ways higher education and science in the United States are under threat during the second Trump Administration.

Published March 12, 2025

Originally published by Times Higher Education

By Nicholas B. Dirks
President and CEO

A 1940 Group photo of E. O. Lawrence, A. H. Compton, V. Bush, J. B. Conant, K. Compton, and A. Loomis. Image courtesy of the U.S. Department of Energy/Lawrence Berkeley Laboratory via Wikimedia Commons.

There was little direct federal support for US scientific research until the National Defense Research Committee was convened in 1940. But on the back of the committee’s key role in developing radar, sonar and the nuclear bomb, its instigator, former MIT vice-president Vannevar Bush, wrote a report, The Endless Frontier, laying out a vision for the creation of a post-war National Science Foundation.

Established in 1950, the NSF provided unprecedented funding for fundamental research, conducted principally in America’s universities by faculty researchers whose projects were evaluated by scientific peers. The National Institutes of Health (NIH), which dates back to the late 19th century, also grew dramatically in the post-war years. And, together, the two agencies turned institutions that had previously struggled to support science into the gold standard for research universities globally.

Science may still be the “endless frontier”, but the federal funding that came as a result of Bush’s influential report may not be.

By 1964, government funding for research and development hit 1.9 per cent of US GDP, amid bipartisan support. But in recent decades it has fallen back to 0.7 per cent. The real growth in support over that period has come from the private sector, but, important though that is, it is too often confined to applied and proprietary research. Real progress, by contrast, is critically dependent on the open, global scientific ecosystem of fundamental research.

The 2023 State of Science in America report by the Science and Technology Action Committee (a non-partisan alliance of non-profit, academic, foundation and business leaders) strongly endorsed the importance of dramatically increasing federal support for science. The justifications voiced in surveys conducted across multiple sectors, including as many self-identified Republicans as Democrats, included a belief that science powers both the economy and national security and a concern that China was spending a much higher percentage of its GDP on research.

But then along came the second Trump administration.

While the effort to dismantle DEI in government offices, corporations and universities was announced in advance, the abrupt halt of NIH and NSF funding took universities by surprise. And even as some funding resumed, programmes presumed to have any connection to DEI “policies” or “preferences” (a far broader interpretation of DEI than had been expected) were peremptorily cancelled, along with other research programmes connected to concerns about climate change.

At the same time, a new – extremely low – cap on overhead rates was set at 15 per cent, abruptly withdrawing support for necessary scientific equipment, infrastructure and other real costs of research. Meanwhile, programme officers and other administrators have been fired, and elaborate protocols for granting and administering funding have been disrupted in ways no one seems yet able to grasp fully.

The consequences of all this are likely to be dire. Scientific research not only helps to drive the economy: it is the core reason why US technological innovation has exceeded that of any other nation. And while it may be commonly overlooked, federally funded research really is the bedrock of that dynamic.

For example, there is a popular myth that Steve Jobs and his team at Apple invented the iPhone. They did package an array of technologies in a single device with nifty design features, to be sure. But, as Mariana Mazzucato has shown in her 2011 book The Entrepreneurial State, those technologies – including the internet, GPS, touchscreen displays and voice-activated Siri – derived from federally supported research.

There are many reasons for the populist scepticism, distrust and downright dislike of science and research universities. Some of these reasons are doubtless our own fault. But it should not only be those directly affected who are upset by the prospect of dismantling the research apparatus of “elite” universities – where the bulk of non-profit scientific research in the US is conducted.

It will also do irreparable harm to the world’s entire scientific, technological and biomedical enterprise, not to mention US prosperity, security and health. University leaders may be correct to be cautious in voicing their alarm, but they would not be wrong to panic. Along with all the rest of us.

What You Need to Know About H5N1 Bird Flu and Everyday Precautions

Guidance on navigating the ongoing avian flu outbreak including how to prepare food, maintain bird feeders, and keep pets safe.

Published February 26, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

Image courtesy of azerbaijan-stockers via stock.adobe.com.

The highly pathogenic avian influenza (HPAI) H5N1 virus, commonly known as bird flu, is making headlines and leaving its mark on grocery shelves. Just last week, I visited two supermarkets, both completely sold out of eggs. Over at a corner bodega in NYC, a dozen eggs were going for a jaw-dropping $16.99. Before bird flu hit, that same dozen cost only a fraction of that. It’s clear that the ripple effects of this virus go beyond the headlines—right down to our daily menu.

Initially spreading among domestic waterfowl, the virus has now migrated to commercial poultry, mammals, cattle, and a host of other animals across the United States. As of February 26, 2025, there have been 70 confirmed, sporadic human cases in the United States. Exposures have been largely tied to dairy herds (58.6%) and poultry operations (34.3%), with smaller proportions linked to other animal exposures (2.9%) and unknown sources (4.3%). The Centers for Disease Control and Prevention (CDC) currently assesses the public health risk as low, with no documented human-to-human transmission, but vigilance remains essential.

Public health agencies are closely monitoring the situation, individual vigilance, such as following proper food safety protocols and being mindful of interactions with pets and wildlife, remains essential in preventing infection. While there is growing concern about the spread of H5N1 to humans, practicing a few hygiene protocols should help to mitigate risk.

1. Are Eggs, Chicken, and Beef Safe to Eat?

The good news: Poultry, eggs, and beef are safe to eat when properly handled and thoroughly cooked. According to the CDC, there have been no reported cases in the U.S. of people contracting H5N1 from food prepared using standard safety practices. However, in Southeast Asia, a small number of avian influenza A virus infections have been linked to the handling or consumption of raw or undercooked poultry and related products, such as blood.

Essential food safety tips include:

Poultry and Eggs: Cook all poultry products to an internal temperature of 165°F (74°C). This includes ensuring scrambled eggs are fully set and avoiding runny yolks in fried or poached eggs.
Egg Safety: Commercial eggs in the U.S. undergo washing and sanitization, significantly reducing risk. Still, always refrigerate eggs and avoid consuming raw dough or batter containing eggs.
Beef: Ground beef should reach 160°F (71°C), while whole cuts should be cooked to at least 145°F (63°C) with a three-minute rest period.
Prevent Cross-Contamination: Keep raw meat separate from ready-to-eat foods. Wash your hands, utensils, and cutting boards thoroughly with soap and water after handling raw meat.

These steps not only protect against H5N1 but also other foodborne pathogens like Salmonella and E. coli. Always wash your hands with soap and warm water for at least 20 seconds after handling raw or undercooked foods! Not sure how long that is? Try singing the “Happy Birthday” song twice while scrubbing to make sure you’re washing long enough.

2. Should I Take Down Bird Feeders?

Bird feeders are a favorite for many of us (myself included), but they can serve as gathering spots where diseases spread among wild birds. The U.S. Department of Agriculture (USDA) doesn’t universally recommend removing bird feeders unless you keep backyard poultry or live near poultry farms.

If you choose to keep your feeder up:

Wear rubber gloves when refilling your feeders or touching them for any reason.
Clean feeders with a bleach solution routinely (wearing appropriate PPE).
Remove spilled seed to prevent attracting large flocks.
Keep pets and children away from feeders and droppings.

If you spot a sick or dead bird:

Do not touch it with bare hands.
Report it to your state’s wildlife agency or the USDA’s wildlife services.
Wear appropriate PPE and wash hands thoroughly after handling feeders or cleaning up around them.

3. Why Avoid Raw (Unpasteurized) Milk?

The detection of H5N1 in nearly 1,000 U.S. dairy herds is concerning. Raw (unpasteurized) milk can harbor the virus, along with other dangerous pathogens like Listeria and Salmonella. Pasteurization, heating milk to a high temperature for a set period, kills these germs, making it the safest choice.

Why skip raw milk products:

Raw milk from infected cows is “teeming” with the virus, potentially posing a direct infection risk.
Vulnerable populations (children under 5, pregnant women, older adults, and immunocompromised individuals) are especially at risk.

Safety tip: Always check labels to ensure dairy products are pasteurized. Refrigerate perishables at 40°F (4°C) or colder and discard expired items.

4. How Can I Keep My Pets Safe?

Pets, particularly cats and dogs, can be exposed to H5N1 through contaminated environments or foods. Alarmingly, there have been recent recalls of raw pet food products due to H5N1 contamination.

To protect your pets:

Avoid raw pet diets: Cooked, commercially prepared pet foods are safest.
Wash hands after feeding pets or cleaning bowls and after handling any raw pet food.
Don’t let pets roam in areas with sick or dead birds or on farms with infected poultry or cattle.
Stay updated: Monitor pet food recall notices and consult your veterinarian for concerns.

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Seasonal Influenza: What You Need to Know

This year the U.S. is experiencing one of the most intense flu seasons in at least 15 years. Public health expert Syra Madad, DH Sc. offers advice on how to protect yourself.

Published February 11, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

Image courtesy of Puwasit Inyavileart via stock.adobe.com.

Influenza, or the flu, is a persistent and evolving viral threat that affects millions of Americans annually. This year, the U.S. is experiencing one of the most intense flu seasons in at least 15 years, with flu-related doctor’s visits exceeding the peaks of previous years. According to the Centers for Disease Control and Prevention (CDC), at least 24 million people have been infected so far this season, leading to 310,000 hospitalizations and 13,000 deaths, including 57 pediatric fatalities.

Several states have reported school closures due to high absenteeism among students and staff. While the flu remains most widespread in the South, Southwest, and Western states, significant activity has been reported across 43 states. In New York City, flu activity has reached its peak for this wave, meaning a substantial number of people in the community are experiencing influenza and flu-like symptoms. It will take several weeks for activity to decline locally. On a national level, seasonal flu activity remains elevated and continues to rise in some regions. However, it’s not too late to get vaccinated. With flu transmission still high, getting vaccinated can provide meaningful protection for both individuals and communities.

How the Flu Spreads and What to Expect

Influenza is highly contagious and spreads easily through close contact with an infected person. The virus is primarily transmitted through droplets released when a sick person coughs, sneezes, or talks. Infection occurs when these droplets, or contaminated saliva or mucus, enter the eyes, nose, or mouth. It can also spread by touching virus-contaminated surfaces and then touching the face. Given its rapid transmission, understanding flu symptoms, prevention strategies, and available treatments are key to minimizing its impact. Here’s what you need to know:

Key Information

Incubation Period	1–4 days after exposure before symptoms appear.
Contagious Period	1 day before symptoms to up to 7 days after onset; longer in children and immunocompromised individuals. Most contagious in the first 3 days
Signs & Symptoms	Fever, chills, cough, sore throat, body aches, fatigue, headache, congestion; vomiting/diarrhea more common in children.
Isolation Period	Stay home until symptoms improve and fever-free for 24 hours without medication.
Prevention	Annual flu vaccine, handwashing, avoiding sick individuals, mask-wearing in crowds, improving ventilation, and disinfecting surfaces.
Treatment	Rest, hydration, antivirals (e.g., oseltamivir) for high-risk or severe cases, most effective within 48 hours of symptoms.
Flu Vaccine Eligibility	Everyone aged six months and older
High-Risk Groups	Young children, older adults, pregnant individuals, and those with chronic conditions or weakened immunity.
Where to Get Vaccinated (NYC)	NYC Vaccine Finder, pharmacies, doctor’s offices, clinics, employer programs. Find a flu vaccine at vaccinefinder.nyc.gov
Where to Get Vaccinated (Outside NYC)	Pharmacies (CVS, Walgreens, Rite Aid), primary care offices, urgent care centers, health departments. Find a flu vaccine at vaccines.gov
Who Should Get Vaccinated	Everyone 6 months+, especially high-risk groups; high-dose options available for older adults.
When to Seek Medical Attention for Emergency Symptoms	Breathing issues, chest pain, dehydration, confusion, worsening symptoms, or fever >3 days or stays above 104°F. In children, rapid breathing, flaring nostrils, difficulty drinking fluids, dehydration, any fever in infants under 3 months, unusual fussiness or poor feeding

Why the Flu Vaccine Matters

Reference: https://www.nyc.gov/assets/doh/downloads/pdf/hcp/weekly-surveillance02012025.pdf. Annotation by Dr. Syra Madad.

Vaccination is the best defense against severe illness, hospitalization, and complications from influenza, particularly for those with chronic health conditions. In recent flu seasons, 9 out of 10 people hospitalized with flu had at least one underlying condition, highlighting the importance of annual vaccination for high-risk individuals.

While flu vaccine effectiveness varies each year, research shows that during seasons when vaccine strains closely match circulating viruses, vaccination reduces the risk of flu illness by 40–60% and related hospitalization by 60%. Even in years with a suboptimal match, vaccination helps reduce symptom severity, prevents associated complications like pneumonia, and lowers the risk of worsening chronic conditions.

Flu vaccines have also been shown to significantly reduce the severity of illness. A 2018 study found that from 2012 to 2015, flu vaccination among adults reduced the risk of being admitted to an intensive care unit (ICU) with flu by 82%. Similarly, a 2014 study showed that flu vaccination reduced children’s risk of flu-related pediatric intensive care unit (PICU) admission by 74% during the 2010–2012 flu seasons.

Flu vaccines protect against three different influenza viruses (two influenza A strains and one influenza B strain), and since multiple influenza viruses often circulate in a single season, vaccination remains essential. Ongoing studies continue to show that even when vaccinated individuals contract the flu, their illness tends to be less severe.

The Bottom Line: Protect Yourself and Others

Influenza poses a serious risk, especially to vulnerable populations. With over 13,000 flu-related deaths recorded this season and numbers expected to rise, taking preventive measures is critical. If you haven’t gotten your flu shot yet, it’s not too late, flu activity remains high, and vaccination can still provide protection.

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2024: A Year of Progress and Persistence

A woman in a blue dress poses for the camera.

Public health expert Dr. Syra Madad reflects on resilience, innovation, and collaboration she saw in 2024, though gaps remain in equity, healthcare worker safety, and public trust in science.

Published January 7, 2025

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

Image courtesy of cherdchai via stock.adobe.com.

As we step into 2025, I reflect on the remarkable progress and challenges of 2024 in the field of special pathogens and public health. From the rapid containment of the Marburg virus in Rwanda to groundbreaking strides in global health in disease elimination, the year was a testament to resilience, innovation, and collaboration. These achievements emerged against a backdrop of formidable challenges, including zoonotic threats like H5N1, the ongoing Mpox Clade 1 outbreak, and the persistent decline in vaccination rates in the United States. Yet, the collective response—driven by scientific advances, decisive leadership, and community engagement—offers a roadmap for tackling future health crises with resolve and ingenuity.

While these milestones provide reasons for optimism, they also underscore the gaps that remain in equity, healthcare worker safety, and public trust in science. The lessons of 2024 reaffirm the critical need for vigilance, preparation, and global solidarity. Here are five key achievements that exemplify the progress we’ve made and the challenges we must continue to address.

1. Marburg Outbreak Response: A Triumph of Speed and Coordination

The 2024 Marburg virus outbreak in Rwanda stands as a benchmark for swift and effective epidemic response. Historically linked with fatality rates as high as 88%, this outbreak achieved an unprecedented case fatality rate of 22.7% thanks to Rwanda’s rapid and coordinated efforts. Within nine days of the outbreak’s declaration, the country launched a vaccine trial, administering over 1,600 doses of the investigational Sabin chAD3 MARV vaccine to healthcare workers—who accounted for nearly 80% of confirmed cases—and other at-risk groups.

The early deployment of experimental therapeutics, such as Remdesivir and monoclonal antibodies, combined with advanced supportive care, saved lives and reduced the outbreak’s severity. Rwanda’s decisive actions underscore the importance of rapid intervention, effective surveillance, and the availability of experimental countermeasures, offering a critical template for managing future high-consequence infectious diseases.

Despite its success, the outbreak highlighted critical challenges, particularly the vulnerability of healthcare workers. In the realm of special pathogens and high-consequence infectious diseases—a field in which I work closely—healthcare worker infections are considered a “never event”—an occurrence that should never happen. As a professional dedicated to preparedness and response in this critical area, I understand firsthand that allowing frontline responders to contract infections while caring for patients signals systemic failures in multiple areas, including infection prevention protocols, administrative controls to ensure safe working environments, and clear, consistent healthcare worker guidance to mitigate exposure risks.

In Rwanda, nosocomial transmission during the Marburg outbreak, compounded by delays in diagnosis, led to unacceptably high infection rates among healthcare workers. This underscores the urgent need for robust infection prevention and control (IPC) measures, surveillance and screening systems, comprehensive training programs, and accessible mental health support to protect frontline healthcare workers. In a co-authored article, “Protecting Healthcare Workers: A Vital Imperative in Rwanda’s Marburg Virus Outbreak and Beyond,” we outlined actionable strategies to strengthen protections for frontline responders during outbreaks. Safeguarding healthcare workers is not just a moral imperative but a foundational requirement for effective epidemic response and resilience in future crises.

2. Significant Milestones in Global Health

The year 2024 witnessed remarkable successes in global health, underscoring the power of collaboration. Among the most notable achievements were strides in disease elimination, with countries like Egypt and Cabo Verde being declared malaria-free after decades of effort. Seven nations, including Brazil, Pakistan, and Chad, eliminated neglected tropical diseases, while Guinea achieved maternal and neonatal tetanus elimination. In the Americas, measles-free status was reverified, and several countries made strides in halting mother-to-child transmission of HIV and syphilis. These accomplishments are a testament to sustained partnerships, robust public health systems, and the collective dedication to improving quality of life worldwide.

Progress was also made in tackling noncommunicable diseases (NCDs) and mental health, with a renewed emphasis on prevention and control. WHO’s 2024 reports highlighted significant declines in tobacco use and a 38% global reduction in drowning deaths since 2000. However, the growing burden of conditions like obesity, diabetes, and neurological diseases underscored the need for innovative strategies and equity in healthcare access. On the global stage, leaders addressed critical health priorities, including antimicrobial resistance and the intersection of climate change and health, while advancing negotiations on pandemic preparedness agreements. These milestones highlight a year of transformative progress in global health!

3. Addressing the Growing Threat of H5N1

The H5N1 avian flu outbreak in the United States has been a sobering reminder of the pandemic potential lurking within zoonotic diseases. While the Centers for Disease Control and Prevention (CDC) maintains that the current risk to humans remains low, the year 2024 saw 66 confirmed human infections—most linked to infected cows or poultry, with two cases of unknown exposure sources.

Each infection represents a gamble, offering the virus an opportunity to mutate in ways that could enhance its ability to spread efficiently between humans, potentially triggering a larger epidemic. The outbreak also recorded its first fatal human case in Louisiana, where the patient, exposed to a sick backyard flock, developed a severe infection with concerning mutations. These mutations could enhance the virus’s ability to bind to human upper airway receptors, a development that underscores the need for vigilance.

Thankfully, efforts to mitigate a larger epidemic are well underway. States like California have declared emergencies to expedite their responses, and the U.S. Department of Agriculture (USDA) has launched the National Milk Testing Strategy (NMTS), which builds on measures taken since H5N1 was detected in dairy cattle in March 2024. Additionally, the Department of Health and Human Services (HHS) has allocated $306 million to bolster monitoring and preparedness efforts against H5N1.

Earlier this year, I co-authored an article outlining the critical role hospitals play in preparing for H5N1 and led one of the nation’s first full-scale healthcare system exercises on H5N1 preparedness. As an infectious disease epidemiologist and a leader in healthcare biopreparedness, I understand the urgency of these proactive measures to prevent and prepare for potentially calamitous outcomes, and it is encouraging to see such decisive steps being taken.

4. A Landmark Step in Environmental Health: Regulating PFAS in Drinking Water

The Biden-Harris Administration’s first-ever national drinking water standard for PFAS, or “forever chemicals,” marks a transformative moment in public health and environmental stewardship. Announced in April 2024, the Environmental Protection Agency’s (EPA) legally enforceable rule sets strict limits on toxic PFAS in drinking water, including PFOA and PFOS, at 4 parts per trillion—the lowest level reliably measurable.

This regulation, part of the EPA’s PFAS Strategic Roadmap, is expected to reduce exposure for 100 million people, prevent thousands of deaths, and significantly lower rates of serious illnesses, such as certain cancers as well as liver and heart conditions. Complementing this rule, the Biden Administration allocated $1 billion through the Bipartisan Infrastructure Law to help communities implement PFAS testing and treatment, part of a historic $9 billion investment to combat PFAS pollution.

The regulation addresses a critical public health challenge, as PFAS contamination has long plagued communities across the United States. These chemicals, commonly found in everyday products like nonstick cookware, firefighting foam, and waterproof clothing, persist in the environment and accumulate over time, leading to adverse health risks. My previous collaboration with a chemist colleague highlighted PFAS exposure pathways, including general exposure (via drinking water, food, and household products), occupational exposure, and prenatal exposure, where contaminated umbilical cord blood crosses the placenta.

The EPA’s decisive action not only sets a new standard for water safety but also exemplifies the importance of a whole-of-government approach to environmental justice. While water utilities face challenges in implementing these measures, this landmark regulation underscores the value of prioritizing health, equity, and the environment to protect current and future generations from the harms of PFAS.

5. Combating Vaccine Mis and Disinformation: The “Let’s Get Real” Campaign

The launch of the HHS’s Let’s Get Real campaign marked a critical step in countering vaccine misinformation and disinformation, a growing threat as vaccination rates in the U.S. continue to decline. In the 2023–2024 school year, national vaccination coverage for key vaccines, such as measles, mumps, and rubella (MMR), fell below 93%, a concerning drop from the pre-pandemic rate of 95%. Additionally, 3.3% of U.S. kindergartners had exemptions from at least one vaccine, the highest rate ever recorded, with 14 states exceeding a 5% exemption rate. These alarming trends jeopardize herd immunity and heighten the risk of outbreaks of vaccine-preventable diseases.

HHS’s Let’s Get Real campaign arrives at a time when public rhetoric around vaccines remains polarized, shaped by misinformation and shifting attitudes toward routine immunizations. This shift also stems from hesitancy about COVID-19 vaccination or objections to vaccine mandates, fueling potential declines in coverage and rising exemptions. A 2024 survey revealed that 8.3% of U.S. parents disagreed with the necessity of school vaccination requirements, while 15.2% expressed no opinion, reflecting a troubling erosion of confidence in vaccines.

Campaigns like Let’s Get Real are critical to reversing these trends and rebuilding public trust in immunization. This mission aligns with my platform, Critical Health Voices, which seeks to amplify perspectives from frontline healthcare and public health experts to combat mis and disinformation and foster informed decision-making. Addressing falling vaccination rates demands a multi-faceted approach, including robust public health campaigns, strict enforcement of school vaccination requirements, and enhanced access to immunization services to ensure preventable diseases do not resurge.

The Road Ahead

While these accomplishments give us cause for celebration, they also highlight the persistent inequities and vulnerabilities that demand our attention. The lessons of 2024 reinforce the importance of preparation, innovation, and collaboration. They also remind us of the power of hope—hope that arises when science, policy, and humanity converge to protect and promote health.

As we look to 2025, I remain optimistic about the path forward. The successes of this year remind us that progress, while often hard-won, is achievable when we work together with purpose and determination.

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Isolationism Will Make Science Less Effective

Increasing global scientific cooperation is fundamental to the mission of the International Science Reserve. Effective collaboration will positively impact how we solve global challenges.

Published December 23, 2024

By Mila Rosenthal, PhD
Executive Director, International Science Reserve

The COVID-19 pandemic was a global human disaster. But the damage done could have been even worse had the spread of the virus not been countered by vaccines, diagnostics, and therapeutics, all developed by the medical and bioscience community at breakneck speed. In that success story, the people involved in the response tend to highlight one vital but often publicly overlooked ingredient: global scientific cooperation.

Could we achieve that level of international collaboration again? There are plenty of reasons to worry that we couldn’t.

First, over the past few years, we have witnessed intensifying economic and political competition between the United States and an increasingly assertive China. This rivalry is being played not just in tariffs, but in increased security restrictions on commercial technology exchanges and scientific collaboration.

An article by Keisuke Okamura last year in Quantitative Science Studies, the official journal of the international association of researchers who study the metrics of science, analyzed the impact of these tensions on scientific collaboration. Using data from published papers, Okamura found that the United States and China, after rapidly moving closer together for decades, had been moving apart since 2019.

Adding to this seismic shift in global relationships will be the potential impact of the new administration and its “America First” protectionist approach to supply chains, international climate standards, and public health cooperation. This potentially threatens our collective ability to respond to new and unexpected crises, as well as those we know too well. A recent Rand Corporation assessment of Global Catastrophic Risk found higher risk levels for hazards from sudden and severe changes to Earth’s climate, nuclear war, artificial intelligence, and pandemics from natural occurrence or synthetic biology.

International Scientific Collaboration Trending Up

Whether it is climate change, the need to build ethical standards for AI, geoengineering, or gene editing— all are science-based challenges that can only be addressed by global level collaboration. Encouragingly, the Okamura paper shows that the overwhelming trend towards international scientific cooperation over the past 50 years has been positive, with scientists from many institutions and countries in multiple scientific disciplines routinely working together.

It is crucial to the future of science that we develop new ways of being proactive, operating cohesively to promote solutions, safety, and stability across borders even as official relationships between states become more difficult. At the International Science Reserve (ISR) at The New York Academy of Sciences (the Academy), we have been promoting pathways for scientific cooperation, building a community that I believe can help function as a communal safeguard in the face of the threat posed by the scientific isolationist model.

Tens of thousands of scientists from more than 100 countries have signed up to the ISR network to be ready to work together in response to future cross-border crises. We help train and prepare scientists and experts on how to handle disasters, crises, and instability—and how to identify and get access to additional resources when needed.

Doomsday Scenarios

Since it is our job to think about doomsday scenarios, let’s talk through one.

Another pandemic hits. Politics— whether institutional or governmental have blocked researchers and medical professionals from different countries from talking, collaborating, and sharing data. Such lack of collaboration results in it becoming harder for us to understand why some regions of the world are being hit harder than others, because we lack the data to understand why. Meanwhile, scientists in other regions have the answer, but they are not sharing it. Lives are lost, economies wrecked, and we are all less safe. This is obviously a scary scenario.

The ISR was developed with the express goal of circumventing the barriers to collaboration. We help researchers talk to each other to build trust and share ideas through our digital hub. We develop games and scenarios to help them better prepare for decision-making in their own contexts when crises hit.

Customized Digital Games

This year, for example, we partnered with the Center for Advanced Preparedness and Threat Response Simulation (CAPTRS) to build customized digital games to test how policymakers make decisions based on evolving scientific information during a crisis. We run scenarios on different kinds of crises—from extreme heat, mega wildfires, and floods to crop failures and new pathogen outbreaks—and we have explored and increased access to the data modelling and analysis tools that researchers need to respond to those. We also celebrate the work of ISR network members and uplift the stories of those who understand firsthand science’s role in global crisis response and help the public to better understand why this matters.

In our hypothetical scenario, the ISR is one of the spaces where scientists are communicating, generating support for each other, and sharing insights. They then can take that research and information back to their local contexts to strengthen their response. Of course, this scenario is hypothetical and high-level and perhaps idealistic. But at this moment, we need a clear vision to work together across borders to reduce harm and save lives.

We can’t predict what will happen next. Science can’t tell us what the day-to-day decisions of world leaders will be. But what we do know is global problems can only be effectively solved through sustained scientific collaboration. To achieve that we need to turn outward, not just inward.

Do you want to be part of this impactful network of scientists? Join the ISR today

Unraveling the Mystery in the DRC’s Disease Outbreak

A recent outbreak of an undiagnosed illness in the Democratic Republic of the Congo is on the radar of public health professionals. Preparedness is key to mitigating the issue.

Published December 10, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP
Public Health Editor-at-Large

Testing for malnourishment in Democratic Republic of the Congo. Image courtesy of DFID – UK Department for International Development, CC BY-SA 2.0, via Wikimedia Commons.

A recent outbreak of an undiagnosed illness in the Panzi health zone of the Democratic Republic of the Congo (DRC) has captured global attention, spotlighting the challenges of outbreak investigations in resource-limited settings. Since late October, over 400 cases have been reported, predominantly among children under five years old. Symptoms such as fever, cough, and body aches have resulted in 31 deaths, with severe malnutrition compounding the crisis.

This outbreak highlights the critical need for strong global public health systems to detect and respond to emerging health threats. Although the cause remains uncertain, investigators are exploring various possibilities, including endemic diseases like malaria and respiratory infections such as acute pneumonia, influenza, COVID-19, and measles. Malnutrition is thought to play a significant role in worsening disease severity. Laboratory testing is ongoing, and health officials are evaluating whether multiple diseases may be contributing to the cases and fatalities reported.

Is This “Disease X”?

The term “Disease X” refers to a hypothetical, unknown pathogen with the potential to cause a global epidemic or pandemic. Coined by the World Health Organization (WHO) in 2018, Disease X represents the growing need to prepare for unforeseen infectious threats. In the 21st century, humanity has faced several emerging and re-emerging viral diseases, including SARS-CoV-1, MERS, and Zika, as well as the most recent Disease X, SARS-CoV-2, the virus responsible for COVID-19. These outbreaks underscore the importance of readiness, as novel pathogens like mpox have also spread beyond their endemic regions, creating widespread public health challenges.

While mysterious outbreaks like the one in the DRC often raise alarms, they are more frequently caused by endemic diseases in under-resourced areas than by new pathogens. Known diseases such as measles or influenza, exacerbated by malnutrition or poor vaccination coverage, are often the culprits. My husband often reminds me of the medical adage, “When you hear hoofbeats, think horses, not zebras,” which emphasizes prioritizing the most likely diagnosis. Yet, as someone who works in high-consequence infectious diseases, my mind often first goes to those zebras.

How Outbreak Investigations Work

Outbreak investigations follow a systematic approach to identify and control the source of illness:

1. Epidemiological Analysis: Investigators collect and analyze data to identify trends, clusters, and possible modes of transmission.

2. Clinical and Laboratory Testing: Samples from patients are tested to rule out suspected pathogens such as malaria, pneumonia, or influenza. In this case, samples have been sent to laboratories in Kinshasa for further testing.

3. Community Engagement: Teams work with local communities to identify additional cases, strengthen infection prevention, and provide treatment for the sick.

In the DRC, the investigation faces significant challenges, including remote locations, poor infrastructure, and a healthcare system strained by supply shortages. Despite these obstacles, international and national health teams are collaborating to identify the cause and strengthen the local response according to the latest WHO situation report.

Preparing for Future Threats

The DRC outbreak underscores the importance of global preparedness for both known and unknown diseases. Research shows that the risk of a pandemic with similar impact to COVID-19 is about 1 in 50 in any given year, with a lifetime probability of around 38%. This risk is amplified by environmental changes, which increase the likelihood of pathogens jumping from animals to humans.

To prepare for the next Disease X, scientists are studying the roughly 25 viral families most likely to harbor a novel pandemic threat. Efforts like CEPI’s 100 Days Mission aim to develop vaccines within three months of identifying a new pathogen, offering a proactive defense against future pandemics.

Lessons for the Present and Future

While it is unknown that the current outbreak in the DRC represents a new Disease X, it serves as a reminder of the need to strengthen health systems worldwide. Early investments in surveillance, laboratory capacity, and community engagement are critical to identifying and controlling outbreaks before they spread.

The ongoing investigation in the DRC is a testament to the dedication of public health professionals working in some of the world’s most challenging conditions. It also highlights the importance of global solidarity in addressing outbreaks, whether they stem from endemic diseases or novel pathogens.

Preparedness is our best defense against the unknown. By investing in science, supporting resource-limited health systems, and fostering international collaboration, we can mitigate the impact of today’s outbreaks and prevent the pandemics of tomorrow.

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A Vital Imperative in Rwanda’s Marburg Virus Outbreak

Healthcare workers in Rwanda are disproportionately affected by the ongoing outbreak of Marburg virus disease, which is highly virulent despite its relatively low case fatality rate. How can these medical professionals best protect themselves?

Published October 30, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP and Nahid Bhadelia, MD, MALD
Academy Public Health Contributors

A shot of downtown Kigali, the capital city of Rwanda.
Image courtesy of F.C.G. – stock.adobe.com.

As Rwanda faces its first outbreak of Marburg virus disease (MVD), it stands at a pivotal moment. The country has confirmed 65 cases of Marburg as of October 28, 2024, with 47 recoveries and 15 deaths, a relatively low case fatality rate (CFR) of 23%. This is a testament to the strength of Rwanda’s healthcare system, which has earned a reputation as one of the most resilient and high-quality systems in Africa. Although this may be Rwanda’s first MVD outbreak, the country is not a stranger to the threat posed by viral hemorrhagic fevers (VHFs). It has had to maintain vigilance during recent Ebola Virus Disease outbreaks in neighboring Democratic Republic of Congo.

Yet, despite these strengths, the current outbreak has highlighted an urgent vulnerability: the safety of healthcare workers. Over 80% of confirmed cases are among healthcare workers, a statistic that underscores the pressing need to enhance protections for those on the front lines of this and future outbreaks.

Rwanda’s Health System: A Success Story Under Strain

Rwanda’s healthcare system has made impressive strides since the country’s recovery from the 1994 genocide. Over the past three decades, Rwanda has transformed its health infrastructure to become a leader in healthcare delivery among low-income countries in sub-Saharan Africa. One of the cornerstones of Rwanda’s success is its Mutuelles de Santé, a community-based health insurance scheme that covers over 90% of the population, making healthcare more accessible and affordable for the vast majority of citizens. Through sustained investments in rural healthcare posts and the decentralization of services, Rwanda has significantly improved healthcare accessibility, particularly for those in remote areas.

These advances have contributed to Rwanda’s remarkable achievements in public health. It is one of the few low-income countries to have met the United Nations Millennium Development Goals related to maternal and child health. Rwanda has also seen significant reductions in the burden of diseases such as malaria, tuberculosis, and HIV/AIDS. During the COVID-19 pandemic, the country’s proactive response and efficient vaccine rollout enabled it to vaccinate over 82% of its population, setting a benchmark in the region and surpassing many of its peers in sub-Saharan Africa.

However, the Marburg outbreak has brought a new set of challenges. The virus, which is transmitted through direct contact with the bodily fluids of infected individuals and can also spread through contaminated surfaces and materials, is highly virulent and shares many similarities with Ebola. Despite Rwanda’s impressive healthcare achievements, the high rate of nosocomial transmission, where infections spread within healthcare facilities, reveals gaps that must be addressed to protect healthcare workers.

Nosocomial Transmission: A Threat to Frontline Workers

The current Marburg outbreak in Rwanda highlights the risks healthcare workers face in outbreaks of VHFs like MVD, particularly when it is not at forefront of clinical suspicion. Nosocomial transmission, or the spread of the virus within healthcare settings, is not uncommon during VHF outbreaks, but it is particularly dangerous for healthcare workers. In Rwanda, the virus has spread primarily in two hospitals, resulting in a disproportionately high number of infections among healthcare professionals.

This is not unique to Rwanda. Across the continent, healthcare workers have been at the epicenter of VHF outbreaks, often working under extreme pressure, sometimes with limited resources. However, Rwanda’s healthcare system, bolstered by strong government commitment and partnerships with international organizations, is better equipped than most to respond to such a crisis. Access to personal protective equipment (PPE) doesn’t seem to be a limiting factor in this outbreak and is further supported by partners like the World Health Organization during this current outbreak.

Yet, despite these resources, healthcare workers remain at risk. This points to the fact that while access to PPE is essential, it is not the only solution. Comprehensive infection prevention and control (IPC) measures, proper training, surveillance and monitoring, and a culture of vigilance within healthcare settings are equally crucial to stopping the spread of the virus among those on the front lines.

Recommendations to Protect Healthcare Workers

Rwanda’s situation is neither unique nor a one-off. The threat posed by viral hemorrhagic fevers like Marburg can emerge anywhere. Any country, regardless of its healthcare infrastructure, can face such outbreaks. The risk of nosocomial transmission, the dangers to healthcare workers, and the broader community impact are universal concerns. The recommendations to strengthen healthcare worker protection in Rwanda extend beyond its borders; they are vital for any nation vulnerable to similar infectious disease threats, which in this globally connected community means all of us. The lessons from Rwanda’s experience provide a framework that can be adapted globally to better protect healthcare workers and communities in the face of future outbreaks.

Here are several recommendations to strengthen the protection of healthcare workers, which apply not only to Rwanda but to any country:

Expand Infection Prevention and Control Training

Continuous and widespread training on infection control is critical to ensuring healthcare workers everywhere are equipped to handle outbreaks of high consequence infectious diseases like MVD. Regular refresher courses, as well as simulations of outbreak scenarios, should be a priority to ensure that healthcare workers remain prepared.

Strengthen Surveillance and Early Detection Systems

Robust surveillance systems that allow for rapid identification, isolation, and treatment of cases can mitigate nosocomial transmission, a threat that any healthcare setting faces.

Invest in Healthcare Worker Safety Programs

Providing comprehensive support, including mental health services, hazard pay, and strong safety protocols—ensures that healthcare workers across the globe feel secure and protected. Furthermore, healthcare facilities must establish clear reporting structures for IPC breaches, allowing for immediate action to protect both healthcare workers and patients.

Foster Global Partnerships for Vaccine Research and Therapeutics

Rwanda is one of the first countries to begin administering vaccines for Marburg, with over 1,149 doses already distributed. However, global support is needed to expand vaccine research and ensure that healthcare workers, those most at risk, are prioritized in vaccination campaigns. Supporting vaccine and therapeutic research, while prioritizing healthcare workers for vaccination, is a global imperative that transcends national boundaries. Rwanda has set a commendable record in deployment of the chAD3 MARV vaccine as part of an open label Phase II trial during the current MVD outbreak, administering 1,609 doses as of October 28th.

A Global Responsibility

Despite the challenges posed by the Marburg outbreak, Rwanda’s response has been commendable. The government’s swift action, transparent communication, and coordinated efforts with international partners have likely prevented a far worse scenario. The relatively low CFR of 23%, compared to historical outbreaks where CFRs have reached as high as 90%, is a testament to the effectiveness of supportive care and early intervention. Rwanda’s healthcare system, known for its resilience, has once again demonstrated its capacity to respond to complex health emergencies.

However, the Marburg outbreak in Rwanda is a stark reminder that viral hemorrhagic fevers are not distant or isolated threats, they are recurring global health crises that require sustained attention and investment. The global health community must rally behind Rwanda, not only to control the current outbreak but to build a future where healthcare workers are fully protected from such dangers.

Healthcare workers are the backbone of any outbreak response, and their safety should be a top priority. The lessons learned from this outbreak in Rwanda should serve as a blueprint for future responses worldwide. Protecting those who protect us is not just a moral imperative, it is essential to ensuring that health systems can withstand the shocks of the next inevitable outbreak.

About the Co-Author

Nahid Bhadelia, MD, MALD, is founding Director at the Boston University Center on Emerging Infectious Diseases, and an associate professor in the Boston University Chobanian and Avedisian School of Medicine.

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