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Weekly Update
Communicable disease intelligence for the FRCPath candidate & clinical microbiologist
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25
FRCPath Results — May 2026 Sitting
Moodlecloud members passed their examination.
Congratulations to all 25 candidates.
Congratulations to all 25 candidates.
Moodle Content Updates This Week
New
Ebola virus — comprehensive new chapter
New
Hantavirus — new chapter
Exam Focus
High-yield topics for the next sitting — new section
UKHSA / Gov.UK — Key Alerts (Week 21)
Hantavirus Disease Added to UK Statutory Notifiable Disease List
New · Notifiable
Hantavirus disease was formally added to the UK notifiable diseases list on 19 May 2026. Both the statutory guidance page and the notifiable diseases poster for registered medical practitioners have been updated.
| HAIRS Risk Assessment | Published 18 May 2026. Qualitative risk assessment for Andes virus infection in a UK rodent. Risk to UK human population assessed as very low — the natural rodent reservoir for ANDV is not present in the UK or Europe. |
| Evidence Review | UKHSA systematic evidence summary published 19 May: human-to-human hantavirus transmission parameters — incubation period, infectious period, asymptomatic/presymptomatic transmission, and transmission routes. |
| Cruise Ship Update | UKHSA published a dedicated update on 22 May covering British nationals involved in the M/V Hondius ANDV outbreak (South Atlantic). |
FRCPath Relevance
High. Hantavirus is now a notifiable pathogen in the UK. The HFRS vs HPS distinction, Andes virus human-to-human transmission (unique among hantaviruses), and rodent reservoir epidemiology are all examinable at Part 1 and Part 2 level.
Ebola (Bundibugyo Virus) — DRC & Uganda: UKHSA Guidance Suite Updated
PHEIC Declared · 17 May 2026
Following WHO’s PHEIC declaration on 17 May 2026, UKHSA updated multiple guidance documents across the week of 18–21 May:
- Returning Workers Scheme (RWS) updated to reflect confirmed DRC and Uganda outbreak.
- Ebola and Marburg: outbreaks and case locations page updated to reflect ongoing incident.
- Ebola: overview, history, origins and transmission updated in light of the PHEIC declaration.
- VHF ACDP algorithm and guidance on management of patients — terminology change: “HCID assessment PPE” replaced throughout with “unified HCID PPE” to reflect renaming of the PPE ensemble.
- HCID country-specific risk list updated for Guinea and Saudi Arabia (21 May).
- Outbreaks under monitoring updated (week 20, 2026).
Key Clinical Point
This outbreak is caused by Bundibugyo virus, not the more commonly encountered Zaire ebolavirus. There are currently no licensed vaccines and no specific treatments for Bundibugyo virus disease. This distinguishes it critically from previous UK HCID preparedness planning, which assumed availability of rVSV-ZEBOV (Ervebo) and mAb114/REGN-EB3.
MERS-CoV — Comprehensive New Guidance Package Published
Risk: Extremely Low (UK)
UKHSA published an extensive suite of new and updated MERS-CoV guidance on 18 May 2026:
- Background information (first published) — transmission, diagnosis, treatment, prevention for public-facing guidance.
- Diagnostic testing (first published) — sample taking, submission and processing guidance for suspected cases.
- Diagnosis and management of cases and contacts (first published) — for healthcare professionals and HPTs.
- Biological principles for control of MERS-CoV (first published) — current knowledge and assumptions on biology and transmission.
- Travel from Middle East advice sheet (first published) — infographic for travellers returning to UK.
- Risk assessment updated — risk for UK travellers to Middle East remains very low; risk of acquiring MERS-CoV in the UK formally reduced to extremely low.
- Minimum dataset form updated to abridged version.
- Clinical management and guidance — ‘MERS-CoV: background information’ added; ‘Diagnosis’ and ‘Public Health Management’ sections removed; travel advice and contacts information sheets updated.
West Nile Virus & Invasive Aedes — National Contingency Plans Published
First Published · 2026
Three major One Health vector-borne disease documents published simultaneously on 21 May 2026:
- National contingency plan for West Nile Virus in England — new 2026 plan. Includes a published map and table of local authorities with sites at Level 1 of the WNV plan.
- National contingency plan for invasive Aedes mosquitoes in England — supersedes the 2020 plan.
- One Health VBD surveillance annual report (2025) — first annual report of its kind integrating vector, animal, and human surveillance data for England. Lyme disease remains the most common vector-borne infection in England in 2025.
Tick-borne encephalitis guidance also expanded with additional epidemiology and resource links (21 May).
New HIV Diagnoses in England — Provisional Data Published
First Published
UKHSA published provisional data on new HIV diagnoses in England (21 May 2026). This is a new annual provisional data report, published earlier than the full annual HIV surveillance report to support timely public health action.
Pertussis Guidance Updated; MMR Community Outbreak PGD Template Added
Operational Update
- Pertussis exclusion period in guidance for children and young people’s settings updated from 14 to 21 days, in line with the revised UKHSA public health management guidelines (21 May 2026).
- MMR PGD template for use in community measles outbreaks added to the immunisation PGD template suite (18 May 2026) — enables non-prescribers to administer MMR vaccine during community outbreaks under a patient group direction.
- Pertussis public health management guidelines formally updated with revised forms (21 May).
ECDC — Communicable Disease Threats Report, Week 21
Andes Virus (ANDV) Outbreak — M/V Hondius, South Atlantic
11 Cases · 3 Deaths
| Status (22 May) | 11 cases total: 9 confirmed, 2 probable. 3 deaths. No new cases or deaths since previous update. |
| Vessel | M/V Hondius (Dutch-flagged). Departed Argentina 1 April. Itinerary: mainland Antarctica → South Georgia → Nightingale Island → Tristan da Cunha → St Helena → Ascension Island → (Cabo Verde, next port). Total 149 embarked: 88 passengers, 61 crew. 23 nationalities including 9 EU/EEA countries. |
| Disembarkation | 122 people (87 guests, 35 crew) disembarked Tenerife 10–11 May. Evacuation flights by NL, Spain, France, Ireland, Greece, UK, Türkiye, Canada, USA, Australia. Vessel departed Tenerife 11 May; arrived Rotterdam 18 May. 27 remaining (25 crew, 2 medical professionals) disembarked; all asymptomatic individuals in quarantine. Vessel undergoing disinfection. |
| Genomics | Preliminary sequencing shows high genetic similarity between isolates, consistent with a single zoonotic spillover event (likely in Argentina, where ANDV is endemic) followed by human-to-human transmission onboard. Further genome results pending. |
| Transmission hypothesis | Passengers exposed to ANDV in Argentina prior to embarkation; subsequent person-to-person transmission onboard. ANDV is the only hantavirus with documented efficient human-to-human transmission. |
| EU/EEA risk | Very low. ANDV rodent reservoir absent in Europe. SoHO donor population risk: negligible. Entry screening of returning travellers not recommended by ECDC. |
| ECDC actions | Threat Assessment Brief published 6 May 2026. Updated IPC guidance for healthcare settings and self-quarantine recommendations for asymptomatic contacts published. Ongoing epidemiological studies on transmission characteristics. |
Background — First Documented Cases
First documented human ANDV infections: Argentina, 1996, causing hantavirus pulmonary syndrome (HPS). European precedent: two imported HPS cases in travellers returning to Switzerland from South America, 2016.
Ebola Disease — Bundibugyo Virus, DRC & Uganda
PHEIC · WHO 17 May 2026
| Burden (21 May) | Over 650 suspected cases, 160 deaths. DRC confirmed: 64 cases, 6 deaths. Uganda confirmed: 2 cases, 1 death. |
| Provinces (DRC) | Ituri (60 confirmed; 4 deaths) and North Kivu (4 confirmed; 2 deaths). Health zones: Rwampara (19), Bunia (6), Nyankunde (4), Mongbwalu (1) in Ituri; Butembo (1), Goma (1), Katwa (1) in North Kivu. Media reports a case in South Kivu (person who travelled from Tsopo Province). Cases in both provincial capitals — Bunia (Ituri) and Goma (North Kivu). Over 1,000 contacts followed up in Ituri; over 100 in Uganda. |
| Index case | A nurse who died in a healthcare facility in Bunia. Presentation: fever, bleeding, vomiting, weakness. |
| Uganda cases | Both confirmed cases had travel links to DRC. First Ugandan case died under treatment in Uganda. |
| International cases | An American healthcare worker from the affected area tested positive; transferred to Germany with 6 high-risk contacts (18 May). One additional contact transferred to Czechia. |
| Genomics | Sequences from DRC and Uganda published (Virological, 18 May). Preliminary analysis shows distinct sequences from both the 2007 Uganda and 2012 DRC Bundibugyo outbreaks. |
| Countermeasures | No licensed vaccines. No specific treatments. Unlike Zaire ebolavirus (rVSV-ZEBOV/Ervebo; mAb114; REGN-EB3), no medical countermeasures are available for Bundibugyo virus. |
| Declarations | WHO PHEIC: 17 May 2026. Africa CDC Public Health Emergency of Continental Security: 18 May 2026. |
| ECDC risk (EU/EEA) | Infection risk for EU/EEA travellers to affected areas: low. Risk for EU/EEA residents: very low (very low likelihood of importation and secondary transmission). Outbreak probably larger than currently detected; ongoing insecurity limits surveillance. |
| Screening policy | ECDC does not recommend entry screening of returning travellers. Evidence from the 2013–2016 West Africa EVD outbreak (tens of thousands of cases; hundreds of EU/EEA personnel deployed) showed entry screening is time- and resource-consuming without effectively identifying infected cases. Exit screening is the recommended approach. |
| Historical context | 17th Ebola outbreak in DRC. Most recent prior: 2025, Kasai Province (Zaire ebolavirus). Bundibugyo virus first identified: 2007, Bundibugyo district, Uganda. Last Bundibugyo outbreak: 2012, DRC. The 2018–2020 North Kivu/Ituri outbreak (Zaire ebolavirus): 3,470 cases, 2,287 deaths. |
Avian Influenza A(H9N2) — New Human Case, Sichuan Province, China
203 Cumulative Cases · CFR ~1%
| Case | Female child, under 5 years, Sichuan Province. Symptom onset 25 April 2026; reported by WHO 15 May, Hong Kong CHP 16 May 2026. |
| Clinical | Fever; symptoms self-resolved. |
| Exposure | Live poultry market prior to symptom onset. |
| Contacts | No additional cases detected among close contacts. |
| Cumulative total | 203 human cases (since 1998), 11 countries, 2 deaths. CFR: 0.98%. Since 2015, China alone has reported 161 cases and 2 deaths (CFR ~1%). |
| ECDC assessment | No evidence of sustained human-to-human transmission. No clusters reported. Risk to EU/EEA human health: very low. Most cases cause mild illness; direct contact with infected birds or contaminated environments is the primary route. |
Respiratory Virus Epidemiology — EU/EEA, Week 20
Baseline / Inter-seasonal
All major respiratory viruses at or near baseline across EU/EEA in week 20.
| ILI/ARI (primary care) | Influenza positivity: 0.4% (median; IQR 0–0%). RSV: 1.1% (0–0.2%). SARS-CoV-2: 2.1% (0–0%). 13 countries reporting ARI rates; 16 reporting ILI rates. |
| SARI (hospitals) | Influenza: 0.2%. RSV: 1.5% (0–5.2%). SARS-CoV-2: 0.6%. 10 countries reporting. |
| Influenza intensity | 18 countries at baseline; 1 at low intensity. |
| Season-wide subtypes | Influenza A(H3): 60% of typed specimens; A(H1)pdm09: 39%. Influenza B/Vic: 1%. RSV-B slightly predominant over RSV-A (55% vs 45% of typed RSV). |
| A(H3) subclade | 2a.3a.1(K) dominant at 89% of characterised A(H3) sequences. |
| Data note | TESSy/ERVISS data temporarily paused due to migration to EpiPulse Cases. Publication expected to resume 22 June 2026. |
Chikungunya Virus Disease — French Guiana, France
249 Cases YTD · Epidemic Phase
| Burden (7 May) | 249 confirmed autochthonous cases since January 2026. Weekly case counts: week 15: 15; week 16: 33; week 17: 61; week 18: 40. |
| Geographic phases | Littoral ouest (western border with Suriname): epidemic phase declared 23 April (198 cases; 80% of total). ORSEC Level 3 (low-intensity epidemic) activated. Île de Cayenne: outbreak clusters phase. Maroni and Savanes: sporadic transmission. Intérieur, Intérieur Est, Oyapock: surveillance only, no cases. |
| Virology | All cases RT-PCR confirmed. Strain: ECSA genotype, lacking the E1-A226V mutation (the mutation that confers efficient replication in Ae. albopictus). Genetically close to recent sequences from Cuba and Brazil. |
| Regional context | Suriname (shares western border): 2,579 cases Jan–mid-March 2026. Last French Guiana outbreak: 2014–2015 (>16,000 suspected cases, 500 hospitalisations; estimated 20% seroprevalence by 2017). |
| Risk assessment | Risk for travellers to French Guiana: low. Risk of onward transmission in mainland Europe from viraemic traveller: low but increasing — rainy season (Jan–July) ongoing; Aedes activity in mainland Europe increasing seasonally. |
| Prevention | Mosquito repellent, bed nets, screened/air-conditioned accommodation, covering clothing. Vaccination per national recommendations where available. |
Measles — EU/EEA & Global Monitoring (Monthly)
3,607 Cases · 12mo EU/EEA
EU/EEA — 12 months (1 April 2025 – 31 March 2026): 3,607 cases; 3,098 (85.9%) lab-confirmed. 5 deaths: France (3), Netherlands (1), Romania (1). CFR: 0.14%.
- Age: 31.7% in children <5 years; 45.1% aged ≥15 years. Highest notification rates: infants <1 year (90.8/million); children 1–4 years (48.9/million).
- Vaccination status (84% of cases with known status): 78.2% unvaccinated; 10.6% one dose; 9.9% two or more doses.
March 2026 (most recent monthly data): 172 cases across 12 countries; 18 countries reported zero. Highest: Bulgaria (52), Italy (44), Spain (24), France (15), Germany (11). Case numbers increased vs previous month.
Active outbreaks (20 May 2026 epidemic intelligence):
- Bulgaria: 277 cases YTD (week 1–20). Outbreak began 19 March. Centred in Vratsa (150), Pleven (48), Lovech (18). Majority in children (189/225). Over 28,000 MMR doses administered in response.
- France: 77 cases Jan–April 2026; 12 outbreaks reported, 3 still active. Cases in 24 departments. 54% of cases with known vaccination status were not fully vaccinated.
- Germany: 82 confirmed/probable cases (weeks 1–21 2026), +23 since week 15.
- Latvia: 49 confirmed cases (outbreak; data to 15 April).
- Spain: 118 cases Jan–17 May (10 imported, 25 import-linked).
- Portugal: outbreak in Beja; 3 cases, ~500 contacts.
- England: 542 lab-confirmed cases, no deaths (Jan–27 April 2026).
Global highlights:
- Bangladesh: 57,856 children with measles-like symptoms; 8,067 confirmed; 481 deaths (80 confirmed); 45,128 hospitalisations since 15 March 2026.
- Mexico: 10,945 confirmed cases + 13 deaths in 2026; Jalisco most affected (9,847 cases). Declining after week 6 peak.
- USA: 1,893 cases Jan–14 May 2026 (93% outbreak-associated; 92% in unvaccinated).
- Canada: 1,018 cases (941 confirmed); multijurisdictional outbreak ongoing.
- Japan: 479 cases weeks 1–19 (exceeds all of 2025: 265 cases); 86% in teenagers and adults; 38 imported.
- Africa CDC: 3,422 confirmed + 92,537 suspected cases; 633 deaths from 21 AU member states in 2026.
FIFA World Cup 2026 Risk Note
ECDC provides a specific alert regarding the upcoming FIFA World Cup 2026 (Canada, Mexico, USA — all countries with active transmission). Travellers should verify vaccination status before departure.
Other Events Under Active ECDC Monitoring
Monitoring
- Salmonella Bovismorbificans — ECDC/EFSA Rapid Outbreak Assessment in preparation for a multi-country outbreak linked to sprouted seeds. Expected publication: 25 June 2026.
- Mpox (Clades I & II) — global and EU/EEA outbreak under monitoring; last updated 8–13 May 2026.
- Avian influenza A(H5N6) — human cases monitoring; last updated 13 May 2026.
- Swine influenza A(H1N2)v — multi-country human cases; last updated 13 May 2026.
- MERS-CoV — monthly update; last updated 8 May 2026.
- Cholera — global monitoring; last updated 30 April 2026.
- Multi-country Salmonella Stanley ST2045 cluster — last updated 8 May 2026.
- SARS-CoV-2 variant classification — last updated 30 April 2026.
Social Intelligence — X.com (16–23 May, UK & Europe)
H5N1 / Avian Influenza
Surge in poultry outbreaks in Poland; new H5N1 cases logged across Europe. Mammalian spillover signals (dairy cattle, Arctic mammals). UK farming policy tie-in: RSPCA mandatory outbreak plans for turkey farms. Activist calls for industry shutdown in some posts.
GEO: Europe-wide (Poland focus) · Last 48h active
MenB / IMD Vaccination
UKHSA provisional 2024–25 data circulating: 378 lab-confirmed IMD cases, 31 deaths; MenB predominant. Calls for phased adolescent catch-up MenB programme in England. Cross-protection of 4CMenB (Bexsero) against gonorrhoea highlighted as dual benefit.
GEO: England (Reading, Dorset, national) · Last 48h active
Pertussis NHS Campaigns
NHS regional catch-up campaigns active (Cheshire/Merseyside; Leicester/Leicestershire & Rutland). Mobile vaccine clinics, red book checks. Clinician notes of local circulation hotspots requiring antibiotics and vaccination.
GEO: England (NHS ICB level)
AMR Policy & NHS Stewardship
UK–Gulf Cooperation Council trade deal includes explicit AMR commitments alongside animal welfare. NHS antibiotic line-flushing and disposal challenges (operational underdosing/environmental risk) discussed by experts and referenced to peer-reviewed commentary.
GEO: UK (policy & NHS operational) · Last 48h active
⚡ Weak Signal — Experts Before Mainstream
4CMenB (Bexsero) cross-protection against gonorrhoea being actively discussed as a dual public health and AMR-reduction benefit in the NHS England programme context. Proposed mechanism: outer membrane vesicle components shared between N. meningitidis and N. gonorrhoeae. If the population-level gonorrhoea burden reduction is validated at scale, it could fundamentally reframe the cost-effectiveness case for broader adolescent MenB vaccination in England beyond current programme boundaries.
⚡ Weak Signal — Circulating Non-COVID Respiratory Viruses
Community clinicians in the UK noting ongoing rhinovirus and hMPV (human metapneumovirus) circulation. Not captured in ECDC ERVISS data at headline level this week — worth monitoring as summer school holiday movement begins.
⚠ Unverified — Treat with Caution
Swine flu park closure, Barcelona: Claim circulating on X that swine flu is responsible for months-long closure of Collserola metropolitan park (largest metropolitan park in Europe). Scepticism expressed by multiple accounts regarding the official rationale. No official confirmation from Spanish or Catalan health authorities has been identified. Anecdotal only — do not act on this signal.