Welcome to the thirty-eighth edition of FOI Clinical. Each week, we'll send you a briefing on outbreak news. When something urgent breaks, you'll get an alert the same day.
In this edition
Measles: congenital infections in Pennsylvania – Hib: 29 cases YTD – Congenital syphilis: increases – Updates on seasonal respiratory viruses – H5N1: expansion in Washington dairy – Dengue: Florida reaches 425 – Ebola: past 10,000 cases – Update on reports of plague infection in Russia
National interest
Measles — congenital infections in Pennsylvania
CDC's measles page, updated October 23, records 4,588 confirmed cases as of October 22, up from 4,410 a week earlier. There have been 43 outbreaks this year; 96% of cases are outbreak-associated, and 10% of patients have been hospitalized. CDC's death count remains three; Pennsylvania is still reporting five, with a sixth under investigation.
In other news, Pennsylvania issued a health advisory on measles in pregnancy and congenital measles. It reports an increase in measles during pregnancy and says congenital measles has been identified for the first time in decades.
The guidance advises:
- Exposed pregnant women: non-immune pregnant women exposed to measles should receive intravenous immunoglobulin within six days of exposure. MMR is a live vaccine and should not be given during pregnancy. Also, pregnancy should be avoided 28 days after vaccination.
- Newborns: neonates born after the mother's symptoms began, and up to 14 days after her rash onset, are at risk of symptomatic and transmissible infection. Test them, give immunoglobulin and isolate empirically.
- Later risk: every infant born to a mother who had measles at any point in pregnancy should be considered exposed, and families should be counseled to watch for seizures or developmental regression that could signal subacute sclerosing panencephalitis (SSPE). SSPE can present months to years after recovery.
- After delivery: non-immune mothers should be vaccinated postpartum, and breastfeeding is not a barrier to MMR.
State updates:
- Pennsylvania: the state's measles dashboard reports 1,398 cases across 44 counties on October 28, up from 1,286 on October 19, and lists 85 new cases in the preceding seven days. To date, 265 people have been hospitalized, and 33% of cases are in people under 18. The dashboard still lists five measles-associated deaths. The health department said on October 21 that providers gave more than 56,000 MMR doses in September, compared to about 25,000 in a typical month, and more than 39,000 in the first three weeks of October.
- Wisconsin: state health services confirmed 335 cases statewide on October 27, up from 289 a week earlier. The southwest outbreak accounts for 282 confirmed and six probable. Chippewa County, which had 11 travel-related cases a week earlier, is now listed as an outbreak, with 28 confirmed and three probable cases.
- New York: the state's measles dashboard, which excludes New York City, counts 170 confirmed cases in 2026 through October 24, two of them in the latest week.
- Georgia: three cases have been reported in Macon County. The state has reported at least 25 cases year to date.
Hib — 29 cases in children under five YTD
CDC’s National Notifiable Diseases Surveillance System reports 29 invasive Haemophilus influenzae type b (Hib) cases in children under five in 2026 as of October 17. That is higher than the 16 reported at the same point last year. Ohio (seven), Pennsylvania (six) and New York (five, excluding New York City) account for most; nine other states have reported one or two. Montana’s health department reported on October 5 that an unvaccinated child died of Hib in September; that case is not yet in CDC’s tables.