Building the Future of Biodefense

Recommendation: Histoplasmosis is an infection acquired from breathing in Histoplasma fungal spores that primarily affects the lungs and can lead to severe outcomes, including meningitis on rare occasions. Histoplasma spores are found in soil contaminated with bird and bat droppings and are prevalent in central and eastern US states, including Tennessee. Exposure typically occurs after contaminated soil is disturbed, often from construction, land clearing/scaping, and severe weather events. Organizations in Williamson and Maury Counties, Tennessee, should advise employees working outdoors or in construction to wear masks, eye protection, and gloves, as well as safely remove birds or bats and their droppings from roosting areas near the workplace. Histoplasmosis does not spread from person to person, but severe cases can result in prolonged worker absenteeism.

Situation: Tennessee reported a rise in pulmonary and disseminated histoplasmosis cases since September, totaling at least 18 cases across residents of Spring Hill and Thompson's Station. Some of the cases were severe. An investigation is ongoing to determine the source(s) of exposure. Media sources reported that at least 1 case lived in an area of Williamson County where construction and turned dirt work is ongoing. [Confidence: Very High]

Recommendation: Organizations in the US and worldwide should not sell ByHeart Inc. recalled infant formula while a botulism outbreak investigation is ongoing. Anyone with these products at their workplace or home should dispose of them, as well as wash and sanitize any items or surfaces that may have been contaminated by the recalled formula. Employees with infants should not feed the product to their child. Organizations should encourage employees to seek immediate treatment if their child develops botulinum toxin symptoms such as gastrointestinal symptoms, difficulty swallowing, muscle weakness, or vision and speech issues.

Situation: The US CDC released an update about the ongoing infant botulism outbreak linked to ByHeart Inc. infant formula. After retrospectively assessing past reported infant botulism cases, investigators expanded the outbreak date range to include 10 cases dating back to December 2023. As of 12/10, a total of 51 infant cases from 19 states were hospitalized. No deaths have been reported. Parents and caregivers were urged to stop using any ByHeart Whole Nutrition infant formula immediately, even if it is mistakenly found for sale in stores or online. See PHC alerts 12/2, 11/17, 11/12, and 11/10 for earlier info. [Confidence: Very High]

Recommendation: Norovirus is highly contagious. Organizations in the US should provide flexible work schedules to allow sick employees (or those with caregiving duties) to stay home until 48 hours after symptoms have stopped. Encourage robust hand hygiene, as the virus is not killed by hand sanitizer.

Situation: Norovirus continues to rise in the US. The WastewaterSCAN Dashboard reported that norovirus detections in wastewater were highest on average in the South, Midwest, and Northeast regions, though all regions nationwide are currently at a High level of activity. Media sources noted that the uptick in norovirus started earlier than usual this year, with increases first observed in October. The increase is likely driven by the norovirus strain GII.17, which was the predominant strain in the 2024-25 season. Norovirus test positivity in the most recent week of data and the number of outbreaks since August were both lower when compared to the same time last year (positivity: 12% vs. 15%; outbreaks: 153 vs 235). The 2024-25 norovirus season was the worst season in over a decade. With holiday gatherings and upcoming travel, proper handwashing and food safety practices should be reinforced. [Confidence: Very High]

Recommendation: Coccidioidomycosis, also known as Valley fever, is not endemic in Taiwan, but may impact at-risk occupations due to frequent international cargo transport and the rising incidence of cases linked to climate change. This fungal infection causes flu-like symptoms and can lead to prolonged illness and absenteeism in severe cases. Employers in Taiwan should familiarize themselves with occupational regulations related to coccidioidomycosis. Those with employees working outdoors or in dusty environments should take steps to limit dust exposure, such as providing masks and watering down soil before digging.

Situation: Taiwan health officials reported the first locally transmitted Valley fever case since launching its testing system in August 2025. The case is a man in his 50s with no recent travel history. His symptom onset started in August, and he significantly improved after treatment with antifungal medication. The individual works in cargo container handling, primarily cleaning and repairing containers. Health officials suspect the case was occupationally exposed to contaminated dust brought in with imported cargo and inhaled while working inside emptied containers. Officials have been monitoring the health of his workplace contacts, and none of them are currently showing any related symptoms. [Confidence: Very High]