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This paper discusses challenges in formulating and harmonizing malaria prevention recommendations for travellers. It explores diverse approaches used by advisory groups to assess malaria risk and shares insights from the 2023 International Expert Committee for Travel Medicine meeting. It also explores future prospects for enhancing malaria prevention recommendations for travellers.

Screening has been a cornerstone of sexually transmitted disease (STD) prevention programs for decades, and continues to be a priority public health activity at the local, state, and federal levels in the US and for other international public health agencies. Here, Ridpath et al discuss the importance of screening for STD.

Hurricane Sandy hit New York City (NYC) on October 29, 2012. Before and after the storm, 73 temporary evacuation shelters were established. The total census of these shelters peaked at approximately 6,800 individuals. Concern about the spread of communicable diseases in shelters prompted the NYC Department of Health and Mental Hygiene (DOHMH) to rapidly develop a surveillance system to report communicable diseases and emergency department transports from shelters. We describe the implementation of this system. Establishing effective surveillance in temporary shelters was challenging and required in-person visits by DOHMH staff to ensure reporting. After system establishment, surveillance data were used to identify some potential disease clusters. For the future, we recommend pre-event planning for disease surveillance.

What is already known about this topic? Locally acquired mosquito-transmitted (autochthonous) Plasmodium vivax malaria was most recently reported in the United States in 2003. What is added by this report? Eight cases of autochthonous malaria were reported to CDC by state health departments in Florida (seven) and Texas (one) during May 18–July 17, 2023. Case surveillance, mosquito surveillance and control activities, and public outreach are ongoing. What are the implications for public health practice? The risk for autochthonous malaria in the United States remains very low. Prompt diagnosis and treatment of persons with malaria and reporting of cases to health departments and CDC is important to ensuring favorable clinical outcomes and a timely public health response. Malaria and other mosquitoborne diseases can be prevented by preventing mosquito bites.

A case of locally acquired (autochthonous) mosquito-transmitted Plasmodium vivax malaria was diagnosed in Arkansas in September 2023. This represents the 10th autochthonous case identified nationally in 2023, after 20 years without recorded local mosquitoborne malaria transmission in the United States. The public health response included case investigation, active case surveillance, mosquito surveillance and control, assessment of medical countermeasures, and clinical and public outreach. Prompt diagnosis and appropriate treatment of malaria can improve clinical outcomes and, in addition to vector control, minimize risk for local transmission. Clinicians should consider malaria among patients who have traveled to countries where malaria is endemic, or with unexplained fever regardless of travel history. Although the risk for autochthonous malaria in the United States remains very low, its reemergence highlights the importance of vectorborne disease preparedness and response. Examples of such efforts include improving awareness among clinicians, access to diagnostics and antimalarial medications, and capacity for mosquito surveillance and control. Collaboration and communication among CDC, health departments, local jurisdictions, clinicians, hospitals, laboratories, and the public can support rapid malaria diagnosis, prevention, and control. Before traveling internationally to areas where malaria is endemic, travelers should consult with their health care provider regarding recommended malaria prevention measures, including chemoprophylaxis and precautions to avoid mosquito bites, to reduce both personal and community risk.

Disseminated gonococcal infection is a rare, systemic complication of untreated gonorrhea that occurs after sexual transmission and through hematogenous spread of Neisseria gonorrhoeae to distant body sites. Disseminated gonococcal infection usually manifests as arthritis, dermatitis, and tenosynovitis. In rare cases, endocarditis, meningitis, myositis, and osteomyelitis can occur. On August 12, 2019, the Kalamazoo County Health and Community Services Department (KCHCSD), Michigan, was notified of three persons hospitalized with disseminated gonococcal infection. Given the rarity of disseminated gonococcal infection, severe case presentations, and ongoing case clustering, KCHCSD and the Michigan Department of Health and Human Services (MDHHS) initiated a joint investigation. confirmed case was defined as isolation of N. gonorrhoeae from any sterile site, including blood, synovial fluid, or cerebrospinal fluid.

On April 2, 2015, four patients were evaluated at the University of Mississippi Medical Center (UMMC) in Jackson, Mississippi, for agitated delirium after using synthetic cannabinoids. Over the next 3 days, 24 additional persons went to UMMC with illnesses suspected to be related to synthetic cannabinoid use; one patient died. UMMC notified the Mississippi State Department of Health, which issued a statewide alert via the Health Alert Network on April 5, requesting that health care providers report suspected cases of synthetic cannabinoid intoxication to the Mississippi Poison Control Center (MPCC). A suspected case was defined as the occurrence of at least two of the following symptoms: sweating, severe agitation, or psychosis in a person with known or suspected synthetic cannabinoid use. A second statewide alert was issued on April 13, instructing all Mississippi emergency departments to submit line lists of suspected patients to MPCC each day. By April 21, 16 days after the first alert was issued, MPCC had received reports of approximately 400 cases, including eight deaths possibly linked to synthetic cannabinoid use; in contrast, during April 2012–March 2015, the median number of telephone calls to MPCC regarding synthetic cannabinoid use was one per month (range = 0–11). The Mississippi State Department of Health, with the assistance of CDC, initiated an investigation to better characterize the outbreak, identify risk factors associated with severe illness, and prevent additional illnesses and deaths.

In January 2019, West Virginia Bureau for Public Health (WVBPH) surveillance staff members noted an increase in diagnoses of human immunodeficiency virus (HIV) infection among persons who inject drugs in Cabell County, West Virginia (population approximately 91,900·). Cabell County, part of a medium-sized metropolitan statistical area and home to the city of Huntington (population approximately 46,000†), had historically high rates of substance use disorder but low rates of HIV infection (1). During 2013-2017, an annual average of two diagnoses of HIV infection had occurred among Cabell County persons who inject drugs; however, in 2018, 14 diagnoses occurred, including seven in the fourth quarter. As of January 26, 2020, a total of 82 persons had met the case definition. Among 61 (74%) persons with a CD4+ count measured ≤3 months after diagnosis, median CD4+ count was 583 (range = 6-1,057), indicating that many infections were recent.