Acute kidney injury (AKI) is a serious, often underrecognized complication among patients hospitalized for drug overdose. Although overdose mortality has recently declined in the United States, less is known about whether serious nonfatal complications, including AKI, have followed similar trends. Adjusted percentages of hospitalizations of patients with drug overdose and AKI were calculated using hospital discharge data during 2016-2025. The percentage with a severe inpatient course (i.e., acute dialysis, respiratory compromise, shock or hypotension, or in-hospital death) was also calculated. Among 1,297,847 drug overdose-involved hospitalizations, AKI was documented in 448,136 (34.5%). The percentage of patients with AKI was 28.2% among those aged ≤24 years, 37.4% among those aged ≥65 years, 29.4% among females, and 38.1% among males. AKI among patients with a drug overdose-involved hospitalization increased during 2016-2022 (annual percent change [APC] = 2.69%) and decreased during 2022-2025 (APC = -5.11%). Among patients with a drug overdose-involved hospitalization and AKI, 273,093 (60.9%) experienced a severe inpatient course, including 68.1% of persons aged ≤24 years, 56.1% of those aged ≥65 years, 61.9% of females, and 60.4% of males. The percentage of drug overdose-involved hospitalizations with a severe inpatient course increased during 2016-2023 (APC = 1.82%), before decreasing during 2023-2025 (APC = -2.89%). Disproportionately severe inpatient courses among younger patients, who might have more years of life at risk for developing chronic kidney disease or kidney failure after AKI, warrants continued attention to early kidney injury detection after drug overdose, postdischarge linkage to care, and overdose prevention through improved access to substance use treatment.

Widespread use of pertussis vaccines in children has resulted in a >90% reduction in the number of annual pertussis cases in the United States. After a period of low U.S. pertussis incidence during and shortly after the COVID-19 pandemic, incidence increased in 2024. Data on the real-world effectiveness of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) against pertussis during this disease resurgence are limited. In response to documentation of a record high pertussis incidence in Alaska during May-November 2024, DTaP vaccine effectiveness (VE) against pertussis in Alaska children aged 6 months-6 years was evaluated. Adjusted VE was 96.2% among children who had completed the 3-dose primary DTaP series and 85.3% among those who were partially vaccinated. Compared with children who had received ≥3 DTaP doses, the odds of laboratory-confirmed pertussis were approximately 26 times as high in unvaccinated children (adjusted odds ratio [OR] = 26.1), and approximately 4 times as high in those who had received 1-2 DTaP doses (adjusted OR = 3.8). These findings reinforce the importance of following pertussis vaccination recommendations to protect for children from the disease and reduce the occurrence of pertussis outbreaks.

Poor mental health accounts for an estimated $300 billion in medical, pharmaceutical, and workplace- and suicide-related costs in the United States each year; promoting physical activity is an evidence-based approach to improving mental health. Identifying geographic groups with high prevalences of frequent mental distress and physical inactivity could help focus strategies that improve both outcomes. Young adults aged 18-29 years experience the highest prevalence of mental health conditions compared with other adult age groups. Using 2012-2024 data for adults aged 18-29 years from the Behavioral Risk Factor Surveillance System, CDC calculated frequent mental distress and physical inactivity prevalences nationally and by state or territory (jurisdiction). Nationwide, from 2012 to 2024, statistically significant overall increases in the prevalences of frequent mental distress (from 12.7% to 21.3%) and physical inactivity (from 15.9% to 16.8%) were observed. These national changes reflect jurisdiction-level changes from 2012 to 2024, because the prevalence of frequent mental distress increased and physical inactivity prevalence remained unchanged or increased in nearly every jurisdiction. However, examining year-to-year national changes revealed substantial recent declines in both frequent mental distress (during 2022-2023 and 2023-2024) and physical inactivity (during 2023-2024). Improving these outcomes can help prevent chronic diseases, reduce health care costs, and improve overall quality of life. Opportunities exist to improve mental health and increase physical activity concurrently through strategies that include social support groups for physical activity or changes to the physical environment. Such approaches might help sustain recent improvements in mental health and physical activity and lead to overall improvements in health.

Unannounced drills using professional patient actors (mystery patients) have been used to evaluate health care facility management of patients with infectious diseases of public health concern. Ongoing outbreaks and the expanding role of urgent care centers highlight the need to evaluate the ability of health care facilities to rapidly identify, isolate, and safely manage patients with transmissible diseases. During January-June 2026, 73 drills were conducted in three jurisdictions within U.S. Department of Health and Human Services Region 2 (New Jersey, New York, and the U.S. Virgin Islands) using a simulated avian influenza A(H5) scenario. During these drills, facilities conducted symptom screening in 68 (93%) drills and obtained travel history upon patient arrival in 58 (80%) drills. Among 60 (82%) drills during which the patient was appropriately masked, the median interval from arrival at the facility to masking was 2 minutes (IQR = 1.0-6.0 minutes) (target = 1 minute), and among 52 (71%) drills during which the patient was isolated, the median interval from arrival to isolation was 11 minutes (IQR = 8.0-19.2 minutes) (target = 10 minutes). Both masking and isolation occurred in 44 (60%) drills. The clinical team planned to notify infection prevention and control teams in 40 (54%) drills. The clinician wore all recommended personal protective equipment in 17 (25%) drills. These drills provided an opportunity for facilities to examine implementation of the principles of identification, isolation, and informing. Findings from these drills will help guide future public health interventions to improve readiness among regional health care facilities for emerging and reemerging infectious disease threats.

The first 100 days after identification of an outbreak are important to understanding transmission dynamics, impact of early public health interventions, and trajectory of potential future cases and deaths. A large Ebola disease outbreak in the Democratic Republic of the Congo (DRC), which has become the country's largest and deadliest, is ongoing. To better understand the current outbreak, this report compared metrics from the first 100 days of this outbreak with those of four past Ebola outbreaks. The historic outbreaks of Ebola disease selected for this comparison include the two largest (the 2014 outbreak in West Africa and a 2018 outbreak in DRC), and the only two previous outbreaks caused by Bundibugyo virus (the 2007 outbreak in Uganda and the 2012 outbreak in DRC). This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.

In early June 2025, approximately 80 persons attended a wedding at a venue in York County, Pennsylvania. Within 3 days, multiple attendees reported experiencing gastrointestinal illness. On June 23, the Pennsylvania Department of Health (PDOH) and the Pennsylvania Department of Agriculture (PDA) contacted CDC to request assistance after PDOH became aware of a laboratory-confirmed Campylobacter jejuni infection and reports of approximately 20 additional symptomatic attendees, with epidemiologic information implicating exposure to untreated spring water at the venue as a common exposure source. The focus of this report is on environmental inspection, testing, and identification of pathogens. This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.

Beginning in early 2025, Florida Department of Health (FDOH) staff members noted an unusually high proportion of reported hepatitis A cases among travelers who had recently been in Cuba. Hepatitis A outbreaks have been reported in Cuban local news media; however, government reports are limited. FDOH investigated to characterize hepatitis A cases associated with travel to Cuba among Florida residents (including four patients who had recently emigrated from Cuba). FDOH found that among 249 confirmed hepatitis A cases identified during June 2024-February 2026, 76 (31%) patients reported recent travel to Cuba before symptom onset. Among patients with Cuba travel-associated hepatitis A, the median age was 39 years, 70% were male, 87% were White, and 92% were Hispanic or Latino. Patients lived in 13 (19%) of Florida's 67 counties. Among 29 patients who completed supplemental travel questionnaires, 55% had visited Havana; other travel destinations included eight additional Cuban provinces. Hepatitis A virus (HAV) genotyping of 18 isolates from unique patients with outbreak-associated cases identified 15 (83%) isolates that matched HAV genotype IA outbreak strain 1, two (11%) that matched IB strain 1, and one (6%) that matched IA strain 2. These findings are consistent with what would be expected were widespread hepatitis A transmission affecting multiple regions of Cuba. CDC recommends hepatitis A vaccination or receipt of immune globulin before travel to Cuba. Providers' consideration of hepatitis A among patients returning from Cuba who have hepatitis A-compatible signs and symptoms, together with elicitation of a detailed travel history, might aid diagnosis of Cuba travel-associated cases.

Since 2017, syphilis cases have increased substantially across the United States, including in Alaska. Nationwide, prevalence of syphilis tends to be higher among incarcerated persons than among the general population. During 2023-2025, opt-out screening for syphilis in Alaska correctional facilities (i.e., routine testing unless a person specifically declines) found reactive rapid plasma reagin (RPR) results, which often indicate a past or current syphilis infection, in 240 (4.6%) of 5,163 persons screened. Among persons with reactive RPR results, 114 (47.5%) had newly identified syphilis cases (2.2% of all persons screened), based on the 2018 Council of State and Territorial Epidemiologists definition. Among persons with newly identified syphilis, 88 (77.2%) were known to have completed treatment by September 2025. Among 1,020 women incarcerated in Alaska who were screened (19.6% of all persons screened), 95 (9.3%) had reactive RPR results. Among those 95 persons, 37 (3.6% of women screened) had newly identified confirmed or probable syphilis, and the remaining 58 (5.7% of women screened) had positive treponemal test results, demonstrating a high current or past syphilis prevalence among women incarcerated in Alaska. Implementing opt-out screening and treatment in correctional facilities could improve syphilis detection and treatment among persons in correctional facilities, and thereby reduce community syphilis transmission and help prevent congenital syphilis.