PAHO warns of increase in yellow fever cases

News brief

Yellow fever cases in the Americas are increasing, the Pan American Health Organization (PAHO) said yesterday in an epidemiologic alert.

Officials have confirmed 131 cases this year in four countries, 53 of them fatal, for a 40% case-fatality rate. This is roughly 70 more cases than PAHO reported in early February.

"In 2024, yellow fever cases were mainly reported throughout the Amazon region of Bolivia, Brazil, Colombia, Guyana, and Peru. In 2025, however, cases have also been detected in the state of Sao Paulo in Brazil and the department of Tolima in Colombia, regions outside the Amazon region of both countries," PAHO said in the alert.

Almost all cases in unvaccinated people

Brazil has 81 confirmed cases, 31 of which have been fatal. Only 1 of the confirmed case-patients had a history of yellow fever vaccination.

Colombia has 31 confirmed cases, including 13 deaths. “All cases had a history of exposure in areas at risk for yellow fever, in the context of work activities that included agriculture, and had no documented history of vaccination against yellow fever,” PAHO said.

Peru has 18 cases and 8 deaths so far in 2025, all in unvaccinated people, while Bolivia has confirmed 1, in an unvaccinated man.

PAHO said the uptick in cases highlights the need for countries to achieve vaccination coverage of at least 95% in populations in at-risk areas.

WHO alert on US measles outbreak adds new genetic details

News brief

Lisa Schnirring

The World Health Organization (WHO) said today that the United States has notified it of an ongoing measles outbreak according to International Health Regulations (IHRs), given that it is an unusual event with potentially significant health impact.

boy with measles — *Natalya Maisheva/iStock*

As of March 20, officials have confirmed 378 cases in 17 states, with three distinct outbreaks and two deaths reported. About 90% of the infections are linked to the three outbreaks. Also, cases linked to the outbreak centered in Texas have also been reported in New Mexico.

Separately, the Kansas Department of Health and Environment has now reported 23 cases in six counties, including 20 in unvaccinated people. Also, the Ohio Department of Health is now reporting 10 cases in an outbreak centered in Ashtabula County, which resulted in a case and exposures in Knox County. None of the patients were vaccinated.

Texas genotype seen in New Mexico, Kansas cases

The WHO said the US Centers for Disease Control and Prevention (CDC) has reported 128 measles genetic sequences. Texas submitted 92 identical sequences that belong to the D8 genotype. Ten identical sequences have been reported from New Mexico, and one sequence matching the Texas outbreak virus has been reported from Kansas.

Five distinct B3 genotype sequences have been reported from eight other states.

"The source of this outbreak is unknown. Currently, there is no evidence of decreased vaccine effectiveness or changes in the virus that would result in increased severity," the WHO said.

The agency said the risk to the Americas region is high because of persistent circulation from imported cases and an increase in susceptible populations owing to low vaccination coverage due to pandemic immunization interruptions, vaccine hesitancy in some groups, and lack of access to health services for vulnerable groups.

COVID impact survey: New doctors less likely to opt for rural practice, more likely to report poor job market

News brief

Mary Van Beusekom, MS

Doctor listening to patient's heart — *Aaron Amat / iStock*

Newly graduated New York physicians' likelihood of practicing in rural areas, as well as their base salaries, declined amid the COVID-19 pandemic—especially for primary care doctors—which could constrain healthcare access in those areas.

The findings come from a Harvard Pilgrim Health Care Institute–led study published in Medical Care.

The researchers used annual data from the 2010-2022 Survey of Residents Completing Training in New York to retrospectively analyze the job market for 31,925 graduating medical residents and fellows, including base salary in 2022 dollars.

Perceptions of job market dim

Of the 31,925 participants, 16,612 (52.0%) had accepted a job offer. Their odds of receiving an offer rose 1.6 percentage point from 2010 to 2022, from 86.6% vs. 88.2%, but the proportion reporting a good job market fell from 55.8% to 44.1%, without a significant change in accepting an offer from before to during the pandemic.

We found that the COVID-19 pandemic was associated with concerning changes in new physician job market outcomes, especially substantial reductions in new physicians' likelihood of entering rural practice and compensation.

Tarun Ramesh, MD candidate

The likelihood of practicing in a rural area decreased 82%, from 3.4% to 0.62%, reversing prepandemic gains, and average base salary declined $23,569, from $288,257 to $264,687. Similarly, the probability of receiving job-related incentives dropped 4%, from 69.2% to 66.3%, as did salary satisfaction (86.5% to 84.1% [-3%]).

New primary care doctors saw larger reductions in rural practice rates and compensation than physicians in other specialties. Noncitizen medical graduates experienced the largest salary reductions, which the researchers said underscores vulnerabilities in this group.

"We found that the COVID-19 pandemic was associated with concerning changes in new physician job market outcomes, especially substantial reductions in new physicians' likelihood of entering rural practice and compensation," lead author Tarun Ramesh, an MD candidate and research fellow at Harvard Pilgrim Health Care Institute, said in an institute news release.

The researchers said the results highlight the need for expanding financial incentives (eg, student loan forgiveness, bonuses) for rural practice, financially supporting primary care practices, and strengthening protections for noncitizen physicians to ensure equitable compensation and reduce the risk of exploitation.

Drug-resistant gonorrhea cases rising in England

News brief

Chris Dall, MA

UK health officials say cases of drug-resistant gonorrhea are rising in England, including extensively drug-resistant (XDR) strains.

According to provisional data published today by the UK Health Security Agency (UKHSA), 17 cases of ceftriaxone-resistant gonorrhea were reported from January 2024 to March 20, 2025, compared with 16 in all of 2022 and 2023. The first case of ceftriaxone-resistant gonorrhea in England was detected in 2015.

Nine cases of XDR gonorrhea, which is also resistant to azithromycin, were reported over the same period, compared with five XDR cases in 2022 and 2023.

In England and elsewhere, ceftriaxone is the guideline-recommended first-line antibiotic, and the last remaining effective antibiotic option, for gonorrhea infections. Azithromycin is the second-line treatment and sometimes used in combination with ceftriaxone.

Cases linked to travel

UKHSA says most cases are linked to travel to or from the Asia-Pacific region, where ceftriaxone resistance is common, and that transmission of resistant gonorrhea within England has been limited so far.

"Gonorrhoea is becoming increasingly resistant to antibiotics, which could make it untreatable in future," Katy Sinka, MSc, head of the sexually transmitted infection section at UKHSA, said in a news release. If left untreated, it can cause serious problems like pelvic inflammatory disease and infertility.

The news comes amid a leveling out of gonorrhea cases in England. UKHSA said the latest provisional data from sexual health services in the first 9 months of 2024 show approximately 54,965 gonorrhea diagnoses, compared with 85,000 reported in all of 2023.