Journal of Travel Medicine

During the 2026 Bundibugyo virus disease outbreak in the Democratic Republic of the Congo and Uganda, we projected potential airline-mediated importation risk using contemporary airline network and an externally calibrated Ebola importation hazard. Effective-distance analyses identified major international hub countries, including Belgium, France, South Africa, Kenya, and the United Arab Emirates, as higher-probability gateways within 30 days. These early projections provide a reproducible framework for real-time international situational awareness, while emphasizing that importation risk does not imply local transmission risk.

We used a stochastic simulation model to estimate the effectiveness of combined exit and entry airport screening for Bundibugyo ebolavirus disease (BVD), using natural-history parameters from a Bayesian re-analysis of the 2012 Isiro outbreak. For a 12-hour international flight from DRC or Uganda at 86% screening sensitivity, we estimate 65% of infected travellers would arrive undetected (95% CrI: 38 - 76%). The main driver of this outcome is the relative duration of the the incubation period (approximately 7.7 days) and the onset-to-severe-disease interval (approximately 4 days): most infected travellers board before symptom onset and are undetectable by any syndromic screen, whilst those who are symptomatic progress rapidly to illness severe enough to preclude travel. This is compounded during active epidemic growth, when recently exposed (and therefore pre-symptomatic) cases are overrepresented among travellers. Syndromic airport screening offers limited protection against BVD spread via air travel, and should be complemented by outbreak control at source and strengthened clinical surveillance in receiving countries with high travel connectivity to affected areas.

Background: Travellers visiting friends and relatives (VFRs) experience a disproportionate burden of travel-associated infectious diseases, yet little is known about the complexity of pre-travel consultations required to support their care. We compared enquiries relating to VFR travellers and tourists received by the UK National Travel Health Network and Centre (NaTHNaC) specialist Advice Line to identify differences in traveller characteristics, destinations and clinical complexity. Methods: We conducted a retrospective observational study of enquiries to the NaTHNaC Advice Line between 1 January 2019 and 31 December 2025. Enquiries relating to VFR travellers and tourists were compared using descriptive statistics and appropriate statistical tests. Traveller demographics, travel characteristics, destinations and enquiry management were analysed. Results: Of 16,367 enquiries relating to specific travellers, 3,090 (18.9%) concerned VFR travellers and 7,237 (44.2%) concerned tourists. Compared with tourists, VFR travellers were younger (median age 24 vs 52 years, P<0.001), more likely to undertake long-stay (8.4% vs 1.8%, P<0.001) and last-minute travel (5.0% vs 1.1%, P<0.001), and more frequently travelled to the WHO African Region (56.6% vs 29.2%, P<0.001) and Eastern Mediterranean Region (12.7% vs 2.8%, P<0.001). Pregnancy was substantially more common among VFR travellers (11.6% vs 4.3%, P<0.001). Enquiries concerning VFR travellers were more likely to require a call-back (16.1% vs 13.8%, P=0.012) and escalation to a specialist doctor (13.1% vs 10.5%, P<0.001), indicating greater consultation complexity. General practice generated a higher proportion of VFR-related enquiries than tourist enquiries (69.5% vs 63.9%, P<0.001). Conclusions: VFR travellers generate disproportionately complex pre-travel consultations characterised by higher rates of specialist escalation, distinct travel patterns and travel to destinations associated with the greatest burden of imported infectious diseases. These findings highlight the importance of specialist travel medicine support for healthcare professionals managing VFR travellers and reinforce the need for equitable access to timely, high-quality pre-travel healthcare for this high-risk population.

The ongoing 2026 Bundibugyo Ebola outbreak in the Democratic Republic of the Congo and Uganda raises concerns about regional dissemination across Africa. Anticipating where imported infections are most likely to occur, and whether recipient countries are prepared to detect and contain them, is essential for prioritizing surveillance and response. We developed an integrated spatial framework combining high-resolution epidemic and population data, air and land mobility, geographical accessibility, conflict-adjusted travel times to estimate the risk of Ebola importation across African countries. We contextualized importation risk using different national readiness indicators. We quantified overall, air-mediated, and land-mediated importation risk under the current epidemic situation and evaluated outbreak amplification scenarios in major regional hubs. Importation risk was highly concentrated geographically, with neighbouring countries accounting for 85% of the estimated continental risk. However, high-risk destinations extended beyond the immediate neighbours, whereas some neighbouring countries remained at low risk, reflecting the complementary roles of land and air mobility in shaping regional dissemination. South Sudan, Rwanda, Kenya, Tanzania, Zambia, Ethiopia, Burundi, Angola, South Africa, the Central African Republic, and Nigeria were estimated at high risk, but differed markedly in healthcare system capacity and emergency preparedness and response. Readiness gaps were largest in South Sudan, Burundi, and the Central African Republic. Botswana, Burkina Faso, Cameroon, Chad, and Ghana emerged as a second tier of preparedness priorities, combining intermediate-high importation risk with low readiness. Under outbreak amplification scenarios, the highest-risk countries remained largely stable, but additional countries entered the high-risk group and continental importation pressure increased substantially, highlighting the need for dynamic preparedness planning. Integrating high-resolution epidemiological data with complementary land and air mobility provides a refined geography of regional risk and preparedness across Africa, supporting better targeted surveillance, preparedness investments, and international support while allowing priorities to be rapidly updated as outbreaks evolve.

High pathogenicity avian influenza H5N1 clade 2.3.4.4b has caused a panzootic of devastating impact to poultry and wildlife globally. The Australian continent and broader Oceania until recently remained the last major region without confirmed detections. Here we report the first H5N1 clade 2.3.4.4b detections from two live seabirds - a brown skua and a southern giant petrel - found on the south coast of Western Australia in June 2026. Virus genome sequencing showed that both viruses were most closely related to H5N1 viruses detected recently on sub-Antarctic islands in the Southern Indian Ocean. In time-calibrated phylogeographic analyses, both viruses sampled in Western Australia clustered with viruses from Heard Island, a sub-Antarctic external territory of Australia. Ancestral location reconstruction also identified Heard Island as the most probable source location, although unsampled intermediate locations cannot be excluded. The two Western Australian detections were estimated to be independent incursions from Heard Island, rather than local transmission on mainland Australia. There was no evidence of reassortment with endemic avian influenza viruses in Australia, and both virus sequences retained key avian-like genetic markers and lacked known substitutions for reduced antiviral susceptibility. These detections revealed a Southern Ocean pathway of recurrent H5N1 incursions into Australia, highlighting the risk of potential establishment on the mainland and the need for heightened surveillance and rapid, nationally-coordinated, virus genomic characterisation.

Japanese encephalitis virus (JEV) is an emerging mosquito-borne flavivirus with potential for geographic expansion, yet the risk of establishment in North America remains poorly characterized. We assessed vector competence of three North American Culex species (Cx. pipiens, Cx. quinquefasciatus, and Cx. tarsalis) for the JEV Nakayama strain, isolated from human brain in 1934 in Japan, across five constant temperatures (15, 20, 25, 30, and 33{degrees}C) at 4, 7, and 14 days post-feeding, quantifying infection, dissemination, and transmission rates. Vector competence was low but non-zero across all species. Cx. pipiens showed higher infection rates than the other species, whereas Cx. quinquefasciatus and Cx. tarsalis were minimally susceptible under these experimental conditions. Temperature had limited effects on infection and no detectable effects on dissemination or transmission. These findings suggest limited transmission potential of JEV Nakayama in North America, with Cx. pipiens as a relatively permissive vector.

Introduction Measles remains a major public health threat worldwide. Following a resurgence of cases, Ho Chi Minh City (HCMC) experienced a severe outbreak in 2024-2025 that differed from the 2018-2020 epidemic. We compared the epidemiology and transmission dynamics of these two outbreaks to inform future surveillance and vaccination strategies. Methods Line-list data for measles cases reported in HCMC between 2018 and 2025 were extracted from the infectious disease surveillance system. Demographic changes were assessed using cross-sectional age distributions and longitudinal birth-cohort analyses. Transmission dynamics were characterized by estimating the effective reproduction number (Rt) using the Cori and Wallinga-Teunis methods. Age-stratified Who-Infected-Whom transmission matrices were constructed to quantify within- and between-age-group transmission before and after interventions. Results The 2018-2020 outbreak primarily affected children under five years of age (median age 3.75 years, IQR 0.9-9.1), whereas the 2024-2025 outbreak shifted toward older age groups (median age 8.4 years, IQR 1-14). Birth-cohort analyses identified two major immunity gaps: children born during the COVID-19 immunization disruption (2019-2023) and adolescents and young adults born before 2014 who were not eligible for the 2018 outbreak response immunization campaign. The 2024-2025 outbreak also showed broader spatial spread and a reversed geographic trajectory compared with the earlier epidemic. Transmission patterns changed substantially, with the 2018-2020 outbreak sustained mainly by transmission among young children, whereas the 2024-2025 outbreak was driven by older age groups, with individuals >15 years acting as an important source of infection for infants. Conclusion The epidemiology of measles in HCMC has shifted from predominantly pediatric transmission to increasing involvement of adolescents and adults, reflecting accumulated immunity gaps across multiple birth cohorts. These findings suggest that age-restricted outbreak response immunization may leave residual susceptible populations that contribute to future outbreaks. Achieving sustainable measles elimination will require vaccination strategies that address historical immunity gaps across all vulnerable age groups, in addition to maintaining high routine childhood vaccination coverage.

The continued emergence of genetically diverse high pathogenicity avian influenza (HPAI) H5N1 viruses with zoonotic potential highlights the urgent need for developing vaccines capable of providing broad protection against multiple circulating clades. Here, we developed a one-shot, multivalent, live-attenuated influenza vaccine (LAIV) based on the temperature-sensitive (ts), cold-adapted (ca), and attenuated (att) influenza A/Ann Arbor/6/1960 master donor virus (MDV) that incorporates the hemagglutinin (HA) and neuraminidase (NA) glycoproteins from representative clades 2.3.4.4b (A/Louisiana/12/2024), 2.3.2.1a (A/Victoria/149/2024), and 2.3.2.1e (A/Cambodia/2302009/2023) H5N1 viruses. A single intranasal (IN) immunization of C57BL/6 mice with the multivalent LAIV elicited robust humoral immune responses, with immune sera exhibiting broad cross-reactivity against antigens from all three H5N1 clades included in the vaccine. Following homologous viral challenge, vaccinated C57BL/6 mice were completely protected from disease, demonstrating the immunogenicity and protective efficacy of the multivalent LAIV. By simultaneously targeting antigenically distinct H5N1 lineages with pandemic potential, this strategy expands antigenic coverage within a single LAIV to confirm pan-H5N1 protection. Together, these findings support the development and implementation of this multivalent LAIV as a broadly protective pan-H5N1 LAIV for pandemic preparedness. SignificanceThe increasing genetic diversity of zoonotic H5N1 viruses complicates vaccine design. We developed a multivalent live-attenuated influenza vaccine (LAIV) based on the temperature-sensitive, cold-adapted, and attenuated (ts, ca, att) master donor virus (MDV) influenza A/Ann Arbor/6/1960 backbone that expresses the hemagglutinin (HA) and neuraminidase (NA) glycoproteins of H5N1 clades 2.3.4.4b, 2.3.2.1a, and 2.3.2.1e. A single intranasal (IN) immunization with the multivalent LAIV induced broadly cross-reactive neutralizing antibody (NAb) responses and protected experimental vaccinated animals against homologous lethal viral challenge, demonstrating the feasibility of the multivalent LAIV to protect against H5N1 clades of highest concern to humans. These findings demonstrate the feasibility of developing and implementing this multivalent LAIV as a broad protective pan-H5N1 LAIV against divergent H5N1 viruses for human use.

An ongoing outbreak of Bundibugyo virus disease (BVD) in the Democratic Republic of the Congo was deemed a public health emergency of international concern in May 2026. To prevent cross-border importation, many countries, including the United States, Canada, India, Thailand, and Kenya have already proposed containment strategies, and others are likely to follow suit. How well (or poorly) are screening and quarantine containment measures are likely to work? We leverage established epidemiological theory and develop a mathematical model of traveler screening and post-arrival quarantine for BVD to answer this question. We find that traveler screening via symptom screening or molecular testing will miss the majority of infected travelers, and should be complemented by post-arrival quarantine and monitoring of sufficient duration to detect those with long incubation periods. Our findings underscore the limitations of border screening and the importance of complementary measures like post-arrival quarantine to prevent local importation of BVD.

Highly pathogenic avian influenza virus (HPAIV) subtype H5N5 was detected in a one-year-old polar bear (Ursus maritimus) and an adjacent adult Atlantic walrus (Odobenus rosmarus rosmarus), both found deceased in Raudfjorden, Svalbard. This represents the first confirmed case of HPAI in a European polar bear and the second in an Atlantic walrus. Viral genomes were nearly identical and harbored PB2-E627V, a marker associated with mammalian adaptation. Several polar bears, including the deceased individual, had previously been observed feeding on the walrus carcass. Antibodies against H5 were detected in 75% of polar bears in 2023 (n=36) and 97% in 2024-2025 (n=65), suggesting extensive circulation of HPAIV in the population following the first detections in birds in Svalbard in 2022, whereas no antibodies were detected in samples from 2014-2022 (n=243).

Context: To ensure healthy resettlement and protect US health security, the Vaccination Program for US-bound Refugees (VPR) offers some recommended vaccines to refugees overseas before resettlement to the United States. The selected vaccines and number of doses vary by country of departure. VPR was found to be cost-saving in 2018 but had since expanded to more sites. Objective: Assess VPR's current costs and impact on post-arrival domestic vaccination needs and costs. Setting and Participants: A model-based analysis of the Federal government costs for VPR and post-arrival (US) vaccination of resettled refugees separated across five regions: Africa, Asia, the Middle East and North Africa/Republic of Turkiye and Middle East, Europe, and the Americas using fiscal year 2024 data. Design: We quantified and compared full vaccination costs for refugees under two scenarios: (1) 'No VPR' and (2) 'VPR'. Refugees would receive no vaccines overseas and be fully vaccinated after US arrival under 'No VPR'. Under 'VPR', refugees receive one or two doses of selected vaccines overseas before completing vaccination schedules after arrival. Main Outcomes: Costs were reported in 2023 US dollars for 'VPR' and 'No VPR' scenarios and further subdivided by grouping countries/sites depending on whether the International Organization for Migration (IOM) provides vaccination services for refugees (IOM sites) versus non-IOM providers (non-IOM sites). Results: 'VPR' resulted in average net cost savings of $147 per person or $14.7 million per 100,000-refugee cohort compared to providing all vaccines after US arrival ('No VPR'). 'VPR' was cost-saving across most regions, except for IOM sites in Europe, where a net cost of $44 per person was observed. Net cost savings per person were highest for IOM sites in Africa ($333). Conclusions: VPR remains a cost-saving strategy, while protecting US-bound refugees' health and US health security by preventing disease outbreaks during resettlement.

Influenza virus infects the respiratory mucosa, highlighting the importance of mucosal immunity for early protection and transmission control. Here, we evaluated whether intranasal (IN) vaccination with recombinant trimeric hemagglutinin protein from A/Michigan/45/2015 (triHA) formulated with a combined mucosal adjuvant, nanoemulsion plus IVT, an RNA-based RIG-I agonist (NE/IVT), could protect guinea pigs against heterologous A/Netherlands/602/2009 challenge and reduce viral transmission. To compare mucosal and parenteral immunization, IN triHA/NE/IVT was benchmarked against IN triHA alone, IM triHA/AddaVax (IM triHA/Advx), and standard IM quadrivalent inactivated influenza vaccine (QIV). We also tested whether IN triHA/NE/IVT could boost IM QIV- primed immunity and included animals previously infected with A/Michigan/45/2015 to model pre-existing infection- induced immunity. Transmission was assessed by co-housing naive sentinels with vaccinated, challenged donors. IN triHA/NE/IVT induced systemic humoral responses comparable to IM triHA/Advx while generating superior nasal mucosal IgA responses. Unexpectedly, IM triHA/AddaVax also induced detectable, albeit lower, mucosal IgG and IgA, contrasting with prior mouse data and highlighting species-specific differences. IN triHA/NE/IVT boosting after IM QIV enhanced serum IgG and mucosal IgA compared with QIV prime-boost alone and increased cross-neutralizing activity against antigenically distinct A/Victoria/4897/2022. Both IN triHA/NE/IVT and IN Michigan/15 prior- infection prevented detectable viral shedding after challenge, and naive sentinels co-housed with IN triHA/NE/IVT- vaccinated donors remained seronegative. Together, these findings support NE/IVT as a potential mucosal platform capable of inducing robust systemic and mucosal immunity and boosting IM vaccine-primed responses.

Enteric fever is endemic to many low- and middle-income countries (LMICs), particularly those in sub-Saharan Africa, South and South-East Asia. The causative agents are typhoidal serovars of Salmonella enterica, including Typhi (S. Typhi) and Paratyphi A (SPA). There are no vaccines currently licensed for SPA, leaving antimicrobials as the only therapeutic option. Multi-drug resistance (MDR) S. Typhi is increasingly prevalent, but to date has not been detected in SPA. In Australia, cases of SPA are notifiable. Here we report on the genomic epidemiology of 208 cases of SPA in returned travellers to Australia, and their close contacts, from 2018 to 2025. A total of 15 unique genotypes were detected, and these were correlated with geographical regions of reported travel. There was a low incidence of antimicrobial resistance with only a single isolate carrying acquired resistance genes. Mutations in quinolone resistance determining regions were common across the genotypes, detected in 95.7% of isolates. A single isolate in a traveller returning from India was resistant to several first line antibiotics including: ampicillin, amoxicillin plus clavulanic acid, ceftriaxone, azithromycin and ciprofloxacin. The isolate carried a plasmid encoding an extended spectrum beta-lactamase (blaCTX-M-231), two macrolide resistance genes (mphA and ermB) and a quinolone resistance gene (qnrS1). Elements of the pangenome were explored, with stable maintenance of small plasmids encoding hypothetical proteins detected in four genotypes. Copy number variation in genes encoding surface antigen biosynthesis genes were detected in six genotypes. These biosynthesis genes are targets for one of the two SPA vaccines in development, and the potential variation in surface antigens could have implications for vaccine efficacy. Linking epidemiological data with genomic studies of SPA provides an opportunity to improve understanding of the emergence, spread and risk of drug-resistant SPA infections, and to better inform empirical treatment guidelines in returned travellers.

During the ongoing Bundibugyo ebolavirus disease outbreak in the Democratic Republic of the Congo, we quantify introduction risk and sustained-transmission potential across the country. This identifies priority zones far from currently affected areas, where rapid amplification could follow introduction and response efforts should be focused.

Background. In 2026, the Democratic Republic of the Congo (DRC) experienced the largest recorded outbreak of Ebola disease caused by Bundibugyo virus, with epidemiologically linked importations and secondary transmission in Uganda. This study analysed the publicly reported trajectory and assessed the risk of introduction and onward transmission in North Africa and Europe. Methods. Public surveillance reports from the World Health Organization (WHO), European Centre for Disease Prevention and Control (ECDC), Africa CDC, national ministries of health, and peer-reviewed sources were synthesised through 15-17 July 2026. Headline counts and crude case-fatality ratios were restricted to laboratory-confirmed cases. Average notification rates were calculated from cumulative DRC counts. Exact Poisson intervals used the Garwood method, and the June-July rate ratio was estimated on the log scale. Risk was assessed across introduction likelihood, conditional onward-transmission likelihood, impact, and confidence. Results. By 15 July, the DRC had reported 2,124 confirmed cases and 828 deaths (crude confirmed-case fatality ratio, 39.0%) across 46 health zones in five provinces. Uganda had reported 20 confirmed cases and two confirmed deaths: 15 imported infections and five secondary cases, with no documented community transmission. DRC notifications averaged 47.4 per day during 1-15 July versus 35.9 per day during 2-29 June (rate ratio 1.32; counting-model 95% interval 1.20-1.46). WHO reported that more than 80% of new cases were detected outside known contact lists, while 119 confirmed healthcare-worker infections and 36 deaths had occurred. Introduction likelihood was assessed as very low to low for North Africa and very low for the general European population; delayed recognition in routine healthcare was the principal scenario for limited secondary transmission. Interpretation. Available indicators were inconsistent with effective control in eastern DRC at the data cut-off. Public reporting-date series cannot separate transmission from changing ascertainment, but they showed no sustained decline. Preparedness in North Africa and Europe should prioritise complete exposure histories, rapid isolation, validated diagnostics, protected clinical care, and contact management rather than reliance on border screening. Keywords: Bundibugyo virus; Ebola disease; outbreak surveillance; rapid risk assessment; importation; North Africa; Europe; Algeria; International Health Regulations.

An uncontrolled and rapidly growing outbreak of Bundibugyo virus (BDBV) is currently gripping the Democratic Republic of the Congo and threatening health security across Central Africa. There are no available BDBV-specific vaccines, although emerging evidence suggests that the Ebola virus-specific vaccine, rVSV-EBOV (also known by its tradename ERVEBO), may offer cross-protective immunity. To directly address this question, we evaluated the efficacy of rVSV-EBOV in the uniformly lethal ferret model of BDBV infection. All vaccinated animals survived BDBV challenge and exhibited minimal clinical signs of infection, presumably as a result of a moderate--but protective--humoral immune response. These findings provide critical evidence further supporting the cross-protective efficacy of rVSV-EBOV, and they suggest a potential role for this vaccine in mitigating the ongoing BDBV outbreak.

Bangladesh reported a nationwide measles outbreak in April 2026 involving over 19,000 suspected cases, despite high reported first-dose vaccine coverage ([&ge;]95%). We assessed whether publicly available molecular data could support epidemiologic interpretation of this resurgence and evaluated broader sequence sharing practices across South Asia. We analyzed public outbreak reports, WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), PubMed indexed literature, and NCBI GenBank records from nine regional countries. Public sequence visibility across the region was highly uneven. While India and Pakistan associated records dominated the public dataset, only 32 Bangladesh origin records were retrieved, and notably, none were collected after 2019. The sole 2026 Bangladesh linked molecular record was a travel associated genotype B3 genome isolated in Australia (PZ189094.1). Its closest public N450 relative was a contemporaneous Pakistan sequence (2-nucleotide difference). The historical Bangladesh sequences were more distant, precluding robust phylogenetic inference regarding local viral persistence, cross-border importation, or transmission direction. Immunization data revealed a high regional baseline but highlighted subnational vulnerability and a significant pandemic era coverage collapse in neighboring Myanmar. The absence of timely, publicly available genomic data during the critical early months of the outbreak highlights a severe genomic surveillance gap. Public molecular records were historically sparse and insufficient to reconstruct outbreak transmission dynamics. To support elimination goals, establishing targeted sequencing pipelines, enforcing minimum metadata standards, and ensuring rapid public data deposition are urgently needed. Keywords: measles; Bangladesh; South Asia; genomic surveillance; molecular epidemiology; immunization coverage

We compared the immunogenicity of three licensed egg-based inactivated influenza vaccines, including TetrAnflu (Sinovac quadrivalent), Fluarix Tetra (GSK quadrivalent), and Vaxigrip (Sanofi trivalent), in adult healthcare workers in Hong Kong during the 2025/26 season. Paired pre- and post-vaccination sera from age- and sex-matched recipients (n=30 to 40 per group) were tested by hemagglutination-inhibition assays against vaccine strains. After adjustment for age, sex, and sampling interval, the vaccines induced broadly comparable rises in antibody titers, proportions achieving titers >=40, and seroconversion rates, with a superior response to A(H1N1) after TetrAnflu. These real-world findings support the interchangeability of these vaccines for influenza vaccination programs.

The Urgepi project is a measles emergency initiative implemented by Medecins Sans Frontieres Operational Centre Paris (MSF-OCP) in the Katanga region of the Democratic Republic of Congo, a setting characterized by recurrent measles epidemics with substantial public health impact. To maximize impact, the project employs a risk-targeted approach directing resources to selected health zones to strengthen surveillance, implement preventive vaccination, and ensure timely epidemic response. This study presents the Urgepi approach, and, based on surveillance data from 2021-2023, evaluates the effectiveness of targeted preventive activities, explores strategies for prioritizing interventions amid multiple alerts, and assesses the overall impact of interventions on measles epidemics. Preventive vaccination successfully averted epidemics in six of the nine vaccinated high-risk health zones, while nine of ten non-vaccinated priority health zones experienced large epidemics. In the three vaccinated health zones that experienced epidemics, more locally adapted vaccination strategies would have been required to achieve higher coverage. Regarding the project's approach to prioritize alerts for investigations and interventions, we found that the Urgepi alert prioritization score was positively associated with subsequent epidemic size, suggesting that this approach allowed effective and timely targeting of larger local measles epidemics. Although no clear impact of epidemic response vaccination on case numbers was observed, likely due to biases introduced in case reporting through provision of free case management, a 50% reduction in the median epidemic duration was recorded. In conclusion, the findings demonstrate the effectiveness of the Urgepi project's risk-targeted approach for measles prevention and control and highlight the importance of timely and context-specific interventions.

Tokyo experienced a measles outbreak (260 cases) in early 2026 despite elimination status. Adults aged 20-39 years were most affected, and 38% of cases were modified measles, increasing with prior vaccination. Although incidence rose until April, the effective reproduction number; R(t) fell below 1, consistent with outbreak control. Multiple clusters were identified, but many cases lacked epidemiological links, suggesting that modified measles is less likely to be considered in differential diagnosis. Intensive contact tracing and surveillance contributed to limiting transmission.