Eurosurveillance - Volume 30, Issue 43, 30 October 2025

We report a confirmed autochthonous human case of classical rabies in Romania involving an individual in their mid-40s from Iași county, who was bitten by a free-roaming dog in February 2025. The case did not receive post-exposure prophylaxis (PEP) and died from rabies in July 2025. This event highlights critical gaps in rabies prevention, the importance of timely PEP, and the need for continued vigilance in rabies surveillance and public health communication.

We report a case of a mild, self-limited rash illness in a child 18 days after measles-mumps-rubella-varicella vaccination. Initial testing with a PCR-based method failed to detect vaccine virus. Sequencing later identified a novel mutation in the probe-binding site of the vaccine assay that had arisen after vaccination and resulted in the false-negative PCR test results.

A German traveller developed leg oedema with adenolymphangitis after a 3-week trip to Sri Lanka. Laboratory tests showed slight eosinophilia, positive filarial serology and motile microfilariae in day and night-time blood samples. PCR revealed 99% homology for Brugia malayi. Lymphatic filariasis has been eliminated in Sri Lanka, but zoonotic B. malayi has re-emerged. Physicians need to be alert and consider filariasis as potential differential diagnosis. Surveillance and vector control efforts should be sustained to prevent resurgence in Sri Lanka.

An outbreak of an ertapenem-resistant Klebsiella pneumoniae clone occurred in a specialist children’s hospital in Liverpool, United Kingdom (UK), from April 2022 to February 2023. Carbapenem-resistant K. pneumoniae is unusual in the UK, and identification of two isolates exhibiting ertapenem resistance in the same ward in December 2022 raised concerns and triggered an outbreak investigation. Potential transmission through shared equipment was identified; a total of 11 patients were colonised and/or infected by phenotypically similar isolates. Multilocus sequence typing supported hospital transmission, and short-read whole genome sequencing (WGS) was performed on all isolates; long-read sequencing was conducted for three isolates to confidently resolve the plasmid structure. WGS confirmed a clonal outbreak and strongly supported the suspected nosocomial transmission. Detailed analysis of the resistance determinants indicated that ertapenem resistance was driven by a combination of different beta-lactamases, which would not alone convey this resistance profile, along with modifications in porin structure that suggested a synergistic interaction. These findings highlight how highly resistant strains could be mislabelled as predicted sensitive when considering genetic determinants in isolation and underscore the need to study beta-lactam resistances beyond the presence or absence of specific genes but also to consider co-occurrence.