Eurosurveillance - Volume 31, Issue 3, 22 January 2026

In October–November 2025, eight autochthonous cases of monkeypox (MPXV) clade Ib virus infection were reported in the Netherlands. All cases were men who have sex with men aged 25–65; none required hospital admission or antiviral treatment. Phylogenetic analysis combined with contact tracing suggest multiple introductions or cryptic circulation with onwards transmission within the community. Highly related international sequences were identified dating back to August 2025, indicating sustained global community transmission of clade Ib outside the African continent.

In November 2023, the UK Health Security Agency was notified of PCR-confirmed group B (MenB) invasive meningococcal disease (IMD) in a 3-year-old child (Case A), followed by probable IMD in a 2-year-old (Case B, culture and PCR tests negative) attending the same nursery. An incident management team (IMT) was convened. Both children were fully vaccinated with the MenB vaccine 4CMenB (Bexsero, GSK Biologicals). All 39 children attending the nursery and nine staff received ciprofloxacin chemoprophylaxis preceded by pharyngeal swabbing. Pharyngeal swabbing yielded two MenB isolates matching Case A. Antibiotic sensitivity testing and assessment of 4CMenB vaccine coverage using the meningococcal antigen typing system (MATS) revealed the strain was not covered by the 4CMenB vaccine. Although the alternative MenB vaccine, MenB-fHbp (Trumenba, Pfizer), is only licensed from 10 years and has never been given to children previously immunised with 4CMenB, the IMT considered the benefits of outbreak control outweighed potential risks. Two doses were given 4 weeks apart to 38 children (one family declined) and all staff; there were no serious adverse events. Our findings highlight the utility of swabbing to identify outbreak strains and provide first evidence for safe use of the MenB-fHbp vaccine in children previously vaccinated with 4CMenB.

The recast Urban Wastewater Treatment Directive (UWWTD) calls for monitoring antimicrobial resistance (AMR) in wastewater of large European agglomerations (≥ 100,000 person equivalents). Guidance on scope and methods is currently in development. Two European Joint Actions share a goal to harmonise procedures and indicators: the European Union (EU)-Wastewater Integrated Surveillance for Public Health (EU-WISH), aiming to strengthen wastewater-based surveillance (WBS) for public health and the EU-Joint Action Antimicrobial Resistance and Healthcare Associated Infections (EU-JAMRAI) 2, providing among others, approaches for environmental surveillance of AMR. An EU-WISH survey in 2024, mapping WBS AMR-related activities across Europe, revealed that of 27 countries surveyed, 11 had an operative AMR WBS system and mainly employed WBS to determine AMR trends, primarily through culture-based analyses, in-depth characterisation of specific bacteria, and quantitative PCR for specific resistance genes. Occasionally metagenomics was used. We argue that prioritising AMR WBS targets should consider the intended objectives of surveillance, which could include uncovering AMR trends and emerging AMR determinants in humans, the assessment of antimicrobial/AMR environmental release, and wastewater treatment efficiency. Targets should be assessed for their public health relevance and the usefulness of complementary information they provide, while integrating measurability, resource efficiency, and expertise from different One Health domains.