Assessments
Time-bound predictions under active review, including assessments that reached horizon and still need a final human resolution.
Time-bound predictions under active review, including assessments that reached horizon and still need a final human resolution.
Public note
For situational awareness and research transparency. Not medical advice.
At least one additional EU/G7 country beyond Spain will report a documented Clade Ib mpox sustained transmission cluster (≥5 epidemiologically linked cases over ≥3 weeks) by September 30 2026, driven by the WHO DON587-confirmed multi-mode global Clade Ib spread and cross-border network linkage with Spain's ongoing outbreak.
Chikungunya will establish autochthonous transmission in at least one subtropical East Asian city outside Guangdong Province (e.g., Taiwan, South Korea, or Japan) during the 2026 or 2027 vector season, based on the documented 2025 Guangzhou urban epidemic demonstrating CHIK transmission competence in a temperate-subtropical East Asian megacity.
At least one PEPFAR-dependent sub-Saharan African country will report a ≥20% absolute decline in HIV viral-load testing volume in 2025 vs 2024, published in PEPFAR Country Operational Plan data, WHO HIV reports, peer-reviewed literature, or official MoH statistics within 180 days.
At least one peer-reviewed or official PEPFAR/Global Fund/WHO report will document ≥5 percentage-point absolute decline in 12-month viral suppression rate, or ≥1,000 confirmed ART-interruption cases, in a PEPFAR-supported sub-Saharan African cohort attributable to the 2025 U.S. foreign-aid disruption, within 180 days.
At least one prospective cohort study will document ARG vertical transfer from mother to neonate as a measurable predictor of neonatal treatment outcomes, demonstrating that community AMR carriage surveillance systematically underestimates baseline population ARG burden
CDC 2026 AR Threats Report (electronic release) will document that ≥3 of the 6 hospital-onset AMR pathogen groups tracked in the 2024 special report (CRAB, CRE, ESBL-Ent, MRSA, MDR-Pa, VRE) remain ≥10% above pre-pandemic 2019 baseline through 2024 surveillance data, confirming sustained post-COVID AMR backslide rather than recovery.
Burundi mystery illness cluster (≥5 deaths, flagged by Africa CDC/CIDRAP Apr 17 2026) will be laboratory-confirmed as a viral hemorrhagic fever agent by WHO DON or Africa CDC within 60 days.
A confirmed MPXV inter-clade recombinant strain (Ia/Ib or Ib/IIb genomic elements) will be reported in a peer-reviewed publication or WHO/Africa CDC bulletin within 180 days, arising from DRC tri-clade co-circulation confirmed Apr 3 2026.
California CDPH will issue a formal mpox Clade I cluster alert or public health emergency with ≥10 confirmed cases by 2026-07-19, based on CDPH messaging shift to statewide surge framing within 72h of the Apr 16 SF index case.
Nepal-India South Asian H5N1 poultry outbreak corridor will generate at least one confirmed human H5N1 case in a South Asian agricultural worker (Nepal, India, or Bangladesh) by Q3 2026, given the ongoing multi-district bird outbreak in Nepal as of April 2026 and concurrent India Karnataka poultry confirmation.
H5N1 HPAI will be confirmed in at least one additional pinniped species or new geographic colony beyond the February 2026 California northern elephant seal index cases, expanding the confirmed US marine mammal reservoir footprint along the Pacific coast by Q3 2026.
H5N1 clade 2.3.4.4b will establish sustained cattle-to-cattle transmission in at least 3 US states by Q2 2026.
At least one confirmed human H5N1 case with no direct poultry contact will be reported by a T1 source before July 2026.
Rift Valley fever will see ≥1 new laboratory-confirmed human outbreak cluster (≥5 cases) reported in Senegal, Mauritania, Kenya, Tanzania, or Sudan between 2026-04-20 and 2026-10-20, following the Sep-Oct 2025 Senegal/Mauritania re-emergence (17 deaths Senegal, Africa CDC "comeback" flag Sep 30 2025) and known seasonal/climate-driven pattern.</magnitude> <parameter name="key_assumption">RVF outbreaks in Sahel follow heavy rainfall patterns; 2025 rains were documented as elevated. Senegal and Mauritania cross-border circulation has ongoing mosquito transmission cycle. CEPI/Oxford/Serum stock...
Clade Ib non-sexual community or healthcare-associated transmission documented in at least one high-income non-African country within 120 days, based on CIDRAP/EurekAlert Dec 2025 evidence of shifting transmission pathways in DRC and Ireland, extended incubation periods, and Spain's ongoing surge driven by vaccination gaps.
The Burundi mystery-illness cluster (≥5 deaths, flagged by Africa CDC per CIDRAP Apr 17 2026) will be laboratory-confirmed within 30 days as either (a) a viral hemorrhagic fever (Ebola, Marburg, Sudan virus, CCHF, or RVF) OR (b) not-VHF (Lassa-negative, filovirus-negative, bacterial/food/chemical etiology). Directional forecast: NOT-VHF is more likely than VHF given typical mystery-cluster etiology distribution, but Great Lakes location (borders DRC, Rwanda, Tanzania) keeps VHF probability meaningfully elevated (~15-25%).</magnitude> <parameter name="key_assumption">Africa CDC / Burundi MoH...
At least one confirmed Clade Ib case in the United States linked to the Mexico-US border corridor (distinct from the San Francisco Clade I case) within 90 days, based on Mexico's confirmed Clade Ib Jan 2026, high-volume cross-border movement, and CDC diagnostic pause creating federal detection gaps.
India will confirm sustained domestic Clade Ib community transmission (≥3 epidemiologically linked locally-acquired cases without direct foreign travel history) within 90 days, based on: Kerala confirmed Clade Ib Jan 2026 with scientists warning of sustained spread; India surveillance gaps noted by Down To Earth; Pakistan Sindh multi-district Clade Ib on India's western border (25 cases, 9 deaths).
Benue State, Nigeria Lassa fever outbreak will cumulatively record ≥20 healthcare worker deaths (from baseline 10 as of Feb 27 2026 per Premium Times Nigeria) by Jun 20 2026, indicating continued nosocomial amplification despite MSF-supported IPC response.</magnitude> <parameter name="key_assumption">Baseline: 10 HCW deaths (Premium Times, Nigerian Observer Feb 27-Mar 3 2026), 15 HCW infections (Punch Feb 22), 5 doctors affected (Premium Times). MSF response began Apr 10-14 2026 (Tribune, Apex). IPC gaps in Benue hospitals well-documented in prior Lassa waves. HCW CFR typically 20-40% for L...
Nigeria NCDC cumulative Lassa fever case count for 2026 will exceed 800 (with deaths >200) by end-Jul 2026, consistent with NCDC trajectory: 469 cases/109 deaths by Mar 17 2026 (Guardian Nigeria) escalating to 170 deaths by Apr 16 2026 (Arise News) during active peak-season transmission and Benue State outbreak.</magnitude> <parameter name="key_assumption">Lassa fever is hyperendemic in Nigeria with annual peak Jan-May; NCDC weekly sitreps and case/death counts are canonical T1 source. Current 2026 trajectory (469→after 4 weeks >600 implied by 170 deaths at CFR ~20-25%) tracks above histori...
At least one peer-reviewed case series or national surveillance report documenting mcr-type colistin resistance co-resident on the same plasmid as NDM or KPC carbapenemase in a US or EU clinical isolate will be published by 2027-04-20, marking the domestication of the South Asia/Southeast Asia CRE-colistin co-resistance mechanism in western healthcare. Thailand CRKP/colistin genomic surveillance (Nature Jan 2026) documents ST11/ST258/ST307 co-resistance via single mobile plasmid; same high-risk clones dominate US CRE outbreaks. One confirmed case of co-plasmid mcr/NDM in US or EU = last-res...
At least one MPXV Clade I or Clade Ib case in the California cluster (or a direct epidemiological contact) will demonstrate tecovirimat treatment failure — defined as progressive or non-resolving lesions after ≥14 days of standard-dose therapy — documented by CDC, CDPH, or peer-reviewed source by 2026-07-19. F13L mutation conferring phenotypic resistance is already documented in Clade IIb (Contag et al., EID Dec 2023, PMC10683816); if the SF/California Clade I exposure is reaching immunocompromised hosts (HIV/AIDS, oncology patients) — the highest-risk population for resistance selection — ...
XDR Shigella will be documented causing nosocomial or healthcare-associated transmission in immunocompromised patient wards (oncology, HIV, transplant) in at least one US academic medical center by end 2026, establishing a new healthcare transmission pathway distinct from the MSM sexual network
XDR Shigella (resistant to azithromycin + fluoroquinolones + 3GC simultaneously) proportion in PulseNet US surveillance will exceed 10% of submitted isolates by end of 2026, up from 8.5% in 2023 (MMWR mm7513a1 data endpoint). CIDRAP Jan 14 2026 reported "novel XDR Shigella strain identified in Los Angeles" — the only confirmed 2026 XDR Shigella signal. MMWR 2011-2023 trend shows acceleration: 0% pre-2016 → 8.5% by 2023, with 84% of XDR cases in 2022-2023.
At least one US cluster (≥5 epidemiologically linked cases) of ceftriaxone-resistant Neisseria gonorrhoeae will be confirmed via CDC GISP/ARLN by mid-2027, prompting updated STI treatment guidelines. WHO Nov 2025 warned of "rising, worrisome levels" globally; Healio/CIDRAP Dec 2025 confirmed global surge; FDA approved first new gonorrhoea treatment (zoliflodacin) Dec 2025 specifically because of resistance trajectory.
Candida auris clinical cases reported to CDC will exceed 12,000 cumulative by end of 2026 (from 7,700+ confirmed Jan 2026), with echinocandin resistance proportion exceeding 5% nationally. CDC Feb 2026 study confirms "substantial antifungal resistance"; C. auris spreading through NY/NJ/MI hospital networks (CBS Jan 2026, MLive Dec 2025).
A phylogenetically linked XDR Shigella case will be documented outside the United States by October 2026, tracing to the Los Angeles novel XDR strain identified December 2024/January 2026 via the MSM sexual transmission network
At least one additional case of XDR Shigella sonnei carrying BOTH blaDHA-1 (cephalosporinase) and blaCTX-M-15 (ESBL) — the dual-cephalosporinase phenotype first reported in two epidemiologically unlinked LA patients (Yang et al., Antimicrobial Stewardship & Healthcare Epidemiology, CIDRAP 2026-01-14) — will be reported in any T1 source (CDC, MMWR, peer-reviewed journal, ECDC, GLASS) by 2026-07-21.
WHO will issue a global health advisory or Disease Outbreak News specifically addressing the XDR Shigella phenotype (azithromycin + fluoroquinolone + 3GC resistant) within 90 days of the US April 2026 emergence cluster, recognizing international spread risk.
FDA will initiate a formal regulatory pathway (emergency use, compassionate use IND, or expedited NDA) for pivmecillinam in the US within 180 days of the April 2026 XDR Shigella emergence, given that XDR phenotype (azithromycin + FQ + 3GC resistant) leaves only carbapenems and pivmecillinam as clinically viable options, and pivmecillinam is currently approved in Europe and Canada but not FDA-approved.