Inside Outbreaks: COVID “Stratus,” Military Base Conjunctivitis, Fiji’s HIV Surge, Borna Virus in Bavaria, and the U.S. Crisis in Congenital Syphilis

In this episode of Thermometer HQ, I sit down with Dr. Jon Epstein to separate signal from noise across several outbreaks dominating headlines—and some that should be. Our goal is the same as always: translate complex surveillance data into practical takeaways for clinicians, public health leaders, and anyone tracking infectious disease risk.

COVID “Stratus” (XFG) and “Nimbus”: Evolution, Not Revolution

Let’s start with the COVID chatter. The “Stratus” (XFG) and “Nimbus” variants have earned breathless coverage—much of it focused on alleged new symptom profiles (“razor-blade” sore throat, “dry cough,” etc.). The science is more straightforward. SARS-CoV-2 continues to mutate; what matters most is whether a lineage substantially changes transmissibility, immune escape, or severity.

Right now, Stratus shows slightly more immune evasion; Nimbus looks modestly more transmissible. Neither appears to cause a clinically distinct illness from prior Omicron-lineage infections. For personal decision-making, the guidance hasn’t changed: stay current on vaccination to reduce risk of severe disease, hospitalization, and post-acute complications. Public health agencies should keep watching the growth advantage curves and neutralization data; individuals don’t need to memorize alphabet soup.

Unusual “Pink Eye” at Joint Base San Antonio–Lackland

Conjunctivitis outbreaks are common in congregate settings—but the etiology here was not. Between February and May 2025, trainees at JBSA-Lackland developed conjunctivitis caused by an atypical strain of Neisseria meningitidis (meningococcus) that lacked its usual capsule. While most conjunctivitis is viral and self-limited, this cluster underscores two truths: bacteria evolve in ways that can alter tissue tropism, and close-quarters living accelerates spread. Topical antibiotics were used in some cases; importantly, the standard meningococcal vaccine doesn’t prevent this particular presentation. Infection control basics—hand hygiene, avoiding shared towels/linens, rapid case identification—remain the backbone of response.

Fiji’s Rapid HIV Upswing—and the Risks of “Bluetoothing”

Fiji is experiencing one of the fastest-growing HIV epidemics globally, with cases rising sharply in 2025, largely linked to injection drug use (IDU). We also discuss reports of “bluetoothing”—the dangerous practice of injecting another person’s blood to seek intoxication. Beyond needle sharing, direct blood injection compounds transmission risks for HIV and other blood-borne pathogens, and can provoke transfusion reactions and bacterial sepsis. Moralizing won’t solve this. Evidence-based harm reduction will: scale-up of low-threshold testing, linkage to antiretroviral therapy, PrEP for sexual partners, medication-assisted treatment for substance use disorder, and—critically—sterile injection supplies and wound care. Public health messaging should meet people where they are, with urgency and empathy.

Ebola in the DRC: Containment Depends on Basics Done Well

The outbreak in the Democratic Republic of the Congo continues to see high case-fatality ratios and tragic losses among healthcare workers. The response toolkit is well-established—rapid case finding, isolation, ring vaccination where available, safe burials, and aggressive contact tracing—but logistics are hard in remote settings. Jon and I are cautiously optimistic that with resources now in place, control is achievable. The lesson is timeless: outbreaks bend when surveillance, community trust, and field operations align.

Borna Disease Virus in Bavaria: Rare, Severe, and Zoonotic

Germany has reported three fatal human cases of Borna disease virus (BoDV-1) this year, including a recent death in Bavaria. Primary reservoirs are shrews; humans are dead-end hosts who develop severe encephalitis after exposure to contaminated excreta. There is no vaccine or specific antiviral therapy, making prevention paramount. While risk to the general public remains low, clinicians in endemic areas should consider BoDV-1 when evaluating rapidly progressive encephalitis of unclear origin, particularly with environmental or animal exposures.

Focus Topic: The 700% Rise in Congenital Syphilis Since 2014

CDC’s 2024 STI surveillance report shows overall declines in chlamydia, gonorrhea, and syphilis—but nearly 4,000 babies were born with syphilis in 2024, up ~700% since 2014. Congenital syphilis is a preventable tragedy and a clear dashboard light for system failure. Where are the breakdowns?

1. Missed adult diagnoses and contact tracing. Men with untreated syphilis seed transmission networks. Underfunded STD programs mean fewer disease investigators, fewer partner services, and delayed treatment.
2. Gaps in prenatal screening. Pregnant people should be tested early in pregnancy, in the third trimester, and at delivery if risk persists. Missed or delayed testing equals missed prevention.
3. Treatment and follow-up barriers. Even when diagnosed, timely benzathine penicillin G may be unavailable due to supply issues, clinic access barriers, or insurance hurdles.
4. Stigma and access. Fear of judgment, clinic hours that don’t match working lives, transportation costs, and insurance churn all conspire to keep people from care.

What works: restore funding for STD clinics and disease intervention specialists; guarantee benzathine penicillin G availability; normalize opt-out prenatal syphilis screening at the recommended intervals; integrate rapid syphilis testing in emergency departments, substance-use programs, carceral settings, and community pharmacies; and expand point-of-care and at-home testing where validated. Above all, communicate without stigma. Sex is a normal human behavior; preventing congenital syphilis is a test of whether our health system can execute on basics.

Practical Takeaways

• COVID: Get your seasonal booster; don’t chase variant headlines.
• Conjunctivitis in congregate settings: Expect unusual etiologies; double down on hygiene and rapid triage.
• HIV and IDU: Scale harm reduction now; confront high-risk practices like “bluetoothing” head-on with facts and services.
• Ebola: Sustained field operations, contact tracing, and community engagement remain decisive.
• Borna virus: Rare but severe; consider in encephalitis with relevant exposures.
• Congenital syphilis: Screen early, screen often in pregnancy; rebuild the STD prevention workforce and supply chain.

Public health may be multidisciplinary, but our north star is simple: prevent avoidable harm. These stories remind us that surveillance without services is just data; it’s the bridge to testing, treatment, vaccination, and supportive care that saves lives.

👉 Watch the full episode on YouTube: https://youtu.be/IUGJZUKBnmY