The National Association of County and City Health Officials (NACCHO) yesterday released its 2024 Forces of Change Survey report that found that more and more local health departments are losing staff through layoffs or attrition, raising concerns about a shrinking public health safety net.

The study spotlights experiences of health departments at the county, city, and district level, including staffing and budget changes, health department governance, use of public health fellowship and training programs, the roles of public health nurses, program evaluation capacity, and activities that address the infectious disease consequences of substance use. Of 1,200 local health departments invited to complete the survey from March to June 2024, a total of 667 (56%) responded.

"The latest findings highlight critical trends and challenges faced by local health departments during a time of uncertainty in the local public health landscape," NACCHO said in a news release.

1 in 5 local health departments note job losses

The survey found that, in 2023, 19% of local health departments reported job losses—an increase from 14% in 2021 and 17% in 2022. The rate rose to nearly 40% among large local health departments. Also, 17% of local health departments reported budget cuts during fiscal year (FY) 2024, with 23% anticipating cuts in FY2025.

The latest findings highlight critical trends and challenges faced by local health departments during a time of uncertainty in the local public health landscape.

In addition, 90% of local health departments reported that nurses are involved in health promotion and protection; 72% said they are involved in emergency preparedness, disaster recovery, and cross-sector collaboration; and 41% reported that nurses contribute to policy and advocacy work.

NACCHO also reported, "In 2024, 84% of local health departments reported having programs with an evaluation component. While most incorporated evaluation into their work, nearly 60% reported challenges due to insufficient staff time or capacity."

NACCHO added, "Overall, few local health departments had individuals from training and fellowship programs assigned to their agency, which puts future workforce development at risk." NACCHO represents more than 3,300 local health departments.

Cambodia's health ministry today announced another human H5N1 avian flu case of the year, involving a 5-year-old boy from Kampot province who is hospitalized in the intensive care unit, according to a Facebook statement translated and posted by Avian Flu Diary, an infectious disease news blog.

The country has reported an uptick in human cases since late 2023, but illnesses have accelerated recently, with 9 reported since early June and 12 so far in 2025.

Boy known to play with backyard poultry

In the latest case, investigators found that the boy's family had a flock of 40 chickens, a few of which were sick or had died. The boy reportedly played with the chickens every day. Kampot province is in the far southern part of Cambodia.

H5N1 is known to circulate in Cambodian poultry, and a new reassortant is circulating that contains genes from an older Cambodian clade and genes from the global 2.3.4.4b clade. 

Human cases in Cambodia typically involve contact with poultry, and illnesses involving the older clade or the new reassortant are often severe or fatal. 

After emerging as an mpox hot spot giving the virus a worrisome foothold in West Africa, cases have declined in Sierra Leone over the past 6 weeks, part of an overall encouraging trend in Africa's outbreaks, a top official from Africa Centres for Disease Prevention and Control (Africa CDC) said today at a weekly briefing.

Yap Boum, PhD, MPH, deputy incident manager for Africa CDC's mpox response, said the case positivity in Sierra Leone last week showed a slight downward trend, a sign that the involvement of more community healthcare workers is having some success at identifying infections occurring outside of hospital settings. He also noted that Sierra Leone is having success pairing contact tracing with mpox vaccination, which he said is very efficient.

Meanwhile, Uganda has reported a slight rise in the past 3 weeks, which Boum said is expected given that the country is providing greater support for contact tracers.

Over the past week, infections in Uganda, Sierra Leone, and Zambia made up 88% of confirmed cases in Africa.

Funds for vaccine purchases dry up

Boum said though plenty of Bavarian Nordic mpox vaccine is available for purchase, there are no funds for UNICEF and other providers to buy more doses to allocate to countries. He added that the supply shortage comes at a bad time, as African countries make headway with their outbreaks and have seen good uptake in affected populations.

"This is a challenge, this is a crisis," Boum said. "This is an imperative of equity."

• The US Centers for Disease Control and Prevention (CDC), though it currently has no director, has quietly accepted three vaccine recommendations from the earlier Advisory Committee on Immunization Practices group that voted on the measures at its April meeting. Since then, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. replaced the board with eight new members, including some who closely ally with his anti-vaccine views. The acceptance of the April recommendations came without an announcement and appears on a CDC web page on ACIP recommendations. The CDC said that on June 25 Kennedy adopted a recommendation that the GSK new pentavalent (five-strain) meningococcal vaccine can be used when the quadrivalent (four-strain) and monovalent (single-strain) B vaccine are indicated at the same visit. Kennedy also adopted ACIP recommendation that adults ages 50 to 59 years old can receive a single dose of respiratory syncytial virus (RSV) vaccine if they are at risk for severe RSV disease. The CDC said it will publish a list of clinical considerations that detail conditions that put patients at increased risk for severe disease. Kennedy also adopted guidance for chikungunya vaccines, which recommends Bavarian Nordic's (BN's) new vaccine for use in travelers heading to outbreak areas and those moving to high-risk countries, use of the BN vaccine in potentially exposed lab workers, and use of Valneva's chikungunya vaccine in travelers to outbreak locations and those spending extended time in higher-risk settings.
• The New York Times reported yesterday that Vinay Prasad, MD, MPH, who leads the Food and Drug Administration (FDA) Center for Biologics Evaluation and Research, overruled agency scientists' approval recommendations for broad use of two newer COVID vaccines, Novavax's protein-based vaccine and Moderna's second-generation COVID vaccine. FDA scientists, following an extensive review, had recommended full approval of the Novavax vaccine for anyone ages 12 years and older. But in the middle of May, the FDA announced an approval limited to people ages 65 and older and younger groups with underlying health conditions. FDA scientists weighing in on Moderna's mNexspike vaccine said the new vaccine was slightly more effective than the original version, with a similar safety profile, and could be used in anyone ages 12 and older. But in early June, the FDA announced that the vaccine was approved only for use in people ages 65 and older and younger people who have health conditions that put them at greater risk for COVID complications.