• California: The California Department of Public Health on Saturday confirmed the first U.S. case of a more aggressive strain of mpox in an individual in the state. The individual had recently traveled from eastern Africa and was treated in San Mateo County based on their travel history and symptoms. The person is now isolating at home and recovering. Currently, public health workers are contacting individuals who have had close contact with the patient but said "there is no concern or evidence" that the strain is spreading in California or the rest of the country. According to CDC, the United States is the sixth country outside of Africa to detect the strain called clade Ib, which can cause more severe disease than the version of the virus that caused an outbreak in 2022. Based on simulation exercises it ran, the agency said that it considers the risk of the virus to the U.S. population to be low. "These simulations indicate that close-contact transmissions within and between households are unlikely to result in a large number of mpox clade I cases in the United States," CDC said. (Branswell, STAT, 11/16; Bendix, NBC News, 11/16)
• Georgia: According to CDC, a E. coli outbreak linked to recalled organic carrots has so far led to dozens of illnesses, 15 hospitalizations, and at least one death across 18 states. Washington, Minnesota, and New York have reported the highest number of cases. The affected carrots were sold by Grimmway Farms, and the company initiated a recall for multiple sizes and brands of its organic baby and whole carrots. The affected carrots were sold at Trader Joe's, Wegmans, Sprouts, Target, Whole Foods, Walmart, and other stores. Although the recalled products are no longer being sold in stores, they may still be in customers' homes. The company has urged customers to discard any recalled products and clean any surfaces that they have touched. "We take our role in ensuring the safety and quality of our products seriously," said Grimmway president and CEO Jeff Huckaby. "The health of our customers and the integrity of our products are our highest priorities, and we are conducting a thorough review of our growing, harvest, and processing practices." (Gomez, USA Today, 11/18; Kim, NPR, 11/17; Alsharif/Good, NBC News, 11/17)
•   Maryland: FDA has declined to grant full approval of Intercept Pharmaceutical's drug Ocaliva, or obeticholic acid, to treat primary biliary cholangitis (PBC). PBC is a rare and chronic liver disease that primarily affects women. It causes the small bile ducts in the liver to become inflamed and destroyed, and if left untreated, it can lead to cirrhosis, liver failure, and death. In a September meeting, FDA's Gastrointestinal Drugs Advisory Committee said that the drug did not have a favorable benefit-risk profile as a second-line agent in PBC patients without contraindications. When asked whether available data supported a clinical benefit, 13 of the 14 panelists said no. According to Intercept, it will work with FDA on next steps for the drug. So far, the drug remains on the market, but it is not clear whether the agency will seek to withdraw it in the future, much like it has done with several cancer drugs that later failed confirmatory trials. In September, the European Commission revoked the drug's marketing authorization for PBC. (Ingram, MedPage Today, 11/12)

Writing for the Harvard Business Review, Jeff Levin-Scherz, Patricia Toro, Siupo Becker, and Meg Alexander of  WTW detail six considerations for employers to create effective policies that help protect workers from monkeypox.