Naegleria fowleri and the future of surveillance: A one-health call to action

<i>Naegleria fowleri</i> causes primary amoebic meningoencephalitis (PAM), a rapidly fatal central nervous system infection acquired through nasal exposure to contaminated water. PAM cases are rare but increasingly reported across wider geographic areas and through emerging exposure routes in humans and animals. Environmental detections of <i>N. fowleri</i> are rising, yet surveillance remains sparse and is often triggered only after clinical cases are identified. This reactive approach delays risk mitigation and limits opportunities for prevention. Rising temperatures, inadequate water treatment, and shifting water use patterns may expand the organism's ecological range. This short communication advocates for proactive environmental and clinical surveillance of <i>N. fowleri</i> as a One Health priority. Drawing on global examples, we propose routine monitoring of high-risk water systems, standardization of detection protocols, and case notification requirements. Together with public education in vulnerable settings, these efforts can strengthen preparedness and improve outcomes for a preventable and nearly universally fatal infection.