H5N1

Social determinants of health and premature death among adults in the USA from 1999 to 2018: A national cohort study

Via The Lancet Public Health: Social determinants of health and premature death among adults in the USA from 1999 to 2018: a national cohort study. The summary:

Background  

Racial and ethnic disparities in mortality persist in the US population. We studied the contribution of social determinants of health (SDoH) to racial and ethnic disparities in premature death.  

Methods  

A nationally representative sample of individuals aged 20–74 years who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were included. Self-reported SDoH (employment, family income, food security, education, access to health care, health insurance, housing instability, and being married or living with a partner) were collected in each survey cycle. Participants were categorised into four groups of race and ethnicity: Black, Hispanic, White, and other. Deaths were ascertained from linkage to the National Death Index with follow-up until 2019. Multiple mediation analysis was used to assess simultaneous contributions of each individual SDoH to racial disparities in premature all-cause mortality.  

Findings  

We included 48 170 NHANES participants in our analyses, consisting of 10 543 (21·9%) Black participants, 13 211 (27·4%) Hispanic participants, 19 629 (40·7%) White participants, and 4787 (9·9%) participants of other racial and ethnic groups. Mean survey-weighted age was 44·3 years (95% CI 44·0–44·6), 51·3% (50·9–51·8) of participants were women, and 48·7% (48·2–49·1) were men. 3194 deaths before age 75 years were recorded (930 Black participants, 662 Hispanic participants, 1453 White participants, and 149 other participants).  

Black adults had significantly higher premature mortality than other racial and ethnic groups (p<0·0001): premature death rates per 100 000 person-years were 852 (95% CI 727–1000) for Black adults, 445 (349–574) for Hispanic adults, 546 (474–630) for White adults, and 521 (336–821) for other adults. Unemployment, lower family income, food insecurity, less than high school education, no private health insurance, and not being married nor living with a partner were significantly and independently associated with premature death.  

Dose–response associations were observed between cumulative number of unfavourable SDoH and premature all-cause mortality: hazard ratios (HRs) were 1·93 (95% CI 1·61–2·31) for those with one unfavourable SDoH, 2·24 (1·87–2·68) for those with two, 3·98 (3·34–4·73) for those with three, 4·78 (3·98–5·74) for those with four, 6·08 (5·06–7·31) for those with five, and 7·82 (6·60–9·26) for those with six or more unfavourable SDoH (p<0·0001 for linear trend).  

After adjusting for SDoH, HRs for premature all-cause mortality for Black adults compared with White adults decreased from 1·59 (1·44–1·76) to 1·00 (0·91–1·10), suggesting complete mediation of this racial difference in mortality.  

Interpretation  

Unfavourable SDoH are associated with increased rates of premature death and contribute to differences between Black and White racial groups in premature all-cause mortality in the US population. Innovative public health policies and interventions targeting SDoH are needed to reduce premature deaths and health disparities in this population.

China’s rolling COVID waves could hit every six months — infecting millions

Via Nature: China’s rolling COVID waves could hit every six months — infecting millions. Excerpt:

The latest surge in COVID-19 cases in China is not surprising to researchers, who say that China will see an infection cycle every six months now that all COVID-19 restrictions have been removed and highly infectious variants are dominant. But they caution that rolling waves of infection carry the risk of new variants emerging.  

“Unfortunately, a new reality with this virus [is that] we will have repeated infections,” says Ali Mokdad, an epidemiologist at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “The fear is that this virus will produce a new variant that can compete with the current ones and is more severe.”  

The current surge is caused mainly by a highly infectious subvariant of Omicron called XBB.1.5, first identified in India last August. According to Nanshan Zhong, a prominent respiratory physician in China, as many as 65 million people could become infected per week by the end of June.  

This is the first major reinfection wave that China has seen since the central government dropped all its COVID-19 control measures in December, prompting a widespread Omicron outbreak.  

China has vaccinated more than 90% of its population, and the outbreak in December infected at least 85% of its people, says Zhong. But immunity is waning, and XBB can evade protection from vaccines and prior infections. Mokdad says that, although XBB has not caused a major rise in hospitalizations and deaths, the sheer number of infections could put pressure on China’s health-care system.  

XBB is also causing minor waves in other parts of the world, such as Singapore and the United States.  

“This is what we see everywhere, but with a large population such as China, it is more apparent,” says Mokdad.  

Yunlong Cao, an immunologist at Peking University in Beijing, and his team have found that antibodies generated against Omicron variants BA.5 and BF.7, the dominant strains during the December wave in China, can provide about four months of protection against strains such as XBB.  

Kayoko Shioda, an epidemiologist at Boston University in Massachusetts, says that previous COVID-19 surges in other countries have shown that XBB is more transmissible than earlier forms. “Once it enters the population, XBB spreads and becomes the predominant variant much quicker than other variants,” she says.  

Last December, more than 200 million people in China contracted COVID-19 in 20 days. This time, the wave is spanning several months, owing to the differences in people’s immune backgrounds, such as antibody levels, says Cao.  

“The peak of COVID-19 waves will generally become flatter and more stretched out after each cycle, which is a pattern we see in countries like the US. People are still getting infected in the US, just not all at once,” he adds. A flatter wave would also lessen the burden on health-care systems, Cao says.

CHP closely monitors human case of avian influenza A(H5N6) in Mainland

Thanks to FluTrackers for alerting me to this report from the Hong Kong Centre for Health Protection: CHP closely monitors human case of avian influenza A(H5N6) in Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health is today (June 5) closely monitoring a human case of avian influenza A(H5N6) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.        

The case involves a 54-year-old female living in Nanchong, Sichuan, who had exposure to live domestic poultry before the onset of symptoms. She developed symptoms on May 19 and was admitted for treatment on the same day. She is in serious condition.        

From 2014 to date, 84 human cases of avian influenza A(H5N6) have been reported by Mainland health authorities.        

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," a spokesman for the CHP said.      

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.      

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

Surveillance for violent deaths — National Violent Death Reporting System, 48 states, the District of Columbia, and Puerto Rico, 2020

Via MMWR, a long, grim report: Surveillance for Violent Deaths — National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020. Excerpt:

The COVID-19 Pandemic and Homicide

Research using NVDRS data to examine the circumstances of COVID-19 pandemic–related homicides are ongoing, but studies have already underscored the changes in homicide rates. The overall firearm homicide rate in 2020 was higher than it has been in the last 20 years. 

This increase was disproportionately experienced by AI/AN and Black persons. The increased social and economic stressors attributable to the COVID-19 pandemic and associated mitigation measures (e.g., job loss and disruptions in emergency services) might have exacerbated the systemic inequities that have been found to increase risk for experiencing violence. 

These stressors might also have increased risk for intimate partner violence and child abuse and neglect. Early pandemic reports indicated increased arrests and police calls related to intimate partner violence, and despite fewer visits, a higher proportion of emergency department visits were child abuse and neglect related. 

Additional research on the impact that the COVID-19 pandemic and mitigation measures might have had on increases in homicide rates and potential changes in the contextual factors and characteristics of these fatal incidents is needed.

Animal health body urges bird flu vaccination to avoid pandemic

Via Reuters: Animal health body urges bird flu vaccination to avoid pandemic. Excerpt:

PARIS, May 21 (Reuters) - Governments should consider vaccinating birds against bird flu to avoid the virus - which has already killed hundreds of millions of birds and infected mammals worldwide - turning into a new pandemic, the head of the World Animal Health Organisation (WOAH) said.  

The severity of the current outbreak of avian influenza, commonly called bird flu, and the economic and personal damage it has caused, has led governments to reconsider vaccinating poultry. However, some, like the United States, remain reluctant mainly because of the trade curbs this would entail.

"We are coming out of a COVID crisis where every country realised the hypothesis of a pandemic was real," WOAH Director General Monique Eloit told Reuters in an interview.  

"Since almost every country that does international trade has now been infected, maybe it's time to discuss vaccination, in addition to systematic culling which remains the main tool (to control the disease)," she said.  

The WOAH is holding a five-day general session from Sunday, and will be focus on global control of highly pathogenic avian influenza, or HPAI. 

A WOAH survey showed only 25% of its member states would accept imports of products from poultry vaccinated against HPAI.  

The European Union's 27 member states agreed last year to implement a bird flu vaccine strategy. France is set to be the first one, starting with ducks in the autumn.  

"If a bloc like the EU, which is a large exporter, starts moving in that direction, it will have a ricochet impact," Eloit said.  

The U.S. department of Agriculture (USDA) told Reuters on Friday that "in the interest of leaving no stone unturned in the fight against HPAI, USDA continues to research vaccine options that can protect poultry from this persistent threat".  

However, it still considers biosecurity measures to be the most effective tool for mitigating the virus in commercial flocks, it said in emailed answers.

WHO launches global network to detect and prevent infectious disease threats

A WHO news release: WHO launches global network to detect and prevent infectious disease threats. Excerpt:

WHO and partners are launching a global network to help protect people from infectious disease threats through the power of pathogen genomics. The International Pathogen Surveillance Network (IPSN) will provide a platform to connect countries and regions, improving systems for collecting and analyzing samples, using these data to drive public health decision-making, and sharing that information more broadly.  

Pathogen genomics analyzes the genetic code of viruses, bacteria and other disease-causing organisms to understand how infectious they are, how deadly they are, and how they spread. With this information, scientists and public health officials can identify and track diseases to prevent and respond to outbreaks as part of a broader disease surveillance system, and to develop treatments and vaccines.  

The IPSN, with a Secretariat hosted by the WHO Hub for Pandemic and Epidemic Intelligence, brings together experts worldwide at the cutting-edge of genomics and data analytics, from governments, philanthropic foundations, multilateral organizations, civil society, academia and the private sector. All share a common goal: to detect and respond to disease threats before they become epidemics and pandemics, and to optimize routine disease surveillance.  

The goal of this new network is ambitious, but it can also play a vital role in health security: to give every country access to pathogen genomic sequencing and analytics as part of its public health system,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.  “As was so clearly demonstrated to us during the COVID-19 pandemic, the world is stronger when it stands together to fight shared health threats.”  

COVID-19 highlighted the critical role pathogen genomics plays in responding to pandemic threats. Without the rapid sequencing of the SARS-COV-2 genome, vaccines would not have been as effective, or have been made available so quickly. New, more transmissible variants of the virus would not have been as quickly identified.  

Genomics lies at the heart of effective epidemic and pandemic preparedness and response, as well as part of the ongoing surveillance of a vast range of diseases, from foodborne diseases and influenza to tuberculosis and HIV. Its use in monitoring the spread of HIV drug resistance, for example, has led to antiretroviral regimes that have saved countless lives.

WHO: Urgent action needed to tackle stalled progress on health-related Sustainable Development Goals

A WHO news release: Urgent action needed to tackle stalled progress on health-related Sustainable Development Goals. Excerpt:

WHO is releasing the 2023 edition of its annual World Health Statistics report with new figures on the impact of COVID-19 pandemic and the latest statistics on progress towards the health-related Sustainable Development Goals (SDGs).  

The report with data up to 2022 underscores a stagnation of health progress on key health indicators in recent years compared with trends seen during 2000-2015. It also alerts us to the growing threat of noncommunicable diseases (NCDs) and climate change, and calls for a coordinated and strengthened response.  

COVID-19 cost in lost lives and health progress  

The report documents updated statistics on the toll of the pandemic on global health, contributing to the ongoing decline in progress towards the SDGs. During 2020-2021, COVID-19 resulted in a staggering 336.8 million years of life lost globally. This equates to an average of 22 years of life lost for every excess death, abruptly and tragically cutting short the lives of millions of people.  

Since 2000, we saw significant improvements in maternal and child health with deaths falling by one-third and one-half, respectively. The incidence of infectious diseases such as HIV, tuberculosis (TB) and malaria also declined, along with a lowered risk of premature deaths from NCDs and injuries. Together, these contributed to an increase in global life expectancy from 67 years in 2000 to 73 years in 2019.  

However, the pandemic has put many health-related indicators further off-track and contributed to inequalities in access to high-quality health care, routine immunizations and financial protection. As a result, improving trends in malaria and TB have been reversed, and fewer people were treated for neglected tropical diseases (NTDs).  

“The World Health Statistics is WHO’s annual check-up on the state of the world’s health. The report sends a stark message on the threat of noncommunicable diseases, which take an immense and increasing toll on lives, livelihoods, health systems, communities, economies and societies,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.  “The report calls for a substantial increase in investments in health and health systems to get back on track towards the Sustainable Development Goals.”

Excess mortality and years of potential life lost among the Black population in the US, 1999-2020

Via JAMA, an appalling report: Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020. The key points and abstract:

Key Points 

Question  How many excess deaths and years of potential life lost for the Black population, compared with the White population, occurred in the United States from 1999 through 2020?  

Findings  Based on Centers for Disease Control and Prevention data, excess deaths and years of potential life lost persisted throughout the period, with initial progress followed by stagnation of improvement and substantial worsening in 2020. The Black population had 1.63 million excess deaths, representing more than 80 million years of potential life lost over the study period.  

Meaning  After initial progress, excess mortality and years of potential life lost among the US Black population stagnated and then worsened, indicating a need for new approaches.  

Abstract  

Importance  Amid efforts in the US to promote health equity, there is a need to assess recent progress in reducing excess deaths and years of potential life lost among the Black population compared with the White population.  

Objective  To evaluate trends in excess mortality and years of potential life lost among the Black population compared with the White population.  

Design, setting, and participants  Serial cross-sectional study using US national data from the Centers for Disease Control and Prevention from 1999 through 2020. We included data from non-Hispanic White and non-Hispanic Black populations across all age groups.  

Exposures  Race as documented in the death certificates.  

Main outcomes and measures  Excess age-adjusted all-cause mortality, cause-specific mortality, age-specific mortality, and years of potential life lost rates (per 100 000 individuals) among the Black population compared with the White population.  

Results  From 1999 to 2011, the age-adjusted excess mortality rate declined from 404 to 211 excess deaths per 100 000 individuals among Black males (P for trend <.001). However, the rate plateaued from 2011 through 2019 (P for trend = .98) and increased in 2020 to 395—rates not seen since 2000. Among Black females, the rate declined from 224 excess deaths per 100 000 individuals in 1999 to 87 in 2015 (P for trend <.001). There was no significant change between 2016 and 2019 (P for trend = .71) and in 2020 rates increased to 192—levels not seen since 2005. The trends in rates of excess years of potential life lost followed a similar pattern. From 1999 to 2020, the disproportionately higher mortality rates in Black males and females resulted in 997 623 and 628 464 excess deaths, respectively, representing a loss of more than 80 million years of life. Heart disease had the highest excess mortality rates, and the excess years of potential life lost rates were largest among infants and middle-aged adults.  

Conclusions and relevance  Over a recent 22-year period, the Black population in the US experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost when compared with the White population. After a period of progress in reducing disparities, improvements stalled, and differences between the Black population and the White population worsened in 2020.

Bird flu could become the next human pandemic – and politicians aren’t paying attention

Via The Guardian, an op-ed: Bird flu could become the next human pandemic – and politicians aren’t paying attention. Excerpt:

Since November, the signals emerging across the world continue to be worrying. In January and February this year, more than 3,000 sea lions died of bird flu in Peru (where the death toll in wild birds reached an estimated 50,000). In Russia, 700 Caspian seals died. Then several dolphins in Britain and the US died of H5N1. Normally, even if an animal catches H5N1 from a bird, it can’t pass it to other mammals. This limits its spread. But the large number of cases in these outbreaks suggest the possibility of mammal-to-mammal transmission, although this hasn’t been confirmed yet by genetic sequencing. A more likely hypothesis is that these outbreaks are groups of animals feeding on infected birds. It is not yet 100% clear what’s happening.  

But the risk of spread among mammals is ever-present. A new research pre-print from Canada showed that H5N1 samples could spread efficiently between ferrets with fatal outcomes. In order to spread efficiently to humans, H5 would need three major categories of genetic changes, according to bird flu expert Prof Richard Webby. So far, the virus has been able to make one of these changes, but not the other two. 

So right now, H5N1 is a theoretical risk for the next human pandemic, rather than one requiring urgency in response today. And a prime minister or health secretary might say, “Why prepare for something that might never happen?” 

To those of us scientists working in global health, there are enough concerning signals that action should already be happening. So that if a certain set of mutations do occur and we see an outbreak in humans in Peru or China or Britain, that the harm it could cause is minimal. This is a disease with an estimated 50-60% fatality rate in humans, including children.  

The cornerstone of infectious disease preparedness is in: surveillance (to know what strain is spreading and where in birds); testing (to identify disease quickly in humans); vaccines (for protection against disease and death); and antivirals (to improve clinical outcomes). The US government is already moving in this direction. Rebecca Katz, professor at Georgetown University Medical Center, has noted that a H5 candidate vaccine virus recently produced by the US Centers for Disease Control and Prevention is likely to provide good protection against the circulating H5N1 viruses.  

The information has been shared with vaccine manufacturers to start the process of stockpiling adequate doses. But this is a challenge because most influenza vaccines are created by incubating doses in chicken eggs (called egg-based production). If bird flu has killed off many of the chickens, then egg shortages are likely. There’s another H5N1 vaccine which is non-egg based, but they could have a maximum of 150m doses ready within six months. The world’s population is almost 8 billion.  

In addition, the FDA-approved antiviral treatments for seasonal influenza could also work against bird flu. But again, getting doses to all parts of the world is a challenge given shortages. Preparation must also involve appropriate PPE for healthcare workers to protect against a respiratory disease (flu) and diagnostics to quickly identify if someone is infectious in hospitals.  

All of these issues are solvable with precise planning, collaboration across countries, scientific ingenuity and good leadership. With post Covid-19 fatigue, the bigger problem is bringing the public along and communicating the facts so that they are trusted and believed. With so much – often understandable – mistrust in our current political leadership, authorities like chief medical officers and independent government advisers become crucial.

Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic

Via PLOS Medicine: Mental health and addiction health service use by physicians compared to non-physicians before and during the COVID-19 pandemic: A population-based cohort study in Ontario, Canada. The abstract:

Background  

The Coronavirus Disease 2019 (COVID–19) pandemic has exacerbated mental health challenges among physicians and non–physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non–physicians, before and during the COVID–19 pandemic.  

Methods and findings  

We conducted a population–based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario’s universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non–physicians. We compared the first 18 months of the COVID–19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID–19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in–person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses.  

Pre–pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non–physicians.  

During the first 18 months of the COVID–19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person–years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non–physicians (615.5 pre versus 675.9 during per 1,000 person–years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non–physicians during the first 18 months of the pandemic.  

Limitations include residual confounding between physician and non–physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access.   

Conclusions  

The first 18 months of the COVID–19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non–physicians. These findings suggest physicians may have had larger negative mental health during COVID–19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness.

Health officials won't publicly admit scale of 'crisis' at Surrey Memorial Hospital ER, doctors' letter says

Via CBC News, yet more evidence of our health system's failure—and not just in one city or province, but nationwide: Health officials won't publicly admit scale of 'crisis' at Surrey Memorial Hospital ER, doctors' letter says. Excerpt:

Dozens of physicians working inside the busiest emergency room in British Columbia have released a scathing letter describing an unrelenting "crisis" at the department, claiming the local health authority has "repeatedly" asked them to keep details of the situation from the public.  

The medical professionals at Surrey Memorial Hospital said it's become necessary to speak out in violation of communications protocol because health-care leaders have not been transparent about the dire reality of overcrowding and inadequate staffing in the facility.  

More than 35 emergency physicians at the hospital backed the page-long letter that says patients are suffering and, in some cases, dying in hallways as a result of "steadily worsening" problems.  

"We have been repeatedly sounding the alarm to our regional and provincial leaders; these alarms have been ignored," read the letter dated Friday and obtained by CBC News.  

"Additionally, these conditions have been poorly and incompletely communicated to the public. We feel that patients and the public deserve honesty. Fraser Health has repeatedly told ER physicians to not openly discuss our 'challenges' with the public."  

CBC News is withholding the physicians' identities as they fear professional repercussions for releasing the letter.   

"It's scary, and we know we're going to get blowback on this. All we want to do is go to work and look after our patients in a reasonable way — and we feel like there's an incomplete truth that's been told," one physician said in an interview.  

"When a patient comes into the emergency department, and they see how busy it is, they see patients in hallways and corridors, there's a natural feeling that the emergency department is failing — and, truly, the emergency department is failing," they added.  

"But the failure is not because of your frontline emergency physicians, nurses, allied staff ... It's actually the system that's failing your emergency providers, and we don't have the resources to provide safe and appropriate care for all patients."

3 key issues, letter says  

The letter said three critical issues are contributing to the problem.  

First, a lack of acute care beds means patients who have already been admitted are taking up room usually reserved for incoming emergencies.  

"This bed-block forces us to routinely treat strokes, heart attacks, traumas, miscarriages and palliative patients in the hallway," the letter read.  

Second, the physicians said there are not enough hospitalists to admit patients from the emergency room to other wards, meaning patients linger in the emergency department for days. Doctors said some die while waiting.  

Third, the letter said elected leaders have failed to provide any "meaningful solutions" to the problem.   

The physician who spoke in an interview said the doctors decided to release the statement Monday after previous letters sent "all the way up the food chain," including to the B.C. Ministry of Health did not result in accountability or transparency.

ECDC: Avian influenza overview March – April 2023

ECDC has published Avian influenza overview March – April 2023. The executive summary::

Poultry outbreaks occurred less frequently compared to the previous reporting period and compared to spring 2022. Most of these outbreaks were classified as primary outbreaks without secondary spread and some of them associated with atypical disease presentation, in particular low mortality. In wild birds, black-headed gulls continued to be heavily affected, while also other threatened wild bird species, such as the peregrine falcon, showed increased mortality. 

The ongoing epidemic in black-headed gulls, many of which breed inland, may increase the risk for poultry, especially in July-August, when first-year birds disperse from the breeding colonies. HPAI A(H5N1) virus also continued to expand in the Americas, including in mammalian species, and is expected to reach the Antarctic in the near future. 

HPAI virus infections were detected in six mammal species, particularly in marine mammals and mustelids, for the first time, while the viruses currently circulating in Europe retain a preferential binding for avian-like receptors. Since 13 March 2022 and as of 10 May 2023, two A(H5N1) clade 2.3.4.4b virus detections in humans were reported from China (1), and Chile (1), as well as three A(H9N2) and one A(H3N8) human infections in China.    

The risk of infection with currently circulating avian H5 influenza viruses of clade 2.3.4.4b in Europe remains low for the general population in the EU/EEA, and low to moderate for occupationally or otherwise exposed people.

Marburg virus disease - Equatorial Guinea and the United Republic of Tanzania

A WHO disease outbreak news report: Marburg virus disease - Equatorial Guinea and the United Republic of Tanzania. Excerpt:

Situation at a glance   

Equatorial Guinea and the United Republic of Tanzania have been responding to separate outbreaks of Marburg virus disease (MVD) since early February and late March 2023, respectively.   

In Equatorial Guinea, from 13 February to 1 May 2023, 17 laboratory-confirmed MVD cases and 23 probable cases have been reported. The last confirmed case was reported on 20 April. Among the laboratory-confirmed cases, there are 12 deaths (Case Fatality Ratio (CFR) 75%).For one confirmed case, the outcome is unknown. Among the confirmed cases, four have recovered. All of the probable cases are dead. The most affected district is Bata in Litoral province, with 11 laboratory-confirmed MVD cases reported.   

In the United Republic of Tanzania, between 16 March to 30 April 2023, a cumulative total of nine cases including eight laboratory-confirmed cases and one probable case have been reported. The last confirmed case was reported on 11 April 2023. A total of six deaths (CFR 66.7%) have been reported, including one probable case and five among the confirmed cases. Among the confirmed cases, three have recovered. All cases have been reported from Bukoba district, Kagera region.   

Health authorities in both countries have shown strong political commitment. In recent weeks they have further strengthened critical response functions, such as disease surveillance, including at points of entry; laboratory activities; clinical case management; infection prevention and control; risk communication and community engagement; and operations support and logistics with support of WHO and partners.  

WHO continues to monitor the situation in these two countries closely and to support the responses.

CDC: Provisional Mortality Data — United States, 2022

Via MMWR: Provisional Mortality Data — United States, 2022. The summary:

Summary  

What is already known about this topic?  

More than 3.2 million persons died in the United States during January–December 2022.  

What is added by this report?  

The overall age-adjusted U.S. death rate decreased by 5.3% from 2021 to 2022. Overall death rates and COVID-19–associated death rates were highest among non-Hispanic Black or African American persons and non-Hispanic American Indian or Alaska Native persons.  

What are the implications for public health practice?  

Provisional death estimates provide an early signal about shifts in mortality trends. Timely and actionable data can guide public health policies and interventions for populations experiencing higher mortality.

WHO: "It is time to transition to long-term management of the COVID-19 pandemic"

From the World Health Organization: Statement on the fifteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic. Excerpt, with WHO's bolding:

The WHO Director-General has the pleasure of transmitting the Report of the fifteenth meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the coronavirus 2019 disease (COVID-19) pandemic, held on Thursday 4 May 2023, from 12:00 to 17:00 CET.  

During the deliberative session, the Committee members highlighted the decreasing trend in COVID-19  deaths, the decline in COVID-19 related hospitalizations and intensive care unit admissions, and the high levels of population immunity to SARS-CoV-2. The Committee’s position has been evolving over the last several months. While acknowledging the remaining uncertainties posted by potential evolution of SARS-CoV-2, they advised that it is time to transition to long-term management of the COVID-19 pandemic.  

The WHO Director-General concurs with the advice offered by the Committee regarding the ongoing COVID-19 pandemic. He determines that COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC).  

The WHO Director-General considered the advice provided by the Committee regarding the proposed Temporary Recommendations and issued them as per the below statement. The WHO Director-General will convene an IHR Review Committee to advise on Standing Recommendations for the long-term management of the SARS-CoV-2 pandemic, taking into account the 2023-2025 COVID-19 Strategic Preparedness and Response Plan.  

During this transition, States Parties are advised to continue following the issued Temporary Recommendations. The Director-General expressed his sincere gratitude to the Chair, the Members, and the Advisors of the Committee for their engagement and advice during the last three years.