H5N1

WHO DON: Outbreak of suspected Marburg Virus Disease– United Republic of Tanzania

Kagera region, Tanzania Google Maps

A Disease Outbreak News item from WHO: Outbreak of suspected Marburg Virus Disease– United Republic of Tanzania. Excerpt:

Description of the situation  

Introduction  

On 13 January 2025, WHO informed its Member States and IHR State Parties of an outbreak of suspected Marburg Virus Disease (MVD) in the Kagera region of the United Republic of Tanzania using our secure web-based platform—the Event Information Site (EIS). Under the International Health Regulations, the EIS is used to issue rapid alerts to Member States of acute and rapidly developing public health risks and events with possible international implications.  

Summary of the situation  

On 10 January 2025, WHO received reliable reports from in-country sources regarding suspected cases of MVD in the Kagera region of the United Republic of Tanzania. Six people were reported to have been affected, five of whom had died. The cases presented with similar symptoms of headache, high fever, back pain, diarrhoea, haematemesis (vomiting with blood), malaise (body weakness) and, at a later stage of disease, external haemorrhage (bleeding from orifices).  

As of 11 January 2025, nine suspected cases were reported including eight deaths (case fatality ratio (CFR) of 89%) across two districts – Biharamulo and Muleba.  Samples from two patients have been collected and tested by the National Public Health Laboratory. Results are pending official confirmation. Contacts, including healthcare workers, are reported to have been identified and under follow-up in both districts.  

The Bukoba district in Kagera region experienced its first MVD outbreak in March 2023, and zoonotic reservoirs, such as fruit bats, remain endemic to the area. The outbreak in March 2023 lasted for nearly two months with nine cases including six deaths.   

Public health response  

National rapid response teams have been deployed to support outbreak investigation and response; surveillance activities have been intensified with contact tracing ongoing; laboratory samples from recent cases have been sent for confirmation at the National Public Health Laboratory. A mobile laboratory is located in Kagera region and treatment units have reportedly been established.  

WHO risk assessment  

The risk of this suspected MVD outbreak is assessed as high at the national level due to several concerning factors. The suspected outbreak thus far involves at least nine suspected cases, including eight deaths, resulting in a high CFR of 89%. Healthcare workers are included among the suspected cases affected, highlighting the risk of nosocomial transmission. The source of the outbreak is currently unknown.  

The reporting of suspected MVD cases from two districts suggests geographic spread. The delayed detection and isolation of cases, coupled with ongoing contact tracing, indicates lack of a full information of the current outbreak. More cases are expected to be identified.  

The regional risk is considered high due to Kagera region's strategic location as a transit hub, with significant cross-border movement of the population to Rwanda, Uganda, Burundi and the Democratic Republic of the Congo. Reportedly, some of the suspected cases are in districts near international borders, highlighting the potential for spread into neighbouring countries.  MVD is not easily transmissible (i.e. in most instances, it requires contact with the body fluids of a sick patient presenting with symptoms or with surfaces contaminated with these fluids). However, it cannot be excluded that a person exposed to the virus may be travelling.  

The global risk is currently assessed as low. There is no confirmed international spread at this stage, although there are concerns about potential risks. Kagera region, while not close to Tanzania's capital or major international airports, is well-connected through transportation networks, and has an airport that connects to Dar es Salaam for onward travel outside Tanzania by air. This highlights the need for enhanced surveillance and case management capacities at relevant points of entry and borders, and close coordination with neighbouring countries to strengthen readiness capacities.

Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture–recapture analysis

Via The Lancet: Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture–recapture analysis. The summary:

Background  

Accurate mortality estimates help quantify and memorialise the impact of war. We used multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between Oct 7, 2023, and June 30, 2024.  

Methods  

We used a three-list capture–recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists' overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024). Resulting annualised age-specific and sex-specific mortality rates were compared with mortality in 2022.  

Findings  

We estimated 64 260 deaths (95% CI 55 298–78 525) due to traumatic injury during the study period, suggesting the Palestinian MoH under-reported mortality by 41%. The annualised crude death rate was 39·3 per 1000 people (95% CI 35·7–49·4), representing a rate ratio of 14·0 (95% CI 12·8–17·6) compared with all-cause mortality in 2022, even when ignoring non-injury excess mortality. Women, children (aged <18 years), and older people (aged ≥65 years) accounted for 16 699 (59·1%) of the 28 257 deaths for which age and sex data were available.  

Interpretation  

Our findings show an exceptionally high mortality rate in the Gaza Strip during the period studied. These results underscore the urgent need for interventions to prevent further loss of life and illuminate important patterns in the conduct of the war.

See also this report in The Guardian.

LDH reports first U.S. H5N1-related human death

A news release from the Louisiana Department of Health and Hospitals: LDH reports first U.S. H5N1-related human death. Excerpt:

The Louisiana Department of Health reports the patient who had been hospitalized with the first human case of highly pathogenic avian influenza (HPAI), or H5N1, in Louisiana and the U.S. has died. The patient was over the age of 65 and was reported to have underlying medical conditions. The patient contracted H5N1 after exposure to a combination of a non-commercial backyard flock and wild birds.  

LDH’s extensive public health investigation has identified no additional H5N1 cases nor evidence of person-to-person transmission. This patient remains the only human case of H5N1 in Louisiana.  

The Department expresses its deepest condolences to the patient’s family and friends as they mourn the loss of their loved one. Due to patient confidentiality and respect for the family, this will be the final update about the patient.   

While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk.   

The best way to protect yourself and your family from H5N1 is to avoid sources of exposure. That means avoiding direct contact with wild birds and other animals infected with or suspected to be infected with bird flu viruses. 

WHO DON: Acute respiratory infections complicated by malaria (previously undiagnosed disease) - Democratic Republic of the Congo

WHO has published a DON update: Acute respiratory infections complicated by malaria (previously undiagnosed disease) - Democratic Republic of the Congo. Excerpt:

Situation at a glance  

 

This is an update to the Disease Outbreak News on Undiagnosed disease in the Democratic Republic of the Congo published on 8 December 2024 (now named acute respiratory infections complicated by malaria). It includes updated epidemiological investigation information and preliminary laboratory results.  

 

On 29 November, an alert was raised by local health zone authorities of Panzi health zone in Kwango province after an increase in deaths, particularly among children under five years of age, following febrile illness.  

 

Enhanced epidemiological surveillance was rapidly implemented, which in the absence of a clear diagnosis was based on the detection of syndromic cases of febrile illnesses with cough, body weakness, with one of a number of other symptoms compatible with acute respiratory and febrile illnesses. This resulted in a rapid increase in the number of cases meeting the definition, with a total of 891 cases reported as of 16 December.  However, the weekly number of reported deaths (48 deaths reported over the period) has remained relatively stable. 

 

As of 16 December, laboratory results from a total of 430 samples indicated positive results for malaria, common respiratory viruses (Influenza A (H1N1, pdm09), rhinoviruses, SARS-COV-2, Human coronaviruses, parainfluenza viruses, and Human Adenovirus). While further laboratory tests are ongoing, together these findings suggest that a combination of common and seasonal viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths, disproportionally affecting children under five years of age.  

 

Multidisciplinary rapid response teams have been deployed to investigate the event and strengthen the response. Efforts are ongoing to address the health needs in Panzi health zone. Enhanced surveillance in the community and within health facilities continues. The teams have also been providing support for diagnosis, the treatment of patients as well as with risk communication and community engagement.  

 

This event highlights the severe burden from common infectious diseases (acute respiratory infections and malaria) in a context of vulnerable populations facing food insecurity. It emphasizes the need to strengthen access to health care and address underlying causes of vulnerability, particularly malnutrition, given the worsening food insecurity.  

 

Description of the situation 

 

Since the last Disease Outbreak News on this event was published on 8 December 2024, 485 additional suspected cases and 17 additional deaths have been reported from Panzi health zone in Kwango Province, Democratic Republic of the Congo, across 25 out of the 30 health areas in Panzi. These cases were identified as a result of enhanced surveillance put in place following the report of deaths in the context of febrile illness with acute respiratory symptoms and anaemia, first reported on 29 November. While the number of reported cases was not deemed particularly unusual in a context of high burden of pneumonia, malaria and acute respiratory infections, particularly at the start of the rainy season, it is the increase in the number of deaths that triggered the alert on 29 November. 

 

In the absence of diagnosis, a broad surveillance case definition was used, with the resulting case numbers reflecting the detection of any febrile illness occurring in Panzi and thus representing a range of diseases and clinical syndromes. The case definition includes: any person living in the Panzi health zone from September 2024 to date, presenting with fever, cough, body weakness, runny nose, with or without one of the following symptoms and signs: chills, headache, difficulty breathing, malnutrition, body aches. This was done to better understand the epidemiology and characteristics of deaths and to collect a range of clinical samples for laboratory testing.  

 

Between 24 October and 16 December 2024, 48 deaths and a total of 891 cases across 25/30 health areas of Panzi health zone met the case definition. Children under five years of age are disproportionally affected, representing 47% of all cases and 54% of all deaths, while they represent around 18% of the population, likely reflecting the vulnerability of young children to severe disease and death in this context. The main symptoms associated with death include difficulty in breathing, anaemia, and signs of acute malnutrition.

Bird flu, measles top 2025 concerns for Canada's chief public health officer

Via The Canadian Press: Bird flu, measles top 2025 concerns for Canada's chief public health officer. Excerpt:

TORONTO - As we enter 2025, Dr. Theresa Tam has her eye on H5N1 bird flu, an emerging virus that had its first human case in Canada this year.  

At the same time, Canada's chief public health officer is closely monitoring measles — a virus that was eliminated in this country more than two decades ago, but is making an accelerated resurgence.  

H5N1, a strain of highly pathogenic avian influenza viruses carried by wild birds, has been on the rise globally. It has decimated poultry farms in Canada and infected dairy cattle herds in several states south of the border.  

But its spread to humans is especially worrisome.  

"What I am particularly concerned about is that this virus has demonstrated the capability of a whole range of clinical outcomes, from asymptomatic infection ... all the way to rare cases of severe illness," said Tam in a year-end interview on Dec. 18.  

"So it's something that we really need to be very vigilant about.”  

Canada's only confirmed H5N1 patient — a teen in B.C. — was severely ill and hospitalized in November. Health officials there have still not been able to determine how the teen got infected.  

No one else got sick with the virus, said Tam, which is encouraging because it suggests there hasn't yet been any human-to-human transmission.  

Although the risk to the general public is still considered low, there have been at least 65 confirmed human cases in the U.S. in 2024, mostly among farm workers. Most cases have been mild, with conjunctivitis, or pink-eye, among the symptoms.  

But on the same day as The Canadian Press interview with Tam, health officials announced the first case of severe illness in the U.S. — a person over 65 in Louisiana who had been in contact with sick birds in a backyard flock.  

”(That) tells me that we need to do significant outreach not just to commercial poultry farms, for instance, but there are people who keep backyard chickens or other birds," Tam said.  

"Those backyard birds are exposed to wild birds that are the carriers of this H5N1 virus."  

Education about wearing personal protective equipment and taking biosecurity measures is important for anyone keeping birds in Canada — not just commercial farms, she said.  

Tam says it's also time for more bird flu awareness among the general public.  

“We need to handle any sick or dead birds (or) other animals with a great deal of care," she said.  

"If in doubt, don't touch and call up your local veterinarian or public health authority in order to know what to do if you do have dead birds or animals in your garden or backyard.”  

But it's not just new illnesses that Tam is worried about. "There's an increase in circulation of a number of vaccine-preventable diseases like measles, like pertussis (whooping cough)," she said.  

Tam said there have been close to 170 measles cases in Canada in 2024, compared to 59 cases last year.

WHO: COVID-19 epidemiological update – 24 December 2024

WHO has published COVID-19 epidemiological update – 24 December 2024. Click or tap through to download the full report. Excerpt:

Overview 

This is a special edition of the epidemiological update on COVID-19 that gives an overview of the situation since the disease was first reported to WHO nearly five years ago.    

SARS-CoV-2, the virus that causes COVID-19, largely circulates without clear seasonality and continues to infect, causing severe acute disease and post-COVID-19 condition. The impact varies by country, and WHO's ability to monitor circulation, severity, and virus evolution is challenged by reduced surveillance, testing, sequencing, and limited integration into long-term prevention programs. Changes to COVID-19 surveillance over the past five years have been consistent, but integration is variable across regions.   

From the start of the pandemic until November 10, 2024, over 776.8 million confirmed COVID-19 cases and over 7 million confirmed deaths were notified to WHO across 234 countries. The majority of COVID-19 associated deaths occurred in 2020, 2021, and 2022, with increased immunity leading to a significant decrease in deaths. For the latest 4 week reporting period, from 14 October to 10 November 2024, 77 countries reported COVID-19 cases and 27 deaths globally. The number of reported cases decreased by 39%, with over 200 000 new cases and 36% of new deaths, compared to the previous 28 days.    

Overall, ICU admissions per 1000 hospitalizations have been decreasing since the peak in July 2021 when the rate was 245 per 1000 hospitalizations, dropping below 132 per 1000 hospitalizations at the beginning of 2022, and to less than 69 per 1000 hospitalizations by the end of 2023. At the beginning of 2024, there was an increase ICU admissions per 1000 hospitalizations, rising to above 191 per 1000 hospitalizations in March, and declining to 108 per 1000 hospitalizations in early November 2024.  

Meanwhile, deaths per 1000 hospitalization showed a consistent decline from June 2021 when they reached 253 per 1000 hospitalizations to a low level of 59 per 1000 hospitalizations in August 2023. Since January 2024, the rate has continued to decline reaching 41 deaths per 1000 hospitalizations by early November 2024.    

Post-COVID-19 condition (PCC), called "long COVID" by some, continues to pose a significant burden on health systems, with an estimated 6% of symptomatic SARS-CoV-2 infections resulting in PCC symptoms. While severe COVID-19 is a significant risk factor for PCC, over 90% of PCC cases arise following mild COVID-19 due to the sheer volume of infections. Vaccination appears to offer a protective effect, reducing the likelihood of developing PCC.   

The COVID-19 vaccine rollout has evolved since 2021, with high-income countries initially having higher vaccination rates. From January 2024, WHO shifted from measuring "continuous" COVID-19 vaccination coverage since the start of the vaccine rollout to measuring annual uptake. Using the new monitoring approach, as of the end of the third quarter of 2024, 39.2 million people in 90 Member States (representing 31% of the global population) received a dose this year, with 14.8 million in quarter three alone.   

In this special edition, we include:   

• Global overview since the pandemic    

• SARS-CoV-2 test positivity     

• Morbidity and Mortality trends     

• Hospitalizations and ICU admissions    

• SARS-CoV-2 variants circulation    

• Vaccination update 

CDC Confirms First Severe Case of H5N1 Bird Flu in the United States

Via the CDC: CDC Confirms First Severe Case of H5N1 Bird Flu in the United States. Excerpt:

December 18, 2024-- A patient has been hospitalized with a severe case of avian influenza A(H5N1) virus ("H5N1 bird flu") infection in Louisiana. This marks the first instance of severe illness linked to the virus in the United States. The case was confirmed by the Centers for Disease Control and Prevention (CDC) on Friday, December 13. Since April 2024, there have been a total of 61 reported human cases of H5 bird flu reported in the United States.  

Partial viral genome data of the H5N1 avian influenza virus that infected the patient in Louisiana indicates that the virus belongs to the D1.1 genotype related to other D1.1 viruses recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. This H5N1 bird flu genotype is different than the B3.13 genotype detected in dairy cows, sporadic human cases in multiple states, and some poultry outbreaks in the United States. Additional genomic sequencing and efforts to isolate virus from clinical specimens from the patient in Louisiana are underway at CDC.  

While an investigation into the source of the infection in Louisiana is ongoing, it has been determined that the patient had exposure to sick and dead birds in backyard flocks. This is the first case of H5N1 bird flu in the U.S. that has been linked to exposure to a backyard flock.  

A sporadic case of severe H5N1 bird flu illness in a person is not unexpected; avian influenza A(H5N1) virus infection has previously been associated with severe human illness in other countries during 2024 and prior years, including illness resulting in death. No person-to-person spread of H5 bird flu has been detected. This case does not change CDC's overall assessment of the immediate risk to the public's health from H5N1 bird flu, which remains low.  

This case underscores that, in addition to affected commercial poultry and dairy operations, wild birds and backyard flocks also can be a source of exposure. People with work or recreational exposures to infected animals are at higher risk of infection and should follow CDC's recommended precautions when around animals that are infected or potentially infected with H5N1 avian influenza virus. This means that backyard flock owners, hunters and other bird enthusiasts should also take precautions.

WHO DON: Undiagnosed disease – Democratic Republic of the Congo

WHO has published Undiagnosed disease – Democratic Republic of the Congo. Excerpt:

Situation at a glance

Between 24 October and 5 December 2024, Panzi health zone in Kwango Province of Democratic Republic of the Congo recorded 406 cases of an undiagnosed disease with symptoms of fever, headache, cough, runny nose and body ache. All severe cases were reported to be severely malnourished. Among the cases, 31 deaths have been registered. The majority of cases reported are among children, particularly those under five years of age.  

The area is rural and remote, with access further hindered by the ongoing rainy season. Reaching it from Kinshasa by road takes an estimated 48 hours. These challenges, coupled with limited diagnostics in the region, have delayed the identification of the underlying cause.  

Rapid response teams have been deployed to identify the cause of the outbreak and strengthen the response. The teams are collecting samples for laboratory testing, providing a more detailed clinical characterization of the detected cases, investigating the transmission dynamics, and actively searching for additional cases, both within health facilities and at the community level. The teams are also aiding with the treatment of patients, risk communication and community engagement.  

Given the clinical presentation and symptoms reported, and a number of associated deaths, acute pneumonia, influenza, COVID-19, measles and malaria are being considered as potential causal factors with malnutrition as a contributing factor. Malaria is a common disease in this area, and it may be causing or contributing to the cases. Laboratory tests are underway to determine the exact cause. At this stage, it is also possible that more than one disease is contributing to the cases and deaths.  

Description of the situation  

On 29 November 2024, the Ministry of Public Health of the Democratic Republic of the Congo reported to WHO an alert regarding increased deaths from an undiagnosed cause in Panzi health zone.  

Between 24 October and as of 5 December 2024, Panzi health zone in Kwango Province has recorded 406 cases of an undiagnosed disease with symptoms of fever, headache, cough, runny nose and body ache and 31 deaths (Case Fatality Ratio or CFR of 7.6%).  The reported cases had a peak in epidemiological week 45 (week ending 9 November 2024). The outbreak is still ongoing.  

According to a press briefing by the Ministry of Health on 5 December, there have been several additional deaths outside of health facilities (community deaths). These deaths still need to be investigated, characterized (age, gender etc) and verified.  

Cases have been reported from nine out of 30 health areas in Panzi health zone: Kahumbulu, Kambandambi, Kanzangi, Kasanji, Kiama, Mbanza Kipungu, Makitapanzi, Mwini ngulu, and Tsakala Panzi. The majority of cases (95.8%) are reported from Tsakala Panzi (169), Makitapanzi (142) and  Kanzangi (78) health areas.  

In Panzi health zone, children aged 0-14 years represent 64.3% of all reported cases, with the age groups 0-59 months, 5-9 years, and 10-14 years accounting for 53%, 7.4%, and 3.9% of cases, respectively. Females constitute 59.9% of the total cases. Among the deaths, 71% are below the age of 15, with 54.8% of the total in children under the age of five years. All severe cases were reported to be malnourished. There are 145 cases aged 15 and above, of which nine died (CFR: 6.2%). Deaths have primarily occurred in the village communities. 

The area experienced deterioration in food insecurity in recent months, has low vaccination coverage and very limited access to diagnostics and quality case management. There is a lack of supplies and transportation means and shortage of health staff in the area. Malaria control measures are very limited.  

The clinical presentation of patients includes symptoms such as fever (96.5%), cough (87.9%), fatigue (60.9%) and a running nose (57.8%). The main symptoms associated with death include difficulty in breathing, anaemia, and signs of acute malnutrition.  

Based on the current context of the affected area and the broad presentation of symptoms, a number of suspected diseases need to be ruled out through further investigations and laboratory testing. These include but are not limited to measles, influenza, acute pneumonia (respiratory tract infection), hemolytic uremic syndrome from E. coli, COVID-19, and malaria. 

WHO supports Democratic Republic of the Congo to reinforce efforts to diagnose disease in remote area

Via WHO AFRO: WHO supports Democratic Republic of the Congo reinforce efforts to diagnose disease in remote area.

Kinshasa – World Health Organization (WHO) is deploying experts to support health authorities in the Democratic Republic of the Congo carry out further investigations to determine the cause of a yet undiagnosed disease that has been reported in Panzi, a locality in Kwango province in the southwest of the country. Laboratory tests are being conducted to determine the cause.  

The WHO experts are joining the National Rapid Response Team and are on their way to Panzi. The team comprises epidemiologists, clinicians, laboratory technicians and infection prevention and control, and risk communication experts. An initial local WHO team has been supporting the health authorities in Kwango since the end of November to reinforce disease surveillance and identify cases.  

The experts being deployed are also delivering essential medicines, diagnostic and sample collection kits to help rapidly analyse and determine the cause of the illness. The team will focus on strengthening response measures such as epidemiological investigation and collection of samples for testing, active case finding, treatment and public awareness activities. The team will also work with community leaders to support disease surveillance and promote measures to prevent infection and to identify and report further cases.   

“Our priority is to provide effective support to the affected families and communities. All efforts are underway to identify the cause of the illness, understand its modes of transmission and ensure appropriate response as swiftly as possible,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.  

According to the Ministry of Public Health, 394 cases and 30 deaths have been reported so far in Panzi health zone. Symptoms of the illness include headache, cough, fever, breathing difficulties and anaemia. Until laboratory test results are received, the cause is unclear.   

Panzi is a rural community located more than 700 km from the capital Kinshasa. Access by road is difficult and communication network is limited. So far, the disease has been reported in seven of the 30 health zones in Kwango province. Most cases are reported in three of the seven affected health zones. A respiratory pathogen such as Influenza or COVID-19 is being investigated as a possible cause, as well as malaria, measles and others.   

WHO will share more information about efforts to identify the disease as soon as available.

WHO DON: Oropouche virus disease - Region of the Americas

WHO has published a new Disease Outbreak News item: Oropouche virus disease - Region of the Americas. Excerpt:

Situation at a glance  

Since the last Disease Outbreak News on this event was published on 23 August 2024, three additional countries and one territory (Ecuador, Guyana, Panama and Cayman Island) have reported confirmed Oropouche virus disease in the Region of the Americas in 2024.  

In addition, imported Oropouche cases have been reported from Canada, the United States of America and countries of the European Region. As of 25 November 2024, a total of 11 634 confirmed Oropouche cases, including two deaths, have been reported in the Region of the Americas, across ten countries and one territory: Bolivia (Plurinational State of), Brazil, Canada, Cayman Islands, Colombia, Cuba, Ecuador, Guyana, Panama, Peru and the United States of America.  

Based on available information, WHO assesses the overall public health risk posed by this virus to be high at the regional level and low at the global level.  

As the arbovirus season is starting in the region, WHO urges countries at risk to strengthen epidemiological and entomological surveillance and to reinforce preventive measures in the population. This is crucial due to the geographical expansion of the virus and the possible new vectors and transmission routes, including vertical transmission, that could affect both the general population and vulnerable groups, such as pregnant women, their fetuses, and newborns.  

Description of the situation  

Since the last Disease Outbreak News on this event was published on 23 August 2024, three additional countries and one territory (Ecuador, Guyana, and Panama) have reported confirmed Oropouche virus disease in the Region of the Americas. In addition, imported Oropouche cases were reported from the Cayman Islands, Canada, the United States of America and a few countries in the European Region.  

Between 1 January and 25 November 2024, 11 634 confirmed Oropouche cases, including two deaths, have been reported in the Region of the Americas: Bolivia (Plurinational State of) (356 cases), Brazil (9563 cases, including two deaths), Canada (two imported cases), Cayman Island (one imported case),  Colombia (74 cases), Cuba (603 cases), Ecuador (two cases), Guyana (two cases), Panama (one case), Peru (936 cases), and the United States of America (94 imported cases).  

Additionally, imported Oropouche cases have been reported in countries in the European Region (30 cases).  

Cases and consequences of vertical transmission of Oropouche virus infection have been reported in Brazil and Cuba. Brazil has confirmed three cases of vertical transmission (two cases of fetal death and one case of congenital anomaly) and reported that under investigation are 15 fetal deaths, five spontaneous miscarriages, and three cases of congenital anomalies. Additionally, in September, Cuba confirmed a case of congenital anomaly with two further cases under investigation.

Increases in US life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop

Via the Institute for Health Metrics and Evaluation, an alarming news release: Increases in U.S. life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop. Excerpt:

SEATTLE, Wash., Dec. 5, 2024 – The U.S. is failing to keep pace with dozens of countries around the world due to the steady decline of the nation’s health progress, according to a detailed analysis of all 50 states and Washington, D.C., published in The Lancet. Researchers at the Institute for Health Metrics and Evaluation (IHME) produced health estimates and forecasts (the most likely future) of life expectancy, mortality, and morbidity due to more than 350 diseases and injuries and 68 risks in the U.S. from 1990 to 2050.  

U.S. life expectancy improvements slow, global ranking drops     

Life expectancy (LE) in the U.S. is forecasted to increase from 78.3 years in 2022 to 79.9 years in 2035 and to 80.4 years in 2050 for all sexes combined. This modest increase lowers the country’s global ranking from 49th in 2022 to 66th in 2050 among the 204 countries and territories included in the latest Global Burden of Disease (GBD) study.   

Nationally, mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischemic heart disease, cancer, and stroke. That contributed to improvements in life expectancy. Despite the progress the U.S. has made over the last three decades, the country is forecasted to rank progressively lower than other nations globally in the average number of years a person can expect to live in good health. Known as healthy life expectancy or health-adjusted life expectancy (HALE), its global ranking is forecasted to drop from 80th in 2022 to 108th by 2050.    

Women’s health in the U.S. is falling behind other peer countries faster than men’s. Female HALE is forecasted to decline by 2050 in 20 states, including Ohio, Tennessee, and Indiana. Only three states remain unchanged: Arizona, Idaho, and North Dakota. This gap between men and women is mainly due to the slow increases or no changes in female life expectancy and HALE rather than due to major improvements for males. 

DR Congo: Over 140 deaths from unknown disease in Panzi, Kwango province

Open Street Map, via perplexity.ai

Via Actualite.cd: DRC-Kwango: over 140 deaths from an unknown disease in Panzi. The Google translation: 

An unknown disease is raging in Panzi, Kwango province. The number of deaths has increased in a few days in the Panzi health zone, going from about sixty to 143 deaths.  

The provincial vice-governor who provided the information, specified that the health concern had been observed since July 10. Rémy Saki announced the arrival of a team of epidemiological experts to take samples to be sent to the National Institute for Biomedical Research (INRB). 

The provincial authority also announced assistance in medical supplies from Sanru, WHO, UNICEF and provincial and national elected officials of Kwango in order to deal with the health crisis. 

According to the Kwango provincial health minister, the deceased suffered from fever, headaches and anaemia.

We will have to await the test results. The Congolese have some hard-won experience in dealing with Ebola. I hope it will be useful in this present outbreak. This Guardian report has more details.

California Acts to Protect Public Health: CDPH Warns Against Drinking Single Lot of Raw Milk Following Bird Flu Detection

Thanks to Helen Branswell and others for alerting me to this news release from the California Department of Public Health: California Acts to Protect Public Health: CDPH Warns Against Drinking Single Lot of Raw Milk Following Bird Flu Detection; Secures Voluntary Recall. Excerpt:

What You Need to Know: CDPH warns consumers not to drink one batch of cream top, whole raw milk from Raw Farm, LLC of Fresno County due to a detection of bird flu virus. Raw Farm, LLC issued a voluntary recall at the state’s request of the affected lot code 20241109 with a Best By date of 11/27/2024. Consumers should immediately return any remaining product to the store where it was purchased. Pasteurized milk remains safe to drink.

Sacramento –​ The California Department of Public Health (CDPH) today is warning the public to avoid consuming one batch of cream top, whole raw milk produced and packaged by Raw Farm, LLC of Fresno County due to a detection of bird flu virus in a retail sample. At the state’s request, the company has issued a voluntary recall of the affected raw milk with lot code 20241109 and Best By date of 11/27/2024 printed on the packaging.​ 

No illnesses associated with this lot of raw milk have been reported. Out of an abundance of caution, and due to the ongoing spread of bird flu in dairy cows, poultry, and sporadic human cases, consumers should not consume any of the affected raw milk. Customers should immediately return any remaining product to the retail point of purchase. CDPH is also notifying retailers to remove the affected raw milk from their shelves.​​   

The County of Santa Clara Public Health Laboratory has been testing raw milk products from retail stores as a second line of consumer protection. The county identified bird flu in one sample of raw milk purchased at a retail outlet. The testing was then verified by the California Animal Health and Food Safety Laboratory System.  

Risks Associated with Raw Milk  

Public health experts have long warned consumers against consuming raw milk or raw milk products due to elevated risks of foodborne illness. Outbreaks due to Salmonella, Listeria monocytogenes, toxin producing E. coli, Brucella, Campylobacter, and many other bacteria have all been reported related to consuming raw dairy products. Raw milk products are not pasteurized, a heating process that kills bacteria and viruses such as bird flu.   

Pasteurized milk and milk products are safe to consume because the heating process kills pathogens, including bird flu, that can cause illness.   

Drinking or accidentally inhaling raw milk containing bird flu virus may lead to illness. In addition, touching your eyes, nose, or mouth with unwashed hands after touching raw milk with bird flu virus may also lead to infection. Symptoms of bird flu infection in humans include eye redness or discharge, cough, sore throat, runny or stuffy nose, diarrhea, vomiting, muscle or body aches, headaches, fatigue, trouble breathing and fever. Anyone who has consumed these specific products, and is experiencing these symptoms, should immediately contact their health care provider or local health department. 

Canada needs a national COVID-19 inquiry now

Via BMC Medicine: Canada needs a national COVID-19 inquiry now . The abstract:

Background  

We are now in the fifth year of an ongoing pandemic, and Canada continues to experience significant surges of COVID-19 infections. In addition to the acute impacts of deaths and hospitalizations, there is growing awareness of an accumulation of organ damage and disability which is building a “health debt” that will affect Canadians for decades to come. Calls in 2023 for an inquiry into the handling of the COVID-19 pandemic went unheeded, despite relevant precedent. Canada urgently needs a comprehensive review of its successes and failures to chart a better response in the near- and long-term.  

Main body  

While Canada fared better than many comparators in the early years of the COVID-19 pandemic, it is clearly still in a public health crisis. Infections are not only affecting Canadians’ daily lives but also eroding healthcare capacity. Post-COVID condition is having accumulating and profound individual, social, and economic consequences.  

An inquiry is needed to understand the current evidence underlying policy choices, identify a better course of action on various fronts, and build resilience. More must be done to reduce transmission, including a serious public education campaign to better inform Canadians about COVID and effective mitigations, especially the benefits of respirator masks. We need a national standard for indoor air quality to make indoor public spaces safer, particularly schools. Data collection must be more robust, especially to understand and mitigate the disproportionate impacts on under-served communities and high-risk populations.  

General confidence in public health must be rebuilt, with a focus on communication and transparency. In particular, the wide variation in provincial policies has sown mistrust: evidence-based policy should be consistent. Finally, Canada’s early success in vaccination has collapsed, and this development needs a careful post-mortem.  

Conclusions  

A complete investigation of Canada’s response to the pandemic is not yet possible because that response is still ongoing and, while we have learned much, there remain areas of dispute and uncertainty. However, an inquiry is needed to conduct a rapid assessment of the current evidence and policies and provide recommendations on how to improve in 2025 and beyond as well as guidance for future pandemics.

Bird flu in Canada may have mutated to become more transmissible to humans

Via The Guardian: Bird flu in Canada may have mutated to become more transmissible to humans. Excerpt:

The teenager hospitalized with bird flu in British Columbia, Canada, may have a variation of the virus that has a mutation making it more transmissible among people, early data shows – a warning of what the virus can do that is especially worrisome in countries such as the US where some H5N1 cases are not being detected.  

The US “absolutely” is not testing and monitoring bird flu cases enough, which means scientists could miss mutated cases like these, said Richard Webby, a virologist at St Jude children’s research hospital’s department of infectious diseases.  

“We need to be following this as closely as we can. Any advanced warning we can get that there’s more viruses making these types of changes, that’s going to give us the heads-up,” Webby continued.

The Canadian teen first developed symptoms on 2 November and was hospitalized at the British Columbia children’s hospital on 8 November. The child is still in critical condition with acute respiratory distress – a serious lung condition that can be fatal.  

Preliminary sequencing of the H5N1 variant sickening the teenager showed a potential mutation on the genomic spot known to make people more susceptible to the virus.  

That could indicate that H5N1 has the capability to become more like a human virus, rather than an avian virus, but it is also not clear yet whether this change is meaningful and more dangerous to people, experts said.  

The virus may have mutated over the course of the teen’s illness; additional sequencing could reveal more about its evolution.  

“Often it’s not just one thing that is going to confer that ability” to infect humans more effectively, said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan.  

“It’s not quite clear what the real-world implications are going to be, but certainly all of these things are a warning sign,” Rasmussen said. “We really do need to pay attention to this, and we really do need to try to reduce more human infections as much as we possibly can.”   

The particular variant of H5N1 circulating among birds in British Columbia and the north-western US appeared over the past few months, several years after bird flu was first found in North America, Webby said. The variant also sickened 11 workers in Washington state who were killing infected poultry, though those workers did not have the possible mutation detected in the teenager.

BC teen with avian flu is in critical condition, provincial health officer says

Via CBC News: B.C. teen with avian flu is in critical condition, provincial health officer says. Excerpt:

The teenager who tested positive for avian flu is in critical condition and being treated for acute respiratory distress at B.C. Children's Hospital, Provincial Health Officer Dr. Bonnie Henry says.  

Henry says the teen, the first presumptive human case of avian flu contracted in Canada, was admitted to hospital late Friday.  

Their condition "varied" over the weekend, Henry said, adding "our thoughts continue to be with this person and their family."  

Henry said work underway to confirm the diagnosis and trace potential sources of exposure through the B.C. Centre for Disease Control had given her "confidence" that the teen has H5 avian influenza, also known as bird flu.

She says it's likely that the teenager contracted the illness from exposure to an animal or the environment, although there's a "very real possibility" that the source will never be found.

Henry said privacy considerations restrict what can be said publicly about the teen, but said he or she did not have any underlying medical conditions.  

The teen first went to the emergency department on Nov. 2 and was tested and sent home, but returned to hospital days later when symptoms worsened.  

Henry said contact tracing has been conducted on 35 to 40 of the teen's family members, friends and acquaintances.  

"We have not identified anyone else that is sick with the virus in B.C. right now," she said. "We don't see right now that there's a risk of a lot of people getting sick."  

She said the teen was not in school during the infectious period of the disease, which roughly began on Oct. 31, two days before the onset of symptoms.  

She said the teen has no links to people who had recently travelled to Southeast Asia, which has seen outbreaks.  

According to Henry, the teen did not have any contact with birds but did interact with a variety of other animals —  including a dog, cats and reptiles — in the days before becoming ill. Henry said testing on those animals has so far been negative for the virus.  

She said no links have been found between the teen and local farms — including the two dozen B.C. poultry farms that have suffered avian flu outbreaks during the fall migration of wild birds. No links have been found to outbreaks taking place across the border in Washington state, she added.

Henry said the case is still being called a "presumptive positive" because it has to be confirmed at the National Microbiology Laboratory in Winnipeg, which could happen later on Tuesday.

First presumptive positive case of H5 avian influenza detected in BC

The BC provincial government published this news release today: First presumptive positive case of H5 avian influenza detected in BC. Excerpt and then a comment:

An individual in British Columbia has tested presumptive positive for avian influenza (also known as bird flu) caused by the H5 influenza virus, the first detection of avian influenza due to the H5 virus in a person in B.C.  

This is also the first detection of a presumed human case of H5 avian influenza acquired in Canada. The positive test for H5 was performed at the BC Centre for Disease Control’s Public-Health Laboratory. Samples are being sent to the National Microbiology Laboratory in Winnipeg for confirmatory testing.  

The individual is a teenager from the Fraser Health region who is receiving care at BC Children’s Hospital. A public-health investigation has been initiated to determine the source of exposure and identify any contacts.  

“Our thoughts are with this young person and their family during this difficult time,” said Dr. Bonnie Henry, B.C.’s provincial health officer. “This is a rare event, and while it is the first detected case of H5 in a person in B.C. or in Canada, there have been a small number of human cases in the U.S. and elsewhere, which is why we are conducting a thorough investigation to fully understand the source of exposure here in B.C.”  

Public health is following up with contacts who may have been exposed in order to assess for symptoms and provide guidance on testing and prevention measures. There have been no further cases identified at this time. The source of exposure is very likely to be an animal or bird, and is being investigated by B.C.’s chief veterinarian and public health teams.  

The investigation involves public health teams from Fraser Health, BC Centre for Disease Control (BCCDC), the BCCDC Public Health Laboratory, BC Children’s Hospital, the Office of the Provincial Health Officer, Office of the Chief Veterinarian, Ministry of Agriculture and Food, and others.  

Health, animal and environmental partners across B.C. have also been working together and with the Canadian Food Inspection Agency and other national and U.S. partners to respond to the increased detections of H5N1 avian influenza in poultry farms and wild birds in the province since early October.

This is almost certainly H5N1, which has been turning up in the Fraser Valley for some time. If the teenager lives on a farm, the source of infection is almost certainly poultry. But it could have been through contact with a wild bird, or with a cat that had killed an infected wild bird. Or it could been contact with another human, though that seems unlikely. 

As far as I know, Canada has not yet reported H5N1 in dairy cattle. So the teenager may not have the mild symptoms now reported in dozens of American dairy workers: fever, pinkeye, and so on. 

So we will have to wait for more details, which our health authorities will take their time releasing. 

BC investigating 1st presumptive human avian flu case in Canada

Via CBC News, some bad but predictable news: B.C. investigating 1st presumptive human avian flu case in Canada. Excerpt:

British Columbia health officials are investigating what's believed to be Canada's first human case of avian influenza after a teenager tested presumptively positive for the disease, the Ministry of Health announced Saturday.   

The teenager, who the ministry says is from the Fraser Health region, is currently receiving care at B.C. Children's Hospital, while officials work to confirm the diagnosis and trace potential sources of exposure.  

According to the statement, avian influenza, also known as bird flu, is a virus that primarily affects birds but can occasionally spread to humans through contact with infected animals or contaminated environments.  

B.C.'s provincial health officer, Dr. Bonnie Henry, says the case marks the first time H5 avian influenza has been detected in a person in Canada, although there have been isolated cases reported in the U.S. and other countries.  

"Our thoughts are with this young person and their family during this difficult time," she said.   

Henry said a thorough investigation is underway to understand how the virus may have been contracted.  

The ministry noted that public health officials are tracking contacts of the patient to monitor for symptoms and to provide guidance on testing and prevention measures. Currently, no other human cases have been identified in connection with this incident.  

According to the federal government, there has only been one human case of A(H5N1) ever reported in Canada. A Canadian resident died of avian influenza A(H5N1) in early 2014 after returning from a trip to China, where they were likely infected.

A person in Texas who had close contact with infected dairy cattle has been diagnosed with bird flu. It's the country's second known human case after the virus was discovered circulating among dairy cows across at least four U.S. states for the first time.  

Since early October, the H5N1 virus has been detected in animals at numerous sites in B.C., including 22 poultry farms and in a variety of wild birds and small mammals such as foxes and skunks.  

Earlier this week, Vancouver Island's health authority warned residents about a possible exposure to avian flu at a petting farm in Campbell River.

WHO DON: Marburg virus disease – Rwanda

WHO has published a new DON: Marburg virus disease – Rwanda. Excerpt:

Situation at a glance  

It has been over a month since the declaration of the Marburg virus disease (MVD) outbreak in Rwanda on 27 September 2024. As of 31 October 2024, 66 confirmed cases, including 15 deaths (CFR: 23%), have been reported including two new confirmed cases since the previous Disease Outbreak News report. WHO continues to support the Government of Rwanda in responding to the outbreak. Enhanced surveillance, contact tracing and infection prevention and control measures must be maintained until the outbreak is declared over.   

Description of the situation  

Since the last Disease Outbreak News on this event was published on 25 October 2024, two additional laboratory-confirmed cases of Marburg virus disease (MVD) were reported in Rwanda on 26 and 30 October respectively. These cases are known contacts of a previously confirmed case and are currently in isolation and receiving treatment. As of 31 October 2024, 66 confirmed cases, including 15 deaths (CFR: 23%), have been reported. Among confirmed cases, 68% are males, and 45% are adults between 30 and 39 years of age.  

Health workers from two health facilities in Kigali account for almost 80% of all confirmed cases. Most cases are reported from the three districts in Kigali city.  

The highest number of new confirmed cases were reported in the first two epidemiological weeks of the outbreak with 26 cases reported in epidemiological week 39 (23 to 29 September 2024) and 23 cases in week 40 (30 September to 6 October).  

Following just one case reported in epidemiology week 42 (14 to 20 October), three cases were reported in epidemiology week 43 (21 to 27 October) and one case in week 44 (reported on 30 October).   

Since the declaration of the outbreak by the Government of Rwanda on 27 September and as of 31 October, 49 confirmed cases have recovered, and two cases are still receiving care at the designated Marburg treatment centre.  

As of 31 October 2024, 6099 tests for Marburg virus have been conducted, with approximately 100-350 samples being tested daily at the Rwanda Biomedical Center.     

Contact tracing is ongoing, with 559 contacts listed under follow-up as of 31 October 2024.  

WHO continues to support the Government of Rwanda to respond to the ongoing outbreak. Enhanced surveillance, contact tracing and infection prevention and control measures must be maintained until the outbreak is declared over.

Political polarization and health

A very timely report via Nature Medicine: Political polarization and health. The abstract:

In addition to social determinants of health, such as economic resources, education, access to care and various environmental factors, there is growing evidence that political polarization poses a substantial risk to individual and collective well-being. 

Here we review the impact of political polarization on public health. We describe the different forms of polarization and how they are connected to health outcomes, highlighting the COVID-19 pandemic as a case study of the health risks of polarization. 

We then offer strategies for mitigating potential harms associated with polarization, with an emphasis on building social trust. Finally, we propose future research directions on this topic, underscore the need for more work in a global context and encourage greater collaboration between social scientists and medical scientists. 

We conclude that polarization is a serious—if largely overlooked—determinant of health, whose impacts must be more thoroughly understood and mitigated.