H5N1

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.

COVID's future: Mini-waves rather than seasonal surges

Via Nature: COVID's future: mini-waves rather than seasonal surges. Excerpt:

Whether you call it a surge, a spike, a wave or perhaps just a wavelet, there are signs of a rise in SARS-CoV-2 infections — again. A growing proportion of tests in some countries are coming back positive, and new variants, most notably a lineage called XBB.1.16, are pushing aside older strains, fuelling some of the uptick in cases.  

Welcome to the new normal: the ‘wavelet’ era. Scientists say that explosive, hospital-filling COVID-19 waves are unlikely to return. Instead, countries are starting to see frequent, less deadly waves, characterized by relatively high levels of mostly mild infections and sparked by the relentless churn of new variants.

Wavelets don’t always create a dramatic spike in hospitalizations and deaths; their effects on health vary between countries. But the relentless series of wavelets looks very different from the slower, annual circulation patterns of influenza and cold-causing coronaviruses, and it seems increasingly unlikely that SARS-CoV-2 will settle into a flu-like rhythm anytime soon, say scientists.  

“We haven’t slowed down in the last year, and I don’t see what factors would cause it do so at this point,” says Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Center in Seattle, Washington. “It will be a continually circulating respiratory disease. It may be less seasonal than things we’re used to.”  

Victorious variant  

In March, scientists in India started seeing signs that a new SARS-CoV-2 variant was causing a rise in infections. The XBB.1.16 lineage has displaced others that drove case surges in India several months ago, says Rajesh Karyakarte, a microbiologist at Byramjee Jeejeebhoy Government Medical College in Pune, India. “We see that it has almost replaced all other variants in India, and we think the same thing will be followed everywhere.” 

In a study posted to the medRxiv.org preprint server, Karyakarte and his colleagues analysed more than 300 cases, from last December to early this month, and found that XBB.1.16 infections tend to cause mild symptoms similar to those from earlier Omicron variants, with few hospitalizations and deaths. “We didn’t see much,” Karyakarte says. The study has not yet been peer reviewed.

The World Health Organization declared XBB.1.16 a ‘variant of interest’ on 17 April. But whether it or another new variant will cause a spike in infections in a particular country will probably depend on the size and timing of the country’s earlier waves, says Tom Wenseleers, an evolutionary biologist at the Catholic University of Leuven in Belgium.

WHO DON: Human infection caused by avian influenza A (H5N1) - Chile

WHO has published Human Infection caused by Avian Influenza A (H5N1) - Chile. Excerpt:

Situation at a glance  

This Disease Outbreak News is an update on the report published on 6 April 2023 concerning human infection caused by avian influenza A(H5N1) in Chile. Since then, WHO received information on the results of genomic sequencing and the ongoing public health response.  

On 5 April, the results of genomic sequencing were completed by the Institute of Public Health of Chile (ISP per its acronym in Spanish), which is the National Influenza Centre (NIC) in Chile, which identified avian influenza virus A(H5N1) phylogenetic clade 2.3.4.4b. The genomic sequencing had 99.9% identity with H5 hemagglutinin sequences from Chilean birds, and complete neuraminidase (NA) had 100% identity with N1 sequences from Chilean birds.   

A total of 12 contacts (close contacts and healthcare workers) were identified. All tested negative for influenza and have completed the monitoring period. No further cases in Chile have been identified so far.  

Avian influenza infection in a human can cause severe disease and is notifiable under the International Health Regulations (IHR, 2005) [1]. 

Description of the case  

As reported previously, on 29 March 2023, the Ministry of Health of Chile notified WHO of the detection of human infection with avian influenza A(H5) virus.  

On 7 April 2023, the Chile International Health Regulations National Focal Point reported the results of genomic sequencing completed on 5 April 2023 by the NIC, which identified avian influenza A(H5N1) phylogenetic clade 2.3.4.4b.  

The patient is a 53-year-old male from the Region of Antofagasta in the north of Chile. He had no history of comorbidities or recent travel.  

On 13 March 2023, the patient developed symptoms including cough, sore throat, and hoarseness. On 21 March, due to worsening symptoms, he sought care at a local hospital. On 22 March 2023, the patient developed dyspnea and was admitted to a Regional Hospital at Antofagasta (SARI Sentinel Site). A nasopharyngeal swab sample was collected as part of routine severe acute respiratory infection (SARI) surveillance and tested negative for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR).  

On 23 March, the patient was admitted to the intensive care unit and treatment with antivirals (oseltamivir) and antibiotics was initiated. The patient remains in respiratory isolation under multidisciplinary management, with mechanical ventilation due to pneumonia. Standard infection control precautions were kept since the detection of the case.  

On 27 March, a bronchoalveolar sample was collected and tested positive for an unsubtypeable influenza A virus by PCR. The sample was sent to the ISP and tested positive for avian influenza A(H5) on 29 March. On 31 March, the NIC forwarded the patient's samples to a WHO Collaborating Centre for further characterization.   

On 5 April, the results of genomic sequencing were completed by the NIC in Chile, which identified avian influenza virus A(H5N1) phylogenetic clade 2.3.4.4b. The genomic sequencing had 99.9% identity with H5 hemagglutinin sequences from Chilean birds, and complete neuraminidase (NA) had 100% identity with N1 sequences from Chilean birds.   

Three close contacts of the case were identified, all asymptomatic, tested negative for influenza and have concluded the monitoring period. Additionally, a total of nine contacts among healthcare workers were identified, all tested negative for influenza and concluded the monitoring period on 4 April. However, on 5 April one of them developed respiratory symptoms, therefore a nasopharyngeal swab was taken, which tested negative for influenza; the monitoring period for this contact was extended for seven additional days, ending on 11 April.  

Avian influenza A (H5N1) was first detected in the Region of the Americas in birds in December 2014. Between December 2022 and February 2023, highly pathogenic avian influenza (HPAI) has been detected in wild aquatic birds (pelicans and penguins) and sea mammals (sea lions) in the Antofagasta Region where the case resides. According to preliminary findings of the epidemiological investigation of this human case, the most plausible route of transmission was through environmental exposure, given the large number of dead sea mammals and wild birds found in the area close to the patient´s residence.

WHO DON: Marburg virus disease - Equatorial Guinea

WHO has published Marburg virus disease - Equatorial Guinea. Excerpt:

Situation at a glance  

Since the last Disease Outbreak News on this event was published on 22 March 2023 (with data as of 21 March 2023), six additional laboratory-confirmed cases of Marburg virus disease (MVD) have been reported in Equatorial Guinea. This brings the total to 15 laboratory-confirmed and 23 probable cases since the declaration of the outbreak on 13 February 2023. Among the laboratory confirmed there are 11 deaths (Case Fatality Ratio 78.6%; for one confirmed case the outcome is unknown), and all probable cases are dead. The most affected district is Bata in Litoral province, with nine laboratory-confirmed MVD cases reported.  

WHO is supporting the Ministry of Health by strengthening different response pillars, including but not limited to surveillance, including at points of entry; laboratory; case management; infection prevention and control; risk communication and community engagement.  

MVD is a disease with high mortality that causes haemorrhagic fever, and is among the diseases that require assessment under the International Health Regulations.  

On 30 March 2023, WHO assessed the public health risk posed by this outbreak as very high at the national level, high at sub-regional level, moderate at the regional level and low at the global level.  

WHO advises against restrictions to international travel and/or trade in Equatorial Guinea.  

Description of the situation  

On 13 February 2023, the Ministry of Health and Social Welfare of Equatorial Guinea declared an outbreak of Marburg virus disease (MVD) after suspected viral hemorrhagic fever deaths were reported between 7 January and 7 February 2023, and a case tested positive on 12 February for Marburg virus by real-time polymerase chain reaction (RT-PCR) at the Institute Pasteur in Dakar, Senegal.  

Since the last Disease Outbreak News on this event (22 March 2023) and as of 11 April 2023, six additional laboratory-confirmed cases of MVD were reported in Equatorial Guinea, bringing the total of cases in the outbreak to 15 laboratory-confirmed. Additionally, 23 probable cases have been reported since the start of the outbreak. Eleven deaths were recorded among laboratory-confirmed cases (Case Fatality Ratio (CFR) among confirmed cases 78.6%), and all probable cases are dead; for one confirmed case the outcome is unknown. Four laboratory-confirmed cases (26.6%) were reported among healthcare workers, of whom two died. Among the confirmed cases, three have recovered.  

Among MVD laboratory-confirmed cases with age and sex information (n = 13), the majority occurred among females (9/14; 64.3%), while the most affected age group is 40-49 years (6/14; 42.8%), followed by the age groups 10-19 and 30-39 (three cases each).  

Five districts (Bata, Ebebiyin, Evinayong, Nsok Nsomo and Nsork) in four provinces (Centro Sur, Kie Ntem, Litoral and Wele-Nzas) have been affected by the outbreak (Figure  2), with Bata district reporting the majority of confirmed cases (n = 9) and deaths (n = 6), and Ebebiyin district, where the outbreak was first detected, reporting the majority of probable cases,(n = 11) (Table 1). 

In the last 21 days (from 22 March 2023 to 11 April 2023), five confirmed cases were reported from Bata (n = 4) and Nsork (n = 1) districts (Figure 3). Among the four cases reported from Bata district, three cases have an epidemiological link either through a family cluster or through health care setting. The fourth and most recent case was reported on 7 April; an investigation of this case is ongoing to establish transmission chains and ensure appropriate identification of all contacts.  

Since the last Disease Outbreak News on this event, one new district, Nsork in Wele-Nzas province, has been affected by the outbreak, reporting one confirmed case, linked to a known case from another district that previously reported confirmed cases.  

Since the start of the outbreak and as of 10 April 2023, a total of 1322 contacts have been listed, with an average follow-up rate around 80-90%.