H5N1

Multi-country monkeypox outbreak: Situation update

WHO has published a DON: Multi-country monkeypox outbreak: situation update. Excerpt:

This current Disease Outbreak News on the multi-country monkeypox outbreak is an update to the previously published Disease Outbreak News of 10 June, with updated data, some further details on surveillance and reporting, One Health, gatherings, Risk communication and community engagement and International travel and points of entry.  

In this edition, we are removing the distinction between endemic and non-endemic countries, reporting on countries together where possible, to reflect the unified response that is needed.  

Outbreak at a glance  

Since 1 January 2022, cases of monkeypox have been reported to WHO from 42 Member States across five WHO regions (the Regions of the Americas, Africa, Europe, Eastern Mediterranean, and Western Pacific). As of 15 June, a total of 2103 laboratory confirmed cases and one probable case, including one death, have been reported to WHO. The outbreak of monkeypox continues to primarily affect men who have sex with men who have reported recent sex with new or multiple partners.  

While epidemiological investigations are ongoing, most reported cases in the recent outbreak have presented through sexual health or other health services in primary or secondary health care facilities, with a history of travel primarily to countries in Europe, and North America or other countries rather than to countries where the virus was not historically known to be present, and increasingly, recent travel locally or no travel at all.  

Confirmation of one case of monkeypox, in a country, is considered an outbreak. The unexpected appearance of monkeypox in several regions in the initial absence of epidemiological links to areas that have historically reported monkeypox, suggests that there may have been undetected transmission for some time.  

WHO assesses the risk at the global level as moderate considering this is the first time that many monkeypox cases and clusters are reported concurrently in many countries in widely disparate WHO geographical areas, balanced against the fact that mortality has remained low in the current outbreak.  

Description of the outbreak  

Between 1 January to 15 June 2022, a cumulative total of 2103 laboratory confirmed cases, one probable case, and one death have been reported to WHO from 42 countries in five WHO Regions. The majority of cases (98%) have been reported since May 2022 (Figure 1).  

Figure 1: Confirmed cases of monkeypox by WHO region from January 2022 to 15 June 2022, data as of 15 June 2022 17:00 CEST 

Note: the data for the current epi week are incomplete and should be interpreted cautiously.

Joint ECDC-WHO Regional Office for Europe weekly hepatitis of unknown origin in children surveillance bulletin

Via ECDC: Joint ECDC-WHO Regional Office for Europe Weekly Hepatitis of Unknown Origin in Children Surveillance Bulletin. The summary:

This report provides an overview of the cases of hepatitis of unknown origin in children aged 16 years and below reported to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy) hosted at ECDC.

 

As of 16 June 2022, 449 cases of acute hepatitis of unknown aetiology have been reported by 20 countries: (Austria (three), Belgium (14), Bulgaria (one), Cyprus (two), Denmark (seven), France (seven), Greece (nine), Ireland (14), Israel (five), Italy (33), Latvia (one), the Netherlands (15), Norway (five), Poland (eight), Portugal (15), Republic of Moldova (one), Serbia (one), Spain (37), Sweden (nine), and the United Kingdom (262)).

 

Since the last surveillance bulletin, which used data as of 17 June 2022, 48 new cases have been reported from eight countries (Austria (one), Greece (three), Ireland (one), Italy (two), the Netherlands (one), Spain (one), Sweden (one), and the United Kingdom (38)). One case (Sweden) previously classified as probable or epi-linked was subsequently discarded.

 

The epicurve shows cases by date of onset when available (276 cases), and date of hospitalisation (155 cases), or date used for statistics when the former two are not available (18 cases). The number of cases reported increased sharply starting in week 12 and remained stable between 26 and 39 cases per week up to and including week 18. As severe hepatitis can take some time to develop following the initial symptoms, and since investigations are required to rule out known causes, there is an expected reporting delay. The recent decrease in cases is therefore challenging to interpret.

 

The majority (76.6%) of cases are five years old or younger.

 

Of the 449 probable cases, 276 have information available on clinical outcome. Of these, 201 have recovered, while 74 remain under medical care.

 

Of 279 cases with available information, 87 (31.2%) required admission to an intensive care unit. Of the 227 cases for which this information is available, 19 (8.4%) have received a liver transplant. There has been one death associated with the disease.

 

Overall, 313 cases were tested for adenovirus by any specimen type and had a valid positive or negative result. Of these, 164 (52.4%) tested positive. The positivity rate was the highest in whole blood specimens (53.9%). Typing data are only available for four cases: type 40 (n = 1), type 41 (n = 2), and type other (n = 1).

 

Of the 292 cases PCR tested for SARS-CoV-2, 31 (10.6%) were positive. Serology results for SARS-CoV-2 are only available for 52 cases, of which 33 (63.5%) resulted positive. Of the 99 cases with data on COVID-19 vaccination, 85 (85.9%) were unvaccinated.

AQLI Update: Most of the world breathes unsafe air, taking more than 2 years off global life expectancy

Via AQLI: AQLI Update: Most of the World Breathes Unsafe Air, Taking More Than 2 Years Off Global Life Expectancy. Click or tap through to download the full report. Excerpt:

Particulate pollution remained high even while Covid-19 slowed the global economy. At the same time, mounting evidence on the health impacts of pollution at low levels led to new guidelines that brought most of the world into the unsafe zone. 

During the first year of the Covid-19 pandemic, the world’s economy slowed. Yet, the global annual average particulate pollution (PM2.5) was largely unchanged from 2019 levels. At the same time, growing evidence shows air pollution—even when experienced at very low levels—hurts human health. This recently led the World Health Organization (WHO) to revise its guideline (from 10 µg/m³ to 5 µg/m³) for what it considers a safe level of exposure of particulate pollution, bringing most of the world—97.3 percent of the global population—into the unsafe zone.  

The Air Quality Life Index (AQLI) finds that particulate air pollution takes 2.2 years off global average life expectancy, or a combined 17 billion life-years, relative to a world that met the WHO guideline (5 µg/m3). This impact on life expectancy is comparable to that of smoking, more than three times that of alcohol use and unsafe water, six times that of HIV/AIDS, and 89 times that of conflict and terrorism.

Mental health after China's prolonged lockdowns

An editorial in The Lancet: Mental health after China's prolonged lockdowns. Excerpt:

On June 1, Shanghai reopened after a 2-month lockdown to curb COVID-19. On June 6, Beijing also eased COVID-19 restrictions by allowing restaurant dining and the gradual reopening of schools from June 13 in most districts. Although many countries instituted various forms of lockdown over the past 2 years, China's have often been the most stringent and frequent. Control policies, including school closures and stay-at-home orders, combined with the stress of the pandemic itself, will have exacerbated the already fragile mental health of many Chinese people. 

According to the first national survey on psychological distress in the COVID-19 epidemic in China from 2020, 35% of respondents experienced distress, including anxiety and depression. School closures were associated with adverse mental health symptoms and behaviours among children and adolescents. Amid the relief of lifting restrictions, there is also widespread anxiety over adapting to routine life and fear that transmission of the virus will rebound. This scenario is cause enough for concern, but it plays out against the wider backdrop of mental disorders in China, which remain largely unaddressed.  

Mental health in China has gained attention among the public and academia only in the past 20 years. The first national survey of mental disorders in China, from 2013–15, showed that the lifetime prevalence of mental health conditions in adults is 16·6%. Considering China's population, the clinical need is huge.  

Yet access to treatment is extremely poor. Only 9·5% of people with depressive disorders received treatment, and very rarely (0·5%) was treatment adequate. Mental health services are concentrated in large specialty hospitals rather than community and primary health care, encouraging the long-established pattern in China of going straight to large hospitals for specialist treatment, rather than first seeing a general practitioner.  

This centralised system of care is not adequate to meet China's mental health-care needs. Transitioning from a hospital-centric system to one that is more integrated, anchored in primary health care, and enabled by the newest technology and data (as recommended in a review of quality of primary health care in China by Xi Li and colleagues) is essential.  

Mental health has long been neglected in China, partly because of a deep-rooted cultural stigma. Discussing mental health remains taboo among many communities. Confucianism emphasises the achievement of personal and social harmony. People with mental disorders are often perceived as unable to fulfil this ideal. Families of patients worry about how a disclosure of mental illness might damage their reputation. The fear of being stigmatised and socially isolated will undoubtedly disincentivise people with mental disorders from seeking care.  

The Chinese Government has introduced a mental health law, as well as the 686 programme, aimed at strengthening the mental health-care workforce, raising awareness, and integrating mental health-care services. If patients are unable to voice how they feel openly and frankly, they will be left invisible and untreated.  

Culturally sensitive, stigma reduction interventions and national campaigns are clearly needed to break down barriers to accessing services. What else? The Lancet has convened a Commission of Chinese and international researchers, led by Michael Phillips from Shanghai Mental Health Center and Shuiyuan Xiao from Xiangya School of Public Health, to identify the key challenges that need to be addressed in China's next 5-year plan for mental health, consider how China's rapid economic, social, and technological changes affect mental health and mental health care, and discuss the growing role of China in the global mental health movement. It is due to report its findings in 2023.