H5N1

ECDC risk assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, Wuhan, China; first update

On January 22, ECDC published Risk assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, Wuhan, China; first update. The executive summary:

On 31 December 2019, the Wuhan Municipal Health Commission in Wuhan City, Hubei province, China reported a cluster of pneumonia cases of unknown aetiology, with a common reported link to Wuhan's Huanan Seafood Wholesale Market (a wholesale fish and live animal market selling different animal species).  

On 9 January 2020, China CDC reported that a novel coronavirus (2019-nCoV) had been detected as the causative agent and the genome sequence was made publicly available. Sequence analysis showed that the newly-identified virus is related to the SARS-CoV clade. Detection systems have been developed and are available for the Member States through WHO and the European Virus Archive global catalogue.  

As of 20 January 2020, a total of 295 laboratory-confirmed cases infected with 2019-nCoV have been reported, 291 from Wuhan, China and four travel-associated from Thailand (2), Japan (1) and South Korea (1). Four deaths have been reported among the cases. Chinese health authorities have confirmed human-to-human transmission and 15 healthcare workers are reported to have been infected in Wuhan. The original source of the outbreak remains unknown and therefore further cases and deaths are expected in Wuhan, and in China. It is possible that further cases will also be detected among travellers from Wuhan to other countries. 

There are considerable uncertainties in assessing the risk of this event, due to lack of detailed epidemiological analyses.  

On the basis of the information currently available, ECDC considers that:  

• the potential impact of 2019-nCoV outbreaks is high; 

• further global spread is likely;

• there is currently a moderate likelihood of infection for EU/EEA travellers visiting Wuhan; 

• there is a high likelihood of case importation into countries with the greatest volume of people travelling to and from Wuhan (i.e. countries in Asia); 

• there is a moderate likelihood of detecting cases imported into EU/EEA countries; 

• adherence to appropriate infection prevention and control practices, particularly in healthcare settings in EU/EEA countries with direct links to Wuhan, means that the likelihood of a case reported in the EU resulting in secondary cases within the EU/EEA is low.

New spike in displacement in Eastern DRC further complicates Ebola response, requires urgent relocation and response

Via ReliefWeb, a report from IOM: New spike in displacement in Eastern DRC further complicates Ebola response, requires urgent relocation and response.

Kinshasa – Renewed violence in the eastern Democratic Republic of the Congo (DRC) region that is struggling to contain the ongoing Ebola outbreak, has claimed the lives of at least 160 people and displaced hundreds of thousands of others, further complicating the response to the public health emergency. 

“The people who fled the frontline of the conflict are living in dire conditions,” said Fabien Sambussy, IOM Chief of Mission in DRC. 

“Humanitarian actors urgently need access to provide assistance and prevent further massive displacement. We are increasingly concerned that rising displacement creates fertile ground for the spread of disease – most worryingly Ebola – in Ituri province.” 

According to the President of the Democratic Republic of the Congo, Felix Tshisekedi, who visited the area recently, an estimated 400,000 persons are currently displaced throughout Ituri Province. 

Djugu Territory has seen a 135 per cent rise in displacement with 20,000 new internally displaced persons (IDPs) registered last month in 12 displacement sites managed by IOM, which has provided Camp Coordination and Camp Management (CCCM) and shelter services since 2018. Thousands more are sheltering in spontaneous sites. 

“Efforts are ongoing to mobilize the necessary resources to determine the number of people displaced and their whereabouts,” added Sambussy, referring to IOM’s Displacement Tracking Matrix (DTM). “Our humanitarian and government partners can use this data to better target and assist affected populations.”  

Poor hygiene conditions in displacement sites severely increase the risk that Ebola, as well as cholera, measles and acute respiratory diseases, will spread. Many of these people are seeking assistance in Ebola-affected Bunia where the displacement site officially called ‘General Hospital Site’ has received more than 5,000 new IDPs, increasing the site’s population to 10,000 – twice its capacity. The overcrowded site, where hygiene conditions are poor, is close to the town’s hospital and the Ebola Treatment Centre (ETC) where 12 suspected and confirmed cases are being treated.  

A plan to relocate IDPs to a new settlement on land owned by Bunia’s Catholic Diocese is currently underway. The 120,000 square meter plot offers favourable conditions for the safe and dignified relocation of IDPs. IOM is mobilizing the financial resources required to start land development as well as the rapid relocation of IDPs exposed to public health hazards and other protection risks.  

IOM is also reinforcing its Ebola surveillance and disease prevention activities in Ituri by supporting health points of control within the country, and Points of Entry at international borders with risk communication, hand washing/hygiene promotion and surveillance activities including temperature screening and collection of key traveller information and health status. 

IOM also uses information on population mobility in the region to target preparedness measures, including in Uganda, South Sudan and Burundi, with the aim of reducing disease transmission to new areas and across borders. 

This recent resumption of violence follows 16 years of relative peace; intercommunal violence in the same area displaced hundreds of thousands of people between 1997 and 2003. The security situation has now deteriorated in resource-rich Djugu and neighbouring Mahagi territories due to intense fighting between Lendu and Hema groups, and conflict between Armed Forces of the Democratic Republic of the Congo (FARDC) and non-state armed actors.  

IOM CCCM operations in DRC are funded by the Governments of Sweden and Canada. Ebola activities are funded by USAID/OFDA and the World Bank.

MMWR: Enterovirus D68–associated acute respiratory illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

MMWR has published Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018. The summary:

What is already known about this topic?  

A nationwide outbreak of enterovirus D68 (EV-D68), which is associated with acute respiratory illness (ARI), occurred in 2014. EV-D68 epidemiology is not fully understood because testing in clinical settings is limited and detections are not notifiable to CDC. 

What is added by this report?  

Based on active, prospective surveillance of ARI through the New Vaccine Surveillance Network, EV-D68 was detected in two (0.8%) patients in 2017 and 358 (13.9%) in 2018. Detections in 2018 peaked in September.  

What are the implications for public health practice? 

Continued active, prospective surveillance is needed to better understand trends in EV-D68 circulation.

Spikes in air pollution can heighten risk of chest infections, research suggests

Via The Guardian: Spikes in air pollution can heighten risk of chest infections, research suggests. Excerpt:

Even short-term increases in air pollution are linked to a higher risk of developing viral chest infections that turn into conditions such as bronchiolitis, new research suggests.  

The study, carried out by scientists in the US, looked at levels of tiny particles in the air known as PM2.5s across eight locations along the Wasatch Front in Utah, including Salt Lake City. This area features a string of towns and is home the majority of the state’s population and, due to various factors, experiences large variations in air pollution. 

The team then looked at the number of people who turned up at local healthcare centres and hospitals and were diagnosed with acute lower respiratory infections during the same period of time. 

The results, published in the American Journal of Respiratory and Critical Care Medicine, reveal that an increase in diagnoses of such infections appears to follow an uptick in air pollution in the previous weeks. 

“There may be some connection between air pollution and lower acute respiratory infections, whether it is that air pollution causes the airway to become more susceptible to infection, or once you are infected it may cause the body to respond less vigorously to the infection,” said Dr Benjamin Horne, director of cardiovascular and genetic epidemiology at the Intermountain Medical Center Heart Institute in Salt Lake City, adding that it could also be that high pollution drives people to stay indoors, increasing the chance of passing infections around.

Flu News Europe, week 4

Excerpted from this week's Flu News Europe:

Week 4/2018 (22–28 January 2018) 

• Influenza activity was widespread in the majority of reporting countries and while activity was increasing, intensity in most countries was reported as low to medium. 

• Both influenza virus types A and B were co-circulating with a higher proportion of type B viruses. Different proportions of circulating influenza virus types and A subtypes were observed between countries in the Region. 

• Of the individuals sampled, on presenting with ILI or ARI to sentinel primary healthcare sites, 51.9% tested positive for influenza viruses, within the range observed in the previous 3 weeks (42–52%).

WHO: Up to 650 000 people die of respiratory diseases linked to seasonal flu each year

A WHO news release: Up to 650 000 people die of respiratory diseases linked to seasonal flu each year. Excerpt:

14 DECEMBER 2017 | GENEVA - Up to 650 000 deaths annually are associated with respiratory diseases from seasonal influenza, according to new estimates by the United States Centers for Disease Control and Prevention (US-CDC), the World Health Organization and global health partners.  

This marks an increase on the previous global estimate of 250 000 – 500 000, which dates from over ten years ago and covered all influenza-related deaths, including cardiovascular disease or diabetes. The new figures of 290 000 – 650 000 deaths are based on more recent data from a larger, more diverse group of countries, including lower middle income countries, and exclude deaths from non-respiratory diseases.  

“These figures indicate the high burden of influenza and its substantial social and economic cost to the world,” said Dr Peter Salama, Executive Director of WHO’s Health Emergencies Programme. “They highlight the importance of influenza prevention for seasonal epidemics, as well as preparedness for pandemics.” 

The estimates take into account findings from recent influenza respiratory mortality studies, including a study conducted by the United States Centers for Disease Control and Prevention (US-CDC), published in The Lancet on Thursday (14 December). 

According to US-CDC, most deaths occur among people aged over 75 years, and in the world’s poorest regions. Sub-Saharan Africa accounts for the world’s greatest flu mortality risk, followed closely by the Eastern Mediterranean and Southeast Asia.  

“All countries, rich and poor, large and small, must work together to control influenza outbreaks before the arrival of the next pandemic. This includes building capacity to detect and respond to outbreaks, and strengthening health systems to improve the health of the most vulnerable and those most at risk,” said Dr Salama. 

Nearly all deaths among children under five with influenza-related lower respiratory tract infections occur in developing countries, but the effects of seasonal influenza epidemics on the world’s poorest are not fully known.  

WHO is working with partners to assess the global influenza burden of disease by providing guidance and expertise to Member States to measure the influenza disease burden and its economic consequences. 

Further surveillance and laboratory studies of other diseases such as cardiovascular disease, which can be influenza-related, are expected to yield substantially higher estimates over the next few years.

Rohingya children in Cox’s Bazar to be vaccinated against cholera

A VOA report: Rohingya Children in Cox’s Bazar to be Vaccinated Against Cholera.

The second phase of a campaign to vaccinate tens of thousands of Rohingya refugee children against cholera gets underway Saturday in Cox’s Bazar, Bangladesh.  

The oral cholera vaccination campaign, which is being led by the World Health Organization, is targeting nearly 180,000 children between the ages of one and five years. They will receive an additional dose of the vaccine for added protection.  

The children had received a first dose of the vaccine when the campaign was launched on October 10. At that time, the oral cholera vaccine was administered to more than 700,000 people above the age of one. 

WHO spokesman Tarik Jasarevic says health workers also will give all children up to the age of five oral polio vaccines during the campaign to protect them against this crippling disease.  

He says so far, no confirmed cases of cholera have been reported. 

“But, there is a risk and this is why we are doing this oral vaccination," Yasarevic said. "And, WHO has set up a lab together with the ministry to do water-quality monitoring. And, the results show that this testing from drinking water that only 17 percent of the samples collected and tested from various settlements met Bangladesh and WHO standards during the reported period.”  

More than 600,000 Rohingya refugees escaping violence in Myanmar have arrived in Cox’s Bazar since late August. They are living in congested, squalid, unsanitary makeshift settlements — a perfect breeding ground for cholera and other diseases.  

Jasarevic says there has been an outbreak of acute watery diarrhea. At present, though, none of the lab tested cases has been confirmed as cholera. He says the most serious health risks are acute respiratory infections and measles.

ECDC on Hurricane Irma: Risk of communicable diseases in the affected countries

ECDC has published Rapid Risk Assessment: Hurricane Irma: risk of communicable diseases in the affected countries. The abstract:

In the aftermath of Hurricane Irma, the most immediate risks in the affected areas of the Caribbean are increased transmission of diarrhoeal diseases related to lack of access to safe drinking water and acute respiratory infection in children accommodated in overcrowded shelters. The risk of an upsurge in cholera cases in areas with previous transmission and flood-specific risks (e.g. tetanus and leptospirosis) should be given priority when adopting mitigating measures. Mosquito-borne diseases represent a delayed risk that should be taken into account in this context.

Lassa fever in Nigeria: 18 states record 82 deaths, 241 cases

Via Vanguard: Lassa fever: 18 states record 82 deaths, 241 cases.

No less than 18 states across the Federation recorded at least one confirmed case of Lassa fever out of a total of  241 recorded cases with 82 deaths since the onset of the latest Lassa fever outbreak in December 2016. 

The affected states include Ogun, Bauchi, Plateau, Ebonyi, Ondo, Edo, Taraba, Nasarawa and Rivers. Others are Kaduna, Gombe, Cross-River, Borno, Kano, Kogi, Enugu, Anambra and Lagos. 

Disclosing this in an update of the Lassa fever outbreak in the country for Week 33 (August 12-17, 2017), the Nigeria Centre for Disease Control, NCDC, said out of the 241 recorded cases, 227 are classified as confirmed while 14 are probable, with 82 deaths (67 confirmed and 14 probable) recorded. 

According to the NCDC, as at week 32 (August 5-11, 2017), the outbreak was active in Ondo, Edo, Plateau, Bauchi, Lagos and Ogun.) 

“Ogun State reported a new confirmed case this week. This brings the state back to the active outbreak category. Contact tracing has commenced in the state. 

“Since the onset of Lassa fever outbreak in Dec. 2016 (Week 49), a total of 241 cases have been classified as: confirmed (227) and probable (14), with 82 deaths (67 deaths in confirmed and 14 in probable) recorded. 

“Case Fatality Rate in confirmed and probable cases is 34 per cent and 16.1 per cent for all cases (including probable, confirmed and suspected).  

“In the reporting Week 32 (August 5-11, 2017), 11 new suspected cases were reported in Ondo (1), Bauchi (1), Plateau (2) and Lagos (7) states. 

“Five of the seven suspected cases reported in Lagos state had lab testing done and all results came out negative. 10 new confirmed cases were reported from Ondo (1), Edo (2), Plateau (2), Ogun (1) and Lagos (4) states.  

“One death was recorded for a confirmed case reported in Lagos state. Two of the pending results from Bauchi came back negative. There are six pending results from Plateau (2), Ondo (1), Bauchi (1) and Lagos (2) states,” the NCDC noted.  

Meanwhile the Ogun State government has discharged the 20-year-old Lassa fever patient that has been in isolation at the Federal Medical Centre, Abeokuta for 21 days.  

A statement by the state Commissioner for Health, Dr. Babatunde Ipaye, confirmed that results of two tests carried out on the patient were negative.

Nigeria: Hunger amplifies infectious diseases for millions fleeing the violence of Boko Haram

Via Science: Hunger amplifies infectious diseases for millions fleeing the violence of Boko Haram. Excerpt:

BORNO STATE, NIGERIA—Flying into Monguno, a recently "liberated" town in a forgotten corner of a forgotten state in northeastern Nigeria, all you can see is a vast expanse of nothingness. There is no horizon, just a haze of sand whipped up by the hot, harmattan winds blowing from the Sahara Desert. No green, except for the curious mossy splotches where groundwater rises to the surface. All else is dust. The only signs of farms are the faint outlines of what were once fields etched into the desiccated land. Every so often the charred remnants of a village come into view. 

This is what scorched earth looks like, a legacy of more than 8 years of terror by the extremist group Boko Haram, which, until recently, held the region in a vice. The world began to wake up to the full horror of that legacy last year, as the Nigerian army started ousting the insurgents from their strongholds here in Borno and the two adjoining states of Yobe and Adamawa. 

As survivors began straggling out, the few humanitarian workers already on the ground were shocked at what they saw: millions sick and near starvation, fresh graves that hinted at an untold number of dead. "We started seeing the state of the people coming out and got a sense of what the magnitude of the crisis might be," says John Agbor, UNICEF's head of health for Nigeria in Abuja.  

Exact numbers are hard to pin down, but across these three states 8.5 million people are in need of humanitarian assistance. About 5.1 million are malnourished, half a million children so severely that without treatment 75,000 more will die by June, warns the U.N. Office for the Coordination of Humanitarian Affairs (OCHA). About 1.8 million people have been internally displaced and are on the move, more than half of them children. In Borno, the hardest hit state, 1.2 million have crowded into the capital city of Maiduguri alone, doubling the population in a matter of months.

The uprooted are crammed into squalid camps and towns already too destitute to deal with the influx. Food, water, and sanitation are scarce or nonexistent, leaving few options other than open defecation. The camps and slums provide a perfect breeding ground for disease. In a deadly cycle, malnutrition renders children more susceptible to infection and less able to fight it. 

Epidemics of measles and malaria rage, and polio has resurfaced. Child mortality is off the charts, "two, three, four times" above the emergency threshold, says Marco Olla, a pediatric specialist with Médecins Sans Frontières (MSF) in Paris. Malaria has been the biggest killer, accounting for about half of all deaths, but acute respiratory infections and diarrhea are now vying for the top spot.  

It is hard to rank human tragedies, but by all accounts this is one of the worst on the African continent today. "It is really, really, really bad for a lot of people. It is a crisis of great severity and magnitude," says Jorge Castilla of the health emergencies program at the World Health Organization (WHO) in Geneva, Switzerland. 

Yet it remains remarkably unrecognized and hugely underfunded, leaving aid workers struggling with how to deliver lifesaving interventions when the needs are so great and the resources so paltry.