H5N1

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 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 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.

Cambodia: Two Takeo boys confirmed infected by H5N1 bird flu

Google Maps

Thanks to Peter O'Meagher for alerting me to this Khmer Times report: Two Takeo boys confirmed infected by H5N1 bird flu. Takeo is a province south of the capital, Phnom Penh. The 3-year-old case was reported yesterday, but not the 5-year-old. Excerpt:

The Takeo Health Department said two boys, ages three and five, have been confirmed to be infected with the H5N1 bird flu, while 29 others are still waiting for test results from the National Institute of Public Health (NIPH) and the Pasteur Institute (PI) of Cambodia.  

H5N1 is a subtype of influenza that predominantly infects birds. However, the H5N1 virus can also infect mammals that have been exposed to infected birds in some cases. In these cases, symptoms are frequently severe or fatal.  

Takeo Health Director Nhea Sithan said yesterday that two children have been diagnosed with the H5N1 bird flu virus, while 29 people were waiting on results of blood tests from the NIPH and PI. He said that the Takeo Provincial Health Department has asked experts to cooperate with the relevant ministries to identify everyone who ate chickens that are suspected of having been infected with the H5N1 bird flu virus.  

“We have dealt with the situation in a timely manner and we’ve sent 29 people who may have been exposed to H5N1 to analyse their blood to see whether they have contracted bird flu or not,” he said.  

The director of the Takeo Provincial Production and Veterinary Office, Thai Ly, said yesterday that more than 600 chickens that were thought to be at high risk of being infected with the H5N1 virus were destroyed after the Takeo Provincial Department of Agriculture, Forestry, and Fisheries identified a case of bird flu in Por village.  

He added that according to past studies of the bird flu virus, this level of infection is unlikely to spread to other villages. However, he urged people not to eat sick or already-dead birds to avoid H5N1 infection.  

“We are calling on people to be vigilant against infection by bird flu by not eating and cooking the chickens and ducks that are sick or die from unknown causes due to the danger caused by H5N1,” he said.

State of Global Air Report 2024

Via the Health Effects Institute: State of Global Air Report 2024. Click or tap through todownload the complete report. The summary:

The State of Global Air 2024 report provides a comprehensive analysis of data for air quality and health impacts for countries around the world. The analysis finds that: 

 ● Air pollution accounted for 8.1 million deaths globally in 2021, becoming the second leading risk factor for death, including for children under five years. Of the total deaths, noncommunicable diseases including heart disease, stroke, diabetes, lung cancer, and chronic obstructive pulmonary disease (COPD) account for nearly 90% of the disease burden from air pollution. 

 ● In 2021, more than 700,000 deaths in children under 5 years were linked to air pollution; this represents 15% of all global deaths in children under five. 

As in previous years, the State of Global Air 2024 report and accompanying website provides comprehensive data on the levels and trends in air quality and health for every country in the world. This State of Global Air report was produced in partnership with UNICEF. 

In the State of Global Air 2024 interactive app, you can explore, compare, and download data and graphics reflecting the latest air pollution levels and associated burden of disease for over 200 individual countries, territories, and regions, as well as track trends from 1990 to 2021.

See also this Guardian story on the report.

WHO: Avian Influenza A (H9N2)—India

A WHO DON: Avian Influenza A (H9N2)- India. Excerpt:

Situation at a glance  

On 22 May 2024, the International Health Regulations (IHR) National Focal Point (NFP) for India reported to WHO a case of human infection with avian influenza A(H9N2) virus detected in a child resident of West Bengal state in India. This is the second human infection of avian influenza A(H9N2) notified to WHO from India, with the first in 2019. The child has recovered and was discharged from hospital.  

According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. Most human cases of infection with avian influenza A(H9N2) viruses are exposed to the virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness.  

Based on available information, further sporadic human cases could occur as this virus is one of the most prevalent avian influenza viruses circulating in poultry in different regions. With the currently available evidence, WHO assesses the current public health risk to the general population posed by this virus as low.  

However, the risk assessment will be reviewed should further epidemiological or virological information become available.  

Description of the situation  

On 22 May 2024, WHO received a notification from the IHR NFP regarding a human case of avian influenza A(H9N2) virus infection in West Bengal state, India.  

The patient is a 4-year-old child residing in West Bengal state. The case, previously diagnosed with hyperreactive airway disease, initially presented to the paediatrician with fever and abdominal pain on 26 January 2024. On 29 January, the patient developed seizures and was brought to the same paediatrician. On 1 February, the patient was admitted to the pediatric intensive care unit (ICU) of a local hospital due to the persistence of severe respiratory distress, recurrent high-grade fever and abdominal cramps. The patient was diagnosed with post-infectious bronchiolitis caused by viral pneumonia.  

On 2 February, the patient tested positive for influenza B and adenovirus at the Virus Research and Diagnostic Laboratory at the local government hospital. The patient was discharged from the hospital on 28 February 2024. On 3 March, with a recurrence of severe respiratory distress, he was referred to another government hospital and was admitted to the pediatric ICU and intubated.  

On 5 March, a nasopharyngeal swab was sent to the Kolkata Virus Research and Diagnostic Laboratory and tested positive for influenza A (not sub-typed) and rhinovirus. The same sample was sent to the National Influenza Centre at the National Institute of Virology in Pune for subtyping. On 26 April, the sample was sub-typed as influenza A(H9N2) through a real-time polymerase chain reaction.  On 1 May, the patient was discharged from the hospital with oxygen support.  

Information on the vaccination status and details of antiviral treatment were not available at the time of reporting. The patient had exposure to poultry at home and in the surroundings. There were no known persons reporting symptoms of respiratory illness in the family, the neighbourhood, or among healthcare workers at health facilities attended by the case at the time of reporting.  

This is the second human infection of avian influenza A(H9N2) virus infection notified to WHO from India, with the first in 2019. Further sporadic human cases could occur as this virus is one of the most prevalent avian influenza viruses circulating in poultry in different regions. 

WHO: Avian Influenza A (H5N1) - Australia

A WHO DON: Avian Influenza A (H5N1) - Australia. Excerpt:

Situation at a glance  

On 22 May 2024, the World Health Organization (WHO) was notified of a laboratory-confirmed case of human infection with avian influenza A(H5N1) virus (clade 2.3.2.1a) by the International Health Regulations (IHR) National Focal Point (NFP) of Australia. This is the first confirmed human infection caused by avian influenza A(H5N1) virus detected and reported by Australia.  

Although the source of exposure to the virus in this case is currently unknown, the exposure likely occurred in India, where the case had travelled, and where this clade of A(H5N1) viruses has been detected in birds in the past. According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. Based on available information, WHO assesses the current risk to the general population posed by this virus as low.  

Description of the situation  

On 17 May 2024, the WHO Collaborating Centre (WHO CC) for Reference and Research on Influenza in Australia notified the NFP of Australia of a suspected case of human A(H5N1) avian influenza (HPAI) in Melbourne, Victoria. The state Victorian Department of Health confirmed this case on 18 May 2024. Under Article 44, the NFP of Australia advised the NFP of India of the confirmed case on 21 May 2024. Under Article 8, the IHR NFP of Australia notified WHO of the case on 22 May 2024.  

The case is a 2.5-year-old female child with no underlying conditions.  She had a history of travel to Kolkata, India from 12 to 29 February 2024. She returned to Australia on 1 March 2024. Upon returning to Australia, the child presented at a hospital in Victoria on 2 March 2024, where she received medical care and was admitted on the same day. 

On 4 March, the patient was transferred to the intensive care unit at a referral hospital in Melbourne, Victoria, due to worsening symptoms, for a period of one week. The patient was discharged from hospital after a 2.5-week admission. The case is now reported to be clinically well.  

The Victorian Department of Health reported on 23 May 2024 that the family advised that the child started to feel unwell on 25 February 2024, with loss of appetite, irritability and fever, and was taken to a doctor on the evening of 28 February 2024 in India. She was febrile, coughing and vomiting and was given paracetamol. It was not reported to an Australian airport biosecurity officer that the child was unwell when she arrived in Australia on 1 March 2024.  

Additional information provided by the family indicates that the case did not travel outside of Kolkata, India, and did not have any known exposure to sick persons or animals while in India. It is understood that no close family contacts of the case in Australia or India developed symptoms, as of 22 May 2024.  

A nasopharyngeal swab and endotracheal aspirate taken on 6 and 7 March respectively tested positive for influenza A at the referral hospital. The samples were sent to the WHO CC for further characterisation on 3 April as part of a batch, as there was insufficient knowledge from the referring practitioners at the hospital to connect the case to the H5N1 virus.  

Virus genetic sequence obtained from the samples confirmed the subtype A(H5N1) and indicated that the haemagglutinin (HA) gene belonged to clade 2.3.2.1a, which circulates in South-East Asia and has been detected in previous human infections and in poultry.

Human case of H5N1 avian influenza (bird flu) detected in returned traveller to Victoria

Thanks to FluTrackers for posting this report from the Victoria health department: Human case of avian influenza (bird flu) detected in returned traveller to Victoria. This case seems unrelated to the avian flu reported yesterday in poultry farms in Victoria. The key points:

• A human case of avian influenza A(H5N1) infection, also known as “bird flu”, has been reported in Victoria.  

• There is a current global outbreak of avian influenza in birds and animals. Avian influenza does not usually infect people, but in rare cases human infection can occur.  

• The recently reported case in Victoria was in a child who returned to Australia from overseas in March 2024. The child experienced a severe infection but is no longer unwell and has made a full recovery.  

• There is no evidence of transmission in Victoria and the chance of additional human cases is very low as avian influenza does not easily spread between people.

WHO: Global immunization efforts have saved at least 154 million lives over the past 50 years

WHO has published a news release: Global immunization efforts have saved at least 154 million lives over the past 50 years. Excerpt:

A major landmark study to be published by The Lancet reveals that global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of lives saved – 101 million – were those of infants.  

The study, led by the World Health Organization (WHO), shows that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood.  

Of the vaccines included in the study, the measles vaccination had the most significant impact on reducing infant mortality, accounting for 60% of the lives saved due to immunization. This vaccine will likely remain the top contributor to preventing deaths in the future.  

Over the past 50 years, vaccination against 14 diseases (diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever) has directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African Region.  

"Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”  

The study found that for each life saved through immunization, an average of 66 years of full health were gained – with a total of 10.2 billion full health years gained over the five decades. As the result of vaccination against polio more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio, once and for all.  

These gains in childhood survival highlight the importance of protecting immunization progress in every country of the world and accelerating efforts to reach the 67 million children who missed out on one or more vaccines during the pandemic years.

Hospital stays for respiratory illnesses increase among Canadian children

A news release from the Canadian Institute for Health Information: Hospital stays for respiratory illnesses increase among Canadian children.

February 22, 2024 —  The data confirms the anecdotal evidence from across the country last year: in 2022–2023, Canada’s hospitals saw a significant increase in stays due to respiratory illnesses among people younger than 18.  

In particular, data from the Canadian Institute for Health Information (CIHI) shows a rebound in hospitalizations for seasonal flu among children age 0 to 4 — the number of stays jumped to 2,444, a return to pre-pandemic volumes. The most common respiratory illnesses among children age 0 to 4 accounted for 32% of all hospitalizations in this group, increasing from 20% the previous year.   

In addition to seasonal influenza, hospitalizations for pneumonia tripled for Canadians age 0 to 17 and almost doubled for asthma. Among children age 0 to 4, hospitalizations doubled for lower respiratory infections, and stays for COVID-19 rose by 43%.  

“Having a baby or young child in hospital for any reason is tremendously difficult on families, and this increase in hospitalizations for respiratory illnesses among Canada’s youngest patients presented additional challenges for hospitals,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We will continue to monitor and report on these trends to equip health system planners and decision-makers with the data required to continue to meet the needs of Canada’s pediatric population.”  

“Last year was unprecedented for all pediatric hospitals in this country and highlighted key gaps in our system. We know from experience that viral seasons will continue to affect our young patients, and this is why it is so important that we invest in our pediatric health system and adopt public health measures to help reduce the risks,” said Dr. Lindy Samson, Chief of Staff and Chief Medical Officer, Children’s Hospital of Eastern Ontario (CHEO), and pediatric infectious disease specialist.  

Quick facts  

• The respiratory illnesses that are in the top 10 reasons for hospitalizations accounted for 32% of all hospitalizations for Canadians age 0 to 4 in 2022–2023.  

• Hospitalizations for seasonal influenza among children age 0 to 4 increased to 2,444 in 2022–2023, similar to 2019–2020 volumes.  

• Large increases were also observed in this age group for other respiratory illnesses:  

* Hospital stays for lower respiratory infections such as acute bronchitis increased from 9,501 to 19,909.  

* Hospitalizations for pneumonia almost tripled, rising from 3,447 to 9,871.  

* Asthma hospital stays increased by 61%, from 3,474 to 5,607.  

* COVID-19 accounted for 3,310 hospitalizations, up 43% from the previous year.  

* Acute upper respiratory infections saw a 32% increase in hospitalizations, going from 2,114 to 2,797.