H5N1

Progress toward regional measles elimination — worldwide, 2000–2021

Via MMWR: Progress Toward Regional Measles Elimination — Worldwide, 2000–2021. The summary:

What is already known about this topic?  

Progress toward measles elimination experienced setbacks in 2020 during the COVID-19 pandemic.  

What is added by this report?  

During 2000–2021, measles vaccination prevented an estimated 56 million deaths worldwide. In 2021, only 81% of children received their first dose of measles containing vaccine (MCV), the lowest coverage reported since 2008, leaving 25 million children vulnerable to measles. Measles surveillance continues to be suboptimal, and large and disruptive outbreaks were reported in 22 countries.  

What are the implications for public health practice?  

Reaching all children with 2 doses of MCV and strengthening measles surveillance is critical to close immunity gaps, prevent outbreaks, and recover progress lost during the pandemic.

Cholera: Fifty deaths and more than 1,500 people hospitalized in Haiti

Via Le Nouvelliste, which has temporarily ceased to publish on paper owing to the conditions in Haiti: Cholera: fifty deaths and more than 1,500 people hospitalized in Haiti. Excerpt from the Google translation:

After three years without any case of cholera in Haiti despite active research, the Ministry of Public Health and Population detected a first case a month ago, which signals the resurgence of this disease in Haiti. Known for its great contagiousness, helped by the humanitarian crisis that has plagued the country for more than two months, cholera is responsible for more than 1,500 hospitalizations and around fifty deaths, including 14 in the civil prison of Port-au-Prince.

Relegated to the background in the face of the multiple crises that dominate the news in Haiti, cholera continues its path, leaving in its wake more than a thousand patients and fifty people who died in less than a month.  

"Anyone presenting with acute watery, profuse diarrhea, with or without vomiting, with or without dehydration, is considered a suspected case", according to the Department of Epidemiology, Laboratories and Research of the MSPP.  

As of October 1, 2022, 2,274 people fit this case definition. Of these, 253 were confirmed by a positive culture for Vibrio cholerae or by epidemiological link, 1,642 were hospitalized, for a total of 52 deaths.  

Still according to the latest MSPP bulletin published on October 26, 2022, 271 suspected cases and 14 deaths were counted in the civil prison of Port au Prince.  

Two facts draw attention in the bulletin: "the distribution of cumulative suspected cases by age group and the distribution of cases by department."  

More than 1,000 suspected cases have been listed among children under 15. A situation that continues to worry epidemiologists and infectious disease specialists.  

A week ago, Dr. Jean William Pape illustrated the seriousness of the situation by informing that out of 79 patients seen in a ward at the Gheskio centers cholera treatment center, 54 were children.  

“Among the children, we have 39 between 0-5 years old, in this age group we have 3 children with severe acute malnutrition and septic shock,” he revealed.  

Pointing to insecurity and fuel shortages, Dr. Jean William Pape had advocated strengthening awareness campaigns and taking oral serum even before going to a cholera treatment center for suspected cases. 

 Another highlight of the epidemiological bulletin of the MSPP is the spread of cholera in 8 departments of the country. The North and South-East are the only departments absent in the distribution of suspected cases, tested and confirmed by the MSPP.

Vietnam: Child H5 bird flu patient no longer in critical condition

Via Dan Tri, a little good news: Child bird flu patient escapes critical condition. The Google translation:

A five-year-old child in the northern province of Phu Tho infected with A/H5 avian flu has escaped critical condition.  

The patient, Vietnam's first human case of A/H5 avian flu since 2014, was taken to the Vietnam National Hospital of Paediatrics on October 8 with severe symptoms, including respiratory failure, liver and acute kidney failure and multi-organ failure.  

Doctor Do Anh Tuan, head of the hospital’s Intensive Care Ward, said that endotracheal intubation has been removed, and she was now quite conscious. Doctors are keeping a close eye on her condition, particularly how her kidneys were functioning.  

The patient’s relatives said that she ate chicken and duck which must have been infected.  

Medical authorities in Thanh Ba District have provided A/H5 avian flu tests for 65 people who came into close contact with her. But, luckily, all of them tested negative for the disease.  

Vietnam has recorded 128 human cases of A/H5 since 2003, including 64 people who died. In 2014 alone, the country saw two cases of H5N1 in the southern provinces of Binh Phuoc and Dong Thap, and both of them died. They had contact with sick poultry.

WHO sees October COVID surge in Ukraine, cites polio concerns

Via Reuters: WHO sees October COVID surge in Ukraine, cites polio concerns. Excerpt:

JERUSALEM, Sept 12 (Reuters) - The World Health Organisation expects a rise in COVID-19 in Ukraine to peak in October, possibly bringing hospitals close to their capacity threshold, WHO's director-general Tedros Adhanom Ghebreyesus said on Monday.  

"We are now seeing an increase in cases of COVID-19 in Ukraine. We project that transmission could peak in early October and hospitals could approach their capacity threshold," Ghebreyesus told WHO'S Regional Committee for Europe conference in Tel Aviv.  

"Oxygen shortages are predicted because major supply sources are in occupied parts of the country," he said. Oxygen is essential for patients with a range of conditions, including COVID-19 and those with other critical illnesses stemming from complications of pregnancy, childbirth, sepsis, injuries and trauma.  

Russia's February invasion of Ukraine has greatly impacted healthcare, with the WHO confirming more than 500 attacks on health infrastructure there, resulting in some 100 deaths. Ghebreyesus also said that the war could increase polio spread. 

"We are also deeply concerned about the potential for the international spread of polio due to the gaps in immunization coverage and mass population movement linked to the war," he said.  

Ukraine has low vaccination coverage for both COVID and polio, an infectious disease mainly affecting children that can cause paralysis and kill in rare cases. Two cases of polio were reported in Ukraine in 2021.

Tomato flu outbreak in India

Via The Lancet Respiratory Medicine, another new threat to children and perhaps adults: Tomato flu outbreak in India. Excerpt:

Just as we are dealing with the probable emergence of fourth wave of COVID-19, a new virus known as tomato flu, or tomato fever, has emerged in India in the state of Kerala in children younger than 5 years. The rare viral infection is in an endemic state and is considered non-life-threatening; however, because of the dreadful experience of the COVID-19 pandemic, vigilant management is desirable to prevent further outbreaks.

Although the tomato flu virus shows symptoms similar to those of COVID-19 (both are associated with fever, fatigue, and bodyaches initially, and some patients with COVID-19 also report rashes on the skin), the virus is not related to SARS-CoV-2. Tomato flu could be an after-effect of chikungunya or dengue fever in children rather than a viral infection. The virus could also be a new variant of the viral hand, foot, and mouth disease, a common infectious disease targeting mostly children aged 1–5 years and immunocompromised adults, and some case studies have even shown hand, foot, and mouth disease in immunocompetent adults. Tomato flu is a self-limiting illness and no specific drug exists to treat it.  

The tomato flu was first identified in the Kollam district of Kerala on May 6, 2022, and as of July 26, 2022, more than 82 children younger than 5 years with the infection have been reported by the local government hospitals. The other affected areas of Kerala are Anchal, Aryankavu, and Neduvathur. This endemic viral illness triggered an alert to the neighbouring states of Tamil Nadu and Karnataka. Additionally, 26 children (aged 1–9 years) have been reported as having the disease in Odisha by the Regional Medical Research Centre in Bhubaneswar. To date, apart from Kerala, Tamilnadu, and Odisha, no other regions in India have been affected by the virus. However, precautionary measures are being taken by the Kerala Health Department to monitor the spread of the viral infection and prevent its spread in other parts of India.

The primary symptoms observed in children with tomato flu are similar to those of chikungunya, which include high fever, rashes, and intense pain in joints. Tomato flu gained its name on the basis of the eruption of red and painful blisters throughout the body that gradually enlarge to the size of a tomato. These blisters resemble those seen with the monkeypox virus in young individuals. Rashes also appear on the skin with tomato flu that lead to skin irritation. As with other viral infections, further symptoms include, fatigue, nausea, vomiting, diarrhoea, fever, dehydration, swelling of joints, body aches, and common influenza-like symptoms, which are similar to those manifested in dengue. 

In children with these symptoms, molecular and serological tests are done for the diagnosis of dengue, chikungunya, zika virus, varicella-zoster virus, and herpes; once these viral infections are ruled out, contraction of tomato virus is confirmed. Because tomato flu is similar to chikungunya and dengue as well as hand, foot, and mouth disease, treatment is also similar—ie, isolation, rest, plenty of fluids, and hot water sponge for the relief of irritation and rashes. Supportive therapy of paracetamol for fever and bodyache and other symptomatic treatments is required.

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 30 June 2022, 473 cases of acute hepatitis of unknown aetiology have been reported by 21 countries: (Austria (three), Belgium (14), Bulgaria (one), Cyprus (two), Denmark (seven), France (seven), Greece (11), Ireland (16), Israel (five), Italy (35), Latvia (one), Luxembourg (one), the Netherlands (15), Norway (five), Poland (10), Portugal (19), Republic of Moldova (one), Serbia (one), Spain (40), Sweden (11), and the United Kingdom (268)).

Since the last surveillance bulletin, which used data as of 17 June 2022, 27 new cases have been reported from 10 countries (France (one), Greece (two), Ireland (two), Italy (two), Luxembourg (one), Poland (two), Portugal (four), Spain (three), Sweden (two), and the United Kingdom (eight)). Two cases (France (one), and Sweden (one)) previously classified as probable were subsequently discarded. One case (Sweden) previously discarded was reclassified as probable. Two cases (United Kingdom) previously reported were not included in the latest data update.

The epicurve shows cases by date of onset when available (294 cases), and date of hospitalisation (159 cases), or date used for statistics when the former two are not available (20 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 (76.1%) of cases are five years old or younger.

Of the 473 probable cases, 302 have information available on clinical outcome. Of these, 221 have recovered, 80 remain under medical care, and one death has been associated with this disease.

Of 295 cases with available information, 87 (29.5%) required admission to an intensive care unit. Of the 242 cases for which this information is available, 20 (8.3%) have received a liver transplant.
Overall, 364 cases were tested for adenovirus by any specimen type and had a valid positive or negative result. Of these, 192 (52.7%) tested positive. The positivity rate was the highest in whole blood specimens (53.7%). Typing data are only available for eight cases: type 31 (n = 1), type 40 (n = 1), type 41 (n = 3), and type other (n = 3).

Of the 322 cases PCR tested for SARS-CoV-2, 35 (10.9%) were positive. Serology results for SARS-CoV-2 are only available for 61 cases, of which 39 (63.9%) resulted positive. Of the 113 cases with data on COVID-19 vaccination, 97 (85.8%) were unvaccinated.

Interim analysis of acute hepatitis of unknown etiology in children aged 10 years — United States, October 2021–June 2022

Via MMWR: Interim Analysis of Acute Hepatitis of Unknown Etiology in Children Aged 10 Years — United States, October 2021–June 2022. The summary:

What is already known about this topic?  

During October 2021–February 2022, a cluster of children with hepatitis of unknown etiology and adenovirus infection was identified in the United States. On April 21, after reports of similar cases in other countries, CDC advised clinicians to report patients aged <10 years with hepatitis of unknown etiology to public health authorities.  

What is added by this report?  

During October 1, 2021–June 15, 2022, a total of 296 U.S. pediatric patients received a diagnosis of hepatitis of unknown etiology, with adenovirus detected among 45%. Preliminary analyses have not identified common exposures (e.g., travel or toxicants).  

What are the implications for public health practice?  

The investigation is ongoing; further clinical data are needed to understand the cause of these cases and to assess the potential association with adenovirus.

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.

Ebola in Mbandaka: Death of a 4th confirmed case

Via Radio Okapi: Ebola in Mbandaka: death of a 4th confirmed case. The Google translation, with my bolding:

The fourth confirmed case of the Ebola virus disease died on Friday May 20 in Mbandaka. This is the fourth recorded since the outbreak of the epidemic on April 21. He was discovered on Thursday in the Maman Balako health area, Wangata health zone and commune.  

Only 24 hours after his discovery, the patient died, after having dragged around the community for a long time without proper care.  

Medical sources claim that the victim was a 12-year-old child in the Maman Balako health area. Since May 14, he had been developing symptoms of Ebola, including fever, fatigue, blackish vomit.  

For five days, he was cared for at home, until Thursday, May 19; date on which he was taken to a medical center in the Mbandaka II district. The results of the analysis of the samples taken on the same day from the child were found to be positive for the Ebola virus disease.  

But the family resisted and brought the child home on Thursday evening, where he passed away on Friday morning.  

Sources add that another 9-year-old child died with the same symptoms, in the same neighborhood, on May 6 and buried, without post-mortem collection or a dignified and secure burial. This raises fears of a multiplication of cases.  

The response teams are preparing for the decontamination of different places, through which the deceased child passed. They seek the cooperation of the populations around the case and in the health area concerned.  

They also invite the inhabitants to appropriate all the preventive measures recently enacted by the provincial authority, in order to avoid a large-scale spread of the disease. Among these measures, there is a compulsory post-mortem sample before any burial of bodies in the city.

Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin

ECDC and WHO have published Joint ECDC-WHO Regional Office for Europe Hepatitis of Unknown Origin in Children Surveillance Bulletin. The surveillance 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 13 May 2022, 232 cases of acute hepatitis of unknown aetiology in children aged 16 years or below have been reported, of which 229 were classified as probable and three as epidemiologically linked, by 14 countries (Belgium (12), Cyprus (two), Denmark (six), Greece (two), Ireland (six), Italy (24), the Netherlands (six), Norway (five), Poland (one), Serbia (one), Slovenia (one), Spain (26), Sweden (nine), and the United Kingdom (131)).  

Of the 229 probable cases, 122 have recovered, while 18 remain under medical care.  

The epicurve shows cases by the date of onset of first symptoms of disease. An increase in the number of cases has occurred from week 9. As severe hepatitis can take some time to develop after the onset of the first symptoms and as investigations take time, there may be a delay in the reporting of cases. The recent decrease in cases is therefore challenging to interpret.  

The majority (75.9%) of cases are <5 years of age.  

Of 143 cases with information, 22 (15.4%) were admitted to an intensive care unit. Of the 98 cases for which this information was available, six (6.1%) have received a liver transplant. There has been one death associated with this disease.  

Overall, 151 cases were tested for adenovirus by any specimen type, of which 90 (59.6%) tested positive. The positivity rate was the highest in whole blood specimens (68.9%).  

Of the 173 cases PCR tested for SARS-CoV-2, 20 (11.6%) tested positive. Serology results for SARS-CoV-2 were only available for 19 cases, of which 14 (73.7%) had a positive finding. Of the 56 cases with data on COVID-19 vaccination, 47 (83.9%) were unvaccinated.