H5N1

Global COVID-19 infections surge as new cases in China keep falling

Via Caixin Global's CX Daily update: Global infections surge as new cases in China keep falling.

Virus spread and reactions /

• Confirmed cases in China climbed to 80,424 as of Wednesday evening,. and the death toll reached 2,984. 

Outside China, 13,688 confirmed cases and 233 deaths were reported in 76 countries.  

•  Iran temporarily released about 54,000 low-level prisoners to prevent the spread of infection in the nation’s jails. Iran was thought to have about 240,000 prisoners as of mid-2019. The country has confirmed more than 2,922 cases of coronavirus and around 92 deaths, including 15 more today, Bloomberg reported. The capital, Tehran, is believed to have more than 1,000 cases (link in Chinese). 

Iranian media reported that at least 23 of the country’s 290-member parliament might have been infected because of contact with constituents across the country. Iran leader Ayatollah Ali Khamenei ordered the armed forces to assist health officials in combating the outbreak.  

• Singapore extended its travel ban to people who have been in Iran, South Korea and northern Italy in the previous 14 days. Before, the ban applied only to Chinese citizens and people who recently visited the Chinese mainland.   

• The Australian government ordered anyone who traveled from Iran after Feb. 19 to self-isolate in their homes, after eight cases of coronavirus were identified among returnees from the country.  

• Japan’s Olympics minister raised the prospect of postponing the summer games, due to start July 24, until later in the year, the BBC reported. Tokyo’s contract with the International Olympic Committee “calls for the Games to be held in 2020.” That “could be interpreted as allowing a postponement,” Seiko Hashimoto said. •

 South Korea’s government will seek an additional 11.7 trillion won ($9.86 billion) to prop up businesses hit by a coronavirus outbreak that has become the world’s second-largest, Bloomberg reported.  

• A researcher at Jakarta’s Stem Cell and Cancer Research Institute cast fresh doubt on Indonesia’s official coronavirus caseload. Various scientists have warned that Indonesia’s failure to test property for the disease could be behind its relatively low count, given the nation’s close person-to-person ties with China. 

• The World Health Organization (WHO) reiterated that containment is possible — even as the disease also continues its troubling spread in other hotspots like Iran and Italy. 

Speaking overnight, WHO chief Tedros Adhanom Ghebreyesus said: “To summarize, Covid-19 spreads less efficiently than flu, transmission does not appear to be driven by people who are not sick, it causes more severe illness than flu, there are not yet any vaccines or therapeutics, and it can be contained — which is why we must do everything we can to contain it.”   

Medical updates  / 

• Recovered patients tested positive again in several provinces, raising concerns that the outbreak could gain ground again following days of declines in new infections in most parts of China. 

• Much is now known about SARS-CoV-2’s ability to infect the respiratory system, but clinical evidence is slowly emerging about how it can also damage the central nervous system (link in Chinese). 

Beijing’s Ditan Hospital reported the case of a 56-year-old coronavirus patient whose disease manifested both in conventional respiratory symptoms and as viral encephalitis, or a swelling of the brain. Doctors found the virus in the man’s spinal fluid. He has since recovered and been discharged.

Coronavirus live updates (Wednesday): Iran furloughs 54,000 prisoners to stop spread in jails; Chinese car sales crushed

Via Caixin Global: Coronavirus Live Updates (Wednesday): Iran Furloughs 54,000 Prisoners to Stop Spread in Jails; Chinese Car Sales Crushed.

Wednesday, March 4, 8 p.m.  

Global cases of coronavirus eclipsed 93,000 on Wednesday, with the death toll rising above 3,200. Outbreaks in Iran, Italy and South Korea continued to spiral. 

 China’s car industry, already battered by economic headwinds through last year, reported a staggering 80% drop in sales for February, according to early figures released Wednesday by the China Passenger Car Association.  

Meanwhile a Caixin survey showed the nation’s services sector contracted at its steepest pace in 14 years last month. 

And an investigation showed how pressure on local officials to meet tough back-to-work targets has forced some to inflate electricity-use statistics and other metrics. 

In other coronavirus news 

1. Leaving lights and air conditioners on all day in empty offices, turning on equipment, faking staff rosters and even coaching factory workers to lie to inspectors are just some ways China’s flashy back-to-work statistics are being manufactured, a Caixin investigation found.  

• Iran temporarily released about 54,000 low-level prisoners in order to prevent the spread of infection in the nation’s jails. Iran was thought to have about 240,000 prisoners as of mid-2019. The country has confirmed more than 2,922 cases of coronavirus and around 92 deaths, including 15 more today, Bloomberg reported. The capital, Tehran, is believed to have more than 1,000 cases (link in Chinese). 

2. Singapore has extended its travel ban to people who have been in Iran, South Korea and northern Italy in the prior 14 days. It previously only applied to Chinese citizens and people who recently visited the Chinese mainland. From 11:59 p.m. on Wednesday, nobody with that travel history will be allowed to enter or even transit through the city state. 

• China’s services sector contracted at its steepest pace in more than 14 years last month, with the gauges for total new business and employment both taking a battering, a Caixin-sponsored survey show.  

• Amazon told staff that an employee working in Seattle had been diagnosed with the disease, Caixin has learned. An internal notice obtained by Caixin said the employee fell ill on Feb. 25, returned home, and did not return to the office. The employee is understood to have worked in a building about 10 minutes walk from the Day 1 tower, where CEO Jeff Bezos’ office is located.  

• Much is now known about SARS-CoV-2’s ability to infect the respiratory system, but clinical evidence is slowly emerging about how it can also damage the central nervous system (link in Chinese). Beijing’s Ditan Hospital reported the case of a 56-year-old coronavirus patient whose disease manifested both in conventional respiratory symptoms, and as viral encephalitis, or a swelling of the brain. Doctors found the virus in the man’s spinal fluid. He has since recovered and been discharged. 

• Japan’s Olympics minister has raised the prospect of postponing the Summer Games, due to start July 24, until later in the year, the BBC reports. Responding to a question in parliament, Seiko Hashimoto said Tokyo’s contracted with the International Olympic Committee “calls for the Games to be held in 2020.” That “could be interpreted as allowing a postponement,” she added. 

3. A researcher at Jakarta’s Stem Cell and Cancer Research Institute has cast fresh doubt on Indonesia’s official coronavirus caseload. “It’s statistically impossible that we have only two cases,” Ahmad Utomo told Science. Various scientists have warned Indonesia’s failure to test property for the disease could be behind its relatively low count, given the nation’s close person-to-person ties with China.

WHO: More than 140,000 die from measles as cases surge worldwide

Via email, a news release from WHO: More than 140,000 die from measles as cases surge worldwide. Excerpt:

5th December 2019 --- Worldwide more than 140,000 people died from measles in 2018, according to new estimates from the World Health Organization (WHO) and the United States Centers for Diseases Control and Prevention (CDC). These deaths occurred as measles cases surged globally, amidst devastating outbreaks in all regions.

Most deaths were among children under 5 years of age. Babies and very young children are at greatest risk from measles infections, with potential complications including pneumonia and encephalitis (a swelling of the brain), as well as lifelong disability - permanent brain damage, blindness or hearing loss.

Recently published evidence shows that contracting the measles virus can have further long-term health impacts, with the virus damaging the immune system’s memory for months or even years following infection. This ‘immune amnesia’ leaves survivors vulnerable to other potentially deadly diseases, like influenza or severe diarrhoea, by harming the body’s immune defenses.

“The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children,” said Dr Tedros Adhanom Ghebreysus, Director-General of the World Health Organization. “To save lives, we must ensure everyone can benefit from vaccines - which means investing in immunization and quality health care as a right for all.”

Measles is preventable through vaccination. However, vaccination rates globally have stagnated for almost a decade. WHO and UNICEF estimate that 86% of children globally received the first dose of measles vaccine through their country’s routine vaccination services in 2018, and fewer than 70% received the second recommended dose.

Worldwide, coverage with measles vaccine is not adequate to prevent outbreaks. WHO recommends that 95% vaccination coverage with two doses of measles vaccine is needed in each country and all communities to protect populations from the disease.

Poorest countries hardest hit but measles remains a staggering global challenge

Estimating the total number of cases and deaths globally and by region, the report finds that the worst impacts of measles were in sub-Saharan Africa, where many children have persistently missed out on vaccination.

In 2018, the most affected countries - the countries with the highest incidence rate of the disease - were Democratic Republic of the Congo (DRC), Liberia, Madagascar, Somalia and Ukraine. These five countries accounted for almost half of all measles cases worldwide.

“We’ve had a safe and effective measles vaccine for over 50 years,” said Dr. Robert Linkins, Branch Chief of Accelerated Disease Control and Vaccine Preventable Disease Surveillance at the CDC, and Chair of the Measles & Rubella Initiative. “These estimates remind us that every child, everywhere needs – and deserves - this life-saving vaccine. We must turn this trend around and stop these preventable deaths by improving measles vaccine access and coverage.”

While the greatest effects have been in the poorest countries, some wealthier countries have also been battling measles outbreaks, with significant ramifications for people’s health.

This year, the United States reported its highest number of cases in 25 years, while four countries in Europe - Albania, Czechia, Greece and the United Kingdom – lost their measles elimination status in 2018 following protracted outbreaks of the disease. This happens if measles re-enters a country after it has been declared eliminated, and if transmission is sustained continuously in the country for more than a year.

Investment and commitment needed to ensure effective measles response

The Measles & Rubella Initiative (M&RI) – which includes the American Red Cross, CDC, UNICEF, the United Nations Foundation and WHO – as well as Gavi, the Vaccine Alliance, are helping countries respond to measles outbreaks, such as through emergency vaccination campaigns.

In addition to rapidly immunizing against measles, outbreak response also includes efforts to reduce the risk of death through timely treatment, especially for related complications like pneumonia. With partners, WHO is therefore providing support to help countries manage cases, including training health workers in effective care for children suffering the effects of the disease.

Beyond outbreak response, there is an urgent need for countries and the global health community to continue investing in high quality national immunization programmes and disease surveillance, which helps ensure measles outbreaks are rapidly detected and stopped before lives are lost.

“It is a tragedy that the world is seeing a rapid increase in cases and deaths from a disease that is easily preventable with a vaccine,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “While hesitancy and complacency are challenges to overcome, the largest measles outbreaks have hit countries with weak routine immunization and health systems. We must do better at reaching the most vulnerable, and that will be a fundamental focus of Gavi’s next five-year period.”

Over the last 18 years, measles vaccination alone is estimated to have saved more than 23 million lives.

The Measles & Rubella Initiative

M&RI is a global partnership founded by the American Red Cross, the CDC, the United Nations Foundation, UNICEF and WHO, that is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Founded in 2001, the Initiative has helped vaccinate over 2.9 billion children and save over 21 million lives by increasing vaccination coverage, improving disease response, monitoring and evaluation, and building public confidence and demand for immunization.

“We are alarmed at the increase in measles in the US and around the globe—but there is hope,” said Gail McGovern, President & CEO, American Red Cross. “Measles outbreaks are entirely preventable through strong systems that ensure no child misses lifesaving vaccines.”

“The unacceptable number of children killed last year by a wholly preventable disease is proof that measles anywhere is a threat to children everywhere,” said Henrietta Fore, UNICEF’s Executive Director. “When children go unvaccinated in significant numbers, entire communities are at risk. We see that even today in remote places like in the Democratic Republic of the Congo, where measles has killed more than 4,500 children under the age of five so far this year; or in Samoa, where a rapidly spreading measles outbreak has left many children ill and unable to go to school.”

“This latest data show that we are unfortunately backsliding in our progress against an easily-preventable disease: measles,” said Kathy Calvin, President and CEO of the United Nations Foundation. “But we can turn the tide against these outbreaks through collective action, robust political commitment, and closing critical funding gaps. Working together works—it’s the only way we will be able to reach everyone, everywhere with life-saving vaccines and services and, more broadly, reach the UN’s Sustainable Development Goals.”

See also this MMWR report, Progress Toward Regional Measles Elimination — Worldwide, 2000–2018. 

Australian doctor talks about Samoa measles struggle

Via the Samoa Observer: Australian doctor talks about measles struggle. Click or tap through for the full report and a video. Excerpt:

The leader of an Australian medical team, Dr. Dan Holmes, who has been helping Samoa to deal with the measles epidemic, has spoken about the struggles to contain a disease that has already claimed 33 Samoan lives.   

Speaking to the Samoa Observer, Dr. Holmes said severe pneumonia has been the most prominent complication of measles in the young children suffering it. Dr. Holmes is the leader of the Australian Medical Assistance Team (AUS.M.A.T.).  

From the beginning of the epidemic, the intensive care unit of the Tupua Tamasese Meaole Hospital has been at capacity, so much so that the Australian Government flew in an eight bed negative pressure tent unit to help. 

Dr.Holmes arrived with the tent and the first team of medical professionals to help meet the urgent demand for intensive care, especially of children.  

“The main complication is undoubtedly pneumonia,” said Dr. Holmes, who is the Clinical Team Leader of the unit. 

“[Measles] affects the immune system so you are unable to fight as well as you normally would be, and on top of that the measles itself can damage the lungs. If you get a bacterial infection on top of that then it can cause a very severe pneumonia.” 

The pneumonia caused by measles needs deeply complex treatment, Dr. Holmes said, including draining infections from the lungs and administering strong antibiotics through the child’s veins. 

“That is a lot for a small child to take and it’s very difficult to sustain that for a long period of time.” 

As well as pneumonia, other children have been suffering encephalitis as a result of measles, the inflammation of the brain which can cause seizures. It occurs when the brain becomes infected with the virus, or by something else that gets in while the immune system is damaged by the measles.   

Measles can also cause long term damage in patients, but those impacts are not yet clear, Dr. Holmes said. 

“There is undoubtedly a chance that there is a burden on those children who have had those very severe infections, that they will go on to have some more problems in the future.  

“At this time we are really dealing with the acute pneumonia, trying to get them better from that and out of hospital.”  

Dr. Holmes and his team will be leaving Samoa on Thursday and a new team arrived on Wednesday ready to replace them for the next two weeks.  

The reinforcements come after the Australian team, alongside their Samoan colleagues, have been working between 14 and 16 hour days, both in the intensive care unit and in the main hospital.

New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019

Via Eurosurveillance: New tick-borne encephalitis virus hot spot in Northern Zealand, Denmark, October 2019. The abstract:

During summer 2019, three patients residing by Tisvilde Hegn, Denmark were hospitalised with tick-borne encephalitis (TBE) after tick bites. A new TBE virus (TBEV) micro-focus was identified in tick nymphs collected around a playground in Tisvilde Hegn forest. Estimated TBEV prevalence was 8%, higher than in endemic areas around Europe. Whole genome sequencing showed clustering to a TBEV strain from Norway. This is the second time TBEV is found in Ixodes ricinus outside Bornholm, Denmark.

Sweden: Rising number of people picking up TBE–infection

Via Radio Sweden: Rising number of people picking up TBE–infection. Excerpt:

A record number of Swedes are taking the vaccine against TBE - Tick Borne Encephalitis. But the disease is still spreading in the country. 

TBE is a virus infection that affects the central nervous system. Sometimes the symptoms are mild, but it can also give high fever, headache, confusion, cramps and vomiting. More severe symptoms are seizures, hallucinations and trouble speaking.  

So far this year, 162 people have caught the disease, which according to the Public Health Agency is the second highest number ever this far into the summer. In the longer perspective, since 2005, the number of cases has increased on average by 5 percent annually, according to the agency.

Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018

Via Eurosurveillance: Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018. The abstract:

Background 

During the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary. 

Aims 

We summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.  

Methods 

Every patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid. 

Results 

Until the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection. 

Conclusion 

Careful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.

No cause identified for death of children in Bihar, India

Via The Lancet: No cause identified for death of children in Bihar, India. Excerpt:

Since June 1, Bihar in eastern India, known for its lush lychee orchards, has been in the news because almost 150 children in Muzaffarpur and adjoining districts have died from an illness that many experts call acute encephalitis syndrome, a blanket term for several neurological manifestations. 

There is no definitive epidemiological diagnosis of these deaths as yet, but local reports suggest that several factors could be responsible, including a toxin that can be found in lychees, extreme heat and humidity, child malnutrition, and an ill-equipped public health system that could not offer timely treatment. The children who died were from very poor families, and most deaths have been attributed to hypoglycaemia. 

Bouts of recurring acute encephalopathy have been reported in Bihar since 1995. A Lancet Global Health study found that these outbreaks are “associated with both hypoglycin A and [methylenecyclopropylglycine] toxicity from lychee consumption” and that “this illness is also associated with absence of an evening meal”. 

“Muzaffarpur is a poor district with a cluster of significant risk factors for widespread child undernutrition—the available data from the National Family Health Survey highlights this very clearly”, Purnima Menon, a senior research fellow at the International Food Policy Research Institute's Poverty, Health and Nutrition Division, told The Lancet. “While we await the epidemiological diagnoses, at this point in time, it seems very much like this cluster of child deaths is very similar to what occurred in the same district in previous years.” 

T Jacob John, a retired virology professor from the Christian Medical College, Vellore, Tamil Nadu, who, along with colleagues, had investigated the disease in Muzaffarpur during outbreaks in 2012, 2013, and 2014, says the children would not have died had they not gone to sleep on an empty stomach. 

“The lychee is not the primary cause”, John told The Lancet. “You have to fix the primary health-care system and the gross malnutrition. No child from a well-to-do family has ever suffered because he or she ate lychees.”

Death toll from acute encephalitis in east Indian town rises to 129 children

Via Thompson Reuters: Death toll from acute encephalitis in east Indian town rises to 129 children. 

NEW DELHI, June 23 (Reuters) - At least 129 children have now died of Acute Encephalitis Syndrome (AES) in the town of Muzaffarpur in the eastern Indian state of Bihar since an outbreak earlier this month, a medical official said on Sunday. 

The death toll from AES, a fever that affects the central nervous system, has risen from 97 reported last Monday and medical and government officials are facing mounting criticism for struggling to contain the crisis in the town of nearly 350,000 people. 

AES, known as 'brain fever' is caused by any one of a number of viruses. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma. Infants and elderly people are particularly vulnerable.  

"I received my last update in the afternoon and according to the latest report that I have, 129 children have died so far," Shailesh Prasad Singh, the top state medical official in Muzaffarpur told Reuters by phone. The town lies about 80 km (50 miles) from Patna, the state capital. 

The precise causes of AES are not known, though a majority of medical professionals say it is linked to a ferocious heat-wave. 

Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur. But many families told Reuters last week that their children had not eaten them in recent weeks. 

Singh said a team of experts, including doctors, paramedics and other government officials were working "round the clock" to contain the spread of AES, which killed more than 350 children in a previous outbreak in Bihar in 2014.  

Doctors from other parts of the country had been dispatched to Muzaffarpur to help staff at the Sri Krishna Medical College Hospital which had to evict a group of sick inmates from a ward to accommodate the surge in AES patients. Most of the children who died were being treated at the hospital.  

Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, making them vulnerable to AES, which grips the town almost every year when summer temperatures surge. 

As the death toll mounts, both the Bihar and the federal governments have come under criticism for their inability to save children, and doctors and government officials have faced angry protests. 

On Sunday, the Bihar government suspended a doctor in Muzaffarpur for dereliction of duties, news agency ANI, a Reuters affiliate, said. 

India's Federal Health and Family Welfare Minister Harsh Vardhan, who is himself a doctor, said last week that health officials have finalised plans for construction of a 100-bed paediatric intensive care unit in Muzaffarpur, but gave no timeframe for when it would be built.

India: More on acute encephalitis syndrome in Muzaffarpur

Via The Washington Post: A mysterious sickness has killed nearly 100 children in India. Could litchi fruit be the cause? Excerpt:

NEW DELHI — The children go to sleep as best they can in the sweltering heat. Early in the morning, the fever spikes and the seizures begin. 

Nearly 100 children have died this month in India from an illness that impairs the functioning of the brain and sends the level of glucose in the blood plummeting.  

The deaths have occurred in and around the city of Muzaffarpur in the northern state of Bihar, one of the poorest regions in India. The illness strikes the area each summer, but in recent years the death toll has been less than 20.  

This year, at least 97 children have died, most of them under the age of 7, said Alok Ranjan Ghosh, a senior government official in Muzaffarpur. About 100 more remain in hospitals. The deaths represent the worst toll since 2014, according to figures provided by a state health official. 

Doctors describe the illness as acute encephalitis syndrome, or AES, which is characterized by the rapid onset of fever combined with disorientation and seizures.  

The syndrome has myriad causes, including viruses spread by mosquitoes and human contact, bacterial infections, parasites and toxins.   

In the Muzaffarpur case, officials say the precise cause of the outbreak remains unclear. Elsewhere in India, a mosquito-borne virus called Japanese encephalitis sometimes played a leading role in outbreaks of AES. But in Muzaffarpur, the virus appears absent in the vast majority of the cases, said Sanjay Kumar, principal secretary at the Bihar state ministry of health.  

The illness has been observed in the area since 1995, Kumar said, flaring up during the Indian summer when temperatures soar and subsiding with the arrival of the rains and somewhat cooler weather. Children are arriving at hospitals with critically low blood-sugar levels, he said.  

Sunil Kumar Shahi, the superintendent of Sri Krishna Medical College and Hospital in Muzaffarpur, where most of the children are being treated, said that all of the patients with the illness were under the age of 9.   

“You can imagine my mental condition. The situation is horrible,” he said, before rushing off to treat more children. “Think of the parents whose kids are admitted.”  

Gopal Shankar Sahni, the head of the pediatrics department at the same hospital, said its halls were crowded with distressed and crying parents. “They ask us to treat their kids, but we ask them to believe in God,” he said.  

A recent study conducted by India’s National Center for Disease Control in conjunction with the Centers for Disease Control and Prevention in the United States pointed to a different possible cause for the illness. The area around Muzaffarpur is a major litchi-growing region, and the study found that toxins occurring naturally in the fruit were a plausible source of the illness, especially when children failed to eat an evening meal the day before becoming sick. 

The outbreaks of this “acute unexplained neurological illness . . . begin in mid-May and peak in June, coinciding with the month-long litchi harvesting season,” the researchers noted, adding that most of the affected children come from poor and rural families.   

They posited that the illness might only occur with a combination of factors, for instance when a poorly nourished child eats a large number of litchis and then misses an evening meal. They also pointed to the limitations on local hospitals in providing critical care to such patients, which likely contributes to the death toll.