H5N1

WHO: Hantavirus pulmonary syndrome – Argentine Republic

WHO has published Hantavirus Pulmonary Syndrome – Argentine Republic. Excerpt:

On 19 December 2018, the Argentinian Ministry of Health and Social Development issued an epidemiological alert regarding an increase in cases of hantavirus pulmonary syndrome (HPS) in Epuyén, Chubut Province. Between 28 October 2018 – 20 January of 2019, a total of 29 laboratory-confirmed cases of HPS, including 11 deaths have been reported in Epuyén, Chubut Province. Epuyén has a population of approximately 2 000 persons, and Chubut Province is located in Patagonia in southern Argentina. 

The index case had environmental exposure prior to symptom onset on 2 November, and subsequently attended a party on 3 November. Six cases who also attended the party experienced the onset of symptoms between 20-27 November 2018. An additional 17 cases, all of whom were epidemiologically-linked to previously confirmed cases, experienced symptom onset between 7 December 2018 and 3 January 2019 (Figure 1). Potential human-to-human transmission is currently under investigation.  

Of the confirmed cases, 59% were female, and had an incubation period ranging from 8 to 31 days. Approximately 50% of these confirmed cases reported symptoms within the past three weeks. Cases were confirmed by ELISA IgM u-captura or by polymerase chain reaction (PCR).  

As of 17 January 2019, a total of 98 asymptomatic contacts have been identified and are being monitored for the potential development of symptoms.  

In Argentina, four endemic regions have been identified: North (Salta, Jujuy), Centro (Buenos Aires, Santa Fe, and Entre Ríos), Northeast (Misiones) and Sur (Neuquén, Río Negro, and Chubut). Between 2013 and 2018, an average of 100 confirmed cases were registered annually, with the provinces of Buenos Aires, Salta, and Jujuy having the highest numbers of cases. 

Between 2013 and 2018, 114 confirmed deaths from hantavirus were reported in Argentina, with a case-fatality rate of 18.6%, though this figure was close to 40% for some provinces in the southern region of the country. 

In Chile, one of the confirmed cases was a healthcare worker who resides in Palena Province, Los Lagos Region, and reported experiencing symptoms on 2 January 2019. The case had a travel history to Epuyén for one day in mid-November, and later hosted and cared for a confirmed case from Epuyén while she was in her prodromal phase. 

This is the first confirmed case of hantavirus in Los Lagos Region in 2019. During 2018, there were eight cases of hantavirus reported in Chile, including two deaths.

WHO: Hantavirus disease – Republic of Panama

WHO has published Hantavirus disease – Republic of Panama. Excerpt:

The Panama Ministry of Health has reported an increase in cases of hantavirus infection in Los Santos Province, Republic of Panama, to the Pan American Health Organization / World Health Organization (PAHO/WHO). Between 1 January and 22 December 2018, a total of 103 confirmed cases of hantavirus have been reported at the national level, 99 of which were reported in Los Santos Province. In Los Santos Province, 51 cases were classified as hantavirus fever (HF) without pulmonary syndrome and 48 cases were classified as hantavirus pulmonary syndrome  (HPS), including four deaths. 

• Of the 51 HF cases, 41% were female, 55% aged between 20-59 years, with 76% occurring between June 2018 and November 2018. 

• Of the 48 HPS cases, 56% were female, 67% aged between 20-59 years, with more than half of the cases occurring in February 2018 (17%) and between June 2018 and September 2018 (42%). 

• Four deaths were reported among HPS cases (two female, two male, all aged over 60 years). 

Cases were confirmed by serology and polymerase chain reaction (PCR)3. Sequencing determined that the type of virus associated with this outbreak is Choclo virus. It was first isolated in 1999 in the western Republic of Panama. 

Hantavirus cases have been reported in the Republic of Panama since 1999 (Figure 1). In the last five years, transmission has been documented in Los Santos, Herrera, Veraguas, and Cocle provinces. During 2018, cases have been reported in Los Santos (99 cases, Figure 2), Herrera (two cases), Cocle (one case) and Veraguas (one case) provinces (Figure 3). 

Since the reservoir for hantavirus is sylvatic rodents and transmission can occur when people come in contact with rodent habitats, the current increase in hantavirus cases in the Republic of Panama could be related to changes in the abundance and distribution of rodent species, as well as strengthened surveillance and laboratory capacity at the provincial level. Environmental and ecological factors affecting rodent populations can have a seasonal impact on disease trends.

Finland: Vole fever season approaches; spring cleaners advised to take care

Via Yle Uutiset: Vole fever season approaches, spring cleaners advised to take care. As if it weren't bad enough that taxes on Finnish summer cottages have tripled since 2000, hantavirus is a threat. Excerpt:

Reliable figures about the vole population in Finland this spring will only be available once the snow melts, but health authorities are warning residents of central and western areas in particular to take precautions against contracting vole fever this spring. 

Vole fever is an illness caused by a strain of the hanta virus known as the Puumala virus, after a small village in Finland. Only the bank vole (Myodes glareolus) carries it. Found throughout the Nordics, the infection is known as myyräkuume in Finnish, sorkfeber in Swedish, and musepest in Norwegian. 

Experts say that numbers of voles, also known as field mice, are actually down in Finland this year, with negligible amounts expected to survive the winter in the south and east. Populations of the virus-carrying voles surge every few years, with peak seasons followed by a plummet because many of the rodents end up dying from the virus they carry. 

"They are not exceptionally abundant right now," says Finland's Natural Resources Centre researcher Otso Huitu. 

He nevertheless advises spring cleaners of summer cottages and storage buildings to take care when cleaning up after the winter season, as up to two-thirds of the vole population could be carrying the Puumala virus. Droppings can spread the virus for up to two months in cold buildings like wood storage sheds, for example. 

"Even just one vole can create a considerable amount of waste," Huitu says.

Climate change and sugarcane expansion increase Hantavirus infection risk

Via PLOS Neglected Tropical Diseases: Climate change and sugarcane expansion increase Hantavirus infection risk. The abstract:

Hantavirus Cardiopulmonary Syndrome (HCPS) is a disease caused by Hantavirus, which is highly virulent for humans. High temperatures and conversion of native vegetation to agriculture, particularly sugarcane cultivation can alter abundance of rodent generalist species that serve as the principal reservoir host for HCPS, but our understanding of the compound effects of land use and climate on HCPS incidence remains limited, particularly in tropical regions. 

Here we rely on a Bayesian model to fill this research gap and to predict the effects of sugarcane expansion and expected changes in temperature on Hantavirus infection risk in the state of São Paulo, Brazil. The sugarcane expansion scenario was based on historical data between 2000 and 2010 combined with an agro-environment zoning guideline for the sugar and ethanol industry. 

Future evolution of temperature anomalies was derived using 32 general circulation models from scenarios RCP4.5 and RCP8.5 (Representative greenhouse gases Concentration Pathways adopted by IPCC). 

Currently, the state of São Paulo has an average Hantavirus risk of 1.3%, with 6% of the 645 municipalities of the state being classified as high risk (HCPS risk ≥ 5%). Our results indicate that sugarcane expansion alone will increase average HCPS risk to 1.5%, placing 20% more people at HCPS risk. Temperature anomalies alone increase HCPS risk even more (1.6% for RCP4.5 and 1.7%, for RCP8.5), and place 31% and 34% more people at risk. Combined sugarcane and temperature increases led to the same predictions as scenarios that only included temperature. 

Our results demonstrate that climate change effects are likely to be more severe than those from sugarcane expansion. Forecasting disease is critical for the timely and efficient planning of operational control programs that can address the expected effects of sugarcane expansion and climate change on HCPS infection risk. The predicted spatial location of HCPS infection risks obtained here can be used to prioritize management actions and develop educational campaigns.

US: Outbreak of hantavirus infections kills three in Washington state

Via Reuters: Outbreak of hantavirus infections kills three in Washington state. Excerpt:

Five people have been stricken with the rare, rodent-borne hantavirus illness in Washington state since February, three of whom have died, in the state's worst outbreak of the disease in at least 18 years, public health officials reported on Thursday.  

The three fatal cases also mark the highest death toll from hantavirus pulmonary syndrome in Washington state during a single year since the respiratory ailment was first identified in the "Four Corners" region of the U.S. Southwest in 1993.  

The disease has been found to be transmitted to humans from deer mice, either through contact with urine, droppings, saliva or nesting materials of infected rodents or by inhaling dust contaminated with the virus. 

Victims in the latest outbreak were men and women ranging in age from their 20s to their 50s from four counties across the state, said David Johnson, spokesman for the Washington State Department of Health.  

The first diagnosed case this year was in February and the most recent was last month, when the infection killed a resident of Spokane County in the eastern part of the state near Washington's border with Idaho. Three of the five cases, including another one that proved fatal, were confirmed in the Puget Sound region of King and Skagit counties. 

The only common factor among those infected by the disease, which typically kills more than a third of its victims, is that they were all exposed to infected mice, Johnson said.

CIDRAP: News scan for April 13, 2017

Via CIDRAP: News Scan for Apr 13, 2017 | Severe H5N6 infections; Deadly hantavirus; Meningitis C in Nigeria. Excerpt:

A new analysis of all 17 H5N6 avian flu cases reported in China since 2014 found that 15 out 16 hospitalized patients required mechanical ventilation, while 12 patients (75%) died from their infections. 

The case-fatality rate was much lower in patients hospitalized for H5N1 infection (70% or 30 out of 43) and H7N9 infection (41%, or 319 out of 782) during the same period. Patients with confirmed H5N6 were older than those with confirmed H5N1 and H7N9 cases. All H5N6 patients reported close contact with live poultry in the 10 days preceding illness, and they were all located in south and southwest China, compared with wider geographic spread in H5N1 and H7N9 cases. 

The analysis was conducted by Chinese officials, the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) and published yesterday in Clinical Infectious Diseases. 

"The laboratory-confirmed H5N6 cases were characterized by severe illness among the 16 hospitalized cases, with a high risk of fatal outcome," the authors wrote. 

"It remains to be seen whether HPAI [highly pathogenic avian influenza] H5N6 virus will continue to circulate among poultry and cause sporadic human infections in coming years, as H7N9 virus has done for four years now."

ECDC: Epidemiology of emerging and vector-borne diseases: What are the trends in Europe?

ECDC has published Epidemiology of emerging and vector-borne diseases: What are the trends in Europe. Click through to download the PDF. The summary:

The emerging and vector borne disease content for the 2014 Annual Epidemiological Report provides a snapshot of the epidemiological situation in Europe. The report features data from 2012 and gives an overview of the epidemiology of each disease: 

• The number of Q fever cases in the EU continues to decrease, small outbreaks are still evident in at risk sheep and goat herds. 

• The 2012 data confirms the tick-borne encephalitis (TBE) trends from previous years: a clear predominance in males over 45 year olds, and seasonally - a clear peak during the summer months. 

• All chikungunya cases reported in 2012 were imported to the EU/EEA. However, their overall numbers have decreased in recent years. 

• While the number of reported dengue fever cases to EU is variable: in 2012 it was nearly twice the number reported in 2011, while still lower than in 2010.  

• The rate of malaria cases remains stable over the last few years, with nearly all (99%) of the reported cases imported by travellers to malaria endemic countries; autochthonous transmission of malaria was occasionally reported in Europe over the last 10 years. 

• Hantavirus, the most commonly reported haemorrhagic disease in Europe, is particularly prevalent in Northern Europe (Finland), indicators show no real increase in the number of cases in Europe.  

• In 2012, the number of human cases of West Nile fever was higher than in 2011 and, with the exception of Greece, the 2013 figures confirm this trend.   

New publication format 

The Annual Epidemiological Report is a key ECDC publication on the epidemiology of communicable diseases of public health significance in Europe. To facilitate more timely publication of the annual epidemiological data, the report is being first published a disease group at a time and will later be compiled into one comprehensive annual report. Easy access to the epidemiological information is encouraged by making available online downloadable data on the main diseases.   

The first chapter of the 2014 epidemiological report, published today, focuses on emerging and vector-borne diseases in Europe and is complemented by downloadable data on malaria, Q fever, tick-borne encephalitis, chikungunya, dengue fever, hantavirus, West Nile fever.

MERS and chikungunya: A midyear look back

Tracking the daily rush of events can induce a kind of amnesia, and it's hard to maintain any kind of perspective on what we're concerned about at any given moment. So I've paused for a moment at midyear to look back at reports from the beginning of 2014.

H7N9 was still very much in the news, and a measles outbreak in the Philippines was a portent of prompt arrival in North America. Ebola was probably established in Guinea by then, but it had not yet come to serious attention.

MERS and chikungunya reports were relatively rare. In ECDC's Communicable Disease Threats Report for January 4, total MERS cases worldwide numbered 176, including 74 deaths. Then as now, Saudi Arabia was the focus, with 141 cases and 57 deaths.

Six months later, Saudi Arabia has confirmed 712 cases and 292 deaths: a quintupling of both cases and deaths.

Chikungunya in the Americas was barely one month old; the first two autochthonous cases had been reported on December 6. ECDC estimated that as of December 19, about 134 cases were scattered over just four islands plus one imported case in French Guiana.

Six months later, PAHO estimates over a quarter of a million chikungunya cases (Dr. John Carroll thinks Haiti alone has "millions" of cases). But only 21 deaths have been attributed to chikungunya.

Neither MERS nor chikungunya is likely to vanish by January 2015. Climate change and world trade and travel almost guarantee that chikungunya will become endemic wherever its vectors are established—which is almost everywhere from Buenos Aires to Chicago. MERS might be stopped dead, as SARS was, by identifying and eliminating the source. But If the source really is camels, good luck culling them; some kind of vaccine to protect camels would be the most politically acceptable response.

And by January 2015 it's a pretty safe bet that Flublogia will by worrying about still more emergent diseases: hantavirus, perhaps, or yet another variation of avian flu, or another coronavirus. They were all here before us, a viral army of genetic safecrackers, patiently spinning our dial until they find our combination. We do the same with them, of course. But our safecrackers are few, and theirs are numberless.

US: Hantavirus deaths in Virginia?

Thanks to bobman for tweeting the link to this report in the Roanoke Times: Illness in Snowville remains 'isolated incident,' officials say. Excerpt:

The Virginia Department of Health and the Centers for Disease Control and Prevention continued Saturday to investigate an as-of-yet unidentified illness that killed two people from Pulaski County on Friday and left four others hospitalized into Saturday. 

No new cases were reported Saturday, the VDH said in news release. The agency again called it an isolated illness and said they have no reason to believe the public is in danger. 

The four hospitalized at Carilion Roanoke Memorial Hospital and the two who died were limited to a small group of people — one family and a “close family friend,” health officials said. 

Josh Tolbert, the emergency management coordinator for Pulaski County, said Friday that the illness could be hantavirus, an infection that can lead to fatal symptoms. 

Robert Parker, a VDH spokesman, said that hadn’t been confirmed and that investigators are looking at a number of different illnesses, as is standard. 

Hantavirus infects people when they come into contact with rodents who have it, or when they’re near their droppings or urine. The disease has never been spread among people in the United States. 

“There is still no indication of person-to-person transmission and no indication of any public health risk,” said Molly O’Dell, the physician director of the New River Health District. “This continues to appear to be an isolated incident with a single-source exposure.” 

Tolbert said Friday the family had been cleaning out a mobile home near their residence and that the family dumped materials in a container at a nearby dump site. 

Parker wouldn’t say how old the victims are or what specific area they’re from, citing privacy protections. Tolbert and Pulaski County Sheriff Jim Davis said Friday that the family is from Snowville. 

Samples were taken from the people who died, Tolbert said. It will likely be early this week before the results come back. 

Health department officials reiterated Saturday in their news release that “the locations where exposure might have occurred are on private property and have been secured.”

If it is hantavirus, the onset and progress were remarkably rapid.

ECDC on World Health Day, April 7, 2014

ECDC has posted considerable resource on its site in the lead-up to World Health Day 2014. Excerpt:

Vector-borne diseases are the focus of World Health Day 2014. In partnership with The WHO Regional Office for Europe and EFSA, ECDC is this year working to raise awareness both of the diseases and of vectors. Dengue, West Nile fever and tick-borne encephalitis are just some of the diseases transmitted by vectors such as mosquitoes and ticks.   

Vector-borne diseases are a global public health threat. A number of factors, such as increased international travel and trade, as well as climate change, influence the public health threat to Europe posed by these diseases.   

ECDC undertakes numerous surveillance activities to monitor the impact and spread of vector-borne diseases in Europe. Disease surveillance activities and vector distribution data collection are carried out in order to tackle the challenges posed to public health in Europe by vector-borne diseases.

For more on this subject, see the WHO website.