H5N1

WHO: Avian influenza A(H5N1) - United States of America

A DON from WHO: Avian Influenza A(H5N1) – United States of America. Excerpt:

Situation at a Glance  

The World Health Organization (WHO) was notified about a laboratory-confirmed case of human infection with an influenza A(H5N1) virus on 1 April 2024 by the United States of America IHR National Focal Point (NFP). The patient developed symptoms on 27 March and had a history of exposure to dairy cattle (cows) presumed to be infected with influenza A (H5N1) virus. This is the first human infection with A(H5N1) acquired from contact with infected cattle and the second confirmed human case of influenza A(H5N1) detected in the country. No additional associated cases of human infection with influenza A(H5N1) have been identified.  

Since the virus has not acquired mutations that facilitate transmission among humans and based on available information, WHO assesses the public health risk to the general population posed by this virus to be low and for occupationally exposed persons, the risk of infection is considered low-to-moderate.  

Description of the Situation  

On 1 April 2024, the IHR NFP of the United States of America notified WHO of a laboratory-confirmed human case of avian influenza A(H5N1) detected in the state of Texas.  

The case is aged over 18 years. On 27 March, the case developed conjunctivitis, was reported to be while working at a commercial dairy cattle farm and had a history of exposure to dairy cattle (cows) presumed to be infected with influenza A(H5N1) virus (1).    

On 28 March, respiratory and conjunctival specimens were collected from the case and tested at the Texas Tech University Bioterrorism Response Laboratory. Reverse transcription-polymerase chain reaction (RT-PCR) analysis indicated that both specimens were presumptive positive for influenza A(H5) virus. The specimens were then sent to the United States Centers for Disease Control and Prevention (US CDC) for further testing.  

They were received and tested at the US CDC on 30 March and confirmed as high pathogenicity avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b by RT-PCR and sequencing (1) (2). Genome sequencing of the virus didn’t show new mutations possibly associated with increased transmission to humans.  

On 28 March, the patient was advised to isolate and given antiviral treatment (oseltamivir) following US CDC guidance. The patient did not report symptoms other than conjunctivitis, was not hospitalized, and at the time of reporting, was recovering (1).    

Household contacts of the patient have not reported illness and have been provided influenza antiviral prophylaxis as per US CDC recommendations.  No additional cases of human infection with influenza A(H5N1) associated with this case have been identified (1).   

In the United States, since January 2022, detections of HPAI A(H5N1) virus among wild birds have been reported in 50 states or territories. There have been reports of sporadic A-(H5) virus outbreaks among poultry and backyard flocks as well as sporadic detections in mammals and outdoor cats on the dairy facilities as reported by the United States Department of Agriculture (USDA) Animal Plant Health Inspection Service (APHIS).  

Influenza A virus infection is exceptionally rare in bovine species (3). This human case had exposure to dairy cattle in Texas, presumed to be infected with HPAI A(H5N1) virus (4)(5). On 25 March, the USDA reported the first detection of HPAI A(H5N1) virus in dairy cattle and unpasteurized milk samples from cattle in Texas and Kansas in four dairy herds. On 29 March, USDA announced confirmation of additional detections in dairy cattle in Michigan dairy cattle that recently received cows from Texas. USDA has also announced additional confirmed detections in dairy cattle in Idaho, New Mexico, and Ohio.  

To date, USDA has announced confirmed detections on 15 farms across six states: Idaho (n=1), Kansas (n=3), Michigan (n=1), New Mexico (n=2), Ohio (n=1), and Texas (n=7) (5,6,7). USDA is continuing to monitor and test samples collected from other farms where cattle are displaying decreased lactation, low appetite, and other signs (1,5,6,7).

The USDA has publicly posted the genetic sequences of several recently detected HPAI A(H5N1) viruses found in US wild birds, poultry, wild mammals and cattle in Texas (8). The viruses are from clade 2.3.4.4b, which is the most common HPAI A(H5N1) virus circulating among birds worldwide currently.  CDC has publicly posted the genome of the virus identified from the patient in Texas and identified only minor changes when compared to the animal viruses (2).  Between 9 February 2022 to 29 March 2024, more than 8000 people were actively monitored in the United States following exposure to animals presumed to be infected with HPAI A(H5N1) viruses.

WHO: Avian influenza A(H5N1) – Viet Nam

A WHO Disease Outbreak News report: Avian Influenza A(H5N1) – Viet Nam. Excerpt:

Situation at a Glance

The World Health Organization (WHO) was notified about a case of human infection with an influenza A(H5N1) virus on 25 March 2024 by the national authorities of Viet Nam. The patient, who had no underlying medical conditions, developed symptoms on 11 March and died on 23 March. Exposure to birds was ascertained to have taken place in the third week of February. Samples collected from close contacts tested negative for influenza A(H5N1) virus.  

This is the first human infection with an avian influenza A (H5N1) virus reported in Viet Nam since 2022. According to the International Health Regulations (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 risk to the general population posed by this virus as low.  

Description of the Situation  

On 25 March 2024, Viet Nam National Focal Point (NFP) for International Health Regulations (IHR) notified the World Health Organization (WHO) of one case of human infection with an influenza A(H5N1) virus in a 21-year-old male with no underlying conditions from Khanh Hoa Province, Viet Nam.  

The case developed a fever and cough on 11 March 2024 and was admitted on 15 March to a local hospital due to persistent symptoms, including abdominal pain and diarrhoea. On 17 March, his condition worsened, and he was transferred to the Intensive Care Unit (ICU) of a provincial hospital. On 20 March, the patient was transferred to another provincial hospital with a diagnosis of severe pneumonia, severe sepsis, and acute respiratory distress syndrome. The case died on 23 March.  

On 19 March, samples were taken for real-time polymerase chain reaction (RT-PCR) testing by the Pasteur Institut in Nha Trang, which resulted in a positive result for the influenza (H5) virus. On 22 March, genomic sequencing conducted by the Pasteur Institut of Nha Trang revealed the presence of the avian influenza A (H5N1) virus.  

Initial results from the case investigation revealed that during the second and third weeks of February 2024, the case went bird hunting. Between that time and the onset of illness, no contact with dead or sick poultry nor contact with anyone exhibiting similar symptoms was reported. Among close contacts traced, no further cases of influenza A(H5N1) were detected.

US: Bird flu reported in person exposed to presumably infected cattle

Via STAT, a report by Helen Branswell, who has been tracking H5N1 longer than anyone else: Bird flu reported in person exposed to presumably infected cattle. Excerpt:

Texas health officials reported Monday that an individual who had been in contact with cattle has contracted H5N1 avian flu, only the second case ever recorded in the U.S.  

The person had contact with dairy cattle that are believed to have been infected with the virus, the Texas Department of State Health Services said in a statement. It went on to say that the individual’s only symptom is eye inflammation — infection of the conjunctiva, the tissue surrounding the eye.  

Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention, said the infected individual is doing well and is being treated with the influenza antiviral oseltamivir, sold as Tamiflu. The individual was instructed to isolate to reduce the risk of infecting others, and to date there’s no indication of onward spread, Shah said.

“We are not aware of reports that any of this individual’s close contacts have developed any symptoms,” he told STAT.  

The person was tested late last week, with confirmatory testing taking place at the CDC over the weekend. The CDC is not currently running any other confirmatory H5 tests, Shah said. “The fact that there are not other samples cooking right now is reassuring, insofar as that we’re not aware of other individuals who are symptomatic following an exposure to livestock,” he added.  

“We are still out there looking, to be very clear,” he said. “Our antennae are up and we have been working with state public health officials in a number of jurisdictions to look for individuals who report signs and symptoms of illness, to make sure they know how to get tested.”

Vietnam: How the Khanh Hoa authorities are responding to the human A/H5 case

Health authorities in Khanh Hoa are evidently working hard to find the source of the fatal A/H5 influenza case. Here's another report from Khanh Hoa Online, as translated by Google:

5 samples taken from A/H5 patient's flock test negative

On the afternoon of March 22, according to the leader of the Center for Disease Control of Khanh Hoa province, the results of 5 samples taken from the poultry flock included 2 samples from the chicken flock in the patient's house and 1 sample from the duck flock 50m away from the house, 2 samples Birds in the area where the patient often visited were all negative for the A/H5 virus. Results of daily health monitoring of people in contact with the patient are stable, no suspicious symptoms of the disease have been detected.

Accordingly, the patient with CKD (21 years old, Ninh Hoa town) started the disease on March 11, with symptoms of fever and phlegmy cough. On March 15, the patient went to Ninh Hoa Town Medical Center (facility 2) for examination, was diagnosed with acute pharyngitis - laryngitis, and received outpatient treatment. On March 16, the patient had fever and fatigue so he went to the Emergency Department of Ninh Hoa Regional General Hospital with a diagnosis of intestinal infection, sepsis, and dengue hemorrhagic fever monitoring. 

On the morning of March 17, the disease became severe, the patient was transferred to Khanh Hoa Provincial General Hospital, Department of General Internal Medicine and Neurology for treatment and had samples taken to send to Nha Trang Pasteur Institute for testing. On the afternoon of March 20, Nha Trang Pasteur Institute announced that the sample results were positive for influenza A/H5, with the diagnosis: Severe pneumonia caused by influenza A/H5. The same evening, the patient was transferred to Khanh Hoa Provincial Hospital of Tropical Diseases for treatment.

As soon as they received the information, on March 20, the Provincial Center for Disease Control coordinated with Khanh Hoa Provincial General Hospital to make a list of 14 medical staff at the hospital and 6 medical staff at the Hospital. Tropical to monitor health, perform disinfection of examination and treatment areas, and transport vehicles. Make a list of the patient's family members including 4 people (mother, aunt and sister) to monitor health. 

On March 21, the Center established a working group to coordinate with Nha Trang University where the patient was studying to investigate epidemiology and implement disease prevention measures. Accordingly, at Nha Trang University, the center has compiled a list of 6 roommates and 60 students studying in the same class as the patient to conduct health monitoring. At the same time, 6 samples were taken from people living in the same dormitory room with the patient at Nha Trang University for testing, and the results were negative for influenza A; Conduct disinfection with Chloramin B in the living room and rooms in the dormitory building, recommending the school to strengthen epidemic prevention measures.

Currently, the Provincial Center for Disease Control is continuing to monitor contact and related cases on the above list; coordinate with Ninh Hoa Medical Center, Nha Trang Medical Center, Department of Livestock and Veterinary Medicine to conduct an investigation to find the source of infection. At the same time, conduct monitoring and sampling of patients with severe acute respiratory syndrome caused by viruses; Communicate to people about measures to prevent respiratory diseases and influenza transmitted from animals to humans.

Vietnam: An update on the Khanh Hoa A/H5 case

I often try to get as close to the locale of a news story as I can, because the local report may have details dropped by other sources. This report from Khanh Hoa Online is a case in point. The writer points out that human-to-human transmission of H5N1 is very rare, so it's no surprise that the young man's contacts have tested negative. If any of them had tested positive, especially without sharing a meal or coming in contact with the same virus source, we would have good reason to be alarmed. The Google translation, re-paragraphed:

The patient positive for influenza A/H5 died
THAO TAM

At noon on March 23, Dr. Ton That Toan - Deputy Director in charge of the Center for Disease Control of Khanh Hoa province said: "Although the medical team and doctors of the Provincial Hospital of Tropical Diseases have been very active in treatment, because the patient's condition was too severe and his lungs were fibrous, the patient tested positive for influenza A/H5 and died after 8 days of treatment."

According to Dr. Toan, the medical team and doctors of the Provincial Hospital of Tropical Diseases were very active in treatment, but the time the patient was admitted to the hospital was quite late, from the time of onset until admission for treatment after 5 years. days, combined with the rapid progression of the disease, when the patient was transferred to the Provincial Tropical Diseases Hospital, he was in a coma, his blood pressure was close to zero, he could not communicate, and had to be on a ventilator. The Provincial Hospital of Tropical Diseases has continuously consulted with the Central Tropical Diseases Hospital and the City Tropical Hospital. Ho Chi Minh City and Khanh Hoa Provincial General Hospital but could not save his life because the patient's condition was too severe and his lungs were fibrotic.

"Currently, the Provincial Center for Disease Control continues to coordinate with relevant units to urgently deploy epidemic prevention measures. We coordinate with Ninh Hoa Medical Center, Nha Trang Medical Center, Chi The Department of Animal Husbandry and Veterinary Medicine is conducting an investigation to find the source of infection. The room and rooms in the Nha Trang University dormitory where the patient lived were disinfected with Chloramin B on March 20. Establishing a list 6 roommates, 60 students studying in the same class as the patient to monitor health. At the same time, take 6 samples from people living in the same dormitory room with the patient at Nha Trang University for testing, tested negative for influenza A.

Take 5 disease samples from the poultry flock (including two samples from the chicken flock in the patient's house, one sample from the duck flock 50 m away from the house, two samples from the bird flock in the place where the patient often goes). Tests all showed negative results for A/H5 virus. A list of 14 medical staff at the Provincial General Hospital and 6 medical staff at the Provincial Hospital of Tropical Diseases, and 4 family members of the patient have been made. (including: mother, aunt and sister) to monitor health; Disinfect examination and treatment areas, transport vehicles...

Up to this point, people in contact with the patients on the above list are stable, with no suspected symptoms of the disease detected. At the same time, conduct monitoring and sampling of patients with severe acute respiratory syndrome caused by viruses; inform people about measures to prevent respiratory diseases and influenza transmitted from animals to humans" - said Dr. Toan.

The male patient's symptoms began on March 11 and did not help with self-medication. Four days later, the patient came for examination at facility 2 of Ninh Hoa Town Medical Center and was diagnosed with acute pharyngitis - laryngitis and monitored for dengue fever. The doctor suggested hospitalization, but the patient refused and asked for outpatient treatment. On March 16, the patient had high fever, abdominal pain around the navel, loose stools, and went to Ninh Hoa Regional General Hospital. The doctor diagnosed an intestinal infection and warned of sepsis. On March 17, the disease became severe and the patient was transferred to Khanh Hoa Provincial General Hospital. On March 20, a patient's specimen at Nha Trang Pasteur Institute tested positive for influenza A/H5, and the patient was transferred for treatment to the Provincial Hospital of Tropical Diseases.

According to doctor Ton That Toan, avian influenza A/H5 is often transmitted in animals but can also be transmitted to humans. However, unlike other types of human flu, influenza A/H5 does not spread easily from person to person. People are infected with influenza A/H5 virus mainly through direct or indirect contact with sick animals. The biggest risk of getting influenza A/H5 is contact with sick poultry or with contaminated surfaces such as poultry feathers, saliva or feces. Very rarely, avian influenza is transmitted from person to person. In cases where there is particularly close contact with a sick person, such as a mother taking care of an infected child, influenza A/H5 can be transmitted from person to person.

Medical experts say that epidemiological monitoring shows that people infected with influenza A/H5 often have symptoms similar to regular influenza and are accompanied by some more dangerous warning signs (within 2- 5 days from the date of invasion by influenza A/H5 virus) Specifically: Sudden high fever over 38 degrees Celsius; chills, headache; chest pain, shortness of breath, fast heartbeat; sore throat, cough, often dry, cough with phlegm; muscle pain, fatigue. After only half a day, the symptoms of influenza A/H5) become more severe, the patient may suffer from acute respiratory failure such as difficulty breathing, rapid breathing, pale skin, even whole body pain, and unconsciousness.

Patient with influenza A/H5 in Khanh Hoa has died

Thanks to Mike Coston and FluTrackers for alerting me to this story. Via Saigon Giai Phong: Patient with influenza A/H5 in Khanh Hoa died. The Google translation:

After 8 days of treatment for influenza A/H5, a 21-year-old male patient, a student at Nha Trang University, became seriously ill and died.  

At noon on March 23, doctor Ton That Toan, Deputy Director in charge of the Center for Disease Control of Khanh Hoa province, confirmed that after 8 days of treatment, the patient had diabetes. (21 years old) infected with avian influenza A/H5 died at Khanh Hoa Tropical Diseases Hospital due to severe illness and fibrotic lungs.  

This is the first death due to influenza A/H5 in Vietnam this year. The source of infection is currently unknown.  

Previously, on March 20, a patient's specimen at Nha Trang Pasteur Institute tested positive for influenza A/H5, and the patient was transferred for treatment to the Provincial Hospital of Tropical Diseases.  

According to medical records, the male patient's symptoms began on March 11 and did not help with self-medication. Four days later, the patient came for examination at facility 2 of Ninh Hoa Town Medical Center and was diagnosed with acute pharyngitis - laryngitis and monitored for dengue fever. The doctor suggested hospitalization, but the patient refused and asked for outpatient treatment.  

On March 16, the patient had high fever, abdominal pain around the navel, loose stools, and went to Ninh Hoa Regional General Hospital. The doctor diagnosed an intestinal infection and warned of sepsis. On March 17, the disease became severe and the patient was transferred to Khanh Hoa Provincial General Hospital.  

After that, the patient was isolated for treatment at the Hospital for Tropical Diseases in a coma, with blood pressure near zero, unable to communicate, and required mechanical ventilation.  

People who came into contact with D. health is monitored. Nha Trang University dormitories, male students' residences, examination and treatment areas, and patient transport vehicles were sprayed with disinfectant chemicals.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic

A major report in The Lancet: Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. The summary:

Background  

Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.

Methods

22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.

Findings

Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019.

 

An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends.

 

Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.

Interpretation

Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.

Welcome to the Canadian Covid Society

Via its home page, the Canadian Covid Society introduces itself. Excerpt:

Our Mission  

At the Canadian Covid Society, we strive to protect the health and safety of people in Canada against the harms of COVID-19 and long Covid, through education, engaging and empowering the public and organizations with scientific knowledge.  

The Stakes  

Covid is the 3rd leading cause of death, behind heart disease and cancer.  There have been nearly 30 million excess deaths worldwide since the start of the pandemic.  While the acute phase of the pandemic has ended, the virus continues to cause significant chronic illness.

Cognition and memory after Covid-19 in a large community sample

Via NEJM: Cognition and Memory after Covid-19 in a Large Community Sample. The abstract: 

BACKGROUND  

Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear.  

METHODS  

We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating (“brain fog”).  

RESULTS  

Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no–Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (−0.23 SD [95% confidence interval {CI}, −0.33 to −0.13] and −0.24 SD [95% CI, −0.36 to −0.12], respectively); larger deficits as compared with the no–Covid-19 group were seen in participants with unresolved persistent symptoms (−0.42 SD; 95% CI, −0.53 to −0.31).  

Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., −0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, −0.20 to −0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, −0.35 SD; 95% CI, −0.49 to −0.20). Results of the analyses were similar to those of propensity-score–matching analyses.  

In a comparison of the group that had unresolved persistent symptoms with the no–Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (−0.33 to −0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported.  

CONCLUSIONS  

Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain.

WHO DON: Nipah virus infection - Bangladesh

A disease outbreak news report from WHO: Nipah virus infection - Bangladesh. Excerpt:

Situation at a Glance  

Outbreaks of Nipah virus (NiV) infection are seasonal in Bangladesh, with cases usually occurring annually between December and April corresponding with the harvesting and consumption of date palm sap. Since 1 January and as of 9 February 2024, two laboratory-confirmed cases of NiV have been reported from the Dhaka division of Bangladesh. Both cases have died.  

WHO assesses the overall risk at the national levels to be moderate due to the severity of the disease, the limitation of treatment, the shared natural habitat of bats and zoonotic transmission partners, and the fact that there are no licensed vaccines to prevent NiV infection.  

Description of the Situation  

On 30 January and 7 February 2024, the Bangladesh National Focal Point (NFP) for the International Health Regulations (IHR) notified the World Health Organization (WHO) of two epidemiologically unlinked cases of NiV infection.  

First case confirmed on 21 January 2024  

The first patient is a 38-year-old male from Manikganj district, Dhaka division. The patient developed a fever followed by respiratory distress, restlessness, and insomnia on 11 January 2024 and was admitted to a local hospital on 16 January. He was transferred to the intensive care unit of a hospital in Dhaka City on 18 January where he was intubated due to worsening of symptoms.  

On 21 January, blood and throat samples were collected and the patient tested positive by reverse transcription polymerase chain reaction (RT-PCR) for NiV RNA from the throat sample and by enzyme-linked immunosorbent assay (ELISA) for anti-NiV Immunoglobulin M (IgM) from serum. On 27 January, the case was transferred to another hospital in Dhaka city, where he died on 28 January.   

The case had a history of consuming raw date palm sap on 31 December 2023. As of 30 January 2024, a total of 91 contacts had been identified, including 11 family members, 20 from the community, and 60 healthcare personnel from different hospitals. However, none of the contacts tested positive for NiV by PCR or anti-NiV IgM by ELISA.   

Second case confirmed on 31 January 2024  

The second patient is a three-year-old female from Shariatpur district, Dhaka division. The patient visited a healthcare facility on 30 January 2024 with a two-day history of fever, altered consciousnesses, and seizures. The case was diagnosed with encephalitis and shock and was transferred to the isolation ward of another hospital in Dhaka city on the same day. Blood and throat samples were collected on 30 January and on 31 January, the case was laboratory-confirmed with NiV infection by RT-PCR for NiV RNA from the throat sample and by ELISA for anti-NiV IgM from serum and died on the same day.    

The case had a history of regularly consuming fresh raw date palm sap. As of 7 February 2024, 67 contacts were identified, including three family members, 21 from the community and 46 healthcare personnel from different hospitals. All identified contacts tested negative for NiV by PCR or anti-NiV IgM by ELISA.  

Since the report of the first case in 2001, human infections have been reported almost every year, with case fatality rate varying between 25% (in 2009) and 92% (in 2005). Clusters of cases are mainly reported in the country’s central and northwest districts.