H5N1

Uganda: Strange disease kills two in Kagadi

Thanks to Viki Hansen-Landis for alerting me to this report in allAfrica.com, reprinted from the Daily Monitor in Kampala: Uganda: Strange Disease Kills Two in Kagadi. Excerpt and then a comment:

Kagadi — Two children have died of a strange disease which presented symptoms similar to those of the Ebola virus.  

The victims of the strange disease are 10-year-old Jovia Natukunda and David Niwagaba who was nine months old.  

They were children of Mr Valence Byaruhanga, a resident of Kikonda village in Kiryanga Sub-county, Kagadi District. They died on Thursday. 

They were passing out blood from the mouth and the nose which symptoms are similar to those caused by the Ebola virus. 

Their death has caused fear among residents in a district that was hit by an outbreak of Ebola in 2012.  

The Kagadi Ebola Task Force led by the District Surveillance Officer, Mr Selevano Thembo, went to the area to investigate the matter. 

Wearing protective clothes, the team carried out the burial as one of the precautionary procedures in cases of suspected contagious diseases.  

"When people see blood coming out of their sick relatives, they tend to take it as a serious disease and our team went to investigate," Mr Thembo said. 

He said that they got blood samples from the bodies which will be taken to the Uganda Virus Research Institute for analysis. 

"Our district is at risk because of the outbreak of the Ebola disease in DR Congo," Mr Thembo said.  

Diseases which present with signs and symptoms similar to those of Ebola include Rift Valley Fever-RVF, Crimean Congo Haemorrhagic Fever-CCHF and Marburg fever. 

In 2018, Crimean Congo Haemorrhagic Fever outbreak was confirmed in neighbouring Kakumiro District in Nkooko Sub-county. It claimed one person.  

In late April, the Ministry of Health gave Shs146 million to Kagadi District for Ebola preparedness activities.

This is not just another health-scare story. The link in the text will take you to a report in 2012 about a real Ebola outbreak in Kagadi, and the town had a similar case less than a month ago. It's also useful to be reminded that Ebola's early symptoms mimic those of several other common diseases in the region—a major reason why relatively few suspected Ebola cases are confirmed. 

ECDC: CDTR, May 17

ECDC has published Communicable disease threats report, 12-18 May 2019, week 20. The summary: 

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 12-18 May 2019 and includes updates on poliomyelitis, chikungunya virus disease and dengue, measles, monkeypox, dengue, Ebola virus disease, influenza, Rift Valley fever, Crimean-Congo haemmorhagic fever and Legionnaires' disease.

ECDC: CDTR, week 17

ECDC has published Communicable Disease Threats Report, 21–27 April 2019, week 17. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period from 21–27 April 2019 and includes updates on influenza A(H7N9), chikungunya and dengue, dengue, Ebola virus disease, influenza, Rift Valley fever and risks of communicable diseases related to Cyclone Idai.

A virus even more dangerous than Zika to pregnant women

Via The New York Times: A Virus Even More Dangerous Than Zika to Pregnant Women. Excerpt:

The mosquito-borne virus that causes Rift Valley fever may severely injure human fetuses if contracted by mothers during pregnancy, according to new research.  

In a study published last month in the journal Science Advances, researchers used infected rats and human fetal tissue to discover how the virus targets the placenta. Results showed that the virus may be even more damaging to fetuses than the Zika virus, which set off a global crisis in 2015 and left thousands of babies in Central America and South America with severe birth defects.  

“Zika caught everybody by surprise,” said Amy Hartman, an infectious disease specialist at the University of Pittsburgh, who led the research. “If doctors had known about Zika’s birth effects, they could have done a lot more to protect pregnant women and babies. With Rift Valley fever, we’re trying to get ahead of the curve.”  

Rift Valley fever primarily occurs in livestock in sub-Saharan Africa, where outbreaks cause 90 to 100 percent of pregnant cows in a herd to miscarry or deliver stillborn calves, often a significant economic loss. 

 But hundreds of cases also occur in humans each year, causing flulike symptoms and severe liver problems. The outbreaks have moved beyond Africa: In late 2000, an outbreak in Saudi Arabia infected more than 100,000 people and led to at least 700 deaths, according to Dr. Hartman. The mosquito that carries the disease is also found in Europe and the Americas. 

“Climate change can alter how emerging infectious diseases will spread,” Dr. Harman said. “As mosquito populations move and change, we have a potential for this to spread far beyond its normal boundaries.”  

There are no vaccines or treatments for Rift Valley fever. The World Health Organization has called the disease a potential public health emergency.  

Two cases of infected fetuses have been documented. One infant was born with an enlarged liver and spleen, among other symptoms; the other died within a week. Because the disease can be asymptomatic in pregnant women, many more cases of abnormalities and stillbirths may have been misidentified. 

Among rats used in the study, 65 percent of the pups born to infected mothers died, compared to 25 percent of pups born from uninfected controls. Each infected mother lost at least one pup, and all of the infected mothers’ offspring contracted the virus. 

Pregnant rats were also more susceptible to death from Rift Valley fever than nonpregnant rats.  

Most surprising to researchers, the infected mothers’ placentas harbored more virus than any other tissue in the body — more than even the liver, where the virus’s damage is typically observed.

Uganda: Suspected Ebola patient isolated at Kabale hospital

Via the Daily Monitor in Kampala: Suspected Ebola patient isolated at Kabale hospital. This sounds more like a scare than a genuine spread of Ebola.

Health workers and patients at Kabale Regional Referral Hospital were on Tuesday morning alarmed after one of the patients admitted, started presenting what looked like signs and symptoms of Ebola. The hospital administration transferred him from the medical ward to an isolation unit in the same hospital.  

The principal nursing officer at Kabale regional referral hospital, Sr Christine Akurut, on Wednesday said that blood samples from the 28-year-old male patient have been taken to the Uganda Virus Research Institute in Entebbe.  

“The patient was admitted on Tuesday morning and when he presented signs and symptoms of either Ebola or the Rift Valley fever, we immediately transferred him to the hospital isolation unit as we wait for the results from the Uganda Virus Research Institute,” Sr Akurut said. Sr Akrut also said that the suspected Ebola patient told the health workers that he participated in the burial of his close friend who died of Rift Valley fever in Mbarara District. 

The suspected Ebola patient also told health workers that he comes from Mitooma District and is a vendor of general merchandise; he moves from town to town looking for customers and uses lodges for accommodation.  

Sr Akrut said that the lodge owners where the suspected Ebola patient stayed before he was taken to Kabale hospital should report to the hospital for case management in case the results are positive for the Ebola fever, that has claimed dozens of people in the neighbouring Democratic Republic of Congo. 

“For now the hospital is well-equipped with the necessary equipment to handle Ebola or Rift Valley and it’s up to the health workers to observe maximum precaution while handling patients,” Sr Akurut said.

WHO: Rift Valley fever – Kenya

WHO has published Rift Valley fever – Kenya. Excerpt:

On 8 June 2018, the Ministry of Health (MoH) for Kenya confirmed an outbreak of Rift Valley fever. The first patient was admitted to a hospital in Wajir County in north-eastern Kenya on 2 June with fever, body weakness, and bleeding from the gums and mouth. The patient reported having consumed meat from a sick animal; the patient died the same day. On 4 June, two relatives of the index patient were admitted. Blood samples were collected and sent to the Kenya Medical Research Institute, one of which was confirmed positive for Rift Valley fever on 6 June. 

As of 16 June, a total of 26 human cases have been reported from Wajir (24 cases) and Marsabit (2 cases) counties, including seven confirmed cases and six deaths (case fatality ratio (CFR) = 23%); six patients have been discharged while one is still hospitalized. A high number of deaths and abortions among livestock, including camels and goats, has been reported in Garissa, Kadjiado, Kitui, Marsabit, Tana River, and Wajir counties. People living in these counties were reportedly consuming meat from dead and sick animals.  

Public Health Response 

Preparedness activities for Rift Valley fever have been ongoing since February 2018 in reaction to the heavy rains and flooding in Kenya. An alert was issued to all County Directors in February 2018 and a general national alert was communicated in May 2018.  

The following actions have been taken since the outbreak was confirmed: 

• On 8 June, the MoH and Ministry of Agriculture convened an emergency meeting with the Ministry of Livestock (MoL) and key stakeholders. A health sector task force meeting was held, and partners pledged their support to Rift Valley fever control. 

• On 14 June, the MoH activated the Emergency Operations Centre, with an Event Manager and supporting technical team. 

• On 14 June, a multi-sectoral investigation teams was deployed in Wajir County to support the county health teams. Another team will soon be dispatched to support the Marsabit County team. 

• As part of ongoing preparedness activities, active surveillance for Rift Valley fever is being strengthened in affected and at-risk counties, as well as contact tracing in Wajir and Marsabit counties. In Wajir County, five treatment centres have been established. 

• Active case searching and community sensitization activities are ongoing in the affected areas. Guidelines for vector control and other informational materials have been dispatched to Wajir County, and messages are being disseminated through Community Health Volunteers. 

• A ban on slaughtering animals and restriction of livestock movement has been imposed in the affected areas.

History of mosquitoborne diseases in the United States and implications for new pathogens

Via EID: Ahead of Print -History of Mosquitoborne Diseases in the United States and Implications for New Pathogens. The abstract:

The introduction and spread of West Nile virus and the recent introduction of chikungunya and Zika viruses into the Americas have raised concern about the potential for various tropical pathogens to become established in North America. A historical analysis of yellow fever and malaria incidences in the United States suggests that it is not merely a temperate climate that keeps these pathogens from becoming established. 

Instead, socioeconomic changes are the most likely explanation for why these pathogens essentially disappeared from the United States yet remain a problem in tropical areas. In contrast to these anthroponotic pathogens that require humans in their transmission cycle, zoonotic pathogens are only slightly affected by socioeconomic factors, which is why West Nile virus became established in North America. 

In light of increasing globalization, we need to be concerned about the introduction of pathogens such as Rift Valley fever, Japanese encephalitis, and Venezuelan equine encephalitis viruses.

WHO: Rift Valley fever – Gambia

WHO has published Rift Valley fever – Gambia. Excerpt:

On 3 January 2018, the Ministry of Health (MoH), Senegal notified WHO of a case of Rift Valley fever, a 52-year-old Korean man who was a resident of Gambia. 

The case was reported from a hospital in Dakar. The case travelled on 5 December 2017, with his brother and two colleagues, from Banjul, Gambia, to Ziguinchor, Senegal and from Ziguinchor to Buba in southern Guinea-Bissau. On 10 December, while being in Bissau (the capital of Guinea Bissau) the case developed symptoms, including a dry cough, fever, headache and joint pain. The brother of the case and the driver also developed a dry cough on 10 December, which resolved by the following day. 

The group arrived back in Gambia on 12 December after stopping in Ziguinchor. The case continued to have a persistent cough during this time. After returning to Banjul, the case also developed fever, headache and vertigo. 

The case was hospitalized on 20 December and diagnosed with severe malaria. Blood film for malaria revealed Plasmodium falciparum parasitaemia above 100 000/µL. On 23 December, he became delirious and developed diarrhoea, vomiting and haemorrhagic symptoms. On 25 December, he entered into a coma and was medically evacuated to a hospital in Dakar, Senegal. His symptoms improved and blood samples were taken on 26, 28 and 30 December. He experienced a recurrence of haemorrhagic symptoms on 31 December 2017 and died that same day. 

A blood sample from the case was tested at the Institute Pasteur in Dakar and was positive for IgM against Rift Valley fever virus. Rift Valley fever virus and other arboviruses were not detected by reverse transcription polymerase chain reaction (RT-PCR). The case had no known history of handling raw meat.  

Public Health Response 

• The first case investigation was conducted by a multidisciplinary team from the Centre of Health Emergency Operations of the MoH of Senegal. 

• As part of this investigation, blood samples were collected from the case’s brother, colleague and driver who experienced cough. These samples were all negative for Rift Valley Fever Virus by RT-PCR. 

• In addition, a second case investigation was conducted by a multidisciplinary team from the Epidemic and Disease Control Unit of the MoH of Gambia in collaboration with the Department of Livestock Services of the Ministry of Agriculture. Rift Valley fever surveillance in the animal population and community awareness activities have been strengthened in Gambia.

WHO: List of Blueprint priority diseases

WHO has published List of Blueprint priority diseases. Excerpt:

For the purposes of the R&D Blueprint, WHO has developed a special tool for determining which diseases and pathogens to prioritize for research and development in public health emergency contexts. This tool seeks to identify those diseases that pose a public health risk because of their epidemic potential and for which there are no, or insufficient, countermeasures. The diseases identified through this process are the focus of the work of R& D Blueprint. This is not an exhaustive list, nor does it indicate the most likely causes of the next epidemic. 

The first list of prioritized diseases was released in December 2015. Using a published prioritization methodology, the list was first reviewed in January 2017. 

The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for:  

• Crimean-Congo haemorrhagic fever (CCHF) 

• Ebola virus disease and Marburg virus disease 

• Lassa fever Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) 

• Nipah and henipaviral diseases 

• Rift Valley fever (RVF) 

• Zika 

• Disease X 

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible.  

A number of additional diseases were discussed and considered for inclusion in the priority list, including: Arenaviral hemorrhagic fevers other than Lassa Fever; Chikungunya; highly pathogenic coronaviral diseases other than MERS and SARS; emergent non-polio enteroviruses (including EV71, D68); and Severe Fever with Thrombocytopenia Syndrome (SFTS). 

These diseases pose major public health risks and further research and development is needed, including surveillance and diagnostics. They should be watched carefully and considered again at the next annual review. Efforts in the interim to understand and mitigate them are encouraged.

Rift Valley fever (RVF) outbreak: Yirol East, Eastern Lakes State, Republic of South Sudan - Situation Report No. 4

Evidently the mysterious outbreak a few weeks ago has been identified as Rift Valley fever. Via ReliefWeb, a report from the government of South Sudan:  Rift Valley Fever (RVF) Outbreak: Yirol East, Eastern Lakes State, Republic of South Sudan - Situation Report No. 4 as at 17.00 Hours; 21 January 2018. The situation highlights:

• Since the last update (of 14 January 2018), five new suspect RVF cases have been reported in Yirol East. These include two males and three females aged 7-32 years, one of whom is still hospitalised in the treatment facility in Yirol East. Their blood samples have been collected and are in the process of being shipped to Juba en route to Entebbe, UVRI for testing.  

• As of 21 January 2018, a total of 15 suspect RVF human cases have been reported in Eastern Lakes State. Out of the 15 suspect human cases reported since 7 December 2017, three human cases have been confirmed, three died and were classified as probable cases with epidemiological linkage to the three confirmed cases, four were classified as non-cases following negative laboratory results for RVF, and laboratory testing is pending for the recent five suspect cases. 

• From 5th – 8th January, 2018, seven human samples were collected from Eastern Lakes state for testing at the Uganda Virus Research Institute (UVRI). 

• The seven human samples initially tested negative on 10 January (by PCR) for Ebola, Marburg, CCHF, RVF and Sosuga viruses. • Follow up serological testing showed one sample had high RVF IgM and IgG and another two samples had high RVF IgG titres.  

• A total of seven animal (two sheep; two goats; and three cattle) samples have also been shipped to UVRI for testing. Test results showed that one cow sample was positive for past RVF infection (RVF IgG).