H5N1

ECDC risk assessment: Monkeypox multi-country outbreak

ECDC has published Risk assessment: Monkeypox multi-country outbreak. Click or tap through to download the full report. The executive summary, with my bolding:

Key messages  

Monkeypox (MPX) does not spread easily between people. Human-to-human transmission occurs through close contact with infectious material from skin lesions of an infected person, through respiratory droplets in prolonged face-to-face contact, and through fomites. The predominance, in the current outbreak, of diagnosed human MPX cases among men having sex with men (MSM), and the nature of the presenting lesions in some cases, suggest transmission occurred during sexual intercourse.  

Based on ECDC’s epidemiological assessment, the likelihood of MPX spreading in persons having multiple sexual partners in the EU/EEA is considered high. Although most cases in current outbreaks have presented with mild disease symptoms, monkeypox virus (MPXV) may cause severe disease in certain population groups (young children, pregnant women, immunosuppressed persons). However, the likelihood of cases with severe morbidity cannot be accurately estimated yet. The overall risk is assessed as moderate for persons having multiple sexual partners (including some groups of MSM) and low for the broader population.  

Treatment is mainly symptomatic and supportive, including prevention and treatment of secondary bacterial infections. Smallpox vaccine can be considered for post-exposure prophylaxis of close contacts at increased risk for severe disease, however careful benefit/risk assessment should be performed for the exposed individual. Important information on the use of currently available smallpox vaccines is missing for groups at increased risk for severe disease. In addition, antivirals are potential treatment options for severe cases.  

EU/EEA countries should focus on prompt identification, management, contact tracing and reporting of new MPX cases. Countries should update their contact tracing mechanisms, their diagnostic capacity for orthopoxviruses and review the availability of smallpox vaccines, antivirals and personal protective equipment (PPE) for health professionals.  

An interim case definition is proposed for case reporting. Guidance for the management of MPX cases and close contacts is also included. Cases should remain isolated until their rash heals completely, avoiding contact with immunosuppressed persons and pets. Abstaining from sexual activity and close physical contact is also advised until the rash heals. Most cases can remain at home with supportive care.  

Close contacts of MPX cases should self-monitor for the development of symptoms up to 21 days from the last exposure to a case.  

Healthcare workers should wear appropriate PPE (gloves, water-resistant gown, FFP2 respirator) when screening suspected cases or caring for a MPX case. Laboratory personnel should also take precautions to avoid occupational exposure.  

Close contacts of a MPX case should be deferred from blood, organ or bone marrow donations for a minimum of 21 days from the last day of exposure.  

Proactive risk communication and multiple community engagement activities should be carried out to increase awareness, provide updates and guidance to those at increased risk and the wider public. Risk communication messages should stress that MPXV is spread through close contact between people, especially in the same household, potentially including the sexual route. A balance should be kept between informing those most at risk but also communicating that the virus does not spread easily between people the risk to the broader population is low.  

There is a potential risk of human-to-animal transmission in Europe, therefore close intersectoral collaboration between human and veterinary public health authorities working from a ‘One Health’ perspective is needed to manage exposed pets and prevent the disease from being transmitted in wildlife. EFSA is not aware to date of any reports on infections in animals (pets or wild animals) in the EU.  

Several unknowns still exist regarding this outbreak and ECDC will continue to monitor developments closely and update the risk assessment as new data and information become available.

Ebola resurgence in Guinea: A recovery from 5 years ago at the base of the new epidemic?

Via Guineematin.com, a long and detailed report: Ebola resurgence in Guinea: a recovery from 5 years ago at the base of the new epidemic? Guinea Matin. The conclusion, in Google translation:

It appears that three genomes of the virus currently circulating are strictly identical and that a fourth genome differs only at the level of a single nucleotide (substitution of a letter in the genetic code). The phylogenetic analysis, aimed at determining the degree of relatedness between the viral genomes, also showed that the 2021 sequences belong to a group of viruses that circulated during the historic epidemic that raged between 2013 and 2016. 

The researchers therefore conclude that the new epidemic is the result of the resurgence of a strain that circulated in West Africa in 2013-2016 and that the low rate of mutation observed during the comparison of genetic sequences would be due to the persistence of Ebola virus, maintained in a state of latency, in a survivor. 

The third report, from researchers at the Guinea Haemorrhagic Fevers Project (PFHG) laboratory in Conakry in association with their counterparts from the Institute of Tropical Medicine in Hamburg (Germany), reports similar results. 

In the light of the above, we could say that the 51-year-old Guinean nurse (the index case in Gouécké), who died on January 28, 2021 and was buried without any respect for the measures recommended for a safe burial, was undoubtedly contaminated. sexually by an individual infected with Ebola five years ago and who has recently had a relapse. 

However, it cannot be ruled out that the nurse was infected with the virus several years ago and only developed few symptoms. In this case, she herself could have been an Ebola survivor without even knowing it and having relapsed.

ECDC: Response plan to control and manage the threat of multi- and extensively drug-resistant gonorrhoea in Europe

ECDC has published Response plan to control and manage the threat of multi- and extensively drug-resistant gonorrhoea in Europe. The executive summary:

Gonorrhoea is the second most notified sexually transmitted infection in the European Union and European Economic Area (EU/EEA) after chlamydia. The overall trend between 2008-2017 among 20 of the 28 EU/EEA countries consistently reporting, showed an increase in the number of notified gonorrhoea cases. In addition, over the past decades, Neisseria gonorrhoeae has developed antimicrobial resistance (AMR) to several antimicrobial classes. 

Six years after the initial ECDC Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe, the threat of untreatable gonorrhoea remains. ECDC reviewed the response plan and the 2019 update strives to further support EU Member States to develop and implement national strategies and interventions to control the threat of multidrug-resistant and extensively drug-resistant gonorrhoea in a multidisciplinary approach by outlining the suggested public health response to this threat with several vital components. 

Preventing the emergence and spread of AMR in N. gonorrhoeae is just one aspect of gonorrhoea control: as part of comprehensive management strategies including appropriate treatment, diagnostics and testing algorithms (e.g., three-site testing in men who have sex with men), test of cure, notification and treatment of partners, enhanced focus on risk groups and STI prevention measures, including advocating for increased condom use.

Ebola in Butembo: 'The Church will not give up until the disease is declared over'

Credit: Radio Moto

Radio Moto Butembo-Beni pays a lot of attention to local religious news, and Catholic officials have been energetic in mobilizing the faithful against Ebola. But sometimes doctrine can conflict with infection prevention: Ebola in Butembo: "The Church will not give up until the disease is declared over" (Mgr Sikuli PALUKU). The Google translation and then a comment:

The Church continues to preach faith to Christians even in the context of the epidemic. This is what the Bishop of Butembo-Beni said during an interview with the RFI, the RMBB and the Voice of the UCG on Saturday October 5th at the bishop's palace. 

Addressing people who, after more than a year, continue to doubt the existence of the disease, Monsignor SIKULI PALUKU Melchizedek advises to believe in the number of people who lost the life of this disease. The prelate of the Butembo-Beni Church used the example of the disease that once attacked the bananerais.  

Using his own experience, SIKULI PALUKU Melchizedek explains that the banana field in which he was born no longer exists as a result of an illness that has been named EBOLA. The bishop complains of people who, after seeing many people lose their lives, continue to doubt.  

"We are cultivating corn, we plant the bean where we had the banana plantations. At the time it came, curiously, the word Ebola was already known. It was said that no, banana has caught a disease called Ebola. Now that it happens in men, I do not understand why you do not understand that it can kill. As much as you have seen a banana plantation disappear completely, why do you doubt it?" asked the Bishop.  

The Nande culture does not advocate proximity to the bodies of the dead  

It is in these words that the bishop of Butembo-Beni responds to those who brandish the culture to refuse the dignified and safe burials. Monseigneur the bishop says that in time, parents took care to keep their children away from the dead. And, the funeral rites were reserved for a fringe of people.  

Monseigneur the bishop deduces that this practice of wanting to touch the corpses arrived with the mixing of the customs of peoples from elsewhere. From where SIKULI PALUKU Melchizedek calls to return on the old customary practices which, today allow to limit the dangerous contacts.  

"Here at home, I think those who are older can remember that here at home, growing up, since even until the age of 20, parents did not even allow children to see a dead person. I who speak to you, I was, I believe 19 years old before I saw a corpse. And even the funeral toilet was made, not by everyone, but it was by a group. I myself was surprised that everyone is trying to touch the body. In principle in our Nande customs, I do not believe that it was something that existed," said Bishop Sikuli PALUKU. 

Abstinence to limit Ebola  

Monseigneur the Bishop of the diocese of Butembo-Beni reminds the winners of EBOLA abstinence. Monsignor SIKULI PALUKU Melchizedek thus addresses Catholic healers who can never use the condom. 

While expressing their sincere congratulations on their healing, Monsignor SIKULI PALUKU Melchizedek reminds them that the gospel remains constant. 

"When one becomes a Christian, it means that one changes the behavior".  

What the Church advises is abstinence. What Jesus tells us, the Gospel, we must stick to. This is not the message that can change overnight; because men change, the gospel remains the same," he said. 

Note that the sequelae of the virus can remain long in the sperms of the survivors of EBOLA, according to the body of each cured. For this reason, the cured are subjected to frequent health checks to approve their total recovery. 

In his words, Monsignor Sikuli Paluku encouraged the faithful to adhere to good practices advocated by the Ebola response in order to eradicate this disease. 

In the end, the Bishop welcomed the advances made in epidemiological statistics today. He declared that the Church will not give up until the illness is declared over. In this interview, the Bishop reminded every Christian family and all people of good will to continue the fight against EBOLA.

Expecting abstinence of all male Ebola survivors, rather than using a condom, is criminally naive.

Surely the bishop doesn't suppose that a survivor with live Ebola virus in his sperm could successfully inseminate his partner, who could then give birth to a healthy baby. Instead he would simply add a female casualty to the list of Ebola cases and deaths. Good doctrine that isn't good public health is very bad doctrine.

Ebola survivors can pass on the virus: We're trying to understand what role sex plays

Via The Conversation Africa, an important article by Jason Kindrachuk and colleagues: Ebola survivors can pass on the virus: we're trying to understand what role sex plays. Excerpt:

The current Ebola disease outbreak in the Democratic Republic of the Congo (DRC) is the second largest in history. It has been raging for over a year with no indication that it is nearing an end. Many of the issues that prevent effective containment of Ebola disease outbreaks have been discussed. These include porous borders, community mistrust of health workers, and the spread of misinformation.

But one area that requires further study is Ebola virus’ persistence in the reproductive systems of otherwise healthy survivors. Understanding how Ebola disease outbreaks are exacerbated by sexual transmission is important to stop new chains of transmission and to prevent the disease from spreading to new geographic regions.  

Multiple reports strongly suggest that re-emergence of Ebola disease is linked to persistent infections and sexual transmission from survivors. What this means is that people who have survived infection by Ebola virus – and who no longer show any symptoms of the disease – can continue to carry the virus and pass on the infection months after they have recovered.  

Our research group recently reviewed the current understanding of rates and mechanisms of Ebola virus persistence in male disease survivors. We are using this information to fill in gaps about how persistence relates to sexual transmission of the virus.  

In addition, we are combining molecular investigations with insights from survivors to better equip future outbreak response efforts. We also hope the work will help address long-term health issues faced by Ebola disease survivors.

Finland: One fifth of teens ignore contraception, HPV vaccines down

Via Yle Uutiset: THL: One fifth of teens ignore contraception, HPV vaccines down. After discussing teenagers' sexual activity, the report continues with worrying news about HPV vaccination rates: 

A vaccination against the human papilloma virus (HPV) is available to teenage girls in Finland, but far fewer girls in some regions are getting vaccinated than in others, the THL's vaccination register shows. 

Nationwide about 70 percent of 13-year-old girls have been vaccinated against HPV, a virus which is known to cause cancer of the cervix, penis, anus, head and neck area. In the Ostrobothnian region in Central Finland, the proportion of girls vaccinated is just 57 percent.  

Swedish-speaking regions of Pohjanmaa were found to have the most antipathies toward vaccinations. In the health district of Pietarsaari, only 44 percent of 13-year-old girls had gotten the HPV shot.  

Infectious disease specialist Kimmo Kuisma from the Malmi hospital in Pietarsaari said that old taboos about sex still live on. 

"Some of the older people here find the subject to be delicate and emotional, because it has to do with sexual health. I'm not surprised, as there is always some pushback to new vaccines. Time and proper education will win out," Kuisma said.  

The HPV vaccine was introduced into the national vaccination programme in 2013. The shot is administered to girls aged 11-12. 

The Ministry of Finance included the proposal in its budget that young boys also be vaccinated against HPV starting in autumn 2020. Parliament will decide on the new budget in December. 

The HPV vaccine is administered as a series of three injections. Starting this autumn the shots will be given to children in the 5th grade, while previously 6th graders were the youngest to receive immunity.

ECDC: Syphilis notifications in the EU/EEA up by 70% since 2010

ECDC has published Syphilis notifications in the EU/EEA up by 70% since 2010. Excerpt:

The number of syphilis cases has been consistently going up across Europe since 2010, mostly affecting men who have sex with men living in urban areas. In 2017, notification rates reached an all-time high in the EU/EEA countries with more than 33 000 reported cases. An in-depth ECDC study published today describes the factors behind this increase and outlines the evidence-based options for public health control of syphilis, including case finding and management as well as educational activities. 

Overall, more than 260 000 confirmed syphilis cases were reported from 30 EU/EEA countries between 2007 and 2017. While annual notifications decreased slightly between 2007 and 2010 (from almost 20 000 to a low of some 19 000 cases), they continuously rose to more than 33 000 cases in 2017. An all-time high since the start of ECDC surveillance recording. 

This trend results from notification data of the 23 countries with comprehensive surveillance systems reporting consistently between 2007 and 2017. The rate dropped to a low of 4.2 per 100 000 persons in 2010, before reaching an EU/EEA peak of 7.1 per 100 000 population in 2017 – an increase of 70% compared with the notification rate in 2010. This means that for the first time since the early 2000s, the EU/EEA countries report more syphilis than HIV cases. 

Striking country variations in Europe 

Between 2010 and 2017, 15 countries reported an increase in the notification rate of more than 15%. However, this varied greatly among countries with rates more than doubling in five countries: Iceland (876%), Ireland (224%), the United Kingdom (153%), Germany (144%) and Malta (123%). On the other hand, Estonia and Romania reported a drop of 50% or more over the same period. 

During this period, syphilis diagnoses were consistently higher among men, with rates doubling from 6.1 per 100 000 in 2010 to 12.1 in 2017. Between 2007 and 2017, close to two-thirds (62%, 94 015 of the 152 233 cases where sexual orientation was known) were reported among men who have sex with men. Heterosexual men contributed 23% of cases and women 15%. The proportion of cases diagnosed among men who have sex with men ranged from below 20% in Latvia, Lithuania and Romania to more than 80% in France, Germany, Ireland, the Netherlands, Sweden and the United Kingdom.  

The ECDC study looked at more than 60 studies reporting on rising syphilis trends in high-income countries since the early 2000s.

Canada: 'Disheartening' having to issue HIV outbreak warning in Thunder Bay, medical officer of health says

Via CBC News: 'Disheartening' having to issue HIV outbreak warning in Thunder Bay, medical officer of health says. Excerpt:

The medical officer of health for the Thunder Bay District Health Unit says it's "disheartening" that public health officials had to declare an outbreak of HIV in the population of the northwestern Ontario city who are homeless or lack stable housing. 

Eight new cases of HIV have been confirmed since January 1 and another two are under investigation, the health unit said, with a spike in May and June, which prompted the outbreak warning. Dr. Janet DeMille said that spike includes seven cases which were either confirmed or are being investigated. 

"It is quite concerning, very much so, and quite disheartening," DeMille said. "We have been aware that we had ... enough risk in the population that this could happen but we were, we actually had very low rates which was very good." 

The health unit said HIV is most commonly spread through sharing needles for injection drug use and unprotected sexual activity. 

"We knew that this could happen and we've been doing more work related to HIV, including increasing testing so we would pick up something like this early," DeMille said. "But it is actually quite disheartening that it's come to the point that it's an actual outbreak." 

People on the street also deal with "many other issues and many other burdens," DeMille said, including a declared outbreak in the population of tuberculosis in 2018.

The risk has always been there, DeMille said, adding that there have been HIV outbreaks declared in other cities in Ontario — DeMille cited London as an example — as well as a number of communities in Canada and the U.S.  

"We've just had more spreading of the virus among people and we reached a certain ... threshold of numbers, number of cases where we've seen, what we call more transmission or spread from person to person," she said. "We knew that this could happen."

'An HIV transmission rate of zero'

Via The Lancet, some momentous good news: Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. The summary:

Background 

The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships. 

Methods 

The PARTNER study was a prospective observational study done at 75 sites in 14 European countries. The first phase of the study (PARTNER1; Sept 15, 2010, to May 31, 2014) recruited and followed up both heterosexual and gay serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex, whereas the PARTNER2 extension (to April 30, 2018) recruited and followed up gay couples only. At study visits, data collection included sexual behaviour questionnaires, HIV testing (HIV-negative partner), and HIV-1 viral load testing (HIV-positive partner). If a seroconversion occurred in the HIV-negative partner, anonymised phylogenetic analysis was done to compare HIV-1 pol and env sequences in both partners to identify linked transmissions. Couple-years of follow-up were eligible for inclusion if condomless sex was reported, use of pre-exposure prophylaxis or post-exposure prophylaxis was not reported by the HIV-negative partner, and the HIV-positive partner was virally suppressed (plasma HIV-1 RNA <200 copies per mL) at the most recent visit (within the past year). Incidence rate of HIV transmission was calculated as the number of phylogenetically linked HIV infections that occurred during eligible couple-years of follow-up divided by eligible couple-years of follow-up. Two-sided 95% CIs for the incidence rate of transmission were calculated using exact Poisson methods. 

Findings 

Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up). 

Interpretation 

Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.

See also this comment in the same issue.

Self-flagellation as possible route of human T-cell lymphotropic virus type-1 transmission

Thanks to Dr. Ian Mackay for tweeting about this issue. Via Emerging Infectious Diseases: Ahead of Print - Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type-1 Transmission. The abstract:

We report human T-cell lymphotropic virus type-1 infection associated with self-flagellation in 10 UK residents. These persons were heterosexual men from Pakistan, India, and Iraq. One person showed seroconversion in adulthood; 1 was co-infected with hepatitis C virus. No other risk factors for bloodborne virus acquisition were identified. Onward sexual transmission has occurred.