Friday, March 22, 2019

CDC FluView Week 11: Flu Season Continues Strong As H3N2 Continues To Climb

https://www.cdc.gov/flu/weekly/index.htm
















#13,950

Influenza activity, which showed signs of peaking twice earlier in the season (see ILI chart below), continues to reinvigorate itself with late season surge in H3N2 activity.


https://www.cdc.gov/flu/weekly/index.htm

While most of the illnesses in this 2018-2019 winter flu season have been due to H1N1,in the past week, 65% of virus samples tested by the CDC were H3N2. The percentage of H3N2 viruses falling into the rising 3C.3a clade - which in week 44 only comprised 4% of H3N2 viruses sampled - has risen to 65%.

https://www.cdc.gov/flu/weekly/index.htm


Even more remarkably, the CDC has analyzed 102 H3N2 viruses over the past two reporting weeks, and of those 92 (90%) belong to this rising clade.  A big reason why yesterday, the WHO Selected the Fall H3N2 Flu Shot Component: Clade 3C.3a.

A few excerpts from today's FluView report, followed by a snapshot estimate of this flu season's burden the public's health.

2018-2019 Influenza Season Week 11 ending March 16, 2019


All data are preliminary and may change as more reports are received.
An overview of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component, is available at http://www.cdc.gov/flu/weekly/overview.htm.

Synopsis:

Influenza activity remains elevated in the United States. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continue to co-circulate. Below is a summary of the key influenza indicators for the week ending March 16, 2019:
  • Viral Surveillance:The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories increased slightly. Nationally, during the most recent three weeks, influenza A(H3) viruses were reported more frequently than influenza A(H1N1)pdm09 viruses and in HHS Regions 2, 4, 5, 6, 7, 8, 9 and 10.
    • Virus Characterization:The majority of influenza viruses characterized antigenically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses. However, an increasing proportion of influenza A(H3N2) viruses are antigenically distinguishable from A/Singapore/INFIMH-16-0019/2016 (3C.2a1), a cell-propagated reference virus representing the A(H3N2) component of 2018-19 Northern Hemisphere influenza vaccines.
    • Antiviral Resistance:The vast majority of influenza viruses tested (>99%) show susceptibility to oseltamivir and peramivir. All influenza viruses tested showed susceptibility to zanamivir.
  • Influenza-like Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) remained at 4.4%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above their region-specific baseline level.
    • ILI State Activity Indictor Map: 26 states experienced high ILI activity; 12 states experienced moderate ILI activity; New York City, Puerto Rico and eight states experienced low ILI activity; four states experienced minimal ILI activity; and the U.S. Virgin Islands and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 44 states was reported as widespread; Puerto Rico and four states reported regional activity; the District of Columbia and two states reported local activity; the U.S. Virgin Islands reported sporadic activity; and Guam did not report.
  • Influenza-associated Hospitalizations A cumulative rate of 47.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. The highest hospitalization rate is among adults 65 years and older (146.0 hospitalizations per 100,000 population).
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths: Eight influenza-associated pediatric deaths were reported to CDC during week 11.

While this year's estimated flu burden still pales when compared to last year's severe H3N2 season, the numbers continue to climb, and the season may have several more active weeks ahead. 


https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm


 

OIE: Multiple Outbreaks Of LPAI H7N4 In Cambodian Poultry

http://afludiary.blogspot.com/2018/02/who-genetic-characteristics-of-avian.html
Credit CDC

#13,949


In February of 2018 in Jiangsu China Reports 1st Novel H7N4 Human Infection, we learned of the first known human infection with a novel H7N4 virus which resulted in a 3-week hospitalization for a 68 year old woman in Jiangsu Province for severe pneumonia. 

Since then, no new cases have been reported, but we have learned a bit more about the virus.
Eight days later, in WHO: Genetic Characteristics Of Avian H7N4, we learned this AI virus was a purely avian LPAI H7 strain - distinct from A(H7N9) - although it carried the PB2  637K marker associated with mammalian adaptation.

That same day the World Health Organization released a Risk Assessment, which read in part:

It is possible that additional human cases of avian influenza A(H7N4) will be detected, however only one human case has been detected so far, and information on the circulation of avian influenza A(H7N4) in birds is not currently available. Further information needs to be gathered to increase the confidence in this assessment.
It's been a year, and very little else has been reported on the H7N4 virus, likely due - at least, in part - to China's massive H5+H7 poultry vaccination campaign, which began about 20 months ago. 

Since then, avian flu reports out of China have been greatly subdued.

Although it isn't exactly a stop-the-presses! moment, today the OIE has been notified of multiple detections of LPAI H7N4 in poultry in southeastern Cambodia, relatively near their border with South Vietnam. 
While details on these outbreaks are sparse, somewhat surprisingly, these outbreaks are listed as having an onset date of February 2018, but are only now being announced.
I suspect that routine samples were collected from poultry a year ago, put into a low priority queue, and have only recently been tested. Hopefully we'll get more details on exactly what happened.

Also, it isn't immediately apparent how closely related these H7N4 avian viruses are to the one reported in China in early 2018. Again, hopefully we'll get a more thorough analysis.

First, a brief announcement in the Vietnamese press.

New strains of avian influenza virus appeared armpit Vietnam

(PLO) - International Forestry and Agriculture Organization (FAO) said the H7N4 bird flu virus has emerged in Cambodia. This new strain previously detected in China in 2018.
FAO assessment new bird flu strain that can appear anywhere and anytime, so Vietnam needs to maintain a research laboratory capacity to detect and prevent.

Before this warning, in the Conference national plans to deploy anti-bird flu period 2019-2025 by the Department of Animal Health held on 22-3, Deputy Minister of Agriculture and Rural Development Phung Duc Tien that can not be ignored, subjective in prevention.

Under the plan approved by the Prime Minister in mid-May 2-2019, the veterinary service will focus not to the branch block, new dangerous viruses infecting Vietnam. With the current strain, to vaccinate at least 80% of the total. Try to minimize or not arising cases of human avian influenza.

Epidemic of avian influenza A / H5N1 appeared in Vietnam in late 2003, then spread to the whole country. The period 2007-2013, each year to slaughter 200,000 poultry have spread to 42 people, dying from this virus. Since mid 2014, the epidemic is under control, reduce the number of poultry to be destroyed while 90,000 children each year, no patient deaths due to influenza A / H5N1 as well.

And some excerpts from today's OIE Notification:


http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review?page_refer=MapFullEventReport&reportid=29915

Epidemiological comments 

Active surveillance conducted in collaboration between National Animal Health and Production Institute (NAHPRI) of the General Directorate of Animal Health and Production (GDAHP), Institut Pasteur du Cambodge and FAO in live bird markets and other high risk sites has identified multiple H7 low pathogenic virus in 2018. The susceptible population in each market was more than 100 and the cases were 1-10 per markets.

While today's report doesn't tell us much about the current dispersal of H7N4 viruses in southeast Asia, we now know that that this subtype was circulating in locations more than 2,700 km apart (see map below) in February of last year.



A sobering reminder of how little real-time data we really get on the evolution, and spread, of potentially dangerous avian flu viruses from many parts of the globe.


UK: DEFRA Update #20 On ASF In Central & Eastern Europe


















#13,948


While the emergence and spread of African Swine Fever over the past 6 months in China, Mongolia, and most recently Vietnam have make the most headlines, this devastating pig disease has been spreading in Eastern Europe and Western Russia for roughly a dozen years.
Last September, however, the virus was found in wild boar in Belgium - signifying a westward jump of more than 500 km (see OIE Notification: African Swine Fever Jumps To Belgium) - raising the stakes for all of western Europe.
This week the UK's DEFRA (Department for Environment, Food and Rural Affairs) released their 20th assessment on the spread of the virus in Eastern (and now, Central) Europe.

The (limited) good news is the number of ASF outbreaks reported over the past 6 months has declined over what we were seeing a year ago, although how long that lasts is anyone's guess.
Updated Outbreak Assessment #20
African Swine fever in Eastern Europe
18 March 2019
Ref: VITT/1200 ASF in Eastern Europe


Disease report


Since our last report on the 8 th January 2019, there have been new outbreaks of ASF in domestic pigs and cases in wild boar in Eastern Europe. The numbers of outbreaks in domestic pigs (backyard and commercial) since July 2018 are summarised in Table 1 for each country. Over the past 6 months (to date), there has continued to be a decrease in reports in domestic pigs, with reports in January to March, to date, restricted to Romania (61), Ukraine (7) and Poland (1).


Although the largest number of outbreaks in domestic pigs each month is for Romania, these were mainly backyard pig small-holdings. In contrast, the number of cases in wild boar has remained high in January and February (Table 2). Although wild boar cases have been increasing from October 2018 in Eastern Europe, there have been no new large geographical jumps so far in 2019, and increased numbers of ASF-positive wild boar may be related to increased wild boar culling and surveillance activities. The last significant jump of ASF within Europe was the emergence of ASF in Belgium in September 2018.


(SNIP)

Situation assessment
 
Eastern Europe is continuing to report outbreaks of ASF in domestic pigs, although this appears to be restricted to the south-east region; namely Ukraine, and Romania, with a single outbreak reported in Poland, and with other countries reporting no outbreaks in January to March, to date.


The picture in wild boar is concerning and shows ASF is increasing since October 2018 in wild boar particularly in Poland, with a few cases in northern Bulgaria. However, this reported increase in Poland may also be due to the surveillance and population control activities which have been carried out in early 2019. In many parts of Eastern Europe and Russia, there has been a severe winter this year and it is likely that additional wild boar carcases will be found as the snow melts.


As these will be sampled, this may result in a small surge in positive reports in certain countries. Disease in wild boar is more likely to spread during the winter months which favours virus survival in the environment, as well as the increased likelihood of wild boar scavenging on other wild boar carcases which have not decomposed in the cold weather. However, while control efforts may be reducing incidence in domestic pigs, the wild boar population represents a significant reservoir in Eastern Europe which may hinder eradication, and serve as a source for further geographic jumps.

Conclusion
 
Despite the significant reduction in the number of ASF outbreaks in domestic pigs in Eastern Europe over the past six months, the disease is still present across much of the region, with large numbers of cases in wild boar. The risk therefore remains at MEDIUM for the entry of contaminated or infected products into UK, given the ongoing situation in Eastern Europe, and continued reports of ASF in wild boar in Belgium. 


The risk of exposure to the pig population in the UK is still highly dependent on the level of biosecurity on individual pig premises but is still considered to be low, although the situation is being kept under review. Under winter conditions, itis more difficult to effectively disinfect vehicles and equipment, and, the ASF virus persists at low temperatures for many weeks. We will continue to monitor the situation as we move into Spring.

We would like to highlight to all pig keepers and the public the importance of ensuring pigs are not fed catering waste, kitchen scraps or pork products, thereby observing the swill feeding ban. All pig keepers should be aware that visitors to their premises should not have had recent contact with pigs and pig premises in the affected regions. Anybody returning from any ASF-affected area should avoid contact with domestic pigs, whether commercial holdings or smallholdings, areas with feral pigs or wild boar, until they are confident they have no contaminated clothing, footwear or equipment. Pig keepers and veterinarians should remind themselves of the clinical signs for ASF.


Any suspect cases must be reported promptly. See: https://www.gov.uk/guidance/african-swine-fever


We would like to remind the public that any feeding of meat products, including the feeding of swill, kitchen scraps and catering waste, to wild boar or feral pigs is also illegal. A poster reminding pig keepers of this is available: 
http://apha.defra.gov.uk/documents/surveillance/diseases/african-swine-fever-poster.pdf


WHO Selects Fall H3N2 Flu Shot Component: Clade 3C.3a

Recent FluView H3N2 Clade Charts











#13,947


The chart above shows the rapid rise in the detection of the 3C.3a clade of the H3N2 virus in the United States since the first of January - rising from an 18% share to nearly 60% in a matter of a couple of months.
 
In light of this rapidly evolving fluscape, a month ago in WHO: (Partial) Recommended Composition Of 2019-2020 Northern Hemisphere Flu Vaccine, the World Health Organization made the unusual decision to delay selection of the H3N2 component for next fall's flu vaccine for 30 days to further evaluate the recent rise of this new, antigenically distinct strain (clade 3C.3a).

They wrote:
 
The majority of A(H3N2) viruses collected from September 2018 to January 2019 belonged to the phylogenetic subclade 3C.2a1b; however, the number of clade 3C.3a viruses has increased substantially since November 2018 in several geographic regions.

There has continued to be considerable genetic diversification of the HA and NA genes, but viruses in subclade 3C.2a2 were much less prevalent than in the previous reporting period.
Yesterday the WHO announced their decision on the H3N2 strain for this fall's vaccine - selecting a 3C.3a clade virus - based on its recent and very rapid rise in the United States, Israel, and and parts of Europe.
It is, admittedly, a gamble. There is no guarantee clade 3C.3a will be the dominant global clade six months from now, as H3N2 viruses continue to change and evolve at a rapid and unpredictable rate.
But since the VE (Vaccine Effectiveness) of the last several H3N2 flu components haven't been anything to brag about (see ECDC: H3N2 Flu Vaccine Component Likely `Suboptimal'), right now rolling the dice on this up and coming clade makes sense.

First, some excerpts from yesterday's announcement, then I'll return with a brief postscript.
Addendum to the recommended composition of influenza virus vaccines for use in the 2019–2020 northern hemisphere influenza season
21 March 2019
On 21 February 2019 WHO announced a recommendation on the composition of three of the four components of influenza vaccines for use in the 2019-2020 northern hemisphere influenza season (https://www.who.int/influenza/vaccines/virus/recommendations/2019_20_north/en/).
The decision on the A(H3N2) component was postponed to allow more time to better understand the distribution and proportions of recently circulating antigenically and genetically  diverse A(H3N2) viruses and to develop and fully characterize appropriate candidate vaccine viruses. This addendum provides the recommendation and supporting data for the A(H3N2) component of 2019-2020 northern hemisphere influenza vaccines.
Additional data obtained in recent weeks has confirmed the wide regional differences in the relative proportion of A(H3N2) viruses belonging to the phylogenetic subclade 3C.2a1b and clade 3C.3a.
The majority of A(H3N2) viruses collected and genetically characterised from September 2018 to February 2019 belonged to the phylogenetic subclade 3C.2a1b; however, the proportion of viruses falling into clade 3C.3a has increased substantially since November 2018 in several countries in western Europe, Israel and especially in the United States of America.
HI and virus neutralisation assays with ferret antiserum panels showed that viruses from subclade 3C.2a1b and clade 3C.3a were antigenically distinct. The majority of recent viruses from subclade 3C.2a1b were inhibited well by post-infection ferret antisera raised against cell culture-propagated A/Singapore/INFIMH-16-0019/2016-like viruses of subclade 3C.2a1 (Table 1).
In contrast, ferret antisera raised against egg-propagated A/Singapore/INFIMH-16-0019/2016-like and egg-propagated A/Switzerland/8060/2017-like viruses of subclade 3C.2a2 inhibited a much smaller proportion of recently circulating viruses (Table 2). Viruses from clade 3C.3a were poorly inhibited by post-infection ferret antisera raised against cell culture-propagated A/Singapore/INFIMH-16-0019/2016-like viruses, but were well inhibited by ferret antisera raised against recent 3C.3a cell culture-propagated reference viruses such as A/Kansas/14/2017 (Table 1).
Ferret antisera raised against egg-propagated A/Kansas/14/2017 inhibited recent viruses from clade 3C.3a but showed little inhibition against viruses from clade 3C2a1b. Current vaccines containing A/Singapore/INFIMH-16-0019/2016-like antigens induced antibodies in humans that cross-reacted with recent 3C.2a1b viruses but reacted poorly with clade 3C.3a viruses.
Accordingly, it is recommended quadrivalent vaccines for use in the 2019-2020 northern hemisphere influenza season contain the following:
- an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
- an A/Kansas/14/2017 (H3N2)-like virus;
- a B/Colorado/06/2017-like virus B/Victoria/2/87 lineage); and
- a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).
It is recommended that the influenza B virus component of trivalent vaccines for use in the 2019-2020 northern hemisphere influenza season be a B/Colorado/06/2017-like virus.
Lists of egg- or cell culture-propagated candidate vaccine viruses (CVVs) suitable for use in human vaccine production are available on  the WHO website 1 . Lists of reagents for vaccine standardisation, including those for this recommendation, can be found on the same WHO website 1 . 

The 4 week delay in deciding on the H3N2 component may result in a 2-4 week delay in vaccine deliveries in the fall, according to the WHO, but they are working on minimizing those impacts. 
The H3N2 virus emerged as a pandemic strain in 1968 (supplanting  a short 11 year run of seasonal  H2N2), settling in the following year as a seasonal flu strain and remained the sole human influenza A strain until 1977, when H1N1 mysteriously reappeared after a 20 year absence.
That makes it the longest-continuously-circulating Influenza A subtype on record by a wide margin.  In order to survive and thrive for half a century, it has to be very good at changing up its game, and avoiding acquired community immunity.

All of which means, unless and until it is supplanted by a new pandemic strain, H3N2 is likely to remain the bane of flu experts, flu victims, and vaccine manufacturers for years to come.


Thursday, March 21, 2019

On The First Day Of Spring, A Disease Blogger's Thoughts Turn To . . . .


https://news.utexas.edu/2017/10/19/why-do-flu-pandemics-come-at-the-end-of-flu-season
Credit Spencer J. Fox


#13,946


Spring officially arrived a little over 12 hours ago in the Northern Hemisphere, and while novel influenza activity has been fairly subdued for the past year, this is the time of year when we tend to see the emergence of new flu viruses.
  • A decade ago, a new soon-to-become-a-pandemic  H1N1 virus was beginning to spread from pigs to humans in Mexico, although we wouldn't be alerted until the last week of April, 2009. 
  • Six years ago, three patients were hospitalized in Eastern China suffering from an `atypical pneumonia', but on March 31th, 2013 it was announced to the world as a newly emerging avian H7N9 virus. 
  • On  April 23rd, 2014 the newshounds of Flutrackers picked up a Chinese language report of a farmer from Nambu county, Sichaun Province hospitalized with a severe - and unidentified - pneumonia.  This turned out to be the first known human infection with H5N6
  • A bit earlier last year (mid-February 2018) Jiangsu China Reported the 1st Novel H7N4 Human Infection.
  • And although it wasn't an influenza virus, the first known (and retrospectively identified) MERS outbreak occurred in April of 2012 in Jordan (see Serological Testing Of 2012 Jordanian MERS Outbreak)
  • An even older example of a non-influenza epidemic, the first known Nipah outbreak - in Malaysia and Singapore - which infected more than 265 (and killing 106) emerged in March of 1999.
Despite these examples, spring certainly doesn't have an exclusive handle on emerging diseases.  And admittedly, many of these viruses may have been circulating at low levels for months before reaching `critical mass' and therefore our notice.

Some non-spring outbreaks of note include:
While the above list provides some anecdotal evidence for a `spring-bias' for emerging viruses, 18 months ago in PLoS Comp. Bio.: Spring & Early Summer Most Likely Time For A Pandemic, we looked at a more scientific study on the timing of pandemics.
Using a computer model, the authors found evidence of a narrow window of opportunity for pandemic emergence, and proposed two possible factors behind this trend.
Given the turning of the seasons, a look back seems in order. First some excerpts from a press release from the University of Texas At Austin, and a link and some excerpts from the study.
Cracking the Code: Why Flu Pandemics Come At the End of Flu Season

Oct. 19, 2017
You might expect that the risk of a new flu pandemic — or worldwide disease outbreak — is greatest at the peak of the flu season in winter, when viruses are most abundant and most likely to spread. Instead, all six flu pandemics that have occurred since 1889 emerged in spring and summer months. And that got some University of Texas at Austin scientists wondering, why is that?

Based on their computational model that mimics viral spread during flu season, graduate student Spencer Fox and his colleagues found strong evidence that the late timing of flu pandemics is caused by two opposing factors: Flu spreads best under winter environmental and social conditions. However, people who are infected by one flu virus can develop temporary immune protection against other flu viruses, slowing potential pandemics. Together, this leaves a narrow window toward the end of the flu season for new pandemics to emerge.

The researchers’ model assumes that people infected with seasonal flu gain long-term immunity to seasonal flu and short-term immunity to emerging pandemic viruses. The model incorporates data on flu transmission from the 2008-2009 flu season and correctly predicted the timing of the 2009 H1N1 pandemic.
(Continue . . . )


Seasonality in risk of pandemic influenza emergence

Spencer J. Fox , Joel C. Miller, Lauren Ancel Meyers

Published: October 19, 2017
https://doi.org/10.1371/journal.pcbi.1005749

Abstract

Influenza pandemics can emerge unexpectedly and wreak global devastation. However, each of the six pandemics since 1889 emerged in the Northern Hemisphere just after the flu season, suggesting that pandemic timing may be predictable.
Using a stochastic model fit to seasonal flu surveillance data from the United States, we find that seasonal flu leaves a transient wake of heterosubtypic immunity that impedes the emergence of novel flu viruses. This refractory period provides a simple explanation for not only the spring-summer timing of historical pandemics, but also early increases in pandemic severity and multiple waves of transmission.
Thus, pandemic risk may be seasonal and predictable, with the accuracy of pre-pandemic and real-time risk assessments hinging on reliable seasonal influenza surveillance and precise estimates of the breadth and duration of heterosubtypic immunity.
       (Continue . .  )


While there is no way to know whether the next few months will spawn the next big public health crisis, the spring and early summer does appear to be conducive to the emergence of new viruses.

Most of these viruses sputter noisily for a few months, and either die out completely (i.e. SARS), or become a low-level endemic threat like MERS-CoV. Only occasionally do they reach their full pandemic potential.
But the next pandemic will come.  This year, next year, five years from now . . .
And once we recognize its presence, and its true potential, the time for preparation will have passed.  With our modern conveyances, and highly mobile society, the next pandemic will spread with remarkable speed.

Over the past year we've seen a resurgence in pandemic preparedness efforts by the United States government, the World Health Organization, and other entities. So, on this first full day of spring, a few blogs worth reviewing as you consider your own vulnerability to the next pandemic:

Last May Johns Hopkins presented a day-long pandemic table top exercise (see CLADE X: Archived Video & Recap), which provides a sobering look at a plausible pandemic where hundreds of millions of people could die, many from indirect causes.
If you don't have the time to watch the entire 8 hour exercise, I would urge you to at least view the 5 minute wrap up video. It will give you some idea of the possible impact of a severe - but not necessarily `worst case' - pandemic.
Recap Video

Earlier this month we looked at the newly released WHO Global Influenza Strategy 2019-2030, with the the stated goals of preventing seasonal influenza, controlling the zoonotic spread of influenza to humans, and preparing for the next influenza pandemic.

Last December the WHO engaged 40 countries in a Global EOC Pandemic Flu Exercise (GEOCX).

Last November the CDC released their 2018 Interim Guidance On Allocating & Targeting Pandemic Influenza Vaccine, with their ambitious aim to:

  • `. . . . vaccinate all persons in the United States (U.S.) who choose to be vaccinated, prior to the peak of disease'
  • . . . . to have sufficient pandemic influenza vaccine available for an effective domestic response within four months of a pandemic declaration'
  • ` . . .  to have first doses available within 12 weeks of the President or the Secretary of Health and Human Services declaring a pandemic'

In October of last year, in WHO: On The Inevitability Of The Next Pandemic, we looked at the global consensus that it is a matter of when - not if - the next pandemic arrives.

Also in October, in JAMA: Osterholm Interview - Our Vulnerability To Pandemic Flu, we looked at some of the reasons why a future pandemic could equal or even exceed the toll of the Spanish flu of 100 years ago.

While we enjoy the relatively lack of novel flu news, we need to be using this time wisely.   While the following quote is more than a dozen years old, it is just as true today as it was in 2006:
“Everything you say in advance of a pandemic seems alarmist.  Anything you’ve done after it starts is inadequate."- Michael Leavitt,  Former Secretary of HHS
All reasons why, we - along with the rest of the world - need to find the foresight, fortitude, and political will to do something substantial to prepare before the next crisis strips us of that opportunity completely.

For more on pandemic planning and preparedness, you may wish to revisit:

#NatlPrep : Because Pandemics Happen

Pandemic Planning For Business

The Pandemic Preparedness Messaging Dilemma

Wednesday, March 20, 2019

Taiwan Intercepts Another ASF-Positive Food Item From Vietnam

Credit BAPHIQ















#13,945

On February 15th of this year, Taiwan announced the first ASF-positive results from a Vietnamese food item, which was confiscated at their international airport.  Four days later Vietnam announcedtheir First (3) Outbreaks Of African Swine Fever, in two provinces (Thái Bình and Hưng Yên).
In the roughly 30 days since that announcement, Vietnam has reported hundreds of outbreaks in small holdings across 18 northern provinces.
Taiwan, which as already intercepted 33 Chinese made food items with the ASF virus being brought in by travelers, today announced their second detection of a ASF-positive food item from Vietnam.

While ASF doesn't pose a direct threat to human health, its continued spread in Asia and Eastern Europe poses an existential threat to their pork industry, as the virus is often 100% fatal in pigs, and no vaccine is currently available.
 
This (translated) report from  Taiwan's BAPHIQ (Bureau of Animal Plant Health Inspection & Quarantine).

Continued monitoring at the border, the second case of African swine fever virus gene was detected from Vietnamese passengers carrying pork products

The Central Hunger Disaster Response Center of the African Hog ​​Chore said today (2) that after the first detection of the African swine fever virus gene from a Vietnamese passenger carrying a pork sandwich on February 15, 2008, the second case was again tested in Vietnamese pork products. The swine fever virus gene indicates that passengers carry pork products from mainland China or Vietnam, and the risk of spreading African swine fever is extremely high.

The Strain Center said that since there were many cases of illegal entry of meat from Vietnamese passengers, the Anti-inspection Bureau began sampling the pork products illegally carried or abandoned by Vietnamese passengers from November, 107, and sent the animal husbandry to detect the African swine fever virus.
A total of 84 tests have been conducted so far, of which 2 are positive, one in February this year (positive rate 3.7%) and one in March (positive rate 7.7%). The strain center added that the second case was sampled from the Tainan Quarantine Station of the Kaohsiung Branch of the Anti-insurance Bureau at the Tainan Quarantine Station of the Anti-inspection Bureau on March 8 from the Ho Chi Minh City, Vietnam, and the pork ham discarded by the passengers at the Tainan Airport. The sample was confirmed by the Natse and the sequence was confirmed. The similarity with the genetic fragments of Chinese swine fever virus strains in China and Vietnam is 100%.

The Strain Center concluded that Vietnam has informed the World Organisation for Animal Health that there have been 207 cases of African swine fever in 19 provinces since February 20, indicating that the epidemic continues to spread.
The Strain Center appealed that Vietnam and other countries with African swine fever in the past three years have entered Taiwan without carrying meat products. If the pork products are illegally seized, the first time they will be fined NT$200,000, the second The penalty was 1 million yuan, and the foreigner was fined 200,000 yuan. The unpaid person refused to enter the country. The punishment was quite heavy. The public should never try the law.

Although the numbers are relatively small, the ASF-positive rate among confiscated and tested pork products from both Vietnam and China continue to run in the 5%-10% range, suggesting the virus has made it into a substantial portion of their commercial food supply.