Thursday, September 20, 2018

Eurosurveillance Rapid Comms: Two cases of Monkeypox imported to the UK

Smallpox Vaccination - Credit CDC


We have a long, and remarkably detailed Rapid Communications published today in the ECDC journal Eurosurveillance on the two recently imported Monkeypox cases to the UK (see UK PHE Imports Smallpox Vaccine For HCWs Caring For Monkeypox Cases), which includes 2 case reports, and details on contact tracing of potentially exposed individuals.
Since Monkeypox had never been seen in the UK before, and because early symptoms are generally non-specific, Monkeypox was not immediately suspected.  As a result, a number of Health care workers were exposed before the patients were isolated.  
Additionally, both cases report being symptomatic prior to flying into the UK, which further increases the number of people who were potentially exposed in transit. 

While not easily transmitted between humans, today's report indicates nearly 250 people are currently being monitored either actively or passively (depending on their level of exposure risk), with more than 100 offered post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP) with the vaccinia vaccine.

This is a very long report, so I've only posted some excerpts.  You'll definitely want to follow the link to read it in its entirety. 

Rapid communication Open Access

Two cases of monkeypox imported to the United Kingdom, September 2018  

Aisling Vaughan1,15, Emma Aarons2, John Astbury3, Sooria Balasegaram3, Mike Beadsworth4,5, Charles R Beck3,14, Meera Chand6,7,8, Catherine O’Connor1, Jake Dunning6,9, Sam Ghebrehewet3, Nick Harper10, Ruth Howlett-Shipley11, Chikwe Ihekweazu12, Michael Jacobs9, Lukeki Kaindama13, Parisha Katwa13, Saye Khoo4,5, Lucy Lamb9,11, Sharon Mawdsley10, Dilys Morgan1, Ruth Palmer10, Nick Phin6, Katherine Russell1, Beng├╝ Said1, Andrew Simpson2, Roberto Vivancos3,15,16, Michael Wade3, Amanda Walsh1, Jennifer Wilburn1

Monkeypox is a rare viral zoonotic disease that occurs mostly in Central and West Africa. In this report, we detail the identification of two separately imported cases of monkeypox to the United Kingdom (UK) in September 2018 and the public health response. Each case was managed as a separate incident in the absence of epidemiological evidence linking them in the UK and the public health responses were conducted accordingly.
The first case, a Nigerian naval officer who was attending a training course at a naval base in Cornwall in the south-west of England, was notified to Public Health England (PHE) on 7 September. He arrived in London from Abuja, Nigeria on 2 September and travelled from London to the military base in Cornwall by train on the same day. 

The case presented to the general practitioner on the naval base on 3 September with fever, lymphadenopathy and a rash in the groin area that had developed the day before leaving Nigeria. The rash was initially thought to be due to a staphylococcal infection and was treated with antibiotics. On 6 September, the rash had spread to the torso, face and arms and after re-examination the patient was isolated in his quarters. Multiple samples including swabs of the lesions were sent for testing at the PHE Rare and Imported Pathogen Laboratory (RIPL). Monkeypox virus DNA was detected by multiple molecular assays and subsequently confirmed by sequencing analysis. The patient was then transported to the High Consequence Infectious Disease (HCID) Unit at the Royal Free Hospital in London. The clinical condition of the case is stable and he is improving.
On 10 September, PHE was notified of a second suspected case of monkeypox infection; the diagnosis was confirmed on 11 September. The individual is a UK resident who had returned from a 22-day holiday in Nigeria on 4 September on a flight via Paris, France. He presented to the Accident and Emergency department at Blackpool Teaching Hospitals on 6 September with fever, lymphadenopathy, a scrotal lump and an itchy maculopapular rash. The rash was reported to have started before departing Nigeria on the face and later spread to other areas including the palms of the hands and had become pustular.

The patient reported being unwell for approximately one week before presentation, following a different febrile illness that had been treated with antibiotics in Nigeria. On clinical examination the patient had crops of vesicles that were progressing and lesions on the mucosal surfaces of the mouth. The patient was isolated at Blackpool Teaching Hospitals from 7 September and multiple samples, including swabs from the lesions, sent to RIPL confirmed the presence of monkeypox DNA by multiple molecular assays. 

Although the patient was isolated, monkeypox was not initially suspected because the first lesions appeared in the groin, and the wearing of full personal protective equipment (a filtering face-piece with three indicating levels of protection (FFP3), eye protection, gloves and sterile disposable gown) was not implemented immediately. A number of healthcare workers (HCW) were potentially exposed as a consequence. The case was transferred to the HCID Unit at the Royal Liverpool University Hospital on 10 September where they remain in a stable condition. 

While the source of infection is not yet known, the patient reported contact with an individual with a monkeypox-like rash at a large family event and consumption of bush meat during his visit to a rural area of Nigeria. Since notification of the first case, no other cases have been identified.
Management of contacts in the United Kingdom
Contacts are being monitored actively or passively depending on their level of exposure risk.
Active surveillance is used for those classified as having a high- or intermediate-risk exposure to a case (direct contact in the South West), their body fluids or potentially infectious materials. This involves the designated PHE contact point contacting the individual every day throughout the 21-day follow-up period to check whether they develop any potential monkeypox prodromal symptoms such as fever, headache, muscle aches, backache, swollen lymph nodes, chills or exhaustion.
Passive surveillance is used for individuals identified as having a low-risk exposure to a case, their body fluids or potentially infectious material (Indirect contact in the South West). They will not be contacted daily during the follow-up period, but will be given a designated PHE contact point to phone if they feel unwell.
Currently 229 of 243 contacts are under investigation; 93 are under active surveillance and 136 are under passive surveillance. Efforts to contact the remainder are ongoing.
Following individual risk assessments (see above), 103 of 229 contacts were offered post-exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP) with vaccinia vaccine. Fifty-nine community and HCW contacts from the North West were offered PEP (46/59, uptake rate 78%) and 17 community and naval base contacts in the South West were offered PEP (5/17, uptake rate 29%).
In addition, 27 HCWs in the HCID units at the Royal Liverpool (Case 2) and the Royal Free hospital (Case 1) managing the patients were offered PrEP. Vaccinees with symptoms consistent with vaccination reactions [2] arising in the 48 h post-vaccination period would be monitored for a further 48 h to discount those in the prodromal phase of monkeypox infection. The individual is advised to discontinue working and self-isolate at home during this time.
Each individual identified as a contact was provided with an information sheet which describes what monkeypox is, how it is spread, and what the symptoms are. This information sheet provides the individual with a designated PHE contact point and telephone number to ring should they develop any symptoms. Contacts can continue to work with no restrictions on their duties if they are asymptomatic. Individuals who develop any symptoms were directed to phone their designated PHE contact point straight away and to stop working until they are assessed by the Imported Fever Service (IFS). Contacts who were planning to travel out of the UK were advised that they may continue with their plans during their 21 days follow-up period if they are asymptomatic. Any contacts under follow-up who are symptomatic are advised not to travel out of the UK.
        (Continue . . . .)

Bulgaria Reports Avian Flu Outbreak In Industrial Poultry Farm

Location of Bulgaria In Europe


While we've enjoyed a relatively quiet summer of bird flu, with the autumnal equinox just two days away, we shouldn't be surprised to see an uptick in outbreaks in the Northern Hemisphere in the months to come. 
Migratory birds are southbound once more from their high latitude summer roosting areas, and with them they can sometimes bring new reassorted viruses (see Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1).
Over the summer, Russia has been the primary hotbed of avian flu, with roughly 80 outbreaks of HPAI H5N2 and HPAI H5Nx reported (see Aug. 20th Brief ESA Report On HPAI H5N2 & H5Nx In Russia).

Credit OIE

Russia first reported HPAI H5N2 in December of last year, but it was only last month that we finally saw confirmation that these recent outbreaks were caused by reassorted clade H5 virus (presumably from H5N8 or H5N6).
The short history of clade H5 viruses has been one of continual evolution, frequent successful reassortment (into H5N6, H5N2, H5N5, etc.), and rapid geographic expansion - primarily via wild and migratory birds. 
Two years ago, Europe's poultry industry and wild bird population were devastated by the arrival of a newly reassorted H5N8 virus. Last year, they took a considerably milder hit from a reassorted H5N6 virus.
The concern this fall is that yet another reassorted virus could make an appearance, particularly with recent reports of a newly reassorted HPAI H5N2 in Western Russia.
Today, Bulgaria - which has reported a smattering of outbreaks over the summer - is reporting a (thus far) unidentified strain of avian flu at an industrial poultry farm in Trilistnik, Plovdiv.

At this time, we don't even know if it is an LPAI or HPAI virus, but from the steps outlined below, authorities are obviously treating this outbreak seriously.  This from the Bulgarian Food Safety Agency.  

BCSA found a primary outbreak of the bird flu vaccine in the village of Trilistnik, Plovdiv


Bulgarian Agency for Food Safety found primary outbreak of avian influenza (flu) in an industrial holding of rearing laying hens, located in. Trilistnik, Maritsa municipality, Plovdiv region. The disease was confirmed by a laboratory test report.

For the control and eradication of the disease, BSAF implemented all measures in accordance with current legislation. Humane killing and destruction of all birds kept on the affected holding is undertaken, followed by cleansing and disinfection. A 3-kilometer protection zone and a 10-kilometer surveillance zone around the outbreak of the disease have been identified. The movement of birds and their products into and out of the protection and surveillance zones is prohibited. In both zones prohibiting trade and the movement of poultry and other wild birds and eggs for breeding and dispersal of birds renewal of game reserves. Daily clinical examinations of birds kept in other settlements in the protection zone are performed.
Enhanced surveillance and biosecurity measures in poultry farms as well as in water basins where the wild bird population is heavily concentrated.
NVS reminded that feed should be stored indoors, as well as raw materials for animal feed - thus avoiding the possibility of wild birds contaminate feed and thus tame to be infected with the virus.

At this stage there are no people affected and there is no danger to consumers. Influenza virus can cause mild respiratory disease. Possible infection can occur when inhaled contaminated farm dust or in direct contact with people with infected birds.

Hopefully we'll see an OIE notification with more details in the next day or so. 

With this fall's bird migration already underway in parts of the Northern Hemisphere, now would be a good time for all poultry stakeholders to review and improve their biosecurity. 

Wednesday, September 19, 2018

Saudi MOH Reports 5th MERS-CoV Case In Buraidah For September

Buraidah Saudi Arabia


Of the 10 MERS cases reported by the Saudi MOH during the first 19 days of September, half (n=5) have come out of Buraidah, and appear to involve - at the very least - a household cluster and a nosocomial transmission.

The scant information we get (which is frequently edited by the MOH, instead of appended to), makes it difficult to follow, but I've excerpted the 5 cases reported since Sept 1st below.
The first case (Sept 1st) reportedly had camel contact, while the second is simply listed as a `community acquired' case.  Case #3 is listed as secondary, hospital acquired while case #4 is listed as secondary, household contact.  Case # 5 is under investigation. 
Four of the 6 patients are listed as deceased, including the latest one added today.  There really isn't enough information here to determine whether these cases comprise 1 cluster or 2 clusters, or exactly where the first (camel contact) and 2nd (community acquired) cases fit in.

Meanwhile, in Riyadh, the MOH is reporting what appears to be a household cluster following an infection in a 44 y.o. male with recent camel contact.

By stressing better infection control, Saudi hospitals have managed to reduce  the number and size of hospital outbreaks of MERS significantly since 2015. 

But we've also recently seen doubts raised (see Evaluation of a Visual Triage for the Screening of MERS-CoV Patients) over how the Saudis conduct MERS surveillance and past research that suggests that many (perhaps most) MERS cases go undetected.
While we obviously don't have a raging epidemic on our hands, MERS continues to jump to humans from camels, and spark small clusters of cases in humans. Each time it does so, it gets another opportunity to accrue host adaptations that might make it a more `humanized' pathogen. 
So we watch - as best we can with the sparse information provided - clusters like we're seeing in Buraidah, looking for any signs that MERS is getting its act together.
Last October, in Study: A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia, we looked at an analysis that concluded that while MERS isn't ready for prime time, it may not have all that far to go.

Report: UK PHE Imports Smallpox Vaccine For HCWs Caring For Monkeypox Cases

Smallpox vaccination - Credit CDC


Aside from the two initial announcements (see here and here) from the UK's PHE (Public Health England), we're heard surprisingly little about the two imported Monkeypox cases in the UK. 
Both cases arrived separately from Nigeria earlier this month, and the Nigerian CDC has promised an epidemiological investigation, but thus far we've heard nothing. (Note: The Nigerian CDC website appears to be temporarily offline this morning).
Nigeria, which saw its first Monkeypox outbreak in nearly 40 years last fall, issued their last SitRep on the outbreak in February (see An Update of Monkeypox Outbreak in Nigeria for Week 9), one which indicated the outbreak was winding down.

What we do have is a press release from Bavarian Nordic - a European Bio-Tech company and vaccine manufacturer - stating that at the request of the PHE, they've shipped a supply of smallpox vaccine to the UK, and that health care workers and others treating these two patients have now been vaccinated.
Smallpox vaccine -  while not an exact match to the Monkeypox virus - confers about an 85% protection to the recipient. Since smallpox was eradicated in the 1970s, relatively few people under the age of 50 have received the vaccine. 
This decline in smallpox immunity appears to have led to an increase in Monkeypox cases over the past 20 years in central Africa (see 2010 PNAS study Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo).

First the press release, then I'll return with more.
Bavarian Nordic Delivers Smallpox Vaccine to England in Response to Current Monkeypox Cases
September 19, 2018 01:31 ET | Source: Bavarian Nordic A/S
English health authorities have ordered IMVANEX smallpox vaccine in response to monkeypox cases
Immediate response ensured rapid delivery and deployment of vaccines

COPENHAGEN, Denmark, September 19, 2018 - After the confirmation on Friday 7th September 2018 of the first case of human monkeypox in England, Public Health England (PHE), as part of their response, engaged Bavarian Nordic to assist in the supply of its IMVANEX® smallpox vaccine, which is approved in the European Union. The vaccine has now been used to vaccinate healthcare workers treating the patients and those involved in their care.
IMVANEX is not approved for monkeypox, however, in the past when smallpox vaccines were routinely administered, they were shown also to be highly efficacious in preventing monkeypox.

Only a few days after the first case, a second, unrelated case was reported in the UK. According to PHE, both patients are believed to have acquired the infection in Nigeria, which recently experienced a large outbreak of monkeypox. Bavarian Nordic continues to work closely with PHE to ensure a sufficient and rapid supply of additional vaccines, should the need arise.

Monkeypox is similar to human smallpox, although it is less transmissible human-to-human and less deadly with an estimated fatality rate of 1-10%. There are no approved vaccines for the prevention of monkeypox.

Currently, a field study is ongoing to evaluate IMVANEX (also known as IMVAMUNE) for the prevention of monkeypox in the Democratic Republic of the Congo, where the virus is naturally occurring, and is known to infect humans. The study, which is conducted in collaboration between Bavarian Nordic, local health authorities and the U.S. Centers for Disease Control and Prevention (CDC) who is also sponsor of the study, has enrolled over 1,000 healthcare and frontline workers who in their daily work are at high risk of being infected with the virus.
(Continue . . . )

As an emerging infectious disease Monkeypox is taken very seriously by public health officials. 

Although normally restricted to small outbreaks in Africa, in 2003 we saw a rare outbreak in the United States when a Texas animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003). 
By the time that outbreak was quashed, the U.S. saw 37 confirmed, 12 probable, and 22 suspected human cases. Among the confirmed cases 5 were categorized as being severely ill, while 9 were hospitalized for > 48 hrs; although no patients died (cite).
The smallpox vaccine was used to curb that outbreak as well. From the MMWR report:

Use of Smallpox Vaccine

To prevent transmission of monkeypox, 30 persons (28 adults and two children) in six states have received smallpox vaccine since June 13. Vaccine was administered pre-exposure to seven persons (three veterinarians, two laboratory workers, and two health-care workers) and post-exposure to 23 persons (10 health-care workers, seven household contacts, three laboratory workers, one public health veterinarian, one public health epidemiologist, and one work contact).
No serious adverse events were reported following smallpox vaccination, and no requests for vaccinia immune globulin have been received. Among the 30 persons who received smallpox vaccine, three (10%) reported rash within 2 weeks of vaccination. One of the three was confirmed as having monkeypox; another person had two skin lesion specimens that tested negative for orthopoxvirus and varicella zoster virus at the state health laboratory; no specimens were obtained for the third person who reported a single, dime-sized, pruritic and erythematous skin lesion (not pustular) remote from the vaccination site that appeared 4 days after vaccination and faded within a week.
In addition to growing societal susceptibility to the virus due to waning vaccine protection, there are also concerns the virus could evolve into a more dangerous pathogen. In a 2014 EID Journal article Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo, the authors cautioned:

Small genetic changes could favor adaptation to a human host, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (40). The ability to spread rapidly and efficiently from human to human could enhance spread by travelers to new regions.
While the smallpox vaccine is not approved for use against Monkeypox, the CDC has issued some advice in the past on its use in an emergency setting.
Smallpox Vaccine Guidance

When properly administered before exposure to monkeyox, smallpox vaccine is effective at protecting people against monkeypox .
Smallpox vaccine is made from live vaccinia virus, a virus closely related to variola virus (smallpox).

The current licensed vaccine available in the United States is ACAM2000®. ACAM2000 is administered as a live virus preparation that is inoculated into the skin by pricking the skin surface.

Following a successful inoculation, a lesion will develop at the site of the vaccination. The virus growing at the site of this inoculation lesion can be spread to other parts of the body or even to other people. Individuals who receive vaccination with ACAM2000 must take precautions to prevent the spread of the vaccine virus.

CDC, in conjunction with the Advisory Committee on Immunization Practices (ACIP), provides recommendations on who should receive smallpox vaccination in a non-emergency setting. At this time, vaccination is recommended for laboratorians working with certain orthopoxviruses and military personnel.
Vaccine Effectiveness
Smallpox vaccine is effective at protecting people against monkeypox when given before exposure to monkeypox. Experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe.

Because monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting monkeypox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox.
Smallpox vaccine is effective at protecting people against monkeypox when given before exposure to monkeypox. Experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe.
Receiving Vaccine After Exposure to Monkeypox Virus

Smallpox vaccination after exposure to monkeypox virus is still possible. However, the sooner an exposed person gets the vaccine, the better.

CDC recommends that the vaccine be given within 4 days from the date of exposure in order to prevent onset of the disease. If given between 4–14 days after the date of exposure, vaccination may reduce the symptoms of disease, but may not prevent the disease.
Revaccination After Exposure

Persons exposed to monkeypox virus and who have not received the smallpox vaccine within the last 3 years, should get the smallpox vaccine.

The sooner the person receives the vaccine, the more effective it will be in protecting against monkeypox virus.
Smallpox Vaccine Risks vs. Monkeypox Disease

For most persons who have been exposed to monkeypox, the risks from monkeypox disease are greater than the risks from the smallpox vaccine.

Monkeypox is a serious disease. It causes fever, headache, muscle aches, backache, swollen lymph nodes, a general feeling of discomfort, exhaustion, and severe rash. Studies of monkeypox in Central Africa—where people live in remote areas and are medically underserved—showed that the disease killed 1–10% of people infected.
In contrast, most people who get the smallpox vaccine have only minor reactions, like mild fever, tiredness, swollen glands, and redness and itching at the place where the vaccine is given. However, the smallpox vaccine does have more serious risks, too.
Based on past experience, it is estimated that between 1 and 2 people out of every 1 million people vaccinated will die as a result of life-threatening complications from the vaccine.

For a more detailed look at Monkeypox, and particularly the recent emergence of the virus in West Africa, you may wish to revisit:

MMWR: Emergence of Monkeypox — West and Central Africa, 1970–2017

OIE Notification: 2nd Occurrence Of CSF In Japan (Wild Boar)

Credit Wikipedia


Ten days ago, in Japan: MAFF Confirms Classical Swine Fever Outbreak, we saw the first detection of CSF in Japan in 26 years.  Much like African Swine Fever, CSF causes a high mortality in pigs, but does not infect humans.
Last Saturday, in Japan: NARO Genetic Analysis Of Classical Swine Fever In Gifu Prefecture, I mentioned a Japanese media report citing the discovery of a dead wild boar within 8km of Japan's CSF affected farm that has also tested positive for the virus, raising concerns the virus is spreading in that population.
Overnight the OIE posted the following notification, along with some epidemiological comments, on that finding.   I'll also have some excerpts from a Japan Ministry of Agriculture (MAFF) statement on this recent development.

 Source of the outbreak(s) or origin of infection     

    Unknown or inconclusive

Epidemiological comments     
1. Affected farm 

(1)Stamping out All pigs in the farm were culled by 10th September 2018.
(2)Disposal of dead animals All bodies were buried by 10th September Disinfection Disinfection for contaminated materials and tools as well as inside of the farm was completed by 11th September 2018 
2. Monitoring and survey of farms, etc. 
(1)Farms to be intensively monitored (13 farms) Thirteen farms are designated for intensive monitoring, which have epidemiological relationship (*) with the affected farm. Clinical test, ELISA and PCR were carried out on 13 farms, and all results were negative to classical swine fever. 
(*) Epidemiological relationship with the affected farm: -Shipping out to the same slaughterhouse -Using the same compost facility -Visited by the same veterinarian 
3. Surveillance of wildlife (the wild boar reported in this follow up report) 
Gifu prefecture started the survey from 13th September 2018. On 13th September, a dead wild boar was found in the zone within 3 to 10 km radius from the affected farm (shipment restriction zone). On 14th September the dead wild boar was confirmed positive to CSF by sequencing at National Institute of Animal Health (NIAH).
4. Epidemiological investigation
(1)Since 9th September 2018, the National Epidemiological Investigation Team has been dispatched.
(2)In order to facilitate the identification of cause and route of infection as well as to prevent the spread of the disease by increasing the experts of team members, Intensified Epidemiological Investigation Team for the CSF case has been established on 12th September 2018. An expert for wildlife joined on 14th September. 
(3) NIAH published the result of gene analysis of the CSFV of the case. NIAH considered that the virus was likely to be introduced from overseas as the virus belongs to subgenotype 2.1 
5. Communication to producers 
(1) On 9 September 2018, Ministry of Agriculture, Forestry and Fisheries re-ordered all prefectures that any farm should comply with Biosecurity Standard and Guidelines for CSF such as adequate disinfection against invasion of CSF virus, early notification, and prevention of wild animals, etc.

A second CSF detection in a wild boar is obviously a big concern to Japan's pork industry, since that will make it far more difficult to stamp out the virus.  Japan's MOA (see below), has issued new steps in an attempt to quantify the extent of this viral incursion, to try to find its source, and to prevent it from spreading to other farms.

For additional information about the corresponding policy in the "Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters."

2018. September 18,
the Ministry of Agriculture, Forestry and Fisheries

In the wild boar of Gifu Prefecture, response to the fact that infection of swine fever is a domestic animal infectious disease has been confirmed, today, to hold a "Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters", so far the response policy, newly 3 we add an item. 

1. corresponding situation

(1) September 9, pig cholera affected animals have been confirmed in a pig farm in Gifu, Gifu Prefecture, held a "Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters", we determine the corresponding policy for the future of the epidemic prevention measures .
(2) September 10, to complete the culling and burial of corpses for pigs are fed the the farm, next September 11, also completed for disinfection processes and barns contaminated article, We have completed the quarantine measures in the farm.
(3) September 9 and later, to monitor the 13-related farm, which has been using the same slaughterhouse and co-composting field with the generation farm, we are continuing the epidemiological investigation. At the moment abnormality has not been verified.
(4) September 14, from the fact that death was swine fever virus from wild boar was (first case) has been confirmed, immediately, intrusion prevention such as thorough and wild boar of disinfection, to comply strictly Standards of Rearing Hygiene Management as, through the beginning nationwide prefectures Gifu Prefecture, and guidance to farmers.
(5) In addition, in the Gifu Prefecture, with the focus on implementing the infection confirmation inspection of the occurrence farms and dead wild boar around 10km distance of co-composting field and capture the wild boar, in the nation, pig for the wild boar who died we have requested the implementation of these inspection.
(6) in Gifu Prefecture, also on September 16, we have confirmed the positive reaction of classical swine fever from the wild boar that died (second case).
(7) In response to this, today held the "Ministry of Agriculture, Forestry and Fisheries swine fever epidemic prevention headquarters", we have added a new response policy to the corresponding policies of the past.
2. Policy Newly added item
(1) generating farm and relevant 13 farm monitoring and to ensure the infection confirmatory test wildlife.
(2) Ensuring that guidance on compliance with feeding hygiene management standards intrusion prevention at the farm farm disinfection and wildlife.
(3) For the investigation and spread prevention of such infection routes, assuming all the possibilities investigate it.
 (Continue . . . . )

Tuesday, September 18, 2018

#NatlPrep: Revisiting The Lloyds Blackout Scenario

Note: September is National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.


With hundreds of thousands of people in the Carolinas currently without power due to Hurricane Florence - and the memory still fresh of last year's triple assault by hurricanes Harvey, Irma, and Maria that left millions in the dark for weeks or even months - today seems like a good day to look back at The Lloyd’s Business Blackout Scenario from 2015.
For our modern, tech dependent society - in terms of both economic and societal impact - very little beats a prolonged and widespread power outage.
Localized outages, such as we're seeing in the wake of Hurricane Florence, can be terribly disruptive, but outside help (mutual aid) is generally available from nearby sources.  Larger outbreaks - or those that involve a massive loss of infrastructure - are much tougher to deal with.

Unlike air, water, shelter, or food . . . we don't actually need electricity to survive.  But we've built our society, and everything that goes with it, on the expectation of always having electrical power at the flick of a switch. 
Without electrical power, water and gasoline doesn’t pump, elevators and air conditioners don’t run, ATM machines and banks close, grocery stores can’t take debit or credit cards, produce, meat and frozen foods spoil, and doing everything - from cooking, to communications, to flushing toilets - becomes difficult or impossible.
Small wonder that many countries view the integrity and continued output from their electrical grid a national security issue, and consider threats against it to be among their biggest challenges.

The U.S. isn't alone in these concerns.  Every couple of years the UK reassesses their threat landscape, and releases an updated CIVIL RISKS REGISTER. Last fall they published a new update, putting a pandemic, followed by major `grid down' event at the top of their list of greatest concerns (see below).

Just over 5 months ago, the UK released an updated National Security Capability Review (NSCR) which (among other things) emphasized the greatest threats they see facing the UK over the next 5 years. 
Diseases and natural hazards affecting the UK.
One or more major hazards can be expected to materialise in the UK in every five year period. The most serious are pandemic influenza, national blackout and severe flooding. We published the latest edition of the National Risk Register of Civil Emergencies in September 2017. It provides an assessment of the likelihood and potential impact of a range of different civil emergency risks that may directly affect the UK over the next five years.
Also of great concern, every four years the ASCE (American Society of Civil Engineers) releases a report card on America’s infrastructure, and their most recent report (2017) warns that our cumulative GPA for infrastructure sits at only a D+, and two of our most vulnerable infrastructures are drinking water and the electrical grid (see When Our Modern Infrastructure Fails).
While hurricanes and aging infrastructure are legitimate concerns, other events - such as large earthquakes, tsunamis, cyber attacks or solar storms must also be considered.
Few people realize how close we came to a grid down disaster six years ago (see NASA: The Solar Super Storm Of 2012). Last September, another major X-flare erupted just after it had passed around the limb of the sun, missing earth by only a few days (see USGS: Preparing The Nation For Severe Space Weather).

In 2014 a study was published suggesting the odds of earth being struck by one of these solar super storms is actually a lot higher than we’ve previously thought.  From a NASA article:

In February 2014, physicist Pete Riley of Predictive Science Inc. published a paper in Space Weather entitled "On the probability of occurrence of extreme space weather events."  In it, he analyzed records of solar storms going back 50+ years.  By extrapolating the frequency of ordinary storms to the extreme, he calculated the odds that a Carrington-class storm would hit Earth in the next ten years.

The answer: 12%.
Unlike most of the scenarios previously discussed, a Carrington-class CME could take out the electrical grid on a hemispheric - perhaps even global - scale.  There would be little or no `mutual aid' as just about everyone would be in the dark, and recovery could take years.

The grid can also be taken down by more nefarious means, a topic explored by well known journalist Ted Koppel in his 2015 book called Lights Out: A Cyberattack, A Nation Unprepared, Surviving the Aftermath.  
There are hours of interviews with Ted Koppel about his book on YouTube, including with PBS, Charlie Rose, and the following hour long discussion with the National Press Foundation.
Despite congressional committees and national GridEx preparedness drills - a recent Congressional Research Service report warns that the US power grid remains vulnerable to attack.
Just over a year ago, in DHS: NIAC Cyber Threat Report - August 2017, we looked at a 45 page report addressing urgent cyber threats to our critical infrastructure that called for `bold, decisive actions'.
Three years ago Lloyds, perhaps the most recognizable name in insurance and risk analysis around the world - in collaboration with the University of Cambridge Centre for Risk Studies – published a 68 page analysis of a fictional but plausible cyber attack on the United States power grid called Business Blackout: The insurance implications of a cyber attack on the US power grid.
From their press release New Lloyd’s study highlights wide ranging implications of cyber attacks.
Wed 08 Jul 2015

Lloyd’s and the University of Cambridge’s Centre for Risk Studies are today launching a new report, Business Blackout. This joint report is the first to examine the insurance implications of a major cyber attack, using the US power grid as an example.

The report depicts a scenario where hackers shut down parts of the US power grid, plunging 15 US states and Washington DC into darkness and leaves 93 million people without power. Experts predict it would result in a rise in mortality rates as health and safety systems fail; a decline in trade as ports shut down; disruption to water supplies as electric pumps fail and chaos to transport networks as infrastructure collapses.

The total impact to the US economy is estimated at $243 billion, rising to more than $1 trillion in the most extreme version of the scenario. The cyber attack scenario shows the broad range of claims that could be triggered by disruption to the US power grid, with total amount of claims paid by the insurance industry estimated at $21.4 billion, rising to $71.1 billion in the most extreme version of the scenario.

(Continue . . . )
Although plausible, and certainly chilling, a cyber attack isn’t inevitable.   But hurricanes, and earthquakes, and even solar storms . . . are.   Admittedly, the average person can't do much about the vulnerabilities of our national infrastructure.
But we can - as individuals, families, and businesses owners -  increase our preparedness and resilience, which will in turn reduce our burden on local governments and relief agencies, while making our lives easier for the duration.
So . . . if a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 7 days  . . .  do you already have:
  • A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials
  • A decent first-aid kit, so that you can treat injuries
  • Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration
  • A way to provide light when the grid is down.
  • A way to cook safely without electricity
  • A way to purify or filter water
  • A way to stay cool (fans) or warm when the power is out.
  • A small supply of cash to use in case credit/debit machines are not working 
  • An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag
  • Spare supply of essential prescription medicines that you or your family may need
  • A way to entertain yourself, or your kids, during a prolonged blackout
If your answer is `no’, you have some work to do.  A good place to get started is by visiting