Thursday, November 15, 2018

More Outbreaks Of Hepatitis A & Upcoming CDC COCA Call

CDC Interactive Map


Since March 2017 a number of states have been reporting community outbreaks of Hepatitis A - primarily among those who use injectable or non-injectable  drugs, the homeless, and their close direct contacts.

Five months ago, in CDC HAN Advisory On Outbreak of Hepatitis A Virus (HAV) Infections among Drug Users & The Homeless, the CDC reported:
From January 2017 to April 2018, CDC has received more than 2,500 reports of hepatitis A infections associated with person-to-person transmission from multiple states. Of the more than 1,900 reports for which risk factors are known, more than 1,300 (68%) of the infected persons report drug use (injection and non-injection), homelessness, or both.8-11
Since then, reports of community-wide outbreaks have continued, and on November 29th the CDC will hold a COCA Call for healthcare providers (Hepatitis A Outbreaks in Multiple States: CDC Recommendations and Guidance).

Hepatitis A is a highly contagious, vaccine-preventable, viral disease spread via a fecal-oral route or by exposure to contaminated food or water. Hepatitis A rates have declined substantially in the United States since the introduction of the hepatitis A vaccine in 1996.
However, since early 2017, the Centers for Disease Control and Prevention (CDC) has observed an increase in the number of community-wide hepatitis A outbreaks in multiple states. For these outbreaks, CDC recommends vaccination for persons who report drug use (injection and non-injection), persons at high risk for drug use (e.g., participating in drug substitution programs, receiving substance abuse counseling or treatment, recently or currently incarcerated), men who have sex with men, and persons experiencing homelessness.

CDC also encourages vaccination in certain settings such as emergency departments and corrections facilities in outbreak-affected areas when feasible. During this COCA call, subject matter experts from CDC will discuss vaccination to stop these outbreaks and current CDC recommendations for the hepatitis A vaccine.
While Hepatitis A infection in a healthy adult usually results in a mild illness of a few week's duration - for some - particularly for those with compromised immune systems, it can be far more serious.

The CDC describes the way the virus spreads as:

Transmission / Exposure

How is hepatitis A spread?
Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.

Contamination of food (this can include frozen and undercooked food) by hepatitis A can happen at any point: growing, harvesting, processing, handling, and even after cooking. Contamination of food or water is more likely to occur in countries where hepatitis A is common and in areas where there are poor sanitary conditions or poor personal hygiene. In the United States, chlorination of water kills hepatitis A virus that enters the water supply. The Food and Drug Administration (FDA) routinely monitors natural bodies of water used for recreation for fecal contamination so there is no need for monitoring for hepatitis A virus specifically.
While relatively rare, food handlers who are infected with the virus can sometimes pass on the infection to their customers. This past week Mecklenburg County Public Health (North Carolina) issued the following alert after an employee from a local restaurant tested positive.

Possible Public Hepatitis A Exposure at Village Tavern on Congress Street; Vaccination Clinics Scheduled 

​Patrons who ate at Village Tavern in Charlotte on Oct. 30 should receive a hepatitis A vaccination as soon as possible.

Public Health Director Gibbie Harris announced today that the outbreak identified by the State and Centers for Disease Control earlier this year in Mecklenburg County has led 24 cases since Jan. 1, including a Village Tavern employee diagnosed Wednesday.
“After consulting with the State today, we are recommending a vaccination for all employees and exposed patrons who ate at Village Tavern located at 4201 Congress Street on Tuesday, Oct. 30,” Harris said. “According to the Centers for Disease Control (CDC), the vaccine must be given within 14 days of exposure for it to be effective.”

Public Health vaccination clinics for customers who might have been exposed and for residents who meet the high-risk factors for hepatitis A will be held at Mecklenburg County Health Department, 249 Billingsley Road:
Thursday, Nov. 8, 8 a.m. – 5 p.m.
Friday, Nov. 9, 8 a.m. – 5 p.m.
Saturday, Nov. 10, 9 a.m. – Noon
Sunday, Nov. 11, 9 a.m. – Noon
Monday, Nov. 12, 9 a.m. – Noon
Tuesday, Nov. 13, 8 a.m. – 5 p.m.
People who dined at Village Tavern on Oct. 30 are strongly urged to get a vaccination in the next six days.

Public Health announced on June 6 that North Carolina Public Health officials and the CDC declared an outbreak of the liver disease in Mecklenburg County. Those who have had a hepatitis A infection, or one hepatitis A vaccination, are protected from the virus and do not need to take action.

The high-risk factors include:

  • Those who are household members, caregivers, or have sexual contact with someone who is infected with hepatitis A
  • Men who have sexual encounters with other men
  • Those who use recreational drugs, whether injected or not
  • Recent travel from countries where hepatitis A is common
  • Homeless individuals who do not have easy access to handwashing facilities
The best ways to prevent hepatitis A include:
  • Get the hepatitis A vaccine,
  • Practice safe handwashing procedures – wash your hands under warm, soapy water for at least 20 seconds after using the bathroom or changing diapers and before you prepare food, and
  • Wear a condom during sexual activity.
Yesterday the Tennessee Department of Health issued a statement on the recent (rare) death due to Hepatitis A, and warned that additional deaths were possible.

TDH Continues Response to Hepatitis A Outbreak
Wednesday, November 14, 2018 | 10:11am

NASHVILLE – The Tennessee Department of Health continues to investigate and respond to a hepatitis A outbreak impacting the state with more than 400 cases of illness to date. One death associated with this hepatitis A outbreak has been reported. The outbreak in Tennessee most heavily affects Nashville and Chattanooga.

“We are very saddened by the recent death associated with hepatitis A and realize unfortunately, we could see more deaths, as this continues to be a very serious outbreak with more than half of the people identified with the illness needing hospitalization,” said TDH Commissioner John Dreyzehner, MD, MPH. “We will continue to respond aggressively, vaccinating high risk populations, educating and working with partners in and out of Tennessee to seek additional ways to stem this outbreak.”

Tennessee’s hepatitis A outbreak is linked to a large, multi-state outbreak that began in 2017. This outbreak is primarily affecting recreational drug users and people experiencing homelessness.

Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus. It is usually transmitted from one person to another through contact with contaminated feces or consumption of contaminated food or water. The most at-risk groups for hepatitis A include recreational drug users, men who have sex with men and people experiencing homelessness. Many of the hepatitis A cases in the current outbreak are associated with recreational drug use.

“More than 36,000 doses of hepatitis A vaccine have been provided to those most at risk in our state and I believe this massive effort has made a huge difference in reducing the number of hepatitis A cases,” said TDH Assistant Commissioner for Communicable and Environmental Diseases and Emergency Preparedness Tim Jones, MD.
“We urge anyone in the high risk groups to get vaccinated as soon as possible, and will continue to work with state and local partners to provide hepatitis A vaccine to people at high risk for infection and educate people on how to prevent the spread of this disease.”

(Continue . . .)
For more on Hepatitis A, the CDC has a webpage:

Hepatitis A Questions and Answers for the Public

MOA Joint Statement On `Very Serious' Spread Of ASF & New Outbreak In Hubei

Another Outbreak In Hubei Province


With half (n=17) of China's 34 provincial-level administrative units (i.e. provinces, municipal cities, Autonomous regions, & SARs) already having reported African Swine Fever - including several of the large pork producing provinces in the south -  it is fair to say the virus has become well entrenched.
As the world's largest pig producer and consumer of pork, the continued spread of this virus could has serious, even devastating impacts on China's economy and food supply. 
Overnight the Ministry of Agriculature, in an unusual joint statement with the Ministry of Public Security (China's principal police and security agency) and the Ministry of Transport, issued the starkest warnings yet, describing the situation:
At present, the situation of prevention and control of pig swine in Africa is very serious. The epidemic has occurred in 17 provinces and has been introduced to the province of pig breeding in the southern hinterland of China.
Citing both improper cleaning and disinfection of livestock transport vehicles and the illegal movement of pigs by `some lawless elements', this statement announces what appears to be a coordinated crackdown by all three Ministries.
The heavy involvement of the Ministry of Public Security in this announcement signals just how seriously China takes this threat. 
A couple of snippets from a much longer document (Public Notice on Strengthening the Supervision of transporting pigs) include:

        (Translated Excerpts)
According to the epidemiological survey results, long-distance transportation of pigs is the main reason for the spread of epidemics across the region. It does not meet the animal epidemic prevention requirements and the uncleaned and disinfected transport vehicles have a high risk of epidemic transmission. 

At the same time, some lawless elements, driven by interests, have transferred pigs from high-risk provinces in violation of laws and regulations, and some areas have caused African swine fever. All local animal husbandry and veterinary departments, transportation departments, and public security departments must attach great importance to it, fully understand the importance and urgency of doing a good job in the supervision and management of live pigs, further strengthen the joint supervision work, and take effective measures to prevent the spread of the epidemic through cross-regional transmission of live pigs.
The animal husbandry and veterinary department should increase the investigation and punishment of illegal and illegal activities such as the transfer of live pigs without animal quarantine certificates, strengthen the effective connection between administrative law enforcement and criminal justice, promptly transfer the suspected crimes to the public security departments and other departments, and resolutely block illegal trafficking.

As we've discussed previously, food insecurity - whether brought on by flood, drought, or disease - is a constant worry in China, and after more than a decade dealing with major losses in the poultry sector, the last thing China needs is a crisis in pig production.

Meanwhile, today the MOA announced another outbreak in Hubei Province.

African swine fever epidemic in Lishui County, Hubei Province

Date: 2018-11-15 14:58 Author: Source: Ministry of Agriculture and Rural Press Office

The Information Office of the Ministry of Agriculture and Rural Affairs was released on November 15th, and an African swine fever epidemic occurred in Lishui County, Huanggang City, Hubei Province.

At 10:00 on November 15, the Ministry of Agriculture and Rural Affairs received a report from the China Animal Disease Prevention and Control Center and was diagnosed by the China Center for Animal Health and Epidemiology (National Center for Animal Disease Research). A farm in Lishui County, Huanggang City, Hubei Province occurred. African swine fever. The farm has 636 pigs, 24 diseases and 13 deaths.

Immediately after the outbreak, the Ministry of Agriculture and Rural Affairs sent a steering group to the local area. The local government has started the emergency response mechanism as required, and adopted measures such as blockade, culling, harmless treatment, disinfection, etc., to treat all the sick and culled pigs harmlessly. At the same time, all pigs and their products are prohibited from being transferred out of the blockade, and pigs are prohibited from being transported into the blockade. At present, the above measures have been implemented and the epidemic has been effectively disposed of.

While ASF doesn't pose a direct health risk to humans, it is a serious threat to the pig industry - and with no vaccine available - the only way to control it is to cull all of the pigs that may have been exposed.

Meanwhile, ASF continues to make inroads in Europe, and further spread there and in Asia seems inevitable (see FAO: African swine fever (ASF) threatens to spread from China to other Asian countries).


 For more, you may wish to revisit:
China: ASF Virus Detected In Commercial Animal Feed
Anhui: New ASF Outbreak & Trilateral MOA Meeting In Beijing
China MOA: Special Measures To Limit Spread Of African Swine Fever

Wednesday, November 14, 2018

A Couple Of Curious Flu Reports From India

Flu Virus binding to Receptor Cells – Credit CDC


It has happened so often over the past decade as to have become a bit of a cliche (see here, here, and here), but there are rumbles coming once again out of India of unusual symptoms reported with seasonal flu, and suggestions that the H1N1 (or some other) virus has `mutated' into a more virulent form.
Despite having been designated a seasonal flu 8 years ago, H1N1 is still treated as if it were a pandemic strain by many in the Indian press - often still referring to as `swine flu' - and confirmed cases (and deaths) are treated like breaking news.
Even local health department officials seem to classify H1N1 as something other than seasonal flu, with the following quote appearing yesterday in a Times of India report:
"Since the symptoms of the H1N1 virus are similar to that of influenza and common cold, unless its severe, the disease can easily go unreported," said a senior health department official.
A couple of sample headlines from the past 24 hours include:
Five more H1N1 deaths in TN over two days
Two succumb to swine flu at govt hospital in Coimbatore
With a population of over 1 billion people, India could easily expect in excess of 100,000 flu deaths - even during a mild year - making anecdotal reports of flu cases like these nearly impossible to assess.

Overnight, however, reports have been published (see Mumbai: Doctors suspect new H1N1 variants) citing `unusual' symptoms - particularly among pregnant women - of hypertension, vomiting and diarrhea associated with a `flu-like' illness.

The article goes on to state:
While 15 samples sent from Mumbai to the National Institute of Virology (NIV) tested negative for H3N2 viral infection, doctors suspect the variant may be present in patches across Mumbai.
No other lab results are mentioned, and the article presents no evidence (beyond citing unusual symptomology) to support their theory.

Another article, published overnight in the Times of India (Influenza 2.0), takes a different tack, and instead suggests it is H3N2 - not an H1N1 variant - causing these unusual symptoms, while acknowledging that none of the samples sent to NIV have come back positive for the H3N2 virus.
While H3N2 tends to produce more serious illness than H1N1 - particularly in the elderly -  the symptoms of infection are quite similar.  Trying to deduce the subtype of an influenza infection by clinical presentation seems a bit of a reach.
The reported lack of lab confirmation of H3N2 (and apparently, H1N1) for these patients could indicate another non-influenza (Adenovirus, Enterovirus, Parainfluenza virus,  etc.) is at work, or even a co-infection (see Double-Whammied By Influenza).
Less likely, but still possible, would be a novel virus. Hopefully, someone is forwarding samples to a WHO reference lab.
Meanwhile, the Deccan Herald is reporting:
Thiruvananthapuram: The District Medical Office (DMO) has put all hospitals including private hospitals on high alert following a spike in H1N1 cases in the state capital. The death of a 16-year-old at Chammaruthy this week has set alarm bells ringing for health authorities across the district. On Tuesday, two more suspected H1N1 cases were reported in the district. Around 20 H1N1 cases have been reported in the state so far this month.
While it would be easy to dismiss these reports as hyperbolic reporting, influenza viruses do have an unfortunate history of mutating over time, and that includes the 2009 H1N1 virus (see Nature Sci Rpts: Continued Evolution Of The 2009 H1N1 Virus).
In 2015, we saw some evidence of mutations in the 2009 H1N1 virus in India (see MIT: Genetic Changes In A 2014 Indian H1N1pdm09 Virus), which was followed in 2016 by Eurosurveillance: Emergence of A(H1N1)pdm09 Genogroup 6B In India, 2015.
All of which means, that while what is being reported in India is likely nothing  more than seasonal flu, we need to take note of these reports, and keep one eye on them.

WHO Novel Flu Summary & Risk Assessment - November


Despite a welcomed drop in H7N9 activity in China over the past year following a massive 2017  H5+H7 poultry vaccination campaign, we've continued to see a few sporadic human infections with HPAI H5N6 in the region, with one case reported in September and an other in October (see map above).
The World Health Organization has published their latest Summary and Risk assessment, which highlights these two cases.
No other human infections with novel (swine or avian) flu viruses have been reported since the last update.  This month's report is therefore fairly brief.

Influenza at the human-animal interface
Summary and assessment, 22 September to 1 November 2018

New infections 1 : Since the previous update, new human infections with avian influenza A(H5N6) viruses were reported.

Risk assessment: The overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the likelihood of sustained human-to-human transmission of these viruses remains low. Further human infections with viruses of animal origin are expected.
Risk management: Selection of new candidate vaccine viruses (CVVs) for zoonotic influenza for influenza pandemic preparedness purposes was done during a recent WHO consultation. 2 

IHR compliance: All human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005). 3 This includes any influenza A virus that has demonstrated the capacity to infect a human and its heamagglutinin gene (or protein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human population. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.

Avian Influenza Viruses
Current situation:
Avian influenza A(H5) viruses

Since the last update on 21 September 2018, two new laboratory-confirmed human cases of influenza A(H5N6) virus infection were reported to WHO. On 30 September 2018, China reported a case in a 22-year-old male in Guangdong Province, China, who developed symptoms on 25 September 2018. He was admitted to hospital one day later with severe pneumonia and was in critical condition at the time of reporting. The patient reported exposure to live poultry before illness onset. Monitoring of his close contacts was ongoing at the time of reporting.

On 31 October 2018, a second case was reported to WHO from China: a 44-year-old male in Guangxi Zhuang Autonomous Region, China, who developed symptoms on 18 October 2018. The patient was admitted to hospital on 21 October and passed away on 27 October. According to the report, the patient did not have a history of contact with live poultry before illness onset. Monitoring of his close contacts was ongoing at the time of reporting.

A total of 22 laboratory-confirmed cases of human infection with influenza A(H5N6) virus have been reported to WHO from China since 2014.

According to reports received by the World Organisation for Animal Health (OIE), various influenza A(H5) subtypes continue to be detected in birds in Africa, Europe and Asia.

Risk Assessment:

1. What is the likelihood that additional human cases of infection with avian influenza A(H5) viruses will occur?
Most human cases were exposed to A(H5) viruses through contact with infected poultry or contaminated environments, including live poultry markets. Since the viruses continue tobe detected in animals and environments, further human cases can be expected.

2. What is the likelihood of human-to-human transmission of avian influenza A(H5) viruses? 

Even though small clusters of A(H5) virus infections have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this and other A(H5) viruses have not acquired the ability of sustained transmission among humans, thus the likelihood is low.

3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?

Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as evidence suggests these viruses have not acquired the ability to transmit easily among humans.

Avian influenza A(H7N9) viruses

According to reports from mainland and the Hong Kong Special Administrative Region China and those received by the World Organisation for Animal Health (OIE), A(H7N9) avian influenza viruses continue to be detected in China but at lower levels compared to previous years. A nationwide domestic poultry vaccination campaign began in 2017.

Overall, the risk assessment has not changed.
        (Continue . .  )

Tuesday, November 13, 2018

CDC AFM Update - Nov 13th

UPDATED: CDC COCA Call posted Audio[MP3 – 5 MB]
Plus a new MMWR Early Release has been published


In advance of today's COCA Call: November 13 – Acute Flaccid Myelitis (AFM): What Health Care Providers Need to Know, the CDC has revamped and updated their Acute Flaccid Myelitis pages, raising the number of confirmed cases for 2018 to 90 of 252 reports of patients under investigation (PUIs).
Investigations take time, and so that number is likely to rise.
While the cause of these polio-like paralysis remains a mystery, a number of enteroviruses (EV-71, EV-D68, etc.) are high on the suspect list. The CDC notes, however, that most cases have tested negative for any virus.

As paralysis often only appears days or even weeks after a suspected viral infection, that may help explain the lack of positive lab tests.  

What CDC has learned since 2014

  • Most of the patients with AFM (more than 90%) had a mild respiratory illness or fever consistent with a viral infection before they developed AFM.
    • Viral infections such as from enteroviruses are common, especially in children, and most people recover. We don’t know why a small number of people develop AFM, while most others recover. We are continuing to investigate this.
  • These AFM cases are not caused by poliovirus; all patients tested negative for poliovirus.
  • We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 414 confirmed cases of AFM since 2014, which points to the cause of their AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.
  • Most patients had onset of AFM between August and October, with increases in AFM cases every two years since 2014. At this same time of year, many viruses commonly circulate, including enteroviruses, and will be temporally associated with AFM.
  • Most AFM cases are children (over 90%) and have occurred in 44 states.
  AFM remains exceedingly rare, striking fewer than 1 person in a million each year, but of those who are affected, 90% are under the age of 18.
We should have the audio recording and a transcript from today's COCA call either later today or in the morning.  I'll post a link at the top of this blog when they become available.
If you suspect you or your child is suffering from unexplained muscle weakness or paralysis, it is important to seek medical care immediately. The CDC continues to investigate, but until more is known, the CDC can only offer the following advice.


Poliovirus and West Nile virus may sometimes lead to AFM.
  • You can protect yourself and your children from poliovirus by getting vaccinated.
  • You can protect against bites from mosquitoes, which can carry West Nile virus, by using mosquito repellent, staying indoors at dusk and dawn (when bites are more common), and removing standing or stagnant water near your home (where mosquitoes can breed).
While we don’t know if it is effective in preventing AFM, washing your hands often with soap and water is one of the best ways to avoid getting sick and spreading germs to other people. Learn about when and how to wash your hands.
For more information on what CDC is doing, see our AFM Investigation page.

UK DEFRA: SitRep On HPAI H5N8 In Bulgaria


Over the past 6 months HPAI H5N8 activity has been subdued across most of Europe, with the lone exception of Bulgaria, which has continued to report outbreaks throughout the summer and fall. 
Two weeks ago we saw Bulgaria's BVBH Reports Two More Avian Flu Outbreaks In Haskovo District, with 3 additional outbreaks in October alone (see here, and here).
Just over a week ago, in Bulgaria's NVS Imposes Stricter Avian Flu Biosecurity Rules, we saw some of the societal impacts - and protests - over attempts to reign in these outbreaks.

Because many migratory birds are overflying Bulgaria via the Black Sea / Mediterranean flyway, the concern is that they might pick up and distribute these avian viruses on their southbound trek to Southern Europe, the Middle East and North Africa (see WHO: Migratory Birds & The Potential Spread Of Avian Influenza).
While the UK sits under a different, albeit adjacent (East Atlantic) flyway, these flyways all overlap, and therefore allow for lateral (east-west) movement of birds (and viruses) as well.
The UK's DEFRA has released the following Situation Report on the risks of continued H5N8 activity in Bulgaria. I've only posted some excerpts from a longer report, so follow the link to read it in its entirety.
Situation Assessment #5
Avian Influenza (H5N8) in Bulgaria
9 November 2018
Ref: VITT/1200 HPAI in Bulgaria
Disease report

The Bulgarian authorities have now reported 24 outbreaks of HPAI H5N8, including 9 outbreaks in October (OIE, 2018). These outbreaks in October have been reported in commercial premises with laying hens (39,000) and ducks (between 1,000 birds and 16,000 birds), small commercial farms (fewer than 500 birds) and one very large commercial premises (130,000 birds). Four regions have been affected to date (see map, below)

Situation assessment

Eradication and control measures according to the Council Directive 2005/94/EC have been put in place, including 3km protection zones and 10 km surveillance zones around each infected premises, a ban on live poultry markets and exhibitions of live birds, and biosecurity measures at infected premises.
In addition to these measures, there has been enhanced active surveillance at all commercial breeders, layers and waterfowl premises since May, where poultry have been sampled and serological testing has been performed every 21 days for a period of three months, followed by a final sampling visit 50 to 60 days later. 

Of those sampled, 25 duck farms to date have been H5N8 HPAI sero-positive, but virus could not be isolated from these farms (PAFF, 2018). Interestingly, recent data reported in the EFSA scientific overview for May to August 2018 documents the latest scientific research on the H5N8 HPAI viruses from the 2016 epizootic, concluding that the virus is avian adapted with increased virulence for waterfowl and higher rates of oropharyngeal rather than cloacal shedding (EFSA, 2018).
However over time these viruses naturally attenuate in domestic waterfowl (but retain their HP phenotype in galliforme species) and result in milder disease signs which provides an explanation for the detection of serologically positive flocks in the absence of virus being isolated.


The EU/OIE/FAO international reference laboratory/UK national laboratory at Weybridge has the necessary ongoing diagnostic capability for these strains of HPAI virus.

Overall, it is considered that the likelihood of any notifiable avian disease in wild birds in the UK remains LOW, however this will be kept under review and may change as the migration season is now underway along the East Atlantic flyway – the risk to the UK will depend on the presence of AI in wild birds and the westward movement along this route, which is affected by the weather. H5N6 HPAI is still circulating in the wild bird fauna of this flyway, but H5N8 HPAI has not been reported since 2017.

The presence of H5N8 HPAI in Bulgaria does not change the risk level for the UK at present. There is no trade in high risk commodities and the migratory wild waterfowl flyways are different.

Nevertheless, we recommend that all poultry keepers stay vigilant and make themselves aware of the latest information on, particularly about recommendations for biosecurity and how to register their flocks using the simplified forms now available.

We will continue to report on any updates to the situation and in particular any changes in disease distribution or wild bird movements which may increase the risk to the UK