Thursday, January 17, 2019

Australia Interdicts ASF Positive Food At Their Border

http://www.fao.org/documents/card/en/c/I8805EN/
Link














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Without detailing the country (or countries) of origin, Australia's Department of Agriculture & Water Resources released a press statement today on the interdiction of 6 ASF positive food items (out of 152 tested) coming into their international airports or mail processing centers over the past two weeks.
We've seen similar reports from Japan, South Korea, and Taiwan in recent months, all ascribing the tainted products to China. But in fairness, African Swine Fever is also endemic in large parts of Eastern Europe, Russia, and Africa. 
Last August, in African swine fever (ASF) threatens to spread from China to other Asian countries, the FAO described how easily ASF can cross borders, and even oceans.
A robust virus with a long life

The ASF virus is very hardy and can survive long periods in very cold and very hot weather, and even in dried or cured pork products. The strain detected in China is similar to one that infected pigs in eastern Russia in 2017 but, so far, and while the investigations continue, the China Animal Health and Epidemiology Center has found no conclusive evidence of this latest outbreak's source or linkages.

"The movement of pig products can spread diseases quickly and, as in this case of African Swine Fever, it's likely that the movement of such products, rather than live pigs, has caused the spread of the virus to other parts of China," explained Juan Lubroth, FAO's Chief Veterinarian.

Although its exact origin isn't known, it is likely that a similar scenario led to the introduction - and rapid spread - of ASF across China last summer. 
As our world becomes increasingly interconnected, by both trade and travel, the risks of inadvertently spreading agricultural diseases like ASF only increase.
This from Australia's Ministry of Agriculture & Water Resources.

Keeping Australia free from African Swine Fever


Thursday, 17 January 2019

In response to the recent spread of African Swine Fever (ASF), the Department of Agriculture and Water Resources has increased its border activities. As part of this, a sample of pork products seized at international airports and mail processing centres over a two week period has been tested for African swine fever.

The testing was conducted at the Australian Animal Health Laboratory in Geelong.

Head of Biosecurity at the department, Lyn O’Connell, said the department has increased our controls and remains committed to keeping Australia’s $60 billion agricultural industries free from the disease.

“The test results show 6 pork products from 152 tested were contaminated with African swine fever virus,” Ms O’Connell said.

“Bringing banned products to Australia puts our environment, industries and animal health at risk.

“The detection of the virus in seized products at the border does not change Australia’s African swine fever free status.

“The test results do however reinforce the importance of continued compliance with Australia’s strict biosecurity requirements.

“African swine fever is not present in Australia. If introduced it would have a significant impact on pig health and production, and contribute to wider economic impacts caused by a loss of access to overseas markets for our pork products.

“Humans are not susceptible to ASF but we all have a role in preventing it, and other exotic animal diseases from arriving in Australia—even if we don’t own or work around farm animals.

“It is crucial that all participants in Australia’s biosecurity system play their part in managing this threat.

“People visiting or returning to Australia from countries where this disease is present need to pay particular attention to biosecurity requirements and not bring banned product with them. If travellers are carrying foods, plant material or animal products in their luggage they must declare them on their incoming passenger card.

“Before making online purchases, check what can and cannot be mailed to Australia. Products such as pork jerky cannot be brought into Australia except under specific import conditions.

“If you are unsure of an item, declare it, or don’t bring it at all.”

Find out more about African swine fever, our biosecurity requirements for incoming passengers and for people who are purchasing goods from overseas at:

www.agriculture.gov.au/pests-diseases-weeds/animal/asf.

Fast Facts:

  • ASF is present in countries of sub-Saharan Africa, and has more recently been detected in other parts of the world such as countries in Eastern Europe, including Russia and the Ukraine. It has most recently been reported in Belgium, China and Mongolia.
  • Our biosecurity officers work at airports and mail centres safeguards Australia’s unique environment, $60 billion agricultural industries and plant, animal and human health status from biosecurity risks.​

From Australia's ADVICE TO TRAVELLERS webpage.

African swine fever

What is the risk?

African swine fever is a highly contagious viral disease of pigs. It is one of the most serious livestock diseases, with high mortality rates in infected pigs. There is no vaccine or cure.

The virus can survive for many weeks, even months, in raw, cured and cooked meats, and on objects such as vehicles, equipment, footwear and clothes.
Why is it a problem for Australia?
An outbreak of African swine fever could devastate Australia’s livestock industries. It could cost the economy billions of dollars and thousands of jobs.
Goods that present a risk
  • fresh, dried, and preserved meat products and dairy products
  • shoes, boots and clothing used on farms, in rural or wilderness areas, markets, zoos or near susceptible animals
  • camping equipment, including backpacks
  • mountain bikes and other sporting equipment
  • animal skins, hunting trophies, horns or bones that have not been properly cleaned/treated.
Treatment

You should clean your equipment thoroughly before you travel to Australia. If you bring goods that have soil and manure, they may require treatment.
Measures
  • do not bring meat products to Australia.
  • you must declare on your IPC if you have visited a rural area or been in contact with, or near, farm animals in the past 30 days.
  • declare and present anything that represents a possible African swine fever risk to a biosecurity officer for inspection on arrival in Australia. For further information visit African swine fever.

Hong Kong's Flu Express Wk 2: A Rapid Increase In Institutional Outbreaks














#13,793

We're seeing a highly variable 2018-2019 Northern Hemisphere flu season, with Canada and South Korea kicking off very early, while Russia - which over the past two decades has seen a shift to earlier flu seasons (see Eurosurveillance: Changes In Timing Of Influenza Epidemics - WHO European Region 1996-2016 -  still remains far below their epidemic threshold (see Russia Influenza Surveillance Week 1, 2019).
Last week Hong Kong announced they had passed their epidemic threshold - and like most of the globe - is reporting mostly H1N1, which typically has a greater impact on younger people than does H3N2.
A good illustration of this demographic impact is the chart (above) showing an impressive 30-fold increase in institutional (mostly school) outbreaks in Hong Kong over the previous reporting week.  This is their biggest, and fastest ramp up in recent memory.

Over the past 3 days Hong Kong's CHP has announced investigations into numerous influenza outbreaks, including:
CHP investigates case of severe paediatric influenza A infection and outbreaks of influenza A at primary school and kindergartens

Update on cluster of Influenza A cases in Kowloon Hospital

CHP investigates cases of severe paediatric influenza A infection and outbreaks of influenza A and influenza-like illness at kindergartens

CHP investigates influenza A outbreaks at kindergarten-cum-child care centre and primary school 

One week into their flu season and already hospitals are getting slammed,  with yesterday's average hospital occupancy rate reaching 111%.  With the Chinese New Year's celebration only about 2 weeks away - where millions of families will gather all over Asia - these numbers could continue to rise.


http://gia.info.gov.hk/general/201901/17/P2019011700277_301958_1_1547690981807.pdf


The headlines in the South China Morning Post (SCMP) this morning - just one week into their flu season - highlight the pressures their healthcare system is already under.

Nurses plan protest as Hong Kong’s public hospitals reach flu season breaking point
Medical staff having to work extra shifts and skip meals to care for influx of flu patients
Bed occupancy rate across Hong Kong’s public hospitals reached average of 111 per cent on Wednesday
PUBLISHED : Thursday, 17 January, 2019, 1:26pm

 Some excerpts from today's much longer CHP Flu Express follow:

VOLUME 16, NUMBER 02 (PUBLISHED ON Jan 17, 2019)
FLU EXPRESS
Flu Express is a weekly report produced by the Respiratory Disease Office of the Centre for Health Protection. It monitors and summarizes the latest local and global influenza activities.s.

Local Situation of Influenza Activity (as of Jan 16, 2019)

  • Reporting period: Jan 6 – 12, 2019 (Week 2)The latest surveillance data showed that the local influenza activity increased markedly last week.
  • Currently the predominating virus is influenza A(H1).
  • Children aged under 6 years were particularly affected as reflected by the very high number of outbreaks of influenza-like illness (ILI) in kindergartens and child care centres, as well as
    influenza-associated admission rate in public hospitals among children aged below six years.
  • Among the severe influenza cases in adults, persons 50-64 years constituted a relative higher proportion (36%), as compared with 15% and 20% during the 2017 summer season predominated by influenza A(H3) and the 2017/18 winter season predominated by influenza B respectively.
  • Influenza can cause serious illnesses in high-risk individuals and even healthy persons. Given that seasonal influenza vaccines are safe and effective, all persons aged 6 months or above except those with known contraindications are recommended to receive influenza vaccine to protect themselves against seasonal influenza and its complications, as well as related hospitalisations and deaths.
(SNIP)
Global Situation of Influenza Activity In the temperate zone of the northern hemisphere influenza activity continued to increase slowly. In East Asia, influenza season appeared to have started, with predominantly influenza A(H1N1)pdm09 detected. In Europe, influenza activity increased, with both A viruses circulating. In the temperate  zones of the southern hemisphere, influenza activity returned to inter-seasonal levels with exception of some parts in Australia. Worldwide, seasonal influenza A viruses accounted for the majority of detections.
  • In the United States (week ending Jan 5, 2019), influenza activity remained elevated. The proportion of outpatient visits for ILI decreased from 4.0% to 3.5%, but remained above the national baseline of 2.2%. The percent of respiratory specimens testing positive for influenza decreased to 12.72% from 16.58% recorded in the previous week. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continued to co-circulate.
  • In Canada (week ending Jan 5, 2019), influenza activity remained high. The influenza season started in late October which was earlier than in recent years. Laboratory detections for influenza declined from the previous week, suggesting that nationally the influenza season may have reached peak levels in the last week of December. Influenza A was the most common influenza virus, and the majority of these viruses were A(H1N1)pdm09.
  • In the United Kingdom (week ending Jan 6, 2019), there was evidence that influenza was now circulating in the community as activity indicators breached baseline threshold levels at low intensity. The positivity of influenza detection was 16.4%, which was above the baseline threshold of 9.2%.
  • In Europe (week ending Jan 6, 2019), influenza activity continued to increase. 44.6% of sentinel specimens were tested positive for influenza virus. The majority of influenza virus detections were type A. Both influenza A(H3N2) and A(H1N1)pdm09 viruses were detected.
  • In Mainland China (week ending Jan 6, 2019), influenza activity in southern and northern provinces continued to increase, reaching the peak of the influenza season currently. Influenza viruses detected were mainly influenza A(H1N1), followed by influenza A(H3N2), and there were few influenza B(Victoria) and B(Yamagata) detections.
  • In Taiwan (week ending Jan 12, 2018), influenza activity increased significantly and was above the national baseline. Influenza A(H1N1) (43.1%) and A(H3N2) (29.4%) viruses co-circulated in the community in recent four weeks.
  • In Macau (Jan 16, 2019), influenza activity remained at the peak level. The proportions of ILI cases in emergency departments among both adults and children remained at a high level, and were on an
    increasing trend. The proportion of influenza detections reached 42% in the first two weeks of 2019. Influenza viruses detected were influenza A(H1) (75%) and influenza A(H3) (25%).
  • In Japan (week ending Jan 6, 2019), influenza activity continued to increase and the influenza season started in early December. The average number of reported ILI cases per sentinel site increased to 16.30 in the week ending Jan 6, 2019, which was above the baseline level of 1.00. The predominating virus in the past four weeks was influenza A(H1N1)pdm09
(Continue . . . )
 
During the run up to last year's Chinese New Year's Holiday - during an unusually severe influenza B season - Hong Closed Schools & Called For Stringent NPIs To Combat Flu. According to an EID analysis published last November, the decision was made after the peak of the outbreak, and only had modest effect.
Mitigation of Influenza B Epidemic with School Closures, Hong Kong, 2018

Abstract


In winter 2018, schools in Hong Kong were closed 1 week before the scheduled Chinese New Year holiday to mitigate an influenza B virus epidemic. The intervention occurred after the epidemic peak and reduced overall incidence by ≈ 4.2%. School-based vaccination programs should be implemented to more effectively reduce influenza illnesses.
Although school closures can be disruptive - particularly to working families -  previous studies have shown a more profound effect can be achieved when the trigger is pulled earlier.

As no two flu seasons are ever alike, a one size-fits-all solution isn't guaranteed to work.  It will be interesting to see what Hong Kong decides to do this year, based on the conflicting results from past school closures.

Wednesday, January 16, 2019

China MOA Denies ASF `Epidemic' While Taiwan Increases Interdiction Efforts

Gansu The Most Recent Province To Report ASF

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Despite the spread of the ASF virus to 24 provinces and/or territories within Mainland China in just over 5 months and the culling of hundreds of thousands of pigs, China's MOA continues to reassure that their is no `ASF epidemic', and that efforts to bring the outbreak under control are underway.

Guang Defu, spokesperson of the Ministry of Agriculture and Rural Affairs: There is no epidemic of the current swine fever in Africa

Date: 2019-01-15 14:07 Author: Source: Ministry of Agriculture and Rural Press Office [Font Size: Big Middle Small】 Print

Guang Defu, the spokesperson of the Ministry of Agriculture and Rural Affairs, recently informed the media that since the African swine fever epidemic occurred in some provinces in mainland China in August, all relevant departments in various localities have fully played the role of the joint prevention and control mechanism in accordance with the central decision-making arrangements and strictly carried out the epidemic situation. 
Strengthen the implementation of key prevention and control measures, and coordinate the prevention and control of disease and the supply of pork in the market. As of January 14, 2019, there were 24 cases in which there were domestic pig and wild boar epidemics, and a total of 916,000 pigs were culled. At present, 77 epidemic areas in 21 provinces have been lifted according to regulations. The epidemic was spotted and there was no epidemic.

Guang Defu said that after the outbreak, the Ministry of Agriculture and Rural Affairs has always carried out the release of the epidemic in accordance with the principle of “timely, open and transparent”, and timely submitted it to international/regional organizations such as the World Organisation for Animal Health (OIE) and relevant countries and regions. A notification was made. Animals of the World Organisation for Animal Health (OIE) can obtain information on animal epidemics from OIE in a timely manner.
This message, which comes a little more than 2 weeks before China's biggest holiday - the Lunar New Year - is almost certainly designed to reassure the public, and I suspect is geared primarily for domestic consumption.
With Taiwan, Japan and South Korea continuing to intercept contaminated food products coming in from the Mainland, dead pigs washing up on the beaches off Fujian Province, and the yesterday's announced emergence of the virus in Mongolia, the view from neighboring countries appears considerably less sanguine.
Today Taiwan's  BAPHIQ (Bureau of Animal Plant Health Inspection & Quarantine) has announced that even more stringent measures will be taken to interdict the virus.

In order to prevent the invasion of African swine fever, 100% comprehensive inspection of passengers haulage and hand luggage from high-risk areas of African swine fever in all airports and ports across the country

The Central Disaster Response Center of the African Hog ​​Chops said today (16) that in response to the inspection of the Taoyuan Airport on the 14th, the Dean of the Executive Yuan instructed the border inspection agency to check the hand luggage of high-risk areas for 100% of the passengers’ luggage, and the Director of the Council of Agriculture, Chen Jizhong Members of the Ministry of Finance, the Ministry of the Interior, the Ministry of Communications and the Public Security Bureau and other relevant personnel were invited to the Taoyuan Airport for on-the-spot investigation this afternoon. They decided to set up three roads at the exit of the empty bridge, the immigration inspection and the baggage inspection of the Customs and Excise Department. The line of defense, in order to cope with the large number of inbound passengers emerging during the upcoming Lunar New Year, to prevent the risk of intrusion of the disease by passengers carrying illegal animal products.
The first line of defense is that the Air Traffic Police station dispatches 112 inbound flights from high-risk areas (China, Hong Kong, Macau) every day. Since today, passengers have stepped out at the boarding gates of the empty bridges and are 100% comprehensive. Check the hand luggage, the required manpower is 40 people. Due to proper planning, there was no passenger waiting time. Take the EVA Air BR828 as an example. The crew and passengers took 126 people to complete the inspection.
The second line of defense is located in front of the immigration inspection desk of the Immigration Department. There is a large-scale propaganda and licensing card in front of the inspection counter. The LED marquee at the top of the inspection desk announces the epidemic prevention message and posts the propaganda board. The passengers can wait in line for inspection. See the propaganda message; in addition, for passengers from high-risk areas (China mainland), after the inspection of the license, the propaganda leaflet will be reminded that if there is meat, it should be disposed of immediately or quarantined to the inspection bureau.
The last line of defense is located in the baggage carousel and the Customs and Excise Department's red and green line clearance passage. As the passenger checked baggage is checked by the X-ray machine, and the Taoji company will start the flight from the high-risk area from January 9th, the checked baggage will be concentrated. On the specific baggage carousel, the quarantine dogs of the Quarantine Bureau will strengthen the consignment and hand baggage inspection. The Customs and Excise Department also increases the hand baggage interception rate for passengers from these baggage carousels, especially those who have no checked baggage.
In addition, Songshan Airport, Taichung Airport, Kaohsiung Xiaogang Airport, Tainan Airport and various port passengers have been checked 100% of the checked baggage and hand luggage.
The Strain Center said that passengers are at high risk of carrying meat to spread African swine fever. As of today, 12 cases of virus-positive cases have been detected from passengers and seized meat, and passengers are urged to enter the country without illegally carrying animal products. In the past three years, the pork products carried in the African countries have been seized. The first time they will be fined NT$200,000, and the second time will be NT$1 million. If the foreigner fails to pay the fine, they will refuse to pay before the payment. It re-enters. The Agriculture Committee finally reminded the public that the Spring Festival holiday is happy to go out and go home safely. Don't be punished for violations of the rules and work together to fight for the epidemic.

Contact: Deputy Director Du Wenzhen Tel: 02-23431464 2019-01-16



China, meanwhile seems to regard Taiwan's reactions as more provocative than protective, blaming their independence movement for over-hyping the ASF  threat (see Sina report "Taiwan independence" said that the pigs are the mainland's "biochemical attack" against Taiwan.)

ASF reports from China have slowed during the first half of January, and while that might be a good sign, China has often delayed the announcement of bad news in the past when it was deemed politically expedient.

Stay tuned.


Tuesday, January 15, 2019

Mongolia Reports The Arrival Of African Swine Fever












#13,791


Mongolia (not to be confused with already affected Inner Mongolia, a province of China) has reportedly detected African Swine Fever - at least based upon local media reporting and an emergency meeting held yesterday by a Special Committee of their Ministry of Agriculture.  
The machine translation of Mongolian, unfortunately, doesn't always produce the clearest syntax, and the use of local idioms - which may have multiple meanings - complicates matters further. 
While we will probably need to wait for the OIE notification to get solid details, - based on overnight reports online - it appears that the ASF virus has been detected in multiple locations, and apparently both in live pigs and in (possibly imported) food products.

First, this report from the UB Post.

Four provinces myalzan pig disease has been found spreading rapidly
2019-01-15

In the four provinces of Bulgan, Tuv and Dundgovi, throughout Mongolia, rapidly spreading pork and diseases, the Emergency Commission of Bayankhongor aimag has urgently called for the prevention of this disease.

In the presence of the disease, the pig is initially manifested by symptoms such as blue spots, high fever, and swine transmitted from swine to pig. In this way, it is possible to intercept the disease and become a carrier. In Bayankhongor aimag there are 4 units of pig farming.

The emergency committees are not allowed to introduce pigs and pork products to the provincial level, shop and service centers prohibit the sale of semi- and pork meat products, not to use pork and meat products for any food industry, and to control the operation of pork traders organizations should be monitored and monitored regularly, not to use pork meat products, Regional governor with a pig head to the Commission was an exceptional decision to conduct detailed surveillance of wild pigs in the land.

The decision was made by Bayankhongor aimag to be appointed by the Deputy Governor of Aimag B.Batsuuri to the relevant authorities or members of the Special Commission.

The term `myalzan' in Mongolia used to refer to Rinderpest (declared eradicated in 2011), but is now apparently being used for African Swine Fever, as in this September media report in Mongolia Today on China's ASF outbreak (see Pork myalzan increasing prevalence of the disease!)

Another media report from Eagle news.

There was a swelling of pigs in Ulaanbaatar

Eaglenews 2019-01-15 11:26:00

There was a swelling of pigs in Ulaanbaatar

In Ulaanbaatar, pork disease has been detected.

"In the capital city there are samples of pork supply at 74 points, a total of 100 samples taken over a three day period, and 50% of them have been detected, and some of the enterprises have been detected," said L.Erdenechuluun, Head of the Specialized Inspection Agency of the Capital City. He said,

"At the national level, 31 thousand pigs are counted, of which 17,000 are in the capital and currently have 17 thousand pigs of 130 enterprises in detention centers, decontamination, and imports should be stopped for a certain period of time.

In addition, the catering and trade organizations need to limit consumption.

Initially, importers sent a declaration to stop distribution and sealed warehouses. 300 tons of reserves in warehouse in Ulaanbaatar and over 1,000 tons of reserves.

The Veterinary Department will be removed from the Veterinary Department because of the positive results of the sample. Our organization will monitor this. According to the General Department of Veterinary Services, it is risky for human beings to be infected with this disease as a carrier. "

In China last November, pig disease has begun. In China, there are quarantine restrictions in the prevalence of epidemic swine flu in Africa.
And finally, this (translated) report from Mongolia's Ministry of Agriculture,
which names ASF directly. 



The State Special Committee convened a duty to ban import of pork and fat temporarily

Source: Ministry of Food and Agriculture

Munkhtuya | 8 hours ago

(2019.01.15) Deputy Prime Minister of Mongolia and State Special Emergency Commission ¹ of Ulaanbaatar, Bulgan, Dundgovi, Tuv, Orkhon Aimag, Ulaanbaatar, Trade, Food Service, Service, Live Pork, Pork and Meat Products .Enkhtuvsh summoned the State Special Emergency Committees.
The meeting discussed the effects of pork disease, measures, and outbreaks of influenza and influenza-like illnesses, as well as ongoing and ongoing measures to be taken.

D.Tumendemberel, head of the General Department of Veterinary Services, said: "Sample of the dead pigs from the state veterinary clinic sanatorium laboratories has proved to be a disease of Pig African. The joint working group of the relevant agencies is working with the Pig African Crisis. There are 10 entities importing pork and meat products in Mongolia. Analyze the warehouse of four organizations. "

Following the report, the Deputy Prime Minister of Mongolia and the President of the State Emergency Commission O.Enkhtuvshin gave directions to the relevant authorities.

Ch.Ulaan Minister of Food and Agriculture and Light Industry:

- Prohibit the import of pork and fat imported from China, Russia, Germany and Poland temporarily by the state border;

- Introduce active surveillance and detection of pig fungus at the national level within 30 days and plan for further action;

- Provide reserves of disinfectants such as "iodine and lemon" with selective services for the disease and organize disinfection of pigs and fodder stores, shelters and fences;

- Provide proper management of burrows of pork Africa with appropriate regulations and guidelines, and organize burying in integrated zones.

D.Tumendemberel, head of the General Department of Veterinary Services:

- The Government of Mongolia's Resolution 266 of 2018 shall organize and supervise all the necessary measures in accordance with the approved procedure during the quarantine and restriction regime;

- Provide information on prevention and prevention of pig disease in the public, and collaborate with the media in collaboration with the State Professional Inspection Agency (GASI) in order to deliver information from one point to another.

- Conduct a risk assessment of animal infectious diseases and identify ways to plan and implement responses to the outcomes.

Governor of aimags and the Capital City and the Special Appellate Committees:

- Disbursement of disinfection and disinfection required for preventive diseases of the pig and infectious diseases of the pig, financed by the capital of aimags and capital city approved by 2019;

- Provide aimag and city Veterinary organizations in the area of ​​disinfecting and disinfection;

- Take necessary measures to temporarily ban migration of humans, animals, animals and vehicles from the epidemic of infectious diseases in Africa,

- Conduct sterilization and disinfection in accordance with relevant instructions and procedures for business entities, organizations, citizens and service establishments;

Head of the Customs General Administration B. Appendix, Chief of the General Agency for Specialized Inspection N. Tsagaankhuu:

- Provide a notice of intensification of inspections on domestic freight and freight on border, customs and border ports;

- Introducing travelers to the border with the purpose of introducing the pork and meat products for their food and luggage.


While hardly a surprise (see last August's FAO: African swine fever (ASF) threatens to spread from China to other Asian countries), these latest developments are nevertheless a sobering reminder of the ongoing threat from ASF, and how quickly it can spread across the region.


Saudi MOH: Another Household Cluster of MERS - Jeddah















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While the overall number of new MERS cases reported by the Saudi MOH has been pretty low the past couple of months, for the third time in 4 weeks we have a reported household cluster.
Today, the Saudi MOH is reporting the third household cluster in the past month, this time the primary case being the 75 y.o. male reported from Jeddah on January 10th, and a 52 y.o. (secondary, household) male reported today.
https://www.moh.gov.sa/en/CCC/events/national/Documents/Epiwk3-19.pdf


Household clusters of MERS are not particularly rare, although 3 in just over a month is a bit unusual, particularly given 70% of the cases over that time period are part of one of these clusters.
Clusters - whether in homes or healthcare settings - illustrate that in close quarters and under the right conditions, MERS transmits reasonably well between humans.
The saving grace so far has been that in the broader community, overt transmission appears far less common, although there are concerns over undetected chains of (asymptomatic or mildly symptomatic) transmissions.

The yardstick by which disease transmissibility is measured is its R0 (pronounced R-nought) or Basic Reproductive Number. Essentially, the number of new cases in a susceptible population likely to arise from a single infection. 
In the simplest of terms, with an R0 below 1.0, a virus (as an outbreak) begins to sputter and dies out. Above 1.0, and an outbreak can have `legs’. 
image


While MERS has yet to become transmissible enough (at least in a community setting) to spark a genuine epidemic, a 2017 study (see A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) provided a detailed statistical analysis of MERS-COV cases reported in Saudi Arabia from May 2013 to May 2015
This study reported a sub-critical R0 (R: 0.85–0.97) across all regions, but found in central and western regions that at times the R0 flirted with epidemic sustaining numbers. 
All of which means - while apparently still not ready for prime time - MERS-CoV wouldn't need to gain a whole lot more transmissibility to become a genuine pandemic threat.

Three small household clusters in a month does not an epidemic make, but we need to remain vigilant, keeping watch for any signs that the virus might be evolving into more of a threat. 

Monday, January 14, 2019

Argentina's Growing Hantavirus Outbreak

Credit Wikipedia

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Hantaviruses - which are carried by rodents in many parts of the world - are contracted by humans primarily through the inhalation or ingestion of aerosolized rodent feces, urine, saliva.
Once infected, however, humans are sometimes able to transmit the virus to those they are in close contact with. 
Scientists have identified dozens of viruses within the genus Hantavirus (named after the Hantaan River of Korea), with mortality that varies from 1%-2% for some varieties (i.e. Seoul Virus, Puumala Virus) to more than 30% for the North American Sin Nombre and South American Andes Virus.
In humans, there are two severe (sometimes fatal) diseases caused by Hantavirus: Hemorrhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS). 
HFRS is found in Europe, Asia, and Africa, while HPS is found in the Americas (North, Central and South).  
 
While relatively rare, every year the U.S. reports between 10 and 50 Hantavirus Pulmonary Syndrome (HPS) cases, of which, roughly 35% prove fatal. Cases have been reported in 35 states (see map below), with 96% of all cases reported west of the Mississippi River.





For the past few days there have been reports of an unusually large outbreak of Hantavirus in the small village of Epuyén in the Patagonian province of Chubut.  The local provincial government's website (Gobierno del Chubat) front page prominently displays the following warning:

http://www.chubut.gov.ar/site/inicio
 


Argentina's Ministry of Health website shows their last update on January 11th, where they talk in general terms about their response and identify the virus as the Southern Andes strain.  

They state the National Administration of Laboratories and Health Institutes (ANLIS) has `. . .  also initiated studies of viral genome sequencing entire human genome and to identify whether there are mutations that increase the transmissibility and lethality'.

Health continues to work with Chubut coordinated by the outbreak of hantavirus in Epuyén
In order to study and contain the outbreak, authorities and technical teams from both jurisdictions held meetings to assess the evolving outbreak affecting the Patagonian locality.

Published on Friday January 11, 2019

Meanwhile, media reports indicate there are now 28 cases and 10 deaths, including reports of a 29 year-old nurse who died in neighboring Santiago, Chile.

This (translated) report from LaRepublica.pe:
Hantavirus travels to Argentina and arrives in Chile: nurse dies in Santiago

The 29-year-old woman died in Santiago de Chile and joins the nine fatalities of the Hantavirus outbreak that originated in Argentina.

The Republic

13 Jan 2019 | 9:21 pm

The Hantavirus caused the death of a person in Chile. A 29-year-old nurse had contact with a person from Epuyén, the town where the outbreak of the viral disease began, and died at a health center in her country. In addition, there are two more cases of contagion.

The woman, identified by Chilean media such as Patricia Martínez, was an officer of the Hospital de Palena, an area where there were conflicts bordering Argentina and Chile. She is the first victim of the Chilean Los Lagos region. He died of a cardiopulmonary picture caused by the Hantavirus in Santiago.
According to the authorities of Los Lagos, his death is related to infections in Epuyen, Argentina. The woman would be the tenth mortal victim of the Hantavirus. The Government of Chile would have imposed the sanitary barrier.

"We were informed of the death of the patient from Palena, as a result of her case of cardiopulmonary syndrome due to hantavirus," said José Antonio Vergara, the Epidemiology physician at the Los Lagos health center, according to Clarín. It was linked to the outbreak that originated in the town of Epuyen, in the province of Chubut, "he said.


(Continue . . . )

A summary of the outbreak was published yesterday by Navva.org.

The first people affected by the virus were people who attended a birthday party on 24 November in an event hall, reported the mayor of Epuyen, Antonio Reato.
A field spy from the area was the first to be infected after cleaning a shed where he would have been in contact with an infected mouse. Later the man attended the celebration in which he infected his wife and other assistants.

The outbreak is motivated safety precautions in the Patagonian city that has already been proclaimed quarantine. Meetings are forbidden and even to view the deceased.

A court decision ordered the insulation for 30 days to 85 residents who had contact with neighbors tested positive for Hantavirus or suspected of having it. Isolated people are not allowed to leave their homes and receive visitors.
 
Complicating matters is the potentially long incubation period for the virus.  A 2006 EID Journal Dispatch (below) suggests - that with new cases still being identified  - it could be some time before this outbreak can be resolved.

Volume 12, Number 8—August 2006
Dispatch

Incubation Period of Hantavirus Cardiopulmonary Syndrome

Pablo Vial* , Francisca Valdivieso*, Gregory Mertz†, Constanza Castillo‡, Edith Belmar*, Iris Delgado*, Mauricio Tapia§, and Marcela Ferrés¶
Abstract

The potential incubation period from exposure to onset of symptoms was 7–39 days (median 18 days) in 20 patients with a defined period of exposure to Andes virus in a high-risk area. This period was 14–32 days (median 18 days) in 11 patients with exposure for < 48 hours.

Given its unusual size and duration, we'll be keeping an eye on this outbreak in the days and weeks ahead.