OSAC: Security Message For US Citizens In Brazil On The Zika Virus

 
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The Overseas Security Advisory Council (OSAC), a department within the United States Department of State,  has issued an adivsory on the growing Zika epidemic in Brazil for all American citizens visiting that country.   

With Carnival in Rio just over a month away, and the summer Olympics scheduled for next August, the recent introduction and rapid spread of Zika in Brazil takes on even greater importance. 

The CDC has issued travel advice for Zika Virus in South America earlier this month. Since its introduction to the Americas in 2014, Zika has now been reported in 14 South and Central American Countries, and is moving into the Caribbean, but Brazil is the most heavily impacted area to date.

The link between thousands of recently reported microcephalic births in Brazil and maternal infection with the Zika virus - while strongly suspected by Brazil's health authorities - has yet to be conclusively proven (see ECDC Rapid Risk Assessment – Zika & Microcephaly).

But given the severity of these birth defects, and the potential for rare potentailly serious neurological side effects from infection, an abudance of caution is warranted.

This posted today on the OSAC website.

Security Message for U.S. Citizens: Brasilia (Brazil), Zika Virus

  Employee Health Safety; Disease Outbreak Western Hemisphere > Brazil; Western Hemisphere > Brazil > Brasilia 12/31/2015

The U.S. Embassy in Brasilia, Brazil informs U.S. citizens of a public health concern regarding the mosquito-transmitted Zika virus.  

As dengue and chikungunya, the main transmitter of the Zika virus is the Aedes egypti, an urban mosquito that prefers to breed in and around homes.  Large urban centers with surrounding poorer slums are ideal breeding grounds for Aedes egypti.  Once infected mosquitoes become established in an area they are hard to contain.

The Zika virus is closely related to dengue.  In 2007 the first known outbreak in humans occurred on the island of Yap in Micronesia and was followed by outbreaks in other Pacific Islands.  Brazil reported its first case of Zika virus disease in May 2015.

Zika has often been called “dengue light.”  Like dengue, only about 25 percent of those infected with Zika develop symptoms.  These may include fever, headache, arthralgia (joint complaints), conjunctivitis (eye inflammation), and a maculopapular (red raised) rash that is generally not as severe as that caused by dengue or chikungunya.  There are no hemorrhagic manifestations and no long term complications. People rarely become ill enough to require hospitalization. On rare occasions, there have been deaths associated with Zika infection. 

Authorities are investigating a possible association between the Zika virus outbreak and increased numbers of babies born with microcephaly, a condition characterized by small head size and associated with cognitive impairment.  As of the end of December, nine states in northeastern Brazil have reported 2,608 cases of microcephaly, a marked increase from previous years. As of the end of December, the state of Pernambuco has reported 150 affected babies - for 2015, compared with only 10 microcephalic babies reported in all of 2014.  The Zika virus was found in the amniotic fluid of two affected babies.  There is no indication that any pregnant woman needs to leave an area that has Zika infections at this time. 

There is no vaccine or treatment for Zika, so prevention of mosquito bites is the only way to avoid infection.  Pregnant women in particular should employ good personal protective measures to minimize the risk of Zika and other mosquito borne infections.  These include use of CDC recommended topical repellants such as DEET or Picaridin, keeping arms and legs covered when outdoors and use of permethrin treated fabrics for clothing and tents.

Up to date information on the Zika virus, including the possible association between Zika virus and microcephaly, is available at http://www.cdc.gov/zika/.

Detailed information on protection against mosquito bites is available at http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods.

To obtain Centers for Disease Control and Prevention (CDC) travel notices, call the CDC at 1-800-CDC-INFO (1-800-232-4636) from within the United States, or 1-404-639-3534 from overseas, or visit the CDC website at http://www.cdc.gov/travel.

U.S. citizens should also consult the Department of State's Country Specific Information for Brazil which is located on the U.S. Department of State, Bureau of Consular Affairs website.  Travelers may obtain up-to-date information on security conditions by calling 1-888-407-4747 toll-free in the United States and Canada, or on a regular toll line at 1-202-501-4444 from other countries.  Stay up to date by bookmarking our Bureau of Consular Affairs website which contains current Travel Warnings and Travel Alerts.

Regularly monitor the State Department's website, where you can find current Travel Warnings, Travel Alerts, and the Worldwide Caution. Read the Country Specific Information for Brazil.  For additional information, refer to "A Safe Trip Abroad" on the State Department's website.

We strongly recommend that U.S. citizens traveling to or residing in Brazil to enroll in the Department of State’sSmart Traveler Enrollment Program (STEP) at www.Travel.State.Gov.  STEP enrollment gives you the latest security updates, and makes it easier for the U.S. embassy or nearest U.S. consulate to contact you in an emergency.  If you don’t have Internet access, enroll directly with the nearest U.S. embassy or consulate.

Jiangxi Province Announces 1 H7N9 Case

Jiangxi Province - Credit Wikipedia


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We get avian flu information out of China in piecemeal fashion, with some provinces announcing cases when they occur, and others burying that information in End Of Month epidemiological reports. Sometimes, as with the four H9N2 cases announced earlier this month, the data is several months old before we hear about it.


Today, however, Jiangxi Province has announced an H7N9 case on their governmental website (h/t Biological on FluTrackers).   The (translated) statement reads:

 Jiangxi confirmed one case of H7N9 cases

Jiangxi Provincial Health and Family Planning www.jxwst.gov.cn 2015 年 12 月 31 2008 Source: Committee of Emergency Management Office  

Jiangxi Provincial Health and Family Planning Commission on December 31 briefing, Jiangxi confirmed one case of H7N9 cases. Currently, patients with stable vital signs, Ganzhou is a hospital for treatment.

Patients with Chen, male, 46 years old, live in Ganzhou Anyuan County. December 30, Jiangxi Province Center for Disease Control and Prevention in Ganzhou patient specimens are sent for review, and identified as H7N9 virus nucleic acid positive. Provincial Family Planning Commission Expert Group Health patients according to clinical manifestations, laboratory tests and epidemiological findings, etc., diagnose the patient with H7N9 cases.

This is the first report of H7N9 out of Jiangxi Province this fall, and only the 11th overall case reported from that province (ranked #8 in number of cases in Mainland China).  The following chart from Hong Kong's CHP lists all known H7N9 cases by province.

The actual number of H7N9 cases in China is not known, as only those sick enough to report to a hospital, and have tests run, are ever identified. Like most viral illnesses, H7N9 can produce a wide range of illness, and we've seen evidence of both mild and aysmptomatic infection.



The fact that only a few small family clusters have been documented, and we haven’t seen evidence of ongoing transmission among the close contacts of known cases, strongly suggests virus does not yet possess the ability to transmit efficiently between humans.

That could change, of course. 

Which is why we watch these outbreaks in China carefully, looking for any signs that the behavior of this virus is changing.

Resolve To Be Ready In 2016

Basic kit : NWS radio, First Aid Kit, Lanterns, Water & Food & cash


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While the residents of Dallas and the Midwest continue to dig out from last week's tornado outbreak, and as the flood waters continue to rise in and along the Mississippi and its tributaries, most of us will end 2015 thankful that disasters like these did not affect our communities, and families.

None of which is to say that everyone got lucky. 

FEMA has declared 43 Major Disasters across the country so far in 2015 (see LIST), along with a couple of Emergency Declarations, and more than 30 Fire Management Assistance Declarations. And there were hundreds more, smaller, localized incidents that caused serious impact for some people, but did not rise to the level of a Federal Declaration.

But Americans avoided truly destructive earthquakes, major land falling hurricanes, disruptive solar storms, and other `big ticket' disasters. 

Other places around the world weren't as fortunate, of course.  Nepal was devastated by a series of huge earthquakes, India suffered both massive floods and heat waves, drought savaged parts of Africa, while the Pacific reeled under the onslaught of 28 typhoons. 


There are certainly no guarantees our luck will hold in the new year. Disasters, large and small, are inevitable, even if where and when they will occur is unknowable. Whether they will directly affect you and your family, is largely a matter of luck.

How you and your loved ones fare during these disasters, however, should never be left solely up to luck.

Ready.gov, FEMA, along with many other agencies continually promote better preparedness for disasters because they know that local, state, and Federal Emergency Services - at least in the opening days of a major event - won't be able to provide assistance to everyone.


Which is why they promote National Preparedness Month each September, and coalition members  like AFD promote preparedness year round. You can search for earlier AFD posts on preparedness using this search link.


Some threats are seasonal, and right now FEMA and READY.GOV are promoting El Nino awareness,  along with winter weather hazards.   In the spring, torando season will take center stage, followed by hurricane season.

But is is always earthquake season, and space weather, cyber attacks on the grid, and pandemics can happen anytime of the year. 

Over the past couple of years we've looked at some of the government's biggest disaster concerns.  Some are, admittedly, low probability events - but should they occur - they'd have a very high impact.

USGS: Preparing The Nation For Severe Space Weather

OSU: Pragmatic Action - Not Fatalism - In Order To Survive The `Big One’

USGS/OGS Joint Statement On Increased Earthquake Threat To Oklahoma

#NatlPrep : Pandemic Planning Considerations

GridEx 2013 Preparedness Drill

None of this is to suggest you should be preparing specifically for any one of these scenarios (although depending where you live, you certainly need to consider some disasters more likely than others). Instead, most experts promote an `all hazards' preparedness plan.

The one common denominator in most disasters, however, is that local utilities may be disrupted - perhaps for days or even weeks.

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 have:

• An emergency plan, including meeting places, emergency out-of-state contact numbers, and in case you must evacuate, a bug-out bag? 
• 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 (and in cold climates, heat) for your family without electricity?   And a way to cook?  And to do this safely?
• A small supply of cash to use in case credit/debit machines are not working?
• Spare supply of essential prescription medicines that you or your family may need?

If your answer is `no’, you have some work to do.  A good place to get started is by visiting Ready.gov.
 

Unfortunately, a lot of people make the wrong choices when they do prepare.  They buy candles instead of battery operated lights, they use generators inside their house or garage, or resort to dangerous methods to cook or to heat their homes. 

As a result, when the power goes out, house fires and carbon monoxide poisonings go up. Each year hundreds of Americans are killed, and thousands affected, by CO poisoning (see In Carbon Monoxide: A Stealthy Killer).
 
 
Food safety after a power outage is another concern, and is something I covered a couple of years ago in USDA: Food Safety When The Power Goes Out.
 

While preparedness may seem like a lot of work, it really isn’t.  

You don’t need an underground bunker, an armory, or 2 years worth of dehydrated food.  But you do need the basics to carry on for a week or two, and a workable family (or business) emergency/disaster plan.
 
For more information on how to prepare, I would invite you  to visit:

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

France: MOA Reports 64th HPAI Outbreak

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After a week without reporting any new outbreaks, today France's Ministry of Agriculture announces a fresh outbreak of HPAI H5N1 (European Lineage) in Dordogne.

- An outbreak of avian influenza highly pathogenic H5N1 was declared December 30, 2015 on a farm of 30 chickens, 150 pigeons and peacocks 4, in the town of Celles in Dordogne.

While the number of reported outbreaks has lessened, after six weeks we still don't have a good understanding of how so many (5) new strains of (HPAI & LPAI) avian influenza could suddenly appear simultaneously in the south of France.

The last DEFRA Update On France's HPAI Outbreak from the UK was released a week ago, and while it offered up some possible explanations, the authors stated they were still hampered by a lack of data. 

Hopefully we'll get another update soon.  Details on all of the HPAI outbreaks to date may viewed at the MOA link below:

What is the current situation in France? (updated 12/31/15 at 12h)

In total, to date, 64 of highly pathogenic avian influenza outbreaks in poultry were detected in 6 southwestern departments of France.

ANSES gave its opinion delivered on 14 December 2015, on the potential danger to humans from the avian influenza strain identified, including the results of the complete sequencing of the H5N1 strain detected in the first home in the Dordogne. She confirmed the absence for this dangerous H5N1 strain of the key markers for human.

Find below the details of homes by department below:

In the Dordogne, 13 homes

In the Landes, 27 homes

In Haute-Vienne, a home

In Gers, 10 homes

In the Pyrénées Atlantiques, 10 homes

In the Hautes-Pyrénées, 3 fireplaces

Saudi MOH: One Primary MERS Case In Unizah

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Although December has been a very quiet month for MERS reports, the Saudi MOH is reporting their second primary case in a week, with this latest case from the town of Unizah (aka Unaizah) which is located roughly 30 km south of Buraidah - a region which has reported two MERS cases since late November.


Today's case is listed as a 59 y.o. male in critical condition, who is categorized as a `primary case' - one that occurs in the community where there is no known exposure to a health care facility or to a known human case.

Over the past 3 years, roughly 40% of Saudi cases are listed as either `primary’ or as from an undetermined origin.

Camel exposure has been assumed to account for some percentage of these cases, but other sources of infection in the community - possibly including asymptomatic cases - are also assumed.

Details, as usual, are scant, but this patient is already far enough along in his illness to be listed in critical condition.

Brazil: MOH Updates Microcephalic Birth Numbers

Microcephalic Case Distribution As Of 12/19/15

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In a normal week Brazil registers roughly 3 microcephalic births, and yearly totals typically run between 130 and 175 cases (see chart below). Starting in October public health officials began to report a huge increase in microcephalic birth defects, and now it is not uncommon to see a year or more worth reported in a week.

This week nearly 200 additional cases are reported, bringing this year's total to 2976 suspected cases.  This represents an increase of more than 2500 cases over the past 6 weeks.


Today's update shows a slowdown in cases - at least compared to the 500+/week we were seeing a month ago - but this may be due to delayed reporting during the holidays, or perhaps due to a decrease in Zika virus transmission (the suspected, but not proven, cause) during Brazil's winter.

Summer in Brazil began last week, and the forecast is for a hotter, wetter season than in recent years (see Rio Worries Over A `Zika Summer'): conditions many fear could exacerbate the spread of the Zika virus in the coming months.

Although their regular epidemiological report has yet to be published, the following summary was posted on the Brazilian MOH website a short while ago.

Registration Date: 12/29/2015 15:12:38 changed the 12/29/2015 in the 16:12:19

REPORT CARD

Health publishes updated data microcephaly

Are under investigation 2,975 suspected cases of the disease in 656 municipalities in 20 Brazilian states

The Ministry of Health announced on Tuesday (29) the latest epidemiological bulletin of the year on microcephaly. The data was compiled by the 26th of December. To date, it has been reported 2,975 suspected cases of the disease in newborns of 656 municipalities in 20 Brazilian states. Also are being investigated 40 suspicious deaths of microcephaly related to Zika virus. 

Of the 20 Brazilian states with suspected cases, nine remained with number of suspected cases equal to the previous bulletin released last week (22/12). Three states (TO, MG and MT) showed a decrease of eight cases showed an increase of cases.

The largest number of cases was registered in Pernambuco (1,153), representing 38.76% of cases across the country. The state was the first to identify microcephaly increase in the country. Next are the states of Paraíba (476), Bahia (271), Rio Grande do Norte (154), Sergipe (146), Ceará (134), Alagoas (129), Maranhão (94) and Piauí (51).

In November, the Ministry of Health declared Emergency Public Health of National Importance to give greater flexibility to the investigations being carried out in an integrated manner with state and municipal health departments. It is a mechanism provided for in cases of public health emergencies that require the urgent job of prevention, control and risk containment, damage and harm to public health. It is also in operation since the 10th of November, the Emergency Operations Center for Global Health (COES), a crisis management mechanism that brings together the various areas to respond to this event.

MOBILIZE NATIONAL  - For the implementation of the National Plan to Combat microcephaly, was set up the National Centre for Coordination and Control for Combating microcephaly. The aim is to intensify the actions of mobilization and combat the mosquito  Aedes aegypti. Also state rooms will be installed, which will be attended by representatives of the Ministry of Health, Departments of Health, Education, Public Security, Social Welfare, Civil Defense and Armed Forces.

They are currently deployed rooms in 18 Brazilian states: Acre, Amazonas, Goias, Mato Grosso, Paraiba, Pernambuco, Paraná, Santa Catarina, Tocantins, Rio Grande do Sul, Distrito Federal, State of Alagoas, Bahia, Espírito Santo, Mato Grosso do Sul , Rio de Janeiro, Sergipe and Ceará. Four other states are in the room implementation phase: Pará, Rio Grande do Norte, Minas Gerais and São Paulo. The other will be guided by the Ministry of Health to implement the rooms.

ORIENTATION - The Ministry of Health recommends that pregnant women take steps that can reduce the presence of disease-transmitting mosquitoes by eliminating breeding sites, and protect themselves from mosquito exposure, keeping doors and windows closed or screened, wear pants and shirt long-sleeved and use repellents allowed for pregnant women. Also part of these guidelines the monitoring and prenatal consultations, with the completion of all tests recommended by your doctor. The Ministry of Health reinforces the guidance of not consume alcohol or any other drugs, not use drugs without medical prescription and avoid contact with people with fever or infection.

ZIKA - Currently, the movement of the Zika is confirmed by PCR with molecular biology technology. From the confirmation in a particular locality, the other diagnoses are made ​​clinically, for medical assessment of symptoms.

The Ministry of Health trained over 11 public laboratories to perform the diagnosis of Zika. Relying on the five reference units in Brazil for this type of examination, there are already 16 centers with the knowledge to take the test. In the next two months, the technology will be transferred to 11 more laboratories, totaling 27 units prepared to analyze 400 samples a month from suspected cases of Zika across the country.

(Continue . . .)

WHO Declares End Of Ebola Transmission In Guinea

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Although the declaration of an `end to Ebola transmission' in Guinea today is a huge and long awaited milestone - it doesn't mean the threat in West Africa is over - but 42 days without registering a new case is a hopeful sign.

We've already seen instances of the virus re-emerging weeks or even months after transmission was halted (see New Ebola Case Confirmed In Liberia After 17 Weeks).

The virus likely remains in the environment, and could easily be reintroduced through the consumption of infected bush meat. And we've strong evidence that some Ebola survivors can carry (and shed) the virus for months after they have recovered, providing yet another route for resurgence. 

• In ECDC On Ebola Persistence & Rapid Risk Assessment, we looked at the unexpected relapse of Scottish nurse Pauline Cafferkey, nine months after her recovery from the the virus
• In WHO: Study Shows Ebola Virus Fragments May Be Detectable In Semen For > 9 Months, we saw additional evidence of the long-term presence of the Ebolavirus in male semen, and last May (see MMWR & WHO On Risks Of Sexual Transmission Of Ebola) we saw evidence of the sexual transmission of the virus.

All of which makes `getting to zero, and staying there’ a daunting task.


Additionally, there are thousands of survivors who continue to suffer from a variety of serious sequelae, and the social stigma of having been infected.  Their recovery, and the region's, will be a long process.


This from WHO.

End of Ebola transmission in Guinea

Geneva, 29 December 2015 - Today the World Health Organization (WHO) declares the end of Ebola virus transmission in the Republic of Guinea. Forty-two days have passed since the last person confirmed to have Ebola virus disease tested negative for the second time. Guinea now enters a 90-day period of heightened surveillance to ensure that any new cases are identified quickly before they can spread to other people.

“WHO commends the Government of Guinea and its people on the significant achievement of ending its Ebola outbreak. We must render homage to the Government and people of Guinea who, in adversity, have shown extraordinary leadership in fighting the epidemic,” says Dr Mohamed Belhocine, WHO Representative in Guinea. “WHO and its partners will continue to support Guinea during the next 90 days of heightened surveillance and in its early efforts to restart and strengthen essential health services throughout 2016.”

A milestone for the Ebola outbreak                    

The end of Ebola transmission in Guinea marks an important milestone in the Ebola outbreak in West Africa. The original chain of transmission started two years ago in Gueckedou, Guinea in late December 2013 and drove the outbreak which spread to neighbouring Liberia and Sierra Leone and, ultimately, by land and air travel to seven other countries.

“This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission that were responsible for starting this devastating outbreak two years ago,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “I commend the governments, communities and partners for their determination in confronting this epidemic to get to this milestone. As we work towards building resilient health care systems, we need to stay vigilant to ensure that we rapidly stop any new flares that may come up in 2016.”

In addition to the original chain of transmission, there have been 10 new small Ebola outbreaks (or ‘flares’) between March and November 2015. These appear to have been due to the re-emergence of a persistent virus from the survivor population.

Among the challenges survivors have faced is that after recovering from Ebola virus disease and clearing the virus from their bloodstream, the virus may persist in the semen of some male survivors for as long as 9-12 months.
  
WHO and its partners are working with the Governments of Liberia, Sierra Leone and Guinea to help ensure that survivors have access to medical and psychosocial care, screening for persistent virus, as well as counselling and education to help them reintegrate into family and community life, reduce stigma and minimize the risk of Ebola virus transmission.

Sustained support to Guinea, Liberia and Sierra Leone

“The coming months will be absolutely critical,” says Dr Bruce Aylward, Special Representative of the Director-General for the Ebola Response, WHO. “This is the period when the countries need to be sure that they are fully prepared to prevent, detect and respond to any new cases.

“The time-limited persistence of virus in survivors which may give rise to new Ebola flares in 2016 makes it imperative that partners continue to support these countries. WHO will maintain surveillance and outbreak response teams in the three countries through 2016.”
  
At the same time, 2016 will see the three most-affected countries implementing a full health sector recovery agenda to restart and strengthen key public health programmes, especially maternal and child health, while continuing to maintain the capacity to  detect, prevent and respond to any flare-up of Ebola.

(Continue . . .)

Guangdong Province: Human H5N6 Case In Critical Condition

Credit FAO/EMPRES



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H5N6 is one of the new generation of HPAI H5 viruses that began to make itself known in China in 2013 and 2014.  A reassortment of the venerable H5N1 virus, which had been the major HPAI player in the world for a decade, H5N6 appeared nearly simultaneously in China and Laos in the spring of 2014 (see  H5N6: The Other HPAI H5 Threat).  

Unlike it's H5N8 cousin (and its reassortants), H5N6 has caused a handful of human infections in China, and among known cases has a very high fatality rate. 

Surveillance, testing, and reporting being what it is (or isn't) in China, we don't really know the true burden of human illness from this emerging virus, although infection is considered rare.


In 2014 H5N6 was also reported in Vietnam, and continues to erupt there, and has turned up this year in dead or dying birds in Hong Kong (see Hong Kong Robin Positive For H5N6).


While not yet as well travelled as HPAI H5N8, which turned up in Europe and North America late last year, this virus (along with H7N9) is also viewed as having the potential to expand its geographic range.

In a departure from the practices of many other Chinese Provinces, Guangdong has been pretty good about quickly reporting human infections with novel flu viruses, likely due to their close proximity and relationship with Hong Kong.

Two reports: First from the Emergency Management Office of Guangdong Province, and the second from Hong Kong's CHP.

Shenzhen report one case of H5N6 cases

 

2015-12-29 17:21:00 Ben

December 29, 2015, the Shenzhen Municipal report one case of H5N6 cases. Wu patient (female, 26 years old), living in Bao'an District, Shenzhen, Shenzhen designated hospital now hospitalized in critical condition.

Experts assess that: The case appeared sporadic cases, lower the risk of spreading the virus at this stage.

(Continue . . . )

 

Notification of confirmed human case of avian influenza A(H5N6) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) has been notified of a confirmed human case of avian influenza A(H5N6) by the Health and Family Planning Commission of Guangdong Province today (December 29) affecting a 26-year-old woman in Shenzhen.

The patient lives in Bao'an, Shenzhen. She is currently hospitalised for treatment and in a critical condition.

A spokesman for the DH said, "All novel influenza A infections (including H5N6) are notifiable diseases in Hong Kong.

"Locally, we will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments."

"In view of cases confirmed on the Mainland, members of the public should maintain good personal, food and environmental hygiene at all times during travel," the spokesman urged.

"All boundary control points have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman added.

Regarding health education for travellers, the display of posters and broadcast of health messages in departure and arrival halls, environmental health inspection and provision of regular updates to the travel industry via meetings and correspondence are proceeding.

(Continue . . . )

As we wait and watch for the return of H5N8/H5N2 in North America, or the resumption of Egypt’s H5N1 epidemic, it is worth noting that we've seen a unusually high number of new HPAI H5 viruses cropping up around the world over the past year (see You Say You Want An Evolution?).

While  it is impossible to predict what any of these individual HPAI subtypes do - or where they will eventually spread – the rapidly increasing diversity and spread of these viruses raises the stakes not only for the poultry industry, but potentially for public health as well.  

And given its limited ability to infect humans, HPAI H5N6 is one of those viruses we tend to watch most closely.

PNAS: The Pandemic Potential Of Eurasian Avian-like H1N1 (EAH1N1) Swine Influenza

Credit ECDC – 125 years of  Pandemic  History 

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While we watch the avian H5 and H7 influenza viruses make tentative jumps to humans - and are justifiably concerned over their pandemic potential - as far back as modern science will allow us to look (about 125 years) the only influenza viruses known to have sparked a human pandemic were either types H1, H2, or H3.

We've looked at the theory that Pandemic Viruses Are Members Of An Exclusive Club on numerous occasions, but the data is fairly limited.

History suggests at least a dozen `influenza-like’ pandemics occurred in the 400 years prior to the 20th century, but we've simply no idea what subtypes might have been involved. 

We do know that the H1, H2, and H3 viruses are hosted not only by humans, but by birds, and a variety of mammalian species - including pigs. Also included are dogs, and horses, and even marine mammals.

The assumption is that H1, H2, and H3 viruses of swine or avian origin likely have a smaller `leap' to adapt to humans than do the strictly avian H5 and H7 subtypes. 

And indeed, we saw that very thing play out with the 2009 H1N1 `swine flu' pandemic, which had been bouncing around North American pig herds for a decade or longer.


Last August we looked at a study that examined two recently discovered swine variant strains (see J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs) of concern. They described both of these novel subtypes as  

“. . . virulent and can sustain onward transmission in pigs, and the naturally occurring mutations in the HA were associated with antigenic divergence from H3 IAV from human and swine’” and goes on to warn that  ``. . . the potential risk of these emerging swine IAV to humans should be considered”.

In recent years we've also been watching evolution of several swine variant viruses (H1N1v, H1N2v, H3N2v), all of which have reassorted with - and picked up the M gene segment from – the 2009 H1N1 pandemic virus (see Keeping Our Eyes On The Prize Pig).

While an avian flu pandemic might be a lot deadlier, many flu researchers worry another swine-origin pandemic virus is more likely to emerge. 

All of which brings us to a new study published in the early edition of PNAS (Proceedings of the National Academy Of Science), where Chinese and Japanese scientists have isolated and characterized a number avian H1N1 virus variants circulating in Chinese pigs that they believe have considerable pandemic potential.
 

Prevalence, genetics, and transmissibility in ferrets of Eurasian avian-like H1N1 swine influenza viruses

Huanliang Yanga,1,Yan Chena,1,Chuanling Qiaoa,1,Xijun Hea,Hong Zhoub,Yu Sunb,Hang Yina,Shasha Menga,Liping Liua,Qianyi Zhanga,Huihui Konga,Chunyang Gua,Chengjun Lia,Zhigao Bua,Yoshihiro Kawaokac,2, and Hualan Chena,2

Abstract

Pigs are important intermediate hosts for generating novel influenza viruses. The Eurasian avian-like H1N1 (EAH1N1) swine influenza viruses (SIVs) have circulated in pigs since 1979, and human cases associated with EAH1N1 SIVs have been reported in several countries. However, the biologic properties of EAH1N1 SIVs are largely unknown. 

Here, we performed extensive influenza surveillance in pigs in China and isolated 228 influenza viruses from 36,417 pigs. We found that 139 of the 228 strains from pigs in 10 provinces in China belong to the EAH1N1 lineage.

These viruses formed five genotypes, with two distinct antigenic groups, represented by A/swine/Guangxi/18/2011 and A/swine/Guangdong/104/2013, both of which are antigenically and genetically distinct from the current human H1N1 viruses.

Importantly, the EAH1N1 SIVs preferentially bound to human-type receptors, and 9 of the 10 tested viruses transmitted in ferrets by respiratory droplet. We found that 3.6% of children (≤10 y old), 0% of adults, and 13.4% of elderly adults (≥60 y old) had neutralization antibodies (titers ≥40 in children and ≥80 in adults) against the EAH1N1 A/swine/Guangxi/18/2011 virus, but none of them had such neutralization antibodies against the EAH1N1 A/swine/Guangdong/104/2013 virus. 

Our study shows the potential of EAH1N1 SIVs to transmit efficiently in humans and suggests that immediate action is needed to prevent the efficient transmission of EAH1N1 SIVs to humans.

In the `Significance' section the authors boil it down to this:

Here, we found that, after long-term evolution in pigs, the EAH1N1 SIVs have obtained the traits to cause a human influenza pandemic.

Xinhua News has an English Language report on all of this, with interviews with the lead author, which you can read at the following link:

 Avian-like H1N1 swine flu may "pose highest pandemic threat": study
    
WASHINGTON, Dec. 28 (Xinhua) -- The Eurasian avian-like H1N1 (EAH1N1) swine flu viruses, which have circulated in pigs since 1979, have obtained the ability to infect humans and may "pose the highest pandemic threat" among the flu viruses currently circulating in animals, Chinese researchers said Monday.
"Pigs are considered important intermediate hosts for flu viruses," Chen Hualan, director of China's National Avian Influenza Reference Laboratory, who led the study, said in an written interview with Xinhua.    

"Based on scientific analysis and comprehensive comparison of the main animal flu viruses: H1N1, H3N2, H5N1, H7N9, H9N2 and EAH1N1, we found the EAH1N1 is the one most likely to cause next human flu pandemic. We should attach great importance to the EAH1N1."
    
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For more on the potential of the next pandemic to emerge from pigs, you may wish to revisit:

JID: Evolutionary Dynamics Of Influenza A Viruses In US Exhibition Swine 
 
Live Markets & Novel Flu Risks In The United States  

Study: Reassortants of H1N1pdm & Swine H1 & H3 Viruses in Japan 

EID Journal: H3N2v Swine To Human Transmission At Agricultural Fairs – 2012
 

    

FluView Week 50: Influenza Activity Low But Increasing

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Due to the holidays the CDC released their weekly FluView update today instead of last Friday, and while flu activity remains low across the nation, there are signs it is increasing. 

The one constant with seasonal flu, however, is you never know what kind of flu season you are going to get. And that goes for the timing, the dominant strain, and the severity.

Some years flu arrives in the fall, other years it peaks in late winter or early spring.  As shown below for 2011-12 - sometimes it barely arrives at all.  Although that is far from the norm.

Today's FluView indicates - for the second week running - that H1N1 is now the most common flu strain reported, although the number of isolates tested remains low. 

Up until early December, H3N2 was leading the pack.  

H3N2 dominant flu seasons tend to be more severe, particularly among the elderly, while H1N1 tends to hit younger adults harder.  Given the low number of viruses identified, it is too soon to be certain of how this will play out.


Here is a brief summary from today's report:

2015-2016 Influenza Season Week 50 ending December 19, 2015

All data are preliminary and may change as more reports are received.

Synopsis:

During week 50 (December 13-19, 2015), influenza activity increased slightly in the United States.

• Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 50 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was low.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below their system-specific epidemic threshold in both the NCHS Mortality Surveillance System and the 122 Cities Mortality Reporting System.
• Influenza-associated Pediatric Deaths: One influenza-associated pediatric death was reported.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.2%, which is above the national baseline of 2.1%. Four of 10 regions reported ILI at or above region-specific baseline levels. One state experienced high ILI activity; Puerto Rico and two states experienced moderate ILI activity; New York City and three states experienced low ILI activity; 44 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: The geographic spread of influenza in Guam, Puerto Rico, and five states was reported as regional; the U.S. Virgin Islands and 14 states reported local activity; the District of Columbia and 27 states reported sporadic activity; and four states reported no influenza activity.

Gonorrhea: The Path Of Increased Resistance

Credit CDC PHIL - photomicrograph Neisseria gonorrhoeae.


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Despite 75 years of effective antibiotic treatments, gonorrhea remains the second most common STD in the United States. In 2009 the CDC recorded 301,174 cases of gonorrhea, and by 2014 that number had jumped to over 350,000.

It is estimated that more than half of all cases go unreported. 

The introduction of penicillin in the 1940s represented the first truly effective treatment, and for the next 30 years, penicillin and tetracycline both proved powerful weapons against this disease.


But by the 1970s penicillin/tetracycline resistant forms of Neisseria gonorrhoeae began to appear in the United States, and by the 1980s had become common.  In response, the CDC began recommending cephalosporins as the first-line treatment for gonorrhea.

In 1993, the CDC also recommended the use of fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) to treat gonorrhea, as they were relatively cheap, effective, and allowed for a 1 dose treatment.

But in less than a decade, fluoroquinolone-resistant N. gonorrhoeae (QRNG) emerged out of Asia and began showing up in Hawaii and then California (see MMWR Increases in Fluoroquinolone-Resistant Neisseria gonorrhoeae --- Hawaii and California, 2001).

 
In 2007, the CDC announced Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections, leaving just one class of antibiotics - the cephalosporins - still recommended and available for the treatment of gonorrhea.

Today, a combination therapy of a cephalosporin (cefixime or ceftriaxone), along with a macrolide antibiotic (preferably azithromycin) are the only recommended treatments that remain for Gonorrhea.

Given the history of its gaining increased resistance over the decades, it is of little surprise that we are beginning to see early evidence of failure with this last line of defense, with an outbreak of `super gonorrhea' in Leeds, England earlier this year (cite BBC report). 


A bleak prospect envisioned more than four years ago in a  2011 MMWR report called Cephalosporin Susceptibility Among Neisseria gonorrhoeae Isolates --- United States, 2000—2010, which contained the following editorial comment:

The epidemiologic pattern of cephalosporin susceptibility in the West and among MSM during 2009--2010 is similar to that previously observed during the emergence of fluoroquinolone-resistant N. gonorrhoeae in the United States (2--3,7). Although the history of fluoroquinolone-resistant N. gonorrhoeae might not predict the patterns of decreasing cephalosporin susceptibility, the observed trends are concerning.

The bottom line, again from the editorial comment is:

In light of the diminished resources available to STD control programs and the past inability to prevent emergence of resistance, the eventual emergence of cephalosporin resistance appears likely.

All of this is making headlines once again this weekend, as Dame Sally Davies - England's Chief Public Health Officer - has issued a warning that:

Gonorrhoea 'could become untreatable'

By James Gallagher Health editor, BBC News website

Gonorrhoea could become an untreatable disease, England's chief medical officer has warned. 

Dame Sally Davies has written to all GPs and pharmacies to ensure they are prescribing the correct drugs after the rise of "super-gonorrhoea" in Leeds.

Her warning comes after concerns were raised that some patients were not getting both of the antibiotics needed to clear the infection. 

Sexual health doctors said gonorrhoea was "rapidly" developing resistance.

(Continue . . . )

None of this comes as any surprise to public health officials, as this issue has been on their radar for years.   Some earlier reports include:

Referral: McKenna On Almost-Untreatable Gonorrhea

WHO: Urgent Action Needed On Resistant Gonorrhea

CDC Grand Rounds: Multidrug-Resistant Gonorrhea

Resistant gonorrhea is just one prong of our growing antibiotic resistance problem, something which author, blogger, and journalist Maryn Mckenna has been writing and talking about for more than a decade. 


If you haven't already seen it, I highly recommend you view:

Maryn McKenna’s TED Talk - What do we do when antibiotics don’t work any more?

 

Saudi MOH: One Primary MERS Case In Jeddah

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Despite the daily list showing `MOH: 'No New Corona Cases Recorded' for the 27th, if you follow the link you'll find a single `primary' case was reported in Jeddah.   This is only the 4th case reported by the Saudis this month, in what has been an unusually quiet December.

`Primary cases’ are those that occur in the community when there is no known exposure to a healthcare facility or to a known human case.   Some may be linked to camel exposure.

 

Other than his age (54), gender (male), and the fact he is an ex-pat, little else is revealed about the patient who is in stable condition.

In The Land Of Limited Press Freedom, The Internet Rumor Is King

Credit Reporters Without Borders

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The three countries in the world with arguably the greatest emerging infectious disease threats at this time are China, Egypt, and Saudi Arabia - countries that also share a decided lack of press freedom as evidenced by the map above and the following ranking chart.

Notably, all three countries have seen significant erosion in press freedom over the past 5 years, with Egypt's being the most precipitous, dropping from #127 on the list to #158.


Of the three, Egypt is the least repressive (if you grade on the curve) and also has the most recent experience with a (relatively) freer press, so we occasionally see the Egyptian media try to `push the envelope', often in creative ways.

Last week, in Keeping One Eye On Egypt (Again) we looked at media reports (and official denials) of (you pick: anywhere between 10, 16, or 30+) suspected bird flu cases in Port Said.  

Despite adamant denials by the Port Said Health Ministry on the 23rd (see Health Directorate in Port Said declares negative cases of suspected bird flu), on the 24th CNN (Arabic) went with the following (translated) report claiming 8 positive H5N1 cases.

Egyptian Health announces 8 new cases of bird flu

Cairo, Egypt (CNN) - Health authorities announced in Egypt Wednesday, 8 for recording injuries mankind virus H5N1 virus that causes "bird flu", raising fears of a return of the disease which caused a lot of panic in different parts of the world recently.

(Snip)

She added that after samples of suspected cases analysis, the results of the analysis showed that 8 cases of them were "positive" for the avian influenza virus, while the results show the 8 others injured as "seasonal influenza."

(Continue . . . )

The above report is offered not to claim a cover up, but merely to show the level of confusion in the media, and the kind of back and forth reporting of `facts' we are witnessing.

As I wrote last week with the initial report of 31 suspect cases, there are a lot of far more likely causes for these hospitalized cases than avian flu.  

Adding to the general confusion, the Egyptian MOH website  has been offline a good deal of the past week and has yet to post a statement on these cases. Their Bird Flu FAQ is also more than a year out of date, still listing 180 total bird flu cases since 2006 (the latest WHO number is nearly twice that, at 346).  


Refuting media reports, denials continue to flow out of Egypt, and now include admonitions to ignore media rumors.

Thursday, December 24, 2015 11:53
Health Port Said denies citizens bird flu infection

Port Said - Bwabhalovd - Abdul Rahman onion:

He denied Dr. Adel Teilb, Undersecretary of the Ministry of Health in Port Said what appeared in the media and news sites and pages of social networking "Facebook" of the existence of positive cases infected with bird flu since revealed the samples contained the results of the central laboratory of the Ministry of Health in Cairo ten cases that have detained fever hospital under observation for negative results for avian influenza and the only positive for seasonal flu, and appealed to citizens to receive news from the correct sources and called on the media not to publish news that excite public opinion without support or guide.

(Continue . . . )

Over the past 36 hours Arabic media, and twitter, has been filled with additional reports of suspected bird flu cases and denials (see The death of 8 cases of seasonal flu Dakahlia)  - and even a suspected MERS case - although the validity of these reports is suspect. 

This from FluTrackers overnight:

Egypt - Pilgrim with suspected Coronavirus - MERS Infection

Today, 02:20 AM

Detention of an anesthesiologist in Mansoura hospital issued on suspicion of injury to «Corona
dec 27, 2015

Detained Mansoura Chest Hospital, on Saturday evening, a physician anesthesia, for suspected infection «Corona», and was placed isolation room, and take the necessary wipes, and sent to the laboratories of the Ministry of Health in Cairo, analyzed, to.

For his part, Dr. Saad al-Makki, Undersecretary of the Ministry of Health, told «Egyptian today» that the doctor «Mamed.h.k», 35 years old, coming from Saudi Arabia, at dawn on Saturday, and entered Ghamr hospital complaining of severe flu, and stress, and a rise in temperature, and the pain of the body, pointing out that it-like symptoms of infection with «Corona».

(Continue . . . )

Another report suggests as many as three MERS cases:

3 citizens detained on suspicion of having to "Corona" in Dakahlia

Today PM 12:18

Wrote: Saleh Ramadan

Dakahlia hospitals detained three citizens including a doctor on suspicion of being infected with "Corona", after returning from performing Umrah in Saudi Arabia.

Dr. Saad al-Makki, Undersecretary of the Ministry of Health Dakahlia, Dr book "Mamed.h" in Mansoura Chest Hospital, and two other people dead immersion Central Hospital, after rising temperatures after returning from Saudi Arabia.

(Continue . . .)

 
These symptoms are consistent with seasonal flu, pneumonia, avian flu, MERS, and a variety other respiratory viral infections, making MERS only one of many possibilities. The fact that fatalities have been reported does nothing to negate the possibility these are seasonal flu.


Some media outlets are using the controversy over the reporting of these suspect cases, the strident official denials, and the resultant confusion of the public as their story  - perhaps giving them a `safer' way to print stories about these outbreaks without incurring official wrath.

Bird flu back .. and «Health» in the negative gearing

Sunday, December 27, 2015 | Mahitap Abdel Fattah | 11:44:02 AM

The announcement of a number of media reports new cases of bird flu entering the winter season, if controversial, among assurances, denied the citizen remains confused after some media announced that the Ministry of health on 16 suspected cases of the virus in the region of port Fouad, specifying that the test results showed that eight of them tested positive, 8 others for seasonal influenza.

Dr. Adel teilab, Undersecretary of the Ministry of health, the media reports is not true at all, and that the suspected cases were not infected with bird flu virus, but only cases of seasonal influenza, adding that he has ordered the formation of a medical team to survey an area easy Tina East port, consisting of doctors and veterinarians and prevention viruses; after the emergence of cases of suspected Bird flu in the region and isolate the 10 people to hospital, viruses.

(Continue . . .)

Whatever the actual situation with avian flu (or MERS) in Egypt, with nearly every media flu report now carrying an official denial, it is pretty obvious the MOH is in full blown damage control mode. 

Their failure to maintain their MOH website and to provide daily bird flu updates (like they used to) has led to a huge information vacuum, one into which all manner of rumor, speculation, innuendo and fears now flow. 

All of which means that while we can still watch Egypt (and China, and Saudi Arabia) looking for signs of bird flu or MERS activity, we do so with a lot less confidence than we had only few short years ago.
  

In short, Caveat Lector.