#NatlPrep: Emergency Preparedness For Kids & Teens

 

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

 
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No matter where you live, if you've got kids, the odds they will have some sort of brush with an emergency or disaster over the next decade. Hopefully it will happen when they are with their parents, but it could happen at school, or other times when they are away from home. 

It could be an earthquake, severe weather, an active-shooter, or some other unexpected crisis. And while you can hope it never happens, the better choice is to make sure they are prepared to cope with it. 

Those of us of a certain age probably got our early initiation into preparedness in the boy or girl scouts, where we learned basic first aid, and what to do in an emergency.  Today, that is less likely to be the case.

Growing up in Florida, I got used to the `drill' of preparing for hurricanes at a very early age. I am also the product of the cold war, of the Cuban Missile Crisis (I was 8), of duck and cover drills, weekly CONELRAD alerts on TV, and films like Survival Under Atomic Attack and `Bert the turtle’ PSAs in elementary school.

It was, admittedly, a different time.  But it probably led me into an early career as an EMT (age 18) and Paramedic (age 20).  Not such a bad result, actually.

Today, while many threats remain, parents appear more reticent to discuss emergency preparedness with their kids. Fortunately, disaster preparedness – particularly for kids - has come a long way from the `bad old days’ of the cold war.

30 Second PSA

Ready.gov provides age appropriate tools for parents and teachers to teach emergency preparedness to both kids and teenagers. 

READY.GOV

While most parents want to protect their kids from undo worry - when a disaster threatens, it threatens all of us – regardless of our age. 

Helping kids to understand more about emergency preparedness and community resilience will help them cope (and perhaps, even help) in the event they, or their community, are caught up in a disaster.

ECDC: Avian Influenza Overview February – August 2019

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Epi Week 40, which this year began yesterday (Sunday Sept 29th), signals the start of the 2019-2020 flu reporting season for the CDC, as well for many other agencies in the Northern Hemisphere.

By the first week of October, the temperatures are growing cooler and the air drier, schools are back in session, and migratory birds - which have spent their summer roosting in the high latitudes - are moving south to warmer climes.

All ingredients that are associated with increased spread of flu - both in humans and in other species. The map above shows the spread of avian flu in Europe over the past 3 years. The impressive twin-peaked mountain (in green) signifies Europe's disastrous avian zoonotic of 2016-2017. 

The following year (2017-2018) is shown in orange, and this latest year (2018-2019) barely shows up as tiny blue blips.

If we were to look further back, to 2015-2016, it would look very much like this past year; with only a smattering of avian flu reports.  Quiescence - while  welcome - can change very quickly. 

As the chart above indicates, heavy bird flu seasons are often followed by one or more less active years, likely due (in part) to acquired immunity in wild birds, and enhanced biosecurity measures taken by poultry interests.

In 2015 - following North America's record HPAI H5 epizootic - we looked at a study (see PNAS: The Enigma Of Disappearing HPAI H5 In North American Migratory Waterfowl) which concluded that - while migratory waterfowl can briefly carry HPAI H5 - they were not a very good long-term reservoir for highly pathogenic avian flu viruses.

HPAI viruses, they posited, burned out fairly quickly in aquatic waterfowl populations - likely due to their immunity to LPAI viruses - and would therefore have to be reintroduced periodically.

A study, published in 2016 (see Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1), suggests that waterfowl pick up new HPAI viruses in the spring (likely from poultry or terrestrial birds) on their way to their summer breeding spots - where they spread and potentially evolve -  and then redistribute them on their southbound journey the following fall.

Meaning that what we see this fall in winter could well depend upon what avian viruses have been circulating among birds in the high latitudes over the summer, and will be carried south by migratory birds for the winter (see WHO: Migratory Birds & The Potential Spread Of Avian Influenza).

While we wait to see what this year's migratory season will bring, we've the ECDC's latest twice annual review of avian flu activity in Europe, which details (in a 38-page PDF) a very subdued avian flu landscape thus far in 2019.

Avian influenza overview February – August 2019

European Food Safety Authority,
European Centre for Disease Prevention and Control and
European Union Reference Laboratory for Avian Influenza

Cornelia Adlhoch, Alice Fusaro, Thijs Kuiken, Isabella Monne, Krzysztof Smietanka, Christoph Staubach, Irene Muñoz Guajardo and Francesca Baldinelli

Abstract

Between 16 February and 15 August 2019, five HPAI A(H5N8) outbreaks at poultry establishments in Bulgaria, two low pathogenic avian influenza (LPAI) A(H5N1) outbreaks in poultry in Denmark and one in captive birds in Germany, one LPAI A(H7N3) outbreak in poultry in Italy and one LPAI A(H7N7) outbreak in poultry in Denmark were reported in Europe.

Genetic characterisation reveals that viruses from Denmark cluster with viruses previously identified in wild birds and poultry in Europe; while the Italian isolate clusters with LPAI viruses circulating in wild birds in Central Asia. No avian influenza outbreaks in wild birds were notified in Europe in the relevant period for this report.

A decreased number of outbreaks in poultry and wild birds in Asia, Africa and the Middle East was reported during the time period for this report, particularly during the last three months. Furthermore, only six affected wild birds were reported in the relevant time period of this report. Currently there is no evidence of a new HPAI virus incursion from Asia into Europe. However, passive surveillance systems may not be sensitive for early detection if the prevalence or case fatality in wild birds is very low. 

Therefore, it is important to encourage and maintain passive surveillance in Europe encouraging a search for carcasses of wild bird species that are in the revised list of target species in order to detect any incursion of HPAI virus early and initiate warning. No human infections due to HPAI viruses - detected in wild birds and poultry outbreaks in Europe - have been reported during the last years and the risk of zoonotic transmission to the general public in Europe is considered very low.

       (SNIP)

Conclusions

Avian influenza outbreaks in European countries and in other countries of interest between 16 February and 15 August 2019

2.1. Main observations

• No human infections with HPAI or LPAI viruses of the same genetic composition as those currently detected in domestic and wild birds in Europe have been reported from the EU/EEA Member States.
• One human case caused by A(H5N1) in Nepal, two cases with A(H9N2) in China and Oman, one human case with A(H7N9) and one with A(H5N6) infection in China have been reported with onset of disease since February 2019.
• In Europe, between 16 February and 15 August 2019 (based on the Animal Disease Notification System (ADNS)):

– five HPAI A(H5N8) outbreaks were reported in poultry in Bulgaria; phylogenetic analysis revealed that the viruses cluster with A(H5N8) European viruses collected during the 2016-2017 epidemic;

– five LPAI outbreaks were reported: two A(H5N1) and one A(H7N7) in poultry in Denmark, one A(H7N3) in Italy, and one A(H5N1) in captive birds in Germany. Genetic characterisation of the Danish isolates showed that they cluster with LPAI viruses previously identified in wild birds and poultry in Europe. Phylogenetic analysis of the Italian isolate revealed that the virus clusters with LPAI viruses circulating in wild birds in Central Asia.

• No HPAI cases in wild birds were reported in Europe during this reporting period.

• Taking the half-year period of this report and the dates of notification into account, the number of reported outbreaks in domestic birds for Asia, Africa and the Middle East was lower than in the previous time period, particularly during the last three months. Furthermore, only six infected wild birds were reported in the relevant time period for this report.

2.2. Conclusions

• The risk of zoonotic transmission of AI viruses to the general public in Europe remains very low.
• In the current 2018–2019 season (from October 2018 to August 2019), compared with the previous 2017–2018 season (from October 2017 to September 2018), there is a decreased number of reported outbreaks in poultry in Europe.
• No cases of HPAI virus infection were reported in wild birds from key areas in Mongolia, western China, or Siberia; in previous years, such reports foreshadowed the incursion of HPAI virus in Europe via the autumn migration of wild birds.
• During the period for this report in the EU/EEA, there has been no evidence of any new HPAI virus incursion from Asia. However, passive surveillance systems may not be sensitive for the early detection of new incursion if the case fatality rate in wild birds is very low.

(Continue . . . )

Major avian flu epizootics - such as visited North America over 2014-2015 and Europe over 2016-2017 - have been very limited outside of China and Southeast Asia, and we have very little data to tell us how often they might reoccur.

Hopefully this year will be just as quiet as the last. But if we know one thing about influenza viruses, it is that they are unpredictable.  And so we'll have to be alert this winter once again for any surprises.

BioRxIv: Avian H3N8 With Multiple Mammalian-Adaptive Mutations in a Rescued Grey Seal

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Human influenza pandemics over the past 100+ years are all believed to have stemmed from either H1, H2, or H3 viruses (see chart above). While the historical records suggest dozens of pandemics before that, those subtypes are lost to history.

The progression of human influenza pandemics over the past 130 years appears to have been H2, H3, H1, H2, H3, H1, H1 . . .

Although the next pandemic could break this repeating pattern - and come from an exotic avian H5, H7, or H10 virus - it makes sense to keep a close eye on the known repeat offenders.

H1, H2, and H3 viruses all circulate in birds, and somewhat infamously in swine, and are constantly evolving.  The 2009 H1N1 pandemic virus circulated in pigs for more than a decade before jumping species to spark the last pandemic. 

Other mammals host these subtypes as well, including dogs (H3N2 & H3N8) and horses (H3N8).

We've looked at the pandemic potential of both equine and canine influenza many times in the past, most recently:

EID Journal: Equine Influenza - A Neglected, Reemergent Disease Threat

Equine H3N8: Looking At A long-shot In The Pandemic Sweepstakes

Emerg. Microbes & Inf.: Genetic & Evolutionary Analysis of Emerging Canine H3N2

Emerg. Microbes & Infect.: Virulence, Transmissibility & Evolution of Canine H3N2 Influenza Viruses

While less well known, seals are also susceptible to a wide variety of influenza infection (see Emerg. Microbes & Inf.: Prevalence Of Influenza A in North Atlantic Gray Seals). 

• During the winter of 1979-1980 seals were found suffering from pneumonia on the Cape Cod. In that instance, the culprit turned out to be an H7N7 influenza. (see Isolation of an influenza A virus from seals G. Lang, A. Gagnon and J. R. Geraci)
• In November of 2011, we saw a die off of seals in New England that was eventually determined to be due to a  Mammalian Adapted avian H3N8 virus.
• In 2013 we saw a report (and a study) from UC Davis showing the human 2009 pandemic H1N1 virus had jumped to wild California Elephant Seals just one year after that virus emerged (see The 2009 H1N1 Virus Expands Its Host Range (Again)).
• The biggest incident we've seen, however, came in northern Europe (mostly Denmark and Germany & Sweden) in 2014, when as many as 3,000 harbor seals  reportedly died from avian H10N7 (see Avian H10N7 Linked To Dead European Seals), prompting warnings to the public not to touch seals.

These seal outbreaks have been of particular interest as they've often involved influenza subtypes (H7N7, H3N8, H10N7, H1N1) that have infected humans in the past, and in some cases the viruses they carry have shown signs of increased mammalian adaptation.   

Although the opportunities for human-seal contact are fewer than with canine or equine species, seals are far from a dead end host, making their suitability as a host for a pandemic virus of genuine interest, if not concern.

All of which brings us to a pre-print article in BioRxiv from earlier this month that looks at the detection of an avian H3N8 virus - with mammalian adaptations - in a rescued grey seal from 2017.

The full paper - which is very much worth reading - can be accessed at the link below.  I've only posted the Abstract.   I'll have a postscript when you return.

Detection of H3N8 influenza A virus with multiple mammalian-adaptive mutations in a rescued Grey seal (Halichoerus grypus) pup

Divya Venkatesh, Carlo Bianco, Alejandro Núñez, Rachael Collins, Darryl Thorpe, Scott M. Reid, Steve Essen, Natalie McGinn, James Seekings, Jayne Cooper, Ian H. Brown, Nicola S. Lewis
doi: https://doi.org/10.1101/741173
This article is a preprint and has not been certified by peer review [what does this mean?].

Preview PDF

ABSTRACT

Avian Influenza A Viruses (IAV) in different species of seals display a spectrum of pathogenicity, from subclinical infection to mass mortality events. Here we present an investigation of avian IAV infection in a 3-4 month old Grey seal (Halichoerus grypus) pup, rescued from St Michael’s Mount, Cornwall in 2017.

The pup underwent medical treatment, but died after two weeks; post-mortem examination and histology indicated sepsis as the cause of death. IAV NP antigen was detected by immunohistochemistry in the nasal mucosa, and sensitive real-time reverse transcription polymerase chain reaction assays detected trace amounts of viral RNA within the lower respiratory tract, suggesting that the infection may have been cleared naturally. IAV prevalence among Grey seals may therefore be underestimated.

Moreover, contact with humans during the rescue raised concerns about potential zoonotic risk. Nucleotide sequencing revealed the virus to be of subtype H3N8. Combining a GISAID database BLAST search and time-scaled phylogenetic analyses, we inferred that the seal virus originated from an unsampled, locally circulating (in Northern Europe) viruses, likely from wild Anseriformes.

From examining the protein alignments, we found several residue changes in the seal virus that did not occur in the bird viruses, including D701N in the PB2 segment, a rare mutation, and a hallmark of mammalian adaptation of bird viruses. IAVs of H3N8 subtype have been noted for their particular ability to cross the species barrier and cause productive infections, including historical records suggesting that they may have caused the 1889 pandemic.

Therefore, infections such as the one we report here may be of interest to pandemic surveillance and risk, and may help us better understand the determinants and drivers of mammalian adaptation in influenza.

        (Continue . . . )


Most of the influenza's evolution goes on out of our sight, and without our knowledge.  Despite billions of attempts, nearly all of these genetic field experiments will fail, as most of these mutated viruses are unable to compete against established strains.

A few times each century, however, this rolling of the genetic dice produces a new, and biologically `fit' virus against which humans have little or no immunity, and another pandemic erupts. 

So obscure or not, we monitor emerging viruses like this one with considerable interest.   

OIE: African Swine Fever Arrives In Timor-Leste

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The African Swine Fever juggernaut continues to roll across Asia, with the 10th nation - East Timor - reporting its arrival in the past 11 months. This represents a geographic jump of anywhere from 1500 km (from the Philippines) to nearly 2000 km (from Vietnam), and brings it uncomfortably close (400km) to Australia. 

ASF doesn't cross oceans without the help of humans, who may carry it via contaminated food products, exported contaminated feed, or even on their shoes or clothing, to new regions.

How ASF Spreads

Yesterday, the Timor-Leste Council of Ministers issued this (translated) press release:

Extraordinary meeting of the Council of Ministers of 27 September 2019

Presidency of the Council of Ministers
VIII Constitutional Government
.............................................................................................................................

Press release

The Council of Ministers met at the government Palace in Dili and approved the government decree, presented by the Minister of Petroleum and Minerals in office, Agio Pereira and the National Petroleum and Minerals Authority of Timor-Leste (ANPM), which regulates the Procedure concerning the allocation of areas of the territory of Timor-Leste to research and oil production activities.

The analysis of the Government's resolution on the authorisation to open public tenders for the conclusion of petroleum contracts was also continued, with a view to carrying out research and oil production activities under the law of Petroleum activities and the regulation of petroleum public procurement.

The Minister of Agriculture and Fisheries in office, Fidelis Leite Magalhães, made a presentation to the Council of Ministers on the disease that has caused the deaths of hundreds of pigs in the country. Samples were taken from these animals and sent for laboratory analysis in Australia confirming that these animals suffer from African swine fever. This disease is highly contagious among animals, not producing effects on humans and has affected several Asian countries. The Ministry of Agriculture and Fisheries, in collaboration with the Government of Australia, has taken all necessary measures to limit the effects of this outbreak, for which there is still no remedy, cure or vaccine. End

The OIE published the following notification, indicating 100 outbreaks in this tiny nation, starting roughly 3 weeks ago.

So far, African Swine Fever has never been reported in North America, but today's report reminds us that wide oceans only provide a limited amount of protection.

Last May, in USDA Enhances Domestic ASF Surveillance Efforts, we looked at plans for enhanced testing and surveillance for ASF in American pigs, in hopes of detecting - and stamping out - any infections as early as possible.

The USDA also recently released a 28-page ASF response plan, in the event  the virus turns up on American soil.

While ASF poses no direct threat to human health, it can be devastating to pork production, and - particularly in food insecure regions - potentially lead to social, political, and economic instability. 

WHO Announces 2 Strain Changes For 2020 Southern Hemisphere Flu Vaccine

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Last February - when the WHO normally decides on which strains to put in this  fall's Northern Hemisphere vaccine - they opted to delay their decision on the H3N2 component for 30 days (see WHO: (Partial) Recommended Composition Of 2019-2020 Northern Hemisphere Flu Vaccine).

At issue was the sudden rise of H3N2 clade 3C.3a reported in North America (and other places), which had started last fall's season as a minor component of what appeared on track to being a relatively mild H1N1 season.

By early 2019 we'd switched into a moderately severe H3N2 season with clade 3C.3a leading the pack (see CDC HAN #0418: Influenza Season Continues with an Increase in Influenza A(H3N2) Activity).

In late March the WHO decided to switch to the surging Clade 3C.3a H3N2  virus, betting that it would become the dominant H3 strain worldwide by this fall. 

Only, that doesn't appear to have happened.  At least, not yet.

Three weeks ago in the latest ECDC Influenza surveillance report (see Influenza Virus Characterisation, July 2019), I noted that H3N2 clade 3C.3a  - while rising slightly compared to the June report - had yet to take off in Europe as it did last winter in North America.  Nor did it dominate Australia's now receding 2019 flu season.

While it is still possible H3N2 clade 3C.3a could break bad again this winter - right now clade 3C.2a1b viruses continue to dominate globally - and that poses a couple of immediate concerns.

• First, this fall's Northern Hemisphere's flu vaccine may not provide as good of a match to the circulating H3N2 viruses as originally hoped. 

• Second, given the six month lead time needed for vaccine production, decisions must be made now about what H3 clade to include in next year's Southern Hemisphere vaccine.

Welcome to the maddening, high stakes game of trying to figure out what a growing array of global influenza viruses will do 6 to 12 months in the future.  And be very glad it isn't your job to make these decisions.
 
This week the World Health Organization brought together representatives from GISRS (Global Influenza Surveillance and Response System), along with members of OFFLU (the OIE/FAO Network on Animal Influenza), and other experts to recommend what flu strains to include in next year's Southern Hemisphere flu vaccine.

I've reprinted their summary (changed strains I've highlighted in red). I'll have a bit more after the break:

Recommended composition of influenza virus vaccines for use in the 2020 southern hemisphere influenza season

27 September 2019

It is recommended that quadrivalent vaccines for use in the 2020 southern hemisphere influenza season contain the following:

• an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
• an A/South Australia/34/2019 (H3N2)-like virus;
• a B/Washington/02/2019-like (B/Victoria lineage) virus; and
• a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.
  

It is recommended that trivalent influenza vaccines for use in the 2020 southern hemisphere influenza season contain the following:

• an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
• an A/South Australia/34/2019 (H3N2)-like virus; and
• a B/Washington/02/2019-like (B/Victoria lineage) virus.
  

For more information

27 September 2019: Recommended composition of influenza virus vaccines for use in the 2020 southern hemisphere influenza season - full report pdf, 496kb

The failure of clade 3C.3a to dominate as expected raises the possibility that - once again - we'll have a less-than-stellar vaccine against H3N2 flu this winter.  But this is but one of four strains included in the vaccine, and H3N2 may not dominate this year's flu season. 

Good H3N2 match or not, I'm glad I've got my shot already, as even a poorly matched vaccine can provide some protection.

H3N2 - which arrived as a pandemic strain in 1968 - has been in circulation now for more than 50 years. Over that time it has had to reinvent itself innumerable times (via antigenic drift) to evade acquired immunity, resulting in an increasing number of subclades of the virus co-circulating around the globe.

As our global society becomes increasingly mobile in this 21st century, so too do the viruses we carry. While this has obvious pandemic implications, it also makes seasonal flu more volatile, complex, and unpredictable. 

As influenza viruses become more antigenically diverse, the job of picking viruses to include in next season's flu vaccine will only become more difficult.

Credit NIAID

All of which makes the development of a`universal' flu vaccine (see J.I.D.: NIAID's Strategic Plan To Develop A Universal Flu Vaccine) of greater importance than ever.

We should see the WHO's twice-annual zoonotic flu vaccine recommendations released shortly.

South Korea: 2 New ASF Outbreaks (n=9) - Others Farms Being Tested

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It's been 10 days since African Swine Fever was first reported in South Korea, and as of today, 9 farm outbreaks - all the northwestern part of the nation near their border with South Korea - have been confirmed. 

While ASF poses no human health threat, it can be devastating to the pork industry, and none of the other 8 Asian nations struck by the disease in the past 13 months have been able to arrest its spread.

The South Korean Agriculture Ministry website (MAFRA) shows a flurry of activity today, with no less than  5 ASF related press releases. A number farms are reporting unusual mortality or illness and are being tested, but two new farms have been confirmed over the past 24 hours.

Note: Machine translators don't always provide the best syntax.  Reporting `voice'  is indicative of a negative test result.

September 26 report suspicious axis pig farm inspection results in two places, one place is determined voice, one position confirmed African swine fever

(ASF)27.09.2019 09:27:52 Defense Policy Bureau

□ Agriculture, Forestry, Animal Husbandry and Food is 9 Mon. 26 days doubts axis overhaul of Agriculture, Forestry and Livestock Quarantine Office on the results reported cases ,

○ games Yangzhou ④ eunhyeonmyeon material pig farm 1 points (550 funnel breeding ) voice has been determined to be

○ Incheon Ganghwa ⑤ hajeommyeon material pig farm 1 points (2,000 funnel breeding ) African swine fever (ASF) today announced that confirmed .

* Domestic ASF diagnosis : a total of 9 cases ( today 1, 旣occurred 8)

1) 9.16 days Report - Gyeonggi Paju material pig farms (9.17 days confirmed )

2) 9.17 days Report - Gyeonggi-do Yeoncheon County pig farm material (9.18 days confirmed )

3) 9.23 days Report - Gyeonggi Gimpo material pig farms (9.23 days confirmed )

4) 9.23 days to report - Gyeonggi Paju material pig farms (9.24 days confirmed )

5) 9.23 days Forecasting - Incheon Ganghwa material pig farms (9.24 days confirmed )

6) 9.25 days to report - Incheon Ganghwa material pig farms (9.25 days confirmed )

7) 9.25 days Forecasting - Incheon Ganghwa material pig farms (9.26 days confirmed )

8) 9.26 days Report - Incheon Ganghwa material pig farms (9.26 days confirmed )

9) 9.26 days Report - Incheon Ganghwa material pig farms (9.27 days confirmed )

□ agri-food section thoroughly disinfected, such as for livestock farms and official quarantine measures and rapid implementation report suspicious axis ( ☏ 1588-9060 / 4060) advised the it was .

Saudi MOH: 2 MERS Cases In Epi Week 39

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Reported MERS cases from Saudi Arabia have dropped off considerably over the summer, with just 6 cases reported in August, and - as of today's report - only 3 so far in September.   

Two of those three have come, however, in the past 72 hours.

There are questions, however, over just how sensitive the Saudi surveillance system really is, and the assumption is a good many - perhaps even most - cases go undetected.

• In November of 2013, we looked at a study published in The Lancet Infectious Diseases, that estimated for every case identified, there are likely 5 to 10 that go undetected. 
• In 2015, when Saudi Arabia had recorded fewer than 1200 MERS cases, a seroprevalence study (see Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study by Drosten & Memish et al.,) suggested nearly 45,000 might have been infected.  
• A 2016 study (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016) suggested that as much as 60% of severe Saudi MERS cases go undiagnosed. 
• Just over a year ago, in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients, we looked at a study of the Saudi MERS triage system - to decide who to isolate and test as a potential  case - that found it severely lacking. 

The Saudis have scaled back the information they provide in their daily updates, but we know both cases are listed as `primary cases', are male (ages 74 & 41), and have unknown recent camel contact.

For now, these appear to be community-acquired cases, from an unknown source.

While MERS-CoV hasn't taken off the way that SARS did 16 years ago, we've seen studies (see A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) suggesting the virus doesn't have all that far to evolve before it could pose a genuine global threat.

So we watch these daily announcements closely, looking for any signs that the pattern is changing. 

CDC Update On Acute Lung Injuries LInked To Vaping (Sept 26th)

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Six weeks ago  the CDC announced an investigation into unexplained acute pulmonary illnesses being reported in dozens of people using e-cigarettes (see CDC Clinical Action: Unexplained Vaping-Associated Pulmonary Illness).

Since then, we've followed a series of CDC announcements and guidance to the medical community designed to quantify the size and scope of this illness. Including:

CDC COCA Call  - Severe Lung Illness Associated with Using E-Cigarette Products 

CDC MMWR Early Release: Acute Lung Injury LInked To Vaping
  CDC : Outbreak Investigation & Telebriefing On Pulmonary Disease Linked To Vaping

In the wake of the growing alarm over reports of serious illness linked to e-cigs, several states (including Michigan, New York) have moved to ban flavored `vape juice', or - in the case of Massachusetts - e-cigs completely.

Earlier this month the Federal government has announced their intent to ban `flavored' vape products that have a high appeal to a younger  market. Exactly when these new restrictions will go into effect has yet to be announced.

Yesterday afternoon the CDC updated their outbreak surveillance number, which have more than doubled over the past two weeks.

Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping

Español (Spanish)

Posted September 26, 2019 at 1:00pm ET

CDC, the U.S. Food and Drug Administration (FDA), state and local health departments, and other clinical and public health partners are investigating a multistate outbreak of lung injury associated with e-cigarette product (devices, liquids, refill pods, and/or cartridges) use.

Key Facts about E-Cigarette Use, or Vaping

• Electronic cigarettes – or e-cigarettes — are also called vapes, e-hookahs, vape pens, and electronic nicotine delivery systems (ENDS).
• Using an e-cigarette product is commonly called vaping.
• E-cigarettes work by heating a liquid to produce an aerosol that users inhale into their lungs.
• The liquid can contain: nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances and additives.

What we know

• There have been 805* cases of lung injury reported from 46 states and 1 U.S. territory. Twelve deaths have been confirmed in 10 states.
• CDC has received complete sex and age data on 373 cases.
  • Nearly three fourths (72%) of cases are male
  • Two thirds (67%) of cases are 18 to 34 years old
  • 16% of cases are under 18 years
  • 38% of cases are in people under 21 years
  • 17% are 35 years or older
• All reported cases have a history of e-cigarette product use or vaping.
• Based on initial data from certain states we know: Most patients have reported a history of using e-cigarette products containing THC. Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.

What we don’t know

• We do not yet know the specific cause of these lung injuries. The investigation has not identified any specific e-cigarette or vaping product (devices, liquids, refill pods, and/or cartridges) or substance that is linked to all cases.

What CDC recommends

• CDC has released interim recommendations for healthcare providers, health departments, and the public.
• Until we know more, if you are concerned about these specific health risks, CDC recommends that you consider refraining from using e-cigarette or vaping products.
• If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
• If you have recently used an e-cigarette or vaping product and you have symptoms like those reported in this outbreak see a healthcare provider.
• Regardless of the ongoing investigation:
• • Anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer.
  • Youth and young adults should not use e-cigarette products.
  • Women who are pregnant should not use e-cigarette products.
  • Adults who do not currently use tobacco products should not start using e-cigarette products.

 (Continue . . .)

Despite the negative publicity in the United States, in the UK vaping is still being touted by the NHS as a `healthier' alternative to smoking tobacco products (see PHE publishes independent expert e-cigarettes evidence review).

Although `vaping' is highly discouraged for non-smokers, the NHS e-cig website states:

E-cigarettes

An estimated 2.9 million adults in Great Britain currently use e-cigarettes and of these, 1.5 million people have completely stopped smoking cigarettes. They carry a fraction of the risk of cigarettes and can be particularly effective when combined with extra quitting support.

While it may take months or even years to unravel the cause - and the extent - of these `vaping-linked' lung injuries, increasingly it's looking like buying a vape shop might not be your best investment opportunity.

South Korea Extends Stop Movement Order As More ASF Is Confirmed

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On Tuesday of this week - when South Korea's outbreak count was still only 4 farms -  MAFRA ordered a 48-hour standstill on all pig farms and feed factories on Tuesday in hopes of containing this outbreak.  

In just two days that number has nearly doubled (n=7) - with several additional farms currently under investigation - which has forced MAFRA to extend the stop movement order for at least another 48 hours. 

The success in containing ASF by other countries around the world has been dismal at best, and so MAFRA well understands the importance of curbing its spread early.

We've 2 (translated) reports from South Korea's Ministry of Agriculture this morning.  First on the 48 hour extension.

48-hour extension of temporary suspension order for nationwide defense measures

2019.09.26 13:17:41 Prevention Policy Bureau

The Ministry of Agriculture, Food and Rural Affairs (Minister: Kim Hyun-Su, Ministry of Agriculture, Food and Rural Affairs) announced on September 9.

❍ African swine fever (ASF) has been added to pig farms in Ganghwa-gun, Incheon, and the government has confirmed that it has extended its 48-hour suspension of movement order.

* (Original) 9.24 (Tue) 12: 00 ~ 9.26 (Thursday) 12 o'clock → (Extended) 9.26 (Thursday) 12 ~ 9.28 (Sat) 12 o'clock

❍ The target is the same for pig farms, slaughterhouses, and entrance vehicles throughout the country.

Currently, we are strengthening the quarantine management by expanding the key management areas, disinfecting pig farms and border areas in Japan, and establishing farm posts.

❍ As a result of joint inspections by the Ministry of Agriculture, Food and Rural Affairs and Forest Service, some of the deficiency measures were found to be insufficient.

❍ At the same time, it was emphasized that all farmhouses and livestock facilities in the country would complete all quarantine measures during that period.

During the temporary suspension order, the central joint inspection team will check the overall status of implementation of the suspension order and guide the implementation status of the operation of the base disinfection facility and compliance with the quarantine measures.

Next, confirmation of the 7th infected farm reported over the past 9 days.

Confirmed 1st pig farm in Ganghwa-gun and confirmed 1st pig farm in Yangju-si, Yeoncheon-gun and Ganghwa-gun

    2019.09.26 14:40:46 Bureau of Defense Policy

□ The Ministry of Agriculture, Food and Rural Affairs conducted a thorough inspection at the Ministry of Agriculture, Food and Rural Affairs and Quarantine Headquarters on Sept. 25 for a pig farm in Samsan-myeon, Ganghwa-gun, Incheon on September 25. Confirmed,

Two farm pigs were found to have been killed (no other farm within 3 km).  

* Confirmation of domestic ASF: 7 cases (1 today, 6 cases occurred)

1) Reported on September 16-Pig farm in Paju, Gyeonggi-do (confirmed on September 17)

2) Reported on September 17-Pig Farm in Yeoncheon-gun, Gyeonggi-do (confirmed on September 18)

3) Reported on September 23-Pig Farm in Gimpo, Gyeonggi-do (confirmed on September 23)

4) Report on 9.23-Pig Farm in Paju, Gyeonggi-do (confirmed on September 24)

5) 9/23 Prediction-Pig Farm in Ganghwa-gun, Incheon (confirmed on September 24)

6) Report on 9.25-Pig Farm in Ganghwa-gun, Incheon (confirmed on September 25)

7) 9.25 Day Forecast-Pig Farm in Ganghwa-gun, Incheon (confirmed on September 26)

□ On the other hand, suspicious symptom (1 pig head dead) in 1 pig farm in Cheongsan-myeon, Cheonsan-myeon, Gyeonggi-do is Yeoncheon-si, and abnormal symptom in 1 pig farm (714 head breeding) in Eunhyeon-myeon, Yangju-si. Two companies were reported to Yangju, respectively.

○ One pig farm in Ganghwa-eup, Ganghwa-eup, Incheon, reported that they had reported abnormal symptoms (such as one pig fattening) during the telephone forecasting process of the Livestock Hygiene and Defense Support Headquarters.

□ The Ministry of Agriculture, Food, and Rural Affairs has sent a team of defense workers to the farms immediately after receipt of the report.

○ The farmers were asked to implement thorough quarantine measures such as disinfection and prompt report of suspicion (☏1588-9060 / 4060).

South Korea is the 9th Asian Nation to report the arrival of African Swine Fever since August of 2018.  Losses in China, Vietnam, Mongolia, North Korea, Laos, and Cambodia have run into the tens . . . if not hundreds . . . of millions of pigs. 

Taiwan, Japan, Thailand, and India are all on alert as this ASF juggernaut inexorably spreads across Asia.

So far, African Swine Fever has never been reported in North America, but the illegal movement of ASF contaminated food products, animal feed, and other products from affected areas remains a constant threat.

Last May, in USDA Enhances Domestic ASF Surveillance Efforts, we looked at plans for enhanced testing and surveillance for ASF in American pigs, in hopes of detecting - and stamping out - any infections as early as possible.

The USDA also recently released a 28-page ASF response plan, in the event  the virus turns up on American soil.

While ASF poses no direct threat to human health, it can be devastating to pork production, and - particularly in food insecure regions - potentially lead to social, political, and economic instability. 

Norway Veterinary Institute Update On Unknown Disease Killing Dogs

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Sixteen days ago we looked at initial reports of an unidentified disease sickening, and killing, dogs in Norway.  FluTrackers has been following this story closely, gathering and translating nearly a dozen reports since the  outbreak began in early September.

Despite performing necropsies and extensive lab tests, the cause of this outbreak has yet to be determined.  Thus far, no similar reports have come from outside of Norway.

As of the latest report, more than 200 dogs have been affected, and at least 43 have died.  It isn't clear whether this is an infectious disease, or due to an environmental exposure or food contaminant.

This (translated) update from Norway's Veterinærinstituttet.

Acute dog disease in September 2019 - this we know

On this page you will find what we know at the moment of acute illness in dogs with severe diarrhea and malaise. The page will be updated when we have new information to share.

Latest update with new information: 25 September 10:45

News updated on 25 September

Announced today the FSA about six new cases of sick dogs since yesterday. Cases of West College (2), Netherlands, Hedmark and Akershus (2).

Yesterday they received two new reports of dogs that have similar symptoms of illness. The two new cases are from Akershus and Hordaland.

These are cases that are reported directly to the Food Safety Authority, and not as feedback via the questionnaire sent out to veterinarians. Survey shows so far that it has been up to 200 cases with similar symptoms in dogs, of varying severity, since 1 August. At last count, there were 173 of these cases through the survey dogs with bloody diarrhea.

See county list below We know this by the FSA.

FSA has estimated that up to 43 dogs with similar symptoms of illness are dead.

Veterinary Institute survey in cooperation with the FSA and NMBU Veterinary Science shows that there are nearly 90 different breeds of dogs and dogs of all ages who have had similar symptoms.

Veterinary Institute has autopsied 15 dogs up to and including 24 September. In twelve of these so far have found ample presence of the bacterium Providencia alcalifaciens which is known to induce diarrhea (though not so powerful that it should lead to death).

A dog from Oslo is received for a new autopsy on September 25.

Latest news item : Last updated status is this page (updated on September 25). Latest news item is Status regarding acute dog disease Thursday, 09/20/2019

Information for veterinarians and clinics

• Veterinarians can find information about submitting samples in connection with outbreaks of disease in dogs as well as advice on infection protection at the Food Safety Authority's website.

• Veterinarians find treatment guidance in acute hemorrhagic enteritis prepared by NMBU Veterinary Science Small Animal Clinic.

• Infection Routines from small animals clinic at NMBU Veterinary Science

For now, and until a definitive cause can be determined, authorities are giving the following advice to dog owners.

Ongoing outbreak of disease in dogs

Last Modified 25/09/2019 

Food Safety Authority's advice to dog owners

• Limit close contact with other dogs, but make sure your dog gets the aeration and the exercise it needs.
• Accumulations of dogs should be avoided, or implemented in a manner that allows contact between dogs is limited.
• Do not let your dog greet or sniff other dogs for a walk.
• Pick up the stool after your dog and dispose of it in a dustbin.
• Prevent the dog sniff or eat things into the ditch where other dogs have been.
• Contact your veterinarian if you notice bloody diarrhea, vomiting, and quickly weakened general condition of your dog.
• Call your vet before you bring acutely sick dog to the clinic.
• Follow vaccine recommendations vet provides.

Questions and Answers - What you should know that the dog owner

CDC COCA Call Today: Recommendations for Influenza Prevention and Treatment in Children

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Although it is only late September, we're starting to see scattered reports of flu around the country - including 2 deaths reported this week in California. Flu viruses circulate year-round, but become far more prevalent in the fall and winter months.

This week I rolled up my sleeve for the 15th consecutive year to get my seasonal jab, and am hopefully now building an army of antibodies to help protect me through the winter.

While far from perfect - given the moderate effectiveness of the quadrivalent seasonal flu against both influenza B lineages - it makes sense to grab whatever protection I can get. Much like always wearing seat belts when I'm in my car; it may not guarantee  I'll walk away form a wreck, but it undoubtedly increases my chances.

And as I've recently reached that dreaded `elderly' demographic, avoiding the flu may also prevent a variety of serious - potentially fatal - cardiovascular complications (see Study Suggests Flu Vaccine May Lower Stroke Risk in Elderly ICU Patients).

The flu can be devastating for the youngest and healthiest among us as well. The CDC singles out Children under 5 (and especially under the age of 2) as being particularly at risk.

Influenza is dangerous for children

Flu illness is more dangerous than the common cold for children. Each year, millions of children get sick with seasonal flu; thousands of children are hospitalized and some children die from flu. Children commonly need medical care because of flu, especially children younger than 5 years old who become sick with flu.
Complications from flu among children in this age group can include:

• Pneumonia: an illness where the lungs get infected and inflamed
• Dehydration: when a child’s body loses too much water and salts, often because fluid losses are greater than from fluid intake)
• Worsening of long-term medical problems like heart disease or asthma
• Brain dysfunction such as encephalopathy
• Sinus problems and ear infections
• In rare cases, flu complications can lead to death.
• Flu seasons vary in severity, however every year children are at risk
• CDC estimates that since 2010, flu-related hospitalizations among children younger than 5 years ranged from 7,000 to 26,000 in the United States.
• While relatively rare, some children die from flu each year. Since 2004-2005, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 deaths to 186 deaths. Information about pediatric deaths since the 2004-2005 flu season is available in the interactive pediatric death web application.

The chart below shows the pediatric flu-related deaths reported over the past 4 years.  As tragic as these numbers are, they likely represent but a portion of the true burden each year.

Later today the CDC will hold a COCA Call for pediatric providers to update them on the latest prevention and treatment recommendations for children. Primarily of interest to clinicians and healthcare providers, these calls are  designed to ensure that practitioners have up-to-date information for their practices.

2019–2020 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers

Date: Thursday, September 26, 2019
Time: 2:00pm-3:00pm (Eastern Time)

Influenza remains a serious threat to children due to its potential to cause significant morbidity and mortality. More than 125 influenza-associated deaths in children were reported to the Centers for Disease Control and Prevention (CDC) during the 2018–2019 influenza season.

Clinicians play a critical role in taking action to immunize children, the children’s family members and caregivers, and themselves. The early use of antivirals in children can reduce the duration of symptoms and prevent serious complications of influenza. However, immunization remains the most effective way to prevent influenza illness and its complications, including death.

During this COCA call, subject matter experts from the American Academy of Pediatrics (AAP) and CDC will discuss strategies pediatric providers can use to improve influenza prevention and control in children for the 2019–2020 influenza season.

If you are unable to attend this live COCA Call, it will be available on-demand a few days after the call. Free continuing education (CE) will be available until October 2021.

South Korea MAFRA Confirms 6th African Swine Fever Outbreak

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Yesterday morning the count stood at 4 confirmed farm outbreaks of African Swine Fever since it was first detected just over a week ago in South Korea. Today, that number rises to 6.

Three farms were suspected, but two tested negative (`voice verdict').

MAFRA - which has extensive experience dealing with outbreaks of both avian flu and FMD - ordered a 48-hour standstill on all pig farms and feed factories on Tuesday in hopes of containing this outbreak. 

While ASF poses no human health threat, it can be devastating to the pork industry, and none of the other 8 Asian nations struck by the disease in the past 13 months have been able to arrest its spread.

This (translated) statement was just recently posted on MAFRA's website.

Press Releases

On September 25, asf suspected axis report confirmed one of the three pig farms, two of them voice verdict, press release 

(9.25, at the time of distribution)
23:30:10 23:30:10 2019.09.25

On September 25, one of the three pig farms reported suspected axis of suspicion, one of the African pig fever (ASF) confirmed, and two places were confirmed by voice

□ The Ministry of Agriculture, Forestry and Livestock and Food conducted an overhaul conducted by the Ministry of Agriculture, Forestry and Livestock Quarantine department on September 25 for two pig farms in Incheon Fortified County and one pig farm in Yeoncheon County, Gyeonggi Province.

○ One pig farm (830 pigs bred) in the cotton of the Fortified Army has been confirmed as african pig fever (ASF),

○ One pig farm in Yeoncheon County,Misan cotton (950 breeding) and one pig farm (1,006 pigs breeding) in Fortified County were each judged by voice.

* Domestic ASF confirmation: 6 cases in total (1 on Friday, 5)

1) 9.16 Days Report - Pig Farm in Paju, Gyeonggi Province (9.17 days confirmed)

2) 9.17-Day Report - Pig Farm in Yeoncheon County, Gyeonggi Province (confirmed 9.18 days)

3) 9.23-Day Report - Pig Farm in Gimpo City, Gyeonggi Province (9.23 days confirmed)

4) 9.23-Day Report - Pig Farm in Paju, Gyeonggi Province (9.24 days confirmed)

5) 9.23-Day Inspection - Pig Farm in Incheon City Fortified Army (9.24 days confirmed)

6) 9.25-Day Report - Pig Farm in Incheon City Fortified County (9.25 days confirmed)

□ The Ministry of Agriculture and Food has asked livestock farmers and officials to implement thorough prevention measures such as disinfection and prompt report on suspected livestock (☏1588-9060 / 4060).

On September 25, asf suspected pig farms were confirmed, two of them were confirmed by voice, press release (9.25, at distribution).hwp (file capacity: 297 KB)

On September 25, asf suspected axial report confirmed one of the three pig farms, two of them voice verdicts, press releases (9.25, at distribution).pdf (file capacity: 131 KB)

On September 25, the Ministry of Agriculture, Forestry and Livestock and Food confirmed one of the three asf suspicious axis report pig farms, two of which were voice-judged, and the press release (9.25, at the time of distribution) work may be used in accordance with the terms and conditions of the "Public Service" source indication.

Previous posts

One suspected farmer was found at one pig farm in Yeoncheon County, Gyeonggi Province, during the report of suspected African pig fever (ASF) and the inspection of a pig farm in Incheon Fortified County.

FDA Approves 1st live, Non-replicating Vaccine to Prevent Smallpox & Monkeypox

Geographic Range of Monkeypox - Credit WHO

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In this year's  CDC: 8 Zoonotic Diseases Of Most Concern In The United States, Monkeypox ranks 29th; about halfway down their list.  Similarly, in 2018's WHO List Of Blueprint Priority Diseases - while Monkeypox did not make the final list (n=8) - it was mentioned as a disease to watch.

Human monkeypox was first identified in 1970 in the DRC, and since then has sparked small, sporadic outbreaks in the Congo Basin and Western Africa. It produces a remarkably `smallpox looking' illness in humans, albeit not as deadly. The CDC's Monkeypox website states:

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease.

Human-to-human transmission is also possible.  This from the CDC’s Factsheet on Monkeypox:

The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.

According to the CDC there are two distinct genetic groups (clades) of monkeypox virus—Central African and West African. West African monkeypox - which has been spreading recently in Nigeria - is associated with milder disease, fewer deaths, and limited human-to-human transmission.

Currently, there is an ongoing Monkeypox outbreak in the DRC (see WHO AFRO Outbreaks and Emergencies Bulletin).

Since the beginning of 2019, a cumulative total of 3 969 monkeypox cases, including 68 deaths (CFR 1.8%) were reported from 111 health zones in 16 provinces. In week 35 (week ending 1 September 2019), 113 cases and four deaths were reported nationally and majority of cases were reported from Kole Health zone in Sankuru

Nigeria reported its first Monkeypox outbreak in nearly 40 years in the fall of 2017, while last fall the UK saw two imported cases from Nigeria (see Eurosurveillance Rapid Comms: Two cases of Monkeypox imported to the UK) and a month later Israel: MOH Confirmed An Imported Monkeypox Case).

More recently, in May of this year Singapore's MOH announced their 1st Imported Case Of Monkeypox (ex Nigeria). Nigeria apparently continues to see sporadic transmission of the Monkeypox virus, but hasn't released an updated Sitrep since January of this year (see Monkeypox Outbreak in Nigeria for Week 5).

Routine vaccination against smallpox - which supposedly provides about 85% protection against Monkeypox - ended in the 1970s. Today more than half of the world's population is unvaccinated, and the level of protection remaining among those vaccinated 50+ years ago is highly suspect.

The world's supply of smallpox vaccine is extremely limited, and the older replicating smallpox vaccine carried some serious health risks. Despite these shortcomings it was used last year to help contain the UK's mini-outbreak (see Report: UK PHE Imports Smallpox Vaccine For HCWs Caring For Monkeypox Cases).

Given the likelihood of additional exports of the virus, and the potential for the virus to evolve into something more easily transmissible, yesterday's  announcement from the FDA that they've approved a new non-replicating Smallpox/Monkeypox vaccine is a welcome development.

This from the FDA.

FDA approves first live, non-replicating vaccine to prevent smallpox and monkeypox 

For Immediate Release: September 24, 2019

The U.S. Food and Drug Administration announced today the approval of Jynneos Smallpox and Monkeypox Vaccine, Live, Non-Replicating, for the prevention of smallpox and monkeypox disease in adults 18 years of age and older determined to be at high risk for smallpox or monkeypox infection. This is the only currently FDA-approved vaccine for the prevention of monkeypox disease.

“Following the global Smallpox Eradication Program, the World Health Organization certified the eradication of naturally occurring smallpox disease in 1980. Routine vaccination of the American public was stopped in 1972 after the disease was eradicated in the U.S. and, as a result, a large proportion of the U.S., as well as the global population has no immunity,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research.

“Therefore, although naturally occurring smallpox disease is no longer a global threat, the intentional release of this highly contagious virus could have a devastating effect. Today’s approval reflects the U.S. government’s commitment to preparedness through support for the development of safe and effective vaccines, therapeutics, and other medical countermeasures.”

Jynneos will be available for those determined to be at high risk of either smallpox or monkeypox infection. This vaccine is also part of the Strategic National Stockpile (SNS), the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency that is severe enough to cause local supplies to be depleted. The availability of this vaccine in the SNS will help ensure that the vaccine is accessible in the U.S. if needed.

Smallpox, which is caused by the variola virus, emerged in human populations thousands of years ago and is a highly contagious and often fatal infectious disease. A person infected with smallpox typically develops a rash characterized by raised pocks on the face and body. The smallpox virus is spread through saliva and droplets from the respiratory tract or by direct or indirect contact with the virus as it is shed from skin lesions. The virus can also be spread through other body fluids and contaminated clothing or bed linen. If a person is infected with smallpox and they are in close contact with others, the virus can spread quickly.

Monkeypox, which does not occur naturally in the U.S., is a rare disease caused by infection with monkeypox virus, which causes symptoms similar to, but milder than, smallpox. Monkeypox begins with fever, headache, muscle aches and exhaustion and can be fatal, even though it is typically milder than smallpox. It is transmitted to people from various wild animals, such as rodents and primates. In 2003, the U.S. experienced an outbreak of monkeypox, which was the first time human monkeypox was reported outside of Africa.

Jynneos does not contain the viruses that cause smallpox or monkeypox. It is made from a vaccinia virus, a virus that is closely related to, but less harmful than, variola or monkeypox viruses and can protect against both of these diseases. Jynneos contains a modified form of the vaccinia virus called Modified Vaccinia Ankara, which does not cause disease in humans and is non-replicating, meaning it cannot reproduce in human cells.

The effectiveness of Jynneos for the prevention of smallpox was determined in a clinical study comparing the immune responses in study participants who received either Jynneos or ACAM2000, an FDA-approved vaccine for the prevention of smallpox. The study included approximately 400 healthy adults, 18 through 42 years of age who had never been vaccinated for smallpox, in which half of the study participants received two doses of Jynneos administered 28 days apart, and half received one dose of ACAM2000. The group vaccinated with Jynneos had an immune response that was not inferior to immune responses to ACAM2000. Vaccine effectiveness for the prevention of smallpox was also inferred from supportive animal studies that showed prior vaccination with Jynneos protected non-human primates who were exposed to viruses related to the smallpox virus.

The effectiveness of Jynneos for the prevention of monkeypox disease is inferred from the antibody responses in the smallpox clinical study participants and from studies in non-human primates that showed protection of animals vaccinated with Jynneos who were exposed to the monkeypox virus.

        (Continue . . . )

Although monkeypox is normally restricted to small outbreaks in Africa, in 2003 we saw a rare outbreak in the United States when a Texas animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003).

By the time that outbreak was quashed, the U.S. saw 37 confirmed, 12 probable, and 22 suspected human cases. Among the confirmed cases 5 were categorized as being severely ill, while 9 were hospitalized for > 48 hrs; although no patients died (cite).

This new vaccine will be incorporated into the Strategic National Stockpile (see Upcoming Webinar: The Strategic National Stockpile), which should provide a safer, and more readily available, medical countermeasure in the event that Monkeypox or Smallpox threaten again.