CDC Statement On Imported (Fatal) Case Of Lassa Fever – New Jersey

Credit CDC’s Lassa Information Page

 

# 10,091

 

A recurring theme in public health is just how easily that `exotic’ diseases can cross vast oceans or borders, propelled by our modern air travel industry and our penchant for international travel (see The Global Reach Of Infectious Disease). 

 

Every week scores of viremic travelers arrive on our shores, carrying everything from measles to dengue to Chikungunya. For some of these diseases – like measles - the risk of them spreading here is quite real. 

 

For others, while plausible, the risks of their spreading are far lower. 

 

Last night it was announced that a traveler – recently returned from Liberia – had died after being isolated last week when suspected of having a hemorrhagic fever.  While he tested negative for Ebola, yesterday his tests confirmed Lassa fever.  

 

The CDC believes that the risk to others is extremely low.

 

Lassa is endemic in Western Africa and  is commonly found in local rodents that often like to enter human dwellings. Exposure is typically through their urine or dried feces.  Roughly 80% who are infected only experience mild symptoms.  The overall mortality rate is believed to be in the 1%-2% range, although it runs much higher (15%-20%) among those sick enough to be hospitalized.

 

You may recall a similar importation last year (see Minnesota: Rare Imported Case Of Lassa Fever), along with a couple of earlier cases (2004 in New Jersey (MMWR) & 2010 in Pennsylvania (EID Journal)) – none of which resulted in a secondary transmission of the virus.

 

While the risks are considered quite low, contact tracing and monitoring will be conducted by health authorities to ensure that any possible spread is quickly detected and contained.   

 

This from the CDC’s media center:

 

Lassa Fever Confirmed in Death of U.S. Traveler Returning from Liberia

Risk to others considered extremely low

 

Press Release

For Immediate Release: Monday, May 25, 2015
Contact: Media Relations
(404) 639-3286

The CDC and the New Jersey Department of Health have confirmed a death from Lassa fever which was diagnosed earlier today in a person returning to the United States from Liberia. The patient traveled from Liberia to Morocco to JFK International Airport on May 17th. The patient did not have a fever on departure from Liberia, did not report symptoms such as diarrhea, vomiting, or bleeding during the flight, and his temperature was taken on arrival in the U.S. and he did not have a fever at that time. On May 18th, the patient went to a hospital in New Jersey with symptoms of a sore throat, fever and tiredness. According to the hospital, he was asked on the 18th about his travel history and he did not indicate travel to West Africa. The patient was sent home the same day and on May 21st returned to the hospital when symptoms worsened. The patient was transferred to a treatment center prepared to treat viral hemorrhagic fevers. Samples submitted to CDC tested positive for Lassa fever early this morning. Tests for Ebola and other viral hemorrhagic fevers were negative. The patient was in appropriate isolation when he died there this evening.

Lassa fever is a viral disease common in West Africa but rarely seen in the United States. There has never been person-to-person transmission of Lassa fever documented in the United States. The New Jersey case is the sixth known occurrence of Lassa fever in travelers returning to the United States since 1969, not including convalescent patients. The last case was reported in Minnesota in 2014. Although Lassa fever can produce hemorrhagic symptoms in infected people, the disease is different from Ebola, which is responsible for the current outbreak in West Africa. In general, Lassa fever is less likely to be fatal than Ebola (approximately 1% case fatality rate for Lassa vs approximately 70% case fatality rate for Ebola without treatment) and less likely to be spread from person to person. However, some Lassa patients develop severe disease, as the patient in New Jersey did.

In West Africa, Lassa virus is carried by rodents and transmitted to humans through contact with urine or droppings of infected rodents. In rare cases it can be transmitted from person to person through direct contact with a sick person's blood or bodily fluids, through mucous membrane, or through sexual contact. The virus is not transmitted through casual contact, and patients are not believed to be infectious before the onset of symptoms. About 100,000 to 300,000 cases of Lassa fever, and 5,000 deaths related to Lassa fever, occur in West Africa each year.

CDC is working with public health officials to generate a list of people who had contact with the patient. Those identified as close contacts of the patient will be monitored for 21 days to see if symptoms occur.

Updates will be provided as the investigation continues.

Hong Kong Reports 2nd Imported H7N9 Case Of The Season

 

# 9618

Reports have been filtering through the Chinese language Hong Kong press for about an hour, but I’ve held off until I could find something  official.  

 

We saw this season’s first imported case late in December (see Hong Kong Official Statements On H7N9 Case) which prompted the raising of their  Influenza Pandemic Response Level on December 27th.

 

Hong Kong’s CHP has just posted the following detailed statement:

 

 

CHP investigates imported human case of avian influenza A(H7N9)

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 23) investigating the second imported human case of avian influenza A(H7N9) in Hong Kong this winter.

"Based on the seasonal pattern, it is likely that the activity of avian influenza viruses might further increase in winter and heightened vigilance is warranted. As the Serious Response Level under the Preparedness Plan for Influenza Pandemic remains activated, we again urge the public to maintain strict personal, food and environmental hygiene both locally and during travel," a spokesman for the CHP said.

Epidemiological investigations and control measures
---------------------------------------------------

The male patient, aged 79 with good past health, has presented with runny nose, sore throat and cough with sputum since January 19 and consulted a private doctor on the same day. He then attended the Accident and Emergency Department (AED) of Alice Ho Miu Ling Nethersole Hospital yesterday (January 22) and was found febrile. He has been transferred to the Hospital Authority Infectious Disease Centre in Princess Margaret Hospital for further management and isolation and has been in stable condition all along.

His nasopharyngeal aspirate tested positive for avian influenza A(H7N9) upon preliminary laboratory testing by the CHP's Public Health Laboratory Services Branch.

Initial epidemiological investigations revealed that the patient had travelled to Zhangmutou, Dongguan, Guangdong, on January 5 on his own during which he had visited a wet market with live poultry stalls but with no direct contact with poultry. He returned to Hong Kong on January 19 via Lo Wu Control Point. Based on information available thus far, it is classified as an imported case. Investigations are ongoing.

Contact tracing conducted so far located two close contacts who accompanied the patient to the AED.

(A) Close contacts
     Close contacts will be put under quarantine and prescribed with antiviral presumptive treatment until the completion of the five-day treatment or ten days after last exposure to the patient, whichever is earlier. They include the patient's son and a female family member who are asymptomatic.
(B) Other contacts
     Tracing of other contacts, including relevant healthcare workers, ambulance officers, immigration officer and the doctor whom the patient consulted as well as relevant staff and clients, is underway. Other contacts will be put under medical surveillance.
     The CHP is communicating with the relevant Mainland health authority to follow up the situation during the patient's stay in the Mainland.

Enhanced surveillance
---------------------
     The CHP has enhanced surveillance of suspected cases in public and private hospitals, and activated electronic reporting system to monitor cases real-time with the Hospital Authority. Clinicians should pay special attention to patients with fever or influenza-like illness who visited wet market with live poultry or had contact with poultry in affected areas within the incubation period, that is ten days before onset.

Letters to doctors, hospitals, kindergartens, child care centres, primary and secondary schools as well as residential care homes for the elderly and the disabled will be issued to alert them to the latest situation.

The case will be notified to the World Health Organization, the National Health and Family Planning Commission (NHFPC), the health authorities of Guangdong and Macau, and the quarantine authority of Shenzhen.

To date, 506 cases have been reported by the Mainland health authorities since March 2013, including 489 cases in the Mainland and 17 cases exported to Hong Kong (12 cases), Taiwan (four cases) and Malaysia (one case).

(Continue . . .)

Complicating matters, Hong Kong is in the midst of a particularly nasty seasonal flu outbreak, with Dr. Ko Wing-man, Hong Kong’s Secretary of Food & Health stating in a press conference today:

 

However, in the past few days, there were reports of a more drastic increase in the number of patients requiring intensive care. If this trend is going to continue, we might then expect a particular high peak in this season.

I am more concerned about the capacity of the Accident and Emergency Departments and Intensive Care Units in public hospitals. We will be liaising with the Hospital Authority (HA) to make sure that they have the measures in hand to address the situation. For individual citizens, it is more important to look at how to prevent or minimise the risk of contracting the illness.

This must be done through healthy lifestyle and emphasis in personal hygiene and hand washing. We also advise people to take influenza vaccination. Although the protection rate of the vaccine being used this year is apparently lower than that in past years, experts are of the opinion that having vaccination is still better than not.

Philippines: Imported Case Of MERS-CoV In a HCW

Source : Philippines DOH Facebook page

 

# 9033

 

 

Based on the drop in the number of MERS cases reported by the Saudi MOH over the the summer, it is a bit surprising this morning to discover that a Philippine nurse, just returned from working in KSA, has tested positive for the virus and is now in isolation at Southern Philippines Medical Center in Davao City. 

 

This makes the second imported case of MERS for the Philippines.

 

First this this report from Xinhua News, then I’ll be back with a bit more. 

 

Philippine gov't confirms Filipina nurse infected with MERS-CoV

English.news.cn   2014-09-03 16:53:46
 

MANILA, Sept. 3 (Xinhua) -- The Philippine Department of Health (DOH) confirmed on Wednesday that a Filipina nurse who returned to the country from Saudi Arabia tested positive for the dreaded Middle East Respiratory Syndrome-Corona Virus (MERS-CoV).

Health Secretary Enrique Ona said the Filipina nurse came home last Friday via Saudia Airlines Flight SV 870. She then took Cebu Pacific Flight SJ 997 going home to General Santos City in southern Philippines.

"The (infected) nurse stayed with the other Filipina nurse in ( the northern Philippine province of) Bulacan until her scheduled flight to General Santos City on August 31," said Ona in a press briefing on Wednesday.

He said the two Filipina nurses returned to the Philippines together. They were tested for MERS-CoV in Saudi Arabia but did not wait for the results.

"The two were working in the same hospital in Dammam and they were tested there. Yesterday, they were informed by their supervisor that one of them was positive (for MERS-CoV)," said Ona.

The infected nurse, whose identity was not disclosed by Ona, was brought to the Southern Philippines Medical Center to be isolated. Throat swab samples collected from her will be analyzed. Results of the analysis are expected to come out on Wednesday night.

Ona said the DOH is now contacting other passengers of the Saudia Airlines and Cebu Pacific flights taken by the Filipina nurse to monitor their condition.

MERS-CoV is a highly fatal respiratory illness presenting an influenza-like illness characterized by fever, cough, and often with diarrhea.

Despite the entry of the infected Filipina nurse in the country, Ona said the Philippines remains free from MERS-CoV since no one has yet acquired the virus locally.

Last week KSA reported a pair of MERS cases at a hospital in Dammam (see  27 August MOH: '1 New Confirmed Corona Case Recorded' & 26 August MOH: '1 New Confirmed Corona Case Recorded'), a symptomatic female (age 52) and a symptomatic male (age 69).  Neither were described as being health care workers.

Today’s report is a reminder that the MERS coronavirus continues to circulate in the Middle East, and that with the Hajj now just 30 days away, it continues to represent a serious public health concern.

 

This confluence of  a couple of million into a confined space, coming from all over the world, provides a perfect `mixing bowl’  for viruses and bacteria, and has the real potential to seed them to new regions of the globe when the pilgrims leave. 

 

Last July, in EID Journal: Respiratory Viruses & Bacteria Among Pilgrims During The 2013 Hajj, we looked at the extraordinarily high percentage of Hajjis (approx. 80%)  who either acquire or leave with some type of respiratory infection while doing this pilgrimage.

 

While the vast majority will have rhinoviruses or influenza, differentiating those from something more serious will be a major public health undertaking – both while in Saudi Arabia, and  later, when these pilgrims return to their home countries.

 

For those contemplating making the Hajj this year, the CDC provides specific travel advice , including required and recommended vaccinations.

UK PHE Reports Imported Case Of CCHF

Photo Credit- CDC

 

# 8805

 

A recurring theme in public health is just how quickly, and easily, that `exotic’ diseases can cross vast oceans or borders, given our modern air travel industry and our penchant for international travel (see The Global Reach Of Infectious Disease). 

 

The introduction of Chikungunya to the Caribbean last fall, and the ensuing (and ongoing) epidemic, are almost certainly the result of an infected traveler coming from an endemic region of the world.

 

Similarly the reintroduction of Dengue to South Florida in 2009, and the arrival of West Nile Virus in New York in 1999, are both thought to have arrived via infected international travelers, and both (probably after multiple introductions) have managed to gain a foothold in the United States.

 

More dramatically, but with less public health impact, earlier this year we saw the first North American importation of H5N in a nurse returning from China (see H5N1 In Canada: A Matter Of Import), while a few months later we saw Minnesota: Rare Imported Case Of Lassa Fever.

 

The good news is - despite their fearsome reputations - neither of these two diseases are easily spread between humans, and no secondary infections were reported.

 

The continual importation of measles has seen us go from the near-elimination of the virus in this country in 2000 to this year’s CDC Telebriefing: Worst US Measles Outbreak In 20 Years.  And the most recent Arbovirus surveillance report lists thus far for 2014  the detection of 24 imported cases of Dengue, 52 imported cases of Chikungunya, and 20 imported cases of Malaria . . . in Florida alone.

Given this track record, no one should be terribly surprised to learn that the Public Health England reported yesterday their second known case of imported CCHF (Crimean-Congo Hemorrhagic Fever).   While CCHF can be transmitted from one human to another, it requires contact with infected blood or bodily fluids, and so it isn’t easily done.

 

 

Crimean-Congo haemorrhagic fever case identified in UK

From: Public Health England

History: Published 3 July 2014

Part of: Public health

PHE is aware of a laboratory-confirmed case of CCHF in a UK traveller who was bitten by a tick while on holiday in Bulgaria.

The patient is responding well to treatment and there is no risk to the general population.

As a precautionary measure, close contacts of the patient, including hospital staff involved in the patient’s care, will be given health advice and encouraged to contact their GP if they experience symptoms.

Although Crimean-Congo haemorrhagic fever (CCHF) can be acquired from an infected person, this would require direct contact with their blood or body fluids and the risk even for close contacts is considered very low.

This is the second laboratory-confirmed case of CCHF in the UK, following the diagnosis in 2012 of CCHF in a UK resident who had recently returned from Afghanistan.

CCHF is the commonest viral haemorrhagic fever worldwide. It is not found in the UK but is endemic in many countries in Africa, the Middle East, Asia and Eastern Europe, including Turkey and Bulgaria.

People most at risk are agricultural workers, healthcare workers and military personnel deployed to endemic areas. CCHF is most often transmitted by a tick bite but can also be spread through contact with infected patients or animals.

Dr Tim Brooks, Head of Public Health England’s (PHE’s) Rare and Imported Pathogens Laboratory (RIPL) said:

It’s extremely rare to see a case of Crimean-Congo haemorrhagic fever in the UK, and it’s important to note there is no risk to the general population. As a precaution, close contacts of the patient will be contacted and monitored, but the risk of transmission is very low and would require direct contact with bodily fluids.

 

 

The first imported case of CCHF in the UK, mentioned above, was a 38-year old man who flew into Glasgow, Scotland from the Middle East (see Update: CCHF Patient In Scotland Dies).

 

While uncommon in Western Europe, this tickborne virus is widely distributed across parts of Eastern Europe, the former Soviet Union, the Mediterranean, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

Credit WHO

 

CCHF is a Nairovirus in the family Bunyaviridae, and was first described in the Crimea in 1944.  Later it was also isolated in the Congo (1969) – hence the name.

 

CCHF is normally transmitted to humans via the bite of a tick, or via contact with the blood of infected animals, although there have been reports of nosocomial (in hospital) transmission as well (see 2010  WHO report on Pakistan).

 

Today’s story isn’t so much about one rare imported case of CCHF, but about how important it is that we anticipate, and prepare for, the inevitable arrival of many more imported diseases. 

 

Which is why the CDC, along with other international public (and animal) health agencies are involved in a series of initiatives to improve global health surveillance & emergency response in this age of rising infectious diseases.  The rationale for which is explained on the CDC’s Global Health Website at:

 

Why Global Health Security Matters

Disease Threats Can Spread Faster and More Unpredictably Than Ever Before

(Excerpt)

A disease threat anywhere can mean a threat everywhere. It is defined by

• the emergence and spread of new microbes;
• globalization of travel and trade;
• rise of drug resistance; and
• potential use of laboratories to make and release—intentionally or not—dangerous microbes.

(Continue . . .)

Taiwan CDC: Epidemiological Follow Up On Imported H7N9 Case

 

 

# 8514

 

Yesterday’s announced imported H7N9 case in Taiwan remains hospitalized and in serious condition, and Taiwan’s CDC is actively involved in monitoring 96 of her contacts – including members of her family, members of her tour group, airline passengers seated near her, and medical staff who were potentially exposed before her diagnosis.

 

Of these, all remain well except one who is complaining of fatigue and fever, and who is undergoing tests.

 

Additionally – based on media reports – `measures to prevent the spread of the disease have been taken to help 48 of them’.  It isn’t clear from that report whether this refers to PEP (post-exposure prophylaxis) antivirals, quarantine, or both.

 

The good news is, while some limited human-to-human transmission of the H7N9 virus has been documented, so far – based on the follow up of hundreds of contacts of known cases – it apparently is a rare event.

 

This from  Taiwan’s CDC .

 

 

 

Disease Control Department keeps track of mainland China imported the H7N9 flu case confirmed cases and their associated contacts (2014-04-23)

Yesterday (4/22) day recognized the Department of Disease Control, Nanjing, Jiangsu Province in mainland China imported 44 year old woman confirmed cases of H7N9 flu, is a serious illness, continued to receive treatment in hospital. Contacts currently available, including cases husband and daughter near the same plane seat passenger, tour leader / guide / driver / medical staff members and a total of 96 people, of which only one group member with fever and malaise, by local medical personnel arrange for medical treatment and specimen collection for examination, another physician evaluate the remaining 95 people who are in close contact with a total of 48 without proper protective prophylactic dosing.

During the tour of patients in Taiwan, visited the attractions, restaurants and hotels, the number of patients who may have contact with the investigation a total of 62 people, all without upper respiratory tract symptoms. Medical personnel have invited all contacts and self health management 10 days to 10 tracks expire, if contact occurs with fever, cough, influenza-like symptoms during the period, please wear a mask their doctor and take the initiative to inform the physician contact history.

The Agency for human disease avian influenza outbreaks travel recommendations, Hunan Province in China, Anhui, Jiangsu, Guangdong, Fujian Province, is the second stage: Alert (Alert), the remaining provinces (excluding Hong Kong and Macao) remains the first stage NOTE: (Watch). The department plans to once again remind people of the affected areas, it is important to implement good hygiene practices such as hand washing, avoiding contact with birds, especially not to pick up dead birds, eating chickens, ducks, geese and eggs to be cooked in order to avoid infection. When you return home if fever or flu-like symptoms, they should inform the airline personnel and airport and port of quarantine officers; such as after returning the above symptoms should wear a mask and seek medical advice and inform the physician contact history and travel history. Latest epidemic diseases and other related information can be found in the Agency website ( http://www.cdc.gov.tw ) the "H7N9 flu Corner" and "International Travel Information" area, or call the toll-free hotline and caring people informed epidemic 1922 ( or 0800-001922) contact.

Hong Kong Detects Their 10th Imported H7N9 Case

H7N9 Awareness Campaign Summer 2013 - Photo credit Hong Kong’s CHP

 

 

 

# 8470

 

 

 

 

 

While our attentions are understandably focused these past few days on the MERS-CoV outbreaks in the Middle East,  the H7N9 virus continues to circulate in Eastern China, occasionally infecting humans.  

Today, for the third time in the past 9 days, Hong Kong’s CHP is reporting an imported case – their 10th to date.

 

 

Imported human case of avian influenza A(H7N9) under CHP Investigation

Sunday, April 13, 2014
Issued at HKT 22:39

 

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (April 13) investigating an imported human case of avian influenza A(H7N9) affecting a woman aged 85.

The patient, with underlying medical conditions, travelled to Dongguan from April 4 to 5 with her husband and younger brother. They lived at their relatives' home where their relatives have reared chickens. The patient also visited a wet market near their home there and helped in slaughtering chickens at home on April 4. She returned to Hong Kong on April 5, and developed fever, cough with blood-stained sputum and shortness of breath since April 11. She was sent to the Accident and Emergency Department of Tseung Kwan O Hospital (TKOH) by ambulance today and was subsequently admitted. She is currently managed under isolation and her condition is critical.

 

Her respiratory specimen was positive for avian influenza A(H7N9) virus upon preliminary laboratory testing by the CHP's Public Health Laboratory Services Branch today.

 

Initial investigation revealed that the patient had visited her husband at Haven of Hope Hospital (HHH) on April 10 who was admitted due to other illness. Her husband has remained asymptomatic so far and is currently under observation at HHH.

 

Apart from her husband, seven other family members of the patient are also considered as close contacts. One of them had sore throat since April 12 and his condition is stable. The other close contacts have remained asymptomatic so far.  These close contacts will be admitted to hospital for observation and their respiratory specimens will be taken for preliminary laboratory testing.

 

The CHP's investigations and tracing of other contacts are ongoing. The patient's brother who travelled to Dongguan with the patient, relevant healthcare workers, ambulance staff and patients who had stayed in the same cubicle with the patient’s husband at HHH are being traced for exposure assessment and medical surveillance.

 

The CHP will liaise with the relevant Mainland health authority to follow up on the patient's contacts during her stay in the Mainland.

 

"The Serious Response Level under the Government's Preparedness Plan for Influenza Pandemic remains activated and the CHP's follow-up actions are in full swing," a spokesman for the CHP remarked.

 

This is the tenth confirmed human case of avian influenza A(H7N9) in Hong Kong. The CHP will notify the World Health Organization (WHO), the National Health and Family Planning Commission as well as health and quarantine authorities of Guangdong and Macau.

(Continue . . . )

Minnesota: Rare Imported Case Of Lassa Fever

Credit CDC’s Lassa Information Page

 

 

# 8433

 

Although its lethality is nowhere in the same league as Ebola Zaire, Lassa fever is another Viral Hemorrhagic Fever (VHF) which is endemic in Western Africa. The Lassa virus is commonly found in multimammate rats, a local rodent that often likes to enter human dwellings.

 

Exposure is typically through the urine or dried feces of infected rodents, and roughly 80% who are infected only experience mild symptoms.  The overall mortality rate is believed to be in the 1%-2% range, although it runs much higher (15%-20%) among those sick enough to be hospitalized.

 

Like many other hemorrhagic fevers, person-to-person transmission may occur with exposure to the blood, tissue, secretions, or excretions of an individual. The CDC is quick to assure, however, that the risk to fellow travelers who may have had contact with this patient is extremely low:

 

Casual contact (including skin-to-skin contact without exchange of body fluids) does not spread Lassa virus. 

 

This is the 7th known imported case of Lassa fever into the US, although most of the early cases were diagnosed abroad and the patients were then airlifted to the US for treatment.  Two previous cases (2004 in New Jersey (MMWR) & 2010 in Pennsylvania (EID Journal)) involved travelers who arrived in the US without knowing they had been infected.

 

Here is the CDC’s press release, after which I’ll return with a bit more:

 

Press Release

For Immediate Release: Friday, April 4, 2014
Contact: CDC Media Relations
(404) 639-3286

Lassa Fever Reported in U.S. Traveler Returning from West Africa

Contact investigation under way; risk to other travelers considered extremely low

The CDC and the Minnesota Department of Health (MDH) have confirmed a diagnosis of Lassa fever in a person returning to the United States from West Africa. The patient was admitted to a hospital in Minnesota on March 31 with symptoms of fever and confusion. Blood samples submitted to CDC tested positive for Lassa fever on April 3. The patient is recovering and is in stable condition.

“This imported case is a reminder that we are all connected by international travel. A disease anywhere can appear anywhere else in the world within hours,” said CDC Director Tom Frieden, M.D., M.P.H.

Lassa fever is a severe viral disease that is common in West Africa but rarely seen in the United States.  Seven other Lassa fever cases, all travel related, have been identified in the United States, with the last one reported in Pennsylvania in 2010. Although Lassa fever can produce hemorrhagic symptoms in infected persons, the disease is not related to Ebola hemorrhagic fever, which is responsible for the current outbreak in West Africa. 

In West Africa, Lassa virus is carried by rodents and transmitted to humans through contact with urine or droppings of infected rodents. In rare cases it can be transmitted from person to person through direct contact with a sick person’s blood or bodily fluids, through mucous membrane, or through sexual contact. The virus is not transmitted through casual contact. About 100,000 to 300,000 cases of Lassa fever, and 5,000 deaths related to Lassa fever, occur in West Africa each year.

CDC is working with public health officials and airlines to determine the patient’s travel route from West Africa and identify any passengers or others who may have had close contact with the infected person. Preliminary information indicates that the patient flew from West Africa to New York City and caught another flight to Minneapolis.

“Given what we know about how Lassa virus is spread to people, the risk to other travelers and members of the public is extremely low,” said Martin Cetron, M.D., M.P.H., director of CDC’s Division of Global Migration and Quarantine. 

“Casual contact is not a risk factor for getting Lassa fever,” said Barbara Knust, D.V.M., M.P.H., an epidemiologist in CDC’s Division of High-Consequence Pathogens and Pathology, which performed the laboratory testing.  “People will not get this infection just because they were on the same airplane or in the same airport.”

As part of its investigation, CDC is working with the airlines to gather contact information for passengers and crew who were seated near the infected individual. CDC will provide passenger contact information to state and local health departments where the passengers live to notify them about their possible exposure.

For additional information about Lassa fever see the CDC website at http://www.cdc.gov/vhf/lassa/.

For more information about airline contact investigations see http://www.cdc.gov/quarantine/contact-investigation.html.

(Continue . . .)

 

While Lassa fever is a rarity, imported diseases such as measles, polio, dengue, malaria (and many others) remain a constant threat – even in places where they have been officially `eliminated’.  And emerging diseases, like Chikungunya, H5N1, H7N9, or MERS-CoV can easily expand to new geographic regions due to enhanced global travel and trade.

Photo Credit- CDC

 

As both the CDC and the World Health Organization reminded us a few weeks ago (see The Global Reach Of Infectious Disease), pathogens are excellent international travelers. A few recent blogs on other `imported’ disease threats includes:

Chikungunya Update & CDC Webinar Online

CDC Statement On 1st H5N1 Case In North America

Pathogens At the Gate

HK CHP: Follow Up Epidemiological Investigation Into Imported H7N9 Case

 

H7N9 Awareness Campaign Summer 2013 - Photo credit Hong Kong’s CHP

 

# 8385

 

Yesterday, in HK CHP Investigating Imported H7N9 Case, we learned of the arrival in that city of a 5-month-old girl from neighboring Guangdong Province, who was infected with the H7N9 avian flu virus.

 

Today, we’ve an update from Hong Kong’s Centre for Health Protection  that focuses on aggressive patient contact surveillance (all asymptomatic and/or negative for Influenza A so far), and reminders to the public on appropriate precautions to avoid infection.

 

To date, Hong Kong has identified 7 imported cases of the H7N9 virus, but none that have been acquired locally.

 

Epidemiological investigation and follow-up actions by CHP on confirmed human case of avian influenza A(H7N9)

The Centre for Health Protection (CHP) of the Department of Health (DH) today (March 18) provided an update on the seventh confirmed human case of avian influenza A(H7N9), which is affecting a 5-month-old girl.

"The epidemiological investigations, enhanced disease surveillance, port health measures and health education against avian influenza are all ongoing," a spokesman for the DH said.

As of 4pm today, five close contacts and 44 other contacts have been identified.

The close contacts included the patient's parents and two patients and a visitor who had stayed in the same cubicle with the index patient in Alice Ho Miu Ling Nethersole Hospital. All of them have remained asymptomatic so far and their respiratory specimens all tested negative for Influenza A virus. They are now under quarantine.

Other contacts included relevant healthcare workers, ambulance staff, visitors of patients and staff at Lo Wu Control Point. All of them have remained asymptomatic so far. They are all under medical surveillance.

"In view of human cases of avian influenza A(H7N9) confirmed locally and multiple cases notified by the Mainland, further cases are expected in affected and possibly neighbouring areas. Those planning to travel outside Hong Kong should maintain good personal, environmental and food hygiene at all times," the spokesman said.

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

Health education for travellers, the display of posters in departure and arrival halls, in-flight public announcements, environmental health inspection and provision of regular updates to the travel industry via meetings and correspondence are all proceeding.

The spokesman advised travellers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, to immediately wear masks, seek medical attention and reveal their travel history to a doctor. Health-care professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas and provinces.

"We have enhanced publicity and health education to reinforce health advice on the prevention of avian influenza," the spokesman said.

(Continue . . . )

Malaysia Reports Their 1st Imported H7N9 Case

Patient arrived Kuala Lampur 2/4 from Guangdong, China

Traveled to Sandakan, Sabah then Kota Kinabalu

# 8289

 

Malaysia’s Ministry of Health has reported their first imported case of H7N9 in a female tourist (age 67) who arrived in Kuala Lampur on either the 3rd or 4th of February (media reports differ), and then traveled to Sandakan, Sabah and  Kota Kinabalu.  T

 

She was hospitalized on Feb 7th in Kota Kinabalu, and tested positive for the H7N9 virus on Feb 11th. She is currently described as being on a ventilator in ICU, but in stable condition.

 

The MOH announcement is in Malaysian, and in a PDF format, making translation difficult.  For now, the best coverage appears to be coming from The Star newspaper.

 

 

First H7N9 case detected in Malaysia involving Chinese tourist

Updated: Wednesday February 12, 2014 MYT 5:44:52 PM

by lee yen mun

 

PUTRAJAYA: The Health Ministry has confirmed the first Influenza A (H7N9) case in the country, involving a female tourist from China.

The import case involves a 67-year-old Chinese woman, who had travelled from Guangdong, China, to Kuala Lumpur on Feb 4.

The woman went to Sandakan, Sabah the next day before going on to Kota Kinabalu on Feb 6.

"The woman was referred to a private hospital in Kota Kinabalu on Feb 7, and (after two screenings) on Feb 11, the sample tested positive for the Influenza A (H7N9) virus.

"She is currently receiving treatment in the ICU, put on ventilator and is in a stable condition," Health Minister Datuk Seri Dr S Subramaniam said in a press conference, here, Wednesday.

Dr Subramaniam stressed that there was no cause for panic over the matter as the risk for human transmission of H7N9 is "very low".

 

Malaysia is now added to the short list, which includes Taiwan and Hong Kong, of places outside of Mainland China, that have detected imported H7N9 cases.

Alberta Canada Reports Fatal (Imported) H5N1 Infection

 

Alberta, Canada – Credit Wikipedia

 

# 8141

 

 

The story is only about 30 minutes old, and details are still emerging, but we have word of the first fatal case of H5N1 in North America, that of a Chinese traveler who recently died in an Alberta hospital, and who was subsequently tested and found to have been infected with the H5N1 virus.

 

Our first stop is an announcement issued by the government of Alberta followed by excerpts from a Canadian Press news report.

 

 

Avian influenza death confirmed in Alberta

Jan 08, 2014 Media inquiries

Health Minister Fred Horne released the following statement today regarding Alberta’s first rare and isolated case of avian influenza.

Results that were received from the provincial laboratory on Monday, and confirmed by the National Microbiology Laboratory on Tuesday, indicate that an Albertan has died from H5N1 avian influenza.

This individual travelled to China in December. Upon returning to Alberta, this person was admitted to hospital on Jan. 1 and passed away on Jan. 3.   

“I would like to extend my condolences to the family for the loss of their loved one. I also want to thank our health care workers and our Chief Medical Officer of Health for their swift action and for their close co-ordination with the Government of Canada,” said Health Minister Fred Horne.

“This is a very rare and isolated case,” said Dr. James Talbot, Alberta’s Chief Medical Officer of Health. “Avian influenza is not easily transmitted from person to person. It is not the same virus that is currently present in seasonal influenza in Alberta.

“Public health has followed up with all close contacts of this individual and offered Tamiflu as a precaution. None of them have symptoms and the risk of developing symptoms is extremely low. Precautions for health care staff were also taken as part of this individual’s hospital treatment.   

“I expect that with the rarity of transmission and the additional precautions taken, there will be no more cases in Alberta.”

In 2013, there were 38 world-wide cases of H5N1 avian influenza reported to the World Health Organization and 24 deaths.

 

This next report comes from  The Canadian Press - ONLINE EDITION

Fatal case of H5N1 bird flu reported in Alberta, first North American case

By: The Canadian Press

Wednesday, Jan. 8, 2014 at 3:12 PM | Comments: 0

OTTAWA - Federal public health officials say a fatal human case of H5N1 bird flu has been reported in Canada, the first such case in North America.

Health Minister Rona Ambrose says the case, which was located in Alberta, was an isolated one and that the risk to the general public is small.

"The risk of getting H5N1 is very low," Ambrose told a hastily assembled news conference in Ottawa via conference call.

"This case is not part of the seasonal flu, which circulates in Canada every year."

The H5N1 strain is unrelated to the seasonal flu outbreak, Ambrose added.

Health officials say the victim had travelled to China last month and was hospitalized after returning to Alberta on Jan. 1, then died two days later.

They say that while it remains unclear how the person contracted the virus, there is no evidence of human-to-human transmission.

(Continue . . .)

 

 

While contact tracing will be done, at this point there’s no indication of onward transmission of the virus in North America.  I expect  we’ll be getting more details in the coming hours.

 
Stay tuned.

Taiwan CDC Reports Second Imported H7N9 Case

 

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Last April Taiwan was the first place, outside of mainland China, to detect an H7N9 case (see Taiwan Confirms First Imported Case Of H7N9) – an event that not only sparked enhanced surveillance, but also a fast track vaccine development program (see Taiwan Adjusts Their H7N9 Vaccine Production Outlook).

 

Today, Taiwan’s CDC has released a press statement indicating that they’ve detected a new imported case of H7N9 – this time an 86 year old man from  Jiangsu Province, China who appears to have been part of a tour group.

 

Below you’ll find the (machine translated) statement.   I expect we’ll be hearing a good deal more on this later today.

 

Command Center confirmed influenza A H7N9 confirmed cases in China are imported (2013-12-31)

Command Center today (12/31) evening to confirm an imported H7N9 influenza cases. Case was a resident in mainland China, Changzhou City, Jiangsu Province 86 year old male, 12/17 inbound tourism in Taiwan, 12/19 began to loss of appetite, 12/23 chest tightness, 12/24 am to hospital emergency medical care, because both sides of the day pneumonia and ventilator ICU stay, 12/26 administered Tamiflu, 12/27 physicians reported to the Centers for Disease Control Department for examination and specimen collection, test results today to determine the present continuous treatment in the intensive care ward. To the press release time deadline, the command center has confirmed the patient group with 25 people who were 12 and 22/24 return to the mainland, their two daughters continued to stay in Taiwan to take care of patients, they no symptoms.

Command Center said the patient during the journey to Taiwan, visited included Taoyuan County, Taipei City, New Taipei City, Taichung City, Chiayi City, Kaohsiung, Taitung, Hualien County and other counties of the famous attractions, patients in the journey in no fever or cough, detailed travel history and had hotel accommodation information, command centers are engraved with a detailed guide to confirm, to facilitate contacts grasp travel period. Now through the district control center, local health officers launched against people travel during the time of investigation, and strive to really grasp all possible close contacts and inventoried tube, other health care hospital for the treatment of patients and other related contacts, has been investigated and inventoried, appropriate protection for those who are not, will be given prophylaxis. Public health workers for all close contacts caught giving full health education and H7N9 influenza independent health management notice and actively track to lift the tube, if contact occurs with fever, cough, influenza-like symptoms, please wear a mask for medical treatment, and initiative to inform the physician contact history.

WHO also sync command center informed and notified the Chinese mainland and Hong Kong and Macao contact window through IHR contact window.

In response to the Chinese mainland and Hong Kong continued to appear since the autumn H7N9 flu cases, indicating the risk of epidemics and the threat increases. Present, except in Guangdong Province and Zhejiang Province, Jiangsu Province, will travel epidemic upgraded to second level: Alert (Alert), the remaining provinces (excluding Hong Kong and Macau) as the first stage: Note (Watch), the command center to alert plan infected people, it is important to maintain good hygiene, avoid contact with birds. Also, once again reminded the people, to the Chinese mainland, the class should avoid contact with birds, especially not to pick up dead birds; eating chickens, ducks, geese and eggs to be cooked;, and should be implemented hand-washing and other personal hygiene measures to avoid infection. When you return home if fever or flu-like symptoms, they should inform the airline personnel and airport and port of quarantine officers; such as after returning the above symptoms should wear a mask and seek medical advice and inform the physician contact history and travel history. Latest epidemic diseases and other related information can be found in the Agency website ( http://www.cdc.gov.tw ) the "H7N9 flu Corner" and "International Travel Information" area, or call the toll-free hotline and caring people informed epidemic 1922 ( or 0800-001922) contact.

• The draft date :2013-12-31
• Update Date :2013-12-31
• Maintenance Unit: Public Relations Office

France: More Details On Imported nCoV Case

 

 

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Based on details from an AFP report, it appears that France’s first imported coronavirus case returned from a visit to Dubai (spanning Apr. 9th-17th) and was hospitalized on April 23rd in Valenciennes, a town of about 40,000 people in the north of France near the Belgium border.

On April 29th, the 65-year-old man was transferred to a hospital in Douai, a distance of about 41 km.

 

Given this patient’s travel history, It’s not immediately clear why it has taken more than two weeks to diagnose and announce this patient's nCoV infection.

 

 

Coronavirus: the patient is 65 years old and was hospitalized in Douai

PARIS - The first French patient with an acute respiratory infection again close the SARS virus (Severe Acute Respiratory Syndrome) is 65 and is hospitalized in Douai (North), said Wednesday the Ministry of Health.

 

The patient was hospitalized on April 23 in Valenciennes, Douai and then transferred to 29 April, where he is in intensive care and benefits of respite care or respiratory assistance and exchange of blood, said Jean-Yves Grall, Director General of Health at a press conference.

 

The man had stayed in Dubai from April 9 to 17, he said. He was hospitalized with acute respiratory disease.

(Continue  . .)

Taiwan Confirms First Imported Case Of H7N9

 

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Not unexpectedly, we now have the first confirmation of an H7N9 case hospitalized outside of the Chinese Mainland, as announced this morning by Taiwan’s Centers For Disease Control.

 

The patient is a 53 year-old man who returned to Taiwan from Jiangsu Province earlier in the month, and who was hospitalized on April 16th. He is listed in critical condition.

 

Interestingly, this patient is a hepatitis B carrier (a virus which is endemic in Asia), and that has been mentioned before (see Crofsblog H7N9: Is Hep B an unindicted co-conspirator?) as a possible contributor to the severity of this infection.

As you’ll see, this patient tested negative for the virus twice before a positive lab result was finally obtained.  We’ve seen similar difficulties in test sensitivity with the H5N1 virus.

 

Additionally, three HCWs who were in contact with this patient have developed upper respiratory symptoms, have received “Self-Health Management Advice for H7N9 Influenza” instructions, and will be followed up closely by health authorities.

 

We’ve got the official statement (h/t Ronan Kelly on FluTrackers)  from Taiwan’s CDC:

 

The first imported human infection with avian influenza A(H7N9) confirmed in Taiwan;

 

Travelers visiting areas affected by H7N9 advised to practice good personal hygiene, avoid touching and feeding live poultry, and avoid visiting traditional markets with live poultry( 2013-04-24 )

In the late afternoon of April 24, 2013, the Central Epidemic Command Center (CECC) confirmed the first imported case of H7N9 avian influenza in a 53-year-old male Taiwanese citizen who worked in Suzhou, Jiangsu Province, China prior to illness onset.  He developed his illness three days after returning to Taiwan.  Infection with avian influenza A (H7N9) was confirmed on April 24, 2013.  The patient is currently in a severe condition and being treated in a negative-pressure isolation room.

 

Minister of Health, Dr. Wen-Ta Chiu, and Commander of CECC, Dr. Feng-Yee Chang, have full knowledge of the situation and have instructed implementation of subsequent prevention and control measures.  In addition, CECC has reported the case to the World Health Organization through the IHR Focal Point.  Furthermore, according to the Cross-strait Cooperation Agreement on Medicine and Public Health Affairs, CECC has also reported the case to the contact point in China.

 

CECC indicated that the case is a hepatitis B carrier with history of hypertension.  Due to the fact that he worked in Suzhou, Jiangsu Province before his illness, he had been traveling back and forth regularly between Suzhou and Taiwan for a long time.  During March 28 and April 9, 2013, the patient traveled to Suzhou.  On April 9, he returned to Taiwan from Shanghai.

 

According to the case, he had not been exposed to birds and poultry during his stay in Suzhou and had not consumed undercooked poultry or eggs.  On April 12, he developed fever, sweating, and fatigue, but no respiratory or gastrointestinal symptoms.  On April 16, he sought medical attention at a clinic when he developed high fever and was transferred to a hospital by the physician.

 

He was then hospitalized in a single-patient room for further treatment. On April 16, he was administered Tamiflu.  On April 18, his chest x-ray showed interstitial infiltrate in the right lower lung.  On the night of April 19, his conditions worsened.  On April 20, he was transferred to a medical center for further treatment. He was then intubated due to respiratory failure and placed in the negative-pressure isolation room in the intensive care unit. During his stay in the hospitals, two throat swab specimens were collected and both tested negative for avian influenza A (H7N9) virus by real-time RT-PCR.  On April 22, the medical center collected a sputum specimen from the patient and the specimen was tested positive for influenza A.  In the morning of April 24, avian influenza A (H7N9) virus was detected in the sputum specimen using real-time RT-PCR.  In the later afternoon of April 24, the National Influenza Center in Taiwan confirmed the identification and completed the genome sequencing of the virus.

 

At the time of writing, CECC has obtained the list of 138 people who have come into contact with the confirmed case, including 3 close contacts, 26 regular contacts (past the 7-day incubation period), and 109 healthcare workers, for investigation and follow-up activities. Of the 109 healthcare workers, 4 have passed the 7-day incubation period and shown no symptoms.

 

Only three contacts failed to put on appropriate personal protective equipment when the contact occurred.  Thus far, the three have not developed symptoms, but they will be followed up until April 27, 2013.  On the other hand, while delivering healthcare services, three healthcare workers who were geared with appropriate personal protective equipment developed symptoms of upper respiratory infection.  The public health authority have conducted thorough health education activities for all contacts, issued them with “Self-Health Management Advice for H7N9 Influenza”, and will be following up with them closely until the period of voluntary contact tracing is lifted.  When a contact develops influenza-like illness symptoms such as fever and cough, the public health authority will voluntarily assist the individual in seeking medical attention.

 

CECC has continued to strengthen surveillance and fever screening of travelers arriving from China, especially areas with ongoing outbreaks of human infection with avian influenza A(H7N9), including Shanghai, Jiangsu, Zhejiang, Anhui, Beijing, Henan and Shandong.  Physicians are once again reminded to report suspected cases to the health authority within 24 hours of detection according to the relevant regulation.  Before the infection is confirmed, please manage the case according to the following: a suspect case-patient with severe respiratory infections should be hospitalized in isolation for treatment. A suspect case-patient with mild symptoms should be asked to conduct self-health management and put on a surgical mask, and provided with thorough health education.  Further, specimens should be collected from the patient for laboratory testing and the need for administering antivirals should be determined.  If human infection with avian influenza A (H7N9) is later confirmed, an appropriate hospital for isolation and treatment will be determined by the Regional Commander of CECC.

 

CECC once again urges travelers visiting China to practice good personal hygiene such as washing hands frequently and putting on a mask, take preventive measures such as avoiding direct contact with poultry and birds or their droppings, avoiding visiting traditional markets with live poultry, consuming only thoroughly cooked poultry and eggs.  If symptoms such as fever and cough develop after returning to Taiwan, please put on a surgical mask and seek immediate medical attention.  Moreover, please inform the physician of the recent travel history to facilitate diagnosis and treatment. For more information, please call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-001922 if calling from a cell phone, or visit the Taiwan CDC’s website at http://www.cdc.gov.tw.