Taiwan CDC: Monitoring 1300+, But No Human H5 Cases Detected

 

# 9613

 

If there is any good news to be had in Taiwan’s massive avian flu outbreak, it is that despite monitoring hundreds of people who have had contact with infected birds, as of January 20th no human infections have been reported.

 

While sharing some of the gene segments with the hard-to-catch but often-deadly H5N1 virus, H5N8 derived viruses (including Taiwan’s new H5N2 & H5N3) have not demonstrated the ability to infect humans. 

 

That could change, of course, as the virus evolves or reassorts with other viruses – but for now it is reassuring news.  

 

Last spring, during Korea’s major outbreak of H5N8 - while no human cases were detected - 11 dogs at 2 poultry facilities developed antibodies to the virus. Hopefully, a few weeks from now, serological tests will be performed on these `contacts’ to see if any of them display raised antibody titers for these new viruses.

 

This from Taiwan’s CDC.

 

 

Although no bird-to-human transmission of avian influenza occurs, Taiwan CDC continues to closely monitor outbreak situation to ensure health and wellbeing of people in Taiwan

( 2015-01-21 )

In response to the occurrence of avian influenza infections in local poultry farms, the Taiwan Centers for Disease Control (Taiwan CDC) will continue to closely monitor the health status of poultry farm workers and disease control personnel. As of January 20, 2015, a total of 1,377 people are being monitored and followed up for influenza-like symptoms. At the time of writing, no bird-to-human transmission of avian influenza has occurred. Poultry workers working at poultry farms where avian influenza infections have occurred are urged to voluntarily notify the local health bureau when respiratory symptoms develop during the health monitoring period for assistance in seeking medical attention.

The ongoing avian influenza outbreak in poultry continues to persist. Although no bird-to-human transmission of H5N2, H5N8, and H5N3 has occurred, Taiwan CDC is monitoring everyone who has been exposed to the poultry farms where avian influenza outbreaks have occurred for influenza-like symptoms for 10 days as a precaution. Those who develop influenza-like illness will be further evaluated and tested for influenza. Of the 1,377 people being monitored and followed up, 32 people have developed influenza-like symptoms. Specimens have been collected from 22 of them (1 is positive for seasonal influenza and the other 21 are negative), while the other 10 people are still being monitored for their health status. 3 other persons have been removed from surveillance.

Taiwan CDC has been maintaining an effective communication channel with the Council of Agriculture to frequently exchange information concerning animal and human influenza outbreaks, including the location of the outbreak, the type of the virus that caused the outbreak, and the contact information of the people involved in the outbreak. As soon as Taiwan CDC was notified of the recent avian influenza outbreaks in local poultry farms by the Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture, Taiwan CDC has been implementing relevant disease control measures correspondingly and according to the standard operation procedures outlined under the “Animal Influenza Preparedness and Response Guidance” in the “Handbook for the Control and Prevention of Novel Influenza A Virus Infections”, including proactively investing the disease outbreaks, conducting relevant health education, compiling lists of contacts, issuing health-monitoring notices, and proactively monitoring and following up on potentially exposed individuals who have developed influenza-like symptoms.

Taiwan CDC reminds poultry workers to take additional preventive measures to prevent infection. If fever or influenza-like symptoms develops, please put on a mask and seek immediate medical attention. Moreover, poultry workers must inform the physician of their job and exposure history to facilitate diagnosis and treatment. For more information, please visit the Taiwan CDC website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).

• Last modified at 2015-01-21
• Data from Division of Planning and Coordination

Texas & Ohio Quietly Reach End Of Ebola Contact Monitoring

Credit CDC PHIL

 

 

# 9295

 

This week marks the end of Ebola contact monitoring in the states of Ohio and Texas, as 21 days have now passed since the last known exposure to an infected patient.   The vigil in Ohio ended mid-week, while the one in Texas will end later today.

Since the majority of those being monitored were extremely `low risk’ contacts, the risks to the community were always considered small. This should, however, offer some reassurance to those who were worried that Ebola might quickly spread in the United States.

New York state continues to monitor contacts of Dr. Spencer, but thus far the new is very encouraging, as there are no indications that he transmitted the virus to anyone else.

 

Despite the media hysteria and the internet conspiracy predictions of doom, the evidence continues to mount that Ebola infected individuals – at least early in the symptomatic phase of their illness – are less infectious than many people originally feared.

 

While this phase of America’s Ebola experience draws to a close, the evidence suggests we’ll see more imported cases of Ebola (or MERS, Avian Flu, etc.) in the future, which will prompt similar public health responses.  Many of the lessons learned in Ohio and Texas will no doubt help other states when it becomes their turn to deal with a local case.

 

Two press releases follow:

 

FOR IMMEDIATE RELEASE November 5, 2014
Contact: Ohio Department of Health Public Affairs, (614) 644-8562

FINAL OHIO DAILY EBOLA CONTACT REPORT

11-05-14
COLUMBUS – The Ohio Department of Health reported this morning in its Daily Ebola Contact Report that there are currently:

• 0 confirmed cases of Ebola in Ohio;
• 0 people under quarantine;
• 0 contacts statewide;
  

Tuesday was the last day of monitoring all contacts as their 21 days exposure has ended. ODH officials and Centers for Disease Control and Prevention (CDC) Ohio team members worked together to identify anyone who may have had contact of some type with the Dallas nurse who was in Northeast Ohio, Oct. 10-13. No individuals have shown any symptoms.

The ODH call center will also go back to operating only between business hours of 8am-5pm. During the Ebola response effort, the call center saw 2404 calls. Ohioans can still call the number if they have any questions about Ebola. The number to call is 1-866-800-1404.

(Continue . . .)

 

Texas Reaches Ebola Monitoring Endpoint

News Release
Nov. 6, 2014

The last person being monitored in connection with the state’s three diagnosed Ebola patients will be cleared from twice-daily monitoring by the end of the day Friday after reaching the 21-day mark, the longest incubation period for the disease.

No additional cases of the disease have been diagnosed in Texas.

A total of 177 people – a mix of health care workers, household contacts and community members – have been monitored over time because they had contact with at least one of the three Texas Ebola patients, specimens or medical waste. The last person being monitored Friday is a hospital worker who handled medical waste Oct. 17.

“We’re happy to reach this milestone, but our guard stays up,” said Dr. David Lakey, commissioner of the Texas Department of State Health Services. “We reached this point through teamwork and meticulous monitoring, and we’ll continue to be vigilant to protect Texas from Ebola.”

Texas also recently cleared the people who were being monitored in Texas because they were passengers on one of the Dallas-Cleveland flights that carried a Dallas health care worker before she was diagnosed with Ebola.

State and local health officials worked with the Centers for Disease Control and Prevention to closely monitor people since the first patient was diagnosed Sept. 30.

Health officials continue to monitor all travelers who return to Texas from countries with widespread Ebola outbreaks. The CDC has identified about 50 people who have returned to Texas from those areas. One of those travelers, a Central Texas nurse who cared for Ebola patients in Sierra Leone, is considered to be at “some risk” of exposure to Ebola and has agreed to stay home until she reaches the 21-day mark. The rest are considered to be “low risk” contacts and are being monitored for symptoms.

ECDC: Management Of Contacts Of Ebola Virus Disease Cases In The EU

 

# 9339

 

One of the `moving targets’ in the global public health response to Ebola has been what constitutes a `low risk exposure’ vs.  a `high risk exposure’, and what kind of monitoring, or movement restrictions, are appropriate.  

 

Previously, we’ve looked at the CDC’s original guidance (see CDC Issues New Ebola Case Definitions)  along with some of updates (see CDC Updated Interim Guidance On Ebola) over time.  In response to the Dallas travel confusion involving HCWs who had treated the index case, the State of Ohio issued their own, stricter rules (see Ohio Daily Ebola Contact Report – Oct 19th).

 

Today the ECDC has issued it’s own set of definitions of low vs high risk exposures, and their recommendations on the monitoring of contacts.  They do state, however, that Implementation may be modified in accordance with the public health assessment carried out by the public health officer interviewing the contacts.

Click the link below to download the full PDF File.

 

Public health management of persons having had contact with Ebola virus disease cases in the EU

22 October 2014

(EXCERPTS)

Definition of contact persons
A contact person of an EVD case is a person not currently presenting symptoms, who has or may have been in contact with an EVD case, with bodily fluids of a case, or with a soiled environment. The associated risk of infection depends on the level of exposure, which will in turn determine the type of monitoring.

1. Contact persons with low-risk exposure; examples:
• Casual or physical contact with a feverish but ambulant and self-caring EVD case (e.g. sharing a seating area or public transportation, including airplane transport; receptionist tasks; etc.)
• Close, face-to-face or physical contact with a case who is not coughing or vomiting.
• Household, classroom or office contact.

2. Contact persons with high-risk exposure; definition2:

• Close face-to-face contact (e.g. within one metre) without appropriate personal protective equipment (including eye protection) with a probable or confirmed case who is coughing, vomiting, bleeding, or has diarrhoea.
• Direct contact with bodily fluids or any materials soiled by bodily fluids from a probable or confirmed case.
• Percutaneous injury (e.g. with a needle) or mucosal exposure to bodily fluids, tissues or laboratory specimens of a probable or confirmed case.
• Participation in funeral rites having direct contact with human remains (including bodily fluids) of a case in or from an area with community transmission without appropriate personal protective equipment.
• Having had unprotected sexual contact with a case within three months of the case recovering from EVD.
• [Having had direct contact with bushmeat, bats or primates, living or dead, from affected areas.] – no relevance to contact management.

3. Healthcare workers with occupational exposure
• Occupational exposure of a healthcare worker, including laboratory workers, involved in caring for a confirmed EVD patient using appropriate personal protective equipment. Contact with EVD patients using appropriate personal protective equipment is considered to be low-risk exposure. However, given the continuous nature of the occupational exposure involved in caring for patients, such exposures should be dealt with as high-risk exposures.

Monitoring of contacts

Figure 1 describes the monitoring of contacts and the actions to take in the event of a contact developing symptoms.

Public health authorities can, depending on the specific situation, support, promote or implement further restrictions (e.g. voluntary limitation of contacts by the person, or avoiding contact with crowds).

The contact tracing and management are based on the following current knowledge:

• The incubation period of Ebola viruses can be as long as 21 days.
• Only symptomatic patients can transmit the infection. Infectiousness starts from the onset of symptoms.
• Transmission may occur through direct contact with the patient or blood and other bodily fluids of the patient.
• Dead bodies and their blood and bodily fluids remain infectious.
• There is no evidence of airborne transmission, but precautions are warranted when aerosol-generating symptoms (such as vomiting) are present or aerosol-producing procedures are performed.
• Transmission via inanimate objects contaminated with infected bodily fluids (fomites) is possible.
Main actions for contact persons

• Contact with low-risk exposure:

− Self-monitoring for EVD symptoms, including fever of any grade, for 21 days after last exposure. Public health authorities may do more, depending on the specific situation.

• Contact with high-risk exposure:

− Active monitoring for EVD symptoms, including fever of any grade, for 21 days after last exposure by public health authorities;
− No travel abroad;
− Remaining reachable for active monitoring;
− Restriction of contacts (voluntary self-quarantine or imposed) to be considered in the event of very high-risk exposure.

• Healthcare worker with occupational exposure:
− Occupational health surveillance of healthcare workers should be enhanced.

Contact persons should immediately self-isolate and contact health services in the event of any symptom appearing within 21 days. If no symptoms appear within 21 days of last exposure the contact person is no longer considered to be at risk of developing EVD.

Contact management steps after a case is identified

The steps are contact listing (and classification of the contact as having had low- or high-risk, or occupational exposure), contact tracing, contact assessment and management, and follow-up by an outbreak control team

CDC Statement On Post-Arrival Monitoring Of Travelers From Ebola Impacted Countries

 

 

# 9235

 

I wasn’t able to listen into today’s CDC press conference, but we have a short press release describing a new system – scheduled to go into effect next week – to actively monitor arrivals from Ebola affected nations for up to 21 days after they enter this country.

 

CDC Announces Active Post-Arrival Monitoring for Travelers from Impacted Countries

Travelers from Guinea, Liberia, and Sierra Leone will receive a CARE (Check And Report Ebola) kit when they arrive in the United States.

The Centers for Disease Control and Prevention (CDC) announced that public health authorities will begin active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea.  These travelers are now arriving to the United States at one of five airports where entry screening is being conducted by Customs and Border Protection and CDC.  Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be followed up daily by state and local health departments for 21 days from the date of their departure from West Africa. 

Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, have already taken steps to plan and implement active post-arrival monitoring which will begin on Monday, October 27.  Active post-arrival monitoring will begin in the remaining states in the days following.   CDC is providing assistance with active post-arrival monitoring to state and local health departments, including information on travelers arriving in their states, and upon request, technical support, consultation and funding.

Active post-arrival monitoring is an approach in which state and local health officials maintain daily contact with all travelers from the three affected countries for the entire 21 days following their last possible date of exposure to Ebola virus. Twenty-one days is the longest time it can take from the time a person is infected with Ebola until that person has symptoms of Ebola. 

Specifically, state and local authorities will require travelers to report the following information daily:  their temperature and the presence or absence of other Ebola symptoms such as headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal bleeding; and their intent to travel in-state or out-of-state. In the event a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a daily basis.

In addition, travelers will receive a CARE (Check And Report Ebola) kit at the airport that contains a tracking log and pictorial description of symptoms, a thermometer, guidance for how to monitor with thermometer, a wallet card on who to contact if they have symptoms and that they can present to a health care provider, and a health advisory infographic on monitoring health for three weeks.

Active monitoring establishes daily contact between public health officials and travelers from the affected region. In the event a traveler begins to show symptoms, public health officials will implement an isolation and evaluation plan following appropriate protocols to limit exposure, and direct the individual to a local hospital that has been trained to receive potential Ebola patients.

Post arrival monitoring is an added safeguard that complements the existing exit screening protocols, which require all outbound passengers from the affected West African countries to be screened for fever, Ebola symptoms, and contact with Ebola and enhanced screening protocols at the five U.S. airports that will now receive all travelers from the affected countries. All three of these nations have asked for, and continue to receive, CDC assistance implementing exit screening. 

RadNet: The EPA’s Radiation Monitoring System

 

 

# 5454

While no harmful levels of radiation are presently expected to reach the United States as a result of the Fukushima reactor crisis, the Environmental Protection Agency’s (EPA) RadNet System has detected very small increases in radiation levels since the March 11th earthquake.

 

The EPA reassures, however:

 

To-date, levels recorded at this monitor have been thousands of times below any conservative level of concern.

 

Still, I know many of my readers possess a good measure of scientific curiosity and would find it of interest to follow radiation monitors around the nation.

 

The EPA, fortunately, has made that information easily available.

 

 

By visiting the RadNet Site you can click on the map (pictured above) and get real-time readout of current and recently detected radiation readings from scores of locations around the nation.

 

The EPA is also posting Daily Summaries on the radiation impact on the United States, along with regular statements.

The latest statement (March 27th) reads:

 

As a result of the incident with the Fukushima nuclear plant in Japan, several EPA air monitors have detected very low levels of radioactive material in the United States consistent with estimates from the damaged nuclear reactors. These detections were expected and the levels detected are far below levels of public-health concern.

 

Elevated levels of radioactive material in rainwater have been expected as a result of the nuclear incident after the events in Japan since radiation is known to travel in the atmosphere. There have been reports received that the states of Pennsylvania and Massachusetts have seen elevated levels of radiation in recent precipitation events. EPA is reviewing this data – however, in both cases these are levels above the normal background levels historically reported in these areas.

 

While short-term elevations such as these do not raise public health concerns – and the levels seen in rainwater are expected to be relatively short in duration – the U.S. EPA has taken steps to increase the level of nationwide monitoring of precipitation, drinking water, and other potential exposure routes to continue to verify that.

 

EPA’s only recommendation to state and local governments is to continue to coordinate closely with EPA, CDC and FDA – EPA will continue to communicate our nationwide sampling results as they come in.

 

Earlier EPA Updates

• March 22, 2011 - Statement on Recent Findings in West Coast States and Hawaii
• March 18, 2011 - JOINT EPA/DOE STATEMENT: Radiation Monitors Confirm That No Radiation Levels of Concern Have Reached the United States
• March 15, 2011 - EPA Statement on Air Monitoring Effort
  • Declaración de EPA (15 de marzo de 2011)

 

You’ll also find an informative FAQ page with information relating to the Fukushima radiation and the EPA’s monitoring network.

 

Frequently Asked Questions

Last updated on Sunday, March 27, 2011 at 2:54:45 PM.

This page provides answers to questions EPA has received about the current nuclear power plant situation in Japan

 

An interesting website, well worth exploring.