FluView, FluWatch, And WHO Flu Surveillance Reports

Week 50 ILI activity – Source CDC FluView

 

# 6801

 

Regardless of your preferred type of celebration (Christmas, Hanukah, Kwanzaa, the Winter Solstice, Festivus . . .) the winter holiday season often finds us gathered together in relatively closed quarters to share presents, good times, and far too often . . . germs.

 

All of which makes this week’s FluView from the CDC, Canada’s FluWatch, and World Health Organization bi-weekly Influenza Summary of particular interest.

 

The early start to this year’s flu season continues across much of the United States, with A/H3N2 by far the predominate strain being reported. While it is a bit early to talk about the severity of this year’s flu season, historically H3N2 dominated seasons have typically produced more severe illness.

 

First stop, the CDC’s FluView Report for week 50.

 

2012-2013 Influenza Season Week 50 ending December 15, 2012

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

Synopsis:

During week 50 (December 9-15), influenza activity increased in the U.S.

• Viral Surveillance: Of 9,562 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories in week 50, 2,709 (28.3%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• Influenza-Associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported. One was associated with an influenza A (H3) virus and one was associated with an influenza A virus for which the subtype was not determined.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.2%; above the national baseline of 2.2%. Nine of ten regions reported ILI above region-specific baseline levels. Twelve states experienced high ILI activity, New York City and 5 states experienced moderate ILI activity; 11 states experienced low ILI activity; 22 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: Twenty-nine states reported widespread geographic influenza activity; 12 states reported regional activity; the District of Columbia and 5 states reported local activity; 3 states reported sporadic activity; Guam reported no influenza activity, and Puerto Rico, the U.S. Virgin Islands, and 1 state did not report.

A description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/overview.htm

 

The following graphic shows just how early detection of influenza has been this year (red line), compared to previous years.

 

Meanwhile, Canada’s FluWatch report indicates that influenza is beginning to ramp up in several provinces as well.

 

Overall Influenza Summary

• Influenza activity in Canada continued to increase in week 50; four regions reported widespread activity, and the majority of regions reported influenza circulation.
• A total of 1502 laboratory detections of influenza were reported, of which 96.7% were for influenza A viruses, predominantly A(H3N2).
• Thirty-one influenza outbreaks were reported: 24 in long-term-care facilities, 4 in hospitals and 3 in other facilities.
• Thirty-three paediatric influenza-associated hospitalizations were reported through the IMPACT network, all but one with influenza A
• Seventy-three hospitalizations with three deaths in adults ≥20 years of age were reported through Aggregate surveillance, all with influenza A.
• The ILI consultation rate increased compared to the previous week and is within the expected range for this time of year.

 

Virus characterization from Canada shows, like the United States, that A/H3N2 makes up the bulk of identified samples.

 

And globally, influenza rates in the Northern Hemisphere are beginning to rise, although many areas are lagging somewhat behind the numbers seen in North America. 

This from the World Health Organization.

 

Influenza update

21 December 2012 - Update number 175

 

Summary

• Many countries in the temperate regions of the northern hemisphere are now reporting elevated detections of influenza, particularly in north America.

 
• Influenza activity was still low in Europe, with co-circulating of both influenza A and B viruses. However increased influenza-like illnesses were reported in more countries than previous weeks.

• There was low, but increasing influenza activity in northern Africa and the Eastern Mediterranean regions, and sporadic detections in eastern Asia.

• Influenza in central America, the Caribbean and tropical south America continued to decline, with low levels of circulation of mainly influenza A(H3N2) and some influenza B viruses, except for Cuba and Peru, where influenza A(H1N1)pdm09 was predominant.

• Influenza activity in Sub-Saharan Africa declined to low levels, with mainly influenza B, except in Ghana, where influenza A(H1N1)pdm09 was reported.

• Influenza in most South East Asian countries was declining, except in Sri Lanka and Viet Nam.
• Influenza activity in the temperate countries of the southern hemisphere continued at inter-seasonal levels.

 

The CDC recommends a flu shot for just about everyone each year, but regardless of whether you received one, this Holiday season is a good time to hone your basic flu hygiene skills.  

 

The CDC recommends:

 

Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose and mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with flu–like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
• While sick, limit contact with others as much as possible to keep from infecting them.

 

As an added bonus, these healthy hygiene habits can also help protect you against the other winter time scourge, Norovirus – which, like influenza, can wreck a family holiday gathering in record time.

»» Read More

WHO Coronavirus Update

 

Photo Credit NIAID

# 6799

 

My thanks to Lisa Schnirring at CIDRAP NEWS for the head’s up this morning on the recently posted update by the World Health Organization on their ongoing investigation into the novel coronavirus.

While no new cases have been discovered, WHO investigators have delved deeper into the outbreak last April at a hospital in Zarqua, Jordan (including 8 healthcare workers) that resulted in two deaths.

 

(See ECDC Report and FluTrackers Thread)

 

Although there were two confirmed (fatal) infections by this coronavirus in the Jordanian cluster, a number of other pneumonia cases (and milder cases) are suspected. These cases suggest that limited human transmission of the virus may have occurred in this hospital setting. 

 

Unfortunately, testing for this virus is still very limited, and no serological test for antibodies (indicating prior infection) is currently available.

 

Interestingly, none of the cases in Jordan developed renal failure – which was a hallmark in 5 of the 7 cases reported over the summer. 

 

One of the confirmed Jordanian cases developed Pericarditis (inflammation of the sac around the heart) and another developed DIC (Disseminated intravascular coagulation).

 

The Jordanian cluster also suggests that milder cases of this infection may occur, although antibody testing will be needed in order to confirm that.

 

The entire update is worth reading.

 

 

Background and summary of novel coronavirus infection – as of 21 December 2012

Over the past three months, WHO has received reports of nine cases of human infection with a novel coronavirus. Coronaviruses are a large family of viruses; different members of this family cause illness in humans and animals. In humans, these illnesses range from the common cold to infection with Severe Acute Respiratory Syndrome (SARS) coronavirus (SARS CoV).

 

This summary provides the latest information on all reported cases and provides details of a WHO mission to Jordan, which has concluded since the last web update.

 

Thus far, the laboratory confirmed cases have been reported by Qatar (two cases), Saudi Arabia (five cases) and Jordan (two cases). All patients were severely ill, and five have died.

 

A total of five confirmed cases have been reported from Saudi Arabia. The first two are not linked to each other and lived in different parts of the country; one of these has died. Three other confirmed cases are epidemiologically linked and occurred in one family living within the same household; two of these have died. One additional family member in this household also became ill, with symptoms similar to those of the confirmed cases. This person has recovered and tested negative, by polymerase chain reaction (PCR) tests, for the virus.

 

Two confirmed cases have been reported in Jordan. Both of these patients have died. These cases were discovered through testing of stored samples from a cluster of pneumonia cases in health care workers that occurred in April 2012.

 

In November 2012 staff from WHO Headquarters and the Eastern Mediterranean Regional Office were invited to Jordan to assess severe acute respiratory infection (SARI) surveillance and infection prevention and control measures, and to review the April 2012 outbreak. The mission included hospital site visits, interviews with patients, relatives and caregivers, and review of case files. In addition to the two previously confirmed cases, a number of health care workers with pneumonia associated with the cases were also included in the review and are now considered probable case.

The main findings of this mission are:

• The index case among this cluster could not be determined.
• All patients had significant respiratory disease presenting as pneumonia. Disease was generally milder in the unconfirmed probable cases. One patient who is a probable case had symptoms that were mild enough to be managed at home and was not admitted to hospital.
• No patient in this cluster had renal failure.
• One patient presented with pneumonia and was discovered to also have pericarditis. This patient had laboratory confirmation of infection and has died.
• A second patient developed disseminated intravascular coagulation as a complication of severe respiratory disease. This patient also had laboratory confirmation of infection and has died.
• The method of exposure is uncertain.
• There was no history of travel or contact with animals among confirmed or probable cases.

Most family members and health care workers who were closely exposed to confirmed and probable cases did not develop respiratory disease. However, the appearance of pneumonia in some who provided care and in at least two family members with direct personal contact increases the suspicion that person-to-person transmission may have occurred. The possibility of exposure to a common source has not been definitively excluded.

Further investigation with serological testing (when it becomes available) to confirm additional cases may help determine the types of exposures that result in infection.

 

The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. The additional unconfirmed probable cases in Jordan indicate that milder presentations may also be a part of the clinical appearance associated with infection. Acute renal failure has occurred in five of the nine confirmed cases but was not a prominent feature of the Jordanian cluster. In addition, pericarditis and disseminated intravascular coagulation have now been seen in two confirmed cases.

 

WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily or sustainably between people, unlike the SARS virus.

 

WHO has closely monitored the situation since detection of the first case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks.

 

Actions taken by WHO in coordination with national authorities and technical partners include the following:

• Investigations are ongoing to determine the likely source of infection and the route of exposure. Close contacts of confirmed cases are being identified and followed up.
• An interim surveillance recommendation has been updated to assist clinicians to determine which patients should undergo laboratory testing for the presence of novel coronavirus.
• Laboratory assays for the virus have been developed. Reagents and other materials for testing are available, as are protocols, algorithms and reference laboratory services. WHO has activated its laboratory network to assist in testing and other services. WHO has now issued preliminary guidance for laboratory biorisk management.
• The three affected countries either have already or are in the process of acquiring the capacity to test for the novel coronavirus in national laboratories and have enhanced their surveillance activities according to WHO guidance along with other countries in the area.
• WHO has created a webpage for coronavirus infections, with guidance for surveillance, infection control, biorisk management, and laboratory testing, which can be found at: http://www.who.int/csr/disease/coronavirus_infections/en/index.html

Based on the current situation and available information:

• WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
• Further, testing for the new coronavirus of patients with unexplained pneumonias should be considered, especially in persons residing in or returning from the Arabian peninsula and neighboring countries. Any new cases should be promptly reported both to national health authorities and to WHO.
• When collecting specimens for testing, priority should be given to collection of lower respiratory tract specimens such as sputa and endotracheal aspirates (for intubated patients).
• In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated, regardless of where in the world they occur. These investigations will help determine whether the virus is distributed more widely in the human population beyond the three countries that have identified cases.
• Health care workers should be advised to scrupulously adhere to standard infection control precautions for all patients. Droplet precautions should be added to standard precautions for any patient known or suspected to have an acute respiratory infection, including patients with suspected or confirmed infection with novel coronavirus. Airborne precautions should be used for aerosol-generating procedures, including intubation and related interventions. Details can be found on the website listed above.
• WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to monitor this situation closely. Unless information is received that changes our understanding of this virus and the disease it causes, the next web update is expected to be posted during the second week of January 2013.

 

»» Read More

WHO: H5N1 Update

 

 

# 6791

 

The World Health Organization recently changed the way it reports on human infections with the H5N1 virus with the following notice.

 

Henceforward, WHO will publish information on human cases with H5N1 avian influenza infection on a monthly basis on the Influenza webpage.

 

Cases of human infection with H5N1 will only be reported on Disease Outbreak News for events that are unusual or associated with potential increased risks.

 

Today, we’ve an update that indicates two new infections (1 in Egypt, 1 in Indonesia ) have been reported since the November update (see Latest HAI Risk Assessment Summary 17 December 2012).

 

Based on previous years’ observations, an increase in reported H5N1 influenza events in poultry is expected for this time of year. Sporadic human cases reported this month in countries with known influenza A(H5N1) virus activity in poultry are within the expected range. No onward sustained human to human transmission was reported.

Public health risk assessment  of  avian  influenza  A(H5N1)  viruses:    The public health risk remains
unchanged. 

 

Neither of these two cases are exactly `news’, in that we saw an Indonesian MOH report on the 4 year-old last week, as well as an FAO report indicated a human case in Egypt.

 

As you can see from the chart above, increases in human infections with the H5N1 virus typically increase in the fall, and peak during the winter and spring.

 

This report also takes note of the H3N2v infection reported by the CDC (see FluView & A Novel Flu Case In Iowa) in November.  Since then, another case has been reported in Minnesota (see FluView Week 49).

The WHO report concludes by stating:

Overall public health risk assessment of the influenza A(H3N2)v viruses: Further human cases and small clusters may be expected as this virus is circulating in the swine population in the USA. Close monitoring of the situation is warranted.

Due to the nature of constant evolving of influenza viruses, WHO continues to stress the importance of
global monitoring of influenza viruses and recommends all Member States to strengthen routine
influenza surveillance.

 

For now, infections with variant swine flu viruses, and with avian influenza, remain sporadic and only rarely reported. 

»» Read More

WHO: World Malaria Report 2012

 

 

# 6787

 

 

The World Health Organization released a report today warning that a drop in global funding to fight malaria threatens to reverse "remarkable recent gains" against one of the world’s biggest infectious diseases.

 

According to the WHO:

 

There were about 219 million cases of malaria in 2010 and an estimated 660 000 deaths. Africa is the most affected continent: about 90% of all malaria deaths occur
there.

Between 2000 and 2010, malaria mortality rates fell by 26% around the world. In the WHO African Region the decrease was 33%. During this period, an estimated 1.1 million malaria deaths were averted globally, primarily as a result of a scale-up of interventions.

 

Follow the links to read the press release, and to download the various reports.

 

 

Slowdown in the fight against malaria

 

Panos/J. Matthews

17 December 2012 -- After a rapid expansion of malaria prevention and control programmes between 2004 and 2009, global funding to fight malaria levelled off between 2010 and 2012. According to the World malaria report 2012, a funding slowdown could reverse recent gains in the fight against one of the world’s leading infectious killers.

• Read the news release on the World malaria report 2012
• View the malaria fact sheet

 

World Malaria Report 2012

The World Malaria Report 2012 summarizes information received from 104 malaria-endemic countries and other sources, and updates the analyses presented in the 2011 report. It highlights the progress made towards the global malaria targets set for 2015 and describes current challenges for global malaria control and elimination.

This report is embargoed until 14.00 CET, Monday 17 December 2012.

• Full report Report without country profiles
  pdf, 9.16Mb
• Country profiles
  pdf, 43.72Mb Annexes
  pdf, 789kb

»» Read More

Sudan Yellow Fever Update: WHO

 

Credit CDC Yellow Book

 

# 6765

 

 

Five weeks ago Yellow Fever was confirmed in Sudan after several weeks of reports of a `mysterious illness’ that had claimed several dozen lives (see WHO: Yellow Fever Outbreak In Sudan).

 

Yellow fever (aka Yellow Jack) is a viral disease transmitted by the Aedes mosquito (and others). A relatively safe and effective vaccine is available and travelers to parts of equatorial Africa and South America are often advised to get it.

 

Today the World Health Organization has updated the situation in Sudan, including details on a planned mass vaccination campaign.

 

 

Yellow fever in Sudan - update

6 December 2012 - As of 4 December, a total of 732 suspected cases of yellow fever, including 165 deaths have been reported in 33 out of 64 localities in Darfur. Laboratory results have confirmed yellow fever by IgM ELISA test and PCR in 40 clinical samples. Tests were conducted at the National Public Health Laboratory in Khartoum, with support from the US Naval Medical Unit 3 (NAMRU-3), WHO Collaborating Center for Emerging Infectious Diseases.

 

Currently, the Federal Ministry of Health is organizing an emergency mass vaccination campaign against yellow fever. The first phase of the campaign began on 21 November 2012, to cover 2.2 million people, and the second phase of the campaign is planned for this month, to cover an additional 1.2 million at risk population.

 

The vaccination campaign is being supported by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG¹), GAVI Alliance, ECHO, Central Emergency Response Fund (CERF), Sudan Common Humanitarian Fund (CHF), and non-governmental organizations working where the campaign is being carried out.

 

A comprehensive assessment of the outbreak is ongoing, to obtain additional epidemiological, laboratory and entomological information to understand the evolution of the outbreak and the risk of the epidemic.

WHO has activated the Global Outbreak Alert and Response Network (GOARN) and is deploying additional experts including an entomologist, virologists and an epidemiologist to support the ongoing response in the country.

---

¹ The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children's Fund (UNICEF), Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile was created by GAVI Alliance.

 

 

The CDC’s 2012 Yellow Book describes the clinical presentation of Yellow Fever this way:

 

Asymptomatic or clinically inapparent infection is believed to occur in most people infected with YFV. For people who develop symptomatic illness, the incubation period is typically 3–6 days.

 

The initial illness presents as a nonspecific influenzalike syndrome with sudden onset of fever, chills, headache, backache, myalgias, prostration, nausea, and vomiting. Most patients improve after the initial presentation.

 

After a brief remission of hours to a day, approximately 15% of patients progress to a more serious or toxic form of the disease characterized by jaundice, hemorrhagic symptoms, and eventually shock and multisystem organ failure. The case-fatality ratio for severe cases with hepatorenal dysfunction is 20%–50%.

 

On November 29th the CDC’s Traveler’s Health division issued an Outbreak Notice for Yellow Fever in Sudan, with the following recommendations (excerpt).

 

How Can Travelers Protect Themselves?

Travelers can protect themselves from yellow fever by getting vaccinated against yellow fever and by preventing mosquito bites.

• Get yellow fever vaccine.
  • CDC recommends that all travelers 9 months of age or older receive a yellow fever vaccine if they are traveling to areas south of the Sahara Desert. The vaccine is not recommended for people traveling only to the Sahara Desert or the city of Khartoum. (See map.)   
  • Visit a yellow fever vaccination (travel) clinic to get your vaccine.
    • You should receive this vaccine at least 10 days before your trip
    • After you receive the vaccine, your doctor or nurse should give you a signed and stamped “International Certificate of Vaccination or Prophylaxis” (ICVP).
    • One vaccine will last 10 years.
• Prevent mosquito bites
  • Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
  • Use an insect repellent with one of the following active ingredients. Higher percentages of active ingredient provide longer protection.
    • DEET
    • Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
    • Oil of lemon eucalyptus (OLE) or PMD
    • IR3535 (Avon Skin So Soft Bug Guard Plus)
  • Always use insect repellent as directed.
    • If you are also using sunscreen, apply sunscreen first and insect repellent second.
    • Reapply as directed.
  • Follow package directions for using repellent on children
• If you feel sick and think you might have yellow fever
  • Talk to your doctor or nurse  immediately if you develop a fever during or soon after travel
  • Get lots of rest, and drink plenty of liquids.
  • Use acetaminophen to reduce pain and fever. Do not take pain relievers that contain aspirin or nonsteroidal anti-inflammatory medications such as ibuprofen
  • By avoiding mosquito bites, you are less likely to spread the disease to others.
  • Seek health care immediately if you have cold, clammy skin; confusion; shortness of  breath; swelling in the face; and weakness

 

»» Read More

WHO: Background & Summary Of Coronavirus Cases

Photo Credit NIAID

# 5755

 

In addition to today’s GAR Update , the World Health Organization has published the following background & summary document on the novel Coronavirus.

 

 

 

Background and summary of novel coronavirus infection – as of 30 November 2012

Over the past two months, WHO has received reports of nine cases of human infection with a novel coronavirus. Coronaviruses are a large family of viruses; different members of this family cause illness in humans and animals. In humans, these illnesses range from the common cold to infection with Severe Acute Respiratory Syndrome (SARS) coronavirus (SARS CoV).

 

Thus far, the cases reported have come from Qatar, Saudi Arabia and Jordan. All patients were severely ill, and five have died.

 

The two Qatari patients are not linked. Both had severe pneumonia and acute renal failure. Both are now recovering.

 

A total of five confirmed cases have been reported from Saudi Arabia. The first two are not linked to each other; one of these has died. Three other confirmed cases are epidemiologically linked and occurred in one family living within the same household; two of these have died. One additional family member in this household also became ill, with symptoms similar to those of the confirmed cases. This person has recovered and tested negative, by polymerase chain reaction (PCR) tests, for the virus.

 

Two confirmed cases have been reported in Jordan. Both of these patients have died. These cases were discovered through testing of stored samples from a cluster of pneumonia cases that occurred in April 2012.

 

The two clusters (Saudi Arabia, Jordan) raise the possibility of limited human-to-human transmission or, alternatively, exposure to a common source. Ongoing investigation may or may not be able to distinguish between these possibilities.

 

The current understanding of this novel virus is that it can cause a severe, acute respiratory infection presenting as pneumonia. Acute renal failure has also occurred in five cases.

 

WHO recognizes that the emergence of a new coronavirus capable of causing severe disease raises concerns because of experience with SARS. Although this novel coronavirus is distantly related to the SARS CoV, they are different. Based on current information, it does not appear to transmit easily between people, unlike the SARS virus.

 

WHO has closely monitored the situation since detection of the first case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks. Actions taken by WHO in coordination with national authorities and technical partners include the following:

• Investigations are ongoing to determine the likely source of infection and the route of exposure. Close contacts of confirmed cases are being identified and followed up.
• An interim surveillance recommendation has been updated to assist clinicians to determine which patients should undergo laboratory testing for the presence of novel coronavirus.
• Laboratory assays for the virus have been developed. Reagents and other materials for testing are available, as are protocols, algorithms and reference laboratory services. WHO has activated its laboratory network to assist in testing and other services. WHO has also issued preliminary guidance for laboratory biorisk management.
• Guidance is available for infection control.

Based on the current situation and available information:

• WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
• Further, testing for the new coronavirus of patients with unexplained pneumonias should be considered, especially in persons residing in or returning from the Arabian peninsula and neighboring countries. Any new cases should be promptly reported both to national health authorities and to WHO.
• In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated, regardless of where in the world they occur. These investigations will help determine whether the virus is distributed more widely in the human population beyond the three countries that have identified cases.
• WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

WHO continues to work with Member States and international health partners to gain a better understanding of the novel coronavirus and the disease in humans and will continue to provide updated information. As the situation evolves, WHO will reassess its guidance and revise it accordingly.

»» Read More

WHO Coronavirus Update: 9 Confirmed Cases

Coronavirus – Credit CDC PHIL

# 6754

 

Today the World Health Organization is reporting two more confirmed cases of infection from the novel coronavirus, this time from Jordan, and stemming from last April.

 

The two cases were part of an of cluster of an up-until-now unidentified severe respiratory illness that infected at least 11 people at a hospital in Zarqua (including 8 healthcare workers), last spring - killing two.  (See ECDC Report and FluTrackers  Thread)

 

Today’s revelation (which has been hinted at the past couple of weeks) raises additional questions over just how transmissible this virus may actually be.

 

Here is the latest update, bringing the total of confirmed cases to 9.

 

 

Novel coronavirus infection - update

30 November 2012 - In addition to the fatal case of novel coronavirus in Saudi Arabia reported to WHO on 28 November, two fatal cases in Jordan have been reported to WHO today, bringing the total of laboratory-confirmed cases to nine.

 

The latest confirmed case from Saudi Arabia occurred in October 2012 and is from the family cluster of the two cases confirmed earlier.

 

The two cases from Jordan occurred in April 2012. At that time, a number of severe pneumonia cases occurred in the country and the Ministry of Health (MOH) Jordan promptly requested a WHO Collaborating Centre for Emerging and Re-emerging Infectious Diseases (NAMRU – 3) team to immediately assist in the laboratory investigation. The NAMRU-3 team went to Jordan and tested samples from this cluster of cases.

 

On 24 April 2012 the NAMRU-3 team informed the MOH that all samples had tested negative for known coronaviruses and other respiratory viruses. As the novel coronavirus had not yet been discovered, no specific tests for it were available.

 

In October 2012, after the discovery of the novel coronavirus, stored samples were sent by MOH Jordan to NAMRU-3. In November 2012 NAMRU-3 provided laboratory results that confirmed two cases of infection with the novel coronavirus.

 

The MOH Jordan has requested WHO assistance in investigating these infections. A mission from WHO Eastern Mediterranean Regional Office (EMRO) and headquarters arrived in Amman on 28 November 2012 to assist in further epidemiological surveillance and to strengthen the sentinel surveillance systems for severe acute respiratory infections (SARIs).

 

In summary, to date a total of nine laboratory-confirmed cases of infection with the novel coronavirus have been reported to WHO – five cases (including 3 deaths) from Saudi Arabia, two cases from Qatar and two cases (both fatal) from Jordan.

»» Read More

WHO Update On Ebola In Uganda

 

Ebola Virus - Credit CDC

 

# 6750

 

Uganda’s second Ebola outbreak of the year continues in the Luweero and Kampala districts, with six confirmed cases over the past several weeks.  The last Ebola update (along with an update on their Marburg virus outbreak) came a week ago (see WHO Update On Marburg Outbreak In Uganda).

 

Today the World Health Organization has released the following update, which encouragingly, hasn’t seen an increase in confirmed cases over the past week. 

 

Ebola in Uganda - update

30 November 2012 - As of 28 November 2012, the Ministry of Health in Uganda reported 7 cases (6 confirmed, 1 probable) with Ebola haemorrhagic fever in Luweero and Kampala districts. Of these cases, 4 died.

 

Field teams continue to investigate cases alerted to them from the communities. The major challenge faced in some communities is the belief that witch-craft and not Ebola was the cause of deaths, despite ongoing intensive awareness campaigns. Social mobilization teams are working closely with traditional healers and religious leaders to raise awareness on prevention and control of the disease.

 

WHO and partners, including the US Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Plan Uganda continue to support the national authorities in the response to the outbreak. Through WHO, an expert on infection prevention and control has been deployed to the field.

 

With respect to this event, WHO does not recommend that any travel or trade restriction be applied to Uganda.

 

Note: The total number of cases reported on 23 November2012 was 10 (6 confirmed, 4 probable) Probable cases that tested negative for Ebola have been classified as Non-Cases and excluded from the case counts.

 

 

While the primary zoonotic reservoir for the Ebola virus has yet to be firmly established, bats are considered to be the most likely candidate. Intermediate hosts, which are often consumed as bushmeat, are also suspected as harboring these viruses.

 

There are currently five known strains of the disease, of which four are highly pathogenic in humans. The odd virus out - Ebola Reston - which can infect and kill non-human primates, has not been shown to produce disease in man.

»» Read More

WHO Corrects Coronavirus Statement

 

 

Photo Credit NIAID 

# 6749

 

The `buzz’ in flublogia yesterday centered around the low-profile release of a new statement on the novel Coronavirus by the World Health Organization.  Not unexpectedly, it increased the number of confirmed cases to 7 (with 1 probable).

 

Somewhat confusingly, however, it cited only one death, contradicting earlier reports of two deaths (see WHO Confirms 7th Coronavirus Case for the original statement).

Sometime over the past 12 hours or so, a corrected version of the statement has been uploaded to the WHO site, and now they cite three deaths.

 

The corrected paragraph (a h/t to sharp-eyed Gert van der Hoek on FluTrackers for catching this) now reads (bolding mine):

 

The clinical picture in all cases was an acute respiratory infection presenting with signs and  symptoms of pneumonia. Of the seven confirmed cases, five developed acute renal failure and three of these died. The remaining two confirmed cases had pneumonia that required intensive support, without renal failure, and recovered. Three of the seven confirmed cases and the one probable case all belong to the same family and were living in the same household. 

 

The corrected document may be downloaded from:

Novel coronavirus technical guidance - surveillance

Interim surveillance recommendations for human infection with novel coronavirus
pdf, 93kb
• 
  28 November 2012

»» Read More

Referral: CIDRAP News Summarizes The Coronavirus Story

Coronavirus – Credit CDC PHIL

# 6648

 

Yesterday Robert Roos, News Editor at CIDRAP News, undertook a difficult assignment; taking the often fragmentary (and sometimes contradictory) reports on the 7 confirmed (and 1 suspected) coronavirus cases in the Middle East - and putting them into a coherent narrative. 

 

Extremely well done, and highly recommended.

 

 

WHO cites 7th coronavirus case, gives surveillance guidance

Robert Roos News Editor

Nov 29, 2012 (CIDRAP News) – A third case in a family cluster of novel coronavirus infections has been confirmed, raising the global case count to seven, and the fourth illness in the family is now listed as a probable case, the World Health Organization (WHO) has announced.

 

In a statement dated yesterday, the WHO also indicated that only one death has been attributed to the novel virus so far, contradicting a Nov 23 announcement that reported two deaths among the first six cases.

(Continue . . . )

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Branswell On Expanded Surveillance For The Coronavirus

 

Coronavirus – Credit CDC PHIL

# 6743

 

Helen Branswell, ace health reporter for The Canadian Press, has an excellent look this morning at the reasons behind the World Health Organization’s request for enhanced global surveillance for the novel coronavirus recently detected in the Middle East.

 

Rather than detract from what is already a concise and informative report, I’ll simply step aside and invite you to read:

 

 

The Canadian Press - ONLINE EDITION

New coronavirus cases suggest source may be more widespread, WHO says

By: Helen Branswell, The Canadian Press

Posted: 3:02 AM |

Clues gleaned from the most recent infections with the new coronavirus are behind the World Health Organization's decision to warn countries to broaden their surveillance for cases, an expert with the agency says.

 

The Geneva-based global health body now believes the risk of exposure to the new virus may exist beyond Saudi Arabia and Qatar, so telling countries they need only look for sick people with travel or residency links to those countries may be misleading and counterproductive.

(Continue . . . )

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WHO Update On Marburg Outbreak In Uganda

Credit CDC PHIL

# 6735

 

The World Health Organization has updated the Marburg Virus outbreak situation in Uganda, with encouraging news that no new laboratory confirmed cases have been hospitalized since October 31st.

 

Marburg haemorrhagic fever in Uganda - update

23 November 2012 - As of 23 November 2012, a total of 20 (probable or confirmed) cases, including 9 deaths have been reported from4 districts in Uganda (Kabale, Ibanda, Mbarara, and Kampala).

 

The last confirmed case was hospitalised on 31 October 2012.

 

The Ministry of Health continues to conduct active surveillance and investigation on all cases alerted in the 4 districts. Close contacts of the Marburg cases are being followed-up for a period of 21 days.

 

WHO and international partners, including the US Centers for Disease Control and Prevention (CDC), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET), Plan Uganda and Médecins Sans Frontières (MSF) are supporting the national authorities in the investigation and response to the outbreak. Experts have been deployed through the Global Outbreak Alert and Response Network (GOARN) to strengthen the field team.

 

Trainings are being provided to health professionals on infection prevention and control (IPC), and on field information management. Social mobilization activities are being conducted to raise awareness on prevention and control of Marburg haemorrhagic fever.

 

With respect to this outbreak, WHO does not recommend that any travel or trade restriction be applied to Uganda.

 

Earlier blogs on this outbreak include:

CDC Travelers’ Notice:The Ugandan Marburg outbreak

WHO Update: Marburg Virus In Uganda

Marburg Virus Reported In Western Uganda

 

Meanwhile, their second Ebola outbreak of the year (see Ugandan MOH Statement On New Ebola Outbreak) continues in the Luweero district, which is  located in the central part of the country.

 

Today the WHO posted this update:

 

Ebola in Uganda

23 November 2012 - As of 23 November 2012, the Ministry of Health (MoH) of Uganda has reported 10 cases (6 confirmed and 4 probable,), including 5 deaths in Luweero and Kampala.

 

The last confirmed case was hospitalised on 17 November 2012. Close contacts of the Ebola cases are being identified and followed up for a period of 21 days. All the cases alerted to the field teams are being investigated.

 

WHO and partners, including the US Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Plan Uganda are supporting the national authorities in the investigation and response to the outbreak.

 

Experts in the area of field epidemiology, health promotion, logistics management, and infection prevention and control , have been mobilized by WHO through the Global Outbreak Alert and Response Network (GOARN), to provide support to the response.

 

With respect to this event, WHO does not recommend that any travel or trade restriction be applied to Uganda.

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WHO Announces Additional Coronavirus Cases

Coronavirus – Credit CDC PHIL

# 6734

 

 

No sooner did we learn of a new coronavirus case out of Germany this morning (see RKI: Another Coronavirus Case Treated In Germany), we get this update from the World Health Organization indicating at least 6 cases have now been identified and others are being tested.

 

We also have what may constitute the first epidemiologically linked cluster of cases, with four family members experiencing similar symptoms, with two of them dying. 

 

One of the family members, who is recovering, tested negative for the coronavirus, while two others were positive.  Test results are awaited on the fourth (fatal) case.

 

With a new virus, we don’t have much of a track record to establish the sensitivity of the tests, so a negative result may not truly be negative.  Obviously the mechanism of how this cluster came to be is of great interest, since we’ve heard repeated claims that there is no evidence of human-to-human spread.

 

This from the World Health Organization.

 

 

 

Novel coronavirus infection - update

23 November 2012 - WHO has been notified of four additional cases, including one death, due to infection with the novel coronavirus. The additional cases have been identified as part of the enhanced surveillance in Saudi Arabia (3 cases, including 1 death) and Qatar (1 case). This brings the total of laboratory confirmed cases to 6.

 

Investigations are ongoing in areas of epidemiology, clinical management, and virology, to look into the likely source of infection, the route of exposure, and the possibility of human-to-human transmission of the virus. Close contacts of the recently confirmed cases are being identified and followed-up.

 

So far, only the two most recently confirmed cases in Saudi Arabia are epidemiologically linked - they are from the same family, living in the same household. Preliminary investigations indicate that these 2 cases presented with similar symptoms of illness. One died and the other recovered.

 

Additionally, 2 other members of this family presented with similar symptoms of illness, where one died and the other is recovering. Laboratory results of the fatal case is pending, while the case that is recovering tested negative for the novel coronavirus.

 

WHO continues to work with the governments of Saudi Arabia, Qatar and other international health partners to gain a better understanding of the novel coronavirus and the disease in humans. Further epidemiological and scientific studies are needed to better understand the virus.

 

WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and is currently reviewing the case definition and other guidance related to the novel coronavirus. Until more information is available, it is prudent to consider that the virus is likely more widely distributed than just the two countries which have identified cases. Member States should consider testing of patients with unexplained pneumonias for the new coronavirus even in the absence of travel or other associations with the two affected countries. In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where in the world they occur.

 

Of the 6 laboratory confirmed cases reported to WHO, 4 cases (including 2 deaths) are from Saudi Arabia and 2 cases are from Qatar.

 

 

Helen Branswell of the Canadian Press has just published a report on this latest development, which you can read at:

 

Four new cases of coronavirus infection: WHO

By Helen Branswell The Canadian Press

Share this Article

The World Health Organization says it has been informed of four additional infections with the new coronavirus, including two people in one family in Saudi Arabia.

(Continue . . .)

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WHO Europe: Revising Pandemic Preparedness Plans

 

The current WHO phase of pandemic alert for avian influenza H5N1 is 3.

 

# 6725

 

 

While not the damp squib that many pundits have mistakenly called it (see Lancet: Estimating Global 2009 Pandemic Mortality), the 2009 H1N1 influenza pandemic could have been worse.

 

A lot worse.

 

As it was, the Lancet study mentioned above found:

 

We estimate that globally there were 201 200 respiratory deaths (range 105 700—395 600) with an additional 83 300 cardiovascular deaths (46 000—179 900) associated with 2009 pandemic influenza A H1N1. 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 59% occurred in southeast Asia and Africa.

 

As we’ve seen with some previous pandemics, the greatest burden of illness and death was shifted to those under 65, a reversal of what we normally see with seasonal influenza. 

 

Still, when compared to 1918 – where between 50 and 100 million people died – the pandemic of 2009 was relatively mild.

We may not be nearly so lucky the next time around.

 

Preparations for an H5N1 pandemic – which began in earnest in 2005 – undoubtedly helped the world respond in 2009, but it is quite clear the world remains poorly equipped to deal with a major global health crisis.

 

Earlier this year the World Health Organization  published a 16-page document that looked at the lessons learned from the 2009 pandemic, called:

 

 

While the document goes into considerable detail, the following excerpt lists key areas where changes are recommended.

 

Key changes to national pandemic preparedness plans

 
The changes being made to pandemic plans follow to a large extent the findings from some evaluations performed by countries, as well as the two EU-wide assessments (TOR1 and TOR2) (7), the WHO/Europe evaluation of pandemic preparedness (8), the external review of the IHR (1) and of ECDC’s response to the pandemic (9). The changes address primarily the following areas:

• intersectoral cooperation, collaboration and leadership
• flexibility and adaptability of plans
• strategies for vaccines and antivirals 
• disease surveillance and monitoring of countermeasures
• strategies for exchanging information and communicating risk
• evaluation of the pandemic response and the transition to seasonal influenza.

 

Four countries (France, UK, Czech Republic, Finland) have updated their pandemic response plans since 2009, while many other countries are in the process of working on revisions.

 

You can view the latest versions of European national plans at this WHO Europe web address:

 

National preparedness plans

Follow the links below to view country-specific national pandemic preparedness plans.

• Finland
  Updated in 2012 (in Finnish)
• Czech Republic
  Updated in 2011 (in Czech and English)
• France
  Updated in 2011 (in French)
• United Kingdom
  Updated in 2011 (in English)

(Continue . . . )

 

European pandemic guidance recommendations are being revised to more closely match the WHO global pandemic guidance. These new guidance recommendations will be presented at a WHO workshop in Copenhagen next month for countries of the South-eastern Europe Health Network (SEEHN), newly independent states, Switzerland and Turkey.

 

This from the World Health Organization:

 

 

 

Revising pandemic influenza preparedness strategies

16-11-2012

Evaluations of the response to the 2009 pandemic have shown that the world is ill-prepared to respond to a severe influenza pandemic or to any similar global, sustained and threatening public health emergency.

 

From the lessons learned it can be concluded that existing country pandemic plans have a number of gaps. Member States are in the process of revising their pandemic plans and 4 countries of the WHO European Region have published their revised plans.

 

A key activity of WHO/Europe in collaboration with the European Centre for Disease Prevention and Control (ECDC) is to provide a strong and clear guide, so that all countries of the Region can revise their pandemic influenza preparedness strategies. To this end, the existing European guidance is being revised in line with revisions from the WHO global pandemic guidance. This new version of the European guide will be discussed during a workshop on pandemic preparedness that will be held 5-7 December 2012 in Copenhagen, Denmark for countries of the South-eastern Europe Health Network (SEEHN), newly independent states, Switzerland and Turkey.

 

The meeting is organized in collaboration with the SEE Regional Health Development Centre for Communicable Diseases Surveillance in Tirana, Albania and will be facilitated by experts from WHO collaborating centres at the University of Nottingham, United Kingdom and the University of Geneva, Switzerland as well as WHO headquarters.

 

Experts from ECDC and Centers for Disease Control and Prevention (CDC) Central Asian Region, Almaty, Kazakhstan will also participate.

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Global Flu Surveillance Updates

 

 

# 6708

 

After an uncommonly subdued 2011-2012 influenza season (see CDC: The Close Of A Mild Season), and a summer that featured an unprecedented number of variant swine flu infections (see An Increasingly Complex Flu Field) in the United States, no one is quite sure what to expect with the coming flu season.

 

Invariably, the word most often used by researchers when describing influenza is `unpredictable’.

 

Nevertheless, in order to come up with a vaccine each year, scientists must decide – 6 months in advance – what flu strains they think will be most active in the season ahead.

 

After 3 years with essentially no changes, this year’s flu vaccine formulation makes alterations to both the H3N2 and B virus strains.

 

• The H1N1 component remains essentially unchanged, with the A/California/7/2009 (H1N1)pdm09-like  still recommended.
• The old A/Perth/16/2009 (H3N2)-like virus now gives way to the A/Victoria/361/2011 (H3N2)-like virus.
• And the Victoria lineage B/Brisbane/60/2008-like virus will be replaced by a Yamagata strain; the B/Wisconsin/1/2010-like virus. 

 

The addition of these two new strains makes getting the vaccine this year all the more important, as community immunity to these recently emerging strains is likely low.

 

The vaccine die having been cast, each fall we monitor influenza activity around the world via a number of reporting tools, including:

 

• The World Health Organization’s bi-weekly global influenza update based on `data sources, including FluNet (reported by the Global Influenza Surveillance and Response System) and influenza reports from WHO Regional Offices and Member States.’
• The WHO/Europe influenza surveillance reports, which are released on a weekly basis. 
• The ECDC provides both their Weekly Influenza Surveillance Overview (WISO) along with their periodic, highly detailed Influenza virus characterisation reports
• Canada releases a weekly FluWatch report.
• And the CDC produces a detailed FluView report each week.

 

There others, of course.

 

Hong Kong’s CHP  produces an excellent Weekly Flu Express, and when it’s summer in the Northern Hemisphere we keep a close watch on the Australian  and New Zealand influenza surveillance sites.

 

Combined, these resources provide us with a pretty good - albeit `backwards looking’ - overview of flu activity. At least in North America, Europe, and parts of the Pacific Rim.

 

Note: There are plenty of areas around the world where surveillance and reporting are lacking, and so we still run the risk of being blindsided by an emerging influenza strain. 

 

During flu season I try to provide links, and highlights, to many of these flu surveillance reports each week. For now, flu activity around the world is low, but there are signs it may be increasing. 

 

From yesterday’s WHO Flu report:

 

Summary

• Many countries of the Northern Hemisphere temperate region reported increasing detections of influenza viruses, particularly in North America and Western Europe, however none have crossed their seasonal threshold for ILI/ARI consultation rates.
• Several countries in the tropical areas experienced active transmission of influenza virus in recent weeks. In the Americas, Nicaragua and Costa Rica reported mainly influenza B virus detections. In Asia, India, Sri Lanka, Nepal, and Cambodia are all reporting a mixture of all three virus subtypes.
• In Sub-Saharan Africa, Cameroon and Ethiopia have reported an increase in influenza virus detections.
• Influenza activity in the temperate countries of the Southern Hemisphere is at inter-seasonal levels. A review of the 2012 southern hemisphere influenza season was published in the Weekly Epidemiological Record (WER) 2 November 2012, vol. 87, 44 (pp. 421–436)

 

The ECDC’s latest WISO Report finds very little flu activity across Europe.

 

Weekly reporting on influenza surveillance for the 2012–13 season started in week 40/2012 in Europe.

•  In week 44/2012, all 26 reporting countries experienced low intensity of clinical influenza activity.
•  Of 279 sentinel specimens tested across 19 countries, only two were positive for influenza virus.
•  No hospitalised laboratory-confirmed influenza cases were reported.

Five weeks into the surveillance season for influenza, there has been no evidence of sustained influenza virus transmission in EU/EEA countries.

 

The story is pretty much the same in Canada, as we learn from their latest FluWatch Report.

 

Overall Influenza Summary

• Influenza activity in Canada increased slightly compared to the previous week; however overall activity still remains fairly low, with most regions of the country reporting no activity.
• In week 44, a total of 64 laboratory detections of influenza were reported; of which 91% were for influenza A viruses [71% A(H3) and 29% A(un-subtyped)].
• Six influenza outbreaks in long-term care facilities were reported in week 44.
• Eleven influenza A-associated hospitalizations were reported in week 44: 8 in adults >20 years of age, and 2 in children.
• The ILI consultation rate increased in week 44 to 21.9 per 1,000 patient visits but is within the expected level for this time of year.

 

In the United States, the CDC’s FluView Reports the beginnings of limited flu activity around the country:

012-2013 Influenza Season Week 44 ending November 3, 2012

 

 

Synopsis:

During week 44 (October 28-November 3, 2012), influenza activity increased in some areas, but overall was similar to activity last week in the United States.

• Viral Surveillance: Of 3,277 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 44, 227 (6.9%) were positive for influenza.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was slightly above the epidemic threshold.
• Influenza-associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.3%, which is below the national baseline of 2.2%. All 10 regions reported ILI below region-specific baseline levels. One state experienced low ILI activity; New York City and 49 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: The geographic spread of influenza in 1 state was reported as regional; 8 states reported local activity; the District of Columbia and 33 states reported sporadic activity; Guam and 8 states reported no influenza activity, and Puerto Rico and the U.S. Virgin Islands did not report.

 

 

Many years, influenza doesn’t begin to really spread until December or even January, so the level of activity we are seeing today is probably a poor prognosticator of what we will be seeing two or three months from now.

 

Influenza, however, is notoriously unpredictable. Which makes each flu season unique, and worthy of our attention.

 

Stay tuned.

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