ECDC: Updated Novel Coronavirus Risk Assessment

Photo Credit NIAID

 

# 6770

 

Although we’ve no fresh reports of infection by the novel coronavirus which appeared in the Middle East last April, and has been confirmed in 9 patients (see WHO: Background & Summary Of Coronavirus Cases), health officials around the globe continue to assess the situation and make provisions to detect and contain the virus.

 

A week ago the World Health Organization  released new Interim surveillance recommendations and an updated Coronavirus FAQ (see WHO Coronavirus Updates).

 

Today, in the wake of the announcement of two cases from Jordan last spring, the ECDC updates their Coronavirus Risk Assessment, previously updated on November 26th.

 

Novel coronavirus: ECDC updates its risk assessment

10 Dec 2012

 

ECDC has published another update of its risk assessment on the novel coronavirus. Two cases in Jordan have retrospectively been confirmed. These additional cases have increased the geographical area in which transmission of the virus has occurred. The two fatal cases were part of a cluster of 11 patients with respiratory symptoms linked to a hospital. The limited information available about this outbreak does not allow for an assessment of whether human-to-human transmission has occurred or indeed whether the cases in this cluster had the same cause.

 

The ECDC risk assessment highlights that healthcare workers should be alerted to the possibility of attending to patients who meet specific characteristics which would require an investigation according to the WHO case definition. The new WHO recommendations favour the investigation of patients returning from the Arabian Peninsula or its neighbouring countries, but do not exclude the testing of patients with unexplained pneumonia in the absence of such travel.

 

A specific serological test and seroepidemiological studies are needed to investigate the occurrence of mild and asymptomatic infections. The diagnostic capacity for novel coronavirus is adequate in the EU. This is confirmed by a newly published article in Eurosurveillance on the results of a survey undertaken by ECDC and WHO. The virus genome is in the public domain and mechanisms for sharing samples and diagnostic methods between countries and laboratories are in place.

 

As of 4 December 2012, a total of nine laboratory-confirmed cases of severe pneumonia caused by the novel coronavirus have been reported to WHO. Five of the nine cases were fatal. Onset of disease was from April to October 2012 and all cases were resident in Saudi Arabia, Qatar or Jordan during the presumed 10 days incubation period.

 

ECDC endorses the WHO travel advice and does not advise any travel or trade restrictions for Saudi Arabia or Qatar.

 

The entire Risk Assessment may be downloaded here.

 

This document’s main conclusions and recommendations reads:

 

• As of 4 December 2012, nine laboratory-confirmed cases of severe pneumonia caused by the novel coronavirus have been reported to WHO. Five of the nine cases were fatal. Onset of disease was from April to October 2012; all cases were resident in Saudi Arabia, Qatar or Jordan during the presumed 10 days incubation period.
• Two retrospectively tested and confirmed cases in Jordan in April 2012 have increased the geographical area in which transmission has occurred. The two fatal cases were part of a cluster of 11 patients with respiratory symptoms linked to a hospital, but the limited information available about this outbreak does not allow for an assessment of whether any human-to-human transmission occurred or whether the cases in this cluster had the same cause.
• Healthcare workers should be alerted to the possibility of attending to patients who meet the WHO case definition. Such cases should be investigated rapidly and managed according to WHO recommendations or national guidance documents.
• The new WHO recommendations for the investigation of patients favour the investigation of patients returning from the Arabian Peninsula or its neighbouring countries, but do not exclude the testing of patients with unexplained pneumonia in the absence such travel.
• Healthcare workers caring for patients under investigation should exercise stringent infection control measures as indicated by national or international guidance. Similarly, health professionals engaged in the medical evacuation of patients presenting with acute respiratory distress syndrome (ARDS) should be particularly vigilant, especially if patients originate from the Arabian Peninsula or its neighbouring countries.
• Testing for the novel coronaviruses should be considered in patients undergoing medical evacuation for ARDS prior to their transfer out of the Arabian Peninsula or its neighbouring countries. All public and private hospitals and private healthcare facilities should test patients on admission for the novel coronaviruses if they present with ARDS and have been medically evacuated from the Arabian Peninsula or its neighbouring countries. Referring providers should inform the recipient hospital if testing for novel coronavirus has been performed.
• Healthcare workers caring for confirmed cases should be monitored for early symptoms of infection. This includes healthcare workers who provided direct clinical or personal care, or performed examination of the cases while they were symptomatic. Close contacts of confirmed cases must be monitored for symptoms as well.
• Any probable or confirmed case diagnosed in the EU/EEA should be reported to national authorities through the Early Warning and Response System (EWRS) and to WHO under the International Health Regulations (2005). Reporting through EWRS allows for an automatic IHR notification and avoids double reporting.
• Patients still under investigation do not need to be reported internationally before confirmation. However, notification at state and national levels needs to follow national legislation or guidance to allow the implementation of infection control measures, initiation of outbreak investigation, and epidemiological monitoring.
• A specific serological test and seroepidemiological studies are needed to investigate the occurrence of mild and asymptomatic infections.
• ECDC endorses WHO's travel advice and does not advise any travel or trade restrictions for Saudi Arabia or Qatar.
• WHO and ECDC re-emphasise the importance of timely and thorough investigations; this includes the reporting of any clusters of severe acute respiratory infections in the community or in healthcare workers, regardless of where in the world they occur.

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ECDC Updates Their Coronavirus Risk Assessment

 

 

# 6741

 

 

The announcement late last week that several new coronavirus cases have been detected in the MIddle East, including what appears to have been a limited cluster of cases in a household, has prompted an update from the ECDC of their risk assessment.

 

Available as PDF in the following languages:

 

ABSTRACT

Since June 2012 and up to 25 November 2012, a total of six confirmed cases of infection with the novel coronavirus (of whom two died) have been reported to WHO. All cases share a history of residence in, or travel to, the Kingdom of Saudi Arabia (KSA) or Qatar. The source and possible routes of transmission of the virus remain unknown.

 

ECDC updated risk assessment concludes that in the absence of evidence of sustained person-to-person transmission outside of household settings, the current facts still point towards a hypothesis of a zoonotic or environmental source with occasional transmission to exposed humans. WHO does not advise any travel or trade restrictions at this point for KSA or Qatar.

 

 

The main conclusions from this report include:

 

•  In September 2012, a group of novel coronaviruses were identified in two patients presenting with a severe acute respiratory illness. Both had a travel history to the Kingdom of Saudi Arabia (KSA) or Qatar. These novel coronaviruses are genetically different from the virus that in 2003 caused the SARS outbreaks (SARS-CoV).

 
•  Since June 2012 and up to 25 November 2012, a total of six confirmed cases of infection with the novel coronavirus (of whom two died) have been reported to WHO, meeting the requirements of its case definitions. Severe respiratory disease was the common factor in all of these. Two of the cases were diagnosed after being transferred to Europe for further medical care. 

•  All six confirmed cases reside or travelled to KSA or Qatar. Two confirmed cases in KSA are from the same family household. A further person in this household is under investigation for infection with the novel coronavirus.

•  The source and possible routes of transmission of the virus remain unknown. Investigations have yet to identify the source or route of infection and infectiousness. At this stage, the detection of a household cluster does not provide conclusive evidence for or against limited person-to-person transmission. It is possible that enhanced surveillance in KSA, Qatar and elsewhere will detect additional sporadic cases and clusters.

 

•  Initial laboratory analyses in Europe of the first of these viruses (known as hCoV-EMC) suggest that it may be able to infect a range of mammalian cells including human cells making human-to-human transmission theoretically possible.

 
•  Healthcare workers should be made aware of the possibility of attending to patients matching the characteristics of patients requiring investigation as per WHO case-definition; however, the geographical area should be extended from KSA and Qatar to include the whole of the Middle East. Healthcare workers caring for patients under investigation should exercise stringent infection control measures following national or international guidance. Testing for the novel coronaviruses should be considered in patients potentially undergoing medical evacuation for acute respiratory distress syndrome (ARDS) prior to their transfer. Healthcare workers caring for confirmed cases and close contacts of confirmed cases should be monitored for symptoms.

•  Patients returning from the Middle East with unexplained pneumonia or ARDS, i.e. where full diagnostic workup for respiratory pathogens (bacterial and viral) is negative, should be considered for investigation and tested for novel coronavirus by EU national reference and research laboratories capable of such testing.

 
•  Any probable or confirmed case being diagnosed in the EU/EEA should be reported to national authorities, through the Early Warning Response System (EWRS) and to WHO under the International Health Regulations (2005) (most easily via the option to report to IHR through EWRS to avoid double report entry).

 

»» Read More

Updated ECDC Risk Assessment On Coronavirus

 

# 6701

 

If you’ll forgive a slight reworking of a famous line from Ian Fleming’s Goldfinger:

 

“Once is happenstance. Twice is coincidence. Three times, it's an emerging infectious disease.”

 

At least that’s what sprang to mind last Sunday with the  announcement from the Saudi Ministry of Health that a third coronavirus case from the Middle East had been indentified, and was responding to treatment (see Saudi Arabia MOH Announces Third Coronavirus Case.

 

The ECDC, which issued a Risk Assessment last September after the second case was announced, has updated their assessment today.

 

 

Epidemiological update: additional case of novel coronavirus

06 Nov 2012

ECDC

On 4 November, the Ministry of Health, Kingdom of Saudi Arabia, posted a report on ProMed about a confirmed case of pneumonia caused by the novel coronavirus which has been temporarily named nCoV-EMC. The patient, who was diagnosed and treated in Riyadh, is recovering. He had not travelled outside of Riyadh but, like the two previously documented cases, had visited a farm prior to onset of symptoms. There are no details on the kind of farm he visited or details of specific animal contact. The coronavirus strain isolated from the current case has not yet been sequenced.

 

On 24 September 2012, ECDC published a Rapid Risk Assessment on Severe respiratory disease associated with a novel coronavirus. The novel coronavirus caused two confirmed severe cases, one of whom died. The reservoir and route of transmission of this virus has not been confirmed but there was an epidemiological link to exposure on the Arabian peninsula. There is no evidence of person-to-person transmission. An analysis of the relation of the hCoV-EMC showed that it was most closely related to bat coronaviruses.

 

The current information on this third case does not change the conclusions in the ECDC rapid risk assessment that the current risk is low, but offers an important opportunity to explore possible exposure and routes of transmission, should the strain be shown to be identical with the two isolates of the hCoV-EMC. ECDC continues to follow developments closely.

Read more on ECDC website:

• Severe respiratory disease associated with a novel coronavirus
• New laboratory diagnostic protocols for novel human coronavirus

 

The lack of any sign of human-to-human transmission is extremely encouraging, but as this assessment points out, there is a great deal we do not yet know about this virus.

 

Most importantly its primary (or even intermediate) host species have not been identified (although it is similar to viruses found in Bats in Hong Kong), nor has the mode of transmission been determined.

 

For now, this coronavirus remains an epidemiological mystery. One that researchers around the world are more than a little anxious to solve.

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ECDC: Coronavirus `does not signal the start of a new SARS outbreak’

 

 

# 6580

 

Along with the statements tweeted earlier today by the World Health Organization (see WHO: Coronavirus Not SARS), we have an assessment just released from the ECDC that states:

 

Further investigations are needed to fully understand the novel coronavirus and the public health implications. However, based on the available information, ECDC assesses the current risk as low.

 

In their statement they also  point out that this novel coronavirus is `not genetically similar to the SARS coronavirus’ and `There is no evidence of person to person transmission’.

 

Coronavirus: collaboration and surveillance the key to early detection and understanding the risk

25 Sep 2012

ECDC

European, international and national public health authorities have been working closely together since the identification of two cases with a novel coronavirus became known. One case has died in Saudi Arabia and the second is in intensive care in a London hospital.

 

This newly identified coronavirus is not genetically similar to the SARS coronavirus and does not signal the start of a new SARS outbreak. There is no evidence of person to person transmission, which was the case with SARS, and the symptom presentation is also different. Coronaviruses can cause quite mild symptoms, similar to the common cold, or more severe disease as witnessed by the 2003 international SARS outbreak.

 

Further investigations are needed to fully understand the novel coronavirus and the public health implications. However, based on the available information, ECDC assesses the current risk as low. The only way we can build a proper understanding of the virus is through coordinated international surveillance and laboratory testing. The value of laboratories has been demonstrated by the excellent work done by the Health Protection Agency (HPA) laboratories in the UK and the Erasmus University Medical Centre in Rotterdam, the Netherlands.

 

There are in place plans and procedures in all public health authorities and international organisations for managing events where there is a little- or un-known disease or virus. These range from sharing the genome of the virus between countries to ensure rapid laboratory identification to regular conference calls of public health officials. This is, in part, due to the legacy of the 2003 international SARS (severe acute respiratory syndrome) outbreak. We now have better surveillance systems and a network of expert laboratories on imported viral diseases.

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ECDC Risk Assessment On DR Congo Ebola Outbreak

Credit Wikipedia

# 6512

 

 

Considering the actual impact that it has on human health around the world, Ebola gets more than its fair share of coverage in the press.

 

First discovered in Zaire and Sudan in 1976, its incredibly high fatality rate and gruesome hemorrhagic symptoms have served to capture the public’s imagination.

 

Helped along, no doubt by movies like 1995’s Outbreak and books like Tom Clancy’s Executive Orders and The Hot Zone by Richard Preston.

 

As a public health threat, Ebola – which has been blamed for fewer than 2,000 deaths over the past 30+ years - pales in comparison to most of the world’s less feared infectious diseases.

 

Simple childhood pneumonia, claims 1.8 million lives each year (cite) and Malaria claims between one half, to one million lives a year (cite).

 

During an exceptionally mild flu year, more people die from influenza in the United States than have been killed by the Ebola virus over the past 3 decades.

 

Nevertheless, whenever an outbreak of a hemorrhagic virus occurs somewhere in the world, we are fascinated by its imagery, and its feared potential.

 

While it is possible (and given enough time, perhaps even inevitable) that an Ebola carrier might someday board a plane and land in Europe or the United States before exhibiting symptoms, the risks of that sparking a major outbreak are considered low.

 

Today, the ECDC has released a reassuring Rapid Risk Assessment on the latest Ebola outbreak in the DR Congo.

 

 

Rapid risk assessment: Outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo

Technical reports - 23 Aug 2012

 

ABSTRACT

In the light of an outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo, ECDC has considered the risk to public health in the EU.

The risk of becoming infected is considered to be low unless a person is in direct contact with bodily fluids of dead or living infected persons or animals. It is therefore unlikely that local or foreign citizens in the Democratic Republic of Congo will become infected. In the unlikely event that a traveller infected in the Democratic Republic of Congo arrives in the EU while incubating the disease and develops symptoms, they should seek medical attention and be isolated, which will prevent further transmission.

 

 

For some recent posts on Ebola outbreaks, you may wish to revisit:

 

WHO: Ebola Update

Update: Ebola Reported In Uganda’s Capital

Uganda: Ebola Sudan And A Timely Dispatch From The EID Journal

»» Read More

H3N2v: CDC Update & ECDC Risk Assessment

 

 

# 6500

 

Friday means the weekly CDC FluView report is out, and right now, the only flu to talk about in the U.S. is H3N2v. We also have a risk assessment from the ECDC  today on this emerging virus, and another state (Pennsylvania) to add to the list of places reporting human infections (4 confirmed, 6 suspected). 

 

First stop though, is the CDC’s H3N2v update page, where the latest state totals are listed. Since last week Pennsylvania, Wisconsin, West Virginia, and Michigan have reported their first cases.

 

 

There you will also find the CDC’s assessment of this virus, and the risks it currently poses to the public’s health.

 

CDC Assessment

It's possible that sporadic infections and even localized outbreaks among people with this virus will continue to occur. While there is no evidence at this time that sustained human-to-human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread. So far, the severity of illnesses associated with this virus in people has been similar to the severity of illnesses associated with seasonal flu virus infections. Limited serologic studies indicate that adults may have some pre-existing immunity to this virus while children do not. CDC is closely monitoring human infections with all novel influenza viruses, including H3N2v viruses, and will provide more information as it becomes available.

 

 

An assessment that is in-line with the latest risk assessment from the ECDC, which finds the risk to public health from this virus to be very low at this time.

 

ABSTRACT

Following recent increased reporting of human infections in the US with an influenza A(H3N2) variant virus of swine origin (A(H3N2)v), ECDC has updated its risk assessment. It concludes that the swine-origin influenza A(H3N2)v viruses do not currently pose a serious risk to human health in general and Europe in particular. Should increased pathogenicity and/or transmissibility be acquired this assessment will be revised as well as further developments presented on the ECDC web-site.

 

Conclusions and recommendations

The swine-origin influenza A(H3N2)v viruses do not currently pose a serious risk to human health in general and Europe in particular. Should increased pathogenicity and/or transmissibility be acquired this assessment will be revised as well as further developments presented on the ECDC web-site. 

 

 

Beyond a few hundred cases of H3N2v, flu activity around the country remains at inter-seasonal low levels, as illustrated by these FluView Reports.

 

 

Today’s FluView contained the following statement on H3N2v.

 

Novel Influenza A Virus:

Novel Influenza A Virus: From July 12 through August 16, 2012, a total of 224 infections with influenza A (H3N2) variant (H3N2v) viruses have been reported in eight states (Hawaii [1], Illinois [3], Indiana [138], Michigan [1], Ohio [72], Pennsylvania [4], West Virginia [3], and Wisconsin [2]). So far during the current outbreaks, eight confirmed cases have been hospitalized as a result of their illness; no deaths have occurred. At this time no ongoing human-to-human transmission has been identified. Public health and agriculture officials are investigating the extent of disease among humans and swine, and additional cases are likely to be identified as the investigation continues. Because of reporting deadlines, the state totals reported by CDC may not always be consistent with those reported by state health departments. If there is a discrepancy between these two counts, data from the state health departments should be used as the most accurate number.

 

CDC is required to report all cases of human infection with novel (non-human) influenza viruses – including influenza viruses of swine origin – to the World Health Organization (WHO) as part of the International Health Regulations (IHR). Domestically, CDC reports these cases in this report and on its website. Early identification and investigation of human infections with novel influenza A viruses is critical in order to evaluate the extent of the outbreak and possible human-to-human transmission. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with livestock can be found at http://www.cdc.gov/flu/swineflu/influenza-variant-viruses-h3n2v.htm.

 

 

While it may not serve to sell newspapers or drive web traffic, this virus is a long way from being any kind of serious public health threat. 

 

That could change over time, of course.

 

Viruses are constantly evolving, and what was true yesterday about H3N2v may not be true next week, or next year. 

 

So we’ll continue to watch these outbreaks with interest. Not because they necessarily portend a pandemic, but because they can teach us a lot about how variant viruses develop and spread.

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Pandemic Uncertainties

 

 

# 6416

 

 

Influenza pandemics come in all strengths and sizes - ranging from the relatively mild events of 1968 and 2009 to the horrendous Spanish Flu of 1918 – making decisions over just what we should be preparing for difficult to settle on.

 

Pandemic planning prior to the H1N1 pandemic of 2009 was centered on a 1918-like scenario, with a nervous acknowledgment that an H5N1 pandemic could actually be worse. 

 

Recognizing pandemics come in all shapes and sizes, the HHS created a pandemic severity scale in 2007, much like the one used for hurricanes, to quantify the impact of a pandemic here in the United States.

Pandemics are rated like Hurricanes.  Category 1-5

 

Of course, pandemics are not static events.

 

Like hurricanes, they can fluctuate in strength - often abruptly. In 1918, the first wave (spring) was mild, by October of that year it had morphed into the deadliest pandemic on record.

 

We also know that the impact of the 1918 pandemic varied widely around the world, with Northern Europe apparently being the most lightly affected, and India and many more tropical countries more heavily affected.

 

What may be a CAT 2 in one region could be a CAT 5 someplace else. Or a CAT 5 outbreak could suddenly weaken to a CAT 2 pandemic.

 

But the mildness of the last two pandemics has left many people questioning whether we should be preparing for a truly `worst-case scenario’.  History has shown – that while they can occur – they happen less often than milder events.

 

Today, a study appears in the International Journal of Risk Assessment and Management, that warns that planning for a `less-than-worst-case’ pandemic may leave us dangerously underprepared.

 

Measuring the uncertainties of pandemic influenza

Jeanne M. Fair; Dennis R. Powell; Rene J. LeClaire; Leslie M. Moore; Michael L. Wilson; Lori R. Dauelsberg; Michael E. Samsa; Sharon M. DeLand; Gary Hirsch; Brian W. Bush

DOI: 10.1504/IJRAM.2012.047550

Abstract:

It has become critical to assess the potential range of consequences of a pandemic influenza outbreak given the uncertainty about its disease characteristics while investigating risks and mitigation strategies of vaccines, antivirals, and social distancing measures. Here, we use a simulation model and rigorous experimental design with sensitivity analysis that incorporates uncertainty in the pathogen behaviour and epidemic response to show the extreme variation in the consequences of a potential pandemic outbreak in the USA. Using sensitivity analysis we found the most important disease characteristics are the fraction of the transmission that occur prior to symptoms, the reproductive number, and the length of each disease stage. Using data from the historical pandemics and for potential viral evolution, we show that response planning may underestimate the pandemic consequences by a factor of two or more.

 

 

While the full study is behind a pay-wall, we’ve a press release with some additional detail.

 

Inderscience Publishers

Measuring the uncertainties of pandemic influenza

Public release date: 2-Jul-2012

A major collaboration between US research centers has highlighted three factors that could ultimately determine whether an outbreak of influenza becomes a serious epidemic that threatens national health. The research suggests that the numbers in current response plans could be out by a factor of two or more depending on the characteristics of the particular pandemic influenza.

Researchers from Argonne, Los Alamos, and Sandia National Laboratories, and the National Renewable Energy Laboratory, have used sensitivity analysis to uncover the most important disease characteristics pertaining to the spread of infection with an influenza virus. These are: the fraction of the transmission that occurs prior to symptoms, the reproductive number, and the length of each disease stage. Their use of data from past pandemics as well as information on potential viral evolution demonstrates that current response planning may underestimate the pandemic consequences significantly.

(Continue . . . )

 

Some key findings in this study include that:

 

• A future worst-case influenza pandemic might be 4 times deadlier than the 1918 pandemic.
• Simulations suggest that antiviral drugs may not be as useful as planners hope.
• While a mix of pharmaceutical and non-pharmaceutical Interventions will be needed, social distancing may be the most effective way to contain the spread of a severe pandemic, albeit at a high societal and economic cost.

 

While a worst-case scenario may be less likely than a mild or moderate pandemic - this study concludes that it is not impossible - and recommend that their findings be incorporated into the planning for the next pandemic.

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ECDC: Risk Assessment On Edinburgh Legionella Outbreak

 

 

# 6386

 

 

This morning the ECDC published a brief Rapid Risk Assessment on the Legionella outbreak in Scotland that has been ongoing for about two weeks (for earlier reports see here, and here).

 

According to NHS Lothian, which is the local public health authority running point on the investigation, the number of cases has remained steady over the past couple of days at 88 (see Update - 13/06/2012).  

 

Yesterday Health Secretary Nicola Sturgeon was quoted as saying:

 

“These numbers today again offer reassurance that the worst of the outbreak is over. The increase of confirmed cases and reduction in the suspected cases is in line with our expectations. However, there is no room for complacency and we will continue to monitor the situation very closely over the coming days.

 

A link to the 4-page ECDC risk assessment, and a few excerpts, follows:

 

Rapid risk assessment: A community outbreak of Legionnaires' disease in Edinburgh, Scotland

Technical reports - 14 Jun 2012

Available as PDF in the following languages:

 

This document is free of charge.

ABSTRACT

ECDC assessed the risk to the EU related to the community outbreak of Legionnaires' disease in Edinburgh, Scotland.

In the absence of an identified and controlled source of Legionella, there may be an ongoing risk of exposure for persons living or visiting the area, although the risk is assessed to be low for the general public due to implemented control measures.

 

Main conclusions and recommendations

Eighty-eight cases of Legionnaires’ disease, of which one was fatal, have occurred in the south-western part of Edinburgh since 24 May 2012 when the first case was reported to have fallen ill.

Although the exact source of the outbreak has not yet been identified, the clustering of cases in the south-western part of Edinburgh and the evolving number of cases suggests an ongoing source in this part of the city. Environmental investigations to confirm the source and treatment of local cooling towers in the area are ongoing. The  implementation of precautionary control measures at any identified suspected  risk installations
are of utmost importance to decrease the risk of exposure.

 

In the absence of an identified and controlled source of Legionella, there may be an ongoing risk of exposure to  Legionella  for persons living or visiting the area, although the risk is assessed to be low for the general public due to implemented control measures.

 

The risk for Legionnaires’ disease should be considered higher for persons above 40 years of age, smokers and immune-compromised persons. For this group, timely diagnosis and appropriate treatment will be particularly important.

 

 

As Legionnaires’ disease cannot be transmitted from human to human, the risk for the EU remains very limited apart from susceptible people visiting the affected areas.

 

The information given  to members of the public about their potential exposure is important to ensure timely diagnosis and appropriate treatment. This has been addressed by the Scottish authorities by  setting up a telephone hotline.

 

 

 

For a brief history of the discovery of Legionnaires disease you may wish to revisit my blog from last week called The Legionella Outbreak in South West Edinburgh. You’ll also find more information on Legionella on the NHS website:

 

Legionnaires' disease

Introduction

Legionnaires’ disease is a potentially fatal lung infection (pneumonia) that is caused by the legionella bacteria. Legionnaires’ disease is caught by breathing in small droplets of contaminated water. It is not contagious and cannot be spread directly from person to person.

 

Initial symptoms include a high fever and muscle pain. Once the bacteria begin to infect your lungs, you may also develop a persistent cough (see Legionnaires disease - symptoms). Prompt treatment using antibiotics is essential to reduce the risk of death. See Legionnaires’ disease - treatment for more information.

(Continue . . . )

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5.8 Mag. Quake Rocks Northern Italy

 

 

# 6353

 

 

For the second time in 10 days, a strong temblor has rocked northern Italy, and early reports indicate at least ten people have died as a result. In the hours since the 5.8 quake struck, there have been several lesser aftershocks.

 

 

 

If you say `earthquake’ and `Europe’ in one sentence, most people would naturally assume you are talking about Italy, or perhaps Greece. Eastern and central Mediterranean regions after all, are well known for seismic activity.

 

But two of the strongest earthquakes to strike Europe over the past millennium occurred in Switzerland  and Portugal.

 

And as the following Seismic Hazard Map (produced by GSHAP – Global Seismic Hazard Assessment Program) shows, other areas of western, central and northern Europe are vulnerable as well.

 

 

Last year in A Look At Europe’s Seismic Risks, we took look at some of the devastating earthquakes to strike Europe over the past 700 years, including the quake that leveled the Swiss town of Basel in 1356 and the horrific earthquake and tsunami that struck Portugal in 1755 on November 1st (All Saint’s Day).

 

In December of last year, in WHO e-Atlas Of Natural Disaster Risks To Europe, we looked at some of the seismic risks to Europe. And in April of 2011 (see UNDP: Supercities At Seismic Risk) we saw a report that stated that half of the world’s supercities (urban areas with 2 million – 15 million inhabitants) are at high risk for seismic activity.

 

And more recently, in January of this year (see UN Agency Warns On Global Seismic Risks), the United Nations International Strategy For Disaster Reduction (UNIDSR.Org) issued a cautionary warning about ignoring seismic threats.

 

UNISDR warns against ignoring seismic threats as quakes wreak havoc for second year

302 human impact disasters claimed 29,782 lives; affected 206 million and inflicted record economic damages of $366 billion in 2011

Geneva, 18 January 2012 – For two consecutive years the long-term disasters trend has been bucked by major earthquakes which claimed thousands of lives and affected millions in both 2010 and 2011, according to new statistics published today by CRED and the UN office for disaster risk reduction, UNISDR.

 

UNISDR Chief, Margareta Wahlström, said today: “The Great East Japan Earthquake and the accompanying tsunami is a reminder to us all that we cannot afford to ignore the lessons of history no matter how forgotten. The many major cities located in seismic zones need to take seriously the probability of return events even if many years have passed since the last seismic event of major magnitude.

(Continue . . . )

 

 

 

While we can’t predict where the next earthquake will strike, or do anything to stop it, we can prepare to deal with one when it happens.

 

For good, solid information on how prepare for `the big one’ (even if you live someplace other than Los Angeles), I would recommend you download, read, and implement the advice provided by the The L. A. County Emergency Survival Guide.

 

While US-centric, FEMA  has an earthquake hazard webpage with a lot of resources that would be of use to just about anyone, including the following preparedness information.

 

Emergencies happen every day.  Disasters, admittedly, less often. But in either event, preparedness is key.

 

At a bare minimum, every household should have a disaster plan, a good first aid kit (and the knowledge to use it), and emergency supplies to last a minimum of 72 hours during a disaster.

 

Personally, I’d be uncomfortable with anything less than a week.

 

To become better prepared as an individual, family, business owner, or community to deal with these types of disasters: visit the following preparedness sites.

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

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

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

»» Read More

UK: Civil Threat Risk Assessment

 

# 6232

 

 

When thinking about the types of disasters that individuals, families, businesses, and communities ought to be preparing for it is useful to look at the threats that governments perceive as being of `high priority’.

 

Since 2008 the UK government has produced, and updated every two years, a National Risk Register For Civil Emergencies – essentially a short list of disaster scenarios (man-made & natural) that the Cabinet Office believe to be genuine threats.

 

They define a `CIVIL EMERGENCY’ as:

 

• an event or situation which threatens serious damage to human welfare in a place in the United Kingdom – where serious damage is defined as ‘loss of human life; human illness or injury; homelessness; damage to property; disruption of a supply of money, food, water, energy or fuel; disruption of a system of communication; disruption of facilities for transport; or disruption of services relating to health’ 
  
• an event or situation which threatens serious damage to the environment of a place in the United Kingdom – where environmental damage is deined a‘contamination of land, water or air with biological, chemical or radio-active matter,or disruption or destruction of plant life or animal life’, and/or
  
• war, or terrorism, which threatens serious damage to the security of the United Kingdom.

Threats are evaluated based on the likelihood of it happening over the next five years, and on severity of impact it would be expected to produce.

 

The damage and impact estimates used in this report represent a `reasonable worst case’ which exclude `highly implausible scenarios’.

 

While prudent for most disaster planning - as Japan learned last year with their combination 9.0 earthquake, 30+ Meter Tsunami, and multiple nuclear reactor failures – sometimes the reality can exceed `reasonable’ expectations.

 

As far as what the Cabinet Office views as the greatest threats to the UK over the next five years?  Number one on their hit parade is . . . you guessed it:

 

 

Pandemic influenza – This remains the most significant civil emergency risk. The outbreak of H1N1 influenza in 2009 (‘swine flu’) did not match the severity of the scenario that we plan for and is not necessarily indicative of future pandemic influenzas; the three influenza pandemics of the 20th century (1918–19, 1957–58 and 1968–69) all had differing levels of severity. The 2009 H1N1 pandemic does not change the risk of another pandemic emerging (such as an H5N1 (avian flu)
pandemic) or mean that the severity of any future pandemics will be the same as the 2009 H1N1 outbreak.

 

Also on their list is a repeat of the 1953 severe coastal flooding event that claimed hundreds of lives and caused extreme property damage and a catastrophic terrorist attack.

 

New this year are the addition of Volcanic threats and the potential impact from severe space weather.

 

You may be wondering about the inclusion of a Volcanic threat to a country that isn’t exactly known for its volcanoes. Their concern stems from the impact of volcanic eruptions outside of their country – notably, in Iceland. Specifically they cite:

 

Severe effusive (gas-rich) volcanic eruptions abroad – The 2010 eruption of the Eyjafjallajökull volcano in Iceland showed some of the consequences that a volcanic eruption abroad can have on the UK and its citizens. Following consultation with geological and meteorological experts about the potential risks the UK faces from volcanic eruptions in Iceland or elsewhere, the assessment is that there are two main kinds of risk from volcanic eruptions. The irst is an ash-emitting eruption, similar to that in 2010. The second, which is slightly less likely than an ash-emitting eruption, but which could have widespread impacts on health, agriculture and transport, is an effusive-style eruption on the scale of the 1783–84 Laki eruption in Iceland. This second type of eruption is now one of the highest priority risks in the NRA and the NRR.

 

 

In 1783 the Craters of Laki in Iceland erupted and over the next 8 months spewed clouds of clouds of deadly hydrofluoric acid & Sulphur Dioxide, killing over half of Iceland’s livestock and roughly 25% of their population.

These noxious clouds drifted over Europe, and resulted in widespread crop failures and thousands of deaths from direct exposure to these fumes. There are also anecdotal reports that suggest this eruption had short-term global climate impacts as well.

 

Another eruption of the type and scale seen in 1783 could present an enormous disaster scenario not only to the UK, but to all of Europe.

 

Also added this year (to coincide with the Solar Maximum expected in 2013) is the inclusion of Severe Space Weather as a national threat.

 

severe space weather – Space weather covers a range of different phenomena, including solar fares, coronal mass ejections and solar energetic particle
events. Severe space weather can cause disruption to a range of technologies and infrastructure, including communications systems, electronic circuits and power grids. The ‘reasonable worst case’ for a severe space weather event is based on the so-called Carrington Event in 1859, which saw some of the largest space weather phenomena ever recorded.

 

While sounding a bit like science-fiction, Solar flares and CMEs are also on FEMA’s radar scope, and are subjects we’ve discussed before:

 

A Flare For The Dramatic

Solar Storms, CMEs & FEMA

A Carrington Event

 

 

NASA, while admitting that a serious solar storm could happen practically anytime, also cautions that the next big one could be many decades away. It is a genuine threat, they say, but the timing is impossible to predict. 

 

The entire 58-page UK risk assessment makes for fascinating reading and can be downloaded from the Cabinet Office website (below):

 

National Risk Register

In 2008 Government published, for the first time, a National Risk Register, fulfilling a commitment made in the National Security Strategy. This was the first step in providing advice on how people and businesses can better prepare for civil emergencies.
The January 2012 update to this document; the National Risk Register of Civil Emergencies- January 2012 edition has been published to update the public on the Government’s current assessment of the likelihood and potential impact of a range of different civil emergency risks ( including naturally and accidently occurring hazards and malicious threats) that may directly affect the UK. It also provides information on how the UK and emergency services prepare for these emergencies.

A wider review of how people and businesses can better prepare for civil emergencies, involving consultation with risk communication experts is underway. The January 2012 version therefore does not include guidance on how to prepare for emergencies. Whilst this review is underway chapter 3 and 4 of the 2010 edition of the NRR (see below) should be used as guidance on how people and businesses can better prepare for emergencies.

Downloads

National Risk Register for Civil Emergencies – January 2012 Edition (pdf, 949kb)

File type: PDF - Portable Document format | File size: 948.78 kB

 

 

 

While individually the odds of seeing a `Carrington Event’, or a repeat of the Laki eruptions, or a catastrophic terrorist attack in the UK are probably low, when you combine the threats, the odds of `something bad’ happening over the next five years go up.

 

Which is why individual, family, and community `All threats’ preparedness makes a lot of sense.

 

Whether you live in the United States, the UK, or anywhere else in the world, you can find good preparedness information at the following links:

 

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

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

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

 

And lastly, you may wish to revisit some of my preparedness essays, including:

 

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

»» Read More

ECDC: Annual Risk Assessment On Seasonal Flu 2011-2012

 

 

# 6219

 

Normally by mid-March the northern hemisphere’s flu season is well past peak, and is in decline.  Not so this year, with flu still continuing to surge (albeit at below average levels in many regions) in the latest reports.

 

Additionally, after two very stable years with the H1N1, H3N2, and Victoria B viruses in circulation, this past winter has seen a growing divergence in the H3N2 and B strains, prompting a change in next year’s vaccine recommendations. 

 

The ECDC has produced a 21-page Risk Assessment for the 2011-2012 flu season, which summarizes this flu season to date.

 

 

ECDC publishes its annual risk assessment on seasonal influenza 2011/2012 in Europe

12 Mar 2012

ECDC

On 12 March 2012 ECDC published its annual risk assessment on seasonal influenza 2011/2012 in Europe. ECDC points out that on this occasion the seasonal influenza epidemics in Europe started unusually late and unlike the last few winters have not followed any particular geographical progression.

 

The annual EU season influenza risk assessment follows a structure that was established in the 2009 pandemic and gives an early description of the epidemics of seasonal influenza in the EU/EEA countries drawing on the experience of the first affected countries. The assessment identifies the special features of the current season, especially areas where public health or clinical actions are justified. It also highlights areas of uncertainty and therefore priorities for further work. The first ECDC seasonal influenza risk assessment was published in January 2011.

 

Virological surveillance data for the season shows that the epidemics have so far been dominated by the A(H3N2) viruses, but recently the proportion of B viruses has increased. The data also shows that some A(H1N1)pdm09 viruses are also circulating, although these are far lower in numbers than in the previous two seasons. However, they are over-represented among the people most severely affected that have been hospitalised with a confirmed infection. Antiviral resistance to the neuramindase inhibitors is almost non-existent this season.

 

At this stage, the role that B viruses will play towards the end of the season is uncertain. Other areas of uncertainty are the degree of effectiveness of the seasonal influenza vaccine in a season when there is an imperfect match between the vaccine and the circulating A(H3N2) viruses and the level of premature mortality that can be expected in older people due to the dominance of the virus A(H3N2). It will be difficult to tease apart the effects due to the influenza from those consequences of the cold weather.

Related links:

• See the full ECDC report: ECDC risk assessment on Seasonal influenza 2011/2012 in Europe (EU/EEA countries)

»» Read More

ECDC Risk Assessment On H5N1 Transmissibility Studies

 

 

# 6185

 

 

Today the ECDC  released a Risk Assessment on the H5N1 transmissibility studies conducted by Fouchier and Kawaoka that illustrates the difficulty that all of us are having in assessing this story.

 

Outside of a closed circle of scientists, none of us have access to all the facts. 

 

And apparently, some of the details that have been reported –  according to Ron Fouchier at this morning’s ASM Biodefense webcast – have not been completely accurate.

 

All of which makes it very difficult to sit back and make any sort of informed judgment from the sidelines. The ECDC’s executive summary acknowledges these limitations by stating:

 

This document’s starting point is that without sight of data and analyses it is very difficult to undertake risk assessments. It is not even clear at present how pathogenic these viruses are in animal models. The
document also puts forward the ECDC position on some of these issues according to ECDC’s limited mandate, recognising the value of the research but also the potential risks.

 

ECDC stresses the need to consider mechanisms
for a robust biorisk-management approach along the lines of international standards and  EU-wide guidance on laboratory biosafety/biosecurity for any future emerging threats.

 

ECDC indicates that it would advocate open publication of the findings and emphasises the importance of sustaining and enacting the pandemic influenza preparedness framework with its underpinning global virological surveillance and sharing of information and benefits in order to enhance global health security.

 

It is ECDC’s intention to support the European Commission and Member States, to monitor these developments closely and with its stakeholders and collaborators to revisit its risk assessment for A(H5N1) viruses as the research findings emerge. 

 

 

Nonetheless, this ECDC risk assessment does a good job in defining many of the complex issues at hand, even if definitive answers are elusive. 

 

 

Risk assessment: Laboratory-created A(H5N1) viruses transmissible between ferrets

Technical reports - 29 Feb 2012

Available as PDF 

ABSTRACT

The results of two, as yet unpublished, investigations of laboratory-induced genetic changes in avian influenza A(H5N1) viruses have been reported to have found that a surprisingly few number of changes make the viruses transmissible between ferrets, the most commonly used model for the way influenza behaves in humans. The possibility that this could have resulted in the development in laboratories of A(H5N1) influenza viruses transmissible between humans has caused concern for public safety and generated unusually high levels of debate in the scientific community.

 

This report summarises and explains the complex public health and scientific issues around these developments including the positive and negative aspects of some of the responses that have been proposed internationally.

»» Read More

UN Agency Warns On Global Seismic Risks

 

 

Seismically active areas of the world

# 6081

 

 

While major earthquakes are normally associated with the Pacific rim, or parts of Asia and the middle-east, in truth many other regions of the world are at some risk of serious seismic activity.

 

Last December, in WHO e-Atlas Of Natural Disaster Risks To Europe, we looked at some of the seismic risks to Europe, and in April of 2011 (see UNDP: Supercities At Seismic Risk) we saw a report that stated that half of the world’s supercities (urban areas with 2 million – 15 million inhabitants) are at high risk for seismic activity.

 

According to the Centre Sismologique Euro- Méditerranéen (CSEM) there have been nearly 750 (mostly minor) Euro-Med earthquakes recorded over the past two weeks. 

 

 

While large earthquakes are rare in central, western, or northern Europe, they are not unheard of.

 

In 1356, on the evening October 18th - the Feast day of Saint Luke the Evangelist – perhaps the strongest quake in central Europe’s history struck in the evening, destroying the Swiss town of Basel and leveling practically every major structure within 30 kilometers of the city.

 

The quake was preceded by a foreshock between 7 and 8 pm, with the main quake striking around 10pm.  It was felt as far away as  Zürich, Konstanz and even in Île-de-France.

 

While seismographs were not invented 650 years ago, estimates put this quake at between 6.2 and 6.5 on the modern Richter scale.

 

Le tremblement de terre qu a eu lieu en 1356. - Karl Jauslin (1842–1904)

 

In 1755, on November 1st (All Saint’s Day), what would prove to be one of the deadliest earthquakes to ever strike Europe literally destroyed Lisbon, Portugal along with dozens of fishing villages along the coast, and sent Tsunami waves crashing into the UK, Northern Africa, and the Caribbean.

 

The quake, which occurred a couple of hundred kilometers offshore, was estimated to have been 8.2 or greater on the Richter scale.

 

Tremendous tsunamis (20+ meters) were reported in Northern Africa, and smaller waves washed ashore in the Caribbean and the Atlantic Coast of the New World many hours later. 

 

Lest anyone think this is simply `ancient history’ -  never to be repeated - a somewhat smaller quake (7.8 magnitude) struck in roughly the same area in 1969.

 

While damage was moderate, and only a minor (1+ meter) tsunami was generated, 13 people were killed and many more injured. 

 

The bottom line is that earthquakes (and tsunamis) can and do occur even in places that are not considered seismically active.  And while rare, they can produce catastrophic results.

 

 

All of which serves as prelude to a Press release issued today from the United Nations International Strategy For Disaster Reduction (UNIDSR.Org) warning against ignoring seismic threats.

 

 

UNISDR warns against ignoring seismic threats as quakes wreak havoc for second year

 302 human impact disasters claimed 29,782 lives; affected 206 million and inflicted record economic damages of $366 billion in 2011

Geneva, 18 January 2012 – For two consecutive years the long-term disasters trend has been bucked by major earthquakes which claimed thousands of lives and affected millions in both 2010 and 2011, according to new statistics published today by CRED and the UN office for disaster risk reduction, UNISDR.

 

UNISDR Chief, Margareta Wahlström, said today: “The Great East Japan Earthquake and the accompanying tsunami is a reminder to us all that we cannot afford to ignore the lessons of history no matter how forgotten. The many major cities located in seismic zones need to take seriously the probability of return events even if many years have passed since the last seismic event of major magnitude.

 

“In 2010 we saw this phenomenon as well when over 220,000 people died in Haiti which had not been hit by an earthquake of such strength for almost 200 years. Unless we prepare for the worst then many earthquake-prone urban areas around the world are destined to see even greater loss of life in the future as more and more people move to cities.”

 

Figures released today by the Centre for Research on the Epidemiology of Disasters (CRED) at a UNISDR-hosted press conference in Geneva showed that 20,943 people lost their lives in earthquakes last year out of a total of 29,782 people directly killed by 302 disasters. The earthquake fatalities included 19,846 who died in Japan while the remainder were largely accounted for by the October earthquake in Turkey.

 

(Continue . . . )

 

The EM-DAT Project is supported by USAID.

• 2011 Disaster Statistics [PDF 217.41 kB]
• Press release [PDF 167.53 kB]

Date: 18 Jan 2012

Sources: United Nations International Strategy for Disaster Reduction Secretariat (UNISDR)

 

While we can’t predict where the next earthquake will occur, or do anything to stop it, we can prepare to deal with one when it happens.

 

For good, solid information on how prepare for `the big one’ (even if you live someplace other than Los Angeles), I would recommend you download, read, and implement the advice provided by the The L. A. County Emergency Survival Guide.

 

 

While US-centric, FEMA has an earthquake hazard webpage with a lot of resources that would be of use to just about anyone, including the following preparedness information.

 

Earthquake Information for Individuals and Families

Below are links to earthquake-related information of use to individuals and families. There are many things that you can do to reduce the chances that you or members of your family will be injured, or that your property will be damaged, by earthquakes. Use the following resources to help make your family, your home, and your community more resistant to the potentially dangerous and damaging effects of earthquakes.

• What to Do During an Earthquake
  Everyone living in or visiting seismically active regions needs to learn—and practice—how to protect themselves in an earthquake. This fundamental seismic safety information can save lives and reduce injuries.
• Earthquake Preparedness at Home
  Learn about what to do at home before, during, and after earthquakes. Topics include how to strengthen your home, secure its contents, and prepare yourself and your family to react safely, take cover, survive on your own, stay in contact, and care for people, pets, and property.
• Earthquake Publications and Tools—Individuals and Families
  Browse and access FEMA publications that provide in-depth guidance on protecting residential structures, their contents, and their occupants from earthquake hazards. All can be downloaded online, and most can be ordered in print or on compact disc.
• Earthquake Contacts
  Find individuals and organizations that you can go to for more information about earthquake risk-reduction activities in your state, in your region, or at FEMA.

 

Emergencies happen every day.  Disasters, admittedly, less often.

 

But in either event, preparedness is key.

 

At a bare minimum, every household should have a disaster plan, a good first aid kit (and the knowledge to use it), and emergency supplies to last a minimum of 72 hours during a disaster.

 

Personally, I’d be uncomfortable with anything less than a week.

 

To become better prepared as an individual, family, business owner, or community to deal with these types of disasters: visit the following preparedness sites.

 

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

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

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

»» Read More

ECDC: Rapid Risk Assessment On China’s H5N1 Fatality

 

 

# 6054

 

 

The other day I spotted a headline that proclaimed the Return of Bird Flu: Chinese Man Dies - as if the H5N1 virus had somehow gone away, only to recently return.

 

Of course, those of us who follow these things know the H5N1 virus has never gone away.

 

During  2011 we saw 60 human infections reported (with 33 fatalities) from around the world - of which the mainstream press rarely took  notice.

 

While this recent case is first one reported from China in 18 months, few veteran flu watchers - I suspect - would care to put money on that being an accurate accounting of Chinese cases. 

 

Or for that matter, wager on the 60 reported cases last year representing the full burden of the disease in humans around the globe.

 

Surveillance and reporting simply isn’t that good.

 

Despite no overt signs of involving human-to-human transmission, the recent case involving a bus driver in Shenzhen, China has – in comparison to the others – garnered a good deal of media attention over the past couple of weeks.

 

Today, the ECDC has released a Rapid Risk Assessment on the H5N1 case in China, where they find that the risk to Europe from the H5N1 virus remains low, and unchanged. 

 

 
 

 

Rapid risk assessment: Human fatality from highly pathogenic avian influenza A(H5N1) virus infection in Guangdong province, China

Scientific Publication - Jan 2012

ABSTRACT

Following reports of a human fatality due to highly pathogenic avian influenza A(H5N1) virus infection in China’s Guangdong province, the European Commission requested an update to the assessment of risk of human-to-human transmission occurring.

ECDC does not consider that there is any change to the previous assessments that the risk for EU/EEA countries is very low.

 

A few excerpts provide their rationale.

 

 

 

ECDC threat assessment for the EU

 
This case of HPAI A(H5N1) virus infection reported in China does not indicate a change in the risk for human-to-human transmission for the following reasons:

•  It is a single isolated case, not part of a cluster.
•  It occurred in a country where avian influenza is entrenched.
•  No contact with sick patients has been reported.
•  The identified clade suggests transmission from birds.

Conclusions 

This new human case is not unexpected. In countries where avian influenza A(H5N1) viruses are entrenched in wild bird populations and are occasionally transmitted to domestic poultry, sporadic infections and even small clusters will probably continue to occur among humans who have contact with infected poultry or wild birds.

Human-to-human transmission cannot be completely ruled out even in this case but there is no evidence of human-to-human transmission here or elsewhere. 

The recent report of a single human case of a wild-type influenza A(H5N1) virus infection in Shenzhen city, Guandong province, China, does not change the current assessment of the risk to human health in the EU or globally. The risk is considered to be very low in EU/EEA countries. However, vigilance for avian influenza A(H5N1) in domestic poultry and wild birds and other animal influenza in Europe and elsewhere remains important.

»» Read More