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#WHO #statement on the 3rd #meeting of the #IHR(2005) #EC on #Zika virus and related #complications (@WHO, June 14 2016)

  Title : #WHO #statement on the 3rd #meeting of the #IHR(2005) #EC on #Zika virus and related #complications. Subject : Zika Virus Diseas...

26 Jul 2016

#Proposals for draft #EU #guidelines on the #prudent use of #antimicrobials in #human #medicine (@ECDC_EU, summary)

 

Title: #Proposals for draft #EU #guidelines on the #prudent use of #antimicrobials in #human #medicine.

Subject: Antimicrobial Resistance, ECDC proposals for guidance.

Source: European Centre for Disease Control and Prevention (ECDC), full PDF file: (LINK). Summary.

Code: [     ]

_____

TECHNICAL REPORT

Proposals for draft EU guidelines on the prudent use of antimicrobials in human medicine 

___

This report of the European Centre for Disease Prevention and Control (ECDC) was coordinated by Diamantis Plachouras. 

Contributing authors

Elias Iosifidis, Dominique Monnet, Annalisa Quattrocchi, Klaus Weist, Mike Catchpole. 

Acknowledgements

Expert group:

Agnes Wechsler-Fördös (Rudolfstiftung Hospital); Herman Goossens (University of Antwerp); Vera Vlahović-Palcevski (University of Rijeka); Céline Pulcini (University of Lorraine); Maria Luisa Moro (Regional Health Agency Emilia-Romagna); Uga Dumpis (University of Latvia); Michael Borg (University of Malta); Inge Gyssens, (Radboud University); Annelie Monnier (Radboud University); Milan Čižman (University of Lubljan); Thomas Tängdén (University of Uppsala); Philippa Moore (Public Health England); Cliodna McNulty (Public Health England); Mike Sharland (University of London). 

Observer:

Radu Botgros (European Medicines Agency)    

THIS DRAFT TECHNICAL REPORT IS SUBJECT TO A PUBLIC CONSULTATION PROCESS. THE RESULT OF THAT PROCESS MAY LEAD TO CHANGES IN THE FINAL REPORT

Stockholm, July 2016 

© European Centre for Disease Prevention and Control, 2016 Reproduction is authorised, provided the source is acknowledged

 

  1. Introduction
  2. The exposure of microorganisms to antimicrobial agents creates the selective pressure that leads to the
  3. development of resistance. Inappropriate use of antimicrobials accelerates the emergence and dissemination of
  4. resistance. Combined with the meagre development of novel antimicrobials, the spread of resistance to existing
  5. ones is leading to loss of effective options for the treatment and prevention of infections, representing a health
  6. security threat for Europe. Antimicrobials are unique among therapeutic medicines because their use affects not
  7. only the person receiving the treatment but also the rest of the population, including other patients, through a
  8. complex effect on microbiota in the human host, other animal hosts and the environment.
  9. In the context of ongoing work against the rising threats from antimicrobial resistance and given the role of
  10. antimicrobial misuse and overuse in the emergence and spread of resistance, the European Commission asked
  11. ECDC to develop draft EU guidelines on the prudent use of antimicrobials in human medicine, including generic
  12. principles of good practice on the appropriate use of antimicrobial agents in human medical practice in the EU.
  13. These draft guidelines will be a key contribution to support the European Commission in its aim to produce a
  14. finalised EU guidelines document.
  15. Definitions
  16. An antimicrobial is an agent with activity against microorganisms (viruses, bacteria, fungi or parasites).
  17. Antimicrobials with activity against bacteria are called antibacterials. The term ‘antibiotic’ is often used to refer to
  18. antibacterials. 
  19. Antimicrobial resistance (AMR) is the resistance of a microorganism to an antimicrobial agent that was
  20. originally effective for treatment of infections caused by this microorganism. 
  21. Antimicrobial therapy can be empiric, when based on a reasonable informed clinical judgement regarding the
  22. most likely infecting organism or definitive when the identity and antimicrobial susceptibility of the infecting
  23. organism is known as the result of appropriate diagnostic or reference testing. 
  24. Antimicrobial prophylaxis is the use of antimicrobials for the prevention of infections. 
  25. Prudent or appropriate antimicrobial use aims to benefit the patient while at the same time minimises the
  26. probability of adverse effects and promotion of the emergence or spread of antimicrobial resistance. 
  27. Antimicrobial stewardship programmes refer to coordinated programmes that implement interventions to
  28. ensure appropriate antimicrobial prescribing and effective antimicrobial treatment, in order to limit antimicrobial
  29. resistance and to prevent Clostridium difficile infections. 
  30. Prescribers are all healthcare professionals qualified to prescribe antimicrobials. In addition to physicians and
  31. dental practitioners, the term may refer to prescribing nurses, pharmacists, clinical microbiologists and midwives,
  32. depending on local regulations. 
  33. Purpose
  34. The purpose of this draft technical report is to provide guidance on generic elements of good practice on the
  35. prudent and appropriate use of antimicrobials in human medical practice. This includes good clinical practice and
  36. the resources, systems and processes that the various authorities and actors should consider in the development
  37. and implementation of strategies for EU health systems to support and promote the prudent use of antimicrobials.
  38. Scope
  39. The present report relates to the prudent use of antimicrobials in human medicine, with special focus on
  40. antibacterials. However, the principles also apply to other classes of antimicrobials.
  41. The report will not cover specific medical conditions or specific antimicrobials.

(…)

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Keywords: ECDC; Updates; European Region; Antibiotics; Drugs Resistance.

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#USA, #Florida: DoH Daily #Zika #Update: Six New #Travel-Related Cases (July 26 2016)

 

Title: #USA, #Florida: DoH Daily #Zika #Update: Six New #Travel-Related Cases.

Subject: Zika Virus, US State of Florida daily epidemiological update.

Source: US State of Florida Department of Health, full page: (LINK).

Code: [     ]

______

Department of Health Daily Zika Update: Six New Travel-Related Cases

By Florida Department of Health, Office of Communications / July 26, 2016 / Press Release / Contact: Communications Office, NewsMedia@flhealth.gov - (850) 245-4111

____

Tallahassee, Fla.

In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared.

There are six new travel-related cases with two in Broward, one in Miami-Dade, one in Hillsborough, one in Orange and one involving a pregnant women.

According to CDC, symptoms associated with the Zika virus last between seven to 10 days.

The department’s investigations into the possible non-travel related Zika virus cases in Miami-Dade and Broward counties are ongoing and the department will share more details as they become available.

Governor Rick Scott and State Surgeon General Dr. Celeste Philip are hosting a Zika roundtable this afternoon in Broward County to discuss with local leaders ongoing Zika preparedness and response needs.

Residents and visitors are urged to participate in requests for urine samples by the department in the areas of investigation. These results will help the department determine the number of people affected.

Zika prevention kits and repellent are being distributed in the areas of investigation, through local OBGYN offices and at both DOH-Broward and DOH-Miami-Dade.

CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas.

According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika affected area for the virus.

CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds.

Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January.

The total number of pregnant women who have been monitored is 49, with 15 having met the previous CDC case definition.

The Council of State and Territorial Epidemiologists and CDC released a new case definition for Zika that now includes reporting both asymptomatic and symptomatic cases of Zika. Prior to this change, states reported only symptomatic non-pregnant cases and pregnant cases regardless of symptoms. This change comes as a result of increased availability for testing in commercial laboratories.

 

[County - Number of Cases (all travel related)]

  1. Alachua – 5
  2. Brevard – 6
  3. Broward  - 53
  4. Charlotte – 1
  5. Citrus – 2
  6. Clay – 3
  7. Collier – 4
  8. Duval – 6
  9. Escambia – 1
  10. Highlands – 1
  11. Hillsborough – 10
  12. Lake – 1
  13. Lee – 6
  14. Manatee – 1
  15. Martin – 1
  16. Miami-Dade – 96
  17. Okaloosa – 2
  18. Okeechobee – 1
  19. Orange – 38
  20. Osceola – 17
  21. Palm Beach – 15
  22. Pasco – 6
  23. Pinellas – 7
  24. Polk – 11
  25. Santa Rosa – 1
  26. Seminole – 11
  27. St. Johns – 3
  28. St. Lucie – 1
  29. Volusia – 5
  • Total cases not involving pregnant women – 315
    • Cases involving pregnant women regardless of symptoms* – 49

___

*Counties of pregnant women will not be shared.

(…)

All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here.

(…)

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Keywords: USA; Updates; Zika Virus; Florida.

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#Macau #Health Department reported a surge in #scarletfever cases (July 26 2016)

 

Title: Macau Health Department reported a surge in scarlet fever cases.

Subject: Scarlet Fever, Macau PRC SAR epi-update.

Source: Macau Department of Health, full page: (LINK).

Code: [     ]

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Serviços de Saúde registam queda do número de casos de escarlatina 

2016-07-26 22:35:00 / Fonte : Serviços de Saúde

Entre os meses de Março e Abril deste ano os Serviços de Saúde registaram um aumento do número de casos de escarlatina que foram detectados em Macau, quando comparados com os números registados o ano transacto, contudo, nos últimos dias tem sido registada uma diminuição no numero de casos.

Neste sentido, os Serviços de Saúde vão continuar a prestar estreita atenção à situação epidemiológica, apelando aos pais, instituições de ensino e creches para a necessidade de estarem em alerta para com a escarlatina.

De acordo com as informações de vigilância, relativamente às doenças de declaração obrigatória, o número de casos de escarlatina registado em Março e Abril sofreu um aumento significativo.

Nos primeiros seis meses do ano corrente, registaram-se 285 casos de escarlatina, o que ultrapassou o número total (268 casos) registado em todo o ano passado.

No entanto, durante o mês de Maio foi evidenciada uma queda gradual no número de casos de escarlatina e os números verificados em Junho e Julho deste ano são semelhantes ao registado no período homólogo do ano anterior, não tendo sido registado casos graves ou de morte.

Recentemente nas regiões vizinhas, foi também relatado um aumento do numero de casos de escarlatina, por razão desconhecida, acreditando-se que o mesmo aconteça devido a flutuações cíclicas.

A Escarlatina é uma doença respiratória aguda transmissível causada pelo estreptococo beta hemolítico do grupo A (Streptococcus pyogenes).

Geralmente, o período de incubação é de 1 a 3 dias.

Esta doença é transmitida principalmente através de contacto com as secreções orais ou respiratórias ou salpicos de saliva de pacientes infectados.

Uma vez que esteja infectado, o paciente fica em estado de elevado contágio, quer antes, quer depois da manifestação da doença.

As pessoas podem contrair escarlatina em qualquer período do ano e a epidemia desta doença chega ao seu pico geralmente na primavera e no inverno, atingindo principalmente crianças entre os dois e os oito anos de idade.

Os principais sintomas são febre, dor de garganta, língua com aspecto semelhante a um morango e prurido.

As erupções aparecem frequentemente no pescoço, no tórax, nas axilas, nas fossas cubitais, na virilha e no lado interno das coxas.

As erupções cutâneas típicas da escarlatina não aparecem no rosto e a pele da região afectada geralmente torna-se muito áspera.

Após o desaparecimento das erupções cutâneas, a pele manifesta descamação.

A escarlatina pertence ao Grupo II constante da lista de doenças transmissíveis que necessitam da declaração obrigatória (SARS e Síndrome respiratória do Médio Oriente-Mers-Cov são doenças transmissíveis que pertencem ao Grupo I).

O tratamento eficaz pode ser conseguido através da administração de antibióticos. Sem tratamento adequado esta doença pode sofre complicações, nomeadamente com o aparecimento de otite média, febre reumática, doença renal, pneumonia, linfadenite, artrite, etc.

Não existe vacina contra a escarlatina, por isso, os alunos, os pais, as instituições de ensino e as creches devem tomar precauções para reduzir a possibilidade de infecção.

As instituições de ensino e as creches logo que detectem qualquer caso de infecção colectiva, devem notificar imediatamente o Centro de Prevenção e Controle de Doenças dos Serviços de Saúde, a Direcção dos Serviços de Educação e Juventude ou o Instituto de Acção Social.

Com vista a prevenir a infecção pela escarlatina, os cidadãos, as instituições de ensino e as creches devem tomar as seguintes medidas:

  • Higiene pessoal
    • 1.Lavar frequentemente as mãos, mantendo-as sempre limpas, ou usar um desinfectante alcoólico, em especial antes de estarem em contacto com os olhos, o nariz e a boca;
    • 2.Procurar cobrir a boca e o nariz quando espirrar ou tossir, de preferência com um lenço e deitá-lo no lixo depois de usado;
    • 3.Não partilhar toalhas com outra pessoa;
    • 4.Utilizar luvas, quando manusear objectos e lugares contaminados por secreções ou excrementos;
    • 5.Praticar sempre desporto, descansar o suficiente, ter uma alimentação equilibrada, evitar fumar e deslocar-se a lugares públicos densamente frequentados;
    • 6.Evitar contactos próximos com doentes que manifestem sintomas da escarlatina;
    • 7.No caso de sofrer sintomas da escarlatina, devem usar máscara e recorrer de imediato ao médico;
    • 8.Os doentes devem permanecer no domicílio e suspender o serviço ou a ida à escola.
  • Higiene ambiental:
    • 1.Manter a limpeza e a secura do ambiente e garantir uma boa ventilação de ar no interior da sala;
    • 2.Proceder, no mínimo, uma vez por dia à limpeza e desinfecção dos brinquedos utilizados, mobiliário, pavimento e locais com os quais as mãos têm contacto frequente;
    • 3.Proceder de imediato a uma desinfecção adequada dos materiais ou lugares contaminados pelas secreções ou excrementos;
    • 4.Assegurar a existência de sabão líquido e toalhas de papel descartáveis ou secador para as mãos nas instalações sanitárias.

-- Fim --

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Keywords: Macau PRC SAR; Updates; Scarlet Fever.

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#USA, #Texas: Reported #Zika Virus Cases – July 26, 2016 (DoH, edited)

 

Title: #USA, #Texas: Reported #Zika Virus Cases – July 26, 2016.

Subject: Zika Virus, US State of Texas daily epidemiological update.

Source: US State of Texas Department of Health, full page: (LINK).

Code: [     ]

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Reported Zika Virus Cases – July 26, 2016

Texas has had 76 reported cases of Zika virus disease.

This count includes three pregnant women, one infant infected before birth, and one person who had sexual contact with a traveler.

 

Texas Zika Cases by County:

[County  - Cases]

  1. Bell  - 1
  2. Bexar  - 6
  3. Collin  - 2
  4. Dallas  - 17
  5. Denton  - 3
  6. Ellis  - 1
  7. Fort Bend  - 3
  8. Frio  - 1
  9. Gray  - 1
  10. Grayson  - 1
  11. Hamilton  - 1
  12. Harris  - 21
  13. Lubbock  - 1
  14. Medina  - 1
  15. Tarrant  - 11
  16. Travis  - 2
  17. Val Verde  - 1
  18. Williamson  - 1
  19. Wise  - 1
    • Total – 76

____

Note: Zika case data for Texas will be updated each weekday no later than 11 a.m.

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Keywords: USA; Texas; Updates; Zika Virus.

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#MERS-CoV, #Saudi Arabia: No New Cases reported in the last 24 hours (@SaudiMOH, July 26 2016)

 

Title: MERS-CoV, Saudi Arabia: No New Cases reported in the last 24 hours.

Subject: Middle East Respiratory Syndrome Coronavirus Epidemic in the Kingdom of Saudi Arabia, daily update.

Source: Saudi Arabia Ministry of Health, full page: (LINK).

Code: [     ]

______

MOH: 'No New Corona Cases Recorded

7/26/2016

______

New Cases:

  • No reports

New Recoveries:

  • No reports

New Deaths:

  • No reports

Cumulative number of confirmed cases and deaths since June 2012:

[Total No. of Cases – Total No. of Deaths – Patients under treatment]

  • 1440At least 608 - 1

______

(…)

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Keywords: MERS-CoV; Updates; Saudi Arabia.

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#Record high in #civilian #casualites in #Afghanistan in first half of 2016, says the #UN (BBC, July 26 2016)

 

Title: Record high in civilian casualites in Afghanistan in first half of 2016, says the UN.

Subject: Afghanistan, civil wars, terrorism.

Source: BBC, full page: (LINK). via Instragram.

Code: [  !  ]

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Keywords: Society; Wars; Terrorism; Mass Casualty Events; Afghanistan.

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25 Jul 2016

#USA, #Florida: DoH Daily #Zika #Update: Five New #Travel-Related Cases (July 25 2016)

 

Title: #USA, #Florida: DoH Daily #Zika #Update: Five New #Travel-Related Cases.

Subject: Zika Virus, US State of Florida daily epidemiological update.

Source: US State of Florida Department of Health, full page: (LINK).

Code: [     ]

______

Department of Health Daily Zika Update: Five New Travel-Related Cases

By Florida Department of Health, Office of Communications / July 25, 2016 / Press Release / Contact: Communications Office, NewsMedia@flhealth.gov - (850) 245-4111

___

Tallahassee, Fla.

In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared.

There are five new travel-related cases with two in Miami-Dade, one in Okaloosa, one in Orange and one involving a pregnant women.

According to CDC, symptoms associated with the Zika virus last between seven to 10 days.

The department’s investigations into the possible non-travel related Zika virus cases in Miami-Dade and Broward counties are ongoing and the department will share more details as they become available.

This weekend, the department worked with Dr. Marc Fischer, medical epidemiologist with CDC to develop the survey model for the expanding investigation. Today, review of the methodology and appropriate training is occurring at both DOH-Broward and DOH-Miami-Dade.

Residents and visitors are urged to participate in requests for urine samples by the department in the areas of investigation. These results will help the department determine the number of people affected.

Zika prevention kits and repellent are being distributed in the areas of investigation, through local OBGYN offices and at both DOH-Broward and DOH-Miami-Dade.

CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas.

According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika affected area for the virus.

CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds.

Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January.

The total number of pregnant women who have been monitored is 47, with 15 having met the previous CDC case definition.

The Council of State and Territorial Epidemiologists and CDC released a new case definition for Zika that now includes reporting both asymptomatic and symptomatic cases of Zika. Prior to this change, states reported only symptomatic non-pregnant cases and pregnant cases regardless of symptoms. This change comes as a result of increased availability for testing in commercial laboratories.

 

[County - Number of Cases (all travel related)]

  1. Alachua – 5
  2. Brevard – 6
  3. Broward – 51
  4. Charlotte – 1
  5. Citrus – 2
  6. Clay – 3
  7. Collier – 4
  8. Duval – 6
  9. Escambia – 1
  10. Highlands – 1
  11. Hillsborough – 9
  12. Lake – 1
  13. Lee – 6
  14. Manatee – 1
  15. Martin – 1
  16. Miami-Dade – 95
  17. Okaloosa – 2
  18. Okeechobee – 1
  19. Orange – 37
  20. Osceola – 17
  21. Palm Beach – 15
  22. Pasco – 6
  23. Pinellas – 7
  24. Polk – 11
  25. Santa Rosa – 1
  26. Seminole – 11
  27. St. Johns – 3
  28. St. Lucie – 1
  29. Volusia  - 5
  • Total cases not involving pregnant women – 310
    • Cases involving pregnant women regardless of symptoms* – 48

___

*Counties of pregnant women will not be shared.

(…)

All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here.

(…)

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Keywords: USA; Updates; Zika Virus; Florida.

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#Spain, first #baby born with #Zika-related #Microcephaly (El Pais, July 25 2016)

 

Title: Spain, first baby born with Zika-related Microcephaly.

Subject:

Source: El Pais, full page: (LINK). Article in Spanish.

Code: [     ]

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Nace en Barcelona el primer bebé de España con microcefalia por Zika

by Jessica Mouzo Quintáns 

El primer bebé en Europa con microcefalia asociada al virus de zika ha nacido este lunes. El niño, que ha nacido por cesárea al término del embarazo, "está estable y no ha precisado ninguna reanimación específica", ha indicado el jefe del servicio de neonatología del hospital Vall d'Hebron de Barcelona, Félix Castillo.

(…)

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Keywords: Zika Virus; Microcephaly; Span; Zika Congenital Syndrome.

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#Colombia #health ministry says #Zika #epidemic in country has ended (CNA, July 25 2016)

 

Title: #Colombia #health ministry says #Zika #epidemic in country has ended.

Subject: Zika Virus Epidemic in Colombia, activity status.

Source: Channel News Asia, full page: (LINK).

Code: [     ]

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Colombian health ministry says Zika epidemic in country has ended

The epidemic of the Zika virus has officially ended in Colombia, the country's vice health minister said on Monday, ten months after the mosquito-borne illness arrived in the Andean nation.

(…)

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Keywords: Zika Virus; Colombia.

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#Avian #Influenza #viruses #H5N1, #H7N9, #H9N2–#Summary and #assessment, 13 June to 19 July 2016 (@WHO, edited)

 

Title: #Avian #Influenza #viruses #H5N1, #H7N9, #H9N2–#Summary and #assessment, 13 June to 19 July 2016.

Subject: Avian and Swine Influenza viruses, monthly situation report.

Source: World Health Organization, full PDF file: (LINK).

Code: [     ]

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Influenza at the human-animal interface Summary and assessment, 13 June to 19 July 2016 

___

  • New infections[1]:
    • Since the previous update, new human infections with A(H5N1), A(H7N9), A(H9N2) and A(H1N2)v viruses were reported. 
  • Risk assessment outcome:
    • The overall public health risk from currently known influenza viruses at the human-animal interface has not changed.
    • Further human infections with viruses of animal origin can be expected, but the likelihood of sustained human-to-human transmission remains low.  
  • Reporting:
    • All human infections caused by a new influenza subtype are reportable under the International Health Regulations (IHR, 2005).[2]
    • This includes any animal and non-circulating seasonal viruses.
    • Information from these notifications will continue to inform risk assessments for influenza at the human-animal interface.  

 

Avian Influenza Viruses 

Avian influenza A(H5) viruses 

  • Current situation
    • Since the last update[3], three new laboratory-confirmed human cases of avian influenza A(H5N1) virus infection were reported to WHO.
    • A 2-year-old male resident of Cairo Governorate, Egypt, had onset of influenza-like illness (ILI) symptoms on 30 May 2016, and a sample collected as part of ILI surveillance tested positive for influenza A(H5N1).
    • The case was hospitalized, treated with antivirals for pneumonia and recovered.
    • Prior to his illness, the case had visited a family member who raised birds.  
    • In addition, a 30-year-old woman from Menia Governorate had onset of illness on 11 June and an 8 year-old girl from Cairo Governorate had onset of illness on 18 June.
    • Both cases had exposure to poultry or poultry-related environments prior to illness, were hospitalized with pneumonia, received antiviral therapy and have recovered.
    • Investigation and follow up of contacts of the three cases took place for 14 days with no further cases reported.
    • Avian influenza A(H5N1) viruses are enzootic in poultry in Egypt.
  • Since 2003, a total of 854 laboratory-confirmed cases of human infection with avian influenza A(H5N1) virus, including 450 deaths, have been reported to WHO from 16 countries (see Figure 1).  
  • Although other influenza A(H5) viruses have the potential to cause disease in humans, no human cases have been reported so far.
  • According to reports received by the World Organisation for Animal Health (OIE), various influenza A(H5) subtypes continue to be detected in birds in West Africa, Europe and Asia.
  • The A(H5N1) virus outbreaks in poultry in West Africa continue since 2014 with Cameroon now reporting outbreaks.
  • No human infections associated with these outbreaks in Western and Central Africa have been identified to date. 

 

Risk Assessment:

  1. What is the likelihood that additional human cases of infection with avian influenza A(H5) viruses will occur?
    • Most human cases were exposed to A(H5) viruses through contact with infected poultry or contaminated environments, including live poultry markets. Since the viruses continue to be detected in animals and environments, further human cases can be expected. 
  2. What is the likelihood of human-to-human transmission of avian influenza A(H5) viruses?
    • Even though small clusters of A(H5) virus infections have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this and other A(H5) viruses have not acquired the ability of sustained transmission among humans, thus the likelihood is low. 
  3. What is the risk of international spread of avian influenza A(H5) viruses by travellers?
    • Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival.
    • If this were to occur, further community level spread is considered unlikely as evidence suggests these viruses have not acquired the ability to transmit easily among humans.  

 

Avian influenza A(H7N9) viruses 

  • Current situation
    • During this reporting period, China reported 12 new laboratory-confirmed human cases of avian influenza A(H7N9) virus infection to WHO, including five deaths.
    • Six cases were reported from provinces/municipalities in northern China, including two newly-affected areas, Liaoning province and Tianjin city.
    • For more details on these cases, see Table 1 below and the Disease Outbreak News. 
  • A total of 793 laboratory-confirmed cases of human infection with avian influenza A(H7N9) viruses, including at least 319 deaths[4], have been reported to WHO (Figure 2).
  • According to reports received by the Food and Agriculture Organization (FAO) on surveillance activities for avian influenza A(H7N9) viruses in China[5], positives among virological samples continue to be detected mainly from live bird markets, vendors and some commercial or breeding farms.

 

Risk Assessment:

  1. What is the likelihood that additional human cases of infection with avian influenza A(H7N9) viruses will occur?
    • Most human cases are exposed to the A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets.
    • Since the virus continues to be detected in animals and environments, further human cases can be expected.
    • Additional sporadic human cases of influenza A(H7N9) in other provinces in China that have not yet reported human cases are also expected.
  2. What is the likelihood of human-to-human transmission of avian influenza A(H7N9) viruses?
    • Even though small clusters of cases have been reported, including those involving healthcare workers, current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans, thus the likelihood is low. 
  3. What is the risk of international spread of avian influenza A(H7N9) virus by travellers?
    • Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival.
    • If this were to occur, further community level spread is considered unlikely as this virus has not acquired the ability to transmit easily among humans. 

 

Table 1: Human cases of avian influenza A(H7N9) reported from 13 June to 19 July 2016 

[Province or region reporting (province of assumed exposure, if different from reporting province or region)  - Age – Sex  - Date of onset (yyyy/mm/dd)  - Case condition at time of reporting  - Exposure to live poultry or live poultry market]

  1. Guangdong  - 63 – M - 2016/05/07 – Died – Yes
  2. Hebei  - 57 – M - 2016/05/10 – Critical – Undetermined
  3. Jiangsu  - 53 – F - 2016/05/22 – Critical – Yes
  4. Beijing  - 49 – M - 2016/05/22 – Critical – Yes
  5. Jiangsu  - 45 – M - 2016/05/20 – Critical – Yes
  6. Jiangsu  - 61 – M - 2016/05/26 – Severe – Yes
  7. Anhui (Henan) – 54 – F - 2016/05/28 – Severe  - Exposure history not available
  8. Beijing (Hebei) – 68 – F - 2016/06/03 – Died – Yes
  9. Tianjin (Hebei) – 67 – F - 2016/06/10 – Severe – Yes
  10. Tianjin – 62 – M - 2016/05/30 – Died – Yes
  11. Liaoning – 66 – M - 2016/06/05 – Died – Yes
  12. Zhejiang – 52 – M - 2016/06/23 – Died – Yes

 

Avian influenza A(H9N2) viruses 

  • Current situation
    • Since the last update[6], one new laboratory-confirmed human case of avian influenza A(H9N2) virus infection was reported to WHO.
    • A 4-year-old female resident of Guangdong Province, China, had onset of illness on 10 June 2016.
    • She was hospitalized on 12 June in serious condition but improved after treatment.
    • A sample from the case tested positive for influenza A(H9N2) virus and investigation revealed exposure to live poultry prior to onset of illness.
    • Follow up of contacts was ongoing at the time of reporting.
    • Avian influenza A(H9N2) viruses are enzootic in poultry in China. 

 

Risk Assessment:

  • 1. What is the likelihood that additional human cases of infection with avian influenza A(H9N2) viruses will occur?
    • Most human cases are exposed to the A(H9N2) virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness.
    • Since the virus continues to be detected in poultry populations, further human cases can be expected. 
  • 2. What is the likelihood of human-to-human transmission of avian influenza A(H9N2) viruses?
    • No case clusters have been reported.
    • Current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans, thus the likelihood is low.
  • 3. What is the risk of international spread of avian influenza A(H9N2) virus by travellers?
    • Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival.
    • If this were to occur, further community level spread is considered unlikely as this virus has not acquired the ability to transmit easily among humans. 

 

Swine Influenza Viruses

Influenza A(H1N2)v viruses

Current situation

WHO was notified of two new laboratory-confirmed human infections with A(H1N2)v viruses in the United States of America (USA) during this reporting period.

One case, from the state of Wisconsin, was hospitalized and was recovering at the time of notification.

The second human infection occurred in the state of Minnesota.

In April 2016, the person was infected with an A(H1N2)v virus.

The patient was not hospitalized and has fully recovered from their illness.

Both cases reported contact with swine prior to illness onset and no human-to-human transmission or other cases were identified surrounding both cases. 

These are the seventh and eighth cases of A(H1N2)v influenza virus infection detected in the USA since 2005. Most cases were associated with mild illness and two were hospitalized.

The previous case who was hospitalized had underlying conditions.[7]

Virological characterization of the viruses from these two cases indicates that they are similar to A(H1N2) viruses currently circulating in swine in the USA.  

 

Risk Assessment:

1. What is the likelihood that additional human cases of infection with influenza A(H1N2)v viruses will occur?

Influenza A(H1N2) viruses circulate in swine populations in many regions of the world. Depending on geographic location, the genetic characteristics of these viruses differ. Most human cases are exposed to the A(H1N2) virus through contact with infected swine or contaminated environments. Human infection tends to result in mild clinical illness. Since these viruses continue to be detected in swine populations, further human cases can be expected.

2. What is the likelihood of human-to-human transmission of influenza A(H1N2)v viruses?

No case clusters have been reported. Current evidence suggests that these viruses have not acquired the ability of sustained transmission among humans, thus the likelihood is low. 

3. What is the risk of international spread of influenza A(H1N2)v viruses by travellers?

Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as these viruses have not acquired the ability to transmit easily among humans. 

 

Overall Risk Management Recommendations:

-- WHO does not advise special traveller screening at points of entry or restrictions with regard to the current situation of influenza viruses at the human-animal interface. For recommendations on safe trade in animals from countries affected by these influenza viruses, refer to OIE guidance.  

-- WHO advises that travellers to countries with known outbreaks of animal influenza should avoid farms, contact with animals in live animal markets, entering areas where animals may be slaughtered, or contact with any surfaces that appear to be contaminated with animal faeces. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

-- Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health. Continued vigilance is needed within affected and neighbouring areas to detect infections in animals and humans. As the extent of virus circulation in animals is not clear, epidemiological and virological surveillance and the follow-up of suspected human cases should remain high.

-- All human infections caused by a new influenza subtype are notifiable under the International Health Regulations (IHR, 2005).[8] State Parties to the IHR (2005) are required to immediately notify WHO of any laboratory-confirmed9 case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic.[6] Evidence of illness is not required for this report. 

-- It is critical that influenza viruses from animals and people are fully characterized in appropriate animal or human health influenza reference laboratories and reported according to international standards. Under WHO’s Pandemic Influenza Preparedness (PIP) Framework, Member States are expected to share their influenza viruses with pandemic potential on a regular and timely basis with the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of public health laboratories. The viruses are used by the public health laboratories to assess the risk of pandemic influenza and to develop candidate vaccine viruses. 

 

Links

-- WHO Human-Animal Interface web page http://www.who.int/influenza/human_animal_interface/en/

-- Cumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO http://www.who.int/influenza/human_animal_interface/H5N1_cumulative_table_archives/en/Avian

-- Influenza A(H7N9) Information http://who.int/influenza/human_animal_interface/influenza_h7n9/en/index.html

-- WHO Avian Influenza Food Safety Issues http://www.who.int/foodsafety/areas_work/zoonose/avian/en/

-- World Organisation of Animal Health (OIE) web page:

- Web portal on Avian Influenza  http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/

-- Food and Agriculture Organization of the UN (FAO) webpage: Avian Influenza http://www.fao.org/avianflu/en/index.html OFFLU http://www.offlu.net/index.html

______

1] For epidemiological and virological features of human infections with animal influenza viruses not reported in this assessment, see the yearly report on human cases of influenza at the human-animal interface published in the Weekly Epidemiological Record. www.who.int/wer/en/ 

2] World Health Organization. Case definitions for the four diseases requiring notification in all circumstances under the International Health Regulations (2005). www.who.int/ihr/Case_Definitions.pdf 

3] http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_05_09_2016.pdf?ua=1 

4] Total number of fatal cases is published on a monthly basis by China National Health and Family Planning Commission.

5] Food and Agriculture Organization. H7N9 situation update. www.fao.org/ag/againfo/programmes/en/empres/H7N9/situation_update.html 

6] http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_05_09_2016.pdf?ua=1 

7] http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_06_13_2016.pdf?ua=1

8] World Health Organization. Case definitions for the four diseases requiring notification in all circumstances under the International Health Regulations (2005). www.who.int/ihr/Case_Definitions.pdf

9] World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza (2011). www.who.int/influenza/gisrs_laboratory/manual_diagnosis_surveillance_influenza/en/

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Keywords: Worldwide; WHO; Updates; Avian Influenza; Swine Influenza; H5N1; H7N9; H9N2; H1N2v, USA; China; Egypt; Human; Swine Influenza.

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