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Welcome to A Time's Memory Blog

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A TIME'S MEMORY - Flu, Bugs & Other Accidents Blog - Year: XIII - Here, Reader, you will find many items if your interests are in the field of emerging threats to global or public health, with a perspective that is not mainstream. Thank to You for the interest!

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19 Jul 2018

[#H7N9 in #China] Reply to Recommendation No. 2751 of th 13th NPC (MoA, July 19 ‘18)

          

Title:

[#H7N9 in #China] Reply to Recommendation No. 2751 of th 13th NPC.

Subject:

Influenza A of Avian Origin, H7N9 subtypes, poultry enzootic and human cases in China.

Source:

Ministry of Agriculture, PR of China, full page: (LINK). Article in Chinese, edited.

Code:

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Index number: 07B130315201800433 / Information unit: Veterinary bureau / Information Name: Reply to Recommendation No. 2751 of the First Session of the 13th National People's Congress / Effective date: July 17, 2018 / Document number: Agricultural Affairs Office [2018] No. 84 / Release date: July 17, 2018


Content overview:

  • Regarding the proposal of the representative of Zhang Lixia on strengthening the management of the live poultry market and live poultry, and further improving the prevention and control of the H7N9 epidemic, the Ministry of Finance and the National Health and Health Commission, the Ministry of Health responded.


Reply to Recommendation No. 2751 of the First Session of the 13th National People's Congress

Zhang Lixia representative:

Your suggestion on strengthening the management of live poultry market and live poultry transportation and further improving the prevention and control of H7N9 epidemic is received. The Ministry of Finance and the National Health and Health Commission have the following replies.

The state has always attached great importance to the prevention and control of H7N9 influenza.

At the beginning of 2013 , China first discovered human cases of H7N9 influenza. Under the unified coordination of the H7N9 joint prevention and control work mechanism (hereinafter referred to as the joint prevention and control work mechanism), all member units responded in a timely manner, resolutely implemented the central decision-making and deployment, and acted quickly and fully.

Strengthen the coordination of the departments, pay close attention to the implementation of measures, and do a good job in all aspects.

At the beginning of 2017 , some provinces found highly pathogenic H7N9 influenza strains of poultry . The joint prevention and control work mechanism timely organized all member units to hold a video conference on joint prevention and control work in the country, deployed and implemented H7N9 influenza prevention and control work, and the Ministry of Agriculture and Rural Areas actively adjusted poultry.

The H7N9 flu prevention and control strategy has been comprehensive immunization of poultry nationwide since the fall of 2017 .

In the joint efforts of the member units, China's mainland H7N9 flu epidemic has been effectively controlled, 2017-2018 annual prevalence season (September 2017 – May 2018), reported only 4 cases of human infection of H7N9 influenza cases, representing a popular The season dropped significantly.


I. On the issue of clarifying the responsibility of the live poultry market

According to the Regulations on Prevention and Control of Highly Pathogenic Avian Influenza in Livestock Management Market (Agricultural Medicine issued [ 2006 ] No. 11 ), the veterinary department is responsible for animal health supervision in the live poultry market, and the health department is responsible for the live poultry market.

Public health management, the industry and commerce department is responsible for the supervision of live poultry operations in the live poultry market. The Circular on Further Strengthening the Management of Live Poultry Management Market (National Guardian Emergency [ 2017 ] No. 44 ) further requires that all localities should implement the responsibility for territorial management, strengthen the awareness of the first responsible person of the local government, and clarify the live poultry market in the jurisdiction.

The competent departments; all relevant departments must strictly implement their responsibilities, strengthen coordination and cooperation, and strictly manage the live poultry management market.

In addition, all member units of the joint prevention and control work mechanism strengthened coordination and coordination, intensified supervision and law enforcement, jointly guided the live poultry management market to complete the independent division of live poultry sales, and strictly implemented the “1110” management system for live poultry management market , namely: one day One clean, one week disinfection, one month off, and overnight zero deposit.


II, on the issue of continuing to play a good role in the joint prevention and control mechanism

The National Health and Health Committee, together with the Ministry of Agriculture and Rural Affairs, the General Administration of Market Supervision and other joint prevention and control work mechanism members, strive to implement the following measures:

  • First, timely study and arrange the prevention and control of the epidemic.
    • Through the convening of a national video conference on joint prevention and control work, video conferences on prevention and control of infectious diseases in the country, symposiums on key epidemic prevention and control, and joint notices on prevention and control work issued by various departments, strengthen work arrangements and guide local governments to strengthen their local management responsibilities. Do a good job in prevention and control of the epidemic.
  • Second is to guide all localities to do a good job in monitoring, assessing and coping with the epidemic.
    • All localities are required to continue to monitor the epidemic situation, organize experts to conduct risk assessments in a timely manner, and guide the provinces where the epidemic situation occurs to deal with the epidemic situation in accordance with relevant prevention and control plans.
    • Continue to implement prevention and control measures such as traceability, epidemiological investigation, close contact tracking and medical observation, and strengthen prevention and control work supervision.
  • Third is to actively promote the implementation of source control measures.
    • Actively play the role of the joint prevention and control work mechanism, and require the discovery of H7N9 influenza cases or the live poultry market to detect the H7N9 influenza pathogen-positive prefectures and counties, close the live poultry market in the main city, and strengthen the control of live poultry transfer to the outside.
    • In areas where the H7N9 flu epidemic occurred, the live animal market access system was further tightened and live bird quarantine was strengthened.
  • Fourth is to strengthen international cooperation and exchanges.
    • Strengthen technical exchanges and cooperation with international organizations, insist on timely notification of information on avian and human epidemics to the World Organisation for Animal Health and the World Health Organization, and timely announce the progress of prevention and control of the epidemic to the public.


III. Regarding the further implementation of Announcement No. 2516

At the beginning of 2017 , some provinces found highly pathogenic strains of poultry H7N9 influenza. The Ministry of Agriculture and Rural Affairs organized and implemented two emergency monitoring in time according to the situation of prevention and control, accurately grasping the scope of contamination of the mutant strains, and issued the announcement No. 2516 , clearly cross The live poultry transported by the province needs to report the quarantine of the place of origin with the test report, and strengthen the supervision of the H7N9 influenza surveillance and cross-regional transportation regulation.

In order to implement the contents of Announcement No. 2516 and do a good job in the prevention and control of H7N9 influenza, the Ministry of Agriculture and Rural Affairs issued the Notice on Doing a Good Job of the Autumn Immunization of Highly Pathogenic Avian Influenza in China (Agricultural Medicine [ 2018 ] No. 24 ), All localities implemented the transportation inspection and certification system in accordance with the requirements of Announcement No. 2516 .

Earlier this year, the Ministry of Agriculture and Rural issuance of "National Poultry H7N9 influenza prevention and control guidance ( 2018 - 2020 years)," further rigorous supervision of live poultry quarantine and circulation, transporting refined detected certificate provisions, to adapt to the current H7N9 influenza prevention and control situation.


IV, on strengthening the publicity and education of H7N9 influenza prevention and control knowledge

The Ministry of Agriculture and Rural Affairs organizes veterinary departments around the country to conduct training on prevention and control of poultry H7N9 influenza, including prevention and control knowledge, laboratory testing techniques and monitoring techniques.

National health committee regularly trained medical personnel to enhance the " four early " (early discovery, early reporting, early diagnosis, early treatment) awareness and ability to adhere to the " four focus " (centralized patient, a pool of experts, pooling of resources, centralized treatment) principle, Strengthen early diagnosis and treatment and treatment of severe cases, and do everything possible to reduce severe illness and death.

In addition, the Ministry of Agriculture and Rural Affairs has repeatedly published H7N9 influenza related reports in the Farmers Daily and other media to guide consumers to scientifically prevent H7N9 flu and rationally treat poultry products; the National Health and Health Commission actively promotes H7N9 flu prevention and control knowledge in various ways to raise public awareness. Self-prevention awareness and ability.


V. Issues concerning the establishment of the annual H7N9 influenza prevention and control special budget

In recent years, the central government has attached great importance to the prevention and control of H7N9 influenza and has continuously increased its investment.

In 2018 , the central government allocated 4.53 billion yuan of animal epidemic prevention subsidies for compulsory immunization and forced culling of major animal diseases such as poultry H7N9 flu; arranged for 170 million yuan for animal disease surveillance and prevention projects for poultry H7N9 flu, etc.

Priority monitoring and epidemiological investigation of disease prevention and control. In addition, the central government allocated 37.4 billion yuan of basic public health service subsidies for basic public health services such as vaccination, infectious disease prevention and public health incident reporting and treatment; and arranged major public health service subsidies of 21.3 billion yuan for Work on prevention and treatment of major infectious diseases and emergency response to public health emergencies.

Considering that there is a clear source of funding for H7N9 flu prevention and control, it is not appropriate to set up a special fund to avoid duplication of funds.

In the next step, all members of the joint prevention and control work mechanism will continue to strengthen departmental cooperation and implement various prevention and control measures in accordance with the principles of scientific prevention and control of H7N9 influenza, beneficial to the healthy development of the poultry industry, and economic and social stability. Maintain poultry production safety, animal product quality and safety and public health safety.

Thank you for your concern about the prevention and control of H7N9 flu, and I hope to continue to support our work in the future.

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Contact Unit and Tel: Department of Veterinary Medicine, Ministry of Agriculture and Rural Areas 010 — 59193200

Ministry of Agriculture and Rural Affairs

2018 / 7 / 17

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Keywords: Avian Influenza; H7N9; Human; Poultry; China.

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18 Jul 2018

Four New Confirmed #MERS #Coronavirus cases reported by #Saudi Arabia (MoH, July 9-14 '18)

          

Title:

Four New Confirmed #MERS #Coronavirus cases reported by #Saudi Arabia.

Subject:

Middle East Respiratory Syndrome in Saudi Arabia, daily update.

Source:

Saudi Arabia Ministry of Health, full PDF file: (LINK).

Code:

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July 9 - 14 2018


New Case Reported:

[Date report - Sex, Age, Citizenship, Resident in, Health Status, Note]

  1. 9/7 - M, 35, ..., Afeef, Critical; *
  2. 10/7 - M, 74, ..., Riyadh, Stable; *
  3. 13/7 - M, 29, ..., Najran, Stable; *
  4. 14/7 - M, 45, ..., Afeef, Stable; **

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{*} Primary case (or exposure history under investigation).

{**} Secondary case (community-acquired infection).

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Cumulative number of confirmed cases and deaths since 2012:

  • Total No. of Cases: ... {§}
  • Total No. of Deaths: ...
  • Patients currently under treatment: ...
  • Case-Fatality Rate: ...

{§} This figure and those below might not be representing actual ones because of inconsistencies in daily reports.

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Keywords: MERS-CoV; Updates; Saudi Arabia.

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Highly pathogenic #avian #influenza H5, #Russia [thirteen #poultry #outbreaks] (#OIE, July 18 ‘18)

          

Title:

Highly pathogenic #avian #influenza H5, #Russia [thirteen #poultry #outbreaks].

Subject:

Avian Influenza, H5 subtype, poultry epizootics in Russia.

Source:

OIE, full page: (LINK).

Code:

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Information received on 18/07/2018 from Dr Nikolay Vlasov, Deputy Head of the Rosselkhoznadzor, Ministry of Agriculture, Ministry of Agriculture, Moscow, Russia

  • Summary
    • Report type    Follow-up report No. 5
    • Date of start of the event    07/06/2018
    • Date of confirmation of the event    09/06/2018
    • Report date    18/07/2018
    • Date submitted to OIE    18/07/2018
    • Reason for notification    Recurrence of a listed disease
    • Date of previous occurrence    13/03/2018
    • Manifestation of disease    Clinical disease
    • Causal agent    Highly pathogenic avian influenza virus
    • Serotype    H5
    • Nature of diagnosis    Clinical, Laboratory (advanced)
    • This event pertains to    a defined zone within the country
  • Summary of outbreaks   
    • Total outbreaks: 13
      • Total animals affected: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of    - Slaughtered
        • Birds    - 300505    - 14369    - 8873    - 64944    - 0
      • Outbreak statistics: Species    - Apparent morbidity rate    - Apparent mortality rate    - Apparent case fatality rate    - Proportion susceptible animals lost*
        • Birds    - 4.78%    - 2.95%    - 61.75%    - **
          • *Removed from the susceptible population through death, destruction and/or slaughter
          • **Not calculated because of missing information
  • Epidemiology
    • Source of the outbreak(s) or origin of infection   
      • Unknown or inconclusive

(...)

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Keywords: OIE; Updates; Avian Influenza; H5 ; Poultry; Russia.

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[#England] #Flu #vaccine #effectiveness in 2017 to 2018 season (@PHE_uk, July 18 ‘18)

          

Title:

[#England] #Flu #vaccine #effectiveness in 2017 to 2018 season.

Subject:

Human Influenza Viruses, A & B subtypes, seasonal winter epidemic in th UK, vaccine effectiveness estimates.

Source:

Public Health England, full page: (LINK).

Code:

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Summary

  • Public Health England (PHE) has today (Wednesday, 18 July 2018) published data on the effectiveness of the flu vaccine in the 2017 to 2018 season.
  • The data show that overall, flu vaccine was 15% effective in all age groups.
    • However, effectiveness varied considerably. By age-group, the vaccine was overall:
      • 26.9% effective in children aged 2 to 17 years (who received the nasal spray)
      • 12.2% in at risk groups aged 10 to 64 years
      • 10.1% in those aged 65 and over
  • There were higher levels of protection against flu B and H1N1pdm09, especially in children (60.8% effective against flu B and 90.3% against H1N1pdm09 in children).
  • Read the full influenza vaccine effectiveness: seasonal estimates data.
  • In 2018 to 2019, a new ‘booster’ vaccine is being made available for all those aged 65 and over which should provide better protection than the current vaccines.
    • We are also recommending that the quadrivalent vaccine, which protects against 4 strains of flu rather than 3 and is currently used for all children under 18 years of age, is made available to all adults in at-risk groups aged between 16 to 64 years.
  • Dr Paul Cosford, Director for Health Protection and Medical Director, said:
    • ‘’Vaccine effectiveness varies year on year as the flu virus changes and is difficult to predict.
    • ‘’Last winter’s flu vaccine provided good protection against A(H1N1)pdm09 and good protection for the quadrivalent vaccine in children against the main Flu B strain which circulated last season.
    • ‘’This upcoming season we are recommending that all those under 65 have the quadrivalent flu vaccine, which protects against both the main B strains and the 2 main flu A subtypes.
    • ‘’We are also making a new booster vaccine available for all adults aged 65 or over in order to improve the immune response.
    • The vaccine offered lower protection against Flu A(H3N2), which also circulated. This is likely due to several factors including a suboptimal match between the main circulating A(H3N2) viruses and the vaccine, the strains for which are recommended by the World Health Organization each year.
    • Vaccines are the best defence we have against flu and not only protect people who have received the vaccine but also those around them. We encourage everyone eligible to take up the offer of the vaccine this winter.

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Keywords: England; UK; Updates; Vaccines; Seasonal Influenza.

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#Influenza [#H1N1pdm09, #H3N2, B] virus characterisation, #Summary #Europe, June 2018 (@ECDC_EU, edited)

          

Title:

#Influenza [#H1N1pdm09, #H3N2, B] virus characterisation, #Summary #Europe, June 2018.

Subject:

Human Influenza Viruses, A (H1, H3) & B subtypes, current epidemiological situation in the European Region.

Source:

European Centre for Disease Prevention and Control (ECDC), full page: (LINK). Summary, edited.

Code:

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Surveillance Report  / 18 Jul 2018 / Publication series: Influenza Virus Characterisation / Time period covered: 2017-2018 influenza season



Summary

  • This is the sixth report of the 2017–18 influenza season.
    • As of week 25/2018, nearly 239 000 influenza detections across the WHO European Region have been reported.
    • Forty-four percent of the detected viruses were type A, with A(H1N1)pdm09 and A(H3N2) viruses being detected in equal numbers.
    • Type B viruses accounted for 56%; B/Yamagata viruses prevailed over B/Victoria viruses at a ratio of over 50:1.


Executive summary

  • Twenty-nine EU/EEA countries have shared influenza-positive specimens with the London WHO CC, Crick Worldwide Influenza Centre (WIC), since week 40/2017, with 1 455 specimens having collection dates after August 2017. 
  • Of the 28 A(H1N1)pdm09 test viruses characterised antigenically, all but one showed good reactivity with antiserum raised against the 2017–18 vaccine virus, A/Michigan/45/2015.
    • The 231 test viruses with collection dates from week 40/2017 genetically characterised at the WIC, as others from the European Region recently deposited in the GISAID EpiFlu database, have all fallen in subclade 6B.1, defined by HA1 amino acid substitutions S162N and I216T, the great majority with additional substitutions of S74R, S164T and I295V.
  • Of 311 A(H3N2) viruses successfully recovered to date, only 86 (28%) had sufficient HA titre to allow antigenic characterisation by HI assay in the presence of oseltamivir, of which 34 were tested since the last report.
    • The majority of these 86 viruses were poorly recognised by antisera raised against the currently used vaccine virus, egg-propagated A/Hong Kong/4801/2014, in HI assays.
    • Of the 298 viruses with collection dates from week 40/2017 genetically characterised at the WIC, 289 were clade 3C.2a (with 161 3C.2a2, 102 3C.2a1, 22 3C.2a3 and four 3C.2a4 subclade viruses) and nine were clade 3C.3a.
    • Of the 102 subclade 3C.2a1 viruses, 96 fell in subgroup 3C.2a1b and three belonged to subgroup 3C.2a1a.
  • A single B/Victoria-lineage viruses was tested by HI, and it reacted well only with post-infection ferret antisera raised against tissue culture-propagated cultivars of B/Norway/2409/2017 and B/Colorado/06/2017, viruses with a deletion of two amino acids in HA1 (Δ162-163).
    • Of the 43 viruses characterised genetically at the WIC with a collection date after week 40/2017, 11 fell within clade 1A and 32 fell within the subgroup (1A(Δ2)) carrying the HA1 double amino acid deletion. 
  • A total of 52 B/Yamagata viruses were characterised antigenically, and all reacted well (within fourfold of the homologous titre) with post-infection ferret antiserum raised against egg-propagated B/Phuket/3073/2013, the recommended vaccine virus for use in quadrivalent vaccines for the northern hemisphere 2017–18 and 2018–19 seasons and for trivalent vaccines in the southern hemisphere 2018 season.
    • The 352 viruses with collection dates from week 40/2017 genetically characterised at the WIC – as others recently circulating in the European Region and reported to the GISAID EpiFlu database – fall within genetic clade 3.

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Download: |--  Influenza virus characterisation, Summary Europe, June 2018 - EN - [PDF-2.66 MB] –|

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Keywords: ECDC; Updates; Seasonal Influenza; European Region.

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17 Jul 2018

[#Travel #Advice] #RiftValley #Fever in #Kenya (@CDCgov, July 17 ‘18)

          

Title:

[#Travel #Advice] #RiftValley #Fever in #Kenya.

Subject:

Viral Hemorrhagic Fevers, RVF outbreak in Kenya, travel advice.

Source:

US Centers for Disease Control and Prevention (CDC), full page: (LINK).

Code:

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Watch - Level 1, Practice Usual Precautions 

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What is Rift Valley fever?

  • Rift Valley fever (RVF) is an illness that is primarily spread by direct contact with blood, fluids, or tissues of infected animals such as cattle, buffalo, sheep, goats, and camels. Less commonly, it can also be spread through mosquito bites.
  • Most people with RVF do not feel sick or have only mild illness.
    • Symptoms of RVF include fever, weakness, back pain, dizziness, and weight loss.
    • However, a small percentage (8%–10%) of people may have more serious illness, such as severe bleeding, swelling of the brain, or eye disease.
    • Approximately 1% of people who get RVF die from the disease.


Key points

  • There is an outbreak of Rift Valley fever (RVF) in Kenya.
  • Travelers to Kenya should protect themselves from RVF by avoiding contact with infected animals and preventing mosquito bites.


What is the current situation?

  • Health officials have reported an ongoing outbreak of RVF in Kenya that began in June 2018. The outbreak has been confirmed in the counties of Wajir, Marsabit, and Siaya.


What can travelers do to prevent Rift Valley fever?

  • Avoid exposure to animals or animal blood
    • Do not handle raw meat.
    • Wear protective equipment if working with animals.
  • Prevent mosquito bites
    • Because RVF and other diseases are spread by mosquito bites, all travelers to Kenya should prevent mosquito bites by:
      • Using insect repellent.
      • Wearing long-sleeved shirts and pants when outdoors.
      • Sleeping in an air-conditioned or well-screened room or under an insecticide-treated bed net.
  • If you get sick during or after travel
    • If you feel sick during travel and think you may have RVF:
      • Seek medical care.
      • Use acetaminophen. Do not take pain relievers that contain aspirin or ibuprofen, which may lead to a greater tendency to bleed.
      • If you get sick after returning to the United States:
      • Seek medical care. Tell your health care provider where and when you traveled.


Information for veterinarians and animal care workers

  • Although no vaccine for humans is available, several vaccines are licensed in other countries to prevent RVF in animals. Vaccinating livestock prevents the spread of infection to humans by decreasing the rate of disease in animals.


Traveler Information


Clinician Information

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Keywords: US CDC; USA; Updates; Travel Warnings; Kenya; RVF.

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#Nipah virus: #epidemiology, #outbreaks and #guidance (@PHE_uk, July 17 ‘18)

          

Title:

#Nipah virus: #epidemiology, #outbreaks and #guidance.

Subject:

Henipavirus, Nipah Virus Infection, human, overview.

Source:

Public Health England, full page: (LINK).

Code:

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The epidemiology, symptoms, diagnosis and management of Nipah virus infections.

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Published 30 May 2018 / Last updated 17 July 2018 — see all updates / From: Public Health England


Contents

  1. Epidemiology
  2. Transmission
  3. Clinical features
  4. Patient assessment
  5. Laboratory diagnosis
  6. Treatment
  7. Infection prevention and control
  8. Advice for travellers to endemic areas
  9. UK risk assessment
  10. Further information


Epidemiology

  • Nipah virus infection is caused by the paramyxovirus Nipah virus (genus Henipavirus).
    • Nipah virus is related to, but distinct from, Hendra virus.
    • The natural animal reservoir of Nipah virus is bats, particularly fruit bats of the Pteropus genus.
    • Nipah virus infections in humans were reported for the first time in 1998, following identification of the virus during an outbreak of acute encephalitis in Nipah, Malaysia, with cases also seen in Singapore.
  • Outbreaks have occurred subsequently in parts of North East India and almost annually since 2001 in specific districts in Bangladesh.
    • Cases of henipavirus infection have also occurred in the Philippines, believed to have been caused by Nipah virus or a Nipah-like virus.
  • In May 2018 an outbreak was reported in Southern India for the first time, in Kozhikode district of Kerala (see map).
    • Local fruit bats tested positive for the virus.
    • The outbreak was short lived, with 18 confirmed cases.
  • Nipah virus has been isolated from the urine of bats in Malaysia, and antibodies against Nipah virus have been detected in 23 species of bat across Asia, and also in bats in Ghana and Madagascar.
    • However, human outbreaks of Nipah virus infection have not been identified outside South and South East Asia, and most outbreaks have occurred in rural or semi-rural locations.
  • See WHO Map of henipavirus outbreaks and fruit bat distribution


Transmission

  • The 1998 Malaysian outbreak occurred following a spill-over event, whereby Nipah virus from bats spread to pigs, with subsequent transmission occurring between pigs, followed by transmission to humans exposed to the infected urine and/or respiratory secretions of infected pigs.
    • Other outbreaks have been associated with consumption or collection of foodstuffs, such as raw or partially fermented date palm sap, which were contaminated with bat saliva and/or excreta containing Nipah virus.
  • Human-to-human transmission also occurs, although the relative contribution of this mode of transmission has varied considerably between outbreaks.
    • Close and direct, unprotected contact with infected patients, especially those with respiratory symptoms, has been implicated as a transmission risk.
    • Person-to-person transmission was responsible for most of the cases in the Kerala outbreak in May/June 2018.
  • Both human-to-human and horse-to-human transmission (slaughtering horses or consuming infected horse meat) were identified in the Philippines outbreak in 2014.
    • There is evidence that Nipah virus can infect other animals, including dogs, cats, goats and sheep.


Clinical features

  • The most important complication of Nipah virus infection is encephalitis, which is associated with a high mortality rate; however, the full spectrum of clinical illness is not completely understood.
    • The incubation period is thought usually to be 4 to 14 days, although a period as long as 45 days has been reported.
  • Typically patients present with a sudden onset, non-specific flu-like or febrile illness, sometimes with gastrointestinal symptoms.
    • Pneumonia and other respiratory manifestations have also been described as a feature, but their onset appears to be variable.
    • These are typically in addition to other signs and symptoms and vary in frequency according to the outbreak (29% in Malaysia; 75% in Bangladesh).
  • In many of the patients in reported series, symptoms and signs of encephalitis and/or meningitis developed after 3 to 14 days of initial illness.
    • Cerebrospinal fluid abnormalities are similar to those seen in other acute viral CNS infections.
    • Magnetic resonance imaging of the brain may reveal multiple small subcortical and deep white matter lesions, without surrounding oedema, but these abnormalities may be seen in other acute CNS infections.
  • Rapid progression to critical illness is said to occur in approximately 60% patients.
    • Mortality has also varied between outbreaks but is high overall (40 to 75%).
    • Neurological sequelae may occur in survivors, including relapsing encephalitis with delayed reactivation of latent virus infection.


Patient assessment

  • Nipah virus is classed as an airborne high consequence infectious disease (HCID) in England and clinical assessment should be performed by specialist hospital staff, with adherence to strict infection prevention and control precautions (see below) to prevent secondary transmission.
  • There are currently no agreed case criteria for Nipah virus infection.
    • Consider Nipah virus infection in a patient with a relevant travel or exposure history who presents with a compatible illness, with the onset of illness within 14 days following a potential exposure.
    • Nipah virus infection is a rare disease and other travel associated and common infections should also be considered in the differential diagnosis.
  • Any suspected cases in England should be discussed with local infection specialists and with the Imported Fever Service (IFS) (24 hour telephone service: 0844 778 8990).
    • The IFS can advise on whether laboratory testing is indicated.
    • The IFS is also available to clinicians in Scotland, Wales and Northern Ireland.
  • Any suspected cases should be notified immediately to the nearest PHEHealth Protection Team.


Laboratory diagnosis

  • In the UK, the Rare and Imported Pathogens Laboratory (RIPL) at PHE Porton Down is the designated diagnostic laboratory.
    • The mainstay of Nipah virus detection at RIPL is RT-PCR.
    • Serology for Nipah antibodies is not available.
  • Any suspected case should be discussed with local infection specialists and with the IFS, as above.
    • The IFS can advise on whether laboratory testing is indicated, and if so, will provide advice about the samples types required.
    • IFS will also advise on sample collection precautions and transport requirements.


Treatment

  • There is no proven, specific treatment for Nipah virus infection, and there is no preventative vaccine; treatment is supportive.
  • Clinical management of confirmed cases in England should be provided by specialist infectious diseases and critical care teams that are capable of safely managing patients with high consequence infectious diseases.
  • Patients have received ribavirin in previous outbreaks, but it was not possible to determine a beneficial effect of treatment.
    • Ribavirin was ineffective in small animal models, as was chloroquine.
    • Several experimental therapies are in pre-clinical development or phase 1 clinical trials, including monoclonal antibodies, fusion inhibitors, and novel antivirals.
  • Nipah virus is one of the pathogens in the WHO R&D Blueprint list of epidemic threats requiring urgent research and development action, including animal and human vaccine development.
    • Further information on experimental therapies and vaccine development is available from WHO.


Infection prevention and control

  • Prevention of transmission of infection by airborne and contact routes is required.
    • Studies have shown contamination of surfaces in hospitals during outbreaks, suggesting that there may be a risk of fomite-mediated transmission.
    • Since Nipah virus infection is an airborne HCID, strict infection prevention and control (IPC) measures are required when caring for both suspected and confirmed patients.
    • Appropriate respiratory isolation is essential for suspected and confirmed cases.
  • Hospital clinicians are advised to follow the same IPC measures used for suspected and confirmed cases of Middle East respiratory syndrome (MERS); this guidance is available on the PHE website.
  • Clinical laboratories should be informed in advance of samples submitted from suspected or confirmed diagnosis of Nipah virus infection, so that they can perform local risk assessments, minimise risk to laboratory workers and, where appropriate, safely perform laboratory tests that are essential to clinical care. Nipah virus is an ACDP/SAPO Hazard Group 4 pathogen.


Advice for travellers to endemic areas

  • Those travelling to endemic areas, particularly areas with active outbreaks, should avoid contact with bats and their environments, and sick animals.
    • Consumption of raw or partially fermented date palm sap should be avoided.
    • Wash fruit with clean water and avoid any fruit that has been partially eaten by animals or that may be contaminated (for example windfall fruit).
  • For information about current outbreaks and travel advice, see NaTHNaC


UK risk assessment

  • Nipah virus does not occur in the UK. Globally, Nipah virus infection has never been reported in a traveller.
  • The risk of a case from an outbreak area being imported into the UK is very low if standard precautions are undertaken.
    • The main risk activities for Nipah virus infection are associated with local practices (for example collection and consumption of raw or fermented date sap) that are generally not undertaken by tourists.
  • The risk for other travellers, such as those visiting friends and relatives or doing local volunteer work, maybe higher dependent on activities undertaken.


Further information

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Published 30 May 2018 / Last updated 17 July 2018 + show all updates

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Keywords: UK; Updates; Nipah Virus.

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Highly pathogenic #avian #influenza #H5, #Ghana [a #poultry #outbreak] (#OIE, July 17 ‘18)

          

Title:

Highly pathogenic #avian #influenza #H5, #Ghana [a #poultry #outbreak].

Subject:

Avian Influenza, H5 subtype, poultry epizootics in Ghana.

Source:

OIE, full page: (LINK).

Code:

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Information received on 17/07/2018 from Dr Kingsley Mickey Aryee, Ag. Chief Veterinary Officer, Veterinary Services Directorate, Ministry of Food and Agriculture, Accra, Ghana

  • Summary
    • Report type    Follow-up report No. 1
    • Date of start of the event    06/06/2018
    • Date of confirmation of the event    21/06/2018
    • Report date    17/07/2018
    • Date submitted to OIE    17/07/2018
    • Reason for notification    Recurrence of a listed disease
    • Date of previous occurrence    04/11/2016
    • Manifestation of disease    Clinical disease
    • Causal agent    Highly pathogenic avian influenza virus
    • Serotype    H5
    • Nature of diagnosis    Clinical, Laboratory (advanced)
    • This event pertains to    the whole country
  • Summary of outbreaks   
    • Total outbreaks: 1
      • Total animals affected: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of    - Slaughtered
        • Birds    - 6451    - 6451    - 2033    - 4418    - 0
      • Outbreak statistics: Species    - Apparent morbidity rate    - Apparent mortality rate    - Apparent case fatality rate    - Proportion susceptible animals lost*
        • Birds    - 100.00%    - 31.51%    - 31.51%    - 100.00%
          • *Removed from the susceptible population through death, destruction and/or slaughter
  • Epidemiology
    • Source of the outbreak(s) or origin of infection   
      • Unknown or inconclusive
      • Illegal movement of animals
  • Epidemiological comments   
    • This outbreak is linked to the index farm at Boankra as there was an illegal movement of infected birds from Boankra to Atia.
    • Also, the distance between the index farm and the farm at Atia is only 2.55 kilometers.

(...)

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Keywords: OIE; Updates; Avian Influenza; H5; Poultry; Ghana.

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#China, #Influenza [#H1N1pdm09, #H3N2, B, #H7N9] Weekly #Report - Week 27 2018 (CNIC, July 17 ‘18)

          

Title:

#China, #Influenza [#H1N1pdm09, #H3N2, B, #H7N9] Weekly #Report - Week 27 2018.

Subject:

Human and Animal Influenza Viruses, A (H1, H3, H7) & B subtypes, current epidemiological situation in China.

Source:

National Influenza Centre, PR of China (CNIC), full page: (LINK).

Code:

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(All data are preliminary and may change as more reports are received)


Summary

  • During week 27, influenza activity level in mainland China was very low, only a few influenza viruses can be detected in the southern provinces, the majority were A(H1N1)pdm09, and there was few influenza virus detected in the northern provinces.
  • Among influenza viruses antigenically characterized by CNIC since October 1st, 2017:
    • 628(95.4%) influenza A(H1N1)pdm09 viruses were characterized as A/Michigan/45/2015-like;
    • 116(31.8%) influenza A(H3N2) viruses were characterized as A/Hong Kong/4801/2014 (H3N2)(EGG)-like,
    • 330(90.4%) influenza A(H3N2) viruses were characterized as A/Hong Kong/4801/2014 (H3N2)(CELL)-like;
    • 154(59.9%) influenza B/Victoria viruses were characterized as B/Brisbane/60/2008-like;
    • 832(97.4%) influenza B/Yamagata viruses were characterized as B/Phuket/3073/2013-like.
  • Among the influenza viruses tested by CNIC for antiviral resistance analysis since October 1st, 2017:
    • all influenza A(H1N1)pdm09 and A(H3N2) viruses were resistant to adamantine;
    • All influenza A(H3N2) and B viruses were sensitive to neuraminidase inhibitors.
    • All but 2 influenza A(H1N1)pdm09 were sensitive to neuraminidase inhibitors.


Outbreak Surveillance

  • During week 27(July 2nd –July 8th , 2018), there was 1 outbreak reported nationwide, the result of this one is negative.


Surveillance of outpatient or emergency visits for Influenza-like Illness (ILI)

  • During week 27, the percentage of outpatient or emergency visits for ILI (ILI %) at national sentinel hospitals in southern provinces was 3.3%, lower than the last week (3.7%) and the same week of 2015-2016 and 2017-2018(3.9%,4.1%), same as the same week of 2016-2017(2.3%). (Figure 1)

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Figure 2. Percentage of Visits for ILI at Sentinel Hospitals in Northern Provinces (2015-2019)

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Virologic Surveillance

  • During week 27, influenza network laboratories tested 4127 specimens, of which 45(1.1%) were positive for influenza, influenza A and influenza B viruses were 30(66.7%) and 15(33.3%), respectively (Table 1).
  • During week 27, the percentage of specimens that were tested positive for influenza in south China was 1.4%, which was slightly higher than the previous week (1.2%) (Figure 3).
  • During week 27, the percentage of specimens that were tested positive for influenza in north China was 0.2%, which was slightly higher than the previous week (0.0%). (Figure 4).


Table 1 Laboratory Detections of ILI Specimens (Week 27, 2018)

[Week 27 - South China - North China – Total]

  • No. of specimens tested – 3185 – 942 – 4127
    • No. of positive specimens (%) - 43(1.4%) - 2(0.2%) - 45(1.1%)
      • Influenza A - 28(65.1%) - 2(100%) - 30(66.7%)
        • A(H3N2) - 2(7.1%) - 0(0) - 2(6.7%)
        • A(H1N1)pdm09 - 26(92.9%) - 2(100%) - 28(93.3%)
        • A (subtype not determined) - 0(0) - 0(0) - 0(0)
      • Influenza B - 15(34.9%) - 0(0) - 15(33.3%)
        • B (lineage not determined) - 0(0) - 0(0) - 0(0)
        • Victoria - 5(33.3%) - 0(0) - 5(33.3%)
        • Yamagata - 10(66.7%) - 0(0) - 10(66.7%)

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Figure 3. Influenza Positive Tests Reported by Southern Network Laboratories (Week 14, 2017–Week 27, 2018)

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Note: Analysis in this part was based on the test results of network laboratories. If it were not consistent with the results of CNIC confirmation, the results of CNIC confirmation were used.

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Figure 4. Influenza Positive Tests Reported by Northern Network Laboratories (Week 14, 2017–Week 27, 2018)

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Note: Analysis in this part was based on the result of network laboratories. If it were not consistent with the results of CNIC confirmation, the results of CNIC confirmation were used.

(…)

H7N9 case report

  • Since the notification of human infection with novel reassortant influenza A(H7N9) virus on 31 March 2013, in total 1564 laboratory-confirmed cases have been reported to WHO.
  • Among them, 32 cases were infected with HPAI A(H7N9) virus, which have mutations in the hemagglutin in gene indicating a change to high pathogenicity in poultry.
  • These 32 cases are from Taiwan (the case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan provinces, with illness onset date before October 2017.
  • No increased transmissibility or virulence to human case was detected in the HPAI A(H7N9) virus.

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|-- china flu report 1827.pdf  --|

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Keywords: China; Updates; Seasonal Influenza; Avian Influenza; H1N1pdm09; H3N2; B; H7N9.

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#Avian #Influenza [#H7N9, #H5N6, #H5N1] #Report - July 8 – 14 ‘18 (Wk 28) (#HK CHP, July 17 ‘18)

          

Title:

#Avian #Influenza [#H7N9, #H5N6, #H5N1] #Report - July 8 – 14 ‘18 (Wk 28).

Subject:

Influenza A of Avian Origin, H5, H7 & H9 subtypes, global poultry panzootic and human cases in China and worldwide.

Source:

Centre for Health Protection (CHP), Hong Kong PRC SAR, full PDF file: (LINK).

Code:

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Keywords: HK PRC SAR; Updates; Avian Influenza; H5N1; H5N6; H7N9; Human; Poultry; China; Worldwide.

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