Welcome to A Time's Memory Blog

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A TIME'S MEMORY - Flu, Bugs & Other Accidents Blog - Year: XV - 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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18 Jan 2020

#Update and Interim #Guidance on #Outbreak of 2019 Novel #Coronavirus (2019-nCoV) in #Wuhan, #China (@CDCgov, HAN, Jan. 18 ‘20)


Title:

#Update and Interim #Guidance on #Outbreak of 2019 Novel #Coronavirus (2019-nCoV) in #Wuhan, #China.

Subject:

2019-nCoV Outbreak in China, Guidance for Healthcare Providers.

Source:

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

Code:

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Distributed via the CDC Health Alert Network | January 17, 2020, 2030 ET (8:30 PM ET) | CDCHAN-00426


Summary

  • The Centers for Disease Control and Prevention (CDC) continues to closely monitor an outbreak of a 2019 novel coronavirus (2019-nCoV) in Wuhan City, Hubei Province, China that began in December 2019.
    • CDC has established an Incident Management System to coordinate a domestic and international public health response.
  • Coronaviruses are a large family of viruses.
    • Some cause illness in people; numerous other coronaviruses circulate among animals, including camels, cats, and bats.
    • Rarely, animal coronaviruses can evolve and infect people and then spread between people such as has been seen with Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) (https://www.cdc.gov/coronavirus/mers/index.html) and Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (https://www.cdc.gov/sars/index.html).
  • Chinese authorities report most patients in the Wuhan City outbreak have been epidemiologically linked to a large seafood and animal market, suggesting a possible zoonotic origin to the outbreak.
    • Chinese authorities additionally report that they are monitoring several hundred healthcare workers who are caring for outbreak patients; no spread of this virus from patients to healthcare personnel has been reported to date.
    • Chinese authorities are reporting no ongoing spread of this virus in the community, but they cannot rule out that some limited person-to-person spread may be occurring.
    • China has reported that two of the patients have died, including one with pre-existing medical conditions.
    • Chinese health officials publicly posted the genetic sequence of the 2019-nCoV on January 12, 2020.
    • This will facilitate identification of infections with this virus and development of specific diagnostic tests.
  • Thailand and Japan have confirmed additional cases of 2019-nCoV in travelers from Wuhan, China.
    • It is possible that more cases will be identified in the coming days.
    • This is an ongoing investigation and given previous experience with MERS-CoV and SARS-CoV, it is possible that person-person spread may occur.
    • There is much more to learn about the transmissibility, severity, and other features associated with 2019-nCoV as the investigations in China, Thailand, and Japan continue.
    • Additional information about this novel virus is needed to better inform population risk.
  • This HAN Update provides a situational update and guidance to state and local health departments and healthcare providers that supersedes guidance in CDC’s HAN Advisory 424 distributed on January 8, 2020.
    • This HAN Update adds guidance for evaluation of patients under investigation (PUI) for 2019-nCoV, prevention and infection control guidance, including the addition of an eye protection recommendation, and additional information on specimen collection.


Background

  • An outbreak of pneumonia of unknown etiology in Wuhan City was initially reported to WHO on December 31, 2019.
    • Chinese health authorities have confirmed more than 40 infections with a novel coronavirus as the cause of the outbreak.
    • Reportedly, most patients had epidemiological links to a large seafood and animal market.
    • The market was closed on January 1, 2020.
    • Currently, Chinese health authorities report no community spread of this virus, and no transmission among healthcare personnel caring for outbreak patients.
    • No additional cases of infection with 2019-nCoV have been identified in China since January 3, 2020.
  • On January 13, 2020 public health officials in Thailand confirmed detection of a human infection with 2019-nCoV in a traveler from Wuhan, China.
    • This was the first confirmed case of 2019-nCoV documented outside China.
    • On January 17, 2020 a second case was confirmed in Thailand, also in a returned traveler from Wuhan City.
    • On January 15, 2020 health officials in Japan confirmed 2019-nCoV infection in a returned traveler from Wuhan City.
    • These persons had onset dates after January 3, 2020.
    • These cases did not report visiting the large seafood and animal market to which many cases in China have been linked.
  • On January 11, 2020, CDC updated the level 1 travel health notice (“practice usual precautions”) for Wuhan City, Hubei Province, China with additional information (originally issued on January 6, 2020): https://wwwnc.cdc.gov/travel/notices/watch/novel-coronavirus-china.


Recommendations for Healthcare Providers

  • Limited information is available to characterize the spectrum of clinical illness associated with 2019-nCoV.
    • No vaccine or specific treatment for 2019-nCoV infection is available; care is supportive.
  • The CDC clinical criteria for a 2019-nCoV patient under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.
  • Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.
    • CDC guidance for evaluating and reporting a PUI for MERS-CoV remains unchanged.


Criteria to Guide Evaluation of Patients Under Investigation (PUI) for 2019-nCoV

  • Patients in the United States who meet the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV in Wuhan City, China.

1) Fever1

AND

- symptoms of lower respiratory illness (e.g., cough, shortness of breath)

and in the last 14 days before symptom onset,

-- History of travel from Wuhan City, China

-or-

-- Close contact2 with a person who is under investigation for 2019-nCOV while that person was ill.

2) Fever1

OR

- symptoms of lower respiratory illness (e.g., cough, shortness of breath)

and

- in the last 14 days before symptom onset,

-- Close contact2 with an ill laboratory-confirmed 2019-nCoV patient.

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  • The above criteria are also available at https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html.
  • The criteria are intended to serve as guidance for evaluation.
    • Patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure).


Recommendations for Reporting, Testing, and Specimen Collection

  • Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV.
    • State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available at https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf.
    • CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays.
    • At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC.
    • Testing for other respiratory pathogens should not delay specimen shipping to CDC.
    • If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI.
    • This may evolve as more information becomes available on possible 2019 nCoV co-infections.
  • For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV.
    • To increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types—lower respiratory, upper respiratory, and serum specimens.
    • Additional specimen types (e.g., stool, urine) may be collected and stored.
    • Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset.
    • Additional guidance for collection, handling, and testing of clinical specimens is available at https://www.cdc.gov/coronavirus/2019-nCoV/.


Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019-nCoV

  • Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to patients under investigation for 2019-nCoV (https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html).
    • Such patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available.
    • Healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield).
    • Immediately notify your healthcare facility’s infection control personnel and local health department.


Additional Infection Control Practices Resources


Notes

  1. Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications. Clinical judgment should be used to guide testing of patients in such situations.
  2. Close contact with a person who is under investigation for 2019-nCOV.
    • Close contact is defined as—
      • a) being within approximately 6 feet (2 meters),
        • or within the room or care area, of a novel coronavirus case for a prolonged period of time while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection);
        • close contact can include caring for, living with, visiting, or sharing a healthcare waiting area or room with a novel coronavirus case.
    • – or –
      • b) having direct contact with infectious secretions of a novel coronavirus case (e.g., being coughed on) while not wearing recommended personal protective equipment.
    • See CDC’s Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus (https://www.cdc.gov/coronavirus/2019-nCoV/infection-control.html).
    • Data to inform the definition of close contact are limited.
    • Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with novel coronavirus (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in healthcare settings.


For More Information

More information is available at at https://www.cdc.gov/coronavirus/2019-nCoV/index.html or by calling 800-CDC-INFO | (800-232-4636) | TTY: (888) 232-6348

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Keywords: US CDC; USA; Updates; China; 2019-nCoV.

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#Transcript of 2019 Novel #Coronavirus #Response #Telebriefing (@CDCgov, Jan. 18 ‘20)


Title:

#Transcript of 2019 Novel #Coronavirus #Response #Telebriefing.

Subject:

2019-nCoV Outbreak in China, current situation and control measures implemented in the US.

Source:

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

Code:

[     ]

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Keywords: US CDC; USA; Updates; 2019-nCoV.

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17 Jan 2020

#Cluster of #pneumonia cases caused by a novel #coronavirus, #Wuhan, #China (@ECDC_EU, 17 January 2020, summary)


Title:

#Cluster of #pneumonia cases caused by a novel #coronavirus, #Wuhan, #China.

Subject:

2019-nCoV Outbreak in China, current situation and risk assessment.

Source:

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

Code:

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RAPID RISK ASSESSMENT


Suggested citation: European Centre for Disease Prevention and Control. Cluster of pneumonia cases caused by a novel coronavirus, Wuhan, China; – 17 January 2020. ECDC: Stockholm; 2020. 

© European Centre for Disease Prevention and Control, Stockholm, 2020 


Summary

  • On 31 December 2019, the Wuhan Municipal Health Commission in Wuhan City, Hubei province, China reported a cluster of pneumonia cases of unknown aetiology, with a common reported link to Wuhan's Huanan Seafood Wholesale Market (a wholesale fish and live animal market selling different animal species).
    • On 9 January 2020, China CDC reported that a novel coronavirus (2019-nCoV) was detected as the causative agent and the genome sequence was made publicly available.
    • Sequence analysis showed that the newly identified virus is related to the SARS-CoV clade.
  • Detection systems have been developed and are available for the Member States through WHO and the European Virus Archive global catalogue.
  • As of 17 January 2020, a total of 44 laboratory-confirmed cases infected with 2019-nCoV have been reported, 41 from Wuhan, China and three travel-associated to Thailand (2) and Japan (1).
  • The onset of symptoms ranged from 8 December 2019 to 5 January 2020 and included fever, coughing, and dyspnoea.
  • Chest radiology showed the typical features of a viral pneumonia with diffuse bilateral infiltrates.
  • The majority of cases were males aged 40–69 years.
  • Seven cases developed a severe disease and two with chronic and severe underlying conditions died.
  • Most cases are epidemiologically linked to the specific food market in Wuhan, which was cleaned and closed to the public on 1 January 2020.
  • Some cases reported having visited a different food market while others did not report any link to such environments but had been in contact with people showing respiratory symptoms.
  • So far, none of the reported cases had a disease onset more than 14 days after the closure of the implicated market.
  • Among the cases reported, two small family clusters were identified.
    • In one cluster, all three members of the family had attended the specific Wuhan market before disease onset.
    • In the other cluster, one member was the spouse of a salesman in the market.
    • She developed symptoms after the husband and did not report having visited the market environment before onset of symptoms.
  • There have been no cases reported in healthcare workers, and so there is no evidence of nosocomial transmission so far. 
  • At the time of writing, the source of infection is unknown and therefore we assume that it could still be active and lead to further cases in China.
  • The occurrence of a few cases having no history of contact with the implicated market or other any similar market suggests the possibility of the infection source being more widely distributed, or of human-to-human transmission similar to other coronaviruses such as SARS-CoV and MERS-CoV.
  • The occurrence of a few family clusters also supports this latter hypothesis.
  • However, there is currently no knowledge on the transmission mode or risk factors for transmission.
  • Furthermore, there is no information on the disease spectrum or risk factors for severity.
  • In light of these unknowns, we cannot exclude the possibility of low-level virus circulation in the Wuhan community and thus the possibility of other clusters occurring in the near future.
  • In light of the current knowledge and the number of unknown factors, ECDC considers that: 
    • There is currently a moderate likelihood of infection for EU/EEA travellers visiting Wuhan;
    • There is a high likelihood of case importation in countries with the greatest volume of people travelling to and from Wuhan (i.e. countries in Asia). 
    • There is a low likelihood of importation of cases in EU/EEA countries, due to the less extensive traffic of people with Wuhan. 
    • Adherence to appropriate infection prevention and control practices, in particular in healthcare settings, in EU/EEA countries, and the evidence of limited person-to-person transmissibility, make the assessed likelihood that a case reported in the EU would result in secondary cases within the EU/EEA very low.

(…)

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Keywords: ECDC; Updates; European Region; China; Hubei; 2019-nCoV.

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Highly pathogenic #avian #influenza #H5N6, #China [#wildbirds #outbreak in #Xinjiang] (#OIE, Jan. 17 ‘20)


Title:

Highly pathogenic #avian #influenza #H5N6, #China [#wildbirds #outbreak in #Xinjiang].

Subject:

Avian Influenza, H5N6 subtype, poultry epizootic in China.

Source:

OIE, full page: (LINK).

Code:

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Information received on 17/01/2020 from Dr Huang Baoxu, Secretary of the Party Leadership Group, Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, China (People's Rep. of)

  • Summary
    • Report type    Follow-up report No. 1
    • Date of start of the event    29/12/2019
    • Date of confirmation of the event    08/01/2020
    • Report date    17/01/2020
    • Date submitted to OIE    17/01/2020
    • Reason for notification    Recurrence of a listed disease
    • Date of previous occurrence    22/03/2017
    • Manifestation of disease    Clinical disease
    • Causal agent    Highly pathogenic influenza A virus
    • Serotype    H5N6
    • Nature of diagnosis    Clinical, Laboratory (basic), Laboratory (advanced), Necropsy
    • This event pertains to    a defined zone within the country
  • New outbreaks (1)
    • Outbreak 1    - Swan bay scenic area, Hejing, Bayingol Mongolian Autonomous Prefecture, Xinjiang
      • Date of start of the outbreak    09/01/2020
      • Outbreak status    Continuing (or date resolved not provided)
      • Epidemiological unit    Natural park
      • Affected animals: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of    - Slaughtered
        • Mute Swan: Cygnus olor(Anatidae)    - 150    - 1    - 1  - … – …
  • Summary of outbreaks   
    • Total outbreaks: 1
      • Total animals affected: Species    - Susceptible    - Cases    - Deaths    - Killed and disposed of    - Slaughtered
        • Mute Swan: Cygnus olor(Anatidae)    - 150    - 1    - 1  - … – …
    • Outbreak statistics: Species    - Apparent morbidity rate    - Apparent mortality rate    - Apparent case fatality rate    - Proportion susceptible animals lost*
      • Mute Swan: Cygnus olor(Anatidae)    - 0.67%    - 0.67%    - 100.00%    - **
        • *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; H5N6 ; Wild Birds; China; Xinjiang.

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#HK, Public #hospital daily #update on #Wuhan-related cases (CHP, Jan. 17 ‘20)


Title:

#HK, Public #hospital daily #update on #Wuhan-related cases.

Subject:

2019-nCoV Outbreak in China, current situation in Hong Kong.

Source:

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

Code:

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The following is issued on behalf of the Hospital Authority:

As at noon today (January 17), public hospitals had reported to the Department of Health (DH) the admission of four patients in the past 24 hours who had been to Wuhan in the past 14 days and presented with fever, respiratory infection or pneumonia symptoms.

Specimens of the patients concerned have been sent to the DH for testing.

Currently, there are six patients still under isolation and in stable condition.

There are currently no patients confirmed as being infected with novel coronavirus in public hospitals.

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[Hospital – Age – Gender]

  1. Queen Elizabeth Hospital – 43 – M
  2. Princess Margaret Hospital – 34 – M
  3. Princess Margaret Hospital – 24 – F
  4. Queen Mary Hospital – 42 – M

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The Hospital Authority will maintain close contact with the Centre for Health Protection to monitor the latest developments and to inform the public and healthcare workers on the latest information in a timely manner.

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Keywords: HK PRC SAR; Updates; 2019-nCoV.

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#China, About the #situation of #prevention and #control of #pneumonia caused by new #coronavirus #infection in #Wuhan (DoH, January 17, 2020)


Title:

#China, About the #situation of #prevention and #control of #pneumonia caused by new #coronavirus #infection in #Wuhan.

Subject:

2019-nCoV Outbreak in Wuhan, current situation.

Source:

Department of Health, Wuhan City, full page: (LINK). Article in Chinese, edited.

Code:

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Wuhan City Health Committee | Published: 2020-01-18 00:13:26


I. About the new cases

  • On January 16, 2020, experts from the provinces and municipalities newly identified 4 cases of pneumonia with a new type of coronavirus infection based on the clinical manifestations, epidemiological history of the patients, and the results detected by the diagnostic kit issued by the country.
  • All 4 patients were male.
  • They developed symptoms from January 5 to 8, 2020, and were admitted to the hospital from January 8 to 13 for treatment.
  • After treatment, the symptoms improved and the condition is stable.
  • They have been transferred to Wuhan Jinyintan Hospital for centralized treatment.
  • Epidemiological investigations of the four new cases are underway, and close contacts are also being tracked.


II, the main measures for the prevention and control of the recent epidemic

  • Further do a good job in the management of pre-inspection and triage of medical institutions at all levels and early diagnosis, and early detection, isolation and early treatment.
  • The sanitary killing of the South China Seafood Wholesale Market, other agricultural fairs in the city and the living environment of related hospitals, patients and close contacts will continue.
  • Carry out a patriotic health campaign with the theme of “renovating the environment, cleaning homes, and welcoming the festival” to promote a healthy lifestyle.


3. Related situation of close contacts of confirmed cases abroad

  • Seventeen close contacts of the first confirmed patient in Thailand were tracked, all of which were included in medical observations.
  • One of them had symptoms of low fever and mild cough, and has been transferred to designated hospitals for treatment.
  • Personnel information, tracking of close family contacts is underway; 4 cases of close family contacts have been traced to patients with confirmed cases notified in Japan, all of which have been included in medical observation.

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Keywords: China; Updates; Hubei; 2019-nCoV.

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#China, #Wuhan: Four New Cases of New #Coronavirus Reported (DoH, Jan. 17 ‘20)


Title:

#China, #Wuhan: Four New Cases of New #Coronavirus Reported.

Subject:

2019-nCoV Outbreak in Wuhan, current situation in China.

Source:

Department of Health, Wuhan, China, full page: (LINK). Article in Chinese, edited.

Code:

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Wuhan City Health Committee | Published: 2020-01-18 00:10:55


At 04:00 on January 16, 2020 , 3 patients were discharged from the hospital and no new deaths were reported.

After comprehensive research and judgment on the clinical manifestations, epidemiological history, and laboratory test results of the national, provincial and municipal expert groups, 4 new cases of pneumonitis infected with new coronavirus have been added in our city.

At present, the new cases have been arranged for transfer to Wuhan.

All cases were treated at Jinyintan Hospital.

All the patients were in stable condition without critical illness.

The time of onset of the cases was concentrated from January 5th to 8th.

Related epidemiological investigations and search of close contacts were underway.

In addition, Thailand and Japan each reported a case of pneumonia with a new coronavirus infection from Wuhan.

Currently, Thai diagnosed cases are being hospitalized; Japanese diagnosed cases have been discharged.

Close contacts in the country are conducting follow-up and medical observations.

As of now, 45 cases of pneumonitis with new-type coronavirus infection have been reported in our city, 15 cases have been cured and discharged, 5 cases are being treated in severe condition, and 2 cases have died.

A total of 763 close contacts have been tracked, 665 medical observations have been lifted, and 98 people are still receiving medical observations.

Among the close contacts, no related cases were found.

January 17, 2020

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Keywords: China; Updates; Hubei; 2019-nCoV.

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Weekly #US #Influenza #Surveillance #Report - Wk 2, ending January 11, 2020 (@CDCgov, summary)


Title:

Weekly #US #Influenza #Surveillance #Report - Wk 2, ending January 11, 2020.

Subject:

Seasonal Influenza, current epidemiological situation in the US.

Source:

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

Code:

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Key Updates

  • Key indicators that track flu activity declined slightly but remain high.
  • Indicators that track severity (hospitalizations and deaths) are not high at this point in the season.

Viruses

Clinical Labs

  • The percentage of respiratory specimens testing positive for influenza at clinical laboratories decreased from 23.6% last week to 22.9% this week.

Public Health Labs

  • Nationally, B/Victoria viruses are the predominant viruses this season; however, during recent weeks, approximately equal numbers of B/Victoria and A(H1N1)pdm09 viruses have been reported.

Virus Characterization

  • Genetic and antigenic characterization and antiviral susceptibility of influenza viruses collected in the U.S. are summarized in this report.


Illness

Outpatient Illness: ILINet

  • Visits to health care providers for influenza-like illness (ILI) decreased from 5.7% last week to 4.7% this week.
  • All regions remain above their baselines.
  • The number of jurisdictions experiencing high ILI activity decreased from 36 last week to 34 this week.
  • The number of jurisdictions reporting regional or widespread influenza activity remained at 50 this week.

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|-- Outpatient Illness: ILI Activity Map –|

|—Geographic Spread –|


Severe Disease

Hospitalizations

  • The overall hospitalization rate for the season increased to 19.9 per 100,000.
  • This is similar to what has been seen at this time during recent seasons.

P&I Mortality

  • The percentage of deaths attributed to pneumonia and influenza increased from 6.0% to 6.9% but remains below the epidemic threshold.

Pediatric Deaths

  • Seven new influenza-associated pediatric deaths occurring during the 2019-2020 season were reported this week.
  • The total for the season is 39.

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

A description of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component is available on the surveillance methods page.

Additional information on the current and previous influenza seasons for each surveillance component are available on FluView Interactive.


Key Points

  • Outpatient ILI and laboratory data remain elevated but declined slightly this week. 
    • While the overall percent of specimens positive for influenza declined nationally, the percent positive for influenza A viruses increased and some regions are seeing increases in the proportion of influenza A(H1N1)pdm09 viruses compared to other influenza viruses.
    • It is too early to know whether the season has peaked or if flu activity will increase again.
  • Levels of outpatient ILI remain elevated; however, hospitalization rates remain similar to what has been seen at this time during recent seasons and mortality, while increasing, has not yet exceeded the epidemic threshold.
  • CDC estimates that so far this season there have been at least 13 million flu illnesses, 120,000 hospitalizations and 6,600 deaths from flu.
  • Flu vaccine effectiveness estimates are not available yet this season, but vaccination is always the best way to prevent flu and its potentially serious complications.
  • Antiviral medications are an important adjunct to flu vaccine in the control of influenza. Almost all (>99%) of the influenza viruses tested this season are susceptible to the four FDA-approved influenza antiviral medications recommended for use in the U.S. this season.


U.S. Virologic Surveillance

Clinical Laboratories

  • The results of tests performed by clinical laboratories nationwide are summarized below.
  • Data from clinical laboratories (the percentage of specimens tested that are positive for influenza) are used to monitor whether influenza activity is increasing or decreasing.

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[Week 2 - Data Cumulative since  September 29, 2019 (week 40)]

  • No. of specimens tested - 40,451 - 541,982
    • No. of positive specimens (%) - 9,277 (22.9%) - 75,552 (13.9%)
      • Positive specimens by type: 
        • Influenza A - 3,899 (42.0%) - 24,881 (32.9%)
        • Influenza B - 5,378 (58.0%) - 50,671 (67.1%)

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|-- View Chart Data | View Full Screen –|


Public Health Laboratories

  • The results of tests performed by public health laboratories nationwide are summarized below.
  • Data from public health laboratories are used to monitor the proportion of circulating viruses that belong to each influenza subtype/lineage.

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[Week 2 - Data Cumulative since September 29, 2019 (week 40)]

  • No. of specimens tested - 1,904 - 32,894
    • No. of positive specimens - 1,148 - 15,580
      • Positive specimens by type/subtype: 
        • Influenza A - 579 (50.4%) - 6,748 (43.3%)
          • (H1N1)pdm09 - 504 (93.3%) - 5,500 (84.2%)
          • H3N2 - 36 (6.7%) - 1,031 (15.8%)
          • Subtyping not performed – 39 – 217
        • Influenza B - 569 (49.6%) - 8,832 (56.7%)
          • Yamagata lineage - 5 (1.2%) - 130 (2.0%)
          • Victoria lineage - 422 (98.8%) - 6,466 (98.0%)
          • Lineage not performed – 142 - 2,236

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  • Nationally influenza B/Victoria viruses have been reported more frequently than other influenza viruses this season.
  • However, during recent weeks, approximately equal numbers of B/Victoria and influenza A(H1N1)pdm09 viruses have been reported nationally.
  • The predominant virus varies by region.
  • Regional and state level data about circulating influenza viruses can be found on FluView Interactive.
  • The predominant virus also varies by age group.
  • Nationally, influenza B/Victoria viruses are the most commonly reported influenza viruses among children age 0-4 years (47% of reported viruses) and 5-24 years (57% of reported viruses), while A(H1N1)pdm09 viruses are the most commonly reported influenza viruses among persons 25-64 years (46% of reported viruses) and 65 years of age and older (53% of reported viruses).
  • Additional age data can be found on FluView Interactive.

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(…)

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Keywords: US CDC; USA; Updates; Seasonal Influenza.

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Novel #Coronavirus – #Japan (a #traveler from #China) (@WHO, Jan. 17 ‘20)


Title:

Novel #Coronavirus – #Japan (a #traveler from #China).

Subject:

2019-nCoV Outbreak in China, imported case in Japan.

Source:

World Health Organization (WHO), full page: (LINK).

Code:

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Disease outbreak news  | 17 January 2020


On 15 January 2020, the Ministry of Health, Labour and Welfare, Japan (MHLW) reported an imported case of laboratory-confirmed 2019-novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.

The case-patient is male, between the age of 30-39 years, living in Japan.

The case-patient travelled to Wuhan, China in late December and developed fever on 3 January 2020 while staying in Wuhan.

He did not visit the Huanan Seafood Wholesale Market or any other live animal markets in Wuhan.

He has indicated that he was in close contact with a person with pneumonia.

On 6 January, he traveled back to Japan and tested negative for influenza when he visited a local clinic on the same day.

On 10 January 2020, due to his continued symptoms of cough, sore throat and fever, he visited a local hospital and was found to have abnormal chest x-ray with infiltrates.

He was admitted to the hospital on the same day and had remained febrile until 14 January.

On 14 January, his attending doctor notified the case to a local public health authority under the surveillance system for “Unidentified Serious Infectious Illness”.

Samples were collected and sent to the National Institute of Infectious Diseases (NIID), and at NIID, polymerase chain reaction (PCR) testing and sequencing was performed twice, which identified very small amount of 2019-nCoV RNA on 15 January 2020.

On 15 January, the case-patient was afebrile and was discharged from hospital. Currently, he is staying at home in a stable condition.


Public health response

  • Contact tracing and other epidemiological investigations are underway by the local health authorities in Japan;
  • The Japanese Government has scaled up a whole-of-government coordination mechanism on the 16 January;
  • The MHLW has strengthened surveillance for undiagnosed severe acute respiratory illnesses since the report of undiagnosed pneumonia in Wuhan, China;
  • From 6 January, MHLW requested local health governments to be aware of the respiratory illnesses in Wuhan by using the existing surveillance system for serious infectious illness with unknown etiology;
  • NIID is supporting local authorities on epidemiologic investigations including contact tracing;
  • Quarantine and screening measures have been enhanced for travelers from Wuhan city at the point of entries since 7 January;
  • NIID established an in-house PCR assay for nCoV on 16 January;
  • Revision of the risk assessment by NIID is being conducted, including case definition of close contacts;
  • The public risk communication has been enhanced;
  • A hotline has been established among the different ministries in the government;
  • The MHLW is working closely with WHO and other related Member States to foster mutual investigations and information sharing.

WHO risk assessment

This was the second exported case of novel coronavirus from Wuhan city, China.

Since the initial report of cases in Wuhan city on 31 December 2019, and as of 12 January 2020, 41 laboratory-confirmed cases of nCoV infection, including 2 deaths in cases with underlying medical conditions have been reported to WHO.

Two cases have been reported from Thailand.

The source of the outbreak is still under investigation in Wuhan.

Preliminary investigations have identified environmental samples positive for nCoV in Huanan Seafood Wholesale Market in Wuhan City, however some laboratory-confirmed patients did not report visiting this market.

To date, there is no reported infection among healthcare workers in China, Thailand or Japan.

No additional cases have been reported since 3 January in China.

Additional investigations are needed to determine how the patients were infected, whether human-to-human transmission has been observed, mode(s) of transmission, the clinical spectrum of disease, and the extent of infection, including presence of subclinical cases that are undetected with current surveillance.

It is critical to review all available information to fully understand the extent of transmissibility between people and likelihood of zoonotic spillover.


WHO advice

Although the source of the novel coronavirus causing this cluster of pneumonia and the mode(s) of transmission are unknown, it would be prudent to remind populations and health workers of the basic principles to reduce the general risk of transmission of acute respiratory infections:

  • Avoiding close contact with people suffering from acute respiratory infections;
  • Frequent hand-washing, especially after direct contact with ill people or their environment;
  • Avoiding unprotected contact with farm or wild animals;
  • People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands);
  • Within healthcare facilities, enhance standard infection prevention and control practices in hospitals, especially in emergency departments;
  • WHO does not recommend any specific health measures for travelers.
    • In case of symptoms suggestive of respiratory illness either during or after travel, the travelers are encouraged to seek medical attention and share their travel history with their health care provider.
    • Travel guidance has been updated.

Health authorities should work with travel, transport and tourism sectors to provide travellers with information to reduce the general risk of acute respiratory infections via travel health clinics, travel agencies, conveyance operators and at points of entry.

WHO has provided interim guidance for novel coronaviruses

WHO advises against the application of any travel or trade restrictions on Japan based on the information currently available on this event.

For more information on novel coronavirus, please see:

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Keywords: WHO; Updates; Japan; China; Thailand; 2019-nCoV.

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#China, #Influenza [#H3N2, #B, #H1N1pdm09, #H7N9] Weekly #Report–Wk 2 ‘20 (CNIC, Jan. 17 ‘20)


Title:

#China, #Influenza [#H3N2, #B, #H1N1pdm09, #H7N9] Weekly #Report–Wk 2 ‘20.

Subject:

Seasonal Influenza, current epidemiological situation in China.

Source:

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

Code:

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Download:China flu report 2002.pdf

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


Summary

  • During week 2, influenza activity continued to increase, but the upward trend had slowed down.
    • It remained at inner-seasonal levels in most provinces, with influenza A(H3N2) viruses predominant, and B-Victoria viruses in several southern provinces.
  • Among influenza viruses antigenically characterized by CNIC since April 1st, 2019:
    • 1655(98%) influenza A(H1N1)pdm09 viruses were characterized as A/Brisbane/02/2018-like;
    • 200(16%) influenza A(H3N2) viruses were characterized as A/Kansas/14/2017 (EGG)-like,
    • 308(25.3%) influenza A(H3N2) viruses were characterized as A/Kansas/14/2017 (CELL)-like;
    • 689(37.6%) influenza B/Victoria viruses were characterized as B/Colorado/06/2017-like;
    • 16(94.1%) influenza B/Yamagata viruses were characterized as B/Phuket/3073/2013-like.
  • Among the influenza viruses tested by CNIC for antiviral resistance analysis since April 1st, 2019:
    • all influenza A(H1N1)pdm09 and A(H3N2) viruses were resistant to amantadine;
    • All influenza A(H3N2) and B viruses were sensitive to neuraminidase inhibitors.
    • All but 1 influenza A(H1N1)pdm09 were sensitive to neuraminidase inhibitors.


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

  • During week 2 (Jan 6th 2020 –Jan 12th 2020), the percentage of outpatient or emergency visits for ILI (ILI%) at national sentinel hospitals in southern provinces was 6.1%, lower than the last week (6.6%) , higher than the same week of 2016-2018 (3.1%, 6.0% and 5.6%). (Figure 1)
  • During week 2, ILI% at national sentinel hospitals in northern provinces was 5.3%, lower than the last week (5.9%), higher than the same week of 2016 (3.6%), lower than the same week of 2017 and 2018 (5.5% and 5.4%). (Figure 2)

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Figure 1. Percentage of Visits for ILI at Sentinel Hospitalsin South China (2016-2020)

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Figure 2. Percentage of Visits for ILI at Sentinel Hospitals in North China (2016-2020)

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Virologic Surveillance

  • During week 2, influenza network laboratories tested 10128 specimens, of which 4574(45.2%) were positive for influenza, influenza A and influenza B viruses were 3278(71.7%) and 1296(28.3%), respectively (Table 1).
  • During week 2, the percentage of specimens that were tested positive for influenza in south China was 48.1%, which was higher than the previous week (47.2%)(Figure 3).
  • During week 2, the percentage of specimens that were tested positive for influenza in north China was 42.3%, which was lower than the previous week (47.4%). (Figure 4).

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Table 1 - Laboratory Detections of ILI Specimens (Week 2, 2020)

[Week 2: South China - North China – Total]

  • No. of specimens tested – 5013 – 5115 – 10128
    • No. of positive specimens (%) - 2412(48.1%) - 2162(42.3%) - 4574(45.2%)
      • Influenza A - 1364(56.6%) - 1914(88.5%) - 3278(71.7%)
        • A(H3N2) – 1244 – 1731 – 2975
        • A(H1N1)pdm09 – 120 – 183 – 303
        • A (subtype not determined) – 0 – 0 – 0
      • Influenza B - 1048(43.4%) - 248(11.5%) - 1296(28.3%)
        • B (lineage not determined) – 17 – 0 – 17
        • Victoria – 1031 – 244 – 1275
        • Yamagata – 0 – 4 – 4

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Figure 3. Influenza Positive Tests Reported by Southern Network Laboratories (Week 14, 2018–Week 2, 2020)

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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, 2018–Week 2, 2020)

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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.

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(...)

Outbreak Surveillance

  • During week 2 (Jan 6th 2020- Jan 12th 2020), there were one hundred and twenty-three outbreaks reported nationwide,
    • fifty-seven of them were A(H3N2),
    • two of them were H1N1pdm,
    • twenty-three of them were B(Victoria),
    • one of them was B(Yamagata),
    • two of them were B(lineage not determined),
    • twenty-eight of them were mixed,
    • one of them was flu negative,
    • nine of them had not been obtained the testing results.


H7N9 Case Report

  • During week 2, no new human infection with novel reassortant influenza A(H7N9) virus was reported.

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Keywords: China; Updates; Seasonal Influenza.

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