Welcome to A Time's Memory Blog

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A TIME'S MEMORY - Flu, Bugs & Other Accidents Blog - Year: XIV - 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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20 Jan 2019

One New #MERS #Coronavirus Case reported by #Saudi Arabia (MoH, January 20 '19)


Title:

One New MERS Coronavirus Case reported by Saudi Arabia (MoH, January 20 '19).

Subject:

Middle East Respiratory Syndrome in Saudi Arabia, daily update.

Source:

Ministry of Health, full page: (LINK).

Code:

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January 20 2019


New Case(s) Reported:

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

  1. 01/19 - Male, 40, ..., Riyadh City (Riyadh region), ..., ..., Hospitalized; *

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{*} Primary case, community-acquired (no contact with camels).

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Cumulative number of confirmed cases and deaths since 2012:

  • Total No. of Cases: 1901 {§}
  • Total No. of Deaths: 732 {§}
  • Patients currently under treatment: ...
  • Case-Fatality Rate: 38.5%

{§} WHO data as of January 10, 2019, see more: http://www.emro.who.int/pandemic-epidemic-diseases/mers-cov/mers-situation-update-december-2018.html

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Keywords: MERS-CoV; Updates; Saudi Arabia.

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19 Jan 2019

#Zika #Virus #Research #References #Library–January 19 2019 #Update, Issue No. 152


Title:

#Zika #Virus #Research #References #Library–January 19 2019 #Update, Issue No. 152.

Subject:

Zika Virus Infection and related complications research, weekly references library update.

Source:

AMEDEO, homepage: https://amedeo.com

Code:

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This Issue:

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  1. HAQSHENAS G, Terradas G, Paradkar PN, Duchemin JB, et al.
    • A Role for the Insulin Receptor in the Suppression of Dengue Virus and Zika Virus in Wolbachia-Infected Mosquito Cells.
      • Cell Rep. 2019;26:529-535.
  2. PEREIRA JP JR, Nielsen-Saines K, Sperling J, Maykin MM, et al.
    • Association of Prenatal Ultrasonographic Findings With Adverse Neonatal Outcomes Among Pregnant Women With Zika Virus Infection in Brazil.
      • JAMA Netw Open. 2018;1:e186529.
  3. LEVINE D.
    • Can Ultrasound Be Used to Reassure Pregnant Women Infected by Zika Virus?
      • JAMA Netw Open. 2018;1:e186537.
  4. BATISTA MN, Braga ACS, Campos GRF, Souza MM, et al.
    • Natural Products Isolated from Oriental Medicinal Herbs Inactivate Zika Virus.
      • Viruses. 2019;11.
  5. VANNICE KS, Cassetti MC, Eisinger RW, Hombach J, et al.
    • Demonstrating vaccine effectiveness during a waning epidemic: A WHO/NIH meeting report on approaches to development and licensure of Zika vaccine candidates.
      • Vaccine. 2019 Jan 10. pii: S0264-410X(18)31713.
  6. KARWAL P, Vats ID, Sinha N, Singhal A, et al.
    • Therapeutic applications of Peptides against Zika Virus: A Review.
      • Curr Med Chem. 2019 Jan 10. pii: CMC-EPUB-95696.
  7. DOS SANTOS SFM, Soares FVM, de Abranches AD, da Costa ACC, et al.
    • Infants with microcephaly due to ZIKA virus exposure: nutritional status and food practices.
      • Nutr J. 2019;18:4.
  8. MLERA L, Bloom ME.
    • Differential Zika Virus Infection of Testicular Cell Lines.
      • Viruses. 2019;11.
  9. VAN DYNE EA, Neaterour P, Rivera A, Bello-Pagan M, et al.
    • Incidence and Outcome of Severe and Nonsevere Thrombocytopenia Associated With Zika Virus Infection-Puerto Rico, 2016.
      • Open Forum Infect Dis. 2018;6:ofy325.
  10. COUNOTTE MJ, Egli-Gany D, Riesen M, Abraha M, et al.
    • Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barre syndrome: From systematic review to living systematic review.
      • F1000Res. 2018;7:196.
  11. MANNING JE, Oliveira F, Parker DM, Amaratunga C, et al.
    • The PAGODAS protocol: pediatric assessment group of dengue and Aedes saliva protocol to investigate vector-borne determinants of Aedes-transmitted arboviral infections in Cambodia.
      • Parasit Vectors. 2018;11:664.
  12. SAMUEL GH, Adelman ZN, Myles KM.
    • Antiviral Immunity and Virus-Mediated Antagonism in Disease Vector Mosquitoes.
      • Trends Microbiol. 2018;26:447-461.
  13. GAYA M, Barral P, Burbage M, Aggarwal S, et al.
    • Initiation of Antiviral B Cell Immunity Relies on Innate Signals from Spatially Positioned NKT Cells.
      • Cell. 2018;172:517-533.
  14. GIZZI AS, Grove TL, Arnold JJ, Jose J, et al.
    • A naturally occurring antiviral ribonucleotide encoded by the human genome.
      • Nature. 2018 Jun 20. pii: 10.1038/s41586-018-0238.
  15. LONG F, Doyle M, Fernandez E, Miller AS, et al.
    • Structural basis of a potent human monoclonal antibody against Zika virus targeting a quaternary epitope.
      • Proc Natl Acad Sci U S A. 2019 Jan 14. pii: 1815432116.
  16. SHEWALE JB, Ganduglia Cazaban CM, Waller DK, Mitchell LE, et al.
    • Microcephaly inpatient hospitalization and potential Zika outbreak in Texas: A cost and predicted economic burden analysis.
      • Travel Med Infect Dis. 2019 Jan 9. pii: S1477-8939(19)30001.

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Keywords: Research; Abstracts; Zika References Library.

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18 Jan 2019

Weekly #US #Influenza #Surveillance #Report - 2018-19 Season, Wk 2 ending Jan. 12 ‘19 (@CDCgov, summary)



Title:

Weekly #US #Influenza #Surveillance #Report - 2018-19 Season, Wk 2 ending Jan. 12 ‘19.


Subject:

Seasonal Influenza, current epidemiological situation in the US.


Source:

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


Code:

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Language: [ English (US) | Español ]
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All data are preliminary and may change as more reports are received.

An overview of the CDC influenza surveillance system, including methodology and detailed descriptions of each data component, is available at http://www.cdc.gov/flu/weekly/overview.htm

Synopsis:
      • Influenza activity remains elevated in the United States.
      • Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continue to co-circulate. Below is a summary of the key influenza indicators for the week ending January 12, 2019:
  • Viral Surveillance:
      • The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories decreased slightly.
      • Influenza A viruses have predominated in the United States since the beginning of October.
      • Influenza A(H1N1)pdm09 viruses have predominated in most areas of the country, however influenza A(H3) viruses have predominated in the southeastern United States (HHS Region 4).
    • Virus Characterization:
      • The majority of influenza viruses characterized antigenically and genetically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses.
    • Antiviral Resistance:
      • None of the viruses tested were associated with highly reduced inhibition by any of the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir).
  • Influenza-like Illness Surveillance:
      • The proportion of outpatient visits for influenza-like illness (ILI) decreased from 3.5% to 3.1%, but remains above the national baseline of 2.2%.
      • All 10 regions reported ILI at or above their region-specific baseline level.
    • ILI State Activity Indictor Map:
      • Nine states experienced high ILI activity; New York City and 13 states experienced moderate ILI activity; 10 states experienced low ILI activity; and the District of Columbia, Puerto Rico and 18 states experienced minimal ILI activity.
  • Geographic Spread of Influenza:
      • The geographic spread of influenza in Guam and 30 states was reported as widespread; Puerto Rico and 16 states reported regional activity; three states reported local activity; and the District of Columbia, the U.S. Virgin Islands and one state reported sporadic activity.
  • Influenza-associated Hospitalizations A
      • A cumulative rate of 12.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
      • The highest hospitalization rate is among adults 65 years and older (31.9 hospitalizations per 100,000 population).
  • Pneumonia and Influenza Mortality:
      • The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
  • Influenza-associated Pediatric Deaths:
      • Three influenza-associated pediatric deaths were reported to CDC during week 2.
(…)
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Keywords: US CDC; USA; Updates; Seasonal Influenza.

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#HK, Suspected #MERS #Coronavirus cases reported (CHP, Jan. 18 ‘19)



Title:

#HK, Suspected #MERS #Coronavirus cases reported.


Subject:

Middle East Respiratory Syndrome, suspected imported cases in Hong Kong.


Source:

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


Code:

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The Centre for Health Protection (CHP) of the Department of Health today (January 18) reported two suspected cases of Middle East Respiratory Syndrome (MERS), and again urged the public to pay special attention to safety during travel, taking due consideration of the health risks in the places they visit.

The case is detailed below:
  • Sex – Female | Male
  • Age – 4 | 66
  • Affected area involved - Dubai, United Arab Emirates | Israel
  • High-risk exposure – Nil | Nil
  • Hospital - Princess Margaret Hospital | Princess Margaret Hospital
  • Condition – Stable | Stable
  • MERS-Coronavirus preliminary test result – Negative | Pending
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(…)

The public may visit:
Tour leaders and tour guides operating overseas tours are advised to refer to the CHP's health advice on MERS.

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Keywords: HK PRC SAR; Updates; MERS-CoV.

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#Influenza and other #Respiratory #Viruses #Research #References #Library – January 18 2019 Issue



Title:

#Influenza and other #Respiratory #Viruses #Research #References #Library – January 18 2019 Issue.


Subject:

Human and Animal Influenza Viruses Research, weekly references library update.


Source:

AMEDEO, homepage: https://amedeo.com


Code:

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This Issue:
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  1. KIM MH, Kang JO, Kim JY, Jung HE, et al.
    • Single mucosal vaccination targeting nucleoprotein provides broad protection against two lineages of influenza B virus.
      • Antiviral Res. 2019 Jan 9. pii: S0166-3542(18)30589.
  2. RENEER ZB, Ross TM.
    • H2 influenza viruses: designing vaccines against future H2 pandemics.
      • Biochem Soc Trans. 2019 Jan 15. pii: BST20180602. doi: 10.1042/BST20180602.
  3. GAYA M, Barral P, Burbage M, Aggarwal S, et al.
    • Initiation of Antiviral B Cell Immunity Relies on Innate Signals from Spatially Positioned NKT Cells.
      • Cell. 2018;172:517-533.
  4. BAZARRAGCHAA E, Okamatsu M, Ulaankhuu A, Twabela AT, et al.
    • Evaluation of a rapid isothermal nucleic acid amplification kit, Alere i Influenza A&B, for the detection of avian influenza viruses.
      • J Virol Methods. 2019 Jan 8. pii: S0166-0934(18)30328.
  5. REICH NG, Brooks LC, Fox SJ, Kandula S, et al.
    • A collaborative multiyear, multimodel assessment of seasonal influenza forecasting in the United States.
      • Proc Natl Acad Sci U S A. 2019 Jan 15. pii: 1812594116.
  6. SEVY AM, Wu NC, Gilchuk IM, Parrish EH, et al.
    • Multistate design of influenza antibodies improves affinity and breadth against seasonal viruses.
      • Proc Natl Acad Sci U S A. 2019 Jan 14. pii: 1806004116.
  7. MOOIJ P, Grodeland G, Koopman G, Andersen TK, et al.
    • Needle-free delivery of DNA: Targeting of hemagglutinin to MHC class II molecules protects rhesus macaques against H1N1 influenza.
      • Vaccine. 2019 Jan 9. pii: S0264-410X(19)30005.
  8. LIU L, Wang T, Wang M, Tong Q, et al.
    • Recombinant turkey herpesvirus expressing H9 hemagglutinin providing protection against H9N2 avian influenza.
      • Virology. 2019;529:7-15.
  9. JHAVERI R.
    • These Findings Are Not Consistent With National Data.
      • Pediatrics. 2018;141.
  10. ROBISON SG, Leman RF.
    • Authors' Response.
      • Pediatrics. 2018;141.
  11. BLASCHKE AJ, Korgenski EK, Wilkes J, Presson AP, et al.
    • Rhinovirus in Febrile Infants and Risk of Bacterial Infection.
      • Pediatrics. 2018 Jan 17. pii: peds.2017-2384. doi: 10.1542/peds.2017-2384.
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Keywords: Research; Abstracts; Influenza References Library.

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#China, #Influenza [#H1N1pdm09, #H3N2, #H7N9, B] - Weekly #Report, Wk 02 ‘19 (CNIC, Jan. 18 ‘19)



Title:

#China, #Influenza [#H1N1pdm09, #H3N2, #H7N9, B] - Weekly #Report, Wk 02 ‘19.


Subject:

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


Source:

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


Code:

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  Download:china flu report 1902.pdf 

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

Summary
  • During week 2, influenza activity level continued to increase and the peak period season have started in mainland China, with mainly A(H1N1)pdm09 detected in most provinces.
  • Among influenza viruses antigenically characterized by CNIC since April 2nd, 2018:
    • 978(94.3%) influenza A(H1N1)pdm09 viruses were characterized as A/Michigan/45/2015-like;
    • 75(82.4%) influenza A(H3N2) viruses were characterized as A/Singapore/INFIMH-16-0019/2016 (EGG)-like,
    • 75(82.4%) influenza A(H3N2) viruses were characterized as A/Singapore/INFIMH-16-0019/2016 (CELL)-like;
    • 59(46.1%) influenza B/Victoria viruses were characterized as B/Colorado/06/2017-like;
    • 364(96.3%) 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 2nd, 2018:
    • 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 3 influenza A(H1N1)pdm09 were sensitive to neuraminidase inhibitors.










Outbreak Surveillance
  • During week 2 (January 7th 2019 –January13th 2019), there were two hundred and fifty-five outbreaks reported nationwide.
  • One hundred and twenty-nine of them were A(H1N1)pdm09, forty-eight of them were A(H3N2), one of them was B, twenty-one of them were mixture, five of them were negative, fifty-one of them had not been obtained the results.

Surveillance of outpatient or emergency visits for Influenza-like Illness (ILI)
  • During week 2, the percentage of outpatient or emergency visits for ILI (ILI %) at national sentinel hospitals in southern provinces was 5.5%, higher than the last week (4.8%) and the same week of 2016 and 2017(3.2% and 3.1%), lower than the same week of 2018(6.0%). (Figure 1)
  • During week 2, ILI% at national sentinel hospitals in northern provinces was 5.3%, higher than the last week (4.2%) and the same week of 2016 and 2017 (3.2% and 3.6%), lower than the same week of 2018 (5.5%). (Figure 2)
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Figure 1. Percentage of Visits for ILI at Sentinel Hospitalsin South China (2015-2019)


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


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Virologic Surveillance
  • During week 2, influenza network laboratories tested 9158 specimens, of which 3441(37.6%) were positive for influenza, influenza A and influenza B viruses were 3420(99.4%) and 21(0.6%), respectively (Table 1).
  • During week 2, the percentage of specimens that were tested positive for influenza in south China was 35.7%, which was higher than the previous week (28.8%) (Figure 3).
  • During week 2, the percentage of specimens that were tested positive for influenza in north China was 39.3%, which was higher than the previous week (31.4%). (Figure 4).

Table 1 - Laboratory Detections of ILI Specimens (Week 2, 2019)

[Week 2 - South China - North China – Total]
  • No. of specimens tested – 4379 – 4779 – 9158
    • No. of positive specimens (%) - 1562(35.7%) - 1879(39.3%) - 3441(37.6%)
      • Influenza A - 1548(99.1%) - 1872(99.6%) - 3420(99.4%)
        • A(H3N2) - 344(22.2%) - 132(7.1%) - 476(13.9%)
        • A(H1N1)pdm09 - 1204(77.8%) - 1739(92.9%) - 2943(86.1%)
        • A (subtype not determined) - 0(0) - 1(0.1%) - 1(0.0%)
      • Influenza B - 14(0.9%) - 7(0.4%) - 21(0.6%)
        • B (lineage not determined) - 2(14.3%) - 0(0) - 2(9.5%)
        • Victoria - 12(85.7%) - 6(85.7%) - 18(85.7%)
        • Yamagata - 0(0) - 1(14.3%) - 1(4.8%)
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Figure 3. Influenza Positive Tests Reported by Southern Network Laboratories (Week 14, 2017–Week 2, 2019)


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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 2, 2019)


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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
  • 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; Avian Influenza; H3N2; H1N1pdm09; B; H7N9.

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[#Travel #Advice:] #Ebola #Outbreak in #DRC (@CDCgov, Jan. 18 '19)



Title:


[#Travel #Advice:] #Ebola #Outbreak in #DRC.

Subject:

Ebola Virus Disease Outbreak in the Dem. Rep. of Congo, travel advice.


Source:

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


Code:

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Alert - Level 2, Practice Enhanced Precautions 

Key Points
  • There is an outbreak of Ebola in the North Kivu (Kivu Nord) and Ituri provinces in the the northeastern part of the Democratic Republic of the Congo (DRC).
  • The outbreak is in a part of the country identified by the U.S. State Department as a “do not travel” zone because of armed group activity and major outbreaks of violence targeting civilians.
  • The armed conflict and violence in the outbreak area is hampering response activities including early identification of cases, and monitoring of "contacts" (people who may have been exposed to Ebola).
  • Travelers to this area could be infected with Ebola if they come into contact with an infected person’s blood or other body fluids.
  • Travelers should seek medical care immediately if they develop fever, headache, body aches, sore throat, diarrhea, weakness, vomiting, stomach pain, rash, or red eyes during or after travel.

What is Ebola?

Ebola virus disease (also known as Ebola hemorrhagic fever) is a rare and deadly disease that periodically causes outbreaks in several African countries. It is spread by direct contact with blood or body fluids of a person infected with Ebola virus. It is also spread by contact with contaminated objects or infected animals.

Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.


What is the current situation?

An outbreak of Ebola is occurring in the North Kivu (Kivu Nord) and Ituri provinces of the DRC, including the cities of Beni and Butembo. This outbreak, in the northeastern part of DRC, is approximately 780 miles from the Ebola outbreak in western DRC that ended in July 2018 (see map of Ebola-affected health zones in the DRC). The DRC Ministry of Health declared this current outbreak on August 1, 2018. For the latest information on this outbreak, including updates on numbers of cases and deaths, see the World Health Organization’s (WHO) Ebola situation reports: Democratic Republic of the Congo.

The North Kivu and Ituri provinces are among the most populated in DRC. These provinces share borders with other countries (Rwanda and Uganda) with frequent cross-border movement for trade activities. The provinces have been experiencing a prolonged humanitarian crisis and deteriorating security situation, which is limiting public health efforts to respond to this outbreak.

The DRC Ministry of Health, WHO, and partners are responding to this outbreak and working to establish its extent. The response includes enhanced illness surveillance and reporting, monitoring of contacts, cross-border surveillance in neighboring countries, expanded laboratory capacity, and vaccination of front-line health workers and contacts.


Who is at risk?

The risk to most travelers to DRC is low, with potential increased risk to those travelers going in or near the outbreak area and inadvertently coming in close contact with person infected with Ebola. Travelers could become infected if they come into contact with blood or body fluids from an infected person. Family and friends caring for people with Ebola, and healthcare workers (HCWs) who do not use correct infection control precautions, are at highest risk.


What can travelers do to protect themselves?

There is no FDA-approved or widely available vaccine or specific treatment for Ebola, and many people who get the disease die. Therefore, it is important to take steps to prevent Ebola.
  • Take action to prevent infection.
    • Avoid contact with other people’s blood or body fluids. (See the section below for special precautions if your work puts you at risk for exposure to Ebola.)
    • Do not handle items that may have come in contact with a person’s blood or body fluids (such as clothes, bedding, needles, or medical equipment).
    • Avoid contact with wild animals and bushmeat.
    • Avoid participating in burial rituals that require handling a dead body.
  • Pay attention to your health during travel and for 21 days after you leave DRC.
    • Monitor yourself for fever and other symptoms.
    • Separate yourself from others and seek medical care immediately if you have been in an area where Ebola is spreading and develop fever, headache, body aches, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes.
    • Before you go to a doctor’s office or emergency room, tell the doctor about your recent travel and your symptoms. Advance notice will help the doctor care for you and protect other people who may be in the office or hospital.
    • Although the risk for Ebola is low in travelers to DRC, other infectious disease risks remain high, including the risk for malaria. Seek medical care and proper treatment if you feel ill during travel or after returning.
  • Register with the U.S. Department of State.
For more information, see WHO recommendations for international travelers related to the Ebola virus disease outbreak in the DRC.


What can travelers do to protect others when leaving DRC?

Travelers who may have been exposed to Ebola or who become sick during travel should postpone further travel and get immediate medical attention. Any person with possible exposure or Ebola-like symptoms will not be allowed to travel unless the travel is part of an appropriate medical evacuation.

Special Recommendations for Health Care Workers in the Outbreak Area

If your work puts you at risk of exposure to Ebola, you should
  • Wear protective clothing, including masks, gloves, gowns, and eye protection whenever you are working with risk of exposure to Ebola virus.
  • Practice proper infection control. For more information, see "Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting."
  • Discuss options for vaccination with your sponsoring organization. DRC, WHO and other partners are offering an investigational vaccine to priority populations such as frontline HCWs. A major clinical trial conducted in Guinea in 2015 showed the vaccine to be highly protective against Ebola.
    • If you choose to be vaccinated against Ebola, get the vaccine before travel, if possible.
    • The National Institutes of Health (NIH) has an open-label clinical trial, entitled “Pre-Exposure Prophylaxis in Individuals at Potential Occupational Risk for Ebola Virus Exposure” or “PREPARE,” to vaccinate adult volunteers (including deploying HCWs and other responders) against Ebola. Study sites are at the NIH in Bethesda, MD, and Emory University in Atlanta, GA.
Upon leaving the outbreak area
  • Monitor yourself for 21 days for symptoms of Ebola infection (fever, headache, body aches, sore throat, diarrhea, vomiting, stomach pain, rash, or red eyes). Contact your sponsoring organization and local health department immediately if you develop any symptoms of possible Ebola infection.
  • Notify your healthcare facility’s infection control professional of your recent travel and self-monitoring activities (if you will be caring for patients in a U.S. healthcare facility during your 21-day self-monitoring period).

Special Recommendations for Nongovernmental Organizations and Faith-Based Organizations Sponsoring HCWs Supporting the Ebola Response

Nongovernmental Organizations (NGOs) and Faith-Based Organizations (FBOs) are responsible for ensuring the health and safety of sponsored HCWs supporting the Ebola response, including after their return to the United States.

CDC recommends that NGOs and FBOs
  • Be in contact with the health department(s) in the states where sponsored HCWs will be staying during their recommended 21-day self-monitoring period
  • Establish points of contact between your organization, state and local health departments, and the returned HCW
  • Work with health department contacts to agree on a process for medical evaluation of returned HCWs exhibiting signs and symptoms of Ebola virus disease
CDC works with NGOs and FBOs to
  • Share CDC's recommendations for returning HCWs
  • Determine the extent to which U.S.-based personnel are participating in the response
  • Understand NGO and FBO occupational health policies for sponsored HCWs supporting the response
For more information or additional guidance, NGOs and FBOs should contact CDC at eocdgmqopschief@cdc.gov.

Traveler Information
Clinician Information
Information for Airline Personnel

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Keywords: US CDC; USA; Updates; Ebola; DRC; Travel Warnings.

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#Ebola virus disease #Outbreak in #DRC (@WHO, Jan. 18 ‘19)



Title:

#Ebola virus disease #Outbreak in #DRC.


Subject:

Ebola Virus Disease Outbreak in the Dem. Rep. of Congo, current situation.


Source:

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


Code:

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Disease outbreak news: Update | 17 January 2019

The Ministry of Health (MoH), WHO and partners continue to respond to the ongoing Ebola virus disease (EVD) outbreak in one of the most complex settings possible. A high number of cases are still being reported, most notably from the metropolitan areas of Katwa Health Zone during the past week. The decline in case incidence has continued in Beni; a positive indication of how effective the response can be despite multiple challenges.

Trends in the number of new cases occurring (Figure 1) reflect the continuation of the outbreak across a number of geographically dispersed areas. During the last 21 days (26 December 2018 through 15 January 2019), 79 new cases have been reported from 11 health zones (Figure 2), including: Katwa (36), Oicha (14), Butembo (11), Beni (4), Mabalako (4), Kalungata (3), Kyondo (3), Komanda (1), Musienene (1), Biena (1) and Manguredjipa (1). The latter is a newly affected health zone, although the case likely acquired the infection in Mabalako Health Zone.

As of 15 January 2019, there have been a total of 663 EVD cases 1(614 confirmed and 49 probable), including 407 deaths (overall case fatality ratio: 61%).

Thus far, 237 people have been discharged from Ebola Treatment Centres (ETCs) and enrolled in a dedicated program for monitoring and supporting survivors.

Among confirmed and probable cases with age and sex reported, 59% (391/661) were female and 30% (200/658) were children less than 18 years. This includes a high number of cases in infants aged less than one year (43) and 1-4 years (61).

All alerts in affected areas, in other provinces, and in neighbouring countries continue to be monitored and investigated. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo, Uganda and Rwanda.

To date, EVD has been ruled out in all alerts outside the outbreak affected areas.
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Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 15 January 2019 (n=663)*


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{*} Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.
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Figure 2: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 15 January 2019 (n=663)


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Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, infection prevention and control, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials, cross-border surveillance, and preparedness activities in neighbouring provinces and countries.

For detailed information about the public health response actions by WHO and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

|-- Ebola situation reports: Democratic Republic of the Congo –|


WHO risk assessment

WHO reviewed its risk assessment for the outbreak and the risk remains very high at the national and regional levels; the global risk level remains low. This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo bordering Uganda, Rwanda and South Sudan. There is a potential risk for transmission of EVD at the national and regional levels due to extensive travel between the affected areas, the rest of the country, and neighbouring countries for economic and personal reasons as well as due to insecurity. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.


WHO advice

International traffic: WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:
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{1} Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

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Keywords: Ebola; DRC; Updates; WHO.

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17 Jan 2019

#Cholera #Outbreak in #Yemen, 16 January 2019 #Update (@WHO EMRO, Jan. 17 ‘19)



Title:

#Cholera #Outbreak in #Yemen, 16 January 2019 #Update.


Subject:

Acute Watery Diarrhea and Cholera outbreak in Yemen, current situation.


Source:

World Health Organization (WHO), Office for the Eastern Mediterranean Region, full page: (LINK).


Code:

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16 January, 2019

The Ministry of Public Health and Population of Yemen has reported 9119 suspected cholera cases, with 16 associated deaths, during epidemiological week 52 (24 – 30 December) in 2018.

11% were severe cases.

The cumulative total number of suspected cholera cases from 1 January 2018 to 16 December 2018 is 369 133, with 504 associated deaths (CFR 0.14%).

Children under five years of age represent 32.0% of the total suspected cases.

22 of 23 governorates and 312 of 333 districts in Yemen have been affected by the outbreak.

To date, out of 10 664 stool samples collected during 2018, 3371 have been confirmed as cholera positive by culture at the central public health laboratories in Al Hudaydahm Sana’a, Taizz, and Aden governorates. In this reporting period, 15 stool samples from Amanat Al Asimah, Ibb, and Lahj tested and confirmed as positive for cholera.

From epidemiological weeks 49 to week 51, the trend of weekly reported suspected cholera cases was stable at country level, but 227 districts out of 333 districts in the country have reported suspected cholera cases within the last three weeks.

In this latest reporting period, upward trends were observed only in Lahj governorates which reported 65 cases compared to 57 cases in week 51.  The governorates reporting more than 1000 cases per week are Sanaa (1246), Amanat Al Asimah (1132), Dhamar (1162), Arman (1158),and Al Hudaydah (1069).

The cholera outbreak in Yemen has been one of the worst cholera epidemics in recent history. WHO continues to provide leadership and support to health authorities and partners to mitigate the outbreak, including case management, surveillance, laboratory investigations, water sanitation, hygiene (WASH) and risk communication.

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|-- Latest Monthly Situation Infographic –|

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Keywords: WHO; Updates; Cholera; Yemen.

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#Measles – #Madagascar (@WHO, Jan. 17 '19)



Title:

#Measles – #Madagascar.


Subject:

Measles outbreak in Madagascar, current situation.


Source:

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


Code:


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Disease outbreak news | 17 January 2019

WHO is supporting the Ministry of Public Health of Madagascar to respond to an unusually large measles outbreak.

Madagascar last experienced measles outbreaks in 2003 and 2004, with reported number of cases at 62 233 and 35 558, respectively.

Since then, the number of reported cases had sharply declined until the current outbreak.

From 4 October 2018 to 7 January 2019, 19 539 measles cases and 39 “facility-based” deaths (case fatality ratio: 0.2%) have been reported by the Ministry of Public Health (MoH) of Madagascar.
 
Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar.

Among the 19 539 measles cases, 375 have been laboratory confirmed (all are IgM+) and 19 164 were confirmed by epidemiological link.

Cases confirmed by epidemiological link are those who presented clinical symptoms based on the case definition and had been in contact with another laboratory confirmed or epidemiologically linked case.

The outbreak has spread to densely populated urban cities including Toamasina, Mahajanga, Antsirabe, Toliara and the capital city Antananarivo.

Most cases were reported from Analamanga (61%) and Boeny (20%) regions.

The highest attack rates were observed in Antananarivo-Renivohitra district (714 per 100 000 inhabitants), and Ambato-Boina district (668 per 100 000 inhabitants), in Analamanga and Mahajanga regions, respectively. These rates are considerably higher compared to the national attack rate of 108 per 100 000 inhabitants.

In the current epidemic, children aged 1 to 14 years account for 64% of the total number of cases. The age distribution in this group is as follows: under five years at 35%, 5-9 years at 22% and 10-14 years at 19%. Both sexes are equally affected with a male to female ratio of 1.04.

The national immunization programme recommends routine measles immunization for children aged nine months. According to WHO and the United Nations International Children’s Emergency Fund (UNICEF), the estimated measles immunization coverage in Madagascar was 58% in 2017.

More than half of the cases (51%) reported during the current outbreak have not been vaccinated or have unknown immunization status.

Madagascar has the highest proportion of malnutrition among children under five (47%) in the African region which can increase children's risk of serious complications and death from measles infection.

The circulating genotype for the current measles outbreak in Madagascar is B3, usually found in Africa and Europe. No measles cases with travel history to Madagascar, however, have been reported in neighboring countries and initial investigations in Madagascar have not shown any link with cases from countries with measles outbreak in the Africa region or Europe.

The measles outbreak has occurred concurrently with the resurgence of plague in the country—which reoccurs seasonally—straining the public health response.


Public health response

The Ministry of Public Health of Madagascar is coordinating the response activities, with the support of WHO and other partners. Public Health response measures include:
  • Enhancement of active surveillance (active case finding, community-based surveillance, distribution of specimen collection kits) in all affected districts.
  • Use of the Global Measles Programmatic Risk Assessment Tool to target priority districts for vaccination.
  • Completion of targeted vaccination campaigns:
    • Campaign conducted from 22 October to 9 November 2018 in four districts of Antanavarivo city. The campaign targeted at least 95% of children aged between nine and 59 months. Preliminary results show coverage of 84% of the targeted population.
    • Campaign planned from 14 to 18 January targeting 2 083 734 children aged between nine months and nine years in 25 districts across 13 regions. The campaign is being funded by Measles Rubella Initiative (MRI), the Government of Madagascar, WHO, UNICEF, Catholic Relief Services (CRS), Commission de l'Océan Indien (COI), the United States Agency for International Development (USAID), the Embassy of France in Madagascar and the World Bank and the total cost is US$ 2 355 989.
  • Reinforcement of routine immunization (one dose of measles-containing vaccine (MCV) as per the national immunization programme) for children aged between nine and 11 months.
  • Continued management of severe measles cases in referral hospitals, provided to patients free of charge. Vitamin A is being administered to patients under care in all referral and district health centres.
  • Continued community mobilization with the support of UNICEF and USAID, aiming to increase understanding of the disease as well as uptake of the vaccines from campaigns and routine vaccination.
  • Reactivation by USAID of the 910 hotline, formerly used during the 2017 plague epidemic, for information sharing on measles.

WHO risk assessment

Measles is an acute, highly contagious viral disease that has potential to lead to major epidemics. Low coverage with measles vaccine combined with a low incidence of measles in recent years in Madagascar has contributed to a significant proportion of the population which is susceptible to measles. According to WHO and UNICEF estimates, the measles immunization coverage in Madagascar was 58% in 2017. The malnutrition rate is also a contributor as malnutrition increases children's vulnerability of serious complications and death from measles infection.

WHO estimates the overall risk for Madagascar from this measles outbreak to be very high.

Currently, several concomitant factors are likely to hinder or delay public health intervention and might jeopardize the response: post-election conflict, geographical isolation and remoteness of cases, insecurity, hurricane season and multiple outbreaks. Targeted immunization campaigns and strengthening of routine immunization activities are paramount in the effective control of the outbreak.

Administration of Vitamin A, specifically in a context of high rates of malnutrition, can reduce illness and deaths from measles infection.

The risk at the regional level is low although the spread of measles to neighboring Indian Ocean islands and other African countries and Europe cannot be excluded. Strengthening of surveillance in neighboring countries is recommended. The overall global risk is considered to be low.


WHO advice

WHO urges all Member States to:
  • Vaccinate to maintain coverage of 95% with two doses of MCV.
  • Vaccinate at-risk populations (without proof of vaccination or immunity against measles and rubella), such as health workers, people working in tourism and transportation (hotel and catering, airports, taxi drivers, etc.), and international travelers.
  • Maintain a reserve of MCV and syringes for control of imported cases in each country in the region.
  • Strengthen epidemiological surveillance of fever or rash cases for timely detection of all suspected cases of measles in public and private healthcare facilities and ensure that samples are received by laboratories within five days of being taken.
  • Provide a rapid response to imported measles cases through the activation of rapid response teams to prevent the establishment or reestablishment of endemic transmission.
  • Administer vitamin A supplementation to all children diagnosed with measles to reduce the complications and mortality …
WHO does not recommend any restriction on travel and or trade to Madagascar based on the information available on the current outbreak.

For more information on Measles, please see the link below:

|-- WHO measles fact sheet –|

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Keywords: WHO; Updates; Measles; Madagascar.

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