INTERNATIONAL AIRLINE MEDICAL ASSOCIATION

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COVID-19:

There are declining hospitalisations and deaths in Japan and South Korea now, along with most locations.  Still surging cases in Russia, and lockdowns in China to control local outbreaks.

A useful summary article from NEJM on Immunity, Variants and Boosters is here – D Barouch:  https://www.nejm.org/doi/full/10.1056/NEJMra2206573

There is an “EPI-WIN” webinar tomorrow “BA.5 What do we know about new variants?” which will be watchable afterwards on the WHO  EPI-WIN YouTube channel.

 Monkeypox:  

The first monkeypox-related death in the United States has been reported in an individual described by officials as "severely immunocompromised" according to Airfinity;  global cases have gone beyond 50,000 now.  However as noted earlier the growth in global cases appears to be on the decline.  UK HSA reported a second strain of monkeypox in the UK, in one person who recently travelled to West Africa. 

Other:

You may have seen news reports of a worrying cluster of atypical pneumonia cases connected to a healthcare facility in Argentina – there were initially nine cases (later 11) and three fatalities (see for example https://www.lemonde.fr/en/international/article/2022/09/02/mysterious-pneumonia-kills-three-in-argentina_5995580_4.html) – and there were concerns that this may be due to a novel organism. However over the weekend, four of the cases tested positive for Legionella species, which are not transmitted directly from person to person but are found in contaminated water and potting mixes.  Infection can occur from contaminated building air conditioning systems of certain types.  Full details published by the WHO are here: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON407#

Best wishes,
David Powell

IATA Medical Advisor

COVID-19

COVID numbers have been surging in both Russia and also in China (>500% increase in two weeks in China, although absolute numbers are still low).

A pre-print publication from Maryland, showing that viral shedding (measured as RNA copies) into exhaled breath aerosol was significantly greater during infections with Alpha, Delta, and Omicron than with other variants (such as the ancestral Wuhan strain, and Gamma).  For participants with Delta and Omicron, their fine aerosol contained on average five times the amount of virus that was detected in their larger, coarse aerosol. There were no statistically significant differences in rates of shedding between Alpha, Delta, and Omicron infections. (However the highest shedder, who had an Omicron infection, and shed 1000 times more viral RNA copies than the maximum observed for Delta and Alpha).   Lai et al:  https://www.medrxiv.org/content/10.1101/2022.07.27.22278121v2.full

Study of unawareness of infection:  In this study in Los Angeles of adults with evidence of seroconversion during a regional Omicron variant surge, 56% reported being unaware of any recent Omicron infection; low rates of Omicron variant infection awareness may be a key contributor to rapid transmission of the virus within communities.  Joung et al: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795246

COVID-19 Information

Hospitalisations are decreasing in most countries as the BA.4/5 wave appears to be past its peak.  The World Health Organization notes in its latest weekly press report that the number of coronavirus deaths fell by 9% in the last week while new cases remained relatively stable. Note however that in Russia, reported and modelled infections are soaring along with an increased rate of deaths.  Deaths have increased in Canada, although case numbers are on the decline (Source: Airfinity).

A useful summary article from BMJ on BA.5 and other recent subvariants - https://www.bmj.com/content/378/bmj.o1969

This gives some context to the potential concerns with the subvariant BA.2.75 and its potential for outcompeting BA.5 (this is discussed in more detail in Cao et al: https://www.biorxiv.org/content/10.1101/2022.07.18.500332v2 and Saito et al: https://www.biorxiv.org/content/10.1101/2022.08.07.503115v1)

Airfinity reports a further subvariant BA.4.6 on the increase, with potential to escape immunity from BA.5

COVID-19:

WHO’s Emergency Committee on COVID-19 met again, and once again advised that this is still a PHEIC. The Committee’s report is here:
https://www.who.int/news/item/12-07-2022-statement-on-the-twelfth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic.

Travel-related recommendations are essentially unchanged, calling for continued adjustment of international travel-related measures based on risk assessment, and against vaccination being obligatory for travellers.

New guidance from WHO on travel came out a few days prior, although some of the referenced data and some of the text is far from new:

https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy-Brief-Risk-based-international-travel-2021.1

https://www.who.int/publications/i/item/WHO-2019-nCoV-Risk-based-international-travel-2021.1

According to Airfinity, vaccine effectiveness against BA.4/.5 may remain similar to BA.2:

While the impact of Omicron on vaccine effectiveness is well documented, it remains unclear whether the recent BA.4/5 Omicron sub-lineages have an additional impact relative to previous sub-lineages. Preliminary data from UKHSA suggests this is not the case, with broadly equal odds of infection of BA.4/5 vs BA.2, in the vaccinated, suggesting similar effectiveness. While further analysis is required, currently there is no evidence to suggest BA.4/5 significantly further impacts the effectiveness of current vaccines.

A few points on COVID-19:

Infection rates have been increasing globally as BA.4 and BA.5 become dominant.  BA.5 in particular shows a higher transmissibility and growth rate, with high numbers of re-infections.  These increases are now being reflected in increasing hospitalisations and deaths in certain countries including:  Brazil (highest death rates since March), USA (over 20% increase in deaths in last 2 weeks), India (deaths more than doubled in 2 weeks but absolute numbers low), and Japan (deaths up a third in last 2 weeks).   In China, Beijing and Shanghai cities both reported getting back to zero new COVID cases after battling for months, but cases flared up in the Yangtze Delta region.

The US FDA called for BA.4/.5 based boosters (bivalent BA.4/5 plus wild type), following positive immunogenicity data from Moderna and Pfizer-BioNTech BA.1 vaccines

(as mentioned earlier, Sanofi/GSK also released data on their bivalent Beta vaccine suggesting it is 72% effective against Omicron infection).

A quick note, on the outcome of the emergency committee meeting on monkeypox convened by WHO under the International Health Regulations. 

The consensus recommendation of the committee, agreed to by the DG of WHO, was AGAINST declaring monkeypox to be a PHEIC.  The Committee’s deliberations are detailed here:   https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee--regarding-the-multi-country-monkeypox-outbreak#:~:text=The%20Committee%20recognized%20that%20monkeypox,access%20to%20essential%20supplies%20worldwide.

The committee listed a number of potential developments which it considered should prompt a re-assessment, including increased growth rate of cases in the next few weeks, involvement of vulnerable groups, increased severity/virulence, enhanced transmissibility, and immune escape. 

 The Singapore Statement on Global Health Security was agreed and released today, building on the Sydney Statement of 2019, and launched at the Singapore Global Health Security Conference: https://gh.bmj.com/content/bmjgh/7/6/e009949.full.pdf


Best wishes,
David Powell

IATA Medical Advisor

 Monkeypox:


The first WHO Emergency Committee on monkeypox met Thursday, Geneva time (https://www.who.int/news/item/23-06-2022-ihr-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox) and a statement is awaited, including advice on the question of whether this is a PHEIC (public health emergency of international concern).  I plan to forward an update after this is received. 

A good summary on monkeypox was meanwhile published in JAMA - Guarner et al: https://jamanetwork.com/journals/jama/fullarticle/2793516

A comprehensive recent WHO update on the outbreak is here: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON393

(And an earlier one from WHO is here:  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390)

And one from the ECDC (noting that the majority of the cases in non-endemic countries have been in Europe) is here: https://monkeypoxreport.ecdc.europa.eu/

Monkeypox cases continue to increase, with well over 3000 confirmed cases in over 50 non-endemic countries. Ring vaccination, in which close contacts of a case are offered a vaccination, has been adopted as a strategy to contain the outbreak, but this strategy relies on efficient diagnosis and contact tracing. Recent data from the UK highlights the challenges of implementing the strategy, with 14% vaccine uptake for community contacts and 72% of sexual contacts from a recent cluster of cases not contactable. If these difficulties are replicated in other regions, alternative vaccination strategy targeting all high-risk groups may be considered more effective.

WHO notes (in the risk assessment, see above reference) that the risk to the general public is low – and “ does not recommend that Member States adopt any  measures that interfere with international traffic for either incoming or outgoing travellers.”  In spite of that you may have seen reports of an airline crew placed in to quarantine for three weeks in Singapore after one was confirmed as a case.

An article looking at the nature of spread of the illness, and factors behind it disproportionately affecting men who have sex with men, is here from Science:

https://www.science.org/content/article/why-the-monkeypox-outbreak-is-mostly-affecting-men-who-have-sex-with-men

with an underlying modelling study from LSHTM here – Endo et al: https://www.medrxiv.org/content/10.1101/2022.06.13.22276353v1

And a further article on spread in mass gatherings (from multiple close contacts) – Sypsa et al: https://www.medrxiv.org/content/10.1101/2022.06.21.22276684v1

 

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