IATA Medical Contact Group - COVID-19, Monkeypox, other outbreaks

 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

 

Scientific Articles relating to COVID-19:

Omicron BA.4 and BA.5 continue to spread more quickly than other variants in Europe, and also in the USA where they are overtaking the BA.2.12.1 variant.  Case numbers are on the rise in many locations especially in Europe and in the USA, but trends in hospitalisations are much less dramatic.  In UK it is reported that 20% of cases are now reinfections (which a US study shows to be associated with worse outcomes than first infections). 

An article looking at the effectiveness of boosters, for Omicron is here – Adams et al: https://www.medrxiv.org/content/10.1101/2022.06.09.22276228v1

And similarly an article by Qu et al: https://www.nejm.org/doi/full/10.1056/NEJMc2206725?query=TOC

Hybrid immunity – Alatarawneh et al: https://www.nejm.org/doi/full/10.1056/NEJMoa2203965?query=TOC

And Reynolds et al: https://www.science.org/doi/10.1126/science.abq1841

And Goldberg et al: https://www.nejm.org/doi/full/10.1056/NEJMoa2118946

And in Airfinity:  “There has been much discussion on the superiority of hybrid immunity and how an Omicron breakthrough acts as a ‘natural booster’. However, a recent study from Imperial College showed that in those infected and tripled vaccinated, a subsequent Omicron infection may have little impact on immunity. While more data is needed, this may be indicative of antigen imprinting (original antigenic sin).”

A good article on the immune escape of BA.4 and BA.5 subvariants, which are on the increase – including in the USA where they are overtaking BA.2.12.1:
Tuekprakhon et al: https://www.cell.com/cell/fulltext/S0092-8674(22)00710-3       
- Key conclusions:  
BA.4/5 resist neutralization by triple-dosed vaccinee serum more than BA.1/2.
BA.1 vaccine breakthrough serum shows reduced neutralization of BA.4/5.
Activity of SARS-CoV-2 therapeutic antibodies against BA.4/5 is reduced.
L452R and F486V mutations both make major contributions to BA.4/5 escape.

And similarly, immune escape with BA.4/5 and also BA.2.12.1 is looked at here – Cao et al:  https://www.nature.com/articles/s41586-022-04980-y

And a further similar one from Israel, Hachmann et al: https://www.nejm.org/doi/full/10.1056/NEJMc2206576

Useful UKHSA data on vaccine protection are contained here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1083443/Vaccine-surveillance-report-week-24.pdf

And this article attests to the reduced severity of Omicron (less so in elderly) compared with previous variants – Auvigne et al: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00185-7/fulltext

A study on the level of population immunity based on blood donor samples in the USA-  Jones et al:  https://jamanetwork.com/journals/jama/fullarticle/2793517

“In this study of US blood donations, the combined seroprevalence from infection or vaccination reached 94.7% by December 2021. Despite this, record levels of infection and reinfections were reported as the Omicron variant became predominant in early 2022.2 The high infection rates are likely related to increased transmissibility and enhanced immune escape mutations of the Omicron variant, along with waning protection from previous vaccination and infection.3-5 During 2021, the infection-induced seroprevalence increased more in regions with low vaccination rates compared with those with high ones.”

And also on testing for COVID-19 immunity (looking at T cells rather than just antibodies) – Schwarz et al:  https://www.nature.com/articles/s41587-022-01347-6 

“……two quantitative PCR assays for SARS-CoV-2-specific T cell activation. The assays are rapid, internally normalized and probe-based…… rely on the quantification of CXCL10 messenger RNA, a chemokine whose expression ….. can thus serve as a proxy to quantify cellular immunity. Our assays may allow large-scale monitoring of the magnitude and duration of functional T cell immunity to SARS-CoV-2, thus helping to prioritize revaccination strategies in vulnerable populations.

 

Other:

A piece in Nature looks at the differential social and health effects of COVID-19 across different income groups, in six graphs: https://www.nature.com/immersive/d41586-022-01647-6/index.html

New cases of acute hepatitis in children have slowed in the UK.  There has been over 700 probable cases of acute hepatitis in children reported across 34 countries, resulting in 10 deaths. The infection rate in the UK, where most cases have been reported in this outbreak, have slowed a little; many of the cases have been infected with adenovirus but this does not usually lead to hepatitis, and other contributory factors including an association with COVID-19 continue to be explored.

A study reported in media, undertaken by University College London concludes that COVID-19 vaccination prevented some 20 million deaths so far.

Anthrax has been identified in Tigray Ethiopia. 

Evidence of vaccine-derived polio virus has been detected in sewage samples in London UK.

Dengue fever is increasing in several regions (including Asia, including Singapore/Vietnam/Cambodia/Philippines, and South America particularly Brazil).

There is a Global Health Security conference in Singapore next week and I hope to include some outputs from that in the next update.

Finally I have attached a reminder about the International Conference in Aerospace Medicine in Paris 22-24 September.  It is preceded by the Aviation Health Conference, 20-21 September (see https://quaynote.com/conference/aviation-health-2022/)


Best wishes,
David Powell

IATA Medical Advisor