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

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

An interesting review of importation, VOC waves and lockdowns in Canada - McLaughlin et al: https://elifesciences.org/articles/73896 - unsurprisingly it finds that the first border closure in March 2020 had the most benefit, before there was too much burden in the community, but that in general, border closures only delayed the inevitable and we need to weigh socioeconomic harms vs closures.  Naturally, most importation into Canada was from USA.  (See also a paper evaluating testing/quarantine measures in inbound travellers to Hong Kong – Martin-Sanchez et al: https://www.medrxiv.org/content/10.1101/2022.08.09.22278572v1.full.pdf)

A different paper with the same author surname, McLaughlin et al: https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00008-4/fulltext which looks at county-level relationship between vaccination rate and death rates (as expected, lower death rates with higher vaccination). 

Airfinity report that data suggest the rate of myocarditis/pericarditis with Novavax may be at least similar to, if not more than, that with the mRNA vaccines. A study shows potential for Novavax as a booster, however the duration of protection is unclear.  An Oxford article suggests that in the first year, the Astra-Zeneca vaccine saved over 6 million lives: https://www.paediatrics.ox.ac.uk/news/oxford-vaccine-saved-most-lives-in-its-first-year-of-rollout

A press article on the duration of virus persistence in air – San Francisco Chronicle https://www.sfchronicle.com/bayarea/pandemicproblems/article/covid-indoors-spread-17349854.php

Two pre-print articles of potential interest looking at hybrid immunity – firstly “The effect of Omicron breakthrough infection and extended BNT162b2 booster dosing on neutralization breadth against SARS-CoV-2 variants of concern” - Graham et al: https://www.medrxiv.org/content/10.1101/2022.08.04.22278160v1.full.pdf and secondly “mRNA vaccines and hybrid immunity use different B cell germlines to neutralize Omicron BA.4 and BA.5” - Andreano et al: https://www.biorxiv.org/content/10.1101/2022.08.04.502828v1

Again the evidence is that an advantage is gained from multiple vaccine doses plus an infection.

You also may be interested in three recent papers (two of them peer-reviewed) on the likely origin of the pandemic, still likely to have indeed been the Huanan seafood market in Wuhan, even if there were was potential for additional foci around the same time:

Worobey et al: https://www.science.org/doi/10.1126/science.abp8715

Pekar et al: https://www.science.org/doi/10.1126/science.abp8337

Gao et al: https://www.researchsquare.com/article/rs-1370392/v1

Finally, in a communication from WHO recently there was an observation that some airlines have been advising passengers, and requiring crew, to use gloves on board as a COVID-related measure – but WHO analysis is that gloves do not reduce, or potentially increase, contamination (not to mention cost and waste).  This is passed on to you for your consideration. 


Monkeypox Information                                     

The US declared monkeypox to be a public health emergency there, a step which will provide greater impetus to the public health response, vaccination programmes and funding – details here:

U.S. Department of Health and Human Services declared the ongoing spread of Monkeypox virus in the United States a Public Health Emergency (PHE): 

Some commentary from the American College of Occupational and Environmental Medicine on monkeypox notes “What we’re not seeing:   Transmissions on planes, buses, trains;  Transmissions during public events;  Transmissions from casual contact;  and finally, transmission in well-resourced healthcare settings appears to be exceedingly rare.”   The ACOEM resources are here:  https://acoem.org/Practice-Resources/Monkeypox

Note that amongst the WHO recommendations are that recent contacts of monkeypox cases “avoid travel” even though this would not seem to be well supported by the mechanisms and dynamics of spread. 

Here’s a useful summary article on monkeypox in JAMA a couple of days ago: https://jamanetwork.com/journals/jama/fullarticle/2795359


Other

Dengue fever is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. Several countries have reported unusually high incidences this year, partly due to climate-related factors. Singapore is reporting a high incidence, assumed to be the consequence of unexpectedly warm and humid weather. Brazil has reported over 1.8 million cases this year, but the number of new cases has been declining since May.  Dengue has caused around 700 deaths in Brazil and 200 in Philippines 200.  

In a follow-up report on autochthonous dengue fever transmission in the state of Florida, the Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) confirmed second and third locally transmitted dengue cases. 

Also there are measles outbreaks in both DRC and Afghanistan.  A future update will include more detail on vector-borne disease outbreaks worldwide.

The vaccine-derived poliovirus type 2 (VDPV2) case in New York has been genetically linked to isolates from wastewater in New York (USA), greater Jerusalem (Israel) and London (UK). It will be essential to increase vaccination coverage globally to mitigate the threat of vaccine-derived poliovirus which can spread very quickly and silently between unvaccinated individuals, and cause paralytic polio.  (Source: Airfinity). 

Finally, a somewhat disappointing article/video in Medscape, on airline Emergency Medical Kits and their contents, and Epipens:

https://www.medscape.com/viewarticle/976805   - It is very US-specific and disappointingly they did not seek input from the airline medical world, and inadequate discussion of the importance of ground-based medical advice service.  Concerning Epipens, the Aerospace Medical Association called for their inclusion in EMK requirements a couple of years ago (see attached).   The European situation is different, and the requirements there gave recently been reviewed and expanded.  Elsewhere, many airline EMK’s have very comprehensive contents, sometimes well in excess of the regulatory requirements.


Best wishes,
David Powell

IATA Medical Advisor