Infectious Diseases
Note that norovirus infections are 66% higher in UK than usual for this time of year according to national surveillance data. Always a risk of on-board infection. Some notes on norovirus from “YLE-Your Local Epidemiologist” are here:
1. Norovirus is very infectious. On average, one infected person will infect 2-7 other people…it can live on surfaces for weeks. It’s spread through the fecal to oral route so transmission avenues include:
- Direct contact.6 in 10 infections are through direct contact, like shaking hands or touching door handles, and then putting your hand in your mouth.
- Indirectly, like through foods. An infected person can touch food with bare hands that have viral particles on them. You can ingest the food and then get sick.
- Aerosolized. If someone throws up in a toilet, for example, viral particles can become aerosoled after flushing. This isn’t the main route of transmission.
Three out of four norovirus outbreaks occur in nursing homes. Restaurants and schools follow. Cruise ship outbreaks usually make the news, but only account for 1% of outbreaks.
2. People only need a few viral particles to get sick. Once the virus enters the body, norovirus hijacks your cells and turns them into viral factories. It latches on, specifically, to cells in your gut causing less than wonderful symptoms. Before 2018, we didn’t know why norovirus chose the gut, but a new study found it’s because our gut is home to one rare type of cell (tuft cells).
3. Third, this virus spreads pre-symptomatically and up to 2 weeks after symptoms resolve. In other words, you can spread it even if you don’t have symptoms.
A second case of human infection with H5N1 (avian flu) was confirmed in Cambodia, the father of the original 11 year old who died. The 11 other close contacts who were possible cases have tested negative, and there is no indication of human-to-human transmission. There is also a report of a historical case of H5N1 in China last October. Cambodia has received 3000 doses of H5N1 vaccine from WHO.
Concerning Marburg virus in Equatorial Guinea: investigations are ongoing to find additional cases, and there have been two more deaths bringing the total to 11. WHO is supporting the response by strengthening contact tracing, case management, infection prevention and control, laboratory, risk communication and community engagement. Thailand (along with some other Asian and African countries) has introduced control checks at ports of entry to screen all arrivals from countries currently reported to be affected by Marburg Virus Disease.
According to media reports quoted by Airfinity, on February 27, 2023 the ministry of health in Israel announced a case of polio, presenting as limb weakness, in an unvaccinated child.
Ghana has reported a further 12 cases of Lassa fever, the viral haemorrhagic fever spread by rodents. Lassa fever in Nigeria totalled 2244 cases this year and 85 deaths (15 in the week before last)
The Bolivian Ministry of Health and Sports on Tuesday reported over 11000 dengue fever cases so far in the current outbreak.
A case of the respiratory disease diphtheria was reported in Latvia, the first in 3 years (around 100 cases in the last decade).
COVID-19 Specifically
A MMWR report just released by CDC relating to a pilot study on genomic surveillance for SARS-CoV-2
Aircraft Wastewater Surveillance for Early Detection of SARS-CoV-2 Variants — John F. Kennedy International airport, showing that aircraft wastewater surveillance can provide a low-resource approach to monitor variants without direct traveller involvement or disruption to airport operations.
Nearly 130,000 child Covid-19 cases were reported in the US in the past four weeks, according to the latest report by the American Academy of Pediatrics (AAP) and the Children's Hospital Association.
Germany has announced it no longer requires a pre-departure COVID-19 test for travellers coming from China, and Malta has announced that from next Monday, 27th February, it will also drop this measure. Cyprus and Italy are also lifting the test requirements. Meanwhile China itself has relaxed the requirement for pre-travel tests for travellers from several different countries, to an antigen test instead of PCR. Airfinity estimates that current COVID-19 case and death rates in China are down below 20% of their recent peak.
Studies in Europe cited by Airfinity indicate that the death rate from the current Omicron outbreak is similar to, or less than, those of the previous BA.2 and BA.4/5 outbreaks.
Another large meta-analysis and review of protection from COVID-19 derived from previous infection is here, showing that protection against severe disease remains high: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02465-5/fulltext
ICAO Briefing
On 14 February, IATA held an informal briefing to the ICAO Council covering three key issues - data protection, pandemic preparedness, and accessibility. IATA submitted working papers on these to the ICAO Assembly last year and various actions were proposed in the report and resolutions. IATA made proposals for how the work could be advanced in this triennium, supported by industry. The aim of the briefing was to gain Council support for the proposals and to ensure that progress is made.
On Pandemic Preparedness/Health: IATA working paper 63, presented at last year’s ICAO Assembly, highlighted how the fragmented nature of measures imposed by States during the COVID-19 pandemic created confusion for both carriers and travellers , which hampered the recovery in international aviation. The paper emphasized the importance of learning lessons from COVID-19 to enhance resilience to future health emergencies.
The focus of the briefing was to promote Council support for a science-based review of the Public Health Safety Measures (PHSM) included in the CART Take-Off guidance as well as subsequent documentation and then draw on the review to inform the development of a "playbook” for responding to future health emergencies.
The Council reiterated the support that WP/63 received at the Assembly and emphasised the importance of future pandemic preparedness with general recognition that the aviation sector still has a lot of work to do in order to enhance resilience to future threats. The concept of a “playbook” that could be deployed rapidly in the event of future outbreaks was welcomed. The Council, Secretary General and Secretariat are now considering the best way to take the work forward, including roles for the CART and CAPSCA. IATA indicated its willingness to take an active role in delivering the evidence-based review.
David Powell
IATA Medical Advisor