Infectious Diseases and Outbreaks
MARBURG:
Tanzania confirmed an outbreak of Marburg virus disease on 23 March. Preliminary samples carried out following the deaths of at least five people yielded some positive tests for the viral hemorrhagic fever. So far, 7 symptomatic cases with 5 dead were reported in addition to 161 contacts being traced by authorities. (GPHiN)
Meanwhile in Equatorial Guinea, concern about potential spread has been raised as four cases have been detected in the port city of Bata (population 200,000). Actual case numbers may well be higher. (WHO)
Fruit bats can transmit the virus to humans, and human-to-human transmission occurs through direct contact with bodily fluids, or contaminated surfaces and materials. The case-fatality rate of Marburg virus disease is high (up to 88%), and no approved vaccines or antiviral treatments exist. However WHO is preparing to commence a phase 3 vaccination trial amongst close contacts of cases (typically 20-50 contacts per case. (Airfinity, WHO).
The Vietnam Health Ministry announced a requirement for visitors arriving from countries with Marburg outbreaks to be monitored for three weeks while in-country. (Airfinity)
Furthermore: As of March 27, an unidentified disease has killed three people in three days in northeastern Burundi. Symptoms developed by patients suffering from this disease resemble those of Ebola virus disease or Marburg virus disease. According to the Minister of Health, the case in Muyinga tested negative for both Ebola virus and Marburg virus disease. (SOS Media Burundi)
COVID-19:
The US Senate on Wednesday passed a bill that would end the national Covid-19 emergency declared by Donald Trump on March 13, 2020.
An article relevant to the discussion on COVID origins, is this one in Nature reporting that raccoon dogs in the area of the Wuhan wet market were found positive for SARS-CoV-2: https://www.nature.com/articles/d41586-023-00827-2
In India one third of new COVID-19 cases are XBB.1.16 and it is suspected that this sub-variant is driving the parallel rise in cases in neighbouring Pakistan. Meanwhile, In USA 90% of new cases are XBB.1.5. An emerging subvariant XBB.2.3 is rising in some regions, but responsible for less than 1% of cases globally.
Other Outbreaks (mostly of low concern for airline aviation):
Mpox: Since the last situation report published on 16 March, WHO was notified of 228 new mpox cases (0.3% increase in total cases) and one new related death have been reported to WHO. • Globally, the number of mpox cases continues to decline, but the Western Pacific region is showing an increase in cases, mainly driven by an outbreak with local transmission in Japan. (WHO)
Cholera: The outbreak in Eastern and Southern Africa has, according to WHO, placed over 28 million people in need across 11 countries. This has been exacerbated by flooding.
Polio: Vaccine-derived polio cases were reported in both Burundi and DRC (Airfinity).
Influenza: The H5N1 influenza virus continues to infect many mammals and occasionally humans are infected by animals (Chile most recently reported its first case). The virus has killed thousands of seals in USA.
Toxoplasmosis: This news piece refers to an outbreak of the parasite, often found in cat faeces, occurring in sea otters: https://www.nbcnews.com/science/science-news/rare-strain-parasite-killed-4-otters-california-pose-danger-humans-res-rcna76461
Candida auris: This antimicrobial resistant fungus being detected in hospitals is seen as a threat to the US health system, and has also now been detected in other countries. It has been arising in intensive care units and aged residential care homes, where it contaminates surfaces and medical devices, being resistant to normal grade disinfectants (Airfinity).
OTHER TOPICS OF INTEREST:
A couple of articles on cancer in aircrew, the first on a study in the US military here, suggesting elevated rates of skin and thyroid cancer, according to media reports. https://www.stripes.com/branches/air_force/2023-03-19/cancer-rates-in-air-and-ground-crews-9541721.html - I will report again once I have been able to view the source paper.
The second is an article in BMJ on a Danish case-control study, finding increased melanoma risk in pilots even after controlling for sun exposure (several previous studies have shown elevated risk but it has generally been thought likely due to sun exposure on the ground). The finding is in contrast to the Australian study only a few years ago which showed no elevation in rates/risk. https://oem.bmj.com/content/early/2023/03/16/oemed-2022-108747
Some unusual legal cases and media reports of relevance in media in the last few days for interest:
https://nypost.com/2023/03/20/ex-flight-attendant-claims-infamous-delta-uniform-gave-her-cancer/
And finally a piece on non-declaration (and treatment avoidance) of medical conditions in military aviators:
https://www.airandspaceforces.com/military-pilots-medical-exam/
David Powell
IATA Medical Advisor