Disease outbreaks and other matters of airline medical interest

From Airfinity’s curated analysis of various health and media sources.

  • From today a total of 34 countries have shared SARS-CoV-2  B.A.2.86 genome sequences. The spike protein in this variant contains 34 additional mutations compared to its BA.2 predecessor, but does not appear to be more dangerous. As this variant has been detected in all those countries with a high sequencing rate, it can be assumed to be widespread. In recent weeks, a related variant, JN.1 (with the L455S mutation), has been identified which has concerning immune-evasion properties. JN.1 was detected in the US in September and has also been identified in 11 other countries but, according to the US CDC, for now makes up less than 0.1% of SARS-CoV-2 viruses. The CDC said initial data suggest that updated COVID vaccines will help protect against BA.2.86, and it expects a similar effect against JN.1.
  • Across the US, wastewater data continues to show decreasing COVID-19 burden. Though still high, hospital admissions have stabilised in the last week, while the UK has shown a decrease in most indicators including hospital patient numbers and test positivity. In Japan also, the number of new COVID-19 cases has been decreasing for seven consecutive weeks. Meanwhile, in Germany cases continue to rise and it is unclear whether this wave will peak soon.
  • The epicentre of deadly bird flu outbreaks seems to have shifted from Asia to Europe and Africa: https://www.nature.com/articles/s41586-023-06631-2 . Avian influenza has been detected in agricultural settings across the US, Canada, Mexico, Europe (Norway, Poland, Romania, Bulgaria) and Mozambique, while in southern Brazil, over 500 sea lions have been found dead due to avian influenza. The disease has been detected for the first time in Antarctica in skuas (a scavenging bird) on Bird Island in South Georgia, as reported by the British Antarctic Survey. It is likely that avian influenza was spread by birds returning from their migration to South America, where cases are high.
  • The spread of cholera now appears to be slowing in Zimbabwe.
  • Earlier this month yellow fever reemerged in Guinea after three years of absence: 178 cases and four deaths have been reported in the East Central district of Dabola.
  • Dengue continues surging throughout the world and coming to places that had never had it, from the US to Chad in Central Africa. In Europe, a total of seven clusters (35 cases) of autochthonous dengue virus transmissions have been reported so far in mainland France (from the ECDC Communicable Disease Threats Report (week 42). Cases of dengue fever have also increased to 66 in Italy, and a second locally acquired case has been reported in Catalonia, Spain.
  • A locally acquired West Nile virus infection has been confirmed for the first time in the Czech Republic since 2019, when two cases were reported. In Europe, the transmission area of West Nile virus has expanded in recent years due to climate change, with a case reported this year as far north as Berlin.
  • While no further Nipah virus infections have been confirmed in Kerala since mid-September, a bat surveillance survey has detected Nipah virus antibodies in Pteropus bat species in 14 states in India, indicating a wider presence of the virus and possibilities of outbreaks across the country.
  • On a different note, an interesting alert related to floor heating systems: Legionella can establish itself in the biofilm that forms on the inside of water pipes, where it can reproduce when conditions are favourable. Testing of different types of water distribution cabinets by researchers at the Norwegian science institute SINTEF has led to the conclusion that cabinets that combine the distribution of both domestic tap water and water for floor heating pose a risk for Legionnaires' disease. The floor heating system gives off heat that causes the temperature in the cabinet to rise to as much as 40 °C, offering the best possible temperature range for Legionella.

SINTEF’s recommendation: cold water should be kept as cold as possible and never be allowed to become warmer than room temperature, regardless of how long it remains standing in the plumbing system. This implies that systems required to supply hot water need to be isolated as much as possible from cold water installations.

Links to selected articles of interest:

And finally a news item that raises hope for more seamless travels in the not so distant future: https://neweralive.na/posts/iata-tests-digital-id-on-international-flight . Provided privacy and confidentiality are assured and the principle of need-to-know safeguarded, imagine if during the pandemic, required passenger data like vaccination status were encrypted and standardized across the world in such a way that a single scan could clear you simultaneously for airline booking, border passport/visa controls and health authority requirements, and also help you track your checked luggage.

Dr Rui Pombal

IATA Medical Advisor