From the ECDC Weekly Communicable Disease Threats Report, the US CDC, and the WHO:
- Marburg virus disease outbreak in Rwanda:
- No new cases of Marburg virus disease have not been reported in Rwanda since the end of October. All patients who were under care have recovered.
- Overall, by mid-November, 66 cases, including 15 deaths, had been reported. All cases seem to belong to one large cluster linked to healthcare facilities and one presumed index case.
- If no cases are reported in the 42-day period starting on 9 November 2024 the outbreak will be declared over.
- The US CDC has been performing enhanced public health screenings at three designated airports (JFKJ, ORD, IAD) to identify air travellers entering the US who might have Marburg symptoms or who may have come in contact with the virus while in Rwanda in the preceding 21 days.
- However, the US is no longer recommending that nonessential travel to Rwanda be reconsidered. The current updated recommendation is for travellers to practice enhanced precautions, which means the CDC Marburg in Rwanda Travel Health Notice level has been lowered from 3 to 2 – details here: https://wwwnc.cdc.gov/travel/notices/level2/marburg-rwanda
- Both the ECDC and the US CDC assess the risk from the Marburg virus outbreak in Rwanda to Europe and to the USA respectively, as s.
- Global outbreak of mpox:
- There have been no significant changes in the global epidemiological situation of clade I and clade II mpox.
- The WHO published on 28 November temporary recommendations agreed during the second meeting of the International Health Regulations Emergency Committee regarding the upsurge of mpox:
https://www.who.int/news/item/28-11-2024-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-upsurge-of-mpox-2024 These recommendations are an addition to the standing recommendations for mpox (see previous MCG update), which will be extended until 20 August 2025. The additional temporary recommendations mainly regard enhancing emergency coordination between countries, collaborative surveillance and laboratory diagnostics, clinical care and vaccination, financing and research. As for international traffic the focus is on provision of information to travellers and operators, without resorting to general travel and trade restrictions unnecessarily impacting local, regional or national economies.
- Avian influenza:
- On 9 November, Canada reported one case of an adolescent in British Columbia who tested positive for avian influenza A(H5N1) virus. The source of infection is unknown so far, but sequencing data point to a mixture of viruses similar to a lineage of H5N1 viruses currently infecting poultry and waterfowl in the region. No additional human cases have been identified including in the three dozen close contacts of the infected teenager.
- On 24 November, California issued a warning against drinking a specific batch of raw milk following detection of avian influenza A(H5) virus in a retail sample. Pasteurised milk is safe to drink but even consumption of affected raw milk has been associated with disease.
- The panorama for cholera cases worldwide does not present significant changes as we can see from the below ECDC map of cumulative cases from the last three months worldwide. The risk of cholera infection in travellers visiting the affected regions remains low.
A selection of other articles of interest:
First Chikungunya Vaccine in the pipeline
So far chikungunya infection prevention has basically relied on vector control and avoidance of mosquito bites. VLA1553 (IXCHIQ®) is a live-attenuated vaccine against chikungunya disease. It is the first vaccine approved (FDA) for the prevention of CHIK in adults, following accelerated development. Ongoing and planned studies will confirm its effectiveness and safety https://academic.oup.com/jtm/article/31/7/taae123/7754743?utm_source=&utm_campaign=jtm&utm_medium=email
Surprising Nocebo Effect in persons believing they were given bread with gluten
The "nocebo effect" consists in patients experiencing symptoms from exposure to a substance they assume is causing their issues but is actually inert, that substance being defined as a “nocebo”, as opposed to the concept of “placebo” whereby therapeutic or positive effects are experienced in the presence of an inert substance. There is still much to be learned about the mechanisms underlying the nocebo and placebo effects, but both may be linked to the person’s beliefs and expectations.
Many individuals without coeliac disease or wheat allergy reduce their gluten intake because they believe that gluten causes their gastrointestinal symptoms.
In this randomised, double-blind, placebo-controlled study conducted in the UK and the Netherlands, researchers investigated the effects of expectancy versus actual gluten intake on symptoms. The patients who ate gluten and were also told they were eating gluten had significantly worse symptoms, suggesting a nocebo effect.
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00317-5/abstract
Dr Rui Pombal
IATA Medical Advisor