Covid 19 Resources Center

From the ECDC Weekly Communicable Disease Threats Report, the US CDC, and the WHO:

• Marburg virus disease (MVD) outbreak in Rwanda: 42 days after the last patient tested negative for the virus twice, as per the usual protocol for ending these types of outbreaks, the outbreak was declared over on 20 December. This outbreak resulted in 66 cases, with 15 deaths, mostly from a single cluster linked to healthcare facilities that treated the index case. The MVD fatality rate ranges from 24% to 88%. In this outbreak, the fatality rate was lower at around 23%.

• Acute respiratory infections complicated by malaria: This is the name now given by the WHO to an initially undiagnosed disease outbreak reported in early December in the Kwango province of the DRC, in a remote region that requires a 48-hour road trip to be reached from the capital, Kinshasa. The WHO has concluded that the outbreak has been caused by a combination of multiple acute respiratory infections complicated by malaria, malnutrition and limited healthcare access. Children under five have been disproportionately affected. Most cases tested positive for malaria. Common respiratory viruses were also detected, such as influenza A (H1N1) and parainfluenza viruses, rhinoviruses, and SARS-CoV-2. Coordination and infection prevention and control measures are to be strengthened. Further details here: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON547
  

• Global outbreak of mpox:
• Overall, the global epidemiological situation of clade I and clade II mpox is fairly stable.
• Outside the affected African countries, small household clusters of cases of MPXV clade Ib have been reported in the UK and Germany since October, the first US case was detected in November, and a case was reported in Belgium earlier this month.  All index cases had travelled to affected areas in Africa.

• Avian influenza:
• The first case of bird flu was confirmed in New Zealand in an egg farm early December. However, this was not a case of the H5N1 type circulating among wildlife around the world, rather a case of H7N6, which is considered unlikely to be transmitted to mammals.
• H5 bird flu is widespread in wild birds worldwide and is causing outbreaks in poultry and US dairy cow. So far there is a total of 66 confirmed human cases of influenza A(H5N1) in the US. One severe case was confirmed on 13 December in Louisiana following exposure to sick and dead birds in backyard flocks. On 18 December, the Governor of California declared a state of emergency in the state to further expand monitoring and contain and mitigate the spread of H5N1.
• Human infections with avian influenza viruses remain rare and sporadic, with no evidence of sustained human-to-human transmission so far.   According to the US CDC, the risk to the general population remains low.

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.

From the ECDC Weekly Communicable Disease Threats Report, the US CDC, the Africa CDC, and the WHO:

• Global outbreak of mpox:
• Overall, more than 24,000 confirmed or suspected mpox cases due to both clades I and II have been reported from 14 African Union Member States since the beginning of the year. Similarly to previous weeks, although there is an increasing trend in cases of MPXV clade I reported by the DRC and Burundi, the epidemiological profile of the cases remains the same.
• No new countries have reported confirmed mpox cases due to clade I.
• No secondary transmission has been reported from the two clade I cases imported to Sweden and Thailand.
• The WHO has not changed its recommendation against implementing travel-related health measures specific for mpox. No international travel or trade restriction measures are recommended.

• Until now this year, a total of 14 human cases of avian influenza A(H5) have been reported in the US. Most of the cases involved individuals who had had direct contact with infected poultry or dairy cattle. The most recent case, from earlier this month, which was reported in the state of Missouri and detected through that state’s seasonal flu surveillance system, is the first instance without any documented exposure to infected animals, and it is still under investigation – it is not yet known whether the implicated virus is H5N1. The patient, who had underlying medical conditions, was hospitalized and treated with influenza antiviral medications, was later discharged from hospital and has recovered.
• The US CDC continues to assess the risk to the general public as low due to the absence of sustained human-to-human transmission. CDC updates here: https://www.cdc.gov/bird-flu/situation-summary/index.html
  

• COVID-19: WHO global COVID-19 dashboard with cases from the last 7 and the last 28 days here: https://data.who.int/dashboards/covid19/cases

• Oropouche virus (OROV) disease: This year and until 31 August, 9,852 cumulative confirmed cases of OROV disease have been reported in Brazil, Peru, Cuba, Bolivia, Colombia, and the Dominican Republic. Over 30 cases have been confirmed in the US - most in Florida and all linked to travellers returning from Cuba. Another 19 exported cases have also been reported in Spain, Italy and Germany. The risk of OROV disease for persons travelling to countries in the Americas where transmission is ongoing or has been reported is assessed by the ECDC as moderate. When travelling to regions where the virus is present, the use of insect repellent and other insect bite prevention measures are recommended. The US CDC also recommends that travellers returning from affected regions use insect repellent for three weeks after returning to prevent possible transmission to others via midges or mosquitoes.

From Airfinity’s curated analysis of various health and media sources, the US CDC, and the ECDC (European Centre for Disease Prevention and Control) Weekly Communicable Disease Threats Report:

• H5N1 infections have now been reported in a total of 185 dairy herds across 13 US states. Colorado is the first state to mandate weekly bulk tank milk testing.
• 25 human H5N1 cases have been detected globally: US (13), Cambodia (9), Vietnam (2), and Australia (1). There is a possible instance of human-to-human transmission in Texas, but outside the US all cases were most likely transmitted from bird to human.
• The US CDC have recommended that children under five, adults 65 years and older, and others at a higher risk of developing serious flu complications, should try and limit contact with animals that could carry influenza viruses at upcoming county fairs. Specific recommendations for fair exhibitors have been issued including reducing the time pigs, poultry, and cattle are on display to not more than 72 hours.
• There currently are several H5N1 vaccine pipeline candidates, eight of which mRNA-based. Meanwhile the US CDC have announced they will offer seasonal influenza vaccines to farmworkers.

• According to the CDC, Colorado has reported the first US case of influenza A(H3N2) variant (v) virus infection in 2024 in a person who attended an agricultural event. The person recovered without hospitalization. When an influenza virus that normally spreads in swine but not people is found in a person it is called a variant influenza virus. No additional cases or person-to-person spread have been identified. Since 2005, 517 variant influenza virus infections have been reported in the US, generally linked to pig exposure.
  

• COVID-19: Indicators of increased SARS-CoV-2 activity in healthcare settings have been observed in Europe since late spring. The overall impact on hospitals and mortality has been relatively low. Variant BA.2.86 and its subvariants, including KP.3, continue to dominate and are not expected to be associated with increased infection severity or to significantly reduce vaccine effectiveness.

• France has reported the first case of autochthonous chikungunya since 2017. The case was reported in the Greater Paris region and is also the first in the whole of EU/EEA since 2017. Previously, between 2010 and 2017, France had had 31 locally transmitted cases of chikungunya. In the Indian state of Tamil Nadu there is an ongoing surge of chikungunya infections, with over three hundred confirmed cases so far this year.

• Malaria has reemerged as a significant issue in Kokrajhar, Chirang, and Udalguri, three districts in Assam, India.

• Nigeria has reported almost five thousand cholera cases since the beginning of the year. Lagos state accounts for 65% of all suspected cases in the country.

From Airfinity’s curated analysis of various health and media sources, the US CDC, and the ECDC (European Centre for Disease Prevention and Control) Weekly Communicable Disease Threats Report:

• H5N1-infected dairy herds continue to be reported across the US.
• Two cases of A(H5N1) infection have been reported in Cambodia in two children living under the same roof.
• In Europe, the lowest number of highly pathogenic avian influenza (HPAI) cases in poultry and wild birds has been recorded since 2019/2020 and the risk to the general public remains low.

• COVID-19:
• The disease burden in Japan has been steadily increasing, not so much in terms of hospitalization rates.
• Following a period of very low SARS-CoV-2 circulation, there is evidence of increased COVID-19 activity since May in several EU/EEA countries, especially among people aged 65 years or more.
• Vaccination continues to be protective, with stronger protection against more severe disease, although this protective effect wanes over time. Vaccine protection of individuals at high risk of severe outcomes (such as older people) remains important.
• The currently circulating and largely dominating SARS-CoV-2 variant in Europe is BA.2.86, including subvariants carrying R346T and/or F456L mutations, often referred to in the media as FLiRT. These variants are not expected to be associated with increased infection severity or to significantly reduce vaccine effectiveness.

From Airfinity’s curated analysis of various health and media sources and from the ECDC (European Centre for Disease Prevention and Control) Weekly Communicable Disease Threats Report:

• The outbreak of highly pathogenic avian influenza (HPAI) A(H5N1) in cattle is still ongoing, with 69 farms affected across nine states of the US.
• As of today, there have been three human cases of avian influenza A(H5N1) reported in workers at US dairy farms with infected cows.
• No meat from affected dairy cows has entered the food supply.
• To date, routine population-based surveillance has not detected any increase in community rates of respiratory infections.

• Hospitals in the US are no longer required to report COVID-19 hospitalisations. Meanwhile, reported COVID-19 oral antiviral uptake and COVID-19 hospitalisations correlate well with SARS-CoV-2 wastewater concentration, indicating that wastewater can provide suitable metrics.

• There has been a global post COVID-19 pandemic resurgence of pertussis, also known as whooping cough. Pertussis is caused by a highly contagious bacterium and typically has a cyclical pattern returning every 3 to 5 years, varying by country. Whooping cough is preventable with a 3-dose vaccine (which also includes diphtheria and tetanus) given to small children, but recent vaccine hesitancy has resulted in an unexpected comeback of the disease. Since vaccine coverage is lowest in Africa and Oceania, these continents could be at highest risk.

• Measles cases have been detected in at least 118 countries worldwide since the start of the year.  According to the US CDC, travellers to areas where measles has been surging  are at risk if they have not been fully vaccinated at least two weeks prior to departure or have not had measles in the past. The majority of measles cases imported into the US have occured in unvaccinated residents who became infected during international travel.

• Thirteen cases of invasive meningococcal disease (IMD) serogroup W have been reported from France, Norway, UK, and US. The cases are epidemiologically linked to religious practices in the Umrah zones in the Kingdom of Saudi Arabia (KSA). International spread of IMD associated with mass gatherings during pilgrimages in the KSA has been reported in the past. Vaccination against meningococcus is recommended for those travelling to KSA to perform Umrah and for Hajj pilgrims – this year, the annual Islamic Hajj pilgrimage will take place between 14 and 19 June.