INTERNATIONAL AIRLINE MEDICAL ASSOCIATION

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

  • At least 29 countries, mostly in Europe, Far East and North America, have now reported detection of the BA.2.86 SARS-CoV-2 variant from human samples or wastewater. This variant is likely to be more widespread than that detected. The number of hospitalisations has fallen and risen in the last few weeks, with a recent uptick in countries like UK, Italy and Canada. From the previous status report: despite the large number of mutations of the variant, with high immune escape potential, at this point BA.2.86 appears less immune-invasive than feared, as well as less infective. 
  • Over 5,000 cholera infections have been reported in a current outbreak in Zimbabwe. Social restrictions are being put in place to contain the outbreak, e.g., banning of large gatherings at funerals, a recommendation against shaking hands, eating at gatherings and buying food from unlicensed vendors in Harare (my note: these measures have been called lockdown-style measures by some, which strictly speaking is a misnomer in this context). A previous cholera outbreak in Zimbabwe in 2008 affected more than 100,000 people and was fatal for around 4,000.
  • A fourth US state (Arkansas) has reported a locally transmitted malaria infection for 2023. The cumulative total of cases of locally acquired malaria in the US this year is now ten (one P falciparum, 9 P vivax).
  • The surge of dengue fever continues, with significant impact in Bangladesh. In the US, a cumulative total of 53 cases have been reported in Florida. In Europe, the total number of clusters of autochthonous dengue virus transmissions identified is up to six in mainland France and three in Italy (From the ECDC Communicable Disease Threats Report (week 39)).
  • Good news: Egypt is on track to achieving the WHO's hepatitis C elimination goal by the year 2030. No further Nipah virus infections have been confirmed in Kerala since mid-September.

There is a WHO “EPI-WIN” Webinar covering Zika virus: learning from the past, preparing for the future, on 30 August 2023 at 1300-1415 Geneva Time (CEST). The webinar can be viewed live and post-event on the channel here: EPI-WIN YouTube channel.

EG.5, the latest “Variant of Interest” is described in a JAMA piece here:  https://jamanetwork.com/journals/jama/fullarticle/2808762

Meanwhile the very rare variant BA.2.86 has a large number of mutations representing a step change, and is being watched closely.  It has been sequenced from patients in Denmark, USA, UK, Israel and South Africa, and also found in wastewater in Switzerland, Thailand and USA. It is likely to be more widespread than this.  There is discussion about the possible ramifications of the variant here: https://www.nature.com/articles/d41586-023-02656-9

Vector-borne diseases:

In this update, note that malaria is on the rise in South Korea. An interesting media piece on a potentially important malaria discovery here: https://www.bbc.com/news/health-66394117

Also:  France confirmed two locally acquired dengue fever cases in the Bouches-du-Rhône department in Southern France. More cases could be detected in the coming weeks in the area or any other department due to the presence of Aedes albopictus mosquitoes in more than two thirds of French departments.

The large dengue outbreak in Bangladesh meanwhile continues to cause major challenges. 

A few headline items as usual on various disease outbreaks (sources: Airfinity, WHO, etc):

No additional MERS-CoV cases have been detected in the United Arab Emirates, since the previously reported case on 10 July in Al Ain.

Cholera incidence rises once again in Zimbabwe, while the outbreaks in other African countries are slowing down.

Pakistan confirms another poliomyelitis case.  Afghanistan and Pakistan have reported a very small number of polio infections in their region this year, fuelling expectations they could be just months away from interrupting the endemic transmission of the crippling virus.

Note increasing COVID-19 hospitalisations (mirroring increased detection in wastewater) in North America, particularly US, and UK with a high rate of the variant EG.5.1. 

West Nile Fever increasing in Europe.

A WHO EPI-WIN webinar on dengue fever is available to view on the WHO EPI-WIN site. 

As of end of July, highly pathogenic avian influenza has been detected across 20 fur farms in Finland, with 50,000 mink and foxes to be culled across fur farms heavily infected with avian influenza. Mink is a problematic species as it can be an effective intermediate host for avian influenza, facilitating the virus to mutate more effectively into a more virulent form that can infect humans.

COVID-19 Antigen tests missed 90% of asymptomatic cases in this prospective volunteer trial of over 5000 volunteers by a Massachusetts group, Soni et al. https://www.acpjournals.org/doi/10.7326/M23-0385

Consider that in context with the report I shared previously on a breath testing device https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(23)00149-4/fulltext

An impressive study from Augusto et al https://www.nature.com/articles/s41586-023-06331-x with commentary in Nature here: https://www.nature.com/articles/d41586-023-02318-w “found a link between asymptomatic infection and an HLA mutation carried by about 10% of the study’s population. People with the mutated gene were twice as likely to remain asymptomatic as were people without it; people with two copies of the gene were eight times as likely.”

Many of the earlier trends continue with areas facing dengue, and areas facing cholera, in big numbers. And there is even a locally acquired cholera case in Italy (Sardinia) reported today. 

Fiji has been on red alert as leptospirosis incidence has been rising – 29 confirmed cases as of 22 June, with just one fatality.  Note that the actual number of cases is probably greater, with 42 admissions for suspected leptospirosis.

Florida chalked up six cases of local malaria. 

Anthrax in Indonesia is approaching 100 cases. 

COVID-19 cases and deaths in US and Europe low and continuing to fall.

A couple more articles on aircraft wastewater testing, one journal and one in media:

Shingleton et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10286959/ https://time.com/6286825/covid-19-variant-tracking-airports-cdc/

The journal article is from the UK Health Security Agency and considers the potential for wastewater testing as an alternative to individual passenger screening, applied to the example of SARS-CoV-2. 

This is interesting from Nature on “supershedders” outlining data from a study back in 2021 in which people were deliberately infected with COVID-19 – a small number of individuals emitted much more airborne virus than the remainder.  In fact, two of the 36 individuals were responsible for 86% of the total emitted virus. 

https://www.nature.com/articles/d41586-023-01961-7

Zhou et al: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(23)00101-5/fulltext