Covid 19 Resources Center

Headlines on infectious diseases (Sources: Airfinity, Nature, Promed):

Crimean-Congo haemorrhagic fever in several middle Eastern locations, and also posing some threat to Europe, with cases now in Georgia.

Cholera and measles significantly burden African countries while dengue continues to claim lives in Asia and South America. 

The outbreak of Lassa fever in Nigeria has been mentioned in previous reports.

Anopheles stephensi, the malaria-spreading mosquito which is resistant to insecticides and well adapted to urban life, has been detected in urban Kenya.

Murray Valley encephalitis in Australia – 14 cases (5 fatal) in 4 Australian states, the most recent one in Western Australia.  Australia has also reported some cases of meningitis and an outbreak of Legionnaire’s disease in Melbourne.

Further to the WHO announcement (see last update) on COVID-19, the IATA response to the end to the PHEIC status is here: https://www.iata.org/en/pressroom/2023-releases/2023-05-06-01/    Also, here is the commentary in Nature: https://www.nature.com/articles/d41586-023-01559-z

Current trends with COVID are the usual mixed picture, as illustrated by rates continuing to decline in India, but trebled over the past month in China (both trends probably related to XBB.1.16 which is now at 10% of new sequences globally) and rising in Indonesia.   

As the pandemic transitions to something that has been termed a “permademic” (an extended health threat before it settles into “background” or endemic), the threat of highly pathogenic avian flu (H5N1) is on the horizon at an unknown distance. 

An analysis by BlueDot assesses the overall risk to humans as low but increasing.  It points to an exponential increase in wild birds rather than domestic poultry and a series of “unusual mortality events” amongst mammals since 2022 (in USA, Spain and Peru), with genetic adaptations for mammals.  It notes that CDC assesses the current H5N1 vaccine candidate, and existing antivirals, as likely to provide good protection/efficacy.  (Source: BlueDot). 

Most of you will have seen that on the advice of the relevant Emergency Committee, WHO’s Director-General announced the end of the Public Health Emergency of International Concern status of COVI19, moving it instead to the status of an ongoing health threat, with a plan to develop standing recommendations which are more enduring.  Here’s the committee statement:

https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic

The key headline sentence is:

The WHO Director-General concurs with the advice offered by the Committee ….. determines that COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC). 

Here’s an article published as a pre-print in Lancet Global Health, proposing a global network of aircraft wastewater screening as part of a surveillance system for novel variants of SARS-CoV-2 and other organisms:
https://authors.elsevier.com/sd/article/S2214-109X(23)00129-8

In the last week WHO launched an initiative “PRET” (Preparedness and Resilience for Emerging Threats) with a three day global meeting for future respiratory pandemic pathogens, which IATA participated in.  This shows promise in terms of a practical start to preparedness, in advance of the more major, long-term structural changes around IHR reform and a new Treaty or Instrument for pandemic response.   The call to action was in three parts:  Update preparedness plans that affirm priority actions; Increase connectivity among stakeholders in pandemic preparedness planning through systematic coordination and cooperation; and Dedicate sustained investments, financing and monitoring of pandemic preparedness.  Here is the WHO statement from the launch workshop:  https://www.who.int/news/item/26-04-2023-who-launches-new-initiative-to-improve-pandemic-preparedness

Marburg

The Marburg virus disease outbreaks (as of 14th April) have reached 38 cases (15 confirmed) and claimed 11 lives (79% CFR of confirmed cases) in Equatorial Guinea along with 8 cases and 5 deaths in Tanzania (63% CFR).  This CFR is typical of past outbreaks, but the occurrence of two simultaneous epicentres is unusual.

Recently WHO advised 26 countries had implemented measures to impede the spread of the virus.   Note that the WHO statement on Marburg advises against travel or trade restrictions with Equatorial Guinea or Tanzania.  See recent updates:  https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON451
https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON459

Marburg

BlueDot recently published an analysis of the risk relating to Marburg virus disease.  Bearing in mind the mode of spread and the travel patterns for the area and beyond, they assess the outbreak as having high concern regionally (Tanzania and neighbouring countries) but low internationally.  Similarly, WHO’s risk assessment is of high risk domestically, moderate risk sub-regionally, and low risk globally.   The forecast highest frequency overseas destination from Tanzania is Dubai (at 18% of traffic), followed by DRC and Kenya (via land borders). 

We see that a number of Middle Eastern countries (including Oman, Kuwait, UAE, Bahrain, Qatar), Indonesia, and others have advised their citizens against non-essential travel to the countries reporting Marburg cases.  Given that the mode of spread requires close contact with people or animals who are symptomatic at the time, this travel advisory seems inappropriately cautious.  Other advised precautions are more reasonable, including avoidance of sick people, of bats and their caves/mines, and of contact with others’ body fluids. 

Marburg has now reached at least 34 cases (including 30 deaths) in Equatorial Guinea.