Three human cases of H5 bird flu reported in California

Three human cases of H5 bird flu reported in California

In October 2024, the United States CDC reported a third human case of H5 bird flu in the state of California. This announcement followed the identification of two human cases just a week before. All three cases have reported occupational exposure to infected dairy cows, but none has been hospitalised. The CDC risk assessment for the public remains “low”.  

Three cases reported 

The first two human cases were reported on 3rd October 2024 in people with occupational exposure to infected dairy cows. H5N1 outbreaks in dairy herds were first reported in California in August 2024. The cases had no known link or contact, indicating separate instances of animal-to-human spread. Sequences from these cases confirmed clade 2.3.4.4b A(H5N1) viruses, closely related to viruses detected in dairy cattle. Whole genome sequencing from one of the cases confirmed a B3.13 genotype virus. 

“There were no genetic changes observed that are known to be associated with an increased ability to infect or spread between people or known to reduce susceptibility to antiviral medications.” 

The third case, reported on 9th October 2024, also reported occupational exposure and no known contact with the other cases. Sequencing of this case is underway. The infected people experienced “mild” symptoms, including conjunctivitis. None of the three cases has been hospitalised.  

The broader risk 

CDC’s risk assessment for the general public is still “low”. This case takes to total human cases of H5 bird flu to 17 in 2024. Cases have been reported in Texas (1), Michigan (2), Colorado (10), Missouri (1), and California (3). Only one case, in Missouri, has not had source confirmation. The agency emphasises the importance of recommended precautions for people with exposure to infected or potentially infected animals.  

At the Congress in Barcelona this month we will explore avian influenza during the One Health and Veterinary track, considering the role of vaccination in One Health strategies and learning from our experts’ experiences. Get your tickets to join us there and don’t forget to subscribe to our weekly newsletters for more health news.  

WHO mpox update: 14 countries in “active” outbreaks

WHO mpox update: 14 countries in “active” outbreaks

A recent WHO situation report on the mpox PHEIC reveals that 14 countries on the continent have reported mpox cases in the last six weeks and are considered to have “active” outbreaks. The most affected country in 2024 is still the Democratic Republic of the Congo (DRC), which recently announced the start of an mpox vaccination campaign. The update presents reported confirmed mpox cases and deaths as well as reported suspected mpox cases, as defined by the countries that have reported them.  

Risk levels 

The report presents the mpox risk of geographical spread and potential impact on health in various regions: 

  • Eastern Democratic Republic of the Congo and neighbouring countries: high 
  • Areas of the Democratic Republic of the Congo where mpox is endemic: high 
  • Nigeria and other areas of West, Central, and East Africa where mpox is endemic: moderate 
  • All other countries in Africa and around the world: moderate  

However, the report notes that individual country or regional bloc assessments may vary, and the risk could be assessed as low. Individual-level risk is “largely dependent on individual factors” like exposure risk and immune status.  

Cases 

By 29th September, 14 countries on the continent have reported mpox cases in the last six weeks. The most affected country in 2024 is the Democratic Republic of the Congo (DRC) with 5,610 confirmed cases and 25 deaths, followed by Burundi, with 853 confirmed cases and no deaths, and Nigeria, with 78 confirmed cases and no deaths. Although the epidemic curve of confirmed cases by country suggests a decline in reported cases in DRC, this trend “should be interpreted with caution” amid “reports of limited testing and stockout of testing supplies”.  

Focus on North Kivu 

As of 28th September 2024, the province of North Kivu in DRC had reported 323 confirmed mpox cases, including two confirmed deaths. After initial detection in May 2024 genomic sequencing analysis revealed clade Ib monkeypox virus (MPXV). There are 34 health zones in North Kivu; 14 have reported confirmed mpox cases, The most affected zones are Goma, Karisimbi, and Nyiragongo. 1,108 suspected mpox cases in North Kivu have been tested with a test positivity of 29%. The number of confirmed cases in the province continues to increase. 

Among confirmed cases, 117 (36%) are individuals living in camps for Internally Displaced People (IDP), in the three most affected health zones. 13 IDP camps have reported at least one mpox case; the most affected are Munigi, Mugunga, Rusayo, and Kanyaruchinya. 8 out of 14 IDP camps (57%) have reported only one case, which indicates sporadic introduction, likely from outside the camp. Transmission may be sustained in the other six, which show more cases over time.  

In North Kivu, around 50% of confirmed mpox cases are among adults and 54% of total cases are male. However, in IDP camps, approximately 75% of mpox cases are among children up to 17 years old and are evenly distributed between males and females. WHO believes that mpox transmission in North Kivu is “exclusively” human-to-human, mainly at the community level. 117 out of 323 (36%) cases have a known epidemiological link. The mode of transmission for 109 cases (34%) is reported to be sexual contact; among these cases, 57 (52%) are reported among female sex workers.  

216 out of 323 (67%) cases have recovered from the disease; 109 are in isolation, 33 in the household, and 76 in healthcare facilities. 19 (9%) cases have presented complications and two have died in hospital.  

Clade Ib detected in India 

On 1st October 2024, the Ministry of Health and Family Welfare of India notified WHO of the first mpox case due to MPXV clade Ib. The National Focal Point reports that the case is an adult male, Indian national, with a recent history of international travel to the United Arab Emirates (UAE). The patient developed mpox symptoms on 8th September in UAE before arriving in India on 13th September. On 16th September he was admitted to a public hospital.  

On 19th September, samples were tested at the National Institute of Virology (NIV) in Pune, confirming MPXV infection. The patient recovered without complications and was discharged on 30th September 2024. The health authorities in UAE are conducting a detailed case and contacts investigation to finalise the “comprehensive verification and validation process as per IHR procedures”.  

This is the second reported case of this clade MPXV infection in the WHO South-East Asia Region (SEAR) and the third reported case of clade Ib MPXV infection outside the African Region. However, the first clade Ib infection in SEAR, reported in Thailand, and the clade Ib infection in Sweden, had a recent history of travel to affected countries in Africa, which this case did not.  

Vaccine updates 

WHO indicates that it is finalising the issuance of prequalification age extension of MVA-BN for persons 12-17 years old after European Medicines Agency (EMA) authorisation. It is providing “strategic and technical support” to the African Vaccine Regulatory Forum (AVAREF) and issuance of emergency use authorisation for MVA-BN to national regulatory authorities. In collaboration with AFRO, DRC, Ghana, Nigeria, Rwanda, and Tanzania, WHO is harmonising the cohort safety event monitoring protocol following mpox vaccination and ensuring global data collection.  

With receipt of 265,000 doses of MVA-BN, DRC has begun a vaccination campaign in North Kivu with the intention of expanding to 11 of the most affected health zones across various provinces.  

Join us at the Congress in Washington in April next year to reflect on the global response to this outbreak and hear updates on continued mpox vaccine development, and don’t forget to subscribe to our weekly newsletters for more insights.  

Rwanda reports its first Marburg outbreak with six deaths

Rwanda reports its first Marburg outbreak with six deaths

In September 2024, WHO’s Regional Office for Africa announced that Rwandan health authorities are “intensifying outbreak control efforts” after detecting Marburg virus disease in the country for the first time. 26 cases have been confirmed in seven of the country’s districts, and six deaths have been reported. The health authorities are implementing “comprehensive response measures” and an investigation to determine the origin of the outbreak. WHO states that it is supporting these efforts with expertise and tools. 

Cases reported and response triggered 

26 cases have been reported; 20 are in isolation and receiving treatment, and six deaths have been recorded. 161 contacts of the reported cases have been identified so far and are being monitored. The Ministry of Health, Rwanda, posted a video on social media with a caption reassuring viewers that “people can continue with their daily activities” and “should not panic” as the “hotspots of the disease” have been identified.  

WHO is “mobilising” expertise and outbreak response tools to “reinforce the control measures” that are being rolled out. A consignment of clinical care and infection prevention and control supplies will be delivered from the WHO Emergency Response Hub in Nairobi, Kenya, to Kigali in the next few days. Efforts are also underway to “reinforce collaborative cross-border measures for readiness and response” in countries that neighbour Rwanda.  

WHO Regional Director for Africa, Dr Matshidiso Moeti, explained that the critical outbreak response aspects are being put in motion “rapidly” to “halt the spread of this virus swiftly and effectively”.  

“With the country’s already robust public health emergency response system, WHO is collaborating closely with the national authorities to provide the needed support to further enhance the ongoing efforts.” 
Marburg  

Marburg virus disease is a “highly virulent” member of the filoviridae family and causes haemorrhagic fever. It has a fatality ratio of up to 88%, with symptoms progressing rapidly after infection. The virus is transmitted to humans from fruit bats and spread among people through direct contact with the bodily fluids of infected people, surfaces, and materials.  

The disease was first recognised after large outbreaks in Germany and Serbia in 1967, associated with laboratory research involving African green monkeys from Uganda. Outbreaks and cases have been reported sporadically since then, and efforts have been made to develop effective medical countermeasures. However, there is no licensed vaccine against Marburg virus disease. 

A confluence of infectious disease 

The Marburg outbreak will increase pressure on the Rwandan health system, which is already fighting its mpox outbreak, declared on 27th July 2024. In September 2024, Dr Jean Kaseya, Director-General of Africa CDC, reported that Rwanda had begun an mpox vaccine campaign after receipt of 1,000 doses. The campaign targeted districts bordering the Democratic Republic of the Congo, the epicentre of the current PHEIC. How will the health services respond effectively to both infectious disease threats, and will there be similarities or ‘doubling up’ in their strategies? 

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Chikungunya in India has a “notorious edge this year”

Chikungunya in India has a “notorious edge this year”

The Times of India reported in September 2024 that cases of chikungunya in children were symptomatic of a “shift” in epidemiology. Case numbers have increased and are more frequently requiring hospitalisation, particularly among children. While these changes are cause for concern for some infectious disease experts, they are careful to emphasise the need for thorough research. Indeed, the increase in cases may be attributed to improved surveillance efforts.  

Cases in children 

The latest report suggests that in Maharashtra, a populous state in the west of India, cases have exceeded 2,600 since the start of the year. This is a 50% increase on the previous year, and the disease is “increasingly” affecting children, some of whom require time in intensive care. Dr Sachin Shah, neonatologist at Surya Hospital in Pune, is concerned by the number of children suffering: 

“In my OPD for older children, it is the most common complaint this week.” 

Five newborns were diagnosed with chikungunya in Pune, two of whom acquired it from their mothers. Dr Shah described high-grade fever, elevated liver function, and low appetite among the symptoms. One neonate developed a “life-threatening disorder” characterised by hyper-inflammation. Infectious disease specialist at H N Reliance Hospital in Girgaum notes the change in severity among patients who are admitted to hospital. 

“Chikungunya has acquired a notorious edge this year.” 

This change is also observed by Dr Anita Mathew, infectious disease specialist at Fortis Hospital, Mulund, who has had patients require ICU attention.  

“The extreme symptoms are new to Mumbai, but are not unknown in medical literature.” 
Is this new? 

While some experts are questioning this “shift” in disease, others are wary of sounding the alarm. Dr Radhakrishna Pawar of the state health department acknowledged the change in clinical appearance but urged further investigation. 

“We need to study it in detail before making such claims.” 

Furthermore, while cases have increased, Dr Pawar noted that they do not reach the numbers required to qualify as an outbreak or epidemic.

Vaccine access 

Although there is a licensed chikungunya vaccine to address the “significant unmet medical need” presented by chikungunya, Valenva’s IXCHIQ is only currently approved in the United States, Europe, and Canada. However, Valneva is “focussed on expanding the vaccine’s label and access”, working with CEPI to support access in LMICs, post-marketing trials, and potential label extensions.  

For the latest on infectious disease management with vaccine innovation, join us at the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.  

CDC: confirmed human avian influenza case in Missouri

CDC: confirmed human avian influenza case in Missouri

The United States CDC confirmed in September 2024 that a human case of avian influenza A(H5) has been reported by the state of Missouri. The case was identified through seasonal flu surveillance and an investigation into the potential exposure is underway at the Missouri Department of Health and Senior Services (DHSS). The patient was hospitalised but has been discharged and has made a recovery. This is the 14th human case of H5 reported in the United States in 2024 but the first without a known occupational exposure to sick or infected animals. 

The case 

Missouri DHSS states that this case was identified through “ongoing influenza surveillance”. The Missouri State Public Health Laboratory received specimen taken from a patient who was hospitalised on 22nd August. The patient has underlying medical conditions and tested positive for influenza A. The laboratory conducted further testing to determine the influenza subtype, which resulted in “presumptive detection of the H5 subtype”. The specimen was then sent to CDC for additional testing, when H5 subtype was confirmed. The patient has recovered and returned home. Notably, this is the first case of H5 without a known occupational exposure to sick or infected animal. No H5 outbreaks in cattle have been reported in Missouri, but H5 outbreaks have been reported in commercial and backyard poultry flocks.  

CDC risk assessment 

CDC continues to describe the risk to the public from H5N1 as “low”, and recommendations have not changed. However, the agency recognises that “circumstances may change quickly” as information emerges.  

“The results of this investigation will be particularly important in light of the current lack of an obvious animal exposure.” 
More questions arise 

As the available information on this case is limited, public health experts have urged a step up in surveillance and public health communication. Professor Marion Koopmans, head of the Erasmus Medical Centre Department of Viroscience, told STAT that a “better safe than sorry” investigation would be encouraging.  

“I would want to see a wide net cast here… [this would] not have to be all in the public eye, but I would want to know this is [being] taken up very seriously.”  

Another expert, University of Saskatchewan’s emerging infectious disease specialist Dr Angela Rasmussen, was unimpressed with the delay in reporting the case. 

“The choice to drag their feet and give no details about follow up is mystifying and reflects very poorly on both Missouri state and federal epidemic response capacity and practice.”  

Dr Rasmussen tweeted that “this is being presented like it’s a triumph for flu surveillance” but finds it “pretty unbelievable” that there’s “no information about how the case is being investigated”.  

The threat of avian influenza will be explored in a panel at the Congress in Washington next April, welcoming public health experts including senior representatives from the United States. Join us there by getting your tickets today, and don’t forget to subscribe for weekly vaccine newsletters here.  

WHO: cholera cases increase and OCV stockpile under pressure

WHO: cholera cases increase and OCV stockpile under pressure

In September 2024 WHO published the global cholera statistics for 2023, revealing an increase in cases and deaths. The current global risk from cholera is described as “very high”; WHO is responding “with urgency” to reduce deaths and contain outbreaks. The increased demand for cholera countermeasures, including the oral cholera vaccines (OCV), has applied pressure to disease control efforts. However, WHO emphasises the importance of “safe drinking water, sanitation, and hygiene” as “the only long-term and sustainable solutions”. 

Cases increase 

103 countries shared cholera data with WHO in 2023, revealing that the 7th cholera pandemic “continued to surge”. 535,321 cases were reported to WHO from 45 countries, territories, and areas. This is an increase from 472,697 in 2022. The geographical pattern of outbreaks continued to evolve, with a 32% reduction in the number of cases reported in countries in the Middle East and Asia and a 125% increase in cases in Africa.  

Very large outbreaks (>10,000 suspected and confirmed cases per country) were reported by 9 countries on 3 continents in 2023: Afghanistan, Bangladesh, the Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Malawi, Mozambique, Somalia, and Zimbabwe. This is 2 more than in 2022 and “more than double” the number of very large outbreaks reported annually between 2019 and 2021. It is possible that increased case numbers are attributable to efforts to enhance cholera surveillance and reporting.  

“Conflict, climate change, limited investment in development, and population displacement due to emerging and re-emerging risks all contributed to the rise in the number of cholera outbreaks.” 
OCV stockpile 

The International Coordinating Group (ICG) manages the oral cholera vaccine (OCV) emergency stockpile; in response to limited OCV availability the ICG made the “unprecedented decision” to temporarily suspend the standard 2-dose regimen in outbreak response campaigns in October 2022. This has been replaced with a single-dose approach, which has continued throughout 2023 and into 2024. It enables available vaccines to protect more people and facilitates more responses to cholera outbreaks.  

Although evidence on the duration of protection is “limited”, the strategy has “proven effective” in outbreak responses. Despite low availability, a record 35 million doses were shipped last year. The last doses of Shancol were distributed in 2023 after the product was discontinued in 2022. The new simplified OCV, Euvichol-S, prequalified in early 2024, is expected to enter the global market later this year. This will increase the global stockpile. While investment into vaccine production continues, the supply constraint is expected to continue into 2025.  

WHO states that it is continuing to support countries with “strengthened public health surveillance, case management, and prevention measures”. Since 2022, US$18 million has been released from the WHO Contingency Fund for Emergencies. Although WHO has appealed for US$50 million to respond to cholera outbreaks in 2024, the need “remains unmet”.  

To contribute to vaccine strategy discussions about using available countermeasures to limit the effects of infectious disease outbreaks, get your tickets to the Congress in Barcelona now. Don’t forget to subscribe to our weekly newsletters here.

Paper details H5N1 detection in Antarctic Region

Paper details H5N1 detection in Antarctic Region

A paper in Nature communications in September 2024 reports on the detection H5N1 high pathogenicity avian influenza virus (HPAIV) in the Antarctic, where HPAIV had “never previously been detected”. After initial detection in brown skuas at Bird Island, South Georgia, in October 2023, H5N1 HPAIV was confirmed across several sampling locations in multiple avian species and two seal species. It was also confirmed in southern fulmar and black-browed albatross in the Falkland Islands. The article describes the detection, species impact, and genetic composition of the virus, proposing introductory routes and potential long-term effects on avian and mammalian species in the region.  

HPAIV in the Antarctic region 

The Antarctic region comprises the ice shelves, water, and island territories in the Southern Ocean inside the ‘Antarctic Convergence’ or ‘Antarctic Polar Front’, a marine belt where Antarctic waters meet the warmer sub-Antarctic waters. HPAIV had not previously been reported inside the region, which hosts “unique ecosystems which support the population strongholds of several avian and marine mammal species”. Although the “relative isolation” of the islands from human populations offers some protection from “anthropogenic environmental change”, wildlife populations in the Antarctic face varied challenges, from introduced species to longline fisheries and rapid climate change.  

Several native bird species are listed as vulnerable or endangered. Iconic long-lived species with late maturity exhibit “low resilience to rapid increases in population mortality”. Thus, high mortality disease outbreaks represent a “substantial threat to already vulnerable seabird populations”. Several seabird species range between the South Atlantic and Southern Ocean, heading to the South American coast to forage or overwinter. 

Birds like brown skuas, kelp gulls, southern giant petrel, and snowy sheathbills are known to be potential vectors of infectious pathogens to the ecosystem because of the migratory traits, scavenging behaviour, and acknowledged roles as carriers of low pathogenicity avian influenza viruses (LPAIV).  

Detection of H5N1 

The authors report the discovery of a southern giant petrel “showing behaviours indicative of loss of coordination, neurological twitching, and lethargy” by researchers of the British Antarctic Survey (BAS) on Bird Island, South Georgia, on 17th September 2023. The bird was observed being preyed and scavenged upon by brown skuas and other southern giant petrels. On 8th October, brown skuas in the same area were found showing lethargy, neck spasms, twitching, and an inability to fly. By 10th October, bird mortality was seen on Bird Island; highest mortality occurred at the roosting site of non-breeding birds. Swab samples, taken from three brown skuas on 8th October and a further brown skua on 11th October, yielded PCR positivity for HPAIV H5N1. The birds were later found dead.  

More positive samples were identified throughout October and November; by 17th November 57 skuas were observed to have died at Bird Island. On 27th November, a South Georgia shag tested positive from King Edward Cove, and an Antarctic tern sampled dead on 6th December. In early December, clinical disease consistent with mammalian infection with HPAIV was observed in colonies of southern elephant seal and Antarctic fur seal. Clinical presentation included difficulty breathing and individuals showed accumulation of viscous fluid around the nasal fluid. Five southern elephant seals and one Antarctic fur seal samples were collected on 9th December, testing positive for the virus.  

Between the initial detection on 8th October and 9th December, 33 avian carcasses and 17 mammalian carcasses were sampled; these included representatives of five avian species and two mammalian species from eight different locations. 66% tested positive for HPAIV H5N1.  

On 30th October, a southern fulmar was reported dead on Stanley, Falkland Islands, and tested positive for the virus. Swabs were taken from various avian species across the Falkland Islands, but only three black-browed albatrosses tested positive from Saunders Island (1) and Steeple Jason (2). Between 30th October and 10th December, samples were taken and tested from 13 carcasses from nine different bird species. 31% tested positive for HPAIV H5N1.  

The importance of data sharing 
“Both the Falkland Islands archipelago and South Georgia represent key areas that are host to significant avian biodiversity and the presence of HPAIV on these islands represents a significant risk to the susceptible bird populations.” 

South Georgia, home to around 29 avian species that breed on the island, is a recognised “Important Bird Area”. Any colony or population threatened by an outbreak of HPAIV on the island could affect the wider population of seabirds. Although seabird colonies show space partitioning between colonies, a “high degree of species overlap” is observed, often attributed to the movement of nonbreeders or juvenile birds. Interactions would aid the spread of disease. 

Further potential for spread arises from “interlinkages between avian and mammalian species” testing positive for H5N1. Circumpolar and trans-Pacific migrants, like the grey-headed albatross and southern giant petrels, may facilitate this spread. Indeed, a threat of transmission to New Zealand and Australia is inferred from phylogeographic analysis that revealed a dynamic geneflow between southern Atlantic populations and Macquarie Island.  

A key element in the “cycle of risk” is the opportunity for infection of scavenging birds, exacerbated by the impossibility of carcass removal, disposal, and environmental clean-up. The region is “one of the most remote environments on earth”, and the potential for virus survival in the cold environment is increased. Furthermore, local ecology of species could “influence the scale of impact”.  

“Critically, assessment of sequences derived from mammalian species did not indicate any adaptive mutations of increased risk to human populations.” 

The authors emphasise that their data does not indicate any increased risk of infection from the viruses. While there were no mutations that would affect the susceptibility to antivirals, they highlight the need for “continual monitoring”. This is particularly pertinent where the virus appears to be the causative agent of mortality events in seals or other avian species where scavenging occurs.  

“Clearly, with continual infection events occurring in mammals globally it is of great importance to understand where mutations may represent a genuine zoonotic risk as well as understand where adaptations that have occurred in mammals become tolerated in avian species.”  

The paper concludes that the current impact is “relatively minimal” for avian species. Despite observations of infection and significant mortality events in fur and elephant seals, the authors find no evidence of viral adaptation for enhanced infection of mammals. Thus, they do not predict an increased risk to human populations on the islands. However, the global release of data “restricts a fulsome interpretation”. With limited numbers of sequences available in public databases, interpretation is limited.  

“This factor, as with countless other studies, highlights the importance of real-time global data sharing as a key tool in understanding the emergence and spread of these viruses. The current lack of publicly available data precludes a conclusive assessment of potential incursion routes.” 

For insights into avian influenza during the One Health and Veterinary track in Barcelona this October, get your tickets here. Don’t forget to subscribe to our weekly newsletters for regular vaccine and infectious disease updates.  

Poliovirus detection in Gaza prompts vaccination campaign

Poliovirus detection in Gaza prompts vaccination campaign

The detection of poliovirus environmental samples from Khan Younis and Deir al-Balah in July 2024 has led to the initiation of an inoculation campaign intended to reach more than 640,000 children. The campaign is supported by a US$5 million pledge from the United Arab Emirates (UAE) and delivered in collaboration with WHO, UNICEF, and UNRWA. The Global Polio Eradication Initiative (GPEI) describes the campaign as a “critical effort to prevent an outbreak” in the territory, which has recorded the first case of paralytic polio in 25 years.  

Poliovirus detected 

WHO warned in August 2024 that poliovirus was detected on 16th July 2024 in environmental samples from Khan Younis and Deir al-Balah, collected on 23rd June 2024. Sequencing analysis confirmed that the circulating variant type 2 poliovirus (cVDPV2) isolates are linked to a variant poliovirus strain that was last detected in Egypt in 2023. Since then, three children have presented with suspected acute flaccid paralysis (AFP), a “common symptom” of polio. Stool samples have been sent for testing at the Jordan National Polio Laboratory.  

Circulating vaccine-derived polioviruses (cVDPVs) are a “rare” but increasing form of polio that presents a risk due to “low immunisation rates within communities”. GPEI emphasises the “many benefits” of the oral polio vaccine (OPV) but highlights that the vaccine virus is excreted in the stool. In communities with low immunisation rates the virus can mutate and spread, leading to cVDPVs.  

Humanitarian pauses 

WHO and UNICEF urged “all parties to the conflict” to implement “humanitarian pauses” in the Gaza Strip for seven days. This would allow two rounds of vaccination campaigns to be conducted. In each round, the Palestinian Ministry of Health (MoH), collaborating with WHO, UNICEF, UNRWA, and partners, will provide two drops of novel oral polio vaccine type 2 (nOPV2) to more than 640,000 children under the age of ten.  

More than 1.6 million doses were expected by the end of August and “detailed plans” to support vaccinators and social mobilisers in reaching eligible children were finalised. 708 teams, involving around 2,700 health workers, will deliver the campaign. To prevent the spread of polio and reduce the risk of re-emergence, WHO aims for “at least” 95% vaccination coverage in each round of the campaign, recognising the “severely disrupted” health, water, and sanitation systems.  

WHO shares mpox update: newly affected countries

WHO shares mpox update: newly affected countries

In August 2024 WHO shared a disease outbreak update on the mpox situation in Africa, presenting information on the latest countries that are reporting cases. The outbreak was declared a PHEIC by WHO and PHECS by Africa CDC, prompting efforts to secure vaccines for the continent. In the update, WHO states that epidemiological data reveal that clade Ib has been spreading “rapidly” through close physical contact; this includes sexual contact identified within “networks of sex workers and their clients”.  However, the affected groups are changing as the virus spreads.  

Newly affected countries 

The following countries are the latest in the African Region to report cases of mpox, either clade I or clade II, since the multi-country outbreak began in 2022.  

  • Burundi – an outbreak was declared on 25th July 2024 after confirmation of three cases. These are the first confirmed mpox cases identified in Burundi. By 17th August, there were 545 alerts of mpox cases, of which 474 suspected cases were investigated and validated. Of 358 suspected cases tested, 142 tested positive for MPXV and genomic sequencing analysis has confirmed clade Ib. No deaths had been reported as of 17th August. Confirmed cases were reported from 26 of 49 districts. Males account for 55.6% of cases and females 44.4%. Children under 5 years were 60.3% of cases, followed by those aged 11 to 20 (42.6%) and those aged 21 to 30 (38.2%).  
  • Kenya – on 29th July a confirmed case of mpox was identified in Taita Taveta County; the patient is a 42-year-old male with a history of travel from Uganda to Kenya. At the time of identification, he was travelling to Rwanda through Tanzania. By 13th August, a total of 14 suspected cases had been identified; one case tested positive for MPXV clade Ib. 12 of the suspected cases tested negative with one outstanding result. No deaths had been reported as of 13th August. This is the first mpox case identified in Kenya.  
  • Rwanda – on 24th July WHO was notified of two laboratory-confirmed mpox cases and an outbreak was declared on 27th July. The cases included a 33-year-old female and a 34-year-old male, both with travel history to the Democratic Republic of the Congo. They are the first confirmed mpox cases identified in Rwanda. By 7th August, four confirmed mpox cases and zero deaths had been reported with close contacts of the cases under follow up. Sequencing analysis confirmed MPXV clade Ib.  
  • Uganda – after enhanced surveillance for mpox disease was initiated in June and early July in response to reported cases in the Democratic Republic of the Congo, six suspected cases were identified on 11th July. Two samples tested positive for MPXV clade Ib on 15th July. These are the first mpox cases identified in the country, but investigations suggest that transmission occurred outside Uganda. By 12th August, 39 suspected cases had been reported. No deaths have been reported.  
  • Côte d’Ivoire – in July 2024, Côte d’Ivoire confirmed two non-fatal cases of mpox with no epidemiological link. By 7th August, seven mpox cases had been confirmed in three health districts. Four of the confirmed cases (57%) are male, and all seven cases are above 15 years old. Forty contacts are being followed up. Although the country has previously reported mpox, no cases had been notified since the start of the multi-country outbreak in 2022. The latest cases belong to clade II.  
Risk of outbreak evolution 

WHO assessed the risk of mpox separately; the risk in the eastern Democratic Republic of the Congo and neighbouring countries is “high” and in Côte d’Ivoire and other West African countries it is “moderate”. However, there is “concern” that the outbreak in Africa will continue to evolve as: 

  • There is evidence of possible under-detection and under-reporting. 
  • Although governments have activated emergency responses, resources to respond remain limited in some countries.  
  • Measures to support adequate patient care and introduce vaccines for people at risk are not currently in place in most countries. Acquisition and roll-out will require time before implementation.  
  • Some of the countries have not reported mpox before, which means public awareness and knowledge and capacity for identifying the disease remains limited.  
  • The global multi-country outbreak of mpox is ongoing. Countries outside Africa are still detecting sporadic cases and the unprecedented increase of cases in the African Region increases the risk of further transmission.  

To join colleagues in considering the role of vaccines in better outbreak preparedness and response at the Congress in Barcelona, get your tickets here, and don’t forget to subscribe to our weekly newsletters for the latest infectious disease updates.  

Sweden reports case of mpox clade 1 after PHEIC declared

Sweden reports case of mpox clade 1 after PHEIC declared

In August 2024 the Public Health Agency of Sweden announced that a person who sought care at Region Stockholm has been diagnosed with mpox caused by the clade 1 variant. This is the first case caused by clade 1 to be identified outside the African continent. The notification from the Public Health Agency came shortly after WHO declared the mpox outbreak in the Democratic Republic of the Congo and neighbouring countries a public health emergency of international concern (PHEIC).  

The infection in Sweden 

Professor Magnus Gisslén, state epidemiologist at the Public Health Agency of Sweden stated that the person developed the infection during a visit to a part of Africa where there is a major outbreak of mpox clade 1. This person has received “care and rules of conduct”. 

“This case does not require any additional infection control measures in itself, but we take the outbreak of clade 1 mpox very seriously. We are closely monitoring the outbreak and we are continuously assessing whether new measures are needed.”   

Although previous cases of mpox in Sweden have been clade 2, the Public Health Agency highlights its “preparedness to diagnose, isolate, and treat people with mpox safely”. Sweden also has access to vaccines and antivirals.  

A “concerning” development 

Dr Jonas Albarnaz, Research Fellow at The Pirbright Institute, describes the case of clade 1 mpox in Sweden as “concerning for two main reasons”. 

“First, this is the first clade 1 mpox virus outside Africa. This indicates that the extent of the international spread of clade 1 outbreak in DRC might be larger than we knew yesterday. And second, clade 1 mpox virus is associated with a more severe disease and higher mortality rates than the clade 2 virus responsible for the international mpox outbreak in 2022.”  

Although it is “hard to predict” further cases of this clade outside Africa, Dr Albarnaz states that this case is a “warning call” to be “vigilant and implement robust surveillance and contact-tracing strategies”.  

Associate Professor of Immunology at the University of Cambridge, Dr Brian Ferguson agrees that this case is a “concerning development”. However, it is “not surprising, given the severity and spread of the outbreak in Africa”. Furthermore, there will “likely be more here and in other parts of the world” as there are “no mechanisms” to prevent imported cases. Dr Ferguson comments on the timing of this case, under 24 hours after the PHEIC declaration and 15 months after the end of the previous mpox PHEIC.  

“The lack of activity in the intervening period has resulted in what could now become a new global outbreak. There should have been a greater effort to produce and distribute vaccines to the affected areas, but this has not happened. It is possible to address these problems, but this requires rapid international co-operation.”  

Professor Francois Balloux, Professor of Computational Systems Biology and Director, UCL Genetics Institute, emphasised that there is “no evidence for transmission in Europe at this stage”. However, it is “to be expected” that other imported cases” will be identified outside Africa soon.  

At the Congress in Washington in April 2025 our vaccine and public health experts will share insights on mpox, so do get your tickets to contribute to these important discussions, and don’t forget to subscribe to our weekly newsletters here.  

UKHSA data shows resistant gonorrhoea rising in England

UKHSA data shows resistant gonorrhoea rising in England

Data from the UK Health Security Agency (UKHSA) shared in August 2024 reveals a “concerning rise” in antibiotic-resistant gonorrhoea infections in England. In 2023 over 85,000 gonorrhoea diagnoses were reported in England; this is the highest number since records began in 1918. There were also 15 confirmed cases of infection with ceftriaxone-resistant Neisseria gonorrhoeae detected in England between June 2022 and May 2024. Since the initial case detected in England in 2015, there have been a total of 31 ceftriaxone-resistant Neisseria gonorrhoeae cases. UKHSA highlights the importance of “regular” STI testing, particularly for people who have “condomless sex with new or casual partners”.  

Developing resistance 

Gonorrhoea is the second most commonly diagnosed sexually transmitted infection (STI) in England. In 2023 the highest annual number of diagnoses (85,223) since records began was reported. The bacteria, Neisseria gonorrhoeae, has developed resistance to every class of antibiotics used to treat it. Cephalosporins are the last remaining class of antibiotics available for use as empirical monotherapy. The recommended first-line therapy is 1g ceftriaxone (a cephalosporin), but there are “sporadic” cases of infection with ceftriaxone-resistant N. gonorrhoeae.  

16 cases were reported between 2015 and May 2022; since then, a further 15 ceftriaxone-resistant infections have been detected in England. Five of these recent cases were extensively drug-resistant (XDR). All 31 cases detected in England have been among heterosexual individuals, mostly in their 20s, and “most” have acquired infection in the Asia-Pacific region, which is the region with the highest prevalence of ceftriaxone-resistance.  

UKHSA response 

UKHSA has sent a clinical alert to sexual health services to “reinforce the need” to culture gonococcal isolates, perform test-of-cure, and refer all ceftriaxone-resistant N. gonorrhoeae strains or potential treatment failures to UKHSA. It also emphasises the importance of correct and consistent condom use to the public.  

Dr Helen Fifer, Consultant Microbiologist at UKHSA, highlighted a concern that gonorrhoea could become “untreatable” in the future.  

“Untreated gonorrhoea can lead to serious health issues, including pelvic inflammatory disease and infertility. Condoms are the best defence, but if you didn’t use one with a recent new or casual partner, get tested to detect the infection and prevent onwards transmission.”  

Professor Matt Phillips, President of the British Association for Sexual Health and HIV (BASHH) described the rise of these antibiotic-resistant infections as a “worrying trend” that “must be addressed with immediate action”.  

“Antibiotic resistance of STIs poses an increasingly major public health threat, which can create physical and psychological harms and place additional demands on other parts of the NHS.” 

Professor Phillips stated that BASHH and sector partners have “repeatedly called” for a sexual health strategy for England. 

“This must be a priority if our expert sexual health workforce are to effectively meet these growing and changing needs in sexual health.”  

In January 2024 CARB-X announced funding for Intravacc’s vaccine efforts against gonorrhoea, which you can read about here. We also look forward to further exploring the role of vaccines in addressing the growing challenge of N. gonorrhoeae at the Congress in Barcelona this October, so get your tickets to join us there, and don’t forget to subscribe to our weekly newsletters here.  

WHO declares “worrying” mpox outbreak a PHEIC

WHO declares “worrying” mpox outbreak a PHEIC

After a meeting of an International Health Regulations (IHR) Emergency Committee on 14th August 2024, WHO Director-General Dr Tedros Adhanom Ghebreyesus announced that the mpox outbreak in the Democratic Republic of the Congo (DRC) and a “growing number” of countries in Africa constitutes a public health emergency of international concern (PHEIC). Dr Tedros’ decision is based on the advice of the Emergency Committee’s, comprising independent experts, who met to review data. The Committee considered the “upsurge” in mpox a PHEIC with potential to spread throughout Africa and outside the continent.  

Opening remarks 

Dr Tedros opened the meeting, commenting on a significant increase in reported cases in the Democratic Republic of the Congo. The emergence and “rapid spread” of clade 1b and its detection in neighbouring countries is “especially concerning”, and Dr Tedros suggested that this was “one of the main reasons” for his decision to convene the Committee. Not only is the emerging clade a concern, but “we are dealing with several outbreaks of different clades in different countries”.  

“Stopping these outbreaks will require a tailored and comprehensive response, with communities at the centre, as always.”  

WHO is reportedly already working with governments in the affected countries, as well as Africa CDC and other partners, to “understand and address the drivers of these outbreaks”. It has also developed a regional response plan, which will require an initial US$15 million for surveillance, preparedness, and response activities. $1.45 million has been released from the WHO Contingency Fund for Emergencies; more is planned to be released in the coming days but WHO is also appealing to donors for funding.  

The standing recommendations under the IHR, issued at the declaration of the end of the previous mpox PHEIC, were due to expire next week. However, Dr Tedros elected to extend them for another year. 

PHEIC declared 

Dr Tedros will share the Committee meeting reporting and issue temporary recommendations to countries. As he declared the PHEIC, he highlighted the need for a “coordinated international response” to “stop these outbreaks and save lives”. WHO Regional Director for Africa Dr Matshidiso Moeti echoed this, commenting that “significant efforts are already underway”. 

“With the growing spread of the virus, we’re scaling up further through coordinated international action to support countries bring the outbreaks to an end.”  

Chair of the Committee, Professor Dimie Ogoina, stated that this is an emergency “not only for Africa, but for the entire globe”.  

“Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.” 
Infectious disease inequality 

Vaccine efforts have already begun, with donations of Bavarian Nordic’s vaccine secured by HERA. However, Dr Boghuma Tianji, Assistant Professor of Medicine, Department of Medicine at Emory University, identified a tension over donations. 

“While there has been substantial criticism of foreign donors for inadequate support, the over-reliance on external aid has highlighted a major flaw in the current response efforts.”  

Indeed, the PHEIC declaration in 2022 “did not lead to significant improved access” for African countries. Professor Jonathan Ball, Deputy Director of Liverpool School of Tropical Medicine and Professor of Molecular Virology, Liverpool School of Tropical Medicine (LSTM) hoped that international recognition of the emergency will “kick-start mobilisation of the necessary infection control measures”.  

“Low- and middle-income countries suffer most from infectious diseases yet have insufficient capacity for surveillance and control. Infectious diseases thrive on these health inequalities so it is essential for other countries to help build capacity – infections do not respect international borders, so this isn’t just someone else’s problem.” 

Professor Marion Koopmans, Head of the Institute for Virus Research and Director of the Pandemic and Disaster Management Centre, Erasmus University Rotterdam, shared insights into the significance of the declaration before it was announced. 

“It raises the level of alert, globally, and may allow WHO to access funds for emergency response. Other than that, the same priorities remain: investing in diagnostic capacity, public health response, treatment support, and vaccination.” 

At the Congress in Washington in April 2025 our experts will explore pressing mpox challenges including in the context of vaccine prioritisation, strategy, and communication. Get your tickets to join us there and don’t forget to subscribe to our weekly newsletters here.   

Africa CDC declares mpox PHECS and prepares for vaccines

Africa CDC declares mpox PHECS and prepares for vaccines

In August 2024 Africa CDC declared the mpox outbreak a Public Health Emergency of Continental Security (PHECS), which enables the organisation to “lead and coordinate responses to significant health emergencies”. This is the first such declaration by Africa CDC since its launch in 2017. On the same day Bavarian Nordic announced an order from HERA (European Health Emergency Preparedness and Response Authority) for the FDA- and EMA-approved MVA-BN vaccine. HERA is to procure 175,420 doses for donation to Africa CDC, to which Bavarian Nordic will add 40,000 doses.  

PHECS 

Under Article 3, Paragraph F of the Africa CDC Statutes Africa CDC can lead and coordinate responses to significant health emergencies, such as those declared PHECS or Public Health Emergency of International Concern (PHEIC). Africa CDC has established a 25-member Incident Management Team based at the epicentre of the epidemic with a mandate to support affected and at-risk countries.  

The declaration of a PHECS: 

  • Enables the mobilisation of resources across affected countries 
  • Unlocks essential funding 
  • Strengthens Risk Communication and Community Engagement (RCCE) 
  • Boosts surveillance and laboratory testing efforts 
  • Enhances human resource capacities to respond effectively to mpox through a One Health approach 

Africa CDC Director General Dr Jean Kaseya highlighted that the declaration signifies the mobilisation of “our institutions, our collective will, and our resources to act – swiftly and decisively”.  

“This empowers us to forge new partnerships, strengthen our health systems, educate our communities, and deliver life-saving interventions where they are needed most.” 

However, Dr Kaseya identifies “no need for travel restrictions”.  

The tip of the iceberg for Africa 

Africa CDC states that “at least 13” African countries have reported mpox outbreaks, including “previously unaffected nations”. Suspected cases on the continent have “surged past 17,000”, but this is “just the tip of the iceberg” as there are “many weaknesses in surveillance, laboratory testing, and contact tracing”.  

Between May 2022 and July 2023 mpox was considered a Public Health Emergency of International Concern (PHEIC) by WHO, but Africa “did not receive the support it urgently needed during this period”. Indeed, as global cases declined the “escalating numbers” in Africa were “largely ignored”. Therefore, Dr Kaseya called for a change in the international approach and close collaboration with Africa CDC. 

“We call on you to stand with us in this critical hour. Africa has long been on the frontlines in the fight against infectious diseases, often with limited resources.” 

Dr Kaseya urged the global community to offer “support, expertise, and solidarity”.  

“The world cannot afford to turn a blind eye to this crisis.”  

Professor Salim Abdool Karim, head of the AIDS research programme CAPRISA, chaired the Africa CDC Emergency Consultive Group (ECG) that reached a unanimous decision on the emergency declaration.  

“The number of cases has significantly increased compared to 2022 when WHO declared mpox a public health emergency. It’s clear that we’re facing a different scenario with far more cases, resulting in a higher burden of illness.” 

Additionally, Dr Karim raised concerns about fatalities, including a potential link between HIV and mpox. 

“Our concern is that we may be seeing more fatalities in Africa due to the association with HIV.”  
Vaccine hope 

As Dr Kaseya commented on the need for “10 million doses to effectively control the outbreak”, Bavarian Nordic announced a HERA order for 175,420 doses, which will be supplemented by 40,000 donated doses. Although only two African countries have granted Emergency Use Authorisation for the MVA-BN vaccine, WHO requested that Bavarian Nordic submit an Expression of Interest for Emergency Use Listing.  

Stella Kyriakides, European Commissioner for Health and Food Safety highlighted the importance of “strong global partnerships”. As health security threats “know no borders”, the collaboration between the EU Commission, Africa CDC, and Bavarian Nordic will make doses available to “protect the most vulnerable”. 

“Preparedness and response to health threats is a global endeavour which we are determined to pursue collectively and with solidarity across borders.” 

Bavarian Nordic’s President and CEO is “proud to support” the contribution of vaccines to the region and “pleased to announce an additional donation”.  

“We also applaud the initiatives from the Africa CDC and WHO to strengthen and coordinate the public health response, helping to ensure our vaccine can reach more people on the African continent.”  

Bavarian Nordic returns to the Congress in Washington 2025 to share insights into vaccine progress, so do get your tickets to meet senior representatives there. For more updates on the evolving outbreak and vaccine responses don’t forget to subscribe to our weekly newsletters here.  

Before mpox emergency meeting WHO prepares for vaccine EUL

Before mpox emergency meeting WHO prepares for vaccine EUL

In August 2024 WHO issued an invitation for manufacturers of mpox vaccines to submit an Expression of Interest for Emergency Use Listing (EUL). This came shortly after the Director-General, Dr Tedros Adhanom Ghebreyesus, announced that he has decided to convene an Emergency Committee under the International Health Regulations to advise on the need to categorise the outbreak as a public health emergency of international concern (PHEIC). As the outbreak evolves and cases are reported in previously unaffected regions, WHO is making efforts to ensure resources are available to address the situation.  

Director-General’s comments 

At a media briefing on 7th August 2024, Dr Tedros Adhanom Ghebreyesus stated that the DRC has reported more than 14,000 mpox cases and 511 deaths since the beginning of the year. Although DRC has been reporting outbreaks of mpox “for decades”, the number of reported cases has been “increasing steadily” every year. The number of cases reported in the first six months of this year “match the number reported in all of last year”. Additionally, recent confirmed and suspected cases have been reported in DRC-neighbouring countries that have previously not reported cases: Burundi, Kenya, Rwanda, and Uganda.  

The Director-General noted that the current outbreak in the Eastern DRC is caused by a “new offshoot” of mpox clade I, known as clade 1b. This causes “more severe disease” than clade 2, which caused the 2022 global outbreak. In other parts of DRC, along with Central African Republic and the Republic of Congo, cases of clade 1a have been reported. Clade 2 is reported in Cameroon, Côte d’Ivoire, Liberia, Nigeria, and South Africa.  

While WHO works with governments in the affected countries, Africa CDC, and partners, to “understand and address the drivers” of the outbreaks, Dr Tedros highlighted the need for a “comprehensive”, community-centred response. Dr Tedros elected to convene an Emergency Committee, setting the date for Wednesday 14th August. This step will bring expert advice on whether the outbreak is a public health emergency of international concern. From there, Dr Tedros will be advised on temporary recommendations for prevention and disease management. 

Vaccines to the fore 

Two mpox vaccines have been approved by WHO-listed national regulatory authorities and are recommended by WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE). Dr Tedros has “triggered the process” for Emergency Use Listing (EUL) of both vaccines to accelerate vaccine access, particularly for lower-income countries. EUL also allows partners like Gavi and UNICEF to procure vaccines for distribution.  

WHO also issued an invitation for mpox vaccine manufacturers to submit an Expression of Interest for EUL. The procedure is “specifically developed to expedite the availability of unlicensed medical products” for use in public health emergency situations. WHO requests that manufacturers submit data to demonstrate that their vaccines are safe, effective, of assured quality, and suitable for target populations. 

At the Congress in Barcelona this October, we will hear from vaccine safety experts about post-authorisation safety and effectiveness evaluation of vaccines that are deployed through emergency use authorisation. To join us, do get your tickets here, and don’t forget to subscribe to our weekly newsletters here.

UKHSA’s whooping cough warning as cases exceed 10,000

UKHSA’s whooping cough warning as cases exceed 10,000

Data from the UK Health Security Agency (UKHSA) released in August 2024 reveal that 10,493 laboratory confirmed cases of pertussis in England were reported between January and June 2024. This compares with 856 laboratory confirmed cases reported in 2023. Since the outbreak began in November 2023, there have been 10 reported infant deaths; 9 of these deaths were reported between January and June 2024. UKHSA continues to urge pregnant women to get vaccinated to “protect their babies from birth onwards”.  

Cases “notably high” 

The last major outbreak of pertussis was recorded in 2012, followed by a cyclical increase in 2016; it is a cyclical disease that peaks every 3 to 5 years. Pertussis activity was “exceptionally low” in England between April 2020 to Summer 2023. Although numbers in 2023 “remained lower than pre-pandemic years”, an increase has since been observed in all age groups and in “every region” in England.  

10,493 cases were confirmed between January and June 2024. Around half of these cases (5,769) were in people aged 15 years or older; 2,226 cases were reported in children aged 10 to 14 years and 1,253 cases in children aged 5 to 9 years. 328 cases were reported in infants younger than 3 months. These infants are at highest risk of severe disease and are too young to be fully vaccinated.  

Vaccination in pregnancy 

Although vaccination in pregnancy is “key to passively protecting babies” before they are “directly protected” through the infant vaccine programme, maternal vaccine uptake is declining. Uptake fell from 74.7% in December 2017 to 58.9% in March 2024. Pertussis vaccination is recommended in every pregnancy and is often administered around the time of the mid-pregnancy scan. To give maximum protection, the vaccine should be given before 32 weeks.  

Dr Mary Ramsay, UKHSA’s Director of Immunisation, emphasises that vaccination is the “best defence against whooping cough”. 

“It is vital that pregnant women and young infants receive their vaccines at the right time.” 

As cases continue to rise and infant deaths are recorded, Dr Ramsay states that “ensuring women are vaccinated in pregnancy has never been more important”. 

“Our thoughts and condolences are with those families who have so tragically lost their baby.” 

The team at UKHSA return to the Congress in Barcelona to share their insights with the community in October, so do get your tickets to join these discussions and don’t forget to subscribe for weekly vaccine updates.  

PAHO alert warns of growing Oropouche virus danger

PAHO alert warns of growing Oropouche virus danger

The Pan American Health Organisation (PAHO) issued an epidemiological alert in August 2024 that urged Member States to “strengthen surveillance and implement laboratory diagnosis” to address the increase in cases of Oropouche virus (OROV). In 2024 there has been a rise in reported cases, which includes areas that previously had no reported cases, and there have been fatal cases associated with OROV infection.  

What is Oropouche fever? 

PAHO states that Oropouche fever has “historically” been transmitted through the bite of a Culicoides in the Amazon. However, factors such as “climate change, deforestation, and unplanned urbanisation” have enabled a spread to non-Amazonia states in Brazil and countries that previously had no reported cases, such as Cuba. Symptoms include a sudden onset of fever, severe headache, pain, and vomiting or diarrhoea, and generally last up to a week.  

OROV can be confirmed by molecular diagnosis, but the clinical presentation is like other arboviral infections. This, combined with a “lack of systematic surveillance in many countries”, means that countries may be underestimating the frequency of disease. There are no vaccines or specific antiviral drugs to prevent or treat OROV infection, so the treatment approach is palliative 

The situation so far 

From epidemiological week (EW) 1 to EW 29 of 2024 there were 8,078 confirmed Oropouche cases, including two deaths, reported in the Region of the Americas. The cases were distributed among five countries in the Region: 

  • The Plurinational State of Bolivia – 356 cases 
  • Brazil – 7,284 cases, 2 deaths 
  • Colombia – 74 cases 
  • Cuba – 74 cases 
  • Peru – 290 cases 

Brazil has reported one foetal death and one miscarriage in the state of Pernambuco, as well as four cases of newborns with microcephaly. A further three possible cases of vertical transmission and their consequences are being investigated, also in Pernambuco, in relation to three foetal deaths.  

PAHO emphasises the importance of disease diagnosis and clinical management, reminding Member States that they should report any “related unusual event”, including deaths associated with OROV infection and possible cases of vertical transmission.

To get regular updates on infectious diseases across the globe, why not subscribe to our weekly newsletters here? 

Cape Town considers seal vaccination amid rabies concern

Cape Town considers seal vaccination amid rabies concern

The City of Cape Town, South Africa, shared the results of an expert scientific workshop convened in partnership with the Department of Forestry, Fisheries, and the Environment (DFFE), the Two Oceans Aquarium Foundation, and Sea Search. The workshop focused on a perceptible increase in “unusual and unprovoked” Cape Fur Seal bites and aggression in the Western Cape, which is “directly linked” to the confirmed presence of the rabies virus in some of these seals.  

Aggression in seals linked to rabies 

Although “some levels” of aggression in seals is regarded as “normal” and result from factors such as “territorial behaviour, maternal protectiveness, pain or distress” and poor health, the statement notes “excessive aggression associated with unusual behaviour”. This change in behaviour is being attributed to the presence of rabies in the seal population. Rabies is reportedly “well-established in the Cape Fur Seal population” and “unlikely to be eradicable”. Therefore, it is now considered endemic, requiring “ongoing and long-term management”.  

It is suggested that rabies was transmitted to these seals from another wildlife population, rather than local domestic dogs. While other animals can experience a “slow burn” of “flares and declines”, there are concerns that seals are different to these populations as they are “highly gregarious animals living in very large colonies”.  

“Given that this is the first documented rabies infection in a marine mammal population there are many unknowns.” 
The response 

Coastal authorities are working with the State Vet, veterinary experts, researchers, marine mammal experts, and animal welfare organisations to implement “ongoing proactive measures” to manage the outbreak. Measures include: 

  • Reporting 
  • Ongoing surveillance 
  • Possible euthanasia 
  • Research partnerships 
  • Vaccination  
  • Testing 
Vaccination concerns 

There are “over 2 million” Cape Fur Seals across Southern Angola and the Eastern Cape, so vaccination of the wild population is “not considered viable or possible”. However, a vaccination strategy could be useful. A vaccination trial focusing on animals that come into regular contact with humans was “strongly recommended”; the Two Oceans Aquarium is to develop a standard procedure for vaccinating seals. Visiting elephant seals and Sub-Antarctic fur seals will also be vaccinated as a precautionary measure. Vaccinated seals will be tagged where possible.  

Public health 

The public health advisory remains that rabies vaccines are “not recommended for the general public at this time”. However, anyone who is bitten or scratched by a seal resulting in an open wound must seek medical attention immediately and receive post-exposure prophylaxis. Domestic dogs should have up to date vaccines and owners must ensure that their dogs avoid contact with seals.  

For more on developing effective vaccination strategies for animal populations, why not join us at the Congress in Barcelona and attend our One Health and Veterinary track? Get your tickets here, and don’t forget to subscribe for more vaccine updates! 

Africa CDC shares update on mpox situation in Africa

Africa CDC shares update on mpox situation in Africa

Africa CDC shared a situation update on mpox on the African continent in July 2024. This reveals that between January 2022 and July 2024 a total of 37,583 cases and 1,451 deaths have been reported. The Case Fatality Rate (CFR) is 3.9%. 15 African Union Member States have reported these cases. In 2024 alone (until July 2024), a total of 14,250 cases and 456 deaths (CFR of 3.2%) have been reported from 10 Member States. This represents a 160% increase in cases and a 19% increase in deaths compared to the same period in 2023.  

A worrying increase 

Over the past two years the 15 Member States that have reported mpox cases are: Benin, Burundi, Cameroon, Central African Republic (CAR), Congo, Democratic Republic of Congo (DRC), Egypt, Ghana, Liberia, Morocco, Mozambique, Nigeria, Rwanda, Sudan, and South Africa. In 2024 the following countries have reported cases: 

  • Burundi – 8 cases, 0 deaths 
  • Cameroon – 35 cases, 2 deaths 
  • CAR – 213 cases, 0 deaths 
  • Congo – 146 cases, 1 death 
  • DRC – 13,791 cases, 450 deaths 
  • Ghana – 4 cases, 0 deaths 
  • Liberia – 5 cases, 0 deaths 
  • Nigeria – 24 cases, 0 deaths 
  • Rwanda – 2 cases, 0 deaths 
  • South Africa – 22 cases, 3 deaths 

Further to these cases, Chad has reported 24 suspected cases but no confirmed cases. DRC accounts for 96.3% of all cases and 97% of all deaths in 2024.  

High geoscope and risk 

Africa CDC ranks the geographic scope (geoscope) for mpox in Africa as “high”. Considering the morbidity and mortality, probability of spread, and availability of effective control measures, the risk assessment is also “high”.  

“While mpox is moderately transmissible and usually self-limiting, the case fatality rate has been much higher on the African continent compared to the rest of the world. Despite a safe and effective vaccine and antiviral treatment against mpox, these are not readily available.”  
Africa CDC’s response 

The update concludes with a few “key ongoing activities” contributing to Africa CDC’s participation in mpox preparedness and response: 

  • Activation of the Emergency Operations Centre (EOC) to enhance coordination and provide technical support to Member States 
  • High-level political advocacy and agenda setting 
  • Deployment of the Africa CDC Rapid Response Team to DRC to support response efforts including coordination, surveillance and contact tracing, field investigation, and strategy development 
  • Laboratory support – providing RT-PCR test kits and ancillary supplies and training participants in sample processing, RT-PCR-based detection, sequencing, and molecular diagnosis 
  • Training and resources – a four-module animated course for public health professionals, policymakers, and health workers in endemic areas with information on mpox prevention, detection, treatment, patient care, infection control, and outbreak investigation 
  • Collaboration with partners  
  • Advocating for strengthened surveillance, diagnostic capacities, and access to vaccines and medical drugs 

For more on using available vaccines to control outbreaks across the world, why not join us in Barcelona for the Congress this October? Don’t forget to subscribe to our weekly newsletters here for infectious disease insights.  

Chandipura virus detected in India “needs more research”

Chandipura virus detected in India “needs more research”

In July 2024 Indian news outlets reported cases and deaths of suspected Chandipura virus (CHPV) in Gujarat. 8 children are said to have died already, with more “battling for their lives”. Samples have been sent to the National Institute of Virology (NIV) in Pune for confirmation, and Gujarat’s Health Minister Rushikesh Patel stated that the deaths can be attributed to the virus “after the reports come in”. There are no approved vaccines or treatments. 

CHPV 

Chandipura virus (CHPV) is an arbovirus of the Vesiculovirus genus in the Rhabdoviridae family. Among identified Vesiculoviruses, CHPV is “considered to be the most significant pathogen of public health importance” with a high case fatality ratio. It was first isolated in 1965 but has been considered an “orphan or concomitant virus” due to low pathogenicity to cause human or domestic animal infections. 

CHPV causes two types of encephalitis: infection-related and auto-immune induced. It is “most commonly” associated with encephalitic sickness in children, clinically defined by a short high-grade fever, altered sensorium, vomiting, generalised convulsions, and decerebrate posture. This can lead to a grade IV coma and death within 48 hours of hospitalisation.  

The situation in Gujarat 

Telegraph India reports that cases have been identified in the Sabarkantha, Aravalli, Mahisagar, Kheda, Mehsana, and Rajkot districts. Since 10th July, 14 people have become ill, of whom 8 have died. The National Institute of Virology has received samples to confirm infection.  

Experts comment 

Weighing in on the apparent evolution of the disease manifestation and vector, Dr Sandipkumar Trivedi is quoted identifying a “new presentation” of two brain haemorrhages among the six deaths. Furthermore, sandflies have been found at “higher heights” than the usual 3 feet from the ground and “new outbreak centres” are emerging.  

Dr Sayan Chakraborty of Manipal Hospital, Calcutta, is concerned that “this is a very rare form of virus” that “needs more research”. Dr Chakraborty wonders if it “thrives more in dry climate” and reflected that without specific treatment options the only solution is symptom management.  

“Only symptomatic treatment is possible in the absence of any anti-viral and take proper care of the patient in an intensive care unit.”  

Dr Abhishek Tiwari from ILS Hospitals, Calcutta, urged parents to be careful of insect bites and “keep our homes and surroundings clean”. 

“Prevention is the only way out.” 

If a child develops a sudden fever or falls unconscious “he or she should be immediately hospitalised”.  

For more on emerging and re-emerging infectious diseases and vaccine development to address them, do join us in Barcelona for the Congress this October or subscribe to our weekly newsletters here.