by Charlotte Kilpatrick | Jul 15, 2024 | Infection |
The Colorado Department of Public Health and Environment announced in July 2024 that, in coordination with the Colorado Department of Agriculture, the State Emergency Operations Centre, and CDC, it is reporting a total of five human cases of avian influenza. The cases were identified in workers “responding to the avian flu outbreak at a commercial egg layer operation”. The CDC has confirmed four of the cases with the fifth “presumptive positive” but pending confirmation.
Poultry workers
The cases are among workers who were culling poultry at a farm in northeast Colorado. They exhibited “mild” symptoms including conjunctivitis (pink eye) and common respiratory infection symptoms. None were hospitalised. It is suspected that these cases are a result of working with infected poultry, but an investigation is underway with CDC support.
On Friday 12th July Colorado Department of Public Health and Environment (CDPHE)’s State Public Health Laboratory sent three samples to CDC for confirmatory testing. A fourth was detected by the State Lab on Friday evening and has been confirmed by CDC. The fifth case sample was presumptive positive at the State Lab on 13th July. There are no further test results pending.
Experts concerned
Although CDC’s risk assessment for the general public remains “low”, experts are expressing concern at the apparent lack of control over the evolving situation. Dr Seema Lakdawala of Emory University told Fortune that “we are on the brink of this being really already in humans” which would be a “real problem to control”.
“I will tell you that what has been driving me the past few months is trying to prevent H5 from becoming a pandemic…I have never felt that were as close as we are now.”
Dr Lackdawala is also surprised that vaccine stockpiles “haven’t been leveraged” to protect farmworkers. Dr Rick Bright, former BARDA director, is also sounding the alarm on the government’s lack of investigation.
“I’d like to see them swabbing from not just the symptomatic people that they’ve talked about, but also asymptomatic people on the same farm, in the family circle unit, and in the community. And I’d like to see them taking blood samples for serology testing.”
Dr Bright is also alarmed by the fact that “we have not seen increased transparency from the USDA”, which is causing confusion through delayed and disordered data.
“It’s ridiculous…By not being transparent and timely with their data, the USDA is really forcing a lot of guesswork.”
As the more cases emerge, the pressure mounts on US agencies to demonstrate an effective response. Managing the avian influenza crisis is a key theme at both the Barcelona Congress this October and the Washington Congress next April, so join us to have your say on the situation, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 11, 2024 | Infection |
In July 2024 the UKHSA shared data revealing that cases of whooping cough are still increasing with 2,591 cases confirmed in May. A significant number of these cases are reported in babies under 3 months old, who are at greatest risk from the infection. Sadly, there have been 8 infant deaths already this year. UKHSA urges vaccination in pregnancy to protect against infant death.
Cases on the rise this year
In England, 7,599 laboratory confirmed cases of pertussis were reported to UKHSA between January and May 2024. Case numbers have been increasing each month: 555 in January, 920 in February, 1,427 in March, 2,106 in April, and 2,591 in May. In this time there have also been 8 reported infant deaths. Of the total cases between January and May 2024, around half (53.4%) were in patients aged 15 years or older and 23.0% were in children between the ages of 10 and 14 years.
The number of confirmed cases in infants under 3 months, the age group most at risk of severe disease and too young to be fully vaccinated, reached a high of 407 in the 2012 outbreak. Between January and May 2024 there were 262 infants under 3 months with confirmed pertussis.
The increase, observed since December 2023, is attributed to a “combination of factors”. Whooping cough is a cyclical disease with peaks every 3 to 5 years; the last cyclical increase occurred in 2016. During the COVID-19 pandemic, restrictions and public behaviours drove case numbers down. A peak year is therefore “overdue”.
Vaccination during pregnancy
Young children are at highest risk of severe complications and death, but vaccination at the “right time” in pregnancy is “highly effective”, providing 92% protection against infant death. However, vaccination in pregnancy uptake data reveal a continued decline; coverage in March 2024 was 58.9% compared to the peak coverage of 72.6% in March 2017.
Dr Mary Ramsay, UKHSA Director of Immunisation, describes vaccination as the “best defence against whooping cough”.
“It is vital that pregnant women and young infants receive their vaccines at the right time. Pregnant women are offered a whooping cough vaccine in every pregnancy, ideally between 20 and 32 weeks.”
Vaccination in pregnancy “passes protection” to the baby for the first months of life when they are “most vulnerable” and too young for their own vaccines. Dr Ramsay offered “thoughts and condolences” to the families who have “so tragically lost their baby” in the outbreak and emphasised the importance of “ensuring women are vaccinated appropriately in pregnancy”. England’s Chief Midwifery Officer, Kate Brintworth, shared “real concern” at the rise in cases and deaths.
“I would urge pregnant women to get vaccinated to help protect their babies in the first few weeks of their life. You can speak with your GP or maternity team if you have any questions about the vaccine.”
Brintworth stated that the NHS is continuing to “identify areas at greater risk” and respond with “robust local vaccination offers”.
“Women can access the vaccine, which also protects against diphtheria and tetanus, through their GP or some antenatal services, and parents should also ensure that their children get protected in the first few months after birth as part of the routine NHS vaccine offer.”
For more from senior representatives of UKHSA at the Congress in Barcelona, get your tickets to join us, and don’t forget to subscribe to get weekly vaccine updates here.
by Charlotte Kilpatrick | Jul 10, 2024 | Infection |
In July 2024, WHO shared a disease outbreak news update on the mpox situation in South Africa. It stated that, between 8th May and 2nd July 2024, the International Health Regulations (IHR) National Focal Point (NFP) of the Republic of South Africa had notified WHO of 20 confirmed mpox cases, including three deaths. Response measures have been implemented with WHO support, but it warns that “confirmed cases are only a small proportion of all cases that might have occurred, and that community transmission is ongoing”.
Cases reported to WHO
WHO was notified of 20 confirmed mpox cases between 8th May and 2nd July 2024, including three deaths. This means that the case fatality ration (CFR) is 15%. The cases were reported in three of nine provinces: Gauteng, Western Cape, and KwaZulu-Natal. The cases are all males between the ages of 17 and 43 years and are “almost all self-identified as men who have sex with men (MSM)”. Most are persons living with HIV, unmanaged or recently diagnosed HIV infection and advanced HIV disease (AHD), and one person has diabetes.
All cases were symptomatic with “extensive” skin lesions; 18 required hospitalisation. None of the cases reported a history of international travel or attendance of high-risk social gatherings. The type of exposure reported is sexual contact. For the first 16 cases, 44 contacts were identified in KwaZulu-Natal, 39 in Western Cape, and 55 in Gauteng province. Although three of the four initial cases in KwaZulu-Natal were epidemiologically linked, at least seven in Gauteng province were not, which suggests that community transmission is taking place.
Genomic sequencing from five confirmed cases identified sub-clade IIb MPXV; this is the clade linked to the multi-country outbreak.
WHO’s assessment
WHO states that the “sudden” appearance of unlinked cases without a history of international travel, the high HIV prevalence among confirmed cases, and the high case fatality ratio indicate that community transmission is underway. Therefore, the cases detected to date likely represent a “small proportion” of cases in the community and it is unknown how long the virus has been circulating. This is partly attributed to the “lack of early clinical recognition” of infection with which South Africa gained “little experience” during the ongoing global outbreak, potential pauci-symptomatic manifestation of disease, or delays in care-seeking behaviour due to “limited access to care of fear of stigma”.
Most of the transmission in the initial cases is linked to recent sexual contacts among men, so the risk for gay men, bisexual men, other men who have sex with men, trans and gender diverse people, and sex workers is “moderate” in comparison with the “low” risk to the wider public in the country. WHO refers to recent Joint United Nations Programme on HIV/AIDS (UNAIDS) data, which estimate HIV prevalence among MSM in South Africa to be around 30%, with only 44% of this group receiving antiretroviral therapy. This group is “extremely vulnerable” to severe mpox disease and death.
Risk of evolution
WHO is concerned that the outbreak in South Africa will “continue to evolve” considering:
- The high likelihood of under-detection and under-reporting of local transmission, given that reported cases have almost exclusively affected the most vulnerable
- All detected cases have presented with severe disease and extensive skin lesions, which could lead to more viral transmission and risks poor outcomes for patients
- Although government and partners are mobilised to introduce treatment for affected patients and vaccines for people at risk, these countermeasures are not yet widely available in the country
- Public awareness of mpox and information about modes of transmission or possible amplifying events or risk of exposure in sex-on-premises venues remains limited in South Africa
- Concurrent outbreaks of mpox are occurring in Africa and elsewhere, increasing the risk of further transmission
We will consider efforts to contain mpox at the Congress in Washington next April, so do get your tickets to join us to participate in these discussions, and don’t forget to subscribe to our weekly newsletter here.
by Charlotte Kilpatrick | Jul 10, 2024 | Infection |
A study from FAIR Health in July 2024, presented as an infographic, shows that the percentage of commercially insured patients with sexually transmitted disease (STD) diagnoses rose by 4.8% from 2020 to 2023. The results are taken from FAIR Health’s repository of over 47 billion commercial healthcare claim records, described as the “largest” in the US. The findings are consistent with CDC data from 2012 to 2022.
Key observations
While the overall increase for all patients was 4.8%, the largest increase was observed in patients aged 65 and older (23.8%). This is followed by patients aged 55 to 64 (16.2% increase). The fastest-growing STD diagnoses in this study were syphilis (29.4%), gonorrhoea (16.8%), and HIV and AIDS (14.1%).
The greatest increase in cases of human papillomavirus (HPV) was also in the age group of 65 and older (32.2%), followed by patients aged 55 to 64 (21.9%). While the percentage of male patients with gonorrhoea grew by 59.2%, the percentage of female patients with the same diagnosis declined by 19.3%. For syphilis, the percentage of male patients grew by 22.9% and the percentage of female patients grew by 46.5%.
FAIR Health President, Robin Gelburd, emphasised that “central to FAIR Health’s mission” is to use the “vast repository of claims data to provide data on public health concerns and support research by others”.
“We hope this information brings greater clarity to the incidence of STDs.”
For more on infectious disease data and management at the Congress in Barcelona get your tickets to join us here, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 4, 2024 | Infection |
The US CDC stated in July 2024 that another human case of highly pathogenic avian influenza (HPAI) A(H5) virus infection has been identified in the US, in Colorado. It is the fourth case associated with an “ongoing multistate outbreak” in dairy cows, but the first in Colorado. Although CDC maintains that the risk assessment for the general public is “low”, it highlights the importance of observing recommended precautions.
The latest case
The patient is a dairy worker who was being monitored because of work exposure to H5N1 virus-infected cattle and reported eye symptoms to state health officials. After state testing was inconclusive, specimens were sent to CDC and were positive for influenza A(H5). Genetic sequencing is underway with further analysis to identify any possible changes that could inform the agency’s risk assessment. The case received oseltamivir treatment and has recovered.
CDC response
The CDC states that the case was detected through the state’s implementation of CDC-recommended monitoring and testing strategies in exposed persons. CDC has:
- Held calls with state and local health departments to increase preparedness
- Taken action to improve supplies of personal protective equipment (PPE) for farmworkers
- Updated interim recommendations for worker protection to include those who work with dairy cows
- Conducted calls with groups representing farmworkers
- Begun targeted paid digital outreach in affected countries to reach farmworkers with information about bird flu prevention and steps to take if they develop symptoms
CDC recommendations
The following are the current recommendations from the CDC:
- People should avoid close, long, or unprotected exposures to sick or dead animals, including wild birds, poultry, other domesticated birds, and other wild or domesticated animals (including cows).
- People should avoid unprotected exposures to animal poo, bedding, unpasteurised (raw) milk, or materials that have been touched by, or close to, birds or other animals with suspected or confirmed A(H5N1) virus.
- CDC encourages people to follow its interim recommendations for the prevention, monitoring, and public health investigations of A(H5N1) virus infections in people.
Avian influenza remains a topic of concern at the Congress in Barcelona this October, so do join us by getting your tickets here. Don’t forget to subscribe for more infectious disease updates here.
by Charlotte Kilpatrick | Jun 27, 2024 | Infection |
In June 2024 health officials shared concerns about a new mpox strain that is moving along the eastern border of Democratic Republic of Congo (DRC), describing it as “incredibly worrying”. This variant poses a threat of cross-border and international spread, with evidence that it can be spread through close skin-to-skin contact as well as sexual contact. This compounds an already dangerous outbreak in DRC; WHO reported 7,851 cases by 26th May 2024, including 384 deaths.
A new threat
The latest strain is a mutated form of clade I mpox, and the US CDC suggests that this clade causes “more severe illness and deaths”. Doctors have reported a fatality rate of “about 5% in adults and 10% in children” and “high rates of miscarriages”. First identified in April in Kamituga, a town in South Kivu province, the “clade Ib” strain has become “more efficient at human-to-human transmission”, with implications for wider spread.
Lecturer at the University of Rwanda, Dr John Claude Udahemuka, shared his concern that this is “undoubtedly the most dangerous of all the known strains of mpox”. He suggested that a change of season would encourage greater movement of people, facilitating disease spread. He emphasised the need for “everyone” to “get prepared”.
“Everyone should be able to detect the disease as early as possible. But more important, everyone should support the local research and local response so that it doesn’t spread.”
Leandre Murhula Masirika, Research Coordinator in the health department in South Kivu province, commented that “the disease can go through airports” because “there are no controls”.
“I’m afraid it’s going to cause more damage.”
The Economist reflects that the region’s situation is “complicated by war, displacement, and food insecurity”.
“Preventing this new mpox strain from becoming another global health crisis requires swift and co-ordinated action.”
Furthermore, there is a likelihood of asymptomatic cases, which will enable further spread. Professor Trudie Lang from the University of Oxford warned that the known case numbers are “the tip of the iceberg”.
“It’s definitely the most dangerous strain yet… We don’t know how many non-severe cases are hidden.”
To get updates on efforts to secure safe and effective vaccines to address this growing threat, don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jun 19, 2024 | Infection |
Analysis by Airfinity and Bloomberg News, reported in June 2024, suggests that at least 13 infectious diseases are showing a resurgence. A study compiling data from over 60 organisations and public health agencies finds that more than 40 countries or territories have reported at least one infectious disease resurgence that is at 10-fold, or above, higher than pre-pandemic baseline. The results are displayed onto a spike map, including the following diseases: chickenpox, cholera, dengue, measles, Mycoplasma pneumoniae, parvovirus B19, invasive Group A Streptococcus, pertussis, influenza, respiratory syncytial virus (RSV), wild poliovirus type 1 (WPV1), vaccine-derived poliovirus, and tuberculosis.
The study
Airfinity states that the analysis “relies heavily” on data reported by all countries globally, which “in turn depends on the robustness of their infectious disease surveillance and reporting systems”. Therefore, the data does not accurately represent the true burden of the diseases within populations, with many cases going undetected. Furthermore, the disease data is “not exhaustive”, with “large gaps” for notifiable and non-notifiable diseases.
“Some countries/regions might be overrepresented than others due to their superior surveillance and reporting systems. In addition, changes testing levels post-pandemic likely affect recent disease incidence, resulting in large post-pandemic spikes that might incorrectly imply significantly higher disease incidence.”
Explaining the spikes
Airfinity offers “three main factors” for the current surge in outbreaks. The first of these is “falling vaccination rates”. Although diseases like measles, polio, whooping cough (pertussis), and tuberculosis are vaccine preventable, declining uptake is “leaving populations vulnerable and allowing the pathogens to spread”.
The example of measles is given; global measles vaccination coverage has declined, with 20 countries in Europe dropping below 90% in 2022. The UK is experiencing a national outbreak and Austria is seeing “its worst measles outbreak on record” with cases from the first 5 months of 2024 hitting 190% higher than the pre-pandemic peak. Other countries, including Denmark, Canada, and the Netherlands are “on track to surpass pre-pandemic levels if sustained transmission persists”. Pertussis is also considered, with Spain among a “growing number” of countries in Europe that is seeing a rise in whooping cough burden with 134% post-pandemic increases in 2024.
The second key factor is an “overall decline in population immunity during the pandemic years”. Restricted social interaction “suppressed” the circulation of pathogens like RSV< Mycoplasma pneumoniae, and invasive Group A Streptococcus, or iGAS. Airfinity indicates that the current resurgence can be “largely” attributed to “more susceptible” populations alongside increased testing and case reporting after the pandemic. For example, last influenza season in the US cases were 28% higher than in 2019. Total influenza cases in Europe’s last season were 75% higher than in 2019.
The third contributing factor is climate change, which is “enabling the spread of diseases such as dengue and cholera, and increasing the pathogens’ reach into new territories”. Argentina has reported the largest rise with a 151-fold increase in dengue cases from 3,220 in 2019 to 488,035 already in 2024. With mosquitoes moving northward, more cases have been identified in southern Europe. Italy has seen a “significant” increase from the first locally acquired case in 2020 to 67 cases in 2023.
Vaccination is crucial
Airfinity Biorisk analyst Kristan Piroeva highlighted that “unvaccinated children are at the greatest risk” during this resurgence of disease.
“These illnesses can often be more severe for infants and young children than the general adult population. Ensuring sufficient vaccination rates is crucial to preventing these vulnerable groups from becoming seriously ill.”
Piroeva reflected that dengue, which “most people think of as a tropical disease”, is moving into non-endemic countries. With rising temperatures, “we could see the disease becoming endemic in southern Europe” and Airfinity’s overview of dengue incidence shows “nearly half the world’s population may now be at risk of dengue infection”.
“An increase in surveillance and testing for disease also plays a significant role in today’s analysis. By enhancing our monitoring capabilities, we can better track the spread of these diseases and implement timely interventions to mitigate their impact.”
To participate in discussions about infectious diseases and vaccination strategies at the Congress in Barcelona get your tickets here and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jun 13, 2024 | Infection |
Next in our series of interviews with experts at The World Vaccine Congress in Washington is a conversation with Absolute Health Care Centre’s Dr Jerry Brown, who joined us in Washington for a panel in the Emerging and Re-emerging Diseases track: “medical countermeasures for Ebola & other emerging infectious diseases: are we ready?” Dr Brown is a physician from Liberia, where he served as the Chief Executive Officer for the primary teaching and referral hospital. He is now a consultant surgeon at a private facility. His experience in Liberia during the Ebola epidemic drew international recognition.
Key themes from the panel
We begin with a question about the panel, and what key discussion points emerged during this important discussion. Dr Brown suggests that a key theme has to do with vaccine availability, and how feasible it would be to deploy vaccines to countries that need them. Related to this, the importance of “capacity to have a repository” in country was emphasised, considering technicalities and policies.
“Another key issue that came up was ‘how prepared are we’… in terms of our diagnostic capacity.”
Dr Brown reflects that, after experiencing the Ebola crisis and COVID-19, Liberia is still behind its neighbouring countries in terms of diagnostic capacities; Liberia has only BSL-2 facilities.
“Diagnostic-wise, we still have a long way to go in Liberia.”
Considering preparedness, Dr Brown suggests that “we have a very good preparedness plan” and “robust surveillance plan” in place.
Lessons from Ebola
We then asked Dr Brown about his experience of the Ebola crisis, and if there are any lessons he identifies in this for future health threats. He believes that a “strength” that they demonstrated both during the Ebola epidemic and again during the COVID-19 pandemic was “having a multi-sectoral collaboration” with private and public interactions.
“The other thing is having a good community engagement, where we’re able to engage the people to kind of ensure that they don’t resist…so that the community becomes receptive.”
Central to this was engaging community health workers, who played a critical role in disease management. While these strengths were in place for COVID-19, they had to be developed in response to Ebola.
“We did learn a lot from what we went through during Ebola, and that helped us greatly during the time of our intervention with COVID-19.”
Dr Brown suggests that “we may not be fully capacitated to do all that is done in the West”, and reminds us that during COVID-19, access to ventilators was delayed. In their absence, clinicians had to use their “clinical skills and knowledge” to “save many lives”.
“The other good thing I think we also learnt to do is working together as a team; that played a significant role in helping us make progress in our fight against the pandemic.”
Key access challenges
Our next question ties back into Dr Brown’s observations about access and capacity. He considers the example of the production of COVID-19 vaccines, which was something “we don’t have control over”. Thus, obtaining vaccines took longer.
“I think it’s the political will also that plays a significant role.”
While Dr Brown doesn’t believe his country was “resistant” to medical interventions, it “took some time”. However, he suggests that “we were grateful” to have access before other nations.
“When it comes to diagnostic capacity, for us to still be lagging behind other nations, I am really trying to figure out why.”
Dr Brown wonders if “political interaction” might be influencing the quantity and quality of investment and support.
“We still have a long way to go to be able to appropriately combat another epidemic if we had now.”
Acknowledging the few opportunities to develop research skills, Dr Brown believes “we are still lacking”.
“There is still a big gap that we still need to fill.”
Why WVC?
Finally, as always, we conclude by asking our experts about their time at the Congress. Dr Brown was interested in sharing his perspectives on a “thought-provoking” panel. A key thing that he was able to stress is that there is “no equilibrium in the distribution” of supplies.
“Let’s face the fact, when those things are distributed or are available, third world countries don’t tend to get a big chunk of it first.”
Dr Brown wants the community to “strive” for more equitable distribution. He also enjoyed some sessions on malaria, and hopes that Liberia will be considered in vaccine strategies in the “not-too-distant future”.
“Another thing that captivated my attention is the quest and zeal I see many persons having for research.”
It’s good to hear that Dr Brown was impressed by the efforts of his colleagues to “impact change”, despite concerns about a reduction in funding. His answer to this comes from experience:
“People pay attention to major crisis.”
He considers wars, which divert attention from health crises.
“When there are global instabilities in other parts of the world, it’s going to affect any outbreak that we have anywhere in the world.”
It was a pleasure to speak to Dr Brown and we hope that you enjoy the interview!
For more conversations with our experts from the Congress in April do make sure you subscribe for weekly updates here!
by Charlotte Kilpatrick | Jun 13, 2024 | Infection |
In June 2024 South Africa’s Minister of Health, Dr Joe Phaahla, announced an additional laboratory-confirmed case of mpox and a second death linked to the disease. This follows an update that reported a total of 5 laboratory-confirmed cases and the first death. As none of the cases have travel history to countries experiencing an outbreak, the Minister infers that there is local transmission in South Africa.
Increasing numbers
The first report from Dr Phaahla stated that all 5 cases were males between the ages of 30 and 39 years. These cases were classified “severe”, requiring hospitalisation. The cases have co-morbidities and were identified as “key populations, Men who have Sex with Men (MSM)”.
A day after the first announcement, a further case was admitted to hospital in uMgungundlovu, KwaZulu-Natal (KZN) and tested positive for mpox on Wednesday 12th June. This patient was living with HIV and presented with “extensive lesions, lymphadenopathy, headache, fatigue, oral ulcers, muscle pain, and sore throat”. He died on the same day.
The country responds
Dr Phaahla emphasised the importance of “personal hygiene, timely presenting at the health facility for early diagnosis, and effective treatment”. Three of the first five cases were given Tecovirimat, a treatment recommended by WHO for use in severe cases. His statement indicates that “options are being considered” for vaccine targeting.
“South Africa is trying to source vaccine from WHO member countries who have stockpiles that exceed their needs as well as from GAVI.”
The vaccines will be stored and distributed from provincial depots. The National Advisory Group for Immunisation (NAGI) Technical Working Group for Mpox vaccines has been appointed and is reportedly considering use of the vaccine for pre- and post-exposure administration for “high-risk groups, including but not limited to sex workers, men-who-have-sex-with-men, healthcare workers, and laboratory workers”.
“One death is too many, especially from a preventable and manageable disease like mpox.”
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by Charlotte Kilpatrick | Jun 13, 2024 | Infection |
In June 2024, shortly after a notification of a fatal case of human infection with avian influenza in Mexico, WHO shared a disease outbreak news update to reflect new information from Mexican authorities. WHO was informed that a national multidisciplinary group of experts who undertook a review of the death concluded that, although the patient was positive for avian influenza A(H5N2), he died from his co-morbidities. The risk assessment issued by WHO remains low.
Updated information
As reported earlier this month, the Mexico IHR NFP reported a confirmed case of human infection with avian influenza A(H5N2) virus to PAHO/WHO. The 59-year-old, a resident of Mexico City, had no known history of exposure to poultry or other animals, and had “multiple” underlying medical conditions. Before symptoms began, the patient was bedridden for three weeks.
In response to the patient’s death, a national multidisciplinary group of experts was formed, including infectious disease specialists, pneumonologists, microbiologists, and intensive care professionals. This team reviewed the patient’s clinical history and records to conclude that, although the patient had laboratory-confirmed infection with avian influenza A(H5N2) virus, he died due to “complications of his co-morbidities”. These included chronic kidney disease, type 2 diabetes, and systemic arterial hypertension for over 14 years. No further cases were reported during this epidemiological investigation.
Risk unchanged
WHO’s risk assessment is “unchanged”; the current risk to the general population is “low”. However, if further epidemiological or virological information becomes available, the risk assessment will be reviewed.
Mexico dismisses WHO’s statement
It has been reported that the Mexican Health Secretary Dr Jorge Alcocer had contradicted the WHO statement in a morning briefing, describing it as “not accurate”. Dr Alcocer is said to have called the update “pretty bad” for attributing the patient’s death to infection with the avian influenza virus.
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by Charlotte Kilpatrick | Jun 12, 2024 | Infection |
In June 2024, WHO shared a disease outbreak news update stating that it has been notified of outbreaks of Oropouche virus disease in two provinces of Cuba: Santiago de Cuba and Cienfuegos. This is the first detection of Oropouche virus disease in the country; WHO therefore suggests that the population is “likely highly susceptible” and identifies “significant risk of additional cases being detected”. There is no evidence of human-to-human transmission.
What is Oropouche?
Oropouche virus disease is an arboviral disease caused by Oropouche virus (OROV), a segmented, single-stranded RNA virus from the Orthobunyavirus genus of the Peribunyaviridae family. It is transmitted to humans through the bite of the Culicoides paraensis midge or some Culex quinquefasciatus mosquitos. WHO suggests that viral circulation includes both epidemic and sylvatic cycles. In the sylvatic cycle, primates, sloths, and potentially birds are vertebrate hosts. However, a “definitive” arthropod vector has not been identified. In the epidemic cycle, humans are the amplifying host.
Disease symptoms are likened to those associated with dengue; they start between four to eight days after the infective bite. Symptoms include fever, headache, joint stiffness, pain, chills, and nausea or vomiting, and can last for up to five to seven days. Although severe clinical presentation is “rare”, it may result in aseptic meningitis.
“There is no specific antiviral treatment or vaccine for Oropouche virus disease.”
Cases reported in May
WHO states that the Ministry of Public Health of Cuba reported its “first ever” outbreak of Oropouche virus disease on 27th May 2024. A total of 74 confirmed cases were reported: 54 from Province of Santiago de Cuba and 20 from Province of Cienfuegos. The cases were detected through “strengthened monitoring and surveillance actions”, a response to increased cases of non-specific febrile illness.
The onset of symptoms in the confirmed cases was reported between 2nd and 23rd May, with a peak in cases observed in epidemic week 21. The most frequently reported symptoms were:
- Fever
- Lower back pain
- Headache
- Loss of appetite
- Vomiting
- Weakness
- Joint pain
- Eye pain
Out of the 74 confirmed cases, 36 are male and 38 are female; the median age is 34 years. All cases showed signs of recovery between the third and fourth day after symptom onset, and no severe or fatal cases were reported by 5th June.
Response and risk assessment
Health authorities in Cuba are implementing public health measures, with a plan to address arboviruses. Actions in this plan include:
- Temporary working groups activated to analyse the epidemiological situation and conduct field operations
- Definition of criteria for suspected and confirmed cases of the disease
- Training all personnel of the National Public Health System on arboviruses, including OROV
- Strengthening human resources for medical care in health areas with transmission
- Reinforcement of vector control actions including focal treatment in transmission and very high-risk blocks, adulticidal treatment, and increased entomological surveillance in transmission areas
- Intensified environmental sanitation actions
- An informative note issued on the situation
WHO’s risk assessment identifies “significant risk of additional case detection” as the population is “likely highly susceptible”. There is also a risk of the disease spreading internationally as Cuba draws international tourism and the putative vector is “widely distributed” in the region. Furthermore, there are other countries with active OROV circulation.
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by Charlotte Kilpatrick | Jun 6, 2024 | Infection |
In June 2024 WHO shared a disease outbreak news update stating that the Mexico International Health Regulations (IHR) National Focal Point (NFP) had reported a confirmed fatal case of human infection with avian influenza A(H5N2) virus. This is the first laboratory-confirmed human case of infection with an influenza A(H5N2) virus reported globally. WHO has assessed the risk to the public as “low”, yet experts have raised concerns about the delay in identification and reporting and unanswered questions.
Case details
The case was a 59-year-old resident of the State of Mexico who had underlying medical conditions and had been bedridden for three weeks prior to the onset of symptoms. The case had no history of exposure to poultry or other animals. On 17th April, the case developed fever, shortness of breath, diarrhoea, nausea, and general malaise before seeking medical attention on 24th April at the National Institute of Respiratory Diseases “Ismael Cosio Villegas”. He died on the same day.
Results from Real-Time Polymerase Chain Reaction (RT-PCR) of a respiratory sample collected at tested on 24th April indicated a non-subtypeable influenza A virus. The sample was sent to the Laboratory of Molecular Biology of Emerging Diseases Centre for Research in Infectious Diseases for sequencing on 8th May. This indicated that the sample was positive for influenza A(H5N2). On 20th May, the sample arrived at Institute of Epidemiological Diagnosis and Reference of the Mexico National Influenza Centre for analysis by RT-PCR. On 22nd May, sample sequencing confirmed that the influenza was A(H5N2). No further cases were reported during the epidemiological investigation.
WHO’s risk assessment and advice
This case is the first laboratory-confirmed human case of infection with an influenza A(H5N2) virus reported globally, and the first A(H5) virus infection in a human reported in Mexico. The health authorities in Mexico continue to investigate the likely source of exposure to the virus; influenza A(H5N2) viruses have been detected in poultry in Mexico recently.
“WHO assess the current risk to the general population posed by this virus to be low.”
The case “does not change” current recommendations on public health measures and surveillance of influenza. However, WHO “continues to stress the importance of global surveillance”. Furthermore, following human exposure, enhanced surveillance “in potentially exposed human populations becomes necessary”.
Despite this response from WHO, experts have expressed concern at the incident. Among them, Dr Rick Bright, immunologist and public health expert, identified “a number of reasons” for caution:
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It took over 6 weeks to identify & report this case
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Person was bedridden, indicating someone brought virus to hum
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No contact w/ poulty (milk?)
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Outcome was fatal
Dr Bright described the update as “very sad” but is “truly shocked” at the delay in going public with the case.
“We must do better.”
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by Charlotte Kilpatrick | Jun 3, 2024 | Infection |
In May 2024 the WHO shared a disease outbreak news update on the global dengue situation, stating that by 30th April 2024 over 7.6 million dengue cases have been reported to WHO in 2024. This total includes 3.4 million confirmed cases, over 16,000 severe cases, and over 3,000 deaths. The “substantial increase” in cases has been “particularly pronounced” in the Region of the Americas, where the number of cases exceeded 7 million by the end of April 2024. This surpasses the annual high of 4.6 million cases in 2023. 90 countries have known active dengue transmission this year.
However, many endemic countries do not have strong detection and reporting mechanisms, which means that the true global burden of dengue is underestimated. WHO states that “real-time robust dengue surveillance” is needed to control transmission “more effectively”. This would address concerns about undetected cases, co-circulation and misdiagnosis as other arboviruses, and unrecorded travel movements.
“The overall capacity for countries to respond to multiple, concurrent outbreaks continues to be strained due to the global lack of resources, including shortages of good quality dengue diagnostic kits for early disease detection, lack of trained clinical and vector control staff, and community awareness.”
WHO maintains that the overall risk at the global level is “high”, with dengue remaining a global threat to public health.
Co-circulation concerns
There is “considerable overlap” in the geographic distribution of dengue, chikungunya, and Zika viruses; these are all transmitted by Aedes mosquitoes and share some clinical features. This can result in misdiagnoses and misreporting in the absence of differential laboratory testing. Surveillance systems that specifically target transmission of chikungunya or Zika are “weak or non-existent” in many countries.
“As dengue, chikungunya, and Zika viruses share the same Aedes mosquito vectors and co-circulate in the same geographic areas, they also share many prevention strategies, such as differential diagnosis, mosquito control, and public awareness campaigns.”
However, WHO notes “important differences” between these diseases that affect risk populations, patient management, and use of health care resources. Therefore, expanding surveillance for all three viruses will help public health authorities determine the true burden of each more accurately and respond appropriately.
Risk assessment and advice
In November 2023 WHO assessed the global risk of dengue as high. In December, the internal emergency response was assigned as G3 at the global level.
“Given the current scale of the dengue outbreaks, the potential risk of further international spread and the complexity of factors impacting transmission, the overall risk at the global level is still assessed as high and thus dengue remains a global threat to public health.”
Vector control interventions are “key” to dengue prevention and control, and WHO states that vector control activities should target “all areas” with risk of human-vector contact, including residences, workplaces, schools, and hospitals. WHO promotes Integrated Vector Management (IVM) to control Aedes species. Personal protective measures during outdoor activities are also encouraged. While there is no specific treatment for dengue infection, WHO highlights that early detection and access to appropriate healthcare for case management reduces mortality.
Vaccination should be considered within an integrated strategy to control the disease; WHO recommends the use of TAK-003 in children aged 6-16 years in settings with high dengue transmission intensity.
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by Charlotte Kilpatrick | May 31, 2024 | Infection |
In May 2024 the US CDC announced that a second human case of highly pathogenic avian influenza (HPAI) A (H5) virus infection had been identified in Michigan, the third human case associated with an “ongoing multistate outbreak” of A(H5N1) in dairy cows. The CDC states that none of these three cases is associated with the others, but the latest case is a dairy farm worker with exposure to infected cows. However, this case is the first human case in the US to report “more typical symptoms” of acute respiratory illness associated with influenza virus infection. Despite assurance that it “continues to closely monitor available data”, questions are being raised about the adequacy of the response so far.
Case details
The case originated from a different farm than the previous case in Michigan and is in a dairy worker with exposure to H5N1-infected cows. The patient reported upper respiratory tract symptoms and was given antiviral treatment and encouraged to isolate. The patient’s symptoms “are resolving” and household contacts have not developed symptoms, nor have other workers at the same farm. Of specimens collected from the patient, one was positive for influenza A(H5) virus when tested at the state health department laboratory. Genetic analysis is underway to assess if changes have taken place within the virus to change the current risk assessment.
Health risk remains low
The CDC states that the case “does not change” the current human health risk assessment for the US public, as all three cases had direct contact with infected cows.
“Risk depends on exposure.”
Therefore, the risk to members of the public who have not had exposure to infected animals “remains low”. However, the recommended precautions remain in place.
Concerns about the response
Since the outbreak emerged in the US, experts have voiced concerns about the public health response and capacity or willingness to increase surveillance. In April, Dr James Lawler of the University of Nebraska Medical Centre’s Global Centre for Health Security told MedPage Today that “we really need to be moving quickly” to understand “what’s happening in the animal population and also what’s happening in the human population”.
“I don’t think we’ve been testing adequately to be able to get a real picture of that.”
For Time in May 2024, Dr Michael Mina, Chief Science Officer of eMed, and Janika Schmitt, Fellow at the Institute for Progress, identified a “complicating factor” in the US’ ability to control outbreaks: the responsibility is “divided between three federal agencies”. The US Department for Agriculture (USDA) manages livestock, the US Food and Drug Administration (FDA) manages food safety, and the CDC manages human health and surveillance. A lack of coordination here would be disastrous, and Dr Mina and Schmitt call for “regular and widespread testing”.
“We must stop flying blind.”
However, they suggest that there is “good news”.
“We have the tools to prevent an H5N1 pandemic at hand. But we must be willing to use them, and fast.”
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by Charlotte Kilpatrick | May 21, 2024 | Infection |
A WHO report shared in May 2024 details the continued “significant public health challenges” posed by HIV, viral hepatitis epidemics, and sexually transmitted infections (STIs). The report identifies increasing cases of STIs across “many regions”, flagging “threats to the attainment” of targets outlined in the Sustainable Development Goals (SDGs) for 2030. The report is the first in a series of biannual progress reports on implementation of global health sector strategies for the period 2022-2030.
Infections increase
WHO states that four curable STIs – syphilis (Treponema pallidum), gonorrhoea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis), and trichomoniasis (Trichomonas vaginalis) – account for “over 1 million infections daily”. A reduction of 20% in these four infections must be achieved to realise targets by 2025 and a reduction of 60% is needed for the 2030 targets.
“The available data suggest that the world is off track to meet targets, with increasing rather than declining trends in new infections.”
Syphilis case increases have been driven by an “increase in the number of estimated new cases of syphilis in the WHO African Region and the WHO Region of the Americas”. These regions regularly share data within the Global AIDS Monitoring process. The report identifies “unprecedented high levels of new infections”, demanding an “urgent acceleration of efforts”.
The data also suggest an increase in “multi-resistant gonorrhoea”. By 2023, from the 87 countries with enhanced gonorrhoea antimicrobial resistance surveillance, 9 countries reported elevated levels.
HIV and hepatitis B challenges
The report suggests that “key achievements demonstrate the feasibility of ending AIDS as a public health concern by 2030. However, “many challenges remain”. For example, in 27 low- and middle-income countries, “less than 50% of people living with HIV were receiving antiretroviral therapy” in 2022. The current rate of declining incidence and HIV-related deaths is “insufficient” to achieve 2025 targets. Furthermore, children under 15 are bearing a “disproportionate burden of mortality”, reflecting “policy and programmatic failings”.
Viral hepatitis is “one of the leading infectious causes of death worldwide”, despite interventions that would support elimination of hepatitis B virus and hepatitis C virus by 2030. These include effective hepatitis B vaccines and effective treatments.
“Access to prevention, testing, and treatment remains low, resulting in increasing mortality and large numbers of new infections…Regaining the trajectory will require strengthening political will and mobilising greater investment.”
Major concerns
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, finds “major concerns” in the rising incidence of syphilis.
“We have the tools required to end these epidemics as public health threats by 2030, but we now need to ensure that, in the context of an increasingly complex world, countries do all they can to achieve the ambitious targets they set themselves.”
Dr Meg Doherty, Director of the Department of Global HIV, Hepatitis, and Sexually Transmitted Infections Programmes at WHO, commented that there has been “impressive uptake” of WHO policies and “expansion of service access”. This is “particularly notable for HIV testing and antiretroviral therapy coverage” alongside expansion of hepatitis C treatment in a “small number of countries”. However, “many challenges persist”.
“While working to further expand services, especially for viral hepatitis and sexually transmitted infections, countries also must prioritise person-centred approaches and sustainability planning across all disease areas, focusing on political commitment, programmatic integration, and financing, while combatting stigma and discrimination in healthcare settings.”
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by Charlotte Kilpatrick | May 20, 2024 | Infection |
The UKHSA shared guidance and information on cryptosporidium in May 2024 following South West Water’s acknowledgement that “small traces” of the parasite were identified in Brixham, south Devon. The water company is investigating the source of the outbreak, with 46 cases of cryptosporidiosis already confirmed. The company issued a boil water notice to residents as 46 confirmed cases were reported and over 100 people contacted their GPs about symptoms. The “microscopic” parasite causes cryptosporidiosis, which is “unpleasant” and “sometimes dangerous”.
What is cryptosporidium?
Cryptosporidium is a “nasty bug” that resides in the intestines of infected humans and animals. It is passed out in poo, when it can spread and contaminate water sources and food. It causes cryptosporidiosis, which is particularly common in young children, people who work with farm animals and contaminated waters, people changing nappies, and those who travel to countries with “poor sanitation”. It can cause “serious illness” in people with weakened immune systems.
Symptoms are “deeply unpleasant”, including severe watery diarrhoea, vomiting, stomach cramps, nausea, fever, or loss of appetite. It can last around 2 weeks. Prevention relies on “simple hygiene” steps, as there is no vaccine:
“The development of partial immunity after exposure suggests the possibility of a successful and effective vaccine, but protective surrogates are not precise.”
There is also no treatment, but rehydration is recommended after diarrhoea.
Outbreak in Devon
In May 2024 the BBC reported that South West Water (SWW) had suggested that a “faulty valve” may have created a route for the parasite into the water network. Laura Flowerdew, chief customer officer emphasised that the team is “doing further work to make sure we’re absolutely confident that’s the cause and the only cause”.
“We’re working through operational procedures in the meantime…public health is our absolute priority at this point.”
However, Anthony Mangall, MP for Totnes and South Devon, was “very concerned” with the response to the outbreak, suggesting that they had been “slow to act” and displayed “poor” communication with customers.
Expert opinion
Professor Paul Hunter from the University of East Anglia (UEA) commented that “in people with severely weakened immune systems it can cause severe disease and can even be fatal”. He suggested that “before effective antiretroviral treatments” for HIV/AIDS, cryptosporidium could be “fatal as recovery didn’t happen”.
“With effective control of AIDS nowadays we see far less severe cryptosporidiosis. There is no effective drug treatment for cryptosporidiosis and all we can do is keep people comfortable and replace fluids until recovery happens.”
Professor Hunter believes that there are “far fewer outbreaks now” than in the 1990s when he was “more involved” thanks to “improvements in treatment plants”. However, without regular summaries from UKHSA it is hard to know how many outbreaks have occurred.
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by Charlotte Kilpatrick | May 15, 2024 | Infection |
In May 2024 WHO announced the prequalification of Takeda’s dengue vaccine TAK-003, the second dengue vaccine prequalified by WHO. The vaccine is a live-attenuated vaccine comprising the four serotypes of the virus that cause dengue. It is hoped that this update will broaden global access to dengue vaccines, particularly as 2024 to date has seen “over five million” cases and “over 2,000” dengue-related deaths globally.
Two prequalified vaccines
The latest prequalification adds TAK-003 to the current vaccine: CYD-TDV by Sanofi Pasteur. TAK-003 is recommended for use by WHO in children aged 6-16 in settings with “high dengue burden and transmission intensity”, administered in a 2-dose schedule with a 3- month interval between doses.
Dr Rogerio Gaspar, WHO Director for Regulation and Prequalification, described the prequalification as an “important step” in the “expansion of global access to dengue vaccines”. It is now eligible for procurement by UN agencies such as UNICEF.
“With only two dengue vaccines to date prequalified, we look forward to more vaccine developers coming forward for assessment, so that we can ensure vaccines reach all communities who need it.”
Dengue concerns
WHO estimates that there are over 100-400 million cases of dengue worldwide each year, with 3.8 billion people living in dengue endemic countries. Most of these countries are in Asia, Africa, and the Americas.
“Dengue cases are likely to increase and expand geographically due to climate change and urbanisation.”
PAHO’s latest dengue situation report identifies a total of 6,769,140 suspected cases between epidemiological weeks 1 and 16 of 2024. This is a cumulative incidence of 717 per 100,000 population and represents an increase of 206% compared to the same period in 2023. It is a further 387% increase on the average of the last 5 years. Out of the reported cases, 3,027,582 cases were confirmed by laboratory, and 6,456 cases were classified as “severe dengue”. 2,844 deaths have been registered.
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by Charlotte Kilpatrick | May 9, 2024 | Infection |
In May 2024 WHO issued a Disease Outbreak News (DON) update stating that it has been notified of three human cases, including one death, of Middle East respiratory syndrome coronavirus (MERS-CoV). These cases were reported between 10th and 17th April 2024 by the Ministry of Health of the Kingdom of Saudia Arabia. Although investigations are “ongoing” to verify the link and route of transmission for the cases, WHO’s overall risk assessment remains “moderate” at both global and regional levels.
What is MERS?
Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by MERS-CoV, with an estimated mortality rate of 36%. However, WHO suggests that this may be an overestimate as the case fatality ration (CFR) is based on laboratory-confirmed cases. The natural host and zoonotic source of the virus is the dromedary camel. Humans are infected from direct or indirect contact with these camels, but the virus has also demonstrated the ability to transmit between humans, mostly in health care settings. MERS disease can be asymptomatic or present mild respiratory symptoms, but it can also cause severe acute respiratory disease and death.
There is no approved vaccine or specific treatment, but there are several MERS-CoV-specific vaccines and therapeutics in development.
The first case
All three cases reported to WHO were identified in Riyadh and linked to the same health-care facility. Two cases were identified through contact tracing, initiated after the identification of the index case. These cases are “suspected to be secondary health care associated cases” from contact with the index case. However, investigations are underway to determine the route of transmission.
The index case is a 56-year-old male, a teacher who lived in Riyadh. After developing a fever, runny nose, cough, and body aches on 29th March, he sought medical care in Riyadh on 4th April. He visited the same hospital where case three was receiving treatment and was admitted to a ward where he shared a room with case two. On 6th April the index case was transferred to Intensive Care Unit (ICU) isolation and intubated. He was tested by RT-PCR, which confirmed MERS-CoV. He had no clear history of exposure to “typical MERS-CoV risk factors”, and investigations to determine the source of infection continue. The index case died on 7th April.
More cases
The second case is a retired 60-year-old male who lives in Riyadh, admitted to ICU on 8th March before being transferred to a ward where he shared a room with the index case on 4th April. This case developed a fever on 6th April and tested positive for MERS-CoV by RT-PCR on 8th April. With “no history of exposure to camels” it is suspected that this case is a secondary healthcare-associated case from contact with the index case.
The third case is another retired 60-year-old male in Riyadh who went to the same hospital before being admitted to a ward on 5th April. After developing shortness of breath on 10th April, he was transferred to the ICU on 15th April and tested positive for MERS-CoV on the same day. Like the second case, this case has no history of exposure to camels and is suspected to be a secondary healthcare-associated case due to contact with the index case. Both the second and third cases were intubated in April and, as of 21st April, were in the ICU.
WHO’s risk assessment
WHO states that these cases do not change the overall risk assessment, and “expects” additional cases to be reported from countries where MERS-CoV is circulating in dromedaries.
“WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information.”
However, WHO “re-emphasises” the importance of “strong surveillance” by all Member States.
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by Charlotte Kilpatrick | May 9, 2024 | Infection |
In May 2024, the UKHSA shared that recent data reveal cases of whooping cough “continue to increase”, with the highest burden born by infants. 1,319 cases were confirmed in March, an increase on January’s 556 cases and February’s 918 cases. This takes the total number of cases in 2024 to 2,793. Unfortunately, during this first quarter there have also been five infant deaths, with young infants being at “highest risk of severe complications and death”. While vaccine effectiveness estimates for pregnancy show “high levels of protection (92%)”, uptake is declining.
Whooping cough
Known as the “100-day cough”, whooping cough (or pertussis), is a bacterial infection that spreads “very easily”. Initial indications are like a cold, but this develops into coughing bouts, gasping for breath, or bringing up mucus. It is a cyclical disease that “peaks” every 3 to 5 years. However, due to pandemic restrictions and behaviour there was a drop in cases. A peak year is “therefore overdue”. Furthermore, the pandemic resulted in “reduced immunity in the population”.
The data in detail
From January to March 2024 there were 2,793 confirmed cases; among these cases around half (50.8%) were in people aged 15 years or older. For infants under 3 months, who are too young to be fully vaccinated, there was a peak in cases to 407 in the 2012 outbreak; this fell after the introduction of the maternal vaccine. More recently, cases in infants under 3 months increased to 48 cases in 2023. Between January and March 2024 there were 108 confirmed cases in infants under 3 months.
Uptake falls
“Vaccination in pregnancy is key to passively protecting babies before they can be directly protected by the infant vaccine programme.”
Vaccination against pertussis is recommended in “every pregnancy” between 20 and 32 weeks, “ideally after the 20-week scan”, but can be given as early as 16 weeks. After birth it is “important” for babies to be vaccinated when eligible at 8, 12, and 16 weeks.
The best defence
Dr Gayatri Amirthalingam, UKHSA Consultant Epidemiologist, reminded the public that “vaccination remains the best defence” against this disease, emphasising that it is “vital” that people get their vaccines “at the right time”.
“Pregnant women are offered a whooping cough vaccine in every pregnancy, ideally between 20 and 32 weeks. This passes protection to their baby in the womb so that they are protected from birth in the first months of their life when they are most vulnerable and before they can receive their own vaccines.”
While whooping cough can affect “people of all ages” it can be “extremely serious” for very young babies. Dr Amirthalingam offered “thoughts and condolences” to the families who have “so tragically lost their baby”.
NHS National Medical Director, Professor Sir Stephen Powis, agreed that it is “vital” that families “come forward to get the protection they need”. Professor Powis recommended that people who are pregnant and have not been vaccinated yet or have unvaccinated children “contact your GP as soon as possible”.
“If anyone in your family is diagnosed with whooping cough, it’s important they stay at home and do not go into work, school, or nursery until 48 hours after starting antibiotics, or 3 weeks after symptoms start if they have not had antibiotics.”
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by Charlotte Kilpatrick | May 8, 2024 | Infection |
In May 2024 PAHO celebrated the latest countries in the Americas that have received WHO certification of the elimination of mother-to-child transmission of HIV and syphilis (EMTCT). This certification is awarded to countries that have:
- Brought the mother-to-child transmission rate to under 5%
- Provided antenatal care and antiretroviral treatment to more than 90% of pregnant women
- Reported fewer than 50 new cases of congenital syphilis per 100,000 newborns
- Achieved an HIV case rate of fewer than 500 per 100,000 live births
Representatives from Belize, Jamaica, and St Vincent and the Grenadines joined a commemorative event in Kingston, Jamaica to highlight the significance of the achievement, a “testament” to years of “dedication, hard work, and collaboration” according to PAHO Director Dr Jarbas Barbosa.
The power of commitment
Speaking at the event, Dr Barbosa recognised the “remarkable resilience” that the three countries have demonstrated in the face of COVID-19 challenges.
“I trust that the celebration today will inspire other countries to reinvigorate their commitments.”
In 2010, countries in the Americas committed to the elimination of mother-to-child transmission of HIV and syphilis, endorsing the regional strategy that was updated in 2016. The achievement of these targets required strengthening prevention and treatments services, updating guidelines, and ensuring the effective screening, monitoring, and following-up of HIV and syphilis exposed individuals.
Dr Tedros Adhanom Ghebreyesus, WHO Director-General, contributed a video message to the event. In this he praised Beliz for integrating primary disease prevention and treatment into maternal and child health services, celebrated Jamaica for civil society organisations’ commitment to human rights, and congratulated St Vincent and the Grenadines investment into robust national laboratory structures. He also emphasised the importance of “sustained efforts” to prevent new infections.
“WHO and partners will continue to support all countries in the Americas to strengthen health systems, provide comprehensive services, and ensure the involvement of women in planning and service delivery.”
Global progress
So far, 19 countries and territories have received the certification of elimination of mother-to-child transmission of HIV and/or syphilis; 11 of these are in the Americas. Cuba “made history” in 2015 by becoming the first country to achieve the dual elimination of HIV and syphilis. PAHO reports that new HIV infections among children in the Caribbean decreased by 25% between 2010 and 2022. In that time, annual notified cases decreased from 2,000 to 1,500.
Christine Stegling, UNAIDS Deputy Executive Director, celebrates a “great public health milestone” and the “global leadership” displayed by Caribbean countries in the “elimination agenda to achieve an HIV free generation”.
“The end of AIDS is an opportunity for a uniquely powerful legacy for today’s leaders.”
UNICEF Regional Director for Latin America and the Caribbean Gary Conville welcomes the commitment of the three countries.
“We are confident that this milestone will be a catalyst for other countries in the region to pursue the Elimination of Mother-to-Child Transmission Agenda towards the 2030 target: No child left behind in the progress to end AIDS.”
Ministers of health
Minister of Health and Wellness in Belize is Kevin Bernard, who recognises the “extremely significant accomplishment for the people and country”.
“The activities leading up to this momentous goal were not always easy; however, with the commitment and motivation of our health care workers, in all areas of health, this has become a reality. We continue to work towards achieving public health goals for a healthier and productive Belize.”
Dr Christopher Tufton, Minister of Health and Wellness of Jamaica, is proud of the “win that underscores protecting the health of all”.
“It is also exemplary of the extraordinary progress being made in our maternal health care. What’s more, it is vitally important that we consolidate the gains made from this achievement, especially through continued community engagement and partnership in the public health interest of all.”
Minister of Health, Wellness, and the Environment for St Vincent and the Grenadines, St. Clair Jimmy Prince, commends the “dedication and commitment” of healthcare workers on achieving this certification.
“This achievement signals to the world that ending paediatric HIV and congenital syphilis through the elimination of mother-to-child transmission of HIV and syphilis is achievable. The Ministry will continue to work towards ending AIDS as a public health threat by 2030.”
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