CDC Issues Interim Travel Advice On Zika Virus (Level 2 - Enhanced Precautions)

#10,897



After a three hour delay, the CDC released their interim travel recommendations of Zika at 7pm EST this evening, recommending - out of an abundance of caution - that Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing.
 

While a direct link between Zika virus infection and birth defects has not been conclusively established, the circumstantial evidence is sufficient for the CDC to make the recommendation. 

The primary concern is Brazil right now, but this travel advisory extends to all countries in the Americas seeing local transmission of the virus.  As of today that includes Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

The full press release may be accessed at the link below.

CDC issues interim travel guidance related to Zika virus for 14 Countries and Territories in Central and South America and the Caribbean

Out of an abundance of caution, pregnant women advised to consider postponing travel to areas where Zika virus transmission is ongoing 

Media Statement

For Immediate Release: Friday, January 15, 2016Contact: Media Relations,
(404) 639-3286

CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

Until more is known, and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant:

• Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
• Women trying to become pregnant who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip. 

Because specific areas where Zika virus transmission is ongoing are difficult to determine and likely to change over time, CDC will update this travel notice as information becomes available. Check the CDC travel website frequently for the most up-to-date recommendations.

Currently, there is no vaccine to prevent or medicine to treat Zika. Four in five people who acquire Zika infection may have no symptoms. Illness from Zika is usually mild and does not require hospitalization. Travelers are strongly urged to protect themselves by preventing mosquito bites:

• Wear long-sleeved shirts and long pants
• Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed.
  • Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant and nursing women and children older than 2 months when used according to the product label. Oil of lemon eucalyptus products should not be used on children under 3 years of age.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents).
• Stay and sleep in screened-in or air-conditioned rooms.

In addition to the steps announced today, CDC is working with public health experts across the U.S. Department of Health and Human Services (HHS) to take additional steps related to Zika. CDC is developing interim guidance for pregnant women as well as sharing additional information about Zika with public health officials, clinicians and the public.  In addition, efforts are underway across HHS to develop vaccines, improved diagnostics and other countermeasures for Zika. 

(Continue . . .)

Some recent blogs on the Zika/Microcephaly situation include:

Despite What You May Have Heard About The 1st Zika Case In The US . . . 

Brazil MOH: Updated Microcephalic Birth Numbers - Epi Week 1

CDC Statement: First Zika VIrus Infection Reported In Puerto Rico

 

Read More

USDA/APHIS Press Conference On H7N8 - Audio

# 10,896


The USDA has posted a 21 minute audio file of a press conference, with Q&A by journalists, regarding today's HPAI H7N8 outbreak in Indiana.  While there are a great many unknowns, the hope is that by the middle of next week we'll know more about how this virus mutated into an HPAI strain.


Although we've no record of human infection with HPAI H7N8 - primarily because it has never been seen in the US before - the CDC is monitoring individuals who may have been exposed to the new strain of bird flu.


According to a Reuters report CDC says closely monitoring outbreak of new bird flu strain, that agency is  coordinating with state and local health officials to implement the protocols  we looked at last year in:

CDC HAN:HPAI H5 Exposure, Human Health Investigations & Response

CDC Clinician Guidance: Evaluating Patients Exposed to HPAI H5 Avian Flu. 

While we've seen sporadic human infection with H7 avian viruses in the past, with the exception of China's H7N9, they have nearly always been mild.  A few examples include:

• In 2003 a large outbreak of H7N7 (89 confirmed, 1 fatality) in the Netherlands – with  nearly all  reported cases having  very mild (often just conjunctivitis) symptoms.
• The Fraser Valley H7N3 outbreak of 2004 resulted in at least two human infections, as reported in this EID Journal report: Human Illness from Avian Influenza H7N3, British Columbia.
• In 2006 1 person in the UK was confirmed to have contracted H7N3, and the following year, 4 people tested positive for H7N2 – both following local outbreaks in poultry.
• 3 mild cases in Italy in 2013 (see ECDC Update & Assessment: Human Infection By Avian H7N7 In Italy).

Of course – H7 flu strains - like all influenza viruses, are constantly mutating and evolving. What is mild, or relatively benign today, may not always remain so.

In 2008 we saw a study in  PNAS that suggested the H7 virus might just be inching its way towards better adaptation to humans (see Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility).

You can read more about this in a couple of blogs from 2008, H7's Coming Out Party and H7 Study Available Online At PNAS.

As I said, we'll know a great deal more about this H7N8 virus in a few more days.  This outbreak may be a one-off event, or like HPAI H5 last year, could signal the beginning of something larger.


Stay tuned. 

Read More

APHIS: HPAI H7N8 In Commerical Turkey Farm - Indiana

Dubois County - Credit Wikipedia

#10,895


 While poultry farmers and the USDA have been waiting anxiously to see if Highly Pathogenic Avian Influenza would return this winter, the subtypes we've been expecting were HPAI H5's - specifically H5N2 and H5N8.

Today, in a surprise statement, APHIS has announced the detection of a completely different HPAI strain - H7N8.

There aren't a lot of citations for H7N8 beyond a handful of low path findings in healthy wild birds. Korea reported an outbreak of LPAI (low path) H7N8 in 2007.

Credit Influenza Research Database

 
There is obviously a lot we are going to need to learn about this newest virus; how this HP strain evolved, how easily it transmits, and how it got past the farm's biosecurity measures.


For now, it is too soon to know how much of an impact this strain is going to have.  But this latest finding does prove that influenza never ceases to surprise us.

USDA Confirms Highly Pathogenic H7N8 Avian Influenza in a Commercial Turkey Flock in Dubois County, Indiana

Last Modified: Jan 15, 2016

Print

Contacts:
Andrea McNally (202)799-7033andrea.c.mcnally@aphis.usda.gov
Lyndsay Cole (970)494-7410lyndsay.m.cole@aphis.usda.gov

WASHINGTON, January 15, 2016 -- The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H7N8 avian influenza (HPAI) in a commercial turkey flock in Dubois County, Indiana.  This is a different strain of HPAI than the strains that caused the 2015 outbreak.  There are no known cases of H7N8 infections in humans.  As a reminder, the proper handling and cooking of poultry and eggs to an internal temperature of 165 ˚F kills bacteria and viruses, including HPAI.

Samples from the turkey flock, which experienced increased mortality, were tested at the Indiana Animal Disease Diagnostic Laboratory at Purdue University, which is a part of USDA’s National Animal Health Laboratory Network, and confirmed by USDA this morning. APHIS is working closely with the Indiana State Board of Animal Health on a joint incident response. State officials quarantined the affected premises and depopulation of birds on the premises has already begun. Depopulation prevents the spread of the disease. Birds from the flock will not enter the food system.
As part of existing avian influenza response plans, Federal and State partners are working jointly on additional surveillance and testing in the nearby area.  The rapid testing and response in this incident is the result of months of planning with local, state, federal and industry partners to ensure the most efficient and effective coordination. Since the previous HPAI detections in 2015, APHIS and its state and industry partners have learned valuable lessons to help implement stronger preparedness and response capabilities. In September, APHIS published a HPAI Fall Preparedness and Response Plan that captures the results of this planning effort, organizing information on preparatory activities, policy decisions and updated strategy documents.

The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.
Anyone involved with poultry production, from the small backyard to the large commercial producer, should review their biosecurity activities to assure the health of their birds. To facilitate such a review, a biosecurity self-assessment and educational materials can be found at http://www.uspoultry.org/animal_husbandry/intro.cfm
In addition to practicing good biosecurity, all bird owners should prevent contact between their birds and wild birds and report sick birds or unusual bird deaths to State/Federal officials, either through their state veterinarian or through USDA’s toll-free number at 1-866-536-7593.  Additional information on biosecurity for backyard flocks can be found at http://healthybirds.aphis.usda.gov.
Additional background

Avian influenza (AI) is caused by an influenza type A virus which can infect poultry (such as chickens, turkeys, pheasants, quail, domestic ducks, geese and guinea fowl) and is carried by free flying waterfowl such as ducks, geese and shorebirds. AI viruses are classified by a combination of two groups of proteins: hemagglutinin or “H” proteins, of which there are 16 (H1–H16), and neuraminidase or “N” proteins, of which there are 9 (N1–N9). Many different combinations of “H” and “N” proteins are possible. Each combination is considered a different subtype, and can be further broken down into different strains. AI viruses are further classified by their pathogenicity (low or high)— the ability of a particular virus strain to produce disease in domestic chickens.

Read More

China Experts: No Evidence Of H-2-H Transmission Of H5N6

 







#10,894


In the first 19 months after it emerged, China reported 4 human infections with the HPAI H5N6 avian flu virus.  Two cases in 2014, and two more in the first 11 months of 2015.

Over the past 30 days, China has reported four more cases, all in Guangdong Province,  raising intense media speculation that something may have changed in the virus's behavior. 

Today Chinese scientists are assuring that no human-to-human transmission of this emerging virus has been documented.

No evidence for human-to-human H5N6 infection: experts

Source: Xinhua   2016-01-15 20:45:33

BEIJING, Jan. 15 (Xinhua) -- Experts have found there is currently no evidence showing the H5N6 avian influenza virus (AIV) is capable of human-to-human infection, said an official at the National Health and Family Planning Commission (NHFPC) on Friday.

Xiong Huang, deputy head of the publicity department of NHFPC, made the announcement based on growing concerns about avian flu in China.

Since September 2015, four isolated H5N6 cases have been reported across the country, with three in south China's Guangdong and one in neighboring Jiangxi Province, according to Xiong.

Despite no human-to-human infections of H5N6 AIV so far, the channels for the virus to spread from bird to human have yet to be eliminated, as people are more likely to be infected with respiratory diseases in winter, while cage-free poultry farming is still common in the country, Xiong said.

The NHFPC has already taken measures to prevent and control the disease, and countermeasures are being taken in the provinces hit by H5N6, Xiong added.

The world's first human H5N6 infection was reported in May 2014 in southwest China's Sichuan Province. A 26-year-old woman with the disease died in Shenzhen City seven months after diagnosis. 

With the Lunar New Year celebration fast approaching (see Hong Kong Alert For Holiday Avian Flu Threat) concerns run high that the winter epidemic of H7N9, and now sporadic cases of H5N6, might expand as millions travel across Asia over the next 30 days. 
 

The fact that only four, widely scattered, cases have been reported in the past month is a good sign the virus is not spreading easily.

But by the same token, the sudden increase in cases tells us the H5N6 virus is far better distributed in China's poultry than it was last year, making H5N6 a virus to watch.


For additional background on this emerging avian flu virus, you may wish to revisit H5N6: The Other HPAI H5 Threat.

Read More

WHO Statement On New Ebola Case

#10,893


The brief WHO announcement this morning (see WHO Confirms Ebola Death In Sierra Leone), has been followed up by the statement below:

New Ebola case in Sierra Leone; WHO continues to stress risk of more flare-ups

WHO statement
 
15 January 2016 

A new case of Ebola has been confirmed in Sierra Leone, reflecting the ongoing risk of new flare-ups of the virus in affected countries.

The Sierra Leone government acted rapidly to respond to this new case. Through the country’s new emergency operations centre, a joint team of local authorities, WHO and partners are investigating the origin of the case, identifying contacts and initiating control measures to prevent further transmission.

WHO stressed in a statement yesterday (14 January), that Guinea, Liberia and Sierra Leone remain at high risk of additional small outbreaks of Ebola in the coming months due to the virus persisting in survivors after recovery. 

"We are now at a critical period in the Ebola epidemic as we move from managing cases and patients to managing the residual risk of new infections,” said Dr Bruce Aylward, WHO’s Special Representative for the Ebola Response, yesterday. “We still anticipate more flare-ups and must be prepared for them.”

Sierra Leone is still in a 90-day period of enhanced surveillance following the declaration on 7 November 2015 of the end of Ebola transmission in the country. This period is designed to ensure no hidden chains of transmission have been missed and to detect any new flare-ups of the disease. 

Read More

More Korean Media Backlash On the MERS `Mutation' Story

#10,892


Last week, in `The `M' Word' we looked at the media's first reaction to a study (Variations in Spike Glycoprotein Gene of MERS-CoV, South Korea, 2015) that found enough genetic variance among a small subset of the Korean viruses sequenced from last summer's MERS outbreak to place them into a new clade.

Two mutations were located in the receptor binding domain of the virus's spike protein, although scientists still don't know what effect - if any - they would have on the spread, or impact, of the virus. 

Last summer, when the virus was running rampant through Korean hospitals, the WHO (see Yonhap News report WHO chief says no mutation of MERS virus found in S. Korea) - and others - reassured that the Korean MERS Sequences Closely Match Middle Eastern Virus. 

The rub being that `Closely' isn't the same thing as `Exactly'. 

And determining what - if any - impact minor genetic changes might have on a virus's behavior can take months of observation. A fine point that officials - perhaps more interested in dampening concerns than in explaining the nuances - didn't exactly stress. 

Simple, reassuring statements are often preferred by governments and agencies in the midst of a crisis, but they sometimes come back and bite you.

Which explains why - seven months later - the scathing headline in the Korean Times today reads:

WHO suspected of lying about MERS mutation 

By Jung Min-ho

When the Middle East Respiratory Syndrome (MERS) outbreak swept the country last year, The Korea Times raised the possibility of a virus mutation (http://www.koreatimes.co.kr/www/news/nation/2015/06/116_180045.html), citing its unusually high infection and low fatality rates.

Following the report, the World Health Organization (WHO) and the government conducted genome sequencing studies of the virus together and concluded that no genetic mutation had occurred.

Speaking to reporters on June 18 in 2015, WHO Director-General Margaret Chan said, "The virus has been sequenced. So far, no genetic changes have been detected that could make the virus easier to transmit among humans."

However, after their own sequencing program, a group of researchers drew a different conclusion this month: the virus apparently had mutated from the one found in Saudi Arabia, where Korea's first MERS patient was infected.

(SNIP)

It is unclear whether WHO investigators lied about the virus mutation. If not, however, the study suggests that they failed to figure it out at a critical time of crisis.

(Continue . . .)

I've only printed a few excerpts from a much longer story, so follow the link to read the (English Language) report in its entirety.

The problem with all of this is that we still don't know whether the genetic changes detected in the Korean MERS virus affected its transmissibility. The authors of the study that found these changes wrote `we cannot conclude that deleterious effects promoting spread of infection will occur because of these mutations.'

If we don't know now, it is hard to fault the WHO for not knowing seven months ago. Could they have been a little more up front about the limits of their knowledge of role of minor genetic changes?

Absolutely.

After the declaration that `no mutations' were found, it would have been a good idea to add that the impact of small genetic changes are not always immediately apparent. An uncertainty I went into in my blog last June in some detail.

Highlighting uncertainties and unknowns is viewed by some, however, as complicating the message.  But doing so can help avoid the kind of second guessing we are seeing in the Korean media today.

Public health agencies have a habit of issuing overlyreassuring statements, or in not clarifying the limits of their knowledge.  And time after time, we see that come back to haunt them.


Last September, in FAO: Addressing Avian Influenza A(H7N9) Risk Communications, we looked at some sage advice offered by risk communications expert Dr. Peter Sandman, where he strongly advises:

• Inform early, often and transparently as the situation develops

—— Warn that messages designed early in an unfolding event may change as knowledge evolves.
—— Be open about your level of uncertainty.
—— Share your wish that you could be more certain.
—— When you modify your recommendations, highlight the fact that you are making a change and explain why the
change needs to be made.
—— Avoid both overly optimistic and overly alarming speculation.
—— Share the worst-case and most-likely scenarios that you are considering.
—— Show empathy (rather than contempt) for the excessive fears or undue complacency of your audience.

• Do not over-reassure—— Avoid the temptation to say “The situation is under control.”
—— Instead of saying “the government is taking all possible/necessary measures,” convey the honest extent of your activities and explain them in detail.

This is just a sample, you'll find a great deal more available on that blog.  For more on effective risk communications, you may wish to revisit:

Sandman & Lanard On Ebola & Failures Of Imagination

NPR: Jody Lanard On Addressing Ebola Fears

Sandman & Lanard: Ebola Risk Communications

Read More

WHO Confirms Ebola Death In Sierra Leone

0435 EST Today

#10,891


With a brief email to journalists this morning and a tweet (above) the World Health Organization has confirmed the suspected Ebola fatality reported in Sierra Leone last night (see Crofsblog Sierra Leone: Ebola death suspected hours after WHO declares end to epidemic in Liberia) - a disappointing, but not unexpected setback in the fight against Ebola in West Africa. 

Just yesterday the WHO declared the Current Ebola Outbreak Over In Liberia - West Africa At Zero, but everyone involved was well aware how tenuous this hold on `zero' would be.  

The virus is still in the environment, and it is likely that hundreds of recovered Ebola victims still carry - and may still shed - small amounts of the virus. Getting to `zero' transmissions - defined as going 42 days within in a country without a reported case - was a gargantuan task.

Staying there is proving very difficult. 

We've seen similar setbacks in Liberia (twice), and yesterday the WHO warned that new flare ups were not only possible, they were likely.    For now, the focus will be on tracing contacts of this latest victim, and containing any chains of transmission. 

The victim is reportedly a 22 year old woman who died earlier this month after seeking medical assistance in Northern Tonkolili District, but hailing from the Northern Kambia district near the Guinea border.

I imagine we'll get a more detailed official statement later today, once the details of this case are pinned down.

Read More