CDC Video: Zika 101

Click to watch On YouTube

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There's been so much hype and misinformation out there about the Zika virus that I'm pleased to see that the CDC's Principal Deputy Director Anne Schuchat, M.D. has been selected to present a 4 minute video explaining the Zika threat. 

Admiral Schuchat was the `voice' of the CDC during the opening months of the 2009 H1N1 pandemic, and her ability to convey rapidly changing and unscripted  information – while acknowledging those things that were still unknown – earned her a lot of fans in the media.

Follow this link, or click the image below, to watch the presentation.

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WHO H7N9 Update - China

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Over the past month we've seen scattered reports of H7N9 cases across mainland China (see Hong Kong CHP Notified Of 19 Additional H7N9 Cases On Mainland),
although few details have been forthcoming.

Today the World Health Organization published an updated listing of 28 `recent' cases - going back to December 21st - reported to them by the Chinese government.

Although comparisons are tough without a real-time disclosure of cases, we seem to be seeing fewer cases reported (and none so far in Hong Kong), compared to the past two winters.

Human infection with avian influenza A(H7N9) virus – China

Disease outbreak news
10 February 2016 

On 5 February 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 28 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, including five deaths. 

Onset dates ranged from 21 December 2015 to 25 January 2016. Cases ranged in age from 14 to 91 years, with a median age of 58 years. Of these 28 cases, 18 (64%) were male. The majority (25 cases, 89%) reported exposure to live poultry or live poultry markets; the exposure history of three cases is unknown or no clear exposure to poultry. No clusters were reported. Cases were reported from six provinces and municipalities: Zhejiang (13), Jiangsu (5), Guangdong (4), Fujian (3), Shanghai (2) and Hunan (1). See attachment for individual case information.

Detailed information concerning these cases can be found in a separate document (see related links).

Public health response

The Chinese Government has taken the following surveillance and control measures:

• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and dissemination of information.

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Russia's Flu Epidemic: Week 6 Epidemiology Report

Russian Research Institute of Influenza

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Russia's flu epidemic has been raging for three weeks, forcing the closure of more than 11,000 schools, and as it consists primarily A(H1N1)pdm09, it is hitting younger adults and children particularly hard.

Today the Russian Research Institute of Influenza has published their latest (week 6) epidemiological report, which shows a slight reduction in flu activity, but still with ILI & ARI morbidity levels running very high.

First some excerpts from today's report, after which I'll have some brief comments.

Week 01.02.2016-07.02.2016

Influenza and ARI morbidity data

Epidemiological data slight (by 13.3%) decrease of influenza activity in Russia in comparison with previous week.  However the nationwide ILI & ARI morbidity level (125.2 per 10 000 of population) exceeded the national baseline (69.5 per 10 000) by 80.1%

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ILI and ARI epidemic thresholds were exceeded in 44 of 58 cities collaborating with two WHO NICs in Russia.

Cumulative number of diagnosed influenza cases

Laboratory diagnosis data. Results of influenza laboratory diagnosis by different tests were submitted by 53 RBLs and two WHO NICs. According to these data as a result of 13246 patients investigation the overall proportion of respiratory samples positive for influenza virus was estimated as 4321 (32.6%) including 3982 (92.2%) influenza A(H1N1)pdm09 cases, 128 (3.0%) influenza A(H3N2) cases, 174 (4.0%) influenza A cases and 37 (0.9%) influenza B cases.

Conclusion

Influenza and ARI morbidity data. Influenza activity decreased slightly on the week 06.2016 however the nationwide ILI & ARI morbidity level (125.2 per 10 000 of population) exceeded still the national baseline by 80.1%.

Etiology of ILI & ARI morbidity. As a result of investigation of 13246 patients in 53 cities of Russia the overall proportion of respiratory samples positive for influenza in traditional surveillance system was estimated as 32.6%. Influenza A(H1N1)pdm09 dominated (92.2% of influenza cases). Influenza A(H3N2) and B cases registered sporadically.

The overall proportion of respiratory samples tested positive for parainfluenza, adenovirus and RSV was estimated in total as 4.5% (PCR) and 13.4% (IFA) of investigated samples.

In sentinel surveillance system clinical samples from 86 SARI and 112 ILI/ARI patients were investigated by rRT-PCR. 59 (68.8%) influenza cases including 55 influenza A(H1N1)pdm09 and 4 influenza A(H3N2) cases were detected among SARI patients. A total 40 (35.7%) influenza cases including 37 influenza A(H1N1)pdm09 and 3 influenza A(H3N2) cases were detected among ILI/ARI patients.

Antigenic characterization. Totally 123 influenza A(H1N1)pdm09, 2 influenza A(H3N2) and 5 influenza B viruses were characterizated antigenically in two NICs of Russia since the beginning of the season. According to St.Petersburg NIC data 21 influenza A(H1N1)pdm09 strains were related closely to influenza A/California/07/09 virus. 

Most of 102 influenza A(H1N1)pdm09 viruses investigated in Moscow NIC were similar to vaccine A/California/07/09 virus however 10 of them had decreased up to 1/16 titer in interaction with antiserum to this virus. Two A(H3N2) strains were similar to influenza A/Hong-Kong/5738/2014 virus, with antiserum to influenza A/Switzerland/9715293/2013 they reacted up to 1/4 - 1/8 of homological titer in HI.

All investigated 5 influenza B viruses belonged to Victorian lineage and were similar to influenza B/Brisbane/60/2008 reference strain reacting with antiserum to this virus up to 1 - 1/8 of homological titer in HI.

Genetic characterization. 54 investigated influenza A(H1N1)pdm09 virus strains were A/South Africa/3626/2013-like. All viruses bear clade 6B specific mutations in HA (S84N, S162+N and I216T) and formed new genetic group according to phylogenetic analysis. Two A(H1N1)pdm09 sequences obtained directly from autopsy sample showed the presence of additional mutation D222G in HA1.

Susceptibility to antiviral drugs. According to genetic investigations 54 influenza A(H1N1)pdm09 viruses were susceptible to oseltamivir and resistant to rimantadine. These results coincided with Munana testing of 10 strains isolated in St.-Petersburg.

Today's report indicates that 15 additional  A(H1N1)pdm09 viruses were antigenically characterized, and (based on the numeric differences from Week 5), all appear to be closely related to influenza A/California/07/09 virus. 

Additionally, the number of virus samples with decreased titers to the vaccine virus remained unchanged from last week at 10. 

Once again, this week's report once again states that - Two A(H1N1)pdm09 sequences obtained directly from autopsy sample showed the presence of additional mutation D222G in HA1. - although it seems likely this is a carry over from last week. 


In a final bit of good news, there doesn't appear to be any sign of a loss of susceptibility of the 6B clade of H1N1 to Oseltamivir - in contrast to last week's Eurosurveillance: Emergence of A(H1N1)pdm09 Genogroup 6B In India, 2015 report which found some (limited) detection of the H275Y resistance mutation. 
 

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Rospotrebnadzor Week 5 Update: Russia's Influenza Epidemic Continues To Rise

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We've been watching Russia's flu epidemic for several weeks, including epidemiological reports suggesting that the H1N1pdm09 virus responsible for the bulk of the misery has evolved into a new subgroup (see WHO Risk Assessment - Seasonal Influenza A(H1N1)pdm09).

We should get the latest (Epi Week 6) update from the  WHO National Influenza Centre Of Russia in the next day or so. 

Minzdrav, the Russian Ministry of Health, has been largely silent regarding their current flu outbreak, but  Rospotrebnadzor - the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing - has provided weekly updates on the societal impact of the epidemic. 

Flu activity has been reported to have peaked in some regions, but today's announcement from Rospotrebnadzor describes the epidemic as `still rising', and they report 11,470 schools, 2,298 kindergartens, 578 colleges,72 universities completely closed due to the epidemic. 

 By comparison, last week the headlines reported The flu epidemic in Russia: in quarantine closed 9,000 schools, making this week's closures a roughly 25% increase over last week.
 

The closing of schools in Russia during severe flu seasons is not uncommon, and every winter we see reports of hundreds - sometimes even a few thousand - schools shuttered to reduce the community spread of the virus.

This year, however, the number of school closings seems unusually high - even for Russia - and many schools have remained closed for as long as three weeks.  The number of schools closed is a pretty good indicator of flu activity, and so we'll continue to watch this metric for signs of improvement.


This from Rospotrebnadzor: 

On the epidemic situation of the incidence of influenza and acute respiratory viral infections in the Russian Federation for the 5 week 2016

02.10.2016 Mr.

February 10, 2015 in Rospotrebnadzor held a conference "On organization of preventive and anti-epidemic measures in the Russian Federation in the period of epidemic rise of influenza and SARS." The meeting was attended by representatives of executive authorities of the Russian Federation, Head of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being on the subjects of the Russian Federation, on Rail Transport, heads of executive bodies of subjects of the Russian Federation in the field of public health protection, enforcement authorities the executive authorities of subjects of the Russian Federation, engaged in public administration in the field of education, the chief doctors of the Federal budget and health care institutions - hygiene and epidemiology centers in the Russian Federation.


At the 5 week (1-7 February 2016) in the Russian Federation continues to rise in epidemic influenza and SARS, weekly epidemic threshold exceeded by the total population registered in the 68-subjects of the Russian Federation.

Excess epidporoga the central city without exceeding epidporoga on the subject reported in 4 cities: Krasnodar, Penza, Irkutsk, Vladivostok.

Among children younger than 2 years of excess weekly incidence thresholds noted in 50 regions of Russia among children 3-6 years - in 63-s of the Russian Federation, 7-14 years - in 44 subjects. Among people older than 15 years exceeded the weekly incidence thresholds noted in 64 subjects of the Russian Federation.

In a number of subjects there is a tendency to reduce the incidence. 

According to the monitoring data in the circulating respiratory viruses structure is dominated by influenza viruses A (H1N1) 2009.

In week 5, taking into account the incidence of pre-school children and pupils were completely closed 11,470 schools, 2,298 kindergartens, 578 colleges, 72 university.

Partially closed schools and kindergartens 8924 and 8411 class groups.

Fully closed schools (extraordinary holidays) in Moscow, Oryol, Leningrad, Tyumen, Chelyabinsk and Omsk regions.

Kindergartens are completely closed in the Leningrad region.

The situation is under the control of Rospotrebnadzor.

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RESEP SAMBAL GOANG DADAKAN KHAS SUNDA

Resep Sambal Goang - Salah satu macam sambal sederhana yang akrab menemani menu makan sehari-hari adalah sambal goang. Umumnya resep sambal goang khas sunda diolah mentah atau tanpa dimasak yang sering disebut juga dengan sambal dadakan karena kepraktisannya. Walaupun sederhana, tetapi sangat populer sebagai pelengkap menu resto-resto di Bandung, Bogor, Sumedang bahkan populer juga di Betawi dengan berbagai aneka kreasinya.

Masyarakat sunda Jawa Barat menjadikan sambal goang sebagai pelengkap menu makan sehari-hari supaya makannya tambah lahap. Bahan utama cara membuat sambal goang bisa menggunakan cabe rawit merah maupun cabe rawit hijau yang dibubuhi garam, kemudian diulek bersama kombinasi bahan dengan stok yang ada atau bahan lainnya yang disesuaikan selera. Ada yang menambahkan kencur, daun kemangi, terasi, kapulaga dan lain sebagainya untuk memberikan variasi rasa dan aroma sehingga lebih sedap disantap. Bahkan dengan pemakaian cabe rawit setan atau cengek domba akan menambah level kepedasan yang semakin menggugah selera.

Persiapan Bahan Sambal Goang

• 15 buah cabe rawit merah (rawit setan atau cengek domba)
• 1 sdt gula merah
• 1/2 sdt garam
• 1 cm kencur
• 1 siung bawang putih ukuran kecil
• 1 sdm terasi udang, goreng sebentar dengan sedikit minyak
• 1 buah jeruk purut
• daun kemangi secukupnya (opsional)

Cara Membuat Sambal Goang

1. Siapkan cobek, kemudian ulek semua bahan kecuali jeruk purut hingga halus serta aduk rata.
2. Beri air perasan jeruk purut dan siap untuk disajikan. Bisa tambahkan daun kemangi atau dapat juga hidangkan terpisah sebagai lalapan.

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WHO Risk Assessment - Seasonal Influenza A(H1N1)pdm09

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The World Health Organization - in conjunction with their bi-weekly global influenza update - has released a special risk assessment on the predominant flu virus across much of the globe this year;  A(H1N1)pdm09.

Over the past several weeks we've been monitoring the emergence of a new subgroup of clade 6B of H1N1pdm09 in Russia, raising questions over its antigenic match to the current vaccine.

According to the WHO, while they acknowledge that new sub-groups of A(H1N1) have emerged, the `majority of the 6B viruses' tested still remain antigenically similar to the vaccine virus.

So far, phylogenetic analysis of the haemagglutinin (HA) demonstrated that the HA genes of all viruses collected since September 2015 belong to genetic subgroup 6B. Within 6B, sub-subgroups with shared amino acid changes have emerged. Despite the genetic evolution of A(H1N1)pdm09 viruses, the majority of 6B viruses including those in the emerging sub-subgroups, remain antigenically¹ closely related to the vaccine virus

The full statement follows:

Risk Assessment - Seasonal Influenza A(H1N1)pdm09

8 February 2016

Compared to previous years, northern hemisphere seasonal influenza activity commenced late in some countries in western Europe, North America and eastern Asia. Transmission, as demonstrated by influenza-like illness (ILI) rates, has started to exceed country-specific baseline rates, but is still relatively low in general with the exception of some eastern European countries where a sharp increase of ILI rates has been observed and countries in western Asia where influenza activity may have already peaked. 

Among the currently circulating seasonal influenza viruses in the temperate zone, influenza A(H1N1)pdm09 virus is predominating, except in northern China where influenza A(H3N2) and influenza B viruses are widely co-circulating though the proportion of A(H1N1)pdm09 virus is increasing. In a few European countries, influenza A(H3N2) and influenza B viruses are also circulating.

In some countries there have been reports of hospitalizations with severe disease associated with influenza A(H1N1)pdm09 virus infections. Based on the WHO global influenza surveillance, in countries with influenza A(H1N1)pdm09 virus predominating, the hospitalization and intensive care unit (ICU) admission patterns seem to be similar to previous seasons when this virus predominated and where young/middle-aged adults experienced severe disease.

The WHO Collaborating Centres for Influenza (CCs) of the WHO Global Influenza Surveillance and Response System (GISRS) have characterized influenza A(H1N1)pdm09 viruses collected from more than 30 countries since September 2015, including those from countries reporting severe infections. So far, phylogenetic analysis of the haemagglutinin (HA) demonstrated that the HA genes of all viruses collected since September 2015 belong to genetic subgroup 6B. Within 6B, sub-subgroups with shared amino acid changes have emerged. Despite the genetic evolution of A(H1N1)pdm09 viruses, the majority of 6B viruses including those in the emerging sub-subgroups, remain antigenically¹ closely related to the vaccine virus. In addition, a pool of human post-vaccination sera collected from healthy adults in the United States of America who received influenza vaccine in the 2015-2016 season well inhibited all recent viruses tested in the WHO CC at the Centers for Disease Control and Prevention (CDC) in Atlanta.

Influenza vaccines containing an A/California/7/2009-like component, as recommended by WHO for use in the 2015-2016 seasonal vaccines, are expected to provide good protection against infections associated with the currently circulating A(H1N1)pdm09 virus. WHO strongly recommends that high risk groups be vaccinated against influenza (Weekly Epidemiological Record, 23 November 2012, vol. 87, 47 (pp. 461-476)). Risk groups for influenza include people at increased risk of exposure to influenza virus as well as those at particular risk of developing severe disease resulting in hospitalization or even death. The former group includes healthcare workers (HCWs) whereas the latter groups include pregnant women, children aged 6–59 months, the elderly and individuals with specific chronic medical conditions.
 
Globally more than 450 A(H1N1)pdm09 viruses have been tested for antiviral susceptibility to neuraminidase inhibitors, of which only two viruses showed reduced susceptibility. Currently circulating viruses are expected to be susceptible to the antiviral drugs oseltamivir and zanamivir. Early administration of neuraminidase inhibitors, ideally within 48 hours of influenza symptom onset, reduces severe complications and death and is recommended for persons at increased risk and progressive disease. When influenza is suspected in such populations, antiviral treatment should not wait for diagnostic confirmation but should start immediately.
 
Countries are encouraged to continue surveillance and programmatic disease control activities, and to timely share surveillance information with WHO and representative viruses with WHO CCs of GISRS in order to have continuous risk assessment of circulating and emerging influenza viruses.

• For further details and regular updates on influenza activity globally, refer to the bi-weekly influenza updates.

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ECDC Zika/Microcephaly/GBS Rapid Risk Assessment - 2nd Update

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Three weeks after the first ECDC Rapid Risk Assessment On Zika Virus Epidemic we have a second update, and as we've come to expect from the ECDC, this 16 page document is both up to date, and feature-rich.

I've only included some small excerpts, so you'll want to download and reviewe the entire PDF. 

Rapid risk assessment: Zika virus disease epidemic: potential association with microcephaly and Guillain–Barré syndrome, Second update


08 Feb 2016
Available as PDF 
 
Abstract

​This document assesses the risks associated with the Zika virus epidemic currently affecting countries in the Americas. It assesses the association between Zika virus infection and congenital central nervous system malformations, including microcephaly, as well as the association between Zika virus infection and the Guillain–Barré syndrome (GBS).

Main conclusions and options for response 
 
Considering the continued rapid spread of Zika virus in the Americas and Caribbean, the growing evidence of an association between Zika virus infection during pregnancy and adverse pregnancy outcomes, the association between Zika virus infection and post-infectious Guillain–Barré syndrome (GBS), and the risk of establishment of local vector-borne transmission in Europe during the 2016 summer season, EU/EEA Member States are recommended to consider the following mitigation measures.

• Travellers visiting countries where Zika virus is currently being transmitted should be made aware of the ongoing outbreak of Zika virus infection. A list of countries and territories with documented autochthonous transmission during the past two months is maintained on the ECDC website (see also Table 1).

• Travellers visiting these countries should use personal preventive measures based on protection against mosquito bites indoors and outdoors, especially from sunrise to sunset when mosquitoes are most active in biting. Such measures include:

− using mosquito repellent in accordance with the instructions indicated on the product label. DEET-based repellent is not recommended for children under three months of age but pregnant women can use it.

− wearing long-sleeved shirts and long trousers, especially during the hours when the type of mosquito that carries the Zika virus (Aedes) is most active.

− sleeping or resting in screened or air-conditioned rooms, otherwise use mosquito nets, even during the day.

• Pregnant women and women who are planning to become pregnant, and who are intending travel to affected areas, should discuss their travel plans and evaluate the risk with their healthcare providers and consider postponing their travel.

• Travellers with immune disorders or severe chronic illnesses should consult their doctor or seek advice from a travel clinic before travelling, and be given advice on effective prevention measures.

• There is evidence that Zika virus can be transmitted sexually through semen, and there are indications that Zika virus can be present in semen for several weeks after a man has recovered from a Zika virus infection. Travellers to Zika-affected areas should be advised that the risk of sexual transmission from an infected man to another person can be reduced by using condoms.

• Travellers showing symptoms compatible with Zika virus disease within three weeks of return from an affected area are advised to contact their healthcare provider and mention their recent travel.

• Pregnant women that have travelled in areas with Zika virus transmission should mention their travel during antenatal visits in order to be assessed and monitored appropriate

• Male travellers returning from areas with local transmission of Zika virus should consider using a condom with a female partner at risk of getting pregnant or already pregnant:

− for 28 days after their return from an active Zika transmission area if they have not had any symptoms compatible with Zika virus infection;

− for 6 months following recovery from a laboratory-confirmed Zika virus infection.

This precautionary advice is based on limited evidence and will be revised as more information becomes available.

Information to healthcare providers

• Ensure that Zika virus-infected patients in areas with Aedes mosquitoes take measures to avoid getting bitten during the first week of illness (insecticide-treated bed nets, screened doors and windows as recommended by PAHO/WHO).

• Increase awareness among health professionals who provide prenatal care of the possible association between Zika virus and microcephaly and adapt prenatal monitoring in accordance with the exposure to the vector.

In addition, due to the unprecedented size of the Zika virus epidemic, health services and practitioners should be alert to the possible occurrence of neurological syndromes (GBS and other neurological syndromes such as meningitis, meningoencephalitis and myelitis according to WHO/PAHO) and potential disease complications not yet described in the scientific literature and atypical clinical presentation among specific populations (i.e. children, the elderly, immunocompromised individuals and those with sickle cell disease).

This document also includes more specific options for substances of human origin, surveillance and preparedness

   

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