History of Mass Transportation: A Battery Powered Electric Multiple Unit (ex DRG AT 543/544) in Skierniewice, Poland

 

{Click on Image to Enlarge}

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By Wassen - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=20339249

Source: 

Link: https://en.wikipedia.org/wiki/List_of_rolling_stock_used_in_Poland

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#Coronavirus Disease Research #References (AMEDEO, August 22 '26)

 

Antiviral Res

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   PubMed         Abstract available
   
   
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4. O'DOWD A
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   Clin Infect Dis

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#Influenza and Other Respiratory Viruses Research #References (AMEDEO, August 22 '26)

 

BMC Pediatr

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   PubMed         Abstract available
   
   

   
   Cell

2. LI L, Yan XL, Wang HY, Zhou HY, et al
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   PubMed         Abstract available
   
   

   
   J Gen Virol

3. SHIM K, Choi JH, Hwang EH, Kim G, et al
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   PubMed         Abstract available
   
   
4. GRANSTAD S, Tonnessen R, Ytrehus B, Descamps S, et al
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   PubMed         Abstract available
   
   

   
   J Virol

5. XU J, Chan H-w, Yang R, Wu X-R, et al
   Nicotine and cotinine enhance SARS-CoV-2 entry through distinct but complementary mechanisms in human respiratory epithelial cells.
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6. HE L, Su Y-WN, Zhang F, Moustafa IM, et al
   Recovery of proofreading-impaired SARS-CoV-2 reveals a mutator phenotype and an ExoN activity threshold for viability.
   J Virol. 2026 Jul 29:e0080926. doi: 10.1128/jvi.00809.
   PubMed         Abstract available
   
   
7. BEETON K, Case JB
   Respiratory mucosal vaccines for emerging viruses: promise and challenges.
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8. ZHOU R, Yue M, Shen Q, Liu N, et al
   Glucagon-like peptide-1 receptor agonist prevents pulmonary fibrosis following acute COVID-19 infection associated with type 2 diabetes.
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9. LAMICHHANE P, Yang L, Santos C, Park H-S, et al
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   Pediatrics

10. HUANG YN, Chang CJ, Dai YL, Kung YH, et al
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11. ANTOON JW, Edwards KM
    Why Not Antivirals? Reconsidering Influenza Treatment in Children.
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    PubMed        
    
    

    
    PLoS Comput Biol

12. KRAMER SC, Pirikahu S, Kussmaul C, Opatowski L, et al
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    PLoS One

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18. KOSINSKA-SELBI B, Kowalczyk J, Pierscinska J, Weleszczuk J, et al
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24. EZEJA L, Ezeala OM, Westrick SC, Qian J, et al
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25. LIU STH, Gonzalez-Dominguez I, Martinez-Perez A, Bozkus CC, et al
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26. KAUTZ A, Yang DH, Chickery S, Irving SA, et al
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27. BROWN J, Brennan H, Levine CB, Gwynn L, et al
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28. DEPICKERE S, Pannus P, Houben S, Charles A, et al
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A mouse #monoclonal #antibody against #H7N9 #influenza virus cross-react with #human #platelets

 

Highlights

    • H7N9–98 mAb specifically binds human platelets and targets a ~60 kDa platelet protein.

    • H7N9 virus induces ITP via molecular mimicry with platelet antigens.

    • H7N9 virus-related ITP correlates with disease severity.

Abstract

Objective

To investigate the association and potential mechanisms between H7N9 influenza virus infection or vaccination and immune thrombocytopenia (ITP), providing foundational data for the prevention and treatment of related ITP.

Methods

Using laboratory-prepared anti-H7N9 influenza virus monoclonal antibodies (mAbs) (H7N9-98 and H7N9-120) as research subjects, the interactions between these antibodies and human platelets were analyzed through Western blotting (WB), immunohistochemistry (IHC), and immunofluorescence (IF) techniques.

Results

The mAb H7N9-98 exhibited specific binding to human platelets, showing positive results in both IHC and IF assays. Western blotting results demonstrated that this antibody could specifically recognize approximately 60 kDa human platelet proteins. The isotype control mAb H7N9-120 did not exhibit the aforementioned binding reactions, with all test results being negative.

Conclusion

These findings suggest that the specific antibodies induced by the H7N9 virus may mediate platelet damage through cross-reactivity with platelet autoantigens. This mechanism warrants further investigation to provide experimental evidence for the pathogenesis of secondary ITP associated with H7N9 infection.

Source: 

Link: https://www.sciencedirect.com/science/article/pii/S1567134826001346?via%3Dihub

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#Italy, {Emergency} Protocol activated for suspected #Ebola case in #Trento Autonomous Province (Local Health Agency, August 22 '26)

 

The patient with compatible symptoms and a recent travel history has been isolated. Analysis is ongoing.

Today, the protocol established in the event of a suspected Ebola case was activated. Specifically, an adult recently returned from the Democratic Republic of the Congo exhibited symptoms consistent with the Ebola virus. These symptoms, according to the Ministry of Health's guidelines, require the implementation of the operational procedures for managing suspected cases.

    The affected person is currently self-isolating at home and is considered low-risk. 

    Healthcare workers will visit the site this afternoon to collect biological samples, which will then be sent to the Luigi Sacco Hospital in Milan for laboratory testing. 

    Asuit's {local health agency} Prevention Department has already begun mapping close contacts, purely as a precaution. 

    It should be noted that the implementation of this protocol is a measure established by the health surveillance network and in no way constitutes confirmation of infection . 

    It should also be remembered that transmission occurs only through direct contact with the blood, secretions, or other bodily fluids of an infected person.

(vt)

Source: 

Link: https://www.asuit.tn.it/notizie/attivato-protocollo-sospetto-caso-di-ebola

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#USA, #Wastewater Data for Avian #Influenza #H5 (US CDC, August 21 '26)

 

{Excerpt}

(...)

A(H5) detections in the past week

Time Period: August 09, 2026 - August 15, 2026

    -- A(H5) Detection: 2 site(s) (0.5%)

    -- No Detection: 426 site(s) (99.5%)

    -- No samples: 79 site(s)

{Click on Image to Enlarge}

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(...)

Source: 

Link: https://www.cdc.gov/wastewater/emerging-viruses/h5.html?

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Emerging Haemagglutinin #Mutations in #Bovine-origin #H5N1 Influenza Viruses from #Humans and #Cattle Retain Avian #Receptor Binding with Increased Stability

 

Abstract

The current H5N1 panzootic has seen an unprecedented host range expansion, including sustained circulation in US dairy cattle, detected in March 2024. By July 2026, infections had been reported on more than 1,150 dairy farms across 19 states. Although the outbreak initially centred in Texas, California has emerged as the principal focus of transmission and accounts for most human infections associated with exposure to infected dairy cattle. Continued transmission in cattle and repeated spillover into humans increase opportunities for acquisition of mammalian-adaptive mutations that could elevate zoonotic and pandemic risk. The haemagglutinin (HA) protein plays a central role in modulating virus receptor binding and airborne transmission. Here, we characterised the receptor-binding and stability phenotypes of HA mutations identified in viruses circulating in Californian dairy cattle. Receptor-binding specificity was assessed using bio-layer interferometry and pseudotype virus entry assays. All tested HA variants maintained a preference for avian-type α2,3-linked sialic acid receptors. We evaluated HA stability using fusion and thermostability assays. All mutants exhibited fusion pH values >5.5, outside the range associated with efficient airborne transmission in humans (pH 5.0-5.5). However, mutations D88G and S94N increased pH stability, with fusion pH values of 5.6 and 5.7, respectively, compared with 5.9 for wild-type HA. Viruses harbouring both mutations displayed increased thermostability. These findings demonstrate that cattle-origin H5N1 viruses retain avian-like receptor specificity despite acquiring mutations that modestly enhance HA stability. Evolution of H5N1 viruses in dairy cattle underscores the importance of genomic and phenotypic surveillance to identify mutations that may increase zoonotic risk.

Competing Interest Statement

The authors have declared no competing interest.

Funder Information Declared

Biotechnology and Biological Sciences Research Council, BB/X006166/1, BB/Y007298/1, BB/X006204/1 BB/Y007271/1, APP104179,, BBS/E/PI/230001B, BBS/E/PI/230001C, BBS/E/PI/230002B, BBS/E/PI/230002C), BBS/E/PI/23NB0004, BBS/E/PI/23NB0003, BB/S011269/1

Medical Research Council, https://ror.org/03x94j517, MR/Y03368X/1,

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.08.18.745528v1

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#USA, Two #human #infections with #influenza #H1N2v virus were reported by the #Michigan (US CDC, August 21 '26)

 

{Excerpt}

(...)

Novel Influenza A Virus Infections

    Two human infections with influenza A(H1N2) variant (A(H1N2)v) virus were reported by the Michigan Department of Health and Human Services.

    The patients, who are <18 years of age, initially developed illness and sought healthcare during the week ending August 15, 2026 (Week 32). 

    The patients were not hospitalized, one patient received influenza antiviral treatment, and both are recovering from their illnesses. 

    Investigation by local and state public health officials identified that both patients, who have not had contact with one another, had attended the same agricultural fair where ill swine were present prior to their illness onset. 

    No additional cases of human infection with A(H1N2)v virus associated with these cases or the fair have been identified.

    These are the third and fourth human infections with a variant influenza virus reported in the 2025-2026 season; all four have been influenza A(H1N2)v viruses.

    When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant” influenza virus. 

    Most human infections with variant influenza viruses occur following exposure to swine, but human-to-human transmission can occur. 

    It is important to note that in most cases, variant influenza viruses have not shown the ability to spread easily and sustainably from person to person.

(...)

Source: 

Link: https://www.cdc.gov/fluview/surveillance/2026-week-32.html

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#Surveillance in #humans in 2026 for #WNV - Weekly #Report (ECDC, August 21 '26): 625 cases so far, of which 311 in #Italy

 

{Week 34 / 2026 - Summary}

Current situation

    Since the beginning of the 2026 transmission season, and as at 21 August, 99 areas affected by West Nile virus (WNV) have been identified in 12 countries across Europe.

    These areas are located in: 

        ° Italy (46), 

        ° Greece (17), 

        ° Romania (14), 

        ° France (eight), 

        ° North Macedonia (three), 

        ° Serbia (three), 

        ° Spain (three), 

        ° Albania (one), 

        ° Austria (one), 

        ° Germany (one), 

        ° Kosovo* (one) and 

        ° the Netherlands (one).

    This week, 21 areas are reported as affected for the first time this season. (...)

    The 12 countries have reported 625 locally acquired human cases of WNV infection: 

        ° Italy (311 cases), 

        ° Greece (157, of which seven with unknown place of infection), 

        ° Spain (63 cases), 

        ° North Macedonia (37 cases), 

        ° Romania (28 cases), 

        ° France (17 cases), 

        ° Serbia (six cases), 

        ° the Netherlands (two cases), 

        ° Albania (one case), 

        ° Austria (one case), 

        ° Germany (one case) and 

        ° Kosovo* (one case)

(...)

Source: 

Link: https://www.ecdc.europa.eu/en/west-nile-fever/surveillance-and-disease-data/disease-data-ecdc

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A randomised, open-label clinical study on the efficacy of #baloxavir marboxil and #oseltamivir for post-exposure #prevention of #influenza in a #hospital setting: a study protocol

 

Abstract

Introduction 

Healthcare settings are high-risk environments for the transmission of respiratory viruses. Effective strategies to prevent hospital-acquired influenza, particularly post-exposure prophylaxis for close contacts (CCs), are urgently needed. This study aims to assess the effectiveness of baloxavir marboxil (baloxavir) and oseltamivir in preventing influenza virus infection among CCs who have been exposed to confirmed influenza cases and are unable to be immediately isolated in the hospital ward.

Methods and analysis 

This multicentre, randomised, open-label, parallel-controlled trial involves hospitalised patients with laboratory-confirmed influenza (index patients) and their CCs. CCs will be randomised into three groups: baloxavir marboxil, oseltamivir or placebo. Baloxavir (40 mg or 80 mg for ≥80 kg) will be administered as a single dose on day 1, while oseltamivir (75 mg) will be given once a day for 5 days. CCs will be monitored for influenza-like symptoms, with respiratory samples collected for rapid antigen test or reverse-transcription PCR testing at baseline, day 5±1 and day 10±1 or earlier if symptoms develop. The primary outcome is the 5-day incidence of clinical influenza, defined as laboratory-confirmed infection with concurrent fever and at least one respiratory symptom. Secondary outcomes will include the 5-day incidence of laboratory-confirmed influenza, the 10-day incidence of clinical influenza and the percentage of CCs infected with resistance-associated treatment-emergent influenza variants.

Ethics and dissemination 

The study has been approved by the Clinical Research Ethics Committee of China-Japan Friendship Hospital (2024-KY-401). The results of the study will be submitted for publication in a peer-reviewed journal with online accessibility. The full protocol, de-identified participant data and statistical code will be openly available in a public repository within 12 months after trial completion.

Trial registration number NCT06762587. 

https://creativecommons.org/licenses/by-nc/4.0/

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Source: 

Link: https://bmjopen.bmj.com/content/16/8/e118748

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Trimester-dependent vertical #transmission of #H5N1 #influenza virus through #placental and mammary routes impairs offspring development

 

Abstract

Avian influenza H5N1 has pandemic potential and historically causes more severe disease in pregnant women than the general population. With increasing transmission of H5N1 detected among placental mammals, animal models are necessary for testing countermeasures, including during pregnancy. Pregnant outbred mice infected with a contemporary strain of bovine H5N1 during the second trimester equivalent causes in utero transmission, with infectious virus detected in the uterus, placenta, and fetus. Birth following third trimester infection results in offspring with decreased size, neurodevelopmental delays, and adolescent behavioral impairments, with infectious virus detected in the neonatal milk ring and lungs, as well as mammary tissues. H5N1 viral protein colocalizes with trophoblast cells in the placenta and epithelial cells in mammary tissue that spatially overlap with lectins for α2,3-linked SA. With the pandemic potential of H5N1, our vertical transmission model in placental mammals is essential for understanding viral spread and evaluating treatments during pregnancy.

Source: 

Link: https://www.nature.com/articles/s41467-026-76891-9

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#Ebola #Bundibugyo virus disease, #DRC - Rapid #risk #assessment V4 (WHO, August 21 '26)

{Extract}

    ° Date and version of current assessment: 14 August 2026, v4

Risk statement

    Since first detected in May 2026, the Bundibugyo virus disease (BVD) outbreak has rapidly evolved into a large and geographically expanding  epidemic in the Democratic Republic of the Congo, with sustained transmission,  high mortality and an increasing risk of further international spread. The current outbreak is the second documented Bundibugyo virus disease outbreak in the country, after the 2012 outbreak, the largest Ebola disease outbreak ever recorded in the Democratic Republic of the Congo, irrespective of Ebola virus  species.

    Following laboratory confirmation of Bundibugyo virus on 15 May 2026, with 13 laboratory-confirmed cases from 20 tested specimens,  retrospective investigations conducted by the provincial field team identified 246  suspected cases and 65 deaths (CFR: 26.4%) across three health zones in Ituri  (Mongbwalu, Rwampara and Bunia) occurring between 15 April and 13 May 2026.

    By 13 August 2026, the outbreak had spread to six of the country’s 26 provinces (Bas-Uélé, Haut-Uélé, Ituri, North Kivu, South Kivu and Tshopo)  encompassing 54 health zones, with 4566 laboratory-confirmed cases and 2128  deaths (see map in the Annex). 

    Since the beginning of the outbreak, 155 healthcare workers have been infected. 

    Positively, 918 patients have recovered and been discharged from  treatment centres. These figures demonstrate a substantial increase in the scale  and geographic extent of the outbreak over the past three months.

    Ituri Province remains the epicentre of the outbreak, accounting for 3912  confirmed cases (86%) and 1701 deaths (80%) as of 13 August. The outbreak  was initially detected as a cluster in Mongbwalu Health Zone, a rural gold-mining  area characterised by high population mobility linked to mining, trade and  movement between communities. 

    Spread to additional health zones within Ituri and subsequently to other  provinces occurred with population movement and connections between affected communities. 

    Healthcare facilities also contributed to the establishment of new transmission chains, with Bas-Uélé being identified as the most recently  affected province on 12 August. This geographic spread has increased the  complexity of the response, requiring sustained surveillance, contact tracing and infection prevention and control measures across an increasing number of  affected areas. 

    Ituri Province also has strong cross-border connectivity with Uganda and  South Sudan, highlighting the continued risk of exportation. 

    The crude case fatality ratio (CFR) to date is 47%, underscoring the  severity of the outbreak and ongoing challenges related to timely case detection,  access to and quality of clinical care, and effective interruption of viral  transmission. 

    Delays in recognising cases increase the likelihood of onward transmission within households, communities and healthcare facilities. 

    Contact tracing and follow-up have increased significantly since the start  of the outbreak, but documentation and registration remain incomplete, limiting  data accuracy. 

    As of 13 August, 18811 contacts had been identified and documented in a  line list with detailed contact information, while the number of contacts reported  as being under follow-up is significantly higher, but many contacts lack detailed  information. This limits the ability to fully assess epidemiological links, exposure  histories and transmission patterns among all contacts under follow-up and  indicate gaps in contact investigation and documentation.

    The outbreak has also demonstrated a clear potential for cross-border spread. The first international spread was identified in Uganda in May 2026, when  a symptomatic patient from the Democratic Republic of the Congo travelled to Kampala and was subsequently confirmed with Bundibugyo virus  disease. 

    Additional cases were subsequently identified in Uganda, demonstrating that  population movement across the border can result in onward local transmission.

    In response to the expanding outbreak and increasing risk of international  spread, on the 17 May 2026, the WHO Director-General determined the outbreak  in the Democratic Republic of the Congo and Uganda a public health emergency of international concern (PHEIC). 

    On 22 May, an International Health Regulation  (IHR) Emergency Committee was convened. Considering the advice of the IHR   Emergency Committee, The Director-General of WHO issued temporary  recommendations to all States Parties, including to strengthen surveillance,  preparedness and response in countries with documented BVD, and those sharing  land borders with affected countriesat highest risk of importation.

    Since the start of the outbreak and as of 13 August, cases have been  detected and/or treated outside of the Democratic Republic of Congo. Uganda  reported 20 confirmed BVD cases during the outbreak (from 15 May 2026). 

    The last imported case was reported on 21 June and discharged on 16  July; the 42-day enhanced monitoring period, as per international guidance, will  therefore finish on 27 August. All 836 identified contacts completed the required  21-day follow-up period; during this period, six contacts, including four healthcare workers, developed BVD and were treated.

    France reported a single imported BVD case on 24 June 2026, with no secondary transmission. The case was discharged on 4 July, and all five identified  flight contacts completed the required 21-day follow-up period without developing symptoms. The 42-day enhanced monitoring period comes to an end  on 15 August.

    Germany reported two BVD cases diagnosed in the Democratic Republic of  the Congo and subsequently medically evacuated to Germany for treatment.  Both patients recovered and were discharged on 6 June and 28 July, respectively. 

    The cases were managed under strict infection prevention and control measures, and no secondary transmission was reported, therefore, no contacts  were identified.

    Although these events demonstrate that imported cases can be detected  and transmission interrupted, the continuing intensity of transmission in the  Democratic Republic of the Congo means that the risk of further exportation  remains.

    Entry and exit health screening and surveillance measures are in place  at airports, ports and official land border crossings; however, movement through  informal border crossing routes may occur, presenting an ongoing risk of virus exportation, importation and onward transmission.

    Countries sharing land borders with the Democratic Republic of the Congo remain at risk because of frequent crossborder population movement.  Uganda, the Central African Republic and South Sudan are of particular  concern for importation given their proximity, high population mobility and  connectivity with areas of the Democratic Republic of the Congo currently  experiencing intense transmission. 

    For the Central African Republic and South Sudan, these risks are further compounded by high humanitarian needs, population displacement, insecurity  and underlying limitations in health-system capacity.

    The risk in the Democratic Republic of the Congo remains assessed as very high, reflecting the current intensity and breadth of the outbreak, sustained  transmission across multiple provinces and health zones, and the continued presence of epidemiological and operational factors that facilitate  further transmission. 

    The main considerations supporting this assessment are:

        • The outbreak has increased substantially since the previous risk  assessment. As of 6 June 2026, 515 confirmed cases and 91 confirmed  deaths had been reported in the Democratic Republic of the Congo. By 13 August  2026, the number of cumulative confirmed cases had increased nearly nine-fold,  from 515 to 4566, while the number of cumulative deaths had  increased more than twenty-three-fold, from 91 to 2128. The CFR increased from 18% on 6 June to 47% on 13 August. Although the CFR  reported on 6 June was noted at the time to likely be an underestimate of the true  fatality ratio, the substantial increase in the CFR nevertheless highlights the  severity of the outbreak and continued challenges in timely detection, referral and  clinical management of cases.

        • The reported CFR may increase further as additional deaths are  investigated and outcomes are established More than 100 probable deaths that  occurred before the outbreak was declared have been investigated and are  awaiting Ministry of Health (MoH) validation; this inclusion could increase the  reported CFR. Additionally, as of 10 August, more than 700 confirmed cases had  no final outcome, excluding reported deaths, recoveries, and patients in  designated isolation centres. This incomplete outcome ascertainment should be considered when interpreting the current CFR.

        • The geographic extent of the outbreak has expanded considerably  since the previous risk assessment. The number of affected health zones has  increased from 25 to 54 (116%) with transmission now reported across five  provinces, compared with three provinces on 6 June.

        • Ituri has the highest number of affected health zones, (28/36),  followed by North Kivu (12/34), Haut-Uélé (6/13), Tshopo (6/23), South Kivu  (1/34), and Bas-Uélé ( 1/11), confirming the continued geographic spread of the  disease. Furthermore, 45 of the 54 affected health zones have reported confirmed  cases within the past 21 days, indicating ongoing active transmission  across a large geographic area.

        • Ituri remains the principal focus of transmission and shows  substantial evidence of ongoing, undetected transmission. The province, which  borders both Uganda and South Sudan, accounts for 86% (3912/ 4566) confirmed  cases and 80% (1701/ 2128) reported deaths in the Democratic  Republic of Congo. Transmission continues in both densely populated  urban areas and rural settings. More than 80% of new infections in the province  are detected outside known contact lists, indicating that many transmission chains  remain unidentified, while retrospective investigation indicates that  approximately 40% of new cases have a known epidemiological link to a previous  case. Approximately two-thirds of deaths occur outside designated Ebola Treatment Centres (ETCs), suggesting delayed healthcare-seeking, late  detection and continued community transmission. Although safe and dignified  burial (SDB) teams are being scaled up, gaps remain in alert management,  notification and investigation of deaths, systematic swabbing, contact  identification and tracing, decontamination and timely implementation of SDB  measures. The continued intensity of transmission in Ituri, together with its  proximity to international borders and spread to additional provinces, increases  the potential for further transmission within the Democratic Republic of the Congo  and across borders.

        • Transmission among healthcare workers and capacity constraints  in health-care settings remain a concern. The number of confirmed  infections among healthcare workers increased nearly tenfold since 6 June, from  16 to 155, including 45 deaths. This continued occurrence of infections highlights  possible occupational exposure risks and gaps in infection prevention and control  (IPC) implementation in healthcare facilities, which may contribute to further  transmission. However, good-quality data are not currently available to determine whether exposures occurred during healthcare duties or in community  settings, as only eight of the 54 affected health zones have received training to  conduct surveillance activities, including detailed case investigations. At the same  time, limited health-care infrastructure, insufficient Ebola treatment and isolation  capacity, and inadequate ambulance availability constrain timely isolation, referral  and clinical management of suspected and confirmed cases. These gaps may  increase the risk of health-care-associated transmission and delayed access to care, while contributing to frustration among affected families, undermining community confidence in the response and potentially delaying care-seeking.

        • Contact tracing and follow-up have increased substantially but  available documentation remains incomplete. Although contact tracing activities  have expanded substantially, more than 80% of newly reported infections continue to be detected outside known contact lists, indicating that  many transmission chains remain unidentified. As of 12 August, 18811 contacts  had been identified and documented with detailed information. However, the  number reported as under follow-up is considerably higher, with complete line-list  data not yet available for all contacts. This limits assessment of epidemiological links, exposure histories and transmission patterns. The scale of contact tracing  needed, insufficient human resources, ongoing strikes among MoH responders and  community health workers, and persistent pockets of community mistrust  and population movement continue to challenge timely and complete contact tracing.

        • Ongoing conflict and insecurity in Ituri and North Kivu provinces  continue to constrain response operations. Insecurity restricts the  movement of surveillance and Rapid Response Teams, limits the secure transport  of laboratory specimens, and hinders contact tracing, SDB activities and  community engagement. These access constraints may delay detection and  investigation of cases and deaths and limit the timely implementation of response  measures. In addition, insecurity may discourage individuals from seeking  healthcare.

        • Laboratory capacity and testing supply constraints continue to affect  timely confirmation and response. Delays in sample transportation and, in some  locations, communication of laboratory test results can delay confirmation, affect  timely isolation, clinical management, contact identification and implementation of  other public health measures, while also contributing to community frustration.

        • No licensed vaccine or specific antiviral treatment is currently  available for Bundibugyo virus disease. Although a randomized clinical trial for  Ervebo is currently being initiated as well as the PARTNERS trial for effective treatments, the response currently relies on community engagement and  early detection and isolation of all cases, intensive supportive clinical care,  infection prevention and control, contact tracing, safe and dignified burials, and  other public health and social measures, placing substantial operational demands  on the response.

        • Community protection and engagement capacities have been  strengthened but remain insufficient relative to the scale of the outbreak. More  targeted and in-depth engagement of local leadership, trusted local networks,  training of community health workers (CHWs) and establishment of community  brigades in hightransmission areas have strengthened community-level response  capacity. Efforts to provide at-risk communities with timely and accurate  information have also increased. However, available resources and capacity  remain inadequate relative to the increasing scale of the outbreak compounded by  persistent community mistrust and delays in scaling up essential response  services, contributing to delays in referral and care-seeking, underreporting and reduced uptake of response measures.

        • Funding gaps threaten the continuity and scale of the response.  Insufficient and unpredictable funding limit  the ability to sustain essential  surveillance, laboratory, clinical care, infection prevention and control, contact tracing, community engagement and other response activities, particularly  in areas affected by insecurity and limited access.

        • The potential for national spread remains significant. The outbreak  has expanded across six provinces and 54 health zones, including Kisangani, a  major port city on the Congo River and a key link to the capital, Kinshasa. Sustained transmission, extensive population movement and major  transport and trade routes linking affected and unaffected areas increase the  likelihood of further geographic expansion within the Democratic Republic of the  Congo. 

    The risk for countries sharing land borders with the Democratic Republic of  the Congo remains assessed as high, reflecting the ongoing transmission and  geographic expansion of the outbreak, and particularly for countries with  sustained cross-border population movement and close social and economic  links with affected areas. 

    The key factors  supporting this assessment include:

        • High population mobility across formal and informal routes. Cross- border movement associated with trade, mining, pastoral activities, family visits,  seeking health care, displacement and insecurity remain frequent across the  region. Movement through both official and informal crossing points, particularly  between border communities and affected areas, creates opportunities for infected individuals to cross borders before detection.

        • Risk of undetected importation and onward transmission. The high proportion of infections identified outside known contact lists indicates that  transmission chains remain undetected in affected communities. Cases or contacts  crossing international borders or being lost to follow-up may therefore  result in delayed detection and onward transmission in neighbouring  countries. Cross-border movement to access health services may be particularly  relevant where health-care capacity is limited in affected areas of the Democratic  Republic of the Congo.

        • Variable surveillance, preparedness and response capacities.  Differences in BVD surveillance and case detection, sample transportation and  laboratory capacity, clinical management, infection prevention and control, contact  tracing and outbreak response capabilities across neighbouring countries  may affect their ability to rapidly identify and contain imported cases.

        • Operational, humanitarian and access constraints may hinder  preparedness and response. Insecurity, population displacement, limited access to  health services and challenging operating environments in border areas may  constrain surveillance, contact tracing, laboratory investigation, community engagements, and other preparedness and response activities in neighbouring  countries.

        • Gaps in cross-border information sharing and community  preparedness may delay detection and response. Delays in sharing information on  cases and contacts who cross borders, including through IHR mechanisms and direct coordination between WHO and partner response teams, may hinder  timely follow-up. Limited resources and uneven capacitiesto train, equip and  support CHWsfor community-based surveillance and RCCE, generate and use  timely community evidence and engage trusted local leaders and community  networks may further delay care-seeking and detection and constrain rapid  response following an imported case. 

    

    The risk for the rest of the African Region and at the global level remains assessed as low, based on the available epidemiological evidence and  the absence of widespread or sustained transmission beyond the main affected  areas.

    The key considerations supporting this assessment include:

        • Transmission remains concentrated in the Democratic Republic of the  Congo. The majority of reported cases and deaths remain concentrated in the  Democratic Republic of the Congo, however, transmission has also been documented in Uganda, and a travel-associated case was detected in France.  These events demonstrate that the virus can cross international borders  through population movement and underscore the importance of strengthened  surveillance, early detection, laboratory capacity, infection prevention and control,  and response readiness in countries with epidemiological and population-mobility  links to affected areas. Accordingly, regional and global preparedness has been increased.

        • There is currently no evidence of sustained transmission beyond the Democratic Republic of the Congo. The continued outbreak in the  Democratic Republic of the Congo presents a risk of further exportation,  particularly to countries with strong population and travel links, but available  evidence does not indicate ongoing international transmission.

        • International exportation remains possible. Individuals infected in the  Democratic Republic of the Congo may travel during the incubation period  before symptoms develop, and cases could therefore be detected in other countries. However, in the absence of evidence of sustained transmission  outside the affected areas both in this outbreak and historically in previous Ebola  outbreaks, this possibility does not currently warrant an increase in the overall  regional or global risk assessment. Despite the risk of wider regional and global  spread remaining limited, continued vigilance is required for surveillance, rapid  detection and investigation of suspected cases, and appropriate preparedness in  countries with travel and population links to the Democratic Republic of the Congo to ensure that any exported cases are promptly identified and contained.

(...)

{1} Confidence refers to the level of confidence in the data/information or the  quality of the evidence available at the time the RRA is conducted. Poor quality  information may increase the overall perceived risk due to the incertitude in the  assessment.

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment-ebola-disease-caused-by-bundibugyo-virus--democratic-republic-of-the-congo-v4

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