Wednesday, August 19, 2026

The return of #H1N1: Reemergence of the #influenza virus A subtype H1N1 in 1977

 


Abstract

Four major influenza pandemics and two notable outbreaks have been recorded since 1900. This paper discusses the history of the 1977 influenza virus A H1N1 outbreak and re-emergence, often referred to as the “Russian flu” or the “red flu". We describe the likely events leading to the outbreak, including a brief history of the 1976 H1N1 outbreak in a military base in the United States. We reconstruct the spread of the H1N1 virus across the globe in 1977–1978 and discuss the epidemiology of the outbreak. We describe the likely origins of this unusual outbreak mainly affecting young people, including opinions and evidence pointing towards an unnatural origin. Finally, we outline the vaccines developed and vaccination campaigns that were carried out to combat the outbreak.

Source: 


Link: https://www.sciencedirect.com/science/article/pii/S0264410X26007723?via%3Dihub

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Tuesday, August 18, 2026

#Ebola #Bundibugyo Virus Disease #Outbreak, #DRC, #Uganda - Situation #Report No. 14, Data as of 16 August '26 (WHO, edited): 5,021 cases & 2,378 deaths in DRC

 




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Event description

Democratic Republic of the Congo

    The Bundibugyo virus disease (BVD) outbreak in the Democratic Republic of the Congo has expanded to a sixth provincewith the detection of a confirmed  case in Bas-Uélé province in the north-east, indicating further geographic  spread beyond the main transmission areas in the eastern part of the country. 

    Since External Situation Report #13, an additional 640 confirmed cases and 367 confirmed deaths have been reported, reflecting continued sustained  transmission and high mortality

    The crude case fatality ratio (CFR) has increased from 45.9% to 47.4%,  continuing the upward trend observed over several weeks.

    As of 16 August 2026, a total of 5 021 confirmed cases, including 2 378 confirmed deaths have been reported across 55 health zones in six provinces. 

    Buta health zone in Bas-Uélé province and Tshopo health zone in Tshopo  province are the latest affected health zones. 

    Ituri remains the epicentre, accounting for 84.8% of cumulative confirmed  cases and 79.0% of cumulative confirmed deaths.


Figure 1. Daily growth trend in confirmed Bundibugyo virus disease cases in the Democratic Republic of the Congo, by date of report, as of 16 August 2026


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    During the most recent 21 days (27 July – 16 August 2026), a total of 1 759 confirmed cases and 941 confirmed deaths were reported nationally. 

    Transmission remained concentrated in Ituri, which accounted for 1 356  cases (77.1%) and 671 deaths (71.3%), followed by Nord-Kivu with 293 cases  (16.7%) and 224 deaths (23.8%), and Haut-Uélé with 101 cases (5.7%) and 42  deaths (4.5%). 

    Compared with the preceding 21-day period (6 – 26 July 2026), the  number of newly reported cases increased by 121 (+7.4%), and deaths by 25  (+2.7%). However, trends varied substantially between provinces. In Ituri, newly  reported cases and deaths declined by 68 (−4.8%) and 97 (−12.6%)  respectively. 

    In contrast Nord-Kivu reported an increase of 123 newly reported cases  (+72.4%) and 101 deaths (+82.1%). Haut-Uélé recorded the largest relative  increase, with 61 additional newly reported cases (+156.4%) and 21 additional  newly reported deaths (+100.0%). Tshopo remained a smaller transmission focus,  while the detection of a case and death in Bas-Uélé indicates further  geographic expansion.

    At the health-zone level, transmission remained geographically widespread. Of the 55 health zones affected since the start of the outbreak, 47  (85.5%) reported at least one confirmed case during the most recent 21 days.  

    Eight health zones reported no new confirmed cases during this period: Adja, Ariwara, Boga and Kambala in Ituri; Goma in NordKivu; Rungu in Haut-Uélé; Lubunga in Tshopo; and Miti-Murhesa in Sud-Kivu. 

    Seven health zones reported confirmed cases for the first time since the  beginning of the outbreak: Gombari in Haut-Uélé, Lubero in Nord-Kivu, Bafwasende, Kabondo, Tshopo and Wanie-Rukula in Tshopo, and Buta in Bas-Uélé.  This indicates continued geographic expansionincluding into previously  unaffected health zones.

    Despite this expansion, transmission remains highly concentrated in a limited number of health zones. BuniaRwampara, Nizi, Katwa, Mongbwalu and  Nia-Nia together reported 1 186 cases during the most recent 21 days, accounting  for 67.4% of all cases reported nationally during this period. 

    The distribution of transmission is also changing. Cases increased  substantially in Bunia (+80; +24.9%), Rwampara (+69; +31.5%) and Katwa  (+63; +71.6%), while substantial relative increases were observed in Wamba  (+31; +281.8%), Beni (+34; +226.7%), Fataki (+37; +246.7%) and Isiro (+18;  +150.0%). Conversely, cases declined in established transmission foci such as Mongbwalu (−134; −61.5%) and Nizi (−97; −34.8%). Overall, the data indicate a redistribution of transmission, with declining activity in some established hotspots occurring alongside intensification in others and continued geographic expansion into new health zones.

(...)

    Mortality remains high and varies substantial across affected areas. Ituri continues to account for the largest absolute burden, with 1 878 cumulative confirmed deaths, representing 79.0% of all deaths nationally.  However, the CFR is considerably higher in Nord-Kivu (70.5%), than in Ituri  (44.1%) and Haut-Uélé (45.3%). This disparity was also evident during the most  recent 21 days, when Nord-Kivu accounted for only 16.7% of reported cases but  24.0% of reported deaths nationally.

    At health-zone level, the largest numbers of deaths were reported from  major transmission foci in Ituri, particularly Bunia, Rwampara and Mongbwalu.  However, CFRs were substantially higher in several health zones in Nord-Kivu, including, Butembo (85.6%), Beni (75.8%) and Katwa (68.1%), compared  with Bunia (29.8%), Rwampara (38.9%), and Mongbwalu (49.9%). These marked  geographic variation indicate that mortality is not explained by  transmission intensity alone and warrants further assessment of differences in case detection, timeliness of presentation and referralcommunity  deaths, access to care and clinical management. 

    Mortality remains high both in the community and among patients in treatment facilities. During the past six weeks, an average of approximately 162  community deaths and 98 treatment facility deaths were reported each week. 

    Community deaths accounted for approximately 60% of all confirmed  deaths during this period. The high proportion of community deaths highlights  persistent challenges in early case detection, referral and access to designated  treatment facilities. 

    Mortality among patients reaching treatment facilities may reflect late  presentation and severe disease at admission, while further assessment is needed  to determine the contribution of clinical management capacity, quality of  care and patient vulnerabilities, including age, malnutrition and comorbidities. For  the purposes of this report, community death refers to death occurring outside a  designated Ebola treatment facility, including at home, in the community, or in  another (non-Ebola) health facility.

(...)

    The current BVD outbreak continues to follow a markedly different trajectory from previous major Ebola disease outbreaks. 
    
    During the first 95 days of reporting, the 7-day moving average increased  progressively, reaching more than 90 confirmed cases per day, substantially  higher than the levels observed during comparable period of the 2014 – 2016 
West Africa and 2018 – 2020 Democratic Republic of the Congo outbreaks. 

    With 5 021 confirmed cases reported as of 16 August 2026, this has  become the largest BVD outbreak ever recorded and the second-largest Ebola  disease outbreak on record. 

    The sustained high incidence and continued geographic expansion indicates  that transmission remains intense and that the outbreak has not yet entered a  clear declining phase.

Figure 5. Comparison of three major Ebola disease outbreak trajectories during the first 95 days of reporting using seven-day moving averages of the daily number of confirmed cases reported.


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Uganda and France

    Uganda has now recorded 31 consecutive days without a new confirmed  BVD case since the last patient was discharged on 16 July 2026. All identified  contacts have completed follow-up, with no further cases detected. The continued  high level of transmission in neighbouring eastern Democratic Republic of the  Congo, however, means that the risk of crossborder reintroduction remains.

    France has reported no new confirmed BVD cases for 43 consecutive days  since the imported case was discharged on 4 July 2026. This period is more  than twice the maximum 21-day incubation period for BVD. No secondary  transmission has been detected, and all five identified flight contacts completed  follow-up without developing symptoms.


Risk Assessment

    The risk of further geographic spread within the Democratic Republic of the Congo remains very high, while the risk of cross-border spread remains  elevated. 

    The detection of a case in Buta, Bas-Uélé and additional affected health  zones in Tshopo, together with sustained transmission in highly mobile areas of  Ituri, Nord-Kivu and Haut-Uélé, increases the potential for onward spread along major transport corridors. Tshopo, particularly the Kisangani transport hub, is of 
particular concern because of its connectivity with other parts of the country and  the potential for longer-distance dissemination towards Kinshasa

    Continued transmission in eastern and north-eastern Democratic  Republic of the Congo also increases the likelihood of cross-border movements of  infected persons. 

    Uganda, South Sudan and the Central African Republic remain at  particularly high risk of importation, given their geographic proximity to affected 
areas of the Democratic Republic of the Congo, established cross-border population movements and connectivity along major mobility corridors. 

    Enhanced surveillance, information sharing, preparedness and cross- border coordination should therefore be maintained along priority mobility corridors and at points of entry.

(...)

Situation interpretation

    The BVD outbreak is evolving into a more geographically dispersed emergency, with persistent transmission in established hotspots occurring  alongside intensification in other areas and continued seeding of new locations. 

    The combination of very high mortality, substantial deaths outside  designated treatment facilities, increasing surveillance workload and  uneven response capacity suggests that current interventions are not yet  achieving sufficient speed, coverage or intensity to interrupt transmission. 

    The response should therefore be increasingly risk-informed and geographically differentiated, with the intensity and combination of  interventions adapted to local transmission patterns and operational gaps, while  simultaneously establishing sufficient response capacity ahead of transmission in 
newly affected and high-risk areas. 

    Given increasing connectivity between affected areas and major  populationmovement corridors, stronger interprovincial and cross-border  surveillance and preparedness are also critical to prevent further geographic spread.

Source: 


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A novel candidate #vaccine virus derived from #Japan's first #mammalian case of clade 2.3.4.4b #H5N1 highly pathogenic avian #influenza virus

 


Abstract

The development of candidate vaccine viruses (CVVs) for pre-pandemic preparedness requires attenuation of pathogenicity while maintaining immunogenicity. In this study, we developed and characterized NIID-002, a reassortant virus derived from A/Ezo red fox/Hokkaido/1/2022 (H5N1; clade 2.3.4.4b), to evaluate its suitability as a candidate vaccine. NIID-002 exhibited markedly reduced pathogenicity compared with its parental strain, while retaining broad antigenic reactivity and protein yield comparable to other clade 2.3.4.4b CVVs. In mammalian models, NIID-002 demonstrated strong attenuation, causing no lethal infection in mice and only minimal weight loss with limited viral replication in ferrets. Antisera raised against NIID-002 reacted broadly with recent wild-type H5N1 isolates, suggesting potential broad protection. Protein yield analysis confirmed a production efficiency comparable to that of other CVVs within the same clade, supporting its feasibility for large-scale vaccine manufacturing. Overall, NIID-002 fulfills the key requirements for the pandemic preparedness of CVV, combining reduced pathogenicity, broad antigenic reactivity, and adequate production efficiency. These findings highlight its potential as a candidate H5N1 vaccine and underscore the continued need for surveillance and refinement of influenza vaccine strategies to address evolving viral threats.

Source: 


Link: https://www.sciencedirect.com/science/article/abs/pii/S0264410X26008571?via%3Dihub

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#Community #engagement strategies for preventing recurrent #Nipah virus #outbreaks in #Bangladesh and #India: adapting a framework for outbreak preparedness and response

 


Abstract

The Nipah virus (NiV) infection is a highly fatal zoonotic disease with pandemic potential which has led to recurrent outbreaks in Bangladesh and India. While transmission pathways, including contaminated date palm sap and human-to-human spread, are increasingly identified, significant uncertainties remain. With no approved therapeutics or vaccines, prevention depends on addressing ecological and behavioural drivers of transmission. This viewpoint draws on selected evidence from NiV outbreaks and response to other zoonotic disease epidemics, such as Ebola, rabies, and the Marburg virus disease, we seek to foster discussion on why community engagement could be central to NiV prevention and preparedness. We highlight the relevance of community engagement through a spectrum of its intensity, which distinguishes between community-oriented, community-based, community-managed, and community-owned approaches. Adapting an existing model, we discuss how community engagement principles can be applied to tackle recurring NiV outbreaks in Bangladesh and India. By aligning interventions with sociocultural realities, community engagement can improve acceptability, enhance early detection, strengthen outbreak response, and support preparedness for future vaccine and therapeutic research. However, evidence specific to NiV remains limited and lessons from other diseases should be applied judiciously. In the absence of medical countermeasures, participatory, locally grounded approaches offer a sustainable pathway to reduce recurrent outbreaks and prevent future spillover events.

Source: 


Link: https://jogh.org/2026/jogh-16-03024

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Enhanced #Pathogenicity and Contact #Transmissibility of #Human-origin Avian #Influenza #H5N1 Clade 2.3.4.4b Genotype B3.13 Compared to D1.1 in #Ferrets

 


Abstract

Since its emergence in 2020, multiple genotypes of the H5N1 clade 2.3.4.4b have been identified, with B3.13 and D1.1 emerging in the USA as two major and concerning genotypes. However, their relative pathogenicity and transmissibility in mammals have not been fully elucidated. We compared the pathogenicity and transmissibility of the first two human H5N1 clade 2.3.4.4b cases caused by B3.13 in Texas (A/Texas/37/2024; HPhTX B3.13) and D1.1 in Louisiana (A/Louisiana/12/2024; HPhLA D1.1) in a ferret model of infection and transmission. HPhTX B3.13 infection resulted in more severe clinical disease and enhanced viral shedding, with evidence of increased transmission relative to HPhLA D1.1. Histopathological analysis revealed more extensive lung pathology in animals infected with HPhTX B3.13, consistent with increased viral loads and inflammatory responses. Importantly, both genotypes showed no significant differences in reactivity to ferret sera raised against candidate vaccine virus (CVV) strains, receptor binding properties, or neuraminidase (NA) activity and thermostability. Whole-genome sequencing revealed no adaptive mutations in HPhTX B3.13 following infection or transmission. In contrast, HPhLA D1.1 showed rapid acquisition of the mammalian-adaptive mutation E627K in infected ferrets and both E627K and Q194K in the only fatal contact animal. Both mutations were associated with enhanced polymerase activity and computational analyses suggested that they enhance interactions with the mammalian host factors ANP32A and B. Our findings indicate that B3.13 is already well adapted for mammalian infection and transmission whereas D1.1 retains evolutionary potential through the rapid acquisition of adaptive mutations, highlighting important genotype-specific differences relevant to zoonotic risk assessment and pandemic preparedness.


Competing Interest Statement

The A.G.-S. laboratory has received research support from Avimex, Dynavax, Pharmamar, and Accurius, outside of the reported work within the last three years. A.G.-S. has consulting agreements for the following companies involving cash and/or stock within the last three years: Castlevax, Amovir, Vivaldi Biosciences, Contrafect, Avimex, Pagoda, Accurius, Applied Biological Laboratories, Pharmamar, CureLab Oncology, CureLab Veterinary, Virofend, Prosetta and A.A.C.T., outside of the reported work. A.G.-S. has been an invited speaker in meeting events within the last three years organized by Seqirus, Novavax and Hipra. A.G.-S. is inventor on patents and patent applications on the use of antivirals and vaccines for the treatment and prevention of virus infections and cancer, owned by the Icahn School of Medicine at Mount Sinai, New York, outside of the reported work. The Icahn School of Medicine at Mount Sinai has licensed some of these inventions to Medimmune, Avimex, Leinco Technologies, Castlevax, Virofend, Kerafast, Cell Signaling, EMD Millipore, Genentech, Paratus and Nura Bio, and as a result receives financial compensation. Subject to Mount Sinai receiving such financial consideration, AG-S will receive a portion of that consideration pursuant to the terms of the Mount Sinai Intellectual Property Policy. All other authors declare no commercial or financial conflict of interest.


Funder Information Declared

NIH/NIAID, 75N93021C00014

Horizon Europe Program, KAPPA-FLU no. 101084171

Source: 


Link: https://www.biorxiv.org/content/10.64898/2026.08.10.744032v1

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#USA, Public health officials report first #Idaho #WNV #encephalitis case of 2026 (DoH, August 18 '26)

 


    Idaho’s first reported case of human West Nile virus (WNV) meningitis this year was identified in a Canyon County resident over the age of 65. This person had been hospitalized for the illness but is recovering at home. 

    WNV is spread by the bite of an infected mosquito and can lead to severe disease in some people. West Nile neuroinvasive disease is a rare but serious complication of West Nile virus infection that occurs when the virus affects the brain or spinal cord, causing conditions such as meningitis, encephalitis (swelling of the brain), or paralysis.

    “If you or someone you know takes medications that suppress your immune system, such as treatments for cancer, autoimmune diseases, or organ transplants, your risk of developing severe West Nile virus illness after a mosquito bite, including death may be up to 40% higher,” said Southwest District Health Epidemiologist Lekshmi Rita Venugopal. 

    “With West Nile virus detected in mosquitoes in Southwest Idaho again this summer, it's especially important for people with weakened immune systems to avoid mosquito bites.”

    Idaho State Epidemiologist Dr. Christine Hahn said public health officials strongly encourage Idahoans to protect themselves and their families from mosquito bites.

    “The report of the first severe West Nile virus disease of the season in an Idaho resident is a good reminder for all of us to take protective measures against mosquito bites,” she said. 

    “This includes wearing insect repellent and protective clothing in addition to reducing standing water around gardens and homes where mosquitoes can lay eggs.”

    Symptoms of WNV infection often include fever, headache, body aches, nausea, and sometimes swollen lymph glands or a skin rash. 

    WNV infection can result in severe illness, especially in people 50 years or older, leading to hospitalization and even death. Talk to your healthcare provider about testing for WNV to confirm your illness.

    There are no licensed vaccines or medicines to prevent WNV disease in people. 

    To protect against WNV infection, people should avoid mosquitoes, particularly between dusk and dawn when the mosquitoes that spread WNV are most active. 

    In addition, everyone should:

        § Wear long, loose-fitting shirts and pants when outdoors and apply DEET or other EPA-approved insect repellent to exposed skin and clothing. Carefully follow instructions on the product label, especially for children.

        § Keep mosquitoes outside the home by using screens on windows and doors or air conditioning, if available. Repair or replace damaged screens. 

        § Reduce standing water on property. Check and drain toys, flowerpots, buckets, kiddie pools, and other items left outdoors that can hold water.

        § Change bird baths, static decorative ponds, kiddie pools, and animal water tanks weekly to reduce suitable mosquito habitats.

        § Consider larvicides for bodies of water that will not be used for drinking and cannot be covered or dumped out.

    WNV activity in mosquitoes has been detected in seven Idaho counties this year by participating mosquito abatement districts.

    For more information, visit the following resources:

        ° https://westnile.idaho.gov

        ° www.cdc.gov/west-nile-virus/index.html

        ° www.epa.gov/insect-repellents

        ° www.cdc.gov/mosquitoes/mosquito-control/mosquito-control-at-home.html

        ° www.cdc.gov/han/php/notices/han00532.html

(...)

Source: 


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#Taiwan, Ministry of Health urges #Schools to prepare for start of lessons as #COVID19 #epidemic still active (August 18 '26, extract): PQ.16.1.1 Variant Predominates

 


{Excerpt}

(...)

    According to CDC monitoring data, the COVID-19 epidemic in Taiwan continues to rise

    In the 32nd week (August 9-15), there were 26,214 outpatient and emergency room visits related to COVID-19, an increase of 4.5% compared to the previous week (August 2-8). 

    Last week (August 11-17), there were 84 new locally transmitted severe cases and 12 new locally transmitted deaths

    Since October 2025, there have been a total of 421 local cases of COVID-19 complicated by severe illness, of which 54 have died

    The majority of severe cases are among those aged 65 and above (73.9%) and those with a history of chronic diseases (83.6%). 88.8% of these cases have not been vaccinated this season. 

    In the past four weeks, the predominant variant strain in local cases is PQ.16.1.1. 

    The global positivity rate is trending upward, particularly in Europe and Africa, while the Western Pacific region remains at a plateau. 

    The US is experiencing a rise in cases, Japan is fluctuating around a relative high point, South Korea's situation is stable, China reached its peak and is now declining weekly, and Hong Kong's situation continues to decline

    The most prevalent global variant strain recently is PQ.16.1.1, followed by NB.1.8.1 and XFG.

(...)

Source: 


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Monday, August 17, 2026

#Lassa fever and Argentine hemorrhagic fever #treatment in guinea pigs using broad-spectrum cap-dependent #endonuclease #inhibitors

 


ABSTRACT

The class Bunyaviricetes encompasses several highly pathogenic viruses that cause lethal hemorrhagic fevers. Due to their limited prevention and treatment options and high pathogenicity, these viruses require handling in biosafety level-4 facilities. Within the bunyaviruses, arenaviruses are particularly notable for their pathogenicity and ability to cause severe hemorrhagic disease in humans. The cap-dependent endonuclease (CEN) is a unique and crucial enzyme involved in the replication cycle of these viruses. As humans do not possess a similar enzyme, CEN represents an ideal target for antiviral drug development with reduced risk of side effects. Recently, we identified a promising CEN inhibitor (CENi) demonstrating potent inhibition of virus replication. In this manuscript, we demonstrate the successful therapeutic efficacy of CENis against Lassa fever and Argentine hemorrhagic fever virus infections in guinea pig models of lethal hemorrhagic fever. In addition, we identified several CENis with antiviral activity against other highly pathogenic arenaviruses. These findings further support the potential of CENis as therapeutic agents for arenavirus infections that cause severe and often lethal hemorrhagic fever. Collectively, our results suggest that CENis are promising candidates for pan-arenavirus therapy and may also have broader utility against other CEN-containing viruses for which no approved antiviral treatments currently exist.

Source: 


Link: https://journals.asm.org/doi/10.1128/mbio.00880-26

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#Netherlands, #WNV detected in a #blood #donor (RIVM, August 17 '26): First case since 2020

 


    A West Nile virus infection has been confirmed in a blood donor in the Netherlands

    This occurred in August 2026 during a Sanquin study among blood donors from areas where the West Nile virus had previously been detected in humans, horses, birds or mosquitoes. 

    A laboratory test (PCR) detected the virus in the donor, who had no symptoms and is still not showing any. 

    The person lives in the province of Utrecht and has not been abroad recently. It is therefore likely that the infection was contracted in the Netherlands.


First confirmed case of infection in a human in 2026

    This is the first confirmed case of a human infection in 2026 that originated in the Netherlands. The last time people contracted a West Nile virus infection in the Netherlands was in 2020.


West Nile virus and West Nile fever

    The West Nile virus occurs in birds

    The common house mosquito can contract the virus when feeding on the blood of an infected bird. 

    An infected mosquito can then pass the virus on to other birds, to mammals such as horses, and to humans. 

    Humans and horses can fall ill with the West Nile virus, but they cannot pass the virus on to others. 

    The disease caused by the West Nile virus is called West Nile fever. 

    80 per cent of people with West Nile fever have no symptoms, 19 per cent have flu-like symptoms and 1 per cent may develop neurological symptoms

    People over 50 and people with weakened immune systems due to illness or medication have a higher risk of becoming very ill from West Nile fever. 

    A small proportion of people who have a severe form of West Nile fever may die.


Mosquitoes capable of transmitting West Nile virus are active

    The fact that, within a short space of time, a horse, a bird and a human have now tested positive for the West Nile virus in different parts of the Netherlands shows that there are mosquitoes active in the Netherlands that carry the West Nile virus. It is still very unlikely for people in the Netherlands to contract West Nile fever.


What can you do to prevent West Nile virus?

    Mosquitoes are mainly active at dusk. To minimise the risk of being bitten, you could, for example:

        § wear clothing that covers the skin (long sleeves, long trousers)

        § keep mosquitoes out (insect screens for windows/doors)

        § use mosquito repellents on exposed skin

        § sleep under a mosquito net


Cooperation and monitoring

    Experts from organisations including the National Institute for Public Health and the Environment (RIVM), the GGDs, Erasmus MC, Royal GD, WBVR, UU, Sanquin and the NVWA are monitoring the situation closely.

Source: 


Link: https://www.rivm.nl/en/news/west-nile-virus-detected-in-a-blood-donor

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Sunday, August 16, 2026

#Coronavirus Disease Research #References (AMEDEO, August 16 '26)

 


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    PubMed        


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    PubMed        


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    Hate has no place in medicine.
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    PubMed        


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    PubMed        

#Influenza and Other Respiratory Viruses Research #References (AMEDEO, August 16 '26)-

 


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    J Clin Microbiol

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    PubMed         Abstract available


    J Gen Virol

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    J Immunol

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    J Infect

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