#USA, #Oregon: State ends year with highest #pertussis case count since 1950

As Oregon sweeps past the 1,100 cases mark, health officials remind everyone that vaccination against whooping cough is best way to prevent transmission

PORTLAND, Ore.—Oregon swept past the 1,100 mark for the number of pertussis cases it’s seen during 2024, beating its 2012 record of 910 cases in a single year—and making the need for people to stay up to date with their vaccinations all the more urgent.

As of Monday, Dec. 30, Oregon Health Authority registered 1,105 cases of pertussis—also known as whooping cough—during 2024. There were 44 outbreaks, although the majority of cases were sporadic individual or household-related cases and not associated with outbreaks. The 2024 count represents the highest number of pertussis cases reported in Oregon in a single year since 1950, when 1,420 cases were reported.

Since 2003, eight Oregonians with pertussis have died. Five were younger than 4 months old, and there have been three deaths in adults – one in 2023 and two in 2024.

While Oregon didn’t beat its 74-year record for most cases in a year, 1,105 is still an extremely high number for a vaccine-preventable disease, said Paul Cieslak, M.D., medical director for communicable diseases and immunizations at OHA’s Public Health Division. It’s also a stark reminder of how quickly the bacterial infection can spread and cause illness, particularly among people who are under- or unvaccinated.

“The pertussis vaccine is a public health success story in terms of its effectiveness in reducing severe illness and deaths from the disease—particularly among infants,” Cieslak said.

According to data from the epidemiologists in Oregon Public Health Division’s Acute and Communicable Disease Prevention Section, the median age of the 2024 cases is 12; 7.2% of cases are less than a year old, 80% are 18 or younger and 50% are female. About half of the cases are up to date with pertussis vaccines.

Lane County has reported the highest number of pertussis cases this year with 315. Rounding out the top five counties are Multnomah, 235 cases; Clackamas, 135; Washington, 119; and Marion, 75.

Pertussis case counts vary considerably from year to year, routinely reaching triple digits. However, during the COVID-19 pandemic, restrictions such as masking requirements and school closures were in effect, which kept annual case counts low, Cieslak said. Vaccination rates also slipped.

“People were less motivated to get vaccinated against pertussis when there was less concern they would be exposed to the infection in the first place,” he said.

But with pertussis activity so high this year, there are more opportunities for people to be exposed, Cieslak noted. Those who are unvaccinated or too young to be vaccinated, such as infants, are at the highest risk from infection, with babies most likely to be hospitalized with pertussis.

But there are ways to protect vulnerable individuals. Pregnant people can protect their young babies by getting the Tdap vaccine—which protects against tetanus, diphtheria and pertussis—at 27–36 weeks’ gestation. Mothers will make antibodies and pass them to their babies across the placenta, protecting them from the moment of birth. It is recommended during each pregnancy.

“In recent years, about two-thirds of pregnant Oregonians have been getting vaccinated during pregnancy,” Cieslak said. “However, only 11 of the mothers of the 80 infant cases this year had documentation of having gotten the recommended shot.”

Vaccination against pertussis is routinely recommended for infants, children, adolescents and adults. Children should receive the DTaP vaccine against diphtheria, tetanus and pertussis at 2, 4, 6 and 15 to 18 months old, and again at age 4 to kindergarten age. All persons 10 years old and older should receive a single dose of Tdap.

“Additionally, when pertussis strikes a household in which an infant or pregnant person lives, we recommend all members of the household receive a course of antibiotics effective against Bordetella pertussis—typically, a five-day course of azithromycin,” Cieslak said.

Source: Department of Health, https://content.govdelivery.com/accounts/ORHA/bulletins/3c9f333

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#Risk #assessment of 2024 #cattle #H5N1 using age-stratified #serosurveillance data

ABSTRACT

The highly pathogenic avian influenza virus A(H5N1) clade 2.3.4.4b has caused a human outbreak in North America since March 2024. Here, we conducted a serosurveillance study to determine the risk of A(H5N1) clade 2.3.4.4b (2024 cattle H5N1) to general population. In the initial screening of 180 serum specimens encompassing all age groups, 2.2% (4/180) had detectable neutralizing antibody (nAb) titers against 2024 cattle H5N1, with all collected from older adults aged ≥60 years old. Further screening showed that 5.0% (15/300) of adults aged ≥70 years old had detectable nAb titers against the 2024 cattle H5N1. All serum specimens with nAb titer of ≥40 had detectable HI titer, and there was a positive correlation between nAb titer and HA binding (r=0.3311, 95% confidence interval 0.2264 to 0.4283; P<0.0001). The nAb titer against seasonal H1N1 virus was 3.9-fold higher for patients with detectable H5N1 nAb than those without (geometric mean titer: 108.5 [95% CI 56.3-209.1] vs 27.9 [95% CI 21.0-37.0], P=0.0039), but there was no statistically significant difference between H5N1 and H3N2 nAb titer. There was no difference in demographics, comorbidities and clinical frailty scores between individuals with detectable H5N1 nAb and those without. Our findings suggest that most individuals lack nAb response against 2024 cattle H5N1 and there is an urgency to develop and evaluate H5N1 vaccine or prophylactic monoclonal antibodies. Immune imprinting may be responsible for the cross neutralization between H5N1 and H1N1 among older adults.

Source: MedRxIV, https://www.medrxiv.org/content/10.1101/2024.12.23.24319580v1

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#Origin, spread, and interspecies #transmission of a dominant #genotype of BJ/94 #lineage #H9N2 avian #influenza viruses with increased #threat

Abstract

The H9N2 subtype of avian influenza viruses (AIVs) is widely prevalent in poultry and wild birds globally, with occasional transmission to humans. In comparison to other H9N2 lineages, the BJ/94 lineage has raised more public health concerns; however, its evolutionary dynamics and transmission patterns remain poorly understood. In this study, we demonstrate that over three decades (1994–2023), BJ/94 lineage has undergone substantial expansion in its geographical distribution, interspecies transmission, and viral reassortment with other AIV subtypes, increasing associated public health risks. These changes were primarily driven by the emergence of a dominant genotype G57. In the first decade, G57 emerged in East China and rapidly adapted to chickens and spread across China. Since 2013, the G57 genotype has expanded beyond China into eight other countries and reassorted with various AIV subtypes to form new zoonotic reassortants. Chickens have played a key role in the generation and circulation of the G57 viruses, with ducks and other poultry species likely assuming an increasingly importantly role. Over the past decade, G57 has been more frequently detected in wild birds, mammals, and humans. Additionally, Vietnam has emerged as a new hotspot for the international spread of G57. Our results suggest that the BJ/94 lineage H9N2 virus may continue to overcome geographical and species barriers, with potentially more severe consequences.

Source: Virus Evolution, https://academic.oup.com/ve/article/10/1/veae106/7919252

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#Germany - High pathogenicity avian #influenza #H5 viruses (#poultry) (Inf. with) - Immediate notification

 A poultry farm in Bayern Region.

Source: WOAH, https://wahis.woah.org/#/in-review/6131

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High Pathogenicity Avian #Influenza Virus (HPAIV) #H5N1 clade 2.3.4.4b recovered from a kelp #gull (Larus dominicanus) in the South Shetland Islands, #Antarctica

Abstract

Whole-genome analysis of the earliest-detected High Pathogenicity Avian Influenza Virus (HPAIV) H5N1 clade 2.3.4.4b detected in Hannah Point, Antarctica (January 2024) reveals close relatedness to strains that circulated in pinnipeds and seabirds along the Atlantic coast of South America during the second half of 2023.

Source: BioRxIV, https://www.biorxiv.org/content/10.1101/2024.12.29.630510v1?rss=1

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Dona Antonia de Ipenarrieta y Galdos and her Son, Diego Velazquez (c.1631)

 

Credits: Public Domain.

Source: WikiArt, https://www.wikiart.org/en/diego-velazquez/dona-antonia-de-ipenarrieta-y-galdos-and-her-son

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The #PA-X #host shutoff site 100 V exerts a contrary effect on viral #fitness of the highly pathogenic #H7N9 #influenza A virus in mice and chickens

ABSTRACT

Several viruses, including influenza A virus (IAV), encode viral factors to hijack cellular RNA biogenesis processes to direct the degradation of host mRNAs, termed “host shutoff.” Host shutoff enables viruses to simultaneously reduce antiviral responses and provides preferential access for viral mRNAs to cellular translation machinery. IAV PA-X is one of these factors that selectively shuts off the global host genes. However, the specific role of PA-X host shutoff activity in viral fitness of IAV remains poorly understood. Herein, we successfully mapped PA-X 100 V as a novel site important for host shutoff of the H7N9 and H5N1 viruses. By analysing the polymorphism of this residue in various subtype viruses, we found that PA-X 100 was highly variable in H7N9 viruses. Structural analysis revealed that 100 V was generally close to the PA-X endonuclease active site, which may account for its host shutoff activity. By generating the corresponding mutant viruses derived from the parental H7N9 virus and the PA-X-deficient H7N9 virus, we determined that PA-X 100 V significantly enhanced viral fitness in mice while diminishing viral virulence in chickens. Mechanistically, PA-X 100 V significantly increased viral polymerase activity and viral replication in mammalian cells. Furthermore, PA-X 100 V highly blunted the global host response in 293T cells, particularly restraining genes involved in energy metabolism and inflammatory response. Collectively, our data provided information about the intricate role of the PA-X host shutoff site in regulating the viral fitness of the H7N9 influenza virus, which furthers our understanding of the complicated pathogenesis of the influenza A virus.

Source: Virulence, https://www.tandfonline.com/doi/full/10.1080/21505594.2024.2445238

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#USA, Snow #Geese Test Presumptive Positive for Avian #H5 #Influenza; #Delaware #poultry producers encouraged to take precautions

 {Excerpt}

DOVER, Del. (Dec. 28, 2024) – The Delaware Department of Natural Resources and Environmental Control (DNREC) and the Delaware Department of Agriculture (DDA) announced today that laboratory testing conducted by the University of Delaware’s Allen Laboratory, part of the National Animal Health Laboratory Network, has returned presumptive positive findings of H5 avian influenza in sick and dead snow geese collected on December 27, 2024, in coastal Sussex County. 

In response to the findings, the state of Delaware has established a Joint Information Center with DNREC, DDA, the Delaware Division of Public Health (DPH) and the Delaware Emergency Management Agency (DEMA).

The detections mark the Delmarva region’s most recent confirmation of H5 avian influenza in wild birds since May 2022, when the virus was found through wildlife surveillance in black vultures in Harford County, Md. Avian influenza is known to be carried by wild birds, especially waterfowl, raptors, and vultures.

Avian influenza is a highly contagious airborne respiratory virus that spreads quickly among birds through nasal and eye secretions and manure. Snow geese, which are waterfowl, are known to migrate from the Arctic and form large flocks in Delaware each winter. Due to close contact with thousands of other snow geese while feeding and roosting, they can get sick and die. It is unknown when or where the snow geese may have acquired the virus given their highly migratory nature and association with other waterfowl and waterbirds throughout the Atlantic Flyway through which they travel into Delaware and more southern states.

People should not touch or handle injured, sick, or dead birds. Special attention should be paid to keep pets and children away from these wild birds and bird droppings.

Even with the ongoing detections of HPAI in wild birds, poultry, and dairy cattle in North America, continuing testing of people who are in close contact with infected animals indicates a low risk to the general public’s health. The H5N1 virus has infected very few people and has not been documented to be transmitted between people. The proper handling and cooking of all poultry and eggs to an internal temperature of 165°F is recommended as a general food safety precaution.

(...)

Source: Department of Health, https://news.delaware.gov/2024/12/28/snow-geese-test-presumptive-positive-for-avian-influenza-delaware-poultry-producers-encouraged-to-take-precautions/

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Molecular #Evolution of the #H5 and #H7 Highly Pathogenic Avian #Influenza Virus #Haemagglutinin Cleavage Site Motif

ABSTRACT

Avian influenza viruses are ubiquitous in the Anatinae subfamily of aquatic birds and occasionally spill over to poultry. Infection with low pathogenicity avian influenza viruses generally leads to subclinical or mild clinical disease. In contrast, highly pathogenic avian influenza viruses emerge from low pathogenic forms and can cause severe disease associated with extraordinarily high mortality rates. Here, we describe the natural history of avian influenza virus, with a focus on H5Nx and H7Nx subtypes, and the emergence of highly pathogenic forms; we review the biology of AIV; we examine cleavage of haemagglutinin by host cell enzymes with a particular emphasis on the biochemical properties of the proprotein convertases, and trypsin and trypsin-like proteases; we describe mechanisms implicated in the functional evolution of the haemagglutinin cleavage site motif that leads to emergence of HPAIVs; and finally, we discuss the diversity of H5 and H7 haemagglutinin cleavage site sequence motifs. It is crucial to understand the molecular attributes that drive the emergence and evolution of HPAIVs with pandemic potential to inform risk assessments and mitigate the threat of HPAIVs to poultry and human populations.

Source: Reviews in Medical Virology, https://onlinelibrary.wiley.com/doi/10.1002/rmv.70012

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   PLoS Comput Biol

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   PLoS One

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Virological and #antigenic characteristics of #SARS-CoV-2 #variants #LF721, #NP1, and #LP81

Abstract

XEC and KP.3.1.1 have surpassed KP.3 to become the globally dominant lineages due to their unique NTD mutations. However, several emerging JN.1 sublineages, such as LF.7.2.1, MC.10.1, NP.1, and, especially, LP.8.1, have demonstrated superior growth advantages compared to XEC. It is critical to access the virological and antigenic characteristics of these emerging SARS-CoV-2 variants. Here, we found that LF.7.2.1 is significantly more immune invasive than XEC, primarily due to the A475V mutation, which enabled the evasion of Class 1 neutralizing antibodies. However, LF.7.2.1's weak ACE2 binding affinity substantially impaired its fitness. Likewise, MC.10.1 and NP.1 exhibited strong antibody immune evasion due to the A435S mutation, but their limited ACE2 engagement efficiency restricted their growth advantage, suggesting that A435S may regulate the Spike conformation, similar to the NTD glycosylation mutations found in KP.3.1.1 and XEC. Most importantly, we found that LP.8.1 showed comparable humoral immune evasion to XEC but demonstrated much increased ACE2 engagement efficiency, supporting its rapid growth. These findings highlight the trade-off between immune evasion and ACE2 engagement efficiency in SARS-CoV-2 evolution, and underscore the importance of monitoring LP.8.1 These findings highlight the trade-off between immune evasion and ACE2 engagement efficiency in SARS-CoV-2 evolution, and underscore the importance of monitoring LP.8.1 and its descend lineages.

Source: BioRxIV, https://www.biorxiv.org/content/10.1101/2024.12.27.630350v1?rss=1

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#USA, Confirmed #H5N1 #influenza #human case summary during 2024 #outbreak, by state and exposure source {as of Dec. 27 '24: 1 new case, total = 66}

 {Excerpt}

Exposure Source

[State - Exposure Associated with Commercial Agriculture and Related Operations: Dairy Herds (Cattle), Poultry Farms and Culling Operations - Other Animal Exposure† - Exposure Source Unknown‡ - State Total]

1) California - 36 - 0 - 0 - 1 - 37 {+1}

2) Colorado - 1 - 9 - 0 - 0 - 10

3) Iowa - 0 - 1 - 0 - 0 - 1

4) Louisiana - 0 - 0 - 1 - 0 - 1

5) Michigan - 2 - 0 - 0 - 0 - 2

6) Missouri - 0 - 0 - 0 - 1 - 1

7) Oregon - 0 - 1 - 0 - 0 - 1

8) Texas - 1 - 0 - 0 - 0 - 1

9) Washington - 0 - 11 - 0 - 0 - 11

10) Wisconsin - 0 - 1 - 0 - 0 - 1

-- Source Total - 40 - 23 - 1 - 2 - 66 {+1}

NOTE: One additional case was previously detected in a poultry worker in Colorado in 2022.

{†} Exposure was related to other animals such as backyard flocks, wild birds, or other mammals

{‡} Exposure source was not able to be identified

Probable human case summary during the 2024 outbreak, by state and exposure source {Seven Cases}

When a case tests positive for H5 at a public health laboratory but testing at CDC is not able to confirm H5 infection, per Council of State and Territorial Epidemiologists (CSTE) guidance, a case is reported as probable.

-- Probable cases with commercial poultry exposure (e.g., poultry farms or culling operations):

- Washington (3)

- Arizona (2)

-- Probable cases with commercial dairy (cattle) exposure:

- California (1)

-- Probable cases with exposure source unknown:

- Delaware (1)

Confirmed and probable cases are typically updated by 5 PM EST on Mondays (for cases confirmed by CDC on Friday, Saturday, or Sunday), Wednesdays (for cases confirmed by CDC on Monday or Tuesday), and Fridays (for cases confirmed by CDC on Wednesday and Thursday). Affected states may report cases more frequently.

(...)

Source: US Centers for Disease Control and Prevention, https://www.cdc.gov/bird-flu/situation-summary/?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm

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Acute #respiratory #infections complicated by #malaria (previously undiagnosed disease) - #DRC

{Excerpts}

27 December 2024

Situation at a glance

This is an update to the Disease Outbreak News on Undiagnosed disease in the Democratic Republic of the Congo published on 8 December 2024 (now named acute respiratory infections complicated by malaria). 

It includes updated epidemiological investigation information and preliminary laboratory results. 

On 29 November, an alert was raised by local health zone authorities of Panzi health zone in Kwango province after an increase in deaths, particularly among children under five years of age, following febrile illness. 

Enhanced epidemiological surveillance was rapidly implemented, which in the absence of a clear diagnosis was based on the detection of syndromic cases of febrile illnesses with cough, body weakness, with one of a number of other symptoms compatible with acute respiratory and febrile illnesses. 

This resulted in a rapid increase in the number of cases meeting the definition, with a total of 891 cases reported as of 16 December. 

However, the weekly number of reported deaths (48 deaths reported over the period) has remained relatively stable. 

As of 16 December, laboratory results from a total of 430 samples indicated positive results for malaria, common respiratory viruses (Influenza A (H1N1, pdm09), rhinoviruses, SARS-COV-2, Human coronaviruses, parainfluenza viruses, and Human Adenovirus). 

While further laboratory tests are ongoing, together these findings suggest that a combination of common and seasonal viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths, disproportionally affecting children under five years of age. 

Multidisciplinary rapid response teams have been deployed to investigate the event and strengthen the response. 

Efforts are ongoing to address the health needs in Panzi health zone. 

Enhanced surveillance in the community and within health facilities continues. 

The teams have also been providing support for diagnosis, the treatment of patients as well as with risk communication and community engagement. 

This event highlights the severe burden from common infectious diseases (acute respiratory infections and malaria) in a context of vulnerable populations facing food insecurity. It emphasizes the need to strengthen access to health care and address underlying causes of vulnerability, particularly malnutrition, given the worsening food insecurity.

Description of the situation

Since the last Disease Outbreak News on this event was published on 8 December 2024, 485 additional suspected cases and 17 additional deaths have been reported from Panzi health zone in Kwango Province, Democratic Republic of the Congo, across 25 out of the 30 health areas in Panzi. These cases were identified as a result of enhanced surveillance put in place following the report of deaths in the context of febrile illness with acute respiratory symptoms and anaemia, first reported on 29 November. While the number of reported cases was not deemed particularly unusual in a context of high burden of pneumonia, malaria and acute respiratory infections, particularly at the start of the rainy season, it is the increase in the number of deaths that triggered the alert on 29 November.

In the absence of diagnosis, a broad surveillance case definition was used, with the resulting case numbers reflecting the detection of any febrile illness occurring in Panzi and thus representing a range of diseases and clinical syndromes. The case definition includes: any person living in the Panzi health zone from September 2024 to date, presenting with fever, cough, body weakness, runny nose, with or without one of the following symptoms and signs: chills, headache, difficulty breathing, malnutrition, body aches. This was done to better understand the epidemiology and characteristics of deaths and to collect a range of clinical samples for laboratory testing.

Between 24 October and 16 December 2024, 48 deaths and a total of 891 cases across 25/30 health areas of Panzi health zone met the case definition. Children under five years of age are disproportionally affected, representing 47% of all cases and 54% of all deaths, while they represent around 18% of the population, likely reflecting the vulnerability of young children to severe disease and death in this context. The main symptoms associated with death include difficulty in breathing, anaemia, and signs of acute malnutrition.

A total of 430 samples including blood samples, oropharyngeal and nasopharyngeal swabs, urine and breastmilk samples were collected from suspected cases in Panzi health zone and transported to the laboratory at the INRB. 

Out of 88 rapid diagnostics tests for malaria performed in the field, 55 (62%) samples tested positive. In addition, out of 26 samples analyzed by PCR BioFire Global Fever Panel test (which tests 18 different pathogens including some of the viral hemorrhagic fevers), 17 (65%) samples tested positive for Plasmodium falciparum.  In addition, a total of 89 samples were tested at INRB Respiratory Disease Surveillance Laboratory. Of the 89 samples, 64 samples were positive for common respiratory viruses including Influenza A (H1N1, pdm09) (n=25), rhinoviruses (n=18), SARS-COV-2 (n=15), Human coronaviruses (n=3), parainfluenza viruses (n=2), and Human adenovirus (n=1).

Other laboratory tests on the collected samples, including virological and bacterial analysis, are still ongoing. The ongoing investigations and preliminary laboratory findings suggest that a combination of common viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths.

Enhanced surveillance will continue, alongside response activities. The number of weekly reported suspected cases has remained steady with the exception of an increase in epidemiological week 50 (week ending 15 December 2024, Figure 1). While this may partly reflect an increase in transmission of respiratory viruses and malaria with the rainy season, it is driven by an increase in surveillance and case finding following the deployment of the rapid response teams. Notably, the increase in cases is not matched with a comparable increase in deaths.

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There are proportionally more cases reported among females (58%, 514/889), particularly among adults (66% female, 173/262). While data is lacking to better understand this difference, it may stem from contact patterns of respiratory virus transmission within households, particularly a close interaction between mothers and children during acute respiratory illnesses. 

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The affected area experienced deterioration in food security in recent months, with increasing levels of acute malnutrition. Between July and December 2024, which coincides with a drop in acute malnutrition, Kwango province was in Integrated Food Security Phase Classification (IPC) Acute Malnutrition (AMN) Phase 3 (Serious). Between January and June 2025, an increase in cases of malnutrition is projected in the province with a significant deterioration in the nutritional situation expected, moving to IPC AMN Phase 4 (Critical). Between July 2024 and June 2025, nearly 4.5 million children aged 6 to 59 months in the DRC are facing or expected to face acute malnutrition, including approximately 1.4 million cases of severe acute malnutrition and 3.1 million cases of moderate acute malnutrition. It is also estimated that 3.7 million pregnant and breastfeeding women are facing or expected to face acute malnutrition over the same period.[1]

Severe acute malnutrition is a life-threatening condition that requires medical treatment. In addition, disease and malnutrition combine to worsen each other. The area has low routine vaccination coverage. There is also very limited access to diagnostics and quality case management, and a lack of supplies and transportation, shortage of health staff in the area, as well as financial and geographical barriers to access to health care. Increasing malaria trends are expected with the start of the rainy season, however, malaria control measures in the area are very limited. Together, these factors may increase the severity of malaria, and common respiratory infections.

Overall, this event highlights the severe burden from common infectious diseases (acute respiratory infections and malaria) in a context of vulnerable populations facing food insecurity and emphasizes the need to strengthen access and quality of health care.

Public health response

1. Leadership and coordination:

Daily coordination meetings are being held at the national level, with provincial teams actively participating in ongoing planning and response.

National rapid response team (RRT) composed of experts from Ministry of Health (MoH), INRB and WHO deployed from Kinshasa on 7 December and arrived in Panzi on 10 December. Following the departure of the national team, a joint MoH-Africa CDC rapid response team has been deployed with support from WHO.

2. Surveillance:

A case definition has been developed based on clinical symptoms observed, guiding surveillance and reporting efforts.  

Active case search is continuing in health facilities and the community. 

Data collection is ongoing, focusing on preparing a line list and detailed epidemiological analysis.  

Community deaths are being investigated to better understand the context of deaths and vulnerability factors.

WHO is deploying a senior epidemiologist and a data manager to support the ongoing surveillance activities and improve data collection.

3. Case Management:

Provincial and national RRTs, including WHO, UNICEF and Médecins Sans Frontières, have been deployed to the affected areas and are strengthening case management in health facilities as well as providing medical supplies including medication. The teams carried medication and medical equipment to support case management and prevent more deaths.

Efforts are underway to strengthen the capacity of healthcare providers to ensure the best possible care for patients. 

Six oxygen concentrators are being installed at the Panzi General Referral Hospital and three hotspot health centers to support patient care.

4. Laboratory:

Laboratory equipment was transported to collect samples from cases and send samples for testing at the INRB in Kinshasa. Additionally, RDTs for malaria and COVID-19 have been provided to assist in diagnosis. 

Laboratory reagents have been procured to continue facilitating the ongoing testing at INRB.

5. Risk communication and community engagement:

Key messages were developed to enhance public awareness and encourage general preventive behaviors. These messages are being disseminated through community engagement, with sensitization campaigns underway. 

6. Infection prevention and control:

Infection prevention and control measures are being reinforced. Health workers have been briefed on key practices, including the proper use of masks, hand washing, and gloves, to reduce the risk of transmission of respiratory and other pathogens. 

7. Logistics

Logistical support is being provided for effective case management, including the transportation of samples to INRB Kinshasa for laboratory testing. Health facilities and hospitals in the most affected health areas are being supplied with appropriate medications and sampling kits to support the response. 

Medical kits for malaria, IPC kits, blood transfusion kits as well as additional medical supplies to support treatment efforts have been provided.

A mobile internet kit is being deployed to address some of the telecommunication challenges in the affected health zone. 

WHO risk assessment

Symptoms such as fever, cough, headache, and body aches have been observed since 24 October, primarily through health worker reports, and an uptick in deaths was observed in epi week 47, which triggered the signal. Since the alert was reported, there has not been any significant increase in reported deaths.

The epidemiological information together with the early laboratory result indicate an event triggered by an increase in acute respiratory virus cases associated with malaria, with a background of a worsening of the nutritional situation in Panzi, disproportionally affecting young children. 

The WHO African Region accounts for about 94% of all malaria cases and 95% of deaths globally (World Malaria Report 2024). Children under five account for about 76% of all malaria deaths in the Region. Over half of these deaths occurred in four countries: Nigeria (30.9%), the Democratic Republic of the Congo (11.3%), Niger (5.9%) and United Republic of Tanzania (4.3%). Support is being provided for laboratory diagnosis and strengthening case management including the treatment of malaria cases with appropriate medication.

An increase in common respiratory viruses and malaria is expected at this time of year in Panzi with the rainy season, however it is the increase in deaths that triggered the initial signal. There has been an increase in influenza and SARS-CoV-2 activity reported from Kinshasa through sentinel sites since mid-October. WHO and UNICEF estimates of national immunization coverage for 2023 show DTP3 and PCV3 coverage at 60% and 59%, respectively, however, no data is currently available for the affected health zone, leading to uncertainties about vaccine-derived population immunity.

The Integrated Food Security Phase Classification (IPC) for acute food insecurity levels in Kwango province increased from IPC 1 (acceptable) in April 2024 to IPC 3 (Crisis Level) in September 2024. This suggests a significant phase of increase in food insecurity and risk of severe acute malnutrition. In Addition, the IPC acute malnutrition classification currently classifies Panzi health zone as IPC acute malnutrition phase 3 (serious), projected to move to phase 4 (critical) from January 2025.

While mortality from common infectious diseases is expected to increase as transmission increases, this event highlights that mortality from known and expected infectious diseases can be high in a context of vulnerability and malnutrition, emphasizing the need to strengthen malaria control, clinical management, improve access to care and reduce the prevalence of malnutrition.

Gaps in case management have also been identified. Stock-outs of medications for treating common diseases frequently occur, and care is not provided free of charge, which could limit access to treatment for vulnerable populations and increase severity and mortality of known and treatable infections.

The affected area’s remoteness and logistical barriers, including a two-day or longer road journey from Kinshasa due to the rainy season affecting the roads and limited telecommunication network coverage across the health areas, have hampered the rapid deployment of response teams and resources. Furthermore, there is no functional laboratory in the health zone or province, requiring the collection and shipment of samples to Kinshasa for analysis. This has delayed diagnosis and can continue to impact the ongoing response efforts. 

Insecurity in the region adds another layer of complexity to the response. The potential for attacks by armed groups poses a direct risk to response teams and communities, which could further disrupt the response. 

Based on the above rationale, the overall public health risk level to the affected communities is assessed as high, and requires an integrated public health approach to reduce mortality from infections, improve nutritional status and strengthen malaria control, among others.

At the national level, the risk is considered low due to the localized nature of the event and that it is caused by a range of illnesses whose severity is compounded by the vulnerability of the population in the local context. However, many other areas of DRC are seeing increasing levels of malnutrition, and what has been witnessed in Panzi could also happen elsewhere in the country.

As such, efforts need to continue to prevent similar situation in other vulnerable parts of the country.  At the regional and global levels, the risk remains low at this time.  

WHO advice

To reduce the impact of the ongoing event in the Panzi health zone, WHO advises the following measures:  

-- Strengthening coordination mechanisms at all levels—national, provincial, zonal, and local—is critical for a unified response. Enhanced communication infrastructure, such as satellite phones, is required to overcome the limited network coverage in affected areas.

-- Improving surveillance efforts is a priority to better understand disease trends and mortality. Active case searches should continue in both health facilities and communities, with a particular focus on areas reporting deaths and family clusters. Community-based surveillance must be strengthened to ensure early case detection and rapid response.

-- Careful characterization of the clinical syndrome and outcomes and an improved case definition based on the information collected will be necessary to understand the situation. In particular, data which clarify possibility of coinfection and multiple pathologies, and uncertainties in outcomes among vulnerable groups should be collected. The WHO has established the Global Clinical Platform to provide rapid turnaround of structured data analysis using anonymized case records; its use is recommended in the detailed capture of patient syndromes and outcomes. 

-- Effective case management requires ensuring an adequate supply of essential medications, access to oxygen therapy, and training of healthcare workers including basic emergency and critical care to support treatment and prevent more deaths. RDTs for malaria should be distributed to facilitate early diagnosis and prompt treatment. Long-term laboratory capacity strengthening, and decentralization will be important in provision of diagnostic capability in the affected health zone and detect cause of deaths early.  

-- Infection prevention and control measures must be reinforced across all health facilities. Healthcare workers should receive training on best practices, including the proper use of personal protective equipment such as masks and gloves, as well as strict hand hygiene protocols. These measures will reduce transmission risks within health facilities and improve the safety of healthcare delivery.  

-- The role and added value of the health sector during food crises is crucial to prevent, reduce and reverse the causal relationship between poor nutrition, disease and death – before, during and after the onset of severe food shortages. As needs and vulnerabilities during food crises are complex, interlinked and multidimensional, intersectoral coordination and collaboration, especially between the health, nutrition, water, sanitation and hygiene (WASH) and food security clusters, should be stepped up as part of the overall humanitarian response. Data collection and analysis should be strengthened to inform the overall response.

-- Risk communication and community engagement are essential to raising public awareness. Targeted messages should be disseminated to educate the public on respiratory illness symptoms, preventive measures, and the importance of seeking care early. Community leaders must be engaged to build trust and encourage adherence to public health guidance. Addressing misinformation and fears within the community is critical to ensuring effective collaboration in the response.  

-- Logistical and security challenges also require attention. Strengthening logistical support for the deployment of teams and supplies will ensure timely access to affected areas. Contingency plans should be developed to address potential insecurity posed by armed groups, safeguarding response personnel and maintaining continuity in response activities.  

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Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON547

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#USA, Novel #Influenza A #H5N1 Virus: Five New Cases reported in Week 51/2024 {3 in #California, 1 in #Wisconsin, 1 in #Iowa}

{Excerpts}

-- Five confirmed cases of influenza A(H5) were reported to CDC this week. 

-- To date, human-to-human transmission of influenza A(H5) virus has not been identified in the United States.

Three of these cases were reported by the California Department of Public Health. The cases occurred in workers aged ≥18 years at commercial dairy cattle farms in an area where highly pathogenic avian influenza (HPAI) A(H5N1) viruses had been detected in cows. The individuals had mild symptoms, which they reported to local health department officials. There have now been 37 total confirmed cases and one probable case in California during the 2024-2025 influenza season.

One case was reported by the Wisconsin Department of Health. This case occurred in an individual aged ≥18 years who worked at a poultry facility where HPAI A(H5N1) virus had been identified in birds. This individual developed respiratory symptoms during Week 50. Specimens were collected from the individual and initially tested at the state public health laboratories using the CDC influenza A(H5) assay before being sent to CDC for further testing. Influenza A(H5) virus was confirmed at CDC. This is the first influenza A(H5) case in Wisconsin.

One case was reported by the Iowa Department of Health and Human Services. This case occurred in an individual aged ≥18 years who worked at a poultry facility where HPAI A(H5N1) virus had been identified in birds. This individual developed conjunctivitis and respiratory symptoms during Week 50. Specimens were collected from the individual and initially tested at the State Hygienic Laboratory at the University of Iowa using the CDC influenza A(H5) assay before being sent to CDC for further testing. Influenza A(H5) virus was confirmed at CDC. This is the first influenza A(H5) case in Iowa.

Notification to WHO of the cases reported by the Wisconsin and Iowa departments of health was initiated per International Health Regulations (IHR). More information regarding IHR can be found at http://www.who.int/topics/international_health_regulations/en/. 

No additional notification to WHO of the cases exposed to dairy cows in California is required per International Health Regulations (IHR).

The CSTE position statement, which includes updated case definitions for confirmed, probable, and suspected cases is available at http://www.cste.org/resource/resmgr/position_statements_files_2023/24-ID-09_Novel_Influenza_A.pdf

An up-to-date human case summary during the 2024 outbreak by state and exposure source is available at www.cdc.gov/bird-flu/situation-summary/index.html

Information about avian influenza is available at https://www.cdc.gov/flu/avianflu/index.htm.

Interim recommendations for Prevention, Monitoring, and Public Health Investigations are available at https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html.

The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, backyard or hobbyist flocks, and mammals in the United States are available from the USDA at https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/animal-disease-information/avian/avian-influenza/2022-hpai.

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Source: US Centers for Disease Control and Prevention, https://www.cdc.gov/fluview/surveillance/2024-week-51.html

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Highly Pathogenic Avian #Influenza Contributes to the #Population Decline of the Peregrine #Falcon (Falco peregrinus) in the #Netherlands

Abstract

Highly pathogenic avian influenza (HPAI) epizootics have caused repeated mass mortality events among wild birds. The effect of the infection is potentially detrimental for a variety of bird species, including the Peregrine Falcon (Falco peregrinus). The numbers of wintering and breeding Peregrine Falcons in the Netherlands have recently declined. We investigated the changes in population trends in relation to HPAI H5 virus outbreaks. For this purpose, we analyzed variations in annual numbers of wintering and breeding birds, the virology of reported dead birds, and the presence of the HPAI H5 virus in unhatched eggs. We showed that significant mortalities of Peregrine Falcons had occurred in 2016–2017 and 2020–2023, years of major HPAI H5 virus outbreaks. In particular, the highest rates of bird mortality and HPAI virus infection were reported in 2023. In this year, over 80% (28/32) of the tested birds were positive for HPAI H5 virus. No HPAI H5 virus was present in the eggs. Based on these findings, we concluded that HPAI represents a serious threat to the Peregrine Falcon population in the Netherlands, and, in combination with anthropogenic factors, may contribute to the decline of this species. Targeted HPAI surveillance and disease mitigation measures are necessary for the conservation of this species.

Source: Viruses, https://www.mdpi.com/1999-4915/17/1/24

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#USA, #Monitoring for Avian #Influenza A(#H5) Virus In #Wastewater (Dec. 27 '24)

{Excerpt}

Time Period: December 15 - December 21, 2024

-- H5 Detection: 52 sites (17.4%)

-- No Detection:  246 sites (82.6%)

-- No samples in last week:  87 sites

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Source: US Centers for Disease Control and Prevention, https://www.cdc.gov/bird-flu/h5-monitoring/index.html

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Evidence of an emerging triple- #reassortant #H3N3 avian #influenza virus in #China

Abstract

The H3 subtype of avian influenza virus (AIV) stands out as one of the most prevalent subtypes, posing a significant threat to public health. In this study, a novel triple-reassortant H3N3 AIV designated A/chicken/China/16/2023 (H3N3), was isolated from a sick chicken in northern China. The complete genome of the isolate was determined using next-generation sequencing, and the AIV-like particles were confirmed via transmission electron microscopy. Subsequent phylogenetic analyses revealed that HA and NA genes of the H3N3 isolate clustered within the Eurasian lineage of AIVs, exhibiting the closest genetic relationship with other H3N3 AIVs identified in China during 2023. Interestingly, the HA and NA genes of the nove H3N3 isolate were originated from H3N8 and H10N3 AIVs, respectively, and the six internal genes originated from prevalent H9N2 AIVs. These findings indicated the novel H3N3 isolate possesses a complex genetic constellation, likely arising from multiple reassortment events involving H3N8, H9N2, and H10N3 subtype influenza viruses. Additionally, the presence of Q226 and T228 in the HA protein suggests the H3N3 virus preferentially binds to α-2,3-linked sialic acid receptors. The HA cleavage site motif (PEKQTR/GIF) and the absence of E627K and D701N mutations in PB2 protein classify the virus as a characteristic low pathogenicity AIV. However, several mutations in internal genes raise concerns about potential increases in viral resistance, virulence, and transmission in mammalian hosts. Overall, this study provides valuable insights into the molecular and genetic characterization of the emerging triple-reassortant H3N3 AIVs, and continued surveillance of domestic poultry is essential for monitoring the H3N3 subtype evolution and potential spread.

Source: BMC Genomics, https://bmcgenomics.biomedcentral.com/articles/10.1186/s12864-024-11152-x

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The #evolution of #hemagglutinin-158 and #neuraminidase-88 #glycosylation sites modulates antigenicity and #pathogenicity of clade 2.3.2.1 #H5N1 avian #influenza viruses

Abstract

Clade 2.3.2.1 of the H5N1 avian influenza virus (AIV) evolved into several subclades. However, the effect of glycosylation on the biological characteristics of hemagglutinin (HA) and/or neuraminidase (NA) from H5N1 AIVs remains unclear. Here, we determined that the global prevalence of clade 2.3.2.1 H5N1 AIVs with deglycosylated residue 158 on HA (HA158-) and glycosylated residue 88 on NA (NA88+) were predominant via multiple sequence analysis. The deglycosylation of residue on NA 88 (NA88-) was observed in clade 2.3.2.1a (new) and clade 2.3.2.1e H5N1 AIVs. Interestingly, NA88- was coupled with the acquisition of 158 glycosylation sites on HA (HA158+) in clade 2.3.2.1e H5N1 AIVs from China, and clade 2.3.2.1a (new) H5N1 AIVs exhibiting the HA158-NA88- pattern were predominant in Bangladesh. Meanwhile, the temporal distribution of strain HA158+ NA88- was highly consistent with the implementation of Re-6 vaccine in China. The recombinant H5N1 AIVs constructed using a reverse genetic system showed that the acquisition of the HA158 glycosylation site facilitated viral evasion from Re-6 antisera, and the virus lacking glycosylation sites at HA158 and NA88 resulted in reduced NA activity, replication in mammalian cells, and pathogenicity in both chickens and mice compared to that of the viruses with alternative glycosylation patterns. Therefore, the acquisition of HA158+ in clade 2.3.2.1e H5N1 AIVs enables evasion of Re-6 vaccination pressure, and the virulence of clade 2.3.2.1 H5N1 AIVs is modulated by the absence of glycosylation sites at HA158 and NA88. Our finding highlighted the importance of epidemiological surveillance and timely updating vaccines of H5 AIVs.

Source: Veterinary Microbiology, https://www.sciencedirect.com/science/article/abs/pii/S0378113524003559?via%3Dihub

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#DRC, #Kwango province affected by #influenza {A #H1N1} virus in #Panzi health zone

The flu caused by the Influenza virus, associated with malaria on a ground of malnutrition, is the unknown disease that has been decimating the population in the health zone of Panzi, in the province of Kwango, for more than a month.

This is what the diagnosis made by the INRB reveals after in-depth analyses. 

The governor of Kwango province, Willy Bitwisila, officially declared on Wednesday night, December 5, this epidemic which has caused around thirty deaths and more than 400 cases in this part of the Kasongolunda territory.

"This is the epidemic that is causing deaths in the previously unidentified Panzi health zone. 

''After a rigorous investigation, the results from the INRB laboratory have just confirmed that it is influenza caused by the Influenza AH1N1 virus, {rhinovirus, SARS-CoV-2, edited, in the article the terms are unreadable}, associated with malaria on the ground of malnutrition. 

''An epidemic that I am now officially declaring. I would therefore like to reassure each and every one of you that all necessary measures are being taken to slow the spread of this virus," said Willy Bitwisila.  

Source: Radio Okapi, https://www.radiookapi.net/2024/12/26/actualite/sante/la-province-du-kwango-affectee-par-le-virus-influenza-dans-la-zone-de

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