Rapid #risk #assessment, acute event of potential public health concern: #Diphtheria, #Africa Region (#WHO, March 20 '26)

{Summary)

Risk statement

-- This WHO Rapid Risk Assessment (RRA, v2) aims to assess the risk of diphtheria at the regional level, considering the public health impact, the risk of geographical spread and the risk of insufficient control capacities with available resources. 

-- Diphtheria is a major public health problem in the WHO African Region (AFR) despite significant efforts on immunization in the past decades (e.g. introduction of DTP vaccine in the Expanded Program on Immunisation in 1974). 

-- Between 2000 and 2024, 75 789 diphtheria suspected cases were reported across the Region with an average 3 500 cases per year.    

-- Between the beginning of 2025 and as of 1 March 2026, over 29 000 suspected diphtheria cases with 1 420 deaths (CFR 4.9%) have been reported across these eight countries: Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria and South. 

-- This represents a 67% increase in the number of suspected cases (11 749 additional cases) and a 59.4% increase in the number of deaths (529 additional deaths) reported since the last WHO RRA (v1) conducted in October 2025, Nigeria continues to account for the majority of suspected cases (62.6%) and deaths (66%) in the Region. 

-- Of the 18 130 total confirmed cases (clinically compatible, laboratory-confirmed and epidemiologically linked) across the eight affected countries, 752 (4%) cases were recorded as laboratory-confirmed: Algeria (8), Chad (1), Guinea (48), Mali (66), Mauritania (12), Niger (313), Nigeria (211) and South Africa (93).     

-- Case data trends from 2026 have been difficult to interpret, with extremely delayed case reporting from countries (both to the national and regional levels), and instances of under-reporting also being notified, particularly from humanitarian settings. 

-- However, a lower number of cases are being consistently reported than earlier in the outbreak and thus it appears that new cases continue to decline or plateau, as seen in half of the affected countries (Chad, Mali, Mauritania, and Nigeria).    

-- Since the first WHO RRA (v1) conducted in October 2025, the regional CFR remains around 5%. 

-- While Guinea continues to report among the highest CFRs in the region at 19%, South Africa’s CFR has increased since the last WHO RRA (v1) to 19%.  

-- Children aged 5–14 yrs (57%) and females (63%) are the most affected; where information is available on the vaccination status of cases, most cases are unvaccinated, under-vaccinated, or with unknown vaccination status.   

-- While the overall risk was previously assessed as “HIGH” at the regional level in October 2025, it is now considered “MODERATE” due to:  

• Overall declining trend in number of weekly cases regionally, with country-specific trends also declining in half of the affected countries (Chad, Mali, Mauritania and Nigeria), and only sporadic cases reported from South Africa. 

• Strengthened coordination of public health response through the activation of an Incident Management System (IMS) in most of the affected countries. A joint Regional Office for Africa (AFRO) and WHO headquarters (HQ) IMS structure was activated to support the regional coordination of the response, with high-level ministerial commitment to controlling the outbreaks in the affected countries.  

• Implementation of immunization activities as part of the outbreak response in most of the affected countries. 

• Strengthening of surveillance, case management, community sensitization, through capacity building activities, and the provision of diphtheria antitoxin (DAT), antibiotics, laboratory supplies, etc.  

-- Nonetheless, some challenges continue to prevent the effective containment of these outbreaks:  

• The complex humanitarian situation in many of the affected countries continues to contribute to poor access to immunization and healthcare services for internally displaced persons (IDPs), nomads, miners, and migrants. Unsanitary living conditions (in displacement camps) are also favouring the transmission of diphtheria. These increase the exposure risk of vulnerable groups (particularly women and children) to diseases.   

• Limited laboratory confirmation due to lack of reagents, sample transportation challenges and limited available of laboratory capacity.  

• In most of the affected countries, the annual coverage for routine diphtheria vaccination remains below the national targets thereby contributing to the resurgence of cases and outbreaks.  

• Global scarcity of DAT for the treatment of affected persons. 

• High internal and cross-border movements of susceptible individuals (unvaccinated or not fully vaccinated). 

• Persistent funding challenges across most affected countries exacerbated by the current challenging international funding landscape.  

-- The overall risk at the global level remains ‘’LOW’’ due to: 

- The global risk of diphtheria outbreaks from the ongoing multi-country diphtheria outbreak in the African region is assessed as low, given the existence of routine immunization programs in most countries. 

- Nonetheless, the risk posed by international travel of susceptible populations from the WHO African Region cannot be overlooked, highlighting the need to strengthen risk communication, demand generation and reactive immunisation, as well as the need for enhanced data sharing and surveillance globally. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment---diphtheria--african-region-v.2

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14th Meeting of #WHO #Expert Working Group of the Global #Influenza #Surveillance and Response System (GISRS) for Surveillance of #Antiviral Susceptibility (March 20 '26)

Weekly epidemiological record 

20 MARCH 2026, 101th YEAR, No 12, 2026, 101, 53–56

http://www.who.int/wer 

Executive Summary 

The WHO Expert Working Group on Surveillance of Influenza Antiviral Susceptibility (AVWG) supports the WHO GISRS by providing practical guidance for monitoring antiviral susceptibility of seasonal and emerging influenza viruses through global surveillance efforts. 

The 14th WHO-AVWG meeting was held in virtual format on 10-12 June 2025. 

Update on susceptibility of seasonal influenza viruses to approved antiviral agents 

From approximately May 2024 to May 2025, five WHO Collaborating Centres (CCs) and two National Influenza Centres (NICs) reported co-circulation of influenza A(H1N1) pdm09, A(H3N2), and B/Victoria viruses. 

A(H1N1)pdm09 dominated in Eastern Asia{1}. Elevated frequency of influenza neuraminidase (NA) inhibitor (NAI) reduced inhibition/ highly reduced inhibition (RI/HRI) was identified among A(H1N1)pdm09 viruses, largely conferred by the NA-H275Y substitution. 

Reporting frequency was 3.8% in China, lower (≤1%) in other reporting regions, but still measurable and were in some cases a result of prior antiviral use or specific local outbreaks (e.g., a hospital in Iceland with a NA-H275Y+S247N cluster, a primary school classroom outbreak in Japan{2}. The NA-S247N substitution (≤3.3%) was also noted by three centres, but these viruses exhibited normal inhibition (NI) by NAIs when available isolates were tested. 

Incidence of RI/HRI or NA-associated markers were less frequently reported for A(H3N2) and B/Victoria viruses than A(H1N1)pdm09 viruses. 

Markers and incidence of reduced susceptibility to baloxavir was detected at low frequencies of 0.07 to 2.2%, where the latter value represented a small sample set of only 2 of 89 viruses in Japan. 

Reduced susceptibility or amino acid markers indicative of reduced susceptibility were observed only in influenza A viruses and not influenza B. 

Update on susceptibility of zoonotic and animal influenza viruses  to approved antiviral agents 

From approximately May 2024 to May 2025, global surveillance data from WHO CCs, NICs, and associated partners including WHO Essential Regulatory Laboratories and the OFFLU (WOAH/FAO Network of Expertise on Animal Influenza) network reported that most zoonotic and avian influenza viruses, particularly circulating A(H5N1/x) HA clade 2.3.4.4b and 2.3.2.1a/e viruses, were broadly susceptible to NAIs and baloxavir. 

A(H5N1) 2.3.4.4b virus oseltamivir inhibitory concentrations remain elevated vs. seasonal N1 viruses. 

Small and isolated incidence of NAI associated RI/HRI or markers included: NA-D199G mediated oseltamivir/zanamivir RI detected in A(H5N1) 2.3.4.4b poultry in the Russian Federation (February 2024, reported June 2025), NA-N295S in poultry in India A(H5N1) 2.3.2.1a isolates, and 8 poultry farms in British Columbia, Canada exhibiting A(H5N1) 2.3.4.4b with NA-H275Y. 

Only two viruses with reduced baloxavir susceptibility were identified, 1 human virus with PA-I38M (California, USA) and 1 environmental virus isolate with PA-V100I (China, Hong Kong Special Administrative Region). 

Beyond A(H5N1/x), nearly 30 avian influenza subtypes including A(H9N2), A(H7N2), A(H7N7), and A(H7N9), and A(H10N7) were analysed across surveillance sites in the Bangladesh, Egypt, the Netherlands and the United States of America (USA). 

They generally lacked NA or PA genotypic markers of reduced drug susceptibility and when available for phenotypic testing, were susceptible to both NAIs and baloxavir. 

A(H7N2) and A(H7N7) viruses from the Netherlands displayed oseltamivir RI compared to human seasonal references, but this may be due to foldchange comparison to a mismatched NA subtype. 

Swine-origin variant viruses (A(H1N1)v, A(H1N2)v, A(H3N2)v) tested across the USA and Europe were largely free of genotypic or phenotypic indicators of reduced susceptibility/inhibition to NAIs or baloxavir. 

Some viruses (the  Netherlands) showed slightly higher NAI median inhibitory concentrations to historical or human seasonal baselines, but all remained below NAI RI thresholds. 

Update of protocols and guidance for GISRS laboratories 

Both genotypic and phenotypic assays may be used as tools to monitor susceptibility of influenza viruses to NAIs and baloxavir. 

The WHO-AVWG routinely reviews and updates influenza NA and PA amino acid substitutions associated with reduced susceptibility to NAIs and baloxavir; updated tables for the previous reporting period were included on the WHO website{3–5}. 

The US CDC continues to update and ship reference virus panels that can be used for NAI and baloxavir susceptibility testing, available via the International Reagent Resource{6} 

Further guidance on baloxavir and other PA inhibitor testing included the Influenza Replication Inhibition Neuraminidase-based Assay (IRINA), published by the Centers for Disease Control and Prevention, USA{7} and included on the WHO website{8}. 

The WHO AVWG continues to develop algorithms for NICs to aid in influenza response planning (zoonotic, pandemic, and antiviral resistance-specific events), guidance to aid in decisions making for testing strategies (genotypic vs. phenotypic), and guidance for consideration of baloxavir and PA inhibitor specific amino acid substitutions associated with reduced drug susceptibility{9}. 

Additionally, the WHO-AVWG has worked with GISAID to continue to refine and implement modifications to existing tools to facilitate identification of NA and PA substitutions upon sequence submission. 

Outbreak and pandemic preparedness with clinicians’ perspectives 

Two physicians, Profs. Prof. David Hui and Bin Cao, were invited to present recently updated WHO guidance on clinical practice guidelines for influenza{10}. 

Significant updates and discussion surrounded inclusion of baloxavir, which was conditionally recommended for non-severe disease high-risk patients and post-virus exposure prophylaxis (PEP) including influenza viruses associated with high mortality. 

Conditional recommendation against any NAI or baloxavir intervention remains for non-severe disease low-risk patients or seasonal virus PEP. 

Data was presented on multiple PA inhibitors rapidly moving through late-stage clinical trials in China which may have implications on expanded usage of this newer class of influenza drugs. 

Review of External Quality Assessment Programme (EQAP) panels 

EQAP was initiated in 2007 to monitor the quality of GISRS, NICs, other national influenza reference laboratories’ capacity for influenza diagnosis and detection. 

An optional antiviral phenotypic NAI panel was introduced in 2013, and genotypic baloxavir susceptibility was introduced in 2020. 

Results for the 2024 Global EQAP panel were reported during the 14th WHO-AVWG meeting. 

Of the 194 participating laboratories, 26.3% participated in NAI susceptibility testing. 

Results and subsequent discussion from this year’s panel were used by members of WHO-AVWG to assess the training needs of NICs. 

Way forward 

The 2020–2023 Annual Global Update on the Susceptibility of Influenza Viruses (Global AVS) manuscript was published{11} and drafting of a 2023–2025 publication is underway. The next WHO-AVWG meeting will be held in June 2026.

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{1} World Health Organization. Influenza Transmission Zones. 2026. https://cdn.who.int/media/docs/ default-source/influenza/influenzaupdates/2025_09_24_influenza-transmission-zones. pdf?sfvrsn=22361408_3&download=true. 

{2} Takashita E, Shimizu K, Usuku S, Senda R, Okubo I, Morita H, et al. An outbreak of influenza A(H1N1) pdm09 antigenic variants exhibiting cross-resistance to oseltamivir and peramivir in an elementary school in Japan, September 2024. Euro Surveill. 2024;29(50).

{3} World Health Organization. Summary of neuraminidase (NA) amino acid substitutions assessed for their effects on inhibition by neuraminidase inhibitors (NAIs). 2025. https://cdn.who.int/media/docs/default-source/ influenza/laboratory---network/quality-assurance/human-nai-marker-table_ for-publication_final_20240918.pdf. 

{4} World Health Organization. Summary of neuraminidase (NA) amino acid substitutions assessed for their effects on inhibition by NA inhibitors (NAIs) among avian influenza viruses of Group 1 (N1, N4, N5, N8 subtypes) and Group 2 (N2, N3, N6, N7, N9 subtypes) NAs. 2025. https://cdn.who.int/media/ docs/default-source/influenza/avwg/avian-nai-marker-whotable__10-10-2025.pdf?sfvrsn=bc0d1e9a_10 

{5} World Health Organization. Summary of polymerase acidic protein (PA) amino acid substitutions assessed for their effects on PA inhibitor (PAI) baloxavir susceptibility. 2025. https://cdn.who.int/media/docs/default-source/influenza/ laboratory---network/quality-assurance/antiviral-susceptibility-influenza/ pa-marker-who-table_28-11-2025_updated.pdf?sfvrsn=5307d6fe_4. 

{6} International Reagent Resource. 2026. https://www. internationalreagentresource.org/. 

{7} Patel MC, Flanigan D, Feng C, Chesnokov A, Nguyen HT, Elal AA, et al. An optimized cell-based assay to assess influenza virus replication by measuring neuraminidase activity and its applications for virological surveillance. Antiviral Res. 2022;208:105457. 

{8} World Health Organization. Baloxavir Susceptibility Assessment using Influenza Replication Inhibition Neuraminidase-based Assay (IRINA). https:// cdn.who.int/media/docs/default-source/influenza/avwg/cdc-phenotypic-lp492rev01d---baloxavir-susceptibility-assessment-using-irina.pdf? 

{9} Patel MC, Nguyen HT, Mishin VP, Pascua PNQ, Champion C, Lopez-Esteva M, et al. Antiviral susceptibility monitoring: testing algorithm, methods, and f indings for influenza season, 2023-2024. Antiviral Res. 2025;244:106299. 

{10} World Health Organization. Clinical practice guidelines for influenza 2024. https://www.who.int/publications/i/item/9789240097759.

{11} Hussain S, Meijer A, Govorkova EA, Dapat C, Gubareva LV, Barr I, et al. Global update on the susceptibilities of influenza viruses to neuraminidase inhibitors and the cap-dependent endonuclease inhibitor baloxavir, 2020-2023. Antiviral Res. 2025:106217.

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Source: 

Link: https://iris.who.int/server/api/core/bitstreams/1ea408da-cd90-438b-b80c-b00aaf4e7315/content

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#USA, #Wastewater Data for Avian #Influenza #H5 (#CDC, March 20 '26)

 

{Excerpt}

Time Period: March 08, 2026 - March 14, 2026

-- H5 Detection: 8 site(s) (1.8%)

-- No Detection: 444 site(s) (98.2%)

-- No samples in last week: 120 site(s)

(...)

Source: 

Link: https://www.cdc.gov/nwss/rv/wwd-h5.html

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Behavioural determinants of #testing behaviour during a hypothetical avian #influenza #outbreak: an interview study

 

Abstract

Background: 

Avian Influenza (AI) is a potential pandemic threat, specifically when human-to-human transmission occurs. For outbreak management testing is essential. Current knowledge on testing behaviour is mostly derived from other infectious diseases such as COVID-19. It is necessary to identify determinants of testing behaviour for AI in an early phase. Therefore, this interview study aims to identify a wide range of behavioural determinants of testing during a hypothetical human-to-human transmissible AI outbreak. 

Methods: 

Semi-structured in-depth interviews, based on the Theoretical Domains Framework, were carried out between May 2024 and February 2025. Participants were included through purposive and convenience sampling. During the interviews an animation was shown illustrating a hypothetical AI outbreak. Verbatim transcripts were thematically analysed. 

Results: 

We included seventeen participants (median age 44, range 20-81; 71% women) with diverse backgrounds in terms of age, gender, educational level and country of birth. We found that having the freedom to decide to test would make testing more acceptable, whereas a decreased sense of autonomy would discourage testing. Most themes included individual rather than population-level benefits as drivers of testing behaviour. These included protecting loved ones, one's own health and gaining psychological reassurance. External conditions like being unable to go to work or an event would generally encourage testing behaviour. Lower trust in governmental authorities could hamper testing behaviour. Previous experiences from the COVID-19 pandemic shaped the participants' answers about AI testing behaviour. 

Conclusion: 

Key considerations include balancing people's need for autonomy with the external measures imposed by employers or the government, rebuilding trust in institutions and acknowledging how prior experiences with testing may shape testing behaviour in future AI outbreaks. Further research is needed to determine how these findings can be translated into effective communication and how trust in authorities can be build.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was supported by ZonMw (projectnumber 10710032310014) an organisation that stimulates innovations to improve healthcare in the Netherlands. The funder had no involvement in study design, data collection, analysis, interpretation of the findings or in manuscript preparation.

Source: 

Link: https://www.medrxiv.org/content/10.64898/2026.03.17.26348610v1

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Early #Detection and #Surveillance of the #SARS-CoV-2 #Variant #BA32 — Worldwide, November 2024–February 2026 (US CDC, MMWR, March 19 '26)

 

Summary

-- What is already known about this topic?

- CDC tracks SARS-CoV-2 variants internationally using digital public health surveillance and in the United States using genomic surveillance, including wastewater and traveler-based surveillance. 

- The highly divergent SARS-CoV-2 variant BA.3.2 was first detected in a respiratory sample collected on November 22, 2024, in South Africa.

-- What is added by this report?

- As of February 11, 2026, BA.3.2 had been reported in 23 countries. 

- Detections began increasing in September 2025. 

- In the United States, BA.3.2 was detected in nasal swabs from four travelers, three airplane wastewater samples, clinical samples from five patients, and 132 wastewater samples from 25 U.S. states.

-- What are the implications for public health practice?

- Monitoring the spread of BA.3.2 provides valuable information about the potential for this new SARS-CoV-2 lineage to evade immunity from a previous infection or vaccination.

Abstract

The SARS-CoV-2 variant BA.3.2 was first identified in South Africa on November 22, 2024. BA.3.2 has approximately 70–75 substitutions and deletions in the gene sequence of the spike protein relative to JN.1 and its descendant, LP.8.1, the antigens used in the 2025–26 COVID-19 vaccines. CDC is using a multimodal SARS-CoV-2 genomic surveillance approach to monitor the emergence and spread of BA.3.2 and other SARS-CoV-2 variants internationally and within the United States. The first U.S. BA.3.2 detection occurred on June 27, 2025, through CDC’s Traveler-Based Genomic Surveillance program in a participant traveling to the United States from the Netherlands. The first U.S. detection of BA.3.2 in a clinical specimen collected from a patient was reported on January 5, 2026. As of February 11, 2026, BA.3.2 had been detected in voluntarily self-collected nasal swabs from four U.S. travelers, clinical samples from five patients, three airplane wastewater samples, and 132 wastewater surveillance samples from 25 states. BA.3.2 has been reported by at least 23 countries. SARS-CoV-2 continues to cause substantial morbidity and mortality worldwide. BA.3.2 mutations in the spike protein have the potential to reduce protection from a previous infection or vaccination. Continued genomic surveillance is needed to track SARS-CoV-2 evolution and determine its potential effect on public health.

Source: 

Link: https://www.cdc.gov/mmwr/volumes/75/wr/mm7510a1.htm?s_cid=OS_mm7510a1_e&ACSTrackingID=USCDC_921-DM153709&ACSTrackingLabel=Week%20in%20MMWR%3A%20Vol.%2075%2C%20March%2019%2C%202026&deliveryName=USCDC_921-DM153709

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#UK, #England: Expansion of #Meningitis B #vaccination offer to #Kent #Students (UKHSA, March 19 '26)

 

The Meningitis B vaccine will now be offered to everyone who has been offered preventative antibiotic treatment as part of this outbreak.

-- Vaccination will now be extended to everyone who has been offered preventative antibiotic treatment as part of this outbreak.

-- Preventative antibiotics – and vaccination – will also now be offered to the 6th form students (years 12 and 13) in schools and colleges in Kent where confirmed or probable cases are identified.

-- On a case-by-case basis, future risk assessment may also support use in other year groups or settings.

-- Students can, and should, continue to attend schools and colleges as normal. 

-- The NHS Kent and Medway website will be updated shortly with vaccination sites for those eligible.

-- The key intervention to protect people and halt the spread remains for people to come forward for antibiotic treatment. A single course of antibiotics is highly effective in preventing the contraction and spread of this disease in 90% of cases.

-- As a further precautionary measure, we are extending the offer of antibiotic prophylaxis and vaccine to any individuals who attended Club Chemistry from the 5 March until it closed voluntarily on 15 March.

-- 20,000 vaccines from the NHS supply will be made available to the private market, to ease current demand experienced by pharmacies. These will enter the private market within around 48 hours.

In response to the ongoing Meningitis B (MenB) outbreak in Kent, the UK Health Security Agency (UKHSA) is expanding the offer of preventative antibiotic treatment and vaccination to control the outbreak. 

Preventative antibiotic treatment and vaccination will now be offered to 6th sixth form students (years 12 and 13) in schools and colleges in Kent with confirmed or probable cases On a case-by-case basis, following risk assessment by the local health protection team, antibiotics and vaccination may also be made available to additional year groups. Students can, and should, continue to attend schools and colleges as normal.

In addition to the approximately 5,000 students who were initially contacted, vaccination will now be extended to everyone who has been offered preventative antibiotic treatment as part of this outbreak. This includes University of Kent students who live on the Canterbury Campus and other relevant halls of residence; close contacts of confirmed or suspected cases, and students in four education settings in Kent where cases have been confirmed. Anyone who visited Club Chemistry in Canterbury between 5 and 15 March will also be offered a vaccine and antibiotics as a precaution after one suspected case revisited the nightclub before it shut voluntarily.

This extension ensures that those most likely to have been in close contact with confirmed or suspected cases are offered longer term protection as early as possible.

The NHS Kent and Medway website will be updated shortly with vaccination sites for those eligible.

Patients eligible for antibiotics will now be able to request a vaccination and antibiotics from their local GP immediately – wherever they are in England.

While preventative antibiotics remain the key intervention to protect people and halt the spread of infection, vaccination is being offered as an additional measure to provide longer term protection for those at increased risk.

Given current demand on the private MenB vaccine market, 20,000 doses will also be released from NHS supply to support continuity of private provision, enabling up to 2,000 pharmacies to receive vaccines in the next 48 hours.

Professor Susan Hopkins, Chief Executive of the UK Health Security Agency, said: 

''By extending the vaccination programme to everyone who has been offered preventative antibiotics, we are taking an important additional step to protect those most likely to have been exposed. The message is simple: if you have had the antibiotic, you are also eligible for the vaccination.

People are reminded to remain alert to the signs and symptoms of invasive meningococcal disease and to seek urgent medical attention if they or someone they know becomes unwell.

Background 

Meningococcal disease (meningitis and sepsis) is an uncommon but serious disease caused by meningococcal bacteria. Very occasionally, the meningococcal bacteria can cause serious illness, (inflammation of the lining of the brain) and sepsis (blood poisoning), which can rapidly lead to sepsis. 

The onset of illness is often sudden and early diagnosis and treatment with antibiotics are vital. 

Early symptoms, which may not always be present, include: 

- a rash that doesn’t fade when pressed with a glass

- sudden onset of high fever

- severe and worsening headache

- stiff neck

- vomiting and diarrhoea

- joint and muscle pain

- dislike of bright lights

- very cold hands and feet

- seizures

- confusion/delirium

- extreme sleepiness/difficulty waking

Young people going on to university or college for the first time are particularly at risk of meningitis because they newly mix with so many other students, some of whom are unknowingly carrying the bacteria at the back of their nose and throat. 

There are numerous strains of the meningococcal infection.

There are numerous strains of the meningococcal infection. The MenACWY vaccination gives good protection against MenA, MenC, MenW, and MenY and is routinely offered to teenagers in school Years 9 and 10. However, this vaccine does not protect against all forms of meningococcal infection. Other strains such as MenB can circulate in young adults, which is why it’s important to know how to spot the symptoms of meningitis and sepsis as early detection and treatment can save lives. 

Further information on meningococcal disease 

Meningitis, The Meningitis Research Foundation, Monday to Friday, 9am to 5pm, UK: 080 8800 3344  -  Republic of Ireland: 1800 41 33 44  

Meningitis Now - 0808 80 10 388 (9am to 4pm Monday to Thursday and 9am to 1pm Friday)

Source: 

Link: https://www.gov.uk/government/news/expansion-of-meningitis-b-vaccination-offer-to-kent-students

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#Finland - #Influenza A viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

 

By USFWS Mountain-Prairie - Canada goose on Seedskadee NWR, Public Domain, https://commons.wikimedia.org/w/index.php?curid=69188087

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A wild Canada Goose in Etelä-Suomen aluehallintovirasto Region.

Source: 

Link: https://wahis.woah.org/#/in-review/7384

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Dynamics and #control of highly pathogenic #H5 avian #influenza in a threatened #pelican population

 

Abstract

The ongoing epizootic of highly pathogenic avian influenza (HPAI) continues to cause massive deaths in wildlife. Fundamental understanding of its disease ecology in natural populations is urgently needed. This knowledge has been hindered by the difficulty of acquiring data on epidemic dynamics. Here, using data collected from a threatened population of Dalmatian pelicans (Pelecanus crispus), we recover the epidemiological and evolutionary history of one of the largest HPAI wildlife mortality events. The results show that this devastating outbreak was likely seeded by a single introduction associated with movement of the species. By estimating epidemiological features of two consecutive outbreaks in the same population, we show that panzootic H5N1 since 2022 likely exhibits higher transmissibility and longer shedding time in non-reservoir birds, compared to previous H5NX subtypes. We also evaluate effectiveness of past and future control measures: carcass removal during the outbreak is shown to have surprisingly little impact on mitigating the mortality; and current H5 vaccines relying on capture and injection to deliver cannot establish herd immunity in a wildlife population. The results provide the first field evidence supporting the hypothesis that viral fitness difference of H5N1 to previous H5NX subtypes is the key cause of the expanded epizootic and panzootic since 2022, and on highly debated HPAI management strategies in wildlife populations.

Competing Interest Statement

The authors have declared no competing interest.

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.03.16.712014v1

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Optimal Dose and #Safety of Intravenous #Favipiravir in Hospitalized Patients With #COVID19: A Dose-Escalating, Randomized Controlled Phase Ib Study

 

Abstract

AGILE (NCT04746183) is a Phase Ib/IIa platform, evaluating candidates to treat COVID-19. Candidate Specific Trial 6 evaluated the safety and optimal dose of a novel intravenous formulation of favipiravir in a dose-escalating, open-label, randomized, controlled, Bayesian adaptive Phase Ib trial. Hospitalized adults with PCR-confirmed SARS-CoV-2 infection, within 14 days of symptomatic COVID-19 were randomized 2:1 in groups of 6 (n = 4 favipiravir, n = 2 standard of care) to ascending doses of intravenous favipiravir twice daily (b.i.d.) for 7 days or standard of care. Clinical data, safety evaluations, virology and pharmacokinetic samples were collected. The primary outcome was safety. Secondary outcomes included clinical, pharmacokinetic and virological endpoints. Twenty-four participants enrolled between September 10, 2022 and November 1, 2023 [10/24 female; median age 74 years (range 52–93)]. Favipiravir was well tolerated despite a high background rate of unrelated adverse events. No dose limiting toxicities were observed, with a model-predicted dose limiting toxicity risk of 16.8% and probability of unacceptable toxicity of 2.7% at the highest dose level. No serious adverse events were deemed related to favipiravir but an expected association with asymptomatic, transient hyperuricemia was observed. Favipiravir exposures increased disproportionally to dose with significant accumulation in plasma, but with marked variability between participants within each cohort. This novel formulation of favipiravir was safe at sustained high doses that reached pre-specified pharmacokinetic targets in a study group with frailty and complex health profiles. We consider doses up to 2,400 mg b.i.d. to be safe for further evaluation.

Study Highlights

-- WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?

- Pre-clinical studies of favipiravir describe broad spectrum antiviral activity, positioning it as a therapeutic candidate for many RNA viruses. An oral formulation of favipiravir has been widely studied as a treatment for COVID-19 in clinical trials. Pharmacokinetic modeling suggests the doses used in many of these trials may not have reached effective plasma concentrations.

-- WHAT QUESTION DID THIS STUDY ADDRESS?

- Was a novel intravenous formulation of favipiravir safe and well tolerated in patients hospitalized with COVID-19? Were pre-specified pharmacokinetic parameters met at doses modeled to be effective for the treatment of COVID-19?

-- WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?

- We demonstrate that high doses of intravenous favipiravir are safe and well tolerated in a frail and co-morbid population who are likely to be eligible for antiviral treatment but are often excluded from early phase clinical trials. We characterize the pharmacokinetic profile of intravenous favipiravir at high doses and recommend an optimal dose to be used in future Phase II studies.

-- HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?

- There is an ongoing unmet need for antivirals to effectively treat COVID-19; however, the significance of these safety and pharmacokinetic data go beyond COVID-19. High doses of favipiravir have a use case against RNA viruses with pandemic potential including viral hemorrhagic fevers and pandemic influenza. The intravenous formulation may be particularly relevant in severely unwell patients for whom oral dosing is not possible or in whom GI absorption is affected. The pharmacokinetic characterization from this study will be used to inform doses for use against a range of significant pathogens. Early phase clinical trials of IV favipiravir in Crimean-Congo Haemorrhagic Fever are ongoing.

Source: 

Link: https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.70261

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#RSV #infection induces heterologous #protection against #SARS-CoV-2 through γδ T cell-mediated trained #immunity and activation of SARS-CoV-2–reactive mucosal T cells

 

ABSTRACT

Respiratory viruses can infect hosts concurrently or sequentially, potentially influencing each other’s pathogenic trajectory. However, the underlying immune mechanisms governing these interactions remain poorly understood. In this study, we examined whether respiratory syncytial virus (RSV) infection modulates host susceptibility to subsequent SARS-CoV-2 infection using two murine models. We found that prior RSV infection conferred dose- and time-dependent heterologous protection against SARS-CoV-2. Transcriptomic and immunological analyses revealed that RSV activated lung antigen-presenting cells (APCs) and SARS-CoV-2–reactive mucosal T cells by day 9 post-infection, with responses waning by 1 month. RSV also promoted expansion of pulmonary γδ T cells and upregulation of their metabolic pathways. Notably, RSV-infected TCRδ⁻/⁻ mice, which lack γδ T cells, exhibited diminished SARS-CoV-2–reactive mucosal T cell responses, elevated viral loads, and exacerbated lung inflammation following SARS-CoV-2 challenge compared to wild-type controls. These findings suggest that RSV infection induces γδ T cell-mediated trained immunity and primes mucosal T cell responses, thereby providing heterologous protection against SARS-CoV-2.

Source: 

Link: https://journals.asm.org/doi/full/10.1128/jvi.01658-25?af=R

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#UK, Northern Ireland: PHA #statement - #meningitis (March 18 '26)

 

The Public Health Agency (PHA) is aware of a probable case of Bacterial Meningitis in a pupil who attends a secondary school in Belfast. 

All appropriate public health actions have been completed.

As a precaution, PHA has worked closely with the school and has issued information to parents and guardians. 

Relevant guidance has also been shared with GP Out-of-Hours services and Emergency Departments.  

All individuals identified as close contacts have been risk assessed and where appropriate, have received antibiotic prophylaxis. 

We urge students, staff and families to remain vigilant for the signs and symptoms of meningitis and act fast if they suspect they may have it.

Symptoms of meningitis develop suddenly and can include: 

- a high temperature (fever) over 37.5C (99.5F)

- being sick

- a headache

- a blotchy rash that doesn't fade when a glass is rolled over it (this won't always develop)

- a stiff neck

- a dislike of bright lights

- drowsiness or unresponsiveness

- seizures (fits) 

PHA will continue to monitor the situation and provide any further advice as required. 

PHA is aware of the meningitis incident in Kent and is participating in regular UK wide meetings in relation to this. To date there is no evidence of spread beyond the South East of England.

For more information, visit: Update on meningitis incident in Kent England | HSC Public Health Agency

Further information on meningitis can be found at www.pha.site/meningitis-nidirect 

Source: 

Link: https://www.publichealth.hscni.net/news/pha-statement-meningitis

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#Outbreak of invasive #meningococcal disease, SE #England - #Alert outlines recommended courses of action to manage cases with #infection and #contacts (#UKHSA, March 18 '26)

 

Invasive meningococcal disease: advice for the NHS in England

You may be aware of an evolving situation involving multiple cases of invasive meningococcal disease (IMD) reported among young people linked to the University of Kent and the Canterbury area. 

More information about IMD, signs and symptoms to look out for, and approaches to clinical and public health management are provided in the accompanying Briefing Note. 

The purpose of this CAS Alert is to outline priority steps that primary care and hospital clinicians should consider taking to manage suspected cases, potential contacts of cases, and to reduce the risk of infection spreading. 

Note that this is a rapidly evolving situation and we will update advice as further information emerges.

Epidemiology

-- Between 13 and 17 March 2026, UKHSA identified 20 cases of invasive meningococcal disease in the South East. 

-- Six cases have been confirmed as Neisseria meningitidis group B. 

-- Most cases are students from the University of Kent, Canterbury, and sixth form students from local secondary schools. 

-- At least 10 cases attended Club Chemistry in Canterbury on 5, 6 or 7 March 2026. 

-- The illness has been severe with rapid deterioration, and 2 deaths have occurred.

Management of cases

Infection prevention and control (IPC) and personal protective equipment (PPE)

-- For patients presenting with suspected meningococcal disease, standard infection prevention and control precautions should be followed in line with the National infection prevention and control manual for England (see Appendix 11). 

-- Use appropriate PPE (including Level 2 PPE where clinically indicated) for assessment and management of suspected IMD:

- clinical staff should apply standard respiratory hygiene and infection control measures in routine clinical settings

- wear a fluid resistant surgical facemask for routine care of patients with suspected invasive meningococcal disease

- wear an FFP3 mask or Hood for aerosol-generating procedures performed on patients with suspected invasive meningococcal disease

- continue transmission-based precautions until the patient has been established on antibiotics for at least 24 hours

- no additional or enhanced IPC measures are required beyond those recommended in national guidance

Immediate case management

-- Patients with IMD may present with septicaemia and/or meningitis. 

-- Meningococcal sepsis should be considered in a rapidly deteriorating patient with sepsis even in the absence of a non-blanching rash, which is usually a late sign. 

-- Clinicians should have a high index of suspicion where a young person aged 16 to 30 attends with consistent signs or symptoms.

-- In a community setting, rapid admission to hospital is the highest priority when IMD is suspected. Conveyance to hospital should not be delayed for procurement or administration of antibiotics.

-- In acute settings, patients with sepsis should be managed according to local sepsis guidelines and immediate clinical management should focus on stabilisation (including fluid resuscitation as appropriate) and early engagement with ITU colleagues where necessary.

-- Initial treatment recommendations are as follows (full treatment regimens will be commenced during hospital admission):

- Immediate single dose of IV/IM Ceftriaxone for suspected meningococcal infections (Ceftriaxone, Drugs, BNFC, NICE):

Age/weight / Dose

- adults - dose: 2g stat

- children with body weight 50kg and over or aged 9 years and older: dose 2g stat

- children up to 50kg body weight or aged under 9 years: dose 80 to 100 mg/kg (maximum per dose 4g)

Alternatively, immediate single dose of IV/IM Benzylpenicillin sodium for suspected meningococcal infections where it is not possible to administer Ceftriaxone (Benzylpenicillin sodium, Drugs, BNF, NICE):

Age / Dose

- adults and children aged 10 years or over: dose of 1.2g

- children aged 1 to 9 years: dose of 600mg

- children aged under 1 year: dose of 300mg

Information regarding clinical samples that should be taken for suspected IMD cases and referring meningococcal-positive clinical materials (including isolates, PCR-positive clinical samples and/or DNA extracts, and lysate extracted from Biofire loading syringes) to the National Meningococcal Reference Laboratory, is included in UKHSA national guidance.

Notifying UKHSA

-- All suspected cases of invasive meningococcal disease are statutorily notifiable by registered medical practitioners to the responsible UKHSA health protection team, without waiting for laboratory confirmation.

-- Notify UKHSA by contacting your health protection team.

Management of contacts

Informing contacts

-- Remind any presenting contacts of the signs and symptoms of meningococcal disease (meningitis and septicaemia) and the importance of seeking urgent medical attention if they have symptoms (even if prophylaxis has been taken). 

-- Early detection and treatment can save lives. 

-- The UKHSA South East Health Protection Team have provided warn and inform information to all cases and close contacts and are liaising closely with all educational and other community settings to provide advice.

Providing antibiotic chemoprophylaxis

-- Close contacts of confirmed or probable cases are being identified by UKHSA and require antibiotic prophylaxis. 

-- Timely chemoprophylaxis will prevent cases of disease and will save lives. 

-- Antibiotic prophylaxis should be given as soon as possible (ideally within 24 hours) after the diagnosis of the index case, regardless of vaccination status.

-- Eligibility is defined in national UKHSA and NICE CKS guidance.

-- This includes people who had the following forms of contact during the 7 days before onset of illness in the index case:

- people who have had prolonged close contact with the case in a household-type setting

- intimate kissing or equivalent close contact

- exposure to respiratory secretions (for example, mouth-to-mouth resuscitation)

- other close contacts identified through UKHSA risk assessment

-- In response to this outbreak, a wider group of contacts have been identified as requiring antibiotic prophylaxis on a precautionary basis:

- Students who live on the Canterbury campus at the University of Kent

- Staff who live or work in affected halls of residence blocks on the Canterbury campus at the University of Kent

- Staff members working at Club Chemistry nightclub, Canterbury, and anyone who attended the nightclub as visitors on 5, 6 or 7 of March 2026.

-- Local clinics are offering chemoprophylaxis to contacts in the Canterbury area. If an eligible close contact presents to a healthcare setting (primary or secondary care) and has not already received prophylaxis through UKHSA‑coordinated clinics, this should be prescribed for them.

-- As the outbreak evolves, further groups may be identified that require antibiotic prophylaxis and will be communicated with directly.

-- Where an eligible close contact presents and has not already received prophylaxis please prescribe this as per National guidance.

The first line treatment is ciprofloxacin: 

Ciprofloxacin dosage (for one dose) [note1]

-- All to be given as a single dose:

Age / Dose

- adults and children aged 12 years and over: 500 mg stat

- children aged 5 to 11 years: 250 mg stat

- children aged 1 to 4 years: 125 mg stat

- infants under 1 year [note 2]: 30 mg/kg to a maximum 125mg stat

Note 1. Ciprofloxacin suspension contains 250 mg/5ml.

Note 2. prescribed off-label. 

-- If ciprofloxacin is not suitable, alternatives are listed in the national guidance.

-- Where demand exceeds capacity, ICBs are responsible for ensuring timely access to post‑exposure prophylaxis and vaccination in line with NHS England commissioning guidance.

Advice concerning vaccination

-- Given the severity of the outbreak, and as an additional precautionary measure, a targeted vaccination programme will begin, starting with students that are residents of the Canterbury Campus Halls of Residence at the University of Kent who will be contacted directly. 

-- Precise details of eligibility will be confirmed by UKHSA. UKHSA will continue to assess ongoing risk to other populations and the programme may be extended.

Source: 

Link: https://www.gov.uk/guidance/outbreak-of-invasive-meningococcal-disease-south-east-england

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#Cambodia - #Influenza A #H5N1 viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

{Bântéay Méanchey, Preah Netr Preah} On 12 March 2026, the outbreak investigation team visited a backyard chicken farm following reports of illness and mortality suspected to be caused by Avian Influenza (AI). During the visit, deaths of wild birds were also observed in the area. A total of six chicken samples were collected and submitted to NAHPRI/GDAHP for testing of Avian Influenza (H5N1). Laboratory results confirmed on 16 March 2026 that 4 out of 6 chicken samples tested positive for Avian Influenza (H5N1). In addition, 13 wild bird carcasses were collected and submitted for laboratory testing. On 16 March 2026, all wild bird samples were confirmed positive for Avian Influenza (H5N1).

{Bântéay Méanchey, Serei Saophoan} On 25 January 2026, the outbreak investigation team visited a backyard chicken farm following reports of illness and mortality suspected to be caused by Avian Influenza (AI). Two chicken samples were collected and submitted to NAHPRI/GDAHP for testing of AI (H5N1). On 26 January 2026, laboratory results confirmed that both samples tested positive for Avian Influenza (H5N1).

Source: 

Link: https://wahis.woah.org/#/in-review/7376

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Characterisation of Naturally Occurring #MERS-CoV #Spike #Mutations and Their Impact on #Fusion and Neutralisation

 

Abstract

In this study, the phenotypic consequences of naturally occurring single nucleotide polymorphisms (SNPs) in the Middle East respiratory syndrome coronavirus (MERS-CoV) Spike protein were investigated. The impact of Spike mutations on the syncytia formation and neutralisation of contemporary MERS-CoV strains is not currently well understood. Mutations were identified by aligning 584 MERS-CoV Spike sequences from either human clinical isolates collected between 2012 and 2024 or from a clinical isolate that had been passaged in human cells. Fifteen SNPs of interest occurring in the N-terminal domain (NTD), receptor binding domain (RBD) and adjacent to the S1/S2 cleavage site were selected for further characterisation based on their location in the Spike protein, frequency and identification in previous studies. A contemporary clade B, lineage 5 wildtype Spike sequence, obtained from a human MERS-CoV clinical isolate, was used as the backbone in this study. The mutations of interest were introduced to the wildtype backbone to generate Spike variants. Spike variants were characterised via cell–cell fusion assays, and a lentiviral pseudotyping system was used to investigate the impact of these Spike mutations on neutralisation. The I529T, E536K and L745F mutations were shown to increase fusion and syncytia formation. The L411F, T424I, L506F, L745F and T746K mutations were found to increase resistance to neutralisation by pooled patient sera. This study has identified novel naturally occurring Spike mutations that resulted in phenotypic differences in the syncytia formation and neutralisation of contemporary MERS-CoV strains. Continued investigation of the phenotypic consequences of MERS-CoV Spike mutations is essential for assessing the risk to public health, especially given the pandemic potential of this virus.

Source: 

Link: https://www.mdpi.com/1999-4915/18/3/377

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Limited durability of #improvements in #infection #prevention and control practices following reactive interventions leaves #healthcare facilities vulnerable to #Ebola virus transmission

 

Abstract

We assessed impact and durability of an infection prevention and control (IPC) bundle intervention during the Kivu/Ituri Ebolavirus outbreak (2018-2020). IPC scores increased initially, then declined 6 months post-intervention (median 19/36, 30/36, and 28/36, p<0.0001). Without sustained IPC practices, health facilities remain vulnerable to nosocomial transmission in future Ebolavirus outbreaks.

Source: 

Link: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciag192/8526630

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Empiric #azithromycin alters the upper respiratory #microbiome and #resistome without anti-inflammatory benefit in #COVID19

 

Abstract

Azithromycin is a widely used antibiotic and was frequently used to treat hospitalized patients during the COVID-19 pandemic. The impact of empiric azithromycin use on the respiratory microbiome in patients with viral respiratory infections is unclear. Here we used longitudinal metatranscriptomics on nasal swabs from a prospective multicentre cohort of 1,164 patients hospitalized for COVID-19. We compared the upper respiratory microbiome, resistome and systemic immune response in patients treated with azithromycin (n = 366) with those who received no antibiotics (n = 474) or other antibiotics (n = 324). We found that azithromycin altered microbiome composition and increased the expression and relative proportion of macrolide/lincosamide/streptogramin (MLS) resistance genes. These changes occurred after 1 day of exposure and persisted for over a week. MLS resistance gene expression was associated with commensals and potential pathogens, while there were no differences in host inflammatory gene expression in blood and airways. This demonstrates that empiric azithromycin treatment impacts the upper respiratory microbiome and resistome without apparent anti-inflammatory benefit.

Source: 

Link: https://www.nature.com/articles/s41564-026-02285-8

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Identification of #thermostability-enhancing #mutations in #H9N2 avian #influenza virus hemagglutinin

 

ABSTRACT

H9N2 avian influenza viruses (AIVs) remain a significant economic burden on poultry production and a persistent zoonotic threat. Hemagglutinin (HA), a surface glycoprotein mediating viral entry and pathogenesis, critically depends on thermostability for its function. Our previous study indicated that recent H9N2 AIVs have experienced a reduction in hemagglutination activity and exhibit low HA thermostability; however, the underlying molecular determinants for this instability remain poorly defined. To address this gap, we employed an in vitro-directed evolution approach to identify HA mutations that enhance thermostability. By subjecting a diverse HA mutant library to iterative heat selection at 48°C, we isolated several HA-stabilizing mutations, including L29I, N133S, N210D, G266R, D387N, A423T, and E509G, and confirmed their effect by site-directed mutagenesis. Further characterization revealed a complex interplay between HA stability, receptor binding specificity, and acid tolerance. Our findings demonstrate that enhancing HA stability can exert pleiotropic effects on key viral properties, highlighting the importance of understanding these relationships for developing effective mitigation strategies against H9N2 AIVs.

Source: 

Link: https://journals.asm.org/doi/full/10.1128/jvi.00168-26?af=R

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#Cambodia: one new #human #infection with avian #influenza virus #H5N1 (HK CHP, March 17 '26)

{Excerpts}

Avian Influenza Report - VOLUME 22, NUMBER 11 - Reporting period: March 8, 2026 – March 14, 2026 (Week 11) (Published on March 17, 2026) 

(...)

-- Date of report: 14/03/2026

-- Country: Cambodia

-- Province / Region District / City: Banteay Meanchey province, Preah Netr, Preah district

-- Sex: Female

-- Age: 45

-- Condition at time of reporting: Hospitalised

-- Subtype of virus: H5N1 

(...)

Source: 

Link: https://www.chp.gov.hk/files/pdf/2026_avian_influenza_report_vol22_wk11.pdf

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