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#Assessment of #risk associated with #influenza A(#H5N8) virus, 17 November 2016 (@WHO)

  Title : #Assessment of #risk associated with #influenza A(#H5N8) virus, 17 November 2016. Subject : Avian Influenza, H5N8 subtype, multi...

9 Dec 2016

#USA, #Texas Announces Additional Local #Zika Cases in #Cameron County (DoH, Dec. 9 ‘16)

 

Title: #USA, #Texas Announces Additional Local #Zika Cases in #Cameron County.

Subject: Zika Virus, current epidemiological situation in Texas.

Source: US State of Texas Department of Health, full page: (LINK).

Code: [     ]

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Texas Announces Additional Local Zika Cases in Cameron County

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The Texas Department of State Health Services and Cameron County Department of Health and Human Services have identified four additional cases of suspected locally transmitted Zika virus disease in Cameron County. The cases were identified as part of the follow up to the state’s first case of Zika likely transmitted by a mosquito in Texas, announced Nov. 28.

The additional patients live in very close proximity to the first case. Though the investigation is ongoing, the infections were likely acquired in that immediate area. They reported getting sick with Zika-like symptoms between Nov. 29 and Dec. 1 and were likely infected several days earlier before mosquito control efforts intensified in that part of Brownsville. None are pregnant women. Testing of people living in an eight-block area around the homes of the identified cases continues but has yet to show any additional evidence of Zika transmission in the rest of that larger area.

“These cases were found through careful public health work and collaboration at the local, state and federal levels,” said Dr. John Hellerstedt, DSHS commissioner, “and we’ll continue to follow through with the investigation and additional surveillance to identify other cases and other places experiencing local mosquito transmission of Zika. That information will be crucial to any future public health guidance.”

It’s also important that health care providers continue to be on the lookout for Zika and pursue testing pregnant women who have traveled to Mexico or other areas where Zika is spreading and testing anyone with symptoms compatible with Zika. More specific guidance for clinicians is available at www.texaszika.org/healthcareprof.htm.

Public health workers from Cameron County and DSHS’ regional office went door to door in the neighborhood last week to provide testing to look for other active Zika infections and educate residents about the illness and how to eliminate mosquito habitats. The education effort ultimately led to the detection of the four additional cases by prompting residents to recognize the symptoms of Zika and contact the health department for testing. Additionally, the City of Brownsville has been spraying for mosquitoes in the vicinity over the last two weeks and has seen a decrease in the number of mosquitoes in the area.

“The combination of mosquito control and colder weather has decreased mosquito activity in Cameron County and greatly decreased the probability of more widespread mosquito transmission of Zika right now,” said Dr. Hellerstedt.

“However, winters are mild in southern Texas, and mosquito populations can rebound even during short periods of warmer weather. Whenever you see mosquito activity, protect yourself and your family from bites.”

People can do that by

  • Using EPA-approved insect repellent.
  • Using air conditioning or window and door screens that are in good repair to keep mosquitoes out of homes.
  • Wearing long pants and long-sleeved shirts that cover exposed skin.
  • Removing standing water in and around homes year-round, including water in trash cans, toys, tires, flower pots and any other container that can hold water.

Prompted by the additional cases, the Texas Health and Human Services Commission is expanding the Medicaid benefit for mosquito repellent beyond Dec. 31 for residents of Cameron County. The benefit was recently brought back with news of the first Zika case likely transmitted locally and is in place statewide through Dec. 31. For Cameron County, the benefit will be in place indefinitely as state health officials collect more information about the scope of transmission in Texas.

Zika virus is transmitted to people primarily through the bite of an infected mosquito, though it can also spread by sexual contact. The four most common symptoms are fever, itchy rash, joint pain and eye redness. While symptoms are usually minor, Zika can also cause severe birth defects, including microcephaly, and other poor birth outcomes in some women infected during pregnancy. DSHS recommends pregnant women avoid traveling to locations with sustained, local Zika transmission, including Mexico. Pregnant women should also use condoms or avoid sexual contact with partners who have traveled to those areas. Travelers and the general public can find more information at TexasZika.org.

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(News Media Contact: Chris Van Deusen, DSHS Press Officer, 512-776-7753)

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Keywords: USA; Updates; Texas; Zika Virus.

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#MERS-CoV, #Saudi Arabia: Three New Cases reported in the last 24 hours (@SaudiMOH, Dec. 9 ‘16)

 

Title: MERS-CoV, Saudi Arabia: Three New Cases reported in the last 24 hours.

Subject: Middle East Respiratory Syndrome Coronavirus Epidemic in the Kingdom of Saudi Arabia, daily update.

Source: Saudi Arabia Ministry of Health, full page: (LINK).

Code: [     ]

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MOH: '3 New Confirmed Coronavirus Cases Recorded' Today

12/8/2016

_____

New Cases: [Sex, Age, Citizenship, Resident in, Health Status, Note]

  1. M, 53, foreign, Riyadh, critical; *
  2. M, 49, foreign, Jeddah, stable; *
  3. M, 60, Saudi, Mahayel Aseer, deceased; **

___

{*} Primary cases (contact with unspecified animal source);

{**} Primary case (contact with camels).

___

New Recoveries:

  • No reports

New Deaths: [Sex, Age, Citizenship, Resident in]

  1. M, 60, Saudi, Mohayel Aseer.

Cumulative number of confirmed cases and deaths since June 2012:

[Total No. of Cases – Total No. of Deaths – Patients under treatment]

  • 1505At least 622 - 18

___

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Keywords: MERS-CoV; Updates; Saudi Arabia.

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Highly pathogenic #avian #influenza #H5N8, #Hungary [twenty-seven #poultry #outbreaks] (#OIE, Dec. 9 ‘16)

 

Title: Highly pathogenic #avian #influenza #H5N8, #Hungary [twenty-seven #poultry #outbreaks].

Subject: Avian Influenza, H5N8 subtype, poultry epizootics in Hungary.

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic avian influenza H5N8, Hungary

Information received on 08/12/2016 from Dr Lajos Bognár, Deputy State Secretary Chief Veterinary Officer, Food Chain Safety Department, Ministry of Agriculture, Budapest, Hungary

  • Summary
    • Report type Follow-up report No. 5
    • Date of start of the event 01/11/2016
    • Date of confirmation of the event 03/11/2016
    • Report date 07/12/2016
    • Date submitted to OIE 08/12/2016
    • Reason for notification Reoccurrence of a listed disease
    • Date of previous occurrence 26/10/2016
    • Manifestation of disease Clinical disease
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N8
    • Nature of diagnosis Laboratory (advanced)
    • This event pertains to a defined zone within the country
    • Related reports
      • Immediate notification (04/11/2016) / Follow-up report No. 1 (14/11/2016) / Follow-up report No. 2 (15/11/2016) / Follow-up report No. 3 (22/11/2016) / Follow-up report No. 4 (06/12/2016) / Follow-up report No. 5 (07/12/2016)
  • New outbreaks (27)
    • Outbreak 1 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 21/11/2016
      • Outbreak status Resolved (29/11/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 3600 – … – … – … – …
          • Affected population Geese
    • Outbreak 2 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 21/11/2016
      • Outbreak status Resolved (29/11/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 3925 – … – … – … – …
          • Affected population Geese
    • Outbreak 3 - Szank, BACS-KISKUN
      • Date of start of the outbreak 22/11/2016
      • Outbreak status Resolved (01/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 11000 – … – … – … – …
          • Affected population Ducks
    • Outbreak 4 - Szank, BACS-KISKUN
      • Date of start of the outbreak 22/11/2016
      • Outbreak status Resolved (02/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 3600 – … – … – … – …
          • Affected population Geese
    • Outbreak 5 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 23/11/2016
      • Outbreak status Resolved (01/12/2016)
      • Epidemiological unit Backyard
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 350 – … – … – … – …
          • Affected population Geese
    • Outbreak 6 - Szank, BACS-KISKUN
      • Date of start of the outbreak 23/11/2016
      • Outbreak status Resolved (30/11/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 25000 – … – … – … – …
          • Affected population Ducks
    • Outbreak 7 - Kiskunmajsa, BACS-KISKUN
      • Date of start of the outbreak 24/11/2016
      • Outbreak status Resolved (03/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 10787 – … – … – … – …
          • Affected population Geese
    • Outbreak 8 - Kiskunmajsa, BACS-KISKUN
      • Date of start of the outbreak 24/11/2016
      • Outbreak status Resolved (28/11/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 9000 – … – 0 – 9000 – 0
          • Affected population Ducks
    • Outbreak 9 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 24/11/2016
      • Outbreak status Resolved (29/11/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 23000 – … – 0 – 23000 – 0
          • Affected population Geese
    • Outbreak 10 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 24/11/2016
      • Outbreak status Resolved (28/11/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 12000 – … – 0 – 12000 – 0
          • Affected population Ducks
    • Outbreak 11 - Bócsa, BACS-KISKUN
      • Date of start of the outbreak 24/11/2016
      • Outbreak status Resolved (02/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 20000  – … – … – … – …
          • Affected population Ducks
    • Outbreak 12 - Szank, BACS-KISKUN
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (01/12/2016)
      • Epidemiological unit Backyard
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 50 – … – … – … – …
    • Outbreak 13 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (02/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 10000 – … – 0 – 10000 – 0
          • Affected population Ducks
    • Outbreak 14 - Szank, BACS-KISKUN
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (03/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 1000 – … – 0 – 1000 – 0
          • Affected population Ducks
    • Outbreak 15 - Csólyospálos, BACS-KISKUN
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (03/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 11100 – … – … – … – …
          • Affected population Ducks
    • Outbreak 16 - Forráskút, CSONGRAD
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (05/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 7800 – … – … – … – …
          • Affected population Ducks
    • Outbreak 17 - Kiskunmajsa, BACS-KISKUN
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (04/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 8900 – … – … – … – …
          • Affected population Ducks
    • Outbreak 18 - Kömpöc, BACS-KISKUN
      • Date of start of the outbreak 25/11/2016
      • Outbreak status Resolved (05/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 10200 – … – … – … – …
          • Affected population Ducks
    • Outbreak 19 - Szank, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (06/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 680 – … – … – … – …
          • Affected population Geese
    • Outbreak 20 - Kiskunfélegyháza, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (03/12/2016)
      • Epidemiological unit Backyard
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 250 – … – … – … – …
          • Affected population Geese
    • Outbreak 21 - Csengele, CSONGRAD
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (04/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 5690 – … – … – … – …
          • Affected population Geese and ducks
    • Outbreak 22 - Petőfiszállás, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (02/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 4600 – … – … – … – …
          • Affected population Geese
    • Outbreak 23 - Kiskunfélegyháza, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (05/12/2016)
      • Epidemiological unit  Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 15000 – … – … – … – …
          • Affected population Ducks
    • Outbreak 24 - Móricgát, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (04/12/2016)
      • Epidemiological unit Backyard
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 190 – … – … – … – …
          • Affected population Geese
    • Outbreak 25 - Bócsa, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (06/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 7100 – … – 0 – 7100 – 0
          • Affected population Ducks
    • Outbreak 26 - Bócsa, BACS-KISKUN
      • Date of start of the outbreak 26/11/2016
      • Outbreak status Resolved (06/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 5840 – … – 0 – 5840 – 0
          • Affected population Ducks
    • Outbreak 27 - Bócsa, BACS-KISKUN
      • Date of start of the outbreak 27/11/2016
      • Outbreak status Resolved (05/12/2016)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 7000 – … – … – … – …
          • Affected population Ducks
    • Summary of outbreaks
      • Total outbreaks: 27
        • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
          • Birds – 217662 – ** – 0 – 67940 – 0
        • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
          • Birds – ** – ** – ** – **
            • *Removed from the susceptible population through death, destruction and/or slaughter
            • **Not calculated because of missing information
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
      • Fomites (humans, vehicles, feed, etc.)
      • Airborne spread
      • Contact with wild species
      • Control measures
  • Measures applied
    • Movement control inside the country
    • Disinfection / Disinfestation
    • Traceability
    • Stamping out
    • Official disposal of carcasses, by-products and waste
    • Surveillance within containment and/or protection zone
    • Zoning
    • Vaccination prohibited
    • No treatment of affected animals
  • Measures to be applied
    • No other measures
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Keywords: OIE; Updates; H5N8; Avian Influenza; Poultry; Hungary.

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Highly pathogenic #avian #influenza #H5N8, #France [four #poultry #outbreaks] (#OIE, Dec. 9 ‘16)

 

Title: Highly pathogenic #avian #influenza #H5N8, #France [four #poultry #outbreaks].

Subject: Avian Influenza, H5N8 subtype, poultry epizootics in France.

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic avian influenza H5N8, France

Information received on 08/12/2016 from Dr Loic Evain, Directeur Général adjoint, CVO, Direction générale de l'alimentation, Ministère de l'Agriculture, de l'Agroalimentaire et de la Forêt, Paris, France

  • Summary
    • Report type Follow-up report No. 3
    • Date of start of the event 25/11/2016
    • Date of confirmation of the event 01/12/2016
    • Report date 08/12/2016
    • Date submitted to OIE 08/12/2016
    • Reason for notification New strain of a listed disease
    • Manifestation of disease Clinical disease
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N8
    • Nature of diagnosis Clinical, Laboratory (advanced)
    • This event pertains to a defined zone within the country
    • Related reports
      • Immediate notification (02/12/2016) / Follow-up report No. 1 (02/12/2016) / Follow-up report No. 2 (05/12/2016) / Follow-up report No. 3 (08/12/2016)
  • New outbreaks (4)
    • Outbreak 1 (11) - Monestiés, Monestiés, TARN
      • Date of start of the outbreak 03/12/2016
      • Outbreak status Continuing (or date resolved not provided)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 1000 – … – 0 – 0 – 0
          • Affected population Samples taken within the frame of the epidemiological investigation, in a farm with 1000 ducks.
    • Outbreak 2 (12) - Monastiés, Monastiés, TARN
      • Date of start of the outbreak 04/12/2016
      • Outbreak status Continuing (or date resolved not provided)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 7000 – 50 – 50 – 0 – 0
          • Affected population: Mortality episode in a farm with 7000 chickens located within the protection zone around the Almayrac outbreak.
    • Outbreak 3 (9) - Monestiés, Monestiés, TARN
      • Date of start of the outbreak 04/12/2016
      • Outbreak status Continuing (or date resolved not provided)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 14900 – 250 – 150 – 0 – 0
          • Affected population: Clinical suspicion after a mortality episode among the 2500 ducks of a multiple-species farm, including also 12400 chickens (without clinical signs), located within the protection zone around the Almayrac outbreak. All the animals are going to be slaughtered and destroyed today (December 8th, 2016).
    • Outbreak 4 (10) - Mouzieys-Panens, Mouzieys-Panens, TARN
      • Date of start of the outbreak 04/12/2016
      • Outbreak status Continuing (or date resolved not provided)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds – 3010 – 20 – 10 – 0 – 0
          • Affected population: Mortality episode in a multiple-species farm located within the protection zone around the Almayrac outbreak. Farm headcount: - 40 ducks - 2000 chickens, including 20 sick and 5 dead - 70 geese - 900 capons, including 5 dead
    • Summary of outbreaks
      • Total outbreaks: 4
        • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
          • Birds – 25910 - 320 ** – 210 – 0 – 0
        • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
          • Birds – ** - 0.81% – ** - 0.81%
            • *Removed from the susceptible population through death, destruction and/or slaughter
            • **Not calculated because of missing information
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
      • Airborne spread
      • Contact with wild species
  • Epidemiological comments
    • A 3-km protection zone and a 10-km surveillance zone were implemented around the affected farms.
  • Control measures
    • Measures applied
      • Screening
      • Disinfection / Disinfestation
      • Traceability
      • Surveillance outside containment and/or protection zone
      • Stamping out
      • Official disposal of carcasses, by-products and waste
      • Surveillance within containment and/or protection zone
      • Zoning
      • Vaccination prohibited
      • No treatment of affected animals
    • Measures to be applied
      • No other measures
  • Diagnostic test results
    • Laboratory name and type – Species – Test - Test date – Result
      • ANSES National Reference Laboratory for avian influenza (National laboratory) – Birds - nucleotide sequencing - 07/12/2016 – Positive
      • ANSES National Reference Laboratory for avian influenza (National laboratory) – Birds - nucleotide sequencing - 08/12/2016 – Positive
      • ANSES National Reference Laboratory for avian influenza (National laboratory) – Birds - real-time reverse transcriptase/polymerase chain reaction (RRT-PCR) - 07/12/2016 – Positive
      • ANSES National Reference Laboratory for avian influenza (National laboratory) – Birds - real-time reverse transcriptase/polymerase chain reaction (RRT-PCR) - 08/12/2016 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Keywords: OIE; Updates; H5N8; Avian Influenza; Poultry; France.

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#Singapore, #Zika #Cases & #Clusters as of December 9 2016 (NEA, edited)

 

Title: #Singapore, #Zika #Cases & #Clusters as of December 9 2016.

Subject: Zika Virus, current epidemiological situation in Singapore.

Source: Singapore National Environment Agency (NEA), full page: (LINK).

Code: [     ]

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Zika Cases & Clusters as of December 9 2016

___

Number of Zika Cases

It is important to note that the day-to-day numbers fluctuate, as they depend on the number of cases notified each day. Therefore, weekly numbers are a better reflection of actual trends.

Number of Reported Cases

  • 03-Dec - 0
  • 04-Dec - 0
  • 05-Dec - 0
  • 06-Dec - 0
  • 07-Dec  - 0
  • 08-Dec - 0
  • 09-Dec at 3pm – 0

Number of Reported Cases by Epi-week (from Sun 0000hrs to Sat 2359hrs)

  • Epi-week 43 (23-29Oct16) - 12
  • Epi-week 44 (30Oct-05Nov16) - 4
  • Epi-week 45 (06-12Nov16)  - 4
  • Epi-week 46 (13-19Nov16)  - 3
  • Epi-week 47 (20-26Nov16) - 1
  • Epi-week 48 (27Nov-03Dec16) - 2
  • Epi-week 49 (04-09Dec16 at 3pm) - 0
    • Cumulative No. of cases for 2016 (First 48 weeks): 456

Compiled by Communicable Diseases Division, Ministry of Health

 

Location of Active Zika Clusters As of 09 Dec 2016

[S/N – Locality]

  1. Bedok Nth St 3 (Blk 542, 544, 545)
      • 7 cases as of 09 Dec 2016, of which 0 case with onset in the last 2 weeks.

___

For a list of clusters closed and under surveillance, please click here.

Last updated on 09 Dec 2016

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Keywords: Singapore; Zika Virus; Updates.

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Highly pathogenic #avian #influenza #H5N6, #HK (infected #birds #droppings) (#OIE, Dec. 9 ‘16)

 

Title: Highly pathogenic #avian #influenza #H5N6, #HK (infected #birds #droppings).

Subject: Avian Influenza, H5N6 subtype, environmental contamination from birds droppings.

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic avian influenza H5N6, Hong Kong (SAR - PRC)

Information received on 09/12/2016 from Dr Thomas Sit, Chief Veterinary Officer / Assistant Director (Inspection & Quarantine), Agriculture, Fisheries and Conservation Department, Hong Kong Special Administrative Region Government, Hong Kong , Hong Kong (SAR - PRC)

  • Summary
    • Report type Immediate notification
    • Date of start of the event 30/11/2016
    • Date of confirmation of the event 08/12/2016
    • Report date 09/12/2016
    • Date submitted to OIE 09/12/2016
    • Reason for notification Reoccurrence of a listed disease
    • Date of previous occurrence 25/11/2016
    • Manifestation of disease Sub-clinical infection
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N6
    • Nature of diagnosis Laboratory (advanced)
    • This event pertains to the whole country
  • New outbreaks
    • Summary of outbreaks
      • Total outbreaks: 1
        • Outbreak Location  - HONG KONG ( Mai Po, Yuen Long )
          • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
            • Avian species:bird (Unknown)  - … – 1  - 0  - 0  - 0
          • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality  rate - Apparent case fatality rate - Proportion susceptible animals lost* 
            • Avian species:bird (Unknown) – … – ** – ** - 0.00% – **
              • * Removed from the susceptible population through death, destruction and/or slaughter;
              • ** Not calculated because of missing information;
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
  • Epidemiological comments
    • An intensive surveillance system is in place for avian influenza virus including screening at Mai Po Nature Reserve in Hong Kong.
    • A faecal environmental sample was collected for the routine academic surveillance study by the University of Hong Kong on 30 November 2016 and subsequently tested positive for H5N6.
    • The location was the same as the three H5N6 positive samples collected on 25 November 2016.
  • Control measures
    • Measures applied
      • Screening
      • Vaccination permitted (if a vaccine exists)
      • No treatment of affected animals
    • Measures to be applied
      • No other measures
  • Diagnostic test results
    • Laboratory name and type - Centre of Influenza Research, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong ( Regional Reference Laboratory )
      • Tests and results: Species – Test - Test date – Result
        • Avian species - gene sequencing - 08/12/2016 – Positive
        • Avian species - virus isolation - 05/12/2016 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Keywords: OIE; Updates; H5N6; Avian Influenza; Wild Birds; HK PRC SAR.

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Weekly #US #Influenza #Surveillance #Report - 2016-17 Season, Wk 48 ending Dec. 3, ‘16 (@CDCgov, summary)

 

Title: Weekly #US #Influenza #Surveillance #Report - 2016-17 Season, Wk 48 ending Dec. 3, ‘16.

Subject: Seasonal Influenza, weekly US CDC activity surveillance report.

Source: US Centers for Disease Control and Prevention (CDC), FluView, full page: (LINK).

Code: [     ]

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Weekly U.S. Influenza Surveillance Report  - 2016-2017 Influenza Season Week 48 ending December 3, 2016

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|-- Full report also available as PDF –|

All data are preliminary and may change as more reports are received.

 

Synopsis:

  • During week 48 (November 27 - December 3, 2016), influenza activity increased slightly, but remained low in the United States.
    • Viral Surveillance:
      • The most frequently identified influenza virus subtype reported by public health laboratories during week 48 was influenza A (H3).
      • The percentage of respiratory specimens testing positive for influenza in clinical laboratories remained low.
    • Pneumonia and Influenza Mortality:
      • Due to data processing problems, the National Center for Health Statistics (NCHS) mortality surveillance data for the week ending November 19, 2016 (week 46) will not be published this week.
    • Influenza-associated Pediatric Deaths:
      • No influenza-associated pediatric deaths were reported.
    • Outpatient Illness Surveillance:
      • The proportion of outpatient visits for influenza-like illness (ILI) was 1.8%, which is below the national baseline of 2.2%.
      • Two regions reported ILI at or above their region-specific baseline levels.
      • Puerto Rico experienced high ILI activity, New York City and four states experienced low ILI activity, 46 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
    • Geographic Spread of Influenza:
      • The geographic spread of influenza in Puerto Rico was reported as widespread; Guam and two states were reported as regional; 19 states reported local activity; the U.S. Virgin Islands and 28 states reported sporadic activity; one state reported no activity; and the District of Columbia did not report.

 

National and Regional Summary of Select Surveillance Components

[HHS Surveillance Regions* - Data for current week: Out-patient ILI† - Number of jurisdictions reporting regional or widespread activity§ - % respiratory specimens positive for flu in clinical laboratories‡  – Data cumulative since October 2, 2016 (week 40): A(H1N1)pdm09 - A (H3) - A (Subtyping not Performed) - B Victoria lineage - B Yamagata lineage - B lineage not performed - Pediatric Deaths]

Influenza test results from public health laboratories only

  • Nation – Normal - 4 of 54 - 3.5% – 73 – 899 – 78 – 37 – 23 – 50 – 0
    • Region 1 – Normal - 0 of 6 - 1.9% – 0 – 41 – 0 – 0 – 0 – 0 – 0
    • Region 2 – Elevated - 1 of 4 - 2.0% – 0 – 70 – 2 – 16 – 4 – 3 – 0
    • Region 3 – Normal - 0 of 6 - 0.9% – 7 – 66 – 9 – 1 – 2 – 7 – 0
    • Region 4 – Elevated - 2 of 8 - 6.1% – 5 – 76 – 10 – 3 – 2 – 29 – 0
    • Region 5 – Normal - 0 of 6 - 1.4% – 3 – 68 – 41 – 7 – 4 – 2 – 0
    • Region 6 – Normal - 0 of 5 - 2.0% – 11 – 24 – 0 – 5 – 5 – 0 – 0
    • Region 7 – Normal - 0 of 4 - 1.6% – 0 -  22 – 1 – 2 – 0 – 0 – 0
    • Region 8 – Normal - 0 of 6 - 2.7% – 28 – 89 – 2 – 0 – 0 – 0 – 0
    • Region 9 – Normal - 1 of 5 - 3.0% – 18 – 241 – 11 – 1 – 6 – 5 – 0
    • Region 10 – Normal - 0 of 4 - 8.7% – 1 – 202 – 2 – 2 – 0 – 4 – 0

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{*} HHS regions (Region 1 CT, ME, MA, NH, RI, VT; Region 2: NJ, NY, Puerto Rico, US Virgin Islands; Region 3: DE, DC, MD, PA, VA, WV; Region 4: AL, FL, GA, KY, MS, NC, SC, TN; Region 5: IL, IN, MI, MN, OH, WI; Region 6: AR, LA, NM, OK, TX; Region 7: IA, KS, MO, NE; Region 8: CO, MT, ND, SD, UT, WY; Region 9: AZ, CA, Guam, HI, NV; and Region 10: AK, ID, OR, WA).

{†} Elevated means the % of visits for ILI is at or above the national or region-specific baseline

{§} Includes all 50 states, the District of Columbia, Guam, Puerto Rico, and U.S. Virgin Islands

{‡} National data are for current week; regional data are for the most recent three weeks

 

U.S. Virologic Surveillance

WHO and NREVSS collaborating laboratories, which include both public health and clinical laboratories located in all 50 states, Puerto Rico, and the District of Columbia, report to CDC the total number of respiratory specimens tested for influenza and the number positive for influenza by virus type. In addition, public health laboratories also report the influenza A subtype (H1 or H3) and influenza B lineage information for the viruses they test and the age or age group of the persons from whom the specimens were collected.

Additional data are available at http://gis.cdc.gov/grasp/fluview/fluportaldashboard.html and http://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html.

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The results of tests performed by clinical laboratories during the current week are summarized below.

[Week 48 - Data Cumulative since October 2, 2016 (Week 40)]

  • No. of specimens tested - 15,262 - 135,871
    • No. of positive specimens (%) - 535 (3.5%) - 3,087 (2.3%)
      • Positive specimens by type:
        • Influenza A - 390 (72.9%) - 2,052 (66.5%)
        • Influenza B - 145 (27.1%) - 1,035 (33.5%)

(…)

View National and Regional Level Graphs and Data

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The results of tests performed by public health laboratories, as well as the age group distribution of influenza positive tests, during the current week are summarized below.

[Week 48 - Data Cumulative since October 2, 2016 (Week 40)]

  • No. of specimens tested – 783 - 9,049
    • No. of positive specimens* – 154 - 1,160
      • Positive specimens by type/subtype:
        • Influenza A - 141 (91.6%) - 1,050 (90.5%)
          • A(H1N1)pmd09 - 6 (4.3%) - 73 (7.0%)
          • H3 - 112 (79.4%) - 899 (85.6%)
          • Subtyping not performed - 23 (16.3%) - 78 (7.4%)
        • Influenza B  - 13 (8.4%) - 110 (9.5%)
          • Yamagata lineage - 2 (15.4%) - 23 (20.9%)
          • Victoria lineage - 2 (15.4%) - 37 (33.6%)
          • Lineage not performed - 9 (69.2%) - 50 (45.5%)

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{*} The percent of specimens testing positive for influenza is not reported because public health laboratories often receive samples that have already tested positive for influenza at a clinical laboratory and therefore percent positive would not be a valid indicator of influenza activity. Additional information is available at http://www.cdc.gov/flu/weekly/overview.htm.

(…)

View National and Regional Level Graphs and Data

(…)

 

Antigenic Characterization

CDC has antigenically characterized 38 influenza viruses [8 influenza A (H1N1)pdm09, 16 influenza A (H3N2), and 14 influenza B viruses] collected by U.S. laboratories since October 1, 2016.

  • Influenza A Virus [24]
    • A (H1N1)pdm09 [8]:
      • All 8 (100%) influenza A (H1N1)pdm09 viruses were antigenically characterized using ferret post-infection antisera as A/California/7/2009-like, the influenza A (H1N1) component of the 2016-2017 Northern Hemisphere vaccine.
    • A (H3N2) [16]:
      • All 16 (100%) influenza A (H3N2) viruses were antigenically characterized as A/Hong Kong/4801/2014-like, a virus that belongs in genetic group 3C.2a and is the influenza A (H3N2) component of the 2016-2017 Northern Hemisphere vaccine, by HI testing or neutralization testing.
  • Influenza B Virus [14]
    • Victoria Lineage [6]:
      • 5 of 6 (83%) B/Victoria-lineage viruses were antigenically characterized using ferret post-infection antisera as B/Brisbane/60/2008-like, which is included as an influenza B component of the 2016-2017 Northern Hemisphere trivalent and quadrivalent influenza vaccines.
    • Yamagata Lineage [8]:
      • All 8 (100%) B/Yamagata-lineage viruses were antigenically characterized using ferret post-infection antisera as B/Phuket/3073/2013-like, which is included as an influenza B component of the 2016-2017 Northern Hemisphere quadrivalent influenza vaccines.

(…)

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Keywords: US CDC; USA; Updates; Seasonal Influenza.

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Preliminary #Report of #Microcephaly Potentially Associated with #Zika Virus #Infection During #Pregnancy — #Colombia, Jan–Nov. ‘16 (@CDCgov)

 

Title: Preliminary #Report of #Microcephaly Potentially Associated with #Zika Virus #Infection During #Pregnancy — #Colombia, Jan–Nov. ‘16.

Subject: Zika Virus Infection and Zika Congenital Syndrome, report.

Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK).

Code: [     ]

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Preliminary Report of Microcephaly Potentially Associated with Zika Virus Infection During Pregnancy — Colombia, January–November 2016

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Early Release / December 9, 2016 / 65

Format: [ PDF [859 KB] ]

Esther Liliana Cuevas, MS, MPH1; Van T. Tong, MPH2; Nathaly Rozo1; Diana Valencia, MS2; Oscar Pacheco, MD1; Suzanne M. Gilboa, PhD2; Marcela Mercado, MS1; Christina M. Renquist, MPH2; Maritza González, MD1; Elizabeth C. Ailes, PhD2; Carolina Duarte1; Valerie Godoshian, MPH2; Christina L. Sancken, MPH2; Angelica Maria Rico Turca1; Dinorah L. Calles, PhD2; Martha Ayala1; Paula Morgan, MPH2; Erika Natalia Tolosa Perez, MD1; Hernan Quijada Bonilla1; Ruben Caceres Gomez1; Ana Carolina Estupiñan3; Maria Luz Gunturiz1; Dana Meaney-Delman, MD2; Denise J. Jamieson, MD2; Margaret A. Honein, PhD2; Martha Lucia Ospina Martínez, MD1

 

Summary

  • What is already known about this topic?
    • Zika virus infection during pregnancy can cause microcephaly and serious brain abnormalities in fetuses and infants exposed in utero.
    • The Zika virus disease outbreak in the World Health Organization’s Region of the Americas began in Brazil, which first reported a laboratory-confirmed Zika virus outbreak in May 2015; Colombia confirmed local transmission of Zika virus about 5 months later, in October 2015.
    • Colombia’s Instituto Nacional de Salud maintains national surveillance for birth defects, including microcephaly.
  • What is added by this report?
    • This report provides preliminary national birth defects surveillance data on congenital microcephaly following a large outbreak of Zika virus infection in Colombia.
    • Microcephaly prevalence increased more than fourfold overall in 2016 compared with 2015, with a ninefold increase in July 2016 (the peak month) compared with July 2015.
    • The temporal association between Zika virus infections and microcephaly, with the peak of reported microcephaly occurring approximately 24 weeks after the peak of the Zika outbreak, provides evidence that the greatest risk period is likely the first trimester of pregnancy and early in the second trimester of pregnancy.
  • What are the implications for public health practice?
    • Colombia has experienced a significant increase in congenital microcephaly in 2016 following the peak of the Zika virus disease outbreak.
    • Ongoing population-based birth defects surveillance is essential for monitoring the impact of Zika virus infection during pregnancy on birth defects prevalence and measuring the success in preventing Zika virus infection and its consequences, including microcephaly.

 

Abstract

In Colombia, approximately 105,000 suspected cases of Zika virus disease (diagnosed based on clinical symptoms, regardless of laboratory confirmation) were reported during August 9, 2015–November 12, 2016, including nearly 20,000 in pregnant women (1,2). Zika virus infection during pregnancy is a known cause of microcephaly and serious congenital brain abnormalities and has been associated with other birth defects related to central nervous system damage (3). Colombia’s Instituto Nacional de Salud (INS) maintains national surveillance for birth defects, including microcephaly and other central nervous system defects. This report provides preliminary information on cases of congenital microcephaly identified in Colombia during epidemiologic weeks 5–45 (January 31–November 12) in 2016. During this period, 476 cases of microcephaly were reported, compared with 110 cases reported during the same period in 2015. The temporal association between reported Zika virus infections and the occurrence of microcephaly, with the peak number of reported microcephaly cases occurring approximately 24 weeks after the peak of the Zika virus disease outbreak, provides evidence suggesting that the period of highest risk is during the first trimester of pregnancy and early in the second trimester of pregnancy. Microcephaly prevalence increased more than fourfold overall during the study period, from 2.1 per 10,000 live births in 2015 to 9.6 in 2016. Ongoing population-based birth defects surveillance is essential for monitoring the impact of Zika virus infection during pregnancy on birth defects prevalence and measuring the success in preventing Zika virus infection and its consequences, including microcephaly.

INS maintains ongoing passive, national surveillance in Colombia for both symptomatic Zika virus disease and major birth defects. Surveillance for Zika virus disease based on clinical symptoms and laboratory testing started in August 2015 in Colombia, and following a cluster of laboratory-confirmed cases of Zika virus disease, immediate mandatory reporting began in October 2015.

At the time, symptomatic Zika virus disease was defined as illness with fever and at least one additional symptom (rash, nonpurulent conjunctivitis, headache, pruritus, arthralgia, myalgia, or malaise) of unknown etiology.

Beginning December 24, 2015, the case definition has included both fever and rash, and at least one of the other symptoms. Colombia’s birth defects surveillance system includes reporting of microcephaly (International Classification of Disease, 10th Revision code Q02) among live births and pregnancy losses (including spontaneous abortions, pregnancy terminations, and stillbirths) from all reporting areas.*

Congenital microcephaly in a newborn is defined as having a head circumference below the third percentile for gestational age and sex. The following clinical specimens are requested for all infants and fetuses with microcephaly to ascertain whether the mother was infected with Zika virus during pregnancy: maternal serum, infant serum from cord and peripheral blood specimens, cerebrospinal fluid (if obtained from infant for clinical reasons), and tissues from fetal losses.

Specimens are tested for Zika virus RNA by real-time reverse transcription–polymerase chain reaction (rRT-PCR), for serologic evidence of infection by Zika immunoglobulin M (IgM) antibody capture enzyme-linked immunosorbent assay (MAC-ELISA), or for Zika viral antigens by immunohistochemistry, as well as for the presence of other infections (syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and other agents); high resolution karyotyping is also performed. The Colombian Ministry of Health recommends a diagnostic algorithm for testing of specimens from all products of conception and infants whose mothers had Zika virus infection during pregnancy; however, these specimens are not always collected soon after birth or submitted for Zika virus testing.

Recommended neuroimaging includes cranial ultrasound for all infants, and if abnormalities are observed on cranial ultrasound then computed tomography scan or magnetic resonance imaging might be necessary. Microcephaly prevalence per 10,000 live births was calculated overall, by reporting area, and by month of pregnancy completion for epidemiologic weeks 5–45 in 2016. A prevalence ratio (PR) was calculated by dividing the prevalence in 2016 by the prevalence in 2015, and 95% confidence intervals (CIs) for the PR were calculated using Poisson regression.

The outbreak of Zika virus disease among pregnant women in Colombia peaked during epidemiologic week 4 in 2016. Reported cases of microcephaly peaked during epidemiologic week 28 in 2016 (24 weeks after the peak of reported cases of Zika virus disease) (Figure 1).

During epidemiologic weeks 5–45 in 2016, a total of 476 infants with microcephaly were reported in Colombia; 28 (85%) of the 33 reporting areas in Colombia reported at least one case of microcephaly (supplemental table https://stacks.cdc.gov/view/cdc/42918).

Overall, the prevalence of reported microcephaly was approximately 9.6 per 10,000 live births. Among areas reporting at least one case of microcephaly, the prevalence ranged from two per 10,000 live births (Nariño and Quindío) to 29 (Amazonas) (Figure 2). Microcephaly cases were reported in areas that include locations >2000 meters (6,562 feet) above sea level (e.g., Bogotá) without active Zika virus transmission; these cases, if Zika-related, likely resulted from travel-associated or sexually transmitted Zika virus infections.

The prevalence of microcephaly increased more than fourfold during epidemiologic weeks 5–45 in 2016 compared with the same period in 2015 (PR = 4.5) (Table). Peak prevalence of microcephaly was registered in July 2016, when the prevalence was ninefold higher than in July 2015 (PR = 9.0). In 2016, among all microcephaly cases, 432 (91%) occurred in live born infants, and 44 (9%) occurred among pregnancy losses; in 2015, among 110 reported cases of microcephaly, 90 (82%) occurred in live born infants, and 20 (18%) occurred among pregnancy losses.

Among the 476 infants and fetuses with microcephaly reported during epidemiologic weeks 5–45 in 2016, a total of 306 (64%) were tested for Zika virus infection; 147 (48%) had laboratory evidence of Zika virus infection by RT-PCR or immunohistochemistry on any placental, fetal, or infant specimen, and five of six tested had serologic evidence of infection by MAC-ELISA.

Among 121 infants tested for other pathogens, 26 (21%) had evidence of infection with other pathogens, including toxoplasmosis (15 infants), herpes simplex (six), cytomegalovirus (four) and syphilis (one); among these 26 infants, 17 (65%) had evidence of coinfection with Zika virus (14 of 15 with toxoplasmosis, two of six with herpes, and one of four with cytomegalovirus).

Neuroimaging results were available for 32% of all microcephaly cases. Among 476 infants or fetuses with microcephaly, mothers of 164 (34%) reported having symptoms compatible with Zika virus infection during pregnancy.

 

Discussion

Based on an average full term gestation, the 24-week period from the peak of the Zika virus outbreak to the peak in reported microcephaly occurrence suggests that the greatest risk for microcephaly is associated with Zika virus infection during the first trimester and early in the second trimester of pregnancy.

During epidemiologic weeks 5–45, there was more than a fourfold increase in reported microcephaly cases in Colombia in 2016, compared with the previous year. Although the microcephaly prevalence in 2016 among infants likely exposed to Zika virus in utero (9.6 per 10,000 live births) in Colombia was not much higher than the median of microcephaly prevalence (6.6 per 10,000 live births) reported by passive surveillance in 17 U.S. states during 2009–2013 (4), the comparison with 2015 Colombia data indicates the magnitude of the increase.

The Zika virus disease outbreak in the World Health Organization’s Region of the Americas began in Brazil, which first reported a laboratory-confirmed Zika virus outbreak in May 2015; Colombia confirmed local transmission of Zika virus about 5 months later, in October 2015.

In 2015, microcephaly prevalence in Brazil was 5.5 per 10,000 live births, representing an approximate ninefold increase over the average prevalence during the previous 14 years (5,6).

In Colombia, the relative increase has been smaller (fourfold); however, the baseline microcephaly prevalence was 2.1 per 10,000 live births in 2015, at least three times higher than Brazil’s reported baseline. There are several possible reasons for differences between the reported baseline microcephaly prevalences in Brazil and Colombia, as well as the differences in increases of microcephaly in the context of the Zika virus outbreaks in the two countries.

First, 50%–75% of the population of Colombia reside at altitudes above 2,000 meters, in areas without active, vectorborne Zika virus transmission (7). Second, microcephaly is a difficult birth defect to monitor because there are inconsistent definitions, obtaining accurate measurements is challenging, and terminology is inconsistent. Because of these challenges, prevalence estimates vary widely among countries and among surveillance systems within the United States (4). Third, the reports of microcephaly from Brazil might have served as an early warning. As evidence was emerging about the link between Zika virus infection and microcephaly, the Colombian Ministry of Health issued a recommendation in February 2016 advising women to consider delaying pregnancy for 6 months, which might have affected subsequent birth rates.§ The number of live births in Colombia during epidemiologic weeks 5–45 decreased by approximately 18,000 from 2015 to 2016.

The findings in this report are subject to at least four limitations. First, the report includes all cases of microcephaly and not just those linked to Zika virus. The majority of cases of microcephaly lacked laboratory confirmation of Zika virus infection. Possible explanations are that specimens were not submitted for all cases, specimens that were submitted were not collected within the recommended time frames (maternal serum specimens within 5 days of date of symptom onset for rRT-PCR testing and infant serum or fetal tissue specimens within 2 days of delivery), and neuroimaging studies were not available for the majority of patients (68%). Second, ascertainment of birth defects, including microcephaly, tends to be more complete among live born infants than among pregnancy losses, because of the condition of the fetus at the time of the loss as well as the relatively infrequent use of fetal autopsy to determine the cause of fetal death, leading to underestimation of the number of cases of microcephaly, especially among pregnancy losses (8).

In addition, because microcephaly is a rare outcome, prevalence ratios comparing 2016 and 2015 might be unstable and should be interpreted with caution. Third, passive reporting systems tend to have less complete ascertainment of all birth defects compared with active surveillance systems (9). Finally, the ascertainment of birth defects generally does not capture infants or fetuses whose birth defects are not apparent prenatally or at delivery, but rather are identified several months after birth. Certain critical outcomes, such as deceleration of brain growth among infants who are born with normal head circumferences, are not captured by this surveillance (10).

Colombia’s national population-based surveillance system for birth defects is based on passive reporting, which provides critical data for monitoring the impact of teratogens and describing trends but likely underestimates the actual prevalence of birth defects, including those defects associated with Zika virus infection during pregnancy. Also, Colombia’s Zika virus surveillance is based on clinical symptoms, and asymptomatic Zika virus infections are not monitored by surveillance. Therefore, the overall percentage of women who are infected with Zika virus, or infected in early pregnancy or during the periconceptional period is unknown.

To better understand the effects of Zika virus, INS and CDC are collaborating on “Proyecto Vigilancia de Embarazadas con Zika” (Enhanced Surveillance Project of Pregnant Women with Zika) to conduct intensified active monitoring in three cities in Colombia with high incidence of Zika virus disease in pregnant women. This project, which includes systematic collection of laboratory specimens for Zika virus testing, will provide more accurate estimates of the risk for microcephaly and other adverse birth outcomes among fetuses and infants of mothers with Zika virus disease during pregnancy.

In the absence of a vaccine to prevent Zika virus infection or a specific medication for treatment, prevention strategies include avoiding travel to areas with active Zika virus transmission, preventing mosquito bites through personal protection and vector control, and avoiding sexual transmission. Ongoing population-based birth defects surveillance provides critical data for monitoring the impact of teratogens, including Zika virus infection, and will be an essential tool to evaluate success in preventing microcephaly and congenital Zika syndrome.

 

Acknowledgments

Claudia Marcela Castro; Lina María Erazo Marquez; Esther Cristina Barros; Pablo Chaparro; Nubia Narváez; Greace Alejandra Avila Mellizo, María Eugenia Pinilla; Andrea Rodríguez Jiménez; Alexandra Caicedo; Luis Roa; Jorge Luis Díaz Moreno; Flavio Enrique Garzón Romero A; Javier Madero Reales; Eliana Barón Velasco; Karen Reyes Hernández; Luz Mary Velandia Nieto: Diana Marcela Walteros Acero; Ana Victoria Padilla; Alfonso Campo Carey; Ana Maria Blandon; Angelica Rojas Barcena; Diana Parra; Irene Alejandra; Javier Madero; Natalia Gutierrez; Nidia Gonzalez; Norma Constanza Cuellar Espita; Paloma Sanchez; Paula Ramirez; Sandra Misnaza; Sandra Rivera; Victor Martinez Gomez; Yurani Sanchez Rodriguez; Wendy Luz Gomez, Yuli Andrea Gamboa; Amparo Sabogal; Andrea Cristancho; Camilo Alfonso; Catalina Arias; Claudia Marcela Munóz; German Ernesto Torres; Ivonie Alayon; Julio Cesar Martinez; Katherine Jiménez Gamarra; Lilian Rodriguez; Luis Carlos Gómez; Patricia Salas; Teodolinda Vega; Vilma Izquierdo; Adriana Gomez Rubio; Clara Maestre Matos, Instituto Nacional de Salud, Bogotá, Colombia; Secretaries of Health from each of the departments, districts, and municipalities in Colombia.

Corresponding author: Margaret A. Honein, zikamch@cdc.gov, 770-488-7100.

1Instituto Nacional de Salud, Bogotá, Colombia; 2National Center on Birth Defects and Developmental Disabilities, CDC; 3Ministerio de Salud y Protección Social, Bogotá, Colombia.

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{*} http://www.ins.gov.co/lineas-de-accion/Subdireccion-Vigilancia/sivigila/Protocolos%20SIVIGILA/PRO%20Microcefalia.pdf.

{†} http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=36428&lang=en.

{§} https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/circular-0013-2016.pdf.

 

References

  1. Instituto Nacional de Salud. Epidemiological week 45 Bogota, Colombia 2016. http://www.ins.gov.co/boletin-epidemiologico/Paginas/default.aspx
  2. Pacheco O, Beltrán M, Nelson CA, et al. Zika virus disease in Colombia—preliminary report. N Engl J Med 2016. Epub June 15, 2016. CrossRef - PubMed
  3. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med 2016;374:1981–7. CrossRef - PubMed
  4. Cragan JD, Isenburg JL, Parker SE, et al. ; National Birth Defects Prevention Network. Population-based microcephaly surveillance in the United States, 2009 to 2013: an analysis of potential sources of variation. Birth Defects Res A Clin Mol Teratol 2016;106:972–82. CrossRef - PubMed
  5. Marinho F, Araújo VE, Porto DL, et al. Microcephaly in Brazil: prevalence and characterization of cases from the Information System on Live Births (Sinasc), 2000–2015. Epidemiol Serv Saude 2016;25:701–12. PubMed
  6. Kleber de Oliveira W, Cortez-Escalante J, De Oliveira WT, et al. Increase in reported prevalence of microcephaly in infants born to women living in areas with confirmed Zika virus transmission during the first trimester of pregnancy—Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65:242–7. CrossRef - PubMed
  7. Departamento Administrativo Nacional de Estadística. Nacimientos por área de ocurrencia y sexo, según grupos de edad de la madre 2016. http://www.dane.gov.co/
  8. Duke CW, Alverson CJ, Correa A. Fetal death certificates as a source of surveillance data for stillbirths with birth defects. Public Health Rep 2007;122:664–9. PubMed
  9. Anderka M, Mai CT, Romitti PA, et al. Development and implementation of the first national data quality standards for population-based birth defects surveillance programs in the United States. BMC Public Health 2015;15:925. CrossRef - PubMed
  10. van der Linden V, Pessoa A, Dobyns W, et al. Description of 13 infants born during October 2015–January 2016 with congenital Zika virus infection without microcephaly at birth—Brazil. MMWR Morb Mortal Wkly Rep 2016;65:1343–8. CrossRef

 

FIGURE 1. Date of symptom onset of reported cases of Zika virus disease among pregnant women* and date of birth of infants or of pregnancy loss for fetuses with reported microcephaly — Colombia, August 9, 2015 (epidemiologic week 32)–November 12, 2016 (week 45)

	The above figure is a line chart showing the date of symptom onset of reported cases of Zika virus disease among pregnant women and the date of birth of infants or of pregnancy loss for fetuses with reported microcephaly in Colombia during August 9, 2015–November 12, 2016.

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{*} Pregnant women with Zika virus disease include women with symptoms of Zika virus disease, regardless of laboratory confirmation; epidemiologic week was based on date of symptom onset. Immediate mandatory reporting of clinical symptoms of Zika virus disease with laboratory testing began in Colombia in October 2015. During October–December 23, 2015, symptomatic Zika virus disease was defined as fever and at least one additional symptom (rash, nonpurulent conjunctivitis, headache, pruritus, arthralgia, myalgia, or malaise). Beginning December 24, 2015, it was defined as fever and rash with at least one of the other symptoms.

{†} Congenital microcephaly in a newborn is defined as head circumference less than the third percentile, compared with the normal standard adjusted for gestational age and sex; epidemiologic week was based on the date of birth or pregnancy loss.

 

FIGURE 2. Prevalence of congenital microcephaly per 10,000 live births during epidemiologic weeks 5–45 (January 31–November 12), by reporting area — Colombia, 2016

	The above figure is a map of Colombia showing the number of cases of congenital microcephaly per 10,000 live births by reporting area during January 31–November 12 in 2016.

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TABLE. Reported cases of congenital microcephaly* during epidemiologic weeks 5–45 (January 31–November 12) — Colombia, 2015 and 2016

[Month pregnancy ended - No. of microcephaly cases reported: 2015 - 2016 - No. of live births: 2015 - 2016 -  Prevalence of microcephaly per 10,000 live births: 2015 - 2016 – Prevalence ratio, comparing 2016 to 2015, (95% CI)]

  • February – 4 – 12 - 48,384 - 50,367 - 0.8 - 2.4 - 2.9 (0.9–8.9)
  • March – 16 – 18 - 55,102 - 54,348 - 2.9 - 3.3 - 1.1 (0.6–2.2)
  • April – 16 – 36 - 52,535 - 52,612 - 3.0 - 6.8 - 2.2 (1.2–4.0)
  • May – 12 – 47 - 54,642 - 53,464 - 2.2 - 8.8 - 4.0 (2.1–7.5)
  • June – 11 – 75 - 53,929 - 51,748 - 2.0 - 14.5 - 7.1 (3.8–13.4)
  • July – 11 – 94 - 56,160 - 53,046 - 2.0 - 17.7 - 9.0 (4.8–16.9)
  • August – 15 – 71 - 55,290 - 55,709 - 2.7 - 12.7 - 4.7 (2.7–8.2)
  • September – 10 – 60 - 58,835 - 56,539 - 1.7 - 10.6 - 6.2 (3.2–12.2)
  • October† – 11 – 49 - 56,870 - 49,262 - 1.9 - 9.9 - 5.1 (2.7–9.9)
  • November§ – 4 – 14 - 24,317 - 21,193 - 1.6 - 6.6 - 4.0 (1.3–12.2)
    • Total – 110 – 476 - 516,064 - 498,288 - 2.1 - 9.6 - 4.5 (3.6–5.5)

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Abbreviation: CI = confidence interval.

{*} Congenital microcephaly in a newborn is defined as head circumference less than the third percentile, compared with the normal standard adjusted for gestational age and sex. Table includes pregnancies ending during this period, regardless of Zika virus testing or pregnancy outcome (i.e., live births and pregnancy losses [spontaneous abortions, pregnancy terminations, and stillbirths combined]).

{†} October 2016 birth data are preliminary.

} Number of cases of microcephaly and number of live births are for the period November 1–12 in both 2015 and 2016. November 1–12, 2016, birth data are preliminary.

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Suggested citation for this article: Cuevas EL, Tong VT, Rozo N, et al. Preliminary Report of Microcephaly Potentially Associated with Zika Virus Infection During Pregnancy — Colombia, January–November 2016. MMWR Morb Mortal Wkly Rep. ePub: 9 December 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm6549e1.

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Keywords: US CDC; Updates; Zika Virus; Zika Congenital Syndrome; Microcephaly; Colombia.

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#HK, CHP notified of #human case of #avian #influenza A(#H7N9) in #Guangdong, #China (Dec. 9 ‘16)

 

Title: #HK, CHP notified of #human case of #avian #influenza A(#H7N9) in #Guangdong, #China.

Subject: Avian Influenza, H7N9 subtype, human case in China Guangdong Province.

Source: Centre for Health Protection, Hong Kong PRC SAR, full page: (LINK).

Code: [     ]

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CHP notified of human case of avian influenza A(H7N9) in Guangdong

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The Centre for Health Protection (CHP) of the Department of Health (DH) today (December 9) received notification of an additional human case of avian influenza A(H7N9) from the Health and Family Planning Commission of Guangdong Province, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The male patient aged 81 from Meizhou is the first human case of H7N9 reported in Guangdong in this winter.

"Based on the seasonal pattern of avian influenza viruses, their activity in the Mainland is expected to increase in winter. The public should avoid contact with poultry, birds and their droppings and should not visit live poultry markets and farms to prevent avian influenza, particularly during travel in the upcoming Christmas and New Year holidays," a spokesman for the CHP said.

From 2013 to date, 778 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities.

"We will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments," the spokesman said.

The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

Travellers, especially those returning from avian influenza-affected areas with fever or respiratory symptoms, should immediately wear masks, seek medical attention and reveal their travel history to doctors. Healthcare professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas.

The public should remain vigilant and take heed of the advice against avian influenza below:

  • Do not visit live poultry markets and farms. Avoid contact with poultry, birds and their droppings;
  • If contact has been made, thoroughly wash hands with soap;
  • Avoid entering areas where poultry may be slaughtered and contact with surfaces which might be contaminated by droppings of poultry or other animals;
  • Poultry and eggs should be thoroughly cooked before eating;
  • Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment (including escalator handrails, elevator control panels and door knobs); and when hands are dirtied by respiratory secretions after coughing or sneezing;
  • Cover the nose and mouth while sneezing or coughing, hold the spit with a tissue and put it into a covered dustbin;
  • Avoid crowded places and contact with fever patients; and
  • Wear masks when respiratory symptoms develop or when taking care of fever patients.

The public may visit the CHP's pages for more information:

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Ends/Friday, December 9, 2016 / Issued at HKT 10:32 / NNNN

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Keywords: HK PRC SAR; Updates; China; Guangdong; Avian Influenza; H7N9; Human.

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#USA, #Florida: Department of Health Daily #Zika #Update (December 8 2016)

 

Title: #USA, #Florida: Department of Health Daily #Zika #Update.

Subject: Zika Virus, current epidemiological situation in Florida.

Source: US State of Florida Department of Health, full page: (LINK).

Code: [     ]

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Department of Health Daily Zika Update

By Florida Department of Health, Office of Communications / December 08, 2016 / Press Release / Contact: Communications Office, NewsMedia@flhealth.gov - (850) 245-4111

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Tallahassee, Fla.

In an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, the department will issue a Zika virus update each week day. Updates will include a Zika case count by county and information to keep Floridians informed and prepared.

In order to keep the public informed, the department has posted our investigation process here.

There are eight new travel-related cases today with four in Orange, one in Broward, one in Miami-Dade, one in Hillsborough and one in Osceola counties.

There no new locally acquired cases today.

The total number of Zika cases reported in Florida as of today is 1,244.

 

[Infection Type - Infection Count]

  • Travel-Related Infections of Zika – 980
  • Locally Acquired Infections of Zika – 249
  • Undetermined – 15
  • Pregnant Women with Lab-Evidence of Zika – 185
    • Note: these categories are not mutually exclusive and cannot be added together.

Please visit our website to see the full list of travel-related cases by county.

(…)

The department is currently conducting 11 active investigations. The department has closed 41 investigations. Information regarding the investigations can be found here. If investigations reveal additional areas of active transmission, the department will announce a defined area of concern. 

The department has conducted Zika virus testing for more than 10,896 people statewide. Florida currently has the capacity to test 6,242 people for active Zika virus and 5,606 for Zika antibodies. At Governor Scott’s direction, all county health departments now offer free Zika risk assessment and testing to pregnant women.

(…)

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Keywords: USA; Updates; Zika Virus; Florida.

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