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#WHO #statement on the 3rd #meeting of the #IHR(2005) #EC on #Zika virus and related #complications (@WHO, June 14 2016)

  Title : #WHO #statement on the 3rd #meeting of the #IHR(2005) #EC on #Zika virus and related #complications. Subject : Zika Virus Diseas...

1 Jul 2016

#USA, #Florida: DoH Daily #Zika #Update: 10 New #Travel-Related Cases (July 1 2016)

 

Title: #USA, #Florida: DoH Daily #Zika #Update: 10 New #Travel-Related Cases.

Subject: Zika Virus, US State of Florida daily epidemiological update.

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

Code: [     ]

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Department of Health Daily Zika Update: 10 New Travel-Related Cases

By Florida Department of Health, Office of Communications / July 01, 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 Florida Department of Health will issue a Zika virus update each week day at 2 p.m. Updates will include a CDC-confirmed Zika case count by county and information to better keep Floridians prepared.

There are 10 new travel-related cases with two in Pasco, two in Polk, one in Charlotte, one in Citrus, one in Miami-Dade, one in Orange counties and two involving pregnant women.

The Declaration of Public Health Emergency has been amended to include Charlotte County

Of the cases confirmed in Florida, 25 are still exhibiting symptoms. According to CDC, symptoms associated with the Zika virus last between seven to 10 days.

CDC recommends that women who are pregnant or thinking of becoming pregnant postpone travel to Zika affected areas.

According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika affected area for the virus.

CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds.

Florida has been monitoring pregnant women with evidence of Zika regardless of symptoms since January.

The total number of pregnant women who have been monitored is 43, with 12 having met the previous CDC case definition.

The Council of State and Territorial Epidemiologists and CDC released a new case definition for Zika that now includes reporting both asymptomatic and symptomatic cases of Zika. Prior to this change, states reported only symptomatic non-pregnant cases and pregnant cases regardless of symptoms. This change comes as a result of increased availability for testing in commercial laboratories.

 

[County - Number of Cases (all travel related)]

  1. Alachua  - 4
  2. Brevard – 4
  3. Broward – 33
  4. Charlotte – 1
  5. Citrus – 2
  6. Clay – 2
  7. Collier – 3
  8. Duval – 3
  9. Escambia – 1
  10. Highlands – 1
  11. Hillsborough – 5
  12. Lee – 5
  13. Martin – 1
  14. Miami-Dade – 69
  15. Okaloosa – 1
  16. Orange – 18
  17. Osceola – 9
  18. Palm Beach – 12
  19. Pasco – 4
  20. Pinellas – 6
  21. Polk – 6
  22. Santa Rosa – 1
  23. Seminole – 8
  24. St. Johns – 2
  25. Volusia – 2
  • Total cases not involving pregnant women – 203
    • Cases involving pregnant women regardless of symptoms* – 43

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*Counties of pregnant women will not be shared.

(…)

All cases are travel-associated. There have been no locally-acquired cases of Zika in Florida. For more information on the Zika virus, click here.

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Keywords: USA; Updates; Zika Virus; Florida.

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#USA, #Texas: Reported #Zika Virus Cases – July 1, 2016 (DoH, edited)

 

Title: #USA, #Texas: Reported #Zika Virus Cases – July 1, 2016.

Subject: Zika Virus, US State of Texas daily epidemiological update.

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

Code: [     ]

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Reported Zika Virus Cases – July 1, 2016

Texas has had 50 reported cases of Zika virus disease.

Of those, 49 were in travelers who were infected abroad and diagnosed after they returned home; one of those travelers was a pregnant woman. One case involved a Dallas County resident who had sexual contact with someone who acquired the Zika infection while traveling abroad.

 

Texas Zika Cases by County:

[County  - Cases]

  1. Bexar  - 6
  2. Collin  - 2
  3. Dallas  - 10
  4. Denton  - 2
  5. Ellis  - 1
  6. Fort Bend  - 2
  7. Grayson  - 1
  8. Hamilton  - 1
  9. Harris  - 13
  10. Lubbock  - 1
  11. Medina  - 1
  12. Tarrant  - 5
  13. Travis  - 2
  14. Val Verde  - 1
  15. Williamson  - 1
  16. Wise  - 1
    • Total – 50

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Note: Zika case data for Texas will be updated each weekday no later than 11 a.m.

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Keywords: USA; Updates; Zika Virus; Texas.

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#USA, #Wisconsin & #Minnesota reported two cases of #H1N2v #swine-origin #flu virus #infection (@CDCgov, July 1 2016)

 

Title: #USA, #Wisconsin & #Minnesota reported two cases of #H1N2v #swine-origin #flu virus #infection.

Subject: Influenza A virus H1N2v variant of swine origin, two human infection in the US.

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

Code: [     ]

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Novel Influenza A Viruses

Two human infections with novel influenza A viruses were reported to CDC during week 25.

One human infection with a novel influenza A virus was reported by the state of Wisconsin.

The person was infected with an influenza A (H1N2) variant (H1N2)v virus.

The patient was hospitalized as a result of their illness, and continues to recover.

Direct contact with swine in the week preceding illness onset was reported.

No ongoing community transmission has been detected.

One human infection with a novel influenza A virus was reported by the state of Minnesota.

In April 2016, the person was infected with an H1N2v virus.

The patient was not hospitalized and has fully recovered from their illness.

No human-to-human transmission has been identified and the case reported close contact with swine in the week prior to illness onset.

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be more fully appreciated and appropriate public health measures can be taken.

Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.

(…)

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Keywords: USA; US CDC; Updates; Swine Influenza; H1N2v; Human; Minnesota; Wisconsin.

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#USA, #Texas Strengthens #Zika #Efforts as #Threat Persists. Statewide #Summit Set for July 6 in Valley. (DoH, July 1 2016)

 

Title: #USA, #Texas Strengthens #Zika #Efforts as #Threat Persists. Statewide #Summit Set for July 6 in Valley.

Subject: Zika Virus, US State of Texas epidemic preparedness.

Source: US State of Texas Department of Health, more info: (LINK).

Code: [     ]

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Texas Department of State Health Services / July 1, 2016 / DSHS News Release

Texas Strengthens Zika Efforts as Threat Persists. Statewide Summit Set for July 6 in Valley.

With mosquito season in full force, Texas continues to ramp up and expand its efforts to prevent or delay local Zika transmission by mosquito bites.

As part of those efforts, Texas is convening a statewide Zika summit in McAllen to bring together public health and other local leaders to sharpen response plans and exercise for the possibility of local transmission of the Zika virus by mosquitoes.

The daylong workshop, formally called the State of Texas Active Response to Zika (STARZ) Conference, will be Wednesday, July 6, at the McAllen Convention Center, 700 Convention Center Blvd., McAllen.

Reporters are invited to participate in a press conference and media availability from 9 to 10 a.m. at the summit. Key participants will be available for interviews until 10 a.m.

“It’s a chance for us to sit down together to coordinate our plans in detail and exercise our actions before Zika is really here,” said Dr. John Hellerstedt, Texas Department of State Health Services commissioner.

“We expect to see some level of local transmission in the state, and Texas is at the forefront and ready.”

The event will include speakers addressing the state’s response plan, public outreach, surveillance and epidemiology. The central element of the event will be two tabletop exercises in which leaders walk through and discuss how they would handle both the first confirmed local transmission of Zika in their jurisdictions and also sustained local transmission.

The event is hosted in partnership between DSHS, the Texas Association of City and County Health Officials, Hidalgo County Health and Human Services, and the City of McAllen. Attendees will include representatives from public health, emergency management, blood banks and other community leaders involved in Zika response.

Texas has made significant progress in its efforts to delay and minimize the impact of Zika on the state. While local transmission in Texas remains likely, public health officials do not expect widespread transmission across large geographic areas of the state.

Small pockets of cases in limited clusters are more likely.

This assessment is based on the state’s past experience with dengue, a similar virus spread by the same mosquitoes, and on the prevalent use of window screens, air conditioning, insect repellent and other mosquito control efforts in Texas.

Here are highlights of some of the latest state public health efforts:

  • Texas Zika Response Plan.
    • The Zika Virus Preparedness and Response Plan has been posted to www.TexasZika.org under the Zika Response tab and describes what actions DSHS will take to successfully respond to Zika.
    • It follows a phased approach and includes specific response activities for local transmission.
    • The plan will continue to be practiced and improved as new information becomes available.
  • Campaign.
    • Texas has boosted its Zika public outreach campaign by $500,000, making it a $2.5 million campaign that will continue through the summer and will now include grassroots outreach in addition to educational materials, advertising, radio and news media.
    • The website www.TexasZika.org launched in February and continues to be the anchor for the campaign and the source of official Texas public health information about Zika.
    • More than 50,000 people visited the site in June.
  • Testing.
    • DSHS has approved testing of specimens from more than 900 patients for Zika virus by the DSHS laboratory and the Centers for Disease Control and Prevention.
    • Other labs across the state now have the ability to test for Zika.
    • DSHS is also working to add the more complex serologic testing for human specimens to detect Zika infection in people who may not have had symptoms.
    • Texas also now has the capability to test mosquito specimens for Zika as warranted for identified high-risk areas.
  • Surveillance.
    • Texas has had 50 cases of Zika virus disease, including one confirmed case of Zika in a pregnant woman.
    • All are related to travel abroad to areas with active Zika transmission.
    • In addition, there have been 28 pregnant Texas residents with laboratory evidence of Zika infection but did not meet the case definition.
    • Texas provides this data weekly to the CDC’s Pregnancy Registry.
  • Pregnant Women.
    • With its link to microcephaly, Zika poses a serious threat to unborn children. DSHS is working to educate women and families about how to protect themselves through its Women, Infants and Children (WIC) program and via healthcare providers.
    • The Texas WIC program is seeking to distribute Zika prevention materials, including mosquito repellent, through its breastfeeding promotion kits.
    • DSHS is working closely with other state agencies to emphasize precaution information to their specific audiences, such as schools, daycares and women’s health programs.

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“With the central goal of protecting unborn babies from Zika, we’re doing everything we can to make sure everyone knows how to prevent it,” said Dr. Hellerstedt.

“If local transmission is suspected, our response will be fast and geared toward identifying actual risk and protecting Texans.”

With the upcoming holiday weekend and other summer activities, state health officials urge everyone to follow precautions to protect themselves from mosquito bites:

  • Apply EPA-approved insect repellent.
  • Wear pants and long-sleeve shirts that cover exposed skin. In warmer weather, wear lightweight, loose-fitting clothing that covers exposed skin.
  • Use screens or close windows and doors to keep mosquitoes out of your home.
  • Remove standing water in and around the home. This includes water in cans, toys, tires, plant saucers, and any container that can hold water.
  • Cover trash cans or containers where water can collect.

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(News Media Contact: Carrie Williams, 512-776-7119, carrie.williams@dshs.state.tx.us)

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Keywords: USA; Updates; Texas; Zika Virus.

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Preliminary #Outbreak #Assessment: #H5 #Avian #Influenza of high pathogenicity in #wildbirds in #Russia (#DEFRA, July 1 2016)

 

Title: Preliminary #Outbreak #Assessment: #H5 #Avian #Influenza of high pathogenicity in #wildbirds in #Russia.

Subject: Avian Influenza, H5N1 subtype, detection of infected wild birds in Russia.

Source: United Kingdom Department for Environment, Food and Rural Affairs (DEFRA), full PDF file: (LINK).

Code: [     ]

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Department for Environment, Food and Rural Affairs / Animal & Plant Health Agency Veterinary & Science Policy Advice Team - International Disease Monitoring

Preliminary Outbreak Assessment: H5 Avian Influenza of high pathogenicity in wild birds in Russia

27th June 2016 / Ref: VITT/1200 HPAI in Russia

 

Disease Report

The Russian Authorities have detected H5 HPAI infection in several species of wild bird in Tuva Republic region, on the border with Mongolia (OIE, 2016; see map).

According to the disease report, the following birds tested positive during active surveillance around UbsuNur lake: Grey Heron (Ardea cinerea), Great Crested Grebe (Podiceps cristatus), Blackheaded gull (Larus ridibundus), Common Tern (Sterna hirundo), Great Cormorant (Phalacrocorax carbo) and unidentified dabbling ducks (Anatidae). 

All 17 carcases were positive for the H5 viruses of the 2.3.4.4 clade. 

 

Situation Assessment

The map below shows the global situation and the regions covered by the various wild bird migration flyways.

As can be seen, the current wild bird incident lies within two flyways and is located close to a third flyway with overlap into the EU.

The bird migration season can start as early as August, for example, Pochards (Aythya ferina) are often some of the first birds to arrive in the UK in September, originating from the breeding grounds in Russia (Delaney et al. 2005).    

Although this is the first report for several months of avian influenza H5N1 in wild birds, other strains are reported in South East Asia and further afield in a variety of wild and captive birds, and we should remain vigilant of potential for contact between wild birds and poultry being a significant risk for the incursion of any notifiable avian disease.

 

Conclusion

We will continue to monitor the situation closely.

We would like to remind all poultry keepers to maintain high standards of biosecurity, remain vigilant and report any suspect clinical signs promptly and in addition using the testing to exclude scheme for avian notifiable disease where appropriate for early safeguard.

For more information, please see www.defra.gov.uk/ahvla-en/disease-control/nad   

The risk level for the UK remains at low, but heightened. 

 

Authors

Professor Ian Brown, Dr Helen Roberts 

 

References

  1. Delany, S., Veen, J. & Clark, J.A. (eds) 2006. Urgent preliminary assessment of ornithological data relevant to the spread of Avian Influenza in Europe. Report to the European Commission. Study contract: 07010401/2005/425926/MAR/B4. Authors: Atkinson, P.W., Clark, J.A., Delany, S., Diagana, C.H., du Feu, C., Fiedler, W., Fransson, T., Gaulthier-Clerc, M., Grantham, M.J., Gschweng, M., Hagemeijer, W., Helmink, T., Johnson, A., Khomenko, S., Martakis, G., Overdijk, O., Robinson, R.A., Solokha, A., Spina, F., Sylla, S.I., Veen, J. & Visser, D. http://ec.europa.eu/environment/nature/nature_conservation/focus_wild_birds/avian_influenza/index_en.htm 
  2. OIE (2016) Highly Pathogenic Avian Influenza, Russia. Date submitted to OIE, 17/06/2016 http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review?page_refer=MapFull EventReport&reportid=20335    

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© Crown copyright 2016

You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v.2. To view this licence visit www.nationalarchives.gov.uk/doc/open-government-licence/version/2/ or email PSI@nationalarchives.gsi.gov.uk  

This publication is available at https://www.gov.uk/government/collections/animaldiseases-international-monitoring 

Any enquiries regarding this publication should be sent to us at  iadm@apha.gsi.gov.uk

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Keywords: UK; Updates; Wild Birds; Russia; Avian Influenza; H5N1.

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#Human #infection with #avian #influenza A(#H7N9) virus – #China (@WHO, July 1 2016)

 

Title: #Human #infection with #avian #influenza A(#H7N9) virus – #China.

Subject: Avian Influenza, H7N9 subtype, human cases in China.

Source: World Health Organization, full page: (LINK).

Code: [     ]

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Human infection with avian influenza A(H7N9) virus – China

Disease outbreak news  / 1 July 2016

On 15 June 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 5 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus, including 1 death.

Onset dates range from 7 May to 22 May.

The cases range in age from 45 to 63 years, with a median age of 53 years.

Of these 5 cases, 4 (80%) are male.

The majority (4 cases, 80%) reported exposure to live poultry, slaughtered poultry or live poultry markets.

No human to human transmission was reported.

Cases were reported from 4 provinces: Jiangsu (2), Beijing (1), Hebei (1) and Jiangxi (1).

 

Public health response

The Chinese Government has taken the following surveillance and control measures:

  • strengthening outbreak surveillance and situation analysis;
  • reinforcing all efforts on medical treatment; and
  • conducting risk communication with the public and dissemination of information.

 

WHO risk assessment

Most human cases are exposed to the A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, further human cases can be expected. Although small clusters of human cases with influenza A(H7N9) viruses have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore, community level spread of this virus is considered unlikely for the time being.

Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and/or its transmission behaviour to humans as it may have a serious public health impact.

 

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

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Keywords: WHO; Updates; H7N9; Avian Influenza; Human; China; Beijing; Jiangsu; Jiangxi; Hebei.

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Highly pathogenic #avian #influenza #H5N6, #Vietnam [one new #poultry #outbreak] (#OIE, July 1 2016, edited)

 

Title: Highly pathogenic #avian #influenza #H5N6, #Vietnam [one new #poultry #outbreak].

Subject: Avian Influenza, H5N6 subtype, epizootic in poultry, VN.

Source: OIE, full page: (LINK).

Code: [     ]

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Highly pathogenic avian influenza H5N6, Vietnam

Information received on 01/07/2016 from Dr Dong Pham Van, Director General, Chief Veterinary Officer, Department of Animal Health, Ministry of Agriculture and Rural Development, Hanoï, Vietnam

  • Summary
    • Report type Immediate notification
    • Date of start of the event 10/06/2016
    • Date of confirmation of the event 18/06/2016
    • Report date 01/07/2016
    • Date submitted to OIE 01/07/2016
    • Reason for notification Reoccurrence of a listed disease
    • Date of previous occurrence 11/03/2016
    • Manifestation of disease Clinical disease
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N6
    • Nature of diagnosis Clinical, Laboratory (advanced)
    • This event pertains to a defined zone within the country
  • New outbreaks
    • Summary of outbreaks
      • Total outbreaks: 1
        • Outbreak Location - QUANG NGAI ( Trung Son, Tinh Hoa, Quang Ngai city )
          • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
            • Birds  - 3700  - 700  - 700  - 3000  - 0
          • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
            • Birds - 18.92% - 18.92% - 100.00% - 100.00%
            • * Removed from the susceptible population through death, destruction and/or slaughter;
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
  • Control measures
    • Measures applied
      • Vaccination in response to the outbreak (s)
      • Disinfection / Disinfestation
      • Surveillance outside containment and/or protection zone
      • Stamping out
      • Surveillance within containment and/or protection zone
      • No treatment of affected animals
    • Measures to be applied
      • No other measures
  • Diagnostic test results
    • Laboratory name and type - Regional Animal Health Office (RAHO4) ( Regional Laboratory )
      • Tests and results: Species – Test - Test date – Result
        • Birds - real-time reverse transcriptase/polymerase chain reaction (RRT-PCR) - 18/06/2016 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Keywords: OIE; Updates; H5N6; Avian Influenza; Poultry; Vietnam.

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#Influenza and other #Respiratory #Viruses #Research #References #Library–July 1 2016 Issue

 

Title: #Influenza and other #Respiratory #Viruses #Research #References #Library–July 1 2016 Issue

Subject: Human and Animal Influenza Viruses, other Respiratory Pathogens Research, weekly references library update.

Source: AMEDEO, homepage: (LINK).

Code: [  R  ]

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This Week’s References:

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  1. CHOI MS, Heo J, Yi CM, Ban J, et al.
    • A novel p38 mitogen activated protein kinase (MAPK) specific inhibitor suppresses respiratory syncytial virus and influenza A virus replication by inhibiting virus-induced p38 MAPK activation.
  2. FLEMING DM, Durnall H, Warburton F, Ellis JS, et al.
  3. ZHANG Y, Tang J, Yang N, Liu Q, et al.
  4. JEGASKANDA S, Luke C, Hickman HD, Sangster MY, et al.
    • The generation and protective ability of influenza-specific antibody-dependent cellular cytotoxicity in humans elicited by vaccination, natural infection or experimental challenge.
  5. ARUNORAT J, Charoenvisal N, Woonwong Y, Kedkovid R, et al.
    • Determination of current reference viruses for serological study of swine influenza viruses after the introduction of pandemic 2009 H1N1 (pdmH1N1) in Thailand.
  6. KEMMEREN J, Honsbeek M, Dijkstra F, de Lange M, et al.
    • Comparison of different collection methods for reported adverse events following pandemic and seasonal influenza vaccination.
  7. GORDON DL, Sajkov D, Honda-Okubo Y, Wilks SH, et al.
    • Human Phase 1 trial of low-dose inactivated seasonal influenza vaccine formulated with Advax delta inulin adjuvant.

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Keywords: Research; Abstracts; Influenza References Library.

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#WestNile #fever–#Situation #update: 30 June 2016 (@ECDC_EU, July 1 2016)

 

Title: #WestNile #fever–#Situation #update: 30 June 2016.

Subject: West Nile Virus activity across Europe, weekly update.

Source: European Centre for Disease Control and Prevention (CDC), full page: (LINK).

Code: [     ]

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West Nile fever - Situation update: 30 June 2016

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As of 30 June 2016, no cases of West Nile fever in humans have been reported in the EU Member States and six cases in the neighbouring countries, since the beginning of the 2016 transmission season.

During the past week, no cases were reported in the EU Member States and neighbouring countries.

 

High resolution maps

|-- Reported cases of West Nile fever, transmission season 2016: updated 30.06.2016 –|

|-- Reported cases of West Nile fever, transmission season 2016 and previous transmission seasons: updated 30.06.2016 –|

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- See more at: http://ecdc.europa.eu/en/healthtopics/west_nile_fever/West-Nile-fever-maps/Pages/index.aspx#sthash.14VGx86R.dpuf

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Keywords: ECDC; Updates; European Region; West Nile Virus.

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#MERS-CoV, #Saudi Arabia: No new cases reported in the last 24 hours (@SaudiMOH, July 1 2016, edited)

 

Title: MERS-CoV, Saudi Arabia: No new cases reported in the last 24 hours.

Subject: MERS 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: 'No New Corona Cases Recorded

7/1/2016

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New Cases:

  • No reports

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

  1. M, 48, Saudi, Taif;
  2. F, 27, Saudi, Riyadh.

New Deaths:

  • No reports

Cumulative number of confirmed cases and deaths since June 2012:

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

  • 1413At least 598 - 16

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(…)

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Keywords: Saudi Arabia; Updates; MERS-CoV.

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