28 Jan 2015

#Antibodies to #Antigenic #Site A of #Influenza H7 #Hemagglutinin Provide #Protection against #H7N9 Challenge (PLoS One, abstract, edited)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

Open Access / Peer-reviewed / Research Article

Antibodies to Antigenic Site A of Influenza H7 Hemagglutinin Provide Protection against H7N9 Challenge [      ]

Falko Schmeisser, Anupama Vasudevan, Swati Verma, Wei Wang, Esmeralda Alvarado, Carol Weiss, Vajini Atukorale, Clement Meseda, Jerry P. Weir

Published: January 28, 2015  / DOI: 10.1371/journal.pone.0117108

 

Abstract

Identifying major antigenic and protective epitopes of the H7 hemagglutinin (HA) will be important for understanding the antibody response to vaccines developed against the novel influenza H7N9 viruses that emerged in China in 2013. To facilitate antigenic characterization of the H7N9 HA and to develop reagents for evaluation of H7N9 candidate vaccines, we generated a panel of murine monoclonal antibodies (mAbs) to the HA of A/Shanghai/2/2013 using mammalian cell-derived virus-like particles (VLP) containing the H7 HA. Neutralizing antibodies identified an HA epitope corresponding to antigenic site A on the structurally similar influenza H3 hemagglutinin. Importantly, the neutralizing antibodies protect against A/Shanghai/2/2013 challenge. This antigenic site is conserved among many H7 viruses, including strains of both Eurasian and North American lineage, and the isolated neutralizing antibodies are cross-reactive with older H7 vaccine strains. The results indicate that the identified antigenic site is a potentially important protective epitope and suggest the potential benefit of cross-reactive antibody responses to vaccination with H7 candidate vaccines.

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Citation:Schmeisser F, Vasudevan A, Verma S, Wang W, Alvarado E, et al. (2015) Antibodies to Antigenic Site A of Influenza H7 Hemagglutinin Provide Protection against H7N9 Challenge. PLoS ONE 10(1): e0117108. doi:10.1371/journal.pone.0117108

Academic Editor: Florian Krammer, Icahn School of Medicine at Mount Sinai, UNITED STATES

Received: October 10, 2014; Accepted: December 19, 2014; Published: January 28, 2015

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication

Data Availability:All relevant data are within the paper.

Funding:This work was supported by the U.S. Food and Drug Administration and by the Biomedical Advanced Research and Development Authority, Department of Health and Human Services. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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Oral #Priming with Replicating #Adenovirus Serotype 4 Followed by Subunit #H5N1 #Vaccine Boost Promotes #Antibody Affinity Maturation and Expands H5N1 Cross-Clade Neutralization (PLoS One, abstract, edited)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

Open Access / Peer-reviewed / Research Article

Oral Priming with Replicating Adenovirus Serotype 4 Followed by Subunit H5N1 Vaccine Boost Promotes Antibody Affinity Maturation and Expands H5N1 Cross-Clade Neutralization [      ]

Surender Khurana , Elizabeth M. Coyle, Jody Manischewitz, Lisa R. King, Glenn Ishioka, Jeff Alexander, Jon Smith, Marc Gurwith, Hana Golding

Published: January 28, 2015  / DOI: 10.1371/journal.pone.0115476

 

Abstract

A Phase I trial conducted in 2009–2010 demonstrated that oral vaccination with a replication competent Ad4-H5 (A/Vietnam) vector with dosages ranging from 107-1011 viral particles was well tolerated. HA-specific T-cell responses were efficiently induced, but very limited hemagglutination-inhibiting (HI) humoral responses were measured. However, a single boost of Ad4-H5-Vtn vaccinated individuals with a unadjuvanted licensed H5N1 (A/Vietnam) subunit vaccine resulted in superior HI titers compared with unprimed subjects. In the current study, the impact of Ad4-H5 priming on the quality of the polyclonal humoral immune response was evaluated using a real-time kinetics assay by surface plasmon resonance (SPR). Total binding of serum polyclonal antibodies from the Ad4-H5-Vtn primed groups against both homologous H5N1-A/Vietnam/1194/2004 (clade 1) and heterologous A/Indonesia-5/2005 (clade 2.1) HA1 head domain was significantly higher compared with sera from individuals that received subunit H5N1 vaccination alone. SPR measurements also demonstrated that the antigen-antibody complex dissociation rates (a surrogate for antibody affinity) of serum antibodies against the HA1 of H5N1-A/Vietnam were significantly higher in the Ad4-H5 primed groups compared with those from the unprimed group. Furthermore, strong correlations were observed between the antibody affinities for HA1 (but not HA2) and the virus neutralization titers against the homologous strain and a panel of heterologous clade 2 H5N1 strains. These findings support the concept of oral prime-boost vaccine approaches against pandemic influenza to elicit long-term memory B cells with high affinity capable of rapid response to variant pandemic viruses likely to emerge and adapt to human transmissions.

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Citation:Khurana S, Coyle EM, Manischewitz J, King LR, Ishioka G, et al. (2015) Oral Priming with Replicating Adenovirus Serotype 4 Followed by Subunit H5N1 Vaccine Boost Promotes Antibody Affinity Maturation and Expands H5N1 Cross-Clade Neutralization. PLoS ONE 10(1): e0115476. doi:10.1371/journal.pone.0115476

Academic Editor: Ray Borrow, Public Health England, UNITED KINGDOM

Received: September 2, 2014; Accepted: November 23, 2014; Published: January 28, 2015

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication

Data Availability:All relevant data are within the paper.

Funding:Wellcome Trust funded the development of the Ad4-H5 vector through Phase I clinical trial for PaxVax. Co-authors Glenn Ishioka, Jeff Alexander, Jon Smith and Marc Gurwith are employed by PaxVax. PaxVax provided support in the form of salaries for authors GI, JA, JS and MG, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles ofthese authors are articulated in the “author contributions” section.

Competing interests: The authors have the following interests: Co-authors Glenn Ishioka, Jeff Alexander, Jon Smith and Marc Gurwith are employed by PaxVax and also own PaxVax stock. JA is listed as an author on a pending U.S. patent application No. 12/847,767. Title: Adenoviral-based vectors. Wellcome Trust funded the development of the Ad4-H5 vector through Phase I clinical trial for PaxVax. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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#Saudi Arabia reported no new #MERS-CoV cases in the last 24 hours (@SaudiMOH, January 28 2015, edited)

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

#Saudi Arabia reported no new #MERS-CoV cases in the last 24 hours [      ]

1/28/2015

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New Cases:

  • No reports

Earlier reported cases discharged from hospital:

  1. man, 77 years old, Saudi national, resident in Riyadh.

Deaths among previously announced cases:

  • No reports

Cumulative Number of Confirmed Cases and Deaths since June 2012:

  • Total No. of Cases: 843
  • Total No. of Deaths: 364
  • Patients currently under treatment: 4

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28-1-2015-1.jpg

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28-1-2015-3.jpg

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#Ebola #Situation #Report - 28 January 2015 (@WHO, edited)

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

Ebola Situation Report - 28 January 2015 [      ]

 

SUMMARY

  • The response to the EVD epidemic has now moved to a second phase, as the focus shifts from slowing transmission to ending the epidemic. To achieve this goal as quickly as possible, efforts have moved from rapidly building infrastructure to ensuring that capacity for case finding, case management, safe burials, and community engagement is used as effectively as possible. 
  • For the first time since the week ending 29 June 2014, there have been fewer than 100 new confirmed cases reported in a week in the 3 most-affected countries. A combined total of 99 confirmed cases were reported from the 3 countries in the week to 25 January: 30 in Guinea, 4 in Liberia, and 65 in Sierra Leone.
  • Case incidence continues to fall in Liberia and Sierra Leone. Guinea reported 30 confirmed cases in the week to 25 January, up from 20 confirmed cases in the previous week.
  • The north Guinean prefecture of Mali, which borders Senegal, has reported its first confirmed case.
  • In the week to 18 January, 6 of 20 (30%) new confirmed and probable cases in Guinea arose among registered contacts. During the week to 25 January, 2 of 4 (50%) new confirmed cases in Liberia arose among known contacts. Equivalent data are not yet available for Sierra Leone. The target is for 100% of new cases to arise among known contacts, so that each and every chain of transmission can be tracked and terminated.
  • In the 21 days to 25 January, it took an average of 0.7 days in Guinea, 0.5 days in Liberia, and 0.8 days in Sierra Leone for a patient sample to go from collection through to the communication of the laboratory test result to a national ministry of health. The target is to have results within 24 hours of sample collection.
  • The case fatality rate among hospitalized cases (calculated from all hospitalized cases with a reported definitive outcome) is between 54% and 62% in the 3 intense-transmission countries, with no indication of an improvement over time.
  • All health care facilities in the 3 most-affected countries are assessed for their compliance with minimum standards of infection prevention and control (IPC), with the aim that 100% of facilities meet such standards. Data will soon be available on the proportion of health facilities that meet minimum IPC standards.
  • A total of 816 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths. Neither Guinea nor Sierra Leone reported a health worker infection in the week to 25 January. Liberia reported 2 health worker infections during the same period, compared with 0 cases the previous week.
  • A total of 27 sub-prefectures in Guinea reported at least one security incident or other form of refusal to cooperate in the week to 21 January. A total of 2 districts in Liberia and 4 districts in Sierra Leone reported at least one similar incident during the same reporting period.

 

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

  • There have been in excess of 22 000 reported confirmed, probable, and suspected cases (Annex 1) of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 8800 deaths (outcomes for many cases are unknown). A total of 30 new confirmed cases were reported in Guinea, 4 in Liberia, and 65 in Sierra Leone in the 7 days to 25 January.
  • A stratified analysis of cumulative confirmed and probable cases indicates that the number of cases in males and females is similar (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are almost four times more likely to be affected than are children.
  • A total of 816 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 488 reported deaths (table 3). 

 

Table 1: Confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone

[Country - Case definition - Cumulative cases - Cases in past 21 days - Cumulative deaths]

  • Guinea
    • Confirmed – 2569 – 92 – 1578
    • Probable – 332 – * – 332
    • Suspected – 16 – * – ‡
      • Total – 2917 – 92 – 1910
  • Liberia
    • Confirmed – 3138 – 20 – ‡
    • Probable – 1864 – * – ‡
    • Suspected – 3620 – * – ‡
      • Total – 8622 – 20 – 3686
  • Sierra Leone
    • Confirmed – 7968 – 366 – 2833
    • Probable – 287 – * – 208
    • Suspected – 2263 – * – 158
      • Total - 10 518 – 366 – 3199
  • Total - 22 057 – 478 – 8795

____

Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

*Not reported due to the high proportion of probable and suspected cases that are reclassified.

‡ Data not available.

[View data »]

 

Table 2: Cumulative number of confirmed and probable cases by sex and age group in Guinea, Liberia, and Sierra Leone

[Country - Cumulative cases: By sex* (per 100 000 population): Male -  Female - By age group‡ (per 100 000 population): 0-14 years - 15-44 years - 45+ years]

  • Guinea – 1341 (25) – 1438 (26) – 443 (10) – 1572 (34) – 742 (47)
  • Liberia – 2550 (128) – 2447 (124) – 829 (48) – 2671 (156) – 1019 (191)
  • Sierra Leone – 5185 (182) – 5501 (190) – 2326 (96) – 5777 (223) – 2414 (327)

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Population figures are based on estimates from the United Nations Department of Economic and Social Affairs 

*Excludes cases for which data on sex are not available. ‡Excludes cases for which data on age are not available.

[View data »]

 

Table 3: Ebola virus disease infections in health workers in the three countries with intense transmission

[Country – Cases – Deaths]

  • Guinea – 162 – 88
  • Liberia – 371 – 179
  • Sierra Leone – 283 – 221
  • Total – 816 – 488

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Data for Guinea represent confirmed cases only, and confirmed and probable deaths. Data for Liberia represent confirmed cases and deaths only. Data from Sierra Leone represent confirmed, probable, and suspected cases and deaths.

 

Figure 1: Geographical distribution of new and total confirmed and probable* cases

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The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

[View interactive map »]

 

GUINEA

  • Key performance indicators that monitor the EVD response in Guinea are shown in table 4.
  • A total of 30 confirmed cases were reported in the 7 days to 25 January 2015 (figure 2), compared with 20 the week before. This is the first time this year that case incidence has increased in Guinea from week-to-week. Eight districts reported a confirmed or probable case during the reporting period (figure 2).
  • The northern district of Mali, which borders Senegal, reported its first confirmed case (figure 1); a man who travelled from Liberia. Senegal has recently reopened border crossings with Guinea; surveillance in districts that border affected countries is being implemented.
  • With 15 confirmed cases, the western district of Forecariah was the worst-affected district in Guinea, accounting for half of all confirmed cases in the week to 25 January. Forecariah borders the Sierra Leonean district of Kambia to the south, which reported 10 confirmed cases during the reporting period: the third highest weekly total of any district in Sierra Leone. There have recently been reports of high levels of community resistance to EVD response measures in Forecariah, indicating a need to better engage the community in the response.
  • Conakry reported 6 confirmed cases (figure 2). The districts of Kissidougou and Macenta both reported their first confirmed cases in 21 days. 12 districts that have previously reported confirmed cases did not report any confirmed cases in the 21 days to 25 January; 3 have reported no cases for over 100 days (figure 1, figure 5).
  • The mean laboratory processing time for Guinea in the 21 days to 25 January (data available for 3 districts) was 0.7 days (range 0.0–1.1 days); processing time is calculated by subtracting the date a sample is collected from the date the results of the sample are communicated to the national ministry of health. If results are returned on the day of collection, processing time is recorded as 0 days; therefore the average processing time in Guinea was between 1 and 2 days. Laboratory locations are shown in figure 7.
  • In the week to 25 January, 30% of new confirmed cases arose among registered contacts; a fall from 53% the previous week. This may be attributable to the high proportion of new cases that arose in Forecariah, where efforts to engage the local community in response efforts need to be intensified.
  • Of the 16 confirmed EVD deaths that occurred in the week to 18 January, 19% occurred in the community. Ideally all cases should be identified and treated in an Ebola-specific facility; there should be no EVD-related deaths in the community.
  • In the week to 18 January, 29 unsafe burials were reported.

 

Figure 2: Confirmed weekly Ebola virus disease cases reported nationally and by district from Guinea

Confirmed weekly Ebola virus disease cases reported nationally and by district from Guinea

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[View data »]

 

LIBERIA

  • Key performance indicators that monitor the EVD response in Liberia are shown in table 4.
  • Case incidence has declined from a peak of over 300 new confirmed cases per week in August and September 2014 to 4 confirmed cases in the 7 days to 25 January 2015 (figure 3), compared with 8 cases the previous week.
  • All 4 confirmed cases were reported from Montserrado, the district that includes the capital, Monrovia (figure 1 and figure 3). The adjacent district of Bomi reported 3 probable cases.
  • Locations of Ebola treatment centres (ETCs) are shown in figure 6.
  • The mean laboratory processing time for Liberia in the 21 days to 25 January was 0.5 days (range 0.0–7.0); processing time is calculated by subtracting the date a sample is collected from the date the results of the sample are communicated to the national ministry of health. If results are returned on the day of sample collection, processing time is recorded as 0 days. Laboratory locations are shown in figure 7.
  • In the week to 22 January, 50% of new confirmed cases arose among registered contacts; a fall from 88% of cases during the previous 21-day period.
  • In the 21 days to the 22 January, 3 unsafe burials were reported.

 

Figure 3: Confirmed weekly Ebola virus disease cases reported nationally and by district from Liberia

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Systematic data on laboratory confirmed cases have been available since 3 November nationally, and since 16 November for each district.

[View data »]

 

SIERRA LEONE

  • Key performance indicators that monitor the EVD response in Sierra Leone are shown in table 4.
  • Case incidence continues to decline rapidly in Sierra Leone. There were 65 new confirmed cases reported in the week to 25 January 2015, compared with 117 the previous week and 184 the week before that.  
  • The west of the country remains the area of most intense transmission. The capital, Freetown, reported 20 new confirmed cases, compared with 30 the previous week. The nearby districts of Kambia and Western Rural reported 10 and 16 new confirmed cases, respectively, in the 7 days to 25 January (figure 1, figure 4).
  • Kambia borders the Guinean district of Forecariah (figure 1), which has reported an increase in cases in over the past 2 weeks.
  • The western district of Port Loko reported 6 new confirmed cases, its lowest total since the week ending 3 August 2014.
  • A total of 7 out of 14 districts reported new confirmed cases in the latest reporting period. Kailahun, which borders Gueckedou, has reported now no confirmed cases for 44 days (figure 5).
  • The district of Kono in the east of the country, also on the border with Guinea, reported a single confirmed case during the reporting period, compared with 13 cases the previous week.
  • Locations of Ebola treatment centres (ETCs) are shown in figure 6.
  • The mean laboratory processing time for Sierra Leone in the 21 days to 25 January was 0.8 days (range 0.5–4.1 days); processing time is calculated by subtracting the date and time a sample is collected from the date and time the results of the sample are communicated to the national ministry of health. If results are returned on the day of collection processing time is recorded as 0 days. Laboratory locations are shown in figure 7.

 

Figure 4: Confirmed weekly Ebola virus disease cases reported nationally and by district from Sierra Leone

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[View data »]

 

Table 4: Key performance indicators for Phase 2 of the Ebola response

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For definitions of key performance indicators see Annex 2. For the lead agencies coordinating the 4 key lines of action see Annex 3.

*A different time period is used for Liberia.

Processing time of samples is calculated for the 21 days up to the 11, 18, and 25 January. If results are returned on the day of collection processing time is recorded as 0 days.

#Includes new confirmed and probable cases.

**Does not include members of foreign medical teams.

§As reported by UNICEF; out of 340 sub-prefectures in Guinea, 15 counties in Liberia, and 14 districts in Sierra Leone.

‡‡The case fatality rate is measured over three non-overlapping 4-week periods; robust outcome data is available up to 28 December for Guinea, 30 November for Liberia, and 2 November for Sierra Leone.

 

Figure 5. Days since last reported confirmed case by district in Guinea, Liberia, and Sierra Leone

image6

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[View interactive map »]

 

COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION

  • Six countries (Mali, Nigeria, Senegal, Spain, the United Kingdom and the United States of America) have reported a case or cases imported from a country with widespread and intense transmission.
  • In the United Kingdom, public health authorities confirmed a case of EVD in Glasgow, Scotland, on 29 December 2014 (table 5). The case was a health worker who returned from volunteering at an ETC in Sierra Leone. The patient was isolated on 29 December and received treatment in London. On 23 January the patient tested negative twice for EVD, and on 24 January the patient was discharged. All contacts have completed 21-day follow-up.

 

Table 5: Ebola virus disease cases and deaths in the United Kingdom

[Country - Cumulative cases: Confirmed – Probable – Suspect – Deaths - Health-care workers - Contact tracing: Contacts under follow-up - Contacts who have completed 21-day follow-up - Date last patient tested negative - Number of days since last patient tested negative]

  • United Kingdom – 1 – 0 – 0 – 0 - 100% – 0 – 55 - 23/01/2015 – 4

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Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

 

Figure 6. Location of Ebola Treatment Centres in Guinea, Liberia, and Sierra Leone

image6

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Locations of community care centres and community transit centres are not shown.

[View interactive map »]

 

PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE

  • The introduction of a case into unaffected countries remains a risk for as long as cases are reported in any country. With adequate levels of preparation, however, such introductions of the disease can be contained with a rapid and adequate response.
  • WHO’s preparedness activities aim to ensure all countries are ready to effectively and safely detect, investigate and report potential EVD cases, and to mount an effective response. WHO provides this support through country visits by preparedness support teams (PSTs), direct technical assistance to countries, and the provision of technical guidance and tools.

 

Tools and resources for preparedness

  • Building on existing national and international preparedness efforts, a set of tools has been developed to support any country to identify opportunities for improvements to intensify and accelerate their readiness. The WHO EVD Preparedness Checklist identifies 11 key components and tasks for countries preparing their health systems to identify, detect and respond to EVD. The 11 components include: overall coordination, rapid response, public awareness and community engagement, infection prevention and control, case management, safe burials, epidemiological surveillance, contact tracing, laboratory capacity, and capacity building for points of entry. A revised list of technical guidelines and related training materials by preparedness component has been finalized and can be found on the revised WHO preparedness website.

 

Figure 7. Location of laboratories in Guinea, Liberia, and Sierra Leone

image6

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[View interactive map »]

 

Priority countries in Africa

  • The initial focus of support by WHO and partners is on highest priority countries – Côte d’Ivoire, Guinea Bissau, Mali and Senegal – followed by high priority countries – Burkina Faso, Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Gambia, Ghana, Mauritania, Nigeria, South Sudan, Niger and Togo. The criteria used to prioritize countries include geographical proximity to affected countries, trade and migration patterns, and strength of health systems.
  • Since 20 October 2014, PSTs have provided technical support in 14 countries: Benin, Burkina Faso, Cameroon, Central African Republic, Côte d'Ivoire, Ethiopia, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Niger, Senegal and Togo. Technical working group meetings, field visits, high-level exercises and field simulations have helped to identify key areas for improvement. Each country has a tailored 90-day plan to strengthen operational readiness. WHO and partners are deploying staff to the 14 countries to assist with the implementation of 90-day plans.
  • Following PST missions, countries that share borders with the countries with intense transmission have taken additional action to prepare for an imported case.
  • A consultative meeting between WHO and partners on EVD preparedness and readiness took place in Geneva between 14 and 16 January. At the meeting an in-depth review of the consolidated checklist for Ebola Preparedness highlighted key gaps and areas to be addressed, including community engagement, infection prevention and control, contact tracing and logistics. A dashboard was also presented which allowed partners to accurately target needs and gaps. This will be used to support in-country preparedness efforts by national authorities. In the coming months, WHO will organize follow up missions to assess progress against 90-day plans, conduct simulation exercises in collaboration with partners, complete the provision of Personal Protective Equipment (PPE) to all fourteen countries, and coordinate WHO and partner engagement with countries. Participants agreed on an action plan and timeline for moving ahead.

 

Preparedness in the rest of the world

  • Beyond the focus on priority countries in Africa, significant efforts have been made in all WHO Regions to strengthen Ebola preparedness. Assessments in several countries in all Regions found that there are still significant gaps and needs related to risk communication, infection prevention and control, laboratory infrastructure, case management and points of entry.  There is also a need for standard operating procedures for rapid response teams. Globally, more than 110 countries have been supported to strengthen their public health response capacities in relation to EVD. Regional Offices have already, or are in the process of, conducting regional/subregional training workshops on risk communication, laboratory testing and biosafety, infection prevention and control, and case management. At the country level WHO has also supported the organization of national workshops and simulation exercises to continue to address these gaps.
  • A global strategy for personal protective equipment and infection control supplies has been developed and supplies have been or are being procured and strategically deployed/stockpiled to ensure their availability in the event of importation in any country of the world.

(…)

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#Influenza at the #human–#animal interface, #Summary and #assessment as of 26 January 2015 [#H5N1, #H7N9 #birdflu viruses] (@WHO, January 28 2015, edited)

[Source: World Health Organization, full PDF document: (LINK). Edited.]

Influenza at the human-animal interface, Summary and assessment as of 26 January 2015 [      ]

 

Human infection with avian influenza A(H5) viruses

From 2003 through 23 January 2015, 718 laboratory-confirmed human cases of avian influenza A(H5N1) virus infection have been officially reported to WHO from 16 countries. Of these cases, 413 have died.

Since the last WHO Influenza update on 6 January 2015, 24 new laboratory confirmed human cases of avian influenza A(H5N1) virus infection, including 11 fatal cases, were reported to WHO from Egypt.

Of the 24 cases, seven had onset of disease in December 2014 and the rest had onset of disease in January 2015.

The cases were reported from nine different governorates of Egypt (see table 1).

Of the new cases, there was one cluster which included two confirmed cases in siblings from Assiut governorate. Both of these cases had disease onset on the same day and both had exposure to backyard poultry.

All cases had exposure to poultry or poultry markets, except for three cases in which the sources of infection are still under investigation.

Currently, there are reports of an increased number of outbreaks and detections of influenza A(H5N1) viruses in poultry in Egypt compared to previous months and compared to this month in previous years.

The number of laboratory confirmed human cases of avian influenza A(H5N1) virus infection reported by Egypt in December was the highest reported by any country in a single month.

Although all influenza viruses evolve over time, preliminary laboratory investigation has not detected major genetic changes in the viruses isolated from the patients or animals compared to previously circulating isolates.

The increase in the number of human cases is likely attributed to a mixture of factors, including increased circulation of influenza A(H5N1) viruses in poultry, lower public health awareness of risks in middle and upper Egypt and seasonal factors such as closer proximity to poultry because of cold weather and possible longer survival of the viruses in the environment.

Epidemiological and virological investigation in humans and animals is ongoing.

Various other H5 subtypes, such as influenza A(H5N2), A(H5N3), A(H5N6) and A(H5N8), have recently been detected in poultry in Europe, North America, and Asia, according to reports received by OIE.

Although these influenza A(H5) viruses might have the potential to cause disease in humans, so far no human cases of infection have been reported, with exception of the 2 human infections with influenza A(H5N6) virus detected in China in 2014.

 

Overall public health risk assessment for avian influenza A(H5) viruses:

Whenever avian influenza viruses are circulating in poultry, sporadic infections and small clusters of human cases are possible in people exposed to infected poultry or contaminated environments.

Human infections remain so far rare and these influenza A(H5) viruses do not currently appear to transmit easily among people.

As such, the risk of community-level spread of these viruses remains to be low.

 

Table 1: Laboratory-confirmed human cases of avian influenza A(H5N1) virus infection (6 January – 26 January 2015)

[Province – Age – Sex - Date of onset - Date of Hospitalisation - Oseltamivir treatment Start date - Date of death - Exposure to]

  1. Menia – 30 – M - 30 Dec 2014 - 31 Dec 2014 - 31 Dec 2014 – NA - Sick and dead backyard poultry
  2. Menia – 11 – M - 28 Dec 2014 - 1 Jan 2015 – NA – NA - Dead birds
  3. Qaliyoubia – 58 – F - 31 Dec 2014 - 5 Jan 2015 - 5 Jan 2015 – 24-Jan-15 - Backyard poultry
  4. Gharbia – 45 – F - 23 Dec 2014 - 1 Jan 2015 – NA - 2 Jan 2015  - Under investigation
  5. Cairo – 6 – F - 27 Dec 2014 - 1 Jan 2015 – NA – NA - Market poultry
  6. Menoufiya – 43 – F - 1 Jan 2015 - 5 Jan 2015 – NA – NA - Sick and dead poultry
  7. Aswan – 10 – M - 4 Jan 2015 - 5 Jan 2015 – NA – NA - Sick and dead backyard poultry
  8. Cairo – 20 – F - 2 Jan 2015 - 7 Jan 2015 - 7 Jan 2015 – NA - Market poultry
  9. Menoufiya – 20 – M - 30 Dec 2014 - 8 Jan 2015 - 8 Jan 2015 – NA - Sick and dead backyard poultry by slaughtering
  10. Assiut  - 65 – F  - 1 Jan 2015 - 4 Jan 2015 - 4 Jan 2015 - 9 Jan 2015 - Backyard poultry
  11. Beheira – 3 – M - 29 Dec 2014 - 2 Jan 2015 - 2 Jan 2015 – NA - Sick and dead poultry
  12. Menia – 7 – M - 7 Jan 2015 - 8 Jan 2015 - 8 Jan 2015 – NA – Poultry
  13. Menoufiya – 27 – F - 7 Jan2014 - 11 Jan 2015 - 11 Jan 2015 – NA - Sick and dead backyard poultry by slaughtering
  14. Assiut – 43 – F - 6 Jan 2015 - 12 Jan 2015 - 12 Jan 2015 - 16 Jan 15 - Sick and dead backyard poultry by slaughtering
  15. Sohag – 35 – F - 8 Jan 2015 - 14 Jan 2015 - 14 Jan 2015 - 22 Jan 15 - Backyard poultry (chickens and ducks)
  16. Cairo – 3 – F - 8 Jan 2015 - 15 Jan 2015 - 15 Jan 2015 – NA - Backyard poultry (ducks)
  17. Assiut – 47 – F - 8 Jan 2015 - 14 Jan 2015 - 14 Jan 2015 - 18 Jan15 - Sick and dead backyard poultry by slaughtering
  18. Cairo – 36 – F - 8 Jan 2015 - 11 Jan 2015 - 17 Jan 2015 - 20 Jan 2015 - Under investigation
  19. Menia – 6 – M - 5 Jan 2015 - 13 Jan 2015 - 15 Jan 2015 - 16 Jan 2015 - Poultry market near residence
  20. Assiut – 3 – M - 13 Jan 2015 - 18 Jan 2015 - 13 Jan 2015 - 24 Jan 15 - Backyard poultry
  21. Assiut – 1 – M - 13 Jan 2015 - 20 Jan 2015 - 15 Jan 2015 – NA - Backyard poultry
  22. Assiut – 1 – F - 13 Jan 2015 - 20 Jan 2015 - 20 Jan 2015 – NA - Backyard poultry
  23. Gharbia – 37 – F - 12 Jan 2015 - 14 Jan 2015 - 14 Jan 2015 –  18 Jan 2015 - Under investigation
  24. Assiut – 5 – M - 5 Jan 2015 - 18 Jan 2015 - 18 Jan 2015 - 20 Jan 2015 - Backyard poultry

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NA: not applicable or not available

 

Human infection with avian influenza A(H7N9) viruses

A total of 486 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus, including 185 deaths, have been reported to WHO: 469 cases by China National Health and Family Planning Commission, four cases by the Taipei Centers for Disease Control (Taipei CDC), 12 cases by the Centre for Health Protection, China, Hong Kong SAR, and one case in a Chinese traveler, reported from Malaysia.

The majority of recently reported human cases are associated with exposure to infected live poultry or contaminated environments, including markets where live poultry are sold.

A(H7N9) viruses continue to be detected in poultry and their environments in the areas where human cases are occurring.

There have been no major genetic changes in the viruses isolated from recent patients compared to previously-isolated viruses from humans.

Information to date suggests that these viruses do not transmit easily from human to human.

 

Overall public health risk assessment for avian influenza A(H7N9) viruses:

Overall, the public health risk from avian influenza A(H7N9) viruses has not changed since the assessment published on 2 October 2014.

WHO is closely monitoring this event and separate risk assessments have been posted. Please find the most updated information at http://www.who.int/influenza/human_animal_interface/influenza_h7n9/Risk_Assessment/en/index.html - http://www.who.int/csr/don/27-january-2015-avian-influenza/en/

Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health, especially over the coming winter months.

All human infections with non-seasonal influenza viruses are reportable to WHO under the IHR (2005).

It is critical that influenza viruses from animals and people are fully characterized in appropriate animal or human health influenza reference laboratories and reported according to international standards.

 

Links:

 

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#WHO #risk #assessment of #human #infection with #avian #influenza A(#H7N9) virus (@WHO, January 28 2015, edited)

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

WHO risk assessment of human infection with avian influenza A(H7N9) virus [      ]

On 26 January 2015 WHO conducted a risk assessment in accordance with the WHO recommendations for rapid risk assessment of acute public health events and concluded that the public health risk has not changed since the assessment published on 2 October 2014.

---> WHO Risk Assessment as of 02 October 2014 pdf, 336kb

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#Saudi Arabia reported a new #MERS-CoV case on January 27 2015 (@SaudiMOH, Jan. 28 2015, edited)

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

#Saudi Arabia reported a new #MERS-CoV case on January 27 2015 [      ]

1/27/2015

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New Cases:

  1. man, 80 years old, Saudi national, resident in Riyadh, currently in critical condition; no known exposure to animals or human cases.

Earlier reported cases discharged from hospital:

  • No reports

Deaths among previously announced cases:

  • No reports

Cumulative Number of Confirmed Cases and Deaths since June 2012:

  • Total No. of Cases: 843
  • Total No. of Deaths: 364
  • Patients currently under treatment: 5

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27-1-2015-1.jpg

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27-1-2015-3.jpg

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#Italy, #Influenza Season 2014-15, #Virological #Surveillance #Update: 60% positive samples tested were #H1N1pdm09 virus (MoH, January 28 2015, extract)

[Source: Ministry of Health, Italy, full PDF document: (LINK). Portion translated, edited.]

#Italy, #Influenza Season 2014-15, #Virological #Surveillance #Update [      ]

(Jan. 28 2015)

_____

Influenza virus activity continues to rise in Italy during week 4/2015.

878 clinical samples have been collected by surveillance network laboratories.

Among them, 432 (49%) tested positive for influenza virus.

Of these, 419 were type A and 13 type B.

Among type A viruses, 258 [60%] were subtyped as #H1N1pdm09, 127 [29%] H3N2 and 34 type A not yet subtyped.

(…)

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Highly pathogenic #avian #influenza #H5N2, Chinese #Taipei [86 new #poultry #outbreaks] (#OIE World Animal Health Information System, January 28 2015, edited)

[Source: OIE, full page: (LINK). Edited.]

Highly pathogenic avian influenza H5N2,  Chinese Taipei [  /!\  ]

Information received on 28/01/2015 from Dr Ping-Cheng Yang, Vice President, Agriculture Technology Research Institute, Council of Agriculture, Hsinchu City, Chinese Taipei

  • Summary
  • New outbreaks (86)
  • (…)
    • Summary of outbreaks
      • Total outbreaks: 86
        • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
          • Birds – 639304 – 102260 – 102260 – 101220 – 0
        • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
          • Birds - 16.00% - 16.00% - 100.00% – **
          • *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
    • Abnormal mortalities were observed in 86 poultry farms in Taichung City, Changhua County, Yunlin County, Chiayi County, Tainan City and Pingtung County.
    • Samples were sent to the National Laboratory (AHRI) for diagnosis.
    • H5N2 subtype HPAI was confirmed by AHRI.
    • These farms have been put under movement restrictions.
    • All animals on the infected farms will be culled.
    • The actual numbers of culled animals will be available when stamping out operation is finished and be reported in the next follow-up report.
    • Thorough cleaning and disinfection will be conducted after stamping out operation.
    • Surrounding poultry farms within 3 km radius of infected farms are under intensified surveillance for 3 months.
  • Control measures
    • Measures applied
      • Stamping out
      • Quarantine
      • Movement control inside the country
      • Screening
      • Zoning
      • Disinfection of infected premises/establishment(s)
      • 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
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - gene sequencing - 21/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - gene sequencing - 22/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - gene sequencing - 23/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - gene sequencing - 24/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - gene sequencing - 25/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 20/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 21/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 22/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 23/01/2015 – Positive
      • Animal Health Research Institute (AHRI) (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 24/01/2015 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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Highly pathogenic #avian #influenza #H5N1, #India [a #poultry #outbreak in #Kerala] (#OIE World Animal Health Information System, January 28 2015, edited)

[Source: OIE, full page: (LINK). Edited.]

Highly pathogenic avian influenza H5N1, India [      ]

Information received on 28/01/2015 from Mr Anup Kumar Thakur, Secretary, Government of India, Department of Animal Husbandry, Dairying & Fisheries, Ministry of Agriculture, New Delhi, India

  • Summary
  • New outbreaks (1)
    • Outbreak 1  - Kureepuzha Regional Poultry Farm, Kureepuzha, Kollam, KERALA
      • Date of start of the outbreak 18/01/2015
      • Outbreak status Continuing (or date resolved not provided)
      • Epidemiological unit Farm
      • Affected animals: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
        • Birds  - 10513 – 1628 – 1628 – 6475 – …
        • Affected population Turkey
    • Summary of outbreaks
      • Total outbreaks: 1
        • Total animals affected: Species – Susceptible – Cases – Deaths – Destroyed – Slaughtered
          • Birds – 10513 – 1628 – 1628 – 6475 – …
        • Outbreak statistics: Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
          • Birds - 15.49% - 15.49% - 100.00% – **
          • *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
    • Epidemiological investigation is ongoing.
    • An intensive surveillance campaign has been launched in 10 km radius zone.
  • Control measures
    • Measures applied
      • Stamping out
      • Quarantine
      • Movement control inside the country
      • Screening
      • Vaccination prohibited
      • No treatment of affected animals
    • Measures to be applied
      • Disinfection of infected premises/establishment(s)
      • Dipping / Spraying
  • Diagnostic test results
    • Laboratory name and type – Species – Test - Test date – Result
      • National Institute of High Security Animal Diseases, Bhopal (National laboratory) – Birds - real-time reverse transcriptase/polymerase chain reaction (RRT-PCR) - 26/01/2015 – Positive
      • National Institute of High Security Animal Diseases, Bhopal (National laboratory) – Birds - reverse transcription - polymerase chain reaction (RT-PCR) - 26/01/2015 – Positive
      • National Institute of High Security Animal Diseases, Bhopal (National laboratory) – Birds - virus isolation - 27/01/2015 – Positive
  • Future Reporting
    • The event is continuing. Weekly follow-up reports will be submitted.

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