Outbreak News This Week: August 17, 2024
Mpox, Polio in Gaza, Oropouche, and Fifth Disease
Mpox
The biggest story this week was Mpox. It actually started when the Centers for Disease Control and Prevention (CDC) issued a travel notice and Health Alert Network due to clade Ib mpox about 10 days ago.
This week, the Africa CDC declared a Public Health Emergency of Continental Security (PHECS), which was followed by the World Health Organization (WHO) declaring mpox as public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR).
In declaring the PHEIC, WHO Director-General Dr Tedros Adhanom Ghebreyesus said, "The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying. On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.”
The emergence last year and rapid spread of a new virus strain in DRC, clade 1b, and its detection in countries neighboring the DRC is especially concerning, and one of the main reasons for the declaration of the PHEIC.
This PHEIC declaration is the second in two years relating to mpox.
The Africa CDC reports at least 13 African countries, including previously unaffected nations like Burundi, Kenya, Rwanda, and Uganda, have reported Mpox outbreaks. So far in 2024, these countries have confirmed 2,863 cases and 517 deaths, primarily in the Democratic Republic of the Congo (DRC). Suspected cases across the continent have surged past 17,000, a significant increase from 7,146 cases in 2022 and 14,957 cases in 2023. They also note that this is just the “tip of the iceberg”.
The first case of clade 1b was also reported this week outside of Africa in Stockholm, Sweden.
The European Centre for Disease Prevention and Control (ECDC) Friday warned that more imported clade 1 infections are highly likely and urged countries to take preparedness steps.
ECDC said due to frequent and close travel links between the EU/EEA and Africa, ECDC recommends that EU/EEA Member States issue travel advice for people visiting or returning from areas affected by the outbreak. The likelihood of infection for people from the EU/EEA travelling to affected areas who have close contact with affected communities is high. Additionally, there is a moderate risk for close contacts of possible or confirmed imported cases into the EU/EEA.
They also recommend that public health authorities in the EU/EEA maintain high levels of preparedness planning and awareness raising activities—effective surveillance, laboratory testing, epidemiological investigation and contact tracing capacities.
The US National Institutes of Health (NIH) also reported this week that the antiviral drug tecovirimat did not reduce the duration of mpox lesions among children and adults with clade I mpox in the Democratic Republic of the Congo (DRC), based on an initial analysis of data from a randomized, placebo-controlled trial.
There are two vaccines currently in use for mpox that are recommended by WHO’s Strategic Advisory Group of Experts on Immunization, and are also approved by WHO-listed national regulatory authorities, as well as by individual countries including Nigeria and the DRC.
Last week, Director-General Tedros triggered the process for Emergency Use Listing for mpox vaccines, which will accelerate vaccine access for lower-income countries which have not yet issued their own national regulatory approval. Emergency Use Listing also enables partners including Gavi and UNICEF to procure vaccines for distribution.
Monkeypox virus (MPXV) has two distinct genetic clades (subtypes of MPXV), I and II, which are endemic to central and west Africa, respectively. Clade I MPXV has previously been observed to be more transmissible and to cause a higher proportion of severe infections than clade II MPXV. The ongoing global mpox outbreak that began in 2022 is caused by clade II MPXV, and cases continue to be reported worldwide.
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Outbreaks of clade I MPXV associated with sexual contact among men who have sex with men and female sex workers and their contacts have been reported in some provinces. In other provinces, patients have acquired infection through contact with infected dead or live wild animals, household transmission, or patient care (transmitted in the absence of appropriate personal protective equipment); a high proportion of cases have been reported in children younger than 15 years of age.
Polio in Gaza
For the first time in a quarter century, a polio case has been reported in Gaza.
According to the Palestinian Ministry of Health, an unvaccinated 10-month old child from Deir Al-Balah tested positive for the disease in Jordan.
“Doctors suspected the presence of symptoms consistent with polio,” the health ministry said. “After conducting the necessary tests in the Jordanian capital, Amman, the infection was confirmed.”
Type 2 poliovirus was detected in samples collected from the territory’s wastewater in June.
UN Secretary General António Guterres called for pauses in the Israel-Hamas war to vaccinate hundreds of thousands of children.
Watch UN Secretary General António Guterres on polio in Gaza:
Oropouche
On Friday, the CDC issued a Health Alert Network (HAN) Health Advisory concerning the increase of in Oropouche virus disease in the Americas region and the risk to travelers.
Between January 1 and August 1, 2024, more than 8,000 cases of Oropouche virus disease were reported, including two deaths and five cases of vertical transmission associated with fetal death or congenital abnormalities. Countries reporting cases include Brazil, Bolivia, Peru, Colombia, and Cuba.
Travel associated cases have been reported in Europe and the United States. In the US, 11 travel associated cases have been reported in Florida in travelers from Cuba. No evidence of local transmission currently exists within the United States or its territories.
CDC previously issued travel notices for Oropouche in South America. On Friday, they issued a travel notice specifically for Cuba for the first time.
Officials offer the following recommendations for travelers:
All travelers can protect themselves from Oropouche, dengue, Zika, and other viruses transmitted by insects by preventing insect bites, including using an Environmental Protection Agency (EPA)-registered insect repellent; wearing long-sleeved shirts and pants; and staying in places with air conditioning or that use window and door screens.
Pregnant travelers should discuss travel plans, reasons for travel, steps to prevent insect bites, and potential risk with their healthcare provider.
Pregnant women considering travel to countries with an Oropouche virus Level 2 Travel Health Notice should reconsider non-essential travel. If travel is unavoidable, pregnant travelers should strictly follow Oropouche virus prevention recommendations to prevent insect bites during travel.
Travelers should be aware that the most common symptoms of Oropouche virus are fever and headache and that symptoms usually begin 3-10 days after being bitten by an infected midge or mosquito. Most people infected with Oropouche virus feel better within a week, but symptoms often come back.
Travelers who have been in areas with Oropouche virus transmission should prevent insect bites for 3 weeks after travel.
Travelers to areas with Oropouche virus transmission, including South America or the Caribbean, who develop fever, chills, headache, joint pain, or muscle pain during or within 2 weeks after travel, should:
Seek medical care and tell their healthcare provider when and where they traveled.
Not take aspirin or other NSAIDS (e.g., ibuprofen) to reduce the risk of bleeding.
Continue to prevent insect bites during the first week of illness to avoid further spread, especially in areas where mosquitoes or biting midges are active.
Fifth disease
On Tuesday, the CDC issued a Health Alert Network (HAN) Health Advisory because of increases of in human parvovirus B19 activity in the United States.
Recently, CDC has received reports indicating increased parvovirus B19 activity in the United States. Data include increased test positivity for parvovirus B19 in clinical specimens and pooled plasma from a large commercial laboratory, and reports of clusters of parvovirus B19-associated complications among pregnant women and people with sickle cell disease.
Parvovirus B19, the fifth common childhood rash that scientists named, hence the name, Fifth disease (first disease (measles), 2nd disease (scarlet fever), 3rd disease (rubella or German measles), 4th disease (Staphylococcal Scalded Skin Syndrome) and 5th disease (caused by Parvovirus B19) and 6th disease (roseola, caused by Human Herpes Virus 6 or to a lesser extent, Human Herpes Virus 7 ), is highly transmissible in respiratory droplets, with 50% of susceptible people infected after household exposure and 20–50% of susceptible students and staff infected during school outbreaks.
Parvovirus B19 infection can lead to adverse health outcomes among people without pre-existing immunity who are pregnant, immunocompromised, or have chronic hemolytic disorders. During pregnancy, most cases of fetal parvovirus B19 infection resolve spontaneously without adverse outcomes. However, the risk of an adverse fetal outcome (e.g., fetal anemia, non-immune hydrops, or fetal loss) is 5–10%, and is highest when acute infection occurs between gestational weeks 9–20.
CDC recommends:
Learn about parvovirus B19 symptoms and who may be at higher risk of severe disease.
Seek medical care if you:
are pregnant and have been exposed to a person with suspected or confirmed parvovirus B19 or you have signs and symptoms of parvovirus B19.
have a weakened immune system or a chronic hemolytic blood disorder including sickle cell disease, thalassemia, and hereditary spherocytosis, and you have signs and symptoms of parvovirus B19.
Follow general respiratory precautions to prevent spread of parvovirus B19 and other respiratory viruses. People at higher risk of severe parvovirus B19 can consider using additional prevention strategies such as wearing a mask when around others.
Know that children and adults with parvovirus B19 are no longer contagious once the characteristic facial rash appears.