China | Human infection with avian influenza A(H7N9) virus – Three confirmed cases with one death

On 15 November 2014, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 3 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus, including 1 death.

Details of the cases are as follows
  • A 54-year-old female from Shihezi City, Xinjiang Uyghur Autonomous Region who developed symptoms on 19 October. The patient died on 1 November. Exposure to live poultry is unknown.
  • A 58-year-old female from Changzhou City, Jiangsu Province who developed symptoms on 24 October. The patient was admitted to a hospital on 28 October. She is now in critical condition. The patient has a history of exposure to a live poultry market.
  • A 45-year-old female from Changzhou City, Jiangsu Province who developed symptoms on 3 November. The patient was hospitalized on 5 November. Her current condition is mild. The patient has a history of exposure to a live poultry market.
The Chinese Government has taken the following surveillance and control measures
  • Strengthen surveillance and situation analysis
  • Reinforce case management and medical treatment
  • Conduct risk communication with the public and release information.

WHO continues to closely monitor the H7N9 situation and conduct risk assessment. So far, the overall risk associated with the H7N9 virus has not changed.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or 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.

UK | NHS volunteers prepare to head to Sierra Leone to join Ebola response team

More than 50 NHS volunteers from the UK are now going through rigorous training as they prepare to deploy to West Africa to help communities affected by Ebola.

The final stage of UK training for the NHS staff – which includes doctors, nurses and paramedics – is taking place over the next few days at the Ministry of Defence’s Army Medical Services Training Centre near York.

NHS staff will join international healthcare workers to undergo 9 days of intensive training. To help them prepare for the working conditions they will face, the centre has created as realistic an environment as possible. The temperature in the facility will be hiked up to 30 degrees to simulate temperatures in Sierra Leone and infection control procedures to mirror those in Freetown have been put in place.

Staff are rigorously trained in the correct use of protective equipment. They are then given the opportunity to practice routine tasks, like taking blood, to get used to the wearing the suit. The training focuses on removing protective suits safely and scanners are in use to check for signs of contamination.

Further training will be given to the NHS staff when they arrive in Sierra Leone.

The first group of staff are expected to leave the UK later this week with the rest of the volunteers going out in stages throughout December.

International Development Secretary Justine Greening said:

British men and women from up and down the country have already gone to Sierra Leone to fight Ebola. These scientists, medics, engineers and aid workers are already having an impact on the ground.

This new team of NHS clinicians will join them after undergoing intensive training.

These medics are putting themselves on the frontline in the UK’s fight against Ebola. Their contribution will make a huge difference to people suffering from this horrific disease.

Health Secretary Jeremy Hunt said:

I want to thank the extraordinary NHS volunteers who have selflessly put their names forward to help fight Ebola in Sierra Leone. They embody the values at the heart of our health service, and their expertise and dedication is second to none.

Lieutenant Colonel Jaish Mahan, Chief Instructor at the Army Medical Services Training Centre said:

The Army Medical Services Training Centre has been a centre of excellence for delivering hospital capability and we are proud to be able to facilitate preparation of the civilian medical staff who have volunteered to help in Sierra Leone.

Professor Tony Redmond, Head of UK Med said:

I continue to be humbled by the continuing response from across the NHS. My enormous thanks go to the teams who are volunteering to go out and the unsung heroes – their NHS colleagues – who are covering their shifts. I’d also like to thank the Trust Executives who facilitate their release.

From December, pre-departure training for NHS and international volunteers will be taken on by RedR, with funding from the Department for International Development.

England | Avian flu outbreak in duck breeding farm in Yorkshire

Defra has confirmed a case of avian flu outbreak in a duck breeding farm in Yorkshire with very low risk to human health and no risk to the food chain.

Immediate action has been taken to control the outbreak including introducing a 10km restriction zone and a complete cull of all 6,000 birds on the farm to prevent any potential spread of infection. The case confirmed on Sunday afternoon has been identified as a H5 avian flu strain and tests are being run to identify the exact strain of the disease. Public Health England have confirmed the risk to public health is extremely low and we have ruled out the H5N1 strain that is infectious for humans.

Further advice from the Food Standards Agency is that avian flu does not pose a food safety risk for UK consumers.

Investigations are now ongoing to discover whether the outbreak is linked to cases found in Netherlands and Germany with further test results expected over the coming days. The UK has a strong track record of controlling and eliminating previous outbreaks of avian flu and all action will be taken to control this outbreak to prevent a further spread of the disease.

The restriction zone bans movements of all poultry, products and waste within the area. Poultry must be housed or isolated in the zone. Bird gatherings (fairs, shows, exhibitions) are banned and game birds cannot be released.

England | Avian influenza outbreak in Yorkshire: risk to public health extremely low

Public Health England (PHE) is assisting the Department for Environment Food & Rural Affairs (Defra) in the investigation of an avian flu outbreak at a duck breeding farm in Yorkshire.

The risk to public health in this case is considered extremely low based on what we currently know about the specific strain of avian flu.

Further testing is ongoing but Defra have already ruled out the H5N1 strain which has sometimes caused severe human infection linked to poultry outbreaks, especially in the Far East.

Dr Stephen Morton, Centre Director for Public Health England in Yorkshire and the Humber, said:

Avian flu (often called bird flu) is primarily a disease of birds. Infection in people is rare and only occurs with some strains of avian influenza. Evidence shows that only people who have handled or have been in very close contact with infected birds are most at risk of getting avian influenza and even then, the risk of severe illness is low.

As a precautionary measure, anyone who is directly involved in culling the birds at the site in Yorkshire will be offered antiviral medicine which is usual practice in incidents of this sort.

The Food Standards Agency has advised that avian flu does not pose a food safety risk in the UK.

France | Dispositif de lutte contre le virus Ebola : renforcement des contrôles aux aéroports

Dans le cadre de la lutte contre le virus Ebola, et du fait de l’évolution de la situation épidémiologique, le dispositif de contrôle et de suivi des passagers sera étendu aux vols en provenance de Bamako (Mali), à compter de samedi 15 novembre 2014.

Ces contrôles seront effectués par les services médicaux des aéroports de Paris Charles de Gaulle et Paris Orly, avec l’appui de la protection civile et de la Croix-Rouge française. La température de chaque passager sera mesurée et une fiche d’information sur la conduite à tenir en cas de fièvre supérieure à 38 ° C dans les 21 jours après leur retour lui sera remise.

Afin d’assurer leur suivi, les passagers auront préalablement rempli un formulaire indiquant leur identité, leur place respective dans l’avion et leurs coordonnées, que les autorités sanitaires garderont durant 21 jours. Un message d’information sera également diffusé durant le vol.

Par ailleurs, le numéro vert (08 00 13 00 00) mis en place pour toute information demeure ouvert de 9h à 21h, 7 jours sur 7.

Marisol Touraine, ministre des Affaires sociales, de la Santé et des Droits des femmes, rappelle que la France est pleinement engagée dans la lutte contre l’épidémie d’Ebola qui frappe l’Afrique de l’Ouest.

Missouri | Gov Nixon activates National Guard to support law enforcement in event of unrest in St Louis region

Gov. Jay Nixon today signed an executive order activating the Missouri National Guard to support law enforcement during any period of unrest that might occur following the grand jury’s decision concerning the investigation into the death of Michael Brown.  The Governor said the Guard will provide support for law enforcement’s objectives of maintaining safety and protecting constitutional rights. 

“As part of our ongoing efforts to plan and be prepared for any contingency, it is necessary to have these resources in place in advance of any announcement of the grand jury’s decision,” Gov. Nixon said. “These additional resources will support law enforcement’s efforts to maintain peace and protect those exercising their right to free speech. The National Guard is well-suited to provide security at command posts, fire stations and other locations as well as perform other functions that will free up law enforcement officers to remain focused on community policing and protecting constitutional rights.”

Gov. Nixon’s executive order also establishes that the Missouri State Highway Patrol, St. Louis County Police Department and St. Louis Metropolitan Police Department will operate as a unified command to keep members of the public safe and protect property, while allowing citizens to exercise their constitutional rights.  Under the executive order, the St. Louis County Police Department will have command and operational control over security in the City of Ferguson in areas of protests and acts of civil disobedience, should such activities occur.

“All people in the St. Louis region deserve to feel safe in their communities and to make their voices heard without fear of violence or intimidation,” said Gov. Nixon. “Public safety demands that we are fully prepared for any contingency, regardless of what the St. Louis County grand jury or the U.S. Department of Justice decides.”

The St. Louis County prosecutor has said publicly that an announcement of the grand jury’s decision will be made later this month. The United States Department of Justice, which is conducting both civil and criminal investigations of the death of Michael Brown, has not announced when its investigations will be concluded.

“Our department, like other police departments in the region, has a full time job keeping our neighborhoods safe.  We are used to working with other agencies in times of necessity,” said St. Louis Metropolitan Police Chief Sam Dotson. “Having the support of the National Guard available will enable local officers to continue to respond promptly to calls for service.”

“We have taken tremendous strides over the past three months, as our officers have undergone thousands of hours of additional training and reached out to build strong relationships across the community,” said St. Louis County Police Chief Jon Belmar. “These additional resources will enhance our ability to achieve our key responsibilities: keeping the public safe, protecting property and enabling people to exercise their constitutional rights.”

Requests from local law enforcement for duties to be performed by the Guard will be handled through the Missouri State Highway Patrol.

“These past three months have been challenging for our community but we have come together in many measurable ways,” said Captain Ron Johnson, commander of Missouri State Highway Patrol Troop C. “The power of communication within the community has allowed us to take steps toward peaceful change that demonstrate the true character of North County. The availability of the National Guard will ensure that law enforcement has the resources to protect three things vital to our community: public safety, property and the constitutional rights of all.”

The Missouri National Guard has been deployed a total of 32 times since 2001 to assist local communities with emergency preparedness and response, from shoring up levees during floods to providing security following the Joplin tornado. The Guard will be commanded by Brigadier General Gregory Mason, a retired 30-year veteran of the Missouri State Highway Patrol.

The Governor’s executive order is available here.

Netherlands | H5N8 avian influenza confirmed at poultry farm in Hekendorp

De Voorzitter van de Tweede Kamer
der Staten-Generaal
Binnenhof 4

Datum 16 november 2014
Betreft Vogelgriep Hekendorp

Geachte Voorzitter,

Op een pluimveebedrijf in Hekendorp (gemeente Oudewater) is op 15 november jl. een uitbraak van vogelgriep (Aviaire Influenza, AI) van de H5 variant vastgesteld. Het betreft hoog pathogene aviaire influenza (HPAI), van het type H5N8. HPAI is bestrijdingsplichtig in de Europese regelgeving.  Met deze brief bericht ik u over deze besmetting en de maatregelen die ik heb getroffen.

Monitoring en early warning

In Nederland worden op commerciële pluimveebedrijven met regelmaat monsters genomen, die worden onderzocht op vogelgriep (reguliere monitoring). Daarnaast bestaat er een systematiek waarbij dierenartsen bij bepaalde ziekteverschijnselen, die kunnen wijzen op vogelgriep, monsters inzenden voor onderzoek (early
warning). Voor vogelgriep geldt een meldplicht bij een verdenking.
Afgelopen vrijdag 14 november jl. zijn van een pluimveebedrijf in Hekendorp (gemeente Oudewater) monsters ingestuurd omdat de kippen ziekteverschijnselen hadden, die mogelijk wezen op vogelgriep. Gisteren werd duidelijk dat het de H5 variant van vogelgriep betrof en vanmorgen werd na laboratoriumonderzoek
duidelijk dat het vogelgriepvirus op dit bedrijf de hoogpathogene variant is.  Inmiddels is ook duidelijk dat het om het type H5N8 van het virus gaat. Dit is hetzelfde type als begin november in Duitsland is vastgesteld.


Het RIVM geeft aan dat in zeldzame gevallen sommige virustypen overgaan van pluimvee op mensen. Dit gebeurt alleen als er sprake is van direct en intensief contact met besmet pluimvee. Mensen die ziek worden van vogelgriep krijgen dezelfde symptomen als bij een gewone wintergriep, over het algemeen verloopt vogelgriep bij mensen mild. Om te voorkomen dat mensen die betrokken zijn bij
de ruiming besmet raken worden beschermende maatregelen getroffen.

Het gaat om een legpluimveebedrijf met zes stallen met in totaal rond 150.000 legkippen. Dit bedrijf heeft geen buitenuitloop. Vandaag, zondag 16 november, is met de ruiming van het bedrijf begonnen. De kippen zullen op het bedrijf worden gedood en worden afgevoerd ter destructie. De ruiming wordt uitgevoerd door de Nederlandse Voedsel- en Warenautoriteit (NVWA).

De hoogpathogene variant van vogelgriep is zeer besmettelijk voor gevogelte. Voor kippen is deze variant dodelijk. Vogelgriep is een zoönose, wat betekent dat de besmetting van dier op mens kan worden overgebracht.

Vanwege het hoge besmettingsgevaar is vanaf zondag 16 november 2014, 11.30 uur een totaal vervoersverbod (standstill) voor onder meer pluimvee en ander gevogelte, eieren, pluimveemest en strooisel van pluimveebedrijven ingesteld. Voor gemengde bedrijven met een pluimveehouderijtak geldt dit vervoersverbod ook voor andere dieren en mest van andere dieren.

Naast het vervoersverbod is ook een ophok- en afschermplicht voor pluimvee en ander gevogelte in heel Nederland ingesteld en geldt een bezoekersregeling op alle pluimveebedrijven en gemengde bedrijven met pluimvee. Ook is er voor heel Nederland een jachtverbod op alle dieren ingesteld. Tenslotte is een  verzamelverbod en tentoonstellingsverbod voor pluimvee en ander gevogelte van kracht. De verplichtingen gelden ook voor hobbydierhouders van pluimvee en ander gevogelte.

De Europese regelgeving schrijft voor dat er een 3 en 10 kilometer gebied wordt ingesteld (beschermings- en toezichtsgebied). Op dit moment gelden in dit gebied dezelfde maatregelen als in de rest van Nederland.

In het 10 kilometer gebied liggen 16 andere pluimveebedrijven.

Deze bedrijven worden bemonsterd en onderzocht op vogelgriep. Ook worden contacten van het bedrijf onderzocht.

De komende dagen zijn erop gericht de oorsprong en verspreiding van het virus te achterhalen en verdere verspreiding te voorkomen.

Vanzelfsprekend zal ik u op de hoogte houden van de ontwikkelingen.

Europe | ECDC – Very low public health threat related to outbreak of avian influenza A(H5N8) in turkeys in Germany

According to the ECDC risk assessment, the outbreak of highly pathogenic avian influenza A(H5N8) in a turkey holding in Germany presents very low public health threat. No human infection with this virus has been reported worldwide. The risk of transmission of this infection to the general public in the EU/EEA countries is thus extremely low. 

On 6 November 2014, German authorities reported an outbreak of highly pathogenic avian influenza virus A(H5N8) at a turkey holding. Culling of the turkeys at the affected holding has started, protection and surveillance zones have been established, and investigations initiated to establish how the birds became infected.

This virus has been detected among wild birds in south-east Asia where it has caused several outbreaks on commercial poultry farms in South Korea and China. This is the first time that avian influenza A(H5N8) has been detected in Europe. It is currently unclear how it was introduced into the turkey flock at the German holding.

This avian influenza virus is highly pathogenic for poultry and has the ability to infect wild birds and cause subsequent outbreaks in poultry, as observed in South Korea. Therefore ongoing monitoring and testing of wild birds and domestic poultry in the EU is important to detect and prevent further spread of this virus in the EU.

Poultry workers that have been in direct contact with infected poultry at the affected holding should be monitored for ten days in order to document possible related symptoms.

Read the ECDC Rapid Risk Assessment on Outbreak of highly pathogenic avian influenza A(H5N8) in Germany

Europe | ECDC – Rapid risk assessment on the outbreak of Legionnaires’ disease in Portugal

The current outbreak of Legionnaires’ disease in Vila Franca de Xira, in the Lisbon area of Portugal is one of the largest outbreaks of the disease in the European Union to date.

As of 12 November, 311 cases have been identified, of which seven have died. Despite the magnitude of the outbreak, this event can be considered a local event and the risk is confined to people in the area or who have travelled to the area in the past three weeks. Investigations are ongoing to discover the source of the outbreak, and cooling towers of major industrial installations in Vila Franca de Xira have been closed as a precaution.
The risk assessment also looks at the possibility of Legionnaires’ disease being transmitted through the transfusion of infected blood, and concludes that this risk is low.
Legionnaires’ disease is a severe pneumonia caused by Legionella bacteria. The disease is not transmitted from person-to-person but through inhalation of contaminated aerosols or aspiration of contaminated water. The illness can be severe and fatality can occur in 8–12% of cases. Known risk factors for the disease include increasing age, male gender, smoking, chronic lung disease and other conditions associated with immunodeficiency.

Europe | ECDC – Epidemiological update: outbreak of Ebola virus disease in West Africa

Since December 2013 and as of 9 November 2014, WHO has reported 14 098 confirmed, probable and suspected cases of Ebola virus disease (EVD) in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and two previously affected countries (Nigeria and Senegal). There have been 5 160 reported deaths. This is an increase of 830 cases and 200 deaths since 4 November.

Distribution of cases

Countries with widespread and intense transmission:

  • Guinea: 1 878 cases and 1 142 deaths as of 9 November 2014;
  • Liberia: 6 822 cases and 2 836 deaths as of 8 November 2014;
  • Sierra Leone: 5 368 cases and 1 169 deaths as of 9 November 2014.

Countries with an initial case or cases, or with localised transmission:

  • Mali reported three confirmed and two probable cases, including four deaths;
  • United States: four confirmed cases, including one death;
  • Spain: one case, no deaths;
  • Nigeria: 20 cases and eight deaths. Nigeria was declared Ebola free on 19 October 2014;
  • Senegal: One confirmed imported case. Senegal was declared Ebola free on 17 October 2014.

Situation in Guinea, Sierra Leone, Liberia and Mali

According to WHO, the weekly incidence appears to be stable at the country level in Guinea. In Sierra Leone, the weekly incidence continues to rise, while in Liberia it appears to be declining. In all three countries, EVD transmission remains persistent and widespread, particularly in the capital cities. All administrative districts in Liberia and Sierra Leone have reported at least one confirmed or probable case of EVD since the start of the epidemic. Cases and deaths continue to be under-reported.

In Mali, after the report of a first case in Kayes imported from Guinea on 23 October, WHO reported four additional cases in Bamako that are not linked to the first case. Two are probable cases from Guinea, one was admitted in a clinic in Bamako on 25 October and died on 27 October, the second was a visitor of this patient who also died (the date of his death is not available so far). The two other cases are confirmed cases in health care workers who cared for the patient in the clinic. One died on 11 November.

Download the data
  • EVD epicurve data
    Cumulative number of cases and deaths for the five West African countries with reported EVD cases (Liberia, Guinea, Sierra Leone, Nigeria, Senegal). Source: WHO
  • EVD map data
    Cumulative number of cases and deaths at subnational level of the five West African countries with reported EVD cases (Liberia, Guinea, Sierra Leone, Nigeria, Senegal). Source: National situation report
    For those weeks without reported data, the most recent figures were used as best estimate of the number of case).

Be well. Practice big medicine.