Global high consequence infectious disease events Monthly update
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Global high consequence infectious disease events Monthly update May 2019
Global high consequence infectious disease events: May 2019 update
About Public Health England
Public Health England exists to protect and improve the nation’s health and wellbeing,
and reduce health inequalities. We do this through world-leading science, knowledge
and intelligence, advocacy, partnerships and the delivery of specialist public health
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Prepared by: Emerging Infections and Zoonoses Section, PHE
For queries relating to this document, please contact: epiintel@phe.gov.uk
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Published June 2019
PHE publications PHE supports the UN
gateway number: GW-485 Sustainable Development Goals
2Global high consequence infectious disease events: May 2019 update
Introduction
This monthly report provides detailed updates on known high consequence infectious
disease (HCID) events around the world.
This report details all the HCID pathogens that are covered during epidemic intelligence
activities. The report is divided into 2 sections. The first contains contact and airborne
HCIDs that have been specified for the HCID Programme by NHS England. The
second section contains additional HCIDs that are important for situational awareness.
Each section consists of 2 tables of known pathogens and includes descriptions of
recent events. A third table will be included in the second section when undiagnosed
disease events occur that could be interpreted as potential HCIDs.
Likelihood assessment
Included for each disease is a ‘likelihood assessment’; the likelihood of a case
occurring in the UK, based on past UK experience and the global occurrence of travel-
associated cases. There are 3 categories currently: LOW, VERY LOW and
EXCEPTIONALLY LOW. This assessment is as of January 2019.
When considering clinical history, it is important to remember that cases can and do
occur outside of the usual distribution area. It is not possible to assess accurately the
risk of cases presenting to healthcare providers in England, but taken together it is
inevitable that occasional imported cases will be seen.
Events found during routine scanning activities that occur in endemic areas will briefly
be noted in the report. Active surveillance, other than daily epidemic intelligence
activities, of events in endemic areas will not be conducted (such as actively searching
government websites or other sources for data on case numbers).
The target audience for this report is any healthcare professional who may be involved
in HCID identification.
3Global high consequence infectious disease events: May 2019 update
Section 1. Incidents of significance of primary HCIDs
Ebola virus disease – outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo (DRC)
Contact HCIDs
Infectious Geographical risk areas Source(s) and route of UK experience Likelihood
disease infection to date assessment
Endemic in Central and • bite from or crushing Two confirmed cases LOW
Eastern Europe, Central of an infected tick (ex-Afghanistan 2012; Rarely reported in
Asia, the Middle East, • contact with blood or ex-Bulgaria 2014) travellers (23 cases in
East and West Africa. tissues from infected world literature)
First locally acquired case livestock
in Spain 2016 • contact with infected
(Risk Assessment) patients, their blood
or body fluids
Crimean-Congo
haemorrhagic fever Recent cases/outbreaks:
(CCHF) • Russia is reporting sporadic cases, consistent with seasonal transmission
• Namibia declared an outbreak, consisting of 1 confirmed case and 6 suspected cases (of which
5 tested negative as of 15 May) across 5 regions in the country
• South Africa reported its third case of the year, in North West province
• Iranian media reported that 12 people have been diagnosed with CCHF since 21 March 2019,
compared to 25 cases in the same period last year
• Kazakhstan reported a fatal case in a child who reportedly acquired infection in Kyrgyzstan
• Turkish media reported a suspected fatal case in Sivas province
4Global high consequence infectious disease events: May 2019 update
Sporadic outbreaks in • contact/consumption of Four confirmed cases VERY LOW
Western, Central and infected animal tissue (1 lab-acquired in UK Other than during the
Eastern Africa (such as bushmeat) in 1976; 3 HCWs West Africa outbreak,
• contact with infected associated with West exported cases are
human blood or African epidemic extremely rare
body fluids 2014-15)
Recent cases/outbreaks:
The Ebola outbreak in DRC is ongoing. As of 1 June, a total of 1,994 confirmed and probable
Ebola virus cases have been reported across 22 health zones in North Kivu and Ituri provinces. This is an
disease increase of 459 confirmed cases in the past month, compared to 406 in April. A new health zone in
North Kivu, Alimbongo, reported a confirmed case for the first time that was epidemiologically
linked to Katwa. An additional 28 probable cases were retrospectively identified across 7 health
zones – all community deaths which had occurred between 30 January and mid-May. The overall
security situation remains highly unpredictable with ongoing threats and attacks against response
teams. The WHO Strategic Advisory Group of Experts (SAGE) recommended adaptations to the
Ebola vaccination strategy to address insecurity and community feedback.
The risk for the UK population has not changed and is currently assessed as negligible to very low.
Endemic in sub-Saharan • contact with excreta or 14 cases since 1971, LOW
West Africa materials contaminated all ex-West Africa Overall it is the most
with excreta of infected common imported VHF
rodent but still rare (global total
• inhalation of aerosols 35 reported since 1969)
Lassa fever of excreta of infected
rodent
• contact with infected
human blood or body
fluids
Recent cases/outbreaks:
5Global high consequence infectious disease events: May 2019 update
• as of 2 June, a total of 2,639 suspected cases, including 581 confirmed, have been reported
across 22 states in Nigeria. Weekly case numbers have decreased since week 10, and only 27
cases were reported in the 4 weeks to 2 June
• Liberia has reported 64 suspected cases, including 13 deaths, since the beginning of the year.
Of these, 22 have been confirmed. Ten were reported in the month of May.
Sporadic outbreaks in Contact with infected No known cases in VERY LOW
Central and Eastern blood or body fluids UK Five travel-related
Africa cases in the world
Marburg virus
literature
disease
Recent cases/outbreaks:
• no cases reported since November 2017
6Global high consequence infectious disease events: May 2019 update
Airborne HCIDs
Infectious Geographical risk areas Source(s) and route of UK experience to Likelihood assessment
disease infection date
All human infections • Close contact with No known cases in UK VERY LOW
acquired in China infected birds or (PHE Risk Assessment)
their environments
• Close contact with
Influenza
infected humans (no
A(H7N9) virus
sustained human-
(Asian lineage)
human transmission)
Recent cases/outbreaks:
• no confirmed or suspected human cases of H7N9 were reported in May
Human cases • Close contact with No known cases in UK VERY LOW
predominantly in SE Asia, infected birds or their (PHE Risk Assessment)
but also Egypt, Iraq, environments
Pakistan, Turkey, Nigeria. • Close contact with
Highly pathogenic H5N1 in infected humans
Influenza birds much more (no sustained
A(H5N1) virus widespread, including UK human-human
transmission)
Recent cases/outbreaks:
• no confirmed or suspected human cases of H5N1 were reported in May
• avian outbreaks were reported in Vietnam and Nepal with no (further) associated human cases
Middle East The Arabian Peninsula – • birborne particles Five cases in total; 3 VERY LOW
respiratory Yemen, Qatar, Oman, • direct contact with imported cases (2012, (PHE Risk Assessment)
syndrome Bahrain, Kuwait, Saudi contaminated 2013 and 2018), 2
(MERS) environment secondary cases in
7Global high consequence infectious disease events: May 2019 update
Arabia and United Arab • direct contact with close family members
Emirates camels of second case; 3
deaths
Recent cases/outbreaks:
• 14 cases, including 5 deaths, were reported in Saudi Arabia in May; 12 were primary and 2 were
secondary cases. In total, Saudi Arabia has reported 150 cases across the country since January 2019
West and Central Africa • close contact with Three cases in total; VERY LOW
infected animal or 2 imported (Sept Reported outside Africa
human 2018) and 1 for the first time in 2018
• indirect contact with nosocomial (2 in UK and 1 in Israel)
contaminated transmission
material eg bed linen
Recent cases/outbreaks:
Monkey pox
• as of 05 May, 1,739 suspected cases have been reported from northwestern DRC in 2019. The
most affected provinces are Sankuru (56%), Tshuapa (10%) and Ecuador (10%)
• laboratory-confirmed monkeypox was reported in Singapore. The patient, a Nigerian citizen, had
recently attended a wedding in Nigeria, where he may have consumed bushmeat. The patient
recovered and all 22 close contacts in Singapore completed their monitoring period (21 days)
without developing disease
8Global high consequence infectious disease events: May 2019 update
Outbreaks in Bangladesh • direct or indirect No known cases in UK EXCEPTIONALLY LOW
and India; SE Asia at risk exposure to infected No travel-related
bats; consumption of infections in the
contaminated raw literature
date palm sap
• close contact
with infected
Nipah virus
pigs or humans
Recent cases/outbreaks:
• Kerala Health Ministry in India reported 1 confirmed case of Nipah virus infection in Ernakulam.
Close contacts are being monitored. This outbreak comes 1 year after an outbreak occurred in a
different part (Kozhikode) of Kerala, with 17 deaths. The source of the current outbreak is
unknown and investigations are ongoing
Predominantly sub- • flea bites Last outbreak in UK VERY LOW
Saharan Africa but also • close contact with 1918 Rarely reported in
Asia, North Africa, South infected animals travellers
Pneumonic America, Western USA • contact with human
plague (Yersinia cases of pneumonic
pestis) plague
Recent cases/outbreaks:
• no confirmed or suspected human cases were reported in May
Currently none; 2 • airborne particles Four cases related to EXCEPTIONALLY LOW
Severe acute outbreaks originating from • direct contact with con- 2002 outbreak Not reported since 2004
respiratory China 2002 and 2004 taminated environment
syndrome (SARS) Recent cases/outbreaks:
• no confirmed or suspected human cases reported since 2004
9Global high consequence infectious disease events: May 2019 update
Section 2. Incidents of significance of additional HCIDs
Nothing of significance
Contact HCIDs
Infectious Geographical risk areas Source(s) and UK experience Likelihood assessment
disease route of infection to date
Argentina (central). • direct contact with No known cases in UK EXCEPTIONALLY
Limited to the provinces of infected rodents LOW
Buenos Aires, Cordoba, Santa • inhalation of Travel-related cases
Fe, Entre Rios and La Pampa infectious rodent have never been
fluids and excreta reported
Argentine
• person-to-person
haemorrhagic
transmission has
fever (Junin virus)
been documented
Recent cases/outbreaks:
• as of 16 May, Argentina has reported 3 confirmed cases of Junin virus from Santa Fe province in
2019. This is consistent with the same time period last year
Bolivia – limited to the • direct contact with No known cases in UK EXCEPTIONALLY
Department of Beni, infected rodents LOW
Bolivian municipalities of the provinces • inhalation of Travel-related cases
haemorrhagic Iténez (Magdalena, Baures infectious rodent have never been
fever (Machupo and Huacaraje) and Mamoré fluids and excreta reported
virus) (Puerto Siles, San Joaquín • person-to-person
and San Ramón) transmission has
been documented
10Global high consequence infectious disease events: May 2019 update
Recent cases/outbreaks:
• Bolivia reported 1 confirmed case in an infant (less than 6 months of age) in Potosi Department
Single case acquired in • presumed rodent No known cases in UK EXCEPTIONALLY
Zambia lead to a cluster in contact (excreta, or LOW
South Africa in 2008 materials contam- Single travel-related
inated with excreta case; not reported
Lujo virus disease of infected rodent) anywhere since 2008
• person-to-person
via body fluids
Recent cases/outbreaks:
• no confirmed or suspected human cases reported since 2008
Only reported from China • presumed to be tick No known cases in UK EXCEPTIONALLY
(southeastern), Japan and exposure LOW
Korea • person-to-person Not known to have
transmission occurred in travellers
described in
household and
hospital contacts,
Severe fever with via contact with
thrombocytopenia blood/bloodstained
syndrome (SFTS) body fluids
Recent cases/outbreak:
• South Korea reported 11 cases in May, relatively consistent with previous years
• Japan reported 8 cases in May, bringing the total reported in 2019 to 25. This is consistent with
previous years
(China does not provide publically available data on cases of SFTS)
11Global high consequence infectious disease events: May 2019 update
Airborne HCIDs
Infectious Geographical risk areas Source(s) and UK experience Likelihood assessment
disease route of infection to date
Chile and Southern • rodent contact No known cases in UK VERY LOW
Argentina (excreta, or materials Rare cases in travellers
contaminated with have been reported
excreta of infected
rodent
• person-to-person
Andes virus transmission
(Hantavirus) described in
household and
hospital contacts
Recent cases/outbreaks:
• Chile reported 3 cases of hantavirus in May, bringing the total for 2019 to 49 cases and 9 deaths
(Chile has stopped reporting specific Hantaviruses separately)
Mostly China (March 2017 Close contact with No known cases VERY LOW
new strain in Greece, and infected birds or their Not known to have
subsequently found in environments occurred in travellers
Influenza
Western Europe) (PHE risk assessment)
A(H5N6)
Recent cases/outbreaks:
virus
• no confirmed or suspected human cases of H5N6 were reported in May
• no avian outbreaks of H5N6 were reported in May
Sporadic occurrence • close contact with No known cases VERY LOW
Influenza including Europe and UK infected birds or their Human cases are rare,
A(H7N7) virus environments and severe disease
even rarer
12Global high consequence infectious disease events: May 2019 update
• close contact with
infected humans (no
sustained human-to-
human transmission)
Recent cases/outbreaks:
• no confirmed or suspected human cases of H7N7 were reported in May
Undiagnosed Disease Events
None reported
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