Human infection with avian influenza A(H7N4) virus – China

On 14 February 2018, the National Health and Family Planning Commission (NHFPC) of China notified the World Health Organization (WHO) of one case of human infection with avian influenza A(H7N4) virus. This is the first human case of avian influenza A(H7N4) infection to be reported worldwide.

The case-patient was a 68-year-old woman from Jiangsu Province with pre-existing coronary heart disease and hypertension and she developed symptoms on 25 December 2017. Seven days later, she was admitted to a local hospital for treatment of severe pneumonia and was discharged after 21 days. On 12 February, the Chinese Center for Disease Control and Prevention (China CDC) confirmed that the case-patient’s samples were positive for avian influenza A(H7N4). The NHFPC confirmed the diagnosis on 13 February 2018. The case-patient had reported a history of exposure to live poultry before onset of symptoms.

Genetic sequencing of this A(H7N4) virus shows that all the virus segments originated from avian influenza viruses. This virus is sensitive to adamantanes and neuraminidase inhibitors based on genetic sequencing.

Twenty-eight close contacts of the case-patient have been under medical observation. Among close contacts, no abnormal findings have been found and all throat swabs from her contacts have tested negative.

Public health response
The Chinese government conducted a risk assessment, and has enhanced prevention and control measures, surveillance and epidemiological investigations including contact tracing and laboratory testing. Public risk communication and information sharing is ongoing.

WHO is in contact with national authorities and is following the event closely. WHO is facilitating information-sharing with Member States and is closely monitoring the situation, in line with the International Health Regulations (2005).

WHO risk assessment
This is the first report of a human case of avian influenza A(H7N4) infection globally and the case reported exposure to live backyard poultry before illness onset. Genetic analysis of this influenza A(H7N4) virus indicates that it is of avian origin.

Close contacts of the case-patient tested negative for avian influenza A(H7N4) and remained asymptomatic. Current evidence suggests that this virus does not have the ability of sustained transmission to humans, thus the likelihood of sustained human to human transmission is low. Any animal influenza virus that develops the ability of human to human transmission can theoretically cause a pandemic.

It is possible that additional human cases of avian influenza A(H7N4) will be detected, however only one human case has been detected so far, and information on the circulation of avian influenza A(H7N4) in birds is not currently available. Further information needs to be gathered to increase the confidence in this assessment.

WHO advice
The public should avoid contact with high-risk environments such as live animal markets/farms and live poultry, or surfaces that might be contaminated by poultry feces. Hand hygiene with frequent washing or use of alcohol hand sanitizer is recommended. WHO does not recommend any specific different measures for travellers.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.



Building health resilience in a fast-changing climate

By Mashida Rashid

When I visited my hometown of Dhaka last September I was shocked. Many of my family and friends were writhing from a mysterious new disease that no one really knew. In my ten years as a public health specialist, I had worked in health systems approaches to malaria, dengue, and other vector borne diseases in Bangladesh, but this was a new one for me. The joint pain that accompanied the fever could stay for months afterwards, and was debilitating. It left previously healthy people hobbling on walking sticks, and apparently there was no cure. The only practical advice was to avoid being bitten by mosquitoes.

So, when ‘Chikunguniya’ was mentioned again at the Prince Mahidol Award Conference in Bangkok — one of the world’s premier public health meets — during a session on climate change and emerging diseases I listened intently.

The name Chikunguniya originates from Tanzania, meaning ‘to become contorted’, describing the stooped appearance of the person who contracts this disease; an apt description of what I had seen in Dhaka.

At the session, organized by the United Nations Development Programme (UNDP), the case study presented was from the mountains of Bhutan. The contrast struck me — geographically the region, at 2000m above sea level, is the very opposite of deltaic, flat land Bangladesh.

Whereas Dhaka’s latest Chikunguniya outbreak comes in the heels of the wettest monsoon in 35 years, this vector-borne disease hadn’t previously made an appearance in the Himalayan range because of its temperate climate. As far away as Italy, a Chikunguniya outbreak followed one of the driest summers in years.

This then is the crux of it: climate change over the years has changed the nature of infectious diseases both spatially and temporally. Diseases are spreading in new and unpredictable ways, and at surprising rates, leaving scientists and policy-makers grappling to understand their etiology and the ramifications.

Several recommendations emerged from the session, as ways to ensure preparedness and build resilience among at-risk communities. Evidence from complex, long-term research has paved the way for modeling, and risk predictions, but there needs to be a thrust on translating that research into practical, actionable policy, and communication of those policies in effective language.

Policy makers not only have to take into account health as a driver, but other non-health sectors such as tourism, transport, and urbanization, in a real effort to understand these complexities.

Integrated, coordinated, multi-sectoral systems responses are what can prevent an outbreak from reaching epidemic proportions.

With advances in data integration and technological innovations, surveillance systems and early warning systems are becoming more sophisticated. This allows for preparedness, which goes a long way in prevention. For example, in 2011 in Singapore there was a three-month advance warning for the next outbreak of dengue: the early warning meant pregnant mothers had three months to prepare themselves for mosquito season, and could ward off potentially life threatening situations. This model, with the right planning, can be replicated for other infectious diseases.

The Building Resilience of Health Systems in Asian Least Developed Countries to Climate Change project, supported by UNDP and the World Health Organization (WHO) with funding from GEF, is strengthening institutional capacities in six Asia Pacific countries to integrate climate risks into health sector planning, improve surveillance and early warning systems, and integrate health into the national adaptation planning processes, among others.

Building resilience to shocks is a step-by-step process. At national levels, it involves providing data to inform government and decision-makers, sharing economic cases that highlight where a country’s finances can deliver the best development gains, and tailoring health systems so that during times of outbreaks, there are well-established processes in place.

At community levels, health resilience requires us to better understand behaviour, adaptive capacity and vulnerabilities. Ultimately, our actions need to empower people, so that they can take stewardship of their future, and be prepared for environmental or health calamities, or both.



Brazil yellow fever: WHO warns travellers to Sao Paulo

The Brazilian state of Sao Paulo, the country's most populous, is at risk of yellow fever, the World Health Organization (WHO) is warning.

The WHO is recommending that travellers to the state and its capital, Sao Paulo, get a yellow fever vaccine before visiting.

The warning comes after a significant rise in numbers of suspected and confirmed cases was reported.

Local officials say travellers will not be at risk if they stay in cities.

Brazilian Health Minister Antonio Nardi said the WHO advice stemmed from "an excess of concern".

What is yellow fever?

  • Caused by a virus that is transmitted to humans by mosquitoes
  • Difficult to diagnose and often confused with other diseases or fevers
  • Most people recover after the first phase of infection that usually involves fever, muscle and back pain, headache, shivers, loss of appetite, and nausea or vomiting
  • About 15% of people face a second, more serious phase involving high fever, jaundice, bleeding and deteriorating kidney function
  • Half of those who enter the "toxic" phase usually die within 10 to 14 days

Source: WHO

He said that while there had been an increase in the number of reported cases it did not constitute an "outbreak".

He also said that most people attending Brazil's famous carnival celebrations in February should be safe as they are held in large cities and not the rural and forested areas which have seen the biggest increase in yellow fever cases.

However, the WHO's advice is for all travellers to the state to get a vaccination at least 10 days prior to travel and to take measures to avoid mosquito bites.

Brazilian health authorities said that since July 2017, 35 cases of yellow fever had been confirmed. Of those, 20 cases proved fatal. Sao Paulo has been the worst-affected state, with 20 confirmed cases.

Mr Nardi said Sao Paulo state authorities would speed up their vaccination campaign with the aim of vaccinating half of the state's population by the end of February.

More than 45 million people live in the state of Sao Paulo.



83 countries affected by Lactalis salmonella scandal: CEO

PARIS - A salmonella scandal at French dairy group Lactalis has affected 83 countries, where 12 million boxes of powdered baby milk are being recalled, the company's CEO said Sunday in an interview with French media.

Emmanuel Besnier, scion of the secretive family behind one of the world's biggest dairy groups, was speaking publicly for the first time since an outcry erupted over claims the company hid the salmonella outbreak at a plant making the product.

"We must take account the scale of this operation: more than 12 million boxes are affected," he said, adding that distributors would no longer have to sort through the produce to find the contaminated powder.

"They know that everything has to be removed from the shelves," Besnier said.

Besnier, who was summoned to the French finance ministry on Friday, promised compensation for all the families affected. He said that the consequences of this health crisis for consumers, including babies under six months, were at the forefront of his mind.

"It is for us, for me, a great concern," he told the Journal du Dimanche.

Hundreds of lawsuits have been filed against the group by families who say their children got salmonella poisoning after drinking powdered milk made by the company.

So far French officials have reported 35 cases of infants getting salmonella from the powder, while one case has been reported in Spain and another is being investigated in Greece.

An association representing victims says the authorities are underestimating the number of cases.

"There are complaints and there will be an investigation with which we will fully collaborate. We never thought to act otherwise," Besnier said.

Created in 1933 by Besnier's grandfather, Lactalis has become an industry behemoth with annual sales of some 17 billion euros (S$27.5 billion), with products including Galbani ricotta and mozzarella in Italy.

With 246 production sites in 47 countries, its list of products also features household names like President butter and Societe roquefort.

Two of those brands, Picot and Milumel baby milk, were the subject of chaotic international recalls issued in mid-December after dozens of children fell sick.

The scandal deepened this month when French investigative weekly Le Canard Enchaine reported that state inspectors had given a clean bill of health to the Lactalis site in Craon, northwest France, in early September.

They failed to find the salmonella bacteria that had been detected by Lactalis's own tests in August and November, which were not reported to the authorities.

The company said it was not legally bound to report the contamination.



Addictive gaming to be recognized as disease: World Health Organization

"Gaming disorder" will be recognized as a disease later this year following expert consensus over the addictive risks associated with playing electronic games, the World Health Organization said Friday.

The disorder will be listed in the 11th edition of the International Classification of Diseases (ICD), to be published in June, WHO spokesman Tarik Jasarevic told reporters in Geneva.

WHO is leading the process of updating ICD-11, which includes input from global health practitioners.

The current working definition of the disorder is "a pattern of gaming behaviour, that can be digital gaming or video gaming, characterised by impaired control over gaming, increased priority given to gaming over other activities to the extent that gaming takes precedence over other interests, Jasarevic said.

Other symptoms include "the continuation and escalation of gaming despite the occurrence of negative consequences".

The provisional guidelines say that an individual should demonstrate an abnormal fixation on gaming for at least a year before being diagnosed with the disorder, which will be classified as an "addictive behaviour", Jasarevic said.

Anecdotal evidence suggests that the condition disproportionately effects younger people more connected to the ever-expanding online gaming world.

But the WHO spokesman cautioned that it was premature to speculate on the scope of the problem.

"Gaming disorder is a relatively new concept and epidemiological data at the population level are yet to be generated", he said.

Despite the lack of hard data, "health experts basically agree that there is an issue" and that official inclusion in the ICD is the next appropriate step, Jasarevic said.

"There are people who are asking for help", he added, noting that formal recognition of the condition will help spur further research and resources committed to combatting the problem.


US funding can save millions of lives through public health programs in 2018

As director of the federal Centers for Disease Control and Prevention (CDC) from 2009 until the beginning of this year, I saw the world make progress against a number of diseases. But in 2018 we will be challenged to make additional progress in protecting public health on multiple fronts – particularly preventing heart attacks, strokes, drug overdoses and epidemics.

Here is an overview of what was achieved this year and what needs to be done in the year ahead.

Opioid overdoses

In 2017 we saw broad recognition that – as we at CDC said back in 2011 – there is a terrible epidemic of opioid overdoses affecting families and communities throughout the United States. The risk is that the continued spread of illicit fentanyl and a lack of concerted action and funding will make it possible for the epidemic to continue.

Preventing epidemics

Many countries improved their ability to track and respond to disease clusters before they become epidemics. However, additional funding for the CDC to partner with other countries to help them develop their ability to stop epidemics will end next year.

If Congress doesn’t provide funding, the U.S. will be forced to abandon these critical efforts, giving our microbial enemies an opening to attack. If in 2018 CDC is forced to retreat from the front lines, the chance that an epidemic like Ebola could happen again will increase.

Programs to prevent epidemics keep Americans safe. They must be continued. Like the war against terrorism, the war against terrible organisms protects our nation from a deadly threat.

Polio eradication

Fewer than 20 cases of polio have been reported around the world so far in 2017.

However, conflicts in Nigeria, Pakistan and Afghanistan – and the need for universal excellence in program operations – may lead to a stalemate in the effort to eradicate polio and protect all children against this dreadful disease forever.

Evaluating preparedness

An additional 40 countries participated in the Joint External Evaluation (JEE) process in 2017, bringing the total to 67. The JEE is a report card for countries to assess how prepared they are to deal with an epidemic. It identifies gaps that need to be addressed.

Unless countries themselves, the World Bank and donor agencies rapidly fill the identified gaps, we will all remain at risk, and countries may lose interest in continuing to assess their status openly and transparently.

This work will be much more difficult if funding cuts force the U.S. to retreat from the field of epidemic prevention.

In 2018, Resolve to Save Lives – the nonprofit organization I now lead – will serve as a catalyst to help countries obtain the technical, operational and financial support they need to address gaps and implement lifesaving programs.

This work is part of our mission to save 100 million lives around the world by implementing proven solutions to prevent heart disease and stroke, the world’s leading causes of death. We are also helping the world prevent the next disease outbreak by catalyzing country action to find, stop and prevent new disease threats.

Blood pressure

Around the world, just one in seven people has their blood pressure under control. The result is literally millions of preventable heart attacks, strokes and deaths, as well as increased medical costs.

Fortunately, the best medicines in the world for the treatment of high blood pressure are generic, safe, effective, once-daily and inexpensive.

This year the American Heart Association and the American College of Cardiology released new guidelines for treating high blood pressure in the U.S.

In our country, life expectancy decreased for the second year in a row – something that hasn’t happened since the 1960s. Opioid use drove this trend, but it was made possible by a stall in the decades-long decrease in cardiovascular deaths.

Better management of blood pressure and cholesterol, and continued decreases in smoking, will be essential to sustaining health progress in the United States. Access to medication and medical care globally will be a major focus of Resolve to Save Lives in 2018.


Global HEARTS is a new initiative from the World Health Organization and the CDC that helps countries scale up prevention and control of cardiovascular disease. This year saw the release of the first draft of the HEARTS technical package details, bringing the world closer than ever to having a playbook to stop the leading cause of death.

Countries now need to implement the HEARTS initiative, increasing the number of people treated for high blood pressure by literally hundreds of millions and reducing sodium intake for billions of people.

Resolve to Save Lives is working with countries around the world to help them achieve their goals of preventing heart attacks and strokes as part of non-communicable disease reduction initiatives.

India Hypertension Management Initiative

In November the government of India and partners took an unprecedented first step toward controlling high blood pressure – a disease that affects more than 200 million adults in India. The India Hypertension Management Initiative gives patients and health-care providers the tools they need for better blood pressure management and control.

However, scaling up effective programs throughout India, particularly for patients cared for by the fragmented private sector, will be difficult.

Trans fat restrictions

This year further demonstrated the public health benefits of reducing artificial trans fat consumption. One study showed there was a significant decline in heart attacks and strokes among New York residents living in areas with trans fat restrictions.

This toxic chemical can be removed from food without altering taste, while drastically improving heart health.

However, only a few countries around the world have policies in place to restrict trans fats. This is something we at Resolve to Save Lives hope to change in 2018.

Resolve to Save Lives was launched this year as an initiative of the global health organization Vital Strategies. We have the tools to address the health issues discussed above and prevent millions of deaths. But unless urgent action is taken, millions of people will continue to die preventable deaths.

We hope that, five years from now, we’ll look back at 2017 as the year these critical public health issues began to improve – similar to improvements we’ve seen in recent decades in progress against HIV/AIDS, polio and smoking.


World Health Organisation (WHO) with Mekong countries call for accelerated action to eliminate malaria before 2030

Representatives from Cambodia, China, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam today called for accelerated action to eliminate malaria in the Greater Mekong Subregion (GMS) by the year 2030. The call comes amid concern over resistance of malaria parasites to antimalarial drugs, including artemisinin—the core compound of the best available antimalarial medicines. To date, resistance has been detected in five of the six GMS countries. The best way to address the threat posed by drug resistance is to eliminate malaria altogether from the countries of the Mekong.

At a high-level meeting convened by the Ministry of Health and Sports of Myanmar in collaboration with the World Health Organization (WHO) and the Asia Pacific Leaders Malaria Alliance (APLMA), representatives from the six GMS countries stressed that eliminating malaria in the Subregion requires urgent and coordinated action, with support from implementing agencies, funders and other partners.

Ministers from the six countries pledged to:

ensure activities to eliminate malaria in the subregion are fully funded, including with more domestic funds;
improve cross-border collaboration and establish an independent oversight body, for which WHO will act as the secretariat;
strengthen systems for the identification and timely reporting of malaria infections, including drug-resistant forms;
provide the best possible prevention, diagnosis and care for all people at risk of malaria, including free services for ethnic minorities and mobile and migrant populations, as part of universal health coverage;
ensure available antimalarial medicines are safe and effective for use;
bring all concerned sectors together to translate policies into time-bound and results-oriented actions; and
engage communities in malaria elimination using innovative communication tools.
Countries requested support from WHO to achieve their malaria elimination goals.

“Malaria is a disease that we can—and must—eliminate from the Greater Mekong Subregion. The drive to achieve this goal by 2030 demonstrates the joint commitment of health leaders from across the subregion to secure the health and well-being of vulnerable populations and ensure no one is left behind,” said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia.

“The malaria parasite doesn’t need a passport or a visa to cross borders. You must work more closely together as one region, with one strategy to drive elimination. Accelerating malaria elimination in the Greater Mekong will not only improve lives today. It will also free future generations from the plague of malaria, and set an example for the rest of the world,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific.

WHO helps governments achieve malaria elimination by:

setting and disseminating guidance and policies on malaria control and elimination;
supporting countries as they adapt, adopt and implement WHO global norms and standards for malaria control and elimination;
assisting countries in the implementation of national malaria strategic plans;
helping countries develop robust malaria surveillance systems; and
responding to requests from countries to address threats, operational emergencies and bottleneck issues.
Recent efforts to fight malaria in the GMS have yielded impressive results. According to the latest WHO estimates, malaria cases in the six countries fell by an estimated 74% between 2012 and 2016. Deaths due to malaria fell by 91% over the same period.

This progress was made possible through greater access to effective malaria control tools, particularly artemisinin-based combination therapies for malaria treatment, rapid diagnostic tests, and insecticide-treated nets. Since 2012, targeted provision of these tools to vulnerable populations has increased substantially across the subregion, leading to acceleration in the pace of progress. Resistance to antimalarial drugs, unless addressed with urgency, could undermine these gains.

Malaria is a life-threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. WHO-recommended malaria control tools include: long-lasting insecticidal bed-nets, spraying inside walls of dwellings with insecticides, preventive treatment for infants and during pregnancy, prompt diagnostic testing, and treatment of confirmed cases with effective anti-malarial medicines.



World Health Organization: Malaria treatment stalls as funding flatlines

The global fight against malaria is grinding to a halt, the World Health Organization warned on Wednesday, amid flat-lining funding and political complacency.

Malaria infected an estimated 216 million people last year — about 5 million more than in 2015 — potentially reversing a six-year trend of decreasing infection cases. The majority of the 440,000 lives claimed by the mosquito-borne disease were young children in sub-Saharan Africa.

WHO Director General Tedros Adhanom Ghebreyesus said "progress appears to have stalled" in the fight against the tropical disease.

"Although there are some bright spots in the data, the overall decline in the global malaria burden has unquestionably levelled off," Ghebreyesus said. "And, in some countries and regions, we are beginning to see reversals in the gains achieved."

Fall in funding

Experts fear financial shortfalls and government complacency have thrown progress off track.

"At the current level of funding and coverage of current tools, we have reached the limits of what can be achieved in the fight against the disease," said Abdisalan Noor, lead author of the WHO's annual malaria report.

Investment into malaria prevention — a third of which came from the US last year — has leveled off since 2010. Analysis by the WHO found that funding in countries with a high risk of malaria had dropped to an average of less than two dollars per person per year.

The WHO says a minimum annual investment of $6.5 billion (€5.5 billion) is required to meet its ambitious 2030 targets.

Funding in 2016 stood at just $2.7 billion.

Change in fortunes

The long-term global decline in malaria-related deaths has helped cut child mortality, driving a sharp increase in global life expectancy.

The WHO has repeatedly made announcement on "the massive roll-out of effective disease-cutting tools" and "impressive reductions in cases and deaths."
Mosquito nets soaked in insecticide — mostly delivered through mass distribution campaigns — are the primary method of protection. But in sub-Saharan Africa fewer than half of households have sufficient access to them.

"If we continue with a business-as-usual approach — employing the same level of resources and the same interventions — we will face near-certain increases in malaria cases and deaths," Ghebreyesus said.

Uneven coverage

Some 80 percent of malaria deaths take place in just 15 countries — 14 sub-Saharan African nations and India.

Emergency work is underway in Nigeria, South Sudan, Venezuela and Yemen, where ongoing humanitarian crises pose further public health risks.
Several countries in the Middle East and central Asia have been certified as malaria-free in the last decade, including Morocco, Armenia and Turkmenistan. Last year, Kyrgyzstan and Sri Lanka joined their ranks, having gone three years without recording an indigenous case of malaria.

"We are up against a tough adversary," Ghebreyesus said. "But I am also convinced that this is a winnable battle."