A new study finds that daily low-dose aspirin may decrease the risk for hepatocellular carcinoma in patients with chronic hepatitis B infection. …

Ndeindo Ndeikoundam Ngangro, Annie Velter, Nathalie Lydie and Florence Lot

Emi Takashita, Chiharu Kawakami, Rie Ogawa, Hiroko Morita, Seiichiro Fujisaki, Masayuki Shirakura, Hideka Miura, Kazuya Nakamura, Noriko Kishida, Tomoko Kuwahara, Akira Ota, Hayato Togashi, Ayako Saito, Keiko Mitamura, Takashi Abe, Masataka Ichikawa, Masahiko Yamazaki, Shinji Watanabe and Takato Odagiri

In January 2019, two influenza A(H3N2) viruses carrying an I38T substitution in the polymerase acidic subunit (PA), which confers reduced susceptibility to baloxavir, were detected from epidemiologically unrelated hospitalised children in Japan. The viruses exhibited reduced susceptibility to baloxavir but were susceptible to neuraminidase inhibitors. Only one of the two children had been treated with baloxavir. An epidemiological analysis suggests possible transmission of the PA I38T mutant A(H3N2) virus among humans.…

Bozidarka Rakocevic, Anita Grgurevic, Goran Trajkovic, Boban Mugosa, Sandra Sipetic Grujicic, Sanja Medenica, Olivera Bojovic, José Eugenio Lozano Alonso and Tomas Vega

Background: In 2009, an improved influenza surveillance system was implemented and weekly reporting to the World Health Organization on influenza-like illness (ILI) began. The goals of the surveillance system are to monitor and analyse the intensity of influenza activity, to provide timely information about circulating strains and to help in establishing preventive and control measures. In addition, the system is useful for comparative analysis of influenza data from Montenegro with other countries. Aim: We aimed to evaluate the performance and usefulness of the Moving Epidemic Method (MEM), for use in the influenza surveillance system in Montenegro. Methods: Historical ILI data from 2010/11 to 2017/18 influenza seasons were modelled with MEM. Epidemic threshold for Montenegro 2017/18 season was calculated using incidence rates from 2010/11–2016/17 influenza seasons. Results: Pre-epidemic ILI threshold per 100,000 population was 19.23, while the post-epidemic threshold was 17.55. Using MEM, we identified an epidemic of 10 weeks’ duration. The sensitivity of the MEM epidemic threshold in Montenegro was 89% and the warning signal specificity was 99%. Conclusions: Our study marks the first attempt to determine the pre/post-epidemic threshold values for the epidemic period in Montenegro. The findings will allow a more detailed examination of the influenza-related epidemiological situation, timely detection of epidemic and contribute to the development of more efficient measures for disease prevention and control aimed at reducing the influenza-associated morbidity and mortality.…

Basel Karo, Anke Kohlenberg, Vahur Hollo, Raquel Duarte, Lena Fiebig, Sarah Jackson, Cathriona Kearns, Csaba Ködmön, Maria Korzeniewska-Kosela , Dimitrios Papaventsis, Ivan Solovic, Dick van Soolingen and Marieke J. van der Werf

Introduction: Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. Aim: We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. Methods: In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002–14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. Results: A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6–0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2–1.5), male sex (OR: 1.3; 95% CI: 1.1–1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1–1.4), positive HIV status (OR: 3.3; 95% CI: 1.6–6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5–2.2). Conclusions: This study provides evidence for an association between INH mono-resistance and a lower likelihood of TB treatment success. Increased attention should be paid to timely detection and management of INH mono-resistant TB.…

Eric Caumes

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African Swine Fever -- ChinaChina:Since the China Ministry of Agriculture and Rural Affairs (MARA) confirmed its 1st African swine fever (ASF) outbreak in Liaoning Province on 3 Aug 2018, a total of 114 ASF outbreaks have been detected in 28 provinces/autonomous region/municipalities. More than 950 000 pigs have been culled in an effort to halt further spread.[During the week 15-22 Mar 2019, a new ASF outbreak was reported from] Chongqing Municipality: one farm with 91 pigs in Shizhu County.Viet Nam:Since the…

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African Swine Fever -- MoldovaInformation received on [and dated] 18 Mar 2019 from Dr. Vitalie Caraus, Head of Animal Health and Welfare Department, Animal Health and Welfare Department, National Food Safety Agency of the Republic of Moldova, Chisinau, MoldovaSummaryReport type: Immediate notificationDate of start of the event: 14 Mar 2019Date of confirmation of the event: 14 Mar 2019Reason for notification: Recurrence of a listed diseaseDate of previous occurrence: 9 Jul 2018Manifestation of disease:…

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African Swine Fever -- BelgiumThe discovery of a dead wild boar infected with African swine fever [ASF] in zone I north, between Les Fossés and Mellier (Léglise), required adjustment of the limits of the restricted areas. The change was applied in cooperation with the European Commission. Zone I (buffer zone) and zone II (contaminated zone) were expanded to the north.[The updated map is available at - Mod.AS].To date, 687 cases of ASF have been detected in wild boar. As a reminder, the 1st cases of ASF were…

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Anthrax -- IndiaFear of an anthrax and diarrhoea outbreak has triggered panic in Dasmantpur area as 3 people have died of it. The 2 diseases may take the form of an epidemic at the block, which has increased tension among the residents of the area.A medical team also visited and inspected Padabagri village of Dumba Guda panchayat [village council] under the block in Koraput district. The team of officers, comprising Dadhi Baman Tripathy, ADMO Arun Kumar Padhi, Koraput DSMO S. Patnayak and a community…

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Avian Influenza H5N1 -- NepalInformation received on [and dated] 17 Mar 2019 from Dr Bimal Kumar Nirmal, Director General, Department of Livestock Services, Ministry of Agriculture and Livestock Development, NepalSummary:Report type: immediate notificationDate of start of the event: 14 Feb 2019Date of confirmation of the event: 6 Mar 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: 10 Sep 2018Manifestation of disease: clinical diseaseCausal agent: Highly pathogenic…

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Dengue -- Worldwide/UnknownCases by country / Week updated / Serotype / Total / Confirmed / Severe / DeathsCentral America and MexicoBelize / 10 [w/e 8 Mar 2019] / D? / 53 / 53 / 0 / 0Costa Rica / 6 [w/e 8 Feb 2019] / D? / 190 / 0 / 0 / 0El Salvador / 9 [w/e 1 Mar 2019] / D2 / 1304 / 217 / 20 / 0Guatemala / 4 / [w/e 25 Jan 2019] / D2 / 435 / 0 / 17 / 2Mexico / 10 [w/e 8 Mar 2019] / D1,2,3 / 7131 / 900 / 55 / 3Nicaragua / 8 [w/e 22 Feb 2019] / D? / 11 574 / 430 / 0 / 0Latin CaribbeanDominican…

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Eastern Equine Encephalitis -- United StatesA horse in Lowndes County has tested positive for eastern equine encephalitis (EEE).Public Health officials urge South Georgians to always wear mosquito spray whenever outdoors to guard against mosquito-borne illnesses no matter how early in the season it may seem."It is crucial to remember that it is never too early for mosquito bite prevention," says Kenneth Lowery, district epidemiologist. "While we generally see EEE beginning in late spring, it would not be unreasonable to see…

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Ebola -- DR Congo- In the last 21 days, 97 new cases have been reported. The 3 main households for this period are Katwa (33 cases, or 34%), Masereka (18 cases, or 18.6%), and Mandima (15 cases, or 15.5%).- This increase in cases was expected, given the paralysis of the response in the town of Butembo after the armed attacks against the 2 CTEs. In addition, the community dialogue is starting to bear fruit. We are seeing an increase in alerts reported by the community, which makes it possible to detect…

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Equine Herpes Virus -- United StatesThe state of Nevada is recommending all equine events scheduled for this weekend [23-24 Mar 2019] in the Silver State be canceled due to 3 horses in southern Nevada recently testing positive for herpes.In a Tuesday morning [19 Mar 2019] statement from the Nevada Department of Agriculture, state veterinarian JJ Goicoechea "strongly urges" equine events, especially in southern Nevada, be shut down in efforts to slow the spread of equine herpesvirus type 1 (EHV-1), which can cause neurologic…

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Equine Influenza -- Germany…

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Foot and Mouth -- UgandaInformation received on 18 Mar 2019 from Dr. Anna Rose Ademun Okurut, Acting Commissioner, Animal Health, Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, UgandaSummaryReport type: Immediate notificationDate of start of the event: 25 Jan 2019Date of confirmation of the event: 8 Mar 2019Report date: 18 Mar 2019Date submitted to OIE: 18 Mar 2019Reason for notification: New strain of a listed disease in the countryCausal agent: Foot and mouth disease…

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Hantavirus -- ChileThe 3rd hantavirus pulmonary syndrome was confirmed, with positive PCR and ELISA tests, in the Bio Bio region this [Fri 15 Mar 2019]. The case is a 57 year old man, resident of the Arauco province, according to indications by the Bio Bio Health SEREMI [Regional Health Ministerial Secretariat]."The patient was 1st seen in the SAPU Eleuterio Ramírez on [10 Mar 2019], later taken to the Curanilahue Hospital, and on [14 Mar 2019] was taken to the Guillermo Grant Benavente Hospital. There he…

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Leptospirosis -- United StatesA rare bacterial disease that every pet owner should know about has surfaced in a Citrus Heights pet. Leptospirosis is spread from wild animals to pets and humans.The disease is found in standing water and with all the rain lately, veterinarians are reminding people to vaccinate pets. All it takes is a puddle of water or an infected blade of grass to infect an animal, but Leptospirosis is preventable through vaccination.Alarm bells are sounding after a Citrus Heights woman admitted her…

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Lumpy Skin Disease -- RussiaInformation received on [and dated] 18 Mar 2019 from Dr Nikolay Vlasov, Deputy Head, Federal Service for Veterinary and Phytosanitary Surveillance, Ministry of Agriculture, Moscou, RussiaSummary:Report type: immediate notificationDate of start of the event: 7 Mar 2019Date of confirmation of the event: 17 Mar 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: 15 Feb 2019Manifestation of disease: clinical diseaseCausal agent: lumpy skin…

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MERS -- Saudi ArabiaIn the period from 13-21 Mar 2019, there have been a total of 3 newly confirmed cases of MERS-CoV infection reported with the most recent case being reported on 16 Mar 2019. In addition there have been 13 outcomes reported -- 2 deaths and 11 recoveries.Information on newly confirmed cases (3):[1]Date of confirmation report: 15 Mar 2019Case No: 19-1879MERS in Abha city: 41-year-old male in Abha city, Aseer [`Asīr] regionContact with camels: NoCase classification: Under…

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Rabies -- United StatesA rabies alert has been expanded to all of Bay County. The Florida Department of Health in Bay County is expanding a rabies alert issued in March [2019]. Health officials say there were 4 confirmed rabies cases in the span of a month.Health officials say the most recent case involved a rabid raccoon killed by dogs off Oakenshaw Drive between Highway 2301 and Camp Flowers Road in Youngstown. Florida law requires pets 4 months or older to be vaccinated. If an animal is not vaccinated, keep…

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Rabies -- United States[One person] in Aiken county may have been exposed to rabies following an unfriendly encounter with a wild raccoon, according to the South Carolina Department of Health and Environmental Control [DHEC].According to a DHEC press release, the victim was on the North Augusta Greeneway Walking Trail on 16 Mar 2019 when they were bitten by a raccoon. The raccoon was later submitted to DHEC and tested positive for rabies. [Apparently the DHEC knows there is a victim so their earlier statement of…

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Salmonella -- NorwayMore cases of salmonellosis have been reported in Norway with a link to imported dried fruit and coconut. _Salmonella_ Agbeni has been detected in several samples of the snack mixes. _Salmonella_ Gamaba was also found in 2 unopened packages from the same lot. The Norwegian Institute of Public Health (Folkehelseinstituttet) reported 32 confirmed and 7 possible _Salmonella_ Agbeni cases in an update from the 21 confirmed and 9 possible infections earlier this month [March 2019].Bama Gruppen…

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African Trypanosomiasis -- South Africa…

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Yellow Fever -- SudanThe Federal Ministry of Health, in collaboration with the World Health Organization (WHO), Gavi, the Vaccine Alliance, and UNICEF, has launched a large-scale mass vaccination campaign in Sudan to vaccinate more than 8.3 million people 9 months to 60 years of age against yellow fever in the states of Blue Nile, Gezira and Sennar during 10-29 Mar 2019.The campaign represents a crucial step in protecting a large portion of the population and reducing the risk of severe and deadly yellow fever…

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-- IndiaResearchers from the Indian Institute of Toxicology Research (IITR) have detected the presence of a toxin -- zearalenone -- in 84% of the cereals tested in Uttar Pradesh. The toxin, which is produced by soil fungi, behaves like an endocrine disruptor in humans, meaning this fungus can possibly lead to hormonal imbalances, birth defects, and other developmental disorders. Various studies have also indicated signs of early puberty in girls on exposure to a high intake of this toxin.The…

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Zika virus -- Worldwide/UnknownJulia A. Brown, Gursewwak Singh, Joshua A. Acklin, Silviana Lee, James E. Duehr, Anupa N. Chokola et al. Dengue Virus Immunity Increases Zika Virus-Induced Damage During Pregnancy.Highlights- Dengue-specific antibodies can enhance Zika virus pathogenesis during pregnancy- Enhancement of Zika pathogenesis was observed in the placenta, not in the fetus- Placental damage was associated with an increase in infected trophoblasts- This process was found to be FcyR mediatedZika virus…

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Chikungunya -- Worldwide/Unknown…

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Foodborne Illness -- IndiaThree members of a family, including 2 minor girls, fell sick after consuming toxic wild mushrooms in Mirigikhoji village under Patana block in Keonjhar district.According to sources, some members of the family complained of vomiting and nausea after consuming the wild mushroom. They were rushed to the Keonjhar district headquarters hospital where their health condition is stated to be critical.Although the actual reason behind the illness has not been ascertained, the doctor suspected…

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Meningitis - Neisseria -- Worldwide/UnknownThe major cause of meningitis in Africa has changed in recent years, a study published in EBioMedicine and funded by Meningitis Research Foundation has confirmed. A type of bacterial meningitis called MenA (meningococcal group A) has seen huge declines, but now meningococcal groups W, X, and C have risen as major causes of meningitis in the African region known as the meningitis belt [Ref. 1].The meningitis belt countries of sub-Saharan Africa have been repeatedly devastated by meningitis…

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Shigellosis -- Guam [USA]The Department of Public Health and Social Services is monitoring an outbreak of shigellosis on Guam. Shigellosis is an infectious disease caused by a group of bacteria called _Shigella_. Most who are infected with _Shigella_ develop diarrhea, fever, and stomach cramps starting a day or 2 after they are exposed to the bacteria.So far in 2019, a total of 10 cases have been reported, 9 have been confirmed. In 2018, a total of 29 cases of shigellosis were reported; 23 were…

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Poisoning -- MalaysiaOver 100 schools have been closed after the dumping of toxic waste into a river caused hundreds of people to fall ill, including many children, authorities said in Malaysia. Over 500 people, many of them school pupils, have received medical treatment after inhaling the fumes.A lorry [truck] is believed to have dumped the waste in southern Johor state last week, sending hazardous fumes across a wide area.Education Minister Maszlee Malik said his Ministry has decided to close all 111…

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Other Plant Disease -- Worldwide/UnknownBoddupalli Prasanna, International Maize and Wheat Improvement Center [CIMMYT], said maize lethal necrosis disease (MLN) is under control but not eradicated. "We have managed to contain the spread within the region but continue to monitor its movements." A survey conducted in late 2018 in eastern and southern Africa showed no MLN in Malawi, Mozambique, Zimbabwe and Zambia. Incidence is falling in Kenya but MLN continues to spread to other regions in Uganda.Prasanna attributed the success…

A once-promising strategy for HIV suppression failed to show efficacy in humans; now Science publishes an "editorial expression of concern" about the monkey study on which it was based. …

Jean-Paul Guthmann and Walter Haas

Loes Soetens, Jantien A. Backer, Susan Hahné, Rob van Binnendijk, Sigrid Gouma and Jacco Wallinga

Introduction With growing amounts of data available, identification of clusters of persons linked to each other by transmission of an infectious disease increasingly relies on automated algorithms. We propose cluster finding to be a two-step process: first, possible transmission clusters are identified using a cluster algorithm, second, the plausibility that the identified clusters represent genuine transmission clusters is evaluated. Aim To introduce visual tools to assess automatically identified clusters. Methods We developed tools to visualise: (i) clusters found in dimensions of time, geographical location and genetic data; (ii) nested sub-clusters within identified clusters; (iii) intra-cluster pairwise dissimilarities per dimension; (iv) intra-cluster correlation between dimensions. We applied our tools to notified mumps cases in the Netherlands with available disease onset date (January 2009 – June 2016), geographical information (location of residence), and pathogen sequence data (n = 112). We compared identified clusters to clusters reported by the Netherlands Early Warning Committee (NEWC). Results We identified five mumps clusters. Three clusters were considered plausible. One was questionable because, in phylogenetic analysis, genetic sequences related to it segregated in two groups. One was implausible with no smaller nested clusters, high intra-cluster dissimilarities on all dimensions, and low intra-cluster correlation between dimensions. The NEWC reports concurred with our findings: the plausible/questionable clusters corresponded to reported outbreaks; the implausible cluster did not. Conclusion Our tools for assessing automatically identified clusters allow outbreak investigators to rapidly spot plausible transmission clusters for mumps and other human-to-human transmissible diseases. This fast information processing potentially reduces workload.…

Hanna Merk, Csaba Ködmön and Marieke J van der Werf

We assessed progress towards the Sustainable Development Goals target for tuberculosis in the European Union/European Economic Area using the latest tuberculosis (TB) surveillance and Eurostat data. Both the TB notification rate and the number of TB deaths were decreasing before 2015 and the TB notification rate further declined between 2015 and 2017. With the current average decline in notification rate and number of TB deaths however, the EU/EEA will not reach the targets by 2030.…