Roundup and analysis of the top headlines on health security, pandemic preparedness, COVID-19, and other news from the Johns Hopkins Center for Health Security
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August 1, 2024
TOP NEWS
Poor surveillance likely missing human H5N1 cases, study suggests; UKHSA raises risk assessment; WHO launches mRNA vaccine development initiative
Poor surveillance has likely missed H5N1 avian influenza infections among farmworkers who were exposed to sick dairy cattle, a preprint study posted on medRxiv this week suggests. The research, which is under review for publication by a leading infectious disease journal, showed that neutralizing antibodies against H5N1 were found in 2 blood samples taken from 14 farmworkers who were recently symptomatic but not previously tested. That amounts to a nearly 15% detection rate from a small sample of workers on only 2 dairy farms out of nearly 175 herds with outbreaks in 13 states this year. The researchers called for stepped up efforts to collect more comprehensive epidemiological data from cattle farms to design interventions and implement mitigation measures.
The US CDC’s bird flu test, the only one currently available for clinical use, reportedly has faced some flaws in ability to detect H5, but the agency has found a workaround to fix the shortcomings. Still, the mishap raises concerns and is reminiscent of dysfunctional tests made by CDC at the start of the COVID-19 pandemic.
Current situation
As of July 26, the CDC reports 13 human cases of avian influenza A(H5) infection in 3 states since April 2024. Of these cases, 4 are associated with exposure to sick dairy cows, while 9 are linked to infected poultry. The agency announced on July 25 that 3 additional cases were confirmed in Colorado poultry workers involved in culling infected chickens. Colorado—which has reported all 9 human cases associated with poultry, as well as one human case associated with dairy cattle, in the current outbreak—recently launched a data table to track human avian flu cases detected in the state.
US CDC response
In response to the growing outbreak, the CDC has implemented several measures, including this week announcing US$10 million for additional efforts. The agency will supply US$5 million to organizations such as the National Center for Farmworker Health to educate and train workers on protecting themselves against bird flu. It will provide an additional US$5 million to a campaign to vaccinate livestock industry workers against seasonal flu. Those shots will not protect workers directly against H5N1. The rationale is to reduce the risk of coinfection with human and avian flu viruses, which could lower the risk of genetic reassortment that could potentially lead to a more transmissible virus strain. Some experts maintain that the US should offer avian flu-specific vaccines to farmworkers at risk of infection, as Finland is doing. Furthermore, officials are so far not planning to vaccinate cows either.
UKHSA risk assessment
The CDC maintains that the risk to the general public remains low. Notably, however, the UK Health Security Agency (UKHSA) recently quietly updated its risk assessment for H5N1, specifically the 2.3.4.4b B3.13 genotype currently circulating in US dairy cows, raising it from level 3 to level 4 on a 6-tier scale. This increase was made with moderate confidence, citing ongoing transmission despite biosecurity measures and the potential for undetected mild zoonotic cases in humans. The UKHSA noted high uncertainty regarding the outbreak's trajectory and emphasized that this higher risk level indicates the virus may be an increasing human health threat due to either increased opportunities for evolution or evidence of ongoing evolution.
WHO mRNA vaccine initiative
WHO this week launched a new initiative to accelerate the development of mRNA-based vaccines against human H5N1 infections, with a focus on supporting research in low- and middle-income countries (LMICs). Led by Argentinian manufacturer Sinergium Biotech, the project aims to create proof-of-concept for mRNA-based H5N1 vaccines through preclinical trials and then share the technology, materials, and expertise with a network of manufacturers in LMICs. The initiative is part of WHO's broader mRNA Technology Transfer Hub and marks the first time a vaccine developer has volunteered know-how to the hub. The initiative could help improve vaccine access in LMICs as well as speed vaccine production during another pandemic.
Mpox cases up 160% in Africa over last year, with little access to treatments, vaccines; Kenya, CAR, Burundi, Rwanda latest nations to report cases
In 2024, mpox cases and deaths have risen by 160% and 19%, respectively, in Africa compared to the same period in 2023, the Africa CDC said this week, warning the risk of further spread is high given a lack of treatments or vaccines on the continent. Kenya and the Central African Republic (CAR) this week declared new outbreaks of mpox. In Kenya, a case was detected in a person traveling from Uganda through Kenya to Rwanda at a border crossing in the south of the country. CAR officials said they are “very concerned” about the cases there, as the outbreak extends to the capital city of Bangui.
The Democratic Republic of Congo (DRC) remains the worst affected country on the continent, with 13,791 cases and at least 450 deaths reported this year, according to the Africa CDC. Most of the cases in DRC are among children, with at least 130 cases detected among youth in displacement camps around Goma. The East African Community regional bloc issued an alert to member states about the disease in DRC, which borders 5 countries in the region as well as 4 others. Burundi and Rwanda, 2 of these neighboring countries, have both recently reported mpox cases for the first time.
Most of these cases are the result of cross-border travel to DRC and are clade I monkeypox virus (MPXV), which can cause more severe illness and higher mortality than the clade II virus that caused the 2022 global mpox outbreak. Complicating these outbreaks is a novel strain of clade Ib MPXV, which has genetic mutations that appear to be facilitating community transmission through sexual transmission and other forms of close contact and that can evade detection by some existing tests. The case fatality rate (CFR) for the clade I outbreaks ranges between 3–5%, but up to 10% among children with severe illness. South Africa has reported 22 cases of clade II MPXV with 3 deaths since May 2024.
A new research consortium established earlier this year to help counter mpox outbreaks in Africa is seeking funding. MpoxReC is focusing its response on new outbreaks in endemic countries as well as previously unaffected countries in Africa. CEPI announced the launch of a clinical trial in DRC and other countries in Africa to assess whether post-exposure vaccination of Bavarian Nordic’s MVA-BN® mpox vaccine could reduce the risk of secondary mpox cases, or, if a person contracts mpox, could reduce their severity of illness. In June, Bavarian Nordic announced a donation of 15,000 doses of mpox vaccine to DRC and other countries experiencing mpox outbreaks.
MORE HEADLINES
Global Pandemic Preparedness Summit highlights dangers of climate change, need to expand research, importance of ensuring equitable access, overall shortcomings in preparedness
Health Policy Watch: Brazil Pandemic Summit Underscores the Global Gaps in Preparedness
PAHO: Addressing health equity is key to ensuring better pandemic preparedness, PAHO Director says
WHO: CEPI and WHO urge broader research strategy for countries to prepare for the next pandemic
See also: MedCity News: What the Ebola Outbreak Reveals about Pandemic Preparedness (opinion)
New White House guidelines aim to protect federally funded research entities from foreign threats
Science: U.S. invests $67 million in national research security centers
American Institute of Physics: White House Issues New Security Rules for Government-Funded Research
See also: New York Times: A.I. May Save Us, or May Construct Viruses to Kill Us (opinion)
US admits ‘missteps’ in communications regarding Chinese COVID-19 vaccines in Philippines
Reuters: U.S. told Philippines it made ‘missteps’ in secret anti-vax propaganda effort
Think Global Health: U.S. Disinformation Plan Put Geopolitics Above Global Health (commentary)
COVID summer wave continues in US, with national wastewater viral activity at high level
CIDRAP: COVID activity continues at brisk pace across much of US
The Guardian: Covid surges in US as unequal access plagues vaccination and treatment rates
Axios: Mapped: COVID summer continues to heat up
ABC News: What to know about the updated COVID vaccines coming this fall
See also: The Nation: Why Covid Keeps Winning (opinion)
Multiple athletes test positive for COVID at Paris Olympics in first Games with no disease-specific restrictions
The Guardian: Covid cluster worsens in Australian Olympic camp as Zac Stubblety-Cook reveals infection
Yahoo Sports: Paris Olympics: Multiple swimmers, including two Americans, test positive for COVID but aren't sent home
See also: Today: Olympic athletes swim in Seine after bacteria levels drop in Paris river
Trust in doctors, medical system declined significantly during COVID pandemic; higher trust increased odds of getting vaccinated
CIDRAP: Americans' trust in doctors, hospitals plunged during pandemic, survey suggests
Washington Times: Study finds declining trust in doctors and hospitals during COVID hurt vaccination rates
“I don’t believe that the lack of trust is primarily the fault of the physicians and hospitals, but the fault of the politicians who first evaded the issue, then abdicated their responsibilities and eventually used the pandemic as just another partisan issue to wield against their political opponents.” – Dr. Amesh Adalja, Center for Health Security Senior Scholar, who was not involved in the study
SARS-CoV-2 spillover from humans to animals widespread, study shows
CIDRAP: SARS-CoV-2 widespread in Virginia wildlife, likely from people
HealthDay News: COVID-19 Virus Is Widespread in U.S. Wildlife
A team from the Johns Hopkins Center for Health Security, along with partner ministries in Jordan and Iraq, recently held a simulation exercise at 2 border crossings between the nations to develop, assess, and test systems and protocols to respond to a transboundary zoonotic event. Read more about the effort in this LinkedIn post from the Center’s team leader, Senior Scholar Dr. Erin Sorrell.
RSV season begins in Florida; vaccine makers enter second year of shots with narrower market
KFF Health News/Tampa Bay Times: Florida’s RSV Season Has Started, and It’s Coming Soon to the Rest of US. Here’s a Primer.
Fierce Pharma: With new CDC recommendations, RSV market's long-term value falls sharply in US: Airfinity
US records 188 measles cases in 2024 so far, triple last year’s total; most cases among unvaccinated people
Fox News: Measles cases surge to triple last year's — with 5 months to go
NBC News: Measles cases in the U.S. are already triple last year’s total, and it’s only July
See also: Minnesota Dept of Health: Health officials confirm three measles cases in metro area
2024 worst year on record for global dengue cases, with warmer temperatures, overseas travel driving disease spread
Precision Vaccinations: Don't End Summer Vacation With Dengue
The Lancet: Dengue: the threat to health now and in the future (editorial)
MedPage Today: Dengue Fever's Worrisome Surge (opinion)
Early, widespread West Nile virus activity may portend more serious season in US
CNN: Early West Nile activity may point to a once-in-a-decade spike in infections. Here’s what survivors want you to know
San Fran Chronicle: Bay Area county reports first West Nile death in nearly two decades
KHOU: 7 cases of West Nile virus confirmed in Harris County residents; over 500 positive mosquito samples
New York Times: What to Know About the West Nile Virus in New York
As 2 malaria vaccines deployed in African nations, scientists call for urgent, multipronged approach to curb drug-resistant malaria
STAT: Behind the malaria vaccines: A 40-year quest against one of humanity’s biggest killers
STAT: 4 takeaways from STAT’s story on the development of malaria vaccines
Gavi VaccinesWork: How effective are malaria vaccines?
Council on Foreign Relations: Is Africa at a Turning Point for Malaria?
VOA News: Urgent action needed to stop spread of drug-resistant malaria, scientists warn
WHO sends more than 1M vaccines for children in Gaza, prequalifies Biological E novel polio vaccine
Reuters: Polio cases 'very likely' in Gaza population, WHO says
Reuters: WHO sends over 1 mln polio vaccines to Gaza to protect children
CIDRAP: WHO prequalifies Biological E novel oral polio vaccine
See also: The Guardian: Children in Gaza are now at risk of polio as well as bombs – we need a ceasefire now (opinion)
Introduced legislation in US House aims to improve indoor air quality in buildings, including schools, childcare facilities, receives endorsement from several entities
Rep. Paul D. Tonko: Tonko, Fitzpatrick Introduce Bill to Improve Indoor Air Quality
ACHR News: IAQ Bill Wins Support
“Unlike drinking water or food, we can’t choose the air we breathe. Thanks to Representatives Tonko and Fitzpatrick’s leadership, the Indoor Air Quality and Healthy Schools Act will ensure that we and future generations all have clean indoor air to breathe.” – Statement endorsing the bill from Center for Health Security Contributing Scholar Dr. Paula Olsiewski
COVID-19 pandemic showed need for enhanced ventilation standards, study says; Australian state launches project to clean indoor air
News Medical: Ventilation must go beyond open windows to prevent airborne diseases, experts urge
ABC (Australia) News: Victoria's new 'clean air' project could help end the COVID pandemic and boost productivity
Melbourne officials investigating legionnaires’ disease outbreak, with 60 confirmed cases
The Guardian: Melbourne’s ‘explosive’ legionnaires’ disease outbreak surges to 60 confirmed cases
The Guardian: Legionnaires outbreak: Australians are contracting the lung disease, what is it and do I need to worry?
See also: WBAL: Another bacteria outbreak linked to Legionnaires' disease found at Baltimore office building
Urgent interdisciplinary research needed to understand risks of, interventions for air pollution exposure; wildfire smoke may pose greater health risk than other types
News Medical: Air pollution: a pressing global health crisis demanding urgent interdisciplinary action
AP: Wildfire smoke may be worse for your brain than other air pollution, study says
As Earth experiences hottest recorded days ever, UN Secretary-General calls for urgent, concerted international efforts to address extreme heat
Euronews: UN Secretary-General calls for action to curb extreme heat
United Nations: Secretary-General's Call to Action on Extreme Heat
The Atlantic: The Global Temperature Just Went Bump
Certain deli meats, produce, pre-packaged foods sold in US recalled due to possible listeria contamination
AP: Boar’s Head expands recall to include 7 million more pounds of deli meats tied to listeria outbreak
Food Safety News: Fresh produce, dips and pre-packaged vegetables sold at Kroger recalled after testing finds Listeria
Forbes: Everything To Know About The Listeria Outbreaks—Including What To Avoid And Who Is Most At Risk
See also: BBC: How fixing food might stop the next pandemic
Center for Health Security Senior Scholar Dr. Caitlin Rivers provides updates on food-related outbreaks and recalls, as well as influenza-like illnesses including COVID-19, in her weekly newsletter Force of Infection. To learn more and sign up, visit: https://caitlinrivers.substack.com/about.
FROM THE CENTER
Center for Health Security publishes meeting report from the 2024 Southeast Asia Strategic Multilateral Biosecurity Dialogue
The Johns Hopkins Center for Health Security this week published a meeting report from the ninth in-person Southeast Asia Strategic Multilateral Biosecurity Dialogue, hosted by the Center in Singapore from April 16–18, 2024. This year’s dialogue included participants from Indonesia, Malaysia, the Philippines, Singapore, Thailand, and the United States.
For the past decade, this dialogue has built and strengthened a network of senior government officials and other experts, dedicated to establishing resilience against the broad scope of biosecurity risks affecting this critical region. Even as countries around the world continue to combat COVID-19 and rebound from the historic impacts experienced in the early years of the pandemic, the 2024 Southeast Asia dialogue pushed participants to look forward, beyond the COVID-19 pandemic, to build on key lessons and strengthen the policies, programs, and capacities necessary at the national and regional levels to combat natural, accidental, and deliberate biological threats.
To access the 2024 Southeast Asia dialogue report, as well as reports from previous meetings, visit the project page: https://centerforhealthsecurity.org/our-work/research-projects/southeast-asia-strategic-biosecurity-dialogue.
