Infectious disease surveillance and monitoring for animal and human health: summary March 2024
Updated 1 August 2024
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Interpreting this report
The UK Health Security Agency’s (UKHSA) Emerging Infections and Zoonoses (EIZ) team uses an integrated horizon scanning approach, which combines information on both human and animal health, to identify and assess outbreaks and incidents of new and emerging infectious diseases globally. For further information about the EIZ team’s horizon scanning process, please see our Epidemic intelligence activities.
This summary provides an overview of incidents (new and updated) of public health significance, which are under close monitoring. The incidents are divided into 2 sections: Notable incidents of public health significance and Other incidents of interest. For each notable incident of public health significance, an incident assessment is provided, based on the EIZ team’s interpretation of the available information.
The report also includes a section that focuses on Novel pathogens and diseases and a final Publications of interest section, which contains new publications relevant to emerging infections.
Epidemiological updates for diseases classified as a high consequence infectious disease (HCID) are published in UKHSA’s HCID monthly summary, unless they are considered a notable incident of public health significance, in which case a more detailed summary will be provided in this report.
For more information, or to sign up to the distribution list to receive an email alert when new reports are published, please contact epiintel@ukhsa.gov.uk
Notable incidents of public health significance
Summary of incidents
| Disease or infection | Location | New or update since the last report |
|---|---|---|
| Avian influenza A(H5N1) | Vietnam | New |
| Rabies | Timor-Leste | New |
Avian influenza A(H5N1): Vietnam
Event summary
In March 2024, Vietnam’s Ministry of Health reported a confirmed case of avian influenza A(H5N1) in a 21-year-old male from Khanh Hoa Province. The case became symptomatic on 11 March 2024, was hospitalised on 15 March 2024, and died on 23 March 2024. The case had no underlying health conditions prior to the onset of illness.
On 19 March 2024, samples were collected from the case for real-time polymerase chain reaction (RT-PCR) testing; returning a positive result for avian influenza A(H5). On 22 March 2024, whole genome sequencing confirmed infection with avian influenza A(H5N1) virus.
The fatal case had no history of contact with dead or infected poultry or human cases but did report trapping wild birds in February 2024. No further cases were detected amongst contacts.
Incident assessment
Between 1 January 2003 and 29 March 2024, 129 human infections with avian influenza A(H5N1), including 65 deaths (case fatality rate (CFR) of 50.4%), have been reported from Vietnam. Prior to this 2024 case, the last case of avian influenza A(H5) was reported in October 2022 from Northern Province of Phu Tho.
The World Health Organization (WHO) assesses the risk to the general population posed by this virus as low. Human infections with avian influenza A(H5N1) are rare and mostly associated with exposure to infected poultry. No evidence of sustained human-to-human transmission has previously been reported.
In the UK, as of 28 March 2024, 5 human infections with avian influenza A(H5N1) have been reported. The risk of avian influenza A(H5N1) infection to UK residents is considered very low. The risk may be higher for those with exposure to potentially infected poultry and/or their contaminated environments.
Rabies: Timor-Leste
Event summary
In March 2024, Timor-Leste reported the first confirmed fatal human rabies case in the country. The case was a 19-year-old female from Pasabe Subregion, Oecusse. She was bitten by a dog on 26 December 2023. The patient did not receive rabies post-exposure prophylactic treatment following the bite.
On 20 March 2024, the patient presented to a local healthcare centre with symptoms of sore throat, hydrophobia, photophobia, cough, and neck stiffness. The patient was transferred to another medical facility on 21 March 2024 and died on 22 March 2024. On 22 March 2024, saliva samples tested positive for rabies by RT-PCR.
Before this case, Timor-Leste had been considered free of canine rabies; therefore in response, Timor-Leste’s Ministry of Health conducted a vaccination campaign of dogs in Oecusse and surrounding municipalities, achieving a vaccine coverage of more than 70%. In addition, risk communication, enhanced surveillance and training of healthcare workers in the clinical management of suspected rabies exposures were implemented.
Incident assessment
Rabies is a vaccine preventable zoonotic disease that causes an acute viral encephalomyelitis. It transmits through infected saliva via bites or scratches from rabid animals (in particular dogs). It is almost invariably fatal once symptoms develop.
Oecusse is an exclave of Timor-Leste which is located within the East Nusa Tenggara province in Indonesia, where rabies is endemic. The WHO has stated that the risk of rabies nationally in Timor-Leste is now considered to be high, due to the limited experience and awareness of residents and healthcare workers regarding rabies, an insufficient stock of human rabies vaccine and the lack of pre-exposure vaccines for frontline healthcare workers.
UKHSA has assessed Timor-Leste as having a high risk of rabies and anyone bitten, scratched or licked by an animal in that country should seek medical attention promptly and have a risk assessment for post-exposure treatment. See further information on rabies risks for travellers.
The UK is considered rabies-free in terrestrial animals, although rabies-like European bat lyssaviruses (EBLV) are present in bats. Human rabies cases are extremely rare in the UK with 6 cases reported since 2000; five were imported cases with animal exposures abroad and one was an infection with EBLV-2 in a bat handler in Scotland. The last rabid terrestrial animal in the UK was a puppy imported from Sri Lanka in 2008.
Summary of other incidents
| Disease or infection | Location |
|---|---|
| Anthrax | multi-country |
| Avian influenza A(H9N2) | China |
| Chikungunya | Brazil |
| Cholera | multi-country |
| Dengue | multi-country |
| Measles | Afghanistan |
| Swine influenza A(H1N2)v | United States |
Anthrax
In Indonesia, on 13 March 2024, media reported 53 suspected human cases (in Indonesian) of anthrax in the Gunungkidul district, Yogyakarta.
In Laos, on 25 March 2024, media reported 54 human cases of anthrax in the southern Champasak province. Response measures implemented by the local health authorities include the quarantine of high-risk areas, ban of abattoirs and culling of infected livestock. Thailand’s Ministry of Health (in Thai) increased its surveillance measures in response to the anthrax outbreak in Laos.
Avian influenza A(H9N2)
In March 2024, 4 human cases of avian influenza A(H9N2) were reported in China. The cases had onset of symptoms in January and February 2024, and all of them recovered. On 12 March 2024, the Centre for Health Protection reported a human case of avian influenza A(H9N2) in 6-year-old male in Anhui Province, who became symptomatic on 3 January 2024. No further case details were provided.
On 28 March 2024, the WHO reported 3 human cases of avian influenza A(H9N2) in China. The first case, a 3-year-old male from Guangxi Province, became symptomatic on 2 February 2024. He was hospitalised on 5 February 2024 and had a severe illness. The case reportedly had exposure to live poultry at a market.
The second case, an 11-year-old male from Jiangxi Province, became symptomatic on 11 February 2024. He was hospitalised with mild illness on 15 February 2024. The third case, a 3-year-old male from Guangdong Province, became symptomatic on 17 February 2024. The case was hospitalised on 19 February 2024 and had a mild illness. Both cases were reportedly exposed to backyard poultry.
Environmental samples taken from the market and backyards of the first and second cases tested positive for avian influenza A(H9), whilst environmental samples associated with the third case tested negative.
Chikungunya
In Brazil, between 1 January and 25 March 2024, 105,922 chikungunya cases and 37 confirmed deaths have been reported by Brazil’s Ministry of Health (accessed 16 April 2024). In 2024, cases peaked in epidemiological week 9 of 2024 (13,046 cases), which is higher than the peak observed in 2023 during epidemiological week 15 (7,448 cases).
Cholera
In Comoros, as of 22 March 2024, 456 cholera cases and 12 deaths (login required) have been reported. The cholera outbreak in Comoros was officially declared on 2 February 2024. Most cases have been reported in Ngazidja (237 cases, 10 deaths). 415 recoveries have been reported.
In Mayotte, on 19 March 2024, media reported the first confirmed cholera case since 2000 (in French). The case travelled from Anjouan (Comoros) to Kwassa and became symptomatic on 18 March 2024. The media report stated that the Mayotte Regional Health Agency prepared a response plan in February 2024 in the event of the introduction of cholera into Mayotte. Response measures include strengthening of health controls at borders, establishment of investigation and monitoring teams and disinfection in the event of cholera case detections.
In Zambia, from October 2023 to 6 March 2024, 21,007 cholera cases and 702 deaths have been reported across 10 provinces. 61 out of 116 districts have reported local cholera transmission. Lusaka is currently the epicentre of the outbreak. Central and Copperbelt provinces have been identified as hotspots, particularly in the fishing districts of Southern and Central provinces. According to the United Nations Children’s Fund, oral cholera vaccine campaigns have been successfully carried out in areas with a high disease burden, achieving a coverage of 99% (1,870,375 out of 1,888,112) of the target population.
In Zimbabwe, since the start of the cholera outbreak on 12 February 2023, a total of 28,974 cholera cases and 603 deaths (case fatality rate of 2%) have been reported as of 17 March 2024. All of Zimbabwe’s 10 provinces are affected with the majority of cases reported from Manicaland, Harare, Mashonaland West and Mashonaland Central provinces.
Dengue
According to the European Centres for Disease Control, more than 2 million dengue cases and over 500 dengue-related deaths have been reported globally. Most cases were reported in the Americas Region, with a cumulative number of 4,883,019 cases and 2,644 deaths reported until week 12 of 2024. This represents a 329% increase in case numbers compared to the same period in 2023 (1,137,614 cases).
In Argentina, 163,419 dengue case and 129 deaths (in Spanish) were reported between January and 31 March 2024. The highest number of dengue cases so far in 2024 were reported in epidemiological week 10 (26,714 cases). Buenos Aires has reported the highest number of dengue cases (43,081 cases) as of epidemiological week 12 of 2024. Cases have been recorded from 19 jurisdictions.
In Indonesia, on 20 March 2024, media reported 27,852 dengue cases and 250 deaths (in Indonesian) nationally since the beginning of 2024 up to 11 March 2024. This is an increase in number of reported cases and deaths when compared to the 2023 equivalent period (12,090 cases and 84 deaths). According to the media article, most cases were reported in East and West Java. The highest incidence rate has been reported in West Jakarta (21.7 cases per 100,000 population).
Measles
In Afghanistan, as of 27 March 2024, a total of 14,570 suspected measles cases and 71 deaths (CFR of 0.5%) were reported. Among suspected measles cases, 11,728 (80.5%) were children under the age of 5-years-old. The epidemiological curve indicates a decline in measles cases during epidemiological week 13, following a steady increase epidemiological week 47 of 2023. The increase in cases was attributed to low immunisation coverage.
Swine influenza A(H1N2)v
On 29 March 2024, the US CDC reported a human case of swine influenza A(H1N2)v. This is the first human case reported in the United States in 2024. The case was a child who had been in contact with pigs. Two of the cases contacts developed mild illness and had been in contact with pigs before the case fell ill. The case is reported to have recovered after being hospitalised on 9 March 2024. There was no evidence of transmission between humans.
Publications of interest
Chapare virus
Chapare virus is a rare viral disease that causes haemorrhagic fever. A recent review summarised the latest epidemiology of Chapare virus. This virus is extremely rare with only 10 reported cases have been documented in the literature, all of which occurred in Bolivia. The incubation period was between 9 and 19 days. The reported CFR was 50%.
The first documented outbreak was between 2003 and 2004 and a second outbreak occurred between 2019 and 2020. Exposure to rodents or their excrement was reported for at least 5 cases, who were agricultural workers or farmers. Human-to-human transmission has been suspected in at least 4 cases (3 of which were health care workers treating a case and one was within a household setting). A potential reservoir was identified through virus detection in tissue samples from the small-eared pygmy rice rat (Oligoryzomys microtis).
Crimean-Congo haemorrhagic fever virus (CCHF)
A cross-sectional study of CCHF virus (CCHFV) was conducted in Northern Tanzania across human and livestock populations to understand the endemicity of the virus. The findings showed that seroprevalence in humans was 15% and as high as 49% in cattle, 33% in goats and 28% in sheep. The seroprevalence in humans was considered to be high, which could suggest a wider exposure of the human population to CCHFV than previously thought. This could be correlated with the relatively high seroprevalence in the ruminant livestock. As such, CCHFV may represent an unrecognized human health risk in this region.
Ebola virus
This review covers the key signs and symptoms of ebolavirus disease, its modes of transmission, and the principles guiding supportive care. Furthermore, it explores recent advancements in treating and preventing ebolavirus infection, highlighting the unique properties of each therapeutic agent and the ongoing progress in discovering new treatment.
The 2 dose Ad26.ZEBOV and the MVA-BN-Filo Ebola virus vaccines (marketing name: Zabdeno/Mvabea) were granted marketing authorisation by the European Medicines Agency in 2020. An open-label randomised phase 2 trial aimed to assess the long-term immunogenicity of the 2-dose vaccination regimen and whether the booster dose given at 1 year or 2 years after the first dose would provide a good immune response. The study showed that booster doses given 1 or 2 years after the first dose resulted in a significant antibody titre increase 7 days after the booster dose was given. One year after booster vaccination, antibody levels remained elevated compared to pre-booster (in other words, first dose only). This study supports a flexible immunisation schedule for prophylactic use in at-risk populations during an outbreak.
Evolutionary drivers of viral zoonoses
Understanding the evolutionary drivers behind zoonotic transmission events helps develop control measures to prevent loss of human life. This study used network and phylogenetic analysis to investigate the mechanisms behind recent viral host spillover events. The analysis showed that viral host jumps occur more frequently from humans to animals than from animals to humans. A key finding was that multi-host viruses in general required less adaptations compared to single-host viruses.
Hantavirus
Hantaviruses are a rodent-borne group of viruses occurring globally with zoonotic potential. A recent study reported the detection of a partial genome of hantavirus in samples collected from Brazilian bats. This partial genome was identified using metagenomic approaches. The sequence shared a 72.8% similarity to an L gene (found in hantaviruses) in the reference genome. This discovery suggests that bats may play a role as a hantavirus reservoir and could have implications for future zoonotic transmission.
Puumala virus
Puumala orthohantavirus (PUUV) is found in the bank vole and when transmitted to humans can cause haemorrhagic fever with renal symptoms. In 2018, a new PUUV variant was reported in Scania, Sweden, which is more than 500km south of previous human hantavirus infections. A secondary case occurred in 2020 within the same area. A recent study sought to investigate the zoonotic source of these cases by conducting rodent trapping studies. PUUV was detected in lung tissue samples in Myodes glareolus bank voles. In addition, these PUUV isolates were not within the same phylogeny as isolates in northern Sweden and Denmark and instead belonged to the Finnish PUUV lineage. This indicates possible introduction from Finland or Karelia (north western Russia), and shows that there is a gap in cross species transmission and evolution of PUUV.
Novel pathogens and diseases
Trypanosoma sp. Pika
Trypanosomatids infect a wide range of hosts including humans and animals. The most notable trypanosomes that cause human disease are Tyrpanosoma brucei and T. cruzi, which cause sleeping sickness and Chagas disease respectively. This study investigated wild rodents as natural host reservoirs and their role in the evolution and emergence of trypanosomes. The study discovered a novel trypanosome, Trypanosoma sp. pika in fleas found on pikas (a small mountain-dwelling rodent). Additionally, a new genotype of a Trypanosomatidae virus (Blechomonas luni) was identified in some of the fleas that infested the pikas. Further research is needed to identify the pathogenicity for humans and animals associated with these protozoan parasites.
Further reading
Avian influenza A(H5N1)
Avian influenza A(H5N6)
Seroprevalence of Avian Influenza A(H5N6) Virus Infection, Guangdong Province, China, 2022
Ebola virus disease
Henipaviruses
New research to develop vaccines against deadly henipaviruses
Invasive/non-native mosquitoes
Malaria
Mpox
Sudan Ebola virus
Oral administration of obeldesivir protects nonhuman primates against Sudan ebolavirus
Related resources
1. High consequence infectious diseases monthly summaries
2. National flu and COVID-19 surveillance reports
3. Avian influenza (influenza A H5N1): technical briefings
4. Avian influenza (bird flu) in Europe, Russia and the UK reports
5. Bird flu (avian influenza): latest situation in England updates
6. Human Animal Infections and Risk Surveillance (HAIRS) group risk assessments and statements
7. Animal and Plant Health Agency (APHA) monitoring of disease in livestock and poultry monthly reports
Authors of this report
UKHSA’s Emerging Infections and Zoonoses team epiintel@ukhsa.gov.uk