Global high consequence infectious disease events: summary July 2024

Question 1

Interpreting this report

Accepted Answer

The report provides updates on known, high consequence infectious disease (HCID) events around the world as monitored by UK Health Security Agency’s (UKHSA) epidemic intelligence activities.

The report is divided into 2 sections covering all the defined HCID pathogens. The first section 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 contains information on known pathogens and includes descriptions of recent events. If an undiagnosed disease event occurs that could be interpreted as a potential HCID, a third section will be added to the report.

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 (for example, 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, treatment and management.

Risk rating

Included for each disease is a current risk rating based on the probability of introduction to the UK and potential impact on the UK public. Past UK experience and the global occurrence of travel-associated cases are also considered. Currently, all diseases are classified into one of 3 categories: Low, very low and exceptionally low to negligible.

Question 2

Contact HCIDs

Accepted Answer

Crimean-Congo haemorrhagic fever (CCHF)

Geographical risk areas	Endemic in Africa, the Balkans, the Middle East and western and south-central Asia. Cases have also been reported in Russia and Georgia. Spain has previously reported locally acquired cases (first reported in 2016, with the latest case reported in 2024) .
Sources and routes of infection	• bite from, or crushing of, an infected tick • contact with the blood, tissues or body fluids of infected humans or animals
UK experience to date	Two cases have been reported in individuals who have travelled to the UK from Afghanistan in 2012 and Bulgaria in 2014.
Risk rating	Low – rarely reported in travellers.
Recent cases or outbreaks	Between 1 January and 27 July 2024, the World Health Organization (WHO) reported 716 CCHF cases (200 confirmed), including 60 deaths (case fatality rate (CFR) of 8.4%), from Afghanistan. Confirmed cases were reported from 8 provinces. In 2023, Afghanistan reported 1,243 CCHF cases (383 confirmed), including 114 deaths (CFR of 9.2%). In Kazakhstan, on 21 July 2024, media reported 16 cases of CCHF in Kazakhstan since the start of 2024. According to the media report, the 16 cases have been reported from Shymkent, Turkestan and Kyzylorda regions. The report states that 10 cases had exposure to animals during farming activities. Five cases were infected by tick bites and one person had exposure by spending time in endemic areas. A total of 115 contacts of the reported cases have been followed up. In Pakistan on 11 July 2024, media reported a CCHF case in Balochistan. According to the media report, the case is a 40-year-old male from Pishin district, who presented with CCHF symptoms and later tested positive for CCHF (the date of symptom onset and laboratory testing are not stated in the article). The article states that 15 CCHF cases and 3 deaths have been reported in the province in 2024. On 23 July 2024, media reported a confirmed case of CCHF in Rawalpindi, Pakistan. The article states that 2 fatal cases have also been reported in this hospital between 8 and 13 July 2024. On 25 July 2024, media reported 7 cases of CCHF in Astrakhan, Russia in 2024. According to the media report, the number of hospitalised CCHF cases is double the number of cases registered during the same period in 2023. On 28 July 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) reported 4 CCHF cases, and no deaths, from Senegal so far in 2024. One case each was reported from Dakar, Kaolack, Matam and Yeumbeul. In Spain, one confirmed CCHF case was reported in Madrid. The case was a 74-year-old male who became symptomatic on 19 July 2024, following a tick bite in the municipality of Buenasbodas (Toledo Province). The case reportedly died on 27 July 2024.

Ebola virus disease (EVD)

Geographical risk areas	Map of countries which have reported EVD cases up to January 2023. No outbreaks of EVD have since been reported.
Sources and routes of infection	• contact with blood, tissues or body fluids of infected animals, or consumption of raw or undercooked infected animal tissue • contact with infected human blood or body fluids
UK experience to date	Four confirmed cases (one lab-acquired in the UK in 1976, 3 healthcare workers associated with West African epidemic 2014 to 2015).
Risk rating	Very low – other than during the West Africa outbreak, exported cases are extremely rare.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Lassa fever

Geographical risk areas	Endemic in sub-Saharan West Africa.
Sources and routes of infection	• contact with excreta, or materials contaminated with excreta from an infected rodent • inhalation of aerosols of excreta from an infected rodent • contact with infected human blood or body fluids
UK experience to date	Three travel-related Lassa fever cases reported in 2022. Prior to this, 8 imported Lassa fever cases had been reported since 1980, all in travellers from West Africa.
Risk rating	Low – overall, Lassa fever is the most common imported viral haemorrhagic fever (VHF) but importations to the UK are still rare.
Recent cases or outbreaks	In Guinea, 27 cases and 2 deaths have been reported between 1 January and 18 July 2024. Between 1 January and 18 July 2024, Liberia reported 46 Lassa fever cases and 4 deaths. This outbreak began in January 2022. Between 1 January and 28 July 2024, Nigeria reported 958 confirmed and 7,518 suspected Lassa fever cases. 163 deaths were reported amongst confirmed cases (CFR of 17.0%). Confirmed cases have been reported from 28 out of 36 states.

Marburg virus disease (MVD)

Geographical risk areas	Sporadic outbreaks have previously been reported in Central and Eastern Africa. A human case of MVD was reported in August 2021 in Guinea; this was the first case to be identified in West Africa. MVD cases were reported in Ghana for the first time in July 2022. MVD outbreaks were reported for the first time in Equatorial Guinea in February 2023 and in Tanzania in March 2023.
Sources and routes of infection	• exposure in mines or caves inhabited by Rousettus bat colonies • contact with infected human blood or body fluids
UK experience to date	No reported cases in the UK.
Risk rating	Very low – globally, 5 travel-related exported MVD cases have previously been reported in the literature.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Question 3

Airborne HCIDs

Accepted Answer

Avian influenza A(H7N9) virus

Geographical risk areas	All reported human infections have been acquired in China.
Sources and routes of infection	• close contact with infected birds or their environments • close contact with infected humans (no sustained human-to-human transmission)
UK experience to date	No known cases in the UK.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Avian influenza A(H5N1) virus

Geographical risk areas	Human cases have been predominantly reported in South East Asia, but also in Egypt, Iraq, Pakistan, Turkey and Nigeria. Human cases (clade 2.3.4.4b) were reported in Spain and the USA in 2022 and 2024, and in the UK in 2022 and 2023. The first human cases of avian influenza A(H5N1) (clade 2.3.4.4b) were reported from South America in 2023, from Ecuador and Chile. Since October 2023, several human cases of clade 2.3.2.1c have been reported in Cambodia.
Sources and routes of infection	• close contact with infected animals (notably birds) or their environments • close contact with infected humans (no sustained human-to-human transmission)
UK experience to date	Since December 2021, 5 detections were reported in the UK, one in 2022 and 4 in 2023.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	In July 2024, 2 human cases of avian influenza A(H5N1) were reported in Cambodia. The first case is a 3-year-old male from Kirivong district, Takeo Province. He developed symptoms on 29 June 2024 and was hospitalised on 2 July 2024. Avian influenza A(H5N1) infection was confirmed on 5 July 2024. The second case, a 5-year-old female, was asymptomatic and detected through contact tracing of the first case. Samples were collected on 6 July 2024, and tested positive on the same day. Since 2003 and as of 19 July 2024, 42 human cases of avian influenza A(H5N1) have been reported in Cambodia. In 2024, 7 cases including one death was reported. In the United States, the multistate outbreak of avian influenza A(H5N1) in animals including dairy cattle and poultry continues. In 2024, ⁠13 human cases of avian influenza A(H5), including 10 avian influenza A(H5N1) cases associated with this outbreak have been reported, as of 25 July 2024.

Middle East respiratory syndrome (MERS-CoV)

Geographical risk areas	Arabian Peninsula – Bahrain, Jordan, Iraq, Kingdom of Saudi Arabia, Kuwait, Oman, Qatar, United Arab Emirates, Yemen. Evidence has also been reported in Iran and Kenya.
Sources and routes of infection	• airborne particles • direct contact with contaminated environment • direct contact with camels or consumption of raw camel milk
UK experience to date	Five MERS-CoV cases in total – 3 imported cases (2012, 2013 and 2018), 2 secondary cases in close family members of the case in 2013, 3 deaths.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Mpox (clade I only)

Geographical risk areas	Central Africa including, Central African Republic, Cameroon, the Democratic Republic of the Congo (DRC), Gabon and Republic of the Congo.
Sources and routes of infection	• close contact with an infected animal (in an endemic country) or an infected person • contact with clothing or linens (such as bedding or towels) used by an infected person • direct contact with mpox skin lesions or scabs • coughing or sneezing of an individual with an mpox rash • consumption of contaminated bushmeat
UK experience to date	No cases of Clade I mpox have been reported in the UK.
Risk rating	Very low – no known importations of Clade I mpox into the UK.
Recent cases or outbreaks	Sequencing data is often not available for mpox cases reported from endemic African countries where Clade I mpox virus is known to circulate. Therefore, we report below all reported mpox cases from these countries, regardless of whether the samples have been sequenced or clade-tested. Between 1 January and 28 July 2024, the Democratic Republic of the Congo (DRC) reported 13,791 mpox cases (of which 2,628 were confirmed), including 450 deaths (CFR of 3.3%), from 25 out of 26 provinces. In the Central African Republic (CAR), as of 28 July 2024, 213 mpox cases (of which 28 were confirmed) and no deaths were reported from 6 of 7 health regions in CAR. During 2023, 20 mpox cases were reported. During July 2024, Burundi, Kenya, Rwanda and Uganda all reported their first ever cases of mpox. Cases in these countries have subsequently been confirmed to be clade Ib, representing the first geographical expansion of clade I mpox across the East Africa region.

Nipah virus

Geographical risk areas	South East Asia, predominantly in Bangladesh and India. Cases have also been reported in Malaysia and Singapore.
Sources and routes of infection	• direct or indirect exposure to infected bats • consumption of contaminated raw date palm sap • close contact with infected pigs or humans
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low to negligible – no travel-related infections in the literature.
Recent cases or outbreaks	On 21 July 2024, a fatal case of Nipah virus infection was reported from Malappuram District, Kerala State, India. The last confirmed case was reported on 15 September 2023. As of 28 July 2023, 472 contacts of the fatal case (including 220 high risk contacts) have been traced, with no new cases identified. This is the seventh outbreak of Nipah virus in India since 2001.

Pneumonic plague (Yersinia pestis)

Geographical risk areas	Predominantly sub-Saharan Africa but also Asia, North Africa, South America, Western USA. Endemic in Madagascar, Peru, and the DRC.
Sources and routes of infection	• flea bites • close contact with infected animals • close contact with human cases of pneumonic plague
UK experience to date	Last outbreak in the UK was in 1918.
Risk rating	Exceptionally low to negligible
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024. However, on 28 July 2024, media reported that a letter addressed to a French minister discovered at a mail-sorting centre near Dijon, France tested positive for plague. The letter contained a powder, which tested positive for plague in preliminary tests carried out by the police.

Severe acute respiratory syndrome (SARS)

Geographical risk areas	Currently none. Two historical outbreaks originating from China in 2002 and 2004.
Sources and routes of infection	• airborne particles • direct contact with contaminated environment
UK experience to date	Four imported SARS cases related to the 2002 outbreak.
Risk rating	Exceptionally low to negligible
Recent cases or outbreaks	No confirmed or suspected human cases reported globally since 2004.

Question 4

Incidents of significance of additional HCIDs

Accepted Answer

Argentine haemorrhagic fever (Junin virus)

Geographical risk areas	All reported human infections have been acquired in China.
Sources and routes of infection	• close contact with infected birds or their environments • close contact with infected humans (no sustained human-to-human transmission)
UK experience to date	No known cases in the UK.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Bolivian haemorrhagic fever (Machupo virus)

Geographical risk areas	Bolivia – cases have been identified in the departments of Beni (Mamoré, Iténez and Yucuma provinces) and Cochabamba (Cercado province).
Sources and routes of infection	• direct contact with infected rodents • inhalation of infectious rodent fluids and excreta • person-to-person transmission has been documented
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low to negligible – travel-related cases have never been reported.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Lujo virus disease

Geographical risk areas	A single case acquired in Zambia led to a cluster in South Africa in 2008.
Sources and routes of infection	• presumed rodent contact (excreta, or materials contaminated with excreta of infected rodent) • person to person via body fluids
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low to negligible – a single travel-related case has been reported. No cases have been reported anywhere since 2008.
Recent cases or outbreaks	No cases have been reported anywhere since 2008.

Severe fever with thrombocytopenia syndrome (SFTS)

Geographical risk areas	Mainly reported from China (south-eastern), Japan and Korea. Cases have also been reported in Taiwan, Thailand, Myanmar and Vietnam. Serological evidence of SFTS in Pakistan.
Sources and routes of infection	• presumed to be tick exposure • person-to-person transmission described in household and hospital contacts, via contact with blood or bloodstained body fluids
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low to negligible – not known to have occurred in travellers.
Recent cases or outbreaks	Between January and July 2024, the Korean Disease Control and Prevention Agency reported 80 SFTS cases. This is a lower number of cases recorded compared to the equivalent 2023 period (78 cases).

Andes virus (Hantavirus)

Geographical risk areas	Chile and Southern Argentina.
Sources and routes of infection	• rodent contact (excreta, or materials contaminated with excreta from an infected rodent) • person-to-person transmission described in household and hospital contacts
UK experience to date	No known cases in the UK.
Risk rating	Very low – rare cases in travellers have been reported.
Recent cases or outbreaks	On 23 July 2024, media reported a fatal case of hantavirus in a 16-year-old female in Guachipas, Argentina. The article does not specify the type of hantavirus. In Chile, on 24 July 2024, media reported a fatal case of hantavirus in the commune of Cochamo, Los Lagos region. This is the second fatal case in this region for 2024. According to the media article, the case was infected while working with fish farming nets that were likely contaminated. The article does not specify the type of hantavirus.

Avian influenza A(H5N6) virus

Geographical risk areas	Mostly China. New strain reported in Greece in March 2017, and subsequently found in Western Europe in birds.
Sources and routes of infection	Close contact with infected birds or their environments.
UK experience to date	No known cases in the UK.
Risk rating	Very low – not known to have occurred in travellers (UKHSA risk assessment).
Recent cases or outbreaks	In July 2024, one fatal human case of avian influenza A(H5N6) was reported from Anhui Province, China. According to the Centre for Health Protection, the case visited a live poultry market prior to the onset of symptoms on 17 June 2024. The case was hospitalised on 19 June 2024 and died on 8 July 2024. Since 2014, and up to 25 July 2024, 93 confirmed human cases of avian influenza A(H5N6), including 57 deaths (case fatality rate of 61%) have been reported in the WHO Western Pacific Region.

Avian influenza A(H7N7) virus

Geographical risk areas	Sporadic occurrence in birds across mainland Europe and the UK. A human case was reported in Ireland in 1996, 89 cases were reported in the Netherlands in 2003, and 3 human cases were reported in Italy in 2013.
Sources and routes of infection	• close contact with infected birds or their environments • close contact with infected humans (no sustained human-to-human transmission reported)
UK experience to date	No known cases in the UK.
Risk rating	Very low – human cases are rare, and severe disease even rarer.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in July 2024.

Question 5

Authors of this report

Accepted Answer

Emerging Infections and Zoonoses Team, UKHSA