flipboard.social is one of the many independent Mastodon servers you can use to participate in the fediverse.
Welcome to Flipboard on Mastodon. A place for our community of curators and enthusiasts to inform and inspire each other. If you'd like to join please request an invitation via the sign-up page.

Administered by:

Server stats:

1K
active users

#who

18 posts17 participants0 posts today

No surprise here: The #WHO Emergency Committee on #mpox, outside experts advising Director-General Tedros, concluded at a meeting Thursday that mpox is still a public health emergency of international concern (PHEIC). Tedros concurred with the EC's recommendation.

13th #Meeting of #WHO Expert Working #Group on #Surveillance of #Antiviral Susceptibility of #Influenza Viruses for WHO #GISRS

Source: World Health Organization, Weekly Epidemiological Record: https://www.who.int/publications/journals/weekly-epidemiological-record

{Excerpt, edited}

Executive summary

The WHO Expert Working Group on Surveillance of Influenza Antiviral Susceptibility (AVWG) supports the WHO Global Influenza Surveillance and Response System (GISRS) by providing practical guidance for monitoring the antiviral susceptibility of seasonal and emerging influenza viruses The 13th WHO AVWG meeting was held in hybrid format (faceto-face and virtually) on 13–14 June 2024 in Lyon, France.

Update on susceptibility of seasonal influenza viruses to approved antiviral agents

Between May 2023 and May 2024, WHO collaborating centres (CCs) and participating national influenza centres (NICs) reported that seasonal influenza activity in various regions had resumed to levels before the coronavirus disease 2019 (COVID-19) pandemic. Co-circulation of A(H1N1)pdm09, A(H3N2) and influenza B/Victoria lineage viruses was detected in most regions. Overall, influenza A and B viruses with reduced inhibition (RI) or highly reduced inhibition (HRI) to neuraminidase (NA) inhibitors (NAIs) were detected at low frequency. The most frequently identified substitution associated with RI or HRI by NAIs was NA-H275Y in A(H1N1)pdm09 viruses, which was detected at <2%. Double amino acid substitutions (NA-I223V+ NA-S247N) in A(H1N1)pdm09 viruses (referred to as dual mutant viruses) that resulted in RI by oseltamivir were first detected in May 2023 and spread rapidly to several regions of the world.{1,2} Influenza A and B viruses with amino acid substitutions in the polymerase acidic (PA) protein associated with reduced susceptibility to endonuclease inhibitor (baloxavir) were detected at low frequency. The PA-I38X (including I38T, I38N, I38M and I38V) amino acid substitution being the most frequently reported, but the overall detection frequency has remained low (<2%).

Update on susceptibility of zoonotic and animal influenza viruses to approved antiviral agents

From May 2023 to May 2024, clade 2.3.4.4b A(H5N1) highly pathogenic avian influenza (HPAI) viruses continued to be detected in various regions of the world. Since early 2024, there has been an outbreak of clade 2.3.4.4b A(H5N1) genotype B3.13 viruses in dairy cattle in several states in the United States of America, resulting in sporadic zoonotic infections in humans. In addition, human infection with clade 2.3.2.1c A(H5N1) HPAI has been reported in Cambodia and Viet Nam. WHO CCs, participating NICs and WHO H5 reference laboratories reported antiviral susceptibility testing of A(H5N1) HPAI, low pathogenic avian influenza (LPAI) of various subtypes and swine influenza viruses. Of the clade 2.3.4.4b A(H5N1) HPAI viruses, the NA-T438I substitution, which confers RI by zanamivir and peramivir, was detected at <2% frequency. NA-H275Y, NA-N295S and NA-N295S+NA-T438N associated with RI or HRI by NAIs were also detected among A(H5N1) viruses. NA-T438I has been detected in A(H5N1) viruses isolated from dairy cattle. PA-I38T, PA-A37T and PA-I38M, associated with reduced susceptibility to baloxavir, were detected in A(H5N1) viruses. Most A(H5N1) HPAI viruses remain susceptible to M2 ion channel blockers. Among LPAI, NA-H274Y with HRI by oseltamivir was detected in one A(H8N4) isolate. PA-E199G with reduced susceptibility to baloxavir was detected in one A(H9N2) virus. Overall, animal or zoonotic influenza viruses with reduced susceptibility to NAIs or baloxavir were detected at very low frequencies.

Update of protocols and guidance for GISRS laboratories

Genotypic and/or phenotypic assays can be used to monitor the susceptibility of influenza viruses to NAIs and baloxavir. The WHO AVWG routinely reviews and updates information on NA{3,4} and PA{5} amino acid substitutions associated with reduced susceptibility to NAIs and baloxavir, respectively. Reference virus panels that can be used for NAI and baloxavir susceptibility testing are available for GISRS laboratories at the International Reagent Resource.{6} The WHO AVWG will develop an algorithm for NICs to decide on testing strategies (genotypic versus phenotypic) and methods according to their capacity. Guidance on phenotypic assays for NAI susceptibility testing is provided in a WHO guidance document to NICs, which was updated in 2018.{7} A new phenotypic assay has been developed for testing susceptibility to baloxavir.{8} The protocol will be posted on the WHO website. The WHO-AVWG will also update the WHO guidance document to NICs to include the new phenotypic assay for baloxavir susceptibility testing. In addition, the WHO AVWG will work with the Global Initiative on Sharing All Influenza Data{9} to facilitate identification of NA and PA substitutions in submitted sequences.

Review of external quality assessment programme (EQAP) panels

EQAP was initiated in 2007, and the antiviral panel was introduced in 2013 (panel 12) as an optional component of EQAP to evaluate the ability of NICs to identify influenza viruses with reduced susceptibility to NAIs. Genotypic testing for baloxavir susceptibility was introduced in 2020 (panel 19) for educational purpose (i.e. not scored). Results for the 2023 Global EQAP panel were reported at the 13th WHO AVWG meeting. A total of 178 laboratories participated in the 2023 EQAP; 46 (25.8%) participated in NAI susceptibility testing and 16 (9.0%) in baloxavir susceptibility testing. The results from the Global EQAP antiviral panel are used by members of the WHO AVWG to assess the training requirements of NICs.

Way forward

Two reports, on global antiviral surveillance in 2020-2023 and in 2023–2024, are being prepared for publication. The next WHO AVWG meeting is scheduled for June 2025.

___

{1} Leung RC et al. Global emergence of neuraminidase inhibitor-resistant influenza A(H1N1)pdm09 viruses with I223V and S247N mutations: implications for antiviral resistance monitoring. Lancet Microbe. 2024;5(7):627–8. doi:10.1016/S26665247(24)00037-5.

{2} Patel MC et al. Multicountry spread of influenza A(H1N1)pdm09 viruses with reduced oseltamivir inhibition, May 2023-February 2024. Emerg Infect Dis. 2024;30(7):1410–5. doi:10.3201/eid3007.240480.

{3} Summary of neuraminidase (NA) amino acid substitutions associated with reduced inhibition by neuraminidase inhibitors (NAIs). Geneva: World Health Organization; 2023 (https://www.who.int/publications/m/item/summary-of-neuraminidase-(na)-amino-acid-substitutions-associated-with-reduced-inhibition-by-neuraminidase-inhibitors-(nais).

{4} Summary of neuraminidase (NA) amino acid substitutions associated with reduced inhibition by neuraminidase inhibitors (NAIs) among avian influenza viruses of Group 1 and Group 2 NAs. Geneva: World Health Organization; 2024 (https://www. who.int/publications/m/item/summary-of-neuraminidase-(na)-amino-acid-substitutions-associated-with-reduced-inhibition-by-neuraminidase-inhibitors-(nais)among-avian-influenza-viruses-of-group-1-and-group-2-nas).

{5} Summary of polymerase acidic (PA) protein amino acid substitutions analysed for their effects on baloxavir susceptibility. Geneva: World Health Organization; 2024 (https://www.who.int/publications/m/item/summary-of-polymerase-acidic-(pa)-protein-amino-acid-substitutions-analysed-for-their-effects-on-baloxavirsusceptibility).

{6} See https://www.internationalreagentresource.org.

{7} Practical guidance for national influenza centres establishing or implementing neuraminidase inhibitor susceptibility surveillance. Geneva: World Health Organization; 2024 (https://www.who.int/publications/i/item/practical-guidance-for-national-inf luenza-centres-establishing-or-implementing-neuraminidase-inhibitor-susceptibility-surveillance).

{8} Baloxavir susceptibility assessment using influenza replication inhibition neuraminidase-based assay (IRINA). Atlanta (GA): Centers for Disease Control and Prevention; 2023 (https://cdn.who.int/media/docs/default-source/influenza/avwg/ cdc-phenotypic-lp-492rev01d—baloxavir-susceptibility-assessment-using-irina. pdf?sfvrsn=f24254ac_3).

{9} See https://gisaid.org.

_____

www.who.intThe Weekly Epidemiological Record (WER)The Weekly Epidemiological Record (WER) serves as an essential instrument for the rapid and accurate dissemination of epidemiological information.
#aH3n2#aH5n1#aH9n2

13th #Meeting of #WHO Expert Working #Group on #Surveillance of #Antiviral Susceptibility of #Influenza Viruses for WHO #GISRS

Source: World Health Organization, Weekly Epidemiological Record: {Excerpt, edited} Executive summary The WHO Expert Working Group on Surveillance of Influenza Antiviral Susceptibility (AVWG) supports the WHO Global Influenza Surveillance and Response System (GISRS) by providing practical guidance for monitoring the antiviral susceptibility of…

etidioh.wordpress.com/2024/11/

ETIDIoH · 13th #Meeting of #WHO Expert Working #Group on #Surveillance of #Antiviral Susceptibility of #Influenza Viruses for WHO #GISRS
More from ETIDIoH

#Influenza at the #human – #animal #interface #summary and #assessment, 1 November 2024 – 28 September to 1 November 2024

Source: World Health Organization, https://www.who.int/publications/m/item/influenza-at-the-human-animal-interface-summary-and-assessment–1-november-2024

{Excerpts}

Influenza at the human-animal interface

Summary and risk assessment, from 28 September to 1 November 2024{1}

New human cases{2}: From 28 September to 1 November 2024, the detection of influenza A(H5) virus in 30 humans and influenza A(H9N2) virus in one human were reported officially.

Circulation of influenza viruses with zoonotic potential in animals: high pathogenicity avian influenza (HPAI) events in poultry and non-poultry continue to be reported to the World Organisation for Animal Health (WOAH).{3} The Food and Agriculture Organization of the United Nations (FAO) also provides a global update on avian influenza viruses with pandemic potential.{4}

Risk assessment{5}: Based on information available at the time of the risk assessment, the overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the occurrence of sustained human-to-human transmission of these viruses is currently considered unlikely. Although human infections with viruses of animal origin are infrequent, they are not unexpected at the human-animal interface.

IHR compliance: All human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005).{6} This includes any influenza A virus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or protein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human population. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.

___

{1} This summary and assessment covers information confirmed during this period and may include information received outside of this period.

{2} For epidemiological and virological features of human infections with animal influenza viruses not reported in this assessment, see the reports on human cases of influenza at the human-animal interface published in the Weekly Epidemiological Record here.

{3} World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at: https://www.woah.org/en/disease/avian-influenza/#ui-id-2.

{4} Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic Potential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-withzoonotic-potential.

{5} World Health Organization (2012). Rapid risk assessment of acute public health events. World Health Organization. Available at: https://iris.who.int/handle/10665/70810.

{7} World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all circumstances under the International Health Regulations (2005). Case definitions for the four diseases requiring notification in all circumstances under the International Health Regulations (2005).

___

(…)

A(H5), United States of America (USA)

Since the last risk assessment of 27 September 2024, influenza A(H5) virus has been detected in 30 humans in the USA; of these, 20 cases were detected in California and 16 of those have been confirmed through partial or whole genome sequencing as clade 2.3.4.4b A(H5N1) viruses, closely related to those detected in dairy cattle. Whole genome sequences from nine of these indicate the viruses are of the B3.13 genotype which is the same genotype detected in dairy cattle.

The ten cases reported in Washington reportedly had exposure to poultry infected with avian influenza viruses. Genetic sequencing of three of these cases confirms that all are A(H5N1) viruses from clade 2.3.4.4b and that all are closely related genetically to the viruses causing infections in poultry on the farm where depopulation was conducted. CDC has successfully obtained partial gene sequences for viruses from three cases in Washington with other cases pending sequence analysis.{7} All cases were reported as adults > 18 years of age; all had reported mild illness and none were hospitalized, and all had recovered or were recovering at the time or reporting. All cases reported mild symptoms. Cases had onsets of illness between 28 September and 26 October 2024. Intensive epidemiological investigation of the case previously reported in Missouri with unknown exposure could not identify any link to an animal or animal product exposure; serology testing of the case and six contacts was negative for five contacts and showed weak immune signals in the sample from the case and one household contact who reported identical symptoms onset. These findings support a single common exposure, which remains unknown, rather than human-to-human transmission.{8,9} Low pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds in the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and backyard flocks in 48 states, impacting over 100 million birds. To date, 37 people have tested positive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in 2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy cattle, except for one case where the exposure source could not be identified. A(H5N1) virus infections in dairy cattle and wild and domestic birds continue to be reported in the USA.{10} According to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in wild and domestic birds in Asia, Europe and the Americas. Infections in non-human mammals are also reported, including in marine and land mammals.11 A list of bird and mammalian species affected by HPAI A(H5) viruses is maintained by FAO.{12}

___

{7} CDC A(H5N1) Bird Flu Response Update November 4, 2024. Available at: https://www.cdc.gov/birdflu/spotlights/h5n1-response-11012024.html.

{8} World Health Organization. Influenza at the human-animal interface, Summary and risk assessment, from 20 July to 27 September 2024. Available at: https://cdn.who.int/media/docs/default-source/influenza/humananimal-interface-risk-assessments/influenza-at-the-human-animal-interface-summary-and-assessment–from20-july-to-27-september-2024.pdf?sfvrsn=355e503c_1&download=true.

{9} United States Centers for Disease Control and Prevention. CDC Report on Missouri H5N1 Serology Testing. Available at: https://www.cdc.gov/bird-flu/spotlights/missouri-h5n1-serology-testing.html.

{10} United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock, 19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpaidetections/livestock.

{11} World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at: https://www.woah.org/en/disease/avian-influenza/#ui-id-2.

{12} Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic Potential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-withzoonotic-potential/bird-species-affected-by-h5nx-hpai/en.

____

Risk Assessment for avian influenza A(H5) viruses:

{1.} What is the current global public health risk of additional human cases of infection with avian influenza A(H5) viruses? Most human cases so far have been infections in people exposed to A(H5) viruses, for example, through contact with infected poultry or contaminated environments, including live poultry markets, and occasionally infected mammals and contaminated environments. While the viruses continue to be detected in animals and related environments humans are exposed to, further human cases associated with such exposures are expected but unusual. The impact for public health if additional cases are detected is minimal. The current overall global public health risk of additional human cases is low.

{2}. What is the likelihood of sustained human-to-human transmission of avian influenza A(H5) viruses? No sustained human-to-human transmission has been identified associated with the recent reported human infections with avian influenza A(H5). There has been no reported human-to-human transmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007 and the years prior, small clusters of A(H5) virus infections in humans were reported, including some involving health care workers, where limited human-to-human transmission could not be excluded; however, sustained human-to-human transmission was not reported. Available evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to efficiently transmit between people, therefore sustained human-to-human transmission is thus currently considered unlikely at this time.

{3}. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers? Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further communitylevel spread is considered unlikely as current evidence suggests these viruses have not acquired the ability to transmit easily among humans.

(…)

____