Wednesday, August 23, 2017

OIE: 3 More Outbreaks Of H5N8 In Wild & Non-Poultry Birds


On the heels of yesterday's report of two new poultry outbreaks in South Africa, today the OIE has received notification of 3 more outbreaks in wild or non-poultry birds.  Two are from Gauteng Province, while the third is from the North West Province, and the first report from that region. 

Affected birds include hobby ducks and swans, white geese, and an African Sacred Ibis (Threskiornis aethiopicus).

This brings the total number of reported outbreaks in South Africa since June 22nd to 22; 14 outbreaks in poultry, and 8 in wild or non-poultry birds.

DHS: NIAC Cyber Threat Report - August 2017



Although this blog is primarily focused on emerging infectious disease threats, community & Individual preparedness comes second on the list of topics I cover. Every September I run a couple of dozen preparedness blogs for National Preparedness Month, and as a native Floridian, I give Hurricane preparedness a fair amount of blog space as well. 
While hurricanes, tornadoes, earthquakes, floods and even pandemics lead the list of `likely' major disasters, the one that keeps most emergency managers awake at night is a prolonged `grid down' event.
Short term power outages affect most of us each year, usually lasting anywhere from a few minutes to a couple of hours. Longer outages, while less common, are far from rare.  A few recent examples:
In 2013, in Dr. Lucy Jones: `Imagine America Without Los Angeles’, we looked at a plausible earthquake scenario that could leave millions of Southern California residents without power, water, internet, and sewer . . . not for weeks . . . but for months.

There are many other areas of the country that could suffer a similar fate, including Alaska,  the Pacific Northwest (see OSU: Pragmatic Action - Not Fatalism - In Order To Survive The `Big One’), New Madrid, or even South Carolina (see #NatlPrep: Half Of All Americans Need An Earthquake Plan).
While the damage might be relatively localized, a major earthquake could damage pipelines, power transmission lines, and other infrastructure that could affect a much larger area of the country. 
Then there's space weather (see USGS: Preparing The Nation For Severe Space Weather) which as the potential to take down an entire nation's electrical grid, and damaging it to the point where it might take years to repair. Similar to a deliberate EMP attack, a `Carrington' level CME directed a earth could seriously damage both our economy and our society.
As vulnerable as we are to natural disasters, as we grow increasingly dependent upon technology, so does our vulnerability to deliberate cyber attacks.
In 2015, Ted Koppel published a book called Lights Out: A Cyberattack, A Nation Unprepared, Surviving the Aftermath, that explores this very scenario, and we've revisited it a number of times over the past few years (see The Lloyd’s Business Blackout Scenario).
Despite years of dire warnings, our infrastructure remains cobbled together out of both old and new equipment, with many places still reliant on 80 year old technology.  
Every four years the ASCE (American Society of Civil Engineers) releases a report card on America’s infrastructure, and their most recent report (2017) warns that our cumulative GPA for infrastructure sits at only a D+, and two of our most vulnerable infrastructures are drinking water and the electrical grid (see When Our Modern Infrastructure Fails).
Some excerpts from that report:

From Energy, which they rate as a D+:

Much of the U.S. energy system predates the turn of the 21st century. Most electric transmission and distribution lines were constructed in the 1950s and 1960s with a 50-year life expectancy, and the more than 640,000 miles of high-voltage transmission lines in the lower 48 states’ power grids are at full capacity. Energy infrastructure is undergoing increased investment to ensure long-term capacity and sustainability; in 2015, 40% of additional power generation came from natural gas and renewable systems. Without greater attention to aging equipment, capacity bottlenecks, and increased demand, as well as increasing storm and climate impacts, Americans will likely experience longer and more frequent power interruptions.
Of course, it isn't just the electrical grid at risk: Think banking, communications, nuclear power plants, even the stock market.   A deliberate attack on any of these sectors could have an extreme impact.

It is against this backdrop that yesterday the President's National Infrastructure Advisory Council (NIAC) released a 45 page report addressing urgent cyber threats to our critical infrastructure.  One that doesn't mince words.  I've only included the executive summary and bullet points.

Follow the link to download the full report, and plan to read it before the lights go out.

Executive Summary: Imperative Takeaways
Our review of hundreds of studies and interviews with 38 cyber and industry experts revealed an echo chamber, loudly reverberating what needs to be done to secure critical U.S. infrastructure against aggressive and targeted cyber attacks. Cyber is the sole arena where private companies are the front line of defense in a nation-state attack on U.S. infrastructure. When a cyber attack can deliver the same damage or consequences as a kinetic attack, it requires national leadership and close coordination of our collective resources, capabilities, and authorities.

Our Assessment

The National Security Council (NSC) tasked the President’s National Infrastructure Advisory Council (NIAC) with examining how Federal authorities and capabilities can best be applied to support cybersecurity of high-risk assets. We reviewed a comprehensive dataset of more than 140 Federal capabilities and authorities, demonstrating impressive depth and complexity of Federal resources.

We believe the U.S. government and private sector collectively have the tremendous cyber capabilities and resources needed to defend critical private systems from aggressive cyber attacks—provided they are properly organized, harnessed, and focused. Today, we’re falling short.


The challenges the NIAC identified are well-known and reflected in study after study. There is a narrow and fleeting window of opportunity before a watershed, 9/11-level cyber attack to organize effectively and take bold action. We call on the Administration to use this moment of foresight to take bold, decisive actions:
Establish SEPARATE, SECURE COMMUNICATIONS NETWORKS specifically designated for the most critical cyber networks, including “dark fiber” networks for critical control system traffic and reserved spectrum for backup communications during emergencies.
ACTION REQUIRED BY: U.S. Department of Energy (DOE), U.S. Department of Homeland Security (DHS), Office of the Director of National Intelligence (ODNI), NSC, and the Strategic Infrastructure Coordinating Council (SICC) (Electricity, Financial Services, and Communications)
FACILITATE A PRIVATE-SECTOR-LED PILOT OF MACHINE-TO-MACHINE INFORMATION SHARING TECHNOLOGIES, led by the Electricity and Financial Services Sectors, to test public-private and company-to-company information sharing of cyber threats at network speed.
Identify best-in-class SCANNING TOOLS AND ASSESSMENT PRACTICES, and work with owners and operators of the most critical networks to scan and sanitize their systems on a voluntary basis.
Strengthen the capabilities of TODAY’S CYBER WORKFORCE by sponsoring a public-private expert exchange program.

Establish a set of LIMITED TIME, OUTCOME-BASED MARKET INCENTIVES that encourage owners and operators to upgrade cyber infrastructure, invest in state-of-the-art technologies, and meet industry standards or best practices.
Streamline and significantly expedite the SECURITY CLEARANCE PROCESS for owners of the nation’s most critical cyber assets, and expedite the siting, availability, and access of Sensitive Compartmented Information Facilities (SCIFs) to ensure cleared owners and operators can access secure facilities within one hour of a major threat or incident.
ACTION REQUIRED BY: DHS, ODNI, NSC, Federal Bureau of Investigation (FBI), Office of Personnel Management, and all agencies that issue/sponsor clearances
Establish clear protocols to RAPIDLY DECLASSIFY CYBER THREAT INFORMATION and proactively share it with owners and operators of critical infrastructure, whose actions may provide the nation’s front line of defense against major cyber attacks.
ACTION REQUIRED BY: NSC, DHS, ODNI, FBI, and the Intelligence Community
PILOT AN OPERATIONAL TASK FORCE OF EXPERTS IN GOVERNMENT AND THE ELECTRICITY, FINANCE, AND COMMUNICATIONS INDUSTRIES—led by the executives who can direct priorities and marshal resources—to take decisive action on the nation’s top cyber needs with the speed and agility required by escalating cyber threats. (Explanatory chart on page 16)
ACTION REQUIRED BY: DOE, DHS, ODNI, NSC, the SICC, the Department of Defense (DOD), Treasury, and Department of Justice (DOJ)
USE THE NATIONAL-LEVEL GRIDEX IV EXERCISE (NOVEMBER 2017) TO TEST the detailed execution of Federal authorities and capabilities during a cyber incident, and identify and assign agency-specific recommendations to coordinate and clarify the Federal Government’s unclear response actions.
Establish an OPTIMUM CYBERSECURITY GOVERNANCE APPROACH to direct and coordinate the cyber defense of the nation, aligning resources and marshaling expertise from across Federal agencies.
Task the National Security Advisor to review the recommendations included in this report and within six months CONVENE A MEETING OF SENIOR GOVERNMENT OFFICIALS to address barriers to implementation and identify immediate next steps to move forward.
ACTION REQUIRED BY: National Security Advisor
The time to act is now. As a Nation, we need to move past simply studying our cybersecurity challenges and begin taking meaningful steps to improve our cybersecurity to prevent a major debilitating cyber attack.
Our Nation needs direction and leadership to dramatically reduce cyber risks. The NIAC stands ready to continue to support the President in this area.
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While there is not much the average citizen can do to mitigate these big ticket concerns, it is important that everyone realize that our infrastructure is vulnerable to a variety of threats, and that as communities and individuals, there is genuine value in being prepared.

So . . . if a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 14  days  . . .  do you have: 

  • A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials?
  • A decent first-aid kit, so that you can treat injuries?
  • Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration?
  • A way to provide light (and in cold climates, heat) for your family without electricity?   And a way to cook?  And to do this safely?
  • A small supply of cash to use in case credit/debit machines are not working?
  • An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag?
  • Spare supply of essential prescription medicines that you or your family may need? 
If your answer is `no’, you have some work to do.  A good place to get started is by visiting
While preparedness may seem like a lot of work, it really isn’t.  You don’t need an underground bunker, an armory, or 2 years worth of dehydrated food.  But you do need the basics to carry on for a week or two, and a workable family (or business) emergency/disaster plan. 
For more information on how to prepare, I would invite you  to visit:

Italy Reports 2 More HPAI H5 Outbreaks (Veneto & Lombardy)

HPAI H5 Since July 1st - Credit IZSV


After a two-week lull, which led authorities to declare `currently all outbreaks of Avian Influenza in Italy have been resolved' on the 18th, Italy's IZSV (Istituto Zooprofilattico Sperimentale delle Venezie) today announced two new outbreaks (1 H5N8, 1 H5) in two different regions.

Highly pathogenic avian influenza (HPAI) in Italy

2016/2017 – H5N5, H5N8
  • Outbreaks | PDF (last update: 22/08/2017)
  • Map | PDF (last update: 22/08/2017)
August 2017
On 21 August, the National Reference Laboratory (NRL) for Avian Influenza and Newcastle Disease confirmed as positive for Avian Influenza A virus a fattening turkey farm in Verona province, Veneto region (subtype H5), and a game birds farm in Lodi province, Lombardy (subtype H5N8).

At the moment of the epidemiological inquiry, in the fattening turkey farm there were 13.248 turkeys (females, 87 day-old). The symptoms started in the days before the confirmation, in particular from Friday there was a sudden increase in the mortality and a decrease in water and feed intake. Culling, cleaning and disinfection procedures are ongoing for this case, while the pre-emptive culling of an at-risk turkey farm, linked to the outbreak, has been planned for the next days. 

Regarding the last case in Lombardy region, in the farm were present about 23.000 birds belonging to different species (pheasants, partridges, mallard hybrids), and the samples were collected after a clinical suspect. Further information on virus characterization and phylogenetic analysis on the two viruses will be provided as soon as available.

Compared to the rest of Europe, Italy came out of this past winter's record avian epizootic  relatively unscathed, losing roughly 360,000 birds across 17 outbreaks between January 1st and May 30th.
Over the past 30 days, however, Italy has reported 15 additional outbreaks, affecting more than 800,000 birds.  Hardest hit has been the Lombardy region (n=10), followed by Veneto (n=4).
While we've seen a smattering of summer bird flu reports across Europe (see DEFRA: Outbreak Assessment On H5N8 In Europe - Summer 2017) - the most recent involving two dead swans in Switzerland - nearly all of the late summer (July & August) reporting has come out of Italy.

This summer activity is a decided change over what was seen with the H5N8 virus in past years, when the virus all but disappeared  (see PNAS: The Enigma Of Disappearing HPAI H5 In North American Migratory Waterfowl).
But the virus that showed up in Europe last fall had undergone extensive changes (see EID Journal: Reassorted HPAI H5N8 Clade - Germany 2016) during the summer of 2016.  It now appears to be more virulent in wild and migratory birds (see here), and has demonstrated an ability to infect a much wider range of birds (see here).
Even as H5N8 hangs on in Italy, and parts of Europe, we find ourselves only 30 to 40 days away from seeing the first arrivals of this fall's southward migration. As we saw in 2016's Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1, this is the time of year when migratory birds are believed most likely to carry, and spread HPAI viruses. 

While past performance is no guarantee of future events, we will need to be on guard for the possibility that HPAI viruses will return to Europe, Asia, and potentially even North America in the months ahead.

Tuesday, August 22, 2017

OIE: H5N8 Reported In South Africa's KwaZulu-Natal Province


Exactly two months ago South Africa reported their first ever outbreak of HPAI H5N8 in a large poultry operation in Mpumalanga Province (see OIE: South Africa Reports Outbreak Of HPAI H5N8). For the first 6 weeks reports were clustered in Mpumalanga and Gauteng Provinces, in the north-east part of the country.
Ten days ago we saw the first reports of H5N8 detected in South Africa's Western Cape Province, signalling a wider spread of the virus.
Today's OIE report adds a 4th province to the affected list, with an outbreak reported at a commercial poultry farm in coastal KwaZulu-Natal province. Another new outbreak is also reported in what appears to be a small holding in hard hit Mpumalanga Province.

This brings South Africa's tally to 14 outbreaks in poultry, and 5 detections in wild birds.

Philippines Lifts Ban On Luzon Poultry - Still Awaiting Full Subtyping


Although the Philippines Reported a 2nd Outbreak Of HPAI H5 Avian Flu last Friday, today Secretary of Agriculture Manny Piñol has announced the lifting of the ban on poultry (outside the quarantine zones) from the island of Luzon, and we have confirmation from the Australian Reference Lab on the virus being an HA H5, but are still waiting for a determination of the NA subtype.

First this statement from the Agricultural Secretary's Facebook page:


By Manny Piñol

The Department of Agriculture and Fisheries (DAF) today lifted the ban on the transport of poultry and poultry products from Luzon to other parts of the country following a report from its bio-security experts that the Avian Influenza cases in San Luis, Pampanga and in San Isidro and Jaen towns in Nueva Ecija have been contained in a seven-kilometer radius.

Earlier today, I signed an Administrative Circular which allowed among others the shipment of dressed chicken, fresh table eggs, cooked duck eggs (balut), day-old chicks, game fowls and others provided these are covered by veterinary certificates issued after tests are conducted by bio-security personnel.

Shipment of fowls, poultry and poultry products coming from inside the 7-kilometer radius of San Luis, Pampanga and the towns of Jaen and San Isidro in Nueva Ecija will not be allowed.

All shipments must be covered by health certificates and quarantine clearances and Quarantine Stations in all airports and ports of the country are directed not to allow passage to poultry and poultry products without the necessary clearances.

The announcement of the lifting of the ban was made after a consultation with stakeholders of the poultry and egg industry in the Agriculture Department Central Office this morning.
The stakeholders forum was facilitated by the Philippine Council for Agriculture and Fisheries through the poultry and livestock sectoral led by Dr. Rufina Salas.

The decision to lift the 11-day-old ban which was declared on Aug. 11 following the confirmation of the presence of Avian Influenza virus in farms in San Luis, Pampanga came following the recommendations made by the Avian Influenza Task Force which handled the containment of the problem in Pampanga and Nueva Ecija.

Dr. Enrico Garzon, assistant secretary for livestock and acting director of the Bureau of Animal Industry, and Dr. Arlene Vytiaco reported that cleaning up operations in San Luis town have been completed while the culling operations in Nueva Ecija are almost complete.

With strict quarantine procedures implemented in the 1-kilometer and 7-kilometer radius of the areas affected, the AI Task Force said the problem has been contained in the three towns.

The National Meat Inspection Service (NMIS) was also instructed today to make rounds of the outlets of poultry and poultry products and post signages certifying that all those sold in the market are safe to eat.

The Administrative Circular will be sent out to the different Quarantine Stations all over the country and shipment from Luzon could immediately start as soon as the shippers could submit the needed health certificates and veterinary clearances.

It's been 10 days since the Philippines announced their first ever HPAI avian flu outbreak, but according to the following report from the Manila Times, we'll probably have to wait a few more days before the viral culprit is fully identified.

Australian lab result confirms bird flu in Pampanga – agriculture dept

By KENNETH HARE HERNANDEZ    on August 22, 2017


Arlene Vytiaco, DA-BAI focal person for avian influenza, said the results verified initial findings in the affected chickens in San Luis town.

“It confirmed our finding at the laboratory. Our test showed that they are positive for avian influenza type A, H5. So our findings are the same as those in Australia,” Vytiaco said.

However, the N subtype is still being verified as the samples needed to be kept in a safe and dry may “There is still no N [sub]type because there are not enough samples and it needs to be propagated to conduct further testing,  so that would take one to three days,” she said.

“We would like to know the N [subtype]so we will know what sub-type it is, but our activities will be the same. Whether it will be H5 or N7 or 5, our activities will be the same to contain the virus-like culling,” she added.

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As previously discussed, in this part of the world the the `usual suspects' would be H5N1, H5N8, or H5N6 - but as we've seen often with the very promiscuous Asian lineage of  HPAI H5  viruses - they can easily spin off other subtypes (H5N2, H5N3, H5N5,H5N9, etc.)  through reassortment with local LPAI avian viruses.

CDC Update: Candida Auris - August 2017


Fourteen months ago (June 24th, 2016) the CDC issued a Clinical Alert to U.S. Health care facilities about the Global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris.

C. auris is an emerging fungal pathogen that was first isolated in Japan in 2009. It was initially found in the discharge from a patient's external ear (hence the name `auris').  Retrospective analysis has traced this fungal infection back over 20 years.

Since then the CDC and public health entities have been monitoring an increasing number of cases (and hospital clusters) in the United States and abroad, generally involving bloodstream infections, wound infections or otitis (see July Update).

Last week the CDC promoted the first ever Fungal Disease Awareness Week, and last Tuesday presented a COCA call webinar called Tackling an Invasive, Emerging, Multi-drug Resistant Yeast: Candida auris — What Healthcare Providers Need to Know, which is now archived and available online. 

Candida auris, an emerging multidrug resistant fungus that can cause invasive infections with high mortality, has been associated with outbreaks in healthcare settings. C. auris was first described in 2009, after being isolated from external ear canal discharge of a patient in Japan. Since then, reports of C. auris infections, including bloodstream infections, have been noted from over a dozen countries—and it has now been found in the United States. As of July 14, 2017, 98 cases have been reported to CDC.

The emergence of C. auris raises several serious concerns for public health. First, many isolates are multidrug-resistant, with some strains having elevated minimum inhibitory concentrations to drugs in all three major classes of antifungal medications, a feature not found in other clinically relevant Candida species. Second, C. auris is challenging to identify, requiring specialized methods like MALDI-TOF or ribosomal DNA sequencing. When using common biochemical methods such as analytical profile index strips or the VITEK 2, C. auris is often misidentified as other yeasts (most commonly Candida haemulonii, but also Candida famata, Rhodotorula glutinis). Finally, C. auris has caused outbreaks in health care settings, spreading from patient to patient, and contaminating healthcare environments. During this COCA call, clinicians will learn about the updated identification, treatment, and infection control recommendtions for C. auris.  

Slides: View Now    Audio: Listen Now   Webcast: Watch Now

The following day CIDRAP's Antimicrobial Stewardship Project (ASP) held an hour long webinar (see below), which is now available on the CIDRAPASP Youtube channel.
(Note: you'll find more than a dozen other on-topic videos available on this channel as well).

Yesterday the CDC updated their C. Auris surveillance page, where they now show 112 cases reported across 8 states, and the number of colonized asymptomatic cases has risen to 120.
August 21, 2017: Case Count Updated as of July 31, 2017

What's New?

Candida auris is an emerging fungus that presents a serious global health threat. Healthcare facilities in several countries have reported that C. auris has caused severe illness in hospitalized patients. Some strains of C. auris are resistant to all three major classes of antifungal drugs. This type of multidrug resistance has not been seen before in other species of Candida. Also of concern, C. auris can persist on surfaces in healthcare environments and spread between patients in healthcare facilities. CDC has developed identification, treatment, and infection control recommendations to help prevent the spread of C. auris.

CDC encourages all U.S. laboratory staff who identify C. auris to notify their state or local public health authorities and CDC at
Location represents the state of C. auris specimen collection. The case counts displayed reflect clinical cases of C. auris (i.e., based on specimens collected in the normal course of care). They do not include patients who screened for presence of C. auris colonization. C. auris has been isolated from an additional 120 patients from healthcare facilities in 4 states where clinical cases were detected.  This map will be updated monthly.


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Some earlier blogs on this emerging pathogen include:
MMWR: Ongoing Transmission of Candida auris in Health Care Facilities
MMWR: Investigation of the First Seven Reported Cases of Candida auris In the United States

mSphere: Comparative Pathogenicity of UK Isolates of the Emerging Candida auris