Friday, May 25, 2018

NOAA 2018 Tropical Outlook: A Near or Above Normal Hurricane Season Expected

















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With a disturbed area of weather over the Yucatan now given a 90% chance of developing into a tropical system over the weekend as it moves slowly north into the Gulf of Mexico, yesterday afternoon NOAA released their 2018 Atlantic Hurricane Season Outlook.
And while not a specific forecast, it is not what storm weary residents of Puerto Rico, Texas, and Florida wanted to hear.
Some excerpts from yesterday's press release, then I'll return with a bit more.

Forecasters predict a near- or above-normal 2018 Atlantic hurricane season
New satellite data and model upgrades to give forecasts a boost

May 24, 2018 NOAA’s Climate Prediction Center is forecasting a 75-percent chance that the 2018 Atlantic hurricane season will be near- or above-normal.
Forecasters predict a 35 percent chance of an above-normal season, a 40 percent chance of a near-normal season, and a 25 percent chance of a below-normal season for the upcoming hurricane season, which extends from June 1 to November 30.

“With the advances made in hardware and computing over the course of the last year, the ability of NOAA scientists to both predict the path of storms and warn Americans who may find themselves in harm’s way is unprecedented,” said Secretary of Commerce Wilbur Ross. “The devastating hurricane season of 2017 demonstrated the necessity for prompt and accurate hurricane forecasts.”

NOAA’s forecasters predict a 70-percent likelihood of 10 to 16 named storms (winds of 39 mph or higher), of which 5 to 9 could become hurricanes (winds of 74 mph or higher), including 1 to 4 major hurricanes (category 3, 4 or 5; with winds of 111 mph or higher). An average hurricane season produces 12 named storms, of which 6 become hurricanes, including 3 major hurricanes.

(SNIP)

In addition to the Atlantic hurricane season outlook, NOAA also issued seasonal hurricane outlooks for the eastern and central Pacific basins. An 80 percent chance of a near- or above-normal season is predicted for both the eastern and central Pacific regions. The eastern Pacific outlook calls for a 70-percent probability of 14 to 20 named storms, of which 7 to 12 are expected to become hurricanes, including 3 to 7 major hurricanes. The central Pacific outlook calls for a 70-percent probability of 3 to 6 tropical cyclones, which includes tropical depressions, tropical storms and hurricanes.

NOAA will update the 2018 Atlantic seasonal outlook in early August, just prior to the peak of the season.
        (Continue . . . )
 
 
While these tropical outlooks don't always pan out, as a native Floridian, I take the threat seriously.  Many hurricanes don't measure up to the hype, but the ones that do (think: Katrina, Andrew Camille, Donna . . . ), often exceed expectations.

And as they say, it only takes one hitting where you live or work, to have a major impact on your life.

Currently the National Hurricane Center is watching what could become the first tropical system of the season (see below), possibly impacting the Gulf coast later this weekend into the early part of next week.

https://www.nhc.noaa.gov/gtwo.php?basin=atlc&fdays=5


While likely mostly a heavy rainmaker, it is possible this system could become a tropical storm or even a minimal hurricane. Residents along the Gulf coast should remain vigilant, and follow the NHC's and any local Emergency Management guidance.


When it comes to getting the latest information on hurricanes, your first stop should always be the National Hurricane Center in Miami, Florida. These are the real experts, and the only ones you should rely on to track and forecast the storm.

If you are on Twitter, you should also follow, @NHC_Atlantic, @NHC_Pacific@FEMA  and @ReadyGov

And if you haven't started your 2018 hurricane preparedness, I'd invite you to revisit Tuesday's blog and  Hurricane Preparedness Week 2018 (May 6th - May 12th).

HK CHP Urges Heightened Vigilance As EV71 Cases Rise



















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Non-polio Enteroviruses (NPEV's) - of which there are dozens - typically spread in the summer and early fall, and generally produce mild or even asymptomatic infections, mostly in children under the age of 10.
Symptomatic cases can range from a mild fever or a runny nose - to HFMD (Hand Foot Mouth Disease) - a generally mild childhood disease characterized by blisters on the hand, feet, and mouth.
In North America HFMD is usually caused by the Coxsackie A16 virus, or less commonly, the Coxsackie A10 virus. In recent years, we’ve also seen the emergence of the Coxsackie A6 virus (see MMWR: Coxsackievirus A6 Notes From The Field) which has been associated with more severe illness.

For several decades - particularly in Asian and Western Pacific nations - we've monitored yearly NPEV epidemics of a much more serious nature, with the most severe illness linked to Human Enterovirus 71 (EV-71), which can cause a polio-like paralysis, and sometimes even death.
Other NPEV's, including EV-D68 and Coxsackievirus A6 are also linked to more severe disease.  But in terms of the number of severe cases, EV-71 is currently the biggest threat.
Yesterday Hong Kong's CHP released their latest EV Scan (Week 21, May 24, 2018), which shows a sharp uptick in the number of EV71 cases in the region during the month of May.
 
EVSCAN (Week 21)
As of May 24, 2018


EV SCAN is a weekly report produced by the Enteric and Vector-borne Disease Office of the Centre for Health Protection, Department of Health. It summarises the surveillance findings of local situation of hand, foot and mouth disease (HFMD) and enterovirus 71 (EV71) infection.


HIGHLIGHTS



  • The activity of hand, foot and mouth disease (HFMD) is increasing in Hong Kong
  • In Hong Kong, the usual peak season for HFMD and EV71 infection is from May to July. A smaller peak may also occur from October to December.
  • HFMD is a common disease in children usually caused by enteroviruses such as Coxsackieviruses and EV71. EV71 infection is of particular concern as it is more likely to be associated with severe medical complications and even death.

https://www.chp.gov.hk/en/guideline/100594.html

Today the CHP issued the following statement:
 
The Centre for Health Protection (CHP) of the Department of Health today (May 25) urged the public to maintain strict personal and environmental hygiene as the local activity of hand, foot and mouth disease (HFMD) and enterovirus (EV) 71 infection has been increasing in the past two weeks.
According to the CHP's surveillance data, the number of institutional HFMD outbreaks recorded increased from five (affecting 23 persons) to 14 (affecting 60 persons) from the week of May 6 to that of May 13. As of yesterday (May 24), 15 outbreaks involving 59 persons had been reported this week. In the last four weeks, most outbreaks occurred in kindergartens and child care centres as well as primary schools.
 
As for EV71 infection, while only one case of infection was recorded per month in February and March this year, the number of cases increased to seven in May. As of yesterday, nine cases had been recorded this year.
 
"HFMD occurs throughout the year. Apart from a summer peak from May to July, a smaller peak may also occur from October to December. As young children are more susceptible, parents should stay alert to their health. Institutional outbreaks may occur where HFMD can easily spread among young children with close contact," a spokesman for the CHP said.
 
"We have issued letters to doctors, child care centres, kindergartens and primary and secondary schools to alert them to the latest situation. Schools are reminded to follow the Guidelines on Prevention of Communicable Diseases on preventive and control measures as well as management of outbreaks, which should be reported to the CHP for prompt follow-up," the spokesman added.

Management of venues with play facilities should pay special attention to the CHP's Public Health Advice for Play Facilities on appropriate infection control in activities involving young children under 6 during the peak season.

"We noted that HFMD activity in neighbouring areas such as Guangdong and Taiwan has also increased recently. Parents travelling with their children in the coming holidays or summer vacation should pay special attention to personal and environmental hygiene while attending play facilities or having close contact with other children," the spokesman added.

To prevent HFMD, members of the public, and especially the management of institutions, should take heed of the following preventive measures: 

  • Maintain good air circulation;
  • Wash hands before meals and after going to the toilet or handling diapers or other stool-soiled materials;
  • Keep hands clean and wash hands properly, especially when they are dirtied by respiratory secretions, such as after sneezing;
  • Cover the nose and mouth while sneezing or coughing and dispose of nasal and oral discharges properly;
  • Clean children's toys and other objects thoroughly and frequently with diluted household bleach (by adding one part of household bleach containing 5.25 per cent sodium hypochlorite to 99 parts of water), followed by rinsing or wiping with clean water;
  • Children who are ill should be kept out of school until their fever and rash have subsided and all the vesicles have dried and crusted;
  • Avoid going to overcrowded places; and
  • Parents should maintain close communication with schools to let them know the latest situation of the sick children.
The CHP's weekly report, EV SCAN (www.chp.gov.hk/en/view_content/21639.html), is issued every Friday to report the latest local situation of HFMD. The public may also visit the CHP's page on HFMD and EV71 infection for more information.
Ends/Friday, May 25, 2018

Issued at HKT 19:05
 
While EV-71 continues to have its biggest impact in Asia and the Eastern Pacific, in recent years we've seen an increasing number of outbreaks in Europe (see ECDC Rapid Risk Assessment Of EV-71 Outbreak In Spain), and there are no guarantees that this virus won't become a bigger factor in Europe of North America in the years ahead.

Among the challenges of controlling EV71 outbreaks are:


For now, control and prevention are limited to promoting good hygiene, and removing children with signs of the disease from child care or school environments.

ECDC Rapid Risk Assessment On Ebola Outbreak In The DRC


















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Although their numbers are already surpassed by more recent updates (see WHO DRC Ebola Update - May 23rd) the ECDC has today published a 9 page RRA (Rapid Risk Assessment) of the ongoing Ebola outbreak in the DRC.
This RRA provides both an overview of the current outbreak and background information on the disease, along with a special emphasis on the potential of Ebola spreading to the EU (which is considered `Very Low').
First, the Executive Summary as provided by the ECDC, followed by a couple of excerpts from a much larger document.

Rapid risk assessment: Ebola virus disease outbreak in Equateur Province, Democratic Republic of the Congo, First update
risk assessment

25 May 2018

From 4 April until 20 May 2018, 49 cases and 26 deaths have been recorded: of which 22 are confirmed, 21 are probable and six are suspected cases.

Executive summary

This is the ninth Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) since the discovery of the virus in 1976. 

From 4 April until 20 May 2018, 49 cases and 26 deaths have been recorded: of which 22 are confirmed, 21 are probable and six are suspected cases. Cases have been reported from the Bikoro health zone (n=29; 10 confirmed and 19 probable), the Iboko health zone (n=16; eight confirmed, two probable and six suspected) and the Wangata health zone (n=4; all confirmed) [1]. The current outbreak is taking place in health zones neighbouring the Congo River, which is an important pathway of trade and travel. In addition, four confirmed EVD cases have been reported in the health zone of Wangata within the port city of Mbandaka which has a population of 1.2 million people. These factors have raised concerns about an increased probability of the spread of the disease at the national level. The identification of EVD cases in the urban area of Mbandaka city and around Tumba Lake both connected to the Congo River increases the risk of regional spread to other provinces of DRC and neighbouring countries (namely Republic of the Congo and the Central African Republic). ECDC is closely monitoring this outbreak in liaison with the Ministry of Health in DRC, WHO and other partners, and will reevaluate the risk for EU/EEA citizens if necessary according to epidemiological findings.

Under the coordination of the Ministry of Health in the DRC, the timely EVD outbreak response is being implemented with the support of UN agencies and international partners. The strategic activities being implemented for the prevention and control of this outbreak include: coordination of the response activities, enhanced epidemiological surveillance for early detection of cases and contact tracing, increase of laboratory capacity, appropriate case management, reinforcement of infection prevention and control (IPC) measures, ensuring safe and dignified burials, social mobilisation and community engagement.

For the European Union/European Economic Area (EU/EEA) citizens living in, or travelling through areas of DRC not known to have EVD cases, the risk of exposure is very low, provided they adhere to the recommended precautions. The overall risk of introduction and further spread of Ebola virus within the EU/EEA is currently considered to be very low.



From the RRA itself:

Risk to EU/EEA citizens living or traveling in DRC
 
The probability of exposure of EU/EEA citizens living in or travelling through areas of DRC not known to have outbreak cases is very low in general as transmission of the Ebola virus occurs in the context of direct contact with sick or dead persons or animals infected with Ebola. Due to the current limited number of cases and affected areas, the risk of infection through daily interaction in the community in Equateur province remains low if visitors and long-term residents adhere to the recommended precautions (see Green Box).
Risk of introduction and further spread within the EU/EEA
 The most likely mode of introduction into the EU/EEA would be through an infected traveller coming from the affected area. The likelihood of EVD-infected individuals arriving in the EU is expected to be minimal due to the limited outbreak size (less than 50 EVD cases), and the fact that its epicentre is currently reported to be primarily in remote and rural areas of Equateur Province, according to available information. Therefore, the overall risk of introduction and further spread of Ebola virus within the EU/EEA is currently considered to be very low.
For comparison, during the substantially larger EVD outbreak in West Africa in 2014, which included a total of about 28 600 cases and 11 300 deaths, only one local transmission occurred in the EU/EEA (Spain) in a healthcare worker attending to an evacuated Ebola patient [38]. However, if there is a substantial increase in the number of cases or in the geographical spread of the EVD outbreak the probability of introduction in Europe may increase.
To date, WHO advises against the application of any travel or trade restrictions on the Democratic Republic of the Congo based on the currently available information and in accordance with the IHR 2005 [30]. Travel restrictions and active screening of passengers on arrival from affected area in DRC at sea ports, airports or ground crossings in non-affected countries are also not currently recommended by WHO.
Exit screening measures are increasingly implemented in DRC both at Kinshasa airport and Mbandaka airport. More information about the value of entry screening during the unprecedented EVD outbreak in Guinea, Sierra Leone and Liberia, is available in the Rapid Risk Assessment Eighth update, 18 November 2014 [4].
Exit screening at borders is part of a continuum of measures to contain the epidemic at the source, in conjunction with educating travellers on risk and self-reporting in case of symptoms. Containment measures also include increased vigilance for detection and management of suspect cases on board of conveyances and at point of exit.


Thursday, May 24, 2018

Sweden: LPAI H5 At A Pheasant Plant Near Malmö



















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A couple of days ago, in ESA Epidemiological Update: HPAI Clade 2.3.4.4 Viruses in Europe as of 3rd May 2018, we looked at recent reports of HPAI (Highly Pathogenic Avian Influenza) across Europe, including the following 4 detections from Sweden.
  • Sweden: cases in two white-tailed eagles (reports on 09/04 and 26/04), in a common buzzard (report on 26/04), and in a Northern goshawk (Accipiter gentilis) (report on 26/04)
While LPAI (low pathogenic avian influenza) viruses are often found in wild birds, and are considered less dangerous than HPAI viruses, they carry one overriding concern; H5 and H7 subtypes have a habit of mutating into far more dangerous HPAI viruses when allowed to spread unchecked in poultry.

Frequently discussed in this blog, this LPAI-to-HPAI mutation was recently the subject of a study (see Frontiers Vet. Sci.: Patterns In the Emergences Of HPAI H5 & H7 Viruses In Poultry) that examined both mutation and reassortment in the generation of HPAI viruses.


Although spontaneous mutation from LPAI-to-HPAI doesn't happen all that often, the risk is considered great enough that all LPAI H5 and H7 outbreaks must be reported to the OIE, and immediate steps must be taken to contain and eradicate the virus.
A little over two weeks ago, in neighboring Denmark, we saw the DVFA order 20,000 Ducks Culled Due To LPAI H5.

Today it is Sweden's turn, as announced by the following press release today  from their Ministry of Agriculture.

 (Translated)
Bird flu at wild bird plant in Skåne
 
Press Release • May 24, 2018 16:14 CEST

A case of avian influenza of the type H5 has been found at a plant breeding pheasants in Arlöv outside Malmö. The virus is presence, that is to say, less pathogenic than the so-called highly pathogenic avian influenza virus that has recently been shown in Sweden. The samples are analysed by the National Veterinary Institute (SVA) within the regular monitoring programme for avian influenza.

"To avoid dispersal to poultry, it is important that poultry producers and hobby bird owners have good disease control procedures," says Karin Åhl, STF Head of unit for horse, poultry and game at the Swedish Board of Agriculture.

"This virus is presence, that is to say, less pathogenic than the so-called highly pathogenic avian influenza viruses that have been demonstrated in Sweden on several occasions in recent years. However, Lpai virus may, under certain circumstances, be transformed into highly pathogenic, which is the main reason for the monitoring of outbreaks with low pathogenic avian influenza, says Karl Ståhl, deputy Statsepizootolog of SVA.

Control area around the infected farm

With regard to the infected plant for pheasant farming, the Swedish Board of Agriculture has now decided on refusal and there are special restrictions which mean that no animals or animal products are allowed to leave or enter the establishment.

The Swedish Board of Agriculture has also decided to introduce a control area with a kilometre radius around the farm. The control area includes the following restrictions:

Persons visiting animal housing with poultry and other birds must comply with the hygiene rules.
  • The transport of poultry, live birds, hatching eggs and poultry products between poultry holdings shall be prohibited.
  • It shall be prohibited to transport poultry, live birds, hatching eggs and poultry products out of and into the control area.
It is possible to apply for exemptions for certain transport operations in the areas.
– To counteract the contamination of the blocked pheasant herd, the animals will be killed. This naturally means a strain on the animal owner, says Karin Åhl
Naturally found among wild birds

Avian influenza is found in many variants and is highly contagious between birds. Milder variants of the virus are found naturally among wild birds, especially in seabirds. Security Level 1 applies in Sweden, which means that poultry can be outside, but that feed and water must be given under roof or under an outdoor shelter.

It is important to have good management practices and to prevent direct and indirect contact with wild birds as far as possible. Pet owners should be attentive and contact the veterinarian if poultry shows increased mortality, changes in feed and water consumption, reduction in egg production or reduced general conditions.

In February 2018, avian influenza was discovered by the type H5N6 of a sea eagle and a buzzards on the Blekinge coast. Subsequently, further cases have been found in a hobby crew in Uppsala County and more wild birds.

General hygiene Rules

  • Ensure that only those who manage Tamfåglarna have access to the animal spaces.
  • Keep clean around houses and enclosures.
  • Be careful with the hygiene procedures.
  • Wash hands after contact with the birds.
  • After a stay abroad, you should not have contact with poultry until at the earliest after 48 hours.

NHC: 80% Chance Of Tropical Development In Gulf This Weekend






















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Technically, the Atlantic Hurricane Season doesn't start for another week, but as I mentioned on Tuesday (see A Pre-Season Reminder To Prepare), the tropics don't always follow the rules.   
What was given a 40% chance to develop on Tuesday now has an 80% chance of becoming a tropical or sub-tropical system over the next 5 days. 
None of this speaks to its intensity - which is likely to top out as a tropical depression or possibly a tropical storm - but it does remind us of the value of being ready for the upcoming hurricane season.

Yesterday NOAA released their estimate for the Pacific Hurricane season (see NOAA predicts a near- or above-normal 2018 hurricane season in the central Pacific), and we should get their take on the Atlantic hurricane season in the next week or so. 
If you haven't started your 2018 hurricane preparedness, I'd invite you to revisit Tuesday's blog and  Hurricane Preparedness Week 2018 (May 6th - May 12th).
The 8am Tropical Outlook from the NWS National Hurricane Center follows:

ZCZC MIATWOAT ALL
TTAA00 KNHC DDHHMM

Special Tropical Weather Outlook
NWS National Hurricane Center Miami FL
740 AM EDT Thu May 24 2018

For the North Atlantic...Caribbean Sea and the Gulf of Mexico:

1. A broad, stationary surface low pressure system centered over the southeastern Yucatan Peninsula is gradually becoming better defined.


Although showers and thunderstorms, along with strong gusty winds, are confined primarily to the adjacent waters of the northwestern Caribbean Sea, gradual development of this system is expected during the next couple of days as it drifts northward near the Yucatan Peninsula.  Environmental conditions are forecast to become more conducive for development through early next week, and a subtropical or tropical depression is likely to form by late Saturday over the southeastern Gulf of Mexico.  


Regardless of development, locally heavy rainfall is forecast across western Cuba and over much of Florida and the northern Gulf Coast into early next week. In addition, the threat of rip currents will steadily increase along the Gulf coast from Florida westward to Louisiana over Memorial Day weekend. For more information on these threats, please see products issued by your local weather office. 
The next Special Tropical Weather Outlook on this system will be issued by 200 PM EDT this afternoon.
* Formation chance through 48 hours...medium...40 percent.
* Formation chance through 5 days...high...80 percent.

Forecaster Stewart

CDC Update: Candida Auris - April 2018


https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html
















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Not quite two years ago (June 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.
Adding to the concern:
  1. C. auris infections have a high fatality rate
  2. The strain appears to be resistant to multiple classes of anti-fungals  
  3. This strain is unusually persistent on fomites in healthcare environments.
  4. And it can be difficult for labs to differentiate it from other Candida strains
The CDC has updated their C. Auris surveillance page, where they show - as of April 30th  - 279 confirmed cases and 29 probable cases, across 11 states.  An increase of more than 10% over the previous month.
 
https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html
 

Additionally, based on targeted screening in four states reporting clinical cases, the CDC reports an additional 517 patients have been discovered to be asymptomatically colonized with C. auris.

As previously mentioned, this isn't just a United States' problem, but a global health threat.  This fungal infection, which was first detected in Japan in 2009, has now turned up on multiple continents.
For more on this emerging fungal pathogen, you may wish peruse the CDC's dedicated web page:
General Information about Candida auris
Tracking Candida auris
Patients and Family Members
Healthcare Professionals
Fact Sheet
Publications
And for some older blogs on the topic, you may wish to revisit:
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