Human Emerging Respiratory Pathogens Bulletin: Issue 29, May 2019

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Organization: Public Health Agency of Canada

Published: 2019-06-11

Monthly situational analysis of emerging respiratory diseases affecting humans (data to May 31, 2019)

In this bulletin

Novel Influenza Updates
Swine Influenza Updates
Middle East Respiratory Syndrome Coronavirus (MERS-CoV)Updates

Update on human emerging respiratory pathogen public health events (as of May 31, 2019)
Novel influenza^{Table 1 Footnote 1}	Cumulative Case Count^{Table 1 Footnote 2}	Deaths	Case Fatality Rate %^{Table 1 Footnote 3}
A(H7N9)	1,568	615	39%
A(H5N1)	878	460	52%
A(H9N2)	51	1	2%
A(H5N6)	23	15	65%
A(H7N4)	1	0	0%
H3N2v	435	1	<1%
H1N2v	26	0	0%
H1N1v	23	0	0%
A(H1N2)^{Table 1 Footnote 4}	2	0	0%
MERS-CoV^{Table 1 Footnote 1}	Cumulative Case Count^{Table 1 Footnote 2}	Deaths	Case Fatality Rate %^{Table 1 Footnote 3}
Global Case Count	2,442	839	34%
Saudi Arabia	2,051	762	37%
Table 1 Footnote 1 Date of 1st Reported Case of Human Infection: MERS-CoV: February 2013 (retrospective case finding to September 2012). A(H7N9): March 2013. A(H5N1): 1997. A(H9N2): 1998. A(H5N6): 2014. A(H7N4): February 2018 (retrospective case finding to December 2017). H3N2v with M gene from pH1N1: 2011. H1N2v: 2005. H1N1v: 2005 Table 1 Return to footnote 1 referrer Table 1 Footnote 2 Cumulative Case Counts: updated using data reported by the World Health Organization (WHO) (avian and swine influenza, MERS CoV), the United States Centers for Disease Control and Prevention (US CDC) (swine influenza), and the Kingdom of Saudi Arabia's Ministry of Health (MERS-CoV) Table 1 Return to footnote 2 referrer Table 1 Footnote 3 Case Fatality Rate: The proportion of cases that resulted in death Table 1 Return to footnote 3 referrer Table 1 Footnote 4 Seasonal reassortant: virus is a reassortant of the A(H1N1)pdm09 and A(H3N2) seasonal strains. Table 1 Return to footnote 4 referrer

Avian Influenza Updates

Avian influenza A(H7N9)

No new H7N9 cases were reported to the WHO in May 2019. The last case was reported in April 2019. A total of 1568 human cases of avian influenza A(H7N9), including at least 615 deaths, have been reported globally since 2013, with 1564 cases reported in wave 5, three cases reported in wave 6 and one case reported in the current wave 7 (Figure 1). Two travel-related cases were reported in Canada in January 2015.

Year	Month	Cases	Deaths
2016	Jun	2	0
Jul	4	0
Aug	0	0
Sep	0	0
Oct	2	0
Nov	10	2
Dec	114	39
2017	Jan	197	29
Feb	93	13
Mar	70	12
Apr	72	24
May	50	6
Jun	19	4
Jul	2	0
Aug	3	2
Sep	1	0
Oct	0	0
Nov	0	0
Dec	1	0
2018	Jan	1	1
Feb	1	0
Mar	0	0
Apr	0	0
May	0	0
June	0	0
July	0	0
Aug	0	0
Sep	0	0
Oct	0	0
Nov	0	0
Dec	0	0
2019	Jan	0	0
Feb	0	0
Mar	0	0
Apr	1	0
May	0	0

Avian Influenza A(H9N2)

No new cases of H9N2 were reported to the WHO in May 2019. The most recent case was reported in March 2019 in China. Globally, 51 cases, including 1 death, have been reported since 1998.

Avian Influenza A(H5N6)

No new cases of H5N6 were reported to the WHO in May 2019. The most recent case of H5N6 was reported in November 2018 in China. The source of exposure was unknown. There have been a total of 23 cases, including 15 deaths, reported globally since 2014, all in China.

Avian Influenza A(H7N4)

No new cases of H7N4 were reported to the WHO in May 2019. On February 14, 2018, the WHO was notified of the first known human case of H7N4. The case was associated with poultry exposure. No cases have been reported since.

Swine Influenza Updates

Swine Origin Influenza A(H3N2)v

The most recent case of swine origin influenza H3N2v was reported in June 2018 in the United States. The case reported exposure to swine at an agricultural fair. A total of 435 cases, including 1 death, have been reported globally since 2011. One locally-acquired case of H3N2v was reported in Canada in December 2016.

Swine Origin Influenza A(H1N2)v

The most recent case of swine origin influenza H1N2v was reported in August 2018 in the United States. The case reported exposure to swine at an agricultural fair. A total of 26 confirmed cases of H1N2v have been reported in the United States since 2005. Most of the reported cases resulted in mild illness.

Swine Origin Influenza A(H1N1)v

The most recent case of swine origin influenza H1N1v was reported in May 2019 from Michigan in the United States. The case was over 65 years, had no history of swine exposure, and has fully recovered. A total of 23 cases have been reported globally since 2005. H1N1v infections have been associated with mild illness.

**Figure 2. Spatial distribution of human cases of avian and swine influenza reported globally in May 2019 (n=1).**

Middle East Respiratory Syndrome Coronavirus Updates

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

In May 2019, 14 new cases of MERS-CoV, including 4 deaths, were reported in Saudi Arabia (Figure 3): a decrease from the number of cases reported in earlier months this year (Figure 4). Approximately 71% (10/14) of these cases were male and the median age was 59 years (range: 22-80 years). Twelve cases were classified as primary cases (eight cases with unknown camel exposure, three cases with camel exposure, and one case with no camel exposure) and two cases were classified as secondary cases. A total of 2442 laboratory-confirmed cases of MERS-CoV, including 839 deaths, have been reported globally since 2012 by the WHO and the Kingdom of Saudi Arabia (Figure 4). No cases have been reported in Canada.

**Figure 3. Spatial distribution of human cases of MERS-CoV reported in May 2019 (n=14).**

**Figure 4. Temporal distribution of human cases of MERS-CoV reported to the WHO, globally, by month and year, January 1, 2017 – May 31, 2019 (n=535).**

Year	Month	Cases	Deaths
2017	Jan	19	7
Feb	20	9
Mar	22	6
Apr	15	3
May	21	5
Jun	59	12
Jul	11	3
Aug	32	7
Sep	8	5
Oct	14	2
Nov	13	4
Dec	14	3
2018	Jan	17	11
Feb	14	2
Mar	17	4
Apr	8	5
May	13	2
June	10	1
July	7	3
August	6	2
Sep	14	6
Oct	9	2
Nov	7	1
Dec	5	0
2019	Jan	19	5
Feb	76	14
Mar	29	3
Apr	22	7

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Date modified:: 2019-09-18

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