Human Emerging Respiratory Pathogens Bulletin: Issue 28, April 2019

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Organization: Public Health Agency of Canada

Published: 2019-05-14

Monthly situational analysis of emerging respiratory diseases affecting humans (data to April 30, 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 April 30, 2019)

Novel influenzaTable 1 Footnote 1	Cumulative Case CountTable 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	22	0	0%
A(H1N2)Table 1 Footnote 4	2	0	0%
MERS-CoVTable 1 Footnote 1	Cumulative Case CountTable 1 Footnote 2	Deaths	Case Fatality Rate %Table 1 Footnote 3
Global Case Count	2,428	835	34%
Saudi Arabia	2,037	758	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)

In April 2019, a new human infection with H7N9 was reported from China. The case is an 82 year old male from Gansu province, but with suspected exposure in Inner Mongolia, China. The case was hospitalized with severe pneumonia. Further information on the source of exposure and the case outcome is expected. This is the first case reported since February 2018. 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.

Note: Graph was prepared by the Centre for Immunization and Respiratory Infectious Diseases (CIRID) using data from the latest WHO Monthly Influenza at the Human-Animal Interface Risk Assessment. This graph reflects data available through these risk assessments as of April 30, 2019.

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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

The temporal distribution of avian influenza A(H7N9), globally, January 1st, 2013 – April 30, 2019, has been displayed in Figure 1. The highest number of reports occurred in 2017, with a peak in January. Three cases were reported in 2018 and one case has been reported in 2019 so far.

Avian Influenza A(H9N2)

No new cases of H9N2 were reported to the WHO in April 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)

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)

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 January 2018 in Switzerland. The case was associated with swine exposure. A total of 22 cases have been reported globally since 2005. H1N1v infection is associated with mild illness.

Note: Map was prepared by the Centre for Immunization and Respiratory Infectious Diseases (CIRID) using data from the latest WHO Monthly Influenza at the Human-Animal Interface Risk Assessment. This map reflects data available through these risk assessments as of April 30, 2019.

Text description

The spatial distribution of avian and swine influenza human cases in April 2019 has been displayed in Figure 2. One avian influenza A(H7N9) has been reporten in April 2019 from China, in Gansu Province.

Middle East Respiratory Syndrome Coronavirus Updates

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

In April 2019, 22 new cases of MERS-CoV, including 7 deaths, were reported in Saudi Arabia (Figure 3). This is a decrease from the number of cases reported in earlier months this year. Approximately 91% (20/22) of these cases were male, and the median age was 56 years (range: 28-83 years). Two cases had reported camel exposure, eight were classified as primary cases with unknown camel exposure and 12 were classified as secondary cases. A total of 2428 laboratory-confirmed cases of MERS-CoV, including 835 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.

Note: Map was prepared by the Centre for Immunization and Respiratory Infectious Diseases (CIRID) using data from the latest WHO Disease Outbreak News and Saudi Arabia's Ministry of Health. This map reflects data available through these risk assessments as of April 30, 2019.

Text description

The spatial distribution of reported MERS cases in April 2019 has been displayed in Figure 3. A total of 22 cases have been reported in April all from Saudia Arabia.

Note: Graph was prepared by the Centre for Immunization and Respiratory Infectious Diseases (CIRID) using data from the WHO Disease Outbreak News and Saudi Arabia's Ministry of Health. This graph reflects data available as of April 30, 2019.

Text description

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