Human emerging respiratory pathogens bulletin: Issue 36, December 2019

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

In this bulletin

Update on human emerging respiratory pathogen public health events (as of December 31, 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) 879 461 52%
A(H9N2) 54 1 <1%
A(H5N6) 24 7 29%
A(H7N4) 1 0 0%
A(H1N2)Table 1 Footnote 4 2 0 0%
A(H3N2)v 435 1 <1%
A(H1N2)v 26 0 0%
A(H1N1)v 23 0 0%
MERS-CoVTable 1 Footnote 1 Cumulative Case CountTable 1 Footnote 2 Deaths Case Fatality Rate %Table 1 Footnote 3
Global Case Count 2,501 858 34%
Saudi Arabia 2,105 779 37%
Table 1 Footnote 1

Date of 1st Reported Case of Human Infection: MERS-CoV: February 2013 (retrospective case finding September 2012). A(H7N9): March 2013. A(H5N1): 1997. A(H9N2): 1998. A(H5N6): 2014. A(H7N4): February 2018. A(H3N2)v with M gene from pH1N1: 2011. A(H1N2)v: 2005. A(H1N1)v: 2005.

Table 1 Return to footnote 1 referrer

Table 1 Footnote 2

Cumulative Case Counts: updated using data reported by the World Health Organization (avian and swine influenza, MERS CoV), and the United States Centers for Disease Control and Prevention (US CDC) (swine influenza).

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 December 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 one case reported in wave 7 (November 1, 2018 to September 30, 2019) (Figure 1). Two travel-related cases were reported in Canada in January 2015. 

Figure 1. Temporal distribution of human infection with avian influenza A(H7N9), globally, by month and year, January 1, 2013 to December 31, 2019 (n=1568).

Figure 1

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 December 31, 2019.

Text description

The temporal distribution of avian influenza A(H7N9), globally, January 1st, 2013 – December 31, 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.

Temporal distribution of human infection with avian influenza A(H7N9), globally, by month and year, January 1, 2013 to December 31, 2019 (n=1568).
Date 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
June 0 0
July 0 0
Aug 0 0
Sept 0 0
Oct 0 0
Nov 0 0
Dec 0 0

Avian influenza A(H5N1)

No new H5N1 cases were reported to the WHO in December 2019. The most recent case of H5N1 was reported in March 25, 2019 in Nepal. A total of 879 cases including 461 deaths have been reported globally since 1997. One fatal travel-related case of H5N1 was reported in Canada in January 2014.

Avian influenza A(H5N6)

No new cases of H5N6 were reported to the WHO in December 2019. The most recent case of H5N6 was reported in China in August 2019. There have been a total of 24 cases, including 7 deaths, reported globally since 2014, all in China.

Avian influenza A(H9N2)

No new cases of H9N2 were reported to the WHO in December 2019.  The most recent case was reported in November 2019 in China. Globally, 54 cases, including 1 death, have been reported since 1998.

Avian influenza A(H7N4)

No new cases of H7N4 were reported to the WHO in December 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 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. To date, the reported H1N1v infections have been associated with mild illness.

Figure 2. Spatial distribution of human cases of avian and swine influenza reported globally in December 2019 (n=0).

Figure 2

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 December 31, 2019.

Text description

The spatial distribution of avian and swine influenza human cases in December 2019 has been displayed in Figure 2. No avian influenza A(H9N2) has been reported in December 2019.

Middle East respiratory syndrome coronavirus (MERS-CoV)

In December 2019, 4 cases of MERS-CoV, including two deaths were reported across three regions in Saudi Arabia (Figure 3, Figure 4). Most of the cases were male (n=3, 75%), and the median age was 68 years (range: 65 to 72 years). Two cases (50%) had known primary camel exposure and the other two cases (50%) had unknown exposure but were classified as primary, meaning it is unlikely that they acquired the infection from a human MERS case. On December 26, 2019, WHO was notified by Qatar's National IHR focal point of three lab confirmed cases identified in November 2019. All three cases are from Doha, Qatar and the source of infection for the first case is under investigation. Two of the cases were asymptomatic but linked to the first case. A total of 2501 laboratory-confirmed cases of MERS-CoV, including 858 deaths, have been reported globally since 2012 by the WHO. No cases have been reported in Canada.

Figure 3. Spatial distribution of human cases of MERS-CoV reported in December 2019 (n=4).

Figure 3

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 December 31, 2019.

Text description

The spatial distribution of reported MERS cases in December 2019 has been displayed in Figure 3. A total of 4 cases have been reported in December.

Figure 4. Temporal distribution of human cases of MERS-CoV reported to the WHO, globally, by month and year, January 1, 2018 to December 31, 2019 (n=343).

Figure 4

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 December 31, 2019.

Text description

The temporal distribution of MERS-CoV, globally, January 1st, 2018– December 31th, 2019, has been displayed in Figure 4. The highest number of reports occurred in 2019, with a peak in February, and cases decreasing since then.

Temporal distribution of human cases of MERS-CoV reported to the WHO, globally, by month and year, January 1, 2018 to December 31, 2019 (n=343).
Date Cases Deaths
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
May 14 4
June 7 1
July 9 4
August 6 1
Sep 4 1
Oct 14 6
Nov 15 2
Dec 4 2
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