Human emerging respiratory pathogens bulletin: Issue 55, July 2021

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Organization: Public Health Agency of Canada

Date published: 2021-08-XX

Monthly situational analysis of emerging respiratory diseases affecting humans (data to July 31, 2021)

In this bulletin

COVID-2019 update
Avian influenza updates
Swine influenza updates
Middle East respiratory syndrome coronavirus (MERS-CoV) update

Update on human emerging respiratory pathogen public health events (as of July 31, 2021)
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)	880	461	52%
A(H9N2)	81	1	1%
A(H5NX)	1	1	100%
A(H5N6)	36	21	58%
A(H5N8)	7	0	0%
A(H7N4)	1	0	0%
A(H1N2)^{Table 1 Footnote 4}	2	0	0%
A(H3N2)v	439	1	<1%
A(H1N2)v	31	0	0%
A(H1N1)v	33	0	0%
A(H10N3)	1	0	0%
Eurasian avian-like A(H1N1)	5	0	0%
Reassortant novel influenza^{Table 1 Footnote 5}	1	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	2,569	877	34%
Saudi Arabia	2,172	799	37%
Table 1 Footnote 1 Date of 1 ^st 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(H5N8): December 2020. A(H7N4): February 2018. A(H1N2): March 2018. A(H3N2)v with M gene from pH1N1: 2011. A(H1N2)v: 2005. A(H1N1)v: 2005. EA A(H1N1): 1986, but the above table counts cases from January 2021. A/Denmark/1/2021: February 2021 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 A(H1N2): virus is a seasonal reassortant of the A(H1N1)pdm09 and A(H3N2) seasonal strains. Table 1 Return to footnote 4 referrer Table 1 Footnote 5 Reassortant novel influenza: refers to A/Denmark/1/2021 A(H1N1) of the pdm09 lineage. Table 1 Return to footnote 5 referrer

COVID-19 update

On December 31, 2019, cases of a pneumonia of unknown etiology were reported in Wuhan, China. These cases have since been determined to be due to a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). On January 30, 2020, the World Health Organization (WHO) first declared the outbreak a Public Health Emergency of International Concern (PHEIC). On March 11, 2020, the WHO characterized the outbreak as a global pandemic. The WHO Director-General convened the International Health Regulations (IHR) Emergency Committee (EC) on COVID-19 eight times throughout 2020 and 2021, continually assessing that COVID-19 constitutes a PHEIC.

As of July 30, 2021, 1,430,483 COVID-19 cases and 26,592 deaths have been reported in Canada. The Public Health Agency of Canada is monitoring the situation closely.

Avian influenza updates

Avian influenza A(H5NX)

On July 21, 2021, the India Ministry of Health and Family Welfare reported an H5NX case in New Delhi. The case, an 11-year-old male with underlying conditions, presented with acute respiratory illness in June 2021, was hospitalized on July 2, 2021, and died on July 12, 2021. Samples tested at the National Institute of Virology showed positive results for A/H5 and Influenza type B (Victoria lineage). Whole genome sequencing and virus isolation is in process with full sub-typing results pending. Health practitioners that treated the patient were monitored for any development of influenza-like-illness and none of the case’s close contacts developed any symptoms.

Avian influenza A(H5N6)

Four human cases of avian influenza A(H5N6) were detected in July 2021, all from China.

The first case, a 55-year-old male farmer from Sichuan province, reported illness onset on June 30, 2021. He was hospitalized with severe pneumonia on July 4, 2021 and was stated to be in critical condition at the time of report. Case two was a 57-year-old male farmer from Sichuan province with an illness onset date of June 22, 2021. He was hospitalized on July 5, 2021 and died as a result of his infection. Case three, a 66-year-old male farmer from the Tongnan district, reported illness onset on June 23, 2021. He was hospitalized on June 30, 2021 and was in critical condition at the time of report. The last case, a 51-year-old female farmer from Sichuan province, reported illness onset on June 25, 2021 and was hospitalized on July 2, 2021. She also died as a result of her infection.

All four cases reported above were exposed to backyard poultry prior to illness onset. Environmental samples collected by health authorities tested positive for A/H5.

Globally, 36 human cases of A(H5N6) have been reported since 2014 (21 of them fatal), with 35 of these cases reported from China. No A(H5N6) detections have been reported in Canadian residents since reporting began in 2014.

Swine influenza updates

Swine origin influenza A(H3N2)v

The most recent case of swine origin influenza A(H3N2)v was reported in June 2021 in Manitoba, Canada. This was the second case of A(H3N2)v detected in Canada. The first case was notified in December 2016 in a child residing in Ontario who had contact with symptomatic infected swine. Globally, 439 A(H3N2)v cases have been reported since 2005, with <1% case fatality rate.

Swine origin influenza A(H1N2)v

The most recent case of swine origin influenza A(H1N2)v was reported in June 2021 from Taiwan. Two A(H1N2)v detections have been reported in Canadian residents since reporting began in 2005, with the latest case reported in April 2021. A total of 31 cases have been reported globally since 2005.

Swine origin influenza A(H1N1)v

The most recent case of swine origin influenza A(H1N2)v was reported in June 2021 from the United States. Two A(H1N1)v detections have been reported in Canadian residents since reporting began in 2005, with the latest case reported in April 2021. Globally, 33 human cases of A(H1N1)v have been reported since 2005, with no associated fatalities.

A figure indicating the spatial distribution of human cases of avian and swine influenza reported globally in July 2021 (n=5). — **Figure 1: Spatial distribution of human cases of avian and swine influenza reported globally in July 2021 (n=5).**

Middle East respiratory syndrome coronavirus (MERS-CoV) update

Two new MERS-CoV cases were reported from Saudi Arabia in July 2021. The first case, a 67-year-old male from Riyadh, reported exposure to camels prior to illness onset and was classified as a primary case (the case likely did not contract the virus from another human). The second case, a 65-year-old male from Riyadh, also reported camel contact prior to illness onset and was also classified as a primary case.

Including these cases, 12 cases of MERS-CoV have been reported around the world in 2021 (5 of them fatal), with 11 of these cases reported from Saudi Arabia. A total of 2,569 laboratory-confirmed cases of MERS-CoV, including 877 deaths, have been reported globally since 2012 by the WHO. No cases have been reported in Canada.

A figure indicating the temporal distribution of MERS-CoV cases, globally, January 1st, 2018 – July 31st, 2021. — **Figure 2: Temporal distribution of human cases of MERS-CoV reported to the WHO, globally, by month and year, January 1, 2018 to July 31, 2021 (n=414).**

Temporal distribution of human cases of MERS-CoV reported to the WHO, globally, by month and year, January 1, 2018 to July 31, 2021 (n=414).
Dates	Deaths	Survived
2018	Jan	11	6
Feb	2	12
Mar	4	13
Apr	5	3
May	2	11
June	1	9
July	3	4
Aug	2	4
Sep	6	8
Oct	2	7
Nov	1	6
Dec	0	5
2019	Jan	5	14
Feb	14	62
Mar	3	26
Apr	7	15
May	4	10
June	1	6
July	4	5
Aug	1	5
Sep	1	3
Oct	6	8
Nov	1	11
Dec	3	2
2020	Jan	2	15
Feb	3	16
Mar	5	10
Apr	0	2
May	1	0
June	0	0
July	0	0
Aug	0	0
Sep	0	0
Oct	0	0
Nov	0	1
Dec	0	3
2021	Jan	0	0
Feb	3	3
Mar	1	1
Apr	0	0
May	1	0
June	0	1
July	0	2

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2021-08-10

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