Responding to the novel coronavirus (2019-nCoV) emerging in Wuhan, China

Map of China highlighting Wuhan City where a novel coronavirus has emerged

By Scott J. Becker, executive director, APHL

As news spreads of the 2019 novel coronavirus (2019-nCoV) emerging in Wuhan, China, we at APHL are taking this threat seriously while also remaining calm and confident that our public health system is prepared. APHL has activated our incident command structure (ICS) to support our members and partners during the response.

Despite being a new respiratory virus strain, there is a familiarity that is reassuring to many of us in public health but can be unsettling to others. This new outbreak resembles SARS, MERS, H5N1 bird flu and other emerging respiratory diseases from the past. However, illness does not appear to be as severe as those previous viruses although our understanding of 2019-nCoV is still developing.

While there is a lot we don’t know about 2019-nCoV, this is what we do know about the outbreak response to prevent its spread:

  • As the first 2019-nCoV patient was identified in the United States, our public health system worked. Efforts to disseminate information to the public and to health care providers led to the patient self-identifying and allowed his providers to quickly initiate screening, isolation and eventual diagnosis. The specimen was immediately sent to CDC for rapid testing and results were promptly reported.
  • Public health laboratories are ready to process and ship specimens to CDC whose laboratory is currently the only one able to perform diagnostic testing in the US. CDC is working hard to develop and qualify a test that public health laboratories can use. Performing testing close to where the patient is being treated is ideal, but developing an effective test requires strong science and that takes time. We expect this new test to be ready for public health lab use in the coming weeks. CDC is already working closely with FDA to get an emergency use authorization (EUA) to deploy the test across the country in the event a US public health emergency is declared. (An EUA cannot be given until the US Secretary of Health and Human Services declares a public health emergency.)
  • For all of the critical players in our public health system – public health laboratory scientists, epidemiologists, CDC, FDA, health care providers and others – this is all in a day’s work. Frequent preparedness training and routine outbreak responses ensure that when a new disease emerges, the public health system is ready.

An outbreak of a new virus like 2019-nCoV can sometimes stir up panic and fear. We understand why some feel that way, but we are also confident that the public health system is working to stop this virus just as it has done with many others. We hope that our confidence in their expertise and abilities is reassuring for you. It is not time to panic – it is time to wash those hands, catch your coughs and continue to be vigilant during this cold and flu season.

Update (Jan 31, 2020): Media Statement on Novel Coronavirus Public Health Emergency Declaration from APHL Executive Director Scott Becker

We will continue to update this post with more information as it becomes available.

 

What is an Emerging Infectious Disease?

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Influenza prevention and response requires a One Health approach

Influenza prevention and response requires a One Health approach | www.APHLblog.org

By Jill Sutton, respiratory diseases intern, APHL

Did you know there’s no known influenza A subtype that’s only found in humans? That makes influenza a perfect example of why a One Health approach is critical to disease prevention and response.

One Health is about breaking down the silos between human, animal and environmental health and adapting a synergistic approach for planning and responding to threats. When it comes to influenza, this multi-disciplinary approach can make us better prepared to evaluate, predict and respond to infections in both humans and animals.

Toward the end of last year’s flu season, I decided I wanted to delve deeper into One Health. I registered for my first One Health Academy talk, which covered the 1918 influenza pandemic and ended with a discussion around the adjacent possibilities in 2018. As I learned more about influenza, I realized the flu wasn’t just a disease infecting humans each winter, but rather a year-round burden causing severe disease in animals too. Eight months later, here I am as the respiratory diseases intern at APHL, and I haven’t missed a single One Health talk yet. If there’s one thing I’ve learned thus far in my career in public health, it’s that we can’t control the future, but we can control how we respond to try and shape the future.

What are some implications of influenza for human & animals?

Influenza prevention and response requires a One Health approach | www.APHLblog.orgZoonotic diseases, such as avian influenza, can infect and cause severe disease in both animals and humans. According to the CDC, 60% of known infectious diseases in humans are of animal origin and 75% of new and emerging infectious diseases are spread from animals. Not only does the flu infect humans, influenza also infects a number of other animals (both domesticated and wild) and can cause severe disease.

The primary threat, of course, is the spread of new influenza strains. Influenza pandemics occur when a novel influenza virus emerges in an animal host, changes to the point where it is able to infect humans, and then changes further so it can continue to spread from one person to another.

Once the virus can be transmitted from human to human, a pandemic becomes possible. Global population movement directly influences the spread of influenza pandemics. Looking back to the 1918 influenza pandemic, troop movement during World War I was a major factor in the spread of the virus between continents. Today, international trade and travel has connected every region of the world. Transportation of humans, animal and goods increases the risk of exposure to pathogens. Did you know the influenza virus can remain infectious on surfaces for up to 48 hours? And when airborne, viral particles from a cough or sneeze can remain suspended in the air for up to 30 minutes. That is, if someone who is infected with the flu sneezes while on an elevator or in the bathroom of an airplane and 10 minutes later you enter that elevator or bathroom, you could become infected from those particles.

Aside from humans moving around the globe, animal travel is capable of spreading influenza too. Each year, birds such as ducks, swans and geese migrate between continents. If the any of those birds are infected with avian influenza, the virus can be carried and transmitted. If agricultural operations, domesticated animals or other potential hosts come in contact with infected birds or their feces, new influenza infections can be sustained.

Because we live in a shared environment where global travel is fast, global trade is easy and plenty of opportunities for inter-species transmission of influenza viruses exist, it’s important that experts work collaboratively. Within the veterinary community, areas of knowledge exist that can complement existing areas of knowledge in human health, and vice versa. One Health allows for an easier exchange of information and support between those professional communities.

In addition to the risk of transmission, influenza pandemics can have serious economic impacts. Societies around the world depend on the health of humans, animals and the environment for food, income and health security. Influenza is a major threat to animal agriculture as it can be fatal to chickens, turkeys and pigs. When a new influenza strain emerges, the livelihood for global communities, especially those who are largely dependent on agriculture cultivation, is put at risk. For example, live poultry markets have been identified as significant risk factors for transmission of avian influenza. Because many people who sell poultry at live bird markets are dependent on their operation for income, they are less likely to implement measures of prevention especially if it means closure of the market even temporarily and are at higher risk for exposure to avian influenza. Their poultry can continue to transmit the virus and, if they themselves become infected, they might also transmit the virus to other customers, their families or community members. In these cases, it’s important to include and understand all stakeholders such as farmers, consumers, market operators, supply chain transporters, and human and animal health professionals by taking a One Health approach to implement long term management for control and prevention of avian influenza.

What gaps exist?

The health of our ever-changing world depends on breaking down the walls between animal, human and environmental sectors. To effectively detect, respond to and prevent outbreaks of pandemic potential, epidemiological and laboratory data needs to be shared across sectors.

Integrated human, animal and environmental health/management systems promotes communication and collaboration among human-animal-eco sectors, thus optimizing success. Multi-sector coordination helps address joint issues and opens discussion on what to anticipate, what gaps exists, how to reduce duplication of efforts and enhances risk reduction. We need harmonized human and animal surveillance and research efforts that compliment and build upon one another. This is important because it can help human and animal health professionals identify the determinants that affect disease transmission such as pathogenicity, infectivity, antigenicity and resistance. By capitalizing on existing systems and infrastructure and by investing in capacity building, we can enhance our understanding of circulating viruses within animals, and better predict when and where a spillover could occur. Increasing laboratory and data sharing capacity at both the human and animal levels so that they’re equally capable to diagnose both human and animal influenza can help prevent knowledge gaps and identify where intervention is needed to prevent exposure. Furthermore, this can increase surge capacity so that more laboratories are able to provide the necessary help for when an outbreak occurs.

As we move forward, we must use a One Health approach to prevent multi-disciplinary threats like influenza pandemics. By collaborating between professionals with a range of experience and expertise, we can better address the unanswered questions around the risks for pandemic influenza at human-animal-environmental interface.

 

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What you need to know about harmful algal blooms

What you need to know about harmful algal blooms | www.APHLblog.org

By Julianne Murphy, intern, Environmental Health

Warm weather brings nature walks, picnics and sunny days by the shore, but it can also bring unwanted changes to your favorite beach. As the temperature rises, lake and ocean waters can turn from blue to mossy green as algae proliferates in unsightly and potentially harmful algal blooms.

What are harmful algal blooms?

Algae are plant-like organisms of one or more cells that use sunlight to make food. Together they can form colonies called algal blooms in both marine and freshwater systems. Some of these algal blooms are hazardous to health, but not all algal blooms are harmful.

Harmful algal blooms may release toxins at concentrations unsafe to humans and animals and may drastically reduce oxygen available to aquatic life. In fresh water bodies, cyanobacteria, aka “blue-green algae,” can produce dangerous cyanotoxins; in saltwater or brackish water, acid-generating plankton – dinoflagellates and diatoms – can pose a health threat.

Should I be concerned about algal blooms?

Algal blooms can pose a risk for human and animal health. People and animals can become ill through eating, drinking, breathing or having direct skin contact with harmful algal blooms and their toxins. Illnesses vary based on the exposure, toxins and toxin levels. Public health and environmental laboratories test samples from harmful algal blooms to confirm the presence and level of toxicity. Remember, not all algal blooms are harmful.

How are public health officials responding to the increase in algal bloom events?

As climate change events amplify conditions favorable to algal blooms, public health scientists are studying when and where associated illnesses are occurring and how to mitigate the effects of exposure. Their efforts have led to increased laboratory testing and electronic surveillance measures at the state and federal level.

For example, public health and environmental officials in Alaska have been tracking and testing harmful algal blooms. The Alaska Harmful Algal Bloom Network, a collaboration of the Alaska Department of Health and Social Services (DHSS) and regional monitoring programs, analyzes fish kills, unusual animal behaviors and other related phenomenon to provide early warning of developing coastal marine blooms. DHSS scientists analyze human specimens for illnesses associated with harmful algal blooms, such as paralytic shellfish poisoning (PSP) caused by saxitoxins. PSP is a potentially fatal poisoning with no treatment except supportive care. Samples from symptomatic patients are forwarded to the Centers for Disease Control and Prevention (CDC) for confirmatory testing as needed. Testing of asymptomatic individuals may be included in future studies.

In addition, Alaska Department of Environmental Conservation (DEC) laboratories test marine shellfish meat samples protect public health and safety as well as for regulatory purposes, illness investigations and non-commercial shellfish upon request. This monitoring literally saves lives.

David Verbrugge, chief chemist at the DHSS Division of Public Health, explains the value of Alaska’s testing of harmful algal blooms, “[Laboratory analysis] helps us to understand the nature of PSP exposures: frequency of occurrence, confirmation when lacking meals to test, and the presence or absence of toxins in asymptomatic co-exposed groups. It also allows us to let people know what they are eating before they eat it.”

Is the CDC involved in testing and surveillance for harmful algal blooms?

Yes, only for freshwater. In 2016, CDC created the One Health Harmful Algal Bloom System to provide a voluntary, electronic reporting system for states, federal agencies and their partners. Using the system, which integrates human, animal and environmental health data using a One Health approach, public health departments and their environmental and animal health partners can report bloom events, and human and animal cases of associated illness. Members of the public may report a bloom event or a case of human or animal illness to the One Health system by contacting their local or state health department.

What is the outlook for future testing and surveillance of harmful algal blooms?

As climatic conditions become more favorable to development of harmful algal blooms, state and local health departments will have to ramp up surveillance and testing to protect public health and to preserve local revenue from beaches. These actions will come with a price tag, requiring action at all levels of government. Resources can be leveraged through collaboration to research and expand clinical testing capacity for these persistent health threats.

Learn More:

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One Health and the Global Health Security Agenda must go hand in hand

One Health and the Global Health Security Agenda must go hand in hand | www.aphlblog.org

By Samantha Dittrich, manager, Global Health Security Agenda, APHL

Did you know that most infectious diseases are caused by pathogens transferred between animals and humans? At least 75% of emerging and re-emerging diseases are either zoonotic or vector-borne. What’s more, animal health can directly affect food security and economic stability.

The One Health approach to disease control recognizes that human, animal and environmental health are connected. As a collaborative effort, One Health brings together multiple disciplines and sectors locally, nationally and globally to prevent, detect and respond to emerging and re-emerging infectious diseases.

We’ve seen how infectious disease epidemics pose a health security threat not only at the local level but also globally. Severe acute respiratory syndrome (SARS), avian influenza H5N1, Ebola and Zika are examples of pathogens that caused major outbreaks that had tremendous impacts on human, animal and economic health across the globe. Future threats are likely to arise as the global population continues to grow, the demand for food becomes greater and microbes become increasingly resistant to treatments such as antibiotics.

Though One Health isn’t a new concept, it is now more critical than ever before. A key component to the Global Health Security Agenda (GHSA) is strengthening One Health capacity to prevent, detect and respond to zoonotic diseases before they become a human public health risk. To do this, there must be a concerted global effort to work across multiple disciplines and through different sectors of government. One way this will be accomplished is through the GHSA Zoonotic Disease Action Package, one of 11 Action Packages aimed at achieving GHSA objectives and targets. The GHSA Zoonotic Disease Action Package specifically focuses on actions to minimize the transmission of zoonotic diseases from animals into human populations.

Governmental support for One Health objectives is expected to enhance countries’ ability to meet international health standards and improve the quality of human and animal health systems. For example, the World Health Organization (WHO) International Health Regulations (IHR) and the World Organization for Animal Health (OIE) Performance of Veterinary Services pathway develop government standards aimed at protecting human and animal health respectively. Their work strengthens reporting and communication between human and animal health sectors during zoonotic disease events, and improves the compatibility of existing animal and human diagnostics and surveillance systems.

As a collaborator in the GHSA, APHL is providing country support to strengthen laboratory systems by reviewing current capabilities, employing high quality laboratory processes and developing systems that foster communication and appropriate integration between laboratory and epidemiology functions. APHL staff are working in Uganda, Vietnam and Tanzania to incorporate One Health strategies into their National Laboratory Strategic Plans, and is making plans to support review of Tanzania’s National Laboratory Policy Review and development of its operational plan as well as development of Kenya’s operational plan and Indonesia’s National Strategic Plan development. APHL has also provided country support for laboratory antimicrobial resistance (AMR) assessments to determine current capacity for reliably detecting AMR. As APHL expands its GHSA work to other countries, the Association will continue to work across human and animal public health systems to deliver a One Health approach that strengthens national laboratory systems.