Global high consequence infectious disease events listing
Monthly update
July 2020
Global high consequence infectious disease events: April - June 2020 update
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Prepared by: Emerging Infections and Zoonoses Section, PHE
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Published August 2020
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gateway number: GW-1534 Sustainable Development Goals
Global high consequence infectious disease events: April – June 2020 update
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Introduction
This report provides detailed updates on known high consequence infectious disease
(HCID) events around the world.
This report details all the HCID pathogens that are covered during epidemic intelligence
activities. The report is divided into 2 sections. The first contains contact and airborne
HCIDs that have been specified for the HCID Programme by NHS England. The
second section contains additional HCIDs that are important for situational awareness.
Each section consists of 2 tables of known pathogens and includes descriptions of
recent events. A third table will be included in the second section when undiagnosed
disease events occur that could be interpreted as potential HCIDs.
Likelihood assessment
Included for each disease is a ‘likelihood assessment’; the likelihood of a case
occurring in the UK, based on past UK experience and the global occurrence of travelassociated cases. There are 3 categories currently – LOW, VERY LOW and
EXCEPTIONALLY LOW. This assessment is as of January 2019.
When considering clinical history, it is important to remember that cases can and do
occur outside of the usual distribution area. It is not possible to assess accurately the
risk of cases presenting to healthcare providers in England, but taken together it is
inevitable that occasional imported cases will be seen.
Events found during routine scanning activities that occur in endemic areas will briefly
be noted in the report. Active surveillance, other than daily epidemic intelligence
activities, of events in endemic areas will not be conducted (for example, actively
searching government websites or other sources for data on case numbers).
The target audience for this report is any healthcare professional who may be involved
in HCID identification.
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Section 1. Incidents of significance of primary HCIDs
Notable event: Ebola virus disease outbreak in Democratic Republic of the Congo (DRC)
Contact HCIDs
Infectious disease Geographical risk areas Source(s) and route of
infection:
UK experience to
date
Likelihood assessment
Crimean-Congo
haemorrhagic fever
(CCHF)
Endemic in Central and
Eastern Europe, Central
Asia, the Middle East,
East and West Africa.
First locally acquired case
in Spain 2016
(Risk Assessment).
• bite from or crushing of
an infected tick
• contact with blood or
tissues from infected
livestock
• contact with infected
patients, their blood or
body fluids
Two confirmed
cases (exAfghanistan 2012;
ex-Bulgaria 2014).
LOW – Rarely reported
in travellers (23 cases
in world literature).
Recent cases/outbreaks:
• Georgia confirmed 1 additional case for 2020, bringing the overall tally for 2020 to 11
• Russia’s Stavropol region reported 8 cases in July, by mid-July 30 cases had been reported for
2020. The Rostov region reported an overall total of 14 cases for 2020 in July.For both regions
incidences were lower than those of 2019.
Ebola virus disease
Sporadic outbreaks in
Western, Central and
Eastern Africa.
• contact/consumption of
infected animal tissue
(such as, bushmeat)
• contact with infected
human blood or body
fluids
Four confirmed
cases (1 labacquired in UK in
1976; 3 HCWs
associated with
West African
VERY LOW – Other
than during the West
Africa outbreak,
exported cases are
extremely rare.
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epidemic 2014 to
2015).
DRC - outbreak in Equateur province
On 1 June 2020, a new outbreak was declared in Équateur province, on the other side of the now declared
over 10th outbreak, when a small cluster of cases was reported in the city of Mbandaka. This province was
previously affected by EVD in the summer of 2018. In July the new outbreak continued to see rising
numbers of confirmed cases and geographical spread to new health areas, with 27 health areas in eight
health zones affected. By end of July a total of 73 cases (69 confirmed and four probable) including 31
deaths (42.5% CFR) had been reported, with three health workers having been affected. The number of
health areas that have reported at least one confirmed or probable case of EVD since the start of this
outbreak has risen to 27, in eight of the 18 health zones in the province. Challenges encountered were
inadequate resources for alert investigations in Mbandaka, and case management in rural and hard-toreach areas continue. According to the WHO, the constant presence of confirmed cases in the community
was of particular concern, along with suspected cases who were not being isolated or delays in isolation.
Additionally, there are insufficient funds available to cover the response required. Although all pillars of
response are active in the affected areas, further actions are required to limit spread to other areas
(including spread to neighbouring countries Republic of Congo and Central African Republic), along with
intense community engagement with community leaders to prevent resistance to response activities and
ensure that communities become fully engaged in response activities.
Lassa fever
Endemic in sub-Saharan
West Africa
• contact with excreta, or
materials contaminated
with excreta of infected
rodent
• inhalation of aerosols of
excreta of infected
rodent
• contact with infected
human blood or body
fluids
Fourteen cases
since 1971, all exWest Africa.
LOW – Overall it is the
most common imported
VHF but still rare (global
total 35 reported since
1969).
Recent cases/outbreaks:
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• Nigeria:after the peak in cases January to March, the decreasing trend observed from April to
June, continues with only 14 confirmed cases in Ondo state mostly in July. The total number of
confirmed cases to 28 June 2020 was 1,054.
• Guinea reported one case (with one death) mid-July
Marburg virus
disease
Sporadic outbreaks in
Central and Eastern
Africa
• contact with infected
blood or body fluids
No known cases in
UK.
VERY LOW – 5 travelrelated cases in the
world literature.
Recent cases/outbreaks:
• no cases reported since November 2017
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Airborne HCIDs
Infectious disease Geographical risk areas Source(s) and route of
infection:
UK experience to date Likelihood assessment
Influenza A(H7N9)
virus (Asian
lineage)
All human infections
acquired in China.
• close contact with
infected birds or their
environments
• close contact with
infected humans (no
sustained human-tohuman transmission)
No known cases in
UK.
VERY LOW (PHE Risk
Assessment).
Recent cases/outbreaks:
• no confirmed or suspected human cases of H7N9 were reported in July
Influenza A(H5N1)
virus
Human cases
predominantly in SE Asia,
but also Egypt, Iraq,
Pakistan, Turkey, Nigeria.
Highly pathogenic H5N1 in
birds much more
widespread, including UK.
• close contact with
infected birds or their
environments
• close contact with
infected humans (no
sustained human-tohuman transmission)
No known cases in
UK.
VERY LOW (PHE Risk
Assessment).
Recent cases/outbreaks:
• no confirmed or suspected human cases of H5N1 were reported in July
Middle East
respiratory
syndrome (MERS)
The Arabian Peninsula –
Yemen, Qatar, Oman,
Bahrain, Kuwait, Saudi
Arabia and United Arab
Emirates
• airborne particles
• direct contact with
contaminated
environment
• direct contact with
camels
Five cases in total; 3
imported cases (2012,
2013 and 2018); 2
secondary cases in
close family members
of 2nd case; 3 deaths
VERY LOW (PHE Risk
Assessment).
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Recent cases/outbreaks:
• As of 2 July, 57 cases (with 20 deaths) have been reported in Saudi Arabia, 2 in the United Arab
Emirates and 1 in Qatar in 2020, as reported by ECDC in July. For awareness, regular reporting
of MERS cases seems to have stalled, especially for Saudi Arabia, since the start of the COVID19 pandemic.
Monkeypox virus
West and Central Africa • close contact with
infected animal or
human
• indirect contact with
contaminated material,
such as bed linen
Three cases in total; 2
imported (Sept 2018)
and 1 nosocomial
transmission.
VERY LOW – Reported
outside Africa for the
first time in 2018 (2 in
UK and 1 in Israel).
Recent cases/outbreaks:
• DRC reported 334 suspected cases including 10 deaths in July. A total of 2,924 suspected
cases (108 deaths) had been reported thus far in 2020. Compared to the same period in 2019,
although the number of cases is slightly lower (3,015 cases by August 2019), the number of
deaths is significantly higher in 2020 (64 deaths by August 2019). The reason for the increased
case fatality rate is unknown at this stage.
• Nigeria reported 3 suspected case up to 26th of July
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Nipah virus
Outbreaks in Bangladesh
and India; SE Asia at risk.
• direct or indirect
exposure to infected
bats; consumption of
contaminated raw date
palm sap
• close contact with
infected pigs or
humans
No known cases in
UK.
EXCEPTIONALLY LOW
– No travel-related
infections in the
literature.
Recent cases/outbreaks:
• no confirmed or suspected cases reported in July
Pneumonic plague
(Yersinia pestis)
Predominantly subSaharan Africa but also
Asia, North Africa, South
America, Western USA
• flea bites
• close contact with
infected animals
• contact with human
cases of pneumonic
plague
Last outbreak in UK
was in 1918.
VERY LOW - Rarely
reported in travellers.
Recent cases/outbreaks:
• DRC’s Ituri province is seeing an increase in plague cases in a single health zone. From midJune to mid-July 45 cases including 9 deaths were reported. Of these, two showed signs of
septicemic plague; all the other cases were diagnosed as having bubonic plague. According to
the available information, it is likely that all three types of plague clinical presentation (bubonic,
septicemic and pneumonic) are present. Overall, 75 cases (17 deaths) were reported for 2020.
Severe acute
respiratory
syndrome (SARS)
Currently none; 2
outbreaks originating from
China 2002 and 2004.
• airborne particles
• direct contact with
contaminated
environment
Four cases related to
2002 outbreak.
EXCEPTIONALLY LOW
– Not reported since
2004.
Recent cases/outbreaks:
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Section 2. Incidents of significance of additional HCIDs
Contact HCIDs
Infectious disease Geographical risk areas Source(s) and route of
infection:
UK experience to date Likelihood assessment
Argentine
haemorrhagic fever
(Junin virus)
Argentina (central).
Limited to the provinces of
Buenos Aires, Cordoba, Santa
Fe, Entre Rios and La Pampa.
• direct contact with
infected rodents
• inhalation of
infectious rodent
fluids and excreta
• person-to-person
transmission has
been documented
No known cases in
UK.
EXCEPTIONALLY
LOW – Travel-related
cases have never
been reported.
Recent cases/outbreaks:
• no confirmed or suspected cases were reported in July
Bolivian
haemorrhagic fever
(Machupo virus)
Bolivia – limited to the
Department of Beni,
municipalities of the provinces
Iténez (Magdalena, Baures
and Huacaraje) and Mamoré
(Puerto Siles, San JoaquÃn
and San Ramón)
• direct contact with
infected rodents
• inhalation of
infectious rodent
fluids and excreta
• person-to-person
transmission has
been documented
No known cases in
UK.
EXCEPTIONALLY
LOW – Travel-related
cases have never
been reported.
Recent cases/outbreaks:
• no confirmed or suspected cases were reported in July
• no confirmed or suspected human cases reported since 2004
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Lujo virus disease
Single case acquired in
Zambia lead to a cluster in
South Africa in 2008.
• presumed rodent
contact (excreta, or
materials
contaminated with
excreta of infected
rodent)
• person-to-person via
body fluids
No known cases in
UK.
EXCEPTIONALLY
LOW – a single travel
related case; not
reported anywhere
since 2008.
Recent cases/outbreaks:
• no confirmed or suspected human cases reported since 2008
Severe fever with
thrombocytopenia
syndrome (SFTS)
Mainly reported from China
(southeastern), Japan and
Korea; first ever cases
reported in Vietnam and
Taiwan in 2019.
• presumed to be tick
exposure
• person-to-person
transmission
described in
household and
hospital contacts, via
contact with
blood/bloodstained
body fluids
No known cases in
UK.
EXCEPTIONALLY
LOW – Not known to
have occurred in
travellers.
Recent cases/outbreak:
• China: media reports of 60 hopitalised cases and 7 deaths for 2020
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Airborne HCIDs
Infectious disease Geographical risk areas Source(s) and route of
infection:
UK experience to date Likelihood assessment
Andes virus
(Hantavirus)
Chile and southern
Argentina.
• rodent contact
(excreta, or materials
contaminated with
excreta of infected
rodent
• person-to-person
transmission described
in household and
hospital contacts
No known cases in
UK.
VERY LOW – Rare
cases in travellers have
been reported.
Recent cases/outbreaks:
• no confirmed or suspected cases were reported in July
Influenza A(H5N6)
virus
Mostly China
(March 2017 new strain in
Greece, and subsequently
found in Western Europe).
• close contact with
infected birds or their
environments
No known cases. VERY LOW – Not
known to have occurred
in travellers (PHE risk
assessment).
Recent cases/outbreaks:
• no confirmed or suspected human cases of H5N6 were reported in July
Influenza A(H7N7)
virus
Sporadic occurrence
including Europe and UK.
• close contact with
infected birds or their
environments
• close contact with
infected humans (no
sustained human-tohuman transmission)
No known cases. VERY LOW – Human
cases are rare, and
severe disease even
rarer.
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Recent cases/outbreaks:
• no confirmed or suspected human cases of H7N7 were reported in July
