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Dr Alexandra Phelan Profile picture
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20 Feb, 9 tweets, 3 min read
Russian has reported seven human cases of avian influenza to @WHO

No confirmation of subtype yet.

No evidence yet of human to human transmission: all cases reported are workers in a poultry plant.

reuters.com/article/us-hea…
There have been a few highly pathogenic avian influenza infections (HPAI) across Europe recently in wild birds (@OIEAnimalHealth – WAHIS appears to be down this morning?)
Under the International Health Regulations (2005), countries must report any cases of a novel influenza subtype in humans as a potential PHEIC.

This is the first cluster in humans of an HPAI in Europe reported this year. It is not yet up on WHO DONs or promed.
Clusters in humans w close contact to birds are a concern, but don't necessarily indicate human2human transmission (limited or sustained).

More info we need:
- subtype? i.e. H5N1, novel
- epidemiology? i.e. cluster breadth
- response measures
With H5N1, we have seen clusters for over a decade, with some limited human to human transmission, but not sustained human to human transmission.

Right now, this is more an "alert not alarmed". If new subtype, we may see more active monitoring.
In WHO's Global Influenza Surveillance & Response System, Russia has a couple of National Influenza Centers and H5 Reference Lab.

As a result, we should have more information about the subtype relatively soon (if it hasn't already been reported to WHO confidentially per Art 11)
(finally, for my students about to do our Global Health Law pandemic simulation today, I promise this is not part of it)
Reports from some news outlets that the subtype is H5N8. This would be the first time we've seen H5N8 in humans.

Russia appears to have rapidly notified per Art6 & Annex 2 of the IHR.

Thanks @KrutikaKuppalli
bnonews.com/index.php/2021…
More discussion here:

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Dr Alexandra Phelan Profile picture
20 Feb
Unofficial reports so far state that the subtype is H5N8 – this would be a novel influenza subtype in humans.

The IHR require immediate reporting of *any* novel human influenza subtypes as potential PHEICs, no matter how serious.
Since 2020, there has been a global H5N8 outbreak among bird populations – wild birds and poultry. Cases have been reported in Saudi Arabia, Russia, Kazakhstan, Netherlands, Germany, Denmark, UK, France, Sweden, India, Japan, Norway, South Korea.

e.g. Estonia's 17 Feb OIE report
We may have just seen the leap occur from animals to humans here because of the nature of the human/animal interactions in this poultry farm, or there may be something genetically distinct. We need sequencing to know this.
Read 6 tweets
Dr Alexandra Phelan Profile picture
29 Jan
*Public health actions to control new SARS-CoV-2 variants*

Our paper just published in @CellCellPress w wonderful co-authors @NathanGrubaugh @firefoxx66 @JosephFauver & @mugecevik

We describe actions govts should urgently take to protect health.

🧵1/7

cell.com/cell/fulltext/…
New SARS-CoV-2 variants of concern will continue to emerge: exacerbating already crippling outbreaks & potentially reducing efficacy of some vaccines, cause increased rates of reinfections and prolonging the pandemic.

2/7
As SARS-Cov-2 variants of concern to date have shown: these are global issues. There must be urgent multilateral cooperation between countries to:
– build local sequencing capacities
– rapidly share sequence data globally
*and separately*

3/7
Read 7 tweets
Dr Alexandra Phelan Profile picture
29 Jan
Today, @ThinkGlobalHlth is celebrating its one year anniversary. @RebeccaKatz5 & I were fortunate enough to be invited to write a piece for this new @CFR_org blog, led by @TomBollyky.

Some reflections from that piece on why global governance matters.
thinkglobalhealth.org/article/why-gl…
From the outset, it was obvious that global governance was about to be seriously tested. Unfortunately, over this pandemic we've seen that play out to be the case – not only globally but also national governance.
There was a huge risk that WHO would be sidelined because states rejected WHO advice (for a range of reasons), but also because it has been woefully underfunded for years.
Read 6 tweets
Dr Alexandra Phelan Profile picture
22 Dec 20
I disagree with folks dismissing the implications of the UK variant of concern.

While individual behaviors to avoid transmission may not change, the impact at the population level is serious: hospitals are already at capacity.

Quick thread
/1
Any factor that ramps up transmission (biological or behavioral) amplifies cases, and as a result, severe cases and deaths. When hospitals hit capacity, cases that could have been treated successfully will be triaged along increasingly stringent crisis standards of care.
/2
At the population level, this also impacts government responses about control measures, which impacts now & future justifications
Short thread on that here:
/3
Read 6 tweets
Dr Alexandra Phelan Profile picture
21 Dec 20
Public Health England has just released their updated report on the UK #SARSCoV2 variant

"Investigation of novel SARS-CoV-2 variant: Variant of Concern 202012/01"

I'll do a quick summary thread below & link to report:
A cluster was identified & used to assess increasing incidence of the Variant of Concern (designated as such 18 Dec) in Kent, UK:
- 4% (255/6130) of Kent cases had available genomes
- in Kent: 117 genomically similar cases identified (10-19 Nov)
- in UK: 962 genomes of VoC(8 Dec)
Out of that 962 UK wide, epi data was available for 915 individuals.

As of 20 Dec, VoC present mainly in London, South East & East of England regions.

The report goes into the details of how the VoC testing is carried out.
Read 8 tweets
Dr Alexandra Phelan Profile picture
20 Dec 20
A lot of good discussion today about what we know and don't know about the new #SARSCoV2 variant in the UK.

But what does this mean (if anything) for government responses & public health law control measures, even if greater transmissibility is confirmed?

Quick notes (1/7)
Firstly, the virus is already sufficiently transmissible to be a concern. As others have noted, already important critical public health measures (avoiding crowds, social distancing, mask wearing, hand washing) will address variants that emerge:
(2/7)
First "but": any potential increase in transmissibility might shift how we weigh the stringency or priority of certain interventions, and how justifications for public health laws determine what is "the least restrictive measure".
(3/7)
Read 7 tweets

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