COVID-19
(312) ウイルスの起源，保有宿主動物
(311) カザフスタン，英/米国 死亡リスク
レクチン中毒－デンマーク
リステリア症－フィンランド
● COVID-19(312) ウイルスの起源，保有宿主動物
PRO/AH/EDR> COVID-19 update (312): China, SARS-CoV2 origin, animal reservoir, WHO mission
Archive Number: 20200711.7565035
情報源 Science Magazine - News 2020年7月10日
COVID-19 パンデミックの起源を明らかにするため 10日，2名の WHO のチームが中国に到着したが，答えを持ち帰ることは難しいとみられている。疫学と動物衛生の専門家各 1名からなる 2名は，中国当局者らと議論することになっている ... 調査の目的は，ウイルスを保有する可能性のある動物の捕獲から，研究施設から漏出した可能性の検証にまで及ぶ ... 当初，1月の数週間に武漢の保健当局者らが語った整然とした起源についての説明は，1か所の海鮮市場に関係する人々が原因不明の肺炎を発症し，市場の閉鎖と消毒作業によりアウトブレイクは収束したというものだった。しかし，初めての武漢市の疫学調査が発表されると，武漢の患者で確認された新型コロナウイルスの起源について混乱が生じた：発端となった SARS-CoV-2 感染の患者 5例中 4例には市場との関連性が認められない。このあとすぐ，別のストーリーが登場した。武漢市にはコウモリのコロナウイルス研究者が所属するウイルス研究所 the Wuhan Institute of Virology (WIV) があるのは偶然ではないと考えるものがいた。同研究者のグループは初めて SARS-CoV-2 ウイルスを分離・解析したうちの １つであり，15年にわたって野生のコウモリを捕獲し，パンデミックの可能性の予測のためにコロナウイルスを調べていた。この研究者らによる今回の新型ウイルスに関する初めての報告の中で，彼女らが保有するコウモリコロナウイルスのうちの １つが，SARS-CoV-2 ウイルスと 96.2% の相同性を有すると記述している。トランプ米大統領は，ウイルスが研究施設で作成されたとの好戦的な説を述べた（同施設の研究者らはそのようなシナリオには何のメリットもないと主張し，他の進化生物学者はこのウイルスには人工的に作られたことを示す証拠が見られないとしている）。最も支持を集めている仮説は，コウモリとヒトの間で感染を橋渡しした，ウイルス感受性のある中間宿主の動物からヒトに感染が拡がった，とするものである。the case of severe acute respiratory syndrome (SARS) の場合，ジャコウネコ civets がその役割を担ったことが判っている。同じコロナウイルス感染症の Middle East respiratory syndrome (MERS) については，より早い時期にラクダであることが明らかになった。中国の当局者は，武漢の海鮮市場での SARS-CoV-2 ウイルス検査を実施したと報告したが，その結果は釈然としないものだった remains sketchy。国営メディアは，市場内の野生動物を売るゾーンの "environmental samples (環境からの検体)" でウイルス検査が陽性となったと伝えたが，検査結果の詳細も，売られていた動物種のリストさえも報告されなかった。他の研究では，SARS-CoV-2 とアリを食べる絶滅種のセンザンコウ pangolins で発見されたコロナウイルスのあいだで類似性が認められたとされたが，このウイルスは SARS-CoV-2 に最も近いコウモリコロナウイルスよりも遺伝学的に離れていたし，センザンコウと中国伝統医薬品でもあるその鱗が市場で販売されていたかどうか，確認できていない。WHO と中国政府当局がパンデミックの起源を調査するとして，解明すべき重要な点がいくつかある。
- 武漢海鮮市場の検体で，正確には何が調査されどのような結果が得られたのか。2002年11月に中国広東省の 1名に SARS が発生したが，3か月間 WHO には報告されず，同省内の各市場での広範囲な動物からのサンプリングにより，ジャコウネコからウイルスが発見されたのは，2003年10月だった。
- これまでに公開されているもの (たとえば https://tinyurl.com/vssjprg and https://tinyurl.com/w5qfs4w) 以上の，初期の感染例についての疫学データはあるのか ? 患者らの渡航歴は ? 動物との接触歴は ? 症例間にどのような関連性があったのか ? 接触者の抗体検査は行われたのか ? 以前の感染を示す可能性のある，接触者の血液等の検体は保管されているのか ?
SARS について言えば，ウイルスの発見から 14か月が経過した 2004年6月になって，研究者らからヒトと動物の疫学解析の詳細が報告された: 39% of the earliest cases は食品取り扱い業務者 food handlers で, 生きた動物の取引に関わったもの traders of live animals は（それ以外の人々の）13倍のウイルス抗体保有率であり，72% が civets を扱っていた。the earliest COVID-19 cases に対する新たなインタビューを行えば，患者らの間に驚くべき関連性が示されるかも知れない。たとえば COVID-19 clusters が，飲食を共にしたり，宗教上の集まりだったり，麻雀でも発生している。
- 武漢で第 1例とされている患者以前の検体について，中国の研究者はどの程度積極的に SARS-CoV-2 について調べているのか ? 武漢以外についてはどうか ? どれくらい遡って調べたのか ?病院または検査機関は，患者，特に死亡原因が不明の患者については，血液，鼻スワブ，組織を保管していることがある。まさにそのような検体により，2012年6月にサウジアラビアで初めて発見されたが，2012年4月にすでにヨルダンで 2人が死亡していたという MERS の真実を明らかにすることにつながった ...
- コウモリや，中国でふつうに見られ SARS-CoV-2 に感受性があるとされている野生動物，たとえば霊長類，シカ，齧歯類など，について広くスクリーニングを実施する可能性があるのか ? 動物の尿や糞にウイルスの遺伝子が含まれることがしばしばある。武漢ウイルス研究所のグループは常日頃からコウモリの排泄物や鼻スワブでコロナウイルスを調べている。サブサハラアフリカ地域のチンパンジーの糞の採取が，HIV-1 流行の起源を知ることに大いに役立ったし，1998年にマレーシアの養豚農家で発見された the Nipah virus は，2年後にオオコウモリ flying bats の尿や食べたフルーツの検体採取で明らかになった。
- 家畜のスクリーニングが COVID-19's origin の手がかりとなり得るのか ? AIDS researchers は，ペットのサルが HIV-2 に近いサル免疫不全ウイルス a simian immunodeficiency virus を保有し，ヒトにも感染することを発見した。武漢の飼い猫と野良猫の調査では，検査した 141検体の 15% で抗体 SARS-CoV-2 antibodies が確認されている。アウトブレイク以前の検体では抗体は確認されなかったが，獣医師らがほかに検体を保有している可能性はないか ? もっと多くのネコの検査は可能か ? ネコはシーフード好きであり，早期の感染拡大に武漢市場が一役買ったのは間違いない。
- 家畜の検体は保管されているか ? 2009年のパンデミックの原因となったインフルエンザウイルスはその遺伝学的特徴からブタ由来であることが明らかになったが，感染したブタを飼育していたと思われるメキシコの複数の農場の場所が研究者から報告されたのは，2016年になってからのことであった。この研究では，2010年から 2014年の間に，メキシコの 6つの州の 22の農場で採取された病気のブタからの検体を診断した検査機関に保管されていた気道検体で，58件のインフルエンザウイルスが確認された ... 系統発生学的解析から，2つの州がパンデミックの発端であり，さらに欧州から輸入されたブタによってメキシコにウイルスが持ち込まれたことが示唆されている。
- SARS-CoV-2 を保有するコウモリや野生動物と接触の可能性のあるヒトの，中国での広範囲のスクリーニング調査実施可能か ？ ホワイトハウスからの圧力により 2020年4月に the National Institutes of Health からの資金が打ち切られた EcoHealth Alliance and Shi の研究者が 2019年，SARS-related coronaviruses を保有するコウモリのいる地域で 1500人近い中国人からの採血検体についての研究報告を行ない，既往歴や動物との接触歴についての聞き取りも行っている。コウモリコロナウイルスの感染の証拠が見つかったのはわずか 9人だったが，抗体がすぐに消失する quickly wane ことも指摘している。研究チームは，コウモリからヒトへの（ウイルスの）漏出は常に起こっているとしている。
- the 1st confirmed case of SARS-CoV-2 が科学的文献で報告された 2019年12月1日以前の possible COVID-19 cases の情報は，政府保健当局からの報告に含まれているのか ? The South China Morning Post は，2019年11月17日の湖北省 Hubei province の 55歳の患者が COVID-19 であったとする，"government data" の存在を把握したと報じている。この記事では 11月中にほかにも 8例の患者が確認されていた，としている。武漢市は湖北省の省都であるが，政府記録にはこれらの患者の居住地は記載がなかったと伝えている。ウイルスがはじめて患者から分離されたのは武漢市であるが，武漢市以外で新興した可能性がある。2009年のパンデミックでは，問題のインフルエンザウイルスがはじめて分離されたのは，発端となったメキシコではなく米国カリフォルニア州 San Diego, California だった。
- 検査可能な中国国内の下水処理施設のサンプルは保管されているか？ ...
- 武漢ウイルス研究所 WIV では，コウモリコロナウイルスを使ってどのような実験が行われているのか ? ... 事故による研究機関からのウイルスの漏出は実際に起こっており，パンデミックになった例まである: 1977年に登場した An influenza strain は strains in Russian labs collected 2 decades earlier と結びつけられている。
- WIV の誰かが感染し，施設外の他者に感染を拡げた可能性はないか ? ...
もう 1つの outstanding question として，武漢の研究者らがコウモリのウイルスの捜査によって，ヒトの間で感染伝播しやすくする実験 "gain-of-function" experiments を行っていたのではないか。同施設の研究者は 2015年，マウスに馴化させたウイルスとコウモリのウイルスを結合させたキメラウイルス a chimeric SARS virus 作成の論文の共著者となっている。ただしこの実験は武漢ではなく the University of North Carolina で行われた。
最後に，2018年の北京の米国大使館からの外交文書において，a new, ultra-high-security lab at WIV は "a serious shortage of appropriately trained technicians and investigators." との警告が伝えられている。
関連項目
COVID -19 update (308): USA (TX) animal, dog conf. 20200708.7554832
● エーリキア症－オーストラリア 輸入されたイヌ
PRO/AH/EDR> Ehrlichiosis - Australia (03): (WA) imported dog, testing
Archive Number: 20200711.7564789
情報源 ABC.net.au 2020年7月10日
北部オーストラリアで，死亡する可能性のある外来のイヌの病気のアウトブレイクの背景は，輸入されるイヌの検査に手落ちがあったと動物衛生当局は考えている。ダニが媒介するエーリキア症 ehrlichiosis は，オーストラリアで初めて 2020年5月に Western Australia's Kimberley region で確認されたことから，どのようにして国内に持ち込まれたかの調査が始まった ... 輸出元の国で検査が行われているとの前提で，ペットのイヌが輸
● レクチン中毒－デンマーク
PRO/AH/EDR> Lectin poisoning - Denmark
Archive Number: 20200711.7564741
情報源 Food Safety News 2020年7月8日
豆 red kidney beans に含まれるレクチン A type of lectin が，2020年のこれまでにデンマークで起きているアウトブレイクの原因だった。4月後半，1日で 24人の患者が発生した日も含めて 45人が中毒により症状を発症した。アウトブレイクは，コペンハーゲンのケータリング会社 1社に限定されていた。中毒の原因は，トルコからスウェーデンを経由して輸入された冷凍の金時豆 frozen red kidney beans に含まれる phytohaemagglutinin (PHA) だった。食品監視当局者は，加熱 boiled が十分でなかったとみられる，と述べている ... 中毒の症状には，レクチンを減少させるのに不十分な加熱であった豆の摂取後数時間で起こる嘔吐と下痢 ...
[ Mod.TG 注－"Lectins は選択的に炭水化物と結合するタンパクで，ほとんどの動物細胞の表面を被う糖タンパクの炭水化物部分であることが重要。幅広い野菜，検査された 88種類のうちの 29種類，で確認できる。消化酵素では分解されにくく，腸管上皮細胞表面に親和性のある，the Leguminosae family などに含まれる Plant lectins は，中毒の原因となり得る ... NIH]
● 日本脳炎－インド
PRO/AH/EDR> Japanese encephalitis & other - India (08): (AS)
Archive Number: 20200711.7563226
情報源 The Sentinel 2020年7月9日
1月以降，アッサム Assam 州では日本脳炎など JE (Japanese encephalitis) and AES (acute encephalitis syndrome) により 23人もの命が奪われた。JE による死者は 5人, AES により 18 lives がなくなった ... 174人 in 27 districts across the State が感染し，うち 38人が JE の患者だった ...
● COVID-19(311)－カザフスタン，英/米国 死亡リスク
PRO/AH/EDR> COVID-19 update (311): Kazakhstan pneumonia, UK, USA mortality risks, WHO
Archive Number: 20200711.7563337
In this update:
[1] Kazakhstan: Follow-up
[2] Risk factors for mortality
[3] Selected countries
[4] WHO situation report 172 (as of 10 Jul 2020)
[5] Global update: Worldometer accessed 10 Jul 2020 22:11 EDT (GMT-4)
[1] カザフスタン: Follow-up
情報源 Live Science 2020年7月10日
カザフスタンの中国大使館は 19日，カザフスタンで原因不明の肺炎により，中国国民を含む 1700人以上が死亡したとして注意喚起を行っているが，他国は COVID-19 が疑われるとしている。CNN は致死率は新型コロナウイルス以上と伝えている。カザフスタン政府当局はこれを否定し，同保健相は，原因不明のウイルス肺炎が国内で発生しているとしながらも，原因不明 "unspecified" とは症状から COVID-19 と診断されているが，検査では確定されなかった（結果が陰性であった）症例に用いる，と述べている ... WHO は調査中とする一方で，レジオネラ症やインフルエンザなどによる非定型肺炎のクラスターも世界中のどこでもいつでも起こりうるとしている。
［Mod.MPP 注－ナイジェリア Kano, Nigeria からの a similar "unexplained pneumonia" with high mortality report が，the Nigeria CDC による調査の結果，COVID-19 と判明した例がある (20200612.7463389)]
[2] Risk factors for mortality
[A] 英国 British NHS study - Nature
情報源 Nature 2020年7月8日
原著タイトル OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. Epub 8 Jul 2020. https://doi.org/10.1038/s41586-020-2521-4
Abstract
--------
COVID-19 has rapidly affected mortality worldwide (1; see source URL for complete references). There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England, here we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17 278 392 adults were pseudonymously linked to 10 926 COVID-19-related deaths. COVID-19-related death was associated with being male (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people with white ethnicity, Black and South Asian people were at higher risk even after adjustment for other factors (HR, 1.48; 1.30-1.69 and 1.44; 1.32-1.58, respectively). We have quantified a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients' records; we will update and extend results regularly.
Discussion
----------
This secure analytics platform operating across over 23 million patient records for the COVID-19 emergency was used to identify, quantify, and explore risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. Most comorbidities were associated with increased risk, including cardiovascular disease, diabetes, respiratory disease including severe asthma, obesity, history of haematological malignancy or recent other cancer, kidney, liver, neurological and autoimmune conditions. People from South Asian and black groups had a substantially higher risk of death, only partially attributable to comorbidity, deprivation or other risk factors. A strong association between deprivation and risk was only partly attributable to comorbidity or other risk factors.
These analyses provide a preliminary picture of how key demographic characteristics and a range of comorbidities, a priori selected as being of interest in COVID-19, are jointly associated with poor outcomes. These initial results may be used subsequently to inform the development of prognostic models. We caution against interpreting our estimates as causal effects. For example, the fully adjusted smoking hazard ratio does not capture the causal effect of smoking due to the inclusion of comorbidities which are likely to mediate any effect of smoking on COVID-19 death (e.g., COPD). Our study has highlighted a need for carefully designed causal analyses specifically focusing on the causal effect of smoking on COVID-19 death. Similarly, there is a need for analyses exploring the causal relationships underlying the associations observed between hypertension and COVID-19 death.
----
[B] USA, CDC - Morbidity and Mortality Weekly Report (MMWR)
情報源 MMWR 2020年7月10日
原著タイトル Characteristics of persons who died with COVID-19 -- United States, February 12-May 18, 2020. MMWR Morb Mortal Wkly Rep. Epub 10 July 2020.
Discussion
----------
Using national case-based surveillance and supplementary data reported from 16 jurisdictions, characteristics of greater than 10 000 decedents with laboratory-confirmed COVID-19 were described. More than one-third of Hispanic decedents (34.9%) and nearly one-third (29.5%) of nonwhite decedents were aged less than 65 years, but only 13.2% of white decedents were aged less than 65 years. Consistent with reports describing the characteristics of deaths in persons with COVID-19 in the USA and China (2-5; see source URL for complete references), approximately three-fourths of decedents had one or more underlying medical conditions reported (76.4%) or were aged greater than or equal to 65 years (74.8%). Among reported underlying medical conditions, cardiovascular disease and diabetes were the most common. Diabetes prevalence among decedents aged less than 65 years (49.6%) was substantially higher than that reported in an analysis of hospitalized COVID-19 patients aged less than 65 years (35%) and persons aged less than 65 years in the general population (less than 20%) (5-7). Among decedents aged less than 65 years, 7.8% died in an emergency department or at home; these out-of-hospital deaths might reflect lack of healthcare access, delays in seeking care, or diagnostic delays. Health communications campaigns could encourage patients, particularly those with underlying medical conditions, to seek medical care earlier in their illnesses. Additionally, healthcare providers should be encouraged to consider the possibility of severe disease among younger persons who are Hispanic, nonwhite, or have underlying medical conditions. More prompt diagnoses could facilitate earlier implementation of supportive care to minimize morbidity among individuals and earlier isolation of contagious persons to protect communities from SARS-CoV-2 transmission.
The relatively high percentages of Hispanic and nonwhite decedents aged less than 65 years were notable. The median age of nonwhite persons (31 years) in the USA is lower than that of white persons (44 years); these differences might help explain the higher proportions of Hispanic and nonwhite decedents among those aged less than 65 years. The median ages among Hispanic and nonwhite decedents (71 and 72 years, respectively) were 9-10 years lower than that of white decedents (81 years). However, the percentage of Hispanic decedents aged less than 65 years (33.9%) exceeded the percentage of Hispanic persons aged less than 65 years in the US population (20%); the percentage of nonwhite COVID-19 decedents aged less than 65 years (40.2%) also exceeded the overall percentage of nonwhite decedents aged less than 65 years (23%) in the US population (8). Further study is needed to understand the reasons for these differences. It is possible that rates of SARS-CoV-2 transmission are higher among Hispanic and nonwhite persons aged less than 65 years than among white persons; one potential contributing factor is higher percentages of Hispanic and nonwhite persons engaged in occupations (e.g., service industry) or essential activities that preclude physical distancing (9). It is also possible that the COVID-19 pandemic disproportionately affected communities of younger, nonwhite persons during the study period (10). Although these data did not permit assessment of interactions between race/ethnicity, underlying medical conditions, and nonbiologic factors, further studies to understand and address these racial/ethnic differences are needed to inform targeted efforts to prevent COVID-19 mortality.
Despite these limitations, this report provides more detailed demographic and clinical information on a subset of approximately 10 000 decedents with laboratory-confirmed COVID-19. Most decedents were aged less than 65 years and had underlying medical conditions. Compared with white decedents, more Hispanic and nonwhite decedents were aged less than 65 years. Additional studies are needed to elucidate associations between age, race/ethnicity, SARS-CoV-2 infection, disease severity, underlying medical conditions (especially diabetes), socioeconomic status (e.g., poverty and access to healthcare), behavioral factors (e.g., ability to comply with mitigation recommendations and maintain essential work responsibilities), and out-of-hospital deaths. Regional and state level efforts to examine the roles of these factors in SARS-CoV-2 transmission and COVID-19-associated deaths could lead to targeted, community-level, mortality prevention initiatives. Examples include health communication campaigns targeted toward Hispanics and nonwhite persons aged less than 65 years. These campaigns could encourage social distancing and the need for wearing cloth face coverings in public settings. In addition, healthcare providers should be encouraged to consider the possibility of disease progression, particularly in Hispanic and nonwhite persons aged less than 65 years and persons of any race/ethnicity, regardless of age, with underlying medical conditions, especially diabetes.
*Underlying medical conditions include cardiovascular disease (congenital heart disease, coronary artery disease, congestive heart failure, hypertension, cerebrovascular accident/stroke, valvular heart disease, conduction disorders or dysrhythmias, other cardiovascular disease); diabetes mellitus; chronic lung disease (chronic obstructive pulmonary disease/emphysema, asthma, tuberculosis, other chronic lung diseases); immunosuppression (cancer, human immunodeficiency virus [HIV] infection, identified as being immunosuppressed); chronic kidney disease (chronic kidney disease, end-stage renal disease, other kidney diseases); neurologic conditions (dementia, seizure disorder, other neurologic conditions); chronic liver disease (cirrhosis, alcoholic hepatitis, chronic liver disease, end-stage liver disease, hepatitis B, hepatitis C, nonalcoholic steatohepatitis, other chronic liver diseases); obesity (body mass index of 30 kg/m2 or greater).
[These 2 studies are basically carrying the same message -- disadvantaged minority groups are at greater risk most likely due to inherent inequities in health services for less affluent society members, so they are coming into this pandemic with a higher incidence of comorbidities, working in jobs that make social distancing unobtainable, and have less access to services so many of the deaths occur at home or soon after arrival at the health service.
Initial studies early on focused on the comorbidities, but these later studies tell a more complete story than the comorbidities alone. - Mod.MPP]
******
[3] Selected countries:
[A] China: National Health Commission, 83 587 total cases, 4634 deaths
[B] South Korea: 13 373 confirmed cases, 288 deaths
[C] Italy: 242 639 total cases, 34 938 deaths
[D] Iran: 252 720 total cases, 12 447 deaths
[E] USA: 3 291 786 total cases, 136 671 deaths
[A] China: National Health Commission, 83 587 total cases, 4634 deaths
情報源 China National Health Commission [in Chinese] 2020年7月10日
[The 2 new confirmed cases in the past 24 hours were both imported, and it is now 5 days that no new cases have been reported from Beijing.
----
[B] South Korea: 13 373 confirmed cases, 288 deaths
情報源 Ministry of Health and Welfare [in Korean] 2020年7月11日
10 Jul 2020 0:00 AM KT 13 338 confirmed cases, 288 deaths
11 Jul 2020 0:00 AM KT 13 373 confirmed cases, 288 deaths
Change: 35 newly confirmed infections; no new deaths
[C] Italy: 242 639 total cases, 34 938 deaths
情報源 Italian Government Health Ministry 2020年7月10日
- 242 639 cumulative cases (+276);
- 13 428 people are currently positive for the virus (-31);
- 194 273 people have recovered (+295);
- 844 patients are hospitalized with symptoms (-27), 65 in intensive care (-4), and 12 519 (no change) are in home isolation;
- 34 938 deaths have been reported (+12).
----
[D] Iran: 252 720 total cases, 12 447 deaths
情報源 IFP news (Iran Front Page) 020年7月10日
Iran's Health Ministry spokeswoman says 215 015 coronavirus patients have recovered from the disease so far and been discharged from the hospital. In a press briefing on Friday [10 Jul 2020], Sima-Sadat Lari said 142 people have also died of the virus in the past 24 hours, bringing the total number of fatalities to 12 447. She confirmed 2262 new cases of infection with the novel coronavirus, raising the total number of cases to 252 720.
A total of 3319 patients are also in severe conditions of the disease, she added. Lari noted that 1 922 501 COVID-19 tests have been taken across the country.
According to Lari, East Azarbaijan, West Azarbaijan, Kermanshah, Khuzestan, Hormozgan, Bushehr, Kurdistan, Khorasan Razavi, and Ilam provinces are still considered as red zones as in previous days. Tehran, Isfahan, Mazandaran, Golestan, Alborz, Kerman, Yazd, Sistan and Baluchestan, Hamadan, and Ardabil provinces are also in dangerous conditions, she added, urging people to seriously avoid any unnecessary travel, especially to Khorasan Razavi and Mazandaran provinces.
[As of 10 Jul 2020, the total number of cases of COVID-19 confirmed in Iran is 252 720, including 12 447 deaths, an increase of 2262 cases and 142 deaths since 9 Jul 2020. The numbers of daily reported cases and deaths are slowing increasing. There are now 9 provinces classified as "red zones" and an additional 10 provinces considered in dangerous condition. Another media report mentioned that most new cases are related to large gatherings such as weddings and funerals (https://en.radiofarda.com/a/iran-to-postpone-nationwide-university-entrance-exams-due-to-surge-in-covid/30719515.html).
----
[E] USA: 3 291 786 total cases, 136 671 deaths
情報源 Worldometer 2020年7月10日
[For those who are interested, a pdf snapshot of the full data Worldometer table at the time we accessed it is available at https://promedmail.org/wp-content/uploads/usa-pdf/JULY10USDATASET_1594435546.pdf.
A 7-day series of cumulative reported cases by states, territories, and reporting entities can be found at https://promedmail.org/wp-content/uploads/usa-pdf/JULY10US7_1594435585.pdf. - Mod.MPP]
USA cases by state - top 20 states
State: Total cases / New cases
------------------------------
New York: 426 016 / 944
California: 312 104 / 8781
Texas: 251 076 / 10 063
Florida: 244 151 / 11 433
New Jersey: 178 218 / 423
Illinois: 152 899 / 1327
Arizona: 116 892 / 4221
Georgia: 111 211 / 4484
Massachusetts: 111 110 / 213
Pennsylvania: 98 574 / 940
North Carolina: 81 499 / 1830
Michigan: 75 685 / 622
Louisiana: 74 636 / 2642
Maryland: 71 910 / 463
Virginia: 68 931 / 943
Ohio: 62 884 / 1553
Tennessee: 59 546 / 1955
South Carolina: 52 419 / 1728
Alabama: 50 508 / 1334
Indiana: 50 300 / 725
All USA total: 3 291 786 / 71 787
Total deaths: 136 671
[The above are the latest breakdowns of confirmed cases of SARS-CoV-2 infection in the USA as per Worldometer data for the top 20 reporting entities. The total number of confirmed cases in the USA and territories is now 3 291 786 including 136 671 deaths, an increase from 3 219 999 cases and 135 822 deaths in the past 24 hours. New York City had a cumulative total of 215 265 cases as of 13:00 EDT (GMT-4) on 10 Jul 2020 (+313 since 9 Jul 2020) including 18 653 (+16 since 9 Jul 2020) confirmed deaths and an additional 4614 probable deaths (https://www1.nyc.gov/site/doh/covid/covid-19-data.page).
The top 10 states in terms of daily reported cases in descending order are Florida, Texas, California, Georgia, Arizona, Louisiana, Tennessee, North Carolina, South Carolina, and [US Military] Ohio. This list includes states that are showing major increases in daily cases reported beginning with the lifting of restrictions around the end of May 2020. All of the top 10 states reported more than 1000 newly confirmed cases in the past 24 hours, with the range being 1553 to 11 433. Of note is that Idaho (in 21st position) reported 500 cases in the past 24 hours -- a sign of increasing transmission. In terms of cumulative case reports, New York is number one, followed by California, Texas, Florida, New Jersey, Illinois, Arizona, Georgia (surpassed Massachusetts in the past 24 hours), Massachusetts, and Pennsylvania. A total of 42 states and entities have reported more than 10 000 cumulative cases each.
In the past 24 hours, the proportion of newly confirmed cases was 2.2%. The 7-day average of newly confirmed cases for the past 7 days is 18.8% higher than the 7-day average for the preceding 7 days, consistent with the ongoing pandemic in the country.
The Centers for Disease Control and Prevention website (https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html) has data on cases, hospitalization, testing, and epidemiologic variables such as age, race, ILI (influenza-like illness), surveillance, and emergency room visits, which are definitely worth reviewing, as a welcome series of analyses. According to the CDC data, the percentage of laboratory specimens testing positive for SARS-CoV-2 with a molecular assay remains at 9% out of 40 787 857 tests performed, consistent with the ongoing, as yet not under control pandemic in the country (https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html).
A map of the United States can be seen at http://www.mapsofworld.com/usa/ and a HealthMap/ProMED map at http://healthmap.org/promed/p/106. - Mod.MPP]
******
[4] WHO situation report 172 (as of 10 Jul 2020)
Date: Fri 10 Jul 2020
Source: WHO [abridged, edited]
*The situation report includes information provided by national authorities as of 10:00 CEST, 10 Jul 2020.
Highlights
----------
- WHO Director-General Dr. Tedros acknowledged how civil society has played a critical role in responding to this pandemic by highlighting the needs of the most vulnerable, fighting for an equitable response, and holding decision-makers to account, in his address to a webinar on "civil society engagement in COVID-19 response at national and local levels," organised by WHO's Health Partnerships department.
- The burden of COVID-19 is overwhelming fragile health systems in Africa, although the accelerating trend of increasing cases is not uniformly distributed across the region. WHO Regional Director for Africa, Dr. Matshidiso Moeti emphasized that "if countries continue to strengthen key public health measures such as testing, tracing contacts and isolating cases, we can slow down the spread of the virus to a manageable level."
- WHO Regional Director for Europe, Dr. Hans Henri P. Kluge urged countries to stand firm and stay focused on what we know works to hold the virus at bay; step in swiftly at the 1st sign of local surges; and sign up to be part of a new culture of health during the summer months. Today we include 2 reports in the "Subject in Focus." The 1st summarizes key points on the updated scientific brief on what we currently know about the transmission of SARS-CoV-2. The 2nd provides an overview of a virtual meeting that was held to share experiences and lessons learnt in COVID-19 preparedness and response at points of entry in Central Africa.
[Links to all documents mentioned are available at the source URL above. - Mod.MPP]
Surveillance
------------
[The following data come from the "Situation in numbers" section. The regional case totals are inclusive of China. - Mod.MPP]
[*On 2 Jul 2020, the Worldometer (and the Johns Hopkins CSSE data) showed a decrease in 29 726 cases for the UK. From https://coronavirus.data.gov.uk/about: "Pillar 2 data for England has had duplicate tests for the same person removed by PHE from 2 Jul 2020. This means that the cumulative total number of UK lab-confirmed cases is now around 30 000 lower than reported on 1 Jul 2020." - Sr.Tech.Ed.MJ
**On 2 Jun 2020, France completed a review of all positive lab tests reported and removed all duplicate tests on individuals who were counted more than once. This led to a decrease in cumulative case counts.
In the table above, NA is "not applicable"; those countries whose 1st case was reported after 1 Mar 2020 did not have cases on 1 Mar 2020. - Mod.MPP]
Countries with notable overnight changes or escalating reports to keep an eye on (in alphabetical order):
Afghanistan, Albania, Algeria, Angola, Argentina, Armenia, Australia, Austria, Azerbaijan, Bangladesh, Belarus, Botswana, Bulgaria, Cabo Verde, Cameroon, Canada, Chile, Costa Rica, DR Congo, Ecuador, Egypt, French Guiana, Ghana, Honduras, Hungary, Iran, Iraq, Israel, Japan, Kazakhstan, Kenya, Kyrgyzstan, Lesotho, Madagascar, Malawi, Mexico, Moldova, Montenegro, Namibia, Peru, Portugal, Qatar, Rep. of Congo*, Romania, Saudi Arabia, Sri Lanka*, Turkey, Turks and Caicos*, Ukraine, Uzbekistan, Venezuela, Zambia, Zimbabwe
*Newly added countries to grouping
Total number of reported deaths: 562 769
Total number of worldwide cases: 12 625 155
Number of newly confirmed cases in past 24 hours: 237 750
[According to the data on the Worldometer website, the total number of reported cases of COVID-19 worldwide is now 12 625 155, with reports of cases by 217 countries and territories worldwide. The global case count rose by 1.9% in the past 24 hours. The USA and Brazil are still the most severely affected countries in terms of cumulative case counts. Sobering is if one tallies the total cumulative case counts for the top 5 countries (USA, Brazil, India, Russia, and Peru), they represent over half of the total cases reported globally (55.1%). A global total of 562 769 deaths have been reported, an increase of 5374 deaths in the past 24 hours.
In descending rank order, the USA is number 1 for the number of newly confirmed cases in the past 24 hours, followed by Brazil, India, South Africa, Mexico, Colombia, Russia, Argentina, Peru, and Saudi Arabia. All these countries are currently experiencing major community-based transmission and considered global hot spots. The range in the top 10 daily newly confirmed cases goes from 3159 to 71 787. The number of daily newly confirmed cases is climbing rapidly in the USA. The Philippines (from the Western Pacific Region) dropped down to the 21st position in terms of daily reported cases. This listing very much reflects the "hot spots" in terms of countries and regions with ongoing high transmission of the SARS-CoV-2 virus.
Impression: The SARS-CoV-2 is still actively being transmitted in all regions of the world, and many countries are showing increases in their daily newly confirmed case counts. - Mod.MPP]
See Also
COVID-19 update (310): Kazakhstan pneumonia, selected countries, WHO, global, RFI 20200710.7560034
● サイクロスポーラ症－米国，カナダ ミックスサラダ回収
PRO/EDR> Cyclosporiasis - USA (04): salad mix, recall, CDC, Canadian cases
Archive Number: 20200711.7562932
[1] CDC：Outbreak of _Cyclospora_ infections linked to bagged salad mix
情報源 CDC 2020年7月9日
Since the last case count update on 26 Jun 2020, 303 new laboratory-confirmed _Cyclospora_ infections have been reported.
As of 8 Jul 2020, a total of 509 people with laboratory-confirmed _Cyclospora_ infections associated with this outbreak have been reported from 8 states: Illinois (151), Iowa (160), Kansas (5), Minnesota (63), Missouri (46), Nebraska (48), North Dakota (6), and Wisconsin (30).
Illnesses started on dates ranging from 11 May 2020 to 1 Jul 2020. Ill people range in age from 11 to 92 years with a median age of 60, and 53% are female. Of 506 people with available information, 33 people (7%) have been hospitalized. No deaths have been reported.
Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by the CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.
Additionally, the Public Health Agency of Canada is investigating an outbreak of _Cyclospora_ infections occurring in 3 Canadian provinces where exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage has been identified as a likely source of the outbreak.
Investigation of the outbreak
-----------------------------
Epidemiologic and traceback evidence continues to indicate that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the 2 weeks before they became ill. Ill people reported eating a variety of brands of bagged salad mix containing iceberg lettuce, carrots, and red cabbage. Salad mixes eaten by ill people were purchased from ALDI, Hy-Vee, Jewel-Osco, and Walmart stores in the Midwest.
Traceback investigations by the FDA suggest that the Streamwood, Illinois Fresh Express production facility is the likely producer of the bagged salad mixes eaten by ill people. The FDA has begun an inspection at this facility. The CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix were contaminated and whether other products are a source of illnesses.
[2] Fresh Express's _Cyclospora_ outbreak now spans 8 states and 3 provinces
情報源 Food Safety News 2020年7月9日
*Editor's note: Late this afternoon [9 Jul 2020] the US Centers for Disease Control and Prevention (CDC) updated its patient count for this outbreak. The US patient count has topped 500, now standing at 509.
A troublesome _Cyclospora_ outbreak continues to grow in North America with 37 confirmed cases in Canada added to 206* in the Midwest USA. _Cyclospora_ is a coccidian parasite that causes diarrheal disease in humans called cyclosporiasis.
The update today [9 Jul 2020] involves an outbreak of _Cyclospora_ infections traced to Fresh Express bagged garden salad products containing lettuce, carrots, and red cabbage.
As of 8 Jul 2020, there were 37 confirmed cases of _Cyclospora_ illness linked to this outbreak in 3 Canadian provinces: Ontario (26), Quebec (10), and Newfoundland and Labrador (1). Canadians became sick between mid-May and mid-June [2020]. One Canadian has been hospitalized. No deaths have been reported. Individuals who became ill are between 21 and 70 years of age. The majority of cases, 76%, are female.
The Public Health Agency of Canada (PHAC) is collaborating with provincial public health authorities, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate the outbreak of _Cyclospora_ infections occurring in 3 provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.
Based on the investigation findings to date, exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots, and red cabbage has been identified as a likely source of the outbreak. Some of the individuals who became sick reported having eaten Fresh Express brand salad products containing these ingredients before their illnesses occurred. The source of illness for the remaining individuals continues to be under investigation.
On 28 Jun 2020, the CFIA issued a food recall for certain Fresh Express brand salad products containing iceberg lettuce, carrots, and red cabbage that were distributed nationally in Canada. The recalled salad products begin with lot code "Z177" or a lower number and have best before dates up to and including 8-14 Jul 2020. For more information on the recalled product, please consult the CFIA's website.
Canadians are advised not to eat the recalled products. Retailers and foodservice establishments are advised not to sell or serve the recalled products, or any items that may have been prepared or produced using these products. The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.
The recalled products can be identified by looking for the Product Code, located in the upper right-hand corner of the front of the package. The recall includes products marked with the letter "Z" at the beginning of the Product Code, followed by the number "178" or lower.
● リステリア症－フィンランド
PRO/AH/EDR> Listeriosis - Europe (02): Finland, MLST 6, whole genome sequencing
Archive Number: 20200711.7562954
情報源 Food Safety News 2020年7月9日
Authorities in Finland are investigating a _Listeria_ outbreak that has affected 8 people. All patients have been hospitalized, but no deaths have been recorded. The age range of those sick is 60 to 93 years old, 5 are female, and they live in different parts of the country.
Ruska Rimhanen-Finne, a veterinary epidemiologist at the National Institute for Health and Welfare (THL), said all illnesses occurred within a month in May and June [2020].
(312) ウイルスの起源，保有宿主動物
(311) カザフスタン，英/米国 死亡リスク
レクチン中毒－デンマーク
リステリア症－フィンランド
● COVID-19(312) ウイルスの起源，保有宿主動物
PRO/AH/EDR> COVID-19 update (312): China, SARS-CoV2 origin, animal reservoir, WHO mission
Archive Number: 20200711.7565035
情報源 Science Magazine - News 2020年7月10日
COVID-19 パンデミックの起源を明らかにするため 10日，2名の WHO のチームが中国に到着したが，答えを持ち帰ることは難しいとみられている。疫学と動物衛生の専門家各 1名からなる 2名は，中国当局者らと議論することになっている ... 調査の目的は，ウイルスを保有する可能性のある動物の捕獲から，研究施設から漏出した可能性の検証にまで及ぶ ... 当初，1月の数週間に武漢の保健当局者らが語った整然とした起源についての説明は，1か所の海鮮市場に関係する人々が原因不明の肺炎を発症し，市場の閉鎖と消毒作業によりアウトブレイクは収束したというものだった。しかし，初めての武漢市の疫学調査が発表されると，武漢の患者で確認された新型コロナウイルスの起源について混乱が生じた：発端となった SARS-CoV-2 感染の患者 5例中 4例には市場との関連性が認められない。このあとすぐ，別のストーリーが登場した。武漢市にはコウモリのコロナウイルス研究者が所属するウイルス研究所 the Wuhan Institute of Virology (WIV) があるのは偶然ではないと考えるものがいた。同研究者のグループは初めて SARS-CoV-2 ウイルスを分離・解析したうちの １つであり，15年にわたって野生のコウモリを捕獲し，パンデミックの可能性の予測のためにコロナウイルスを調べていた。この研究者らによる今回の新型ウイルスに関する初めての報告の中で，彼女らが保有するコウモリコロナウイルスのうちの １つが，SARS-CoV-2 ウイルスと 96.2% の相同性を有すると記述している。トランプ米大統領は，ウイルスが研究施設で作成されたとの好戦的な説を述べた（同施設の研究者らはそのようなシナリオには何のメリットもないと主張し，他の進化生物学者はこのウイルスには人工的に作られたことを示す証拠が見られないとしている）。最も支持を集めている仮説は，コウモリとヒトの間で感染を橋渡しした，ウイルス感受性のある中間宿主の動物からヒトに感染が拡がった，とするものである。the case of severe acute respiratory syndrome (SARS) の場合，ジャコウネコ civets がその役割を担ったことが判っている。同じコロナウイルス感染症の Middle East respiratory syndrome (MERS) については，より早い時期にラクダであることが明らかになった。中国の当局者は，武漢の海鮮市場での SARS-CoV-2 ウイルス検査を実施したと報告したが，その結果は釈然としないものだった remains sketchy。国営メディアは，市場内の野生動物を売るゾーンの "environmental samples (環境からの検体)" でウイルス検査が陽性となったと伝えたが，検査結果の詳細も，売られていた動物種のリストさえも報告されなかった。他の研究では，SARS-CoV-2 とアリを食べる絶滅種のセンザンコウ pangolins で発見されたコロナウイルスのあいだで類似性が認められたとされたが，このウイルスは SARS-CoV-2 に最も近いコウモリコロナウイルスよりも遺伝学的に離れていたし，センザンコウと中国伝統医薬品でもあるその鱗が市場で販売されていたかどうか，確認できていない。WHO と中国政府当局がパンデミックの起源を調査するとして，解明すべき重要な点がいくつかある。
- 武漢海鮮市場の検体で，正確には何が調査されどのような結果が得られたのか。2002年11月に中国広東省の 1名に SARS が発生したが，3か月間 WHO には報告されず，同省内の各市場での広範囲な動物からのサンプリングにより，ジャコウネコからウイルスが発見されたのは，2003年10月だった。
- これまでに公開されているもの (たとえば https://tinyurl.com/vssjprg and https://tinyurl.com/w5qfs4w) 以上の，初期の感染例についての疫学データはあるのか ? 患者らの渡航歴は ? 動物との接触歴は ? 症例間にどのような関連性があったのか ? 接触者の抗体検査は行われたのか ? 以前の感染を示す可能性のある，接触者の血液等の検体は保管されているのか ?
SARS について言えば，ウイルスの発見から 14か月が経過した 2004年6月になって，研究者らからヒトと動物の疫学解析の詳細が報告された: 39% of the earliest cases は食品取り扱い業務者 food handlers で, 生きた動物の取引に関わったもの traders of live animals は（それ以外の人々の）13倍のウイルス抗体保有率であり，72% が civets を扱っていた。the earliest COVID-19 cases に対する新たなインタビューを行えば，患者らの間に驚くべき関連性が示されるかも知れない。たとえば COVID-19 clusters が，飲食を共にしたり，宗教上の集まりだったり，麻雀でも発生している。
- 武漢で第 1例とされている患者以前の検体について，中国の研究者はどの程度積極的に SARS-CoV-2 について調べているのか ? 武漢以外についてはどうか ? どれくらい遡って調べたのか ?病院または検査機関は，患者，特に死亡原因が不明の患者については，血液，鼻スワブ，組織を保管していることがある。まさにそのような検体により，2012年6月にサウジアラビアで初めて発見されたが，2012年4月にすでにヨルダンで 2人が死亡していたという MERS の真実を明らかにすることにつながった ...
- コウモリや，中国でふつうに見られ SARS-CoV-2 に感受性があるとされている野生動物，たとえば霊長類，シカ，齧歯類など，について広くスクリーニングを実施する可能性があるのか ? 動物の尿や糞にウイルスの遺伝子が含まれることがしばしばある。武漢ウイルス研究所のグループは常日頃からコウモリの排泄物や鼻スワブでコロナウイルスを調べている。サブサハラアフリカ地域のチンパンジーの糞の採取が，HIV-1 流行の起源を知ることに大いに役立ったし，1998年にマレーシアの養豚農家で発見された the Nipah virus は，2年後にオオコウモリ flying bats の尿や食べたフルーツの検体採取で明らかになった。
- 家畜のスクリーニングが COVID-19's origin の手がかりとなり得るのか ? AIDS researchers は，ペットのサルが HIV-2 に近いサル免疫不全ウイルス a simian immunodeficiency virus を保有し，ヒトにも感染することを発見した。武漢の飼い猫と野良猫の調査では，検査した 141検体の 15% で抗体 SARS-CoV-2 antibodies が確認されている。アウトブレイク以前の検体では抗体は確認されなかったが，獣医師らがほかに検体を保有している可能性はないか ? もっと多くのネコの検査は可能か ? ネコはシーフード好きであり，早期の感染拡大に武漢市場が一役買ったのは間違いない。
- 家畜の検体は保管されているか ? 2009年のパンデミックの原因となったインフルエンザウイルスはその遺伝学的特徴からブタ由来であることが明らかになったが，感染したブタを飼育していたと思われるメキシコの複数の農場の場所が研究者から報告されたのは，2016年になってからのことであった。この研究では，2010年から 2014年の間に，メキシコの 6つの州の 22の農場で採取された病気のブタからの検体を診断した検査機関に保管されていた気道検体で，58件のインフルエンザウイルスが確認された ... 系統発生学的解析から，2つの州がパンデミックの発端であり，さらに欧州から輸入されたブタによってメキシコにウイルスが持ち込まれたことが示唆されている。
- SARS-CoV-2 を保有するコウモリや野生動物と接触の可能性のあるヒトの，中国での広範囲のスクリーニング調査実施可能か ？ ホワイトハウスからの圧力により 2020年4月に the National Institutes of Health からの資金が打ち切られた EcoHealth Alliance and Shi の研究者が 2019年，SARS-related coronaviruses を保有するコウモリのいる地域で 1500人近い中国人からの採血検体についての研究報告を行ない，既往歴や動物との接触歴についての聞き取りも行っている。コウモリコロナウイルスの感染の証拠が見つかったのはわずか 9人だったが，抗体がすぐに消失する quickly wane ことも指摘している。研究チームは，コウモリからヒトへの（ウイルスの）漏出は常に起こっているとしている。
- the 1st confirmed case of SARS-CoV-2 が科学的文献で報告された 2019年12月1日以前の possible COVID-19 cases の情報は，政府保健当局からの報告に含まれているのか ? The South China Morning Post は，2019年11月17日の湖北省 Hubei province の 55歳の患者が COVID-19 であったとする，"government data" の存在を把握したと報じている。この記事では 11月中にほかにも 8例の患者が確認されていた，としている。武漢市は湖北省の省都であるが，政府記録にはこれらの患者の居住地は記載がなかったと伝えている。ウイルスがはじめて患者から分離されたのは武漢市であるが，武漢市以外で新興した可能性がある。2009年のパンデミックでは，問題のインフルエンザウイルスがはじめて分離されたのは，発端となったメキシコではなく米国カリフォルニア州 San Diego, California だった。
- 検査可能な中国国内の下水処理施設のサンプルは保管されているか？ ...
- 武漢ウイルス研究所 WIV では，コウモリコロナウイルスを使ってどのような実験が行われているのか ? ... 事故による研究機関からのウイルスの漏出は実際に起こっており，パンデミックになった例まである: 1977年に登場した An influenza strain は strains in Russian labs collected 2 decades earlier と結びつけられている。
- WIV の誰かが感染し，施設外の他者に感染を拡げた可能性はないか ? ...
もう 1つの outstanding question として，武漢の研究者らがコウモリのウイルスの捜査によって，ヒトの間で感染伝播しやすくする実験 "gain-of-function" experiments を行っていたのではないか。同施設の研究者は 2015年，マウスに馴化させたウイルスとコウモリのウイルスを結合させたキメラウイルス a chimeric SARS virus 作成の論文の共著者となっている。ただしこの実験は武漢ではなく the University of North Carolina で行われた。
最後に，2018年の北京の米国大使館からの外交文書において，a new, ultra-high-security lab at WIV は "a serious shortage of appropriately trained technicians and investigators." との警告が伝えられている。
関連項目
COVID -19 update (308): USA (TX) animal, dog conf. 20200708.7554832
● エーリキア症－オーストラリア 輸入されたイヌ
PRO/AH/EDR> Ehrlichiosis - Australia (03): (WA) imported dog, testing
Archive Number: 20200711.7564789
情報源 ABC.net.au 2020年7月10日
北部オーストラリアで，死亡する可能性のある外来のイヌの病気のアウトブレイクの背景は，輸入されるイヌの検査に手落ちがあったと動物衛生当局は考えている。ダニが媒介するエーリキア症 ehrlichiosis は，オーストラリアで初めて 2020年5月に Western Australia's Kimberley region で確認されたことから，どのようにして国内に持ち込まれたかの調査が始まった ... 輸出元の国で検査が行われているとの前提で，ペットのイヌが輸
● レクチン中毒－デンマーク
PRO/AH/EDR> Lectin poisoning - Denmark
Archive Number: 20200711.7564741
情報源 Food Safety News 2020年7月8日
豆 red kidney beans に含まれるレクチン A type of lectin が，2020年のこれまでにデンマークで起きているアウトブレイクの原因だった。4月後半，1日で 24人の患者が発生した日も含めて 45人が中毒により症状を発症した。アウトブレイクは，コペンハーゲンのケータリング会社 1社に限定されていた。中毒の原因は，トルコからスウェーデンを経由して輸入された冷凍の金時豆 frozen red kidney beans に含まれる phytohaemagglutinin (PHA) だった。食品監視当局者は，加熱 boiled が十分でなかったとみられる，と述べている ... 中毒の症状には，レクチンを減少させるのに不十分な加熱であった豆の摂取後数時間で起こる嘔吐と下痢 ...
[ Mod.TG 注－"Lectins は選択的に炭水化物と結合するタンパクで，ほとんどの動物細胞の表面を被う糖タンパクの炭水化物部分であることが重要。幅広い野菜，検査された 88種類のうちの 29種類，で確認できる。消化酵素では分解されにくく，腸管上皮細胞表面に親和性のある，the Leguminosae family などに含まれる Plant lectins は，中毒の原因となり得る ... NIH]
● 日本脳炎－インド
PRO/AH/EDR> Japanese encephalitis & other - India (08): (AS)
Archive Number: 20200711.7563226
情報源 The Sentinel 2020年7月9日
1月以降，アッサム Assam 州では日本脳炎など JE (Japanese encephalitis) and AES (acute encephalitis syndrome) により 23人もの命が奪われた。JE による死者は 5人, AES により 18 lives がなくなった ... 174人 in 27 districts across the State が感染し，うち 38人が JE の患者だった ...
● COVID-19(311)－カザフスタン，英/米国 死亡リスク
PRO/AH/EDR> COVID-19 update (311): Kazakhstan pneumonia, UK, USA mortality risks, WHO
Archive Number: 20200711.7563337
In this update:
[1] Kazakhstan: Follow-up
[2] Risk factors for mortality
[3] Selected countries
[4] WHO situation report 172 (as of 10 Jul 2020)
[5] Global update: Worldometer accessed 10 Jul 2020 22:11 EDT (GMT-4)
[1] カザフスタン: Follow-up
情報源 Live Science 2020年7月10日
カザフスタンの中国大使館は 19日，カザフスタンで原因不明の肺炎により，中国国民を含む 1700人以上が死亡したとして注意喚起を行っているが，他国は COVID-19 が疑われるとしている。CNN は致死率は新型コロナウイルス以上と伝えている。カザフスタン政府当局はこれを否定し，同保健相は，原因不明のウイルス肺炎が国内で発生しているとしながらも，原因不明 "unspecified" とは症状から COVID-19 と診断されているが，検査では確定されなかった（結果が陰性であった）症例に用いる，と述べている ... WHO は調査中とする一方で，レジオネラ症やインフルエンザなどによる非定型肺炎のクラスターも世界中のどこでもいつでも起こりうるとしている。
［Mod.MPP 注－ナイジェリア Kano, Nigeria からの a similar "unexplained pneumonia" with high mortality report が，the Nigeria CDC による調査の結果，COVID-19 と判明した例がある (20200612.7463389)]
[2] Risk factors for mortality
[A] 英国 British NHS study - Nature
情報源 Nature 2020年7月8日
原著タイトル OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. Epub 8 Jul 2020. https://doi.org/10.1038/s41586-020-2521-4
Abstract
--------
COVID-19 has rapidly affected mortality worldwide (1; see source URL for complete references). There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England, here we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17 278 392 adults were pseudonymously linked to 10 926 COVID-19-related deaths. COVID-19-related death was associated with being male (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people with white ethnicity, Black and South Asian people were at higher risk even after adjustment for other factors (HR, 1.48; 1.30-1.69 and 1.44; 1.32-1.58, respectively). We have quantified a range of clinical risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients' records; we will update and extend results regularly.
Discussion
----------
This secure analytics platform operating across over 23 million patient records for the COVID-19 emergency was used to identify, quantify, and explore risk factors for COVID-19-related death in the largest cohort study conducted by any country to date. Most comorbidities were associated with increased risk, including cardiovascular disease, diabetes, respiratory disease including severe asthma, obesity, history of haematological malignancy or recent other cancer, kidney, liver, neurological and autoimmune conditions. People from South Asian and black groups had a substantially higher risk of death, only partially attributable to comorbidity, deprivation or other risk factors. A strong association between deprivation and risk was only partly attributable to comorbidity or other risk factors.
These analyses provide a preliminary picture of how key demographic characteristics and a range of comorbidities, a priori selected as being of interest in COVID-19, are jointly associated with poor outcomes. These initial results may be used subsequently to inform the development of prognostic models. We caution against interpreting our estimates as causal effects. For example, the fully adjusted smoking hazard ratio does not capture the causal effect of smoking due to the inclusion of comorbidities which are likely to mediate any effect of smoking on COVID-19 death (e.g., COPD). Our study has highlighted a need for carefully designed causal analyses specifically focusing on the causal effect of smoking on COVID-19 death. Similarly, there is a need for analyses exploring the causal relationships underlying the associations observed between hypertension and COVID-19 death.
----
[B] USA, CDC - Morbidity and Mortality Weekly Report (MMWR)
情報源 MMWR 2020年7月10日
原著タイトル Characteristics of persons who died with COVID-19 -- United States, February 12-May 18, 2020. MMWR Morb Mortal Wkly Rep. Epub 10 July 2020.
Discussion
----------
Using national case-based surveillance and supplementary data reported from 16 jurisdictions, characteristics of greater than 10 000 decedents with laboratory-confirmed COVID-19 were described. More than one-third of Hispanic decedents (34.9%) and nearly one-third (29.5%) of nonwhite decedents were aged less than 65 years, but only 13.2% of white decedents were aged less than 65 years. Consistent with reports describing the characteristics of deaths in persons with COVID-19 in the USA and China (2-5; see source URL for complete references), approximately three-fourths of decedents had one or more underlying medical conditions reported (76.4%) or were aged greater than or equal to 65 years (74.8%). Among reported underlying medical conditions, cardiovascular disease and diabetes were the most common. Diabetes prevalence among decedents aged less than 65 years (49.6%) was substantially higher than that reported in an analysis of hospitalized COVID-19 patients aged less than 65 years (35%) and persons aged less than 65 years in the general population (less than 20%) (5-7). Among decedents aged less than 65 years, 7.8% died in an emergency department or at home; these out-of-hospital deaths might reflect lack of healthcare access, delays in seeking care, or diagnostic delays. Health communications campaigns could encourage patients, particularly those with underlying medical conditions, to seek medical care earlier in their illnesses. Additionally, healthcare providers should be encouraged to consider the possibility of severe disease among younger persons who are Hispanic, nonwhite, or have underlying medical conditions. More prompt diagnoses could facilitate earlier implementation of supportive care to minimize morbidity among individuals and earlier isolation of contagious persons to protect communities from SARS-CoV-2 transmission.
The relatively high percentages of Hispanic and nonwhite decedents aged less than 65 years were notable. The median age of nonwhite persons (31 years) in the USA is lower than that of white persons (44 years); these differences might help explain the higher proportions of Hispanic and nonwhite decedents among those aged less than 65 years. The median ages among Hispanic and nonwhite decedents (71 and 72 years, respectively) were 9-10 years lower than that of white decedents (81 years). However, the percentage of Hispanic decedents aged less than 65 years (33.9%) exceeded the percentage of Hispanic persons aged less than 65 years in the US population (20%); the percentage of nonwhite COVID-19 decedents aged less than 65 years (40.2%) also exceeded the overall percentage of nonwhite decedents aged less than 65 years (23%) in the US population (8). Further study is needed to understand the reasons for these differences. It is possible that rates of SARS-CoV-2 transmission are higher among Hispanic and nonwhite persons aged less than 65 years than among white persons; one potential contributing factor is higher percentages of Hispanic and nonwhite persons engaged in occupations (e.g., service industry) or essential activities that preclude physical distancing (9). It is also possible that the COVID-19 pandemic disproportionately affected communities of younger, nonwhite persons during the study period (10). Although these data did not permit assessment of interactions between race/ethnicity, underlying medical conditions, and nonbiologic factors, further studies to understand and address these racial/ethnic differences are needed to inform targeted efforts to prevent COVID-19 mortality.
Despite these limitations, this report provides more detailed demographic and clinical information on a subset of approximately 10 000 decedents with laboratory-confirmed COVID-19. Most decedents were aged less than 65 years and had underlying medical conditions. Compared with white decedents, more Hispanic and nonwhite decedents were aged less than 65 years. Additional studies are needed to elucidate associations between age, race/ethnicity, SARS-CoV-2 infection, disease severity, underlying medical conditions (especially diabetes), socioeconomic status (e.g., poverty and access to healthcare), behavioral factors (e.g., ability to comply with mitigation recommendations and maintain essential work responsibilities), and out-of-hospital deaths. Regional and state level efforts to examine the roles of these factors in SARS-CoV-2 transmission and COVID-19-associated deaths could lead to targeted, community-level, mortality prevention initiatives. Examples include health communication campaigns targeted toward Hispanics and nonwhite persons aged less than 65 years. These campaigns could encourage social distancing and the need for wearing cloth face coverings in public settings. In addition, healthcare providers should be encouraged to consider the possibility of disease progression, particularly in Hispanic and nonwhite persons aged less than 65 years and persons of any race/ethnicity, regardless of age, with underlying medical conditions, especially diabetes.
*Underlying medical conditions include cardiovascular disease (congenital heart disease, coronary artery disease, congestive heart failure, hypertension, cerebrovascular accident/stroke, valvular heart disease, conduction disorders or dysrhythmias, other cardiovascular disease); diabetes mellitus; chronic lung disease (chronic obstructive pulmonary disease/emphysema, asthma, tuberculosis, other chronic lung diseases); immunosuppression (cancer, human immunodeficiency virus [HIV] infection, identified as being immunosuppressed); chronic kidney disease (chronic kidney disease, end-stage renal disease, other kidney diseases); neurologic conditions (dementia, seizure disorder, other neurologic conditions); chronic liver disease (cirrhosis, alcoholic hepatitis, chronic liver disease, end-stage liver disease, hepatitis B, hepatitis C, nonalcoholic steatohepatitis, other chronic liver diseases); obesity (body mass index of 30 kg/m2 or greater).
[These 2 studies are basically carrying the same message -- disadvantaged minority groups are at greater risk most likely due to inherent inequities in health services for less affluent society members, so they are coming into this pandemic with a higher incidence of comorbidities, working in jobs that make social distancing unobtainable, and have less access to services so many of the deaths occur at home or soon after arrival at the health service.
Initial studies early on focused on the comorbidities, but these later studies tell a more complete story than the comorbidities alone. - Mod.MPP]
******
[3] Selected countries:
[A] China: National Health Commission, 83 587 total cases, 4634 deaths
[B] South Korea: 13 373 confirmed cases, 288 deaths
[C] Italy: 242 639 total cases, 34 938 deaths
[D] Iran: 252 720 total cases, 12 447 deaths
[E] USA: 3 291 786 total cases, 136 671 deaths
[A] China: National Health Commission, 83 587 total cases, 4634 deaths
情報源 China National Health Commission [in Chinese] 2020年7月10日
[The 2 new confirmed cases in the past 24 hours were both imported, and it is now 5 days that no new cases have been reported from Beijing.
----
[B] South Korea: 13 373 confirmed cases, 288 deaths
情報源 Ministry of Health and Welfare [in Korean] 2020年7月11日
10 Jul 2020 0:00 AM KT 13 338 confirmed cases, 288 deaths
11 Jul 2020 0:00 AM KT 13 373 confirmed cases, 288 deaths
Change: 35 newly confirmed infections; no new deaths
[C] Italy: 242 639 total cases, 34 938 deaths
情報源 Italian Government Health Ministry 2020年7月10日
- 242 639 cumulative cases (+276);
- 13 428 people are currently positive for the virus (-31);
- 194 273 people have recovered (+295);
- 844 patients are hospitalized with symptoms (-27), 65 in intensive care (-4), and 12 519 (no change) are in home isolation;
- 34 938 deaths have been reported (+12).
----
[D] Iran: 252 720 total cases, 12 447 deaths
情報源 IFP news (Iran Front Page) 020年7月10日
Iran's Health Ministry spokeswoman says 215 015 coronavirus patients have recovered from the disease so far and been discharged from the hospital. In a press briefing on Friday [10 Jul 2020], Sima-Sadat Lari said 142 people have also died of the virus in the past 24 hours, bringing the total number of fatalities to 12 447. She confirmed 2262 new cases of infection with the novel coronavirus, raising the total number of cases to 252 720.
A total of 3319 patients are also in severe conditions of the disease, she added. Lari noted that 1 922 501 COVID-19 tests have been taken across the country.
According to Lari, East Azarbaijan, West Azarbaijan, Kermanshah, Khuzestan, Hormozgan, Bushehr, Kurdistan, Khorasan Razavi, and Ilam provinces are still considered as red zones as in previous days. Tehran, Isfahan, Mazandaran, Golestan, Alborz, Kerman, Yazd, Sistan and Baluchestan, Hamadan, and Ardabil provinces are also in dangerous conditions, she added, urging people to seriously avoid any unnecessary travel, especially to Khorasan Razavi and Mazandaran provinces.
[As of 10 Jul 2020, the total number of cases of COVID-19 confirmed in Iran is 252 720, including 12 447 deaths, an increase of 2262 cases and 142 deaths since 9 Jul 2020. The numbers of daily reported cases and deaths are slowing increasing. There are now 9 provinces classified as "red zones" and an additional 10 provinces considered in dangerous condition. Another media report mentioned that most new cases are related to large gatherings such as weddings and funerals (https://en.radiofarda.com/a/iran-to-postpone-nationwide-university-entrance-exams-due-to-surge-in-covid/30719515.html).
----
[E] USA: 3 291 786 total cases, 136 671 deaths
情報源 Worldometer 2020年7月10日
[For those who are interested, a pdf snapshot of the full data Worldometer table at the time we accessed it is available at https://promedmail.org/wp-content/uploads/usa-pdf/JULY10USDATASET_1594435546.pdf.
A 7-day series of cumulative reported cases by states, territories, and reporting entities can be found at https://promedmail.org/wp-content/uploads/usa-pdf/JULY10US7_1594435585.pdf. - Mod.MPP]
USA cases by state - top 20 states
State: Total cases / New cases
------------------------------
New York: 426 016 / 944
California: 312 104 / 8781
Texas: 251 076 / 10 063
Florida: 244 151 / 11 433
New Jersey: 178 218 / 423
Illinois: 152 899 / 1327
Arizona: 116 892 / 4221
Georgia: 111 211 / 4484
Massachusetts: 111 110 / 213
Pennsylvania: 98 574 / 940
North Carolina: 81 499 / 1830
Michigan: 75 685 / 622
Louisiana: 74 636 / 2642
Maryland: 71 910 / 463
Virginia: 68 931 / 943
Ohio: 62 884 / 1553
Tennessee: 59 546 / 1955
South Carolina: 52 419 / 1728
Alabama: 50 508 / 1334
Indiana: 50 300 / 725
All USA total: 3 291 786 / 71 787
Total deaths: 136 671
[The above are the latest breakdowns of confirmed cases of SARS-CoV-2 infection in the USA as per Worldometer data for the top 20 reporting entities. The total number of confirmed cases in the USA and territories is now 3 291 786 including 136 671 deaths, an increase from 3 219 999 cases and 135 822 deaths in the past 24 hours. New York City had a cumulative total of 215 265 cases as of 13:00 EDT (GMT-4) on 10 Jul 2020 (+313 since 9 Jul 2020) including 18 653 (+16 since 9 Jul 2020) confirmed deaths and an additional 4614 probable deaths (https://www1.nyc.gov/site/doh/covid/covid-19-data.page).
The top 10 states in terms of daily reported cases in descending order are Florida, Texas, California, Georgia, Arizona, Louisiana, Tennessee, North Carolina, South Carolina, and [US Military] Ohio. This list includes states that are showing major increases in daily cases reported beginning with the lifting of restrictions around the end of May 2020. All of the top 10 states reported more than 1000 newly confirmed cases in the past 24 hours, with the range being 1553 to 11 433. Of note is that Idaho (in 21st position) reported 500 cases in the past 24 hours -- a sign of increasing transmission. In terms of cumulative case reports, New York is number one, followed by California, Texas, Florida, New Jersey, Illinois, Arizona, Georgia (surpassed Massachusetts in the past 24 hours), Massachusetts, and Pennsylvania. A total of 42 states and entities have reported more than 10 000 cumulative cases each.
In the past 24 hours, the proportion of newly confirmed cases was 2.2%. The 7-day average of newly confirmed cases for the past 7 days is 18.8% higher than the 7-day average for the preceding 7 days, consistent with the ongoing pandemic in the country.
The Centers for Disease Control and Prevention website (https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html) has data on cases, hospitalization, testing, and epidemiologic variables such as age, race, ILI (influenza-like illness), surveillance, and emergency room visits, which are definitely worth reviewing, as a welcome series of analyses. According to the CDC data, the percentage of laboratory specimens testing positive for SARS-CoV-2 with a molecular assay remains at 9% out of 40 787 857 tests performed, consistent with the ongoing, as yet not under control pandemic in the country (https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html).
A map of the United States can be seen at http://www.mapsofworld.com/usa/ and a HealthMap/ProMED map at http://healthmap.org/promed/p/106. - Mod.MPP]
******
[4] WHO situation report 172 (as of 10 Jul 2020)
Date: Fri 10 Jul 2020
Source: WHO [abridged, edited]
*The situation report includes information provided by national authorities as of 10:00 CEST, 10 Jul 2020.
Highlights
----------
- WHO Director-General Dr. Tedros acknowledged how civil society has played a critical role in responding to this pandemic by highlighting the needs of the most vulnerable, fighting for an equitable response, and holding decision-makers to account, in his address to a webinar on "civil society engagement in COVID-19 response at national and local levels," organised by WHO's Health Partnerships department.
- The burden of COVID-19 is overwhelming fragile health systems in Africa, although the accelerating trend of increasing cases is not uniformly distributed across the region. WHO Regional Director for Africa, Dr. Matshidiso Moeti emphasized that "if countries continue to strengthen key public health measures such as testing, tracing contacts and isolating cases, we can slow down the spread of the virus to a manageable level."
- WHO Regional Director for Europe, Dr. Hans Henri P. Kluge urged countries to stand firm and stay focused on what we know works to hold the virus at bay; step in swiftly at the 1st sign of local surges; and sign up to be part of a new culture of health during the summer months. Today we include 2 reports in the "Subject in Focus." The 1st summarizes key points on the updated scientific brief on what we currently know about the transmission of SARS-CoV-2. The 2nd provides an overview of a virtual meeting that was held to share experiences and lessons learnt in COVID-19 preparedness and response at points of entry in Central Africa.
[Links to all documents mentioned are available at the source URL above. - Mod.MPP]
Surveillance
------------
[The following data come from the "Situation in numbers" section. The regional case totals are inclusive of China. - Mod.MPP]
[*On 2 Jul 2020, the Worldometer (and the Johns Hopkins CSSE data) showed a decrease in 29 726 cases for the UK. From https://coronavirus.data.gov.uk/about: "Pillar 2 data for England has had duplicate tests for the same person removed by PHE from 2 Jul 2020. This means that the cumulative total number of UK lab-confirmed cases is now around 30 000 lower than reported on 1 Jul 2020." - Sr.Tech.Ed.MJ
**On 2 Jun 2020, France completed a review of all positive lab tests reported and removed all duplicate tests on individuals who were counted more than once. This led to a decrease in cumulative case counts.
In the table above, NA is "not applicable"; those countries whose 1st case was reported after 1 Mar 2020 did not have cases on 1 Mar 2020. - Mod.MPP]
Countries with notable overnight changes or escalating reports to keep an eye on (in alphabetical order):
Afghanistan, Albania, Algeria, Angola, Argentina, Armenia, Australia, Austria, Azerbaijan, Bangladesh, Belarus, Botswana, Bulgaria, Cabo Verde, Cameroon, Canada, Chile, Costa Rica, DR Congo, Ecuador, Egypt, French Guiana, Ghana, Honduras, Hungary, Iran, Iraq, Israel, Japan, Kazakhstan, Kenya, Kyrgyzstan, Lesotho, Madagascar, Malawi, Mexico, Moldova, Montenegro, Namibia, Peru, Portugal, Qatar, Rep. of Congo*, Romania, Saudi Arabia, Sri Lanka*, Turkey, Turks and Caicos*, Ukraine, Uzbekistan, Venezuela, Zambia, Zimbabwe
*Newly added countries to grouping
Total number of reported deaths: 562 769
Total number of worldwide cases: 12 625 155
Number of newly confirmed cases in past 24 hours: 237 750
[According to the data on the Worldometer website, the total number of reported cases of COVID-19 worldwide is now 12 625 155, with reports of cases by 217 countries and territories worldwide. The global case count rose by 1.9% in the past 24 hours. The USA and Brazil are still the most severely affected countries in terms of cumulative case counts. Sobering is if one tallies the total cumulative case counts for the top 5 countries (USA, Brazil, India, Russia, and Peru), they represent over half of the total cases reported globally (55.1%). A global total of 562 769 deaths have been reported, an increase of 5374 deaths in the past 24 hours.
In descending rank order, the USA is number 1 for the number of newly confirmed cases in the past 24 hours, followed by Brazil, India, South Africa, Mexico, Colombia, Russia, Argentina, Peru, and Saudi Arabia. All these countries are currently experiencing major community-based transmission and considered global hot spots. The range in the top 10 daily newly confirmed cases goes from 3159 to 71 787. The number of daily newly confirmed cases is climbing rapidly in the USA. The Philippines (from the Western Pacific Region) dropped down to the 21st position in terms of daily reported cases. This listing very much reflects the "hot spots" in terms of countries and regions with ongoing high transmission of the SARS-CoV-2 virus.
Impression: The SARS-CoV-2 is still actively being transmitted in all regions of the world, and many countries are showing increases in their daily newly confirmed case counts. - Mod.MPP]
See Also
COVID-19 update (310): Kazakhstan pneumonia, selected countries, WHO, global, RFI 20200710.7560034
● サイクロスポーラ症－米国，カナダ ミックスサラダ回収
PRO/EDR> Cyclosporiasis - USA (04): salad mix, recall, CDC, Canadian cases
Archive Number: 20200711.7562932
[1] CDC：Outbreak of _Cyclospora_ infections linked to bagged salad mix
情報源 CDC 2020年7月9日
Since the last case count update on 26 Jun 2020, 303 new laboratory-confirmed _Cyclospora_ infections have been reported.
As of 8 Jul 2020, a total of 509 people with laboratory-confirmed _Cyclospora_ infections associated with this outbreak have been reported from 8 states: Illinois (151), Iowa (160), Kansas (5), Minnesota (63), Missouri (46), Nebraska (48), North Dakota (6), and Wisconsin (30).
Illnesses started on dates ranging from 11 May 2020 to 1 Jul 2020. Ill people range in age from 11 to 92 years with a median age of 60, and 53% are female. Of 506 people with available information, 33 people (7%) have been hospitalized. No deaths have been reported.
Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by the CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.
Additionally, the Public Health Agency of Canada is investigating an outbreak of _Cyclospora_ infections occurring in 3 Canadian provinces where exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage has been identified as a likely source of the outbreak.
Investigation of the outbreak
-----------------------------
Epidemiologic and traceback evidence continues to indicate that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the 2 weeks before they became ill. Ill people reported eating a variety of brands of bagged salad mix containing iceberg lettuce, carrots, and red cabbage. Salad mixes eaten by ill people were purchased from ALDI, Hy-Vee, Jewel-Osco, and Walmart stores in the Midwest.
Traceback investigations by the FDA suggest that the Streamwood, Illinois Fresh Express production facility is the likely producer of the bagged salad mixes eaten by ill people. The FDA has begun an inspection at this facility. The CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix were contaminated and whether other products are a source of illnesses.
[2] Fresh Express's _Cyclospora_ outbreak now spans 8 states and 3 provinces
情報源 Food Safety News 2020年7月9日
*Editor's note: Late this afternoon [9 Jul 2020] the US Centers for Disease Control and Prevention (CDC) updated its patient count for this outbreak. The US patient count has topped 500, now standing at 509.
A troublesome _Cyclospora_ outbreak continues to grow in North America with 37 confirmed cases in Canada added to 206* in the Midwest USA. _Cyclospora_ is a coccidian parasite that causes diarrheal disease in humans called cyclosporiasis.
The update today [9 Jul 2020] involves an outbreak of _Cyclospora_ infections traced to Fresh Express bagged garden salad products containing lettuce, carrots, and red cabbage.
As of 8 Jul 2020, there were 37 confirmed cases of _Cyclospora_ illness linked to this outbreak in 3 Canadian provinces: Ontario (26), Quebec (10), and Newfoundland and Labrador (1). Canadians became sick between mid-May and mid-June [2020]. One Canadian has been hospitalized. No deaths have been reported. Individuals who became ill are between 21 and 70 years of age. The majority of cases, 76%, are female.
The Public Health Agency of Canada (PHAC) is collaborating with provincial public health authorities, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate the outbreak of _Cyclospora_ infections occurring in 3 provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.
Based on the investigation findings to date, exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots, and red cabbage has been identified as a likely source of the outbreak. Some of the individuals who became sick reported having eaten Fresh Express brand salad products containing these ingredients before their illnesses occurred. The source of illness for the remaining individuals continues to be under investigation.
On 28 Jun 2020, the CFIA issued a food recall for certain Fresh Express brand salad products containing iceberg lettuce, carrots, and red cabbage that were distributed nationally in Canada. The recalled salad products begin with lot code "Z177" or a lower number and have best before dates up to and including 8-14 Jul 2020. For more information on the recalled product, please consult the CFIA's website.
Canadians are advised not to eat the recalled products. Retailers and foodservice establishments are advised not to sell or serve the recalled products, or any items that may have been prepared or produced using these products. The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.
The recalled products can be identified by looking for the Product Code, located in the upper right-hand corner of the front of the package. The recall includes products marked with the letter "Z" at the beginning of the Product Code, followed by the number "178" or lower.
● リステリア症－フィンランド
PRO/AH/EDR> Listeriosis - Europe (02): Finland, MLST 6, whole genome sequencing
Archive Number: 20200711.7562954
情報源 Food Safety News 2020年7月9日
Authorities in Finland are investigating a _Listeria_ outbreak that has affected 8 people. All patients have been hospitalized, but no deaths have been recorded. The age range of those sick is 60 to 93 years old, 5 are female, and they live in different parts of the country.
Ruska Rimhanen-Finne, a veterinary epidemiologist at the National Institute for Health and Welfare (THL), said all illnesses occurred within a month in May and June [2020].