COVID-19(337) 各国からの短信，米国
● COVID-19(337) 短信，米国
PRO/AH/EDR> COVID-19 update (337): Al Jazeera, USA, travel, selected countries, WHO, global
Archive Number: 20200730.7628961
In this update:
[1] Snippets on country updates and collateral damage
[2] USA: Experts recommend "reset" coronavirus approach
[3] Early COVID-19 spread linked to travel
[4] Selected countries: 29 Jul 2020 case and death updates
[5] WHO situation report 191 (as of 29 Jul 2020)
[6] Global update: Worldometer accessed 29 Jul 2020 22:20 EDT (GMT-4)
[1] 短信：Snippets on country updates and collateral damage
情報源 Al Jazeera 2020年7月30日
- 11:35 GMT - フィリピン: 1日として最多となる 3954 new infections
- 10:30 GMT - 中国: Urumqi, the capital of China's western Xinjiang region の禁足令。現在，本土における新型コロナウイルス感染発生の中心地となっており，29日にも 96 of 105 confirmed COVID-19 cases が報告。
- 10:25 GMT - イラン: Number of coronavirus cases passes 300 000
- 10:20 GMT - チェコ: Coronavirus spike, cases top 16 000
- 07:45 GMT - ロシア: Over 5500 new coronavirus cases
- 09:24 GMT - パキスタン: Downward trajectory of active coronavirus cases
5月12日以降で最小の 25 253 例にまで減少し，1日の新規患者数は 1114人。
- 08:23 GMT - インド: Daily coronavirus cases top 50 000
- 07:25 GMT - 香港: Virus ban on restaurant dining reversed
- 06:35 GMT - ポーランド: フランス，スペインなどからの帰国者に検疫措置実施の可能性示唆。
- 06:10 GMT - ウクライナ: Daily high of 1197 new coronavirus cases
- 06:01 GMT - 日本: Spike in coronavirus cases
- 05:00 GMT - 米国: Johns Hopkins researchers call for "reset" in US pandemic response
- 04:30 GMT - ベトナム: Hanoi plans mass testing in wake of Danang outbreak
- 03:30 GMT - オーストラリア: Highest number of cases。30日，723 new cases
- 00:15 GMT - オーストラリア Australia's Victoria state: to report more than 700 cases, 13 deaths
- 03:20 GMT - パプア NG: Coronavirus situation worsening：検査・治療体制が限界に近づいている。
- 01:35 GMT - 米国: Records a coronavirus death every minute as total surpasses 150 000
- 00:00 GMT - ブラジル: a record of 1595 daily deaths from coronavirus.
[2] 米国: Experts recommend "reset" coronavirus approach
情報源 Al Jazeera 2020年7月30日
米国の科学者らは政府に対し，世界最悪の被害が発生する同国が，アウトブレイクへの収束に向かっていないとして，パンデミックへの対応を見直すよう求めている。29日，Johns Hopkins University の研究者からの The scientists' policy brief の中で，ステイホームの指示の実施により 5月には患者を減少させることが出来ていたが，現在の患者増加により全米各地の病院が感染者であふれかえっている ... ほとんどの州において，入院患者に占める COVID-19 患者の率が，3月から4月のピーク時の New York City のそれと同じか，それを上回っている。世界中の他の国々と異なり，米国は感染コントロールに向かっていない。今こそ見直す時期である，と述べられている。常にマスクを着用し，physical distancing・手指衛生に留意し，大人数で集まらない，ことを勧めている。実施しなければ，コントロールできないばかりか，さらなる増加につながるとしている。もはや個人の選択ではなく，社会的責任として実施すべき段階にあると述べている。
Stay-at-home orders
アウトブレイクの状況が悪化する地域では，少なくとも 2週間にわたって患者数が改善されるまで，stay-at-home orders を続けるべき。また，医療機関への個人防護衣と検査キットの供給体制強化，疫学データのより詳細な解析，範囲を全米に拡大した接触者トレース，も求められている。guidelines to maintain physical distancing and wear masks in public が守られれば，より十分にコントロールされる状況となる，との多くの専門家らのアドバイスにも同調している ...
[3] Early COVID-19 spread linked to travel（中国，イラン，イタリアへの旅行）
情報源 Contagion Live 2020年7月29日
The Lancet Infectious Diseases に掲載された新たな報告によれば，発生国の初期の患者 initial COVID-19 cases in affected countries のうち，およそ 2/3 が，中国，イラン，イタリアに関係する旅行者であったことが示唆されている。SARS-CoV-2 の初期の感染拡大に関するデータや，中国本土を除く確定患者の世界的な疫学情報はは限られており，複雑な感染伝播の流れがある中，科学研究の論点となるだろう。パンデミック発生前の 2020年3月10日までの期間についての公表された，保健当局等による疫学情報をまとめたもので，渡航歴や他の患者との接触，患者背景なども調べられている。中国本土を除く，感染が発生した 99か国（の初期の患者）のうち，75 (76%) に affected countries への渡航が確認され，60 (61%) が China, Italy, or Iran への旅行だった。年齢や性別の情報が確認できた 1200例のうち，874 (73%) が各国で記録された初発例から 100例目までの early cases であった。年齢の情報が得られた 762 early cases の年齢の中間値は 51 歳; 25 (3%) of 762 early cases は 18歳未満だった。さらに，1200例のうちの 21例（2％）が医療従事者だった。パンデミック以前に起きた 101 clusters クラスター発生の環境として，家庭内 (76 [75%]) が最も多く，次いで医療現場を除く職場 (14 [14%]), 大人数の集会 large-scale community gatherings (11 [11%]) の順であった ...
[4] Selected countries: 29 Jul 2020 case and death updates
[Details for this section have been eliminated. - Mod.UBA]
[A] 中国: National Health Commission, 84 165 total cases, 4634 deaths (outbreaks ongoing in Xinjiang (96 new cases) and Liaoning (5 new cases); 1 in Beijing; 118 new cases in Hong Kong)
[B] 韓国: 14 269 confirmed cases, 300 deaths (11 imported, 7 locally transmitted)
[C] イタリア: 246 776 total cases, 35 129 deaths [comparative 7-day averages have gone up by 24.2% from the preceding 7 days]
[D] イラン: 298 909 total cases, 16 343 deaths
[E] 米国: 4 568 037 total cases, 153 840 deaths [comparative 7-day averages have gone down by 3.5% for daily case count but up by 26.7% for reported deaths]
[F] スペイン: 282 641 cases, 28 441 deaths [14-day population-based rate: 51.11/100 000: up from 7.74 on 25 Jun 2020]
[5] WHO situation report 191 (as of 29 Jul 2020)
情報源 WHO 2020年7月29日
Highlights
- The WHO Regional Office for Europe がトルクメニスタンに対し，COVID-19 アウトブレイクへの対策強化を求めた。これまでのところ，同国からは 1例の感染も報告されていない; しかしながら，最近になって同国内では，呼吸器感染症の感染予防策が実施されている ...
Surveillance
WHO region (no. countries/territories): Total confirmed cases (new) / Total deaths (new)
Western Pacific Region (19): 295 613 (3620) / 8262 (12)
European Region (61): 3 283 277 (20 993) / 211 616 (705)
South East Asia Region (10): 1 892 056 (53 676) / 42 233 (867)
Eastern Mediterranean Region (22): 1 507 734 (13 037) / 38 815 (444)
Region of the Americas (54): 8 840 524 (111 562) / 342 635 (2984)
African Region (49): 738 344 (12 239) / 12 519 (262)
Cases on an international conveyance (Diamond Princess): 712 (0) / 13 (0)
Confirmed cases (new conf. cases) / Total deaths (new deaths)
Grand total: 16 558 289 (215 127) / 656 093 (5274)
...
- The European region では 9.7% of the global newly reported cases and 13.3% of the newly confirmed deaths globally が報告。ロシア 26.1% (5475) of the regional newly confirmed cases, 次いでイスラエル 9.7% (2052), カザフスタン 7.4% (1544), ルーマニア 5.4% (1151), ウクライナ 4.8% (1022), トルコ 4.6% (963), スペイン 4.3 % (905), doitu 3.3% (684), フランス 3.2% (672), キルギスタン 3.2% (668), ウズベキスタン 3.1% (663), and 英国 2.7% (581) の順。
他の地域についても同様の情報あり。
[6] Global update: Worldometer accessed 29 Jul 2020 22:10 EDT (GMT+4)
情報源 Worldometer 2020年7月29日[For the detailed global data]
関連項目
COVID-19 update (336): countries, collateral damages, WHO, global 20200729.7622848
● 大腸菌 EHEC－ノルウェー，死亡
PRO/AH/EDR> E. coli EHEC - Norway: hemolytic uremic syndrome, fatal
Archive Number: 20200730.7625577
情報源 Outbreak News Today 2020年7月28日
The Norwegian Institute of Public Health (NIPH), or Folkehelseinstituttet, reported the 1st death in a child from hemolytic uremic syndrome (HUS) from E. coli in more than a decade. The child, from Oslo municipality, was under 2 years of age. The source of the infections was not published.
● エボラ(36)－コンゴ(民)
PRO/AH/EDR> Ebola update (36): Congo DR (EQ)
Archive Number: 20200730.7626335
In this update:
[1] Case updates
- CIDRAP (Center for Infectious Disease Research and Policy) 29 Jul 2020
- WHO/AFRO, Weekly Bulletin on Outbreaks and Other Emergencies 26 Jul 2020
[2] Long term persistence
[1] Case updates
- Wed 29 Jul 2020
[CIDRAP (Center for Infectious disease Research and Policy) abridged, edited]
One more Ebola case has been confirmed in the Democratic Republic of the Congo (DRC) Equateur province outbreak, raising the total to 68 cases, the World Health Organization (WHO) African regional office said today [29 Jul 2020] on Twitter.
The patient is apparently from Mbandaka, the provincial capital, which is a concern, given its travel connections to Kinshasa and neighboring countries. The number of deaths held steady at 31.
The outbreak has been under way since early June [2020], and the continued increase in cases is a grave concern, given the rising incidence and geographic spread, the WHO's regional office said yesterday [28 Jul 2020] in its weekly outbreaks and health emergencies update.
The event is complicated by COVID-19, measles outbreaks, and other challenges, as well as confirmed cases that remain in the community or are lost to follow-up. 3 healthcare workers are among the confirmed cases.
In other Ebola developments, the US Biodefense Advanced Research and Development Authority (BARDA), part of the Department of Health and Human Services, has signed an agreement with Regeneron to buy supplies of its Ebola triple antibody cocktail, REGN-EB3, as part of building national preparedness, the company said today in a press release. The drug is currently under priority review by the Food and Drug Administration.
The company said it expects to deliver an established number of treatment doses over a 6-year period and receive about USD 10 million in 2021 and USD 67 million per year for each of the next 5 years.
REGN-EB3 is one of 2 drugs that stood out as more effective than other options in studies conducted in the DRC.
--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>
[The prior report, CIDRAP 27 Jul 2020, reported 2 more cases from Mbandaka, the provincial capital, bringing the total number to 67 (63 confirmed, 4 probable) with 31 deaths and 21 recovered before this latest report of 1 additional case, raising the total to 68. The community deaths, as discussed below, are the greatest concern, particularly because the burials are unlikely to be safe. - Mod.LK]
- Sun 26 Jul 2020. Equateur Province
[WHO/AFRO, Weekly Bulletin on Outbreaks and Other Emergencies; abridged, edited]
https://apps.who.int/iris/bitstream/handle/10665/333517/OEW30-2026072020.pdf
Week 30: 20-26 Jul 2020; data as reported by: 26 Jul 2020
Ebola virus disease Democratic Republic of the Congo (Equateur Province) CFR 46.3%
--------------------------------------------------------------------------------
Event description
The Ebola virus disease (EVD) outbreak in Equateur Province, Democratic Republic of the Congo, is escalating further, with 23 health areas in 7 health zones affected. Since our last report (weekly bulletin 29), another 9 additional confirmed EVD cases have been reported, with 9 new deaths, one of which was is a man who had returned 2 negative PCR results before dying of complications of EVD. One new confirmed case was reported on 25 Jul 2020, the wife of a man who had died of the disease on 22 Jul 2020. Their child had also been reported as a confirmed case. The patient was a known contact who had been vaccinated and was monitored regularly.
As of 25 Jul 2020, there are a total of 67 [now 68] cases (63 confirmed and 4 probable) including 31 deaths (case fatality ratio 46.3%). The case fatality ratio among confirmed cases is 42.9% (27 deaths/63 confirmed cases). 3 health workers are among the confirmed cases, making up 4.5% of all cases. The number of health areas that have reported at least 1 confirmed or probable case of EVD since the start of this outbreak has risen to 23, in 7 of the 18 health zones in the province. In the past 21 days (5-25 Jul 2020), 25 confirmed cases have been reported in 13 health areas across 5 health zones. However, Iboko Health Zone has gone 21 days without a confirmed case of EVD, with the last confirmed case reported on 4 Jul 2020.
Out of the 6 health zones, 5 reported contacts on 25 Jul 2020. Of the 914 new contacts reported, 354 (58.4%) were reported from Bikoro. Out of 5360 active contacts, 4242 (79.1%) had been seen in the previous 24 hours. Of the 531 contacts who were not seen in this 24-hour period, 161 (30.3%) have never been seen, 25 (4.7%) were lost to follow-up and 345 (65%) had not been seen in the previous 24 hours. In addition, 13 contacts have become symptomatic, including 10 in Bikoro, 2 in Mbandaka and 1 in Bikoro. Seven health zones reported alert data on 16 Jul 2020, with 501 new alerts reported, including 4 deaths. A total of 1015 alerts were reported, of which 441 (43.4%) were investigated. Of these, 79 (17.9%) were validated as suspected cases and 26 (32.9%) were investigated. For the 3rd consecutive day, the number of alerts investigated remained low in Mbandaka at 10.5%, suggesting that more investigators are needed in this health zone.
Situation interpretation
The EVD outbreak in Equateur Province is escalating, with increasing new confirmed cases along with geographical spread to new health areas. Community resistance to response activities is being seen and there are challenges around inadequate resources for alert investigations in Mbandaka, and in case management in rural and hard-to-reach areas. The constant presence of confirmed cases in the community is of particular concern, along with suspected cases who are not isolated. Although all pillars of response are active in the affected areas, further actions are required to limit spread to other areas, along with intense community engagement with community leaders to prevent resistance to response activities and ensure that communities become fully engaged in response activities.
--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>
[COVID-19 and measles are also plaguing the region, exacerbating the situation. See report at the source URL above for a map of the distribution of confirmed EVD cases in Congo DR. - Mod.LK
Maps of Congo DR: http://goo.gl/DM2AT8 and http://healthmap.org/promed/p/44490]
[2] Long-term persistence of Ebola-specific immune activity
情報源 News Medical Life Sciences, French National Research Institute for Sustainable Development (IRD) report 2020年7月27日
In the 2013-2016 Ebola outbreak in West Africa, more than 28 000 people were infected, causing over 11 000 deaths. While the long-term health impacts on survivors are still poorly understood, an increasing number of studies describe persistent clinical after-effects in these patients, such as generalized fatigue, musculoskeletal pain, and eye disorders.
To pinpoint these health problems, the research teams used data from the follow-up of cohorts of survivors, such as the Inserm PostEboGui cohort, developed with the French National Research Institute for Sustainable Development (IRD) and the Center for Training and Research in Infectious Diseases in Guinea (CERFIG). Made up of 802 former Ebola patients enrolled in several centers across Guinea, this cohort aimed to describe and analyze the clinical, immunological, psychological, and socio-anthropological impacts of Ebola over 2 years [see reference below for this multidisciplinary observational cohort study. - Mod.LK]
The study, published in Nature Communications and conducted by Prof. Yves Levy with Aurelie Wiedemann at the Vaccine Research Institute (VRI, Inserm/Universite Paris-Est Creteil), is one of the first to focus on the long-term immuno-inflammatory profile of Ebola survivors.
The researchers based their study on the analysis of blood samples from 35 members of the PostEboGui cohort who were recruited to participate in this study on average, 2 years after the onset of their disease. A control group was also set up to compare their immune profiles. Each patient was seen 3 times for these blood samples to be taken. Samples of saliva, urine, and semen were also analyzed to rule out the presence of the virus.
Such research was only possible thanks to the involvement of the local teams, which had been specifically trained in handling biological samples. It is, therefore, the fruit of close collaboration between Inserm and IRD teams and Guinean laboratory technicians and scientists at the National Institute of Public Health (INSP) and CERFIG.
Inflammation and immune markers
-------------------------------
Analysis of the blood samples showed that even when survivors are physically recovered and no longer have any detectable virus, they still present a specific immune profile, different from that of people who have never contracted the disease.
In particular, the researchers identified the presence of immune cells known as CD4+ and CD8+ memory T cells, specific to the virus, which remained in the blood of the 35 survivors 2 years after the disease. Also, there was a higher number of cytotoxic CD8+ T-cells involved in the destruction of the infected cells, as well as the presence of IgG antibodies specific to the Ebola virus in these survivors.
What is more, the team showed the presence of a large number of inflammatory markers in the blood samples (pro-inflammatory cytokines, markers of immune activation), which indicate the persistence of inflammation in Ebola survivors. Finally, this study showed that certain specific immune markers were associated with the persistence of symptoms in these patients.
These findings, therefore, highlight the long-term persistence of Ebola-specific immune activity and intense and chronic inflammation in these former patients, 2 years after being infected with the virus.
"Our work underscores the importance of long-term follow-up of Ebola survivors, something that has already been emphasized in studies of clinical after-effects. It is important to see how their condition and immune profile evolve and whether they are moving towards a chronic disease." Aurelie Wiedemann, Vaccine Research Institute (VRI, Inserm/Universite Paris-Est Creteil)
In the context of the ongoing Ebola epidemic in the Democratic Republic of Congo, a new cohort with an immunity component is currently being developed there, following a similar strategy to that used to implement PostEboGui. It will be an opportunity for researchers to confirm their findings on the immune profile of survivors in a more significant number of patients.
[Reviewed by Emily Henderson, BSc]
Reference
---------
Wiedemann A, Foucat E, Hocini H, et al. Long-lasting severe immune dysfunction in Ebola virus disease survivors. Nat Commun. 2020; 11(1): 3730; https://www.nature.com/articles/s41467-020-17489-7
--
Communicated by:
Mary Marshall
<mjm2020@googlemail.com>
[The study reported here is a follow-up of this earlier study, now 2 years after infection: Etard JF, Sow MS, Leroy S, et al. Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study. Lancet Infect Dis. 2017; 17(5): 545-552; https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30516-3/fulltext
The long term sequelae of Ebola are important to understand as they add to the burden of this devastating disease. Similarly, as we learn more about COVID-19, sequelae following apparent recovery from the disease are becoming evident. - Mod.LK
HealthMap/ProMED map of Guinea: http://healthmap.org/promed/p/45]
See Also
Ebola update (35): Congo DR (EQ) 20200727.7614562