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Interpreting this report

The UK Health Security Agency’s (UKHSA) Emerging Infections and Zoonoses (EIZ) team uses an integrated horizon scanning approach, which combines information on both human and animal health, to identify and assess outbreaks and incidents of new and emerging infectious diseases globally.

This summary provides an overview of incidents (new and updated) of public health significance, which are under close monitoring. The incidents are divided into 2 sections: ‘Notable incidents of public health significance’ and ‘Other incidents of interest’. Notable incidents that the EIZ team have been monitoring are allocated an incident assessment rating (see Incident assessment key for descriptions). The report also includes a ‘Publications of interest’ section, which contains new publications relevant to emerging infections, and a final section that focusses on ‘Novel pathogens and diseases’.

For more information, or to sign up to the distribution list to receive an email alert when new reports are published, please contact epiIntel@ukhsa.gov.uk

For further detail about high consequence infectious disease (HCID) events that are detected during UKHSA’s epidemic intelligence activities, see High consequence infectious diseases: monthly summaries.

Incident assessment key

Rating	Description
Deteriorating	Incident is deteriorating with increased implications for public health
No change	Update does not alter current assessment of public health implications
Improving	Incident is improving with decreasing implications for public health
Undetermined	Insufficient information available to determine potential public health implications

Notable incidents of public health significance

Cholera, Haiti and the Dominican Republic

Event summary

The has now spread to all 10 departments of the country. The outbreak was originally declared in October 2022, after 3 years with no reported cases of cholera. As of 20 December 2022, 18,469 suspected cases and 324 associated deaths have been reported. The Ouest department, where Haiti’s capital Port-au-Prince is located, has reported 74% of confirmed cases.

In December 2022, Haiti received (1.17 million doses). A targeting 1.64 million people was launched on 18 December 2022.

The outbreak is exacerbated by the . There is limited access to healthcare and essential services including water and sanitation due to ongoing gang violence, socio-political conflicts, insecurity, fuel shortages, and economic instability. The capacity of the public health system and international partners to respond to the outbreak is also reduced by insecurity. As a result, WHO assess the risk of this outbreak as very high in the island of La Hispaniola (Haiti and the Dominican Republic).

In the neighbouring Dominican Republic, 8 cases of cholera had been confirmed as of 20 December 2022. Of these cases .

Incident assessment

No change – update does not alter current assessment of public health implications

Cholera, Malawi

Event summary

Malawi continues to experience which is the largest reported in the country over the last 10 years. As of 31 December 2022, the had reported 17,448 confirmed cases and 576 deaths. The number of cases and deaths being reported increased with (November to May). The President of Malawi declared the cholera outbreak a on 5 December 2022, due to the increase in complex cholera cases.

The case fatality rate is 3.3%, higher than expected with early and proper treatment.

All 29 of Malawi’s health districts have reported cholera cases since the start of the outbreak in March 2022. Mangochi District has been the most affected, reporting 4,218 cases and 85 deaths as of 31 December 2022.

A took place between 28 November and 2 December 2022, reaching more than 2 million people.

Incident assessment

No change – update does not alter current assessment of public health implications.

COVID-19, global update

Event summary

By the end of December 2022, WHO had reported over and over 6.67 million deaths globally.

Incident assessment

No change –update does not alter current assessment of public health implications

Further information

The World Health Organization (WHO)’s global .

European Centre for Disease Prevention and Control (ECDC)’s for European countries.

UKHSA’s national COVID-19 surveillance reports.

Polio, global update

Wild polio virus type 1 (WPV1)

Between 1 January and 27 December 2022, a total of , with 2 cases reported from Afghanistan, 8 from Mozambique and 20 from Pakistan. WPV1 remains : Afghanistan and Pakistan.

Circulating vaccine derived polio virus (cVDPV)

As of 27 December 2022, 83 cases of acute flaccid paralysis (AFP) caused by , with symptom onset in 2022, have been reported globally. Cases were reported from the Democratic Republic of the Congo (DRC) (49 cases), Madagascar (13 cases), Malawi (3 cases) and Mozambique (18 cases). This is an increase in cases compared to 2021 and 2020, when 16 and 35 cases had symptom onset in the reporting year, respectively.

As of 27 December 2022, 482 AFP cases of (cVDPV2), with symptom onset in 2022, have been reported from 18 countries. The number of cases globally in 2022 is lower than in previous years (682 cases in 2021 and 1,082 cases in 2020). However, some countries have observed an increase in cases. The DRC saw a large increase in cases in 2022 (210 cases) compared to previous years (28 and 81 cases in 2021 and 2020, respectively). The number of cases in Yemen increased from 66 in 2021 to 159 in 2022.

On 12 November 2022, from Pidie district in Aceh province. were isolated from the case and 3 healthy community contacts. WHO assess the risk to be high at a national level due to several factors including low vaccination coverage, sub-optimal surveillance capacity and vaccine hesitancy among the at-risk population. A vaccination campaign has been launched in the affected areas.

In December 2022, collected in August 2022. The sampling sites had been selected based on connections with communities in New York, United States of America, where VDPV2 was previously detected.

As of 27 December 2022, one case of was reported globally in 2022. The case occurred in Israel and was confirmed in March 2022. This was .

Incident assessment

No change – update does not alter current assessment of public health implications.

Other incidents of interest

Infectious diseases

Argentine haemorrhagic fever (Junin virus)

In December 2022, media reported .

Avian influenza A(H5N1)

In November 2022, . The case developed symptoms on 22 September 2022 and died on 18 October 2022. The case had had exposure to live domestic poultry before symptom onset. Since 2005, 54 human cases of avian influenza A(H5N1) have been reported in mainland China.

Cholera

Globally, , with 29 countries reporting cholera outbreaks (including Haiti and Malawi as above). Outbreaks have been reported in several countries that are not considered cholera-endemic, such as Lebanon and Syria.

Overall capacity to respond to these outbreaks is under pressure from the lack of resources as well as overstretched health and medical personnel. The global oral cholera vaccine stockpile is currently insufficient, despite manufacturers producing at maximum capacity. As a result, the International Coordinating Group temporarily limited reactive vaccination campaigns to one single dose since October 2022. WHO have highlighted several additional factors which are exacerbating the current outbreaks, including widespread flooding and drought.

Dengue

In 2022, . As of 20 November 2022, 52,807 cases and 230 associated deaths had been reported. Dhaka was the most affected division, accounting for 70.6% of cases. The . An increase in Aedes mosquitoes, the primary vector for dengue, has been caused by unusual amounts of rainfall since June 2022, together with high temperatures and humidity.

Ebola virus disease

On 20 September 2022 . The last case was confirmed on 27 November 2022. A total of 142 confirmed (55 deaths) and 22 probable cases (22 deaths) were reported. The . This was the fifth outbreak of Sudan ebolavirus to be reported in Uganda. The country last reported an outbreak of Sudan ebolavirus in 2012.

Invasive group A streptococcal (iGAS) infections

In December 2022, several countries in Europe (France, Ireland, the Netherlands, Sweden, and the UK), reported that , particularly in the second half of the year. Scarlet fever has also been observed in an increased number of cases. The most affected group is children under 10 years old.

In the UK 1,148 notifications of iGAS were received so far during the season, as of 25 December 2022 (weeks 37 to 52 of 2022). This is higher than the last 5 seasons for the same weeks.

WHO have assessed the risk for the general population as low, stating that the increase may be due to an early start to the infection season. This has coincided with circulation of respiratory viruses and possible viral co-infection, which may increase the risk of iGAS. Furthermore, increased population mixing is occurring following relaxation of COVID-19 pandemic restrictions and a period of reduced circulation of group A streptococcus. No new gene sequence type has been identified and there have been no reports of increased antibiotic resistance.

Hantavirus

As of 17 December 2022, , in 2022. The type of hantavirus is not reported.

As of 25 November 2022, during 2022. In December 2022, media reported and . The type of hantavirus is not reported. In total, 37 hantavirus cases were reported in Chile during 2021.

Lassa fever

In December 2022, in the Health District of Gueckedou.

As of 18 December 2022, Nigeria has reported , including 183 deaths in 2022. During the equivalent 2021 time period 4,273 suspected and 454 confirmed cases, including 92 deaths, were reported.

As of 1 December 2022, in 2022 (case fatality rate of 32.8%). In 2021, 25 confirmed cases and 16 deaths were reported (case fatality rate of 64.0%). WHO attribute the reduction in case fatality rate between 2021 and 2022 to improved case management and the availability of Ribavirin treatment in district level hospitals.

Measles

In November 2022, WHO published . Measles vaccination coverage decreased as a result of the COVID-19 pandemic, with first dose coverage in 2021 at 81%. Coverage of is required for herd immunity. WHO state that measles is an imminent public health threat in all regions, with the largest decrease in first dose vaccination coverage between 2019 and 2020 being observed in the South-East Asia Region.

Mpox

During November and December 2022, the . As of 28 December 2022, 83,751 confirmed and 1,551 probable cases including 75 deaths had been reported to WHO. . The WHO Region of the Americas was the most affected region during 2022 (reporting 55,722 cases and 44 deaths as of 11 December 2022), with the United States of America reporting the highest number of cases globally (29,513 cases as of 11 December 2022)

In November 2022, WHO announced that , following consultation with global experts.

Nipah virus

Media have reported that during 2022, including 2 deaths. Nipah virus was . Cases have been reported almost annually in the country since. In 2021, 2 cases and no deaths were reported.

Plague

In December 2022, media reported . One additional case who had pneumonic plague was reported to have recovered.

Usutu virus

In November 2022, France reported . The case had no travel history and is therefore the second locally acquired case to be reported in France. Usutu virus has been circulating in France since 2015. However, only one locally acquired case has previously been reported, which occurred in Occitanie in 2016.

West Nile virus

The West Nile virus transmission season in Europe generally occurs from June to November each year. During the , as of 23 November 2022, 1,191 human cases had been reported in Europe. Compared to previous years, relatively high numbers of cases were reported from .

Yellow fever

In 2022, were reported from 13 countries in the WHO Africa Region, as of 7 December 2022. 40 deaths were reported, equating to a case fatality rate of 9%.

The countries reporting the highest numbers of confirmed cases were Ghana (62 cases), Cameroon (35 cases) and Chad (31 cases). Over 4 million people have been vaccinated in reactive immunisation campaigns in Cameroon, the Central African Republic, Chad, Ghana and Kenya.

A gradual downward trend in cases has been observed in 2022. However, WHO still assess the risk at the regional level as moderate, noting that there is ongoing virus circulation in high-risk areas such as those facing security and access challenges.

Zika virus

In December 2022, . This is the first time that a case has been reported in the state. The case did not have any travel history. Cases of Zika virus disease have in the states of Kerala, Gujarat, Madhya Pradesh, Maharashtra and Rajasthan.

Publications of interest

Infectious diseases

Dengue

France experienced an unprecedented increase in the number of locally acquired dengue cases in 2022, compared with previous years. A found that several departments (Corse-du-Sud, Haute-Garonne, Hautes-Pyrénées, Pyrénées-Orientales and Tarn-et-Garonne) recorded autochthonous cases for the first time.

Ebola

The results of were published in December 2022. Immune responses were observed from day 14 to month 12 with each of the 3 different vaccine regimes used in the trials. No safety concerns were identified.

Bombali ebolavirus is a species of Ebola virus for which human cases of infection have not been documented. Bombali ebolavirus RNA was . The Bombali ebolavirus sequences were found to be closely related to sequences reported in bats in Sierra Leone, Kenya, and Guinea.

Elizabethkingia anophelis

to define the geographic distribution of the emerging species E. anopheles, which was found to already be distributed in various countries worldwide, especially the United States of America and China.

Influenza A(H3) Viruses

A recent study for antibodies against all major circulating swine, avian, and equine H3 influenza A virus lineages.

Seroprevalence rates for circulating influenza A viruses from swine in North America were >51%, swine in Europe 7% to 37%, and birds and equids ≤12%. Efficient replication of H3 influenza A viruses of swine in human respiratory tissues suggested that swine pose the highest risk for introduction of H3 influenza A viruses to humans.

Malaria

A in November 2022 linked an outbreak of malaria in the city of Dire Dawa, Ethiopia, to the Anopheles stephensi mosquitoe. An. stephensi is native to southern Asia and was first identified in Africa in the Republic of Djibouti, which borders Ethiopia, in 2014. Malaria is usually considered to impact rural areas. However, An. stephensi is also well adapted to urban settings.

A phase 2 clinical trial examining whether a monoclonal antibody can prevent Plasmodium falciparum infection in an endemic region found that .

Nipah

In November 2022, researchers in Bangladesh documented the for the first time.

Novel pathogens and diseases

Erysipelothrix Piscisicarius

E. piscisicarius is a novel pathogen in fish aquaculture. A recent publication documented . The case was likely infected during exposure to marine products, and developed symptoms including dizziness, headache and shortness of breath. They later recovered following hospitalisation.

Authors of this report

Alethea Charlton
Bláthnaid Mahon
Michael Reynolds