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Global high consequence infectious disease events: summary February and March 2024

Interpreting this report

The report provides updates on known, high-consequence infectious disease (HCID) events around the world as monitored byÌýthe UK Health Security Agency’s (UKHSA) epidemic intelligence activities.

The report is divided into 2 sections covering all the definedÌýHCIDÌýpathogens. The first section contains contact and airborneÌýHCIDsÌýthat have been specified for theÌýHCIDÌýprogramme by NHS England. The second section contains additionalÌýHCIDsÌýthat are important for situational awareness.

Each section contains information on known pathogens and includes descriptions of recent events. If an undiagnosed disease event occurs that could be interpreted as a potentialÌýHCID, a third section will be added to the report.

Events found during routine scanning activities that occur in endemic areas will briefly be noted in the report. Active surveillance, other than daily epidemic intelligence activities, of events in endemic areas will not be conducted (for example, actively searching government websites or other sources for data on case numbers).

The target audience for this report is any healthcare professional who may be involved inÌýHCIDÌýidentification, treatment and management.

Risk rating

Included for each disease is a current risk rating based on the probability of introduction to the UK and potential impact on the UK public.ÌýPast UK experience and the global occurrence of travel-associated cases are also considered. Currently, all diseases are classified into one of 3 categories: Low, very low and exceptionally low/negligible.

Incidents of significance of primaryÌýHCIDs

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Crimean-Congo haemorrhagic fever (CCHF)

Geographical risk areas	Endemic in Africa, the Balkans, the Middle East and western and south-central Asia. Cases have also been reported in Russia and Georgia. Spain has previously reported locally acquired cases (, with the ).
Sources and routes of infection	• bite from, or crushing of, an infected tickÌý • contact with the blood, tissues or body fluids of infected humans or animals
UKÌýexperience to dateÌýÌý	Two cases have been reported in individuals who have travelled to the UK from and .
Risk ratingÌý	Low – rarely reported in travellers.
Recent cases or outbreaksÌý	Between 1 January and 30 March 2024, the World Health Organisation (WHO) reported from Afghanistan. CCHF was confirmed in 2 out of 48 suspected cases which have been tested since the beginning of 2024. The confirmed cases were from Balkh and Kapisa provinces. For comparison, (case fatality rate (CFR of 9.2%)). A total of 1,098 suspected cases of suspected CCHF cases were tested in 2023, of which 383 were confirmed. On 22 March 2024, the of CCHF from Dakar. In 2023, Senegal reported 7 CCHF cases, including 2 deaths (CFR of 28.6%) from 6 regions. Between 28 January and 10 March 2024, (CFR of 42.9%). Cases were reported from Kampala, Kiruhura, Kyankwanzi, Lyantonde and Mbarara districts.

Ebola virus disease (EVD)

Geographical risk areasÌý	Map of countries which have reported EVD cases up to January 2023. No outbreaks of EVD have since been reported.
Sources and routes of infectionÌýÌý	• contact with blood, tissues or body fluids of infected animals, or consumption of raw or undercooked infected animal tissue • contact with infected human blood or body fluidsÌý
UKÌýexperience to dateÌý	Four confirmed cases (one lab-acquired in the UK in 1976, 3 healthcare workers associated with West African epidemic 2014 to 2015).Ìý
Risk ratingÌýÌý	Very low – other than during the West Africa outbreak, exported cases are extremely rare.Ìý
Recent cases or outbreaksÌý	No confirmed or suspected human cases were reported in February or March of 2024.

Lassa fever

Geographical risk areasÌý	Endemic in sub-Saharan West Africa.
Sources and routes of infectionÌý	• contact with excreta, or materials contaminated with excreta from an infected rodentÌý • inhalation of aerosols of excreta from an infected rodentÌý • contact with infected human blood or body fluids
UKÌýexperience to dateÌý	. Prior to this, 8 imported Lassa fever cases had been reported since 1980, all in travellers from West Africa.
Risk ratingÌý	Low – overall, Lassa fever is the most common imported viral haemorrhagic fever (VHF) but importations to the UK are still rare.Ìý
Recent cases or outbreaksÌý	Between 6 January 2022 and 13 February 2024, (CFR of 29%). Between 1 January and 31 March 2024, Nigeria reported , with confirmed cases reported from 27 states. 150 deaths were reported among confirmed cases (CFR of 18.6%). This is an increase in cases and deaths when compared to the equivalent , including 148 deaths among confirmed cases (CFR of 17.5%), were reported. Ìý

Marburg virus disease (MVD)

Geographical risk areasÌý	Sporadic outbreaks have previously been reported in Central and Eastern Africa. A human case of MVD was reported in ; this was the first case to be identified in West Africa. for the first time in July 2022. MVD outbreaks were reported for the first time in and in .
Sources and routes of infectionÌý	• exposure in mines or caves inhabited by Rousettus bat colonies • contact with infected human blood or body fluids
UKÌýexperience to dateÌý	ÌýNo reported cases in the UK.
Risk ratingÌý	Very low – globally, 5 travel-related exported MVD cases have previously been reported in the literature.
Recent cases or outbreaksÌý	No confirmed or suspected human cases were reported in February or March of 2024.

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Avian influenza A(H7N9) virus

Geographical risk areasÌý	All reported human infections have been .Ìý	Ìý
Sources and routes of infectionÌý	• close contact with infected birds or their environmentsÌý • close contact with infected humans (no sustained human-to-human transmission)Ìý	Ìý
UKÌýexperience to dateÌý	No known cases in the UK.Ìý	Ìý
Risk ratingÌý	ÌýVery low (UKHSAÌýrisk assessment).Ìý	Ìý
Recent cases or outbreaksÌý	No confirmed or suspected human cases were reported in February or March of 2024.	Ìý

Avian influenza A(H5N1) virus

Geographical risk areasÌý	Human cases have been predominantly reported in South East Asia, but also in Egypt, Iraq, Pakistan, Turkey and Nigeria. Human cases (clade 2.3.4.4b) were and the , and and 2023. The first human cases of avian influenza A(H5N1) (clade 2.3.4.4b) were reported from South America in 2023, from and .
Sources and routes of infectionÌýÌý	• close contact with infected birds or their environments • close contact with infected humans (no sustained human-to-human transmission)Ìý
UKÌýexperience to date	As of September 2023, 5 detections were reported in the UK, and 4 in 2023.
Risk ratingÌý	ÌýVery low (UKHSAÌýrisk assessment).Ìý
Recent cases or outbreaksÌý	On 9 February 2024, the Cambodia MoH reported a fatal case of avian influenza A(H5N1) in a 9 year old male from Kratie Province. A subsequent confirmed case of avian influenza A(H5N1) was reported on 12 February 2024, from Kratie Province. This case, who reported no respiratory symptoms, was the 16 year old brother of the case reported on 9 February 2024. Dead poultry had been reported around the cases’ home, which were then consumed. On 21 February 2024, the Cambodia MoH reported the confirmation of an additional human case of avian influenza A(H5N1), in a 17 year old female from Kampot Province. Dead poultry were reported in or around the case’s home prior to symptom onset. Including these 3 latest cases, a total of 5 human cases of avian influenza A(H5N1) have been reported in Cambodia so far in 2024, from Prey Veng (one case), Siem Reap (one case), Kratie (2 cases) and Kampot (one case) provinces. After 9 years without reporting a case of avian influenza A(H5N1), were reported in Cambodia during 2023. On 25 March 2024, in Khanh Hoa Province, Vietnam. The case had exposure to birds prior to symptom onset. Since 2003, a total of 129 human cases of avian influenza A(H5N1), including 65 deaths, have been reported in Vietnam.

Middle East respiratory syndrome (MERS-CoV)

Geographical risk areasÌý	The Arabian Peninsula – Yemen, Qatar, Oman, Bahrain, Kuwait, Saudi Arabia and UnitedÌýArabÌýEmirates.Ìý
Sources and routes of infectionÌý	• airborne particles • direct contact with contaminated environmentÌý • direct contact with camels or consumption of raw camel milkÌý
UKÌýexperience to dateÌý	– 3 imported cases (2012, 2013 and 2018), 2 secondary cases in close family members of the case in 2013, 3 deaths.Ìý
Risk ratingÌý	ÌýVery low (UKHSAÌýrisk assessment).Ìý
Recent cases or outbreaksÌý	On 16 February 2024, the WHO reported that between 13 August 2023 and 1 February 2024, 4 laboratory-confirmed cases of MERS-CoV, including 2 deaths, were . The cases were confirmed between 10 October and 16 November 2023. The cases were from Riyadh, Eastern, and Qassim regions and no known epidemiological links were identified between the cases. One of the 4 cases was a camel owner, while another had a history of indirect contact with camels (family members were camel owners). There was no clear history of exposure to known risk factors for the other 2 cases. Of the cumulative total of 2,609 MERS-CoV cases and 939 deaths reported globally since 2012, 84% and 91%, respectively, have been reported from the Kingdom of Saudi Arabia.

Mpox (Clade I only)

Geographical risk areasÌý	Central Africa including, .Ìý
Sources and routes of infectionÌýÌý	• close contact with an infected animal (in an endemic country) or an infected person • contact with clothing or linens (such as bedding or towels) used by an infected person • direct contact with mpox skin lesions or scabs • coughing or sneezing of an individual with an mpox rash • consumption of contaminated bushmeat
UKÌýexperience to date	No cases of Clade I mpox have been reported in the UK.
Risk ratingÌý	ÌýVery low – no known importations of Clade I mpox into the UK.
Recent cases or outbreaksÌý	Sequencing data is often not available for mpox cases reported from endemic African countries where Clade I monkeypox virus (MPXV) is known to circulate. Therefore, we report below all reported mpox cases from these countries, regardless of whether the samples have been sequenced or clade-tested. In 2024, as of 29 March, from 5 regions. Cameroon reported 140 mpox cases, including one death, in 2023. In 2024, the from 11 districts, as of 24 March. In 2023, the CAR reported 67 mpox cases, including 2 deaths. In 2024, as of 24 March, the , including 296 deaths (CFR of 6.5%), from 19 of 26 provinces. While in samples from a small proportion of these cases, the number that have been clade-tested nationally is unclear. Approximately 70% of suspected mpox cases reported in the DRC in 2024, are among children under 15 years of age, with 60% of confirmed cases reported in males. However, South Kivu Province, where sexual transmission has been reported, has confirmed the most cases in women aged between 20 and 40 years. (14,434 cases, including 728 deaths). In the from 5 departments in 2024, as of 24 March. During 2023, 95 mpox cases, including 5 deaths were reported.

Nipah virus

Geographical risk areasÌý	South East Asia, predominantly in . Cases have also been reported in Malaysia and Singapore.
Sources and routes of infectionÌý	• direct or indirect exposure to infected bats • consumption of contaminated raw date palm sap • close contact with infected pigs or humansÌý
UKÌýexperience to dateÌýÌý	ÌýNo known cases in the UK.Ìý
Risk ratingÌý	Exceptionally low/negligible – no travel-related infections in the literature.Ìý
Recent cases or outbreaksÌý	No new cases of Nipah virus infection were confirmed in February or March of 2024 ().

Pneumonic plague (Yersinia pestis)

Geographical risk areasÌý	Predominantly . Endemic in Madagascar, Peru, andÌýthe DRC.
Sources and routes of infectionÌý	• flea bitesÌý • close contact with infected animalsÌý • close contact with human cases of pneumonic plagueÌý
UKÌýexperience to dateÌý	Last outbreak in the UK was in 1918.Ìý
Risk rating	Exceptionally low/negligible
Recent cases or outbreaksÌý	(CFR of 3.4%) since the beginning 2024, as of 22 March. It was not stated if these cases were bubonic and/or pneumonic plague. . On 8 March 2024, in the USA . It was not specified if this case was bubonic or pneumonic plague. The was the first human case of plague reported in New Mexico since 2021 and the first death since 2020.

Severe acute respiratory syndrome (SARS)

Geographical risk areas	Currently none. Two historical outbreaks originating from China in 2002 and 2004.
Sources and routes of infection	• airborne particlesÌý • direct contact with contaminated environment
UKÌýexperience to date	related to the 2002 outbreak.Ìý
Risk rating	Exceptionally low/negligible
Recent cases or outbreaks	No confirmed or suspected human cases reported globally since 2004.Ìý

Incidents of significance of additionalÌýHCIDs

Argentine haemorrhagic fever (Junin virus)

Geographical risk areas	(central). Endemic to the provinces of Buenos Aires, Córdoba, Santa Fe and La Pampa.
Sources and routes of infection	• direct contact with infected rodentsÌý • inhalation of infectious rodent fluids and excretaÌý • person-to-person transmission has been documentedÌý
UKÌýexperience to date	ÌýNo known cases in the UK.Ìý
Risk rating	Exceptionally low/negligible – was identified in Belgium in 2020.Ìý
Recent cases or outbreaks	No confirmed or suspected human cases were reported in February or March of 2024.

Bolivian haemorrhagic fever (Machupo virus)

Geographical risk areas	Bolivia – (Mamoré, Iténez and Yucuma provinces) and Cochabamba (Cercado province).Ìý
Sources and routes of infection	• direct contact with infected rodentsÌý • inhalation of infectious rodent fluids and excretaÌý • person-to-person transmission has been documentedÌý
UKÌýexperience to date	ÌýNo known cases in the UK.Ìý
Risk rating	Exceptionally low/negligible – travel-related cases have never been reported.Ìý
Recent cases or outbreaks	No confirmed or suspected human cases were reported in February or March of 2024.

Lujo virus disease

Geographical risk areas	A single case acquired in Zambia led to a cluster in South Africa in 2008.Ìý
Sources and routes of infection	• presumed rodent contact (excreta, or materials contaminated with excreta of infected rodent)Ìý • person to person via body fluidsÌý
UKÌýexperience to date	No known cases in the UK.
Risk rating	Exceptionally low/negligible – a single travel-related case has been reported. No cases have been reported anywhere since 2008.Ìý
Recent cases or outbreaks	No confirmed or suspected human cases reported since 2008.Ìý

Severe fever with thrombocytopenia syndrome (SFTS)

Geographical risk areas	Mainly reported from China (south-eastern), Japan and Korea. Cases have also been reported in , , and . Serological evidence of SFTS in .Ìý
Sources and routes of infection	• presumed to be tick exposureÌý • person-to-person transmission described in household and hospital contacts, via contact with blood or bloodstained body fluidsÌý
UKÌýexperience to date	No known cases in the UK.Ìý
Risk rating	Exceptionally low/negligible – not known to have occurred in travellers.Ìý
Recent cases or outbreaks	No confirmed or suspected human cases were reported in February or March of 2024.

Andes virus (Hantavirus)

Geographical risk areas	ÌýChile and southern Argentina.Ìý
Sources and routes of infection	• rodent contact (excreta, or materials contaminated with excreta from an infected rodent)Ìý • person-to-person transmission described in household and hospital contactsÌý
UKÌýexperience to date	ÌýNo known cases in the UK.Ìý
Risk rating	ÌýVery low – rare cases in travellers have been reported.Ìý
Recent cases or outbreaks	On 1 March 2024, media reported that . According to the article, this was the first case reported in the region in 2024. On 4 March 2024, the , reported that a case of hantavirus had been confirmed. On 6 March 2024, media reported that a , Argentina. The type of hantavirus was not specified for any of these cases.

Avian influenza A(H5N6) virus

Geographical risk areas	Mostly China. New strain reported in , and subsequently found in Western Europe in birds.Ìý
Sources and routes of infection	Close contact with infected birds or their environments.Ìý
UKÌýexperience to date	ÌýNo known cases in the UK.Ìý
Risk rating	Very low – not known to have occurred in travellers (UKHSAÌýrisk assessment).Ìý
Recent cases or outbreaks	No confirmed or suspected human cases were reported in February or March of 2024.

Avian influenza A(H7N7) virus

Geographical risk areas	Sporadic occurrence in birds across mainland Europe and the UK. in 1996, in 2003, and in 2013.
Sources and routes of infection	• close contact with infected birds or their environmentsÌý • close contact with infected humans (no sustained human-to-human transmission reported)Ìý
UKÌýexperience to date	ÌýNo known cases in the UK.Ìý
Risk rating	ÌýVery low – human cases are rare, and severe disease even rarer.Ìý
Recent cases or outbreaks	No confirmed or suspected human cases were reported in February or March of 2024.

Authors of this report

Emerging Infections and Zoonoses Team, UKHSA