Pacific Syndromic Surveillance System Weekly Bulletin / Système de Surveillance Syndromique dans le Pacifique - Bulletin Hebdomadaire: W46 2024 (Nov 11-Nov 17) [EN/FR]

Alerts : AFR – Guam (1)

Prolong fever: Wallis & Futuna (5)

Respiratory virus epidemiology in the Pacific Island Countries for EPI – WK 46, 2024

• PSSS, EPI -WK46, 2024 Influenza-like Illness (ILI), Severe Acute Respiratory Illness (SARI), and COVID-19-like cases are compared to WK44 and tabulated as below for easy comparison (▼ Decreasing ▲ Increasing ● Stable). To provide additional context on the figures and trends, the percentage of country sentinel sites reporting WK45 & WK46 are also included. Reporting below 80% is indicated as ▼low reporting and – is no report available.

• Please refer Seasonal Influenzafor Pacific Island Countries and Areas - ILI Surveillance

• Attached is the weekly bulletin for your reference and additional information.

• Actual increases in the number of ILI cases has been seen in Cook Islands, Kiribati, RMI, CNMI and Wallis & Futuna for the week. SARI cases increased in Fiji, Kiribati, and Wallis and Futuna for the week. Increased COVID-19 cases seen in Fiji and CNMI for the week. The increased ILI cases seen in Fiji and New Caledonia may be due to the increased number of sites reporting for the week.

• The reduction in the number of ILI cases has been seen in Guam, Niue, and Tonga for the week. Furthermore, the number of SARI cases decreased in Guam, CNMI, and Tonga for the week. Decreased COVID-19 cases seen in Guam and Wallis and Futuna for the week. The decreased ILI cases seen in Samoa and Solomon Islands may be due to the decreased number of sites reporting for the week.

• No ILI cases reported in Pitcairn Islands and Tokelau, no SARI cases reported from Cook Islands, RMI, Niue, New Caledonia, Pitcairn Islands and Tokelau. Furthermore, no COVID-19 cases were identified in Cook Islands, Kiribati, RMI, Niue, New Caledonia, Pitcairn Islands, Samoa, Solomon Islands, Tonga and Tokelau for the week.

• No reports were available from French Polynesia, FSM and Tuvalu for the week.

• American Samoa has not participated in the surveillance.

• Surveillance figures are not intended to capture all country cases but to describe trends over time and are invaluable when trends rise beyond country baselines which should then trigger alerts and timely actions to characterize the actual nature and magnitude of the disease.

Influenza and Other Respiratory Virus in PICs:

• In week 46, the CNMI reported two (2) new COVID-19 cases, reflecting a 50% increase compared to the previous three weeks, with no hospitalization. Laboratory tests confirmed seven (7) cases of influenza A and three (3) Flu B from 193 samples and 4 SARI case for the week. Additionally, six (6) clinical pneumonia cases were reported, and 14 cases of Respiratory Syncytial Virus (RSV) were detected. (Situation Report WK46, 2024).
• In week 46, Fiji tested 40 flu samples, identifying 8 positive cases of influenza A/H3 positive cases and three (3) new SARS-CoV-2 for the week.
• In Week 45, French Polynesia reported 106 consultations for acute respiratory infections (ARI) were reported by sentinel network doctors, continuing a decline in ARI cases across all archipelagos. Other respiratory viruses, such as RSV (increasing), adenovirus, rhinovirus/enterovirus, and metapneumovirus, were detected. Influenza: Two new cases of influenza A were reported from 60 tests conducted. COVID-19: No new cases were confirmed from 61 tests, with the number of confirmed cases stable compared to the previous week. No new hospitalizations were reported. Source: Bulletin de surveillance sanitaire Polynésie française N° 45, 2024.
• New Caledonia in 2024, the percentage of acute respiratory infections ranged from 1.3% to 6.6%, with notable peaks during weeks 8–12 due to RSV circulation and weeks 17–21 linked to influenza A circulation. Since week 26, the percentage has remained stable below 5%, except for a rise in week 46. Influenza: 1,887 tests were conducted, confirming 101 influenza cases: 69 A/H3N2, 8 A/H1N1, and 24 un-subtyped. Cases increased in early October but declined from mid-October onwards. COVID-19: 2,055 tests confirmed 132 COVID-19 cases. No cases were reported between weeks 10–15 and 17–25, with cases reemerging in week 26. COVID-19 circulation increased in early October, followed by a decline from mid-October. Since January, 91 strains have been sequenced, primarily JN.1 subvariants. The current circulating variant, KP 3.1.1, was first detected in July. (Situation Report WK46, 2024).

Pertussis

• On 22 November 2024, Health New Zealand declared a whooping cough (pertussis) epidemic, identifying babies as the most vulnerable group. A total of 263 cases were reported in the past month, the highest count this year, following earlier spikes in May, June, and July. With half of infected babies under 12 months requiring hospitalization and the risk of fatalities, officials stress the urgency of vaccination. Free and safe pertussis vaccines are available for pregnant people, children, and eligible adults to protect against severe illness. A whooping cough in New Zealand.
• Since June 2024, in French Polynesia, 313 confirmed pertussis cases have been reported, with 39 in week 45 and mostly in Tahiti. The first resident case in Tubuai was linked to exposure in Tahiti. Most cases are in individuals aged 7-79 years (71.3%), with 12.1% in infants under 1 year. A <3-month-old infant hospitalized in week 46 tragically died, marking the first death and severe complication of the outbreak. 11 hospitalizations have been recorded, including 8 infants under 8 months. While overall cases have declined over the last two weeks, pertussis remains active in Tahiti. Source: Bulletin de surveillance sanitaire Polynésie française N° 45, 2024.
• As of 21 November 2024, New Caledonia has reported 110 pertussis out of 755 tests. since April, with 31 cases in October and 35 in September. 24 cases have been reported so far in November. – Source

Avian Influenza Weekly Update : (attached)

• From 15 to 21 November 2024, no new case of human infection with avian influenza A(H5N1) virus was reported to WHO in the Western Pacific Region.
• United States: As of 15 November 2024, a total of 52 human cases have been reported from seven US states this year. Among these, 30 individuals were exposed to infected or presumed-infected dairy cattle with A(H5N1), 21 were poultry farm workers exposed to outbreaks of HPAI A(H5), and one had no known animal exposure.Six new cases of zoonotic avian influenza A(H5) have been reported in the US. Five cases in California were linked to cattle exposure, while one case in Oregon involved exposure to infected poultry.
• Hawaii Case: On November 18, 2024, the USDA’s Animal and Plant Health Inspection Service (APHIS) confirmed highly pathogenic avian influenza (HPAI) in a non-commercial backyard flock in Honolulu County, Hawaii. This is the first case of HPAI in domestic birds in Hawaii since the outbreak began in February 2022.
• Oregon Case: Oregon has confirmed its first human case of bird flu, linked to a poultry flock outbreak in Clackamas County.
• Canada Case: On November 13, Canada reported its first domestically acquired human case of avian influenza A(H5N1).
• Virus Mutation: Scientists studying the genetic sequence of H5N1 from a British Columbia teenager case have identified mutations that may increase its ability to infect humans.
• Resources for Workers: The CDC’s "Toolbox Talk – Personal Protective Equipment for H5N1 Bird Flu" is available in English and Spanish to guide employers in discussing workplace hazards related to bird flu.

COVID -19

• Refer Monthly update (06 November 2024). Q3 vaccination data collection began on 15 October 2024.
• Please refer to the linksituation-reports where disaggregated data is available for download.
• The CDC recently reported a shift in COVID-19 variant proportions, with a decline in KP.3.1.1 from 57% to 52% over the past two weeks, while the recombinant XEC variant increased from 17% to 28%. Another variant, MC.1, also showed rising proportions. The CDC noted that MC.1 is a descendant of KP.3.1.1, and the updated vaccine is expected to be effective against emerging variants like XEC and MC.1.
• Global WHO Coronavirus (COVID-19) Dashboard 2024**.** Refer here

WHO is currently tracking several SARS-CoV-2 variants, including:

• Two variants of interest (VOIs): BA.2.86 and JN.1
• Variants under monitoring (VUMs): JN.1.7, JN.1.18, KP.2, KP.3, KP.3.1.1, LB.1, and XEC.
• As of September 24th, a new variant named XEC, which is a recombinant of KS.1.1 and KP.3.32, has been classified as a VUM.

Dengue

• Latest Dengue Situation Updates for the Western Pacific from PSSS weekly report here. Out of 21 Pacific Island Countries and Areas (PICs) who provided surveillance data, Fiji (200), Samoa (5), Solomon Islands (7) and Wallis & Futuna (1) reported dengue-like-illness (DLI) cases for the week.
• French Polynesia Dengue updates: In Week 45, 30 new dengue cases were reported, bringing the total to 272 since the outbreak began on November 27, 2023. Most cases were from Tahiti (9), Huahine (8), and Raiatea (5), with clusters active in Paofai and Pointe Venus, and a new cluster identified in Tuauru, Mahina. The predominant serotype is DENV-1 (66%), with DENV-2 accounting for 34%. Two short-term hospitalizations were recorded (ages 1 and 39), but no severe cases or deaths have been reported. Cases continue to rise in the Windward Islands, with a positivity rate reaching 30%, partly linked to recent inter-island travel. Young adults and children are the most affected, with a median age of 30 years. The outbreak remains in the alert phase due to increasing cases in Tahiti and spread to other islands. Source: Bulletin de surveillance sanitaire Polynésie française N° 45, 2024.Source: Bulletin de surveillance sanitaire Polynésie française N° 45, 2024.

Global events:

MPXV Clade I and Clade II

Global situation update based on available data:

Since 1 January 2022 to 31 October 2024, there have been 115,101 laboratory confirmed mpox cases and 2 probable cases including 255 deaths across 126 countries according to WHO data. Published on 21 November 2024.

• Cases of mpox caused by MPXV clade Ib have been reported outside Africa in several countries: Sweden and Thailand (August 2024), India (September 2024), Germany and the UK (October 2024), and the US (November 2024). Cases in Sweden, Thailand, Germany, the UK, and the US were linked to travel to Africa, while the case in India was associated with travel to the United Arab Emirates. Secondary transmission of mpox due to MPXV clade Ib outside Africa has been documented only in the UK.

Situation in Africa:

• Since January 1, 2022 to 17 November 2024, 15,000 laboratory-confirmed mpox cases and 77 deaths have been reported to WHO from 24 African countries.
• As of November 17, 2024, 19 countries reported 12,596 confirmed cases and 54 deaths in 2024. The three countries with the most cases in 2024 are Democratic Republic of the Congo (9,513 cases), Burundi (2,050 cases), Uganda (549 cases)
• In past six weeks, 2950 new cases have been confirmed, and 9 new deaths of mpox were reported from 24 countries: DRC (1249 and 5 deaths), Burundi (1063 and one death), Uganda (480 and 1 death), Nigeria (49), Cote d’lvoire (18), Central Africa Republic (22 and 1 death), Liberia (28), Rwanda (27), Kenya (5 and 1 death), Ghana (1) Zimbabwe (2), Angola (1), Mauritius (1) Zambia (1).
• The circulation of mpox clades across several African countries shows distinct patterns. Clade Ib is found in Burundi, Uganda, Rwanda, Kenya, Zimbabwe, Zambia and while Clade Ia is reported in the Central African Republic, Cameroon, Congo and Sudan. The Democratic Republic of the Congo (DRC) have a mix of both Clade Ia and Ib. Clade II (a and/or b) is more prevalent in West African nations such as Nigeria, Côte d’Ivoire, Liberia, south Africa, Morocco, Guinea, Benin, Egypt, and Mozambique, with Cameroon also reporting both Clade Ia and Clade II (a and/or b) according to the weekly report (November 17, 2024) WHO data.
• On 13 August 2024, Africa CDC declared mpox a Public Health Emergency of Continental Security, followed by WHO's declaration of the Clade I outbreak as a public health emergency of international concern on 14 August 2024.

Multi-country outbreak of cholera

• From January to October 2024, 486,760 cholera and acute watery diarrhea cases and 4,018 deaths were reported across 33 countries, with deaths increasing by 54% compared to 2023 despite fewer cases. Conflict, displacement, natural disasters, and climate change have exacerbated outbreaks, particularly in rural and flood-affected regions with poor infrastructure. Recent outbreaks were reported in Iraq, Lebanon, and South Sudan. While record production of Oral Cholera Vaccines (OCVs) was achieved in November, emergency stockpile levels remain critically low, with less than 600,000 doses available—far below the required five million—hindering effective outbreak responses. WHO report #20 - 20 November 2024

E. coli O121 Outbreak Linked to Organic Carrots

• On November 19,2024 CDC reported an E. coli O121 outbreak has sickened 39 people across 18 states, with one death and 15 hospitalizations. Grimmway Farms organic whole and baby carrots are suspected sources, leading to a recall of products sold between August 14 and November 12, 2024.Cases range from ages 1 to 75, with a median age of 29 years, and 71% are female.

Others

• “Investing in climate-resilient health facilities is not a luxury.