Research and analysis

Infectious disease surveillance and monitoring for animal and human health: summary March 2022

Updated 25 April 2024

Summary of notable incidents of public health significance: March 2022

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 which focusses on Novel pathogens and diseases.

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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

Coronavirus (COVID-19): global update

Event summary	By the end of March 2022, the World Health Organization (WHO) had reported over 485 million COVID-19 cases and nearly 6.1 million deaths globally. A total of 10.9 billion vaccine doses had been administered globally as of 30 March 2022.
Other updates	In March 2022, the International Rescue Committee highlighted global COVID-19 vaccine inequality. Many countries at risk of experiencing deteriorating humanitarian crises in 2022 have very low vaccination levels. For example, at the time of reporting, 0.8% of the population were vaccinated in the Democratic Republic of the Congo (DRC), 1% in Haiti and 2% in Yemen.
Incident assessment	No change – update does not alter current assessment of public health implications
Further information	• WHO’s global weekly epidemiological updates • The European Centre for Disease Prevention’s (ECDC) weekly surveillance summary for European countries • UKHSA’s national COVID-19 surveillance reports

Extensively drug-resistant (XDR) Shigella sonnei, Europe

Event summary

A recent increase in cases of XDR Shigella sonnei infections has been observed in the UK. Between 4 September 2021 and 1 March 2022, 84 cases of XDR S. sonnei were reported. In the 17 months prior to this period (1 April 2020 to 31 August 2021), only 16 cases of S. sonnei were reported, none of which were XDR. Investigations found that the most common route of transmission was direct, person-to-person transmission including sexual transmission between men who have sex with men. Cases of XDR S. sonnei have been reported in 9 other European countries, as of 17 March 2022, including Austria, Belgium, Denmark, France, Germany, Ireland, Italy, Norway and Spain. Health authorities are undertaking investigations into transmission routes and genomic linkage between cases. The increase in XDR S. sonnei cases is concerning as treatment options for infected individuals are limited. WHO assesses the likelihood of spread of XDR S. sonnei from the UK to other countries as high, based on the limited information currently available. Globally, shigellosis is a major cause of bloody diarrhoea; introduction of XDR S. sonnei to countries with sub-optimal water, sanitation and hygiene standards would be particularly concerning due to the risk of a diarrhoeal disease outbreak.

Incident assessment

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

Polio: global update

Wild polio virus type 1 (WPV1)	No cases of WPV1 were reported to the Global Polio Eradication Initiative (GPEI) during March 2022. So far, one case with symptom onset in 2022 has been reported from Afghanistan. In total, 6 confirmed cases of WPV1 have been identified with symptom onset in 2021: 4 in Afghanistan, 1 in Pakistan and 1 in Malawi.
Circulating vaccine-derived polio virus (cVDPV)	As of 30 March, one case of acute flaccid paralysis (AFP) cVDPV type 1 has been reported globally. The case was in Madagascar and had a symptom onset in January. In total, 16 cases have been reported with symptom onset in 2021: 13 in Madagascar and 3 in Yemen. In total, 18 AFP cases of cVDPV type 2 have been reported with symptom onset in 2022, as of 30 March: 9 in the DRC, 8 in Nigeria and 1 in Somalia. In March 2022, a case of cVDPV type 3 was confirmed in Israel in an unvaccinated child who had developed AFP. This is the first case of polio virus to be reported in Israel since 1988. Testing found genetic links to strains detected in environmental samples from Jerusalem and Bethlehem taken between September 2021 and January 2022. As of 31 March, the Ministry of Health of Israel has reported 7 children with positive cultures (6 symptomatic children and 1 asymptomatic child) and 1 suspected case with cultures pending. 18,197 vaccines have been administered in response to the outbreak. Testing of sewage systems throughout Israel is underway. GPEI notes that the situation also poses a risk to unvaccinated children in the occupied Palestinian territory due to proximity to Israel.
Other updates	Malawi launched the first round of a polio vaccination campaign against WPV1 in March, targeting more than 23 million children under 5 years of age. Vaccination campaigns are also planned in the neighbouring countries of Mozambique, Tanzania, Zambia and Zimbabwe. The response follows the confirmation of a WPV1 case in Lilongwe district, Malawi, in February 2022, who originally developed AFP in November 2021. This was the first case of wild polio virus to be reported in Malawi since 1992.
Incident assessment	No change – update does not alter current assessment of public health implications

Yellow fever: Kenya

Event summary

The Kenya Ministry of Health declared an outbreak of yellow fever in Isiolo county, central Kenya, on 4 March 2022. Between 12 January and 15 March 2022, 53 cases, including 6 deaths, were reported. Two of the cases were confirmed by the Kenya Medical Research Institute. Additional laboratory testing is underway. Within Isiolo county, the highest numbers of cases were reported from Chari (21 cases) and Cherab (14 cases) wards. In response to the outbreak, a rapid response team has been deployed to Isiolo county and surrounding areas. Yellow fever cases have never previously been reported in Isiolo county. The last yellow fever outbreak to be reported in Kenya was in 2011. Although endemic in Kenya, yellow fever is not included as part of the national routine immunisation programme in all counties. The vaccination status of the cases is not known. Nationally, the estimated vaccination coverage is 7%, which is well below the 80% recommended to confer herd immunity. WHO assesses the outbreak as high risk at the national and regional levels, given that Isiolo country and surrounding areas frequently see large population movements.

Incident assessment

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

Other incidents of interest

Infectious disease	Event summary
Anthrax	In Russia, during March 2022, media reported a suspected case of anthrax in Karabudakhkent district in a person with likely exposure during the slaughter of cattle. District authorities introduced quarantine measures on the village of Kakashur, where the case resides. Six other individuals were reported to be at risk of exposure.
Avian influenza A(H5N6)	In China, 3 new cases of avian influenza A(H5N6) were reported during March 2022. The cases were residents in Guangxi Province (2 cases) and Jiangxi Province (1 case). All cases had exposure to poultry. From 2014 to the end of March 2022, 74 human cases of avian influenza A(H5N6) had been reported in China, 17 of which were reported in 2022.
Bubonic plague	In the DRC, media reported 25 cases (including 2 deaths) of bubonic plague in Rethy health zone, Ituri Province, in 2022, as of the end of March. Of these cases, 22 were children. Contacts were provided with chemoprophylaxis. Plague is endemic in the Rethy health zone. Prior to this outbreak, the WHO regional office for Africa had reported 600 cases of plague and 45 deaths in the DRC between March 2019 and 6 March 2022, with only one of these cases being reported in 2022.
Cholera	Cameroon reported 3,239 suspected and 168 confirmed cholera cases between 29 October 2021 and 27 March 2022. There have been 83 deaths, equating to an overall case fatality rate of 2.4%. Case numbers continue to increase. At least 531 samples have been tested and 168 cultures were positive. Vibrio cholerae O1 Ogawa was the dominant strain identified. There are currently 5 regions with active cholera outbreaks including the Centre, Littoral, South, South-West, and North regions. WHO has reported healthcare system and security challenges, as well as a high population movement of internally displaced people, which is impacting the outbreak. The DRC has reported 4,565 cases of cholera, including 60 deaths (case fatality rate of 1.3%) across 10 provinces during 2022, as of 27 March. This is an increase compared to the same period of the previous year, when 1,989 suspected cases were reported.
Crimean-Congo haemorrhagic fever (CCHF)	In Mauritania, a CCHF outbreak, first reported in February 2022, continues. One additional case was reported in March, bringing the total number of cases as of 14 March to 6, including 2 deaths (case fatality rate of 33.3%). Cases have been identified in 3 different regions (Hodh El Gharbi Waliya, Trarza Waliya, and South-Nouakchott Waliya). There are no known epidemiological links between the cases. WHO notes that the outbreak appears to be under control as only 6 cases have been reported over a 6-week period. The UK reported a case of CCHF on 25 March 2022 in an individual who had recently travelled to Central Asia. However, this case was not confirmed as CCHF on follow-up samples. Prior to this, 2 cases of CCHF had been reported in the UK in individuals who had travelled from Afghanistan in 2012 and Bulgaria in 2014.
Dengue	In India, Delhi continues to report an unusually high number of dengue cases for the time of year. In total, 61 cases have been reported so far in 2022, as of the end of March. In comparison, the number of cases reported in the same time period in previous years was lower: 7 cases in 2021, 6 cases in 2020 and 6 cases in 2019. Usually, the highest number of dengue cases are reported between July and November in India.
Hantavirus	Chile’s Ministry of Health reported a case of hantavirus in the region of Ñuble during March 2022. This case brings the total number of hantavirus cases reported in the country in 2022 to 5, with 3 deaths. The type of hantavirus was not specified.
Japanese encephalitis	Australia declared a Japanese encephalitis outbreak as a Communicable Disease Incident of National Significance, on 4 March 2022. As of 31 March, 34 cases of Japanese encephalitis, including 3 deaths, had been reported. The state of New South Wales had reported the most cases (10 confirmed and 1 probable). The outbreak represents geographical spread of the Japanese encephalitis virus as, prior to this year, New South Wales had not previously identified locally acquired cases in either humans or animals. In response to the outbreak, a national working group has been established which will support the roll-out of vaccines and mosquito surveillance and control measures.
Lassa fever	In Nigeria, since the start of 2022 and as of 27 March, 3,542 suspected and 681 confirmed cases have been reported. There have been 127 deaths amongst confirmed cases, resulting in a case fatality rate of 18.6%. The number of confirmed cases being reported weekly has been declining since a peak in February 2022. However, the number of cases reported so far in 2022 remains higher than during the same period in 2021 (1,430 suspected cases, 230 confirmed cases and 49 deaths). Liberia has reported 24 suspected and 17 confirmed cases of Lassa fever between 1 January and 6 March 2022. A total of 7 deaths were reported, equating to an overall case fatality rate of 17.1%. Three of Liberia’s 15 counties are currently affected by the outbreak: Bong, Grand Bassa and Nimba. Lassa fever is endemic in Liberia. In 2021, between 1 January and 21 November, 112 suspected and 24 confirmed cases were reported, including 15 deaths. Sierra Leone has reported 4 cases of Lassa fever in 2022, as of 20 March. Between 2016 and 2020, the number of cases reported in Sierra Leone decreased. However, a subsequent increase was observed in 2021, when 16 cases were reported (compared to 8 in 2020).
Measles	Afghanistan has been experiencing a measles outbreak since October 2021. Between 1 January and 5 March 2022, 46,237 cases and 232 deaths have been reported. The number of cases reported has continued to increase sharply since the end of 2021. The provinces of Helmand, Kabul, Kunduz, Kandahar and Nangarhar are the most affected. A measles vaccination campaign took place from 12 to 18 March, vaccinating more than 1.2 million children. The DRC continues to report measles cases, with 31,826 suspected cases between 1 January and 27 March 2022. A total of 563 deaths were reported, equating to a case fatality rate among suspected cases of 1.8%. Case numbers are higher than in 2021, when 16,258 suspected cases and 222 deaths were reported during the same time period. A responsive vaccination campaign is planned in 64 health zones from mid-April. Guinea continues to report measles cases, most notably from the Conakry region (82% of cases), although all 8 regions of the country have reported cases. As of 13 March, 10,811 suspected cases had been reported. There have been 16 deaths, resulting in a case fatality rate among suspected cases of 0.14%. The week ending 6 March 2022 saw the largest number of cases reported since the start of the year (1,636 suspected cases). Vaccination rates in Guinea are lower than the 95% target recommended to confer herd immunity. WHO also highlighted challenges in diagnosing measles cases due to insufficient transportation of biological samples to laboratories for analysis.
Meningitis	Ethiopia has been experiencing an outbreak of meningitis since December 2021. A total of 1,398 suspected cases have been reported, as of 13 March. There have been 13 deaths, equating to a case fatality rate among suspected cases of 0.9%. Out of Ethiopia’s 12 regions, 11 are affected, with the region Oromia reporting the most cases (610 cases). Testing of 14 cerebrospinal fluid samples found 2 samples positive for herpesvirus and one for Neisseria meningitidis. WHO has emphasised the importance of further sample analysis in order to establish the dominant pathogen and therefore provide appropriate vaccines.
Middle East respiratory syndrome (MERS)	In Qatar, the Ministry of Public Health reported a case of MERS on 22 March 2022. The case is reported to have had direct contact with camels. None of the case’s contacts reported any related symptoms. This is the first case reported in Qatar since February 2020; 24 cases have been reported in Qatar since 2014.
Monkeypox	The Central African Republic (CAR) reported 4 cases of monkeypox in March 2022 in the health districts of Mbaïki and Bimbo, including 2 deaths. Monkeypox cases are sporadically reported in the CAR, with 61 cases reported between 2010 and 2019. The DRC has reported 704 cases of monkeypox in 2022, as of 6 March, with 37 deaths recorded (case fatality rate of 5.3%). In comparison, 754 cases and 24 deaths (case fatality rate of 3.2%) were reported during the same time period in 2021.
Yellow fever	Uganda‘s Ministry of Health declared a yellow fever outbreak on 6 March 2022, when 4 confirmed cases were reported in the south of the country. A total of 8 cases were confirmed as of 16 March. Although Uganda is classed as high-risk in the ‘Eliminate Yellow Fever Epidemics’ Strategy, yellow fever is not part of the routine immunisation program. A preventative vaccination campaign is planned for specific districts.

Publications of interest

Infectious disease	Publication summary
Ebola virus disease (EVD)	In a study published during March, EVD-specific antibody treatments (ansuvimab and REGN-EB3) were evaluated in 32 patients during the EVD outbreak in the DRC which occurred from June to November 2020. The proportion of patients that died was lower in the group that received the treatments than the group that did not receive any EVD-specific treatment. A serology survey of healthcare workers in the Mbandaka Health Region of the DRC found that community health workers were more likely to have EVD antibodies than healthcare workers with direct patient contact, such as nurses. The authors suggest that this may be due to workers in these positions having less occupational training and access to personal protective equipment.
Influenza	Researchers pooled data from 707 human cases of variant influenza viruses (H1N1v, H1N2v and H3N2v) identified globally between 1959 and 2021 and found that cases generally had mild disease. The average number of people infected by a human case was estimated to be low (upper limit of effective reproduction number: 0.09).
Lassa fever	A systematic review examining pre-clinical data and human pharmacokinetic data found that the clinical evidence for ribavirin as a treatment for Lassa fever was limited. The authors state that there is a possibility that the current ribavirin regimens in clinical use are unlikely to reliably achieve serum concentrations required to inhibit Lassa virus replication.
Meningitis	Researchers developed a model to analyse meningococcal infection dynamics during the Hajj pilgrimage, an annual mass gathering event, in Saudi Arabia between 1995 and 2011. The event was estimated to increase transmission by 78-fold, impacting both the local population and pilgrims. Hajj is reported to have had a limited impact on transmission in the pilgrims’ countries of origin, and vaccination was shown to be effective in reducing outbreaks.
Nipah virus	There are currently no approved vaccines for Nipah virus. In a study published during March, researchers vaccinated 9 African green monkeys with a vaccine targeting the Bangladesh strain of Nipah virus. All vaccinated monkeys survived a lethal challenge of Nipah virus when vaccinated 7 days prior to exposure, while 67% of animals survived when vaccinated 3 days prior. During March, a study documented the public health response to a confirmed human case of Nipah virus first identified during August 2021 in Kerala state, India. Contact screening and the establishment of a Nipah virus diagnostic facility contributed to the rapid containment of the outbreak, with no further cases identified. Genomic sequencing of the virus indicated 99.6% nucleotide similarity to sequences obtained from the 2018 Nipah outbreak of the Indian (‘I’) genotype. Nipah virus RNA was not detected in samples tested from bats analysed as part of the study, but Nipah virus antibodies were detected in 21% of Pteropus medius and 38% of Rousettus leschenaultia bats species captured from areas close to the residence of the index case.
Omsk haemorrhagic fever	During March, researchers published a study that investigated the geographical expansion of Omsk haemorrhagic fever virus into Kazakhstan, which had previously only been detected in Western Siberia in Russia (1,600km away). Of 130 patients with meningitis of unknown cause in Kazakhstan, 2 were positive for Omsk haemorrhagic fever virus and 1.1% of samples taken from rodents trapped in the area were positive for the virus.
West Nile virus	In New York State, US, a substantial increase in the prevalence of West Nile virus in mosquitoes was found between 2010 and 2018. The NY10 West Nile virus strain was first detected in 2010 and has since become the dominant genotype. Experimental infection of birds and mosquitoes in the study supported the association of NY10 with increased infectivity and transmissibility.

Novel pathogens and diseases

Agent or pathogen	Event summary
Alpha and beta coronaviruses	In Argentina, stool and pharyngeal samples from bats in Jujuy and La Pampa provinces demonstrated the presence of novel alphacoronaviruses. Virological surveillance in Malaysia found that 40% of the bat population sampled from Wind Cave Nature Reserve, Sarawak, were positive for novel alpha and beta bat-coronaviruses.