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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.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
• 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 latest case reported in 2022).
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 date	Two cases have been reported in individuals who have travelled to the UK from and .
Risk rating	Low – rarely reported in travellers.
Recent cases or outbreaks	Between 1 January and 27 January 2024, the World Health Organization (WHO) reported from Afghanistan. In 2023, Afghanistan reported 1,243 suspected CCHF cases, including 114 deaths (case fatality rate of 9.2%).

Ebola virus disease (EVD)

Geographical risk areas	Map of countries which have reported EVD cases up to January 2023. No outbreaks of EVD have since been reported.
Sources and routes of infection	• 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 fluids
UKÌýexperience to date	Four confirmed cases (one lab-acquired in the UK in 1976, 3 healthcare workers associated with West African epidemic 2014 to 2015).
Risk rating	Very low – other than during the West Africa outbreak, exported cases are extremely rare.
Recent cases or outbreaksÌý	No confirmed or suspected human cases were reported in January 2024.

Lassa fever

Geographical risk areas	Endemic in sub-Saharan West Africa.
Sources and routes of infection	• 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 date	. Prior to this, had been reported since 1971, all in travellers from West Africa.
Risk rating	Low – overall, Lassa fever is the most common imported viral haemorrhagic fever (VHF) but importations to the UK are still rare.
Recent cases or outbreaks	Between 6 January 2022 and 7 December 2023, Liberia has reported a total of (case fatality rate of 29.9%). Between 1 January and 21 January 2024, Nigeria reported , with confirmed cases reported from 17 states. 43 deaths were reported among confirmed cases (case fatality rate of 20.4%). This is an increase in cases and deaths when compared to the equivalent 2023 period, when , including 39 deaths among confirmed cases, were reported.

Marburg virus disease (MVD)

Geographical risk areas	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 infection	• exposure in mines or caves inhabited by Rousettus bat colonies • contact with infected human blood or body fluids
UKÌýexperience to date	ÌýNo reported cases in the UK.
Risk rating	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 January 2024.

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Avian influenza A(H7N9) virus

Geographical risk areas	All reported human infections have been .	Ìý
Sources and routes of infection	• close contact with infected birds or their environmentsÌý • close contact with infected humans (no sustained human-to-human transmission)	Ìý
UKÌýexperience to date	No known cases in the UK.	Ìý
Risk rating	ÌýVery low (UKHSAÌýrisk assessment).	Ìý
Recent cases or outbreaks	No confirmed or suspected human cases were reported in January 2024.	Ìý

Avian influenza A(H5N1) virus

Geographical risk areas	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 infection	• close contact with infected birds or their environments • close contact with infected humans (no sustained human-to-human transmission)
UKÌýexperience to date	As of September 2023, 5 detections were reported in the UK, and 4 in 2023.
Risk rating	ÌýVery low (UKHSAÌýrisk assessment).
Recent cases or outbreaks	In January 2024, the Cambodian Ministry of Health reported 2 confirmed cases of avian influenza A(H5N1). The first case was a , reported on 26 January 2024. The second case, reported on 28 January 2024, was a , who required hospitalisation in intensive care. Both cases had exposure to sick or deceased poultry prior to symptom onset. After 9 years without reporting a case of avian influenza A(H5N1), were reported in Cambodia during 2023.

Middle East respiratory syndrome (MERS-CoV)

Geographical risk areas	The Arabian Peninsula – Yemen, Qatar, Oman, Bahrain, Kuwait, Saudi Arabia and UnitedÌýArabÌýEmirates.
Sources and routes of infection	• airborne particles • direct contact with contaminated environmentÌý • direct contact with camels or consumption of raw camel milk
UKÌýexperience to date	– 3 imported cases (2012, 2013 and 2018), 2 secondary cases in close family members of the case in 2013, 3 deaths.
Risk ratingÌý	ÌýVery low (UKHSAÌýrisk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in January 2024.

Mpox (clade I only)

Geographical risk areas	Central Africa including, .Ìý
Sources and routes of infection	• 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. Between 2018 and 2021, 7 cases of Clade II mpox were identified in the UK which would no longer be classified as HCID mpox, but were treated as HCID cases at the time: 4 of the cases were imported from Nigeria, 2 cases were household contacts and one case was a healthcare worker involved in the care of an imported case.
Risk rating	ÌýVery low – no known importations of clade I mpox into the UK.
Recent cases or outbreaks	Sequencing data is rarely available for mpox cases reported from endemic African countries where clade I MPXV is known to circulate. In the Central African Republic (CAR), were reported in Bangui on 8 January 2024. Between 1 January and 26 November 2023, the CAR reported . Between 20 September 2023 and 28 January 2024, media reported in the Kamituga health zone, South Kivu Province, DRC. During 2023, the DRC reported its highest annual number of mpox cases. National data suggests case numbers were during January 2024. In the Republic of the Congo, 100 mpox cases () and 5 deaths were reported from 7 provinces during 2023. During 2022, were reported in the Republic of the Congo.

Nipah virus

Geographical risk areas	South East Asia, predominantly in . Cases have also been reported in Malaysia and Singapore.
Sources and routes of infection	• direct or indirect exposure to infected bats • consumption of contaminated raw date palm sap • close contact with infected pigs or humans
UKÌýexperience to date	ÌýNo known cases in the UK.
Risk ratingÌý	Exceptionally low/negligible – no travel-related infections in the literature.
Recent cases or outbreaks	In January 2024, were confirmed from Dhaka division, Bangladesh. Both cases had consumed raw date palm sap prior to symptom onset. During 2023, Bangladesh reported .

Pneumonic plague (Yersinia pestis)

Geographical risk areas	Predominantly . Endemic in Madagascar, Peru, andÌýthe DRC.
Sources and routes of infection	• flea bitesÌý • close contact with infected animalsÌý • close contact with human cases of pneumonic plague
UKÌýexperience to date	Last outbreak in the UK was in 1918.
Risk rating	Exceptionally low/negligible
Recent cases or outbreaks	On 11 January 2024, media reported in Ambositra District, Madagascar.

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.
Risk rating	Exceptionally low/negligible
Recent cases or outbreaks	No confirmed or suspected human cases reported globally since 2004.

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 documented
UKÌýexperience to date	ÌýNo known cases in the UK.
Risk rating	Exceptionally low/negligible – was identified in Belgium in 2020.
Recent cases or outbreaks	On 2 January 2024, media reported in a 42 year old male in Santa Fe Province, Argentina. The case was reported to have worked in agricultural fields.

Bolivian haemorrhagic fever (Machupo virus)

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

Lujo virus disease

Geographical risk areas	A single case acquired in Zambia led to a cluster in South Africa in 2008.
Sources and routes of infection	• presumed rodent contact (excreta, or materials contaminated with excreta of infected rodent)Ìý • person to person via body fluids
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.
Recent cases or outbreaks	No confirmed or suspected human cases reported since 2008.

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 .
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 fluids
UKÌýexperience to date	No known cases in the UK.
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 January 2024.

Andes virus (Hantavirus)

Geographical risk areas	ÌýChile and southern Argentina.
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 contacts
UKÌýexperience to date	ÌýNo known cases in the UK.
Risk rating	ÌýVery low – rare cases in travellers have been reported.
Recent cases or outbreaks	During January 2024, media reported cases of hantavirus in Cardenal Caro (), Colchagua (one death), and Malleco () provinces, Chile. 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.
Sources and routes of infection	Close contact with infected birds or their environments.
UKÌýexperience to date	ÌýNo known cases in the UK.
Risk rating	Very low – not known to have occurred in travellers (UKHSAÌýrisk assessment).
Recent cases or outbreaks	On 16 January 2024, the Hong Kong Centre for Health Protection reported a . The case, a 59 year old female living in Ziyang City, Sichuan Province, developed symptoms on 25 November and was hospitalised on 29 November 2023. She had visited a live poultry market prior to symptom onset. From 2014 to 16 January 2024, have been reported by mainland China health authorities.

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)
UKÌýexperience to date	ÌýNo known cases in the UK.
Risk rating	ÌýVery low – human cases are rare, and severe disease even rarer.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in January 2024.

Authors of this report

Emerging Infections and Zoonoses Team, UKHSA