ÒÁÈËÖ±²¥

Global high consequence infectious disease events: summary November 2024

Interpreting this report

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

The report is divided into 2 sections covering all the defined HCID pathogens. The first section contains contact and airborne HCIDs that have been specified for the HCID programme by NHS England. The second section contains additional HCIDs that 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 potential HCID, 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 in HCID identification, 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 to negligible.

Incidents of significance of primaryÌýHCIDs

°ä´Ç²Ô³Ù²¹³¦³ÙÌýHCIDs

Crimean-Congo haemorrhagic fever (CCHF)

ÌýGeographical 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 ). Portugal reported its first human case in with symptom onset in July 2024.
ÌýSources 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
ÌýUKÌýexperience to dateÌýÌý	Two cases have been reported in individuals who have travelled to the UK from and .
ÌýRisk rating Ìý	Low – rarely reported in travellers.
ÌýRecent cases or outbreaksÌý	During November 2024, 31 new cases of CCHF and one associated death were reported in Afghanistan. Between 1 January and 30 November 2024, (case fatality rate (CFR) of 7.9%) were reported. On 27 November 2024, media reported that were registered in Senegal between 1 January and 27 November 2024, across 5 health districts. Ìý In Uganda, were registered between 1 January and 27 November 2024. 7 fatalities were reported among cases.

Ebola virus disease (EBOD)

ÌýGeographical risk areasÌý	Map of Ebola disease in Africa
ÌýSources and routes of infectionÌý	• 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
ÌýUKÌýexperience to date	Four confirmed cases (one lab-acquired in the UK in 1976, 3 healthcare workers associated with West African epidemic 2014 to 2015).Ìý
ÌýRisk ratingÌý	Very low – other than during the West Africa outbreak, exported cases are extremely rare.Ìý
ÌýRecent cases or outbreaksÌý	No confirmed or suspected human cases were reported in November 2024.

Lassa fever

ÌýGeographical risk areasÌý	Endemic in sub-Saharan West Africa.
ÌýSources 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
ÌýUKÌýexperience to dateÌý	. Prior to this, 8 imported Lassa fever cases had been reported since 1980, all in travellers from West Africa.
ÌýRisk ratingÌý	Low – overall, Lassa fever is the most common imported viral haemorrhagic fever (VHF) but importations to the UK are still rare.Ìý
ÌýRecent cases or outbreaks	Between 1 January and 24 November 2024, Nigeria reported (1,089 confirmed; 9,195 suspected; 17 probable). 179 deaths were reported amongst confirmed cases (CFR of 16.4%). This is a lower CFR compared to the same period in 2023 (17.1%). Confirmed cases were registered from 28 out of 36 states. 425 cases (46 confirmed) were reported during November 2024. In Liberia, between 1 January and 25 November 2024, (CFR of 29%) were registered across Liberia. In 2023, Liberia recorded 186 cases and 5 deaths.

Marburg virus disease (MARD)

ÌýGeographical risk areas	Sporadic outbreaks have previously been reported in Central and Eastern Africa. Outbreaks were reported for the first time in (in 2021), (in 2022), and (in 2023) and (in 2024). Ìý
ÌýSources and routes of infection	• exposure in mines or caves inhabited by Rousettus bat colonies • contact with infected human blood or body fluids
ÌýUKÌýexperience to date	ÌýNo reported cases in the UK.
ÌýRisk rating	Very low – globally, 5 travel-related exported MARD cases have previously been reported in the literature.
ÌýRecent cases or outbreaks	On 27 September 2024, Rwanda’s Ministry of Health declared . As of 29 November 2024, , were reported. On 9 November 2024, the reported that health officials in Rwanda had discharged the last MARD patient, starting the mandatory 42-day countdown to declaring the end of the outbreak.

´¡¾±°ù²ú´Ç°ù²Ô±ðÌýHCIDs

Avian influenza A(H7N9) virus

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

Avian influenza A(H5N1) virus

ÌýGeographical risk areas	Human cases have been predominantly reported in Southeast Asia, but also in Egypt, Iraq, Pakistan, Turkey and Nigeria. Since 2022, human cases of clade 2.3.4.4b have been reported in , the , and the UK, and . Since October 2023, 11 human cases of clade 2.3.2.1c have been reported in .
ÌýSources and routes of infection	• Close contact with infected animals (notably birds) or their environments • Close contact with infected humans is a theoretical risk although there is currently no evidence of any human-to-human transmission having occurred).
ÌýUKÌýexperience to date	Since December 2021, 7 detections were reported in the UK, , 4 in 2023, and one in 2024.
ÌýRisk rating	ÌýVery low (UKHSAÌýrisk assessment.
ÌýRecent cases or outbreaks	On 13 November 2024, the Public Health Agency of Canada (PHAC) reported a confirmed . This is the first domestically acquired human case of avian influenza A(H5N1) in Canada. Genomic sequencing indicates that to the avian influenza A(H5N1) viruses detected in the ongoing outbreak in poultry in British Columbia (clade 2.3.4.4b, genotype D.1.1). The case was detected via hospital-based influenza surveillance. In United States, were reported between April 2024 and 18 November 2024. Of these, 21 cases reported exposure to infected poultry, while 30 cases were exposed to infected dairy cattle and the source of exposure in one case could not be determined. Most cases have been reported in California.

Middle East respiratory syndrome (MERS-CoV)

ÌýGeographical risk areas	MERS has been concentrated in countries from the Arabian Peninsula, with the majority of cases having occurred in the Kingdom of Saudi Arabia. Other previously affected countries in the region include . MERS is transmitted from camels and has been detected in camels from the Arabian Peninsula and also parts of North, West and Eastern Africa.
ÌýSources and routes of infection	• Transmission through the air •Direct contact with contaminated environment • Direct contact with camels or consumption of raw camel milk • Working in or exposure to healthcare settings where outbreaks are occurring airborne particles
ÌýUKÌýexperience to date	– 3 imported cases (2012, 2013 and 2018), 2 secondary cases in close family members of the case in 2013, 3 deaths.
ÌýRisk rating	ÌýVery low (UKHSAÌýrisk assessment).Ìý
ÌýRecent cases or outbreaks	No confirmed or suspected human cases were reported in November 2024.

Mpox (Clade I only)

ÌýGeographical risk areas	including , and .
ÌýSources and routes of infection	• close contact with an infected animal (in an endemic country) or an infected person - including sexual contact • 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
ÌýUKÌýexperience to date	Five cases in total – 3 imported cases (2024) and 2 secondary cases in household members of a case from 2024.
ÌýRisk rating	ÌýThe importation risk of clade I mpox into the UK is considered . The risk of potential spread in the UK is considered low to medium. The risk of acquisition in the UK is considered low. Travel-associated cases of clade I mpox have been reported in , , , , and . Ìý
ÌýRecent cases or outbreaks	In endemic countries where clade I mpox is known to circulate, access to subclade specific PCR or sequencing may be limited. Therefore, we report below all reported mpox cases from these countries, regardless of whether the samples have undergone specific subclade testing. A comprehensive list of mpox clade I affected countries is available from the UKHSA. Burundi declared an mpox outbreak on . As of 25 November 2024, and one death have been reported from 45 out of 49 health districts. The Central African Republic (CAR) reported and 2 deaths (CFR of 2.7%) between 1 January and 25 November 2024. Cases were reported in 6 of the 7 health regions. 52.7% of cases were in children under 15-years-old. Between 1 January and 25 November 2024, the Democratic Republic of the Congo (DRC) reported . Among the most affected provinces are South Kivu (14,627 cases and 38 deaths), followed by Equateur (7,989 cases and 392 deaths). Kenya reported its first confirmed case of clade Ib mpox on . As of 30 November 2024, . Uganda first identified 2 confirmed cases of clade Ib mpox on . As of 24 November 2024, (CFR of 0.3%) have been reported. 48 districts have reported at least 1 confirmed mpox case. Most cases have been reported from Kampala (307 cases), Wakiso (102 cases) and Nakasongola (66 cases). Rwanda declared an outbreak of clade Ib mpox on . As of 24 November 2024, have been reported. Ìý During November 2024, 3 countries outside of the African region reported travel-associated cases of clade I mpox, including the United Kingdom, and the . The cases had a travel history to clade I mpox affected African countries.

Nipah virus

ÌýGeographical risk areas	South East Asia, predominantly in . Cases have also been reported in Malaysia and Singapore.
ÌýSources 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
ÌýUKÌýexperience to date	ÌýNo known cases in the UK.
ÌýRisk rating	Exceptionally low to negligible – no travel-related infections in the literature.Ìý
ÌýRecent cases or outbreaks	No confirmed cases of Nipah virus infection were reported in November 2024.

Pneumonic plague (Yersinia pestis)

ÌýGeographical risk areas	Predominantly . Endemic in Madagascar, Peru, andÌýthe DRC.
ÌýSources and routes of infection	• flea bitesÌý • close contact with infected animalsÌý • close contact with human cases of pneumonic plague
ÌýUKÌýexperience to date	Last outbreak in the UK was in 1918.
ÌýRisk rating	Exceptionally low to negligible
ÌýRecent cases or outbreaks	On 9 November 2024, media reported in Antananarivo province, Madagascar.

Severe acute respiratory syndrome (SARS)

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

Incidents of significance of additionalÌýHCIDs

Argentine haemorrhagic fever (Junin virus)

ÌýGeographical risk areas	(central). Endemic to the provinces of Buenos Aires, Córdoba, Santa Fe and La Pampa.
ÌýSources and routes of infection	• direct contact with infected rodentsÌý • inhalation of infectious rodent fluids and excretaÌý • person-to-person transmission has been documented
ÌýUKÌýexperience to date	ÌýNo known cases in the UK.
ÌýRisk rating	Exceptionally low to negligible – was identified in Belgium in 2020.
ÌýRecent cases or outbreaks	No confirmed or suspected human cases were reported in November 2024.

Bolivian haemorrhagic fever (Machupo virus)

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

Lujo virus disease

ÌýGeographical risk areas	A single case acquired in Zambia led to a cluster in South Africa in 2008.
ÌýSources and routes of infection	• presumed rodent contact (excreta, or materials contaminated with excreta of infected rodent)Ìý • person to person via body fluids
ÌýUKÌýexperience to date	No known cases in the UK.
ÌýRisk rating	Exceptionally low to negligible – a single travel-related case has been reported. No cases have been reported anywhere since 2008.
ÌýRecent cases or outbreaks	No cases have been reported anywhere since 2008.

Severe fever with thrombocytopenia syndrome (SFTS)

ÌýGeographical risk areas	Mainly reported from China (south-eastern), Japan and Korea. Cases have also been reported in , , and . Serological evidence of SFTS in .Ìý
ÌýSources 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
ÌýUKÌýexperience to date	No known cases in the UK.
ÌýRisk rating	Exceptionally low to negligible – not known to have occurred in travellers.
ÌýRecent cases or outbreaks	Between January and November 2024, the Korean Disease Control and Prevention Agency reported . This is a lower number of cases recorded during the equivalent 2023 period (198 cases).

Andes virus (Hantavirus)

ÌýGeographical risk areas	ÌýChile and Southern Argentina.Ìý
ÌýSources and routes of infection	• rodent contact (excreta, or materials contaminated with excreta from an infected rodent) • person-to-person transmission described in household and hospital contacts
ÌýUKÌýexperience to date	ÌýNo known cases in the UK.
ÌýRisk rating	ÌýVery low – rare cases in travellers have been reported.Ìý
ÌýRecent cases or outbreaks	On 8 November 2024, media reported a fatal case of hantavirus in a 66-year-old male in Tartagal, Salta province, Argentina. Between 1 January and November 2024, have been reported in Salta province. In Bolivia, between 1 January and 17 November 2024. The cases were recorded in Santa Cruz (8 cases), Tarija (5 cases), La Paz (4 cases) and Cochabamba (one case). The type of hantavirus is not specified for the above cases.

Avian influenza A(H5N6) virus

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

Avian influenza A(H7N7) virus

ÌýGeographical risk areas	Sporadic occurrence in birds across mainland Europe and the UK. in 1996, in 2003, and in 2013.
ÌýSources 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
ÌýUKÌýexperience to date	ÌýNo known cases in the UK.
ÌýRisk rating	ÌýVery low – human cases are rare, and severe disease even rarer.
ÌýRecent cases or outbreaks	No confirmed or suspected human cases were reported in November 2024.

Authors of this report

Emerging Infections and Zoonoses Team, UKHSA