Research and analysis

Global high consequence infectious disease events: summary September 2023

Updated 15 May 2025

Interpreting this report

The report provides updates on known, high-consequence infectious disease (HCID) events around the world as monitored by the UK Health Security Agency바카라 사이트™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. Past 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 primary HCIDs

Contact HCIDs

Crimean-Congo haemorrhagic fever (CCHF)

Geographical risk areas	. 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	바카라 사이트¢ bite from, or crushing of, an infected tick 바카라 사이트¢ contact with the blood, tissues or body fluids of infected humans or animals
UK experience to date	Two cases have been reported in individuals who have travelled to the UK from and
Risk rating	Low 바카라 사이트“ rarely reported in travellers.
Recent cases or outbreaks	Between 1 January and 30 September 2023, a total of (case fatality rate (CFR) of 9.4%) were reported in Afghanistan by the World Health Organization (WHO). Most fatal cases were reported from Kabul (48 deaths) and Balkh (15 deaths) provinces. In 2022, , including 15 deaths. In Iraq, between 1 January and 10 September 2023 (latest available data), , were reported nationally. On 24 September 2023, had been registered in the week prior.  On 9 September 2023, in a 23-year-old female from Assaba Region. This is the second confirmed CCHF case reported in Mauritania so far in 2023. In September 2023, . As of 30 September 2023, 5 confirmed cases, including 1 death, have been reported in 2023 (one each from Dakar, Gossas, Fatick, Louga and Yeumbeul regions).

Ebola virus disease (EVD)

Geographical risk areas	Map of countries which have reported EVD cases up to January 2023.
Sources and routes of infection	바카라 사이트¢ contact with blood, tissues or body fluids of infected animals, or consumption of raw or undercooked infected animal tissue 바카라 사이트¢ contact with infected human blood or body fluids
UK experience 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 바카라 사이트“ other than during the West Africa outbreak, exported cases are extremely rare.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

Lassa fever

Geographical risk areas	Endemic in sub-Saharan West Africa.
Sources and routes of infection	바카라 사이트¢ contact with excreta, or materials contaminated with excreta from an infected rodent 바카라 사이트¢ inhalation of aerosols of excreta from an infected rodent 바카라 사이트¢ contact with infected human blood or body fluids
UK experience to date	. Prior to this, had been reported since 1971, all in travellers from West Africa.
Risk rating	Low 바카라 사이트“ overall, Lassa fever is the most common imported viral haemorrhagic fever (VHF) but importations to the UK are still rare.
Recent cases or outbreaks	On 6 September 2023, , were detected at Boko hospital, Borgou department, Benin. In Liberia, from 6 January 2022 to 21 September 2023, a total of were reported nationally. This is an increase of one case and death since the last report. Between 1 January and 17 September 2023, reported Lassa fever cases. Among confirmed cases, 181 deaths have been reported (CFR of 16.9%). The number of confirmed cases and deaths reported in 2023 is higher compared to the equivalent 2022 period (857 cases including 169 deaths; CFR of 19.1%), while the CFR remains lower.

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	바카라 사이트¢ exposure in mines or caves inhabited by Rousettus bat colonies 바카라 사이트¢ contact with infected human blood or body fluids
UK experience to date	No reported cases in the UK.
Risk rating	Very low 바카라 사이트“ globally, 5 travel-related exported MVD cases have previously been reported in the literature.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

Airborne HCIDs

Avian influenza A(H7N9) virus

Geographical risk areas	All reported human infections have been .
Sources and routes of infection	바카라 사이트¢ close contact with infected birds or their environments 바카라 사이트¢ close contact with infected humans (no sustained human-to-human transmission)
UK experience to date	No known cases in the UK.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

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	바카라 사이트¢ close contact with infected birds or their environments 바카라 사이트¢ close contact with infected humans (no sustained human-to-human transmission)
UK experience to date	As of September 2023, 5 detections were reported in the UK, and 4 in 2023.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

Middle East respiratory syndrome (MERS-CoV)

Geographical risk areas	The Arabian Peninsula 바카라 사이트“ Yemen, Qatar, Oman, Bahrain, Kuwait, Saudi Arabia and United Arab Emirates.
Sources and routes of infection	바카라 사이트¢ airborne particles 바카라 사이트¢ direct contact with contaminated environment 바카라 사이트¢ direct contact with camels or consumption of raw camel milk
UK experience to date	바카라 사이트“ 3 imported cases (2012, 2013 and 2018), 2 secondary cases in close family members of the case in 2013, 3 deaths.
Risk rating	Very low (UKHSA risk assessment).
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

Mpox (Clade I only)

Geographical risk areas	Central Africa including, .
Sources and routes of infection	바카라 사이트¢ close contact with an infected animal (in an endemic country) or an infected person 바카라 사이트¢ contact with clothing or linens (such as bedding or towels) used by an infected person 바카라 사이트¢ direct contact with mpox skin lesions or scabs 바카라 사이트¢ coughing or sneezing of an individual with an mpox rash 바카라 사이트¢ consumption of contaminated bushmeat
UK experience to date	In June 2022, the Advisory Committee on Dangerous Pathogens (ACDP) recommended that the strain of monkeypox virus (MPXV) largely responsible for the global outbreak (Clade IIb, B.1 lineage) should no longer be classified as an HCID. In January 2023, the ACDP recommended that all Clade II MPXV should no longer be classified as an HCID. No cases of Clade I mpox have been reported in the UK. Between 2018 and 2021, 7 cases of 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	Very low 바카라 사이트“ 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 September 2023, were reported from the Republic of the Congo, bringing the total number of cases to 12 reported by WHO from this country in 2023. In the DRC, were reported in September 2023, bringing the total number of confirmed cases reported since the start of 2023 to 610, including 2 deaths.

Nipah virus

Geographical risk areas	South East Asia, predominantly in . Cases have also been reported in Malaysia and Singapore.
Sources and routes of infection	바카라 사이트¢ direct or indirect exposure to infected bats 바카라 사이트¢ consumption of contaminated raw date palm sap 바카라 사이트¢ close contact with infected pigs or humans
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low/negligible 바카라 사이트“ no travel-related infections in the literature.
Recent cases or outbreaks	Between 12 and 15 September 2023, , including 2 deaths, in Kozhikode district, Kerala. The last confirmed case was reported on 15 September 2023. As of 27 September 2023, 1,288 contacts of the confirmed cases had been traced, with no new cases identified. This is the sixth outbreak of Nipah virus in India since 2001.

Pneumonic plague (Yersinia pestis)

Geographical risk areas	Predominantly . Endemic in Madagascar, Peru, and the DRC.
Sources and routes of infection	바카라 사이트¢ flea bites 바카라 사이트¢ close contact with infected animals 바카라 사이트¢ close contact with human cases of pneumonic plague
UK experience to date	Last outbreak in the UK was in 1918.
Risk rating	Exceptionally low/negligible 바카라 사이트“ no known current outbreaks globally.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

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	바카라 사이트¢ airborne particles 바카라 사이트¢ direct contact with contaminated environment
UK experience to date	related to the 2002 outbreak.
Risk rating	Exceptionally low/negligible 바카라 사이트“ no cases have been reported internationally since 2004.
Recent cases or outbreaks	No confirmed or suspected human cases reported globally since 2004.

Incidents of significance of additional HCIDs

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	바카라 사이트¢ direct contact with infected rodents 바카라 사이트¢ inhalation of infectious rodent fluids and excreta 바카라 사이트¢ person-to-person transmission has been documented
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low/negligible 바카라 사이트“ was identified in Belgium in 2020.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

Bolivian haemorrhagic fever (Machupo virus)

Geographical risk areas	Bolivia 바카라 사이트“ (Mamoré, Iténez and Yucuma provinces) and Cochabamba (Cercado province).
Sources and routes of infection	바카라 사이트¢ direct contact with infected rodents 바카라 사이트¢ inhalation of infectious rodent fluids and excreta 바카라 사이트¢ person-to-person transmission has been documented
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low/negligible 바카라 사이트“ travel-related cases have never been reported.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

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	바카라 사이트¢ presumed rodent contact (excreta, or materials contaminated with excreta of infected rodent) 바카라 사이트¢ person to person via body fluids
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low/negligible 바카라 사이트“ 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	바카라 사이트¢ presumed to be tick exposure 바카라 사이트¢ person-to-person transmission described in household and hospital contacts, via contact with blood or bloodstained body fluids
UK experience to date	No known cases in the UK.
Risk rating	Exceptionally low/negligible 바카라 사이트“ not known to have occurred in travellers.
Recent cases or outbreaks	On 20 September 2023, media reported that between 1 January and 20 September 2023, . During the equivalent 2022 period, 129 cases and 22 deaths were reported.

Andes virus (Hantavirus)

Geographical risk areas	Chile and southern Argentina.
Sources and routes of infection	바카라 사이트¢ rodent contact (excreta, or materials contaminated with excreta from an infected rodent) 바카라 사이트¢ person-to-person transmission described in household and hospital contacts
UK experience to date	No known cases in the UK.
Risk rating	Very low 바카라 사이트“ rare cases in travellers have been reported.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

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.
UK experience to date	No known cases in the UK.
Risk rating	Very low 바카라 사이트“ not known to have occurred in travellers (UKHSA risk assessment).
Recent cases or outbreaks	In China, was reported in Chongqing Municipality during September 2023. The case was a 68-year-old male living in Chongqing, Sichuan Province, who had exposure to live domestic poultry before the onset of symptoms on 5 August 2023. From 2014 to 28 September 2023, were 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	바카라 사이트¢ close contact with infected birds or their environments 바카라 사이트¢ close contact with infected humans (no sustained human-to-human transmission reported)
UK experience to date	No known cases in the UK.
Risk rating	Very low 바카라 사이트“ human cases are rare, and severe disease even rarer.
Recent cases or outbreaks	No confirmed or suspected human cases were reported in September 2023.

Authors of this report

Emerging Infections and Zoonoses Team, UKHSA