Army Public Health Weekly Update, 30 July 2021

Date Published: 7/30/2021
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​The Army Public Health Update is a collection of articles taken from public sources to offer awareness of current health issues and the media coverage given to them. The articles do not necessarily represent U.S. Army Medical Command opinions, views, policy, or guidance, and should not be construed or interpreted as being endorsed by the U.S. Army Medical Command.

The Army Public Health Weekly Update does not analyze the information as to its strategic or tactical impact on the U.S. Army and is not a medical intelligence product. Medical intelligence is available from the National Center for Medical Intelligence External Link .

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Table of Contents


    Interim Public Health Recommendations for Fully Vaccinated People- Summary of recent changes

    Updates as of July 27th, 2021:

    - Updated information for fully vaccinated people given new evidence on the B.1.617.2 (Delta) variant currently circulating in the United States.

    - Added a recommendation for fully vaccinated people to wear a mask in public indoor settings in areas of substantial or high transmission.

    - Added information that fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated.

    - Added a recommendation for fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.

    - CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status. CDC External Link


    Austin calls on service members to stop stigmatizing mental health help

    24 July- After a briefing from leaders about the spike in suicides among service members in Alaska, Secretary of Defense Lloyd J. Austin III said today he's concerned about the number of suicides there and across the force. "I'm deeply concerned about the suicide rates, not only here but across the force," he said during a press conference at Eielson Air Force Base, Alaska. "One loss by suicide is too many. While we're working hard on this problem, we have a lot more to do." Addressing the problem must start with reducing the stigma associated with seeking help for mental health issues, he said. "Mental health is health, period," Austin said. The secretary said the Defense Department must approach the suicide issue with the same energy applied to any other health issue. Getting help to those suffering from mental health issues must be done with compassion and professionalism, not stigma, he said. "So, if you're hurting, there are resources available," Austin said. "And I know that our leaders here are committed to making those resources even more accessible and available." From Day 1 in his tenure at the helm of the DOD, Austin has said that his first priority is to defend the nation. "But key to achieving it is taking care of our people," he said. "One of my messages to the men and women that I spoke with today is we need to look out for one another, and I promised I would be looking out after them." External Link 

    DoD dragged its feet on toxic chemical exposure prevention and clean-up, IG finds

    27 July- Back in 2011, the Defense Department's Emerging Chemical Program issued a "risk alert" detailing the hazards of per- and polyfluoroalkyl substances, known collectively as PFAS, found in aqueous film-forming foam used to fight vehicle and aircraft fires. Then nothing happened. Due to a tricky bit of bureaucracy, that risk alert had no muscle behind it, because it wasn't endorsed by the Pentagon's Emerging Chemicals of Concern Governance Council, according to an inspector general report released Friday. In short, they could put out the alert, but there was no accompanying instruction to allow them to do anything about it. "Therefore, DoD officials were not required to plan, program, and budget for any actions in response to the 2011 risk alert," according to the IG report. "EC Program officials did not require proactive risk management actions for PFAS‑containing AFFF until 2016." The report comes two years after dozens of lawmakers requested a DoD IG review of the use of PFAS on installations and exposure to those living on and around them. The IG announced the evaluation in early 2020. DoD has been aware of the risks of PFAS for decades, including their tendency to build up in the body over time, as well as their links to cancer. In addition to testing drinking water and installing filtering systems on installations, the military limits the use of aqueous film-forming foam to active firefighting situations. But for much of the 20th century it was also used in training, causing decades of build-up in ground water. "This Inspector General's report confirms that the Defense Department must urgently do more to protect service members and their families from PFAS chemicals," Dan Kildee (D-Mich.), co-chair of the Congressional PFAS Task Force, said in a Tuesday release from the Environmental Working Group. "Due to the Defense Department's use of firefighting foam containing PFAS chemicals, many service members, military firefighters and their families are still at risk of exposure." Military Times External Link

    Many Soldiers still aren't vaccinated; What's the Army's plan?

    24 July- Thousands of soldiers are still not vaccinated against COVID-19, and Army leaders are moving to educate the unvaccinated as the deadly Delta variant sweeps through the country. Col. Owen Price, the Fort Bragg Force Health Protection officer, said vaccine hesitancy mostly spurs from health concerns and latching onto misinformation mostly found on social media. "There's two camps," Price told in an interview. "One is they just haven't heard the message that resonates with them to overcome hesitancy. Whether that concerns pregnancy or side effects, long-term health effects are a big concern for some. The other camp is people who have just received a ton of misinformation, and it's very hard to unseat that even when providing them facts." Price said soldiers who have come to recent education sessions on the vaccine are misinformed about it. He said in his experience, soldiers are usually not pedaling conspiracy theories surrounding the virus, but some have leaned on random, faulty information from social media, versus the science, and they are coming with concerns from a health conscious point of view. He said the key now is talking to soldiers individually and addressing their concerns respectfully. "This has been an uptick recently, with soldiers coming to education sessions with a list they found online -- with ingredients such as metals and plastics, which aren't in the vaccine at all," Price said. "One soldier had an outlandish figure of people that have died from the vaccine but couldn't explain where they got that information from. There's crazy stuff out there." But some soldiers have health concerns, even if experts say the research doesn't back up those fears. Pvt. Abegail Finck, who is stationed at Fort Campbell, Kentucky, has a family history of an autoimmune disease she's afraid the vaccine could inflame. She is also pregnant and concerned whether the vaccines could harm her or her baby. "For me, I'll keep wearing the mask to work," she said. " This being my first child, I didn't want to risk anything." The Centers for Disease Control and Prevention say the vaccines are safe for pregnant women and recommend meeting with a health-care provider to go over concerns. External Link

    Shocking spike in suicides among US troops

    27 July- Since suicide rates in the military peaked in 2012, the last three years have been the worst consecutive years of active service member suicide. Now, the defense secretary says it's way past time to stop stigmatizing mental health.  "I'm deeply concerned about the suicide rates, not only here but across the force," Secretary of Defense Lloyd J. Austin III said during a press conference at Eielson Air Force Base, Alaska. "One loss by suicide is too many. While we're working hard on this problem, we have a lot more to do." In 2020, Army officials reportedly said that discussions within the Department of Defense indicated up to a 20 percent spike in military suicides from the year before. "We cannot say definitively it is because of COVID," said Army Secretary Ryan McCarthy at the time. "But there is a direct correlation from when COVID started, the numbers actually went up." More than 30,000 active duty personnel and veterans of the post-9/11 wars have died by suicide, nearly three times as many as service members killed in post-9/11 war operations, according to a recent study. The study also estimates that the actual number of post-9/11 veteran suicides is higher than recorded, noting that the Veterans Affairs office does not differentiate suicides by time of service and has not reported an exact number. "So, if you're hurting, there are resources available," Austin said. "And I know that our leaders here are committed to making those resources even more accessible and available." "One of my messages to the men and women that I spoke with today is we need to look out for one another, and I promised I would be looking out after them." The Hill External Link


    Antibodies from Sinovac's COVID-19 shot fade after about 6 months, booster helps - study

    26 July- Antibodies triggered by Sinovac Biotech's (SVA.O) COVID-19 vaccine decline below a key threshold from around six months after a second dose for most recipients, although a third shot could have a strong boosting effect, according to a lab study. Chinese researchers reported the findings from a study of blood samples from healthy adults aged between 18-59 in a paper published on Sunday, which has not been peer reviewed. For participants receiving two doses, two or four weeks apart, only 16.9% and 35.2% respectively still had a level of neutralizing antibodies above the threshold six months after the second dose, the paper said. Those readings was based on data from two cohorts involving more than 50 participants each, while the study gave third doses to a total of 540 participants. When participants in some cohorts were given a third dose, about six months after the second, neutralizing antibody levels after a further 28 days had increased around 3-5 fold from the levels seen four weeks after the second dose, the study showed. The study was conducted by researchers at disease control authorities in Jiangsu province, Sinovac, and other Chinese institutions. Researchers cautioned the study did not test the antibodies' effect against more transmissible variants, and that further research was needed to assess antibody duration after a third shot. Reuters External Link

    Covid: Delta variant spreads globally as cases soar

    25 July- The Delta variant of Covid-19 has now been detected in 124 territories worldwide, the World Health Organization (WHO) says. It is expected to become the dominant variant globally in the coming months, with the WHO predicting that there could be more than 200 million confirmed cases within a matter of weeks. Infections are rising, particularly in Europe and the western Pacific region. Some Western countries have started to ease restrictions as death rates have dropped. But those without access to vaccines or with a slower vaccine rollout are facing a deadlier threat. Here, BBC journalists around the world give a sense of the toll the Delta variant is taking and what impact its spread could have. BBC External Link

    If you are not vaccinated against Covid-19, you shouldn't go into a bar or restaurant, expert says

    26 July- Less than half of the US population is fully vaccinated against Covid-19 – and with cases on the rise, experts are urging a return to precautions reminiscent of the earlier days of the pandemic. "What I would say bluntly is: If you are not vaccinated right now in the United States, you should not go into a bar, you should probably not eat at a restaurant. You are at great risk of becoming infected," CNN Medical Analyst Dr. Jonathan Reiner, professor of medicine and surgery at George Washington University, told CNN's Fredricka Whitfield. In 48 states, the rate of new Covid-19 cases in the past week jumped by at least 10% compared to the previous week, according to data from Johns Hopkins University. In 34 of those states, the rate of new cases increased by more than 50%. And hospitals are filling up with Covid-19 patients again, except now, patients are younger than before, said doctors in Alabama, Mississippi, Florida and Missouri. Despite the encouragement of many officials and experts' warnings that the best protection from the virus comes from vaccinations, only 49.1% of the US population is vaccinated, according to data from the US Centers for Disease Control and Prevention. If a large swath of people remains resistant to vaccination, Reiner said, the US is left with two options to control the spread: shut down businesses – which few people want to do – or return to masks. "The only way to get the unvaccinated to mask up is to mask everyone up," Reiner said. While masking, like vaccination, could come from mandates by state leaders, Vanderbilt University Medical Center Professor of Infectious Diseases Dr. William Schaffner said he anticipates more success if the push to return to precautions comes from local officials and trusted community leaders. CNN External Link

    Shingles (Herpes Zoster) vaccine approved for immunocompromised adults

    26 July- London-based GlaxoSmithKline plc (GSK) announced today the U.S. FDA had approved the Shingrix vaccine to prevent shingles (herpes zoster) for people 18+ years who are or who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. Immunocompromised individuals are at greater risk of shingles and associated complications than immunocompetent individuals, says GSK. Shingrix is the first shingles (herpes zoster) vaccine indicated for use in those who are at increased risk of the disease due to being immunodeficient or immunosuppressed due to disease or therapy. It combines a non-live antigen to trigger a targeted immune response with a specifically designed adjuvant system to generate a Varicella-Zoster Virus-specific immune response. Shingrix is intended to be administered in two doses, 2 to 6 months apart, for immunocompetent adults. This FDA approval for a new population was based on clinical studies examining the safety and efficacy of Shingrix in adults who had undergone an autologous hematopoietic stem cell transplant and those undergoing treatment for hematological malignancies. In addition, further safety and immunogenicity data were generated in adults who were, or were anticipated to be, immunodeficient or immunosuppressed due to known disease or therapy, including patients with HIV, solid tumors, and renal transplants. Precision Vaccinations External Link

    Study: 2 COVID vaccine doses much more effective than 1 against Delta

    22 July- COVID-19 vaccine effectiveness for one dose of the Pfizer/BioNTech or the AstraZeneca/Oxford vaccine against the Delta variant (B1617.2) was much lower compared with one-dose effectiveness against the Alpha variant (B117), according to a UK study yesterday in the New England Journal of Medicine. Two doses, however, narrowed the gap. People are generally considered fully vaccinated with the Pfizer and the AstraZeneca vaccines 14 and 15 days after the second dose, respectively. The Public Health England-led research team said that their observational, case-control study underscores the urgency of increasing uptake of two doses of a COVID-19 vaccine among vulnerable populations. The highly transmissible and possibly deadlier Delta, which is gaining dominance around the world, has caused infection surges that have overwhelmed hospitals in India and is behind a notable uptick in England. The investigators used data on all sequenced cases of symptomatic COVID-19 in England from Apr 5 to May 16 and found that out of 19,109 sequenced cases, 4,272 were Delta infections (22.4%), and 14,837 were caused by Alpha (77.6%). They then estimated the effectiveness of the Pfizer and AstraZeneca vaccines against each variant after one and two doses. CIDRAP External Link

    Why some teens aren't getting COVID-19 vaccines

    26 July- The vaccination drive among adolescents, a critical part of the wider effort to build society-wide immunity to COVID-19, has slowed, as many parents harbor safety concerns. Many parents rushed to get their children inoculated in May after regulators widened use of Pfizer Inc.'s COVID-19 shot to children as young as age 12. Yet vaccinations have flagged since. Other parents have held off because of concerns about the shot's speedy development and a rare side effect, an inflammatory heart condition called myocarditis. They are struggling with how to weigh these risks against research indicating that COVID-19 itself isn't a significant risk for children. Some of the reluctant parents are vaccinated themselves, a new challenge for public-health officials trying to overcome more general hesitancy about vaccines, as they race against the Delta variant and prepare for the resumption of schools. Fox News External Link

    Will influenza reignite this flu season?

    24 July- The COVID-19 pandemic and the implementation of nonpharmaceutical interventions (physical distancing, staying home) reduced the transmission of some viral respiratory pathogens such as influenza viruses, stated the U.S. CDC report issued on July 23, 2021. In the USA, influenza activity initially decreased in March 2020, was historically low infection rates reported through the summer of 2020. From October 3, 2020–May 22, 2021, influenza activity was lower than during any previous flu season since 1997, the first season for which data are publicly available, says the CDC. Furthermore, the 2021-2022 influenza season is expected to begin in the fall, with many unanswerable questions. Such as when should people get their flu shot? Should flu shots and COVID-19 vaccines be co-administered?  The CDC says 'Clinicians should be aware of increased circulation, sometimes offseason, of some respiratory viruses and consider multi pathogen testing. In addition to recommended preventive actions, fall influenza vaccination campaigns are important as schools and workplaces resume in-person activities with relaxed COVID-19 mitigation practices. 'Clinicians should be aware that respiratory viruses might not exhibit typical seasonal circulation patterns and that a resumption of circulation of certain respiratory viruses is occurring. Therefore, an increased index of suspicion and testing for multiple respiratory pathogens remain important,' stated the CDC. Most people over 6-months of age are encouraged to get vaccinated every flu season since influenza infections can create severe consequences, said the CDC. The most common flu shot in the Northern Hemisphere are quadrivalent vaccines that protect people against four viruses: influenza A (H1N1) virus, influenza A (H3N2) virus, and two influenza B viruses, said the CDC. Precision Vaccinations External Link 


    CDC: Weekly U.S. Influenza Surveillance Report

    2020-2021 Influenza Season for Week 28, ending July 17, 2021:

    Influenza-Associated Hospitalizations- The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in 14 states and represents approximately 9% of the U.S. population. As in previous seasons, patients admitted for laboratory-confirmed influenza-related hospitalization after April 30, 2021, will not be included in FluSurv-NET. Data on patients admitted through April 30, 2021, will continue to be updated as additional information is received.

    Influenza-Associated Pediatric Mortality- No influenza-associated pediatric deaths were reported to CDC during week 28. CDC External Link


    CFIA recalls Zucchini spirals for possible Listeria contamination

    26 July- Veg Pak Produce of Ontario Sunday recalled Harvest Fresh brand Zucchini Spirals from Canada's marketplace due to possible Listeria monocytogenes contamination...If you think you became sick from consuming a recalled product, call your doctor. Check to see if you have the recalled product in your home. Recalled products should be thrown out or returned to the store where they were purchased. Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still make you sick. Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalled product and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure. Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop.  Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. Food Safety News External Link


    RSV is here early this year: know the symptoms to look for

    23 July- Respiratory Syncytial Virus is a viral disease that mostly affects children, with symptoms that include fever, wheezing and difficulty breathing — it can occur in people of all ages, however, and generally takes the form of cold or flu-like symptoms in adults with stronger immune systems. Though RSV had shown a downward trend in numbers since 2020, likely due to the adoption of public health measures to reduce the spread of COVID-19, the Centers for Disease Control and Prevention has observed an increase in RSV detections since March. Pediatric advice is to watch for worsening symptoms and seek medical attention. "Adults and older children can also be infected with RSV but generally tolerate it quite well," GLWACH Pediatrician Capt. Parker Thompson said. "However, children under 3 years old are more affected by the virus's ability to increase mucus production in the airways and tend to have a more difficult time fighting the virus." It is spread by direct contact with infectious materials through eyes, mouth and nose. RSV can also be spread by an infected person with fever or contact with a surface that an infected person has touched or coughed on. Mitigation measures for COVID-19 work well to also prevent the spread of RSV, said Capt. Terra Forward, chief of Fort Leonard Wood's Department of Public Health. "Proper hand washing, cleaning contact surfaces and staying home are key in slowing the spread," she said. According to Maj. Austin Drake, Primary Care Service Line interim chief, RSV is one of the oldest viruses pediatricians test for. External Link

    Why some experts recommend upgrading to N95 masks to help fight the delta variant

    24 July- The debate over masks is heating up again, with increasing calls for all Americans, regardless of coronavirus vaccination status, to return to wearing face coverings in indoor public places to help thwart the spread of the highly contagious delta variant. But some experts say the recommendations should specify the kind of masks people should be using. "Delta is so contagious that when we talk about masks, I don't think we should just talk about masks," Scott Gottlieb, former commissioner of the Food and Drug Administration, said during a recent appearance on CBS's "Face the Nation." "I think we should be talking about high-quality masks," such as N95 respirators. In an interview with The Washington Post, Monica Gandhi, a professor of medicine and an infectious-disease expert at the University of California at San Francisco, expressed a similar sentiment: "We can't say we're going back to masks without discussing type of mask." Vaccinations, experts emphasized, remain the first line of defense against the coronavirus. "Far and away the best prevention we have are still the vaccines," said Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women's Hospital in Boston. "All of these things pale in comparison to getting the remaining people who are eligible for vaccination vaccinated." The Washington Post External Link


    Nigeria cholera outbreak grows, Eyes on Lagos state

    25 July- Nigerian health officials continue to report an increase in cholera cases across the country. In the week ending July 11, eight states and Federal Capital Territory (FCT) reported 1,885 suspected cases, including 31 deaths. Bauchi state was hit the hardest with 1,364 suspected cases. Kwara state became the 18th state to report cholera this year, accounting for half the country's states affected. As of July 11, 2021, a total of 19,305 suspected cases including 479 deaths (CFR 2.5%) have been reported from 18 states and FCT (Benue, Delta, Zamfara, Gombe, Bayelsa, Kogi, Sokoto, Bauchi, Kano, Kaduna, Plateau, Kebbi, Cross River, Niger , Nasarawa, Jigawa, Yobe, Kwara and FCT) since the beginning of 2021. Noticeably absent is Lagos state, home of Nigeria's largest city and commercial center. Health experts are, however, warning that Lagos may not escape the cholera outbreak already ravaging many states in the country, noting that poor sanitation and blocked drainage channels that have become a common sight, making the state prone to an outbreak. Outbreak News Today External Link


    Riyadh man is Saudi Arabia's 10th MERS case of 2021

    26 July- Saudi Arabia health officials reported a new case of Middle East respiratory syndrome coronavirus (MERS-CoV) in a 67-year-old man from Riyadh City. It is reported the man had contact with camels. This is the tenth MERS case of 2021 in the Kingdom and the 11th overall (one in the United Arab Emirates). Middle East respiratory syndrome coronavirus (MERS-CoV) is a virus transferred to humans from infected dromedary camels, according to the World Health Organization. It is a zoonotic virus, meaning it is transmitted between animals and people, and it is contractible through direct or indirect contact with infected animals. MERS-CoV has been identified in dromedaries in several countries in the Middle East, Africa and South Asia. In total, 27 countries have reported more than 2,500 cases since 2012, leading to nearly 900 known deaths due to the infection and related complications. Outbreak News Today External Link


    Ukraine: Woman contracts tularemia in Volyn Oblast

    24 July- Health authorities in Volyn Oblast report a tularemia case in a woman from the village of Sadiv in Lutsk district. According to the results of the epidemiological investigation, it was established that the disease was probably caused by a bite of an insect (fly) on June 20 this year. The patient had symptoms typical of tularemia: during the day the body temperature rose and chills appeared. On the third day, there were complaints of redness and swelling of the skin at the site of the insect bite, joint pain and enlarged cervical and inguinal lymph nodes (buboes) characteristic of tularemia. Infectious disease doctors suspected tularemia and performed the necessary selection of material for laboratory testing. Laboratory analysis confirmed tularemia. The patient is in outpatient treatment at the Volyn Regional Infectious Diseases Hospital with a diagnosis of "Tularemia, ulcerative-bubonic form, moderate." This is the first case of tularemia in the area since the beginning of the year. Outbreak News Today External Link


    Thailand reports record 15K COVID-19 cases Sunday

    25 July- Thailand health officials reported a record 15,335 COVID-19 cases Sunday, which includes 641 cases in the prison population. This topped the country's previous high on Friday (14,575). 129 additional deaths were recorded. Bangkok saw the most cases with 2700, while Samut Prakan and Samut Sakhon provinces recorded more than 1,000 each. Thailand has reported a total of 497,302 COVID-19 cases since the beginning of the pandemic, including 4059 deaths. Outbreak News Today External Link


    U.S.: South Carolina- Officials say more than two dozen people exposed to rabid puppy

    25 July- South Carolina health authorities reported Friday that a puppy found in Edgefield County, near Lanier Road in Johnston, SC has tested positive for rabies. At least 25 people were exposed and have been referred to their healthcare providers. Six dogs were exposed and will be quarantined as required in the South Carolina Rabies Control Act. The puppy resided in Augusta, GA from July 14, 2021, through July 17, 2021. The South Carolina Department of Health and Environmental Control (DHEC) is collaborating with the Georgia Department of Public Health to identify additional exposures. It was brought to Florence County, SC on July 17, 2021. The puppy was submitted to DHEC's laboratory for testing on July 19, 2021, and was confirmed to have rabies on July 20, 2021. This puppy is the first animal in Edgefield County to test positive for rabies in 2021. Outbreak News Today External Link


    Argentina reports more Delta variants in travelers

    24 July- The Ministry of Health of Argentina reports that the national reference laboratory ANLIS Malbrán isolated another 17 new cases of Delta variant related to travelers. The samples correspond to residents of the City of Buenos Aires, Santa Fe, the province of Buenos Aires, Tucumán and Salta. Currently, the national and jurisdictional health authorities are conducting epidemiological investigations of all cases and symptomatic cohabiting contacts. To date, a cumulative total of 46 genomic sequencing of this variant of concern has been identified in the country. Of which 45 have a history of international travel, while one corresponds to a case with an epidemiological link with one of the travelers. Regarding people with a travel history, the national health portfolio indicated that 36% were detected in the testing device upon entering the country (16 cases) and 64% (29 cases) were positive during their isolation for having started symptoms later of their entry into the country or for having had positive results on the occasion of performing the PCR test on the seventh day of isolation. Travelers who tested positive for the Delta variant came from the United States, Spain, the Netherlands, Mexico, Montenegro, Panama, France, Denmark, and Venezuela. Outbreak News Today External Link