On 18 February 2021, the National IHR Focal Point for the Russian Federation notified WHO of detection of avian influenza A(H5N8) in seven human clinical specimens. These are the first reported detection of avian influenza A(H5N8) in humans. Positive clinical specimens were collected from poultry farm workers who participated in a response operation to contain an avian influenza A(H5N8) outbreak detected in a poultry farm in Astrakhan Oblast in the Russian Federation. The laboratory confirmation of the seven specimens were performed by the State Research Centre for Virology and Biotechnology VECTOR (WHO H5 Reference Laboratory). The age of seven positive cases ranged between 29 to 60 years and five were female.

Between 3 and 11 December, a total of 101 000 of 900 000 egg laying hens on the farm died. This high mortality rate prompted an investigation. Samples were collected from these birds and an initial detection of avian influenza A(H5N8) was performed by the Russian regional veterinary laboratory. On 11 December, the outbreak was confirmed by the World Organisation for Animal Health (OIE) Reference laboratory, and the Federal Centre for Animal Health (FGBI-ARRIAH), in Vladimir, the Russian Federation. Outbreak containment operations started immediately and continued for several days due to the large size of the poultry farm.

On 14 February 2021, the Ministry of Health (MoH) of Guinea informed WHO of a cluster of Ebola Virus

Rift Valley fever (RVF) has been reported in Kenya in humans in Isiolo and Mandera counties and in

A 35-year-old immunocompromised male who was at 2-year status after simultaneous liver and kidney transplant presented to the emergency department with 1 week of nausea, vomiting, and epigastric pain and 1 day of coffee-grounds emesis. Both recipient and donor were known to be seropositive for the cytomegalovirus and the Epstein-Barr virus. The patient had a history of uncontrolled diabetes mellitus type 1 and was not compliant with his medications. He had also been taking immunosuppressants inconsistently for 1 month prior to the presentation due to financial constraints. He denied fever, chills, diarrhea, hematochezia, melena, or dysuria. He was an active smoker but denied alcohol and illicit drug use. The patient was hemodynamically stable on admission with a physical examination remarkable for scleral icterus, jaundice, and epigastric tenderness without rebound. Laboratory investigation showed a hemoglobin of 13 g/dL, white blood cell count of 15 × 10⁹/L with left shift, a platelet count of 216 × 10⁹/L, blood glucose of 773 mg/dL with an anion gap of 22 mEq/L, aspartate aminotransferase of 459 IU/L, alanine aminotransferase of 280 IU/L, total bilirubin of 24.7 mg/dL, alkaline phosphatase of 2570 IU/L, blood urea nitrogen of 67 mg/dL, and creatinine of 3.9 mg/dL. His blood B-hydroxybutyrate was positive. Computed tomographic (CT) scan of his abdomen revealed diffuse gastric wall thickening, gastric cardia pneumatosis, as well as air in the adjacent gastric vein, superior mesenteric vein, and main portal vein without intra-abdominal free air (Figure 1). Upper gastrointestinal endoscopy was performed and demonstrated esophagitis, portal hypertensive gastropathy, severely erythematous gastric mucosa with stigmata of recent bleeding, and dark red blood clots (Figure 2). Biopsies were taken for histology. The pathology of the gastric body biopsy is shown in Figure 3.

To the Editor—We thank Chandereng and Chappell [1] for their informative letter. We agree that applying response-adaptive randomization (RAR) to blocks instead of individuals and performing a stratified analysis should be more robust to bias caused by temporal trends than the commonly used RAR methods. We also agree with the title of their letter, especially the “if you really must” part. We do not believe that there is an ethical imperative to use RAR. Those who feel an ethical obligation to use RAR should insist on the safeguards provided in the Chandereng and Chappell letter.