Sunday, July 15, 2018

Post-Disaster Sequelae

Three Major Disasters In Just Over 30 Days


The NEJM has published a special report (see below) that attempts to calculate  the death toll in the wake of Hurricane Maria last September. As everyone knows by now, most of the inhabitants were without electricity, potable water, and cellular service for months.

Other long duration post-storm challenges included a badly damaged infrastructure and severely compromised supply chain, making it difficult to obtain food, prescription medicines, medical care, and police or rescue services. 
Extrapolating the results of a survey of 3299 randomly selected households, they estimated 4645 excess deaths occurred in first 100 days following the storm. 
I've excerpted the abstract, but you'll want to follow the link to read the report in its entirety.   After which, I'll have more.

Mortality in Puerto Rico after Hurricane Maria
Nishant Kishore, M.P.H., Domingo Marqués, Ph.D., Ayesha Mahmud, Ph.D., Mathew V. Kiang, M.P.H., Irmary Rodriguez, B.A., Arlan Fuller, J.D., M.A., Peggy Ebner, B.A., Cecilia Sorensen, M.D., Fabio Racy, M.D., Jay Lemery, M.D., Leslie Maas, M.H.S., Jennifer Leaning, M.D., S.M.H., Rafael A. Irizarry, Ph.D., Satchit Balsari, M.D., M.P.H., and Caroline O. Buckee, D.Phil.



Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64.

Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016. 


From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.


This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.)
Not being a statistician, I'm not going to try to analyze their methods or results, I'll only toss in my 2 cents that this estimate is likely still an undercount.  And these numbers are only calculated through December 31st, 2017.
The challenges of responding to any major disaster are enormous, and coming - as this one did - as the third major U.S. disaster in just over a month (preceded by Hurricanes Harvey in Texas & Irma in Florida), resources were already badly strained.
Add in that the hurricane struck an island nearly 1000 miles from the mainland,  whose long neglected infrastructure was already in bad shape - and you have all the necessary plot points for a bad disaster movie.  Except this was no movie.

As a first responder in the 1970s, we had a radio code that - quite frankly - we heard far too often.  It varies by municipality, but where I worked it was 10-89; No Units Available. 
It meant that every ambulance, and every rescue unit, was tied up. No units were available to respond. And the next emergency call might go unanswered for 10, 20, maybe 30 minutes or longer. 
For months after the storm - whether it be restoration of utilities, delivery of food and medicine, or availability of medical care -  much of Puerto Rico was in 10-89 status. And as a result, a lot of people died.
The debate over what could have been done differently will continue, but I can tell you, for a first responder there is no hell quite like not being able to respond when you know you are desperately needed and lives are at stake. 
The question is, was this a fluke? A once-in-a-lifetime disaster that no one could have anticipated, or reasonably prepared for?   Or are we deluding ourselves by believing `it can't happen here (again)'.

Since - until last year - the United States had been in a 10+ year major hurricane drought, the idea of 3 major storms hitting the U.S. in quick succession seemed unlikely.  
But in 2005, we saw a modern record of 28 Atlantic named storms, 7 of which were of major (Cat 3+) intensity.  Nine storms had impact on the United States, although three - Katrina, Rita, and Wilma - were particularly destructive. 
The previous year (2004) also saw 9 U.S. land falling storms, and while not as destructive, no fewer than 5 named storms crossed over Florida, four of which were major hurricanes.


So the potential for seeing multiple major hurricanes strike in short order - even in the same state - is certainly there.
As bad as these disaster were, they pale in comparison to the 2010 earthquake in Haiti, which probably killed more than 200,000 people.  Or the estimated quarter of a million people who died from the 2004 Indian ocean tsunami, or the tens of thousands who perished from the 2011 Tōhoku earthquake and tsunami in Japan.
But all of these disaster areas have something in common.

It may take weeks, months, or even years before life returns to normal, and the actual loss in terms of mortality, morbidity and permanent disability, PTSD, homes and belongings, businesses, jobs and life savings, and continuity of a community are never fully tallied or appreciated.
We've looked at some of these after effects in the past.
There are always the usual post-disaster accidents; drownings, carbon monoxide poisoning from using charcoal or generators indoors. Falls from roofs or ladders from clearing debris, or chain saw accidents. And even skin infections and food poisoning from contaminated waters (see After The Storm Passes).

Heat (or cold) related deaths may occur when the power is out for extended periods (see MMWR: Heat-Related Deaths During an Extreme Heat Event), and people who rely on oxygen concentrators at home could find themselves in a life threatening situation.
But some after effects may be harder to link to a disaster.
In March of 2009, in a study led by Dr. Anand Irimpen (Associate Professor of clinical medicine at Tulane), it was disclosed that residents of New Orleans saw a 300% increase in heart attacks in the first 2 years after hurricane Katrina.
A follow up, published in 2014 (see Tulane University: Post-Katrina Heart Attack Rates - Revisited), once again found the impact of Katrina on cardiac health remained pronounced.
Also in 2014, in Post-Disaster Stress Cardiomyopathy: A Broken-Hearted Malady, we looked at a rare condition known as Takotsubo cardiomyopathy – or stress induced cardiomyopathy which is often linked to extreme grief or stress, as might be experienced following a disaster.
Also known as broken heart syndrome, this acute ballooning of the heart ventricles is a well-recognized cause of acute heart failure and dangerous cardiac arrhythmias. 
While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. In 2011, in Post Disaster Stress & Suicide Rates, we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder). 

This has been recognized as such a pressing problem that the  World Health Organization released a comprehensive Guidelines For Post-Trauma Mental Health Care book on the treatment of PTSD, acute stress, and bereavement in 2013.

Our list of post-disaster sequelae is long, and far from complete.  But it does provide us with an idea of just how much is at risk when a major disaster strikes.

Another CAT 5 storm will strike a populated area of the United States, a major earthquake (M7.0+) will hit a major metropolitan area, and the world will see another severe pandemic.  
It's just a matter of time.  
And when that happens - no matter how well prepared we think we are - we'll wish we had done more.  As a nation, as a community, and as individuals.
The lesson of hurricane Maria is that back-to-back disasters can quickly overwhelm local, state, and federal relief efforts and that failed or damaged infrastructure can prevent needed help or supplies from reaching the victims for days, weeks, or even months. 
While I can't control what FEMA or my state is able to do in response to the next disaster, I do have a say in what I can do.

Living in hurricane country, I've made it a point to have a disaster plan, a disaster buddy, a bug-out destination, and the things I would need to survive without electricity, running water, open grocery stores or pharmacies for a week or longer. 
As long-time readers of this blog already know, I was forced to put all of that into action last year with Hurricane Irma (see A Post Irma Update).
While none of this guarantees me a good outcome when the next disaster strikes, it does better my odds.  And it also allows me to be in a position to help others, either directly, or by not taking immediate assistance from local relief efforts so that it can go to someone else.

For more on the long-term impacts of disasters, and how to prepare for them, you may wish to revisit:
All Disaster Responses Are Local
Supply Chain Of Fools (Revisited)
Little Preps Mean A Lot
In An Emergency, Who Has Your Back?
When 72 Hours Isn’t Enough

Friday, July 13, 2018

From H5N1 to HxNy: Overview Of Human Infection with AI in The Western Pacific Region - WHO


Until the mid-1990s, avian influenza viruses were thought to pose only a very limited threat to human health, and the few novel human infections that had been detected, had generally been mild. 
That notion abruptly changed in 1997 when 18 people contracted H5N1 in Hong Kong, and six of them died. 
A massive campaign of poultry eradication bought a 5 year respite, but in 2003 two members of a family turned up in Hong Kong with the virus after visiting Fujian Province, China (see WHO H5N1 timeline). A third family member had died on the Mainland, but no tests were taken.

From this sputtering and uncertain beginning (see chart above), H5N1 began to spread - at first across Southeast Asia (Vietnam, Laos, Cambodia, Thailand) - and within a couple of years, into Europe, Africa, and the Middle East. 
For several years Indonesia and Vietnam were the world's hot spots for human infection, but eventually that focus would shift to Egypt. 
Along the way, the virus was also changing, diversifying into new clades and subclades. The H5N1 virus circulating in Indonesia was genetically distinct from the H5N1 found in China, or that spreading in Egypt. 

For the first decade, H5N1 stood pretty much alone at the top of our avian flu worry list, albeit with some second tier viruses (H7N7, H5N2, H9N2, etc.) in the wings. In 2013, H7N9 - a worthy contender to H5N1 - emerged in China, and has (at least for now) replaced H5N1 as our biggest concern.
But it wasn't alone.
Several other HPAI viruses, able to infect humans - all originating from China - would emerge in 2013 and 2014; H10N8 and H5N6. Earlier this year, we saw the first known human infection with H7N4 (see UK PHE Guidance & Risk Assessment On Human H7N4 In China).

While novel flu viruses can emerge from anywhere on the globe, Eastern China has an impressive record of spawning new subtypes (see Viral Reassortants: Rocking The Cradle Of Influenza). 
This week the World Health Organization has published a review of human infections with avian flu viruses in the Western Pacific over the past 15 years.
It's a long and informative read, and discusses in frank terms some of the challenges in getting accurate data, and the likelihood of seeing additional novel viruses emerge from this region in the future.

I've only excerpted the abstract and some comments from the Conclusions. Follow the link to read it in its entirety. 

From H5N1 to HxNy: An epidemiologic overview of human infections with avian influenza in the Western Pacific Region, 2003–2017

Sarah Hamid,a Yuzo Arima,b Erica Dueger,a,f Frank Konings,a Leila Bell,a Chin-Kei Lee,c Dapeng Luo,d Satoko Otsu,e Babatunde Olowokure,a Ailan Lia and WPRO Health Emergencies Programme Teama

a WHO Regional Office for the Western Pacific.
b National Institute of Infectious Diseases, Japan.
c WHO Country Office China.
d WHO Country Office Lao People's Democratic Republic.
e WHO Country Office Viet Nam.
f Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.


Since the first confirmed human infection with avian influenza A(H5N1) virus was reported in Hong Kong SAR (China) in 1997, sporadic zoonotic avian influenza viruses causing human illness have been identified globally with the World Health Organization (WHO) Western Pacific Region as a hotspot. A resurgence of A(H5N1) occurred in humans and animals in November 2003.

Between November 2003 and September 2017, WHO received reports of 1838 human infections with avian influenza viruses A(H5N1), A(H5N6), A(H6N1), A(H7N9), A(H9N2) and A(H10N8) in the Western Pacific Region. Most of the infections were with A(H7N9) (n = 1562, 85%) and A(H5N1) (n = 238, 13%) viruses, and most (n = 1583, 86%) were reported from December through April. In poultry and wild birds, A(H5N1) and A(H5N6) subtypes were the most widely distributed, with outbreaks reported from 10 and eight countries and areas, respectively.

Regional analyses of human infections with avian influenza subtypes revealed distinct epidemiologic patterns that varied across countries, age and time. Such epidemiologic patterns may not be apparent from aggregated global summaries or country reports; regional assessment can offer additional insight that can inform risk assessment and response efforts. As infected animals and contaminated environments are the primary source of human infections, regional analyses that bring together human and animal surveillance data are an important basis for exposure and transmission risk assessment and public health action. Combining sustained event-based surveillance with enhanced collaboration between public health, veterinary (domestic and wildlife) and environmental sectors will provide a basis to inform joint risk assessment and coordinated response activities.



Despite these limitations, disseminating regional analyses can improve Member States' situational awareness, knowledge of the epidemiology in neighbouring countries as well as of the broader regional perspective, and risk assessment and response efforts.
This analysis specifically demonstrates the usefulness of combining multiple sources of surveillance data for better informed risk assessments, including those based on the WHO Tool for Influenza Pandemic Risk Assessment.57 Moreover, using multiple sources of information helps to assess potential surveillance biases, thereby improving decision-making.

Further sporadic human infections with avian influenza viruses are likely to occur. Although A(H5N1) incidence may have declined, A(H7N9) virus has emerged, and other avian influenza viruses have been detected in recent years.

In China, country of the origin of recently identified avian influenza virus strains, the poultry industry has expanded greatly in the past two decades.58 In many areas, the close proximity of humans and animals increases the risk of human exposure to zoonotic influenza viruses.3 As infected animals or contaminated environments are the primary sources for human infection, risk assessments should incorporate a One Health approach and gather information from all relevant sectors. Continued surveillance at the human–animal interface is imperative for all avian influenza viruses.

Every sporadic human infection provides a virus with an opportunity to change its genetic makeup, increasing the possibility of an influenza virus with pandemic potential to arise.

Strengthened communication and collaboration between animal and human health sectors at subnational, national, regional and global levels are necessary to monitor the dynamics of influenza virus activity. An APSED approach that aligns with One Health initiatives combining sustained event-based surveillance with enhanced collaboration between the human, animal (domestic and wildlife) and environmental sectors will provide a basis to inform joint risk assessment and coordinate response capacities.
       (Continue . . . )

Hamid S, Arima Y, Dueger E, Konings F, Bell L, Lee CK, et al. From H5N1 to HxNy: An epidemiologic overview of human infections with avian influenza in the Western Pacific Region, 2003–2017. Western Pac Surveill Response J. 2018 Jul;9(2). doi:10.5365/wpsar.2018.9.2.001

Thursday, July 12, 2018

UK DEFRA: Update On H5N6 HPAI UK/Europe & H5N8 HPAI In Europe & Russia - July


While it pales in comparison to the winter 2016-17 avian epizootic, Europe has reported low levels of HPAI H5N6 and H5N8 activity in 2018 with most of the H5N6 activity found in Northern & Western Europe, while H5N8 has made appearances in Southern and Eastern Europe, along with Western Russia.
As we've discussed previously, a major bird flu season is generally followed by one or more less severe years (see chart below), and so this relative lull in activity is not unprecedented.

Today the UK's DEFRA has released their 4th assessment of 2018, which covers not only the UK and EU countries, but also recent HPAI H5 reports from Western Russia as well.

Due to its length, I've only included some excerpts. Follow the link to read the report in its entirety.  When you return, I'll have a postscript.

Department for Environment, Food and Rural Affairs
Animal & Plant Health Agency
Advice Services Team - International Disease Monitoring
Situation Assessment #4
Update on H5N6 HPAI in UK/Europe and H5N8 HPAI in Europe/Western Russia
9 th July 2018
Ref: VITT/1200 Avian Influenza in Europe
Disease report
This is an update to our previous assessment on the 4 th April 2018 on the current situation for highly pathogenic avian influenza virus (HPAIV) H5N6 in the UK, including the current status of the prevention zones and other findings in Europe and an assessment of the ongoing H5N8 HPAIV outbreaks in poultry in south-eastern Europe and in western Russia.
The two H5N6 outbreaks in poultry in northern Europe in the early part of this year were swiftly controlled with no secondary spread. It is important to note that to date, there have still been no detections of H5N6 HPAI in poultry in the UK, either in the commercial or non-commercial sectors.
There has been one further wild bird finding in the UK (Northern Ireland) and the late winter period to March resulted in sporadic detections of H5N6 in Northern Europe but at much lower levels than with H5N8 in 2017/18. The number of wild bird H5N6 cases, however, has markedly decreased through April into May, probably due to a combination of firstly the departure from the UK of the wintering water birds (which were the main source of virus) and secondly an increased rate of decay of any excreted virus present in the aquatic environment due to higher ambient temperatures, thus diminishing further exposure to resident wild birds.
The risk of further incursions in wild birds in the UK is now considered greatly diminished (reduced to LOW across UK) compared to earlier in the year (Defra, 2018) and as a result the Avian Influenza Prevention Zones in place in England and in Wales were lifted on Friday 25 May 2018.
This report is to inform readers of the ongoing likelihood of more HPAIV findings in wild birds in the UK during the summer and to review the biosecurity needs to continue to prevent incursions into poultry farms and backyard poultry

H5N6 HPAI in Europe
The return migration of wild waterfowl species from their wintering sites in Western Europe (including the UK) to their summer breeding grounds in the Arctic tundra in late March/early April may have been responsible for many of the cases of H5N6 reported in wild birds in northern Europe including Scandinavia since the previous report.
Indeed the general increased movement of waterfowl species across the region leads to further spread of risk. It is interesting to note that the cases were located along the migration route on the Baltic Sea through to Finland (see map below). Going west to east, Demark, Sweden and Finland reported cases in wild birds in April and into May.
Denmark in particular recorded a number of cases in wild birds with 10 findings during April. The species were Eurasian buzzards and a few White-tailed eagles (Haliaeetus albicilla) but also Hooded crows (Corvus cornix), Mute swans (Cygnus olor) and other waterbird species. Sweden reported three more White-tailed eagles in April/early May. Finland reported two cases in White-tailed eagle in mid and late April in south-west near a key migration route. Germany recorded a single case in early May in a Eurasian buzzard, following a nearby case in a White stork (Ciconia ciconia) at the end of April. The White
stork case is interesting in that it may have been a newly arrived spring migrant from Africa and was presumably infected on arrival in Germany.
H5N8 HPAI in Europe
The HPAIV H5N8 strain has only been reported in southern and south-east Europe this year. Bulgaria had not reported any H5N8 cases in poultry since early March until an outbreak on a commercial duck farm in the Drobrich region on the 25 May following an increase in mortality. According to information from the Bulgarian authorities, this premises also had H5N8 HPAI outbreak earlier in October 2017.
The same or very similar virus appears to have been maintained at low level in this area raising the issue of the effectiveness of secondary cleansing and disinfection and/or the need for continual biosecurity preventing incursion from wild birds. Another outbreak of H5N8 has also been recently reported in July in Bulgaria in the same region at a commercial premises.

H5N8 HPAI in western Russia

Since early June, some 32 outbreaks of H5N8 have been reported in commercial poultry across several oblasts of western Russia including Kurskaya Samarskaya, Orlovskaya, Saratovskaya, Kurskaya, Smolenskaya and Penzenskaya. In addition, one outbreak occurred in a large poultry farm of 190,000 birds in Penzenskaya oblast in mid-June.
This emphasises the requirement for robust control measures in order to ensure mitigation for risk of spread of infection. These outbreaks currently present very low risk to UK, because 3migratory wild waterbirds are not migrating from this region until the autumn. The status of H5N8 in wild birds in western Russia is not known at present.

The EU/OIE/FAO international reference laboratory/UK national laboratory at Weybridge has the necessary ongoing diagnostic capability for these strains of virus, whether low or highly pathogenic AI.
The wild migratory waterfowl which have over-wintered in the UK have now returned to their breeding grounds in north-eastern Europe, Russia and the Arctic tundra. The new migration season for overwintering waterfowl arriving in the UK will begin again towards the end of the summer but this may be weather dependent.
We would like to remind readers that while H5N6 and H5N8 HPAI viruses were both circulating in Europe this year, there was a single case of H5N2 HPAI in Russia in December 2017 which could be circulating in wild birds as well.

(Continue . . . )

Interestingly, DEFRA is identifying the recent Russian activity as due to HPAI H5N8, while the OIE continues to only report HPAI H5.  
While considered the most likely culprit, the arrival of HPAI H5N6 in Europe last winter, along with the unexpected announcement of an HPAI H5N2 outbreak in Russia last December, has complicated matters.
While the threat of avian flu outbreaks has temporarily declined - at least in Western Europe - migratory birds will begin to return to the UK and the rest of Europe from their high latitude summer retreat in a couple of short months. 

A study, published in 2016 (see Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1), suggests that waterfowl can pick up new HPAI viruses in the spring (likely from poultry or terrestrial birds) on their way to their summer breeding spots.
Assuming these viruses are biologically `fit' (and can persist in the avian population for the summer - they may reassort with other avian flu viruses - and then be carried south by migratory birds the following fall. 
Which means, in two or three months, this welcomed lull in European bird flu activity could change.  Or not. 

The only thing predictable about influenza is, that it is unpredictable.

OIE Notification Of Avian Flu Outbreaks In Rostov, Oryol, Kursk and Nizhegorod Oblasts


Twenty-four hours ago, in Russian Media: Reports Of Avian Flu In Rostov & Other Locations, we looked at unconfirmed reports of fresh outbreaks of HPAI H5 across western Russia.  This morning we have OIE confirmation of the Rostov report, and 7 other outbreaks.
Despite more than 40 outbreaks across 8 Russian states over the past month, we still only have HPAI H5 listed as the subtype by the OIE. Recent history suggests HPAI H5N8, but other subtypes are possible.
Other than the Rostov outbreak, where > 600,000 birds are at risk, most of today's reports come from small holdings with fewer than 100 birds.

Wednesday, July 11, 2018

Russian Media: Reports Of Avian Flu In Rostov & Other Locations


Russia's summer resurgence of HPAI H5 doesn't appear to be slowing, with Russian media now reporting an outbreak in Rostov - which you'll recall was the site of a major outbreak and poultry inspection scandal in May of 2017 - along with numerous new outbreaks in Samara, and removal of contaminated poultry products in the Udmurt Republic.

While the official (Rosselkhoznadzor) websites have not yet posted updates, we have the following (translated) report from Tass.

Poultry farm in the Rostov found bird flu


July 10, 17:28 update date: July 10, 19:16 UTC + 3

Genome of influenza A virus subtype H5 bird discovered on the territory of JSC "Poultry factory Belaya Kalitva"

ROSTOV-ON-DON, July 10. / TASS /. The hearth of the disease bird flu detected on the territory of JSC "Poultry factory Belaya Kalitva" in the Rostov region, the management of information policy of the regional government.

"Specialists of the Rostov regional veterinary laboratory and research center ARRIAH (Federal Center for Animal Health) have identified a gene of influenza A virus subtype H5 bird in pathological material samples from dead chickens taken at area housing №3 JSC" Poultry factory Belaya Kalitva. "It was decided to determine the epizootic a hotbed of the entire territory of poultry farms, the endangered area considered the territory within a radius of 5 km and a surveillance zone set within a radius of 10 km, "- said in a statement.

"The endangered zone and the surveillance zone veterinarians carried out a clinical examination of poultry in private farms, there is also planned forced poultry vaccination and monitoring studies of wild and synanthropic birds", - added in the management of information policy of the regional government.

(Continue . . . )

Meanwhile, media reports from Samara Oblast - which first reported an outbreak of HPAI H5 in the middle of June - now indicate a much more widespread event, with 14 additional farms in 8 villages reportedly infected. 

In eight localities of the Samara region we have found bird flu

SAMARA, July 10 - RIA Novosti. Foci of avian influenza A found in 14 private farms in eight villages of the Samara region, said on Tuesday the press office of Rosselkhoznadzor for the region.

"In the course of the epidemiological investigation of the registration of highly pathogenic avian influenza in the territory of the Samara region is established ... the presence of influenza virus type A RNA in the poultry pathological material in 14 personal subsidiary farms in eight settlements" - said in a statement.

According to the press service, the bird flu found in villages Penzin Great Chernigovka and in the village Irgiz More, Chernigov region, in the village of Kurumoch Volga region, in the village of Kochetov Krasnoarmeyskiy district, in the village Vasilevka within the city gratifying in Podgornoye Bor district and village noon Kinel-Cherkassy region.

(Continue . . . )

And much like we saw during the summer of 2017 (see Rosselkhoznador: HPAI Contaminated Poultry Shipped To At Least 9 Regions Of Russia), we are seeing Russian media reports (but few official statements) on the removal of `flu contaminated' poultry products from the shelves in several regions.

Overnight several media outlets are carrying nearly identical reports from the Udmurt Republic.

17 tons of chicken meat contaminated with avian influenza found in shops in Izhevsk

The products were seized and destroyed.
Izhevsk. Udmurtia. 

In the shops of Izhevsk found 17 tons of chicken meat infected with avian influenza. According to the press service of the city administration, the products were seized and destroyed. 

Meat arrived on the shelves of the city's outlets from disadvantaged regions. Thus, at the beginning of July 28 outbreaks of highly pathogenic influenza among poultry in Kursk, Lipetsk, Orel, Samara were registered in Russia. Two foci of disease at poultry farms in the Penza region.
Sanitary and anti-epidemic commission commissioned the municipal police of the administration of Izhevsk, regional administrations together with law enforcement bodies to organize raids on places of unauthorized trade to stop illegal sale of poultry products
(Continue . . . )

The assumption right now is that Russia is dealing with a relatively low-risk (to humans, anyway) H5N8 virus, but none of the official reports I've seen specify the exact subtype. 

Also, it is not entirely clear what is behind this sudden spike in avian flu activity. Wild birds may be carrying the virus from farm-to-farm, or perhaps lateral spread - via the movement of contaminated poultry products, equipment or personnel - may be the driver. 
In all likelihood, it will turn out to be a combination of factors.  
Even after an exhaustive epidemiological investigation of the 2015 HPAI H5 epizootic in the United States - - researchers were unable to nail down a `specific pathway or pathways for the current spread of the virus’.
Regardless, we keep a close eye on these sorts of events because increased HPAI activity over the summer in Russia has previously led to outbreaks in Europe in the fall (see FAO/EMPRES: H5N8 Clade Detected Over Summer In Russia).

Stay tuned.

Tuesday, July 10, 2018

California: 11 New Outbreaks of VND In Poultry - Quarantine Ordered In 2 Counties

Quarantine Orders For San Bernardino and Riverside Counties


Since our last update on July 2nd (see California Reports 10 More Outbreaks Of Virulent Newcastle Disease In Poultry), California's Department of Food and Agriculture (CDFA) has reported 11 more outbreaks of Virulent Newcastle Disease (VND) in San Bernardino and Riverside County.

The CDFA describes Virulent Newcastle Disease as:

Virulent Newcastle Disease (VND)

Virulent Newcastle disease (VND), formerly known as Exotic Newcastle Disease, is a serious, highly contagious viral disease that can affect poultry and other birds.
In rare cases, humans that have exposure to infected birds may get eye inflammation or mild fever-like symptoms. These signs generally resolve without treatment, however, medical care should be sought if symptoms persist. Infection is easily prevented by using standard personal protective equipment.
Virulent Newcastle disease is not a food safety concern. No human cases of Newcastle disease have ever occurred from eating poultry products. Properly cooked poultry products are safe to eat.

Since May 17th, Southern California has reported at least 39 outbreaks of Virulent Newcastle Disease in backyard exhibition poultry, 37 of which have come from San Bernardino County.  One case hailed from Los Angeles, while last week, another from Riverside county.
With the pace of outbreaks increasing, and some signs of geographic spread beyond San Bernardino County, yesterday the CDFA ordered an emergency poultry quarantine for specific areas of two counties in Southern California.
The operative part of the order reads:
Required Action: Pursuant to California Food and Agricultural Code Section 9562 and Title 3, California Code of Regulations, Section 1301 et seq., require the following:

Hold the population of animals and animal products described above on the premises where it is now located.
Segregate and Isolate the population of animals and animal products described above from other animals or products no later than: 5:00 PM on July 10, 2018.
  • The method of isolation shall be confinement to one premises in a pen, cage or other means that prevents poultry from moving off the premises.
  • No poultry or hatching eggs shall be moved onto the premises and no poultry, poultry products, used poultry equipment or other items that could spread disease due to contact with poultry or poultry manure shall be moved off the premises until this quarantine is rescinded or revised; or unless the owner has signed a compliance agreement with the California Department of Food and Agriculture (CDFA) and such movement is made using a CDFA or United States Department of Agriculture (USDA) movement permit.
  • All owners shall immediately report any clinical signs suggestive of VND (described on CDFA website at and any unexpected decreases in egg production or increase in mortality (above expected rate for strain and age) by phone to the sick bird hot line at (866) 922-2473 or California State Veterinarian at (916) 900-5000.
Euthanize and Dispose of the population of poultry that cannot be isolated as described above. 
Due to the high risk of exposure to VND in the above designated disease control areas, CDFA or USDA will assist with euthanasia if poultry are free roaming and not isolated as described by 5:00 PM on July 11, 2018.

Although there is a slight risk of human infection, illness is generally mild, and usually presents as conjunctivitis. The real threat is to the poultry industry, should the virus find its way again into commercial flocks. 
According to the California Dept. of Food & Agriculture, the last outbreak in commercial poultry back in 2003 led to the depopulation of 3.16 million birds at a cost of $161 million.  Prior to that, in 1971, an outbreak in Southern California led the culling of 12 million birds.
This current outbreak is the first reported in poultry in the United States in 15 years, although detections in wild birds have occurred (cite). So far no commercial poultry operations have been affected.
You can view an updated list of cases at the USDA website:
By implementing this quarantine, the hope is a repeat of the devastating VND outbreak of 2003 - which lasted 11 months and spread into neighboring Nevada and Arizona (see CIDRAP's 2003 report Exotic Newcastle disease spreads out of California) - can be avoided.

Stay tuned.