Thursday, June 21, 2018

Bulgaria To Recall 1 Million Eggs Due To HPAI H5N8

Credit Wikipedia













#13,376


About this time last summer we were following the considerable efforts of Russia's Federal Service for Veterinary and Phytosanitary Surveillance (Rosselkhoznadzor) to locate tons of HPAI Contaminated Poultry That Had Been Shipped To At Least 9 Regions Of Russia.
Even had bird flu contaminated products been consumed by the public, the risk of human infection was very low (particularly since the virus was H5N8).
But if live birds (or eggs) had been sent to other poultry facilities, or poultry products (meat or eggs) were disposed of improperly (where birds and wildlife could get at them), then there were legitimate concerns of seeing the virus spread further.

Last week, in Bulgarian Food Safety Agency Reports Avian Flu At Poultry Farm In Dobrich, we saw reports from Bulgarian Agency For Food Safety of an outbreak in Dobrich, a region which had been hit last March as well.
A follow up report last Friday indicated that a recall of eggs from the newly affected farm would be ordered, and that about 35,000 birds would be destroyed. 
Today, we've an official report estimating the number of eggs to be recalled at over a million, and unofficial media reports that 330,000 birds will now be destroyed.
While we await an OIE report, the FAO is reporting this outbreak is due to HPAI H5N8.
First this (translated) statement from the Bulgarian Agency For Food Safety.

Downloaded eggs pose no risk to public health 
20.06.2018
 
The disease Influenza ( "flu") influenza is a highly contagious viral disease in birds. The disease has two forms (H5 and H7), which differ in their ability to infect:

  • Low pathogenic usually causes mild symptoms, often, but not always show clear signs of infection (remains "hidden");
  • Highly pathogenic form spreads rapidly and causes very high mortality rates in most poultry species. This form of the virus causes serious consequences and enormous financial losses to poultry.
The virus of avian influenza has the opportunity for rapid mutation (change) and switching from low pathogenic to highly.

For these reasons, early detection of infection in poultry and their rapid destruction is a key element of control to prevent the spread of infection in the country.

To prevent the spread of infection, creating restricted zones, prohibited the movement of poultry and the use of products liable to be contaminated, are enhanced biosecurity measures at all levels of poultry production (cleaning and disinfection of the infected holdings) performed surveillance (clinical examination and sampling, if necessary) the holdings in containment areas.

Measures to combat disease applied in a proportionate and flexible manner, taking into account different levels of risk of infection caused by various forms of the virus, the likely social and economic impact on the agricultural sector and the risk to public health and animal health.

Since early 2018 confirmed 11 outbreaks of bird flu - two on farms for laying hens and 9 in duck farms.

The latest outbreak was found on 13/06/2018 on a farm for laying hens.

Within the eradication of the outbreak and limiting the spread of the virus, NVS is condemned and withdrawn more than 1 041 220 the number of eggs that will be targeted for destruction.
Since the egg recall goes back nearly a month, there is a good chance some have already been sold to and consumed by the public, hence the safety reassurances from the Bulgarian authorities.

While I haven't seen an official statement on the number of birds to be culled, a media report from btvnovinite.bg - based in part on a TV interview with Dr. Kremena Stoeva of the Bulgarian Agency for Food Safety (NVS) - indicates that number has now risen to over 300,000. 


Outbreak of bird flu in Dobrich, 320 thousand. Chickens will be culled 

The market again will be downloaded over 1 million. Eggs

Posted at 8:15 PM. On 21/06/2018

Outbreak of bird flu was discovered in Dobrich - village Donchevo. Holding in which the infection has been established is the largest producer of eggs in the country. It was decided that about 320,000 laying hens will be killed and all eggs produced after May 23 - to be destroyed.
Market pull batch numbers: 2BG08001 and 3BG08001. It's about more than 1 million. Pieces.

Since the beginning of the year, here are 11 confirmed outbreaks of bird flu - two on farms for laying hens and 9 in duck farms.

To prevent the spread of infection in Dobrich, locals are advised to keep poultry indoors. The feed also is not open.

From health inspection in Dobrich said for bTV, none of the workers on the farm, which was established bird flu, has not sought medical attention.

(Continue . . . )

After a relatively quiet spring, over the past 10 days we've seen an uptick in the number of avian flu reports, particularly across Europe and Russia.  Nothing dramatic, but certainly noticeable.

Yesterday morning's blog Russia Reporting Avian Flu Outbreaks In Samara, Penza & Kursk Regions, was further quantified a few hours later by an OIE report, detailing 16 new outbreaks in Russia.


Credit OIE
That OIE report  lists these outbreaks as HPAI H5, and does not provide a full subtype. While H5N8 seems a good bet, last December Russia reported an unusual outbreak of HPAI H5N2, and HPAI H5N6 has been reported in both Europe and Asia.
None of this tells us what kind of avian flu season Europe can expect next fall, but it is a reminder that a variety of HPAI H5 viruses continue to circulate in the wild across much of Europe and Asia.
And that last winter's welcomed lull in poultry and wild bird outbreaks isn't guaranteed to last.


Wednesday, June 20, 2018

National Academy Of Sciences: Biodefense in the Age of Synthetic Biology













#13,375


Just over a month ago Johns Hopkins held a day-long pandemic table-top exercise (see CLADE X: Archived Video & Recap), with former and current government officials playing the roles of the President's National Security advisory team, as a pandemic scenario unfolded.
The virus used for this exercise was a bio-engineered parainfluenza-Nipah virus hybrid, unleashed on the world by a fictitious radical terrorist group.
A scenario not so very different from 2015's Blue Ribbon Study Panel Report on Biodefense, where a bi-partisan panel described a fictional biological attack on Washington D.C. using a genetically engineered Nipah virus as part of their presentation.

Although nature may be the most prolific bio-terrorist, the past decade has seen a huge proliferation of the type of knowledge and a dramatic drop in the cost and complexity of the kind of lab equipment that one would need to create, or enhance, a pandemic virus.  
What a few short years ago would have required the resources of a technologically advanced nation state, can be accomplished today on a far more modest budget. 
And as the costs go down for these sorts of technologies in the years ahead, the odds that some group with a radical agenda will use them to create a `better' bug will only increase.Yesterday's implausible science fiction plots have an unnerving way of becoming tomorrow's fait accompli.

With that in mind, scientists have been working for years on ways to counter the triple threats of a biological attack, an accidental release, or naturally occurring pandemic with a highly pathogenic biological agent.
Yesterday the National Academies of Sciences published a 234 page PDF on the rapidly advancing state of the science of synthetic biology and our growing vulnerability to synthetic or enhanced bio-agents.
Despite its impressive pedigree and voluminous content, anyone expecting to find easy solutions to these complex and continually changing threats will come away disappointed.

As the authors write:
`. . . because it was outside of the study’s scope to consider all of the mitigation options available to the defense enterprise, the report does not make comprehensive, explicit recommendations regarding mitigation approaches.'
The full report may be downloaded (for free) as a PDF file from www.nap.edu. While I've not had time to do more than glance at this lengthy study, a press release (below) describes the report.
June 19, 2018

FOR IMMEDIATE RELEASE

If Misused, Synthetic Biology Could Expand the Possibility of Creating New Weapons; DOD Should Continue to Monitor Advances in the Field, New Report Says
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24890&_ga=2.34910051.374787785.1529515752-1675346060.1529515752

WASHINGTON – Synthetic biology expands the possibilities for creating new weapons — including making existing bacteria and viruses more harmful — while decreasing the time required to engineer such organisms, concludes a new report by the National Academies of Sciences, Engineering, and Medicine.  Although some malicious applications of synthetic biology may not seem plausible right now, they could become achievable with future advances.

Synthetic biology, a field that creates technologies for engineering or creating organisms, is being used for a variety of purposes that benefit society. Applications include treating diseases, improving agricultural yields, and remediating pollution.  Even though synthetic biology holds great promise in many areas, it is possible to imagine harmful uses that could threaten U.S. citizens and military personnel.  To better prepare for potential misuse, the National Academies were asked by the U.S. Department of Defense (DOD) to develop a framework for evaluating security concerns related to advances in synthetic biology. The task included assessing the levels of concern warranted for such advances, and recommending potential options to anticipate and respond to such threats.

“In and of itself, synthetic biology is not harmful.  The level of concern depends on the specific applications or capabilities that it may enable,” said Michael Imperiale, Arthur F. Thurnau Professor of Microbiology and Immunology at the University of Michigan and chair of the committee that conducted the study and wrote the report.  “The U.S. government should pay close attention to this rapidly progressing field, just as it did to advances in chemistry and physics during the Cold War era.”

In its interim report, the committee proposed a strategic framework to identify and prioritize potential areas of concern associated with the field and to help biodefense analysts as they consider the current and future synthetic biology capabilities.  The framework is designed for analyzing existing biotechnology tools in order to evaluate the dangers at present, understand how various technologies compare with and complement each other, and assess the implications of new experimental outcomes.

In the final report, the committee used this framework to analyze potential vulnerabilities enabled by synthetic biology.  The results were based on the availability and ease of use of the technologies, the challenges of producing an effective weapon, the expertise and resources required to carry out an attack, and both proactive and reactive measures that might be taken to help mitigate the effects of an attack.  The committee ranked the synthetic biology capabilities from highest relative level of concern to lowest in the figure below.

The report emphasizes that many of the traditional approaches of biological and chemical defense will be relevant to synthetic biology-enabled threats, but the field will also present new challenges.  DOD and its partners should continue to explore strategies that can be applied to a wide range of threats and also to account for broader capabilities enabled by the field now and in the future.  Since synthetic biology-enabled weapons might be unpredictable and hard to monitor or detect, DOD should consider evaluating how the public health infrastructure needs to be strengthened to adequately recognize a potential attack.

“It’s impossible to predict when specific enabling developments will occur; the timelines would depend on commercial developments as well as academic research, and even converging technologies that may come from outside this field,” added Imperiale.  “So it is important to continue monitoring advances in synthetic biology and other technologies that may affect current bottlenecks and barriers, opening up more possibilities.”

The study was sponsored by DOD.  The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.  The National Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.  For more information, visit http://national-academies.org.

Contacts:
Riya V. Anandwala, Media Relations Officer
Andrew Robinson, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail news@nas.edu

Social Media:
Follow us on Twitter: @theNASEM
Follow us on Instagram: @theNASEM
Follow us on Facebook: @NationalAcademies

Video: Senate Subcommittee Hearing On The State of U.S. Public Health Biopreparedness

https://energycommerce.house.gov/hearings/the-state-of-u-s-public-health-biopreparedness-responding-to-biological-attacks-pandemics-and-emerging-infectious-disease-outbreaks/














#13,373


The full name of the Energy and Commerce Subcommittee hearing, held on June 15th is:

The State of U.S. Public Health Biopreparedness: Responding to Biological Attacks, Pandemics, and Emerging Infectious Disease Outbreaks

And it features a stellar panel of experts whose names are no doubt familiar to most of my readers:

Dr. Rick A. Bright
Director, Biomedical Advanced Research and Development Authority; Deputy Assistant Secretary, Office of the Assistant Secretary for Preparedness and Response

Dr. Anthony Fauci
Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health

Rear Admiral Denise Hinton
Chief Scientist, U.S. Food and Drug Administration

Dr. Anne Schuchat
Principal Deputy Director, Centers for Disease Control and Prevention

The video is clocked at 2hrs and 12 mins, but the hearing doesn't get started until about 15 minutes in, and the opening 20 minutes are consumed by opening statements by subcommittee members, so the actual testimony doesn't begin until nearly nearly the 40 minute mark.

Much of this hearing was devoted to the handover of control of the Strategic National Stockpile (for background see Webinar: The Strategic National Stockpile) from the CDC to the HHS's Assistant Secretary for Preparedness and Response (ASPR), and progress reports on vaccine development and point of care diagnostics.
But just over an hour into the video, each of the panel members was asked what biological threat keeps them up at night.  Not surprisingly influenza - or an influenza-like pandemic virus (i.e. SARS, MERS, etc.) - was at or near the top of many of their lists. 
While more than cordial, there were some tough questions asked of the panel, and it is always good to see how the real experts are assessing the current threat environment.

The full video (and accompanying documents) may be viewed at this link.


Russia Reporting Avian Flu Outbreaks In Samara, Penza & Kursk Regions














#13,373


While it isn't all that unusual to see avian flu activity in Russia during the spring and summer, the past five months have been unusually quiet, with nothing reported out of Russia since a large HPAI H5N2 outbreak was announced last December.
That is, until last week. 
In Rosselkhoznadzor & OIE: HPAI H5 Reported In Kursk Oblast, we learned of at least two outbreaks of an HPAI H5 virus (full subtype not yet identified) in Kursk Oblast.
The first in a small backyard flock in the village of N. Grayvoronka, and the second involved carcasses of poultry (chickens), found in the forest belt Ryshkovskogo.
While the Kursk Oblast office of Rosselkhoznadzor hasn't posted an update since June 14th, Russian media continues to report continued avian flu activity in the region, including this report from TASS.
In the Kursk region registered the third hearth of bird flu In the country

June 19, 18:12 UTC + 3


The governor of the region Alexander Mikhailov signed a decree on the introduction of quarantine in the district where the identified disease foci


Kursk, 19 June. / TASS /. Experts have registered the third focus of avian influenza in the territory of Kursk region. This was reported by TASS on Tuesday in the regional veterinary administration.

"At the moment we have [the flu outbreak of bird] in the Soviet area - two personal subsidiary farms in the same locality, in the Kursk region - a waste of bird carcasses, and the third case - the village Vasilevka This is also the Soviet area, but another location." , - said the source.

Experts have identified the first influenza virus hotbed of avian type A subtype H5 in the Kursk region last week in pathological material taken from dead chickens and ducks in a private farm in the village of Lower Grayvoronke Soviet area, the second - on the territory of the village council shelterbelts Ryshkovskogo Kursk region.


(Continue . . . )

Announced in just the last couple of hours - from the Federal Service for Veterinary and Phytosanitary Surveillance (Rosselkhoznadzor) of the Chelyabinsk region - are reports of fresh outbreaks of avian flu in both Samara and Penza, both of which lie several hundred miles to the west of Chelyabinsk.
Cases of bird flu in the Samara and Penza regions

Office of Rosselkhoznadzor for the Chelyabinsk region informs that on 16 and 17 June in the pathological material taken from the fallen poultry contained in private farms in Bolsheglushitsky district of the Samara region and Kolyshleysky District Penza region highlighted the genetic material of the virus avian influenza.

In Bolsheglushitsky district of the Samara region and Kolyshleysky District Penza Oblast cases poultry deaths recorded contained in private farms. Also Kolyshleysky District Penza Oblast cases deaths recorded turkey, contained in the Company 'PenzaMolInvest "at the site of rearing and fattening. Laboratory confirmed that the isolated genetic material of the virus avian influenza.

In areas all measures are taken to prevent the spread of avian influenza.

Recall that the avian influenza - a highly contagious, acute viral proceeding affecting agricultural, commensal and wild birds disease affecting the respiratory and gastrointestinal tracts. Avian influenza is able to take the form of epizootic diseases, causing massive population coverage and having widespread. In unfavorable aviary suspicious diseased and disease in poultry discarded kill bloodless manner and utilized. Apparently healthy livestock are killed for meat. In the case of visiting poultry farms (farms) bird flu, caused by the highly pathogenic virus, introduced stringent sanitary operation of the economy.

In the Chelyabinsk region avian influenza was detected in 2005. Then killed 480 birds, 500 more were killed in the village of Oktyabrsky Oktyabrsky district.

Curiously, as of this writing,  I can find no mention of these outbreaks on either the main Rosselkhoznadzor website, or on the Samara or Penza local web portals.

Since avian flu activity during the summer in Russia has previously been linked to seeing increased outbreaks in Europe later in the year (see FAO/EMPRES: H5N8 Clade 2.3.4.4 Detected Over Summer In Russia), we pay attention to these types of events.
After several months of quiescence, over the past week we've seen a bit of a surge in avian flu reports in the Northern Hemisphere; specifically in Bulgaria, Northern Ireland, and now multiple locations in Russia



A subtle reminder that with the constant migration and mixing of potentially infected birds around the globe, that avian flu viruses have the ability to pop up when and where you least expect them. 

And that biosecurity against poultry diseases is now - out of necessity - a year-round endeavor.

June 19, 18:12 UTC + 3

The governor of the region Alexander Mikhailov signed a decree on the introduction of quarantine in the district where the identified disease foci

Share
Kursk, 19 June. / TASS /. Experts have registered the third focus of avian influenza in the territory of Kursk region. This was reported by TASS on Tuesday in the regional veterinary administration.
"At the moment we have [the flu outbreak of bird] in the Soviet area - two personal subsidiary farms in the same locality, in the Kursk region - a waste of bird carcasses, and the third case - the village Vasilevka This is also the Soviet area, but another location." , - said the source.
Experts have identified the first influenza virus hotbed of avian type A subtype H5 in the Kursk region last week in pathological material taken from dead chickens and ducks in a private farm in the village of Lower Grayvoronke Soviet area, the second - on the territory of the village council shelterbelts Ryshkovskogo Kursk region. In connection with the incident, the governor of the region Alexander Mikhailov signed a decree on the introduction of quarantine areas in the territory, providing increased control of all poultry farms, operating in closed mode, as well as the number of poultry, which is contained in private farms.


Подробнее на ТАСС:
http://tass.ru/v-strane/5304803

n the Kursk region registered the third hearth of bird flu

June 19, 18:12 UTC + 3

The governor of the region Alexander Mikhailov signed a decree on the introduction of quarantine in the district where the identified disease foci

Share
Kursk, 19 June. / TASS /. Experts have registered the third focus of avian influenza in the territory of Kursk region. This was reported by TASS on Tuesday in the regional veterinary administration.
"At the moment we have [the flu outbreak of bird] in the Soviet area - two personal subsidiary farms in the same locality, in the Kursk region - a waste of bird carcasses, and the third case - the village Vasilevka This is also the Soviet area, but another location." , - said the source.
Experts have identified the first influenza virus hotbed of avian type A subtype H5 in the Kursk region last week in pathological material taken from dead chickens and ducks in a private farm in the village of Lower Grayvoronke Soviet area, the second - on the territory of the village council shelterbelts Ryshkovskogo Kursk region. In connection with the incident, the governor of the region Alexander Mikhailov signed a decree on the introduction of quarantine areas in the territory, providing increased control of all poultry farms, operating in closed mode, as well as the number of poultry, which is contained in private farms.


Подробнее на ТАСС:
http://tass.ru/v-strane/5304803

DAERA: 2nd Wild Bird Confirmed With HPAI H5N6 At Lurgan Park in Northern Ireland

2018 H5N6 Reports - Northern Ireland








#13,372


Last Friday, in DAERA: H5N6 Confirmed In Wild Bird In Northern Ireland, we learned of the recovery of a dead greylag goose from Lurgan Park in County Armagh, N.I. that has tested positive for HPAI H5N6.
This location holds some significant because earlier this month, Lurgan Park was also the site of a large agricultural show (see Crowds flock to Lurgan park as farming show celebrates 106th year), which included many animal exhibits, including poultry. 
All of which makes yesterday's announcement by DAERA of a second infected greylag goose found in that park worth noting. According to a report in Farming Life, DAERA representatives met with local poultry industry representatives after the first case was announced last week.

The OIE Report on the first bird, reported last week, gives a date of the start of the outbreak as June 14th, but it isn't entirely clear when the bird was recovered, or likely died.
While we've seen no sign of sick or infected poultry linked to this agricultural show, the Chief Veterinary Officer for Northern Ireland is urging all bird keepers to be vigilant, and to review their biosecurity.
This is only the third wild bird with HPAI H5N6 detected in Northern Ireland this year (see chart at top of blog), but it is a reminder that the virus continues to circulate in the wild, even well into summer.

Chief Vet stresses importance of biosecurity and vigilance against avian flu

Date published: 19 June 2018

The Department of Agriculture, Environment and Rural Affairs (DAERA) today confirmed that a second wild greylag goose, found in Lurgan Park, County Armagh, has tested positive for H5N6 Avian Influenza. The second goose, like the first, was reported to DAERA as part of its dead wild bird surveillance programme, and was submitted for testing at the Agri-Food and Biosciences Institute (AFBI), where initial testing has indicated avian influenza, sub-type H5N6.
The Chief Veterinary Officer for Northern Ireland, Dr Robert Huey, said: “This latest case in a wild bird further emphasises the requirement for all bird keepers to remain vigilant and to critically review their biosecurity measures, for example, feeding and watering birds under cover to help reduce the risk of their poultry coming in contact with wild birds. It is important that flock keepers report early any suspicions of disease.

“While it is not unexpected to find another case of avian flu in a wild bird in close proximity to the confirmed case of last week, and the risk to poultry remains low, it is important that flock keepers remain vigilant and it is essential that we take the necessary steps to protect our poultry industry, international trade and the wider economy.

“I continue to encourage strongly all bird keepers to register their flocks. This will ensure they receive the latest information from the Department and also allow them to be contacted in an avian disease outbreak enabling them to protect their flock at the earliest opportunity. I would also encourage bird keepers to subscribe to the Avian Influenza text service by simply texting: ‘BIRDS’ to 67300”.

Bird keepers visiting waterfowl sites such as lakes and ponds should also take measures to prevent disease spread to back yard flocks through contamination of footwear with wild bird faeces.

Advice from the Public Health Agency is that the risk to public health from the virus is very low, however, the general public is advised to take appropriate biosecurity precautions before touching or picking up birds that are dead, or appear to be sick or dying. Further advice can be found on the DAERA website.

The Food Standards Agency has confirmed that Avian Influenza does not pose a food safety risk for UK consumers. Thoroughly cooked poultry and poultry products, including eggs, are safe to eat.

Members of the public are encouraged to report dead waterfowl (swans, geese or ducks) or gulls, or five or more dead wild birds of other species in the same location, to the DAERA helpline on 0300 200 7840, Mon-Fri 9.00am to 5.00pm.

Tuesday, June 19, 2018

Neuroinfluenza: A Review Of Recently Published Studies

















#13,371

Although primarily a self-limiting infection of the respiratory tract, for a small subset of cases - most often among children - influenza can present with a variety of subtle, and sometimes profound, neurological symptoms.
 
Credit CDC 2018 COCA Call On Severe Influenza

The exact mechanisms behind these neurological manifestations are unknown, as seasonal flu viruses are generally regarded as being non-neurotropic. But some researchers have suggested that these neurological symptoms may be due to neuroinflammation induced by the host's immune response.
That said, we have seen evidence that some influenza viruses - particularly novel flu types - can be more neuroaffective than others.
In 2009, a PNAS study (link below) found that the H5N1 virus was highly neurotropic in lab mice, and in the words of the authors `could initiate CNS disorders of protein aggregation including Parkinson's and Alzheimer's diseases’.
Highly pathogenic H5N1 influenza virus can enter the central nervous system and induce neuroinflammation and neurodegeneration
In 2015, after the death of the first imported H5N1 case in Canada, we saw a study (see CJ ID & MM: Case Study Of A Neurotropic H5N1 Infection - Canada), where the authors wrote: `These reports suggest the H5N1 virus is becoming more neurologically virulent and adapting to mammals'.
 
In a Scientific Reports study on the genetics of the H5N1 clade 2.3.2.1c virus - Highly Pathogenic Avian Influenza A(H5N1) Virus Struck Migratory Birds in China in 2015 – the authors warned of its neurotropic effects, and that it could pose a ` . . . significant threat to humans if these viruses develop the ability to bind human-type receptors more effectively.'
Far less certain are the long-term neurological impacts of severe (or repeated) influenza infections, although we've seen studies suggesting links to Parkinson's, Schizophrenia, and even Alzheimer's  (see Nature Comms: Revisiting The Influenza-Parkinson's Link). 
We last looked this topic in February, in JNeurosci: Another Study On The Neurocognitive Impact Of Influenza Infection, where we saw a study from the Technical University of Braunschweig, which found long-term neurocognitive impairment in mice following infection with specific types (H3N2 & H7N7) of influenza viruses - but not in others (H1N1).
Obviously, not-so-good news if you are a mouse, but how relevant these results are for humans remains an open question. 
Since February several new studies have been published on this topic, and so today a brief review, with links and excerpts.  I'll return with a bit more at the end. 
(Note: Although published in February,  the first study (below) was made available online in 2017).
Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study)
Paksu, M.S., Aslan, K., Kendirli, T. et al. Childs Nerv Syst (2018) 34: 335. https://doi.org/10.1007/s00381-017-3554-3
Abstract

Purpose

Although influenza primarily affects the respiratory system, in some cases, it can cause severe neurological complications. Younger children are especially at risk. Pediatric literature is limited on the diagnosis, treatment, and prognosis of influenza-related neurological complications. The aim of the study was to evaluate children who suffered severe neurological manifestation as a result of seasonal influenza infection.

Methods

The medical records of 14 patients from six hospitals in different regions of the country were evaluated. All of the children had a severe neurological manifestations related to laboratory-confirmed influenza infection.

Results

Median age of the patients was 59 months (6 months—15.5 years) and nine (64.3%) were male. Only 4 (28.6%) of the 14 patients had a comorbid disease. Two patients were admitted to hospital with influenza-related late complications, and the remainder had acute complication.
The most frequent complaints at admission were fever, altered mental status, vomiting, and seizure, respectively. Cerebrospinal fluid (CSF) analysis was performed in 11 cases, and pleocytosis was found in only two cases. Neuroradiological imaging was performed in 13 patients. The most frequent affected regions of nervous system were as follows: cerebellum, brainstem, thalamus, basal ganglions, periventricular white matter, and spinal cords. Nine (64.3%) patients suffered epileptic seizures. Two patients had focal seizure, and the rest had generalized seizures. Two patients developed status epilepticus. Most frequent diagnoses of patients were encephalopathy (n = 4), encephalitis (n = 3), and meningitis (n = 3), respectively.
The rate of recovery without sequelae from was found to be 50%. At discharge, three (21.4%) patients had mild symptoms, another three (21.4%) had severe neurological sequelae. One (7.1%) patient died. The clinical findings were more severe and outcome was worse in patients < 5 years old than patients > 5 years old and in patients with comorbid disease than previously healthy group.

Conclusion

Seasonal influenza infection may cause severe neurological complications, especially in children. Healthy children are also at risk such as patients with comorbid conditions. All children who are admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications even if their respiratory complaints are mild or nonexistent.

Our next study comes from the journal Brain Development.

Influenza-associated neurological complications during 2014–2017 in Taiwan
Li-Wen Chen, Chao-Ku Teng, Yi-Shan Tsai, Jieh-Neng Wang, Yi-Fang Tu, Ching-Fen Shen,  Ching-Chuan Liu
Introduction

Seasonal influenza-associated neurological complications had high mortality and morbidity rates in recent studies. We reported influenza-associated encephalitis/encephalopathy in children during 2014–2017 in Taiwan, focusing on neurological presentations, neuroimaging correlations, and critical care managements.

Materials/Subjects

During January 1st 2014 to June 30th 2017, pediatric patients reported to the Taiwan Centers for Disease Control surveillance system for severe complicated influenza infections in the hospital were retrospectively reviewed. Children with influenza-associated encephalitis/encephalopathy were inspected for clinical presentations, laboratory data, neuroimaging studies, treatment modalities, and neurological outcomes.

Results

Ten children with median age 5.9 years were enrolled for analysis. Influenza-associated encephalitis/encephalopathy appeared in the spring and summer, with a delayed peak comparing with the occurrence of pneumonia and septic shock.
The neurological symptoms developed rapidly within median 1 day after the first fever episode. All patients had consciousness disturbance. Seven patients (70%) had seizures at initial presentation, and six of them had status epilepticus. Anti-viral treatments were applied in all patients, with median door-to-drug time 0.9 h for oseltamivir and 6.0 h for peramivir. Multi-modality treatments also included steroid pulse therapy, immunoglobulin treatment, and target temperature management, with 85.2% of the major treatments administered within 12 h after admission.
Nine of the ten patients recovered without neurological sequelae. Only one patient had epilepsy requiring long-term anticonvulsants and concomitant cognitive decline.

Conclusions

In highly prevalent area, influenza-associated encephalitis/ encephalopathy should be considered irrespective of seasons. Our study suggested the effects of timely surveillance and multi-modality treatments in influenza-associated encephalitis/encephalopathy.


While influenza-related neurological complications are most often reported in children, adults are not necessarily immune, as reported in the following two studies. 
Acute necrotizing encephalopathy in an adult with influenza A infection
Nobuaki Ochi,1 Kento Takahashi,2 Hiromichi Yamane,1 and Nagio Takigawa1

Abstract


Acute necrotizing encephalopathy following influenza infection is a rapidly progressing disease with high morbidity. Although the neurological disorder is sometimes reported in children, it is very rare in adults.
We herein describe an adult with acute necrotizing encephalopathy captured on a series of brain magnetic resonance images. A 55-year-old man had fever and impaired consciousness. He was diagnosed with influenza A (H1N1). Brain magnetic resonance imaging revealed symmetrical lesions in the cerebellum and basal nucleus, showing typical acute necrotizing encephalopathy. Physicians should know that influenza-associated acute necrotizing encephalopathy can occur even in middle-aged adults.
(Continue . . . )

And finally, this study from the Indian Journal of Critical Care Medicine.
Adult Influenza A (H1N1) Related Encephalitis: A Case Report
Devinder Midha, Arun Kumar, Pratibha Vasudev, Zafar Ahmad Iqbal, and Amit Kumar Mandal
Abstract

The year 2009–2010 saw H1N1 influenza outbreaks occurring in almost all countries of the world, causing the WHO to declare it a pandemic of an alert level of 6. In India, H1N1 influenza outbreaks were again reported in late 2014 and early 2015. Since then, sporadic cases of H1N1 influenza have been reported.
H1N1 influenza usually presents itself with respiratory tract symptoms. In a minority of patients, abdominal symptoms may occur as well. Acute influenza-associated encephalopathy/encephalitis mostly occurs in the pediatric population, whereas in adults, it is a rare complication. The incidence of neurological complications appears to have increased after the 2009 H1N1 influenza A virus pandemic.
We would like to draw attention to an adult patient case who initially presented with respiratory symptoms but then deteriorated and developed encephalitis, which is rarely reported. As per literature reviewed by Victoria Bangualid and Judith Berger on PubMed, only 21 cases of neurological complications were found in adult influenza A patients, out of whom 8 had encephalopathy.
(Continue . . . )

Despite the mounting evidence, the neurological impacts of influenza are still largely unappreciated by the public, and even by a lot of doctors, and therefore cases likely go under reported.
It may also turn out that some, if not most, of the reported behavioral problems which have been previously (and tentatively) linked to the use of oseltamivir (aka Tamiflu) may have more do to with the neurocognitive effects of influenza infection than from taking the drug. 
But most of all, these studies - along with others, like NEJM: Acute Myocardial Infarction After Laboratory-Confirmed Influenza Infection and Eur. Resp.J.: Influenza & Pneumonia Infections Increase Risk Of Heart Attack and Stroke - are reminders that influenza is a far more complex, and far more dangerous, virus than most people give it credit for.

Something to seriously consider when you are deciding whether to bother getting that flu shot next fall.