Thursday, October 18, 2018

Bulgaria: 2 Outbreaks Of Avian Flu - Vietnam: 1 Outbreak Of H5N6














#13,606
 
Bulgaria - which has has been plagued by scattered outbreaks of HPAI H5N8 in commercial poultry throughout the summer (see here, here, here, and here) - reports two more outbreaks (of presumably H5N8) in the southern province of Haskovo today. 
While Bulgaria's bird flu woes pale compared to Russia's summer surge in HPAI H5 (see Brief ESA Report On HPAI H5N2 & H5Nx In Russia), both Bulgaria and Western Russia lie under the migratory flyways that lead from Siberia to Europe, the Middle East, and Africa.




As we move into the colder months of fall and winter, the incidence of avian flu in the Northern Hemisphere is expected to increase.


This from
Bulgaria's Food Safety Agency.

BVBH found Avian influenza in two livestock farms in the village of Voyvodovo, Haskovo municipality, Haskovo district
18.10.2018

The Bulgarian Food Safety Agency (BNSA) has identified two outbreaks of the Avian Influenza (influenza) disease in livestock farms intended for breeding broodstocks and chicken broilers located in the village of Voyvodovo, Haskovo municipality, Haskovo district. The disease was confirmed by a laboratory test report.

For the control and eradication of the disease, NVS started implementing all measures in accordance with current legislation. Humane killing and destruction of all birds kept in the affected sites is undertaken, followed by cleansing and disinfection. The 3-kilometer protection zones and 10-kilometer surveillance zones around the outbreaks have been identified. The movement of birds and their products into and out of the protection and surveillance zones is prohibited. In both areas, the marketing and movement of domestic, wild and other breeding birds and eggs, as well as the displacement of birds for the renewal of the wild game stock, are prohibited. Daily clinical examinations of birds kept in other settlements in the protection zone are performed.

Enhanced surveillance and biosecurity measures in poultry farms as well as in water basins where the wild bird population is heavily concentrated.

There is an epizootic study of the causes of the disease.

The NVS reminds that feed should be kept indoors as well as feedstocks - thus avoiding the possibility of wild feathered birds infesting the feed, and hence the hosts being infected with the virus.

At this stage there are no people affected and there is no danger to consumers. Influenza virus can cause mild respiratory disease. Possible infection can occur when inhaled contaminated farm dust or in direct contact with people with infected birds.

Meanwhile, Vietnam reports to the OIE today on another outbreak of HPAI H5N6 in poultry  - that country's 5th reported outbreak since September.  Unlike neighboring China, Vietnam has never reported a human infection with H5N6.


http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review?page_refer=MapFullEventReport&reportid=28315


South Korea Finds More Environmental AI - Clarifies H5N2 As LPAI
















#13,605

With migratory birds now arriving in South Korea on the southbound leg of their annual migration, we are starting to get reports of Avian Influenza (AI) detection in wild bird feces (see here), including one identified as H5N2.
Today in a follow up to those blogs, MAFRA reports that the H5N2 sample tested - as expected - as LPAI, along with several more AI virus samples which are being analyzed. 
The first (translated) report finds more infected feces collected in Paju, and clarifies that the H5N2 virus announced yesterday was LPAI. 
Detection of H5-type avian influenza (AI) antigen in feces of wild birds in Paju, Gyeonggi-do, Korea

2018.10.18 11:00:23

Agriculture, Forestry, Animal Husbandry and Food ( Minister : yigaeho ) is 10.8 days Jeonbuk Gunsan Mangyeong estuary and 10.15 days North Chungcheong Province Cheongju Miho Stream taken from the wild bird feces on the test results , 10.17 days H5 type AI antigen detection have been announced .

❍ According to the AI ​​Emergency Action Guideline (SOP)

① Set up a 10-km radius as "wild bird's water prospecting area," ② forecast, inspect, control and disinfect poultry and birds in the area, ③ strengthen preventive measures against nearby farms such as migratory birds and small rivers, ④ The local governments have taken preventive measures such as disinfection every day by mobilizing the anti-pollution vehicles such as the wide-area fire extinguisher.

※ It takes 3 ~ 4 days for the final judgment,

In addition, the feces of wild algae collected from the mouth of the Han River in Paju, Gyeonggi province, on October 11, were confirmed by the Ministry of Agriculture, Forestry and Livestock Quarantine Headquarters as a result of 10.17 days of low-pathogenic AI (H5N2 type).

A second (translated) report today finds more AI positive samples collected from the Southwest and center of the country. 

Detection of H5 type avian influenza (AI) antigen in feces of wild algae in Chunbuk Gunsan (Mangyeong River) and Chungbuk Cheongju (Mihocheon)
 
    2018.10.18 11:23:10 

The Ministry of Agriculture, Forestry and Livestock Food and Beverage (Minister of Agriculture and Rural Affairs) said on 10.17, H5 type AI was detected in the feces of wild algae collected from the Mt. Mangyeong River Estuary in Jeonbuk Province on Oct. 10 and Cheongju Mihocheon in Chungbuk Province on October 15.

  ❍ According to the AI ​​Emergency Action Guideline (SOP)

   ① Set up a 10-km radius as "wild bird's water prospecting area," ② forecast, inspect, control and disinfect poultry and birds in the area, ③ strengthen preventive measures against nearby farms such as migratory birds and small rivers, ④ The local governments have taken preventive measures such as disinfection every day by mobilizing the anti-pollution vehicles such as the wide-area fire extinguisher.

    ※ It takes 3 ~ 4 days for the final judgment,

The Ministry of Agriculture and Fisheries explained that AI was continuously detected in the feces of wild birds in Paju (Han river estuary), Jeonbuk Gunsan (Mangyeong River estuary) and Cheongju (Mihocheon)

  ❍ In recent years, the risk of AI has been increased due to the arrival of birds in Korea in earnest. So, the farmers and livestock facilities have been requested to thoroughly prevent the occurrence of AI.

The poultry farmers thoroughly disinfected by applying quicklime between the farm access road and the barn to prevent AI outbreaks, thoroughly check for damage to the network of the poultry house,

  ❍ Each local government and producers' group also requested that the poultry farmers strengthen their education and publicity in order to strictly adhere to the rules of prevention and abatement.

So far, South Korea hasn't reported any infected poultry this fall and Japan's Ministry of Environment hasn't reported any AI detections since last spring.


JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient

Credit WHO














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The MERS coronavirus continues to simmer in the Middle East with the latest WHO EMRO report showing 118 cases reported (through Sept 30th) in 2018.  Since 2012, 2260 conīŦrmed cases of MERS - including 803 fatalities - have been reported globally.
While MERS has yet to take off in a big way, it has proven itself to be more easily spread among humans than either of the two major avian flu viruses (H5N1, H7N9) we've been following for years. 
There are also legitimate questions over just how well surveillance systems are picking up infections, and the role - if any - of asymptomatic or mildly symptomatic cases in spreading the virus in the community.

Recently, in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients - we looked at a review by prolific MERS researcher and former KSA Deputy Minister of Health,  Ziad Memish, MD et al. of the visual triage & scoring system developed by the Saudis in 2017 to alert Health Care workers of possible MERS infection in their patients.

After evaluating the sensitivity and selectivity of this method, their conclusion:
The sensitivity and specificity of the scoring system was low and further refinement of the score is needed for better prediction of MERS-CoV infection.
The authors were particularly blunt in their assessment (bolding mine) of the current system. 
The  current  study  conducted  on  a  large  number  of  patients  shows  that  clinical  scoring  is not predictive  of  MERS  infection. 
Our  results  are  robust  and  confirm  that  MERS  cannot  be distinguished from other respiratory infections based on  risk factors  and clinical features.  Thus all  patients with  non-specific  symptoms  in  a  MERS  endemic  area  will  have  to  be  isolated  until MERS can be ruled out by rapid PCR testing.

In addition to seeing as steady stream of `community acquired' cases in KSA without a known risk exposure, we've seen other analyses that have concluded that only a fraction of MERS cases are likely diagnosed, including:
Today we've a recently published review of an atypical presentation of MERS-CoV in a previously healthy adult, who may have contracted the virus from an undiagnosed, asymptomatic (or mildly symptomatic) patient in a hospital.

I've excerpted a few passages from a much longer report. For more of the details on this case, you'll want to follow the link and read it in its entirety.

Atypical presentation of Middle East respiratory syndrome coronavirus in a Lebanese patient returning from Saudi Arabia
  • Saeed El Zein American University of Beirut Medical Center, Beirut, Lebanon
  • Jinane Khraibani American University of Beirut Medical Center, Beirut, Lebanon
  • Nada Zahreddine American University of Beirut Medical Center, Beirut, Lebanon
  • Rami Mahfouz American University of Beirut Medical Center, Beirut, Lebanon
  • Nada Ghosn American University of Beirut Medical Center, Beirut, Lebanon
  • Souha S Kanj American University of Beirut Medical Center, Beirut, Lebanon
DOI: https://doi.org/10.3855/jidc.9979 

Abstract

Around 2090 confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) from 27 countries have been reported to the World Health Organization (WHO) between September 2012 and October 2017, the majority of whom occurring in countries in the Arabian Peninsula, mainly in Saudi Arabia.
MERS- CoV can have atypical and misleading presentations resulting in delays in diagnosis and is associated with a high mortality rate especially in elderly patients with multiple comorbidities.
Herein, we present the first case of confirmed MERS-CoV infection diagnosed at the American University of Beirut Medical Center (AUBMC) - Lebanon in June 2017 presenting without any respiratory symptoms. This is the second confirmed case of MERS-CoV infection in Lebanon since 2014. The first case presented with a febrile respiratory infection with persistent symptoms despite antibiotic treatment.
(SNIP)
We report a case of MERS-CoV infection diagnosed in Lebanon, in a previously healthy patient resident of Riyadh, Kingdom of Saudi Arabia (KSA) presenting with fever and gastrointestinal symptoms.
The patient did not develop respiratory symptoms at any time throughout the course of the disease. To our knowledge, our case is the second documented case of MERS-CoV infection in Lebanon, and one of the few reported cases in the literature with complete absence of respiratory symptoms.

Case Report


The patient is a 40-year-old male, previously healthy gastroenterologist, resident of Riyadh (KSA) for the past 5 years. On June 8, 2017 while still in Riyadh, he developed high grade fever, anorexia and fatigue. At that time, a nasopharyngeal swab for MERS- CoV by Polymerase Chain Reaction (PCR) was negative.
The patient had no contact with dromedary camels and did not drink camel milk. He also had no documented contact with any confirmed MERS-CoV patients and is not practicing in a hospital with known MERS-CoV cases.
However, he reported that he examined patients returning from Mekkah for Umrah several days prior to his illness. He failed to improve on a 7-day course of oral ciprofloxacin started on June 9. The patient reported taking a 5-day course of metronidazole started on June 11 after developing diarrhea.
(SNIP)
There is still debate on the extent of infectivity of asymptomatic carriers of MERS-CoV [14]. Ongoing viral shedding for 6 weeks has been detected by PCR from an asymptomatic healthcare worker [15].
Our patient, similar to many others reported in the literature, had no direct contact with a confirmed infected case suggesting that acquisition from an asymptomatic or mildly symptomatic carrier could be an important contribution to ongoing transmission [15,16].

Interestingly, 60 new cases of MERS-CoV infection were reported to the WHO in KSA between April 21 and June 10, 38 of which being from Riyadh [17], coinciding with the period in which our patient is thought to have acquired the infection.


(SNIP)
Conclusion
 
MERS-CoV infection has a high fatality rate especially in elderly patients with multiple comorbidities. Human-to-Human transmission is well documented and asymptomatic carriers may play a big role in the transmission cycle. Our case proves that patients with confirmed MERS-CoV infection can have an atypical presentation with no respiratory symptoms making identification and adequate patient isolation a challenging task. 
It is possible that MERS-CoV is underdiagnosed in patients with the above clinical picture. Therefore, it is very important to keep a high index of suspicion in all patients who present with fever of unclear etiology and have a direct epidemiological link to a MERS-CoV endemic area even with no history of exposure to a confirmed case within the past 14 days prior to presentation. Successful diagnosis will help in early isolation of the patient to prevent potential transmission to household members, travelers and healthcare workers and to avoid unnecessary antibiotics use.
        (Continue . . . )

While MERS-CoV hasn't embarked on a global tour the way that SARS did in 2003, we've seen analyses (see Study: A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) suggesting the virus doesn't have all that far to evolve before it could pose a genuine global threat.

Earlier this year, in the WHO List Of Blueprint Priority Diseases, we saw MERS-CoV listed among the 8 disease threat in need of urgent accelerated research and development.
List of Blueprint priority diseases
(SNIP)
The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:
  • Crimean-Congo haemorrhagic fever (CCHF)
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever (RVF)
  • Zika
  • Disease X

All of which makes gaining a better understanding of how - and how well - the MERS coronavirus continues to spread in the community a high priority.

Wednesday, October 17, 2018

WHO IHR Committee Determines DRC Ebola Outbreak Is Not Currently A PHEIC


WHO Twitter Announcement
WHO Twitter Announcement





















#13,603


Earlier today the WHO convened an emergency session of their IHR Emergency Committee to determine if the ongoing outbreak of Ebola in the DRC constitutes a Public Health Emergency Of International Concern (PHEIC) - and if so, what measures to recommend. 
The designation of a PHEIC by the WHO was first proposed in the revised 2005 IHR, but the first time it was invoked was in 2009 with the H1N1 pandemic. 
While meetings have been convened several times in the past for both MERS-CoV and Yellow Fever, only 3 other PHEICs have been declared to date:
The bar for declaring a PHEIC is purposefully set pretty high, as invoking one does have some down sides, particularly in regards to travel and trade for an affected region. 
Today, after considering the pros and cons, the decision was made (for now, at least) not to declare this Ebola outbreak a Public Health Emergency Of International Concern.
It is a concern, they say, but is currently believed to be more of a regional threat than a global one.  Below you'll find an excerpt, and a link to the full WHO statement.

Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
17 October 2018

Statement

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Wednesday, 17 October 2018, from 13:00 to 17:00 Geneva time (CET).

Conclusion

It was the view of the Committee that a Public Health Emergency of International Concern (PHEIC) should not be declared at this time. But the Committee remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical. The Committee also noted the very complex security situation. Additionally, the Committee has provided public health advice below.
Proceedings of the Meeting

Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo on the epidemiological situation, the response strategies, and recent adaptations, including implementation of rapid response teams at community level, with a focus on Beni. A representative of the Office of the Deputy Special Representative of the Secretary-General (MONUSCO) reported on the work of MONUSCO, including its logistics and security activities to support the response. During the informational session, the WHO Secretariat provided an update on the situation and the response to the current Ebola outbreak and preparedness activities in neighbouring countries.

The Committee’s role was to provide to the Director-General its views and perspectives on:


  • Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
  • If the event constitutes a PHEIC, what Temporary Recommendations should be made.
 (Continue . . . . )

Follow the link to read the full statement, which includes a assessment of the Current Situation and a list of Key Challenges.


China: Shanxi Province Reports 1st ASF Outbreak - Another In Liaoning

Credit Wikipedia















#13,602

Shanxi Province becomes the 10th province, territory or region in China to report Africa Swine fever since the virus first emerged there in early August, while Liaoning Province adds yet another outbreak to its sizable lead.

Two reports today from China's MOA.


Datong investigation and the African swine fever epidemic 
Date: 2018-10-17 17:29 Author: Source: Agriculture and Rural Department of Public Information Office
  Ministry of Agriculture and Rural Press Office 10 Yue 17 released, Shanxi Province, Datong investigation and the pig disease African swine fever.

  10 Yue 17 Ri 12 , the Ministry of agriculture and rural areas to the control center reported Chinese animal epidemic prevention, the China Animal Health and Epidemiology Center (National Center for Exotic Animal Disease Research) confirmed, Shanxi Datong Zuoyun a farmers investigation the African swine fever epidemic. The farmers herds of pigs 15 heads incidence of 7 head and died 4 headers.

  After the outbreak, the Ministry of Agriculture and Rural immediately sent a steering group to the local. Started as required by local emergency response mechanism, to take the blockade, culling measures to deal with harmless treatment, disinfection, culling of all pigs died and sound processing. At the same time, prohibiting all pigs and their products to bring up the blockade zone, prohibiting the transport of live pigs blockade zone . Currently the epidemic has been effectively disposed of.

And this, the 5th outbreak in the past 3 days (see here, and here) reported from Panjin City, Liaoning Province.

Panjin City, Liaoning Province investigation and the African swine fever epidemic
Date: 2018-10-17 14:13 Author: Source: Agriculture and Rural Department of Public Information Office
  Ministry of Agriculture and Rural Press Office 10 Yue 17 released, Panjin City, Liaoning Province investigation and the pig disease African swine fever.

  10 Yue 16 Ri 20 , the Ministry of agriculture and rural areas to the control center reported Chinese animal epidemic prevention, the China Animal Health and Epidemiology Center (National Center for Exotic Animal Disease Research) confirmed, Dawa District, Panjin City, Liaoning Province, a farming town of Xi'an household investigation and the African swine fever epidemic. The farmers pig herds 161 head incidence of 43 head and died 43 headers.

  After the outbreak, the Ministry of Agriculture and Rural immediately sent a steering group to the local. Started as required by local emergency response mechanism, to take the blockade, culling measures to deal with harmless treatment, disinfection, culling of all pigs died and sound processing. At the same time, prohibiting all pigs and their products to bring up the blockade zone, prohibiting the transport of live pigs blockade zone . Currently the epidemic has been effectively disposed of.


While African Swine Fever has never been reported in North America, its recent geographic expansions in Europe and inroads into China have pork producers around the world on high alert.

This from the USDA.

African Swine Fever (ASF)

African swine fever (ASF), first described in the 1920s in Kenya, is a highly contagious hemorrhagic disease of wild and domestic suids with extremely high morbidity and mortality rates. ASF is a notifiable disease with the World Organization for Animal Health (OIE) due to its ability to spread rapidly and cause severe illness.
ASF does not pose a risk to public health. ASF is unique, as it is the only known arthropod-borne, DNA virus. The disease is endemic in Sardinia, most countries of sub-Saharan Africa, and some West African countries. Spain and Portugal eradicated ASF in the mid-1990’s; it was also eradicated from the Caribbean following outbreaks from 1977–1980.
However, the unimpeded spread of ASF through Russia, the Caucasus and recent introduction into China is cause for concern. ASF has never been reported in the United States, Canada, Australia, or New Zealand.



South Korea Testing Pathogenicity Of H5N2 Detected In Wild Bird Feces


Paju - Credit Wikipedia




















#13,601

October is the time of year when we expect to see migratory birds in the Northern Hemisphere arriving to more temperate zones after leaving their high latitude summer roosting places.
Typically, in Asia, we hear from South Korea and Japan first.
On Oct. 2nd South Korea's MAFRA Warned: South Korea's Fall Migratory Bird Season Begins, and a few days later announced that Changyeong Found H5 Virus In Wild Bird Feces, a sample that eventually proved to be a low pathogenic strain.

Low path avian influenza (LPAI) viruses are common in wild and migratory birds, and are generally considered to be low risk (there are exceptions).  Highly pathogenic (HPAI) viruses - particularly H5 & H7 subtypes - are of much greater concern.
Today, South Korea announces the detection of avian H5N2 in wild birds in the North of the country, and pathogenicity testing is underway.  Results should be available in a day or two.
LPAI H5N2 has been detected in migratory birds in South Korea before, and it will surprise no one if this sample proves to be low path as well.
But over the past year, Russia has reported a few outbreaks of a new, reassortant, HPAI H5N2 virus (see Brief ESA Report On HPAI H5N2 & H5Nx In Russia), raising the stakes for this year's fall migration. 
First the (translated) announcement from South Korea's MAFRA, and then I'll return with a postscript.
Bird Flu Infection Disaster Prevention Division Director (044-201-2551), Hwang Seong-cheol (2555) Date of Delivery: October 17th (1 copy)

In the wild bird feces of Paju (Han river estuary) in Gyeonggi-do Detection of H5N2 type avian influenza (AI) antigen
- Blocking according to the AI ​​Emergency Action Instructions (SOP)

  The Ministry of Agriculture, Forestry, Livestock and Livestock Food and Drug Administration (Minister of Agriculture and Rural Affairs) said, "According to the 'Plan for AI Surveillance Inspection in 18 years', the results of the inspection of the agricultural, forestry and livestock quarantine headquarters on the feces of wild algae collected in Paju (Han river estuary) And the antigen was detected.


  ❍ According to the AI ​​Emergency Action Guideline (SOP)

① Set up a 10-km radius as "wild bird's water prospecting area," 
② forecast, inspect, control and disinfect poultry and birds in the area, 
③ strengthen preventive measures against nearby farms such as migratory birds and small rivers,
④ The local governments have taken preventive measures such as disinfection every day by mobilizing the anti-pollution vehicles such as the wide-area fire extinguisher.
    ※ It takes 1 ~ 2 days for the final judgment, such as whether the disease is highly pathogenic.
 
With this fall's bird migration already well underway across the Northern Hemisphere we'll be watching Asia, Europe, and North America closely for any signs of the return of HPAI clade 2.3.4.4. H5Nx or the arrival of any new H5 or H7 reassortant viruses.



In truth - like with seasonal flu - we never know what kind of avian flu season we're going to see until its over.  In 2014/15, the United States saw its worst avian epizootic in history, but since then it has been pretty quiet. 
Over the winter of 2016/17, it was Europe's turn, with more than 2000 farms hit by HPAI H5Nx.  
The last 18 months have been remarkably quiet on the migratory bird front, and while poultry producers are hoping for a repeat this winter, recently the OIE urged better biosecurity in backyard flocks to counter bird flu threat.

Stay tuned.