Saturday, February 28, 2015

CDC H5 Avian Flu Update

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Major Global Migratory Flyways – Credit FAO

 

# 9766

 

Although currently a far greater concern to poultry producers than to public health, we’ve been watching the first incursion of HPAI (Highly Pathogenic Avian Influenza) Eurasian H5 viruses into North America over the past few months, as has the CDC.  

 

Until November of last year, HPAI H5N8 had been essentially a threat only to East Asia.

 

It first appeared in Korea in January of 2014, was carried to Japan by migratory birds that spring (and again last fall), and had been reported in North Eastern China.  While it recently has produced a massive outbreak in Taiwan - it had not strayed outside of the far northern half of the East Asian Flyway.

 

At least, not until early November when it abruptly showed up at a German poultry farm (see Germany Reports H5N8 Outbreak in Turkeys), which was quickly followed by reports in the Netherlands, the UK, and eventually even Italy and (this week) Hungary. 

 

Remarkably, H5N8 had travelled farther in a matter of a few months than its H5N1 cousin had managed to do over several years. A history we looked at three months ago in  H5N8: A Case Of Deja Flu?

 

It was only few weeks later that British Columbia reported an outbreak of HPAI H5N2 (see Fraser Valley B.C. Culling Poultry After Detecting H5 Avian Flu), followed two weeks later by the announcement from OIE/APHIS: HPAI H5N8 & H5N2 Detected In Washington State Wild Birds.

H5N8 had done in less than a year what H5N1 has yet to do since it re-emerged in 2003; it crossed oceans and got a foothold in North America.

 

And once here, it has managed to successfully reassort with North American (NA) avian influenza viruses, producing new, highly pathogenic subtypes. In short order wild and migratory birds in six western states (Washington, California, Oregon, Idaho, Utah & Nevada) were discovered to be carrying these viruses (see Oregon Quarantines Another Backyard Flock Over HPAI).

 

The USDA maintains an Avian Flu Information page where they post the latest news:

Avian Influenza Disease

Last Modified: Feb 25, 2015

A Threat to U.S. Poultry
 

Worldwide, there are many strains of avian influenza (AI) virus that can cause varying degrees of clinical illness in poultry. AI viruses can infect chickens, turkeys, pheasants, quail, ducks, geese and guinea fowl, as well as a wide variety of other birds. Migratory waterfowl have proved to be a natural reservoir for the less infectious strains of the disease.

AI viruses can be classified as highly pathogenic (HPAI) or low pathogenic (LPAI) strains based on the severity of the illness they cause. HPAI is an extremely infectious and fatal form of the disease that, once established, can spread rapidly from flock to flock and has also been known to affect humans.  LPAI typically causes only minor illness, poses no risk to human health, and sometimes manifests no clinical signs.  However, some LPAI virus strains are capable of mutating under field conditions into HPAI viruses.

USDA’s Animal and Plant Health Inspection Service (APHIS) works to keep HPAI from becoming established in the U.S. poultry population.

(Continue . . . )

 

The good news is, thus far, we’ve seen no evidence of a serious threat to human health from these viruses, but the CDC remains cautious and has issued specific guidance documents (see CDC Interim Guidance For Testing For Novel Flu  & CDC Interim Guidance On Antiviral Chemoprophylaxis For Persons With Exposure To Avian Flu).

 

With Avian flu on the move again, and with serious outbreaks involving humans both in China and Egypt, the bird flu threat is once again making public health headlines (see WHO Warns On Evolving Influenza Threat). Late this week the CDC posted the following statement on H5 viruses in North American birds.

 

Avian Flu Update: H5 Viruses Detected Among U.S. Domestic and Wild Birds

Recent detections of highly pathogenic avian influenza H5 infections in U.S. domestic and wild birds pose a low risk to human health at this time according to the Centers for Disease Control and Prevention. In December 2014, the United States Department of Agriculture (USDA) first detected H5 avian viruses in wild birds in Washington state. Since that time, additional infections in birds with highly pathogenic avian influenza A H5N2, H5N8 viruses and with a newly identified H5N1 virus have been reported in the western states of California, Idaho, Oregon, Utah, Washington and Nevada. No human infections with these viruses have been reported to date.

Avian influenza (Bird flu) is a viral disease of birds. Migratory waterfowl and shore birds may carry avian influenza viruses that do not usually make them sick. Avian influenza viruses can be classified as either “low pathogenic” avian influenza viruses or “highly pathogenic” avian influenza viruses (HPAI), based on molecular characteristics and the ability of the virus to cause disease in birds. HPAI viruses can cause severe illness and death in birds, particularly in domestic poultry.

In general human infections with avian influenza viruses are rare and most often occur after people are in direct or close contact with an infected bird. Illnesses in humans from avian influenza virus infections have ranged in severity from mild to severe.

While no human infections with these HPAI H5N8, H5N2, or this new H5N1 virus have been reported worldwide, similar viruses (like Asian-origin H5N1, for example) have infected people in the past. The H5N1 virus recently isolated from a U.S. wild bird is a new mixed-origin virus (a reassortant) that is genetically different from the Asian-origin avian H5N1 viruses that have caused human infections with high mortality.

CDC is communicating and coordinating with state health departments on appropriate human health measures and is working with animal health colleagues to evaluate and minimize public health risk. The risk to people from these HPAI H5 infections in U.S. birds and poultry is believed to be low at this time because these viruses do not normally infect humans easily, and even if a person is infected, the viruses do not spread easily to other people. People in contact with known infected or possibly infected birds should take precautions to protect against infection. In addition, CDC has developed testing and influenza antiviral prophylaxis guidance for persons exposed to birds possibly infected with HPAI H5 viruses.

Because avian influenza A viruses have the potential to change and gain the ability to spread easily among people, monitoring for human infection and person-to-person transmission is extremely important for public health.

CDC continues to monitor this situation to minimize the risk to people and will provided updated information as it becomes available.

For more information about avian influenza visit the CDC avian flu web site and the USDA ARS and Animal and Plant Health Inspection Service (APHIS) websites.

The U.S. Department of Interior (DOI) and the USDA are the lead federal agencies for outbreak investigation and control in wild birds and the USDA APHIS is the lead agency for such activities in domestic birds. The latest information on avian influenza findings in the Pacific Flyway is available on USDA’s website.

Guangdong & Anhui Provinces Report H7N9 Cases

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# 9765

 

Unlike last winter, day-to-day reporting of H7N9 cases from much of Mainland China has been slow, although it isn’t entirely clear how much of this is due to an actual reduction in cases and how much is due to a change in the way some provinces are reporting. 

 

We’ve seen some case announcements turn up belatedly in Provincial EOM epidemiological reports.


Earlier this week the World Health Organization, in their most recent Antigenic and genetic characteristics of zoonotic influenza viruses and candidate vaccine viruses developed for potential use in human vaccines, described this year’s H7N9 activity and virus evolution as:

 

Influenza A(H7N9) activity from 24 September 2014 to 23 February 2015


During this period, 148 human cases of avian influenza A(H7N9) virus infection were reported to WHO, bringing the total number of cases to 602 with 227 deaths reported4. All human cases were detected in China, or in travelers who visited China (2 in Canada). Increased genetic heterogeneity of HA and NA gene sequences was observed among recent viruses from humans, poultry and environmental samples. Comparison of these viruses using haemagglutination inhibition (HI) assays showed that the majority remained antigenically similar to the CVVs derived from A/Anhui/1/2013-like viruses.

 

`Increased genetic heterogeneity of HA and NA gene sequences’  is evidence  that the H7N9 virus continues to evolve, something we’ve looked at previously in Eurosurveillance: Genetic Tuning Of Avian H7N9 During Interspecies TransmissionEID Journal: H7N9 As A Work In Progress.

 

Two reports this morning courtesy of Hong Kong’s CHP.

 

HP notified of additional human case of avian influenza A(H7N9) in Guangdong


The Centre for Health Protection (CHP) of the Department of Health (DH) is today (February 27) closely monitoring an additional human case of avian influenza A(H7N9) in Guangdong notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.


According to the GDHFPC, a male patient aged 80 in Shantou was hospitalised for treatment in critical condition.

To date, 589 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (176 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (19 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

 

After not having reported any H7N9 cases this winter, Anhui Province – which reported two cases on February 25th (see CHP closely monitors three additional human cases of avian influenza A(H7N9) in Mainland) – has apparently notified Hong Kong’s Centre for Health Protection of two more cases (1 from Anqing City and the other from Tongling).

 

 

HP closely monitors two additional human cases of avian influenza A(H7N9) in Mainland


The Centre for Health Protection (CHP) of the Department of Health (DH)is today (February 28) closely monitoring two additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.


According to the Health and Family Planning Commission of Anhui Province, a male patient and a female patient, both aged 58 with poultry exposure before onset, were hospitalised for management. They were in critical condition.


To date, 591 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (176 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (21 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

Friday, February 27, 2015

Oman Worries Over H5N1 Blowin’ In The Wind

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Dust Movement Across The Globe – Credit NASA

 

 

# 9764

 

An unusual story has appeared in Omani press his week, where worries are expressed that avian flu (or MERS) might be carried in from other regions via the long-lived dust storms that frequent the Middle East during the spring.

 

While there isn’t a lot of evidence to support the notion that viable avian flu viruses could be carried sucessfully over long distances by dust storms, the idea isn’t completely far-fetched.


Some viruses have been documented capable of traveling significant distances on the wind. As an example, the USDA/APHIS  Overview of the FMD Response Plan: The Red Book lists Foot & Mouth Disease (FMD) as being windborne, stating:

 

FMDV has also been known to spread through windborne transmission, where the virus infects naïve animals located some miles from known infected animals without any history of contact. The distance of windborne transmission over land surfaces depends on the atmospheric conditions and the amount of virus emitted into the air by the infected animals. Sources suggest FMDV may spread to distances of approximately 60 kilometers over land in favorable conditions and potentially even greater distances over water.

 

Granted, FMDV is more heat tolerant than influenza viruses, but this shows it is possible for viruses to be carried – intact – for hundreds of kilometers.  First a link to the Oman story, then I’ll be back with some more research on the long distance propagation of viruses via the wind.

 

Oman health: Dust storms pose risks of bird flu; hospitals under siege

by Rahul Das | February 24, 2015 , 9 : 32 pm GST  Muscat: Hospitals in Oman say they are under siege as the changing weather has sparked off health alerts, even as a specialist warned that the walls of dust that barrelled across the Sultanate can transmit a variety of airborne infections, including bird flu.


Dr Thashli Thankachen, physician – internal medicine, Lifeline Medical Centre, said that the dreaded bird flu can drift in a sandstorm from an affected area to another region not previously under an epidemic attack.

"Viruses, bacteria and fungal spores are blown over from one place to another place along with climatic fluctuations increasing the risk of a whole range of infections like respiratory tract infections, conjunctivitis and influenza, in addition to  Severe Acute Respiratory Syndrome (SARS),  foot  and mouth disease, brain fever (Meningitis) etc," he told the Times of Oman on Tuesday.


The warning was issued after hospitals and clinics witnessed a significant increase in footfalls of patients after the temperature dropped by 18° Celsius in the last 72 hours in Muscat.

(Continue . . . )

 

Long time readers will recall that back in January of 2008 I wrote a blog called The Virus My Friend, Is Blowin' In The Wind where I cast a dubious eye upon claims by the Indian Government that the bird flu virus (H5N1) was being blown by the wind across the border from neighboring Bangladesh, and was infecting hapless Indian Poultry.

 

It wasn’t impossible, of course.  And I went into some of the other types of pathogens (mostly fungi and bacteria) that are known to travel in the wind.

 

Of course, bacteria and fungi can be pretty hearty organisms.  Viral particles are usually far more fragile; more susceptible to UV rays, desiccation, and are further encumbered by being unable to replicate outside of a host.

 

Fast forward to May of 2010 (see Viruses Blowin’ In The Wind?) and we saw a report in the journal Environmental Health Perspectives, that suggested that it was possible for H5N1 (or any Influenza A virus) to be transported across long (hundreds of kilometers) distances in the air.

 

Although researchers demonstrated influenza RNA could be detected in ambient air samplings, they didn’t establish that the virus remained viable over long distances.

 

In December of 2012 we revisited the idea again (see Barnstorming Avian Flu Viruses?) when we looked at a study in the Journal of Infectious Diseases called Genetic data provide evidence for wind-mediated transmission of highly pathogenic avian influenza that found patterns that suggested farm-to-farm spread of the 2003 H7N7 outbreak due to the prevailing wind.

 

Another study of the same outbreak, Modelling the Wind-Borne Spread of Highly Pathogenic Avian Influenza Virus between Farms (PloS One 2012), found that windborne transmission could have accounted for up to 24% of the transmission over distances up to 25 km

 

We have also seen studies indicating that the H5N1 virus can – under the right environmental conditions – remain viable for hours or even days in the environment (see EID Journal: Persistence Of H5N1 In Soil and H5N1: Hiding In Plain Sight

 

So, the science is far being a slam-dunk one way or the other on the issue.   Short-distance carriage (20-30km) seems plausible, and while I’m somewhat skeptical, longer-distance travel doesn’t seem to have been completely ruled out. 

 

But it would probably take ideal environmental conditions - and a coalescing of a lot of unlikely factors – for an infectious dose of H5N1 to successfully migrate across several hundred kilometers of desert on the back of an Arabian dust storm. 

WHO: H5 Currently The Most Obvious Avian Flu Threat

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How viruses shuffle their genes (reassort)

 

# 9763

 

 

In the `Good Old Days’ – that is, before the spring of 2013 – the bird flu threat around the world was pretty much centered around the H5N1 virus, which re-emerged in 2003 after making a brief appearance in the mid-1990s in Hong Kong and Southern China. 

 

Sure, there were some `minor’ players – primarily H7 viruses and H9N2 – that had shown the ability to infect humans on rare occasions, but they only tended to produce mild illness, and were pretty far down the threat list.

 

The one we worried about most was H5N1 – or rather, the many clades of H5N1 – as the virus is constantly evolving, reinventing itself as it traveled through hosts and around the world.   While we often talk about H5N1 as a single threat, in truth it encompasses a growing array of viruses, with considerable variability in each strain’s ability to infect, and kill (see Differences In Virulence Between Closely Related H5N1 Strains).

 

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(click to load larger image)  (Note: Chart only goes through 2011)

 

Quite simply, the clade of H5N1 circulating in Cambodia is genetically different from the clade in Indonesia, or Egypt.  And within each of these clades there are constantly evolving variants.

 

By the winter of 2013 H5N1 had infected in excess of 600 people, killing roughly 60% of known cases.

 

But on March 31st of 2013 we learned of a new dangerous player in the bird flu world, and unexpectedly it emerged from the H7 camp, which previously had only produced mildly pathogenic (in humans) viruses.  The H7N9 virus appeared in China, and in two short months infected at least 134 people, killing about 1/3rd.


Although H5N1 didn’t go away, it did recede from the limelight as H7N9 quite impressively managed to infect as many people in its first 24 months as H5N1 was known to have infected in its first 10 years.

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Credit Dr. Ian Mackay’s VDU Blog

 

After a decade of monolithic concerns, we had two serious avian flu threats to contend with. 

 

But within a matter of months we would see that roster expand to include H5N2, H5N3, H5N6, H5N8, and H10N8.

 

While H5N2 and H5N8 have not (as yet) proved to be a human health threat, they are viewed with caution as they continue to evolve, and are closely related to viruses that do (see CDC Interim Guidance For Testing For Novel Flu).

 

Over the past four months we’ve watched a remarkable resurgence of H5N1 in both poultry and humans in Egypt, with  108 human infections reported over the past 120 days (see WHO Releases Updated Egyptian H5N1 Numbers).

 

This is now the biggest sustained run of human H5N1 cases in one country since the virus appeared in 2003, and it shows little signs of abating any time soon.

 

While we still watch H7N9 closely for signs that it is becoming more easily transmitted among humans - and we keep close watch on these other new subtypes - H5N1 is back on top of our avian flu watch list, as last night’s announcement from the World Health Organization  (see WHO Warns On Evolving Influenza Threat) attests.

 

(excerpt)

H5 viruses: currently the most obvious threat to health

The highly pathogenic H5N1 avian influenza virus, which has been causing poultry outbreaks in Asia almost continuously since 2003 and is now endemic in several countries, remains the animal influenza virus of greatest concern for human health. From end-2003 through January 2015, 777 laboratory-confirmed human cases of H5N1 virus infection have been reported to WHO from 16 countries. Of these cases, 428 (55.1%) have been fatal.

Over the past two years, H5N1 has been joined by newly detected H5N2, H5N3, H5N6, and H5N8 strains, all of which are currently circulating in different parts of the world. In China, H5N1, H5N2, H5N6, and H5N8 are currently co-circulating in birds together with H7N9 and H9N2.

The H9N2 virus has been an important addition to this mix, as it served as the “donor” of internal genes for the H5N1 and H7N9 viruses. Over the past four months, two human infections with H9N2 occurred in China. Both infections were mild and the patients fully recovered.

Virologists interpret the recent proliferation of emerging viruses as a sign that co-circulating influenza viruses are rapidly exchanging genetic material to form novel strains. Viruses of the H5 subtype have shown a strong ability to contribute to these so-called “reassortment” events.

The genomes of influenza viruses are neatly segmented into eight separate genes that can be shuffled like playing cards when a bird or mammal is co-infected with different viruses. With 18 HA (haemagluttinin) and 11 NA (neuraminidase) subtypes known, influenza viruses can constantly reinvent themselves in a dazzling array of possible combinations. This appears to be happening now at an accelerated pace.

For example, H5N2 viruses recently detected in poultry in Canada and in wild birds in the US are genetically different from H5N1 viruses circulating in Asia. These viruses have a mix of genes from a Eurasian H5N8 virus, likely introduced into the Pacific Flyway in late 2014, along with genes from North American influenza viruses.

Little is known about the potential of these novel viruses to infect humans, but some isolated human infections have been detected. For example, the highly pathogenic H5N6 virus, a novel reassortant, was first detected at a poultry market in China in March 2014. The Lao People’s Democratic Republic reported its first outbreak in poultry, also in March, followed by Viet Nam in April. Genetic studies showed that the H5N6 virus resulted through exchange of genes from H5N1 viruses and H6N6 viruses that had been widely circulating in ducks.

China detected the world’s first human infection with H5N6, which was fatal, in April 2014, followed by a second severe human infection in December 2014. On 9 February 2015, a third human H5N6 infection, which was fatal, was reported.

The emergence of so many novel viruses has created a diverse virus gene pool made especially volatile by the propensity of H5 and H9N2 viruses to exchange genes with other viruses. The consequences for animal and human health are unpredictable yet potentially ominous.

(Continue . . .)

 

Although not a major threat in itself, H9N2 appears instrumental in the creation of new, dangerous H5 reassortant viruses (see PLoS Path: Genetics, Receptor Binding, and Transmissibility Of Avian H9N2). This ubiquitous, yet fairly benign avian virus is quite promiscuous, as we keep finding bits and pieces of it turning up in new reassortant viruses


Of the H5 avian flu viruses we are currently watching with the greatest  concern – all  share several important features (see Study: Sequence & Phylogenetic Analysis Of Emerging H9N2 influenza Viruses In China):

 

    • They all first appeared in  Mainland China
    • They all  have come about through viral reassortment in poultry
    • And most telling of all, while their HA and NA genes differ - they all carry the internal genes from the avian H9N2 virus

 

In January of 2014, The Lancet carried a report entitled Poultry carrying H9N2 act as incubators for novel human avian influenza viruses by Chinese researchers Di Liu a, Weifeng Shi b & George F Gao that warned:

 

Several subtypes of avian influenza viruses in poultry are capable of infecting human beings, and the next avian influenza virus that could cause mass infections is not known. Therefore, slaughter of poultry carrying H9N2—the incubators for wild-bird-origin influenza viruses—would be an effective strategy to prevent human beings from becoming infected with avian influenza.

We call for either a shutdown of live poultry markets or periodic thorough disinfections of these markets in China and any other regions with live poultry markets.

 

Although this swelling of the ranks of avian flu viruses has yet to produce a pandemic virus, it is problematic on a number of fronts. First is the impact they are having on poultry production and trade around the globe.  And while the number of human infections remains relatively low, they can be quite devastating to those affected.


But this recent expansion of flu viruses also makes the emergence of additional novel subtypes even more likely, as the more diverse and dense the playing field, the more `interchangeable’ genetic parts that are available for reassortment and the greater chance of co-infecting a common host..

 

The bottom line is, after  a decade of pretty much only having one avian virus to worry about, over the past two years we’ve seen the emergence and spread of multiple clades of HPAI avian H5N8, H5N6, H5N3, and H5N2 along side H7N9, H10N8 and a handful of `minor players’ like canine & equine H3N8, canine H3N2, and even H10N7 in marine mammals.

 

And of course, we have no idea what new reassortants may appear over the next few years.

 

While no one can predict where any of these viruses will end up - the greater the diversity of novel viruses in circulation - the greater the chances of someday seeing one successfully adapt to humans.

.

For more on this rapidly expanding array of novel flu viruses you may wish to revisit:

 

The Expanding Array Of Novel Flu Strains

EID Journal: Predicting Hotspots for Influenza Virus Reassortment

Viral Reassortants: Rocking The Cradle Of Influenza

Thursday, February 26, 2015

WHO Warns On Evolving Influenza Threat

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Credit NIAID

 

 

# 9762

 


The World Health Organization has issued a lengthy and strong statement on the emergence and proliferation of new subtypes of novel influenza around the world, and the potential risks they pose to global health.  Themes that are familiar to regular readers of this blog.

 

Helen Branswell has a report this evening summarizing the statement, and I’ve posted a link to it and a few excerpts.  I’ll have more to say about the specifics of this statement tomorrow.

 

 

The Canadian Press - ONLINE EDITION

Volatility of global patterns of novel flu viruses a source of concern: WHO

By: Helen Branswell, The Canadian Press

 

Follow the link to read the WHO statement in its entirety, where you’ll find specific discussions on the recent spike in H5N1 cases in Egypt (see WHO Releases Updated Egyptian H5N1 Numbers from earlier today), and China’s third winter wave of H7N9.

 

Warning signals from the volatile world of influenza viruses

February 2015

The current global influenza situation is characterized by a number of trends that must be closely monitored. These include: an increase in the variety of animal influenza viruses co-circulating and exchanging genetic material, giving rise to novel strains; continuing cases of human H7N9 infections in China; and a recent spurt of human H5N1 cases in Egypt. Changes in the H3N2 seasonal influenza viruses, which have affected the protection conferred by the current vaccine, are also of particular concern.

Viruses in wild and domestic birds

The diversity and geographical distribution of influenza viruses currently circulating in wild and domestic birds are unprecedented since the advent of modern tools for virus detection and characterization. The world needs to be concerned.

Viruses of the H5 and H7 subtypes are of greatest concern, as they can rapidly mutate from a form that causes mild symptoms in birds to one that causes severe illness and death in poultry populations, resulting in devastating outbreaks and enormous losses to the poultry industry and to the livelihoods of farmers.

Since the start of 2014, the Organisation for Animal Health, or OIE, has been notified of 41 H5 and H7 outbreaks in birds involving 7 different viruses in 20 countries in Africa, the Americas, Asia, Australia, Europe, and the Middle East. Several are novel viruses that have emerged and spread in wild birds or poultry only in the past few years.

Some of the outbreaks notified to OIE have involved wild birds only. Such notifications are indicative of the heightened surveillance and improved laboratory detection that have followed the massive outbreaks of highly pathogenic H5N1 avian influenza that began in Asia in late 2003.

Detection of highly pathogenic avian influenza viruses in wild birds signals the need for a close watch over poultry farms. Migratory waterfowl, immune to the disease, are known to spread avian viruses to new areas by quickly crossing continents along the routes of several flyways. These migratory waterfowl subsequently mix with local wild birds and poultry that then become infected.

<SNIP>


Warning: be prepared for surprises

Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.

WHO and its collaborating laboratories continue to help countries strengthen their alert, surveillance, and response capacities. A quality assurance program has been conducted by WHO since 2007 to maintain global influenza virus laboratory detection capacity, with panels of testing materials being provided free-of-charge to countries once or twice a year. To further capacity building in countries, particularly developing countries, nearly $17 million was provided in 2014 through the Pandemic Influenza Preparedness framework.

Virological research, which has done so much to aid the detection and understanding of novel viruses, assess their pandemic risks, and track their international spread, needs to continue at an accelerated pace.

More R&D is needed to develop better vaccines and shorten the production time. During a severe pandemic, many lives will be lost in the 3 to 4 months needed to produce vaccines.

An influenza pandemic is the most global of infectious disease events currently known. It is in every country’s best interests to prepare for this threat with equally global solidarity.

Saudi MOH Announces 3 New MERS Cases & 3 Deaths

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# 9761

 

We’ve an unusually late update today from the Saudi MOH, where they cite 3 new cases and three recent fatalities. But disappointingly, and without explanation, their English version doesn’t carry the usual line listing.

 

The Arabic version (see below) has a line listing, but as it is a graphic format, doesn’t lend itself to our normal translation tools.

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However, we can piece together that one case is from Al-Jawaf, another from Riyadh, and the third is from Khobar

 

The cases from Riyadh and Khobar both appear to be under investigation as possibly healthcare related, although neither are listed as HCWs.


If the MOH gets an English graphic up, from which we can glean additional details, I’ll append it to this post.