Media Reports: New H7N9 Case in Hong Kong & Zhejiang Province

 

 

# 8047

 

While I’m sure we’ll get additional details in the next few hours, this morning RTHK is reporting that a second H7N9 case has been identified in Hong Kong.  It isn’t entirely clear whether this second case is fully confirmed, as some reports refer to the patient as `suspected’.  

 

So far, nothing official has appeared on the Centre for Health Protection website, but at least one report refers to a press conference scheduled in about an hour. A h/t to @Ironorehopper on FluTrackers for the head’s up.  

 

Indian H7N9 infection without commission with the situation improved artificial lung

2013-12-06 HKT 20:00

Hong Kong's first confirmed infection of H7N9 avian influenza were 36-year-old Indian commission, still in Queen Mary Hospital, the situation improved, without the use of artificial lung ventilation.

In addition, the news that Hong Kong's second confirmed case of human infection of H7N9 avian influenza, the patient was a 80-year-old Nagai Mainland men who eat chicken in the mainland, is currently in Tuen Mun Hospital in stable condition.

 

Another report, this time from http://hk.on.cc,  provides similar details.

 

Add one of our H7N9 suspected cases

on.cc Hong Kong added a suspected case of H7N9 bird flu, authorities confirmed a second positive test. It is understood that after a Tuen Mun Hospital from Shenzhen to Hong Kong for treatment of 80-year-old man, suspected H7N9, the hospital immediately for his quick test to determine infection of H7N9; their mild illness, will accept the isolation treatment. Hospital Authority and the Centre for Health Protection will be 21:15 held a press conference to explain the details.

 

 

In addition, there are reports this morning  of a new H7N9 case hospitalized in Zhenjiang Province. This report from CCTV.

 

Zhejiang new case of human infection of bird flu H7N9

At 17:06 on December 6, 2013
Source: CCTV

 

CCTV News: [Zhejiang add one case of human infection with H7N9 avian influenza] Zhejiang Provincial Health Department briefing today, Zhejiang add one case of human infection with H7N9 avian influenza. Patients Yu, male, 30 years old, Hangzhou people diagnosed on December 5, and now Hangzhou, a hospital for treatment. Weather turns cold, cases of human infection with H7N9 avian influenza may distribute appear. The figure is the H7N9 Raiders prevention, the fight against H7N9, spread! (CCTV reporter Zhao Yi)  

Saudi Arabia Announces Two New MERS Cases

 

# 8046

 

 

Overnight, in the first announcement of new MERS cases out of Saudi Arabia in over two weeks, KSA’s Ministry of Health posted the following bare-bones announcement of two new cases.  

 

One, a 26 y.o. health care worker with exposure to a previously identified case experienced either mild, or no symptoms, while the other (age 51) and with a history of chronic disease is in intensive care.   

 

As per usual, no onset dates or other epidemiological information are provided.

 

(Health) recorded two cases Pfyrus (Corona)

02/03/1435

In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the virus, "Corona" that causes respiratory syndrome, the Middle East, announced the Ministry of Health for the registration of two cases. The first resident in Riyadh working in the health sector at the age of 26 years and contact with the confirmed case and has no symptoms, and the second for citizenship Jawf region at the age of 51 years suffering from several chronic diseases have been converted to the Riyadh region to complete therapy intensive care. Praying to God for them healing.

TSRI: H7N9 Virus Still Binds Preferentially to Avian Receptors

Binding of H7N9 to Avian Receptors

Credit: Rui Xu, The Scripps Research Institute

 

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Research over the summer has repeatedly suggested that the newly emerging H7N9 virus in China is better adapted to mammalian hosts than many other avian influenza viruses we’ve previously seen (see Science: H7N9 Transmissibility Study In Ferrets & Nature: Limited Airborne Transmission Of H7N9 Between Ferrets), giving rise to the concern that this virus might be close to sparking a pandemic.

 

Yet, despite these findings, only a handful of small clusters of human infection have been documented, and the vast majority of contacts of known cases never become infected.

 

While the virus appears more readily transmitted from birds to humans than say, the H5N1 virus . . .  it has not yet shown the crucial ability to transmit efficiently from one human to another.   

 

Viruses constantly change, of course, and no one is entirely sure what change (or more likely, what combination of changes) are needed to fully `humanize’ this virus.

 

Influenza viruses have an RBD - Receptor Binding Domain (the area of its genetic sequence that allows it to attach to, and infect, host cells) that – like a key slipping into a padlock -`fit’ the receptor cells commonly found in their preferential host.

 

Avian adapted flu viruses, like the H5N1 virus, bind preferentially to the alpha 2,3 receptor cells found in the gastrointestinal tract of birds, while `humanized’ flu viruses have an affinity for the alpha 2,6 receptor cells most commonly found in the human respiratory system. .

 

While there are some α2-3 cells deep in the lungs of humans – which may explain the high rate of pneumonia in the unlucky few who do contract avian flu -  for an influenza to be truly successful in a human host, it needs to a able to bind to the α2-6  receptor cells in the upper airway.

 

Today, The Scripps Research Institute (TSRI) has published their analysis of the receptor binding of the H7N9 virus to both human, and avian, receptor cells.  And while this virus does, indeed bind weakly to human α2-6 receptor cells, it still shows a strong preference to bind to avian α2-3 cells.

 

First a link to the study, then some excerpts from the press release.

Preferential Recognition of Avian-Like Receptors in Human Influenza A H7N9 Viruses

Rui Xu, Robert P. de Vries, Xueyong Zhu, Corwin M. Nycholat, Ryan McBride, Wenli Yu, James C. Paulson,Ian A. Wilson

Editor's Summary

The 2013 outbreak of avian-origin H7N9 influenza in eastern China has raised concerns about its ability to transmit in the human population. The hemagglutinin glycoprotein of most human H7N9 viruses carries Leu²²⁶, a residue linked to adaptation of H2N2 and H3N2 pandemic viruses to human receptors. However, glycan array analysis of the H7 hemagglutinin reveals negligible binding to humanlike α2-6–linked receptors and strong preference for a subset of avian-like α2-3–linked glycans recognized by all avian H7 viruses. Crystal structures of H7N9 hemagglutinin and six hemagglutinin-glycan complexes have elucidated the structural basis for preferential recognition of avian-like receptors. These findings suggest that the current human H7N9 viruses are poorly adapted for efficient human-to-human transmission.

(Continue . . . )

 

Scripps Research Institute

TSRI scientists: Emerging bird flu strain is still poorly adapted for infecting humans

LA JOLLA, CA—December 5, 2013—Avian influenza virus H7N9, which killed several dozen people in China earlier this year, has not yet acquired the changes needed to infect humans easily, according to a new study by scientists at The Scripps Research Institute (TSRI). In contrast to some initial studies that had suggested that H7N9 poses an imminent risk of a global pandemic, the new research found, based on analyses of virus samples from the Chinese outbreak, that H7N9 is still mainly adapted for infecting birds, not humans.

"Luckily, H7N9 viruses just don't yet seem well adapted for binding to human receptors," said Ian A. Wilson, the Hansen Professor of Structural Biology and chair of the Department of Integrative Structural and Computational Biology at TSRI.

"Because publications to date have implied that H7N9 has adapted to human receptors, we felt we should make a clear statement about this," said James C. Paulson, chair of TSRI's Department of Cell and Molecular Biology.

The Wilson and Paulson laboratories collaborated on the study, which is reported in the December 6, 2013 issue of the journal Science.

(Continue . . . )

 

Hong Kong: Dr. Ko Wing-man On H7N9 Investigation

 

Dr. Ko Wing-man  SFH

# 8044

 

 

While Hong Kong’s CHP has been working feverishly to contain any further spread of the H7N9 virus, media reports indicate that such is not the case in Shenzhen,  where Hong Kong’s first patient is suspected of having been infected.  According to the following report in the the South China Morning Post, the trade in live poultry continues in that city’s markets.

 

Travellers to Hong Kong tested for bird flu but it's business as usual in Shenzhen

Health Department sends 40 staff to borders as temperature checks beefed up in wake of H7N9 infection, but Shenzhen wet markets still open

UPDATED : Thursday, 05 December, 2013, 11:50am Emily Tsang and He Huifeng in Shenzhen

(Continue . . . )

 

Since there is no actual proof that the virus was acquired in Shenzhen, this report indicates that `attitudes towards the virus were more relaxed in the government and media. Sterilisation measures were little used at Shenzhen's markets.’

 

Another controversy exists over the delay in testing this patient for the H7N9 virus when she first appeared at Tuen Mun Hospital.  In a letter sent to local hospitals on December 3rd, the CHP reminded:

In response to the newly confirmed imported case in Hong Kong, we have enhanced surveillance by activating zero reporting with both public and private hospitals. We would like to urge you to pay special attention to those who presented with influenza-like illnesses and had history of visiting wet market with live poultry or contact with poultry in Guangdong Provinceand other affected areas within the incubation period (i.e. 10 days before onset of symptoms).

 

Today, in brief remarks, Hong Kong’s Secretary of Food & Health (SFH) – Dr. Ko Wing-man – touched on both of these issues.

SFH on confirmed human case of avian influenza A(H7N9)

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending the 12th Joint Meeting of Senior Health Officials of the Mainland, Hong Kong and Macao today (December 5):

Reporter: (On the source of infection of the first confirmed human case of avian influenza A(H7N9) in Hong Kong, and the accusation that Tuen Mun Hospital has delayed in detecting the virus)

Secretary for Food and Health: Regarding the first patient diagnosed as having avian influenza A(H7N9), investigation relating to the epidemiological aspect, especially the source of infection, is still continuing. The Controller of the Centre for Health Protection, Dr Leung Ting-hung, will give an update later. On the clinical testing of the infection, although there are guidelines for the clinical staff, doctors still have to make clinical judgement considering the individual condition of every patient. In this particular incident, a particular factor which might have affected the judgement of the doctor-in-charge would be the fact that the patient has not disclosed earlier that she went to Shenzhen and had a contact history with poultry.
(Please also refer to the Chinese portion of the transcript.)

Ends/Thursday, December 5, 2013
Issued at HKT 20:30

HK CHP: H7N9 Daily Update – Nov 5th

H7N9 Awareness Campaign Summer 2013 - Photo credit Hong Kong’s CHP

 

# 8043

 

Hong Kong’s CHP continues to provide daily progress reports on their epidemiological investigation into that city’s first H7N9 case.  So far, the news continues to be good.  Despite 17 close contacts in isolation - and roughly 220 additional contacts under medical surveillance - none have tested positive for the H7N9 virus.

 

Meanwhile, hospitals have ramped up their infection control protocols,  extensive public education campaigns are underway, and border control points (BCPs) are scanning incoming visitors for signs of fever or illness (an imprecise, but commonly employed control measure).

 

While none of these steps are guaranteed to keep the H7N9 virus at bay forever, they are about as fine of an example of a proactive public health response as one could hope for. Hong Kong’s dedication to avian flu drills, planning, and constant vigilance (see Hong Kong: Avian Influenza Drill) appears to be paying huge dividends.

 

As winter sets in and more H7N9 cases begin to emerge in Eastern China, one shouldn’t be too surprised to see this virus hitch a ride in another traveler, perhaps showing up outside of China. Hopefully public health agencies around the world are watching Hong Kong’s response, and taking notes. 

 

 

Epidemiological investigation and follow-up actions by CHP on confirmed human case of avian influenza A(H7N9) 

 

The Centre for Health Protection (CHP) of the Department of Health (DH) today (December 5) provided an update on the first confirmed human case of avian influenza A(H7N9) in Hong Kong.

"The epidemiological investigation, enhanced disease surveillance, port health measures and health education are proceeding," a spokesman for the DH remarked.

As of 2pm today, no additional close contacts have been identified. The number of close contacts located remains at 17 while there are over 220 other contacts. Details are as follows:

(A) 17 close contacts remain under quarantine for 10 days since their last contact with the patient. Their specimens tested negative for the avian influenza A(H7N9) virus upon preliminary laboratory testing by the Public Health Laboratory Services Branch of the CHP. During isolation, if their health conditions change, further testing and surveillance will be conducted. They include:

1. Ten home contacts (including four with non-specific symptoms);
2. A female collateral aged 33, who visited Shenzhen with the patient; and
3. Six patients in Tuen Mun Hospital (TMH) who stayed in the same cubicle with the confirmed patient (including one with non-specific symptoms).

(B) Over 220 other contacts, including two private doctors whom the patient consulted, their clinic staff, patients and accompanying relatives, healthcare workers (HCWs) of TMH, Queen Mary Hospital (QMH) and the ambulance service, and relevant hospital visitors, are all under medical surveillance. Among them:

1. A patient who consulted Dr Wong Chun-yan and presented with non-specific symptoms tested negative for the avian influenza A(H7N9) virus; and

2. Twelve HCWs of TMH and QMH who presented with non-specific symptoms tested negative for the avian influenza A(H7N9) virus.

Locally, enhanced surveillance over suspected cases in public and private hospitals is underway. The CHP will continue to maintain liaison with the World Health Organization (WHO), the Mainland and overseas health authorities to monitor the latest developments and obtain timely and accurate information. Local surveillance activities will be modified according to the WHO's recommendations.

 

"All border control points (BCPs) have implemented disease prevention and control measures. Thermal imaging systems are in place at BCPs for body temperature checks of inbound travellers. The DH has liaised with the Auxiliary Medical Service and the Civil Aid Service to deploy additional manpower at BCPs to conduct random temperature checks using handheld devices," the spokesman said.

 

The Port Health Office of the DH is maintaining liaison with the Shenzhen Entry-Exit Inspection and Quarantine Bureau to stay alert for travellers and also cross-boundary students with fever or other symptoms. Suspected cases will be immediately referred to public hospitals for follow-up investigation.

 

Regarding health education for travellers at BCPs, the distribution of health education pamphlets, display of posters on avian influenza A(H7N9) in departure and arrival halls, in-flight public announcements, environmental health inspection and the provision of regular updates to the travel industry via meetings and correspondence have all been escalated. The DH will keep a close eye on the latest developments and adopt corresponding port health measures.

 

"We have enhanced our publicity and health education on the prevention of avian influenza. Meanwhile, consulates, foreign domestic helpers' associations and non-governmental organisations serving ethnic minorities have been notified of the case, the latest developments and the preventive measures. Health educational materials are being distributed through them," the spokesman added.

 

An array of key publicity materials of the CHP, including those on avian influenza, influenza, guidelines for proper hand washing and personal and environmental hygiene in various languages including Indonesian, Hindi, Nepali, Urdu, Thai and Tagalog, can be accessed in the CHP's website (

www.chp.gov.hk/en/submenu/424.html).

The CHP hotline (2125 1111) has been set up for public enquiries and operates from 9am to 6pm. As of 4pm today, 57 calls had been received.

"Travellers, especially those returning from avian influenza A(H7N9)-affected areas with fever or respiratory symptoms, are reminded to immediately wear facial masks, seek medical attention and reveal their travel history to a doctor. Healthcare professionals should also pay special attention to patients who might have had contact with birds, poultry or their droppings in affected areas," the spokesman advised.
he spokesman also urged travellers not to visit live poultry markets in the affected areas and avoid direct contact with poultry, birds and their droppings. If contact has been made, they should thoroughly wash their hands with soap and water.

Members of the public should remain vigilant and are reminded to take heed of the following preventive advice against avian influenza:

* Poultry and eggs should be thoroughly cooked before eating;

* Wash hands frequently with soap, especially before touching the mouth, nose or eyes, handling food or eating; after going to the toilet or touching public installations or equipment such as escalator handrails, elevator control panels or door knobs; or when hands are dirtied by respiratory secretions after coughing or sneezing;

* Cover the nose and mouth while sneezing or coughing, and hold the spit with a tissue and put it into a covered dustbin;

* Avoid crowded places and contact with fever patients; and

* Wear a mask when respiratory symptoms develop or when taking care of fever patients. 

The public may visit the CHP's avian influenza page (

www.chp.gov.hk/en/view_content/24244.html) and its website (www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf) for more information on avian influenza-affected areas.

Ends/Thursday, December 5, 2013

WHO Statement On the 4th IHR Emergency Committee Meeting On MERS-CoV

Coronavirus - Photo Credit WHO

 

 

# 8042

As I mentioned a couple of days ago (see WHO To Convene 4th Meeting Of IHR Emergency Committee On MERS-CoV) the World Health Organization was to convene a teleconference today of experts to review what has been learned about the MERS coronavirus, and to to decide whether the threat posed by MERS-CoV rises to the level of a "public health emergency of international concern" or PHEIC.

 

According to the WHO IHR FAQ, the term public health emergency of international concern (PHEIC ) is defined in the International Health Regulations as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”.

 

That meeting was held today at 12:00 hrs Geneva time, and we now have the following statement from the WHO.

While the continued surfacing of MERS-CoV cases in the Middle East remains a serious concern, to no great surprise, it was the unanimous decision of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

 

The full statement, along with some details on their findings, follows below:

 

 

WHO Statement on the Fourth Meeting of the IHR Emergency Committee concerning MERS-CoV

WHO Statement
4 December 2013

The fourth meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] concerning MERS-CoV was held by teleconference on Wednesday, 4 December 2013, from 12:00 to 15:50 Geneva time (CET).

In addition to Members of the Emergency Committee, two expert advisors also participated¹. A number of affected States Parties reporting recent cases of MERS-CoV – Kingdom of Saudi Arabia, Kuwait, Oman, Qatar and Spain – were also on the teleconference.

During the informational session of the meeting, the WHO Secretariat provided an update on and assessment of epidemiological and scientific developments, including a description of cases over time, notable recent clusters, detection by polymerase chain reaction testing of MERS-CoV in camels, and the public health preparation and experience of the Hajj pilgrimage.

The above affected States Parties presented on recent developments in their countries.

After discussion and deliberation on the information provided, the Committee concluded that it saw no reason to change its previous advice to the Director-General. Based on a risk assessment of current information, it was the unanimous decision of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

The situation continues to be of concern, in view of ongoing cases and of new information about the presence of the virus in camels. Although it still does not consider the events to constitute a PHEIC, the Committee reinforced its previous advice for consideration by WHO and Member States, as follows:

• strengthening surveillance, including in countries with pilgrims;
• continuing to increase awareness and effective risk communication concerning MERS-CoV;
• supporting countries that are particularly vulnerable, especially in sub-Saharan Africa, taking into account the regional challenges;
• increasing relevant diagnostic testing capacities;
• continuing with investigative work, including identifying the source of the virus and relevant exposures through case-control studies and other research;
• timely sharing of information in accordance with the International Health Regulations (2005) and ongoing active coordination with WHO.

Based on events since its last meeting, the Committee emphasized the need for:

• investigative studies, including international case-control, serological, environmental, and animal-human interface studies, to better understand risk factors and the epidemiology;
• further review and strengthening of such tools as standardized case definitions and surveillance and further emphasis on infection control and prevention.

The Committee commended the extensive public health preparation for, surveillance and management of the Hajj pilgrimage by the Kingdom of Saudi Arabia.

As it has since the initial meeting, the WHO Secretariat continues to provide regular updates to the Committee Members and Advisors. With regard to reconvening the Committee, it was suggested that March 2014 might be an appropriate time (i.e. after the Northern Hemisphere winter). It was noted that any serious developments may require re-convening the Committee before then.

Based on this advice and the currently available information, the Director-General accepted the Committee’s assessment. The Director-General thanked the Committee Members and Advisors for their advice.