Wednesday, December 31, 2014

Updating CDC/PHAC Listeria Investigation Linked To Caramel Apples

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Credit CDC

 

# 9520

 

It’s been 11 days since I last updated this story (see CDC Investigating Multistate Outbreak Of Listeriosis Linked To Caramel Apples), and in that time the CDC has identified 4 more cases, spread to 1 new state (Nevada), and an additional death linked due to listeria food poisoning, linked to commercially sold caramel apples.

 

Additionally, Canada’s PHAC is investigating two possible cases as well (Dec 29th link), stating:

The Public Health Agency of Canada has identified two cases of illnesses with the same genetic fingerprint as seen in the US investigation. There is one case in Ontario, and one case in Manitoba. The status of these individuals is not known at this time.

The Public Health Agency of Canada is working with its provincial and territorial partners to determine the source of these illnesses. At this time, it is not known whether these illnesses are linked to commercially produced, prepackaged caramel apples imported from the US.

The Canadian Food Inspection Agency has issued a food recall warning for Happy Apples caramel apples and is continuing to work closely with U.S. officials to determine if other potentially affected product may have been distributed in Canada. If further products are identified, the Agency will inform the public and ensure that they are promptly removed from the marketplace.

 

Listeriosis is an infection caused by the bacterium Listeria monocytogenes, and is most commonly seen in the form of food poisoning.  Each year the CDC estimates Listeriosis causes an average of 1600 illnesses, and 28 deaths in the United States.

 

Most healthy people will either have no symptoms or a mild and self-limiting gastroenteritis, but for pregnant women, newborns, the elderly, or those with weakened immune systems this infection can be deadly.

 

Excerpts from the latest update from the CDC below, but follow the link for full details:

Multistate Outbreak of Listeriosis Linked to Commercially Produced, Prepackaged Caramel Apples

Posted December 31, 2014 11:00 AM ET

Highlights
  • Read the Advice to Consumers and Retailers>>
  • CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis) linked to commercially produced, prepackaged caramel apples. Listeria can cause a serious, life-threatening illness.
  • The information CDC has at this time indicates that commercially produced, prepackaged caramel apples may be contaminated with Listeria and may be causing this outbreak.
    • Three voluntary recalls of commercially produced, prepackaged caramel apples have been announced by Happy Apples, California Snack Foods, and Merb’s Candies after hearing from Bidart Brothers, an apple supplier, that there may be a connection between Bidart Brothers apples and this listeriosis outbreak.
    • Investigators are continuing to work to identify if any other brands or types of commercially produced, prepackaged caramel apples may be linked to illnesses.
    • CDC continues to recommend that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided.
    • Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes.
  • As of December 30, 2014, a total of 32 people infected with the outbreak strains of Listeria monocytogenes have been reported from 11 states.
    • Thirty-one ill people have been hospitalized and six deaths have been reported. Listeriosis contributed to three of these deaths and it is unclear whether it contributed to an additional two deaths. The sixth death was unrelated to listeriosis.
    • Ten illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant), with one illness resulting in a fetal loss.
    • Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.
    • To date, 23 (88%) of the 26 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.
    • At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not prepackaged or to caramel candy.
  • The Public Health Agency of Canada (PHAC) has identified 2 cases of listeriosis in Canada with the same PFGE patterns as seen in the US outbreak.
    • PHAC is working with its provincial and territorial partners to determine the source of these illnesses.
  • This investigation is rapidly evolving, and new information will be provided as it becomes available.

Egyptian MOH Announces Their 27th H5N1 Case Of 2014

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# 9519

 

The Egyptian Ministry of Health has announced their 27th H5N1 case of the year, their 23rd case since mid-November, that of a 3 year-old child from Giza Governorate.  They also announced their 11th fatality, that of a 30 year-old woman from Menofia.

 

After going two years during which time they only reported 8 cases, the past six weeks has seen a major jump in human infections, with announcements coming almost daily this past week.

 

While concerning, there are no signs of community spread or large clusters of cases, and for now the risk appears to be associated with having direct contact with infected birds.  H5N1 became endemic in Egyptian Poultry shortly after its arrival in 2006, and government attempts to reduce the home raising of birds, and to close live markets have been met with strong public resistance.

 

 

Health central laboratory results confirmed positive infection status of بڤيرس N5H1

The Ministry of health and population of infection for confirmed case بڤيرس (N5H1) by bird flu for a child of three years of Giza governorate, where he suffered from heat – cough, and patient on 26/12/2014 to viruses of the Abbasid and the chest x-ray showed pneumonia, was suspected in the case of avian influenza on 26/12/2014, has emerged as a result of the sample positive for bird flu virus H5N1 in central laboratory on 29/12/2014 and the general condition of the patient is critical.

As the Ministry of health and population on death cases of the bird flu virus is an old lady 30 years from Menofia Governorate, management of Southend, died in a hospital, abbassia, bringing the total number of cases of bird flu in 2014 so far 27, 12 cases of healing, 4 cases under treatment, 11 deaths

Therefore calls upon the Ministry of health and population of citizens who handle poultry to go immediately to the nearest hospital to receive health service if they have flu symptoms, where the infected bird flu drug Tamiflu within the first 24 hours of the onset of symptoms increases the healing rates of disease and reduces the mortality and Health Ministry advised people who deal with poultry to be careful and prudent when dealing with birds that show symptoms of the disease and the need to take preventive action to prevent such infection cover The mouth and nose when handling poultry, wash hands with SOAP and water after handling birds and children not accompany poultry or slaughter premises as well as the need to separate from living birds.

Source: Media Center

Hong Kong: Update On Investigation Into H7 Infected Poultry

Photo: ©FAO/Tariq Tinazay

Credit FAO

 

# 9518

 

This time last year Hong Kong’s SFH (Secretary of Food & Health), Dr. Ko Wing-man was taking a lot of heat from mainland Chinese officials over his insistence on performing both serological and PCR spot checks on shipments of imported poultry from neighboring provinces (see Dr. Ko Wing-man On H7N9 Testing Of Poultry).

 

While serological tests can determine if a bird has ever been exposed to and infected by a specific virus (very handy for viruses like H7N9 that produce no symptoms in birds), PCR testing must be used to determine if a bird is actively infected, and able to spread the virus.


Mainland officials have lobbied extensively against serological testing, feeling that a positive result would unfairly malign their poultry industry, and cause unnecessary culling of their product.

 

In the past 24 hours, a new batch of poultry arrived in Hong Kong and a handful of tested samples showed a positive result via serology, but negative by PCR.  The positive serological results were viewed (rightfully so) as a red flag, which led Hong Kong to perform PRC testing on a larger number of birds, and last night the results were announced (see Imported Poultry PCR Positive For H7 Avian Flu).


Today Hong Kong is busy culling birds, and doing contact tracing and surveillance on those people who may have been exposed to infected birds. Two reports,  first a statement by Dr. Ko Wing-man on the situation, followed by a progress report on local contact tracing efforts.

 

SFH on result of H7 PCR tests of imported live chickens

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, at a media session on result of H7 Polymerase Chain Reaction (PCR) tests (genetic testing) of imported live chickens at the lobby of West Wing, Central Government Offices, this morning (December 31):


Reporter: (On the testing result of samples from a consignment of imported live chickens)


Secretary for Food and Health: On December 30, the Government found in a consignment of imported live chickens a number of samples tested positive in H7 avian influenza (AI) serology tests, whilst all swab samples collected from the same consignment of live chickens were tested negative in H7 Polymerase Chain Reaction tests. According to our risk management mechanism, we collected 120 additional swab samples from the same consignment of live chickens to conduct PCR tests. Shortly before now, the results were back. A number of samples were tested positive for H7 AI. Accordingly, we kicked off a number of public health measures to prevent the risk of spreading of H7N9 virus.

Firstly, the Agriculture, Fisheries and Conservation Department (AFCD) has declared the Cheung Sha Wan Temporary Wholesale Poultry Market as an infected place. It will be closed for 21 days. This will mean that supply of live poultry from the Mainland will also have to be suspended for the same period of time. After the 21-day suspension period, the index registered farm of this particular consignment of poultry has to be verified that it is safe in terms of bio-security measures before resuming supply of live chicken to Hong Kong.

AFCD will also arrange to cull all the live poultry, around 15 000 in total, in the Cheung Sha Wan Temporary Wholesale Poultry Market, starting this morning.

AFCD will then conduct inspections and collect additional samples for testing from all of the 29 registered live poultry farms in Hong Kong to ensure that they are not affected by H7 AI. We will then channel the local live chickens to the Ta Kwu Ling Checkpoint before they could be dispatched to the retail points.  

Reporter: (On whether the Mainland authorities could step up their inspections at poultry farms)


Secretary for Food and Health: Hong Kong Government is always in very close collaboration with the relevant Mainland authorities. Our Mainland counterparts have been doing a lot in terms of safeguarding the health of live poultry to be supplied to Hong Kong. In fact, the supply chain of live poultry for Hong Kong is entirely segregated from other live poultry on the Mainland. You are right that this is not the first time that we have detected a positive H7 AI specimen from the live poultry supplied from the Mainland. This time is special. It is the first time that we have utilised the serology tests which helped us in detecting a batch of live poultry affected by H7 virus.    
(Please also refer to the Chinese portion of the transcript.) 

Ends/Wednesday, December 31, 2014
Issued at HKT 09:23

 

Update on contact tracing for imported live chickens positive for avian influenza A(H7)


The Centre for Health Protection (CHP) of the Department of Health today (December 31) reported the latest updates on contact tracing after samples of live chickens imported from the Mainland tested positive for avian influenza A(H7) virus, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

In collaboration with the Food and Environmental Hygiene Department and the Agriculture, Fisheries and Conservation Department, the CHP's epidemiological investigations have so far identified one close contact who is a poultry worker at Cheung Sha Wan Temporary Wholesale Poultry Market (CSWTWPM), and 77 other contacts including a lorry driver who transported the involved consignment of live chickens, poultry workers and staff at CSWTWPM and Man Kam To Animal Inspection Station, and workers involved in the poultry culling operation.

The CHP is tracing these contacts and will monitor their health conditions. Among them, a member of staff at CSWTWPM developed sore throat and his specimen tested negative for influenza A virus.

"Enhanced surveillance of suspected human cases in public and private hospitals is ongoing," a spokesman for the CHP remarked.

"Poultry workers, who have prolonged exposure to live poultry, might have higher risks of contracting the virus from infected poultry and hence increased risks of genetic reassortment of the virus. Poultry workers have been recommended by the CHP's Scientific Committee on Vaccine Preventable Diseases as one of the priority groups and have been covered in the Government Vaccination Programme under which they are eligible for free influenza vaccination. We advise them to get vaccinated early as it is one of the effective means to prevent influenza-associated complications and hospitalisations," the spokesman added.

Letters to doctors and hospitals will be issued to alert them to the latest situation.

The National Health and Family Planning Commission and the health authorities of Guangdong and Macau have been informed.

Poultry workers and cullers in doubt may call the CHP's avian influenza hotline (2125 1111) for enquiries and it operates from 9am to 6pm.

Ends/Wednesday, December 31, 2014
Issued at HKT 18:11

Tuesday, December 30, 2014

Hong Kong: Imported Poultry PCR Positive For H7 Avian Flu

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# 9517

 

Several hours ago, in Hong Kong: Positive H7 Serological Test On Imported Chickens, we saw a report that several chickens among a batch of imported poultry from mainland China had tested positive (by serology) for H7, but that they were not PCR positive, which would indicate active infection.

 

Extended PCR testing was immediately ordered on 120 birds from this shipment, and apparently those results show some of the birds to be actively infected with the H7 virus. 

 

Although it is nearly 4am in Hong Kong, the announcement  was quickly published on the HK Government Info Website, along with the steps that would be immediately taken to prevent further spread of the virus.

 

Live poultry imported from Mainland tested positive for H7 avian influenza virus


The Government today (December 31) confirmed that a number of samples from a consignment of live chickens from a registered farm in Huicheng District of Huizhou in Guangdong were positive in H7 avian influenza (AI) Polymerase Chain Reaction (PCR) tests.


The Secretary for Food and Health, Dr Ko Wing-man, said that the Hong Kong Special Administrative Region Government (HKSARG) had decided to implement contingency measures in accordance with the Preparedness Plan for Influenza Pandemic on the Serious Response Level to prevent the virus from spreading and safeguard public health.

The Agriculture, Fisheries and Conservation Department (AFCD) has declared the Cheung Sha Wan Temporary Wholesale Poultry Market as an infected place. All of the some 15 000 live poultry in the market will be culled starting from this morning. The market will also be closed for 21 days (counting from the next day following completion of the culling operation) for thorough cleansing and disinfection. During the closure period, trading of live poultry will be suspended.

"During the closure of the wholesale market, AFCD would inspect all local farms and collect more samples for testing. Upon confirmation that all local chicken farms are not affected by AI, local chickens could be dispatched to retail points via the Ta Kwu Ling Checkpoint," Dr Ko said.

In accordance with the consensus reached with the Mainland on the handling of H7 AI cases, the HKSAR Government has notified the relevant Mainland authorities of the incident to facilitate investigation of the source of infection. Supply of live poultry from the index registered farm would be suspended, during which the relevant inspection and quarantine authorities will conduct investigation at the farm concerned and ascertain that the farm has met all of the biosecurity and management requirements. Upon expiry of the 21-day suspension period, the relevant inspection and quarantine authorities will notify the HKSAR Government of the investigation result. The farm concerned will resume supply of live poultry to Hong Kong only upon acceptance of the investigation result by both sides.  


AFCD, the Food and Environmental Hygiene Department and the  Centre for Food Safety (CFS) will also strengthen the surveillance and control measures against H7N9 along the supply chain of live poultry.

Dr Ko stressed, "The HKSAR Government has built up a resilient and stringent system and collaborated closely with the Mainland authorities for the surveillance and control of AI. We have since April 2013 introduced the PCR testing for H7 AI, and since January 2014 introduced the H7 serological testing to strengthen early warning against AI."

"All live poultry supplied to Hong Kong markets, whether locally reared or imported, are subject to stringent inspection and quarantine procedures.  Animal health certificates would be issued only if the test results are satisfactory. Prior to leaving the farms, the poultry are put under quarantine and are required to pass PCR and serology tests for AI to show that the poultry carry sufficient level of antibodies against H5; are free of any AI virus and do not bear AI clinical symptoms.

"After the live poultry have entered Hong Kong, CFS will collect blood and swab samples from the live poultry at the Man Kam To Animal Inspection Station and pass the samples to AFCD's Veterinary Laboratory for testing. The detection of positive H7 AI samples in imported live poultry in the current case demonstrates that the testing system has achieved what it is designed to do, namely reducing the risk of infected birds entering our retail markets and performing its gate-keeping role for protecting public health," he added.


The Centre for Health Protection (CHP) of the Department of Health would contact poultry wholesalers and workers in the Man Kam To Animal Inspection Station and the Cheung Sha Wan Temporary Wholesale Poultry Market to follow up on their health condition. CHP and the Hospital Authority will remind all doctors in Hong Kong and healthcare workers in public hospitals to stay vigilant and should report immediately if there is any suspected avian influenza case.


Dr Ko appealed to the public again to maintain good personal and environmental hygiene, including washing hands frequently, wearing masks when feeling unwell, avoiding contact with live poultry or visiting live poultry markets in the affected districts, revealing their travel history to doctors and not bringing poultry to Hong Kong illegally, which are important and effective measures for preventing diseases.

Ends/Wednesday, December 31, 2014
Issued at HKT 02:37
NNNN

 

Saudi MOH: 1 MERS Case In Najran

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# 9516

 

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Hong Kong: Positive H7 Serological Test On Imported Chickens

Photo: ©FAO/Tariq Tinazay

Credit FAO

 

# 9515

 

The 7 million+ residents of Hong Kong consume more poultry than can be produced locally, so every week a large quantity of live poultry is imported from neighboring Guangdong Province. In order to protect both the residents, and the poultry operations, in Hong Kong a small number of chickens in each batch is tested – both by PCR and by Serology – for avian flu viruses.

 

While PCR testing can tell if there is a current infection, serology can show evidence of earlier infections.   And that can help define just how big a problem a virus is becoming.

 

Testing is particularly important for H7N9, as the virus does not cause symptoms in poultry, but can be deadly for humans. Often we only first learn of an outbreak in poultry when exposed humans fall ill. 

 

Last year the use of both testing methods by Hong Kong led to considerable political friction, as powerful mainland agricultural interests felt the serological tests were unfairly prejudicial against their product (see  Hong Kong: Dr. Ko Wing-man On H7N9 Testing Of Poultry).  

Today we learn that a small number of imported chickens have tested positive by serology (but not PCR) for the H7 virus, and that additional PCR testing is underway to determine if there are any actively infected birds in this shipment.  Results should be available in a few hours.

 

 

Samples of imported live chickens tested positive in serological tests for H7 avian influenza

The Government today (December 30) found in a consignment of imported live chickens a number of samples tested positive in H7 avian influenza (AI) serological tests, whilst all swab samples collected from the same consignment of live chickens were tested negative in H7 Polymerase Chain Reaction (PCR) tests. According to the established risk management protocol, the relevant government departments are now collecting 120 additional swab samples from the same consignment of live chickens to conduct PCR testing.  Preliminary results will be available around midnight at the earliest.


The serological test serves as a surveillance measure on birds or farms to determine if they have been infected with H7 AI in the past. While a positive result in serological test reflects the fact that the live poultry have been infected in the past, it does not mean the concerned chickens are carrying AI virus at the time when being tested. To ascertain if individual birds are carrying AI virus, the accepted protocol is to rely mainly on PCR testing for H7 AI which is currently in use.


If the additional 120 swab samples are all tested negative in the H7 PCR tests, it reflects that the consignment of live chickens is not carrying AI virus and can be released to the market. For good measure, the Hong Kong Government will notify the relevant Mainland authorities for strengthened surveillance and investigation on the registered farm concerned.  After both sides have agreed on the investigation result, the farm in question may continue to supply live poultry to Hong Kong.


If any of the additional 120 swab samples is tested positive in the H7 PCR tests, it would suggest that the consignment of live chickens carries H7 AI virus.  The Government will accordingly activate the AI contingency plan.

Ends/Tuesday, December 30, 2014
Issued at HKT 20:55
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PNAS: Evolution Of H9N2 And It’s Effect On The Genesis Of H7N9

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Photo Credit – FAO

 

# 9514

 


We’ve a nifty piece of avian flu research which appears this week in PNAS, that looks at the continued evolution of H9N2 in Chinese poultry, and how that may have prompted  the emergence of the H7N9 virus during the spring of 2013.

 

A joint effort of several Chinese science institutions and the St. Jude Children's Research Hospital, this study features Jinhua Liu, Ph.D., of the College of Veterinary Medicine at the China Agricultural University, and Dr. Robert Webster as co-corresponding authors.

 

Regular readers of this blog are aware that the avian H9N2 virus – which has been rife in Asian poultry for the past couple of decades – has been a major contributor to the creation of new avian viruses. Of the viruses we are currently watching with the most concern – H5N1, H7N9, H5N6, and H10N8 – 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

 

Last January, 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.

 

Last May, in EID Journal: H7N9 As A Work In Progress, we looked at a study that found the H7N9 avian virus continues to reassort with local H9N2 viruses, making the H7N9 viruses that circulated in wave 2 genetically distinct from those that were seen during the 1st wave.

Although categorized by their two surface proteins (HA & NA) Influenza A viruses have 8 gene segments (PB2, PB1, PA, HA, NP, NA, M1, M2, NS1, NS2).

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H7N9 carries 6 genes from H9N2Credit Eurosurveillance

 

And while we have only seen a handful of human infections with H9N2 (see Hong Kong: Isolation & Treatment Of An H9N2 Patient), it is also true that in areas where this virus is most common, testing and surveillance for the virus is extremely limited.  Like so many other novel viruses, we can only guess at is true burden in the human population.

 

While it’s impact on emerging avian flu viruses has been well documented, the reasons behind it’s influence have been less than clear. 

 

Today, however, we have research that shows a new, better adapted genotype  (G57) of the H9N2 virus has emerged  – one that evades the poultry vaccines currently in use – and that it has become widespread among vaccinated Chinese poultry since 2010.

 

This spread has provided more opportunities for reassortment, and so we see more avian viruses emerging.

 

First the Abstract from the study, followed by some excerpts from a St. Jude Children’s Research Hospital press release, after which I’ll return with a bit more.

 

Evolution of the H9N2 influenza genotype that facilitated the genesis of the novel H7N9 virus

Juan Pua,b,1, Shuoguo Wangc,1, Yanbo Yind,1, Guozhong Zhanga, Robert A. Carterc, Jinliang Wanga, Guanlong Xua, Honglei Suna, Min Wanga, Chu Wena, Yandi Weia, Dongdong Wangd, Baoli Zhue, Gordon Lemmonc, Yuannian Jiaoc, Susu Duanb, Qian Wanga, Qian Dua, Meng Suna, Jinnan Baoa, Yipeng Suna, Jixun Zhaoa, Hui Zhangf, Gang Wuc, Jinhua Liua,2, and Robert G. Websterb,2

 

Significance

The emergence of human infection with a novel H7N9 avian influenza reassortant in China raises a pandemic concern. However, it is not fully understood how these H9N2 chicken viruses facilitated the genesis of the novel H7N9 viruses. Here we show that a “fittest” genotype (G57) emerged with changed antigenicity and improved adaptability in chickens. It became predominant in vaccinated farm chickens and caused widespread outbreaks before the H7N9 virus emergence, increasing reassortment between H9N2 and other subtype viruses and finally providing all of their internal genes to the novel H7N9 viruses. The prevalence and variation of H9N2 influenza virus in farmed poultry could provide an important early warning of the emergence of novel reassortants with pandemic potential.

Abstract

The emergence of human infection with a novel H7N9 influenza virus in China raises a pandemic concern. Chicken H9N2 viruses provided all six of the novel reassortant’s internal genes. However, it is not fully understood how the prevalence and evolution of these H9N2 chicken viruses facilitated the genesis of the novel H7N9 viruses. Here we show that over more than 10 y of cocirculation of multiple H9N2 genotypes, a genotype (G57) emerged that had changed antigenicity and improved adaptability in chickens. It became predominant in vaccinated farm chickens in China, caused widespread outbreaks in 2010–2013 before the H7N9 viruses emerged in humans, and finally provided all of their internal genes to the novel H7N9 viruses. The prevalence and variation of H9N2 influenza virus in farmed poultry could provide an important early warning of the emergence of novel reassortants with pandemic potential.

 

Tracing evolution of chicken flu virus yields insight into origins of deadly H7N9 strain


Memphis, Tennessee, December 29, 2014

An international research team has shown how changes in a flu virus that has plagued Chinese poultry farms for decades helped create the novel avian H7N9 influenza A virus that has sickened more than 375 people since 2013. The research appears in the current online early edition of the scientific journal Proceedings of the National Academy of Sciences.

The results underscore the need for continued surveillance of flu viruses circulating on poultry farms and identified changes in the H9N2 virus that could serve as an early warning sign of emerging flu viruses with the potential to trigger a pandemic and global health emergency. The work focused on the H9N2 chicken virus, which causes egg production to drop and leaves chickens vulnerable to deadly co-infections. Scientists at St. Jude Children’s Research Hospital and the China Agricultural University, Beijing, led the study.

Researchers used whole genome sequencing to track the evolution of the H9N2 chicken virus between 1994 and 2013. The analysis involved thousands of viral sequences and showed that the genetic diversity of H9N2 viruses fell sharply in 2009. From 2010 through 2013 an H9N2 virus emerged as the predominant subtype thanks to its genetic makeup that allowed it to flourish despite widespread vaccination of chickens against H9N2 viruses.

Evidence in this study suggests the eruptions set the stage for the emergence of the H7N9 avian virus that has caused two outbreaks in humans since 2013, with 115 confirmed deaths. The H9N2 infected chickens likely served as the mixing vessel where H9N2 and other avian flu viruses from migratory birds and domestic ducks swapped genes, researchers noted. The resulting H7N9 virus included six genes from the H9N2.

"Sequencing the viral genome allowed us to track how H9N2 evolved across time and geography to contribute to the H7N9 virus that emerged as a threat to human health in 2013," said Robert Webster, Ph.D., a member of the St. Jude Department of Infectious Diseases. He and Jinhua Liu, Ph.D., of the College of Veterinary Medicine at the China Agricultural University, are co-corresponding authors.

"The insights gained from this collaboration suggest that tracking genetic diversity of H9N2 on poultry farms could provide an early warning of emerging viruses with the potential to spark a pandemic," Webster said.

(Continue . . .)

 

If all of this sounds vaguely familiar, last April in Study: Sequence & Phylogenetic Analysis Of Emerging H9N2 influenza Viruses In China, we saw H9N2 viruses collected from two Chinese Provinces (Zhejiang & Guangdong) in late 2011 showed signs of evolving antigenically away from the vaccine strain, with a majority of isolates (14 out of 18) showing an amino acid change in the receptor binding site suggestive of an enhanced ability to bind to human receptor cells.

 

While poultry vaccination has been adopted by a number of countries to control their avian flu problems, there are distinct downsides to relying on vaccines for the control of avian viruses (for earlier blogs see OIE: Countries That Vaccinate Poultry Need An `Exit Strategy' & Food Insecurity, Economics, And The Control Of H7N9).

 

While vaccines can often protect poultry against illness - with increasingly diverse and rapidly evolving avian flu viruses - they can’t always prevent infection.  Particularly if they aren’t updated often.

 

The end result being that subclinical infections can go undetected, viruses continue to circulate unnoticed, and new variants or reassortants continue to emerge. These failures are not limited to the H9N2 vaccines, as we’ve seen similar results with H5 vaccines as well (see EID Journal: Subclinical HPAI In Vaccinated Poultry – China &  Egypt: A Paltry Poultry Vaccine). 

 

There are, unfortunately, no simple solutions.

 

Countries like China, Indonesia, Vietnam, and Egypt – places where avian flu viruses are well entrenched in both commercial and home raised poultry - rely heavily on poultry vaccines. They view the immediate culling of infected birds, the standard control practice for most of the rest of the world, as being impractical and fear the social and economic impacts of such a policy.

 

The problem is, as new avian flu subtypes, clades, and sub clades emerge, the vaccines in use inevitably lose the battle, and over time that can lead to a snowball effect where the number of viruses in circulation escalate rapidly.

 

Given the recent emergence of H7N9, H10N8, H5N6, H5N8 and H5N3, one has to wonder just how much faster this snowball will roll over the next few years.

Egyptian MOH: 26th H5N1 Case Announced

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Credit Wikipedia

 

# 9513

 

The steady trickle of H5N1 cases continues out of Egypt, with the 6th case announced over the past 7 days. This brings to 26 the total number of cases announced this year, and boosts to 22 the number of cases reported since mid-November.

 

While an unusually high number of cases  for such a short period of time, there are currently no signs of community spread of the virus, and the risks are primarily confined to those who raise poultry in their homes. .  

 

This statement from the Egyptian MOH.

 

 

Health central laboratory results confirmed positive infection status of بڤيرس N5H1

The Ministry of health and population of infection for confirmed case bevirs N5H1 (bird flu). A 51-year-old from Asyut province where he was suffering from fever, cough, runny-decongestant-vomiting-tight to breathe, and the patient went on Monday, 22/12/2014 to Saint Maria hospital in Assiut, where examination and chest x-ray were the rays having double pneumonia is suspected in the case of bird flu

The case was transferred to a hospital, Assiut on 24/12/2014 and isolated on the same day the general condition of the patient is stable.

-Bringing the total number of cases of bird flu in 2014 so far 26 cases (12 cases of healing, 4 cases under treatment, 10 deaths).

Therefore calls upon the Ministry of health and population of citizens who deal with poultry and go immediately to the nearest hospital to receive health service if they have flu symptoms, where the infected bird flu drug Tamiflu within the first 24 hours of the onset of symptoms increases the healing rates of disease and reduces the mortality and Health Ministry advised people who deal with poultry caution and prudence when dealing with birds that show symptoms of the disease and the need to take preventive action to prevent such infection cover The mouth and nose when handling poultry, wash hands with SOAP and water after handling birds and children not accompany poultry or slaughter premises as well as the need to separate from living birds.

Monday, December 29, 2014

Scottish Govt. Statement: Confirmed Ebola Case Arrived In Glasgow

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Credit CDC PHIL

 

# 9512

 

The news is just coming across the wires, apparently based on the following statement posted on the Scottish Government website roughly 40 minutes ago.  The case involves a medical worker who just returned last evening from West Africa, who reported feeling unwell this morning, and has now tested positive for the virus.

 

 

 29/12/2014 18:35

 

Confirmed case in Glasgow

A confirmed case of Ebola has been diagnosed in Glasgow.

NHS Scotland infectious diseases procedures have now been put into effect and the patient has been isolated and is receiving treatment in the specialist Brownlee Unit for Infectious Diseases on the Gartnavel Hospital campus.


The patient is a health care worker who was helping to combat the disease in west Africa. They returned to Scotland from Sierra Leone late last night via Casablanca and London Heathrow, arriving into Glasgow Airport on a British Airways flight at around 11.30pm.


The patient was admitted to hospital early in the morning after feeling unwell and was placed into isolation at 7.50am. All possible contacts with the patient are now being investigated and anyone deemed to be at risk will be contacted and closely monitored. However, having been diagnosed in the very early stages of the illness, the risk to others is considered extremely low.


First Minister Nicola Sturgeon has chaired a meeting of the Scottish Government Resilience Committee (SGoRR) to ensure all necessary steps are being taken, and has also spoken to Prime Minister David Cameron.


According to UK and Scottish protocol for anyone diagnosed with Ebola, the patient will be transferred to the high level isolation unit in the Royal Free hospital, London, as soon as possible. This is where the facilities, staff and systems are in place to ensure the best quality and safest care.


While public health experts have emphasised that the risks are negligible, a telephone helpline has been set up for anyone who was on the Heathrow to Glasgow flight last night.


The number is: 08000 858531


First Minister Nicola Sturgeon said:

“Our first thoughts at this time must be with the patient diagnosed with Ebola and their friends and family. I wish them a speedy recovery.

“Scotland has been preparing for this possibility from the beginning of the outbreak in West Africa and I am confident that we are well prepared.

“We have the robust procedures in place to identify cases rapidly. Our health service also has the expertise and facilities to ensure that confirmed Ebola cases such as this are contained and isolated effectively minimising any potential spread of the disease.

“Scotland’s NHS has proved it is well able to cope with infectious diseases in the past, such as swine flu, and I am confident we will be able to respond effectively again.”

 

Shenzhen Reports H7N9 Case

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*** UPDATED *** :  HK’s CHP has posted this case (see bottom).

 

# 9511

 


Even as neighboring Hong Kong deals with their first imported case of the winter -  a local resident with recent travel history to Shenzhen in Guangdong Province - we now learn of the `first’ local case reported by Shenzhen authorities – that of a 35 year-old woman who fell ill on December 20th and whose condition worsened, and was hospitalized on the 26th.

 

Fair warning: the Guangdong Department of Health website isn’t responding, and I find no mention of this case yet on the Shenzhen CDC website, so all we have at this time are media reports.

 

 

Shenzhen 1 new confirmed cases of human infection with H7N9 avian influenza

12--30 01:58

 

Epidemic control mechanism BEIJING defense office in Shenzhen December 29 (by Chen Wei deep faith) Shenzhen prevention and control of human infection with H7N9 avian influenza 29 evening news release, Shenzhen, one new confirmed cases of human infection with H7N9 avian influenza, this case Since May of this year, the city's first case found.

Ms. Yang patients, female, 35 years old, Han, Ji'an people, domestic staff, now living Longhua District, Dalang Street. December 20 and on the incidence of Longhua People's Hospital early community health center for treatment, December 26 to Shenzhen People's Hospital for treatment Longhua Branch, exacerbations, at 16:00 pm on the 28th pick in the hospital nasal swab samples After the families of patients in the referral request to Shenzhen Second People's Hospital, 28 at 23:00 own family members of patients to find the car (at the time the test results are not out) transferred to the First Affiliated Hospital of Guangzhou Medical University, Institute of Respiratory Diseases do further treatment, is now in critical condition.

(Continue . . .)

 

*** UPDATE ***

From Hong Kong’s CHP:

CHP notified human case of avian influenza A(H7N9) in Shenzhen

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (December 30) closely monitoring an additional human case of avian influenza A(H7N9) in Shenzhen 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, the female patient aged 35 was hospitalised for management in critical condition. This is the first case in Shenzhen this winter.

To date, 455 human cases of avian influenza A(H7N9) have been confirmed in the Mainland in Zhejiang (141 cases), Guangdong (112 cases), Jiangsu (59 cases), Shanghai (42 cases), Hunan (24 cases), Fujian (23 cases), Anhui (17 cases), Jiangxi (eight cases), Xinjiang Uyghur Autonomous Region (eight cases), Beijing (five cases), Shandong (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

(Continue . . . )

FluView Week 51

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FluView Week 51


# 9510

 

While avian flu in China and Egypt have captured a good deal of our attention, we continue to tread deeper into a difficult H3N2 dominated flu season, with increasing media reports of crowded hospitals and scattered deaths across the nation. 

 

Keeping track of all of this,we have the CDC’s FluView report – normally released on Fridays – but delayed last week due to the mid-week Holidays and was posted this morning.

 

The new `drifted’ H3N2 virus – one that is a poor match for this year’s vaccine strain – continues to show up in surveillance, although unlike last week where all of the samples (n=12) were a `miss’, this week 14 of 30 H3N2 viruses tested match the vaccine.  At this point in the season, roughly 2/3rds of the H3N2 viruses tested are of the new strain.


This week, for the first time in this year’s flu season, the P&I (Pneumonia & Influenza) Mortality level was at the epidemic threshold. Nearly all of the flu being reported is influenza A, and nearly all of those cases are H3N2, which often produces a more severe flu season than does H1N1. 

 

Some excerpts from this weeks report include:

 

2014-2015 Influenza Season Week 51 ending December 20, 2014

All data are preliminary and may change as more reports are received.

Synopsis:

During week 51 (December 14-20, 2014), influenza activity continued to increase in the United States.

  • Viral Surveillance: Of 21,858 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 51, 6,152 (28.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was at the epidemic threshold.
  • Influenza-associated Pediatric Deaths: Four influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 9.7 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 5.5%, above the national baseline of 2.0%. All 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and 22 states experienced high ILI activity; six states experienced moderate ILI activity; New York City and eight states experienced low ILI activity; 14 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 36 states was reported as widespread; Guam, Puerto Rico, and 10 states reported regional activity; the District of Columbia, the U.S. Virgin Islands, and two states reported local activity; and two states reported sporadic activity.

INFLUENZA Virus Isolated

Influenza Virus Characterization*:

CDC has characterized 305 influenza viruses [10 A(H1N1)pdm09, 239 A(H3N2), and 56 influenza B viruses] collected by U.S. laboratories since October 1, 2014.

Influenza A Virus [249]

  • A (H1N1)pdm09 [10]: All 10 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere influenza vaccine.
  • A (H3N2) [239]: Seventy-eight (32.6%) of the 239 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere influenza vaccine. One hundred sixty-one (67.4%) of the 239 viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable, from the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.

Influenza B Virus [56]

Thirty-nine (70%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 17 (30%) influenza B viruses tested belong to B/Victoria/02/87 lineage.

  • Yamagata Lineage [39]: All 39 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014-2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines.
  • Victoria Lineage [17]: Fifteen (88%) of the 17 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014-2015 Northern Hemisphere quadrivalent influenza vaccine. Two (12%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

    Pneumonia And Influenza Mortality

Influenza-Associated Pediatric Mortality:

Four influenza-associated pediatric deaths were reported to CDC during week 51. Three deaths were associated with an influenza A (H3) virus and occurred during weeks 49 and 50 (weeks ending December 6 and December 13, 2014, respectively). One death was associated with an influenza B virus and occurred during week 51 (week ending December 20, 2014).

A total of 15 influenza-associated deaths have been reported during the 2014-2015 season from nine states (Arizona [1], Colorado [1], Florida [2], Minnesota [2], North Carolina [2], Nevada [1], Ohio [2], Texas [3], and Virginia [1]).
Additional data can be found at:
http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html.

Click on image to launch interactive tool

 (Continue . . . )

 

Whether you got the shot or not, with holiday gatherings upon us our focus now should be on practicing good flu hygiene. 

The CDC suggests:

  • Try to avoid close contact with sick people.
  • If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)
  • While sick, limit contact with others as much as possible to keep from infecting them.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

WHO: Ebola Cases Top 20,000 In West Africa

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# 9509

 

It is, admittedly, an arbitrary and artificial milestone, and would likely have been surpassed some time ago if all of the Ebola cases in Guinea, Sierra Leone, and Liberia could have been counted, but today for the first time the World Health Organization is reporting the case count has exceeded 20,000 individuals.


While a far cry from some of the stratospheric Ebola estimates produced a few short months ago (see MMWR: Estimating The Future Number of Cases In The Ebola Epidemic), this is nonetheless a tragic number, and is likely a significant undercount of the reality in the region.

 

Although I cover Ebola in this blog from time to time, for the best daily readout of the events in West Africa I would whole heartily recommend the coverage by Crof on Crofsblog.

Two More H7N9 Reports From Zhejiang Province

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Zhejiang Province – Credit Wikipedia

 

# 9508

 

H7N9 reports out of Zhejiang Province, China continue to emerge piecemeal, with no single authority making announcements. The Zhejiang Health and Family Planning website, a place we’d normally look for such reports, remains strangely quiet on H7N9.

 

Over the past couple of days we’ve seen two H7N9 cases reported out of Zhejiang – a 57 year-old man from Jinhua on the 27th, and yesterday a 75-year-old man Zhoushan townThese cases are geographically quite distant from one another and are not linked.

 

Today we are seeing reports of a 20 year-old from Shaoxing  City and a 33 year-old from Yongkang City having been diagnosed with the virus.  

 

Our first stop, the Shaoxing City Municipal Health Bureau (h/t Shiloh on FluTrackers for the link).

 

One case of H7N9 confirmed cases keqiao area


Source: Municipal Health Bureau Date: 2014-12-29 

December 28 Keqiao District confirmed one case of H7N9 cases, this is the first cases appeared in this winter of our city, our province, following the recent Jiaxing, Yiwu, Yongkang found after the first five cases of H7N9 cases.


According to CDC epidemiological investigation, the patient Xing Moumou, female, 20 years old, currently living area keqiao Anchang, one week prior to the onset has been to the farmers market, no clear history of exposure to poultry, currently in critical condition, still active treatment, the epidemic prevention and control measures are being ordered implemented.


Really good job in the prevention and control of H7N9 and other respiratory diseases in winter and spring, to protect people's lives and the safety and health of the city since the fall of the H7N9 prevention measures to further strengthen the government held a special meeting, a clear focus on the prevention and control tasks, strengthen epidemic patient monitoring and treatment of preparatory work, promote poultry "slaughter, kill white listed" to regulate the management of live poultry market transactions, joint special rectification, investigate and punish illegal trade of live poultry and other measures.


Experts advise consumers to prohibit live poultry trade, the implementation of cold fresh selling not only the government's requirements, but also to prevent bird flu, pay attention to science inevitable choice for a healthy lifestyle, the general public need to change consumer attitudes, and establish healthier eating chilled products, Safer scientific concept. At the same time, the current high season coincided respiratory diseases, people should pay attention to personal hygiene, indoor ground ventilation, air circulation and less places to go, do not contact with sick / dead poultry category, carefully touching live poultry, fever, cough, etc. Symptoms medical institutions should be approaching fever clinic.

 

Meanwhile, from Yongkang City (200km from Shaoxing), we get this report of a 33 year-old infected with the virus.  Additionally, it appears that one of the two cases reported earlier this week has died.

 

Yongkang third case confirmed H7N9 cases, 1 death

At 19:55 on December 29th, 2014
Source:
China News Network

BEIJING, Dec. 29 Jinhua (Reporter Hu Fengsheng) 29 evening, according to the government press center Yongkang official microblogging "Yongkang release" message in the afternoon, Yongkang confirmed three cases of H7N9 flu cases first. It is in this winter, following Jiaxing, Zhejiang Yiwu confirmed two cases since the emergence of the first five cases. Zhejiang Province, according to the CDC epidemiological investigation, before the onset of the previous two patients had history of exposure to poultry. The former situation is different in the two cases is that the patient is female, Lee, 33, East Street who is now being treated in isolation.

Preliminary statistics, there are close contacts with Lee 4, currently in good health, fever, cough and other symptoms did not appear suspicious, other close contacts is under investigation.

According to information released by the relevant departments, two cases found in previous cases, one case has died and another is in critical rescue in one case.

Local representation, analysis of these three cases, no timely attention to flu symptoms is a key factor in exacerbations, and epidemiological point of view, H7N9 influenza in Yongkang still sporadic cases, there is no direct correlation. According to the law in previous years, winter and spring are people infected with H7N9 influenza virus in a high incidence of, based on this law, the health department said the next period of time, do not rule out the case there will be sporadic cases. Local government appeal: people cough, fever and other symptoms, be sure to go to hospital for treatment.

Health department Again, try not to touch live poultry, once exposed, must be cleaned and disinfected. Also, to develop good habits and a healthy lifestyle, a balanced diet, regular exercise, pay attention to rest, to improve their resistance to disease; wash their hands frequently ventilation, timely change clothes, to avoid the cold.

 

Admittedly, we try to document as many confirmed cases of novel influenza as possible. But it is with the knowledge that we are probably only seeing the tip of the iceberg.  For every hospitalized case, we suspect there may be a number of mild or asymptomatic infections that go undetected.

 

We’ve seen estimates (see Eurosurveillance Clinical severity of human infections with avian influenza A(H7N9) virus, China, 2013/14) that there may have been thousands of undetected H7N9 cases in China over the past two years, although no one really knows for sure.

 

While a few family clusters have been reported, reassuringly among close contacts of known H7N9 cases, very little transmission appears to have taken place.  For now, bird-to-human transmission appears to be the norm.

 

Although it may not be possible for surveillance and reporting systems to capture the full impact of these outbreaks, the ability to closely examine a subset of cases can still provide excellent insights into the behavior of, and risks posed by, this emerging virus.

Egyptian MOH Confirms 25th H5N1 Case Of 2014

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# 9507



The Egyptian Ministry of Health has confirmed yet another H5N1 case, this time near Cairo, bringing to 25 the total number of cases this year and the 21st case reported in just over 6 weeks.   

 

The MOH today also announced the successful treatment and release from the hospital of four recent cases.

 

We continue to see media reports of additional `suspected’ cases being isolated and tested, but so far no indication of anything beyond sporadic bird-to-human transmission of the virus, predominantly among rural housewives and children who have frequent contact with home-raised birds.

 

Health: central laboratory analysis results confirm positive infection status of بڤيرس N5H1 "

The Ministry of health and population of infection confirmed case بڤيرس N5H1 (bird flu) to a 42-year-old from Helwan governorate of Cairo where it started symptoms on 23/12/2014 and went for treatment to a hospital in Helwan on viruses, 26 December 2014 where he suffered from fever, cough and diarrhea-suspected case of bird flu was found to have pneumonia and isolated on the same day and general condition medium.

Bringing the total number of cases of bird flu in 2014 so far 25 cases (10 cases of healing, 5 cases under treatment, 10 deaths).

Therefore calls upon the Ministry of health and population of citizens who are dealing with immediate direction to the nearest poultry hospital for the health service if they have flu symptoms, where the infected bird flu drug Tamiflu within the first 24 hours of the onset of symptoms increases the healing rates of disease and reduces the mortality and Health Ministry advised people who deal with poultry caution and prudence when dealing with birds that show symptoms of the disease and the need to take preventive action to prevent such infection cover The mouth and nose when handling poultry, wash hands with SOAP and water after handling birds and children not accompany poultry or slaughter premises as well as the need to separate from living birds.

Source: Media Center

Japan: H5 Confirmed in Miyazaki Poultry – Testing In Yamaguchi

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Map source - Wikipedia

 

# 9506

 

Yesterdays’ preliminary positive tests at a poultry farm in Miyazaki Japan have been confirmed as HPAI H5, and 42,000 birds are to be culled in the second outbreak in two weeks in the same region of southern Japan.  The outbreak reported on December 16th was H5N8, although of a different sub clade than previously seen in Japan.

 

Meanwhile, further north in Yamaguchi Prefecture, officials report a preliminary positive test as well.


These poultry outbreaks come amid the backdrop of repeated detections of H5N8 in wild and migratory birds which come to southern Japan each year to overwinter (see Japan: H5N8 Detected In Izumi Crane & H5N8 In Migratory Bird Droppings).


Two reports, therefore.  The first from NHK News:

And dispose of the bird flu detected about 42 000 birds

December 29 12:13

The 28th, in response to the fact that the H5 type of avian influenza virus from poultry farms of chicken Miyazaki has been detected, Miyazaki Prefecture, and dispose of the chicken about 42 000 birds of this poultry farms, the work to fill in the site we are.

The 28th, it was confirmed the 30 chickens are dying at a poultry farm in Miyazaki Takaoka-cho, where Miyazaki Prefecture were in detail inspection, bird flu virus that could of virulent of "the H5" is detected from a few birds has been. For this reason, Miyazaki Prefecture dispose of the chicken about 42 000 birds that had been raised in this poultry farms based on the country of guidelines, we are currently working and disinfection to fill

(Continue . . .)


And this report from Asahi.com, on a suspected outbreak in Nagato.

 

Nagato of poultry farms suspicion of highly pathogenic avian influenza infection in Yamaguchi

At 20:44 on December 29, 2014 Yamaguchi Prefecture on the 29th, cases of infection were suspected to highly pathogenic avian influenza virus in the prefecture has been confirmed, was announced. According to the prefecture, that chickens suspected infected with poultry farms of the prefecture Nagato is found. In this poultry farm, you are reared about 30 007 Senba Beef chicken. Ken open measures conference from the same day 18:30, to discuss the correspondence.

(Continue . . .)

 

While biosecurity measures at poultry operations in Japan tend to be excellent, in 2011 an outbreak of H5N1 in Miyazaki forced the destruction of a million birds, and so concerns over the extent of this latest intrusion by HPAI into Japan are running high.

Hong Kong: CHP Update On Latest Imported H7N9 Case

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# 9505

 

 

The epidemiological investigation – including contact tracing – on Hong Kong’s 11th imported case of H7N9 continues, and today we learn that her two traveling companions, and one of the doctors she initially consulted, have now been located and are asymptomatic.

 

Two reports from Hong Kong’s CHP.  First an investigation status update, followed by excerpts from the letter sent to local doctors informing them of the case, alerting them of the possibility of seeing additional cases, and providing additional details on the patient’s presentation and course of treatment. 

 

 

Update of human case of avian influenza A(H7N9)

The Department of Health (DH) today (December 29) reported the latest updates on the first confirmed human case of avian influenza A(H7N9) in Hong Kong this winter, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.


Further epidemiological investigations by the Centre for Health Protection (CHP) of the DH have so far located two travel collaterals who travelled with the patient to Shenzhen on December 13. According to them, the trio visited a wet market in Niulanqian, Bao'an, Shenzhen, bought vegetables, and did not purchase or have contact with live chickens sold there. Both travel collaterals have remained asymptomatic for more than 10 days (incubation period) since their last contact with the patient and have been put under medical surveillance.

Investigations also revealed that the patient had consulted two private doctors practising in the same clinic on December 19 and 23 respectively. While the CHP has reached one of the duo thus far, the other private doctor is now out of town and follow-up is under way.

According to the private doctor whom the CHP has reached, the patient did not reveal her travel history to the Mainland during consultation. The clinic staff have remained asymptomatic and have been put under medical surveillance. Tracing of the relevant clients who attended the clinic at the same time with the patient is under way.

In addition, the patient underwent a chest X-ray examination in a medical laboratory centre on December 23, and the CHP's follow-up is under way.


Investigations are ongoing.

Ends/Monday, December 29, 2014
Issued at HKT 18:56

 

 

And this letter sent to local doctors (similar ones were sent to hospitals):

 

Surveillance And Epidemiology Branch            December 28, 2014

Dear Doctors,


A Confirmed Case of Human Infection with Avian Influenza A(H7N9) virus and Activation of Serious Response Level of Government’s Preparedness Plan

I would like to draw your attention to a confirmed case of human infection with avian influenza A(H7N9) virus in Hong Kong. The patient is a 68-year-old Chinese woman who has hypertension. She lives with her husband in Tuen Mun in Hong Kong.


According to the patient's family, she developed fever and symptoms of influenza-like illness (ILI) on December 19 and consulted two private doctors on December 19 and 23. She subsequently developed shortness of breath on December 25 and attended Accident and Emergency Department (AED) of Tuen Mun Hospital (TMH). Chest X-ray taken at AED showed extensive right side pneumonia and she was admitted to TMH. She developed desaturation soon after admission. She was intubated and was transferred to intensive care unit for treatment on the same day. She is now in critical condition.


Her endotracheal aspirate, nasopharyngeal aspirate and nasopharyngeal swab were all tested positive for influenza A(H7N9) virus by polymerase chain reaction by the Centre for Health Protection (CHP)'s Public Health Laboratory Services Branch on December 27, 2014.


Preliminary epidemiological investigation revealed that the patient travelled to Longgang, Shenzhen on December 13 for a day trip and returned to Hong Kong on the same day. During the trip, she ate cooked chicken at her friend's residence in Longgang. The CHP is communicating with the Health and Family Planning Commission of Guangdong to investigate the source of her infection. The patient did not visit any wet market in Hong Kong during the incubation period. According to available information, this is likely to be an imported infection. The CHP is tracing the exposed close contacts of the patient and will provide them with antiviral presumptive treatment and put them under quarantine. CHP’s investigation is on-going.


In view of this confirmed case, the Government has raised the influenza response level from “Alert” Response Level to “Serious” Response Level under the Framework of Government’s Preparedness Plan for Influenza Pandemic. Prior to this case, ten imported cases of human infection with avian influenza A(H7N9) virus were recorded in Hong Kong since December 2013.


Cumulatively, a total of 470 confirmed human H7N9 cases have been reported since March 2013, including at least 184 deaths (as of December 27, 2014). These included 454 cases in Mainland China and 16 cases exported from Mainland China to Hong Kong (11), Taiwan (4) and Malaysia (1).


As the winter months approached, there has been increase in number of sporadic human cases of avian influenza A (H7N9) infection occurring in Mainland China. There have been 16 human H7N9 cases reported (as of December 27) with onset dates since the beginning of September. These 16 cases occurred in Xinjiang (6), Jiangsu (3), Guangdong (2), Zhejiang (2), Beijing (1), Fujian (1) and Shanghai (1). Based on the seasonal pattern of avian influenza viruses, it is likely that the disease activity of H7N9 in Mainland China may further increase in the winter and heightened vigilance is warranted.


In response to the newly confirmed case in Hong Kong, we have enhanced surveillance by activating zero reporting with both public and private hospitals. Private hospitals are obliged to report the number of suspected cases on a daily basis and a nil return is required (Appendix 1 and 2). We would like to urge you to pay special attention to those who presented with ILI or fever and had history of visiting wet market with live poultry or contact with poultry in Guangdong or other affected areas within the incubation period (i.e., 10 days before onset of symptoms). The list of affected areas is regularly updated and is available at the following webpage of the CHP website:


http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf

 
Any suspected case meeting the reporting criteria (available from:
https://ceno.chp.gov.hk/casedef/casedef.pdf ) should be immediately reported to the Central Notification Office (CENO) of CHP via fax (2477 2770), phone (24772772) or CENO On-line (www.chp.gov.hk/ceno).

Please also contact the Medical Control Officer (MCO) of the Department of Health at pager: 7116 3300 (call - 3 - 9179) when reporting any suspected case. CHP will make  arrangement to send the patient to regional public hospitals for isolation, testing and treatment. Besides, it is important to isolate the patient to minimize contact/exposure to staff and other patients and advise the patient to wear a surgical mask while waiting for transport.


For updates on the latest situation of avian influenza, please visit the CHP’s designated website at http://www.chp.gov.hk/en/view_content/24244.html.

Thank you for your ongoing support in combating communicable diseases.


Yours faithfully,
(Dr. SK CHUANG)
for Controller, Centre for Health Protection
Department of Health