Tuesday, March 31, 2015

Media Report: HPAI H5N2 In Montana Falcon


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Although I’ve not yet found an official source, The Missoulian is reporting that a captive gyrfalcon in Columbia Falls (Northwest Montana, very near the Canadian border) has died from HPAI H5N2 after being fed a wild duck. Montana becomes the 12th state to report the detection of HPAI H5 this winter.

The bird that died was owned by a falconer who owns roughly 50 other birds, all of which will be tested for the virus.


First a brief excerpt from a much longer report, then I’ll be back with a bit more:


Poultry producers warned as bird flu kills captive falcon in Columbia Falls

 By Vince Devlin

COLUMBIA FALLS – The death of a captive gyrfalcon here was caused by highly pathogenic avian influenza, the Montana Department of Livestock confirmed Tuesday.

It’s the first case, outside of hunter-harvested wildlife, reported in Montana in years.

The influenza can decimate commercial poultry stocks, killing up to 99 percent in an infected flock.

No mortalities in domestic poultry in the state due to avian influenza have been detected, and no human health issues have been reported for this particular strain, H5N2, to date.

Martin Zaluski, a veterinarian with the Department of Livestock, said the avian influenza is primarily found in wild waterfowl.

“However, the extent of avian influenza in the Continental flyways right now is unprecedented,” Zaluski said, and infected domestic poultry has been found in several states in the past several weeks, including Idaho, Washington and Oregon.

(Continue . . . )


The rate of spread of these HPAI H5 viruses across the western states has been truly remarkable, and it is expected that additional states will be added to the list in the weeks and months to come. 


While primarily a concern for the poultry industry, a week ago, in  CDC: HPAI H5 Viruses In The United States,  we looked at the CDC’s advice regarding these avian viruses.



Meanwhile, the USDA offers the following biosecurity advice for those who may come in contact with wild birds:

Bird Enthusiasts:

Do not pick up deceased or obviously sick birds. Contact your State, tribal, or Federal natural resources agency if you find sick or dead birds.

  • Wear rubber gloves when cleaning your bird feeders.
  • Wash hands with soap and water immediately after cleaning feeders.
  • Do not eat, drink, or smoke while cleaning bird feeders.


Follow routine precautions when handling wild birds.

  • Do not handle or consume game animals that are obviously sick or found dead.
  • Do not eat, drink, or smoke while cleaning game.
  • Wear rubber gloves when cleaning game.
  • Wash hands with soap and water, or alcohol wipes, immediately after handling game.
  • Wash tools and working surfaces with soap and water and then disinfect.
  • Keep uncooked game in a separate container, away from cooked or ready-to-eat foods.
  • Cook game meat thoroughly; poultry should reach an internal temperature of 165 degree Fahrenheit to kill disease organisms and parasites.
  • To report unusual signs in birds you have seen in the wild, call 1-866-4-USDA-WS. To learn more about how you can help, visit usda.gov/birdflu.

JVI: Investigating Dromedary Immune Serum As MERS-CoV Treatment

Photo: ©FAO/Ami Vitale

Credit FAO

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We’ve a study, published  in the Journal of Virology (JVI), that uses the mouse model to explore the possibility of using camel antibodies as a treatment option for MERS-Cov infection.


As we discussed last year in MERS-CoV: The Long Road To A Pharmacological Solution, with no coronavirus-specific therapy in our arsenal, treatment for infection has basically been supportive (e.g. fluids, vasopressors, ventilators and/or ECMO, dialysis, and antibiotics for secondary infections).


We’ve seen some limited testing of Ribavirin & Interferon Treatment of MERS-CoV, but he results from treating humans with this drug combo were far from encouraging.  Other drugs are under investigation, like Biocryst’s experimental antiviral BCX4430, but  it is too early to know how effective it might be.


The therapeutic option with perhaps the most promising future is the use of Convalescent Plasma, taken from patients who have already recovered from infection, but here again, there have been roadblocks, Many MERS survivors – due to advanced age, general health, or low antibody titers – are poor donors.


The idea of using convalescent serum for MERS goes back nearly two years; This is from the World Health Organization Novel coronavirus summary and literature update – as of 8 May 2013.

An international network of clinical experts has been convened to discuss therapeutic options. It concluded that in the absence of clinical evidence for disease-specific interventions, convalescent plasma is the most promising therapy. A memo containing advice for setting up international or regional serum centers, to obtain and share convalescent plasma, has been circulated by WHO to ministries of health in affected countries. WHO and the International Severe Acute Respiratory and Emerging Infection Consortium have developed and shared a set of research protocols and case report forms to help clinical investigators establish studies of pathogenesis and pharmacology. These are available at http://www.prognosis.org/isaric/.


Making headlines last year, and sparking a great deal of Arabic twitter traffic,  was talk that serum antibodies might be harvested from camels, along with camel milk immune proteins, and then used to treat human infections.

It is not that far-fetched, as horse serums have been used for treating humans for more than a century, although their use has declined in recent years due to concerns over adverse reactions and other available options.


As nearly all adult camels in Saudi Arabia have been infected with MERS-CoV, they carry specific antibodies against the virus (see Lancet: Camels Found With Antibodies To MERS-CoV-Like Virus), and could theoretically be an abundant source for convalescent serum.


Fast forward to today, and we have a study in the Journal of Virology (JVI)  and an accompanying press release, that looks at using dromedary convalescent plasma to treat (or protect against) MERS-CoV infection in mice.

Mice are not a perfect analog for humans, and normally are not even susceptible to the MERS virus (nor are most lab animals, including non-human primates, making studies difficult).  Transgenic mice, however, can be rendered susceptible to the virus, and this study found that camel sera was shown to be protective against a MERS-CoV challenge.


The caveat being that what works on mice may not necessarily work in humans. 


But as a `proof of concept’  this is a pretty good start.   Follow the link to the study, and the press release below: 


Passive Immunotherapy With Dromedary Immune Serum In An Experimental Animal Model For MERS Coronavirus Infection.

Jincun Zhao1, Ranawaka A.P.M. Perera2, Ghazi Kayali3, David Meyerholz4, Stanley Perlman1* and Malik Peiris2*


The Middle East Respiratory Syndrome (MERS) is a highly lethal pulmonary infection. Sera from MERS convalescent patients may provide some benefit but is not readily available. In contrast, nearly all camels in the Middle East were previously infected with MERS-CoV. Here, we show that sera obtained from MERS immune camels augment the kinetics of MERS-CoV clearance, and reduce the severity of pathological changes in infected lungs, with efficacy proportional to MERS-CoV neutralizing serum antibody titers.



Could antibodies from camels protect humans from MERS?

American Society for Microbiology

Antibodies from dromedary camels protected uninfected mice from Middle East Respiratory Syndrome (MERS), and helped infected mice expunge the disease, according to a study published online March 18th in the Journal of Virology, a journal published by the American Society for Microbiology. MERS, which emerged in humans last year in the Saudi Arabian peninsula, causes severe respiratory disease, with a high mortality rate of 35-40 percent. No specific therapy is currently available.

"Our results suggest that these antibodies might prove therapeutic for MERS patients, and might protect uninfected household members and healthcare workers against MERS," says corresponding author Stanley Perlman, MD, PhD, a professor in the Departments of Microbiology and Pediatrics, the University of Iowa, Iowa City.

Passive immunization, a procedure where you inject a former patient's antibodies into a new patient to fight the disease, has been used in the past, including last year in a small number of cases of Ebola, but in the case of MERS, few former patients are available to donate antibodies. Additionally, their antibody titers are often too low, and many former patients are not healthy enough to donate.

Suspecting that humans and dromedaries were likely infected by the same virus, first author Malik Peiris, D. Phil., Professor of Medical Science, School of Public Health, the University of Hong Kong, SAR, China suggested that camel sera might be used to combat MERS. The vast majority of dromedaries on the Arabian peninsula are infected, and many have high antibody titers. The investigators decided to test dromedary antibodies against virus taken from humans. They tested the antibodies in mouse models infected with the latter virus.

 (Continue . . .)

Saudi MOH: 1 MERS Case In Najran



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CDC Study: Lives Saved By the Flu Vaccine



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Given this year’s poor performance, and resultant bad press, from the seasonal flu shot it is understandable that the CDC, and other public health entities, would want to `rehabilitate’ the flu vaccine’s recently maligned reputation.  Particularly since - even in a `bad-match’ year - the flu vaccine can save lives.


The flu shot – while far from perfect – has an excellent safety profile, and most years provides a moderate degree of protection against seasonal influenza.  


As regular readers of this blog already know, I get one every year. And while I sometimes worry that the benefits (and effectiveness) of the flu vaccine are oversold, flu vaccines remain our best protection against a virus that is estimated to kill a half million people around the globe each year.    


I often liken it to wearing a seatbelt – something that cannot guarantee you’ll walk away from a head-on collision - but it does definitely improve your chances.


Flu shots do not, however, protect against non-influenza respiratory viruses. And this year – due to the late arrival of a `drifted’ H3N2 virus (see CDC HAN Advisory On `Drifted’ H3N2 Seasonal Flu Virus) – it didn’t do very well against influenza either.


Seasonal flu VE (Vaccine Effectiveness) ratings, which normally run 50%-60%, came in at a disappointing 18% according to the CDC’s Updated Estimated Seasonal Flu Vaccine Effectiveness report.

Given the speed by which influenza viruses mutate, and the need for six months lead time to create, produce, and deploy the vaccine, it is inevitable that some years the vaccine will miss its mark. 


Our reliance on what is essentially 50 year-old vaccine production technology is a bottleneck we’ve discussed often (see Revisiting CIDRAP’s - The Need For Better Flu Vaccines), and one that could really come to haunt us should a pandemic virus emerge. 


Showing that even a modestly effective vaccine can save lives, we have the following CDC sponsored study published in the journal Vaccine, followed by a press statement from the CDC.


Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14

Ivo M. Foppaa, b, , , , Po-Yung Chenga, b, Sue B. Reynoldsa, c, David K. Shaya, Cristina Cariasd, e, Joseph S. Breseea, Inkyu K. Kima, b, Manoj Gambhird, Alicia M. Frya



Excess mortality due to seasonal influenza is substantial, yet quantitative estimates of the benefit of annual vaccination programs on influenza-associated mortality are lacking.


We estimated the numbers of deaths averted by vaccination in four age groups (0.5 to 4, 5 to 19, 20 to 64 and ≥65 yrs.) for the nine influenza seasons from 2005/6 through 2013/14. These estimates were obtained using a Monte Carlo approach applied to weekly U.S. age group-specific estimates of influenza-associated excess mortality, monthly vaccination coverage estimates and summary seasonal influenza vaccine effectiveness estimates to obtain estimates of the number of deaths averted by vaccination. The estimates are conservative as they do not include indirect vaccination effects.


From August, 2005 through June, 2014, we estimated that 40,127 (95% confidence interval [CI] 25,694 to 59,210) deaths were averted by influenza vaccination. We found that of all studied seasons the most deaths were averted by influenza vaccination during the 2012/13 season (9398; 95% CI 2,386 to 19,897) and the fewest during the 2009/10 pandemic (222; 95% CI 79 to 347). Of all influenza-associated deaths averted, 88.9% (95% CI 83 to 92.5%) were in people ≥65 yrs. old.


The estimated number of deaths averted by the US annual influenza vaccination program is considerable, especially among elderly adults and even when vaccine effectiveness is modest, such as in the 2012/13 season. As indirect effects (“herd immunity”) of vaccination are ignored, these estimates represent lower bound estimates and are thus conservative given valid excess mortality estimates



CDC Study: Flu Vaccine Saved 40,000 Lives During 9 Year Period

March 30, 2015 – The seasonal flu vaccine prevented more than 40,000 flu-associated deaths in the United States during a nine year period from 2005-2006 through 2013-2014 according to estimates in a new study published in the journal Vaccine. This estimate represents a little less than a one-quarter (22%) reduction in the deaths that would have occurred in the absence of flu vaccination during that time. CDC has estimated previously that seasonal flu-associated deaths in the United States range between 3,000 and 49,000 people each year.

Estimates from the study showed that the majority of the flu-associated deaths prevented—nearly 89 percent (88.9%)—were in people 65 years of age and older. Next to older people, young children 6 months through 4 years of age benefitted most from flu vaccine in terms of the percentage of deaths averted. Children younger than 5 years old and adults 65 years of age and older are at high risk of serious flu complications and typically account for the majority of flu-associated deaths and have the highest flu-associated hospitalization rates.

The study included a breakdown of deaths prevented by season. The most deaths were prevented during the 2012-2013 season, when nearly 9,400 deaths were prevented by vaccination, despite modest estimated vaccine effectiveness that season. Like the current 2014-2015 flu season, H3N2 viruses circulated predominantly during the 2012-2013 season.

The fewest deaths prevented by flu vaccination occurred during the 2009 pandemic. Researchers estimated that 222 deaths were prevented by vaccination that season. Study authors attributed this to the fact that 2009 monovalent pandemic vaccine did not become widely available until well after the peak of influenza illness had occurred. Flu activity during the pandemic was dominated by 2009 H1N1 virus circulation, with almost no seasonal viruses being detected during that time.

To conduct the study, researchers applied statistical modeling with U.S. age-group specific estimates of flu-associated excess deaths, monthly flu vaccination coverage estimates, and summary seasonal flu vaccine effectiveness (VE) estimates.

Overall, the findings from the study continue to support the benefits of flu vaccination and suggest that both increased flu vaccination coverage and increased flu vaccine effectiveness would help to prevent more flu-associated deaths.

The article is available online from the Vaccine journal’s website.


Indonesian MOH Statement On 2 Recent H5N1 Cases


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Four days ago, in Watching Indonesia: Media Reports Two H5N1 Cases In Tangerang, we saw unconfirmed media reports of two recent (fatal) H5N1 cases in Tangerang, very near the capital Jakarta.   Although these reports continued over the weekend, today the Indonesian MOH has finally posted a statement on their Sehat Negeriku (Healthy Mine Own Country) website.


Between 2006 and 2008, Indonesia was the undisputed leader in human H5N1 infections (122 cases & 112 deaths over 3 years), a dubious mantle claimed from Vietnam which led the pack between 2003 to 2005.  In 2009 Egypt took the title, and except for Cambodia’s brief run up in 2013, has held it since.


Over the past three years Indonesia’s bird flu cases have dwindled down to single digits, with only 2 cases reported in 2014. Their case fatality rate, however, remains among the highest in the world at 83.9% – more than double that we’ve seen in Egypt and a full 50% higher than the global average.


In today’s report we learn that a 40 year-old man and his son fell ill 4 days apart (son first) earlier this month, both were treated and released by different local hospitals – then readmitted as their conditions worsened – and both died within 48 hours of each other. 


Diagnosis of H5N1 did not come until each was at or very near the end of their life, a delay perhaps exacerbated by the decline in local H5N1 cases reported over the past 5 years. Media reports have linked their infections to a visit to the man’s sister’s farm where poultry had recently died, but their exact exposure remains under investigation.



Bird Flu Case report 198 and 199

Bird Flu Case report 198 and 199

Ministry of Health, through the Directorate General of Disease Control and Environmental Health announced two new cases of bird flu have been confirmed by the Center for Biomedical and Health Technology Association, Agency for Health Research and Development.

The first case of an employee initials TS (L, 40), a resident of the city of Tangerang, Banten province. On March 15, 2015, the case began to complain of not feeling well, but still works. Dated March 17, 2015, symptoms of fever, coughing and outpatient treatment to a private hospital. Dated March 21, 2015 TS Hospital emergency room treatment to other private, chest X-ray results show dextra pleuropneumonia . Because fixed fever and cough accompanied by weakness and nausea, in the evening treatment case back to the hospital and treated with a working diagnosis of pleural effusion dextra et causa pneumonia . On March 23, 2015, and a worsening case admitted to the ICU with a diagnosis of pleural effusion dextra, pneumonia and liver dysfunction. The next day the date of March 24, 2015 and grew more difficult cases diagnosed as Suspect Bird Flu, getting worse and and died at 16:25 pm. Dated March 25, 2015, stating Balitbangkes PCR laboratory test results TS Positive cases of H5N1.

The second case initials MAIPS (L, 2 years) is a subsidiary of TS cases, lived one house with his parents. Dated March 11, 2015, symptoms of fever, cough and runny nose then went to a private hospital and treated. On March 16, 2015, the case out of the hospital, but at home complaining of bloating and cough. Circumstances of the case there is no change, the case complained of tightness and referred to other private hospitals. Because of deteriorating, dated March 26, 2015, the case was referred to the Friendship Hospital hour 02:40 pm, and died at 4:10 pm. Dated March 26, 2015, stating Balitbangkes PCR laboratory test results MAIPS Positive cases of H5N1.

DG team and PL, Research and Development Agency, the Department of Health and PHC Tangerang Tangerang City, Rapid Response Unit Strategic Animal Diseases (URCPHMS) - Ministry of Agriculture has been an epidemiological investigation into the homes of people and the environment. In case the house does not have a good pet birds or other, but in the neighborhood there are many cases of people who maintain ornamental birds and pigeons. Possible risk factors in the case, among others, domestic poultry neighbors around the house case; and the direct and indirect contact with domestic poultry sister case in the District. Bogor.

With the increase in these two cases, from 2005 until this news was published, the cumulative number of AI cases in Indonesia is 199 cases with 167 deaths.

Director General of Disease Control and Environmental Health dr. Mohamad dawn, MPPM as the National Focal Point for International Health Regulations (IHR) has been informed about the case to the WHO.

The government together with the whole community has made various efforts to control bird flu since 2005. In the 10-year period (2005-2014) looks downward trend avian influenza in animals and humans. During the nine months from June 2014 until February 2015 no cases of Bird Flu in Indonesia.

The success of AI control is determined by the role and support of the whole community, especially the role of society in prevention efforts. Efforts to do community is to avoid contact with sick or dead birds suddenly; maintain personal hygiene and the environment clean and healthy life behavior; and recognize the symptoms of Bird Flu include fever / high heat, cough and sore throat. If there are signs of AI immediately went to the clinic or hospital.

This information is published by Center for Public Communication, Secretariat General of the Ministry of Health. For more information please contact via telephone: 021-52907416-9, fax: 021-52921669, Call Center: 021-500567 and 021-30413700 or e-mail address puskom.publik@yahoo.co.id ; info @ Ministry of Health .go.id ; kontak@depkes.go.id .


Monday, March 30, 2015

A Quail Of A Tale

26 pounds of confiscated raw Quail Eggs – Credit U.S. Customs


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Every once in awhile we hear a story about someone attempting to bring potentially dangerous food items or even live animals into this, or other countries, packed in their luggage. Sometimes there are attempts to conceal these items, and other times they are declared only for their owners to discover they are prohibited, and must be destroyed.

A few examples over the years:

  • In 2010, two men were indicted for attempting to smuggle dozens of song birds (strapped to their legs inside their pants) into LAX from Vietnam (see Man who smuggled live birds strapped to legs faces 20 years in prison).
  • In 2012, in Taiwan Seizes H5N1 Infected Birds, we learned of a smuggler who was detained at Taoyuan international airport in Taiwan after arriving from Macau with dozens of infected birds. Nine people exposed to these birds were observed for 10 days, and luckily none showed signs of infection.
  • In May of 2013, in All Too Frequent Flyers, we saw a Vietnamese passenger, on a flight into Dulles Airport, who was caught with 20 raw Chinese Silkie Chickens in his luggage.
  • The following month we saw a traveler (see Vienna: 5 Smuggled Birds Now Reported Positive For H5N1) attempt to smuggle 60 live birds into Austria from Bali, only to have 39 die in transit, and five test positive for H5N1.   Fortunately, no humans were infected.

Today, Boston’s WCBV-TV is reporting that customs officials at Logan Airport intercepted, and destroyed, 26 pounds of raw quail eggs being brought in by a passenger from Vietnam (who declared the food items).


Vietnam is one of those countries where H5N1, and other avian flu viruses have been been frequently reported, making raw eggs (and the material they are packed in) potentially hazardous.

Passenger at Logan found with 26 pounds of quail eggs

Customs agents destroy quail eggs

UPDATED 12:35 PM EDT Mar 30, 2015

BOSTON —A passenger carrying 26 pounds of raw quail eggs was intercepted at Logan Airport earlier this month, authorities said.

U.S. Customs and Border Protection officials said the passenger had just arrived from Vietnam and declared various foods to customs agents, including 26 pounds of quail eggs wrapped in rice hulls.

All eggs and egg products originating from countries or regions affected with avian flu must be accompanied by a USDA Veterinary Services permit and meet all permit requirements, or be consigned to an approved establishment, according to officials.

(Continue . . . )


While we don’t hear about it often, every day customs officials intercept thousands of pounds of potentially hazardous food items, or exotic animals, that could easily be carrying a dangerous disease like avian flu.


Individually, most of these incidents represent a low risk of infection, but that risk is not zero. And that risk is multiplied by hundreds of incidents around the globe each day.


The movement of poultry and poultry products across porous borders in China, Vietnam, Laos, Cambodia, India, and Bangladesh has undoubtedly helped in the spread of the H5N1 virus. 


And more than a dozen years ago `wild flavor’ restaurants were the rage in mainland China, but most particularly in Guangzhou Province. Diners there could indulge in exotic dishes – often slaughtered and cooked tableside - including dog, cat, civit, muskrat, ferret, monkey, along with a variety of snakes, reptiles, and birds.


It was from this practice that the SARS is suspected to have emerged, when kitchen workers apparently became infected while preparing wild animals for consumption.


From there 8,000 people were infected, 800 died, and the world brushed uncomfortably close to seeing the first pandemic of the 21st century.


Perhaps even more risky is the (often illegal) trade in exotic animals, such as birds and small mammals.


Photo Credit USDA


In November of 2011, in Psittacosis Identified In Hong Kong Respiratory Outbreak, we saw a limited outbreak among personnel at an agricultural station where smuggled birds seized by customs agents had been quarantined. Subsequently 3 parrots died, and 10 were euthanized.


Another  example, in 2003 we saw a rare outbreak of Monkeypox in the United States when an animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003)


(Photo Credit CDC PHIL)

This outbreak infected at least 71 people across 6 states. Fortunately, no one died, as the virus has a relatively high (10%) fatality rate in Africa (see `Carrion’ Luggage & Other Ways To Import Exotic Diseases).


While the next pandemic virus is far more likely to arrive carried by an infected, but not yet symptomatic, air traveler – that isn’t the only plausible import scenario. 


Beyond H5N1, SARS and monkeypox, a few other viruses of concern include Hendra, Nipah, Ebola, other avian influenzas (H7N9, H5N6, H5N8, etc.), assorted hemorrhagic fevers, many variations of SIV (Simian immunodeficiency virus), and of course . . .  Virus X.


The one we don’t know about.   Yet.

OIE/FAO Notifications Of Bird Flu In Italy & Romania


A busy avian flu season for Europe (prior to Mar. 13th)  – Credit Defra



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On Friday, in Media Reports: Bird Flu Detected In Romania & Italy, we looked at two  reported bird flu outbreaks in Europe. The Romanian outbreak – reportedly H5N1 – came on the heels of a similar announcement earlier last week from neighboring Bulgaria.


The outbreak in Italy wasn’t immediately identified, but it follows earlier outbreaks of LPAI H7, LPAI H5, and HPAI H5N8 viruses.


Today we’ve confirmation of both of these outbreaks, and of their subtypes, from separate reports issued by the OIE and the FAO.


First stop, Italy – where low path (LPAI) H7N1 has been identified on a farm in the Veneto region in the following FAO report.




Of greater concern is an outbreak of HPAI H5N1 in waterfowl around the Danube Delta, as described in the following OIE Report, which describes 64 dead pelicans. 





Source of the outbreak(s) or origin of infection

  • Unknown or inconclusive

Epidemiological comments

On 25 March, the County Sanitary Veterinary and Food Safety Directorate (CSVFSD) of Tulcea was notified by the Danube Delta Biosphere Reserve Administration (ARBDD) about the identification of 64 carcasses of pelicans in an inhabited area, on Ceaplace island, Sinoe lake. This area is located at the border of Tulcea and Constanta Counties, and no other localities with domestic birds are found on a radius more than 10 km. The entire population of pelicans counted initially more than 250 birds, adults and young. Excluding the dead pelicans (found in different stages of putrefaction), no other birds were observed with clinical signs in the area. Also, in the area were observed other birds species, still unspecified.



After several years of relative quiescence on the bird flu front (at least, outside of China), we are suddenly seeing a remarkable surge in activity, involving several different strains.  

H5N1 is not only on the move in migratory birds – showing up in Eastern Europe, and Nigeria after five years absence – it is also raging in poultry in Egypt, and is spilling over into humans this winter at a record rate (see FAO: Egypt’s H5N1 Case Count Continues To Climb).


Meanwhile, the recently emerged H5N8 virus has not only spread across much of Eastern Asia, and into both Europe and North America, it has spawned a number of `local’ reassortant viruses. `New’ versions of H5N2, H5N3, and H5N1 have appeared in Taiwan, and in North America, and already they have had major impacts on the poultry industry in both regions. 


And while far less worrisome for now, we’ve also seen an unusual number of low path (LPAI) outbreaks (H5s & H7s) in poultry from Italy, to the UK, to Kansas.   


In many ways, the winter of 2014-15 has seen more bird flu activity – over a greater geographic range – than we’ve seen since the great bird flu expansion of 2006, when H5N1 escaped the confines of Asia and barnstormed much of  Europe (see H5N8: A Case Of Deja Flu?).


All of which has brought, once again, the role of migratory and wild birds in the spread of these viruses back to the forefront.  


While there are still a lot of missing pieces to this puzzle – and outbreaks often appear linked to or exacerbated by the movement of poultry products (legal and illicit), equipment, or personnel – this resurgence in bird flu has brought wild and migratory birds under new scrutiny.  


A few recent blogs on the topic include:


Erasmus Study On Role Of Migratory Birds In Spread Of Avian Flu
FAO On The Potential Threat Of HPAI Spread Via Migratory Birds
The North Atlantic Flyway Revisited

FAO: Egypt’s H5N1 Case Count Continues To Climb



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Although the Egyptian MOH remains largely silent on their H5N1 outbreak, and the Egyptian media continues to publish numbers from some alternate reality (this report today cites only 13 deaths for the year), we’re able to keep some semblance of track via updates from the World Health Organization, releases from the FAO EMPRES website, and the hard work of Sharon Sanders who curates the Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List.

Our last update from the FAO came two weeks ago (see Egypt’s H5N1 Bird Flu Beat Goes On . . . .),  which was followed up a few days later by a WHO EMRO Update On Egypt’s H5N1 Outbreak, which pegged the number of H5N1 cases in Egypt for the year at 116, with 36 deaths (as of March 17th).

While we’ve seen scattered reports in the media of additional cases over the past two weeks, we rarely see a confirmation by Egyptian authorities.  Luckily, they still continue to report to International agencies like the WHO and FAO under the rules established under the IHR (International Health Regulations).


Today the FAO has announced 11 more H5N1 cases, the links you’ll find below:


  1. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Assiut, for human
  2. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Port Said, for human
  3. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Fayoum, for human
  4. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human
  5. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human
  6. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Menoufia, for human
  7. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Dakahlia, for human
  8. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Suhag, for human
  9. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human
  10. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Behera, for human
  11. 30/03/2015: Egypt - Influenza – Avian  Confirmed Influenza - Avian in Shrkia, for human

Based on this report, previous reports, and FluTrackers2015 Egypt H5N1 Case List , Egypt is up to 128 cases for the year. Deaths are often reported late (or sometimes not at all), but the WHO’s last tally was 36, and several more appear to have died since then.

While it is not entirely clear what is behind this sudden increase in H5N1 cases, Egypt has reported heavy rates of poultry infections this winter – even among vaccinated flocks (see Egypt H5N1: Poultry Losses Climbing, Prices Up 25% - which calls into question the effectiveness of the vaccines currently being used.


Poorly matched vaccines can often protect poultry against illness – but with increasingly diverse and rapidly evolving avian flu viruses - they cannot always prevent infection. The end result is that healthy looking chickens can harbor undetected infections, that viruses continue to circulate, and new variants or reassortants continue to emerge.


And without the traditional warning signs of sick or dying chickens, people who handle them are not aware of the the danger they pose.


While we’ve not seen any evidence of increased or efficient human-to-human transmission of the H5N1 virus in Egypt, it is worrisome that this outbreak has now gone on for five full months, and that in excess of 150 people have been infected. 


Twice as many human cases as has ever been reported by one country in a single year.  And each human infection provides the virus with another opportunity to better adapt to human physiology.


Although the future threat from H5N1 is unknown, these outbreaks in  Egypt and the rapid emergence and spread of new HPAI H5 reassortants around the globe over the past year recently prompted the World Health Organization to issue a pointed warning (see WHO: H5 Currently The Most Obvious Avian Flu Threat).

Saudi MOH: 2 New MERS Cases & Weekly MERS Statement



# 9882


A subtle change (again) to the daily reporting comes with the combining of suspected or confirmed contacts in both  the community and healthcare setting.  Two weeks ago, suspected nosocomial contacts were abruptly dropped from the chart without explanation, but are now apparently lumped in with community exposures.  


While the daily case graphic promises that `More information on the exposure history will be posted on the Weekly update’,. there is actually very little case-specific information to be gleaned from the following (translated,and syntax challenged) report except . . . all appear to be ex-pats.


How and why they came to be infected isn’t really addressed, although 2 cases appear to be household contacts.  We will hopefully get more information in the next WHO report.


Health weekly statement issued and recorded 8 cases last week

10 April 1436

A continuation of the Ministry of health to inform everyone on the developments of the Middle East respiratory syndrome Corona

The Department of Health announces that from 2 to 8 Rajab 1436 e was recording 8 confirmed cases infected with coronavirus, aged 20-65 years, including three in Riyadh and one in both Jeddah and Makkah, Najran and Taif and the northern border and the nationality as follows (EUR 3, Yemeni1, Filipino 1, Pakistan 1, 1 Sudanese, Bangladeshis 1) including 7 male and 1 female.

The Ministry has shown that the registry as established healthcare facilities were observed for 4 cases, while the last four spotted in private enterprises.

The Ministry confirmed that the recording of cases of infection were in Makkah, Najran and Jeddah and Arar tayv of society while recording the number 2 if contacts home and number 1 one case under investigation.

The rapid response teams to combat infection health facilities had about 16 field trip between visits and visits to append last week

As preventive medicine teams visit the 9 homes and been limited to 102 contacts are being followed home until the incubation period for the virus.

The Ministry said that the number of communications that are initiated from the Agriculture Ministry teams (including follow-up to previous cases had direct contact with camel 2 communications in both Mecca and tayv).

The Ministry stressed that the command center which continues its efforts around the clock through the epidemiological surveillance and ensure the commitment of all Government and private health facilities to implement infection control measures and coordination with concerned government sectors and international health organizations, including the World Health Organization and expertise to follow all committed for the coronavirus.

WHO: Updated MERS-CoV Summary


Credit WHO EMRO MERS Summary


# 9881


Even though avian flu has captured much of our attention this winter, running a close second is the MERS coronavirus, which continues to plague inhabitants of the Arabian peninsula – particularly in central and Western Saudi Arabia. 


Now nearly three years into this outbreak, we still have many unanswered questions regarding its source, and how it is spreading among humans.

After seeing low levels of cases in  2012 and 2013, we watched the number of cases skyrocket in April and May of last year (see chart below).   While a repeat performance is far from guaranteed, it is notable that the number of cases this year in the first quarter of the year is even higher than in 2014. 



With nearly 1,000 cases reported out of Saudi Arabia alone, and a roughly 40% fatality rate, MERS – over the past three years – has `outperformed(in terms of # of people infected, deaths, and  h-2-h `clusters’) all of the avian flu strains we’ve been watching (H5N1, H7N9, H5N6, H10N8, etc.) around the globe combined.


While impressive metrics, what these numbers can’t tell us is which of these viruses – if any – have the `legs’ to spark a global health crisis.  


Influenza viruses have a long, if infrequent history of sparking pandemics, and novel strains are always viewed with concern. But our experience with virulent coronaviruses is far less extensive, with basically only the `close-but-no-cigar’  SARS outbreak of 2003 to go on (see SARS and Remembrance).


Comparisons between SARS and MERS are inevitable given that both are coronaviruses, both probably originated in bats but were believed spread to humans via an intermediate host, both cause severe respiratory syndromes, and both are easily spread in a hospital environment.


But they also differ in some fundamental ways. 

  • SARS had a fatality ratio of roughly 10% while MERS has been fatal in about 40% of hospitalized cases
  • SARS had an R0 (Basic Reproductive Number) estimated between 2.0-3.0 while MERS remains  < 1.0
  • SARS burned intently for about 8 months and died out, while MERS has been slowly accelerating for 3 years
  • Half of SARS cases were under the age of 50, while the vast majority of MERS cases are over the age of 50
  • Unlike SARS which was fairly evenly divided, MERS cases are (for reasons not yet known) heavily skewed towards males


With April – and a possible repeat of last year’s surge – just around the corner, the World Health Organization has released an updated summary on the MERS virus, which includes some very useful graphics. 


While many questions about its transmission in the community remain, the basic epidemiology of the virus and demographics of its victims appears unchanged.


This from WHO’s Eastern Mediterranean Regional Office (EMRO).


Update on Middle East respiratory syndrome, March 2015

  • A total of 967 laboratory-confirmed cases of MERS-CoV, including 379 deaths (case-fatality rate 39%) were reported from Saudi Arabia. Of these, a total of 145 cases, including 58 deaths (case-fatality rate 40%), were reported in 2015 to date.
  • The epidemiological and demographic characteristics of the disease do not show any significant difference. The majority of cases continue to be male and the most affected age group among primary cases are those between 50 and 59 years of old.
  • Nosocomial outbreaks in hospitals, though smaller in size and risk, as compared to the past, have been reported from Riyadh, Qassem, Al-Jouf and eastern Regions.
  • Since the last big hospital outbreak in Jeddah in 2014, nosocomial infection reported among health care workers have continued to decline (from as high as 25% to 12%).

Read the latest update on MERS-COV


Sunday, March 29, 2015

Saudi MOH: 3 MERS Cases, 2 Fatal



# 9880


After a two-day lull, the Saudi MOH is back with three new MERS cases, two of which are already listed as deceased.  Given the recent reduction in case information being presented in these daily updates, we’ll need to wait for a WHO update to get some sense as to how they were exposed.



More Than One Way to `Contain An Outbreak’


Credit WHO



# 9879


Until the middle of January, Egypt’s Ministry of Health got good marks in reporting this winter’s surge in H5N1 cases, publishing frequent updates that included YTD numbers for cases, deaths, hospitalizations, and recoveries. 


That streak ended on January 22nd, when Egypt’s MOH Confirms their 21st H5N1 Case of 2015.


Since then, as has been noted often (see The Silence Of The Egyptian MOHMedia: WHO H5N1 Mission To Egypt), the Egyptian MOH has ceased to report most cases on their website and the YTD numbers attributed to MOH spokesmen in the Egyptian media have been `fanciful’ at best.

As a result, we continue to see reports like the one below – published today - which cherry picks a single recent H5N1 case, while at the same dramatically downsizing the YTD impact of this year’s H5N1 outbreak.  


While never directly mentioning 2015’s YTD numbers, by admitting to 16 deaths and referring to a CFR of 37.4%, the reader is left with the idea that there have been perhaps 43 or 44 cases this year.  


A far cry from the latest World Health Organization numbers (as of March 17th) of 116 cases and 36 deaths for the year (see Avian influenza A (H5N1) in Egypt update, 21 March 2015).


Egypt bird flu death toll at 16 in 2015

Sun, 29/03/2015 - 11:43

A 27-year old woman who raised birds in her home in the Sohag governorate, died of bird flu on Sunday.

Tahta Fevers Hospital received the victim, who was suffering from bird flu symptoms, before she was transferred to Assiut Fevers Hospital upon the request of her family, according to a medical source at Tahta hospital.

A medical team inspected the woman's house in Tahta and conducted tests on those who were in contact with the woman as a preventive measure.

(Continue . . .)

Although local media reports are sporadic, and are unlikely to represent the true burden of this year’s outbreak,  FluTracker’s conservatively curated Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List  continues to add cases, with at least 120 cases logged for the year.

Fortunately,  Egypt continues to report cases to the World Health Organization under the IHR (International Health Regulations) - which requires countries to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO – so we are not completely in the dark regarding this H5N1 outbreak.


While we don’t have a recent WHO update to compare it to, China’s recent silence on H7N9 is also suspect, with no new cases reported now for 20 days (see last week’s HK CHP Avian Flu Report: 2 Weeks Without An H7N9 Case Report and  H7N9: No News Is . . . . Curious).  


This dramatic halt in reporting comes – perhaps coincidentally – at the same time we saw a major study appear in the Journal Nature  (see Dissemination, Divergence & Establishment of H7N9 In China) warning that the H7N9 virus was evolving rapidly, and that it posed a growing pandemic threat.

A search on Xinhua’s English language news site for the term `H7N9’ returns their last article on March 12th of this year, which (again, perhaps coincidentally) dealt with the Nature study above (see Scientists call for effective measures amid H7N9 mutation Xinhuanet 2015-03-12 14:13).



The Chinese language IFENG search engine does return more recent `H7N9’ articles, but they all refer to cases in February and/or steps local and national health officials are taking to prevent new cases.  


But if there have been any H7N9 cases detected since early March, they aren’t being reported in the media, or on provincial MOH websites.


It is certainly possible that fewer infections are being recorded this winter, and interventions such as the closing of live poultry markets have dramatically reduced transmission.  That all cases should halt abruptly, this early in the year, and across the entire region would be remarkable, however. 

We’ll have more to go on when the next WHO update on China is released.


Since China and Egypt are both dealing with high-profile infectious disease outbreaks, their `management’ of the news understandably draws a good deal of attention, but they are far from being the only nations who indulge in `creative disease reporting’.  


All governments have an aversion to mobs bearing pitchforks and torches, and therefore want to project the image that they are competent, in control, and (most importantly) vitally important to the people they supposedly serve. 


Even in this country I see a number of state and local health and agricultural department websites which seem far more concerned with extolling their services and achievements, than they are in addressing local problems.  Of course, none of them are dealing with a deadly avian flu outbreak, so direct comparisons are hard to make.


While it may seem an odd bit of logic, as long as governments can control the message - as we are seeing in Egypt – it is a pretty good sign that avian flu infections remain sporadic and that efficient transmission of the virus is not happening.   


So, in a sense, no news can be `good news’ – at least in the short run. 


The problem is, the less we know about the early trajectory of an outbreak, the less lead time we’ll have to prepare - if and when something does start to change.

Saturday, March 28, 2015

USDA: 3rd Minnesota Turkey Farm Hit By H5N2



# 9878


Just 24 hours after the 2nd infected Minnesota turkey farm was announced, we learn of a facility in Stearns county that has tested positive.  The first outbreak, in neighboring Pope county, was reported 3 weeks ago.


This week Wyoming became the 11th state to report HPAI H5 viruses in either wild birds, or poultry,  which has led to repeated warnings to both commercial and backyard poultry operations on the need for enhanced biosecurity (see USDA Avian Flu Biosecurity Videos).

This from APHIS.


USDA Confirms Highly Pathogenic H5N2 Avian Influenza in Stearns County, Minnesota Commercial Turkey Flock

Last Modified: Mar 28, 2015


CDC considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low

WASHINGTON, March 28, 2015 -- The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H5N2 avian influenza (HPAI) in a commercial turkey flock in Stearns County, Minnesota.  This is the third confirmation in a commercial flock in Minnesota.  The flock of 39,000 turkeys is located within the Mississippi flyway where this strain of avian influenza has previously been identified. CDC considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low.  No human infections with the virus have been detected at this time.

Samples from the turkey flock, which experienced increased mortality, were tested at the University of Minnesota Veterinary Diagnostic Laboratory and the APHIS National Veterinary Services Laboratories in Ames, Iowa confirmed the findings. APHIS is working closely with the Minnesota Board of Animal Health on a joint incident response. State officials quarantined the affected premises and birds on the property will be depopulated to prevent the spread of the disease. Birds from the flock will not enter the food system.

The Minnesota Department of Health is working directly with poultry workers at the affected facility to ensure that they are taking the proper precautions. As a reminder, the proper handling and cooking of poultry and eggs to an internal temperature of 165 ˚F kills bacteria and viruses.

As part of existing avian influenza response plans, Federal and State partners are working jointly on additional surveillance and testing in the nearby area. The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.

USDA will be informing the World Organization for Animal Health (OIE) as well as international trading partners of this finding. USDA also continues to communicate with trading partners to encourage adherence to OIE standards and minimize trade impacts. OIE trade guidelines call on countries to base trade restrictions on sound science and, whenever possible, limit restrictions to those animals and animal products within a defined region that pose a risk of spreading disease of concern.

These virus strains can travel in wild birds without them appearing sick. People should avoid contact with sick/dead poultry or wildlife. If contact occurs, wash your hands with soap and water and change clothing before having any contact with healthy domestic poultry and birds.

All bird owners, whether commercial producers or backyard enthusiasts, should continue to practice good biosecurity, prevent contact between their birds and wild birds, and report sick birds or unusual bird deaths to State/Federal officials, either through their state veterinarian or through USDA’s toll-free number at 1-866-536-7593.  Additional information on biosecurity for backyard flocks can be found at http://healthybirds.aphis.usda.gov.

(Continue . . .)


USDA Avian Flu Biosecurity Videos



# 9877


Although Europe, Asia, Africa, and the Middle East have had to deal with highly pathogenic avian H5 viruses for the better part of a decade, until very recently North America’s poultry industry and wild bird population have been spared.  All that changed last December when a dozen poultry farms in British Columbia’s Fraser Valley reported an outbreak of HPAI H5, which in very short order was reported in Washington, Oregon, and California.


Like falling dominos, more states began to report detections of HPAI H5 (H5N1, H5N2, H5N8) in wild birds, and backyard and commercial poultry operations. As of this week 11 states have now reported the virus, although their actual spread is likely to be greater.


Since November we’ve seen H5N8 and/or H5N2/H5N1 turn in both the Pacific and Mississippi Americas Flyways, and at this point no one would be terribly surprised to see these viruses turn up further east along the Atlantic Americas flyway.


Credit FAO


While migratory flyways are predominately north-south corridors, their overlapping allows for a lateral (east-west) movement of avian viruses as well – often via shared nesting areas and ponds – something we’ve looked at recently in The North Atlantic Flyway Revisited & FAO On The Potential Threat Of HPAI Spread Via Migratory Birds.


Since we’ve yet to see any human infections from these reassortant H5 viruses, the immediate health risk to the public is considered very low. But as these new subtypes are related to viruses which have caused serious human infections (H5N1, H5N6) in other countries, they are being viewed cautiously by the CDC (see CDC: HPAI H5 Viruses In The United States)



The more immediate concerns revolve around protecting commercial and backyard poultry operations from infection, as these viruses are not only devastating to flocks in their current incarnation, they have the potential to evolve or reassort with other avian viruses with unpredictable results.

While commercial poultry operations have the most to lose, they are probably the best prepared to prevent infection.


In recent years we’ve seen a resurgence in the raising of backyard flocks in this country, and they are particularly vulnerable to infection. Late yesterday afternoon the USDA posted a blog on small flock biosecurity measures, along with links to several videos.


Bird Flu Is a Reminder For Back Yard Poultry Owners to Protect Their Birds By Practicing Good Biosecurity

Posted by Dr. Chrislyn Wood Nicholson, Poultry Health Specialist, USDA Animal and Plant Health Inspection Service, on March 27, 2015 at 5:00 PM

Dr. Wood on set with Healthy Harry taping new biosecurity videos.

Dr. Wood on set with Healthy Harry taping new biosecurity videos.

Since December 2014, there have been several highly pathogenic avian influenza (HPAI) confirmations in migratory wild birds, back yard flocks, captive wild birds and commercial poultry in several states along the Pacific, Mississippi and Central Flyways.  These HPAI virus strains can travel in wild birds without them appearing sick.  In fact, if back yard poultry flocks are exposed to these particular HPAI virus strains, they are highly contagious and cause bird death.  We are expecting that there will be more HPAI confirmations this spring as the bird migrations continue, so if you own or handle poultry, now is a great time to check your biosecurity practices.  You should follow good biosecurity at all times to help protect the birds’ health.  Your actions can make a difference!  Learn more here: http://healthybirds.aphis.usda.gov

As part of good biosecurity, you should prevent contact between your birds and wild birds, and report sick birds or unusual bird deaths to State/Federal officials, either through the state veterinarian or through USDA’s toll-free number: 1-866-536-7593.  You also should avoid contact with sick/dead poultry or wildlife. If contact occurs, wash your hands with soap and water and change clothing before having any contact with healthy domestic poultry and birds.   You are the best protection your birds have!  Learn more here:  http://healthybirds.aphis.usda.gov

What is biosecurity?  Biosecurity means taking some simple steps to keep your birds away from germs AND germs away from your birds.   If you follow good biosecurity, you will help ensure your birds remain healthy.

For backyard bird owners, there are 6 simple steps to biosecurity:

Commercial producers should follow biosecurity recommendations from their industry associations and the National Poultry Improvement Plan.

Want to learn more about practicing good biosecurity while being entertained?  Need to share information with 4H, FFA or school groups?  Here are links to a series of videos about biosecurity on YouTube:

Healthy Flocks Rock

Keep It Clean

Know Your Birds

Simple Steps to Keep Your Backyard Poultry Healthy

These videos will help you see biosecurity in action so you can feel confident you are taking the right steps to protect your backyard birds.