Monday, April 25, 2016

China Reports 2nd H5N6 Case in A Week

# 11,307

Two years ago this week (April 23rd, 2014) the newshounds of Flutrackers picked up a Chinese language report of a farmer from Nambu county, Sichaun Province hospitalized with a severe - and unidentified - pneumonia. 

It would take another 12 days, but on May 5th, the patient (who by then, had died) was announced as the first human infected with a newly  emerging avian H5N6 virus. 

About the same time, H5N6 began showing up in poultry flocks in Laos, and over the summer and fall, in Vietnam.  But a second human infection wouldn't turn up for nearly 8 months (Dec 2014) - this time in Guangdong province.

The first half of 2015 saw two cases, both from Yunnan province (Feb and July), and more scattered reports of H5N6 in poultry (and wild birds).  But between April 2014 and early December 2015 - a span of almost 20 months - there had only been 4 human cases reported.

Since then, that number has now tripled (n=12), with 8 new cases - and affecting two new provinces - over the past 4 months.

Despite this increase in human infection reports, all of these cases appear to be isolated, and we've seen no evidence of clustering, or human-to-human transmission.

There is apparently one more case - mentioned by the WHO in their January update - but we have no details beyond age and gender (F, 5). 

First, today's report from Hunan Province, then I'll have a bit more.

Source: Central Emergency Office  Updated: 2016-4-23

A hospital on April 19, 2016, Hunan province reported a case of pneumonia cases with unknown causes, after repeated sampling, Changsha city, Hunan provincial Center for disease control and prevention and detection, in the evening of April 20 case detected in specimens from lower respiratory tract H5N6 of avian influenza virus nucleic acid, April 22 by the China Center for disease control and prevention reviewed confirmed. According to the clinical manifestations, laboratory and epidemiological findings, judging the cases of human infection cases of H5N6.
The patient, female, 11 years old, lusong district, Zhuzhou city, and on April 11, feel discomfort, 13th to a hospital in Hunan province, with "heat check" income. Progressive disease after admission, 18th to ICU treatment. By infection, mechanical resistance for oxygen, immune support and symptomatic therapy, patients are gradually improving.
H5N6 virus as a breeding bird flu viruses, and limited its ability to infect humans, there is no evidence of sustained person-to-person. Currently all close contacts of the cases did not develop fever, cough and other flu-like symptoms. Lower risk experts to research found that the spread of the virus at this stage.

It appears this patient was hospitalized for 5 days before being placed in the ICU, and at least two more days elapsed before she was tested for H5N6.  There is no information as to when she might have been placed in isolation.

Of the 12 cases reported by Chinese Authorities, at least 6 have died, and  we don't know the outcomes for several recent cases.  Although a small sample, human infection with H5N6 appears to rival H5N1 in severity.

While the overall case counts remain low, the upward trend is of concern, as are the detections of H5N6 in poultry in Vietnam and Laos, and showing up in migratory birds in Hong Kong.

All of which has Vietnam, Laos, Cambodia and Taiwan watching H5N6's progress carefully. 

For more background on this emerging avian flu threat, you may wish to revisit these  blogs from last year:

H5N6: The Other HPAI H5 Threat
H5N6 Rising: Infecting Birds, Humans, & Even Cats
EID Journal: Influenza A(H5N6) Virus Reassortant, Southern China, 2014

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