Taiwan MOH: Mainland China Reports 2 H9N2 Cases In November - WHO

Flu Virus binding to Receptor Cells – Credit CDC

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Human infection with avian LPAI H9N2 remains only rarely reported (see FluTrackers List)) - but serological studies suggest mild cases may be far more common than we know - and despite a generally mild presentation in humans, the CDC and WHO consider the virus to have at least some pandemic potential  (see CDC IRAT SCORE).

Although most cases have been reported from China, Egypt, and Bangladesh, a little over 2 weeks ago, in EID Journal & IJID : Human Infection With LPAI H9N2 - India & Oman, we looked at reports of human infection in two new countries.

A month ago, in Viruses: Characterization of the H9N2 Avian Influenza Viruses Currently Circulating in South China, we looked at a a new study, published in the journal Viruses, that reported that China's current crop of H9N2 viruses continues on an evolutionary path that increases its pandemic potential.

Today Taiwan's CDC & MOH are both carrying reports of two new H9N2 cases from Mainland China, reported to the WHO in November; one from Fujian Province (F,4), and the other from Anhui (F,5).

First the translated report, then I'll return with a bit more.

Mainland China has reported 2 cases of H9N2 influenza. People are advised to implement the principle of "five to six" when visiting the epidemic area.

Source: CDC
Date Filed : 108-12-10
Updated: 108-12-10

The World Health Organization (WHO) announced on December 4 that mainland China will report one new case of H9N2 on November 12th and 22nd, which will be the first two new cases of influenza A in mainland China during this epidemic season (from October). There was no association between cases. One of them was a 4-year-old girl from Sanming City, Fujian Province. She developed symptoms on October 26 this year, and her condition was mild. The other was a 5-year-old girl from Fuyang City, Anhui Province. He has recovered, and both cases had a history of poultry or poultry slaughterhouse exposure before onset.

There have been 39 cases of global H9N2 influenza since 2013, mostly in mainland China. The rest of the country includes Hong Kong (1 case, imported from Guangdong Province), Egypt (3 cases), Bangladesh (2 cases), and Oman (1 case). ); So far, there has been 1 death, with a fatality rate of 2.6%. The WHO said that since the virus is still detected in poultry and the environment, cases are expected to occur, but the risk of human-to-human transmission is low because the virus has not been capable of continuous transmission among humans.

The Department of Disease Control said that although most human H9N2 cases were mild, a case of severe pneumonia was reported for the first time in March this year. It is a 9-year-old boy in Jiangsu who has a history of exposure to the live poultry market and the public must remain vigilant. At present, the CDA has listed the new type A influenza tourism epidemic in Anhui Province, Beijing, Fujian, Guangdong, Guangxi Zhuang Autonomous Region, Hunan Province, Jiangsu Province, Inner Mongolia Autonomous Region, and Yunnan Province as the second level alert (Alert) , Other provinces and cities are listed as the first level Watch.

The CDA reminded that when traveling to mainland China, the principle of "five to six and no" should be implemented. Fifth: poultry and eggs should be cooked, hands should be washed with a soapy base, masks should be provided for prompt medical attention if symptoms occur, and long-term contact with birds Those who need to be vaccinated against influenza, have a balanced diet, and take appropriate exercise; 6 No: do not eat raw poultry eggs or products, do not smuggle and purchase meat from unknown poultry, do not contact or feed migratory birds and birds, do not release and Randomly discard birds, do not mix breeding birds with other poultry and livestock, do not go to places with no air circulation or crowded people.

If you have a fever or flu-like symptoms when returning to China, you should take the initiative to inform airline personnel and quarantine personnel at airports and ports; if you experience the above symptoms after returning to China, you should wear a mask to seek medical treatment as soon as possible, and inform the physician of your history of travel contact. For related information, please refer to the CDC website (https://www.cdc.gov.tw/), or call the toll-free epidemic prevention line 1922 (or 0800-001922) for inquiries.

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Beyond the fact that LPAI H9N2 may infect humans far more often than case reports suggest, this virus is a concern because:

• H9N2 has become widespread - even ubiquitous - among poultry across Asia and the Middle East, and has made recent inroads into Africa.

• H9N2 reassorts easily with other viruses, and its internal genes are often found inside many HPAI viruses (including H5N1, H5N6, and H7N9) -  (see The Lancet's Poultry carrying H9N2 act as incubators for novel human avian influenza viruses)

• H9N2 viruses continue to accrue evolutionary changes, which include mammalian adaptations, and increased binding to human receptor cells (see PLoS Path: Genetics, Receptor Binding, and Transmissibility Of Avian H9N2).

For more on this versatile and fascinating virus, you may wish to revisit:

Virology Journal: Mouse-adapted H9N2 Avian Influenza Virus Causes Systemic Infection in Mice

Viruses: A Global Perspective on H9N2 Avian Influenza Virus

OFID: Avian H5, H7 & H9 Contamination Before & After China's Massive Poultry Vaccination Campaign

J. Virology: Genetic Compatibility of Reassortants Between Avian H5N1 & H9N2 Influenza Viruses

Virology: Receptor Binding Specificity Of H9N2 Avian Influenza Viruses

EID Journal: Two H9N2 Studies Of Note

Iraq Media: Unconfirmed Reports Of `Bird Flu' Cases In Mosul

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Arabic language media reports on avian influenza can sometimes be misleading since many outlets have the unfortunate habit of labeling seasonal flu as ' انفلونزا الطيور` (aka `Bird Flu').

While you can usually differentiate these reports by other references (to birds, or the subtype), you still need to take these reports with a large grain of salt.

With those caveats in mind, and the fact that that the reported cases are only `suspected', we have numerous reports overnight on at least 5 cases, and 2 deaths, of people in Nineveh (near Mosul) due to `bird flu'. 

Typical of the reports is this (translated) one from Kirkuknow.com.

Mosul recorded cases of death and bird flu 

2019-12-09

Mosul record of the cases and the death of bird flu over the past twenty-four hours, as announced a senior medical source at the Directorate of Nineveh Health Department.

Bird flu is caused by a type of influenza virus rarely infects humans have been identified more than a dozen species of bird flu, including strains which have recently suffered by the humans - H5N1 and H7N9. When bird flu infects humans be deadly.

Dr. Jassim architectural director of Nineveh Health, said in a press interview (Kirkuk NOW), said that "four suspected cases of being infected with bird flu have been recorded in the hospital Ibn Sina in Mosul has been the reservation to two places private health isolation, while two died, and after sending samples medical laboratories to the capital of Baghdad was making sure injured one case of this disease. "

Bird flu signs and symptoms appear within two to seven days of picking up the infection, according to the type of influenza, and in most cases, similar to the signs and symptoms of regular flu and include (cough, fever, sore throat, muscle pain, headache, shortness of breath).

The Iraqi Ministry of Health will equip the Directorate of Nineveh Health 20 A vaccine special bird flu

Dr. Jassim architectural director of the health of Nineveh added that the deceased as a result of bird flu was an engineer aged 33 years and that the last two cases have also been sending medical samples to the capital Baghdad laboratories for analysis and to make sure the type of flu sufferer.

People with bird flu feel nausea, or vomiting or diarrhea are infected, and in a few cases, the disease does not indicate only a slight inflammation of the eye (conjunctivitis).

The World Health Organization recorded less than 500 deaths due to bird flu since 1997.

"The Iraqi Ministry of Health will equip the Directorate of Nineveh Health 20 A vaccine special bird flu" This was confirmed by the Director General of Health, Dr. Jassim Architect

Hot water and soap to wash cutting boards, utensils and all surfaces that have touched raw poultry would reduce the incidence of bird flu.

Raw eggs are often contaminated shell bird droppings, so avoid eating foods that contain uncooked eggs or cooked well protects against infection with bird flu.

(Continue . . . )

There are, obviously, some problems with this report.  The number of `avian flu' cases (H5, H7 & H9) reported by the WHO since 1997 is now well over 2,000, not less than 500.  And the deployment of a `a vaccine special bird flu' - unless they mean for local poultry - seems unlikely. 

This report does appear to reference `bird flu' - rather than seasonal flu - even though no subtype is provided.

There are probably a dozen other Arabic language reports on this incident, including what appears to be a press conference and local news report (see YouTube Video).   Other recent reports include:

Nineveh Health announces the registration of deaths due to bird flu

A health official in Nineveh: hospitals in the province so far five suspected cases of bird flu

If these reports sound vaguely familiar, it is because we've trod this ground before, with conflicting reports in early 2018 of an outbreak (again, in Mosul) which claimed 5 deaths had occurred (see Conflicting Bird Flu Reports From Iraq).

The Iraqi government vigorusly denied these reports, but a week later (see Peering Down Iraq's Bird Flu Rabbit Hole), a lengthy report appeared on
Russia's Federal Service for Veterinary and Phytosanitary Surveillance (Rosselkhoznadzor) website that seeminly contradicts the official narrative.

About human cases of influenza birds in the Republic of Iraq

25.01.2018 Mr.

According to the medical service of the province of Salah-ed-Din (north of the Republic of Iraq) of January 21, 2018, the death of a patient infected with the avian influenza virus was recorded in Balad. In the other two cases, the cause of death is established. In total, in the past few days, five deaths of people allegedly from avian influenza and one in Baghdad (January 18 of this year) have been recorded in Salah-ed-Din province.

The authorities also report two deaths in humans, presumably from bird flu in the provinces of Nineveh and Diyala (in the north and northeast of the country).

Although in official reports of fatal cases in humans, the serotype of the influenza virus was not named, earlier the Republic of Iraq notified the World Organization for Animal Health (OIE) that the cause of the bird flu epidemic in the country's poultry farms is the strain AH5N8.

(Continue . . . )

Officially, Iraq hasn't recorded a human infection with avian flu since 2006, although H5Nx and H9N2 continue to cause major losses in poultry across the region.  

That said, surveillance and testing - and a willingness to publicly disclose results - are often in short supply in this part of the world.

While global bird flu activity has been subdued the past couple of years, we've seen the emergence of several newly reassorted viruses in the Middle East (see EID Journal: Novel Reassortant HPAI A(H5N2) Virus in Broiler Chickens, Egypt) in 2019, a reminder that bird flu can always reinvent itself.


So, while I remain cautiously skeptical over the details of today's report, it is at least worthy of our notice.        

HCWs Willingness To Work During A Pandemic

Me in 1976, giving Swine Flu Shots.



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Forty-three years ago, when I was an impossibly young paramedic (see photo above), public health authorities were preparing for the feared return of an H1N1 pandemic after a handful of soldiers at Fort Dix, NJ had fallen ill with a novel flu virus the previous winter. 

H1N1 had last circulated in 1957, and we'd seen two pandemics (H2N2 in 1957 and H3N2 in 1968) in the previous 20 years.  Because of its similarity to the 1918 pandemic virus, public health authorities were preparing for the worst.

While that pandemic failed to materialize, those interested in the history of that pandemic scare - and my (very) minor role in helping my county to prepare for its arrival - may wish to read my 2009 essay Deja Flu, All Over Again.

One of the topics of conversation among the EMTs, nurses, doctors, and other health care workers at the time was whether everyone would continue to work once the pandemic arrived. 

While much of it may have been false bravado, I don't recall anyone actually admitting they wouldn't work, at least as long as they were physically able. 

But then, we all had more faith in the emergency vaccine than it probably deserved, and I don't think any of us knew at the time just how bad the 1918 pandemic had really been.

Today we have a much more vivid image of a severe pandemic, and the odds of having an effective vaccine at the start are pretty slim.  Even PPEs (masks, gowns, and gloves) are likely to be in short supply a few weeks into a pandemic.

Our track record for being ready to deal with even lesser outbreaks isn't particularly reassuring.

• During the opening months of the relatively mild 2009 H1N1 pandemic, sporadic PPE shortages were reported (see California Nurses Association Statement On Lack Of PPE), and would likely happen again.
• In 2009 the Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics  released draft ethical pandemic guidelines on the rationing of scarce resources, where they estimated their were only enough PPE’s in the state of Minnesota to last 3 weeks into a severe pandemic.
• In 2014 in NIOSH: Options To Maximize The Supply of Respirators During A Pandemic, we looked at strategies to try and cope with the expected shortfall in PPEs during a severe pandemic. 
• And in the fall of 2014, during the Ebola scare in Texas and New York City, a general shortage of PPEs around the country found the CDC Stockpiling Ebola-Specific PPE Kits For Rapid Deployment

The limited (16-hospital) MERS outbreak in South Korea in 2015 (see Study: Burnout & PTSD Among Nurses Working During A Large MERS-CoV Outbreak - Korea, 2015) illustrates - at least partially - the pressures HCWs would be under during a pandemic.

Staff shortages - along with shortages of everything from PPEs, to IV supplies and meds, to hospital beds (see Supply Chain Of Fools (Revisited)) - will further exacerbate the stress, and the resultant fallout among HCWs.

In the epilogue video (below) from last year's Johns Hopkins Clade X Tabletop Pandemic Exercise, the butcher's bill read, in part: `. . . 20 months into the pandemic . . . half of all healthcare workers had either died, become disabled, or quit . . .' 

All of which suggests the concerns of Health Care Workers over their safety during a severe pandemic are far from misplaced.

Over the years we've looked at a number of polls and studies of HCWs (Health Care Workers) on their willingness to work during a severe pandemic, and consistantly a lack of PPEs, or a vaccine for workers (and their families), and inadequate hospital staffing and security are frequently cited as deal breakers.

Six years ago, in Study: Willingness of Physicians To Work During A Severe Pandemic, we looked at a study  published in the Asia Pacific Family Medicine journal, that polled Canadian doctors to try to determine under what circumstances they would be unwilling to work during a pandemic.

Although limited by only a 22% response rate to the poll, under certain scenarios, fewer than half of the doctors who responded would be willing to report for work during a severe pandemic.

The numbers from that Canadian poll are not out of line with previous studies we’ve seen, including a 2010 report (See Study: Willingness Of HCWs To Work In A Pandemic) that polled 18,612 employees of the Johns Hopkins Hospital from January to March 2009, and found: 

Demographic and professional distribution of respondents was similar to all hospital staff. Overall, more than one-in-four (28%) hospital workers indicated they were not willing to respond to an influenza pandemic scenario if asked but not required to do so.

Only an additional 10% were willing if required. One-third (32%) of participants reported they would be unwilling to respond in the event of a more severe pandemic influenza

More recently, a study published 6 months ago in Prehospital and Disaster Care asked the question: 

Are Australian Pharmacists Willing to Work in a Disaster?

Elizabeth McCourt (a1), Kaitlyn Watson (a1), Judith Singleton (a1), Vivienne Tippett (a1) ...
DOI: https://doi.org/10.1017/S1049023X19002097

Abstract

Introduction:

Current literature suggests that a large percentage of the health workforce may be unwilling to work during a disaster. The willingness of pharmacists to work during a disaster is under-researched internationally and non-existent in Australia.

Aim:

To determine if Australian pharmacists are willing to work in a disaster and the factors that affect the willingness to work.
Methods:

A 13-question survey was developed from the current literature and released nationally through professional organizations and social media.

Results:

Sixty Australian pharmacists completed the survey. Most participants believed their pharmacy was an essential service for their community. Pharmacists reported they would be likely to report to work during a pandemic or biological disaster (73%) or natural disaster (78%).

The two major factors likely to prevent pharmacists from working in a disaster are family and safety concerns. Pharmacists perceived that their duty of care to their patients would make them likely to work during a disaster. Most pharmacists noted they would work even if they were expected to work outside their scope of practice, or if their place of work lacked electricity or was damaged.

Discussion:

Depending on the disaster, up to 27% of the pharmacy workforce may be unwilling to work in a disaster. Family and safety concerns were the primary barriers to pharmacists reporting to work in the aftermath of a disaster. Providing guidelines on how pharmacists can prepare their family for a disaster may assist in ensuring pharmacists are willing to work.

(Continue . . . )

This week, another study has been published, one that polls EMS workers on their willingness to work during a severe pandemic.

The full report is behind a paywall, and we aren't privy to the `pandemic scenario' presented, but once again a significant number of EMS workers indicated their unwillingness to work during a future pandemic.

Emergency Medical Services Personnel’s Pandemic Influenza Training Received and Willingness to Work During a Future Pandemic

T. Rebmann, RL Charney, TM Loux, JA Turner, YS Abbyad & M. Silvestros
Accepted author version posted online: 04 Dec 2019
Download citation
https://doi.org/10.1080/10903127.2019.1701158

Objective

Identify determinants of emergency medical service (EMS) personnel’s willingness to work during an influenza pandemic.

Background

Little is known about the willingness of EMS personnel to work during a future influenza pandemic or the extent to which they are receiving pandemic training.

Methods

EMS personnel were surveyed in July 2018 – Feb 2019 using a cross-sectional approach; the survey was available both electronically and on paper. Participants were provided a pandemic scenario and asked about their willingness to respond if requested or required; additional questions assessed their attitudes and beliefs and training received. Chi-square tests assessed differences in attitude/belief questions by willingness to work. Logistic regressions were used to identify significant predictors of response willingness when requested or required, controlling for gender and race.

Results

433 individuals completed the survey (response rate = 82.9%). A quarter (26.8%, n = 116) received no pandemic training; 14.3% (n = 62) participated in a pandemic exercise. Significantly more EMS personnel were willing to work when required versus when only requested (88.2% vs 76.9%, X2 = 164.1, p  < .001).

Predictors of willingness to work when requested included believing it is their responsibility to work, believing their coworkers were likely to work, receiving prophylaxis for themselves and their family members, and feeling safe working during a pandemic.

Discussion

Many emergency medical services personnel report lacking training or disaster exercises related to influenza pandemics, and a fair percentage are unwilling to work during a future event. This may limit healthcare surge capacity and could contribute to increased morbidity and mortality. Findings from this study indicate that prehospital staff’s attitudes and beliefs about pandemics influence their willingness to work. Pre-event training and planning should address these concerns.

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On top of the number of HCWs (and other essential workers) who will refuse to work during a pandemic, there will also be attrition of the workforce due to illness, death, or the understandable need to stay home to care for loved one. 

Those who work in the periphery of healthcare - housekeeping, hospital security, food service - are even less incentivised to work, given their pay scale.  

While one might blame the HCWs who are unwilling to put themselves (and by extension, their families) in harm's' way during a severe pandemic, in truth, hospitals, EMS agencies, and practically all levels of government have failed to seriously prepare for the next global health crisis (see WHO: Survey Of Pandemic Preparedness In Member States).

Our battle against the next severe pandemic will likely be either won or lost in hospitals all across the nation. And while there are a lot of potential points of failure (lack of beds or ventilators, lack of IVs or meds, etc.), if we don't have the nurses, techs, EMTs and their support staff willing and able to work, it's pretty much game over.

If we lose the ability to provide reasonable health care - not only to pandemic victims, but also to those with heart attacks, strokes, cancer, and trauma - the societal and economic impact of the next pandemic could be unfathomable.

All reasons why, we - along with the rest of the world - need to find the foresight, fortitude, money, and political will to do something substantial to prepare before the next crisis strips us of that opportunity completely.

For more on pandemic planning and preparedness, you may wish to revisit:

JHCHS Pandemic Table Top Exercise (EVENT 201) Videos Now Available Online

#NatlPrep : Because Pandemics Happen

Pandemic Planning For Business

The Pandemic Preparedness Messaging Dilemma

China: Outbreak Of Brucellosis Reported At Veterinary Research Institute - Gansu Province

Credit Wikipedia

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Overnight Chinese media has been filled with reports of a large outbreak of Brucellosis at a Veterinary Research Institute located in Lanzhou, Gansu Province. 

Early reports suggested at least 65 people had tested positive, while more recent reports put that number closer to 100. It isn't clear how many are symptomatic, as some are described as `latent' infections.

Brucellosis is a bacterial disease of livestock that can also infect humans. While rarely fatal, it can cause serious and prolonged illness, with symptoms that may may include recurrent fevers, endocarditis, and neurological symptoms. 

According to the CDC, person-to-person transmission is very rare, and most infections occur through three routes.

• Eating undercooked meat or consuming unpasteurized/raw dairy products
• Breathing in the bacteria that cause brucellosis (inhalation)
• Bacteria entering the body through skin wounds or mucous membranes

While hunters and farmers may be occasionally exposed , occupations with the highest risk of exposure are:

• slaughterhouse workers
• meat-packing employees
• veterinarians
• laboratory workers

The CDC states that `Brucellosis is the most commonly reported laboratory-associated bacterial infection.', and in 2005 a survey found nearly 12% of 600+ lab workers tested in Spain were positive for the bacteria.

Three strains of Brucella (Brucella abortus, Brucella melitensis & Brucella suis)  have been listed as Select Agents - pathogens that have been deemed to pose a significant biological hazard - and could potentially be used as bioterrorism agents (against both humans and livestock).

A search of Chinese Language media this morning for `染布魯氏菌病' (aka  Brucellosis') returns numerous reports on this incident, including this from state run Xinhua.

Brucellosis cases confirmed in NW China

Source: Xinhua| 2019-12-07 02:08:58|Editor: yan

LANZHOU, Dec. 6 (Xinhua) -- Sixty-five people in a veterinary research institute in Lanzhou, northwest China's Gansu Province, have been diagnosed with brucellosis, local health authority said Friday night.

Four suspected cases of brucellosis, all from the Lanzhou Veterinary Research Institute of the Chinese Academy of Agricultural Sciences, were reported by the First Hospital of Lanzhou University on Monday, the city's health commission said.

As of Friday noon, 263 people at the institute had been tested, of which 65, mainly laboratory staff, were confirmed antibody-positive.

The patients have been under medical observation and will be given standard treatment if necessary, the commission said.

The local department of agriculture is investigating the source of the disease and carrying out monitoring work.

Brucellosis, also known as the Mediterranean fever, is an infectious bacterial disease of human beings caused by brucella, transmitted by contact with infected livestock including cattle and sheep. It is characterized by fever, malaise and headaches.

The local health commission said the risk of human-to-human transmission of brucella is minimal.

A more recent report from CGTN (China Global Television Network) puts the number of positive cases to 96, and reiterates that the source of the outbreak is still under investigation.

96 confirmed cases of brucellosis in NW China

CGTN

As of Saturday noon, 96 people in a veterinary research institute in Lanzhou, northwest China's Gansu Province, were confirmed with brucellosis antibody-positive, local health authority said.

The authority said that 317 people at the institute had been tested, of which 96 were confirmed antibody-positive without obvious symptoms.

The patients have been under medical observation and will be given standard treatment, if necessary.

The local department of agriculture is investigating the source of the disease and carrying out monitoring work.

(Continue . . . )

Most years, only about 100 sporadic Brucellosis cases are reported in the United States, although larger outbreaks are not unheard of.  In 1992, 18 people were infected at pork processing plant in North Carolina, and in 2006 scores of lab workers - working in two different states (Indiana & Minnesota)  - were exposed, but only 2 were confirmed infected. 

Hopefully additional details as to the type, route of exposure, and extent of this outbreak will become available in the days ahead.

CDC FluView Week 48: Influenza B dominates

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Today's CDC FluView reports shows that the 2019-2020 flu season is now well underway across most of the nation, and that unusually, influenza B is leading the pack, followed by H1N1 and then H3N2.

Influenza B activity most often surges in late spring, as the winter Influenza A epidemic subsides, although we've recently seen several countries report influenza B dominated flu seasons (see Denmark's Flu 2017-18 Season: Attack of The Killer B's and in China for much of the 2017-2018 flu season.

Despite a long-standing reputation as being `less serious' than influenza A, recent studies have shown little difference in their respective severity (see Influenza B: A Virus Not To Be Underestimated).

A study published in early 2018 - NEJM: Acute Myocardial Infarction After Laboratory-Confirmed Influenza Infection- found that Influenza B (rather than A) that produced the highest coronary risk, at least among their limited sample size (n=364).

Dominant flu strains often shift dramatically over the course of a single flu season, and while influenza B is currently king of the viral mountain, there is plenty of time for either H1N1 or H3N2 to make a bid for the lead. 

Interestingly, clade 3C.3a H3N2 viruses which took over the second half of last year's U.S. flu season - and prompted a delayed decision on this year's flu vaccine (see WHO Selects Fall H3N2 Flu Shot Component: Clade 3C.3a) - has yet to turn up in this year's CDC testing. 

Some excerpts from today's FluView report include:

Weekly U.S. Influenza Surveillance Report

Key Updates for Week 48, ending November 30, 2019

 

Seasonal influenza activity in the United States has been elevated for four weeks and continues to increase.

Key Points

• The 2019-2020 flu season is underway for most of the country, however some parts of the country are still seeing lower levels of flu activity.
• Activity is being caused mostly by influenza B/Victoria viruses, which is unusual for this time of year. H1N1 viruses are the next most common, followed by H3N2 viruses, which are decreasing in proportion.
• The flu season is just getting started; elevated flu activity is expected to continue for weeks. It’s not too late to get vaccinated. Flu vaccination is the best way to reduce the risk from flu and its potentially serious complications.

Nationally, influenza B/Victoria viruses are the most commonly reported influenza viruses among children age 0-4 years (46% of reported viruses) and 5-24 years (60% of reported viruses), while A(H3N2) viruses are the most commonly reported influenza viruses among persons 65 years of age and older (54% of reported viruses). Among adults aged 25-64 years, approximately equal proportions of influenza A(H1N1)pdm09 and B/Victoria viruses (35% and 34%, respectively) have been reported. Additional age data can be found on FluView Interactive.  

Nationwide during week 48, 3.5% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.4%.

 (Continue . . . )

It is not too late to get a flu shot, and if you do get sick, call your doctor. Early treatment with antivirals can shorten your illness, and for some patients, can be life saving.

Now is also the time to rigorously practice good flu hygiene. Stay home if you are sick, avoid crowds, wash your hands frequently, and cover your coughs and sneezes. 

While this year's flu season has arrived several weeks earlier than usual, there is no way of knowing how long this year's flu season will last. Safe to say, however, there's probably at least a couple of months flu activity still ahead.

Indonesian Veterinary Medical Assoc. (PDHI) Urges Govt. To Declare ASF Epidemic

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For the past couple of months we've been following reports of unusual pig mortality (`Babi Mati') in North Sumatra, carried by the Indonesian press (see Indonesia: Media Reports Of Unexplained Pig Deaths In Multiple Regions) - and while the suspicion of many observers has been that African Swine Fever  is the culprit - officially the government has not confirmed the cause.

For now, the government is calling this outbreak  `pig cholera' - which usually refers to Classical Swine Fever (CSF) - while insisting that additional tests are pending'.

This, despite our seeing Media Reports Of Positive ASF Test Results In North Sumatra in early November and almost daily reports of dead pigs dumped in rivers, lakes, and along roadsides (see YouTube Video).

Earlier this week we saw a comment from the FAO indicating they were ' . . . . liaising with the Directorate General of Livestock and Animal Health Services, Indonesia to confirm the cause and explore needs.'

As the death toll in pigs increases (reportedly now over 20,000 head), and fears that the epidemic will spread, Indonesia's Veterinary Medical Association (PDHI) is reportedly calling upon the government to declare an outbreak of ASF, citing `positive test results'.

        (Translated)

PDHI Urges Government to Declare African Swine Fever Plague

CP name Kompas.com

Reporter Ellyvon Pranita

Upload12/06/2019

KOMPAS.com - Indonesian Veterinary Association (PDHI) urged the government to immediately declare that the African Swine Fever (ASF) outbreak has entered Indonesia.

Delivered by the Chairman of PDHI, Drh H Muhammad Munawaroh MM, the pressure was based on the case of pig deaths in a number of livestock businesses in North Sumatra.

Swine mortality rates continue to increase from August 2019 until early December 2019 and reach a total of 20,500 head. Then, based on laboratory results, it was stated that the death of the pigs was positively caused by ASF.

'For this reason, we from PDHI actually want to urge the government to declare that the ASF outbreak in pigs has entered Indonesia,' Munawaroh told Kompas.com, Friday (6/12/2019).

        (Continue . . . )


We'll have to see whether this very public application of pressure on the Indonesian government yields any results.

Stay tuned.