Tuesday, September 17, 2019

Japan MAFF: 43rd Farm Outbreak of Classical Swine Fever (Saitama Prefecture)


For the 3rd time in the past 5 days (see here and here), Japan is reporting a new farm outbreak of Classical Swine Fever.  This is the 43rd farm outbreak since the disease re-emerged just over a year ago in Japan.

Today's (translated) announcement from MAFF.

Confirmation of suspected affected animals of swine fever in Saitama Prefecture, about (43 cases eyes domestic)

Ryowa first year September 17,
the Ministry of Agriculture, Forestry and Fisheries

Today, suspected affected animals of swine fever has been confirmed in a farm of the national 41 cases eyes of the carry-out is in the restricted area monitored and made to have Saitama Prefecture Chichibu-gun ogano.
We are taken all possible measures for the quarantine measures for the disease.
Interview in the field, thank you for your cooperation as strictly refrain from such that there is a risk that cause the spread of the disease. 

1. Overview of the occurrence farm

Location: Saitama Prefecture, Chichibu-gun ogano
breeding situation: 1,118 head

2. Background 

(1) Saitama Prefecture, September 16 (Monday), from the farm, received a report of a breeding pig has exhibited abnormal, we conducted a site inspection by animal health inspectors. 

(2) the same day, because the suspicion of swine fever is caused by the inspection at the Livestock Hygiene Service Center, was subjected to a thorough examination, today (September 17, Tuesday), turned out to be a suspected affected animals of swine fever want did.

The most recent OIE report (#35) detailed the recent farm outbreaks, but did not update the number of wild boar tested, or found positive.  It states:
Summary of the wild boar surveillance The report about the latest results of wild boar surveillance will be provided on the following follow-up report.
While CSF is similar in appearance and impact to African Swine Fever (ASF), it is caused by a different virus. Both, however, are highly contagious among pigs, and can be economically devastating for pork producers, but neither disease poses a direct human health threat.

COCA Call Today: HHS and CDC Recommendations to Expand the Use of Naloxone



In the CDC's August Vital Signs briefing, researchers reported that far too little naloxone - a drug that can quickly reverse an opioid overdose - is being dispensed in many areas of the country that need it the most.
I can attest that as a paramedic in the 1970s - when heroin was the addict's drug of choice - it was one of the most frequently used items from our (limited) drug kit, and it saved a lot of lives. 
Today the CDC will hold a follow-up COCA Call, providing clinicians with the HHS and CDC recommendations for the prescribing or dispensing of naloxone to patients at risk for opioid overdose.

HHS and CDC Recommendations to Expand the Use of Naloxone—A Life-saving, yet Underutilized Drug for Reversing Opioid Overdose

= Free Continuing Education

Date: Tuesday, September 17, 2019

Time: 2:00pm-3:00pm (Eastern Time)

Instructions for Obtaining Continuing Education (CE)
To receive continuing education (CE) for WC2922-091719 – (Webcast) Clinician Outreach and Communication Activity (COCA) Calls/Webinars – COCA Call: HHS and CDC Recommendations to Expand the Use of Naloxone—A Life-saving, yet Underutilized Drug for Reversing Opioid Overdose, September 17, 2019, please visit TCEO and follow these 9 Simple Steps by October 21, 2019

To receive continuing education (CE) for WD2922-091719 – Clinician Outreach and Communication Activity (COCA) Calls/Webinars – COCA Call: HHS and CDC Recommendations to Expand the Use of Naloxone—A Life-saving, yet Underutilized Drug for Reversing Opioid Overdose, September 17, 2019 (Web on Demand), please visit TCEO and follow these 9 Simple Steps by October 22, 2021.

About 48,000 drug overdose deaths involved opioids in the United States in 2017. Naloxone is a life-saving drug that can reverse the effects of an opioid overdose. Despite recent progress in naloxone dispensing, naloxone remains under-prescribed and underused, often in a variable pattern. Healthcare providers and pharmacists play a critical role in ensuring patients receive naloxone, as they have a frontline view and can make progress in prescribing and dispensing of naloxone. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommends that healthcare providers consider prescribing or dispensing naloxone to patients at risk for overdose.

During this COCA Call, clinicians will learn about HHS and CDC recommendations for the prescribing or dispensing of naloxone to patients at risk for opioid overdose.
A few minutes before the webinar starts, please click the link below to join:
https://zoom.us/j/996942494external icon

Or iPhone one-tap :
US: +16468769923,,996942494#  or +16699006833,,996942494#

Or Telephone:
Dial(for higher quality, dial a number based on your current location):
US: +1 646 876 9923  or +1 669 900 6833

Webinar ID: 996 942 494
International numbers available: https://zoom.us/u/anixAVglVexternal icon

Taiwan Reports 1st Avian H5N5 Virus In Ducks


Influenza viruses are constantly reinventing themselves via two well established routes; Antigenic drift & Antigenic Shift (reassortment).
  • Antigenic drift causes small, incremental changes in the virus over time. Drift is the standard evolutionary process of influenza viruses, and often come about due to replication errors that are common with single-strand RNA viruses (see NIAID Video: Antigenic Drift).
  • Shift occurs when one virus swap out chunks of their genetic code with gene segments from another virus.  This is known as reassortment. While far less common than drift, shift can produce abrupt, dramatic, and sometimes pandemic inducing changes to the virus (see NIAID Video: How Influenza Pandemics Occur).
In either case, most of these mutations/reassortments are evolutionary failures.  But every once in awhile a more `fit' virus is produced, and it goes on to thrive.

In early 2015 Taiwan - along with Japan, the United States, Canada, and parts of Europe - was visited by a particularly robust, relatively new clade ( of the H5 virus (see Taiwan Reports H5N8 On Goose Farm and `New Strain’ Of H5N2), which rapidly became endemic on the island nation.  
Clade H5 viruses are notorious for their ability to reassort and reinvent themselves into new subtypes (including H5N1, H5N2, H5N5, H5N6, H5N8, and H5N9).
While Taiwan has had to contend primarily with H5N2 and H5N8, today we learn that - for the first time - they have detected an H5N5 virus. Its origins are still under investigation, so we don't know if this is a local reassortment, an imported virus, or (less likely) the product of an LPAI-to-HPAI mutation.

First the (translated) announcement from Taiwan's APHIS, then I'll return with a bit more.
The first time the detection of highly pathogenic H5N5 avian influenza virus, initially determined that the virus has not spread, called on the industry with epidemic control measures 
 Ref: 8376
Release date: 108-09-16
Published Authority: Animal and Plant Health Inspection Service

Council of Agriculture (COA) today (16 May) confirmed that the publication of the 12th District, Kaohsiung Qishan 1 duck (active surveillance) H5 subtype highly pathogenic bird flu cases, the animal health tests (livestock Wei ) further testing analysis, diagnosed as infected with H5N5 highly pathogenic avian influenza (HPAI) virus, the virus detected in 15 cases in wild birds in Europe between 2016 to 2018, and in Germany (3 turkey farm) and 克罗埃西亚 (4 poultry farm) poultry farm sporadic cases, the rest of the world around no serious epidemic.
Because for the first time detected cases of H5N5 bird flu virus, the COA can not be taken lightly, for the case of field three kilometers surrounding poultry farms have completed a comprehensive sampling and monitoring and found no new cases, initially determined that the virus has not spread .

COA pointed out that from Kaohsiung H5N5 bird flu cases, non-communicable diseases common to humans and animals, was the alternate on the eve of the season will start to strengthen surveillance for avian influenza among ducks reared high volume counties, subject to the further testing by animal health, 13 on the afternoon diagnosed with H5N5 subtype of HPAI, livestock guardian of the virus nucleic acid analysis, the H5 virus carrying the gene and 104 domestic invasion of H5 avian influenza virus most closely, N5 gene similar to the virus found in wild birds in Eurasia. 

The source speculated that the presence of this virus strain H5N2 virus in Taiwan at this stage with wild birds carrying the virus HXN5 recombination, but it can not be completely ruled out by the wild birds come to carry. In addition, according to the World Organization for Animal Health (OIE) Terrestrial Animal manual review of the virus HA cleavage site amino acid sequence should be judged highly pathogenic avian influenza virus. 
Kaohsiung City Animal Protection in post-informed of the outcome, then close links with the Council of Agriculture decided within 3 km radius around the poultry farms to conduct a comprehensive sample testing, and on the 15th to complete sampling for examination, specimen examined by animal health were negative, initially identified HPAI virus subtype H5N5 has not spread.

COA explanation, Taiwan to (107) of avian flu to H5N2 subtype of HPAI based, a total of 98 poultry farms occur; this (108) As of Year ended September 15, HPAI subtype H5N2 epidemic is still mainly , 55 poultry farms field occurs mainly infects birds land, the epidemic situation to last year although the decrease compared to the number of games, but still can not be taken lightly.

COA pointed out that currently only 1 domestic poultry farms confirmed H5N5 subtype of HPAI, is effective in preventing the spread of pathogens, will strengthen monitoring of the hot zone poultry farms, and the implementation of field area clean and disinfect the poultry industry through each group counseling industry, in addition to raising appeal again be sure to strengthen the poultry industry's anti-bird birdhouse facilities, poultry and avoid waiting (wild) birds in contact, while the implementation of access control, time out poultry farms, all personnel must replace clothing and shoes, and all kinds of vehicles, cages, equipment and other out, have to go through Chedi disinfection, quarantine function to enhance the venue of independent, effectively prevent the spread of avian influenza through various media, and new viruses and reduce the risk of spread. In addition, household poultry should also be observed daily independent poultry health situation, if there is an abnormal death warning, shall immediately notify the local animal epidemic prevention agencies, should not be thrown away sick or dead poultry, and with the necessary sampling and monitoring work, to serve Central Lee timely disposal of the local epidemic prevention authorities, together Fangdu spread of the epidemic, in violation of the relevant provisions will be notified and keeping heavy penalties, to ensure the safety of poultry industry and sustainable development.
The first time the detection of highly pathogenic H5N5 avian influenza virus, initially determined that the virus has not spread, called on the industry with epidemic control measures
Ref: 8376
Release date: 108-09-16
Published Authority: Animal and Plant Health Inspection Service 

During Europe's 2016-2017 avian H5N8 epizootic, we saw a handful of `spinoff' reassortants, including HPAI H5N5, isolated from a duck collected in the Netherlands (see OIE Notification).

Germany's Friedrich-Loeffler-Institut (FLI)  described this new virus as:
Since mid-December 2016 a further subtype, H5N5, has been circulating in wild birds, which now has first been introduced into a poultry holding. This virus is is likely to be a reassortant based on the original H5N8. Mixed viruses, so-called reassortants, of avian influenza viruses are generated, if several virus subtypes are present in one infected animal and exchange genetic material during replication. Generation of reassortants must be expected when different high and low pathogenic influenza viruses are circulating in one population.
H5N5 appeared to fizzle after the spring of 2017, but another reassortment - H5N6 - returned the following year, showing up in both Asia and Europe.
Hopefully we'll get more detailed information about the clade (likely, but that needs to be confirmed) - and possible origins of this virus - in the days to come.
In the meantime, this reminds us how quickly the existing fluscape can change, and why we need to be prepared for surprises.  

South Korea Confirms 1st Outbreak Of African Swine Fever


Last May North Korea confirmed their first outbreak of African Swine Fever in Chagang-Do, very near their northern border with China (see OIE Notification: African Swine Fever In North Korea). Despite persistent rumors of more outbreaks, there's only been radio silence from the DPRK, and no follow-up reports have been filed with the OIE.
Since then  South Korea's Ministry of Agriculture (MAFRA) has been practically on a war footing over the ASF threat, and has imposed enhanced surveillance across the country, but most particularly near their border with North Korea. 
Today MAFRA has announced South Korea's first confirmed ASF outbreak in Paju, very near the border with North Korea. Additionally, they appear to be investigating a 2nd suspected outbreak in nearby Yeoncheon County.

There is currently no evidence (other than circumstantial) to suggest these outbreaks stem from North Korea, but the proximity of both incidents to the border does raise the suspicion.

We've two translated reports from MAFRA this morning.  The first, on the confirmed outbreak, followed by the suspected outbreak. (Note: Korean doesn't translate as well as some other languages, but it is readable).

In the game, a pig farm in Paju African swine fever (ASF) occurred
09.17.2019 09:19:56 Defense Policy Bureau

1. ASF outbreak situation
□ Agriculture, Forestry, Animal Husbandry and Food has 2019 years 9 Mon. 17 days 06 City 30 minutes of domestic African swine fever occurred official check revealed that the .
O 9.16. 18 City mother pig pig farm in Paju, Gyeonggi material 5 has two had a report that mortality ,

O Accordingly, Gyeonggi-sanitary laboratories holding a sample on our axis taken , today (9.17.) AM 6 City 30 minute when Agriculture, Forestry and Livestock Quarantine Office inspection results were confirmed positive African swine fever .
Ministry of Agriculture, Food and Rural Affairs dispatches quarantine headquarters epidemiological investigation team to identify the cause of occurrence
O but also check whether a nearby farm propagate , generate radial farm 3km than in pig farms were found not separately .
2. Action
□ Agriculture, Forestry, Animal Husbandry and Food conducted a urgent preventative measures for their immediate farms caused suspicion that African swine fever notification received .

O Veterinary First Responders bangyeoktim Defense Support Division (3 teams , 6 people ), a commitment to the agricultural report the farm Zhangzhou , livestock , vehicles , was out of control, such as an outsider .

O based disinfection facilities (16 points ) and control post (15 points ) and also operating , the livestock vehicle was also strengthened measures for disinfection ,

O generating farms and farmers owning 2 farms 3,950 by also carried live disposal measures for the two completed the first responders preventative measures .
□ Agriculture, Forestry, Animal Husbandry and Food is African swine fever confirmed positive decision immediately to the African swine fever crisis stage alert highest level of " serious " was promoted to the stage .
O Today 06 City 30 from minute 48 during the time the national pig farms , slaughterhouses , feed factories , targeting vehicles entering the country temporarily move the stop command (Standstill) a was issued ,

O Get in Gyeonggi ‧ for the export of pigs try to ban one week longer conduct class action and , the National Swine Farm 6300 courtesy symptoms suspected to be also carried out surveillance immediately and whether the current .
□ it should also strengthen management of African swine fever propagation major factor .
O pig farms the remaining half of the food ban and mouth ,

O Ministry of Environment in collaboration with the relevant ministries, including the border area 14 dogs in the wild Hammamet counties are also it plans to regulate pig populations .
      (Continue . . . )

Yeoncheon County, Gyeonggi material African swine fever in a pig farm (ASF) report suspicious axis

17.09.2019 18:29:59 Defense Policy Bureau

□ ( hygiene conditions ) Agriculture, Forestry, Animal Husbandry and Food is 9 Mon. 17 days Yeoncheon County, Gyeonggi material pig farms ( breeding size : 4732 Two , consistent breeding ) in ASF announced that this report suspicious axis .

○ Veterinary later in the course of telephone surveillance Defense Support Division ( sows first two mortality ) have been identified that farmers are 9 Mon. 17 days 14 City 40 Gyeonggi-minute animal health was reported to the laboratory .

○ Gyeonggi livestock quarantine tube 15 City 40 to arrive at the scene for a minute inspection by sampling jungyimyeo transferred to the Agriculture, Forestry and Livestock Quarantine Office , test results 9 Mon. 18 is expected to turn out on Sunday morning .
* 旣occurred : one thing ( Gyeonggi Province Paju material pig farm / 9.16 days to report , 9.17 days confirmed )
□ ( preventative measures ) Agriculture, Forestry, Animal Husbandry and Food Report received immediately after the first responders to the farmers a commitment to bangyeoktim people , animals and vehicles moving control , it is urgent preventative measures, such as disinfection ,
○ inspection results , ASF when it is identified as ASF emergency action plan (SOP) on plans to take the necessary preventative measures such as an emergency buy disposed of .
□ ( coordination points ) Agriculture, Forestry, Animal Husbandry and Food livestock farmers and livestock officials ASF those that will thoroughly implement preventative measures, such as disinfection of the farm and associated facilities for the generation and propagation prevention
○ ASF has fast if there is any doubt whether the observed symptoms were advised to report .
(Continue . . . )

You can read an English language news report from Agence France-Presse at the link below:

South Korea confirms first swine fever outbreak
All of this comes on the heels of the announcement just 10 days ago by the Philippines DOH Confirming African Swine Fever, which joined Laos and Myanmar in reporting their first outbreaks in the past 3 months.
While African Swine Fever poses no direct threat to human health, its rapid spread across Asia threatens their economies, and their ability to produce adequate meat protein for more than a billion people. 
Meanwhile Taiwan, Japan, Thailand, and India are all on alert, as ASF marches on.

Monday, September 16, 2019

Philippines Ag. Dept. Warns On Illegal Disposal Of Dead Pigs

YouTube Video Link


Over the weekend it has been widely reported (see YouTube video above) that dozens of pig carcasses have been discovered dumped into local waterways. The assumption is many of these pigs are infected with African Swine Fever.
The dumping of infected livestock into rivers, lakes, and ponds can easily spread the disease, and is a sign that the epizootic is likely larger than is being reported.
While the Philippines Department of Agriculture continues to emphasize the positive (see Dar: “ASF outbreak managed, contained and controlled in Rizal and Bulacan”), they are understandably concerned over the clandestine dumping of pigs.

This press release issued today (Sept 16th).  I'll have a brief postscript after the break.

Dar: “Report sick pigs; let vets dispose of dead ones properly”
Author: DA Communications Group | 16 September 2019

Agriculture Secretary William D. Dar appeals to backyard swine raisers to report sick and dead pigs to their respective municipal or city veterinarians, who will, in turn, coordinate with the Department of Agriculture-Bureau of Animal Industry (DA-BAI) to determine the cause of sickness or death.

Dar made the appeal on the wake of dozens of pigs found floating along Marikina River and a creek in Quezon City.

“It was utterly irresponsible on the part of the backyard raisers as they did not only violate current laws, but their misdoing also spread the disease pathogens much faster,” he said.

“They violated RA 8485 or the Animal Welfare Act, as they deprived their dead pigs of adequate care, maltreating them in the process,” the DA chief said.

“Violators are punishable by imprisonment of not less than six months nor more than two years or a fine of not less than P1,000 nor more than P5,000. Also, the suspected backyard raisers violated RA 9003 or the Solid Waste Management Act,” added Secretary Dar, “as they brazenly and irresponsibly dumped dead pigs in public places like waterways.”

Violators of RA 9003 are punished with a fine of not less than P300 but not more than P1,000 or render community service for not less than one day to not more than 15 days.

Dar said that sickly animals deserve proper care and adequate treatment. Should they eventually die, there are strict protocols on how they should be disposed of.

“The DA through the BAI and the National Meat Inspection Service (NMIS) — in partnership with the private sector particularly with commercial hog raisers’ groups, local government units, the PNP and military — has taken all the necessary measures to manage, control and contain the possible spread of African Swine Fever and major swine diseases,” Dar said.

“The irresponsible dumping of dead pigs simply adds scare to the public, and this should not be tolerated. The perpetrators must be punished in accordance with the law,” concluded Dar. ### (DA Comms Group)
        (Continue . . . )

In China, where `officially' fewer than 1.2 million pigs have been lost to African Swine Fever - but unofficially  that number is believed 100 times greater - we've seen numerous reports of the illegal disposal of dead pigs (see here, here, and here).
Farmers know that if even one of their pigs tests positive for ASF, their entire herd will be destroyed, and their neighbor's pigs will be quarantined and tested.
And while most governments offer some sort of compensation, it is rarely enough to offset the farmer's losses. And so when a few pigs die, they often elect to do a midnight disposal, and hope the disease doesn't affect any more of their herd.
It rarely works out for the farmer, his neighbors, or their nation and is almost always a sign that things are worse than being reported. 
Stay tuned.

CDC COCA Call This Week: Severe Lung Illness Associated with Using E-Cigarette Products


Late this week (Thursday) the CDC will hold a COCA call on their recent investigation into severe lung injury associated with the use of E-cigarettes or `vaping'.
Primarily of interest to clinicians and healthcare providers, COCA (Clinician Outreach Communication Activity) calls are designed to ensure that practitioners have up-to-date information for their practices.
While the alarm went out less than a month ago (see CDC Clinical Action: Unexplained Vaping-Associated Pulmonary Illness), already nearly 400 probable cases have been identified, along with 6 deaths (see CDC UPDATE).

As there is a high likelihood that these initial numbers represent just the tip of the pyramid (see CDC graphic below), and so the CDC is trying to get the word out to practitioners on how to recognize - and report - suspected cases.

Details on Thursday's COCA call follow.   This is likely to be a `hot ticket' event, so you'll probably want to log in early.

Save the Date: COCA Call: Severe Lung Illness Associated with Using E-Cigarette Products

Date: Thursday, September 19, 2019

Time: 2:00pm-3:00pm (Eastern Time)


During this COCA Call, clinicians will learn background information on the multistate outbreak of severe pulmonary disease associated with using e-cigarette products and CDC experts will provide recommendations based on currently available information. 

COCA Call Objectives
Call Materials
Call Information
Additional Resources

At the conclusion of the session, the participant will be able to accomplish the following:
  • Cite background information on the topic covered during the presentation.
  • Discuss CDC’s role in the topic covered during the presentation.
  • Describe the topic’s implications for clinicians.
  • Discuss concerns and/or issues related to preparedness for and/or response to urgent public health threats.
  • Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional team of health care providers.

In case you missed it, ove the past 3 weeks the CDC held a teleconference (audio & transcript below) on the their investigation, and the MMWR has released interim guidance and an investigative report from North Carolina.

CDC : Outbreak Investigation & Telebriefing On Pulmonary Disease Linked To Vaping

CDC MMWR Early Release: Acute Lung Injury LInked To Vaping