# 9768
After reporting no new cases yesterday, the Saudi MOH adds 4 new cases to close out month of February – the fourth biggest month on record. Three are from Riyadh – and while one of those is listed as a HCW – a bit surprisingly, none are listed as having nosocomial exposures.
The MOH also announces one recovery and one fatality.
# 9767
Baby chicks and ducklings are popular gifts around Easter, but practically every year they are linked to outbreaks of Salmonella in humans. Beyond the risk of illness, once the novelty wears off - these irresistibly cute and cuddly baby birds often come to a bad end - as this National Audubon Society report explains (see Colored Chicks Raise Concerns But, After Easter, Many Face Fates Worse Than Dye).
But from a public health perspective, baby chicks as pets – particularly for young children – pose a significant health risk.
In early summer of 2012, in That Duck May Look Clean, But . . ., we looked at a multi-state outbreak of Salmonella Montevideo involving 66 persons across 20 states linked to the handling of live poultry (baby chicks or ducklings or both) sold via mail-order hatcheries and agricultural feed stores.
By the time the outbreak was declared over in October, it had grown to 93 persons from 23 states and Puerto Rico, although it is generally accepted that surveillance only picks up a fraction of the cases.
You may recall that similar warnings have gone out in the past regarding Human Salmonella Infections Linked to Small Turtles. Reptiles, amphibians, and small rodents (like hamsters) – along with birds - can carry and spread salmonella bacteria, which makes good hand hygiene particularly important after touching these creatures.
Once again, last year the CDC tracked a large Multistate Outbreak of Human Salmonella Infections Linked to Live Poultry in Backyard Flocks, which involved 363 persons infected with the outbreak strains of Salmonella Infantis, Salmonella Newport, or Salmonella Hadar from 43 states and Puerto Rico.
The Investigation found: One hundred seventy-four (73%) of 237 ill persons interviewed reported contact with live poultry (e.g., chicks, chickens, ducks, ducklings) in the week before becoming ill. - and - Many ill persons in this outbreak reported bringing live poultry into their homes, and others reported kissing or cuddling with live poultry.
For some tips on avoiding Salmonellosis this spring, you may wish to visit the CDC’s webpage:
Risk of Human Salmonella Infections from Live Baby Poultry
Peep, chirp, quack! Live baby poultry, such as chicks, ducklings, goslings, and baby turkeys, can carry harmful germs called Salmonella. After you touch a chick, duckling, or other baby bird, or anything in the area where they live and roam, WASH YOUR HANDS so you don't get sick!
Often, live baby poultry may be put on display at stores where children may be able to touch the birds or areas where they are displayed. Because these birds are so soft and cute, many people do not realize the potential danger that live baby poultry can be, especially to children.
<SNIP>
How do I reduce the risk?
DO
- Wash hands thoroughly with soap and water right after touching live baby poultry or anything in the area where they live and roam. Use hand sanitizer if soap and water are not readily available.
- Adults should supervise hand washing for young children.
- Clean any equipment or materials associated with raising or caring for live poultry outside the house, such as cages or feed or water containers.
DON'T
- Don’t let children younger than 5 years of age, older adults, or people with weak immune systems handle or touch chicks, ducklings, or other live poultry.
- Don't snuggle or kiss the birds, touch your mouth, or eat or drink around live baby poultry.
- Don't let live baby poultry inside the house, in bathrooms, or especially in areas where food or drink is prepared, served, or stored, such as kitchens or outdoor patios.
- Don’t eat or drink in the area where the birds live or roam.
- Don't give live baby poultry as gifts to young children.
- Send a Health-e-Card: Teach Hand Washing
- Download a CDC Kidtastics Podcast: Why Parents Should Think Twice Before Giving Baby Birds to Young Children for Easter [PODCAST - 4:09 minutes]
What are the signs, symptoms, and types of treatment available for Salmonella infections?
Salmonella can make people sick with
- Diarrhea
- Vomiting
- Fever
- Abdominal cramps
Sometimes, people can become so sick from a Salmonella infection that they have to go to the hospital. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.
You can learn more about the signs, symptoms and treatment of Salmonella infection by visiting the CDC's Salmonella website. If you suspect you or your child has Salmonella infection, please contact your health care provider immediately.
Major Global Migratory Flyways – Credit FAO
# 9766
Although currently a far greater concern to poultry producers than to public health, we’ve been watching the first incursion of HPAI (Highly Pathogenic Avian Influenza) Eurasian H5 viruses into North America over the past few months, as has the CDC.
Until November of last year, HPAI H5N8 had been essentially a threat only to East Asia.
It first appeared in Korea in January of 2014, was carried to Japan by migratory birds that spring (and again last fall), and had been reported in North Eastern China. While it recently has produced a massive outbreak in Taiwan - it had not strayed outside of the far northern half of the East Asian Flyway.
At least, not until early November when it abruptly showed up at a German poultry farm (see Germany Reports H5N8 Outbreak in Turkeys), which was quickly followed by reports in the Netherlands, the UK, and eventually even Italy and (this week) Hungary.
Remarkably, H5N8 had travelled farther in a matter of a few months than its H5N1 cousin had managed to do over several years. A history we looked at three months ago in H5N8: A Case Of Deja Flu?
It was only few weeks later that British Columbia reported an outbreak of HPAI H5N2 (see Fraser Valley B.C. Culling Poultry After Detecting H5 Avian Flu), followed two weeks later by the announcement from OIE/APHIS: HPAI H5N8 & H5N2 Detected In Washington State Wild Birds.
H5N8 had done in less than a year what H5N1 has yet to do since it re-emerged in 2003; it crossed oceans and got a foothold in North America.
And once here, it has managed to successfully reassort with North American (NA) avian influenza viruses, producing new, highly pathogenic subtypes. In short order wild and migratory birds in six western states (Washington, California, Oregon, Idaho, Utah & Nevada) were discovered to be carrying these viruses (see Oregon Quarantines Another Backyard Flock Over HPAI).
The USDA maintains an Avian Flu Information page where they post the latest news:
Last Modified: Feb 25, 2015
A Threat to U.S. Poultry
Worldwide, there are many strains of avian influenza (AI) virus that can cause varying degrees of clinical illness in poultry. AI viruses can infect chickens, turkeys, pheasants, quail, ducks, geese and guinea fowl, as well as a wide variety of other birds. Migratory waterfowl have proved to be a natural reservoir for the less infectious strains of the disease.
AI viruses can be classified as highly pathogenic (HPAI) or low pathogenic (LPAI) strains based on the severity of the illness they cause. HPAI is an extremely infectious and fatal form of the disease that, once established, can spread rapidly from flock to flock and has also been known to affect humans. LPAI typically causes only minor illness, poses no risk to human health, and sometimes manifests no clinical signs. However, some LPAI virus strains are capable of mutating under field conditions into HPAI viruses.
USDA’s Animal and Plant Health Inspection Service (APHIS) works to keep HPAI from becoming established in the U.S. poultry population.
The good news is, thus far, we’ve seen no evidence of a serious threat to human health from these viruses, but the CDC remains cautious and has issued specific guidance documents (see CDC Interim Guidance For Testing For Novel Flu & CDC Interim Guidance On Antiviral Chemoprophylaxis For Persons With Exposure To Avian Flu).
With Avian flu on the move again, and with serious outbreaks involving humans both in China and Egypt, the bird flu threat is once again making public health headlines (see WHO Warns On Evolving Influenza Threat). Late this week the CDC posted the following statement on H5 viruses in North American birds.
Avian Flu Update: H5 Viruses Detected Among U.S. Domestic and Wild Birds
Recent detections of highly pathogenic avian influenza H5 infections in U.S. domestic and wild birds pose a low risk to human health at this time according to the Centers for Disease Control and Prevention. In December 2014, the United States Department of Agriculture (USDA) first detected H5 avian viruses in wild birds in Washington state. Since that time, additional infections in birds with highly pathogenic avian influenza A H5N2, H5N8 viruses and with a newly identified H5N1 virus have been reported in the western states of California, Idaho, Oregon, Utah, Washington and Nevada. No human infections with these viruses have been reported to date.Avian influenza (Bird flu) is a viral disease of birds. Migratory waterfowl and shore birds may carry avian influenza viruses that do not usually make them sick. Avian influenza viruses can be classified as either “low pathogenic” avian influenza viruses or “highly pathogenic” avian influenza viruses (HPAI), based on molecular characteristics and the ability of the virus to cause disease in birds. HPAI viruses can cause severe illness and death in birds, particularly in domestic poultry.
In general human infections with avian influenza viruses are rare and most often occur after people are in direct or close contact with an infected bird. Illnesses in humans from avian influenza virus infections have ranged in severity from mild to severe.
While no human infections with these HPAI H5N8, H5N2, or this new H5N1 virus have been reported worldwide, similar viruses (like Asian-origin H5N1, for example) have infected people in the past. The H5N1 virus recently isolated from a U.S. wild bird is a new mixed-origin virus (a reassortant) that is genetically different from the Asian-origin avian H5N1 viruses that have caused human infections with high mortality.
CDC is communicating and coordinating with state health departments on appropriate human health measures and is working with animal health colleagues to evaluate and minimize public health risk. The risk to people from these HPAI H5 infections in U.S. birds and poultry is believed to be low at this time because these viruses do not normally infect humans easily, and even if a person is infected, the viruses do not spread easily to other people. People in contact with known infected or possibly infected birds should take precautions to protect against infection. In addition, CDC has developed testing and influenza antiviral prophylaxis guidance for persons exposed to birds possibly infected with HPAI H5 viruses.
Because avian influenza A viruses have the potential to change and gain the ability to spread easily among people, monitoring for human infection and person-to-person transmission is extremely important for public health.
CDC continues to monitor this situation to minimize the risk to people and will provided updated information as it becomes available.
For more information about avian influenza visit the CDC avian flu web site and the USDA ARS and Animal and Plant Health Inspection Service (APHIS) websites.
The U.S. Department of Interior (DOI) and the USDA are the lead federal agencies for outbreak investigation and control in wild birds and the USDA APHIS is the lead agency for such activities in domestic birds. The latest information on avian influenza findings in the Pacific Flyway is available on USDA’s website.
# 9765
Unlike last winter, day-to-day reporting of H7N9 cases from much of Mainland China has been slow, although it isn’t entirely clear how much of this is due to an actual reduction in cases and how much is due to a change in the way some provinces are reporting.
We’ve seen some case announcements turn up belatedly in Provincial EOM epidemiological reports.
Earlier this week the World Health Organization, in their most recent Antigenic and genetic characteristics of zoonotic influenza viruses and candidate vaccine viruses developed for potential use in human vaccines, described this year’s H7N9 activity and virus evolution as:
Influenza A(H7N9) activity from 24 September 2014 to 23 February 2015
During this period, 148 human cases of avian influenza A(H7N9) virus infection were reported to WHO, bringing the total number of cases to 602 with 227 deaths reported4. All human cases were detected in China, or in travelers who visited China (2 in Canada). Increased genetic heterogeneity of HA and NA gene sequences was observed among recent viruses from humans, poultry and environmental samples. Comparison of these viruses using haemagglutination inhibition (HI) assays showed that the majority remained antigenically similar to the CVVs derived from A/Anhui/1/2013-like viruses.
`Increased genetic heterogeneity of HA and NA gene sequences’ is evidence that the H7N9 virus continues to evolve, something we’ve looked at previously in Eurosurveillance: Genetic Tuning Of Avian H7N9 During Interspecies Transmission & EID Journal: H7N9 As A Work In Progress.
Two reports this morning courtesy of Hong Kong’s CHP.
HP notified of additional human case of avian influenza A(H7N9) in Guangdong
The Centre for Health Protection (CHP) of the Department of Health (DH) is today (February 27) closely monitoring an additional human case of avian influenza A(H7N9) in Guangdong notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
According to the GDHFPC, a male patient aged 80 in Shantou was hospitalised for treatment in critical condition.To date, 589 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (176 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (19 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).
After not having reported any H7N9 cases this winter, Anhui Province – which reported two cases on February 25th (see CHP closely monitors three additional human cases of avian influenza A(H7N9) in Mainland) – has apparently notified Hong Kong’s Centre for Health Protection of two more cases (1 from Anqing City and the other from Tongling).
HP closely monitors two additional human cases of avian influenza A(H7N9) in Mainland
The Centre for Health Protection (CHP) of the Department of Health (DH)is today (February 28) closely monitoring two additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
According to the Health and Family Planning Commission of Anhui Province, a male patient and a female patient, both aged 58 with poultry exposure before onset, were hospitalised for management. They were in critical condition.
To date, 591 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (176 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (21 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).
Dust Movement Across The Globe – Credit NASA
# 9764
An unusual story has appeared in Omani press his week, where worries are expressed that avian flu (or MERS) might be carried in from other regions via the long-lived dust storms that frequent the Middle East during the spring.
While there isn’t a lot of evidence to support the notion that viable avian flu viruses could be carried sucessfully over long distances by dust storms, the idea isn’t completely far-fetched.
Some viruses have been documented capable of traveling significant distances on the wind. As an example, the USDA/APHIS Overview of the FMD Response Plan: The Red Book lists Foot & Mouth Disease (FMD) as being windborne, stating:
FMDV has also been known to spread through windborne transmission, where the virus infects naïve animals located some miles from known infected animals without any history of contact. The distance of windborne transmission over land surfaces depends on the atmospheric conditions and the amount of virus emitted into the air by the infected animals. Sources suggest FMDV may spread to distances of approximately 60 kilometers over land in favorable conditions and potentially even greater distances over water.
Granted, FMDV is more heat tolerant than influenza viruses, but this shows it is possible for viruses to be carried – intact – for hundreds of kilometers. First a link to the Oman story, then I’ll be back with some more research on the long distance propagation of viruses via the wind.
Oman health: Dust storms pose risks of bird flu; hospitals under siege
by Rahul Das | February 24, 2015 , 9 : 32 pm GST Muscat: Hospitals in Oman say they are under siege as the changing weather has sparked off health alerts, even as a specialist warned that the walls of dust that barrelled across the Sultanate can transmit a variety of airborne infections, including bird flu.
Dr Thashli Thankachen, physician – internal medicine, Lifeline Medical Centre, said that the dreaded bird flu can drift in a sandstorm from an affected area to another region not previously under an epidemic attack."Viruses, bacteria and fungal spores are blown over from one place to another place along with climatic fluctuations increasing the risk of a whole range of infections like respiratory tract infections, conjunctivitis and influenza, in addition to Severe Acute Respiratory Syndrome (SARS), foot and mouth disease, brain fever (Meningitis) etc," he told the Times of Oman on Tuesday.
The warning was issued after hospitals and clinics witnessed a significant increase in footfalls of patients after the temperature dropped by 18° Celsius in the last 72 hours in Muscat.
Long time readers will recall that back in January of 2008 I wrote a blog called The Virus My Friend, Is Blowin' In The Wind where I cast a dubious eye upon claims by the Indian Government that the bird flu virus (H5N1) was being blown by the wind across the border from neighboring Bangladesh, and was infecting hapless Indian Poultry.
It wasn’t impossible, of course. And I went into some of the other types of pathogens (mostly fungi and bacteria) that are known to travel in the wind.
Of course, bacteria and fungi can be pretty hearty organisms. Viral particles are usually far more fragile; more susceptible to UV rays, desiccation, and are further encumbered by being unable to replicate outside of a host.
Fast forward to May of 2010 (see Viruses Blowin’ In The Wind?) and we saw a report in the journal Environmental Health Perspectives, that suggested that it was possible for H5N1 (or any Influenza A virus) to be transported across long (hundreds of kilometers) distances in the air.
Although researchers demonstrated influenza RNA could be detected in ambient air samplings, they didn’t establish that the virus remained viable over long distances.
In December of 2012 we revisited the idea again (see Barnstorming Avian Flu Viruses?) when we looked at a study in the Journal of Infectious Diseases called Genetic data provide evidence for wind-mediated transmission of highly pathogenic avian influenza that found patterns that suggested farm-to-farm spread of the 2003 H7N7 outbreak due to the prevailing wind.
Another study of the same outbreak, Modelling the Wind-Borne Spread of Highly Pathogenic Avian Influenza Virus between Farms (PloS One 2012), found that windborne transmission could have accounted for up to 24% of the transmission over distances up to 25 km.
We have also seen studies indicating that the H5N1 virus can – under the right environmental conditions – remain viable for hours or even days in the environment (see EID Journal: Persistence Of H5N1 In Soil and H5N1: Hiding In Plain Sight)
So, the science is far being a slam-dunk one way or the other on the issue. Short-distance carriage (20-30km) seems plausible, and while I’m somewhat skeptical, longer-distance travel doesn’t seem to have been completely ruled out.
But it would probably take ideal environmental conditions - and a coalescing of a lot of unlikely factors – for an infectious dose of H5N1 to successfully migrate across several hundred kilometers of desert on the back of an Arabian dust storm.
How viruses shuffle their genes (reassort)
# 9763
In the `Good Old Days’ – that is, before the spring of 2013 – the bird flu threat around the world was pretty much centered around the H5N1 virus, which re-emerged in 2003 after making a brief appearance in the mid-1990s in Hong Kong and Southern China.
Sure, there were some `minor’ players – primarily H7 viruses and H9N2 – that had shown the ability to infect humans on rare occasions, but they only tended to produce mild illness, and were pretty far down the threat list.
The one we worried about most was H5N1 – or rather, the many clades of H5N1 – as the virus is constantly evolving, reinventing itself as it traveled through hosts and around the world. While we often talk about H5N1 as a single threat, in truth it encompasses a growing array of viruses, with considerable variability in each strain’s ability to infect, and kill (see Differences In Virulence Between Closely Related H5N1 Strains).
(click to load larger image) (Note: Chart only goes through 2011)
Quite simply, the clade of H5N1 circulating in Cambodia is genetically different from the clade in Indonesia, or Egypt. And within each of these clades there are constantly evolving variants.
By the winter of 2013 H5N1 had infected in excess of 600 people, killing roughly 60% of known cases.
But on March 31st of 2013 we learned of a new dangerous player in the bird flu world, and unexpectedly it emerged from the H7 camp, which previously had only produced mildly pathogenic (in humans) viruses. The H7N9 virus appeared in China, and in two short months infected at least 134 people, killing about 1/3rd.
Although H5N1 didn’t go away, it did recede from the limelight as H7N9 quite impressively managed to infect as many people in its first 24 months as H5N1 was known to have infected in its first 10 years.
Credit Dr. Ian Mackay’s VDU Blog
After a decade of monolithic concerns, we had two serious avian flu threats to contend with.
But within a matter of months we would see that roster expand to include H5N2, H5N3, H5N6, H5N8, and H10N8.
While H5N2 and H5N8 have not (as yet) proved to be a human health threat, they are viewed with caution as they continue to evolve, and are closely related to viruses that do (see CDC Interim Guidance For Testing For Novel Flu).
Over the past four months we’ve watched a remarkable resurgence of H5N1 in both poultry and humans in Egypt, with 108 human infections reported over the past 120 days (see WHO Releases Updated Egyptian H5N1 Numbers).
This is now the biggest sustained run of human H5N1 cases in one country since the virus appeared in 2003, and it shows little signs of abating any time soon.
While we still watch H7N9 closely for signs that it is becoming more easily transmitted among humans - and we keep close watch on these other new subtypes - H5N1 is back on top of our avian flu watch list, as last night’s announcement from the World Health Organization (see WHO Warns On Evolving Influenza Threat) attests.
(excerpt)
H5 viruses: currently the most obvious threat to health
The highly pathogenic H5N1 avian influenza virus, which has been causing poultry outbreaks in Asia almost continuously since 2003 and is now endemic in several countries, remains the animal influenza virus of greatest concern for human health. From end-2003 through January 2015, 777 laboratory-confirmed human cases of H5N1 virus infection have been reported to WHO from 16 countries. Of these cases, 428 (55.1%) have been fatal.
Over the past two years, H5N1 has been joined by newly detected H5N2, H5N3, H5N6, and H5N8 strains, all of which are currently circulating in different parts of the world. In China, H5N1, H5N2, H5N6, and H5N8 are currently co-circulating in birds together with H7N9 and H9N2.
The H9N2 virus has been an important addition to this mix, as it served as the “donor” of internal genes for the H5N1 and H7N9 viruses. Over the past four months, two human infections with H9N2 occurred in China. Both infections were mild and the patients fully recovered.
Virologists interpret the recent proliferation of emerging viruses as a sign that co-circulating influenza viruses are rapidly exchanging genetic material to form novel strains. Viruses of the H5 subtype have shown a strong ability to contribute to these so-called “reassortment” events.
The genomes of influenza viruses are neatly segmented into eight separate genes that can be shuffled like playing cards when a bird or mammal is co-infected with different viruses. With 18 HA (haemagluttinin) and 11 NA (neuraminidase) subtypes known, influenza viruses can constantly reinvent themselves in a dazzling array of possible combinations. This appears to be happening now at an accelerated pace.
For example, H5N2 viruses recently detected in poultry in Canada and in wild birds in the US are genetically different from H5N1 viruses circulating in Asia. These viruses have a mix of genes from a Eurasian H5N8 virus, likely introduced into the Pacific Flyway in late 2014, along with genes from North American influenza viruses.
Little is known about the potential of these novel viruses to infect humans, but some isolated human infections have been detected. For example, the highly pathogenic H5N6 virus, a novel reassortant, was first detected at a poultry market in China in March 2014. The Lao People’s Democratic Republic reported its first outbreak in poultry, also in March, followed by Viet Nam in April. Genetic studies showed that the H5N6 virus resulted through exchange of genes from H5N1 viruses and H6N6 viruses that had been widely circulating in ducks.
China detected the world’s first human infection with H5N6, which was fatal, in April 2014, followed by a second severe human infection in December 2014. On 9 February 2015, a third human H5N6 infection, which was fatal, was reported.
The emergence of so many novel viruses has created a diverse virus gene pool made especially volatile by the propensity of H5 and H9N2 viruses to exchange genes with other viruses. The consequences for animal and human health are unpredictable yet potentially ominous.
Although not a major threat in itself, H9N2 appears instrumental in the creation of new, dangerous H5 reassortant viruses (see PLoS Path: Genetics, Receptor Binding, and Transmissibility Of Avian H9N2). This ubiquitous, yet fairly benign avian virus is quite promiscuous, as we keep finding bits and pieces of it turning up in new reassortant viruses
Of the H5 avian flu viruses we are currently watching with the greatest concern – all share several important features (see Study: Sequence & Phylogenetic Analysis Of Emerging H9N2 influenza Viruses In China):
In January of 2014, The Lancet carried a report entitled Poultry carrying H9N2 act as incubators for novel human avian influenza viruses by Chinese researchers Di Liu a, Weifeng Shi b & George F Gao that warned:
Several subtypes of avian influenza viruses in poultry are capable of infecting human beings, and the next avian influenza virus that could cause mass infections is not known. Therefore, slaughter of poultry carrying H9N2—the incubators for wild-bird-origin influenza viruses—would be an effective strategy to prevent human beings from becoming infected with avian influenza.
We call for either a shutdown of live poultry markets or periodic thorough disinfections of these markets in China and any other regions with live poultry markets.
Although this swelling of the ranks of avian flu viruses has yet to produce a pandemic virus, it is problematic on a number of fronts. First is the impact they are having on poultry production and trade around the globe. And while the number of human infections remains relatively low, they can be quite devastating to those affected.
But this recent expansion of flu viruses also makes the emergence of additional novel subtypes even more likely, as the more diverse and dense the playing field, the more `interchangeable’ genetic parts that are available for reassortment and the greater chance of co-infecting a common host..
The bottom line is, after a decade of pretty much only having one avian virus to worry about, over the past two years we’ve seen the emergence and spread of multiple clades of HPAI avian H5N8, H5N6, H5N3, and H5N2 along side H7N9, H10N8 and a handful of `minor players’ like canine & equine H3N8, canine H3N2, and even H10N7 in marine mammals.
And of course, we have no idea what new reassortants may appear over the next few years.
While no one can predict where any of these viruses will end up - the greater the diversity of novel viruses in circulation - the greater the chances of someday seeing one successfully adapt to humans.
.
For more on this rapidly expanding array of novel flu viruses you may wish to revisit:
The Expanding Array Of Novel Flu Strains
EID Journal: Predicting Hotspots for Influenza Virus Reassortment
Credit NIAID
# 9762
The World Health Organization has issued a lengthy and strong statement on the emergence and proliferation of new subtypes of novel influenza around the world, and the potential risks they pose to global health. Themes that are familiar to regular readers of this blog.
Helen Branswell has a report this evening summarizing the statement, and I’ve posted a link to it and a few excerpts. I’ll have more to say about the specifics of this statement tomorrow.
The Canadian Press - ONLINE EDITION
Volatility of global patterns of novel flu viruses a source of concern: WHO
By: Helen Branswell, The Canadian Press
Follow the link to read the WHO statement in its entirety, where you’ll find specific discussions on the recent spike in H5N1 cases in Egypt (see WHO Releases Updated Egyptian H5N1 Numbers from earlier today), and China’s third winter wave of H7N9.
Warning signals from the volatile world of influenza viruses
February 2015
The current global influenza situation is characterized by a number of trends that must be closely monitored. These include: an increase in the variety of animal influenza viruses co-circulating and exchanging genetic material, giving rise to novel strains; continuing cases of human H7N9 infections in China; and a recent spurt of human H5N1 cases in Egypt. Changes in the H3N2 seasonal influenza viruses, which have affected the protection conferred by the current vaccine, are also of particular concern.
Viruses in wild and domestic birds
The diversity and geographical distribution of influenza viruses currently circulating in wild and domestic birds are unprecedented since the advent of modern tools for virus detection and characterization. The world needs to be concerned.
Viruses of the H5 and H7 subtypes are of greatest concern, as they can rapidly mutate from a form that causes mild symptoms in birds to one that causes severe illness and death in poultry populations, resulting in devastating outbreaks and enormous losses to the poultry industry and to the livelihoods of farmers.
Since the start of 2014, the Organisation for Animal Health, or OIE, has been notified of 41 H5 and H7 outbreaks in birds involving 7 different viruses in 20 countries in Africa, the Americas, Asia, Australia, Europe, and the Middle East. Several are novel viruses that have emerged and spread in wild birds or poultry only in the past few years.
Some of the outbreaks notified to OIE have involved wild birds only. Such notifications are indicative of the heightened surveillance and improved laboratory detection that have followed the massive outbreaks of highly pathogenic H5N1 avian influenza that began in Asia in late 2003.
Detection of highly pathogenic avian influenza viruses in wild birds signals the need for a close watch over poultry farms. Migratory waterfowl, immune to the disease, are known to spread avian viruses to new areas by quickly crossing continents along the routes of several flyways. These migratory waterfowl subsequently mix with local wild birds and poultry that then become infected.
<SNIP>
Warning: be prepared for surprises
Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.
WHO and its collaborating laboratories continue to help countries strengthen their alert, surveillance, and response capacities. A quality assurance program has been conducted by WHO since 2007 to maintain global influenza virus laboratory detection capacity, with panels of testing materials being provided free-of-charge to countries once or twice a year. To further capacity building in countries, particularly developing countries, nearly $17 million was provided in 2014 through the Pandemic Influenza Preparedness framework.
Virological research, which has done so much to aid the detection and understanding of novel viruses, assess their pandemic risks, and track their international spread, needs to continue at an accelerated pace.
More R&D is needed to develop better vaccines and shorten the production time. During a severe pandemic, many lives will be lost in the 3 to 4 months needed to produce vaccines.
An influenza pandemic is the most global of infectious disease events currently known. It is in every country’s best interests to prepare for this threat with equally global solidarity.
# 9761
We’ve an unusually late update today from the Saudi MOH, where they cite 3 new cases and three recent fatalities. But disappointingly, and without explanation, their English version doesn’t carry the usual line listing.
The Arabic version (see below) has a line listing, but as it is a graphic format, doesn’t lend itself to our normal translation tools.
However, we can piece together that one case is from Al-Jawaf, another from Riyadh, and the third is from Khobar.
The cases from Riyadh and Khobar both appear to be under investigation as possibly healthcare related, although neither are listed as HCWs.
If the MOH gets an English graphic up, from which we can glean additional details, I’ll append it to this post.
Variegated Squirrel – Credit Wikipedia
# 9760
As it’s been nearly a week since I’ve written about a newly discovered, deadly zoonotic pathogen affecting humans (see CDC & EID Journal On The Recently Discovered Bourbon Virus), allow me to introduce you to a recently identified bornavirus that appears to be behind a cluster of acute fatal encephalitis in three squirrel breeders in Europe.
Variegated squirrel breeders may have died as a new virus
18.02.2015, 16:28 clock | dpa
In Saxony-Anhalt three Variegated squirrel breeders are apparently died of a previously unknown virus. Scientists from the Friedrich-Loeffler-Institut on the island of Reims discovered in an animal of a deceased person to a novel Borna
Variegated squirrels (Sciurus variegatoides) are a tree squirrels in the genus Sciurus that are native to Central America (yes, I looked it up), and apparently are being imported in Europe. Today the ECDC has published a Rapid Risk Assessment on the possible zoonotic transmission of a new bornavirus from these rodents to humans.
Main conclusions and options for action
A recently reported cluster of acute fatal encephalitis in three squirrel breeders possibly related to an infection with a newly identified bornavirus is an unusual event. The novel nature of this occurrence requires that additional investigations are undertaken into the role of a new bornavirus in the aetiology of these cases, the identification of natural hosts, reservoir and the transmission route.
Nevertheless, pending the completion of the cluster investigation, it is advised that feeding or direct contact with living or dead variegated squirrels should be avoided, as a precautionary measure.
Further investigations are ongoing to characterise these cases. In addition, testing of cases of human encephalitis for this newly identified bornavirus, especially in areas where the presence of bornavirus is documented in animals, can contribute to a better understanding of the risk of bornavirus infection in humans.Event background information
On 19 February 2015 Germany posted a message on EWRS, reporting three cases of fatal encephalitis in residents of the state of Saxony-Anhalt. The first clinical case was seen in 2011, and the second and the third in 2013 in different hospitals. Affected persons were males aged 62 to 72 years and of age-typical health status. Each of them was known to breed variegated squirrels (Sciurus variegatoides), a type of tree squirrel common to Central America that can be kept as an exotic outside pet. They knew each other but did not live in close proximity to one another. It is unclear whether they exchanged animals.
During the prodromal phase, which lasted for two weeks or longer, the patients presented with fever and shivering, fatigue, weakness and walking difficulties. Due to increased confusion and psychomotor impairment they were admitted to neurology wards where they developed ocular paresis. They rapidly deteriorated within a few days and died after some time in intensive care, despite mechanical ventilation. Investigations for usual (non-purulent) encephalitis aetiologies performed at the Bernhard Nocht Institute for Tropical Medicine in Hamburg at first did not produce any evidence for known pathogens in cerebrospinal fluid and samples of brain tissue of the deceased.
The Friedrich Loeffler Institute on Riems Island investigated the carcass of one variegated squirrel belonging to the third patient. Genetic analysis of a tissue sample pool of the animal using a metagenomics approach produced sequences of a newly identified type of bornavirus. Further molecular and immunohistochemical analysis of brain tissue from the three deceased patients confirmed presence of this virus in the human cases as well. The newly identified virus is clearly different from all currently known bornaviruses.
Tissue and cerebrospinal fluid collections from bio banks are now being investigated for the identification of additional cases. Previously unresolved cases of encephalitis are being re-evaluated in view of the new virus. Breeders/owners of variegated squirrels will be questioned as to their health condition and asked about anecdotal knowledge of possible fatal cases among breeders/owners. The available evidence is compatible with this virus being a zoonotic pathogen. In limited testing of additional variegated squirrels from one breeder and a zoo no other animal was found to be positive for this infection, but further tests are ongoing. Breeders are asked to send in deceased animals to the Friedrich Loeffler Institute.<SNIP>
Conclusions
This cluster of acute fatal encephalitis in three squirrel breeders possibly related to an infection with a newly identified bornavirus is an unusual event. The role of new bornavirus in the aetiology of these cases, the identification of natural hosts, reservoirs and transmission route require additional investigations.
Nevertheless, pending the completion of the cluster investigation, feeding or direct contact with living or dead variegated squirrels should be avoided as a precautionary measure.Further investigations are ongoing to characterise these cases. Testing cases of human encephalitis for this newly identified bornavirus, especially in areas where the presence of bornavirus is documented in animals, can contribute to a better understanding of the risk of bornavirus infection in humans.
We’ve seen other exotic diseases brought in via imported animals, including a little over a decade ago – the United States experienced an unprecedented outbreak of Monkeypox - 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 2003 MMWR Multistate Outbreak of Monkeypox --- Illinois, Indiana, and Wisconsin, 2003).
Now that a virus has been identified and linked to their illness, it will be interesting to see how many unresolved cases of encephalitis end up being due to the same etiology.
Credit NIAID
# 9759
Twice each year influenza experts gather to discuss recent developments in human and animal influenza viruses around the world, and to decide on the composition of the next influenza season’s flu vaccine. Due to the time it takes to manufacture and distribute a vaccine, decisions on which strains to include must be made six months in advance.
Which means the composition of the northern hemisphere’s vaccine must be decided upon in February of each year, while decisions on the southern hemisphere’ vaccine are made in September.
NIAID has a terrific 3-minute video that shows how influenza viruses drift over time, and why the flu shot must be frequently updated, which you can view at this link.
Of course, there is always the danger that during the manufacturing or service period for this vaccine a new flu virus could emerge, and that is exactly what happened this past year with the H3N2 vaccine component.
While barely a blip on the radar when vaccine decisions were made 12 months ago, by October of 2014 a `drifted’ H3N2 virus was rapidly overtaking the competition (see CDC HAN Advisory On `Drifted’ H3N2 Seasonal Flu Virus), seriously driving down this year’s flu vaccine’s efficiency.
Yet despite the occasional miss , most years the flu vaccine turns out to provide at least a moderate level of protection (see CDC Vaccine Effectiveness - How Well Does the Flu Vaccine Work?), and along with good flu hygiene (washing hands, covering coughs, etc.), are your best protection against catching the flu.
This week the World Health Organization brought together representatives from GISRS (Global Influenza Surveillance and Response System), along with members of OFFLU (the OIE/FAO Network on Animal Influenza), and other experts to determine the Recommended composition of influenza virus vaccines for use in the 2015-2016 northern hemisphere influenza season.
Once again, the H1N1 component remains unchanged from the 2009 H1N1 virus, but the H3N2 has been shifted to match the `drifted’ version which plagued this year’s vaccine. The primary B component has also been updated.
26 February 2015
It is recommended that trivalent vaccines for use in the 2015-2016 influenza season (northern hemisphere winter) contain the following:
- an A/California/7/2009 (H1N1)pdm09-like virus;
- an A/Switzerland/9715293/2013 (H3N2)-like virus;
- a B/Phuket/3073/2013-like virus.
It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/60/2008-like virus.
For more information
# 9758
Yesterday, in Egypt’s Uncertain H5N1 Case Count, we looked at the efforts of Sharon Sanders to maintain FluTracker’s Egypt - 2015 WHO/MoH/Provincial Health Depts H5N1 Confirmed Case List, which today shows 74 cases for the year, and 20 deaths for the year.
Today I was pleased to stumble upon a new report, issued by the World Health Organization, that closely matches Sharon’s totals, indicating that since September 24th Egypt has recorded 109 H5N1 cases, of which between 75 & 80 have occurred since the first of the year.
Sharon’s conservatively curated count over the same period was an impressively close 107.
This excerpt comes from a series of reports, issued today, called:
There is a good deal more to these documents than these summaries, and I expect to revisit these documents over the next couple of days. For now, however:
Influenza A(H5) activity from 24 September 2014 to 23 February 2015
A(H5) viruses have been detected in birds in Africa, Asia, Europe, the Middle East and North America. A(H5) human infections have been reported to WHO by China (3 cases) and Egypt (109 cases), countries in which infections have been detected in birds (Table 1). Two of the human infections in China were caused by A(H5N6) viruses. One human case in China and those in Egypt were caused by A(H5N1) viruses. A(H5) viruses were detected in birds in Bangladesh, Bulgaria, Canada, China, Egypt, Germany, India, Indonesia, Israel, Italy, Japan, Netherlands, Nigeria, Republic of Korea, Russian Federation, United Kingdom of Great Britain and Northern Ireland (United Kingdom), United States of America (USA), Viet Nam and West Bank and Gaza Strip
Within this same document is a summary of recent H7N9 activity (that once again, comes pretty close to FluTrackers Independent Tally):
Influenza A(H7N9) activity from 24 September 2014 to 23 February 2015
During this period, 148 human cases of avian influenza A(H7N9) virus infection were reported to WHO, bringing the total number of cases to 602 with 227 deaths reported4. All human cases were detected in China, or in travelers who visited China (2 in Canada). Increased genetic heterogeneity of HA and NA gene sequences was observed among recent viruses from humans, poultry and environmental samples. Comparison of these viruses using haemagglutination inhibition (HI) assays showed that the majority remained antigenically similar to the CVVs derived from A/Anhui/1/2013-like viruses.
Kudos go to Sharon Sanders, and her entire FluTrackers team for keeping such good track of these cases over the months, even when the Ministries of Health have been less than forthcoming.
Credit FAO
# 9757
Earlier this week a big story hit the Arabic press – and has caused heavy (and very concerned) traffic on Arabic Twitter – stating that 90% of Saudi Camels have the MERS virus. I mentioned it briefly two days ago in Postcards From The MERS Twitterverse, but have been unable to find any paper, or study to back up this assertion.
First a media report on this story, after which I’ll be back with reasons why I think this report is off base.
Almost all Gulf camels have MERS, warns Saudi health official
Wednesday, 25 February 2015 1:50 PM
Almost all camels in the Gulf are infected with the Middle East Respiratory Syndrome (MERS), a Saudi Health Ministry official has been reported as saying.
The fatal virus, which already has infected more than 1000 and killed at least 376 patients, is believed to have spread from camels to humans.
The high rate of camel infection – 90 percent, according to Saudi Arabia’s undersecretary for preventative health Abdullah Asiri – raises a serious issue for the Gulf, where camels are a deep part of daily life for many locals.
Asiri said exterminating the animals was not an acceptable solution and instead research on a vaccine needed to be accelerated, Arab News reported.
Obviously, if 90% of Saudi Camels are actively infected, this would pose major infectious disease risk.
But it is makes far more sense that 90% of Saudi Camels have been infected with the MERS coronavirus (i.e. have serum antibodies) sometime in the past. Not that 90% are currently infected (and capable of spreading the disease) as intimated by this report.
It is a small, but important difference.
The idea that camels are a repository for the MERS coronavirus gained traction in August of 2013 when we saw a study in the Lancet: Camels Found With Antibodies To MERS-CoV-Like Virus, which found specific antibodies to the MERS coronavirus in all 50 (100%) of the dromedary camel samples gathered (from multiple locations) in Oman.
Much lower levels of antibodies were detected in 14% of camels from two dromedary herds tested from the Canary Islands.
The following January (2014) in EID Journal: MERS-Like Antibodies In Camels, UAE 2003-2013, we saw a report showing 97% of dromedary camel serum samples collected in 2003 and 2013 in the United Arab Emirates (UAE) showed specific antibodies for the MERS coronavirus.
Again in August, in EID Journal: Three Decades Of MERS-CoV Antibodies In Camels, we saw serological evidence showing an infection rate of 81% going back over 30 years.
But none of these studies were designed to show that these camels were actively infected and shedding the virus.
While we’ve limited reports from the field on active infection with MERS virus in camels, we’ve one study that found 10 of 35 (27%) camels tested during the 2013–14 calving season (see EID Journal: MERS Coronavirus In A Saudi Dromedary Herd) actively shedding the virus. From the report:
At farm A, we detected MERS-CoV in 1 of 4 dromedaries sampled on November 30, none of 11 sampled on December 4, nine of 11 sampled on December 30, and none of 9 sampled on February 14 (Table 1). Of the 10 dromedaries that tested positive for MERS-CoV, 9 had parallel nasal and fecal specimens tested, with virus detected in the nasal swab specimens from 8 and the fecal specimen from 1.
At the December 30 sampling, 7 of 8 calves and 2 of 3 adults tested positive for MERS-CoV, indicating that when MERS-CoV circulates on a farm, both calves and adults can be infected (Technical Appendix[PDF - 81 KB - 3 pages] Table). Because all 12 adults with serum collected before December 30 were seropositive (titers >320), it is likely, though not certain, that the MERS-CoV infections in the 2 adults (nos. 21, 19Dam) sampled on December 30 were reinfections, as has been reported for other CoVs.
And last year (see EID Journal: MERS Coronaviruses in Dromedary Camels, Egypt) we saw a sampling from Egypt that found 4 (3.6%) of nasal swabs (out of 110 tested) were positive for the MERS-CoV virus (via RT-PCR testing). A positive PCR test is indicative of a current infection, with active viral shedding.
Obviously nowhere near the 90% range.
Perhaps even more on point, in EID Journal: Replication & Shedding Of MERS-CoV In Inoculated Camels we saw a study showing that camels intentionally inoculated with the human MERS strain shed copious amounts of the virus via nasal discharge for at least a week.
While there is some evidence that a camel can become re-infected with the MERS coronavirus, we don’t know how often that really happens. But whether the first infection, or a subsequent one, the `window’ of opportunity for passing on the virus to humans (or other camels) appears limited to a week or two.
As young camels have the least exposure to the virus, they appear the most susceptible to infection. And that has been postulated as a factor in the spring surge of MERS infections across the Middle East.
Camels appear to be an important conduit for the virus to move into the human population, but we’ve seen estimates that only 3% of cases are caused by direct zoonotic infection (see Dr. Tariq Madani: 97% Of MERS Cases From Human-to-Human Transmission).
If camel-to-human transmission could be eliminated, it might stop the reseeding of the virus into the human population.
And until a camel vaccine can be developed, and deployed, exercising caution and good infection control practices around camels is certainly advisable.
But as far as the claim that 90% of camels have MERS, that appears to be more than a little overstated.
125 Years of Pandemics – Credit ECDC
# 9756
Although the next pandemic may not arrive for years, or even decades, the next big global health crisis could just as easily emerge this year or next. While many think we’ve `already had our pandemic’, there is no mandated minimum `time out’ period between these global events.
We’ve seen 6 influenza pandemics over the past 120 years (plus several `close calls’ in 1951, 1975, 1976 see Pseudo Pandemics And Viral Interlopers), and in recent years we’ve seen a sharp increase in the number of viral threats in circulation (Influenzas, coronaviruses, etc.).
Last year, the Director of the CDC – Dr Thomas Frieden – weighed in on the pandemic threat in a special piece he penned for CNN News (see CDC Director Frieden: On Preventing A Pandemic). He wrote:
While it is impossible to know when another pandemic will occur, few scientists doubt that it will happen again. Pandemics have swept the globe for centuries, and show no signs of abating despite our modern medical advances.
According to respected anthropologist and researcher George Armelagos of Emory University, we have entered the age of re-emerging infectious diseases which he has dubbed The Third Epidemiological Transition. Dr. Armelagos describes this trend in his 2010 paper The Changing Disease-Scape in the Third Epidemiological Transition.
It is characterized by the continued prominence of chronic, non-infectious disease now augmented by the re-emergence of infectious diseases. Many of these infections were once thought to be under control but are now antibiotic resistant, while a number of “new” diseases are also rapidly emerging. The existence of pathogens that are resistant to multiple antibiotics, some of which are virtually untreatable, portends the possibility that we are living in the dusk of the antibiotic era. During our lifetime, it is possible that many pathogens that are resistant to all antibiotics will appear. Finally, the third epidemiological transition is characterized by a transportation system that results in rapid and extensive pathogen transmission.
In other words, the emergence of MERS-CoV, H5N1, Nipah, Hendra, Lyme Disease, H7N9, H5N6, H10N8, NDM-1, CRE, etc. are not temporary aberrations. They are the new norm, and we should get used to seeing more like these appear in the coming years.
In December of 2012 the U.S. National Intelligence Council released a report called "Global Trends 2030: Alternative Worlds" that tries to anticipate the global shifts that will likely occur over the next two decades (see Black Swan Events). Number one on their hit parade?
Global Trends 2030's potential Black Swans
1. Severe Pandemic
"No one can predict which pathogen will be the next to start spreading to humans, or when or where such a development will occur," the report says. "Such an outbreak could result in millions of people suffering and dying in every corner of the world in less than six months."
The threat of another influenza pandemic is consistently ranked higher by most governments than a major cyber/terrorist attack, solar flare, or nuclear/WMD war – and is considered all but inevitable by many experts.
A decade ago, we saw a massive global push for pandemic preparedness, and many groups selected a CPO; a Chief Pandemic Officer. Someone in their business, organization, or family - whose job it was to coordinate their pandemic plan (see Quick! Who's Your CPO?)..
Unfortunately, since the 2009 pandemic was perceived by many as being mild and the next event thought years away, many corporate, organizational, or agency pandemic plans haven’t been updated – or in many cases even looked at – in years.
While it may sit on the back-burner for most people, Ready.gov and FEMA continue to urge pandemic preparedness. This from Ready.gov:
Inspire others to act by being an example yourself, Pledge to Prepare & tell others about it!
You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.
Plan for a Pandemic
- Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
- Periodically check your regular prescription drugs to ensure a continuous supply in your home.
- Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
- Get copies and maintain electronic versions of health records from doctors, hospitals, pharmacies and other sources and store them, for personal reference. HHS provides an online tool intended to help people locate and access their electronic health records from a variety of sources. http://healthit.gov/bluebutton
- Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
- Volunteer with local groups to prepare and assist with emergency response.
- Get involved in your community as it works to prepare for an influenza pandemic.
If you are an employer, you should know that OSHA considers it your responsibility to provide a safe workplace and has produced specific guidance on preparing workplaces for an Influenza Pandemic along with Guidance for Protecting Employees Against Avian Flu
Meanwhile, Flu.gov – the government’s influenza pandemic portal – has these (and other) documents available for business pandemic preparedness:
They also say in their community preparedness section:
Pandemic Flu
The federal government cannot prepare for or respond to the challenge of a flu pandemic alone. Your community can develop strategies that reduce the impact and spread of pandemic flu.
Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist (PDF – 68.91 KB)
Lista de Preparacion para una Pandemia de Gripe Tanto para Organizaciones Comunitarias como Religiosas (PDF – 268 KB)
Community Strategy for Pandemic Influenza Mitigation (PDF – 10.3 MB)
Plan Now to Be Ready for the Next Flu Pandemic (PDF – 213.55 KB)
The Next Flu Pandemic: What to Expect (PDF – 226.83 KB)
Their advice (and this is for before a pandemic threat becomes imminent).
And if you follow only one link from this blog post, I’d recommend the following 20 minute video produced by Public Health - Seattle & King County - called Business Not As Usual .
If you’ve not seen this movie, or haven’t seen it recently, it is well worth taking the time to watch it.
If preparing for a pandemic seems like a lot of work, you’re right.
This it isn’t something you want to start doing after a pandemic threat has already appeared. Pandemic planning should be part of your (company, agency, even family) overall disaster & recovery plan, and if you haven’t updated that recently, you (or your CPO) have a fair amount of work to do.
For more information on pandemic planning, you may want to revisit:
Pandemic Planning For Business
NPM13: Pandemic Planning Assumptions
The Pandemic Preparedness Messaging Dilemma
