Hong Kong: Oriental Magpie Tests Positive For H5

Photo Credit- Wikipedia

 

# 9995

 

 

You may recall that just two weeks ago, HK authorities reported their first Wild Bird Found Infected With H5N6 – a peregrine falcon – and over the past decade they’ve seen scores of (mostly migratory) birds carrying the H5N1 virus. Hong Kong is one of the few places in the world where public health authorities take notice of something as seemingly inconsequential as a single dead bird.

 

To understand why, you have to go back to 1997, when the H5N1 Bird Flu virus suddenly appeared in Hong Kong – infecting 18 residents and killing 6. The source of the infection turned out to be their own domesticated poultry industry, likely infected by wild birds.

 

It was only the complete eradication of all poultry in the territory that managed to halt what many feared could have been a disaster. Since then, Hong Kong has kept a particularly watchful eye on their winged visitors.

 

The strain of HPAI H5 in today’s case has yet to be determined, but authorities are already advising poultry interests of the potential threat.  

 

This from Hong Kong’s CHP.

 

Oriental magpie robin tests positive for H5 virus

Preliminary testing of an Oriental magpie robin found in Sai Kung has returned a positive result for the H5 avian influenza virus, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (April 30), adding that further confirmatory tests are being conducted.

The sick Oriental magpie robin was found and collected near 10B Sha Kok Mei First Lane, Sai Kung yesterday (April 29). Oriental magpie robins are common resident birds in Hong Kong.

The spokesman said cleansing and disinfection have been stepped up at the venue, adding that there are no poultry farms within three kilometres of where the dead bird was found.

In view of the case, the AFCD has phoned poultry farmers to remind them to strengthen precautionary and biosecurity measures against avian influenza. Letters have been issued to farmers, pet bird shop owners and licence holders of pet poultry and racing pigeons reminding them that proper precautions must be taken.

The spokesman said the department would conduct frequent inspections of poultry farms and the wholesale market to ensure that proper precautions against avian influenza have been implemented. The department will continue its wild bird monitoring and surveillance.

"People should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. The public can call 1823 for follow-up if they come across suspicious, sick or dead birds, including the carcasses of wild birds and poultry," the spokesman said.

The Food and Environmental Hygiene Department (FEHD) will continue to be vigilant over imported live poultry as well as live poultry stalls. It will also remind stall operators to maintain good hygiene.

The Department of Health will keep up with its health education to remind the public to maintain strict personal and environmental hygiene to prevent avian influenza.

The AFCD, the FEHD, the Customs and Excise Department and the Police will strive to deter the illegal import of poultry and birds into Hong Kong to minimise the risk of avian influenza outbreaks caused by imported poultry and birds that have not gone through inspection and quarantine.

All relevant government departments will continue to be highly vigilant and strictly enforce preventive measures against avian influenza. Health advice is available from the "H5N1 Health Advice" page on the AFCD website at www.afcd.gov.hk.

Ends/Thursday, April 30, 2015
Issued at HKT 20:44
NNNN

EID Journal: Extensively Drug Resistant NDM Bacteria In The Environment – Dhaka, 2012

E. coli – Photo Credit CDC

 

# 9994

 

It’s been nearly 5 years since The Lancet published a study (see NDM-1: A New Acronym To Memorize)  by Walsh, Toleman, Livermore, et al. that awakened the world to the emergence and growing prevalence of the NDM-1 (New Delhi metallo-β-lactamase) enzyme that can make many types of bacteria resistant to a wide spectrum of antibiotics - including Carbapenems.

 

Carbapenems are newer generation beta-lactam antibiotics (a class that includes penicillins, cephalosporins, cephamycins, and carbapenems) that are usually reserved as an antibiotic of last resort.

 

Complicating matters, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species) in a shared environment. 

In 2011 (see Lancet Study: NDM-1 In New Delhi Water Supply), Timothy Walsh, Janis Weeks, David M Livermore, and Mark A Toleman  published a study that looked for – and found – bacteria carrying the NDM-1 enzyme in New Delhi's drinking water supply.

 

A snippet from the press release stated ominously (emphasis mine):

 

Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

In an interview for Reuters, co-author Mark Toleman of Britain’s Cardiff University School of Medicine stated that as many as 500,000 residents of New Delhi may be carrying the NDM-1 resistance gene in their gut flora. Like with MRSA, carriage of NDM  bacteria does not necessarily mean infection, and even asymptomatic carriers can still spread it to contacts and to the environment.

 

Since then, scattered variants of NDM-1 have begun to emerge (see First Imported Case Of NDM-4 Reported In Hong Kong) around the globe, often in travelers recently returned from the Indian Subcontinent (see VOA News  report  Concerns Mount Over India's Role In Incubating Drug-Resistant Bacteria).

 

India’s response to all of this negative publicity was initially angry denial, but in 2014 – bowing to immense international pressure – India introduced new regulations designed to halt the unregulated sale of more than 3 dozen cheap and powerful (Schedule H1) antibiotics.

 

Recent media reports (see 515 chemists lose licences in Pune div) suggest less than full compliance, so it is difficult to know how much of an impact these laws are having.

 

Last year, in EID Journal: Acquisition of Drug Resistant Genes Through International Travel, we looked at a study from the Netherlands tested that 122 healthy travelers both before and after making an international trip for evidence that they carried one of (several) antimicrobial resistance-inducing genes.

 

They found a high rate of resistance genes in the commensal gut bacteria of returning travelers – particularly those visiting Southeast Asia and the Indian subcontinent .

 

All of which serves a prelude to a new Dispatch in the EID Journal  – again from Dr. Toleman et al.  - that looked for, and found, NDM encoding bacteria prevalent in the Dhaka’s environment.  They also found evidence - that while rife today - this carbapenemase is a relatively recent arrival to Bangladesh.

 

I’ve only excerpted the abstract and conclusions, so follow the link to read this report in it its entirety.

 

Dispatch

Extensively Drug-Resistant New Delhi Metallo-β-Lactamase–Encoding Bacteria in the Environment, Dhaka, Bangladesh, 2012

Mark A. Toleman , Joachim J. Bugert, and Syed A. Nizam

Abstract

Carriage of the New Delhi metallo-β-lactamase variant 1 (NDM-1) enables drug resistance to move between communities and hospitals. In Bangladesh, we found the bla_NDM-1 gene in 62% of environmental waters and in fermentative and nonfermentative gram-negative bacteria. Escherichia coli sequence type (ST) 101 was most commonly found, reflecting a common global relationship between ST101 and NDM-1.

<SNIP>

Conclusions

Our findings indicate that NDM-1 is widespread in the Dhaka environment. We detected 241 NDM-1–encoding bacterial isolates; they were found in all 7 sampled regions and at 36 (62%) of the 58 sampling sites. This high level of environmental bla_NDM-1 contamination is of concern, especially because drinking water in Bangladesh usually carries high levels of sewage-derived bacteria (11). It is therefore likely that bla_NDM-1 carriage rates will rise rapidly. Future environmental studies could provide indicators of epidemics of emerging resistant bacteria before they are realized in hospitals.

Despite the widespread presence of NDM-1 in Dhaka, it appears that this carbapenemase has recently emerged in the Bangladesh environment. Studies in northern Bangladesh did not find NDM-1 in wild ducks and poultry in 2009 (9) or in crow and gull feces in 2010 (10). Similarly, NDM-1 was not detected in drinking water in Dhaka during 2008–2009 (11) even though all samples had high levels of fecal and bla_CTX-M-15 contamination. Furthermore, a study of 1,879 clinical E. coli and Shigella spp. isolates collected during 2009–2010 in Bangladesh did not detect bla_NDM-1 (12). The first known clinical isolates date from 2008 (12), and the first evidence of human gut carriage of bla_NDM-1 was found in samples collected in Dhaka (13) a month before our study.

Because E. coli is the leading cause of human urinary tract infections, bloodstream infections, and neonatal meningitis, the ability of NDM-1 to give this bacterium clinical resistance to carbapenems is of concern (14). E. coli is also universally carried in the human gut. Therefore, we focused on this species because it is likely to be the greatest threat to human health. E. coli encoding NDM-1 were found in 3 of the 7 sampled regions, and genotyping showed they belonged to only 3 STs: ST648, ST101, and ST405. These same 3 E. coli genotypes are responsible for 80% of clinical NDM-1–encoding E. coli isolates in the United Kingdom (15). Furthermore, ST101 is the most common E. coli genotype in the Bangladesh environment (10.3% prevalence) and in clinical isolates from the United Kingdom (50%). Results of a literature search for NDM-1–encoding E. coli belonging to ST101 showed that this genotype has been detected in 15 nations (Figure 2). Thus, E. coli ST101 appears to be a successful global genotype that is often associated with NDM-1. This association with a single global genotype is analogous to the association between E. coli ST131 and the cephalosporinase CTX-M-15. Because of the critical nature of extensively drug-resistant bacteria, we are investigating the underlying factors responsible for the success of these particular antimicrobial drug–resistant strains

 

While still relatively rare – at least in the United States and Europe – this ever expanding rogues gallery of new, multi-drug resistant organisms continues to gain traction around the world, threatening an early demise for much of our current antibiotic arsenal. 

 

In early 2012 World Health Director-General Margaret Chan expressed a dire warning about our dwindling antibiotic arsenal (see Chan: World Faces A `Post-Antibiotic Era’). A year later CDC Director Thomas Frieden called it a `nightmare bacteria’ during the release of a major US report on the threat (see MMWR Vital Signs: Carbapenem-Resistant Enterobacteriaceae (CRE)).

 

For more on the growing threat of antibiotic resistant bacteria, you may wish to revisit:

 

AAP/CDC: New Guidance On For Antibiotics For Children

The Lancet: Antibiotic Resistance - The Need For Global Solutions

UK CMO: Antimicrobial Resistance Poses `Catastrophic Threat’

HPAI H5: Minnesota Reports 11 More Farms, Iowa Reports 4 More As `Probable’

 

# 9993

 

Although we don’t have a good count on the number of birds affected, tonight the Minnesota Board of Animal Health has announced an additional 11 farms have been hit with the HPAI H5N2 virus since yesterday’s update – putting the total at 67 farms across 19 counties.

https://www.bah.state.mn.us/avian-influenza

All of the counties – except 1 (Steele) – have reported previously outbreaks.

 

Meanwhile Iowa – which has seen fewer farms, but far larger numbers of birds affected - reports four more probable outbreaks. Kossuth County becomes the 6th Iowa county to report outbreaks of the highly infectious avian virus.

 

FOUR ADDITIONAL CASES OF HIGHLY PATHOGENIC AVIAN INFLUENZA IN BUENA VISTA AND KOSSUTH COUNTIES

CDC considers the risk to people to be low

DES MOINES – The Iowa Department of Agriculture and Land Stewardship is responding to four probable cases of highly pathogenic avian influenza (HPAI) in commercial poultry farms in Buena Vista and Kossuth counties.  These four new cases would join eight cases of the disease in Iowa that were previously announced. State officials have quarantined the premises and once the presence of the disease is confirmed, all birds on the property will be humanely euthanized to prevent the spread of the disease.

Buena Vista 2 – Turkey farm with an estimated 50,000 birds that experienced increased mortality.  Initial testing showed it positive for H5 avian influenza.  Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

Buena Vista 3 – Turkey farm that has experienced increased mortality.  An estimate on the number of birds at the site is still pending. Initial testing showed it positive for H5 avian influenza.  Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

Buena Vista 4 – Commercial laying operation with an estimated 63,000 birds that has experienced increased mortality.  Initial testing showed it positive for H5 avian influenza.  Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

Kossuth County – Chicken breeder farm with an estimated 19,000 birds that has experienced increased mortality.  Initial testing showed it positive for H5 avian influenza.  Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

As the Department receives final confirmations of the disease updated information will be posted to the Iowa Department of Agriculture and Land Stewardship’s website at www.iowaagriculture.gov/avianinfluenza.asp.

The Center for Disease Control (CDC) and Iowa Department of Public Health considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low.  No human infections with the virus have ever been detected there is no food safety risk for consumers.

(Continue . . . )

 

Two CDC Updates: HPAI H5 & H3N2 Canine Flu

CDC HPAI Risk Assessment

 

# 9992

 

Although neither of these viruses have shown the ability to infect humans, they are nevertheless newly arrived pathogens in North America, are spreading with impressive speed, and are capable of further evolution.  

 

All of which means that – while they currently pose little threat to human health -  they need to be carefully watched.

The CDC has updated their HPAI H5 webpage, and has published an announcement on the sequencing of the canine H3N2 virus, which they say shows no overt signs of being better able to infect humans than the H3N8 canine flu.

 

H5 Viruses in the United States

Page last updated: April 29, 2015

Highly pathogenic avian influenza (HPAI) H5 infections have been reported in U.S. domestic poultry (backyard and commercial flocks), captive wild birds, and wild birds. HPAI H5 detections began in December 2014 and have continued into April 2015. USDA is reporting that H5 viruses have been detected in birds in 18 U.S. states; 13 states have experienced outbreaks in poultry flocks and 5 states have detected H5 in wild birds.

No human infections with these viruses have been detected at this time, however similar viruses have infected people in other countries and caused serious illness and death in some cases. Human infections with other avian influenza viruses have occurred after close and prolonged contact with infected birds or the excretions/secretions of infected birds (e.g., droppings, oral fluids).

While the health risk posed to the general public by these domestic HPAI outbreaks is low at this time, it is possible that human infections with these viruses may occur. CDC has guidance for clinicians and public health professionals in the United States on appropriate follow-up, preventive treatment, testing, specimen collection and processing of samples from patients who may be infected with H5 viruses and has been in close contact with state health departments from all 16 states that have detected H5 in birds.

• Guidance
• Updates and Publications
• Outbreaks of Avian Influenza in North America

• General information about avian influenza in birds
• General information about avian influenza in people

CDC Recommendations for the Public

• As a general precaution, people should avoid wild birds and observe them only from a distance; avoid contact with domestic birds (poultry) that appear ill or have died; and avoid contact with surfaces that appear to be contaminated with feces from wild or domestic birds.
• People who have had contact with infected bird(s) should monitor their own health for possible symptoms (for example, conjunctivitis, or flu-like symptoms).
• People who have had contact with infected birds may also be given influenza antiviral drugs preventatively.
• Health care providers evaluating patients with possible HPAI H5 infection should notify their local or state health departments which in turn should notify CDC. CDC is providing case-by-case guidance at this time.
• There is no evidence that any human cases of avian influenza have ever been acquired by eating properly cooked poultry products.
• CDC will update the public as new information becomes available.

 

 

 

Update on H3N2 Canine Influenza (Dog Flu) Virus

April 28, 2015 – Experts from CDC’s Influenza Division have analyzed genetic sequences of the H3N2 canine influenza A virus recently detected in the United States and found no evidence suggesting an increased potential for this virus to infect humans or cause severe disease in humans. Therefore, the risk to humans posed by this virus continues to be low and is equivalent to that associated with previously circulating H3N8 canine influenza viruses.

CDC conducts year-round surveillance and genetic analysis on circulating human and novel influenza A viruses in order to assess human health risk and prepare for vaccine virus selection. This work is based in part on an informal inventory of genetic mutations that are associated with viral characteristics like increased transmissibility or severity. While genetic analysis of the H3N2 canine flu virus did not show any of these markers, the agency will continue to analyze this virus and watch the field situation closely.

H3N2 canine flu virus is responsible for an outbreak of dog flu reported in the Chicago area according to a press release issued by Cornell University, home to the New York State Animal Diagnostic Laboratory. Dog flu is a contagious respiratory disease in dogs. Two canine influenza viruses have been identified worldwide: an influenza A H3N8 virus and an influenza A H3N2 virus. No human infections with either of these canine influenza viruses have ever been reported.

Previously, canine influenza A H3N8 viruses have been identified in U.S. dog populations. However, testing at the New York State Animal Diagnostic Laboratory and the Wisconsin Veterinary Diagnostic Laboratory showed that the dog flu virus responsible for the current outbreak in dogs is an H3N2 virus. This virus is similar to H3N2 dog flu viruses that have been detected in dogs in parts of Asia since 2007.

Updates on ongoing antigenic and phenotypic analyses will be shared when they are available. For more information on canine influenza (dog flu), please visit Key Facts about Canine Influenza.

FEMA: 60% Of Americans Not Practicing For Disasters

# 9992

 

As I’ve mentioned a couple of times this month (see here, and here), tomorrow is America’s PrepareAthon Day, and FEMA has released the disappointing results of a recent survey showing that the majority of Americans have not practiced for a disaster in the past year, or even developed a family emergency plan.

 

I’m sure part of the problem has been that we are now nearly 10 years without seeing a major (Category 3+) hurricane strike the United States (Wilma in 2005), and that the past three years has produced an unusually low number of tornadoes.  We’ve not seen a truly destructive earthquake in two decades, North American volcanoes have been remarkably quiet since Mt. St. Helens erupted in 1980.

 

While undeniably welcome trends, they won’t last forever. 

 

Another Category 4 or 5 storm will waltz out of the Atlantic one of these days, and into a highly populated region.   We will see another super outbreak of tornadoes, like we saw in 2011 and in 1974.  And the San Andreas, New Madrid, or some other big fault line will eventually rupture causing tremendous damage.

You can put money on it.

 

The only real questions are when, and whether you and your family will be prepared when it happens. 

 

This from FEMA.

 

Sixty Percent of Americans Not Practicing for Disaster: FEMA urges everyone to prepare by participating in National PrepareAthon! Day on April 30

Release date:  April 28, 2015

Release Number:  HQ-15-019

WASHINGTON – A recent Federal Emergency Management Agency (FEMA) survey found that nearly 60 percent of American adults have not practiced what to do in a disaster by participating in a disaster drill or preparedness exercise at work, school, or home in the past year. Further, only 39 percent of respondents have developed an emergency plan and discussed it with their household. This is despite the fact that 80 percent of Americans live in counties that have been hit with a weather-related disaster since 2007, as reported by the Washington Post. With the number and severity of weather-related disasters on the rise, the America’s PrepareAthon! is an opportunity for individuals, organizations, and communities to take action to prepare for specific hazards through group discussions, drills, and exercises.

“When it comes to preparedness, practice makes perfect,” said FEMA Administrator Craig Fugate. “America’s PrepareAthon! is about taking action now to better prepare yourself, your family, and your community to be ready to respond to these events before they occur.”

America’s PrepareAthon! is a national community-based campaign that provides free, easy-to-use guides, checklists, and resources to get more people to take action to prepare every day. On April 30, individuals, families, workplaces, schools and organizations will come together to practice simple actions to stay safe before, during, and after emergencies relevant to their area. Examples include:

1. Sign up for local text alerts and warnings and download weather apps to your smartphone.
2. Develop an emergency communication plan for your family. This will help you be in touch if a disaster strikes and family members are in different locations.
3. Collect important documents and keep them in a safe place. This will help you evacuate without delay and get back on track after the disaster passes.
4. Gather emergency supplies. Pack a “go bag” to evacuate quickly and have supplies in the home to be safe without water or power.

Visit the America’s PrepareAthon! website, ready.gov/prepare to take action, be counted and spread the word.

America’s PrepareAthon! was established to provide a comprehensive campaign to build and sustain national preparedness as directed by Presidential Policy Directive-8. The campaign is coordinated by FEMA in collaboration with federal, state, local, tribal, and territorial governments, the private sector, and non-governmental organizations.

 

While it may not seem a big deal, having a supply of food and water, battery operated lanterns, and an NWS weather radio can take a lot of the stress off of any disaster scenario. 

 

Millions of people who endured Hurricane Sandy’s trek across the Mid-Atlantic states in 2012 learned the hard way just how uncomfortable going a week with no running water, electricity, or other basic services can be in the month November. 

 

Twelve months later, in Sandy: Coping With The Aftermath we looked at some of the long lasting emotional scars. And six years after Katrina hit New Orleans, that city still reported a 300% increase in heart attacks (see Tulane University: Post-Katrina Heart Attack Rates – Revisited).

 

While the psychological impact of a major disaster cannot be completely mitigated, encouraging individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

 

FEMA, Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities of the value of preparing for a wide variety of emergencies and disasters.

Basic kit : NWS radio, First Aid Kit, Lanterns, Water & Food & cash

 

Having a modest supply of food, water, and medicine – and a workable family or business disaster plan – can go a long ways toward reducing both stress and hardship during and after a disaster

 

And when it comes to getting prepared, it is far better to be 6 months too early than 6 minutes too late.

Waiting For The Next Flu To Drop

 

My 2012  Influenza Timeline Graphic

 

# 9991

 

Three years ago, with the 2009 H1N1 pandemic behind us, I wrote a blog called An Increasingly Complex Flu Field, where we looked at the growing number of novel flu threats that were beginning to appear on our radar. 

 

In addition to the venerable H5N1 virus, low path H9N2 and several LPAI H7 strains, I listed three up and coming `swine variant’ strains (H1N1v, H1N2v, H3N2v) that had recently jumped to humans, and were raising alarm bells (see CDC Teleconference & HAN Advisory On H3N2v).

 

Swine, like birds, are considered excellent `mixing vessels’ for influenza, and proved to the the crucible for the last (2009 H1N1) pandemic virus.  They are susceptible to a variety of influenza types, and when simultaneously infected by two different strains, are capable of producing a hybrid – or reassortant – virus.  

 

But as we’ve seen over the past few years, the number and variety of hosts for influenza reassortment go far beyond just pigs and birds.

 

Flu viruses can reassort in humans (see HK’s Dr. Ko Wing-man On Flu Reassortment Concerns), dogs (see Canine H3N2 Reassortant With pH1N1 Matrix Gene), and presumably in many other mammals (see Mixing Vessels For Influenza) including cats, seals, and even camels.

 

Over the past three years the number of newly emerged – or at least recently discovered – novel flu viruses has increased dramatically. Some of these viruses – like H5N6, H6N1, H7N9, and H10N8 – have already shown some limited ability to infect humans.

 

Others, like H5N8, H5N2, and H5N3 are related to viruses that can infect humans, but have not yet demonstrated the ability to do so.  Whether they will maintain that status quo is unknowable.

 

A partial list of influenza viruses of growing concern include:

 

I’ve purposefully excluded some recent influenza virus discoveries – like H17N10 and H18N11 found in bats, or the Novel Influenza C Virus In Bovines & Swine – because what little is known about these pathogens suggests they don’t pose a serious threat to human health at this time.

 

While most of the viruses I listed will likely never seriously threaten public health, this rapid increase in the number of pathogenic players is a concern. As they say, it only takes one.  And we’ve literally gone from watching a half dozen or so `novel’ flu viruses to having to keep track of nearly two dozen over the past three years.

 

The threat becomes even larger when you consider that each of these subtypes can have multiple clades, or genotypes.

 

• The H7N9 virus – which emerged in China in 2013, at last count (see Nature report), has produced at least 48 genotypes, spread across three major clades, and it is likely that constellation of H7N9 variants continues to expand.
• Likewise, H5N1’s evolution from 1996, when it emerged as clade 0, has spawned a constantly expanding family tree (albeit, not all of these incarnations continue to circulate)

 

So when we discuss a flu virus – like H5N1, H7N9 or H5N8 – we aren’t talking about a single, monolithic threat.  We are talking about an ever-expanding family of related viruses, which can vary considerably in their behavior and the threat they pose (see Differences In Virulence Between Closely Related H5N1 Strains).

 

The only real point we can draw from all of this is the number of potential influenza pandemic virus candidates has increased significantly over the past few years.

 

And with the geographic expansion of many of these viruses, the opportunities for them to interact with – an reassort with – other viruses, only increases. This is how North America ended up with two new HPAI H5 viruses (H5N2, H5N1 N/A) over the winter after the arrival of H5N8 in the Pacific Northwest last fall.   

 

It is certainly possible that – over time – additional reassorted H5 viruses will appear in the United States or Canada.   How they may end up affecting wild birds, poultry, or even humans is frankly . . .  unpredictable.

 

Three years ago, all eyes were on the emerging swine variant viruses (see A Variant Swine Flu Review), which caused more than 300 infections across the Midwest in 2012.  Although those viruses have receded from the headlines the past couple of summers, they haven’t gone away, and may surge again. 

 

These swine viruses are important because – unlike many of the avian strains – they belong to the H1, H2, and H3 HA types that have led to all of the known pandemics of the past 130 years.  

 

The progression of human influenza pandemics over the past 130 years has been H2, H3, H1, H2, H3, H1, H1 . . . .  and while that doesn’t prove that an H5 or an H7 virus couldn’t adapt to humans (or hasn’t in the past), it has led some researchers to wonder whether a non H1, H2, or H3 virus has the `right stuff’ to spark a pandemic (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?).

 

This propensity for H1, H2, and H3 viruses to start human pandemics is another reason we keep our eyes on the H2N2 virus in birds (see H2N2: What Went Around, Could Come Around Again), H3N2 and H3N8 viruses canine viruses, the H3N8 seal virus, H2N2 and even H3N8 in horses (see Study: Dogs As Potential `Mixing Vessels’ For Influenza). 

 

But whether a repeat in the H1-H3 cycle, or a deviation into the more exotic avian virus realms, another influenza pandemic is considered all but inevitable.  

 

Two months ago (see WHO Warns On Evolving Influenza Threat) the World Health Organization advised:

 

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.

 

Given the growing number of candidate viruses in circulation, unlike the last interpandemic period, we may not have another three decades before the next pandemic appears.

WHO: Survey & Analysis On Global Response To Antimicrobial Resistance

 

# 9990

 

In early 2012 World Health Director-General Margaret Chan expressed a dire warning about our dwindling antibiotic arsenal (see Chan: World Faces A `Post-Antibiotic Era’) – a sentiment echoed a year later by CDC Director Dr. Thomas Frieden during the release of a major US report on the threat (see McKenna On CDC Antibiotic Resistance Report).

 

Inevitable conclusions backed up by a long list studies showing the inexorable erosion of our current cache of antibiotics.   Some of these reports I’ve covered in the past include:

 

EID Journal: Acquisition of Drug Resistant Genes Through International Travel

The Lancet: Antibiotic Resistance - The Need For Global Solutions

UK CMO: Antimicrobial Resistance Poses `Catastrophic Threat’

MMWR Vital Signs: Carbapenem-Resistant Enterobacteriaceae (CRE)

 

Despite decades of warnings, better stewardship of our dwindling antibiotic resources has been slow in coming, even as the number of resistant bacteria continue to grow. 

 

In many countries antibiotics are still available freely (and cheaply) over the counter, public awareness of the risks is low, and surveillance for resistant infections is either low, or non-existent.

 

Today the World Health Organization released a report, that – while finding some glimmers of hope - nonetheless paints a picture of an international community that is either not really engaged, or lacks the resources, to effectively fight antibiotic resistance.

 

Of 194 member nations, nearly 1/3rd (n=61) did not respond to this two-year survey conducted by the WHO, leaving huge gaps in the data.  Participation was highest in the South East Asian Region (100%) and lowest in the Africa Region (17%). 

 

 

Results from individual countries are not published, instead combined data is presented for each of the six WHO regions.  First links to the full report and the executive summary, followed by some excerpts from the press release.

 

Publication details

Number of pages: 42
Publication date: 29 April 2015
Languages: English
ISBN: 978 92 4 156494 6
WHO reference number: WHO/HSE/PED/AIP/2015.1

Downloads

• Full report
• Summary report

 

WHO report finds systems to combat antibiotic resistance lacking in all regions of the world

29 April 2015 Ç€ GENEVA – A quarter of countries that responded to a World Health Organization (WHO) survey have national plans to preserve antimicrobial medicines like antibiotics, but many more countries must also step up. A new report, Worldwide country situation analysis: Response to antimicrobial resistance, which outlines the survey findings, reveals that while much activity is underway and many governments are committed to addressing the problem, there are major gaps in actions needed across all six WHO regions to prevent the misuse of antibiotics and reduce spread of antimicrobial resistance.

“This is the single greatest challenge in infectious diseases today,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security. “All types of microbes—including many viruses and parasites—are becoming resistant to medicines. Of particularly urgent concern is the development of bacteria that are progressively less treatable by available antibiotics. This is happening in all parts of the world, so all countries must do their part to tackle this global threat.”

Issued a year after WHO’s first report on the extent of antimicrobial resistance globally, which warned of a ‘post-antibiotic era’, this survey—which was completed by 133 countries in 2013 and 2014—is the first to capture governments’ own assessments of their response to resistance to antimicrobial medicines used to treat conditions such as bloodstream infections, pneumonia, tuberculosis (TB), malaria and HIV. It summarizes current practices and structures aimed to address the issue, and shows there are significant areas for improvement.

“While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time,” says Dr Fukuda. “Scientists, medical practitioners and other authorities including WHO have been sounding the warning of the potentially catastrophic impact of ignoring antibiotic resistance. Today, we welcome what has been achieved so far, but much more needs to be done to avoid losing the ability to practise medicine and treat both common and serious illnesses.”

Key findings of the report include:

• Few countries (34 out of 133 participating in the survey) have a comprehensive national plan to fight resistance to antibiotics and other antimicrobial medicines.
• Monitoring is key for controlling antibiotic resistance, but it is infrequent. In many countries, poor laboratory capacity, infrastructure and data management are preventing effective surveillance, which can reveal patterns of resistance and identify trends and outbreaks.
• Sales of antibiotics and other antimicrobial medicines without prescription remain widespread, with many countries lacking standard treatment guidelines, increasing the potential for overuse of antimicrobial medicines by the public and medical professionals.
• Public awareness of the issue is low in all regions, with many people still believing that antibiotics are effective against viral infections.
• Lack of programmes to prevent and control hospital-acquired infections remains a major problem.

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While we worry about the sudden emergence of a novel  pathogen that could sweep across the globe killing millions, we already have a slow rolling pandemic of antibiotic resistance, which is only growing more dire by the year. 

 

The WHO’s updated factsheet on Antibiotic resistance shows just some of these impacts.

 

Antimicrobial resistance

Fact sheet N°194
Updated April 2015

Key facts

• Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
• It is an increasingly serious threat to global public health that requires action across all government sectors and society.
• Antimicrobial resistance is present in all parts of the world. New resistance mechanisms emerge and spread globally.
• In 2012, WHO reported a gradual increase in resistance to HIV drugs, albeit not reaching critical levels. Since then, further increases in resistance to first-line treatment drugs were reported, which might require using more expensive drugs in the near future.
• In 2013, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 100 countries. MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB.
• In parts of the Greater Mekong subregion, resistance to the best available treatment for falciparum malaria, artemisinin-based combination therapies (ACTs), has been detected. Spread or emergence of multidrug resistance, including resistance to ACTs, in other regions could jeopardize important recent gains in control of the disease.
• There are high proportions of antibiotic resistance in bacteria that cause common infections (e.g. urinary tract infections, pneumonia, bloodstream infections) in all regions of the world. A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Gram-negative bacteria.
• Treatment failures due to resistance to treatments of last resort for gonorrhoea (third-generation cephalosporins) have been reported from 10 countries. Gonorrhoea may soon become untreatable as no vaccines or new drugs are in development.
• Patients with infections caused by drug-resistant bacteria are generally at increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are not resistant.

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All of which means it is hard to overstate the seriousness of the problem, or the consequences to humanity should we fail to adequately address it.  

 

APHIS: USDA Confirms HPAI H5N2 In Two Wild Birds From Kentucky

 

 

# 9989

 

My thanks to Lisa Schnirring of CIDRAP for forwarding the news that another state (#17 if you are keeping track) has reported finding the HPAI H5 virus – this time in wild birds.  

 

Credit Wikipedia

 

McCracken County is located on the southern shore of the  Ohio river, bordered to the north by Illinois and very near the Missouri line.  It’s county seat is Paducah. 

 

This marks the furthest east we’ve seen this HPAI virus reported in the United States.  It is certainly not unreasonable to assume that these viruses may already be circulating in additional states that have not yet reported them.

This stakeholder’s statement is from APHIS.

 

 

USDA Confirms Highly Pathogenic H5N2 Avian Influenza in Wild Birds in Kentucky

Published: Apr 28, 2015  

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

WASHINGTON, April 28, 2015 -- The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of highly pathogenic H5N2 avian influenza (HPAI) in two wild birds, a goose and a duck, in McCracken County, Kentucky.  These birds were found within the Mississippi flyway where this strain of avian influenza has previously been identified. CDC considers the risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry, to be low.  No human infections with the virus have been detected at this time.

The samples, taken from dead birds, were tested by the Southeastern Cooperative Wildlife Disease Study at the University of Georgia and confirmed by USDA’s National Veterinary Services Laboratories (NVSL) in Ames, Iowa.  NVSL is the only internationally recognized AI reference laboratory in the United States.  The United States has the strongest AI surveillance program in the world, and USDA is working with its partners to actively look for the disease in commercial poultry operations, live bird markets and in migratory wild bird populations.

USDA will include the confirmation information in routine updates to the World Organization for Animal Health (OIE).  OIE trade guidelines call on countries to base trade restrictions on sound science and specifically state that countries should not impose trade restrictions based on findings of HPAI in wild birds.

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

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

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North Dakota BAH Limits Poultry Movements

 

Credit Wikipedia

 

# 9988

 

Although migratory birds are viewed as being behind the spread of HPAI H5 across the Western half of the nation, experience has shown that once a commercial operation becomes infected, it is all too easy to spread the virus via the movement of personnel, equipment or poultry products. 

 

While less affected than many of its Midwestern neighbors (only 2 outbreaks so far), North Dakota is imposing some strict rules on the movement of poultry and other birds in hopes of staving off additional outbreaks.  

 

Today’s order, which will be reviewed on June 10th, strives to prevent the intermingling of birds from around the state at shows, exhibitions and public sales.  This review is scheduled roughly 3 days before the start of that state’s county fair season – where roughly two dozen fairs (many featuring livestock exhibits) are scheduled across the state between June and August.

North Dakota’s State Fair runs from July 17-25, 2015 in Minot, ND.

 

Last week, you may recall there were media reports out of Minnesota (see Avian flu places State Fair poultry exhibition in doubt) suggesting similar measures may be needed there this summer.  

 

Many will recall the problems that swine variant flu viruses caused pig exhibitors during the summers between 2011 and 2013 (see CDC HAN Advisory On H3N2v), and more recently concerns have emerged over the spread of PEDV (see  Fair Biosecurity & H3N2 In North Dakota Show Pigs).

 

While there are hopes that summer temperatures will dampen down the avian flu threat – at least until the fall – states must weigh their options and decide on how best to reduce to the risks to their poultry industry. 

 

This from the North Dakota Board of Animal Health.

 

 

Poultry/bird movements limited to control spread of avian influenza

Submitted April 28, 2015

BISMARCK, N.D. – To protect North Dakota’s poultry industry from potential exposure to H5 avian influenza virus, the State Board of Animal Health (BOAH) has halted bird movement to shows, exhibitions and public sales within the state in which birds from different locations are intermingled at an event. This does not apply to approved private sales that meet North Dakota importation requirements.

“The state board is taking this precaution to reduce the risk of avian influenza exposure to North Dakota birds,” State Veterinarian Dr. Susan Keller said. “Mixing birds could unnecessarily increase the risk of exposure.”

This board action prohibits the specified poultry/bird movements until further notice. BOAH is continuing to monitor and assess the disease threat, which will be reviewed at their June 10 quarterly meeting.

North Dakota has had two confirmed cases of avian influenza in commercial poultry operations in Dickey and LaMoure counties affecting over 100,000 birds. Nationally, the outbreak has affected nearly 10 million birds in 13 states.

Bird owners should immediately report death loss to their local and state veterinarian, restrict access to their property, prevent contact between their birds and wild birds and practice enhanced biosecurity.

State Veterinarian Dr. Susan Keller is reminding anyone bringing birds into North Dakota to contact the North Dakota Department of Agriculture’s Animal Health Division at 701-328-2655 to ensure they are meeting all importation requirements.

The CDC Recaps The 2014-15 Flu Season

P&I Mortality the past 5 Flu Seasons – Credit FluView

 

 

# 9987

 

With this year’s flu season essentially over in the Northern Hemisphere, it is time once again for the CDC to assess the damage, and as many already know – it was a tough flu year.   Between having an H3 dominated year, and a `drifted’ H3N2 virus that largely evaded this year’s vaccine, the impact was particularly hard on those over the age of 65.

 

2014-15 will go down as the third moderately severe flu season in a row, which followed two comparatively mild seasons (2010-11 & 2011-12), proving you just never know what the next flu season will bring.

 

Yesterday the CDC released the following post-mortem analysis of this latest influenza epidemic season.

 

 

2014-2015 Flu Season Drawing to a Close

April 27, 2015 – Flu activity continues to decline, according to the most recent FluView, which reports that influenza-like-illness (ILI) in the United States has fallen below baseline for the second consecutive week since the middle of November. Other key indicators are declining as well, signaling that the 2014-15 flu season is drawing to a close. The April 24, 2015 FluView covers influenza activity reported from April 12-April 18, 2015.

During the 2014-2015 season, influenza activity started early and had a relatively long duration. Influenza-like-illness (ILI) went above baseline the week ending November 22 and remained elevated for 20 consecutive weeks, making this season slightly longer than average. For the past 13 seasons, influenza-like-illness has been at or above baseline for 13 weeks on average, with a range of 1 week to 19 weeks. The ILI curve for this season is most similar to that from the 2012-2013 season, which is the season during which ILI activity remained above baseline for 19 weeks.

This season was severe for people 65 and older especially. While hospitalization rates are almost always highest among people 65 and older, this season CDC recorded the highest hospitalization rates among this age group since this type of record-keeping began in 2005. People 65 and older accounted for more than 60 percent of all reported hospitalizations and from September 28 through April 18, an estimated 313.8 per 100,000 people in the age group were hospitalized from flu. The next highest recorded hospitalization rate in this age group (182.3 per 100,000) occurred during the 2012-2013 season.

The extremely high hospitalization rate in older adults elevated the overall hospitalization rate for all age groups in the United States to 63.6 per 100,000 people. Hospitalization rates for other age groups were either similar to or lower than what has been seen previously. For example, the age group normally next-most affected by severe illness resulting in hospitalization is children 0-4 years of age. While children in that age group did have the second-highest hospitalization rate this season, that rate through the week ending April 18 (55.4 per 100,000) is lower than what was seen during the same week in 2012-2013 (65.9 per 100,000).

During most of the season influenza A (H3N2) viruses predominated however the country experienced a second wave of influenza B flu activity since early March. Second waves of influenza B activity are common. Seasons during which influenza A (H3N2) viruses predominate typically have higher rates of hospitalizations and more deaths, particularly among older people and children. The last season when H3N2 viruses predominated was in 2012-2013.

Flu-related deaths this season were within expected boundaries for an H3N2 dominant season. CDC monitors flu-related deaths through the 122 Cities Mortality Reporting System, which reports the total number of death certificates processed and the number of those for which pneumonia or influenza is listed as the underlying or contributing cause of death in 122 U.S. cities. Pneumonia and influenza diagnoses (P&I) first rose above the epidemic threshold the week ending January 3, 2015 and peaked the week ending January 17, 2015 at 9.3%. This is comparable to recorded percentages for past severe seasons, including the 2003-04 season when P&I reached 10.4% and the 2012-13 flu season when P&I peaked at 9.9%.

(Continue . .. )

 

Our eyes now turn to the Southern Hemisphere, where the newly formulated flu vaccine is hoped will make a bigger dent in H3N2’s impact this year. But we never really know whether the Southern Hemisphere will be a continuation of our outgoing flu season, or prove to be a harbinger of changes we might see here come the fall.

Iowa Adds Another Big Poultry Farm To Their HPAI List

 

# 9987

 

Late yesterday afternoon the Iowa Department of Agriculture released a statement (see Iowa: Four `Probable’ HPAI H5 Farms Quarantined),  announcing `probable’ infections at four farms, encompassing 2.3 million birds.    A few hours later, they revised that statement to five farms, with the addition of a second farm in Sioux County, involving another 3.8 million birds.

 

While having only a fraction of the number of infected farms as Minnesota (last count =55), Iowa – with nearly 10 million birds affected – has seen the greatest poultry losses to date.

 

The revised press release (FIVE PROBABLE CASES OF HIGHLY PATHOGENIC AVIAN INFLUENZA IN OSCEOLA, O’BRIEN AND SIOUX COUNTIES) adds the following information.

 

Sioux County 2 – Commercial laying operation with an estimated 3.8 million birds that has experienced increased mortality.  Initial testing showed it positive for H5 avian influenza.  Additional confirmatory testing is pending from the APHIS National Veterinary Services Laboratories (NVSL) in Ames.

 

 

According to the Iowa Agriculture’s Avian Influenza site, the 10 million layers affected in the state represent nearly 1/6th of the state’s total layer population.   This outbreak affects more than just infected farms, as many countries have either banned, or placed restrictions on the U.S. Poultry exports.

 

Iowa Poultry Production

• In March 2015, Iowa had 59.5 million egg layer chickens (16% of national stocks) in 3,821 laying facilities
• A typical layer hen weighs between 3–4 pounds, with an average weight 3.6 – 3.7 pounds.
• The laying period begins at 18-20 weeks old and is productive for approximately two years
• The accepted industry value is $1.50 per productive laying hen
• 16.5 billion eggs produced annually (17% of national production)
• In March 2015, Iowa layers produced 1.41 billion eggs – or 0.77 eggs per hen per day
• Raise over 11 million turkeys (9th in US turkey production) in about 200 farm sites

Trade/Export

• At least 30 countries have placed restrictions on U.S. poultry exports:
• Ban on all US poultry products: China, South Korea, South Africa, Thailand
• Limited restrictions on poultry products from individual States: Japan, Mexico, Taiwan
• Limited restrictions to counties in individual States: Canada, Singapore, Hong Kong, and the European Union \

 

For an excellent roundup of yesterday’s avian flu news, I heartily recommend the end-of-day wrap up by Robert Roos and Lisa Schnirring of CIDRAP NEWS , whose report  Avian flu hits more farms in Iowa, Minnesota provides the latest stats, and excellent background information as well.

Reminder: America’s PrepareAthon! On Thursday April 30th

 

# 9986

 

Last week’s devastating M7.8 Earthquake in Nepal, and its many aftershocks, are a grim reminder of just quickly disaster can strike anywhere in the world. 

 

One minute everything is normal, and the next . . .   lives are altered, and normalcy and stability may be months or even years away. 

 

For years the American Red Cross, FEMA, Ready.gov, and just about everyone else in emergency services has urged that individuals and families be prepared to deal for at least 72 hours after a major disaster.

 

The operative words being, `at least’.  Being able to go a week, or even 10 days would be even better (see When 72 hrs Isn’t Enough ), and with good reason

 

The logistics of delivering emergency assistance to millions of people - while hampered by bad weather, crippled communications, damaged infrastructure, and stressed supply chains - all within the first three days of a major disaster, are daunting, and in some cases impossible. 

 

The popularity of Doomsday Preppers on the National Geographic Channel  has a lot of people believing that preparedness is all about getting ready for the perpetually impending apocalyptic collapse of society.  But for the vast majority of us who embrace the preparedness lifestyle - it is the far more common localized disaster that spurs us on:

 

. .. hurricanes, tornadoes, ice storms, blizzards, earthquakes, floods (and yes, even a pandemic)  . . . along with even more limited emergencies like house fires, car accidents, or personal accident and injury.

 

While we can’t pick and choose what emergencies will befall us – we can elect whether or not to be prepared to deal with them –  which is why federal agencies like FEMA and READY.GOV work year-round to encourage Americans to think about their risks, and to prepare for them.

 

To that end, last year FEMA and READY.GOV introduced National PrepareAthon! Day, which is actually part of a two-season campaign for better preparedness.  The spring National PrepareAthon! Day occurs on April 30th, while the fall component comes on September 30th at the close of National Preparedness Month.

 

To learn how you can take part, go to America's PrepareAthon!

About America's PrepareAthon!

America's PrepareAthon! is an opportunity for individuals, organizations, and communities to prepare for specific hazards through drills, group discussions, and exercises.

National PrepareAthon! Day is April 30, 2015 and will revolve around taking the actions to prepare for these six specific hazards:

• Earthquake
• Flood
• Hurricane
• Tornado
• Wildfire
• Winter Storm

Campaign Goals

The goal of this campaign is to increase the number of individuals who:

• Understand which disasters could happen in their community
• Know what to do to be safe and mitigate damage
• Take action to increase their preparedness
• Participate in community resilience planning

What can I do?

• Register to participate in America’s PrepareAthon! and provide details about the activities you’re planning.
• Plan your own local community or organizational preparedness event
• Participate in discussion forums online with like-minded community members
• Learn the actions to take for disaster preparedness and practice them!

Where can I find more information?

• For more information about disasters, preparedness, and ways to get involved in America's PrepareAthon!, click here to access the America's PrepareAthon! Fact Sheet and Frequently Asked Questions.

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As a former paramedic, I can’t stress enough the importance of being prepared to deal with the unexpected, and having the basic resources on hand to get through an emergency. 

 

Ready.gov recommends that first and foremost, you need to Make a Plan, then you can go about Building A Kit.

 

Things like having a good first aid kit at home, and another one in your car.  And just as importantly, learning how to properly use one. Taking a first-aid course, and CPR training, are both investments that could pay off big someday, for you, and for your loved ones. 

 

Having enough stored water for at least 3 days (1 gal/day per person + pets), a reasonable supply of non-perishable food, a NWS Emergency weather radio, a little cash in case the ATMs and Credit Card readers are down, and a safe form of emergency lighting (not candles) are all things every household should have on hand. 

 

And for my money, perhaps most importantly, having – and being – a `disaster buddy’. 

 

In NPM14: In an Emergency, Who Are You Going To Call?, I wrote that a `Disaster Buddy’ is simply someone you have prearranged that you can call on during a crisis, and who in turn, can call on you if they need help.  And the more `disaster buddies’  you have in your personal network, the more options you will have in an emergency.

 

And for more on emergency preparedness, you may wish to revisit some of these earlier blogs.

 

• Spring Forward Into Preparedness
• Appreciating The Nature Of The Threat
• When Evacuation Is The Better Part Of Valor