Korean CDC Epidemiological Update On Unidentified Respiratory Outbreak

 

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Although we still don’t know the cause of the Konkuk University pneumonia outbreak, the Korean CDC has released an impressively detailed epidemiology report on the event today. Over the past couple of weeks, 41 students and/or faculty members have been diagnosed with what has been described as a  `mild pneumonia’ and placed in isolation.

 

All appear to have had direct exposure to the Konkuk University Animal Life Sciences building, and thus far none of their close contacts have come down with the illness.  Numerous tests have been run, but so far no viral, bacterial, or fungal cause has been determined.  

 

The lack of transmission to contacts is a hopeful sign, and may indicate an `environmental’ exposure directly connected to the building.  Some press reports suggest lung biopsies are being tested for signs of mold or fungal infection.  So far, we’ve not seen any results.

 

The Korean CDC is cautiously hopeful that further spread will be limited.

 

It is still early days, but the good news is the Korean CDC isn’t repeating the mistakes of the opening weeks of their MERS outbreak, and is updating us regularly on their progress.

 

 
Department
Infectious Management Division, Epidemiology Research Division

Konkuk University research related respiratory disease occurred in three primary

□ Centers for Disease Control (General Manager Yang byeongguk) is 10.31 il 0 Current total during 44 investigating who the case, is among 41 patients suspected on the chest radiation pneumonitis findings have been confirmed patient - a 7 gae is distributed to institutions that receive quarantine treatment He said .

- Suspected: 10.8 days after Konkuk University Animal Life Sciences building character who visited 37.5 & lt; 0 & gt; C on the chest radiograph with fever cases with suspected pneumonia findings

* Three of the patients seen at home (in the current state of mild symptoms, the symptoms change during chest radiography expected)

○ suspected patients being hospitalized are fever, muscle aches, etc. These mainly mild symptoms may appear, respiratory symptoms are not severe cases, such as showing a relatively rare pneumonia findings.

 

□ Epidemiology apparently 41 All patients who are suspected Konkuk University Animal life in permanent workers within the University building, one myeong * except for 40 people all 4-7 layers and the lab worker, * one of them General Laboratory Professor

 

○ 41 living with people suspected patient 70 from people looking for fever or respiratory symptoms are cases not so far,

- Points not determine if additional cases of close contacts of the disease disseminative or low disease is not transmitted from person this disease one may be suggesting the possibility, not yet completely rule out the possibility of propagation does.

□ clinical symptoms and the progression is relatively lightly, chest X Awards are nonspecific findings and pneumonia appears as a common,

○ some lung CT findings for the phase appeared abnormal lung tissue were collected undergoing inspection.

□ apparently laboratory tests 10.30 conducted by germs and viruses pathogenic to be 16 human samples test results for the species, specific findings were not found.

• Total 4 confirmed Rhino virus in people, but that is popular in the domestic cold is a viral respiratory illness and Konkuk University this one kinds relevance Low

□ In addition , targeting the building entrant 30 caused the symptoms started from one monitor jittering the result was not confirmed until now it has specific cases .

□ Centers for Disease Control are investigating and taking the necessary steps as possible for the attribution and management of respiratory disease caused this,

○ relevant ministries and academics to them ‧ collaboration with medical experts and actively, the progress from time to time planning to inform the public and the media.

Korea Reports Another H5N8 Outbreak

Korea’s Fall outbreaks - Credit Japan’s MAFF 

 

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While things remain quiet on the North American and European avian flu fronts, South Korea finds itself already well into their third H5N8 season, with yet another farm in the Southwestern part of the nation hit with the virus. 

 

This latest outbreak occurs on a duck farm within a 3-km radius of a farm that tested positive more than 10 days ago (see South Korea Records 8th H5N8 Outbreak In A Month).  Thus far this fall, all of Korea’s AI reports have come from South Jeolla Province.

 

First this report from KBS News (translated), then I’ll be back with more:

 

Occur again in the bird flu, South Jeolla Province

Input: 2015-10-31 12:34:09 Modify: 2015-10-31 12:34:09

Strong highly pathogenic avian influenza of toxicity has occurred again in the South Jeolla Province Yeongam (Yon'amu) county of southwest.

When agriculture and forestry depends on the livestock food section, October 18, infection of bird flu has been confirmed in the "H5N8 type" of highly pathogenic in South Jeolla Province Yeongam (Yon'amu) County farm, duck 27 000 birds too, which has been bred was killed was an emergency epidemic prevention in.

But the 27th is also in other farms within a radius of three kilometers of the farm, is that highly pathogenic avian influenza virus has again been detected.

(Continue . . .)

 

Remarkably, just two years ago, HPAI H5N8 was all but unknown, having never caused an outbreak in poultry.  Prior to its emergence in January of 2014 (see  Media Reporting Korean Poultry Outbreak Due To H5N8), H5N8 was normally only seen in a low pathogenic form (although one HPAI H5N8 sample had been previously described in China).

 

By the end of its first year, HPAI not only devastated Korean poultry, it had wreaked havoc in Japan, China, Russia, Europe, Taiwan, and North America poultry as well.

 

H5N8 has spread faster, and farther, than any HPAI virus we’ve seen to date, covering more ground in its first year than H5N1 did in a decade.   Not only does it appear well suited for carriage by a variety of wild and migratory birds, it has also reassorted repeatedly with local LPAI bird flu strains, both in Asia and North America.

As a result, H5N8 not only introduced itself to Taiwan last winter, it created novel versions of H5N2 and H5N3 there as well.   In North America, H5N8 spawned H5N2 and a North American version of H5N1.

 

This winter one of the things we will be watching for – beyond the return, and possible geographic expansion of the virus’s range – are new reassorted subtypes based on this HPAI’s H5 gene.   While far from guaranteed, the continual evolution of HPAI H5 makes this a possibility.

 

While it has been hard to find any good news in all of this, the one bright spot thus far is that none of the HPAI H5 viruses derived from the H5N8 parental gene have shown any signs of being pathogenic in humans. 

The CDC, however, remains cautious and alert for any changes in these viruses, and has issued guidelines for dealing with HPAI H5 Exposure, Human Health Investigations & Response.

 

H5N8 began showing up in Europe, Japan, and North America in November of last year, and in the United States in December.   Outbreaks began to decline as warmer weather returned, and by June had ended completely. 

 

While past performance is never a guarantee of future results, the expectation is that the regions that saw HPAI H5 last fall are at high risk of seeing its return this winter. Perhaps of even greater concern, many areas that have yet to see the virus may very well get their turn this winter.

Stay tuned.

USGS: Preparing The Nation For Severe Space Weather

Credit NASA

 

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In 2012 the earth narrowly missed being hit by a massive solar storm, one that - had it been earth-directed - could have caused extensive damage to our electrical grid and electronic infrastructure (see NASA: The Solar Super Storm Of 2012).   In 1989  an earth-directed storm caused a major power outage in Quebec, and in 2003, power stations in Europe were affected by another solar event

 

Yesterday, there was a significant far-side explosion on the sun that launched a large CME (Coronal Mass Ejection) – fortunately – along a trajectory that will miss the earth.

Credit SOHO 10/29/15 via Spaceweather.com

 

These events happen fairly regularly on our sun, and while we’ve been pretty lucky the past few decades, scientists know that our luck won’t hold forever.  One day we’ll be hit again – as we were in 1859 (see A Carrington Event) – by a massive CME that now, more than ever, has the potential of causing severe disruptions to our world.

 

A CME  is the ejection of a massive amount of plasma (electrons and protons & small quantities of helium, oxygen, and iron) from the the sun that may last for hours. Some of this plasma falls back into the sun, but trillions of tons can escape and if aimed in their direction, impact surrounding planets.

 

A CME may arrive on earth – 93 millions miles distant from the sun – anywhere 12 to 72 hours after it is observed, and spark a Geomagnetic Storm.  The quicker it arrives, the more powerful it is apt to be.  

 

While they pose no direct physical danger to us on the earth’s surface (we are protected by the earths magnetic field and atmosphere), a large CME can wreak havoc with electronics, power generation, and radio communications.

 

While seemingly the stuff of science fiction, the threat is quite real. 

 

In 2009 the National Academy of Sciences produced a 134 page report on the potential damage that another major solar flare could cause in Severe Space Weather Events—Understanding Societal and Economic Impacts. Among their conclusions:

These assessments indicate that severe geomagnetic storms pose the risk for long-term outages to major portions of the North American grid. While a severe storm is a low-probability event, it has the potential for long-duration catastrophic impacts to the power grid and its affected users. The impacts could persist for multiple years with a potential for significant societal impacts and with economic costs that could be measurable in the several trillion dollars per year range.

 

And in 2013 Lloyds issued a risk assessment for the insurance industry called Solar storm Risk to the north American electric grid which calls another `Carrington’ class event inevitable, and the effects likely catastrophic, but the timing is unknowable.  Some of my other blogs on this threat include:

 

The UK’s Space Weather Preparedness Strategy

Solar Storms, CMEs & FEMA

NASA Braces For Solar Disruptions

 

Yesterday the OSTP (Office of Science & Technology Policy) highlighted the risks of space weather, and released enhanced preparedness plans to deal with a direct hit by a major CME, in the following Whitehouse.gov blog. 

 

Enhancing National Preparedness to Space-Weather Events

October 29, 2015 at 2:00 PM ET by Tamara Dickinson and Bill Murtagh

Summary:

Today, OSTP hosted an event and announced new materials and commitments to enhance national space-weather preparedness.

Enhancing Preparedness for Space-Weather Events

Our Nation’s security, economic vitality, and daily functioning depend on the reliable operations of satellites and aircraft, communications networks, navigation systems, and the electric power grid. As these and other, similar technologies and infrastructures become increasingly ubiquitous and interdependent, the United States – and indeed, the world – faces greater risks from the threats posed by space weather events.

(SNIP)

Learn More

• National Space Weather Strategy (pdf)
• Space Weather Action Plan (pdf)
• OSTP Fact Sheet: New Actions to Enhance National Space-Weather Preparedness (pdf)

 

For those looking for an overview, the USGS provides one in yesterday’s news release:

 

The Nation Prepares for Extreme Space Weather

Categories: Featured, Natural Hazards
Posted on October 29, 2015 at 2:17 pm
Last update 2:22 pm By: Jessica Fitzpatrick (jkfitzpatrick@usgs.gov)

Aurora or “northern lights” are the result of magnetic storms. Credit: Getty Images

A severe solar storm could disrupt the nation’s power grid for months, potentially leading to widespread blackouts. Resulting damage and disruption for such an event could cost more than $1 trillion, with a full recovery time taking months to years, according to the National Academy of Sciences.

Today marks a significant advancement towards improving our nation’s preparedness for extreme space weather events. A newly published National Space Weather Strategy identifies high-level priorities and goals for the nation, while an accompanying Action Plan outlines how federal agencies will implement the strategy. These documents were released by the White House’s National Science and Technology Council (NSTC).

USGS scientists provide a unique role in exploring space weather by monitoring activity on the Earth’s surface. This work is critical to protecting our nation as the surface where we live and where most of our modern infrastructure is located. The USGS was also one of the key leaders in developing the newly released strategic and action plans and will play an essential role in achieving the outlined goals.

(Continue . . . )

 

 

Having a response plan is a good first step, but we are a long ways from being ready to deal with this type of threat. Hardening our infrastructure will take years, perhaps decades. 

 

I certainly don’t advocate lying awake at night worrying about solar flares (I certainly don’t!), as it might be decades before we are seriously threatened. But I do believe that we all need to be prepared to deal with a variety of disaster scenarios.

 

The simple truth is, if you are well prepared to deal with an earthquake, pandemic, or a hurricane . . you are automatically in a better position deal with any other disaster, including low probability-high impact events like massive solar storms. 

 

While governments can plan to deal with disasters on a macro level, we all need to become bettered prepared to deal with emergencies on a more immediate and personal level.  For more information on emergency preparedness, some of my  blogs include:

 

When 72 Hours Isn’t Enough

#NatlPrep - The Gift Of Preparedness

In An Emergency, Who Has Your Back?

 

 

 

Korean Respiratory Outbreak Investigation – Day 2

 

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Despite our modern diagnostic technology, the microbial cause of between 30%-50% of all CAP (Community Acquired Pneumonia) cases is never identified.  A few years ago, during an aggressive 12-month study at the Karolinska Institute in Sweden, researchers managed to bump that up to 67% by supplementing traditional diagnostic methods with new PCR-based methods.

All of which means that  pneumonia of unknown origin and `mystery’ diseases’ are hardly unique headlines. We see them often, and when they are finally resolved, they usually turn out to be something fairly benign (see `Mystery Diseases’ In Hard To Verify Places).  

 

There are exceptions, of course. MERS, H5N1, SARS, HIV and H7N9 all were first discovered when doctors were presented with atypical pneumonias of unknown etiology.

 

So when we start seeing large clusters (dozens) of CAP among healthy college-age students – and all are linked to an animal research center -  well,  that does tend to grab our attention. 

 

As it has the Korean CDC’s 

 

Below you’ll find their Day 2 SitRep where they have increased the number of `suspect’ cases from yesterday’s 31 to 45 today.  Of those, 11 are in home quarantine, while 34 are quarantined across 7 hospitals. Their conditions appear to range from mild symptoms to moderate or even severe, although scant details are provided. 

 

For now, despite extensive testing, no microbial cause has been determined.  Serological tests often must wait until 2-4 weeks after the initial infection for antibodies to form,  so one of the `usual suspects’  might still turn up as the culprit here.

 

The syntax of these Korean translations is always a bit murky, but we can get the gist.  If we get a more readable English language report later today, I’ll post it.

 

 

Konkuk respiratory disease occurred on two primary investigation

Added
2015-10-30 [Last Updated: 2015-10-30]
Konkuk respiratory disease occurred on two primary investigation

Centers for Disease Control (General Manager Yang byeongguk) is a respiratory disease associated with Konkuk University and proceeded to the day 10.29 bacteria and viruses pathogens in 16 kinds of human specimens for examination results, but had not found specific findings.

One patient, one of the virus's genetic testing Rhino on the common cold virus was confirmed as positive, the patients do not commonly appear in full and respiratory diseases, and we believe this is irrelevant,

This addition to the serum antibody test (brucellosis, Q fever, Legionella), even in patients without a confirmed positive status, which shall be confirmed through secondary inspection plan (convalescent serology) after three weeks.

Along with the cooperation of bacteria and viruses, as well as environmental and chemical factors animals for research on infectious diseases and toxicology, including experts from various fields to participate in the dynamics Questioned, announced that through a comprehensive review of progress attribution task of respiratory diseases.

Patient Status with the 10.30 days 0:00 are currently investigating a total of 45 cases, of which are distributed in seven hospitals as a chest X Award pneumonia findings identified 34 patients suspected - and getting a quarantine treatment, fever, muscle aches, etc. Light look no symptoms, severe cases of pneumonia are identified 34 suspected cases so far

11 of them are currently staying at the home in addition to this will determine whether or not its doubts whether the patient hospitalized and then underwent chest radiography.

- Suspected: chest X-phase with 10.8 days after the founding of the University of Life Sciences building have visited animal characters and fever of 37.5 ℃ If you suspect pneumonia findings

Management system for the building entrant is

While the animal received from Konkuk University College of Life Sciences was running a liaison personnel and property if there ever voluntarily report based on such symptoms as fever is the entrant list

Starting this afternoon is going to perform a system for monitoring whether an individual symptom one days two times through the Centers for Disease Control call center (109).

However, for 10.25 days SK Group, the public employment examination examinees about 500 people, is a one-time exposure to individuals who guide and Precautions and Adverse symptoms occurred plans to continue operating the system to induce voluntary returns (109 call center).

Konkuk University Animal Life Sciences Building is a state disinfect the inside and completely control the access to preventative measures as the seven-storey building,

The suspected patient survey results at the 5th floor of the lab workers in the field have been confirmed as caused by the dynamics Questioned intensive (16 of 34),

‧ appropriate for that building work entrant laboratory workers, laboratory workers, and is adjacent to other workers, such as floor plans to examine in detail the classification.

Centers for Disease Control are investigating and taking the necessary steps as possible for the attribution and management of respiratory disease caused this,

Actively cooperate with relevant ministries and academic medical specialist ‧ To this end, progress is often plan to inform the public and the media.

WHO MERS Update : Saudi Arabia – Oct 29th

 

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The World Health Organization has published a MERS update listing 12 cases reported by the Saudi MOH between October 17th – October 24th.  Of these, four are members of a household/compound where expat employees live together, and a MERS outbreak has been ongoing for a couple of weeks. 

 

Their exposures are pretty straight forward, although we never learned how the `index’ case in this cluster was exposed.

Two others acquired the virus via nosocomial transmission, one as a HCW caring for a MERS patient and the other simply unlucky to be hospitalized in a facility where MERS is being treated.

 

The remaining 6 are less well defined.  One is noted to raise sheep, and had camel contact prior to falling ill, but the other five appear to fall into that nebulous category of `primary’ cases from the community, without an obvious exposure.

 

Our understanding of community transmission of the MERS virus continues to be hampered by the lack of a well-mounted case-control study out of Saudi Arabia (see  WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps).

 

 

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
29 October 2015

Between 17 and 24 October 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 12 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases

1. A 45-year-old, non-national male from Alkharj city developed symptoms on 13 October and, on 22 October, was admitted to hospital. The patient, who had comorbidities, tested positive for MERS-CoV on 23 October and, on the same day, passed away. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
2. A 60-year-old female from Riyadh city developed symptoms on 13 October and, on 22 October, was admitted to a hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 23 October. Currently, she is in critical condition in ICU. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
3. A 47-year-old, non-national, female health care worker from Riyadh city developed symptoms on 15 October and, on 19 October, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 21 October. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient ‬‬provided care to a laboratory-confirmed MERS-CoV case (see DON published on 22 October – case no. 1). She has no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
4. A 28-year-old, non-national female from Riyadh city developed symptoms on 15 October and, on 16 October, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 21 October. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient lives in a housing compound that has been experiencing a MERS-CoV outbreak. She has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Investigation of possible epidemiological links with previous cases detected in the compound is ongoing.
5. A 75-year-old male from Hofuf city developed symptoms on 20 October, while admitted to hospital due to chronic conditions since 8 October. The patient tested positive for MERS-CoV on 21 October. Currently, he is in critical condition in ICU. The patient was admitted to the same ward as a laboratory-confirmed MERS-CoV case (see below – case no. 10). He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Investigation of possible epidemiological links with the case and with shared health care workers is ongoing.
6. A 52-year-old, non-national female from Riyadh city was identified through contact tracing while asymptomatic. The patient, who has comorbidities, tested positive for MERS-CoV on 21 October and, on the same day, was admitted to hospital. Currently, she is still asymptomatic and in stable condition in a negative pressure isolation room on a ward. The patient lives in a housing compound that has been experiencing a MERS-CoV outbreak; furthermore, she has a history of contact with a MERS-CoV case (see DON published on 22 October – case no. 4). The patient has no history of exposure to other known risk factors in the 14 days prior to being detected.
7. A 37-year-old male from Hofuf city developed symptoms on 8 October and, on 11 October, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 17 October. Currently, he is in critical condition in ICU. The patient owns sheep and has frequent contact with them; furthermore, he has a history of contact with camels in the 14 days prior to the onset of symptoms. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
8. A 29-year-old, non-national female from Riyadh city was identified through contact tracing. She developed symptoms on 15 October and, on 16 October, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 18 October. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient lives in a housing compound that has been experiencing a MERS-CoV outbreak; furthermore, she has a history of contact with a MERS-CoV case (see DON published on 22 October – case no. 4). The patient has no history of exposure to other known risk factors in the 14 days prior to being detected.
9. A 61-year-old female from Riyadh city developed symptoms on 14 October and, on 16 October, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 18 October. Currently, she is in critical condition in ICU. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
10. A 76-year-old male from Hofuf city developed symptoms on 3 October and, on 14 October, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 16 October. Currently, he is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
11. A 65-year-old male from Aldawadmi city developed symptoms on 11 October and, on 16 October, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 17 October. Currently, he is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
12. A 29-year-old, non-national female from Riyadh city was identified through contact tracing. She developed symptoms on 13 October and, on 14 October, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 17 October. Currently, she is in stable condition in a negative pressure isolation room on a ward. The patient lives in a housing compound that has been experiencing a MERS-CoV outbreak; furthermore, she has a history of contact with a MERS-CoV case (see DON published on 22 October – case no. 4). The patient has no history of exposure to other known risk factors in the 14 days prior to being detected.

Contact tracing of household and healthcare contacts is ongoing for these cases.

Globally, since September 2012, WHO has been notified of 1,611 laboratory-confirmed cases of infection with MERS-CoV, including at least 575 related deaths.

Korea Expands Investigation Into Respiratory Outbreak

 

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We are starting to see more media reports in the wake of the announcement today by the Korean CDC that they are investigation 31 pneumonia cases linked to a university animal research center. 

This one, from the Korea Herald, indicates that the CDC is closely monitoring as many as 850 people who may have been exposed, and is urging anyone with ties to the facility and with symptoms to report them to the CDC immediately.

At this time, most common human and zoonotic infection have been tested for, and tentatively ruled out.  Some tests may need to be repeated, however.   For now, the cause remains a mystery.

 

A hat tip to Pathfinder on FluTrackers for posting this link.

 

 

South Korea on alert as 31 hit by mystery illness

Published : 2015-10-29 18:51
Updated : 2015-10-29 19:19

Health authorities stepped up monitoring Thursday on students and faculty at Konkuk University in Seoul after an unconfirmed virus infected a total of 31 people and a school building was shut down.

Ten more were confirmed to be suffering from similar symptoms on the same day, after 21 had shown symptoms of high fever and coughing since last week.

The government said it is closely monitoring over 850 students and lecturers who have been using the College of Animal Bioscience and Technology building in northeastern Seoul, to check if more have been infected.

All the 31 patients are from three laboratories in the university building. Of the patients, 23 were placed in isolation at state-run facilities, while eight others were quarantined at home, with the government still trying to find the cause of the infection.

The university also put up posters around campus asking those who visited the bioscience building from Oct. 8-28 and who are showing suspicious symptoms to report to the Centers for Disease Control and Prevention.

SK Group, which used the building Sunday for a test for job applicants, said it would contact the candidates to notify them of the possible infection. The company refused to reveal the number of people who took the exam in the building.

(Continue . . . )

More On The Korean Respiratory Outbreak

 

 

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I’ve looked around and finally found an English Language report on the unknown respiratory outbreak at Konkuk University I wrote about earlier this morning (see Korean University Research Center: Respiratory Outbreak Of Unknown Etiology).

 

This report is about 12 hours old, and so the case counts are less than today’s report (which is now 31 cases).

 

This from the Chosun Ilbo.

 

Mystery Virus Sweeps Konkuk University

A mysterious virus has infected 21 graduate students at Konkuk University's school of veterinary science in Seoul.

Health authorities have placed all 21 in quarantine and closed off the school building. The Korea Centers for Disease Control and Prevention on Wednesday said the victims started coming down with pneumonia last week, and a team of epidemiologists have been dispatched to the university.

According to the KCDC, those infected are master's and doctoral candidates who used the school's lab from Oct. 19 to 28. They are being treated in isolation at state-run hospitals.

The first four graduate students who showed symptoms were hospitalized at Konkuk University Medical Center and then transferred to the National Medical Center on Wednesday. All of them visited a cattle fair in Gyeonggi Province last week as well as an animal farm owned by the university in Chungju, North Chungcheong Province.

(Continue . . .)

Korean University Research Center: Respiratory Outbreak Of Unknown Etiology

 

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We’ve a bit of a mystery this morning, with a respiratory outbreak reported at Konkuk University, reportedly linked to an animal research lab.  Thirty-one people are currently affected, and are either hospitalized or in home quarantine. 

 

Despite intensive testing for a wide variety of human and zoonotic diseases, no cause has been established.  They’ve apparently ruled out MERS, Influenza, Brucellosis, Q Fever, Legionella,  and a number of fairly common respiratory viruses.

 

Most of the patients appear to have only mild symptoms, but as this has occurred at an animal research facility, getting to the bottom of this is obviously a priority.  The somewhat syntax-challenged translation  from the Korean HHW website follows.

 

Respiratory disease-related research in progress, konkuk University

Posted by 2015-10-29 views 122

Person in charge of the Department of infectious disease management and Jin Kwak

Konkuk University research related to respiratory disease progression occurred in

□ Disease control headquarters (General Manager Yang Byung Kook) Oct. 29 00: currently, konkuk University as a respiratory disease-related causes all 31 people during the investigation of the DOE, which is in contrast to an additional ten cases at 17:00 on the day before the receipt of the said situation.

○ 31 cases of fever and respiratory symptoms, as reported, is currently one of these 23 national treatment and inpatient care on a relatively mild symptoms, is being quarantined at home 8.

□ Field epidemiological investigation of the cause of a respiratory disease, 31, all animal life sciences Pavilion of cases the DOE building as people were working in the last week of the onset of intensively between BOA, the buildings and the associated mass of common factors are believed to occur.

○ To identify the causes of the onset of the patient and building environmental specimen from the headquarters of the bacterial disease control take ‧ virus testing, and currently does not make this an unusual feature,

* Major test results

: Genetic testing conducted with respect to the cause and the serum antibody test for some patients was confirmed by negative

‧ PCR-negative infectious diseases tests

- Respiratory bacteria: Mycoplasma, Chlamydia, whooping cough, diphtheria
- Respiratory viruses: Merck's, adenovirus, RS virus, parainfluenza virus, virus meth pneumophila, Boca virus, influenza virus, corona virus

‧ PCR negative antibody test in progress or infectious diseases
- Brucellosis, Q fever, Legionella (3 weeks after retesting with convalescent serum)

* The possibility to end the cause of the infection, called the voices excluded, depending on the symptoms, such as retesting is also available

○ The collective generation of infectious pathogens, as well as environmental factors and related chemicals from various angles, including the possibility of an investigation.

□ Meanwhile, konkuk University/College closed for animal Sciences University building measures 28-sustainable, and last October 8-28 of its buildings to access if you have a fever a disease management Division to report to the call center (109) Guide.

○ In the SK Group building, 10.25, public employment has been a test, SK Group has nearly 500 for causing the symptoms of disease control headquarters over to the call center (109) to use to quickly launched a separate Bulletin.

□ Moreover, disease control headquarters levels and respiratory symptoms in the patient care medical institutions: ensure that the life sciences University, konkuk University School of animal power ever for physicians and Hospital Association cooperate with the request.

 

I’ll update when we know more.

Korean Government Delays Declaring End To MERS Outbreak

 

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Had things gone according to plan, today is the day the Korean government had hoped to officially end their 5+ month-long MERS outbreak.  The last (of 186) MERS positive cases had tested negative, and was released from the hospital during the first week of October, setting the `28-days till clear’ clock running.

Things went sideways on October 11th, when that last patient developed a fever, was re-hospitalized, and tested positive for the virus once more (see Korean Govt. Statement On MERS Patient `Relapse’ and Isolation) 

Authorities quarantined 190 close contacts of the patient (they were released on Monday), and the `clock’ was set back to zero.  While no additional transmission of the virus has been reported in Korea since early July - until this last patient tests negative again - that’s where it will probably stay.

This from KBS news.

 

 

Gov't Puts off Declaring End to MERS Outbreak

Write : 2015-10-29 13:53:23 Update : 2015-10-29 20:02:10

Health authorities have decided to delay declaring an official end to the outbreak of Middle East Respiratory Syndrome (MERS), which was initially set to be issued on Thursday.

The Ministry of Health and Welfare said Thursday that it reached the decision in order to exercise more caution, noting that a 35-year-old patient who was thought to be the last patient to recover from MERS continues to test positive.

(Continue . . . )

Saudi MOH: Another HCW Infected With MERS In Hofuf

#10,671

 

Hofuf – which saw a large hospital acquired MERS outbreak earlier this year (April-July) – reported two `primary’ (community acquired, unknown origin) MERS cases about two weeks ago, and over the past 10 days has reported five hospital acquired cases (4 patients, 1 nurse) as well.

 

Today’s case adds yet another HCW, reportedly a 28 y.o. female expat in critical condition. 

 

Although we rarely get an explanation from the MOH, it isn’t unusual to see cases announced that are already well advanced into their illness, sometimes even reported posthumously.

 

Whether this speaks to the effectiveness of their surveillance and testing, or to the timeliness of their public reporting of cases, isn’t clear.

 

The MOH also announces a death of a 78. y.o. male in Hofuf, whose age doesn’t exactly match any of the recently announced cases.  We saw a 75 y.o. hospital patient announced on October 22nd, and a 76  y.o. `primary’ case from October 18th, but we’ll have to wait for a WHO report to figure exactly which patient this is.

JID: Statins & Flu Vaccine Effectiveness

Photo Credit - CDC PHIL

 

#10,670

 

One of the challenges with the flu vaccine is that it is generally less effective for those over the age of 65, which also happens to be the the age cohort at greatest risk from influenza.  Several reasons are believed behind this, but prime among them is the fact that our immune responses simply become less robust as we age.

 

But other factors – including medicines they may be taking – may also affect vaccine effectiveness (VE).

 

A number of years ago, in A Few Inflammatory Remarks, we looked at several studies that suggested that taking antipyretic medications – like acetaminophen, Aspirin, or other NSAIDs – could reduce the effectiveness of some vaccinations or blunt the level of acquired immunity from actual infection.

 

Recently, in Study Suggests Low Dose Aspirin Doesn’t Reduce Flu Vaccine Immune Response, we looked at a study which seems to exonerate LD aspirin – often taken daily to prevent heart attacks and strokes – as reducing flu vaccine effectiveness. 

 

This study only looked at low-dose aspirin use, and therefore cannot be automatically assumed to apply to other NSAIDs or antipyretics, or larger doses of aspirin.

 

But statins are another widely prescribed (40% of those > 65) class of prescription drug with proven anti-inflammatory and immunomodulatory effects, both of which could plausibly impact vaccine effectiveness.  Previously, and for the very same reasons, we’ve seen statins suggested as a possible treatment for pneumonia, pandemic influenza, and even MERS.

 

While the theory behind the use of statins to treat these, and other inflammatory response producing illnesses, is reasonable – results from very limited real-world studies have thus far been mixed.

 

Overnight the Journal of Infectious Diseases released two studies, and a commentary, on the possible effect of statins on flu vaccine effectiveness.  I say `possible’, because these are preliminary studies, will require further research to confirm, and are by no means the final word on the subject.  

 

First some excerpts from the press release by the IDSA.

 

Studies raise questions about impact of statins on flu vaccination in seniors

Findings suggest statin use may hinder immune response, vaccine effectiveness

Infectious Diseases Society of America

A new pair of studies suggests that statins, drugs widely used to reduce cholesterol, may have a detrimental effect on the immune response to influenza vaccine and the vaccine's effectiveness at preventing serious illness in older adults. Published in The Journal of Infectious Diseases, the findings, if confirmed by additional research, may have implications for flu vaccine recommendations, guidelines for statin use around the time of vaccination, and future vaccine clinical trials in seniors.

In one of the new studies, researchers analyzed immune response data from an earlier flu vaccine clinical trial conducted during the 2009-2010 and 2010-2011 flu seasons. In the new study, funded by Novartis Vaccines, which also sponsored the original clinical trial, investigators focused on the potential effect of statin use on patients' initial immune responses after being immunized against flu. The analysis drew on data for nearly 7,000 adults over the age 65 in four countries, including the United States.

Statin users had a significantly reduced immune response to vaccination compared to those not taking statins, as measured by the level of antibodies to the flu vaccine strains in patients' blood three weeks after being vaccinated, the researchers observed. The effect was most dramatic in patients on synthetic statins, rather than naturally derived statins.

(SNIP)

The results from both new studies are biologically plausible and raise important questions, but the findings should not yet affect how physicians care for their patients, according to a related editorial commentary by Robert L. Atmar, MD, and Wendy A. Keitel, MD, of Baylor College of Medicine in Houston.

"Instead, the results of these studies should be viewed as hypothesis-generating and should prompt further investigations into whether statins reduce inactivated influenza vaccine immunogenicity and, if so, the mechanisms by which immune responses and associated vaccine effectiveness are adversely affected," the commentary authors wrote. The commentary accompanies the two studies in The Journal of Infectious Diseases.

Fast Facts

• Statins are used by more than 40 percent of the U.S. population over the age of 65, according to the Centers of Disease Control and Prevention.
• In one study of flu vaccine recipients older than 65, statin users had a significantly reduced immune response to flu vaccination, compared to those not taking statins.
• In another study, vaccine effectiveness at preventing serious respiratory illness was lower among patients taking statins compared to patients who were not on statins.
• Additional research is needed to confirm the findings from both studies before potential changes in clinical practice are warranted.

 

The three articles may be accessed at:

 

Influence of Statins on Influenza Vaccine Response in Elderly Individuals

http://jid.oxfordjournals.org/content/early/2015/10/15/infdis.jiv456.full

Impact of Statins on Influenza Vaccine Effectiveness Against Medically Attended Acute Respiratory Illness

http://jid.oxfordjournals.org/content/early/2015/10/15/infdis.jiv457.full

Influenza Vaccination of Patients Receiving Statins: Where Do We Go From Here?

http://jid.oxfordjournals.org/content/early/2015/10/15/infdis.jiv459.full

 

The authors advise - If confirmed - these findings could support the preferential use of high-dose flu vaccine or vaccines containing adjuvants to boost immune response in the elderly.

For those over 65 taking statins, there is a High-Dose flu vaccine option currently available  that contains 4 times the normal amount of antigen; 60 µg of each of the three recommended strains, instead of the normal  15 µg (see MMWR On High Dose Flu Vaccine For Seniors).

 

While ACIP and the CDC have not expressed a preference for using a high-dose vaccine in those > 65, in their Fluzone High-Dose Seasonal Influenza Vaccine Q&A they write;

 

Does the higher dose vaccine produce a better immune response in adults 65 years and older?

Data from clinical trials comparing Fluzone to Fluzone High-Dose among persons aged 65 years or older indicate that a stronger immune response (i.e., higher antibody levels) occurs after vaccination with Fluzone High-Dose. Whether or not the improved immune response leads to greater protection has been the topic on ongoing research. A study published in the New England Journal of Medicine indicated that the high-dose vaccine was 24.2% more effective in preventing flu in adults 65 years of age and older relative to a standard-dose vaccine. The confidence interval for this result was 9.7% to 36.5%).

 

Additionally, work continues on improving overall vaccine effectiveness, including research on adjuvants – not currently approved in the United States but widely used in Europe – to boost the immune response.

The Blue Ribbon Study Panel Report on Biodefense

#10,669

 

Of the myriad large-scale disaster scenarios out there, the two I take most seriously are a highly pathogenic biological threat (either natural or manmade), and a massive grid-down scenario (again . . . either natural or manmade). 

 

Both have the potential to affect whole nations, if not the entire world, and both are very difficult to adequately plan for.

Last July, in The Lloyd’s Business Blackout Scenario, we looked at the impact of a prolonged grid down disaster caused by solar flares, EMP, or cyber-attack.   All three are plausible, and as we saw in the GridEx 2013 Preparedness Drill, our government is actively looking at ways to mitigate the risks.

 

I would note that this week long time journalist Ted Koppel has released a book called Lights Out: A Cyberattack, A Nation Unprepared, Surviving the Aftermath, that explores this very plausible scenario.  One that outgoing DHS Secretary Napolitano warned about publicly in 2013. 

 

Today, we have the 84 page Bipartisan Report of The Blue Ribbon Study Panel On Biodefense that looks at our nation’s vulnerability to the the`other’  big threat;  a biological attack, an accidental release, or naturally occurring pandemic with a highly pathogenic biological agent.

Maggie Fox of NBC News has a nice summary, after which I’ll return with links to the report and more.

 

The Biothreat Is Real — And We're Not Ready, Report Says

by Maggie Fox

It's a scary scenario: A genetically engineered Nipah virus is sprayed into the air during a July 4th celebration in Washington, D.C., and across the country, killing more than 6,000 people.

A badly prepared United States does almost nothing at first, and people die as officials scramble to get a grip on what happened.

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You’ll find the 2-page Executive Summary available HERE.

While the full 84-page report can be downloaded HERE, which lays out 33 recommendations for the U.S. government to improve their biothreat preparedness.

Nature News also has coverage of this report in:

 

US panel proposes executive biodefence office

Centralized approach promoted to streamline response and reduce overlap between government agencies.

Sara Reardon

A focus on weapons such as bombs and nuclear missiles has left the US government ill-prepared to deal with bioterror attacks and even natural threats such as Ebola, according to a group of former government officials.

In a report released on 28 October, the Blue Ribbon Study Panel on Biodefense panel lays out 33 recommendations for the US government to improve its biosecurity policy. Chief among them are the creation of a centralized biosecurity office and a greater emphasis on detecting biological threats through intelligence gathering and surveillance.

(Continue . . . .)

 

While an `intentional release’ of a bio-engineered pathogen might sound the stuff of fiction, the tools and knowledge required to create enhanced or synthetic life forms becomes more affordable and accessible every year.   What once might only have been possible in a multi-million dollar lab can now be done on a limited budget in a basement somewhere.

But even if you discount a deliberate attack, we’ve seen a rash of  lab accidents involving  `select agents’ – like Anthrax, Ebola, H5N1, and even Smallpox – over the past couple of years, many involving government labs. How many others that have gone unreported is unknown.  

 

While none have escaped the confines of the lab, the threat of an accidental release is quite real.

 

And of course nature’s laboratory is open 24/7 as well, experimenting,  evolving, and constantly coming up with new and challenging biological threats.   We’ve seen an explosion in novel viruses over the past 3 years, and it is likely just a matter of time before one of them is ready for prime time.

 

All of which makes a consolidated and comprehensive bio-defense policy badly needed and long overdue.

Egypt Forms Bird Flu Committee & The MOH H5N1 Plan

 

# 10,668

 

Just shy of a year ago Egypt began reporting on what would turn out to be the largest human H5N1 outbreak on record, one that over the ensuing six months would result in 160+ infections, and 51 deaths (see EID Dispatch: Increased Number Of Human H5N1 Infection – Egypt, 2014-15).  

 

At first the MOH was quite open about the size and severity of the outbreak, but stopped issuing daily reports in late January (see Revisiting Egypt’s Murky H5N1 Battle). 

In May, after the outbreak had wound down, we saw the WHO Statement On Joint H5N1 Mission To Egypt,  with specific recommendations for addressing the crisis.

The 7-page executive summary, warns:

` . . .  the presence of H5N1 viruses in Egypt with the ability to jump more readily from birds to humans than viruses in other enzootic countries is of concern and requires a high level of vigilance from the Ministries of Health and Agriculture.’

 

This unprecedented H5N1 outbreak in Egypt, along with the sudden proliferation of several other HPAI H5 reassortant viruses around the globe (H5N6, H5N8, H5N2, H5N3, etc.) no doubt influenced last February’s announcement WHO: H5 Currently The Most Obvious Avian Flu Threat.   

With the approach of cooler weather, we are beginning to see Egypt’s Ministries of Health and Agriculture publically prepare for another round of bird flu.  Last week we saw the deployment of thousands of doses of Tamiflu ® to local hospitals (see Egypt Readies For The Return Of H5N1).

 

Today local Arabic media are reporting on the the formation of a special bird flu committee, and on the MOH’s plan to combat the return of H5N1.  The following are machine translations.

 

Health»: the formation of a committee comprising the ministries of environment, agriculture and local development to combat bird flu

The Ministry of Health and Population announced for San Dr Mohammed Geneidi, chairman of the Central Administration of Preventive Medicine has been the formation of a committee comprising the ministries of local development, agriculture, the environment and the Radio and Television Union and the queries next to the Ministry of Health to implement counter bird flu plan.

He explained, "Geneidi" in a statement to "Echo of the country" that the role of the Ministry of Agriculture of the Commission is in the application of bio-safety standards and monitor the implementation of infection control during disposal of the birds in the affected areas, in addition to putting in place to deal with the epicenter of the positive incidence of poultry for the disease and will be plans implemented in these outposts surrounding areas.

He explained that the role of the Ministry of State for Environmental Affairs of the Commission is the development and implementation of safe disposal of dead birds plan, pointing out that the role of the Ministry of State for Local Development is to develop and implement a plan at all levels for safe disposal of dead birds as well as coordination with the Ministry of Agriculture to control the disease and work to prevent its spread from infected regions to another.

He stressed, "Geneidi" The role of the (Radio and Television Union - SIS) and various media is to raise the awareness of citizens in the bird flu and how to prevent it

 

 

 

With the onset of winter. We publish the Health Ministry plan to counter bird flu

Mahmoud Nofal

Wednesday 28.10.2015-06:54 am

The Ministry of health and population has announced it has implemented a series of measures, including the revitalization of surveillance for influenza and pneumonia in all hospitals of the Republic daily to assess the epidemiological situation and follow up continuously for viruses.

As well as the follow-up to the global situation and the recommendations of the World Health Organization in this respect, as well as genetic mutation at the global and regional levels, and follow-up of contacts for positive foci show injury in bird training and print case definition.

The remarks, reported by media that drug Tamiflu used to treat bird flu and necessary to deal with the disease in all hospitals in large quantities, with the support of the central laboratories of the Ministry and regional laboratories for screening influenza viruses, balkwashf supplies needed to examine cases.

She said the Ministry has trained its personnel on how to drag and save and transfer the necessary samples, as well as sharing samples with who reference laboratories and national research center of the Ministry of scientific research.

She noted that the plan also included the need to immediately report to veterinary medicine for all cases in humans in the case of suspicion, in the framework of coordination between the Ministry of health and Ministry of agriculture to address bird flu.

 

For the better part of two decades the H5N1 virus has been on the `verge’ of sparking a pandemic, beginning with its first outbreak in Hong Kong in 1997.  Skeptics point out that if it hasn’t happened after 18 years, it probably won’t.

But the H5N1 viruses in circulation today are a far cry from the ones that first plagued Hong Kong, or re-emerged in Southeast Asia in 2003. They have evolved from a single clade (0), to literally dozens of clades . . . with new clades, and variants, forming all the time. 

(click to load larger image)  (Note: Chart only goes through 2011, and not all clades continue to circulate)

Last winter’s exceptional Egyptian H5N1 outbreak has tentatively been linked to changes in the virus which began to show up in the summer of 2014 (see Eurosurveillance: Emergence Of A Novel Cluster of H5N1 Clade 2.2.1.2),  another indication that H5N1 is truly a moving target.

 

The future threat from H5N1 is far from certain, for while the virus continues to change, not all changes will drive it towards human adaptation.  

 

But in recent years H5N1 has been joined by a new generation of novel flu subtypes -  H5N6, H5N8, H5N2, H5N3, H7N9, H10N8 – all of which continue to evolve and diversify. We seem to be facing a growing number of threats every year. 

 

As the WHO stated last February in Warning signals from the volatile world of influenza viruses:

 

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.

Saudi MOH Statement On Hofuf MERS Cluster

Saudi MOH – No New MERS Cases Today

 

 

#10,667

 

We’ve been following a  MERS outbreak in Hofuf, Al-Ahsa region, for about two weeks and as of yesterday we had noted 7 cases; two primary and 5 nosocomial (see Saudi MOH Announces 4 MERS Cases (Riyadh & Hofuf)). 

 

This is one of two hospital outbreaks ongoing in Saudi Arabia (the other being in Riyadh), and the second major outbreak in Hofuf this year. Between April and July Hofuf reported 40+ cases, most being hospital acquired (see June 15th EMRO MERS report).

 

While the MOH is reporting no new cases today, overnight they posted a statement on the Hofuf/Al-Ahsa cluster. What follows is a machine translation from the Arabic.

 

Health announces limited cases coronavirus in almana General Hospital in Al-Ahsa

15 Muharram 1437

The Health Ministry said that in the framework of epidemiological investigation and under continuous monitoring of coronavirus in Saudi Arabia.

The Ministry would like to announce the registration of a limited number of cases of corona virus in almana General Hospital auth seven cases. So began the initial state of emergency then infection in two sections put patients. It logged 5 additional cases as a result of infection in the hospital and one other preliminary is not linked to any of the cases. One of the cases was that of a nurse.

The Ministry immediately apply many precautionary measures followed in these cases, all cases were transferred to the King Fahad hospital-alhafoof, stop the entry of scheduled cases simply enter critical cases only with the full implementation of infection control requirements. As well as an inventory of all contacts either at home or health practitioners also includes discharged from hospital since the first case. It was also examining all close contacts of patients and health practitioners, and inform all hospitals in Al-Ahsa and outbreak preparedness.

 

Among the things we don’t learn from this statement are the source(s) of community exposure that started this cluster, and the events that led to the transmission of the virus to 4 patients and 1 nurse inside the hospital.

 

When South Korea was blindsided by their first imported MERS case last May, they failed to identify and isolate the index case, and as a result  saw a massive multi-facility outbreak (n=186 cases).

 

Yet, through aggressive quarantine and infection control policies, they managed to halt the transmission relatively quickly.  While they have continued to treat PCR positive patients, they’ve not seen the transmission of the virus in roughly 4 months.

Many other hospitals around the world have managed to isolate and treat MERS cases without secondary transmission (see Eurosurveillance: Estimating The Odds Of Secondary/Tertiary Cases From An Imported MERS Case). 

Credit Eurosurveillance

As the chart above illustrates, out of 23 MERS importations around the world through July 1st, 2015, 19 managed to isolate and treat cases without seeing secondary/nosocomial cases.  

 

Exactly why – after three years of dealing with the virus -  Saudi (and other Middle Eastern) hospitals continue to struggle so with containment remains a mystery.

Australia: Wild Bird Avian Influenza Surveillance

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If one needs evidence that the avian influenza situation is far from static, up until 11 months ago North America had never reported HPAI viruses in wild or migratory birds.  Low Path (LPAI) viruses are quite common, but they haven’t often posed a big threat to the domestic poultry industry and are fairly easily controlled.

 

The introduction of HPAI H5 from Asia via migratory birds has always been thought possible, of course. But after more than a decade of testing and surveillance -and no positive results – many believed we were adequately protected by the oceans on either side of us.

That is, until it happened.  Now, all bets are off and we await the return of HPAI this winter.

Similarly, Australia has been viewed as being sufficiently separated by water from the rest of the world to largely protect it from HPAI via infected migratory birds. Not a 100% guarantee, of course, but reassuring.

 

According to Australia’s Department of Agriculture (formerly DAFF), the odds of seeing HPAI arrive by migratory birds are `remote’.

 

Avian Influenza or Bird Flu

The Key Facts (excerpts)

• Avian influenza and human pandemic influenza are different diseases.
• Avian influenza in birds does not easily cause disease in humans. There have been numerous deaths from H5N1 avian influenza in the world since the virus first emerged in 2003.
• In 2013 a H7N9 strain of avian influenza in poultry emerged which caused human deaths in China.
• There is only the most remote possibility of a human pandemic influenza developing in Australia as a result of migratory birds carrying avian influenza virus to Australia. If a human pandemic influenza develops as a result of mutation of an avian influenza virus, it will most likely occur somewhere else in the world and any spread to Australia would be from international travellers.
• Surveillance continues to show H5N1 avian influenza virus is not present in Australia. Waterfowl, which are the normal hosts of avian influenza and are thought to have had a role in the spread of the H5N1 virus in Europe, Asia and Africa do not migrate to Australia. A number of species of wading birds do migrate to Australia but they are not the normal hosts or spreaders of avian influenza. Australia’s strict quarantine measures prevent the disease coming into Australia through imported birds or poultry products.
• There is little risk of people in Australia being affected by avian influenza through normal contact with birds. As always, practice good personal hygiene when handling birds.

 

The speed with which H5N8 has spread from South Korea, to Japan, Taiwan, across China, and into both Europe and North America has understandably heightened concerns.  It has spread farther in its first year than H5N1 did in its first decade, and there’s a rogues gallery of other emerging bird flu viruses making inroads in China (H7N9, H5N6, H10N8, etc).

But even if imported migratory birds prove unable to bring these viruses to Australia, the land down under may well have the building blocks – in the form of indigenous LPAI H5 and H7 viruses – to evolve their own.

First this abstract, which appears in the Australian Veterinary Journal, after which I’ll have a bit more.

 

Avian influenza in Australia: a summary of 5 years of wild bird surveillance

VL Grillo^1,*, KE Arzey², PM Hansbro³, AC Hurt⁴, S Warner⁵, J Bergfeld⁶, GW Burgess⁷, B Cookson⁸, CJ Dickason⁹, M Ferenczi¹⁰, T Hollingsworth¹¹, MDA Hoque⁷, RB Jackson¹², M Klaassen¹⁰, PD Kirkland², NY Kung¹³, S Lisovski¹⁰, MA O'Dea¹⁴, K O'Riley⁵, D Roshier¹⁰, LF Skerratt⁷, JP Tracey¹⁵, X Wang⁵, R Woods¹ and L Post¹⁶

Article first published online: 26 OCT 2015

DOI: 10.1111/avj.12379

© 2015 Australian Veterinary Association

Volume 93, Issue 11, pages 387–393, November 2015

Background

Avian influenza viruses (AIVs) are found worldwide in numerous bird species, causing significant disease in gallinaceous poultry and occasionally other species. Surveillance of wild bird reservoirs provides an opportunity to add to the understanding of the epidemiology of AIVs.

Methods

This study examined key findings from the National Avian Influenza Wild Bird Surveillance Program over a 5-year period (July 2007–June 2012), the main source of information on AIVs circulating in Australia.

Results

The overall proportion of birds that tested positive for influenza A via PCR was 1.9 ± 0.1%, with evidence of widespread exposure of Australian wild birds to most low pathogenic avian influenza (LPAI) subtypes (H1–13, H16). LPAI H5 subtypes were found to be dominant and widespread during this 5-year period.

Conclusion

Given Australia's isolation, both geographically and ecologically, it is important for Australia not to assume that the epidemiology of AIV from other geographic regions applies here. Despite all previous highly pathogenic avian influenza outbreaks in Australian poultry being attributed to H7 subtypes, widespread detection of H5 subtypes in wild birds may represent an ongoing risk to the Australian poultry industry.

 

One should note the wild bird surveillance used by this took place between 2007 and 2012 – before the emergence (and/or spread) of H7N9, H5N6, H5N8, or H10N8.  

 

As we’ve discussed before, LPAI (low path) H5 and H7 viruses can – if introduced into the right conditions – mutate into HPAI viruses.   While fairly rare, we saw this happen in Lancashire, England earlier this year (see UK APHA: Epi Report On HPAI H7N7 Outbreak In Lancashire), and this has been observed a number of other occasions as well.  

 

This is the reason why LPAI H5 and H7 viruses are considered `reportable’ to the OIE, and efforts are made to stamp them out whenever they occur in poultry.

 

In addition to the H5’s and H7’s, three years ago in EID Journal: Human Infection With H10N7 Avian Influenza, we learned that the H10N7 avian flu virus had been detected in two poultry abattoir workers in Australia from 2010. Although 7 abattoir workers reported symptoms, only 2 tested positive for the H10 virus.

As further evidence of the diversity of LPAI viruses in Australia, the Queensland Department of Agriculture and Fisheries lists the following non-H5/H7 LPAI detections across the country.

 

The following LPAI (not H5/H7) detections have been made:

• Antibodies to LPAI H1, H4, H5, H7 and H9 subtypes were detected in ducks on a farm in Victoria in 1992.
• LPAI (H4N8) was detected on a multi-age, commercial duck farm in Victoria in 1994.
• LPAI (H6N4) was isolated from a single duck on a property in Queensland in 2006.
• Chickens in several sheds from a property in New South Wales tested seropositive to LPAI (H6N4) in 2006.
• LPAI H10N7 was detected in 2010 in a chicken farm in New South Wales, where transmission to abattoir workers during the processing of the poultry was documented.
• An LPNAI H5N3 virus was detected in a free-range duck flock in Victoria during routine surveillance in 2012. The source of the virus could not been determined, but it is speculated that the primary source may have been wild birds, since wild birds were freely able to access the range area.
• In April 2012, LPAI H9N2 was confirmed on a turkey farm housing about 26,500 turkeys in three sheds near the Hunter Valley in New South Wales; the source of the infection is unknown.
• In 2012, LPAI H4N6 virus was found in ducks of several age groups on a multi-age farm of 2,400 ducks located on the north coast of New South Wales.
• In 2012, an LPAI H10N7 virus was detected in a Queensland poultry flock; the source of the infection is unknown, but it is likely that the primary source may have been wild birds.

 

The 2012 discovery of LPAI H9N2 is particularly interesting, as this same subtype has been linked to the evolution of nearly all of China’s HPAI viruses over the past two decades (H5N1, H5N6, H7N9, etc.).  Whether Australia’s H9N2 virus has the `right stuff’  (mostly internal genes) to do the same is unknown.

Today’s report warns `Given Australia's isolation, both geographically and ecologically, it is important for Australia not to assume that the epidemiology of AIV from other geographic regions applies here.’

Having once seen a platypus, I have to agree that is probably good advice.