Jiangxi Province Reports H7N9 Case

Credit Wikipedia

#12,070


Jiangxi Province has never exactly been a hotbed of H7N9 cases, accounting for less than 2% (n=14) of all of the 815 known cases in China. Last year, they reported only 3 infections.

Today, in a brief announcement from the Jiangxi Health & Family Planning Commission, we learn of their first case of this winter.

Jiangxi confirmed a case of H7N9 cases

Published: 2016-12-31

Jiangxi Provincial Health and Family Planning Commission reported on December 31, Jiangxi confirmed cases of H7N9 cases. At present, the patient in critical condition, is a hospital in Nanchang.

Patients Wang, male, 53 years old, live in Jingdezhen City. December 30, Jiangxi Provincial Center for Disease Control and Prevention of Jingdezhen City, sent to the patient samples were identified as H7N9 virus nucleic acid positive. Provincial Health and Family Planning Committee of experts based on clinical manifestations of patients, laboratory testing and epidemiological survey results, the diagnosis of patients with H7N9 cases.

While the number of H7N9 cases has been on the uptick in the past few weeks, case reports remain widely scattered, infections appear sporadic, and primarily associated with contact with infected birds - usually poultry.

We are entering the 5th winter epidemic of H7N9, and while the virus continues to evolve, and its behavior has changed slightly (see MMWR: Assessing The 4th Epidemic Wave Of H7N9 In China), we haven't seen any evidence of sustained or efficient human-to-human transmission of the virus. 

The caveat being we are likely only seeing the `sickest of the sick' being identified by Chinese surveillance, and the number of confirmed cases is likely a significant undercount of the true burden of the disease.

The MMWR report referenced above noted:

There is no evidence of increased transmissibility of A(H7N9) virus from poultry or environmental exposures to humans in China or sustained human-to-human transmission; however, using the Influenza Risk Assessment Tool (10), CDC found that A(H7N9) virus has the highest potential pandemic risk of any novel influenza A viruses that have been assessed. 

So we watch the events in China very closely.

 

Korean Media Reporting H5N6 Confirmed In Cat Deaths

#12,069


Yesterday, in Korea MAFRA: Avian Flu Suspected In Cat Deaths,
we looked the official report of 4 cats found dead this week in Pocheon, Gyeonggi Province. Testing was reportedly underway for the exact cause, although a preliminary test had indicated influenza.

Since it is both Saturday, and New Year's Eve in Korea, it is not terribly surprising that neither the MAFRA nor the Korean CDC website have posted the results.

What we do have are several media reports indicating the tests have come back positive for HPAI H5N6.  While not unexpected, this is the first detection of HPAI jumping to a Korean mammal since several dogs tested positive for H5N8 antibodies in 2014 and early 2015. 

First excerpts from an English Language report from Yonhap News, after which I'll be back with more. 

Highly pathogenic strain of bird flu found in cats

2016/12/31 00:07

POCHEON, South Korea, Dec. 31 (Yonhap) -- A highly pathogenic strain of bird flu was discovered in two dead cats on Saturday, a provincial government official said, marking the first infection of the virus found in mammals in two years.

The H5N6 strain of avian influenza (AI) which has infected chickens across the country was found in the bodies of the cats in Pocheon, some 46 kilometers north of Seoul, the official said, citing information from health authorities.

(SNIP)

Health authorities said that they are looking at samples to verify whether they were infected with a more highly pathogenic strain of AI.

"Even if it is the same N6 strain, there are some differences in gene structure," the official said. "We are awaiting test results."

(Continue . . . )

While only rarely reported, we've seen cats infected by HPAI H5 viruses before, most famously affecting (and sadly, killing) rare tigers and leopards which were accidentally fed infected chicken in South East Asian Zoos early in the last decade. 

The following comes from a World Health Organization GAR report from 2006.

H5N1 avian influenza in domestic cats

28 February 2006
(EXCERPTS)

Several published studies have demonstrated H5N1 infection in large cats kept in captivity. In December 2003, two tigers and two leopards, fed on fresh chicken carcasses, died unexpectedly at a zoo in Thailand. Subsequent investigation identified H5N1 in tissue samples.

In February 2004, the virus was detected in a clouded leopard that died at a zoo near Bangkok. A white tiger died from infection with the virus at the same zoo in March 2004.

In October 2004, captive tigers fed on fresh chicken carcasses began dying in large numbers at a zoo in Thailand. Altogether 147 tigers out of 441 died of infection or were euthanized. Subsequent investigation determined that at least some tiger-to-tiger transmission of the virus occurred.

In 2006, Dr. C.A. Nidom demonstrated that of 500 cats he tested in and around Jakarta, 20% had antibodies for the bird flu virus,
while in 2012 we saw Israel: Cats Infected With H5N1, and just last May, in Fatal H5N1 Infection In Tigers By Different Reassortant Viruses - China we looked at a series of large cat infections over 2014-2015. 

There are other examples, but suffice to say the infection of cats by HPAI H5N6 isn't unprecedented.  It is, however, concerning. 

Bird flu viruses are primarily adapted to avian physiology, and (so far) have only demonstrated a limited ability to infect, and be transmitted between, mammals.   

Avian viruses bind preferentially to the kind of receptor cells commonly found in the digestive and respiratory tracts of birds; alpha 2,3 receptor cells, and replicate most efficiently at the higher temperatures found in that species.

When avian flu viruses do manage to jump to mammals - whether that be cats, dogs, rodents, or humans - it gives the virus another opportunity to adapt to a mammalian host; to bind to alpha 2,6 receptor cells, found in the respiratory system, and to replicate at lower temperatures.


The virus has had numerous opportunities to do this in the past, and it hasn't succeeded, so some hope there may be some genetic `species barrier' preventing it from ever happening.

While a comforting thought, few scientists put a lot of faith in that idea. 

It may just be that the right roll of the genetic dice, in the right host - which happens to be in the right place to spread the mutated virus in a sustained fashion - just hasn't happened, yet.

Regardless of whether HPAI H5N6 (or any of its AI cousins) ever adapts to humans, its presence in small peridomestic (and domestic) animals - like cats, dogs, mice, voles, and other small mammals - may be helping it spread from farm to farm.

• In 2015, in Taking HPAI To The Bank (Vole) we looked at the susceptibility of the European bank vole to both H5 and H7 avian viruses, and concerns they may be getting past farm bio-security measures.
• Also in 2015, we looked at the expanded host range that is susceptible to infection with H5N6 in H5N6 Rising: Infecting Birds, Humans, & Even Cats.
• While just last May, in Report: Skunks and Rabbits Can Catch And Shed Avian Flu, we looked at a report that suggested that infected small mammals were a plausible intermediate host, and may be part of the chain of transmission of avian flu.

All of this becomes all the more important with clade 2.3.4.4. H5 viruses now appearing to spread more readily among wild and migratory birds, increasing the opportunities for small mammals to come in contact with the virus, and potentially spread it to farms. 

While the detection of HPAI H5N6 in cats isn't necessarily alarming, it does have the potential to make it tougher for Korea (and other governments) to contain and eradicate outbreaks.

 

France: MOA Announces 11 More H5N8 Outbreaks

#12,068



A week ago (Dec 23rd) the number of outbreaks of HPAI H5N8 in France stood at 47, all of which have been reported during the first three weeks of December. 

Today, that tally jumps to 75 outbreaks, an increase of 28 cases in the past 7 days.  Gers continues to see the most activity, with 39 outbreaks.

Along side these H5N8 outbreaks we've also seen a handful of other HPAI detections, including H5N5 and H5N9, along with several Low Path (LPAI) subtypes. 

Avian Influenza: France in the home monitoring
 
30/12/2016 avian influenza
© Pascal Xicluna / Min.Agri.Fr
In France
 
Situation at 30 December 2016: 75 H5N8 outbreaks in farms and 5 cases in wildlife confirmed and communicated.

Learn more about the epidemiological surveillance Animal Health platform .

    Map of France with homes
    Focus on households in farms

List of homes in the departments
 

• Landes: 10 homes
• Tarn: 8 homes
• Gers: 39 homes
• Lot-et-Garonne: 7 homes
• Hautes-Pyrénées: 7 homes
• Pyrénées-Atlantiques: 2 homes
• Aveyron: 2 homes

List of outbreaks in wildlife
 

• Pas-de-Calais: 1 home
• Haute-Savoie: 2 homes
• Tarn: 1 home
• Channel: 1 home

Russia: Rosselkhoznadzor Reports Avian Flu Outbreaks in Rostov & Krasnodar

# 12,067


Overnight Russia's Rosselkhoznadzor (Federal Service for Veterinary and Phytosanitary Surveillance) posted the following two notices on outbreaks of avian flu (subtype not specified) in two regions of the country.

On the outbreak of bird flu in the Rostov region

December 30, 2016
 

© Central body

Subordinate to the Rosselkhoznadzor Federal Centre for Animal Health has identified the gene of avian influenza virus samples of pathological material taken from turkeys kept at two sites in the Oktyabrsky district of Rostov region. In unfavorable point are specialists of the State Veterinary Service of the Rostov region under the control of the territorial Rosselkhoznadzor .

About bird flu outbreak in the Krasnodar Territory

December 30, 2016

© Central body

 

Kropotkin edge veterinary laboratory in samples of pathological material taken from geese belonging to the individual entrepreneur, who operate the farm Kuvichinsky Krymsk district of Krasnodar region has identified the virus genome. 

In unfavorable point are specialists of the State Veterinary Service of Krasnodar region under the control of the territorial Rosselkhoznadzor.

These reports follow outbreaks of HPAI H5 reported in late November and early December - first in the Republic of Kalymkia - and then in the Astrakhan Oblast, about 200km east of Kalymkia.
 

A Bit More Detail On the Hong Kong H7N9 Case

#12,066

Although we've already seen this morning's CHP update on their second H7N9 case of the season, we often can get more detail on the patient's condition and medical history via the letters the CHP sends out to local physicians.  

This letter's primary thrust is to remind local physicians to ask patients with acute flu-like symptoms or pneumonia about their recent travel history and/or `at risk' exposures (including live poultry workers, history of visiting market with live poultry, contact with poultry, etc.) and to report suspect cases promptly.

Whether this latest case turns out to be imported, or locally acquired, the expectation is that this won't be the last case to turn up in Hong Kong this winter.

December 30, 2016

Dear Doctors,

A Confirmed Case of Human Infection with Avian Influenza A(H7N9) Virus

We would like to draw your attention to the second confirmed case of human infection with avian influenza A(H7N9) virus in Hong Kong this winter and solicit your support to remain vigilant against avian influenza.

The case involved a 70-year-old man who had history of carcinoma of bladder, stroke and hyperlipidaemia. According to information provided by the patient and his wife, he developed fever, cough with sputum, shortness of breath, vomiting and diarrhoea on December 26, 2016. He attended the Accident and Emergency Department of United Christian Hospital on December 27 and was admitted to an isolation ward on December 28 for management of pneumonia. His sputum specimen was tested positive for influenza A(H7N9) virus by the Public Health Laboratory Services Branch of the Centre for Health Protection (CHP). 

The patient has been transferred to Princess Margaret Hospital for further management and is now in serious condition. According to the assessment by the attending physicians, the onset date of the patient was likely before December 26 based on pneumonic changes detected in the chest X-ray taken upon admission and clinical findings.

The CHP’s investigation revealed that the patient had travelled to Shenzhen and Zhongshan of Guangdong since December 13 and returned to Hong Kong on December 16. He claimed that he came across mobile stalls selling live poultry in Zhongshan. In Hong Kong, the patient recalled having purchased a chilled chicken from a shop near a wet market in Kwun Tong on December 22 but there was no sale of live poultry in the shop. According to the patient, he did not enter the wet market in Kwun Tong. The source of infection is still under investigation. 

His close contacts have remained asymptomatic so far and have been put under medical surveillance. Tracing of his other contacts is underway. The CHP's investigation is continuing.

Prior to this case, 17 imported human H7N9 cases have been recorded in Hong Kong. Cumulatively, a total of 818 human H7N9 cases have been reported globally since March 2013.

We would like to draw your attention that there has been increase in the activity of avian influenza viruses in neighboring areas and overseas countries since November 2016. The avian influenza activity is expected to remain high in the winter based on its seasonal pattern. In this regard, please pay special attention to patients who present with fever or influenza-like illness. It is essential to obtain their travel history and relevant exposure history during travel as appropriate.

Any patients with acute respiratory illness or pneumonia, and with at-risk exposure (including live poultry workers, history of visiting market with live poultry, contact with poultry, etc.) in affected areas within the incubation period (i.e. 10 days before onset of symptoms) should be managed as suspected cases and immediately reported to the Central Notification Office of the CHP via fax (2477 2770), phone (2477 2772) or CENO On-line (https://cdis.chp.gov.hk/CDIS_CENO_ONLINE/ceno.html).

Private doctors should contact the Medical Control Officer of the Department of Health at pager: 7116 3300 (call 9179) when reporting any suspected case outside office hours. The CHP will make arrangement to send the patient to a public hospital for isolation, testing and treatment. Besides, in order to minimise contact with or exposure to staff and other patients, it is important to isolate the patient and advise the patient to wear a surgical mask while waiting for transfer.

For updates on the latest situation of avian influenza and the affected areas, please visit the CHP’s designated website at http://www.chp.gov.hk/en/view_content/24244.html. Please draw the attention of the healthcare professionals and supporting staff in your institution/ working with you to the above. Thank you for your ongoing support in combating communicable diseases.

Yours faithfully,
(Dr. SK CHUANG)
for Controller, Centre for Health Protection
Department of Health

HK CHP: Update On Latest H7N9 Case

#12,065


Yesterday's announcement of Hong Kong's second H7N9 case in just two weeks came with the suspicion - because of the reported onset date of the 26th - that the virus might have been acquired locally rather than from the patient's recent trip to Guangdong province.

Today's HK CHP update backs away from the 26th onset date slightly - based on the interpretation of chest x-rays - and makes it more likely this was an imported case.

The incubation period for H7N9 is thought to max out between 7 and 10 days, although outliers are always possible. With symptom onset based on the patient's subjective recall, a certain amount of `fudge factor' comes into play. 

While potentially good news for Hong Kong, today's update does not (yet) declare this to be an `imported' case.

This latest Hong Kong case is just one of three cases announced yesterday, and so today's update also mentions the Hunan and Shanghai cases. 

Update on human case of avian influenza A(H7N9)

 

     The Centre for Health Protection (CHP) of the Department of Health today (December 30) reported an update on the second human case of avian influenza A(H7N9) in Hong Kong this winter.

     Enquiries revealed that the male patient aged 70 had claimed that he had come across mobile stalls selling live poultry in Shagang Xu, Zhongshan, on December 14.

     Although the patient claimed to have symptoms on December 26, according to the clinical and chest radiological assessment, the onset of his illness was likely to be before December 26.

     Contact tracing has so far identified 17 close contacts and 85 other contacts.

     Close contacts include the patient's family contacts as well as relevant in-patients, visitors and healthcare workers (HCWs) of United Christian Hospital (UCH). All have remained asymptomatic. They will be given antiviral prophylaxis with oseltamivir (Tamiflu) for five days, advised to wear a mask and put under medical surveillance for 10 days following their last exposure to the patient.

     Other contacts are the patient's travel collateral, other family members, relevant in-patients, visitors and HCWs of UCH. His travel collateral with cough tested negative for influenza A virus and the others have remained asymptomatic. They will be advised to wear a mask and will be put under medical surveillance for 10 days following their last exposure to the patient.

     The CHP is also closely monitoring a total of two additional human cases of avian influenza A(H7N9) in Hunan and Shanghai, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

     According to the Hunan Provincial Center for Disease Control and Prevention, the female patient aged 53 from Shaoyang had close contact with poultry before onset. In addition, the Shanghai Municipal Commission of Health and Family Planning reported that the male patient aged 34 is from Sichuan.

     "Locally, two human cases of avian influenza A(H7N9) were recently detected in this winter. Neighbouring Guangdong and Macau also reported their first human H7N9 cases in this winter. The activity of avian influenza is expected to increase in winter based on its seasonal pattern," a spokesman for the CHP said.

     "The public should avoid touching birds, poultry or their droppings and visiting poultry markets or farms during travel, particularly in the upcoming New Year holidays. If feeling unwell such as having fever or cough, wear a mask and seek medical advice at once. Travellers returning from affected areas should consult doctors promptly if symptoms develop and let them know their travel history," the spokesman added.

     The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

     The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

     The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below while handling poultry:
 

• Avoid touching poultry, birds, animals or their droppings;
• When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
• Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
• Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
• Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.
  

     The public may visit the CHP's pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

 

Ends/Friday, December 30, 2016

Issued at HKT 19:15

Korea MAFRA: Avian Flu Suspected In Cat Deaths

 


#12,064



With six-week losses from HPAI H5N6 outbreaks approaching 28 million birds, HPAI H5N8 resurfacing two weeks ago, along with recent detections of LPAI H7N2 and H7N7 in wild birds, Korea is understandably already reeling from this winter's avian onslaught.

Today their Ministry of Agriculture (MAFRA) has announced yet another potential wrinkle, in the form of a group of cats that have died suddenly, which they suspect have been infected with some type of bird flu. 

We've seen cats infected with avian flu before, particularly with H5N1 (see Catch as Cats Can) and more recently in New York City with LPAI H7N2), and in 2014 Korea reported a number of dogs which showed antibodies for H5N8.


Although we don't yet know what subtype has infected and killed the cats in today's report (tests are pending), we have seen reports of H5N6 infecting felines before (see H5N6 Rising: Infecting Birds, Humans, & Even Cats).

Cat-to-human transmission of avian flu is undoubtedly rare, but as was demonstrated last week in New York City, it is possible.

According to today's report, MAFRA has provided prophylactic antivirals to all who have been exposed to the sick or dying cats. So far, none of those exposed have shown any signs of infection.

The (translated) report is a little rough in the syntax department, but the gist is fairly obvious. `Goat cat' appears to refer to feral, or `outside' cats - using other translators, it comes out at `route cat'.

Gyeonggi Pocheon Cats Bird Flu Influenza Suspect

Date Registered 2016-12-30 17:00:00

□ One male (12.25 days) and one goat kitten (12.26 days) were found dead in a house in Pocheon, Gyeonggi Province on 12.25 days and 12.26 days.

* 7 goat cats (1 mother, 6 kittens) came to the house to save food, and it is estimated that they are family members with the dead domestic cat (male).

* One male cat from our home has been sent to the quarantine headquarters via Gyeonggi Province. Three of six kittens are dead (one dead is already in the store and two dead are going to be inspected at the quarantine headquarters)

* The remaining 3 live kittens are captured in Gyeonggi Province today and will be sent to the quarantine headquarters tomorrow, and they are currently trying to capture the mother cat.

○ A PCR test was conducted at the Animal Health Hygiene Laboratory in Gyeonggi Province. As a result, it was suspected of avian influenza virus, and the Ministry of Agriculture, Forestry and Livestock Quarantine Headquarters of Gimcheon Province requested a close inspection on 12.30. The Epidemiological Investigation Team (2 teams) He is

* As for the avian influenza virus type, the result will be as early as today (12.30), and as to whether the disease is highly pathogenic, tomorrow (12.31)

In this regard, the Government has implemented preventive and preventive measures against human infection as follows

○ The Ministry of Agriculture and Fisheries should arrange the local governments (Gyeonggi Province)

○ The Disease Control Headquarters and Gyeonggi Province investigated the infection of human beings through our public health center for our cat contact persons and prescribed antiviral drugs prophylactically.

- There are no suspicious symptoms to date, and we plan to carry out active surveillance over the next 10 days.

* There was a case of AI antibody found in 2014 (press release 2014.3.14).

Hong Kong Announces Another H7N9 Case

Credit HK CHP

#12,063


Although it is after midnight in Hong Kong, their Centre For Health Protection has issued as statement on their 2nd H7N9 case of this winter.  The first case, reported on the 19th, was an imported case while today's case remains under investigation.

This latest case does have travel history to mainland China between the 13th and 16th, but reportedly did not become symptomatic until the 26th, at what is considered the near maximum incubation period. 

This patient also purchased a chilled chicken at a shop very near a live market in Hong Kong on the 22nd, and so the investigation into the source of his infection continues.

This is the third H7N9 case announced today, and the third to turn up in the Hong Kong/Macao region in the past three weeks.

CHP investigates confirmed human case of avian influenza A(H7N9)

     The Centre for Health Protection (CHP) of the Department of Health is today (December 30) investigating a confirmed human case of of avian influenza A(H7N9) in Hong Kong, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.    

      The male patient, aged 70 with underlying illnesses, claimed to have developed fever, cough with sputum, shortness of breath, vomiting and diarrhoea since December 26. He attended the Accident and Emergency Department of United Christian Hospital (UCH) on December 27 and was admitted to isolation ward on December 28.

      His sputum specimen collected on December 28 was received and confirmed yesterday (December 29) to be positive for influenza A(H7N9) virus by the CHP's Public Health Laboratory Services Branch (PHLSB). The patient is now in stable condition and has been transferred to Princess Margaret Hospital for further management.

    The patient travelled to Shenzhen and Zhongshan since December 13 and returned to Hong Kong via Lo Wu on December 16. He claimed that he came across mobile stalls selling live poultry in Zhongshan.

      In Hong Kong, the patient recalled having purchased a chilled chicken from a shop near a wet market in Kwun Tong on December 22 but no live poultry was sold in the shop. According to the patient, he did not enter the wet market. 

     The source of infection is still under investigation.

     His close contacts have remained asymptomatic so far and have been put under medical surveillance. Tracing of his other contacts in Hong Kong is underway.

     "The case will be notified to the World Health Organization and the national, Guangdong and Macau health authorities. We are communicating with the Mainland authority to follow up the patient's exposure and movements in the Mainland," a spokesman for the CHP said.
   
     "Our epidemiological investigations are ongoing. Since the patient had purchased a chilled chicken near a wet market in Kwun Tong, as a precautionary measure, we are working closely with the Food and Environmental Hygiene Department to assess and investigate the case," the spokesman said.  

    Letters to doctors, hospitals, schools and institutions will be issued to alert them to the latest situation.

    "Locally, the first imported human case of avian influenza A(H7N9) in this winter was recently detected. The neighbouring Guangdong and Macau also reported their first human H7N9 cases in this winter. The activity of avian influenza is expected to increase in winter based on its seasonal pattern.

      "The public should avoid touching birds, poultry or their droppings and visiting poultry markets or farms during travel, particularly in the upcoming New Year holidays. If feeling unwell such as having fever or cough, wear a mask and seek medical advice at once. Travellers returning from affected areas should consult doctors promptly if symptoms develop and let them know their travel history," the spokesman added.

     The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

     The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is underway. The travel industry and other stakeholders are regularly updated on the latest information.

     The public should maintain strict personal, hand, food and environmental hygiene and take heed of advice below while handling poultry:
 

• When handling live chickens, do not touch them or their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
• Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
• Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
• Wear a mask if fever or respiratory symptoms develop, going to a hospital or clinic, or while taking caring of patients with fever or respiratory symptoms.

     The public may visit the CHP's pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

Ends/Friday, December 30, 2016

Issued at HKT 0:47

NNNN

France: H5N8 Poultry Outbreaks Jump to 64

#12,062

The number and scope of Europe's H5N8 outbreaks continue to rise, with literally hundreds of outbreaks spread across a dozen EU states.  Some areas are reporting a reduction in outbreaks, but the crisis is far from ended.

Intermingled among these H5N8 outbreaks we've also seen a handful of other HPAI detections, including H5N5 and H5N9, along with several Low Path (LPAI) subtypes. 

France, which did not report its first outbreak in poultry until early December, continues to be  badly affected.  Last Friday, the count sat at 47 outbreaks, as of yesterday, that number had jumped to 64.

Much of the increase in outbreaks over the past two weeks has been centered in the department of Gers, which has jumped from 5 outbreaks to 34 outbreaks over the past 14 days.

Avian Influenza: France in the home monitoring
 
29/12/2016 avian influenza
© Pascal Xicluna / Min.Agri.Fr

In France
 
Situation at 28 December 2016: 64 H5N8 outbreaks in farms and 5 cases in wildlife confirmed and communicated.

Learn more about the epidemiological surveillance Animal Health platform .

    Map of France with homes
    Focus on households in farms

List of homes in the departments

• Landes: 6 homes
• Tarn: 8 homes
• Gers: 34 homes
• Lot-et-Garonne: 7 homes
• Hautes-Pyrénées: 5 homes
• Pyrénées-Atlantiques: 2 homes
• Aveyron: 2 homes

List of outbreaks in wildlife

• Pas-de-Calais: 1 home
• Haute-Savoie: 2 homes
• Tarn: 1 home
• Channel: 1 home

Hunan Province Confirms An H7N9 Case

#12,061


No sooner that I had posted the last blog about Shanghai's second H7N9 case, the following report appeared on the Hunan CDC website:

A case of human infection with H7N9 was confirmed in Hunan province

 Source: Central Office of Emergency 

    December 28, 2016, Hunan Province, confirmed a case of human infection with H7N9 influenza. Patients Yang Moumou, female, Shaoyang Longhui County, 53 years old, before the onset of close contact with poultry history, is actively treatment.

At present, the case of all close contacts were not fever, cough and other flu-like symptoms.

This is Hunan's first reported H7N9 case of the 2016-17 winter epidemic, although they did report a fatal H5N6 case in November. Since the H7N9 virus emerged in 2013, Hunan Province has reported 35 cases.

Since China abandoned their coordinated, real-time announcing of avian flu cases two years ago, we primarily rely upon rare media reports, intermittent provincial announcements, and often belated reporting to the WHO to track each winter's epidemic.

Which means we are likely only to hear about them in drips and drabs.

 
Traditionally, the peak of China's H7N9 epidemic occurs in January and February, so things are likely just getting started.

Stay tuned.

Shanghai Municipality Reports A New H7N9 Infection

# 12,060


For the second week running Shanghai is reporting an H7N9 case, although unlike the imported case last week, this week's case appears to be home grown.

I say `appears' because the details provided in the  Shanghai Municipal Health and Family Planning Department's statement are pretty thin.

Today's is the second announced case from Shanghai for the 2016-17 winter epidemic:

H7N9 virus confirmed case of human infection case report in Shanghai

Published: 2016-12-29

　　Shanghai Health and Family Planning Commission December 29 briefing, H7N9 virus confirmed case of human infection case report in Shanghai.

　　Patient, Liu, M, 34 years old, Sichuan Koto membership. Confirmed on December 29, is now in active treatment.

It is worth noting that many provinces don't even provide this level of `real-time' notification of cases, and that often we don't learn about cases until an epidemiological summary is issued, usually near the middle of the following month.

All of which means there may well be more cases under treatment right now across China than we are aware of.     

South Korea Detects H7N7 & H7N2 In Wild Birds

#12,059


Under the heading of `If you look, you'll probably find it', South Korean officials have announced that their enhanced wild bird surveillance for HPAI H5N6 and HPAI H5N8 has turned up low path H7 viruses including H7N7 and H7N2.
 

First this report from KBS World News:

Other Strains of AI Detected in Wild Birds in S. Korea

Write : 2016-12-28 08:56:37 Update : 2016-12-28 09:23:59

As the highly pathogenic H5N6 bird flu is sweeping South Korea, other strains of the disease have also been detected in wild birds.

The Ministry of Agriculture, Food and Rural Affairs said on Tuesday that feces of wild birds in Sacheon, South Gyeongsang Province, were confirmed to have carried the H7N7 strain of avian influenza(AI).

The confirmation comes after another H7 strain of bird flu, H7N2, was detected in wild bird feces in Buan County, North Jeolla Province, on December 17th.

The ministry said both H7 strains were not highly contagious and would not cause a serious problem. 

However, it is known to be looking into the possibility that the highly pathogenic H7N9 strain will spread in the country. H7N9 infected 808 people in Hong Kong and Canada in recent years, killing 324 people.

A formal announcement has not yet appeared on the South Korean MAFRA website.

There are two broad categories of avian influenza; LPAI (Low Pathogenic Avian Influenza) and HPAI (Highly Pathogenic Avian Influenza).

• LPAI viruses are quite common in wild birds, cause little illness, and only rarely death.  They are not considered to be a serious health to public health. The concern is (particularly with H5 & H7 strains) that LPAI viruses have the potential to mutate into HPAI strains.
• HPAI viruses are more dangerous, can produce high morbidity and mortality in wild birds and poultry, and can sometimes infect humans with serious result. The type of bird flu scientists have been watching closely for the past decade has been HPAI H5N1 (and to a lesser extent HPAI H7s & H9s). 

Before the middle of the last decade, there was no uniform requirement to report or track LPAI infections.  That changed in 2006 when the OIE made reporting of LPAI H5 & H7 viruses mandatory.

The finding of LPAI H7 viruses in wild birds is therefore not terribly surprising, and under normal circumstance would scarcely warrant a mention.   

But with highly promiscuous and mutable clade 2.3.4.4. H5N6 and H5N8 circulating in wild birds across the Korean peninsula, and a very dangerous (albeit LPAI) H7N9 spreading in China, the addition of additional H7 viruses to the mix could complicate matters, either:

• By directly causing outbreaks of H7 in poultry, as we've seen previously with both of these subtypes in Europe and North America.
• Or (far less likely) by reassorting with the co-circulating H5 strains, thereby producing new subtypes of avian influenza.

While both are long shots, when the control of avian flu outbreaks are going as badly as they are in South Korea, the last thing they need is an additional complication.

Saudi MOH Announces 3 Primary MERS Cases on the 27th

#12,058


The release time for the Saudi MOH's daily MERS reports has  become somewhat erratic in recent weeks, and yesterday's report had not yet appeared on their site when I last checked it late yesterday afternoon.

This morning, the link for the report of the 27th indicates 2 new cases, but the map and chart actually show 3 (plus 3 recoveries).

In any event, this is likely to be the first of two reports I'll post today on Saudi MERS cases.  Or not. Depending on when or if the report for the 28th is published.


Today's report shows three primary cases, from three different cities, and all three list no known or suspected source of infection.  Two of the cases are in critical condition, while one is stable. 

HK CHP: Imported H7N9 Case Has Died

Credit HK CHP

#12,057


The wide spectrum of illness caused by avian H7N9 in humans is clearly illustrated by the two very different outcomes from last week's cases in Hong Kong and Macao.


The 58 y.o. poultry trader in Macao never showed symptoms, and was proclaimed free of the virus on Saturday, whereas the 75 y.o. man in Hong Kong was listed in critical condition when we learned of his infection.  

Today, the HK CHP has released the following short statement:

 

Update on imported human case of avian influenza A(H7N9)

     In response to media enquiries, the Centre for Health Protection (CHP) of the Department of Health today (December 27) reported an update on the first imported human case of avian influenza A(H7N9) in Hong Kong this winter.
 
     The CHP noted that the 75-year-old man, confirmed human case of avian influenza A(H7N9), who was admitted to North District Hospital on December 9 for management passed away on December 25.

 

Ends/Tuesday, December 27, 2016

Issued at HKT 14:25

While age differences, medical histories and comorbidities, and even the type and extent of exposure may account for these two very different outcomes, exactly why some people can fight off this infection without apparent illness and others struggle to survive is unknown.

Mild or asymptomatic infections such as we saw in Macao remind us that the `official' number of H7N9 infections in China is likely a serious undercount.

Most people with mild to moderate influenza never seek medical care (where they are likely to be tested), and some serious or fatal cases are likely missed by surveillance as well.  

Early estimates of the incidence of H7N9 in China (see Lancet: Clinical Severity Of Human H7N9 Infection) suggested the real number might be 10 to 100 times greater than reported.  

This becomes all the more important during the winter seasonal flu epidemic, when other - already human adapted - influenza A viruses (H3N2 & H1N1) co-circulate with these avian viruses.  

While it doesn't happen often, we know that humans can be infected by two influenza A viruses at the same time, and very rarely, that can lead to the generation of a `reassorted' virus - one that contains genetic material from both viruses. 

With both H5N6 and H7N9 circulating in China, H5N6 now in Japan and Korea, and both H5N8 and H5N1 making serious inroads in Europe, the Middle East, and Africa - plus a plethora of swine variant viruses - the odds of a chance hook up between a novel and seasonal flu virus is going up.

Granted, most reassortant viruses are evolutionary failures, unable to compete with existing `wild' viruses. But every once in a great while a new hybrid will emerge with genuine pandemic potential, and so the risks cannot be discounted.

For more on co-infection in humans and reassortment, you may wish to revisit:

JVI: Reassortant Seasonal-Pandemic H1N1 viruses In Co-infected Humans

J Clin Virol: Influenza Co-Infection Leading To A Reassortant Virus

EID Journal: Human Co-Infection with Avian and Seasonal Influenza Viruses, China

 

Japan: MAFF Announces HPAI H5 Outbreak In Kumamoto Prefecture

#12,056

Although HPAI H5N6 arrived in Japan via migratory birds very shortly after landing in South Korea, and Japan has nearly 120 detections of the virus in the wild, the difference between the impact on the Korean poultry Industry and Japan's has been like night and day. 

Korea has either lost or depopulated in excess of 25 million birds across more than 200 farms, while Japan is only reporting their 7th poultry outbreak today. 

Exactly why the virus has spread so much faster in South Korea than  Japan remains unknown, and will no doubt be the subject of intense post-mortem investigation.


First today's announcement from Japan's Ministry of Agriculture (MAFF), followed by an update from Japan's Ministry of Environment on non-farm HPAI dectections.

For confirmation of the suspected affected animals of highly pathogenic avian influenza in Kumamoto Prefecture

2016 December 27, 

the Ministry of Agriculture, Forestry and Fisheries

For cases of highly pathogenic avian influenza is suspected in Kumamoto Prefecture, which has been confirmed yesterday, the results of genetic testing, is an H5 subtype, today, it has been confirmed to be a suspected affected animals of highly pathogenic avian influenza.

1. Overview

For cases of highly pathogenic avian influenza is suspected in Kumamoto Prefecture, which has been confirmed yesterday, the results of genetic testing, is an H5 subtype, today, it has been confirmed to be a suspected affected animals of highly pathogenic avian influenza. 

In the future, we will conduct the testing in animal health research department (Note) NA subtype.

(Note) The National Research and Development Institute of Agriculture and Food Research Organization of Animal Health Research Institute: Japan's only research institute on animal health (Kenichi Division Sakamoto) 

2. Other

(1) The farm has to refrain from moves such as breeding poultry from the point at which there was a report from the farmers.
(2) In Japan, this by eating poultry meat and poultry eggs to, cases of avian influenza virus was transmitted to humans has not been reported.
(3) interviews in the field, that there is a possibility that the cause of the spread of the disease, since it could violate the privacy of those farmers, thank you for your cooperation as abstain strictly.
(4) In the future, so we will endeavor to provide quick and accurate information, so as not to be confused by such production relations and consumers, such as who is unfounded rumor, thank you for your cooperation.

In the 8 days since we last checked in with Japan's Ministry of Environment the number of wild bird and environmental detections of HPAI H5 has jumped from 70 in 13 Prefectures to 117 across 15 Prefectures.

Wild birds for avian influenza occurrence in the domestic (case of being monitored)

Highly pathogenic avian influenza confirmed number in wild birds (breeding birds, feces, including water samples)
2016 December 26, 2008 21 : 30 current 15 prefectures 117

To put this in some kind of perspective, during America's 2014-15   epizootic of H5N8 - during which time more than 220 farms were affected and 50 million birds were destroyed - fewer than 90 wild birds were found carrying the virus across all of the United States.

As we've seen with HPAI H5N8 in Europe this fall, HPAI H5N6 appears to be spreading more aggressively via wild and migratory birds than we've seen previously. 

A listing of the press releases on these detections since the 19th follows:

• Highly pathogenic avian influenza virus confirmed positive test and the type A avian influenza virus simple test positive in 2016, December 26, 2008 death of wild birds, Ibaraki Prefecture, about genetic testing positive (H28.12.26 21:30)
• For the dispatch of emergency investigation team in the highly pathogenic avian influenza-positive cases in the breeding bird of 2016, December 26, 2008 Kyoto (H28.12.26 18:30)
• 2016, December 26, 2008 for the highly pathogenic avian influenza wild birds due to the occurrence urgent investigation results of the investigation by a team of in Aomori Prefecture (H28.12.26 17:30)
• 2016, December 26, 2008 about the results of the investigation by the wild bird emergency research team associated with the highly pathogenic avian influenza occurred in wild birds died in Mie Prefecture (H28.12.26 17: 00) 
• With the dispatch of emergency investigation team in the highly pathogenic avian influenza-positive case in 2016, December 26, 2008 death of wild birds, Iwate Prefecture (H28.12.26 13:30)
• 2016, December 26, 2008 for the highly pathogenic avian influenza virus confirmed positive test in the death of wild birds, Ibaraki Prefecture and Iwate Prefecture (H28.12.26 12:00) 
• 2016 December 25, for the type A avian influenza virus simple test positive in the death of wild birds, Iwate Prefecture (H28.12.25 17:30)
• 2016 December 25, for the type A avian influenza virus simple test positive in the death of wild birds, Ibaraki Prefecture (H28.12.25 17:00)
• December 24, 2016 for the type A avian influenza virus simple test positive in Iwate Prefecture (H28.12.24 20:00)
• December 24, 2016 for the type A avian influenza virus simple test positive in Ibaraki Prefecture (H28.12.24 18:00)
• 2016 December 23, for the type A avian influenza Zausu genetic testing in breeding bird of Kyoto (H28.12 .23 19: 00)
• 2016 December 23, survey results about the Hokkaido of wild birds emergency investigation team (H28.12.23 16:00)
• 2016 December 22, for the type A avian influenza virus simple test positive in Hanamaki, Iwate Prefecture (H28.12.22 18:30)
• 2016 December 22, for the highly pathogenic avian influenza simple test positive in the death of wild birds Kyoto (H28.12.22 18:00) 
• 2016 December 22, for the type A avian influenza virus genetic testing positive in the death of wild birds, Niigata Prefecture (H28.12.22 16:30)
• 2016 December 22, for the type A avian influenza virus simple test positive in the death of wild birds, Nagasaki Prefecture (H28.12.22 16:00) 
• 2016 December 22, survey results of wild bird emergency research team associated with the highly pathogenic avian influenza occur for in Tochigi Prefecture (H28.12.22 15:00)
• For the dispatch of emergency investigation team in the highly pathogenic avian influenza-positive case in 2016 December 22, Mie Prefecture death wild birds (H28.12.22 14:30)
• 2016 December 22, for the highly pathogenic avian influenza virus confirmed positive test in the death of wild birds, Niigata Prefecture (H28.12.22 12:00)
• 2016 December 22, Aomori, Hokkaido, for highly pathogenic avian influenza virus confirmed positive test in the death of wild birds, Iwate Prefecture (H28.12.22 12:00)
• 2016 December 21, for the highly pathogenic avian influenza virus confirmed a positive test and a simple test positive in the death of wild birds, Ibaraki Prefecture (H28.12.21 18: 00)
• 2016 December 20, for the type A avian influenza virus simple test positive in the death of wild birds, Iwate Prefecture (H28.12.20 19:00)
• 2016 December 20, for the type A avian influenza virus simple test positive in the death of wild birds, Ibaraki Prefecture (H28.12.20 19:00)
• 2016 December 20, for the highly pathogenic avian influenza confirmed positive test in Aichi Prefecture of Zoo (H28.12.20 18:00)
• 2016 December 20, for the type A avian influenza virus simple test positive or the like in the death of wild birds Hokkaido (H28.12.20 16:00)
• 2016 December 20 for defined test negative in the death of wild birds, Fukushima Prefecture (H28.12.20 15:00) 
• 2016 December 20, for the highly pathogenic avian influenza virus confirmed positive test in the death of wild birds, Mie Prefecture (H28.12.20 15:00)
•  2016 December 20, Aomori Prefecture, Hokkaido, for highly pathogenic avian influenza virus confirmed positive test in the death of wild birds, Niigata Prefecture (H28.12.20 12:00)
• 2016 December 19, for the type A avian influenza virus genetic testing and a simple test positive in the death of wild birds, Ibaraki Prefecture (H28.12.19 20:00)
• For the dispatch of emergency investigation team in the highly pathogenic avian influenza-positive case in 2016 December 19-day mortality of wild birds, Tochigi Prefecture (H28.12.19 17:00)
• 2016 December 19, for the highly pathogenic avian influenza confirmed test negative in the Aichi Prefecture of Zoo (H28.12.19 17:00)
• 2016 December 19, for the highly pathogenic avian influenza virus confirmed positive test in Kagoshima Prefecture (H28.12.19 16:30)
• 2016 December 19, for the type A avian influenza virus genetic testing positive in the death of wild birds, Fukushima Prefecture (H28.12.19 16:00)
• 2016 December 19, for the type A avian influenza virus simple test positive in the death of wild birds, Iwate Prefecture (H28.12.19 15:30)