South Africa Debates Poultry Vaccination To Control H5N8

#12,734



Two months ago, shortly after the first outbreaks of H5N8 were reported in South Africa,  government officials quickly decided to Reject Vaccination to Control Bird Flu  - opting instead to go with quarantine and culling - a policy long recommended by the OIE.

As we've discussed often in the past, poultry vaccination brings with it a new set of problems, and can sometimes make a country's avian flu situation worse (see MPR: Poultry AI Vaccines Are Not A `Cure-all’ &  New Scientist: The Downsides To Using HPAI Poultry Vaccines).

As the virus has spread, and losses have mounted, there has been increasing pressure from the poultry sector for the South African government to approve the use of vaccines.  Last week the headlines read:

Task team to look at vaccination against Avian Flu

By Sonja Raasch

August 25, 2017

Agriculture Minister Senzeni Zokwana has met with CEOs and senior managers in the poultry industry in a closed meeting to find solutions and discuss mitigation strategies to the current Avian Influenza outbreak.

In a statement, the department said the current outbreak was threatening the existence of South African Poultry industry as well as jobs in the sector.

The industry raised concerns on compensation and guidelines relating to the principles and guidelines of compensating affected farms. Another area of concern was vaccination of poultry against Avian Influenza. Industry also requested to be given permission to import fertile eggs to close the gap as a result of culled birds. (Continue . . . .)

These reports apparently raised hopes that approval was imminent, an expectation the Agriculture Department today appears to be trying roll back.  Overnight a number of `cautious' statements on poultry vaccines have been published in South African media.

Agriculture Dept urges caution on vaccination against avian flu

As farmers grapple with the highly pathogenic outbreak of the H5N8 strain, the sector wants government’s approval to vaccinate.

Rahima Essop | about 6 hours ago

CAPE TOWN - The Agriculture Department says farmers have to be cautious about vaccinating against avian flu because past experience has shown there are repercussions for the poultry industry.

As farmers grapple with the highly pathogenic outbreak of the H5N8 strain, the sector wants government’s approval to vaccinate.

(SNIP)
Maja says this time around, they need to be careful about rushing to vaccinate.

“There are certain vaccines available, globally, but none registered for use in the country.”

(Continue . . . )


'Bird flu vaccine would have to be based on sound scientific research'

Thousands of chickens have been culled and their eggs destroyed. Ostriches and other birds are also affected.

Rahima Essop | about 19 hours ago

CAPE TOWN - Agriculture Minister Senzeni Zokwana says 24 outbreaks of Avian Flu have been detected since a recent outbreak of the disease in June. (SNIP)

Desperate for a solution, the poultry industry wants government to roll out a vaccine for the highly pathogenic H5 N8 strain.

But Minister Zokwana says such a decision would have to be based on sound scientific research.

“It is the decision that is to be based on scientific research for the long-term benefit of the sector and the country.”

The Agriculture Department's Doctor Mpho Maja says there are serious risks associated with vaccines.

“There are too many repercussions to vaccines that we would not take the decision lightly.”

(Continue . . . )

The handful of countries (primarily China, Egypt, Vietnam & Indonesia) that elected to go down the poultry vaccination road a dozen years ago - instead of aggressive quarantine and culling - are still battling avian flu. 

While vaccines can often protect poultry against illness -  they don't necessarily prevent infection - resulting in subclinical `stealth' infections can spread unnoticed. Poorly matched or improperly administered vaccines can actually drive the evolution of `vaccine escape' variants, which increases viral diversity and further diminishes the vaccines effectiveness. 

The HPAI Poultry Vaccine Dilemma

Study: Recombinant H5N2 Avian Influenza Virus Strains In Vaccinated Chickens

         EID Journal: Subclinical HPAI In Vaccinated Poultry – China

Lastly, vaccinated poultry may not be readily accepted by foreign markets, since it hinders testing for the virus. This could cause a greater economic loss for some countries than the virus itself.

While many countries remain staunchly resistant to the use of poultry AI vaccines - particularly across the EU and in North America - should avian flu viruses continue to proliferate at the rate we've been seeing over the past couple of years, this is a debate that we could see raised more often.

Meanwhile, China - which is arguably too dependent upon poultry vaccines to change policies now - decided to roll out a new combination HPAI H5 + H7 vaccine this summer (see China MOA Orders HPAI H7N9 Vaccine Deployed Nationwide This Fall) in hopes that it will help curb their rapidly evolving H7N9 virus, as well as reining in their growing number of HPAI H5 viruses.

For more on the potential unintended consequences of poultry AI vaccination, you may wish to revisit:

Virology: Selection Of Antigenic Variants Of An H5N1 HPAI Virus In Vaccinated Chickens

Taiwan COA Warns Against Importation & Use Of AI Vaccines

Subclinical Highly Pathogenic Avian Influenza Virus Infection among Vaccinated Chickens, China).

Switzerland: OIE Notified Of 2 More H5N8 Outbreaks In Waterfowl

#12,733


Two weeks ago, in Switzerland: Two Dead Swans Test Positive For H5N8, we saw the announced discovery of two dead swans from the southern shores of Lake Neuchatel, near Yverdon-les-Bains (VD).  This was the first detection of the virus in Switzerland since last March.

Today, the OIE has a follow up report which lists 3 dead mallards, retrieved from two separate locations, that have tested positive for the virus.

The first report is once again from Lake Neuchatel, while the second comes from Lake Geneva (aka Lac Léman), some 30 miles to the south and east of the first location.
 

This comes on the heels of the announcement of multiple H5N8 outbreaks this summer in Northern Italy (see Italy: 3 More HPAI H5 Outbreaks Reported By The IZSV), and last weekend's report of Germany Finding H5N8 In 3 Dead Swans.


This unusual and persistent (albeit low) level of avian flu activity across Europe for this time of year likely influenced the Government of Wales decision to issue the following statement today.

Poultry keepers urged to take action now to prepare for winter avian flu threat

All poultry keepers across the UK are being urged to remain vigilant to the threat of bird flu and take action now to reduce the risk to their flocks and the wider poultry industry this winter in a joint call from the Chief Vets of Wales, Scotland, Northern Ireland and the UK.

Wednesday 30 August 2017

Simple measures can help to keep flocks disease free. All keepers – whether they run a large commercial farm or keep just a few pet chickens in their back garden – can get ahead of the game and take these simple steps to reduce the risk of disease before autumn migration of ducks and geese begins again this winter:

• keep the area where birds live clean and tidy, control rats and mice and regularly disinfect any hard surfaces. Clean footwear before and after visits
• place birds’ food and water in fully enclosed areas that are protected from wild birds, and remove any spilled feed regularly
• put fencing around outdoor areas where birds are allowed, and limit their access to ponds or areas visited by wild waterfowl
• in Great Britain, stay alert by signing up online to a free service to receive text or email alerts on any outbreaks of bird flu in the UK. You can also quickly and easily register your flock online. In Northern Ireland, visit the DAERA website for further information.

Last winter, the H5N8 strain of bird flu was found in 13 kept flocks in the UK – ranging in size from as few as nine to as many as 65,000 birds. We’ve seen a decline in the number of new cases over the summer, but the disease is still circulating in kept poultry across Europe, with Italy the most recent country to suffer a series of outbreaks. It has also recently been confirmed in a dead mute swan in Norfolk.

Government is working with groups including NFUs, RSPCA, British Hen Welfare Trust, Poultry Club of Great Britain and UFU to highlight the importance of keeping up high biosecurity even though the immediate disease risk has dropped.

         (Continue . . . )

NHC Issuing Advisories On T.S. Irma

#12,732


With the 2017 Atlantic Hurricane season not quite half-over, the National Hurricane Center began issuing advisories at 11am AST this morning on rapidly moving Tropical Storm Irma, far out in the Atlantic. This storm is at least 7 to 10 days away from impacting any land, and its future course and intensity are far from certain. 

Irma is the 10th named storm of the season, and we are now just coming up to the peak of hurricane season. 

The storm is expected to move westward for the next several days, and them make a slightly unusual turn towards the south-west.  After that, models are highly speculative, although some put the storm off the eastern seaboard late next week.

As Harvey showed, storms can brew quickly this time of year, and so Irma may not be the only tropical threat we may have to deal with in the next couple of weeks. 

Hurricane Season Peaks in Mid-September

 

With all of this in mind, I would once again urge all 50 million Americans who live along the Gulf and Atlantic coastlines - and even those well inland - to review their hurricane preparedness plans, and supplies.

While living in a Hurricane zone requires extra planning, no matter where you live or work, you need to think about potential threats and how you will deal with them should one emerge. If you haven’t already downloaded the updated Tropical Cyclone Preparedness Guide, and visited NOAA's Weather-Ready Nation Hurricane Preparedness Week 2017 web page, now would be an excellent time to do so.

Even if you don't live in `hurricane country', you may have to deal with blizzards, wildfires, earthquakes, tornadoes, floods . . . even terrorist attacks, or a pandemic.  Which is why all next month this blog will participate in National Preparedness Month.

So - before disaster strikes -  you need to ask yourself: If a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 7 to 14  days . . . do you have:

• An emergency plan, including meeting places, emergency out-of-state contact numbers, and in case you must evacuate, a bug-out bag?
• A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials?
• A decent first-aid kit, so that you can treat injuries?
• Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration?
• A way to provide light (and in cold climates, heat) for your family without electricity? And a way to cook? And to do this safely?
• A small supply of cash to use in case credit/debit machines are not working?
• Spare supply of essential prescription medicines that you or your family may need?

If your answer is `no’, you have some work to do. A good place to get started is by visiting Ready.gov.

Beyond having the basic skills and supplies for you and your family, I would strongly urge that you cultivate a network of `disaster buddies ’ (see In An Emergency, Who Has Your Back?) among your friends, relatives, co-workers, and neighbors.

While being prepared doesn't guarantee a good outcome for you and your family, it certainly improves your odds. To become better prepared as an individual, family, business owner, or community, I would invite you to visit the following preparedness sites.

FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/

Saudi MOH: 2 More Asymptomatic MERS Cases In Domat Al Jandal

#12,731


Today marks the opening day of this year's Hajj, and while MERS reports in and around the Holy Cities have diminished, the Domat Al Jandal (aka Dawmat AlJandal) region continues to be a hot spot.

Daily reports from the MOH continue to be erratic (see list below), with belated postings, skipped days, and incorrectly labeled links (see master list below).

Building on last Sunday's report (see Saudi MOH: 6 MERS Cases Over Past 4 Days), two more household members in Domat Al Jandal have tested positive for the MERS virus.  Both are listed as asymptomatic. 

South Africa: NICD Statement Dispels Media Bird Flu Report

#12,730


Unlike its cousins H5N1 and H5N6, HPAI H5N8 - despite thousands of poultry worker exposures on three continents - has never been shown to infect humans. That could change as the virus evolves (see Study: Virulence Of HPAI H5N8 Enhanced By 2 Amino Acid Substitutions), but so far, H5N8 has only posed a threat to avian species. 

Which is why, when reports of a human infection (see Pretoria child diagnosed with bird flu) began to appear in the South African Press today, I immediately checked their National Institutes of Communicable Diseases (NICD) for an official response.

Given the hyperbolic nature of the media report, it wasn't too surprising to find the following statement had already been posted refuting the story. 

Avian Influenza: No Confirmed Human Cases in South Africa

Alerts August 30, 2017

The outbreak of highly pathogenic avian influenza A (H5N8) in poultry is ongoing after its emergence in South Africa in June 2017. According to the OIE website, 24 localized outbreaks have been identified to date from three provinces (Mpumalanga, Gauteng and Western Cape) as follows: 10 outbreaks in commercial chickens, 3 outbreaks in commercial ostrich, 5 outbreaks in wild birds, 3 outbreaks in birds that were kept as a hobby and 3 outbreaks in backyard poultry. The OIE reports may be found at http://www.oie.int.

Similar to experience in other countries that have had the avian influenza A(H5N8) outbreak in the past, there have been no human cases of A(H5N8) in South Africa. Following the first reported avian influenza A(H5N8) outbreaks in poultry in South Africa, human surveillance to detect possible human infections was initiated by the National Institute for Communicable Diseases (NICD) in persons exposed to the virus on affected farms. 

To date, 60 workers who had been exposed to infected birds have been tested and none have tested positive. Poultry and poultry products that are available for sale in retail outlets are safe for human consumption. There have been media reports that a learner from Centurion has been diagnosed with bird flu, NICD can confirm that there have been no confirmed human cases of bird flu in South Africa.

Poultry and poultry products that are available for sale in retail outlets are safe for human consumption. There is no danger of transmission of avian influenza from chicken or egg products to humans.

Additional information can be accessed at www.nicd.ac.za

 

Italy: 3 More HPAI H5 Outbreaks Reported By The IZSV

HPAI H5 Outbreaks Since July 1st - Credit IZSV

#12,729


After nearly a week without a issuing a new report (other than confirming several earlier HPAI H5 outbreaks as H5N8), Italy's IZSV (Istituto Zooprofilattico Sperimentale delle Venezie) has announced three more outbreaks of HPAI H5; two in commercial poultry, and one in a wild bird (mute swan) found in the Lombardy region.

Highly pathogenic avian influenza (HPAI) in Italy
 
2016/2017 – H5N5, H5N8

    Outbreaks | PDF (last update: 29/08/2017)
    Map | PDF (last update: 29/08/2017)

August 2017

29/08/2017 – On 25 August, the National Reference Laboratory (NRL) for Avian Influenza and Newcastle Disease confirmed as positive for Avian Influenza A virus subtype H5N8 a rural farm with 25 chickens in Pavia province (Lombardy region). The birds have already been culled.

On the same day, another positive for Avian Influenza A virus subtype H5N8 was confirmed in a mute swan (Cygnus olor) found dead near a pond in Bergamo province (Lombardy region).

On 28 August, the NRL confirmed as positive for Avian Influenza A virus subtype H5 a fattening turkey farm in Verona province (Veneto region). At the moment of the epidemiological inquiry, there were 10.700 turkeys (males, 52 day-old). On 27 August, some turkeys exhibited nervous symptoms and, in the following day, a small increase in mortality and a decrease in the water consumption were observed. Culling, cleaning and disinfection procedures are ongoing for this last case.

       (Continue .. . . )


Although other European countries have reported a smattering of H5N8 cases over the summer (see DEFRA: Outbreak Assessment On H5N8 In Europe - Summer 2017) , Italy has reported far more cases (and greater losses) this summer than they saw during last winter's record epizootic.

Since July 1st, Italy has reported 19 outbreaks in poultry, and 2 detections in wild birds, resulting in the loss of over 900,000 birds.  

This persistence over the summer - albeit at low levels - is in sharp contrast to previous years when reports of H5N8 in Europe and North America all but disappeared once spring ended (see PNAS: The Enigma Of Disappearing HPAI H5 In North American Migratory Waterfowl).

The H5N8 virus that invaded Europe last fall arrived with several genetic changes (see EID Journal: Reassorted HPAI H5N8 Clade 2.3.4.4. - Germany 2016), resulting in pronounced changes in its behavior (record geographic spread, increased virulence in wild birds, increased avian host range, and the spinning off of new subtypes). 

As Italy and the rest of Europe continue to deal with what are presumably remnants from last winter's epizootic, we are rapidly approaching the start to this year's fall migration (see 2016's Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1).

Exactly what that will bring to Europe, North America and Asia this fall is unknowable, but given last year's impact, poultry interests throughout the Northern Hemisphere should be prepared for surprises.

A Prescription For Any Disaster

#12,728


Although I've mentioned it before (see here), five weeks after Katrina devastated New Orleans I was there with my brother, trying to retrieve what little we could from his ground floor French Quarter apartment. 

Also on his list was getting refills on a prescription from his local pharmacy.  But 5 weeks after the storm, the power was still out across the city and his Mom & Pop pharmacy was still shuttered and vacant.

Like so many other displaced persons from Katrina, he not only lost everything, he was faced with having to find a new doctor in a strange town, just to get a prescription filled. 

For him, it was an inconvenience, but for those with more pressing medical needs, it could have had much more serious implications.

The AMA, FEMA, and others (including this blog) have long extolled the virtues of keeping a `disaster stash' of essential prescription medicines; enough for at least 2 weeks.

From  FEMA's Special Needs Require Special Preparation

“Disaster preparedness is not a ‘one size fits all’ concept,” said Federal Coordinating Officer Gracia Szczech. “People with special needs may require special attention and preparation. Everyone needs to get a kit, make a plan and be informed.”

Considerations for people responsible for disabled individuals:

• For those on respirators or other electric-powered medical equipment, make prior arrangements with your physician or check with your oxygen supplier about emergency plans, and be sure to have electrical back-up for any medical equipment.
• Maintain a two-week supply of items such as dressings, nasal cannulas and suction catheters.
• Maintain a two-week supply of both prescription and non-prescription medications.
• Keep copies of your medical records.
• Keep copies of prescriptions for medical equipment, supplies and medications.
• Keep extra contact lenses and supplies, extra eyeglasses and extra batteries for hearing aids.
• Make plans now to have accessible transportation in case of evacuation.
• Shelters may be limited in accommodations to meet some of the needs of those with disabilities. Prepare ahead of time to ensure you will have what you need.

 From the American Medical Association (2008):

 PERSONAL MEDICATION SUPPLY IN TIMES OF DISASTER:

Earthquakes, hurricanes and floods have headlined recent news reports. This new policy  supports allowing all patients with chronic medical conditions to maintain  an emergency reserve of prescription medications. It also encourages
 patients to carry a list of current medications and the prescribing  physician's contact information with them to ensure continuity of care in the event of a disaster or other emergency.

"There are more than 125 million Americans living with chronic  illnesses who rely on medication," said AMA Board Member Steven Stack, M.D. "Disasters can happen at any time, and ensuring that patients with chronic  conditions have access to needed medications may help minimize the uncertainty, confusion and health risks following a disaster."

Of course, all of this is easier said than done. Insurance companies are very strict about the timing and quantity of refills, and while most doctors will write the Rx for extra meds, many simply cannot afford the cash outlay.

Heeding the lessons of Katrina, on Friday the Governor of Texas, as part of his disaster declaration, issued the following order:

Hurricane Harvey
Emergency Dispensing of Prescription Medications

 
Governor Greg Abbott has declared a state of disaster in the following counties: Aransas, Austin, Bee, Calhoun, Chambers, Colorado, Brazoria, DeWitt, Fayette, Fort Bend, Galveston, Goliad, Gonzales, Harris, Jackson, Jefferson, Jim Wells, Karnes, Kleberg, Lavaca, Liberty, Live Oak, Matagorda, Nueces, Refugio, San Patricio, Victoria, Waller, Wharton and Wilson.

The laws and rules governing the practice of pharmacy in Texas, allow pharmacists to provide emergency refills when the prescriber cannot be reached. Specifically, in an emergency, a pharmacist may use his/her professional judgment in refilling a prescription drug order for a drug (other than a Schedule II controlled substance) provided failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

In most cases, pharmacists may not dispense more than a 72-hour supply of medication. However, in the event of a natural or manmade disaster, the Texas Pharmacy Act (Sec. 562.054) and board rule 291.34 allow a pharmacist to dispense up to a 30-day supply of a prescription drug, other than a Schedule II controlled substance, without the authorization of the prescribing practitioner if:

• failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering;
•  the natural or manmade disaster prohibits the pharmacist from being able to contact the practitioner;
•  the governor has declared a state of disaster under Chapter 418, Government Code; and
•  the board, through the executive director, has notified pharmacies in this state that pharmacists may dispense up to a 30-day supply of a prescription drug.
  

Accordingly, Gay Dodson, R.Ph., Executive Director/Secretary, has authorized ALL pharmacists in Texas to dispense up to a 30-day supply of medication (other than a II controlled substance) for patients affected by Hurricane Harvey. 

While this was absolutely the right thing to do, and will undoubtedly help a lot of people, many may still find themselves unable to get to a pharmacy for days, and there may also be delivery delays for certain medications, even if you can find a pharmacy that is open. 

All of which makes having that extra supply on hand still an essential part of preparedness, along with having enough food and water.

Particularly after a disaster - when families may be temporarily separated - every one in your family should have a medical ID card in their wallet or purse; one that lists their medical history, prescription meds, doctor's name, and emergency contact.

While we all would like to believe we'd never get caught up in a major, prolonged disaster, the reality is that none of us are immune. Regardless of where we live.

For more on how to put together your family's medical history, you may wish to revisit:

Thanksgiving Is National Family History Day

China MOA: Poultry Die Off In Anhui Province Confirmed As H7N9

#12,727


While it slowed much later this summer than in the past, H7N9 activity has finally been reduced to a trickle in China, although two human cases were reported last Friday in far western Xinjiang Uygur Autonomous Region.  

This welcomed lull will probably end later this fall once the weather turns cooler.

With this sharp drop in human infections, China's main focus has switched to deploying a new (H5 + H7) poultry vaccine, one they rolled out last July (see China MOA Orders HPAI H7N9 Vaccine Deployed Nationwide This Fall).

The decision to add an H7 component to their existing poultry vaccine only came after a new, highly pathogenic strain of H7N9 emerged in Gaungdong Province last December, and over the spring began moving north.

Unlike LPAI H7N9 - which does not visibly sicken or kill birds - HPAI H7N9 has a high mortality rate in poultry.

Over the first six months of 2017, the FAO tracked the spread of this new HPAI H7N9 virus:

Highly pathogenic virus findings: The H7N9 highly pathogenic avian influenza virus was detected in a total of 48 poultry or environmental samples (37 chickens, 1 duck and 10 environmental samples) from 23 live bird markets (LBMs) in: Fujian (Longyan City), Guangdong (Dongguan, Guangzhou, Huizhou, Lufeng, Meijiang, Meizhou, Zhongshan Cities and Haifeng County), Hunan (Chenzhou City) and Guangxi (Guilin City) Provinces;

and from 8 farms in: Guangxi (Guilin City), Hebei (a chicken layer farm in Xingtai City [reference]), Henan (a chicken layer farm in Pingdingshan City [reference]), Hunan (backyard in Chenzhou City and a large chicken layer farm in Yongzhou City [reference]), Shaanxi (a chicken layer farm [reference]), Tianjin (a chicken layer farm [reference]), Inner Mongolia (two chicken layer farms in Hohhot and Baotou Cities [reference 1, reference 2] and Heilongjiang (a chicken layer farm in Shuangyashan City [reference]) Provinces.

Out of the 1584 confirmed human cases, H7N9 virus isolates from 25 human cases (including one from Taiwan Province) were found to be highly pathogenic for chickens.

Now, whenever we see the combination of unusual poultry mortality and a positive H7N9 lab test, the suspicion is high that HPAI H7N9 is at work - although requires additional lab tests to confirm the presence of the HA cleavage site mutation that is used to differentiate HPAI from LPAI.

Which brings us to the following report describing a symptomatic H7N9 outbreak in Anhui Province with excess mortality.  

We'll have to await further lab confirmation before this outbreak can be officially labeled HPAI.

Chuzhou Quanjiao occurred in poultry H7N9 flu epidemic has been effectively controlled at present

Date: 2017-08-25 17:11     source:

August 17, Chuzhou City, Anhui Province Quanjiao veterinary authorities found a broiler farms appear in the monitoring of suspected bird flu symptoms, the incidence of 1368, 910 died. August 18, animal disease prevention and control center in Anhui diagnosed as suspected H7 subtypes of avian flu. 

August 24, by the National Avian Influenza Reference Laboratory confirmed the outbreaks as H7N9 flu. After the outbreak, according to the relevant local prevention plans and technical specifications, adhere to the prevention and control law, science and prevention and control, really good job epidemic disposal, have been culling and safe disposal 74 463 poultry. Currently, the outbreaks has been effectively controlled.

While HPAI H7N9's ultimate impact (and that of the vaccine) remains unclear, we are starting to learn more about this new HPAI variant:

• In early May in Eurosurveillance: Biological Characterisation Of (HPAI) A(H7N9) Viruses In Humans, we learned that HPAI H7N9 virus retains the ability to infect both birds and humans, and in fact, appears to be potentially slightly more infectious in both than the LPAI version. 

• Two week later, in EID Journal: 2 Expedited HPAI H7N9 Studies, we saw the first detailed reports on China's HPAI H7N9 human infections - and while their numbers (n=8) remained low, making it difficult to draw any conclusions - there were already concerns this HP variant might be slightly more pathogenic in humans.

With HPAI H7N9's rapid spread, and outbreaks reported last June less than 100 miles from the Russian border in Heilongjiang Province, the big question continues to be: 

 How long will H7N9 remain just China's problem?

A threat which Russia - which continues to deal with their own HPAI H5N8 woes - is keenly aware of (see China's Nervous Neighbors). 

WHO MERS-CoV Update - UAE

#12,726


Although I haven't seen any formal announcement from the UAE Health Authority, today the WHO is reporting of a single MERS case with illness onset in mid-July.  The patient, a 54 y.o. male with no comorbidities, and no obvious exposure risks, remains on a ventilator more than a month after falling ill.

Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates

Disease outbreak news
28 August 2017

On 29 July 2017, the national IHR focal point of the United Arab Emirates reported one additional case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Details of the case

Detailed information concerning the case reported can be found in a separate document (see link below).

MERS-CoV cases reported on 29 July 2017
xlsx, 46kb

The patient, who lives and works in Al Ain, United Arab Emirates, presented at a hospital in Al Ain on 16 July 2017. On 16 July, a chest X-ray showed pneumonia and he was treated with antibiotics and non-invasive ventilation. On 25 July, his symptoms worsened and a sputum sample was collected and tested for MERS-CoV and influenza. On 26 July, showing no signs of improvement, the patient was transferred to a second hospital in Al Ain and placed in an intensive care unit.

A second sputum sample was collected on 26 July and both samples tested positive for MERS-CoV on 27 July 2017. The patient is currently in ICU on mechanical ventilation. Investigations into the source of infection are ongoing. At the time of writing the results of the investigation were not yet provided to WHO.

Globally, 2067 laboratory-confirmed cases of infection with MERS-CoV including at least 720 related deaths have been reported to WHO.

Public health response

The Ministry of Health in Abu Dhabi carried out contact tracing and followed up 89 health care workers and 95 contacts at his place of employment. All identified contacts were monitored for 14 days from the last date of exposure. No additional cases were detected.

         (Continue . . . )

Virology: Detection & Characterization Of Avian H4N6 In Midwestern Swine (2015)

#12,725


Avian Low path (LPAI) H4N6 viruses commonly circulate in aquatic birds around the globe, including in North America. They cause little or no illness in their natural avian reservoir  hosts, are only rarely reported in domestic poultry, and so far have little or no track record of human infection.

At first glance, this subtype appears fairly benign.  But, the one constant in influenza is change, and in recent years we've seen some changes in H4N6

Eighteen years ago (1999) avian H4N6 was first detected in mammalian hosts among Canadian swine. The following year, this report appeared in the Journal of Virology.

J Virol. 2000 Oct;74(19):9322-7.

Isolation and characterization of H4N6 avian influenza viruses from pigs with pneumonia in Canada.

Karasin AI1, Brown IH, Carman S, Olsen CW.

Abstract

In October 1999, H4N6 influenza A viruses were isolated from pigs with pneumonia on a commercial swine farm in Canada. Phylogenetic analyses of the sequences of all eight viral RNA segments demonstrated that these are wholly avian influenza viruses of the North American lineage. To our knowledge, this is the first report of interspecies transmission of an avian H4 influenza virus to domestic pigs under natural conditions.

In 2002, the USDA published:

Pathogenesis of H4N6 Influenza A Virus Infection in Pigs and Turkeys: A Newly Emerging Disease Concern

Objective:Two isolates of H4N6 influenza A viruses were recently recovered from pigs with pneumonia in Canada. These were the first H4N6 subtype viruses ever isolated from naturally infected pigs. Our genetic analyses revealed these to be wholly avian viruses, but despite their avian lineage, preliminary research results have demonstrated that they can spread from pig-to-pig. 

Furthermore, additional results have shown that they preferentially bind to SAL2,6Gal molecules, which is the receptor type present in human tracheal cells, rather than the SAL2,3Gal receptors utilized by avian viruses. Given this finding and the fact that our swine and human populations are both immunologically naive to H4 viruses, these viruses pose an emerging disease concern for both veterinary and human health.

         (Continue . . . )

Pigs are susceptible to a range of human, swine, and avian flu viruses, and possess both avian-like (SAα2,3Gal) and human-like (SAα2,6Gal) receptor cells in their respiratory tract, making them potential`mixing vessels' for influenza reassortment. 

Over the past decade we've seen a number of brief references to H4N6 in mammalian hosts, including North American Raccoons, Raccoons in Japan, Chinese pigs, and seals.   

Three weeks ago, in Cell: Avian-to-Human Receptor-Binding Adaptation by Influenza A Virus Hemagglutinin H4, researchers presented evidence that avian H4N6 viruses can adapt to human receptor cells while in a swine host (using the 1999 Ontario isolate), warning:

These results clearly implicate the potential threat posed by H4 viruses to public health. Therefore, early-warning study of H4 subtype human receptor-binding property is highly appreciated.

All of which leads us to a new study, published last week in the Virology journal, detailing the first discovery (in 2015) of avian H4N6 in swine from America's Midwest.

Detection and characterization of an H4N6 avian-lineage influenza A virus in pigs in the Midwestern United States

Eugenio J. Abentea, Phillip C. Gaugerb, Rasna R. Waliaa, Daniela S. Rajaoa, 1, Jianqiang Zhangb, Karen M. Harmonb, Mary Lea Killianc, Amy L. Vincenta, ,

https://doi.org/10.1016/j.virol.2017.08.021Get rights and content
Highlights•

• An avian H4N6 influenza A virus was detected and isolated from a pig in Midwestern United States
• Analysis of clinical samples suggests the H4N6 virus was not widespread in swine
• The H4N6 replicated efficiently in the lungs of challenged pigs and caused lesions.
• Virus was not detected in the upper respiratory tract of challenged pigs.
• There was no evidence of transmission in contact pigs exposed to challenged pigs.
  

Abstract

H4Nx viruses were reported in swine in Canada and China, but had not been recognized in swine in the USA. In late 2015, an avian-origin H4N6 influenza A virus was isolated from pigs in the United States during a routine diagnostic investigation of clinical respiratory disease in the herd. 

Serological analysis from additional pigs at the farm and other pigs within the swine production system indicated that the virus did not efficiently transmit from pig-to-pig and the mode of transmission to swine could not be determined. The isolate was characterized at the molecular level and the pathogenesis and transmission was experimentally evaluated in pigs. 

Although the virus replicated in the lungs of pigs and caused mild pulmonary lesions, there was no evidence of replication in the upper respiratory tract or transmission to indirect contacts, supporting the findings on the farm.

Although this avian H4N6 virus appears far from being ready for prime time, and its current pathogenicity in humans appears marginal, by circulating in pigs it also provides additional unique genetic `building blocks' for reassortment with swine, human, or other avian influenza viruses.

Since avian H4N6 is just one of many non-swine viruses jumping to pigs (see below), the concern is this mix and match style of evolution will eventually produce a viable subtype with genuine pandemic potential.

For other recent swine reassortant related blogs, you may wish to revisit:

J. Virology: A Single Amino Acid Change Alters Transmissability Of EAH1N1 In Guinea Pigs

I&ORV: Triple-Reassortant Novel H3 Virus of Human/Swine Origin Established In Danish Pigs

Emerg. Microbes & Inf.: Pathogenicity & Transmission Of A Swine Influenza A(H6N6) Virus - China

Sci Rpts:Reassorted H9N2:pH1N1 Virus Transmission After Serial Passage In Swine

 

Saudi MOH: 6 MERS Cases Over Past 4 Days

#12,724



With literally a couple of million religious pilgrims flooding into Saudi Arabia for this week's Hajj, any uptick in MERS activity - even away from the Holy Cities of Meccah and Medinah - is of concern.

Unfortunately, reporting from the MOH over the past 10 days has become erratic again, with delayed postings, skipped days, and incorrectly labeled links (see master list below). 

Since Thursday, 6 new cases have been announced, five of which come from Domat Al Jandal (aka Dawmat AlJandal) region, which between August 2nd and 11th reported 13 cases linked to a hospital/family cluster (see WHO Aug 17th Update). 

The initial case reported August 2nd (M,51) was listed as having an unknown primary exposure. 

After a break of nearly 2 weeks, on the 24th a primary case (F, 40) was reported (again, no known exposure) again from Domat Al Jandal , followed yesterday by 3 household contacts (2 girls ages 10 & 14, and 1 male age 50).  The two young girls are listed asymptomatic.

Today KSA is reporting yet another primary case from Domat Al Jandal (F, 33), again with no listed exposure. 

While the source of many MERS infections are self evident (camel contact, household contact, hospital acquired), for many we simply don't know how an individual was exposed.  The possibility has been raised of mild or asymptomatic transmission in the community, but that remains largely unproven.

Exactly why Domat Al Jandal has seen so many community acquired cases this month remains a mystery, although hopefully someone is doing the necessary epidemiological investigations to explain it. 

Meanwhile, the Hajj is set to begin on Wednesday, August 30th and run through next Monday.

J Vet Sci: Evolution, Global Spread, And Pathogenicity Of HPAI H5Nx Clade 2.3.4.4

Credit J. Vet. Sci. 2017; 18(S1): 269-280 

#12,723



Although wild and migratory (particularly aquatic) birds are the primary reservoir for LPAI (Low Pathogenic Avian Influenza) viruses - until 1996,  highly pathogenic (HPAI) viruses had only been detected on poultry farms.

Mutated HPAI viruses would sometimes appear on farms after LPAI H7 and H5 viruses circulated unchecked among gallinacious birds (chickens, turkeys, quail,  etc.) for several weeks. Hence the OIE regulation to quarantine, cull, and report any H5 or H7 outbreak, even if its pathogenicity is low.

Also called `fowl plague', HPAI viruses were never detected in wild or migratory birds until 1996, when a previously unknown H5N1 virus (clade 0) was detected in a domestic goose in Guangdong Province, China (A/Goose/Guangdong/1/1996 (GsGD)).

The following year, H5N1 appeared in Hong Kong's chickens, and sparked the first human epidemic, hospitalizing 18 and killing six (see Outbreak of avian influenza A(H5N1) virus infection in Hong Kong in 1997). A bold decision to cull every chicken in Hong Kong, and the immediate isolation of cases, are credited with stopping this first outbreak.

The virus appeared to go to ground for five years, but re-emerged - albeit as a new clade - in Hong Kong when a two members of a family fell ill (one fatally) after returning from Fujian Province on the Mainland. A third relative died (untested) on the mainland.

Credit WHO

Within a year, variants of this H5N1 virus caused outbreaks in poultry, wild birds, humans, and even captive animals from Beijing and Korea to Thailand and Vietnam. Two years later, H5N1 had made it out of Asia and was impacting Europe, Africa, and the Middle East.

And as H5N1 expanded geographically, it expanded genetically as well (see chart below), forming new clades, subclades, and genotypes. Many of these variants were less `fit' than their competition, and died out along the way, but others thrived and survived, and became the dominant clade in different parts of the world. 

 

The most recent WHO report finds H5N1 clade 2.2.1.2  viruses circulating in Egypt, clade 2.3.2.1c viruses in China, West Africa, and Southeast Asia, and clade 2.3.2.1a viruses in Bangladesh, Bhutan and India.

While there were other H5 viruses in circulation (primarily in China) - including HPAI H5N2, H5N5, and H5N8 - until 2014, H5N1 was the HPAI H5 virus of greatest concern. That year two new clade 2.3.4.4. subtypes emerged; H5N8 in South Korea, and H5N6 in China/Laos/Vietnam.

H5N8 is the first HPAI H5 virus to make the jump to North America sparking the United State's largest avian flu outbreak, and caused Europe's greatest epizootic on record last winter.  H5N6 has shown a limited ability to infect - and kill - humans, and has expanded its range in eastern Asia (Japan, South Korea, Philippines, Taiwan) over the past year.

Not only have both have proven themselves to be unusually well adapted for carriage by wild and migratory birds, they are both evolving at a rapid rate. All of which brings us to an excellent, and highly detailed look at this growing threat.  

I've included a link, the abstract, and few small excerpts, but you'll definitely want to download, read, and save the full report.

J. Vet. Sci. 2017; 18(S1): 269-280  

Evolution, global spread, and pathogenicity of highly pathogenic avian influenza H5Nx clade 2.3.4.4
 
Dong-Hun Lee1, Kateri Bertran1, Jung-Hoon Kwon2, David E. Swayne1,*

Received: June 30, 2017; Accepted: July 22, 2017; Published online: August 31, 2017.

Abstract

Novel subtypes of Asian-origin (Goose/Guangdong lineage) H5 highly pathogenic avian influenza (HPAI) viruses belonging to clade 2.3.4, such as H5N2, H5N5, H5N6, and H5N8, have been identified in China since 2008 and have since evolved into four genetically distinct clade 2.3.4.4 groups (A–D). 

Since 2014, HPAI clade 2.3.4.4 viruses have spread rapidly via migratory wild aquatic birds and have evolved through reassortment with prevailing local low pathogenicity avian influenza viruses. Group A H5N8 viruses and its reassortant viruses caused outbreaks in wide geographic regions (Asia, Europe, and North America) during 2014–2015. 

Novel reassortant Group B H5N8 viruses caused outbreaks in Asia, Europe, and Africa during 2016–2017. Novel reassortant Group C H5N6 viruses caused outbreaks in Korea and Japan during the 2016–2017 winter season. Group D H5N6 viruses caused outbreaks in China and Vietnam. A wide range of avian species, including wild and domestic waterfowl, domestic poultry, and even zoo birds, seem to be permissive for infection by and/or transmission of clade 2.3.4.4 HPAI viruses. Further, compared to previous H5N1 HPAI viruses, these reassortant viruses show altered pathogenicity in birds. 

In this review, we discuss the evolution, global spread, and pathogenicity of H5 clade 2.3.4.4 HPAI viruses.

(SNIP)

Concluding Remarks
 
Since 2014, HPAI clade 2.3.4.4 viruses have spread rapidly and globally through wild birds and have evolved through reassortment with prevailing local LPAI viruses. A wide range of avian species, including wild and domestic waterfowl, domestic poultry, and even zoo birds, appear to be permissive for infection by and/or transmission of clade 2.3.4.4 viruses. 

In general, clade 2.3.4.4-infected birds exhibit clinical disease, mortality, and pathological features that are indicative of a typical HPAI virus infection, although several studies have pointed out that these H5 reassortants have reduced virulence compared to the parental Gs/GD H5N1 virus. Interestingly, clade 2.3.4.4-infected waterfowl may either succumb to infection or act as asymptomatic spreaders, even with viruses that are optimally adapted to domestic poultry. 

The wide host range of clade 2.3.4.4 viruses, which can enable unrecognized virus spread, might explain the successful recent globalization of this lineage. The emergence of novel reassortant viruses and their circulation among bird populations are of great concern because of the potential for virus dissemination by intercontinental wild bird migration. 

Therefore, in places where HPAI has become endemic in domestic poultry, explicit efforts should be taken to eradicate HPAI by using a combination of preventive and control measures that include stamping out, appropriate vaccination with post-vaccination monitoring, movement control, and enhanced biosecurity. In addition, intensified surveillance and further characterization of HPAI viruses can provide insight into preventing future outbreaks and assessing zoonotic potential.

Keywords: epidemiology, influenza in birds, poultry, transmission, virulence

© 2017 The Korean Society of Veterinary Science.

After the dramatic changes in range and behavior that came with both H5N6 and H5N8 last winter, there is a great deal of interest in what might return this fall. While no study can predict that with any accuracy, this report does provides us with a detailed benchmark for comparison.

It also reminds us how quickly things can change, particularly when dealing with a rapidly evolving influenza virus.

Germany Finds H5N8 In 3 Dead Swans

#12,722


Earlier this week the carcasses of 3 dead swans were sent to the testing laboratory at Germany's Friedrich-Loeffler-Institut (FLI).   Although the OIE hasn't posted anything yet, German media is reporting overnight that the results have come back positive for H5N8.

Two (translated) reports, then I'll return with a bit more.

Bird flu H5N8 detected in dead swans

Friday, 08.25.2017, 16:12

The three dead swans near Seeburg in Mansfeld-Südharz the bird flu virus H5N8 has been detected. All three samples were in nationwide competent Friedrich Loeffler Institute tested positive for the highly infectious virus (FLI), the environment and agriculture ministry said in Magdeburg on Friday.

Around the area where the swans a restricted area with a radius of one kilometer and an observation area had been established with a radius of three kilometers. In Sperrbezirk Nine poultry farmers befänden with 120 animals, in the observation area 62 poultry farmers are established with 1,239 head of poultry. Animals would be held from once in stables and should no longer outside.

The swans were found on Tuesday. The European circulating avian influenza H5N8 was last registered to FLI information in a wild bird in Germany in May in North Rhine-Westphalia. The virus can persist in the soil and infect animals later according to the experts. But it is also possible that they are entered on wild birds new to Germany.

         (Continue . . . )

Dead swans in Seeburg detected bird flu virus at Sweet Lake

At Sweet lake in the district of Mansfeld-Südharz the bird flu virus H5N8 has been detected in three dead swans. In a restricted area of ​​one kilometer around Seeburg and in the observation area poultry must now remain in the stables. 71 poultry farmers are affected by the arrangement. Owners of dogs and cats must ensure that their animals do not walk about freely.

In Saxony-Anhalt, the bird flu is back. On all three dead swans on the lake Sweet highly contagious viral H5N8 has been detected. This was announced by the Ministry of Environment with early Friday afternoon. Geflügekhalter must keep their animals in sheds. The barn obligation concerns nine poultry farmers with 120 animals, in the observation area 62 poultry farmers with 1,239 animals.

The district Mansfeld-Südharz had announced on Friday morning that a H5 virus was detected in the three dead swans. The dead animals were sent to determine the virus subtype in the Friedrich Loeffler Institute on the island Riems.

A spokeswoman for the institute said MDR SACHSEN-ANHALT because the timing was so early in the year very unusual must be examined whether the virus had come to Germany recently. It could also be that it is the same virus that causes the end of 2016 to May 2017 Germany had occurred. With a first result you could probably count on Monday, the spokeswoman said.

         (Continue . . . )


Since we've seen a modest number of reports of H5N8 lingering in Europe over the the summer (see here, here, and here) it is very possible that these swans were infected by the remnants from last winter's epizootic.

But with legitimate concerns this fall's southbound migration could bring a fresh wave of avian flu, authorities will be looking closely at these viruses to see if there are any genetic changes that would suggest they only recently arrived in Germany. 

Although it seems early, in many places migratory birds are already on the move, as explained by the following article from eBird.org.

Understanding birds & weather: Fall birding basics

(Excerpt)

Fall migration starts earlier than most people realize, with many shorebirds on the move by late June, and the first landbirds heading south soon thereafter. August through October are peak months, but migration continues into December for some species, especially shorter-distance landbirds (e.g., sparrows, blackbirds), raptors, waterfowl, and seabirds. 

Considering the changes in behavior that came with last year's virus (see EID Journal: Reassorted HPAI H5N8 Clade 2.3.4.4. - Germany 2016), there will be a good deal of interest should any new changes be found.

Stay tuned.

Harvey: Downgraded, But Far From Over

#12,721


Although we won't get a good idea of the scale and scope of Harvey's destruction for a few more hours - based on the live streaming from storm chasers hunkered down in  Rockport as it came ashore last night - this storm was truly a CAT 4 at landfall. 

And that means a lot of people may be forced to fend for themselves, or rely on neighbors and friends  - perhaps for days - until help can arrive.  A reminder of the importance of individual, family, and community preparedness.

This morning, the NHC has downgraded the storm to a CAT 1, but all indications are it will linger in the region as a storm, then as a depression, dropping heavy rain for several more days.  Thirty inches of rain are possible in some areas.

After the rains end, flood waters will be slow to recede, and they can leave behind a multitude of hidden dangers. Downed electrical lines, dangerous debris, weakened and compromised structures, and even displaced wildlife can pose ongoing threats following the storm.

Not only do flood waters easily hide dangerous objects - like broken bottles, razor sharp metal sheeting, live electrical wires, and rusty nails – they can also harbor nasty viruses and bacteria, along with dangerous wildlife. 

A review, therefore, of some of those threats and how to avoid them:

First, many people may find themselves without electrical power, Internet or even cell phone service for days, or possibly even weeks. In 2012, Hurricane Sandy left some parts of the Northeast without power for a week or longer, while Katrina took out the power for well over a month in parts of Louisiana and Mississippi.

While most people will have battery operated flashlights or LED lanterns (no candles, please!) for lighting, many people can expect to lose perishable food items as freezers and fridges begin to lose their chill.

The USDA maintains a Food Safety and Inspection website with a great deal of consumer information about how to protect your food supplies during an emergency, and how to tell when to discard food that may no longer be safe to consume.

A Consumer's Guide to Food Safety: Severe Storms and Hurricanes

    Note: This text-only version of the Guide has been optimized for accessibility. The illustrated PDF version (2.1MB) is recommended for printing.

        Power Outages
        Safety of Food in Containers Exposed to Flood Waters
        Removing Odors from Refrigerators & Freezers
        Refrigerator Foods
        Frozen Food
        Food Safety Contacts for Areas Affected by Severe Storms and Hurricanes

    FOOD SAFETY DURING AN EMERGENCY

    Did you know that a flood, fire, national disaster, or the loss of power from high winds, snow, or ice could jeopardize the safety of your food? Knowing how to determine if food is safe and how to keep food safe will help minimize the potential loss of food and reduce the risk of foodborne illness. This Consumer's Guide will help you make the right decisions for keeping your family safe during an emergency.

Another common risk that comes when dealing with power outages is the use of generators, and improvised cooking or heating methods, which if done improperly can result in (preventable) Carbon Monoxide poisonings.

In Carbon Monoxide: A Stealthy Killer I wrote in depth on the issue, but this brief video from the CDC will provide you with an overview.

CO poisoning should not to be underestimated. It is colorless, odorless, and often induces a state of lethargy which prevents people from realizing they are being slowly poisoned.  After every major storm we see numerous deaths and injuries from CO poisoning.

Chainsaw accidents also figure prominently after many weather-related disasters, as many people with little experience find themselves clearing driveways and rooftops of fallen branches. The CDC maintains a chainsaw safety web page:

Preventing Chain Saw Injuries During Tree Removal After a Disaster

Each year, approximately 36,000 people are treated in hospital emergency departments for injuries from using chain saws. The potential risk of injury increases after hurricanes and other natural disasters, when chain saws are widely used to remove fallen or partially fallen trees and tree branches.

    (Continue . . .)

Flooding, or standing water can provide its own set of challenges, as it can easily become contaminated with chemicals and sewage. The CDC provides a web page on these threats as well.  Often, cases of Vibrio vulnificus infection (see Vulnerable To Vibrio) will spike following coastal flooding events.

Flood Waters or Standing Waters    

Health Risks

Flood waters and standing waters pose various risks, including infectious diseases, chemical hazards, and injuries.

Infectious Diseases expanded

For more detailed information, see CDC’s Infectious Disease After a Disaster page.

Diarrheal Diseases 

Wound Infections 

Other Health Effects 

Chemical Hazards 

Injuries 

Cleanup of Flood Water

When returning to your home after a flooding emergency, be aware that flood water may contain sewage. For more information on how to protect yourself and your family, visit CDC’s Flood Water After a Disaster or Emergency.

More Information

• CDC. After a Flood
• CDC. Prevent Illness and Injury After a Disaster
• Ready.gov. Floods

In the aftermath of a storm it is important to realize that you, your family, or your neighbors may find yourself suffering from the psychological effects of the disaster. 

Four years ago, in Sandy 1 Year Later: Coping With The Aftermath, we looked at some of the lingering effects of New England’s brush with that storm, and in 2015 the CDC held a COCA Call: Understanding The Mental Health Impact Of Hurricane Sandy.

While the psychological impact of a major disaster can never be fully prevented, individual, family, and business preparedness can go a long ways towards reducing the impact of any disaster.

The National Center For PTSD provides guidance - including videos - on how to provide Psychological First Aid.

Psychological First Aid: Field Operations Guide

    Psychological First Aid
    For Disaster Responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning.

A small reminder that in the wake of a major disaster not all wounds bleed, not all fractures will show up on an X-ray, and that the best treatment won't always be found inside your first aid kit. 


Lastly, September is National Preparedness Month, and once again this year AFD is proud to lend support to this important topic.  But as Hurricane Harvey shows, disasters can happen anytime, and often with little or no warning. 

The time to prepare is always before a threat appears on the horizon. Wherever you are, the time to prepare is now.

To become better prepared as an individual, family, business owner, or community to deal with all types of disasters, I would encourage you to visit the following preparedness sites.

FEMA http://www.fema.gov/index.shtm
READY.GOV http://www.ready.gov/
AMERICAN RED CROSS http://www.redcross.org/

A few of my (many) blogs on this subject include:

In An Emergency, Who Has Your Back?

When 72 Hours Isn’t Enough

When Evacuation Is The Better Part Of Valor