HK CHP Notified Of Human H5N6 Case In Gaungdong Province

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After months of very little avian flu activity reported from China - likely due to their aggressive poultry vaccination program launched last summer -  over the past few weeks we've seen a slight uptick in H5N6 activity.

In August, we saw Guangxi Province Report Their 3rd Human H5N6 Infection - and only the 2nd case of 2018 - and just yesterday we saw  An HPAI H5N6 Outbreak In Guizhou Province Poultry.

In the past few hours Hong Kong's CHP has posted a notification of a new H5N6 infection in Guangzhou in Guangdong Province. This is the 8th case reported from Guangdong Province since the virus emerged in 2014, and the first there in 30 months.

The patient is a 22 year old man reported to be in serious condition. He apparently had recent contact with live poultry.

Although we've only seen full notifications of 20 cases (hence the numbering in the graphic above), 1 additional case is known to have been reported to the WHO - making this the 21st human case on record.

Gaps in surveillance and testing - which we've discussed before - may also contribute to these relatively low numbers.

While two cases - 5 weeks and 500 km apart - isn't what you would call a trend, traditionally August and September are pretty quiet months for avian flu in China. Nearly half (n=9) of all human H5N6 infections have been reported in either November or December.

These last two cases, in fact, are the only H5N6 infections to be reported in either August or September. Its close proximity to Hong Kong (75 miles) is also worth noting.

The HK CHP announcement follows:

HP notified of human case of avian influenza A(H5N6) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) today (September 30) received notification of an additional human case of avian influenza A(H5N6) in Guangdong from the National Health Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The case involved a 22-year-old man from Guangzhou in Guangdong. He developed symptoms on September 25 and was hospitalised on the next day. He is now in a serious condition. The patient had contact with live poultry before the onset of symptoms.

From 2014 to date, 21 human cases of avian influenza A(H5N6) have been reported by the Mainland health authorities.

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," the spokesman said.

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

While local surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

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 if 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 the eggs 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/Sunday, September 30, 2018
Issued at HKT 22:51

China: MOA Announces 5 New Outbreaks Of ASF In Liaoning Province

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In early August China's MOA reported their country's first occurrence of African Swine Fever (in Liaoning Province), which was followed up a month later with 4 more retrospective reports from the same region.  From the OIE report.

In total 19,373 pigs were killed and disposed of, including 8,116 pigs in the epidemic area and 11,257 pigs in the process of screening and tracing. Seven new pathogenic positive cases were detected from 59 samples collected from 4 pig farms in 2 towns of Shenbei New District.

Yesterday the provincial government announced the removal of their blockade on the shipping of pigs from that region, citing no new occurrences over the past 6 weeks. This from Xinhua news yesterday.

Lifting the blockade of the African pig plague area in Shenyang, Liaoning Province

Xinhua News Agency, Beijing, September 29th

The Ministry of Agriculture and Rural Affairs received a report from the Animal Husbandry and Veterinary Department of Liaoning Province on the 29th. After passing the assessment and acceptance, the African pig plague area in Shenyang, Liaoning Province has been lifted.

(SNIP)

After the completion of the culling of the pigs in the epidemic area, after 6 weeks of continuous monitoring and investigation, no new cases and monitoring were found in the affected areas. The local animal husbandry and veterinary department tested the epidemic area and checked the situation of the epidemic, in line with the regulations on the lifting of the blockade in the epidemic area. The African swine fever has been extinguished. The local government issued an unblocking order to lift the blockade of the infected area.

(Continue . . . )

This welcome news was short lived, however, as twenty-four hours later the MOA has announced 5 new outbreaks in and around Yingkou City, Liaoning Province - about 100 miles south and west of Shenyang.

African swine fever epidemic in Yingkou City, Liaoning Province

Date: 2018-09-30 17:11 Author: Source: Ministry of Agriculture and Rural Press Office

The Information Office of the Ministry of Agriculture and Rural Affairs was released on September 30, and an epidemic of pigs and African pigs occurred in Yingkou City, Liaoning Province.

On September 28th, the Liaoning Provincial Animal Disease Prevention and Control Center detected that some samples sent by Yingkou City according to the special monitoring program were positive for African piglet nucleic acid.

On September 30, it was diagnosed as African swine fever by the China Center for Animal Health and Epidemiology (National Center for Animal Disease Research).

The positive samples were from five farmer households in Dashiqiao City and Laobian District of Yingkou City. There were 378 live pigs and 102 deaths.

Immediately after the outbreak, the Ministry of Agriculture and Rural Affairs sent a steering group to the local area. The local government has started the emergency response mechanism as required, and adopted measures such as blockade, culling, harmless treatment, disinfection, etc., to treat all the sick and culled pigs harmlessly. At the same time, all live pigs and susceptible animals and products are prohibited from entering or leaving the blockade. At present, the above epidemic has been effectively disposed of.

Although the `official' count varies from source to source, the number of outbreaks in China since early august is well over two dozen across 8 provinces and/or territories.  

While ASF doesn't pose a health risk to humans, it is truly a nightmare disease for pig producers - and with no vaccine available - the only way to control it is to cull all of the pigs that may have been exposed.    

For more on the growing threat of ASF to China, its neighbors, Europe, and potentially the world, you may wish to revisit:

FAO: African Swine Fever (ASF) `Here to Stay' In Asia

African swine fever (ASF) threatens to spread from China to other Asian countries

Russia: Rosselkhoznadzor Tracing ASF Contaminated Meat Products

UK: DEFRA Preliminary Assessment Of ASF Reported In Belgium

Saudi MOH reports 2 More MERS Cases

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Ten days ago, in Saudi MOH Reports 5th MERS-CoV Case In Buraidah For September, I reported on an uptick in that region which included both household and hospital secondary cases.

Today, the Saudi MOH has announced two new MERS cases. One community acquired case is from Buraidah, while the other is listed as from `Alasiah City' (aka Al-asyah) - which is about 20 miles outside of Buraidah.

This second case is listed as deceased, and is still under investigation. Details are printed below:

MERS in Buraidah city: 65-year-old male in Buraidah city, Qaseem region
29/09/2018

New

Contact with camels: No
Case classification: Primary, community acquired
Current status: Hospitalized

----------------------------------------------
MERS in Alasiah city: 46-year-old male in Alasiah city, Qaseem region
29/09/2018
New

Contact with camels: No
Case classification: Under investigation
Current status: Deceased

The Qaseem region has about 1.3 million people, or roughly 4% of the total Saudi Arabian population.  Since September 1st, this region has provided 8 of the 13 MERS cases reported by the MOH (6 from Buraidah, 2 from elsewhere in the region). 

• The first Qaseem case (Sept 1st) reportedly had camel contact
• the 2nd & 3rd are simply listed as a `community acquired' cases  
  
• case #4 is listed as secondary, hospital acquired 
• case #5 is listed as secondary, household contact.  
• Case #6 is still listed as under investigation. 
• Case #7 is listed as Primary, community acquired 
• and case #8 is under investigation.

Five of the 8 Qaseem patients are listed as deceased, including the latest one added today, which is high, even for MERS.  Seven of the eight cases are male, and patient ages range from 45 years to 66 years. 

There really isn't enough information here to make any determination of exactly what epidemiological links - if any - might exist between any of these cases, other than there were two secondary cases reported. 

Hopefully we'll get a more detailed report from the monthly WHO EMRO MERS Outbreak Summary, due in about 2 weeks. Until then, we'll continue to keep an eye on the region.

WHO: Candidate Vaccines For Pandemic Preparedness - Sept 2018

Credit NIAID

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As we discussed yesterday morning, twice each year influenza experts gather to discuss recent developments in human and animal influenza viruses around the world.

Yesterday we looked at the WHO's recommendations for next year's Southern Hemisphere seasonal flu vaccine, while today we'll look at their selections for the development of novel flu vaccines for those viruses that possess some degree of pandemic potential.

Just as there are currently more than a half dozen subclades of seasonal H3N2 jockeying for dominance in the flu world (see The Enigmatic, Problematic H3N2 Influenza Virus), there are dozens of subclades and genotypes of avian and swine flu viruses competing in the wild.

Simply put, the H5N1 virus in Egypt (Clade 2.2.1.2) isn't isn't the same as the H5N1 virus in Nigeria (Clade 2.3.2.1c), or the one circulating in Bangladesh (Clade 2.3.2.1a).

So, when we speak of the avian H5N1 virus, or H7N9 - we are really talking about multiple genetically distinct variants - each on their own evolutionary path. And a vaccine developed against one strain of the same subtype may not prove protective against another.

Since H5N1 emerged in 2003, more than three dozen H5N1 candidate vaccine viruses (CVVs) have been selected by WHO for development.  While it can be expensive, having a proven CVV already tested and approved can save months of valuable time if mass production and distribution of a vaccine is ever required.

Similarly there are currently 14 H7N9 CVVs, and 7 H9N2 CVVs either developed or in the pipeline.  Other novel viruses, including swine variant H1 and H3 viruses, have CVVs as well.

The latest report from the WHO calls for 3 new CVVs (2 avian, 1 Swine variant) to be developed:

Influenza A(H5) candidate vaccine viruses
 
Based on the current antigenic, genetic and epidemiologic data, a new A/duck/Bangladesh/17D1012/2018-like A(H5N1) CVV is proposed.

Influenza A(H9N2) candidate vaccine viruses

Based on the current antigenic, genetic and epidemiologic data, a new A/Anhui-Lujiang/39/2018-like A(H9N2) CVV is proposed

Influenza A(H1)v candidate vaccine viruses
Based on the current genetic and epidemiologic data, a new A/Michigan/383/2018-like A(H1N2)v CVV is proposed.

 The highly detailed full report can be read at:

Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness

September 2018

The development of influenza candidate vaccine viruses (CVVs), coordinated by WHO, remains an essential component of the overall global strategy for pandemic preparedness. Selection and development of CVVs are the first steps towards timely vaccine production and do not imply a recommendation for initiating manufacture. National authorities may consider the use of one or more of these CVVs for pilot lot vaccine production, clinical trials and other pandemic preparedness purposes based on their assessment of public health risk and need.

Zoonotic influenza viruses continue to be identified and evolve both genetically and antigenically, leading to the need for additional CVVs for pandemic preparedness purposes. Changes in the genetic and antigenic characteristics of these viruses relative to existing CVVs, and their potential risks to public health, justify the need to select and develop new CVVs.

This document summarises the genetic and antigenic characteristics of recent zoonotic influenza viruses and related viruses circulating in animals 1 that are relevant to CVV updates. Institutions interested in receiving these CVVs should contact WHO at gisrs-whohq@who.int or the institutions listed in announcements published on the WHO website 2 .

        (Continue . . . )

#NatlPrep: The Gift Of Preparedness 2018

Note: September is National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.

This month, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.

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Eleven years ago, in Hickory Farms Will Hate Me For This, I began promoting the idea that - instead of gifting cheese platters, fruitcakes and ugly sweaters to friends and family we should be giving preparedness items for holidays, birthdays, and anniversaries.

As the CDC infographic above illustrates, nearly half of all Americans families don't even have the basics to deal with a short term emergency, much less a major disaster.

This was driven home for me a little a year ago when Hurricane Irma was bearing down on Florida, and I saw thousands of Floridians going from store to store, desperately seeking flashlights, bottled water, and batteries.

Luckily, I'd prepared months in advance, and was even able to help out a couple of neighbors with extra LED lanterns, a camp stove, and some other supplies. 

But as prepared as I thought I was, my 5-day bug out experience highlighted some gaps in my own preparedness plans, which I've worked on rectifying over the past 12 months.

While everyone will need to craft their own preparedness plans, and gear, to suit their particular circumstances (in Florida, I don't have to worry about earthquakes or blizzards, but hurricanes and power outages are real threats), your basic goals should include having:

• 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 when the grid is down.
• A way to cook safely without electricity
• A way to purify or filter water
• A way to stay cool (fans) or warm when the power is out.
• A small supply of cash to use in case credit/debit machines are not working 
• An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag
• Spare supply of essential prescription medicines that you or your family may need
• A way to entertain yourself, or your kids, during a prolonged blackout

Whether due to a hurricane, an earthquake, a solar flare, or a deliberate EMP or cyber attack, a widespread grid down situation - such as what happened in Puerto Rico after hurricane Maria - is every emergency manager's worst nightmare (see When Our Modern Infrastructure Fails).

While having no TV, or Internet, or electric lights for a week or two might seem more of an inconvenience than anything else, sometimes not having power can be deadly.

During the summer of 2012, a powerful Derecho swept across the Mid-Atlantic states (see Picking Up The Pieces), killing 15 and leaving nearly 4 million people without power, some for more than 2 weeks. While 15 people died during the storm, at least 32 died of heat-related illnesses in the two weeks that followed (cite).

Below you'll find some of the types of items that I have either bought for myself, or for other people, in my quest to become better prepared.  Most of these items are inexpensive - many under $20 - but are invaluable when you really need them.

Products mentioned or pictured below are to provide a general idea of the type of gift, and should not be viewed as an endorsement of one brand over another. I often find these gifts on sale in discount stores, bargain basements, and flea markets, and stock up whenever I come across a good deal. 

Sometimes I make the gifts myself, as when several years back I cobbled together some first aid kits, and distributed them to a number of friends and relatives. You can either put one together yourself, or purchase one already assembled. 

 









Trust me, there is no substitute for having a well stocked first aid kit when you really need one. Having a kit isn't enough.  Knowing what to do in an emergency is equally  important.  Luckily there are a number of good first aid books available, including:

A couple of years ago I also bought several 5 gal. buckets (with lids) from a home improvement store, along with mylar bags and oxygen absorbers from Amazon, and put together some long-term food storage buckets for friends.  

Cost per bucket?  About $30.  But enough food to keep two people going for ten days or more in an emergency.  I keep a couple on hand (one for me, one for the cat), myself.

Anyone who knows me knows that I have a particular interest in (ok, its more of a fetish for) LED flashlights and lanterns. Probably because I lived so many years aboard a sailboat in the tropics with hot, smelly kerosene lanterns.

LEDs are far preferable to many other light sources because they run a very long time on batteries, they don't pose the fire hazard of candles or kerosene, and they don't produce heat or fumes.

My collection of LED lights continues to grow, and the best part is none of the items pictured below cost me more than $5 each.  My local Walmart has LED flashlights for $1 apiece in the sporting goods section; cheap but serviceable and a great stocking stuffer.

High on the list of things to have is a way to make water potable.

Although (unscented) bleach will work, it requires measuring, and imparts a taste to the water many dislike.  An option that has gotten a lot less expensive in recent years are personal filtration systems, like the LifeStraw ®.
 

At just 2 ounces, this personal water filter will reportedly filter 1000 liters down to .2 microns. Not bad for around $20.  I've recently added the Sawyer Mini-Filter to my preps, again about $20.

Speaking of water, having a way to store enough water for three days (1 gal/person/day) is essential. A family of 4 will need at least 12 gallons for 72 hours.   Personally, I keep enough on hand for a couple of weeks.

While there are plenty of `free options’ – like rinsed and recycled 2-liter plastic soda bottles or other food-safe plastic jugs – you can also buy collapsible 5 gallon containers.

I also picked up a few single burner Propane stove units on sale for $10 each. Add a couple of 1 pound propane cylinders (about $3 each) and you can cook for a week.

Every home should have a battery operated radio (with NWS weather band), yet many do not.  Some are available with crank or solar charging.  In any event, you'll want something which can pick up the NOAA NWS Emergency Broadcaster in you region.

As I've described previously in Rethinking Solar Power On A Budget, it is a relatively easy task to set up a simple solar charging system.

No, you won’t keep the A/C or refrigerator running on a budget system, but you can keep your LED lantern batteries, cell phone, iPod or iPad, or notebook computer running.

In recent years I'm seeing reasonably priced `briefcase’ solar panels – often for between $50 and $80 – that, when unfolded, can charge a 12 volt storage battery with up to 13 watts of power. Add a $20 inverter (converts 12 volt battery power to 120v AC), and you can do a heck of a lot.











 
For cell phone charging, LED lights, and running mini-fans I've recently purchased several solar charging USB battery packs.  I haven't tested the solar charging efficiency yet, but I expect these 10,000 mAh battery packs will recharge with 12 to 15 hours of direct sun. 







.



While far less powerful than my 12 volt solar panels and batteries, these are portable enough to go in my bug out bag, and a pair of them should keep my phone, MP3 player, LED light, and USB mini-fan (see below) going pretty much non-stop. 

Something as simple, and as utilitarian, as a multi-function `Swiss’ army knife, a`Multi-tool’, a `plug in' auto 12 volt USB charger (see below), or even  multi packs of AA or AAA batteries, makes a great preparedness gift.









While not necessarily lifesaving, having a way to occupy your mind (or your kids) during an extended grid down situation can help maintain your sanity.  Books, board games, and having good old-fashioned conversations are undoubtedly the best, but when they run dry having a low drain battery powered MP3 player, or a battery run DVD player, can seem like a lifesaver.

Take a walk through any camping supply or hardware store and you will find plenty of inspiration. Just ask yourself . . . what would you want if the power and water were out for a week or longer, and the stores were closed?  Buy first for yourself, and then for a friend or a loved one.

In a world where bad things can, and do happen, we need to cultivate a culture of preparedness both here in this country, and around the world. 

And we can start doing that, one gift at a time.

China: MOA Announces HPAI H5N6 Outbreak In Guizhou Province Poultry

Guizhou Province - Credit Wikipedia

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China's aggressive use of a new H5+H7 poultry vaccine (see 2017's  China MOA Orders HPAI H7N9 Vaccine Deployed) has led to a remarkable drop in poultry outbreaks over the past year (see CIDRAP News' Study: Bivalent avian flu vaccine tied to less H7N9 in Chinese poultry), although occasional outbreaks of both H5N6 and H7N9 have been reported. 

Human infections have been drastically reduced as well, although not entirely eliminated. A little over a month ago, in China: Guangxi Province Reports Their 3rd Human H5N6 Infection, we saw China's 2nd reported H5N6 case of 2018.

 
Today, from the same province (Guizhou), China's MOA is reporting on an outbreak of H5N6 at a poultry farm located some 350 km to the NW of the human case reported in Laibin last August. 

So far, I've found no reports of any human cases linked to this outbreak.

(translation)

A highly pathogenic avian influenza epidemic of poultry H5N6 subtype occurred in Huishui County, Guizhou Province
 
Date: 2018-09-29 16:38 Author: Source: Ministry of Agriculture and Rural Press Office 

The Information Office of the Ministry of Agriculture and Rural Affairs was released on September 29, and a high-pathogenic avian influenza epidemic of poultry H5N6 subtype occurred in Huishui County, Guizhou Province, Buyi and Miao Autonomous Prefecture.

On September 7, some poultry raised in Huishui County died of unexplained death. As of September 16, there were 11,055 poultry, 5,297 poultry, and 4,948 dead poultry. On September 16, Guizhou Provincial Animal Disease Prevention and Control Center diagnosed a suspected bird flu epidemic. On September 29, the National Avian Influenza Reference Laboratory confirmed that the epidemic was a highly pathogenic avian influenza outbreak of H5N6 subtype.

After the outbreak, the local authorities adhered to the relevant laws and regulations on prevention and control, adhered to the law prevention and control, scientific prevention and control, and effectively handled the epidemic situation. They have culled 32,351 poultry, and all the sick and culled poultry have been treated harmlessly. At present, the epidemic has been effectively controlled.

Despite the initial success of China's bivalent poultry vaccine rollout, avian influenza viruses continue to circulate and evolve in both poultry and in wild birds, and some may eventually drift far enough away from the vaccine strain that they are able to stage a comeback.

And when one set of viruses are well suppressed by a vaccine, it may provide an opportunity for other subtypes to emerge, such as the H10N8, H7N4, or H6N1 viruses we've on rare occasions in recent years.

All reasons why, despite the recent respite in bird flu in China, we continue to watch the region with considerable interest.

WHO Raises Risk Assessment On Ebola In the DRC

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Although the number of new confirmed Ebola cases in the DRC has dropped since earlier this summer, the WHO's latest assessment (Ebola virus disease – Democratic Republic of the Congo) increases the national and regional public health risk levels to VERY HIGH due to `. . . recent increases in insecurity, incidents of community reluctance and geographical spread.'

Last week's risk assessment read (in part):

Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally. 

As the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.

The latest assessment raises the ante, with:

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries.

The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri continues to hinder the implementation of response activities. Since the last Disease Outbreak News on 20 September 2018, WHO has assessed the risk to be very high at the national and regional levels, and low globally³. 

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities³. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.

WHO advice

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no countries have implemented any travel restriction to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

       (Continue . . . )

UK: DEFRA Update #1 On African Swine Fever in Wild Boar in Belgium

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Two weeks ago, in UK: DEFRA Preliminary Assessment Of ASF Reported In Belgium, we saw the first details on the abrupt arrival of African Swine Fever to North Central Europe.  Four wild boar, found dead near the border with both France and Luxembourg, were initially confirmed as infected.

Since then, additional wild boar in the region have been found dead, and have tested positive for the virus.

Today DEFRA returns with an updated assessment of the situation, and the risks it poses to the pork producers in the UK and the rest of Europe.

Department of Environment, Food and Rural Affairs
Animal and Plant Health Agency
Advice Services Team - International Disease Monitoring
Updated situation assessment #1
27 September 2018

Ref: VITT/1200 ASF in wild boar in Belgium

African swine fever in wild boar in Belgium

Disease report

The Belgian Authorities have reported three new cases of ASF in wild boar since our first report (5 in total) in the Luxembourg region of Belgium (see map), close to the border with France. According to the three new disease reports, this involved a further seven wild boar altogether, and samples were tested by PCR (ADNS).

However, a total of 18 cases of ASF in wild boar found dead in the same region has been reported by Belgium’s food safety agency (AFSCA).

The source of virus incursion has not been confirmed, and investigations are continuing. The European Commission has confirmed that interim protective measures under 2002/60/EC Article 15 are in place, delineated by the border with Luxembourg and France. An Infected zone has been established (of 630 km 2 ).

Situation assessment

In the Infected Zone there are few pig farms: two commercial breeding premises (1000 animals, and 400 animals) and 5-6 small commercial premises of 50 animals (PAFF). In the infected zone, there is a ban on hunting and feeding of wild boar, collection and testing of all wild boar found dead, as well as limited access to the forest. Members of the public have been asked not to leave the main roads or to enter the forests. Additional national biosecurity measures have also been put in
place, such as a ban on pig gatherings.

At present, there is no further information on how disease has been introduced into this area. The virus isolated in Belgium is thought to belong to genotype II, which is currently circulating in Eastern Europe (Platforme). Current hypotheses include that infected meat products from ASF-infected areas has been brought and discarded along the main route through this area, but this has not yet been confirmed.

In Luxemburg, there is a surveillance zone along the border with Belgium and commercial outdoor pigs are being housed, and Belgium is facing export bans from 13 countries outside the EU, despite having no cases in domestic pigs.

Conclusions

The risk level, remains at MEDIUM. The risk of exposure to the pig population in the UK is still dependent on the level of biosecurity on pig premises and is still considered to be LOW, although the situation is being kept under review.

It is important to highlight that all products of porcine origin (including wild boar), unless processed in a certain way, is a high risk commodity from affected areas.

These products include fresh or frozen pig meat, salamis and hams, skins and bristles, germinal products, live animals, hunting trophies and any equipment which has had contact with an affected animal or the environment where they are found.

Pig keepers and veterinarians should remind themselves of the clinical signs for ASF and images and descriptions of clinical signs and pathology of ASF are provided on this link: https://www.flickr.com/photos/defragovuk/sets/72157694954571532/

We will continue to closely monitor the situation.

Authors
Dr Francesca Gauntlett
Jonathan Smith
Dr Helen Roberts

OIE Notification: Virulent Newcastle Disease In California Live Market

Link

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We've been following an outbreak of Virulent Newcastle Disease among backyard birds in Southern California since last May (see APHIS: USDA Confirms Virulent Newcastle Disease In Backyard Flock - California),
which has since expanded to more than 150 outbreaks across 4 counties (Los Angeles, San Bernardino, Ventura, and Riverside).

While posing only a minor threat to human health - generally only causing mild flu-like symptoms and/or conjunctivitis - Virulent Newcastle Disease can be up to 100% fatal in poultry, and remains a serious threat to poultry interests world wide.

An outbreak in 1971 that began in Southern California led to the culling of 12 million birds and a loss of tens of millions of dollars while the last outbreak in 2003 led to the depopulation of 3.16 million birds at a cost of $161 million (cite)

Thus far, only backyard birds have been affected, but this morning we have an  OIE Notification of the detection of the disease at a live bird market in Los Angeles County. Details are scant at this hour, but I expect we'll learn more later in the day.

As part of enhanced surveillance for virulent Newcastle disease virus in exhibition birds, the virus was detected in a live bird market. As a result, the USDA Animal and Plant Health Inspection Services (APHIS) and the California Department of Food and Agriculture (CDFA) are conducting a comprehensive epidemiological investigation of the event with enhanced surveillance.

State officials have quarantined the affected premises and implemented movement controls. The market has been depopulated and cleaned and disinfected. Live bird markets in the area have been ordered to close for a day and perform cleaning and disinfection with environmental sampling.

Measures applied    

    Movement control inside the country
    Surveillance outside containment and/or protection zone
    Surveillance within containment and/or protection zone
    Quarantine
    Stamping out
    Zoning
    Disinfection
    Vaccination permitted (if a vaccine exists)
    No treatment of affected animals

The California Department of Food and Agriculture (CFDA) Newcastle Website doesn't currently have any information posted on this latest development, but describes the threat below:

Virulent Newcastle Disease (VND)

Virulent Newcastle disease (VND), formerly known as Exotic Newcastle Disease, is a serious, highly contagious viral disease that can affect poultry and other birds. In rare cases, humans that have exposure to infected birds may get eye inflammation or mild fever-like symptoms. These signs generally resolve without treatment, however, medical care should be sought if symptoms persist. Infection is easily prevented by using standard personal protective equipment. Virulent Newcastle disease is not a food safety concern. No human cases of Newcastle disease have ever occurred from eating poultry products. Properly cooked poultry products are safe to eat.

The virus is found in respiratory discharges and feces and may cause high rates of sickness and death in susceptible birds. For poultry, chickens are most susceptible and ducks and geese are the least susceptible. Mortality rates for Psittacine birds (parrots) can range from zero up to 75%. Certain parrots, especially Amazon parrots, can shed VND virus intermittently in excess of one year. Other birds may be infected, but may not show any symptoms and may still be able to spread the disease. Once VND is introduced into domestic avian populations, subsequent spread is normally caused by domestic bird-to-bird contact or through contact with contaminated people, feed or equipment. Other types of Newcastle disease known as lentogenic and mesogenic are less virulent and may cause mild symptoms or none at all.

There is no effective cure for virulent Newcastle Disease. It is important that all commercial and non-commercial poultry owners maintain effective barriers to mitigate the risk of VND. Biosecurity tips for commercial poultry owners can be found here. For Backyard and non-commercial poultry owners, biosecurity tips can be found here.

WHO: Recommended Composition of The 2019 Southern Hemisphere Flu Vaccine

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Twice each year influenza experts from around the world gather to discuss recent developments in human and animal influenza viruses, and to decide on the composition of the next influenza season’s flu vaccine.

Due to the time it takes to manufacture and distribute a vaccine, decisions on which strains to include must be made at least six months in advance, which means the composition of next year's Southern Hemisphere’s vaccine must be decided upon in late September.

As we've discussed before (see The Enigmatic, Problematic H3N2 Influenza Virus), the recent rapid mutation and growing diversity of H3N2 strains has made creating a good vaccine match increasingly more difficult the past few years.

Also, in recent years a new problem with egg-based vaccines has emerged, particularly concerning H3N2 viruses. Tiny changes (mutations) can occur which can affect how well the vaccine recognizes (and protects against) the flu strain it was created from (see PLoS Path.: A Structural Explanation For The Low VE Of Recent H3N2 Vaccines).

While newer manufacturing techniques (cell-based & recombinant) are being phased in, currently most flu vaccines are still produced using the 70 year-old process of taking the selected Candidate Vaccine Virus (CVV) and injecting it into fertilized hen's eggs, and then allowing the virus to replicate for a number of days.

The virus-laden fluid is then harvested from the eggs, and (for flu shots) the viruses are then inactivated (killed), and virus antigen is purified.

While there are some early signs that our Northern Hemisphere may see less H3N2 than last year, we never really know until the season is over. And next year's Southern Hemisphere's flu season is too far off for us to even speculate.

All of which leads us to the announcement from the World Health Organization of their recommendations for next year's Southern Hemisphere Flu shot, which includes a new H3N2 strain. 

Recommended composition of influenza virus vaccines for use in the 2019 southern hemisphere influenza season
27 September 2018

It is recommended that egg based quadrivalent vaccines for use in the 2019 southern hemisphere influenza season contain the following:

• an A/Michigan/45/2015 (H1N1)pdm09-like virus;
• an A/Switzerland/8060/2017 (H3N2)-like virus;
• a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage); and
• a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).
  

It is recommended that egg based trivalent vaccines for use in the 2019 southern hemisphere influenza season contain the following:

• an A/Michigan/45/2015 (H1N1)pdm09-like virus;
• an A/Switzerland/8060/2017 (H3N2)-like virus; and
• a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage).
  

It is recommended that the A(H3N2) component of non-egg based vaccines for use in the 2019 southern hemisphere influenza season be an A/Singapore/INFMH-16-0019/2016-like virus together with the other vaccine components as indicated above.

For additional details on how they made their selections, you may wish to download and read:

Recommended composition of influenza virus vaccines for use in the 2019 southern hemisphere influenza season - full report
pdf, 547kb

China: MOA Reports Another African Swine Flu Outbreak In Jilin Province

Jilin Province, China - Credit Wikipedia

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Seven days ago  Jilin became the 8th Chinese Province and/or territory to report an outbreak of African Swine  Fever since the virus was first detected in that nation in early August. 

Today, China's MOA reports a second outbreak in Jilin Province, more than 100 km from the first outbreak.

First this translated report from China's Ministry of Agriculture, then I'll return with a postscript.

Songyuan City, Jilin Changling County African swine fever outbreaks occur

Date: 2018-09-28 11:46 Author: Source: Agriculture and Rural Department of Public Information Office 
 
Ministry of Agriculture and Rural Press Office 9 Yue 28 released, Changling County, Songyuan City, Jilin Province, African swine fever epidemic occurred in pigs.

9 Yue 28 Ri , the Ministry of agriculture and rural areas to the control center reported Chinese animal epidemic prevention, the China Animal Health and Epidemiology Center (National Center for Exotic Animal Disease Research) confirmed Changling County, Songyuan City, Jilin Province, a farmers occurrence of African swine fever epidemic. The farmers herds of pigs 44 heads incidence 8 head death 3 headers.

After the outbreak, the Ministry of Agriculture and Rural immediately sent a steering group to the local. Started as required by local emergency response mechanism, to take the blockade, culling measures to deal with harmless treatment, disinfection, culling of all pigs died and sound processing. Meanwhile, the ban on all live pigs and susceptible animals and products into or out of the blockade zone . Currently the epidemic has been effectively disposed of.

In the not quite two months since ASF was first reported in China we've seen roughly 2 dozen outbreaks, spread across 8 regions of Northeastern China. The exact number is difficult to pin down because the MOA announcements don't exactly match the notifications from the OIE.

There are also always concerns that some smallholders may not report pig deaths, fearing a visit from the government and the loss of other animals, as we've seen in the past with avian flu in poultry.

While we aren't getting ASF updates on a daily basis the MOA, they are coming in at a worrying rate. There seems little doubt that the African Swine Fever virus has already become well established in China, and that it had likely been circulating there for months before it was identified and announced last month.

Complicating matters, there are reports - similar to what we saw last year in Russia with avian flu - of falsified veterinarian certificates being used to illegally move and sell pigs (see Reuters Report China detains four for transporting pigs amid swine fever outbreaks).

For more on the threat of ASF to China, its neighbors, Europe, and potentially the world, you may wish to revisit:

FAO: African Swine Fever (ASF) `Here to Stay' In Asia

African swine fever (ASF) threatens to spread from China to other Asian countries

Russia: Rosselkhoznadzor Tracing ASF Contaminated Meat Products

UK: DEFRA Preliminary Assessment Of ASF Reported In Belgium

CDC: More Than 900,000 Hospitalizations & 80,000 Deaths In Last Winter's Flu Season

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Last night CDC Director Dr. Robert Redfield, in an interview with the Associated Press, revealed that at least 80,000 Americans died during last winter's severe flu season, while more than 900,000 were hospitalized.  

Both are record breaking numbers, probably not matched since the 1968 H3N2 pandemic. Moreover, those estimates - once refined - could even go higher.

As we discussed last June (see A Snapshot From Last Winter's Severe Flu Season - Texas), getting `good' estimates  on flu-related deaths can be  extraordinarily challenging.

Heart attacks and strokes have been linked to recent flu infection (see Eur. Resp.J.: Influenza & Pneumonia Infections Increase Risk Of Heart Attack and Stroke) and many of those deaths are attributed to cardiovascular - not viral - causes. To be picked up by the P&I surveillance system, influenza or pneumonia has to be cited on the death certificate as being a contributing factor to a patient's death.

If the patient had cancer, or heart problems, was of advanced age, or had any other significant co-morbidity - that - not influenza or pneumonia, is usually listed as the primary cause of death.

The CDC has an `expected range' of seasonal influenza hospitalizations and deaths (see chart below), but even without a novel virus, it is possible to see an unusually severe `outlier' season.  

And last year clearly falls into that category, with at least 40% more deaths than the `maximum expected' seasonal flu-related fatalities. While all of this is based on - as yet - unpublished data, we have a statement this morning from the CDC on last year's influenza impact.

National Press Conference Kicks Off 2018-2019 Flu Vaccination Campaign
On September 27, 2018, the Centers for Disease Control and Prevention (CDC) and the National Foundation for Infectious Diseases (NFID) along with other public health and medical groups kicked off the 2018-2019 flu vaccine campaign at a press conference held at the National Press Club in Washington, D.C. CDC early estimates indicate that more than 900,000 people were hospitalized and more than 80,000 people died from flu last season[1]. These new estimates are record-breaking, and emphasize the seriousness and severity of flu illness and serve as a strong reminder of the importance of flu vaccination.

Flu vaccination has been shown to reduce the risk of flu illness, and a growing body of evidence supports the fact that vaccination also reduces the risk of serious flu outcomes that can result in hospitalization and even death. CDC estimates that flu vaccines prevent tens of thousands of hospitalizations each year and a CDC study in 2017 was the first of its kind to show flu vaccination reduced the risk of flu-associated death by half (51 percent) among children with underlying high-risk medical conditions and by nearly two-thirds (65 percent) among healthy children.

Most recently, an August 2018 study showed that flu vaccination lessened the risk of severe flu among adults, including reducing the risk of hospitalization and admission to the intensive care unit, and also lessened severity of illness. These benefits are especially important for people at high risk of serious flu complications, like people 65 and older, children younger than 5 years, pregnant women and people with certain underlying long-term medical conditions like heart and lung disease, or diabetes.

CDC recommends that people be vaccinated anytime between now and the end of October. CDC recommends an annual flu vaccine for everyone age six months and older.

[1] Note: Estimates based on unpublished CDC data[435 KB, 4 pages]

While we could get lucky, and see a much milder flu season this year - as I wrote last January in Remembering 1951: The Year Seasonal Flu Went Rogue - even a mild flu season can turn ugly without warning.

The flu vaccine is admittedly not as protective as we'd like it to be - and a better vaccine is sorely needed - but it still provides moderate protection most years.

Even when it fails to prevent infection, it has been shown it can reduce the severity of illness (see CMAJ Research: Repeated Flu Vaccinations Reduce Severity of Illness In Elderly).

When combined with practicing good flu hygiene (covering coughs, staying home when sick, and washing/sanitizing your hands) - they are the best steps you can take each year to reduce your chances of getting the flu.

You'll find more information in the following statement, released today, from NFID (National Foundation for Infectious Diseases).

INFLUENZA AND PNEUMOCOCCAL DISEASE CAN BE SERIOUS, HEALTH OFFICIALS URGE VACCINATION

Data Shows Importance of Protection Against Influenza for Everyone 6 Months and Older

WASHINGTON, D.C., September 27, 2018 – Following a particularly severe 2017-2018 influenza (flu) season with a record-breaking estimated 900,000 hospitalizations and more than 80,000 deaths in the U.S., the National Foundation for Infectious Diseases (NFID), along with public health and medical organizations, presented the benefits of flu vaccination and urged the public and healthcare professionals to follow the Centers for Disease Control and Prevention (CDC) recommendation that everyone age 6 months and older get vaccinated against flu each year.

“Last season illustrated what every public health official knows — influenza can be serious in people of all ages, even in the healthiest children and adults,” says U.S. Surgeon General Jerome M. Adams, M.D., M.P.H. “It is critical that we focus national attention on the importance of influenza vaccination to protect as many people as possible every season. Today, I am leading by example and getting vaccinated against flu.”

(Continue . . . )