Taiwan English Language News - Youtube
#16,241
After two decades of avian flu, SARS, and SARS-CoV-2 outbreaks in China, we tend to take notice whenever we see reports of hospitalized `atypical pneumonia' cases from that part of the world. Luckily, not every case represents the emergence of a new viral threat.
Over the past several days there have been numerous media reports of a `Parrot Fever' outbreak in Zhejiang Province, which has hospitalized 7, and killed one. This (translated) summary from Sohu.com.Sometimes, it is something far less ominous, and more familiar.
Zhejiang Lishui 5 cases of parrot fever recovered and discharged from the hospital 1 clinical symptom has disappeared
2021-10-06 08:40
According to CCTV news reports, the Centers for Disease Control and Prevention in Lishui City, Zhejiang Province, issued a notice that since september 9, 2021, the first case of parrot fever was reported, Lishui City has found seven cases reported.
As of 5 October, 5 cases have been cured and discharged from hospital after treatment, and 1 case has been admitted to hospital on 23 September, the current clinical symptoms have disappeared, the condition is stable, still in hospital observation, and another case due to severe underlying diseases, treatment invalid death.
After the outbreak, Lishui City and related counties (cities) CDC quickly launched an investigation and disposal.
Psittacosis - often called parrot fever - is a rarely reported, atypical bacterial pneumonia caused by Chlamydia psittaci. The CDC cites an average of 10 cases of Psittacosis reported each year in the US, although many others may go undiagnosed.
The CDC also reports:
Since 1988, there has been a decline in reported psittacosis cases. This decline may be the result of improved diagnostic tests that distinguish Chlamydia psittaci from more common Chlamydia pneumoniae infections.
As we've discussed previously, while community acquired pneumonia (CAP) is the #1 cause of hospitalization of adults with an infectious disease in the United States, in more than half of the cases the type of infection (viral, fungal, bacterial) is never actually identified.
A 2015 study published in the NEJM (see The CDC’s EPIC CA-Pneumonia Study) followed 2500 cases over 5 years and found that in the majority (62%) of cases no definitive pathogenic agent could be determined.
Luckily, even without a definitive diagnosis, patients can be treated empirically. Psittacosis generally responds well to Tetracycline, and most people treated are able to recover.
While relatively rare, we've covered outbreaks in the past. In 2017, we saw Japan Report 2 Fatal Cases of Parrot Fever (Psittacosis) In Pregnant Women, and in 2019 we looked at the Hong Kong CDW: A Review of Psittacosis in 2018-2019, after 17 cases were reported in 2018.
Human infection, at least until about a decade ago, had been solely attributed to direct or indirect contact with infected birds.
But in 2012, the journal Eurosurveillance carried a report called Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012, involving four family members and a health-care worker, which suggested human-to-human transmission.
The following year, in Sweden Reports Rare Outbreak Of Parrot Fever, we saw a credible report of human transmission of parrot fever, where a 75 year old man who died in Kronoberg appeared to have spread the infection to at least 8 close contacts, including healthcare personnel.
In 2014, the ECDC's Eurosurveillance Journal carried a follow up report called:
Eurosurveillance, Volume 19, Issue 42, 23 October 2014Surveillance and outbreak reports
Multiple human-to-human transmission from a severe case of psittacosis, Sweden, January–February 2013
Proven transmission of Chlamydia psittaci between humans has been described on only one occasion previously. We describe an outbreak which occurred in Sweden in early 2013, where the epidemiological and serological investigation suggests that one patient, severely ill with psittacosis after exposure to wild bird droppings, transmitted the disease to ten others: Two family members, one hospital roommate and seven hospital caregivers. Three cases also provided respiratory samples that could be analysed by PCR. All the obtained C. psittaci sequences were indistinguishable and clustered within genotype A.
The finding has implications for the management of severely ill patients with atypical pneumonia, because these patients may be more contagious than was previously thought. In order to prevent nosocomial person-to-person transmission of C. psittaci, stricter hygiene measures may need to be applied.
And in 2018 we saw yet another example, in PLoS Currents: A Psittacosis Outbreak Among Office Workers WIth Little Or No Bird Contact - UK.
While H-2-H transmission of C. psittaci now appears possible, contact with infected birds still remains the primary suspected route of transmission.
All of which means that the odds of seeing a major outbreak of Parrot Fever are slim, although it can still present a serious public health threat.
Nine years ago, in How Parrot Fever Changed Public Health In America, we looked at the fascinating (and tragic) story of how a multi-state outbreak of parrot fever in 1929 - 10 years after the end to the Great Pandemic - sparked a brief national panic, and led to the deaths of several of the public health officials investigating the mysterious epidemic.
Before it was quashed, the outbreak sparked 169 cases of parrot fever nationwide, along with 33 deaths (including Dr. Daniel S. Hatfield and Dr. William Stokes of the Baltimore Health Department, and Henry (Shorty) Anderson of the Hygienic Lab).
But out of this tragedy also came congressional funding for a new, far better equipped national public health laboratory.
One that today you know as the National Institute of Health.
