Details & Background On the H5N2 Poultry Outbreak In Hebei Province

Photo Credit CRIENGLISH

 

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When it comes to variety, avian influenzas come in more flavors than you’ll find in a Baskin-Robbins store. Which explains  why in the past couple of months our attentions have been divided between H5N1 in Cambodia and Indonesia, H7N9 in Mainland China, an upstart H10N8 (again in China), and now H5N2 in Hebei Province, China.

 

While we worry most about H5N1 and H7N9 – primarily because both have been shown to produce severe illness and even death in humans – all H5 and H7 varieties are of concern, since these subtypes have a history of morphing from low-pathogenic strains to highly pathogenic strains if not controlled.  

 

Which is why all H5 and H7 outbreaks are reportable to the OIE, and quarantine and immediate culling are the preferred course of action.

 

Yesterday China reported an outbreak of H5N2 at a poultry farm in Baoding City, Hebei Province.  Reports today indicate that more than 120,000 birds have been culled, and that 11 people who were in direct contact with the poultry have been placed in isolation (and probably given Tamiflu ®), but none have shown signs of infection.

 

First a report from Sina  News, then I’ll be back with more on the history of H5N2

 

Hebei people infected with H5N2 bird flu yet (Alt Translation Hebei infection of H5N2 avian flu nobody has yet been)

CNA (2013-12-22 18:18)

(CNA Taipei 22 (Xinhua)) Hebei Baoding Nanshiqu officials said today, raising the local chicken farm H5N2 bird flu has been effectively controlled occurred, 11 were in direct contact with the relevant chickens were isolated observation, it was not found infected.

China News Service reported, Baoding Nanshiqu Agriculture Secretary Zhang Guang pointed out that, in addition to the above measures, culling chickens participating Nanshiqu work were monitored twice daily, were not unusual. Meanwhile, the official has the region's comprehensive agricultural and sideline products and fragmented market of live poultry trade to clean up and banned.

Zhang also said that the official and farm stocks of eggs into the marketing ruin handling , disposal of tracing the source of the product sold. Meanwhile, the live poultry within 3-5 km range chicken farm near the outbreak, have been carried out culling.

H5N2 outbreak was discovered south downtown Baoding Zhu Village tiger phoenix chicken farm was built in 1992, is a self-employed business , keeping more than 120,000 laying hens only, no chickens. 4000 chickens on the 17th because the epidemic of death was November 27 to buy from overseas. 1021222

 

It should be noted that we’ve seen both HPAI (Highly pathogenic) and LPAI (Low Pathogenic) H5N2 outbreaks in the past, notably in Taiwan, Canada, the United States, Korea, Japan, and Mexico.

 

The isolation (and usually, antiviral treatment) of those who have been in direct contact with infected birds is standard procedure, and should not be viewed as being particularly alarming.  While not normally thought of as a serious threat to public health (see WHO: Human Risk From H5N2 Is Low), we have seen some limited evidence of H5N2’s ability to infect humans in recent years.

 

Eighteen months ago, in Taiwan: Three Poultry Workers Show H5N2 Antibodies, we looked at a report that three poultry workers and officials working in animal quarantine have tested positive for antibodies for the H5N2, but all remained healthy and asymptomatic (note: refer to article for other possible causes of seropositivity)..  

 

Some earlier H5N2 studies include:

 

J Epidemiol. 2008;18(4):160-6. Epub 2008 Jul 7.

Human H5N2 avian influenza infection in Japan and the factors associated with high H5N2-neutralizing antibody titer.

Ogata T, Yamazaki Y, Okabe N, Nakamura Y, Tashiro M, Nagata N, Itamura S, Yasui Y, Nakashima K, Doi M, Izumi Y, Fujieda T, Yamato S, Kawada Y.

Arch Virol. 2009;154(3):421-7. Epub 2009 Feb 3.

Serological survey of avian H5N2-subtype influenza virus infections in human populations.Yamazaki Y, Doy M, Okabe N, Yasui Y, Nakashima K, Fujieda T, Yamato S, Kawata Y, Ogata T.

 

While these reports are suggestive of prior H5N2 human infection – particularly among poultry workers – we haven’t seen any good evidence that it has produced significant or serious human illness. 

 

The caveat being, that up until the emergence of H7N9 in March of this year, H7 avian flu viruses had been generally regarded as posing a minor threat to human health, and until this past week, we’d never seen a human infection with the H10N8 virus.

 

With influenza viruses, the only constant is change.  What may be relatively benign today, may become virulent or increase its host range tomorrow.

 

Which makes the rapid and intense response to bird flu outbreaks  – such as we are seeing  with H5N2 in China right now – the prudent course of action.

Hebei H7N9 Patient Dies In Beijing

Hebei Province  – Credit Wikipedia

 

 

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The 61-year-old H7N9 patient hospitalized last month in Langfang City in Hebei Province - and transferred to Beijing Chaoyang Hospital on July 18th (see July 21st WHO GAR Update On New Chinese H7N9 Case) - has died after more than a month of illness.

 

This patient’s condition was reported as improving a little more than a week ago (see Hebei H7N9 critically ill patients removed the "artificial lung").  Although she was removed from ECMO support early in the month, she reportedly succumbed to sepsis and multiple organ failure.

 

While a bit syntax challenge, we’ve a long, detailed, and reasonably readable (machine translated) report on this patient’s course of treatment, brief period of improvement, followed by deteriorating condition from Beijing’s Municipal Health Bureau.

 

Hebei to Beijing to severe human infection with H7N9 avian influenza patients due to multiple organ failure died

 

Time :2013 -08-12 Source: Beijing Municipal Health Bureau Views: 0

After 25 days of rescue and Hebei to Beijing for medical treatment of people infected with H7N9 avian influenza in patients with severe, although once respiratory function improved, but in the end due to infection increased, died of multiple organ failure on the evening of 11 August 2013 22:00 about death. This case development and evolution of the disease and treatment process on the future treatment of human infection with H7N9 avian influenza severe cases have important implications.

 

Patients Zhang, female, 61 years old, living in Langfang City, Hebei Province, for "five days fever, cough, dyspnea two days" on at 18:00 on July 18, 2013 by Langfang City 120 go to Beijing Chaoyang Hospital. The patient was admitted to hospital, his condition deteriorated rapidly, admissions doctors based on patient characteristics fever and respiratory symptoms, the hospital expert consultation, and rapidly carry out the new flu virus checks and by the Beijing-level expert consultation in July 2013 20 confirmed human infection of H7N9 avian influenza in severe cases. The patients with concomitant acute respiratory distress syndrome, severe sepsis, acute renal failure, disseminated intravascular coagulation, and other serious complications.

 

Beijing Chaoyang Hospital, set up headed by a vice president of the medical treatment group of experts, to carry out treatment. During the period of rapid progression, unstable vital signs, repeatedly issued to the families of patients in critical condition notice.

The full treatment, after 1 August 2013 the patient was once signs of improvement in respiratory function, August 4 from the ventilator can be intermittent after spontaneous breathing function recovery exercise, infection was part of the control, consciousness regained conscious, you can eat water. August 9 review H7N9 virus nucleic acid test results were negative, indicating the effect of antiviral therapy.

 

Aug. 10 patients with recurrence of infection increased, August 11 quickly developed into sepsis, septic shock, leading to multiple organ failure. At 21:00 on August 11th, patients with decreased heart rate, blood pressure can not be maintained, 21:22 heart rate drops to 0, respiratory arrest, blood pressure is 0, the active rescue, breathing, heartbeat is still not restored, died at 22:01 declared clinically dead. Death diagnose human infection of avian influenza H7N9 pneumonia (severe cases), acute respiratory distress syndrome, acute renal failure, septic shock.

 

August 12 morning, the Beijing Chaoyang Hospital, organize experts to death were discussed. Experts believe that: The patient's condition improved in the course of severe pneumonia increased again, the rapid development of sepsis, septic shock, leading to multiple organ failure, although the rescue, and finally failed to save lives.

The case where the process of evolution and progression of human infection with H7N9 avian influenza on severe cases have three inspirations:

First, anti-viral treatment for people infected with H7N9 avian influenza remains critically ill patients is necessary also effective. The patients with severe human infection of H7N9 avian influenza patients, but after antiviral therapy viral stock has been effectively controlled, the final test result is negative, combined with extracorporeal membrane oxygenation (artificial lung) applications, once signs of improvement in respiratory function, so human infection with H7N9 avian influenza on critically ill patients to be active antiretroviral therapy.

Second, except for the treatment of severe cases concern the treatment of viral infection, attention should also be multi-organ protection and support to improve the overall success rate. The early onset patients with acute renal failure, have not been able to break away hemofiltration, and ultimately the development of multiple organ failure, indicating that the avian flu patients with severe multiple organ will be hit hard, with severe human infection with the H7N9 avian flu is always there life-threatening.

Three for severe cases, conventional mechanical ventilatory support in difficult circumstances, the timely application of extracorporeal membrane oxygenation (artificial lung) therapy is effective measures.

WHO GAR Update On New Chinese H7N9 Case

Hebei Province  – Credit Wikipedia

 

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From the World Health Organization’s Global Alert & Response (GAR) page, we’ve details on China’s first new H7N9 case reported since the end of May (note: we learned of a retrospective case from April earlier this month). 

 

After the @WHO update, we have a brief report from China’s official news agency, Xinhua.

 

 

Human infection with avian influenza A(H7N9) virus – update 20 July 2013

20/07/2013

20 JULY 2013 - The National Health and Family Planning Commission, China notified WHO of an additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus. This is the first new confirmed case of human infection with Influenza A(H7N9) since 29 May 2013.

 

The patient is a 61 year-old woman from Langfang City in Hebei Province who became ill on 10 July 2013. She was admitted to a local hospital from 10-15 July and transferred to a hospital in Beijing on 18 July . She is in a critical condition. On 20 July 2013, Beijing Municipal Center for Disease Control (CDC) confirmed H7N9 by nucleic acid detection.

 

To date, WHO has been informed of a total of 134 laboratory-confirmed human cases with avian influenza A(H7N9) virus including 43 deaths. Four cases are hospitalized and 87 have been discharged. So far, there is no evidence of sustainable human to human transmission.

 

The Chinese government continues to take strict monitoring, prevention and control measures, including: Strengthening of epidemic surveillance and analysis; deployment of medical treatment; conducting public risk communication and information dissemination; strengthening international cooperation and exchanges; and is continuing to carry out scientific research.
WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions.

 

 

The following Xinhua reports suggests a potential point of contact with the virus (a farmer’s market), and mentions that 9 close family contacts have shown no symptoms of infection.

 

 

New H7N9 patient in critial condition in Beijing

Xinhua, July 20, 2013

A woman from north China's Hebei Province Saturday became the latest confirmed case of the H7N9 strain of bird flu, said health authorities in Beijing.

 

The 61-year-old from the city of Langfang, Hebei, developed symptoms including cough and fever on July 10 and was diagnosed as suffering from severe pneumonia four days later, the Beijing municipal health bureau said in a statement.

 

Her condition did not turn better after treatment and she was therefore transferred to an intensive care unit in Beijing Chaoyang Hospital on Thursday.

 

She was confirmed positive of the deadly H7N9 bird flu strain on Saturday and is currently under emergency treatment.

 

Before developing the illness, the woman often bought vegetables from a local farm produce market near her home where live poultry are sold, the statement said.

 

Nine family members who have had close contacts with her have not shown any flu symptoms.

 

Earlier 132 human cases of H7N9 avian flu were reported on the Chinese mainland, including 43 that have ended in death, after the virus was first discovered in March, according to updates released by the National Health and Family Planning Commission on July 10.