14.26
Raden Rahmad
No comments21.04Raden RahmadNo comments
Seasonality of H5N1 in poultry
Source FAO H5N1 HPAI Global Overview
# 10,408
Although transmission never completely stops, since HPAI H5 viruses began circulating widely in 2003, we’ve always seen a significant lull in poultry AI outbreaks during the summer months. Like human flu, bird flu is largely seasonal, and spreads better in cooler, less humid environments.
So the usual pattern is relatively few reports between June and September, followed by a slow ramping up during the fall and winter, and peaking sometime between January and April. That pattern is also reflected in human HPAI infections (see below).
But the summer of 2015 continues to see an unseasonable number of HPAI outbreaks (in wild birds and/or poultry) around the globe. While no new outbreaks have been report in the United States since June 16th, we’ve seen numerous reports coming out of Egypt, Western Africa, parts of Europe, China, and Southeast Asia.
A comparison of HPAI reports to the OIE between June 1st – August 10th 2015 vs. 2014 shows this dramatic increase in summertime outbreaks.
The following maps were generated by the OIE’s WAHID Mapping tool, depicting Highly Pathogenic AI in birds. Human cases are not included. Not only are the number of reports vastly greater over the same time period, so too is the geographic range.
An even starker comparison comes when you look at the Year to Date reports for 2015 vs the same time period in 2014.
This upsurge in bird flu really began last fall, and so one more useful comparison. The fall of 2014 vs the fall of 2013. Once again we see a major increase in avian flu activity over the previous year.
After the great H5N1 Diaspora of 2006, avian flu activity began to gradually recede in 2008 and 2009, and by 2010 outbreaks were mostly confined to a handful of countries (China, Egypt, Indonesia, Bangladesh, India, etc.)
The emergence of H7N9 in China in the spring of 2013, followed quickly by the arrival of H10N8, H5N6, H5N8, has helped to reverse this trend. Of these, H7N9 and H5N8 (and its reassorted progeny) have had the biggest impact so far, but other subtypes continue to threaten.
Past performance is, of course, no guarantee of future results. In 2007, just when it looked as if avian flu was on the verge of becoming a global threat, it unexpectedly reversed course. The same thing could happen again.
But in 2007 were dealing with only one HPAI subtype of genuine concern; H5N1. Today we face a far more diverse field of subtypes circulating around the world (H5N1, H7N9, H5N8, H5N2, H5N6, H10N8, etc.), and there could be even more reassortants emerge this fall and winter.
Last February, in response to this unprecedented emergence of new flu subtypes, the remarkable and rapid spread of HPAI H5 viruses to Europe and North America, and Egypt reporting the worst human H5N1 outbreak in history, the World Health Organization released a blunt assessment called:
Warning signals from the volatile world of influenza viruses
February 2015
The current global influenza situation is characterized by a number of trends that must be closely monitored. These include: an increase in the variety of animal influenza viruses co-circulating and exchanging genetic material, giving rise to novel strains; continuing cases of human H7N9 infections in China; and a recent spurt of human H5N1 cases in Egypt. Changes in the H3N2 seasonal influenza viruses, which have affected the protection conferred by the current vaccine, are also of particular concern.
The entire report is well worth reading, but after warning that H5 viruses were currently the most obvious threat to health, they also advised:
Warning: be prepared for surprises
Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.
While I’m not making any predictions, given the unusual amount of avian flu activity we're seeing during this supposed `off season’, this may well turn out to be excellent advice.
18.45Raden RahmadNo comments
#10,407
The World Health Organization has released a lengthy roundup of 17 recent MERS cases reported out of Saudi Arabia (Aug. 3rd-9th). Three of the cases are female HCWs (1 pregnant, and the only one with direct contact with a MERS case), two are listed as having contact with lab confirmed cases, and as many as 10 patients may have acquired the virus while hospitalized for other conditions.
If you count today’s WeCanStopThis update, Riyadh has reported an additional 11 new cases in the 3 days since the cutoff date of this report.
Despite having three years experience dealing with the virus, and numerous edicts on infection control from the MOH, Saudi hospitals continue to struggle to prevent nosocomial outbreaks.
Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia
Disease outbreak news
12 August 2015Between 3 and 9 August 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 17 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 3 deaths.
Details of the cases
- A 55-year-old, non-national, female health care worker from Riyadh developed symptoms on 5 August and was admitted to hospital on 6 August. The patient, who has no comorbidities, tested positive for MERS-CoV on 8 August. She works in a hospital that has been experiencing a MERS-CoV outbreak. Currently, the patient is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to the MERS-CoV cases admitted to her hospital is ongoing. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- A 60-year-old female from Riyadh city developed symptoms on 30 July and was admitted to a hospital in Riyadh on 6 August. The patient, who has comorbidities, tested positive for MERS-CoV on 8 August. Currently, she is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 31-year-old female from Riyadh city developed symptoms on 30 July while admitted to hospital for an unrelated medical condition since 12 July. This hospital has been experiencing a MERS-CoV outbreak. The patient tested positive for MERS-CoV on 1 August. Currently, she is in stable condition in a negative pressure isolation room on a ward. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.
- A 74-year-old male from Riyadh city, Riyadh Region developed symptoms on 5 August and was admitted to hospital on 6 August. The patient, who has comorbidities, tested positive for MERS-CoV on 7 August. Currently, he is in stable condition in a negative pressure isolation room on a ward. The patient is a contact of a laboratory-confirmed MERS-CoV case (case n. 10 – see below). He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- A 50-year-old female from Riyadh city developed symptoms on 6 August and, on the same day, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 7 August. Currently, she is in stable condition in home isolation. The patient is a contact of a laboratory-confirmed MERS-CoV case (case n. 6 – see below). Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 55-year-old male from Riyadh city developed symptoms on 23 July and, on 27 July, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 29 July. Currently, he is in critical condition admitted to ICU. Investigation of possible epidemiological links with MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 42-year-old male from Riyadh city developed symptoms on 1 August while admitted to hospital for an unrelated medical condition since 10 July. This hospital has been experiencing a MERS-CoV outbreak. The patient tested positive for MERS-CoV on 3 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with positive MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
- A 72-year-old female from Riyadh city developed symptoms on 2 August while admitted to hospital for an unrelated medical condition since 29 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who had comorbidities, tested positive for MERS-CoV on 4 August and passed away on 9 August. Investigation of possible epidemiological links with MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing. Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is also ongoing.
- A 29-year-old, non-national, female health care worker from Riyadh developed symptoms on 3 August and was admitted to hospital on the same day. The patient, who has no comorbidities, tested positive for MERS-CoV on 4 August. She works in a hospital that has been experiencing a MERS-CoV outbreak. Currently, the patient is in stable condition in home isolation. Investigation of history of exposure to MERS-CoV cases admitted to her hospital is ongoing. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- A 49-year-old male from Riyadh city developed symptoms on 24 July and was admitted to hospital on the same day. The patient, who has comorbidities, tested positive for MERS-CoV on 2 August. Currently, he is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 38-year-old male from Riyadh city developed symptoms on 29 July and was admitted to hospital on 2 August. The patient, who has no comorbidities, tested positive for MERS-CoV on 4 August. Currently, he is in critical condition in ICU. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 50-year-old male from Najran city developed symptoms on 29 July. On 2 August, the patient was admitted to hospital and tested positive for MERS-CoV. The patient, who has no comorbidities, works in an administrative role in a hospital. He has a history of frequent contact with camels and consumption of their raw milk. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in stable condition in a negative pressure isolation room on a ward.
- A 31-year-old, non-national, female health worker from Riyadh developed symptoms on 27 July and was admitted to hospital on the same day. The patient, who is pregnant with no comorbidities, tested positive for MERS-CoV on 31 July. Currently, she is in critical condition in ICU. The patient works in a hospital that has been experiencing a MERS-CoV outbreak. Between 2 and 21 July, she provided care to a laboratory-confirmed MERS-CoV case (case n. 4 – see DON published on 24 July). Investigation of possible epidemiological links with other MERS-CoV cases admitted to the hospital is ongoing. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- An 86-year-old male from Riyadh city developed symptoms on 25 July and, on 27 July, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 29 July. Currently, he is in critical condition in ICU. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.
- A 78-year-old male from Riyadh city developed symptoms on 10 July and, on 11 July, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient, who had comorbidities, tested positive for MERS-CoV on 28 July and passed away on 31 July. Investigation of possible epidemiological links with other MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing. He had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms.
- A 75-year-old, non-national male from Riyadh city developed symptoms on 21 July while hospitalized for an unrelated medical condition since 15 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who had comorbidities, tested positive for MERS-CoV on 27 July and passed away on 4 August. Investigation of possible epidemiological links with MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing. The patient had no history of exposure to the other known risk factors in the 14 days prior to the onset of symptoms.
- A 53-year-old male from Riyadh city developed symptoms on 20 July and was admitted to hospital on the same day. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 30 July. He is a relative of a laboratory-confirmed MERS-CoV case (case n. 5 – see DON published on 29 July). Investigation of history of exposure to other known risk factors in the 14 days prior to the onset of symptoms is ongoing. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.
Contact tracing of household and healthcare contacts is ongoing for these cases.
The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 2 MERS-CoV cases that were reported in previous DONs on 6 August (case n. 1) and on 29 July (case n. 7).
Globally, since September 2012, WHO has been notified of 1,401 laboratory-confirmed cases of infection with MERS-CoV, including at least 500 related deaths.
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