Jumat, 14 Agustus 2015

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#10,415


After reporting only one new case yesterday, the Saudi MOH is back today with 4 new MERS cases in Riyadh, along with reporting the death of a previously reported case.   Three of today’s cases are listed as contacts of previously identified laboratory confirmed cases.

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Although the reporting has been erratic (the WeCanStopThis.com website is still offline), and there are gaps in the reports on the Saudi MOH portal, over the past 12 days Saudi Arabia has reported 33 MERS Cases.  The MOH is currently reporting 28 cases in isolation at this time, with 3 at home and 25 in the hospital.

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# 10,413

 

Among our rogues gallery of emerging HPAI H5 viruses in China, the H5N6 subtype holds particular interest because – like its venerable ancestor H5N1 – it has been shown to be capable of infecting, and killing, human hosts.  While its track record isn’t long (it only first emerged in April of 2014), it has already been detected across large swaths of China and as far south as central Vietnam.

 

As is typical for avian flu, reports of outbreaks over the summer months tend to drop off, although they have not totally dried up.

 

Last April, and again in May, H5N6 was detected in wild birds in Hong Kong (see Hong Kong: Wild Bird Found Infected With H5N6), and over the summer Vietnam has reported several small poultry outbreaks.  The biggest splash came in mid-July when China reported their 4th human infection, that of a 37 year-old woman in Yunnan Province.

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China’s most recent OIE update was filed in late May (see Follow-up report No. 8) where they list 29 outbreaks to date, which is plotted on the following map.

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Overnight the Chinese media is reporting an outbreak in Quingyuan City, Guangdong Province, along with an emergency order for agricultural interests to tighten up biosecurity and control efforts.

 

Guangdong Qingyuan found H5N6 bird flu cull 38,110 birds

 Huang Hao process 2015-08-14 08:33

August 12 afternoon, then informed the Ministry of Agriculture and Veterinary Bureau of Qingyuan City, Fogang a farm suspected H5 subtype of avian influenza positive samples, the review confirmed as H5N6 bird flu.

After the outbreak, the provincial Agriculture Department attaches great importance to immediately send experts to the scene to guide emergency response work, and urgently allocated Qingyuan five tons disinfectants used for disinfection and original. Local authorities suspected outbreaks were blocked, and the outbreaks in poultry farms remaining 820 birds were culled and safe disposal, fully cleaned and disinfected. After the notification from the Ministry of Agriculture confirmed the outbreak, Fogang committee and government attach great importance to the blockade affected areas issued orders, but decided to affected areas (3 km radius of the infected range) within 13 poultry farms do culling all 38,110 birds treatment; poultry investigation by the county and found no abnormalities. Currently, the province has not received new reports of major animal epidemic.

August 13, the provincial Department of Agriculture issued an emergency notice requiring all localities to strengthen immunity, to ensure that "should be free to make free, do not stay neutral"; strengthening surveillance investigation, responsibility to the people, Fenpianbaogan; strengthen quarantine, slaughter and quarantine and circulation of supervision; guidance farms (households) to strengthen the integrated management of prevention, strengthen emergency preparedness personnel in place to ensure that when outbreaks of disease, specific responsibilities, contact the smooth, according to the law effective disposal in accordance with regulations.

This year, the province's agricultural sector at all levels strengthen immunization, surveillance and quarantine, as of now, the province's poultry 51,026,000 quarantine, slaughter and quarantine of poultry 41.632 million; 601 million copies of the actual immunization feather bird flu vaccine, should avoid immune population density of 100%; the province to monitor parts of HPAI sample 97485, the passing rate of 84.56 percent immunization, livestock effective immune protection status.


The impressive numbers cited in the final paragraph illustrate how much impact avian flu has had on Guangdong’s poultry industry this year, and shows the lengths to which they are going in order to keep HPAI viruses under control. 

 

As the voracious consumer of nearly 91% of the world’s avian flu poultry vaccines ( cite Impact of vaccines and vaccination on global control of avian influenza by David Swayne), China has been able to reduce the visible impact of bird flu on their poultry industry, but not without some hidden costs.

 

It has been long known that poultry vaccines don’t always prevent disease – sometimes they just hide the symptoms.  And that can allow HPAI viruses to propagate (and evolve) silently in vaccinated flocks.

 

In 2009 Professor C.A. Nidom, of the Institute of Tropical Disease, Airlangga University, Indonesia warned against relying on poultry vaccines to control bird flu (see Indonesia: Debate Over Poultry Vaccination), while that same year   Zhong Nanshan, a respiratory disease specialist in China, warned that vaccinated poultry can still become infected (and possibly transmit) the H5N1 virus (see Chinese expert issues new bird flu warning).

 

Since then we’ve seen research (see here, here, and here) suggesting that poorly matched vaccines, often inconsistently or haphazardly applied, may be driving vaccine-escape flu variants, and may be at least partially responsible for the sudden emergence of new avian flu subtypes we’ve seen over the past couple of years (H5N3, H5N5, H5N6, H5N8, H7N9, H10N8, etc. ).

 

This sudden proliferation of HPAI H5 viruses in China prompted the FAO to issue an FAO-EMPRES Report On The Emergence And Threat Of H5N6 in early November of last year, which warned:

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The possibility exists that wild birds could become infected and spread these viruses to other countries or continents. Migratory birds, which have played a key role in the introduction of H5N1 to Europe and Africa [Kilpatrick et al, 2006] and of H5N8 to the Republic of Korea [Jeong et al, 2014], could spread the viruses to other countries or continents.

 

As if on cue, H5N8 showed up – first in Europe, and then in North America - at practically the same time this report was released.  The obvious concern is that other subtypes might eventually follow H5N8’s lead, and make their way out of China and Southeast Asia.


While the damage wrought by H5N8 to poultry interests in Europe and North America has been considerable, so far it hasn’t posed any serious human health hazards. 

 

Things would become far more complicated if H5N1, H7N9, or H5N6 – all capable of infecting humans hosts -  should ever follow in H5N8’s globetrotting footsteps. So we follow outbreaks like the one in Guangdong province with considerable interest.

Cara Membuat Seblak Mie Instan Resep Enak Pedas
Resep Seblak Mie pedas atau lada pisan dalam bahasa Sundanya. Seblak adalah salah satu sajian kuliner dengan bumbu pedas menggoda khas dari kota kembang Bandung. Makanan ini juga sudah sangat terkenal dalam bagian dari aneka jajanan masyarakat Sunda Jawa Barat yang biasa disajikan sebagai menu cemilan.

Dalam perkembangannya tidak hanya kerupuk saja untuk bahan seblak tetapi bermacam-macam bahan dapat dikreasikan dengan menggunakan bumbu seblak dengan ciri khas pemakaian cabe untuk rasa pedas (seuhah dalam istilah gaul Sunda untuk menyatakan pedas), bawang dan kencur sebagai penetral panas serta untuk menambah segar rasanya.

Cara membuat seblak mie juga bisa menambah alternatif bagi kita untuk variasi olahan mie instan dengan rasa sesuai selera karena bumbu praktis dari mie instanlah yang kita gunakan selain bumbu khas seblak. Pada kesempatan kali ini adalah menggunakan mie instan kuah walaupun kita mungkin juga bisa menggunakan mie goreng mie kuning basah ataupun jenis yang lainnya.

RESEP SEBLAK MIE
Tambahan kreasi lainnya adalah campuran bahan sosis dan siomay supaya lebih mantap, sedangkan bumbu seblak yang digunakan merupakan bumbu sederhana dan praktis dimana takaran atau ukuran cabe rawitnya bisa kita sesuaikan dengan selera pedas seuhah masing-masing. Selain sebagai menu cemilan, seblak mie enak pedas juga dapat kita hidangkan bersama nasi putih untuk menambah selera makan.

Bahan dan bumbu seblak mie instan :
  • 2 bungkus mie instan direbus lalu angkat dan tiriskan
  • bumbu mie instan
  • 2 buah sosis sapi dipotong serong
  • 50 gram siomay kering kecil
  • 100 ml air
  • minyak untuk menumis
Haluskan :
  • 1 buah cabe merah besar
  • 5 buah cabe rawit merah/ setan (cengek domba) dan tambah bila terasa kurang
  • 1 cm kencur
  • 1 siung bawang putih
  • 3 butir bawang merah
CARA MEMBUAT SEBLAK MIE INSTAN PEDAS
  1. Panaskan minyak secukupnya lalu tumis bumbu halus hingga harum. Masukkan air, bumbu mie instan, potongan sosis sapi dan siomay kering lalu aduk rata.
  2. Masukkan mie instan yang sudah direbus tadi, aduk hingga mie tercampur rata dengan bumbu dan kering. Matikan api lalu angkat dan siap dituang dalam piring saji untuk dihidangkan.

Kamis, 13 Agustus 2015

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# 10,412

 

Although bird flu has gotten the bulk of the press coverage over the past few years, swine variant viruses (H1N1v, H1N2v, H3N2v) are also consider a potential source of  pandemic viruses, and in 2009 we saw exactly that when a swine-origin H1N1 virus jumped to humans.  

 

As we’ve discussed before, the subtypes of flu viruses that commonly spread in swine (H1, H2 & h3) are also the subtypes that have caused all of the known human pandemics going back 130 years (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?), and so are regarded as have less far to `jump’ to than many avian viruses.

 

Although human infections with swine-origin viruses are rare (usually only a handful are reported each year), in 2012 the United States saw more than 300 cases, possibly the result of the acquisition of the M gene from the 2009 H1N1 virus, which is may have enhanced its transmissibility.

 

Since then, we’ve seen a number of studies looking to see just how susceptible the world’s population would be to an emerging H3N2v virus.

 

 

Today the ECDC’s Eurosurveillance Journal publishes a study that similarly finds low levels of cross-protective antibodies against H3N2v in children under 10, while protection appeared highest in adults aged 18 to 29 years.

 

As with the earlier studies, immunity appears to decline with age.

 

Unlike the studies listed above, which looked for antibodies against the North American H3N2v virus, today’s research tested against a European H3N2v virus. The study describes the three different H3N2 viruses used in this research thusly:

  • Influenza A/Wisconsin/12/2010 (A/Wisconsin) was used as representative for the A(H3N2)v virus, the primary target of the study.
  • A/Niedersachsen/59/2007 (A/Niedersachsen), was a swine A(H3N2) virus circulating among pigs in Germany that caused one human infection in Germany in 2009 [16] and is closely related to the A(H3N2) swine viruses that emerged in Europe around 1980 after reassortment between human A(H3N2) viruses and swine viruses of subtype A(H1N1)
  • A/Perth/16/2009 (A/Perth), was the A(H3N2) vaccine strain used in the influenza seasons 2010/11 and 2011/12, representing human influenza A(H3N2) viruses circulating recently


The serum samples tested came from two population-wide, representative health examination surveys conducted in Germany. 

  • The adult samples came from a survey conducted between November 2008 and December 2011, and provided 600 samples, 200 in each age bracket.
  • The adolescent/child samples were collected from 2003 through 2006, and numbered 815 across 3 age brackets (0-9,10-13,14-17).


The entire report is well worth reading in its entirety, but I’ve only excerpted the abstract and final paragraph below.

 

Eurosurveillance, Volume 20, Issue 32, 13 August 2015

Research articles

Age-related prevalence of cross-reactive antibodies against influenza A(H3N2) variant virus, Germany, 2003 to 2010

B Blümel ()1,2,3,4, B Schweiger1, M Dehnert1,5, S Buda1, A Reuss1, I Czogiel1, P Kamtsiuris1, M Schlaud1, C Poethko-Müller1, M Thamm1, W Haas1

ABSTRACT

To estimate susceptibility to the swine-origin influenza A(H3N2) variant virus (A(H3N2)v) in the German population, we investigated cross-reactive antibodies against this virus and factors associated with seroprotective titre using sera from representative health examination surveys of children and adolescents (n = 815, 2003–06) and adults (n = 600, 2008–10).

Antibodies were assessed by haemagglutination inhibition assay (HI); in our study an HI titre ≥ 40 was defined as seroprotective. We investigated associated factors by multivariable logistic regression.

Overall, 41% (95% confidence interval (CI): 37–45) of children and adolescents and 39% (95% CI: 34–44) of adults had seroprotective titres. The proportion of people with seroprotective titre was lowest among children younger than 10 years (15%; 95% CI: 7–30) and highest among adults aged 18 to 29 years (59%; 95% CI: 49–67).

Prior influenza vaccination was associated with higher odds of having seroprotective titre (odds ratio (OR) for children and adolescents: 3.4; 95% CI: 1.8–6.5; OR for adults: 2.4; 95% CI: 1.7–3.4). Young children showed the highest and young adults the lowest susceptibility to the A(H3N2)v virus.

Our results suggest that initial exposure to circulating seasonal influenza viruses may predict long-term cross-reactivity that may be enhanced by seasonal influenza vaccination.

(BIG SNIP)

Any influenza vaccination in the lifetime of our study participants (after adjustment for age and sex) was positively associated with having a seroprotective titre of cross-reactive antibodies against all three investigated strains. This effect was strongest for the human influenza A(H3N2) virus A/Perth and weaker for the swine-related influenza A(H3N2) viruses A/Wisconsin and A/Niedersachsen, which is plausible considering that A/Wisconsin and A/Niedersachsen are less related to human vaccine strains than A/Perth.

(SNIP)

Our results indicate that young children have the highest susceptibility to infection with the A(H3N2)v virus. In case of increased sustained human-to-human transmission of the virus, these children may contribute to the rapid spread of the A(H3N2)v virus as transmission among children plays a major role in the propagation of the spread of influenza [35]. They are also at high risk for severe disease from influenza infections.

A large proportion of the population 10 years and older has cross-reactive antibodies at potentially seroprotective level and thus, based on this correlate for immunity, may be at low risk for A(H3N2)v infection. Our results suggest that the first exposure to circulating seasonal influenza viruses in a person’s lifetime may predict their long-term cross-reactive antibody response.

These cross-reactive antibodies can be boosted by vaccination and possibly by exposure to seasonally circulating influenza viruses. Further studies may further our understanding of the effect of seasonal influenza viruses on the serological immune response.

(Continue . . . )

 

Of course, the usual caveats for seroprevalence studies apply.

 

  • Cross reactive antibodies are suggestive of possible immunity, but don’t always correlate to actual protection against infection or illness, and should be regarded as optimistic estimates of protection.
  • And since H3N2v viruses – like all flu viruses – vary by strain and are constantly changing and evolving - the results based on A/Niedersachsen/59/2007 may differ from what might be obtained using other H3N2v viruses.

 

For some additional background on swine variant influenza viruses, you may wish to revisit:

JID: Evolutionary Dynamics Of Influenza A Viruses In US Exhibition Swine 

Live Markets & Novel Flu Risks In The United States 

CDC FluView: 1 Novel (H3N2v) Flu Case Reported – Minnesota

FluView Week 17: Fatal Swine Variant (H1N1v) Case In Ohio

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# 10, 411

 

An early head’s up for an event next week, since this is a COCA (Clinician Outreach and Communication Activity) call that many will want to schedule time to attend. It focuses on controlling the two biggest HAI (hospital acquired infection) risks facing healthcare today; CRE and C. difficile..

 

Although primarily of interest to clinicians, the CDC holds frequent COCA  calls which are designed to ensure that practitioners have up-to-date information for their practices.

 

This COCA call is obviously a follow up to last week’s Vital Signs report (A Coordinated Approach To Curb The Spread Of Antibiotic Resistance), which featured mathematical modeling that projected increases in drug-resistant infections and Clostridium difficile (C. difficile) without `immediate, nationwide improvements in infection control and antibiotic prescribing’.


The details of the event come from the CDC’s COCA website:

 

 

CRE and C. difficile : Is Your Healthcare Facility Implementing the Necessary Approach to Stop the Spread?

 

Image of Continuing Education Credits abbreviation. = No Continuing Education

 

Date:Thursday, August 20, 2015

Time:2:00 - 3:00 pm (Eastern Time)

Join by Phone:

  • 888-469-1370 (U.S. Callers)
  • 517-308-9046 (International Callers)

Passcode:3791890

Join by Webinar:

https://www.mymeetings.com/nc/join.php?i=PW5080898&p=3791890&t=c

 

Moderator:

Arjun Srinivasan, MD
Associate Director for Healthcare-Associated Infection Prevention Programs
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

 

Presenter(s):

Robert A. Weinstein, MD
Professor of Medicine
Chairman, Division of Infectious Diseases, Stroger Hospital of Cook County
Chief Operating Officer, Ruth M. Rothstein CORE Center
Co-Director, Rush Translational Sciences Consortium

Sara Cosgrove, M.D., M.S., FSHEA, FIDSA
Associate Hospital Epidemiologist
Director, Antimicrobial Stewardship Program
Associate Professor of Medicine
Johns Hopkins University School of Medicine

 

Overview:

We're at a tipping point: an increasing number of germs no longer respond to the drugs designed to kill them. Inappropriate prescribing of antibiotics and lack of infection control actions can contribute to drug resistant infections such as carbapenem-resistant Enterobacteriaceae (CRE) and put patients at risk for deadly diarrhea (caused by Clostridium difficile). Even if one facility is following recommended infection controls, germs can be spread inside of and between healthcare facilities when patients are transferred from one healthcare facility to another without appropriate actions to stop spread. During this call, clinicians will hear from some of the nation’s top clinical experts on preventing antibiotic resistant infections and improving antibiotic stewardship. Join the discussion to learn about best practices that can be implemented today to protect patients from these potentially deadly infections.

 

Additional Resources

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#10,410

 

Amid some erratic reporting from the Saudi MOH, we learn of one additional MERS case from Riyadh today, whose exposure is still under review.

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As you’ll note from the screenshot below, reports for August 6th (1 case) and August 12th (4 cases) have not been posted on the Saudi MERS portal.

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Additionally, the Saudi MOH WeCanStopThis website is currently offline.

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Photo Credit –CDC PHIL

 

#10,409

 

Readers with long memories will recall that a series of reports emerged five or six years ago questioning the conventional wisdom of taking antipyretics (NSAIDs, acetaminophen, or aspirin) for influenza. 

 

 

Somewhat related to all of this have been studies suggesting that  the concurrent use of antipyretics may inhibit the immune response when receiving vaccines (see Anti-Inflammatory Meds And Vaccines and Common Pain Relievers May Dampen Vaccination Benefits).

 

While none of these studies provided definitive proof of harm, they (and others) have raised some interesting questions.

 

Today we’ve a study in the JJID (Japanese Journal of Infectious Diseases) that while subject to a number of limitations, and far from being the last word, should provide some reassurance on the use of antipyretic drugs with influenza.

 

Nonsteroidal Anti-inflammatory Drugs, Aspirin, and Mortality Among Critically Ill Pandemic H1N1 Influenza Patients: An Exploratory Analysis

Holly Epperly, Frances L. Vaughn, Andrew D. Mosholder, Elizabeth M. Maloney, Lewis Rubinson

[Advance Publication] Released: August 07, 2015

Jpn J Infect Dis. 2015 Aug 7. [Epub ahead of print]

Abstract

We explored NSAID and aspirin use and mortality in the U.S. Department of Health and Human Services' registry of 683 adult and 838 pediatric critically ill pandemic 2009 H1N1 influenza (pH1N1) patients.

Among adults, 88 (12.9%) reported pre-admission use of an NSAID, and 101 (14.8%) ASA use; mortality was similar (23-24%) with or without NSAID or ASA use. Mortality among 89 pediatric NSAID users and 749 nonusers did not differ significantly (10.1% and 8.8%, respectively). One of 16 pediatric ASA users died.

Among pediatric patients, the adjusted relative risk estimate for NSAID use and 90-day mortality was higher when influenza vaccination was included in the model (RR= 1.51; 95% CI 0.7-3.2), though not statistically significant. Among adults, RR estimates did not change appreciably after adjusting for age, sex, health status, or vaccine status.

We found no compelling evidence that NSAID or ASA use influenced mortality in severe pH1N1.

 


The full report is available in an Advanced Published PDF file.

 

The authors describe a number of limitations to their analysis, including possible confounding effects of statin use among adults, the small number of pediatric cases using aspirin, the overwhelming use of ibuprofen as the NSAID of choice in the study, and an inability to differentiate between antipyretic and cardioprotective (low dose) aspirin use in adults.

 

 

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Hadith Prophet Muhammad

It is narrated on the authority of Amirul Mu’minin, Abu Hafs ‘Umar bin al-Khattab, radiyallahu ‘anhu, who said: I heard the Messenger of Allah, sallallahu ‘alayhi wasallam, say: “Actions are (judged) by motives (niyyah) , so each man will have what he intended. Thus, he whose migration (hijrah) was to Allah and His Messenger, his migration is to Allah and His Messenger; but he whose migration was for some worldly thing he might gain, or for a wife he might marry, his migration is to that for which he migrated.” [Al-Bukhari & Muslim]

Abu Hamzah Anas bin Malik, radiyallahu ‘anhu, who was the servant of the Messenger of Allah, sallallahu ‘alayhi wasallam, reported that the Prophet, sallallahu ‘alayhi wasallam, said: “None of you truly believes (in Allah and in His religion) until he loves for his brother what he loves for himself.” [Al-Bukhari & Muslim]

About History

The urgent of reading history is that we become aware of his past life, progress and destruction of a nation, understand the wisdom behind the nation's history, feel the love, angry, sad, all within the scope of history. Because history is an art. Art is beauty. So people who do not know history, its own history, at least then he would not know the beauty of the wheel of life that applies to every person.

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