H7N9 Case Notifications In Drips & Drabs

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Hong Kong's CHP has published another notification of an H7N9 case from the mainland, this time from the Shanghai Municipal Commission of Health and Family Planning, reporting the hospitalization of a 58 year old woman.

The announcement from Shanghai, however, list her as living in Shandong.   This from the CHP.

CHP closely monitors additional human case of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 9) closely monitoring an additional human case of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the Shanghai Municipal Commission of Health and Family Planning, the patient is a 58-year-old woman. She is now hospitalised for treatment.

From 2013 to date, 668 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities.

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Meanwhile Biological on FluTrackers picked up the belated announcement (buried in an EOM Epidemiological report) from Jiangsu Province of two cases from last December.  This tactic, of quietly releasing case counts (without details) - often weeks after the fact - has become increasingly common with some Chinese Provinces.

Perhaps the only good thing to say about China's notifications of human avian flu infections is that it beats Egypt's reporting of H5N1 by a mile.

While one hopes that both countries are being more open about sharing avian flu information with the World Health Organization than they are their own people, the paucity of information we see in WHO updates suggests otherwise.

Even under the best of circumstances we assume we are only seeing the tip of the iceberg when it comes to disease outbreaks around the world. 

But of late with avian flu, we're barely getting ice cubes.

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Nigeria: Lassa Fever Outbreak With 40 Fatalities

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Although endemic in West Africa, for the past three years Nigeria has seen a steady decline in the number of Lassa Fever cases  - and deaths - with the last significant outbreak reported in 2012.

Last year, Nigeria reported only 250 cases (likely a substantial under count) and 8 deaths.   By contrast - in 2012 - 117 deaths were recorded.

Lassa is a Viral Hemorrhagic Fever (VHF), although it is nowhere near as virulent as Ebola or Marburg. The Lassa virus is commonly carried by multimammate rats, a local rodent that often likes to enter human dwellings.

Exposure is typically through the urine or dried feces of infected rodents, and roughly 80% who are infected only experience mild symptoms.  The overall mortality rate is believed to be in the 1%-2% range, although it runs much higher (15%-20%) among those sick enough to be hospitalized.

Like many other hemorrhagic fevers, person-to-person transmission may occur with exposure to the blood, tissue, secretions, or excretions of an individual, although the CDC reassures:

Casual contact (including skin-to-skin contact without exchange of body fluids) does not spread Lassa virus. Person-to-person transmission is common in health care settings (called nosocomial transmission) where proper personal protective equipment (PPE) is not available or not used. Lassa virus may be spread in contaminated medical equipment, such as reused needles.

Over the past couple of days alarm bells have started ringing in Nigeria as it was revealed that 86 Lassa cases have been reported from 10 states over the past 6 weeks, and of those, 40 have died. 

An initial mortality rate (among hospitalized cases) of 46% -  roughly triple that normally expected. 

While this high mortality rate is getting a lot of press, this is a relatively small sample, there is often a bias towards identifying the most critically ill subset of patients early in any outbreak, and that there may be unreported co-factors at work here.

All of which could help to skew the mortality figures higher. 

Forty deaths in such a short time period, however, is a substantial jump over recent years. Last night (Friday), the Health Minister Isaac Adewole, speaking at a news conference, announced the latest case counts and called the number of deaths `unusual'. 

 This report from NAIJ.COM.

Lassa Fever Kills 40 In 10 States
 
Isaac Adewole, the minister of health, has confirmed that 40 people have died in Nigeria in a suspected outbreak of Lassa fever.


Speaking at a news conference in Abuja, the minister said: “The total number (of suspected cases) reported is 86 and 40 deaths, with a mortality rate of 43.2 percent.”

He also warned Nigerians that the disease has already spread to ten states in the six weeks since the first case was reported.

Seven of the affected states are in the north: Bauchi, Nasarawa, Niger, Taraba, Kano, Plateau and Gombe, while the remaining three are in the south: Rivers, Edo and Oyo.

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The twitter hashtag  #Lassafever  is seeing a lot of traffic overnight, with @EbolaAlert posting public health infographics and links.

While Lassa is unlikely to spark a major epidemic, the same could have been said for Ebola a couple of years ago. Of late - when it comes to infectious diseases - conventional wisdom has suffered some setbacks.


So we'll keep an eye on this outbreak, and I'll report back any significant information.

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Lane Community College - United States

Lane has released over US$700,000 dollars of scholarship money that is available to all students.

For more information, please contact/visit your nearest JM Office today

                  

                                                                                                                                                              Article is courtesy of  Lane Community College

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Wellington Institute of Technology - New Zealand

Congratulations to the School of Engineering!

Engineering Achieves International Accreditation

Graduates from WelTec’s School of Engineering will now have their qualifications officially recognised globally. 

WelTec has been formally recognised by an independent panel convened by the Institution of Professional Engineers New Zealand (IPENZ) – New Zealand’s professional body for engineers –as having qualifications that meet international standards. The NZ Diploma in Engineering and the Bachelor of Engineering Technology degree have been successfully recognised as meeting the requirements of two benchmark international accords. WelTec’s Engineering Degree has been accepted for recognition within the Sydney Accord and the Engineering Diploma within the Dublin Accord.

Achieving this world class status means our engineering degree qualification and our graduates are recognised by nine individual member countries who are party to the Sydney Accord and our diploma is recognised by seven member countries that have joined the Dublin Accord. Graduates will now have their WelTec qualifications recognised around the world which really enhances the mobility of our alumni. These Accords are the gold standard test for technologist and technician engineering qualifications and this recognition is a credit to all WelTec staff involved in their delivery.

For more information, please contact/visit your nearest JM Office today

                  

                                                                                                                                                 Article is courtesy of  Wellington Institute of Technology

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The University of Adelaide - Australia

The University of Adelaide has offered two new Bachelor programme (Bachelor of Liberal Arts and Sciences & Bachelor of Criminology) commencing in February 2016. 

Bachelor of Liberal Arts and Sciences

Program Name	Bachelor of Liberal Arts and Sciences
CRICOS Code	089705J
AQF Level	7 – Bachelor Degree
Duration	3 years (156 weeks)
Location	North Terrace
Number of Units	72
Intakes	Semester 1 (February), Semester 2 (July)

Bachelor of Criminology 

Program Name	Bachelor of Criminology
CRICOS Code	089645E
AQF Level	7
Duration	3 years
Location	North Terrace
Number of Units	72
Intakes	February,  July

For more information, please contact/visit your nearest JM Office today

                  

                                                                                                                                                 Article is courtesy of  The University of Adelaide

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Monash University - Malaysia

You are invited to attend our Workshops and Talks on the Application Day.

Take this opportunity to discuss your study options with  our course counsellors and academic staff and discover what an Undergraduate or Postgraduate degree from Monash can do for you and your future! 

Attend our Application Days to find out more:

Venue	Date	Time
Clinical School Johor Bahru (Hospital Sultanah Aminah)	9 Jan 2016	11am-4pm
St Giles Wembley, Penang	16 Jan 2016	11am-4pm

For more information, please contact/visit your nearest JM Office today

                  

                                                                                                                                                 Article is courtesy of  Monash University Malaysia

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FluView Wk 52: A Slight Increase In Activity & A Novel H3N2v In New Jersey

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Influenza activity remains fairly low for this time of year, but has increased slightly in recent weeks. Interestingly, a flu season that early on appeared destined to be dominated by H3N2 has - in the past month - switched over to seeing a majority of H1N1 cases.

Today's FluView also carries a report on the 7th novel swine variant flu infection of the year.

First a quick look at the regular flu stats, then a look at the novel flu detection.

2015-2016 Influenza Season Week 52 ending January 2, 2016

All data are preliminary and may change as more reports are received.

Synopsis:

During week 52 (December 26, 2015-January 2, 2016), influenza activity increased slightly in the United States.

• Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 52 was influenza A, with influenza A (H1N1)pdm09 viruses predominating. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was low.
• Novel Influenza A Virus: One human infection with a novel influenza A virus was reported.
• Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below their system-specific epidemic threshold in both the NCHS Mortality Surveillance System and the 122 Cities Mortality Reporting System.
• Influenza-associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported.
• Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.8%, which is above the national baseline of 2.1%. Seven of 10 regions reported ILI at or above region-specific baseline levels. Puerto Rico and two states experienced high ILI activity; New York City and two states experienced moderate ILI activity; seven states experienced low ILI activity; 39 states experienced minimal ILI activity; and the District of Columbia had insufficient data.
• Geographic Spread of Influenza: The geographic spread of influenza in Guam and two states were reported as widespread; six states reported regional activity; 13 states reported local activity; the U.S. Virgin Islands and 27 states reported sporadic activity; the District of Columbia and two states reported no influenza activity; and Puerto Rico did not report.

      
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While only rarely reported – partly due to limited surveillance and testing – swine variant influenza infections are suspected to be more common than we know (see CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012).

 Illness due to these strains is usually mild to moderate, and the symptoms look like any other flu.

Up until about six years ago the CDC only received 1 or 2 swine variant infection reports each year. In 2010, that number jumped to 8, and in 2011 to 12. In 2012 we saw more than 300 cases – mostly mild - and nearly all associated with exposure to pigs at state and local agricultural fairs.

In 2015 we've received word of 7 cases (4 - H1N1v & 3 - H3N2v).   Today's FluView has the details on this latest detection, which comes from New Jersey.

Novel Influenza A Virus:

One human infection with a novel influenza A virus was reported by the state of New Jersey. The person was infected with an influenza A (H3N2) variant (H3N2v) virus. The patient was not hospitalized and has fully recovered from their illness. The patient visited a farm near where swine are frequently housed but no direct contact with swine was reported in the week prior to illness onset. No ongoing human-to-human transmission has been identified.

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be more fully appreciated and appropriate public health measures can be taken. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.

While we’ve not seen sustained or efficient spread of these swine variant viruses in humans - like all flu viruses - swine variant viruses are capable of evolving, reassorting, and adapting to their hosts. Last summer we looked at a study that examine two recently discovered swine variant strains (see J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs).
 

They described both of these novel subtypes as “. . . virulent and can sustain onward transmission in pigs, and the naturally occurring mutations in the HA were associated with antigenic divergence from H3 IAV from human and swine’” and goes on to warn that  ``. . . the potential risk of these emerging swine IAV to humans should be considered”.

 
Although avian flu gets most of the headlines – mostly due to their high fatality rate – swine flu viruses are considered more likely to jump to humans, simply because they fall in the same H1, H2, and H3 subtypes as `humanized’ flu strains of the past 130 years.   
 

The 2009 H1N1 pandemic virus evolved in pigs, and so easily could the next pandemic virus.

 
For some more recent blogs on swine and swine variant influenza, you may wish to revisit:

 

PNAS: The Pandemic Potential Of Eurasian Avian-like H1N1 (EAH1N1) Swine Influenza

Eurosurveillance: Seroprevalence Of Cross-Reactive Antibodies To Swine H3N2v – Germany
 
JID: Evolutionary Dynamics Of Influenza A Viruses In US Exhibition Swine

 
Live Markets & Novel Flu Risks In The United States

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