China: NHFPC Announces 10 H7N9 Cases, 3 Deaths In December

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Almost a year ago China stopped their timely (and usually reasonably detailed) reporting of avian flu cases (see H7N9: No News Is . . . . Curious) and since that time we've had to rely primarily on sporadic provincial announcements, rare media reports, sparse WHO updates, and EOM epidemiological reports that are essentially devoid of detail. 

We're you to add up the H7N9, H5N1 & H5N6 reports we've seen officially mentioned for December you'd have a couple of H5N6 cases, and five H7N9 cases (3 of which were announced in the past four days).

Today Sharon Sanders of FluTrackers has picked up China's NHFPC monthly epidemiology report of infectious diseases for December, where buried in the line list are two entries - one for H7N9 cases, and another for all other avian flu cases.

Curiously, although we've had a WHO notification of two H5N6 cases with onsets in December, neither are listed.  China reports ZERO (non-H7N9) avian flu cases in December. 

As for H7N9, they report 10 cases, and 3 fatalities for December.  Presumably the 5 we already knew about (see FluTrackers H7N9 List), and 5 more that were never publicly reported.  Where they occurred, the ages and genders, and any other epidemiological information is not provided. 

December 2015 National Notifiable Infectious Diseases Overview
 

People's Republic of China National Health and Family Planning2016-01-11  

December 2015 (at 0:00 on December 1st 2015 to December 31st 24), the national (excluding Hong Kong, Macao and Taiwan, the same below) reported a total of 543,130 cases of legal infectious diseases, died 1858 people. Among them, the CPI infectious plague, cholera incidence and deaths have been reported. B infectious SARS, polio, highly pathogenic avian influenza and diphtheria morbidity, mortality report, the remaining 22 kinds of infectious diseases were reported incidence of 288,365 cases, 1846 people died. Before the reported incidence of five diseases were viral hepatitis, tuberculosis, syphilis, gonorrhea, and scarlet fever, accounting for 92% of the total reported cases of class B infectious diseases. 

Over the same period, the country reported a total of 254,765 cases of Class C infectious diseases, the death of 12 people. Where filariasis morbidity, mortality report, the number of reported incidence of the previous three diseases were hand, foot and mouth disease, other infectious diarrhea and mumps, accounting for 93% of the total reported cases of class C infectious diseases.

No mention of Avian flu cases in the narrative, but the line list (which I've modified below), shows both items listed.

While avian flu reporting remains disappointing out of China, they are hardly alone in this regard.  As we discussed in Saturday's H7N9 Case Notifications In Drips & Drabs, we remain woefully uninformed on the world's two biggest avian flu hot spots (China & Egypt).


And, as for much of the rest of the developing world, we don't know what we don't know.

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Scotland: Suspected H5 Avian Flu On Farm In Fife

Fife, Scotland - Credit Wikipedia

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With the exception of France, bird flu outbreaks in Europe have been scarce this winter, although the UK did report three outbreaks (2 H7 & 1 H5) in 2015.  Overnight the Scottish government announced the detection of (likely LPAI) H5 on a farm in Dunfermline, roughly 15 miles north and west of Edinburgh.

While full lab analysis is awaited, the usual precautions are ordered around the affected farm, and the birds there will be culled. 

Adjacent farms will monitored for signs of infection, and the word has gone out to all farmers in the UK to remain vigilant.  For now, this appears to be an isolated case, although that could change in the days ahead.


This from the Scottish Government Website.

Avian influenza case

Poultry industry urged to be vigilant.

Scottish poultry producers are being urged to stay vigilant following the reporting of a suspect case of avian influenza in Fife.

A suspect case of avian influenza has been identified in chickens on a farm in Dunfermline.

Initial test results have indicated presence of a notifiable strain of Avian Influenza (H5) and the clinical picture suggests that this is a Low Pathogenic strain and further testing is underway to confirm the strain.

In order to limit the further spread of disease, appropriate restrictions have been imposed on the suspected premises and any identified contact premises. 

The birds at the suspect premises will be humanely culled and a 1 km Temporary Control Zone (TCZ) put in place around the farm. 

Within this zone a range of different controls are in place which include restrictions of the movement of poultry, carcasses, eggs, used poultry litter and manure and restrictions on bird gatherings. 

There have been a number of recent cases of avian influenza across continental Europe in recent months including three cases in other parts of the UK in 2015.

Scotland’s Chief Veterinary Officer, Sheila Voas said:

“We have taken immediate action to contain this case as part of our robust procedures for dealing swiftly with avian flu. 

"Evidence suggests this is a low severity form of the virus however we are taking action to ensure that the disease does not spread or develop into a more severe form.

“I would urge poultry keepers in the surrounding area to be vigilant for any signs of disease and to ensure they are maintaining good biosecurity on their premises.”

Cabinet Secretary for Rural Affairs Richard Lochhead said:

"Livestock owners and the general public should be assured that we are doing everything we can to control and prevent the spread of the disease. Any poultry producers who are concerned should immediately seek veterinary advice.”

Dr Jim McMenamin, Consultant Epidemiologist and Respiratory Infection lead for Health Protection Scotland said:

“Based on what we know about this strain of avian influenza and the actions that have been taken, the risk to human health in this case is considered very low. Health Protection Scotland continues to work closely with Animal Health throughout this investigation"

Rita Botto, Head Veterinarian of Food Standard Scotland said:

“On the basis of current scientific evidence, Food Standards Scotland’s advice is that bird flu does not pose a food safety risk for UK consumers.”

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RESEP SAMBAL MANGGA MUDA PEDAS

Resep Sambal Mangga - Mangga muda dapat menjadi hidangan enak dan nikmat tatkala diolah menjadi sambal pedas. Mangga masih muda atau mangga yang hampir matang (mengkal atau gumading) lebih disukai dari mangga matang karena masih renyah saat digigit, selain itu perpaduan rasa sambal pedas dengan rasa asam yang segar sangat cocok menjadi pelengkap hidangan penambah selera.

Bermacam jenis mangga bisa kita pilih untuk digunakan, termasuk mangga kweni (kaweni, kuweni) serta kerabatnya bacang (macang) yang menjadi favorit karena aroma dan rasanya yang khas. Berikut adalah cara membuat sambal mangga muda enak dan sederhana dengan cita rasa asam pedas.

Persiapan Bahan dan Bumbu Sambal Mangga

• 1 buah mangga muda diserut kasar
• 6 buah cabe keriting merah
• 5 buah cabe rawit merah
• 1/2 siung bawang putih
• 1/4 sdt garam
• 1/2 sdt gula pasir
• 1/2 sdt terasi bakar

Cara Membuat Sambal Mangga Muda

1. Ulek atau haluskan semua bahan sambal di atas, campurkan serutan mangga, kemudian aduk-aduk dengan sambal serta sambil sedikit ditekan-tekan hingga menyerap dan tercampur rata.
2. Sambal mangga siap untuk disajikan bersama nasi putih panas bersama menu masakan lainnya.

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Jiangxi Province Reports Fatal H5N6 Case - Ex Guangdong Province

Jiangxi Province - Credit Wikipedia

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FluTrackers (h/t Biological) today has picked up a report from the Jiangxi Provincial Health and Family Planning website somewhat belatedly announcing what is China's 8th human H5N6 infection to date.

While the patient was hospitalized (and died) in a Ganzhou hospital, he apparently lived in Jieyang City, Guangdong Province - a city which has recently reported two H7N9 cases.  Guangdong province has also reported three recent H5N6 cases.

In the 20 months since the H5N6 virus was first detected China has reported 8 H5N6 cases, 4 of which have occurred in the past three weeks.  And all four recent cases either occurred in, or have links to, Guangdong Province.

We found one case of H5N6 cases in our province in the regular monitoring of severe pneumonia cases

Jiangxi Provincial Health and Family Planning www.jxwst.gov.cn 2016 年 1 月 08 2008

Source: Committee of Emergency Management Office 

Jiangxi Provincial Health and Family Planning Commission communications:

After entering the winter and spring of influenza and other respiratory diseases high season, the province stepped up surveillance of influenza, severe pneumonia. In routine monitoring, from 1 cases of severe pneumonia cases detected H5N6 avian influenza virus nucleic acid positive. 1 month 7 days, the Chinese Center for Disease Control to review the detection identified as H5N6 virus nucleic acid positive . Provincial expert group on the basis of the clinical cases, laboratory testing and epidemiological findings, diagnosis in this case as H5N6 confirmed cases.        

Patients, male, 42 years old, currently residing in Jieyang City, Guangdong Province , has a history of contact with live poultry business market exposure history. December 21st due to fully died in a hospital in Ganzhou. All close contacts did not appear abnormal normal.       

Experts judged the view that this case appears as sporadic cases, the lower the risk of spreading the virus at this stage.

Recent blogs on H5N6 and H7N9 cases in China include:

HK CHP: 3rd H5N6 Case In Guangdong Province In Last 2 Weeks

Hong Kong Alert For Holiday Avian Flu Threat

Hong Kong: H5N6 Detected In Dead Egret

WHO Update On H5N6 In China 

 

While H7N9 and H5N1 have proved to be the most dangerous avian flu viruses to date, H5N6 is showing signs of being a contender, and is definitely a virus to watch.

 

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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.

(Continue . . .)

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.

(Continue . . . )

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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