Bureau of Santé Animale: Avian Flu Outbreak In France - Update

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It's been nearly a month since the resource center of Epidemiosurveillance Santé Animale  last posted an update on France's ongoing HPAI/LPAI bird flu outbreaks, but this morning they have released an epidemiological update as of 01/07/16.

Of 129 suspected outbreaks, 67 have tested  positive for HPAI H5, 15 positive for LPAI H5, 45 proved negative, and 3 are still under investigation. 

Of note, while 20 of the HPAI H5 viruses' neuraminidase was undetermined, of the remainder H5N9 was the most common subtype detected, followed by H5N1.

Figure 6: Distribution of confirmed outbreaks of avian influenza by HP or insulated subtypes (France at 01/07/2016)

Follow the link below for the full report, which includes numerous maps, charts, and graphs.

(Translated)

Suspicions and Avian Influenza H5 outbreaks in France - Point 2016-1 situation in 01/07/2016

Submitted by Vera Kant on 01/12/2016 - 9:31.

 











Sophie Le Bouquin (1), Adeline Huneau-Salaun (1), Rozenn Souillard (1), Manon Hamon (2) Matilda Saussac (3), Laure Bournez (3), Eric Niqueux (4), Audrey Schmitz (4) Jean-Yves Cough (1), Nicolas Eterradossi (4), Virginia Michel (1), Alexandre Fediaevsky (2), Didier Calavas (5), Pascal Hendrikx (3), Anne Bronner (2)

(1) Epidemiology Unit ANSES Ploufragan
(2) DGAl 
(3) Unit UCAS, Anses, Laboratories Directorate
(4) Virology Unit, National Reference Laboratory, ANSES Ploufragan
(5) Epidemiology Unit Anses-Lyon

1. Summary of suspicions

On 7 January 2016, 129 suspected cases of influenza avian were investigated leading to the identification of 67 (52%) outbreaks influenza avian highly pathogenic subtype H5, 14 (11%) outbreaks of influenza avian LPAI subtype H5 (Figure 1); 45 suspicions were overturned and three are being analyzed.

As part of the monitoring, a suspected infection of livestock by a H5 influenza virus can be of origin: 

o "Event": clinical signs of avian influenza observed in breeding,
o "analytic" from : 

· the annual national survey of serological surveillance, where farming has positive serological results, 

· the identification of epidemiological links between livestock and or proven outbreaks,

· screenings during movements provided of animals from livestock out of restricted areas.

These suspicions are reversed when H5 is not identified by PCR, or confirmed as H5 is present. In this case, the virus identified is qualified by a degree of pathogenicity, highly pathogenic (HP) or low pathogenic (LP).

HP avian influenza outbreaks were identified in seven departments (Figure 2). Four of them (Landes, Pyrénées-Atlantiques, Gers and Dordogne) comprise 92% of these homes.

 Among the 126 investigated suspicions for which we have information, 58 (46%) were "Event" and 68 (54%) "analytical", making mostly a result of movements of animals before screening for outlet a restricted area (45 of 68, or 66% of analytical suspicions) (Table 1). About half of activation suspicions (43%) were confirmed (Figure 3), all for a subtype HP. As for screenings carried out under waivers for zone output, 42% (= 36/86) Waterfowl of farms in which samples were taken were found confirmed positive in HP, reflecting a significant contamination of the sector in restricted areas. All FP influenza cases have been identified from an original analytical suspicion.

(Continue . . .)

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Saudi MOH Reports 1st MERS-CoV Case Of 2016

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After an active summer, reported MERS cases in Saudi Arabia have dropped markedly in recent months, with only 5 cases recorded in December. 

Today, however, the MOH is reporting a new - primary case (camel contact) - in an 85 year old man from Bisha who is listed in stable condition.

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China MOA: National H7N9 Animal Surveillance - December 2015

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Since it first emerged in the winter-spring of 2013, avian H7N9 has proved exceptionally difficult to control because - unlike the HPAI H5 viruses we monitor (H5N1, H5N6, H5N8, etc.) - the H7N9 virus is benign in most birds (including poultry).

HPAI H5 viruses - at least in unvaccinated birds - produce significant morbidity and mortality in poultry, and that provides an early warning to poultry producers that something is amiss and testing and safety precautions are needed. 

With H7N9, often our first clue that local poultry are infected comes only after humans - who are susceptible to severe infection - fall ill.    All of which makes H7N9 a stealth virus among poultry, and particularly difficult to detect and eradicate.



Selective serological and PCR testing of poultry for the H7N9 virus began in 2013 - but a decade ago China was reportedly raising in excess of 15 Billion birds (cite) each year - so only a tiny fraction of a single percent can be tested.

Despite these limitations, testing can give us an idea of how far the virus is spreading geographically, and a general idea of its degree of infiltration into a region's poultry. 

Serological testing indicates the birds have antibodies to the virus, indicating prior exposure, while PCR testing finds evidence (either directly from the bird, bird feces, or environmental  sampling) of active infection and viral shedding. 

Based on nearly 190,000 samples tested in December, the MOA surveillance system detected low to moderate levels of the virus in samples from 8 different provinces (out of 32 Provinces, municipalities & regions tested). 

A bit surprisingly, the two highest serological detection rates were Sichuan Province (5.97%) and Gansu Province (3.13%), neither of which has reported any human H7N9 cases to date.


The full report (including my modified chart) follows:

December 2015 H7N9 national animal influenza surveillance

 

Date: 2016-01-11 16:43 source:

In December 2015, the national veterinary laboratory animal 188,241 samples total sampling at various levels, covering some 6,467. 134,476 detection of serological samples, check out the H7 subtype of seropositive 380 samples from Sichuan province, Gansu province, Henan province, Jiangxi province and 33 farms (household) and 5 live bird market. Detection of pathogenic 53,765 samples, check out 12 H7N9 pathogen-positive samples, from Jiangsu Province and Shanghai Municipality, Hunan province and Jiangxi province, Fujian province and Guangdong Province, 6 7 live poultry markets in the provinces.

Instructions for positive samples

A serological positive samples, the H7 subtype of bird flu (380)

(A) chicken samples, Sichuan province, 197, 3 chicken farms and from deyang City 2 live bird market.

(B) chicken 129 samples in Gansu province, from Lanzhou city, Jiuquan, Zhangye city, Pingliang, Tianshui, dingxi city and 16 chicken farm of linxia (), as well as live poultry market in Lanzhou and Baiyin city, 3.

(C), 33 chicken samples, Henan, respectively from Zhengzhou, Anyang, jiaozuo, changyuan dengzhou, and 11 chickens (household).

(D) of Jiangxi province 7 samples from a chicken farm, Ganzhou City; Duck 14 samples from 2 duck farms in Nanchang.

Second, H7N9 pathogen-positive samples (12)

(A) Chong ' an sea food market in Wuxi city, Jiangsu Province, chicken sample 2, ducks 1 samples.

(B) the Shanghai Songjiang district Shanghai Huai agricultural and sideline products markets chicken 2 samples, environmental samples 1.

(C) the AP sample 1 xiangyin, Yueyang city, Hunan province, Hunan province, farmers ' markets, Yuanjiang, yiyang city of Hunan province market samples of chickens, ducks 1.

(D) of Poyang County, Shangrao city, Jiangxi province, Gao Jia Ling chicken market sample 1.

(E) xiangan district, Xiamen City, Fujian province, MA Xiang, the farmer's market chicken samples 1.

(Vi) in haizhu district, Guangzhou City, Guangdong Province, China market of chicken samples 1.

 

Click To Enlarge - Modified From MOA Chart

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WHO Update On H5N6 In China - Jan 11th

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For the second Monday in a row, the World Health Organization finds itself updating us on two new H5N6 infections in Guangdong Province, China.  Last week (see WHO Update On H5N6 In China  they reported on cases in Shenzhen and Zhaoqing City, with onsets in late December.

Today two more cases (1 from December, 1 from January) are described.

Prior to last December, only 4 cases had been reported out of China in the previous 19 months.   For some additional background on this emerging HPAI H5 virus, you may wish to revisit H5N6: The Other HPAI H5 Threat.

Human infection with avian influenza A(H5N6) virus – China

Disease outbreak news
11 January 2016

On 8 January 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 2 additional laboratory-confirmed cases of human infection with avian influenza A(H5N6) virus.

Details of the cases

• The first case is a 25-year-old male from Shenzhen City, Guangdong Province, who developed symptoms on 1 January. The patient was admitted to hospital on 4 January and is now in severe condition. He has a history of visiting a live poultry market.
• The second case is a 42-year-old male from Jieyang City, Guangdong Province, who developed symptoms on 12 December. The patient was admitted to hospital on 19 December and died on 21 December. He had a history of visiting a live poultry market.

Public health response

The Chinese Government has taken the following surveillance and control measures:

• making every effort to treat the patient; collecting and testing the specimens of the patient, carrying out viral isolation and whole genome sequencing and comparison;
• conducting epidemiological investigation; tracing, managing and observing the close contacts of the patient;
• strengthening surveillance of unexplained pneumonia and routine sentinel surveillance of influenza; strengthening the etiological surveillance of influenza/avian influenza virus.

WHO risk assessment

WHO continues to closely monitor the influenza A(H5N6) situation and conduct risk assessments. So far, the overall risk associated with avian influenza A(H5N6) viruses has not changed.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

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. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

Related links

• Influenza at the Human-Animal Interface (HAI)
• Monthly Risk Assessment Summaries – Influenza at the Human-Animal Interface
• A guide to healthy food markets
• Reducing risk of exposure to pathogens during slaughter and preparation of food
• Avian influenza in humans
• China country profile

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Another H7N9 Case In Zhejiang Province (Ningbo)

Zhejiang Province - Credit Wikipedia

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Last week in Media: 1 H7N9 Case In Zhejiang Province (Ningbo) we saw a report of a recently diagnosed H7N9 case in the port city of Ningbo in Zhejiang province.  No details as to age, or gender were provided.


Today Ningbo's Health and Family Planning Commission has published a brief notice stating that there are now two cases in the city's Yinzhou district. There is no indication from this report whether these cases are related in any way, and no other information (age, gender, exposure) - other than one is in critical condition -  is provided.

The city infected with H7N9 bird flu no deaths occur

Source: Health and Family Planning Commission Ningbo Published: 2016-01-11 author:

As of January 11 this year 18:00 pm, the city Yinzhou District has confirmed two cases of H7N9 cases. One patient in critical condition, is to rescue, one case of mild disease. Currently, the city no H7N9 deaths occur. Close contact with staff and medical personnel were not involved in the treatment of infections. Health department reminded the public, H7N9 preventable and controllable. Note that no live poultry exposure, symptoms of fever, cough, especially those with a history of contact with live poultry, should be timely treatment.

Parsimonious though its details might be, at least we are getting a notification from Ningbo.  Which is more than some of China's provinces are willing to divulge (see China: NHFPC Announces 10 H7N9 Cases, 3 Deaths In December).

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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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