Indiana BOAH: Additional H7N8 Outbreaks Were LPAI

Indiana BOAH - Jan 17th

#10,902


An update today from Indiana's Board of Animal Health clarifies and revises last night's statement now that laboratory testing has come back on 8 of the 9 newly discovered outbreaks.

Instead of all of those outbreaks being HPAI H7N8, the vast majority (so far) are LPAI.

Highly pathogenic avian influenza is more apt to be recognized based on the appearance and behavior of infected birds, and that is what led to the initial quarantine and  testing.  LPAI infection is more subtle, and isn't always readily apparent without testing.

It turns out that eight of the nine subsequent positive tests returned from other farms in Dubois county are LPAI H7N8, with one still pending.  No additional farms have been announced as infected today.

This statement was emailed a short while ago from the Indiana BOAH.

Indiana Clarifies Avian Flu 

Findings in Nine Flocks

Laboratory Results Confirmed Overnight

FOR IMMEDIATE RELEASE

INDIANAPOLIS (17 Jan. 2016)--Laboratory testing of samples from eight of nine Southern Indiana turkey flocks was completed overnight by the U.S. Department of Agriculture (USDA) National Veterinary Services Laboratory in Ames, Iowa. While all nine were announced as H7 influenza-positive yesterday, the specific strain was yet to be determined. The Indiana State Board of Animal Health (BOAH) has been informed eight are low-pathogenic H7N8. Testing continues on the remaining sample.

Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. The Centers for Disease Control and Prevention (CDC) considers the risk of illness to humans to be very low.

Indiana State Veterinarian Bret D. Marsh, DVM calls this good news, and evidence that Indiana’s aggressive surveillance and response efforts in Dubois County are working.

“The low-path H7N8 virus was identified during testing in the 10-km zone around the initial flu-positive flock,” Dr. Marsh said. “Because flu viruses are constantly mutating, we want to catch any case as early as possible after infection. We know this virus strain can intensify, so finding these cases as low-path strains shows we are keeping pace with the spread of this disease in the area.”

In addition to the HxNx naming scheme for specific strains, AI viruses are further classified by their pathogenicity—the ability of a particular virus strain to produce disease in domestic chickens. Highly pathogenic avian influenza (HPAI) virus strains are extremely infectious, often fatal to domestic poultry, and can spread rapidly from flock to flock. Low pathogenicity avian influenza (LPAI) virus strains occur naturally in wild migratory waterfowl and shorebirds without causing illness. LPAI viruses have the potential to mutate into HPAI.

“This finding does not alter the aggressive control strategy BOAH has set forth,” added Dr. Marsh. “Nor does it change our resolve to eliminate this virus wherever we find it.”

Priority response by the state of Indiana and USDA continues on all the infected farms. Turkeys are being humanely euthanized on infected sites within 24 hours of diagnosis. Depopulation eliminates the source of infection to prevent the disease from spreading. Disposal of the turkeys, primarily via indoor composting, will be followed by thorough cleaning and disinfection of all barns.

Aggressive testing of other poultry farms in the area continues. During the last 24 hours, commercial farms have yielded 100 negative flu tests, beyond the nine new positives. In addition, state and federal teams have visited 503 residences in the area to identify any small flocks for testing. Tests are pending on 17 small flocks. Residential visits will continue in the 10-km area.

 From APHIS, a similar announcement (excerpt below), the a brief discussion.

Update on H7 Avian Influenza Cases in Indiana, Additional Flocks Now Confirmed as Low Pathogenic

Last Modified: Jan 17, 2016

Cases Found Through Surveillance Testing in Initial Control Area

 

WASHINGTON, January 17, 2016 -- The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the pathogenicity of eight of the nine H7N8 avian influenza detections announced on January 16. The turkey flocks have been confirmed as low pathogenic avian influenza, with additional testing ongoing for the ninth flock.

These January 16 detections were identified as part of surveillance testing in the control area surrounding the initial highly pathogenic H7N8 avian influenza (HPAI) case in that state, identified on January 15.

The pathogenicity of a virus refers to its ability to produce disease.  Birds with low pathogenic avian influenza (LPAI) often show no signs of infection or only have minor symptoms.  HPAI viruses spread quickly and cause high mortality in domestic poultry.  H7 LPAI viruses have been known to mutate into HPAI viruses in the past.

“It appears that there was a low pathogenic virus circulating in the poultry population in this area, and that virus likely mutated into a highly pathogenic virus in one flock,” said Dr. John Clifford, USDA Chief Veterinarian. “Through cooperative industry, state and federal efforts, we were able to quickly identify and isolate the highly pathogenic case, and depopulate that flock.  Together, we are also working to stop further spread of the LPAI virus, and will continue aggressive testing on additional premises within the expanded control area to ensure any additional cases of either HPAI or LPAI are identified and controlled quickly.”

(Continue . . .)

HPAI viruses have been generated in the lab by repeated passage of LPAI viruses through chickens (cite FAO) but exactly how and why this occurs naturally is poorly understood (see JVI  Emergence of a Highly Pathogenic Avian Influenza Virus from a Low Pathogenic Progenitor). .

While we haven't seen it happen all that often, the risk is considered great enough that all LPAI H5 and H7 outbreaks must be reported to the OIE, and immediate steps must be taken to contain and eradicate the virus. 

Over the past year we've seen an unusual increase in number of these LP to HP conversions  (see You Say You Want An Evolution?) involving multiple H7 & H5 subtypes.  Now, it appears, we can add Indiana to the list.


It is going to be very interesting to see what the epidemiological investigation turns up on this newest avian influenza virus, and we will hopefully learn more about the European outbreaks in the days ahead as well.

Read More

Egyptian MOH Statement: No Bird Flu Cases Since Last Summer

#10,991


By this time last year, Egypt was embroiled in the largest outbreak of H5N1 human infection on record (see EID Dispatch: Increased Number Of Human H5N1 Infection – Egypt, 2014-15), and would soon stop publicly reporting on cases altogether (see Regarding The Silence Of The Egyptian MOH).

Last month in In The Land Of Limited Press Freedom, The Internet Rumor Is King, we looked what happens when local health officials are less than open about disease outbreaks.   

Over the past few weeks we've seen a constant stream of frantic Arabic media headlines announcing `Confirmed Bird Flu Cases', which are followed almost immediately by denials from health officials.  A couple of recent examples include:

«Bird flu» to end the life of Egyptian girl

Al-Qabas  - Jan 16, 2016    

Announced an Egyptian hospital death-old girl two years and a half as a result of being   infected with Pfirs bird flu, as has been the detention of her cousin under treatment. The results of the tests confirmed the child bird flu, after he came to the hospital in a degraded state suffer pneumonia twofold.

Health»: 15 suspected case of the avian influenza in North Sinai
Saturday, January 16, 2016 - 19:52

Undersecretary of the Ministry of Health in northern Sinai, Dr. Tarek Khater, that the total pathological cases and suspected of having the flu emerging at the county level stood at 15 cases, and was placed under them treatment 8 cases in El-Arish General Hospital and 7 in the central Bir al-Abed Hospital

These media reports often confuse seasonal flu with bird flu, and continue to regard seasonal A/H1N1 as a highly dangerous pandemic `swine flu'.  Add in the vagaries of translation software, and you end up with a melange of dubious value.


While there have been numerous statements from officials denying bird flu cases appearing  in the media, the MOH website itself has been largely silent on the issue. At least until yesterday, when they posted the following long, reassuring statement, insisting there have been no bird flu (H5N1) cases reported in Egypt since last summer. 

(translation)

Influenza Conference statement January 16, 2016

In the official spokesman of the Ministry of health and population Dr. Sampath at the press conference held by the Ministry here Saturday by the National Institute for training in Abbasiya letter reassuring for citizens not to worry or fear from seasonal influenza Ah1n1, noting that Egypt has no epidemic outbreaks of the virus, stressing the adoption of all the measures, the Ministry and preventive measures necessary to confront and prevention, called on citizens to proper health methods in disease prevention and, in the case of the onset of symptoms is consult Doctor or go to the nearest hospital.

Dr. said Mohamed Awad tageldin, former Health Minister Professor of respiratory diseases, contagious viral disease influenza, there is a difference between flu and colds since cold symptoms is simple and its nose only flu symptoms, your entire body with high temperatures and infect the upper respiratory tract and lower, and noted that the most serious complications of influenza infection is pneumonia.

He thanked all the viruses and chest hospitals operating in receiving influenza cases and provide treatment and medical care.

He explained that the more serious categories are children less than 5 years and older persons click 65 General and thoracic sensitivity ill, pregnant women and women who are breastfeeding, chronic diseases heart, kidney and diabetes, and those with weak immune systems, such as organ transplantation.

He advised the most susceptible to influenza virus infection to receive vaccinations each year for cases with weak immune and above, and washing hands down, good ventilation, and consult your physician in cases of high temperatures.

Dr. said Underwood, head of the preventive medicine, Ministry of health and population during the press conference, it was suspected the number 1037 if bird flu since June 2015 until now, where all came negative for bird flu, confirmed the absence of any confirmed human cases of infection with the bird flu virus in Egypt since June 2015, and that winter this year completely free of bird flu so far, they have not recorded any cases of injury or death Until now.

Qandil, confirmed once again the absence of so-called alkhnair flu virus now infects humans, as this was the most commonly used title in 2009 when the global influenza pandemic, since 2010 the World Health Organization announced the end of the pandemic, the virus causing the pandemic has same epidemiology of seasonal influenza viruses since then was put into viruses involved in seasonal influenza vaccination.

Underwood said that seasonal influenza virus H1N1-type is prevalent during the current influenza season at global, regional and national level and is from seasonal influenza, which is monitored in Egypt and respond to treatment with the drug tamiflu and is the same type of viruses within the taste of existing seasonal flu.

(Continue . . . )

Given the Egyptian MOH's past obfuscation of bird flu reports, and the media's penchant for prematurely calling any severe respiratory illness a `suspected bird flu', I wouldn't care to wager any money on what is really going on in Egypt.  

I'm not blogging individual media reports because my level of confidence in them is so low.   

But since Egypt has been a perennial hot spot for avian flu, I continue to monitor it - as do other Flublogians (i.e. Crof, FluTrackers, etc.) - and if something credible emerges, you can be certain we'll write about it. 

Read More

APHIS/Indiana BOAH: HPAI H7 Avian Flu Detected At 9 Additional Farms

Indiana BOAH

#10,900



The USDA's APHIS and the Indiana Board of Animal Health (BOAH) have announced this evening the results of rapid testing of farms around the turkey farm that yesterday was determined to be infected with a new, HPAI H7N8 virus.

Nine additional farms, all located in Dubois county, have tested postive for H7 avian flu.  Although likely H7N8, the full subtype should be known in a day or so. 

This dashes the hopes, expressed yesterday, that the first farm might be an isolated event, and will undoubtedly lead to even greater testing and surveillance in the region.   First a statement from the Indiana BOAH, then the statement from APHIS.

FOR IMMEDIATE RELEASE
 
More Cases of Highly Pathogenic Avian Influenza Diagnosed in Indiana

INDIANAPOLIS (16 January 2016)—The Indiana State Board of Animal Health (BOAH) announces nine more commercial turkey farms in Dubois County have tested positive for highly pathogenic avian influenza. This brings the total to 10 commercial turkey operations. Further testing is underway to determine the virus type.

All positive flocks are located within the original control area, and were identified by surveillance testing. New 10 km circles have been drawn, to expand the control area slightly beyond Dubois County into Martin, Orange, Crawford and Davies counties.
Avian influenza does not present a food safety risk; poultry and eggs are safe to eat. The Centers for Disease Control and Prevention (CDC) considers the risk of illness to humans to be very low.

Poultry flocks in the surrounding area are being tested daily for the presence of avian influenza. State and federal agencies are working alongside the poultry operations to minimize the impact and eliminate the disease.

Depopulation activities are underway on most of the sites. Depopulation of the index site was completed this morning. All infected flocks are located in Dubois County, Indiana.

REPORTING
 
Backyard poultry owners are encouraged to be aware of the signs of avian influenza and report illness and/or death to the USDA Healthy Birds Hotline: 866-536-7593. Callers will be routed to a state or federal veterinarian in Indiana for a case assessment. Dead birds should be double-bagged and refrigerated for possible testing.

Signs include: sudden death without clinical signs; lack of energy or appetite; decreased egg production; soft-shelled or misshapen eggs; swelling or purple discoloration of head, eyelids, comb, hocks;nasal discharge; coughing; sneezing; incoordination; and diarrhea. A great resource for backyard bird health information is online at: www.healthybirds.aphis.usda.gov

UPDATES and INFORMATION:
 
Situation updates and status reports about ongoing avian influenza activities, along with critical disease-related information, will be posted online at: www.in.gov/boah/2390.htm . Users may subscribe to email updates on a link at that page.

Additional H7 Avian Influenza Cases Found in Indiana

Last Modified: Jan 16, 2016

 

Cases Found Through Surveillance Testing in Initial Control Area

Andrea McNally (202)799-7033andrea.c.mcnally@aphis.usda.gov
Lyndsay Cole (970)494-7410lyndsay.m.cole@aphis.usda.gov

WASHINGTON, January 16, 2016 -- The United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed the presence of H7 avian influenza in 9 flocks in southwestern Indiana.  These new cases were identified as part of surveillance testing in the control area surrounding the initial highly pathogenic avian influenza (HPAI) case.  Testing is currently ongoing at the National Veterinary Services Laboratories in Ames, Iowa to determine the pathogenicity of these new cases.

No cases of HPAI H7N8 virus infection have been reported in humans at this time, and no human infections associated with avian influenza A viruses of this particular subtype (i.e., H7N8) have ever been reported. As a reminder, the proper handling and cooking of poultry and eggs to an internal temperature of 165 ˚F kills bacteria and viruses, including HPAI.

APHIS continues to work closely with the Indiana State Board of Animal Health on a joint incident response. State officials quarantined the affected premises and depopulation of birds on the affected premises has already begun. Depopulation prevents the spread of the disease. Birds from the flock will not enter the food system.

(Continue . . . )

Read More

CDC Zika Press Conference: Audio & Transcript

#10,899


The CDC has posted the transcript of last night's hastily called CDC press conference (at 7pm EST) on yesterday's release of new, interim travel advice for pregnant women seeking to travel to countries where the Zika virus is transmitting.


As to why a late Friday presser instead of waiting until Monday, (asked by journalist Eben Brown), Dr. Lyle Petersen explained:

The reason is we believe this is a fairly serious problem. The infection is or the virus is spreading fairly rapidly throughout the Americas. We know in populations that it does affect, a large percentage of the population may be become infected. And because of this growing risk of or growing evidence that there's a link between Zika virus and microcephaly, which is a very severe and devastating outcome, it was important to warn people as soon as possible.

A press release by the state of Hawaii yesterday (HAWAII DEPARTMENT OF HEALTH RECEIVES CONFIRMATION OF ZIKA INFECTION IN BABY BORN WITH MICROCEPHALY) - born to a mother who lived in Brazil during her 1st trimester last year - only serves to highlight the risks.


Last night the CDC followed up this press conference by releasing: 

CDC Issues Interim Travel Advice On Zika Virus (Level 2 - Enhanced Precautions) 

CDC HAN: Recognizing, Managing & Reporting ZIka Virus Infections In Travelers

 

The audio and transcript of last night's 38 minute press conference outlines some of the preliminary data - gathered primarily in Brazil - that prompted the issuance of these recommendations, and discusses the potential for future spread in the United States. 


The transcript/audio is very informative, and highly recommended. 

 

Transcript for CDC Telebriefing: Zika Virus Travel Alert

Press Briefing Transcript

Friday, January 15, 2016 at 7 pm E.T.

• Zika Virus Travel Alert[audio MP3 - 8 MB]

Please Note:This transcript is not edited and may contain errors. 

(Continue . . )

 

 

Read More

CDC HAN: Recognizing, Managing & Reporting ZIka Virus Infections In Travelers

# 10,898



Although we’ve seen a handful of  viremic Zika virus infected travelers arrive into the United States in the past (see Despite What You May Have Heard About The 1st Zika Case In The US . . .), those numbers have been small (20+ detected), and so far (unlike dengue and CHKV), we haven’t seen any evidence of local transmission. 

But with the Zika virus spreading rapidly in Central & South America, the number of Zika infected travelers to the United States is expected to increase. 

Any travelers who are viremic (producing large quantities virus in their blood), and arrive in areas where suitable mosquito vectors are present, could potentially `seed' the virus to the local mosquito population and start small chains of local transmission. 


While Zika virus infection is mild for most people, there are anecdotal reports of increases in Guillain-Barré syndrome in regions where outbreaks have occurred, and mounting concerns that maternal infection during the 1st and 2nd trimester may produce profound microcephalic birth defects.

(See ECDC: Complications Potentially Linked To The Zika Virus Outbreaks In Brazil & French Polynesia).

Given that Zika is an exotic and unfamiliar disease to most American doctors, late yesterday the CDC issued a LEVEL-2 Travel Advisory and the following HAN Advisory to help doctors identify, treat and report cases.

Recognizing, Managing, and Reporting Zika Virus Infections in Travelers Returning from Central America, South America, the Caribbean, and Mexico

This is an official

CDC HEALTH ADVISORY

Distributed via the CDC Health Alert Network
Friday, January 15, 2016, 19:45 EST (7:45 PM EST)
CDCHAN-00385

Summary

In May 2015, the World Health Organization reported the first local transmission of Zika virus in the Western Hemisphere, with autochthonous (locally acquired) cases identified in Brazil. As of January 15, 2016, local transmission had been identified in at least 14 countries or territories in the Americas, including Puerto Rico (See Pan American Health Organization [PAHO] link below for countries and territories in the Americas with Zika virus transmission). Further spread to other countries in the region is likely.

Local transmission of Zika virus has not been documented in the continental United States. However, Zika virus infections have been reported in travelers returning to the United States. 

With the recent outbreaks in the Americas, the number of Zika virus disease cases among travelers visiting or returning to the United States likely will increase. These imported cases may result in local spread of the virus in some areas of the continental United States, meaning these imported cases may result in human-to-mosquito-to-human spread of the virus.  

Zika virus infection should be considered in patients with acute onset of fever, maculopapular rash, arthralgia or conjunctivitis, who traveled to areas with ongoing transmission in the two weeks prior to illness onset. Clinical disease usually is mild. However, during the current outbreak, Zika virus infections have been confirmed in several infants with microcephaly and in fetal losses in women infected during pregnancy. We do not yet understand the full spectrum of outcomes that might be associated with infection during pregnancy, nor the factors that might increase risk to the fetus. Additional studies are planned to learn more about the risks of Zika virus infection during pregnancy.

Healthcare providers are encouraged to report suspected Zika virus disease cases to their state health department to facilitate diagnosis and to mitigate the risk of local transmission. State health departments are requested to report laboratory-confirmed cases to CDC. CDC is working with states to expand Zika virus laboratory testing capacity, using existing RT-PCR protocols.

This CDC Health Advisory includes information and recommendations about Zika virus clinical disease, diagnosis, and prevention, and provides travel guidance for pregnant women and women who are trying to become pregnant. Until more is known and out of an abundance of caution, pregnant women should consider postponing travel to any area where Zika virus transmission is ongoing. Pregnant women who do travel to these areas should talk to their doctors or other healthcare providers first and strictly follow steps to avoid mosquito bites during the trip. Women trying to become pregnant should consult with their healthcare providers before traveling to these areas and strictly follow steps to avoid mosquito bites during the trip.

Background

Zika virus is a mosquito-borne flavivirus transmitted primarily by Aedes aegypti. Aedes albopictus mosquitoes might also transmit the virus. Outbreaks of Zika virus disease have been reported previously in Africa, Asia, and islands in the Pacific.  

Clinical Disease

About one in five people infected with Zika virus become symptomatic. Characteristic clinical findings include acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. Clinical illness usually is mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and fatalities are rare. During the current outbreak in Brazil, Zika virus RNA has been identified in tissues from several infants with microcephaly and from fetal losses in women infected during pregnancy. The Brazil Ministry of Health has reported a marked increase in the number of babies born with microcephaly. However, it is not known how many of the microcephaly cases are associated with Zika virus infection and what factors increase risk to the fetus. Guillain-Barré syndrome also has been reported in patients following suspected Zika virus infection.

Diagnosis

Zika virus infection should be considered in patients with acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis who recently returned from affected areas. To confirm evidence of Zika virus infection, RT-PCR should be performed on serum specimens collected within the first week of illness. Immunoglobulin M and neutralizing antibody testing should be performed on specimens collected ≥4 days after onset of illness. Zika virus IgM antibody assays can be positive due to antibodies against related flaviviruses (e.g., dengue and yellow fever viruses). Virus-specific neutralization testing provides added specificity but might not discriminate between cross-reacting antibodies in people who have been previously infected with or vaccinated against a related flavivirus.

There is no commercially available test for Zika virus. Zika virus testing is performed at the CDC Arbovirus Diagnostic Laboratory and a few state health departments. CDC is working to expand laboratory diagnostic testing in states, using existing RT-PCR protocols. Healthcare providers should contact their state or local health department to facilitate testing.

Treatment
 
No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics. Because of similar geographic distribution and symptoms, patients with suspected Zika virus infections also should be evaluated and managed for possible dengue or chikungunya virus infection. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue can be ruled out to reduce the risk of hemorrhage. In particular, pregnant women who have a fever should be treated with acetaminophen. People infected with Zika, chikungunya, or dengue virus should be protected from further mosquito exposure during the first few days of illness to reduce the risk of local transmission.

Prevention
 
No vaccine or preventive drug is available. The best way to prevent Zika virus infection is to:

• Avoid mosquito bites.
• Use air conditioning or window and door screens when indoors.
• Wear long sleeves and pants, and use insect repellents when outdoors. Most repellents, including DEET, can be used on children older than two months. Pregnant and lactating women can use all Environmental Protection Agency (EPA)-registered insect repellents, including DEET, according to the product label.

Recommendations for Health Care Providers and Public Health Practitioners

• Zika virus infection should be considered in patients with acute fever, rash, arthralgia, or conjunctivitis, who traveled to areas with ongoing transmission in the two weeks prior to onset of illness.
• All travelers should take steps to avoid mosquito bites to prevent Zika virus infection and other mosquito-borne diseases.
• Until more is known and out of an abundance of caution, pregnant women should consider postponing travel to any area where Zika virus transmission is ongoing. Pregnant women who do travel to one of these areas should talk to their doctors or other healthcare providers first and strictly follow steps to avoid mosquito bites during the trip. Women trying to become pregnant should consult with their healthcare providers before traveling to these areas and strictly follow steps to avoid mosquito bites during the trip.
• Fetuses and infants of women infected with Zika virus during pregnancy should be evaluated for possible congenital infection and neurologic abnormalities.
• Healthcare providers are encouraged to report suspected Zika virus disease cases to their state or local health department to facilitate diagnosis and to mitigate the risk of local transmission.
• Health departments should perform surveillance for Zika virus disease in returning travelers and be aware of the risk of possible local transmission in areas where Aedes species mosquitoes are active.
• State health departments are requested to report laboratory-confirmed Zika virus infections to CDC.

For More Information

• General information about Zika virus and disease: http://www.cdc.gov/zika/
• Zika virus information for clinicians: http://www.cdc.gov/zika/hc-providers/index.html
• Protection against mosquitoes: http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods
• Travel notices related to Zika virus: http://wwwnc.cdc.gov/travel/notices
• Information about Zika virus for travelers and travel health providers: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/zika
• Pan American Health Organization (PAHO):  http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html
• Approximate distribution of Aedes aegypti and Ae. albopictus mosquitoes in the United States: http://www.cdc.gov/chikungunya/resources/vector-control.html

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

Read More

CDC Issues Interim Travel Advice On Zika Virus (Level 2 - Enhanced Precautions)

#10,897



After a three hour delay, the CDC released their interim travel recommendations of Zika at 7pm EST this evening, recommending - out of an abundance of caution - that Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing.
 

While a direct link between Zika virus infection and birth defects has not been conclusively established, the circumstantial evidence is sufficient for the CDC to make the recommendation. 

The primary concern is Brazil right now, but this travel advisory extends to all countries in the Americas seeing local transmission of the virus.  As of today that includes Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

The full press release may be accessed at the link below.

CDC issues interim travel guidance related to Zika virus for 14 Countries and Territories in Central and South America and the Caribbean

Out of an abundance of caution, pregnant women advised to consider postponing travel to areas where Zika virus transmission is ongoing 

Media Statement

For Immediate Release: Friday, January 15, 2016Contact: Media Relations,
(404) 639-3286

CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

Until more is known, and out of an abundance of caution, CDC recommends special precautions for pregnant women and women trying to become pregnant:

• Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who must travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
• Women trying to become pregnant who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip. 

Because specific areas where Zika virus transmission is ongoing are difficult to determine and likely to change over time, CDC will update this travel notice as information becomes available. Check the CDC travel website frequently for the most up-to-date recommendations.

Currently, there is no vaccine to prevent or medicine to treat Zika. Four in five people who acquire Zika infection may have no symptoms. Illness from Zika is usually mild and does not require hospitalization. Travelers are strongly urged to protect themselves by preventing mosquito bites:

• Wear long-sleeved shirts and long pants
• Use EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535. Always use as directed.
  • Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant and nursing women and children older than 2 months when used according to the product label. Oil of lemon eucalyptus products should not be used on children under 3 years of age.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents).
• Stay and sleep in screened-in or air-conditioned rooms.

In addition to the steps announced today, CDC is working with public health experts across the U.S. Department of Health and Human Services (HHS) to take additional steps related to Zika. CDC is developing interim guidance for pregnant women as well as sharing additional information about Zika with public health officials, clinicians and the public.  In addition, efforts are underway across HHS to develop vaccines, improved diagnostics and other countermeasures for Zika. 

(Continue . . .)

Some recent blogs on the Zika/Microcephaly situation include:

Despite What You May Have Heard About The 1st Zika Case In The US . . . 

Brazil MOH: Updated Microcephalic Birth Numbers - Epi Week 1

CDC Statement: First Zika VIrus Infection Reported In Puerto Rico

 

Read More

USDA/APHIS Press Conference On H7N8 - Audio

# 10,896


The USDA has posted a 21 minute audio file of a press conference, with Q&A by journalists, regarding today's HPAI H7N8 outbreak in Indiana.  While there are a great many unknowns, the hope is that by the middle of next week we'll know more about how this virus mutated into an HPAI strain.


Although we've no record of human infection with HPAI H7N8 - primarily because it has never been seen in the US before - the CDC is monitoring individuals who may have been exposed to the new strain of bird flu.


According to a Reuters report CDC says closely monitoring outbreak of new bird flu strain, that agency is  coordinating with state and local health officials to implement the protocols  we looked at last year in:

CDC HAN:HPAI H5 Exposure, Human Health Investigations & Response

CDC Clinician Guidance: Evaluating Patients Exposed to HPAI H5 Avian Flu. 

While we've seen sporadic human infection with H7 avian viruses in the past, with the exception of China's H7N9, they have nearly always been mild.  A few examples include:

• In 2003 a large outbreak of H7N7 (89 confirmed, 1 fatality) in the Netherlands – with  nearly all  reported cases having  very mild (often just conjunctivitis) symptoms.
• The Fraser Valley H7N3 outbreak of 2004 resulted in at least two human infections, as reported in this EID Journal report: Human Illness from Avian Influenza H7N3, British Columbia.
• In 2006 1 person in the UK was confirmed to have contracted H7N3, and the following year, 4 people tested positive for H7N2 – both following local outbreaks in poultry.
• 3 mild cases in Italy in 2013 (see ECDC Update & Assessment: Human Infection By Avian H7N7 In Italy).

Of course – H7 flu strains - like all influenza viruses, are constantly mutating and evolving. What is mild, or relatively benign today, may not always remain so.

In 2008 we saw a study in  PNAS that suggested the H7 virus might just be inching its way towards better adaptation to humans (see Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility).

You can read more about this in a couple of blogs from 2008, H7's Coming Out Party and H7 Study Available Online At PNAS.

As I said, we'll know a great deal more about this H7N8 virus in a few more days.  This outbreak may be a one-off event, or like HPAI H5 last year, could signal the beginning of something larger.


Stay tuned. 

Read More