Xinhua: H7N9 Case In Fujian Province

Fujian Province - Credit Wikipedia

#10,910


Although I find no official notice on the Fujian Health Ministry website, Xinhua (English) News is carrying the following report of what seems to be the 1st H7N9 case in Fujian Province of this 4th epidemic season.


First the report, then I'll return with a bit more.

East China province reports 1st H7N9 case this winter

Source: Xinhua   2016-01-19  21:41:49

XIAMEN, Jan. 19 (Xinhua) -- East China's Fujian Province on Tuesday confirmed its first human infection of H7N9 bird flu virus this winter.

The patient from Zhangpu County was confirmed to have the virus on Saturday. The patient is being treated and is in stable condition, the local publicity department said.

The county authorities have ordered to halt livestock sales in three townships in a bid to reduce the risk of infection.

On Tuesday, health authorities in Shanghai said that one of the city's two confirmed H7N9 patients has basically recovered and another is no longer critical.

The two are a 59-year-old man and a 58-year-old woman. 

Editor: Xiang Bo

Fujian Province ranks #4 overall in the number of reported human H7N9 cases, with the last case reported a 5 year old girl from Quanzhou, who recovered as of May 10th, 2015. 


This year, Zhejiang Province (which leads overall) has reported the most cases with 19, followed by Guangdong Province with 5. Whatever Guangdong Province has been missing in terms of H7N9 activity has been made up for by 5 recent H5N6 infections.

Credit HK CHP - Jan 19th Report

Whether the lack of reported cases during this 4th winter in provinces like Anhui, Shandong, or Henan reflect a change in the distribution of the virus, changes in human behavior around birds, or are the result of less stringent surveillance and reporting is unknown.

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DEFRA: Preliminary Outbreak Assessment - LPAI H5N1 In Scotland

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Over the past year we've seen a number of LPAI (low path) and HPAI (high path) avian flu outbreaks across Europe  that have included several new strains of avian influenza. In December, we learned of new H5N1, H5N2, and H5N9 subtypes in France, while last summer Germany and the UK were hit by new strains of HPAI H7.

Last week Scotland reported the UK's first outbreak of 2016 (see Fife, Scotland Avian Flu Outbreak Confirmed As LPAI H5N1), and today DEFRA has published their preliminary outbreak assessment (dated, curiously, 5 days ago).

 
The virus has been identified as a European LPAI H5N1 strain, similar to those commonly carried by wild birds. They note it is unrelated to either the Eurasian HPAI H5N1 virus, or to the HPAI H5 viruses circulating in poultry in Southwest France.


The authors find there is a low, but constant risk of poultry infection by H5 and H7 avian viruses in the UK via direct or indirect contact with wild birds, and recommend continued vigilance. 

Low Pathogenic Avian Influenza (H5N1) in the UK (Scotland)
 
14 January 2016 Ref: VITT/1200 LPAI in UK
Disease Report

On January 13th, the UK confirmed an outbreak of Low Pathogenic Avian Influenza (LPAI) subtype H5N1 on a commercial broiler breeder (parent) holding in the region (parish) of Dunfermline, Scotland (OIE, 2016; see map and inset). 


The premises had a flock of approximately 40,000 57 week old housed hens. The birds were housed in 5 sheds and the operation was “all in all out”. Mild clinical signs (egg drop and inappetence) were observed; there was no increase in mortality. Disease control measures were put in place on 8 January, when suspicion was raised after the receipt of the first non-negative laboratory test results. Measures include a 1km restriction zone, culling of all poultry on the infected premises and the destruction of eggs originating in the holding placed at the company hatchery has now been completed. An epidemiological investigation is being undertaken.
 
Situation Assessment

The holding is in a low poultry density area and there are no other commercial premises in the 1km zone, but there are areas where wild birds congregate within a few kilometres. The source of infection is unknown at this stage, and disease investigations continue. In general, LPAI (H5 and H7) viruses are considered to occasionally circulate in European waterfowl. 

National surveillance programmes in Europe have shown H5 seropositive flocks of farmed anseriformes (ducks and geese) and rarely in galliformes (chickens and turkeys) (European Commission, 2005-2014), nevertheless in the last 12 months over twenty outbreaks of various LPAI strains have been reported in domestic poultry in France, Germany, Italy, Netherlands and the UK, which is an indication of high awareness and effective screening in these countries.
 
Genetic sequencing results provided by the UK National Reference Laboratory (NRL) / EU Ref Lab (EURL) confirm that this is a European strain with common ancestry with other European LPAI H5 viruses most probably deriving from similar wild bird progenitor strains. The virus is clearly distinguishable from the Eurasian origin H5N1 viruses causing disease in poultry and occasionally people in close contact with infected poultry in Asia since 2003. It is also unrelated to the HPAI viruses circulating in poultry in Southwest France.

An interrogation of TRACES, the EU trade notification system, indicate there has been no recent trade to other Member States or Third countries of live poultry, hatching eggs or day old chicks from the affected premises or the restriction zone.
 
Conclusions
 
We consider that there is a constant low risk of incursion of any notifiable avian disease into the poultry in the UK from direct or indirect contact with wild birds. Prompt reporting of disease by farmers and vets in the UK, rapid diagnosis and swift disease control measures, often in advance of final strain identification, as in this case, enable rapid eradication from the UK poultry flock. The risk to public health and food safety is negligible.
 
For exports to non-EU countries the UK has taken immediate action to ensure that, in those cases where an importing country requires national freedom from Avian Influenza (i.e. that there be no reported cases of AI within the UK), the relevant Export Health Certificates have been suspended. In most cases the principle of regionalisation has been applied to enable trade to continue from outside the restricted area.
 
This disease event emphasises the importance of maintaining vigilance and appropriate biosecurity measures at all times throughout the year on poultry premises. Livestock keepers are reminded of the requirement to report all suspect notifiable diseases. 

We will continue to report on the situation if there are any significant changes.
 

Authors
Dr Helen Roberts
Professor Ian Brown

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CHINA MOA: H5N6 Strikes Rare Bird Farm In Hunan Wuling

FAO Report Nov 2014

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As one of the more recently emerged avian flu viruses (spring 2014), and with the bulk of its activity occurring in China, there's a good deal about the HPAI H5N6 virus that we don't know. 

A quick search of PubMed returns only a disappointing handful of abstracts for H5N6, compared to more than 7,000 for the H7N9 virus.

In the 20 months since it was first detected, we've seen 9 human infections (5 in the past month), with most having a fatal outcome. We've seen numerous poultry farms (ducks, geese & chickens) affected in China, Vietnam and Laos, and the virus has been isolated in live bird markets (LMBs) in China.


We've also seen scattered reports of wild birds (egrets, falcons, magpie robins) found dead in Hong Kong with the virus, and last summer, in H5N6 Rising: Infecting Birds, Humans, & Even Cats, we learned cats were susceptible. 

But our knowledge of its ecology, epidemiology, evolution, and host range remains extremely limited.

We don't tend to get a lot of information out of Mainland China, but today the Chinese Ministry of Agriculture reports a farm raising black swans and peacocks located in Hunan Wuling was hit by the H5N6 virus earlier this month.

You may recall the OIE reported a different peacock farm in Huaihua, Hunan - nearly 300 km to the southwest - was hit by the same virus in early December, 2015.

While H5N6 hasn't managed to spread as aggressively as H5N1 and H5N8, the virus continues to gain ground in China, and there are legitimate concerns this virus might expand its geographic range to Europe, Japan, India, or even North America over time.

Changde City, Hunan Wuling occurred breeding rare birds of HPAI

Issued by: Ministry of Agriculture press office Date: 2016-01-18 13:57 Keywords: bird flu; epidemic; Hunan

Agriculture Ministry press office on January 18 release, Changde City, Hunan Wuling occurred rare breed of highly pathogenic avian influenza.

January 9, Changde City, Hunan Wuling a rare birds breeding farm reared black swans, peacocks and other suspected bird flu symptoms appear, the incidence of 165, died 91. January 12, animal disease prevention and control center in Hunan diagnosed as suspected bird flu. January 18, by the National Avian Influenza Reference Laboratory confirmed that outbreaks of H5N6 subtype highly pathogenic bird flu.

After the outbreak, the local plan and control techniques in accordance with relevant regulatory requirements, earnestly epidemic disposal work. 1132 has been for the rare birds and poultry culling and safe disposal. Currently, the outbreaks had been effectively controlled.

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RESEP SEMUR TAHU SEDERHANA PRAKTIS

Resep Semur Tahu Sederhana - Bumbu semur tahu praktis kali ini merupakan perpaduan bumbu kecap manis dengan bumbu merah dari cabe keriting yang dihaluskan. Selain berasa manis yang gurih, juga ada tambahan rasa sedikit pedas sehingga bisa membantu menambah variasi menu hidangan sehari-hari yang enak dan sederhana.

Tempe, kentang, telur ayam atau telur puyuh juga bisa anda kombinasikan, jika ingin mengkreasikan cara membuat semur tahu supaya lebih komplit dan spesial.

Persiapan Bahan dan Bumbu Semur Tahu

• 10 buah tahu putih ukuran 4x4 cm digoreng hingga berkulit
• 1 buah tomat merah dipotong-potong
• 7 sdm kecap manis
• 1/2 sdt garam
• 1 sdm gula pasir
• 1/2 sdt kaldu bubuk
• 600 ml air
• minyak goreng secukupnya

Haluskan :

• 4 buah cabe merah keriting
• 1 sdm ketumbar
• 3 butir kemiri
• 2 cm jahe
• 4 butir bawang merah
• 3 siung bawang putih

Cara Membuat Semur Tahu Sederhana

1. Panaskan sedikit minyak, masukkan bumbu halus dan tomat, lalu tumis serta aduk-aduk hingga harum. Tuang air, garam, gula pasir, kaldu bubuk, dan aduk rata.
2. Masukkan tahu yang sudah digoreng tadi dan masak hingga mendidih. Tuang kecap manis, aduk rata lalu masak hingga agak mengental. Angkat semur tahu dan tuang dalam mangkuk saji, selanjutnya siap untuk dihidangkan.

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Jamaican MOH Advises Women To Delay Pregnancies Due To Zika Threat

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A testament to just how worried public health officials are in the path of the growing Zika epidemic, today the Health Minister of Jamaica - a country not yet affected by the virus - is urging all women to avoid getting pregnant for the next 6 to 12 months.


The following statement was posted on the MOH website earlier today.

Ministry of Health is Advising Women to Delay Pregnancy in Light of Zika Virus Links to Birth Defects

The Ministry of Health is advising women to delay becoming pregnant for the next six to twelve months and those already pregnant to take extra precaution to prevent being bitten by mosquitoes given the possible link between zika virus infection and microcephaly.

Microcephaly is an abnormal growth of the brain and stunting of the growth of the head of the foetus arising from infection in the first months of pregnancy. Babies who develop microcephaly in the womb may not live to full term, may be born prematurely, may be still born or may survive but with life-long disability.

Minister of Health, Hon. Horace Dalley says although there is no absolute proof the evidence from Brazil and the information from the Pan American Health Organization/World Health Organization (PAHO/WHO) and other technical partners is strong enough for the Ministry to take this position in seeking to prevent any possible adverse outcome to pregnant women.

“The zika virus is inching closer and closer to Jamaica as several of our Caribbean neighbours have reported cases. Women are therefore being advised to delay pregnancy if possible. Those already pregnant must take action to prevent being bitten by mosquitoes as the unborn baby is at high risk if the mother is infected in the first few months of pregnancy,” Minister Dalley advises.

Minister Dalley is calling on every citizen to play their part in taking the necessary steps to rid their communities of the Aedes aegypti mosquito which transmits the zika virus.

Persons can destroy mosquito breeding sites by looking for anything around the home, school, churches and business places that may collect water and either cover it, keep it dry or dispose of it. Repair leaking pipes and outdoor faucets, cut the grass short and trim shrubbery, clear roof gutters and eaves to prevent water from settling and fill in and drain any low places in the yard such as areas where there are usually puddles when it rains.

Persons can protect themselves from mosquito bites by using insect repellent containing DEET, putting mesh on windows and doors and wearing long sleeved clothing where possible.

The Ministry of Health has heightened its alert and is scaling up its vector control activities.

 
  Posted on January 18, 2016

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PAHO: Epidemiological Update On Zika - Jan 17th

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The Pan American Health Organization (PAHO) has released a new epidemiological update on the Zika virus, which they now indicate is transmitting locally in 18 countries and territories in the Americas. 

That is an increase of 14 countries since November of 2015.

While microcephalic birth defects have gotten the bulk of our attention, today's report spends a good deal of time looking at at evidence suggesting Zika virus infection may produce neurological symptoms (Guillain-­Barré Syndrome, meningitis, meningoencephalitis and myelitis) as well.


Follow the link to download and read the entire PDF file, as I've only included an excerpt.

Epidemiological UpdateNeurological syndrome, congenitalanomalies, and Zika virus infection

17 January 2016
Situation summary

Autochthonous transmission of Zika virus

From February 20141 to 17 January 2016, there are 18 countries and territories in the Americas that have confirmed autochthonous circulation of Zika virus (ZIKV) in 2015 and 2016: Brazil, Barbados, Colombia, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, and Venezuela. 

Between November 2015 and January 2016, local transmission of the virus was detected in 14 new countries and territories.

Increase in neurological syndromes

Guillain-­Barré Syndrome

During the Zika virus outbreak in French Polynesia (2013-­2014),2 74 patients had presented neurological syndromes or auto-­immune syndromes after the manifestation of symptoms consistent with Zika virus infection. Of these, 42 were classified as Guillain-­Barré syndrome (GBS). Of the 42 registered SGB, 24 (57%) were male, and 37 (88%) had signs and symptoms consistent with Zika virus infection (3, 4, 5).

In July 2015, Brazil reported the detection of patients with neurological syndromes who had recent history of Zika virus infection in the state of Bahia. There were 76 patients with neurological syndromes identified, of which 42 (55%) were confirmed as GBS. Among the confirmed GBS, 26 (62%) had a history of  symptoms consistent with Zika virus infection.
 
In addition, on 25 November 2015, the Aggeu Magalhães Research Center of the Oswaldo Cruz Foundation reported that ZIKV infection was found in 10 of the 224 suspected dengue patients whose samples were analyzed for Zika virus infection. Seven of the 10 samples analyzed corresponded to patients with neurological syndrome.

In January 2016, El Salvador reported the detection of an unusual increase of GBS since early December 2015. On average, El Salvador records14 cases of GBS per month (169 cases per year), however, between 1 December 2015 and 6 January 2016 there were 46 GBS recorded, of which 2 died. Twenty-­five (54%) were male and 35 (76%) were over 30 years old. All were hospitalized and treated with plasmapheresis or immunoglobulin. Of the deceased patients, one had a history of multiple underlying chronic diseases. In 22 patients whose information was available 12 (54%) had febrile rash illness between 7 and 15 days prior to the onset of GBS.

Currently, similar situations are being investigated in other countries of the Americas. These findings are consistent with a temporal and spatial link between Zika virus circulation and the increase of GBS. Although the etiopathogenesis and associated risk factors have not yet been well established, Member States should implement surveillance systems to detect unusual increases in cases and prepare health services for patients care with neurological conditions.

Other neurological syndromes
 
Zika virus can cause other neurological syndromes (meningitis, meningoencephalitis and myelitis), as described in French Polynesia outbreak (2013-­2014). While in the Region of the Americas such syndromes have not been reported so far, health services and practitioners should be alert about their  possible occurrence to properly prepare health facilities for rapid detection and  appropriate treatment of cases.

Increase in microcephaly and other congenital anomalies

In October 2015, the Brazil International Health Regulations (IHR) National Focal Point (NFP) notified the detection of an unusual increase in microcephaly3 cases in public and private healthcare facilities in Pernambuco state, Northeast Brazil. 4 As of epidemiological week 1 of 2016, there were 3,530 microcephaly cases recorded, including 46 deaths, in 20 states and the Federal District. Between 2010 and 2014, an average of 163 (Standard deviation 16.9) microcephaly cases was recorded nationwide per year.5 Figure 1 shows the comparative distribution of microcephaly case (annual average between 2010 and 2014 compared with cases registered in 2015). 

In January 2016, ophthalmological findings were reported in three children with microcephaly and cerebral calcifications detected by CT scans and presumable intrauterine ZIKV infection. The three infants had unilateral ocular findings involving the macular region and loss of foveal reflex. In one child a well defined macular neuroretinal atrophy was detected (6).


Evidence of vertical transmission of Zika virus

 
On 13 January 2016, the Brazil Ministry of Health reported the detection of Zika virus genome, through the RT-­PCR technique in four cases of congenital malformation in the state of Rio Grande do Norte. The cases correspond to two miscarriages and two at full-­term newborns (37 and 42 weeks respectively) who died in the first 24 hours of life. Tissue samples from both newborns were also positive for Zika virus by immunohistochemistry (1).

This adds to the evidence reported in the Epidemiological Alert of 1 December 2015 with respect to the detection of Zika virus genome through RT-­PCR technique in the amniotic fluid of two pregnant women in Paraiba, whose fetuses presented with microcephaly according to the ultrasound (7). 

(Continue . . .)

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Monkeypox Outbreak Reported In Central African Republic

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Monkeypox is a rare virus, endemic in monkeys and rodents in central Africa, that produces a remarkably `smallpox looking'  illness in humans, albeit with a much lower fatality rate. Human monkeypox was first identified in 1970 in the DRC, and since then has sparked mostly small, sporadic outbreaks in the Congo Basin and Western Africa.

But in 1996-97, a major outbreak occurred in the Democratic Republic of Congo (see Eurosurveillance Report), where more than 500 cases in the Katako-Kombe and Lodja zones were identified.  Mortality rates were lower for this outbreak (1.5%) than earlier ones, but this was the biggest, and longest duration outbreak on record.

The name `monkeypox’  is a bit of a misnomer. It was first detected (in 1958) in laboratory monkeys, but further research has revealed its host to be rodents or possibly squirrels.  Humans can contract it in the wild from an animal bite or direct contact with the infected animal’s blood, body fluids, or lesions.

Consumption of undercooked bushmeat is also suspected as infection risk, but human-to-human transmission is also possible.  This from the CDC’s Factsheet on Monkeypox:

The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.

According to the CDC there are two distinct genetic groups (clades) of monkeypox virus—Central African and West African. West African monkeypox is associated with milder disease, fewer deaths, and limited human-to-human transmission.

Credit CDC

On December 30th the Institut Pasteur in Bangui confirmed two cases of monkeypox virus infection in the Bangassou district of the  Central African Republic.  In a report on their website, they wrote:

A team from Doctors without Borders Belgium located in this area at the border of the Democratic Republic of the Congo, has collected samples from two children of the same family who presented with rashes (maculopapular) after consuming thryonomys meat a rodent locally known as sibissi.

One of the children, aged 9 years died. As the clinical picture was not in favor of a measles infections, highly endemic in Central African Republic, the samples were sent to the Institut Pasteur in Bangui for analysis.

The Laboratory of Arboviruses, Viral Hemorrhagic Fevers and of Emerging Zoonotic viruses led by Dr. Emmanuel Nakouné  received the samples on December 25th and immediately conducted molecular analyzes that proved positive for monkeypox virus.

Today Pathfinder on FluTrackers posted a media report that indicates this outbreak extends beyond those first two cases, although details remain scant.

Virus "Monkeypox": the epidemic confirmed in the Mbomou

Par Journaldebangui.com, source Rjdh - 18/01/2016

It is the Minister of Public Health has certified that the Thursday, January 14, 2016, during a press conference. A virus epidemic "Monkeypox" plaguing the region

This is for several days as information relating to the presence of the disease in Mbomou circulate. Two deaths were deplored and several patients quarantined. This is now a reality and that the Ministry of Health has certified. Ms. Margueritte Maliévo Samba said that after tests and investigations made ​​by his department, the disease is confirmed in the Mbomou.

The government official gave details on disease patterns of contamination, saying "there are two modes of transmission of this disease. The first mode is that of the transmission of live or dead animals, contaminated with man. The second mode is sick or deceased person to another healthy person in close contact with body fluids including blood, urine, vomit, sweat, semen or by handling objects contaminated by secretions " .

The Ministry of Health says have control of the situation, however, calls for vigilance "I call all the Central African population in general and that of the Prefecture of Mbomou especially for calm and strict compliance with preventive measures which were to wash hands regularly, avoid any manipulation with sick or dead animals and secretions of infected person and objects "launched the Health Minister.

(Continue . . .)

Although generally limited to small outbreaks in Africa, in 2003 the United States saw an outbreak (of the milder, West African clade) that affected 47 confirmed and probable cases in six states—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, all of whom had contact with infected prairie dogs purchased as pets.

These pets became infected when an animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003).

While still considered a geographically limited threat, in 2010 a study that appeared in PNAS warned that the incidence of human monkeypox infection was increasing, and that it posed a potential risk well beyond localized outbreaks in Africa. 

Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo 

Anne W. Rimoina,b,1,Prime M. Mulembakanic, Sara C. Johnstond,James O. Lloyd Smithb,e,Neville K. Kisaluf, Timothee L. Kinkelac,Seth Blumbergb,e,Henri A. Thomasseng,Brian L. Pikeh,Joseph N. Fairh,Nathan D. Wolfeh,Robert L. Shongoi,Barney S. Grahamj,Pierre Formentyk,Emile Okitolondac,Lisa E. Hensleyd,Hermann Meyerl,Linda L. Wrightm, andJean-Jacques Muyemben

(Excerpt)

Thirty years after mass smallpox vaccination campaigns ceased,human monkeypox incidence has dramatically increased in rural DRC. Improved surveillance and epidemiological analysis is needed to better assess the public health burden and develop strategies for reducing the risk of wider spread of infection.

Although monkeypox outbreaks tend to burn themselves out fairly quickly, and rarely spread very far, those were the same qualities we attributed to Ebola two years ago.  So we'll keep an eye on this outbreak, in the unlikely event it should spread beyond a handful of cases in Mbomou.

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