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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Hong Kong Issues Zika Travel Advice & Letter To Doctors

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Due to the rapid spread of the  Zika Virus in the tropical Americas, and a concurrent rise in microcephalic birth defects in Brazil, the CDC issued a revised travel advisory and a HAN: Recognizing, Managing & Reporting ZIka Virus Infections In Travelers for clinicians late on Friday. 

While a firm connection between the Zika virus and the increase in Microcephalic births in Brazil has yet to be completely established, the risks to women and their unborn babies is considered great enough to demand immediate action.

Today it is Hong Kong's turn.  First with a statement on their CHP website, and then via a letter sent to all local doctors asking them to stay vigilant for possible imported cases.

18 January 2016

DH alerts travellers to risk of Zika virus infection 

The Department of Health (DH) today (January 18) drew the public's attention to the latest situation of the mosquito-borne Zika virus infection and appealed to travellers for vigilance and due consideration of health risks before travel.

According to the latest report by the Pan American Health Organization (PAHO)/World Health Organization (WHO), autochthonous transmission of Zika virus was reported from epidemiological week 17 of 2015 to epidemiological week 2 of 2016 in the following countries and territories in the Americas Region: Brazil, Columbia, Ecuador, El Salvador, French Guiana, Guyana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Puerto Rico, Paraguay, Saint Martin, Suriname and Venezuela.

"We have been monitoring Zika virus transmission overseas and noted reports of microcephaly and other poor pregnancy outcomes in babies whose mothers were infected with Zika while pregnant and studies are being carried out to determine what effects Zika virus can have on foetuses. In view of the latest situation, as a precautionary measure, we advise pregnant women and those planning pregnancy to adopt necessary anti-mosquito precautions. We will issue letters to doctors and hospitals for heightened vigilance," a spokesman for the DH said.

Pregnant women should consider deferring their trip to areas with past or current evidence of ongoing Zika virus transmission. Those who must travel to any of these areas should seek medical advice from their doctor before the trip, strictly follow steps to avoid mosquito bites during the trip, and consult and reveal their travel history to their doctor if symptoms develop after the trip.

Women preparing for pregnancy should also consult their doctor before travelling to these areas, strictly follow anti-mosquito precautions during the trip, and report to their doctor if feeling unwell after the trip.

"Locally, no human cases have been reported to the Centre for Health Protection (CHP) of the DH so far and the CHP's Public Health Laboratory Services Branch (PHLSB) is capable of detecting Zika virus. Although Zika virus infection is not a statutorily notifiable infectious disease under the Prevention and Control of Disease Ordinance (Cap 599) now, we appeal to doctors to stay alert to the possibility of Zika in travellers returning from affected areas who present a clinically compatible picture not attributable to dengue fever or chikungunya fever. Laboratory testing for Zika virus infection is available at the PHLSB. They should contact the PHLSB for further information as necessary," the spokesman said.

Zika is primarily transmitted to humans through bites from Aedes mosquitoes. Aedes aegypti, which is currently not found in Hong Kong, is considered the most important vector for Zika transmission to humans. Other Aedes mosquito species such as Aedes albopictus widely present locally are also considered as potential vectors. There is therefore a risk of secondary spread for imported infections in Hong Kong.

(Continue . . .)

The letter to doctors (Vigilance against Zika virus infection (  717.93 Kb) repeats much of the above information, and adds:

Medical practitioners should be aware of the possibility of Zika virus infection for travellers returning from affected areas and present with clinically compatible picture. Laboratory testing for Zika virus infection is available at the Public Health Laboratory Services Branch (PHLSB) of CHP. Please contact PHLSB for further information as necessary. 

If you encounter patients with laboratory confirmed Zika virus infection please report to the Central Notification Office (CENO) of CHP via fax (2477 2770), CENO On-line (https://cdis.chp.gov.hk/CDIS_CENO_ONLINE/ceno.html) or phone (2477 2772) for investigation and control measures.

While there is always great reluctance to issue travel advice that will negatively impact  a nation's economy - particularly one as precarious, and as dependent upon tourism as Brazil's -  until the risks are better understood health departments much act out of an abundance of caution.

The concern is two-fold.     

First and foremost over the concerns for mothers and their unborn child, but secondly because viremic travelers who return to areas where suitable mosquito vectors are present, could potentially `seed' the virus to the local mosquito population and start chains of local transmission.


For some recent blogs on that possibility, you may wish to revisit:

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

The International Exchange Rate Of Infectious Diseases

PNAS: Asymptomatic Humans Transmit Dengue Virus To Mosquitoes

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CHP: Guangdong Province - 5th H5N6 Case In Past Month

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Up until a month ago, known H5N6 cases were widely scattered and sporadic in China, with only 4 cases reported across three provinces (Sichaun =1, Guangdong = 1, Yunnan=2)  over a span of 19 months.  

Between December 29th and mid-January we saw 4 additional cases emerge from Guangdong province, prompting state media sources to reassure on Friday that there was No Evidence Of H-2-H Transmission Of H5N6.

Today we have a 5th notification, involving a 31 year old woman hospitalized in Futian, Shenzhen, published by neighboring Hong Kong's CHP.   Given Guangdong Province's close proximity to, and trade relations with, Hong Kong - they tend to be more willing to share timely avian flu reports than do other Provinces.


First the Hong Kong Notification, then I'll have a bit more.

 CHP notified of additional human case of avian influenza A(H5N6) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) was notified of an additional human case of avian influenza A(H5N6) in Guangdong by the National Health and Family Planning Commission today (January 18), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The case involves a woman aged 31 in Futian, Shenzhen. She developed fever and cough on January 8 and is currently hospitalised for treatment in critical condition.

From 2014 to date, a total of nine human cases of avian influenza A(H5N6) have been reported by the Mainland health authorities.

"All novel influenza A infections, including H5N6, are statutory notifiable infectious diseases in Hong Kong," a spokesman for the CHP said.

"We will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments," the spokesman said.

(Continue . . . )

Although it has yet to have as big of impact as avian H7N9, the recently (2014) emerged H5N6 virus - a reassortant of H5N1 and H6N6 - has generated a good deal of concern as it has infected a small, but growing number of humans over the past 20 months.


Last October, in H5N6: The Other HPAI H5 Threat, we looked at the history of this rising avian flu threat, while last summer H5N6 Rising: Infecting Birds, Humans, & Even Cats, we looked at a report which appeared last June’s Nature’s Scientific Reports, that warned:

The extensive migration routes of wild birds may contribute to the geographic spread of H5N6 AIVs and pose a risk to humans and susceptible domesticated animals, and the H5N6 AIVs may spread from southern China to northern China by wild birds. Additional surveillance is required to better understand the threat of zoonotic transmission of AIVs.

While details have been scant, we've seen nothing to suggest any of these five cases are epidemiologically related, or that the virus is circulating in the human population.

Five cases in such a short period of time, however, does suggest the virus is getting better established in poultry populations and the environment.

It has already turned up in wild and migratory birds in Hong Kong (see Hong Kong: Magpie Robin Tests Positive For HPAI H5) several times. Given the lack of wild bird surveillance and reporting out of Mainland China, we don't really have a good feel for how rapidly the virus might be spreading. 

While H7N9 and H5N1 have been the most worrisome avian flu viruses to date, H5N6 is showing signs of becoming a contender, and is definitely a virus to watch.

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