An Update On The Russian Influenza Epi Report

#10,940


Thanks to a sharp eyed reader (@BVance) we have an update - posted today - from the WHO National Influenza Centre Of Russia that refutes recent Russian media claims (see A Russian Influenza Epidemiology Report To Ponder) of a `mutated, highly virulent H1N1 virus', but that does not back away from their own reports of recently identified antigenic changes.

As I pointed out this morning, there was nothing in Week 3 Russian Epi report to support the media's claim of increased `morbidity and mortality'  associated with these changes. 

This latest media release (in Russian) indicates that seasonal flu activity continues to rise across much of Russia, but denies the media's assertions of a hyper-virulent strain.  While the intent of this strongly worded statement is to reign in a hyperbolic press, they go on to state:

The genomes examined to date strains indeed several mutations have been identified, but they are not associated with high pathogenicity, and are probably the result of conventional genetic drift.

As previously stated, the importance of all of this is whether any of these genetic changes might impact the selection (next month) of the H1N1 strain to be included in next fall's flu vaccine. 

Press Release: Influenza epidemic situation on 01.27.2016

PRESS RELEASE

The epidemiological situation of influenza on 01/27/2016 

The rise of the incidence of influenza began with the 2nd week of 2016 in the Volga region (Volgograd, Rostov-on-Don, Stavropol) and has now exceeded the epidemic threshold fixed in 47 regions of the Russian Federation in all federal districts, except the Crimean Federal District.

At the present time (4 weeks. Years) the incidence of influenza and SARS on the population of the Russian Federation as a whole was 91.6 cases of flu and colds by 10 thousand. People., Which is higher than the baseline for Russia (69.5 cases) 31.8% and epidemiological week. threshold (61.8) 48.2%.

This week, compared with the previous week, the incidence observed in the cities of Russia continued to grow. The incidence of influenza and SARS on the European criteria relating to the mean intensity of the epidemic.

The geographical spread of the flu in Russia as a whole and in all districts widespread, except for Siberia, where the spread of influenza corresponds to the regional level.

The etiological structure of influenza overwhelming place is the virus that caused the pandemic of 2009 - A (H1N1) pdm09. A feature of the virus is higher pathogenicity for humans compared with other influenza viruses. However, the incidence rises caused by the influenza A (H1N1) pdm09 since 2009 are regular and are not something special or unforeseen.

The greatest danger is the flu for people with reduced immunity, the elderly and people with chronic diseases. It was found that among the dead from the flu and its complications are no persons vaccinated against influenza.

In this regard, appeared in the media with reference to the State Organization "Institute of Influenza" Russian Ministry of Health information about the high incidence of influenza in the current epidemic season is associated with mutations in the genome of circulating virus A (H1N1) pdm09, to inform you that this information does not correspond to reality.

According to a preliminary molecular genetic analysis of circulating influenza A (H1N1) pdm09 antigenic properties and nucleotide sequences correspond to the vaccine strain A / California / 7/09. The genomes examined to date strains indeed several mutations have been identified, but they are not associated with high pathogenicity, and are probably the result of conventional genetic drift.

The genome studied to date strains indeed found several mutations, but they are not associated with high pathogenicity, and are due to normal genetic drift, which is of interest only to specialists, virologists.

FGBI "Influenza Research Institute" Russian Ministry of Health reminds you of the need for timely treatment to the doctor in the case of the first symptoms of the disease.

Read More

Brazil MOH: Epi Week 3 Microcephaly Update

# 10,939


At first glance the numbers presented today by the Brazilian MOH are a bit confusing, as they highlight they are now investigating 3,448 Microcephaly cases, seemingly a reduction from last week's 3893 Suspected Microcephaly Cases Under Investigation. 

All becomes clear when you look at the chart above, which shows that 270 cases are now confirmed - and removed from that number - and 462 cases have been discarded. 

Today's report actually adds 287 suspected cases since last week's report, but after you deduct the discarded and confirmed cases, you end up with 3,448.  All totaled, the number of cases that have been investigated in 2015-16 is 4,120.


The MOH summary (the full Epi report has not yet been posted) follows:

REPORT CARD

Ministry of Health investigates 3,448 suspected cases of microcephaly

Apart from the cases that remain under investigation, the ther 270 have had confirmation of the disease and 462 were classified as discarded

The Ministry of Health investigates 3,448 suspected cases of microcephaly across the country. The new report released on Wednesday (27) also points out that 270 cases have had microcephaly confirmation, and 6 with respect to the Zika virus. Other 462 reported cases have been discarded. In all, 4,180 suspected cases of microcephaly were recorded until 23 January.

"Regarding the report released on January 20, there appears a tendency to reduce the number of notifications. The increase identified in a week of reported cases was 7%. However, the amount of discarded cases grew 63%, from 282 to the current 462, "said Claudio Maierovitch, director of the Department of Surveillance of Communicable Diseases of the Ministry of Health.

In total, 68 deaths were reported due to congenital malformations after delivery (stillbirth) or during pregnancy (miscarriage). Of these, 12 were confirmed to the relationship with congenital infection, all in the Northeast, 10 in Rio Grande do Norte, one in Ceará and one in Piauí. Continue research in 51 deaths and five have already been discarded.

It should be noted that the Ministry of Health is investigating all cases of microcephaly or defects reported by the states, and the possible relationship with the Zika virus and other congenital infections. The microcephaly can be caused by various infectious agents beyond Zika, such as syphilis, toxoplasmosis, Other Infectious Agents, Rubella, Cytomegalovirus and Herpes Viral.

According to the report, the 4,180 cases reported since the beginning of the investigation on 22 October last year - were recorded in 830 municipalities in 24 Brazilian states. The Northeast region has 86% of reported cases and Pernambuco continues with the highest number of cases that remain under investigation (1125), followed by the states of Paraíba (497), Bahia (471), Ceará (218), Sergipe (172 ), Alagoas (158), Rio Grande do Norte (133), Rio de Janeiro (122) and Maranhão (119).

So far, they are with indigenous circulation of Zika virus 22 units of the federation. They are: Goiás, Minas Gerais, Federal District, Mato Grosso do Sul, Roraima, Amazonas, Para, Rondonia, Mato Grosso, Tocantins, Maranhao, Piaui, Ceara, Rio Grande do Norte, Paraiba, Pernambuco, Alagoas, Bahia, Espírito Santo , Rio de Janeiro, Sao Paulo and Parana.

A table showing Microcephalic cases under investigation by Regions and Federative Units is available at the above link.

Read More

Xinhua: Hunan Province Reports 1st H7N9 Case Of The Season

# 10,938


Hunan Province, which ranks 7th in the number of announced H7N9 cases (n=26) since 2013, reports their first H7N9 positive patient for the winter of 2015-16.

Human H7N9 case reported in central China

Source: Xinhua   2016-01-27 19:51:56

CHANGSHA, Jan. 27 (Xinhua) -- A new human H7N9 avian flu case was confirmed in central China's Hunan Province, with several coastal provinces reporting such cases this winter.

The patient is a 33-year-old man from Xintian County who is receiving treatment in a hospital, said the Hunan Provincial Health and Family Planning Commission on Wednesday.

Sporadic human H7N9 cases have been reported in Shanghai, Zhejiang, Guangdong and Fujian, including two fatalities, one in Zhejiang and another in Guangdong.

Three human H5N6 cases were also reported in Guangdong and one in Jiangxi. The H5N6 patient in Jiangxi, a 42-year-old male who lived in Guangdong, died in a hospital in Jiangxi in December. One H5N6 patient died in Guangdong in the same month. 

We've yet to see the kind of January surge in H7N9 cases that we've witnessed over the past couple of years in China.  Whether this reflects some change in the behavior or spread of the virus, or a change in surveillance and reporting, is unknown.

As I noted in yesterday's WHO: Influenza at the Human-Animal Interface - January 2016, since February of last year we've seen significantly reduced (or delayed) reporting on avian flu out of China, with many provinces preferring to release information in batches, often weeks after the fact.

While the reduction in reported infections may be a good sign, it may be several months before we see China's full accounting of avian flu cases.

Read More

Saudi MOH Reports 1 Primary MERS Case (Camel Contact)

 

# 10,937

The Saudi MOH has announced their 5th positive MERS case in a week, and following the trend we've seen all month, this case is linked to camel contact. 

Read More

A Russian Influenza Epidemiology Report To Ponder

UPDATED:  See An Update On The Russian Influenza Epi Report

# 10,936


Every winter since the end of the 2009 H1N1 pandemic we've seen frequent, vague, often hyperbolic reports of H1N1 outbreaks around the world carrying an unusually high mortality, often suggesting that a `mutation' was responsible.

In India and the Middle East, the (now) seasonal H1N1pdm virus is still regarded as a `swine flu' by the media, and is always good for a headline.  Doubly so if the `M' word can be incorporated.

Yet despite this yearly hype, over the seven years since it appeared A/H1N1pdm09 has remained remarkably stable. While the H3N2 vaccine strain has been changed repeatedly, nearly all circulating H1N1 viruses have remained antigenically similar to the H1N1 strain that appeared back in 2009.

We have seen some limited, sporadic mutations (see 2014's  EID Journal: Emergence of D225G Variant A/H1N1, 2013–14 Flu Season, Florida) linked to enhanced virulence, and recently the ECDC reported that a genetic subcluster of viruses within the 6B subgroup has emerged, defined by HA1 amino acid substitutions S162N and I216T (see  Influenza virus characterisation, Summary Europe, December 2015).

Despite these changes, the H1N1 viruses that have been examined have all reportedly been antigenically similar to the vaccine virus A/California/07/2009. 

Once again this winter we've been seeing numerous reports of large H1N1 outbreaks - mostly in the Middle East and Eastern Europe -  with supposedly high mortality rates. Over the past couple of weeks, there have been multiple reports coming out of Russia and the Ukraine.

This morning Sharon Sanders on FluTrackers posted the following (translated) report: 

Russia - Government says "high incidence" of flu is due to H1N1pdm09 mutation not covered by vaccine - January 26, 2016

Today, 05:44 AM

In Russia, died from the flu 50 people, a high incidence is related to a mutation of the H1N1 virus Society January 26th, 16:19 UTC + 3, 24 people died this week, said Head of the Laboratory of Biotechnology and Research Institute of Influenza diagnostic preparations


PETERSBURG, January 26. / Correspondent. Natalia Mihalchenko TASS /. High morbidity and mortality from influenza in certain regions of Russia is associated with a mutation of the virus H1N1 (Swine Flu). This was reported by TASS Head of the Laboratory of Biotechnology and Research Institute of Influenza diagnostic preparations Anna Sominina.

Total of 50 Russians died of influenza, including 24 this week," - she said. "Among the isolated and studied in laboratories around 40% of viruses are changes in the genome that do not contain the vaccine. All in all today was able to identify three mutations" - added Sominina. According to the Institute of influenza in the country weekly epidemic threshold was exceeded by 48.8%, the baseline - 32%. Among the types of circulating influenza virus H1N1 predominant (96%). 

(Continue . . . )

Granted, Tass isn't always the most reliable source.   But Sharon also found and posted the following (week 3) Epidemiological report from the WHO National Influenza Centre Of Russia, which lends some credence to the above report.

Week 11.01.2016-17.01.2016
Influenza and ARI morbidity data

Epidemiological data show increase of influenza and other ARI activity in Russia in comparison with previous week. The nationwide ILI & ARI morbidity level (60.6 per 10 000 of population) was lower than the national baseline (69.5 per 10 000) by 12.8%.

ILI and ARI epidemic thresholds were exceeded in 9 of 59 cities collaborating with two WHO NICs in Russia.

Cumulative number of diagnosed influenza cases

Cumulative results of influenza laboratory diagnosis by different tests were submitted by 50 RBLs and two WHO NICs. According to these data as a result of 2580 patients investigation the overall proportion of respiratory samples positive for influenza virus was estimated as 25.3% including 615 (94.1%) influenza A(H1N1)pdm09 cases, 17 (2.6%) influenza A(H3N2) cases, 10 (1.5%) influenza A cases and 12 (1.8%) influenza B case.
Results of influenza diagnosis

Conclusion

Influenza and ARI morbidity data.  Increase of influenza and other ARI activity was registered during the week 03.2016 in traditional surveillance system in Russia. The nationwide ILI & ARI morbidity level (60.6 per 10 000 of population) was lower than the national baseline by 12.8%.

Etiology of ILI & ARI morbidity. The overall proportion of respiratory samples positive for influenza  was estimated as 25.3%. Percent of positive ARI cases of non-influenza etiology (PIV, adeno- and RSV) was estimated as 22.2% of investigated patients by IFA and 16.0% by PCR.

Antigenic characterization. Totally 45 influenza A(H1N1)pdm09 and 2 A(H3N2) viruses were characterizated antigenically in two NICs of Russia since the beginning of the season. 35 (76.6%) influenza A(H1N1)pdm09 strains were related closely to influenza A/California/07/09 virus, 10 (23.4%) influenza A(H1N1)pdm09 viruses had decreased up to 1/16 titers. Two A(H3N2) strains were similar to influenza A/Hong-Kong/4801/2014 virus but reacted with antiserum to influenza A/Switzerland/9715293/2013  vaccine strain up to 1/4 - 1/8 of homological titer only.

Genetic characterization. Three influenza A(H1N1)pdm09 viruses were identical for 97.8% to A/California/07/09 virus and for 99.0% to influenza A/South Africa/3626/13  virus. All investigated strains had  substitutions S84N, S162N+ and I216T in HA.

In sentinel surveillance system clinical samples from 57 SARI and 50 ILI/ARI patients were investigated by rRT-PCR. 24 (35.6%) influenza SARI cases were detected including 21 influenza A(H1N1)pdm09, 1 influenza A(H3N2) and 2 influenza B cases. 5 (10.0%) influenza ILI/ARI cases were detected including 4 influenza A(H1N1)pdm09 and 1 influenza A(H3N2) cases.

 

Two of the amino acid substitutions mentioned in the above report (S162N+ & I216T) are associated with the new genetic subcluster within subgroup 6B mentioned by the ECDC, while the third change (S84N) has been linked to reduced antigenic reactivity (cite).

Going back through the Russian Epi Weekly reports, as of the last week of 2015, they reported 23 of the 23 viruses H1N1 viruses examined to be antigenically similar to the vaccine strain, meaning that these reduced titer samples have all appeared over the past three weeks.

It would not be a huge surprise to finally see some significant antigenic drift in the H1N1pdm09 virus.  It has remained stable far longer than anyone expected. But it remains to be seen whether these `reduced titer' viruses will spread beyond the region.



The reports of increased `morbidity and mortality' from these viruses  - while possible - appear to be anecdotal at this time, and are not reflected in the data provided by the Russian Epi report. 

Influenza viruses  - `mutated' or otherwise - are responsible for hundreds of thousands of deaths each year, and so these statements will require additional  data to substantiate. 

The timing here is important, as decisions on what vaccine strains to include in next fall's North American Influenza vaccine are normally made by the end of February.


So we'll keep an extra close eye on the Russian Influenza reports in the weeks to come.

Read More

CDC Adds Two Destinations To Zika Travel Advisory

Credit PAHO - Epi Week 3

#10,935


Twelve days ago the CDC issued a Level-II travel advisory for 14 countries and territories over the Zika Virus threat, asking pregnant women to considered postponing travel to regions that were affected. Seven days later they added 8 additional countries and/or territories.  

Last night two more travel destinations were added to the list (United States Virgin Islands and Dominican Republic) both having recently reported confirmed local transmission of the virus.  

It should be noted that while evidence of a tentative link between the introduction of Zika to the Americas and the sharp rise in microcephalic births in Brazil continues to grow, a causal link has yet to be established.  Doing so could take months.

Given the potentially dire outcome of maternal infection, the CDC is acting out of an abundance of caution and is recommending that pregnant women avoid travel to these affected regions until more is known.

This rapid expansion of the virus is expected to continue, and there are likely countries in the Americas where the virus is already circulating but it has yet to be confirmed.  Four months ago, only two countries in the Americas (Brazil & Columbia) were reporting cases.


On Monday in PAHO Statement On Zika Transmission & Prevention, it was postulated that other than in Canada and perhaps Chile, the virus would likely find suitable mosquito vectors (at least part of the year) across much of the Western Hemisphere. 

The following CDC statement was released last night. 

CDC adds 2 destinations to interim travel guidance related to Zika virus

Media Statement

For Immediate Release: Tuesday, January 26, 2016Contact: Media Relations, (404) 639-3286

CDC is working with other public health officials to monitor for ongoing Zika virus‎ transmission. Today, CDC added the following destinations to the Zika virus travel alerts: United States Virgin Islands and Dominican Republic.  Previously, CDC issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing: the Commonwealth of Puerto Rico, a U.S. territory; Barbados; Bolivia; Brazil; Cape Verde; Colombia; Ecuador; El Salvador; French Guiana; Guadeloupe; Guatemala; Guyana; Haiti; Honduras; Martinique; Mexico; Panama; Paraguay; Saint Martin; Samoa; Suriname; and Venezuela.  Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time.

As more information becomes available, CDC travel alerts will be updated. Travelers to areas where cases of Zika virus infection have been recently confirmed are at risk of being infected with the Zika virus. Mosquitoes that spread Zika are aggressive daytime biters, prefer to bite people, and live indoors and outdoors near people. There is no vaccine or medicine available for Zika virus. The best way to avoid Zika virus infection is to prevent mosquito bites.

Some travelers to areas with ongoing Zika virus transmission will become infected while traveling but will not become sick until they return home. Some people who are infected do not have any symptoms. Symptoms include fever, rash, joint pain, and red eyes. Other commonly reported symptoms include muscle pain and headache. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. Travelers to these areas should monitor for symptoms or illness upon return. If they become ill, they should tell their healthcare professional where they have traveled and when.

Until more is known, CDC continues to recommend that pregnant women and women trying to become pregnant take the following precautions:

• Pregnant women 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 professional first and strictly follow steps to avoid mosquito bites during the trip.
• Women trying to become pregnant should consult with their healthcare professional before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip. 

Guillain-Barré syndrome (GBS) has been reported in patients with probable Zika virus infection in French Polynesia and Brazil. Research efforts will also examine the link between Zika and GBS.

Read More

NIH Director's Blog On Zika: An Emerging Health Threat

# 10,934


The geographic range of two type of Aedes mosquitoes known to transmit the Zika virus includes much of the United States, and according to a blog post today by NIH Director Dr. Francis Collins, that conceivably puts as many as 200 million Americans at risk - at least during the summer months.  

Another  22.7 million Americans live in parts of the country (primarily Southern Florida and Texas) where one or both of these mosquito breeds can live year round. 

While the Zika virus is not currently circulating in North American mosquito populations, all it requires is for a Zika infected individual to arrive on our shores and provide a blood meal to the right kind of mosquito.

Assuming that mosquito goes on to bite another person within a reasonable period of time, they have the potential to pass on the virus.  

In reality, it likely takes multiple introductions over time, and under the right conditions, before a virus like Zika (or Dengue, or Chikungunuya) can successfully establish itself (at least temporarily) in a new location.  But, as we've already seen with Dengue in Florida, Texas, and Hawaii . . .  when provided enough opportunities . . . it can and does happen.

According to a study sponsored by the NIH, 2.7 million travelers arrive in the United States each year from Brazil (and many more from other endemic regions), providing ample opportunities for the virus to be imported.

All of which makes it of paramount importance for researchers to determine if there is a causal link between maternal Zika infection and microcephalic birth defects, to develop better diagnostics and (hopefully) effective therapeutics, and perhaps find ways to mitigate the spread of the virus.


NIH Director Dr. Francis Collins discusses all of this, and more, in his blog today. Follow the link to read:

Zika Virus: An Emerging Health Threat

Posted on January 26, 2016 by Dr. Francis Collins

 

Credit: Kraemer et al. eLife 2015;4:e08347

For decades, the mosquito-transmitted Zika virus was mainly seen in equatorial regions of Africa and Asia, where it caused a mild, flu-like illness and rash in some people. About 10 years ago, the picture began to expand with the appearance of Zika outbreaks in the Pacific islands. Then, last spring, Zika popped up in South America, where it has so far infected more than 1 million Brazilians and been tentatively linked to a steep increase in the number of babies born with microcephaly, a very serious condition characterized by a small head and brain [1]. And Zika’s disturbing march may not stop there.

In a new study in the journal The Lancet, infectious disease modelers calculate that Zika virus has the potential to spread across warmer and wetter parts of the Western Hemisphere as local mosquitoes pick up the virus from infected travelers and then spread the virus to other people [2]. The study suggests that Zika virus could eventually reach regions of the United States in which 60 percent of our population lives. This highlights the need for NIH and its partners in the public and private sectors to intensify research on Zika virus and to look for new ways to treat the disease and prevent its spread.

(Continue . . . )

Read More