H7N9 Case Reports From Guangdong & Zhejiang Province

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H7N9 reports continue to dribble out of China with reports today from Hong Kong's CHP and from the Xinhua News agency alerting us to two cases, one from Guangdong Province and the other from Zhejiang.

As discussed many times before, many Chinese provinces only release information in EOM epidemiology reports, and so we often learn about their cases weeks after the fact. 

First from Hong Kong's CHP and announcement of two cases (the Hunan case I reported yesterday), but with a new case from Guangdong Province as well.

28 January 2016
 
CHP closely monitors two additional human cases of avian influenza A(H7N9) in Mainland 

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 28) closely monitoring two additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the Health and Family Planning Commission (HFPC) of Guangdong Province and the HFPC of Hunan Province, the 74-year-old male patient lived in Meizhou, Guangdong, while another 33-year-old male patient, with poultry contact history, lived in Yongzhou, Hunan. 

(Continue . . .)

The second case, reported by Xinhua News, contains a bit more detail.

New human H7N9 case reported in east China
 
Source: Xinhua   2016-01-28 17:31:12     [More]

HANGZHOU, Jan. 28 (Xinhua) -- Another human H7N9 avian flu case has been confirmed in east China's Zhejiang Province, several other provinces have also reported cases this winter.

The patient is a 59-year-old woman from Gaoxin District in Shaoxing City, she has been hospitalized, according to the Municipal Health and Family Planning Commission on Thursday.

The patient had purchased a hen from Dahutou Village and had killed it herself, according to the commission.

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

H7N9 is a bird flu strain first reported to have infected humans in March 2013 in China. It is most likely to strike in winter and spring.

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RESEP COBEK GENJER BUMBU ONCOM TERASI

Menikmati menu masakan lainnya dari olahan genjer dapat mencoba resep cobek genjer oncom terasi ala masakan Sunda Jawa Barat berikut ini. Cobek genjer adalah cara memasak genjer yang dipadukan dengan bumbu sambal oncom terasi pedas yang dibuat menggunakan cobek.

Istilah cobek/coet/coek merupakan alat dapur yang berfungsi untuk melumatkan atau menghaluskan bumbu dapur bersama ulekan/muthu sebagai pasangannya.

Persiapan Bahan dan Bumbu Cobek Genjer

• 2 ikat genjer muda dipotong-potong dan cuci bersih
• 70 gram oncom
• minyak secukupnya untuk menumis

Bumbu halus :

• 1 sdt gula merah
• 1/2 sdt terasi
• 1 buah cabe merah besar
• 5 buah cabe rawit merah atau sesuai selera
• 1 cm kencur
• 3 butir bawang merah
• 1 siung bawang putih
• garam dan kaldu bubuk secukupya

Cara Membuat Cobek Genjer

1. Ulek bumbu-bumbu hingga halus pada sebuah cobek dan aduk rata, tambahkan oncom serta tekan-tekan dengan ulekan dan aduk-aduk hingga oncom tercampur rata dengan bumbu.
2. Panaskan sedikit minyak, lalu tumis bumbu oncom tersebut dan aduk-aduk hingga harum. Masukkan genjer, aduk rata dan masak hingga genjernya layu atau matang, angkat dan siap untuk disajikan.

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WHO Update - Lassa Fever In Nigeria

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For most of January we've been following a Lassa Fever outbreak in Nigeria (see Nigeria: Lassa Fever Outbreak With 40 Fatalities), one which appears to have an unusually high mortality rate (at least based on the numbers provided).


Lassa is a Viral Hemorrhagic Fever (VHF), albeit not as deadly as Marburg or Ebola. The Lassa virus is commonly carried by multimammate rats, a local rodent that often likes to enter human dwellings. Exposure is typically through the urine or dried feces of infected rodents, and roughly 80% who are infected only experience mild symptoms. 

The overall mortality rate is believed to be in the 1%-2% range, although it runs much higher (15%-20%) among those sick enough to be hospitalized.

Like many other hemorrhagic fevers, person-to-person transmission may occur with exposure to the blood, tissue, secretions, or excretions of an individual, although the CDC reassures:

Casual contact (including skin-to-skin contact without exchange of body fluids) does not spread Lassa virus. Person-to-person transmission is common in health care settings (called nosocomial transmission) where proper personal protective equipment (PPE) is not available or not used. Lassa virus may be spread in contaminated medical equipment, such as reused needles.

Today's update from WHO lists 159 suspected cases of Lassa fever and 82 deaths, pushing the fatality rate to over 50%.  The Nigerian MOH's most recent status update  Daily Situation Report No. 16: 24th January 2016 lists:

• Total cases reported (confirmed and suspected): 172; Total deaths (confirmed and suspect): 83 (CFR: 48%)
• Total confirmed cases: 57; Deaths in confirmed cases: 34 (CFR: 60%)

By either measure, this is an unusually high fatality rate for Lassa Fever. 


The last major outbreak of Lassa in Nigeria was  reported in 2012.  Last year, Nigeria only reported 250 cases (likely a substantial under count) and 8 deaths.   By contrast - in 2012 - 117 deaths were recorded, but the fatality rate remained under 10%.

Lassa Fever – Nigeria

Disease outbreak news
27 January 2016

The National IHR Focal Point of Nigeria has notified WHO of different outbreaks of Lassa fever occurring in the country.

Details of the outbreaks

Between August 2015 and 23 January 2016, 159 suspected cases of Lassa fever, including 82 deaths, were reported across 19 states. Investigations are ongoing and a retrospective review of cases is currently being performed; therefore, these figures are subject to change.

The 4 most affected states are Bauchi, Edo, Oyo and Taraba, which account for 54% of the confirmed cases (n=54) and 52% of the reported deaths (n=34). The remaining 15 States have reported less than 5 confirmed cases.

Samples of 54 cases, including 34 deaths, were confirmed for Lassa fever by reverse transcription polymerase-chain reaction (RT-PCR). All samples tested negative for Ebola virus disease, Dengue and yellow fever.

To date, 4 health care workers were laboratory-confirmed for Lassa fever; of these 4 cases, 2 passed away. It is important to note that these cases are not considered as cases of hospital-acquired infection as no confirmed or suspected cases were reported in the 4 different health facilities where these health care workers were employed.

As of 21 January, 2,504 contacts had been listed and 1,942 are currently being monitored. A total of 562 contacts have completed follow up. So far, none of the contacts have tested positive for Lassa fever.

Public health response

The WHO country office is supporting the Federal Ministry of Health (MoH) in coordinating the response, especially regarding surveillance (including active surveillance and contract tracing), case management, infection prevention and control, and sensitization of community and health workers. WHO and MoH have identified a need to reinforce trainings for clinicians and community sensitization.

Background

Lassa fever is endemic in Nigeria and causes outbreaks almost every year in different parts of the country, with yearly peaks observed between December and February. The disease is an acute viral haemorrhagic illness caused by Lassa virus, a member of the arenavirus family of viruses. It is transmitted to humans from contacts with food or household items contaminated with rodent excreta. The disease is endemic in the rodent population in parts of West Africa. Person-to-person infections and laboratory transmission can also occur, particularly in the hospital environment in the absence of adequate infection control measures. Diagnosis and prompt treatment are essential.

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An Update On The Russian Influenza Epi Report

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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.

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Brazil MOH: Epi Week 3 Microcephaly Update

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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.

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

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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.

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Saudi MOH Reports 1 Primary MERS Case (Camel Contact)

 

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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. 

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