Saturday, June 29, 2013

#H5N1 Vietnam - Poultry is smuggled into inland through the quarantine turnaround

[editing is mine]
The paper uses multiple rotating quarantine, the contraband made poultry dealers mingled with domestic poultry, causing difficulties in controlling the disease, a great influence on the environment and people's health .
On 28/6, at 6 months of Preliminary Conference to prevent smuggling of poultry of unknown origin showed that despite the use of more tightening measures smuggled poultry.But poultry is illegal in any way invade our country, such as eggs, chicken smuggled tea mixed with domestic goods sold in the market, taking advantage of sealing between the different places to eat poultry amount of time.
Ms. Nguyen Thi Nhu Mai, deputy director of Hanoi Department of Industry and Trade said that the phenomenon of illegal chicken mingled with domestic poultry, quarantine certificate turnaround. Eggs are also smuggled infiltrated local farms, then use domestic quarantine certificate to validate that contraband. "We have to take place, to the same test, and last interdisciplinary forces arrested 117 thousand eggs for contraband such as in the form" - Ms Mai said.
Notably, the paper revolving chicken quarantine to smuggle contraband into the market. Mr. Nguyen Dac Loc, deputy director of Hanoi Market Management said the chicken business objects illegally smuggled chicken mixed with domestic poultry, quarantine records used to transport chickens in the city legally, or chicken slaughter before being consumed, making it difficult to identify smuggled or domestic. Once traders have intentionally bypassed the management team also difficult market tightly controlled, more is still in a state of "relaxed" when trying to manage multiple, sometimes unintentionally forces .
19.6 tons of food destroyed by CP
Recently, the Department of Trade and Industry, Hanoi found lots of food (chicken feet, bones crushed, ground meat ...) company shares (in Quang Minh Industrial Zone, Me Linh District, Hanoi) has expired from several this month. CP was forced destruction, and sanctions more than 100 million (shipments worth more than 1 billion).
Corporation has applied to retain the seat for grinding food to feed, but the Department of Industry and Trade has requested be destroyed due to the re-use monitoring.

#H5N1 Vietnam - Ca Mau - Results of Serum Samples Poulry in Market Carry H5N1, but show no Symptoms

Updated on: 06/27/2013 19:31:58

But three outbreaks of avian influenza occurred in the province is detected early, promptly extinguished, but the situation is still complicated disease.

More worryingly for the vaccination for poultry this year is not supported by the State as before, people have to spend money to buy the injectable vaccine. Therefore, the vaccination for poultry certainly difficult if not implemented uniformly and tightly controlled.

 On the other hand, the province's livestock industry has not developed, farmers usually a few dozen chickens, ducks, until the big catch to market.The results of serum samples on the poultry is sold in the market but there are no signs, symptoms of bird flu, but still carry the H5N1 virus.
This shows that the bird flu virus is spreading in many natural environments. Thing more dangerous, since serum samples until the results of time lasting about 1 week, the results were positive for the bird flu in poultry has been sold.
This time, the localities should focus on the preventive vaccine for pets in the area. This is one of the measures most effective initiative to reduce pandemic.
Mr. Phan Van Dang, vets An Loi commune, Tran Van Thoi District, said the vaccination of cattle and poultry are key tasks should be focused social drastically this work. Currently, local specific plan directing people to make them.
For the prevention of disease in animals with high efficiency requires attention drastically, from the synchronization. For the industry professional, need to prepare adequate materials, chemicals, and vaccines to meet local demand for the implementation of vaccination.
Strengthen inspection, supervision and guidance measures to prevent and combat the disease promptly from industry professionals. In particular, the detection of cattle, poultry, disease and death, the people must be active immediately to the veterinary authorities and local authorities for timely handling, not to spread. /. 

WHO Update: Interim surveillance recommendations for human infection with Middle East respiratory syndrome coronavirus

[This update is also located on the right side-bar under "Coronavirus MERS CoV".

June 27, 2013
WHO is updating its guidance for surveillance for Middle East respiratory syndrome coronavirus (MERSCoV)thatwere first published in late 2012. WHO will continue to update these recommendations as new information becomes available.
This document summarizesWHOrecommendations, and is not a comprehensive summary of current case reports, which are found on WHO’s novel coronavirus page

It is important to note that these WHO recommendations need to be implemented in different countries with varying resources and epidemiological patterns.

Two key changes in this 27 June 2013 update
• Stronger recommendations for lower respiratory specimens, rather than nasopharyngeal swabs, to be used to diagnose MERS-CoV infection.
• A longer period of observation for contacts of cases; this is based on accumulating information about the incubation period.

2013 Hangzhou H5N1 Wraps H7N9 Genes

In addition to H9N2 wraping H7N9, Hangzhou CDC has released sequences (at GISAID) from H5N1, A/Environment/Hangzhou/109/2013, wrapping H7N9 genes.

Friday, June 28, 2013

Vietnam #H1N1 Case List

As of 6/28/13

46M—Yen Bai—Early April—DOD early April
72M--HCMC Dist. 11—Cho Ray Hosp--DOD early May
56M—Ha Giang—April—DOD 5/21
61M--Dong Thap-Cho Ray Hosp--DOD 6/3
3yo—Dong Thap—Childrens Hosp HCMC—contact of 61M--recovered 
24F—HCMC Dist. 9—6/1 Cho Ray Hosp-- DOD 6/5
49M—HCMC Dist. 3—5/24 Gia Dinh Hosp HCMC--DOD 6/3 
48M—Ben Tre—6/9—DOD 6/12
Nurse—Ben Tre—6/?—Stable
47F—My Thanh, Ben Tre—6/2—DOD 6/12
50M—HCMC Dist. 3—Nhan Gia Dinh Hosp.
Justice Dept Empl.—Tien Giang—6/3—discharged 6/21
Justice Dept Empl—Tien Giang—6/3—discharged 6/21
Justice Dept Empl—Tien Giang—6/3—discharged 6/21
Justice Dept Empl—Tien Giang—6/3—discharged 6/21
Woman—Mang Thit Dist, Long Tan Comm.,Vinh Long—6/15—DOD 6/17
55—Ward 8, Vinh Long—Gia Dinh Hosp—DOD 6/14
69(M)—Nguyen Phich, U Minh, Ca Mau—5/21
no name—Hoa Hiep, H. Tam Binh Vinh Long—6/21—
no name—Hoa Hiep, H. Tam Binh Vinh Long—6/21
30(M)—Binh Thanh Dist , HCMC—6/23
Le Hoang Be—Ca Mau—6/19—Pham Ngoc Thach Hospital
L.V.D.—U Minh, Ca Mau--6/26—U Minh Hospital
T.T.M.—Phu Tan, Ca Mau—Cai Nuoc Hospital
30(F)—Cai Doi Vam, H.Phu, Ca Mau—6/27—
58(M)-- Vĩnh Viễn, Hau Giang Prov.—6/18—DOD 6/27

#H1N1 Vietnam - Ca Mau 3 Cases

[Maybe I can make some sense into this situation.  In the original, bold is name, red is location, blue is hospital]

TTM - On 28-6, BS Dan Nguyen Thanh, director of the Preventive Medical Center of Ca Mau Province, said that in the area there are three cases of H1N1 infection. Specifically, Mr. Le Hoang Baby (director of Ca Mau Department of Interior, is being treated at Pham Ngoc Thach Hospital, Ho Chi Minh City), he LVD. (Nguyen commune Plugs, U Minh district, being treated in isolation Hospital U Minh district), she TTM (Cai Doi Vam town, Phu Tan district, was treated at Hospital Cai Nuoc district). 
Dr. Dan says his own baby cases were H1N1, health centers have conducted preventive disinfection in place, the agency he worked Baby health and the Committee of Ca Mau province, Hospital Ca Mau general. At the time allocated for oral exposure to the baby during the time he was infected with H1N1 occurred.

TTM - Ngày 28-6, BS Nguyễn Thanh Dân, giám đốc Trung tâm y tế dự phòng tỉnh Cà Mau cho biết, hiện trên địa bàn có ba trường hợp bị nhiễm cúm H1N1. Cụ thể: ông Lê Hoàng Bé (giám đốc Sở nội vụ Cà Mau, hiện đang điều trị tại Bệnh viện Phạm Ngọc Thạch, TP HCM), ông L.V.Đ. (xã Nguyễn Phích, huyện U Minh, đang điều trị cách ly tại Bệnh viện đa khoa huyện U Minh), bà T.T.M (thị trấn Cái Đôi Vàm, huyện Phú Tân, đang điều trị tại Bệnh viện đa khoa huyện Cái Nước). 
BS Dân cho biết, riêng trường hợp ông Bé bị nhiễm cúm H1N1, trung tâm y tế dự phòng đã tiến hành tiêu độc khử trung nơi ở, cơ quan ông Bé làm việc và Ban bảo vệ sức khỏe tỉnh ủy Cà Mau, Bệnh viện đa khoa tỉnh Cà Mau. Đồng thời cấp phát thuốc uống cho những người tiếp xúc với ông Bé trong thời gian xảy ra nhiễm cúm H1N1.

#H1N1 Vietnam - The first one in Hau Giang A/H1N1 flu death


28.6, Dr. Tran Phong Nha, Director of Preventive Medicine American H.Long, Hau Giang province has said in a case of death due to influenza A/H1N1.

This is the first deaths in Hau Giang influenza A/H1N1 infection. The victim was Ly Van Thanh (58 years old, living in 12 2, xã Vĩnh Viễn, H.Long Mỹ).

According to his family Thanh, from 18.6 days, he had headaches, coughing and high fever ... family brought him to the bar at the clinic treat private patients locally but not all, his health Thanh increasingly weaker. By day 24.6, the family took him to the emergency at H.Long Mỹ.

After his serum sample to be tested Thanh, Thanh hospital immediately transferred to Bệnh viện Quân y 121 (TP.Cần Thơ) for treatment. However, because of illness too heavy, untimely emergency, to 27.6 days, Mr. Thanh died.

According to Dr. Tran Phong Nha, 28.6 days, Ho Chi Minh City Pasteur Institute has announced his bar serum samples positive for influenza A/H1N1.

Currently the family and authorities still have not determined the cause of his A/H1N1 infection, because before he was sick, he did not go far from locally.

 Immediately after the announcement of the Pasteur Institute, the Centre for Preventive Medicine American H.Long the professional staff of the Pasteur Institute is conducting staking, spraying disinfectant treatment of radius 400 m, and also allocate preventive medication to people nearby. Particularly in his family who had been function for serum samples to be tested in case it spreads.

#H1N1 Vietnam - Death in Hau Giang Province

Nhan Dan Online-According to information from the Center for Preventive Medicine of Long Mỹ, ông Lý Văn Thanh ở ấp 12, xã Vĩnh Viễn died of A/H1N1 flu. These are deaths due to influenza A/H1N1 infection in the first year of Hau Giang.

Numerous local people came to pay his family Ly Van Thanh.
It is known that he was ill from 18-6 bar. After six days of treatment in private clinics locally, but the situation did not reduce disease, who brought the patient to the District HospitalLong Mỹ và Bệnh viện Quân y 121 in Can Tho City to continue treatment . But due to severe illness than the patient died on day 27-6.
Through examination of the Pasteur Institute in Ho Chi Minh Thanh identified positive for influenza A/H1N1.
Local time sector function conducted spraying to kill pathogens, environmental remediation, instruction Thanh and his family households neighboring prevention measures.

Potential Hot Spot for Avian Flu Transmission Identified in Western Alaska #H5N1

[editing is mine]
Released: 6/27/2013 5:00:00 PM
Contact Information:
U.S. Department of the Interior, U.S. Geological Survey
Office of Communications and Publishing
12201 Sunrise Valley Dr, MS 119
Reston, VA 20192

ANCHORAGE, Alaska — Low-pathogenic avian influenza viruses with Eurasian genes have been found among birds in the Yukon-Kuskokwim Delta of western Alaska, supporting the theory that the area is a potential point of entry for foreign animal diseases such as the more highly pathogenic H5N1 strain, according to a new study by U.S. Geological Survey scientists.

The Yukon-Kuskokwim Delta is an important breeding ground for many bird species and is located where multiple migratory flyways converge, providing opportunities for avian pathogens to spread. Among these pathogens are H5N1 avian influenza, which occurs in both low-pathogenic and the more dangerous highly pathogenic forms.  

After the outbreak of the highly pathogenic H5N1 strain of avian influenza in wild birds of China in 2005, the USGS and the U.S. Fish and Wildlife Service, in cooperation with the Yukon-Kuskokwim Health Corporation,  the Kawerak Tribal Corporation and other partners, conducted four years of testing wild migratory birds in western Alaska for the highly pathogenic H5N1 strain.

In a paper published by the USGS and the USFWS scientists no highly pathogenic forms of avian influenza were found in more than 24,000 samples tested from 82 species on the Yukon-Kuskokwim Delta from 2006 to 2009, however, 90 low-pathogenic strains of the virus were obtained from these Alaskan samples.  Low-pathogenic avian influenza viruses are common among wild birds and do not cause mortalities to the degree often seen with highly pathogenic forms of the virus, said USGS research geneticist Andrew Reeves, lead author of the paper. The significance of this study is that it demonstrates that viruses with genes of Eurasian origin can enter North America via migratory birds. 
In addition, researchers discussed how low pathogenic virus samples from birds further from Asia contained fewer genes attributable to Eurasian strains. 
"This finding supports a 'dilution-by-distance' idea we've hypothesized in other studies," Reeves said. "Birds sampled further from Asia, such as in the lower-48 United States, very rarely contain avian influenza viruses with Eurasian genes, but in Alaska they are more common." 
"Many of the bird samples used in the study were provided by subsistence hunters in 11 villages throughout the Yukon-Kuskokwim Delta who collected samples from many species, including ducks, geese, swans and shorebirds," said Kim Trust of the USFWS.  
"Without our partners in western Alaska, we would not have the robust data set that supports the findings in this paper," Trust said. 
Reeves added that the current study provides support for retaining the Yukon-Kuskokwim Delta as a high-priority region for the surveillance of potentially harmful avian pathogens.
The paper in the Journal of Wildlife Diseases, "Genomic analysis of avian influenza viruses from waterfowl in western Alaska, USA," by Andrew Reeves, John Pearce, Andrew Ramey, Craig Ely, Joel Schmutz, Paul Flint, Dirk Derksen and Hon Ip of the USGS and Kimberly Trust of the USFWS, is available online.

Vietnam - 30 yo Critical Condition with #H1N1 from Binh Thanh District

After three people died of H1N1 flu in Ho Chi Minh City in the first months of this year, a 30-year-old man is now being treated in a serious condition. 

The Tropical Disease Hospital in Ho Chi Minh City is treating a patient, from Binh Thanh District, who has contracted the H1N1 flu virus and is now in fatal condition, doctors said.

So far this year, many people have infected with the deadly virus, and three of them have died, local health authorities reported.  

The latest patient, whose name has not been announced, was first hospitalized at Nhan Dan Gia Dinh Hospital on June 23 after experiencing a high fever and difficulty breathing.

Tests later confirmed he had contracted the virus, and that he was also suffering from hepatitis C, doctors said.

Three days later, the patient was transferred to the Tropical Disease Hospital with respiratory failure and serious pneumonia.

Despite intensive treatment and care, the patient’s health is in very serious condition and he is being put on a respirator, doctors said.

In related news, the Health Ministry’s Institute for Vaccines and Medical Biologicals, under the Health Ministry, is stepping up preparations to produce a vaccine against H1N1 in late 2014 or early 2015.

The institute conducted the first trial of its vaccine, A/H1N1/09, on 48 healthy people in Ben Luc District, southern Long An province from April to November 2012 to assess the vaccine’s effect and its safety.

If everything continues going smoothly, the last trial will be carried out on 1,000 people before the vaccine can be produced in mass quantity, Duong Huu Thai, deputy head of the institute, said.
The trial will last for six months, during which every aspect of the vaccine will be examined and assessed, he added.

The price of the H1N1 vaccine produced by the institute will be equal to only one-third that of the imported version, Thai said.

Vietnam: Director of the Department of the Interior Mau #H1N1 positive

Height 27.6, Dr. Nguyen Thanh Dan, director of the Preventive Medical Center of Ca Mau Province said: "According to information I received is Le Hoang Be patient, Director of the Department of the Interior Ca Mau province tested positive for H1N1 flu ".
Earlier, on 19.6, ông Bé to Protect Health Board Provincial examination with cough and fever were transferred to the unit hospital (general hospital) Ca Mau and treatment monitoring.
The next day, sick of his evolution increasingly heavy baby, but not Ca Mau province general hospital patients found infected with influenza.
By day 26.6, patients with symptoms of high fever, difficulty breathing much more should be referred to the Pham Ngoc Thach Hospital, Ho Chi Minh City.
After examination and take samples for test, 27.6 days, Pham Ngoc Thach Hospital phoned to inform leaders of the provincial Health Protection Committee Le Hoang Be patient was positive for H1N1 influenza.
It is reported that the Center for Preventive Medicine of the province is on the list for monitoring exposure. At the same time will disinfect, disinfect work areas and patients previously treated patients.
Dr. Dan adds, the regional general hospital H.Cai water (Ca Mau) are also monitoring a suspected influenza H1N1 cases. Around 10 am on 27.6, TTM sister (30 years old, live Cai Doi Vam town, H.Phu Tan, Ca Mau) was transferred to the general hospital in New H.Phu fever, cough and shortness of breath. This time the patient was treated by isolated H1N1 influenza treatment regimen.
"The flu situation is quite complex evolutions in the province. Earlier, HU Ming also detected cases of influenza A H1N1, "said Dr. Dan.

#H1N1 Vietnam - Director of the Department of the Interior Mau H1N1

Translation [this sounds like the Dir. of Provincial Affairs in Ca Mau has been confirmed, and is recuperating.  And before that, their baby also contracted it and is not doing well]


Director of the Department of the Interior Mau H1N1

Mr. Le Hoang Little [Ông Lê Hoàng Bé], Director of Provincial Affairs Ca Mai fever for several days, treatment should be remission moved to HCMC. Results of tests translated throat patients positive for A/H1N1 flu virus.

Prior to that, Mr. Baby on Board Health Protection Committee of Ca Mau province [vào Ban Bảo vệ chăm sóc sức khỏe Tỉnh ủy Cà Mau] examination with symptoms of fever, was transferred to the General Hospital in Ca Mau treatment of the disease, but more bad.  morning of 26/6, the patient high fever, shortness of breath should be forwarded to the Pham Ngoc Thach Hospital (HCMC). 

Here sample for testing, the results were positive for A/H1N1 flu virus. Currently Ca Mau health epidemiological investigation conducted, finding the cause of his baby H1N1 virus infection. The patients were spraying disinfectant chemical disinfection. She exposed his relatives were also instructed to medical treatments and recommended early to health facilities when symptoms fever, shortness of breath. 

Mr. Nguyen Thanh Dan, Director of Preventive Health Center of Ca Mau Province said the Hospital District Cai Nuoc (Ca Mau) are treating a 30-year-old woman suspected A/H1N1 influenza virus. This patient Cai Doi Vam town of Phu Tan districts, state hospitalization in the treatment of fever and quarantined to prevent spread of disease to the community.
Thus, from the beginning of the year more than a dozen western people infected with the H1N1 flu virus, most occur in June. Not only that many working people who work office also infected. Tien Giang Province Department of Justice last month to nearly a 4 persons positive for H1N1. Both were treated for 4 regimen, health is stable.
Not as lucky as the Department of Justice officials Tien Giang, Ben Tre Phan on, she lived with Mr Luong Vinh Long died because of H1N1. These 3 patients Mekong Delta die from the disease. 
Prior complicated by H1N1, people need to know how to protect themselves by simple measures. The disease can spread through the respiratory tract, gastrointestinal or regular exposure to the outside toilet properly.
Children need hard habit to wash their hands with antiseptic soap before eating, after using the toilet and after playing to minimize bacteria from hands by ingestion, breathing into the body. If any family members have the early signs of flu to health care facilities to detect the disease and timely treatment.

Thursday, June 27, 2013

AIR Worldwide Releases Global Pandemic Flu Model

[Excerpt - editing is mine]
For Immediate Release:

AIR Worldwide Releases Global Pandemic Flu Model

BOSTON, June 27, 2013 - Catastrophe risk modeling firm AIR Worldwide (AIR) announced today that it has released its Pandemic Flu Model. AIR developed its Pandemic Flu Model to capture the excess morbidity, mortality, and insurance losses caused by pandemic influenza. AIR is a member of the Verisk Insurance Solutions group at Verisk Analytics (Nasdaq:VRSK).

The model includes more than 18,000 simulated events, ranging in severity from mild to severe, that can start and spread anywhere in the world and last from months to years. This new model builds upon AIR's existing mortality modeling capabilities that enable clients to enter injury or life exposures in its natural catastrophe models to obtain estimates of loss.


"The 1918 Spanish flu pandemic was one of the largest public health catastrophes of the past century, causing life insurance losses of nearly $100 million, which is comparable to nearly $20 billion today," continued Madhav. "Insurers striving to manage pandemic risk need to know that a modern-day pandemic on par with the Spanish flu of 1918 could occur. Of course, post-1918 medical advancements and the graying of the global population would affect the severity of a pandemic today. Probabilistic modeling accounts for medical advancements and other societal changes and enables a more complete understanding and management of pandemic risk than relying on the historical record alone."

The AIR Pandemic Flu Model is currently available in Version 15.0 of the CATRADER® catastrophe risk management system.

Complete article:

#MERS #Coronavirus Saudi Arabia - Tighten controls on the health of pilgrims

June 26, 2013
 The bed hospital is obliged to provide at least one all interests

 And directed the Ministry of Health, Population and Hospital Reform, strict instructions to the directors of hospitals and health institutions to implement the scheme express particular virus Corona or'' Mears'', by tightening control measures of health.

According to the text of correspondence bearing No. 06, holds'' day'' on a copy of which, given the recording of cases of infection'' Corona'' in France, Tunisia and the Middle East, ordered the Ministry of Health, to provide backup security, which includes all means of HIV prevention, including masks, surgical masks, coveralls, and protectors Hair, as well as glasses, noting that all interests must be available on this stock, in order to counter the threat posed by this disease in the event of outbreaks.

Among the measures taken by the ministry, is to provide equipment disarmament blood, and their means of delivery, in anticipation of receiving any cases of infected virus, stressing the need to provide a single bed at the level of the interests of the recovery, internal medicine, respiratory diseases, diseases التعفنية, pediatrics, as well as the interest of Gynecology. also stressed the ministry on the need to notify the officials from the centers of health monitoring at the level of the border areas, and at the level of airports, from in order to take all the necessary precautions, in anticipation of the registration of any cases of infection, which includes passengers traveling to the Middle East countries, in particular the pilgrims, with the need to follow all the conditions of hygiene and personal care clean hands the first place.

In a related development, emphasizes the instruction that all person showing symptoms of unusual private travelers newly returning from regions outbreaks of the virus from infected acute respiratory'' Mears'', imposed on the medical staff to keep the situation in the hospital, and sampling for diagnosis depth, to confirm infection. identified Ministry

Indiana Detects 4 People Infected With H3N2v virus after attending County Fair

[you can obtain specific important information on H3N2v by clicking on the links under the heading, on the right side-bar of this page.  Article below is from the Indiana State Department of Healtlh.]

INDIANAPOLIS—State health officials are encouraging Hoosiers to take steps to protect themselves at county and 4H fairs around the state this summer following detection of four cases of variant influenza A (H3N2v). All individuals visited the Grant County Agricultural Fair, June 16-22, prior to illness, and at least two had contact with swine.  Variant influenza A H3N2v was identified in Indiana last year, with a total of 138 cases in 2012.

The Indiana State Department of Health and the Grant County Health Department continue to investigate these cases. Human infections with H3N2v are rare but have most commonly occurred after close proximity to live infected pigs, such as working with them in barns and livestock exhibits at fairs. Influenza viruses are not transmitted by eating pork and pork products. 

According to the State Board of Animal Health, thirteen pigs at the fair tested positive for H3N2.  It is not uncommon for pigs to be infected with swine influenza viruses but not show any signs of illness.  If ill with influenza they typically recover.

“Fairs are a great way to get outdoors, have some fun and learn about agriculture,” said State Health Commissioner William VanNess, M.D. “If you plan to attend a fair this summer, just be sure to wash your hands frequently and avoid taking food into areas where animals are kept.”

Symptoms of variant influenza A include: fever, cough, sore throat, chills, headache and muscle aches. Diarrhea and nausea may occur in children. Symptoms can begin approximately one to four days after being exposed to the illness and last from two to seven days.

As several county fairs will open in the next few weeks, State health officials are increasing surveillance for influenza-like illness. 

“We are increasing our surveillance so we can learn more about this virus and because antiviral treatment is most effective if given within 48 hours,” said Dr. VanNess. “It’s important to contact your health care provider if you begin experiencing flu-like symptoms.”

And if you have visited a fair or been around animals, let your health care provider know. Influenza antiviral drugs can treat infection with H3N2v and quick treatment is especially important for people who are at high risk of serious flu complications, including the very young, the elderly, people with chronic health conditions like asthma, diabetes and heart disease and pregnant women.

Visiting animal exhibits is fun and educational, and Hoosiers are reminded to follow some simple safety steps to prevent illness. Wash hands with soap and water before and after petting or touching any animal. Never eat, drink or put anything in your mouth when visiting animal areas and avoid face-to-face contact with animals. People at high risk for flu complications should avoid close contact with swine in the fair setting particularly. 

While influenza is not an uncommon diagnosis in pigs, the State Board of Animal Health encourages swine owners to contact a veterinarian if their animals show signs consistent with flu, including coughing, respiratory illness, off-feed and fever. Most county fairs have a private veterinary practitioner on call for on-site assistance.

Since there is no vaccine available for people to protect against this H3N2v virus, the best way to prevent infection with variant influenza is to avoid sources of exposure to the virus. As always good hygiene and other everyday preventive actions are important to take as well. Wash your hands frequently. Cough or sneeze into your sleeve or elbow. Avoid contact with people or animals that are ill. Stay home if you develop influenza symptoms and contact your health care provider. 

In 2012, the Centers for Disease Control and Prevention (CDC) reported 309 infections with H3N2v in the United States. According to the CDC, most of these infections resulted in mild illness, though 16 people were hospitalized and one person died. Most of the people who were hospitalized and the person who died had one or more high risk conditions.

MERS-CoV meeting: WHO/EMRO (Eastern Mediterranean Regional Office)

Published Date: 2013-06-26 22:03:14
Subject: PRO/AH/EDR> MERS-CoV - Eastern Mediterranean (35): Saudi Arabia, WHO
Archive Number: 20130626.1793072
A ProMED-mail post
[1] Saudi Arabia: WHO Global Alert and Response
[2] MERS-CoV meeting: WHO/EMRO (Eastern Mediterranean Regional Office)

Excerpt (#2 below)
[2] MERS-CoV meeting: WHO/EMRO (Eastern Mediterranean Regional Office)
Date: Wed 26 Jun 2013
Source: WHO EMRO [edited]

Health officials meet to discuss urgent measures for control of novel coronavirus infection (MERS-CoV).

Meeting on MERS-CoV concludes with urgent call to improve surveillance and strengthen global health preparedness
Over 100 health officials from the countries in the Eastern Mediterranean Region as well as from France, Germany and the United Kingdom met in the WHO Regional Office in Cairo from [20 to 22 Jun 2013] and discussed a collective response plan to counter the threats of novel coronavirus infection to global health.

Dr Ala Alwan, WHO Regional Director for WHO Eastern Mediterranean, and Dr Keiji Fukuda, Assistant Director-General for Health Security and Environment, inaugurated this meeting, which was also attended by WHO staff from the Regional Offices for the Eastern Mediterranean and for Europe and WHO headquarters, as well as representatives of WHO collaborating centres and other key technical partners and networks that have been involved in the global response to MERS-CoV. The meeting discussed the public health threats related to the emergence of this virus, reviewed the current level of preparedness and response measures in the region as well as provided recommendations that can collectively improve and strengthen global public health preparedness against MERS-CoV.

The meeting recognized that 3 main epidemiological patterns of this novel virus have been observed so far.
- Sporadic cases in communities: At present, the source of the virus infection or how these people became infected remains unknown;
- Clusters of infections in families: In most of these clusters, there appears to be person-to-person transmission, but it seems that this transmission was limited to people who were in close contact with a sick family member;
- Clusters of infections in health care facilities: In these clusters, the sequence seems to be that an infected person was admitted to hospital where that person then transmitted the virus to other people in the health care facility.

The meeting acknowledged that despite no current evidence of sustained human-to-human transmission, MERS-CoV may evolve to spread quickly among humans and affect wider geographical areas. While major knowledge gaps remain in understanding the emergence of this virus, clinical manifestations as well as the transmission risk, recent scientific research is enhancing the global knowledge on the disease. This new knowledge now needs to be translated into a set of concrete public health actions in order to improve global and regional public health preparedness.

The meeting also recognized that as much as collecting and sharing of full epidemiological, clinical, immunologic and virologic information related to MERS-CoV infections is essential for better understanding and characterization of the disease that will contribute to global preparedness against this novel infection, coordinated and inter-sectoral actions are also important to increase global, regional and inter-regional collaboration among countries, with WHO and other international health partners in responding to the outbreak caused by this novel virus.

The countries were also encouraged to improve surveillance for detection of any sign that signals sustained human-to-human transmission as well as participate in further development of diagnostic assays through international networking with technical agencies, sharing of materials and resources, and participation in laboratory studies.

The meeting identified a set of concrete public health action points that can collectively improve and strengthen global public health preparedness, surveillance and response to MERS-CoV.

Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[This moderator would have liked to have been a fly on the wall of this meeting to hear the actual presentations and discussions of the full epidemiological, clinical immunologic and virologic information related to MERS-CoV infections. - Mod.MPP]

Wednesday, June 26, 2013

CDC EID: Clinical Findings for Early Human Cases of Influenza A(H7N9) Virus Infection, Shanghai, China

Volume 19, Number 7—July 2013

Shuihua Lu1Comments to Author , Yufang Zheng1, Tao Li1, Yunwen Hu1, Xinian Liu, Xiuhong Xi, Qingguo Chen, Qingle Wang, Ye Cao, Yanbing Wang, Lijun Zhou, Douglas Lowrie, and Jing Bao
Author affiliations: Shanghai Public Health Clinical Center, Shanghai, China (S. Lu, Y. Zheng, T. Li, Y. Hu, X. Liu, X. Xi, Q. Chen, Q. Wang, Y. Cao, Y. Wang, L. Zhou, D. Lowrie); Henry M Jackson Foundation–Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (J. Bao)


A novel strain of influenza A(H7N9) virus has emerged in China and is causing mild to severe clinical symptoms in infected humans. Some case-patients have died. To further knowledge of this virus, we report the characteristics and clinical histories of 4 early case-patients.

Excerpt (under Discussion):
The benefits of oseltamivir treatment of influenza A(H7N9) virus infections are debatable; for example, case-patients 2 and 3 remained positive for the virus after 9–11 days of oseltamivir treatment (Technical Appendix Adobe PDF file [PDF - 310 KB - 3 pages] Table 1). Thus, it is essential to determine whether the virus has developed resistance to oseltamivir. Ineffectiveness of the oral oseltamivir formulations may also have contributed to treatment failure, especially for case-patients 1 and 4: the drug may not have been well absorbed, especially by patients in severe condition. If available in the future, systemic delivery of oseltamivir may be superior.

Full article:


CDC EID: Avian Influenza A(H7N9) Virus Infections, Shanghai, China

Volume 19, Number 7—July 2013 

To the Editor: On March 31, 2013, the National Health and Family Planning Commission of China notified the World Health Organization of 3 cases of human infections with avian influenza A(H7N9) virus. These cases were caused by a novel virus that was identified by laboratory testing at the China Centers for Disease Control and Prevention (CDC) on March 29 (1).
As of April 19, 2013, a total of 91 laboratory-confirmed human cases (17 deaths) of infection with avian influenza A(H7N9) virus were reported in 4 provinces in China (2). We report clinical features of 2 infected adults who died, 2 critically ill infected adults who recovered, and 1 infected child who had a mild case during this outbreak in Shanghai, China.
A 3.5-year-old boy had fever (39.5°C) for 3 days and mild rhinorrhea starting on March 31. He was admitted to a district pediatric outpatient clinic on April 1. At admission, the child was given oseltamivir for 5 days, even though signs and symptoms had resolved. Nasopharyngeal swab samples were positive by real-time PCR for avian influenza A(H7N9) virus. All symptoms resolved uneventfully by April 3, and CDC was notified that avian influenza A(H7N9) virus was identified in his respiratory sample. The patient was discharged on day 11 after illness onset.
The 4 adult patients were given diagnoses of severe pneumonia with shortness of breath, dyspnea, and marked hypoxia (Table). Duration from disease onset to severe illness was 5–7 days. At admission, the 4 patients with severe cases had decreased peripheral blood leukocyte counts and increased levels of aspartate aminotransferase; 3 had increased levels of lactate dehydrogenase (Table).
Thumbnail of Chest computed tomographic scans for 3 patients infected with avian influenza A(H7N9) virus, Shanghai, China. A) Patient 1, who died, showing extensive lung infiltrates at day 7 of illness onset. B) Patient 3, who had a severe case, showing partial rear lung infiltrations on both sides of the lung and partial normal lung at day 7 of illness onset. C) Patient 4, who had a mild case, showing only partial left lung lobar involvement at day 9 of illness onset.Figure. . Chest computed tomographic scans for 3 patients infected with avian influenza A(H7N9) virus, Shanghai, China. A) Patient 1, who died, showing extensive lung infiltrates at day 7 of illness onset....
All 4 adult patients had radiologically confirmed pneumonia and bilateral patchy alveolar opacities or diffused lobar consolidation with or without pleural effusion (Figure, Appendix). Findings on chest radiographs for severe cases requiring mechanical ventilation were consistent with those for acute respiratory distress syndrome.
Among the 4 severe cases in adults, a 52-year-old woman (patient 1) and a 49-year-old man (patient 2) died from acute respiratory distress syndrome and multiple organ failure on days 14 and 10, respectively, after disease onset and 1–2 days after progression to respiratory failure. Two other patients showed improvement and were virus negative 6 and 4 days after antiviral treatment. After 23–24 days of treatment in an intensive care unit, the 2 patients with severe cases recovered and were discharged (Table).
The 2 patients who died were given methylprednisolone. Of the 2 patients who recovered, 1 was given a low dose of methylprednisolone for 1 week and the other was not given methylprednisolone. Although it is difficult to assess the role of glucocorticoids in treatment because of limited number of cases, caution is advised because of possible serious adverse events, including death, as reported for human infection with influenza A(H1N1) virus (4).
One of the adult patients reported exposure to poultry. The family of the child patient raised chickens and ducks, but these animals had no apparent disease, and cloacal swab specimens were negative for avian influenza A(H7N9) virus. One patient who died (patient 2) had frequent occupational exposure to poultry. Sixteen contacts of the child and 45 contacts of the 4 adult patients were monitored, and routine virologic sampling was performed. One contact (husband of patient 1) of a patient who died (Table) became febrile and was positive for avian influenza A(H7N9) virus on April 12 (day 24 after disease onset for patient 1); as of the date of this report, he was receiving treatment in an intensive care unit. However, it is difficult to tell if this is a case of human-to-human transmission or if both persons were exposed to infectious poultry. All remaining contacts had no symptoms and were negative for virus by PCR.
Several features of this avian influenza A(H7N9) outbreak are distinct from those of previous avian influenza outbreaks. Human infection with this virus showed a case-fatality rate of 18.7% (17/91), but this rate is not as high as that for avian influenza A(H5N1) virus (case-fatality rate 59%) (5).
Avian influenza A(H7N9) virus infection seems to cause more severe human illness than do other subgroups of H7 influenza A viruses (subtypes H7N2, H7N3, and H7N7), which are usually associated with poultry outbreaks but cause mild disease in humans. However, infection with avian influenza A(H7N7) virus resulted in the death of a veterinarian during an outbreak in the Netherlands (6). In the 5 patients reported here, avian influenza A(H7N9) virus caused fatal disease in 2 adult patients 52 and 49 years of age, who had other medical conditions. Older age has been reported to confer higher risk for developing more severe influenza-associated outcomes (7).
In conclusion, these cases indicated that avian influenza A(H7N9) virus might not be as virulent as avian influenza A(H5N1) virus in humans. Avian influenza A(H7N9) virus does not appear to cause obvious disease in poultry and causes mild disease in children. More severe disease in adults occurred among those had concurrent diseases or were immunodeficient.
Zeng Mei1, Shuihua Lu1, Xianzheng Wu1, Lingyun Shao1, Yu Hui1, Jiali Wang, Tao Li, Haixia Zhang, Xiaohong Wang, Feifei Yang, Jialin Jin, Ying Zhang, and Wenhong ZhangComments to Author 
Author affiliations: Children’s Hospital of Fudan University, Shanghai, China (Z. Mei, Y. Hui, X. Wang); Fudan University, Shanghai (S. Lu, T. Li, W. Zhang, Y. Zhang); Tongji Hospital of Tongji University, Shanghai (X. Wu, H. Zhang); Huashan Hospital of Fudan University, Shanghai (L. Shao, J. Wang, F. Yang, J. Jin, W. Zhang); Johns Hopkins University, Baltimore, Maryland, USA (Y. Zhang)


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Suggested citation for this article: Mei Z, Lu S, Wu X, Shao L, Hui Y, Wang J, et al. Avian influenza A(H7N9) virus infections, Shanghai, China [letter]. Emerg Infect Dis [Internet]. 2013 Jul [date cited]. Web Site Icon
DOI: 10.3201/eid1907.130523
1These authors contributed equally to this article.