Friday, August 9, 2013

China: Guangdong woman tests positive for H7N9 avian flu

Friday, 09 August, 2013

Hong Kong heath authorities said on Friday they were monitoring avian flu developments on the mainland after a woman in Guangdong tested positive for the new H7N9 strain.
The case involves a 51-year-old woman living in Huizhou, about 100 kilometres northeast of Hong Kong, who had contact with poultry before falling ill.
The woman had been tested positive for the H7N9 virus in Guangdong provincial laboratories but her samples were being sent to Beijing for further tests to confirm the result, said.Hong Kong Centre for Health Protection controller Dr Leung Ting-hung.
Leung also said Guangdong authorities notified the centre of the case on Friday.
In view of the large number of H7N9 cases in eastern China and the significant mortality rate among them, we must not underestimate the risk to our local citizens
The woman had contact with 36 people, none of whom have showed any bird flu symptoms, Leung said, citing information provided by Guangdong authorities.
The new H7N9 was first identified in eastern China, with the first known human case of the virus reported in March. So far, 134 cases have been reported, resulting in 43 deaths.
Leung said that given the busy traffic between Hong Kong and mainland, it was possible that the virus could spread into the city.
“In view of the large number of H7N9 cases in the eastern part of China and the significant mortality rate among them, we must not underestimate the risk to our local citizens,” he said.
He said a team of Hong Kong health officials and experts would visit Guangdong to meet their counterparts next week to get more information about the new case.
Hong Kong would also continue preventive measures put in place months ago, Leung said. These include the surveillance of travellers’ heath at border stations and raising doctors’ awareness on how to identify patients with avian flu symptoms

China: Guangdong Province Suspected Case in Huizhou City

[Huìzhōu (Chinese: 惠州) is a city located in central Guangdong province of the People's Republic of China.]
August 9, 2013

Guangzhou, August 9 power (Cheng Jingwei Luo Yishan) According to the Guangdong Provincial Health Department on August 9 briefing, the province Huizhou City, one case of human infection with the H7N9 avian influenza suspected cases. Guangdong Provincial Agriculture Department after receiving the report the urgent deployment of prevention and control work, organization of expert group to Huizhou guidance to carry out epidemiological investigations and avian flu prevention and control, and emergency allocated Huizhou 5 tons disinfectant for disinfection destroy the original.


WHO: Frequently Asked Questions on Middle East respiratory syndrome coronavirus (MERS-CoV) Updated

[located on the right side-bar of this blog, for future reference]
9 August 2013

What is coronavirus?

Coronaviruses are a large family of viruses that cause illness in humans and animals. In people, coronaviruses can cause illnesses ranging in severity from the common cold to Severe Acute Respiratory Syndrome (SARS).
The novel coronavirus, first detected in April 2012, is a new virus that has not been seen in humans before. In most cases, it has caused severe disease. Death has occurred in about half of cases.
This new coronavirus is now known as Middle East respiratory syndrome coronavirus (MERS-CoV). It was named by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses in May 2013.

Where are MERS-CoV infections occurring?

Nine countries have now reported cases of human infection with MERS-CoV. Cases have been reported in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates, and the United Kingdom. All cases have had some connection (whether direct or indirect) with the Middle East. In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people who had not been to the Middle East but who had been in close contact with laboratory-confirmed or probable cases.

How widespread is MERS-CoV?

How widespread this virus may be is still unknown. WHO encourages Member States to continue to closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia. WHO will continue to share information as it becomes available.

What are the symptoms of MERS-CoV?

Common symptoms are acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. Most patients have had pneumonia. Many have also had gastrointestinal symptoms, including diarrhoea. Some patients have had kidney failure. About half of people infected with MERS-CoV have died. In people with immune deficiencies, the disease may have an atypical presentation. It is important to note that the current understanding of illness caused by this infection is based on a limited number of cases and may change as we learn more about the virus.

What is the significance of recent findings of virus antibodies in camels?

The recent study by Reusken and colleagues (link to the article) suggests that MERS-CoV or a virus very similar to the MERS-CoV has been recently circulating among camels. More study is needed to know whether the virus is actually the identical to that found in humans. To do this, it is important to recover the MERS virus itself from a camel.
The paper provides a very important clue to the source of the virus and a direction for further investigation. The most critical question remains to be answered, that is, the type of human exposures that result in infection. Most human cases do not have a history of direct contact with camels; if camels or other animals are the source, the route of transmission to humans may be indirect.
It is premature to rule out the possibility that other animals might serve as a reservoir or an intermediate host for the MERS-CoV. There continues to be a need for well planned, structured investigations carried out in conjunction with exposure investigations in humans.

How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to determine the source of the virus, the types of exposure that lead to infection, the mode of transmission, and the clinical pattern and course of disease.

How is the virus being transmitted to humans?

We still do not know the answer to this question. It is unlikely that transmission of the MERs-CoV to people occurs through direct exposure to an infected camel, as very few of the cases have reported a camel exposure. More investigations are needed to look at the recent exposures and activities of infected humans. WHO is working with partner agencies with expertise in animal health and food safety, including FAO, OIE and national authorities, to facilitate these investigations. Many technical organizations are offering their expertise to assist ministries responsible for human health, animal health, food, and agriculture. Investigation protocols and guidelines for dealing with new cases are available on the WHO website.

Should people avoid contact with animals or animal products?

Because neither the source of the virus nor the mode of transmission is known, it is not possible to give specific advice on prevention of infection. Contact with any obviously sick animals (including birds) should be avoided, and basic hygiene measures taken, especially frequent hand washing and changing of clothes and shoes or boots, after handling animals or animal products. Sick animals should never be slaughtered for consumption. The consumption of raw or undercooked animal products, including milk and meat, carries a high risk of infection from a variety of organisms that might cause disease in humans. Animal products processed appropriately through cooking or pasteurization are safe for consumption but should also be handled with care, to avoid cross-contamination with uncooked foods. Other hygiene measures include avoiding unwashed fruits or vegetables, and drinks made without safe water.

Are bats the source of the virus?

MERS-CoV has recently been found to be genetically related to a virus identified in bats from Southern Africa. But there is no definitive evidence that MERS-CoV originates in bats.

Can the MERS-CoV persist in the environment?

We do not yet know the answer to this question. Some types of environment are better suited for persistence of certain viruses but we still do not know exactly how well and under what conditions MERS-CoV may persist in the environment.

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission has occurred. These clusters have been observed in health-care facilities, among family members and between co-workers. However, the mechanism by which transmission occurred in all of these cases, whether respiratory (e.g. coughing, sneezing) or direct physical contact with the patient or contamination of the environment by the patient, is unknown. Thus far, no sustained community transmission has been observed.

Is there a vaccine or treatment for MERS-CoV?

No. No vaccine is currently available. Treatment is largely supportive and should be based on the patient’s clinical condition.

How many people have been infected by MERS-CoV?

Are health workers at risk from MERS-CoV?

Yes. Transmission has occurred in health-care facilities, including spread from patients to health-care providers. WHO recommends that health-care workers consistently apply appropriate infection prevention and control measures.

How is WHO responding to the emergence of MERS-CoV?

Since the emergence of this virus, WHO has been working under the International Health Regulations to gather scientific evidence to better understand this virus and provide information to Member States. For this purpose, WHO convened the first international meeting on MERS-CoV in Cairo in January 2013.
On 19-22 June, WHO convened a second meeting in Cairo to discuss advances in scientific research and the international response to MERS-CoV. On 5 July, WHO announced it would convene an Emergency Committee under the International Health Regulations (2005). This Committee will advise the Director-General as to whether this event constitutes a Public Health Emergency of International Concern (PHEIC). The Committee may also offer advice to the Director-General on public health measures that should be taken.
WHO is also working with affected countries and international partners to coordinate the global health response, including the provision of updated information on the situation, guidance to health authorities and technical health agencies on interim surveillance recommendations, laboratory testing of cases, infection control, and clinical management.

What is WHO recommending that countries do?

WHO encourages all Member States to enhance their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns of SARI or pneumonia cases. WHO urges Member States to notify or verify to WHO any probable or confirmed case of infection with MERS-CoV.

Has WHO recommended any travel or trade restrictions related to this new virus?

No. WHO does not recommend any travel or trade restrictions with respect to MERS-CoV. WHO will continue to review all recommendations as more information becomes available. 

Middle East respiratory syndrome coronavirus neutralising serum antibodies in dromedary camels: a comparative serological study

The Lancet Infectious Diseases, Early Online Publication, 9 August 2013
doi:10.1016/S1473-3099(13)70164-6Cite or Link Using DOI



A new betacoronavirus—Middle East respiratory syndrome coronavirus (MERS-CoV)—has been identified in patients with severe acute respiratory infection. Although related viruses infect bats, molecular clock analyses have been unable to identify direct ancestors of MERS-CoV. Anecdotal exposure histories suggest that patients had been in contact with dromedary camels or goats. We investigated possible animal reservoirs of MERS-CoV by assessing specific serum antibodies in livestock.


We took sera from animals in the Middle East (Oman) and from elsewhere (Spain, Netherlands, Chile). Cattle (n=80), sheep (n=40), goats (n=40), dromedary camels (n=155), and various other camelid species (n=34) were tested for specific serum IgG by protein microarray using the receptor-binding S1 subunits of spike proteins of MERS-CoV, severe acute respiratory syndrome coronavirus, and human coronavirus OC43. Results were confirmed by virus neutralisation tests for MERS-CoV and bovine coronavirus.


50 of 50 (100%) sera from Omani camels and 15 of 105 (14%) from Spanish camels had protein-specific antibodies against MERS-CoV spike. Sera from European sheep, goats, cattle, and other camelids had no such antibodies. MERS-CoV neutralising antibody titres varied between 1/320 and 1/2560 for the Omani camel sera and between 1/20 and 1/320 for the Spanish camel sera. There was no evidence for cross-neutralisation by bovine coronavirus antibodies.


MERS-CoV or a related virus has infected camel populations. Both titres and seroprevalences in sera from different locations in Oman suggest widespread infection.


European Union, European Centre For Disease Prevention and Control, Deutsche Forschungsgemeinschaft.
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Thursday, August 8, 2013

NEJM: Middle East Respiratory Syndrome Coronavirus Infections in Health Care Workers

[editing below is mine]

New England Journal of Medicine
August 7, 2013DOI: 10.1056/NEJMc1308698

To The Editor:

We recently identified seven health care workers with MERS-CoV infection (two of whom were asymptomatic and five of whom had mild upper respiratory tract symptoms) through screening of single sample nasopharyngeal swabs by means of a real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) amplification test, with amplification targeting both the upstream E protein gene (upE) and open reading frame 1a (ORF1a) for confirmation. A patient was confirmed as having MERS-CoV infection if both assays were positive.
All the infected nurses were women, and all had previously been healthy except for one who had diabetes. Two had asymptomatic cases of MERS-CoV infection, one had only a runny nose, and four reported mild symptoms. They did not require treatment, recovered fully within a week, and remained healthy on follow-up. On daily follow-up PCR testing, six of seven tested positive for MERS-CoV on day 2 and negative on day 3; one remained positive until day 8. There was no history of exposure to animals or to persons with MERS-CoV infection in the community, and no subsequent cases of MERS-CoV were associated with these seven health care workers.
Ziad A. Memish, M.D.
Ministry of Health, Riyadh, Saudi Arabia

Alimuddin I. Zumla, Ph.D.
University College London, London, United Kingdom
Abdullah Assiri, M.D.
Ministry of Health, Riyadh, Saudi Arabia
5 References

Wednesday, August 7, 2013

Gain-of-Function Experiments on H7N9

Science DOI: 10.1126/science.1243325
  • Letters

Gain-of-Function Experiments on H7N9

Since the end of March 2013, avian a influenza viruses of the H7N9 subtype have caused more than 130 human cases of infection in China, many of which were severe, resulting in 43 fatalities. Although this A(H7N9) virus outbreak is now under control, the virus (or one with similar properties) could reemerge as winter approaches. To better assess the pandemic threat posed by A(H7N9) viruses, NIAID/NIH Centers of Excellence in Influenza Research and Surveillance (CEIRS) investigators and other expert laboratories in China and elsewhere have characterized the wild-type avian A(H7N9) viruses in terms of host range, virulence, and transmission, and are evaluating the effectiveness of antiviral drugs and vaccine candidates. However, to fully assess the potential risk associated with these novel viruses, there is a need for additional research including experiments that may be classified as “gain-of-function” (GOF). Here, we outline the aspects of the current situation that most urgently require additional research, our proposed studies, and risk-mitigation strategies.

The A(H7N9) virus hemagglutinin protein has several motifs that are characteristic of mammalian-adapted and human influenza viruses, including mutations that confer human-type receptor-binding and enhanced virus replication in mammals. The pandemic risk rises exponentially should these viruses acquire the ability to transmit readily among humans.
Reports indicate that several A(H7N9) viruses from patients who were undergoing antiviral treatment acquired resistance to the primary medical countermeasure—neuraminidase inhibitors (such as oseltamivir, peramivir, and zanamivir). Acquisition of resistance to these inhibitors by A(H7N9) viruses could increase the risk of serious outcomes of A(H7N9) virus infections.
The hemagglutinin proteins of A(H7N9) viruses have a cleavage site consistent with a low-pathogenic phenotype in birds; in the past, highly pathogenic H7 variants (with basic amino acid insertions at the cleavage site that enable the spread of the virus to internal organs) have emerged from populations of low pathogenic strains circulating in domestic gallinaceous poultry.
Normally, epidemiological studies and characterization of viruses from field isolates are used to inform policy decisions regarding public health responses to a potential pandemic. However, classical epidemiological tracking does not give public health authorities the time they need to mount an effective response to mitigate the effects of a pandemic virus. To provide information that can assist surveillance activities—thus enabling appropriate public health preparations to be initiated before a pandemic—experiments that may result in GOF are critical.
Therefore, after review and approval, we propose to perform the following experiments that may result in GOF:
(i) Immunogenicity. To develop more effective vaccines and determine whether genetic changes that confer altered virulence, host range, or transmissibility also change antigenicity.
(ii) Adaptation. To assist with risk assessment of the pandemic potential of field strains and evaluate the potential of A(H7N9) viruses to become better adapted to mammals, including determining the ability of these viruses to reassort with other circulating influenza strains.
(iii) Drug resistance. To assess the potential for drug resistance to emerge in circulating viruses, evaluate the genetic stability of the mutations conferring drug resistance, evaluate the efficacy of combination therapy with antiviral therapeutics, determine whether the A(H7N9) viruses could become resistant to available antiviral drugs, and identify potential resistance mutations that should be monitored during antiviral treatment.
(iv) Transmission. To assess the pandemic potential of circulating strains and perform transmission studies to identify mutations and gene combinations that confer enhanced transmissibility in mammalian model systems (such as ferrets and/or guinea pigs).
(v) Pathogenicity. To aid risk assessment and identify mechanisms, including reassortment and changes to the hemagglutinin cleavage site, that would enable circulating A(H7N9) viruses to become more pathogenic.
All experiments proposed by influenza investigators are subject to review by institutional biosafety committees. The committees include experts in the fields of infectious disease, immunology, biosafety, molecular biology, and public health; also, members of the lay public represent views from outside the research community. Risk-mitigation plans for working with potentially dangerous influenza viruses, including 1918 virus and highly pathogenic avian H5N1 viruses, will be applied to conduct GOF experiments with A(H7N9) viruses (see supplementary text). Additional reviews may be required by the funding agencies for proposed studies of A(H7N9) viruses (see
The recent H5N1 virus transmission controversy focused on the balance of risks and benefits of conducting research that proved the ability of the H5N1 virus to become transmissible in mammals (see These findings demonstrated the pandemic potential of H5N1 viruses and reinforced the need for continued optimization of pandemic preparedness measures. Key mutations associated with adaptation to mammals, included in an annotated inventory for mutations in H5N1 viruses developed by the U.S. Centers for Disease Prevention and Control, were identified in human isolates of A(H7N9) viruses. Scientific evidence of the pandemic threat posed by A(H7N9) viruses, based on H5N1 GOF studies, factored into risk assessments by the public health officials in China, the United States, and other countries.
Since the H5N1 transmission papers were published, follow-up scientific studies have contributed to our understanding of host adaptation by influenza viruses, the development of vaccines and therapeutics, and improved surveillance.
Finally, a benefit of the H5N1 virus research controversy has been the increased dialogue regarding laboratory biosafety and dual-use research. The World Health Organization issued laboratory biosafety guidelines for conducting research on H5N1 transmission and, in the United States, additional oversight policies and risk-mitigation practices have been put in place or proposed. Some journals now encourage authors to include biosafety and biosecurity descriptions in their manuscripts, thereby raising the awareness of researchers intending to replicate experiments.
The risk of a pandemic caused by an avian influenza virus exists in nature. As members of the influenza research community, we believe that the avian A(H7N9) virus outbreak requires focused fundamental and applied research conducted by responsible investigators with appropriate facilities and risk-mitigation plans in place. To answer key questions important to public health, research that may result in GOF is necessary and should be done.
  1. Robert G. Webster6
  1. 1Department of Viroscience, Erasmus Medical Center, 3015GE, Rotterdam, Netherlands.
  2. 2Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53711, USA.
  3. 3Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN 55108, USA.
  4. 4Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA.
  5. 5Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
  6. 6Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
  7. 7State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong SAR.
  8. 8Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
  9. 9Centre of Influenza Research, School of Public Health, The University of Hong Kong, Hong Kong SAR.
  10. 10Department of Veterinary Medicine, University of Maryland, College Park, College Park, MD 20742, USA.
  11. 11College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA.
  12. 12Department of Zoology, University of Cambridge, Cambridge, CB2 3EJ, UK.
  13. 13Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
  14. 14Department of Microbiology and Immunology, Center for Vaccine Biology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA.
  15. 15Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY 14642, USA.
  1. *Corresponding author. E-mail: (R.A.M.F.); (Y.K.)

Scientists air topics for H7N9 gain-of-function research

Nature: Handle with care

August 7, 2013

The possibility that H7N9 avian influenza may evolve sufficiently to cause a pandemic has scientists turning again to controversial research —they must be careful how they justify the risks taken.

Researchers now want to make genetically engineered versions of H7N9 that are more transmissible and pathogenic in mammals. In a Correspondence published jointly this week in Nature and Science (see page 150), 22 scientists, including Ron Fouchier of the Erasmus Medical Center in Rotterdam, the Netherlands, and Yoshihiro Kawaoka of the University of Wisconsin-Madison, argue that such research can help to assess the ‘pandemic potential’ of H7N9. The dilemma is that should such engineered strains be accidentally or deliberately released from a lab, they could spark a flu pandemic.
The announcement is likely to prompt some replay of last year’s debate over the creation by Fouchier and Kawaoka of lab strains of H5N1 that could transmit between ferrets. And it offers the first test of some of the review and oversight structures put in place for this ‘gain-of-function’ flu research. As this journal has said before, scientists who push for such research should be wary of over-selling the benefits to public health, at least in the short term, as a way to justify the risks taken.

A sense of perspective is crucial here. The long-term benefits of such work are clear — as long as it is done to the highest biosafety standards. It will shed light on, for example, the mechanisms of virus transmissibility and pathogenicity. But the immediate benefits to public health and our short-term ability to counter the threat of H7N9 are less clear-cut. Scientists cannot predict pandemics, so to assess the pandemic potential of viruses — and to decide which strains warrant the manufacture of trial vaccines — comes down to judgements of relative risk.
Tests of how flu viruses behave in animal models such as ferrets can certainly provide information on the risk of transmissibility and pathogenicity, although it can be difficult to extrapolate those results to humans. A rash of papers this year has shown that H7N9 does have limited airborne transmissibility in ferrets, although the virus is not transmitting between people in the current outbreak in China.
Another way to assess pandemic potential is to monitor wild-type viruses for mutations that allow the virus more ready access to human cells. H7N9 has already acquired some of these mutations, which is why it infects humans more easily than does H5N1. But as researchers pointed out in June, there is no scientific evidence that such mutations predict the risk of a pandemic (D. M. Morens et al. N. Engl. J. Med. 368, 2345–2348; 2013). Transmissibility is more complex than that.
In creating mammalian- transmissible versions of H7N9, scientists would go a step further and hope to identify combinations of mutations that could increase virus transmissibility in ferrets or other models. Such work could yield information on the biological principles affecting transmission. But nature could well come up with combinations for transmission that are different from those obtained in experiments.
Following the H5N1 controversy, the US Department of Health and Human Services has introduced an extra layer of review that will apply to anyone seeking funding for work to make mammalian-transmissible strains of H7N9 (see page 151). The risks and benefits of the work will be assessed by a panel of experts in public health, security, risk assessment, law and ethics, and, importantly, any extra steps needed to mitigate biosafety risks will be considered. The way the review handles H7N9 will be an important test of the effectiveness and transparency of this new approach.

Scientists to make mutant forms of new bird flu #H7N9 to assess risk

LONDON (Reuters) - Scientists are to create mutant forms of the H7N9 bird flu virus that has emerged in China so they can gauge the risk of it becoming a lethal human pandemic.
The genetic modification work will to result in highly transmissible and deadly forms of H7N9 being made in several high security laboratories around the world, but it is vital to prepare for the threat, the scientists say.
The new bird flu virus, which was unknown in humans until February, has already infected at least 133 people in China and Taiwan, killing 43 of them, according to the latest World Health Organization (WHO) data.
Announcing plans to start the controversial experiments, leading virologists Ron Fouchier and Yoshihiro Kawaoka said H7N9's pandemic risk would rise "exponentially" if it gained the ability to spread easily among people.
And the only way to find out how likely that is, and how many genetic changes would need to take place before it could happen, is to engineer those mutations in laboratory conditions and test the virus's potential using animal models, they said.


Vietnam: People faced with the possibility of infecting more than 200 diseases

According to statistics of the Ministry of Health, in the first six months of the year the country recorded 400 thousand cases of influenza with the disease progresses more and more complex, including influenza A (H1N1) accounted for 57% with six deaths ... Survey The latest look of Ho Chi Minh City Pasteur Institute showed that for every 100 people, two medical people infected with influenza A (H1N1).

Statistics also show that in the first seven months of the year the country recorded more than 42 thousand children infected Hand-foot-mouth disease, including 14 deaths across the country.
Evolution influenza A (H1N1) and hand-foot-mouth disease complex caused great loss to the society and are becoming health issues need to be addressed. 

Vietnam: Capacity prevention of avian influenza and other emerging infectious diseases


On 6-8, in Hanoi, Agency for International Development (USAID) held a total of four years of project initiatives and pandemic influenza in Vietnam.
  In the past four years, USAID has helped the health authorities, from farm level to provincial and Surgeons social organizations to apply effective models, to reduce the cost risk of influenza infection poultry and emerging infectious diseases. Specifically, the model was solved as separate problems in the live poultry markets livelihood; training livestock biosecurity, improve sanitary conditions in the slaughterhouses, cattle, Small-scale poultry, quarantine issues poultry products ...
  As of May 7-2013, had 12 Veterinary Department organized training for vets provincial, district, commune and 37 provinces and cities to plan training rooms, infection control staff medical facility under the USAID program.

Taiwan Reports First Ever Occurrence Of H5N3 Bird Flu On Duck Farm

August 6, 2013
Taiwan has notified the World Organization of Animal Health (OIE) of it’s first ever detection of H5N3 avian influenza virus, a low pathogenic avian influenza (LPAI).

The outbreak occurred on a “meat-type” duck farm in Yuli, Hualien county.  The virus was isolated from swabs taken from the farm July 16 and confirmed by the nationallaboratory Aug. 2, according to the OIE.
However, in domestic poultry, infection with avian influenza viruses causes two main forms of disease, distinguished by low and high virulence. The so-called “low pathogenic” avian influenza (LPAI) commonly causes only mild symptoms (e.g. ruffled feathers, a drop in egg production) and may easily go undetected.
The highly pathogenic avian influenza (HPAI) form is far more dramatic. It spreads very rapidly through poultry flocks, causes disease affecting multiple internal organs, and has a mortality that can approach 100%, often within 48 hours. Currently only some strains of viruses of the H5 and H7 subtypes are known to cause the highly pathogenic form of the disease in poultry.

Tuesday, August 6, 2013

BMJ: First probable person to person transmission of new bird flu virus in China

Tuesday, August 6, 2013 - 11:33
Research: Probable person to person transmission of novel avian influenza A (H7N9) virus in Eastern China, 2013: epidemiological investigation
Editorial: Human to human transmission of H7N9
The first report of probable person to person transmission of the new avian influenza A (H7N9) virus in Eastern China is published on today.
The findings provide the strongest evidence yet of H7N9 transmission between humans, but the authors stress that its ability to transmit itself is “limited and non-sustainable.”
Avian influenza A (H7N9) virus was recently identified in Eastern China. As of 30 June 2013, 133 cases have been reported, resulting in 43 deaths.
Most cases appear to have visited live poultry markets or had close contact with live poultry 7-10 days before illness onset. Currently no definite evidence indicates sustained human-to-human transmission of the H7N9 virus.
The study reports a family cluster of two patients (father and daughter) with H7N9 virus infection in Eastern China in March 2013.
The first (index) patient – a 60 year old man – regularly visited a live poultry market and became ill five to six days after his last exposure to poultry. He was admitted to hospital on 11 March.
When his symptoms became worse, he was transferred to the hospital’s intensive care unit (ICU) on 15 March. He was transferred to another ICU on March 18 and died of multi-organ failure on 4 May.
The second patient, his healthy 32 year old daughter, had no known exposure to live poultry before becoming sick. However, she provided direct and unprotected bedside care for her father in the hospital before his admission to intensive care.
She developed symptoms six days after her last contact with her father and was admitted to hospital on 24 March. She was transferred to the ICU on 28 March and died of multi-organ failure on 24 April.
Two almost genetically identical virus strains were isolated from each patient, suggesting transmission from father to daughter.
Forty-three close contacts of both cases were interviewed by public health officials and tested for influenza virus. Of these, one (a son in law who helped care for the father) had mild illness, but all contacts tested negative for H7N9 infection.
Environmental samples from poultry cages, water at two local poultry markets, and swans from the residential area, were also tested. One strain was isolated but was genetically different to the two strains isolated from the patients.
The researchers acknowledge some study limitations, but say that the most likely explanation for this family cluster of two cases with H7N9 infection is that the virus “transmitted directly from the index patient to his daughter.” But they stress that “the virus has not gained the ability to transmit itself sustained from person to person efficiently.”
They believe that the most likely source of infection for the index case was the live poultry market, and conclude: “To our best knowledge, this is the first report of probable transmissibility of the novel virus person to person with detailed epidemiological, clinical, and virological data. Our findings reinforce that the novel virus possesses the potential for pandemic spread.”
So does this imply that H7N9 has come one step closer towards adapting fully to humans, ask James Rudge and Richard Coker from the London School of Hygiene and Tropical Medicine, based in Bangkok, in an accompanying editorial?
Probably not, they say. Limited transmission between humans “is not surprising, and does not necessarily indicate that the virus is on course to develop sustained transmission among humans.”
Nevertheless, they point to several traits of H7N9 are of particular concern, and conclude that, while this study might not suggest that H7N9 is any closer to delivering the next pandemic, “it does provide a timely reminder of the need to remain extremely vigilant: the threat posed by H7N9 has by no means passed.”
The authors also summarise their findings in a video abstract. Dr Zhou says that the reason for carrying out this study was because there was “no definite evidence to show that the novel virus can transmit person-to-person”, plus she and her co-authors wanted to find out whether the novel avian influenza virus possesses the capability to transmit person-to-person. She concludes that “the infection of the daughter is likely to have resulted from her father during unprotected exposure” and suggest that the virus possesses the ability to transmit person-to-person in this cluster. She does add however that the infection was “limited and non-sustainable as there is no outbreak following the two cases”.
Chang-jun Bao, Deputy Chief, Jiangsu Province Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
Email: (please email in the first instance)
Tel: +0086 25 83759404 / +0086 13951687404
James Rudge or Richard Coker via London School of Hygiene and Tropical Medicine Press Office
Tel: +44 (0)207 927 2802

First probable person to person transmission of new bird flu virus in China


Contact: Stephanie Burns
BMJ-British Medical Journal 


The findings provide the strongest evidence yet of H7N9 transmission between humans, but the authors stress that its ability to transmit itself is "limited and non-sustainable."
So does this imply that H7N9 has come one step closer towards adapting fully to humans, ask James Rudge and Richard Coker from the London School of Hygiene and Tropical Medicine, based in Bangkok, in an accompanying editorial?
Probably not, they say. Limited transmission between humans "is not surprising, and does not necessarily indicate that the virus is on course to develop sustained transmission among humans."

Nevertheless, they point to several traits of H7N9 are of particular concern, and conclude that, while this study might not suggest that H7N9 is any closer to delivering the next pandemic, "it does provide a timely reminder of the need to remain extremely vigilant: the threat posed by H7N9 has by no means passed."

Complete Article:

Chinese find 1st evidence new bird flu spreads from person to person, though not easily

Washington Post:
In the new study, Chinese researchers interviewed the family and close friends of a father and daughter both killed by H7N9 in eastern China to figure out how the virus might have spread between them. Both patients lived in the same household, were critically ill during the investigation and could not be interviewed.

The father, 60, was in charge of buying food for the family and bought six live quails before falling sick. His daughter, 32, rarely left the residential district where they lived and didn’t have any known contact with birds, except for two black swans raised by the property owners.

The daughter took care of her father when he became ill, without wearing any protective equipment. She fell sick several days afterward and died one month later. The bird flu viruses isolated from the father and daughter were nearly genetically identical.

Complete article:

First study of human transmission of new bird flu raises worries


Tue Aug 6, 2013 6:30pm EDT
* First probable person-to-person transmission of new strain
* Study raises concerns about H7N9'S pandemic potential
* Experts stress virus not spreading easily in people now

By Kate Kelland

LONDON, Aug 6 (Reuters) - The first scientific analysis of probable human-to-human transmission of a deadly new strain of bird flu that emerged in China this year gives the strongest evidence yet that the H7N9 virus can pass between people, scientists said on Wednesday.

Research published in the British Medical Journal (BMJ) analysing a family cluster of cases of H7N9 infection in eastern China found it was very likely the virus "transmitted directly from the index patient (a 60-year-old man) to his daughter."

Experts commenting on the research said while it did not necessarily mean H7N9 is any closer to becoming the next flu pandemic, "it does provide a timely reminder of the need to remain extremely vigilant."


Bird flu confirmed in Nawalparasi

Bird flu has been confirmed in Nawalparasi district.
The bird flu was confirmed after lab test carried out on samples from the dead fowls of Lila Mahato of Prasauni-1 tested positive to H5N1, the virus that causes the disease. The District Livestock Office, Nawalparasi, had sent the samples for lab test on July 31.
Veterinary doctor, Uttam Acharya, said that according to the lab report the samples tested positive for the bird flu virus.

Novavax announced positive preclinical trial for H7N9 influenza vaccine

 by Emma Rogers

Novavax announced on July 29 a positive preclinical trial for its virus-like particle vaccine candidate against the H7N9 Influenza A, which protected 100 percent of the mice studied in the trial from infection.
The data from the study was published in the journal Vaccine. Researchers in the study used three control groups to test the efficacy of the new vaccine candidate; the control groups used a VLP vaccine against H7N3, a VLP vaccine against H5N1 and a placebo. Some of the immunizations also contained Isomatrix, an adjuvant based on saponin.
Researchers from the study conducted the preclinical trial based on a mouse model. During the study, researchers saw an increase in the hemagglutination-inhibition antibody response towards H7N9.