Saturday, September 21, 2013

Insight: Oklahoma winds may spread deadly swine virus #PEDv

By Carey Gillam and P.J. Huffstutter

September 20, 2013

(Reuters) - On the windswept prairies of the Oklahoma Panhandle, the hog barns of Prestage Farms are lined up like military barracks. The 20,000-sow operation near the Texas border stands at the front lines of a months-long battle to contain a virus that has already killed some 1.3 million hogs in the United States.

Since June, when Porcine Epidemic Diarrhea virus, or PEDv, first hit, Prestage workers have quarantined the area, scrubbed vehicles and sprayed buildings with antiseptic. But those precautions have not stopped a virus that can kill 80 percent of piglets that contract it.



Friday, September 20, 2013

Middle East respiratory syndrome coronavirus (MERS-CoV) summary and literature update – as of 20 September 2013

[red bolding below is mine]

Since April 2012, 130 laboratory-confirmed and 17 probable cases of human infection with Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to WHO. Affected countries in the Middle East include Jordan, Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Qatar; in Europe countries affected include: France, Germany, the United Kingdom (UK) and Italy; and in North Africa: Tunisia. Infections presumably acquired through exposure to non-human sources have all occurred in the Middle East; limited transmission in the countries of Europe and North Africa has occurred in close contacts of recent travellers from the Middle East. No new countries have reported MERS-CoV cases since the last update; the last exported case to a country outside the Middle East was in June 2013.
Since the last update, 37 new laboratory-confirmed cases of MERS-CoV have been reported; these include 34 cases from KSA and three cases from Qatar. In addition, one previously reported probable case in Tunisia has now been confirmed as a result of additional laboratory testing. Two cases previously counted as confirmed have been reclassified as probable on the basis of further clarifications of the case definition. Of the 130 confirmed cases, 58 (45%) have died. Seventy-seven of 124 confirmed cases (63%) for which sex is known were male and the median age of the 125 confirmed cases with known age is 50 years (range, 14 months to 94 years).
Nine new cases were reported to be sporadic, i.e. cases that were reported to have no prior contact with another known case and including cases that were the first case within a cluster. Of these, 56% were female; the median age was 53 years; and 89% had at least one underlying condition reported. Eighty-nine percent were severely ill or died. Eight of these cases were probably exposed to the virus in KSA (six in Riyadh, one in Medina, one in Hafr Al Batin) and one in Qatar. The median age and gender balance of these nine new cases represents a shift compared with earlier cases. Up until mid-July 2013, the median age of sporadic cases was 59.5 years and 83% were male.
Three recent outbreaks are described below:
  • Five cases were reported in Medina. The first Saudi case reported was a 55-year-old male who had probable contact with a 59-year-old Qatari male, who was in Medina at the time of onset of illness. The remaining cases were contacts of confirmed cases and included two asymptomatic health care workers identified through contact tracing. One additional health care worker, who died in the course of his illness, was reported without information about contact with other confirmed cases. None of the cases was reported to have performed pilgrimage while in Medina.
  • Two clusters were reported in Riyadh. In a cluster of six cases, one male index case aged 53 years is thought to have infected five other cases, including two health care workers. Both health care workers experienced mild illness. In the second cluster, all three cases were health care workers. A 41 year old Filipino healthcare worker who did not have any contact to confirmed cases of MERS-CoV infections acquired the disease from an unknown source and is thought to have transmitted it to two more healthcare workers. During this same period of time, an additional four sporadic cases were reported (mentioned above) with no contact with known cases, and five with no information on exposure.
  • The first case of the cluster in Hafr Al Batin was a 38-year-old male with onset of illness in early August. Five family members ranging in age from 7 to 79 years subsequently became infected. Two children aged 3 and 18 years and one 74 year-old female were also reported as contacts of a known case but their connection with this family was not reported.
For further details regarding the cases please refer to:

WHO raises concerns about MERS-CoV patterns and pace

CIDRAP - September 20, 2013

Regarding changes in demographics, the WHO said the median age of sporadic cases has dropped slightly, but a shift in gender is more pronounced and persistent. More than half (56%) of the newer case-patients have been female. This contrasts with earlier cases: Through the middle of July, 83% of the patients were male.
The WHO report fleshes out connections between many of the new cases. For example, it notes that a 41-year-old nurse from the Philippines didn't have contact with any known confirmed MERS-CoV cases but is thought to have infected two other healthcare workers.
In a Twitter post today, WHO spokesman Gregory Hartl said the WHO's MERS-CoV emergency committee will meet on Sep 25 to discuss outbreak updates and that a press briefing will be held afterward. The emergency committee was formed in early July, and the meeting next week will be the group's third.
At its last meeting in the middle of July, the committee said that MERS-CoV outbreak developments were concerning and serious but didn't rise to the level of a global health emergency.

Complete Article:


Published Date: 2013-09-20
Archive Number: 20130920.1958494

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Highly pathogenic avian influenza, Italy
Information received on (and dated) 18 Sep 2013 from Prof Dr Romano Marabelli, Chief Veterinary Officer, Department for Veterinary Public Health, Food Safety and Collegial Bodies for Health Protection, Ministry of Health, Rome, Italy

Report type: follow-up report no 5 (final report)
Date of start of the event: 10 Aug 2013
Date of pre-confirmation of the event: 14 Aug 2013
Report date: 18 Sep 2013
Date submitted to OIE: 18 Sep 2013
Reason for notification: new strain of a listed disease
Manifestation of disease: clinical disease
Causal agent: _Highly pathogenic avian influenza virus_
Serotype: H7N7
Nature of diagnosis: clinical, laboratory (basic)
This event pertains to a defined within the country

Outbreaks: there are no new outbreaks in this report

Source of the outbreak(s) or origin of infection: unknown or inconclusive

Epidemiological comment: the National Reference Laboratory in Padova has confirmed for all the 6 outbreaks HPAI virus subtype H7N7.

Control measures
Measures applied: stamping out; quarantine; movement control inside the country; screening; disinfection of infected premises/establishment(s); vaccination prohibited; no treatment of affected animals
Measures to be applied: no other measures

Future reporting
The event is resolved. No more reports will be submitted.

[The location of the outbreak can be seen on the interactive map included in the OIE report at the source URL above.]

Communicated by:

[In their final report submitted to the OIE, the Italian animal health authorities have updated the number of birds destroyed. Based on the information found in the WAHID summary, the 6 outbreaks that were reported have been resolved. The total number of animals affected in those 6 outbreaks was: 952 658 susceptible, 151 863 cases, 5676 dead, and 946 982 destroyed. For all 6 outbreaks HPAI virus subtype H7N7 was confirmed.

Avian influenza could resurface in upcoming flu season, FAO warns

From Poultry Production News Blog
September 20, 2013

The H7N9 and H5N1 avian influenza viruses continue to pose serious threats to human and animal health, and the risk will be elevated as the traditional flu season emerges, officials from the United Nations' Food and Agriculture Organization warned. The viruses and their threats were discussed September 16 during a joint meeting between the Food and Agriculture Organization (FAO), the United States Agency for International Development (USAID), the World Health Organization and the World Organisation for Animal Health.
"The world is more prepared than ever before to respond to bird flu viruses in light of a decade of work on H5N1 and the recent response to H7N9," Food and Agriculture Organization Chief Veterinary Officer Juan Lubroth said during the meeting.

"However, constant vigilance is required. Bird flu viruses continue to circulate in poultry. Efforts must continue and be strengthened, not only in affected countries, but also in neighboring states and areas with strong trade linkages. This is especially true for H7N9, since it causes no clinical signs in birds and is therefore very difficult to detect in poultry."

Heads of Food and Agriculture Organization Reference Centers, in Australia, the People's Republic of China, Italy and the United States of America were also in attendance, along with representatives from the Centers for Disease Control and Prevention and the United States Department of Agriculture.
Avian influenza surveillance of vital importanceFAO and USAID stress that more work is required. In the short term this includes continued, targeted surveillance and trace back throughout the production and marketing system, contingency planning and compensation scheme development.

In the longer-term fight against H7N9 and other viruses, Food and Agriculture Organization and United States Agency for International Development are urging countries to invest in improving the way they market and sell poultry.

FAO continues its call for funds to bolster the global H7N9 response. FAO is urging countries to make key investments in improving markets and promoting healthy food systems to fight viruses affecting animals and humans as part of overarching efforts to ensure the animal sector realizes its potential in the promotion of healthy and productive lives.

Funds committed to fight avian influenzaFAO has committed $2 million of emergency funding supplemented by more than $5 million from USAID to kick-start H7N9 response efforts. USAID support has enabled FAO to help countries at risk dramatically improve surveillance capacities.

"Several at-risk countries previously unable to pick up the virus can now accurately detect H7N9," explained Lubroth. "Identifying the virus with consistency is critical to targeting control efforts and reducing spread." 

CNN: CDC director: A disease outbreak anywhere is a risk everywhere

By Dr. Tom Frieden, Special to CNN
updated 7:23 AM EDT, Fri September 20, 2013
Editor's note: Dr. Tom Frieden is the director of the Centers for Disease Control and Prevention and an expert in internal medicine, infectious diseases, public health and epidemiology.
A blind spot anywhere is a risk to us everywhere
Keeping people safe is the role of public health agencies such as the CDC -- a role that becomes even more important every day. We are all connected by the air we breathe, the water we drink and the food we eat, and the next outbreak may be just a plane ride away.
The world faces a perfect storm of vulnerability. On average, we identify one previously unknown microbe each year. We're also finding that more and more infections are showing resistance to all available drugs. And the threat exists that sometime, somewhere, someone will unleash a deadly, genetically modified microbe for which we may have no warning and little preparation.
Since we can't predict where or when the next outbreak will happen, we have to be vigilant at all times.
For example, nothing has the potential to kill more people than influenza. A strain such as H7N9 could create a pandemic. When something with that much potential to cause widespread harm emerges, we must identify it in hours or days, not weeks or months. H7N9 doesn't yet spread from person to person, and it may never. But when it comes to new infectious diseases, the question is not whether, but when and where.

The Lancet: Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study

Early Online Publication, 20 September 2013

Matthew Cotten PhD b , Simon J Watson PhD b , Prof Paul Kellam PhD b m , Abdullah A Al-Rabeeah FRCS a, Hatem Q MakhdoomPhD c, Abdullah Assiri MD a, Jaffar A Al-Tawfiq MD d, Rafat F Alhakeem MD a, Hossam Madani PhD c, Fahad A AlRabiah MD g, Sami Al Hajjar MD g, Wafa N Al-nassir MD h, Ali Albarrak MD i, Hesham Flemban MD j, Hanan H Balkhy MD k, Sarah Alsubaie MD l, Anne L Palser PhD b, Astrid Gall Dr Med Vet b, Rachael Bashford-Rogers MChem b, Prof Andrew Rambaut Prof e f, Prof Alimuddin I ZumlaFRCP a m n , Prof Ziad A Memish FRCP a Corresponding Author Email Address



Since June, 2012, Middle East respiratory syndrome coronavirus (MERS-CoV) has, worldwide, caused 104 infections in people including 49 deaths, with 82 cases and 41 deaths reported from Saudi Arabia. In addition to confirming diagnosis, we generated the MERS-CoV genomic sequences obtained directly from patient samples to provide important information on MERS-CoV transmission, evolution, and origin.


Full genome deep sequencing was done on nucleic acid extracted directly from PCR-confirmed clinical samples. Viral genomes were obtained from 21 MERS cases of which 13 had 100%, four 85—95%, and four 30—50% genome coverage. Phylogenetic analysis of the 21 sequences, combined with nine published MERS-CoV genomes, was done.


Three distinct MERS-CoV genotypes were identified in Riyadh. Phylogeographic analyses suggest the MERS-CoV zoonotic reservoir is geographically disperse. Selection analysis of the MERS-CoV genomes reveals the expected accumulation of genetic diversity including changes in the S protein. The genetic diversity in the Al-Hasa cluster suggests that the hospital outbreak might have had more than one virus introduction.


We present the largest number of MERS-CoV genomes (21) described so far. MERS-CoV full genome sequences provide greater detail in tracking transmission. Multiple introductions of MERS-CoV are identified and suggest lower R0 values. Transmission within Saudi Arabia is consistent with either movement of an animal reservoir, animal products, or movement of infected people. Further definition of the exposures responsible for the sporadic introductions of MERS-CoV into human populations is urgently needed.


Saudi Arabian Ministry of Health, Wellcome Trust, European Community, and National Institute of Health Research University College London Hospitals Biomedical Research Centre.

National Institute of Health (NIH) Begins Testing #H7N9 Vaccine Candidates

Back on July 9th of this year, I posted a news release from NIH announcing the needed assessment for the pandemic potential of the H7N9 avian influenza virus (and related viruses...):

The emergence of a novel H7N9 avian influenza virus in humans in China has raised questions about its pandemic potential as well as that of related influenza viruses. In a commentary published online today, scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, address these questions by evaluating past outbreaks of H7 subtype influenza viruses among mammals and birds and comparing H7 viruses with other avian influenza viruses and strains.

The possibility that H7N9 or another H7 virus may adapt to easily infect humans highlights a need for more research on how avian influenza strains adapt to mammals, especially humans, and better integration of influenza research between human and veterinary public health specialists, the study authors conclude.


Study authors Anthony S. Fauci, M.D., NIAID director; David M. Morens, M.D., senior advisor to the NIAID director; and Jeffery K. Taubenberger, M.D., Ph.D., section chief in NIAID’s Laboratory of Infectious Diseases are available to discuss the article.

On September 18, there was a news release from NIH announcing the testing in humans for a vaccine.  The editing below is mine:

Researchers at nine sites nationwide have begun testing in humans an investigational H7N9 avian influenza vaccine. The two concurrent Phase II clinical trials, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, are designed to gather critical information about the safety of the candidate vaccine and the immune system responses it induces when administered at different dosages and with or without adjuvants, substances designed to boost the body’s immune response to vaccination.

Human cases of H7N9 influenza first emerged in China in February 2013, with the majority of reported infections occurring in the spring. As of Aug. 12, 135 confirmed human cases, including 44 deaths, have been reported by the World Health Organization. Most of these cases involved people who came into contact with infected poultry. Although no H7N9 influenza cases have been reported outside of China and the virus has not demonstrated sustained person-to-person transmission, there is concern that it could mutate to pose a much greater public health threat. 

“H7N9 avian influenza virus — like all novel influenza virus strains to which people have not been exposed — has the potential to cause widespread sickness and mortality,” said NIAID Director Anthony S. Fauci, M.D. “We are now testing a vaccine candidate with and without adjuvant in an effort to prepare for and, hopefully, protect against this possibility.”

The two clinical trials, which will enroll healthy adults ages 19 to 64, will evaluate an investigational H7N9 vaccine developed by Sanofi Pasteur. The candidate vaccine was made from inactivated H7N9 virus isolated in Shanghai, China in 2013.

Adjuvants are being tested with the investigational vaccine because previous vaccine research involving other H7 influenza viruses has suggested that two doses of vaccine without adjuvant may not produce an immune response adequate to provide effective protection. In pandemic situations, adjuvants also can be used as part of a dose-sparing strategy, which would allow production of more doses of vaccine from the available supply of the viral antigen, thereby allowing a greater number of people to be vaccinated more quickly.

The first clinical trial, led by Mark J. Mulligan, M.D., of Emory University in Atlanta, will enroll as many as 700 study participants who will be randomly assigned to one of seven groups (up to 100 participants in each group). Each group will receive two equivalent dosages (3.75 micrograms [mcg], 7.5 mcg, 15 mcg or 45 mcg) of the candidate vaccine, approximately 21 days apart. Five of the groups will receive the vaccinations along with MF59 adjuvant, developed by Novartis Vaccines and Diagnostics.

Of these five groups, three will receive adjuvant with both vaccinations; one group of participants will receive adjuvant only with the first vaccination; and another group of participants will receive adjuvant only with the second vaccination. Two groups of participants will not receive adjuvant. The MF59 adjuvant that is being tested is also contained in the Fluad seasonal influenza vaccine currently licensed in Europe and Canada for use in people age 65 years or older. 

The second trial, led by Lisa A. Jackson, M.D., M.P.H., of Group Health Research Institute in Seattle, will enroll as many as 1,000 participants. Each participant will be randomly assigned to one of 10 groups (up to 100 participants per group) and will receive two equivalent doses (same dosages as the other trial) of the investigational H7N9 vaccine given 21 days apart.

Seven of these groups will receive the vaccinations either with or without AS03 adjuvant, developed by GlaxoSmithKline Biologics. Two groups will receive their first vaccination with AS03 or MF59 adjuvant and then receive the alternate adjuvant at time of second vaccination. One group will receive the MF59 adjuvant at both vaccinations. The AS03 adjuvant that is being tested was used in a 2009 H1N1 influenza vaccine, Pandemrix, used in several European countries during the 2009-2010 H1N1 influenza pandemic.

In both studies, which are expected to conclude in December 2014, a panel of independent experts will closely monitor safety data at regular intervals throughout the trial.

#MERS #Coronavirus Reuters: Gene sequences of deadly Saudi virus show complex transmission

LONDON | Fri Sep 20, 2013 4:43am IST
(Reuters) - Genetic analysis of samples of the deadly MERS virus that has killed 58 people in the Middle East and Europe shows the disease has jumped from animals to humans several times, scientists said on Friday.

After conducting genome sequencing studies of the virus - from the same coronavirus family as the one that caused SARS a decade ago, British and Saudi researchers found several infection transmission chains and said they painted a picture of what they called lively "pathogenic chatter" between species.

"Our findings suggest that different lineages of the virus have originated from the virus jumping across to humans from an animal source a number of times," said Paul Kellam, a professor of viral pathogenesis at Britain's Sanger Institute and University College London (UCL), who led the research.

Complete article:

#MERS #Coronavirus WHO Reclassifies Previous Confirmed in Italy

From the previous post
The reclassification follows further analysis of the laboratory tests performed in May 2013, which has shown that the two cases do not fulfil the current WHO case definition for a "confirmed case" for MERS-CoV. The two cases are the two-year-old girl and a 42-year-old woman who were identified as close contacts of the index case who travelled from Jordan.

The cases from my list:

Date of Report:  6/1
Name:  18mos(F)
Adm:  6/1 Pediatric Hospital, sym’s of coughing.
From:  Florence, Tuscany Italy
Note:  Grandson/Granddaughter of Index Case.  Stable condition.  Discharged 6/5.

Name:  42(F)  
Adm:  6/1
From:  Florence, Tuscany, Italy
Note:  Co-worker to Index Case.  Contact with Index case for a few hours on 5/27.  Her 3 children are under observation.  Stable Condition.  Discharged 6/6.

·      15 Dr’s & Nurses under observation. 
·      Tested patients Brother (contact since arriving back in Italy).  Contacts given prophylaxis.
·      Name:  Meyer (5) Nephew to Index Case
Adm:   6/1  Santa Maria Nuova Careggi Hospital ,sym’s of coughing.

·      12 Family/Contacts in Jordan under observation
·      Total of 40 under observation
·      10 People Tested positive of virus by throat swabs.  All are asymptomatic
·      Meeting on 6/4 w/Experts from Institute of Health.

WHO: Middle East respiratory syndrome coronavirus (MERS-CoV) - update September 20, 2013

Two patients earlier reported as laboratory-confirmed with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Italy in the Disease Outbreak News on 2 June 2013 are being reclassified as probable cases.
The reclassification follows further analysis of the laboratory tests performed in May 2013, which has shown that the two cases do not fulfil the current WHO case definition for a "confirmed case" for MERS-CoV. The two cases are the two-year-old girl and a 42-year-old woman who were identified as close contacts of the index case who travelled from Jordan. 

A "probable" designation by WHO criteria refers to patients who are considered to have a high likelihood of having been infected with MERS-CoV, but from whom adequate samples could not be obtained for complete testing according to the current criteria established for laboratory confirmation. 

Globally, from September 2012 to date, WHO has been informed of a total of 130 laboratory-confirmed cases of infection with MERS-CoV, including 58 deaths.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations.
Specimens from patients’ lower respiratory tracts should be obtained for diagnosis where possible. Clinicians are reminded that MERS-CoV infection should be considered even with atypical signs and symptoms, such as diarrhoea, in patients who are immunocompromised.
Health care facilities are reminded of the importance of systematic implementation of infection prevention and control (IPC). Health care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health care workers and visitors.
All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.
WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

WHO has convened an Emergency Committee under the International Health Regulations (IHR) to advise the Director-General on the status of the current situation. The Emergency Committee, which comprises international experts from all WHO Regions, unanimously advised that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met. 

Epidemiological update: Highly pathogenic influenza H7N7 in poultry and transmission to two human poultry workers in Emilia-Romagna, Italy, September 2013

[editing below is mine]
19 Sep 2013
​Summary of the situation
On 14 August 2013 highly pathogenic avian influenza (HPAI) was detected in poultry in Ostellato, Ferrara province, Emilia-Romagna, Italy. Subtype H7N7 was confirmed. Protection and surveillance zones have been established in accordance with European Council Directive 2005/94. Monitoring of avian influenza, and epidemiological and virological investigations, are being carried out by regional authorities. Despite the establishment of protection and surveillance zones, several subsequent outbreaks have been reported in this region: on 21 August 2013 in Mordano, Bologna, in a farm with commercial layer hens; on 23 August 2013 in a farm with commercial layer hens in Mordano, Bologna; and on 27 August in Portomaggiore, Ferrara, in a commercial turkey farm. On 4 and 5 September 2013 there were two other H7N7 confirmed outbreaks; one in a farm in Mordano, Bologna and another in a backyard flock in Bondeno, Ferrara.
All affected holdings have been cleaned and disinfected. Up to one million poultry will be culled in order to contain this outbreak. The protection zones remain in place for 21 days after the last action in an affected farm.

Human infections due to avian influenza - zoonotic transmission
Since H7N7 has been known to spread from poultry to humans with mild (conjunctivitis) to devastating (death) results, active surveillance has been established on all people living in the affected farms as well as exposed workers (and their cohabitants) with direct contact to sick animals (before the avian flu diagnosis). This active surveillance is continued for up to 10 days after the last exposure. Up to 70 regular poultry workers and family contacts, as well as up to 300 workers involved in culling operations, have been under surveillance. Monitored people have been contacted on a daily basis and interviewed about symptoms and general health.
As of 10 September 2013, three humans have identified with conjunctivitis due to H7N7. The infected men were between the ages of 46 and 51 years and had either been working on an affected farm or had participated in the culling. After the conjunctival swabs were found to be positive, the workers were isolated at home. The cases of conjunctivitis healed after 5-6 days without complications. One case had chills and muscle aches in addition to conjunctivitis.
A serological study screening exposed workers, cases and the family members of human cases is being planned to determine the number of seroconversions in those exposed. These results will provide valuable information about the frequency of avian-to-human transmission of H7N7 and the potential risk factors for being infected with H7N7 in people who have close contact to infected poultry in outbreak situations.

Other reports from zoonotic transmission
A limited number of human cases associated with HPAI outbreaks in poultry have been reported since 1959 (the date of first recognition). In the past, there have been reports of single cases of people infected from their domestic poultry which mixed with wild birds.[1, 2] Since 2000 there have been increasing and larger outbreaks of HPAI in poultry reported in the EU. The reason for this is unclear. Very large outbreaks have occurred in densely populated commercial bird populations such as in Italy in 1999 (type A/H7N1), the Netherlands, Belgium and Germany in 2003 (type A/H7N7) and Canada in 2004 (H7N3). An outbreak of highly pathogenic A/H7N7 avian influenza in birds, which began in the Netherlands in February 2003, caused the death of one veterinarian (from an acute respiratory illness). It also caused some mild illness (mostly eye infections) in 88 poultry workers and members of their families [3-5]  .

Serologic studies performed in Northern Italy between December 2008 and June 2010 compared 188 Italian poultry workers exposed to high and low pathogenic H5 and H7 avian influenza virus and 379 non-exposed controls. A total of 6 of 188 (3.2%) poultry workers were H7-seropositive and none of the controls was positive [6].

ECDC concludes that the risk of the current H7N7 avian influenza found in Italy being transmitted to the general population is low. Persons at risk are mainly people in direct contact/handling diseased chickens or their carcasses e.g. farmers, veterinarians and those labourers involved in the culling. Those groups are being actively monitored by the local health authorities. Human-to-human infections need to be monitored very closely to prevent further spread. The ECDC recommendation of pre- or post-expositional prophylaxis using antiviral treatment for people at risk need to be considered as this has been shown to decrease the risk of transmission of H7N7. ( 
Outbreaks of HPAI can severely affect farms where it is found. Control of HPAI requires excellent surveillance (for both birds and humans) and stringent control measures. European sanitation protocols need to be followed and active surveillance systems have to be installed where HPAI affected farms are reported.


1. Wong, S.S. and K.Y. Yuen, Avian influenza virus infections in humans. Chest, 2006. 129(1): p. 156-68.
2. Malik Peiris, J.S., Avian influenza viruses in humans. Rev Sci Tech, 2009. 28(1): p. 161-73.
3. Bos, M.E., et al., High probability of avian influenza virus (H7N7) transmission from poultry to humans active in disease control on infected farms. J Infect Dis, 2010. 201(9): p. 1390-6.
4. Koopmans, M., et al., Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Lancet, 2004. 363(9409): p. 587-93.
5. Fouchier, R.A., et al., Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci U S A, 2004. 101(5): p. 1356-61.
6. Di Trani, L., et al., Serosurvey against H5 and H7 avian influenza viruses in Italian poultry workers. Avian Dis, 2012. 56(4 Suppl): p. 1068-71.

Thursday, September 19, 2013

How Far Are We From a Super-Pandemic?


Fall is flu season and this year, as usual, federal health officials are asking the public to get their annual flu vaccine shot.

But scientists say there are much more deadly bugs lurking out there that could someday make the jump from local outbreak to a worldwide super pandemic that could wipe out people across the globe. All it takes is a few biological tricks for a microscopic virus to turn into a raging killer like the 1918 Spanish flu virus that killed 50 to 100 million people, or the SARS virus that started in China in 2003 and spread to 37 countries in just a few weeks. It eventually killed fewer than 800 people.

This year, two contagions that are scaring epidemiologists the most are another Asian virus called H7N9, and MERS, or Middle East respiratory syndrome. Both appeared in 2012.