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Unique reassortant of influenza a(H7N9) virus associated with severe disease emerging in Hong Kong

Available online 24 February 2014

In Press, Accepted Manuscript — Note to users

 

Summary

Objective

Human infections caused by avian influenza virus A(H7N9) re-emerged in late 2013. We reported the first Hong Kong patient without risk factors for severe A(H7N9) disease.

Methods

Direct sequencing was performed on the endotracheal aspirate collected from a 36-year-old female with history of poultry contact. Bioinformatic analysis was performed to compare the current strain and previous A(H7N9) isolates.

Results

The influenza A/Hong Kong/470129/2013 virus strain was detected in a patient with acute respiratory distress syndrome, deranged liver function and coagulation profile, cytopenia, and rhabdomyolysis, The HA, NA and MP genes of A/Hong Kong/470129/2013 cluster with those of other human A(H7N9) strains. The PB1, PB2 and NS genes are most closely related to those of A/Guangdong/1/2013 strain identified in August 2013, but are distinct from those of other human and avian A(H7N9) strains. The other internal genes NP and PA genes are more closely related to those of non-A(H7N9) avian influenza A viruses. A unique PA L336M mutation, associated with increased polymerase activity, was found. The patient required salvage by extracorporeal membrane oxygenation.

Conclusions

The A/Hong Kong/470129/2013 virus is a novel reassortant derived from A/Guangdong/1/2013 virus. The unique mutation PA L336M may enhance viral replication and therefore disease severity.

http://www.sciencedirect.com/science/article/pii/S0163445314000498 

Camels Linked to Spread of #MERS Virus in People

By DENISE GRADYFEB. 25, 2014

A new study suggests that camels are the major source of the Middle East Respiratory Syndrome, or MERS, a viral disease that has sickened 182 people and killed 79 of them since it was first detected in Saudi Arabia in 2012.

The animals are most likely to infect people through respiratory secretions — from coughing, sneezing, snorting or spitting — that travel through the air or cling to surfaces.

People with chronic illnesses like diabetes, lung disease or kidney failure, or other conditions that weaken their immunity, seem to be most susceptible, and should avoid close contact with camels, researchers say.

Continued:  http://www.nytimes.com/2014/02/25/health/camels-linked-to-spread-of-deadly-virus-in-people.html?_r=0

Fujian Reports #H7N9 1 Case Cured - No New Cases in February

Translation
2/25/14

  Health and Family Planning Commission of Fujian Province 2 months 25 days notification, Quanzhou Yongchun County 2 months 4days confirmed human infection with H7N9 avian flu Moumou, after treatment was 2 months 25 days discharged.

    As of 2 months 25 days , the province reported a total of people infected with H7N9 bird flu confirmed cases 15 cases, including the death of three patients were cured and discharged eight cases. Currently hospitalized four cases, there are twocases of H7N9 avian influenza virus nucleic acid detection has two negative. From this month, 7 days so far, no new cases occur in our province. (Emergency Management Office)

http://www.fjphb.gov.cn/show.aspx?ctlgid=246246&Id=90325 

Guangdong Province #H7N9 1 Confirmed Case, 2 Cured & 1 Death

Translation
2/25/14

 Health and Family Planning Commission of Guangdong Province on February 25 Bulletin, Foshan new confirmed cases of H7N9 avian influenza case of human infection. 
    Case Zhu, male, 71 years old, currently residing in Nanhai District of Foshan City, coronary heart disease, hypertension history. February 23 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition, were treated at a local hospital sentinel. 
    Another Shenzhen January 20 confirmed cases Jeong, February 4 confirmed cases were cured in Dengmou February 25 discharged; Foshan City, January 8 cases diagnosed cure Choi was discharged on February 25, 2 May 4 confirmed cases cure a strict discharged on February 22. 
    Jiangmen City, February 20 confirmed cases of labor due to respiratory failure in a February 24 died.

http://www.gdwst.gov.cn/a/zwxw/2014022511359.html

Guangdong Province 4 new confirmed cases of with #H7N9 avian influenza & 1 Death

Translation
2/24/14
Health and Family Planning Commission of Guangdong Province on February 24 Bulletin, Guangzhou, Foshan new confirmed cases of H7N9 avian influenza four cases of human infection.
    Case 1 Yemou, male, 76 years old, currently residing in Haizhu District of Guangzhou City, suffering from chronic obstructive pulmonary disease, tuberculosis and other chronic diseases 30 years. February 21 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition, were treated at a local hospital sentinel. 
    Case 2 Lee, female, 55 years old, currently residing in Liwan District of Guangzhou City, suffering from high blood pressure, diabetes and other chronic diseases for 10 years, on February 21 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition, were treated at a local spot hospital.    
    Case 3 Jimmy A, F, 75 years old, currently residing in Tianhe District, Guangzhou City, February 21 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition, were treated at a local hospital sentinel.    
    Case 4 Hwang, male, 33 years old, currently residing in Shunde District of Foshan City, February 23 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition at Zhongshan Hospital Wards hospitalized.    
    Also, Zhaoqing City, February 20 confirmed cases in a certain way because of respiratory failure in February 23 died.
http://www.gdwst.gov.cn/a/zwxw/2014022411350.html 

WHO Human infection with avian influenza A(H7N9) virus – update February 24, 2014

24 February 2014 - On 20 and 21 February 2014, the National Health and Family Planning Commission (NHFPC) of China notified WHO of nine additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.
Seven of the nine cases are males. The age range is 29 to 81 years. Cases were reported from Anhui (1), Hunan (2), Jilin (1) and Guangdong (5). One case died, six cases are in a critical condition, one case is in a severe condition and one case is in a stable condition. Six cases are reported to have had a history of exposure to live poultry. Investigations are ongoing.

Details of the cases notified on 20 February are as follows:

• A 64 year-old farmer from Shaoyang City, Hunan Province. He became ill on 9 February, was admitted to a hospital on 15 February and is currently in a critical condition. The patient has a history of exposure to poultry.
• A 29 year-old resident from Changsha City, Hunan Province. She became ill on 8 February, was admitted to a hospital on 16 February and is currently in a critical condition. The patient has a history of exposure to poultry.
• A 79 year-old man from Foshan City, Guangdong Province. He became ill on 10 February, was admitted to a hospital on 14 February and is currently in a severe condition.
• A 60 year-old food handler from Xuancheng City, Anhui Province. He became ill on 13 February, was admitted to a hospital on 19 February and is currently in a critical condition. The patient has a history of exposure to poultry.
• An 81 year-old man who lives in Guangzhou City, Guangdong Province. He became ill on 7 February, was admitted to a hospital on 16 February and is currently in a critical condition. The patient has a history of exposure to poultry.

Details of the cases notified on 21 February are as follows:

• A 46 year-old woman from Zhaoqing City, Guangdong Province,. She became ill on 13 February, was admitted to a hospital on 19 February and is currently in a critical condition. The patient has a history of exposure to poultry.
• A 64 year-old man from Guangzhou City, Guangdong Province. He became ill on 9 February, was admitted to a hospital on 15 February and died on 18 February.
• A 69 year-old man from Jiangmen City, Guangdong Province. He became ill on 10 February, was admitted to a hospital on 18 February and is currently in a critical condition. The patient has a history of exposure to poultry.
• A 50 year- old chicken farm keeper from Jilin Province. He became ill on 15 February, was admitted to a hospital on 19 February and is currently in a stable condition. 

Continued:  http://www.who.int/csr/don/2014_02_24/en/

Guangdong Province 1 new confirmed cases of human infection with #H7N9 avian influenza

Translation
2/23/14
 Health and Family Planning Commission of Guangdong Province on February 23 Bulletin, Jiangmen new confirmed cases of H7N9 avian influenza case of human infection. 
    Case Mou, male, 31 years old, currently residing in Jiangmen. February 22 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable, treated at a local hospital sentinel.
http://www.gdwst.gov.cn/a/zwxw/2014022311348.html

Fujian Province two cases of human infection with #H7N9 avian influenza cases were cured

Translation - February 21, 2014

Health and Family Planning Commission of Fujian Province 2 months 21 days notification, Quanzhou Hui'an 1 month 24 days confirmed human infection with H7N9 avian flu Wang Moumou, Quanzhou Luojiang District 1 month 16 days confirmed human infection with H7N9 avian flu Xu Moumou, After treatment, respectively, in two months 20 , 21 were discharged.

    As of 2 months 21 days , the province reported a total of sporadic human infection with H7N9 avian influenza confirmed cases of 15 patients have been cured and discharged seven patients died three cases. Admitted to the hospital after each active treatment, the current five patients hospitalized cases, three patients in a row two times the virus nucleic acid testing negative. (Emergency Management Office)

http://www.fjphb.gov.cn/show.aspx?ctlgid=246246&Id=90287 

Guangdong Province 3 new confirmed cases of human infection with H7N9 avian influenza & 1 Cured

Translation - February 21, 2014
   Health and Family Planning Commission of Guangdong Province on February 21 briefing, Guangzhou, Zhaoqing, Jiangmen City 3 3 new cases of human infection of H7N9 avian influenza confirmed cases. 
    Cases a certain way, female, 46 years old, currently residing in Zhaoqing Sihui. February 19 confirmed cases of human infection of H7N9 avian influenza, currently fixed at a local hospital admitted. 
    Case 2 Tangmou, male, 64 years old, currently residing in Haizhu District of Guangzhou.Patients on February 18 after she died. February 19 retrospectively confirmed cases of avian influenza H7N9 human infections. 
    Case 3 workers, male, 69 years old, currently residing in Jiangmen, Kaiping City. February 20 confirmed cases of human infection of H7N9 avian influenza, currently fixed at a local hospital admitted. 
    Another Shenzhen January 30 confirmed cases Tangmou and Zhaoqing City on February 7, Lee confirmed cases have been cured.
http://www.gdwst.gov.cn/a/zwxw/2014022111346.html 

#MERS #Coronavirus Saudi Arabia Announces 2 New Cases (with 1 Death)

Translation - 2/20/14

In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the virus (Corona) that causes Acquired Middle East respiratory MERS CoV, Ministry announces the registration of the case of HIV infection for citizen province of Al-Ahsa, at the age of 58 years old, suffering several chronic diseases, and receives the necessary care, God asking him a speedy recovery.

The Ministry announces the registration of the case of HIV infection for citizenship in Riyadh, at the age of 81 years, suffering several chronic diseases, has passed away, Ngmayora he rest in peace.

http://www.moh.gov.sa/CoronaNew/PressReleases/Pages/mediastatemenet-2014-02-20-001.aspx 

Anhui Province added one case of human infection of bird flu #H7N9

Translation - February 20, 2014

Anhui Provincial Health Department on February 20 briefing, the province confirmed one case of human infection with the H7N9 avian influenza.

    Ryu patient, male, 60 years old, Jing County, February 19 was infected with H7N9 bird flu confirmed human cases, is in critical condition at a hospital in Wuhu City for treatment.

http://www.ahwst.gov.cn/chn200909261718343/article.jsp?articleId=134051049 

Guangdong Province 1 new case with #H7N9 avian influenza & 1 Death

The death they speak of below is:

Guangdong

Date of Report:  1/24/14

Name:  58(F) Yuan

From:  Boluo, Huizhou City

Onset:  1/10

Adm:  1/16

Adm:  1/23 Transferred ICU Guangzhou

Confirmed:  1/24

Note:  Exposure to poultry

DOD:  2/19

Translation - February 20, 2014
 Health and Family Planning Commission of Guangdong Province on February 20 briefing, the Guangzhou new confirmed cases of H7N9 avian influenza case of human infection. 
    Hemou cases, male, 81 years old, now lives in Panyu District, Guangzhou City, suffering from chronic bronchitis, coronary heart disease and other chronic diseases decade. February 19 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in the Guangzhou Hospital Wards hospitalization. 
    Also, Huizhou City, January 24 confirmed cases YuanMou due to multiple organ failure on February 19 died.

http://www.gdwst.gov.cn/a/zwxw/2014022011343.html 

Death toll from flu rises as #H1N1 strain returns, with ‘young invincibles’ most affected

From the Washington Post
By Ariana Eunjung Cha, February 19, 2014
Excerpt:
The H1N1 virus responsible for the 2009 global pandemic is back. State health officials from across the country say the resurgence is resulting in a dramatic rise in flu deaths in young and middle-aged adults and in children this season. While the reported death tolls so far are only a fraction of what they were four years ago, they are significantly higher than last year. The Centers for Disease Control and Preventionsaid the flu has been killing at epidemic levels since mid-January.
-snip-

In recent months, the World Health Organization has been tracking more than 300 cases, mostly in China, of people infected by a dangerous avian influenza strain, H7N9. A quarter of those infected are estimated to have died, but so far the WHO says there is no evidence of sustained human-to-human transmission.
In early February, there was more alarming news: Chinese officials, writing in the journal Lancet, said they identified yet another brand-new bird flu, H10N8, in a 73-year-old woman in Nanchang, a city in the southeastern part of the country. Researchers hypothesize that the woman, the first known death from this strain, may have contracted the virus while at a poultry market. The scientists warned that the virus could become extremely dangerous if it developed the ability to be transmitted from human to human. “The pandemic potential of this novel virus should not be underestimated,” the researchers concluded. 

Full article:  http://www.washingtonpost.com/national/health-science/death-toll-from-flu-rises-as-h1n1-strain-returnswith-young-invincibles-most-affected/2014/02/19/71f539f4-98b0-11e3-b931-0204122c514b_story.html

Humans with bird flu #H7N9 pose no threat to poultry populations, says UN agency

19 February 2014 – The United Nations Food and Agriculture Organization (FAO) said today there is no evidence that human patients infected with influenza A(H7N9), a low pathogenic virus in poultry, can transmit the virus to animals, including birds.

“Humans that become ill with influenza A(H7N9) constitute no threat to poultry populations,” underlined FAO Chief Veterinary Officer Juan Lubroth.

The agency’s comments come in the wake of the first human case of A(H7N9) outside China. The patient is originally from Guangdong Province in China – one of the provinces most affected by the virus this year and where the woman is thought to have contracted the infection. She was hospitalized in Malaysia while visiting the country as a tourist.

“This case does not come as a surprise and should not be a cause for increased concern, but should remind the world to remain vigilant,” said Mr. Lubroth.

Continued:  http://www.un.org/apps/news/story.asp?NewsID=47178&Cr=influenza&Cr1=#.UwUwQ0JdXw4

Cambodia H5N1 Case List 2014

Although there are 3 cases reported so far in 2014, 2 of them appear to be contact cases.  In addition, there is a 3rd contact case that was not tested, the sibling of the 8yo, that died before testing and cannot be confirmed.

Cambodia – Kampong Thom

Date of Report:  2/4/14

Name:  5(M)

From:  Chongda Village, Tbaung Kropeur Commune, Santuk Dist.

Onset:  1/24

Adm:  1/27 Private Clinic

Adm:  1/30 Jayavarman Hospital,

Confirmed:  2/1/14

Note:  200 Poultry died & parents cooked it, boy was around the area.

Cambodia – Kratie –Contact Case

Date of Report:  2/12/14

Name:  8(M) & 3(F)

From:  Kbal Trach Village, Sre Cha Commune, Snourl District

Onset:  1/31

Adm:  Kompong Cham Provincial Hosp.

Confirmed:  7(M)  [3(F) died before testing]

DOD:  2/7 (both on same day)

Note:  Exposure to dead poultry they ate the night before onset.

Cambodia – Kratie – Contact Case

Date of Report:  2/19/14

Name:  4(M)

From:  Kbal Trach Village, Sre Cha Commune, Snourl District

Onset:  2/8

Adm:  2/13 Kratie, mild

Confirmed:  2/14

Note:  Exposure to dead & sick poultry

Contact:  Detected by mobil surveillance team during contact tracing of the 2^nd confirmed case

#H5N1 Cambodia MOH On 4(M) Case: Detected by surveil. team during contact tracing of 2nd confirmed case: Contact Case

The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that one new human case of avian influenza has been conformed for the H5Nl virus. This is the 3rd case this year and the 50th person to become infected with the H5Nl virus in Cambodia. The case is from Kratie province. Of the 50 confirmed cases, 38 were children under 14, and 27 of the 50 were female. In addition, since the first case happened in Cambodia in 2005 there were only 16 cases survived.

A 4-year-old boy from KbalTraclt village, Sre Cha commune, Snourl district, Kratie province, was confirmed positive by Institut Pasteur du Cambodge (IPC), on 14th February 2014. The boy had onset fever and vomiting on 8th February 2014. The boy was detected by the mobile surveillance team during contact tracing of the 2nd confirmed case on 12th February. His symptoms were fever, running nose, vomiting, sore throat and cough. He was admitted to Kratie Provincial Hospital on 13th February and Tamiflu was administered on the same day. The symptoms were mild and the boy is now in good condition

-snip-

Detected by mobil surveillance team during contact tracing of the 2^nd confirmed case 

http://www.cdcmoh.gov.kh/PressRelease/50-PressRelease.Eng.pdf 

Cambodia reports 3rd bird flu #H5N1 case this year

PHNOM PENH, Feb. 19 (Xinhua) -- A four-year-old boy from Cambodia's northeastern Kratie Province has been confirmed for H5N1 human avian influenza, becoming the 3rd case this year, said a joint statement by the World Health Organization and the Cambodian Health Ministry on Wednesday.

The boy was confirmed positive for the virus last Friday after he had onset fever, running nose, vomiting, sore throat and cough, the statement said.

"The boy was admitted to Kratie Provincial Hospital on Thursday last week and Tamiflu was administered on the same day," it said. "The symptoms were mild and the boy is now in good condition."

The statement said the boy had direct exposure with dead and sick poultry six days before his illness.

Continued:  http://news.xinhuanet.com/english/health/2014-02/19/c_133126902.htm

Guangdong Province 1 new confirmed cases of human infection with #H7N9 avian influenza

Translation - February 19, 2014
  Health and Family Planning Commission of Guangdong Province on February 19 Bulletin, Foshan new confirmed cases of H7N9 avian influenza case of human infection. 
    Luomou cases, male, 79 years old, currently residing in Gaoming District, Foshan City, February 18 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable, treated at a local hospital sentinel.
http://www.gdwst.gov.cn/a/zwxw/2014021911337.html