Bangladesh-3 market workers infected with bird flu #H5N1 #BIRDFLU

3 market workers infected with bird flu Mon, Mar 5th, 2012 9:10 pm BdST

Nurul Islam Hasib bdnews24.com Senior Correspondent Dhaka, Mar 5 (bdnews24.com)—Detection of three new human infections with the deadly H5NI strain of bird flu in a week has set alarm bells ringing as scientists have found evidence of the virus in the live-bird market in crowded Dhaka. The Institute of Epidemiology, Disease Control and Research (IEDCR) confirmed a human case on Feb 26 when a worker of a live-bird market in southern part of the capital was tested H5N1 positive at the IEDCR's surveillance site. Its director Prof Mahmudur Rahman told bdnews24.com that they had informed the government's Department of Livestock right away and suggested 'immediate' steps to disinfect wet markets. bdnews24.com saw no cleaning drive but learned the livestock department fixed a technical committee meeting for Wednesday instead of beginning to disinfect the market. In the meantime, the IEDCR that oversees human infections of bird flu disclosed on Monday that another two cases were confirmed on Sunday night in their lab. "They are also live-bird market workers," Prof Rahman told bdnews24.com and added that they expected the livestock department to move quickly for the sake of public health safety. "The virus's presence in live-bird market means it is now even closer to people," he added. A scientist with the IEDCR told bdnews24.com that they had run into evidence suggesting presence of the H5N1 virus in the live-bird market's garbage, as well. The virus has the potential to cause severe illness in human with a high fatality rate. "We are lucky as the strain (clade 2.2) of H5N1 that circulates in Bangladesh is less virulent, but it can change into another class (2.1), which is highly infectious to human," the IEDCR director said. According to World Health Organisation, across the globe H5N1 killed 349 out of its 592 victims, except the latest two detected in Bangladesh. Livestock authorities could not be reached immediately. Chief veterinary officer Mosaddek Hossain, who oversees poultry infections of bird flu, declined comment when bdnews24.com approached him at around 6.30pm. Prof Nitish C Debnath, FAO expert on avian influenza, told bdnews24.com that the government should launch 'wet market cleaning' drive at this moment. "All should be vigilant to prevent sick poultries from entering into the market," he warned. With four strains of flu virus – H5N1, H1N1, H3N2 and H9N2 – circulating in Bangladesh, the Food and Agriculture Organisation in Aug last year warned of a possible major resurgence of bird flu. It said a mutant strain of the H5N1 virus is spreading in Asia including Bangladesh. The government has confirmed first case of human infection with H5N1 in 2007, and two cases were reported in 2011. IEDCR advises people wash egg shells and suggests consuming well-cooked poultry products. It also urged not to litter giblets and dead birds just anywhere and maintain personal hygiene – cough into the crook of elbow and wash hands with soap often. The first human infection from H5N1 was detected in 1997 in Hong Kong.   http://bdnews24.com/details.php?id=219613&cid=2

Vietnam: The risk of flu outbreak more dangerous

02.17.2012

Weather of season is more favorable conditions for developing strains of influenza virus. But only a few sporadic cases of the disease, but if not careful, it will spread the risk of dangerous flu.

According to Tran Thanh Duong - Deputy Director of Department of Preventive Health (MOH), the influenza A - H1N1 strain of influenza is a common nowadays. It also causes most human flu. However, recent weather elements are unusual, unfavorable environment influenza A had the new varieties.

Specifically mention the possible varieties of influenza virus as influenza A danger - H1N1 in humans, influenza A - H3N2 in pigs, influenza A - H5N1 in chickens. These are dangerous strain, with great force, causing high mortality risk. Often less incidence, spread slowly (except influenza A-H1N1), but if getting the death rate may be 100%.

Currently, to deal with this disease, the Health Ministry has instructed the Department of Preventive Medicine of measures to strengthen surveillance in all key regions of pigs and poultry in the country. Also, ask the Pasteur Institute in the country, the Institute of Hygiene and Epidemiology an update and report regularly to the disease situation has plans to direct and timely.

Currently influenza A - H5N1 in poultry is happening in many places across the country, to actively prevent flu transmission from animals to humans, the Department of Preventive Medicine has called for strengthening people measures for personal hygiene and living environment. From the beginning of the year, the country has recorded three cases of dangerous flu. Including 2 cases of influenza A - H5N1 have died. The cases of influenza A - H3N2 has been recorded on the morning of 15.02. The patient had of danger and are being tracked, monitored and treated.

New Flu Strain Puts Pork Industry on Alert After 2009 Pandemic #h5n1 #H3N2 #BIRDFLU

[This is also named S-OtrH3N2 and we have information on it located in the right side-bar]

New Flu Strain Puts Pork Industry on Alert After 2009 Pandemic

Wednesday, 04 Jan 2012 10:25 AM

A new flu virus thought to have originated in pigs has agricultural producers on alert two years after a swine flu pandemic caused sales to drop and disrupted U.S. pork exports.
Twelve people in five states have been infected, with three hospitalized, according to the Centers for Disease Control and Prevention in Atlanta. At least six reported no recent exposure to pigs, suggesting “limited human-to-human transmission,” according to the report. Eleven of those stricken were children.

The virus may not become as prevalent as the 2009 variant, known as H1N1, which led to as many as 89 million cases and 18,300 deaths in the U.S. in the first flu pandemic in more than 40 years, according to the CDC. Still, livestock producers are concerned that consumers may fear they can get a potentially lethal disease from eating pork. Flu is transmitted through droplets of infected body fluids when people cough, sneeze or talk.

“It’s always something that we need to keep an eye on, that it doesn’t get more severe or spread more quickly,” Liz Wagstrom, chief veterinarian with the National Pork Producers Council, which has offices in Des Moines, Iowa, and Washington. “It’s very important the public understand you can’t get flu from eating pork.”

Import Ban
During the H1N1 pandemic, China and Russia closed their markets to U.S. pork and industry revenue was estimated to have fallen by nearly $2.2 billion in the last eight months of 2009, according to the council. The H1N1 strain contained genetic material from five different flu viruses, including North American swine and bird flu and two swine flu viruses found in Europe and Asia.
The Des Moines, Iowa-based National Pork Board, which conducts research on pork and promotes the food, has sent out alerts, said Wagstrom. Veterinary labs that test samples from sick pigs are on the lookout for the strain, she said.

U.S. agencies are not referring to the new strain as swine flu, mindful of the popular description of H1N1 that upset markets and producers. Such illnesses contain a genetic mix of viruses seen in pigs, birds and people and get the moniker because the overall structure is the type that affects pigs.

“We are aware of the pork industry’s concerns,” said Jeff Dimond, an agency spokesman, in an interview.
CDC has “gone overboard” not to use the description, he said.

Genetic Similarity
The new virus, called H3N2v, contains a gene from the 2009 variant, according to the CDC. The agency is “taking this situation very seriously” and has increased surveillance in areas where cases occurred, according to a Dec. 9 CDC report. As a precaution, a candidate vaccine has been developed and provided to manufacturers so they can begin production if necessary, according to the report.

The strain has been detected in Indiana, Iowa, Maine, Pennsylvania and West Virginia, according to the Atlanta-based health agency.
Despite the added surveillance, government scientists haven’t made conclusions about the durability of the new strain.
All the people sickened have recovered and no continuing transmission has been detected, according to the CDC. Human immunity may be a concern because it’s a new virus.

‘Could Get Legs’
“This particular strain could get legs, so to speak, or just die out,” Dimond said.
The strain isn’t too worrisome because it doesn’t seem to be spreading quickly, said Peter Katona, associate clinical professor of infectious diseases at the University California, Los Angeles, in an interview.
The reported cases have prompted “concern, but I wouldn’t say it’s super high,” John Treanor, chief of the infectious disease division at the University of Rochester Medical Center in New York, said in an interview.
It’s important to track such viruses so the U.S. can respond if they begin spreading rapidly and become more virulent, he said.
“Will the viruses be able to emerge from pigs into humans and cause another pandemic in humans?” said Treanor. “That’s why we keep track of what kinds of viruses are emerging.”

Update: Influenza A (H3N2)v Transmission and Guidelines — Five States, 2011

Early Release

December 23, 2011 / 60(Early Release);1-4

From August 17 to December 23, 2011, CDC received reports of 12 human infections with influenza A (H3N2)v viruses that have the matrix (M) gene from the influenza A (H1N1)pdm09 virus (formerly called swine-origin influenza A [H3N2] and pandemic influenza A [H1N1] 2009 viruses, respectively [Box]). The 12 cases occurred in five states (Indiana, Iowa, Maine, Pennsylvania, and West Virginia), and 11 were in children (1,2). Six of the 12 patients had no identified recent exposure to swine. Three of the 12 patients were hospitalized, and all have recovered fully.
A case in an adult male in Indiana with occupational exposure to swine was among the 12, and two children in West Virginia who regularly attended the same day care accounted for the latest cases. This report describes those cases and swine influenza virus (SIV) surveillance being conducted by the U.S. Department of Agriculture (USDA).

Case Reports

Indiana.
 On October 28, 2011, CDC was notified by the Indiana Department of Health of a suspected case of A(H3N2)v virus infection in an adult male. The patient experienced onset of fever, cough, shortness of breath, nausea, vomiting, and body aches on October 20, and was hospitalized for 4 days. He did not receive treatment with influenza antiviral medications and recovered fully.
On October 22, a respiratory specimen from the patient was positive for influenza at the hospital. On October 28, the virus was identified by real-time, reverse transcription–polymerase chain reaction (rRT-PCR) testing at the Indiana State Public Health Laboratory as an inconclusive influenza A virus, consistent with results seen with other recent A(H3N2)v infections. On October 31, genome sequencing at CDC confirmed the virus as A(H3N2)v with the M gene from the A(H1N1)pdm09 virus, similar to the viruses identified in the other cases of human infection in the United States since August 2011.
The patient reported direct contact with swine during his work in the week before illness onset. He said he did not wear any personal protective equipment (PPE) because the swine did not exhibit signs of illness. No illness was reported among the patient's household members or other close contacts
.
West Virginia.
 On November 19, a child aged <5 years developed acute onset of fever after 1 week of cough and congestion. The child had been hospitalized for an unrelated condition 2 days before the onset of fever. On November 21, a respiratory specimen was collected. Rapid diagnostic tests conducted by the hospital were negative for influenza and respiratory syncytial virus, but influenza A was identified by an alternative rRT-PCR at the hospital. The specimen was forwarded to the West Virginia Office of Laboratory Services, where it was identified as a suspected influenza A (H3N2)v virus. Subsequent genome sequencing conducted at CDC confirmed the virus as A(H3N2)v with the M gene from the A(H1N1)pdm09 virus. The child, who had no recent travel or exposure to swine, was discharged on November 21, and has since recovered from the influenza illness.
An investigation was conducted to ascertain respiratory illnesses among contacts of the child that occurred during November 9–December 19. Multiple contacts, including children who regularly attended day care with the child, were found to have had respiratory illness during this period. On November 29, a second child aged <5 years who attended day care regularly with the first child and who had no recent travel or swine exposure became ill with fever, cough, diarrhea, and rhinorrhea. The second child did not seek medical care and recovered fully from the illness. A respiratory specimen obtained from the second child on December 7 was inconclusive by rRT-PCR at the West Virginia Office of Laboratory Services; however, the specimen was confirmed as influenza A (H3N2)v with the M gene from the A(H1N1)pdm09 virus via genome sequencing at CDC.
No additional A(H3N2)v cases have been identified among the other ill day care attendees or contacts of either patient. Enhanced surveillance for influenza-like illness and increased diagnostic testing of respiratory specimens is being conducted in West Virginia and adjacent counties in Maryland as part of the ongoing investigation of these cases. Currently, no evidence of additional human-to-human transmission in the community has been identified.

Influenza Surveillance of U.S. Swine

Surveillance for SIV in the United States is overseen by USDA, largely in swine that display influenza-like illness. In July 2009, USDA's Animal and Plant Health Inspection Service and the swine industry implemented a SIV surveillance program* to characterize the distribution of SIV in U.S. swine herds. To date, approximately 150 SIV isolates have undergone sequencing of three genes (hemagglutinin, matrix, and neuraminidase gene segments) and sequences have been submitted to GenBank.† Thirty isolates have been identified as A(H3N2) viruses and eight of those 30 have the M gene from the influenza A (H1N1)pdm09 virus as determined by an informal analysis of GenBank submission data by the USDA Agricultural Research Service. Further characterization and analysis are ongoing, and new submissions are added as diagnostic work is completed.

Reported by

Shawn Richards, Mark Glazier, Katie Masterson, Michael Denton, Indiana State Dept of Health; Cheryl Miller, DVM, Indiana Board of Animal Health. Carl Liebig, MD, Andrew J. Root, Cynthia Whitt, Mineral County Health Dept, Julie Freshwater, PhD, Sherif Ibrahim, MD, Danae Bixler, MD, Christi Clark, Loretta Haddy, PhD, West Virginia Dept of Public Health. Swine Influenza Virus Team, U.S. Dept of Agriculture. Douglas Jordan, MA, Matthew Biggerstaff, MPH, Scott Epperson, MPH, Lynnette Brammer, MPH, Lyn Finelli, DrPH, Susan Trock, DVM, Michael Jhung, MD, Joseph Bresee, MD, Stephen Lindstrom, PhD, Alexander Klimov, PhD, Daniel Jernigan, MD, Nancy Cox, PhD, Influenza Div, National Center for Immunization and Respiratory Diseases. Rachel Radcliffe, DVM, Career Epidemiology Field Officer Program, Office of Public Health Preparedness and Response; Tegwin Taylor, DVM, EIS officer, CDC. Corresponding contributor: Douglas Jordan, dejordan@cdc.gov, 404-639-3747 begin_of_the_skype_highlighting 404-639-3747 end_of_the_skype_highlighting.

Editorial Note

Human infections with the influenza viruses currently circulating among swine are rare. Since 2005, only 35 cases have been reported in the United States, but the frequency with which they have been detected increased in 2011. When different influenza viruses simultaneously infect a single host (e.g., a human or swine), exchange of genetic material can occur, resulting in a new influenza virus. Depending on the antigenic distance between the new virus and recently circulating seasonal viruses, little or no immunity might exist in the human population. Influenza A (H3N2)v viruses resulted from reassortment of influenza A (H1N1)pdm09 viruses with swine influenza A (H3N2) viruses. A diagram depicting this reassortment is available online from CDC's Public Health Image Library.§ Because these viruses carry a newly identified combination of genes, little information is available regarding transmission efficiency in swine, in humans, or between swine and humans. However, the recent human cases involving swine exposure and results of SIV surveillance indicate that these viruses also currently are circulating in swine herds.
The case of influenza A (H3N2)v infection after occupational contact with swine in Indiana and the apparent limited human-to-human transmission of A(H3N2)v virus that occurred in a day care setting in West Virginia represent two different possible scenarios for transmission of this virus. Work exposure highlights the risk for interspecies influenza transmission in occupational settings where humans are exposed to swine, an association that has been described previously (3–7). To minimize the risk for interspecies influenza transmission in occupational settings, CDC and the Occupational Safety and Health Administration (OSHA) encourage swine workers to 1) get vaccinated against human seasonal influenza, 2) wear appropriate PPE, and 3) practice good hygiene, such as washing hands thoroughly with soap and water, when in contact with swine, especially swine that show signs of illness. The National Pork Board also recommends producers work with their veterinarian to develop appropriate prevention and control measures for influenza in swine, which can include vaccinating swine against swine influenza. Similar to humans, swine infected with influenza viruses do not always exhibit signs of infection (8). Persons with swine exposure in the week before onset of an illness with symptoms of influenza requiring medical care should notify their health-care provider of their swine exposures. Persons who develop symptoms of influenza after close contact with swine are recommended to stay home until well to minimize contact with persons and swine as much as possible.
Guidance materials for persons who work with swine have been published by OSHA.¶ In addition, the National Pork Board,** CDC, and the National Association of State Public Health Veterinarians have published guidance for persons exposed to swine in public settings (9). Clinicians should consider variant influenza virus infection in the differential diagnosis of patients with febrile respiratory illness who have been near swine whether at work or at an agricultural event, such as a fair or exhibit.
The A(H3N2)v cases in West Virginia involved two children who attended the same day care, but the first child was unlikely to have transmitted the virus to the second child, given the ≥10-day difference in their symptom onset dates. This represents a scenario of limited human-to-human transmission occurring in a day care setting. Therefore, clinicians also should consider the possibility of influenza A (H3N2)v infections in patients who have not had exposure to swine, particularly young children in those states where influenza A (H3N2)v cases have been reported. Clinicians who suspect variant influenza virus infection should obtain a nasopharyngeal swab, place the swab in viral transport medium, and contact their state or local health department to facilitate transport and timely diagnosis (10). Influenza A (H3N2)v viruses detected to date are susceptible to oseltamivir and zanamivir for the treatment of influenza. Clinicians who suspect variant influenza infection in a patient should consider treatment with these medications if clinically indicated (10). Because these viruses have the M gene from the influenza A (H1N1)pdm09 virus, they are resistant to amantadine and rimantadine.

CDC requests that state public health laboratories notify CDC immediately of suspected variant influenza A specimens and send them to the CDC Influenza Division's Virus Surveillance and Diagnostics Branch Laboratory. Confirmed cases should be investigated thoroughly and expeditiously to ascertain whether swine-to-human or human-to-human transmission is ongoing and to limit further exposures between humans with others and swine. Such investigations require close collaboration among state, local, and federal public and animal health officials.

CDC is working with USDA and state public health and animal health experts in the locations where these cases have occurred to investigate each case fully and to enhance influenza surveillance to detect human cases of variant influenza virus infections. The CDC rRT-PCR assay that was approved by the Food and Drug Administration in September 2011 is able to identify these cases as presumptive influenza A (H3N2)v cases. These diagnostic test kits have been distributed to public health laboratories in the United States and National Influenza Centers designated by the World Health Organization in other countries. Additional rRT-PCR test enhancements to further improve detection of influenza A (H3N2)v viruses are under development.
Limited serologic studies conducted to date indicate that young children have little preexisting immunity to influenza A (H3N2)v viruses. Because the hemagglutinin genes of these viruses are related to human influenza A (H3N2) viruses that circulated in the 1990s, older children and adults might have limited immunity against these viruses. Certain persons, including young children, pregnant women, persons with chronic health conditions such as asthma, diabetes, or heart and lung disease, and persons aged ≥65 years, are likely to be at greater risk for serious influenza-related complications from variant influenza viruses such as influenza A (H3N2)v. The influenza A (H3N2)v virus is different enough from current human seasonal influenza viruses that the seasonal influenza vaccine is not expected to provide significant protection.
CDC will provide routine and timely communications regarding these influenza A (H3N2)v viruses and other variant influenza viruses with the public, partners, state and local health departments, and stakeholders. Updated information and guidance documents related to A(H3N2)v viruses are available online from CDC at http://www.cdc.gov/flu/swineflu/influenza-variant-viruses.htm. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e1223a1.htm

Complications of influenza virus - can not ignore!

Complications of influenza virus - can not ignore!Monday, 12.12.2011, 02:58 (GMT +7)Cold weather is favorable for the development of flu, especially in conditions of different influenza virus is circulating in our country. More worryingly, recent and Prevention Centers for Disease Control (CDC) reported detecting more cases of new flu virus more dangerous than the combination of H1N1 and H3N2. This warns of a new flu outbreak without excluding any country.
A patient infected with influenza A are being treated. Photo: Q. Khanh

Dr. Nguyen Van Binh, Director of Preventive Medicine, said the CDC reported that, a new influenza virus strain called S-OtrH3N2 is more dangerous than the virus strains mutate from recombinant strains of influenza A/H1N1 pandemic influenza A/H3N2 in 2009 and originated from pigs. Currently, the U.S. has 10 people infected with this new strain of influenza. In Vietnam, up to this point, although some people have flu seasons have tended to increase supervision over the country but has not recorded any cases of new flu virus strain infected S-OtrH3N2.
However, Dr Binh fears that, with regular seasonal influenza viruses as influenza B, H1N1, H3N1, H5N1 ... presence in our country, the influenza virus strains combine or mutate create a new influenza virus virulent and dangerous than is entirely possible. Although H1N1 and H3N2 recombine with each other has created a new influenza virus strains but still the most feared reassortment between H5N1 influenza strain associated with H1N1. Because the H1N1 strain can spread very quickly, and the H5N1 strain deadly force should the pandemic threat of strong poison, spread on a large scale is very high. Furthermore, influenza A virus often change antigen structure to adapt to the environment likely to cause dangerous epidemics. Only a small change of antigen will be pandemic virus is one of the most difficult to cope.
 
Treatment of patients infected with influenza A in the Central Hospital for Tropical Diseases.

Meanwhile, the perspective of treatment of influenza experts, MA Nguyen Hong Ha, deputy director of the Central Hospital for Tropical Diseases that with the climate of our country, especially when the weather turn cold and wet will cause some the increase due to the flu virus to develop. But now, we do not have any patient suffering from a new influenza virus strain S-OtrH3N2 it can not accurately assess the severity of this new virus. However, special attention should have had the regular flu vaccine can still get other strains of influenza if they recombine into and when it is easy to make pandemic because people have lost immunity.
Prior to this risk, Ma Ha said that if at the same time that many patients with flu syndrome, and even deaths should focus on testing and found the cause to have countermeasures. Along with that, people should get vaccinated against the flu vaccine is being circulated in our country. For pregnant women, infants, people with chronic conditions are subject to high risk to health facilities for medical examination and treatment in time when the expression of influenza appear.
To the Department of Preventive Medicine, Director Nguyen Van Binh said to be active against influenza virus invade and spread in our country, the Department has asked the Institute of Hygiene and Epidemiology, Institut Pasteur in the country increased intensity activities quarantine border, close monitoring of patients with fever, flu syndrome from epidemic areas. At the same time, strengthen monitoring of cluster flu, suspected cases of viral pneumonia in the community, particularly the influenza sentinel key national focus for early detection of changes and the circulation of the virus influenza. In addition, the Department of Preventive Medicine is also actively cooperates with the World Health Organization and CDC for technical assistance in monitoring and detecting the influenza virus strains.


Since the beginning of this year, Vietnam has 759 people with influenza A/H1N1, including 17 deaths. More ominously, within one month of the morbidity and mortality due to influenza A/H1N1 has tended to increase with 25 cases and 3 deaths.

http://www.sggp.org.vn/ytesuckhoe/2011/12/275839/

WHO: Influenza like illness in the United States of America

24 November 2011 - The United States Government has reported three cases of human infection with swine origin triple reassortant Influenza A H3N2. Between 10 and 13 November 2011, three children (aged 11 months, 2 years and 3 years) experienced onset of febrile respiratory illness. All three children had visited the same health care provider in Iowa State. None of them were hospitalized and all three have recovered.

Laboratory testing conducted on 18 November 2011 in the State Hygienic Laboratory at the University of Iowa showed a swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus. This was confirmed by sequencing at the Centers for Disease Control and Prevention (CDC) on 20 November.

The three children attend the same daycare facility. There is an ongoing investigation and to date, no epidemiological link to swine has been identified in any of the three children. Additional investigation is currently underway to identify and characterize the illness in other daycare attendees, family members, or other contacts, and to determine any exposure to swine.

These are 16th, 17th and 18th cases of human infection with swine origin triple reassortant influenza A (H3N2) detected in the United States since 2009, and the 8th, 9th, and 10th cases reported this year.

WHO is closely following the situation with the US Government, CDC and other partners.