[On July 18, we posted to this blog, an article on this subject:
Vietnam: H5N1 Virus Clade 2.3.2 Appears, Vaccine Almost No Effect
http://pandemicinformationnews.blogspot.com/2011/07/vietnam-h5n1-virus-clade-232-appears.html]
29 August 2011, Rome - FAO today urged heightened readiness and surveillance against a possible major resurgence of the H5N1 Highly Pathogenic Avian Influenza amid signs that a mutant strain of the deadly Bird Flu virus is spreading in Asia and beyond, with unpredictable risks to human health.
The H5N1 virus has infected 565 people since it first appeared in 2003, killing 331 of them, according to WHO figures. The latest death occurred earlier this month in Cambodia, which has registered eight cases of human infection this year -- all of them fatal.
Since 2003 H5N1 has killed or forced the culling of more than 400 million domestic poultry and caused an estimated $20 billion of economic damage across the globe before it was eliminated from most of the 63 countries infected at its peak in 2006.
However, the virus remained endemic in six nations, although the number of outbreaks in domestic poultry and wild bird populations shrank steadily from an annual peak of 4000 to just 302 in mid 2008. But outbreaks have risen progressively since, with almost 800 cases recorded in 2010-2011.
Virus spread in both poultry and wild birds
At the same time, 2008 marked the beginning of renewed geographic expansion of the H5N1 virus both in poultry and wild birds.
The advance appears to be associated with migratory bird movements, according to FAO Chief Veterinary Officer Juan Lubroth. He said migrations help the virus travel over long distances, so that H5N1 has in the past 24 months shown up in poultry or wild birds in countries that had been virus-free for several years.
"Wild birds may introduce the virus, but peoples' actions in poultry production and marketing spread it," Lubroth noted.
Recently affected areas are to be found in Israel and the Palestinian Territories, Bulgaria, Romania, Nepal and Mongolia.
A further cause for concern, Lubroth said, is the appearance in China and Viet Nam of a variant virus apparently able to sidestep the defences provided by existing vaccines.
In Viet Nam, which suspended its springtime poultry vaccination campaign this year, most of the northern and central parts of the country -- where H5N1 is endemic -- have been invaded by the new virus strain, known as H5N1 - 2.3.2.1.
High alert
Viet Nam's veterinary services are on high alert and reportedly considering a novel, targeted vaccination campaign this fall. Virus circulation in Viet Nam poses a direct threat to Cambodia, Thailand and Malaysia as well as endangering the Korean peninsula and Japan further afield. Wild bird migration can also spread the virus to other continents.
"The general departure from the progressive decline observed in 2004-2008 could mean that there will be a flareup of H5N1 this fall and winter, with people unexpectedly finding the virus in their backyard," Lubroth said.
The countries where H5N1 is still firmly entrenched – Bangladesh, China, Egypt, India, Indonesia and Vietnam – are likely to face the biggest problems but no country can consider itself safe, he said.
"Preparedness and surveillance remain essential," Lubroth underlined. "This is no time for complacency. No one can let their guard down with H5N1."
Monday, August 29, 2011
Saturday, August 27, 2011
Hong Kong: Surveillance in Pigs finds virus that is a combo of Pandemic H1N1 & Swine Influ. H3N2
Published on: 2011-08-26
Hong Kong (HKSAR) - The Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department (FEHD) today (August 26) announced results of the regular influenza virus surveillance programme on pigs conducted by the University of Hong Kong (HKU) for May to July at the Sheung Shui Slaughterhouse. Among some 1,300 samples tested, no human swine influenza virus (pandemic H1N1) was detected. However, 16 samples taken in June and July were found to contain a virus that was essentially a swine influenza H3N2 virus but had picked up some genes of human swine influenza virus.
A spokesman for the CFS said, "A case of swine influenza H1N1 virus carrying the genes of the human swine influenza virus was also found in the surveillance programme early last year.
There have been reports from many parts of the world showing similar findings."
According to Professor JSM Peiris, the HKU expert in charge of the surveillance programme, it is unlikely that this swine influenza H3N2 virus, which carried the genes of the human swine influenza virus, will cause any major human health risk or problems in food safety.
The spokesman said, "Given the fact that the human swine influenza virus has spread worldwide in humans and pigs have also been infected by this virus, the recent finding is not a cause for surprise. HKU is conducting further tests to learn more about this particular strain.
"The CFS would continue to monitor reports of the HKU surveillance programme and make announcements on a regular basis. Results will be announced immediately if there are significant public health impacts."
Under the regular influenza virus surveillance programme for pigs, the CFS has been helping HKU researchers to collect blood and tracheal and nasal swabs from pigs at the Sheung Shui Slaughterhouse twice a month to monitor influenza virus activity in pigs.
According to the World Health Organization, the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations, human swine influenza would not be contracted by consuming pork and pork products that are handled properly and thoroughly cooked.
Members of the public are advised that it is safe to eat pork and pork products that are cooked to an internal temperature of 70 degrees Celsius or above.
The CFS spokesman said that all imported live pigs from the Mainland come from registered farms and are accompanied with animal health certificates issued by the Mainland authorities.
"The FEHD inspects the certificates and health of the imported pigs at the boundary control points.
Both imported and local pigs also have to go through ante-mortem and post-mortem inspections in the slaughterhouses. Only pigs that pass the inspections can be supplied to the market and sold for consumption," he said.
Apart from the enhanced inspection of imported live pigs, the FEHD has reminded slaughterhouse staff and people who might be in contact with live pigs to pay attention to personal hygiene and to wear masks and appropriate protective gear at work.
The CFS has been keeping close liaison with the Mainland authorities over any abnormal situation concerning Mainland farms supplying live pigs to Hong Kong, and farm inspection would be stepped up when necessary, the spokesman added.
In addition, the Agriculture, Fisheries and Conservation Department also closely monitors the health situation of pigs in Hong Kong and regularly reminds local pig farmers to maintain good farm and personal hygiene and report to the Department any abnormality in farms.
Source: HKSAR Government
Hong Kong (HKSAR) - The Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department (FEHD) today (August 26) announced results of the regular influenza virus surveillance programme on pigs conducted by the University of Hong Kong (HKU) for May to July at the Sheung Shui Slaughterhouse. Among some 1,300 samples tested, no human swine influenza virus (pandemic H1N1) was detected. However, 16 samples taken in June and July were found to contain a virus that was essentially a swine influenza H3N2 virus but had picked up some genes of human swine influenza virus.
A spokesman for the CFS said, "A case of swine influenza H1N1 virus carrying the genes of the human swine influenza virus was also found in the surveillance programme early last year.
There have been reports from many parts of the world showing similar findings."
According to Professor JSM Peiris, the HKU expert in charge of the surveillance programme, it is unlikely that this swine influenza H3N2 virus, which carried the genes of the human swine influenza virus, will cause any major human health risk or problems in food safety.
The spokesman said, "Given the fact that the human swine influenza virus has spread worldwide in humans and pigs have also been infected by this virus, the recent finding is not a cause for surprise. HKU is conducting further tests to learn more about this particular strain.
"The CFS would continue to monitor reports of the HKU surveillance programme and make announcements on a regular basis. Results will be announced immediately if there are significant public health impacts."
Under the regular influenza virus surveillance programme for pigs, the CFS has been helping HKU researchers to collect blood and tracheal and nasal swabs from pigs at the Sheung Shui Slaughterhouse twice a month to monitor influenza virus activity in pigs.
According to the World Health Organization, the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations, human swine influenza would not be contracted by consuming pork and pork products that are handled properly and thoroughly cooked.
Members of the public are advised that it is safe to eat pork and pork products that are cooked to an internal temperature of 70 degrees Celsius or above.
The CFS spokesman said that all imported live pigs from the Mainland come from registered farms and are accompanied with animal health certificates issued by the Mainland authorities.
"The FEHD inspects the certificates and health of the imported pigs at the boundary control points.
Both imported and local pigs also have to go through ante-mortem and post-mortem inspections in the slaughterhouses. Only pigs that pass the inspections can be supplied to the market and sold for consumption," he said.
Apart from the enhanced inspection of imported live pigs, the FEHD has reminded slaughterhouse staff and people who might be in contact with live pigs to pay attention to personal hygiene and to wear masks and appropriate protective gear at work.
The CFS has been keeping close liaison with the Mainland authorities over any abnormal situation concerning Mainland farms supplying live pigs to Hong Kong, and farm inspection would be stepped up when necessary, the spokesman added.
In addition, the Agriculture, Fisheries and Conservation Department also closely monitors the health situation of pigs in Hong Kong and regularly reminds local pig farmers to maintain good farm and personal hygiene and report to the Department any abnormality in farms.
Source: HKSAR Government
ProMed: Australia (NS) H275Y mutation cluster
25-AUG-2011
A cluster of oseltamivir-resistant A(H1N1)2009 influenza cases with onset between May and August 2011 has been detected in the Hunter region of New South Wales (NSW), Australia. Viruses from 25 of 184 (14 percent) A(H1N1)2009 cases from the Hunter New England region exhibited highly reduced oseltamivir sensitivity due to the H275Y substitution in the neuraminidase. The H275Y mutation is a well-established substitution previously reported to confer oseltamivir resistance in N1 neuraminidases and was present in the widespread oseltamivir resistant pre-pandemic seasonal A(H1N1) virus. 15 of the 1st 16 cases lived within a 50-km radius of the regional centre of Newcastle. 16 of the 25 patients have been interviewed, and none had received oseltamivir prior to influenza specimen collection. Only 5 were hospitalised at the time of specimen collection. None of the 16 had a history of immune suppression; 3 cases were pregnant. No one was admitted to ICU or had a fatal outcome. Further interviews with cases and virological analyses are ongoing.
A cluster of oseltamivir-resistant A(H1N1)2009 influenza cases with onset between May and August 2011 has been detected in the Hunter region of New South Wales (NSW), Australia. Viruses from 25 of 184 (14 percent) A(H1N1)2009 cases from the Hunter New England region exhibited highly reduced oseltamivir sensitivity due to the H275Y substitution in the neuraminidase. The H275Y mutation is a well-established substitution previously reported to confer oseltamivir resistance in N1 neuraminidases and was present in the widespread oseltamivir resistant pre-pandemic seasonal A(H1N1) virus. 15 of the 1st 16 cases lived within a 50-km radius of the regional centre of Newcastle. 16 of the 25 patients have been interviewed, and none had received oseltamivir prior to influenza specimen collection. Only 5 were hospitalised at the time of specimen collection. None of the 16 had a history of immune suppression; 3 cases were pregnant. No one was admitted to ICU or had a fatal outcome. Further interviews with cases and virological analyses are ongoing.
Tamiflu-Resistant Flu Outbreak Reported in Australia’s Newcastle, WHO Says
By Jason Gale - Aug 25, 2011 9:25 PM ET
More than two dozen cases of H1N1 swine flu resistant to Roche Holding AG (ROG)’s Tamiflu pill were reported in Australia in the largest outbreak of the drug- evading influenza strain.
Viruses from 25 of 184 patients in the Newcastle area of eastern Australia infected with the pandemic germ had a genetic mutation that reduces the potency of Tamiflu, scientists said in a report distributed today by the International Society for Infectious Diseases’ ProMED-mail program.
The cases, first reported in May, raise concern that the resistant strain may spread, leaving doctors without their preferred treatment for influenza. GlaxoSmithKline Plc (GSK)’s Relenza drug is effective against the mutant strain, which is still found in the Newcastle area, according to the World Health Organization’s Collaborating Centre for Influenza in Melbourne.
Continued (click on title for full article)
Australia reports oseltamivir-resistant 2009 H1N1 cluster
Lisa Schnirring * Staff Writer
Aug 26, 2011 (CIDRAP News) – Australian public health officials yesterday reported a cluster of oseltamivir (Tamiflu)-resistant 2009 H1N1 infections, one of the largest to date, centered in one region of New South Wales state.
Between May and August, 25 (14%) of 184 2009 H1N1 cases in the Hunter New England region of New South Wales have shown reduced sensitivity to oseltamivir due to the H275Y mutation, the group said in a report posted on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.
Though smaller clusters of oseltamivir-resistant 2009 H1N1 infections have been detected mainly in healthcare settings where patients were treated with antivirals, none of the 16 patients interviewed so far had been treated with the drug.
Five were hospitalized when specimens were collected, and none had a history of immune suppression, the authors reported. Three of the cases were in pregnant women. None of the patients were admitted to the intensive care unit or died.
Fifteen of the first 16 cases live within a 50-km radius of Newcastle, the regional center.
Further interviews with the patients who had oseltamivir-resistant infections are ongoing, and more detailed virologic analysis of the isolates is under way, according to the report.
Dr Jennifer McKimm-Breschkin, an antiviral expert at Commonwealth Science and Industrial Research Organization in Melbourne, said the Australian cluster is the largest to date involving the H275Y mutation and the 2009 H1N1 virus, Bloomberg News reported yesterday. She said the report suggests that the virus can transmit efficiently and without drug pressure and speculated that a treated patient may have passed the variant on to others.
The World Health Organization (WHO) said in a June surveillance update that the detection rate for oseltamivir-resistant 2009 H1N1 viruses is very low, at 1.5%, based on routine testing at five of its collaborating centers. Overall, the monthly detection rate increased slightly after October 2010, then declined in March. It added that patterns vary at different centers.
Clinical history has also varied by region, the WHO reported. In Japan most oseltamivir-resistant cases involved patients who received treatment of prophylaxis, but in the United Kingdom the percentage of resistant infections with no known exposure to the drug increased from 11% during the 2009-10 season to at least 28% during the 2010-11 season.
Dr Ian Barr, deputy director of the WHO's Collaborating Center for Influenza in Melbourne told Bloomberg that the cluster is only worrisome if it spreads beyond the Newcastle area. "Fortunately, we're heading toward the end of our flu season," he added.
Global update shows some hot spots
In a global influenza update today, the WHO said flu activity in Australia is increasing, based on rising levels of doctors' visits for flu-like illness and the number of lab-confirmed flu infections. It said the 2009 H1N1 virus and influenza B are co-circulating in the country, with varying distribution.
In neighboring New Zealand, where influenza B is the dominant strain, flu activity is at expected levels for this time of year, the WHO said. The Southern Hemisphere's flu season usually runs from May through October.
Flu activity is low in tropical locales, except in a few areas of the Americas, Western Africa, and Southern Asia. Hot spots include Cuba and Honduras, where the influenza A (H3N2) virus is dominant. Flu transmission continues in the Dominican Republic, which is now seeing a larger proportion of influenza B. Elsewhere, flu transmission is increasing in Cameroon, which is reporting mostly influenza B, with some circulation of 2009 H1N1.
The areas of greatest flu activity in South Asia include Bangladesh, India, and Thailand, which are reporting mainly H3N2 with smaller numbers of influenza B and 2009 H1N1.
Northern Hemisphere countries are reporting low or no flu activity, which is typical for the interseasonal period, the WHO said.
US flu markers stay low
In the United States, flu markers showed very low flu activity, with doctors' visits for flu-like activity at 0.5%, putting it well below the 2.5% baseline, the Centers for Disease Control and Prevention (CDC) said today in its report for the week ending Aug 20. Deaths for flu and pneumonia were also well below the baseline for this time of year, and no pediatric flu deaths were reported.
See also:
Aug 25 ProMed post
Aug 26, 2011 (CIDRAP News) – Australian public health officials yesterday reported a cluster of oseltamivir (Tamiflu)-resistant 2009 H1N1 infections, one of the largest to date, centered in one region of New South Wales state.
Between May and August, 25 (14%) of 184 2009 H1N1 cases in the Hunter New England region of New South Wales have shown reduced sensitivity to oseltamivir due to the H275Y mutation, the group said in a report posted on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.
Though smaller clusters of oseltamivir-resistant 2009 H1N1 infections have been detected mainly in healthcare settings where patients were treated with antivirals, none of the 16 patients interviewed so far had been treated with the drug.
Five were hospitalized when specimens were collected, and none had a history of immune suppression, the authors reported. Three of the cases were in pregnant women. None of the patients were admitted to the intensive care unit or died.
Fifteen of the first 16 cases live within a 50-km radius of Newcastle, the regional center.
Further interviews with the patients who had oseltamivir-resistant infections are ongoing, and more detailed virologic analysis of the isolates is under way, according to the report.
Dr Jennifer McKimm-Breschkin, an antiviral expert at Commonwealth Science and Industrial Research Organization in Melbourne, said the Australian cluster is the largest to date involving the H275Y mutation and the 2009 H1N1 virus, Bloomberg News reported yesterday. She said the report suggests that the virus can transmit efficiently and without drug pressure and speculated that a treated patient may have passed the variant on to others.
The World Health Organization (WHO) said in a June surveillance update that the detection rate for oseltamivir-resistant 2009 H1N1 viruses is very low, at 1.5%, based on routine testing at five of its collaborating centers. Overall, the monthly detection rate increased slightly after October 2010, then declined in March. It added that patterns vary at different centers.
Clinical history has also varied by region, the WHO reported. In Japan most oseltamivir-resistant cases involved patients who received treatment of prophylaxis, but in the United Kingdom the percentage of resistant infections with no known exposure to the drug increased from 11% during the 2009-10 season to at least 28% during the 2010-11 season.
Dr Ian Barr, deputy director of the WHO's Collaborating Center for Influenza in Melbourne told Bloomberg that the cluster is only worrisome if it spreads beyond the Newcastle area. "Fortunately, we're heading toward the end of our flu season," he added.
Global update shows some hot spots
In a global influenza update today, the WHO said flu activity in Australia is increasing, based on rising levels of doctors' visits for flu-like illness and the number of lab-confirmed flu infections. It said the 2009 H1N1 virus and influenza B are co-circulating in the country, with varying distribution.
In neighboring New Zealand, where influenza B is the dominant strain, flu activity is at expected levels for this time of year, the WHO said. The Southern Hemisphere's flu season usually runs from May through October.
Flu activity is low in tropical locales, except in a few areas of the Americas, Western Africa, and Southern Asia. Hot spots include Cuba and Honduras, where the influenza A (H3N2) virus is dominant. Flu transmission continues in the Dominican Republic, which is now seeing a larger proportion of influenza B. Elsewhere, flu transmission is increasing in Cameroon, which is reporting mostly influenza B, with some circulation of 2009 H1N1.
The areas of greatest flu activity in South Asia include Bangladesh, India, and Thailand, which are reporting mainly H3N2 with smaller numbers of influenza B and 2009 H1N1.
Northern Hemisphere countries are reporting low or no flu activity, which is typical for the interseasonal period, the WHO said.
US flu markers stay low
In the United States, flu markers showed very low flu activity, with doctors' visits for flu-like activity at 0.5%, putting it well below the 2.5% baseline, the Centers for Disease Control and Prevention (CDC) said today in its report for the week ending Aug 20. Deaths for flu and pneumonia were also well below the baseline for this time of year, and no pediatric flu deaths were reported.
See also:
Aug 25 ProMed post
Wednesday, August 24, 2011
Six-year-old dies of bird flu in Cambodia: WHO
The child, from eastern Kampong Cham province, died on August 14 after contracting H5N1 avian influenza, the health ministry and WHO said in a joint statement.
"The girl is the 18th person in Cambodia to become infected with the H5N1 virus and the 16th to die from complications of the disease," since 2005 they said, adding that she had been in contact with sick or dead poultry before falling ill.
All eight of Cambodia's bird flu cases since January have been fatal. Seven of the victims were children.
The H5N1 strain of avian influenza has killed 331 people worldwide since 2003, the statement said
AI Landa Sinjai
Eastern Tribune - Wednesday, August 24, 2011 22:38
Sinjai, Tribun-TIMUR.COM - a huge number of chicken farms in six villages in the District of North Sinjai, Sinjai regency, South Sulawesi, reportedly hit by bird flu virus. Kelurahan is, sub Bongki, Balangnipa, Lappa, Biringere, and AlehanuaE and Lamatti Rilau.
Of the six villages, recorded two commercial farms were affected. Hundreds of chickens owned by residents were reported dead.
A number of chickens that examined the team from the Animal Husbandry Department was sentenced Sinjai tested positive for H5N1 virus. After reporting the death of chickens crow, the other events popping up with the same case, the sudden death of chickens
Sinjai, Tribun-TIMUR.COM - a huge number of chicken farms in six villages in the District of North Sinjai, Sinjai regency, South Sulawesi, reportedly hit by bird flu virus. Kelurahan is, sub Bongki, Balangnipa, Lappa, Biringere, and AlehanuaE and Lamatti Rilau.
Of the six villages, recorded two commercial farms were affected. Hundreds of chickens owned by residents were reported dead.
A number of chickens that examined the team from the Animal Husbandry Department was sentenced Sinjai tested positive for H5N1 virus. After reporting the death of chickens crow, the other events popping up with the same case, the sudden death of chickens
Monday, August 22, 2011
40 Cambodian kids die of dengue fever in first 7 months
Monday, 22 August 2011 16:59 DAP-NEWS
PHNOM PENH, Aug. 22 (Xinhua) -- Forty Cambodian children died of dengue fever in the first seven months of this year, an increase from 37 such deaths in whole last year, Minister of Health Mam Bunheng said Monday.
From January to July this year, some 7,867 cases of dengue fever had been reported, exceeding the whole year 2010 of 5,497 cases, the minister told reporters during visit to dengue fever patients at the National Pediatric Hospital in Phnom Penh.
"The disease has claimed more Cambodian children's lives this year than in last year, so I'd like to appeal to parents to let their children sleep under mosquito nets and if their kids have symptom that is suspicious of the disease, they should urgently send them for medical attention," he said.
Dengue is an infectious tropical disease caused by the dengue virus. Symptoms include headache, fever, exhaustion, severe muscle and joint pain, swollen glands and rash.
In Cambodia, the outbreak of dengue fever usually takes place in the rainy season from May to October.
Cambodia: Concern over eighth bird flu death this year
Health officials yesterday called for increased vigilance following the latest death from bird flu, the eighth so far this year and the 17th since the H5N1 virus was first detected in a person in Cambodia in 2005. Every case this year has been fatal.
The latest victim, a six-year-old girl from a village in Kampong Cham province, had died on August 14, the Ministry of Health said on Friday.
She developed symptoms of the disease on August 7 after having been in contact with sick poultry, but was not admitted to hospital until August 12, the ministry said.
“We are concerned about the very high mortality rate. The situation calls for vigilance,” Dr Nima Asgari, a public health specialist at the World Health Organisation, said yesterday.
He added, however, that health officials’ biggest concern, transmission of the virus from one person to another, had not yet occurred.
Moreover, no mutations in the virus had been detected.
Cases of bird flu during the rainy season were not consistent with patterns from previous years, when the threat of bird flu was restricted to the dry season, Dr Asgari said.
Srou Sroeurn, an animal health expert at Kampong Cham’s Agricultural Department, said a swift response was under way.
Officials had sprayed disinfectant at 105 homes in Taing Thloeung village, in Batheay district’s Mepring commune, where the girl had contracted the disease, he said.
Chickens and ducks had also been tested for the disease, and transport of poultry in the area has been suspended.
More than 1,500 village health volunteers and village livestock volunteers had been alerted to increase their monitoring of dead or sick poultry and report any cases immediately, Srou Sroeurn said.
Dr Sok Touch, director of the communicable disease control department at the Ministry of Health, said 15 people in the village had been tested last week but none were infected.
Dr Asgari said his officials were working closely with the ministry to find ways to increase public awareness of H5N1.
“People are forgetting about avian influenza,” he said. “People should not be eating dead or sick chickens.”
The latest victim, a six-year-old girl from a village in Kampong Cham province, had died on August 14, the Ministry of Health said on Friday.
She developed symptoms of the disease on August 7 after having been in contact with sick poultry, but was not admitted to hospital until August 12, the ministry said.
“We are concerned about the very high mortality rate. The situation calls for vigilance,” Dr Nima Asgari, a public health specialist at the World Health Organisation, said yesterday.
He added, however, that health officials’ biggest concern, transmission of the virus from one person to another, had not yet occurred.
Moreover, no mutations in the virus had been detected.
Cases of bird flu during the rainy season were not consistent with patterns from previous years, when the threat of bird flu was restricted to the dry season, Dr Asgari said.
Srou Sroeurn, an animal health expert at Kampong Cham’s Agricultural Department, said a swift response was under way.
Officials had sprayed disinfectant at 105 homes in Taing Thloeung village, in Batheay district’s Mepring commune, where the girl had contracted the disease, he said.
Chickens and ducks had also been tested for the disease, and transport of poultry in the area has been suspended.
More than 1,500 village health volunteers and village livestock volunteers had been alerted to increase their monitoring of dead or sick poultry and report any cases immediately, Srou Sroeurn said.
Dr Sok Touch, director of the communicable disease control department at the Ministry of Health, said 15 people in the village had been tested last week but none were infected.
Dr Asgari said his officials were working closely with the ministry to find ways to increase public awareness of H5N1.
“People are forgetting about avian influenza,” he said. “People should not be eating dead or sick chickens.”
Saturday, August 20, 2011
Hot bird flu in central Vietnam
From the beginning of the year, the province of Quang Tri several outbreaks occur in poultry farming in Hai Lang district, Vinh Linh, Gio Linh. Beginning in June alone, there have been four outbreaks of avian flock of 7 on 9 households in Hai Lang district and Gio Linh district.
By this time in Quang Tri province has more than 23,000 children have been infected poultry culled. Next time, SDAH Quang Tri continue vaccinating 1 million doses of vaccine in poultry in all districts and cities in the province, especially in risk areas of high bird flu outbreak. Information on VNA.
By this time in Quang Tri province has more than 23,000 children have been infected poultry culled. Next time, SDAH Quang Tri continue vaccinating 1 million doses of vaccine in poultry in all districts and cities in the province, especially in risk areas of high bird flu outbreak. Information on VNA.
CDC Asks to Sample Virginia Waters for Deadly Amoebaba
Published August 20, 2011
RICHMOND, Va. – Federal authorities are asking for samples of Virginia waterways in an attempt to develop a test for detecting deadly microscopic amoeba.
Health officials say two children and a young man nationwide have died this summer from a fatal infection known as primary amoebic meningoencephalitis stemming from a brain-eating amoeba that lives in water.This month, a 9-year-old Virginia boy died a week after he went to a fishing day camp. Christian Alexander Strickland had visited several bodies of water during
The Richmond Times-Dispatch reports that The Centers for Disease Control and Prevention is asking Virginia for help to sample waters for Naegleria fowleri.
The free-living amoeba gets up the nose, burrows up into the skull and destroys brain tissue. It's found in warm lakes and rivers during the hot summer months, mostly in the South."It's a terrible disease that we would like to know more about and be able to tell the public more about from a prevention standpoint," said Michael Beach, the federal agency's associate director for healthy water. "We are trying to learn more, but it's a tough one because it's such a rare occurrence."
It's a medical mystery why some people who swim in amoeba-containing water get the fatal nervous system condition while many others don't, experts say."That's the million-dollar question," he said. "We have no idea."....
Vietnam: Prevention H5N1 Hanoi
"Management" tight to prevent disease outbreaks in poultry
Hanoi Department of Animal Health and Veterinary Station facilities have enhanced inspection of eggs supply, sanitation and veterinary facility for professional organizations and hatching eggs, providing bulk seed to farmers in Hanoi and other provinces and neighboring cities.
Department of Animal Health in Hanoi, said: In the area of poultry production scale in suburban areas, farmers tend to expand farming, increasing rapidly to meet market demand in the months. However, before the weather with rain and sunshine mix, very high humidity caused disease outbreaks in the herds. In recent days, bird flu has reappeared in several provinces to farmers in Hanoi as not subjective, neglected stage of disease prevention for pets.
Therefore, the Hanoi Department of Animal Health and Veterinary Station facilities have enhanced inspection of eggs supply, sanitation and veterinary facility for professional organizations and hatching eggs, provided large number of seeds to farmers in Hanoi and other provinces and neighboring cities. Also timely handling of cases of transportation and trading of poultry and poultry products of unknown origin, did not have enough valid quarantine certificate and suspension facilities hatching eggs are not eligible veterinary hygiene
Particularly in Phu Xuyen district, where more than 100 establishments specialized in breeding birds on a large scale, Department of Animal Health in Hanoi to coordinate with local government training for all under-hatched regulations the law on veterinary services, hygienic conditions during the import of poultry eggs, hatching into the oven and selling animals.
Hanoi Department of Animal Health and Veterinary Department suggested the provinces and neighboring cities shall regularly exchange information about the disease situation, a list of households specializing in transportation of cattle, poultry in Hanoi and from Hanoi to other provinces as well as large numbers of violations for coordinated management.
According to the Department of Veterinary City: Hanoi which provide seed sources for large poultry breeding areas of the capital and provinces nearby. Only in Phu Xuyen district - which they call the "oven" to provide the same bird under the largest has almost 500 incubators are operating at full capacity, each year provides hundreds of thousands of birds like the country farmers
Friday, August 19, 2011
Cambodian girl dies from H5N1 infection
Lisa Schnirring 
Aug 19, 2011 (CIDRAP News) – Cambodia's health ministry has confirmed that a 6-year-old girl died from an H5N1 avian influenza infection, the World Health Organization (WHO) announced today.
The girl, from Kampong Cham province in eastern Cambodia, got sick Aug 7 and was first treated by local healthcare providers, the WHO said. After her condition didn't improve she was admitted to Kantha Bopha Children's Hospital in Phnom Penh on Aug 12, where she died 2 days later.
Her infection and death raise Cambodia's H5N1 toll to 18 cases and 16 deaths, the WHO said.
Cambodia has reported eight H5N1 cases this year, all of them fatal. Though a recent report from German researchers noted that the overall case-fatality rate for the disease has declined over the past 5 years, it has been lethal in Cambodia, which reported its first cases in 2005 and has had only two patients who survived their infections.
Cambodia's latest case raises the world's H5N1 total to 565 cases, which include 331 deaths.
An investigation into the source of the girl's illness suggests that she had been exposed to sick poultry. There were recent reports of poultry die-offs in the girl's village.
National and local response teams are conducting an outbreak investigation, according to the WHO report. So far none of the girl's contacts have tested positive for the H5N1 virus.
Tuesday, August 16, 2011
World too complacent on bird flu
Last week, Egyptian officials reported to the World Health Organization that a 6-year-old girl was successfully treated for avian influenza, which she is suspected to have contracted as a result of exposure to diseased poultry. A week earlier Cambodian officials confirmed that a 4-year-old girl from a farming village in that country died of avian influenza after being exposed to an infected chicken. According to World Health Organization statistics, these girls are the 563rd and 564th humans to be infected with bird flu, and the Cambodian girl was the 330th to die of it.
Most remarkable about these cases are just how unremarkable it has become to learn that bird flu has jumped the species barrier. When it first became apparent that avian influenza took a human life in Hong Kong in 1997, it was big news. The Centers for Disease Control and Prevention mobilized experts to conduct an on-site investigation. WHO officials went into crisis mode. And newspapers around the world reported on the events.Since then, bird flu has become endemic among poultry in many countries, including China, Indonesia, Egypt and Vietnam, and it has killed nearly 60 percent of the humans it has infected. Nonetheless, the reports during the past two weeks of two recent infections and another death raised little concern except among public health officials.
The fact that bird flu in developing nations receives little public attention reveals that the world has become complacent about this threat. Not that we have been sitting idle. Countries have pledged more than $4 billion to combating bird flu since 2005, and developing nations have....
Vietnam - Avian influenza outbreaks have very high risk
16/08/2011 20:55:00
Spray disinfection of poultry trade in the region.
At its meeting the National Steering Committee for Avian Influenza Prevention pm 16 / 8, Hoang Van Nam, Director General for Animal Health warned that the risk of outbreak of new bird flu outbreak in this period is very high if the local does not control the outbreak, lax supervision of shipping and integrated disease prevention.
Weather changes, unexpected developments in the many poultry reduced resistance also causes an increased risk of contributing to the spread of disease.
Steering Committee of local requirements enhance communication to farmers, trade, slaughter and consumption of poultry to reduce risk behaviors arise and spread. Also, the local implementation of synchronous prevention services such as livestock biosecurity, hygiene organizations, disinfection, sterilization livestock sector, the transport, slaughter and trade in poultry market especially from areas with outbreaks.
So far, the country also two provincial bird flu is less than 21 days Nghe An and Quang Tri.
In Nghe An, translations appeared in 11 communes and towns of the four Nghi Loc district, Dien Chau, Yen Thanh Hung Nguyen, and with the total number of birds killed and destroyed more than 8,000 children. In Quang Tri, avian influenza appears in the small farming households in Gio Linh district of the total bird deaths and the destruction of nearly 1,000. Avian influenza occurs in the two provinces mainly on ducks.
Ministry of Agriculture and Rural Development has made two provinces on vaccines for RE5 to serve prevention.
As reported by the Veterinary Department, blue ear disease and foot and mouth disease in cattle is temporarily controlled the whole country, not a locality notice is translated.
Spray disinfection of poultry trade in the region.
At its meeting the National Steering Committee for Avian Influenza Prevention pm 16 / 8, Hoang Van Nam, Director General for Animal Health warned that the risk of outbreak of new bird flu outbreak in this period is very high if the local does not control the outbreak, lax supervision of shipping and integrated disease prevention.
Weather changes, unexpected developments in the many poultry reduced resistance also causes an increased risk of contributing to the spread of disease.
Steering Committee of local requirements enhance communication to farmers, trade, slaughter and consumption of poultry to reduce risk behaviors arise and spread. Also, the local implementation of synchronous prevention services such as livestock biosecurity, hygiene organizations, disinfection, sterilization livestock sector, the transport, slaughter and trade in poultry market especially from areas with outbreaks.
So far, the country also two provincial bird flu is less than 21 days Nghe An and Quang Tri.
In Nghe An, translations appeared in 11 communes and towns of the four Nghi Loc district, Dien Chau, Yen Thanh Hung Nguyen, and with the total number of birds killed and destroyed more than 8,000 children. In Quang Tri, avian influenza appears in the small farming households in Gio Linh district of the total bird deaths and the destruction of nearly 1,000. Avian influenza occurs in the two provinces mainly on ducks.
Ministry of Agriculture and Rural Development has made two provinces on vaccines for RE5 to serve prevention.
As reported by the Veterinary Department, blue ear disease and foot and mouth disease in cattle is temporarily controlled the whole country, not a locality notice is translated.
Avian influenza outbreak in eight communes and towns of Quang Politics
SDAH Ha Tinh province, said the province has more than five million birds, but more than a million children have been vaccinated by the lack of bird flu vaccine. Room service initiative, the province increased control of the trading and transportation of poultry from the province of Nghe An and Quang Binh. National Highway 1A, set up two checkpoints in the south of Ben Thuy bridge, north of Pass Horizontal. At the same time ending up second in Tien Son commune, Huong Son Commune Lien Minh, Duc Tho district of Ho Chi Minh. As of 16-8, the area eight communes and towns, the two districts of Gio Linh and Hai Lang (Quang Tri) has more than 23 thousand poultry deaths and destruction caused by avian influenza. In the village States Truc, Quang Gio (Gio Linh) appear more new outbreak on a flock of 600 children households. Through the test results positive for influenza virus H5N1.Chi provincial Veterinary Bureau has coordinated the districts to monitor and monitored flocks, prohibits the sale and transportation of poultry from areas.
More than 23,000 avian influenza A/H5N1 infection
Tuesday, 16/08/2011 18:04
ANTD - 16-8 Day, from Veterinary Bureau said Quang Tri Province, to the present time the province had 23,120 birds have died and destruction caused by influenza A/H5N1 infection. The number of infected poultry is concentrated in eight communes and towns in two districts of Gio Linh and Hai Lang.
Shortly after the outbreak, SDAH Quang Tri was quickly coordinate with the local implementing disease control measures, the total destruction of infected poultry; emergency vaccination on herd animals in two districts of Gio Linh Hai Lang and simultaneously prepare for vaccinating the entire poultry in the province.
By this time, Hai Lang district did not detect more poultry outbreaks, Gio Linh district separately discovered a new outbreak on the household's flock 600 Hoang Van Vinh village States Architecture, Gio Quang, check survey results were positive for H5N1 virus.
The Quang Tri province is leading the local monitoring and surveillance of poultry at local, prohibited the sale and transportation of poultry in the epidemic areas, conduct and reporting process as soon as you sign Disease name
ANTD - 16-8 Day, from Veterinary Bureau said Quang Tri Province, to the present time the province had 23,120 birds have died and destruction caused by influenza A/H5N1 infection. The number of infected poultry is concentrated in eight communes and towns in two districts of Gio Linh and Hai Lang.
Shortly after the outbreak, SDAH Quang Tri was quickly coordinate with the local implementing disease control measures, the total destruction of infected poultry; emergency vaccination on herd animals in two districts of Gio Linh Hai Lang and simultaneously prepare for vaccinating the entire poultry in the province.
By this time, Hai Lang district did not detect more poultry outbreaks, Gio Linh district separately discovered a new outbreak on the household's flock 600 Hoang Van Vinh village States Architecture, Gio Quang, check survey results were positive for H5N1 virus.
The Quang Tri province is leading the local monitoring and surveillance of poultry at local, prohibited the sale and transportation of poultry in the epidemic areas, conduct and reporting process as soon as you sign Disease name
Eurosurvellance: Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases
Eurosurveillance, Volume 16, Issue 32, 11 August 2011
Research articles
Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases, September 2006 to August 2010
L Fiebig ()1,2, J Soyka1,2, S Buda1, U Buchholz1, M Dehnert1, W Haas1
Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
These authors contributed equally to this article
Excerpt:
Case fatality
Fifty-six percent (132/235) of confirmed cases died. The CFR differed across countries ranging from 28% (27/98) in Egypt to 87% (71/82) in Indonesia. The cCFR and the 19-month rCFR indicated a decline in case fatality over the study period (Figure 1). Whereas the cCFR was little affected by the outcome of new cases and had only slightly decreased, the rCFR had steeply declined in the period from April 2008 to April 2009. Until mid 2008, a large proportion of cases occurred in Indonesia (country with highest CFR) and shifted thereafter to Egypt (country with lowest CFR). Accordingly, country-specific rCFRs for Indonesia and Egypt were less steep than the overall rCFR. The 19-months rCFR was privileged as it was less affected by case-free periods than rCFRs calculated over shorter periods (not shown).
In Egypt, fatal cases had a median age of 25 years, which was, at significant level, higher than the age of cases who survived (four years, p<0.001; Table 2). The CFR in Egypt was significantly higher in women than in men, (39% (22/56) vs 12% (5/42) respectively, p=0.003), which was not observed elsewhere (China: 63% (5/8) in women vs 70% (7/10) in men, p=1.0; Indonesia: 84% (43/51) vs 90% (28/31), p=0.521; Vietnam: 58% (7/12) vs 69% (9/13), p=0.688; remaining countries: 80% (4/5) vs 40% (2/5), p=0.524, respectively).
A significant difference in time from symptom onset to hospitalisation between survivors and fatal cases was only found in Egypt (one day vs four and a half days respectively, p=0.001, Table 3). All 19 cases worldwide hospitalised eight days after symptom onset or later had died.
Figure 3 shows the CFR in function of the time from symptom onset to hospitalisation, stratified by Egypt and Asian countries (grouped).
Figure 3. Time from confirmed avian influenza A(H5N1) human cases’ symptom onset to hospitalisation and case fatality rate stratified for Egypt and Asian countries, September 2006–August 2010 (n=197)
The median time from symptom onset to death was nine days (N=118), irrespective of the patients’ sex (p=0.605), and without significant difference across age groups (p=0.564, data not shown) or reporting countries (p=0.213).
The multivariable logistic regression revealed that odds of fatal outcome increased by 33% with each day that passed from symptom onset until hospitalisation (OR: 1.33, 95% CI: 1.11–1.60, p=0.002). In relation to children of 0–9 years, odds of fatal outcome were more than six times higher in 10–19 year-olds and 20–29 year-olds (OR: 6.06, 95% CI: 1.89–19.48, p=0.002 and OR: 6.16, 95% CI: 2.05–18.53, p=0.001, respectively), and nearly five times higher in patients of 30 years and older (OR: 4.71, 95% CI: 1.56–14.27, p=0.006).
Using Indonesia as a reference, odds of dying were lower elsewhere, namely by 92% in Egypt (OR: 0.08, 95% CI: 0.03–0.22, p<0.001), by 81% in China (OR: 0.19, 95% CI: 0.04–0.90, p=0.036), and by 79% in Vietnam (OR: 0.21, 95% CI: 0.06–0.75, p=0.016), but not in the grouped remaining countries (OR: 0.23, 95% CI: 0.04–1.27, p=0.091). Exposure to poultry was not significant and none of the interaction terms significantly improved the model fit. They were thus not retained in the final model.
Discussion and conclusions
With this study, we summarised the current global AI situation in humans. It is, to our knowledge, the first study that not only analysed human AI cases worldwide on the basis of a line list collected over several years but in addition made these case-based data available online. We found that a longer delay from symptom onset to hospital admission and belonging to older age groups were associated with higher mortality in AI patients, and that the situation in Egypt differed markedly from other countries with highest AI incidences in children and lowest CFR.
With our line list, cumulative case numbers published by WHO [4] could be largely reproduced: 235 of 256 WHO confirmed cases (92%) and additional 59 unconfirmed cases were captured between September 2006 and August 2010. The identified median reporting delay of 11 days after symptom onset may partly be explained by a deferred presentation to healthcare facilities as well as by the time needed for pathogen confirmation. About 52% of confirmed cases had been reported elsewhere in a median of three days prior to the WHO report. Because delays in availability of information could hamper investigations of the source of infection and of clusters of human cases [30], it could be beneficial to report and document probable cases in parallel with confirmed ones [31].
Confirmed cases had a median age of 18 years, which is consistent with earlier findings, although investigation periods and affected countries varied [2,19,21]. The identified predominance of female cases in Indonesia and Egypt and the low age median among Egyptian cases support findings from previous studies [2,23-25]. Schroedl [32] examined the mean age of cases in Egypt over four seasons between August 2006 and July 2009 and found a declining age-based pattern over time, but did not address sex-specific differences. We found, in line with other studies, a significantly older age of female cases than male cases, whose proportion had increased since 2008 in Egypt [24,25]. Chen et al., analysing AI cases worldwide before June 2006, also identified sex-specific differences in the age-groups of 4 to 6 years (95% male) and 25 to 30 years (83% female) [33]. They assumed particularly high levels of exposure in pre-school boys playing outdoors and housewives taking care of fowl and frequenting live markets. Fasina et al. suggested a similar explanation for the situation in Egypt [25].
Ninety-six percent of the cases had reportedly direct or indirect contact to potentially infected poultry, recognised as the most important risk factor for humans AI [8,34]. The WHO Clinical Case summary Form [35], where e.g. “poultry” can be checked as “most likely source of infection” has enhanced the systematic collection of information since 2007. However, currently reported information yields little insights into the actual source of infection and the intensity and quality of exposure needed to infect humans [36-38].
The median time from symptom onset to hospitalisation was four days, which is remarkably stable when compared to earlier studies [19,21]. If time to hospital admission is regarded as an indicator for monitoring case management and patients’ awareness [31], no progress would be evident from a global perspective so far.
The cases’ average CFR was 56%, which is widely consistent with findings from earlier investigation periods [2,19,23]. Using a 19-month rolling CFR, we found a clear decrease in case fatality, which persisted when stratifying for Egypt and Indonesia. It could thus not simply be explained by a predominance of Egyptian cases since 2009. Regarding the decreasing CFR in Egypt, Schroedl [32] suggested that the circulating AI virus strain may have become less virulent and more apt to spreading among children.
Analytical results revealed lowest odds of dying for Egyptian cases, even when adjusted for age, sex and time to hospitalisation. Thus, the high proportion of survivors in Egypt cannot be entirely explained – as often assumed – by sex-specific differences in CFR [21,24] and the high proportion of children among AI patients in Egypt [5], as well as short delays from symptom onset to hospitalisation [25].
It cannot be ruled out, that different virus clades circulating in Egypt (clade 2.2) and Asia (clades 2.1 and 2.3) shape the country-specific epidemiological features [2,23]. Differences in CFR across countries and changes over time might also partly be explained by differences in intensity and quality of exposure, health-seeking behaviour, reporting attitudes, overall performance of the surveillance system, and access to diagnostics and medical care [23,27,39,40], such as the time to start of oseltamivir treatment, the antiviral recommend by WHO for human infections with AI virus [2]. However, country-specific details on its administration are widely unknown and it remains controversial up to how many days after symptom onset the application of the antiviral reduces mortality [30,41]. In our study all patients hospitalised eight or more days after symptom onset died. This suggests a rather narrow time window for antiviral drug administration.
Our study was solely based on data from publicly available case reports and is subject to several limitations. Our monitoring instrument was only entirely implemented in August 2006 and thus trend analyses were not exploited to its full extent. Within the used reports, negative values, e.g. “case not hospitalised”, were not systematically mentioned, which may lead to biases. Time specifications, e.g. on dates of exposure or hospitalisation, needed for time-to-event analyses, were often incomplete. Case reports did not systematically contain details on medical care and specific antiviral treatment. Therefore, analyses were restricted to “hospitalisation” as general indicator for access to medical care. Given the sparse information on possible contact with infected individuals and clusters of human AI cases available from the serial reports within the investigated period, clusters could not be evaluated as initially planned. Other studies reporting on clustered cases had mostly accessed additional case-investigation reports and patient interviews [23,30]. We based our analyses on WHO confirmed cases, although unconfirmed cases had been recorded in our line list, due to lacking information for probable and suspected cases. Including probable cases in our analyses did, however, not change the cases’ sex ratio or CFR substantially when compared to confirmed cases only.
Our study points out that data extracted from the public domain already yields pertinent epidemiological information for assessing the current situation and developments of AI in humans. A line list format as provided would enhance the analysability of key data, their updating, and the evaluation of variables needed. Several countries monitor the global AI situation, whether they currently face human AI cases, e.g. Egypt [25], or not, e.g. France [27]. This indicates a common interest in data and if they were directly provided in such format, this would help to save time and resources for public health authorities and researchers.
A line list needs to be flexible in view of potential new information to be entered. New variables and parameter values might come up, when the minimum dataset suggested Bird and Farrar [31] on direct and indirect exposures to avian influenza A(H5N1) confirmed and non-confirmed poultry and human exposures would be implemented or when results from prospective studies involving exposed and unexposed individuals as designed by Kayali et al. [34] are available. Unconfirmed cases would ideally be recorded as systematically as confirmed cases, either in a common or separate database as suggested by Bird and Farrar [31].
Presenting cases in the format of a line list is not a goal in itself, but a prerequisite for targeting surveillance and identifying risk factors, as well as a starting point for prospective studies, e.g. investigating potential human-to-human transmission, the transmissibility of avian influenza viruses, and host-related factors including age-dependent immunity in humans [33,42].
We would like to encourage that an anonymised case-based database for AI in humans is directly placed publicly and continuously updated, e.g. by an internationally renowned organisation such as WHO. Open access to analysable data might accelerate the identification and implementation of research questions and surveillance priorities and thus enhance our understanding of – still mostly fatal – AI in humans and permit the rapid detection of epidemiological changes with implications for human health.
[Click on title for full document]
Research articles
Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases, September 2006 to August 2010
L Fiebig ()1,2, J Soyka1,2, S Buda1, U Buchholz1, M Dehnert1, W Haas1
Robert Koch Institute, Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Berlin, Germany
These authors contributed equally to this article
Excerpt:
Case fatality
Fifty-six percent (132/235) of confirmed cases died. The CFR differed across countries ranging from 28% (27/98) in Egypt to 87% (71/82) in Indonesia. The cCFR and the 19-month rCFR indicated a decline in case fatality over the study period (Figure 1). Whereas the cCFR was little affected by the outcome of new cases and had only slightly decreased, the rCFR had steeply declined in the period from April 2008 to April 2009. Until mid 2008, a large proportion of cases occurred in Indonesia (country with highest CFR) and shifted thereafter to Egypt (country with lowest CFR). Accordingly, country-specific rCFRs for Indonesia and Egypt were less steep than the overall rCFR. The 19-months rCFR was privileged as it was less affected by case-free periods than rCFRs calculated over shorter periods (not shown).
In Egypt, fatal cases had a median age of 25 years, which was, at significant level, higher than the age of cases who survived (four years, p<0.001; Table 2). The CFR in Egypt was significantly higher in women than in men, (39% (22/56) vs 12% (5/42) respectively, p=0.003), which was not observed elsewhere (China: 63% (5/8) in women vs 70% (7/10) in men, p=1.0; Indonesia: 84% (43/51) vs 90% (28/31), p=0.521; Vietnam: 58% (7/12) vs 69% (9/13), p=0.688; remaining countries: 80% (4/5) vs 40% (2/5), p=0.524, respectively).
A significant difference in time from symptom onset to hospitalisation between survivors and fatal cases was only found in Egypt (one day vs four and a half days respectively, p=0.001, Table 3). All 19 cases worldwide hospitalised eight days after symptom onset or later had died.
Figure 3 shows the CFR in function of the time from symptom onset to hospitalisation, stratified by Egypt and Asian countries (grouped).
Figure 3. Time from confirmed avian influenza A(H5N1) human cases’ symptom onset to hospitalisation and case fatality rate stratified for Egypt and Asian countries, September 2006–August 2010 (n=197)
The median time from symptom onset to death was nine days (N=118), irrespective of the patients’ sex (p=0.605), and without significant difference across age groups (p=0.564, data not shown) or reporting countries (p=0.213).
The multivariable logistic regression revealed that odds of fatal outcome increased by 33% with each day that passed from symptom onset until hospitalisation (OR: 1.33, 95% CI: 1.11–1.60, p=0.002). In relation to children of 0–9 years, odds of fatal outcome were more than six times higher in 10–19 year-olds and 20–29 year-olds (OR: 6.06, 95% CI: 1.89–19.48, p=0.002 and OR: 6.16, 95% CI: 2.05–18.53, p=0.001, respectively), and nearly five times higher in patients of 30 years and older (OR: 4.71, 95% CI: 1.56–14.27, p=0.006).
Using Indonesia as a reference, odds of dying were lower elsewhere, namely by 92% in Egypt (OR: 0.08, 95% CI: 0.03–0.22, p<0.001), by 81% in China (OR: 0.19, 95% CI: 0.04–0.90, p=0.036), and by 79% in Vietnam (OR: 0.21, 95% CI: 0.06–0.75, p=0.016), but not in the grouped remaining countries (OR: 0.23, 95% CI: 0.04–1.27, p=0.091). Exposure to poultry was not significant and none of the interaction terms significantly improved the model fit. They were thus not retained in the final model.
Discussion and conclusions
With this study, we summarised the current global AI situation in humans. It is, to our knowledge, the first study that not only analysed human AI cases worldwide on the basis of a line list collected over several years but in addition made these case-based data available online. We found that a longer delay from symptom onset to hospital admission and belonging to older age groups were associated with higher mortality in AI patients, and that the situation in Egypt differed markedly from other countries with highest AI incidences in children and lowest CFR.
With our line list, cumulative case numbers published by WHO [4] could be largely reproduced: 235 of 256 WHO confirmed cases (92%) and additional 59 unconfirmed cases were captured between September 2006 and August 2010. The identified median reporting delay of 11 days after symptom onset may partly be explained by a deferred presentation to healthcare facilities as well as by the time needed for pathogen confirmation. About 52% of confirmed cases had been reported elsewhere in a median of three days prior to the WHO report. Because delays in availability of information could hamper investigations of the source of infection and of clusters of human cases [30], it could be beneficial to report and document probable cases in parallel with confirmed ones [31].
Confirmed cases had a median age of 18 years, which is consistent with earlier findings, although investigation periods and affected countries varied [2,19,21]. The identified predominance of female cases in Indonesia and Egypt and the low age median among Egyptian cases support findings from previous studies [2,23-25]. Schroedl [32] examined the mean age of cases in Egypt over four seasons between August 2006 and July 2009 and found a declining age-based pattern over time, but did not address sex-specific differences. We found, in line with other studies, a significantly older age of female cases than male cases, whose proportion had increased since 2008 in Egypt [24,25]. Chen et al., analysing AI cases worldwide before June 2006, also identified sex-specific differences in the age-groups of 4 to 6 years (95% male) and 25 to 30 years (83% female) [33]. They assumed particularly high levels of exposure in pre-school boys playing outdoors and housewives taking care of fowl and frequenting live markets. Fasina et al. suggested a similar explanation for the situation in Egypt [25].
Ninety-six percent of the cases had reportedly direct or indirect contact to potentially infected poultry, recognised as the most important risk factor for humans AI [8,34]. The WHO Clinical Case summary Form [35], where e.g. “poultry” can be checked as “most likely source of infection” has enhanced the systematic collection of information since 2007. However, currently reported information yields little insights into the actual source of infection and the intensity and quality of exposure needed to infect humans [36-38].
The median time from symptom onset to hospitalisation was four days, which is remarkably stable when compared to earlier studies [19,21]. If time to hospital admission is regarded as an indicator for monitoring case management and patients’ awareness [31], no progress would be evident from a global perspective so far.
The cases’ average CFR was 56%, which is widely consistent with findings from earlier investigation periods [2,19,23]. Using a 19-month rolling CFR, we found a clear decrease in case fatality, which persisted when stratifying for Egypt and Indonesia. It could thus not simply be explained by a predominance of Egyptian cases since 2009. Regarding the decreasing CFR in Egypt, Schroedl [32] suggested that the circulating AI virus strain may have become less virulent and more apt to spreading among children.
Analytical results revealed lowest odds of dying for Egyptian cases, even when adjusted for age, sex and time to hospitalisation. Thus, the high proportion of survivors in Egypt cannot be entirely explained – as often assumed – by sex-specific differences in CFR [21,24] and the high proportion of children among AI patients in Egypt [5], as well as short delays from symptom onset to hospitalisation [25].
It cannot be ruled out, that different virus clades circulating in Egypt (clade 2.2) and Asia (clades 2.1 and 2.3) shape the country-specific epidemiological features [2,23]. Differences in CFR across countries and changes over time might also partly be explained by differences in intensity and quality of exposure, health-seeking behaviour, reporting attitudes, overall performance of the surveillance system, and access to diagnostics and medical care [23,27,39,40], such as the time to start of oseltamivir treatment, the antiviral recommend by WHO for human infections with AI virus [2]. However, country-specific details on its administration are widely unknown and it remains controversial up to how many days after symptom onset the application of the antiviral reduces mortality [30,41]. In our study all patients hospitalised eight or more days after symptom onset died. This suggests a rather narrow time window for antiviral drug administration.
Our study was solely based on data from publicly available case reports and is subject to several limitations. Our monitoring instrument was only entirely implemented in August 2006 and thus trend analyses were not exploited to its full extent. Within the used reports, negative values, e.g. “case not hospitalised”, were not systematically mentioned, which may lead to biases. Time specifications, e.g. on dates of exposure or hospitalisation, needed for time-to-event analyses, were often incomplete. Case reports did not systematically contain details on medical care and specific antiviral treatment. Therefore, analyses were restricted to “hospitalisation” as general indicator for access to medical care. Given the sparse information on possible contact with infected individuals and clusters of human AI cases available from the serial reports within the investigated period, clusters could not be evaluated as initially planned. Other studies reporting on clustered cases had mostly accessed additional case-investigation reports and patient interviews [23,30]. We based our analyses on WHO confirmed cases, although unconfirmed cases had been recorded in our line list, due to lacking information for probable and suspected cases. Including probable cases in our analyses did, however, not change the cases’ sex ratio or CFR substantially when compared to confirmed cases only.
Our study points out that data extracted from the public domain already yields pertinent epidemiological information for assessing the current situation and developments of AI in humans. A line list format as provided would enhance the analysability of key data, their updating, and the evaluation of variables needed. Several countries monitor the global AI situation, whether they currently face human AI cases, e.g. Egypt [25], or not, e.g. France [27]. This indicates a common interest in data and if they were directly provided in such format, this would help to save time and resources for public health authorities and researchers.
A line list needs to be flexible in view of potential new information to be entered. New variables and parameter values might come up, when the minimum dataset suggested Bird and Farrar [31] on direct and indirect exposures to avian influenza A(H5N1) confirmed and non-confirmed poultry and human exposures would be implemented or when results from prospective studies involving exposed and unexposed individuals as designed by Kayali et al. [34] are available. Unconfirmed cases would ideally be recorded as systematically as confirmed cases, either in a common or separate database as suggested by Bird and Farrar [31].
Presenting cases in the format of a line list is not a goal in itself, but a prerequisite for targeting surveillance and identifying risk factors, as well as a starting point for prospective studies, e.g. investigating potential human-to-human transmission, the transmissibility of avian influenza viruses, and host-related factors including age-dependent immunity in humans [33,42].
We would like to encourage that an anonymised case-based database for AI in humans is directly placed publicly and continuously updated, e.g. by an internationally renowned organisation such as WHO. Open access to analysable data might accelerate the identification and implementation of research questions and surveillance priorities and thus enhance our understanding of – still mostly fatal – AI in humans and permit the rapid detection of epidemiological changes with implications for human health.
[Click on title for full document]
Sunday, August 14, 2011
Vinh Long: Destruction of 2,500 chickens have bird flu.
According to the provincial Veterinary Bureau, has worked with local organizations and destruction of 2,500 chickens was avian households in two communes of Hoi Chanh (Mang Thit district). From this year, the province has nearly 20,000 chickens have bird flu treatment destroyed. However, avian influenza vaccination for chickens phase I/2011 was only 40.8% of the plan (flock reaches 116% of plan).
UAE intensifies efforts to contain cholera in Somalia
15 August 2011
MOGADISHU - As an outbreak of cholera threatened tens of thousands of people fleeing the famine-hit areas of Somalia to pack into the crowded camps in the country’s capital, Mogadishu, the UAE fortified its medical efforts to contain the spread of the epidemic.
UAE’s mobile hospital continued to provide its ambulatory and medical services to the patients in the makeshift camps in and around the capital.
The Emirati mobile hospital has been welcomed as a great humanitarian service by the people in the region and is a worthy addition to the achievements in the vital initiatives of this kind.
The single hospital in Mogadishu is virtually helpless to cope up with the increasing number of patients being brought into it. According to the UN World Health Organisation, several people have died from suspected cholera cases in the hospital in Mogadishu, and there have been many other confirmed cholera outbreaks across the country.
Since the mobile hospital was inaugurated last week, it has visited the refugee camp in the suburbs of Mogadishu to give treatment to more than 820 patients suspected to be suffering from Cholera.
Cholera is caused by a bacteria that infects the small intestine and is spread through dirty water.
It is easily treated with oral rehydration salts and antibiotics. But many health centres in Somalia lack even these basic supplies. As a result, those who get cholera, especially children, can die of dehydration within days or even hours of being infected.
Since day one of its opening, the mobile hospital continues to receive increasing number of patients, many of whom are women and children.
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