WHO: Antigenic and genetic characteristics of influenza A(H5N1) and influenza A(H9N2) viruses for the development of candidate vaccine viruses for pan

Excerpts (click on title for full PDF file)

Influenza A(H5N1)
Since 2003, highly pathogenic avian influenza A(H5N1) viruses have become enzootic in some countries and continue to cause outbreaks in poultry as well as sporadic human infections. The A(H5N1) viruses have diversified both genetically and antigenically leading to the need for multiple candidate vaccine viruses for pandemic preparedness purposes.

Despite the emergence of the pandemic 2009 influenza A(H1N1) [A(H1N1)pdm09]2 viruses, the zoonotic and pandemic threats posed by A(H5N1) viruses remain. This summary provides an update on the characterization of A(H5N1) viruses isolated from birds and humans, and the current status of the development of candidate A(H5N1) vaccine viruses.
-snip-
Influenza A(H5N1) activity from 27 September 2010 to 15 February 2011
A(H5N1) viruses have been detected in birds in Africa and Asia. Human infections have been reported to WHO from Cambodia, China Hong Kong Special Administrative Region (Hong Kong SAR), Egypt and Indonesia, countries, areas or territories that have also reported infections in birds (Table 1).

Antigenic and genetic characteristics
A nomenclature for phylogenetic relationships among the haemagglutinin (HA) genes of A(H5N1) viruses was devised in consultation with representatives of the Food and
Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and WHO. This nomenclature is updated when new genetic clades emerge and can be found on WHO website3.
Viruses characterized from 27 September 2010 to 15 February 2011 belonged to the
following clades.
-snip-
Clade 2.3.2 viruses were detected in wild birds in Hong Kong SAR, Japan and Republic of Korea, and in poultry in Japan, Nepal, Republic of Korea and Viet Nam. A human case was also detected in Hong Kong SAR. Although the recent viruses are genetically similar to viruses isolated in 2009 and 2010, viruses within clade 2.3.2 form two distinct phylogenetic groups represented by A/Hubei/1/2010 and A/barn swallow/Hong Kong/D10-1161/2010
(Figure 3). The human case from Hong Kong SAR in 2010 belonged to the A/Hubei/1/2010 group. Antigenically, the clade 2.3.2 viruses are heterogeneous and not all viruses react well to postinfection ferret antiserum raised to the candidate vaccine virus A/common
magpie/Hong Kong/5052/2007 (Table 3).
-snip-
Influenza A(H5N1) candidate vaccine viruses
Based on the current antigenic, genetic and epidemiological data, further clade 2.3.2 candidate vaccine viruses are recommended. Candidate vaccine viruses based on an A/Hubei/1/2010-like virus and an A/barn swallow/Hong Kong/D10-1161/2010-like virus are proposed. The available candidate A(H5N1) vaccine viruses are listed in Table 4. On the basis of the geographical spread, epidemiology and antigenic and genetic properties of the A(H5N1) viruses, national authorities may recommend the use of one or more of these candidate vaccine viruses for pilot lot vaccine production, clinical trials and stockpiling of A(H5N1) vaccines.

For pandemic preparedness purposes, new A(H5N1) candidate vaccine viruses will be
developed as the viruses continue to evolve and announced as they become available.
Institutions, companies and others who wish to receive these candidate vaccine viruses
should contact the WHO Global Influenza Programme at GISN@who.int or the institutions
listed in announcements published on the WHO website4.
-snip-
[Click on image to enlarge]

Bird flu deaths in Asia prompt call for scrutiny

Aug 30, 2011 5:24pm IST

(Reuters) - Virologists warned on Tuesday that there was no vaccine against a mutant strain of H5N1 bird flu now spreading in China and Vietnam and called for closer monitoring of the disease in poultry and wild birds to stop it spreading to people....

While scientists are uncertain if this new strain -- called H5N1-2.3.2.1 -- is more virulent in people, they said it was different enough from its predecessor to escape a human H5N1 vaccine that can tackle the parent strain....

"H5N1 cases in Cambodia always have high mortality because they are detected late," Peiris told Reuters in an interview."It doesn't necessarily indicate that this particular virus strain is more virulent to humans. But it is a threat because it has become more widespread globally."

UN issues mutant bird flu warning

August 30, 2011 21:21:04
The United Nations has warned of a possible major resurgence of the deadly bird flu virus and the spread of a mutant strain in Asia and elsewhere. VIDEO AT LINK.

Aussies urged to avoid chickens in Asia

• August 30, 2011 5:48PM

AUSTRALIANS travelling to South-East Asia are advised to avoid contact with live chickens following a UN warning about bird flu.

The UN's Food and Agricultural Organisation on Tuesday said there were signs that a mutant strain of H5N1 was spreading in Asia.

One person has died in August in Cambodia, where the infection has killed another seven people this year.

Bangladesh, China, Egypt, India, Indonesia, Vietnam and Laos are also susceptible, health experts say.

The World Health Organisation Collaborating Centre for Reference and Research on Influenza has urged Australians travelling to southeast Asia to be careful.

"They should avoid wet markets ... selling poultry or live birds," the centre's Melbourne-based deputy director Ian Barr said.

Dr Barr said the chance of catching bird flu in Asia was low "but not zero".

"I don't think we need to be unnecessarily alarmed by this," he said.

Still, Nobel-prize winner Professor Peter Doherty, from the University of Melbourne's department of microbiology and immunology, said a global bird flu pandemic was possible.

"This is a dangerous situation," the former Australian of the Year said in a statement.

"The continued exposure of humans and pigs could lead to the emergence of a mutant, or a reassorted H5N1 virus, that could spread between people and trigger a global pandemic."

More info on the H5N1 mutation

‘The general departure from the progressive decline in 2004-2008 could mean that there will be a flare-up of H5N1 this fall and winter, with people unexpectedly finding the virus in their backyard,’ Lubroth said in a statement.

But leading microbiologist, Professor Hugh Pennington, says that while there is no evidence that the flu is yet mutating to spread from person to person it is a 'reasonable speculation' that it has become resistant to Tamiflu - the main drug used in the UK to fight the virus.

The British and Scottish Governments spent over £100m on over 50 million doses of Tamiflu - enough for 80 per cent of the population

The emeritus professor of bacteriology at Aberdeen University had warned last year that deadly flu pandemics with special antiviral drugs could create an even more dangerous, untreatable 'superflu' after the UK expanded anti-viral stocks from 35 million to 50 million.

The Scottish government's effort to combat a possible pandemic is also heavily reliant on Tamiflu, an oral drug produced by the Swiss manufacturer Roche, despite warnings that it may be ineffective.

"Tamiflu should only be given to high risk cases. I think it is a reasonable speculation to make - given the new reports - that Tamiflu has been handed out inappropriately and the virus has developed a resistance to it. If that is the case that would mean that the UK's stocks of the drug would be largely ineffective,' said Professor Pennington.

'The idea that Tamiflu was a cure-all was plainly wrong.

'There is no need to panic yet because there is no evidence that the virus is spreading person to person and there are other anti-virals - such as Relenza - that do have an effect.

'There is also no evidence that the virus is becoming vaccine resistant. A new vaccine will have to be made, but that is to be expected. Flu is always changing and it would be staggering if this flu didn't. Vaccines have to be constantly updated.'

However, the UK Government has stockpiled only about ten million doses of Relenza and it is more difficult to take. While Tamiflu can be swallowed as a pill at home, Relenza is a powder that must be administered with an inhaler, normally under medical supervision.

But Professor Pennington warned that stocks of Relenza had to be increased. 'We have to get as much Relenza as possible because we don't know how effective Tamiflu will be,' he said.

'With flu the best advice is to prepare for the worst and hope for the best.'

Prof. Pennington, a past president of the General Society for Microbiology, said it was also 'impossible' to predict when this year's flu would strike.

Dr Steve Gamblin, the joint head of molecular structure at the National Institute for Medical Research, has also previously warned that the mutation renders Tamiflu about 250 times less effective than it should be.

Sir William Stewart, the chairman of the Health Protection Agency, has also said that the widespread use of antiviral drugs to treat illnesses, including bird flu and seasonal influenza, is causing- viruses to mutate into drug-resistant-forms.

He has claimed that drug-resistant viruses now represented as big a threat to public health as antibiotic-resistant superbug bacteria, such as MRSA.

Concerns that a pandemic flu virus might develop resistance to Tamiflu first emerged in 2005, after reports from Vietnam that H5N1 virus was showing signs of decreased sensitivity to the drug.

Vietnam: H5N1 Clade 2.3.2 Article from July (translation)

Previous post:

[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]

Here is an article from July 21, 2011:

H5N1 flu recurrence in the North
RFA 21.07.2011

The recurrence of bird flu across the two northern provinces - Phu Tho and Quang Tri.

At the Public commune, Ha Hoa district, Phu Tho, flu re-emerged again from July 10. Within 11 days, there were 2 thousand 300 birds infected with H5N1 influenza and died.

In Quang Tri, the virus appeared on July 6. Until now, local destruction of two thousand two hundred chickens, ducks infected.

Especially as the test bird flu samples in the two places are for a positive result with the new clade 2.3.2 viruses (called branch 2). The virus appeared last year and there is no preventive vaccine. According to experts, this new type of virus usually occurs in the northern provinces, while the virus clade 1 (old branch) still appear in the South.

Vietnam monitored the H5N1 virus changes

[Translated out of Vietnam]
Nam Nguyen, RFA reporter

2011-08-29

Veterinary Industry of Vietnam react to warnings of the UN Food and Agriculture Organization of the avian influenza virus can transform serious outbreak.

Nam Nguyen exchange rapidly with Dr. Van register, Head of Epidemiology Department of Animal Health of Vietnam, from Hanoi, said Dr. Van Sign:

TS Application for registration: bird flu vaccine now has problems of epidemiological characteristics, the virus has changed is the H5N1 clade (branch) 2.3.2 China has done the vaccine. This problem is very high risk, if you are not monitoring for early detection processing time, it will be spread without the vaccine will be very dangerous.

From May 9 / 2010 H5N1 virus had changed, before bird flu virus circulating in Vietnam and China are clade clade 2.3.4 is now 2.3.2. This is a very important issue, said a pandemic would spread to the extent it is not so, but still alert.

Nam Nguyen said Vietnam Information has stopped vaccinating poultry in northern and central ... what about in the South actually like?

TS Application for registration: The problem is that scientists find anti-viral vaccine for this new clade. We are interested in whether a vaccine to be prepared for vaccination because of round 1 round 2 were not vaccinated then. Now bird flu vaccines primarily given to the southern provinces, because this area is the virus H5N1 clade 1 vaccine-RE5 is effective vaccination. We have vaccinated 50 million doses and prepare 60 million doses needed for phase 2.

Wait for new vaccines

Nam Nguyen: The spread between regions in Vietnam are unavoidable as happened in the past, vaccinating older types can be wasteful and inefficient?

TS Application for registration: This is for the North instead! South vaccine still works normally be vaccinated against epidemic and in the South is the next vaccination and sampling to check the virus in the South is changing or not. We reported the minister (MARD) Epidemiological features of virus circulation in the South is still the clade 1 has been vaccinated. Particularly clade 2.3.2 does not work, we stop injecting, we're waiting to see China has devised the new vaccine or not either Mexico or another country are more domestic vaccine research. This is a problem we are interested in leading.

Nam Nguyen: Dear Dr., in the context of the current avian influenza was detected changes in the North is no longer vaccinated, while in the South is still vaccination. So the fact Vietnam is dealing with the risk of bird flu outbreaks like?

TS Application for registration: Of course now no longer a vaccine is to monitor their time ... occur in small outbreaks, but their findings will collapse sooner or recompiled. We have reported outbreaks in Phu Tho, we found early and treated immediately, it does not spread further to other places. There is no prophylactic vaccine, the problem is that we must strengthen surveillance systems, early detection, treatment destroyed immediately, but if we neglect to spread to other places where it will spread into higher great service. More than a year we do not have any outbreak of bird flu spreading to humans, so I think virulent virus to infect people was not high, so the past may no patients infected with H5N1.

Nam Nguyen: Thank you, Dr. Van registration interview.

Recombinomics: FAO Warns of Fujian H5N1 Spread In China and Vietnam

Recombinomics Commentary 14:20
August 29, 2011

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.

The above comments are in an FAO announcement warning of the spread of Fujian clade 2.3 (sub-clade 2.3.2.1), which was reported in the spring of 2008 in outbreaks in poultry in South Korea and Russia, as well as whooper swans in northern Japan. The sub-clade has a clade 2.3.2 HA reassorted with other genes from clade 2.3.4. This sub-clade was reported earlier in Hong Kong, and the spread to northern Japan, Korea and Russia raised concerns that it would migrate to Mongolia in the summer of 2008.

Sequences analysis confirmed this migration, and identified recombinants between clade 2.2.1 in Egypt and clade 2.3.2 in wild birds. Clade 2.3.2 was subsequently confirmed in poultry in Romania and a wild bird in Bulgaria.

The most recent public sequences are from a Feb 2011 isolate from a chicken in Vietnam, but this HA sequence is related to a 2010 human case in China (A/Hubei/01/2010). WHO has published an HA phylogenetic analysis, which includes the Hubei sequence, as well as poultry sequences from Vietnam. The is no current H5N1 vaccine against human clade 2.3.2 sequences, although the Hubei sequence has been selected as a candidate.

Full sequences for all 8 gene segments of the Hubei isolate are available at GISAID, and these sequences confirm matches with wild bird sequences from 2008.

Release of 2011 human sequences from China and southeast Asia would be useful.

S. Korea: H5N1 Found in Migratory Birds in 2011

It appears that the H5N1 2.3.2 clade has already entered S. Korea.
Excerpt from previous FAO article:

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.
http://pandemicinformationnews.blogspot.com/2011/08/fao-bird-flu-rears-its-head-again.html#links

Virus Res. 2011 Jul 12. [Epub ahead of print]
Genetic characterization and pathogenicity assessment of highly pathogenic H5N1 avian influenza viruses isolated from migratory wild birds in 2011, South Korea.

Kwon HI, Song MS, Pascua PN, Baek YH, Lee JH, Hong SP, Rho JB, Kim JK, Poo H, Kim CJ, Choi YK.
Source

College of Medicine and Medical Research Institute, Chungbuk National University, 12 Gaeshin-Dong Heungduk-Ku, Cheongju 361-763, Republic of Korea.
Abstract

The continued spread of a highly pathogenic avian influenza (HPAI) H5N1 virus among wild birds and poultry has posed a potential threat to human public health. In the present study, we report the isolation of HPAI H5N1 viruses (A/Md/Korea/W401/11 and A/Md/Korea/W404/11) from fecal samples of migratory birds. Genetic and phlyogenetic analyses demonstrated that these viruses are genetically identical possessing gene segments from avian virus origin and showing highest sequence similarities (as high as 99.8%) to A/Ws/Hokkaido/4/11 and 2009-2010 Mongolian-like clade 2.3.2 isolates rather than previous Korean H5N1 viruses. Both viruses possess the polybasic motif (QRERRRK/R) in HA but other genes did not bear additional virulence markers. Pathogenicity of A/Md/Korea/W401/11 was assessed and compared with a 2006 clade 2.2 HPAI H5N1 migratory bird isolate (A/EM/Korea/W149/06) in chickens, ducks, mice and ferrets. Experimental infection in these hosts showed that both viruses have high pathogenic potential in chickens (2.3-3.0LD(50)s) and mice (3.3-3.9LD(50)s), but A/Md/Korea/W401/11 was less pathogenic in duck and ferret models. Despite recovery of both infection viruses in the upper respiratory tract, efficient ferret-to-ferret transmission was not observed. These data suggest that the 2011 Korean HPAI wild bird H5N1 virus could replicate in mammalian hosts without pre-adaptation but could not sustain subsequent infection. This study highlights the role of migratory birds in the perpetuation and spread of HPAI H5N1 viruses in Far-East Asia. With the changing pathobiology caused by H5N1 viruses among wild and poultry birds, continued surveillance of influenza viruses among migratory bird species remains crucial for effective monitoring of high-pathogenicity or pandemic influenza viruses.

Copyright © 2011. Published by Elsevier B.V.

PMID:

21782862

[PubMed - as supplied by publisher]

hat-tip Giuseppi Michieli

FAO Warns of Spread of Fujian H5N1 Mutation

Another post on the FAO Alert, from Scott McPherson's Web Presence. One of my favorite sites. Thanks Scott! It's good to see you posting on H5N1 again.

Click on title for full article

Posted on Monday, August 29, 2011
Back in 2008, flublogia announced the origins of a new clade, or substrain, of bird flu. And I joined right in, proclaiming that the new clade -- nicknamed "Fujian," after the province where it was subtyped -- would eventually cause major problems. The best blog of mine that I could remember on the topic, from 2008, can be read here. You might also be entertained by my original blog on the Chinese H2H case involving Fujian H5N1, here. I know I was; I have forgotten half of this stuff!

Fujian H5N1 was the cause of the father-to-son (or was it son-to-father) Chinese H2H infection back in 2008. The arrival of simultaneous Fujian B2B and H2H bird flu was extremely troubling to all of us.

[continued]

Additional Article regarding Bird Flu Virus Signs of Mutant Strain

From the Washington Post:

UN warns of possible resurgence of bird flu virus, signs a mutant strain spreading in Asia
Click on title for full article

FAO: Bird Flu rears its head again - Increased preparedness and surveillance urged against variant strain

[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."

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

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.

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

Six-year-old dies of bird flu in Cambodia: WHO

PHNOM PENH — A six-year-old Cambodian girl has become the eighth person to die from bird flu in the country this year, the World Health Organization (WHO) said Wednesday.

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

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.”