Cambodia: Update on 4th Human Case #H5N1

[The 35yo male that died, was also from Kong Pisei district.  He was from Preah Nipean commune.]

Excerpts:
An official on the Ministry of Health’s human influenza hotline and a commune chief said yesterday a two-year-old girl from Kampong Speu was diagnosed with H5N1 on Saturday after being admitted to Kantha Bopha hospital in Phnom Penh, where a 15-year-old girl died of the virus last Monday.

Due to less-rigorous monitoring of the disease in other hospitals, the cases seen in Kantha Bopha hospital were likely just the “tip of the iceberg”, said Dr Philippe Buchy, head of the virology unit at the Institut Pasteur du Cambodge, the medical research centre that tested the recent cases. 

Local health officials had buried the burned birds outside the village, sprayed the village and distributed medicine to eradicate the virus, he said.

Officials in Kong Pisei district’s Prey Nhat commune, in Kampong Speu province, the home of the two-year-old confirmed on Saturday to be the fourth case of the year, were pushing similar measures, according to commune chief Chan Sun.

Sun said a lot of poultry in the commune tended to get sick during the dry season, and officials had told villagers not to cook or touch sick or dead birds.  

“They have to burn and bury the dead poultry,” he said. “We have also prohibited poultry buyers who usually come into the commune from buying chickens in the commune for a while until we are sure everything is safe.”

More than 40 chickens at the infected toddler’s house had fallen sick and died, and, as with the other three cases this month, health officials suspect contact with poultry had caused her to become ill.

“Health officials went to the girl’s and her neighbours’ houses this morning to spray and distribute medicines, and they tested some poultry,” Sun said. 

Cambodia: 4 Human Cases #H5N1 In One Month

PHNOM PENH — Two Cambodians have already died from bird flu in 2013, making a worrying start to the year.

Now a two-year-old Cambodian girl is in a serious condition in Phnom Penh after being hospitalized with the H5N1 virus, also known as avian, or bird, flu.

Sonny Inbaraj Krishnan, the communications officer for the World Health Organization in Phnom Penh, says the development has health professionals concerned.

“This is the fourth case this month of human influenza H5N1," Krishnan said. "Last year we had three cases, so within one month in the new year we've got four cases, and we're quite concerned about that.”
-snip-
Over the weekend officials culled and burned more than 4,000 chickens and ducks in the village that was home to the 15-year-old victim.  
-snip-
“Well our specific worry is that this H5N1 virus could undergo what we call a recombination and then re-assortment with another influenza virus," he explained, "and that could give rise to a new virus that is transmittable between humans - so that’s our main concern.”

Cambodia is a predominantly agricultural nation, and every village has its chickens and ducks. Health ministry staff are monitoring those who came into contact with the patients who were infected, and teams from the agriculture ministry are testing poultry in the affected villages and destroying sick birds.

http://www.voanews.com/content/new-bird-flu-case-raises-fears-in-cambodia/1592100.html 
 

Cambodia Ministry of Health Statement on 1/25/13

 This is a Press release dated 1/25/13. 

Joint Press Release Between The Ministry of Health Kingdom of Cambodia and the World Health Organization (WHO).

The Statement goes on to say the first case was an 8 month old from Chrey Korng Village, Sangkat Chorm Chao, Khan Por Sen Chey, Phnom Penh.  He developed symptoms on 1/8, was brought to the hospital on 1/9, samples were sent on 1/11, with results on 1/22. 

The 2nd case, a 15 year old female was from Snao Village, Snao Commune, Prey Kabass district in Takeo Province.  She becameill on 1/11, was initially treated by a private practitioner, and admitted to hospital on the 1th.  She died on the 21st.

The 3rd case was a 35 year old man from Trapeang Sla village, Preah Nipean commune, Kong Pisey district, Kampong Speu province.  He has his first symptoms on 1/13, was hospitalized on 1/21.  Being treated by a private practitioner beforehand.  He died shortly after the samples were taken, which was on 1/21/13.

There is a campaign underway to educate the public on avian influenza.  They are also checking close contacts, any epidemiological linkage among the three cases.

The whole statement can be found here.

Cambodia: 4th #H5N1 Confirmed Human Death

Photo: Mary Kozlovski/IRIN

Preparing poultry at Phnom Penh's Orussey market

PHNOM PENH, 28 January 2013 (IRIN) - Health authorities in Cambodia will bolster public awareness campaigns on H5N1 avian influenza after four people became infected in January, resulting in two fatalities.

“Ongoing public awareness campaigns need to be reinforced through TV and radio,” Sok Touch, director of Cambodia’s Communicable Disease Control Department (CDC), told IRIN on 28 January, calling on people to be vigilant. “We’re planning on doing this immediately as there is no room for complacency.”

The four cases of H5N1 avian influenza, commonly known as bird flu, are the first confirmed in Cambodia this year. There were three recorded cases (all fatal) in 2012.

Since 2005, 24 people have been infected resulting in 21 deaths, according to WHO, with over half of the infections in children under 14.

According to a joint statement from the Ministry of Health and World Health Organization (WHO) on 25 January, an eight-month-old boy from the capital Phnom Penh recovered after being infected with bird flu, while a 15-year-old girl from southwestern Takeo Province and a 35-year-old man from southwestern Kampong Speu Province died after contracting the virus.

The CDC said the boy had contact with chickens at a market, but the girl from Takeo and the man from Kampong Speu both fell ill after cooking dead chickens gathered from their villages.

A fourth case, also in Kampong Speu, was confirmed by the Ministry of Health on 27 January, when a 17-month-old girl tested positive for H5N1.
“We are working closely with the Ministry of Health to enhance surveillance of H5N1,” said Sonny Krishnan, communications officer with WHO in Phnom Penh, adding that WHO did not know yet if there was a link between the cases of the girl and 35-year-old man.

“We just did a map of the two communes and they’re not far from each other, so there could be an indication of a movement of poultry," Krishnan said.

Philippe Buchy, head of virology at the Pasteur Institute in Phnom Penh, said the best way to avoid further infections was to contain infected poultry, which is complicated in Cambodia.

“The country is large, there is not the surveillance required; a lot of resources [that are needed]... are not available to monitor clearly the poultry deaths everywhere, especially in a country where most of the production is backyard,” he said.

An earlier report by the UN Food and Agriculture Organization (FAO) indicated that chickens are kept by 90-95 percent of rural households, providing an important source of protein and livelihoods for millions.

According to WHO, since 2003, there have been 613 laboratory confirmed cases of H5N1 with 362 related deaths worldwide.

mk/ds/cb

Egypt: "Agricultural production" Shura demanding Ptfl veterinary supervision on poultry farms & cattle

Arabic Translation:
1/28/13

Committee called the Shura Council's agricultural production, to activate the implementation of Ministerial Decree No. 58 of 1982 on the conditions for the establishment of farms raising cattle and poultry, to ensure full veterinary supervision on these farms and to ensure early warning before any crisis of epidemic proportions. 

This came during a committee meeting today under the chairmanship of Mr. sad, to discuss a proposal submitted by the desire MP Dr. Yasser Hammoud on veterinary supervision on the farm. 

MP in the proposal need to ensure the safety of bio-farms and healthy food access safe for the citizens. 
He noted that the government had halted work this decision when he was Dr. Youssef Wali, minister of agriculture in 1985, which led to the spread of the plague among cattle, while veterinary supervision limit. 

He explained that when the bird flu appeared in 2006 caused the lack of veterinary supervision and quarantine enough in the presence of 300 epicenter of the disease, which is causing losses estimated in the billions on Egypt's economy. 

For his part, Dr. Osama Salim chief of veterinary services, the importance of increasing awareness of the importance of veterinary supervision under the reform of the system of veterinary in the entire farm. 

In turn, noted Dr. Khalid Mansour, head of the Livestock Development, Ministry of Agriculture, it does not have to download more of its energy farms Belzamh veterinary supervision costs.

Notes from the Field: Emergence of New Norovirus Strain GII.4 Sydney — United States, 2012

[You can find Informational links on the Norovirus along the right side-bar of the blog]

January 25, 2013 / 62(03);55-55


Noroviruses are the leading cause of epidemic gastroenteritis, including foodborne outbreaks, in the United States (1). Hospitalization and mortality associated with norovirus infection occur most frequently among elderly persons, young children, and immunocompromised patients. Noroviruses belong to the family Caliciviridae and can be grouped into five genogroups (GI through GV), which are further divided into at least 34 genotypes. Human disease primarily is caused by GI and GII noroviruses, with most outbreaks caused by GII.4 strains (1). During the past decade, new GII.4 strains have emerged every 2–3 years, replacing previously predominant GII.4 strains. Emergence of these new norovirus strains has often, but not always, led to increased outbreak activity. For example, the previously dominant GII.4 New Orleans strain was not associated with increased norovirus outbreak activity in the United States (2). CDC collects information on norovirus strains associated with outbreaks in the United States through an electronic laboratory surveillance network called CaliciNet (3). This report documents the recent emergence of a new GII.4 strain, GII.4 Sydney, which caused most (53%) of the norovirus outbreaks reported through CaliciNet during September–December 2012. Continued surveillance will enable further assessment of the public health implications and significance of this new strain.
In March 2012, a new GII.4 norovirus strain was identified in Australia. Named GII.4 Sydney, this emergent strain has since caused acute gastroenteritis outbreaks in multiple countries (4). In the United Kingdom, an early onset of the 2012 winter norovirus season was reported in association with emergence of GII.4 Sydney as the dominant strain implicated in outbreaks.* In the United States, GII.4 Sydney has spread rapidly nationwide, causing an increasing number of outbreaks. During September–December 2012, a total of 141 (53%) of the 266 norovirus outbreaks reported to CaliciNet were caused by GII.4 Sydney. The other outbreaks were caused by 10 different GI and GII genotypes, including GII.4 New Orleans. A statistically significant increase in the proportion of outbreaks caused by GII.4 Sydney was noted: four (19%) of 21 outbreaks in September 2012; 22 (46%) of 48 in October 2012; 70 (58%) of 120 in November 2012; and 45 (58%) of 77 in December 2012† (chi-square test for trend; p<0.01). Most (72 [51%]) of these GII.4 Sydney outbreaks resulted from direct person-to-person transmission; 29 (20%) were foodborne, one (1%) was waterborne, and the transmission mode was unknown in 39 (28%) of the outbreaks. Long-term–care facilities and restaurants were the most frequently reported settings, accounting for 91 (65%) and 18 (13%) of the GII.4 Sydney outbreaks, respectively. During the three previous winters, the peak in reported norovirus outbreaks occurred in January; therefore, at present, it is too early to make an assessment of the relative magnitude of the current season.
GII.4 noroviruses remain the predominant cause of norovirus outbreaks, and the GII.4 Sydney strain appears to have replaced the previously predominant strain, GII.4 New Orleans. Compared with other norovirus genotypes, GII.4 noroviruses have been associated with increased rates of hospitalizations and deaths during outbreaks (5). Health-care providers and public health practitioners should remain vigilant to the potential for increased norovirus activity in the ongoing season related to the emergent GII.4 Sydney strain. Continued surveillance for norovirus outbreaks through CaliciNet and additional data on clinical and epidemiologic features of outbreaks collected through the National Outbreak Reporting System (NORS)§ will enable further assessment of the public health implications of the new GII.4 Sydney strain, including any association with increased severity or level of activity in the ongoing 2012–13 winter norovirus season. Proper hand hygiene, environmental disinfection, and isolation of ill persons remain the mainstays of norovirus prevention and control (1).

Reported by

Leslie Barclay, Mary Wikswo, MPH, Nicole Gregoricus, MSPH, Jan Vinjé, PhD, Ben Lopman, PhD, Umesh Parashar, MBBS, Aron Hall, DVM, Div of Viral Diseases, National Center for Immunization and Respiratory Diseases; Eyal Leshem, MD, EIS officer, CDC. Corresponding contributor: Eyal Leshem, eleshem@cdc.gov, 404-639-7251.

References

1. CDC. Updated norovirus outbreak management and disease prevention guidelines. MMWR 2011;60(No. RR-3).
2. Yen C, Wikswo ME, Lopman BA, Vinje J, Parashar UD, Hall AJ. Impact of an emergent norovirus variant in 2009 on norovirus outbreak activity in the United States. Clin Infect Dis 2011;53:568–71.
3. Vega E, Barclay L, Gregoricus N, Williams K, Lee D, Vinje J. Novel surveillance network for norovirus gastroenteritis outbreaks, United States. Emerg Infect Dis 2011;17:1389–95.
4. van Beek J, Ambert-Balay K, Botteldoorn N, et al. Indications for worldwide increased norovirus activity associated with emergence of a new variant of genotype II.4, late 2012. Euro Surveill 2013;18(1).
5. Desai R, Hembree CD, Handel A, et al. Severe outcomes are associated with genogroup 2 genotype 4 norovirus outbreaks: a systematic literature review. Clin Infect Dis 2012;55:189–93.

* Additional information available at http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2013PressReleases/130109Norovirusnewstrain.

† Data for 2012 are incomplete.

§ Additional information available at http://www.cdc.gov/nors. 

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6203a4.htm 

Iraq prohibits the import of poultry and poultry products due to Pandemic Influenza

[Arabic Translation]
Baghdad Jafar Nasrawi
Thursday 24 / January 2013

The Iraqi government announced on preventing the importation of various types of birds, feathers and eggs and poultry products from 21 countries, including Egypt, to hedge against pandemic influenza, attributed to the instructions of the World Animal Health Organization, and its commitment to the safety of the citizens of the injury epidemic that has become a threat to them.

The government said in a statement issued Thursday, and received "The Arabs today," a copy of it, she "decided to ban the import of live birds of prey and whites of both types, table and hatching, and bird feathers and all the materials that go into poultry or poultry products in the installation."

The government added in its statement that "the decision was made based on the last update of the OIE (OIE), which included countries Bangladesh, Bhutan, Cambodia, China, India, Hong Kong, the occupied Palestinian territories, Laos, Myanmar, Egypt, Sri Lanka , Vietnam, Japan, Canada, Germany, South Korea, the Netherlands, South Africa, Indonesia, Nepal and Australia. "

The Iraqi government pointed out, according to the statement, that "the decision was made in order to preserve the integrity of the Iraqi citizen of the transitional disease, which has become a threat to Iraqis.

The spokesman of the Ministry of Health Ziad Tariq, said in a press statement, "said the ministry faced a problem in tackling the spread of the epidemic, caused by lack of health awareness among the citizens to prevent it, indicating that there is a similarity in symptoms between pandemic flu and normal in the initial stages of infection."

The ministry confirmed earlier that the injuries recorded disease Pandemic Influenza "controlled and does not pose a threat" to public health community, and revealed, Tuesday, the 22 of this month, for the registration of 36 cases infected with influenza epidemic in the whole of Iraq, including Two new cases of infection سجلتا in the provinces of Wasit, Karbala.

In a related development, announced Health and Environment Committee in the province of Maysan, (its city of Amarah, 390 km south of Baghdad), on Thursday, wounding six citizens from the province flu epidemic, out of 30 patients questionable in their situation, unexpected increase in the number of cases diagnosed in the next term.

And emerged pandemic influenza for the first time in Iraq in 2009 as the number of injuries this disease 338 of including 49 cases and deaths, while recorded six injuries in 2010, and 177 in 2011, including seven deaths, and 422 injuries in 2012, including two deaths.

Pandemic Influenza is divided into two types first (H5N1), known bird flu, the most lethal, while known as type II less serious, as swine flu (H1N1).

It is noteworthy that several countries in the region, such as Lebanon, Jordan and Palestine, recorded injuries flu epidemic, a wave reached the area during the winter month, and confirms Iraqi health authorities that the epidemic moved to Iraq from neighboring, but the injuries several were recorded in previous years, but was kind of H5N1 bird flu known.

http://www.arabstoday.net/2009-08-28-13-58-22/20130124/389068.html

Iraq: The Woman's Death From Bird Flu Epidemic in Karbala

[Arabic translation]
01.25.2013
woman died pandemic flu disease in the province of Karbala.said Chairman of the Health Committee in the provincial council Hussein al-Aboudi told all of Iraq [where] on Friday, "a woman at the age [50], died in hospital Hussein year the city center after bird flu epidemic. "and added that "an emergency meeting held today circuits health in Karbala to take the necessary measures to reduce the spread of the disease and control it, a committee was formed healthy visited family and the the victim in the area of free northern province, and sampling them for the early detection of infection. "The slave "We possess adequate stocks of medicines for the disease, and the situation is still worrying, and controlled."revealed medical sources reported deaths and injuries to a number of of people ill pandemic influenza [H1 N1] killer known [swine flu] in some provinces of the country.decided the General Secretariat of the Council of Ministers, preventing the importation of live birds and raptors, ornamental birds and eggs of both types [table and hatching] from 21 countries for the prevention of disease transition.For his part, Member of the parliamentary health committee, Jawad Albzona, the Ministry of Health to vaccinate vulnerable segments pandemic flu disease as doctors and nurses, professor and teacher, at the same time demanding the ministry to open centers in the border to check arrivals of Iraq. ended.

http://www.sotaliraq.com/iraq-news.php?id=86128#axzz2IzmmqWoo

WHO: Three new human cases of avian influenza H5N1 in Cambodia in 2013

Joint news release of the Ministry of Health of the Kingdom of Cambodia and World Health Organization

PHNOM PENH, 25 JANUARY 2013 - The Ministry of Health (MoH) of the Kingdom of Cambodia wishes to advise members of the public that three new human cases of avian influenza have been confirmed positive for the H5N1 virus.

The first case, an 8-month old infant boy from Chrey Korng Village, Sangkat Chorm Chao, Khan Por Sen Chey, Phnom Penh has been diagnosed with H5N1 influenza. He developed symptoms on 08th January 2013 then was brought to the National Paediatric Hospital for consultation on 9th January with fever, cough, runny nose, and vomiting. The boy was registered in the Influenza-Like Illness Sentinel Surveillance and the samples were sent to the National Institute of Public Health's laboratory on 11th January. The result was confirmed by Institut Pasteur du Cambodge on 22nd January 2013. The infant has recovered and had history of coming into contact with poultry prior to becoming sick.

The second case, a 15-year-old female from Snao village, Snao commune, Prey Kabass district, Takeo Province, has been diagnosed with H5N1 influenza on 22nd January 2013. She became sick on 11th January suffering with fever and cough. She was initially treated by local private practitioners. Her condition worsened and she was admitted to Kantha Bopha Hospital on 17th January with fever and shortness of breath. Unfortunately, despite intensive medical care, she died on 21st January. There is evidence of recent deaths among poultry in the village and the patient prepared sick chicken for food prior to becoming sick.

In the third case, a 35-year-old man from Trapeang Sla village, Preah Nipean commune, Kong Pisey district, Kampong Speu province has been diagnosed with H5N1 influenza on 23rd January 2013 by Institut Pasteur du Cambodge. He became sick on 13th January, 2013 suffering with fever and cough. He was initially treated by local private practitioners. His condition worsened and he was admitted to the Khmer-Soviet Friendship Hospital in Phnom Penh with fever and dyspnea on 21st January. Samples were taken the same day and sent to the National Institute of Public Health's laboratory. Despite intensive medical care, the patient died soon after the samples were taken. There is evidence of recent deaths among poultry in the village and the patient prepared sick chicken for food prior to becoming sick. The man is the twenty-fourth person in Cambodia to become infected with H5N1 virus, and the third person this year and the twenty-first person to die from complications of the disease. Of all the twenty four cases, 15 were children under 14, and fifteen of the twenty four confirmed cases occurred in females.

"Avian influenza H5N1 is still a threat to the health of Cambodians. This is the three cases of H5N1 infection in human this year, and children still seem to be most vulnerable. I urge parents and guardians to keep children away from sick or dead poultry, discourage them from playing in areas where poultry stay and wash their hands often. If they have fast or difficulty breathing, they should be brought to medical attention at the nearest health facilities and attending physicians be made aware of any exposure to sick or dead poultry." said HE Mam Bunheng, Minister of Health.

The Ministry of Health's Rapid Response Teams (RRT) have gone to the hospitals and the field to identify the patient’s close contacts, any epidemiological linkage among the three cases and initiate preventive treatment as required. In addition, public health education campaigns are being conducted in the villages to inform families on how to protect themselves from contracting avian influenza. The government's message is - wash hands often; keep children away from poultry; keep poultry away from living areas; do not eat sick poultry; and all poultry eaten should be well cooked.

H5N1 influenza is a flu that normally spreads between sick poultry, but it can sometimes spread from poultry to humans. Human H5N1 Avian Influenza is a very serious disease that requires hospitalization. Although the virus currently does not easily spread among humans, if the virus changes it could easily be spread like seasonal influenza. Hence, early recognition of cases is important.

Globally since 2003, there have been 613 laboratory confirmed cases of avian influenza with 362 related deaths.

The Ministry of Health will continue to keep the public informed of developments via the MoH website www.cdcmoh.gov.kh where relevant health education materials can also be downloaded.

For more information on human influenza please call the MoH Influenza Hotline numbers:

115 (free call); 012 488 981 or 089 669 567

or contact:

Ministry of Health
Dr Sok Touch: Tel +855 12 856 848
Dr Ly Sovann: Tel +855 12 825 424

World Health Organization
Dr Pieter JM van Maaren: Tel +855 23 216 610
Dr Reiko Tsuyuoka: Tel +855 23 216 610

http://www.wpro.who.int/mediacentre/releases/2013/20130125/en/index.html 

Cambodia: #H5N1 Two Human Deaths in Past 8 Days

25 January 2013
 
Two Cambodians have died from avian influenza (H5N1) in the past eight days.

The victims were a 15-year-old girl from Smao village, in the Prey Kabass district of Takeo province, and a 35-year-old man from Trapeang Sla village, in Kampong Speu province’s Kong Pisey district, the Ministry of Health and the World Health Organisation said today.

The man was the 24th person in Cambodia to become infected with the H5N1 virus. All but three of the victims have died.

Fifteen of the 24 reported cases were children under the age of 14. 

“Avian influenza is still a threat to the health of Cambodians, and children still seem to be the most vulnerable,” Health Minister Mam Bunheng said.
 
“I urge parents and guardians to keep children away from sick or dead poultry, discourage them from playing in areas where poultry stay and wash their hands often.
 
“If they have difficulty breathing, they should be brought to the nearest health facility.”
 
Ministry of Health rapid-response teams were identifying the latest victims’ close contacts, looking for any epidemiological link between the cases and initiating preventive treatment, Bunheng said.

 

Cambodia 2 Human 2 Deaths in Provinces Takeo & Kampong Speu

WHO and Cambodia's health ministry announced Friday that a 15-year-old girl in a village in southeastern Takeo province and a 35-year-old man in central Kampong Speu province died after being hospitalized with H5N1, better known as bird flu. An 8-month-old boy in the capital, Phnom Penh, was treated and survived.

Read more: http://www.ctvnews.ca/health/cambodia-reports-3-new-bird-flu-cases-in-2013-2-fatal-1.1129007#ixzz2IzX9kMJo

Two Cambodians die from bird flu after preparing infected chicken: WHO

Jan 25, 2013

PHNOM PENH (AFP) - Two Cambodians have died from bird flu contracted while preparing infected chicken, the World Health Organisation (WHO) said today.

Tests on the victims, a 15-year-old girl and a 35-year-old man who died earlier this week, confirmed they had contracted the H5N1 strain of avian influenza, the WHO said in a joint statement with the Cambodian health ministry.

An eight-month-old boy admitted to hospital in Phnom Penh on Jan 9 was also infected with H5N1 but later recovered, the statement said.

There was evidence of infections among poultry in the villages of the two who died and the pair "prepared sick chicken for food prior to becoming sick", the statement said.

http://www.straitstimes.com/breaking-news/se-asia/story/two-cambodians-die-bird-flu-after-preparing-infected-chicken-who-2013012

Yum's chicken in China contained excessive levels of drugs - Xinhua

January 25, 2013
Excerpts:
SHANGHAI (Reuters) - Chicken sold to KFC's parent Yum Brands Inc in China contained excessive levels of chemicals, the official Xinhua news agency reported on Friday, escalating a month-long food scare that has hit Yum's sales in its biggest market.
-snip-
Yum and McDonald's Corp's have come under intense scrutiny from local media since the official China Central Television reported in late December that some of the chicken supplied to them contained excess amounts of antiviral drugs and hormones used to accelerate growth.

On investigating, the Shanghai Food and Drug Administration found the levels of antibiotics and steroids in KFC chicken were safe, though the watchdog found a suspicious level of an antiviral drug in one of the eight samples tested.

http://finance.yahoo.com/news/yums-chicken-china-contained-excessive-102759992.html?l=1

Seasonal Flu: Indiana Up To 40 Deaths from 21 Deaths on 1/15

Previousy posted here:

January 15, 2013
[I reported on January 9th, 10 deaths in Indiana.  That post is located here.  Today,, 6 days later,  I report 21 dead.]

INDIANAPOLIS - The number of flu-related deaths in Indiana jumped to 21 on Monday, state health officials said.

Two children are among those who have succumbed to the illness, which has infected thousands across the country.

 
January 23, 2013

Flu death toll rises to 40 in Indiana

Flu has claimed the lives of another 13 people in the state this week and five in Marion County alone, Indiana health officials report, which brings the total death toll this season to 40. -snip-
Thirty-eight of those who died had underlying medical conditions and some had multiple problems. Fourteen of those who died had received the flu vaccine, 10 had not, and vaccination status was not known for the other 16, the state's report said.

All of those who died in the past week were adults, 11 of them over the age of 65. This season there have been two flu-related child deaths.

Full article:  http://www.indystar.com/article/20130123/NEWS/301230332/Flu-death-toll-rises-40-Indiana