ICEID: Another H5N1 Seroprevalence Study To Ponder

 

 

# 6218

This week I hope to highlight some of the ICEID 2012 abstracts (see ICEID 2012: Abstracts & Program) of particular interest to Flublogians.

 

With the recent controversy over the seroprevalence of H5N1 virus (see Science: Peter Palese On The CFR of H5N1 & mBio: Mammalian-Transmissible H5N1 Influenza: Facts and Perspective) we’ve seen estimates ranging from there being relatively few undetected human cases of H5N1 infection to `millions’.

 

If there are mild or subclinical infections with the virus going undetected, the best way to find them is to look for antibodies in the blood of those who have had substantial exposure to poultry.

 

Which is precisely what researchers at International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Bangladesh’s Institute of Epidemiology, Disease Control and Research (IEDCR), and the CDC did.

 

They performed microneutralization assays on workers from 89 poultry farms with confirmed H5N1 outbreaks and 3 live bird markets reporting high poultry mortality to detect neutralizing antibodies in sera using A/Bangladesh/207095/2008 (H5N1).

 

The following abstract can be found on page 116 of the 2012 ICEID Abstract, I’ve just excerpted the conclusion.

 

Board 183. Sero-prevalence of H5N1 Antibodies among Poultry Workers in Bangladesh, 2008–2009

S. Nasreen, S.U. Khan, E. Azziz-Baumgartner, K. Hancock, J.M. Katz, V Veguilla, D. Wang , M. Rahman, A. Alamgir, E.S. Gurley, K. Sturm-Ramirez T.M. Uyeki , S.P. Luby

Conclusions: Despite extensive poultry
exposures, no serological evidence of H5N1 virus infection was found among farm or market poultry workers during 2008-09.

However, the recent cases of human H5N1 infection detected in Bangladesh and the continued circulation of H5N1 among poultry warrants continued surveillance among a larger cohort of poultry workers to monitor the risk of avian-to-human H5N1 virus transmission.

 

 

It should be noted that since the beginning of the year, Bangladesh has detected 3 H5N1 infections among live poultry market workers through routine surveillance (see IEDCR On The Bangladesh H5N1 Cases).

 

All appear to have had mild to moderate illness, and have recovered.

 

With multiple clades of the H5N1 virus in circulation around the world - and constantly mutating - what may have been true in 2009 may not hold true today. 

So ongoing seroprevalence studies in Bangladesh, and other regions where the virus is endemic, are sorely needed.

»» Read More

IEDCR On The Bangladesh H5N1 Cases

 

 

# 6198

 

Last week we learned of a the detection of the H5N1 virus in a vendor at a live bird market in Bangladesh (see Bangladesh: Reporting Their 4t/h H5N1 Case), making the 4th known case from that nation.

 

Yesterday a number of websites carried a news report (see Crofsblog Bangladesh: 3 market workers infected with H5N1 on the detection of 2 more cases. 

 

Since then, I’ve attempted to access Bangladesh’s IEDCR (Institute of Epidemiology, Disease Control & Research) to get more information, but their website has been offline until this morning.

 

While their site is running unusually slow, we now have access, and as you’ll see by the screen shot below, avian influenza is suddenly a hot topic.

 

 

The 2nd entry (Fifth and Sixth H5N1 Human Case In Bangladesh) is brief.

 

Fifth and Sixth H5N1 human case in Bangladesh

Two cases of Influenza H5N1 has been reported from the same surveillance site, as of fourth case, at live bird market in Dhaka City (South) on 04 March 2012. This was confirmed by Real time RT-PCR. It may be mentioned that they are the fifth and sixth cases of laboratory confirmed Influenza H5N1 cases of Bangladesh since the first case detected in 2008.

The fifth case is 26 year old male and sixth case is 18 year old male who had presented with history of cough. Now they are free from symptoms. Nasal and throat swab were collected and found positive for H5N1. They are also live bird market workers, like the fourth case.

They are being treated and followed up by National Rapid Response Team members from IEDCR and ICDDR,B.

 

 

They have also posted a 126-page pdf on the handling of human H5N1 cases, which unlike many of the documents on this site, is in English (not Bengali).

 

 

And lastly, a 4-page educational PDF written in Bengali – appropriately named Birdflumess.pdf.

 

 

Unlike nearly every other country that has seen H5N1 infections in humans, those detected in Bangladesh appear to have been only of mild to moderate severity, and all have recovered.

 

Leaving us with a bit of a mystery. 

Is there something different about the virus circulating in Bangladesh, or do people in that region – due to previous exposure to avian viruses – carry some level of community immunity?

Something I’m sure researchers are eager to find out.

»» Read More

Bangladesh: Reporting Their 4th H5N1 Case

# 6186

 

Although Bangladesh has seen a great deal of H5N1 in poultry over the past 4 years, they have – until now – only reported 3 human infections with the avian flu virus. The first case was detected in 2008, while two additional cases were found in 2011.

All of these cases involved young toddlers (ages 15 to 39 months), and were detected via their influenza sentinel surveillance system. All three recovered.

 

Today an eagle-eyed Ronan Kelly on FluTrackers has picked up a report from Bangladesh’s IEDCR (Institute of Epidemiology, Disease Control & Research) – dated February 28th – that describes that country’s 4th known H5N1 detection.

 

Unlike the three earlier cases, this one involves an adult male. But as with the others, this patient has fully recovered.

 

 

Fourth H5N1 human case in Bangladesh

A 40 year old male has been diagnosed as fourth case of Human Avian Influenza (H5N1) in Bangladesh. This case has been reported from live bird market surveillance system in Dhaka City on 26 February 2012. This was confirmed by rRT-PCR. The patient is a live bird market worker.

The case presented with cough. Throat and nasal swabs were collected and found positive for H5N1. Presently he is free from symptom. IEDCR & ICDDR,B jointly investigating the case and monitoring the situation. 

In Bangladesh the first case was detected in 2008, second and third cases were found in 2011. 

 

Presumably the IEDCR has notified the World Health Organization, and we’ll get a confirmation in due time.

 

Bangladesh is somewhat unique in that all of their known H5N1 cases have recovered, while apparently experiencing only mild to moderate illness (Myanmar, with only 1 reported case, also has a 100% recovery rate).

 

Contrast this with Indonesia, where more than 80% of the known cases have died, or Egypt, where nearly 40% have succumbed, and it certainly begs the question; why the huge disparity?

 

• Is this just some sort of statistical, reporting, or surveillance fluke?
• Or is the virus circulating in Bangladesh less pathogenic to humans than the one in Indonesia? 
• Or is it perhaps, the people of some regions carry higher levels of community immunity to the H5 virus?

 

Fascinating questions, but for now, answers remain elusive.

»» Read More

Bangladesh: Charges That A Lack Of Compensation Sends Infected Birds To Market

 

 

Photo Credit – FAO

# 6120

 

 

While its not exactly breaking news that some H5N1 infected poultry have made their way into local food markets, most of the countries where the virus is endemic have taken steps to reduce those risks. 

 

Many nations have introduced poultry vaccination against the bird flu virus (albeit, not always a good thing), and most countries have some form of monetary incentive for farmers to cull their flocks if their poultry become infected.

 

Today (h/t Cottontop on the Flu Wiki) we’ve a lengthy and scathing report on the proliferation of the H5N1 virus in Bangladeshi poultry, and deficits in their compensation program that are claimed to be responsible for farmers sending infected birds to market.

 

This via the Financial Express. Follow the link to read it in its entirety.

 

Bird flu affected chickens being supplied to local markets

Arafat Ara Dhaka, Saturday February 4 2012

Bird flu affected chickens are being supplied to the local markets due to lack of monitoring and proper policy support to the poultry farmers by the authority, said sector insiders.

They said the farmers are selling their infected chickens in the markets hiding the information as the government does not compensate the farmers adequately.

(Continue . . . )

While media reports can sometimes slant stories - and part of this story relies on information obtained from unnamed `insiders’ - it is worth noting that the most recent report filed with the OIE on bird flu in Bangladesh ( 15/01/12 Follow-up report No. 37 ) lists 526 outbreaks in that country since 2007.

Map Credit OIE

 

Hardly a reassuring picture that Bangladesh is anywhere close to getting control over their endemic bird flu situation.

»» Read More

Bangladesh: Nipah Claims 5 Lives

 

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

 

# 6098

 

 

Last summer the movie `Contagion’ showed the world how a bat virus might mutate, evolve, and eventually move into the human population. While the movie used a fictionalized MEV-1 virus, it was based on the all-too-real Nipah Virus, which first came to prominence in the 1990s after a deadly outbreak in Malaysia in 1998.

 

While human infections with Nipah (or its Australian cousin Hendra) have been relatively uncommon, when they have occurred they have proven particularly lethal, with fatality rates pushing 60%.

 

During the Malaysian outbreak in 1998, the virus jumped to local swine herds from bats, and along with infecting hundreds of people caused the loss over 100 lives. The virus was then exported via live pigs to Singapore, where 11 more people died.

 

Over the past decade, Nipah has sparked a number of small outbreaks across Southern Asia, although the most intense activity has been centered around Bangladesh.

 

Over the past 48 hours we’ve seen some reports coming out of Bangladesh indicating that several people have been infected with the Nipah virus. Nipah reports out of this region typically come between December and May.

 

Today, the IEDCR issued the following statement, indicating there have been 5 fatalities thus far.

 

Nipah Outbreak at Joypurhat in January 2012

From 20 January 2012, two clusters of Nipah were identified in the Joypurhat Municipality area and Khetlal upazila of Joypurhat district. A joint team of IEDCR and ICDDR,B are working in the field now.

 

Till date (23 rd January 2012), the team identified 3 cases from the municipal area and 2 cases from Khetlal. All 5 cases have died. Laboratory tests for Nipah were done in IEDCR. All four samples collected from suspected cases were positive for Nipah.

 

 

Map Credit- Wikipedia

 

CIDRAP has a nicely done Overview of the Nipah Virus including the clinical symptom chart below:

 

 

Exactly how the Nipah virus is transmitted from human-to-human isn’t well understood, although it is thought to be mostly through direct contact with respiratory secretions or other bodily fluids.

 

For now - while Human-to-human transmission has been documented - only limited outbreaks have been reported.

 

Last February, in Bangladesh: Updating The Nipah Outbreak I wrote about a couple of EID Journal  studies that looked at Nipah transmission between humans.

 

The World Health Organization has this to say about the human-to-human transmission of the Nipah Virus.

 

Transmission

During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.

 

In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.

 

During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.

Reducing the risk of infection in people

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

 

Public health educational messages should focus on the following.

• Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.
• Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
• Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.

 

While the Nipah Virus may not pose anywhere near as great of a threat to the world as a pandemic influenza, it does point out the need for increased surveillance and improved public health programs around the world.

»» Read More

Bangladesh To Share H9N2 Bird Flu Virus

 

 

# 5849

 

 

To go along with my blog earlier today (see Dr. Robert Webster’s bird flu concerns), we’ve a report from Bangladesh on an agreement to share samples of the H9N2 bird flu virus with the U.S. CDC for development of a seed vaccine.

 

As has been mentioned here before, H9N2 – while generally producing mild symptoms in humans and poultry – is considered to have pandemic potential.

 

The concern is that it could reassort (swap genes) with other influenza viruses (including H5N1), producing a more virulent and easily transmissible strain.

 

First today’s report from bdnews24.com  (h/t Treyfish on FluTrackers), and then I’ll return with more.

 

 

B'desh to help make bird flu vaccine

Sun, Sep 18th, 2011 9:24 pm BdST

 

Nurul Islam Hasib bdnews24.com Senior Correspondent

Dhaka, Sep 18 (bdnews24.com) – Bangladesh will share a new strain of bird flu virus, identified as a possible pandemic threat, with US Centres for Disease Control and Prevention (US CDC) to develop 'seed virus,' key ingredient to make a vaccine in emergency.

"We will share the vaccine for scientific use," health secretary Muhammad Humayun Kabir told bdnews24.com on Sunday as he confirmed about the sharing of the H9N2 strain of bird flu—A/Bangladesh/0994/2011 (H9N2).

(Continue . . . )

 

 

This article mentions human infections from H9N2 were detected in Bangladesh last March, although no details are provided.  FluTrackers did pick up an FAO/EMPRES report on a human case during that time period which you can read here.

 

Since H9N2 circulates in regions of the world where influenza testing is rarely done, we don’t really know how often this virus infects humans. Over the past dozen years a small handful of cases have been identified – mostly in Hong Kong (see CIDRAP Avian Influenza (Bird Flu): Implications for Human Disease).

 

Adding to the concern, just last week a study was published that looked at level of antibodies to H5N1 and H9N2 flu viruses among rural villagers in Thailand.

 

Evidence for Subclinical Avian Influenza Virus Infections Among Rural Thai Villagers

Clinical Infectious Diseases

Volume53, Issue8

Pp. e107-e116

Benjawan P. Khuntirat1, In-Kyu Yoon1, Patrick J. Blair2, Whitney S. Krueger3,4, Malinee Chittaganpitch5, Shannon D. Putnam2, Krongkaew Supawat5, Robert V. Gibbons1, Sirima Pattamadilok5, Pathom Sawanpanyalert5, Gary L. Heil3,4, John A. Friary3,4, Ana W. Capuano6, and Gregory C. Gray3,4

 

 

In testing 800 villagers they found 38 (4.7%) who were seropositive for the Hong Kong H9N2 flu strain, 45 (5.6%) had antibodies to A/Thailand/676/2005 H5N1, and 28 (3.5%) were shown to be seropositive to A/Thailand/384/2006 H5N1.

 

Interestingly, direct exposure to poultry was not found to be associated with positive serologic findings for any of these avian strains.

 

This study – while limited – suggests that mild (or possibly subclinical) infections by these avian viruses may be occurring in parts of Asia.  

 

Despite causing rare human infection, these avian viruses need to acquire genetic changes before they could spark a pandemic. Which is why we concern ourselves with their ability to reassort with other flu strains.

 

Reassortment (or Shift), happens when two different influenza viruses co-infect the same host and swap genetic material.

 

 

Influenza A viruses have 8 gene segments (PB2, PB1, PA, HA, NP, NA, M1, M2, NS1, NS2).

 

Which means that any two compatible influenza viruses could conceivably – and under the right conditions – generate 256 different combinations by swapping one or more of their 8 (potentially) interchangeable gene segments.

 

 

Last February in PNAS: Reassortment Of H1N1 And H9N2 Avian viruses we saw research from Chinese scientists that created – using reverse genetics – 128 reassorted viruses from the avian H9N2 virus and the (formerly pandemic) H1N1 virus.

 

In mouse testing, they found half of the hybrid viruses were biologically `fit’ as far as replication goes, and 8 hybrids were significantly more pathogenic than either of their parental viruses.

 

Research such as this shows the potential for the H9N2 virus to move towards a more `humanized’ pathogen. And with H1N1 and H9N2 both known to be circulating in pigs in Asia, there are ample opportunities for them to co-infect the same host.

 

A few notable H9N2 stories from the past include:

• In December 2008 Revisiting A Malik Peiris Interview On H9N2

• In January of 2010, in H9N2: The Other Bird Flu Threat

• And just this past November Study: The Continuing Evolution Of Avian H9N2

 

Unlike the H7 and H5 avian flu strains, poultry (and swine) infections by the H9N2 virus are not required to be reported to the OIE.  So we have far less data on how widespread H9N2 might be.

 

As we saw in 2009, sometimes a pandemic virus will emerge from an unexpected source, and with a surprising lineage. While the world was waiting for an H5 bird flu to emerge from Asia, we were blindsided by a H1N1 swine flu from North America.

 

All of which highlights the importance of establishing better global surveillance of humans, and farm animals, for the next emerging influenza virus. 

 

Regardless of its strain.

»» Read More

Bangladesh: Conflicting Bird Flu Reports

 

 

# 5564

 

 

We’ve a curious report today in the Financial Express – the only English language financial daily in Bangladesh – on the level of bird flu activity in that country.

 

Since 2007 we’ve often heard of outbreaks of the H5N1 bird flu virus on poultry farms, and the OIE (to whom reporting of H5 & H7 avian flu is mandatory) lists 34 reports totaling 514 outbreaks since May of that year.

 

 

(Photo Credit – OIE Bangladesh H5N1)

The last OIE notification was on May 12th of 2011, which noted 3 recent outbreaks,  and the total number of poultry affected since 2007 is listed as just under 640,000.

 

(Photo Credit – OIE Bangladesh H5N1 Stats)

 

Which makes the following story in the Financial Express - wherein an Industry leader puts the number of outbreaks at 20 times higher – a bit hard to reconcile.

 

A hat tip to Carol@SC on the Flu Wiki for this link.

 

 

Bird flu wreaks havoc in poultry industry: official

 

Dhaka, Friday July 1 2011

Doulot Akter Mala

A third of the country's farm-raised chicken has been decimated by the latest outbreak of the bird-flu, a top poultry farmer has said Thursday, demanding compensation for the affected farms.

 

He told the FE the government needed to roll up its sleeve and help the affected farms with compensation and vaccines in an effort to prevent Avian Influenza from inflicting a mortal blow to the key industry.

 

"We've estimated that 10,000 to 15,000 poultry firms have been affected by bird-flu. Unfortunately the government shows it only 153," said Syed Abu Siddique, president of the Bangladesh Poultry Industries Association,

(Continue . . . )

 

This makes for a sizeable discrepancy between the claims made by the President of the Bangladesh Poultry Industries Association and what has been officially reported to the OIE.

 

The accuracy of either number is difficult to verify, since the OIE can only report what is voluntarily submitted to them.

 

And between this report, and others, there is obviously a good deal of political pressure being exerted in Bangladesh over current and future tax breaks for the poultry Industry, compensation for culled birds, and the importation of vaccine.

 

A cause that would be bolstered by higher poultry losses.

 

There is also the possibility that Siddique is including LPAI outbreaks – such as H9N2 – in his numbers, although only H5N1 is mentioned in the article.

 

We are left with a bit of a mystery it seems.

 

And while I am a bit skeptical that 95% of the outbreaks in Bangladesh are going unreported - that country remains one of the hotspots for bird flu activity in the world - and so it deserves our continued attention.

»» Read More

WHO: Three Bird Flu Updates

 

 

# 5484

 

 

The World Health Organization has released updates on human H5N1 infections from three countries this morning.   Some of these are cases we’ve heard about earlier, but are only now being confirmed.

 

First stop, Bangladesh which appears to confirm a case I wrote about on March 16th (see Bangladesh: 2nd Bird Flu Case In Two Days).

 

 

Avian influenza - situation in Bangladesh - update

11 April 2011 - The Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh has confirmed a new case of human infection with avian influenza A(H5N1) virus.

 

The case is a 2 years old male from Kamalapur, Dhaka. He developed symptoms on 1 March. He visited the influenza sentinel surveillance site on 9 March where he was sampled. He completely recovered.

 

Detailed epidemiological investigation and contact follow up was conducted by a team from the Institute of Epidemiology Disease Control and Research (IEDCR), the International Centre for Diarrhoeal Disease Research, Bangladesh ( ICDDRB) and WHO Bangladesh, and no further cases were identified.

 

The investigation into the source of infection indicate that the case had exposure to sick poultry. Although the case is from the same locality as the previous case they had no direct contact with each other.

 

The case was confirmed as being infected with A(H5N1) by the Institute of Epidemiology Disease Control and Research (IEDCR).

 

 

 

Next stop, Cambodia which I reported on April 6th (see Cambodia: 4th Bird Flu Fatality Of 2011).

 

 

Avian influenza – situation in Cambodia - update 2

11 April 2011 - The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

 

The case was an 11 year old girl from Steung Trang district, Kampong Cham Province. She developed symptoms on 22 March, was initially treated by local villagers with no effect and was admitted to a local hospital on 29 March. Further treatment at the local hospital was ineffective and she was referred to a regional hospital where she died within four hours of admission on 31 March.

 

There have been reports of poultry die off in her village. The girl is the fourteenth person in Cambodia to become infected with the H5N1 virus and the twelfth to die from complications of the disease. All four cases of H5N1 infections in humans in Cambodia this year have been fatal.

 

All contacts of the case have been tested and are negative for A/H5N1 influenza virus.

 

Last stop is Egypt, which has been very busy this year with human H5N1 cases.   Last week in Egypt: 4 New Bird Flu Cases,  I wrote:

 

The newshounds on FluTrackers are aware of several  more possible cases listed on the Egyptian Ministry of Health’s web page, although not yet confirmed to the WHO yet.

 

Today we get confirmation on 4 new cases.

 

Avian influenza - situation in Egypt - update 50

11 April 2011 - The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.

 

The first case is a 20 years old female from Behaira Governorate. She developed symptoms on 14 March and was hospitalized on 19 March. She was in a critical condition and died on 28 March.

 

The second case is a two years old female from Menofeya Governorate. She developed symptoms on 26 March and was hospitalized on 27 March. She is still under treatment and in a stable condition.

 

The third case is a 55 year old female from Behaira Governorate. She developed symptoms on 20 March and was hospitalized on 22 March. She recovered and was discharged on 5 April.

 

The fourth case is a 1 year old male from Fayoum Governorate He developed symptoms on 20 March and was hospitalized on 28 March. He is still under treatment and in a stable condition.

 

All the cases received oseltamivir treatment at the time of hospitalization.

 

Investigations into the source of infection indicate that the cases had exposure to sick and/or dead poultry suspected to have avian influenza.

 

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Of the 141 cases confirmed to date in Egypt, 46 have been fatal

 

It should be noted that as of April 8th the Egyptian Ministry of Health (MOH) website lists 142 total cases, and 47 fatalities. 

 

So at least one more case appears to be in the pipeline.

»» Read More

Bangladesh: 2nd Bird Flu Case In Two Days

 

 

# 5406

 

 

 

 

While I’ve been away from my desk this morning (it happens, but not often!) word of a second toddler from Dahka, Bangladesh with unusually mild H5N1 symptoms has crossed the wires.   

 

Although from the same general area as the case reported on Monday, authorities state that the two cases are not connected. 

 

Mild cases of H5N1 are viewed – a bit counter-intuitively – as being particularly notable because the less ill a person becomes, the more likely they are to have contact with others and potentially spread the virus.

 

Some scientists also worry that a decrease in severity could signal a better adaptation to human physiology.

 

You may recall that concerns were expressed back in 2009 when a number of similarly aged children in Egypt came down with very mild H5N1 infections.   

 

During 2009, the CFR (case fatality ratio) in Egypt dropped to under 10%. The traditional pattern of mixed ages (although mostly under the age of 50), and a higher CFR (33%) has returned to Egypt since the start of 2010.

 

Obviously, with two cases cropping up at the same time in the same area, an epidemiological investigation is underway.

 

This report from BDNews24.

 

 

Another human case of bird flu surfaces

Wed, Mar 16th, 2011 6:40 pm BdST

 

Dhaka, March 16 (bdnews24.com) — Another human case of avian influenza has been detected in the Kamalapur area of the capital, two days after a 13-month-old girl was found carrying the H5N1 virus in the same locality.

 

The Institute of Epidemiology Disease Control and Research (IEDCR) discovered the fresh case while mopping up the area on Wednesday. It launched a drive in the locality following the detection of first case of the year in the area on Sunday.

IEDCR director Prof Mahmudur Rahman told bdnews24.com that a 31-month-old boy had been detected carrying the virus in their lab.

(Continue . . . )

»» Read More

WHO Confirms Bangladesh H5N1 Case

 

 

# 5404

 

 

 

 

As I mentioned on Monday (see Bangladesh Reports Human Bird Flu Infection) Bangladesh reported their second human bird flu case this week.  The first was recorded in 2008.

 

While it doesn’t add a lot to what we already knew, today the World Health Organization has posted an official confirmation, and an update to the situation.

 

 

Avian influenza - situation in Bangladesh

 

16 March 2011 - The Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh has confirmed a case of human infection with avian influenza A (H5N1) virus. The case was detected through the influenza sentinel surveillance centre run by the Institute of Epidemiology Disease Control and Research (IEDCR) and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).

 

The case is a 16 month old female from Kamalapur, Dhaka. She presented at a influenza sentinel surveillance on 8 March with a history of cough and fever and subsequently recovered.

 

A detailed epidemiological investigation and contact follow up is being conducted by a team of epidemiologists from IEDCR, ICDDRB and WHO Bangladesh.

 

The case was confirmed as being infected with A(H5N1) by the Institute of Epidemiology Disease Control and Research (IEDCR).

»» Read More

Bangladesh Reports Human Bird Flu Infection

 

 

 

# 5392

 

 

A report, posted by CopitoSp on FluTrackers this morning, indicates that a 13 month-old girl has tested positive for the H5N1 virus in Dhaka, Bangladesh. 

 

This marks the 2nd known human infection in that country, the first being reported in 2008.

 

The Bangladeshi Institute for Epidemiology, Disease Control & Research (IEDCR) announced the case earlier today.

 

 

 

BDNews24 has the details in this recently updated report.

 

 

Girl found infected bird flu

Mon, Mar 14th, 2011 6:27 pm BdST

Dhaka, Mar 14 (bdnews24.com) — The first case of human infection of avian influenza or bird flu this year has been detected in Dhaka, confirms the Institute of Epidemiology, Disease Control and Research (IEDCR).

 

IEDCR director Mahmudur Rahman told bdnews24.com that the human infection was confirmed on Monday after testing the samples of saliva and nasal swab of a 13-month-old girl running temperature, who visited an influenza surveillance centre recently.

 

The surveillance centre is run jointly by the IEDCR and International Centre for Diarrhoeal Diseases and Research, Bangladesh (ICDDR,B), he said.

 

Family members of the child were also examined, said the IEDCR director, adding that the minor girl, undergoing treatment in IEDCR supervision, was out of danger.

(Continue . . . )

 

 

Bangladesh has reported more than 400 outbreaks of avian flu among poultry since 2007, according to the OIE.

 

Event summary: Highly pathogenic avian influenza, Bangladesh

»» Read More

Bangladesh: Mystery Fever Identified As Nipah

 

 

Note:  I’ll be away from my desk for much of the next two days, although I’ll endeavor to check in when I can.

To stay current on the latest infectious disease news, visit Crofsblog, Chen Qi, Arkanoid Legent, and A Time’s Memory along with the other bloggers, flu forums, and resources in my sidebar. 

 

# 5288

 

 

Over the past two days reports of a `mystery fever’ that has claimed as many as 19 lives in Bangladesh's Hatibandha sub-district of Lalmonirhat district have been coming across the news wires.

Initially, some type of encephalitis was suspected, but now authorities reportedly believe they’ve identified the Nipah virus as the culprit.

 

Nipah virus electron micrograph  Image courtesy of C.S. Goldsmith and P.E. Rollin (CDC), and K.B. Chua (Malaysia). (From CDC  Nipah Fact Sheet).

 

You can follow the progression of this story on FluTrackers over the past couple of days in this thread.

 

This morning Shiloh has this report from bdnews24.com.

 

 

BREAKING NEWS

Killer virus identified as Nipah

Fri, Feb 4th, 2011 5:33 pm BdST

Dhaka, Feb 4 (bdnews24.com) — The virus that has taken 14 lives in Hatibandha of Lalmonirhaat has been identified as the Nipah virus.

 

Locals claim the death toll was 19.

 

Institute of Epidemiology Diseases Control and Research (IEDCR) director Mahmudur Rahman told reporters on Friday afternoon that tests had confirmed the virus was Nipah.

 

IEDCR advised against drinking raw date juice to avoid infection.

  

Unknown until 1998, Nipah appears to be carried by certain species of fruit bats that are distributed across portions of of Australia, Indonesia, Malaysia, and the Philippines islands.  While the bats are the natural host for this virus (along with another variant called the Hendra Virus), they are unaffected by it.

 

The bats are believed to transmit the virus, via their saliva or other fluids, to pigs (Nipah) or horses (Hendra).  From there, the virus has found its way into the human population.

 

The Nipah virus was first detected in Malaysia in 1998, where it infected 250 people and claimed 100 lives.   The most common vector appeared to be from pigs to humans.  Over 1 million pigs were culled in Malaysia to control that outbreak.

 

The World Health Organization has this to say about the human-to-human transmission of the Nipah Virus.

 

Transmission

During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.

 

In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.

 

During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.

 

Reducing the risk of infection in people

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

 

Public health educational messages should focus on the following.

• Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.
• Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
• Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.

 

 

While the Nipah Virus may not pose anywhere near as great of a threat to the world as a pandemic influenza, it does point out the need for increased surveillance and improved public health programs around the world.

 

We ignore these emerging diseases, at our peril.  For once they establish themselves, they can quickly spread out of control.

 

And the next zoonotic disease to emerge may be a lot harder to deal with than the Nipah virus.

»» Read More