Showing posts with label Bird Flu. Show all posts
Showing posts with label Bird Flu. Show all posts

Indonesia: H5N1 Clade 2.3.2 Reaches Bali

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# 6829

 

Not quite a month ago we learned that a `new’ clade of H5N1 had shown up in in Indonesia, causing the deaths of hundreds of thousands of ducks (see Report: Clade 2.3.2 H5N1 Detected In Indonesia) on the island of Java. 

 

Although new to Indonesia, clade 2.3.2 has been circulating across Asia for several years. I wrote of the spread of this emerging clade in 2011 in What Goes Around, Comes Around and EID Journal: H5N1 Branching Out).

 

In the spring of 2010 we began to see reports of poultry vaccine failures in Vietnam due to the spread of a mutated version this clade (further classified as clade 2.3.2.1), which led to this statement FAO Warns On Bird Flu.

 

The H5N1 virus is constantly changing, and as it does, forms distinct genetic groups, or clades. Since its discovery in 1996, the H5N1 virus has evolved into more than 20 distinct clades (and subclades), with many variations within each.

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Some of these clades have flared briefly and then died out, supplanted by more biologically `fit’ versions of the virus. But even so there is a good deal of variety among the strains in circulation today.

 

Clade 2.3.2 (and now 2.3.2.1) is very common in South East Asia, clades 2.2.1 and 2.2 are endemic in Egypt and up until recently, Indonesia had only dealt with clades 2.1.1, 2.1.2. and 2.1.3, but now adds 2.3.2.

 

Until this past week, all of the reports we’ve seen of this newly emergent clade in Indonesia have come from the island of Java. 

 

Three days ago, Gert van der Hoek on FluTrackers posted a machine translation of a VOA Indonesia article (New Bird Flu Clade Detected in 3 districts in Bali) indicating the new clade had jumped to the vacation island of Bali.

 

Today, an English Language report from the Jakarta Post, Bali Edition, carries details of this latest discovery.

 

Bali braces for bird flu epidemic

by Muliarta on 2013-01-07

The local health authorities have begun implementing the necessary measures to deal with the ongoing outbreak of avian influenza affecting the duck population, and the possible spillover of the disease into the human population.

 

The measures have been taken following confirmed reports of avian influenza killing thousands of ducks in farming areas in three separate regencies: Buleleng, Tabanan and Klungkung.

 

Laboratory tests have confirmed that the ducks were killed by the new, more malignant strain of the avian influenza virus known as H5N1 Clade 2.3.2. A similar strain of the virus killed hundreds of thousands of ducks across farming regions in Java weeks before the first reported case in Bali.

(Continue . . . )


Although the arrival of this new clade has sparked fears of more human infections, so far, we’ve not seen any sudden increase in reports of human cases in Indonesia.

 

Bali, a popular international tourist destination, has seen more than a half dozen high profile human H5N1 cases over the past several years.

 

In order to protect the island’s economy, in 2005 it was decreed that only locally raised chickens could be sold on the island.

 

But like many other laws and edicts concerning poultry trade in Indonesia, they have gone largely ignored. Ducks fetch a higher price on the island of Bali than on Java, providing ample incentive to smuggle poultry.

 

While it isn’t known whether this new strain arrived via illegal trade, or migratory birds, its arrival has nerves on edge. Bali public health officials have alerted three local hospitals to be ready to receive human cases, and a public awareness campaign is underway.

 

H5N1 remains largely an avian-adapted virus, and for now primarily a threat to poultry.

 

The concern, of course, is that with continual changes to the virus, one of these days it may better adapt to human or mammalian physiology.

 

Which is why, even after 10 years after its return in 2003, we continue to follow developments with keen interest.

»» Read More

Indonesia MOH Reports Bird Flu Fatality

 

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# 6781

 

My thanks to Gert van der Hoek on FluTrackers for picking up this report from Indonesia’s Ministry of Health, announcing a recent bird flu (H5N1) fatality in West Java.


The following is a machine translation of a press release. Additional information will no doubt be posted on this FluTrackers thread.

 

Report of 192nd Case of Bird Flu


DECEMBER 14, 2012 | 3:56 PM

Ministry of Health, Directorate General of Disease Control and Environmental Health announced a new case of H5N1 has been confirmed by the Center for Basic Biomedical and Health Technologies, Balitbangkes.


Case on behalf of the IT (male, 4 years old) residents of Kampung Nagreg, Gorowong Village, District Parung Panjang, Bogor regency, West Java. Dated 30 November 2012 symptoms of fever, December 1, 2012 the case went to Pustu. Dated December 4, 2012 because there was no change in the case of seeing a private doctor, dated December 5, 2012 morning the case went to the health center and in the afternoon the case was referred to the Private RSIA for hospitalization. Dated December 6, 2012 the case was referred to the Tangerang District Hospital because of fever, cough, and shortness. The situation gets worse case and the case eventually died at 23:40 pm.


Epidemiological investigations have been conducted into the hospital, and the case surrounding the Integrated Team MoH and local health service, possible risk factors that come in direct contact with poultry carcasses (entog) in the neighborhood.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news broadcast is 192 cases with 160 deaths.

 

Director General of Disease Control and Environmental Health, Prof. dr. Tjandra Yoga Aditama as the focal point of the International Health Regulations (IHR) has been informed about the case to the WHO.

 

This information is released by Center for Public Communication, Secretariat General of the Ministry of Health. For further information, please contact via telephone: (021) 52907416-9, Fax: (021) 52921669, Rapid Response Response Centre (PTRC): 500-567 and 081 281 562 620 (sms), or e-mail contacts @ depkes.go.id

 

 

As Gert helpfully points out in a following post, `Entog’ means `duck’ in Bahasan.

 

Possibly related: we’ve recently seen reports of large die offs of ducks on the island of Java due to the recently arrived strain of H5N1 – clade 2.3.2.1 (see VOA Report On The Indonesian Duck Die Off).

 

This is the first report of a human H5N1 infection since August, although it is certainly possible that some cases are not being picked up or reported by surveillance programs around the world.

 

For now, H5N1 remains primarily a threat to poultry and wild birds, and to a lesser extent people in close contact with them. While human to human transmission transmission has been documented, it is very rare, as the virus remains poorly adapted to human physiology.

 

But around the world more than 600 widely scattered human infections have been reported, and the mortality rate has been a horrendously high 60% among known cases.

 

And so we track these scattered human infections with considerable interest, in case they herald a change in the behavior of the virus.

»» Read More

Dr. Alan Hampson Interview On Indonesia’s New Bird Flu Clade

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Photo Credit – FAO


# 6775

 

On Monday we began to see reports that a previously unseen clade of the H5N1 virus had recently turned up in Indonesia, causing the deaths of tens of thousands of ducks (see Report: Clade 2.3.2 H5N1 Detected In Indonesia) in and around central Java.

 

Today, Radio Australia has an excellent interview (audio & transcript available) with Dr. Alan Hampson about this recent news.

 

Dr. Hampson, who is chair of Australia’s Influenza Specialist Group (ISG), is the former Deputy Director of the Australian World Health Organization Collaborating Centre for Reference and Research on Influenza.

 

Dr. Hampson assesses the risks, discusses how the virus may have arrived in Indonesia,  and defines the difficulties in controlling H5N1 in that country.  

 

He also warns that the H5N1 strains currently circulating in the Middle East appear to be the ones moving quickest towards `being able to become a human influenza virus.’

 

Follow the link to read/listen to this five-minute, highly informative interview.

 

 

Indonesia identifies new strain of bird flu: report

Updated 12 December 2012, 17:36 AEST

The Indonesian Agriculture Ministry has reportedly identified a new, more virulent type of bird flu that's killed hundreds of thousands of ducks in recent weeks.

 

There are suspicions the virus entered Indonesia from other countries - like Vietnam or Thailand.

 

To determine this, the agriculture ministry's veterinary chief has reportedly written a letter to local government offices and the World Health Organisation calling for further research into the origins of the virus.

 

(Continue . . . )

»» Read More

CSIRO: The Quest For Flu Resistant Poultry

 

 

# 6657

 

The idea of creating genetically modified chickens with a built-in resistance to the H5N1 virus has been around for some time, and given the threat posed by an avian flu pandemic, and the costs of the virus to the world’s poultry industry, I can understand the allure.

 

At the forefront of research in this field has been Australia's national science agency called CSIRO (Commonwealth Scientific and Industrial Research Organisation).

 

Below is a snapshot of a 2005 cover of CSIRO’s Livestock Research Magazine, where Cambridge University virologist Laurence Tiley stated, “The tools to make poultry resistant to flu infection already exist”. His bigger concern was whether they could persuade the public of the benefits of Genetically Modified (GM) poultry.

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Since 2005, research on how best to make resistant poultry has been conducted at the Australian Animal Health Laboratory (AAHL), a BSL-4 facility located in Geelong, Victoria.


Earlier this summer, CSIRO released a 7-minute audio podcast where one of their researchers – Dr Tim Doran – is interviewed about the research.

 

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The audio and transcript are available at this link.

 

Overnight,  The Conversation – which is a combined journalistic effort by a number of Australian Universities – published details of a presentation by Dr. Doran at CSIRO’s Emerging Infectious Diseases Symposium, where he announced that the first `challenge study’ will be conducted on transgenic chickens later this year.

 

23 October 2012, 3.39pm AEST

 

Silencing the bird flu gene: scientists prep live hen trials

Researchers hoping to produce modified chickens hatched with in-built resistance to bird flu will conduct trials on live hens later this year, an Australian scientist said on Tuesday.

 

CSIRO research scientist, Dr Tim Doran, has been using a technique called gene silencing to “switch off” virus genes that make chickens susceptible to H5N1, the bird flu that has devastated livestock and killed 359 people worldwide since 2003.

(Continue . . .)

 


This experiment is being billed as a `proof of concept’, and given the regulatory hurdles that lie ahead, we are still quite some time away from seeing GM flu resistant chickens entering the food chain.

 

Assuming this challenge study works, the biggest barrier will be getting the public to willingly accept the idea of eating transgenic chicken & dumplings for Sunday dinner.

 

Although I’m not a part of the `anything genetically modified must be bad’ camp, I’m always mindful of the law of unintended consequences. History is filled with examples of experiments that `seemed like a good idea’ at the time, but turned out to be less so in the long run.

 

Two particularly famous examples of this law in action come from Australia. The introduction of rabbits for food stock in the 18th century, and the importation of the Cane toad (Bufo marinus) to control the cane beetle in 1935.

 

Both spread quickly as invasive and environmentally damaging species, and both continue to require expensive control programs to this day.

 

The rabbit overpopulation became such a problem in the 1950s, scientists deliberately released the Myxoma virus into the rabbit population. While that virus quickly decreased the rabbit population, the resistant survivors quickly re-gained lost ground.

 

Another attempt was made with the release  of RHD(Rabbit Hemorrhagic Disease) in the 1990s, and while initially effective, its efficacy appears to be waning (cite).

  

 

Given the furor we’ve seen over the release of GM mosquitoes (see Key West: Public Debate Over GM Mosquitoes), and some high profile miscalculations in the past, getting the public to accept transgenic chickens at this point may prove a hard sell.

 

Of course, one severe flu pandemic springing out of poultry, and public sentiment might change in a hurry.

»» Read More

Nepal: H5N1 Outbreak In Poultry

 

 

 

# 6634

 

The pattern with the H5N1 virus has been that it declines during the warm summer months, only to return when cooler weather returns with the fall and winter. 

 

This pattern is easily seen in the FAO chart below:

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Although not the hotspot for bird flu like Indonesia, Egypt, or Bangladesh, the H5H1 virus has been making its presence known in Nepal each winter since it was first detected in January of 2009 (see Nepal: Concerns Rise Over More Poultry Deaths).

 

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Located as it is between two nations with a long history of outbreaks of H5N1 (India and China), and separated by but a few kilometers from Bangladesh – another bird flu hotspot – it isn’t surprising that the bird flu virus has made its way to Nepal.

 

 

Ironically, Nepal filed a final bird flu report with the OIE just one week ago, six months after the end of their last outbreak.  But with the return of cooler weather, H5N1 has once again emerged.

 

Today, we’ve a report in The Himalayan (h/t Giuseppe Michieli on FluTrackers), indicating a fresh outbreak of the virus, killing 1,200 chickens on a poultry farm in Bhaktapur, outside of the capital Kathmandu.

 

Bird flu confirmed in Bode farm

2012-10-15

ISHWOR K KHAIJU

BHAKTAPUR: At least 1,200 chickens have died of bird flu at a poultry farm in Bode-3 of Madhyapur Thimi in Bhaktapur till Monday noon.

(Continue . . .)

 

 

Nepal’s Animal Health Directorate has declared the area a crisis zone, and for the next 90 days will conduct enhanced surveillance.

»» Read More

China Reports H5N1 Outbreak In Poultry

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Credit Wikipedia

 

# 6562

 

 

Via Xinhua news this morning, confirmation of a large cull of poultry in China’s Guangdong Province, after the discovery of the H5N1 `bird flu’ virus on Sept 11th.

 

 

Bird flu hits S China city

English.news.cn   2012-09-18 19:19:19

BEIJING, Sept. 18 (Xinhua) -- The H5N1 avian flu virus has been detected in the city of Zhanjiang in south China's Guangdong province, experts confirmed on Tuesday.

 

The virus has infected 14,050 ducks and killed 6,300 of them since Sept. 11, when symptoms were first reported, a Ministry of Agriculture official said.

 

After the epidemic was confirmed, local authorities cordoned off an infected area in the city and killed all poultry in the area before starting to decontaminate it, the official said.

 

China is particularly prone to bird flu epidemics, as it has the world's largest poultry population and many rural farmers live in close proximity to their poultry.

 

 

 

Zhanjiang is a prefecture-level city, with a population of more than 6 million, and is a prominent seaport and a major trade center.  

 

While this story states that China is particularly prone to bird flu epidemics, relatively few are mentioned in the state controlled media.

»» Read More

Watching Egypt

 

UPDATED 9/18/12:  Sharon Sanders on FluTrackers has posted a notice from Egypt’s Undersecretary of Health stating that these three cases have tested negative.

# 6558

 

 

Overnight a number of Arabic-Language news reports have emerged from Egypt indicating that three brothers (ages 19,16, 9) from the village of Manshiet Galal are being tested for suspected `bird flu’.

 

Sharon Sanders at FluTrackers started a thread last night, with several of these news reports, and Laidback Al has produced a handy map of the location.

 

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Meanwhile Crof, at Crofsblog, has prevailed upon an Arabic-speaking friend to translate one of the news reportsthat increases its readability considerably over machine translations - which you’ll find at Egypt: Suspected H5N1 in three brothers.

 

We haven’t heard much out of Egypt this year, with the last confirmed H5N1 infection reported in early June (see WHO: Egypt Announces New H5N1 Case) – making Egypt’s 10th case of 2012.

 

Given the ongoing political and social turmoil in the Middle-East, it isn’t entirely clear how diligent surveillance and reporting on disease outbreaks like H5N1 are right now.

 

For now, these three cases reported today are just suspected cases, and it is often the case that suspected cases prove to have some other illness.

 

I’ll provide an update when we learn more.

»» Read More

Vietnam Intensifies Bird Flu Prevention Efforts

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H5N1 Outbreaks In Vietnam - Map Credit OIE


# 6488

 


While an emerging H3N2v swine flu and reports of H3N8 `seal flu’ have been making headlines over the past few weeks, in Vietnam the struggle to contain and control outbreaks of H5N1 bird flu in poultry continues.

 

In recent days Vietnam has reported fresh outbreaks of the disease in the cities of Hai Duong and Hai Phong, and the provinces of Quang Binh and Ha Tinh.

 

Today, local media is reporting that Nguyen Van Binh, head of Department of Preventive Health, has ordered new steps to be taken across the country to curb the spread of the virus.

 

The story appears in the Saigon-Daily, and it appears to call for a fresh look, and new approaches to containing the disease.

 

Health departments to ascertain, curb possible spread of H5N1 virus

Friday, Aug 10, 2012

Nguyen Van Binh, head of Department of Preventive Health, said that municipal and provincial departments of health across the country have been ordered to do a thorough study of old cases of outbreaks of diseases, so as to ascertain and curb the possible spread of H5N1 virus.

 

Medical workers, especially those at border gates, have been advised to keep a close watch on patients suspected of having contracted the H5N1 strain, by placing them in quarantine and isolation wards in hospitals.

(Continue . . . )

 

 

Vietnam was one of the earliest countries affected by the H5N1 virus, and for a time, lead the world in human cases and deaths.

 

Through massive educational and regulatory efforts, by 2006 they’d gone from being the worst afflicted country in the world to being viewed as the `poster child’ for successful bird flu containment.

 

But that victory was fleeting.

 

After nearly 18 months  of quiescence, the virus retuned in 2007.  Since then, Vietnam has been engaged in a more-or-less constant battle with sporadic outbreaks of the virus in poultry, along with occasional human infections and fatalities.  

 

 

The latest OIE filing on the H5N1 virus (08/08/12
Follow-up report No. 73) indicates there have been 346 outbreaks reported since 2007.

 

The news out of Vietnam isn’t all bad.

 

Despite hundreds of outbreaks in poultry, they’ve managed to keep reported human cases down to the low and mid single digits since 2007. 

 

A far cry from the 61 cases they reported in 2005.

 

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Today’s report indicates that there are still great concerns over the the spread of virus in Vietnam, particularly in those provinces bordering China, Laos, and Cambodia.

 

The arrival of a vaccine resistant clade of the H5N1 virus (2.3.2.1) in 2010 (see FAO Warns on Bird Flu), only increases the need for Vietnam to be proactive in identifying and containing the virus.

»» Read More

Indonesia Announces H5N1 Fatality

 

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WHO Human H5N1 Count 8/10/12

 

# 6488

 

 

While recent reports of human infections with the H5N1 virus have been scarce, today we’ve an announcement from the Indonesian Ministry of Health of a recent fatal case involving a 37-year old from Prambanan, Sleman District, Yogyakarta Special Province.

 

Translated from Bahasan, the statement reads:

 

Bird Flu Case report 191

August 9, 2012 | 7:11 pm

Ministry of Health through the Directorate General of Disease Control and Environmental Health announced a new case of H5N1 have been confirmed by the Center for Biomedical and Health Technology base, Balitbangkes.

 

Case on behalf of AW (Female, 37 years) who Prambanan, Sleman District, Yogyakarta Special Province, is a self-employed. Dated July 24, 2012 symptoms of high fever, the following day case treatment to a hospital outpatient PR. Because of persistent high fever and started coughing case, dated July 27, 2012 the case went to the hospital again and finally treated PR. Care hospital in public relations, the more elevated fever accompanied by cough and shortness, so that on July 29, 2012 the case was referred to Hospital B and ventilator. Circumstances of the case gets worse and finally died on July 30, 2012 at 12:05 pm.

 

Epidemiological investigations have been carried into the homes of people and the environment by the Integrated Team Ministry of Health, the local Health Department, Animal Husbandry Department and Officer PDSR Kab.Sleman DIY province, the provincial Agriculture Department DIY, acquired risk factors, namely the possibility of contact with the environment in the workplace and ornamental birds around 50 meters from the house there are cases where the cuts of chicken, quail and duck farms and there is also the case in the home environment.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 191 cases with 159 deaths.

(Continue . . .)

 

 

The World Health Organization has just updated their chart of human cases, and has posted this summary of the above report:

 

Avian influenza – situation in Indonesia – update

10 August 2012 - The Ministry of Health of Indonesia has notified WHO of a new case of human infection with avian influenza A(H5N1) virus.

 

The case is a 37 year old male from Yogyakarta province. He developed fever on 24 July 2012, was hospitalized on 27 July and died on 30 July.

 

Epidemiological investigation on the case found that the case had four pet caged birds in his home, which is about 50 metres from a poultry slaughter house and near a farm.

 

Infection with avian influenza A(H5N1) virus was confirmed by the National Institute of Health Research and Development (NIHRD), Ministry of Health and reported to WHO by the National IHR Focal Point.

 

To date, the total number of human influenza A(H5N1) cases in Indonesia is 191 with 159 fatalities, 8 (all fatal) of which occurred in 2012.

 

 

Although we continue to see isolated human infections around the world, and the virus continues to evolve (see H5N1: An Increasingly Complex Family Tree), for now H5N1 is primarily a threat to poultry.

 

The concern, of course, is that over time that could change.

 

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting better to humans.

»» Read More

Mexico: High Path H7 In Jalisco

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Photo Credit – FAO

 

# 6506

 

 

Last night Lisa Schnirring writing for CIDRAP NEWS  brought us details on the first highly pathogenic bird flu outbreak in Mexico in nearly two decades.  The last time was during the mid-1990s, and the virus was H5N2.

 

This time, the culprit it is H7N3.

 

Follow the link below to read  Lisa’s excellent report, after which I’ll return with a bit more.

 

Tests reveal high-path H7N3 in Mexican poultry farm outbreaks

Lisa Schnirring * Staff Writer

Jun 26, 2012 (CIDRAP News) – Mexican veterinary authorities are intensifying avian influenza control efforts in a region that houses several large commercial farms after further tests determined that the strain responsible for more than 200,000 bird deaths at three farms is the highly pathogenic H7N3 subtype.

(Continue . . . )

 



While there are a number of avian flu viruses circulating in the wild, the OIE only requires that H5s and H7s be reported due to their known ability to mutate from a low pathogenic virus to highly pathogenic virus.

 

When it comes to avian influenzas, the H5N1 virus gets the bulk of the headlines, and rightfully so. While a matter of some controversy (see Revisiting The H5N1 CFR Debate), among known human cases, the mortality rate has been a staggering 60%.

 

Other strains that have demonstrated at least some ability to infect humans include H7, H9, H10, and H11. Fortunately, most of the time these rare infections have produced only mild flu symptoms (sometimes only localized conjunctivitis).

 

Last April, in EID Journal: Human Infection With H10N7 Avian Influenza we looked at some recent H10 infections, and in 2011 we explored A Little Background On H11 Avian Influenzas.

 

For now, however, these viruses are primarily a threat to the poultry industry, and to a lesser extent, people working in direct contact with infected fowl.

 

Although global surveillance and reporting on novel avian viruses in humans is spotty at best, some known H7 cases include:

 

  • In 2003 an outbreak of H7N7 at a poultry farm in the Netherlands went on to infect at least 89 people. Most of the victims were only mildly affected, but one person died.
  • In 2004 two people in British Columbia tested positive for H7N3 (see Health Canada Report) during an outbreak that resulted in the culling of 19 million birds.
  • In 2006 and 2007 there were a small number of human infections in Great Britain caused by H7N3 (n=1)  and H7N2 (n=4), again producing mild symptoms.

 

For now, H7 avian influenzas are presumed to pose a low public health threat, which may leave you wondering why all this fuss over this outbreak of H7N3?

 

The H7s, like all influenza viruses, are constantly mutating and evolving.  

 

While considered mild today, there are no guarantees that the virus won’t pick up virulence over time, or reassort with another virus and increase its affinity for humans.

 

Four years ago, we saw a study in PNAS that indicated that the H7 virus might just be moving more towards adapting to humans.

 

Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility

You can read more about this in a couple of blogs from 2008, H7's Coming Out Party and H7 Study Available Online At PNAS.

 

The last pandemic, you will recall,  came out of left field; from a region of the world (North America), host species (swine), and influenza strain (H1N1) all considered unlikely to spark a global epidemic.

 

Which is why we pay attention whenever there is an outbreak of a novel flu virus for which mankind may have little or no immunity.

»» Read More

CHP: Updating The Hong Kong H5N1 Case

 

 

# 6388

 

 

The Centre For Health Protection (CHP) produces an online bi-weekly Communicable Diseases Watch  report which usually features one or more current infectious disease investigations ongoing in Hong Kong.

 

Today’s issue - Communicable Diseases Watch Volume 9, Number 12, Week 22-23 (May 27, 2012 – Jun 9, 2012) - provides updated details on the condition and investigation into the 2-year old from Guangdong Province who is being treated at the Princess Margaret Hospital for H5N1.

 

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As I wrote last week in H5N1 And The Hong Kong Public Health Response, the CHP does a remarkably thorough job of surveillance and reporting on H5N1 – along with many other public health threats – in Hong Kong.

 

Would that every public health agency around the globe be as capable, and open.

 

A few excerpts (slightly reparagraphed for readability) from today’s report, but follow the link to read the article in its entirety:

 

An imported human case of influenza A(H5N1) infection in Hong Kong, June 2012


Reported by DR HENRY WONG, Medical Officer, and Dr Alice Wong, Senior Medical Officer, Respiratory Disease Office, Surveillance and Epidemiology Branch, CHP.


The Centre for Health Protection (CHP) confirmed a case of imported human influenza A (H5) infection affecting a 2-year-old boy on June 1, 2012. He lived with his parents and maternal grandmother in Gangzhou, Mainland China. He presented with fever and runny nose since May 23, 2012 while in Guangzhou. He sought medical attention but his symptoms persisted. He was then brought to Hong Kong on May 26 and sought medical attention from a private medical clinic in Mong Kok.

 

Subsequently, he developed febrile seizures and was admitted to Caritas Medical Centre (CMC) Special Care Unit (SCU) on May 28. The clinical diagnosis was encephalitis. His nasopharyngeal aspirate (NPA) collected on May 28 was confirmed to be influenza A virus of subtype H5 by Public Health Laboratory Branch (PHLSB) of CHP on June 1 and later confirmed to be influenza A(H5N1) infection on June 2. The patient was put on Tamiflu and antibiotics. He was transferred to Princess Margaret Hospital (PMH) for isolation and treatment on June 1.

 

Magnetic resonance imaging (MRI) scan for the brain on June 2 was suggestive of obstructive hydrocephalus. Emergency operation was performed on the same day to relieve the hydrocephalus.


Cerebrospinal fluid specimens taken on June 2, 3, 4 and brain tissue specimen taken on June 2 were tested positive for influenza A(H5) by polymerase chain reaction. He is currently under intensive care treatment in PMH and is in serious condition. His parents were asymptomatic and had been quarantined in PMH until June 9. NPAs taken from them were tested negative for influenza A(H5).

 

CHP had traced around 90 people who might have got into contact with the patient in the private medical clinic in Mong Kok, ambulance and CMC. NPAs taken from eight contacts including three healthcare workers from CMC, two patients from CMC, two health care workers of the private clinic and another patient who attended the same clinic, who reported respiratory symptoms were tested negative for Influenza A (H5). They were all put under medical surveillance.


Epidemiological investigation revealed that the patient was brought by his mother to buy a live duck in a wet market near his residence in Guangzhou during the period of May 17-19. From May 20-22, he travelled with his parents by private car to Anhui province but had no direct poultry contact during the trip.

(Continue . . . )

 

 

This edition of the CDW also contains reports on a case of listeriosis in a tourist, a case of Streptococcus suis infection, as well as a 3-year review of institutional scabies outbreaks in Hong Kong.

 

You’ll also find a series of charts showing surveillance data on a variety of infectious diseases.

 

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For a listing of weekly, bi-weekly, and other reports from the CHP you can visit their Disease Control Page.

»» Read More

WHO Update On Hong Kong H5N1 Case

 

 

# 6366

 

Basically summarizing what we already have heard, the World Health Organization has posted a situation report on the toddler from Guangdong Province, China being treated for H5N1 in a Hong Kong hospital.

 

 

Avian influenza - situation in China, Hong Kong Special Administrative Region (Hong Kong, SAR) - update

5 June 2012 - The Centre for Health Protection of the Department of Health, Hong Kong, China, has reported a human case of avian influenza A(H5N1) virus infection.‪ The case is a 2 year-old male from Guangzhou City, Guangdong province. He developed symptoms on 23 May 2012 in Guangdong province and went to a private clinic in Hong Kong, China, on 26 May 2012. He developed febrile convulsion and was transferred to a hospital on 28 May 2012 and was laboratory confirmed as A(H5N1) on 2 June 2012. His condition remains serious and he remains hospitalized.

 

The mother brought the case to visit a wet market with live poultry in Guangzhou in mid-May 2012 and a live duck was bought and slaughtered in the market. Close contacts of the case have tested negative for the virus.‪ Evidence so far indicates that this is a sporadic case of human infection with A(H5N1) virus, with no secondary spread or clustering.

 

So far, a total of 22 human cases of influenza A(H5N1) infection were reported in Hong Kong, China, including 18 cases in 1997, two cases in 2003, one case in 2010, and the current case in 2012.

 

You can view the latest tally of reported human cases at the link below.  I’ve excerpted the 2012, and cumulative totals in the graphic below.

 

 

Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO

 

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»» Read More

H5N1 And The Hong Kong Public Health Response

 

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# 6365

 

 

There is little change to the news this morning regarding the 2 year-old boy from Guangdong Province who is being treated at the Princess Margaret Hospital in Hong Kong for H5N1 (see Progress Reports On H5N1 Investigation).

 

The boy remains in serious condition, and despite aggressive contact tracing, no additional cases have been identified.  Authorities appear hopeful that this will remain an isolated case.

 

The Hong Kong response to H5N1 stands as a impressive example for the rest of the world on how to deal with a budding public health crisis. Not only do they have world class diagnostics and surveillance in place, they continue to do an admirable job in keeping the public informed on the details and progress of their investigation.

 

Since crisis and risk communications is part and parcel to any emergency response, today I thought we’d take a look at some of the communications coming out of the Centre For Health Protection on this case.

 

I’ve already covered several of the press releases from the CHP, including a Q&A with Dr. York Chow on Saturday, in earlier blogs (see here, here, and here).

 

But in addition to these, the CHP has sent out letters to Hospitals, Doctors, Schools, Child Care Facilities, and Nursing Homes with details on the threat, and specialized instructions for these facilities. 

 

You can view these letters by clicking this link, or the graphic below.

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As an example, on June the 2nd, the CHP sent out this remarkably clear and detailed letter to doctors in their jurisdiction.  They then posted this letter to their website.

 

Our Ref. :  (49) in DH SEB CD/8/6/1 Pt. 27 

2 June 2012

Dear Doctors,

Confirmation of a Human Case H5 avian Influenza Infection and Activation of Serious Response Level of Government’s Preparedness Plan

I would like to draw your attention to a confirmed case of human influenza A H5 infection in Hong Kong. The patient is a 2-year-old boy with good past health. He lives with his parents and maternal grandmother in Guangzhou, Mainland China.

 

He developed fever since 23 May  2012 while in Guangzhou. He sought medical attention there but his symptoms  persisted. He was then brought to Hong Kong on 26 May 2012 and was admitted to Caritas Medical Centre (CMC) Special Care Unit (SCU) on 28 May 2012 for febrile  seizures. The clinical diagnosis was encephalitis.

 
His nasopharyngeal aspirate (NPA) collected on 28 May 2012 confirmed to be of subtype H5 by Public Health Laboratory Branch (PHLSB) of the Centre for Health Protection (CHP) on 1 June 2012. The patient, along with his parents, was transferred to Princess Margaret PMH for single  isolation on 1 June 2012 evening. Latest radiological imaging was suggestive of obstructive hydrocephalus. Investigation is underway to exclude underlying cause.   His current condition is serious.

 

Epidemiological investigation revealed  that during the period of 17-19 of May, he was brought by mother to buy a live duck in a wet market near his residence. He travelled to Anhui province with his parents from 20 May to 22 May 2012 but had not contacted any live poultry there. CHP is communicating with the Guangdong Health Department to investigate  the source of his infection.  His close contacts are all
asymptomatic and his parents are put under quarantine in Hong Kong.

 

The Government has raised the influenza response level from “Alert” Response Level to “Serious” Response Level under the Framework of Government’s Preparedness Plan for Influenza Pandemic.

 

So far, 22 human cases of H5N1 infections were recorded in Hong Kong. Apart from the case confirmed yesterday, there was one outbreak of influenza A (H5N1) in 1997 with 18 people affected, of whom six died.  In February 2003, two imported cases were detected and one of them died.  According to the latest update from the World Health Organization (29 May 2012), worldwide  there were so far a total of 604 confirmed cases (including 357 deaths) of human infection with the H5N1 avian influenza virus.

 

Please be reminded that Influenza A (H2, H5, H7, and H9) is a notifiable disease. Apart from the statutory notification system, CHP will further strengthen surveillance for suspected human case of influenza A(H5N1) infection. I attach again (Annex) for your attention the Reporting Criteria for Human Influenza A(H5N1). In addition, I would like to urge you to pay special attention to those who presented with influenza like illness and had history of visiting wet market or contacting poultry in Guangzhou within the incubation period (i.e. 7 days before onset of symptoms).

 

Any suspected case meeting the reporting criteria
(
https://ceno.chp.gov.hk/casedef/casedef.pdf) should be reported to the Central Notification Office of CHP via fax (2477 2770), phone (2477 2772) or CENO On-line (www.chp.gov.hk/ceno). Please also contact the Medical Control Officer (MCO) of the Department of Health at Pager: 7116 3300 call 9179 when reporting any suspected case.

Yours sincerely,

(Dr. SK CHUANG)

for Controller, Centre for Health Protection
Department of Health

 

 

While most health departments maintain a static, rarely updated avian influenza information page, Hong Kong proactively produces a detailed Avian Influenza Report every week. Not only can you always read the latest report, you can go back through the archives of hundreds of reports beginning in 2005 on this archive page.

 

Today’s report can be accessed by clicking the graphic below.

 

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A few excerpts include:

 

Cambodia:  A 10-year-old  girl from Kampong Speu was confirmed positive for H5N1 avian influenza infection. She died on May  27, 2012.  Investigations indicated recent deaths among poultry in her village and the patient  had also  prepared sick chicken as food prior to becoming sick. (WHO, May 29, 2012)


Hong Kong:  A 2-year-old boy  was confirmed with  H5  avian influenza infection. He  lived in Guangdong with his parents and maternal grandmother. He had visited a wet market with live poultry near his residence in Guangzhou in mid-May. The boy’s subsequent laboratory results confirmed H5N1 avian influenza infection. He is  in serious condition.  (Department of Health, Hong Kong, China, June 1, 2012)

 

You’ll also find updated tables and charts, including this one on the CFR (Case Fatality Rate) over the past 9 years.

 

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Unfortunately, Hong Kong is the exception, not the rule when it comes to quality reporting on bird flu. Many countries either ignore the threat, or if they find they must address it, release as little information as they feel they can get away with.

 

While you can never know what you don’t know, the impression that Hong Kong’s CHP gives is one of remarkable openness about disease threats, and of a willingness to trust that the public will be able to handle the truth.

 

A refreshing, if all too rare, risk communications policy that ought to be emulated more widely around the globe.

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Hong Kong H5N1 Clade Identified

 

 


# 6364

 

 

Today Hong Kong’s CHP (Centre for Health Protection) released new details on their imported H5N1 case from neighboring Guangdong Province.

 

The virus has been identified as clade 2.3.2.1 – which you may recall was the subject of a press release from the FAO last August (see Bird Flu rears its head again) due to its ability to evade the current H5 poultry vaccines in use across much of Asia.

 

Because we’ve not discussed this clade in a while, a bit of  a review, then today’s statement from the CHP.

 

While not new, clade 2.3.2.1  has been making inroads across much of Asia in recent years. You can see an overview of the evolution of the H5N1 virus since it emerged in 1996 in the graphic below.

 

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H5N1, like all influenza A viruses, is constantly under pressure to change and mutate, looking for a biological advantage. Most of these mutations, thankfully, are evolutionary dead ends and fail to spread and thrive.

 

But in this viral version of king-of-the-hill, nature occasionally produces a more `fit’ and competitive virus, and it begins to dominate and spread.

 

One of these `new’ clades seeing much success over the past few years has been 2.3.2.  I wrote of the spread of this emerging clade last year in What Goes Around, Comes Around and EID Journal: H5N1 Branching Out).

 

In the spring of 2011 we began to see reports of poultry vaccine failures in Vietnam due to the spread of a mutated version this clade (further classified as clade 2.3.2.1).

 

The spread of the 2.3.2.1 clade of the virus was characterized last September (see WHO Report : Antigenic & Genetic Characteristics of H5N1 & H9N2 Viruses) as having appeared in wild birds and poultry in Bangladesh, China Hong Kong SAR, India, Japan, the Republic of Korea, Myanmar, and Vietnam.

 

While the press briefly had a field day over this new strain the CDC , the OIE, and the World Health Organization  quickly reminded us that while the bird flu threat remains, there was no evidence at the time to suggest that this new strain is any more transmissible to – and among – humans than the earlier strains.

 

 

WHO Statement On New Bird Flu Clade

OIE Statement On H5N1 Clade 2.3.2.1

ECDC Risk Assessment On Avian Flu & Human Health

The CDC On The `New’ H5N1 Clade 2.3.2.1

 

And while we’ve continued to see sporadic human infections with the H5N1 virus, they have not (as yet) escalated in frequency with the spread of this new clade.

 

H5N1 remains primarily a disease threat to birds, as it has not yet adapted sufficiently well to human physiology to spread efficiently from human-to-human.

 

The concern, of course, is that given enough time and opportunities . . . it might.

 

 

All of which brings us to today’s update from Hong Kong’s CPH on the toddler being treated at the Princess Margaret Hospital.

 

Further updates on H5N1 case

The Centre for Health Protection (CHP) of the Department of Health today (June 4) provided further updates on the Influenza A (H5N1) case involving a 2-year-old boy.

 

Further tests conducted by the Public Health Laboratory Services Branch of the CHP on the Influenza A virus isolate from the nasopharyngeal aspirate taken from the boy showed that the H5 gene of the isolate belonged to clade 2.3.2.1, which is the same clade as the isolates from wild birds detected in 2011 and 2012 and in the imported human infection case in late 2010. So far all the genes characterised belong to avian origin and there is no evidence of resistance to the antiviral agent oseltamivir (Tamiflu).

 

The boy is currently receiving intensive care in the Paediatric Intensive Care Unit of Princess Margaret Hospital. Investigation into the cause of his obstructive hydrocephalus is still under way. His current condition remains serious.

 

The CHP so far has kept some 80 contacts under medical surveillance.

 

Nasopharyngeal aspirates taken from the parents and the five contacts who reported respiratory symptoms tested negative for Influenza A (H5).

 

As at 5pm today, a total of 20 public enquiries have been received on the DH hotline (2125 1111).


The investigation is continuing.

Ends/Monday, June 4, 2012
Issued at HKT 17:54
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Hong Kong: Updates On H5N1 Investigation

 

 

 

# 6361

 

 

We’ve some additional information this morning on Hong Kong’s first human H5N1 infection in 18 months (see HK Raises Alert Level: Toddler Hospitalized With H5 Flu), among them confirmation that the virus is indeed, H5N1.

 

Yesterday’s raise in Hong Kong’s pandemic response level – from ALERT To SERIOUS – is an intermediary step, and as outlined in Hong Kong’s Preparedness Plan for Influenza Pandemic, is implemented under one of two scenarios:

 

Serious Response Level 


4.  Serious Response Level depicts two possible scenarios. The first scenario depicts confirmation of HPAI outbreaks in the environment of  or among poultry population in retail markets, wholesale markets or farms in Hong Kong due to a strain with known human health impact. Upon the advice of DAFC or Director of Food  and Environmental Hygiene, SFH will activate this Response Level.

 

5.  The second scenario depicts the confirmation of human case(s) of avian influenza in Hong Kong without evidence of efficient human-to-human transmission. Upon the advice  of DoH, SFH will activate this Response Level.

 

 

The detection of a single (imported) case of H5N1 infection falls under the second scenario above. Were efficient H-2-H transmission suspected, the response level would have been boosted to the EMERGENCY level instead.

 

Hong Kong was the site of the first human cluster of H5N1 infection 15 years ago and bore the brunt of the SARS outbreak in 2003. And in 2010, they saw their first human infection from the H5N1 virus since 2003.

 

Authorities there are, quite understandably, quick to act whenever there is even a hint of threat from a novel flu virus. 

 

First, an update on the patient’s condition, and that of family contacts, and then some local responses, including comments by York Chow.

 

 

Updates on H5 case


Latest laboratory results received by the Centre for Health Protection (CHP) of the Department of Health today (June 2) confirmed that the two-year-old boy was infected with Influenza A (H5N1).

 

The boy is put under intensive care treatment in Princess Margaret Hospital (PMH) and is now in serious condition. Latest radiological imaging studies showed obstructive hydrocephalus. Investigation is underway for the underlying cause.

 

Preliminary investigation revealed that the boy had visited a wet market with live poultry in Guangzhou in mid-May.

 

"The boy's parents are all along asymptomatic, which means the chance of a human-to-human transmission is slim," a CHP spokesman said.

 

The parents are being quarantined at PMH and nasopharyngeal aspirates taken from them were tested negative.  Laboratory tests of two health care workers of the private clinic and another patient who attended the same clinic were also tested negative for Influenza A (H5).

 

As at 4pm today, a total of six public enquiries have been received on the DH hotline (2125 1111).  

Investigation continues.

Ends/Saturday, June 2, 2012
Issued at HKT 16:38

 

 

 

Hong Kong’s Secretary for Food and Health (SFH), Dr. York Chow, made some extensive remarks in English during a press conference earlier today regarding the 2-year-old boy from Guangdong Province.

 

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His remarks appear on the info.gov.hk website.

(June 2):

Reporter: (On the condition of the patient.)

Secretary for Food and Health: The condition of the patient is not serious. For our contingency plan, whenever there is a local case of avian influenza in Hong Kong, we need to raise our alert to the serious level. That is the reason why I have just announced all those measures that we had to take, including raising the alert in the public hospitals; checking the imports of live chickens; inspecting our farms and birds and so on. We think it is an important measure to take for particularly Hong Kong, because we had experiences of outbreaks of avian influenza in Hong Kong. For this particular case, so far the chance of it being spread to other humans is relatively low. But we still need to go through the whole process of analysing the origin and channel of the infection and have to study the virology of the virus.

 
Reporter: (On temperature and health check at the border.)


Secretary for Food and Health:

The temperature check is only able to detect people with high temperature. With anybody who is suppressing their body temperature with medicine, it is always difficult to detect. What is more important for the whole exercise of checking body temperature is to alert our tourists and also our Hong Kong returnees to be aware of their health. In case there are any symptoms or signs, they should seek medical treatment. Everyday, we are able to detect more than 10 to 20 people with high temperature passing through our border. We do not quarantine them or take them to hospitals. We will check their contact history to see whether they have been exposed to poultry or birds and so on; and what type of infection they are likely to have. Many of them follow our advice and go to seek medical treatment.   

Reporter: (On banning live poultry imported from the Mainland.)


Secretary for Food and Health:

We have done a lot in the last few years in controlling avian influenza in our poultry, including those imported from the Mainland as well as from our local farms. We are also handling our chickens at the retail level with the "no retention overnight" policy. These are effective policies as far as controlling avian influenza in Hong Kong is concerned. But as far as the whole environment is concerned, as you know that this year we have 20 dead wild birds tested positive for carrying the H5N1 virus. It means that if the virus is always in existence in our natural environment, although they might not be affecting our poultry, might not be affecting our humans, but they are there. In all aspects, we have to be very cautious all the time to ensure that all the measures we took are being followed by the respective stakeholders and Government regulators.       

Reporter: (On whether there will be an import poultry ban.)


Secretary for Food and Health:
I do not see any reason for changing our supply of live poultry at the moment. But we will of course always be vigilant about the situation. If we find anything that would increase the risk of H5N1 infection on humans, we will of course take extra measures. 


Reporter: Do Hong Kong people need to be worried about the incident?


Secretary for Food and Health:

At the moment, it is an isolated case. We feel that there is no need for panic among Hong Kong citizens. We have measures to tackle all types of infectious diseases, including controlling avian influenza through various means such as our control at poultry farms and retail level and so on.  We also have very good diagnostic tools within the health care system. All the hospitals are equipped to test influenza virus by a fast test and are able to alert within a few hours. All in all, the only message I like to advise the public is to always maintain a good level of personal and environmental hygiene. When you visit other places outside Hong Kong, be careful of those wet markets and places where there might have poultry. It is always more risky when you get into a large concentration of animals if you do not know their health status.

 

Reporter: (On transmission mode of the virus.)

Secretary for Food and Health: For all experiences, the most common course of transmission is from infected poultry to human. Infected poultry means that the chicken is usually still alive. It is very rare that dead chicken or chilled or frozen chicken would transmit the virus to humans. 


(Please also refer to the Chinese portion of the transcript)

Ends/Saturday, June 2, 2012
Issued at HKT 14:53

 

 

And finally, a statement from the Hospital Authority on their ramped up surveillance, looking for additional potential infections.

 

 

Hospital Authority enhanced surveillance programme for patient with influenza symptom

The following is issued on behalf of the Hospital Authority:


The Central Committee on Infectious Diseases & Emergency Responses of the Hospital Authority (HA) held a special meeting today (June 2) afternoon to discuss and review infection control measures of activation of Serious Response Level in public hospitals after confirmation of an Influenza A (H5N1) case. The HA also implemented an Enhanced Surveillance Programme for patient with influenza symptom.

 

The HA spokesman reiterates that hospital staff at Accident & Emergency Departments and general outpatient clinics were reminded to be vigilant to patients.  Triage assessment and appropriate segregation at waiting areas would be arranged.

 

Under the Serious Response Level, more stringent infection control measures will be enforced in public hospitals, which include no visiting at isolation wards unless on compassionate ground.  For all acute hospitals, visiting hours would be not more than 2 hours per day and not more than 2 visitors per visit, and not more than 4 hours per day for all convalescent hospitals. Volunteering service in hospitals would be suspended.  Visitors to public hospitals and clinics are advised to put on surgical masks if they have respiratory infection symptoms and perform hand hygiene before and after visiting patient areas.

According to the spokesman, HA would continue to work closely with the Centre for Health Protection in monitoring the latest situation and keep the general public as well as healthcare workers updated of the development on a regular basis.

Ends/Saturday, June 2, 2012
Issued at HKT 19:04

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HK Raises Alert Level: Toddler Hospitalized With H5 Flu

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Map Credit Wikipedia

 

# 6350

 

 

We are just now starting to get details, but it appears that a 2-year-old boy from neighboring Guangdong Province is being treated in a Hong Kong hospital for H5 avian influenza, and as a result the Centre for Health Protection has raised their pandemic response level from `Alert’ to `Serious’.

 

 

Two reports out of Hong Kong, first detailing the case, and the second with details on the initial response.

 

Boy infected with H5 in stable condition

 

The serious response level under the Government's Preparedness Plan for influenza pandemic was activated today (June 1) as the Centre for Health Protection (CHP) of the Department of Health (DH) investigated a case of influenza A H5 infection affecting a two-year-old boy.

 

The patient developed fever and runny nose on May 23 in Guangdong province. He came to Hong Kong on May 26 and sought medical attention from a private medical clinic in Mong Kok. Subsequently, he developed febrile convulsion and was taken to the Accident and Emergency Department of Caritas Medical Centre on May 28.  He was admitted for suspected encephalitis. He is now in stable condition.

 

A spokesman for the CHP said that the nasopharyngeal aspirate taken from the boy tested positive for Influenza A (H5). Further studies on the virus were in progress.

 

Investigation revealed that the patient lived in Guangdong province with his parents and maternal grandmother. His exposure history during incubation period is pending.

 

His home contacts were asymptomatic.

 

A telephone hotline, 2125 1111, has been set up to answer public enquiries from tomorrow (June 2). The hotline will be operated from 9am to 6pm.

 

"The CHP is also closely liaising with the Mainland authorities and the Hospital Authority to monitor the situation," the spokesman said.

 

He advised members of the public that the best way to combat influenza infection was to build up body resistance by having a proper diet with adequate exercise and rest.

 

"Good ventilation should be maintained to avoid the spread of respiratory tract infection.

 

"Members of the public should seek medical consultation promptly if they develop influenza-like illness.

 

"Members of the public should also avoid direct contact with poultry and birds, and if contacts have been made, they should wash hands thoroughly with soap and water," the spokesman said.

Ends/Friday, June 1, 2012
Issued at HKT 23:36

 

The second press release concerns the raising of the alert level.

 

 

Serious Response Level activated in public hospitals


The following is issued on behalf of the Hospital Authority:

The Hospital Authority (HA) spokesman announced today (June 2) the activation of Serious Response Level in public hospitals to tie in with the Government's raising the response level for avian influenza from "Alert" to "Serious".

 

The HA spokesman said hospital staff at Accident & Emergency Departments and general outpatient clinics was reminded to be vigilant to patients.  Triage assessment and appropriate segregation at waiting areas would be arranged.

 

 

Under the Serious Response Level, more stringent infection control measures will be enforced in public hospitals, which include no visiting at isolation wards unless on compassionate ground.  For all acute hospitals, visiting hours would be not more than 2 hours per day and not more than 2 visitors per visit, and not more than 4 hours per day for all convalescent hospitals. Volunteering service in hospitals would be suspended under "Serious" Level.  Visitors to public hospitals and clinics are advised to put on surgical masks if they have respiratory infection symptoms and perform hand hygiene before and after visiting patient areas.

According to the spokesman, HA would continue to work closely with Centre for Health Protection in monitoring the latest situation and keep the general public as well as health care workers updated of the development on a regular basis.

Ends/Saturday, June 2, 2012
Issued at HKT 00:39

 


The good news, of course, is there is probably no place in the world more vigilant -  or better able to respond – to any H5 outbreak than Hong Kong.

 

We’ll obviously be watching this story closely over the next several days.

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