Vietnam: Ministry Bans Transport Of Waterfowl Over H5N1 Fears

Photo Credit – FAO

 

# 6564

 

 

Over the past few weeks we’ve seen a growing number of reports out of Vietnam regarding a newly emerging sub-clade of the H5N1 virus (see Vietnam Reports A Possible Change In The H5N1 Virus). 

 

While the origin of this virus is in dispute (see V Said, C Said), what is clear is the concern being expressed by officials over this new threat.

 

This new sub-clade has been dubbed 2.3.2.1 C, and is the third variation of the 2.3.2.1 clade that has been circulating for several years in South East Asia and China. Just over a year ago (see FAO Warns On Bird Flu) concerns were raised over this clade, as the poultry vaccine currently in use was ineffective against it.

 

The myriad of H5N1 viruses we have today have all essentially evolved from clade 0, first identified in 1996. You can see the history of the virus in the chart below. H5N1 – like all flu strains – is a constantly moving target, continually evolving, looking for an evolutionary advantage.

 

Some less successful clades have died out along the way, but many co-circulate around the globe today.

 

(click to load larger image)

 

All of which means we are not watching just one H5N1 virus strain, we are watching at least 20 genetically separate clades of the virus, with many minor variants of each clade thrown in the mix.

 

Which brings us to today’s report from the SGGP (Sài Gòn Giải Phóng), the official newspaper of the Vietnamese government.

Ministry fears spread of virus, bans transport of water fowl

Wednesday, Sep 19, 2012

 

The Ministry of Agriculture and Rural Development has decided to stop transport of live water-fowl from North and Central Vietnam to the South, in an effort to curb spread of the new highly toxic strain of avian flu virus.

 

Pham Van Dong, deputy director of the Department of Animal Health, stated this at a meeting held yesterday in Hanoi by the National Steering Committee for Avian Flu Prevention and Control.

 

The new strain, 2.3.2.1 C, which has been detected, is highly toxic and therefore extremely deadly.

 

The virus strain has recently spread to Vietnam and is now present in affected areas in the northern and central provinces of Hai Phong, Ha Tinh, Ninh Binh, Nam Dinh, Bac Kan, Thanh Hoa and Quang Ngai.

 

Fearing the virus may spread to South Vietnam, the Department of Animal Health was asked to isolate the virus and ban transport of live water-fowl from infected areas.

 

Dong said that slaughterhouses practicing good hygiene should be mentioned to localities from the central province of Thua Thien-Hue to Ho Chi Minh City.

 

Because the new strain is different from the earlier A/H5N1 virus, the ministry has urged for experiments and tests to confirm whether the vaccine used to combat A/H5N1 is also effective against the new strain. If the existing vaccine is ineffective, studies on new vaccines should be conducted soon.

 

The Central Veterinary Diagnosis Center has been asked to study the new strain to help find a specific medication to fight the virus.

 

 

Although the above story describes this new strain (2.3.2.1 C) as `highly toxic and therefore extremely deadly’ this would appear to be referring mainly to its effect on poultry.

 

Vietnam has reported only 4 human infections this year (2 fatal), and none have been reported since last March (see WHO Update Avian influenza – situation in Viet Nam – update).

 

Thus far, we have scant hard data on the threat this new clade poses to humans.

 

While we continue to see isolated human infections around the world, 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 adapt to human or mammalian physiology.

 

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 moving towards becoming a bigger threat.

»» Read More

Hong Kong: Progress Reports On H5N1 Investigation

 

 

 

# 6363

 

Via the Centre For Health Protection in Hong Kong we get an update on the investigation of the 2 year-old from Guangdong Province hospitalized with H5N1, which indicates that so far, no additional H5N1 infections have been detected.

 

No doubt complicating matters is the fact that Hong Kong is experiencing an unusually heavy, late season surge in seasonal influenza (see Hong Kong: Flu Activity Continues To Rise).

 

The most recent Flu Express report from the CHP indicates that flu activity (week 21) in Hong Kong is at the highest level of the year.

 

 

 

 

 

Updates on H5N1 case

• The Centre for Health Protection (CHP) of the Department of Health today (June 3) provided further updates on the Influenza A (H5N1) case involving a two-year-old boy.

• The CHP's epidemiological investigation found that the boy had been to Anhui, China with parents from May 20 to 22, during which he had no direct poultry contact. He had visited a wet market with live poultry near his residence in Guangzhou in mid-May.

• The boy is currently receiving isolation treatment at Princess Margaret Hospital (PMH). His condition remained serious.

• The CHP continued contact tracing work. Apart from the boy's parents, the CHP had traced contacts with the patient in the private medical clinic in Mong Kok, ambulance and Caritas Medical Centre (CMC), totalling around 80 people. Among them, two healthcare workers from CMC developed some respiratory symptoms and nasopharyngeal aspirates taken from them were tested negative for Influenza A (H5).

• Earlier, laboratory tests of the boy's parents, two health care workers of the private clinic and another patient who attended the same clinic were all tested negative for Influenza A (H5).

• The CHP has issued letters to doctors yesterday, reminding them to pay special attention to patients who have visited wet markets or had poultry contact in Guangzhou. They are also reminded to report any suspected H5 cases to the CHP.

• As at noon today, a total of 10 public enquiries have been received on the DH hotline (2125 1111).

• Investigation continues.

Ends/Sunday, June 3, 2012
Issued at HKT 14:54

»» Read More

Indonesia MOH Reports Bird Flu Fatality

 

Riau, Indonesia

# 6309

 

Last week we were following conflicting reports of a 2-year-old in Bali suspected of having died from the H5N1 virus (see Bali: Suspected Bird Flu Fatality), but today’s report is on a different toddler, this time from Riau.

 

A hat tip to Gert van der Hoek on FluTrackers for picking up this announcement from the Indonesian Ministry of Health.

 

Bird Flu Case Report

MAY 1, 2012 | 8:49 PM
Ministry of Health, "Directorate General of Disease Control and Environmental Health" announced one new case of H5N1 have been confirmed by the Center for Biomedical and Health Technology base, Balitbangkes.

Case on behalf of MAF (Female, 2 years) from Siak, Pekanbaru, Riau province.

Dated 17 April 2012 symptoms of fever, dated 20 April 2012 the case to the Private Clinic but no improvement so the evening went to the hospital Z.

On 21 April 2012 cases admitted to hospital and treated in EB Hospital. Treating physician to report to the Command Post Riau Provincial Health Office. On 27 April 2012 patient was referred to hospital AA. The situation gets worse case and the case died on 27 April 2012 at 23:45 pm in the Hospital AA.

Epidemiological investigations have been carried into the homes of people and the environment by the local health office team, acquired risk factors, namely the possibility of contact with poultry (quail eggs) for the case of parents selling quail eggs.

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 189 cases with 157 deaths.

»» Read More

Indonesia MOH Announces Bird Flu Fatality

 

# 6213

 

The Indonesian Ministry of Health has published details on a recent H5N1 fatality in Bengkulu, Bengkulu province on the island of Sumatra.

 

The victim is a 24-year-old female (?) who died on March 1st, who is described as an employee of the District Hospital Dr. M. Jonah. 

 

The epidemiological investigation, however, appears centered on poultry deaths in his neighborhood as opposed to any workplace exposure.

 

The following is a Google translation from the MOH website (the gender of this patient has previously been reported to be female, so the gender given below may be a translation error)

 

 

Bird Flu Case Update

March 9, 2012 | 7:43 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 Basic Biomedical and Health Technology, Agency for Healthcare Research.

 

Case on behalf of M (Male, 24 years old) Queen of district residents Samban, the city of Bengkulu, Bengkulu province, and the employee at the District Hospital Dr. M. Jonah. Symptoms of fever cases since February 23, 2012. He then admitted to hospitals for treatment and DR. M. Jonah the next day. Because of cough, shortness of breath, and accompanied by a decrease in consciousness, then the case was transferred to the intensive care unit (ICU). Finally, the case died on March 1, 2012 at 22:45 pm.

 

Epidemiological investigations have been carried into the homes of people and the environment by the Integrated Team Ministry of Health, Public Health Service and the local Animal Husbandry Department. Based on these investigations, obtained the possibility that the patient has risk factors for contact environments where there are sudden deaths of poultry in the neighborhood.

 

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news was broadcast on 187 cases with 155 deaths.

 

»» Read More

Media Report: 4th Vietnamese H5N1 Case Of 2012

Photo Credit Wikipedia

 

# 6209

 

The Thanh Nien Daily is reporting on Vietnam’s 4th known H5N1 infection of 2012, that of a 32-year-old male, known as N.D.T, from Dak Lak Province.  This would appear to be the same case that Crof mentioned overnight (here), but with a few more details.

 

Unlike the other cases we’ve seen this year from Vietnam, which have all come from the southern provinces, this one hails from the Central Highlands region.

 

 

 

Vietnam reports 4th bird flu infection 

Last Updated: Wednesday, March 07, 2012 07:10:00

Vietnam’s fourth bird flu (H5N1) patient of the year, and the first in the Central Highlands region, is being treated at the Hospital for Tropical Diseases in Ho Chi Minh City, the hospital’s deputy director Le Manh Hung told Thanh Nien Wednesday.

 

The 32-year-old male patient, known as N.D.T, from Dak Lak Province, was admitted to the hospital on Monday with high fever, fatigue and respiratory problems.

 

He was put on a breathing machine and kept in quarantine.

(Continue . . . )

 

 

While we continue to see a steady trickle of human H5N1 cases coming out of regions where the virus is endemic, most of these cases have been `one-off’ infections, with no sign of onward transmission.

 

For now, it remains difficult for humans to contract this virus, as it is far better adapted to avian physiology.

 

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

»» Read More

Hong Kong: H5N1 Infected Goose Carcass Found On Beach

 

 

#6102

 

 

With an avian punctuality usually reserved for the arrival of swallows to Capistrano or the buzzards to Hinckley, Ohio - January once again finds an H5N1 infected bird carcass on the beaches of Hong Kong.

 

Located adjacent to mainland China - which has a long history of H5N1 outbreaks in poultry and in wild birds – Hong Kong sits at the outflow of the Pearl River to the sea.

 

 

Photo Credit- Wikipedia

 

The Pearl River Delta serves as a catchment area for dozens of tributaries flowing out of the highly industrialized and economically booming Guangdong Province, has been described as one of the more heavily polluted waterways in the world.

 

Industries, and farms, are known to use these rivers as a convenient disposal system, and what gets dumped upstream flows out to the sea past Lantau island.

 

In the winter of 2009, we saw a number of decomposed poultry carcasses wash up on the beaches of Hong Kong, presumably carried to the sea via the Pearl River, which flows out of Guangdong Province, China.

 

Some of my blog coverage of those events included:

 

Hong Kong Authorities Investigating More Dead Birds

All Eyes On Mainland China

More Concerns Surface Over China

 

Chinese authorities denied knowledge of any bird flu outbreaks in Guangdong Province and eventually the number of dead birds showing up on shore declined.

 

Again, over the winter of 2010-2011 we saw multiple reports of badly decomposed poultry carcasses washing up on Hong Kong beaches.

 

H5N1 Infected Chicken Carcass On Hong Kong Beach

Hong Kong: More H5N1 Infected Chickens Wash Up On Beach

 

And today, via Hong Kong’s Centre for Health Protection, we get this report of a badly decomposed goose carcass on the beach near Sham Tseng.

 

While this report doesn’t explicitly state that the carcass washed ashore, that has been the pattern observed in past years.

 

 

Goose carcass found in Sham Tseng tests positive for H5N1 virus

Ends/Thursday, January 26, 2012

A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (January 26) that a goose carcass found in Sham Tseng was confirmed to be H5N1 positive after laboratory testing.

The goose carcass was found and collected at Anglers' Beach, 13 milestone, Castle Peak Road, Sham Tseng, on January 20. It was highly decomposed when found and required a series of tests before H5N1 avian influenza was confirmed today.

The spokesman said there were no poultry farms within 3 kilometres of where the dead goose was found. AFCD staff have conducted inspections and found no evidence of any backyard poultry being kept there. AFCD will continue to monitor the situation and conduct inspections of the area.

 

In view of the case, the AFCD has phoned poultry farmers to remind them to strengthen precautionary and biosecurity measures against avian influenza. Letters have been issued to farmers, pet bird shop owners and licence holders of pet poultry and racing pigeons reminding them that proper precautions must be taken.

 

The spokesman said the department would conduct frequent inspections of poultry farms and the wholesale market to ensure that proper precautions against avian influenza have been implemented. The department will continue its wild bird monitoring and surveillance.

"People should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. The public can call 1823 for follow-up if they come across suspicious sick or dead birds, including the carcasses of wild birds and poultry," the spokesman said.

(Continue . . . )

 

 

 

Admittedly one infected carcass doesn’t tell us much about what may –or may not – be going on upstream from Hong Kong, but it will be interesting to see if – as in years past – more of them continue to show up over the next few months.

»» Read More

Branswell: WHO on H5N1 Research Controversy

 

# 6051

 

Note: I’ve been otherwise occupied today, dealing with unexpected family matters and haven’t had an opportunity to post.

 

So I’m happy to report that Crof over at Crofsblog  has posted a number of stories, including one from Helen Branswell on the World Health Organization, and the incredibly complex and controversial issues they must consider regarding bird flu research projects around the world.

 

As always with a Branswell story, you’ll want to follow the link and read it in its entirety.

 

Controversial bird flu studies raise complex problem, defy easy solutions: WHO

Helen Branswell,  Wednesday, January 04, 2012 2:49 PM

Read it on Global News: Global Calgary | Controversial bird flu studies raise complex problem, defy easy solutions: WHO

 

 

I hope to be back blogging regularly tomorrow, but in the meantime check Crof, Arkanoid Legent, and A Times Memory – along with FluTrackers and the Flu Wiki – for breaking flu & infectious disease news.

»» Read More

Referral: A Summary Of Worldwide H5N1 Cases in 2011

 

 

 

# 6048

 

One of the senior moderators at FluTrackers, who goes by the moniker Laidback Al, has put together an impressive overview of human H5N1 cases reported during the year just past.

 

Al, who is well known at FluTrackers for his skill with maps and charts, uses visual representations of the data to good effect here.

 

I’ve posted just a snippet from the abstract and smaller versions of a couple of his graphics below, but I encourage everyone to go to the thread and read it in its entirety.

 

This is as fine of an overview of the situation as you are apt to find anywhere, and I’ve already downloaded a copy and put in into the reference folder on my desktop.

 

It’s a keeper, and highly recommended.

 

 

A Summary of Worldwide Human H5N1 Cases in 2011

Laidback Al, Senior Moderator, www.FluTrackers.com
January 1, 2012

Abstract – In 2011, 59 human cases of H5N1 were reported from around the world, a 23% increase over 2010. Five countries reported cases in 2011, Bangladesh, Cambodia, China, Egypt, and Indonesia. Almost half of the 59 cases (about 45%) were children under 10 years old. The fatality rate did not appreciably decline in 2011, about half of all the reported cases died. Four small family clusters were noted during the year. The source of exposure for all of the cluster cases has been reported as exposure to sick and dying poultry. None of these clusters resulted in sustained human to human transmission. Based on an analysis of the 2011 data, the potential for a virulent H5N1 pandemic has not diminished.

(Continue . . . )

»» Read More

Host Genetic Susceptibility to Avian Influenza

 

 

Photo Credit – CDC PHIL

 

# 5912

 

 

There is a belief, at least among some researchers, that there exists some – as yet unidentified -  genetic propensity for contracting the H5N1 virus.

 

This idea is based primarily on the observation that - despite ample opportunities for exposure – relatively few humans have been infected, and that the few clusters of human-to-human transmissions we've seen appear to happen primarily among blood relatives.

 

While this idea has been around for a number of years, it hasn’t exactly been universally embraced. 

 

In 2007 the CDC’s Emerging Infectious Diseases Journal published a study suggested that mere chance could account for family clustering.

 

Little Evidence for Genetic Susceptibility to Influenza A (H5N1) from Family Clustering Data

Virginia E. Pitzer , Sonja J. Olsen†, Carl T. Bergstrom‡, Scott F. Dowell†, and Marc Lipsitch

Abstract

The apparent clustering of human cases of influenza A (H5N1) among blood relatives has been considered as evidence of genetic variation in susceptibility. We show that, by chance alone, a high proportion of clusters are expected to be limited to blood relatives when infection is a rare event.

 

While this article proposed a plausible alternative theory for family clustering, it didn’t disprove that host genetics played a role in transmission.

 

In 2008, in the Journal of Infectious Diseases, we saw a study that suggested there might be a heritable susceptibility to death from the influenza virus.

 

Evidence for a heritable predisposition to death due to influenza.

 

Albright FS, Orlando P, Pavia AT, Jackson GG, Cannon Albright LA.

Abstract (extract)

Evidence for a heritable contribution to death due to influenza was examined using a resource consisting of a genealogy of the Utah population linked to death certificates in Utah over a period of 100 years. The relative risks of death due to influenza were estimated for the relatives of 4,855 individuals who died of influenza.

 

Both close and distant relatives of individuals who died of influenza were shown to have a significantly increased risk of dying of influenza, consistent with a combination of shared exposure and genetic effects. These data provide strong support for a heritable contribution to predisposition to death due to influenza.

 

 

While interesting, this study doesn’t provide us with a smoking gene. However, the following year a PLoS ONE  research article (doi:10.1371/journal.pone.0004857) came a bit closer.  

 

Entitled Host Genetic Background Strongly Influences the Response to Influenza A Virus Infections by Srivastava B, Błażejewska P, Heßmann M, Bruder D, Geffers R, et al., it reports on the results of experiments utilizing seven inbred strains of lab mice that were exposed to influenza A viruses.

 

From the abstract:

 

The genetic make-up of the host has a major influence on its response to combat pathogens. For influenza A virus, several single gene mutations have been described which contribute to survival, the immune response and clearance of the pathogen by the host organism.

 

While mouse models are often useful, what happens in mice doesn’t always correspond to what happens with human physiology.

 

Another (as far as I can tell, unpublished) study, conducted in Thailand, Singapore, and Indonesia by the South East Asia Infectious Disease Clinical Research Network, looks at whether:

 

“. . .  host genetic factors may shed light on key pathogenic interactions between H5N1 and human cells . . .  ”

 

The overview of the study is available on clinicaltrials.gov at:

 

Host Genetic Susceptibility to Avian Influenza A/H5N1

 

Hopefully this will provide us with more clues as to why some people appear susceptible to the H5N1 virus, while others less so.

 

All of which serves as prelude for a study that appeared yesterday in the journal Clinical Infectious Diseases, which provides more evidence supporting the notion that host genetics influences acquisition and transmission of the H5N1 virus.

 

This study looked at 113 sporadic and 26 cluster outbreaks of the H5N1 virus in Indonesia through July 30th, 2009 and found  human transmission of bird flu to be heavily influenced by host genetic susceptibility.

 

Below you’ll find a link to the abstract, and an excerpt (slightly reformatted for readability) of the results. Go read it, and when you return I’ll have a little more.

 

 

Risk Factors for Cluster Outbreaks of Avian Influenza A H5N1 Infection, Indonesia

Tjandra Y. Aditama, Gina Samaan, Rita Kusriastuti1, Wilfried H. Purba, Misriyah, Hari Santoso, Arie Bratasena, Anas Maruf, Elvieda Sariwati, Vivi Setiawaty, Alex R. Cook, Mark S. Clements, Kamalini Lokuge, Paul M. Kelly, and I. Nyoman Kandun

(EXCERPT)

Risk factors for cluster outbreaks were the number of first-degree blood-relatives to the index case (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI]: 1.20–1.86) and index cases having direct exposure to sources of AI H5N1 virus (aOR, 3.20; 95% CI: 1.15–8.90).

 

Risk factors for secondary case infection were being aged between 5 and 17 years (aOR, 8.32; 95% CI: 1.72–40.25), or 18 and 30 years (aOR, 6.04; 95% CI: 1.21–30.08), having direct exposure to sources of AI H5N1 virus (aOR, 3.48; 95% CI: 1.28–9.46), and being a first-degree relative to an index case (aOR, 11.0; 95% CI: 1.43–84.66).

 

Siblings to index cases were 5 times more likely to become secondary cases (OR, 4.72; 95% CI: 1.67–13.35).

 

 

In Indonesia, young age (under 30) and being a blood relative to the index case in a cluster, were both found to significantly increase the odds of catching the virus.

 

While it is more than a little tempting to hope that some unidentified human genetic quirk limits the ability of the H5N1 virus to ever become a pandemic, the whole point of viral evolution is to figure out a host’s defenses.

 

What may have served as a limiting factor in the past, doesn’t provide a guarantee for the future.

 

Determining what (if any) genetic factors influence transmission could provide vital clues of just how big of a pandemic threat the H5N1 virus really presents, and might even lead to more effective treatments and prevention.

 

The difficulty, of course, is that studies like this take time to mount and to interpret, and the virus never sleeps.

»» Read More

Cambodia: 6th Bird Flu Fatality Of 2011

 

 

# 5618

 

 

Yesterday RoRo on FluTrackers picked up on an FAO Empres report about a human bird flu infection in Cambodia.   Few details were available at that time, but this morning we know more, as evidenced by the following World Health Organization  situation update.

 

 

Avian influenza – situation in Cambodia - update 4

10 June 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 a 7 year old female from Prasat village, Prasat commune, Kampong Trabek district, Prey Veng Province. She developed symptoms on 24 May, was initially treated by local private practitioners with no effect and was later admitted to Kantha Bopha Children Hospital on 31 May. She died on 7 June, seven days after admission.

 

There have been reports of poultry die off in her village and the case is reported to have had exposure to sick poultry. The female is the sixteenth person in Cambodia to become infected with the H5N1 virus and the fourteenth to die from complications of the disease. All six cases of H5N1 infections in humans in Cambodia this year have been fatal.

 

The National and local Rapid Response Team (RRT) is conducting outbreak investigation and response following the national protocol.

 

After seeing only 4 cases of H5N1 infection in humans over the past 4 years, Cambodia in 2011 has suddenly become the focus of renewed attention after 6 fatal cases have been reported over the past four months.

 

Four of these cases have been detected in Prey Veng Province, and 5 have been young children.

Earlier reports on these cases include:

 

Cambodia Reports 5th Bird Flu Fatality

IRIN: Cambodia’s Bird Flu Risk "under control" - Experts

Cambodia: 4th Bird Flu Fatality Of 2011

WHO Update On Cambodian H5N1 Fatalities

 

The clustering of cases in and around Prey Veng Province, and over an extended period of four months, suggests that the virus may be well entrenched in local poultry.

 

Luckily, H5N1 remains difficult for humans to catch. Although we continue to see isolated human infections around the world, for now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

 

The concern, of course, is that over time that may 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 to humans.

»» 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

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

WHO Updates Indonesia’s H5N1 Count

 

 

# 5393

 

 

 

The World Health Organization today released an update with two human H5N1 infections (both fatal) which were reported by the Indonesian Ministry of Health over the past several days.

 

This brings the official toll in Indonesia to 174 known infections, and 144 deaths.

 

 

Avian influenza – situation in Indonesia - update

14 March 2011 - The Ministry of Health of Indonesia has announced 2 new but unrelated confirmed cases of human infection with avian influenza A (H5N1) virus.

 

The first case is a 2 year old male from Depok City, West Java Province. He developed symptoms on 3 February, was admitted to a private clinic on 5 February and referred to a hospital on 6 February. He died on 6 February. Prior to his illness, sick and dead poultry were reported in the his neighborhood.

 

The second case is a 31 year old female from Bekasi City, West Java Province. She developed symptoms on 23 February, was admitted to a private clinic on 25 February and referred to a hospital on 28 February, where she received oseltamivir treatment. She died on 1 March. Initial investigations indicate the case visited a traditional market where live poultry were sold.

 

Laboratory tests have confirmed infection with the H5N1 avian influenza virus.

 

Of the 174 cases confirmed to date in Indonesia, 144 have been fatal.

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Padang: Bird Flu Suspect Cases Increase To 5

 

 

# 5355

 

 

Thus far, it has turned out to be a bird flu centric morning here at AFD. Continuing in that vein, we have an update on a report out of Indonesia yesterday, increasing the number of hospitalized H5N1 suspect cases in Padang from 2 to 5.

 

In yesterday’s report (see More Indonesian Bird Flu Suspicions) we learned of two children hospitalized in Padang, suspected of H5N1 infection. 

 

Today, Dutchy123 at FluTrackers has this update from MNC–TV news, which increases that number to 5.

 

"Five Toddlers Suspected to be Infected with Avian Influenza"

5 infants in the city of Padang suspected bird flu virus infected and treated at the Hospital Muhammad Jamil.

 

The five toddlers who allegedly infected with bird flu in the city of Padang, allegedly had contact with dead poultry. They treated intensively in isolation rooms in hospital with suspected disease M Jamil. Some of them, has been hospitalized for three days.

 

Until now, their condition is not stable and are still experiencing shortness of breath and high fever. To verify whether or not they are positively infected by H5N1 virus, blood samples have been sent to a hospital in Jakarta. Based on the testimony of parents of patients, their children had direct contact with chickens died suddenly in the home environment.

 

Anticipating the spread of the H5N1 virus, Animal Husbandry Department sprayed the town of Padang and check poultry in traditional markets market. Since early 2011, found 10 cases of birds died suddenly in the town of Padang. Dozens of dead birds was positively infected by H5N1 virus. Traders are encouraged to maintain the cleanliness of their chicken coop.

 

You can follow any new reports on this thread at FluTrackers.com.

 

Meanwhile, the Jakarta Globe has a story on yesterday’s report on a family of four in Indramayu suspected of having the H5N1 virus.

 

Again, test results are awaited, and so for now . .  . these are merely suspected cases.

 

Indramayu Family Believed to Have Bird Flu Hospitalized

 

Dessy Sagita | March 04, 2011

 

 

We’ll have to wait to find out if any of these suspected cases actually turn out to have the H5N1 virus.   If that should turn out to be true, the next question will be the route of infection.

 

Obviously, we’ll watch for any signs of human-to-human transmission.  While we’ve seen that a few times in the past, it has been a rare event.

 

There are now at least a half dozen clades (branches off the family tree) of the H5N1 virus circulating in Asia and the Middle East, and potential mutations and adaptations of the virus to non-avian hosts are an ongoing concern.

 

You can see the evolution of the virus over the years in the graphic below.

For more on this evolution see Variations On A Bird Flu Theme.

 

So we watch these cases, and particularly clusters of cases, with considerable interest.

 

For now, however, H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

 

The concern, of course, is that over time that may 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 to humans.

 

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Indonesia: Bird Flu Suspect Tested Negative

 

 

# 5033

 

 

As often happens, a suspected H5N1 patient in Indonesia ultimately tested negative for the virus.  This time, the case involved an 8-year-old boy hospitalized in Tangerang, Indonesia (see Another Bird Flu Suspect In Indonesia) who had been hospitalized for a week.

 

Since many other diseases can present with symptoms similar to bird flu (including regular flu, Dengue, Malaria, and other viral fevers), patients are often placed in the `suspected bird flu’ category until lab tests can prove otherwise.

 

Admittedly, laboratory testing for the virus hasn’t always been completely reliable, with false negative results not being uncommon.

 

But according to this report from Ida at The Bird Flu Information Corner, posted by Dutchy this morning on this FluTrackers thread following this case, this child has been diagnosed with Tuberculosis instead.

 

Tangerang, Banten : Boy tests negative bird flu

Posted by Ida on November 5, 2010
Tangerang – A bird flu suspect boy, FI (8 years old) is recovering. He’s still being treated in Tangerang hospital and tested negative bird flu H5N1.

“His condition is improving and test result showed negative bird flu. He is diagnosed lung TB,” said Ati Pramudji, spokesman of Tangerang’s Health Service.
Source: Indonesia newspaper, Koran Tempo.

 

 

So far, I’ve not seen any lab results on the 5-year-old fatality from last week, suspected of having an H5N1 infection (see Indonesia: Suspected Bird Flu Fatality).

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Bird Flu Reports Out Of Egypt

 

 

 

# 4784

 

 

Twelve days ago, after several months of no reported human H5N1 infections coming out of Egypt, we learned of a 20-year old woman (see Egypt Announces 110th Bird Flu Case) with the virus who died on July 27th.

 

Today, Treyfish on FluTrackers has found, translated, and posted a couple of articles from the Arabic media that indicate at least one, and possibly two new human cases.

 

First, from http://www.ahram.org.eg/  front page we get this report.

You can follow this case on the FluTrackers website by going to this thread.  A machine translation of the full story follows.

 

New cases of bird flu, child

Ministry of Health announced the discovery of bird flu disease, injury drink it for old girl from Cairo Governorate Alamraamin This is Case No. 111 since the onset of the disease.

 

The ministry said in a statement today, the first girl went to hospital on Monday, with a high temperature and after exposure to birds suspected of being infected with bird flu.

 

Added that the girl was transferred to a hospital has been given the Tamiflu drug Altammivlually drug immediately and in stable condition.

 

Another media report today (which you can follow on this FluTracker Thread) concerns a suspected  H5N1 infection in a 30 year-old woman currently being treated at hospital in Mallhalah.

 

Detention camp Bhmyat new cases of suspected bird flu

Wednesday, August 4th, 2010 - 21:33

Detained in a hospital Mahallah new situation for the lady in the third decade of age for suspected bird flu after an outbreak symptoms of the disease and the high temperature, and taking blood samples and throat swabs to set out the extent of her illness or not.

 

The Fever Hospital camp have been held yesterday Shaimaa Mohammed Khadir (30 years) from the village Cbrabail Center area suspected of having bird flu virus, and taking blood samples, including swabs shaving them, and sent to the central laboratories of the Ministry of Health to show the extent of her illness or not, and given the drug Tamiflu.

 

Egypt, like Indonesia (and likely a handful of other countries) continues to see sporadic human infections with the H5N1 avian flu virus. Most (but not all) have been linked to close contact with infected poultry or birds.

While the virus has yet to adapt well enough to human physiology to transmit effectively between people, scientists continue to warn that the the threat from this virus has not diminished much since it re-emerged in 2003 (see   Eurosurveillance: 500 H5N1 Cases After 6 1/2 Years)

 

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Indonesia: Another Suspected Bird Flu Fatality

 

 

 

# 4761

 

 

This morning we are hearing of a 24 year-old sand miner named Yenpa Yenti, from Padang, Indonesia who has died of suspected H5N1 infection. 

 

 

Thus far, this appears to be a clinical diagnosis, based on symptomology.  Laboratory confirmation will be required before we can be certain, as there are a number of other infectious diseases that can mimic H5N1. 

 

Ida at BFIC has this translation of an article that appeared in the local newspaper Era Baru.

 

Padang, West Sumatera ::: Bird flu suspect dies

Posted by Ida on July 28, 2010

Padang – A sand miner named Yenpa Yenti (24), resident of Kampung Sawah Taratak Mudiak Muaro Kalaban, Sawah Lunto, West Sumatera, allegedly died of H5N1 infection in M Djamil hospital, Padang, Wednesday (28/7).

 

Victim’s parent, Rosmaniar (60) described her son started to experience high fever and chill of hand and feet on 22 July.

 

Next, Rosmaniar brought Yenti to a local health worker, of where she was recommended to bring her son to Sawah Lunto hospital. Because medical team of Sawah Lunto hospital suspected bird flu infection on Yenti, victim was transferred to M Djamil hospital in Padang.

 

Yenti was admitted to M Djamil hospital on 24 July and placed in special unit until the death on 28 July.

 

Director of M Djamil hospital, Irayanti said Yenti was suspected of having bird flu infection with  symptoms such as fever up to 38℃ and breathing difficulty. Chest x-ray also showed evidence of lung infection. “According to patient’s parents, he had contact with chickens”, added Irayanti.

Yenpa Yenti is first fatal bird flu suspect patient in M Djamil hospital during 2010.

(Continue . . . )

 

 

We are seeing a bit of a an uptick in reporting on cases out of Indonesia in recent weeks.  Whether that reflects more cases, or simply an increased willingness to report on them, is difficult to know.

 

A few blogs concerning Indonesia’s bird flu problem during the month of July include:

 

Another Suspected Bird Flu Fatality In Indonesia

Recent Bengkulu Poultry Deaths Confirmed as H5N1

Forgotten, But Not Gone

Indonesia: MOH Confirms Bird Flu Fatality

Follow Up On Kalimantan Province Report

 

Meanwhile, SAIDR this morning is reporting the sad news that Egypt’s most recent H5N1 infection (see Egypt Announces 110th Bird Flu Case) has died.  My thanks to Lisa at CIDRAP for the head’s up on this report.

• Date of report: 28 July 2010
• Governorate: Qalyoubia
• District: Not reported
• Event summary: Woman, age not reported, was admitted to a hospital July 21 with bilateral pneumonia and was placed on mechanical ventilation. The MOH reported this was the 110th case of highly pathogenic avian influenza in Egypt in humans and the 35th human death from HPAI.
• Source of report: Egypt Ministry of Health

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Cambodia: Promoting Bird Flu Awareness

 

# 4690

 

 

 

Just a few years ago, for many villagers in places like Indonesia, Vietnam, and Cambodia, it would have been unthinkable to believe that their chickens could make them sick.   

 

Families had raised these birds for generations without ill effect, and so convincing them that H5N1 is a threat isn’t easy.  

 

In 2007 the NGO CARE conducted a poll in Cambodia to gauge perceptions among villagers about the dangers of bird flu, and recently re-polled to see if these perceptions had changed in three years.

 

While progress has been made, more than 20% of respondents would still kill and eat a sick chicken.

 

A hat tip to RoRo on FluTrackers for this report from the Phnom Penh Post.

 

 

Project seeks H5N1 awareness

Thursday, 01 July 2010 15:00 Khoun Leakhana

POULTRY farmers in three border provinces exhibited improved awareness of avian influenza following the introduction of a village-based education project, though in some areas more than 20 percent still say they would eat an animal found to be infected with the disease, according to survey results released this week.

 

The survey was conducted in three provinces – Prey Veng, Svay Rieng and Koh Kong – as part of a programme led by the NGO CARE International. Overall, it found that the farmers benefited from education efforts implemented by Village Surveillance Teams, or VSTs.

 

In 2007, farmers were interviewed in order to assess their understanding of the A(H5N1) influenza virus, commonly known as bird flu. In particular, the initial interviews assessed the farmers’ knowledge of how the virus spreads to humans and how diseased poultry should be disposed of.

---

THEY’RE NOT ONLY PROTECTING THE BIRDS. THEY’RE PROTECTING THEIR OWN FAMILIES.

---

When they were interviewed again at the end of a three-year pilot programme in 2009, the farmers demonstrated that they were better equipped to deal with avian flu cases.

 

In villages in Prey Veng and Svay Rieng, for example, the number of respondents who said they would kill and eat a bird if they were to find it sick was nearly halved, from 43 to 23 percent, according to the survey.

 

“We saw that there was a behaviour change,” said Cecilia Dy, CARE’s avian influenza project coordinator.

 

(Continue . . .)

 

 

While they don’t get a lot of publicity, health education campaigns such as these by NGO’s like  CARE, SAVE THE CHILDREN, Humanitarian Pandemic Preparedness H2P  and others are taking place in remote regions all around the world.

 

These projects not only help to protect the people living in those countries, but they also help protect the world.

 

Every time a virus like H5N1 is denied a human host, it is also denied another opportunity to mutate and adapt to humans.

 

Something worth considering the next time you think about where your charitable contributions will go this year.

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Two Reports From Indonesia

 

 

# 4685

 

 

Ida at BFIC – a joint effort between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has translations of a couple of recent articles from the Indonesian press regarding two suspected incidents of bird flu.

 

As stated often in this blog, the Indonesian government is less than anxious to discuss their bird flu situation (see Indonesia To Stop Announcing Bird Flu Deaths), and rarely confirms or comments on these media reports.

 

Suspected cases, however, are simply that.   There are a number of diseases to be found in Indonesia that can produce `bird flu-like’ symptoms. 

 

Laboratory confirmation is required before a case can be attributed to the H5N1 virus.   Lab tests for bird flu, however, are not always reliable and multiple tests are required.

 

With that preface in place, the two translated reports from the Bird Flu Information Corner.

 

Boyolali, Central Java ::: A man possibly dies of bird flu

Posted by Ida on June 30, 2010

Boyolali – Syamsudin (27), a resident of Desa Paras, Kecamatan Cepogo, Kabupaten Boyolali allegedly died of bird flu/avian influenza H5N1 infection.

 

Head of Boyolali Health Service, dr Yulianto Prabowo, mentioned patient had been treated in Pandan Arang Boyolali regional public hospital before the death.

 

Patient was diagnosed as bird flu suspect, and  in critical condition that must be referred to Dr. Moewardi hospital in Solo.

 

He died during treatment in Dr Moewardi hospital and diagnosed to have respiratory infection.

 

Previously, hundreds of chickens died in Dukuh Bandung, Desa Beji, Kecamatan Andong, Boyolali. However, officials faced difficulty in diagnosing the cause of death because no dead chickens left for sample.

 

So far, no report of bird flu signs in human, but area monitoring is still ongoing.

Source: Indonesia news office, ANTARA-JATENG.

 

 

This next report concerns the isolation of 4 children who are exhibiting flu-like symptoms after exposure to sick and dying chickens in West Kalimantan.

This province is one of the few in Indonesia that has been certified as bird flu free.  In recent weeks, however, they’ve begun reporting poultry deaths.

 

 

West Kalimantan Province, Indonesia

A week ago we had a report of a 4 year-old hospitalized from this region with suspected H5N1 (see Indonesia: Bird Flu Suspect).  That child, according to this report, tested negative and has been released from the hospital.

 

Pontianak, West Kalimantan ::: 4-year-old negative bird flu. Four other children under isolation

Posted by Ida on June 30, 2010

Pontianak – Following to avian influenza (AI) outbreak in chickens, four people from different areas in Pontianak are under intensive treatment of alleged bird flu infection. Patients were reported to develop fever and flu symptoms after chickens suddenly died around their neighborhood.

 

Patients are being treated in dr Soedarso hospital, Pontianak. A patient has recovered and discharged from hospital, while four patients are still isolated, Ad (10), Ap (15), Da (10) and Wt (9). Da and Wt are cousins, and neighbors of Ap residing in Karya Bhakti street. Ad is resident of Pak Benceng of Pontianak city.

 

Head of Medic and Non-Medic Service Division, Dr Soedarso hospital, Dr Hj Tita Selati said patients had been taken care according standard procedure (protap). “They are isolated and given Tamiflu”, said Tita.

 

In the meantime, patients’ swab samples have been sent to research and development laboratory of Ministry of Health (Litbangkes) in Jakarta for bird flu confirmation.

 

Ap was referred from Gang Sehat public health center and Wt was from Purnama public health center.

 

Previously, Dd (4.5), a bird flu suspect patient in dr Soedarso had been confirmed negative by Litbangkes, and discharged from hospital.

Source: Indonesia local newspaper, Equator News

 

 

Reports such as these come out of Indonesia, and other bird-flu endemic regions, sporadically.  Some will turn out to be H5N1, while others will not.   And it is likely that some cases are never detected.

 

H2H (Human to Human) transmission of the virus remains exceedingly rare, and most of the cases still appear to be due to contract with infected birds.

Still, these reports are a valuable reminder that the H5N1 virus remains active in some parts of the world, and its potential for causing a pandemic sometime in the future has not diminished.

 

My thanks to Ida at the BFIC , and the other newshounds around the world who diligently pour through hundreds of news sources every day looking for obscure items of interest, and then translating and posting them.

»» Read More

Vietnam Confirms First H5N1 Case Of 2010

 

 

# 4373

 

 

 

We actually got our first hint about this story coming out of Vietnam yesterday, when Treyfish on FluTrackers posted a series of translated news reports on this thread. 

 

Although machine translations are pretty good for conveying the gist of a story, the details can be a bit more of a challenge to interpret.  Luckily, Vietnam is one of the countries where we usually get an English language version of their bird flu reports within a few hours.

 

 

Overnight  we got just such a report from the Thanhnien News.

 

 

 Wikipedia Map

 

 

Last Updated: Tuesday, February 23, 2010 16:34:53 Vietnam (GMT+07)

 

Khanh Hoa girl is first bird flu patient of the year

A three-year-old girl in the central province of Khanh Hoa has tested positive for H5N1, becoming the country’s first bird flu patient this year, the Ministry of Health reported in Hanoi on Monday.

 

The girl, who lives in Ninh Hoa District’s Ninh Than Commune, fell sick with fever, sore throat, cough and a runny nose on January 27.

 

She was admitted to Ninh Hoa Hospital the next day and was confirmed to be infected with the virus on February 12, according to the ministry.

 

The girl was recovering, it said.

 

An inspection conducted in Ninh Than showed no sign of the avian flu in the commune, and the poultry raised by the girl’s family showed no signs of sickness.

 

However, the ministry’s inspectors found that about a month earlier, ostriches had died of unclear reason sat a farm a kilometer away from the patient’s home.

 

According to the ministry, 112 people had been infected by H5N1 since 2003, and 57 have died.

»» Read More