H5N1 in 2012: The Year in Review

 

 

# 6815

 

For several years now, Laidback Al (Editor–Senior Moderator–& Newshound) on FluTrackers – has published  a terrific overview of the previous year’s global H5N1 activity in early January.

 

You’ll find his 2010, and 2011 summaries here, and here.

 

Today Al has posted another detailed and highly informative analysis of the past year’s H5N1 human cases (complete with his signature charts & graphs).

 

This fine piece of work is a `keeper’, and I’ve already saved it to my desktop as a PDF file. I’m sure I’ll refer to it often over the next year or so, as I have with his earlier efforts. 

 

A few excerpts follow, but use the link and download this entire review.

 

H5N1 in 2012: The Year in Review

Laidback Al, Senior Moderator, www.FluTrackers.com
January 1, 2013

Abstract – In 2012, 32 human cases of H5N1 were reported from around the world, the lowest number of reported human cases since the World Health Organization (WHO) began reporting H5N1 cases in 2003. In 2012, six countries reported cases, Bangladesh, Cambodia, China, Egypt, Indonesia, and Viet Nam. More than 60% of the reported cases died, a slight increase in the fatality rate over 2011. Although there were only 32 cases reported in 2012, five are associated with two clusters. The source of infection for all of the cases has been reported as exposure to sick and dying poultry.

 

Also, in 2012, controversy over H5N1 laboratory experimentation erupted, several genetic studies were published, and seroprevalence results were evaluated. Although fewer cases were reported in 2012 than preceding years, an H5N1 pandemic is still a potential worldwide public health threat.

Background

Influenza A(H5N1) (often referred to “bird flu” or avian influenza or HPAI) is a novel influenza virus. It was first detected in humans in Hong Kong in 1997. Since 2003, the World Health Organization (WHO) has been monitoring human outbreaks of H5N1, because of its potential to become a pandemic virus. The current WHO report on Human infection with avian influenza A(H5N1) viruses and associated animal health events was updated on December 17, 2012. Through December 31, 2012, WHO has officially reported a total of 610 confirmed human cases of H5N1. The most recent WHO time line of significant events associated with the H5N1 virus was last updated on June 15, 2012 (link).

 

The following summary of human cases from 2012 is generally organized according to the outlined presented last year in “A Summary of Human H5N1 Cases in 2011”(FT link). Additional discussions of H5N1 topics from 2012 are also presented in this review.

(continue . . . )

 

 

Highly recommended.

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Watching Indonesia Again

# 6793

 

 

A hat tip to Treyfish at FluTrackers for picking up a couple of reports this morning regarding a suspected H5N1 case hospitalized at St Elisabeth Hospital, in Semarang.

 

The Jakarta Post has an English language report which provides us with a few details.  The patient is a 54 year old man suffering from a cough, cold, and high fever with (according to another article in Bahasan) exposure to poultry that recently died suddenly.

 

Tests are underway, and so at this time this is just a `suspected case’.  

 

Suspected bird flu victim in Semarang

Ainur Rohmah, The Jakarta Post, Semarang | Archipelago | Wed, December 19 2012, 7:55 PM

 

The Central Java Health Agency says it has received a report of a suspected case of bird flu in the province.

The 54-year-old man, a resident of the Sambiroto subdistrict, was currently under treatment at St. Elisabeth Hospital in Semarang, officials said.

(Continue . . .)

 

In recent weeks tens of thousands of poultry (primarily ducks) have died across the Indonesian island of Java, and we’ve learned recently of the detection of a `new’ clade of the H5N1 virus (2.3.2) in that country (see Dr. Alan Hampson Interview On Indonesia’s New Bird Flu Clade).

 

All of which serves to put authorities on heightened alert for human infections with the virus.

 

Last week the Indonesian Ministry of Health reported on the death of a 4 year-old boy from the virus, bringing their total number of cases reported for the year to 9 – all of which have proved fatal.

 

There are many other illnesses that can cause `bird-flu-like symptoms’, and so we will have to wait for more definitive test results before we can know if this case is due to the H5N1 virus.

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FluTrackers: Assessment Of H5N1 In China

 

 

# 6097

 

 

The newshounds on the major flu forums do an incredible job searching for, translating, and analyzing media reports of infectious diseases from all over the world. I’ve said it before, but much of what I do in this blog is only possible due to their efforts.

 

In terms of organization, quality, and volume of information, it would be hard to find a more impressive repository of emerging disease news than one can find at FluTrackers.com.

 

With two recent high profile human infections from the H5N1 virus in China (and others being reported in Indonesia, Cambodia, Egypt, and Vietnam), along with the ongoing controversy over the merits and dangers of H5N1 research, media attention has once more turned towards bird flu.

 

Sharon Sanders, Editor of FluTrackers, has distilled the combined efforts of the FluTrackers team into a handy overview of the H5N1 risks in China based on information they have been able to accumulate.

 

Anyone wanting a crash course on the H5N1 situation in China need only follow the embedded links to get a grasp of the situation. As this overview emphasizes, state control of local media makes making definitive statements difficult.

 

 

 

FluTrackers.com Risk Assessment of H5N1 type influenza in China

The FluTrackers Team
January 24, 2012

We feel that we can not say with 100% certainly what the exact situation is but this is our opinion based on the facts as we ascertain them as of this date and time.

Humans are at continuous risk of exposure to H5N1 poultry.

1) China has an endemic H5N1 problem in poultry. We know this for several reasons:

a) There have been warnings over the years to clean eggs shells due to surface contamination including H5N1:

China - Experts Call for More Stringent Standards for Cleaning Eggs - Avian Flu Mentioned As Risk May 2011

China - Nutrition Society warns on poultry egg shells, meat, and storage due to avian influenza H5N1 contamination January 2012

2) There are numerous H5N1 drills to train emergency personnel how to react to human and poultry outbreaks. A sample of recent drills includes:

China - Human Bird Flu H5N1 Drill held in Qinzhou, Guangxi province – January 2012

China - CDC Holds Suspected Human H5N1 Emergency Drill in Binzhou City, Shandong province December 2011

China - Emergency Poultry Bird Flu Drill Held in Rizhao City, Shandong province December 2011

China - Major H5N1 Poultry Farm Drill Held in Jangmen, Guangdong province November 2011

 

3) There are recent H5N1 poultry outbreaks in countries that border China: Tibet, Vietnam (Human), Vietnam (poultry), Hong Kong (wild bird), Hong Kong (poultry), Bhutan, & Nepal

4) The Russian health minister warned citizens on January 4, 2012 to be vigilant about H5N1 when traveling in China here.

5) Other hints and tips in the Chinese press regarding H5N1 status:

China - "Raw" poultry not allowed on trains in Shenzhen due to bird flu fears January 15, 2012

Ministry of Health: human infection of highly pathogenic avian influenza surveillance will be strengthened for the sporadic cases January 2012

China - Shanghai public health requires all medical institutions to monitor carefully for unexplained pneumonia November 2011

6) No country, where H5N1 has become endemic in the environment, has been able to successfully eliminate this disease. Indonesia, Vietnam, and Egypt, each experiencing current poultry and human H5N1 cases, are the most outstanding examples of this unfortunate phenomena. Therefore, despite the fact that China is not reporting any current H5N1 outbreaks in poultry we believe they occur and this is a constant threat to human health.

We see no evidence of sustained and efficient H5N1 infection between humans in China. However, we feel this risk is unknown since China is not forthcoming, generally, about its disease status.

 

On June 14, 2011 the Ministry of Health announced a creation of a “black list” for media that do not report government sanctioned information. We feel this represents a risk to human health, in general, in China.

The risk of human contamination from H5N1 positive wild birds is unknown in China.Hong Kong reports sporadic cases of H5N1 in wild birds but there are no corresponding human infections that result from contact with such wild birds.

The risk of human contamination from animals (other than poultry), or the environment, in general, is not known.

 

Many studies have demonstrated that animals can harbour the H5N1 virus, including domestic cats and dogs. In an H5N1 endemic environment, it should be assumed that there are many possible vectors for infection.

It is unclear how the most recent human cases of H5N1 were infected here and here. The government of China denied any human-to-human transmission in the Shenzhen case. The government also denied H5N1 poultry as the source. There were some press announcements that contact with a wild bird may have been the cause of the human case in Shenzhen. If this is true, then, logically, there must be many human cases of H5N1 in China amongst people who frequent parks and other outdoor venues. We feel this scenario, while possible, is not likely.

In conclusion, we feel there is a risk to the human population in China from H5N1 type influenza. A culture of hand washing, avoidance of wild birds and poultry, sanitary contact with domestic pets, and social distancing in public is advisable.

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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 . . . )

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FluTrackers 5th Anniversary

 

 

# 5299

 

After several weeks of intense preparation, FluTrackers  opened their doors to the public five years ago this week.  From humble beginnings, FT has grown into one of the best repositories of emerging infectious disease news on the internet.

 

Unlike some of the other flu forums, the focus at FT has been 90% newsgathering.  They’ve eschewed unbridled speculation and survivalist talk in favor of more sober, and professional discussions.

 

The volunteer newshounds of FluTrackers do a terrific job of finding, translating, and analyzing media reports from all over the world.  You can read more about the work the do in Newshounds: They Cover The Pandemic Front.

 

I tend to use FT as a reference library, and visit it – along with the other grande dame of Flu Forums – the Flu Wiki – several times each day.

 

To commemorate the occasion, Sharon Sanders, editor-in-chief of FT, has put together a brief history of FluTrackers which you can read on this thread.

 

My congratulations go to Sharon, and the whole team at FluTrackers on their first five years.

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Referral: A Summary Of 2010 H5N1 Cases

 

 

# 5198

 

 

Laidback Al (Editor–Senior Moderator–& Newshound) on FluTrackers is perhaps best known for his well rendered maps, charts and graphs illustrating recently posted news items. 

 

Al also provides level-headed analysis as well.

 

This morning Al has posted an absolutely terrific overview (complete with his signature charts & graphs) of the H5N1 human infections reported worldwide during 2010. 

 

This fine piece of work is a `keeper’, and I’ve already saved it to my desktop as a 4 –page PDF file.  I’m sure I’ll refer to it often over the next year or so.

 

Read:

 

A Summary of Human H5N1 Cases in 2010

 

 

(a sample of Al’s handiwork)

 

 

Highly recommended.

»» Read More

Referral: A FluTrackers Commentary

 

 

 

# 5161

 

Over the past 24-36 hours we’ve been watching a number of confusing (well, to me anyway) media stories out of Egypt combining reports of both H1N1 and H5N1 influenza cases.

 

It certainly sounds like something is going on, but I don’t have a lot of confidence (yet) in the details of these reports (see Keeping One Eye On Egypt).

 

Machine translations are at best murky and convoluted, and sometimes border on the indecipherable.  They can often provide us with early indications that something is amiss, but I tend not to put a lot of faith in their details.

 

The good news is, the newshounds on the flu forums continue to find, translate, and post these articles, while they and other forum members attempt to dissect and analyze them.

 

To that end, overnight Sharon Sanders Editor-in-Chief of FluTrackers has put together a terrific summary of recent (confirmed and suspected) H5N1 cases out of Egypt, along with some thoughts on the current situation there.

 

I’ve only posted the opening to a much longer analysis (with links to source material).  Follow the link to read it in its entirety.

 

 

Commentary - December in Egypt - A/H1N1 and A/H5N1 Quandary

---

by The FluTrackers Team -

In December the influenza situation has intensified. There have been reports of confirmed and suspected cases of both A/H5N1 and A/H1N1 in humans. In addition, it appears that many poultry continue to be infected with A/H5N1 and this is a direct threat to humans who are in the vicinity.

In December we believe that there are 4 total H5N1 cases confirmed by the central government and/or governorate authorities:

#113 - 30 year old female, onset date November 28, 2010 - hospitalized December 1, 2010 - Gharbia governorate – Death

Governorate confirmed case- 30 year old male, onset date unknown, death reported on December 7, 2010 - Dakahlia governorate – Death

#114 - 25 year old female, onset date unknown at this time - Behiera governorate

#115 - 44 year old male, onset date unknown at this time - Dakahlia governorate Death

The case designated as "Governorate confirmed case" was confirmed by Dakahlia public health officials but has not been confirmed by the Egypt Ministry of Health (MOH) or by the World Health Organization.

Confusing this situation further, the Egyptian MOH fired the director of a hospital on December 16 for not reporting an H5N1 case. We do not know which case this is in reference to. It might be this case or an entirely new case that we have no information about.

In addition, an unnamed "medical source" reported 3 "confirmed" H5N1 cases in Sharqia Governorate yesterday but these cases have not been ratified by either the govenorate or Egyptian MOH. Tests are also pending for 2 suspected cases in Fayoum govenorate.

(Continue . . . )

 

Kudos to Sharon, and everyone on the FluTrackers team, for this commentary and the source material behind it.

 

While it may not provide definitive answers, it certainly does help put things into perspective. 

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The Price Of Vigilance

 

 

 

# 5143

 

 

As most of you know, I along with others in Flublogia depend heavily on the volunteer newshounds on the flu forums, and on ISID’s ProMED Mail surveillance system, for much of the infectious disease news we get each day.

 

These entities are not government supported, and rely instead on the generosity of their members and the public. 

ProMED Mail each year at this time asks for financial help to support their reporting network. I’ve just made a small donation, and I would ask that my readers consider doing the same.

 

 

Similarly, FluTrackers is an all-volunteer flu forum that requires about $400 a month to keep going. Most months, those costs have come out of the owner’s pocket.  

 

 

Both are tax-exempt, nonprofit organizations, and both serve as important early warning systems for infectious disease outbreaks.

 

I know money is tight this holiday season.

 

But if you appreciate the work being done by these volunteers, I would hope you would consider making a small contribution to help them continue their work in 2011.

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Dr. David Fedson Radio Interview Today

 

 

# 3933

 

 

Later today Dr. David Fedson will be interviewed on Radio Sandy Springs by Sharon Sanders of Flutrackers.

 

The show will air at 4pm EST, on Atlanta's 1620 AM, and will be simulcast on the Internet on Radio Sandy Springs.

 

If you are unable to listen at 4pm, the show is generally repeated at 6pm, and is archived for downloading within a couple of days.  Dr. Fedson’s was interviewed in May by Sharon, and that show may be listened to at 05/18/09 Guest Dr. David Fedson.

Fedson is a former Professor of Medicine at the University of Virginia School of Medicine and was formerly Director of Medical Affairs, Aventis Pasteur MSD.

 

Fedson is the author of a number of journal articles, and in recent years has devoted a great deal of attention to how we can meet the challenge of a global pandemic.

 

Last March Fedson was interviewed on FluTrackers by Sharon Sanders in the wake of the publication of his latest article in the CDC’s Journal of Emerging Infectious Disease, entitled Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries.

 

An overview of his work, including the recent FluTrackers Interview may be viewed on the following two blogs:

 

Fedson On Meeting The Challenge Of A Pandemic

FluTrackers Interview With Dr. David Fedson

 

One of the subjects sure to come up will be the potential of using statins – cholesterol lowering drugs – in the treatment of influenza.  An idea that Dr. Fedson has encouraged more research in for years.

I wrote about this subject on Friday in Statins Revisited as did Revere at Effect Measure in Statins for influenza. Why don't we know if it works yet?.

 

      *       *       *      *      *      *      *      *      *      *      *

 

Radio Sandy Springs 1620 AM, is a low-powered Atlanta based talk radio station that simulcasts on the Internet.   An archive of recent Infectious Disease Hour shows may be accessed here.

This ought to be an interesting hour, so make plans to listen, or to download the archive when it gets posted next week.

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Decree: Ukraine Flu Threatens National Security

 

# 3927

 

Today a report (hat tip Dutchy at FluTrackers) from Itar-Tass news agency outlining the impact of the flu epidemic in the Ukraine.  The situation, according to a decree by President Viktor Yushchenko, `has assumed a threatening and unpredictable nature and is a threat to national security’.

 

Sadly, 4 doctors are now said to have died from this flu in Ukraine’s Ternopol and Lvov region.

 

FluTrackers continues to post updates on this emerging story, with newshounds working practically around the clock.  You’ll find this is the most active thread but check the Latest Posts button for new threads.

 

You’ll find earlier coverage of this Ukrainian situation in these blogs.

 

WHO Statement On The Ukraine Flu Outbreak

Ukraine: A Rush To Buy Flu Supplies

WHO Dispatching Team To Ukraine

Ukraine Update: H1N1 Quarantine

Reports Out Of The Ukraine

 

 

 

Epidemic situation in Ukraine threatens national security, 53 people die of cold and flu

01.11.2009, 20.48

KIEV, November 1 (Itar-Tass) - The epidemic situation in Ukraine “has assumed a threatening and unpredictable nature and is a threat to national security”, says a decree of October 31 by President Viktor Yushchenko, published on Sunday. The decree enacts a decision of the National Security and Defence Council on measures to fight the new flu (A/N1N1).

 

In the opinion of the Security Council, “the Ministry of Health and local bodies of executive power showed insufficient readiness to ensure treatment of patients”.

 

In this connection, the government was instructed to create reserves of medical equipment and anti-virus preparations, to strengthen anti-epidemic regime in places frequented by people, to restrict mass events and to involve the Defence Ministry and the Ministry for Emergencies to render medical aid to population.

 

The Health Ministry is to inform the Security Council secretary of the situation daily. The Defence Ministry was instructed to organise a check-up of population in the countryside with mobile teams from hospitals.

 

Incidentally, Slovakia, Poland, Hungary and Romania sent humanitarian aid to Ukraine to fight the flu epidemic, reported the press service of the Ukrainian Foreign Ministry on Sunday.

 

Fifty-three people, including a child and two pregnant women, have died of cold and flu in Ukraine, the Health Ministry said.

 

In all, the country’s cold and flu rate amounts to 185,000, including 9,400 cases of flu. The number of A/H1N1 flu cases is unknown.

 

The situation is the worst in the Lvov region, where about 70,000 people have cold and flu. The cold and flu rate is also high in the Ternopol, Ivano-Frankovsk and Chernovtsy regions.

 

Four doctors died of flu in Ukraine’s Ternopol and Lvov regions, Health Minister Vasily Knyazevich said at the Sunday meeting of the operative headquarters for the prevention and treatment of A/H1N1 flu.

 

Ukraine enacted border crossing rules because of the A/H1N1 flu outbreak, Timoshenko said.

 

Ukrainian President Viktor Yushchenko has asked the world to help handle the flu epidemic.

 

The president sent letters to the presidents of Belarus, Hungary, Moldova, Poland, Russia, Romania, Slovakia and the United States, the NATO secretary general and the European Commission president.

»» Read More