MMWR: Mild H7N3 Infections In Two Poultry Workers - Jalisco, Mexico

 

Photo Credit SENASICA

 

# 6554

 

 

Roughly 10 weeks ago (June 27th) we learned of an outbreak of Highly Pathogenic H7N3 avian influenza among poultry in Jalisco, Mexico; the first such outbreak in that country since an outbreak of H5N2 in the early 1990s.

 

Since that time, more than 22 million birds have either died from the disease, or have been culled, and Mexico’s poultry industry has taken a terrible beating.

 

The good news - according to a report yesterday in MeatPoultry.com - is no new infections have been reported in the past 3 weeks, and restocking of birds is set to begin (see Mexico tallies birds culled, restocking to begin).

 

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.

 

Among the avian influenzas, 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 conjunctivitis).

 

For now, 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:

Chart lifted and edited from CIDRAP’s excellent overview Avian Influenza (Bird Flu): Implications for Human Disease  showing known H7 avian flu infections in humans over the two decades.

 

 

To this short list of human cases we can now add two more (admittedly, very mild) cases, as is detailed in today’s MMWR.

 

 

Notes from the Field: Highly Pathogenic Avian Influenza A (H7N3) Virus Infection in Two Poultry Workers — Jalisco, Mexico, July 2012

Weekly

September 14, 2012 / 61(36);726-727

During June–August 2012, Mexico's National Service for Health, Safety, and Food Quality reported outbreaks of highly pathogenic avian influenza (HPAI) A (H7N3) virus in poultry on farms throughout the state of Jalisco (1,2). This report describes two cases of conjunctivitis without fever or respiratory symptoms caused by HPAI A (H7N3) virus infection in humans associated with exposure to infected poultry.

 

Patient 1. On July 7, a poultry worker aged 32 years complaining of pruritus in her left eye was examined at a clinic in Jalisco. Physical findings included redness, swelling, and tearing. Conjunctivitis was diagnosed; the patient was treated symptomatically and recovered fully. Because the patient had collected eggs in a farm where HPAI A (H7N3) virus was detected, the Institute for Epidemiological Diagnosis and Reference, Mexico, tested ocular swabs from both of her eyes for influenza A (H7) by real-time reverse transcription–polymerase chain reaction (rRT-PCR), and embryonated chicken eggs were inoculated for viral isolation. The swab material was positive for influenza A (H7) virus by rRT-PCR and virus was isolated from each eye. These findings were reported to the World Health Organization on July 19, and full genome sequences (CY125725–32) were uploaded to GenBank. The virus was closely related by nucleotide sequence to previously reported HPAI A (H7N3) viruses collected during poultry outbreaks in Jalisco with sequences available in GenBank (JX397993, JX317626).

 

Patient 2. A man aged 52 years, who was a relative of patient 1 and worked on the same farm, developed symptoms consistent with conjunctivitis on July 10 and sought care at a local clinic on July 13. He was treated symptomatically and recovered without sequelae. When public health authorities became aware of this patient, they obtained eye swabs, which were tested by rRT-PCR, revealing influenza A (H7).

 

Mexico has continued its efforts to contain poultry outbreaks in affected areas in Jalisco. Those efforts include quarantining affected farms, culling infected birds, vaccinating uninfected birds, and disinfecting contaminated areas. Government agencies also have provided personal protective equipment to farm personnel and are conducting active surveillance for influenza-like illness (ILI) and severe acute respiratory illness at two sentinel sites near the outbreak.

 

Avian influenza A viruses are designated as HPAI or low pathogenicity avian influenza (LPAI) based on molecular characteristics of the virus and the ability of the virus to cause disease and mortality in birds (3). To date, only influenza A (H5) and (H7) subtypes have been described as HPAI. Influenza A (H7) subtype viruses have been detected in wild birds in many parts of the world and can cause outbreaks in poultry. Influenza A (H7) infection in humans is uncommon, but can occur after direct contact with infected birds, especially during outbreaks of influenza A (H7) virus among poultry (4). Illness can include conjunctivitis without fever, upper respiratory tract symptoms, or both (4,5), and severity can range from mild to fatal (4). In the United States, avian influenza outbreaks in poultry are rare, but they are detected and reported sporadically. In the United States, only two cases of illness with LPAI A (H7) virus infection are known to have occurred in humans, both of whom recovered (6,7).

 

The conjunctivitis cases in Jalisco most likely represent HPAI A (H7N3) virus transmission from infected poultry to humans through direct contact. United States agricultural, public health, and clinical personnel should be aware of these poultry outbreaks with transmission to humans in a neighboring country. Persons working with poultry known or suspected to be infected with influenza A viruses should use appropriate personal protective equipment, including face masks, gloves and eye protection (e.g., goggles). Clinicians and epidemiologists should consider avian influenza A virus infection in patients who have conjunctivitis or ILI and have contact with poultry in areas with known avian influenza outbreaks. Clinicians who suspect avian influenza A virus infections in humans should obtain a conjunctival or respiratory specimen, or both, depending on signs and symptoms, and submit samples to a national, regional, or state public health laboratory to enable specific influenza testing. Clinicians also should consider early empiric antiviral treatment of suspected cases with a neuraminidase inhibitor (8,9). Public health officials should survey family members and contacts of infected persons to find cases of human-to-human transmission.

 

 

Since the H7 viruses usually only produce mild symptoms in humans, you may be wondering why all the concern over a couple of H7 infections?

 

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

 

What is mild, or relatively benign today, may not always remain so.

 

And in 2008 we saw a study in  PNAS that suggested the H7 virus might just be inching its way towards better adaptation to humans.

 

So we watch, with considerable interest, anytime a novel flu virus manages to jump to humans.  Even if only in a very limited fashion.

 

For more details on that study, and some more posts on the H7 constellation of flu viruses, you may wish to revisit:

 

H7's Coming Out Party

H7 Study Available Online At PNAS

 

When Flu Strains Collide

»» Read More

Updating Mexico’s H7N3 Outbreak

 

Photo Credit SENASICA

 

# 6432

 

Just over three weeks ago the OIE was notified by Mexico’s Director General of Animal Health Dr Hugo Sanchez Fragoso of an outbreak of highly pathogenic H7N3 avian influenza among poultry in the state of Jalisco (see Mexico: High Path H7 In Jalisco). 

 

A week later, Mexico’s Agricultural Ministry (Secretaría de Agricultura, Ganadería, Desarrollo Rural, Pesca y Alimentación; SAGARPA) Declared a National H7N3 Animal Health Emergency as the H7N3 virus continued to spread.

 

Map Credit OIE

 

 

Since humans have only rarely been reported to have been infected by this strain of avian flu, the big concern right now is for poultry operations. Cesar de Anda, vice chairman of the International Egg Commission, was quoted by EFE news yesterday as stating:

 

"The industry will fail to produce $50 million, not only from the cost of the (dead) birds, but also from the intrinsic value of production, the generation of wealth and of indirect jobs in other fields."

 

According to Anda, if this outbreak is not brought under control, as many as 32,000 jobs could be at risk.

 

To date, 2.5 million poultry have either died, or been destroyed because of this virus, and according to a press release from SENASICA (Mexico’s Food Safety agency) as many as 17 million birds in the region may be at risk.

 

The latest OIE Filing (Follow-up report No. 3 ) states the source or origin of the virus remains unknown, and provides brief summaries of 31 separate outbreaks. 

 

Under Epidemiological comments, they list:

 

• During the epidemiological surveillance carried out in response to the event, the National Food Quality, Food Safety and Health Service (SENASICA) has taken samples in the outbreaks and around the outbreaks in 148 poultry farms.
• 31 farms were identified by viral isolation, diagnosis is ongoing in other 83 and 34 have tested negative to H7N3 highly pathogenic virus.
• The population at risk in these 148 farms amounts to about 17 million birds, of which 86.1% of layers, 6.9% of broilers and 7% of breeders.
• As part of the measures taken to reduce the risk, the buffer zone has been extended to 60 km around the index outbreak and includes 161 poultry farms at risk with a population of 25.8 million of birds.
• Control measures on birds and their products movements have been strengthened in the quarantine area and eight check points have been established with the support of 26 health technicians with 9 vehicles that monitor the quarantine zone.
• Epidemiological surveillance activities continue in the outbreaks, around the outbreaks and in the buffer zone. As a measure to reduce the risk, sampling will be carried out in neighbouring States and in poultry farms at risk outside the buffer zone.

 

In the first six months of 2012, 14 countries have reported outbreaks of high path avian flu with strains ranging from H5N1 and H5N2 to H7N3. Surveillance and reporting around the world is spotty at best, and so it is likely that we don’t hear about all of the outbreaks.

 

For now, however, these viruses are primarily a threat to the poultry industry, and to a far lesser extent, people working in direct contact with infected fowl.  While H7 viruses have been known to infect humans on rare occasions, most of the reported cases have produced only mild to moderate illness.

 

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

 

In 2008 we saw a study in  PNAS that suggested the H7 virus might just be inching towards adapting to humans. For more details on that study, you may wish to revisit H7's Coming Out Party and H7 Study Available Online At PNAS.

 

So, while the H7 virus poses a minimal risk to human health at this time, it pays to keep an eye on outbreaks such as the one in Jalisco.

 

Influenza viruses are constantly changing, and evolving, always seeking an evolutionary advantage. So, what was true about a specific flu virus yesterday, may not hold true tomorrow.

»» Read More

Mexico Declares National H7N3 Animal Health Emergency

 

# 6417

 

 

Mexico’s Agricultural Ministry (Secretaría de Agricultura, Ganadería, Desarrollo Rural, Pesca y Alimentación; SAGARPA) today announced a national animal health emergency as the H7N3 outbreak that made headlines last week (see Mexico: High Path H7 In Jalisco) has reportedly now affected more than 1.7 million birds.

 

ChannelNewsAsia has an AFP report Mexico declares bird flu emergency, but a short version of the announcement can be found on the SENASICA (National Health Service, Food Safety and Food Quality) website:

 

Avian Influenza

Avian Influenza type A, subtype H7N3 does not affect humans, only birds, according to Organization Animal Health (OIE).

See Frequently Asked Questions
Audio News

Press release

Was published today in the Official Journal of the Federation agreement that activates, integrates and operates the National Emergency Animal Health, pursuant to Article 78 of the Federal Animal Health Law, to diagnose, prevent , control and eradicate avian influenza virus type A, subtype H7N3, actions taken since last week in coordination with the farming.

 

While H7N3 is not considered to represent a high human health risk, the statement that it does not affect humans is not strictly true. As I wrote last week, there have been a handful of (generally mild) human infections detected with this subtype of avian flu.

 

The following is a machine translation of a more detailed press release (including information on the quarantine, slaughter, vaccination, and the destruction of infected poultry), which is available from the SARGAPA website. 

 

SENASICA published in the Official Gazette of the National Emergency Animal Health

Mexico City, July 2, 2012

Was published today in the Official Journal of the Federation agreement that activates, integrates and operates the National Emergency Animal Health, pursuant to Article 78 of the Federal Animal Health Law, to diagnose, prevent, control and eradicate avian influenza virus type A, subtype H7N3, actions taken since last week in coordination with the farming.

The agreement is issued under the June 20, 2012 the National Health Service, Food Safety and Food Quality (SENASICA) confirmed the presence of a virus highly pathogenic avian influenza exotic for Mexico in two municipalities of Jalisco and considers that requires immediate attention for its control and eventual eradication, to prevent severe damage to the poultry industry.

The coordination of the National Emergency Animal Health will be in charge of SENASICA through the Directorate General of Animal Health (DGSA), which will be supported by the Mexico - United States for the Prevention of FMD and other diseases Exotic Animals (CPA).

 

Although the virus is focused on municipalities and Acatic Tepatitlan, Jalisco, the operation will be activated throughout the country, in order to prevent the spread of the disease, for which the country is divided into eight regions emergency .

 

The eight regions will be regulated and directed by SENASICA through the DGSA, with the support of the CPA and actions will be executed in each region under the supervision of the Coordinators responsible for compliance to the Agreement will have the Groups State Animal Health Emergency (GEESA), led by the coordinators of the CPA.

 

The agreement also establishes the animal health measures and coordinated urgent application to the diagnosis, prevention, control and eradication of Avian Influenza virus type A subtype among which are: animal health education on avian influenza to poultry and people and legal entities related to the poultry industry.

 

Under the transmission of the virus highly pathogenic avian influenza in birds occurs by direct or indirect animal products and byproducts from infected birds exposed and sets the control of the movement of poultry and their products and products as well as other animal species regulated by the Animal Health Act and provisions thereunder, which may represent a risk to poultry.

 

They also provide animal health and ordering cords retention and disposition of poultry products and byproducts, as well as biological, chemical, pharmaceutical and food for use or consumption by these birds that could cause an outbreak of Avian Influenza.

 

As animal health measures include diagnostic work and identification of avian influenza virus, quarantine and isolation for affected farms and the work you reinforce surveillance and epidemiological research.

 

To avoid transmission of avian influenza virus type A subtype H7N3 is ordered sanitation practices, disinfection, disinfestation, sterilization, using germicides and pesticides in animals, premises and transport.

 

SENASICA further instructs the culling sick or exposed to avian influenza and disposal of poultry products and byproducts in the manner specified in the body.

 

Similarly, immunization will be permitted upon express authorization of SENASICA, to protect and prevent the spread of the disease.

 

SENASICA establish mechanisms of coordination with other agencies of the Federal Government, the Governments of the States, the National Technical Advisory Council for Animal Health, the National Union of Poultry Farmers, as well as poultry producers and individuals linked to activities related to poultry, which are required to provide the SENASICA all the support and technical and administrative cooperation, as well as the epidemiological data and production is required to diagnose, prevent, control and eradicate avian influenza virus type A subtype H7N3 of the country.

 

Finally, the agreement indicates that the Ministry of Agriculture, Livestock, Rural Development, Fisheries and Food, through the National Health Service, Food Safety and Food Quality, assess the health status of the areas recognized as being of low prevalence, in control, and eradication or free of notifiable avian influence, in order to determine the measures necessary for the proper implementation of the Agreement.

 

 

And the actual declaration may be found HERE.

 

While public health authorities will no doubt be keeping their eyes on this situation, this is primarily a concern to agricultural interests. 

 

An H7N3 outbreak in 2004, highly pathogenic H7N3 outbreaks in British Columbia's Fraser Valley back in 2004 led to the culling of 19 million birds.

»» Read More

Mexico: High Path H7 In Jalisco

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

7.6 Magnitude Earthquake Strikes Southern Mexico

 

# 6236

 

 

Although the magnitude has been bouncing around (7.6 – 7.9) and may yet be adjusted again by the USGS, what was obviously strong seismic event has struck southern Mexico near the town of Ometepec (pop. 55,000), in the state of Guerrero. 

 

This is about 115 miles from Acapulco. There are no immediate reports of damage or injuries.

 

 

While local tsunami or tidal changes may be reported, as of now there are no Pacific wide Tsunami warnings issued by the Pacific Tsunami Warning Center.

 

»» Read More

The Sonora/Arizona GBS Cluster

 

 

# 5694

 

 

Since the end of June the diligent newshounds on FluTrackers have been following reports of a growing number of `flaccid paralysis’ – sometimes described as Guillain-Barré Syndrome (GBS) – cases reported in Sonora Mexico and Southwestern Arizona.

 

The tracking thread, which as of today contains 35 – mostly Spanish-to-English translations - may be viewed here.

 

Those with good memories may recall that late last year another cluster of unexplained GBS-like cases occurred some 1500 miles to the south-east in Veracruz, Mexico.

 

I wrote about that outbreak twice (see Guillain-Barre Syndrome in Mexico, More On the Veracruz Paralysis Outbreak). Despite the detection of 38 cases, and several months of investigation, no definitive cause was determined.

 

Vaccines were eliminated from the suspect list, and the focus was on testing water, food, and environmental samples for toxins and bacterial contamination.

 

The Veracruz cluster dwindled in early 2011, and since then there have only been a few scattered cases of GBS in that region.

 

Since late last month Spanish Language newspapers in Sonora have been reporting on an unusual number of `flaccid paralysis’ cases and an elevated level of diarrheal diseases in their community.

 

Guillain-Barré Syndrome is an autoimmune disorder that causes muscle weakness ands sometimes paralysis. Most patients recover after a few weeks, although permanent nerve damage can remain.  On rare occasions, patients can die from the illness.

 

While all of the causes of GBS are not known, doctors do know that it often follows a bacterial or viral infection. 

 

This from the CDC’s Guillain-Barré syndrome (GBS)  Q&A page.

What causes GBS?

Many things can cause GBS; about two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with diarrhea or a respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS.

People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.

 

Late Wednesday afternoon the Yuma (Arizona) County Health Department issued a statement on the recent rise in diarrheal/Campylobacter cases and cluster of GBS-like cases in Southern Arizona and neighboring Sonora, Mexico.

Rare Condition Sparks Investigation

 

Posted Date: 7/13/2011 4:00 PM

Yuma County, Arizona, and San Luis, Sonora, have recently seen an increase in Campylobacter infection/acute diarrheal illness and Guillain-Barre’ Syndrome within their respective communities.

 

Campylobacter infection/acute diarrheal illness usually comes from a food or water source(s), and it causes diarrhea; sometimes with abdominal pain, and fever.

 

Campylobacter infection/acute diarrheal illness is one of the most common causes of diarrheal infection. Guillain-Barre’ Syndrome is a rare complication that can cause muscle weakness and sometimes paralysis. This condition is thought to be caused by an immune reaction response to a recent illness/infection.

 

The Yuma County Health District, along with the Arizona Department of Health Services, the Centers for Disease Control and Prevention (CDC) and Sonora health officials are working together to conduct an investigation into the source(s) of these health conditions.

 

“An investigation of this nature takes a lot of time and a lot of people. It’s like putting a puzzle together. You need all the pieces before you see the picture,” said Becky Brooks, Director of Yuma County Health District. “The response from all agencies has been great, and the expertise from each has certainly contributed to the investigation.”

 

Health officials from Arizona and Sonora have also conducted outreach and education and have asked physicians and hospitals to watch for the signs of GBS or Campylobacter infection and quickly contact their local health department with any possible cases.

 

It is important to note that GBS is not passed person to person and the best thing to do is to prevent gastrointestinal infections in the first place.

 

Good hand washing habits and safe food preparation go a long way to prevent common illnesses. Everyone should wash their hands thoroughly after using the bathroom, before and while they are cooking, and before eating.

 

Be sure to follow the four food safety tips: Clean, Separate, Cook, and Chill.

Clean: Wash hands, cutting boards, utensils, and countertops.
Separate: Keep raw meat, poultry, and seafood separate from ready-to-eat foods ( fruits, vegetables, food that do not require cooking).
Cook: Use a food thermometer to ensure that foods are cooked to a safe internal temperature: 145 F for whole meats (allowing the meat to rest for 3 minutes before carving or consuming), 160 F for ground meats, and 165 F for all poultry.
Chill: Keep your refrigerator below 40 F and refrigerate food that will spoil. Keep cold things cold and hot things hot.

• Seek medical care if you develop Gastrointestinal symptoms.
• Don’t prepare food for others if you have diarrhea or vomiting.
• Be especially careful preparing food for children, pregnant women, those in poor health and older adults.
• Washing your hands is the single most important thing you can do to prevent illness.

 

Since this release, the local media has picked up on the story.  A few examples include:

 

Mystery diarrhea outbreak in Yuma County, Mexico

Diarrhea Cases on the Rise, Yuma Health Officials Investigates

CDC investigating increase in illnesses in Yuma County

 

While fairly rare, GBS affects between 3,000 and 6,000 Americans every year.  Campylobacter infections, on the other hand, are very common, with an estimated 2.4 million cases in the U.S. every year.

 

This from the CDC’s  NCZVED information page on:

 

Campylobacter

What is campylobacteriosis?

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain, and fever within two to five days after exposure to the organism. The diarrhea may be bloody and can be accompanied by nausea and vomiting. The illness typically lasts one week. Some infected persons do not have any symptoms. In persons with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a serious life-threatening infection.

 

(Continue . . .)

 

Although a campylobacter link has not yet been established, this GBS outbreak will  likely subside once the outbreak of diarrheal disease can be stemmed.

 

The newshounds on FluTrackers will continue to follow the story in the U.S. and Mexican press, and if anything unusual comes out of the CDC’s investigation, I’ll report on it here.

»» Read More

Follow Up On Juarez Reports

 

 

# 5448

 

 

Two days ago the Mexican media was filled with stories regarding multiple cases of `atypical pneumonia’ in and around Juarez, which has resulted in at least one death (see Some Curious Reports Out Of Juarez).

 

Not too surprisingly, yesterday a number of reports began to emerge stating that these cases were caused by a return of the 2009 H1N1 virus. 

 

Typical of these reports is this one from El Nacional  (hat tip Alert on FluTrackers).

 

Mexico confirms reappearance of H1N1 influenza, which leaves 2 dead

25 Mar 2011 | 09:27 pm

The Ministry of Health of the State of Chihuahua, Ciudad Juárez to which it belongs, confirmed on Friday at a news conference a second death caused by this virus for days after a traffic policeman died and the infection of another person stable.

 
The Mexican health authorities today confirmed the reappearance of H1N1 virus, also called flu, which caused the emergency epidemic two years ago and has already left two dead and one person infected in Ciudad Juarez on the U.S. border.

 

The Ministry of Health of the State of Chihuahua, Ciudad Juárez to which it belongs, confirmed on Friday at a news conference a second death caused by this virus for days after a traffic policeman died and the infection of another person stable.

 

The state Health Secretary Sergio Piña said that clinical studies confirmed the presence of H1N1 virus in all three cases.

(Continue . . . )

 

 

The H1N1 virus, while no longer a pandemic threat, is still capable of mutating or evolving towards increased virulence or transmissibility. 

Given the earlier alarm expressed by local officials and the media over these cases, no doubt some sort of investigation is underway to determine if there is anything about these cases that merits particular concern.

 

FluTrackers has maintained an extensive thread on these reports which you may view here.

»» Read More

Some Curious Reports Out Of Juarez

 

Note: Update on 3/26/11 Follow Up On Juarez Reports identifies illness as H1N1

 

# 5439

 

Given the sudden emergence of a novel H1N1 pandemic virus out of Mexico almost exactly 2 years ago, one can understand a heightened sense of vigilance whenever we begin to hear of unusual respiratory ailments coming out of that region of the world.

 

Yesterday, newshounds on FluTrackers began to pick up multiple news reports on what has been called an `atypical pneumonia’ that has claimed the life of a healthy 28 year-old police officer, and sickened a number of other officers.

 

In just over 12 hours, nearly a dozen news reports have been gathered (and machine translated) by newshounds Tonka, CopsitoSP, Alert, and Tetano. 

 

The thread with these reports may be accessed here.

 

`Atypical Pneumonia’ is generally used to describe several specific bacterial infections; including Legionella pneumophila , Mycoplasma pneumoniae , and Chlamydophila pneumoniae.

 

Pneumonia due to mycoplasma and chlamydophila bacteria is generally mild, while legionella can often produce more serious illness – particularly in older patients, smokers, or those with chronic illnesses.

 

But it isn’t at all clear from these translated newspaper articles whether these illnesses stem from these relatively common bacterial infections, or perhaps from something more unusual.

 

 

The first report calls it a rare, and mystifying illness.  It also calls it a `virus’, although that may simply be a non-exact description or an artifact of translation.  

 

This from Excelsior.com.

 

Attacks agents Ciudad Juárez a deadly virus ...

One died and three have the same symptoms of a rare disease. There is a commander in critical condition

Carlos Coria Rivas / Correspondent

CHIHUAHUA, March 23 .- A rare viral disease attacked several municipal traffic police in Ciudad Juarez, killing one, while three have the same symptoms.

 

The commander of the Eastern sector, Guadalupe Gutiérrez Palma, was reported in critical condition and two more agents are under observation have the same disease.

 

At a press conference, authorities of the municipality, headed by Dr. Ariel Díaz de León, they were puzzled by the unknown origin and characteristics of evil.

(Continue . . . )

 

 

Since that article yesterday, we’ve seen a steady stream of reports that have suggested everything from H1N1, to bacteria, to fungi (and even cobalt poisoning) as potential causes of these illnesses.

 

 

The latest report suggests an increased level of concern by the local government, although the nature of the illness has yet to be announced.

 

 

Enact health fence today for deadly virus outbreak
F. CABRERA / M. VARGAS
2011-03-24  00:00:12

After the reported death of a Transit agent caused as a result of an alleged fulminant atypical pneumonia and more people infected by a virus not yet identified, the state government decreed the establishment of a local health fence, it was learned unofficially .

A source said the state governor, Cesar Duarte Jaquez and federal health secretary, José Ángel Córdova moved yesterday evening to this city to personally assess the problem and atypical outbreaks suddenly appeared and claimed that a person's life.

 

For as yet unknown health care plan will be implemented and are expected today during the day the announcement is official, after an extraordinary meeting to be called the health departments of the three levels of government.

 

(Continue . . . )

 

For a full translation visit this FluTrackers link.

 

The latest reports raise the number of suspect cases to 14, with at least one in critical condition, and with 1 fatality.  

 

The Mexican media and local officials appear to be taking these reports seriously, although they may yet end up being due to something fairly common, like Legionella or H1N1.

 

Hopefully we’ll get some test results soon that will clear up this mystery. 

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More On the Veracruz Paralysis Outbreak

 

 

# 5157

 

 

Two days ago in Guillain-Barre Syndrome in Mexico, I wrote about a mysterious outbreak of acute flaccid paralysis in Mexico that at first was attributed to GBS, or Guillain-Barre Syndrome.

 

Since that time we’ve seen numerous news stories in the Mexican media, often with conflicting information.   FluTrackers has a thread with more than 50 posts on this outbreak, which has numerous translated news articles.

 

Early suggestions that this might in some way be connected to flu vaccinations (a common kneejerk reaction whenever GBS appears), are being dismissed by the Health Secretariat who announced that `of the 35 cases of acute flaccid paralysis, only two received the vaccine against seasonal influenza’.

 

Tonka, senior moderator on FluTrackers, posted a translation from an article from excelsior.com this morning.

 

SSA denies link with vaccine and H1N1 outbreak

The deputy director of epidemiology says there is no evidence that flaccid paralysis is caused by the vaccine and Guillain-Barré syndrome

Georgina Olson

• Strange outbreak sparks alert at Veracruz, and there are two dead

• Suman 33 patients with syndrome 'Guillain-Barre'

MEXICO CITY, Dec. 18 .- Of the 42 cases of acute flaccid paralysis have been presented in Veracruz and Nayarit none have been caused by the application of the vaccine against influenza A H1N1 or which is used to attack the influenza Seasonal also still have no evidence to prove that the disease is Guillain-Barré syndrome, said in an interview with Excelsior Dr. Hugo López-Gatell, deputy general director of epidemiology at the Health Secretariat (SSA).

"No, there is no evidence linking the vaccine against influenza A virus H1N1 or other influenza season, with the occurrence of these cases of acute flaccid paralysis," the official said.

(Continue . . . )

 

 

While all of this tells us what this outbreak isn’t, right now no one seems to know what this outbreak is.

 

According to media reports, of the (and the numbers here seem to vary a bit) 3 dozen or so cases reported so far, only 10 remain hospitalized.  

 

GBS-like symptoms (acute flaccid paralysis) can be caused by a variety of factors, including as sequelae from viral and bacterial infections, and even from environmental toxins.

 

According to another report on El Mundo, also posted by Tonka, health authorities are taking water, food,  and environmental samples from areas where these cases have been reported.

 

Performed first water sample

Staff of the Department of Health investigates the factors that can trigger paralysis, to make them known to the public and can be prevented.

Friday, December 17, 2010 Juliet H. Zambrano

 

 

All of these tests will likely take weeks.

 

The good news is that the number of cases does not seem to be expanding very rapidly, and that most of these cases are resolving fairly quickly.

 

For now, however, the cause of this outbreak remains unknown.

 

I’ll update this story from time to time, but you can follow this thread on Flutrackers to keep up with the latest news reports.

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Guillain-Barre Syndrome in Mexico

 

 

 

 

# 5148

 

 

Every once in awhile we see reports of unusual disease activity from around the globe. Our first hint of something amiss often comes from (usually) fragmentary reporting in the local media, and is often first detected by the newshounds on the flu forums.

 

These early media reports are often incomplete, conflicting, and difficult to decipher. Many are machine translated into English, which can add another layer of ambiguity to the report.

 

So I tend to wait before posting them, since the details often change over time.

 

That said, we’ve some curious reports out of Mexico this week of an outbreak of what they are generally  describing as either Guillain Barre Syndrome or acute flaccid paralysis.

 

Tonka on FluTrackers began a thread on these reports on December 12th, which you can follow here, and which now has 30 posts.  The latest media reports indicate that there are now 33 cases, and 2 deaths associated with this outbreak.

 

Although (almost inevitably) some media sources are mentioning vaccine-related adverse affects as a possible cause, health officials are cautioning people not to leap to any conclusions.

 

Yesterday’s Healthmap blog carried a short report yesterday on the outbreak, and ProMed Mail has an RFI (request for information) out as well.

 

While a country the size of Mexico (111 million people) could reasonably expect to see a couple of thousand cases of Guillain-Barre syndrome a year, the number and geographic clustering of these reports does seem out of the ordinary.

 

The diagnosis of GBS is primarily one of clinical assessment and exclusion.  Diagnosis, particularly in its early stages, can be difficult.

 

This from the CDC’s Guillain-Barré syndrome (GBS)  Q&A page.

 

What causes GBS?

Many things can cause GBS; about two-thirds of people who develop GBS symptoms do so several days or weeks after they have been sick with diarrhea or a respiratory illness. Infection with the bacterium Campylobacter jejuni is one of the most common risk factors for GBS.

 

People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination.

 

Since this seems to be an unusual outbreak of the syndrome, we’ll obviously be keeping a close eye on the investigation.

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Study: Impact Of 1918 Pandemic In Mexico

 

 

# 4698

 

 

 

The 1918 Spanish Flu was the worst pandemic in modern history, killing (estimates vary) between 40 million and 100 million people worldwide in a matter of 18 months.

 

The course and impact of the pandemic was reasonably well documented in places like the United States, England, and parts of Europe . . . but for much of the world the death toll can only be approximated.

 

Earlier studies have suggested a wide variation in the CFR (Case Fatality Ratio) of this pandemic among various countries and regions of the world.

 

In 2006, in a Lancet journal (doi:10.1016/S0140- 6736(06) 69895-4) article cited as much as a 30-fold difference in mortality rates around the world:

 

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918—20 pandemic: a quantitative analysis

 

Christopher JL Murray , Alan D Lopez , Brian Chin , Dennis Feehan , Kenneth H Hill

 

Excess mortality ranged from 0·2% in Denmark to 4·4% in India. Since there was some under-registration of mortality in India, total pandemic mortality could have been even higher.

 

One of the striking features of the 1918 pandemic – aside from the high death toll – was the sparing of those over the age of 65 in the United States.

 

The infamous `W shaped curve’ of the 1918 pandemic clearly shows that the death rates among those in their teens, 20s, and 30s was much higher than was normally seen in previous influenza years.

 

Those over the age of 65, however, saw a reduction in mortality during the pandemic.

 

A situation not unlike what we saw last year with few over the age of 60 contracting the 2009 H1N1 pandemic virus.

 

We’ve a new study, appearing in the Journal of Infectious Diseases that suggests that the course of the 1918 pandemic was different in Mexico than in its immediate neighbor to the north.  

 

That unlike in the United States, those over 65 experienced an increased mortality rate, raising interesting questions regarding geographic differences in pre-existing immunity to the virus.

 

Since the full article is behind a pay wall, I’ve not read the entire paper. The abstract is available, however. 

 

Hopefully we’ll get a more in depth summary of this paper from another source in the next couple of days.  If so, I’ll update this post with a link.

 

 

Mortality Patterns Associated with the 1918 Influenza Pandemic in Mexico: Evidence for a Spring Herald Wave and Lack of Preexisting Immunity in Older Populations

Gerardo Chowell, Cécile Viboud, Lone Simonsen, Mark A. Miller, and Rodolfo Acuna‐Soto

Background. Although the mortality burden of the devastating 1918 influenza pandemic has been carefully quantified in the United States, Japan, and European countries, little is known about the pandemic experience elsewhere. Here, we compiled extensive archival records to quantify the pandemic mortality patterns in 2 Mexican cities, Mexico City and Toluca.

 

Methods. We applied seasonal excess mortality models to age‐specific respiratory mortality rates for 1915–1920 and quantified the reproduction number from daily data.

 

Results. We identified 3 pandemic waves in Mexico City in spring 1918, autumn 1918, and winter 1920, which were characterized by unusual excess mortality among people 25–44 years old. Toluca experienced 2‐fold higher excess mortality rates than Mexico City but did not experience a substantial third wave. All age groups, including that of people >65 years old, experienced excess mortality during 1918–1920. Reproduction number estimates were <2.5, assuming a 3‐d generation interval.

 

Conclusion. Mexico experienced a herald pandemic wave with elevated young adult mortality in spring 1918, similar to the United States and Europe. In contrast to the United States and Europe, there was no mortality sparing among Mexican seniors > 65 years old, highlighting potential geographical differences in preexisting immunity to the 1918 virus. We discuss the relevance of our findings to the 2009 pandemic mortality patterns.

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