Tuesday, December 01, 2015

WHO/PAHO Issue Epidemiological Alert On Neurological Syndrome, Congenital Defects & Zika Virus





A rapidly evolving story we’ve been following closely for well over a week has been the sudden, and unprecedented spike in microcephalic birth defects reported in Brazil (see Brazilian MOH Reports 500 New Microcephaly Cases In Past Week). 


This surge in microcephaly comes just months after the mosquito-transmitted Zika Virus was first reported in Brazil, and we are beginning to get data from the Zika outbreak in French Polynesia that indicates a similar (albeit smaller) surge in neurological complications (see  ECDC: Complications Potentially Linked To The Zika Virus Outbreaks In Brazil & French Polynesia).


Complicating matters further, the Zika virus appears to be spreading rapidly across both Central and South America, and the Caribbean and even parts of North America are at risk as well. The virus has now been reported in 9 countries in the Americas; Brazil, Chile (on Easter Island), Colombia, El Salvador, Guatemala, Mexico, Paraguay, Suriname, and Venezuela.

Today the World Health Organization and PAHO have issued a joint Epidemiological Alert, which runs 11 pages in length.  Far too large to reprint here.  It may be downloaded in PDF format from:


PAHO/WHO Epidemiological Alerts and Updates


The gist can be read in the abstract, which reads:

Given the increase of congenital anomalies, Guillain-Barré syndrome, and other neurological and autoimmune syndromes in areas where Zika virus is circulating and their possible relation to the virus, the Pan American Health Organization / World Health Organization (PAHO/WHO) recommends its Member States establish and maintain the capacity to detect and confirm Zika virus cases, prepare healthcare facilities for the possible increase in demand at all healthcare levels and specialized care for neurological syndromes, and to strengthen antenatal care. In addition, Member States should continue efforts to reduce the presence of mosquito vectors through an effective vector control strategy and public communication.





These are early days, of course, and the investigation into this virus – and the health risks – are just getting started.  Given the severe consequences of infection, particularly for pregnant women and their unborn children, an aggressive posture when it comes to surveillance, and prevention, makes sense.


For more on this evolving story you may want to read Lisa Schnirring’s coverage on CIDRAP News  ( see Zika virus spreads to more countries), check out FluTracker’s Zika Virus Forum, or revisit these recent Zika blogs:


Brazilian MOH Statement On Zika Virus, Microcephaly & Deaths
WHO Update: Microcephaly In Brazil
Post-Zika Outbreak Spike In Congenital Abnormalities In Brazil & French Polynesia
ECDC Risk Assessment: Microcephaly In Brazil Potentially Linked To The Zika Virus Epidemic

Italy: LPAI H5N2 On A Turkey Farm


Credit Wikipedia



With the onset of winter we are starting to see an uptick in both LPAI (low pathogenic) and HPAI (high pathogenic) avian flu outbreaks in Europe, with Italy being the latest to report activity. LPAI viruses are commonly found in wild and migratory birds, often only producing mild symptoms in poultry.


The concern is -  when LPAI H5 and H7 viruses are not quickly controlled -  they have the potential to mutate into highly pathogenic strains. 

Over the past few months we’ve seen (quite unusually) three such conversions from LPAI to HPAI in Europe (see  DEFRA: France’s HPAI H5N1 Another Mutated LPAI Strain), adding renewed impetus for quick reporting and eradication.

This latest outbreak takes place at a turkey farm in Emilia Romagna, a region heavily affected by avian influenza (notably H7N7 in 2013) in the past, and at high risk suffering major losses should the virus spread.  Accordingly, the government has ordered `exceptional monitoring’ for nearby turkey farms.


This report from http://www.anmvioggi.it/   Ministero della Salute DIREZIONE GENERALE DELLA SANITA’ ANIMALE E DEI FARMACI VETERINARI  attached as a PDF.



LPAI turkeys, exceptional monitoring Emilia Romagna

Tuesday, December 1, 2015 16:17


Outbreak of low pathogenic avian influenza in the province of Forlì-Cesena. By the Ministry of Health updates on the measures and checks.

Serotype H5N2 in samples taken in self-control of turkeys at a farm located in the Municipality of Meldola (Forlì-Cesena), Region Emilia Romagna. The confirmation came on November 30 by the National Reference Centre at the IZS delle Venezie, after RT-PCR and gene sequencing. The animals showed a mild respiratory symptoms.

In accordance with the requirements of current legislation (Legislative Decree no. 9/2010 implementing Directive 2005/94 / EC) the veterinary services responsible for the area have been responsible for seizure, with block the movements in and out of the farm, slaughter of (about 21,850 animals) to be followed by cleaning and disinfection. It 'was also set up a restricted area of 1 km radius of the company.

In making information, the Directorate General for Animal Health adds that further checks are being epidemiologically related farms, taking into account that the farm belongs to a large poultry sector. The Emilia Romagna - the statement concludes ministeriale- ordered an exceptional monitoring, for the moment only in farms that raise turkeys in the chain, which provides pre-loading samples within 4 days prior to the first shipment (male and female) to be repeated every 4 days, all withdrawals in turkey farms in the supply chain with animals over 4 weeks, control cards mortality and consumption of food, checks at the slaughterhouse.

Even companies that have had contact with the epidemiological outbreak will be impounded precaution and brought under control with immediate verification of reproductive parameters, blood tests and tracheal swabs, samples of dead animals on the farm.


BAPHIQ: Taiwan Culls 5 Million Birds In 2015


Credit Japan’s MAFF 


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From Taiwan’s BAPHIQ (Bureau of Animal Plant Health Inspection & Quarantine) we get an assessment on the impact of avian flu on that island nation since it flared up in January when  three new HPAI H5 viruses appeared  – all apparently related to the H5N8 virus which first erupted in South Korea 12 months earlier.


Shortly after arriving - likely carried in by migratory birds - the H5N8 virus reassorted with local avian influenza viruses and produced new versions of H5N2, and an H5N3 reassortant.  The old H5N2 remains in circulation, but has now been joined by the `new’ H5N2 strain, H5N8, and a novel H5N3.


To date, these outbreaks have affected nearly 1,000 farms and have resulted in the culling or deaths of 5 million birds.  First a link to a syntax challenged translation of the today’s announcement, then a link to a far more readable English language media report.


Cases of avian influenza field, the surrounding area within a radius of one kilometer of non-case field and general poultry farms should be in accordance with "H5, H7 subtypes in poultry influenza prevention measures" provides hardware and software implementation of the biosecurity measures

a) supervise the implementation of autonomy informed the poultry industry, assisted by the animal epidemic prevention authorities seized Mining confirmed cases of immediate disposal of poultry farms epidemic
ended yesterday (30) days 18:00 only, namely 15 cities and counties by the poultry industry to take the initiative to inform the field of censorship 1,000 games (November 25 to November 30, no new inspection games), confirmed the H5 subtype of avian influenza field 965 (November 25 to 30 Month Day Added confirmed Pingtung County 1 1 chicken duck farm and field), confirmed negative 34 games and one game H6N1 subtype (other than a reportable disease OIE), namely the completion of 964 field culled (a total of 5,098,096 only).

(Continue . . . )

Luckily Focus Taiwan has a brief, but far more readable report at:


5 million poultry culled this year due to bird flu

2015/12/01 20:05:27

aipei, Dec. 1 (CNA) More than 5 million head of poultry have been culled this year due to avian influenza outbreaks, the Bureau of Animal and Plant Health Inspection and Quarantine said Tuesday.

As of 6 p.m. Monday, 1,000 poultry farms in 15 counties and cities had been tested, of which 965 were positive for the H5 bird flu virus, 34 were negative, and one was positive for the H6N1 virus, the bureau said.

A total of 5.09 million birds from 964 farms had been culled, it said.

(Continue . . . )


Although the United States culled 10 times as many birds during our avian flu outbreak, Taiwan’s population is only about 1/14th that of the United States.    


The detection of one outbreak of H6N1 is not unexpected given that it has been endemic in Taiwan for decades (see Taiwan: Debating The Importance Of H6N1 In Dogs).  Not being a reportable subtype, however, and having low pathogenicity in poultry, we don’t often hear about it.


H6N1 made headlines in 2013 when was detected in a 20-year-old female who presented at local hospital with mild pneumonia on May 8th, was hospitalized and treated with oseltamivir, and who was released 3 days later.  None of 36 close contacts followed up on were found to be infected with the H6N1 virus.

Although Taiwan has not enjoyed quite the respite in avian flu outbreaks that Europe and North America have for the past few months, they are bracing themselves for another winter surge in the coming months.  

Vietnam: 10 Fatal Strep suis Cases In 2015


Credit EID JournalEpidemiology of Strep suis




With avian flu outbreaks on the rise in Vietnam, and the festivals of the Lunar New Year just a couple of months away, the Vietnamese government is raising warnings over another potentially deadly food borne pathogen; Streptococcus suis.


A Gram-positive bacterium, with 35 known serotypes - S suis represents a large and diverse species of bacteria – many of which are carried asymptomatically by healthy pigs.


Serotypes 1-8 are most often associated with disease in pigs, and among humans, infection is most commonly by serotype 2.


The Merck Veterinary Manual states:

S suis is found in the upper respiratory tract, particularly the tonsils and nasal cavities, and the genital and alimentary tracts of pigs.

Clinical infections are seen mainly in weaners or growing pigs and less frequently in suckling piglets. S suis has been isolated from a wide range of animal species, eg, cattle, sheep, goats, horses, and birds, as well as humans. Its presence in the environment is transitory.

In the western world, most cases are due to occupational exposure (abattoir workers, butchers, pig breeders) while in Asia, the consumption of raw pig products is often the source of infection (cite EID Journal  Epidemiology, Clinical Manifestations, and Outcomes of Streptococcus suis Infection in Humans).


This report from VNA.


10 people died from using pork improperly

Tuesday, 12/01/2015 05:16 PM

(VNA) - From the beginning of the year had 10 people die from Streptococcus suis infection by contact, using pork improperly.

Deputy Director of the Department of Preventive Medicine (Ministry of Health) Truong Dinh Bac said: Climate Winter - Spring favorable for communicable diseases arise and develop, especially the respiratory transmitted diseases, gastrointestinal tract, such as seasonal flu, avian flu, acute diarrhea, hand foot and mouth disease ...

Patients infected with Streptococcus suis.

"In particular, spring is also the season harvesting festival should take place more pigs. Currently, many places still keep the habit of eating pork and duck spring rolls made ​​from raw pork CHAO. This is very dangerous if infection streptococcal pig, "said North said.

Information on the program is shared in the media encounter disease prevention Winter Spring took place on 1/12.

According to the Department of Preventive Medicine: From early May to 11/2015, the country recorded 82 new cases, 10 deaths caused by Streptococcus suis. And one week ago, had 2 people hospitalized with Streptococcus suis infection.

 (Continue . . .)


Although most cases are one-offs, there have been outbreaks reported – notably in China. This from a 2007 Lancet  report identifying S. suis as an important emerging pathogen.

Streptococcus suis: an emerging zoonotic pathogen.

Lun ZR, Wang QP, Chen XG, Li AX, Zhu XQ.


Streptococcus suis is a major porcine pathogen worldwide, and can be transmitted to human beings by close contact with sick or carrier pigs. S suis causes meningitis, septicaemia, endocarditis, arthritis, and septic shock in both pigs and human beings, and mortality is high.

Human infection with S suis occurs mainly among certain risk groups that have frequent exposure to pigs or pork. Outbreaks of human S suis infection are uncommon, although several outbreaks have occurred in China in recent years.

In July, 2005, the largest outbreak of human S suis infection occurred in Sichuan province, China, where 204 people were infected and 38 of them died. There have been 409 cases of human S suis infection worldwide, most of which have occurred in China, Thailand, and the Netherlands, and these infections have led to 73 deaths.


More recently, in Frontiers in Microbiology, researchers suggested that S. suis may serve as an important antibiotic resistance reservoir, and may be contributing to the spread of resistance genes to other bacteria (see Streptococcus suis, an Emerging Drug-Resistant Animal and Human Pathogen).


And from another   EID Journal letter we get an idea of just how prevalent this infection is in Vietnamese pigs:

Streptococcus suis and Porcine Reproductive and Respiratory Syndrome, Vietnam

In Vietnam during September 2006–November 2007, the carrier rate of S. suis among slaughterhouse pigs was 41% (222/542); SS2 was the most frequently identified serotype in 14% (45/317) of S. suis isolations (4)


While seemingly a minor concern in North America, a study conducted in 2008 at the University of Iowa - by Tara C. Smith (Aetiology Blog) et al. – suggests that this bacterial infection may be more prevalent than we know.

Occupational Exposure to Streptococcus suis among US Swine Workers
Tara C. Smith, Ana W. Capuano, Brenda Boese, Kendall P. Myers, and Gregory C. Gray

Despite numerous cases of human infection with Streptococcus suis worldwide, human disease is rarely diagnosed in North America. We studied 73 swine-exposed and 67 non–swine-exposed US adults for antibodies to S. suis serotype 2.

Serologic data suggest that human infection with S. suis occurs more frequently than currently documented.

(Continue . . .)


The authors provide two reasons why this bacterial infection may be going under reported in North America.

One possibility is under diagnosis or misdiagnosis, rather than a true absence of the disease.

A second possibility is that S. suis strains colonizing swine in the United States may be less virulent than Asian strains and therefore unlikely to cause overt human disease even when transferred between species.

One need only note that we’ve seen the arrival of new strains of PEDV (Porcine Epidemic Diarrhea Virus) arrive in the United States over the past couple of years with a high nucleotide identity with Chinese strain AH2012.  Oceans and vast distances are no longer barriers to the spread of infectious diseases in the 21st century.


With the Tết celebrations set for early February, and already concerns over both H5N1 and H5N6 in Vietnam and H7N9 in neighboring China,  the Vietnamese government is ramping up the public health messaging early, in hopes of averting a bigger problem later this winter.

Saudi MOH Reports Primary MERS Case In Riyadh





After an unusually quiet middle of November Saudi Arabia reports their second primary MERS case in the past three days, this time in the Capital City of Riyadh.  The designation as a `Primary’ case only tells us these cases had no known exposure to an identified MERS case or a healthcare facility.


Nearly 40% of all known Saudi cases fall into this `primary’ category, and for most, the exact source of infection remains a mystery.



Today’s case is identified as a 21 y.o. female who is listed in critical condition. This is a fairly unusual demographic for a primary case (as was Sunday’s case, a 35 y.o. female also listed in critical condition), as they tend to skew towards older males outside of hospital or family clusters


Since the MOH doesn’t provide us with dates of onset - and has been known to delay reporting of cases for several days - it makes it difficult to draw any conclusions based on the advanced stage of illness of these two patients.


Late detection, however, could indicate a delay in diagnosis and a greater risk of exposure to others. Hopefully we’ll learn more when the WHO posts an update.



Monday, November 30, 2015

FRANCE: MOA Reports Two Additional Avian Influenza Outbreaks


Location Dordogne  - Credit DEFRA



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A week after reporting their first case of H5N1 in eight years in a backyard poultry flock, the French Ministry of Agriculture today has announced two more outbreaks of avian influenza in the same region.


It is not entirely clear if today’s announcements are for H5N1, or some other subtype.


Although no specifics were offered regarding strain/subtype being reported today, last week a report from DEFRA: France’s HPAI H5N1 Another Mutated LPAI Strain indicated the H5N1 strain in the first outbreak was not the classic Eurasian H5N1 which emerged in 2003, but a recently mutated strain.

The following press release was released late today by France’s Ministry of Agriculture.



Ministry of Agriculture, of agri-food and forest

Press contacts

Paris, November 30, 2015


Two new cases of Avian Influenza detected in Dordogne

Following the detection of the first case of avian influenza in a farmyard on 24 November, the national emergency  response plan has been activated immediately, in accordance with the European regulations and International.

Among the actions deployed without delay, the Direction départementale de protection populations of Dordogne has set up protection zones and supervision strengthened around the barnyard. In addition, active surveillance extended has been implemented in the farms which are the subject of a monitoring annual with regard to Avian Influenza virus. Samples were made at various farms in Dordogne, despite the absence of mortality or clinical signs.

The results of these samples revealed the presence of Influenza strains Avian pathogenic to poultry at two farms. Them detailed sequencing is being carried out by the handles.

To protect and to limit the spread of the disease to more farms sensitive species, the services of the Ministry of  agriculture proceed currently for the slaughter of all the animals of the farms concerned and have decided the implementation of biosecurity measures in the entire Department.

Furthermore, it should be recalled that avian influenza is not transferable to human consumption of meat, eggs, fatty liver and more generally any food.

The mobilization of the State services is total alongside professionals for limiting the spread and consequences of the  disease, particularly in export.