Friday, November 28, 2014

H7N9 Case In Guangdong Province


Credit Wikipedia


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Although there have been local media reports suggesting a couple of other H7N9 cases in China over the past week, so far only today’s case – announced by Hong Kong’s CHP – that of a 31 year old woman hailing from Guangdong province, has been officially announced.


Wed don’t seem to be seeing near the detail (or timeliness) of case reporting in recent months that we grew accustomed to during the first two waves.


Notification of confirmed human case of avian influenza A(H7N9) in Guangdong

The Centre for Health Protection (CHP) of the Department of Health (DH) has been notified by the Health and Family Planning Commission of Guangdong Province of a confirmed human case of avian influenza A(H7N9) today (November 28) affecting a 31-year-old woman in Dongguan, Guangdong Province.

The patient, who is in critical condition, is currently receiving treatment in a hospital in Guangzhou.  

To date, 444 human cases of avian influenza A(H7N9) have been confirmed on the Mainland in Zhejiang (139 cases), Guangdong (110 cases), Jiangsu (58 cases), Shanghai (41 cases), Hunan (24 cases), Fujian (22 cases), Anhui (17 cases), Jiangxi (eight cases), Beijing (five cases), Shandong (five cases), Henan (four cases), Xinjiang Uygur Autonomous Region (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

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Saudi MOH Reports 2 MERS Cases (Sakaka & Taif)


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Two weeks after reporting a pair of cases in Sakaka -  the capital of Al Jawf Province in the north of Saudi Arabia – the MOH is reporting a 3rd infection, that of a 34 y.o. old male. Taif, which has seen the most cases this fall, records another case today as well, this time a 40 y.o. male. 

Both are Ex-pats, and a route of exposure for these cases has not been determined.


A Dog & Cat Flu Review



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Until about a decade ago, it was widely (and erroneously) believed that dogs and cats were not generally susceptible to influenza A infections. 


That perception began to change in 2004 with two unrelated events; the jump of equine H3N8 influenza from horses to Florida greyhounds, and the infection by avian H5N1 of tigers fed infected chickens in Thailand.


While not considered major players (yet) in the spread of human or novel influenza viruses, their role as companion animals make dogs and cats of particular interest to influenza researchers.


First a look back at some of the evidence on dogs & cats susceptibility to influenza – then I’ll have a couple of new studies that shed additional light on their ability to contract, and spread, certain subtypes of flu.


In 2004, the H3N8 equine influenza – a strain that has been around in horses nearly a half century – was discovered to have jumped, and adapted to dogs, creating a new dog-specific (canine) lineage of H3N8. 


Since then, H3N8 has continued to spread among dogs both in North America and around the globe.

While we’ve yet to see any evidence that this equine/canine H3N8 virus can infect humans, there are a number of different H3N8 lineages out there, including the equine, canine, avian, and even a recently discovered Mammalian Adapted H3N8 In Seals.

And a related H3N8 virus is thought to have sparked the 1900 influenza pandemic, giving it a track record in humans, and is considered likely to return someday (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?).

Added to this mix, in 2008 the CDC’s EID Journal carried the following report on a newly emerging canine flu in Korea.


Transmission of Avian Influenza Virus (H3N2) to Dogs

Daesub Song, Bokyu Kang, Chulseung Lee, Kwonil Jung, Gunwoo Ha, Dongseok Kang, Seongjun Park, Bongkyun Park, and Jinsik Oh


In South Korea, where avian influenza virus subtypes H3N2, H5N1, H6N1, and H9N2 circulate or have been detected, 3 genetically similar canine influenza virus (H3N2) strains of avian origin (A/canine/Korea/01/2007, A/canine/Korea/02/2007, and A/canine/Korea/03/2007) were isolated from dogs exhibiting severe respiratory disease.


In late 2012, in China: Avian-Origin Canine H3N2 Prevalence In Farmed Dogs, we saw a study that found more than 12% of farmed dogs tested in Guangdong province carried a strain of canine H3N2 similar to that seen in Korea.


During the 2009 H1N1 pandemic we saw reports of dogs infected, and in the middle of the last decade we saw several reports indicating that dogs were susceptible to the H5N1 bird flu virus (see Study: Dogs And H5N1).

Cats, too, were infected during the 2009 H1N1 pandemic (see Companion Animals And Novel H1N1 & EID Journal: Pandemic H1N1 Infection In Cats), and In 2011, it was announced that Korea’s canine H3N2 had jumped to cats (see Korea: Interspecies Transmission of Canine H3N2).


Previously we’d seen reports of cats infected with the H5N1 virus after consuming infected birds.  The following comes from a World Health Organization GAR report from 2006.

H5N1 avian influenza in domestic cats

28 February 2006


Several published studies have demonstrated H5N1 infection in large cats kept in captivity. In December 2003, two tigers and two leopards, fed on fresh chicken carcasses, died unexpectedly at a zoo in Thailand. Subsequent investigation identified H5N1 in tissue samples.

In February 2004, the virus was detected in a clouded leopard that died at a zoo near Bangkok. A white tiger died from infection with the virus at the same zoo in March 2004.

In October 2004, captive tigers fed on fresh chicken carcasses began dying in large numbers at a zoo in Thailand. Altogether 147 tigers out of 441 died of infection or were euthanized. Subsequent investigation determined that at least some tiger-to-tiger transmission of the virus occurred.

In 2006, Dr. C.A. Nidom demonstrated that of 500 cats he tested in and around Jakarta, 20% had antibodies for the bird flu virus. In 2007 the FAO warned that: Avian influenza in cats should be closely monitored, and in 2012 the OIE reported on Cats Infected With H5N1 in Israel, although so far no sustained virus transmission in cats or from cats to humans has been observed.


Contrary to the prevailing scientific opinion until the early 2000’s, dogs and cats are obviously both susceptible to a variety of influenza A viruses. All of which proves that you never know what you are apt to find until you actually start looking for it. 


Which brings us to a pair of recently published studies.  The first being on the virulence (or lack, thereof) of H5N1 in dogs and cats, and what that might portend as far as transmission is concerned.


Arch Virol. 2014 Nov 22. 

Greater virulence of highly pathogenic H5N1 influenza virus in cats than in dogs.

Kim HM1, Park EH, Yum J, Kim HS, Seo SH.

Author information

Highly pathogenic H5N1 influenza virus continues to infect animals and humans. We compared the infectivity and pathogenesis of H5N1 virus in domestic cats and dogs to find out which animal is more susceptible to H5N1 influenza virus. When cats and dogs were infected with the H5N1 virus, cats suffered from severe outcomes including death, whereas dogs did not show any mortality.

Viruses were shed in the nose and rectum of cats and in the nose of dogs. Viruses were detected in brain, lung, kidney, intestine, liver, and serum in the infected cats, but only in the lung in the infected dogs. Genes encoding inflammatory cytokines and chemokines, Toll-like receptors, and apoptotic factors were more highly expressed in the lungs of cats than in those of dogs.

Our results suggest that the intensive monitoring of dogs is necessary to prevent human infection by H5N1 influenza virus, since infected dogs may not show clear clinical signs, in contrast to infected cats.

An interesting result, considering that last spring  Korea Detected H5N8 Antibodies In asymptomatic Farm Dogs.

The second study, which appears in the December issue of the EID Journal, looks at the ability of cats to contract, and spread a contemporary strain of the equine/canine H3N8 virus.


Equine Influenza A(H3N8) Virus Infection in Cats

Shuo Su1, Lifang Wang1, Xinliang Fu, Shuyi He, Malin Hong, Pei Zhou, Alexander Lai , Gregory Gray, and Shoujun Li


Interspecies transmission of equine influenza A(H3N8) virus has resulted in establishment of a canine influenza virus. To determine if something similar could happen with cats, we experimentally infected 14 cats with the equine influenza A(H3N8) virus. All showed clinical signs, shed virus, and transmitted the virus to a contact cohort.


That cats are susceptible to EIV by direct inoculation is not surprising because infection of cats with various influenza A viruses has been reported. Feline respiratory tract epithelial cells contain sialic acid α-2,3-galactose β-1,3-N-acetyl galactosamine (SA α2,3 gal) receptors for avian and equine influenza viruses and SA α2,6 gal receptors for mammalian influenza virus (13).

However, our finding of horizontal transmission of EIV among cats is significant. If transmission occurs outside the laboratory, and if the basic reproduction rate is higher than 1.0, then EIV could potentially establish itself and circulate in this new host species. Why it has not yet happened naturally, as it did for canine influenza virus (H3N8), remains to be determined. Possibilities include lower transmission efficiency, lower probability of horse–cat contact, less virus shedding in a laboratory, or feline behavior (less social contact than dogs).


These researchers repeated this experiment with an older strain of the equine H3N8 virus, and while some of the cats seroconverted, they all remained asymptomatic. Illustrating the variance of virulence one often finds between clades or strains of the same influenza A subtype.


In just over a decade we’ve gone from believing that dogs and cats aren’t really susceptible to flu to viewing them as Potential `Mixing Vessels’ For Influenza


Last summer, in Canine H3N2 Reassortant With pH1N1 Matrix Gene, we looked at this precise scenario. At roughly the same time the American Society for Microbiology issued this warning:


Evolution of Equine Influenza Led to Canine Offshoot Which Could Mix With Human Influenza

WASHINGTON, DC – June 19, 2014 – Equine influenza viruses from the early 2000s can easily infect the respiratory tracts of dogs, while those from the 1960s are only barely able to, according to research published ahead of print in the Journal of Virology. The research also suggests that canine and human influenza viruses can mix, and generate new influenza viruses.

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Although  it’s true that pigs and birds are considered  far superior biological `flu factories’,  any jump of a novel flu virus to a new species is viewed with concern, because it affords the virus new opportunities to acquire host adaptations – or reassort with other viruses – and thereby increases its chances of becoming a human health threat.

While the future role of dogs and cats in the evolution of influenza is subject to debate, for now, your pet is at far greater risk of catching the flu from you, than you are from it (see Companion Animals & Reverse Zoonosis).

WHO On Ebola In Semen Of Convalescent Men




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One of the more unusual aspects of an Ebola virus infection is that even after a man has recovered, he can shed the virus in his semen for up the three months.   This is a topic that we’ve looked at in the past, most recently in Lancet: Mackay & Arden On Ebola In Semen Of Convalescent Men, and prior to that in a pair of VDU blogs Ebola virus in semen is the real deal....Ebola: Blood, sweat and tears.

While it has been recommended that men are counseled to use condoms to protect their partners for 3 months post-infection, earlier this month we saw India isolate a man with Ebola-infected semen, more than six weeks after he was pronounced cured (Sept 30th) and released from a Liberian hospital.


Today the World Health Organization has published their own review of the evidence, and while they find there is a potential danger of infection, there are no documented cases of of sexual transmission of the ebolavirus. They reiterate the opinion that there is no need to isolate men during this convalescent period. 


Ebola virus in semen of men who have recovered from Ebola virus disease

Key messages
26 November 2014

Survivors of Ebola working with WHO, Sierra Leone

  • Sexual transmission of Ebola virus disease (EVD) has not been documented
  • In four studies that investigated persistence of Ebola virus in seminal fluid from convalescent patients (a total of 43 patients), three men who had recovered from Ebola virus disease were reported to shed live virus in semen 40 days, 61 days and 82 days after onset of symptoms, respectively.
  • In two studies, Ebola virus was isolated from semen, but subsequent infections were not identified in household contacts.
  • Men who have recovered from Ebola virus disease should be aware that seminal fluid may be infectious for as long as three months after onset of symptoms.
  • Because of the potential to transmit the virus sexually during this time, they should maintain good personal hygiene after masturbation, and either abstain from sex (including oral sex) for three months after onset of symptoms, or use condoms if abstinence is not possible.
  • WHO does not recommend isolation of male convalescent patients whose blood has been tested negative for EVD.

The Ebola virus is shed in bodily fluids such as blood, vomit, faeces, saliva, urine, tears, and vaginal and seminal fluids. There is evidence that seminal fluids of convalescing men can shed the Ebola virus for at least 82 days after onset of symptoms. Although the scientific evidence is limited, it is clear that semen is a potential source of infection and could therefore cause transmission of the virus through delivery of the infectious virus on a mucosal surface.

1. How long is Ebola virus present in semen?

In a study performed during the Ebola outbreak in Gulu, Uganda, in 2000, the authors tested the semen of a single convalescent patient and were able to isolate Ebola virus up to 40 days after the onset of illness. One study in 1977 (Edmond et al., laboratory infection in England) detected live Ebola virus in semen of one convalescent man 61 days after onset of symptoms. One study in1995 (Rodriguez et al. Ebola outbreak in Kikwit, Democratic Republic of Congo) also detected live Ebola virus in semen in one convalescent man 82 days after disease onset. Therefore, it is possible for Ebola virus to be present in semen for 3 months after disease onset.

2. Is semen that tests positive for Ebola virus infectious?

The evidence is inconclusive. One study (Rowe et al.) that followed four men recovering from Ebola virus disease and their sexual partners found that no sexual partner developed symptoms.

  • Bausch, D. et al. (2007) Assessment of the risk of Ebola virus transmission from bodily fluids and fomites, The Journal of Infectious Diseases, 196, pp. S142-7.
  • Emond, R. et al. (1977) A case of Ebola virus infection, British Medical Journal, 2, pp. 541-544.
  • Rodriguez, L. et al. (1999) Persistence and genetic stability of Ebola virus during the outbreak in Kikwit, Democratic Republic of Congo, 1995, The Journal of Infectious Diseases, 179(1), pp. S170-6.
  • Rowe, A. et al. (1999) Clinical, Virologic, and Immunologic Follow-up of Convalescent Ebola Hemorrhagic Fever Patients and their Household Contacts, Kikwit, Democratic Republic of the Congo, The Journal of Infectious Diseases, 179(1), pp.S28-35.

Thursday, November 27, 2014

Bird Flu Reports From India, Japan, Korea & Taiwan


Credit UK Defra


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Between 2004 and 2007 the H5N1 avian flu virus expanded its range, going from basically being a problem for a handful of Southeast Asian countries, to being a problem for much of Europe, Asia, and the Middle East.  We saw huge wild bird die offs in China, Indonesia, and Eastern Europe, along with thousands of poultry infestations and culling operations.  


Along the way, several hundred humans were infected as well.


In 2008, H5N1’s expansion seemed to halt, and in many places the virus actually receded, leaving behind about a dozen places around the world where the virus remained entrenched.  Among them were Indonesia, Vietnam, Egypt, Cambodia, India,  Pakistan, Bangladesh, and China.


Even in these countries, the number of outbreaks reported – and the number of human infections – dropped markedly, with the peak reached in 2006 (n=115) and steadily dropping since then (2013= 39 cases).   The foci of infections also shifted away from Vietnam and Indonesia towards Egypt and Cambodia.

While never quite going away, it seemed as if the avian flu threat was simply fading away.


That is, until a new avian flu virus – H7N9 – appeared abruptly in China in the spring of 2013 sparking two consecutive winter epidemics, and is expected to return again this winter as well.  In quick succession, several more avian flu viruses appeared – including H5N8 in Korea (now spread to Europe & Japan), H5N6 in China and Vietnam, H5N3 in China, and H10N8 in China.


Now, instead of one avian flu threat, we have anywhere from three to six to keep track of (H5N1, H7N9, H5N8, H5N6, H5N3, H10N8), and no one should be terribly surprised if several more novel reassortants emerge over the next couple of years. 


Reassortant viruses emerge when two different flu viruses share a common host and swap genetic components. Most reassortant viruses are evolutionary failures, but every once in awhile a more `fit’ virus emerges.

Not only are there more `building blocks’ in play, for flu viruses to swap and play with, the poultry vaccines in use in China and elsewhere are losing their effectiveness, and that may be promoting the creation of new flu strains (see EID Journal: Subclinical HPAI In Vaccinated Poultry – China).


In recent weeks we’ve seen more bird flu stories, from more diverse locations, than we have in a number of years.  While this may be a flash in the pan, for now bird flu concerns are once more on the ascendant – albeit, for now, mostly for poultry operations


With so much going on in India, Korea, Japan, the Netherlands, Germany, the UK, and Egypt – instead of blogging separately about these news stories – I’ve put together a morning round up.

Our first stop: India, where over the past few days we’ve seen reports of massive duck die offs in Kerala, and government plans to cull 200,000 birds.  While initially only identified as an HPAI H5 virus, today multiple media sources are reporting the virus is the H5N1 subtype.


Kerala Confirms Bird Flu is Deadly and Highly Contagious Strain

Updated: November 27, 2014 15:56 IST

Kottayam: Kerala has confirmed that the outbreak of bird flu in the state is of the feared H5N1 strain, which is highly contagious and can be fatal to humans.

Government officials said that massive culling of birds is being done to prevent the spread of the disease.

The virus itself killed about 15,000 infected ducks in Kottayam and another 500 in nearby Alappuzha, the first cases of the disease in the country since February this year.

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Meanwhile, in Korea, there are fresh reports the the H5N8 virus – which emerged there last January and proceeded to devastate the poultry industry -  has been detected again on a poultry farm in the coastal city of Gyeongju in Gyeongsang Province.


Bird Flu Spreads in S. Korea

Pyongyang, November 26 (KCNA) -- A bird flu occurred at a chicken farm in Kyongju City, North Kyongsang Province, south Korea on Nov. 24, according to KBS of south Korea.

Hundreds of chickens were culled and buried.

It was also reported that bird flu caused by migratory birds is spreading.

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In Japan, another report of migratory bird feces testing positive for the H5N8 virus, this time in Tottori.

This season highly pathogenic avian influenza detected in Tottori third example

November 27, 2014

Ministry of the Environment is the 27th, highly pathogenic avian influenza virus from droppings of ducks found in Tottori (H5N8 subtype) was detected, was announced. Domestic wild birds in the highly pathogenic avian influenza has been confirmed Shimane Prefecture Yasugi, season three cases eyes continued to Chiba Prefecture Nagara.

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And from Taiwan this morning, reports (h/t Ronan Kelly of FluTrackers) of both H7N9 and H7N5 in migratory bird feces samples collected this month from Tainan City, in the southwest of Taiwan.  Further testing will be required to determine the pathogenicity of these subtypes.


Four grass wetlands and migratory birds excrement detection of H7N9 subtype avian influenza virus vaccination started around the poultry farms safe and secure

Published date: 2014/11/27 morning 10:55:20| last modification date: 2014/11/27 10:55:20

Four wetland today in this city (103) on November 15, feces sampling inspection in routine monitoring of migratory birds on 25th H7N5 and subtype H7N9 avian influenza viruses isolated, identified highly pathogenic virus does not at present, but homologous strains is a city, pending final confirmation.

Protection of animal epidemic prevention Department said in this city, as a safeguard against four grass migratory birds carrying the virus, around the 25th started 6 games within a 3 km radius of poultry farms quarantine measures, including 1 feeding chickens, health situation is good, same day sampling inspection. Animal Health Department has stepped up poultry farms in and around the public road disinfection and epidemic prevention work, and to strengthen the poultry farm visits and monitoring of the epidemic, and take precautions against the epidemic. According to the sampling frequency of the disposal process 1 times per month on poultry farms within 3 kilometers to strengthen monitoring for 3 months after confirming that the avian influenza virus activity was not detected, you can unlock the wetlands regional monitoring measures.

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Meanwhile we continue to see scattered media reports of bird flu `alarm’ in Egypt, amid numerous poultry outbreaks and three recent human infections (see Meanwhile, Back In Egypt . . . .), and Europe continues to ratchet up their biosecurity measures against any further introductions of the H5N8 virus (see Defra updated bird flu guidance).

While the public health threat fairly remains low from these viruses, the one constant with influenza viruses is their capacity for change.  So we watch these outbreaks carefully, for any signs that these viruses may be evolving into a greater human health threat.

Wednesday, November 26, 2014

WHO Ebola Response Roadmap - Situation Report 26 Nov




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The World Health Organization has released their latest weekly Ebola situation report, and while case counts and death tallies are still believed to be under-counted, they report that the number of new cases appears to be stable or declining in Liberia and Guinea, but may be rising again in Sierra Leone.

The toll on healthcare workers continues to run high, with nearly 600 infected, and 330 deaths.   Follow the link below ro read the full update online, or Download the PDF


Ebola response roadmap - Situation report

26 November 2014


A total of 15 935 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 23 November. There have been 5689 reported deaths. Cases and deaths continue to be under-reported in this outbreak. Reported case incidence is stable in Guinea (148 confirmed cases reported in the week to 23 November), stable or declining in Liberia (67 new confirmed cases in the week to 23 November), and may still be rising in Sierra Leone (385 new confirmed cases in the week to 23 November). The total number of cases reported in Sierra Leone since the outbreak began will soon eclipse the number reported from Liberia. The case fatality rate across the three most-affected countries in patients with a recorded definitive outcome is approximately 60%. Three health-care workers were reported infected with EVD in Guinea in the week to 23 November. 

Response activities continue to intensify in line with the UNMEER aim to isolate 70% of EVD cases and safely bury 70% of EVD-related deaths by 1 December. Guinea isolates over 70% of all reported cases of EVD, and has more than 80% of required safe burial teams. Progress on isolation and safe burials has apparently been slower in parts of Liberia and Sierra Leone, although uncertainties in data preclude firm conclusions. At a national level, both countries are apparently unable to isolate 70% of patients, although data on isolation is up to 3 weeks out of date. Every EVD-affected district in the three intense-transmission countries has access to a laboratory for case confirmation within 24 hours of sample collection. All three countries report that more than 80% of registered contacts associated with known cases of EVD are traced, though the low mean number of contacts registered per case suggests that contact tracing is still a challenge in areas of intense transmission.  


Health-care workers

A total of 592 health-care workers (HCWs) are known to have been infected with EVD up to the end of 23 November, 340 of whom have died (table 5). The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the US (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas).


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