Sunday, February 19, 2017
Although they can happen anytime during they year, during late winter and spring we tend to see an uptick in MERS cases with camel exposure. It has been theorized that young camels - usually born early in the year - are immunologically naive, and are therefore more likely to acquire the virus and transmit it to humans.
Theory or not, of the 10 cases reported by by Saudi Arabia during this month of February, 7 are listed as `Primary (Camel Contact)', including 2 cases announced today.
Throughout its relatively short (4 year) reign, we've watched H7N9's evolution closely for signs that it might be evolving into a more dangerous pathogen. During that time we've seen its genetic diversity grow rapidly through continual reassortment with other avian viruses (particularly H9N2), antigenic drift, and its passage through a variety of host species.
A process dubbed `genetic tuning’ by the authors of a paper that appeared in Eurosurveillance back in 2014 (see Genetic Tuning Of Avian H7N9 During Interspecies Transmission).
With this diversity we've also seen some subtle (sometimes regional) changes in H7N9's behavior, something which was the topic of last December's MMWR: Assessing The 4th Epidemic Wave Of H7N9 In China, where researchers warned of `the continued geographic spread, identification of novel reassortant viruses, and pandemic potential of the virus' - stating that `using the Influenza Risk Assessment Tool (10), CDC found that A(H7N9) virus has the highest potential pandemic risk of any novel influenza A viruses that have been assessed.'
But the two constants with H7N9 until now have been its low pathogenicity in birds and its lack of sustained transmission in humans.Today we've a brief announcement from Guangdong's CDC that two virus samples collected from human hosts last month suggest one of those constants may be changing; its pathogenicity in birds.
While the ultimate significance and impact of this discovery remains unclear, this is another sign that the H7N9 virus continues to evolve in unexpected ways. First the (translated) announcement, then I'll be back with a bit more.
H7N9 virus mutant was found in human cases from ChinaAlthough capable of causing serious (even fatal) illness in humans, H7N9 has - at least until now - been strictly an LPAI (Low Pathogenic Avian Influenza) virus in birds. As such, it has been very difficult to identify and contain in domesticated or wild bird populations.
Release Date: 2017-02-19 Views: Contributed by: Information Department of Publicity: Office Font: Big Middle Small
In January 2017, Guangdong Provincial Center for Disease Control and Disease on the two cases of human infection H7N9 cases were isolated virus gene sequencing analysis, found in the two strains of hemagglutinin link peptide position of the gene insertion mutation occurred, the test results Has been confirmed by the National Center for Viral Disease National Influenza Center.
I center experts to judge and communicate with the relevant experts in the agricultural sector that H7N9 virus in the hemagglutinin link peptide position of the gene insertion mutation, suggesting that the virus mutation to the highly pathogenic virus against birds; the second is based on the virus Sequence analysis results have not yet appeared in the mutant virus that has increased resistance to human infectivity, virulence and interpersonal communication.
Two cases of disease before the incidence of bird exposure history, and in the exposure of poultry birds have occurred in the phenomenon of death. At present, a case has been cured, another case is still in treatment. All the 105 cases of close contact after two weeks of medical observation, were not fever, cough and other symptoms.
H7N9 virus is a influenza virus, one of its main features is prone to gene reassignment and mutation. Some mutations may lead to the virus on the human appeal, virulence and interpersonal communication ability enhancement, so the virus variation has been widely concerned about the domestic and foreign.
It is understood that the agricultural sector laboratory also from Guangdong, four poultry specimens found similar to the variation of the virus. China's health care system will work together with the agricultural sector, the common source of the virus, the scope of the impact of in-depth study, and continue to strengthen the monitoring of H7N9 virus, in time to find any possible variation.
The results have been communicated to the World Health Organization.
China Center for Disease Control and Prevention
A change to an HPAI virus might make identification in poultry flocks easier (potentially a good thing) - but could also serve as an evolutionary `bridge' to other changes; changes that might negatively impact how it behaves in mammalian hosts.Admittedly, I've employed a lot of `weasel words' here, since we simply don't know where this new fork in H7N9's evolutionary road will lead. The fact that it has been detected in both humans and poultry in Guangdong Province, however, suggests it isn't just some `spontaneous' dead end mutation.
But until we learn more we won't know how biologically `fit' these variants really are.
Interestingly, on Friday Science Magazine ran a story (see Bird flu strain taking a toll on humans) with an interview with renown virologist Dr. Guan Yi from the University of Hong Kong, which seems to have telegraphed this discovery.
"It is too late to contain the virus in poultry," Guan says. He predicts that the virus will continue to spread in China's farms, possibly evolving into a strain that would be pathogenic for poultry. Authorities have culled more than 175,000 birds this winter to stamp out local outbreaks of H7N9 and other avian flu strains. Further spread of H7N9 "will naturally increase human infection cases," Guan says.While today's announcement doesn't necessarily move H7N9 closer to becoming a pandemic strain, it is a reminder how labile and unpredictable influenza viruses can be.
Friday, February 17, 2017
Yesterday, in Hong Kong: More On Today's Interdepartmental Meeting On H7N9, among the steps they announced they were taking was - `the CHP will issue letters to all doctors in Hong Kong, reminding them to beware of cases of AI.'
Today we have that letter, which provides an excellent overview of the H7N9 situation, along with the CHP's case criteria for reporting of suspected cases.
Due to its length I've only excerpted parts of it. Follow the link to read it in its entirety.
Our Ref. : (147) in DH SEB CD/8/6/1 Pt.35
February 15, 2017
Be vigilant against avian influenza
We would like to draw your attention to the high activity of avian influenza viruses in neighboring areas and overseas countries and solicit your support to remain vigilant against avian influenza.
The activity of avian influenza A(H7N9) viruses has been increasing markedly in Mainland China since the end of 2016. This wave (i.e. the fifth wave) has been progressing much faster than that in the previous winter. According to the National Health and Family Planning Commission, the number of reported cases of human infection with avian influenza A(H7N9) virus in Mainland China increased from six in November 2016 to 106 and 192 cases in December 2016 and January 2017 respectively, as compared to 40 cases recorded from November 2015 to January 2016.
In this wave so far, 357 human H7N9 cases have been reported by health authorities in 17 provinces/municipalities/autonomous regions in the Mainland (as of February 14, 2017) (Annex I). The number of cases recorded has already exceeded that recorded in the previous four waves (135, 318, 224 and 121 in the first, second, third and fourth wave respectively).
Among the 357 cases, their ages ranged from 3 – 91 years (median: 57). Most cases presented with severe conditions. Among the cases where information on exposure history was known, as previous waves, most reported prior exposure to live poultry or potentially contaminated environments, including in live poultry markets (LPMs).
According to the World Health Organization, there has been no indication of significant changes in the epidemiology of the human infections, no evidence of sustained human-to-human transmission and no significant changes in the clinicalpresentation or disease outcome.
Apart from H7N9, outbreaks of highly pathogenic avian influenza A(H5N2), A(H5N6) and A(H5N8) have occurred in farms in many parts of the world including Mainland China, Taiwan, Japan, Korea and many countries in Europe. Two cases of human infection with H5N6 have been detected in Mainland China in late 2016.
In this regard, we would like to urge you to pay special attention to patients who presented with fever or influenza-like illness (ILI). Travel history and relevant exposure history during travel should be obtained from them. Please note that the history of possible exposure to poultry or contaminated environments may not be voluntarily told by the patients in the beginning. If patients report seeing any live poultry during their travel in the Mainland, detailed information on possible exposure to environments contaminated by poultry should be solicited from them.
Any patients with acute respiratory illness or pneumonia, and with at-risk exposure (including live poultry workers, history of visiting market with live poultry, contact with poultry, etc.) in affected areas within the incubation period (i.e. 10 days before onset of symptoms) should be managed as suspected cases and immediately reported to the Central Notification Office of the Centre for Health Protection (CHP) via fax (24772770), phone (24772772) or CENO On-line (https://cdis.chp.gov.hk/CDIS_CENO_ONLINE/ceno.html). Please refer to the Annex II for the reporting criteria.
Private doctors should contact the Medical Control Officer of the Department of Health at pager: 7116 3300 (call 9179) when reporting any suspected case outside office hours. The CHP will make arrangement to send the patient to a public hospital for isolation, testing and treatment. Besides, it is important to isolate the patient to minimise contact with or exposure to staff and other patients and advise the patient to wear a surgical mask while waiting for transfer.
The CHP has collaborated with the Hospital Authority to enhance surveillance for avian influenza. The following cases will be routinely tested for avian influenza: (i) community-acquired pneumonia (CAP) of unknown causes, requiring admission to intensive care unit, occurring in clusters or involving healthcare workers, irrespective of travel history; (ii) paediatric in-patients with ILI and travel history to an affected area; and (iii) CAP with travel history to an affected area.
For updates on the latest situation of avian influenza, please refer to the designated website of the CHP (English: http://www.chp.gov.hk/en/view_content/24244.html; Chinese: http://www.chp.gov.hk/tc/view_content/24244.html). Please draw the attention of the healthcare professionals and supporting staff in your institution/ working with you to the above. Thank you for your ongoing support in combating communicable diseases.
(Dr. SK CHUANG)
for Controller, Centre for Health Protection Department of Health
The current case criteria for H7N9 and H5 infection follows:
The link between live poultry markets and the transmission of H7N9 to humans has been long established. In the summer of 2014, in CDC: Risk Factors Involved With H7N9 Infection we looked at a case-control study conducted by an international group of scientists, including researchers from both the Chinese and the US CDC which concluded.
Exposures to poultry in markets were associated with A(H7N9) virus infection, even without poultry contact. China should consider permanently closing live poultry markets or aggressively pursuing control measures to prevent spread of this emerging pathogen.
In October of 2013 we saw another study (see The Lancet: Poultry Market Closure Effect On H7N9 Transmission) which found:
Closure of LPMs reduced the mean daily number of infections by 99% (95% credibility interval 93—100%) in Shanghai, by 99% (92—100%) in Hangzhou, by 97% (68—100%) in Huzhou, and by 97% (81—100%) in Nanjing. Because LPMs were the predominant source of exposure to avian influenza A H7N9 virus for confirmed cases in these cities, we estimated that the mean incubation period was 3·3 days (1·4—5·7).
LPM closures were effective in the control of human risk of avian influenza A H7N9 virus infection in the spring of 2013. In the short term, LPM closure should be rapidly implemented in areas where the virus is identified in live poultry or people. In the long term, evidence-based discussions and deliberations about the role of market rest days and central slaughtering of all live poultry should be renewed.
While the transmission of H7N9 (or H5N6, H5N1, H10N8, etc.) to humans is the most obvious threat from live bird markets, they also likely play a major role in the evolution (and creation) of novel flu viruses.
As we discussed a little over two years ago in The Lancet: Interventions To Reduce Zoonotic & Pandemic Risks From Avian Flu In Asia, by bringing together - into very close quarters - many different types of avian species (chickens, ducks, geese, quail, etc.) these markets provide an ideal environment for two or more avian viruses to infect the same host, which can drive reassortment, and the creation of new flu subtypes.
Despite the evidence that it would greatly reduce the transmission of the virus, closing LMBs (Live Bird Markets) has been a tough sell to the Chinese public. Purchasing live market birds is deeply ingrained in their culture, as it reassures the buyer that the bird is both fresh and healthy.
In the spring of 2009 - after China was rocked by 7 human H5N1 infections, and 4 deaths that January - we saw China Announce A Plan To Shut Down Live Poultry Markets In Many Cities. The idea was to permanently (or at least during the winter and spring months) shutter LBMs in `all large and medium-sized cities throughout China' within a year.
A plan that, despite its good intentions, obviously never went anywhere.
Still, in years past - when H7N9 cases have been far fewer than during this 5th epidemic wave - hard hit provinces have shut down their live bird or poultry markets. Often for weeks, and almost always showing an immediate decline in human infections, despite ongoing black market sales of birds.
This year - for reasons that are difficult to fathom - market closures appear to have been far more sporadic, slower to be ordered, and have often only been for a few days duration.
Overnight, however, there are reports that Beijing may be ordering a harder stance.
A Xinhua report this morning, published by the Shanghai Daily, details the plans to close LBMs in regions where H7N9 cases have been reported.
Source: Xinhua | February 17, 2017, Friday
The situation has prompted health authorities to step up prevention and control measures. The National Health and Family Planning Commission is training workers in screening and early diagnosis, and in treatment of critically ill patients. The commission has also ordered a ban on the live poultry trade in places where H7N9 cases have been reported.
On Thursday, Guangzhou, capital of south China's Guangdong Province, stopped live poultry trading for the rest of the month, with all poultry markets to be thoroughly disinfected.
Exposure to live poultry is the major source of infections, particularly in rural areas. All human infections in Guangdong originated in live poultry and February - March is a crucial time for epidemic control, according to the local health commission.
Zhejiang, with 35 human infections and 11 fatalities in January, is suffering the worst epidemic in three years. The virus was found in 40 percent of live poultry markets this month, compared with 10 percent in September. All rural live poultry markets there were closed from Saturday. The trade has been banned in the cities since 2014.
Live poultry sales have also been suspended in Xiamen, Suzhou and several cities in Hunan and Sichuan provinces.
The bans have greatly reduced the number of new infections in many regions, said Ni Daxin, deputy director of the emergency response center at the Center for Disease Control and Prevention. Ni suggested replacing live poultry with frozen birds to reduce the risk of infection.
(Continue . . . )
Popular or not - moving away from live bird markets is probably the only way for China to get a handle on their yearly H7N9 epidemic. Whether they have the political will this time to see it through, remains to be seen.
Thursday, February 16, 2017
|FAO Update Feb 15th|
Although Beijing has reported two recent imported cases, they are normally somewhat removed from China's yearly H7N9 epidemic, with only 11 cases reported since the virus first appeared in 2013.
This year's epidemic is unusually robust, and two imported cases in less than a week is a bit of a wake up call, which likely explains the rather detailed advice proffered today by Beijing's CDC.
[Beijing] CDC to remind you prevent H7N9, focusing on self-protection
Source: City CDC - Advocacy Center
This year, China appears more H7N9 cases. According to the Beijing Municipal Health and Family Planning Commission Bulletin, February 11, 2017, the Beijing report a case of imported H7N9 cases. The patient is a man in Hebei Province, the local medical institutions for treatment. Because the condition gradually worsened, on February 6 go to the city for treatment. The patient in critical condition, still in the full treatment. After investigation, patients with suspected history of exposure to poultry, which are currently in close contact with no associated symptoms. The patient is the first case of H7N9 cases found in the city in 2017.
February 14, 2017, the city has reported 2017 second cases of imported H7N9 cases. The seedlings of a patient, male, 48 years old, Liaoning Xingcheng people; the incidence in the local January 31; February 3 - 7 days, patients in local medical institutions for treatment did not improve; February 8 morning, I was transferred to City medical institution. At present, the patient serious condition, still in the full treatment. After investigation, the patient exposure history in the field of live poultry. Currently close contacts in Beijing had no associated symptoms.
H7N9 , the disease can not be ignored
H7N9 as Class B infectious diseases, acute respiratory infections caused by the avian influenza virus, and higher mortality. According to available research data show that as of now its etiological characteristics of the virus, transmission and propagation mode did not change significantly, the birds carry the virus and their droppings, secretions may still be the main source of infection of the H7N9 virus. China city and town live bird markets transactions ubiquitous phenomenon backyard poultry in the short term is difficult to eliminate. Birds carrying the virus situation persists. In view of this, it is expected there will still be cases of H7N9, the epidemic is still mainly sporadic state, there will be a small number of clusters of disease.
At present, China is in the high season H7N9 epidemic, several provinces in southern H7N9 case report persistent. Although Beijing has issued regulations related to live bird markets closed since 2005, but there are still small-scale illicit trading of live poultry in some urban and rural areas scattered in the sale of live poultry sales and secretly slaughtered condition persists and stored in other provinces live birds enter the case. Therefore, do not rule out the possibility of Beijing residents infected with H7N9 virus. Especially in close contact with poultry workers at greater risk. In addition, Beijing is rich medical resources, a large number of foreign patients to Beijing for treatment, and does not exclude foreign imported cases to Beijing medical institution may be diagnosed.
Daily life how to prevent infection H7N9 ?
Prevention of H7N9, the most important thing is to reduce the exposure, good personal protection, to develop good health habits. In this remind you:
To avoid contact with livestock; buy chilled poultry meat from the formal channels, the consumption of poultry eggs to fully cooked, and pay attention to separate raw and cooked; avoid contact with wild birds or entering wildfowl habitat; attention away from the farmhouse in play poultry slaughtering site; wash their hands, pay attention to personal hygiene; avoid going to crowded, polluted air of the place, especially to avoid going to live poultry markets have traded; reasonable diet, to ensure adequate nutrition and sleep; timely addition and subtraction clothes; take part in outdoor sports activities.
In close contact with poultry population on how to prevent H7N9 ?
At present, evidence suggests contacting live poultry and live bird markets are important risk factors for H7N9 infection. By direct contact with respiratory or carrying the virus in poultry and their droppings, secretions may be the main route of transmission of H7N9 virus infection. The main route of infection by the following: inhalation of droplets or droplet nuclei containing avian influenza virus; direct contact with the avian influenza virus infected birds or their secretions and excretions; indirect contact with bird flu virus-contaminated objects and the environment.
1 , avian lovers should be how to prevent H7N9 ?
(1) strengthen management, improve the body resistance to disease poultry; note cages hygiene; ensure cage ventilation; loft birdcage pay special attention to health, pay attention to daily disinfection.
(2) keep birds at home, they should avoid contact with wild birds. Once in contact, should be promptly to disinfect the cage, if necessary, also to animal epidemic prevention departments.
(3) at the time of raising birds or bird-watching as much as possible to avoid contact with birds and their droppings, handling their droppings should wear gloves; after contact with them or their droppings must use soap and water thoroughly clean your hands.
(4) does not pick up dead birds during bird watching, do not eat wild birds.
2 , employees should be how to prevent avian H7N9 ?
(1) contact with poultry during work activities, should wear protective clothing, wearing masks and gloves, good personal protection, reducing direct contact with poultry.
(2) when cleaning the poultry houses, to strictly implement the cleaning and disinfection procedures; after cleaning, to be timely and thorough hand washing and sanitizing; when physical contact birds dirt, but also a thorough cleaning.
(3) When you find sick or dead poultry, and notify the local animal quarantine department.
(4) When the fever, cough, sore throat, general malaise and other symptoms when you should wear a mask, and as soon as the fever outpatient, and their professional activity before the onset of the history and active Advertisement doctor.
(5) holding wash their hands frequently indoor ventilation, attention to nutrition, to ensure adequate sleep and rest, increasing physical activity.
3 , poultry processing workers how to prevent H7N9 ?
(1) Regular cleaning and disinfection for all workstations, equipment and utensils to prepare poultry, wash hands frequently.
(2) processing to do separate raw and cooked poultry. In particular, some utensils, containers should also pay attention to separate raw and cooked.
(3) ensure that food cooked to the proper temperature, the bird flu virus generally sensitive to heat, strong resistance to low temperature, heating 65 ℃ 30 minutes or boiling (100 ℃) 2 minutes can be inactivated completely cooked poultry / pork is edible. However, the virus can survive at a lower temperature for 1 week at 4 ℃ water or glycerol remains active presence of more than one year.
(4) When the hands are broken handle meat is recommended to wear gloves.
Curiously, despite today's announcement of another 61 cases from the mainland, and obvious signs of concern both in Hong Kong and Macao, and on the mainland, we are seeing media reports suggesting that China's avian flu outbreak is declining (see Reuters China says bird flu spread slows, vows to stiffen controls).
While one hopes that to be the case, the numbers we've seen announced by the NHFPC over the past couple of weeks (100+ cases) seem about on par with the number of cases we saw announced for the month of January (n=190).
With Taiwan's poultry sector still reeling from 2015's H5Nx epizootic, which spread to more than 1,000 farms and saw the loss of more than 5 million birds, the discovery 10 days ago that the highly virulent HPAI H5N6 virus had arrived on the island understandably set off alarm bells.
Since then we've seen a steady progression of reports (see here, here, and here) of additional outbreaks at both local farms and slaughter houses.With at least six farms now confirmed infected with H5N6, Taiwan's COA (Council of Agriculture) has announced a plan to halt transport of poultry, and poultry products (with some exceptions - see below) for 7 days in an attempt to contain the spread of the virus.
Over the past three months both South Korea and Japan have also been hit by this HPAI virus. In South Korea more than 300 farms have been affected, resulting in the loss of 33 million birds. Japan, while less hard hit, has nonetheless seen 10 farms infected, and has detected the virus in hundreds of wild bird and environmental samples.
From February 17 nationwide ban on poultry slaughter embargo seven days white chickens, egg washing is not affected
Company: Animal and Plant Health Inspection and Quarantine Bureau
Avian influenza epidemic Central Response Center today (16) held a meeting, commander Lin Congxian announced that, after 106 years at 0:00 on February 17 until at 0:00 on February 24 ended, the national poultry ban mobile seven days; since 106 years at 12:00 on February 17 and ends at 12:00 on February 24 only, the country slaughtered poultry slaughterhouse off seven days.
Reared and sent directly to the slaughterhouse slaughter white chickens, and one day old chicks permitted. Poultry eggs after washing or if fumigation, accompanied by a veterinarian authorized by opening a certificate, can sell transport.
Relevant industry affected by the ban against slaughter, the government also proposed supporting measures and compensation for the loss of low-interest loans.
Avian flu is grim, recently diagnosed cases covered counties to expand the scope of the phenomenon, the Council of Agriculture yesterday invited a number of domestic experts and scholars held vaccination discussion, the experts recommended that the Government will take drastic measures to prevent the spread of the virus, who is also the center of the outbreak of avian flu strain COA chairman Lin Congxian center commander, I'm in full support of the Executive Yuan Dean, the epidemic prevention conference held today, determine to adopt high strength and supporting prevention initiatives, from zero 106 years until the morning of February 17 0:02 morning of February 24 ended, the national poultry ban mobile seven days; since 106 years at 12:00 on February 17 and ends at 12:00 on February 24 only, the country slaughtered poultry slaughterhouse off seven days. Prevention and Quarantine Bureau explained that the bird flu virus H5N6 poultry infections are most incidence within a week, so in accordance with the experts suggested that a ban on movement and slaughter ban seven days to make prevention work of an effect.
COA Prevention and Quarantine Bureau emphasized that during the ban movement and slaughter ban, the precautionary measures ongoing bird flu cases occurred Rengyi disposal vaccination program; unban mobile and off post-mortem, shall be subject to inspection ducks bird flu negative, may only listed slaughter; sampling inspection can be carried out before lifting the ban. Hugh slaughterhouse after slaughter and pre-slaughter implement open thorough cleaning and disinfection. Eggs will also strengthen fumigation certificate of verification. After opening slaughter, will enhance the health certificate poultry and duck farms inspection report inspection.
During the off-slaughter industry could be affected for the Council of Agriculture also proposed supporting measures, including specifications and additional losses in feed costs caused by the poultry farmers, according to the provisions of compensation; slaughterhouses, transport will also need to consider which suffered loss of substance, will also give appropriate compensation. Calculated on the basis of compensation, the COA will be invited actuarial experts and industry representatives. Losses caused by related industries, can apply for low-interest loans to the government bailout.
In terms of market supply, the COA Animal Husbandry Department estimates that domestic production capacity with white broiler chicken has been shipping in volume will be imported, there are more than forty thousand metric tons of inventory to be adjusted, at least a three-day supply of domestic consumer demand . Chicken, the domestic industry there are one hundred thousand (approximately 200 tonnes) of frozen stock, can supply two-day market consumption. Duck stock of about five thousand, Roue no inventory, consumption of poultry meat turkey is not the mainstream, there are three thousand stocks, market consumption for three days.
Executive Yuan Lin Chuan president in today's Cabinet meeting, for bird flu prevention and control, special instructions inter-ministerial cooperation, strengthening ban Sizai. In this regard, the Council of Agriculture has completed the inter-ministerial coordination, National Police Agency and the anti-seizure county and city governments will jointly seizing Sizai effort, in addition to future illegal slaughtering place the tubes, we will also strengthen seizing trafficking place.
Prevention and Quarantine Bureau reminded the Council of Agriculture, during the establishment of the Central Disaster Response Center avian influenza, were slaughtered or seized illegal trafficking and other cases, the maximum will be cut each fined NT $ 100,000 fines, seizure prevention bureau also called for the market to sell poultry a vendor, be sure to get qualified purchase slaughter proved not to purchase from unidentified sources, in order to avoid illegal punishment.