H5N1, Bird Flu Updates

indigo girl · May 1, 2010

indonesia

h5n1: indonesia: suspected bird flu spreads to other villages

indonesia: suspected bird flu spreads to other villages
via ida at bird flu information corner, a report from riau pos: sungaiapit, riau ::: bird flu spreads to other villages. excerpt:
bird flu h5n1 had spread to desa parit i/ii, desa harapan and kelurahan sungaiapit since it was firstly identified in desa lalang. until now, bird flu infected human suspect has reached nine victims. two of them are now being treated at arifin achmad hospital in pekanbaru, while others are refused to be hospitalized.
ida has another report, from west sumatera, about a widespread outbreak of b2b h5n1 and one suspected human case, an 11-year-old boy.

indigo girl · May 1, 2010

thailand

investigating thousands of dead storks? how truly terrible to think about. might not even be h5n1, but sad just the same...

thailand: investigating thousands of dead storks

a farmer shows carcasses of two openbill storks among thousands which have died in ayutthaya's phak hai district. residents fear bird flu is the cause of the deaths. photo: sunthorn pongpao
a vast wasteland in tambon khok chang of ayutthaya is home to tens of thousands of asian openbill storks (nok pakhang). it is one of the largest flocks of birds in ayutthaya.
a few days ago thousands of asian openbill storks died without apparent cause.
residents are worried the flock might have been infected with the bird flu virus as phak hai district was one of many areas nationwide reported with the virus outbreak last year.

indigo girl · May 6, 2010

binyamina, israel

likely h5n1 at petting zoo in israel

bird flu? given that most of the birds died, it is strongly suggestive of a highly pathogenic virus such as h5n1, & they are not denying that it is influenza.

eighteen out of 25 chickens were found dead in the northern town of binyamina on thursday, in what veterinarians suspect might have been caused by the bird flu.
laboratory findings have so far located the existence of one of the two proteins that are identified with the virus. final results are to be received later on thursday, and will indicate whether the second protein is also found in the chickens.
h5n1 in israel would not be a surprise. the h5n1 isolated in 2006 in israel and gaza were virtually identical to the h5n1 in egypt and djibouti (see satellite map). although only egypt reported h5n1 last season, it was likely present in all of the above countries last year. in late 2005, israel also reported a suspect case.
this season the h5n1 detection in birds and patients in egypt has increased dramatically in recent days (see satellite map) and h5n1 has also been common in saudi arabia. there have also be reports (and denials) of h5n1 in iran.

migration of fujian h5n1 through israel?

the israelis are confirming that it is h5n1 & resulting from bird migration. dr. niman's commentary suggests that it is the fujian strain with uvs lake in mongolia as point of origin, & that it has moved into the middle east in the past year.

two emus that died thursday in kibbutz ein gedi's menagerie succumbed to a deadly strain of the avian flu virus, israel radio reported.
the above comments confirm h5n1 in an israel petting zoo. the suggestion that the emus were infected by migratory birds raises concerns that the fujian strain (clade 2.3.2) may have migrated to the middle east. earlier this year israel reported another outbreak of h5n1, which also raised concerns that the fujian strain had migrated into the area.
a year ago fujian h5n1 was found in migratory birds at uvs lake setting the stage for migration south in 2009, and a return in the spring of 2010. the above infection may signal that migration.

indigo girl · May 7, 2010

Egypt - Why We Worry

Fixing of 125del In Human H5N1 In Egypt

The lower case fatality ratio (CFR) in Egypt sounds optimistic, doesn't it? That is until you realize that it probably indicates increased transmission of a disease, many strains of which are deadly. Its impressive host range includes birds, dogs, cats, pigs, ferrets, humans, donkeys, and probably many other species that we are unaware of yet. Donkeys? Who knew? But, maybe it is not so surprising since after all, H3N8 jumped from horses to greyhounds, and this is just another flu...

Just prior to the first news of the initial swine flu cases in North America, virologists were becoming alarmed about the situation in Egypt, and puzzling over the increasing number of cases in toddlers. Why were the adult cases continuing to die, & why were we seeing case after case of benign disease in toddlers? We heard something about WHO sending a team into Egypt, but instead with no warning, Mexico happened. So, we are still left with this ongoing mystery, and left to wonder what it means. Is this cause for concern? Maybe.

NAMRU-3 has recently released HA and NA sequences from recent H5N1 cases in Egypt (11 from 2009 and 12 from 2010). All 23 HA sequences had 125del (3 BP deletion), indicating the deletion is becoming fixed in human H5N1 in Egypt. An earlier paper, “Characterization of conserved properties of hemagglutinin of H5N1 and human influenza viruses: possible consequences for therapy and infection control” had noted similarities between H5N1and seasonal H1N1, raising concerns of increased human transmission (H2H) of H5N1 with 125del. This concern was increased by the recent paper describing the detection of H5N1 in donkeys and serological evidence of widespread H5N1 antibodies in donkeys.
Concerns of human to human H5N1 transmission in Egypt were raised when mild cases in children were reported in the spring of 2007. Several had the 3 BP deletion and sequences were closely related. There children had a mild course, which did not include pneumonia.
In early 2009, mild cases were reported in toddlers. The large number of cases reduced the case fatality rate for H5N1 in 2009 to approximately 10%. The sequences from these toddlers also had 125del, which was followed by the most recent 23 sequences which were from the summer of 2009 to March 31, 2010.
...Egypt does not H5N1 test patients who do not have a poultry contact, the full extent of H5N1 remains largely unknown. Serological testing has been discussed for over a year. During that time a serological survey on donkeys was conducted, which showed widespread antibodies in donkey serum.
Results for a comparable test in humans, using a 125del H5N1 target is long overdue.

indigo girl · May 8, 2010

The Chinese/Egyptian Connection

Fujian / Qinghai H5N1 Recombinants In Egypt

As I first read this commentary, I wondered why a Chinese lab would be sequencing virus from Egyptian poultry, & I still wonder how they even received the samples to do so. I was not aware that birds from China actually do migrate down to Egypt & presumably back again. Who knew? I think that what Dr. Niman is suggesting is quite possibly correct given this information.

China's national labs in Harbin released 10 HA sequences from Egyptian poultry, including 2 from 2010, 2 from 2009, and 6 from 2008. None of the sequences had 125del. However, one, A/chicken/Egypt/36-4/2008, had a deletion in the HA cleavage site that matched the Fujian sub-clade (2.3.2) found in wild birds at Uvs lake as well as the 2008 outbreak in Japan, South Korea, and Russia. The cleavage site and flanking region covering 200 BP matched clade 2.3.2 isolates indicating these polymorphisms were acquired by homologous recombination.
The movement of Fujian clade 2.3.2 sequences into Egypt was not a surprise. In early 2008, clade 2.3.2 was in wild birds in Japan and eastern Russia, followed by wild birds at Uvs Lake in 2009. Birds from Uvs Lake migrate through Egypt, leading to dual infections and acquisitions via recombination.
It is unclear why there are not more examples in the Middle East. However, the recent report of wild bird H5N1 sequences in Emus at an Israeli petting zoo suggests Fujian H5N1 clase 2.3,2 may have been recently detected.

indigo girl · May 14, 2010

Tulkarm, Palestine

News Briefs - Israel National News

Veterinary officials in the Palestinian Authority (PA) ordered the destruction of 200,000 chickens on Thursday after avian flu was discovered in their chicken coop.

(hat tip flutrackers/treyfish)

indigo girl · May 15, 2010

West Bank

H5N1: West Bank: A serious B2B H5N1 outbreak

Apparently this outbreak is worse than originally reported.

At least 750,000 chickens will be slaughtered and destroyed in the Tulkarem-area town of Bal'a, as a heavy Palestinian police presence surrounded the area, ensuring area birds diagnosed with bird flu were not transported out.
The village, which exports between 4-5,000 cartons of eggs per day to areas in the West Bank, and hundreds of pounds of meat, will have its poultry stock wiped out following the discovery of bird flu by PA officials from the Ministry of Agriculture.
No human cases of the influenza virus have yet been reported, but officials said they are monitoring the area heavily to ensure proper containment mechanisms are put in place.

indigo girl · May 15, 2010

A Graphic Reminder

A Graphic Reminder

The World Health Organization released an updated map today showing the locations around the world where laboratory confirmed cases of H5N1 has been detected in humans.
Although it is entirely likely that some human infections have escaped detection, the few seroprevalence studies conducted in H5N1 hot-zone countries indicate that the virus remains difficult to catch, and only rarely has it been demonstrated to have been transmitted from one person to another.
That could change at any time, of course, if the virus should mutate into a more human adapted form.

indigo girl · May 15, 2010

Laos

FluTrackers - View Single Post - Highly pathogenic avian influenza, Laos (OIE, May 14 2010, edited)

Epidemiological comments
The layers started to show clinical signs on 27 April 2010 and from 28 to 29 April 2010 two layers died. The first two dead poultry were submitted to the National Avian Influenza Laboratory. At the laboratory, necropsy of the two whole carcasses was performed as well as rapid test to detect influenza A and H5; results were slightly positive for avian influenza. Movement control measures of poultry and poultry products were effective.
From 1 to 5 May 2010, the mortality of the poultry increased drastically in the farm and the farmer sent some more whole carcasses to the laboratory. The samples were tested using rapid test and were positive for influenza A and H5. On 6 May 2010, the samples were retested for confirmation using real-time PCR and results were positive for highly pathogenic avian influenza H5N1.
Actions for containing the spread of the infection were applied such as culling of infected and potentially infected poultry and disinfection of the premises; both were completed on 7 May 2010. Active and passive surveillances are on-going within 5 km radius around the infected farm. In addition, movement control is also effective.
Diagnostic test results
Laboratory name and type Avian Influenza Laboratory at the National Animal Health Centre (National laboratory)
Tests and results: Species - Test - Test date - Result
Birds - real-time PCR - 06/05/2010 - Positive

indigo girl · May 21, 2010

Israel: Fear of Bird to Bird Spread from Palestinian Villages

H5N1: Israel: Fears of B2B H5N1 spreading from Tulkarem

...Officials in the Civil Administration have recently learned of an outbreak of bird flu in PA villages in the Tulkarem district, and to the dismay of Israeli officials, the birds are not being destroyed as they should.
As a result, it is now feared that the illness, which is very serious, has made its way over the Green Line into 'Israel proper".
Veterinary officials in Beit Dagan have received samples from infected areas confirming the reports, that bird flu, the HSN1 virus has infected chickens in the PA areas but it appears PA officials are unable or unwilling to take the necessary actions to ensure the infected birds are destroyed.

indigo girl · May 21, 2010

israel: tamiflu resistance

community transmission of ph1n1 tamiflu resistance in israel

this is why we worry about bird flu in places like israel and palestine. tamiflu resistance occurring even though the person was never even treated with the drug is worrisome. i think that we can expect resistance to occur world wide within a few years just as it did with seasonal h1n1.

ph1n1 refers to pandemic h1n1, the swine flu virus.

h274y is a viral genetic marker indicating that a particular strain of flu virus is resistant to tamiflu. they still will treat with tamiflu at a higher dosage, and maybe for longer time period, but they will not always be successful as the virus adapts to the drug in the future. the use of drug cocktails might be the smarter way to go as we have limited drug options right now, even using the older drugs like amantadine and rimantadine. problems with how the current drugs are administered is also a concern. relenza is usually inhaled, and with some patients this is not an option. peramivir must be given iv & cdc must be involved to use it.

in november 2009, a healthy 2-year-old boy was admitted to the pediatric intensive care unit at the western galilee hospital in nahariya, israel, after he had been hit by a car. one day before the accident, he had exhibited fever and cough (for which he had been treated with acetaminoiphen). his 4-year-old brother had recovered recently from an influenza-like illness without antiviral treatment.
the above comments are from the upcoming paper entitled "community-acquired oseltamivir-resistant pandemic (h1n1) 2009 in child, israel". the child was subsequently treated with oseltamivir, but the sample collected prior to the start of treatment was h274y positive. since the brother was the likely index case in the familial cluster, and had not been treated, he likely also had been infected with ph1n1 containing h274y.
the train passengers in vietnam, who were treated with tamiflu after sample collection, represented a similar situation. h274y was detected through routine screening of the samples months after the patients recovered. it appears that these patients, who had h274y prior to treatment, would also be categorized as h274y in patients treated with tamiflu.
the authors of the above paper, as well as the paper on the train passengers, noted the low number of patients who were h274y positive and not linked to treatment. however, this low number appears to be based on a classification system that is factually correct, but misleading to most, including physicians and researchers in the field. the situations in israel and vietnam are common, since testing for h274y is not done in real time, and even when in-house testing is in place, patients are still started on tamiflu prior to receipt of test results. thus, patients with h274y and no treatment are largely limited to patients that are tested but not treated, which is rare because most hospitalized patients are treated and most non-hospitalized patients, like the index case in this cluster, are not tested.
moreover, the detection of h274y in treated patients is usually linked to a short time after the start of treatment, supporting the presence of a mixture, which becomes h274y positive, when the ratio favoring h274y is increased due to treatment. thus, prophylactic patients develop symptoms 5-6 days after the start of treatment, and infected patients convert to h274y positive after a few days of treatment.
...there is no data arguing against a minor subpopulation that rises to the detectable level 5-6 days post treatment as was seen in prophylactic patients.
this scenario is supported by the israeli and hong kong patients who had detectable h274y in spite of a lack of treatment and the h274y was found in association with wild type ph1n1.
the vast majority of 2010 ph1n1 sequences in japan now have h274y and isolates cluster in phylogenetic analysis, indicating h274y is widely transmitted in japan. thus, the spread of h274y in untreated ph1n1 patients is following the pattern season during the fixing of h274y in seasonal. recombination facilitates the jump of h274y from one genetic background to another, which eventually leads to increases through clonal expansion and genetic hitchhiking.

indigo girl · May 24, 2010

Egypt Failed in Eliminating Bird Flu

Knowing why they failed is probably important. So, is having the will and the resources to try to make it better. It may well be too late, and the rest of the world will pay for this failure.

Official: Egypt failed in eliminating bird flu - Bikya Masr

CAIRO: An international expert said last Thursday that Egypt failed in eliminating the danger of Avian influenza. Farid Hosni, the head of the project "Stop bird flu stop AI" of the United States Agency for International Development (USAID), said in a speech at a conference organized by the project in collaboration with the General Authority for Veterinary Services, that the bird flu virus "is the more serious and deadly than swine flu, especially in Egypt, where death rates reached 59 percent."
Hosni continued that Nigeria was able to round up and fight against the disease despite their "weak potential, but have followed the policy of compensation, as the government paid each farmer, large and small and even those who bring up birds, and these compensations were larger than the market prices, but Egypt so far failed to eradicate the disease despite the resources it possesses."
He said that 90 percent of farms in Egypt are not registered and therefore its owners do not report on the emergence of cases.
"The purpose of registration is to compensate the farm owners in the event of detecting the disease after being told about its appearance," Hosni said.
The official criticized the policy of vaccination on poultry farms and rural upbringing, asserting that it failed miserably.

"The vaccination does not prevent disease but rather prevents the onset of symptoms only and the rate of immunization in Egypt has not exceeded 10 percent of the proportion of those birds," he added.
He also criticized the policy of the immunization of chicks "one day" followed by the government because it is "scientifically proven that these chicks do not have the immune system to accept immunization."
He launched a sharp attack on the promoters of the disease hitting the elderly and the chronically ill, and said it was "nonsense" that most of the cases during the last year were children.

(hat tip PFI/monotreme)