H5N1, Bird Flu Updates

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Tracking Bird Flu Cases

Bird flu deserves its own thread for tracking suspected and confirmed cases. It's not the pandemic virus, but it is still an ongoing and significant threat because of its virulence. As Margaret Chan, the Director General of the WHO says, we do not know how H5N1 will react under pressure from the pandemic virus, H1N1. All of the countries with endemic H5N1 are also reporting cases of swine flu. As everyone should know by now, the new concern revolves around what will happen if the two viruses co-infect the same host. Flu viruses exchange genetic material with each other all of the time. Right now we have a pandemic virus that is very transmissible, but does not kill the majority of people infected. Bird flu, on the other hand has a case fatality ratio (CFR) of around 60%.

In the past year, something different began to happen in Egypt. We started seeing many cases of young toddlers infected with mild cases of bird flu there. But, we also saw some older children and adults that had fatal cases. No one has yet explained why the disease began to change in Egypt. Just prior to the beginning of the swine flu cases appearing in the US and Mexico, the WHO was going to send in a team to Egypt to investigate why this was so. And, then the swine flu pandemic began in earnest, leaving this question unanswered. Why this situation has changed in Egypt but not in Indonesia, is most likely very important information.

Egypt continues to try to isolate swine flu cases. At some point, they won't be able to contain that virus, and will have to bow to the inevitable. Nobody knows what will happen then, but the Egyptians are clearly concerned. Remember, this is the country that slaughtered its entire pig population a few months ago to international dismay. Maybe they were right to do so, as we are now finding swine flu in pigs in Canada, Argentina and Australia. Pigs, the perfect mixing vessels for influenzas, may have been harboring the current swine flu for years undetected because they are almost never tested in most countries unless they are sick. This lack of disease surveillance is now being compensated for by a heightened awareness and increased testing of pig herds in many countries.

With all of that being said, here is a translation regarding a new case of bird flu, H5N1 in another child in Egypt. They do not state the child's age in this article, and some translations are saying that this is a male child. They would have isolated her anyway with bird flu, but with swine flu also in Egypt, they are likely to be very worried. Descriptions of these cases almost always mention dead birds being found in the same location. That of course, is going to be helpful in determing which flu they are dealing with at least for now, but maybe not later...

Egypt - Case #82

http://www.flutrackers.com/forum/showpost.php?p=272110&postcount=1

D. Abdel-Rahman Shahin, official spokesman of the Ministry of Health

The Ministry of Health on Sunday, a new human case of bird flu, a girl from a province of Kafr el-Sheikh for a total of 82 case of injuries so far.

A statement by the Ministry of Health said on Sunday that the new situation of the girl child is Muhammad Mustafa Ahmed Rania from the village of "Sidi Ghazi," the Department of Kafr El-Sheikh governorate of Kafr el-Sheikh.

The statement pointed out that the disease developed symptoms on July 24 of this hospital was incorporated in fevers of Kafr el-Sheikh on July 25 with a high temperature, running nose and cough after exposure to dead household birds, suspected of being infected with bird flu.

He also pointed out that the statement was given the drug "Tamiflu" as soon as the suspicion of being infected with the disease and her condition is stable and satisfactory communications are being carried out and procedures for the transfer to the hospital in the capital Cairo for the completion of treatment.

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Thanks, for the update, Al! That does seem more likely if there were other people showing symptoms.

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Cambodia-WHO Update

http://www.who.int/csr/don/2011_02_25/en/index.html

It's just influenza, but the case fatality ratio is not in our favor, and that is why we study it.

A 19-year-old female, from Takong village, Ta Kong commune, Malay district, Banteay Meanchey Province, developed symptoms on early hours of 5 February, was admitted to a private clinic on 9 February, referred to a hospital on 12 February, and died on 12 February without avian influenza being considered as a diagnosis. She had travelled from her home with her husband, her 11-month old son, her mother in law and her sister in law to Rokar Chor village, Bantey Chakrey commune, Prash Sdach district, Prey Veng Province on 3 January. She had multiple exposures to sick and dead poultry between the second half of January and early February. A blood specimen collected at hospital on 12 February was transferred to Institut Pasteur du Cambodge on 22 February and tested positive by (polymerase chain reaction) PCR.

The 11-month-old son developed symptoms on 5 February, was admitted to hospital 15 February and died on 17 February. He also had multiple exposures to sick and dead poultry in the same time frame. The presence of H5N1 virus in nasopharyngeal specimens was confirmed by Institut Pasteur du Cambodge, the National Influenza Centre on 20 February. Of the 13 cases of human H5N1 virus infection confirmed since 2005 in Cambodia, 11 have been fatal.

Suspected Human H5N1 Cases - Indonesia

For those of you following suspected human cases of H5N1 in Indonesia, 14 people have ILI symptoms in an area with H5N1 outbreaks in poultry in Central Java.

see: http://www.flutrackers.com/forum/showthread.php?t=162661

Elsewhere, in West Java, in area with H5N1 poultry outbreaks, there are at least two individuals hospitalized with symptoms of H5N1 infections, an adult and a child, along with dozens and dozens of other individuals being monitored for H5N1 infections. The hospitalized adult is the Head of Technical Services Unit Banyuresmi District Livestock Office. This person is in charge of eradicating H5N1 among poultry flocks in the local community.

see:http://www.flutrackers.com/forum/showthread.php?t=161944

Three new human cases of H5N1 in Egypt

Today, WHO confirmed three new cases of H5N1 in Egypt since the middle of January. One died, one was released from the hospital, and one is still hospitalized. The recent political upheaval in Egypt has obviously affected the reporting process to WHO.

see: http://www.who.int/csr/don/2011_02_28/en/index.html

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Silat Al-Harithiya. Palestine

http://www.maannews.net/eng/ViewDetails.aspx?ID=365697

A flock of 2,000 turkeys has been diagnosed with the H5N1 "bird flu" virus in the northern West Bank village of Silat Al-Harithiya near Jenin, government officials said.

The ministry official said all necessary procedures were carried out according to international standards. All farms within three kilometers were examined once every 48 hours, and a quarantine was imposed on a 10-kilometer radius for three days preventing the exit or entry of any farm birds, he said.

(hat tip crofsblog)

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Hong Kong

http://www.news.gov.hk/en/categories/health/html/2011/03/20110304_122744.shtml

Not surprisingly, it seems to be showing up in all the usual locations this time of year, and it likely originated in mainland China.

Laboratory tests have confirmed the goose carcass found on Lantau Island on March 1 was infected with the H5N1 virus.

The Agriculture, Fisheries & Conservation Department today said the highly decomposed bird was picked up at a beach near Sham Shek Tsuen.

(hat tip crofsblog)

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Pandang, Indonesia

http://afludiary.blogspot.com/2011/03/padang-residents-warned-on-bird-flu.html

Over the past couple of weeks residents in at least 8 districts (Padang Barat, Padang Utara, Padang Timur, Padang Selatan, Kuranji, Lubuk Begalung, Koto Tangah and Nanggalo) have reported numerous sudden deaths among their poultry holdings.

Last week we learned of two children in the city who had been hospitalized with `bird flu-like symptoms' at M Djamil hospital, beginning on February 26th.

Admittedly, many other illnesses can mimic bird flu, including seasonal flu. So the presence of clinical `flu' symptoms, even in conjunction with exposure to infected poultry, is hardly conclusive.

That number has now grown (see Padang: Bird Flu Suspect Cases Increase To 5), although we have yet to receive official word on their test results.

At least one subject reportedly has tested positive via a `rapid test' (see BFIC Padang, West Sumatera ::: A bird flu suspect rapid tests positive).

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Tripura, India

http://news.in.msn.com/national/article.aspx?cp-documentid=5000310

Tripura government has launched fresh culling operation at Bridrinagar gram panchayat areas, close to government-run R K Nagar Farm where hundreds of ducks died of avian influenza last month.

As many as 116 birds were culled at Bridrinagar, 7.5 km from here yesterday, Joint Director of Animal Resource Development Department (ARDD) Jyotirmoy Chakraborty said today.

Altogether 16 Rapid Response Teams have been inducted in the culling operation that will cover around 12 to 15 villages of West Tripura district over the next few days, he said.

There was a report of outbreak of avian flu in another government-run farm at Gandhigram where 380 chicks and ducks died since March 1, he said.

(hat tip flutrackers/shiloh)

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rosh tzurim, israel

http://english.pnn.ps/index.php?option=com_content&task=view&id=9666&itemid=30

local sources said a number of turkeys with bird flu had passed the disease to the entire coop, prompting the israeli health ministry to destroy the coop in accordance with protocol, culling 40,000 turkeys. any surrounding coops in a three kilometer area will also be destroyed as a precaution.

a palestinian source told pnn on tuesday morning that the palestinian ministry of agriculture, veterinary directorate, and other authorities were monitoring everything coming in and out of bethlehem governorate, fearing the possible entry of infected birds.

this source, unnamed, said that all palestinian farms within a 10-kilometer radius of the infected coop would be thoroughly inspected, but that there was no reason for worry either for palestinian consumers or farmers as appropriate measures were being taken.

(thanks to crofsblog for the link)

http://www.recombinomics.com/news/03081102/h5n1_232_israel.html

if this farmer was only hospitalized for a few days, it seems unlikely that he had h5n1 given how sick the infected cases usually become. of course there have been some exceptions, notably all those egyptian toddlers who for some unknown reason survived this flu that generally kills the adults.

concern that a poultry farmer from kibbutz rosh tzurim in gush etzion contracted bird flu. the man was hospitalized a few days at shaare zedek hospital in jerusalem. the deadly virus was discovered yesterday in one of his kibbutz runs. blood tests of laboratory testing verbalist transferred, and results are expected tonight.

the above translation describes a suspect h5n1 case associated with an outbreak on a turkey farm, which led to the culling of 40,000 birds. this outbreak follows reports of h5n1 in poultry in palestine.

if confirmed, this would be the first reported case in israel, and if clade 2.3.2 is confirmed, this would be the first reported human case west of china. all prior human cases (in turkey, iraq, azerbaijan, and egypt) have been the qinghai strain (clade 2.2).

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Egypt - Two More Human Cases Announced

http://www.who.int/csr/don/2011_03_07/en/index.html

Notice that the adult woman is in critical condition, yet the two year old is in "good general condition" according to this report.

This seems to be the pattern for H5N1 in Egypt but no where else.

The Ministry of Health of Egypt has announced two new confirmed cases of human infection with avian influenza A (H5N1) virus.

The first case is a 32 year old female from Sharkia Governorate. She developed symptoms on 10 February and was hospitalized on 14 February. She is in a critical condition.

The second case is a two year old male from Kafr Elsheikh Governorate. He developed symptoms on 18 February and was hospitalized on 20 February. He is under treatment and is in a good general condition.

Investigations into the source of infection indicate that the two cases had exposure to poultry suspected to have avian influenza.

The cases were confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Of the 127 cases confirmed to date in Egypt, 41 have been fatal.

(hat tip avian flu diary)

Yesterday WHO confirmed two more H5N1 case in Egypt, one died. . . .

Egypt Announces More Human Bird Flu Cases

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Avian influenza - situation in Egypt - update 46

10 March 2011 - The Ministry of Health of Egypt has announced two new confirmed case of human infection with avian influenza A (H5N1) virus and the death of a previously announced case.

The first case is a 17 year old female from Behira Governorate. She developed symptoms on 27 February and was hospitalized on 1 March. She is in a stable condition.

The second case is a 17 year old female from Dakahlia Governorate. She developed symptoms on 24 February and was hospitalized on 26 February. She died on 28 February.

Investigations into the source of infection indicate that the both cases had exposure to sick and dead poultry. Both cases received oseltamivir treatment.

The cases were confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

The previously reported case, a 32 year old female from Sharkia Governorate (see update 45), died on 3 March.

Of the 129 cases confirmed to date in Egypt, 43 have been fatal.

http://www.who.int/csr/don/2011_03_10/en/index.html
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Bekasi, Indonesia

http://birdflucorner.wordpress.com/2011/03/13/indonesia-another-confirmed-h5n1-in-bekasi/

Biomedical and Pharmaceutical Research Center Laboratory, Indonesia Ministry of Health confirmed an additional H5N1 case. Victim is a 31-year-old female with initial IL, resident of Bekasi, West Java province.

Victim started to develop illness on 23 February 2011 with signs of fever, coughing and breathing difficulty. She sought for treatment to a private medical practitioner in Bekasi on 25 February 2011. Later she was referred to a referral hospital in East Jakarta, and immediately treated in an isolation unit according to standard protocol. She died in this hospital.

Risk factor: victim was frequently visiting a nearby market about 200 meters from her house; also many neighbors are rearing ornamental birds.

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