H5N1, Bird Flu Updates - page 19

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... Read More

  1. Visit  indigo girl profile page
    0
    Cambodia

    http://afludiary.blogspot.com/2011/0...y-of-2011.html

    Quote from afludiary.blogspot.com
    The case was a 7 year old female from Prasat village, Prasat commune, Kampong Trabek district, Prey Veng Province. She developed symptoms on 24 May, was initially treated by local private practitioners with no effect and was later admitted to Kantha Bopha Children Hospital on 31 May. She died on 7 June, seven days after admission.

    There have been reports of poultry die off in her village and the case is reported to have had exposure to sick poultry. The female is the sixteenth person in Cambodia to become infected with the H5N1 virus and the fourteenth to die from complications of the disease. All six cases of H5N1 infections in humans in Cambodia this year have been fatal.
  2. Visit  indigo girl profile page
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    Egypt

    From WHO:

    http://www.who.int/csr/don/2011_06_16/en/index.html

    These influenza cases are from May and June in a warm country. Four out of five of these were fatal cases. All were treated with Tamiflu but probably not soon enough. They don't say anything about Tamiflu resistance although we do know that there have been Tamiflu resistant cases in Egypt. The pregnant woman didn't stand a chance. I don't know of any pregnant cases in any country where the mother or infant survived bird flu. I don't expect to ever find one.

    Quote from www.who.int
    The Ministry of Health of Egypt has notified WHO of five cases of human infection with avian influenza A (H5N1) virus.

    The first case is a 40 years old female from Aswan District, Aswan Governorate. She developed symptoms on 14 May, and was hospitalized. She completed the course of oseltamivir, recovered and was discharged.

    The second case is a 21 years old pregnant female from Ashmoun District, Menofia Governorate. She developed symptoms on 21 May, was hospitalized and received oseltamivir. She died on 29 May.

    The third case is a 31 years old male from Shobra Elkhima District, Qaliobia Governorate. He developed symptoms on 21 May, was hospitalized and received oseltamivir. He died on 5 June.

    The fourth case is a 32 years old male from Elzawya District, Cairo Governorate. He developed symptoms on 23 May was hospitalized and received oseltamivir. He died on 2 June.

    The fifth case is a 16 years old male from Ashmoon District, Menofia Governorate. He developed symptoms on 21 May was hospitalized and received oseltamivir. He was in a critical condition but he is recovering.

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

    The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network.
    (thank you to Croft and Mike Coston for bringing this to my attention)
  3. Visit  indigo girl profile page
    0
    egypt

    http://afludiary.blogspot.com/2011/0...-fatality.html

    toddlers, as we have seen, generally recover, but anyone older usually does not survive.

    Quote from afludiary.blogspot.com
    although bird flu cases generally decline during the warmer summer months, today's announcement from the world health organization is the third such update this month, reporting a total of 7 cases reported since mid-may.

    also surprising are the number of fatal cases (5 of 7), and that all of the victims have been somewhat older than we have normally seen in egypt, ranging in age from 16 to 40.

    avian influenza - situation in egypt - update 54
    22 june 2011 - the ministry of health of egypt has notified who of a new case of human infection with avian influenza a (h5n1) virus.

    the case is a 27 year-old male from qena governorate, deshna district. he developed symptoms on 5 june 2011, was hospitalized and was put on oseltamivir treatment on 13 june. he died on 14 june 2011.
  4. Visit  indigo girl profile page
    0
    South Africa

    http://crofsblogs.typepad.com/h5n1/2...-for-h5n1.html

    So, how did this virus get all the way down to South Africa, you might well ask. That is a very good question. I give them credit for trying to control it, but cannot imagine having to put down so many animals to do so. It has to be moving somehow in the environment despite the control measures. They don't mention any of the staff on the farms or the cullers being treated with Tamiflu either, but hopefully, this is being done.

    Quote from crofsblogs.typepad.com
    The Western Cape Agriculture Department says two more farms in the Oudtshoorn area have tested positive for the Avian bird flu strain, despite the area being under quarantine.

    The bird flu in the Little Karoo has also spread to Heidelberg in the Southern Cape. At least 23 000 ostriches have been culled since the virus was detected a few months ago.

    Tests are currently being conducted in surrounding farms to determine the extent of the strain. Agriculture Ministry spokesperson, Wouter Kriel says at this stage they are busy with the second round of testing for the avian influenza in the Oudtshoorn area.
    "We are testing 206 farms and we have unfortunately picked up avian influenza on two farms within the controlled area again," says Kriel.
  5. Visit  Laidback Al profile page
    0
    Human H5N1 Cases - 2011

    It has been eerily quite in the official media about reports of human H5N1 cases. The last official WHO confirmed cases was in Egypt on June 22, 2011 as reported by indigo girl in post #236 above. Yesterday, a four year old girl from Cambodia is reported to have died from H5N1 (link). This is the first human case in about 6 weeks.

    Also, the lack of reports of human cases from Indonesia is suspect and disconcerting. Since early July, four major islands in the Indonesian Archipelago have had outbreaks of H5N1 among poultry (link). And in three province on Sulawesi Island (Central, South, and West Sulawesi), more than 180,000 chicken have died from H5N1 infection (link). Yet, conveniently for Indonesian health officials, no recent human cases of H5N1 have been discovered anywhere in Indonesia.
  6. Visit  indigo girl profile page
    0
    Egypt

    http://afludiary.blogspot.com/2011/0...-flu-case.html

    It is wonderful news that this child survived as for the most part, it has been only the toddlers that have lived after infection in Egypt. No known reason for why this has been the case.

    Quote from afludiary.blogspot.com
    Traditionally, reports of H5N1 infections generally decline during the summer months, pick up over the fall and winter, and peak in the Spring. This year has been running true-to-form, with only a handful of human cases reported over the past couple of months.

    Egypt, which has seen the highest number of cases this year, today reported their 32nd case of 2011 to the World Health Organization.

    In this case, the patient was a 6 year-old girl from Behira governorate who fell ill on July 12th, but recovered and was discharged from the hospital on the 30th.
    Last edit by indigo girl on Aug 11, '11
  7. Visit  indigo girl profile page
    0
    http://www.eurosurveillance.org/View...rticleId=19941

    Quote from www.eurosurveillance.org
    AVIAN INFLUENZA A(H5N1) IN HUMANS: NEW INSIGHTS FROM A LINE LIST OF WORLD HEALTH ORGANIZATION CONFIRMED CASES, SEPTEMBER 2006 TO AUGUST 2010

    The threat of avian influenza (AI) viruses to humans in Europe in 2005 prompted the Robert Koch Institute to establish a routine monitoring instrument condensing information on all human AI cases worldwide reported from the World Health Organization (WHO) and other sources into a line list for further analysis. The 235 confirmed AI cases captured from September 2006 to August 2010 had a case fatality rate of 56% (132/235), ranging from 28% (27/98) in Egypt to 87% (71/82) in Indonesia. In a multivariable analysis, odds of dying increased by 33% with each day that passed from symptom onset until hospitalisation (OR: 1.33, p=0.002). In relation to children of 0-9 years, odds of fatal outcome were more than six times higher in 10-19 year-olds and 20-29 year-olds (OR: 6.06, 95% CI: 1.89-19.48, p=0.002 and OR: 6.16, 95% CI: 2.05-18.53, p=0.001, respectively), and nearly five times higher in patients of 30 years and older (OR: 4.71, 95% CI: 1.56-14.27, p=0.006) irrespective of the country, which had notified WHO of the cases. The situation in Egypt was special in that case number and incidence in children were more than twice as high as in any other age group or country. With this study, we show that data from the public domain yield important epidemiological information on the global AI situation. This approach to establish a line list is time-consuming but a line list is a prerequisite to such evaluations. We thus would like to encourage the placing of a publicly accessible line list of anonymised human AI cases, e.g. directly by WHO. This might enhance our understanding of AI in humans and permit the rapid detection of changes in its epidemiology with implications for human health.
    (hat tip avian flu diary)
  8. Visit  Laidback Al profile page
    0
    H5N1 CFR for the period between December, 2003 and August, 2006

    The case fatality rate for human H5N1 cases is high. The Eurosurveillance study only looked at 234 confirmed cases between September of 2006 and August, 2010 and discovered a CFR of 56%. However, there were actually 245 other human H5N1 cases confirmed by WHO between 2003 and August of 2006 that were not included in the study. Of these earlier infected individuals, 143 died leading to a CFR of 58% for the earlier period. The 2% drop in the case fatality rate between these two datasets is insignificant. What is significant is that about 6 out of 10 people who become infected with H5N1 do not survive.
  9. Visit  indigo girl profile page
    0
    Quote from Laidback Al
    H5N1 CFR for the period between December, 2003 and August, 2006

    The case fatality rate for human H5N1 cases is high. The Eurosurveillance study only looked at 234 confirmed cases between September of 2006 and August, 2010 and discovered a CFR of 56%. However, there were actually 245 other human H5N1 cases confirmed by WHO between 2003 and August of 2006 that were not included in the study. Of these earlier infected individuals, 143 died leading to a CFR of 58% for the earlier period. The 2% drop in the case fatality rate between these two datasets is insignificant. What is significant is that about 6 out of 10 people who become infected with H5N1 do not survive.
    Yes, but why is that? Here is the CIDRAP analysis of that study.

    http://www.cidrap.umn.edu/cidrap/con...11h5n1-jw.html

    Quote from www.cidrap.umn.edu
    Analysis of H5N1 cases finds sinking fatality rate


    ...57% of patients were women...

    Children under age 10 were far less likely to die of the illness than were older children and adults, the analysis shows. Compared with the under-10 group, patients aged 10 to 19 and 20 to 29 were more than six times as likely to succumb. Adults aged 30 and up had almost a fivefold increase in risk, compared with children under 10.

    ...in Egypt, H5N1 survivors averaged just 4 years old, versus 25 years for patients who died--a much larger difference than in the other countries. Also, the CFR in Egypt was significantly higher for females than males: 39% versus 12%.

    ...the low overall CFR in Egypt can't be explained entirely by sex-related differences in CFR and the high proportion of children among Egyptian cases. They say that after adjustment for differences in these factors and in time to hospitalization, Egyptians still had the lowest risk of dying. This might reflect different H5N1 clades circulating in Egypt and in Asia and various other factors, they suggest.


    ...the researchers recommend that an organization such as the WHO establish and continuously update a case-based database for avian flu in humans. "Open access to analysable data might accelerate the identification and implementation of research questions and surveillance priorities and thus enhance our understanding of--still mostly fatal--AI in humans," they write.

  10. Visit  Laidback Al profile page
    0
    Pandemic CFR

    In response to post #242 and the CIDRAP summary . . .

    The most devastating pandemic in modern times was the 1918 pandemic. The estimated CFR for that pandemic was only 2-2.5%. Based on all confirmed WHO H5N1 cases through today, the CFR stand at 58% (330/564) for H5N1. World societies today could probably not handle a pandemic with even a 2% CFR. My point is that a pandemic in this modern age with a CFR of 20 or 10 or even 5 times the rate in 1918 would have unimaginable consequences. Scientists can quibble over whether the CFR for H5N1 is 56% or 58% and is stable, increasing, or even decreasing. But the reality is that the CFR for a future pandemic will need to be below 2% if civilization, as we know it, is to survive.

    I do think there is hope. The Egyptian data hint at how a lower CFR could evolve for this novel influenza virus. From the Eurosurveillance study itself "Regarding the decreasing CFR in Egypt, Schroedl [32] suggested that the circulating AI virus strain may have become less virulent and more apt to spreading among children."

    As we know children are highly susceptible to influenza, yet here in Egypt we have young children actually recovering and surviving at a greater rate than adults. And these kids are surviving infection from a novel virus in which they have no protective immunity. Generally, as was shown in the most recent H1N1 pandemic, adults have cross-protective immunity from novel influenza strains because of a lifetime of exposure to influenza. Children do not have the benefit of exposure to lots of strains of influenza, yet children in Egypt are surviving a novel H5N1 infection more frequently than adults. The circumstances of why this is occurring is unclear, but deserve future research.
  11. Visit  indigo girl profile page
    0
    Cambodia

    http://www.who.int/csr/don/2011_08_19/en/index.html

    Seven days from symptom onset to death, and only 6 years old...

    Quote from www.who.int
    The case was a 6 year old female from Taing Thleung Village, Mepring Commune, Cheung Prey District, Kampong Cham Province.

    She developed symptoms on 7 August, was initially treated by local practitioners with no effect and was later admitted to Kantha Bopha Children Hospital in Phnom Penh on 12 August. She died on 14 August, two days after admission.

    There have been reports of poultry die off in her village and the case is reported to have had exposure to sick poultry. The female is the eighteenth person in Cambodia to become infected with the H5N1 virus and the sixteenth to die from complications of the disease. All eight cases of H5N1 infections in humans in Cambodia this year have been fatal.
  12. Visit  indigo girl profile page
    0
    FAO warns of possible H5N1 resurgence in birds

    http://www.cidrap.umn.edu/cidrap/con...g2911h5n1.html

    Quote from www.cidrap.umn.edu
    ... a new H5N1 variant in Vietnam and China, called clade 2.3.2.1, is able to sidestep existing poultry vaccines. The strain has invaded most of northern and central Vietnam, and the country suspended its spring vaccination campaign this year as a result, the FAO said.

    "Viet Nam's veterinary services are on high alert and reportedly considering a novel, targeted vaccination campaign this fall," the FAO stated. "Virus circulation in Viet Nam poses a direct threat to Cambodia, Thailand and Malaysia as well as endangering the Korean peninsula and Japan further afield. Wild bird migration can also spread the virus to other continents."

    Lubroth said the recent increase in outbreaks could mean there will be a "flare-up" of H5N1 this fall in winter, with the virus popping up in unexpected places. The countries where the virus is endemic--Bangladesh, China, Egypt, India, Indonesia and Vietnam--are likely to face the biggest problems, but no country can consider itself safe, he said.
  13. Visit  indigo girl profile page
    0
    http://www.scottmcpherson.net/journa...-mutation.html

    Quote from www.scottmcpherson.net
    As of August 19th of this year, there were more confirmedhuman bird flu cases than in all of 2004, 2008 or 2010. Keep in mind that this includes an alarming increase in Egyptian human cases and accompanying deaths. But most distressing is the sudden re-emergence of Cambodia as a bird flu incubator. While Egypt has had 32 cases and 12 deaths to date, Cambodia has had 8 cases -- all fatal. Of course, we shrug our shoulders at Indonesia, which continues to befuddle Western experts with its distressing lack of transparency.

    So 2011 already ranks as the fifth-worst year for human H5N1, and we have the beginnings of flu season in which to add to that total. It would take a huge, but not impossible, acceleration of human cases to move it past 2009's 73 totals. that is the good news. But the FAO apparently sees a cause-and-effect relationship between the initial discovery of a new clade, the distribution of that new clade, its ability to overtake the existing clade as the dominant substrain, and then extend its reach back into humanity. Now it is hard to calculate an accurate Case Fatality Rate (CFR) based on such low numbers, but it is safe to say that of all the documented H5N1 human cases, we are still at a reliable 50% figure, meaning that half of all human bird flu patients either die of the disease or its byproducts. In Egypt, that figure is currently 37%; in Cambodia and Indonesia, it is much, much higher.

    The FAO is signaling that it fully expects bird flu cases in poultry and in humans to accelerate in 2011. The efforts to vaccinate poultry, while admirable, have failed to eradicate the disease (did we ever really expect this effort to be successful?). Pockets of H5N1 remained and pockets remain today. While migratory wildfowl (laden with virus) are the primary culprit, humans and their myriad and almost universally bad ways of moving poultry from area to area are also culpable. Perhaps even more so, when humans smuggle sick and dying poultry across borders, as happens hourly from the Bird Flu Ho Chi Minh Trail from Vietnam into China.

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