H5N1, Bird Flu Updates

indigo girl · Mar 15, 2011

dhaka, bangladesh

http://afludiary.blogspot.com/2011/03/bangladesh-reports-human-bird-flu.html

so a baby survives this in bangladesh, meanwhile adults elsewhere, do not. maybe it is the degree of exposure that makes the difference?

iedcr director mahmudur rahman told bdnews24.com that the human infection was confirmed on monday after testing the samples of saliva and nasal swab of a 13-month-old girl running temperature, who visited an influenza surveillance centre recently.
the surveillance centre is run jointly by the iedcr and international centre for diarrhoeal diseases and research, bangladesh (icddr,b), he said.
family members of the child were also examined, said the iedcr director, adding that the minor girl, undergoing treatment in iedcr supervision, was out of danger.

more commentary on this case:

http://www.recombinomics.com/news/03141101/h5n1_dhaka_toddler.html

mild cases like this make some of us nervous. you would think that mild cases are good news but, that might not be true.

and, we wonder about just how much we are not hearing about. it is likely as dr. niman suggests, that at least some of the problem is lack of adequate testing. we worry that the virus is continually adapting to humans through more frequent contact than is being reported or that anyone is aware of.

...a link to birds was not described, and treatment with an antiviral was not stated. these two cases strongly suggested that h5n1 infections in bangladesh and india are far more widespread than the two confirmed cases in bangladesh (and no confirmed cases in india).
recently israel also reported a suspect case with mild symptoms that was not lab confirmed. however, the frequent reports of human cases in egypt strongly suggest that the lack of confirmed cases in israel is surveillance / reporting related, which is also the case for india.
testing for h5n1 in humans remains abysmal. many countries with high levels of h5n1 in poultry, like egypt or indonesia, rarely test symptomatic cases that do not have a poultry link. milder cases, such as the above case, would rarely seek medical attention, and most who did would rarely be tested for h5n1.
the recent receptor binding domain change (s227r) reported in h5n1 in japan continues to increase concerns that h5n1 in humans is widespread in patients who are not tested.

indigo girl · Mar 15, 2011

Ismailia Governate, Egypt

http://www.who.int/csr/don/2011_03_15/en/index.html

The Ministry of Health of Egypt has announced a new confirmed case of human infection with avian influenza A (H5N1) virus.
The case is a 38 year old female from Ismailia Governorate. She developed symptoms on 1 March and was hospitalized on 7 March.
She was in a critical condition under artificial ventilation and died on 11 March.
Investigations into the source of infection indicate that the case had exposure to sick poultry suspected to have avian influenza.

(hat tip Avian Flu Diary)

indigo girl · Mar 16, 2011

bangladesh again

http://afludiary.blogspot.com/2011/03/bangladesh-2nd-bird-flu-case-in-two.html

another toddler infected! even though both of these cases have been mild (just like all the reports of toddlers in egypt), this is not good news. mike coston's commentary over at avian flu diary explains why.

mild cases of h5n1 are viewed – a bit counter-intuitively – as being particularly notable because the less ill a person becomes, the more likely they are to have contact with others and potentially spread the virus.
some scientists also worry that a decrease in severity could signal a better adaptation to human physiology.
you may recall that concerns were expressed back in 2009 when a number of similarly aged children in egypt came down with very mild h5n1 infections.
the institute of epidemiology disease control and research (iedcr) discovered the fresh case while mopping up the area on wednesday. it launched a drive in the locality following the detection of first case of the year in the area on sunday.
iedcr director prof mahmudur rahman told bdnews24.com that a 31-month-old boy had been detected carrying the virus in their lab.

indigo girl · Mar 16, 2011

Fukushima, Japan

http://www.recombinomics.com/News/03161102/H5N1_S227R_Fukushima.html

Apparently, it's not just the tsunami, earthquake and radiation that are a big problems in this part of Japan lately. Of course, this problem lies under the radar given the scale of disaster going on over there right now.

Hokkaido University released the H5N1 sequence from a duck in Fukushima, A/duck/Fukushima/2/2011, which was collected in January, 2011. Like the sequence from the whooper swan in Hokkaido, A/whooper swan/Hokkaido/4/2011, it had S227R (in addition to V223I and M230I). A third sequence from Tochigi, A/peregrine falcon/Tochigi/15/2011, had the earlier changes (V223I and M230I), but did not have S227R.
The duck sequence was closely related to the whooper swan protein sequence (the duck also had E362D), raising concerns that the receptor binding domain changes (V223I, S227R, M230I) are widespread in H5N1 clade 2.3.2 in northern Japan, including the region most affected by the earthquake and tsunami.
The three receptor binding domain changes raise concerns that this emerging sub-clade could infect humans. These concerns were increased by the recent reports of two confirmed H5N1 cases in the Kamalapur area of Dhaka, Bangladesh.

indigo girl · Mar 18, 2011

Lack of Poultry Link in Bangladesh H5N1 Cluster

No exposure to poultry would seem to indicate that this influenza is circulating in the human population, and that is rather worrisome despite the fact that these cases are mild. Not all cases would be likely to be mild, if we think of Egyptian cases in adults.

Are we seeing the very beginning of a future in which this disease becomes more widespread as well as more deadly to humans? We were concerned when we began to see the mild toddler cases in Egypt while adults continued to die, and now we are seeing some of the same scenario in Bangladesh. What does this mean?

http://www.recombinomics.com/News/03181101/H5N1_Dhaka_Cluster_Poultry_NOT.html

...WHO comments on the first H5N1 case in Bangladesh in 2011 clear do not cite a link between the confirmed case and poultry. Similarly, the media reports on both cases fail to cite any link between the two H5N1 confirmed cases and poultry.
Both patients presented at a surveillance center in Kamalapur, Dhaka with flu like symptoms, This surveillance center typically takes samples from every fifth patient with flu-like symptoms, which are initially tested for influenza A. Positives are sub-typed and those that are not sub-typable for H3N2 or H1N1 are then tested for H5N1. In both cases, the H5N1 was detected via routine surveillance. The above Promed comment (in brackets) on exposure to infected poultry is not supported by any public documents, and is rather misleading. If ProMed has such evidence it should be cited specifically.
In the absence of such documentation, the two cases in Kamalapur bear a striking resemblance to the first two US H1N1 cases in the spring of 2009. Like the Kamalapur cluster, the clustering was in time and space, but was not associated with contact with each other or an animal source.
As happened in 2009 with H1N1, an epidemiological investigation is currently being conducted by WHO.

Laidback Al · Mar 26, 2011

Human bird flu cases - March 25, 2011 Update

Bangladesh

The first WHO confirmed case in 2011 in Bangladesh.
The case is a 16 month old female from Kamalapur, Dhaka. She presented at a influenza sentinel surveillance on 8 March with a history of cough and fever and subsequently recovered.
see post #216 and http://www.who.int/csr/don/2011_03_16/en/index.html
Another human H5N1 case has been reported in Bangladesh (see post #218) but this case has not yet been officially confirmed by WHO. So the overly alarmist implications of an H5N1 epidemic as implied by Recombinomics quote in post #220 are premature to say the least.

Indonesia

Of more concern are three recent human cases of H5N1 in Indonesia not yet reported in this thread.

A 2 year old male from Depok, West Java, was infected with H5N1 in early February and died. http://www.who.int/csr/don/2011_03_14/en/index.html
A 31 year old woman, from Bekasi, West Java, was infected with H5N1 in late February and died on March 1, 2011 http://www.who.int/csr/don/2011_03_14/en/index.html
As reported today, the two year old daughter of number 2 above (also from Bekasi), contracted H5N1 within one day of her mother's death. So this is now a family cluster. The young girl apparently recovered. http://www.who.int/csr/don/2011_03_25/en/index.html

indigo girl · Mar 29, 2011

H5N1 in Feral Raccoons in Japan

http://www.cdc.gov/eid/content/17/4/714.htm

Although all known subtypes of influenza A virus are maintained in waterfowl, these viruses have also been isolated from various avian and mammalian species. In particular, numerous reports have been made of highly pathogenic avian influenza viruses (H5N1) infecting mammals, causing lethal infections in some species (1,2). Wild mammals could transmit these viruses among other wild and domestic animals, for example, on poultry or pig farms, posing a risk for virus spread and the emergence of mutant viruses. Such viruses could have pandemic potential if they were able to infect humans, thus giving rise to a serious public health concern. Therefore, the continuous monitoring of the exposure of wild mammals to avian influenza viruses, particularly H5N1 viruses, is essential.
Raccoons (Procyon lotor), which belong to the Carnivora, are native to North America. Since the 1970s, a large number of raccoons have been imported as pets into Japan. The release and escape of these animals have resulted in a feral population widely distributed throughout Japan, which continues to increase despite an official eradication program. Recent reports, including serologic surveys and experimental infections, indicate that raccoons can be symptomatically or asymptomatically infected with low pathogenic influenza viruses, such as avian influenza subtype H4N8 or human influenza subtype H3N2 viruses, which they shed for several days, resulting in virus transmission to other raccoons by aerosol (3-5). Such findings present the possibility that wild raccoons could play a role in the transmission of subtype H5N1 viruses in a natural setting. We conducted a serologic survey for subtype H5N1 virus infection in feral raccoons in Japan.
Japan has experienced 3 outbreaks of highly pathogenic subtype H5N1 viruses. In the first in early 2004, clade 2.5 subtype H5N1 viruses were detected in poultry farms in western Japan. The second, in early 2007, involved the isolation of clade 2.2 subtype H5N1 viruses from poultry in western Japan. The third occurred in mid-2008, when clade 2.3.2 viruses were isolated from diseased swans in the lakes in the northern area of eastern Japan. All of these outbreaks were contained by prompt culling of birds. Since 2008, subtype H5N1 viruses have not been reported in any poultry or wild migratory birds under the government surveillance program. Our data indicate that raccoons in western Japan were likely infected with the clade 2.2 viruses, whereas those in eastern Japan were infected with the clade 2.3.2 virus. Notably, some antibody-positive raccoons in western Japan were captured 6 months before the poultry outbreak with clade 2.2 virus, suggesting that a clade 2.2 subtype H5N1 virus had invaded Japan by 2006.
Because wild raccoons are omnivores and highly opportunistic at exploiting foods they prefer, whenever available they could eat diseased or dead migratory birds from areas where subtype H5N1 viruses are enzootic. They also sometimes attack poultry farms for food, creating the potential to transmit virus to domestic poultry. In addition, the increasing likelihood for contact between wild raccoons and humans elevates the possibility of human infection with these viruses, posing risks to public health and increasing the possibility of the emergence of mammalian-adapted mutant viruses with pandemic potential. Further investigation and surveillance of influenza virus infections in peridomestic animal species are needed to better understand influenza ecology.

indigo girl · Mar 30, 2011

Egypt

http://www.who.int/csr/don/2011_03_29/en/index.html

The Ministry of Health of Egypt has announced three new confirmed cases of human infection with avian influenza A(H5N1) virus.
The first case is a 32 year old male from Suez Governorate. He developed symptoms on 8 March, was hospitalized on 12 March and died on 13 March.
The second case is a 28 year old female from Giza Governorate. She developed symptoms on 8 March and was hospitalized on 10 March. She is in a stable condition.
The third case is a 4 year old male from Behira Governorate. He developed symptoms on 5 March and was hospitalized on 7 March. He recovered and was discharged on 12 March.
Investigations into the source of infection indicate that the cases had exposure to sick and/or dead 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.
Of the 133 cases confirmed to date in Egypt, 45 have been fatal.

indigo girl · Apr 2, 2011

indonesia

http://crofsblogs.typepad.com/h5n1/2011/04/indonesia-another-h5n1-death.html

the news from indonesia always seems to be bad, and they don't like to admit that these human infections are occurring there.

biomedical and basic health technology research center laboratory of ministry of health announced that ss, a 28-year-old female resident of kabupaten gunung kidul, d. i. yogyakarta province, had been tested positive bird flu (h5n1) infection.
on 1 march 2011, victim started to suffer of fever, coughing and vomiting. during the period of 6 to 10 march, patient had sought for medical treatment to several health workers and private clinics. on 11 march 2011 patient went to a public health service and then referred to a private hospital with diagnose of febris (fever).
her condition was worsened and started to develop breathing difficulty during the hospitalization. two days later she was referred to a bird flu referral hospital in yogyakarta, where she received treatment according to the standard procedure. she died in this hospital.

Laidback Al · Apr 10, 2011

Just to keep everyone up to date ---- These are new cases are in addition to those posted by Indigo Girl in post #223.

Egypt - New Human H5N1 Cases

Avian influenza - situation in Egypt - update 49
6 April 2011 - The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.
The first case is a one year old male from Behaira Governorate. He developed symptoms on 14 February, was hospitalized on 16 February. He recovered and was discharged on 22 February.
The second case is a three years old female from Behaira Governorate. She developed symptoms on 10 March, was hospitalized on 12 March. She recovered and was discharged on 18 March. The previous two cases are from the same district but different villages and they are not relatives.
The third case a 34 year old female from Alexandria Governorate. She developed symptoms on 9 March and was hospitalized on 15th March. She is still under treatment in a stable condition.
The fourth case is a 30 years old female from Kafr El-Shaikh Governorate. She developed symptoms on 7 March and was hospitalized on 15 March. She recovered and was discharged on 27 March.
Investigations into the source of infection indicate that all cases had exposure to sick and/or dead 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.
Of the 137 cases confirmed to date in Egypt, 45 have been fatal.

http://www.who.int/csr/don/2011_04_06/en/index.html

Laidback Al · Apr 12, 2011

Six More Human H5N1 Cases

Today WHO confirmed four more human H5N1 cases from Egypt, one from Cambodia, and one from Bangladesh.

So far these are all isolated cases and there is no evidence of H2H transmission among these cases or their contacts.

indigo girl · Apr 16, 2011

Cilacap, Central Java

http://birdflucorner.wordpress.com/2011/04/15/cilacap-central-java-a-man-possibly-die-of-bird-flu/

What is amazing is that there is only one death reported, and no one else with s/s...

A 30-year-old with initial S, a resident of Desa Karangsari RT3 RW2, Kecamatan Adipala, Cilacap Timur, Central Java Province possibly died of bird flu virus H5N1 on Thursday (14/04).
Victim developed severe breathing difficulty, fever and other bird flu-like signs after hundreds of birds, such as chickens, ducks and swans, died-off in his neighborhood. Investigation through rapid test showed those birds were positive bird flu H5N1.
S reported to get sick since 7 April, and he went to a local health worker for medical treatment. His condition was worsened that his family transferred him to Adipala public health center, and later referred to Cilacap hospital. Hospital diagnosis showed pneumonia or lung infection, high fever and low thrombocyte count.

(hat tip crofsblog)