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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Lebak, Banten, Indonesia

http://crofsblogs.typepad.com/h5n1/2009/11/indonesia-more-b2b-h5n1-outbreaks.html

I have not been paying much attention to this virus lately, but it is still around. There was a human case publicized recently that I now have to find. Hopefully with the appointment of the new Minister of Health there, Indonesia will be more transparent with information about these cases.

This the time of year that we can expect an upswing in birds, animals, and people in that area of the world.

Dozen of dead chicken bodies tested positive bird flu infection have been disposed into irrigation canal of Kampung Babakan, Desa Aweh, Kecamatan Kalanganyar on Monday (9/11).

Worrying of bird flu infection, people reported bad smell of rotten chicken bodies came from the irrigation canal to local livestock service. According to this report, officials dispatched to investigate the location. Examination to several chicken samples showed those chickens had died of bird flu infection.

It is assumed those chickens belong to farms of Desa Aweh that had bird flu outbreak several days ago.

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Suphan Buri, Thailand

http://enews.mcot.net/view.php?id=12824

One thousand dead ducks is not a good sign. This is a bad time of year.

Of course, the Thai also have to deal with swine flu in their country as well so everyone is concerned that a co-infection in human hosts with the H5N1 virus not occur, hence the targeted education campaign on bird flu for the local population.

About one thousand ducks were found dead of unknown causes in Suan Taeng sub-district of the Suphan Buri provincial seat on Friday. Government veterinary workers destroyed the rest of the ducks in the flock to prevent a possible outbreak of influenza and are now awaiting for laboratory test results from Kasetsart University.

Director-General Dr Manit Theeratantikanont of the Disease Control Department said that according to the reports from doctors and expert observers following the bird flu situation, the lower northern and central provinces must be more closely monitored as bird flu patients were previously found in Sukhothai, Kamphaeng Phet, Phichit, Phitsanulok, Phetchabun, Uthai Thani, Kanchanaburi and Suphan Buri.

Dr Manit urged local residents to help keep close watch on the situation and inform concerned officials or health volunteers if any wildfowl or domestic fowl is found dead from unknown reason. (TNA)

(hat tip crofsblog)

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h5n1 hazards for survivors

http://crofsblogs.typepad.com/h5n1/2009/11/h5n1-hazards-for-survivors.html

there has been much speculation all along that this was a possibility. here is a study in mice looking more closely at this phenomenon. considering the mortality rate for bird flu though, especially in indonesia (over 80%), this might be a relatively rare occurence.

as crofs wonders, whether or not this can occur from other types of infliuenza is indeed, a very good question.

evidently h5n1, like the spanish flu, may cause longterm harm in its survivors: highly pathogenic h5n1 influenza virus can enter the central nervous system and induce neuroinflammation and neurodegeneration. the abstract:

one of the greatest influenza pandemic threats at this time is posed by the highly pathogenic h5n1 avian influenza viruses. to date, 61% of the 433 known human cases of h5n1 infection have proved fatal.

animals infected by h5n1 viruses have demonstrated acute neurological signs ranging from mild encephalitis to motor disturbances to coma. however, no studies have examined the longer-term neurologic consequences of h5n1 infection among surviving hosts.

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Alan Sipress: Playing chicken with a nightmare flu

This is why we continue to watch and worrry about bird flu. Lots of really great info

from this author on the political/economic history involved with bird flu. Information

on contagious diseases tends to be heavily censored in many countries for economic reasons. Everyone knows this, right? Well, it is true. Certainly, everytime an outbreak

of what is always described as a low pathogenic avian virus in North America occurs,

all information is at least somewhat censored here and in Canada as well. The public

is always assured that there is no danger, and most of the time that is probably true.

The USDA has two roles. One is to protect the public but the other is to promote US agricultural products including poultry and livestock. Sometimes, one role takes precedence over the other, and perhaps they are not as transparent about this as we might like. This is no different from countries like Indonesia where bird flu is endemic, and bird flu certainly has been known to occur on the beautiful tourist paradise island of Bali, a source of tourist dollars that would be at risk if Australians were to suddenly hear of an increase in outbreaks of the virus. For two years now, Indonesia has kept silent about those outbreaks.

From the Washington Post today, an outlook & Opinion column by Alan Sipress, WaPo’s economics editor and the author of the book "The Fatal Strain: On the Trail of Avian Flu and the Coming Pandemic."

Sipress has spent years on the trail of avian flu, traveling across much of Asia as he filed reports. He gives us some deep background into the concerns held by many scientists that the H5N1 avian flu virus could meet up with, and swap genetic material, with the pandemic H1N1 virus.

The result could be a new, highly virulent, and easily transmissible pandemic virus.

More at: http://afludiary.blogspot.com/2009/11/alan-sipress-playing-chicken-with.html

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Egypt: 88th H5N1 Infection Reported

http://afludiary.blogspot.com/2009/11/egypt-88th-h5n1-infection-reported.html

While we've seen a steady stream of reports of infected poultry coming out of Egypt over the past few months, this is the first confirmed human infection since late September.

RECENT CASES:

Date of report: 17 November 2009

Governorate: Alexandria

District: Sedy Baher

Event summary: Man, 21 years old, university student. The patient began to experience fever, cough and difficulty breathing November 11. He was admitted to Maamoura Chest Hospital on November 15 and received Tamiflu. He reported having slaughtered and other close contact with sick poultry. He was reported in stable condition November 17. The MOH reported this was the 88th case of highly pathogenic avian influenza in Egypt.

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Beni Suef, Egypt

http://www.saidr.org/en/animals.php

Date of result: 8 November 2009

Governorate: Beni Suef

Village: El Awawna

Type of rearing: Household

Species: Mixed (Chickens, ducks, turkeys)

Number of birds: Not reported

Vaccination status: Chickens vaccinated

Purpose of sampling: PDS

Comment:

The mortality started in a turkey provided as a gift from another family in the same village. The turkey died, and a duck developed nervous manifestations.

The layer chickens were vaccinated, were apparently healthy at the date of sampling, and were still alive with neither illness nor mortality for 3 successive days after sampling until the day of culling.

The poultry (pigeons and turkeys) at the household which provided the turkey as a gift had no problems and tested negative by PCR for HPAI.

The team concluded that the vaccinated chickens were previously infected and shedding the HPAI virus, infecting the ducks and newly introduced turkey. This reflects the risk of silent spread of HPAI unless there is an efficient surveillance program to monitor the virus circulation in vaccinated flocks.

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H5N1 reminds us it's still here, despite swine flu pandemic

Scott McPherson is the Chief Information Officer [CIO] of the Florida House

of Representatives, and was an invited speaker at the recent CIDRAP

Conference on "Keeping the World Working during the Pandemic" held in

Minneapolis. I had the distinct pleasure of "hanging out" with Scott at most

of the presentations there as well as with my good friend, Mike Coston, author

of the Avian Flu Diary blog as both had been invited as speakers by Dr. Osterholm

as representatives of the "new media" aka bloggers. I was just a tag along

flu buddy but happy to be invited.

What is interesting is the case of the Egyptian college student. He reportedly had slaughtered poultry just days before his onset of symptoms, and it is to the Egyptian doctors' credit that they had the presence of mind to test the lad for H5N1 as well as H1N1.

There is no word if a co-infection was present, but this does confirm the concern that Egyptian authorities have expressed ever since they ordered the slaughter of every pig in the nation (overkill, to be sure). Namely, they were worried about Egypt becoming the mixing vessel for an H1/H5 mutant virus.

This makes the third time and third locale that H5 and H1 have rubbed elbows. In Vietnam and in Indonesia, the two viruses were in extremely close physical proximity to one another. Now, in the midst of the current (first?) wave of swine flu in Egypt, a young adult acquired bird flu.

More at:

http://www.scottmcpherson.net/journal/2009/11/19/h5n1-reminds-us-its-still-here-despite-swine-flu-pandemic.html

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Kawaoka, UW-Madison receive $9.5 million from Bill Gates for flu research

The international team of scientists working on the project will look for mutations in viral proteins that allow avian influenza, commonly called bird flu, to bind to human receptors.

Avian viruses, the release said, don't generally infect humans, but a mutation happens every now and then that could allow the virus to adapt to human cells.

By identifying mutations that might allow this to happen, the project team hopes an early warning system could be developed to make it easier to predict pandemic potential of influenza viruses.

More at: http://www.scottmcpherson.net/journal/2009/11/19/kawaoka-uw-madison-receive-95-million-from-bill-gates-for-fl.html

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Bird Flu Endemic in Three More Countries

http://www.manilatimes.net/index.php/news/nation/6654-bird-flu-virus-now-endemic-in-three-more-countries--who

Since 2003, outbreaks have been reported in poultry flocks in 60 countries in Asia, Europe and North

Africa. The virus is now considered endemic in Egypt, Indonesia and Vietnam.

"First, it places those in direct contact with birds--usually rural folk and farm workers--at risk of catching the often-fatal disease. Second, the virus could undergo a process of 'reassortment' with another influenza virus and produce a completely new strain," the WHO said in a statement.

Health experts do not count out the possibility that the bird flu virus may combine with the A(H1N1) virus, producing a deadlier and more contagious disease.

(hat tip flutrackers/treyfish)

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China: Zhong Nanshan On Viral Reassortment

http://afludiary.blogspot.com/2009/11/china-zhong-nanshan-on-viral.html

We owe a hugh debt to this man, Dr. Zhong. He is the guy who pressured the Chinese govt into closing down the "wild flavor" restaurants where the animal reservoirs of the SARS virus were being slaughtered and served. The practice of eating many different types of wild animals was a popular symbol of the increasing affluence of prosperous Chinese.

As everyone knows, the govt of China denied the existence of this disease for several months, allowing the virus to be unleashed on the populations of other countries as well.

Dr. Zhong is speaking out publicly again, this time about the cover up of the true number of cases of H1N1 in his country, and also of the danger of a possible co-infection of human hosts with H5N1 bird flu and H1N1 together.

Last week Zhong publicly questioned the official death toll from the H1N1 virus (see Zhong Nanshan On China's Death Toll), which brought a response 24 hours later from the Health Ministry, promising to punish anyone caught hiding fatalities.

Today, Reuters has a long and very informative article regarding his concerns over the possible reassortment of the pandemic H1N1 virus with H5N1 bird flu.

Reassortment occurs when two compatible viruses infect the same host (human, pig, bird, etc.) at the same time, and swap genetic material. This can produce a hybrid virus, with parts of both viral donors.

This Doctor Zhong is a real 21st Century hero.

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Egypt: WHO Update On 89th H5N1 Infection

http://afludiary.blogspot.com/2009/11/egypt-who-update-on-89th-h5n1-infection.html

Although FluTrackers had word of an 89th confirmed human H5N1 infection out of Egypt a couple of days ago, the WHO has posted an official update today, along with a new table of cases by country.

It should be noted that Indonesia stopped reporting H5N1 cases nearly a year ago, after a couple of years of less than stellar reporting.

Numbers from other countries, where surveillance and reporting may be less than optimal, probably don't reflect the true picture either.

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