H5N1, Bird Flu Updates - page 24

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,... Read More

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    WHO: The latest H5N1 tally


    This is why we watch.

    Quote from crofsblogs.typepad.com
    ...it's the potential of H5N1 to become a catastrophic pandemic that keeps us watching it. Of the 552 cases, 322 have been fatal. That's a case fatality ratio of 58.3 percent—in effect, three out of five people who catch H5N1 will die of it.

    And 58.3 is the global CFR for H5N1. In Indonesia the CFR has stubbornly persisted for years at around 82 percent. In Cambodia (with just 15 cases and 13 deaths so far) the CFR is 86 percent.

    Egypt looks good only by comparison: 143 cases, with 47 deaths, gives a CFR of just 32.8 percent—still a horrendous toll.

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    West Jakarta, Indonesia


    Quote from crofsblogs.typepad.com
    The case is an 8-year old female from West Jakarta district, DKI Jakarta Province. She developed symptoms on 1 April, was admitted to a health care facility on 4 April and referred to a hospital on 8 April. She died on 11 April.

    Epidemiological investigation identified a possible risk factor as exposure to wild bird faeces found around the house. In addition, during the week before the child developed symptoms, her mother purchased chickens from a local market.

    Laboratory tests have confirmed infection with avian influenza A(H5N1) virus.

    Quote from crofsblogs.typepad.com
    ...the case fatality ratio for Indonesian H5N1 cases remains at 82.4 percent, about where it's been for close to five years. That means four out of five Indonesians who contract the disease will die of it.

    The global CFR, meanwhile, is 58.4 percent—also horrible, but meaning that H5N1 worldwide has killed just three out of every five of its victims. The Spanish flu of 1918-19 killed varying percentages, but in North America the CFR seems to have been about 2 to 3 percent.

    This is why I've run this blog for six years: If H5N1 ever learns how to move from human to human, and it doesn't lose its lethality, we are going to be in the worst trouble we've seen since the Black Plague arrived in Genoa in the 1340s.
    Most likely so.
    Last edit by indigo girl on May 15, '11
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    Human to Human to Human Transmission of H5N1 in Pakistan in 2007

    Elsewhere I wrote this . . .

    The article below from Emerging Infectious Disease affirms H2H2H spread of H5N1 in Pakistan in late 2007. FluTrackers members noted and reported on numerous potential cases at that time based on media reports (link and link). These concerns were never investigated and WHO only officially confirmed 3 human cases of H5N1 at the time (link and link).

    Four years later, this analysis indicates that human to human to human transmission probably occurred along with nosocomial infection of H5N1. The authors conclude “Taken together, these features suggest that current surveillance might undercount the extent of human infection with influenza (H5N1) virus and that human-to-human transmission might possibly be associated with less severe disease.”

    Indeed, we have every reason to believe that underidentification of human H5N1 cases, especially cases with mild symptoms, is occurring. But that is no justification for underreporting of human H5N1 or to cut back on H5N1 surveillance. Hoping that any H5N1 pandemic will be a mild one is not a good public health strategy. Research into H5N1 vaccine development, production, and distribution needs to be our highest priority to avoid a bird flu pandemic.

    The full EID article can be found here: http://www.cdc.gov/eid/content/17/6/1056.htm
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    Acquisition of Human-Type Receptor Binding Specificity by New H5N1 Influenza Virus Sublineages during Their Emergence in Birds in Egypt


    Quote from www.plospathogens.org
    ... since 2009 Egypt has unexpectedly had the highest number of human cases of H5N1 virus infection, with more than 50% of the cases worldwide, but the basis for this high incidence has not been elucidated. A change in receptor binding affinity of the viral hemagglutinin (HA) from α2,3- to α2,6-linked sialic acid (SA) is thought to be necessary for H5N1 virus to become pandemic. In this study, we conducted a phylogenetic analysis of H5N1 viruses isolated between 2006 and 2009 in Egypt. The phylogenetic results showed that recent human isolates clustered disproportionally into several new H5 sublineages suggesting that their HAs have changed their receptor specificity. Using reverse genetics, we found that these H5 sublineages have acquired an enhanced binding affinity for α2,6 SA in combination with residual affinity for α2,3 SA, and identified the amino acid mutations that produced this new receptor specificity. Recombinant H5N1 viruses with a single mutation at HA residue 192 or a double mutation at HA residues 129 and 151 had increased attachment to and infectivity in the human lower respiratory tract but not in the larynx. These findings correlated with enhanced virulence of the mutant viruses in mice. Interestingly, these H5 viruses, with increased affinity to α2,6 SA, emerged during viral diversification in bird populations and subsequently spread to humans. Our findings suggested that emergence of new H5 sublineages with α2,6 SA specificity caused a subsequent increase in human H5N1 influenza virus infections in Egypt, and provided data for understanding the virus's pandemic potential.

    Author's Summary

    Even though highly pathogenic avian H5N1 influenza viruses lack an efficient mechanism for human-human transmission, these viruses are endemic in birds in China, Indonesia, Viet Nam and Egypt. Hotspots for bird-human transmission are indicated in areas where human cases are more than 80% of total H5N1 influenza cases. Circulation among hosts may allow H5N1 virus to acquire amino acid changes enabling efficient bird-human transmission and eventually human-human transmission. The receptor specificity of viral hemagglutinin (HA) is considered a main factor affecting efficient transmissibility. Several amino acid substitutions in H5 virus HAs that increase their human-type receptor specificity have been described in virus isolates from patients, but their prevalence has been limited. In contrast, we show here that new H5 sublineages in Egypt have acquired a change in receptor specificity during their diversification in birds. We found that viruses in those sublineages exhibited increased attachment and infectivity in the human lower respiratory tract, but not in the larynx. Our findings may not allow a conclusion on the high pandemic potential of H5N1 virus in Egypt, but helps explain why Egypt has recently had the highest number of human H5 cases worldwide.
    (hat tip PFI/Goju)
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    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.
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    From WHO:


    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)
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    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.
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    South Africa


    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.
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    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.
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    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

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