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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Myanmar (Burma)

http://www.focus-fen.net/index.php?id=n209245

Not very specific. Are they talking about a poutry outbreak? Probably...

Yangon. Bird flu H5N1 has re-struck Myanmar with one case occurring in Yangon's Mayangong township in the beginning of this month, according to a statement of the Livestock Breeding and Veterinary Department (LBVD) Saturday, Xinhua News Agency informed.

Control measures are being against the spread of the disease, the statement said, calling on people to step up bio-security measures, change of livestock breeding system, avoidance of illegal import, transport and trading of chickens and its products, and prompt report of suspected bird flu case.

(hat tip flutrackers/Shiloh)

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WHO's latest update on human H5N1 cases

Why is the CFR falling in Egypt?

http://crofsblogs.typepad.com/h5n1/2010/02/whos-latest-update-on-human-h5n1-cases.html

...six new cases in Egypt, none fatal. With 473 confirmed cases since 2003, and 282 deaths, bird flu is not a huge threat--unless you catch it. Its worldwide case fatality ratio now stands at 59.6 percent.

The CFR in Egypt is falling, and now stands at 28 percent.

But in Indonesia, thanks to 19 deaths out of 20 confirmed cases in 2009, the CFR is 83.2 percent. That's a couple of percentage points higher than this time last year.

http://afludiary.blogspot.com/2010/02/who-updates-egypts-h5n1-count.html

Avian influenza - situation in Egypt - update 28

8 February 2010 -- The Ministry of Health of Egypt has announced two new cases of human H5N1 avian influenza infection.

The first case is a 40-year-old female from Banha District in Daqahliya Governorate. She developed symptoms on 31 January and was hospitalized on 2 February, where she received oseltamivir treatment. She is in stable condition.

The second case is a 29-year-old female from Elsadat District, Menofya Governorate. She developed symptoms on 27 January and was hospitalized on 3 February, where she received oseltamivir treatment. She is in a critical condition.

http://afludiary.blogspot.com/2010/02/egyptian-media-moh-reports-another-h5n1.html

Ministry of Health announced the discovery of human infection No. (97) bird flu on Monday, a man in the governorate of Helwan.

The press statement of the Ministry of Health, the date of onset of disease, January 31, 2010, then entered the hospital on their impact on the Abbasid issued Feb. 6, suffering from fever, runny, difficulty in breathing, pneumonia after being exposed to birds suspected of having bird flu birds.

He also gave Tamiflu immediately and his condition is critical.

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Optimism from Idonesia's Ministry of Health

http://afludiary.blogspot.com/2010/02/optimism-from-indonesias-ministry-of.html

They must be joking! No one would believe that this is for real.

From the `If you don't believe it, just ask us' Department, we get optimistic assurances today from the Indonesian government that they've got their bird flu problem under control.

The claim that the mortality rate of H5N1 has dropped is curious since the only report issued by the Indonesian MOH in the past 12 months (Dec 30th) indicated they'd seen 20 H5N1 infections with 19 deaths.

That's a 95% fatality rate for 2009.

If they are strictly going by the total number of deaths, then yes, they are reporting a decline. 2009 saw one less fatality than 2008, but about half the number of the deaths seen in 2007.

http://afludiary.blogspot.com/2010/02/media-report-two-indonesian-bird-flu.html

And, not surprisingly, we get this report later today...

But, what is surprising is that one of the victims, a toddler, lived. That is more like the scenario in

Egypt where the adults usually die but the toddlers are surviving.

The following translation comes from Ida at BFIC.

Jakarta and Bekasi ::: Bird flu victims

February 10, 2010

Jakarta - Two bird flu victims had been tested H5N1 positive. A residents of Bekasi, West Java province, named NL, 25 years old, tested positive bird flu H5N1 infection. NL had died on 25 January 2010. Laboratory test showed positive H5N1 infection, said Tritarayati, the Head of Public Communication Center Ministry of Health. Victim was possibly infected from direct contact with birds.

Another victim, AD, 3 years old, a resident of Jakarta, was reported to show mild influenza like illness signs. "Laboratory test showed positive H5N1 infection. Patient has been recovered and not showing any of ILI signs," said Tritarayati.

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Vietnam

http://english.vovnews.vn/Home/Bird-flu-hits-many-provinces/20102/112560.vov

Bird flu is now spreading rapidly in many provinces after a long period of containment, the Department of Animal Health (DAH) said on February 8.

The provinces of Ca Mau, Ha Tinh, Dien Bien, Soc Trang, Kon Tum and Quang Tri have all reported cases of bird flu infection in the last 21 days.

Quang Tri is the latest province to confirm a bird flu outbreak in Trieu Phong district. It has culled 400 birds in a farm and is carrying out measures to prevent any further spread of the disease.

(hat tip crofsblog)

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Lampung, Indonesia

http://www.thejakartapost.com/news/2010/02/10/suspect-quarantined-lampung-hospital.html?

Abdul Moeloek General Hospital in Bandarlampung, Lampung, has again quarantined a patient suspected of being infected the bird flu after showing symptoms of high fever, coughing and difficulties of breathing.

The patient, named as Suh, was reported to have had direct contact with her chickens that had suddenly died. She burned the dead chickens and buried them near her house a few days ago.

Her husband Udin said thousands of chickens near his home had abruptly died in the past two weeks. "The dead chickens included 15 of mine. All the chickens in our neighborhood have died," Udin said Tuesday.

Laboratory tests on the dead chickens in Way Laga subdistrict showed that the birds were infected with the avian flu virus.

(hat tip pfi/pixie)

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West Bengal, India

http://crofsblogs.typepad.com/h5n1/2010/02/india-400-people-put-on-bird-flu-medication-in-west-bengal.html

At least 409 people have been put on medication in bird flu-hit areas of West Bengal, health authorities said Monday.

In the last few years, the country has not registered any case of human transmission of bird flu but there is always a possibility of human infection among the high risk groups.

"A total of 409 poultry workers, cullers, veterinary surgeons involved in culling operations have been put on chemoprophylaxis," a health ministry official said.

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indonesia: banten bird flu suspect

http://afludiary.blogspot.com/2010/02/indonesia-banten-bird-flu-suspect.html

serang, banten ::: fifty-year-old bird flu suspect man

a 50-year-old man, with initial s, is treated in isolation unit of serang regional hospital. patient was transferred to serang regional hospital from grogol public health center, cilegon.

hospital's spokesman, yopi triana s said that patient arrived in serang regional hospital on wednesday (10/1) afternoon with body temperature 37℃. according to patient's family, s developed fever after had direct contact with suddenly died chickens nearby his house. patient also showed common signs of bird flu infection such as, sore throat, and low of leukocyte (white blood cell) count for less than 5,000 per ml blood, added yopi.

who updates indonesia's bird flu cases

http://afludiary.blogspot.com/2010/02/who-updates-indonesias-bird-flu-cases.html

in 2009 indonesia declined to report on any human h5n1 infections until the 30th of december, when they released confirmation of 20 cases and 19 fatalities.

today indonesia has informed the world health organization of a new confirmed bird flu fatality - that of a 25 year-old woman from jakarta in january.

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...and bird flu keeps coming in 2010

I always enjoy commentary from Scott McPherson, the Chief Information Officer for the Florida

House of Representatives. I had the pleasure of meeting him at the latest CIDRAP Conference

on Keeping the World Working during the Pandemic which was held in Minneapolis this past fall.

He is a really great guy, well informed, well connected and very funny!

...just this morning, news of a third Indonesian bird flu patient arrives via proMED. This patient, a woman in Lampung, accompanies a huge die-off of birds in the province.

While this is taking place, the Western press is reporting about the roasting of public health officials over regarding what some misguided souls proclaim to be a "false pandemic" of H1N1v. As the public health officers of the civilized world circle the wagons in the West, swine flu continues to insinuate itself throughout Asia. And as it does what the flu does, it will absolutely have multiple opportunities to rub elbows with bird flu in towns and villages. It has already had multiple opportunities with each and every confirmed human H5N1 case since April of 2009.

Everyone is asking him/herself, "What virus was shed by those who are testing positive for bird flu? Who might have walked into a cloud of H5N1 particles expunged by someone? And what if that person, in turn, also acquires H1N1v swine flu? Deep in the lungs of those dual-flu victims, what terrible reassortment experiments might be churning? And what is the form and substance of that mutation, if it survives?"

Wait, you ask. Why should swine flu mix with bird flu? Recall that swine flu is only one-third swine. It is also one-third human, and one-third avian. Look at the number of flocks of turkeys all over the world that have acquired swine flu. (interesting that I can only recall turkey flocks having acquired H1N1v).

More at: http://www.scottmcpherson.net/journal/2010/2/10/and-bird-flu-keeps-coming-in-2010.html

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WHO

Avian influenza - situation in Egypt - update 30

http://www.who.int/csr/don/2010_02_17/en/index.html

Sadly, the second case died, and she was pregnant. No mention of any emergency

c-section being done so I suspect fetal demise as well. That is what usually happens

with bird flu. I don't remember any cases where the baby survived the mother's death

from H5N1 in any country.

17 February 2010 -- The Ministry of Health of Egypt has announced two new cases of human H5N1 avian influenza infection.

The first case is a 32 year-old male from Ashmon district in Menofya Governorate. He developed symptoms on 6 February and was hospitalized on 8 February, where he received oseltamivir treatment. He is in a stable condition.

The second case is a 29 year-old pregnant female from Elsadat District, Menofya Governorate. She developed symptoms on 6 February and was hospitalized on 12 February, where she received oseltamivir treatment. She died on 13 February.

Investigations into the source of infection indicated that both cases had exposure to sick and dead poultry.

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

Egyptian authorities have also reported that 2 deaths have occurred in the previously announced cases; the 37 year-old male from Helwan District, Helwan Governorate who developed symptoms on 31 January and the 29 year-old female from Elsadat District, Menofya Governorate who developed symptoms on 27 January .

Of the 99 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 30 have been fatal.

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb1710avian-br.html

Investigations into the two cases revealed that both patients were exposed to sick and dead poultry. The two illnesses mark Egypt's 98th and 99th H5N1 cases.

Egyptian officials also reported two deaths in previously announced cases. They involve a 37-year-old man from Helwan governorate who got sick on Jan 31 and was previously listed as Egypt's 97th H5N1 case-patient, and a 29-year-old woman from Elsadat district in Menofia governorate who got sick on Jan 27 and was previously announced as the 96th case-patient. These two deaths, plus the newly announced fatal case, raise the number of fatal H5N1 infections in Egypt to 30.

Egypt has recorded nine cases and three deaths from the H5N1 virus so far this year. The infections seem to be striking mostly adults this year, a change from 2009 when young children seemed to bear the greatest disease burden. Of the nine H5N1 infections reported to the WHO so far, seven have occurred in adults—four women and three men.

It's unclear why the virus is hitting adults harder this year, but a report in the Jan 28 issue of Eurosurveillance suggested that Egyptian women may have more exposure to the virus, because they do the bulk of poultry culling, slaughtering, and defeathering. The report also said Egyptian adults aren't hospitalized as quickly as children, which could increase their death rates. Studies have shown patients infected with the H5N1 virus are more likely to survive their infections if they receive early antiviral treatment.

The country has reported dozens of poultry H5N1 outbreaks this year, most of them in household birds, though the virus has struck some commercial farms.

The new Egyptian cases and deaths raise the global H5N1 total to 478 cases, which include 286 fatalities.

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West Bengal, India

http://pib.nic.in/release/release.asp?relid=57939

On 17th February 2010, Central Team conveyed

o That scientists and specialists from the Ministry of Animal Husbandry, Govt. of India have visited the affected villages and collected samples from the birds and sent for laboratory confirmation.

o That the specimen sent from Diara (Mallickpur) on 13.02.10 tested at HSDL Bhopal found Positive for H5N1 Virus (report available on 15.02.10)

o That State Govt has decided to cull the repopulated Birds in the villages coming within around 3 KM radius centered from Diara under Khargram Block of Murshidabad.

o That the Culling team culled 814 Birds on 16.02.2010 ( till 09.00 PM)The Medical Team of Khargram Block including the BMOH of Khargram Block PHC had examined the Cullers and administered 75 mg of Oseltamivir to each culler and supporting Staff as prophylactic dose.

o Surveillance within 0-3 KM area (18 Villages and 19289 population) and Bi-weekly fever surveillance at 3-10 KM area from Diara (Mollickpur) village of Khargram Block is being initiated.

o The stock of drugs & logistics are sufficient and the arrangements in District and Sub divisional Hospital of this district are adequate to combat with avian influenza human cases, if occurred.

o There is NO SUSPECTED HUMAN CASE of ILI in affected block till date and no unusual poultry deaths in the district.

(hat tip flutrackers/RoRo)

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Rwanda: Veterinarians assess bird flu preparation

http://crofsblogs.typepad.com/h5n1/2010/02/rwanda-veterinarians-assess-bird-flu-preparation.html

It is interesting to note that it is the veterinarians that are the heroes in most of these countries where bird flu has been occurring. Animal health is intimately connected with human health in a way that most of us do not ever think about. It is not just that poultry is a source of food either. All influenza originates from wild bird populations at some point in the past including swine flu.

The interaction of wild and domestic birds, the trafficking of poultry across international borders, and the travel of humans from country to country all come into play if we think about how H5N1 might some day become the threat that virologists have nightmares over. Veterinary medicine is at the forefront of protecting the health of the human population across the globe. They are the watch dogs, the planners, and the educators

thru organizations such as the OIE.

What happens in Africa and Asia matters. As we are all now well aware, flu is not just a local experience...

Veterinary experts from the five partner states of East African Community (EAC) and United Nations Office of Humanitarian Affairs convened in Kigali to assess the region’s preparedness to fight Avian Influenza (Bird Flu).

The Permanent Secretary in the Ministry of East Africa, Robert Ssali, said that commercial poultry production is becoming a very attractive income generating venture, but is affected by health consciousness by consumers.

He said the region is under a looming threat of the flu which has already appeared in Sudan, a country neighbouring EAC partner states.

“Our region as you already know, is under threat because it has been reported in Sudan, it’s a cause of concern,” Ssali said.

He added that the best approach is ‘early detection, early response’ and that an integrated plan is necessary to help the public be aware of the situation.

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Egyptian Media: Birds Flu Cases #101 and #102

http://afludiary.blogspot.com/2010/02/egyptian-media-bird-flu-cases-101-102.html

Why the increase in human H5N1 cases this year? It is also odd that many cases are in adults who tend to not recover as opposed to the toddler cases of last year, that were unusually mild. What is causing this increase? Maybe, flu is just more noticeable this year because of the occurrence of swine flu in the same population at the same time. It certainly is alarming that both diseases are there concurrently as it could increase the chances of H5N1 picking up greater transmissibility from swine flu in a host infected with both influenzas. This is not a good scenario, imo.

...the newshounds on FluTrackers began seeing hints that there might be a couple of new H5N1 cases in Egypt, but the information in the Arabic press was scant, ambiguous, and difficult to interpret.

Today, Twall (who resides in Egypt) posted this article from the Egyptian Press on what is reported to be their 101st and 102nd H5N1 cases - or #11 and #12 for the year.

As it is, the number reported H5N1 cases in Egypt is running at more than twice the rate we saw this time last year, and unlike the winter of 2009, most of this year's cases involve adults.

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