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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Vietnam: More on the latest H5N1 survivor

http://crofsblogs.typepad.com/h5n1/2010/04/vietnam-more-on-the-latest-h5n1-survivor.html

The woman from Soc Son District in Ha Noi was hospitalised on March 10 with a high fever and respiratory failure, five days after developing flu-like symptoms.

Many of her organs had begun to fail and her blood had begun to coagulate because she had been admitted to hospital too late, medical staff said.

"Two hours after checking in to hospital, her condition began to deteriorate very rapidly so we decided to filter her blood with the aid of polymyxin-B (Pmx-B) [a type of antibiotic] that was the result of a scientific research co-operation project between Bach Mai Hospital and the Japan International Medical Centre," said Dr Nguyen Gia Binh, director of the Intensive Care Department.

Health authorities said the H5N1 virus was growing increasingly resistant to Tamiflu.

http://pandemicinformationnews.blogspot.com/

Translated article:

Vietnam: Survival of patients severe influenza A/H5N1 by dialysis

[A bit more on the 25 yo from Hanoi, that successfully beat H5N1]

(02/04/2010)

Dan - good luck this case the patient T. Nguyen Thi Thu (25 years) in Soc Son, Hanoi. This is influenza A/H5N1 patients had complications viscera failure was saved by using results filtering method was first applied in Vietnam.

The tests showed that the disease has turned the organ failure: respiratory failure, circulatory failure, kidney failure, blood clotting disorders, metabolic disorders, severe infections.

In the treatment of patients influenza A/H5N1, scientists have warned very clearly: Tamiflu works well when used within 48 hours after virus penetration body. Accordingly, Dr. Nguyen Gia Binh - Dean of intensive care, Bach Mai hospital - because she said T. too late to hospital, five days after the influenza A/H5N1 virus, so treatment with antiviral drug Tamiflu have very little effect. Not to mention, with a weak condition after birth (she is raising children Vol 3 months), patients face a high risk of death.

The doctors have decided to combine the treatment with Tamiflu use continuous dialysis method, using special filtering effect adsorption of toxins in the blood reduces the inflammatory response.

After 10 days of treatment, patients used three filtering effect and gradually recovered health. This morning, Ms. T. was discharged.

This is influenza A/H5N1 patients had complications viscera failure was saved by using results filtering method was first applied in Vietnam. It is known that adsorption filter result is the invention of Japanese scientists, effects and filters to keep the toxins circulating in the blood, reduces the organ injury. Price per fruit is 3.500USD filter.

Read full post and comments

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egypt: 34 h5n1 deaths

http://crofsblogs.typepad.com/h5n1/2010/04/egypt-34-h5n1-deaths.html

via daily news egypt: bird flu death toll reaches 34. excerpt:

egypt's ministry of health announced the 34th bird flu-related death in the country, an 18-year-old woman from fayoum.

this comes one week after minister of health hatem el-gabaly lauded the success of the government's plan in combating bird flu (h1n5), explaining that the death rate from the virus has substantially decreased while citizen awareness has increased.

"the government has been dealing with the issue with complete transparency and sincerity, as well as a commitment to giving the highest quality treatments at the hospitals," the minister told the people's assembly last week.

the number of bird flu cases witnessed a hike in 2010; the 18-year-old is the seventh reported this year. a total of 109 cases have been reported since the virus first appeared in egypt in 2006.

egypt's h1n5 death rate stands at 6.3 percent, lower than the global rate of 7.61 percent, the ministry said in a statement last week.

i don't understand that "6.3 percent" death rate. thirty-four deaths out of 109 confirmed h5n1 cases means a case fatality ratio of 31.1 percent. that's awful, but it's still enormously better than indonesia's 82.8 percent.

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vietnam

http://afludiary.blogspot.com/2010/04/vietnam-reports-new-bird-flu-case.html

the patient, trung van hoa, 22, from na tao hamlet, nhu co commune, cho moi district, is currently in critical condition. he is being treated at the central hospital for tropical diseases.

the patient got sick on march 30 with symptoms of high fever and cough. he was admitted to bac kan provincial hospital, and then sent to the central hospital for tropical diseases on april 3 where he tested positive for the lethal strain of a/h5n1 virus.

at present, four other people in nhu co commune show similar symptoms of high fever and cough. they are under quarantine and being treated at bac kan provincial hospital.

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All eyes on Vietnam for potential human bird flu cluster

http://www.scottmcpherson.net/journal/2010/4/6/all-eyes-on-vietnam-for-potential-human-bird-flu-cluster.html

Clusters are interesting. Human to human spread of a highly pathogenic organism is of great concern, and that is why we continue to watch H5N1, bird flu. Thus far, there has been little human to human transmission although it has happened on occasion between family members. When it does occur, it is very alarming, and merits close attention.

We also worry about two different influenzas co-infecting the same host and exchanging genetic information. In countries where H5N1 is endemic, such as Egypt, Indonesia, Vietnam and China, continued observation for that possibility is ongoing. Hopefully,

this will never happen...

The patient in question was taken ill on the 30th of March, and then sent to Hanoi when his condition worsened. The four suspected human bird flu cases are currently in quarantine at the provincial hospital in the provincial capital of Bak Kan...

There are many unanswered questions. The most obvious of these is whether these four suspected cases are bird flu, or swine flu?

If these cases are indeed bird flu, has there been human-to-human chain transmission, or were these people all infected during the same timeframe by a single vector? Were they all infected by sick poultry, or were they sickened by a human infection?

OK, let's assume these four people were all H1N1/swine flu infections. That is not good news! That would mean that, once again, bird flu and swine flu had "rubbed elbows" in rural Vietnam. Search my Blogsite for the earlier known case, back in 2009.

According to the Vietnamese Department of Preventive Medicine and the Environment, there are no outbreaks of H1N1 anywhere in Vietnam.

...it is becoming apparent that Vietnam, more than any other nation save Egypt, may have the potential to be that flashpoint where H5 and H1 reassort. Vietnam has had, to date, prior to this report, 5 bird flu cases with 2 deaths. Egypt, in contrast, has had 18 human bird flu cases with 6 deaths. Both areas are of huge concern.

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Cold Fronts Linked to Bird Flu Outbreaks in Europe

http://www.alertnet.org/thenews/newsdesk/LDE63621S.htm

New and interesting info on how H5N1 has spread in Europe. It is true that it is almost exclusively found in the wild birds of that continent.

Leslie Reperant of Princeton University in the United States and Thijs Kuiken of the Erasmus Medical Centre in the Netherlands said their findings offered a possible way to predict and control where and when bird flu might erupt again.

"Forecasts predicting near-freezing temperatures in Europe may act as an indication for concern," they wrote.

They found that most H5N1 outbreaks occurred at sites where maximum temperatures were between 0 degrees Celsius and 2 degrees Celsius. This was usually on the edge of cold fronts where fresh water remained unfrozen.

"Many wild waterbirds need unfrozen bodies of fresh water in winter to feed," they wrote.

"To minimise the distance flown, they also try to stay as close as possible to the northern breeding grounds to which they will migrate during spring...The resulting congregation of different species of waterbirds along the freezing front likely created ideal conditions for the transmission of the H5N1 virus."

(hat tip crofsblog)

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Egypt: H5N1 Isolated In Donkeys

http://afludiary.blogspot.com/2010/04/egypt-h5n1-isolated-in-donkeys.html

More bad news about a wiley pathogen that we continue to worry about because we, as a species have no immunity to it. Remember, the 1918 H1N1 that killed millions? The case fatality ratio was only 2% for that flu while H5N1, bird flu is over 50%.

The highly pathogenic H5N1 is a major avian pathogen that crosses species barriers and seriously affects humans as well as some mammals. It mutates in an intensified manner and is considered a potential candidate for the possible next pandemic with all the catastrophic consequences.

We demonstrated that H5N1 jumped from poultry to another mammalian host; donkeys. Phylogenetic analysis showed that the virus clustered within the lineage of H5N1 from Egypt, closely related to 2009 isolates. It harboured few genetic changes compared to the closely related viruses from avian and humans. The neuraminidase lacks oseltamivir resistant mutations. Interestingly, HI screening for antibodies to H5 haemagglutinins in donkeys revealed high exposure rate.

Conclusions

These findings extend the host range of the H5N1 influenza virus, possess implications for influenza virus epidemiology and highlight the need for the systematic surveillance of H5N1 in animals in the vicinity of backyard poultry units especially in endemic areas.

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3 BP Deletion in Donkey H5N1 In Egypt

http://www.recombinomics.com/News/04161001/3BP_Donkey_H5N1.html

Thinking about what this means makes me a little bit queasy. H5N1 is not going away, and the fact that it continues to infect new mammalian hosts is worrisome. And those mild cases are very concerning because we don't know what that means, but all suspect, it is not really good news...

...The HA and NA sequences from A/equine/Egypt/av1/2009 have been placed on deposit at Genbank and the HA sequence has the 3 BP deletion previously reported in mild cases in Egypt.

The milder cases were first noted in 2007 and then attracted considerable interest because of the large number of mild cases in young children in 2009. The sequences from these milder cases contained the 3 BP deletion, raising concerns that the deletion allowed for efficient spread of H5N1 in humans, which was largely undetected because of the mild nature of the infection.

The discovery of this H5N1 in mild infections of donkeys raises significant concerns. H5N1 has not been reported in equine previously, although its host range includes many mammalian species. The potential role of the 3 BP deletion raises concerns that H5N1 may be much more widespread in humans. The same deletion has been reported in clade 7 in China, raising additional concerns of human infections.

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3 bp deletion in donkey h5n1 links to h1n1

http://www.recombinomics.com/news/04191001/3bp_donkey_h5n1_h1n1.html

in addition, the equine isolate lacks aa s145. this deletion is also present in all other viruses grouped into 2.2 sublineage a1, which also includes sequences from human h5n1 isolates (fig. 2). the significance of this deletion is unknown, but it should be noted that this position is close to a domain modulating receptor interaction.

interestingly, strains with this deletion appear to evolve towards a receptor usage that is similar to that of the seasonal human h1n1[31].

the above comments are from the paper, “isolation and characterization of highly pathogenic avian influenza virus subtype h5n1 from donkeys” and notes the prior paper on h5n1 in egypt which identified sequences with the 3 bp deletions as those most likely to have a high affinity for human h1n1 receptors. sequences with the deletion were of interest because they were linked to mild cases of h5n1 in egyptian children in 2007 and 2009. the sequences in 2007 included closely related sequences in southern egypt, raising concerns of human to human transmission. these concerns increased in 2009 when virtually all initial confirmed cases were mild and in toddlers.

it was at this time in early 2009 that the h5n1 was isolated from donkeys, a/equine/egypt/av1/2009, and as noted above had the same deletion. moreover, the donkeys were only symptomatic for three days and there were no fatalities. further serological analysis indicated the h5n1 was widespread in donkeys in the beni suef governorate, and therefore were likely throughout egypt because in 2009 the h5n1 with deletion was the most common h5n1 sub-clade detected in egypt in humans and poultry, including waterfowl.

the detection of h5n1 in donkeys raised concerns that h5n1 was also in horses and camels as well as other mammals, including humans, but was not described because of a lack of testing / reporting, which extends to other regions and sub-clades.

the identical 3 bp deletion was also found in china in clade 7 in shanxi and hunan province in 2006, raising concerns of widespread transmission in mammals in china including humans. the lack of testing / reporting increases those concerns. the mild nature of many of the cases in egypt raise concerns of silent spread and recombination in humans or other mammals co-infected with ph1n1, giving rise to more recombinants including h5n1 which is more transmissible in humans, or h1n1 which is more lethal in humans.

note: ph1n1 refers to swine flu. it has for the most part, replaced seasonal flu across the globe. co-infection of hosts with swine as well as bird flu, h5n1 is a great concern. if bird flu in its milder form is truly that widespread in egypt, then this may be worth following. hard to forget, the egyptians culling all of their pigs in a panic at the beginning of the swine flu pandemic...

Cambodia Man Dies of H5N1

Beside the two WHO confirmed human H5N1 cases in Vietnam that recovered, a 27 year old Cambodia man is reported to have been infected with H5N1 and died on April 17th. He has only been confirmed locally.

see: Cambodia - Man, 27, Dies of Bird Flu, 8th Confirmed Death - FluTrackers

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Cambodia

First H5N1 Death for 2010

H5N1: Cambodia reports 8th bird flu death, 1st this year

A 27-year-old man in eastern Cambodia has died of bird flu, the country's first fatality this year and its eighth since the virus started to sweep through Asia almost seven years ago.

Cambodia's Health Ministry said in a statement issued jointly Wednesday with the World Health Organization that the man in Prey Veng province died Saturday. It was the country's 10th human case of the disease.

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Cambodia

More than 1,000 birds killed by H5N1 virus | National news | The Phnom Penh Post - Cambodia's Newspaper of Record

MORE than 1,000 ducks and chickens in Prey Veng province's Kampong Leav district are believed to have died after contracting the A(H5N1) virus, known as bird flu, and a further 1,500 will soon be tested for the disease, a health official said Thursday, just over a week after a man from the same district became the eighth person to die of the disease since it was first detected in Cambodia in 2004.

Chhun Dy, the district's chief of animal health, said officials would await test results from the 1,500 animals before deciding whether to begin culling.

Sok Touch, director of the Health Ministry's Communicable Diseases Control Department, said officials had warned villagers to stay away from the area where the infected poultry died. Kao Phal said that area had been "cleaned".

(hat tip flutrackers/shiloh)

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Indonesia

Media: Indonesian Bird Flu Fatality

Indonesian media is reporting the 4 year-old girl who died on Wednesday in the flu isolation unit of Arifin Achmad hospital in Pekan Baru, Indonesia has tested positive for the H5N1 virus.

Meanwhile, three others from the same region remain hospitalized with suspected H5H1 infection. A 40 year-old mother, her 14-year-old child, and an 8-year-old neighbor.

Their conditions are reported as improving.

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