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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Study: What Makes Avian Flu So Deadly

Avian flu, particularly H5N1, has our attention because unlike regular influenza, it has a very high mortality rate. Among those we know to have been infected, roughly 60% have died.

A rate well over 100 times higher than with regular flu.

Apoptosis is programmed cellular death, while Scribble is a protein the body’s immune system uses to promote the early death (apoptosis) of virally infected cells.

In this way, the immune system can help limit viral replication while it develops defenses (antibodies, cytokines, etc.) against the invader.

In the case of H5N1, the virus’s PDZ binding-motif works to deactivates the host’s apoptosis defense mechanism, giving the virus a decided advantage.

More at: Study: What Makes Avian Flu So Deadly

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cairo, egypt - case #112

h5n1: egypt: a new case of human h5n1

if she is not responding to tamiflu, let us hope that they will use relenza or peramivir for this unfortunate woman. as we all know by now, the adult cases in egypt frequently do not survive but the toddlers do. and, we have to ask, why is the tamiflu not working?

was she treated too late or is this strain of h5n1 tamiflu resistant (which is always a hugh concern)?

the patient, a female resident of the qalyubiya governorate, is currently receiving treatment at a cairo hospital.

according to a ministry statement, her symptoms include high fever and breathing difficulties. she contracted the illness after coming into contact with poultry suspected of having been infected with the virus, the statement noted, adding that she remained in critical condition despite having been treated with the anti-viral drug tamiflu on arrival to the hospital.

the last time an egyptian succumbed to the h5n1 virus was in april. that case brought the total number of bird flu fatalities in egypt to 34.

kuna: egypt announces 112th bird flu infection

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Ferreting Out the Transmissibility of H5N1

One of the (many) unanswered questions about H5N1 avian flu is why it doesn't more easily infect humans and why is human-to-human transmission so rare?

We think we know part of the reason:

Avian adapted influenza viruses bind preferentially to Alpha 2,3 receptor cells, which are commonly found in the digestive tract of birds. This explains why most avian flu viruses are gastrointestinal infections in birds.

Human adapted viruses have an affinity for the alpha 2,6 receptor cell, which populate the upper airway and lungs. This is why influenza is a respiratory virus in humans.

But of course, we've got at least 500 exceptions to the rule. H5N1 does, on rare occasion, find a home in a human host.

More at: Ferreting Out The Transmissibility Of Aerosolized H5N1

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Indonesia: Two New Reports

Two New Reports Out Of Indonesia

Getting bird flu news out of Indonesia can be particularly difficult since the Health Ministry decided several years ago that constantly talking about their H5N1 problem was bad for the country's image (see Indonesia To Stop Announcing Bird Flu Deaths).

Today Ida has two stories.

First, the suspected Bird Flu infection of a young girl in West Kalimantan, which if you will recall, was the location of a suspected bird flu fatality in July...

A second report details steps that are being taken in Luwu Timur, South Sulawesi to try to combat an outbreak of H5N1 in domestic birds, where thousands of birds have recently died.

In response, the Health Service has formed a special avian influenza treatment unit in anticipation of possible human cases.

This story also suggests that standard control measures in Luwu Timur, such as the spraying of disinfectant, have failed to control the outbreak.

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Spain

Spain: H5 Avian Flu In Doves

I am having a little problem understanding how and why this happened. The virus is a highly pathogenic avian influenza (HPAI), and an H5. Highly pathogenic means a high mortality rate.

Is it H5N1, "the bird flu" of Egypt, Indonesia, Vietnam, China and Cambodia or another virus? They are not saying. It would be useful to know as humans are at risk if it is H5N1.

The normal host of avian flu viruses are ducks, and other water birds. Doves are not the usual victims of this virus. Chickens that have become infected have a high mortality rate if they become infected. They make great victims. Doves, though, kind of unusual to hear of this...Btw, pidgeons are a type of dove, rock doves specifically. I seem to remember that as another name for the common pidgeon.

Pigeons, however - which are of the same bird family (Columbidae) - have gotten somewhat more attention over the past few years, partially because they (and their feces) are so ubiquitous in many population centers.

Around the world, opinions vary over the threat these city dwellers present. In Bangladesh pigeons, along with ducks and chickens, are routinely culled in their fight against bird flu.

The good news is, since we haven't seen more than a few pigeon or dove related bird flu stories over the years, the evidence is scant that they pose much of a health threat to humans.

Of course, the H5N1 virus is constantly changing and evolving, and so that assessment could change in the future.

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USSR

Russia - Virus killed 1000+ birds in Krasnoyarsk lake - FluTrackers

machinetranslated

Unknown virus in Krasnoyarsk lake killed 500 birds

KRASNOYARSK, September 20. On the shore of Lake Tagar in the Krasnoyarsk Territory ornithologists found dead migratory birds.

Among the dead birds - ducks (mallard, Cherokee, shelohvost) and crows. According EMERCOM Russia in Krasnoyarsk region, only found about 500 animals.

In connection with the emergency on the lake and 100-meter zone of sanitary quarantine. 2 posts were put up DPS and get information boards. Moreover, in Minusinsk District banned the hunting passes Ngs.ru

Causes of death of the birds are being investigated. Presumably, the death of the birds could occur as a result of acute viral disease. In this regard, there are already several reports on the return of bird flu.

http://www.rosbalt.ru/2010/09/20/773...B0%D0%BB%D1%82)

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south sulawesi, and east java, indonesia

first we have this story:

a bad week for indonesian chickens

malili - avian influenza or bird flu h5n1 attacked kabupaten (municipal) luwu timur, south sulawesi. at least twenty-four thousand birds in nine sub-districts, kecamatan wotu, burau, tomoni, mangkutana, tomoni timur, kalaena, malili, angkona and wasuponda had been infected.

so far, the virus is not transmitted to human.

and now this one:

watching indonesia again

the newshounds on flutrackers are watching reports out of indonesia today on 8 people with flu-like symptoms in the region (pinrang) where thousands of chickens recently died from the h5n1 bird flu (see a bad week for indonesian chickens).

reports like these usually end up being something other than bird flu - since seasonal flu, along with many other illnesses - can produce similar symptoms.

still, human cases and even clusters have occurred in indonesia in the past, and so reports like these are taken seriously by local health officials and are watched closely by the rest of the world.

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The Ongoing Bird Flu Flap in Indonesia

The Ongoing Bird Flu Flap In Indonesia

The situation in Indonesia over night appears to be evolving, but `into what' isn't easy to say.

The headline - if it can be trusted - is that the number of people being `monitored' with flu-like symptoms in the area where thousands of birds have recently died has grown to 18.

But exactly what criteria is being used to decide who to monitor, and how seriously ill any-or-all of them are is difficult to determine.

Indonesia - suspected human H5N1 cases, update

A hospital spokesperson in Makassar on Sulawesi Island said that four individuals hospitalized for H5N1 tested negative. They all recovered and have been released. Each of the patients did exhibit symptoms of ILI including high temperatures. No diagnosis was provided. see: Indonesia - South Sulawesi - Bird flu suspects tested negative

Meanwhile, on the island of Kalimantan in the city of Balikpapan, two other youths have been hospitalized with suspected H5N1 infection. Laboratory tests are being performed. see: Indonesia- Balikpapan, Kalimantan - Second Suspected Bird Flu Patient Hospitalized

Indonesia Confirms Two New Human Cases of H5N1

Yesterday, the Ministry of Health in Indonesia confirmed two new human cases of H5N1, one from August and one from September. Both were from metropolitan areas on Java, far from any reported H5N1 outbreaks in poultry. These can be expected to be included in the WHO counts sometime next week.

Link to translation of Indonesian Dept of Health statement: FluTrackers - View Single Post - Indonesia - Ministry of Health - Bird Flu Reports 2010

Comment: Although International Health Regulation require reporting of human H5N1 cases to WHO within 24 hours of local confirmation, Indonesia has continued to flaunt these requirements. The 35 year old man from Jakarta was diagnosed with H5N1 on August 24, 2010, and 40 year old woman from Depok died from H5N1 on September 17, 2010.

WHO confirms two recent H5N1 cases in Indonesia . . .

Indonesia Confirms Two New Human Cases of H5N1

Yesterday, the Ministry of Health in Indonesia confirmed two new human cases of H5N1, one from August and one from September. Both were from metropolitan areas on Java, far from any reported H5N1 outbreaks in poultry. These can be expected to be included in the WHO counts sometime next week.

Link to translation of Indonesian Dept of Health statement: FluTrackers - View Single Post - Indonesia - Ministry of Health - Bird Flu Reports 2010

Comment: Although International Health Regulation require reporting of human H5N1 cases to WHO within 24 hours of local confirmation, Indonesia has continued to flaunt these requirements. The 35 year old man from Jakarta was diagnosed with H5N1 on August 24, 2010, and 40 year old woman from Depok died from H5N1 on September 17, 2010.

These two cases were confirmed by WHO on October 18, 2010. see: WHO | Avian influenza situation in Indonesia - update 4

Meanwhile, 3 children are suspected with H5N1 infection in Lampung City, Indonesia. see: Indonesia - 3 Children Suspected Bird Flu patients hospitalized in isolation, tests pending - in Bandar Lampung - FluTrackers

Hong Kong - 59 year old woman infected with bird flu

For those of you concerned about H5N1, a press release today

Press Release

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Woman infected with H5 in serious condition

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The serious response level under the Government's Preparedness Plan for influenza pandemic was today (November 17) activated as the Centre for Health Protection (CHP) of the Department of Health (DH) investigated a case of influenza a H5 infection affecting a 59-year-old woman.

The patient developed running nose since November 2 and fever and cough on November 5. She sought medical attention from the Accident and Emergency Department of Tuen Mun Hospital (TMH) on November 12. On November 14, she was admitted to TMH for persistent fever and productive cough with blood-stained sputum. She was diagnosed to have pneumonia and is now in serious condition.

A spokesman for the CHP said that the nasopharyngeal aspirate taken from the woman tested positive for Influenza A (H5). Further studies on the virus were in progress.

Investigation revealed that the patient travelled to the Mainland with her husband and daughter between October 23 and November 1, during which she did not have any contact with live poultry contact and had not visited farms.

Her 60-year-old husband had history of running nose and productive cough but has recovered.

"The CHP has stepped up surveillance by testing all severe pneumonia cases for H5," the spokesman said. The serious response level under the Government's Preparedness Plan for influenza pandemic has been activated. A telephone hotline 2125 1111 has been set up to answer public enquiries.

"The CHP is also closely liaising with the Mainland authorities and the Hospital Authority to monitor the situation."

He advised members of the public that the best way to combat influenza infection was to build up body resistance by having a proper diet with adequate exercise and rest.

"Good ventilation should be maintained to avoid the spread of respiratory tract infection.

"Members of the public should seek medical consultation promptly if they develop influenza-like illness.

"Members of the public should also avoid direct contact with poultry and birds, and if contacts have been made, they should wash hands thoroughly with soap and water," the spokesman said.

Ends/Wednesday, November 17, 2010

Issued at HKT 21:16

http://www.info.gov.hk/gia/general/2...1011170291.htm

hat tip to Dutchy
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