H5N1, Bird Flu Updates - page 18

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... Read More

  1. by   Laidback Al
    Human bird flu cases - March 25, 2011 Update


    1. The first WHO confirmed case in 2011 in Bangladesh.
      The case is a 16 month old female from Kamalapur, Dhaka. She presented at a influenza sentinel surveillance on 8 March with a history of cough and fever and subsequently recovered.
      see post #216 and http://www.who.int/csr/don/2011_03_16/en/index.html
    2. Another human H5N1 case has been reported in Bangladesh (see post #218) but this case has not yet been officially confirmed by WHO. So the overly alarmist implications of an H5N1 epidemic as implied by Recombinomics quote in post #220 are premature to say the least.


    Of more concern are three recent human cases of H5N1 in Indonesia not yet reported in this thread.

    1. A 2 year old male from Depok, West Java, was infected with H5N1 in early February and died. http://www.who.int/csr/don/2011_03_14/en/index.html
    2. A 31 year old woman, from Bekasi, West Java, was infected with H5N1 in late February and died on March 1, 2011 http://www.who.int/csr/don/2011_03_14/en/index.html
    3. As reported today, the two year old daughter of number 2 above (also from Bekasi), contracted H5N1 within one day of her mother's death. So this is now a family cluster. The young girl apparently recovered. http://www.who.int/csr/don/2011_03_25/en/index.html
  2. by   indigo girl
    H5N1 in Feral Raccoons in Japan


    Quote from www.cdc.gov
    Although all known subtypes of influenza A virus are maintained in waterfowl, these viruses have also been isolated from various avian and mammalian species. In particular, numerous reports have been made of highly pathogenic avian influenza viruses (H5N1) infecting mammals, causing lethal infections in some species (1,2). Wild mammals could transmit these viruses among other wild and domestic animals, for example, on poultry or pig farms, posing a risk for virus spread and the emergence of mutant viruses. Such viruses could have pandemic potential if they were able to infect humans, thus giving rise to a serious public health concern. Therefore, the continuous monitoring of the exposure of wild mammals to avian influenza viruses, particularly H5N1 viruses, is essential.

    Raccoons (Procyon lotor), which belong to the Carnivora, are native to North America. Since the 1970s, a large number of raccoons have been imported as pets into Japan. The release and escape of these animals have resulted in a feral population widely distributed throughout Japan, which continues to increase despite an official eradication program. Recent reports, including serologic surveys and experimental infections, indicate that raccoons can be symptomatically or asymptomatically infected with low pathogenic influenza viruses, such as avian influenza subtype H4N8 or human influenza subtype H3N2 viruses, which they shed for several days, resulting in virus transmission to other raccoons by aerosol (3-5). Such findings present the possibility that wild raccoons could play a role in the transmission of subtype H5N1 viruses in a natural setting. We conducted a serologic survey for subtype H5N1 virus infection in feral raccoons in Japan.

    Japan has experienced 3 outbreaks of highly pathogenic subtype H5N1 viruses. In the first in early 2004, clade 2.5 subtype H5N1 viruses were detected in poultry farms in western Japan. The second, in early 2007, involved the isolation of clade 2.2 subtype H5N1 viruses from poultry in western Japan. The third occurred in mid-2008, when clade 2.3.2 viruses were isolated from diseased swans in the lakes in the northern area of eastern Japan. All of these outbreaks were contained by prompt culling of birds. Since 2008, subtype H5N1 viruses have not been reported in any poultry or wild migratory birds under the government surveillance program. Our data indicate that raccoons in western Japan were likely infected with the clade 2.2 viruses, whereas those in eastern Japan were infected with the clade 2.3.2 virus. Notably, some antibody-positive raccoons in western Japan were captured 6 months before the poultry outbreak with clade 2.2 virus, suggesting that a clade 2.2 subtype H5N1 virus had invaded Japan by 2006.

    Because wild raccoons are omnivores and highly opportunistic at exploiting foods they prefer, whenever available they could eat diseased or dead migratory birds from areas where subtype H5N1 viruses are enzootic. They also sometimes attack poultry farms for food, creating the potential to transmit virus to domestic poultry. In addition, the increasing likelihood for contact between wild raccoons and humans elevates the possibility of human infection with these viruses, posing risks to public health and increasing the possibility of the emergence of mammalian-adapted mutant viruses with pandemic potential. Further investigation and surveillance of influenza virus infections in peridomestic animal species are needed to better understand influenza ecology.
  3. by   indigo girl


    Quote from www.who.int
    The Ministry of Health of Egypt has announced three new confirmed cases of human infection with avian influenza A(H5N1) virus.

    The first case is a 32 year old male from Suez Governorate. He developed symptoms on 8 March, was hospitalized on 12 March and died on 13 March.

    The second case is a 28 year old female from Giza Governorate. She developed symptoms on 8 March and was hospitalized on 10 March. She is in a stable condition.

    The third case is a 4 year old male from Behira Governorate. He developed symptoms on 5 March and was hospitalized on 7 March. He recovered and was discharged on 12 March.

    Investigations into the source of infection indicate that the cases had exposure to sick and/or dead 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.

    Of the 133 cases confirmed to date in Egypt, 45 have been fatal.
  4. by   indigo girl


    the news from indonesia always seems to be bad, and they don't like to admit that these human infections are occurring there.

    Quote from crofsblogs.typepad.com
    biomedical and basic health technology research center laboratory of ministry of health announced that ss, a 28-year-old female resident of kabupaten gunung kidul, d. i. yogyakarta province, had been tested positive bird flu (h5n1) infection.

    on 1 march 2011, victim started to suffer of fever, coughing and vomiting. during the period of 6 to 10 march, patient had sought for medical treatment to several health workers and private clinics. on 11 march 2011 patient went to a public health service and then referred to a private hospital with diagnose of febris (fever).

    her condition was worsened and started to develop breathing difficulty during the hospitalization. two days later she was referred to a bird flu referral hospital in yogyakarta, where she received treatment according to the standard procedure. she died in this hospital.
  5. by   Laidback Al
    Just to keep everyone up to date ---- These are new cases are in addition to those posted by Indigo Girl in post #223.

    Egypt - New Human H5N1 Cases

    Avian influenza - situation in Egypt - update 49

    6 April 2011 - The Ministry of Health of Egypt has announced four new confirmed cases of human infection with avian influenza A(H5N1) virus.
    The first case is a one year old male from Behaira Governorate. He developed symptoms on 14 February, was hospitalized on 16 February. He recovered and was discharged on 22 February.
    The second case is a three years old female from Behaira Governorate. She developed symptoms on 10 March, was hospitalized on 12 March. She recovered and was discharged on 18 March. The previous two cases are from the same district but different villages and they are not relatives.
    The third case a 34 year old female from Alexandria Governorate. She developed symptoms on 9 March and was hospitalized on 15th March. She is still under treatment in a stable condition.
    The fourth case is a 30 years old female from Kafr El-Shaikh Governorate. She developed symptoms on 7 March and was hospitalized on 15 March. She recovered and was discharged on 27 March.
    Investigations into the source of infection indicate that all cases had exposure to sick and/or dead 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.
    Of the 137 cases confirmed to date in Egypt, 45 have been fatal.
  6. by   Laidback Al
    Six More Human H5N1 Cases

    Today WHO confirmed four more human H5N1 cases from Egypt, one from Cambodia, and one from Bangladesh.

    So far these are all isolated cases and there is no evidence of H2H transmission among these cases or their contacts.
  7. by   indigo girl
    Cilacap, Central Java


    What is amazing is that there is only one death reported, and no one else with s/s...

    Quote from birdflucorner.wordpress.com
    A 30-year-old with initial S, a resident of Desa Karangsari RT3 RW2, Kecamatan Adipala, Cilacap Timur, Central Java Province possibly died of bird flu virus H5N1 on Thursday (14/04).

    Victim developed severe breathing difficulty, fever and other bird flu-like signs after hundreds of birds, such as chickens, ducks and swans, died-off in his neighborhood. Investigation through rapid test showed those birds were positive bird flu H5N1.

    S reported to get sick since 7 April, and he went to a local health worker for medical treatment. His condition was worsened that his family transferred him to Adipala public health center, and later referred to Cilacap hospital. Hospital diagnosis showed pneumonia or lung infection, high fever and low thrombocyte count.
    (hat tip crofsblog)
  8. by   indigo girl
    Egypt - WHO Update


    Yet, again, an adult dies but a toddler survives H5N1 in Egypt.

    Quote from http://www.who.int/csr/don/2011_04_21d/en/index.html
    The first case was a 29 years-old male from Fayoum Governorate Wadi Elrian area who developed symptoms on 1 April , was hospitalized on 4 April and died on 7 April.

    The second case was a one -and-a -half year-old male child from Fayoum Governorate, Sennores District who developed symptoms on 9 April and was hospitalized on 11 April. He is under treatment and is in stable condition.

    All the cases received oseltamivir treatment at the time of hospitalization.
  9. by   Laidback Al
    Cambodia H5N1

    Also today WHO announced the fifth human H5N1 case in Cambodia this year, a young girl who died on April 16th. All five cases in Cambodia this year have died. . . .

    Avian influenza - situation in Cambodia - update 3

    21 April 2011 - The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.
    The case was a 5 year old girl from Pea Raing district, Prey Veng Province. She developed symptoms on 11 April, was initially treated by local private practitioners with no effect and was later admitted to Kantha Bopha Children Hospital on 13 April. Despite all intensive care, she died on 16 April, four days after admission.
    There have been reports of poultry die off in her village. The girl is the fifteenth person in Cambodia to become infected with the H5N1 virus and the thirteenth to die from complications of the disease. All five cases of H5N1 infections in humans in Cambodia this year have been fatal.
    Specimens from 53 contacts of the cases were collected and are being tested by the National Institute for Public Health laboratory.
  10. by   indigo girl
    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.
  11. by   indigo girl
    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
  12. by   Laidback Al
    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
  13. by   indigo girl
    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)