H5N1, Bird Flu Updates

[indigo girl]

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.

[Laidback Al]

Family cluster of H5N1 infections in Bali in October - The mother and two children died

In mid October two siblings from Bali died from H5N1. A few days later the mother also died and has only now been reported by WHO (link) to have been infected with H5N1. This is largest cluster of WHO confirmed cases since the three family members in Pakistan in 2007. Unsurprisingly, WHO does not discuss the possibility of human-to-human transmission in this cluster.

[Laidback Al]

Another H5N1 Case in Egypt

On November 29th WHO announced another human case of H5N1 in Egypt. A 31 year old woman from Dakahlia Governorate showed symptoms on November 10 and was hospitalized in November 16th. As of November 29th she was still in intensive care with ventilation support.

http://www.who.int/csr/don/2011_11_29/en/index.html

[Laidback Al]

More H5N1 Cases in November and December, 2011

Dakahlia Governorate, Egypt, Mother and Child

In late November, a pregnant woman and her child from Dakahlia Governorate, Egypt developed symptoms on the same day on November 26 from H5N1 infection. They were both hospitalized. The mother died on December 3. The child apparently survived. Both individuals had exposure to sick and dead backyard poultry (chicken and turkeys).‬‪ (WHO link)

Dakahlia Governorate, Egypt, 29-year-old Male

On December 21, WHO reported another H5N1 case, a 29-year-old male also from Dakahlia Governorate in Egypt. He developed symptoms on 8 December 2011 and was admitted to the hospital on 15 December 2011. He died 4 days later on 19 December 2011. Investigations into the source of infection indicated that the case had exposure to backyard poultry. (WHO link)

What was NOT reported by WHO on December 21, was that the 29-year-old male from Dakahlia Governorate was the brother of the pregnant woman who died from bird flu on December 3, and the uncle of the child who survived the bird flu infection as reported by WHO on December 15. These three individuals constitute a family cluster. It is not certain if all were infected from a common exposure or if limited H2H transmission occurred.

Bao'an District, Shenzhen City, Guangdong Province, China, Bus Driver

In the past 72 hours, media reports in China identified a 39-year-old bus driver from Shenzhen City who was infected with H5N1. He was symptomatic on December 21, hospitalized on December 25, and died on December 31, 2011. Chinese media reports are conflicting on how he contracted the H5N1 infection. Contact tracing has been initiated, but so far no other human cases of H5N1 infection have been discovered. Detailed tracking of this case can be found at this FluTrackers link.

[Laidback Al]

A Summary of Worldwide Human H5N1 Cases in 2011

I have prepared an overview of human H5N1 infections in 2011.

Abstract - In 2011, 59 human cases of H5N1 were reported from around the world, a 23% increase over 2010. Five countries reported cases in 2011, Bangladesh, Cambodia, China, Egypt, and Indonesia. Almost half of the 59 cases (about 45%) were children under 10 years old. The fatality rate did not appreciably decline in 2011, about half of all the reported cases died. Four small family clusters were noted during the year. The source of exposure for all of the cluster cases has been reported as exposure to sick and dying poultry. None of these clusters resulted in sustained human to human transmission. Based on an analysis of the 2011 data, the potential for a virulent H5N1 pandemic has not diminished.

. . . .

The full article is presented at this FluTrackers link.

[indigo girl]

Should we fear avian H5N1 influenza?

Should we fear avian H5N1 influenza?

Why did Paul Keim, chair of the National Science Advisory Board for Biosecurity (NSABB) say “I can’t think of another pathogenic organism that is as scary as this one”. What lead Donald McNeil, writing about H5N1 in the New York Times, to conclude that “In its natural form, it is known to have infected only about 600 people since its discovery in 1997, but it killed more than half of them.”

To know the fatality rate of avian H5N1 influenza virus in humans, we need to divide the number of fatalities by the number of infections. We do not know that last number – but there are hints that it could be quite large. In a recent study of rural Thai villagers, sera from 800 individuals were collected and analyzed for antibodies against several avian influenza viruses, including H5N1, by hemagglutination-inhibition and neutralizationassays. The results indicate that 73 participants (9.1%) had antibody titers against one of two different H5N1 strains. The authors conclude that ‘people in rural central Thailand may have experienced subclinical avian influenza virus infections’. A subclinical infection is one without apparent signs of illness.

Until we know how many individuals are infected with avian influenza H5N1, we must refrain from making dire conclusions about the pathogenicity of the virus. Doing so has only lead us down a dangerous path of fearing that H5N1 influenza virus might be used as a weapon of bioterrorism, and restricting the publication of scientific papers on the virus.

[indigo girl]

Israel: Cats Infected With H5N1

Influenza can infect both birds and mammals. Consuming a meal of an infected bird or animal uncooked will lead to illness and probable death for mammals including humans. There is quite a history of animals being infected if you read some of these links. The point to remember is that bird flu mostly infects birds but other species are susceptible as well.

I remember being very surprised when I read of this occurring in Indonesia when Dr. Andrew Jeremijenko found virus in a feral kitten while he was working for NAMRU 2 (the US Naval research station there). He was testing the birds and, only tested the cat out of curiosity. What do you know? The kitty was positive.

http://www.nature.com/nature/journal/v440/n7081/full/440135a.html

Andrew Jeremijenko, head of influenza surveillance at the US Naval Medical Research Unit 2 in Jakarta, Indonesia, detected H5N1 in a kitten he found near a poultry outbreak in Cipedang, West Java, and tested out of curiosity on 22 January. The virus from the kitten is closely related to recent H5N1 strains isolated from humans in Indonesia: it shares genetic changes found in human strains that are not present in samples from birds.

http://scienceblogs.com/effectmeasure/2006/08/questions_raised_by_latest_ind.php

Aup and his cousin fed the poultry carcasses to dogs. Published reports make it fairly certain that domestic and large cats eating infected meat have become infected and are able to spread the disease horizontally (from cat to cat). Millions of infected poultry are also being eaten by other mammals (and probably non mammals), but we have no systematic surveillance of other species for infection with this virus. We expect that the discovery of wild birds in North America infected with high path H5N1, when and if it occurs, will again raise the issue of infection via the gastrointestinal route. We hope so. An honest examination of this question is needed, not just a reflexive spinning as a way to protect the poultry industry.

But the issue goes beyond that, to questions of other animal reservoirs of the virus.