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

http://crofsblogs.typepad.com/h5n1/2009/11/vietnam-a-new-human-h5n1-death.html

According to the translators over at flutrackers, this man had eaten duck soup about 7 days prior to being admitted. The soup is made of raw duck's blood. These ducks can harbor bird flu without showing any s/s of it.

Unfortunately, this is the time of year when we can expect to see more cases of H5N1. Occurring in the same region as the more transmissible swine flu, it is worrisome. Bird flu is endemic in Vietnam.

Via Reuters: PRESS DIGEST - Vietnam newspapers - Dec 1. Excerpt:

The Health Ministry confirmed the H5N1 virus has killed a 23-year-old man last month in the northern province of Dien Bien, the fifth fatality in Vietnam so far this year. Vietnam currently has no outbreaks among poultry, the Agriculture Ministry said.

UPDATE

This link is saying it was duck blood pudding not soup. At any rate, the

exposure to duck blood, is problematic. I wonder, did he slaughter the

bird himself? Very risky with no PPE, and then to eat it raw...

http://www.thanhniennews.com/healthy/?catid=8&newsid=54002

(hat tip pfi/monotreme)

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Bird to Bird Transmission of H5N1 in Vietnam and Egypt

No, bird flu has not disappeared except in our US news reports. It is still

very much an issue.

With the first day of winter less than a week away in the northern hemisphere, and cooler weather already present in many places, we are beginning to see an upsurge in reports of B2B (bird to bird) H5N1 avian flu around the world.

While hardly earth shattering news (we see this pattern every year), it is an important reminder that there are other flu viruses out there that deserve our attention.

For an update go to: http://afludiary.blogspot.com/2009/12/b2b-bird-flu-in-vietnam-and-egypt.html

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Egypt: WHO Update on 90th Human H5N1 Case

http://www.who.int/csr/don/2009_12_21/en/index.html

The disease began striking toddlers last year in Egypt, and surprisingly was mild. This recent case is an adult, and how much exposure to the virus she may have had might play a role in her outcome. Unfortunately, adult cases are frequently fatal in that country and elsewhere.

The Ministry of Health of Egypt has reported a new laboratory confirmed human case of avian influenza A(H5N1) on 19 December 2009.

The case is a 21 year old female from the El Tanta District of Gharbia Governorate. She developed symptoms of fever and cough on 15 December 2009.

She was admitted to Tanta Fever Hospital where she received oseltamivir treatment on the same day. She is in a stable condition. Investigation revealed that the case had close contact with dead poultry and was involved in slaughtering sick birds.

(hat tip Avian Flu Diary)

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indonesia: a bombshell from the minister of health

http://crofsblogs.typepad.com/h5n1/2009/12/indonesia-a-bombshell-from-the-ministry-of-health.html

since 1 january to 28 december 2009, a total 20 h5n1 cases reported in indonesia. of those confirmed cases, 19 have been fatal. first h5n1 case was reported from bogor on 9 january, and latest was reported from south jakarta on 23 september 2009.

total cumulative number of h5n1 in indonesia since 2005 to 2009 is 161 with 134 deaths.

this information is broadcasted by public communication center, general secretary ministry of health.

this is more bird flu information from indonesia than we've received in over a year. as brief as it is, it has some important implications.

the indonesian case fatality ratio is now 83 percent, slightly higher than the 81 percent before the news blackout. this indicates the health system isn't catching cases early, or isn't dealing with them effectively.

http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/dec3009indo.html

indonesia's ministry of health, updating information on h5n1 avian influenza for the first time since january, quietly reported this week that the country has had 20 human cases so far this year, with 19 of them fatal--a 95% case-fatality rate (cfr).

indonesia's then-health minister, siti supari, announced in june 2008 that the government would stop issuing prompt reports of new h5n1 cases and instead offer only periodic updates. the announcement raised concern about the world's ability to track the virus's evolution and impact.

since the june 2008 announcement, indonesia has issued few official reports of h5n1 cases.

the often deadly h5n1 virus has not yet gained the ability to spread easily from person to person, though it has circulated widely in birds for the past 6 years. disease experts still fear that it could gain transmissibility through mutation or by reassorting with another flu virus.

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Cambodia

http://www.meattradenewsdaily.co.uk/news/020110/cambodia___bird_flu_strikes_again.aspx

The Cambodian veterinary authority has sent an Immediate Notification dated 28 December to the World Organisation for Animal Health (OIE).

The report describes a new outbreak of HPAI in a village poultry flock of 1,216 birds in La-ak in the province of Kg. Cham, which is in the south-east of the country, near to the border with Viet Nam. The disease broke out on 16 December. In all, 143 birds died and the rest were destroyed.

According to the report, the affected population were backyard poultry comprising 1,012 chickens and 204 ducks. Of the birds culled, 751 were chickens and 124 were ducks.

The presence of the H5N1 sub-type of the virus has been confirmed.

(hat tip pfi/monotreme)

Human H5N1 cases in 2009

For those interested in bird flu I have summarized the information on human cases in 2009.

A General Discussion of Human H5N1 Cases in 2009

H5N1 was widely expected to the first pandemic virus of the 21st century. The outbreak of the novel H1N1 in the North America in the early months of 2009 caught everyone by surprise. The pandemic spread of novel H1N1 across the globe captured the world's attention throughout the year, while information and reports on H5N1 were back page news.

Number of Human H5N1 Cases in 2009

H5N1 avian influenza ("Bird Flu") is an internationally reportable disease. Since 2003 until December 31, 2009, the World Health Organization (WHO) has reported a total of 467 confirmed human cases of H5N1 (link). The cases associated with the initial human outbreak of H5N1 in Hong Kong in 1997 are not included in the official WHO totals (link).

For 2009, the final tabulation for WHO confirmed H5N1 cases is 72 (link). Twenty of these 72 cases occurred throughout the year in Indonesia but were only reported by Indonesia on December 28th, and incorporated into the WHO statistics on December 30, 2009 (link).

The number of H5N1 cases increased in 2009 relative to 2008. The number of H5N1 cases in 2009 is almost double the number of H5N1 cases reported in 2008 (See graph below). The number of H5N1 cases reached an all time annual high of 115 in 2006, but another doubling of human H5N1 infections in 2010 would exceed this previous annual high.

In 2009, Egypt had the most confirmed cases with 39 reported to WHO. Indonesia is next with 20 reported cases followed by China, Vietnam, and Cambodia in descending order. All five of these countries had previously reported human H5N1 cases. No other countries reported human H5N1 infections in 2009.

Demographics of H5N1 Victims in 2009

For about 52 of the WHO confirmed cases demographic information is available in the Disease Outbreak News and translated news posts here at FluTrackers and elsewhere. There is no official information on the 20 reported cases from Indonesia, although internet flu trackers have posted numerous news articles throughout 2009 about human H5N1 infections and deaths in Indonesia. Among the 52 cases with reported statistics, 25 males (48%) and 27 (52%) females were infected. This suggests that in 2009 both males and females were about equally susceptible to H5N1 infection. Ages range from 1 to 57 years old for these cases, with a median age of 4. This low median age results from the 39 cases from Egypt. The age statistics from Egypt for human H5N1 infections in 2009 show an unusual trend. Thirty-one of the 39 human cases were children under 9 years of age. Even more striking is the fact the CFR among the 39 Egypt cases in 2009 was only .10.

Case Fatality Ratio

Based on WHO confirmed human cases, the overall case fatality ratio (CFR) to date is .60. As noted above for 2009 the CFR for Egypt was .10. This is lowest annual CFR number of any country since WHO started tracking H5N1 infections. The survival rate for confirmed H5N1 cases in 2009, at least for Egypt, increased compared to preceding years.

. . .

The remainder of the discussion and graphs are at this link: http://www.flutrackers.com/forum/showthread.php?t=138276
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Kaziranga National Park, Assam, India

http://crofsblogs.typepad.com/h5n1/2010/01/india-b2b-h5n1-in-assam.html

A bird flu scare has hit the Kaziranga National Park in Assam with carcasses of at least a dozen migratory Bar-headed Geese found in the sanctuary, officials said Friday.

A park warden said at least seven geese were found dead Friday. Five carcasses of the same species that had recently arrived at the sanctuary from Siberia were recovered Thursday.

'A team of experts, including veterinarians, are carrying out post-mortem of the birds and samples would be sent to Bhopal to find out if the deaths were due to avian influenza or some other disease,' a park ranger told IANS.

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Pekanbaru, Riau, Indonesia

http://www.thejakartapost.com/news/2010/01/10/bird-flu-suspect-critical-condition.html?

A 17-year-old teenager who is suspected of having contracted the H1N1 bird flu virus is in a critical condition at the Arifin Achmad regional public hospital in Pekanbaru, Riau.

The hospital head for bird flu control, Azisman Saad, said Sunday the teenager was receiving intensive treatment in an isolation room at the hospital.

"The suspect is still in a comma-like condition and is suffering from a high fever," Azisman said.

He added the patient needed a machine to assist his breathing.

(hat tip pfi/pixie)

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Beni Suef, Egypt

This the 91st lab confirmed case of H5N1 bird flu in Egypt. The case fatality rate is improving for the disease in that country, but is still high. To put this into persepective, the CFR in the 1918 pandemic was a horrific 2% and millions died across the globe. Now, compare this with a 60% CFR in Egypt or the greater than 80% CFR of Indonesia, and it is easy to understand the concern that H5N1 generates. Luckily, it has not yet developed the ability to become more transmissible. With luck, that may never happen.

Ministry of Health on the status of injury No. 91 for bird flu-old girl (20 years) from Beni Suef.

The Health Ministry said in a statement that the onset of symptoms the disease the patient was on Jan. 6, entered the hospital in Beni Suef, issued January 11, has been suffering from fever, cough, sore throat and difficulty in breathing, after they were dealing with dead birds suspected of being infected with disease, and make sure that today, Wednesday, she became ill and was given the drug Tamiflu in stable condition.

More at: http://afludiary.blogspot.com/2010/01/egypt-reports-91st-h5n1-infection.html

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H5N1: Far From Gone

While the world's flu fighters have concentrated on countering the H1N1 swine flu pandemic, avian influenza H5N1 has quietly continued to take its toll on both poultry and humans.

Last year, 17 countries, stretching from Côte d'Ivoire and Germany to China and Japan, reported outbreaks of H5N1 in domestic poultry and wild birds; and the World Health Organization, which still says H5N1 poses a pandemic threat, recorded 72 human cases, 32 of them fatal.

The brunt of the outbreak, entering its eighth year, is still in China and the developing countries of Southeast Asia. Indonesia alone accounted for 19 of the 32 H5N1 deaths; Vietnam, for 5 and China, for 4. But there are glimmers of progress.

More at: http://crofsblogs.typepad.com/h5n1/2010/01/h5n1-far-from-gone.html

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Egyptian Media Reports 92nd Human Case of H5N1

http://afludiary.blogspot.com/2010/01/egyptian-media-reports-92nd-h5n1.html

It is worrisome that swine flu cases are occurring concurrently in Egypt as well.

...a child from the province Dakahliya one year old and a half.

The ministry of Health on "Friday" that the onset of symptoms since the child started on 7 January, where he entered the hospital in Mansoura issued on Jan. 12, suffering from fever, cough and shortness of breath.

She noted that it had been given proper treatment of the drug "Tamiflu" as soon as a suspected injury, and his health is stable and in good health.

I was reading an article on bird flu the other day on the internet. I found this article interesting. Just have a look.

http://www.caring.com/news/new-weapon-may-help-battle-bird-flu

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