HEALTH 2/11-2/18/10 Bird, Other Flu Weekly Thread:13 Recent H1N1 Deaths In Michigan

Link to last weeks thread:

2/3-2/10/10 Bird, Other Flu Weekly Thread:Recombination Driving H1N1 D225G and H274Y

http://www.timebomb2000.com/vb/showthread.php?t=354159

Please See:

Confirmed cases of Swine Flu and maps
http://www.timebomb2000.com/vb/showthread.php?t=330689

Comprehensive Flu Thread, Latest reports, States, Countries, Closings.

http://www.timebomb2000.com/vb/showthread.php?t=330395

Useful Links:

Avian Influenza (Bird Flu)
http://www.cdc.gov/flu/avian/gen-info/facts.htm

Johns Hopkins on influenza:
http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

National Avian Influenza Surveillance Information:
http://wildlifedisease.nbii.gov/ai/

CDC
http://www.cdc.gov/flu/avian/index.htm

WHO
http://www.who.int/csr/disease/avian_influenza/en/index.html

CIDRAP
http://www.cidrap.umn.edu/

Official U.S. Government Web site
http://www.pandemicflu.gov/

FAO
http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/avian_qa_e.html

European Union
http://ec.europa.eu/dgs/health_consumer/dyna/influenza/country_en.htm

The World Bank
http://web.worldbank.org/WBSITE/EXT...68427~piPK:64168435~theSitePK:1793593,00.html

13 Recent H1N1 Deaths In Michigan Raise Concerns​

http://www.recombinomics.com/News/02111001/H1N1_MI_13.html

Cumulative deaths associated with any influenza strain since Sept 1, 2009: 79

The above comment in the most recent Michigan update describes a dramatic spike in H1N1 fatalities in the past 2 weeks in Michigan. This recent rate of approximately 1 death per day is in marked contrast to deaths between December 12, 2009 and January 19, 2010 when only 2 fatalities were reported. The spike in Michigan coincides with a spike in Pneumonia and Influenza deaths in the US, but in Michigan the spike was in lab confirmed H1N1, raising concerns that a new wave has begun in the US and is more lethal than the wave which largely ended in December and early January.

The start of a new wave is not unexpected. Multiple waves within one pandemic seasonal have been noted previously, and the likelihood of a wave in early 2010 was increased by the early appearance of the fall wave, as well as the absence of seasonal influenza A. Moreover, the decline in wild type H1N1 provides an opportunity for the emergence and dominance of a new strain. Recent increases in the reporting of H1N1 sequences with D225G and D225N have raised concerns that this lethal strain could become more common leading to more severe and fatal cases.

There has also been a recent surge in H1N1 confirmed fatalities in Mexico, raising additional concerns for the spread of D225G. In a recent series of 10 HA sequences from fatal cases in Mexico, 5 had D225G, D225N, or both. The two sequences with both were collected within a day of each other in San Luis Potosi, raising concerns of H225G/N transmission, which was recently seen in a death cluster at Duke Medical Center in North Carolina.

Sequence data from the fatal cases in Michigan and Mexico would be useful.

Avian influenza - situation in Egypt - update 29​

http://www.who.int/csr/don/2010_02_10/en/index.html

10 February 2010 -- The Ministry of Health of Egypt has announced a new case of human H5N1 avian influenza infection.

The case is a 37-year-old male from Helwan District, Helwan Governorate. He developed symptoms on 31 January and was hospitalized on 6 February, where he received oseltamivir treatment. He is in a critical condition.

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Of the 97 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 27 have been fatal.

Cambodia to check poultry shipped to capital for bird flu infection​

http://news.xinhuanet.com/english2010/health/2010-02/11/c_13172089.htm

PHNOM PENH, Feb. 11 (Xinhua) -- With the increased transport of poultry ahead of the upcoming Chinese New Year, the Ministry of Agriculture is setting up special checkpoints for poultry transported on the main roads into Phnom Penh in order to prevent any birds infected with the H5N1 avian influenza virus from reaching the capital, local media reported on Thursday.

Kao Phal, director of the ministry's department of animal health production, was quoted by The Cambodia Daily as saying that agriculture officials and officers from the Economic Police were deployed along National Road 1 on Wednesday and would be stationed on all main roads into the capital to check the influx of poultry in the days leading up to the Chinese New Year, which takes place this weekend.

"We check the birds before we allow them to be transported to the markets, we do not test for bird flu, we just check the birds' sanitation and health," he said, adding the measure was part of a nationwide campaign to prevent the potential spread of the H5N1 avian influenza virus.

"We called all the 24 provincial agriculture departments to the ministry recently to appeal to them to educate the villagers in each province" about the virus, kao Phal said.

Lotfi Allal, chief technical advisor at the UN Food and Agriculture Organization, was quoted as saying that in recent years the government has taken specific measures during major holidays to check poultry for H5N1.

"The high risk periods are around these festivals. There is a lot of trade in animals, such as poultry, around this time. Always around this period we support the government with their public awareness campaigns," he said.

Allal also said FAO and government officials were wrapping up their activities to control the recent H5N1 outbreak in Takeo province, as bird culling in a 1-km radius around the outbreak's epicenter had ceased, while investigations in a 5-km range were also completed.

Earlier this month, more than 10,000 ducks have died and some 30,000 others are sick in the country's southern province of Takeo.

Indonesia reports 2 new bird flu cases, 1 of them fatal​

http://beforeitsnews.com/story/17455/Indonesia_reports_2_new_bird_flu_cases,_1_of_them_fatal.html

Feb. 11 (AP) - (Kyodo)—Indonesia has reported two new bird flu cases for the first time this year, one of them fatal, bringing the country's human death toll from the disease to 135 since it emerged here in 2005, according to the government.

The Health Ministry, which had the information on its website Thursday, said a 25-year-old woman from Jakarta died on Jan. 25 and her blood samples tested positive for bird flu. The woman had a history of contact with poultry, according to the ministry.

The second case was also detected in Jakarta during routine bird flu surveillance last month when a 3-year-old boy tested positive, but he soon recovered.

Indonesia has reported 135 deaths from bird flu, nearly half of the 282 fatalities worldwide, according to the World Health Organization.

So far, most human cases have been linked to contact with infected chickens. But health experts worry the H5N1 virus could mutate into a form that passes easily among humans, sparking a pandemic that could kill millions.

Indonesia is considered a potential hotspot for that to happen.

Bandar Lampung, Lampung ::: 41-year-old female suspected of having bird flu​

http://birdflucorner.wordpress.com/...year-old-female-suspected-of-having-bird-flu/

Bandar Lampung – Abdul Moeloek regional hospital in Bandar Lampung treated a bird flu H5N1 suspect patient. Blood and throat swab samples had been sent to Jakarta for laboratory test.

A woman with initial Suh (41), resident of Desa Gunungsinar, Way Laga, Panjang, Bandar Lampung, was admitted to emergency unit of Abdul Moeloek because of fever after previously treated at Way Laga public health center, said Pad Dilangga, Vice Director of Medical Service Division Abdul Moeloek hospital.

After initial examination, patient was then placed at isolation unit for bird flu patient. “She was transferred to isolation unit after we discovered that she had developed cough, cold and high fever for 15 days,” said Pad.

Pad also mentioned that further x-ray examination of patient’s lung was showing pneumonia signs. Moreover, patient was reported to have had direct contact with dead chickens.

In mean time, patient has been treated with tamiflu, a bird flu medicine.

Suh is the first bird flu suspect patient in 2010. During 2005-2009, the hospital has recorded 59 bird flu H5N1 suspect patients and 3 positive H5N1 patients.

Source: Indonesia national newspaper, Kompas.

http://cetak.kompas.com/read/xml/2010/02/10/03324873/RSUD.Abdul.Moeloek.Rawat.Terduga.Flu.Burung

Spike In H1N1 Deaths In Mexico Raise Concerns​

http://www.recombinomics.com/News/02111002/H1N1_Mexico_Spike.html

The recently released update from the Ministry of Health in Mexico lists 1026 lab confirmed fatalities, which is markedly higher than the 880 reported a month earlier. Although there is a delay in lab confirmations of fatal cases, a comparison of confirmations in the four weeks prior to each report has 44 fatalities for the February 8 report, compared to 9 for the January 6 report. Moreover, the total number of cases confirmed has been declining, leading to an increase in the apparent case fatality rate.

Recent sequences, including those from Mexico have shown an increase in D225G and D225N in samples from fatal cases. These increases have raised concern that a new wave of infections could have a higher frequency of this two receptor binding domain changes, leading to more severe and fatal cases. Comments on more severe cases have been made by physicians in Tennessee and North Carolina, and the recent spike in H1N1 confirmed fatalities in Michigan has increased those concerns.

The increases in Mexico could be due in part to an emphasis on confirmation of fatal cases, but media reports have also described increases in fatalities in patients with H1N1 symptoms, indicating the increases in recently confirmed cases represent a spike in fatal cases, and not an increased focus on testing fatal cases.

However, sequences from these recently confirmed cases and any information in changes in confirmation procedures or emphasis would be useful.

Avian influenza – situation in Indonesia ​

http://www.timebomb2000.com/vb/newreply.php?do=newreply&noquote=1&p=3646648

12 February 2010 -- The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 25-year-old female from South Jakarta District, DKI Jakarta Province died on 25 January 2010. Laboratory tests were positive for H5N1 virus infection. The case was possibly infected from direct contact with poultry.

Of the 163 cases confirmed to date in Indonesia, 135 have been fatal.

West Bengal Reports New Case of H5N1 Avian Flu​

http://www.thepoultrysite.com/poultrynews/19531/west-bengal-reports-new-case-of-h5n1-avian-flu

WEST BENGAL, INDIA - A new case of highly pathogenic avian influenza (HPAI) has been reported to the World Organisation for Animal Health (OIE).

Follow Up Report No. 3 from the Indian veterinary authority to OIE gives details of a new outbreak of HPAI.

It started on 18 January in the same district of West Bengal as other previous outbreaks. In all, 8,601 village poultry were involved. Of these, 17 died and 3,138 were destroyed.

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

Another Case of Low-Path Avian Flu in Taiwan​

http://www.thepoultrysite.com/poultrynews/19530/another-case-of-lowpath-avian-flu-in-taiwan

TAIWAN - A second case of low pathogenic avian influenza (LPAI) has been reported to the World Organisation for Animal Health (OIE).

Follow Up Report No. 1 from the Taiwanese veterinary authority to OIE gives details of the latest case of LPAI. It started on 27 January on a farm in Fang-Yuan township in Chang-hua municipality in the west of Taiwan. Twenty of the 29,000 layers on the farm were affected but none has died.

The report adds that after the previous outbreak identified on 9 January 2010, epidemiological and clinical health investigations were conducted on 113 poultry farms within a three kilometre-radius of the index farm. In this investigation, a layer farm was tested positive by virus isolation. Movement control on this farm has also been implemented. The results of clinical findings, laboratory tests and basic amino acid motifs of the HA0 cleavage site demonstrate that the virulence of the virus is low pathogenic. The IVPI test and the sequence of nucleic acid of this virus isolate are on-going and the result will be reported to the OIE.

As to the index farm, the local veterinary authority has collected samples again for the detection of the virus and a negative result was obtained on 5 February 2010. By determining the basic amino acid of the cleavage site of the haemagglutinin and by IVPI test (IVPI=0) and gene sequencing, it has been demonstrated that the virulence of the virus is low pathogenic. The movement control on the farm was released by the local veterinary authority on 5 February 2010.

The presence of the H5N2 sub-type of the virus in the layers on the latest farm to be affected has been identified.

Serang, Banten ::: Fifty-year-old bird flu suspect man​

http://birdflucorner.wordpress.com/2010/02/12/serang-banten-fifty-year-old-bird-flu-suspect-man/

Cilegon, Banten – A 50-year-old man, with initial S, is treated in isolation unit of Serang regional hospital. Patient was transferred to Serang regional hospital from Grogol public health center, Cilegon.

Hospital’s spokesman, Yopi Triana S said that patient arrived in Serang regional hospital on Wednesday (10/1) afternoon with body temperature 37℃. According to patient’s family, S developed fever after had direct contact with suddenly died chickens nearby his house. Patient also showed common signs of bird flu infection such as, sore throat, and low of leukocyte (white blood cell) count for less than 5,000 per mL blood, added Yopi.

S is first bird flu suspect treated in Serang regional hospital in 2010. The hospital had treated 27 bird flu suspect patients in 2009. One of them had died before laboratory confirmed, meanwhile remaining 26 cases were negative.

Source: Indonesia local newspaper, Radar Banten. http://www.radarbanten.com/mod.php?mod=publisher&op=viewarticle&artid=52029

Dramatic H1N1 CFR Spike In Mexico Raises Concerns
​

http://www.recombinomics.com/News/02121001/H1N1_Mexico_CFR.html

The Feb 10 report from Mexico has confirmed H1N1 fatalities increasing to 1035, which is an increase of 9 over the Feb 8 report. Although some of these fatalities are from earlier weeks, the steady increase in fatalities, while confirmed cases are low, raises concerns of a more virulent H1N1 and a higher case fatality rate (CFR). Confirmed cases in Mexico peaked in October, when weekly totals exceeded 3000. In December, weekly totals declined to about 200, where they have remained.

However, weekly fatalities have been running at about 20, which is approximately 10% of confirmed cases. In contrast, overall figures in Mexico were at 1% of confirmed cases on Dec 7 (713/66,323), but have risen to 1.5% (1035/70,453) in this latest update. This change is either due to a radical change in how cases are selected for confirmation, or a significant increase in H1N1 virulence.

Sequences released in December had D225G, D225N or both in 5 of 10 HA sequences from fatal cases in Mexico, raising concerns that these changes are now more frequent, leading to a dramatic rise in CFR in confirmed cases.

Sequences from recent cases, as well as information on cases selected for lab confirmation, would be useful.

Garut, West Java ::: Zoo birds possibly die of bird flu​

http://birdflucorner.wordpress.com/2010/02/13/garut-west-java-zoo-birds-possibly-die-of-bird-flu/

Garut – Birds in Cikembulan zoo, Kecamatan Kadungora, Kabupaten Garut possibly died of bird flu H5N1 infection. Climate factor and inappropriate vaccination schedule were suggested as contributing factors of bird deaths. First bird death was observed on Thursday (11/2), said Cikembulan zoo manager, Rudi Arifin.

Cikembulan zoo was opened on September 2009, in an area of 25 hectares. The zoo has animal collection over 216 consists of 74 species which are dominated with birds.

Rudi mentioned that last bird flu vaccination was done a year ago by veterinary practitioner. Whereas, effective vaccination for preventing bird flu infection should be done at least once in four months periodically.

According to Livestock, Fishery and Marine Service (Disnakanla) of Kabupaten Garut, number of dead birds in Cikembulan zoo reached five birds from neighboring cages. Blood samples of death birds have been sent to laboratory in Cikole, Bandung.

Source: Indonesia local newspaper, Pikiran Rakyat. http://newspaper.pikiran-rakyat.com/prprint.php?mib=beritadetail&id=127422

Uh, oh.... here we go again! That Michigan report, combined with the Mexican figures, is NOT good news. Damn... I was hoping we weren't going to see the "third wave" ala 1918...

Summerthyme

And... what just occurred to me (yeah, I'm slow today)... the Olympics are going on right now. Talk about THE perfect way to start the third wave spreading worldwide and FAST...

Got preps?

Summerthyme

Cambodia - Culling bird flu-affected ducks​

http://www.meattradenewsdaily.co.uk/news/140210/cambodia___culling__bird_flu_affected_ducks.aspx

Cambodian authorities have begun a mass killing of ducks after confirming a fresh outbreak of the deadly bird flu virus, reports the Sydney Morning Herald.
The cull comes after more than 15,000 ducks died last week in the southern province of Takeo and samples tested positive on Tuesday for the H1N1 avian influenza virus, said Kao Phal, an official of the Agriculture Ministry.

He said the sale of duck meat and its transport from the affected villages would be banned, reports state.

Negative Duke D225G/N Death Data Raise Concerns​

http://www.recombinomics.com/News/02141001/Duke_Negative.html

a study done by the WHO Collaborating Centres for Reference and Research on Influenza (WHOCC) in Atlanta located in the Centers for Disease Control and Prevention (CDC) found the D222G substitution in 14 virus isolates but not in viruses in the original clinical specimens indicating the D222G substitution in these 14 virus isolates occurred after growth in the laboratory.

The above statement is from a WHO preliminary report on HA D225G (D222G in H1 numbering). Like virtually all main points in the paper, the interpretation of the sequences is at odds with the actual data. This report is misleading and should be updated with current information. The points made in the original report raise serious questions on the ability of WHO and consultants to interpret sequence data. Their efforts to support their outdate paradigm of random mutations continue to imperil the world’s health.

Recently released sequences by the CDC of a fatal Tamiflu resistant H1N1 cluster at Duke Medical Center are among the examples of detection of D225G and D225N in virus grown from clinical samples. However, most examples of D225G and D225N are present as mixtures in original samples. The failure to detect D225G and D225N in the original sample is easily explained by a lack of sensitivity in the initial sequencing.

In the case of the Duke samples, four partial HA sequences were released by the CDC. All four sequences had a wild type receptor binding domain as well as a rare marker Y233H. The sequence from the original sample from a fifth collection was conspicuously absent. Three of the five cloned sequences had D225G or D225N, including two samples from with same patient which had both.

The source of the partial HA sequences is unclear. Each is listed as “original”. Most of the examples of D225G, D225N, or both markers have come directly from autopsy samples, showing that the changes are not due to growth in the laboratory and also showing that the RBD changes are frequently present as mixtures, either between one virus with D225G and another with D225N, or mixtures of an RBD change and a wild type sequences. Since the RBD changes can affect tissue tropism, samples from nasopharyngeal swabs or other locations in the upper respiratory tract may have low levels of virus with these changes.

This possibility is supported by the sequential samples from one of the patients. The sequence from the virus grown from the initial sample had a mixture of D225G and wild type, while the subsequent sample was reported as D225G only, indicating the ratio of D225G to wild type was increasing with time. The sequence from the second original sample was not released.

However, many labs, including the CDC, have released sequences from original samples that had D225G or D225N. In the first series of CDC sequences from Ukraine the two novel samples had D225N and both were from original samples (and one of the two sequences was a mixture with wild type). Similarly, sequences from Ukraine released by Mill Hill also came from the original lung or throat samples and had D225G, D225N or both markers. D225G and D225N in sequences in original samples have been released by labs worldwide, including those in Brazil, Mexico, and Russia.

Thus, the strong linkage of D225G and D225N with original samples from fatal cases supports the presence of both markers in the fatal cases at Duke, which was further supported by the detection of these changes in three of five samples.

WHO and the CDC have failed to provide evidence that the D225G substitution occurred after virus growth in the laboratory. Similarly, the frequent detection of both markers in samples from fatal cases in Ukraine and Russia invalidates the additional comments in the WHO report indicating that D225G was not clustered in time, space, and phylogeny. Moreover, the attempts to discount the positive data detecting D225G and D225N by citing the negative data of partial HA sequences represents an argument that is well outside of scientific standards.

The frequent misinterpretation of sequence data in WHO reports raises serious issues that should be addressed by an independent analysis.

These repeated errors by WHO and the CDC in interpretation of sequence data, in failed attempts to support the random mutation paradigm continue to be hazardous to the world’s health.

Duke D225G/N Death Data Destroys Random Mutation Paradigm​

http://www.recombinomics.com/News/02151001/Duke_Destroy.html

Centers for Disease Control and Prevention (CDC) found the D222G substitution in 14 virus isolates but not in viruses in the original clinical specimens indicating the D222G substitution in these 14 virus isolates occurred after growth in the laboratory.

The above comments from the WHO preliminary report on D225G (D222G in H1 numbering) represent the swan song for random mutations as a key driver of influenza antigenic drift. Recently released sequences by the CDC at GISAID from the death cluster at Duke did not have D225G or D225N in initial samples from four H1N1 positive patients, but viruses lab isolated from samples from these four patients were positive for D225G or D225N in 3 of 5 sequences, including D225G in isolates from two sequential samples from the same patient. These sequences all had the same rare genetic HA marker Y233H.

The detection of D225G and D225N in this fatal cluster was not unexpected. The four patients were on the same ward and infected with the same virus. Three of the four died, suggesting a viral genetic change was responsible. D225G and D225N have been frequently identified in direct sequencing of clinical samples, indicating such detections were not due to growth of the virus in the lab. Moreover, the isolates were clustered in time and space, supporting transmission of the lethal strain. However, the Duke cluster represented clear lethal transmission of the same H1N1 among contacts.

The detection of D225G and D225N in two of the four cases was difficult to explain by random mutation. The four patients were infected with H1N1 that had the rare marker Y233H in all HA sequences and H274Y in all NA sequences from the cluster, leaving little doubt that the virus was transmitting to all four patients. This sub-clade was distinct from the H1N1 in Ukraine and Russia, which also had a high frequency of the same two changes in fatal cases, including 11 cases in Ukraine that had both D225G and D225N. The presence of both of these changes in the same patient or same cluster is difficult to explain by random mutation, because these clusters also include sequences with wild type receptor binding domain sequences, which would therefore require multiple new introductions. Thus, for Duke one patient would require a copy error leading to D225N, while another would require a D225G error, which would have to happen twice in samples from the same patient if the detection was due to an in vitro effect.

Although this ad hoc tortured explanation is extremely unlikely, it is cited in the original WHO report, as quoted above, and is repeated in a subsequent WER distribution. This logic is clearly an act of desperation to shore up the WHO working hypothesis that D225G is generated by repeated copy errors that are spontaneous and sporadic, which is not supported by the actual data generated in multiple countries by multiple labs sequencing original clinical samples which show that D225G and D225N is clustered in space and time and found in phylogenetically related sequences, which would require multiple independent introductions of both markers, which is not credible.

However, the WHO pronouncements can have a significant effect on the world’s health. This week WHO is selecting the H1N1 target for the 2010/2011 vaccine for the northern hemisphere, and the tortured logic used in the WHO paper on D225G may be used to recommend the current vaccine target which lacks D225G in the killed vaccine.

Mill Hill has characterized a Ukraine isolate with D225G as a “low reactor” which indicates that target has a titer that is at least 4 fold lower than the vaccine target used to create the reference anti-sera. There is also evidence for an increase of D225G/N in fatal cases, raising concerns that D225G will be more dominant in the next wave, and a vaccine target lacking D225G will have reduced efficacy against H1N1 circulating next season in the northern hemisphere.

An independent analysis of WHO’s ability to interpret sequence data from pandemic H1N1,as well as a reliance on random mutations to explain influenza evolution is long overdue.

Bird flu under control​

http://www.thehimalayantimes.com/fullNews.php?headline=Bird+flu+under+control&NewsID=227245

KATHMANDU: Dr Prabhakar Pathak, director general, Livestock Department, on Friday said the bird flu had been taken under control in Pokhara. He said the government had provided compensation to farmers for the killed fowls. The ministry provided Rs 100 per chicken, 50 paisa per egg and Rs 5 per kg of bran as relief. Pokhara and its neighbourhoods were on high alert since January 4.

Adamantane Sensitive H1N1 in Houston Texas​

http://www.recombinomics.com/News/02151002/H1N1_S31.html

nearly all of 2009 H1N1 viruses tested since April 2009 have been resistant to the adamantanes (amantadine and rimantadine).

The above comments from the latest CDC influenza update refers to a table which has 1188/1191 H1N1 isolates with adamantane resistance (S31N in M2). Recently released sequences by JCVI included two adamantane sensitive sequences from the Houston, TX area. The two samples (A/Texas/45103259/2009 and A/Texas/45062633/2009) were collected four days apart in September, suggesting the isolates were from contacts or from the same patient (age and gender were not included). These changes signal an increase in H1N1 evolution which is driven by the immunological response to the spread of H1N1 worldwide and in Texas.

The MP sequence is closely related to other swine H1N1 sequences, indicating the sensitivity was not due to reassortment involving a human MP gene segment or an adamantane sensitive swine sequence. Several additional polymorphisms in MP and throughout the two flu genomes were found in a series of isolates from Texas, indicating the S31 was a recent acquisition.

The increase in H1N1 evolution raises concerns that variants such as those with D225G and D225N will become dominant in the next wave, which may have already started in region 4 as well as Mexico.

Egypt reports another H5N1 case, more poultry outbreaks​

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb1510avian-br.html

Feb 15, 1010 (CIDRAP News) – Egypt's health ministry reported another human H5N1 influenza case, in a 29-year-old woman from Menofia governorate who died of her infection, according to a statement yesterday from the Egyptian State Information Service.

News of the latest human case came as Egypt's animal health officials detailed 33 new H5N1 outbreaks in poultry that have been confirmed since Feb 1 and as foreign-language media sources reported other human H5N1 infections and deaths.

The notice of the woman's infection contained few details, but said her death brought the number of fatalities to 30 and raised the number of cases to as many as 99. When the World Health Organization (WHO) reported the latest Egyptian case on Feb 10, it listed Egypt's total as 97 cases and 27 fatalities, so it's unclear if Egypt's tally includes H5N1 cases and deaths that haven't yet been reported to the WHO. The FluTrackers infectious disease message board has noted what appear to be additional H5N1 deaths and an illness that have only been reported in the Arabic press so far.

Since the first of the year Egypt has reported seven H5N1 infections in humans, and the infections seem to be striking adults more than children, a change from a pattern in 2009, when the youngest children seemed to bear the greatest disease burden. Among seven H5N1 infections reported to the WHO this year, five have occurred in adults—three women and two men.

Meanwhile, the rise in human H5N1 infections seems to be following increased H5N1 activity in the country's s poultry. Egypt's Strengthening Avian Influenza Detection and Response (SAIDR) site recently posted reports of 33 H5N1 detections since Feb 1. The outbreaks hit birds in 12 different governorates, with the highest numbers of outbreaks in Dakahlia (7), Qalyubia (6), and Menofia (5).

Most of the outbreaks were detected in household birds, though the virus was detected at four farms—two during routine surveillance. The type of operation was not reported for one of the outbreaks.

See also:

Feb 14 Egypt State Information Service statement
http://www.sis.gov.eg/En/Story.aspx?sid=46563

Feb 11 FluTrackers thread
http://www.flutrackers.com/forum/showthread.php?t=141061

H1N1 D225E Converted to D225G in Egypt​

http://www.recombinomics.com/News/02161001/H1N1_Egypt_D225E_G.html

Mill Hill released new sequences at GISAID. Included were two December sequences from Egypt, A/Egypt-Vacsera162/2009 and A/Egypt-Vacsera/138/2009. Both had T717A, which codes for D225E and both sequences also had C940T, which is found in isolates with D225E.

However, A/Egypt-Vacsera/138/2009 also had G716A, which converted D225E to D225G. Reports of these conversions are becoming increasingly common and raise concerns that D225G is offering a selective advantage. Recent conversions have been seen in Japan, Italy, Norway, Sweden, and Spain.

Position 225 in pandemic H1N1 is hyper-variable. The conversion of the position to D225E is widespread, especially in Europe. In some countries, like Italy, the frequency of D225E is approaching 50% of deposited sequences, suggesting this change offers significant selection advantage. Although fatal cases with D225E have been reported, the countries with high levels of D225E do not have unusually high levels of fatalities.

However, in other countries like Ukraine and Russia, other position 225 changes (D225G and D225N) are more common and are strongly associated with fatal cases. Although the clade in Ukraine and Russia has the highest reported frequency of D225G/N, the same change is found on different sub-clades in different countries, including the death cluster at Duke Medical Center in North Carolina.

One of the Ukraine isolates was antigenically characterized by Mill Hill and was designated a low reactor, raising concerns that this change would be under positive selection pressure in patients previously infected with wild type H1N1 or those who had been vaccinated with the killed vaccine.

Consequently, a new wave may have a markedly higher frequency of D225G or D225N leading to a significant increase in severe and fatal H1N1 cases.

More sequence data on recent severe and fatal H1N1 cases would be useful.

H1N1 Spread In North Carolina
​

http://www.recombinomics.com/News/02161002/H1N1_NC_Spread.html

Some of these symptoms are similar to the flu so doctors are testing for it, but so far none have come back positive. If your child has a cough for more than ten days you need to take them to see a doctor.

Doctors at Cape Fear Pediatrics describe the flu as a dull roar. Most of the cases they have seen have been the H1N1 flu.

They are also seeing a viral stomach virus with fever and vomiting.

The above comments on upper and lower respiratory illness in North Carolina have much in common with reports from last fall, when schools were reporting double digit absenteeism and the illnesses responsible were said to be seasonal flu, stomach flu, bronchitis, allergies, or strep. However, the symptoms matched those of swine flu and in the fall H1N1 was the major virus in circulation. Since there are more respiratory viruses circulating at this time of the year, calling the above cases H1N1 is more difficult.

Seasonal flu has essentially disappeared, so cases considered seasonal flu based on an influenza A positive test are almost certainly H1N1. The influenza rapid test has always had a low sensitivity, which is even lower for swine H1N1. The CDC has reported sensitivities as low as 10%, which would then lead to misdiagnosis based on the extremely high rate of false negatives.

Similarly, H1N1 infections are frequently fever free, which also leads to misdiagnosis and a gross undercount of cases. However, even with these limitations the detection frequency for H1N1 has steadily increased this year, signaling a new wave, which has also been reported in other states in the southeast (region 4).

Concerns remain high that this new wave will have a higher frequency of D225G and D225N leading to more severe and fatal cases. Sequences from the more severe and fatal cases would be useful.

Cambodia - Bird flu​

http://www.meattradenewsdaily.co.uk/news/170210/cambodia___bird_flu_.aspx

In three Asian countries, the high pathogenic bird flu virus H5N1 broke out, according to OIE reports.

In Cambodia, the virus has been found on a farm with 31,000 birds.

In the South of Burma, the disease has been detected on a poultry farm with 2,500 animals. The animals are being culled.

In Nepal, the virus has been found on a poultry farm with 235 birds.

Vaccine Failure and Severe H1N1 Cases in Wyoming
​

http://www.recombinomics.com/News/02171001/H1N1_WY_Failure.html

“He called in sick on Monday, saw a doctor on Tuesday and went to Urgent Care Wednesday and Thursday,” Barron said. “Then they flew him to Salt Lake on Friday.”

Unlike Barron’s employee, Benefiel had been vaccinated, friends said. Despite the vaccination, Benefiel contracted severe pneumonia as a result of H1N1 and had to be transported from St. John’s Medical Center in Jackson to Utah.

The above comments describe two of three Wyoming residents who contracted a severe form of H1N1 which required transfer to Utah. At least one was said to have been vaccinated, raising concerns that the H1N1 has evolved away from the current vaccine. Prior sequences from Utah included one fatal case with an HA sequence, A/Utah/42/2009, that had D225G and D225N. Another sequence, A/Utah/20/2009, was designated as a low reactor, while a third isolate, A/Utah/34/2009, had H274Y.

The presence of “low reactors” in Utah raises concerns of immunological escape from the current vaccine. In addition to designating Utah/20 a low reactor, the CDC tested a D225G positive clone from Utah/42 but did not designate it as a low reactor. Similarly, a D225G positive clone from Ukraine was also not designated a low reactor, although Mill Hill tested an isolate from the same patient and did designate it as a low reactor, suggesting Mill Hill and CDC were using different anti-sera in the characterization test.

Although both labs presumably used an anti-sera directed against Califirnia-7, the original isolate produced mix signals. Reassortants were generated with and without D225G for the killed vaccine as well as the attenuated live vaccine. However, the commercial killed vaccine shot did not have D225G, while the attenuated live nasal spray did. Thus, the selection of the influenza-like target could affect titers in antigen characterization tests.

The Mill Hill low reactor designation for H1N1 with D225G raises concerns that a vaccine lacking D225G, as well as natural immunity to an infection by wild type H1N,1 will generate a response with reduced activity against D225G variants, which are linked to severe and fatal H1N1 infections.

This week the WHO is selecting the vaccine target for the 2010/2011 season, and WHO reports have significantly downplayed the role of D225G in fatal case, raising concerns that this week’s recommendation will be to use the same California/7 target as used for the current season in the northern hemisphere and the upcoming season in the southern hemisphere, which would lead to use of current stocks and further scale up of the current target, which lack D225G.

The descriptions in the WHO Dec 28 report on D225G were obsolete by the time the report came out, and was further discounted by sequences that became public just before and after the Jan 21 mailing. Since the Jan 21 e-mailing and WER publication represents the last official comment on D225G, there is concern that the obsolete and thoroughly discounted data will be used to recommend continued use of the California/7-like target, and the use of a target without D225G will be hazardous to the world’s health.

Avian influenza - situation in Egypt - update 30​

http://www.who.int/csr/don/2010_02_17/en/index.html

17 February 2010 -- The Ministry of Health of Egypt has announced two new cases of human H5N1 avian influenza infection.

The first case is a 32 year-old male from Ashmon district in Menofya Governorate. He developed symptoms on 6 February and was hospitalized on 8 February, where he received oseltamivir treatment. He is in a stable condition.

The second case is a 29 year-old pregnant female from Elsadat District, Menofya Governorate. She developed symptoms on 6 February and was hospitalized on 12 February, where she received oseltamivir treatment. She died on 13 February.

Investigations into the source of infection indicated that both cases had exposure to sick and dead poultry.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Egyptian authorities have also reported that 2 deaths have occurred in the previously announced cases; the 37 year-old male from Helwan District, Helwan Governorate who developed symptoms on 31 January and the 29 year-old female from Elsadat District, Menofya Governorate who developed symptoms on 27 January .

Of the 99 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 30 have been fatal.

EGYPT: H1N1 flu down but not out ​

http://www.irinnews.org/Report.aspx?ReportId=88149

CAIRO, 18 February 2010 (IRIN) - The number of H1N1 influenza patients has fallen sharply in Egypt since the start of 2010, but health officials say they are bracing for a second wave of infections.

The Health Ministry said it is recording 500 infections a week, as against 2,500 a week in December.

“We’re still on high alert,” Amr Qandeel, head of the Preventive Medicine Section at the Egyptian Health Ministry, told IRIN. “Our hospitals and labs are ready to receive patients and test samples to ensure that the virus doesn’t spread on a massive scale.”

He said the Ministry had ample stocks of the H1N1 vaccine, and that around five million doses were in the nation’s hospitals.

H1N1 influenza first hit Egypt in July 2009. To date, 16,052 people have been infected and 267 have died.

Most cases have been reported in schools and universities in Greater Cairo and Alexandria, where high population density makes the spread of the virus more likely, health officials say.

Some health experts have attributed recent declines in H1N1 cases to school mid-year breaks, which began in early February and end on 19 February.

“The virus is now in the lowest part of its curve,” said Mohamed Abdelmeguid, director of Abassiya Fever Hospital, a treatment centre for H1N1 patients. “But we expect it to be active again in a matter of a few weeks.”

Overhyped?

Meanwhile, the Egyptian media have been speculating whether the H1N1 threat merits the level of government expenditure on mitigation measures.

“This virus is even less dangerous than normal influenza, which kills hundreds of thousands of people worldwide every year,” said Fathi Shabana, a leading fever specialist. “Statistics are rare in Egypt, but I’m sure that this [seasonal] influenza has caused the deaths of more people than swine flu did.”

He said the death rate per H5N1 (bird flu) case was far higher than for H1N1. Of the 96 Egyptians who have contracted avian influenza since the first case in 2006, there have been 28 deaths.

However, Amr Qandeel said the government’s preventive measures had “succeeded in minimizing infections”.

Those who had died of the H1N1 virus mostly had pre-existing health problems, the Health Ministry said.

States on Bangladesh border at bird flu risk: Pawar
​

http://www.thaindian.com/newsportal...-border-at-bird-flu-risk-pawar_100322078.html

New Delhi, Feb 18 (IANS) Indian states sharing a border with Bangladesh were particularly at risk of avian influenza or bird flu, Food and Agriculture Minister Sharad Pawar has said.
As long as Bangladesh remains in the grip of avian influenza, India will also be affected, Pawar told the Parliamentary Consultative Committee attached to his Ministry.

“Most of India’s neighbours are frequently affected by avian influenza and states sharing a common border with Bangladesh remain particularly at risk,” he informed the committee meeting here Wednesday.

The minister said India has offered assistance to neighbouring countries in testing samples and providing training to their technical manpower in diagnostic techniques.

“A beginning in this regard has been made and three scientists from Bangladesh received training at the high security Animal Disease Laboratory at Bhopal a few months ago,” Pawar said.

He added: “Avian influenza is a regional problem and requires a regional approach.”

Reiterating the central government’s determination to prevent avian influenza, the minister said a comprehensive programme of surveillance against the disease has been undertaken.

“Significant steps have been taken to upgrade the laboratory infrastructure,” he said.

Link to next weeks thread:

2/19-2/26/10 Bird, Other Flu Weekly Thread:WHO H1N1 Vaccine Target Selection Failure

http://www.timebomb2000.com/vb/showthread.php?t=355281