Combatting bird flu in Nepal

Nepal to cull 500,000 chickens near Kathmandu to combat major bird flu outbreak: declares emergency zone

Half a million chickens are to be culled in a district on the outskirts of Nepal's capital Kathmandu, as efforts to combat a major outbreak of bird flu are stepped up

ABC,

16 August, 2013, 18.24

Tens of thousands of birds have already been killed in what government officials have described as one of the country's worst outbreaks of avian flu.

Now authorities in the Himalayan nation have declared the area of Bhaktapur an emergency zone.

Some 62 cases of bird flu have been recorded at 250 poultry farms in three districts in the past few weeks, officials said.

A spokesman for the Directorate of Animal Health said the government ordered the cull to be stepped up after a week-long ban imposed on the sales of poultry products failed to control the H5N1 virus.

"We could not control it (the outbreak) because the supply of poultry products continued despite the ban," Narayan Ghimire said.

"Now, the poultry farmers have joined us in our battle. We are sure we will control it."

Nepal's first outbreak of bird flu was in January 2009.

H5N1, a common strain of bird flu, has killed 377 people globally between 2003 until July 5 this year, according to the World Health Organisation.

No human deaths from bird flu have been reported in Nepal.

https://www.youtube.com/watch?v=K3lyiXSM5OY

 

Bird flu

Concern after bird flu 'passes from father to daughter'

Researchers have reported the first case of human-to-human transmission of the new bird flu that has emerged in China.

BBC,

6 August, 2013

The British Medical Journal said a 32-year-old woman was infected after caring for her father.

Until now there had been no evidence of anyone catching the H7N9 virus other than after direct contact with birds.

But experts stressed it does not mean the virus has developed the ability to spread easily between humans.

By 30 June there had been 133 cases of H7N9 bird flu reported in eastern China and 43 deaths.

Most people had visited live poultry markets or had close contact with live poultry in the week or two before they became ill.

Intensive care

Yet researchers found that the 32-year-old woman had become infected in March after caring for her 60-year-old father in hospital.

Unlike her father - who had visited a poultry market in the week before falling ill - she had no known exposure to live poultry but fell ill six days after her last contact with him.

Both died in intensive care of multiple organ failure.

Tests on the virus taken from both patients showed the strains were almost genetically identical, which supports the theory that the daughter was infected directly from her father rather than another source.

Public health officials tested 43 close contacts of the patients but all tested negative for H7N9, suggesting the ability of the virus to spread was limited.

The researchers said that while there was no evidence to suggest the virus had gained the ability to spread from person to person efficiently, this was the first case of a "probable transmission" from human to human.

'Strong warning sign'

"Our findings reinforce that the novel virus possesses the potential for pandemic spread," they concluded.

Dr James Rudge, of the London School of Hygiene and Tropical Medicine, said that limited transmission between humans is not surprising and has been seen before in other bird flu viruses, such as H5N1.

He added: "It would be a worry if we start to see longer chains of transmission between people, when one person infects someone else, who in turn infects more people, and so on.

"And particularly if each infected case goes on to infect, on average, more than one other person, this would be a strong warning sign that we might be in the early stages of an epidemic."

An accompanying editorial in the BMJ, co-authored by Dr Rudge, concluded that while this study might not suggest that H7N9 is any closer to delivering the next pandemic, "it does provide a timely reminder of the need to remain extremely vigilant

The Influenza Threat

Triple Threat: Middle East Respiratory Virus And 2 Bird Flus

The World Health Organization is warning health care workers everywhere to suspect a disease called Middle Eastern Respiratory Syndrome, or MERS, whenever they see a case of unexplained pneumonia.

NPR,

10 June, 2013

Monday's warning comes at the end of a six-day WHO investigation in Saudi Arabia, where 40 of the 55 cases of the respiratory disease have occurred. Sixty percent of those people with known infections died.

Meanwhile, recent reports in the journal Cell present evidence that two other worrisome viruses — H5N1 and H7N9 flu — may be on the verge of becoming more contagious in humans.

Recent samples of these bird flu viruses are only one or two genetic mutations away from developing the ability to latch onto receptors lining the respiratory tracts of humans, biologists at the Massachusetts Institute of Technology say.

"Some of them are one amino acid away from achieving the necessary strength or affinity to latch onto human receptors," Ram Sasisekharan of MIT tells Shots. "That's a key step."

Both viruses have shown themselves capable of infecting people and causing serious illness and death. H5N1 has sickened 630 people over the past decade and killed 60 percent of them.

The H7N9 virus, which popped up this spring in southeastern China, has infected 132 people, 37 fatally, according to the latest WHO tally. Cases have dwindled in recent weeks, and only 14 remain in the hospital. But health authorities worry the virus could return with cooler autumn weather, especially if precautions are eased at the live bird markets that seem to be the source of most infections.

Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, says the MIT reports are "important evidence" of how the flu viruses are evolving. "However, that is not the entire story, at all, of how viruses evolve in a way to have sustained transmission," he says.

Fauci says what makes animal flu viruses highly contagious among people is complex and poorly understand. "In fact," he says, "I'm not even sure what the extent of the complexity is."

Reassuringly, he points out that there's never been a flu pandemic involving the H5 or H7 families of viruses.

When it comes to MERS, Fauci says he's taking it "very seriously."

He acknowledges that it's unheard of to have three emerging disease threats to worry about simultaneously.

"I've been doing emerging infections for a very long period of time," Fauci says. "And we usually have one on the radar screen, and occasionally two. But to have three on the radar screen, at least in my experience, is pretty unique."

For all three of the current viral threats, the numbers of people affected so far don't seem so threatening on a global scale. But officials worry that as human infections continue, any of the viruses could acquire the characteristics necessary to spread readily through the air and efficiently infect cells in human respiratory tracts.

With MERS, they're also concerned that some people could become so-called super-spreaders of infection — people who produce large amounts of virus in respiratory secretions and then pass the virus to dozens of others. This is how SARS, a cousin of MERS, spread rapidly to around 8,000 people in 2003, killing 11 percent of them.

"The primary lesson from SARS is we do need to watch for that sort of thing," Dr. Anthony Mounts of WHO tells Shots. "SARS didn't seem so transmissible among normal circumstances. But then we saw these events in which it spread really crazy fast from person to person."

Health authorities worry that the MERS virus might spread among pilgrims expected to visit holy sites in Saudi Arabia next month during Ramadan, or the millions more expected in October for the annual Hajj to Mecca.

Mounts is also concerned the MERS virus could sneak out of the region in the lungs of guest workers. "Pakistan, India, Indonesia, the Philippines all have large populations in the Middle East, and travel back and forth quite a bit," he says.

MERS has already shown its ability to spread within health care facilities in Saudi Arabia, Jordan and France. And its incubation period is believed to be as long as 12 days — plenty of time for an infected person to carry the virus anywhere in the world before falling ill.

Hence the new WHO warning that health care workers everywhere should think about MERS if they encounter unexplained respiratory illness.

Last week's WHO investigation in Saudi Arabia produced no new information on how people are getting MERS in the first place — from what animal source, or by what route.

The purpose of last week's mission to Saudi Arabia, led by WHO assistant director-general and virus specialist Dr.Keiji Fukuda, was to help sort through the data collected by the Saudis to discern patterns of spread and exposure.

There's been mounting frustration among public health workers over the lack of information about MERS coming from Saudi Arabia. Officials there have tended to release numbers of cases with a bare minimum of detail and little or no epidemiologic analysis.

For example, the Saudis startled everyone last month by announcing 13 new cases that turned out to have occurred in a hospital in Al-Ahsa in the kingdom's eastern province. That brought unhappy reminders of SARS, which spread rampantly in health care institutions.

But there has, so far, been no thorough analysis of how the hospital outbreak unfolded.

Similarly, there are reports of a second hospital outbreak involving five cases in a different Saudi town. But the circumstances and location were unclear last week even to WHO workers monitoring the situation.

WHO officials had expected to hold a press conference on Sunday to announce the results of their latest investigation, but that didn't happen. The press release the agency put out on Monday contained only general statements about the MERS outbreaks in Saudi Arabia and lauded the Saudis for doing "an excellent job in investigating and controlling the outbreaks."

The statement noted that "large gaps" remain in the knowledge of MERS, but cautioned that "it often takes time for scientific investigations to produce results."

MERS first appeared in Saudi Arabia last June, and the coronavirus that causes it was first described last September.

Bird flu resistant to Tamiflu

Drug resistance in new China bird flu raises concern

The new bird flu strain that has killed 36 people in China has proved resistant to Tamiflu for the first time, a development scientists said was "concerning".

Reuters,

28 May, 2013

The H7N9 virus was found to be resistant to Roche's widely used flu drug in three out of 14 patients who were studied in detail by doctors from Shanghai and Hong Kong.

Tamiflu, which is given as a pill, belongs to a group of medicines known as neuraminidase inhibitors that currently offer the only known treatment option for bird flu. GlaxoSmithKline's inhaled medicine Relenza has the same mode of action.

In one patient, the gene mutation responsible for resistance appears to have arisen after infection took hold, probably as a result of treatment with Tamiflu, leading to concerns that medication may be the trigger for resistance to develop.

"The apparent ease with which antiviral resistance emerges in A/H7N9 viruses is concerning; it needs to be closely monitored and considered in future pandemic response plans," the researchers wrote in an article published online by The Lancet medical journal on Tuesday.

Earlier genetic studies had raised worries about drug resistance but this is the first time that the problem has been documented in clinical cases.

For most of the 14 patients studied, Tamiflu successfully reduced the amount of virus found in throat swabs and helped speed clinical recovery. But it had no impact on the amount of virus found in swabs from three patients who became severely ill.

A spokeswoman for Swiss-based drugmaker Roche said rates of Tamiflu resistance remained low globally, but it took the issue of resistance "very seriously" and was collaborating with health authorities to monitor the situation.

The H7N9 virus is known to have infected 131 people in China since February, but no new cases have been detected since early May, according to the World Health Organization.

Experts from the United Nations agency said last week the bird flu outbreak in China had caused some $6.5 billion in losses to the economy.

Scientific studies of the virus have established it is being transmitted from birds - probably mostly chickens - to people. But experts have yet to identify the source of the circulating virus - the so-called "reservoir" - that is leading to chickens contracting it and sporadically passing it on to humans.

Frenchman dies of new coronavirus after trip to Dubai

A Frenchman has died after contracting a SARS-like virus that has killed 22 of its 44 known victims, the Associated Press reported

ABC News,

28 May, 2013

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The 65-year-old man, whose name has not been made public, was hospitalized with respiratory symptoms after a trip to Dubai in mid-April. His hospital roommate also tested positive for the illness, according to the AP.

The new virus, dubbed MERS-CoV for Middle East respiratory syndrome coronavirus, was first identified in September 2012 following the infections of a Qatari man in a British hospital and a woman who died in Saudi Arabia. Like its cousin SARS, severe acute respiratory syndrome, it can cause pneumonia and organ failure. But unlike SARS, which a decade ago sickened more than 8,000 people and killed 775, it doesn't appear to spread as easily from person to person.

Although European countries such as the United Kingdom and France have seen cases of MERS-CoV, the majority of cases have clustered in the Arabian Peninsula, according to the U.S. Centers for Disease Control and Prevention.

"CDC recommends that U.S. travelers to countries in or near the Arabian Peninsula monitor their health and see a doctor right away if they develop fever and symptoms of lower respiratory illness, such as cough or shortness of breath. They should tell the doctor about their recent travel," the agency said in a statement.

Saudi Arabia has seen 32 cases of MERS-CoV, 17 of which were fatal, according to the World Health Organization. The majority of the country's cases stemmed from an outbreak at an Al-Ahsa health care facility, where 22 patients have been sickened by the virus and 10 have died.

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Bird flu

New bird flu can spread to humans

The new H7N9 bird flu virus can be transmitted between mammals not only via direct contact but also in airborne droplets, and may be capable of spreading from person to person, Chinese and American researchers have found.

Stuff,

25 May, 2013

A study published in the journal Science and presented at a briefing in Hong Kong on Friday found that three ferrets - an animal often used for research on flu - that were in the same cage as ferrets infected with H7N9 had contracted the disease.

One of three ferrets kept in separate cages nearby also became infected, through airborne exposure.

The World Health Organization (WHO) has previously said it has no evidence of "sustained human to human transmission" of the virus, which has killed 36 people in China.

"The findings suggest that the possibility of this virus evolving further to form the basis of a future pandemic threat cannot be excluded," said the research team, led by bird flu expert and microbiologist Yi Guan.

The virus can also infect pigs, but could not be transmitted from pig to pig or from pigs to other animals, the study showed, although the team urged authorities to maintain surveillance to check whether the virus was mutating.

The WHO said the findings were useful but warned that people "have to be very careful about what's going on on the ground".

"Studies like that are really helpful for increasing general knowledge and it's really helpful to know that, under lab conditions, this thing could transfer from person to person," WHO chief spokesman Gregory Hartl told Reuters.

"We've already seen maybe a few limited instances of human to human transmission within close family range, within close contacts, so this is another piece of the puzzle," he said.

The findings come just days after the WHO said the H7N9 virus appeared to have been brought under control in China thanks to restrictions at bird markets.

H7N9 has relatively mild clinical signs in ferrets, according to the study. All the animals infected with the virus in the experiments presented symptoms for no more than seven days and all recovered from the disease.

The researchers said that all cases where humans had died or become extremely ill had involved additional factors.

The team also found that some infected animals did not develop fever or other clinical signs, suggesting that asymptomatic infections among humans may also be possible.

"The potential public health implication of this ... is that a person infected by H7N9 avian influenza virus who does not show symptoms could nevertheless spread the virus to others," the researchers wrote in their study.

United Nations experts said this week the bird flu outbreak in China had caused some $6.5 billion in losses to the economy.

The H7N9 virus is known to have infected 131 people in mainland China and one in Taiwan since February, but no new cases have been detected since early May

Bird flu

China's Bird Flu Goes Airborne

Zero Hedge,

23 May, 2013

As if China was not suffering enough from a slumping economy, the South China Morning Post now reports that the H7N9 'bird flu' virus that has infected 131 people (and killed 36) so far can be transmitted not only by close contact but by airborne exposure. 

Domestic reports suggest the virus appears to be brought under control largely through restrictions at bird markets but the team at the University of Hong Kong has also found that pigs can be infected (cue 'when pigs can fly' pun). The findings suggest that there may be many more cases that have been detected or reported since "people may be transmitting the virus before they know they've even got it."

 

For more information on individual patients infected: blue, patients infected with the H7N9 virus under treatment; red, those infected with H7N9 who have died; yellow, those who have fully recovered; and pink, those infected other types of the Influenza A virus, including H1N1.

 

Via SCMP,

The H7N9 bird flu virus can be transmitted not only through close contact but by airborne exposure, a team at the University of Hong Kong found after extensive laboratory experiments.

 

...

 

"We also found that the virus can infect pigs, which was not previously known," said Dr Maria Zhu Huachen, a research assistant professor at HKU's School of Public Health.

 

...

 

It was found the virus could spread through the air, from one cage to another, albeit less efficiently.

 

...

 

This means there may be more cases than have been detected or reported.

 

...

 

"People may be transmitting the virus before they even know that they've got it," Zhu said.

 

...

 

She said the government had collaborated with HKU on intensive surveillance of both birds and pigs. Zhu added that people who regularly had close contact with live poultry or pigs should take precautions, have routine body checks and report their case immediately if they feel unwell.

Influenza

H7N9 case has drug- and non-resistant strains

The only H7N9 patient so far in Taiwan was carrying two strains of the same virus, with one being drug resistant and the other not, making it tricky to treat to him, doctors said

Your Health,

19 May, 2013

Huang Li-min, a doctor from National Taiwan University Hospital (NTUH), explained that it was possible the avian flu virus was not drug resistant when the patient was first infected, but mutated later to become resistant to Tamiflu.

With Tamiflu failing, NTUH later switched to another intravenous drug, Huang said. Because of the presence of the two strains simultaneously, it was difficult for doctors to determine how much the virus' drug resistance had undermined the therapy.

Chou Chi-hao, deputy director-general of the Centers for Disease Control (CDC), said it is natural for viruses to mutate, saying the H1N1 flu strain mutated after infecting human beings.

But Huang said H7N9 has limited chances of human-to-human transmission through respiratory secretions because the virus has difficulty surviving the environments of human upper respiratory systems. Patients do not have symptoms of a runny nose or sneezing.

The patient, surnamed Lee, got sick on April 12, three days after returning from a business trip in China. His condition was initially critical, but has improved much. He has already been transferred from the intensive care unit to an ordinary ward at NTUH.

The findings by the NTUH and CDC about H7N9 are to be published in a local medical journal next month.

New SARS-Like Coronavirus Suspected at New York Hospital

Marketwire,

18 May, 2013

LONG BEACH, CA--(Marketwired - May 18, 2013) - AvianFluTalk.com, an online discussion forum created in 2005 to track the potential threat of an avian flu pandemic, has been the venue for a serious discussion regarding the new SARS-like coronavirus infecting patients at a New York Hospital leaving several in critical condition and resulting in 3 deaths.

The new SARS-like coronavirus recently emerged in the Middle East infecting 41 total worldwide resulting in 20 deaths and is primarily spread by limited human-to-human transmission. Experts fear that the virus' early ability to transmit among humans could spark a global pandemic should the virus mutate further and achieve sustained human transmission.

Nurses working at a St. Luke's hospital in New York have claimed that there are several cases of the new SARS-like virus in the hospital's ICU, which have gone misdiagnosed and that are in fact the new deadly virus.

A nurse who works at the hospital believes there is a potential outbreak of this new SARS-like virus and she too has now been hospitalized with flu-like symptoms. Although hospital administrators have made no comment about this matter, posters on the online message board at avianflutalk.com have indicated through research that it is influenza B. The nurses are disputing that claim stating that in fact the new coronavirus is the culprit.

The nurses feel that they have an obligation to speak-out about their suspicions in this matter.

To follow this rapidly developing story, visit the online discussion forum's latest news section atwww.avianflutalk.com.

Influenza

WHO reports first patient-to-nurse spread of new SARS-like virus

Two health workers in Saudi Arabia have become infected with a potentially fatal new SARS-like virus after catching it from patients in their care - the first evidence of such transmission within a hospital, the World Health Organization said

Reuters,

15 May, 2013

The new virus, known as novel coronavirus, or nCoV, is from the same family of viruses as those that cause common colds and the one that caused the deadly outbreak of Severe Acute Respiratory Syndrome (SARS) that emerged in Asia in 2003.

"This is the first time health care workers have been diagnosed with (novel coronavirus) infection after exposure to patients," the Geneva-based U.N. health agency said in a disease outbreak update late on Wednesday.

The health workers are a 45-year-old man, who became ill on May 2 and is currently in a critical condition, and a 43-year-old woman with a coexisting health condition, who fell ill on May 8 and is in a stable condition, the WHO said.

France has also reported a likely case of transmission within a hospital, but this was from one patient to another patient who shared the same room for two days.

NCoV, like SARS and other similar viruses, can cause coughing, fever and pneumonia.

Scientists are on the alert for any sign that nCoV is mutating to become easily transmissible to multiple recipients, like SARS - a scenario that could trigger a pandemic.

WHO experts visiting Saudi Arabia to consult with the authorities on the outbreak said on Sunday it seemed likely the new virus could be passed between humans, but only after prolonged, close contact.

Initial analysis by scientists at Britain's Health Protection Agency last year found that nCoV's closest relatives were most probably bat viruses. Yet further work by a research team in Germany suggests nCoV may have come through an intermediary - possibly goats.

The WHO's Wednesday update said that, while some health care workers in Jordan had previously contracted nCoV, these Saudi cases were the first clear evidence of the virus passing from infected patients.

"Health care facilities that provide care for patients with suspected nCoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients and health care workers," it said.

It also advised health care providers to be "vigilant among recent travelers returning from areas affected by the virus" who develop severe acute respiratory infections.

Since nCoV first emerged and was identified in September 2012, the WHO says it has been informed of a total of 40 laboratory-confirmed cases worldwide, including 20 deaths.

Saudi Arabia has had most of the cases - with 30 patients infected, 15 of them fatally - but nCoV cases have also been reported in Jordan, Qatar, Britain, Germany and France.

Death toll rises to 36 in H7N9 outbreak

The first patient in China's Hunan province with confirmed H7N9 influenza has died, lifting the outbreak's fatality count to 36, according to official and media reports today.

CIDRAP,

15 May, 2013

The patient is a 64-year-old woman who died yesterday morning at a hospital in Shaoyang, about 20 days after her illness was detected, according to a report from Xinhua, China's state news agency. The source of the information is the Hunan Provincial Health and Family Planning Commission.

The number of new H7N9 infections has tailed off in recent week, with the latest one reported May 7, which edged the number of cases to 131. However, the death toll continues to rise, because many of the previously confirmed patients are still hospitalized, battling the often serious complications of the disease, which can include acute respiratory distress syndrome and organ failure.

It's not clear why the outbreak has stalled. Influenza experts suspect closures of live-poultry markets could be curbing infections in humans, or the virus could be showing a drop in warm weather months seen with other avian influenza viruses. Another possibility is that H7N9 could be dying out, a pattern that has been seen before with other novel flu viruses.

In other developments, a veterinary epidemiologist from Scotland yesterday raised the possibility that H7N9 could emerge and circulate in the poultry trade without a link to commercial farms. Nick Honhold, BVSc, MSc, PhD, a consultant based in Edinburgh, detailed his suggestion in a post on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

Despite extensive testing by Chinese animal health authorities, the virus has not been detected on poultry farms and has mainly been found in a fairly small number of poultry wholesalers and live-poultry markets. The lack of poultry farm findings has been one of the puzzling aspects of the H7N9 outbreak.

Honhold wrote that the poultry market and trading system in China is varied and complex and more testing is needed to determine the proportions of people who had contact with poultry markets who did and didn't get sick. He added, however, that the lack of another common source suggests that live-poultry markets must somehow be involved.

He questioned if movements of birds, equipment, and people between the markets could spread and maintain the disease. Also, he wrote that more details are needed about the farms that have been tested for the virus, such as whether they're backyard units or facilities that are supplying the markets.

An understanding of China's poultry market system is essential to understanding how the virus could be spreading, he wrote. China's system might resemble that of other countries in which collection points aggregate birds from several sources before smaller shipments make their way to live markets.