UNDIAGNOSED ILLNESS - GERMANY: (HAMBURG) RESPIRATORY, FATAL, REQUEST FOR INFORMATION

Published Date: 2013-04-11 09:46:51
Subject: PRO/AH/EDR> Undiagnosed illness - Germany: (HH) respiratory, fatal, RFI 
Archive Number: 20130411.1636626

Date: Wed 10 Apr 2013
Source: Bild [in German, machine trans., edited]
http://www.bild.de/regional/hamburg/viren/toetet-polizisten-im-uke-29943928.bild.html


A 49 year old policeman is dead, 5 other persons are ill and doctors are puzzled by this mysterious disease just outside of Hamburg.

Andreas Breitner, Minister of the Interior, confirmed to the "Schleswig Holstein newspaper" the death of the 49-year-old policeman at the University Medical Center Hamburg-Eppendorf (UKE) on Tuesday [9 Apr 2013], after multi-organ failure.

Another policeman, aged 38 years is in critical condition. He is suffering from similar flu symptoms, including severe pneumonia.

A teacher from the Schacht Audorf area near Rendsburg has also died of multi-organ failure in the UKE, and according to unconfirmed reports, 3 other persons from the same region are seriously ill.

All are suffering from flu-like symptoms but the doctors do not know what disease is affecting them. It could be a "degenerated virus" [?mutated], the "Schleswig Holstein" newspaper reporter quotes" an official.

District spokesperson Martin Schmedtje said: "Both policemen showed the same clinical picture. However, we do not know yet whether there is a pathogen or whether a pathogen was actually the cause."

After investigation there are no known connections between both colleagues.

Police spokesperson Sonke Hinrichs said, "the 2 policemen did not work in the same agency, were not on duty together, do not live in the same place. There is no visible connection, but naturally we are working together to try to find out what has happened."

The hospital is also investigating a possible link. UKE spokesperson Christine Jaehn said, "At present no patients with unusual infectious diseases are being treated in the UKE intensive care unit. Moreover, no accumulation of patients exists in the Rendsburg area."

Public health authorities in Rendsburg-Eckernfoerde have been activated since Friday [5 Apr 2013].

But so far nobody knows what this deadly disease is. On Wednesday evening [10 Apr 2013] the Rendsburg-Eckernfoerde District Administrator announced, " Despite the efforts of the specialists involved we have not been able to identify a pathogen."

However, the danger has been estimated as low. District spokesman Martin Schmedtje said, "a recommendation from the health services to close public facilities as a precaution is not necessary. General hygiene measures taken in times of rampant influenza, are sufficient."

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ProMED-mail


[Given the heightened awareness of the public and public health community for severe acute respiratory illness (SARI) and the identification of 2 new novel organisms producing SARI -- the novel coronavirus (nCoV) identified in individuals with contact with Middle Eastern countries and the appearance of human cases of influenza H7N9, an avian influenza virus in Eastern China, a report such as the one above is potentially cause for concern. Other reports on this occurrence in Germany have been posted on FluTrackers (http://www.flutrackers.com) where there is mention that the fatality referred to in the newswire above was found to be attributable to influenza, but a specific virus was not mentioned (?H1N1, H3N2).

As there is no history of travel outside of Germany, the likelihood of this being due to infection with either the nCoV or the avian influenza H7N9 is very low. More information on the results of laboratory studies and other investigations would be greatly appreciated.

Rendsburg-Eckernfoerde is a district in Schleswig-Holstein, Germany. It is bordered by (from the east and clockwise) the city of Kiel, the district of Ploen, the city of Neumuenster, the districts of Segeberg, Steinburg, Dithmarschen, and Schleswig-Flensburg, and the Baltic Sea (seehttp://en.wikipedia.org/wiki/Rendsburg-Eckernf%C3%B6rde for a map and additional information on the District).

Mysterious flu insecure Bay Audorf

Dead cop

11th April 2013 

A 49-year-old policeman died from a mysterious flu. Mayor Eckard Reese in shaft Audorf in Rendsburg-Eckernförde is now besieged with questions. "It is no use to stoke rumors," he says.

Schacht-Audorf. When Mayor Eckard Reese in shaft Audorf (Rendsburg-Eckernförde) on Wednesday was a lot of running. After the message had made ​​the rounds that on Tuesday a 49-year-old police officer died of a mysterious flu and a colleague will be treated seriously ill in the ICU of the University Hospital Eppendorf needs, representatives of TV channels, radio stations and newspapers from all over northern Germany traveled to the channel community to learn more.

"I can only confirm that a police officer has died and I have heard of the illness of a colleague," said Reese. Of panic he had felt in the community nothing: "It is no use to foment unrest and spread rumors and whether the death of a young teacher, five weeks ago in connection with the current cases is, to identify professionals.."

The rumor mill

Despite all the efforts of the participating specialists it was not been possible to identify a pathogen Schmedtje said Martin, the Speaker of Rendsburg-Eckernförde.He acknowledged, however, that the patients were treated with antibiotics, "That could at least theoretically be one reason that nothing was found." However, it striking that the number of reported flu cases in Schleswig-Holstein is increased compared to the prior year.

In shaft Audorf the rumors long before the publication of serious diseases. "We've done it for some time concerned about it, how to turn a simple flu so life-threatening diseases," said a woman who declined to give her name. Another Audorfer had learned from the cases only from the newspapers. "This is very disturbing," he said."Rumors and uncertainty will probably fall silent only when it is determined officially, what causes are responsible." http://www.shz.de/nachrichten/top-thema/artikel/verunsicherung-und-medienrummel-in-schacht-audorf.html

Flu death of a police officer remains a mystery

Fatal pneumonia

11th April 2013

The death of a police officer from the district of Rendsburg-Eckernförde raises further questions. Despite all efforts, it is the specialists so far failed to identify a pathogen.

Kiel. High pressure physicians looking for days the virus, which is in the ranks of Rendsburg police responsible for two cases of severe lung diseases, one of which is fatal. That occur in a relatively small group of police two diseases of similar gravity, holds the director of the Institute for Infectious Diseases of UKSH in Kiel, Helmut Fickenscher, for "unusual". Because the two policemen are suffering to a greater distance in time, but there is no direct connection in infectious diseases. It could also be a coincidence, and thus to cases with separate causes.

Among the specific cases may manifest the professor of the Institute of Infectious Diseases at the University of Kiel not, but the probabilities of individual causes of disease. The fact was that there are currently different flu viruses are on the road, including the virus of the so-called "swine flu", which in most patients causes only mild symptoms, but with a few more young people, very severe cases of pneumonia show.

"There is no evidence"

Unlikely Fickenscher holds that in connection with the police this week brought Q fever is important. That'll about herd animals - mostly sheep - widespread and occurs in summer in conjunction with dust. "There were a few opportunities this winter," said Fickenscher.

Also, infection with the H7N9 virus currently circulating in Asia excludes the infectiologist. "There is no evidence." Especially since there were no reports so far on a human-to-human transmission, so there is direct contact with poultry in Asia would be necessary.

No geographical linkage to the Middle East

Highly dangerous for he holds the SARS-like corona virus, which has now been demonstrated in Arabia. In Germany, the first time a man died of the new virus. A 73-year-old was on 19 March has been seriously ill postponed from Abu Dhabi to Munich for treatment. The two policemen Rendsburger Fickenscher was loud but no geographical linkage to the Middle East known. Therefore this corona virus in these cases is extremely unlikely.

Remains but the flu, which rarely takes a serious course, especially when the lung experienced by a viral infection, superinfection with bacteria. "Pneumococci and staphylococci can be with joy down there, where the mucous membrane is already damaged." Such courses of disease he had seen several times in recent years.The patients were ventilated and survived. http://www.shz.de/nachrichten/top-thema/artikel/toedliche-lungenentzuendung-aerzte-raetseln-ueber-ursache.html

Mysterious death: cops worried

11th April 2013 | 00:05 clock | By mor

Neumünsteraner colleagues sympathize with those affected Rend burgers / hygiene is paramount

Neumünster. Sentiment in the police is pressed. After a co-worker (49), in the district of Rendsburg-Eckernförde did his service, died apparently of a mysterious flu-like pathogen, the investigators also mourn in Neumünster. Because the Rendsburger policemen belong to police headquarters Neumünster, there is a personal connection to many colleagues in the neighboring district. That another colleague (38) is life-threatening illness with similar symptoms, prepares them also worry. He also belongs to the district of Rendsburg (the Courier reported). "The death of colleagues and the severe disease are certainly a topic with colleagues," said police spokesman Rainer Wetzel. "In particular, of course, are the officials of the district in Rendsburg affected that have made ​​the service colleagues," said the spokesman. "But we try to approach the subject as objectively as possible," said Rainer Wetzel. These included hygiene instructions to all officials have been made ​​in this connection attention once more. On a business meeting was also pointed out to wash after contact with other people's hands and disinfect if necessary. "It's about the whole classical rules," said the police spokesman. There were free to everyone to be examined by a doctor. "That was actually took place - especially from the Rendsburger colleagues," it said. still physicians and other experts are looking for the cause of dangerous diseases. While both showed a similar disease and policemen were among others with severe pneumonia admitted to the University Hospital Eppendorf (UKE) in Hamburg, but they provided no shared their service, not previously met on missions and did not live in the same place. Whether it is possible to get a flu with particularly severe course is, as some experts suggest, is still unclear. "But of course, every police officer can decide for himself whether he can get a flu shot," said Rainer Wetzel.  http://www.shz.de/nachrichten/lokales/holsteinischer-courier/artikeldetails/artikel/raetselhafter-tod-polizisten-in-sorge.html

HK education chief alerts schools on H7N9

(Xinhua)

19:53, April 11, 2013   

HONG KONG, April 11 (Xinhua) -- Hong Kong Secretary for Education Eddie Ng onThursday urged all schools to stay vigilant to prevent the spread of communicable diseases, especially H7N9.

During a visit to a local school, Ng said the government is concerned about the H7N9virus, and bureaus and departments have liaised closely on preventive and control measures.

"We have already provided the Guidelines on Prevention of Communicable Diseases for schools to guard against communicable diseases," Ng said, adding that the bureau has also issued a letter to schools, together with the Center for Health Protection' s advice, to remind them to stay vigilant.

He also said the bureau and the center would continue to provide schools with timel y advice and guidelines, and will organize health talks for schools in April and May for healthcare staff to share their expertise on preventing and controlling communicable diseases.

The local school management briefed Ng on raised alertness and the crisis management team set up to coordinate measures including strengthened home-school cooperation, under which parents check their children's body temperature daily and record it in student handbooks.

Speaking to media after the visit, Ng said the government has established preventive measures at boundary control points, such as facilities to measure body temperature.There are also arrangements on coaches for cross-boundary students.

The measures for schools with students crossing the boundary is the same as that oflocal schools, including hand-washing procedures and encouraging students tomeasure their body temperature and not attend school if feeling unwell. http://english.peopledaily.com.cn/90882/8204158.html?

Nation on high alert for bird flu / Airports, local govts prepare for outbreaks

April 12, 2013

[The Yomiuri Shimbun]

Local governments and airports throughout Japan are on high alert against the new strain of bird flu in anticipation of its global outbreak as the death toll from the disease is increasing slowly but steadily in China.

To develop a vaccine, the Health, Labor and Welfare Ministry has obtained the H7N9 strain from China, where its infection of humans was reported for the first time on March 31. "I'd say the current situation is two stages prior to the major outbreaks of the disease four years ago," an official of the ministry said Wednesday.

The first cases of the disease were announced last month by Chinese authorities, who said two of three patients had died. Since then, the number of patients has steadily increased, totaling 33 as of Wednesday. The death toll stands at nine.

According to the World Health Organization, there were two suspected cases of patients within the same "family clusters" in China that may have been the first cases of human-to-human infection.

The ministry said it believes that the cases of infection within the same families announced by WHO were the results of individual infections occurring in an enclosed space and not necessarily the product of human-to-human infection, which could trigger a pandemic.

The ministry, however, did not rule out the possibility of a global outbreak of the disease as a virus can mutate into something more highly contagious.The health ministry's assessment that the current situation is "two stages prior" to the major outbreak in 2009 was based on significant differences in the surrounding circumstances.

After the disease was confirmed in Mexico and elsewhere in April 2009, the avian flu instantly spread to many countries. The strain was confirmed in humans in Japan the following month. This time, however, the H7N9 strain has been found only in areas of China, including Shanghai and the provinces of Anhui and Jiangsu. The spread of the infection has also been much slower than in 2009.

The ministry obtained the virus Wednesday from the Chinese Center for Disease Control and Prevention to develop a vaccine at the National Institute of Infectious Diseases.

To combat the strain, the Japanese government has decided to introduce a special law for dealing with new types of influenza Friday, earlier than scheduled. The law will enable the government to declare a state of emergency and allow heads of local governments to ask their residents to voluntarily stay indoors.

Stepping up prevention measures

Airports and local governments have started taking measures to check for bird flu.At airports including Narita, Kansai and Shin-Chitose, posters that urged passengers to China "not to come close to animals without caution" and to "wash your hands often" were put up in the quarantine areas. Thermographic devices at the quarantine station were used to scan the body temperatures of passengers for cases of high fever.Local governments including Hokkaido, Kyoto and Fukuoka prefectures asked medical institutions to immediately report any possible cases of infection to public health authorities. The Osaka prefectural government held a meeting last week to address the situation. The prefectural government planned to increase its stock of Relenza, an antiviral drug.

However, little progress has been made in securing the human resources to conduct virus testing and establishing outpatient departments at hospitals specialized in handling the virus.Local government officials said they would examine such measures if confirmed cases of human-to-human infection arise. http://the-japan-news.com/news/article/0000125214?

Bird Flu Causing Suffocation Shows Severe Spectrum of New Virus

By Jason Gale - Apr 11, 2013 7:38 AM ET

Bird flu turned fatal for a 52- year-old Shanghai woman whose lungs became so damaged that she began to suffocate, causing her vital organs to rapidly shut down, doctors in China said.

The retiree became ill March 27, with a fever that soared as high as 40.6 degrees Celsius (105.1 Fahrenheit), doctors at Huashan Hospital in Shanghai wrote in a report on the case in the journal Emerging Microbes & Infections. Treatment with intravenous antibiotics, steroids, antibody therapy, and mechanical ventilation failed to help, and she died April 3.

4:17

April 9 (Bloomberg) -- Malik Peiris, professor of medical science at the University of Hong Kong’s School of Public Health, talks about the outbreak of deadly bird flu in China. He speaks with Susan Li on Bloomberg Television's "First Up." (Source: Bloomberg)

3:49

April 8 (Bloomberg) -- Gregory Hartl, a spokesman for the World Health Organization, discusses the outbreak of H7N9 avian influenza in China. He speaks from Geneva with Francine Lacqua and Guy Johnson on Bloomberg Television's "The Pulse." (Source: Bloomberg)

Her illness, the first H7N9 avian influenza case to be described in a medical journal, highlights the seriousness of the new strain, which has sickened at least 35 people in eastern China, killing 10, in the past two months. Hospital doctors didn’t know the cause of the woman’s illness when she was admitted. Tests identified the H7N9 virus after she died.

“What they had here was a seriously ill patient and they didn’t know what was going on,” said Dominic Dwyer, director of the Institute of Clinical Pathology and Medical Research at Sydney’s Westmead Hospital, who reviewed the case report. “This person was so ill, they just threw everything” at her.

More than two dozen cases have been reported since the woman’s death, spurring heightened vigilance for the new strain, which the World Health Organization said doesn’t appear to be spreading from person to person.

Anti-flu Drugs

“All fatal cases in Shanghai, including this patient, were admitted to hospital very late until the symptom of shortness of breath developed,” Feifei Yang and colleagues at Huashan Hospital wrote in the journal.

Without knowing the cause of their disease, the patients weren’t offered anti-flu drugs, such as Roche Holding AG’s (ROG) Tamiflu, that might have helped them fight the virus, especially if taken within the first few days of their illness, the authors said.

The woman began experiencing fevers and chills on March 27. After several days, she developed a cough, tightness in her chest and difficulty breathing. A chest X-ray showed severe pneumonitis and she was given antibiotics. Her condition worsened and a week after her symptoms began, she was hospitalized for acute respiratory distress syndrome and died the next day.

Blood tests showed cardiac enzymes that suggest the patient had a heart attack, Dwyer said, referring to the published case report. Her heart complications may have been caused by the virus directly or the effects of “trying to push blood through a very heavily congested lung,” he said.

“This is what happens with severe influenza, even if it doesn’t go outside the lung,” Dwyer said. “The big question here is, are these severe cases the tip of a very big iceberg or do most cases get really ill like this?’

To contact the reporter on this story: Jason Gale in Melbourne at j.gale@bloomberg.net

http://www.bloomberg.com/news/2013-04-11/bird-flu-causing-suffocation-shows-severe-spectrum-of-new-virus.html?

China’s Actions in Flu Cases Draw Critics

Ray Young/European Pressphoto Agency

TAKING STEPS A clinic for H7N9 avian influenza at a hospital in Shanghai. Of the 31 people who have been reported stricken by H7N9, nine are dead, one has recovered and the rest are hospitalized.

By KEITH BRADSHER

Published: April 10, 2013

HONG KONG — Of all the mysteries surrounding the emergence of a new and deadly strain of avian influenza around Shanghai, one of the biggest is why China’s hundreds of medical and veterinary labs did not spot the problem sooner — or if they did, why it was not disclosed.

Even the censored Chinese news media has begun cautiously questioning why the authorities did not say anything sooner about a disease that resulted in the first known human case in eastern China on Feb. 19, but was not announced to the public until March 31. The announcement came two weeks after the closing of the National People’s Congress, a show event during which the Communist Party traditionally avoids acknowledging problems.

“People are still asking, why did it take the government so long to confirm the outbreak?” The Communist Youth Daily, the official newspaper of the Communist Youth League, said in a column several days ago. “The transparency of information from the government is still being called into question by the public, and the actions the government has taken have not convinced the public.”

China’s health ministry is now finding three to five human cases a day, a brisk pace for a disease that Chinese officials and the World Health Organization assert is still transmitted from animals to people, and not from person to person. The Centers for Disease Control and Preventionin Atlanta activated its emergency operations center this week as governments around the world began making preparations in case of a flu pandemic.

Yet Chinese government officials have not yet publicly identified any farms with poultry infected with the new strain of bird flu, H7N9 avian influenza. The government has focused so far on closing wholesale markets in Shanghai and several nearby cities, and it has sent guards with nets to chase pigeons in Shanghai parks, to snare and later euthanize the potentially infected birds.

Chinese health officials assert that they have acted promptly upon laboratory confirmation of cases. Agriculture officials have said less, but they have also said that they are being transparent.

Western health officials and scientists say that they do not know whether China deliberately concealed the disease for six weeks after the first person fell sick with it; China says lab confirmation did not come until March 29. But they note that unusual properties of the virus, together with a controversial Chinese response to a previous bird flu outbreak of distributing millions of free vaccines, may have made the outbreak harder than usual to detect at first.

The virus can be detected in animals in two ways: a widely used, easily performed test for antibodies in the serum or plasma of poultry, known as a serology test, or a much more expensive and difficult experiment to isolate specific viruses from the birds, which can only be done in a few well-equipped labs in China.

The crucial question is whether veterinary technicians were doing serology tests only for H5N1 bird flu, which has been a chronic problem in China for 16 years, or whether they were testing for a broader range of avian influenza viruses and misread, ignored or decided not to publicize any detection of H7N9.

Chinese officials have been largely silent on the details of their test protocols. The Agriculture Ministry had no immediate response to questions submitted by fax on Wednesday.

Dr. Juan Lubroth, the chief veterinary officer of the United Nations’ Food and Agriculture Organization, said that he suspected China had been testing broadly for more avian influenza viruses than just H5N1. “When you are running a serology, you usually don’t run it against one, you run it against a battery of viruses that you know are circulating,” he said in a telephone interview.

But while H7N9 has been spotted before in the West, it has not been documented before this spring in East Asia. Dr. Lubroth said that he did not know the details of the Chinese test protocol, and that if the Chinese were focused on H5N1 test results, these tests would not detect H7N9.

At least 31 human cases, including nine deaths, have been confirmed by the Chinese government so far, and the Chinese police have been detaining people who assert on the Internet that there are more cases. Chinese officials say that one patient has recovered and the rest are still sick in hospitals, mostly in serious or critical condition.

Dr. Malik Peiris, the director of the Center of Influenza Research at Hong Kong University, said that another serious challenge in finding the disease was that poultry, unlike people, can be infected with H7N9 and show very few symptoms. So Chinese technicians may not have seen a need to do much testing in recent months when there was little sign of H5N1, which does kill chickens.

“Generally people don’t go around testing apparently healthy poultry,” he said.

The World Organization for Animal Health, a veterinary group in Paris that sets international standards for animal care, has a mandatory policy for China and other member countries. Members must report all outbreaks of highly pathogenic avian influenza in wild or domesticated birds, and outbreaks of low-pathogenic avian influenza in domesticated birds.

Dr. Alex Thiermann, the president of the organization’s standard-setting Code Commission, said that H7N9 qualifies as a low-pathogenic bird flu virus, so China had an international obligation to report it to the World Organization for Animal Health. China did so last week.

Dr. Thiermann said that the organization’s rules allowed a country to fully confirm the presence of a virus before reporting it, but he declined to say whether he thought China had been slow in reporting it.

He also expressed concern that China might have initially missed the virus because of its controversial approach to fighting H5N1 virus ever since the disease led to mass deaths of chickens in 2004 and 2005: a massive vaccination for poultry across the country. The advantage of vaccination is that while it does not stop all infections, it reduces the amount of virus that a bird sheds when infected. The disadvantage is that the poultry develops antibodies to the virus, so serology tests become unreliable.

Dr. Thiermann says that his organization recommends mass culling of birds as a more reliable way to stamp out a disease and then monitor for any resurgence. He warned that vaccination for H5N1 might have masked the emergence of H7N9.

Dr. Arnold Monto, a professor of epidemiology at the University of Michigan, said that there might have been a slight delay in disclosing the emergence of the virus in people, since the Chinese government had already calculated the entire genetic sequence of the virus before announcing it. But other scientists said that decoding a gene sequence can now be done in China in two days and was a natural step before announcing the disease.

Dr. Monto said that the difficulty in spotting the virus in seemingly healthy poultry had made the whole task more complex than usual. “You’ve got to give them credit for identifying it,” he said. “The thing that is worrisome is the virus itself.” http://www.nytimes.com/2013/04/11/world/asia/delay-on-china-avian-flu-announcement-questioned.html?pagewanted=1&_r=0&smid=tw-share

Shanghai new three patients with confirmed cases of the H7N9 avian flu which deaths

As of 17:00 today, the city's newly confirmed cases of human infection of H7N9 avian influenza: Jeong, 74-year-old retiree; Kang, female, 83 years old, retired personnel; Tangmou, male, 68 years old, retired back recruits. Which, Jeong died by the rescue efforts. Currently, Shanghai found 18 confirmed cases, including 6 deaths, 11 cases are isolated treatment, patients have recovered and been discharged.http://sh.qq.com/a/20130411/000387.htm?qq=0&ADUIN=562944693&ADSESSION=1365666117&ADTAG=CLIENT.QQ.5059_.0&ADPUBNO=26123

Shanghai new confirmed three cases

 April 11: According to the Shanghai Municipal Government Information Office official microblogging "Shanghai release" message, as of 17:00 today, the city of new confirmed cases of human infection of H7N9 avian influenza: Jeong, male, 74 years old, retired personnel; Kang, female, 83 years old, retired personnel; Tangmou, male, 68 years old, retired back to the recruits. Which, Jeong died by the rescue efforts. Currently, Shanghai found 18 confirmed cases, including 6 deaths, 11 cases are isolated treatment, patients have recovered and been discharged.  http://sh.eastday.com/m/20130411/u1a7317859.html

Scientists questioned China delay conceal the epidemic

Chinese every day in the increase in the number of cases of human infection with the H7N9 avian influenza virus. The latest report from the Ministry of Health is the country reported a total of 33 confirmed cases, of which nine people died. The first case of human infection with avian influenza virus is known on February 19 Sunrise now, but the official has until March 31 to the public disclosure of this disease. Western health officials and scientists doubt that China is not deliberately conceal the epidemic, drag it to the first person recognized infections six weeks after the announcement to the outside world. Montone (Arnold Monto), professor of epidemiology at the University of Michigan, said that in view of the Chinese government before the announcement of the disease has calculated the entire genetic sequence of the virus, the Chinese may be a slight delay in the disclosure infected. But other scientists said that China decoding a gene sequence only takes two days, and prior to the announcement of the disease, the decoding is an inevitable step.http://www.solidot.org/story?sid=34248

H7N9 avian flu onset to death fastest 6 days

The law reporters late Statistics found from existing cases reported in the majority of patients from the onset to treatment, six days apart. From 9 deaths from onset to death, the shortest six days, the longest 30 days. By age 21, 55 years of age or older, and accounted for 60%.http://www.kaixian.tv/R1/n1786920c11.shtml

Thailand stocks up antiviral drugs against bird flu

Thursday April 11, 2013 MYT 11:22:00 AM

BANGKOK: Thailand has stocked up some four million doses of antiviral drugs, as part of the Ministry of Public Health's high alert against deadly bird flu of all strains, Thai News Agency (TNA) reported.

Public Health Minister Dr. Pradit Sinthawanarong told reporters that his ministry has also closely coordinated with experts of the Thai Ministry of Agriculture and Cooperatives' Department of Livestocks Development, the Geneva-based World Health Organisation (WHO) and Thailand MOPH-US CDC Collaboration (TUC) to monitor the updated situation although there have been no bird flu cases reported in Thailand for over seven years.

Dr. Pradit acknowledged that his ministry's moves are in response to latest reports that current outbreaks of the new deadly H7N9 avian flu in China have killed three more people, while the H5N1 strain has re-emerged in neighbouring Cambodia and Vietnam, with eight fatalities in Cambodia alone so far.

Dr. Pradit said there has been no evidence that both the H7N9 and the H5N1 avian influenza of the A-strain, spreading in China, Vietnam and Cambodia, has been spread from human to human, insisting that two antiviral drugs, including oseltamivir and zanamivir, remain effective for bird flu patients.

According to updated reports, there have been three more H7N9 fatalities in China, bringing the death toll from the H7N9 virus in the country to nine, from a total of 21 patients so far.

Vietnam, meanwhile, has recorded one H5N1 patient, a four year-old boy, while the same viral strain has killed eight people in Cambodia lately. 

http://thestar.com.my/news/story.asp?file=/2013/4/11/nation/20130411112455&sec=nation

Residents in China ordered to cull poultry

Residents of a Chinese city were ordered to cull all their poultry as authorities stepped up attempts to halt the spread of the deadly H7N9 bird flu, state media reported Thursday.

Thousands of birds and livestock were slaughtered by the Tuesday midnight deadline in Nanjing, in the eastern province of Jiangsu, the China Daily said.

The number of cases of the H7N9 strain of avian influenza rose to 33 on Wednesday, with nine deaths since China announced over a week ago that it had been found in humans for the first time.

Residents who did not comply with the regulation in Nanjing would fined up to 50 yuan ($8), the China Daily said, adding that local officials offered help to kill birds and animals, with more than 2,000 dispatched by the authorities.

The newspaper also indirectly quoted an agricultural official in Beijing saying that the measure "goes too far and could cause panic".

Shanghai has culled more than 111,000 birds, banned trading in live poultry and shut markets in a bid to curb the outbreak.

Nanjing and the city of Suzhou followed suit with bans on live poultry trade, while Hangzhou culled poultry after discovering infected quail.

In China poultry is often bought live from markets and taken home before being slaughtered, cooked and eaten.

Meanwhile, the state-run Global Times reported Thursday that anti-bird nets were being erected in poultry farms in Beijing to prevent possible avian flu infection from migrant birds.

"With the weather getting warmer, migrant birds are back now but there is still not enough food for them in Beijing," the newspaper quoted a spokesman for Beijing Infectious Animal Plague Prevention Office as saying.

"It is possible that they will seek food in open poultry farms with free range poultry. If there are H7N9 carriers, other birds might get infected and that is why we made this decision," the official added. http://uk.news.yahoo.com/residents-china-ordered-cull-poultry-033525931.html?#5hFaUMZ

Nanjing culling of more than 8,000 live birds into cold storage to send archive the rest buried alive

2013-04-11 16:12:4

 Nanjing culling three major markets over 8000 nearly 8 percent of the live poultry sent to cold storage "isolation" and the rest buried

　　In response to the bird flu epidemic, Nanjing suspended Purple Mountain Wholesale Poultry Market, Tin Indian Hill Wholesale Poultry Market, and Jianye poultry warehouse three poultry wholesale market, and sealed more than 8,000 live birds.

　　The Modern Express reporter Expand visits have all learned that more than 8,000 live birds have been culled. For the archive live poultry processing and subsidy standards, the person in charge of the Nanjing Bureau of Commerce, Li did not formulate a unified standard, but by the various District government, and processed according to the actual situation.

　　Jianye

: More than a thousand poultry have been buried

　　Jianye District poultry warehouse, archive of more than 1,000 birds, mainly ducks, as well as 97 geese.

　　Market-disclosure, April 6, all of these poultry culling is completed and buried "taken innocuous treatment."

　　Subsidies for business users, the Modern Express reporter learned that, all amounts due April 9th ​​the Jianye District Government has allocated. A total of five or six million. Doing we average one duck around $ 50. In this regard, a market source said, "the price and the market price is almost the price can also" the next two days, the money will continue to be released into the hands of business users.

　　The Zijinshan: All cold storage archive

　　The Zijinshan poultry wholesale market, the archive of more than 6000 live poultry.

　　COAG concerned parties involved in the live poultry slaughter process, over 6000 poultry slaughter, spent two or three days. The wholesale market management sent a lot of employees, we take advantage of the electric hair removal machine overnight overtime, and finally slaughtered all finished. "We slaughtered side side of disinfection treatment to ensure that the scene was not hidden dangers of humans and animals to cross-infection."

　　More than 6,000 birds, buried in a short time in the main city, is more difficult to find such a place. "According to to COAG persons, after the slaughter, all poultry arrangements shipped to Vanguard, a large cold storage processing. It is understood that the cold storage is closed, the poultry into them equal isolation. Brought into the library, quarantine officers also affix the seal. Recently, the Agriculture Committee will also samples from cold storage testing, to see whether the avian flu virus. If all poultry will be unified harmless. Poultry is shipped fully gone comprehensive disinfection, quarantine officers on the wholesale market.

　　It is understood that the Purple Mountain subsidy payments of over 6000 live poultry, Xuanwu District Government has also allocated amounts totaling about 30 million, down an average of one to four or five poultry. This is closer to the market price. According to the wholesale market to concerned parties, I heard that the money now to the Leading Group of the District of avian flu prevention and control work, payment will be arranged by the group, "should these two days can be sent to the hands of the market dealers."

　　The days Indian Hill: The amount of subsidy being uncertain

　　The number of day Indian Hill wholesale market of live poultry at least a total of more than 870.

　　It is understood that, on April 7, these live birds had harmless and buried. For the case of subsidies, an unnamed source, the current the emergency consultations district, as soon as possible. For a specific amount of subsidies, this person said, will certainly be developed based on the market price.http://news.lcxw.cn/china/yaowen/20130411/359745.html

Tamiflu-resistance gene in H7N9 bird flu spurs drug tests

A gene mutation known to help influenza resist Tamiflu was found in the first of three H7N9 bird-flu patient specimens in China, sequence data show.

The flu virus from the patient in Shanghai has a mutation known as R292K that causes high-level resistance to the Roche Holding AG (ROG) pill and reduced sensitivity to a related drug from GlaxoSmithKline Plc (GSK) called Relenza, genetic sequence information posted on the website of the Global Initiative on Sharing Avian Influenza Data show. Subsequent H7N9 specimens from a patient in Shanghai and one in Anhui province don’t show the mutation.

The finding of the mutation warrants further analysis, said Masato Tashiro, a director at Japan’s National Institute of Infectious Diseases in Tokyo. Preliminary tests so far show no evidence that the new flu strain, which has sickened at least 33 people, killing nine, in eastern China, has developed resistance to the neuraminidase inhibitor drugs Tamiflu and Relenza, the World Health Organization said in a statement yesterday.

“When you look at the raw data and compare the three strains of the virus, there’s a signal from one strain that it’s less sensitive to both of the neuraminidase inhibitors,” Tashiro said in a telephone interview. “It’s not a strong signal, but there’s a possibility” of resistance, he said.

The Chinese Center for Disease Control and Prevention in Beijing has studied H7N9 specimens and confirmed that the virus is sensitive to neuraminidase inhibitors, Tashiro said.

“At this point, we should accept what the Chinese CDC says,” he said.

More experiments are needed to understand the biological significance of gene sequence data, said Gavin Smith, an associate professor in the emerging infectious diseases program at Singapore’s Duke-NUS medical school.

Absence of the R292K mutations “would be of less concern than having them there, but it still needs to be tested,” said Smith. “They provide an indication of the type of things we should be looking at.”

http://www.bloomberg.com/news/2013-04-11/tamiflu-resistance-gene-in-h7n9-bird-flu-spurs-drug-tests.html

Jiangsu new patients diagnosed two cases of human infection with the H7N9 avian influenza

Health Department of Jiangsu Province, April 11 Bulletin, Jiangsu Province, newly confirmed two cases of human infection with the H7N9 avian influenza.

　　Patients surnamed Yin, male, 31 years old, now a hotel in Yangzhou City in chefs work. Disease, March 31 at noon on April 11, the provincial Expert Group on the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases. Currently, where a critical condition in a hospital in Nanjing. After investigation, the close contacts of the case has a total of 19 people, far showed no abnormality.

　　Patients Qianmou, male, 56 years old, now live in the Suzhou Industrial Park, teachers. Onset of April 3, April 11 at noon, the provincial expert group diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases.Currently in a hospital in Suzhou City, where a critical condition. After investigation, the close contacts of the cases there were 33 people, far showed no abnormality.

http://news.cntv.cn/2013/04/11/ARTI1365667687146955.shtml

H7N9 found in more poultry samples in China

China's agriculture authority said on Wednesday that its tests have found 14 more H7N9-positive poultry samples in east China.

The avian flu virus, so far responsible for the deaths of nine people nationwide, was detected in 11 chicken samples from Jiangsu, two duck samples from Zhejiang and one duck sample from Anhui Province, the Ministry of Agriculture said in a statement.

All of the samples were collected from poultry markets in those regions.

After gene sequence analysis, the national avian flu reference laboratory concluded that the strain of the H7N9 virus found on those 14 samples was highly congeneric with that found on a pigeon on April 4.

The ministry has ordered the three provinces to shut down the marketplaces from which the samples were taken and cull all live poultry there. Thorough disinfection is obligatory.http://www.china.org.cn/china/2013-04/10/content_28507469.htm?