Hunan new H7N9 avian influenza

[16:39] 01/05/2013
Hunan Province, today confirmed a new human cases of H7N9 avian influenza infection. The 69-year-old male patient Zhao, Shaoyang City Wugang farming. On May 24, the disease, is currently in critical condition. Zhao before the onset of a history of exposure to poultry, its close contact with a total of 50 people have been taken under medical observation, has not found exception.http://news.on.cc/cnt/china/20130501/bkn-20130501163949274-0501_00922_001.html

China culls birds as flu deaths mount

Published on 30 Apr 2013

Scientists Infect Chicks in Race to Halt Bird Flu Spread

By Jason Gale - Apr 30, 2013 7:06 PM 

Deep inside a high-security laboratory an hour from Melbourne, scientists working behind air-locked doors inject six-week-old chickens with a virus that has killed one in five people it’s known to have infected.

The pathogen is H7N9 bird flu, and it came to Australia’s second-biggest city 12 days ago in a 0.5 milliliter sample -- 10 would fit on a teaspoon -- from a patient in China’s Anhui province. Antibodies from the chickens will help create tests for the virus, part of a race to head off a global outbreak.

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Scientists conduct research at the Australian Animal Health Laboratory (AAHL) in Geelong, Australia. The center received on April 19 a half a milliliter specimen of the H7N9 virus taken from a patient in China’s Anhui province. Source: CSIRO via Bloomberg

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A scientist conducts tests inside an air-locked chamber in a biosecurity level-3 area of the Australian Animal Health Laboratory (AAHL) in Geelong, Australia on April 30, 2013. Photographer: David Williams/CSIRO via Bloomberg

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“If one in five people getting infected die, that’s a pretty frightening infection to be confronted with,” said Dr. Peter Daniels, assistant director of the Australian Animal Health Laboratory (AAHL). “It may be that it won’t start spreading person to person. If it does, the world is facing a severe disease situation.” Source: CSIRO via Bloomberg

While disease trackers have yet to pinpoint how the 127 human infections in China and Taiwan occurred, they say contact with poultry is the most likely cause. Birds carry the disease without showing symptoms, making tests to monitor farms and markets vital to halting its spread, said Peter Daniels, assistant director of the Australian Animal Health Laboratory.

“If one in five people getting infected die, that’s a pretty frightening infection,” said Daniels, 64, whose lab is the world’s largest high-security bio-containment research facility. “It may be that it won’t start spreading person to person. But if it does, the world is facing a severe disease situation.”

An earlier bird flu strain known as H5N1, first isolated from a farmed goose in China’s Guangdong province in 1996, has infected wild birds and domestic poultry in more than 60 countries over the past decade. That virus, which killed 60 percent of the 628 people known to have been infected, doesn’t spread efficiently from human to human. That’s unlike a novel swine flu virus known as H1N1 that emerged inMexico in 2009 and spread worldwide in months.

1918 Pandemic

Wild birds are the primary natural reservoir for influenza viruses capable of causing pandemics, according to the Centers for Disease Control and Prevention in Atlanta. The 1918 Spanish Flu pandemic, which killed as many as 50 million people, began when an avian flu virus jumped to people who had no immunity to the new strain, doctors say.

H7N9 isn’t known to have infected humans before, so no one has immunity to it. Drugmakers including Melbourne-basedCSL Ltd. (CSL) and Beijing-based Sinovac Biotech Ltd. (SVA) have started to prepare for the possible need to make immunizations, which would be triggered by widespread human-to-human infections in multiple regions.

Dead Crows

H7N9 has already moved outside mainland China. Last week, officials in Taiwan reported a case in a 53-year-old man who had just returned to Taiwan via Shanghai after a business trip to the eastern city of Suzhou. The man is in critical condition, doctors said. Government officials in Yokohama, on the outskirts of Tokyo, are testing wild birds for avian flu after 17 crows and a pigeon were found dead, Yomiuri Shimbun said yesterday.In the past week, the Australian Animal Health Laboratory, or AAHL as its known locally, dispatched samples of the virus’s genetic material to Indonesia and Vietnam as reagents for tests that can detect H7N9 viral material in tissue specimens, which would indicate acute infection, Daniels said. Three more countries will receive specimens this week, with further shipments planned.

Opened in 1985 by the Australian government, AAHL looks like an enormous, grey-concrete bunker. Its six floors have 65,000 square meters (700,000 square feet) of space, a labyrinth of laboratories and animal enclosures. The only windows to the outside are in the cafeteria. The building was designed to operate for 100 years, withstanding 1-in-10,000-year natural disasters such as 300 kilometer-per-hour winds and magnitude 5.8 earthquakes.

Kate Winslet

Its research on disease-causing microbes such as the Nipah and Hendra viruses earned it a mention in the 2011 movie “Contagion” starring Matt Damon and Kate Winslet.

The H7N9 antibodies are being raised in the center’s Diagnostic Emergency Response Laboratory, opened five years ago in a part of the building once used for bottle-washing. It can process 10,000 antibody tests and 1,000 genetic tests a day, Daniels said. Inside the secure building lab, capable of safely handling the most lethal and virulent biological agents known to mankind, the H7N9 virus is replicated in sterile, fertilized hen’s eggs inside an air-locked chamber.

The lab is also producing antisera -- blood serum containing antibodies -- against H7N9 in ferrets for the World Health Organization. The material will be used to assist in identifying infections in people, said Ian Barr, deputy director of the WHO’s Collaborating Center for Reference and Research on Influenza in Melbourne.

Commercial Flight

That center, on the fringe of Melbourne’s downtown, was the original destination for the specimen from China. After being transported on a commercial flight from Beijing in a tightly packed vial inside a sealed foam carton, the virus was replicated in 15 eggs before samples were sent to Daniels’ lab three days later, Barr said.

“It grows very well, this virus,” Barr said.

The ferret research will help public health officials understand the new virus’s ability to cause disease in mammals, and to determine whether it spreads via direct contact alone or can be transmitted by coughing and sneezing.

Early indications from experiments with ferrets in the U.S. suggest that infections caused by the virus aren’t as severe as those from the H5N1 bird flu strain, typically not extending beyond the respiratory tract, Barr said, adding that more research is needed to validate the findings. Antisera collected from the ferrets will help scientists determine whether H7N9 is undergoing important genetic changes, he said.

“We need to remain very vigilant,” Barr said. “It’s still on the precipice of potentially tipping over from isolated animal-human infections to something more serious.”http://www.bloomberg.com/news/2013-04-30/scientists-infect-chicks-in-race-to-halt-bird-flu-spread.html

the Longyan H7N9 patients Luomou condition has improved

2013/5/1 7:16:05 Source: Taiwan News Online　

▲ the Longyan H7N9 patients Luomou condition has improved

High-risk elderly mortality stronger than SARS

[02:30] 2013/05/01
 H7N9 avian influenza in Hong Kong threat looming.CHP's new discovery and infectious animal diseases Scientific Committee meeting yesterday to analysis of the latest outbreak, the next six months is the key, so far found that the elderly are a high risk group of H7N9, 5% of the patients in the Mainland over the age of 60, elderly mortality Bi Shashi higher .Chairman of the Committee, the University of Hong Kong, Department of Microbiology, Chair Professor Yuen Kwok-yung warning, H7N9 has not yet signs of human to human transmission, Mainland outbreak can be controlled below the stage, must have an impact on Hong Kong, to improve border and poultry epidemic prevention.  http://news.on.cc/cnt/news/20130501/bkn-20130501023031374-0501_00822_001.html

US HHS Approves Emergency H7N9 Diagnostics

Recombinomics Commentary 21:15
April 30, 2013

On April 19, 2013, the Secretary determined that there is a significant potential for a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad and that involves the avian influenza A (H7N9) virus.
 
The above comments are from the US Health and Human Service (HHS)notice entitled “Determination and Declaration Regarding Emergency Use of in Vitro Diagnostics for Detection of the Avian Influenza A (H7N9) Virus”.  The notice allows use of an unapproved diagnostic test for the detection of H7N9 bird flu.

Although WHO has cited a lack of evidence for efficient human to human transmission of H7N9, the sequence data provides compelling evidence for sustained transmission in Jiangsu Province (see map), which is further supported by the export of H7N9 from Jiangsu Province to Taiwan via a traveler using a commercial airline.  The export of H7N9 suggests the levels of H7N9 infections are markedly higher than the lab confirmed cases, which relies on an insensitive assay which has produced an alarming number of false negatives, when samples from the upper respiratory tract are used.

The emergency notice by the US HHS provides addition evidence for efficient human H7N9 transmission, WHO denials notwithstanding.

Notice.

SUMMARY

The Secretary of Health and Human Services (HHS) is issuing this notice pursuant to section 564(b) of the Federal Food, Drug, and Cosmetic (FD) Act, 21 U.S.C. 360bbb-3(b)(4). On April 19, 2013, the Secretary determined that there is a significant potential for a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad and that involves the avian influenza A (H7N9) virus.

On the basis of this determination, she also declared that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection of the avian influenza A (H7N9) virus pursuant to section 564(b)(1) of the FD&C Act, 21 U.S.C. § 360bbb-3(b)(1), subject to the terms of any authorization issued under that section. The Secretary also specified that this declaration is a declaration of an emergency with respect to in vitro diagnostics as defined under the Public Readiness and Emergency Preparedness (PREP) Act Declaration for Pandemic Influenza Diagnostics, Personal Respiratory Protection Devices, and Respiratory Support Devices signed by then Secretary Michael Leavitt on December 17, 2008.1

173 FR 78362 (Dec. 22, 2008).

 

TABLE OF CONTENTSBack to Top

• DATES:
• FOR FURTHER INFORMATION CONTACT:
• SUPPLEMENTARY INFORMATION:
• I. Background
• II. Determination by the Secretary of Health and Human Services
• III. Declaration of the Secretary of Health and Human Services
• Footnotes

DATES:Back to Top

The determination and declaration are effective April 19, 2013.

FOR FURTHER INFORMATION CONTACT:Back to Top

Nicole Lurie, M.D., MSPH, AssistantSecretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW., Washington, DC 20201, Telephone (202) 205-2882 (this is not a toll free number).

SUPPLEMENTARY INFORMATION:Back to Top

I. BackgroundBack to Top

Under Section 564 of the FD&C Act, the Commissioner of the Food and Drug Administration (FDA), acting under delegated authority from the Secretary of HHS, may issue an Emergency Use Authorization (EUA): (1) Authorizing the emergency use of an unapproved drug, an unapproved or uncleared device, or an unlicensed biological product; or (2) an unapproved use of an approved drug, approved or cleared device, or licensed biological product. Before an EUA may be issued, the Secretary of HHS must declare an emergency justifying the authorization based on one of four determinations: (1) A determination of a domestic emergency, or a significant potential for a domestic emergency, by the Secretary of Homeland Security; (2) the identification of a material threat by the Secretary of Homeland Security pursuant to section 319F-2 of the Public Health Service (PHS) Act ^[2] sufficient to affect national security or the health and security of United States citizens living abroad; (3) a determination of a military emergency, or a significant potential for a military emergency, by the Secretary of Defense; or (4) a determination by the Secretary that there is a public health emergency, or a significant potential for a public health emergency, that affects, or has a significant potential to affect, national security or the health and security of United States citizens living abroad, and that involves a biological, chemical, radiological, or nuclear agent or agents, or a disease or condition that may be attributable to such agent or agents (see 21 U.S.C. 360bbb-3(b)(1)). ^[3]

Based on any of these four determinations, the Secretary of HHS may then declare that circumstances exist that justify the EUA, at which point the FDA Commissioner may issue an EUA if the criteria for issuance of an authorization under section 564 of the FD&C Act are met.

The Centers for Disease Control and Prevention (CDC), HHS, requested that the FDA, HHS, issue an EUA for in vitro diagnostics for detection of the avian influenza A (H7N9) virus to allow the Department to take preparedness measures based on information currently available about the avian influenza A (H7N9) virus detected in China. The determination of a significant potential for a public health emergency, and the declaration that circumstances exist justifying emergency use of in vitro diagnostics for detection of the avian influenza A (H7N9) virus by the Secretary of HHS, as described below, enable the FDA Commissioner to issue an EUA for certain in vitro diagnostics for emergency use under section 564(a) of the FD Act, 21 U.S.C. 360bbb-3(a).

II. Determination by the Secretary of Health and Human ServicesBack to Top

On April 19, 2013, pursuant to section 564(b)(1)(C) of the FD Act, 21 U.S.C. 360bbb-3(b)(1)(C), I determined that there is a significant potential for a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad and that involves the avian influenza A (H7N9) virus.

III. Declaration of the Secretary of Health and Human ServicesBack to Top

Also on April 19, 2013, on the basis of my determination of a significant potential for a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad and that involves the avian influenza A (H7N9) virus, I declared that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection of the avian influenza A (H7N9) virus pursuant to section 564 of the FD Act, 21 U.S.C. 360bbb-3, subject to the terms of any authorization issued under that section.

I also specified that this declaration is a declaration of an emergency with respect to in vitro diagnostics as defined under the PREP Act Declaration for Pandemic Influenza Diagnostics, Personal Respiratory Protection Devices, and Respiratory Support Devices signed by then Secretary Michael Leavitt on December 17, 2008.

Notice of the EUAs issued by the FDA Commissioner pursuant to this determination and declaration will be provided promptly in theFederal Register as required under 21 U.S.C. 360bbb-3(h).

Dated: April 19, 2013.

Kathleen Sebelius,

Secretary.

[FR Doc. 2013-10055 Filed 4-29-13; 8:45 am]

BILLING CODE 4150-37-P

FOOTNOTESBack to Top

1. 73 FR 78362 (Dec. 22, 2008).

2. 42 U.S.C. 247d-6b.

3. As amended by the Pandemic and All-Hazards Preparedness Reauthorization Act, Public Law 113-5, the Secretary may make determination of a public health emergency, or a significant potential for a public health emergency, under section 564 of the FD Act. The Secretary is no longer required to make a determination of a public health emergency in accordance with section 319 of the PHS Act, 42 U.S.C. 247d to support a determination or declaration made under section 564 of the FD Act.Show citation box

Back to Contexthttps://www.federalregister.gov/articles/2013/04/30/2013-10055/determination-and-declaration-regarding-emergency-use-of-in-vitro-diagnostics-for-detection-of-the

Evidence For Sustained H7N9 Human Transmission

Recombinomics Commentary 03:15
April 30, 2013

The Zhejiang Provincial Center for Disease Control and Prevention has released full sequences from two H7N9 bird flu cases, A/Zhejiang/1/2013 (37M) and A/Zhejiang/2/2013 (64M) and they are to be commended for the rapid release of these important sequences.  The age, gender, and collection dates suggest these sequences originated from the cases that generated A/Hangzhou/1/2013 (by the Hangzhou Center for Disease Control and Prevention) and A/Zhejiang/DTID-ZJU01/2013 (by the State Key Laboratory of Diagnosis and Treatment of Infectious Diseases at Zhejiang University).  The recent sequences confirmed that the earlier case (37M) had H7 L226I and PB2 E627K, while the second case (64M) had H7 Q226L and PB2 D701N, all of which are mammalian adaptation markers.  Both of these cases were fatal and detail was provided in the recent Lancet paper  These sequences were from Patient #1 and Patient #3, respectively (see map).

The recently released avian sequences had Q226L, which had not been reported previously in H7  (or H5).  However, Q226L has become common in avian H9N2 sequences and the close relationship of the six H7N9 internal genes to H9N2 sequences suggests these internal genes were compatible with Q226L in avian hosts.  However, the PB2 changes(E627K and D701N) have not been identified in any of the recent H7N9 sequences from live markets in and around Shanghai, and some have speculated that these mammalian adaptations happened in the human cases.  However, the presence of E627K in six of the seven human cases and the absence in any of the avian cases does not support the repeated acquisition E627K.  The presence of L226I, another mammalian adaptation, in the two sequences from the earlier case (who has been described as 39M, 38M, and 37M) raises serious questions about a recent avian source, since this adaptation has not been reported in any of the avian sequences.

Moreover, the recently released  H7 sequence from a Jiangsu case (45M), A/Jiangsu/01/2013, also has L226I, and the H7 sequence is identical to A/Hangzhou/1/2013 and A/Zhejiang/1/2013.  Although the PB2 sequence from A/Jiangsu/01/2013 has not been released, N9 and MP sequences are public and both sequences exactly match A/Hangzhou/1/2013.  The H7 and N9 sequences have synonymous changes (A1215C and T409C, respectively), which are also not present in other human or avian sequences, strongly supporting clonal expansion.
However, there is no reported contact between the two cases.  The earlier case is a chef who lived in Hangzhou, but worked in Jiangsu, while the second case was from Jiangsu, but not near the occupational local for the first case.  The identity in the three sequences from cases without contact with each other strongly supports sustained human to human transmission, which is also supported by the presence of PB2 E627K in 6 of the 7 human cases 9and absence in all five if the avian PB2 sequences.

This sustained transmission contradicts WHO statements, which rely on testing of upper respiratory tract samples, which have produced frequent false negatives.  In contrast to the negative data cited by WHO, the exact matches in the two cases above provides clear evidence for sustained human transmission.  Release of a full set of sequences from the Jiangsu case would be useful (and quite doable since the sequences from the first three gene segments were from an egg isolate).

The WHO claims of no evidence of H2H transmission, and the failure to address the identities in the human H7N9, continue to raise serious pandemic concerns.

Damietta completely free of bird flu Chinese

 

Denied Dr. Hamdy Hawass, Undersecretary of the Ministry of Health in Damietta, the existence of any state reserved the hospital diets Damietta infected with bird flu . Hawass said he was "no truth to the rumors about the existence of a new type called bird flu Chinese , "noting that the province of Damietta completely free of the disease . , adding that the situation called نعسة Ibrahim that rumors it was the first case of bird flu was suspected case and not injured . pointed senses that the cases that have reached the hospital fevers Damietta, all of which were negative and non-carriers of the disease, did not witness this year, any outbreak of the disease so far .
http://www.el-balad.com/475371

We're Not Prepared For China's Deadly Bird Flu

4/30/2013 @ 8:35AM |

In Asia, more than 120 people have been sickened, and 23 are dead, from a potent strain of bird flu that has the frightening markings of a potential pandemic strain.

We have grappled with deadly pockets of potent flu outbreaks before. But this one has characteristics that make it different.

There’s a greater risk that this strain could acquire the ability to spread more easily from person to person. If it does, it could have devastating consequences.

That’s because we may not be ready. We have the capacity to make a vaccine. But we may not have the time. What we need are oral drugs that can combat a wide range of different pandemic flu strains. For the most part, we don’t have these medicines.

The number of confirmed H7N9 bird flu cases in Mainland China increased by five on Sunday, the country’s official Xinhua news agency reported. Four provinces — Zhejiang, Shandong, Jiangxi and Fujian — reported illnesses.

Like other strains of bird flu, this H7N9 virus affects mostly poultry – and has spread mostly to people handling chickens.

The Chinese Government suspects that there have already been human-to-human cases – proof that the virus has developed the capacity to spread by people. Of the patients analyzed so far, half appear to have had no contact whatsoever with poultry. Officials from the World Health Organization have confirmed that this new strain transmits to humans more easily than previous bird flues. American health authorities have confirmed the human spread.

Moreover, a case has already been reported outside China — an equally worrisome development.

Another problem is the absence of visible illness in poultry infected with the new virus. This makes it harder to track the spread of the disease, and to eradicate its source by slaughtering stricken birds.

Right now, 18 percent of the cases in China have ended in death. This is less deadly than the previous avian flu outbreak in China six years ago (that H5N1 bird flu virus killed more than 300 people after spreading from China to other countries in 2006). But this new strain has characteristics that make it perhaps more problematic.

One flu expert, John Oxford from Queen Mary University in London, told Reuters this week that this new strain of bird flu is “very, very unsettling.” It’s, in fact, a mixture of three different types of bird flu variants and “seems to have been quietly spreading in chickens without anyone knowing about it,” he said.

As Reuter’s noted, recent pandemic viruses, including the H1N1 “swine flu” that spread through the United States in 2009 and 2010, have been mixtures of mammal and bird flu. These kinds of hybrids are more likely to be milder because mammalian flu tends to make people less severely ill than bird flu.

By contrast, pure bird flu strains, such as the new H7N9 virus that’s now spreading in China, are generally more deadly for people.

So are we ready to battle a pandemic strain of bird flu if this new virus picks up the capacity to more efficiently spread from person to person?

For the most part, our strategy for preparing for pandemic flu focuses on the development of vaccines. We’ve made a lot of strides in recent years developing the tools and infrastructure for rapidly developing just such vaccines.

Moreover, countries where these viruses often get their start (in Asia) have become much more aggressive and transparent at combating early outbreaks.

Our tools for surveillance and quarantine in the U.S. have also gotten a lot better.

But there’s good reason to believe this may not be enough.

What we really need are potent antiviral medicines with broad activity against many different strains of pandemic virus. These drugs could be used not only to treat infected patients, but as a prophylaxis in those who might be exposed to the bug.PAGE 2 OF 2

In the event of a full-blown outbreak of pandemic flu, there may not be enough time or capacity to develop an effective vaccine and to deliver it.

Antiviral drugs can also be effective at containing early outbreaks, before they become a full-blown pandemic.

Moreover, we may not know that a strain has turned into a pandemic until its too late to scale up vaccine production, which can take six months or longer if we have trouble getting a viral seed stock to use in that process.

Finally, the government may be skittish at undertaking a costly, crash program to develop a vaccine until a pandemic is already manifested.

The Feds got a spate of criticism for their expensive effort to rapidly develop a vaccine to the H1N1 swine flu strain the rippled through the country in 2009 – a government effort that by most reasonable measures was not only prudent, but successful. Yet the political fallout from that episode could make public officials skittish next time, giving the virus a dangerous chance to get the jump on us.

The mix of programs that we have put in place over the last decade to combat a potential pandemic has generally underinvested in developing oral antiviral drugs. Yet there are a number of promising drugs already on the shelf, and with adequate investment, it seems likely more could be developed.

An adequate vaccine is an important tool. But it may not be enough — or come in time. We have given comparatively short shrift to developing an oral antiviral with broad applicability to a range of pandemic strains. Yet we need one on our shelf if we’re going to be ready for this bird flu outbreak, or a future one.

http://www.forbes.com/sites/scottgottlieb/2013/04/30/were-not-prepared-for-chinas-deadly-bird-flu/?

HK Health chief urges strict hygiene

Health chief urges strict hygiene

April 30, 2013

Centre for Health Protection Controller Dr Leung Ting-hung has called for strict personal and environmental hygiene, as the next six months will be critical in the development of the avian influenza A(H7N9) virus.
 
He made the appeal after today's Scientific Committee on Emerging & Zoonotic Diseases meeting, with its Chairman Prof Yuen Kwok-yung.
 
They said while the public should not be overly worried about the situation, the possibility of H7N9 being imported to Hong Kong from the Mainland cannot be ruled out, so people should maintain good personal hygiene by washing hands frequently especially before touching their eyes, nose and month, and to avoid contact with live poultry.
 
Dr Leung said the coming months will be critical in the virus' development, and it cannot be predicted whether and when it will be transmitted among humans, therefore good personal and environmental hygiene must be kept at the highest standard at all times.
 
He said measures are already in place against any possible H7N9 case spreading in Hong Kong, including stringent monitoring of suspected cases and strengthening exchange of information with international and Mainland health organisations and authorities.
 
A working group will formulate medical strategy and make suggestions to frontline doctors on how to treat such cases.
 
More manpower has been deployed to boundary checkpoints to monitor the body temperature of travellers.
 
Prof Yuen said so far the genetic and epidemiological data indicates low efficiency in human to human transmission of the virus. However, as H7N9 does not kill poultry, it has been difficult to monitor, adding public vigilance must be maintained. http://www.news.gov.hk/en/categories/health/html/2013/04/20130430_143130.shtml