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Thursday, May 2, 2013

AVIAN INFLUENZA, HUMAN (68): H7N9, USA VIEW


A ProMED-mail post
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International Society for Infectious Diseases
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Date: Wed 1 May 2013
Source: MMWR Morb Mortal Wkly Rep 2013; 62 (early release); 1-6 [summ., edited]
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0501a1.htm?s_cid=mm62e0501a1_e


Emergence of avian influenza A(H7N9) virus causing severe human illness -- China, February-April 2013

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On 29 Mar 2013, the Chinese Center for Disease Control and Prevention completed laboratory confirmation of 3 human infections with an avian influenza A(H7N9) virus not previously reported in humans (1). These infections were reported to the World Health Organization (WHO) on 31 Mar 2013, in accordance with International Health Regulations. The cases involved 2 adults in Shanghai and one in Anhui Province. All 3 patients had severe pneumonia, developed acute respiratory distress syndrome (ARDS), and died from their illness (2). The cases were not epidemiologically linked. The detection of these cases initiated a cascade of activities in China, including diagnostic test development, enhanced surveillance for new cases, and investigations to identify the source(s) of infection. No evidence of sustained human-to-human transmission has been found, and no human cases of H7N9 virus infection have been detected outside China. This report summarizes recent findings and recommendations for preparing and responding to potential H7N9 cases in the United States. Clinicians should consider the diagnosis of avian influenza A(H7N9) virus infection in persons with acute respiratory illness and relevant exposure history and should contact their state health departments regarding specimen collection and facilitation of confirmatory testing.

Epidemiologic investigation
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As of 29 Apr 2013, China had reported 126 confirmed H7N9 infections in humans, among whom 24 (19 per cent) died (1). Cases have been confirmed in 8 contiguous provinces in eastern China (Anhui, Fujian, Henan, Hunan, Jiangsu, Jiangxi, Shandong, and Zhejiang), 2 municipalities (Beijing and Shanghai), and Taiwan. Illness onset of confirmed cases occurred during 19 Feb-29 Apr 2013. The source of the human infections remains under investigation. Almost all confirmed cases have been sporadic, with no epidemiologic link to other human cases, and are presumed to have resulted from exposure to infected birds (3,4). Among 82 confirmed cases for which exposure information is available, 63 (77 per cent) involved reported exposure to live animals, primarily chickens (76 per cent) and ducks (20 per cent) (3). However, at least 3 family clusters of 2 or 3 confirmed cases have been reported where limited human-to-human transmission might have occurred (3).

The median age of patients with confirmed infection is 61 years (interquartile range: 48-74); 17 (21 per cent) of the cases are among persons aged 75 years or older and 58 (71 per cent) of the cases are among males. Only 4 cases have been confirmed among children; in addition, a specimen from one asymptomatic child was positive for H7N9 by real-time reverse transcription-polymerase chain reaction (rRT-PCR). Among the 71 cases for which complete data are available, 54 (76 per cent) patients had at least one underlying health condition (3). Most of the confirmed cases involved severe respiratory illness. Of 82 confirmed cases for which data were available as of 17 Apr 2013, 81 (99 per cent) required hospitalization (3). Among those patients hospitalized, 17 (21 per cent) died of ARDS or multiorgan failure, 60 (74 per cent) remained hospitalized, and only 4 (5 per cent) had been discharged (3).

Chinese public health officials have investigated human contacts of patients with confirmed H7N9. In a detailed report of a follow-up investigation of 1689 contacts of 82 infected persons, including health care workers who cared for those patients, no transmission to close contacts of confirmed cases was reported, although investigations including serologic studies are ongoing (3). In addition, influenza surveillance systems in China have identified no sign of increased community transmission of this virus. Seasonal influenza A(pH1N1) and influenza B viruses continue to circulate among persons in areas where H7N9 cases have been detected, and the Chinese Centers for Disease Control and Prevention has reported that rates of influenza-like illness are consistent with expected seasonal levels.

CDC, along with state and local health departments, is continuing epidemiologic and laboratory surveillance for influenza in the United States. On 5 Apr 2013, CDC requested state and local health departments to initiate enhanced surveillance for H7N9 among symptomatic patients who had returned from China in the previous 10 days (5). As of 29 Apr 2013, 37 such travelers had been reported to CDC by 18 states. Among those 37 travelers, none were found to have infection with H7N9; 7 had an infection with a seasonal influenza virus, one had rhinovirus, one had respiratory syncytial virus, and 28 were negative for influenza A and B. Among 31 cases with known patient age, 7 travelers were aged less than 18 years, 13 were aged 18-64 years, and 11 were aged 65 years or older. In addition, influenza activity in the United States is low and continues to decrease, with morbidity and mortality surveillance systems reporting activity below seasonal baseline levels. Although low numbers of influenza viruses are being detected, the majority in recent weeks have been influenza B.

Laboratory investigation
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As of 30 Apr 2013, Chinese investigators had posted 19 partial or complete genome sequences from avian influenza A(H7N9) viruses to a publicly available database at the Global Initiative on Sharing All Influenza Data (http://www.gisaid.org). Sequences are from viruses infecting 12 humans and 5 birds, and 2 are from viruses collected from the environment. These sequences indicate that all 8 genes of the H7N9 virus are of avian origin, with the closest phylogenetic relatives from 3 Eurasian influenza virus lineages (H7N3 from domestic ducks, H7N9 from wild birds, and H9N2 from birds widely distributed throughout East Asia). In addition, genetic changes in the sequences are present that have been associated with adaptations leading to enhanced virus binding to and replication in mammalian respiratory cells and increased severity of infection (2,4,6).

Immediately after notification by Chinese health authorities of the H7N9 cases, CDC began development of a new H7 diagnostic test for use with the existing CDC influenza rRT-PCR kit. This test has been designed to diagnose infection with Eurasian H7 viruses, including the recently recognized China H7N9 and other representative H7 viruses from Southeast Asia and Bangladesh. On 22 Apr 2013, this new H7 test was cleared by the Food and Drug Administration for use as an in vitro diagnostic test under an Emergency Use Authorization, thus allowing distribution and use of the test in the United States. The CDC H7 rRT-PCR test is now available to all qualified US public health and US Department of Defense laboratories and WHO-recognized National Influenza Centers globally and can be ordered from the Influenza Reagent Resource (http://www.influenzareagentresource.org). Access to the CDC H7 rRT-PCR test protocol is available at http:/www.cdc.gov/flu/clsis. Guidance on appropriate biosafety levels for working with the virus and suspect clinical specimens is being developed.

Animal investigation and US animal health preparedness activities
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As of 26 Apr 2013, reports from the China Ministry of Agriculture indicate that 68 060 bird and environmental specimens have been tested, 46 (0.07 per cent) were confirmed H7N9-positive by culture (7). The H7N9 virus has been confirmed in chickens, ducks, pigeons (feral and captive), and environmental samples in 4 of the 8 provinces and in Shanghai municipality. As of 17 Apr 2013, approximately 4150 swine and environmental samples from farms and slaughterhouses were reported to have been tested; all swine samples were negative. (Additional information available at http://www.chinacdc.cn). The China Ministry of Agriculture is jointly engaged with the National Health and Family Planning Commission in conducting animal sampling to assist in ascertaining the extent of the animal reservoir of the H7N9 virus. Sampling of animals is concentrated in the provinces and cities where human cases have been reported. Poultry markets in Shanghai and other affected areas have been closed temporarily, and some markets might remain closed.

The US Department of Agriculture (USDA) has set up a Situational Awareness Coordination Unit with a core team of subject matter experts and other USDA representatives, including the Animal and Plant Health Inspection Service (APHIS), the Agricultural Research Service (ARS), the Food Safety and Inspection Service, and the Foreign Agricultural Service. USDA and CDC are working collaboratively to understand the epidemiology of H7N9 infections among humans and animals in China. To date, no evidence of this strain of avian influenza A(H7N9) virus has been identified in animals in the United States. The US government does not allow importation of live birds, poultry, and hatching eggs from countries affected with highly pathogenic avian influenza. The current US surveillance program for avian influenza in commercial poultry actively tests for any form of avian influenza virus and would be expected to detect avian influenza A(H7N9) if it were introduced to the United States. A screening test for avian influenza is available from the National Animal Health Laboratory Network and the National Veterinary Services Laboratories (NVSL), which can be used together with confirmatory tests at NVSL to detect this strain of avian influenza A(H7N9) in poultry and wild bird samples.

Editorial note
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The epidemiology of H7N9 infections in humans so far reveals that most symptomatic patients are older (median age: 61 years), most are male (71 per cent), and most had underlying medical conditions. In comparison, among the 45 avian influenza A(H5N1) cases reported from China during 2003-2013, the median patient age is 26 years (8). This difference in median age might represent actual differences in exposure or susceptibility to H7N9 virus infection and clinical illness, or preliminary H7N9 case identification approaches might be more likely to capture cases in older persons. Ongoing surveillance and case-control studies are needed to better understand the epidemiology of H7N9 virus infections, and to determine whether younger persons might be more mildly affected, and therefore less likely to be detected via surveillance.

Available animal testing data and human case histories indicate that most human patients have poultry exposure; however, relatively few H7N9 virus-infected birds have been detected. During the month after recognition of H7N9, increasing numbers of infected humans have been identified in additional areas of eastern China, suggesting possible widespread occurrence of H7N9 virus in poultry. Enhanced surveillance in poultry and other birds in China is needed to better clarify the magnitude of H7N9 virus infection in birds and to better target control measures for preventing further transmission.

The emergence of this previously unknown avian influenza A(H7N9) virus as a cause of severe respiratory disease and death in humans raises numerous public health concerns. First, the virus has several genetic differences compared with other avian influenza A viruses. These genetic changes have been evaluated previously in ferret and mouse studies with other influenza A viruses, including highly pathogenic avian influenza A(H5N1) virus, and were associated with respiratory droplet transmission, increased binding of the virus to receptors on cells in the respiratory tract of mammals, increased virulence, and increased replication of virus (5). Epidemiologic investigations have not yielded conclusive evidence of sustained human-to-human H7N9 virus transmission; however, further adaptation of the virus in mammals might lead to more efficient and sustained transmission among humans. Second, human illness with H7N9 virus infection, characterized by lower respiratory tract disease with progression to ARDS and multiorgan failure, is significantly more severe than in previously reported infection with other H7 viruses. Over a 2-month period, 24 deaths (19 per cent of cases) have occurred, compared with only one human death attributed to other subtypes of H7 virus reported previously. Third, H7N9-infected poultry are the likely source of infection in humans, but might not display illness symptoms. Consequently, efforts to detect infection in poultry and prevent virus transmission will be challenging for countries lacking a surveillance program for actively identifying low-pathogenicity avian influenza in poultry. In the United States, an active surveillance program is in place that routinely identifies low-pathogenicity viruses. If this newly recognized H7N9 is detected, public health and animal health officials should identify means for monitoring the spread of asymptomatic H7N9 virus infections in poultry and maintain vigilance for virus adaptation and early indications of potential human-to-human transmission.

Beginning in early April 2013, CDC and US state and local health departments initiated enhanced surveillance for H7N9 virus infections in patients with a travel history to affected areas. A new CDC influenza rRT-PCR diagnostic test has been cleared by the Food and Drug Administration under an Emergency Use Authorization and is being distributed to public health laboratories to assist in evaluating these suspect cases. Clinicians should consider the possibility of H7N9 virus infection in patients with illness compatible with influenza who 1) have traveled within 10 days of illness onset to countries where avian influenza A(H7N9) virus infection recently has been detected in humans or animals, or 2) have had recent contact (within 10 days of illness onset) with a person confirmed to have infection with avian influenza A(H7N9) virus. Because of the potential severity of illness associated with avian influenza A(H7N9) virus infection, CDC recommends that all H7N9 patients (confirmed, probable, or under investigation for H7N9 infection) receive antiviral treatment with oseltamivir or zanamivir as early as possible. Treatment should be initiated even more than 48 hours after onset of illness. Guidance on testing, treatment, and infection control measures for H7N9 cases has been posted to the CDC H7N9 website (9).

On 5 Apr 2013, CDC posted a Travel Notice on the Traveler's Health website informing travelers and US citizens living in China of the current H7N9 cases in China and reminding them to practice good hand hygiene, follow food safety practices, and avoid contact with animals (10). CDC and WHO do not recommend restricting travel to China at this time. If travelers to China become ill with influenza signs or symptoms (such as, fever, cough, or shortness of breath) during or after returning from their visit, they should seek medical treatment and inform their doctor about their recent travel. Travelers should continue to visithttp://www.cdc.gov/travel or follow @CDCtravel on Twitter for up-to-date information about CDC's travel recommendations.

Given the number and severity of human H7N9 illnesses in China, CDC and its partners are taking steps to develop a H7N9 candidate vaccine virus. Past serologic studies evaluating immune response to H7 subtypes of influenza viruses have shown no existing cross-reactive antibodies in human sera. In addition, CDC has activated its Emergency Operations Center to coordinate efforts. In the United States, planning for H7N9 vaccine clinical trials is under way. Although no decision has been made to initiate an H7N9 vaccination program in the United States, CDC recommends that local authorities and preparedness programs take time to review and update their pandemic influenza vaccine preparedness plans because it could take several months to ready a vaccination program, if one becomes necessary

CDC also recommends that public health agencies review their overall pandemic influenza plans to identify operational gaps and to ensure administrative readiness for an influenza pandemic. Continued collaboration between the human and animal health sectors is essential to better understand the epidemiology and ecology of H7N9 infections among humans and animals and target control measures for preventing further transmission.

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ProMED-mail


[The preceding report provides an account of the current H7N9 outbreak from a US perspective (the complete report and references are available at the source URL above). State and local health authorities are being encouraged to review pandemic influenza preparedness plans to ensure response readiness. Clinicians in the US should consider H7N9 virus infection in recent travelers from China who exhibit signs and symptoms consistent with influenza. Patients with H7N9 virus infection (laboratory-confirmed, probable, or under investigation) should receive antiviral treatment with oral oseltamivir or inhaled zanamivir as early as possible.

The report includes a map of the confirmed cases and deaths from avian influenza A(H7N9) in China as of 29 Apr 2013. At that point China had reported 126 confirmed cases of H7N9 infection, of which 24 (19 per cent) have resulted in death. The map displays the locations of the confirmed cases in 8 contiguous provinces in eastern China (Anhui, Fujian, Henan, Hunan, Jiangsu, Jiangxi, Shandong, and Zhejiang), 2 municipalities (Shanghai and Beijing), and Taiwan.  http://www.promedmail.org/direct.php?id=20130502.1686919

WHO warning risk outbreak influenza pandemic poultry H7N9



Thursday, 2/5/2013 14 o'clock | Print post write Print this page
Variants new of virus flu poultry H7N9, outbreak at Trung Quoc in time has just through, is termites seriously threaten respect with humans. The experts belonging Health Organization world (WHO) day 1/5 has put out statement above in press conference in the capital London, Anh.
According the experts, virus flu-H7N9 is strains of virus can cause high mortality and can is the cause lead to a global pandemic. Currently, child people have ability infected with virus H7N9 from poultry, and not yet found evidence shows this virus spread from human to human. However, virus flu-H7N9 have two-style genetic mutations, thing which do increase ability spread from human to human. If this ability happen, here will is conditions causing influenza pandemic H7N9 in humans.
One house science working at Institute medical research national Anh for that virus flu H7N9 spread self due in environment live in time increasingly long then risk of it spread from person to person increasingly high. In when which, Managing Director Center research the disease about respiratory tract belonging colleges Royal London, he Peter Openshaw, for know diseases translated this're evolutions quite complex. If flu H7N9 spread widely more than, the disease outbreaks this will become downright dangerous. The experts also recorded receive that the patients infected with influenza H7N9 at any age different, thing which shows not ages any may exempt translated with strains of this flu.
According figures of WHO, at Trung Quoc calculated to now has have at least 125 ca flu infection H7N9, in which 24 person mortality.http://thethaovanhoa.vn/quoc-te/who-canh-bao-nguy-co-bung-phat-dai-dich-cum-gia-cam-h7n9-n20130502135945381.htm

China reports 27th death from H7N9 bird flu


China reports 27th death from H7N9 bird flu

BEIJING: A man in central China has died from the H7N9 flu virus, state media said Thursday, bringing the toll from a new outbreak to to 27.
The 55-year-old whose surname was given as Jiao died on Wednesday in Hunan province after receiving medical treatment, state news agency Xinhua said, citing local authorities.
Xinhua earlier Thursday reported that 26 people had died from the virus, indicating two more deaths from previous reported tallies.
More than 120 people have been diagnosed with the virus since it was first reported in late March, with most cases confined to eastern China.
The only one reported outside the mainland has been in Taiwan, although that victim was infected in China.
Experts fear the possibility of the virus mutating into a form easily transmissible between humans, with the potential to trigger a pandemic.
The World Health Organization has said so far there is no evidence of human-to-human transmission but warned H7N9 is "one of the most lethal" influenza viruses ever seen.
Chinese health officials have acknowledged so-called "family clusters", where members of a single family have become infected, but have not established any confirmed instances of human-to-human transmission.
Most of the cases reported have not yet resulted in death, and some patients have been discharged from hospital after apparently recovering.  http://www.channelnewsasia.com/news/asiapacific/china-reports-27th-death-from-h7n9-bird-/661474.html?

"Avian epidemic" Ko Wing-man's visit to Beijing this afternoon for H7N9


on May 02, 2013 16:05 Harbour communication 
  Secretary for Food and Health Bureau, Mr Ko Wing Man will be held this afternoon for Beijing, met the delegation and the national health and family planning committee and officials of the General Administration of Quality Supervision, Inspection and Quarantine of the People's Republic of China led by tomorrow, for avian influenza A (H7N9) virus in mainland. view the two prevention and control measures taken in response to the H7N9 virus to further strengthen bilateral associated.   Members of the delegation include the Permanent Secretary for Food and Health (Food), Mrs Marion Lai, Director of Health, Dr Constance Chan, the Food and Environmental Hygiene Department for Food Safety, Gloria Tam, Assistant Director of Agriculture, Fisheries and Conservation Department (Inspection and Quarantine) Dr Thomas Sit and Hospital Authority Chief Manager (Infection, Emergency Services) Liu Shaohuai.   The delegation will tomorrow night to Hong Kong. 
http://hkstock.cnfol.com/130502/132,2113,15004696,00.shtml

Jiangxi H7N9 bird flu after she died



2013-05-02 17:11 
Securities Times Online ( www.stcn.com ) 05 02 News
May 2, according to China National Radio, Tonggu County, Jiangxi Province of human infection of H7N9 avian influenza in patients with confirmed cases Jiaomou due to critical condition, He died, and died on May 1.
Up to now, Jiangxi were found infected with the H7N9 avian flu case in 5 cases, no new cases. http://kuaixun.stcn.com/2013/0502/10455664.shtml

Human infections with avian influenza A(H7N9) virus in China – update 2



02-05-2013
As of 29 April 2013, 125 laboratory-confirmed human cases with A(H7N9) virus infection, including 24 fatalities, have been reported in China from eight provinces (Anhui, Fujian, Henan, Hunan, Jiangsu, Jiangxi, Shandong and Zhejiang) and two municipalities (Beijing and Shanghai). In addition, one case has been reported from the Taipei Centers for Disease Control.
WHO/Europe produces a weekly update – including a risk assessment, recommendations and key references and guidance – for countries in the WHO European Region. 

More information

http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/influenza/news/news/2013/05/human-infections-with-avian-influenza-ah7n9-virus-in-china-update-2

Mild case of bird flu in Emsland!


In their own checks, the mild form of avian flu was (H7 type) found in laying hens in a free range in the district of Emsland.
Mild case of bird flu in Emsland! In controls, a mild case of bird flu has been discovered in an operation in Emsland. http://www.webnews.de/1479543/fall-milder-vogelgrippe-im-emsland-

Israel Bird flu drill to be held next week


Bird flu drill to be held next week

05/02/2013 10:59
As part of a series of actions to increase preparedness for bird flu, the Agriculture Ministry will hold exercises on Monday and Tuesday as to how to cope with the disease should it emerge in the country's northern poultry farms. The North contains many densely packed farms of egg-laying hens, fattened livestock, turkeys and reproducing animals, the ministry said.

Should an outbreak of bird flu occur in one of the chicken coops, the disease could easily spread to farms nearby.

The poultry industry represents 17 percent of Israeli agriculture, and about 65% of the battery hens and 17% of the fattened poultry livestock are located in the North. About 2 billion eggs and 100,000 tons of chicken for food from the region is annually marketed to the Israeli public, the ministry said. The last bird flu outbreak in Israel occurred in March 2012, and the disease was eliminated efficiently, the ministry added.   
http://www.jpost.com/Headlines/Article.aspx?id=311783&R=R101

Hunan H7N9 patients where he died.


Xinhua News Agency microblogging "exclusive report", Tonggu County, Jiangxi Province, the H7N9 avian influenza confirmed cases Jiaomou of Hunan had admitted and died.
The patient in critical condition, was the morning of the 1st died due to multiple organ failure.
In addition, 1 pm, Hunan Province Health Department of Hunan new case of human infection of H7N9 avian influenza confirmed cases, the Shaoyang patients Zhao history of exposure to poultry before the onset of the current critical condition. A total of 128 confirmed cases between the two sides.  http://news.sinchew.com.my/node/293898

"Corona" reaps 5 new deaths in Saudi Arabia


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"Corona" reaps 5 new deaths in Saudi Arabia]
 Saudi police began to take precautionary measures in anticipation of the spread of the disease

Dubai, United Arab Emirates (CNN) - announced that the health authorities in Saudi Arabia Thursday, for the registration of seven new cases of HIV, "Corona", a virus deadly causing flu, died five of them, while still cases the other two shall receive treatment and care units Concentrated.
The Saudi Ministry of Health that the incidence of new HIV "Corona", all were monitored in the province of "Eastern", the largest provinces of the eastern region in the Kingdom, during the past few days.
The ministry said in a statement reported by the Saudi Press Agency that it "is doing all the precautionary measures for Mkhaltin for people, as routers local and international scientific sampling of them to see if there are cases among them."
She noted that she has been so far, recording 17 confirmed cases of the disease, at the world level.
The virus " Corona "A viruses that infect the respiratory tract, which represents 15 per cent of influenza viruses that affect humans.
This is also a new style, does not yet exist on the level of the world accurate information about the source of the virus, and its modes of transmission, as there is no vaccine or 
preventive antibiotic treatment for the virus.

Wednesday, May 1, 2013

Scientists are unable to confirm the route of infection mystery, like the H7N9 virus


Halle, a biology professor Ke Kule (Alexander Kekule) said: "We do not understand why the H7N9 virus will cause this strange infection in the human body." Compelling scientific theory is easy, especially between poultry borne viruses rarely spread from poultry to human body. This new type of H7N9 virus seems to overturn this claim. Biosafety Institute Ke Kule explains: "The virus in birds who almost do not see any signs of sick." Not aware of birds or infected with the virus, so the chicken with the H7N9 virus duck poultry or pigeons consumption risk.

Ke Kule say a disturbing message: "According to the genetic analysis we can conclude that the virus must have been in humans or other mammals, such as pigs, latent for some time. "
The virus during the incubation period to adapt to the new environment, and choose the best shelter in the human body - Hu respiratory tract.
April 1, WHO has reported, for the first time this new type of avian influenza virus in eastern China was confirmed in three patients contaminated by the H7N9 virus. Subsequently about a month, WHO issued the number of infections has risen to 126 cases and 24 deaths. According to the authorities, this is a deadly influenza pathogens. Some Asian countries have introduced tougher airport screening measures.
The spread of the epidemic
Experts are facing a frightening problem: this new type of avian influenzavirus will trigger a large-scale epidemic around the world, resulting in millions of deaths. This does not have a clear answer.
A flu virus must occur gene conversion, an easy human-to-human transmission of the virus to be able to cause a worldwide pandemic, experts believe that the H7N9 virus has not this happens.
According to WHO, so far there is no indication that the persistent interpersonal communication. But one thing is sure, stained with H7N9 patients, some patients had not been and poultry have been in contact. The Keku Le concludes: "So, the way of the virus in other mammals, or the possibility of human-to-human transmission is very large."
But the virologists think H7N9 is far less than the extent of the terrorist virus: "The virus must be experienced in order to achieve the multiple genetic changes cause the extent of the pandemic." Ke Kule optimistic It added that, so far, has not monitored H7 viruses in the human spread of the phenomenon.
Faces an uncertain future
Robert Koch, the (Robert-Koch-Institut) Suzanne Grice Mach, Susanne Glasmacher stressed that an avian influenza virus gene changes the direction of the interpersonal communication, and can not make predictions this.
The current H7N9 virus and the H5N1 avian influenza virus in a few years ago. We have seen the killing of animals due to the impact of the H5N1 avian flu, poultry farms in Germany. Since 2003, world- wide, more than 370 people died of the H5N1 avian influenza virus. And the incidence of H5N1 symptoms similar to suffering from H7N9 avian influenza disease poison the patient's onset of symptoms, including severe pneumonia. The typical clinical manifestations there are high fever, and on Hu respiratory tract infections and Hu dyspnea. WHO said that there are some patients, the symptoms are not obvious. http://www.aboluowang.com/2013/0502/302997.html?utm_source=dlvr.it&utm_medium=twitter#.UYHdnLVwe8A

Second case from Hunan raises H7N9 total to 128


Lisa Schnirring * Staff Writer

May 1, 2013 (CIDRAP News) – The new H7N9 avian flu virus has been detected in one more patient in China, a finding that edges the number of cases in the outbreak to 128, which includes 24 deaths.
The patient is a 69-year-old man from Hunan province, located in south central China, according to a statement today from Hong Kong's Centre for Health Protection (CHP). The man—Hunan province's second H7N9 case-patient—is hospitalized in critical condition.

Today is International Worker's Day in China, a public holiday. May 1 is known as Labor Day in Hong Kong, where it is also designated as a public holiday.
The World Health Organization (WHO) yesterday updated its frequently asked question background information on the H7N9 virus, which said that although evidence points to live poultry as the source of infections, investigations haven't confirmed that the birds are the primary or only source.
Addressing the role of live-bird markets in the transmission of the virus, the WHO said the markets should be periodically closed and emptied of all birds for regular cleaning. New birds brought into the market should be regularly sampled and tested to detect diseases early.

The WHO said regular maintenance of market environments can help minimize economic disruptions and the impact on a key source of protein for people. It also noted that the markets help ensure that the bird trade isn't diverted to channels of uncontrolled sales.
Until more information is known about the infections, it's difficult to determine if the H7N9 virus poses a significant risk of person-to-person spread in the community, the WHO said. "This possibility is the subject of epidemiological investigations that are now taking place."

It's not known yet whether H7N9 is a pandemic threat, the agency said. Animal viruses that infect people theoretically carry a pandemic risk, but some animal influenza viruses known to infect people haven't sparked pandemics.
Regarding potential risks to healthcare workers, the WHO said standard and extra precautions should be taken when caring for patients with suspected or confirmed H7N9 infections. In China and Taiwan, monitoring of close contacts of H7N9 patients turned up some instances of respiratory symptoms in health workers who cared for H7N9 patients, but so far tests have not confirmed H7N9 flu in any worker.
In other developments, a rush to publish scientific papers based on H7N9 genetic sequences that the Chinese National Influenza Center uploaded to the GISAID database early in the outbreak has sparked worries that China might not receive credit for its efforts to isolate and sequence the virus, according to a news report in Nature today.

One of the points of conflict involves a genetic analysis and case study that Chinese scientists submitted to the New England of Journal of Medicine on Apr 5. At about that time, the researchers learned that other groups were preparing papers or had already published studies on the sequences that Chinese researchers had uploaded to GISAID.
At that time the Chinese researchers also learned that pharmaceutical company Novartis and the J. Craig Venter Institute had used the uploaded sequences to develop US-funded H7N9 vaccine without collaboration with the Chinese team, according to Nature. The Chinese researchers believed that the usage wasn't handled in the spirit of the GISAID database, which requires scientists who use the sequences to credit and propose collaboration with those who deposited the data.

A spokeswoman from Novartis said the company explored research collaboration with China and is committed to sharing meaningful insights from the vaccine work with Chinese officials, Nature reported.
Kristine Sheedy, PhD, associate director of communication science at the National Center for Immunization and Respiratory Diseases, with the US Centers for Disease Control and Prevention (CDC), toldNature that the CDC's use of the sequences isn't part of the misunderstandings. She added that the agency has had strong ongoing collaborations with China since the start of the outbreak. http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/may0113china.html

Thailand-Four ministries draft emergency plan to prepare for h7n9 bird-flu threat


Four ministries will propose to the Cabinet an urgent plan of action to prepare for a possible pandemic of the deadly bird flu H7N9, as well as other emerging diseases.

The four ministries - Public Health, Natural Resources and Environment, Agriculture and Cooperatives, and Interior - are drafting an emergency-preparedness plan to combat a possible pandemic of the influenza virus H7N9, which has killed 22 people and infected 108 others in China.

The plan will be submitted to Cabinet and a meeting of a national committee to prevent and handle the new emerging disease, chaired by Deputy Prime Minister Plodprasob Suraswadi, according to Disease Control Department director-general Dr Pornthep Siriwanarangson.

The urgent action to prevent spread of the outbreak and compensation for poultry farmers will be included under this plan, as well as the establishment of a subcommittee to oversee measures to control any pandemic, he added.

The plan is based on a draft by the Livestock Development, Disease Control, National Parks, Wildlife and Plant Conservation, and Disaster Prevention and Mitigation departments.

So far there has been no sign of a pandemic in Thailand, but Pornthep suggested the agencies should keep a close eye on birds along the coastal areas, such as seagulls. They also need to conduct a surveillance system for poultry farms located along the flight paths of migratory birds.

Information on the movement across boundaries of live poultry is also needed to monitor any threat of an H7N9 outbreak, he added.

"Personally I believe the outbreak of this avian flu virus will reach Thailand by October, because of the rainy season. It will also deal a psychological blow to the poultry industry, not only in frozen chickens but cooked chicken as well," he said.

Agriculture and Cooperatives Minister Yukol Limlaemthong said he expected the meeting with Plodprasob to come up with a concrete and systematic plan to deal with any outbreak.

The plan would follow previous ones adopted with the H1N1 flu pandemic in 2009.

He also ordered livestock officials to monitor the situation around the clock and, in the eventuality of an outbreak of H7N9 bird flu, instructed them to use disinfectant immediately to kill the virus and slaughter infected poultry as a main measure to control it.

"The H7N9 bird-flu virus is spreading in China. Currently, however, we have good luck, as the migratory birds are flying back to their homes in the northern part of the world.

"We can breathe now - but after the rainy season, if the virus still exists in China, the migratory birds might come back here again. This would be the worst time," he said.

Dr Anan Sirimongkolkasem, president of the Thai Broiler Processing Exporters Association, said he was worried that the processed-chicken industry, worth about Bt70 billion a year, would be affected if a bird-flu pandemic took hold in Thailand.

"We are really worried about chickens that could be infected with the virus but do not display any symptoms," Anan said.

He added that the frozen-chicken industry would be more affected than the cooked-chicken sector.

"We are now monitoring the situation of the H7N9 bird flu pandemic" via the Internet, he said.

Associate Professor Dr Taweesak Songserm, an animal-health expert at Kasetsart University, suggested that relevant agencies set up a laboratory network to monitor the situation and exchange information about any outbreak of the bird fluin the Kingdom.
 
He added that this virus could be difficult to contain as it had mutated a lot. http://www.nationmultimedia.com/national/Four-ministries-draft-emergency-plan-to-prepare-fo-30205212.html

Pigeons, dwelling building poultry mite invasion bites household


H7N9 outbreak has made people smell the mere mention of birds, Hsinchu Meng Township building adjacent to the Temple of Confucius Plaza often feed the pigeons, makes about 70 pigeons, a stranger to the building, tenants often have to clean the bird droppings or clean up dead feral pigeon, who the poultry mite bites rash all over, complain about "really going crazy!" more worried about H7N9 infection.

Hsinchu City Vice Mayor Yu Jianhua said yesterday it will first call the Environmental Protection Agency to assist the disinfection of the building, and set up in front of the Temple of Confucius prohibit the feeding of pigeons, notices. Hsinchu City Government Property Development conservation chief said Huang Zaidian H7N9 epidemic continues to spread, people should avoid contact with poultry class, do not pick up directly contact with poultry carcasses, contact with birds or bird droppings, should be immediately cleaned with soap double hand and wipe dry.
Meng Township, about 6,70 feral pigeons living in the home building outdoor walls, beams, air conditioning, balcony, the feral pigeon feces covered walls, windows, also fall in the atrium and the surrounding rainy, Mr Zhang Zuyan, Hsinchu City, With the the rainwater inflow of home, residents worry about bringing meningitis, pigeons poultry mites invade homes, households can afford to bites rash, itching all day to stand.
The building director Huang 100 building close to Confucius Temple square in front of many people to the square to feed the pigeons, leading to flock together more, one, two hundred pigeons, of which approximately 60, 70 only in the evening, fly to the building perched residents access to the building should pay attention to pigeon dung "heaven", and occasionally see a dead pigeon in the Atrium, H7N9 menacing, people see pigeons afraid, pigeons, the city government to solve problems.
Households Chen show neck bitten traces, frown complain poultry mites invade your home wall, bed, family body is covered with a rash, scratching caught almost cried, feral pigeon feces and Qing Qing, every night pigeons sound quarreling sleep, leaving residents worried about avian influenza.
The Zhang Zuyan requirements of the City as soon as possible erected in the square in front of the Temple of Confucius "No feeding the pigeons," signs, pigeons, because of the lack of food and find another habitat, but also hope that the city government as soon as possible in the vicinity of disinfection, killing poultry mites, but also kill other feral pigeons carry infectious agents to protect public health.


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19 H7N9 cases reported on Chinese mainland last week

English.news.cn   2013-05-02 02:18:52
BEIJING, May 2 (Xinhua) -- The Chinese mainland confirmed another 19 cases of H7N9 infection last week, health authorities said on Wednesday.
From 4 p.m. April 24 to 4 p.m. May 1, 19 people were confirmed to have been infected with the new type of bird flu, bringing the total H7N9 cases on the Chinese mainland to 127, according to the National Health and Family Planning Commission.
Among the 19 cases, 16 were founded in east China provinces including Jiangsu (3), Zhejiang (4), Jiangxi (5), Fujian (3) and Shandong (1), while 3 were found in central provinces of Hunan (2) and Henan (1), according to the commission.
The virus has killed 26 people in the mainland, while 26 infected people have recovered, the commission said. http://news.xinhuanet.com/english/china/2013-05/02/c_132352814.htm

New bird flu poses "serious threat", scientists say


By Kate Kelland

LONDON | Wed May 1, 2013 5:34pm EDT
(Reuters) - A new strain of bird flu that is causing a deadly outbreak among people in China is a threat to world health and should be taken seriously, scientists said on Wednesday.
The H7N9 strain has killed 24 people and infected more than 125, according to the Geneva-based World Health Organization (WHO), which has described it as "one of the most lethal" flu viruses.
The high mortality rate, together with relatively large numbers of cases in a short period and the possibility it might acquire the ability to transmit between people, make H7N9 a pandemic risk, experts said.
"The WHO considers this a serious threat," said John McCauley, director of the WHO Collaborating Centre for Influenza at Britain's National Institute forMedical Research.
Speaking at a briefing in London, experts in virology said initial studies suggest the virus has several worrisome characteristics, including two genetic mutations that make it more likely to eventually spread from person to person.
"The longer the virus is unchecked in circulation, the higher the probability that this virus will start transmitting from person to person," Colin Butte, an expert in avian viruses at Britain's Pirbright Institute, said.
Of the some 125 people infected with H7N9 so far, around 20 percent have died, approximately 20 percent have recovered and the remainder are still sick. The infection can lead to severe pneumonia, blood poisoning and organ failure.
"This is a very, very serious disease in those who have been infected. So if this were to become more widespread it would be an extraordinarily devastating outbreak," Peter Openshaw, director of the center for respiratory infection at Imperial College London, told the briefing.
Scientists who have analyzed genetic sequence data from samples from three H7N9 victims say the strain is a so-called "triple reassortant" virus with a mixture of genes from three other flu strains found in birds in Asia.
Recent pandemic viruses, including the H1N1 "swine flu" of 2009/2010, have been mixtures of mammal and bird flu - hybrids that are likely to be milder because mammalian flu tends to make people less severely ill than bird flu.
Pure bird-flu strains, such as the new H7N9 strain and the H5N1 flu, which has killed about 371 of 622 the people it has infected since 2003, are generally more deadly for people.
Human cases of the H7N9 flu have been found in several new parts of China in recent days and have now been recorded in all of its provinces.
Last week a man in Taiwan became the first case of the flu outside mainland China, though he was infected while travelling there.
The H7N9 strain was unknown in humans until it was identified in sick people in China in March.
Scientists say it is jumping from birds - most probably chickens - to people, and there is no evidence yet of the virus passing from person to person.
Jeremy Farrar, a leading expert on infectious diseases and director of Oxford University's research unit in Vietnam, said the age range of those infected so far stretched from toddlers to people in their late 80s - a range that appeared to confirm the virus is completely new to the human population.
"That suggests there truly is no immunity across all ages, and that as humans we have not seen this virus before," he said.
"The response has to be calm and measured, but it cannot be taken lightly," he said. http://www.reuters.com/article/2013/05/01/us-birdflu-threat-idUSBRE94011D20130501?feedType=RSS&feedName=healthNews

Customs letting virus-infected chicken enter country despite ban


 
May 01, 2013

LAHORE - A large number of consignments of virus-infected Chinese chicken products are being imported from China to Pakistan for big fast food restaurants, despite the fact that Chinese Veterinary Authorities have endorsed presence of influenza virus A(H7N9) in their poultry.Though the Ministry of Commerce, in its trade policy for 2012-15, has imposed ban on import of chicken products from those countries which are under virus attack, yet Customs department is violating the rules openly.
Due to presence of the new virus at least 180 cases have been reported in China while more than 24 people have died there just in one month, industry sources informed and added that fatal virus can easily be transmitted into human beings particularly in children and aged people. 
Sources confirmed that around 4500kg to 2000kg of chicken products are being imported from China, putting at risk thousands of citizens’ lives who are unaware of the situation while Chicken products including crispy chicken patty, grilled chicken patty, chicken nuggets, value chicken and chicken meat in large consignments are arriving at Karachi port on regular basis and all consignments are cleared without any warning of health hazards.
Sources said that Customs authorities have endangered lives of Pakistani citizens by allowing unchecked import of Chinese chicken for large fast food restaurants in Pakistan. 
Chinese authorities have killed 20,000 birds at a wholesale market in Shanghai with an advice to people to avoid live poultry while Hanoi chicken market has been shut down after isolating Avian Influenza virus H7 N9 from a pigeon.
Sources confirmed that consignment of crispy chicken patty from China (Xiadian Town) of 6804kg arrived on 06 March 2013. Similarly, consignment of grilled chicken patty of 950kg, consignment of chicken patty of 1768kg, consignment of chicken nugget of 4665.6kg, consignment of value chicken patty of 1152kg, consignment of chicken patty of 2652kg and consignment of value chicken patty of 2288kg arrived on March 06 2013.
Sources also revealed that different consignments of crispy chicken patty, grilled chicken patty, chicken nuggets, value chicken and chicken meat totaling 41931.44kg was imported from China on March 27, 2013.
According to FAO (Food & Agriculture Organization of UNO), it is revealed that a previously unknown Avian Influenza virus H5N1, which is not so lethal, has infected 7 persons in China with at least six deaths but the up to date reported cases have increased to 24. The World Health Organization has shown its concern as to how the said virus has infected humans.
Vietnam has already banned import of Chinese poultry due to the risk involved in importing Chinese chicken.
Market sources said that Malaysia has banned all imported chicken from China and is urging its own poultry farmers to beware of H7N9 bird flu after Taiwan reported a case of the deadly strain, the first outside mainland China.
Pakistan Poultry Association former chairman Abdul Basit criticized the govt carelessness in this regard, urging the authorities to issue another notification to ban the chicken products infected with new virus of H7N9, which is more fatal.
He said that Pakistani chicken products are still banned all over the world due to outbreak of bird flue long ago in the country. Though the OIE has cleared the Pakistani products from bird flu, yet export has not gained pace due inefficiency of our foreign ministry, he added.
Former PPA central chairman said that it is really tragic and a matter of concern to note that Pakistan has taken no notice of the situation.
He said that children and old age persons become easy victim of the virus while enjoying the contaminated chicken and it is ready to eat value added products which are widely available at these golden arch outlets. 
The present situation demands that Pakistan Health authorities, the Ministry of National Food Security & Research should immediately take notice of the consequences and order an immediate ban on import of Chinese chicken meat and its products to protect public from the clutches of this deadly virus.http://www.nation.com.pk/pakistan-news-newspaper-daily-english-online/business/01-May-2013/customs-letting-virus-infected-chicken-enter-country-despite-ban

H7N9 human-to-human transmission? Expert Calls: experience diseased blood of Taiwanese relatives



"If relatives antibody on behalf of human-to-human transmission."
The increase in mainland H7N9 avian influenza outside Gan fear of fear into a human-to-human transmission. Honorary Professor of the National Taiwan University College of the veterinary profession, Lai, spike, the first case of imported cases, surnamed Li, Taiwan, just fever and symptoms, and many family members, relatives and friends contact friends and relatives so far, although asymptomatic, but he suggested that the CDC for contact with blood relatives, observe whether the antibody if the antibody on behalf of infected but asymptomatic, and human-to-human transmission.
Tzou-Yien Lin, Deputy Director of Health, pointed out that the Central Epidemic Command Center did not test the blood relatives of Taiwanese, surnamed Li, the current epidemic prevention perspective, is not considered necessary. Taiwan University's academics, however, has begun testing surnamed Li, Taiwan intimate contact with the blood, as research purposes.
The initial fear of a small amount of virus infected but asymptomatic
Lai, spike, surnamed Li, Taiwan Hong Kong immediately after infection with fever tested H7N9 initial viral load is small, but patients during contact with a lot of friends and relatives in a small amount of virus in the state, may be infected but without symptoms. Although the incidence of their friends and relatives were not, it is recommended that should be able to adopt the blood tests of their friends and relatives about friends and relatives who does appear antibody, the antibody is infected but asymptomatic If so, you can prove H7N9 feared human-to-human transmission.
Southward by the wind affect the H7N9 virus
He also believes that Shanghai H7N9 has been popular for some time, the chickens should have antibodies, chicken discharged viral load is not too large, and not even shed the virus, if there are new cases, fear of human to human transmission concern. Lai, Pamela said, affected by wind, the H7N9 virus will gradually southward, Fujian cases, the Fujian people contaminated with the virus in the nasal cavity or hand, came to Taiwan will not cause infection domestic concerns.
http://udn.com/NEWS/NATIONAL/NATS3/7868345.shtml

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 farmingOn 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

Tuesday, April 30, 2013

China culls birds as flu deaths mount


Published on 30 Apr 2013