H5N1

ECDC: Disease threats report for week 20

ECDC has published Monitoring current threats: ECDC Communicable Disease Threats Report (CDTR), week 20. The summary:

The CDTR reports this week on an ongoing outbreak of hepatitis A virus (HAV) affecting individuals from various northern countries in the EU. Since the beginning of the outbreak on 1 October 2012 until 17 May 2013 a total of 85 cases were reported, of which 34 are confirmed. No cases have travel history outside of the EU during their potential exposure period. 

The source of the outbreak has not yet been identified but preliminary investigations point to frozen berries as the vehicle of infection. Public health authorities in the affected countries and ECDC are actively collaborating to identify the vehicle of the infection in order to prevent the occurrence of additional cases. 

Between April 2012 and 16 May 2013, 40 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV), including 20 deaths, have been notified. All cases worldwide remain associated (including indirect association following secondary person-to-person transmission in the UK and France) with transmission in the Arabian Peninsula. 

ECDC published an update of its risk assessment on 17 May. ECDC is closely monitoring the situation in collaboration with the World Health Organization and the European Union Member States.

China: Infectious diseases in Beijing last week

Via the Beijing Municipal Health Bureau, a Google translated report: The Weekly Epidemiological (2013.04.29-2013.05.05).

Situation of the Epidemics 　　

2013 Week 18 (2013, April 29 to May 5, 2011), the city reported a total of 1934 cases of legal infectious diseases, 4 patients died (viral hepatitis). B infectious diseases were reported in 12 of 516 cases, the number of reported cases among the top five diseases were diarrhea, tuberculosis, viral hepatitis, scarlet fever and syphilis. Class C infectious diseases were reported in 1418 cases, the number of reported cases among the top three diseases were hand-foot-mouth disease, other infectious diarrhea and mumps. 　　

Focus of the Epidemic 　　

(A) measles 　　

21 cases reported this week 　　

(B) foot and mouth disease 　　

759 cases reported this week

The bureau also has an H7N9 page, accessible to Google Translate and Google Chrome, but it hasn't been updated since May 3, and most of the items are from April.

Containment begins as H7N9 spreads to Taiwan

Via The China Post, an April 25 report: Containment begins as H7N9 spreads to Taiwan. Excerpt:

Taiwan has its first confirmed case of H7N9 avian influenza, the Central Epidemic Command Center (CECC) announced yesterday. 

The patient is a 53-year-old male Taiwanese citizen who had worked in China's Jiangsu province. 

The CECC said that the patient, who returned to Taiwan from Shanghai on April 9, is currently in serious condition and is being treated in a negative-pressure isolation room. 

One hundred and thirty-nine people who have come into contact with the man have been contacted by the CECC for health checks and follow-up observations. Among them are three health care workers who developed symptoms of upper respiratory infection. 

CECC Commander-in-Chief Chang Feng-yee (張峰義) said that the center has reported the case to the World Health Organization through the IHR Focal Point system as well as through its contact point in China, in accordance with the Cross-strait Cooperation Agreement on Medicine and Public Health Affairs. 

“The CECC will not make the number of the flight that the patient took to return to Taiwan public because he did not show any signs of infection when he entered Taiwan, or on the two days following his arrival,” Chang said. 

Health Minister Chiu Wen-ta (邱文達) said that special clinics for H7N9 and the negative-pressure isolation rooms in 22 hospitals listed as disease control centers will be opened in response to the possible outbreak of the strain in Taiwan. 

According to the CECC, the patient is a hepatitis B carrier with a history of hypertension and had been traveling between Jiangsu province's Suzhou City and Taiwan before contracting the virus. 

He was in Suzhou from March 28 to April 9 and had not been exposed to birds or poultry, or consumed undercooked poultry or eggs, the CECC said. 

The patient developed a fever, began sweating profusely and suffering fatigue on April 12. He was hospitalized for a high fever on April 16. He was incubated due to respiratory failure and placed in the negative-pressure isolation room in the hospital's intensive care unit on April 20. 

The CECC said that the National Influenza Center in Taiwan confirmed the strain of the disease and completed the genome sequencing of the virus yesterday morning. 

Chang said that the CECC has continued to strengthen surveillance and fever screening of travelers arriving from China, especially from Shanghai, Jiangsu, Zhejiang, Anhui, Beijing, Henan and Shandong. 

“Travelers visiting China should practice good personal hygiene, avoid visiting traditional markets with live poultry, and consume only well-cooked poultry and eggs,” Chang said. 

According to the CECC, there are currently 108 confirmed H7N9 cases in China, including 22 deaths since the first case was reported on March 31. 

Ban on Slaughters in Markets may be Brought Forward 

Deputy Agriculture Minister Wang Cheng-teng (王政騰) said yesterday that if more local cases are found, new regulations prohibiting the slaughter of live fowl in traditional markets in Taiwan proper might take effect before the scheduled date of June 17.

ECDC: Communicable disease threats report for week 16

ECDC has published its Monitoring current threats in week 16/2013. Click through to download the full report. The summary:

Food-borne hepatitis A outbreak 

An outbreak of hepatitis A infection has been reported in Denmark, Finland, Norway and Sweden over the last six months with 68 cases reported as of 17 April 2013, an additional two being reported this week. The source of the outbreak has not been identified but epidemiological investigations in the affected countries point towards frozen berries as vehicle of infection. ECDC’s assessment is that this is this is a multinational food-borne outbreak with a persistent common source. ECDC and the European Food Safety Agency published a joint rapid outbreak assessment on 16 April. 

Measles 

Large outbreaks of measles are continuing in the north-east of England and Wales. A new outbreak has also been reported in Berlin, Germany with 43 cases since February compared to only five for the previous period last year. 

Avian influenza A(H7N9) 

The CDTR also continues to report on the recent outbreak of avian influenza A(H7N9) in China. Between 11 and 18 April 2013, 49 additional confirmed human cases of influenza A(H7N9) virus, including seven deaths, have been reported from six provinces in eastern China. Since the beginning of the outbreak, 87 confirmed cases have been reported, of which 17 people have died.

H7N9: A little more on hepatitis B

Lucy Lecomte has found this item at Wiley Online Library: Telbivudine versus lamivudine in Chinese patients with chronic hepatitis B: Results at 1 year of a randomized, double-blind trial. An excerpt from the abstract:

The end-stage sequelae of chronic HBV infection, cirrhosis-related liver failure, and hepatocellular carcinoma are responsible for over 1 million deaths each year worldwide. More than one-third of the world's 350 to 400 million chronic HBV carriers live in China, where the average prevalence of chronic HBV infection is over 9%. 

Among patients of Chinese ancestry, chronic HBV infection leads to a striking increase in the life-time risk of cirrhosis, hepatic decompensation, hepatocellular carcinoma, and liver-related premature mortality. It is estimated that over 500,000 Chinese die annually from end-stage hepatitis B complications. In China, as in other countries, progression to end-stage disease is associated with increased healthcare costs and other socioeconomic burdens. 

The prevalence of specific HBV genotypes in China differs from that observed in Western countries and may contribute to differences in disease characteristics. Chinese HBV carriers are infected almost exclusively with genotype C or genotype B, whereas Western patients of non-Asian ethnicity display an array of HBV genotypes, primarily genotypes A, D, E, and F.

So hepatitis B is already a major health disaster, quite apart from its conjectural role in H7N9. In not quite ten weeks, H7N9 has killed 20 or 21 Chinese. In that period, hep B must have killed over 90,000.

H7N9 and hepatitis B

Lucie Lecomte has been sending me a lot of excellent links, including this one from WHO, a fact sheet on Hepatitis B. As the fact sheet points out, it's endemic in China and other Asian nations. But it's also a chronic disease in Amazonian Brazil, southern and eastern Europe, and in the Middle East and South Asia, "an estimated 2-5% of the general population is chronically infected."

Some 600,000 die of the disease every year, and Dr. Guan Yi recently noted that many H7N9 victims have had hep B in their medical histories, so it could be a critical factor in the H7N9 case fatality rate. Excerpt from the fact sheet:

Who is at risk for chronic disease? 

The likelihood that infection with the hepatitis B virus becomes chronic depends upon the age at which a person becomes infected. Young children who become infected with the hepatitis B virus are the most likely to develop chronic infections: 

• 90% of infants infected during the first year of life develop chronic infections; 

• 30–50% of children infected between one to four years of age develop chronic infections. 

In adults: 

• 25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis; 

• 90% of healthy adults who are infected with the hepatitis B virus will recover and be completely rid of the virus within six months.

Elderly 'most at risk from H7N9'

Via South China Morning Post, an April 20 report: Elderly 'most at risk from bird flu virus'. Excerpt:

New research has revealed the elderly are most at risk of contracting the H7N9 bird flu virus, but health officials are still uncertain how humans are becoming infected. 

The study by the Joint Influenza Research Centre of Shantou University Medical College and the University of Hong Kong in Shantou, points out that the majority of severe cases have occurred in those aged over 60. 

Few of the children on the mainland who have contracted the virus have been seriously ill. 

This is in sharp contrast with the H5N1 strain, which caused a high proportion of severe cases and deaths in the young. 

The H7N9 virus has been found in 91 people on the mainland, including four new cases in the eastern provinces of Jiangsu and Zhejiang. It has caused 17 deaths. 

The findings come as the World Health Organisation (WHO) expressed concern that more than half of those infected by the virus had not been in contact with poultry. The WHO also revealed details of three families who had shown possible human-to-human transmission. 

But its China representative Michael O'Leary said it appeared human-to-human transmission was rare. "This is still an animal virus that occasionally infects humans," he said. 

"With rare exceptions, we know that people are not getting sick from other people. What we don't know is the size of the iceberg under this tip." 

The research also raised the possibility that the hepatitis B virus might be a contributing factor to fatalities. This could be "problematic" as the number of hepatitis infections in China and other Asian countries is extremely high. 

Scientists analysed 60 confirmed cases received before Monday and found 61 per cent of severely affected patients were over the age of 60. 

"It may due to an imbalance in exposure of the elderly [to H7N9], or physiological factors related to ageing, such as decreased immune function," the report said.

I couldn't find the report (or even a news release about it) on the Joint Influenza Research Centre website, but I'll keep looking. The hepatitis B connection is a very interesting idea.

H7N9: Is Hep B an unindicted co-conspirator?

I just got a tweet from Brian McConnell, who's involved with an interesting translation system called Der Mundo. He sent the link to Der Mundo : H7N9增五例 長者與乙肝高危 - Yahoo! 新聞香港. It raises a very interesting idea (from Dr. Guan Yi, no less) that H7N9 cases with hepatitis B tend to die; hence the high number of older cases and the ability of children to recover. Brian's tweet brought back memories of Guangzhou in 1983, when too many of my students had to leave school after contracting hepatitis. Here's part of the translation:

Clear Pao Mainland H7N9 avian flu yesterday another five cases and one death, a total of 87 confirmed and 17 people were killed. Avian influenza Hunter said Guan Yi, a professor of published studies, H7N9 multi-headed toward the elderly caused by severe and Mainland death may get hepatitis B or harder to resist H7N9.

HKU new infectious diseases State Key Laboratory of Influenza Research Center director Guan Yi, together with Guangdong Shantou Medical expert analysis up to the 14th of this month, 60 H7N9 confirmed cases, 61% of the cases for senior citizens aged 60 or above with serious cases of H5N1 and more children are obviously different.

Is different from the H5N1 for children

Tube in the study pointed out that the Mainland first three confirmed cases are on the death of co-morbidity (co-morbidities), among 27-year-old Wu Liang Liang and Anhui 35-year-old woman surnamed Han patients are suffering from hepatitis B.

"Will the body at the same time with the hepatitis B virus will prevent the body the start key reaction to resist and clear the H7N9 virus?," The study pointed out.

ECDC: Current threat report for week 15

ECDC has published its Communicable Disease Threats Report for week 15. Click through to download the PDF. The summary:

An outbreak of hepatitis A infection has been reported in Denmark, Finland, Norway and Sweden over the last six months with 66 cases as of 11 April 2013. The source of the outbreak has not been identified but epidemiological investigations in the affected countries point towards frozen berries as vehicle of infection. 

In relation to measles, large outbreaks are currently on-going in the North-East of England and in Wales. Denmark reported a small outbreak in the Silkesborg area. 

Influenza activity across Europe continues to decline or has already returned to baseline levels. 

The CDTR also reports about the recent cases of avian influenza A(H7N9) in China. During the last week 24 additional cases were confirmed by Chinese authorities, including two deaths, for a total of thirty-eight cases of human infection. At this point, there is no evidence of on-going human-to-human transmission and there has not been further geographical spread.

India: Dengue fever and hepatitis in Idukki district, Kerala state

Via Manorama Online: Dengue fever and hepatitis in Idukki district. Excerpt:

Idukki: Cases of dengue fever and hepatitis are reported from various places in Idukki district . More than 50  patients are hospitalized with dengue fever in Adimali whereas 20 patients are confirmed with  hepatitis in Thodupuzha. 

Epidemics detected in the border villages of  Kerala- Tamilnadu two weeks back have started spreading to various places in Idukki district. Reports say that dengue fever is spreading at alarming rate in many places. More than 50 persons were diagnosed with dengue fever in Adimali, Vellathooval and Mankulam areas in a week period. 

Eighteen persons are undergoing treatment  at Taluk hospital in Adimali  whereas  infected people are being brought to private hospitals of  Adimali, Kothamangalam, and Kolenchery. Health department informed that though cases are still being reported from across the district, treatment facilities have been arranged for the affected patients. 

More cases of hepatitis are reported from Thodupuzha and surrounding places. Sixteen patients are affected with hepatitis A while four patients are diagnosed with hepatitis B. Besides, blood samples of around 30 persons suspected with symptoms were sent for testing.