H5N1

Populations at risk for severe/complicated H5N1

Thanks for Greg Folkers for sending the link to this PLOS ONE report: Populations at Risk for Severe or Complicated Avian Influenza H5N1: A Systematic Review and Meta-Analysis. The abstract:

Background 

Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic. 

Objectives 

To systematically evaluate risk factors for severe outcomes in patients with avian influenza H5N1 infection. 

Data sources 

MEDLINE, EMBASE, CINAHL, GlobalHealth, and CENTRAL through March 2011 

Eligibility criteria for selecting studies 

Observational studies of any design published in English, French, Spanish, German or Korean that reported on risk factor-outcome combinations of interest in participants with confirmed H5N1 infections. Outcomes considered included death, ventilator support, hospital and ICU admission, pneumonia, and composite outcomes. 

Study appraisal 

Risk of bias was assessed using the Newcastle-Ottawa scale (NOS). 

Results 

We identified 20 studies reporting on 999 patients infected with H5N1. The majority of studies (n = 14, 70%) were at intermediate risk of bias, i.e. 4–6 points on the NOS. Females were at increased risk of death (OR 1.75, 95% CI 1.27–2.44), while young age, in particular <5 years of age (OR 0.44, 95% CI 0.25–0.79 for death), was protective. Data on traditional risk factors was scarce and requires further studies. Another major limitation in the published literature was lack of adjustment for confounders. 

Interpretation 

Females were at increased risk for complications following H5N1 infection while young age protected against severe outcomes. Research on traditional risk factors was limited and is required.

UK: Warning over hospital superbug linked to 16 deaths

Via BBC News: Warning over hospital superbug linked to 16 deaths. Excerpt:

Sixteen people have died in Manchester in the past four years while infected with a highly resistant superbug, figures show. Klebsiella pneumoniae carbapenemase (KPC) is causing increasing concern and a rising number of cases. 

Some 1,241 patients were affected within the Central Manchester University Hospitals trust area from 2009 to 2013, the figures show. 

Despite infection control, the numbers have increased year on year. 

The figures, revealed in a Freedom of Information request by the BBC, found 62 patients so far have suffered blood poisoning - with 14 confirmed deaths within 30 days of infection - at Central Manchester University Hospitals NHS Foundation Trust. 

Two further deaths have occurred in the current year, the hospital trust confirmed. 

KPC, which causes urinary tract infections and pneumonia in sick patients, is resistant to carbapenems, the last major group of antibiotics to work against multidrug-resistant bacteria. 

The trust said the chemical, an enzyme, that KPC uses to render antibiotics ineffective had now entered other bacteria, including E. coli and Enterobacter. 

"This trust has and continues to make strenuous efforts to control and reduce this infection. We continue to work very closely with Public Health England at both a local and national level to develop solutions for the long-term management of patients," it said.

Vietnam: Measles, chickenpox outbreaks in Ho Chi Minh City schools

Via Saigon Giai Phong: Outbreaks of diseases in schools in HCMC.

Dr. Nguyen Tri Dung, director of the Preventive Medicine Center, warned of disease outbreaks in schools on March 5. 

The city is facing various outbreaks of diseases including measles and dengue in the past two months, said Dr. Dung. The wet weather is a good environment for spread of the viruses. 

An adult died of dengue fever in HCMC last time, according to the Tropical Disease Hospital. The rate of infections increased 28 percent compared to the same period in 2013. 

The Children Hospital No. 1 and 2 and the Tropical Disease Hospital received more than 200 serious measles cases in the first two months of 2014. The Department of Health will be dispensing vaccinations to children under three years old from March 7 to end of April. 

Ten students in Le Quy Don Junior High School in District 3 contracted chicken pox, said Dr. Dung. After sending the children home, no more cases were reported. 

The health and education centers are currently working together to raise public awareness of disease prevention.

Finland: Public health services proposed for undocumented aliens

Via Yle Uutiset: Public health services proposed for undocumented aliens.

A report commissioned by the Ministry of Social Affairs and Health proposes that public healthcare services be made available to undocumented aliens. If implemented, the State would reimburse local governments for extra costs incurred. 

The working group that produced the report examined healthcare issues in regard to people in the country without residence rights or health insurance. According to the study, it is estimated that the number of undocumented aliens in Finland is around 3,500 individuals. 

The report concludes that the best care model would be one providing undocumented aliens the same basic healthcare services as are available to citizens. This would also meet constitutional requirements and Finland’s commitments under international human rights agreements. 

A less favoured alternative by working group members, but contained in the report, is to provide the same services as are guaranteed to asylum seekers arriving in the country. Under current law, this would mean access to emergency care, and full care for those under the age of 18, as well as pregnant women and new mothers. 

If adopted, the system would apply the same fees as are charged to local residents. Any other costs would be carried by the State.

Now, there's a dangerous idea: health care as a human right. 

The Lancet: A planetary health manifesto

Via The Lancet: From public to planetary health: a manifesto. Click through to read the full document; you'll find a link in The Lancet's right-hand column where you can sign it. Excerpt:

This manifesto for transforming public health calls for a social movement to support collective public health action at all levels of society—personal, community, national, regional, global, and planetary. 

Our aim is to respond to the threats we face: threats to human health and wellbeing, threats to the sustainability of our civilisation, and threats to the natural and human-made systems that support us. Our vision is for a planet that nourishes and sustains the diversity of life with which we coexist and on which we depend. Our goal is to create a movement for planetary health. 

Our audience includes health professionals and public health practitioners, politicians and policy makers, international civil servants working across the UN and in development agencies, and academics working on behalf of communities. Above all, our audience includes every person who has an interest in their own health, in the health of their fellow human beings, and in the health of future generations. 

The discipline of public health is critical to this vision because of its values of social justice and fairness for all, and its focus on the collective actions of interdependent and empowered peoples and their communities. 

Our objectives are to protect and promote health and wellbeing, to prevent disease and disability, to eliminate conditions that harm health and wellbeing, and to foster resilience and adaptation. In achieving these objectives, our actions must respond to the fragility of our planet and our obligation to safeguard the physical and human environments within which we exist. 

Planetary health is an attitude towards life and a philosophy for living. It emphasises people, not diseases, and equity, not the creation of unjust societies. We seek to minimise differences in health according to wealth, education, gender, and place. We support knowledge as one source of social transformation, and the right to realise, progressively, the highest attainable levels of health and wellbeing. 

Our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation. The harms we continue to inflict on our planetary systems are a threat to our very existence as a species. The gains made in health and wellbeing over recent centuries, including through public health actions, are not irreversible; they can easily be lost, a lesson we have failed to learn from previous civilisations. We have created an unjust global economic system that favours a small, wealthy elite over the many who have so little.

Canada: Public health officials search for 200 families exposed to measles virus

Via the Ottawa Citizen: Public health officials search for 200 families exposed to measles virus. Excerpt:

Ottawa Public Health officials are trying to track down 200 families that may have been exposed to a child with measles over four days in late February. 

The unidentified child, a student at St. Stephen School in Stittsville, has been released from hospital and is out of medical danger, but others who may have been exposed to the highly contagious disease remain at risk. 

Among those at risk are St. Stephen students who have not been immunized. 

Ottawa Public Health officials have identified a dozen St. Stephen students who have not submitted the required immunization records. Those students were issued school suspension letters Thursday by the city’s public health agency, which has the power to suspend students without up-to-date immunization records for 20 days. 

“If they come forward with immunization records then they will be removed from that suspension list,” said Dr. Rosamund Lewis, Ottawa’s associate medical officer of health. 

Infants and adults who have not been immunized are at greatest risk of developing a severe case of measles. 

Those exposed may not know they’re infected since the incubation period for measles is about 10 days, according to the Public Health Agency of Canada. The rash commonly associated with the disease usually appears two weeks after exposure. 

Ottawa Public Health has not yet found any sign that the virus has spread to new patients. 

The city’s public health officials have identified three potential exposure points in addition to St. Stephen School: the Med-Team Clinic on Kakulu Road in Kanata (between 8:45 a.m. and noon on Feb. 25); the Active Care Clinic on Klondike Road in Kanata (between 9:30 a.m. and 1 p.m. on Feb. 27); and CHEO’s emergency department (between noon and 2:20 p.m. on Feb. 28). 

The infected child was not diagnosed with measles until a third medical visit.

Vietnam reports H5N1 virus mutation

Via Thanh Nien Daily: Vietnam reports bird flu virus mutation.

Vaccine-resistant mutation of H5N1 bird flu virus strain has been confirmed in the Mekong Delta province of Tra Vinh while vaccinated fowls fell sick in central Vietnam. 

Ngo Duc Thanh, director of Tra Vinh animal health department, said the kinds of vaccine that have been used for many years showed weaker effects this year. 

Thanh said most samples from sick poultry would be tested for a new mutation. 

He asked farmers to inject their livestock with a new kind of vaccine that is also available. 

Animal health officials from the central province of Quang Nam last week noticed that a local herd of 1,000 ducks have fallen sick and five of six samples tested positive for H5N1 although they were vaccinated a month earlier. 

Vaccinated poultry from the Mekong Delta city of Can Tho were also infected earlier despite vaccination. Officials said the vaccine could have been ineffective to a virus mutation, or the vaccination process faulty. 

The health and agriculture ministries on March 5 said there were 69 H5N1 bird flu outbreaks ravaging in 23 cities and provinces. An average of two new outbreaks have occurred every day since early February, killing more than 63,000 fowls. 

According to health ministry regulations, a city/province can declare the end of a bird flu epidemic if no infections are detected 21 days after the last outbreak was announced, removing Nam Dinh Province outside Hanoi and the Mekong Delta’s Long An out of the list. 

Hai Duong Province outside Hanoi, Gia Lai in the Central Highlands and the Mekong Delta’s Soc Trang Province announced new outbreaks on February 28, with more than 5,000 fowls disposed of. 

Experts have warned of further spread of the virus thanks to cold weather. 

Control teams have been set up by the health ministry and local authorities to keep track on the infection. 

H5N1 has killed three people in the country this year, including Huynh Thanh Tuan, 30, of Nha Trang, a 52-year-old man from Binh Phuoc Province and a 60-year-old woman from Dong Thap Province, both in the south. 

The strain has been ravaging Vietnam since 2003 and has claimed 65 lives so far, one of the highest fatality rates in the world, according to the World Health Organization.

China: H7N9 vaccine may hit market in May

Via Shanghai Daily: H7N9 vaccine may hit market in May. Excerpt:

Vaccines for H7N9 bird flu could hit the market as early as May, a Chinese expert on infectious disease said Friday. 

The vaccine is currently being submitted to drug control authorities for tests, said Li Lanjuan, an academician with the Chinese Academy of Engineering. 

"If everything goes smoothly, we could have the vaccine on the market within one to two months," said Li, who is also a member of the Chinese People's Political Consultative Conference National Committee. 

According to official statistics, H7N9 has infected more than 120 people in China and killed at least 36 of them so far this year. 

The latest victim is a 75-year-old man who died Saturday in Guangzhou. A test conducted Monday found the man had been infected with the virus. 

Li said there has not been any substantial evidence for consistent human-to-human infection of H7N9, adding that poultry markets remained the primary source of infection. 

Closing markets and culling poultry are still the most effective ways to contain the virus, she said.

WHO: H7N9 update, March 7

WHO has published Human infection with avian influenza A(H7N9) virus – update. Excerpt:

On 4 March 2014, the Centre for Health Protection (CHP) of the Department of Health, Hong Kong SAR, China, notified WHO of an additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus. 

The patient is an 18 month-old girl who developed mild fever. She consulted a doctor on 28 February, was admitted to a hospital on 1 March and was discharged from the hospital on 3 March in stable condition. 

Following laboratory-confirmation with avian influenza A(H7N9) virus infection on 4 March, the patient was admitted to another hospital. She is currently asymptomatic, with no fever. 

Initial epidemiological investigation revealed that the patient travelled to Foshan, Guangdong province from 5-27 February, where she visited a wet market with her mother. Further investigations into her travel and exposure history are ongoing, including tracing of all close contacts. 

Sporadic human cases 

The overall risk assessment has not changed (see WHO Risk Assessment under 'Related links'). 

The previous report of avian influenza A(H7N9) virus detection in live poultry exported from mainland China to Hong Kong SAR shows the potential for the virus to spread through movement of live poultry, at this time there is no indication that international spread of avian influenza A(H7N9) has occurred. However as the virus infection does not cause signs of disease in poultry, continued surveillance is needed. 

Further sporadic human cases of avian influenza A(H7N9) infection are expected in affected and possibly neighbouring areas. 

Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. If this were to occur, community level spread is unlikely as the virus does not have the ability to transmit easily among humans. 

Until the virus adapts itself for efficient human-to-human transmission, the risk of ongoing international spread of H7N9 virus by travellers is low.

China: A new Guangdong H7N9 case

Via Xinhua: One more human H7N9 case in China. Excerpt:

China reported one more human H7N9 virus infection on Friday. 

The man, surnamed Liao, 88, from Yuexiu District in Guangzhou, capital of south China's Guangdong Province, was confirmed on Wednesday to have contracted the virus, according to the Guangdong Provincial Health and Family Planning Commission. 

The patient, who has a history of hypertension and diabetes, is in critical condition now and is receiving treatment at a local hospital. 

A patient from northeast China's Jilin Province, who was confirmed to be infected with H7N9 bird flu on Feb. 21, has recovered and been discharged from the hospital, the provincial health and family planning commission said on Friday.