H5N1

US: A meeting I wish I could attend (updated)

Thanks to Greg Folkers for sending me the link to this page on the website of 113th general meeting of the American Society for Microbiology, which lists the sessions for Tuesday, May 21:

Session Number: LBS001 

Session Title: Pandemic Threats from Emerging Avian Influenza Viruses (H7N9 and H5N1): Challenges for Public Health, Research, Surveillance and Countermeasures 

Session Type: Symposium 

Session Start/End Time: Tuesday, May 21, 2013, 11:00 AM - 1:30 PM 

Location: Mile High Ballroom 3 

Presentations: 

The Continuing Influenza Threat: H5N1, H7N9 or More? 5/21/2013 11:00:00 AM Robert G. Webster; St. Jude's Res. Hosp., Memphis, TN. 

H5N1 and H7N9: From Zoonosis to Pandemic? 5/21/2013 11:30:00 AM Albert D. Osterhaus; Erasmus MC, Rotterdam, Netherlands. 

The Challenge of Avian Influenza Viruses: From Basic Research to Practical Public Health Strategies 5/21/2013 12:00:00 PM Carole A. Heilman; NIH, NIAD, Bethesda, MD. 

Responding to the Emerging Avian Influenza Threat: Preventing a Pandemic 5/21/2013 12:30:00 PM Stephen C. Redd; Influenza Team Lead, CDC/CCID, Atlanta, GA.

I will be delighted and grateful to post any reports that come out of these sessions.

Update: And Greg Folkers has promptly sent the link to the ASM live video feed, which will include the Tuesday session. I'll repost the link on Monday night or Tuesday morning. You can also follow events at #asm2013.

Hong Kong: No new human case of avian influenza A (H7N9) in the Mainland

Via the Centre for Health Protection: No new human case of avian influenza A (H7N9) in the Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) verified with the National Health and Family Planning Commission (NHFPC) no new human case of avian influenza (H7N9) in the Mainland today (May 19).      

As of 9pm today, a total of 130 cases have been laboratory confirmed with avian influenza (H7N9) in the Mainland, which included Zhejiang (46 cases), Shanghai (33 cases), Jiangsu (27 cases), Jiangxi (six cases), Fujian (five cases), Anhui (four cases), Henan (four cases), Shandong (two cases), Hunan (two cases) and Beijing (one case).     

A spokesman for the DH stressed that the CHP is closely monitoring the situation and will continue to maintain close liaison with the Mainland health authorities for more case information, as well as keep a close eye on the latest advice from the World Health Organization.

Caribbean on alert for H7N9

Via the Jamaica Observer: Caribbean on alert for new strain of bird flu. Excerpt:

BRIDGETOWN, Barbados (CMC) — The Caribbean Public Health Agency (CARPHA) has put regional countries on alert for the Avian Influenza A (H7N9), also known as bird flu, that has killed at least 20 people in China. 

"CARPHA has specifically put all of us in the Caribbean on alert, and what we have been asked to do is to intensify our surveillance systems for acute respiratory infections and submit any viruses that we cannot subtype," said Barbados Chief Medical Officer Dr Joy St John. 

"We have stepped it up to involve all doctors to ensure that if they see any unusual clinical pictures, any unusual displays of respiratory illness, that they should alert us and send in samples of the nasal pharyngeal swabs with a clear travel history and all of the other required information. 

"We have surveillance (for acute respiratory and severe acute respiratory illnesses) that has been going on for years. In the Caribbean region, we are very strong on this. So every week, the Epidemiology Unit checks how many of these cases we've had and we have sentinel sites around the island mainly through the policlinics." 

Dr St John said that the health authorities have been getting daily reports on the International Health Regulations (IHR) focal points. 

"As part of the normal system we were already checking, and then we have had alerts from WHO (World Health Organisation) and backups from PAHO (Pan American Health Organisation) directly on the IHR focal points, and then now we have the overlay of the Caribbean putting us on alert and asking us to do specific things that we were already doing." 

Dr St John said Barbados is part of a regional network, in addition to the PAHO Americas and WHO networks, and that health officials had been "characterising and keeping a careful watch of all levels of illness". 

She said the Ministry of Health has not yet detected any strange patterns, "but as soon as we do we will ramp up our measures and inform as we always do".

ECDC: Diagnostic preparedness for H7N9

When H7N9 could arrive in your country on the next flight from Shanghai, this April 24 technical document from ECDC is extremely well timed: Diagnostic preparedness in Europe for detection of avian influenza viruses. Click through to download the PDF. The abstract:

In China, a novel avian-origin reassortant influenza A(H7N9) virus has been detected in a number of human cases. In response to the potential cross-border health threat associated with emerging disease caused by the appearance of the novel virus, European laboratories need to be aware of the novel virus and adapt and confirm their diagnostic capability to detect and identify it. 

This document is a joint CNRL/ECDC/WHO Europe technical briefing note for virology laboratories. It is designed to assist clinical and public health laboratory directors in appraising options for establishing novel diagnostic assays for screening and confirming cases of infection in humans. 

This document is intended for use in the area of human influenza surveillance, investigation, risk assessment, and control, encouraging cooperation between expert and reference laboratories in order to foster the development of sufficient capacity within the Community for the diagnosis, detection, identification and characterisation of infectious agents which may threaten public health. 

This document contains a list of laboratory preparedness considerations to ensure European-wide diagnostic capability; an update on current methods used for molecular detection of human infection with avian influenza A(H7N9) virus by RT-PCR;a table of H7 HA assay validation criteria; information on positive controls for RT-PCR assays.

WHO: Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution

Via WHO's Western Pacific Surveillance and Response Journal, a very interesting article: Human infections with avian influenza A(H7N9) virus in China: preliminary assessments of the age and sex distribution. Excerpt:

While poultry exposure appears to be a common risk factor in the current event, the age distribution among reported cases also raises the question why so few young adults (i.e. those of working age exposed to poultry as vendors/LBM workers/breeders/transporters) have been reported. This not only suggests greater exposure among elderly men but also a possible greater biological susceptibility to more severe outcomes. 

The number of cases and the CFR is higher among elderly men relative to elderly women (although this may be a function of dose response due to greater or more frequent exposure). Serologic investigations among close contacts and other subpopulations in the area will assist with our understanding of the clinical spectrum of this infection, information regarding smoking, underlying medical conditions and other risk factors among the current case series would help to elucidate some of these issues. 

Healthcare-seeking behaviour and access also need to be considered as an explanatory factor. If elderly men are more likely to access healthcare, be detected or reported, surveillance bias may occur such that the distribution of the reported cases does not reflect the underlying distribution of disease occurrence in the population. 

However, given the high severity among the majority of the reported cases to date, the current high awareness level in both the public and the healthcare community and the nation-wide implementation of enhanced influenza-like illness and severe acute respiratory illness surveillance activities, it seems unlikely that elderly men are being overly selected.

Hong Kong: All quiet on H7N9 front

Via the Centre for Health Protection: Update on number of suspected human cases of avian influenza A(H7) notified to CHP.

The Centre for Health Protection (CHP) of the Department of Health (DH) today (April 23) provided an update on the latest number of suspected human cases of avian influenza A(H7) notified to the CHP, including suspected human cases of avian influenza A(H7) fulfilling reporting criteria, and remaining ones not fulfilling reporting criteria.      

From noon yesterday (April 22) to noon today, the CHP received no notifications of cases which fulfilled reporting criteria nor cases which did not fulfil reporting criteria.      

The total number of notifications received by the CHP since March 31 of cases fulfilling reporting criteria of suspected human cases of avian influenza A(H7) remains at 14 while the total number of notifications not fulfilling reporting criteria remains at 38.      

A spokesman for the DH urged travellers not to visit wet markets with live poultry in the affected areas, and to avoid direct contact with poultry, birds or their droppings. If contact has been made, people should wash their hands thoroughly with soap and water.

H7N9: "Right now, anything is possible"

Via the Shots blog at NPR.org, a very good report: With Bird Flu, 'Right Now, Anything Is Possible'. Excerpt:

Another mystery is what animal species are serving as the source of the virus. It's presumed to be poultry, but Chinese authorities and WHO officials say a significant proportion of H7N9 victims have had no known contact with poultry. 

So far, testing of nearly 48,000 animals — nearly all birds — has found the virus in only 39. 

"There are very few positives for H7N9," says Dr. Juan Lubroth, the chief veterinary officer of the United Nations' Food and Agriculture Organization, based in Rome. "I would have expected maybe more hits in the poultry sector." 

Lubroth tells Shots that Chinese agricultural investigators took samples from bird markets, poultry slaughterhouses, poultry farms, wild bird habitats and bird environments. 

They also looked at pig slaughterhouses but found no evidence of infection. That's good, because pigs can be infected simultaneously with bird, swine and human viruses. The mingled viruses can swap genes, giving rise to new viruses that can spread among people. 

But the search for the animal sources of H7N9 is really only beginning. Until last week, Lubroth says, animal tests for it weren't very reliable. There's a good test, but the Chinese haven't had time to distribute it very widely. 

"They have more samples than they have results," he says. Forty-thousand samples currently await analysis. 

The basic problem is that H7N9 viruses are tiny needles in a gargantuan haystack. There's no way to test every last chicken, duck or pigeon in the five provinces and two enormous cities where cases have been found. 

"The surveillance has to be very targeted," Lubroth says, "and because we don't have a lot of information, that target is quite dark." 

The usual tactic in this kind of situation is called "trace-back." That is, start with the poultry markets where people who got the virus shopped or worked, then trace the source of the poultry back to the farms where they came from. 

But Lubroth says many poultry-sellers don't keep good records. And asking them where they got their chickens often leads to dead ends. 

"They can shrug. They can say there's a middleman," Lubroth says, "and then you go to the middleman and he's not there anymore."

H7N9: Hong Kong checking suspected cases

A news release from the Centre for Health Protection: Update on number of suspected human cases of Influenza A (H7) notified to CHP. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) today (April 15) provided an update on the latest number of suspected human cases of Influenza A (H7) notified to the CHP, including suspected human cases of Influenza A (H7) fulfilling reporting criteria, as well as the remaining ones not fulfilling reporting criteria.     

From noon yesterday (April 14) to noon today, the CHP received notification of one case which fulfilled the reporting criteria of suspected human cases of Influenza A (H7), and three cases which did not fulfil the reporting criteria. Please see case details in the attachment.      

This brings the total number of notifications received by the CHP since March 31, 2013, of cases which fulfilled the reporting criteria of suspected human cases of Influenza A (H7) to 11, and the total number of notifications which did not fulfil the reporting criteria to 27. 

"Influenza A (H7) is a statutorily notifiable infectious disease in Hong Kong and no confirmed human cases of Influenza A (H7N9) have been recorded so far," a spokesman for the DH stressed.

Canada: National electronic disease surveillance: a dream delayed

Via CMAJ: National electronic disease surveillance: a dream delayed. Excerpt:

After the SARS disaster killed 44 people in Ontario in 2003, the federal government was advised by an expert panel to bolster a "system that will collect, analyze, and disseminate laboratory and health care facility data on infectious diseases and noninfectious diseases" while also extending "the business processes for infectious disease surveillance." 

To help get this monumental job done, the panel, led by Dr. David Naylor, the then-dean of medicine at the University of Toronto in Ontario, suggested Ottawa invest in electronic information systems "to enhance disease surveillance and link public health and clinical information systems." 

Ten years later, many observers give Ottawa substantial credit for extending national disease surveillance capacity, but progress has been achingly slow on developing a national electronic surveillance system, they lament. 

Ottawa's initial response to the Naylor panel's call for a national electronic surveillance system was swift and generous. In March 2004, the federal government provided $100 million (increased to $135 million in 2007) to support the development of a pan-Canadian Health Surveillance System to Canada Health Infoway, a crown corporation created in 2001 to create a national electronic health "infostructure." 

Infoway forged a collaboration with the British Columbia Ministry of Health and selected IBM to create the system, which was dubbed Panorama. IBM completed the design in 2008 and, according to the initial contract, development and implementation of the system was to be completed by 2009. But according to an audit of the project published that year, progress was delayed by numerous technical problems and confusion amongst the provinces — a pattern remarkably similar to the confusion and delays with Infoway's broader efforts to create the national infostructure. 

Since then, little has been seen or heard of Panorama, says Dr. Tom Noseworthy, professor of health policy and management in the department of community health sciences at the University of Calgary in Alberta. 

"The concept has gone almost nowhere," he says, while noting that Alberta opted out of Infoway's surveillance plan from the outset. 

Dr. Vivek Goel, president and CEO of the Ontario Public Health Agency, offers a more optimistic view. Despite years of delay, due largely to jurisdictional and political barriers, some parts of the Panorama system could begin functioning in Ontario in 2014, he believes, in large part because BC's efforts to create the system are now at least starting to take a concrete form that other provinces can assess. 

BC Ministry of Health spokeswoman Laura Neufeld says BC has been reimbursed $47.8 million for leading the development of Panorama. BC will soon implement immunization and family health components of the system, she adds, and "the final two Panorama modules — Investigations and Outbreak Management — are scheduled for release across the province a year from now." 

Outside of BC, she adds "product delivery is in various phases across multiple jurisdictions in support of the national vision of standardized public health reporting." The system is a "public health care application" she says that will be used in public health and First Nations community clinics outside hospitals. 

"While deployment to hospitals is not part of the strategy at this time, it is possible if the business need arises to deploy Panorama in an acute care environment to support outbreak management," she adds. 

Goel and Noseworthy both say they worry that Infoway's decade-old technological framework for Panorama may have been overtaken by rapid technological changes.

Hong Kong: Travel trade H7N9 meeting held

The Hong Kong government website posted several bird flu reports on April 8. Here's one: Travel trade H7 meeting held.

Secretary for Commerce & Economic Development Gregory So and Secretary for Food & Health Dr Ko Wing-man today met travel trade representatives at the Central Government Offices to discuss preventive and surveillance measures against H7N9.   

Attendees included Tourism Board Chairman Peter Lam, Travel Industry Council Chairman Michael Wu, Commissioner for Tourism Philip Yung, Deputy Secretary for Food & Health Janice Tse, and Deputy Director of Health Dr Cindy Lai.   

They discussed the communication mechanism to strengthen the prevention and surveillance of H7N9, especially in the run-up to the Labour Day holiday period on the Mainland from April 29 to May 1.    

The Government is highly alert for influenza outbreaks. The Department of Health has boosted temperature checks and surveillance, and publicity, at immigration control points.

As well, Hong Kong reports that a 58-year-old woman has tested negative for H7N9, and a brief item on the three new cases reported in Shanghai and Jiangsu today.