H5N1

ECDC: Communicable disease threats report, week 52

ECDC has published Communicable  disease threats report, 21-28 December 2013, week 52. Among other diseases, it deals with influenza in the EU, chikungunya in St. Martin, H7N9 in China, H5N1, MERS, dengue, and polio. As always, the CDTR is a concise and reliable survey.

Taiwan reports 2nd case of imported H7N9 in 2013

Via Focus Taiwan: Taiwan reports 2nd case of imported H7N9 in 2013 (update).

Health authorities confirmed Tuesday that a Chinese tourist in Taiwan has been infected with the H7N9 strain of bird flu, marking the second imported H7N9 infection this year. 

The infected, an 86-year-old man from Jiangsu Province, is still in Taiwan receiving treatment, though most of his 25-person tour group has already returned to China, according to the Centers for Disease Control (CDC). 

Two of his daughters have stayed with him but have thus far shown no symptoms associated with the virus. 

The man entered Taiwan Dec. 17 and began showing symptoms two days later, starting with a loss of appetite. On Dec. 23, he reported tightness of the chest before being rushed to an emergency room the next day, where he was put on a ventilator to treat pneumonia. 

An infectious diseases experts familiar with the case said he was not surprised by the second case of H7N9 coming from China following the first back in April. 

Even so, this patient's symptoms were slightly different from previously reported infections, indicating that doctors still face some difficulty in diagnosing the virus, he added. 

The man's infection could mean that H7N9 has become prevalent across all of southern China even though, puzzlingly, major duck and chicken farms in the region have been found disease-free. 

"Beware of the virus if you see any ducks in the Jiangnan (south of the Yangtze River) area," he cautioned.

Mike Coston at Avian Flu Diary has two posts about this case, here and here.

MERS: Thoughts on private sorrow, stigma, and public health

This morning I woke to a tweet from Andrew Rambaut, for whom I have deep respect. He is one of the people I call grownups, the trained professionals who understand what's involved in dealing with the outbreak of a new disease. Compared to the grownups, the rest of us Flublogians are mere gawkers, commenting on the progress of the fire but with no real idea what the firefighters are doing.

Andrew was responding to my complaint about the lack of detail in the Saudis' reports on MERS cases: 

Re: privacy. It is a pity that the age and gender are being reported - these are the least useful and most identifying traits. ... If a unique ID and broad age categories used then perhaps detail about places, contacts, exposure - would be more useful.

Ian Mackay came (sort of) to my defence:

Age bands sound like good idea for privacy but is imprvd privacy really the hindrnce for otherwise patchy & slow #MERS data?

These are important issues, both ethically and politically, and they deserve far more than a couple of tweets. So here, hesitantly, I offer my own response.

One of the greatest health hazards we face is not this or that virus or bacteria, but our fellow-humans' response to our falling ill with it. Evolution, I guess,  taught us to avoid people who get sick, whether or not they're related.

But we're not in the Pleistocene any more, and we are learning, slowly and painfully, to save ourselves by saving our sick. The painful part comes with what we now call "stigma" -- not an actual wound, but a mark of shame, a blaming of the victim for being sick. It's hard to save someone you both fear and despise, so the victim of the disease must bear a greater burden.

In his satirical novel Erewhon, Samuel Butler long ago mocked this attitude. In his New Zealand Utopia, people find no shame in committing a crime, but can't bear admitting to illness. Sooner than say he'd caught a cold, an Erewhonian would say: "I was off stealing a pair of gloves."

Stigma is responsible for many millions of HIV/AIDS deaths (and Uganda's new anti-homosexuality law, if President Musevene accepts it, will kill thousands of Ugandans all by itself). Here's a case where evolution seems to be working against itself: To pass along our genes, we want to mate with very sexy persons who will give us sexy offspring. Yet we profess to be appalled by sexy behaviour, and especially when it leads to a disease like AIDS.

In the case of MERS, however, we have no idea how it's contracted. Perhaps a few Arabs, like American cowboys and their horses in old Hollywood movies, would rather kiss their camels, but I doubt it. Nevertheless, contracting this bizarre new disease has invoked stigma on the victims, and thereby made it that much harder to understand the disease in the first place.

When a disease becomes a public threat, privacy itself is a health hazard. You may want to curl up in bed with your secret shame, but if your secrecy is going to infect me and my kids, I'm ready to out you. And I'm not even mad at you -- you're just an unlucky victim of yet another invasion from the microscopic world. Like a soldier in combat, I'll try to drag you to safety, not blame you for stopping a bullet.

Consider the rumours of the MERS cases in Afif, Saudi Arabia. The only people who know the teacher, the principal, and the student involved in those cases are the people in that community -- and they know exactly who they are. The healthcare workers in Saudi hospitals know exactly who got sick and who died. So do the workers whose colleagues fell ill in Jordan in the first known outbreak of MERS. Privacy is irrelevant to those who know the cases.

For an old retired teacher in Vancouver and his readers to know the cases' names is also irrelevant to their privacy. One of the functions of this blog is to recognize and honour those who die of H5N1 or encephalitis or any other disease, like 15-year-old Fatima Kocyigit, who died in eastern Turkey almost exactly eight years ago. She would be a 23-year-old woman now, but she and her relatives died for our sake. We owe her and her shattered family more than an embarrassed silence. 

I accept the presence of stigma in our benighted culture as I accept the presence of Streptococcus aureus and countless other stupid organisms. Privacy may give the victims and their families a little less to be anxious about, but cholera, MRSA, Aedes aegypti, and MERS don't give a shit about you or your family or what the neighbours think; to them, you're just bug chow.

So yes, let us do as Andrew suggests, and give only each MERS case's age range, and perhaps even ignore the case's sex; that can emerge in the research reports, if it's epidemiologically relevant. But let every announcement of a new case also make the point: This was not the patient's fault.

Japan: The homeless clean up Fukushima, working for the Yakuza

Thanks to Shane Granger for sending the link to this Reuters report on his excellent blog Peak Jobs: Japan: The homeless clean up Fukushima, working for the Yakuza. Excerpt:

Seiji Sasa hits the train station in this northern Japanese city before dawn most mornings to prowl for homeless men. He isn’t a social worker. He’s a recruiter. The men in Sendai Station are potential laborers that Sasa can dispatch to contractors in Japan’s nuclear disaster zone for a bounty of $100 a head. 

“This is how labor recruiters like me come in every day,” Sasa says, as he strides past men sleeping on cardboard and clutching at their coats against the early winter cold. 

It’s also how Japan finds people willing to accept minimum wage for one of the most undesirable jobs in the industrialized world: working on the $35 billion, taxpayer-funded effort to clean up radioactive fallout across an area of northern Japan larger than Hong Kong. 

Almost three years ago, a massive earthquake and tsunami leveled villages across Japan’s northeast coast and set off multiple meltdowns at the Fukushima nuclear plant. Today, the most ambitious radiation clean-up ever attempted is running behind schedule. The effort is being dogged by both a lack of oversight and a shortage of workers, according to a Reuters analysis of contracts and interviews with dozens of those involved. 

In January, October and November, Japanese gangsters were arrested on charges of infiltrating construction giant Obayashi Corp’s network of decontamination subcontractors and illegally sending workers to the government-funded project. 

In the October case, homeless men were rounded up at Sendai’s train station by Sasa, then put to work clearing radioactive soil and debris in Fukushima City for less than minimum wage, according to police and accounts of those involved. The men reported up through a chain of three other companies to Obayashi, Japan’s second-largest construction company.

El Salvador: Volcano continues activity

Via Diario El Mundo: Continúa actividad en el Chaparrastique.[Chaparrastique continues activity] The full report, with my translation:

Este día el volcán Chaparrastique en San Miguel amaneció sin presentar actividad eruptiva, tras la explosión producida ayer que ha dejado más de dos mil evacuados. 

Today the Chaparrastique volcano in San Miguel began the day without showing eruptive activity, after yesterday's eruption caused over 2,000 to be evacuated.

Sin embargo, alrededor de las 8:50 a.m., se reportó aumento en emanaciones de ceniza y gases. 

Still, around 8:50 a.m. an increase was reported in venting of ash and gases.

A tempranas horas de la mañana el vulcanólogo Francisco Barahona aseguró que el Chaparrastique amaneció en la normalidad. “El volcán amanece bastante relajado, pensamos que va a la etapa de relajación”, dijo en la entrevista matutina Frente a Frente. 

Early this morning the vulcanologist Francisco Barahona said the Chaparrastique volcano started the day normally. "The volcano was pretty calm. We think it's going into a stage of calm," he said on the morning interview program Face to Face.

Mientras tanto, el ministro de Medio Ambiente, Hernán Rosa Chávez, dijo que se mantienen en permanente monitoreo de la actividad, pero que de momento, no han podido acercarse al cráter por pequeñas emanaciones de gases. 

Meanwhile Environment Minister Hernán Rosa Chávez said the volcano is being permanently monitored, but it's impossible to go near the crater because of minor gas venting.

Aclararon que el peligro aún continúa pese al cese de emanaciones de ceniza. 

It was said the danger continues despite the end of ash venting.

El evento no ha dejado víctimas mortales pero ha dejado 2,214 personas evacuadas, de acuerdo al director de Protección Civil, Jorge Meléndez. 

The eruption has not caused any deaths, but it has forced 2,214 persons to be evacuated, according the Jorge Meléndez, Director of Civil Protection.

Las autoridades mantienen alerta naranja en la zona del volcán y alerta amarilla en el resto del país.

Authorities are maintaining an orange alert in the region of the volcano and a yellow alert in the rest of the country.

More on chikungunya in St. Martin/Sint Maarten

Via St. Martin News Network, a December 27 report: Ministry of Public Health reports one confirmed case of Chikungunya; Residents urgently advised to be proactive in eliminating mosquito breeding sites. Excerpt:

Collective Prevention Services (CPS), an agency of the Ministry of Public Health, Social Development and Labour confirms that the country has one confirmed case of Chikungunya, a 38-year old male residing in the district of Saunders. The case was confirmed on December 19, 2013 by the Center National de Reference des Arbovirus, Marseille. 

Residents are therefore urged to take extra efforts to eliminate mosquito breeding sites in and around their homes and businesses on a daily basis and to stop mosquitoes from feeding. 

Chikungunya (CHIK) fever is an emerging, mosquito-borne disease caused by an alphavirus, Chikungunya virus (CHIKV). This disease is transmitted predominantly by Aedes aeqypti and Ae. Albopictus mosquitoes, the same species involved in the transmission of dengue. 

Country Sint Maarten's Ministry of Public Health has been actively appealing to the public to reduce breeding sites and clean-up around their properties. Numerous press releases with the Minister of Public Health's 'Get Checked' campaign, and adverts in the Government Information Page (GIP) have been published along with public service announcements in the broadcast media over a period of months in relation to dengue fever/mosquito prevention measures. 

Ministry of Public Health Vector Control Team have been visiting homes and other properties on a monthly basis appealing to residents to clean-up and also providing information about the two vector borne diseases. 

You can call CPS if you desire more information on how to eliminate your mosquito breeding sites at 542-2078 or 542-3003. 

Other interventions that have taken place are: fogging; training of vector control staff; placing physicians on alert and increasing public health surveillance for chikungunya; national, regional and international public health organizations appraised as part of reporting protocols; yard to yard inspections planned for Belvedere and Oyster Pond area; and alerting ports of entry and providing information flyers to visitors.

Hong Kong: More on the H9N2 human case

Via the South China Morning Post: Hong Kong sees first case of H9N2 avian flu in four years. In addition to some details on the case, the story also provides some background. Excerpt:

The man arrived at the Lo Wu border crossing suffering from chills, a cough and excess sputum. He was then taken to a hospital in an ambulance. He developed a mild fever in the hospital. 

More than 50 medical and ambulance workers at the hospital are now being monitored for symptoms. The man's relatives in Shenzhen had not displayed any symptoms of illness, the Department of Health said. 

Both Centre for Health Protection controller Dr Leung Ting-hung and HKU microbiologist Professor Yuen Kwok-yung said that the H9N2 strain usually caused a mild infection. 

The virus did not spread to humans easily and there was no evidence of human-to-human transmission, Leung said. However, the strain could be serious for the elderly and those with a weak immune system, Yuen said. 

The south of the mainland had seen sporadic cases of human infection with H9N2 since 1998, he said. 

In Hong Kong, where the virus was a statutory notifiable disease, seven cases had been recorded since 1999, the department said, two of which were imported from the mainland and four of which were local infections. One case was of an unknown origin. 

The last case, an imported infection, was in 2009. All of the infected recovered from the virus. 

Leung said H9N2 had been detected around the world. 

The emergence of different strains of bird flu in humans heightened the risk of genetic swapping, which might lead to mutated viruses, Yuen said. 

Increased demand for chicken on the mainland had prompted traders to pack more birds into the same amount of space in wet markets, increasing the risk of cross infection and genetic adaptation, he said. "Biosecurity measures and regulatory controls on the mainland have not caught up with increasing poultry numbers," he added. 

Ho said that before Hong Kong banned wet markets from keeping live poultry overnight in 2008, the H9N2 infection rate was 5 per cent to 6 per cent. The rate fell below 1 per cent after the ban. Leung urged the public to avoid contact with live poultry and to practise good personal hygiene. He expects more cases of avian influenza as temperatures fall.

CIDRAP: Caribbean chikungunya outbreak grows, poses threat to US

Via CIDRAP, Lisa Schnirring writes: Caribbean chikungunya outbreak grows, poses threat to US. Excerpt:

Health officials are reporting a sharp rise in the number of patients sickened in a chikungunya fever outbreak centered on the Caribbean island of St. Martin, which may signal an increasing risk to the US mainland. 

On the French part of the island, where most of the infections have been reported, the number of confirmed cases has risen from 26 to 66, according to a Dec 28 update from the European Centre for Disease Prevention and Control (ECDC). 

In addition, health officials from the Netherlands have confirmed the first case on the Dutch side of St. Martin (Sint Maarten), and illnesses have been detected on two other nearby islands: three on Martinique and one on Guadeloupe, according to the ECDC report. Both of those islands are south and slightly east of St. Martin. 

The case in Guadeloupe represents the island's first documented local chikungunya case, which was detected because of enhanced surveillance for the disease in all French Caribbean territories, the ECDC said. The patient is co-infected with dengue serotype 4 and had not recently traveled to another area where chikungunya exists. 

Meanwhile, health officials in the area are investigating a slew of suspected and probable cases. They include 167 suspected cases and 14 probable cases on the French side of St. Martin, and two patients have been hospitalized. Martinique has 27 suspected cases, and on the island of St. Barthelemy, 21 suspected cases are under investigation. 

The outbreak represents the first known indigenous transmission of chikungunya fever in the Americas The ECDC said in its update that the outbreak underscores the recommendations it made earlier this month, urging health providers to heighten their vigilance against the disease, especially with increased travel during the holidays.

CIDRAP: Qatar says MERS-CoV-infected camels now virus-free

Via CIDRAP, Robert Roos writes: Qatar says MERS-CoV-infected camels now virus-free. The post also discusses the latest developments in Saudi MERS cases. Excerpt:

A camel herd in Qatar that had Middle East respiratory syndrome coronavirus (MERS-CoV) infections associated with two human MERS cases now seems to be free of the virus, Qatari authorities reported yesterday via the World Organization for Animal Health (OIE). 

"The samples from the same herd tested using the same technique were negative and this may show that MERS-CoV infection in camels is a self-limiting disease," a Qatari agriculture official said in the OIE report. 

Three of 14 camels in the herd had tested positive for the virus, according to findings reported by Qatari health officials in late November. The camels were tested in October, after MERS-CoV was diagnosed in their 61-year-old owner and in a 23-year-old man who worked on the farm. 

Scientists found that the camel viruses were nearly identical to the viruses in the two patients, according to a separate report published 2 weeks ago in the Lancet Infectious Diseases. But they couldn't determine if the camels had passed the virus to the humans or vice versa, or if some other host had infected both camels and humans.

Finland: Cold temperatures may kick off flu epidemic

Via Yle Uutiset: Cold temperatures may kick off flu epidemic.

Between the end of November and the end of this month only about a dozen cases of influenza were diagnosed in the Finnish capital. 

According to Helsinki's City Epidemiologist Hannele Kotilainen, the slow spread of the flu can be in part attributed to unseasonably warm temperatures. 

"The influenza virus does well in the cold, so when very cold temperatures arrive, the virus will spread more easily," explains Kotilainen. 

Last winter's seasonal flu epidemic was at its height in late January and early February. Kotilainen believes that will happen once again this winter. 

Hannele Kotilainen is urging anyone in a group at special risk who has not been vaccinated against the flu to get a jab now. This, she says, may well prevent a hospital stay later, possibly even death. 

"Many people think that the chance to get a vaccination ends after Christmas, but there is still time. Once an epidemic is in full swing, it will no longer be worthwhile," she points out.