H5N1

US: California H1N1 deaths for those under 65 running far ahead of last year

Via The Los Angeles Times: California flu deaths for those under 65 running far ahead of last year. Excerpt:

Influenza-related illness has killed 147 Californians under age 65 this season, including 17 people in Los Angeles County and one in Long Beach, state health officials have confirmed. 

The toll is unusually high: At the same point last year, only 14 people in that age group had died of the flu, Dr. James Watt of the California Department of Public Health told reporters Friday. 

Throughout the entire 2012-2013 flu season, the state logged just 106 confirmed deaths. 

The new fatalities are a sign that this year's flu season continues to be especially severe, even as some indicators of influenza activity, such as hospitalizations for flu-related illness, seem to be plateauing in L.A. County, California and elsewhere across the U.S. 

"Unfortunately, one of the things we always say about influenza is that it's unpredictable," said Watt, chief of the public health department's Division of Communicable Disease Control. "It's too early to say if this decline will be sustained." 

The state confirmed 52 new deaths last week. Public health workers were investigating an additional 44 reported influenza deaths, most of which are likely to be confirmed in coming days. 

"We expect the number to climb," Watt said.

Hong Kong: CHP reports 5 more Mainland H7N9 cases, 1 death

The Centre for Health Protection has published a February 1 news release: CHP notified of five additional human cases of avian influenza A(H7N9) in Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) received notification yesterday (January 31) of five additional human cases of avian influenza A(H7N9) respectively in Guangdong (four cases) from the Health and Family Planning Commission of Guangdong Province, and in Hunan (one case) from the National Health and Family Planning Commission.      

The four cases in Guangdong involve three men aged 28, 59 and 82 and a woman aged 81. Among them, the 59-year-old man passed away on January 30 while the remaining patients are under treatment in hospital.      

The case in Hunan involves a man aged 38 who is now hospitalised for treatment.      

As of yesterday, a total of 271 human cases of avian influenza A(H7N9) have been confirmed in the Mainland, including Zhejiang (111 cases), Shanghai (41 cases), Jiangsu (36 cases), Guangdong (41 cases), Fujian (16 cases), Jiangxi (six cases), Anhui (four cases), Henan (four cases), Hunan (four cases), Beijing (three cases), Shandong (two cases), Hebei (one case), Guizhou (one case, imported from Zhejiang) and Guangxi (one case).

Nigeria: Expatriates to be arrested over refusal to allow polio vaccination

Via ThisDay Live.com: Kano Orders Arrest of Indian, Lebanese over Polio. Excerpt:

New cases of Polio virus has been reported in Kura Local government area of Kano State where health officials blamed the incidence on refusal of residents to ensure their children were immunised. 

The development is coming on the heels of an order by the State government for the arrest of a Lebanese and an Indian who refused the immunisation of their children from the polio virus few hours after the announced confirmation of new cases. 

Director of Public Health, Kano State Ministry of Health, Dr. Muhd Nasir Mahmud confirmed the new polio case in Kura Local Government Area of the state to a delegation of “Journalists Against Polio” at the key stakeholders meeting held in Kano to wrap up this round of the routine immunisation exercise. 

Mahmud said the new case was discovered during the December round of  immunisation exercise, attributing the discovery to non compliance on the part of the parent of the victim. He therefore urged the parents and guardians to always accept polio vaccine for their under five children for proper immunisation to compliment the stakeholders effort in eradicating polio in their domain and the nation at large before the end of this year. 

The directive for the arrest of the foreign nationals came 24 hours after uncovering a new polio case in Kura Local Government Area of the state. 

According to a statement by Bala Salihu Dawakin Kudu, the Director of Press to the state Deputy Governor, Dr. Umar Ganduje, the state was determined to ensure nothing will hinder it from ensuring that children were immunised. 

It added that the deputy governor was visibly worried over the attitude of the expatriates and warned that no one will be allowed to hinder government’s efforts in eradicating the disease from the state. According to the directive, Ganduje said the security agents have already moved to arrest any foreign national that was found to be resisting the polio vaccine. 

The statement disclosed that Ganduje, the chairman of Kano State Task Force on Polio Eradication, accompanied polio vaccinators to many households in the area, where most of the foreigners refused to allow their children to be immunized.

Dr. Mackay: Can we trust the H7N9 tests?

On his VDU's blog, Dr. Ian Mackay writes: Neither market nor farm poultry very positive for H7N9; songbirds the the culprit...? Excerpt and then a comment:

Following on from yesterday's post, "If not poultry then what?", I thought it worth noting the impressive numbers from the Chinese Ministry of Agriculture. 

From 2013: 

• 1,630,000 poultry and environmental samples tested 

• 88 POS; all from live bird markets 

• None from poultry farms 

From 2014, to date: 

• 33,400 poultry and environmental samples 

• 8 H7N9 POS; all from live bird markets 

• None from poultry farms 

The other alternative to answer the question in my heading; the testing methods are at fault.  

No detail of what approach has been used to obtain these numbers in the links below. Viral culture and serology with some PCR have been noted before. I'd wager culture yields chicken scratchings compared to PCR for detecting virus in the wild; but serology has successfully been a pillar upon which animal testing rests. So that's why the numbers above are such a quandary for the epidemiologist who reads about the high frequency of links between human disease and exposure to poultry. 

It would be nice to see some technical papers on antibody test testing (development and validation) at some point.

I keep wondering about the statistics of H7N9 as well. In a nation of 1.3 billion hearty eaters of billions of chickens, how is it that so few people come down with H7N9? Why do the authorities find H7N9 in one of two places: in the victims, and in live poultry markets?

We know that a bird crawling with H7N9 will look you in the eye and seem perfectly healthy, so could it be that far more of them are carrying H7N9 than we have so far found? And are far more people catching mild or even asymptomatic cases than we realize? 

I have no idea. But the striking aspect of both H7N9 and MERS is that even after months of intensive research, we still don't really understand them.

H7N9: A little good news from Fujian

Via What's On Xiamen: 2-yr-old H7N9 patient discharged from Xiamen hospital after treatment. Excerpt:

Xiamen reported two human H7N9 infection cases amid H7N9 bird flu outbreak fears, and an infected 2-year-old recovered and left the hospital on 30th January.

The patient was confirmed as infected with the virus on 29th January, and discharged from the hospital the next day, after effective and timely treatment.

CIDRAP: China reports 4 more H7N9 infections, 1 fatal

Via CIDRAP, Lisa Schnirring writes: China reports 4 more H7N9 infections, 1 fatal. Excerpt:

With China celebrating its Lunar New Year holiday today, new reports of H7N9 avian flu cases slowed, with only one province reporting cases, four of them, along with one death. 

Lunar New Year holiday celebrations extend into next week, and health officials have said they expect to see more H7N9 cases, as families gather and live-poultry transport and sales escalate. The resurgence in H7N9 cases has already pushed the case total in the second wave higher than that in the first. 

In other developments, the World Health Organization (WHO) provided another update on the latest reports it has received from China and updated background documents with the latest information about the disease. 

Four new cases, one fatal 

The FluTrackers infectious disease news message board today noted that Guangdong province reported four new cases, in a 28-year-old man who is in critical condition, an 82-year-old man who is in critical condition, a 59-year-old man who died from his infection, and an 81-year-old woman who is in stable condition. 

The new cases edge the number of H7N9 infections to 277, according to FluTrackers’ running total. The additional fatality raises the outbreak’s unofficial death count to 61. 

In addition today, the WHO provided new details about six lab-confirmed cases, one of them fatal, based on reports from Chinese and Hong Kong health officials that it received on Jan 29. The five patients from the mainland are from Zhejiang (3), Fujian (1), and Guangdong provinces (1). 

Patient ages range from 2 to 63 years. Four of them are hospitalized in critical or serious condition. Four had been exposed to poultry or a live-poultry market before getting sick. 

The 2-year-old is a boy from Fujian province and is hospitalized with a mild infection. His family slaughters and sells ducks, according to the WHO report.

Branswell: Assessing the risk of H7N9

Via the Brandon Sun, a report by Helen Branswell of The Canadian Press: With Chinese New Year H7N9 cases soar, but experts struggle to assess the risk. Excerpt:

Human infections of H7N9 bird flu soared in the lead up to Friday's start of the lunar New Year celebrations in China, with fall-winter cases now overtaking the tally from last spring's first explosive outbreak of the new virus. 

The Chinese New Year is the single biggest travel event on the global calendar; the movement around the country of hundreds of millions of people and the family feasts associated with the multi-day holiday are expected to raise the infection count higher still. 

Scientists who monitor influenza are watching China especially closely now. 

"For the current period it is important to remain extra vigilant, I would say," says Dr. Sylvie Briand of the World Health Organization, stretching out the first syllable of "extra" for emphasis. 

While Briand and other flu experts are worried, they are in a quandary. They know the new virus poses a pandemic risk, perhaps a greater one than any non-human flu virus that has emerged in recent times. Certainly no bird flu virus has infected people so easily and frequently in known history. 

In fact the numbers are rising so fast it's tough to keep track of where the count stands. Between the time this article is written and when it is read, the numbers will almost certainly change. 

Late Thursday the U.S. Centres for Disease Control's tally was 272 cases and 62 deaths since the first known cases occurred in late February 2013. To put that in context, there have been about 650 cases of H5N1 avian flu over the past decade. In fact, some experts think it is possible that by the time this flu season subsides in China in the late spring, H7N9 may have overtaken H5N1 — in just over a year. 

"The march of this virus into other regions in China and other countries will be occurring over the next months and years," says Nancy Cox, who heads the CDC's influenza division. 

"So ... even if it doesn't occur by the spring, we certainly will have in time as many cases of H7N9 as we have of H5N1. And I would expect it to take far less time." 

But will geographic spread and a rapidly rising case count presage the century's second flu pandemic, the worldwide spread of the virus? Since it can't do it now, it seems H7N9 would need genetic changes to be able to spread easily from person to person. And scientists have absolutely no way to gauge if or when that might happen. 

"I can't say whether that mutation will occur tomorrow, in 10 years, or never," Dr. Tom Frieden, director of the U.S. Centres for Disease Control, said Thursday. 

That is a fact that is difficult to explain to a public that generally wants clarity, not caveats. Briand, who is director of the WHO's pandemic and epidemic disease department, readily acknowledges the limited state of the current science. 

"We know there is a risk, but it is very hard to say (if it is) very low or very high. And most of the time we conclude: OK, it's a middle risk," she says.

The Lancet: Alcohol and mortality in Russia

Via The Lancet: Alcohol and mortality in Russia: prospective observational study of 151 000 adults. The summary:

Background 

Russian adults have extraordinarily high rates of premature death. Retrospective enquiries to the families of about 50 000 deceased Russians had found excess vodka use among those dying from external causes (accident, suicide, violence) and eight particular disease groupings. We now seek prospective evidence of these associations. 

Methods 

In three Russian cities (Barnaul, Byisk, and Tomsk), we interviewed 200 000 adults during 1999—2008 (with 12 000 re-interviewed some years later) and followed them until 2010 for cause-specific mortality. In 151 000 with no previous disease and some follow-up at ages 35—74 years, Poisson regression (adjusted for age at risk, amount smoked, education, and city) was used to calculate the relative risks associating vodka consumption with mortality. We have combined these relative risks with age-specific death rates to get 20-year absolute risks. 

Findings 

Among 57 361 male smokers with no previous disease, the estimated 20-year risks of death at ages 35—54 years were 16% (95% CI 15—17) for those who reported consuming less than a bottle of vodka per week at baseline, 20% (18—22) for those consuming 1—2·9 bottles per week, and 35% (31—39) for those consuming three or more bottles per week; trend p<0·0001. 

The corresponding risks of death at ages 55—74 years were 50% (48—52) for those who reported consuming less than a bottle of vodka per week at baseline, 54% (51—57) for those consuming 1—2·9 bottles per week, and 64% (59—69) for those consuming three or more bottles per week; trend p<0·0001. 

In both age ranges most of the excess mortality in heavier drinkers was from external causes or the eight disease groupings strongly associated with alcohol in the retrospective enquiries. Self-reported drinking fluctuated; of the men who reported drinking three or more bottles of vodka per week who were reinterviewed a few years later, about half (185 of 321) then reported drinking less than one bottle per week. Such fluctuations must have substantially attenuated the apparent hazards of heavy drinking in this study, yet self-reported vodka use at baseline still strongly predicted risk. 

Among male non-smokers and among females, self-reported heavy drinking was uncommon, but seemed to involve similar absolute excess risks. 

Interpretation 

This large prospective study strongly reinforces other evidence that vodka is a major cause of the high risk of premature death in Russian adults.

Beijing smog contains witches' brew of microbes

Via Nature News & Comment: Beijing smog contains witches' brew of microbes. Excerpt:

For people racked by the dreaded ‘Beijing cough’, it is all too clear that particles in the city’s thick smogs pose a public-health problem. But much less clear is the impact — or even the identity — of the microbes that also drift through the brown haze. 

Chinese researchers have now used genome sequencing to identify about 1,300 different microbial species in an exceptionally soupy smog that hit Beijing in January 2013. Reassuringly, most of the microbes they found are benign — but a few are responsible for allergies and respiratory disease in humans. And on days with heavier pollution, the proportion of DNA from these allergens and pathogens increased, suggesting that they might present an additional health threat to vulnerable groups, such as older people or those with weakened immune systems. 

Surveys of airborne microbes have long relied on culturing samples in the lab, a method that can easily miss key species. In the past few years, researchers have looked at the microbial genomes found in air to identify broad families or genera of bacteria — an approach called metagenomics. But this is the first time that a survey has drilled down to pinpoint particular species of microbes in air, which is important for assessing their pathogenic potential, says Ting Zhu, a biologist at Tsinghua University, Beijing, who was part of the team that performed the latest study. “It’s a proof of principle that one can extract and identify these microbes at the species level,” says Zhu. “It adds to our understanding of what we inhale every day.” 

Fog filter 

The scientists took 14 air samples over 7 consecutive days and filtered out two types of particles: those measuring less than 2.5 micrometres across, and those up to 10 micrometres across, known as PM2.5 and PM10, respectively. On some days during the experiment, Beijing’s PM2.5 levels topped 500 micrograms per cubic metre — some 20 times the World Health Organization’s guideline limits. 

The scientists extracted and sequenced DNA from the samples, and compared the results with a large gene database. The most abundant species identified was Geodermatophilus obscurus, a common soil bacterium. But they also found Streptococcus pneumoniae, which can cause pneumonia; Aspergillus fumigatus, a fungal allergen; and a range of other bacteria typically found in faeces. 

The proportion of DNA from these species increased by 2–4 times on the smoggiest days, although the samples probably included material from dead cells too, “so we don’t know if they are still viable”, says Zhu. The researchers suggest that clinical studies could look for the same microbes in the sputum of patients with respiratory tract infections, to assess whether smoggier days lead to more infections.

Andrea Franzetti, a microbiologist at the University of Milan–Bicocca, Italy, says that the make-up of the microbial community in Beijing's air is broadly in line with a similar survey of airborne bacteria that his team conducted in Milan. “What’s new is the high number of sequences,” he says. That helps to quickly pinpoint bacteria that might have worrying health effects, allowing microbiologists to target them for further study. “There is increasing evidence that bacteria could play an important role in the health effects [of airborne particles],” says Franzetti. 

Even so, “the PM2.5 and PM10's are way more problematic than any of the microbes,” notes Norman Pace, a microbiologist at the University of Colorado Boulder, who led a sequencing-based survey of microbes in New York subway air. The technique might be more revealing in locations such as hospitals, where there are greater concerns about airborne pathogens, he suggests.

China closing Shezhen poultry markets, developing H7N9 vaccine

Via Xinhua: China Focus: China closes poultry markets. Excerpt:

The southern metropolis of Shenzhen has closed all live poultry markets until Feb. 13 for a thorough cleaning. The city near Hong Kong has reported 14 human H7N9 cases since Dec. 18. 

Live poultry trading has been halted in Hangzhou, Ningbo and Jinhua cities in Zhejiang, which reported the largest number of human H7N9 cases. 

China has stepped up research for an H7N9 vaccine in the face of the increasing threat from the virus. 

Beijing's Sinovac Biotech Ltd., which developed the A/H1N1 and H5N1 vaccines, said in a press release on Wednesday that it has completed preclinical studies of an H7N9 vaccine and prepared several types for clinical testing. 

The company has submitted an application to the China Food and Drug Administration to start clinical trials. 

Hualan Biological Engineering Inc. said in early January that the H7N9 vaccine developed by its subsidiary, Hualan Biological Bacterin Co., Ltd., had passed an initial examination by the food and drug watchdog in central China's Henan Province. 

The vaccine is being handled by the China Food and Drug Administration, but it is still hard to say when and if it will be approved for production, according to the Henan Provincial Food and Drug Administration.