H5N1

Chile: Health ministry reports first human case of H5N1, in north of country

I believe this is the first case of human H5N1 contracted in the Americas. Via La Nación: Minsal informa primer caso humano de gripe aviar en el norte del país.[Health ministry report first human case of avian flu in the north of the country] The full report, with my translation:

El Ministerio de Salud (Minsal) informó la tarde de este miércoles el primer caso en Chile de gripe aviar en humanos, reportado en el norte del país. 

The Ministry of health reported Tuesday afternoon on the first case in Chile of avian flu in a human, reported in the north of the country.

La persona enferma corresponde a un hombre de 53 años afectado por un cuadro de influenza grave. El paciente se encuentra estable dentro de su gravedad. 

The person is a 53-year-old man with a case of severe influenza. The patient is in serious but stable condtion.

Se indicó que se activaron los protocolos sanitarios establecidos para el manejo de esta enfermedad y se tomaron los exámenes correspondientes para su análisis por el Instituto de Salud Pública (ISP), que confirmó que se trata de influenza aviar. 

The ministry said it had activated health protocols established for control of the disease; tests were analyzed by the Institute of Public Health, which confirmed the disease was avian flu.

Se investiga la fuente de contacto y si existen antecedentes de otros afectados en el entorno del paciente. 

The source of the infection in being investigated, as well as the possibility of others' infection among the patient's contacts.

El virus H5N1 o gripe aviar es un virus que se puede transmitir desde aves o mamíferos marinos al ser humano, pero no se conocen casos de contagios de humano a humano. 

The H5N1 virus, or avian flu, can be transmitted from birds or infected marine mammals to humans, but human-to-human cases are unknown.

El Ministerio de Salud hace un llamado a la ciudadanía a no manipular aves o mamíferos enfermos o muertos e insta a los trabajadores avícolas a seguir los protocolos de seguridad correspondientes y a vacunarse contra la influenza estacional.

The Ministry of Health asked the public not to handle or touch birds of marine mammals, whether sick or dead, and asked workers in the poultry industry to follow the appropriate safety protocols and to obtaain a vaccination against seasonly influenza.

Kirundo-Muyinga: A mysterious disease with symptoms resembling those of the Ebola virus appears

Via SOS Médias Burundi, a March 27 report: Kirundo-Muyinga: a mysterious disease with symptoms resembling those of the Ebola virus appears. The Google translation:

An as yet unidentified disease killed three people in three days in the commune of Gitobe in the province of Kirundo and in the commune of Butihinda in the province of Muyinga (north-eastern Burundi). 

Symptoms developed by patients suffering from this disease resemble those of Ebola hemorrhagic virus or Marburg virus disease. In the case of Kirundo, the governor and the provincial doctor are waiting for the results of samples taken by specialists from the INSP (National Institute of Public Health) to decide.  

The ministry in charge of health has already confirmed for that of Muyinga that it is neither the Marburg virus disease nor Ebola. (SOS Media Burundi) This disease, not yet identified but having signs similar to those of Ebola, has just claimed the lives of two people in the commune of Gitobe. Both people died within 24 hours of showing the signs. All the patients come from the same Migwa hill, in the Baziro area.  

According to witnesses on the spot, "the symptoms include abdominal pain, nasal bleeding which increases after death, acute headaches, high fever, vomiting and dizziness". This disease kills very quickly, noted a nurse interviewed by SOS Media Burundi.  

“It's a disease that kills quickly. Within 24 hours, the infected person dies. It's terrible, we are all waiting for death," said a panicked nurse from the Migwa health center in the Gashoho health district in Muyinga province where patients were sent, including two women who died there.

When the population of Baziro wanted to bring the third person there, the population of Migwa blocked the entrances, fearing the spread of the disease. For the moment no one can leave the area of ​​Baziro which, it seems, has been confined. 

Samples were taken by the INSP to identify which disease it is.  

But until now the disease is not yet detected, according to doctors.  

In the morning of Friday, the governor of Kirundo, Albert Hatungimana, accompanied by the provincial doctor, carried out a raid in the commune of Gitobe, but they made no forecast.  

"We are awaiting the results of the swabs," a member of the governor's cabinet said.  

The population is worried because, she says, "So far no real prevention strategy against this disease has been communicated".  

“Apart from washing your hands and avoiding greeting each other, there are no strict measures, which can promote contamination,” residents insisted.  

Note that at Kirundo hospital, the first case was also admitted on Friday evening. In the commune of Ntega (same province), people with the same symptoms were reported on the same Friday evening.  

The population of the urban center of Kirundo lives in panic fear. She asks the government to declare the epidemic so that there is a rapid intervention.  

Another case was recorded in Giteranyi commune, Muyinga province (neighboring Kirundo). A student from Kobero Basic School not far from the border with Tanzania, died of this disease last Thursday.  

Tanzania declared a Marburg virus epidemic on March 21. A cousin of Ebola, this “filovirus” causes high fevers accompanied by virulent haemorrhages. So far, there is no vaccine or antiviral treatment for this disease, which can also attack primates. It is suspected that it is the Marburg virus which has spread in the Burundian provinces bordering Tanzania, the epidemic having been detected in the Kagera region in the north-west of Tanzania not far from Burundi and Rwanda .

Unravelling the commercial determinants of health

Via The Lancet, an editorial: Unravelling the commercial determinants of health. Excerpt:

In early March, in the wake of the COVID-19 pandemic, nearly 200 people—including former UN Secretary-General Ban Ki-moon—signed a letter strongly criticising pharmaceutical companies for putting a desire to make extraordinary profits before the needs of humanity. Selling publicly funded vaccines, treatments, and tests to the highest bidder resulted in inequities that cost more than a million lives, while private companies made billions of dollars. The signatories called on world leaders to ensure that such an injustice is never repeated.  

The conflict between profits and health equity is not new. The global health community fought for decades to provide access to antiretrovirals for patients with HIV/AIDS in less-resourced settings. Many commercial actors attempt to negatively influence national and international policies, undermine science, or to directly attack individuals calling out their actions. The recent Lancet Series on breastfeeding showed how an extensive network of lobbying by formula milk companies has derailed progress on breastfeeding education. 

This history speaks to the central importance to health equity of the commercial determinants of health, the subject of a Series published in this issue of The Lancet, led by Rob Moodie of the University of Melbourne, along with authors spanning 15 countries and six continents, with the support of the Victorian Health Promotion Foundation of Australia.  

The headline findings are startling: four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year. Yet much of the work to understand the harmful (or beneficial) impact of commercial actors has to date been done in health research silos. Each field faces many of the same tactical battles and strategies without a unified agenda to protect health. There is a lack of consensus across fields of health to define and understand the commercial determinants of health.  

The Lancet Series seeks to remedy this long-standing and complex situation with a consensus definition of the commercial determinants of health (“systems, practices, and pathways through which commercial actors drive health and equity”), a framing to understand commercial entities' impact on health, and a commitment to address its challenges in a holistic way.  

The Series authors set out a bold vision in which governments, commercial actors, and civil society contribute first and foremost to improving health and societal wellbeing. Such a vision is needed urgently. As the second paper in the Series outlines, commercial actors are diverse and many play a vital role in society, but the products and practices of many are having increasingly negative impacts on human and planetary health and equity.  

The Series provides a comprehensive agenda for action, recognising the need for regenerative business models and accountable transparent policies (including an end to commercial actors opposition to health regulation and policies).  

Moodie emphasises that the Series is not anti-business; it is pro-health. There are some notable good models of pro-health-acting businesses. For example, nearly 200 leading financial institutions (which together manage more than US$16 trillion) have signed a pledge to support tobacco-free policies across lending, investment, and insurance. However, although Environmental, Social and Governance frameworks are increasingly used to guide more responsible investment, they still lack specific health indicators.  

Health needs to become a crucial consideration of investor frameworks and global capital markets. Doing so will require the adoption of different economic models, new legislative and regulatory measures, civil society advocacy and accountability, and better corporate social responsibility. Governments must be empowered to encourage businesses to prioritise positive health impacts.  

As Tedros Adhanom Ghebreyesus, WHO Director-General, writes in an accompanying Comment, public health cannot progress without action on the commercial determinants of health. The Lancet welcomes the upcoming WHO Congress and first Annual Report on the commercial determinants of health, especially in helping to address non-communicable diseases. Given their huge unresolved impacts, the commercial determinants of health must be recognised—and funded—as a crucial field of research.

Tanzania confirms first-ever outbreak of Marburg Virus Disease

Via WHO AFRO: Tanzania confirms first-ever outbreak of Marburg Virus Disease.

Brazzaville/Dar es Salaam – Tanzania today confirmed its first-ever cases of Marburg Virus Disease after laboratory tests were carried out following reports of cases and deaths in the country’s north-west Kagera region.  

Tanzania’s National Public Health Laboratory analysed samples to determine the cause of illness after eight people developed symptoms including fever, vomiting, bleeding and renal failure. Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.  

“The efforts by Tanzania’s health authorities to establish the cause of the disease is a clear indication of the determination to effectively respond to the outbreak. We are working with the government to rapidly scale up control measures to halt the spread of the virus and end the outbreak as soon as possible,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.  

WHO is supporting the Ministry of Health to deploy an emergency team to Kagera to carry out further epidemiological investigations. The emergency team will focus on active case finding in the community and local health care facilities to identify more contacts and provide them with appropriate care.  

While Tanzania has never previously recorded a Marburg case, it has had to respond to other health emergencies including COVID-19, cholera and dengue within the past three years. A strategic risk assessment conducted by WHO in September 2022 showed that the country is at high to very high risk for infectious diseases outbreaks.   

“The lessons learnt, and progress made during other recent outbreaks should stand the country in good stead as it confronts this latest challenge,” said Dr Moeti. “We will continue to work closely with the national health authorities to save lives.”  

Marburg virus disease is highly virulent and causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.  

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves likelihood of survival.

Tanzania on high alert after strange disease kills five

Via The Citizen: Tanzania on high alert after strange disease kills five.

Tanzania’s ministry of health has issued a public notice about an unknown disease that has so far killed 5 people in Bukoba, Kagera Region.  

The notice comes after 7 people were reported to have fallen ill, showing symptoms of fever, vomiting, bleeding, and kidney failure.  

The ministry has called on the general public to remain alert and advised that anyone who shows signs of nausea, weakness, bleeding, diarrhea, or fever to report to the nearest health centre. 

“Anyone who sees someone with the aforementioned symptoms should alert authorities by calling a toll-free number (199).”  

It is believed that the disease is infectious and samples from the dead bodies have been taken to determine what type of disease it is.  

The ministry also said that a rapid response team has been dispatched to the affected areas.

8 dead skunks found in Vancouver and Richmond test positive for H5N1 avian flu

Via CBC News, a story that's getting close to home: 8 dead skunks found in Vancouver and Richmond test positive for avian flu. Excerpt:

Eight skunks found dead last month in Vancouver and nearby Richmond, B.C., have tested positive for avian flu. 

The B.C. government says it is the same strain of avian influenza associated with the outbreak that began in April 2022.  

The skunks were found in residential areas in both cities and were taken to B.C.'s Animal Health Centre over concerns they may have been deliberately poisoned.  

British Columbia's Ministry of Agriculture says the skunks were infected with the same H5N1 strain that has caused the deaths of millions of domestic poultry since the outbreak began in April last year.  

The ministry says in a statement the skunks may have contracted H5N1 by scavenging on infected wild birds.  

The statement says while avian flu in skunks is considered to be a low risk to human health, there are always risks when people or pets come into contact with sick or dead wild animals.

Avian influenza overview December 2022 – March 2023

ECDC has published Avian influenza overview December 2022 – March 2023. The abstract:

Between 3 December 2022 and 1 March 2023 highly pathogenic avian influenza (HPAI) A(H5N1) virus, clade 2.3.4.4b, was reported in Europe in domestic (522) and wild (1,138) birds over 24 countries. An unexpected number of HPAI virus detections in sea birds were observed, mainly in gull species and particularly in black-headed gulls (large mortality events were observed in France, Belgium, the Netherlands, and Italy). The close genetic relationship among viruses collected from black-headed gulls suggests a southward spread of the virus. Moreover, the genetic analyses indicate that the virus persisted in Europe in residential wild birds during and after the summer months. 

Although the virus retained a preferential binding for avian-like receptors, several mutations associated to increased zoonotic potential were detected. The risk of HPAI virus infection for poultry due to the virus circulating in black-headed gulls and other gull species might increase during the coming months, as breeding bird colonies move inland with possible overlap with poultry production areas. 

Worldwide, HPAI A(H5N1) virus continued to spread southward in the Americas, from Mexico to southern Chile. The Peruvian pelican was the most frequently reported infected species with thousands of deaths being reported. The reporting of HPAI A(H5N1) in mammals also continued probably linked to feeding on infected wild birds. 

In Peru, a mass mortality event of sea lions was observed in January and February 2023. Since October 2022, six A(H5N1) detections in humans were reported from Cambodia (a family cluster with 2 people, clade 2.3.2.1c), China (2, clade 2.3.4.4b), Ecuador (1, clade 2.3.4.4b), and Vietnam (1, clade 2.3.4.4b), as well as two A(H5N6) human infections from China. 

The risk of infection with currently circulating avian H5 influenza viruses of clade 2.3.4.4b in Europe is assessed as low for the general population in the EU/EEA, and low to moderate for occupationally or otherwise exposed people.

Bangladesh: One dies of Nipah virus in Rajshahi

Thanks to ProMED-mail for linking to this report in the Dhaka Tribune: One dies of Nipah virus in Rajshahi.

One woman died of Nipah virus in Rajshahi Medical College Hospital (RMCH) Wednesday afternoon.  

The deceased, Farida Yasmeen, 25, was admitted to the neuro medicine ward of RMCH with common symptoms like fever and seizures.   

Complications escalated after she was diagnosed with Nipah virus on Wednesday morning and was eventually referred to Nipah ICU. She died around 5pm while undergoing treatment.  

Besides, her mother-in-law Rahima Begum is admitted in the Nipah Suspect Ward with the same symptoms. Farida's father-in-law Abdul Haque had died at home with the same symptoms two weeks ago.  

Although the family thinks it was a natural death, however, doctors believe that her father-in-law was also infected with Nipah virus. Besides, it has been reported that their entire family eats date juice without boiling it, a common cause of the spread of this disease.  

Dr Azizul Haque, medicine specialist at Rajshahi Medical College Hospital, said: “Relatives of deceased patients are at higher risk of infection. So, they need to be extra careful. We are working in coordination with IEDCR.”  

He urged to be careful while drinking date juice.  

However, Rajshahi Civil Surgeon Dr Abu Yusuf Mohammad Farooq said that there is no need for regular care of the patient's relatives. The IECCR has collected and tested the samples of everyone who came in contact with the infected patient. However, everyone should be careful while drinking date juice.   

A total of five people have died in Rajshahi Medical College Hospital (RMCH) so far. All of them have a history of drinking date palm juice. Besides, everyone was admitted to the general ward of the hospital with common symptoms like jaundice. Then suddenly the physical condition started to deteriorate. Death occurred on admission to the ICU. Nipah in one of the deceased was identified after death.

China reports new H5N1 avian flu case

Thanks to FluTrackers for alerting me to this CIDRAP report by Lisa Schnirring: China reports new H5N1 avian flu case. Excerpt:

China has reported a new human H5N1 avian flu case, marking the second case in recent months, an official with the World Health Organization (WHO) confirmed today.  

Daniel Epstein, with the WHO's news media team, said China informed the WHO about the case on Feb 24. The patient is a 53-year-old woman from Jiangsu province who has a history of contact with poultry. The woman's symptoms began on Jan 31, and she was hospitalized on Feb 4.       

Genetic sequencing suggests that she was infected with the 2.3.4.4b H5N1 clade, which is currently circulating widely in birds, Epstein said. "Since 2020, an increased number of avian influenza outbreaks have been reported in wild birds and poultry globally, and we can expect additional sporadic human cases."  

The new case from China was first reported yesterday by BNO News.  

China's last H5N1 case involved a woman from Guangxi province who was sick in November and died from her infection. In a late December risk assessment, the WHO said the virus from that Chinese patient, as well as a recent case in Vietnam, also involved the 2.3.4.4b H5N1 clade.  

CDC weighs in on Cambodian H5N1 clade  

In related news, the US Centers for Disease Control and Prevention (CDC) yesterday detailed its genetic analysis of the full H5N1 avian flu virus sequence, shared by Cambodia's health ministry, from a girl who recently died from her infection.  

The CDC said that the virus belongs to the 2.3.2.1c clade and is different from the 2.3.4.4b clade that is currently circulating in US wild birds and poultry and in domestic and wild birds across the globe. It added that the clade found in the Cambodian patient is similar to 2.3.2.1c clade H5N1 viruses that have been circulating in Southeast Asia in recent years.  

Sequencing by the CDC also suggests that an existing clade 2.3.2.1c candidate vaccine virus would offer protection against the virus. Also, the CDC found no genetic changes known to be linked to enhanced ability to spread to people or reduced susceptibility to antiviral medications.