H5N1

Cambodia: Two Takeo boys confirmed infected by H5N1 bird flu

Google Maps

Thanks to Peter O'Meagher for alerting me to this Khmer Times report: Two Takeo boys confirmed infected by H5N1 bird flu. Takeo is a province south of the capital, Phnom Penh. The 3-year-old case was reported yesterday, but not the 5-year-old. Excerpt:

The Takeo Health Department said two boys, ages three and five, have been confirmed to be infected with the H5N1 bird flu, while 29 others are still waiting for test results from the National Institute of Public Health (NIPH) and the Pasteur Institute (PI) of Cambodia.  

H5N1 is a subtype of influenza that predominantly infects birds. However, the H5N1 virus can also infect mammals that have been exposed to infected birds in some cases. In these cases, symptoms are frequently severe or fatal.  

Takeo Health Director Nhea Sithan said yesterday that two children have been diagnosed with the H5N1 bird flu virus, while 29 people were waiting on results of blood tests from the NIPH and PI. He said that the Takeo Provincial Health Department has asked experts to cooperate with the relevant ministries to identify everyone who ate chickens that are suspected of having been infected with the H5N1 bird flu virus.  

“We have dealt with the situation in a timely manner and we’ve sent 29 people who may have been exposed to H5N1 to analyse their blood to see whether they have contracted bird flu or not,” he said.  

The director of the Takeo Provincial Production and Veterinary Office, Thai Ly, said yesterday that more than 600 chickens that were thought to be at high risk of being infected with the H5N1 virus were destroyed after the Takeo Provincial Department of Agriculture, Forestry, and Fisheries identified a case of bird flu in Por village.  

He added that according to past studies of the bird flu virus, this level of infection is unlikely to spread to other villages. However, he urged people not to eat sick or already-dead birds to avoid H5N1 infection.  

“We are calling on people to be vigilant against infection by bird flu by not eating and cooking the chickens and ducks that are sick or die from unknown causes due to the danger caused by H5N1,” he said.

State of Global Air Report 2024

Via the Health Effects Institute: State of Global Air Report 2024. Click or tap through todownload the complete report. The summary:

The State of Global Air 2024 report provides a comprehensive analysis of data for air quality and health impacts for countries around the world. The analysis finds that: 

 ● Air pollution accounted for 8.1 million deaths globally in 2021, becoming the second leading risk factor for death, including for children under five years. Of the total deaths, noncommunicable diseases including heart disease, stroke, diabetes, lung cancer, and chronic obstructive pulmonary disease (COPD) account for nearly 90% of the disease burden from air pollution. 

 ● In 2021, more than 700,000 deaths in children under 5 years were linked to air pollution; this represents 15% of all global deaths in children under five. 

As in previous years, the State of Global Air 2024 report and accompanying website provides comprehensive data on the levels and trends in air quality and health for every country in the world. This State of Global Air report was produced in partnership with UNICEF. 

In the State of Global Air 2024 interactive app, you can explore, compare, and download data and graphics reflecting the latest air pollution levels and associated burden of disease for over 200 individual countries, territories, and regions, as well as track trends from 1990 to 2021.

See also this Guardian story on the report.

WHO: Avian Influenza A (H9N2)—India

A WHO DON: Avian Influenza A (H9N2)- India. Excerpt:

Situation at a glance  

On 22 May 2024, the International Health Regulations (IHR) National Focal Point (NFP) for India reported to WHO a case of human infection with avian influenza A(H9N2) virus detected in a child resident of West Bengal state in India. This is the second human infection of avian influenza A(H9N2) notified to WHO from India, with the first in 2019. The child has recovered and was discharged from hospital.  

According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. Most human cases of infection with avian influenza A(H9N2) viruses are exposed to the virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness.  

Based on available information, further sporadic human cases could occur as this virus is one of the most prevalent avian influenza viruses circulating in poultry in different regions. With the currently available evidence, WHO assesses the current public health risk to the general population posed by this virus as low.  

However, the risk assessment will be reviewed should further epidemiological or virological information become available.  

Description of the situation  

On 22 May 2024, WHO received a notification from the IHR NFP regarding a human case of avian influenza A(H9N2) virus infection in West Bengal state, India.  

The patient is a 4-year-old child residing in West Bengal state. The case, previously diagnosed with hyperreactive airway disease, initially presented to the paediatrician with fever and abdominal pain on 26 January 2024. On 29 January, the patient developed seizures and was brought to the same paediatrician. On 1 February, the patient was admitted to the pediatric intensive care unit (ICU) of a local hospital due to the persistence of severe respiratory distress, recurrent high-grade fever and abdominal cramps. The patient was diagnosed with post-infectious bronchiolitis caused by viral pneumonia.  

On 2 February, the patient tested positive for influenza B and adenovirus at the Virus Research and Diagnostic Laboratory at the local government hospital. The patient was discharged from the hospital on 28 February 2024. On 3 March, with a recurrence of severe respiratory distress, he was referred to another government hospital and was admitted to the pediatric ICU and intubated.  

On 5 March, a nasopharyngeal swab was sent to the Kolkata Virus Research and Diagnostic Laboratory and tested positive for influenza A (not sub-typed) and rhinovirus. The same sample was sent to the National Influenza Centre at the National Institute of Virology in Pune for subtyping. On 26 April, the sample was sub-typed as influenza A(H9N2) through a real-time polymerase chain reaction.  On 1 May, the patient was discharged from the hospital with oxygen support.  

Information on the vaccination status and details of antiviral treatment were not available at the time of reporting. The patient had exposure to poultry at home and in the surroundings. There were no known persons reporting symptoms of respiratory illness in the family, the neighbourhood, or among healthcare workers at health facilities attended by the case at the time of reporting.  

This is the second human infection of avian influenza A(H9N2) virus infection notified to WHO from India, with the first in 2019. Further sporadic human cases could occur as this virus is one of the most prevalent avian influenza viruses circulating in poultry in different regions. 

WHO: Avian Influenza A (H5N1) - Australia

A WHO DON: Avian Influenza A (H5N1) - Australia. Excerpt:

Situation at a glance  

On 22 May 2024, the World Health Organization (WHO) was notified of a laboratory-confirmed case of human infection with avian influenza A(H5N1) virus (clade 2.3.2.1a) by the International Health Regulations (IHR) National Focal Point (NFP) of Australia. This is the first confirmed human infection caused by avian influenza A(H5N1) virus detected and reported by Australia.  

Although the source of exposure to the virus in this case is currently unknown, the exposure likely occurred in India, where the case had travelled, and where this clade of A(H5N1) viruses has been detected in birds in the past. According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. Based on available information, WHO assesses the current risk to the general population posed by this virus as low.  

Description of the situation  

On 17 May 2024, the WHO Collaborating Centre (WHO CC) for Reference and Research on Influenza in Australia notified the NFP of Australia of a suspected case of human A(H5N1) avian influenza (HPAI) in Melbourne, Victoria. The state Victorian Department of Health confirmed this case on 18 May 2024. Under Article 44, the NFP of Australia advised the NFP of India of the confirmed case on 21 May 2024. Under Article 8, the IHR NFP of Australia notified WHO of the case on 22 May 2024.  

The case is a 2.5-year-old female child with no underlying conditions.  She had a history of travel to Kolkata, India from 12 to 29 February 2024. She returned to Australia on 1 March 2024. Upon returning to Australia, the child presented at a hospital in Victoria on 2 March 2024, where she received medical care and was admitted on the same day. 

On 4 March, the patient was transferred to the intensive care unit at a referral hospital in Melbourne, Victoria, due to worsening symptoms, for a period of one week. The patient was discharged from hospital after a 2.5-week admission. The case is now reported to be clinically well.  

The Victorian Department of Health reported on 23 May 2024 that the family advised that the child started to feel unwell on 25 February 2024, with loss of appetite, irritability and fever, and was taken to a doctor on the evening of 28 February 2024 in India. She was febrile, coughing and vomiting and was given paracetamol. It was not reported to an Australian airport biosecurity officer that the child was unwell when she arrived in Australia on 1 March 2024.  

Additional information provided by the family indicates that the case did not travel outside of Kolkata, India, and did not have any known exposure to sick persons or animals while in India. It is understood that no close family contacts of the case in Australia or India developed symptoms, as of 22 May 2024.  

A nasopharyngeal swab and endotracheal aspirate taken on 6 and 7 March respectively tested positive for influenza A at the referral hospital. The samples were sent to the WHO CC for further characterisation on 3 April as part of a batch, as there was insufficient knowledge from the referring practitioners at the hospital to connect the case to the H5N1 virus.  

Virus genetic sequence obtained from the samples confirmed the subtype A(H5N1) and indicated that the haemagglutinin (HA) gene belonged to clade 2.3.2.1a, which circulates in South-East Asia and has been detected in previous human infections and in poultry.

Human case of H5N1 avian influenza (bird flu) detected in returned traveller to Victoria

Thanks to FluTrackers for posting this report from the Victoria health department: Human case of avian influenza (bird flu) detected in returned traveller to Victoria. This case seems unrelated to the avian flu reported yesterday in poultry farms in Victoria. The key points:

• A human case of avian influenza A(H5N1) infection, also known as “bird flu”, has been reported in Victoria.  

• There is a current global outbreak of avian influenza in birds and animals. Avian influenza does not usually infect people, but in rare cases human infection can occur.  

• The recently reported case in Victoria was in a child who returned to Australia from overseas in March 2024. The child experienced a severe infection but is no longer unwell and has made a full recovery.  

• There is no evidence of transmission in Victoria and the chance of additional human cases is very low as avian influenza does not easily spread between people.

WHO: Global immunization efforts have saved at least 154 million lives over the past 50 years

WHO has published a news release: Global immunization efforts have saved at least 154 million lives over the past 50 years. Excerpt:

A major landmark study to be published by The Lancet reveals that global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of lives saved – 101 million – were those of infants.  

The study, led by the World Health Organization (WHO), shows that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but continue leading healthy lives into adulthood.  

Of the vaccines included in the study, the measles vaccination had the most significant impact on reducing infant mortality, accounting for 60% of the lives saved due to immunization. This vaccine will likely remain the top contributor to preventing deaths in the future.  

Over the past 50 years, vaccination against 14 diseases (diphtheria, Haemophilus influenzae type B, hepatitis B, Japanese encephalitis, measles, meningitis A, pertussis, invasive pneumococcal disease, polio, rotavirus, rubella, tetanus, tuberculosis, and yellow fever) has directly contributed to reducing infant deaths by 40% globally, and by more than 50% in the African Region.  

"Vaccines are among the most powerful inventions in history, making once-feared diseases preventable,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Thanks to vaccines, smallpox has been eradicated, polio is on the brink, and with the more recent development of vaccines against diseases like malaria and cervical cancer, we are pushing back the frontiers of disease. With continued research, investment and collaboration, we can save millions more lives today and in the next 50 years.”  

The study found that for each life saved through immunization, an average of 66 years of full health were gained – with a total of 10.2 billion full health years gained over the five decades. As the result of vaccination against polio more than 20 million people are able to walk today who would otherwise have been paralysed, and the world is on the verge of eradicating polio, once and for all.  

These gains in childhood survival highlight the importance of protecting immunization progress in every country of the world and accelerating efforts to reach the 67 million children who missed out on one or more vaccines during the pandemic years.

Hospital stays for respiratory illnesses increase among Canadian children

A news release from the Canadian Institute for Health Information: Hospital stays for respiratory illnesses increase among Canadian children.

February 22, 2024 —  The data confirms the anecdotal evidence from across the country last year: in 2022–2023, Canada’s hospitals saw a significant increase in stays due to respiratory illnesses among people younger than 18.  

In particular, data from the Canadian Institute for Health Information (CIHI) shows a rebound in hospitalizations for seasonal flu among children age 0 to 4 — the number of stays jumped to 2,444, a return to pre-pandemic volumes. The most common respiratory illnesses among children age 0 to 4 accounted for 32% of all hospitalizations in this group, increasing from 20% the previous year.   

In addition to seasonal influenza, hospitalizations for pneumonia tripled for Canadians age 0 to 17 and almost doubled for asthma. Among children age 0 to 4, hospitalizations doubled for lower respiratory infections, and stays for COVID-19 rose by 43%.  

“Having a baby or young child in hospital for any reason is tremendously difficult on families, and this increase in hospitalizations for respiratory illnesses among Canada’s youngest patients presented additional challenges for hospitals,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We will continue to monitor and report on these trends to equip health system planners and decision-makers with the data required to continue to meet the needs of Canada’s pediatric population.”  

“Last year was unprecedented for all pediatric hospitals in this country and highlighted key gaps in our system. We know from experience that viral seasons will continue to affect our young patients, and this is why it is so important that we invest in our pediatric health system and adopt public health measures to help reduce the risks,” said Dr. Lindy Samson, Chief of Staff and Chief Medical Officer, Children’s Hospital of Eastern Ontario (CHEO), and pediatric infectious disease specialist.  

Quick facts  

• The respiratory illnesses that are in the top 10 reasons for hospitalizations accounted for 32% of all hospitalizations for Canadians age 0 to 4 in 2022–2023.  

• Hospitalizations for seasonal influenza among children age 0 to 4 increased to 2,444 in 2022–2023, similar to 2019–2020 volumes.  

• Large increases were also observed in this age group for other respiratory illnesses:  

* Hospital stays for lower respiratory infections such as acute bronchitis increased from 9,501 to 19,909.  

* Hospitalizations for pneumonia almost tripled, rising from 3,447 to 9,871.  

* Asthma hospital stays increased by 61%, from 3,474 to 5,607.  

* COVID-19 accounted for 3,310 hospitalizations, up 43% from the previous year.  

* Acute upper respiratory infections saw a 32% increase in hospitalizations, going from 2,114 to 2,797.

DRC: At least 10 schools closed following the plague and measles

Thanks to FluTrackers for alerting me to this Radio Okapi report: Ituri: at least 10 schools closed following the plague and measles. The Google translation:

At least ten primary schools have been closed since Tuesday February 20 in the Rety health zone, 100 kilometers from the town of Bunia in the territory of Djugu (Ituri). The closure follows the resurgence of bubonic plague and measles, which mainly affect students.   

School and health authorities say they have taken this measure to protect children and intensify response measures against these pathologies.   

More than three thousand children no longer go to school following the resurgence and rapid spread of measles and bubonic plague, two diseases declared since February 3 in the Rety health zone in the territory of Djugu.   

The first school to be affected was EP Kpandroma, where around twenty children were declared positive after tests. Other cases were reported in Shun, Apolo, EP 2 Kpandroma, Gola, Baidjo, Bwa, Mont Bleu and Rethy primary schools.   

The decision to close all these schools is contained in a letter from the zone head doctor, published after consultation with the head of the Primary, Secondary and Technical Education (EPST)/Djugu 2 sub-division.  

The objective of this measure is to protect children against these diseases. It is also a question of triggering a vast spraying campaign of these schools underway in the area in response to the resurgence of these diseases, specified Benjamin Ngabu, a civil protection actor in the area.  

However, this measure which will last three days could affect secondary school finalists who are doing their internship in these schools.

‘Deadliest outbreak ever seen’: Climate crisis fuels Bangladesh’s worst dengue epidemic

Via The Guardian: ‘Deadliest outbreak ever seen’: climate crisis fuels Bangladesh’s worst dengue epidemic. Excerpt:

In a small, dimly lit control room at the Directorate General of Health Services (DGHS) in Dhaka, data on Bangladesh’s dengue outbreak flashes across multiple computer screens. Government analysts here have been busy collecting and monitoring the impact of the disease across the country since cases were first reported last April.  

In 2023, the total reported cases of dengue numbered 321,179, with 1,705 deaths recorded, a massive jump from the year before, when 62,000 people were known to have had the virus, and 281 died. It was the highest number of annual deaths caused by the mosquito-transmitted disease ever recorded in Bangladesh.

The deaths last year included at least 113 children. According to Save the Children, the majority of these deaths were of children under the age of 10, with 38 deaths among those under five.  

“Children make up around 30% of all dengue cases in Bangladesh and are particularly vulnerable to the virus because of underdeveloped immune systems,” says Dr Shamim Jahan, Bangladesh director of Save the Children. “Those under five are particularly at risk from developing severe symptoms, such as dehydration and shock.”  

Over the past few months, the surge in cases has pushed Bangladesh’s health system to the limit, with hospital corridors overflowing with patients as wards run out of beds.  

“It’s been the deadliest outbreak of dengue the country has ever seen,” says Dr Mohammad Shafiul Alam, a scientist at the ICDDR,B health research centre in Dhaka.  

The high death toll has continued into the new year. As of Wednesday, the outbreak had affected 756 people so far this month, resulting in 10 deaths, compared with 424 cases and three deaths this time last year.  

However, the official figures may not give a true indication of the scale of the outbreak. “These reported figures are likely an underestimation of the actual burden,” says Alam. “Numerous healthcare facilities in Bangladesh operate beyond the reporting framework. This underscores the likelihood that the actual figures could be several times higher.”

Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’

Via The Globe and Mail, health reporter Carly Weeks writes: Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’. Excerpt:

At least two children have died in Canada after contracting influenza in recent weeks, but Ottawa has so far not released any data on how flu season is affecting pediatric patients across the country – a situation clinicians say is leaving them in the dark and may be compromising the response to emerging problems.  

“It’s really concerning that we don’t know what’s going on,” said Manish Sadarangani, a pediatric infectious diseases specialist. “I sort of feel like we’re flying blind.”  

“It really helps to know what infections are currently circulating and which infections are causing more severe illness and hospitalization in children,” said Ashley Roberts, a clinical assistant professor of pediatric infectious diseases at the University of British Columbia.  

“To not have that active data present for our clinical care is certainly a loss right now,” Dr. Roberts added.  

Each week, the Public Health Agency of Canada publishes a FluWatch report that details influenza trends across the country. Last season, for instance, the report helped pediatricians understand and respond to soaring rates of hospital admission for the flu at a time when COVID-19 and respiratory syncytial virus (RSV) were also sickening many kids across Canada.  

But as of Oct. 1, FluWatch reports have not included any information on the number of children who have fallen severely ill as a result of the flu. The reports simply state the data were “not available.” 

The lack of information appears to be the result of a decision by PHAC to put a new group in charge of collecting pediatric data on severe outcomes for respiratory viruses.  

On Nov. 1, the agency awarded a new contract to the University of Calgary, PHAC spokesperson Tammy Jarbeau wrote in an e-mail. She said the government is working with the group “on the implementation of the contract and the transition” to ensure the new data will be comparable to information collected in previous years.  

According to another PHAC spokesperson, Marie-Pier Burelle, the government received the first cache of data on Nov. 24, and the information is being used internally. It should be made public sometime this month, she wrote in an e-mail.  

For more than 25 years, Ottawa had been using the same surveillance network, IMPACT, to collect this data. IMPACT, which stands for Canada’s Immunization Monitoring Program ACTive, is run by the Canadian Paediatric Society and has experts based in 12 pediatric sites, representing 90 per cent of tertiary care pediatric beds in the country.  

Dr. Sadarangani, a co-principal investigator of IMPACT, said it’s critical to have data on pediatric respiratory virus outcomes for this season, given that last season hospitals saw an unusually high influx of flu, RSV and COVID-19 cases. And it’s expected that a new vaccine to prevent severe illness in infants with RSV will become available next season, so experts will need detailed information on RSV cases this season to help them determine who should get that vaccine and when, he said.  

“We really need that data this year, almost more than ever,” Dr. Sadarangani said.