H5N1

Nepal: Lab report gives reprieve to people who came in contact with man who died of H5N1 bird flu virus

Via The Kathmandu Post: Lab report gives reprieve to people who came in contact with man who died of bird flu virus. Excerpt:

Test results of all specimens collected from the people who came in contact with a man who died of H5N1 virus (bird flu) have returned negative, according to the Epidemiology and Disease Control Division.  

The division said the World Health Organization had informed the office of the test results. 

 The division had collected 179 samples, from those who came in close contact with the deceased.  

Of the 179 samples, 172 were taken from hospital staff—doctors, nurses, lab technicians, cleaning staff—who were involved in the treatment of the patient. The remaining seven samples were from the family members of the deceased. 

“They have informed us that all samples have tested negative for H5N1,” Dr Bibek Kumar Lal told the Post. 

Among the samples, 42 were sent for tests at UN health body’s Collaborating Centre for Influenza in Japan. The same laboratory had confirmed the virus for the cause of death of the 21-year-old man from Kavrepalanchok district. 

 The man, who had been residing in a rented room in Bhaktapur, had died of bird flu virus on March 29, while he was undergoing treatment for influenza like illness in a Kathmandu-based hospital.  

Following confirmation that the deadly virus was responsible for the death of a patient, a 35-member rapid response team comprising experts from the WHO regional Office in Delhi, WHO Nepal country office, WHO South East Asia Region, Food and Agriculture of the United Nations, UNICEF, World Food Programme was formed to carry out epidemiological surveillance.

Branswell: The last flu pandemic was a 'quiet killer.' Why we can't predict the next one

Via STAT, Helen Branswell writes a must-read: The last flu pandemic was a 'quiet killer.' Why we can't predict the next one. This brings back a lot of memories. Excerpt:

The cryptic phone call came on a Monday. The Centers for Disease Control and Prevention was holding an important teleconference for a few reporters. I should dial in. 

When the time came, just a handful of reporters were on the line. Also there: the CDC’s top flu experts. They sounded worried. 

Two unrelated children from southern California had tested positive for flu infections caused by viruses that normally sicken pigs. This could have been a fluke, but from the unusual nature of the call and from the tension in the voices of the experts, it was clear that the CDC officials thought it might be something else: an influenza pandemic. 

 That teleconference took place on April 20, 2009. Over the next seven weeks it became apparent that any fears they had had been well-founded.  

On June 11, 2009 — 10 years ago today — the World Health Organization declared that the swine flu virus we now simply call H1N1 had indeed triggered a pandemic, the first time in four decades a new flu virus had emerged and was triggering wide-scale illness around the globe.

Since it started circulating in the spring of 2009, H1N1 has infected about 100 million Americans, killing about 75,000 and sending 936,000 to the hospital, the CDC estimates. Another virus, H3N2, is responsible for more infections, but “in terms of the severity, H1 is kind of this quiet killer,” said Dr. Daniel Jernigan, head the CDC’s flu division.  

In the hands of Hollywood, pandemics tend to be of the one-size-fits-all variety. They unleash massive chaos and spread at lightning speed, as health officials in hooded biohazard suits rush to distribute vaccinations. And in real life, flu pandemics, which tend to strike only a few times each century, could be that terrifying. But, a decade onward, the experience of H1N1 is a reminder that it’s impossible to know from the get-go how a pandemic will play out. 

Science currently has no way to predict when pandemics will occur. The fact that there were 41 years between the 1968 pandemic — known as the Hong Kong flu — and the 2009 pandemic doesn’t mean the next will take another 30 years or so to materialize. There is no pattern; flu pandemics happen when they happen, and pandemic planning is ever ongoing. 

In the case of H1N1, the public health world was steeling itself for a potentially catastrophic outbreak. Just six years earlier, officials began to respond to a very dangerous bird flu virus called H5N1, first in Southeast Asia and then beyond. It was deadly to chickens and other poultry but — and this was unusual — it was also occasionally infecting people. When it did, the outcome was sobering: More than half of people known to have been infected with the virus died from the infection. 

The number of people infected with H5N1 was small, but it stoked fears that this fearsome flu might be readying itself to cause a pandemic. In its place, however, arrived H1N1. 

It was distantly related to other H1N1 viruses that had circulated among people for most of the 20th century. In fact, pigs acquired H1N1 decades before from people. But this new virus had evolved in a way that helped it unlock the mysteries of the human respiratory tract and sicken people.

Fortunately, though the infection could be severe, it was not devastating in most cases. A study published in 2013 suggested between 123,000 and 200,000 people globally may have died as a result of the 2009 H1N1 pandemic.  

This was certainly not nothing. But it was also not what people had feared would be in store, and it was a substantially lower death toll than was seen in the 1957 and 1968 pandemics, which each killed about 1 million people at a time of lower global populations. In fact, the H1N1 death toll was lower than the global death toll for typical flu seasons, as estimated by the WHO.  

But just looking at the number of deaths masks the full impact of the pandemic, because the people who died were younger than those influenza normally claims. (The elderly, whose immune systems had seen viruses similar to this one long ago, weathered the pandemic pretty well.) A group of researchers who analyzed the deaths based on years of life lost concluded the pandemic’s toll in the United States was at least as bad as an average H3N2 flu season and potentially as severe as the 1968 pandemic.

H5N1 high pathogenic avian influenza identified in a recent outbreak in Bangladesh

Via The Poultry Site: H5N1 high pathogenic avian influenza identified in a recent outbreak in Bangladesh.

Scientists have identified a novel strain of avian influenza that contained several genetic mutations.  

A team of researchers at Bangladesh Agricultural University examined 15 dead or sick birds from 13 clinical outbreaks of avian influenza in Bangladesh. The birds in their sample included ducks, geese, chickens and turkeys. Researchers used RT-PCR (a laboratory method used to detect genetic material and specific proteins) to detect the virus that affected the birds in their sample. Results indicated that the birds were infected with a new variety of H5N1 influenza. 

The new iteration of the virus combined various genetic markers from other low pathogenic influenza types that were found in the region since 2013. Researchers hypothesised that this newer version of the virus will supplant the current strain that is infecting poultry and wild birds in Southern Asia. 

The researchers also concluded that the mutations detected in the H5N1 samples could be associated with increases in the virus’ ability to infect mammals and reductions in its susceptibility to antiviral agents. 

The abstract of the article can be accessed here.

Nepal: After the first H5N1 bird flu death

Via The Himalayan Times, a well-informed and thoughtful article by Dr. Sher Bahadur Pun: First bird flu death: What next?

On May 3, the Ministry of Health and Population called an unexpected press meet to announce that a 21-year-old male had died of influenza A “H5N1”, popularly known as “bird flu”. This is the first reported case of a human casualty from a bird flu infection in Nepal. 

It would be worth mentioning here that this author had previously examined two other suspected bird flu cases, but they could not be verified by laboratory testing due to its unavailability. The author again met a female patient, with a 7-day history of high-grade fever, cough, shortness of breath, and showing signs of pneumonia in the chest x-ray. According to her, she had disposed of chickens herself after their sudden unexplained deaths. 

These are some recent developments of possible bird flu infections that reinforce one to think “what next?” 

Hong Kong was the first country to report H5N1 bird flu infection in humans in 1997. Since then, it has been known to spread to more than 60 countries. Avian influenza H5N1 virus was first reported in chickens in mid-January 2009 in Nepal, the third nation in South Asia to do so after Pakistan and Bangladesh. 

This incident immediately triggers several questions: What was the source of infection? Does the virus have the ability to spread from birds to humans or even human-to-human? Is chicken meat or egg safe for consumption? 

Interestingly, one of the visitors at our hospital showed fears of bird flu infection after handling live chickens. Some people even began avoiding consumption of chicken or eggs. Indeed, this incident occurred nearly a month ago, and the concerned body has not felt the need to address such panic. It is essential to prepare for a public situation that can trigger such anxiety and panic attacks.  

The screening for H5N1 virus on a regular basis is necessary for farmers, chicken handlers, transporters, chicken sellers, frequent visitors to live bird markets, butchers and veterinarians, especially during bird flu outbreaks. Importantly, healthcare providers are always at increased risk of contracting bird flu infection. 

According to the Epidemiology and Disease Control Division (EDCD), out of 179, 172 (96%) samples have been taken from healthcare providers and sent to Japan to screen for the virus. It shows that healthcare providers are at the highest risk of bird flu infection. Nepal is not capable of confirming the H5N1 virus, which may delay in identifying it.  

A couple of weeks ago, there was a sudden death of a large number of crows due to the H5N1 virus in Kathmandu, something not known previously. At present, it is unclear how this highly pathogenic avian influenza H5N1 virus was introduced in the crow population of Kathmandu. Policy makers usually believe that bird flu infection spreads through transportation of an infected chicken or bird from one place to another. However, many research studies have shown that wild migratory birds are a major source of spreading avian influenza from one place to another or even between regions. There is not much information on wild migratory birds that are potentially spreading bird flu infection in this country.  

In the case of Nepal, the present case is the first H5N1 virus infection in humans, but certainly may not be the last one, meaning a future infection or an outbreak of this deadly virus in humans is possible anytime, anywhere. Those who are in the risk groups must take precautionary measures. Until now, it is believed that the H5N1 virus does not spread from human to human, although the question itself remains debatable. 

It is interesting to mention here that data from the WHO (from 2007 to 2012) showed that most of the H5N1 victims were children less than 5 years old, meaning, there is still a huge knowledge gap about its exact nature of transmission. Influenza A(H1N1)pdm09 virus, popularly known as “swine flu”, now spreads from human to human.

Nepal: Authorities to send more specimens abroad to test for H5N1 bird flu virus

Via The Kathmandu Post: Authorities to send more specimens abroad to test for bird flu virus.

The Epidemiology and Disease Control Division says it is preparing to send specimens collected from the people who came in close contact with the person who died after contracting the H5N1 (bird flu) virus on March 29.  

The division, under the Department of Health Services, had formed a team of medical doctors and lab technicians to carry out an epidemiological investigation after the death of a 21-year-old from Kavrepalanchok district from the bird flu virus. 

“We have collected specimens from doctors, nurses, close family members, relatives, and hospitals--and also from homes,” Dr Bibek Kumar Lal, director at the division, told the Post. 

The name of the deceased has not been disclosed yet, but he was said to be residing in Bhaktapur in a rented room and worked as a driver. 

The Health Ministry, however, announced only on April 30 that the man had died from H5N1. Throat swabs of the deceased had been sent to the World Health Organisation’s Collaborating Centre for Influenza in Japan, which confirmed that he had contracted Influenza A (H5N1), which caused his death.  

Following the confirmation of deadly virus responsible for the death, health experts from the WHO’s headquarters and its regional office in New Delhi, India arrived in Kathmandu to assist Nepali health officials to carry out an epidemiological investigation. 

According to Lal, his office would send samples to the country recommended by the UN health agency. 

Earlier, WHO officials suggested that specimens be sent to the Collaborating Center for Influenza in Japan that confirmed the virus. Such labs are in several countries and the UN health body may recommend any one of them.  

“We are working closely with them and will decide our next step accordingly,” said Lal. 

The division has secured all collected samples in the biosafety level-3 laboratory of the National Public Health Laboratory. 

Health officials say it takes time to send samples to laboratories abroad, as manpower trained to handle the biohazard are required for that. 

Airlines do not easily carry such specimens and for that, protocols of international health regulations need to be followed, according to officials at the Health Ministry. 

Meanwhile, the ministry said it was still tracking some people, who came in contact with the deceased but are out of home for personal business.  

The death of the 21-year-old from H5N1 virus, the first bird flu casualty in Nepal and first in the world since February 2017, has been a cause for concern. H5N1 is a lethal bird flu virus strain that is highly pathogenic.

Nepal: H5N1 bird flu detected in Nawalparasi (East)

Via The Kathmandu Post: Bird flu detected in Nawalparasi (East).

The H5N1 influenza virus, commonly known as bird flu, has been detected among the chickens reared by a farmer at Madhyabindu Municipality in Nawalparasi (East).  Dr Shyam Krishna Tiwari, chief of the municipal veterinary service unit, said bird flu virus was detected among the chickens belonging to Pitambar Mahato.   

Mahato had taken the samples collected from his chickens to the National Avian Disease Investigation Laboratory in Chitwan for test after some 0f the fowls started dying in the coop. 

The lab results confirmed that the chickens had contracted the avian flu, Dr Tiwari said.  After the lab confirmed the bird flu virus, a joint team of technicians from Ministry of Land Management, Agriculture and Cooperative Management of Gandaki Province, Livestock Development Office, National Avian Disease Investigation Laboratory and the municipality was deployed to Mahato’s farm to cull the chickens. The team also destroyed the poultry and feeds belonging to Mahato’s neighbours. 

The local administration has urged the local poultry farmers to stop rearing fowls until the bird flu comes under complete control.

Nepal: First H5N1 bird flu death in the country exposes passive surveillance and poor preparedness

Thanks to Mike Coston at Avian Flu Diary for posting on this story. Via The Kathmandu Post: First bird flu death in the country exposes passive surveillance and poor preparedness. Excerpt and then a comment:

The H5N1 bird flu virus that has been confirmed as the first cause of death in Nepal, 10 years after it was first detected in birds in 2009, is the world’s first H5N1 human infection since February 2017 and has raised issues of public health emergency of international concern as government and WHO officials refuse further information on the case.  

“We are taking the help of the UN body to contain the disease,” Ministry of Health and Population spokesperson Mahendra Prasad Shrestha told the Post.  

As experts from the World Health Organization headquarters and its Delhi office gather in the Capital to take stock of the situation, Shrestha says the government is taking the incident seriously and adhering to the standard protocols of international health regulations that Nepal is obligated to. 

The deceased, a 21-year-old from Kavrepalanchok district, who had been residing in Bhaktapur and whose identity has not been revealed by the government, was first admitted to Nepal Medical College on March 24 after showing signs of fever and cough.  

Doctors, who had then suspected influenza infection sent throat swab specimens to the National Public Health Laboratory on March 25. The same day, before the laboratory results were out, the patient was administered with Oseltamivir, an influenza antiviral medication taken from the Epidemiology and Disease Control Division. But the laboratory failed to identify the strain of the virus, the ministry said in a statement on Thursday. 

The patient, who worked as a driver, was then transferred to Om Hospital as his condition became critical, according to one official who wanted to remain anonymous. Four days later, on March 29, the patient died due to respiratory complications while undergoing treatment. 

Throat swab specimens were then sent to the WHO Collaborating Center for Influenza in Japan, according to the ministry and laboratory results received on April 30 tested positive for Influenza A (H5N1). 

H5N1 is a lethal bird flu virus strain that is highly pathogenic. The first infection in humans was reported in 1997 in Hong Kong and the virus has since spread to Asia, Africa, Middle East and Europe and other parts of the world causing millions of poultry infections.  

Although rare, confirmed human cases for bird flu as reported by the WHO from 2003 to April 9 this year stands at 860 human cases and 454 deaths. According to the UN body, almost all cases of H5N1 infection have been associated with close contact with infected live or dead fowls or contaminated environment.

For some reason I can't access the website of the Ministry of Health and Population (my location in Canada is "blacklisted"). But this appears to be a confirmed report, and I'll follow the story with interest.

Ten years ago: The first news of H1N1

Ten years ago, this blog was just about all H5N1, and I had a lot of news on cases in Indonesia, Egypt, and Pakistan. Then, on April 21, I posted an item by Helen Branswell, then with The Canadian Press: Branswell on the California swine-flu cases. Excerpt and then a comment:

U.S. public health authorities are investigating two cases of swine flu in unrelated children in California, a development that has officials in Canada and elsewhere on alert.   

Discovery of the two cases, in children who apparently had no contact with pigs or with each other, suggests there probably has been some person-to-person spread of swine flu viruses, officials of the U.S. Centers for Disease Control said Tuesday.  

Whether the viruses continue to spread isn't currently known.   

"The investigation is not finished. It's ongoing. But of course not having that direct swine link does raise additional questions and does suggest that there may have been human-to-human transmission. And so it basically ratchets it (concern) up a bit," said Dr. Nancy Cox, head of the CDC's influenza division.  "I think this is one of those situations where everyone will want to stay tuned."  

U.S. officials notified the World Health Organization of the cases last Friday, as required under the International Health Regulations. That treaty stipulates that countries must notify the WHO when they see cases of infectious diseases that pose an international threat, such as novel subtypes of influenza with pandemic potential. 

The next day saw a "swine flu" post from the much-missed Revere, Flublogia's resident grownup in those days. Although I didn't post it, the CDC also issued a notice about it on April 22, and on the 23rd the Globe and Mail warned that Canadians returning from Mexico should be alert to the symptoms of "Mexican flu."

What followed was not so much mission creep as mission drag, as a real live serious novel influenza hauled me and the rest of Flublogia out of our comfortable niche and into a much more complicated world. That drag continues.

Bhutan: H5N1 bird flu in Phuentsholing contained

Via KuenselOnline: Birdflu in Phuentsholing contained.

Birdflu (H5N1) outbreak in Phuentsholing has been fully contained. The rapid response team is currently conducting active surveillance and border vigilance.  

The outbreak was confirmed on April 8 at Dhamdara, a village at the outskirt of Phuentsholing proper. No human contact was reported. 

About 14 households were affected. The response team culled about 1,130 birds, disposed of 3,955 eggs and 613kgs of commercial feeds. 

Incident commander for incident operation centre, Dr Basant Sharma from the Regional Livestock Development Centre (RLDC) Tsimasham, said the team was visiting all households in Phuentsholing to collect samples from sick birds.  

He said that the surveillance would continue for 20 more days. 

The department of livestock, Chukha dzongkhag livestock sector, department of public health, Royal Bhutan Police, Bhutan Agriculture and Food Regulatory Authority and the Regional Livestock Development Centre RLDC and local authorities in Phuentsholing initiated the response to the H5NI outbreak jointly.

Bhutan: 1,130 poultry culled after H5N1 bird flu outbreak

Via KuenselOnline: 1,130 poultry birds culled after bird flu outbreak. Excerpt:

A bird flu (H5N1) outbreak has affected 13 poultry farms and one turkey farm at Dhamdara in Phuentsholing.  

The outbreak was confirmed on April 8 through laboratory test from National Centre for Animal Health (NCAH), Serbithang, Thimphu.  

No human contact was reported. 

In response, a total of 1,130 poultry birds in the affected areas were culled, about 4,002 eggs disposed, 613kgs of feed disposed and 12 chicken coops destroyed. 

The National Incident Command Committee (NICC) has activated the Incident Operation Centre (IOC) at Thromde Veterinary Hospital in Phuentsholing with the Rapid Response Team (RRT) from different ministries and agencies for immediate containment and response to the outbreak. 

A press release from the ministry states, “As the disease is brought under control at the source of outbreak the public should not panic. The public is also advised to take precautions like washing of hands after handling poultry, chicken and eggs with soap and water.” 

Program director of NCAH, Dr RB Gurung, the focal person of bird flu said the outbreak was reported in the field on April 6. 

He said the outbreak is under control by about 80 percent yesterday. As the outbreak location was at the outskirt of town, there were not much vehicles plying, which made it easier, he added.  

The response team also created awareness in the community. Vehicles plying out of the demarcated infected and restricted zone are also disinfected. 

Dr RB Gurung said poultry farmers are cautioned to comply farm bio-security measures and not allow visitors into the farms without proper safety measures.