H5N1

Flu News Europe: Update for week 5

Via Flu News Europe: Week 05/2016 (1-7 February 2016). Click or tap through for the full post including an interactive country-by-country list and graphs. The summary:

• Twenty-five of the 50 Member States that reported epidemiological data from surveillance for influenza-like illness (ILI) and acute respiratory infection (ARI) indicated increasing rates in week 05/2016; 38 countries reported influenza virus detections in specimens from sentinel sources, indicating increased influenza activity in the WHO European Region as a whole. 

• Belarus, Greece and Ireland indicated high-intensity influenza activity; Finland, the Russian Federation and Ukraine reported very high activity, as in the previous week. 

• A(H1N1)pdm09 viruses predominated, accounting for 87% of subtyped sentinel surveillance detections of influenza virus. 

• An increase in cases of severe disease, mainly in people aged 15–64 years, was seen again this week, with most of them associated with A(H1N1)pdm09.  

Season 

• So far, a predominance of influenza A(H1N1)pdm09 viruses has characterized the 2015–2016 influenza season; this virus subtype may cause more severe disease and deaths in adults aged 15–64 years than A(H3N2) viruses. 

• Since week 52/2015, several European countries with sentinel surveillance systems for severe acute respiratory infection (SARI) have reported increasing numbers of cases associated with A(H1N1)pdm09 infection. Similarly, countries reporting laboratory-confirmed influenza cases in hospitals and intensive care units (ICUs) have detected influenza A virus in the majority of cases since the start of the season, with A(H1N1)pdm09 the dominant subtype. 

• Most of the viruses characterized so far have been similar to the strains recommended for inclusion in this winter’s trivalent or quadrivalent vaccines for the northern hemisphere. 

• Risk assessments for the season are available from the European Centre for Disease Prevention and Control (ECDC) and WHO.

ECDC: CDTR, week 5

ECDC has published Summary of public health threats, CDTR week 5/2016. Click or tap through to download the full report and use the links. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period from 31 January to 6 February 2016 and includes updates on seasonal influenza and Zika virus infection outbreaks. 

Seasonal influenza 

So far, the 2015–16 influenza season has been characterised by a predominance of influenza A(H1N1)pdm09 viruses, accounting for 67% of sentinel surveillance detections of influenza in the WHO European Region. Compared to A(H3N2) viruses, A(H1N1)pdm09 may cause more severe disease and deaths in adults aged 15–64. 

During week 4/2016, 31 of the 50 countries and territories that reported epidemiological data from ILI and ARI surveillance indicated increasing rates, with 34 countries reporting influenza virus detections in specimens from sentinel sources for week 04/2016, indicating increased influenza activity in the WHO European Region as a whole. 

Belarus, Greece, Ireland and Malta indicated high-intensity influenza activity, as in the previous week, and Finland, the Russian Federation and Ukraine reported very high activity. 

ECDC monitors influenza activity in Europe during the winter season and publishes its report weekly on the Flu News Europe website. 

Zika - monitoring global outbreaks 

As of 4 February, no autochthonous Zika virus transmission has been reported in the EU. 

On 1 February 2016, WHO declared a Public Health Emergency of International Concern (PHEIC) regarding clusters of microcephaly cases and other neurologic disorders in some areas affected by Zika virus. 

Since last week, five additional countries or territories have reported laboratory-confirmed autochthonous transmission in the past two months: American Samoa, Samoa, Costa Rica, Jamaica and Tonga. Several Outermost EU regions continue to report autochthonous transmission, namely, Martinique, Guadeloupe, Saint Martin, French Guiana and Curaçao.

Ukraine: Is some kind of virulent new flu spreading? (Spoiler alert: No)

ECDC Headquarters, Stockholm

I've been hearing rumours of some kind of "California flu" spreading in Ukraine, causing severe illness and death. Mike Coston at Avian Flu Diary has posted An Update On The Russian Influenza Epi Report, which says influenza is increasing across the region but it's not especially virulent.

I got in touch with a friend who's very knowledgeable about flu, and he referred me to Flu News Europe, a joint ECDC-WHO/Europe website with regular weekly updates. And yes, flu and influenza-like illness are on the increase, notably influenza A(H1N1)pdm09, the virus that caused the 2009 pandemic but which has now subsided to routine nastiness. (Flu News Europe going in my Key Sites list.)

 

One of the useful aspects of the site is that you can check flu by country. Ukraine's flu is certainly increasing, most of it H1N1, but nothing unusual.

 

From my yearly visits to ECDC in Stockholm I've learned that its staffers talk about "the pandemic" the way veterans talk about "the war." ECDC's epidemic intelligence division is very good, with access to information we Flublogians can only dream about. 

 

So if some new and virulent flu strain ever emerges on ECDC's turf, including Ukraine, expect to be deafened by the alarm bells going off in Stockholm. Until then, save your worries for more deserving threats. And don't believe everything you read on the net.

New Zealand: Early flu causes concern

Via The New Zealand Herald: Early flu causes concern. Excerpt:

Health officials are concerned clusters of the harmful H1N1 virus, responsible for the 2009 swine flu pandemic, are appearing unseasonably early. 

One woman is critically ill in Hawke's Bay Hospital with the virus and eight others have been admitted to the hospital's intensive care unit. 

Dr Nicholas Jones, Hawke's Bay District Health Board medical officer, said the virus had struck before the usual winter flu season, which was cause for concern. 

"We don't have an explanation for that. From what I can tell, there hasn't been a big change with it [the virus], which is one of the things you worry about," he said. 

"The testing seems to show that it's similar to the one that was around in 2009." 

Since then, H1N1 had been part of the standard influenza vaccine and people who were vaccinated need not worry, he said. 

 In South Canterbury, Dr Daniel Williams, Medical Officer of Health, said there had been a "significant" cluster of influenza-like illnesses in Geraldine. It was not unusual to have some cases out of season, but it did appear to be worse this year. 

University of Otago Associate Professor of Health Michael Baker said calling the virus swine flu was now largely redundant since it had become one of the three strains circulating the planet every winter. 

"It's best to say it's seasonal flu. It just happens to be the same strain that caused the pandemic." 

A Ministry of Health spokesman said he was not aware of other clusters around the country, however, it was not a notifiable illness so it was possible it was occurring elsewhere.

Bat-derived influenza-like viruses H17N10 and H18N11

Thanks to Greg Folkers for sending the link to this report in Trends in Microbiology: Bat-derived influenza-like viruses H17N10 and H18N11. The abstract:

Shorebirds and waterfowls are believed to be the reservoir hosts for influenza viruses, whereas swine putatively act as mixing vessels. The recent identification of two influenza-like virus genomes (designated H17N10 and H18N11) from bats has challenged this notion. 

A crucial question concerns the role bats might play in influenza virus ecology. Structural and functional studies of the two major surface envelope proteins, hemagglutinin (HA) and neuraminidase (NA), demonstrate that neither has canonical HA or NA functions found in influenza viruses. However, putative functional modules and domains in other encoded proteins are conserved, and the N-terminal domain of the H17N10 polymerase subunit PA has a classical structure and function. 

Therefore, potential genomic reassortments of such influenza-like viruses with canonical influenza viruses cannot be excluded at this point and should be assessed.

Regardless of how many newfangled viruses they come up with, I'm not changing the name of this blog.

Malaysia: Four H1N1 patients discharged, 3 still in hospital

Via BorneoPost Online:, a report datelined Kota Kinabalu: H1N1: Four discharged, 3 still in hospital. Excerpt:

If there is no detection of new cases of H7N9 by February 18, seven days after the first Influenza A case was found in Sabah, the state health authorities will declare the virus as contained and not an epidemic, in line with public health policy. 

Sabah Women and Children Hospital director Dr Tan Bee Hwai said however, the hospital would not take the issue or any other illnesses lightly and would constantly be on the alert as well as take precautionary measures. 

“Similar to what happened with the H1N1 virus, we consider every case as important and are constantly on the alert. We are not taking this hands down,” Tan told reporters and Api-Api assemblywoman Christina Liew, during a courtesy visit to the hospital, yesterday. 

Tan reiterated the Health Ministry’s advice to the public to always take precautionary measures, such as frequent hand-washing and wear surgical masks for those who experience any influenza-like-illness (ILI) symptoms. 

This is because, those who may be affected by the H1N1 and H7N9 project only symptoms that are similar to ILI, which are, fever of 38 degree Celsius and above, cough, and flu. 

“Unfortunately, the only symptoms are those similar to ILI so self-examination to know whether or not it’s H1N1 or H7N9. So self-declaration is very important. Those who experience any such symptoms and want to get themselves checked should do so at the nearest health facilities,” advised Tan. 

Meanwhile, he disclosed that out of the seven H1N1 patients who were treated at the hospital, four had been discharged while three are still being warded. No new cases had been detected, he said.

Branswell: Kids can get sick in doctors' waiting rooms

Via The Ottawa Citizen, a report by Helen Branswell of The Canadian Press: Kids can get sick in doctors' waiting rooms. Excerpt:

They are called "well child visits" - the checkups and appointments for vaccinations that are scheduled at regular intervals throughout the first years of a young life. 

But a new study suggests there's a risk healthy children or their parents will go home brewing a cold or the flu, having picked up a bug while sharing a doctor's waiting room with others who are there because they are sick. 

The study suggests the risk for individuals is small. But it estimates there are nearly 800,000 medical visits each year in the United States as a result of so-called influenza-like infections picked up in a waiting room by a child or parent there for a well-child checkup. 

"The physical proximity of these two different forms of care can expose healthy people - or unhealthy people - to contagious illnesses, especially upper respiratory infections," says Dr. Philip Polgreen, a physician and a professor of computational biology at the University of Iowa. Polgreen is the senior author of the study, which is published in the March issue of the journal Infection Control and Hospital Epidemiology, released Thursday. 

"Individually it's a small risk. But if you think about how many (of these occur) across the country, it really adds up." 

Polgreen and his co-authors examined data from the U.S. Agency for Healthcare Research and Quality's medical expenditure panel survey, looking for cases where children or members of their family visited a doctor for an influenza-like illness within two weeks of having a wellchild visit. 

They then used mathematical modelling to assess the risk and come up with the overall figure. As well, they looked at whether influenza-like illness return visits spiked during flu season. And they did see increased doctor visits for influenza-like illnesses in the period immediately after well-child visits, especially during cold and flu season.

Canada: BCCDC issues influenza surveillance report

The BC Centre for Disease Control has published the latest in its Influenza Surveillance Reports. This one covers weeks 51-52 (December 15-28). Click through for the full PDF. The summary:

In weeks 51-52 (December 15 to 28, 2013), influenza activity increased in BC. Influenza A(H1N1)pdm09 continues to be the predominant circulating strain,representing 51/61 (83.6%) of specimens with subtype information available during weeks 51-52. 

The proportion of respiratory specimens testing positive for influenza increased sharply from 17.3 in week 50 to 25.6% in week 51 and 42.5% in week 52.

The BC Medical Services Plan (MSP) claims for influenza illness as a proportion of all claims increased throughout the province and were above 10-year maximum values. The proportion of patient with influenza-like illness among those presenting to sentinel physicians and the consultation rates attributed to ILI at BC Children’s Hospital ER also increased significantly during this period after remaining stable for the past few weeks.

Consistency across surveillance indicators suggests a real increase in influenza activity in BC, but may also reflect differences in health care seeking behaviour during the holiday period. Ongoing monitoring is required in the coming weeks.

Texas flu: "We don't even think we're at the peak"

Via the Houston Chronicle: Flu-like activity increasing in Houston and Texas. Excerpt:

Texas public health officials say every region of the state, including Montgomery and Harris counties, is seeing intense flu activity this season, which could result, as in past years, in at least several hundred deaths. 

In Harris County, hospital emergency room visits for flu-like symptoms are at a five-year high. 

Christine Mann, spokeswoman for the Texas Department of State Health Services, said Thursday her agency is aware of suspected flu cases that Montgomery County public health officials are investigating. She said the county is sending specimens to the Centers for Disease Control and Prevention in Atlanta for more extensive testing and confirmation. 

"We'll wait and see what they find," Mann said, adding that the H1N1 virus, formerly known as swine flu, is the predominant strain this season, which started in September and typically runs until spring. 

On Thursday, Montgomery County officials confirmed their second case of H1N1 virus. The unidentified patient is being treated at an area hospital, spokeswoman Jennifer Nichols-Contella said in a written statement. Tests are to be performed on six other cases, including the deaths of four people who suffered flu-like symptoms. 

"The Montgomery County Public Health District is coordinating with regional and state resources to manage the case investigations," Nichols-Contella said. 

Meanwhile, Mann stressed that the state is in the middle of flu season. So it's typical, she noted, for hospitals and doctors this time of year to see many cases. 

"We don't even think we're at the peak," she said. "It's not unexpected." 

Mann said there's no way to know how many people have died because flu cases are not required to be reported unless they involve children. No children have died so far this flu season in Texas.

US: Update on the Texas flu cases

Via the Montgomery County Hospital District: 12/19/203 Update: Influenza like illness arises in Mongomery County. Excerpt:

As of Wednesday afternoon, there has been one confirmed case of H1N1 virus. Of the eight reported cases, four patients are deceased. Of the remaining four cases in an area hospital, one case has tested positive for the H1N1 virus. Two of the patients tested negative for all flu viruses. Montgomery County Public Health District is awaiting test results for the remaining patient. The 2013 Influenza vaccine does protect against the H1N1 virus. At this time no known deaths received the vaccine.    

Based on CDC data, the H1N1 virus is nationally on the rise.  It can reasonably be expected that the occurrence of more H1N1 cases will be reported. Public Health Officials will continue to monitor the situation diligently and will provide more information as it is received. 

The Montgomery County Public Health District is grateful for Conroe Regional Hospital’s astute physicians who recognized the unusual nature of the illness and began the appropriate testing to reach a diagnosis. Montgomery County Public Health District has been in discussion with the Texas Department of State Health Services along with the CDC to coordinate investigation efforts. Despite ongoing investigations, it cannot be emphasized enough that common infection control practices should be followed to prevent the spread of infection.  As with common flu strains, some people are more likely to develop flu complications than others.