HK confirms dead Beijing woman had H5N1 bird flu

HONG KONG, Jan 6 (Reuters) - A 19-year-old woman has died of the H5N1 bird flu virus in Beijing, the Beijing Municipal Bureau and Hong Kong’s government said on Tuesday.

“The woman fell ill on Dec. 24, was hospitalised on Dec. 27 and died on Monday (at) 7.20 am,” the bureau said in a faxed statement.

Hong Kong’s Centre for Health Protection said the woman had had contact with poultry before the onset of symptoms. China’s official Xinhua News Agency earlier reported the woman had bought nine ducks at a market in Hebei province, which surrounds Beijing.

The death reported by the Press Association gives another detail:

[snip] Huang Yanqing died after buying and cleaning nine ducks last month at a market in Hebei province, which borders Beijing, the report said.

Ducks can be especially problematic because they are more prone to harbor asymptomatic H5N1 infections, though China does have a vaccine regimen for their domestic ducks, it is reported to be ~90% effective, at best, and only after the second inoculation. An outbreak in domestic ducks in 2007 reported by Hong Kong’s The Standard:

[snip] Nearly 10,000 ducks that died of bird flu at farms near Guangzhou’s Panyu district had been vaccinated against the disease, sparking fears the deadly H5N1 virus may have mutated.

According to Guangdong Animal Epidemic Prevention Center director Yu Yedong, the 9,800 ducks that died at Sixian village had been vaccinated. But he added the first vaccination could only be 65 percent effective, while a second shot would have made it 90 percent.

He believed the birds were infected after the first shot.

Given that H5N1 is endemic in various parts of the world, China included, the occasional human infection is no doubt something we will continue to read about until we solve the problem of human infections, or H5N1 goes away of its own evolutionary accord. A fatal infection reminds us that we need to pay attention to those periodic infections.

Much like welcoming a new baby into the world, gazing down at a squirming bundle of yet to be realized potential, the advancing of the calendar seems to confer a sense of potential awaiting us.

Given my more optimistic nature, I like to frame musing along those lines in a positive light. Sure, bad things are going to happen in 2009, one need only look to the struggles we begin it with, but if we are nimble enough and smart enough to draw on the lessons learned from past years, in the aggregate, things have the potential to be generally positive.

News of a fresh outbreak of H5N1 in West Bengal is a case in point. While not “a good thing” in and of itself, the prior experiences with infected poultry will, one assumes, afford an efficient response.

India’s West Bengal reports fresh bird flu outbreak

KOLKATA, India, Jan 3 (Reuters) – Health and veterinary workers culled poultry in a densely populated eastern Indian state on Saturday after a fresh outbreak of H5N1 bird flu, officials said.

The latest outbreak of the virus in poultry is the fourth in the state of West Bengal since 2007.

Bird flu first broke out in India in 2006. Millions of chicken and ducks have been culled since to contain the virus, but it has resurfaced from time to time. India has reported no human infections.

West Bengal officials said they had begun culling about 60,000 poultry after the fourth outbreak was confirmed on Saturday near Siliguri town, bordering Bangladesh.

Culling operations in West Bengal to contain the third outbreak had ended barely a fortnight ago.

“We have sent 30 teams to kill chickens and ducks in the village where dead birds tested positive,” Surendra Gupta, a senior government official, told Reuters.

Hundreds of thousands of birds had also been culled in India’s northeastern Assam state and neighbouring Meghalaya after bird flu was detected in November.

An outbreak of H5N1 in a densely populated area always tests my optimism, and this outbreak is no different on that score. India is not dealing with only H5N1; it is on top of the tensions with Pakistan and the global financial crisis.

Thus far, India has successfully navigated the triple crisis. And so, on this third day of a brand new year, I say… “practice makes perfect”.

SZ

Researchers ponder future of bird flu

The Canadian Press

TORONTO — Five years after the avian influenza strain H5N1 started killing poultry and people in Southeast Asia, researchers still don’t know what to make of the dangerous and unpredictable virus.

After cutting an ever-widening swath through poultry flocks and infecting — and killing — mounting numbers of people in Asia, the Middle East and Africa, the virus seemed to almost take a breather in 2008. The year that just ended saw fewer recorded human cases than any since 2003, when this cycle of H5N1 activity began.

It begs the question: Is H5N1 on the wane?

Sadly, science knows too little about how flu viruses emerge, spread and jump — or don’t jump — from one species to the next to answer that question. Given the knowledge gap, influenza scientists are still pushing for pandemic preparedness.

“Whether or not H5N1 virus is going to cause a human pandemic — nobody can predict that,” says Dr. Tim Uyeki, deputy chief of influenza surveillance and prevention for the U.S. Centers for Disease Control.

“I believe it’s still a threat. But it’s not the only threat,” he adds, noting a two-month-old Chinese girl was hospitalized in Hong Kong in late December with an H9N2 avian flu infection.

Whatever the uncertainty about H5N1, one thing is clear. A fog of exhaustion has settled over the influenza science community as well as the public health officials who have been slaving over pandemic plans. A healthy portion of the broader public is probably sick to death of the subject too.

“I think flu fatigue is certainly a phrase which is thrown around a fair amount in the past several months or past year or so,” admits Dr. Keiji Fukuda, head of the World Health Organization’s global influenza program.

“In stepping back after going through three or four years of working really hard, I think that there is a genuine sense of `Wow! We have been pushing so hard and we are tired of that.”‘

Fukuda says the fear associated with the initial re-emergence of H5N1 — which infected 18 people and killed six in 1997 in its first known foray into humans — fuelled an urgent drive to prepare for what was feared to be an emerging pandemic.

“There was truly a sense that we simply do not understand what this virus is going to do and it could just change at any moment into something. And I think that that really drove people to work incredibly hard,” Fukuda says.

But as time as [sic] gone on, it has become apparent the virus isn’t working on a discernible timetable.

Continues…

From The Standard [Hong Kong]

Baby gets bird flu
[Excerpt]
Nickkita Lau and Beatrice Siu

A Hong Kong-born baby who lives in Shenzhen has been infected with the H9N2 bird flu virus, sparking new fears of an outbreak.

Health chiefs described the infection of the two-month-old girl V who is now in an isolation ward in Tuen Mun HospitalV as being of some concern because it is normally the result of direct contact with poultry.

However, her family do not keep poultry and there are no farms near their home.

Health workers and patients who dealt with or have had contact with the girl were screened and so far no abnormalities have been found.

While Centre for Health Protection controller Thomas Tsang Ho-fai said yesterday that H9N2 was a mild form of avian flu commonly found in poultry in southern China, in August 2008, a team of researchers said it also poses a threat to humanity.

H9N2 might well pose a threat of becoming a humanly transmissible influenza virus, but as the virus is currently, “threat to humanity” seems a bit of an overstatement.

Previous H9N2 patients were aged one, four, five and nine and all recovered.

Tsang said the public cannot expect zero H9N2 infection as the virus is common. He reminded people to avoid contact with live poultry.

Prior to H5N1 most of the world was ignorant about the extent to which we co-exist with avian influenza, but we do coexist, and have for a very long time. An August 2006 paper, Avian Influenza among Waterfowl Hunters and Wildlife Professionals, provided the first authoritative hints as to the extent of that unknown coexistence.

Abstract

We report serologic evidence of avian influenza infection in 1 duck hunter and 2 wildlife professionals with extensive histories of wild waterfowl and game bird exposure. Two laboratory methods showed evidence of past infection with influenza A/H11N9, a less common virus strain in wild ducks, in these 3 persons.

Wild ducks, geese, and shorebirds are the natural reservoir for influenza A virus; all 16 hemagglutinin (H) and 9 neuraminidase (N) subtypes are found in these wild birds. Recently, the rapid spread of influenza A/H5N1 virus to new geographic regions, possibly by migrating waterfowl, has caused concern among public health officials who fear an influenza pandemic. Until now, serologic studies of the transmission of subtype H5N1 and other highly pathogenic strains of avian influenza have focused on humans who have contact with infected domestic poultry. In this cross-sectional seroprevalence study, we provide evidence of past influenza A/H11 infection in persons who were routinely, heavily exposed to wild ducks and geese through recreational activities (duck hunting) or through their employment (bird banding). To our knowledge, this study is the first to show direct transmission of influenza A viruses from wild birds to humans.

Though I agree, we need to be aware and conscientious when we handle poultry or operate in their habits we cannot run in terror every time we hear the term Avian Influenza.

[snippet from the Conclusion section of the above paper]

The relative lack of antibody response in our study population, who had substantial exposures to waterfowl with influenza A infections, and in inoculated volunteers from Beare and Webster suggests that avian influenza infections in humans exposed to wild waterfowl may occur more commonly than we are able to detect with current methods. Although the sample size of our study was relatively small, our results suggest that handling wild waterfowl, especially ducks, is a risk factor for direct transmission of avian influenza virus to humans.

Being aware and careful should not require we append every human infection of every avian influenza virus with the “threat to humanity” admonition, and it waters down the message of those zoonotic diseases that are a genuine threat.

Screening of passengers for flu called a success
[Excerpt]

The process aims to prevent the spread of infectious diseases

By Helen Altonn

A voluntary screening process for flulike illnesses among international arrivals at Hono- lulu Airport worked so well it may be done more often next year, a state Health Department official said.

The process was tested recently on 435 arriving Japan Airlines passengers, said Dr. Sarah Park, chief of the Disease Outbreak Control Division.

The program is aimed at intercepting passengers with possibly infectious diseases such as bird flu or severe acute respiratory syndrome (SARS) before they can expose a broader population.

The passengers “did their part to help us out,” Park said. “We were pleasantly surprised how fast they went through. Each time we do this, we’re learning and tweaking the process and improving upon it.”

Having a plan on paper is one thing, and certainly better than having nothing at all, but it is always advisable to test plans, both for training personnel, as well as identifying any weaknesses or flaws.

Fearing the introduction of infectious diseases into Hawaii, the state in November 2005 became the first in the nation to set up a passive airport surveillance program for Hawaii-bound international travelers.

Pilots must notify the airport tower if they have a potentially ill passenger on board, and the U.S. Centers for Disease Control and Prevention’s Quarantine Station is called to evaluate the passenger at the gate. Those who have fever and respiratory symptoms are asked to be tested for flu.

In June, the Health Department worked with the CDC, U.S. Customs and Border Protection, Department of Transportation and Hawaiian Airlines to start a pilot project. Federal officials hope that efficient standard procedures can be developed to be used across the country.

After the world’s experience with SARS in 2002/03 it comes as somewhat of a surprise that there is not, as yet, an in place set of “standard procedures” across the United States.

Since the natural reservoir of SARS was never identified, there is some concern that it might one day reappear, and then there is H5N1, a pandemic threat since 2003. Now, one could quibble over exactly how much of a threat infectious disease represents and how much effort we should expend to prevent [or limit] disease introductions into the country, but there is little argument over emergent or reemerging infectious diseases having heath and economic consequences.

Charleston, South Carolina is a port city and I have a casual familiarity with the efforts expended by law enforcement to protect it against terrorist attacks or using the port as an entry point for chemical or biological materials intended for a future act of terrorism. Charleston is not alone in these protective measures; they have become a part of law enforcement in every port city around the country.

It is difficult for me to understand the difference in actions taken to protect the country from the threats of attack by terrorists compared to the threats of communicable diseases. The cynic in me is tempted to assume that the asymmetric response to a potential threat has to do with funding. Organizations get huge infusions of Federal funds for terrorist threats, not so much for threats from communicable disease.

Money.

Protecting the nation should not be a function of how profitable doing so is for an organization.

SZ

I did wonder, however, how a fire such as this would be dealt with should a severe pandemic happen, one assumed to cause 30 – 40% absenteeism.

Fire breaks out in famed French biology institute

By ANGELA CHARLTON

PARIS (AP) — Fire broke out Wednesday in a biology laboratory at the Pasteur Institute in Paris, famed for research on fighting infectious diseases, officials said.

No victims were reported, and no sensitive materials or viruses were affected by the fire, which was extinguished by firefighters, an official at the institute said. The official was not authorized to be publicly named according to company policy.

The cause of the blaze was unclear.

The fire broke out mid-morning in an underground level of one of the buildings in the institute’s campus in southern Paris, a lab that conducts research in developmental biology, the official said.

The Paris fire department said 17 fire engines were sent to the site. All those inside the lab building were evacuated but were let back in after the fire was extinguished at midday, the institute official said.

The degree of damage was being investigated.

The Pasteur Institute was founded in 1887 by scientist Louis Pasteur. Its Web site says it has 2,600 employees of more than 60 nationalities, and 30 subsidiary institutes around the world.

Dead chickens get H5N1 mutation all-clear
Adele Wong
Friday, December 19, 2008

The H5N1 virus found in dead chickens in a Yuen Long farm had not mutated, Undersecretary for Food and Health Gabriel Leung told the Legislative Council’s panel on food safety and environmental hygiene yesterday.

The genetic sequencing of the bird flu virus detected in the farm on December 9 did not contain obvious differences from previous viruses, Leung told the panel.

Leung also said more tests were needed to find out how the chickens contracted the virus.

[snip]

Meanwhile, an Agriculture Fisheries and Conservation Department spokeswoman yesterday explained why the government has been using an H5N2 vaccine manufactured in the Netherlands to protect local chickens from the flu since 2003, even though recent outbreaks showed the virus strain to be subtype H5N1. She said when vaccines were first introduced to local chicken farms, tests had shown the H5N2 vaccine to be effective against the viruses found in South China.

“The H5N2 vaccine is also effective against H5N1 viruses,” the spokeswoman said, adding that in 2006, the government had let US authorities test the vaccine, which also showed it is effective for use in southern China.

“However, no vaccine is 100 percent effective. The government has set up an investigation group on avian influenza to look into the matter,” she said.

Vaccinating poultry is an imperfect means of preventing infection with avian influenza virus; however, it is our best means of protecting a food source much of the world has grown dependent. Fortunately, vaccination programs work far more often than not.

I am still curious as to whether the vaccine was administered in the strength and the formula specified by vaccination protocols. I may have to remain forever curious however because vaccine from the batch(s) used may no longer exist to be analyzed.

I have confidence in China’s willingness to search out any answers that may be gleaned as to the cause or source of the outbreak, but willingness to search and investigate does not always yield answers, or at least answers of the definitive sort.

For the time being, it’s probably wise to accept the premise of imperfect vaccines and imperfect vaccine programs.

SZ

UN agency urges nations to fund ‘human rescue’ package needed to feed millions

16 December 2008 – Without a “human rescue” package, costing a mere fraction of the financial bailout and economic stimulus initiatives tabled in Western Europe and the United States, millions of people around the world will go hungry early next year, warned the United Nations World Food Programme (WFP) today.

WFP, which aims to feed nearly 100 million of the world’s hungriest people in 2009, announced that it will start the New Year needing $5.2 billion to urgently support its programmes combating global hunger.

Unless donors provide a rapid injection of funds, the agency’s warehouse stocks will run out by the end of March, condemning millions of people in Haiti, the Democratic Republic of the Congo (DRC), Ethiopia, Kenya and other hunger hot spots to live without essential food assistance.

“As we take care of Wall Street and Main Street, we can’t forget the places that have no streets,” stressed WFP Executive Director Josette Sheeran, speaking during a visit to India, which has the single largest undernourished population in the world.

With just one per cent of the money proposed for bailout packages across the developed world, Ms. Sheeran said that WFP could fully fund its work, and make a mark toward meeting other urgent hunger needs. Feeding all 59 million hungry school children worldwide, for example, would only cost $3 billion per year.

“The world is poised to produce trillions for financial rescue packages. What will they produce for the human rescue?” asked Ms. Sheeran.

“World leaders need to be confronted with the values implicit in the policy choices they are making,” she noted.

WFP’s urgent call comes off the back of historically high food prices and market volatility, which is compounded by the financial meltdown in the developed world, spilling into the developing world as incomes are affected, and trade, capital flows and remittances slow.

This month alone, the Kyrgyz Government asked WFP to help feed 600,000 people pushed into desperate hunger following a sharp decline in the remittances which account for 20 per cent of the country’s gross domestic product (GDP).

Ms. Sheeran noted that hunger can lead to civil unrest as witnessed in Haiti, where people were killed and a prime minister was driven from office when food prices soared earlier this year.

“We are at a critical juncture where we risk watching hunger spiral out of control as the world’s population is set to climb toward 9 billion [by] mid-century,” she said, adding “We can’t afford to lose the next generation.”

From the World Food Programme’s news release:

As we each suffer our personal financial anxieties and losses it is easy to forget that to 2 billion people around the world we are unimaginably rich and blessed. Yes, even residents of G8 countries are struggling, but that struggle is nothing like the struggle to survive of the 100 million anticipated in the program against global hunger.

No country can support these needs alone, even in good economic times, but as Washington contemplates ways to rescue failed industries, I hope that my government finds a way to continue to support the WFP. After all, it’s sobering to think about the fact that one of the listed countries is an immediate neighbor [Haiti].

SZ

Via The Wall Street Journal
[Excerpt]

DECEMBER 17, 2008

By GORDON FAIRCLOUGH

SHANGHAI — Chinese agriculture officials ordered the slaughter of more than 300,000 chickens after they found poultry infected with a lethal form of avian influenza — the first such outbreak publicly reported in mainland China since June.

The discovery of the H5N1 form of the bird-flu virus in two areas of Jiangsu province northwest of Shanghai follows recent outbreaks in India, Hong Kong and Southeast Asia, raising the risk of human infections during the winter.

After routine testing turned up signs of the H5N1 virus in chicken eggs on farms in two locales, the agriculture ministry said it moved to kill 377,000 chickens and ban the transport of poultry in or out of the affected areas.

China has a “robust” vaccination program for poultry, both chicken and duck. China pioneered a successful vaccination program in domestic ducks, something not previously managed, so when I say their program is “robust” I mean it is well developed and well deployed.

That said however, there have been problems with efficacy of substandard batches of vaccine, some reported little more, or actually, plain water. It is not the production of substandard vaccine, rather a few unscrupulous distributers, reminiscent of the melamine adulterated milk products scandal of late.

I am wondering if the circulating strain has shifted away from the strain used to produce the vaccine, suggested in the Hong Kong outbreak, or if we are seeing the result of a substandard vaccine. Either one seems to be a reasonable possibility at this time, and neither one would bode well for this winter’s resurgence of H5N1.

As usual, we will just have to wait to see how everything unfolds, or even if it unfolds.

SZ

Via Reuters:

CAIRO, Dec 15 A 16-year-old girl died of the deadly H5N1 strain of bird flu on Monday, the 23rd fatality and 51st case of the disease among humans in Egypt, state news agency MENA said.

[snip]

The official said Salem began suffering symptoms a week ago, after two of the household ducks died and the remainder of the flock was slaughtered in the house.

Salem was subsequently admitted to hospital with a high fever, vomiting and diarrhea, and then transferred to intensive care. She was treated with the antiviral drug tamiflu, but suffered a pulmonary infection and respiratory failure, and died on Monday.

There are no further details about the course of her illness, or if there were preexisting health issues. Egypt has a better survival rate than most countries that have suffered human infections. We do not yet know if that is a function of the circulating strain, a function of the medical treatment(s) received, the timing of the treatments, or some combination.

Given that young Samiyah presented with high fever, vomiting, and diarrhea, severe dehydration could have been a contributor. Severe dehydration is a very serious condition in and of itself, and then to develop what seems to be pneumonia, a healthy young person, healthy in every other way, could rapidly succumb, even with antiviral treatment.

I say all of that because it might be all too easy to assume that Tamiflu was wholly ineffective. We should be cautious with our assumptions however, as we simply don’t have enough details.

Since Egypt has a laudable record of transparency and international collaborations, I am hopeful that details will be made available to those who might benefit in a “broader picture” way.

SZ