Influenza Virus Mashup

29 December 2010 – The Ministry of Health of Egypt has announced two new cases of human infection with H5N1 avian influenza.

A 28 year-old woman from Damanhour district of El Beheira governorate developed symptoms on 12 December. She was admitted to hospital on the 14th and subsequently discharged on the 22nd in good and stable condition. She has a history of exposure in a market where live animals are sold.

An 11 year-old girl from Esna district of Luxor governorate developed symptoms on 18 December and was admitted in the hospital the following day. She experienced severe respiratory symptoms requiring mechanical ventilation and died on 23 December. No information is available regarding poultry exposure. Investigations into the source of infection are underway.

Laboratory tests have confirmed H5N1 virus and both patients were treated with antiviral medications. Of the 115 cases confirmed to date in Egypt, 38 have been fatal.

http://www.who.int/csr/don/2010_12_29/en/index.html

Of the 36 flu viruses subtyped at the state lab during week 51, 28 (78%) were seasonal A/H3N2, 3 (8%) were unsutypeable (sic), 3 (8%) flu type B and 2 (6%) the 2009 A/H1N1.

The above comments from the week 51 report from Pennsylvania cite three unsubtypable samples, which is unusual in 2010. Last year there were samples that were influenza A positive but unsubtypable because they were swine H1N1, and subtyping was done with reagents directed against human H1 and human H3. The swine cases were subsequently identified with reagents that targeted the swine H1.

Pennsylvania has reported trH3N2 previously, but the trH3N2′s have a human H3 from the mid-1990′s. It is possible that the human H3 sub-typing reagents would fail to recognize trH3N2, because it continues to evolve away from seasonal H3. If there really are three new trH3N2 cases in PA, it would be the highest number of novel influenza in a given state since pandemic H1N1 was identified in California
(Snip)
if these are three new trH3N2 cases, the sequences should be released and an alert should be made.

http://www.recombinomics.com/News/12291002/PA_Unsubtypable.html

Canada
• Montreal’s two children’s hospitals hit by winter flu (Link)
• British Columbia: 3 Surrey prisoners infected with H1N1 (Link)

Egypt
• WHO confirms 2 human H5N1 cases (1 fatal) (Link)

France
• Two dead as flu cases widen in France (Link)

Pakistan
• Avian influenza virus H9 (Link)

South Korea
• Dead Teal Ducks With Bird Flu [H5N1] Strain (Link)
• Suspected bird flu quarantines South Korean farm (Link)

• S. Korea reports suspected case of bird flu (Link)
• Man dies of H1N1 in metro hospital (Link)
• After foot-and-mouth, avian flu feared spreading (Link)

• S Korea confirms outbreak of H5N1 in two provinces (Link)

Sri Lanka
• Sri Lanka swine flu outbreak kills 22 (Link)

United Kingdom
• Swine flu kills Queen’s patient (Link)
• Swine flu alert at hospital (Link)
• GPs report flu cases rose again last week (Link)
• Cases of flu increase more than 40% (Link)
• Hospital patient in swine flu death (Link)
• Arrowe Park hospital suspends in-patient visiting to reduce spread of flu (Link)

• Winter flu claims two more lives in Scotland (Link)
• Cornwall Hospital puts doctors on alert over flu (Link)
• Flu deaths continue to increase (Link)
• Next Steps on Flu Announced by Health Secretary (Link)
• Flu deaths continue to rise (Link)
• Influenza A in Oxford (Link)

• Flu deaths spark ad campaign return (Link)

United States
• FL: Flu and flu-like illness rises ten-fold in Martin County (Link)

• CDC: Flu season picks up, widespread in 5 states (Link)

General
• Flu Activity on the Rise (Link)

• CIDRAP: Flu activity up globally, in US, and notably in UK (Link)

Research
• Adjuvanted pandemic flu vaccine efficacious in children and young adults (Link)

• Study finds antiviral resistance in US pandemic 2009 H1N1 cases rare (Link)

Commentary
• Recombinomics: UK H1N1 ICU Cases Spike To 738 (Link)

Via JoongAng Daily, the first report dated January 1, 2011: H5N1 avian flu confirmed in 2 farms. Excerpt:

Two poultry farms in South Chungcheong and North Jeolla were verified to have avian influenza A (H5N1), the government said yesterday. 

According to the Ministry for Food, Agriculture, Forestry and Fisheries, a duck farm in Cheonan, South Chungcheong, and a chicken farm in Iksan, North Jeolla, were confirmed to be infected with the highly pathogenic avian influenza. 

Quarantine officials in North Jeolla have already slaughtered and buried about 10,000 ducks at the Cheonan farm and more than 90,000 chickens at the Iksan farm and nearby farm. 

Quarantine cordons of a 3-kilometer (1.8-mile) radius have been set up around the two infected farms and labeled as dangerous, and areas within a 10-kilometer radius have been put on alert. 

Lee Sang-gil, director of the Food Industry and Marketing Bureau of the Food Ministry, said, “[We will] not carry out further slaughtering but will step up monitoring since there are no more poultry farms within a 500-meter radius [except those farms that already went through the culling process].” 

Nevertheless, there are concerns that the virus will spread. The two infected farms raise either breeding ducks or hens and have sold ducklings and chicks to other farms, so infected birds may have already been transported out of the area. 

On top of that, health officials continue to detect more migratory birds infected with the virus in Chungcheong and Jeolla, raising more concerns about a nationwide spread.

(Fri, 31 Dec 2010 11:40:00 +0000)

# 5195

The HPA has released their weekly influenza surveillance report, and once again it shows a significant increase in flu-like illness across that nation. 

Consult levels have not reached epidemic proportions, although that could still happen over the next couple of weeks.

Links, some excerpts, and a few graphs from this week’s report follow:

 

Weekly national influenza report, 30 December 2010

31 December 2010

Latest figures from the Health Protection Agency (HPA) indicate that levels of seasonal flu are continuing to increase across the UK.

 

The two main strains of flu circulating are Influenza A H1N1 (2009) ’swine’ flu and Influenza B, with H1N1 being the predominant strain. A small proportion of flu cases are resulting in severe disease, particularly in people under the age of 65. This is due to the fact that H1N1 is more likely to infect young people and, unfortunately, a very small number of these may develop severe disease.

 

In the past week, the HPA has been notified of a further 12 people who have died with confirmed flu, bringing the total number since the flu season began in October this year to 39. 36 of these people died with the H1N1 (2009) strain and 3 with Influenza B. All except one case were under 65 years of age and four were under the age of five.

 

Where information is available on the fatal cases, 23 out of 38 (61 per cent) of those who have died were in a clinical ‘at risk’ group for vaccination.

Where vaccination status is known for this season’s trivalent vaccine, only two people out of 33 had received their jab.  Last year’s pandemic vaccine was only received by one person out of 30, where information is available.

(Continue . . . )

 

HPA Weekly National Influenza Graphs (PDF, 678 KB)

HPA Weekly National Influenza Report - week 52 (2010) (PDF, 331 KB)

 

 

Report published 30 December 2010

Summary

Influenza activity continues to increase across the UK.  GP consultation rates are now above baseline levels in all four countries. Influenza A H1N1 (2009) and B are the predominant circulating viruses with few, sporadic A (H3N2) viruses detected.  The H1N1 (2009) virus strain is virologically and epidemiologically similar to that seen during the pandemic.  The virus strains circulating are overall well matched to the current influenza vaccine.  The HPA expects to see continued elevated influenza activity for several weeks.

• In week 51 (ending 26 December), the weekly ILI consultation rates increased across the UK. The weekly influenza/influenza-like illness (ILI) consultation rates remain above baseline levels in England (124.4 per 100,000) and Wales (92.1 per 100,000). The rates have now increased above the baseline in Scotland (58.4 per 100,000) and Northern Ireland (99.4 per 100,000).
• The weekly national proportion of NHS Direct cold/flu calls for week 51 has increased however, the daily proportion has decreased slightly to 10.4% on 28 December, from a peak of 12.9% on 21 December. The proportion of calls for fever in the 5-14 year age group decreased from 21.6% to 16.8%, though this remains above the baseline level of 9%.  This suggests the possiblity that we may be approaching the peak of influenza activity.

(Continue . . . )

The number of ILI (influenza-like-illness) GP consults in the latest reporting week (red line) remain roughly half of what was seen during the 1999-2000 epidemic, but are approaching that seen during the summer peak of the 2009 pandemic.

The age group most often seen by GPs last week for ILIs was age 1-4, followed by those 5-14 years of age, and then young adults.   Unlike most years, those over 65 years of age were the least commonly seen cohort.

While obviously a serious flu outbreak, the overall numbers haven’t come close to those seen during the disastrous 1999-2000 flu season.  What makes this year unique, and distressing, is the burden this particular virus places on young adults and children.

The numbers reported – particularly 39 fatalities – should be taken with a large boulder of salt.

Most flu-related deaths are not recorded as such, and so `official numbers’ such as these almost always represent a significant undercount of the real toll. 

Although this report suggests the outbreak may be close to peaking, the next couple of weeks – with the reopening of most schools on January 4th – will be closely watched.

(Fri, 31 Dec 2010 09:26:00 +0000)

# 5194

In a story we’ve been following for several days, last night officials announced that two poultry farms located in different parts of South Korea have tested positive for the highly pathogenic H5N1 bird flu virus.

Culling is reportedly complete at a duck farm in Cheonan and a poultry farm in Iksan City.  Both farms remain under quarantine, and movements of vehicles and people are restricted.

In recent weeks there have been more than a half dozen bird flu reports out of South Korea and Japan, involving 3 farms (2 in Korea, 1 in Japan) and a number of wild and/or migratory birds.

Both countries have been reported free of the H5N1 virus since 2008.  A few recent reports include:

Korea: 2nd Farm Investigated For Bird Flu

South Korea Investigating Cheonan Duck Farm

South Korea Finds 2 H5N1 Infected Owls

Korea: Bird Flu Discovered In Teal Ducks

Although a number of media sources are now carrying the story of the confirmation, this one (hat tip Shiloh on FluTrackers) comes from Yonhap News.

2010/12/31 10:44 KST

S. Korea confirms bird flu outbreak at 2 poultry farms

SEOUL, Dec. 31 (Yonhap) — South Korea on Friday confirmed its first bird flu outbreak in two years at two poultry farms in the central and southwestern part of the country.

 

The outbreaks at the farms in Cheonan and Iksan, 90 and 230 kilometers south of Seoul, respectively, were first detected on Wednesday after birds started to die off.

 

Both farms have been placed under quarantine with authorities moving to cull and bury their ducks and chickens to prevent further spreading of the disease.

 

(Continue . . . )

During their last H5N1 outbreak in April-May 2008, South Korea waged a month-long, very expensive battle to contain the virus that resulted in the culling of more than 8 million birds.  

Since then, South Korea has conducted year-round monitoring for the bird flu virus (see South Korea To Begin Year-Round Bird Flu Monitoring) in hopes of preventing future outbreaks.

In the wake of these latest discoveries, health officials are stepping up inspections, and poultry operations are being urged to increase biosecurity measures.