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Online Discussion: Tracking new emerging diseases and the next pandemic; Now tracking the Aussie Flu.

H2H h7n9

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    Posted: May 29 2017 at 3:03pm
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Avian flu surveillance efforts. Credit: Province of British Columbia

For the first time, a new strain of bird flu was transmitted human-to-human. This is highly unusual–and could be the first sign of new global pandemic.

 
 
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In 1918, the world was rocked by pandemic flu. A virulent strain of influenza, H1N1 influenza swept across the whole planet. A fifth of the world’s population was infected, and 20-40 million people died. It killed more people than World War One.

We haven’t seen pandemic influenza on that scale since then, but it’s been because of luck, not skill. Our globalized world is actually at a greater risk for pandemic than we were in 1918. Thanks to air travel, people travel farther, faster, and more often than they did a century ago. In just the last decade, we’ve seen Ebola cross borders, Zika infect a new continent, and a 2009 H1N1 pandemic that had a thankfully, inexplicably, low mortality rate.

So far, however, we haven’t seen a truly devastating flu epidemic in humans. Mild forms of the flu have been very contagious, and do routinely cross borders and infect large numbers of people, but they’re mild. People get unpleasantly sick, and the very young and very old may die, but the mortality rates are not unusually high. At the same time, we’ve experience some very deadly forms of the flu. Avian influenza, known as H7N9, kills 40% of people who are infected. That’s a mortality rate to fear – H1N1 had a mortality rate of 2-5% in 1918. However, avian influenza is not contagious from person to person – it spreads bird to person.

The pandemic of 1918 was both highly contagious and highly deadly. We haven’t seen that in the last hundred-something years.

Which brings us to last week, when a Chinese medical journal reported a human-to-human transmission of H7N9. H7N9, as mentioned, has a mortality rate of about 40%. Its impact on humans has been mitigated by the fact that it only spreads from birds. Family members can care for each other without fear.

Last week, though, China reported a case of H7N9 that appears to have spread person to person, not bird to person. The infected patient had no contact with birds or live bird markets, and he had no underlying medical condition. He was a healthy 62-year-old man, who helped a family member hospitalized with H7N9 to use the bathroom. Genetic analysis of the infecting virus indicates that he was infected with the same strain of virus that infected his family member.

This could be a sign that H7N9 is evolving into a virus that spreads among people. A highly contagious virus that has a 40% mortality rate. By way of comparison, Ebola is a highly contagious virus with a 50% mortality rate that spreads among people. There is serious potential here for global catastrophe.

It’s not doomsday yet. Helping someone use the toilet is a very intimate act; that means a contagious virus, but not necessarily highly contagious. Spreading in that kind of close quarters does not mean it will spread in schools or markets. And according to the epidemiological report, “There were a lot of family members in the ward, but he was the only one who was in close contact with the index case, and he was the only one confirmed H7N9.” So even being in the same room with an infected person does not necessarily mean infection.

The WHO has called for increased surveillance efforts for H7N9, but it isn’t quite ringing the alarm. While these human cases are a sign of an evolving virus, it hasn’t so far evolved into the  danger zone. Their analysis states that “current epidemiological and virologic evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore the likelihood of further community level spread is considered low.”
 The US Centers for Disease Control and Prevention (CDC) is less certain. According to acting director Anne Schuchat, “This one hasn’t (evolved) yet.  But that’s why we’re keeping our eye on it. Because it has the capacity to evolve and change.”

If you’re watching viruses, though, you’re watching this one.

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Post Options Post Options   Thanks (1) Thanks(1)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: May 29 2017 at 3:09pm

Human infection with avian influenza A(H7N9) virus – China

Disease outbreak news 
23 May 2017

On 13 May 2017, the National Health and Family Planning Commission of China (NHFPC) notified WHO of 23 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China.

Details of the case patients

Onset dates ranged from 11 April to 6 May 2017. Of these 23 case patients, ten were female. The median age was 58 years (range 31 to 83 years). The case patients were reported from Beijing (2), Fujian (1), Gansu (1), Hebei (5), Henan (3), Hubei (1), Jiangsu (2), Shaanxi (3), Sichuan (3), Tianjin (1), and Zhejiang (1).

At the time of notification, there were seven deaths, 15 case patients were diagnosed as having either pneumonia (5) or severe pneumonia (10), and one case was mild. Nineteen case patients were reported to have had exposure to poultry or live poultry market, one case patient was reported to have visited a patient with avian influenza A(H7N9) in the hospital, one case patient was reported to have had both exposure to live poultry and a contact with a confirmed case, and two were reported to have had no known poultry exposure.

Two clusters were reported:

  • A 63-year-old male from Xi’an, Shaanxi Province. He had symptom onset on 29 April 2017 and was admitted to hospital on 2 May. His symptoms were mild. He had visited a confirmed case in the hospital, a 62-year-old male from Shaanxi Province with symptom onset on 18 April 2017 and who was previously reported to WHO on 5 May.


  • A 37-year-old female from Chengde, Hebei Province. She had symptom onset on 2 May 2017 and was admitted to hospital on 3 May with pneumonia. She raised backyard poultry before her onset. She also had contact with a confirmed case, her mother, a 62-year-old with symptom onset on 16 April 2017 and who was previously reported to WHO on 5 May.

To date, a total of 1486 laboratory-confirmed human infections with avian influenza A(H7N9) virus have been reported through IHR notification since early 2013.

Public health response

The Chinese governments at national and local levels are taking further measures, mainly including:

  • Convening a video conference with some key epidemic provinces to provide avian influenza A(H7N9) epidemic information and guidance on strengthening risk assessment and prevention and control measures.
  • Continuing to strengthen control measures with a focus on hygienic management of live poultry markets and cross-regional transportation.
  • Conducting detailed source investigations to inform effective prevention and control measures.
  • Continuing to detect and treat cases of human infection with avian influenza A(H7N9) early to reduce mortality.
  • Continuing to carry out risk communication and issue information notices to provide the public with guidance on self-protection.
  • Strengthening virology surveillance to better understand levels of virus contamination in the environment as well as mutations, in order to provide further guidance for prevention and control.

WHO risk assessment

The number of human infections with avian influenza A(H7N9) and the geographical distribution in the fifth epidemic wave (i.e. onset since 1 October 2016) is greater than in earlier waves. This suggests that the virus is spreading, and emphasizes that further intensive surveillance and control measures in both the human and animal health sector are crucial.

Most case patients are exposed to avian influenza A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, and live poultry vending continues, further human infections can be expected. Although small clusters of human infection with avian influenza A(H7N9) virus have been reported including those involving patients in the same ward, current epidemiological and virologic evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore the likelihood of further community level spread is considered low.

Close analysis of the epidemiological situation and further characterization of the most recent viruses are critical to assess associated risk and to adjust risk management measures in a timely manner.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid, if possible, poultry farms, contact with animals in live poultry markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water, and follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling in or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and influenza-like illness (ILI) and to carefully review any unusual patterns, ensure reporting of human infections under the IHR 2005, and continue national health preparedness actions.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: May 29 2017 at 7:36pm
Thanks for the vigilance, Carbon20! 
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12 monkeys!!!!!
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