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Tracking the next pandemic: Avian Flu Talk

Air passenger H7 flu

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Pixie View Drop Down
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    Posted: June 28 2013 at 10:18am
Plane diverts to Edmonton with ill patient; tests show man had H7 flu

This April 15, 2013 electron microscope image provided by the Centers for Disease Control and Prevention shows the H7N9 virus which can take on a variety of shapes.

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Helen Branswell, The Canadian Press 
Published Thursday, June 27, 2013 7:17PM EDT 
The Public Health Agency of Canada says an American man who ended up in an Edmonton hospital tested positive for previous infection with an H7 influenza virus.
Canada's acting chief public health officer says the man is not currently ill with flu and therefore is not contagious.
Dr. Gregory Taylor says, though, that the event is a reminder that viruses like the new H7N9 bird flu are only a plane ride away.
The blood test used to diagnose the previous infection cannot determine the neuraminadase or N component of the virus with which the man was infected.
But the infectious diseases specialist who treated him in Edmonton was on the lookout for H7N9 flu, which has infected 132 people in China this spring, killing at least 39 of them.
The man had travelled in southern China in late May, though apparently not in a part of the country where human infections with H7N9 flu were recorded.
"Could he have been infected with H7N9? Maybe. We don't know for sure," Taylor says.
But he notes Canada has been on heightened surveillance for the new virus and this case suggests the system is working.
"It's a small world and these plane rides are short," Taylor says.
The unidentified man, described as elderly, has been travelling extensively in recent weeks. Taylor says he did not know where the man was from in the United States.
He travelled to China and from there to Singapore and India.
The man became severely ill in India and apparently spent time in an intensive care unit in a hospital there. Taylor says he doesn't know what city that occurred in or what illness led to his hospitalization.
After his release from hospital, the man travelled to Cairo, where he boarded a flight bound for San Francisco. While that flight was in the air, the man became ill and lost consciousness. The plane was diverted to Edmonton.
Taylor says the man may have suffered a diabetic coma in flight.
When he landed quarantine officers assessed the case and determined that the man's symptoms did not indicate active influenza, Taylor says.
Once the man was in hospital, he developed what appeared to be aspiration pneumonia -- pneumonia caused by drawing in fluids to the lungs. An infectious diseases specialist at the hospital where he is being treated knew the man's travel history and ordered a battery of tests.
The tests were negative for active viral infection. But the blood tests turned up evidence of a past infection with H7 flu.
"The reassuring thing is that the viral tests are all negative," Taylor says.
"Our understanding is he is improving and hopes to go home soon."
Taylor says the Public Health Agency has been liaising with the U.S. Centers for Disease Control on the case and the U.S. agency believes it is safe for the man to return to the United States.
He says Canadian authorities are also notifying counterparts in countries where the man had travelled.


Read more: http://www.ctvnews.ca/health/plane-diverts-to-edmonton-with-ill-patient-tests-show-man-had-h7-flu-1.1344985#ixzz2XX3ROTfy
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Suzi Quote  Post ReplyReply Direct Link To This Post Posted: June 28 2013 at 5:48pm
He traveled in China. Although not in areas where H7N9 cases were reported.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote EdwinSm, Quote  Post ReplyReply Direct Link To This Post Posted: June 28 2013 at 10:01pm
Originally posted by Suzi Suzi wrote:

He traveled in China. Although not in areas where H7N9 cases were reported.


That struck me as well.  And he had other health conditions.  The information released on H7N9 cases has the most serious cases amongst the elderly and those with other chronic health problems. 

It sounded like they only ran test for the H7 part, so he can not officially be added to the h7n9 cases yet. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 29 2013 at 4:00am
Well, I believe an article came out that there could be an estimated 1500 - 27,000 unreported cases.  Not sure why Chan doesn't consider that "a threat to the entire world" this upcoming winter,  but the 70 MERS cases is.   Confused
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 29 2013 at 6:44am
No wonder Chan NEVER mentions the potential threat of h7n9 and focuses 100% on MERS.  Most of her career has been in Hong Kong.  Not addressing the potential 20,000 h7 cases and the impact it could have this winter is a little concerning, and truly shows her loyalty to China. 



Dr Margaret Chan: Biography

http://www.who.int/entity/dg/chan/Margaret_Chan_bio.jpg - Dr Margaret Chan
WHO

Dr Margaret Chan, from the People's Republic of China, obtained her medical degree from the University of Western Ontario in Canada. She joined the Hong Kong Department of Health in 1978, where her career in public health began.

In 1994, Dr Chan was appointed Director of Health of Hong Kong. In her nine-year tenure as director, she launched new services to prevent the spread of disease and promote better health. She also introduced new initiatives to improve communicable disease surveillance and response, enhance training for public health professionals, and establish better local and international collaboration. She effectively managed outbreaks of avian influenza and of severe acute respiratory syndrome (SARS).

In 2003, Dr Chan joined WHO as Director of the Department for Protection of the Human Environment. In June 2005, she was appointed Director, Communicable Diseases Surveillance and Response as well as Representative of the Director-General for Pandemic Influenza. In September 2005, she was named Assistant Director-General for Communicable Diseases.

Dr Chan was elected to the post of Director-General on 9 November 2006. The Assembly appointed Dr Chan for a second five-year term at its sixty-fifth session in May 2012. Dr Chan's new term will begin on 1 July 2012 and continue until 30 June 2017.

http://www.who.int/dg/chan/en/



"She effectively managed outbreaks of avian influenza and of severe acute respiratory syndrome (SARS)."

Is the WHO referring to China's initial cover-up of SARS under Chan's watch?  Shocked
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Suzi Quote  Post ReplyReply Direct Link To This Post Posted: June 29 2013 at 8:00am
If thousands in China have had H7N9 then transmission is easily H2H and it would already be everywhere. Am I right?
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 29 2013 at 9:07am
Possibly, but as seen in the summer months, flu cases are usually low.  Wait until next winter - and next flu season.  Chan never addresses anything that has to do with China and any emerging disease/threat out of the country.

This next winter is going to be a rough ride, and with Chan at the helm protecting China's economic issues relating to such an upcoming event, don't expect any warning from the WHO. They're big on the 70 MERS cases in the middle east, but not a peep out of them regarding the potential thousands of h7 cases in China - and what's headed our way once the temps drop and winter arrives.  It's a Chan replay of the SARS cover-up.    

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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: June 30 2013 at 6:35am
Mers is scary because it has consistent human to human transfer. The WHO aren't promoting one more than the other. Mers is being prepared for in the US on the quiet. They don't want to alarm people like what happened in the past. I agree with this tactic. Unnecessary fear can be detrimental. Mers is very scary!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Diligent Quote  Post ReplyReply Direct Link To This Post Posted: June 30 2013 at 7:15am
Hi cobber,  Can you help me ?  The mention in your post that the U.S. is preparing quietly for MERS.  Can /would you help me to better understand what you mean--so we can help others ? 
 
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Post Options Post Options   Thanks (1) Thanks(1)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: June 30 2013 at 12:02pm
Several signs. Unofficially, but seems very official screening of people for Mers coming out of Mideast. Several reports and documents to such effect posted here. Also Head of health from CDC or US health dept enacted a law which allows blood to be taken without consent from suspected cases. Ie hold you down and take blood! Quarantine etc. Last time it was this serious was when Sars hit.

Official line from WHO is no need to screen yet.

So either USA is jumping the gun or they know more than WHO is telling the public.

Sorry on my phone so difficult to give a full description. Look through past topics.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote KiwiMum Quote  Post ReplyReply Direct Link To This Post Posted: June 30 2013 at 8:41pm
Albert, I take it Margaret Chan isn't on your christmas card list then?
Those who got it wrong, for whatever reason, may feel defensive and retrench into a position that doesn’t accord with the facts.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Diligent Quote  Post ReplyReply Direct Link To This Post Posted: June 30 2013 at 10:51pm
Thank-you, cobber. I appreciate the help. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SPIRITFAN Quote  Post ReplyReply Direct Link To This Post Posted: July 02 2013 at 9:58am
Hello,  I have been a lurker for years.  I manage a primary care md office.  I got an update from the Mass Department of Public Health, Division of Epidemiology and Immunization on 6/14/13.  A Clinical Advisory, Middle East Respiratory Syndrom Coronavirus.    It included this summary. 1.  As of 6/12/13, over 50 cases of MERS-Cov have been reported and 32 of these people have died.  So far there is no report of anyone in the USA infected. 2. Most people with recognized MERS infection had severe acute respiratory illness with symptoms of fever, cough, and shortness of breath, but some people were reported with mild respiratory illness.  3.  There is history of humam to human transmission with close contact.  Standard, contact and airbourne precautions are recommended in hospital.  4. Diagnostic testing to detect  MERS is advailable at the MDPH Hinton State lab Institute.
5. Clinicians should consider MERS in patients with with an acute respiratory infection and hx of travel to the Arabian Penninsula or neighboring countries in the 14 days prior to onset of symptons.  6. Providers can call their local health dept and/or Mass dept of Public Health for further guidance.  7.  There is no vaccine for the prevention of MERS-CoV infection and no specific therapy has been studied or identified.
I though that was an interesting e -mail to get...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: July 02 2013 at 10:05am
That is an interesting e-mail. Thanks for sharing Thumbs Up
"Buy it cheap. Stack it deep"
"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Pixie Quote  Post ReplyReply Direct Link To This Post Posted: July 10 2013 at 5:14pm
TORONTO - An American man being treated in an Edmonton hospital who was suspected of having survived infection with the H7N9 virus may not have been infected with the new bird flu after all.

Though testing done at the National Microbiology Laboratory in Winnipeg showed evidence of antibodies to H7 flu in his blood, tests conducted at the U.S. Centers for Disease Control did not corroborate that finding.

The Atlanta-based CDC did not spot H7 antibodies in the man's blood, officials of the Public Health Agency of Canada revealed on Tuesday. And an additional test which the CDC runs, called a microneutralization test, also did not find evidence of H7 antibodies.

Dr. Gregory Taylor, Canada's acting chief public health officer, says the results are now deemed inconclusive because two labs found two different results. That can happen, Taylor said, especially with newly developed tests for new viruses.

But Dr. Judith Bosse, the deputy minister responsible for Canada's National Microbiology Laboratory, went a bit further, suggesting the Winnipeg lab's test may have generated a false positive result.

"Probably the initial reaction was what we call a false positive, which is the sad part about serology tests," Bosse, assistant deputy minister for the infectious diseases prevention and control branch, said in an interview.

"And that's why we have to run multiple (ones), is false positives do exist."

Microneutralization tests expose cells infected with a virus — in this case a flu virus with an H7 protein on its outer shell — to blood. If the blood has antibodies to the virus, they should shut down the infection. If there are no H7-specific antibodies, infection would continue unabated.

Bosse said this type of test is "fairly specific."

"That's why we're actually ruling out that this is not a conclusive sample," she said.

Late last week the Public Health Agency revealed that an unidentified American whose plane diverted to Edmonton because he was unconscious had tested positive for antibodies to an H7 flu virus. The man had visited China in late May, and then travelled to India. While there he became severely ill and spent time in an intensive care unit in a hospital.

After he was released he travelled to the United Arab Emirates, where he boarded a plane bound for San Francisco. While en route, he lost consciousness, forcing an emergency landing in Edmonton.

While his in-flight illness may have been diabetes related, he went on to develop pneumonia a few days after being admitted to the Edmonton hospital. An infectious diseases doctor who consulted on his case learned of the man's travel history and ordered tests for a variety of pathogens, including H7N9 flu. China battled a large outbreak of the new bird flu this spring.

There was no evidence the man was currently infected — and therefore he was not infectious — but a blood sample sent to the Winnipeg lab tested strongly positive for H7 antibodies.

Bosse said blood tests designed to detect antibodies to new viruses can be difficult to operate in the early days, when they haven't been validated.

In order to ensure a new blood test works well, a laboratory needs to test it against multiple blood samples taken from people who haven't been exposed to the virus as well as samples from people who were known to have been infected and have recovered. Those latter blood samples are called convalescent sera.

Only by running that kind of validation process can a lab be certain their blood test is catching the positive cases and not cross-reacting with antibodies to other viruses. If a test cross-reacts, it could generate a false positive result.

Bosse said the Winnipeg lab is still trying to get access to convalescent sera from China to validate its blood test. Other countries are in the same boat, she said.

Taylor said the lab is re-examining its H7N9 blood test as a result of the event.

"NML functions as the reference laboratory for all of Canada. So when you have a reference laboratory which has a test which is inconsistent, you can bet that they're looking through that very carefully.''

But Taylor said he did not believe this was a case of a laboratory error.

"Our lab has got the very highest quality standards. They are ISO certified. They do absolutely everything possible," he said. (ISO is the International Organization for Standardization.)

"Could it have been a lab error and totally false? I guess anything is possible, but that's not how I'd characterize it. I'd characterize it as a new test that we can't validate with thousands of serum specimens that came forward as positive."

When Canada believed the man had been previously infected with an H7 virus, it notified the World Health Organization and the countries the man visited during his trip. In the latter case that was to alert them to the possibility he may have been infected with H7N9 and might therefore have passed the virus to people he came in contact with during his travels.

Taylor said the Public Health Agency has followed up to inform the countries that the test result is now considered inconclusive.

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