H5N1 human cases SE Asia ?

[url]https://bnonews.com/index.php/2023/02/young-girl-dies-of-h5n1-bird-flu-in-cambodia/[/url] or https://bnonews.com/index.php/2023/02/young-girl-dies-of-h5n1-bird-flu-in-cambodia/ ;

The Infectious Diseases Department at Cambodia’s Ministry of Health said the young girl, who lived in Roleang village in Prey Veng province, fell ill last Thursday when she developed a cough and a fever of 39°C (102°F).

“After receiving treatment at the local level, the girl started to get tired and was sent to the National Children’s Hospital in Phnom Penh for treatment,” the department said in a statement. The girl died on Wednesday and she was buried in her village.

A few hours later, a sample which was sent to the National Institute of Public Health tested positive for H5N1 bird flu.

There was no immediate word on how or when the girl was infected but villagers told investigators that an unusual number of wild animals had recently died. An emergency response team has been sent to the area.

Timeline; symptoms feb.16, sampling february 21-girl died...feb. 22 H5N1 was detected...

Also [url]https://www.thailandmedical.news/news/breaking-h5n1-avian-flu-news-11-year-old-girl-dies-from-h5n1-avian-flu-virus-in-cambodia-s-prey-veng-province[/url] or https://www.thailandmedical.news/news/breaking-h5n1-avian-flu-news-11-year-old-girl-dies-from-h5n1-avian-flu-virus-in-cambodia-s-prey-veng-province 

Claiming several cases in mammals and humans not only in Cambodia but also Myanmar, Vietnam...

[url]https://flutrackers.com/forum/forum/cambodia/cambodia-h5n1-tracking/968975-cambodia-death-of-11-yr-old-female-in-prey-veng-province-h5n1?view=stream[/url] or https://flutrackers.com/forum/forum/cambodia/cambodia-h5n1-tracking/968975-cambodia-death-of-11-yr-old-female-in-prey-veng-province-h5n1?view=stream latest;

I do not like this part - veterinarians. Which type of animals ? It did not specify birds

Originally posted by Treyfish View Post

....

Ms. Youk Sambath said that, according to sources from the villagers, there was an abnormal death of wild animals in the village.

After the incident, veterinarians took samples on February 17, 2023 and are waiting for the results from the veterinary laboratory.

Ms. Youk Sambath, continued that, after finding out the case of bird flu, the Ministry of Health’s emergency response team worked closely with the veterinary team to investigate and find the source of both animal and human infections and to to find suspected cases and people in order to prevent transmission to others, both in the community and in ceremonies..

...
https://www.khmertimeskh.com/5012441...h5n1-bird-flu/

DJ...could H5N1 be spreading in mammals and humans in SE Asia...? Sampling/sequencing takes time...

[url]https://www.coronaheadsup.com/health/bird-flu/cambodia-12-more-infected-with-h5n1-bird-flu-following-death-of-an-11yr-old-girl/[/url] or https://www.coronaheadsup.com/health/bird-flu/cambodia-12-more-infected-with-h5n1-bird-flu-following-death-of-an-11yr-old-girl/ ;

Cambodia’s health department is reporting that 12 more people have been infected with H5N1 Avian flu following the death of a 11yr old girl from the virus yesterday.

Ms. Youk Sambath, Secretary of State of the Ministry of Health, has confirmed that the Ministry of Health’s emergency response team has found 12 more people infected with Highly Pathogenic Avian Influenza A(H5N1) in Prey Veng province.

The Secretary of State stated that four of the affected people have begun to show symptoms.

She added that the emergency response team took their samples for analysis at a laboratory in Phnom Penh and the results will be released tomorrow.

Ms. Youk Sambath also said that the Ministry of Health’s emergency response team will continue to search for those affected by bird flu in schools tomorrow.

Khmer Times report

UPDATE 1 – 23rd February 2023

Translation from a Khmer newspaper confirms that only four people are currently showing symptoms:

Twelve people infected with bird flu were found and four people showed symptoms, a senior official of the Ministry called on people to be more careful.

Ms. Youk Sambath also said that the Ministry of Health’s emergency response team will continue to search for those affected by bird flu in schools tomorrow.

Freshnewsasia.com report

UPDATE 2 – 24th February 2023 – First bird flu death in Cambodia since 2014

This was the first death from bird flu in Cambodia since 2014, and the 57th case in the Kingdom. The authorities reported 37 H5N1-related deaths between 2005 and 2014.

According to the Secretary of State, four of the afflicted people have begun to exhibit symptoms. She went on to say that the emergency response team sent their samples to a laboratory in Phnom Penh for analysis, and that the results would be revealed today (24th February 2023).

Dolenglish.vn report

UPDATE 3 – 24th February 2023 – “An irregular number of dead wild animals”

The Health Ministry said its emergency response teams are investigating the area where the case happened.

The statement said “an irregular number of dead wild animals” were found near the place where the infected girl lived.

Samples from the dead animals were taken for lab testing and the ministry is awaiting the results.

Khmertimeskh.com report

UPDATE 4 – 24th February 2023 – Dead girl’s father also infected with H5N1

The father of the girl who died of bird flu yesterday has tested positive: “Doctors have found another H5N1 bird flu positive person in Prey Veng province, the father of the girl who died due to bird flu recently”

vayofm.com radio station report

DJ [url]https://flutrackers.com/forum/forum/cambodia/cambodia-h5n1-tracking/968975-cambodia-confirmed-one-h5n1-avian-flu-death-11-yr-old-female-in-prey-veng-province-media-report-her-father-test-positive-february-22-2023?view=stream[/url] or https://flutrackers.com/forum/forum/cambodia/cambodia-h5n1-tracking/968975-cambodia-confirmed-one-h5n1-avian-flu-death-11-yr-old-female-in-prey-veng-province-media-report-her-father-test-positive-february-22-2023?view=stream also trying to follow events...

[url]https://www.thailandmedical.news/news/breaking-h5n1-avian-flu-news-12-more-individuals-infected-with-h5n1-bird-flu-in-cambodia-human-to-human-transmissions-now-possible[/url] or https://www.thailandmedical.news/news/breaking-h5n1-avian-flu-news-12-more-individuals-infected-with-h5n1-bird-flu-in-cambodia-human-to-human-transmissions-now-possible ;

-37 other possible cases in isolation

-Prey Veng province is densly populated-3rd province by population in Cambodia; 1.1 million

- 4 cases -all 11/12 y/o at ICU in Phnom Penh, the 7 other cases in local health centers

-Some cases in the same school as where the 11 y/o girl that died of H5N1 visited

-More reports of possible cases in othe regions in Cambodia

-Also reports of "death animals" in the region (of the 11 y/o girl)

-WHO team on its way to learn more

-Symptoms at first severe cold-like, later on severe body pains

TMN claims also possible human H5N1 cases in Myanmar, Vietnam...(testing on its way ?)

I agree about the school cases. With the family cases perhaps they all shared a meal of infected undercooked meat or the same insanitary conditions but with the school, that's different. The one factor in common between the school and the family home is the 11 year old girl. 

We need to watch this carefully because there is H2H transmission then that's terrible. The other thing that struck me was that the girl was 11 years old. At that age children aren't licking things or as relaxed about bodily fluids as toddlers are at daycare, so if she has spread this to her friends, it must be quite contagious.

DJ, Human-to-human spread would be a bad scenario..In my opinion mutations that result in easier spread from birds to mammals (including humans) could be maybe even worse ?

Certainly aerosol spread from death birds/bird droppings with H5N1 could be a nightmare...We have not seen the worst of the H5N1 global spread in birds...spring is on its way/fall in the south...so a lot of birds will soon migrate again...

Here in NL we have over 100 million farm birds (extreme high number !!!) ...we did see farm birds get infected even with filters in ventilation...unclear how the virus did get to the birds (the farm cat did not do it either...)

[url]https://afludiary.blogspot.com/2023/02/ecdc-update-risk-assessment-on-avian.html[/url] or https://afludiary.blogspot.com/2023/02/ecdc-update-risk-assessment-on-avian.html ;

Current epidemiological and virological evidence suggests that A(H5N1) viruses reman avian-like. Transmission to humans remains a rare event and no sustained transmission between humans has been observed. The risk of zoonotic influenza transmission to the general public in EU/EEA countries remains the same and is considered to be low. The risk to occupationally exposed groups such as cullers has been assessed as low to medium.

Direct contact with infected birds or a contaminated environment is the most likely source of infection and the use of personal protective measures for people exposed to dead birds or their droppings will minimise the remaining risk. The recent severe cases in Asia and South America in children and people exposed to infected sick and dead backyard poultry underline the risk associated with unprotected contact to infected birds in backyard farm settings and suggests the appropriate use of personal protective equipment.

Actions 

ECDC is in contact with WHO and other partners to obtain more information on the current event in Cambodia. ECDC monitors avian influenza strains through its influenza surveillance programme and epidemic intelligence activities in collaboration with EFSA and the EU reference laboratory for avian influenza, in order to identify significant changes in the virological characteristics and epidemiology of the virus. ECDC, together with EFSA and the EU reference laboratory for avian influenza, produces a quarterly updated report of the avian influenza situation. The most recent report was published on 20 December 2022.

and [url]https://afludiary.blogspot.com/2023/02/who-recommended-2023-2024-northern.html[/url] or https://afludiary.blogspot.com/2023/02/who-recommended-2023-2024-northern.html ;

In a separate document (see Genetic and antigenic characteristics of zoonotic influenza A viruses anddevelopment of candidate vaccine viruses for pandemic preparedness February 2023), the WHO described recent findings of influenza (H5N1, H9N2, and H1N1) in animals around the world, and their recommendations for new vaccine development.

As we discussed two weeks ago, in How The WHO & CDC Are Developing Candidate H5N1 Vaccines, since H5N1 reemerged in 2003, more than three dozen H5 CVVs have been selected by WHO for development. Most of these viruses have gone extinct over time, while new ones have emerged, necessitating the continual development of new vaccine candidates. 

The WHO describes the recent spate of human H5 infections as follows:

Genetic and antigenic characteristics of influenza A(H5) viruses

Three A(H5N6) and two A(H5N1) infections were identified in China, one A(H5N1) infection in Ecuador, two A(H5N1) detections in Spain, and one A(H5N1) infection in Viet Nam. The majority of cases reported exposure to poultry. Two of the A(H5N6) cases were fatal, the third was severe. 

One of the A(H5N1) cases was fatal, three more were severe, and two were asymptomatic. All cases from which sequence information is available (n=6) were caused by clade 2.3.4.4b viruses. The HAs of the sequenced viruses had 2 to 7 amino acid substitutions compared with the HA of A/Astrakhan/3212/2020, from which a clade 2.3.4.4b CVV has been developed.

They report specifically on the clade 2.3.4.4b viruses as:

Clade 2.3.4.4b viruses were detected in birds in many countries in Africa, Asia, Europe, North America and, for the first time, in Central and South America. An increasing number of infections in wild and captive mammals has been reported, with mink-to-mink transmission suspected on a farm in Spain.

Viruses from this clade have been associated with several different NA subtypes with N1 now predominating. The high levels of infection in birds with these viruses and increased geographic distribution have been accompanied by genetic diversification.

Some A(H5N1) viruses from Europe, the United States of America (USA) and Viet Nam show reduced reactivity with post-infection ferret antisera raised against the A/Astrakhan/3212/2020 CVV.

All viruses from Europe reacted well with post-infection ferret antiserum raised against A/chicken/Ghana/AVL763_21VIR7050-39/2021; a representative CVV is being developed. Many viruses from the USA that had reduced reactivity with antisera raised against the A/Astrakhan/3212/2020 CVV showed better reactivity with post-infection ferret antisera raised against A/American wigeon/South Carolina/22-000345-001/2021 (Table 2). 

Based on these findings, they recommend:

Based on current antigenic, genetic and epidemiologic data, a new clade 2.3.4.4b CVV that is antigenically like A/American wigeon/South Carolina/22-000345-001/2021 is proposed.

This document also describes recent human infections with H1 viruses, and H9N2, but does not recommend any new CVVs at this time. 

DJ, So far claims of H5N1 cases in Myanmar, Vietnam have not been confirmed...Sequencing of H5N1 takes time...(Is the recent Equador H5N1 case same clade as the Cambodia one ???) 

DJ, 

In recent news 2 H5N1 cases in China were reported on top of the two Cambodia cases. [url]https://www.thailandmedical.news/news/h5n1-news-suspected-outbreak-of-h5n1-avian-flu-virus-among-humans-being-investigated-in-south-kalimantan,-indonesia[/url] or https://www.thailandmedical.news/news/h5n1-news-suspected-outbreak-of-h5n1-avian-flu-virus-among-humans-being-investigated-in-south-kalimantan,-indonesia several Indonesia cases ? 

[url]https://afludiary.blogspot.com/2023/03/cdc-update-on-cambodian-h5n1-cluster.html[/url] or https://afludiary.blogspot.com/2023/03/cdc-update-on-cambodian-h5n1-cluster.html trying to put it some sort of perspective;

Officially, there have been 870 human H5N1 infections, 84 H5N6 infections, and nearly 1,600 H7N9 infections.  All of these are likely under counts, and these numbers don't include the scores of H9N2 and sporadic human infections with H7N4, H10N3, H3N8, H7N2, etc. that have been reported. 

The period between 2013 and mid-2017 saw the highest number of human infections with (H7 & H5) avian flu, averaging several hundred each year.  In a few cases, H-2-H transmission appears to have occurred. 

Luckily, these viruses were far better at jumping from poultry to people, than from human-to-human. The concern is that these viruses - as they occasionally spillover into humans and other mammals - could pick up host adaptations that will allow the virus to spread more efficiently among humans. 

DJ...some remarks;

-Yes in the past we did see a lot more human H5/H7 cases

-However H5N1 has never been this widespread in birds (H5N6 also going that way ?)

-H5N1 spreads on top of a still ongoing CoViD pandemic - CoViD damages human immune defenses

-H5N1 also more and more found in mammals

-We may be missing an even higher number of H5N1 cases (in mammals & humans) due to mild/no symptoms, wrong diagnosis

-The more cases of H5N1 the more mutations, "sub-groups/clades"

-Healthcare in many places exhausted (Corona) and defunded( war)...

-You do NOT need H2H/human-to-human spread to end up in a very major crisis

Time will tell how bad H5N1 further will become...It is already having its influence in food prices. Eggs, poultry are "limited" in some areas.