NEWS SCAN: H5N1 risk in China, predicting flu in kids, UK flu vaccine coverage, avian flu gene clues, pine nut outbreak over

FAO official warns of elevated risk of avian flu in China
H5N1 avian flu is widespread in China's poultry markets, especially in the south, according to a United Nations (UN) official. Guo Fusheng, technical adviser in animal health for the UN Food and Agriculture Organization (FAO), said the country is facing an increased risk of the virus, in both poultry and people, according to a China Daily story today. Fusheng, citing data from China's Ministry of Agriculture, said H5N1 clade 2.3.2.1 poses a special risk, given that current vaccines in poultry do not fully protect against it. "With the arrival of autumn and winter, the country is facing an escalating risk of bird flu outbreaks among poultry as well as that of humans getting infected," he warned. Yu Kangzhen, chief veterinary officer of the Ministry of Agriculture, said that, while localized outbreaks will be hard to prevent, "the chance of large-scale outbreaks is quite slim."

Nov 17 China Daily story
Meanwhile, surveillance has uncovered low-pathogenic H5N2 avian flu on a farm near Hsinchu City, Taiwan, according to a report filed today with the World Organization for Animal Health (OIE). Twenty chickens in a 6,000-bird flock were infected, and serologic and virologic tests confirmed H5N2. The report states, "Movement restriction was implemented on the infected farm immediately when the virus was detected. Clinical health investigation in the infected farm was done and showed that the breeders were in healthy condition and without clinical signs." Officials are investigating surrounding farms to prevent any possible virus spread.

Fever shown to independently predict flu in children
Fever was the only sign or symptom that independently predicted influenza infection in children who had respiratory infections, according to a matched case-control study. Finnish researchers observed children 13 years old and younger for signs of respiratory symptoms, then logged signs and symptoms and conducted virologic tests of nasal swab samples. They then matched 353 children with lab-confirmed flu with 353 children who tested negative for flu. Their multivariate logistic regression analyses determined that fever was the only sign that independently predicted flu, with the likelihood increasing with higher fevers. Odds ratios ranged from 13.55 (95% confidence interval [CI], 6.90-26.63) to 50.10 (95% CI, 16.25-154.45), depending on the level of fever. The likelihood ratio of a fever of 40.0°C (104°F) or higher in predicting flu was 6.00 (95% CI, 2.80-12.96). The investigators caution, however, that "the optimal use of influenza-specific antiviral drugs in children may require virologic confirmation."
Nov 13 Eur J Clin Microbiol Infect Dis abstract

UK panel advises against expanding flu vaccination to all kids
A UK advisory committee recommended that the country not extend influenza vaccine coverage to include healthy children, the Yorkshire Post reported today. The Joint Committee on Vaccination and Immunization (JCVI), which advises the British government on vaccination policy, said the current at-risk groups should remain a priority. These groups currently include seniors, pregnant women, and adults and children who have a serious medical condition. This policy contrasts with that of the United States, where all people 6 months and older are encouraged to receive flu vaccine. The JCVI reviewed the data and said that an initial study by the UK's Health Protection Agency suggests that vaccinating healthy children may be cost-effective. It added, however, that "further data is needed before the committee is able to make a recommendation to Government on vaccinating healthy children," according to the Post article.
Nov 17 Yorkshire Post article

Study finds gene changes that would boost avian flu transmissibility
In experiments to shed light on what polymerase changes in avian flu viruses are needed to clear the barriers for infecting human cells, researchers found that reassortment involving a human PA protein were key. US scientists assembled different combinations of avian and human influenza polymerase genes, then conducted tests to assess polymerase activity and virus replication. They then infected mice with the recombinant viruses to determine if the polymerase changes increased pathogenicity. They found that polymerase acid (PA) subunits from human viruses restored the ability to infect humans, even in a strain with a previously known restrictive polymorphism. Polymerases that contained PA proteins from 2009 H1N1 isolates were most active, and polymerase activity tests showed that viruses that contained avian basic polymerase 1 (PB1), basic polymerase 2 (PB2), and nucleocapsid protein (NP) genes, along with a human PA subunit, replicated more quickly in culture and were more virulent during mouse infections. The group concluded that avian influenza A viruses with seasonal human flu, the 2009 H1N1 virus, and swine-adapted viruses are circulating in pigs and have already formed new reassortants. They write that their findings suggest that further reassortment could create new viruses that can infect a wider host range and be more pathogenic.
Nov 17 J Virol abstract

CDC says pine nut Salmonella outbreak is over
The US Centers for Disease Control and Prevention (CDC) said today that a Salmonella Enteritidis outbreak linked to bulk pine nuts imported from Turkey is over. It added one more case to the outbreak, a patient from New York, raising the total to 43 in five states (Maryland, 1; New Jersey, 2; New York, 28; Pennsylvania, 8; and Virginia, 4). The number of patients hospitalized remained at two, and no deaths were reported. The implicated pine nuts were purchased from bulk bins at Wegmans Food Markets. The CDC said public health labs in Maryland and Pennsylvania also identified the outbreak strain in pine nut or pesto made from the pine nuts, raising the number of positive samples from 5 to 14. Though the outbreak is over, Salmonella is still an important cause of human illness in the United States, the CDC said.
Nov 17 CDC final outbreak update

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