Avian Flu Scan for Sep 19, 2013

News brief

Two Cambodian girls contract H5N1, one dies

Two young Cambodian girls have contracted H5N1 avian flu, one fatally, bringing the country's case total this year to 20, according to a report today from Xinhua, China's state news agency.

A 2-year-old girl from Kampot province died yesterday in a Phnom Penh hospital. The deputy director of Kantha Bopha Children's Hospital said, "The little girl from Kampot was in very serious condition when she arrived at our hospital."

The second girl, age 5, is from Takeo province. She is in stable condition in Kantha Bopha hospital. The Xinhua story did not specify when the girls got sick or whether they had contact with sick or dead poultry.

Of the 20 Cambodian H5N1 cases so far this year, 11 have been fatal, and the disease has hit children especially hard since it was first detected in the country in 2005. Since then, Cambodia has confirmed 41 H5N1 cases and 30 deaths.
Sep 19 Xinhua article

 

H7N9 gene study hints at two reassortant events

A detailed genetic analysis exploring how the new H7N9 flu virus evolved in China found that it took at least two reassortant steps involving distinct H9N2 viruses from different hosts to generate the virus. The study, conducted by a research team from China, appeared today in Cell Host & Microbe.

The group based its observations on whole-gene sequencing and phylogenetic analysis of 45 H7N9 and 42 H9N2 viruses from humans, poultry, and wild birds. Analysis revealed that the first reassortant, which produced an early version of the virus in wild birds, likely occurred between an H9N2 virus and other Eurasian avian influenza strains that contained H7 or N9 components.

Because of difficulty obtaining viral isolates from wild birds, scientists haven't been able to precisely determine the source of H7N9 hemagglutinin and neuraminidase (the "H" and "N" components, respectively). They wrote, though, that, considering surveillance data from humans and birds, the components likely came from wild birds.

The second reassortant probably came from an H9N2 in Chinese domestic birds and an earlier H7N9 strain that had spread from wild birds to domestic ones.

The researchers estimated that the second reassortment likely occurred in early 2012 and that the events, plus gene mutations and minor reassortant events, might help explain the diverse genotype seen in China's new H7N9 viruses.

The findings reinforce the important role wild birds play in the emergence of new flu viruses and the need to include many data sources for effective flu surveillance, the team concluded.
Sep 19 Cell Host Microbe abstract

News Scan for Sep 19, 2013

News brief

Donald Low, MD, Canadian SARS leader, dies at 68

Donald E. Low, MD, who became Canada's public face of SARS 10 years ago, died last night, according to media reports and Mount Sinai Hospital in Toronto, where he headed the microbiology department until recently.

Low, 68, was diagnosed as having a brain tumor early this year. He was a native of Winnipeg, where he worked in the 1980s before being hired by Mount Sinai. In his career he co-authored nearly 400 peer-reviewed articles, 41 book chapters, and almost 100 invited articles, the Canadian Press reported today. He was known as a high-energy natural leader, the story said.

Low was a global expert in necrotizing fasciitis caused by group A Streptococcus. He was also an early, passionate voice for the need for antibiotic stewardship to combat drug-resistant organisms. But during the 2003 outbreak of SARS (severe acute respiratory syndrome) he became a household name in Canada.

"Dr. Low's many friends and colleagues here at Mount Sinai are profoundly saddened by this loss, and will remember him not only for his many outstanding contributions, including the significant role that he played here at Mount Sinai and all of Toronto during the 2003 SARS crisis, but for his kindness, good humour and commitment to patient care," said Joseph Mapa, president and CEO of Mount Sinai, in a hospital news release.

Allison McGeer, MD, who worked under Low at Mount Sinai, told the Canadian Press that Low's most important contribution was mentoring a large network of infectious disease specialists.

"The most important thing he leaves behind," McGeer said, "is an entire generation of people who he has supported to be bigger and better and to find the place in the world that was right for them where they were going to do things. They don't come better."

Low is survived by his wife, Maureen Taylor, and by three children from a previous marriage.
Photo courtesy of Mount Sinai Hospital.
Sep 19 Canadian Press story
Sep 19 Mount Sinai news release

 

Risk assessment aims to keep polio-free African countries that way

Continued risk-mitigation efforts against polio are necessary in African nations deemed to be polio-free in light of persistent transmission of wild poliovirus (WPV) in three countries and of an ongoing outbreak that began in the spring and that numbered 178 cases as of Sep 10, says a report today in Morbidity and Mortality Weekly Report (MMWR).

"All countries will continue to have some level of risk for WPV outbreaks as long as endemic circulation continues in Afghanistan, Nigeria, and Pakistan," it says. Cases in the current outbreak have occurred in Somalia (163 cases), Kenya (14), and Ethiopia (1).

Since 2003, indigenous West African WPV has been imported into 21 previously polio-free countries constituting the so-called "WPV importation belt" despite mitigation efforts developed through the Global Polio Eradication Initiative (GPEI), the report explains.

The GPEI plans and prioritizes risk-mitigation activities guided by continued assessments of the risk for WPV and circulating vaccine-derived poliovirus (cVDPV) in polio-free countries, according to the report. The risk assessments are based on population immunity, quality of surveillance for acute flaccid paralysis (AFP), and such population-specific factors as proximity to areas in which WPV is actively circulating, presence of insecurity or civil unrest, and capacity to respond to outbreaks.

Mitigation activities include routine immunization efforts, supplemental immunization activities, strengthened AFP surveillance, and enhanced public health capacity for a quick response if WPV importation occurs.

A Centers for Disease Control and Prevention (CDC) editorial comment following the report points out that risk-mitigation activities "are continually adapted based on the availability of funds, variation in the vaccine production cycle, and the changing epidemiology of WPV" necessitating that "GPEI partners make data-driven decisions to prioritize activities."
Sep 20 MMWR report

 

WHO cites best practices against MDR/XDR-TB in Europe

The World Health Organization (WHO) Regional Office for Europe has issued a new compilation of best practices in the continuing struggle against multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) in that region, which, according to the report, has the highest proportion of M/XDR-TB patients in the world.

The 40 practices published, which were chosen from among 82 submitted by 30 countries, are aimed at continuing implementation of a consolidated action plan against M/XDR-TB adopted in September 2011 by the WHO Regional Committee for Europe and outlining tasks to undertake by 2015.

The practices fall into seven broad categories and include such things as reform of mandatory TB screening (from Hungary), mobilization of religious leaders for TB "stigma reduction" (Tajikistan), TB control in the prison system (Azerbaijan), psychosocial patient support (Kazakhstan), and improving hospital TB infection/transmission control using the F-A-S-T strategy (Russia).

The compendium, titled "Best Practices in Prevention, Control and Care for Drug-Resistant Tuberculosis," states that the percentage of M/XDR-TB patients receiving treatment has significantly improved, from 63% in 2009 to 96% in 2011. Challenges remain, however: The success rate of treatment is as low as 48.5%, well below the 75% goal. Among the causes listed are lack of efficient agents, suboptimal program performance, and a lack of efficient cross-border care.

Says WHO Regional Director for Europe Zsuzsanna Jakob in the foreword of the report, "Despite the steady decline of TB incidence, our Region has faced the largest proportion of M/XDR-TB among individuals diagnosed with TB, requiring a stronger link between health system strengthening and M/XDR-TB control to adequately prevent and treat this deadly disease."
WHO report (96-page pdf document)

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