Flu Scan for May 06, 2014

News brief

China detects first known human H5N6 infection

Chinese health officials have confirmed what appears to be the first known H5N6 avian influenza infection in a human, a farmer from Sichuan province who had severe pneumonia and died, according to a post yesterday from ProMED-mail, the online reporting system of the International Society for Infectious Diseases.

According to a machine translation of a May 4 statement from Sichuan's health department, the 49-year-old man from Nanchong had been exposed to sick and dead poultry before he got sick. His close contacts are under medical observation, and so far no other illnesses have been detected.

The health department said the virus was detected because of enhanced monitoring for flu and pneumonia cases of unknown causes. It said China's Center for Disease Control and Prevention confirmed the finding.

ProMED-mail also flagged a report from China's agriculture ministry that said it investigatedof the man's sick chickens on Apr 23 and that the national reference laboratory isolated H5N6 from the samples.

In a report on the findings yesterday to the World Organization for Animal Health, the agriculture ministry said the H5N6 detected in the poultry is low-pathogenicity and that 1,338 birds were culled to curb the spread of the virus. The source of the virus is unknown, it said.

In a comment on the events, ProMED Mail moderator Arnon Shimshony, DVM, a professor of veterinary medicine at Hebrew University of Jerusalem, said H5N6 has been found in wild birds on several continents in the past, including Taiwan in 2004. He noted that H5N6 has been used as a poultry vaccine strain that allows veterinarians to differentiate infected birds from vaccinated ones.

Flu surveillance in China occasionally turns up uncommon flu strains in humans and birds. For example, at the end of 2013 and in early 2014 China reported three H10N8 cases, two of them fatal, in humans.
May 5 ProMED Mail post
May 4 Sichuan health department statement
May 5 OIE report
Feb 13 CIDRAP News scan "New fatal H10N8 case reported in China"

Global flu activity near interseasonal levels

Influenza activity in the Northern Hemisphere is approaching interseasonal levels in most countries, the World Health Organization (WHO) said in an update yesterday as influenza B continues to increase its share of circulating viruses.

Flu levels are slowly declining in North America, the agency said, while most European nations either approached or reached interseasonal levels. The highest levels were reported in eastern Europe, though they were still low. H3N2 predominated in Europe, followed by 2009 H1N1. The B strain was at low levels.

Influenza B predominated in East Asia, western Asia, and northern Africa, and all three regions reported low levels. Flu remained at low levels in the Southern Hemisphere as well, the WHO reported.
May 5 WHO update

Harris poll: 13% said they had flu in 2013-14, 44% got vaccine

The flu season that is just winding down had fairly typical numbers of flu cases and people receiving the vaccine, according to a Harris Poll released today. The self-reported vaccine effectiveness was also typical, Harris Interactive said in a press release.

Harris surveyed 2,300 US adults from Apr 16 to Apr 21. The company found that 44% reported getting flu vaccine, which compares with 40%, 39%, 44%, 40%, and 44% over the five previous seasons.

Vaccine uptake was highest in the elderly: 76% of people 65 or older were vaccinated, and only 7% of seniors said they got the flu. People aged 25 to 29 were the least likely (16%) to be vaccinated, and they were the most likely (19%) to say they had the flu.

Overall, 13% of respondents believed they contracted influenza during the 2013-14 season, compared with 18%, 12%, 11%, 11%, and 14% over the past five seasons.

As in most of the Harris Polls over the past 10 years, the number of people who believe they had the flu was almost the same for people who received flu vaccine (12%) and those who did not (13%), Harris said.

"However, it would be a mistake to conclude from this that the vaccine was ineffective," according to the Harris news release. "There is clear evidence in this poll that people who were more vulnerable were also more likely to have received shots."

Also, only 47% of those had flu vaccine and who thought they had contracted flu said the diagnosis was made by a physician. Flulike symptoms can be caused by a variety of pathogens.
May 6 Harris press release

News Scan for May 06, 2014

News brief

Pakistan responds to WHO polio alert by adding vaccination posts

The health ministry of Pakistan, the country with the most polio cases of late, has committed to setting up mandatory immunization counters for travelers at all its airports, border crossings, and seaports in response to yesterday's World Health Organization (WHO) declaration of a worldwide polio emergency, according to a story in the current issue of Pakistan Today.

One of just three countries where polio is still endemic, Pakistan had 91 cases last year, compared with 58 the year before, and has had 59 of the 74 cases worldwide reported so far this year.

Polio immunization programs in the country have met with resistance, attacks, and even killings. Violent factions in the country see the immunization campaigns as foreign espionage, and many residents have been told the vaccine causes infertility. The other countries with endemic polio are Afghanistan and Nigeria.

The WHO stated that wild poliovirus has made inroads several countries previously declared polio-free, often spreading across borders as refugees flee violence in their countries. The organization called upon Pakistan, Cameroon, and Syria to ensure that residents and long-term visitors are vaccinated 4 weeks to 1 year before traveling outside their country.

Where time does not allow compliance with this recommendation, at least one dose is to be given before a person's departure, the WHO advises. In additions, travelers are to be issued certificates of vaccination to prove their status.
May 6 Pakistan Today story
May 5 CIDRAP News story on WHO declaration

Probable Ebola cases still rising in Guinea

Guinea's cumulative case total for Ebola virus disease (EVD) has risen by 5 since last week, to 231, with the number of deaths increasing by 6, to 155, says an update today from the WHO.

Laboratory-confirmed cases held steady at 127 of the 210 patients tested, and deaths among that group rose by 1, to 82. The increase in cumulative cases has come entirely from those classified as probable, with that number now at 49, compared with 44 last week. Five of the 6 new fatalities have involved probable cases, bringing that total to 39.

Most clinical EVD has occurred in Guekedou prefecture, with 145 cases and 105 deaths, and Conakry, with 53 cases and 24 deaths. Other areas that have been affected, but in lower numbers, are Macenta, Kissidougou, Dabola, and Djingaraye. No new cases were reported from those areas.

No new EVD has been reported in Liberia or Sierra Leone. WHO support of the regions affected by the Ebola outbreak continues, with 87 experts deployed to Guinea, 20 to Liberia, 1 to Sierra Leone, and 4 to the WHO's African Regional Office.
May 6 WHO update
Last (May 2) WHO update

Delaware reports case of highly resistant Pseudomonas aeruginosa

Delaware has reported the country's first known infection with New Delhi metallo-beta-lactamase (NDM)–producing carbapenem-resistant Pseudomonas aeruginosa, a multidrug-resistant bacterium first reported in Serbia, said Delaware Health and Social Services (DHSS) yesterday.

The case, in an 81-year-old New Castle County man who has underlying medical conditions, was confirmed by the US Centers for Disease Control and Prevention (CDC), the DHSS said in a news release. The man is receiving medical care in Pennsylvania after being hospitalized in Delaware.

In addition, a Pennsylvania resident has an NDM-producing Pseudomonas infection and is receiving care in the same medical center, the DHSS said, and officials are investigating both cases.

The Delaware Division of Public Health (DPH) is working closely with the CDC and the Pennsylvania Department of Health to gather information and determine appropriate next steps, the DHSS said. The DPH is testing the man's Delaware hospital roommates.

Pseudomonas can cause a variety of healthcare-associated infections, most commonly in the lungs, urinary tract, and bloodstream, according to the DHSS release. An estimated 51,000 healthcare-associated P aeruginosa infections occur in the United States each year, and more than 13% are multidrug-resistant, the agency said.
May 5 DHSS news release