Flu Scan for Dec 29, 2014

News brief

US flu markers rise higher

The nation's flu markers showed another sharp spike last week, with all 10 of the Centers for Disease Control and Prevention (CDC) regions reporting that clinic visits for flu-like illness were above their baselines.

Overall, the percentage of doctor's visits for flu-like illness climbed from 3.7% to 5.5% last week, while the percentage of respiratory samples that were positive for flu increased from 25.9% to 28.1%

Four more pediatric flu deaths were reported, lifting the season's total to 15 from 9 states. Overall deaths from pneumonia and flu reached the epidemic threshold for the first time this season.

Twenty two states—mostly in the Southeast and Midwest—and Puerto Rico reported intense flu activity, up from 13 the week before, and 36 states are now reporting geographically widespread flu, up from 29 and Guam the previous week.

H3N2 is still the dominant strain, and 67.4% of the viruses tested showed a mismatch with the strain included in the vaccine, which is slightly less than the percentage seen the week before.
Dec 29 CDC FluView

Four H5N1 cases, one fatal, reported in Egypt

Egypt has identified four human H5N1 influenza cases over the past few days, according to government and media reports, continuing an increase in the rate of cases that began in November.

Today Agence France-Presse (AFP) said a case was identified in a 42-year-old Cairo man, marking the city's first case this year but the 25th case nationwide. The story also cited a fatal case in the southern province of Aswan but gave no details; it said this was the country's 10th death this year.

A machine-translated report from the Egyptian Ministry of Health, posted Dec 25 on the blog Avian Flu Diary, said the fatal case involved a 5-year-old boy who fell ill after having contact with sick birds and died on Dec 24.

A third case involves a 25-year-old woman in Minya province, according to another machine-translated MOH statement posted by Avian Flu Diary. The fourth case, according to a translated media report posted by the same blog, is in a 30-year-old woman in Monufia province who had contact with sick chickens.

Meanwhile, a Gulf Today story today reported four fatal avian flu cases in neighboring Libya, but it didn't specify which strain. It said three cases were in Tripoli, the capital, and the fourth was in Tobruk, which lies near the Egyptian border.

The country's health minister said the World Health Organization (WHO) would be sending a team to check on the cases within 2 days, according to the story.
Dec 29 AFP story
Avian Flu Diary posts:
Dec 28
Dec 27
Dec 25

Four H7N9 cases reported in China, Hong Kong

Four more H7N9 avian influenza infections have been reported over the past 5 days, three in China's Zhejiang province and one in a Hong Kong resident that had recently traveled to Guangdong province.

Two of the Zhejiang province cases are in men from Yongkang, a 57-year-old who has been isolated and hospitalized and a 75-year-old who died from his infection, according to translated reports from the FluTrackers infectious disease news message board and a report today from Agence-France Presse (AFP).

The other case-patient from the province is a 20-year-old woman from Shaoxing. According to FluTrackers' translation of a city health bureau statement, she had visited a farmers market a week before she got sick and is hospitalized in critical condition.

The patient whose H7N9 infection was detected in Hong Kong is a 68-year-old woman who had visited the Guangdong city of Shenzhen 2 weeks ago, according to a separate AFP story today. She was hospitalized on Dec 25. Hong Kong's Centre for Health Protection (CHP) said today that health officials have located two people who traveled with the woman on Dec 13 and that the group went to a wet market where they bought vegetables but did not have contact with poultry.

She apparently visited two doctors in Hong Kong on Dec 19 and Dec 23, but did not reveal her travel to the mainland, the CHP said. The CHP is monitoring clinic staff and tracing people who were at the clinic during those times. Her infection is the 10th H7N9 illness detected in Hong Kong since the virus emerged. All had a history of travel to China's mainland.

The H7N9 detection in Hong Kong, the first since early 2014, prompted the CHP yesterday to raise its pandemic alert level from serious to alert. The four new cases lift the global H7N9 total to 474 cases, according to a case list kept by FluTrackers.

In a related development, the WHO on Dec 24 supplied more details about 11 H7N9 cases, 5 of them fatal, that China reported to the agency on Dec 16. Symptom onsets ranged from Nov 11 to Dec 1. Ages range from 31 to 81 years, and three of the patients are women.

Cases are from five different provinces: Xinjiang (4), Zhejiang (2), Guangdong (2), Fujian (1), and Jiangsu (1), and one patient is from Shanghai. All but one had a history of exposure to live poultry. Five are listed in severe condition, and one has mild infection that hasn't required hospitalization.
Dec 29 AFP story
FluTrackers H7N9 case list
Dec 29 CHP statement on H7N9 case
Dec 29 AFP story on Hong Kong case
Dec 24 WHO statement

Avian flu pops up in Russia, Taiwan, South Korea, Japan

Various strains of both highly pathogenic avian influenza (HPAI) and low-pathogenicity H5 avian flu have been reported in birds in Russia, Taiwan, South Korea, and Japan in recent days.

Russia reported a Eurasian wigeon infected with H5N8 avian flu, which has not been seen in the Russian Federation before. The infection was discovered in a sample from the bird's trachea during monitoring, according to a Dec 12 notice from the International Organization for Animal Health (OIE).

The bird, which was destroyed, was in Belaya Gora in the Sakha republic, which is in northeastern Russia. Further investigation, including screening for H5N8 and wildlife control, will be conducted, said the OIE notice.

The Taiwan outbreak, reported by OIE Dec 26, involves subclinical low-pathogenicity H5 avian flu in 20 ducks on a breeder farm housing 2,600 birds. None have died or been destroyed. The farm has been quarantined and disinfected, and movement of poultry within the country has been restricted. The outbreak occurred in Jiaoxi Township in Yilan County, which is in northeastern Taiwan.

Meanwhile, a case of avian flu of unspecified type occurred in Seongnam, a satellite city of Seoul, South Korea, according to a short notice today in the Chosun Ilbo newspaper. It says this is the first case of avian flu in the Seoul area this winter.

In Japan, 42,000 chickens have been slaughtered on a farm in Miyazaki after confirmation of H5N8 avian flu there, according to an article in the Japan Times. It is the second outbreak of HPAI this year in Japan; the first occurred earlier this month in nearby Nobeoka and resulted in destruction of 4,000 birds.

Movement of poultry within 10 kilometers of the new outbreak farm has been restricted. According to the article, officials are shocked at the new outbreak, saying, "Unlike the first case (in Nobeoka), the bird flu this time will involve far bigger numbers of chickens and farms. We need to move quickly."
Dec 12 OIE notice regarding Russia
Dec 26 OIE notice regarding Taiwan
Dec 29 Chosun Ilbo notice
Dec 29 Japan Times article

News Scan for Dec 29, 2014

News brief

Jordan, Saudi Arabia report MERS-CoV cases

Jordan and Saudi Arabia reported three new Middle East respiratory syndrome coronavirus (MERS-CoV) cases over the past 5 days, according to media and government sources.

Few details were available about Jordan's latest case, other than that the patient is a man who is an "Arab national" who is in stable condition at a private hospital, Kuwait News Agency (KUNA) reported on Dec 25, citing an official from Jordan's health ministry. The latest case pushes Jordan's MERS-CoV case count to 12, of which 6 were fatal.

In Saudi Arabia, the Ministry of Health (MOH) on Dec 26 announced two more infections, involving a 31-year-old woman from Riyadh who is in critical condition and a 70-year-old man from Qurayyat in the northwestern part of the country who is in stable condition.

Officials are investigating if the man had animal exposure, but no exposure was listed for the woman. Neither was thought to have had contact with confirmed or suspected cases in the hospital or in the community. Both had underlying health conditions. The two new infections boost Saudi Arabia's total to 824 cases, including 355 deaths.

In a related development, the World Health Organization (WHO) on Dec 26 posted additional details about three case reports it received from Saudi Arabia between Dec 8 and 16. Illness onsets ranged from Dec 1 through Dec 10. Two of the patients are men, ages 61 and 70, from different cities who have underlying conditions and have a history of frequent contact with camels and often consumed raw camel products. Neither had been exposed to other known risk factors in the 14 days before they got sick. One of the men died, and the other is in critical condition.

The third patient is a 29-year-old foreign woman who got sick after she had contact with a MERS-CoV case-patient while she was working in an isolation ward in Taif. She is hospitalized in stable condition. The WHO said it has been notified of 941 lab-confirmed cases, of which at least 347 were fatal.
Dec 25 KUNA story
Dec 26 MOH statement
Dec 26 WHO statement

Two firms recall caramel apples in wake of Listeria outbreak

Recalls covering 31 states have been issued for two brands of commercially produced, prepackaged caramel apples potentially linked with an outbreak of Listeria monocytogenes that has caused 29 illnesses, 3 of them fatal, in 10 states over the past couple of months, say two notices from the Food and Drug Administration (FDA).

One company, Happy Apple Co. of Washington, Mo., said that apples supplied to its California facility by a firm called Bidart Brothers may be connected with the outbreak. The company voluntarily recalled its Happy Apple caramel apples with best-use-by dates of Aug 25 through Nov 23. The apples come in single as well as three, four, and eight packs, according to a Dec 24 FDA notice.

Happy Apple products are sold in groceries, discount, and club stores in Alabama, Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Washington, and Wisconsin.

The company said it "ceased our operations at the end of October as part of our normal, seasonal shut down and the caramel apples produced are no longer available in stores."

Another company, California Snack Foods, also cited Bidart Brothers as a supplier of apples that could be associated with the outbreak. The California company recalled its caramel apples dated Aug 15 through Nov 28. Their product comes in single and three packs, says a Dec 27 release from the FDA. The products were distributed to grocery, discount, and club stores in Arizona, California, Nevada, Texas, and Utah.

The company reportedly used the last of its Bidart apples early in November, so they are likely no longer available in stores.

The 29 patients who have contracted listeriosis in the outbreak have all required hospitalization. Listeria was implicated in three deaths and may have contributed to a fourth. No illnesses or deaths have been related to plain apples or caramel candies.
Dec 24 FDA notice
Dec 27 FDA notice
Dec 23 CIDRAP News scan on outbreak