Avian Flu Scan for Feb 03, 2015

News brief

CDC posts avian flu update, guidance on possible human disease

The US Centers for Disease Control and Prevention (CDC) today published a summary of the recent US outbreaks of avian flu in birds in western states, and late last week it published two guidance documents in response to those detections.

The CDC said today in a special update in Morbidity and Mortality Weekly Report (MMWR) that 14 instances of Asian-origin, highly pathogenic avian flu have been reported from Dec 15 to Jan 16 involving H5N2 (7 detections), H5N8 (6), and H5N1 (1)—the first time these strains have been confirmed in wild or domestic US birds. The report does not include an outbreak of H5N8 at a California turkey farm that was first noted on Jan 24.

"Although these viruses are not known to have caused disease in humans, their appearance in North America might increase the likelihood of human infection in the United States," federal officials said in the report.
Feb 3 MMWR report

The first document that the CDC published Jan 30 is on chemoprophylaxis—or drug therapy to prevent disease—for those who might be exposed to avian flu viruses known to cause human disease (such as H5N1 and H7N9) or potentially able to cause human disease, such as H5N2, H5N8, and the newly recognized reassorted H5N1 strain identified in Washington state last month.

It says the decision to initiate antiviral drugs should be based on clinical judgment, "with consideration given to the type of exposure and to whether the exposed person is at high risk for complications from influenza." The CDC recommends either oseltamivir (Tamiflu) or zanamivir (Relenza).

The second guidance document covers surveillance, testing, specimen collection, and processing of specimens for patients with possible infections from the above-mentioned viruses. It updates a document published by the CDC last May that specified only H5N1 and H7N9 viruses.

The CDC said in the MMWR report, which cited the guidance: "Until more is known about these viruses, CDC is taking a cautious approach, and recommendations are largely consistent with guidance for influenza viruses associated with severe disease in humans."
Jan 30 CDC guidance on avian flu prophylaxis
Jan 30 CDC guidance on novel flu testing and processing

At least 1 new H5N1 case added to recent surge in Egypt

Egypt's Ministry of Health and Population has reported an additional case of H5N1 avian flu, according to a machine translation posted today by FluTrackers, an infectious disease news message board. The country has seen a surge in cases in the past 2 months.

The case-patient is a 13-year-old girl from Qena governorate along the Nile Valley. She is reportedly hospitalized and undergoing treatment.

The notice also mentions the recovery of three case-patients, all of them adult women, but their cases have apparently not been reported previously.

Another apparent case of H5N1 from yesterday, that of a 19-year-old high school student in Damanhur, near Cairo in the Beheira governorate, was noted by FluTrackers yesterday. He is apparently hospitalized in stable condition, but the information is sketchy.

None of these cases will be added to the FluTrackers case listing until more information is made available.
Feb 3 FluTrackers post on 13-year-old girl
Feb 2 FluTrackers post on 19-year-old patient
Feb 3 FluTrackers case listing
Jan 29 CIDRAP News scan on Egypt's rising cases

China reports new H7N9 avian flu cases in man, infant

Two additional cases of H7N9 avian flu in China, both in Guangdong province, were reported today in a press release from Hong Kong's Centre for Health Protection (CHP).

The new illnesses are in a 56-year-old man from Guangzhou who is hospitalized in critical condition, and a 9-month-old girl from Zhongshan who is in stable condition. Guangdong, with 144 cases so far, is second only to Zhejiang province, with 146, in number of cases, the CHP said.

The CHP continues to issue warnings to the public to be vigilant for disease symptoms and to practice numerous hygienic and other measures to avoid the illness. The new cases bring the outbreak total since 2013 to 543, according to an H7N9 case list compiled by FluTrackers.
Feb 3 CHP press release
FluTrackers H7N9 case list

High-path H5 hits more poultry in Israel, Vietnam

Highly pathogenic H5 avian flu has struck more flocks in Israel and Vietnam, according to reports posted yesterday and today by the World Organization for Animal Health (OIE).

Israel's report to the OIE yesterday details four outbreaks involving H5N1, bringing to seven the number of outbreaks caused by that strain in the country in 2 weeks. All of the new outbreaks are near Hod HaSharon, a city in Israel's Central District not far from Tel Aviv. Two are very close to each other, the report says. The previous three outbreaks were in Haifi district, immediately to the north.

Three of the newly affected farms raise turkeys, while a fourth houses broiler poultry of an unspecified breed. They range in size from 3,000 to 37,000 birds, for a total of 87,000. Cumulatively, 2,900 poultry on the farms were infected and 730 died, while 49,640 additional birds were culled to prevent disease spread.
Feb 2 OIE report on Israel

Vietnam reported an outbreak of H5 in a village flock in Ca Mua, the country's southernmost province, which is Vietnam's fifth such outbreak since mid December but the first of 2015.

Of 824 poultry, 260 died from the disease and the remainder were culled, according to the OIE report today. No non-fatal cases were reported.
Feb 3 OIE report on Vietnam

News Scan for Feb 03, 2015

News brief

Study: Oseltamivir shortens flu symptom duration but not viral shedding

Oseltamivir (Tamiflu) taken within 24 hours of flu symptom onset shortened the duration of all symptoms by 56%, but had no effect on household flu transmission or viral shedding, according to a study yesterday in the Journal of Infectious Diseases.

The observational study comprised 582 people with lab-confirmed influenza and their household members living in Hong Kong from 2008 to 2013. Children under 5 years old made up 21% (121) of the study population, while 43% (250) were children from 6 to 12.

Researchers from the University of Hong Kong and the Harvard University School of Public Health found that patients who took oseltamivir within 24 hours of flu symptom onset experienced a 56% reduction in their duration of symptoms (95% confidence interval (CI), 41%-67%).

Oseltamivir reduced fever duration by 47% (95% CI, 45%-63%) and reduced respiratory symptom duration by 56% (95% CI, 33%-59%).

The study did not find an association between oseltamivir use and the patient's infectivity or viral shedding in his or her household. Of the 1,420 household contacts of 467 patients, 139 (9.8%) were infected with influenza.

The authors say that limitations to the study include the small sample size and the fact that viral shedding was measured by reverse transcriptase polymerase chain reaction (PCR), so viral presence could only be confirmed in the nose and throat.
Feb 2 J Infec Dis study

Study: Obese elderly have greater risk of flu-related death

Obese elderly people have a greater risk of death related to respiratory symptoms during flu seasons, regardless of body mass comorbidities and other risk factors, according to a study yesterday in Clinical Infectious Diseases.

The population-based cohort study involved 66,820 Chinese people age 65 and older receiving services at Elderly Health Centres in Hong Kong from 1998 through 2012.

Before the 2009 H1N1 flu pandemic, obese elderly people were 19% more likely to die of respiratory causes during flu seasons when compared with normal-weight people (hazard ratio [HR], 1.19; 95% CI, 1.01-1.42). The association between flu and mortality was 11% higher for obese elderly people from 2009 to 2012 (HR, 1.11; 95% CI, 1.01-1.22).

Increased risk remained the same even when adjusted for age, health status, presence of other circulating respiratory viruses, and comorbidities like chronic illness, smoking, or alcohol abuse, the researchers note.

They also stratified mortality risk for obese sub-groups by the time between influenza infection and death (the lag in weeks). Obese people in good health were 35% more likely to die from influenza than normal-weight people during a 5-week lag (HR, 1.35; 95% CI, 0.97-1.87). Obese people in poor health were 21% more likely to die during a 1-week lag compared with their normal-weight counterparts (HR, 1.21; 95% CI, 1.00-1.46).

The study estimated that 26.1% to 36.4% of elderly community-dwelling people in Hong Kong are vaccinated for influenza and suggested further prioritizing flu vaccine and preventive outreach for obese older people.
Feb 2 Clin Infect Dis study