Avian Flu Scan for Nov 13, 2013

News brief

H7N9 efforts marked by cooperation, quick response, report says

Lessons learned in response to H7N9 avian flu in China this year include the importance of global cooperation, transparent communication, and collaboration between human health and animal health professionals, the World Health Organization's (WHO's) Western Pacific Region Office (WPRO) said in a new report.

It added, however, that the region is not prepared for a severe public health emergency.

The report, "Avian Influenza A(H7N9) Response: An Investment in Public Health Preparedness," includes a history of the outbreak, an overview of the disease, details on China's response, the role of the WHO, and a framework for future action.

Other lessons learned from the outbreak, according to the report, include the importance of investment in public health preparedness and the key guidance afforded by the International Health Regulations. The WPRO commended China for its rapid and open response, as well as its collaboration with the WHO and other global health leaders. It also applauded the country's infection-control and virus-sharing efforts.

Among the steps that the WHO took in response to H7N9 was to quickly activate the WPRO's newly upgraded Emergency Operations Center and to provide rapid risk assessments and other updates, the report said.
WHO WPRO report

OIE: 85 H5N1 outbreaks in Nepal led to 1.4 million dead poultry

Outbreaks of H5N1 avian flu in Nepal in recent months have affected 85 farms and backyard flocks, killed 43,691 poultry, and led to the culling of 1,372,309 additional birds, according to a report posted yesterday by the World Organization of Animal Health (OIE).

All but one of the outbreaks began in August—with onset dates ranging from Aug 14 to Aug 24—and one began Sep 14. The outbreaks were resolved from late August to early October. The report details five distinct outbreaks and groups the rest as four separate "outbreak clusters."

The outbreaks that are listed individually varied in scope from 724 to 14,255 poultry deaths due to H5N1, with culling of anywhere from 1,276 to 783,745 additional birds. The outbreak clusters involved from 688 to 8,440 poultry deaths, with another 14,312 to 213,447 birds culled to stop disease spread.

Together, the outbreaks resulted in 1,416,000 poultry dead from the virus or subsequent culling. The country's previous H5N1 report to the OIE, on Sep 21, cited55,628 poultry killed by the virus and 294,211 culled, for a total of 349,839 birds killed in 43 separate outbreaks.
Nov 12 OIE report
Sep 24 CIDRAP News scan on previous OIE report

News Scan for Nov 13, 2013

News brief

Kuwait announces its first two MERS cases

Kuwait's Ministry of Health (MOH) today announced the country's first two Middle East respiratory syndrome coronavirus (MERS-CoV) infections, according to the Kuwait News Agency (KUNA) and the MOH's Twitter account. The cases might not be laboratory confirmed.

The first case is in a 47-year-old Kuwaiti who has diabetes and high blood pressure is being isolated in intensive care after contracting MERS, said Dr. Musab Al-Saleh, chief of the ministry's disease control unit, KUNA said. The man is in critical condition, Agence France-Presse (AFP) reported.

The second case appears to be in a 52-year-old Kuwaiti man, according to a machine-translated Arabic news account today posted on the infectious disease blog Avian Flu Diary. His case is unrelated to the first case, the news report said. The country's MOH said via Twitter that the two patients are in the same hospital south of Kuwait City.

The first case has not been confirmed by lab tests, World Health Organization (WHO) spokesman Gregory Hartl noted today on Twitter. As of this writing, Hartl had not commented on the second case.

If confirmed, the cases would raise the WHO-confirmed global total to 155 MERS cases, 64 of which have been fatal. The vast majority of cases have occurred in Saudi Arabia.

Confirmation of the cases would make Kuwait the sixth Middle Eastern nation to be affected by MERS-CoV. In addition to Saudi Arabia, the others are Jordan, Oman, Qatar, and the United Arab Emirates.
Nov 13 KUNA report
Kuwait MOH Twitter feed
Nov 13 AFP story
Nov 13 Avian Flu Diary blog post
Gregory Hartl's Twitter feed

Study: Biggest factor in restaurant-associated food outbreaks is workers

Food worker health and hygiene was the most common contributing factor in foodborne disease outbreaks associated with eating at restaurants and delicatessens, followed by improper food preparation practices, a study in the Journal of Food Protection found.

The authors analyzed data from the 457 foodborne illness outbreaks, defined as an incident where two or more persons experienced similar illnesses from ingestion of a common food, reported in 2006 and 2007 at Foodborne Diseases Active Surveillance Network (FoodNet) sites, which at that time comprised about 15% of the US population. A total of 300 (66%) of the outbreaks were associated with restaurants and delicatessens, with 295 (98%) of the reports listing at least one contributing factor.

A single etiologic agent was identified in 257 of the restaurant-associated outbreaks, with norovirus by far the most common, causing 154 (60%) of them; worker health and hygiene was listed as a contributing factor in 137 (89%) of these.

Among all the single-etiology outbreaks, worker health and hygiene was listed as a contributing factor in 165 (64%). Food preparation factors, such as inadequate cleaning of equipment and improper storage, were reported in 88 (34%), and contamination of foods before their arrival at restaurants was reported in 56 (22%).

Food handling by workers who were infected or were carriers of a pathogen and workers' bare-handed contact with food were the top factors reported among handler-associated contamination. The authors conclude that more work is needed to educate restaurant workers not to work when they are ill, but they note the challenge inherent in the fact that paid sick leave is uncommon in the food industry.
November J Food Protect abstract

Improved food safety practices needed on smaller farms

A large portion of farmers with small- to medium-sized farms follow such practices as using raw manure on crops and potentially unsafe water for irrigating and washing produce that can put consumers at risk for foodborne illness, according to a study in the Journal of Food Protection.

Results of mail and online surveys from 226 farmers and 45 managers of farmers markets or other small, local produce markets in Georgia, Virginia, and South Carolina were analyzed to determine the prevailing food safety practices in these settings. Of the farmers responding, 128 (>56%) reported using manure on their crops, with 34% of that group using either raw or mixed raw and composted manure and more than 26% applying manure less than 90 days before harvest.

About half the farmers reported that their crops are harvested with bare hands, but only two-thirds had bathroom or hand-washing facilities near fields or packing sheds.

Water sources for irrigation that had not been tested for safety were used by 27%. Sixteen percent used untested water for washing produce, and surfaces that touch produce were not sanitized on 43% of the farms. Moreover, two thirds of farmers did not clean the containers used to transport produce between uses. Those that did clean containers used a wide range of agents.

No cooling methods were used for produce on 18.1% of farms, and 35% of farmers reported never or rarely cooling produce during transport to markets.

Market managers' responses showed that no food safety standards were in force in 42% of markets, and 11% or less ask farmers about farm conditions that could affect produce safety. The surfaces at markets were sanitized in less than 25% of cases, only 11% of markets clean surfaces between uses, and more than three fourths give no sanitation training to workers or vendors.

A large portion of both farmers and managers expressed interest in receiving food safety training for workers. According to the authors, the unsafe practices identified could "threaten the future of the locally grown food movement, which has provided new access to fresh produce and increased the economic viability of these small farms and the communities they serve."
November J Food Protect abstract