Avian Flu Scan for Oct 27, 2014

News brief

Study: evidence of subclinical H10N8 avian flu in animal workers in China

Some animal workers in southern China, home of the first H10N8 avian flu infections, may have had asymptomatic or subclinical infections with the strain even before the first human case was recognized in November 2013, so surveillance should continue in this population as well as in healthcare workers, say the authors of a study today in BMC Medicine.

The researchers, from Guangzhou, China, and Durham, N.C., retrospectively studied archived serum samples from 720 animal workers and 107 non–animal workers from May through August 2013 during a surveillance program for novel zoonotic flu in occupationally exposed individuals.

Samples were tested by hemagglutination inhibition (HI) assay; those with positive reactivity to H10N8 (defined as titer > 1:20) were further tested by microneutralization (MN) assay. Questionnaires given by the animal workers regarding risk factors for H10N8 were also evaluated.

Of the 827 samples, 21 (2.5%) tested positive, three with titers of 1:40. None of those who tested positive had flu symptoms during the 3 months before sampling was done. Of the three people with the higher titers, two had MN antibody titers of 1:40, evidence of possible previous H10N8 infection, and one had a titer of 1:80, indicative of a probable previous infection. All three were animal workers.

H10N8 virus was first identified in a duck in Guangdong province during 2012; the authors say the virus infected dogs in the area as well. They point out that the Guangdong province has been a hotbed of novel influenza virus generation, including the H7N9 strain that is the source of an ongoing outbreak that began in 2013 and has caused more than 450 cases.
Oct 27 BMC Med abstract


Five strains of H5 avian flu reported across China

Reports of outbreaks in China involving five different highly pathogenic H5 avian influenza strains were filed with the World Organization for Animal Health (OIE) recently.

Two of the strains—H5N8 and H5N3—have not been reported by China to the OIE before. Two outbreaks of the former were reported in September, each involving one bird (a duck and an unspecified bird) sampled during a national surveillance plan. One was at a slaughterhouse and the other in a wetland area; both were in Liaoning province in the northeast.

H5N3 occurred in a duck at a live-bird market in China's south central Hunan province. The bird's infection was also discovered during surveillance.

Eight outbreaks of H5N2 on farms, at bird markets, and in wetland areas were reported from Sep 12 through Oct 24. The total susceptible birds numbered 6,254, of which 6,253 were destroyed (1 bird was discovered during surveillance). Geographic areas affected included the following provinces: Hubei in the east central region (three outbreaks), Heilongjiang and Liaoning in the northeast, Ningxia and Liaoning in the northwest, Guangxi in the south central region, and Tibet.

Twenty-four H5N6 avian flu outbreaks among ducks, geese, and chickens at markets and farms were reported to the OIE in September, all but one involving just one or two birds during sampling done as part of a national surveillance plan. The larger outbreak was on a farm in Heilongjiang province. Two birds in a flock of 1,421 were infected, and all birds were destroyed.

H5N1 avian flu was the cause in 16 outbreaks, all of them involving 1 or 2 ducks, geese, or chickens, again occurring at markets and discovered as part of national surveillance.
Oct 24 OIE report on H5N3
Oct 24 OIE report on H5N8
Oct 24 OIE report on H5N2
Oct 24 OIE report on H5N6
Oct 24 OIE report on H5N1

News Scan for Oct 27, 2014

News brief

Saudi Arabia reports 5 new MERS cases

Saudi Arabia's Ministry of Health (MOH) has reported five new MERS-CoV cases from Oct 25 to today and two deaths on Oct 25, bringing the country's total to 777 cases and 331 deaths since June 2012. One of the deaths occurred in a newly reported case.

The new case on Oct 25 was in a 75-year-old man from Taif, who had contact with suspected or confirmed cases in hospitals or clinics, although he was not a healthcare worker, the MOH said.

New MERS-CoV (Middle East respiratory syndrome coronavirus) cases reported on Oct 26 were in a 53-year-old man, which proved fatal, and in a 44-year-old man, both from Riyadh. The 44-year-old man is a healthcare worker and may have had contact with cases in a healthcare setting.

Cases reported on Oct 27 involved a 61-year-old woman and a 90-year-old woman from Riyadh and Jeddah, respectively. Both women are currently being treated in an intensive care unit.

All of the newly reported patients had a preexisting disease, although none had been exposed to animals or suspected or confirmed cases in a community setting.

On Oct 25, the Saudi MOH also reported the recovery of a 35-year-old woman from Taif, and on Oct 26, the death of a 70-year-old man from Taif. Since June 2012, 433 people in Saudi Arabia have recovered from MERS-CoV, the ministry said.
Oct 25 MOH update
Oct 26 MOH update
Oct 27 MOH update


Chikungunya increases in the Caribbean, new cases in France

An Oct 24 update from the Pan American Health Organization (PAHO) shows chikungunya cases continuing to climb in the Caribbean and Americas, with 16,347 new suspected cases and 666 new confirmed cases since the Oct 17 PAHO update.

The new cases bring the total outbreak numbers to 776,089 suspected and 12,993 confirmed cases, for 789,082 total cases.

Since Oct 17, Guadeloupe reported 6 deaths, and Martinique reported 7 deaths due to chikungunya. Of the 152 deaths attributed to chikungunya, 93% have occurred on Guadeloupe and Martinique, according to the PAHO report.
Oct 24 PAHO report
Oct 20 CIDRAP news scan on previous PAHO update

In related news, the US Centers for Disease Control and Prevention (CDC) on Oct 21 reported an increase of 100 US chikungunya cases since Oct 10, bringing the total number of US cases to 1,482. (PAHO reported this increase on Oct 17.)

Most US cases have occurred in people who have traveled to places where infection is more prevalent, and 11 locally transmitted cases have been reported in Florida.
Oct 21 CDC update

Outside the Caribbean and Americas outbreak area, the World Health Organization (WHO) received a report of four locally acquired chikungunya cases in France, according to an Oct 23 WHO Global Alert and Response report.

The International Health Regulations focal point for France notified WHO of the cases on Oct 21. All cases occurred in one family, who lived near a case-patient whose disease was imported from Cameroon, according to the WHO report.

An Oct 25 Communicable Disease Threats Report from the European Centre for Disease Prevention and Control (ECDC) identified one additional case of locally acquired chikungunya in France, noting that the new case-patient lived in the neighborhood of the four recently infected patients.

In response to the first cases of locally acquired chikungunya in France since 2010, French authorities are focusing efforts on vector control and disseminating information to healthcare providers and the general public, the WHO said.
Oct 23 WHO report
Oct 25 ECDC update


US EV-D68 cases reach 1,035 in 47 states

With 37 new cases of enterovirus 68 (EV-D68) confirmed today, the US total has reached 1,035, the CDC reported, up from 998 on Oct 24.

Almost all the cases, which involve severe respiratory illness, have been in children, many of whom have asthma, the CDC said. They have occurred in 47 states and Washington, DC, which is the same as on Oct 24.

Cases were first reported in mid-August. The CDC expects numbers to decline by late fall.

Of the more than 2,000 specimens the CDC has assayed, about half have tested positive for EV-D68, and about a third have tested positive for a different enterovirus or a rhinovirus.
CDC EV-D68 outbreak page
CDC EV-D68 activity by state

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