Flu Scan for Apr 14, 2014

News brief

China and Hong Kong report new H7N9 cases

Hong Kong and China each reported a new H7N9 influenza case over the past 2 days, according to official statements, signaling ongoing low-level activity in the second wave of activity.

Hong Kong's Centre for Health Protection (CHP) yesterday reported an H7N9 infection in an 85-year-old woman who got sick after a recent visit to the mainland's Guangdong province, where she had been exposed to poultry. Her illness marks Hong Kong's 10th such infection, and all have had connections to the mainland.

The woman had traveled to the city of Dongguan from Apr 4 to Apr 5 with her husband and younger brother, where they stayed with relatives who rear chickens. The patient had also visited a wet market in the area and helped slaughter chickens at the home on Apr 4. She started having symptoms on Apr 11 and was hospitalized in an isolation unit yesterday where she is listed in critical condition.

Investigation of her contacts found that on Apr 10 she had visited her husband in a different hospital, where he was being treated for another illness. So far her husband is asymptomatic, and health officials are monitoring seven other family members who are considered close contacts.

On the mainland today, Jiangsu province reported an H7N9 infection in a 52-year-old man from Changzhou, according to a health department statement translated and posted by FluTrackers, an infectious disease news message board. He is hospitalized in serious condition.

The two infections boost the overall outbreak total to 421, according to FluTrackers' running list of human cases. So far 285 of the cases have been reported in outbreak's second wave, compared with 136 during the first wave.

In other developments, the World Health Organization (WHO) today provided more details about four H7N9 reports that it received from China on Apr 11. All four are from Guangdong province, where three had been exposed to live poultry markets and one had been exposed to poultry. Patients include two women, ages 71 and 81, and two men, ages 79 and 37.

Illness onsets range from Mar 26 through Apr 7. All four of the patients are hospitalized in critical condition.
Apr 14 FluTrackers thread
Apr 13 CHP statement
FluTrackers human H7N9 case count
Apr 14 WHO statement


Japan culls 112,000 chickens after H5 outbreaks

Japan culled about 112,000 chickens on two farms on the southern island of Kyushu and restricted shipments of almost 400,000 chickens after H5 avian flu outbreaks, Bloomberg News reported yesterday. A report filed with the World Organization for Animal Health (OIE) yesterday said at least one of the outbreaks was caused by a highly pathogenic strain.

Officials started culling birds 2 days ago after H5 killed about 1,100 chickens on a farm near the town of Taragi in Kumamoto prefecture, according to Bloomberg.

The other farm, in a nearby town, had 200 poultry killed by the virus, according to the OIE report. The remaining 56,200 birds were then culled. Further testing is under way to determine the specific H5 strain, the report said.

The two farms are owned by the same operator, Bloomberg News reported. The last avian flu outbreak in the country—in 2010 and 2011—resulted in the culling of 1.83 million chickens on 24 farms in nine prefectures, Japan's agriculture ministry said.
Apr 13 Bloomberg News story
Apr 13 OIE report

News Scan for Apr 14, 2014

News brief

Study: Northern states have higher E coli O157 isolation rates

Northern states appear to have higher rates of Escherichia coli O157 than southern states do, and young children appear to be infected most often, according to data from the Centers for Disease Control and Prevention (CDC) published today in Epidemiology & Infection.

The team analyzed data from 1996, when public health labs first began reporting on the pathogen, through 2011. The authors found a national isolation rate of 0.84 per 100,000 population, but the rate varied from 0.43 in southern states to 1.52 in northern regions.

They also found that counties with more than three fourths of the population living in rural areas have lower rates. Counties with a 76% or higher rural population had an isolation rate of 0.67, compared with rates from 0.81 to 0.92 for more urban counties. The researchers also noted that isolation rates in kids 1 to 4 years old were highest, at 3.19.

The investigators said they do not know the reason for the higher rate in northern states but said the finding is consistent with other studies.
Apr 14 Epidemiol Infect abstract


Camel farm tests point to MERS viral load, antibody patterns

A study of adult and baby dromedary camels at two farms in Saudi Arabia during the peak of the most recent calving season found that Middle East respiratory syndrome coronavirus (MERS-CoV) was more commonly isolated from nasal swabs than from feces, while blood tests found that preexisting antibodies didn't always protect against infection. A research team from Saudi Arabia, Egypt, and Hong Kong published their findings today in the latest online edition of Emerging Infectious Diseases.

The herds were located 4 to 5 km apart in Al-Hasa governorate, and the peak calving season spanned December 2013 through February 2014. To gauge virologic features of MERS-CoV in the animals, researchers collected samples from animals at the bigger of the two farms—nasal, oral, and rectal swabs, plus blood—at five different times from November through February. Camels in the smaller herd were sampled in February.

Of 70 animals in the larger herd, 10 tested positive for MERS-CoV. Results were negative for the camels at the smaller farm. Tests suggested likely reinfection for two of the adults, and, in calves, that maternal antibodies might not provide complete protection. Researchers were able to isolate viruses from two nasal swabs and one fecal swab.

Full genome sequencing found 99.9% similarity to those of human clade B MERS-CoV.

The authors concluded that viruses were more frequently isolated from the nose than the feces, but that both could be possible sources of transmission to humans or other animals. The team added that although their preliminary findings suggest that preexisting MERS-CoV antibodies might not protect camels against reinfection, the issue needs more investigation.
Apr 14 Emerg Infect Dis study


Berry-linked hepatitis A still sickening Europeans

A hepatitis A outbreak that was first reported in travelers to Italy in 2013 has now grown to 1,315 cases in 11 countries, 7 of which have reported patients infected with the virus who didn't have a history travel in the previous 12 months, according to an update from the European Center for Disease Prevention and Control (ECDC) and the European Food Safety Authority (ESFA).

The outbreak is one of four berry-linked hepatitis A events reported last year, all involving unique outbreak strains. One affected Scandinavian countries, a second was reported in Europeans who had traveled to Egypt, and a third in the United States was linked to pomegranate seeds imported from Turkey. The Italian-linked outbreak involves the IA subtype and has an identical or closely related genetic sequence.

ECDC and EFSA issued their first report on the outbreak in May, when 15 cases had been reported from 3 countries, all in people who had traveled to northern Italy. In July, the groups reported that as many as 200 infections in Italy were likely part of the outbreak, along with 3 in Ireland in those who had no travel history, suggesting exposure to the same contaminated food vehicle.

Since then, France, Germany, Norway, the Netherlands, Sweden, and the United Kingdom have all reported cases with no travel history in the past 12 months. The most recent illness onsets occurred in February and March in patients from Norway.

So far the epidemiologic investigations suggest that frozen berries are the infection source and that the event could represent a single outbreak linked to a common, continuous source in Europe, the groups said. However, they said other sources can't be ruled out, including cross-contamination during food production.
Apr 11 ECDC report


This week's top reads