Vietnam’s Department of Preventive Medicine under the Ministry of Health announced on Monday that the country’s first H5N1 bird flu death of 2014 was reported this week in southern Binh Phuc province. The victim, a man aged 52, was hospitalized Jan. 11 presenting symptoms of fever, cough, and shortness of breath.
The official Chinese news agency Xinhua reports that according to the DPM announcement, the victim’s lung was damaged quickly, and he died Jan. 18, breaking an interregnum of nine months without any human H5N1 bird flu cases in the Southeast Asian country. Laboratory testing later confirmed that the man had been positive for avian influenza.
The DPM reiterated the boilerplate recommendation from health officials that people not eat sick, dead or unknown origin poultry, and that local authorities should be informed immediately when sick or dead poultry are detected.
First North American Death From H5N1 Avian Flu Virus
Interestingly, North America had recorded a death from H5N1 this year before Vietnam did. Earlier this month, we reported that North America’s first ever human avian influenza fatality was confirmed by Canadian federal health officials. The victim, a 29 year old woman, died from the virus in Alberta on Jan. 3 after falling ill while enroute aboard Air Canada flight 030 from Beijing to Vancouver returning from a trip to China on December 27, 2013. This person was the first person to die from that flu strain in North America.
Canadian authorities are assuring the public that person-to-person transmission of avian flu is “extremely rare,” and that the woman’s family members have not presented with any signs of the illness. Fellow passengers on flights with the H5N1 victim were contacted and “reassured” of the low infection risk.
Most patients infected with H5N1 have either been in close contact with sick or dead infected poultry, had prolonged exposure to H5N1 environments such as live poultry markets while traveling abroad, or in rare instances contact with an infected H5N1 patient. Some 650 lab-confirmed human cases of H5N1 flu have been reported in 15 countries since 2003, 384 of which resulted in death, making the H5N1 mortality rate for infected humans about 60 percent.
Officials affirm that in North America, H5N1 risk to the general public is very low and this avian flu is in no way related to seasonal flu, which this year is predominantly H1N1 — a variant of swine flu that caused a global pandemic in 2008-’09 but has since been added to the list of seasonal flu virus strains. Fortunately, H1N1 is one of the three virus strains specifically targeted by this year’s trivalent flu vaccine for the Northern Hemisphere. the World Health Organization says it’s confident that the H5N1 bird flu virus will not spread in North America.
H7N9 And H5N1 Avian Flus On The Rise Again In Southern And Eastern China
On Sunday, the UN Food and Agriculture Organization (FAO) reported that human infections with influenza A (H7N9) — another avian flu virus strain, are on the rise again in China, warning that upcoming China’s Lunar New Year falls on January 31, and that celebrations later this month that will provide opportunity for enhancing further spread and human exposure. The 40 days of the Chinese New Year Spring Festival are the most important Chinese occasion for family reunions, and the biggest annual human migration.
Millions of people and poultry are expected to be on the move during the holiday period according to a National Development and Reform Commission press release, and many households slaughtering poultry at home to celebrate the New Year. Xinhua Insight notes that the Chinese have a long tradition of eating fresh ingredients especially at important feasts and family reunions, especially those in eastern regions who like to buy live chicken and duck and slaughter them at home for freshness and a festival atmosphere. Despite a government ban, live poultry markets are reemerging in some regions. The FAO urges neighboring countries to remain vigilant lookout for cases of influenza A(H7N9) and other avian influenza viruses, such as the highly pathogenic H5N1 that killed the Alberta woman. Chinese health officials have raised concern about holiday travelers getting sick in urban areas, which appear to be the epicenter for the outbreak, then bringing the virus back to their rural home regions.
The University of Minnesota’s Center For Infectious Disease Research And Policy reported Monday that the number of new H7N9 infections in China’s current outbreak continues to climb a steep trend curve, with 23 more cases reported over the previous four days, including four deaths — one of them of a Shanghai hospital health worker. The report notes that the daily number of new H7N9 cases now equals the pace of disease activity seen during the peak of last spring’s H7N9 outbreak.
The World Health Organization (WHO) has reported that The number of human H7N9 infections has spiked up since late December in East and Southeast China. The increase in cases was expected, since flu viruses are usually more active in winter and spring, and high density transportation in buses, trains and aircraft creates “favorable circumstances” for the epidemic to spread, according to Li Lanjuan of the Chinese Academy of Engineering cited by Xinhua Insight . Li is China’s leading researcher on bird flu and a member of the H7N9 prevention and control group. The WHO said that 13 of the 23 patients covered in its two reports had been exposed to poultry before they got sick. One had been exposed to a live poultry market, later Tweeting that China has notified it of five more lab-confirmed H7N9 cases. The tranche of new H7N9 reports over four days brought the outbreak total to 217 cases, 57 of them fatal as of January 20.
So far, no other country has reported influenza A (H7N9) in humans, animals, or in the marketplace so far this year, and according to the WHO, no sustained human-to-human transmission has occurred thus far. Genetic analysis by FAO reference centers has determined that the virus has not changed significantly since its emergence last year.
“Chinese authorities are enforcing important measures to reduce the risk of human exposure to the A(H7N9) virus,” comments FAO Chief Veterinary Officer Juan Lubroth DVM, PhD, in a FAO release. “This includes temporary closures of live bird markets, regular market rest days, improved hygiene in markets, heightened and ongoing surveillance in poultry and live bird market environment, and control of poultry movements.”
“Risk To Humans Remains”
“But countries need to stay alert, as the virus continues to circulate in poultry without showing any visible clinical signs. The risk to humans remains, especially over the next few months and particularly during the Chinese New Year’s holiday period,” Dr. Lubroth says. The FAO is assisting a number of member countries, particularly those at high risk, in preventing and preparing for possible A(H7N9) introductions into their poultry populations, conducting risk assessment, contingency planning and expansion of diagnostic capabilities, and risk based surveillance.
In South and Southeast Asia, the FAO, with strong support from the United States Agency for International Development (USAID), has assisted countries with their implementation of animal and environmental surveillance at live bird markets and on farms since June of last year. FAO supported projects are also underway to assist some countries in Africa to prevent and be prepared for facing threats from avian influenza viruses, including A(H7N9).
Focusing on good biosecurity standards on farms and markets, regular market cleaning and disinfection, and targeted surveillance in areas that have direct or indirect live poultry trade with infected areas, are considered essential. If infection in animals is shown or suspected to be confined to a specific area, culling should be considered as long as it performed in a humane way with appropriate compensation paid to producers and marketers.
Margaret Chan, MD, the World Health Organization (WHO) director-general, weighed in on the outbreak Sunday in Geneva during her address to the group’s executive board, affirming:
” Vigilance is our watchword as we continue to monitor sporadic cases of MERS coronavirus, and H7N9 and other avian influenza viruses, including North America’s first case of H5N1 reported earlier this month.
“Nothing can be predicted with certainty, but on present evidence, none of these viruses shows a potential to spread widely or cause an explosive outbreak. Nonetheless, this situation reinforces the importance of building the core capacities of the International Health Regulations to detect cases, report, and respond.”
Also on Sunday, Hong Kong’s Centre for Health Protection (CHP) of the Department of Health (DH) reported that it had received notification from China’s National Health and Family Planning Commission of nine additional human cases of avian influenza A(H7N9) in Zhejiang (six cases), Shanghai (two cases) and Fujian (one case). The cases in Zhejiang involve a woman aged 71 and five men aged 53, 54, 55, 61 and 63. They are all currently hospitalized for treatment. The Shanghai cases in involve two men aged 31 and 77. Both patients passed away on January 18. The Fujian case in involves a 55-year-old man who was still hospitalized for treatment, with a total of 204 human cases of avian influenza A(H7N9) having been confirmed in the Mainland, including Zhejiang (77 cases), Shanghai (40 cases), Jiangsu (30 cases), Guangdong (23 cases), Fujian (12 cases), Jiangxi (six cases), Anhui (four cases), Henan (four cases), Beijing (two cases), two cases in Guangzhou (a 5-year-old girl and an 83-year-old woman Hunan (two cases), Shandong (two cases),Shenzhen involves (one case – a 62-year-old man), Hebei (one case) and Guizhou (one case – a migrant worker who returned from Zhejiang on Jan. 4), as of 9 PM January 20. Zhejiang was also the site of China’s first confirmed human-to-human transmission last November, when a man was infected while caring for his father-in-law.
Xinhua Insight reports that results of research by a Chinese team, published in the Lancet, have established that a variation of an amino acid on the H7 gene has made the H7N9 strain more infectious to mammals. “On the PB2 gene, we have found another variation in a key amino acid. One more variation of a specified amino acid, and human-to-human transmission will become much more likely,” comments Dr. Liang Weifeng of the medical college at Zhejiang University., indicating his extremely high concern over the possibility. The research team recently identified a new partial variation in the virus, demonstrating its capacity to adapt to its environment. “It has increased the risk of human-to-human transmission and brought more difficulty in treatment,” Liang added.
The Hong Kong government CHP has announced that all boundary control points have implemented disease prevention and control measures, with thermal imaging systems in place for body temperature checks of inbound travelers, and that random temperature checks by handheld devices will also be arranged. “Suspected cases will be immediately referred to public hospitals for follow-up investigation,” according to a CHP spokesman.
Regarding health education for travelers, distribution of pamphlets, display of posters in departure and arrival halls, in-flight public announcements, environmental health inspections and provision of regular updates to the travel industry via meetings and correspondence are all proceeding.
“Travelers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, should immediately wear masks, seek medical attention and reveal their travel history to doctors. Health-care professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas and provinces,” the spokesman advised.
The Secretary for Food and Health, Dr Ko Wing-man announced last Friday that starting from January 24, Hong Kong and the Mainland will conduct serological test for H7 avian influenza (AI) on live poultry at Mainland registered farms and the Man Kam To Animal Inspection Station. Serological test will also be introduced to local poultry farms in Hong Kong on the same day. In Hong Kong, starting from April 2013, the CFS has conducted H7 genetic tests on imported live poultry at the boundary control point. More than 14 000 samples have been tested so far and all were negative for H5 and H7 viruses. The Agriculture, Fisheries and Conservation Department, the FEHD and the CFS have also strengthened the preventive and control measures against H7N9 at various levels of the local live poultry supply chain.
“The Government will continue to closely monitor the development of the H7N9 outbreak and update the risk assessment. However, preventive measures can only be effective with the support of the public. I appeal to the public again to join us in our preventive efforts and maintain good personal and environmental hygiene, including washing hands frequently, wearing masks when feeling unwell, avoiding contact with live poultry or visiting live poultry markets in the affected districts, revealing their travel history to doctors and not bringing poultry to Hong Kong illegally. These are important and effective measures for preventing diseases,” Dr Ko added.
UN Food and Agriculture Organization (FAO)
University of Minnesota Center For Infectious Disease Control And Policy (CIDRAP)
World Health Organization (WHO)
Centre for Health Protection (CHP) of the Department of Health (DH) (Hong Kong)
National Health and Family Planning Commission (China)
Xinhua News Agency