Monday, October 24, 2016

Delhi Govt. Issues Health Advisory On H5N8


For the past several days the Delhi government has insisted that the avian H5N8 virus, which very recently arrived in India, poses no threat to human health.

Our own CDC's stance is that while the risks are probably low, they are not zero. They cautiously advise:
H5 Viruses in the United States

At this time, no human infections with these viruses have been detected, however similar viruses have infected people in other countries and caused serious illness and death in some cases. Human infections with other avian influenza viruses have occurred after close and prolonged contact with infected birds or the excretions/secretions of infected birds (e.g., droppings, oral fluids). While the health risk posed to the general public by domestic HPAI outbreaks is low, it is possible that human infections with these viruses could occur.

The H5N8 virus - like all flu viruses - is continually evolving, and its behavior in the past is no guarantee of how it will behave in the future. Additionally, many of those  exposed in the past (cullers, poultry workers, etc.) wore protective gear, and were offered prophylactic antivirals.
Today the Delhi government - while still insisting the virus poses little danger - has issued a health and safety advisory to the public on the handling of, and consumption of, poultry and other birds. 

While I've not been able to locate the official statement, the following report from the Indian Express provides a summary, along with some additional information on some of the steps (including disinfecting around ponds and lakes) the government is taking to reduce the risks.

Follow the link to read it in its entirety.

Updated: October 24, 2016 9:28 pm

Follow these measures to be safe in this season to avoid bird flu or avian influenza.

Here are guidelines and advisory, a combination of those issued by the Delhi government and Dr Raman Abhi, AD, Internal Medicine, Fortis Memorial Research Institute.


People can suffer from mild flu-like symptoms to a severe respiratory disease in the form of pneumonia, Acute Respiratory Distress Syndrome (ARDS), MODS (sudden and severe onset of cough, cold, high fever, shortness of breath).

If situation aggravates, this could even lead to multi-organ failure, rhadomyolysis and acute kidney injury.

Please remember that the infection has a high mortality rate.


The treatment course is very similar to that of Swine Flu. One must avoid self-medication, home remedies and immediately consult a doctor.

Nose and mouth swab for rPCR.

Avoid direct contact with bird secretions
  • Clean all feeders, waterers, cages used for birds with detergents. Dispose properly all the slaughtered wastes.
  • Please don’t touch dead birds with naked hands and inform the Control Room (011-23890318) for further action.
  • Wash hands frequently at the time of dealing with raw poultry products. Take due care of personal hygiene. Maintain cleanliness in your surroundings.
  • Always use a mask and gloves at the time of dealing with raw chicken/chicken products.
  •  Eat only completely cooked meat and meat products (100 degrees Celsius).
  • In case there is any pond or stagnant water body in your neighbourhood/area, and it is not being disinfected with lime, etc., then inform the Control Room.
  • Do not consume uncooked chicken/eggs.
  • Do not consume half-cooked chicken/bird or half boiled or half fried eggs.
  • Prevent exposure from sick-looking (sluggish) chicken.
  • While storing meat, even in the fridge, do not keep raw meat near the cooked meat.
As it is said, prevention is better than cure, this simple to-do list would help you to take all the measures to stay healthy and fit.

FAO Notification Of H5N8 In India


Although we've been covering this story for the past three days (see India: H5N8 Detected At 3rd Location),  today we have official confirmation from the FAO that the subtype is - as has been widely reported by the media - H5N8.

Saudi MOH: 1 Primary (Camel Contact) MERS Case In Hufoof


KSA reports their 11th MERS case since October 15th, 4 of which have hailed from Hufoof (aka `Hafuf').  Today's case - like the first of this recent series of cases which began 9 days ago - is attributed to direct contact with a camel.

Despite two years of warnings from the MOH about the risks of contracting MERS from camels (see KSA MOH Reiterates Camel Warnings On MERS), camel-to-human transmission continues reseed the virus into the human population.

Unless and until the virus can be eliminated in this ubiquitous and much beloved animal host, this pattern is unlikely to change.

Frontiers Micro: Novel H7N2 & H5N6 In Sentinel Chickens - Jiangsu Province, China



New, hybrid (reassorted) viruses can sometimes emerge when two different influenza A subtypes (like H5N1 & H6N6) infect the same host (human, swine, avian, or otherwise) at the same time.
Under the right conditions, they can swap one or more gene segments and produce a new, hybrid virus. Luckily, most of these genetic experiments are evolutionary failures; unable to compete with the existing wild viruses, and so they fade away quickly.
Every once in awhile, however, a new one appears that is both biologically fit and capable of spreading between hosts. And in recent years we've seen a growing number of new flu viruses turn up in the wild.

China -  where human, avian, and swine influenza viruses circulate more-or-less year round, population densities are very high, and humans and farm animals are often live in close quarters  -   provides a unusually `target rich environment' for flu hunters.

In 2013, just two weeks before we first learned about China's newly emerging H7N9 virus, in EID Journal: Predicting Hotspots for Influenza Virus Reassortment, we looked at a study that identified 6 key geographic regions where reassortments are likely to emerge.

And high on that list (you guessed it), was Eastern mainland China.
In 2013, in addition to H7N9, China reported a new lineage of H7N7 (see Nature: Genesis Of The H7N9 Virus), and a never-seen-in-humans before H10N8 virus (see HK CHP Notified Of Fatal H10N8 Infection In Jiangxi). 

In 2014 two other new viruses - H5N8 and H5N6 - emerged from China, with the former spreading rapidly to Korea, Europe, Taiwan, and North America and the latter continuing to crop up in China, Vietnam, and Laos.

And these are just the main avian `players', there are others in China - including H9N2, H5N5, H5N9, H6N1 - and a whole host of novel swine viruses as well.

Among this second tier of avian viruses, H9N2 holds a special place, as it has lent some of its internal genes - via reassortment - to a large number of emerging flu viruses over the past couple of decades, including H5N1, H7N9, H5N6, and H10N8 (see PNAS: Evolution Of H9N2 And It’s Effect On The Genesis Of H7N9).

Two years ago, in an EID Journal Dispatch (Novel Influenza A(H7N2) Virus in Chickens, Jilin Province, China, 2014), we saw yet another reassortment of the H7N9 and H9N2 virus produce a novel virus; H7N2.  From the Abstract:
In February 2014, while investigating the source of a human infection with influenza A(H7N9) virus in northern China, we isolated subtypes H7N2 and H9N2 viruses from chickens on the patient’s farm. Sequence analysis revealed that the H7N2 virus is a novel reassortant of H7N9 and H9N2 viruses. Continued surveillance is needed.

Wild bird surveillance, unfortunately, is limited in China, just as it is in much of  the rest of the world. And so we've heard very little about these new H7N7 and H7N2 viruses since those initial reports.

Today, however, we have a new report in Frontiers of Microbiology, where researchers set out sentinel chickens around Taihu Lake in Wuxi City, Jiangsu - more than 1,000 km south and west of the Jilin study (above) - also in 2014.

Distance between two H7N2 Studies in 2014

Taihu Lake hosts  40 species of wild birds and 19 species of
resident birds and is a major stopover for migratory waterfowl. During their 10 month study, they isolated 5 avian viruses among the sentinel chickens; two H7N2, one H5N6, and two H9N2.

First the abstract, then I'll have a bit more on this open access study.
Novel H7N2 and H5N6 Avian Influenza A Viruses in Sentinel Chickens: A Sentinel Chicken Surveillance Study

Teng Zhao1, Yan-Hua Qian2, Shan-Hui Chen2, Guo-Lin Wang1, Meng-Na Wu1, Yong Huang1, Guang-Yuan Ma2, Li-Qun Fang1, Gregory Gray3, Bing Lu2, Yi-Gang Tong1, Mai-Juan Ma1* and Wu-Chun Cao1

In 2014, surveillance of sentinel chicken for avian influenza virus was conducted in aquatic bird habitat near Wuxi City, Jiangsu Province, China. Two H7N2, one H5N6, and two H9N2 viruses were isolated. Sequence analysis revealed that the H7N2 virus is a novel reassortant of H7N9 and H9N2 viruses and H5N6 virus is a reassortant of H5N1 clade 2.3.4 and H6N6 viruses.

Substitutions V186 and L226 (H3 numbering) in the hemagglutinin (HA) gene protein was found in two H7N2 viruses but not in the H5N6 virus. 

Two A138 and A160 mutations were identified in the HA gene protein of all three viruses but a P128 mutation was only in the H5N6 virus. A deletion of three and eleven amino acids in the neuraminidase stalk region was found in two H7N2 and H5N6 viruses, respectively. Moreover, a mutation of N31 in M2 protein was observed in both two H7N2 viruses.

High similarity of these isolated viruses to viruses previously identified among poultry and humans, suggests that peridomestic aquatic birds may play a role in sustaining novel virus transmission.

Therefore, continued surveillance is needed to monitor these avian influenza viruses in wild bird and domestic poultry that may pose a threat to poultry and human health. 

The full text of this open access study is available at the link above, and is well worth reading.  While it deals with H5N6, H9N2, and H7N2, we'll focus on the newest of these subtypes (H7N2) for today's blog.

The detection of multiple reassortant H7N2 viruses - both in 2014 and more than 1,000 km apart - makes this subtype likely more than just a flash in the pan.

A molecular analysis (available in the full text of the study) found the H7N2 virus - like its parental H7N9 virus - is likely to have low pathogenic effects in poultry. A `stealth' factor that - like with H7N9 - makes it difficult to detect.

The did note, however:
A160, V186 and L226 (H3 numbering) was observed suggesting a possible increased affinity for binding human α2,6-linked sialic acid receptors.
Purely avian viruses bind preferentially to α2,3-linked sialic acid receptors.  A switch to α2,6 receptor cells - which line the human upper respiratory tract - is viewed as one of the essential steps needed for a flu virus to adapt to a human host. 

So far, we've not seen any evidence of human H7N2 infection in China, which may indicate the virus has not yet gained the ability to infect humans. 

Another possibility is that it can sometimes infect humans, but doesn't produce serious enough illness to require hospitalization, and therefore hasn't been detected by China's influenza surveillance system. 

Either way, H7N2 adds to the growing constellation of flu viruses circulating - and continually evolving - in China. And given its detection in two widely separated provinces more than two years ago, is probably more prevalent than we know.

Sunday, October 23, 2016

KSA Announces 2 New MERS Cases & 2 Recent Deaths


The Saudi MOH caught up with their MERS reporting after going 48 hours without an update, posting numbers for the 22nd and 23rd of October.

Yesterday's report showed no new cases, but one death - that of the 53 y.o. male from Abha who was listed in critical condition last Thursday. 

Today's report adds 2 new cases.  First, yet another nosocomial case from Hufoof - the 3rd in the past week or so.  This patient is described as a male, age 55, who had already died at the time of this announcement.

The second new case is a primary case from Arar; a 58 y.o. male listed in critical condition.

Posthumous announcements - and cases that are already listed in critical condition when announced - are worthy of notice since they might  indicate delayed detection and/or isolation, thus raising the chances of seeing additional hospital acquired cases.

At this point, however, we don't know the onset of illness date, or date of diagnosis for these cases. 

After going the first two weeks of October without a single case, in the past 8 days Saudi Arabia has now announced 10 cases, with 4 of those listed as secondary cases (2 HCWs & 2 Patients) exposed at two different health care facilities.

India: H5N8 Detected At 3rd Location


According to media reports, avian H5N8 has been detected at a second park in New Delhi, bringing to total number of outbreaks to 3 over the past several days.  The following excerpt comes from the Deccan Herald

Bird flu: Threat of infection to migratory birds
New Delhi, Oct 23, 2016, (PTI)
The Centre had yesterday formed a three-member committee to keep a constant vigil around the park, as well as monitor and contain the H5 Avian Influenza.

A total of 40 birds have died of the Influenza in the national capital since October 14. While 12 deaths were reported at the Delhi zoo, 28 ducks died at the Hauz Haas Deer Park. A death was also reported from the Asola Bhatti Wildlife Sanctuary.

The Department of Animal Husbandry, Dairying and Fisheries at the Centre had on Friday said a new bird flu virus subtype, H5N8, has been confirmed in samples from Gandhi Zoological Park, Gwalior.

The government has also issued an advisory to all wildlife/bird sanctuaries in this regard.
      (Continue  . . . )

Another report - this time from the Business Standard - suggests the bird die continues today at the Hauz Hass Deer Park, which is about 5 miles south and west of the first outbreak reported on Friday at the New Delhi Zoological Park.

Because of bird flu deaths, the Delhi Zoo has also been ordered shut until further notice.

IANS  |  New Delhi 
So far, we've not seen any reports from poultry farms, but the alert has been raised to look for any signs of infection.
Although some migratory birds have already arrived in the region from their northern nesting areas, the bulk of the migration will occur in November and December.
As you'll recall, it was in November of 2014 when H5N8 turned up in Japan, Western Europe, and the Pacific Northwest.  After causing numerous outbreaks through the spring of 2015, the virus failed to return last fall.

While it is impossible to predict where or when H5N8 will turn up next, the detection of the virus in Russia and of H5N2 in Alaska over the summer - and these recent outbreaks reported from India - certainly suggests that HPAI H5 is alive and well, and on the move again this fall in migratory birds.