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.....Since their expsore may have been as early as May 7, when one of the 15 infected birds died, the owners may have cleared the H7N2 by the time they were tested, which would have been after May 17, when poultry samples were collected for testing.
So they need to test for antibodies after May 28th?
.
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Dr Lyons said that the possibility of person-to-person contact could not be ruled out
'Dozens in contact with bird flu'
9.18, Sun May 27 2007
Up to 36 people may have been in contact with bird flu as test results from a farm in north Wales are awaited, health officials have said.
Eleven of the 36 people, all of whom are in Wales, have symptoms of flu or conjunctivitis in relation to the H7N2 strain of the virus. Results from tests on a farm in Corwen, on the Llyn Peninsula, are yet to be released.
The National Public Health Service for Wales has stressed that no one is seriously ill and the lead consultant in communicable disease control with the NPHS, Dr Marion Lyons, said: "We believe the risk to the health of the general public is low."
The case was confirmed last week after 15 Rhode Island Red chickens bought by the farm's owners at Chelford Market, Cheshire, died. A further 30 birds have now been slaughtered.
Dr Lyons said that the possibility of person-to-person contact could not be ruled out.
She said: "Person-to-person spread would be very unusual but limited spread of this type has been seen elsewhere in the past in some cases of bird flu. There is no laboratory confirmation."
The NPHS defined possible contacts of bird flu as those who had been in contact with affected premises or infected poultry. It also includes people who have had close contact with another person with confirmed or suspected bird flu.
Dr Lyons added: "Of the people with conjunctivitis or a flu-like illness, some did not have close contact with infected poultry."
Hopefully, this situation will provide a current high-profile illustration of the highly communicable characteristics of AI and people will take the H5N1 prep advice more seriously.
It would be interesting to see the outcome if one of these H7N2 infected people were exposed to H5N1 within less than 90 days. They might be protected like the ducks in ?HK were protected from HP H5N1 by a recent infection of H9N2.
.
"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
By Ray Ryan, Agribusiness Correspondent
THE Department of Agriculture has taken measures to prevent bird flu from reaching Ireland.
The move comes as vets probing an outbreak of a mild strain of the virus in Wales ordered tests at a second location.
Bird flu was confirmed among chickens at a farm in Conwy, north Wales, last Thursday but it was the low pathogenic H7N2 strain ? not the H5N1 strain which is potentially deadly to humans. Vets have now ordered samples be taken from birds at a farm on the Llyn Peninsula because of a link with a market in Chelford, England, where the chickens at the first farm were bought. Authorities in Wales said there was no significant risk to public health. They have traced 26 people who may have been in contact with the disease. Eleven of these people have shown flu-like symptoms, but none has been seriously ill.
Officials in Dublin are monitoring the situation and keeping in contact with colleagues in Cardiff and Belfast. Agriculture Minister Mary Coughlan announced an immediate ban on the import of birds from Britain, with the exception of racing pigeons and other captive poultry participating in bird gatherings and shows.
A similar measure is being introduced in the North and reflects the all-island approach that has been consistently adopted in response to any increased threat associated with avian flu.
Ms Coughlan said the ban does not apply to birds from the North. Bird owners on either side of the Border are free to have their birds participate in shows and gatherings anywhere on the island.
The decision to introduce the ban follows a meeting of the management committee of her department?s National Disease Control Centre.
Ms Coughlan said her department has a wild bird surveillance programme in place, which is targeting priority areas regarded as being at the greatest risk of the introduction of avian flu, taking account of a number of specified criteria.
She urged flock owners to continue to take appropriate biosecurity measures to protect their flocks.
Anybody who may have purchased poultry at Chelford Market in Cheshire on May 7 is asked to call the Department of Agriculture?s dedicated helpline on 1890 252283.
Children at a primary school are being offered anti-bird flu treatment as a pupil is thought to have the virus.
The year five pupil at Ysgol Henllan, Denbighshire, is linked to a smallholding near Corwen, Conwy, where a mild form of the virus was found.
Officials said nine-11-year-olds in years five and six were being offered tamiflu to protect them from infection.
Four people have tested positive for bird flu and 11 have shown flu-like symptoms, but no-one is seriously ill.
The child who is believed to have the virus is said to be responding to treatment at home.
This is an unusual step for us to take because the risk of the infection being passed from the child to other pupils is so small.
Twelve children and two teachers from the school have been identified as having been in prolonged close contact with the pupil, on days when there was a "small risk" of the child being infectious.
Only these children and staff have been offered tamiflu - an antiviral medication which reduces the severity of any impact of the infection.
The parents of each child are being contacted by staff at the National Public Health Service for Wales (NPHS).
Dr Brendan Mason from the NPHS, said: "This is an unusual step for us to take because the risk of the infection being passed from the child to other pupils is so small.
"However, this particular virus usually only affects birds and is relatively unknown in humans. Its clinical characteristics have not been fully defined.
"It is very rare to see this particular flu virus so we are taking every reasonable precaution to eliminate it from the community."
Dr Mason said the NPHS was contacting all parents by letter to invite them to meet officials at 1700 BST on Monday and Tuesday.
"From a public health perspective, the school will be safe to reopen as normal after the half term break. The risk of avian flu to the public is low."
Officials have now traced 36 people in total who may have been in contact with the disease, although only 11 of these have shown flu-like symptoms.
The confirmed case involved a smallholding at Llanfihangel Glyn Myfyr, Conwy.
An outbreak was confirmed at the Conwy smallholding on Thursday
Owners Tony Williams and Barbara Cowling, who have tested negative for the virus, called in a vet after their Rhode Island Red chickens began to die.
They bought the chickens at Chelford Market at Macclesfield, Cheshire, some 70 miles (112 km) away, on 7 May.
A total of 30 chickens from the smallholding have now been slaughtered after 15 birds died.
Officials have stressed that the disease found at the Conwy farm was the H7N2 strain of bird flu, not the more virulent H5N1.
The second possible case emerged on Saturday about 35 miles (56 km) away, at a farm on the outskirts of Efailnewydd, near Pwllheli. It has also been linked to the market.
Officials have said there is not a "significant risk" to public health. A helpline has been set up to offer information about bird flu. The number is 0845 600 3678, and it is open from 0700 - 2000 BST daily.
The Department for Environment, Food and Rural Affairs (Defra) wants to hear from anyone - who has not already been contacted - who purchased from or supplied to Chelford Market, Cheshire, on Monday, 7 May, or any poultry keeper who visited the market on that day whose birds have subsequently become ill.
They are asked to contact their local animal health office or the Defra helpline 08459 335577. Lines are open between 0900 - 1700 BST seven days a week.
The child who is believed to have the virus is said to be responding to treatment at home.
This is an unusual step for us to take because the risk of the infection being passed from the child to other pupils is so small.
Officials have said there is not a "significant risk" to public health. A helpline has been set up to offer information about bird flu. The number is 0845 600 3678, and it is open from 0700 - 2000 BST daily.
The Department for Environment, Food and Rural Affairs (Defra) wants to hear from anyone - who has not already been contacted - who purchased from or supplied to Chelford Market, Cheshire, on Monday, 7 May, or any poultry keeper who visited the market on that day whose birds have subsequently become ill.
They are asked to contact their local animal health office or the Defra helpline 08459 335577. Lines are open between 0900 - 1700 BST seven days a week.
The reporting on the H7N2, like the pronouncement by the health authorities, continues to be irresponsible. Transmission to humans is based on the H receptor binding domain. H7 is efficiently transmitted to humans, as happened for H7N7 in 2003, H7N3 in 2004, H7N3 in 2006, and H7N2 in 2007. Over 1000 people were infected by H7N7 in 2003. Most had mild symptoms, but a vet died.
The low risk of H2H is nonsense, especially if the pupil is the confirmed case without contact with poultry.
The latest BBC bulletin (Sun 27 May 2007) reports that 11 people out
of 26 possible contacts with H7N2 infected chickens have shown
flu-like symptoms, but none has become seriously ill.
<http://news.bbc.co.uk/1/hi/wales/6696035.stm>.
There have been no official updates to the Welsh Assembly Government,
DEFRA or Health Protection Agency Websites in the last 24 hours.
ProMED-mail's archived posting 20070526.1692 states: "From a
subscriber in the UK, we have received the following comment: 'The
infected birds which died were bought at Chelford Market from a
private dealer, and there is no traceable paperwork. I find it quite
incredible that after everything that has happened with regard to
avian notifiable diseases in the past few years, auctioneers allow
private sales out of the back of a van to go on at their premises on
a sale day without any formal identification or inspection.'"
My comment:
At this point, there has been no official statement as to whether the
sale was out of the back of a van or through the official livestock
auctions that occurred at Chelford Market on that day. A sobering
report from the Farmers Guardian of 9 Jun 2006 starts with the line:
"There is seemingly little in the world of agriculture that can't be
bought or sold at Chelford Market in Cheshire." [See "Chelford market
profile" by Nick Yates at
<http://www.farmersguardian.com/story.asp?sectioncode=49&storycode=2360>.].
As this article goes on to say: "It has made a success of diversity,"
no doubt this statement was in praise of the entrepreneurial spirit
of the operation but seems to have acquired a quite different meaning
in the light of recent events.
It is worth stating that it would not be in the interest of
auctioneers to "allow private sales out the back of a van," as they
would not be in receipt of any buyer or seller commission, and this
would be anti-entrepreneurial.
I suspect that it is impossible for them to police all areas, parking
areas and attendees and to prevent private deals being struck.
The auctioneers that run the market have not placed any notice on
their website [<http://www.frmauctions.co.uk/index.html>] which might
encourage anyone attending the market either as a seller or purchaser
to contact the authorities. There are 2 links under the poultry
section. One link leads to a report of the total livestock sales for
Mon 7 May 2007, which included 1400 head of poultry. The other is a
notice that poultry sales will be reconvened after a suspension of
sales following the Bernard Mathewes - Hungarian H5N1 outbreak, dated
16 Feb 2007. [It says: "We have been informed by DEFRA that sales can
recommence with immediate effect. We will therefore be open on Mon 19
Feb 2007, although numbers forward are likely to be minimal due to
lack of time to advertise re-opening. Full poultry sales service will
recommence on Mon 26 Feb 2007." - Mod.AS]
Readers of the website are reminded that there is a General license
on poultry and other bird livestock movements in force under European law.
We should not prejudge any official enquiry or further statements.
However, there seems to have been some unrecorded movement of
livestock that has created a great deal of additional work for DEFRA
and the police and at the same time caused delay in containing the
outbreak. This is very reminiscent of the 2001 FMD outbreak. Since
that time, movement restrictions and documenting animal movements
have become an extremely time consuming and bureaucratic exercise as
an UK farmer will confirm. Other than the price they are paid for
their produce, this is one thing I hear constantly bemoaned by local
farmer friends.
Over the last 30 years or so, many people have moved into the area to
live an alternative lifestyle. Keeping a few chickens and selling
them and their eggs has been a popular source of income in the area
for longer than anyone or any records can tell; the proceeds are not
always declared for taxation purposes (reference: My father, a
retired chartered accountant who practiced for 50 years in the region).
It is unlikely that "grey marketers" with their few chickens will
suffer any great financial consequences from the inability of the
authorities to rapidly shut down the outbreak, an inability that is
due to the grey marketers' lack of records and unwillingness to come
forward with information. It could not have come at a worse time for
the game farmers of the region who will be selling poults to the
commercial shoots of this region and further afield. Over the next
few weeks, both game farmers and the shoots will be wanting to move
hundreds of thousands of pheasant and partridge poults to woods and
game crops in preparation for the beginning of the shooting season in
September. This industry is one of the economic lynch pins of the
winter economy in Wales.
--
Communicated by:
Dr John Morgan MB BS DipGUM
Golden Grove
Trem Dyffryn
Red Bank
Welshpool
Powys SY21 7PT
<davidjohnmorgan@gmail.com>
[We are grateful to Dr Morgan for shedding local light, based upon
firsthand observations, on the Welsh feathered situation behind
curtains and official news.
ProMED-mail's Rapporteur Mary Marshall adds the following
complementary information: "Traded birds aren't only pet or hobby
birds. They can be small-scale commercial to be traded on or kept for
poultry, eggs or poultry products to be sold locally at farmers
markets, or they can be part of a much wider trade. I am told that Chelmsford Market is huge and takes place every week and that it
draws people from at least 50 miles away."
Readers might be reminded of a rather similar situation which
unfolded during the HPAI H7N7 outbreak in the Netherlands in 2003,
when "Hobby birds" and commercial as well as non-commercial
small-holdings became a major factor, sometimes obstacle, in the
authorities' efforts to control the epizootic. - Mod.AS]
Mon May 28, 2007 6:18PM BST
By Kate Kelland
LONDON (Reuters) - Pupils and staff at a school in Wales are being offered anti-flu drugs after being in contact with a child suspected of contracting bird flu in an outbreak of a mild strain of the virus, health authorities said on Monday.
Teachers and children at the school, which is close to a farm in Corwen, North Wales, where the H7N2 strain of bird flu was discovered last week, were being treated with antiviral medication as a precaution, the National Public Health Service (NPHS) said in a statement.
A total of 12 people have been identified as suffering from the flu, reporting "symptoms of a flu like illness or conjunctivitis" it said, but stressed no one was seriously ill.
It identified 142 people who may have had contact with the avian flu and said it could not rule out person-to-person contact.
"Person-to-person spread would be very unusual but limited spread of this type has been seen elsewhere in the past in some cases of bird flu," said Dr Marion Lyons of the NPHS.
"As a precautionary measure the NPHS is continuing to offer people who have had contact with individuals with this illness antiviral medication to minimize the risk of spread. "
Authorities confirmed an outbreak of bird flu last Thursday among chickens at a farm in North Wales.
NOT H5N1
But it was the low pathogenic H7N2 strain of bird flu, not the H5N1 strain, which is potentially deadly to humans and has caused scares elsewhere in the past.
Lyons said that investigations into the H7N2 strain had shown that when it spreads from person to person, the illness become milder.
But she added: "Experience of this particular bird flu virus in humans is limited so we are actively managing the public health response."
Britain has been on the watch for bird disease after Europe's biggest turkey producer Bernard Matthews was forced to destroy 160,000 turkeys because of an outbreak of the H5N1 strain of bird flu in England earlier this year.
The World Health Organization says 186 people have died of bird flu since the H5N1 virus resurfaced in Southeast Asia in 2003. The virus has since spread throughout much of Asia, parts of Europe, the Middle East and Africa.
The presence of an H7 virus in poultry is treated seriously by animal health officials because scientists believe that, when allowed to circulate in poultry populations, a low pathogenic virus can mutate into the highly pathogenic form.
I noticed this conjunctivitis thing. It was also in the Dutch H7N7 cases.
Seems to be specific to H7 infections.
So, does H7 usually enter through the eyes ?
And do other flus also show conjunctivitis , and when, is it a
sign that the victim rubbed his/her eyes and that's how the virus entered ?
THE number of people with symptoms of bird flu rose to 13 in Wales yesterday.
The National Public Health Service (NPHS) for Wales last night said these 13 have ? or have had ? flu-like symptoms or conjunctivitis.
They include a healthcare worker, who was working at Ysbyty Glan Clwyd, a patient treated at Ysbyty Gwynedd and a child at Ysgol Henllan, near Denbigh.
Health officials have also identified 220 people who have had contacts with either poultry infected with H7N2 bird flu, the Ty?n Llwyn smallholding at the centre of the outbreak, or people who have experienced symptoms.
But none of the 69 patients who were in contact with the man treated at Ysbyty Gwynedd have shown any symptoms of the illness, officials said.
A total of 79 people who were in contact with the healthcare worker have been given the anti-viral medicine Tamiflu.
Dr Marion Lyons, lead consultant in communicable disease control for the NPHS, said, ?North West Wales NHS Trust staff have contacted all 69 patients and staff who had been in contact with the patients at Ysbyty Gwynedd. No one reported symptoms of conjunctivitis or flu-like illness in the time period when the flu could have been incubating. So, I am pleased to conclude that there has been no spread of the flu in the hospital.?
Local health boards and other primary care services have introduced a system to help identify patients who may be suffering mild flu-like symptoms or conjunctivitis. Officials expect this to lead to a rise in the number or people suspected of contracting the disease. Dr Lyons said, ?We have been looking more closely at these and I expect to identify some new cases of people who could have avian flu.?
It also emerged last night that everyone who has become ill is directly connected either with the infected poultry or the first few cases of illness.
There have been no cases of illness in people with more distant contacts. Tests on 12 of the affected people in Wales have revealed that two have tested positive for the H7 subtype of the virus which was isolated from the affected poultry.
But the definition of a case of avian flu relies as much on clinical symptoms with a history of contact with infected birds or another human case.
Meanwhile, Wales? chief veterinary officer said there was no cause for complacency among poultry keepers, despite tests on a second farm on the Llyn Peninsula coming back negative for the H7N2 virus.
Birds on the farm were tested because of a connection with Chelford Market, in Cheshire, on May 7 ? the Corwen outbreak is believed to have been caused by infected chickens bought there.
Dr Christianne Glossop said, ?We are very pleased with the results but must not be complacent so early in our investigations into the source of this outbreak. Considerable efforts continue in this complicated tracings exercise.
?Anybody in Wales who either bought or sold poultry at Chelford on May 7 or any poultry keeper in Wales who visited the market on this date whose birds have subsequently become ill, to contact their local animal health office.
?All birdkeepers throughout Wales should be vigilant and maintain strict bio-security precautions, monitoring their birds for any signs of infectious disease.?
The T?n Llwyn farm, in Llanfihangel Glyn Myfyr, has been cleansed and disinfected.
By 3pm yesterday, Wednesday, 17 avian flu contacts had been identified who have or have had symptoms of a flu like illness or conjunctivitis.
No one is seriously ill.
It is eight days since a 1km restriction zone was placed around Tn Llwyn farm in Llanfihangel Glyn Myfyr, near Corwen, Denbighshire, after 15 chickens died from H7N2 avian flu.
The National Public Health Service for Wales (NPHS) has identified 256 people who may have had contact with the avian flu:
* 39 in the household setting (up eight on the day before)
* 14 in school (unchanged)
* 203 in the workplace setting (28 up on the day before)
Of the 256 contacts, 79 have come out of the incubation period for avian flu.
The full list of contacts is constantly changing as possible contacts are added to or taken off the database. Contacts are added if contact was possible. They are taken off if detailed questioning shows that there was no contact.
The National Public Health Service (NPHS) is using the following definitions of cases and contacts:
* A case is an individual with influenza-like illness (fever above 38¢ª C, aches and pains, cough/head cold, sore throat or conjunctivitis) who has been in contact with affected premises or to known infected poultry (handling/within one metre) or close
contact with another human case.
* A contact is defined as an individual who has been in contact with affected premises or with known infected poultry (handling/within one meter) or has had close contact with another person with confirmed or presumptive avian influenza).
Investigations
The NPHS has received microbiological test results from 14 people in Wales so far. Two tests have been reported as positive for the H7 flu virus.
Definition of a case of avian flu relies as much on clinical symptoms with a history of contact with infected birds or another human case.
For this reason, the NPHS is contacting every individual who has been in close contact with the people who are cases. People identified as contacts are being offered medication to reduce the severity of any impact from the infection if they are still within the incubation period.
The NPHS is continuing to investigate and identify potential contacts today.
Dr Marion Lyons, Lead Consultant in Communicable Disease Control for the National Public Health Service for Wales, said: "We are actively managing the outbreak. This involves taking every precaution in identifying possible contacts of the infected
poultry or people who have been ill after contact with the infected poultry.
"We have been contacting every close contact so people who are not contacted by us should not worry.
"We are looking for people who have had flu like symptoms or conjunctivitis. It is the symptoms which are important to identify. It is reassuring that so few of the large number of contacts have had symptoms.
"Local health boards and primary care services put in place a system which has helped identify potentially symptomatic patients after the bank holiday weekend. The return of people who were away over the weekend has led to the identification of
additional cases of conjunctivitis or flu-like symptoms. This explains the increase we are reporting for the day.
"However, the new cases have all reported symptoms starting a few days ago. We are not seeing any new spread of the flu in the community.
"We will remain vigilant. Most people fall ill within two or three days of coming into contact with the virus but this period can be as long as seven days. It will therefore be next week before we can be certain that the spread has been stopped.
"Of the cases we have identified so far it is clear that everyone who has had symptoms is directly connected with the infected poultry or the first few cases of illness. We have found no illness in people with more distant contacts."
People who had prolonged close contact with infected poultry and or ill people who had been in contact with the infected poultry have been offered a 10 day course of tamiflu. After completing this course, people cannot get the avian flu virus from the contact we identified.
Dr Lyons said,"All our action has been geared to place a virtual cordon around the virus so that it cannot be spread further. We have identified the potential pattern of spread and it does not appear to spread to distant contacts - people well down a chain of contacts.
"As time moves on, we can start to take people off the list of people we are monitoring. There are 79 people where there is now no risk at all of infection with this avian flu virus. This is very reassuring to them. It is also very reassuring to us because it demonstrates that the already low risk of spread is confirmed."
Control Measures
People with symptoms of conjunctivitis and flu and meet the definition of a case have been given treatment. They have been advised to stay at home until they are better.
All well contacts are being given medication to reduce the severity of any impact from the infection if their last contact with a case was only a week ago.
Public Health Messages
Dr Lyons said: "We believe the risk to the health of the general public is low. Avian flu is primarily a disease of birds. H7N2 is different
to and very mild compared with H5N1.
"Of the people with conjunctivitis or a flu-like illness, some did not have close contact with infected poultry.
"The illness people are experiencing is, for the most part, not serious. No one is seriously ill.
"Preliminary investigations indicate that we cannot exclude person to person spread having occurred in this outbreak. Person to person spread would be very unusual but limited spread of this type has been seen elsewhere in the past in some cases of bird flu. There is no laboratory confirmation.
"Investigations also show that, when it spreads from person to person, the illness experienced becomes milder.
"Experience of this particular bird flu virus (H7N2) in humans is limited so we are actively managing the public health response."
Communication
A special helpline available for general information about avian flu in people is open from 7am to 8pm daily. The number is 0845 600 3678.
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Richard Horton, Editor-in-Chief The Lancet
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