How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 3 (Nov 25, 2012+)
Is Bird Flu (H5N1) Still a Global Public Health Threat?
This thread is a continuation of the previous threads concerning Influenza A (H5N1) and its potential to impact world populations. Influenza A (H5N1), also known as bird flu, is an avian influenza flu virus that first infected humans in 1997 in Hong Kong. Since then, more than 600 people have been infected by H5N1 in the Eastern Hemisphere. Of these individuals more than 350 have died.
This thread provides an opportunity for FluTrackers participants to discuss articles, make observations, and speculate about the current status of influenza A (H5N1) and the potential for H5N1 to become a pandemic virus.
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Does WHO think that bird flu is still a serious health threat?
Although WHO stated recently that the public health risk for H5N1 remains unchanged (link), WHO has now modified its policy on reporting human cases of H5N1. Going into the future, WHO will only be reporting H5N1 cases on a monthly basis as noted below.
Quote:
Announcement: WHO to change the way it reports H5N1 cases
Henceforward, WHO will publish information on human cases with H5N1 avian influenza infection on a monthly basis on the Influenza webpage:
Cases of human infection with H5N1 will only be reported on Disease Outbreak News for events that are unusual or associated with potential increased risks.
Member States will be continued to require to report information on every sporadic case of H5N1 human infection or novel influenza virus infection to WHO as per Article 6 of the International Health Regulations (2005).
“Cases of human infection with H5N1 will only be reported on Disease Outbreak News for events that are unusual or associated with potential increased risks.”
The motivation for this change in reporting policies is unclear. With only 600+ human H5N1 infection over the past 15 years I would think each new human H5N1 case can be considered “unusual”. I am not sure how WHO will be determining which new cases constitute sufficient increased risk to prompt immediate reporting. The decline in case reporting by WHO member nations is no reason to delay reporting.
Each human H5N1 case, and every human H5N1 case, has the potential for being the index case of a bird flu pandemic.
WHO should be reporting any human H5N1 cases in Disease Outbreak News to world within 24 hours, the same time period that WHO gives member nations to report their confirmed cases.
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Although it may seem counter intuitive, I suspect WHO has made this change so that in some way it can encourage additional reporting and reduce the economic penalty to countries doing the reporting.
If reports are reterospective and summarised monthly, by the time cases are announced for any country, they will already have 'cleaned up' and responded to the outbreak.
Although H5N1 is a reportable disease, the economic consequences of reporting are high in terms of culling of poultry and ensuing health checks for the population; additionally, some countries place an immediate ban on poultry imports, including food imports. That must really hurt economies, and the security of the food supply chain.
Sometimes outbreaks are highly localised but widespread stamping out occurs - perhaps in some way this new regimen would allow affected countries to make a more proportional response with a lower financial implication for its populations? I suspect the answer is somewhere here, and not that H5N1 is in any way less of a threat than it has been. Its just the economics in affected countries, and I suspect Western financial support is being reduced due to the harsh economic climate.
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
I would like to point out that Egypt has reported only 10 human H5N1 cases to the World Health Organization so far this year. In 2011 Egypt reported 39 cases.
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Where are all of the human cases of bird flu in 2012?
Since January 1, 2012, only 30 human H5N1 cases have been reported worldwide by the World Health Organization (WHO) (link). WHO reported the most recent case on August 10, 2012, a man from Sleman Regency in Indonesia who died on July 30, 2012 (link). It has been almost four months since the last H5N1 case has been officially reported.
WHO uses elapse time between onset dates of illness in sequential cases in order to assess human-to-human transmission of infectious diseases within local clusters of cases. But long time periods between onset dates may have epidemiological or political significance as well.
Since WHO began reporting human cases of H5N1 in 2003 there have only been three elapse periods of more than 100 days between the onset dates of sequential cases. In 2004, there was a 131-day period between two cases, both originating in Vietnam (March 10, 2004 – July 19, 2004; Table 1 in http://whqlibdoc.who.int/hq/2005/WHO_CDS_2005.29.pdf ). And in 2008, there was a 110-day period between two confirmed cases, both originating in Indonesia (July 20, 2008 link - November 7, 2008 link).
The third instance of an elapse period of more than 100 days between onset dates is occurring right now. The onset date for the last reported case this year, the man from Sleman Regency, was July 24. If the suspected case from Vietnam identified in media reports today (FluTrackers link) is confirmed, it would be 125 days between the onset of this case and the man from Indonesia. If this case is not confirmed and if WHO does not retrospectively report an onset date before December 3, there will be a new record of at least 132 days between onsets dates for sequential human bird flu cases. This would be an unprecedented length of time with no reported H5N1 cases in the nine years since WHO began tracking and reporting H5N1 infections in 2003.
Because almost all past human cases of H5N1 have been associated with sick or dead poultry, the overall declining frequency of human H5N1 cases in 2012 is perplexing and open for speculation. Especially because, as reported in various threads here at FluTrackers, poultry infections of H5N1 have not declined in 2012.
Are the limited number of human cases this year just statistical variation or is it a pattern of non-identification and non-reporting by WHO member nations?
In Temryuk District today announced quarantine. Around the estuary, on the banks of which found thousands of dead birds set dezbarery.
...
"A circle of individuals who require vaccination. This is, basically, people Veselovka.
Quote:
''Who identify influenza virus, will be hospitalized, and all the rest - vaccinated. instructed hunters who collected dead birds, immediately start taking antiviral drugs, so as not to get sick, "- said Alina Sevost'yanova, head of the territorial department of Rospotrebnadzor for Temryuk district.
Now Veselovka village quarantined at home bypass doctors. All: adults and children - to take a blood test.
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Latest Human Bird Flu Case
On Friday, December 14, the Ministry of Health in Indonesia formally reported the death of a four year child from H5N1 (link). The child had symptoms starting on November 30 and died on December 6.
The last reported human case of H5N1 was another individual from Indonesia who had symptom onset on July 24. It was 129 calendar days between the onset of symptoms for the case in July and the young boy who died on December 6. It was not quite a record, but almost, see post #5 above.
Perhaps WHO will report this case at the end of December or the beginning of January. As noted in post #2 above, The World Health Organization (WHO) has stated that it will no longer immediately report routine human H5N1 cases but will include then in monthly summaries.
For family and friends, there is nothing about the death of this child that is routine.
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
How serious is WHO about reporting H5N1 cases?
In the December 17th WHOInfluenza at the human-animal interface pdf report, two new human H5N1 cases are announced. As you can see from the captured image below, the 2 year old girl from Damietta Governorate was hospitalized before she even exhibited symptoms. Does anyone proofread these reports?
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Quote:
Originally Posted by Laidback Al
How serious is WHO about reporting H5N1 cases?
In the December 17th WHOInfluenza at the human-animal interface pdf report, two new human H5N1 cases are announced. As you can see from the captured image below, the 2 year old girl from Damietta Governorate was hospitalized before she even exhibited symptoms. Does anyone proofread these reports?
Either WHO proofreads its reports after the fact or they read posts here at FluTrackers.
Today, December 20, WHO published an update to this report. The update indicates that onset for the 2-year-old girl was on December 3 and she was hospitalized on December 4th, with a neuraminidase inhibitor administered on the same day. She apparently is still being treated.
Re: Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
China bird flu drills – thoughtful preparation or cover up?
Although the most populous country in the world, China has only reported 43 humans cases of H5N1 since 2003. There is speculation that China may be deliberately withholding information about human H5N1 cases in light of the history of reporting on the SARS situation in 2002-2003. Also, the crackdown on internet access and media reporting in China suggests that Chinese officials are trying to completely control media reports on H5N1. As a side note, recent computer attacks on the FluTrackers’ servers have all originated in China.
Cynics might suggest that perhaps China has experienced one or more local outbreaks of human H5N1 clusters in 2012 that have been covered up by media reports as “bird flu drills”. If so, each of these outbreaks have been contained.
During 2012, China conducted at least 11 bird flu drills in eight separate provinces. See list and FT links below. Each of the eight provinces is listed below with the number of officially reported human H5N1 cases reports in parentheses.
If theses drills are not cover-ups, then China is the only in country in the world that is taking the threat of bird flu outbreaks seriously and preparing for a possible H5N1 pandemic.
- - - - - -
China provinces with recent bird flu drills and (number of previously reported human H5N1 cases from the province)
Guangxi (3)
Guangdong (5)
Shandong (1)
Sichuan (3)
Chongqing (0)
Shaannxi (0)
Hunan (7)
Zhejiang (1)
FluTrackers’ List Bird Flu Drills in China in 2012
Re: Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Why doesn’t China report any H5N1 bird flu outbreaks?
The map below depicts H5N1 outbreaks and surveillance results from northern Viet Nam.
Despite protestation from China that poultry from Guangxi province are not infected with H5N1 (FT link), the testing of poultry smuggled from China into two northern provinces of Viet Nam showed that perhaps as many as 50% of the birds were infected with H5N1 (FT Link). Two other northern provinces in Viet Nam adjacent to China, Dien Bien and Ha Giang, have recently reported H5N1 outbreaks in poultry as well (FT Link).
China needs to be more open about its poultry and human outbreaks of H5N1.
Re: How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 3 (Nov 25, 2012+)
Yi Guan Interview -
In a recent exclusive interview with Nanfang Daily, Professor Yi Guan discusses SARS, NCoV, and commented on H5N1 (bird flu). Professor Guan is the Director of the State Key Laboratory of Emerging Infectious Diseases at the University of Hong Kong and a long-time influenza researcher. He was instrumental in early research on SARS and H5N1.
Translated excerpt (edited)
Nanfang Daily: You witnessed the first case of human infection with the H5N1 virus in 1997. What is the latest progress in research on the bird flu?
Guan Yi: After more than a decade, the avian flu becomes seems even more likely to infect humans. Some people think human-to-human transmission of bird flu is not possible, this is a very dangerous idea. If [widespread] human-to-human transmission occurs, it would 1000 time more deadly than SARS, because avian flu has a high fatality rate. This is an important national issue. I once wrote a report to the Prime Minister to recognize the importance of the control of avian influenza.
Nanfang Daily: avian flu, why you so obsessed?
Guan Yi: I have researched avian flu since 1996, during that period, I witnessed the 1997, 2001, 2002 Hong Kong outbreak and participated in the investigation and control of avian flu. In 2001, the H5N1 highly pathogenic avian influenza outbreak started on February 16 in the live bird market. From March to April, several sporadic cases were detected. On May 15, there was another outbreak of avian flu. At that time, we immediately decided to cull all the birds in the market. That year there were no human bird flu cases. Post hoc analysis showed that the outbreaks were caused by five H5N1 avian influenza virus variants.
Variant of the H5N1 avian influenza virus quickly developed and in 2006 we discovered the different avian flu variants in different regions. Between the decade from 1996 to 2006, the H5N1 avian flu virus has been produced at least 45 variants. Based on their gene sequencing, we can know the direction of propagation of these viruses.
H5N1 avian influenza in China has not been completely controlled. Highly pathogenic avian influenza outbreaks still occur around the world indicating that there is still room for improvement in our work. Our laboratory and team lives in Hong Kong, it is very difficult to monitor the country's bird flu situation. I hope that our Mainland virology counterparts are able to further establish a perfect national network of monitoring system to step up monitoring of the epidemic.
Re: How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 3 (Nov 25, 2012+)
Avian Influenza A( H5N1) has not gone away
Researchers and specialists from around the world are struggling to understand the recent outbreak of avian influenza A(H7N9) and whether or not it might become a pandemic virus. Since mid-February almost 120 human cases of A(H7N9) have been identified in Eastern China and Taiwan (FT link). The case-fatality ratio for this confirmed group is now at .20.
Meanwhile, avian influenza A(H5N1) cases continue to be reported with 18 confirmed cases to date in 2013. These 18 cases are not concentrated in one country but are widely scattered, reported from five countries in the eastern hemisphere (FT Link). Consider that since January 1, 2013, 14 of the 18 cases of A(H5N1) have died, a CFR of .77. Also, consider that since 2003 the overall CFR for reported A(H5N1) cases is .59 which exceeds the CFR for reported A(H7N9) cases by a factor of 3.
While we are watching the evolution of A(H7N9) virus we should not forget that A(H5N1) continues to represent a pandemic threat.
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How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 3 (Nov 25, 2012+)
Re: Discussion - Is Bird Flu (H5N1) Still a Global Public Health Threat? (Nov 25, 2012+)
Biological
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