H5N1 case in North America with recent travel history to China Discussion Thread

sharon sanders · Jan 9, 2014

Our news thread is here.

I decided to start this discussion thread because there is probably a lot to say.

First, I would like to thank our excellent team here. It remains one of the highlights of my life to work among all of you.

Second, Our most sincere condolences to the family and friends of the young adult who lost her life.

It looks to me like the WHO will have a very difficult job coordinating the scenarios since the Beijing Municipal Health department has indicated that there is no H5N1 there. This puts the ball back into the court of Canada. Is it possible the deceased became infected on December 27 or 28 upon her return and then died a week later? What is the probability of this after spending 3 weeks in a country with a history of human H5N1 infections?

The world is not stupid. The team here, in particular, has been following H5N1 for 8 years. Our analysts are experienced.

I hope all those involved will act in the best interests of global public health.

Giuseppe · Jan 9, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

Sharon, you forget that in China there are not a single poultry farm infected with H5N1, or H7N9!

No one is suggesting to reduce wholesale live poultry markets in the wake of the H7N9 outbreak in Guangdong. But it would be one of the last measure to reduce the spread of the virus.

H5N1 is also disappeared from Egypt, Indonesia, Vietnam, Thailand, Nepal, Bangladesh and Cambodia.

H5N1 does not longer infect humans in these endemic regions!

H5N1 has been downgraded by the WHO to one among several animal origin viruses.

H5N1 has eventually landed in N America....

NS1 · Jan 9, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

We may already have the highest quality and quantity of information that will be disclosed.

Laidback Al · Jan 9, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

NS1 said:
We may already have the highest quality and quantity of information that will be disclosed.

While we get more clinical details about this case, we may never get a straight answer from China about where or how this person got infected.

NS1 · Jan 9, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

Laidback Al said:
While we get more clinical details about this case, we may never get a straight answer from China about where or how this person got infected.

Accuracy is your mainstay, Al!

sharon sanders · Jan 10, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

It is late afternoon now on the east coast of the US. It is very late in Geneva. We are not going to see anything from the WHO about this case until Monday at the earliest.

If we do not see any results from the WHO or China by mid-week then we will make our own conclusions based on the facts at that point in time and our 8 years of experience.

As it appears now, this is an exported H5N1 case from China to Canada. Since this patient was reportedly ill upon arrival in Canada on December 27, this is a 2013 case. Furthermore, while she died on January 3rd in North America, this is a case for China's tally.

While there are no reports of any contacts who have become sick, people who had exposure to the deceased should continue to monitor their health. Things to watch for are listed here which are typical of a meningitis type illness:

Common symptoms in infants
Fever
Irritability
Poor eating
Hard to awaken

Common symptoms in adults
High fever
Severe headache
Stiff neck
Sensitivity to bright light
Sleepiness or trouble waking up
Nausea, vomiting
Lack of appetite

Of course, anyone who has a high fever, trouble breathing, or is bleeding should seek immediate medical attention.

If I was in Alberta or British Columbia I would continue my usual routine. This is a wake up call for everyone to practice safer hygiene to avoid all kinds of illnesses, including the flu. Here is the CDC page about flu for ideas on how to prevent the flu. There is no available vaccine for H5N1.

If I was in China I would be very cautious about a lot of things considering the undisclosed H5N1 cases and the emerging H7N9 situation. There is also no available H7N9 vaccine. The animal source of H7N9 has never been defined so it is hard to know how to protect yourself except to avoid "markets", eggs, poultry (including chicken and goose), feathers, wild birds, and other people who might be sick. A large task.

Pathfinder · Jan 13, 2014

Re: China - H5N1 death in Alberta, Canada upon return from China trip - died from meningoencephalitis

Re: China - H5N1 death in Alberta, Canada upon return from China trip - died from meningoencephalitis

WHO is confident bird flu won't spread in Canada

CTVNews.ca Staff
Published Monday, January 13, 2014 7:51AM EST

The World Health Organization says it is confident that the bird flu virus will not spread in Canada after an Alberta nurse who had recently travelled to China died of the virus earlier this month.

Bernhard Schwartlander, a WHO representative in China, said that it?s very rare for the H5N1 virus to be transmitted from one infected person to another.

"That's what makes us confident right now, based on the current evidence, that people do not need to worry in Canada that the virus will spread any further," Schwartlander told CTV News.
...
Schwartlander says while Chinese authorities will attempt to track every possible source of the infection, it will be very difficult considering the woman had likely visited several heavily populated areas during her stay.

"Chinese authorities work very closely with the WHO and the Canadian authorities to see whether we can actually track the likely cause, which is not only important to clarify what happened to this person, but also to see whether we can take action to make sure these cases are not happening in the future," he said.
...
"The Chinese authorities recognize that one, it's an obligation that they have entered into in terms of international health regulations, and second, that it's in their very own interest to protect their own society."
...
Full text:
http://www.ctvnews.ca/health/who-is-confident-bird-flu-won-t-spread-in-canada-1.1636399

sharon sanders · Jan 13, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

I made a copy of the above post from the news thread.

While Dr. Schwartlander has impeccable medical credentials, the message of "don't worry, be happy" is the wrong one.

Of course, people in Canada should be worried about the appearance of H5N1 on their shores in a person who flew through a very busy international airport, visited at least 2 emergency rooms, and traveled on 2 airplanes. In post 6 above I made some suggestions of what people might do if they think they might have been exposed.

What should be said is that H5N1 type influenza can be transmitted from human to human but it appears, as of this date, no one else was infected in this event.

This doctor sitting in China can not possibly relate to the shocking realization by some Canadians that they shared an airplane or emergency room with a person who had an active H5N1 infection. Everyone knows that the fatality rate for this disease is very high. Flip a coin. It is 50/50 at the best.

So save the platitudes.

I think Alberta Health Services has done a great job of informing the public about the situation. The contacts of the deceased are being interviewed and antivirals have been dispensed. In addition, a detailed case report was released on a Sunday - which is really unusual.

What do we have from China? A denial of H5N1 infections in Beijing.

All of us should be concerned. Not just Canadians. A person boarding an airplane with an active H5N1 infection is a world threat.

China needs to get real. I do not give the government of China credit for fabulous H7N9 reporting as many others do. I do not think the top government officials have changed their attitudes and behaviors "dramatically" in the years since the SARS event.

I may not be a medical doctor, but I am a digital disease detection expert, specializing in China with 8 years experience, and I categorically state that China is not forthcoming about their disease status.

Period.

Giuseppe · Jan 13, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

But, Sharon, you have to admit that H5N1 is a Panzootic virus: from Egypt to Indonesia, from Vietnam to Nepal, there are continuously poultry outbreaks, massive animal die-off.

Furthermore, people made often travel to exotic location, such as Bali, taking with them endangered birds (Austria, H5N1 smuggled birds).

Is is strange to detect a human case? Yes & not.

Yes, because Beijing is a very large megalopolis and it is really difficult to hide a big outbreak.

Not, because after this enormous amount of info about H7N9 & MERS, people seem to have forgot the danger of H5N1 and the fact that it is present Always in the same places - but - strangely, no human cases even in regions with hundreds of poultry outbreaks.

Is it possible to have no cases in Bangladesh & Nepal (the most recent hotspots), to not say in Egypt or Indonesia?

I think there a lot of undetected cases out there, and this is extremely hazardous.

gm

Laidback Al · Jan 13, 2014

Re: China - H5N1 death in Alberta, Canada upon return from China trip - died from meningoencephalitis

Re: China - H5N1 death in Alberta, Canada upon return from China trip - died from meningoencephalitis

Pathfinder said:
. . . Bernhard Schwartlander, a WHO representative in China, said that it?s very rare for the H5N1 virus to be transmitted from one infected person to another. . . .

Schwartlander?s comments about the rarity of human to human transmission of H5N1 is a relative assessment. Rare in relation to what? Certainly it is rare in relation to common circulating seasonal influenza viruses. But is human to human transmission of H5N1 rare in relation to other emerging infectious diseases?

Since February, 2013 more than 170 cases of H7N9 have been reported. Among these cases, only five or six small clusters (2-4 people) have been identified. Since the World Health Organization (WHO) has been reporting cases of H5N1 in 2003 there have been more than 650 confirmed cases. Among these H5N1 cases there have been more than 60 human clusters ranging in size from 2-8 people from nine different countries. Many of these clusters are result of infection from a common poultry source, but at least some are a result of human to human transmission.

In comparison to another emerging infectious avian influenza virus, H7N9, human to human transmission of H5N1 is not rare.

Pathfinder said:
. . ."That's what makes us confident right now, based on the current evidence, that people do not need to worry in Canada that the virus will spread any further," Schwartlander told CTV News. . . .

It is certainly true, based on the epidemiological evidence, that the H5N1 virus is not transmitting between people in Canada. But it does not follow from Schwartlander's earlier statement that people in Canada or anywhere else in the world should be unconcerned about human to human transmission of H5N1.
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Giuseppe · Jan 13, 2014

Re: H5N1 case in North America with recent travel history to China Discussion Thread

I would add that - although the incubation period is nearly expired for some if not most of patient's contacts - the H5N1 with neurotropism may have a PB2 change (E627K) - in addition to the polybasic cleavage site & possible PA & NS1 extra aa residues - that could improve h2h transmission.

Of such possibility health authorities should take account.

H5N1 case in North America with recent travel history to China Discussion Thread

sharon sanders

Editor-in-Chief & President

Giuseppe

Emeritus

NS1

Well-known member

Laidback Al

Well-known member

NS1

Well-known member

sharon sanders

Editor-in-Chief & President

Pathfinder

Editor, Senior Moderator

sharon sanders

Editor-in-Chief & President

Giuseppe

Emeritus

Laidback Al

Well-known member

Giuseppe

Emeritus