US CDC asked local healthcare providers to keep an eye out for "signs of H7N9 flu". Rather than watch for feathers, this will entail being on the lookout for cases with influenza-like illness (ILI) among those who have themselves, or are in contact with someone who, recently traveled China who are influenzavirus-negative by standard laboratory testing methods. Rapid prescription of Tamiflu is...
A mutation musing
A collaborative report (by Dutch and Chinese contributor) published yesterday from Eurosurveillance shows that 5/7 H7N9 strains from humans, birds and the environment have an amino acid change in the HA gene called Q226L (the normal" glutamine [Q] found at amino acid position 226 has "mutated" to a Leucine[L]). In the past, this change has been associated with binding of influenzavirus to a receptor...
Good read.
I highly recommend this Editorial over at crofsblogs. Adds a little context to some exaggerated headlines over the past three weeks and looks at the emergence of a novel virus from a...different ang...
The 15-person strong "influenza A-team"...
...have arrived in China to examine, understand and advise on the avian influenza A(H7N9) virus situation in Shanghai and Beijing. The comment that "with perhaps rare exceptions, people are not getting sick from other people. Of the many hundreds of people who were in close contact with the H7N9 patients, all the care-givers, neighbors, family members, and so on, there are only a very few cases...
Despite a dodgy serology test...
..not my interpretation, tweet from WHO's Gregory Hartl, it seems that at least one son of this outbreak's first reported H7N9 case (Case #1, 87M) has been confirmed as also being H7N9 positive. What does this mean? It doesn't mean the sky is falling - contacts, by their very nature share things. In a family you often share (inhale, have land in your eyes etc) aerosolized (virus-laden) droplets...
How to solve a problem like transmission?
Perhaps once Prof Ron Fouchier can get the virus into his ferret model he should be able to definitively answer whether avian influenza A(H7N9) can be transmitted via the airborne route and the real impact of the much discussed mutations found in H7N9 over recent weeks. He will also look at the virus by infecting rhesus macaques and African green monke...
Looking like Shanghai contributed 6 cases overnight.
However, dates are scant and patchy so I have not further updated the charts yet. I'm hoping for some clear data later in the day. New retrospective test results have appeared - these comprise serological data for two cases (seroconversion to influenzavirus can take 12-21d which may vary further in the elderly or those with immunocompromise) and culture isolations for two cases as well as two...
Editor's Note #3
Increasing calls to reduce paranoia and stop overstating the likelihood of pandemic. Hopefully VDU doesn't add to the blather too much - collecting only verified observations of interest is the name of its game on this page. Opinions are mine alone and I hope they don' extend beyond hard data...too mu...
Aaron BerkowitzPGY-3, NeurologyTravel Grant: Neurology Education in MalawiQueen Elizabeth Central Hospital in Blantyre, Malawi is the country�s largest hospital, with over 1000 inpatients. As there is no district hospital in the vicinity, the hospital provides all levels of care from primary through...
VDU's Editor in Chief comments...
... in an article by Jason Gale, Editor, Bloomberg News, picked up by crofsblogs and on ProMED too in the AVIAN INFLUENZA, HUMAN (47): CHINA H7N9 UPDATE upda...
The old question of how much do we trust PCR?
Over at FluTrackers, expert virology communicator (the virology blog), picornavirologist and teacher Prof Vincent Racaniello reiterates a point that hasn't been mentioned much with respect to the H7N9 emergence. "Conclusions about etiology are more difficult to determine if viral sequences are detected by PCR in the absence of clinical symptoms". In other words its important to consider the much...
(waaaay) Down the track...
..it will also be interesting to see whether the H7N9 circulation had an unusual impact on "seasonal" respiratory viruses like parainfluenzaviruses (PIVs), enteroviruses (EVs) and rhinoviruses (HRV) which reportedly, like influenzavirus, can peak in Beijing and Shanghai around May (Ren et al., Clin Microbiol Infect 2009;p1146-; Wang et al. J Clin Virol 2010;p21...
A new question...
...to mull over: Have viral co-infections and bacterial super-infections been sought, or excluded, in the H7N9 fatalities to date (some mention the 3 cases NEJM article)? What contribution do they make, along with existing co-morbidities, in the deaths of the 14 (as of 15.04) H7N9-positive cas...
Editor's Note #2.
Just a note of sincere thanks and a fair serving of awe to the tireless (perhaps sleepless) efforts of the dedicated guys at FluTrackers (Sharon Sanders, EiC) and the Avian Flu Diary (Mike Coston), and Crofs blogs for help and generous hat tips (see #7137 and others) that have kept VDU fed over the past couple of wee...
Asymptomatic H7N9 case detected.
Multiple reports of the first asymptomatic case in a 4-year old male (4M) living across the street from the previously H7N9-POS, 7F. This may demystify a lot of H7N9 confusion as well as seriously increase the threat level for H7N9 spread...a stealth virus not only in poultry but humans is a new game. As I've suggested earlier, the widespread use of sensitive molecular detection methods, not...
Three more cases and a death.
The latter of a 77F previously H7N9 POS. Numbers of new notifications are surprisingly low after the weekend's flur...
Editor's Note #1
A new format for the Cases Chart is being tried out to help me cope with the increasing analysis. Check out the other H7N9 charts of province, age, sex and mortalities all at the H7N9 pa...
Biggest single H7N9 notification day?
Today saw a remarkable 11 H7N9 confirmations added including 2 new deaths and a new province (Henan; population >94,000,000) added to the list. FluTrackershas all the details...although many cases do not have full details; the best quality data come from Shanghai, Beijing and Henan at the moment. Cases jump to 60 with 13 deaths but the Case Fatality Rate remains steady at 22%. No sustained...
