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Showing posts with label Beijing. Show all posts
Showing posts with label Beijing. Show all posts

H5N1: 1st fatal case in North America...[UPDATED x4-FINAL]

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An otherwise healthy resident of Alberta, Canada, died 3-Jan after contracting influenza A(H5N1) virus during a visit to Beijing ,China. The person did not leave the Beijing area and did not visit live bird market. The victim returned on Air Canada flights (according to a Tweet from @HelenBranswell), showing signs and symptoms on admission to hospital 1-Jan which included high fever and lethargy without cough or other signs of acute respiratory tract illness. The patent died of meningoencephalitis. The lab confirmed H5N1 7-Jan. 

Canadian officials will not be describing the patients age, sex or occupation. Giving the region would be enough to identify the patient given there is only 1 case.

A highly pathogenic avian influenzavirus (HPAI or "high-path) that can kill the birds it infects, H5N1 has been confirmed in 648 people across 15 countries since its identification in a 3-year old boy in Hong Kong in May 1997 (first identified in a goose in 1996). There were 38 cases identified globally in 2013, with 24 deaths. A slow-burn that seems comparable to H7N9's current spread. How often H5N1 is considered in the screening of influenza-like illness I do not know; another similarity might be under-reporting/limited prospective PCR-based screening.

As ever, these sporadic imported cases also serve to highlight that the pathogen is circulating at the source. The route of acquisition for this case is unclear at this stage. H5N1 does not readily transmit among humans requiring close contact with birds and there has been no sustained human-to-human transmission.

When a human does become infected by the virus, severe acute respiratory distress syndrome can result. This is ascribed to the availability of receptors in the deeper airways and lungs, which bind the virus and trigger the person's own immune-mediated disease via a "cytokine storm"; a large scale release of the chemicals our bodies usually employ to keep virus infections in check, but on a larger scale with more severe consequences to the host. Such a storm does not commonly occur following infection by a seasonal influenza virus (e.g. H3N2) infection, 

The WHO does not list any H5N1 cases in the area around Beijing on its 2013 map (18-Dec-2013). An out-of-date timeline of "major" H5N1 events lists human cases in Beijing in Nov-2003 and Dec-2008. Major outbreaks among birds in China have centered around Qinghai lake.

There is no H5N1 component in the current seasonal influenza vaccine, but then there is no significant risk to the Canadian public health from H5N1.

The current WHO phase of pandemic alert for H5N1 is ALERT:
This is the phase when influenza caused by a new subtype has been identified in humans. Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.

As the Public Heath Agency Canada recommend, Think-Tell-Test....
THINK
  • implement best practices for triage, infection control and patient management as indicated
TELL
  • Consult your local Public Health for assistance in SRI/severe ILI patients with the following:
    • Recent travel or contact with travelers to an affected area with confirmed H5N1 activity in humans and/or domestic poultry
TEST
  • Consult your local Public Health for guidance on appropriate testing, recommended procedures and prioritization for H5N1 investigation IF significant exposure history has been established which may include:
    • Close contact (within 1 metre, i.e. touching distance) with a confirmed human case of H5N1 or
    • Close contact with sick or dead domestic poultry or wild birds

Other news and related information sources include...
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H7N9 in Beijing.

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Busy night. According to crofsblogs and Avian Flu Diary, Beijing has reported a new case of H7N9 in a 6M, confirmed 28.05.13. This makes 133 cases and 37 deaths-3 in Beijing when including an asymptomatic lab confirmation.
This case comes after Beijing rolled H7N9 into its normal influenza virus laboratory testing system and one of China's leading respiratory virus researchers noted the need to remain vigilant about H7N9.
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Asymptomatic H7N9 case detected.

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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 just on the cases with the most severe clinical signs and symptoms, is absolutely essential to detect mild or asymptomatic cases of infection. The use of PCR in this way seems to have done just that. 

I'll keep a close eye on this story but I suspect it will result in a drastic change to the landscape of detection numbers and epidemiology. 

Symptoms alone tell only a small part of the story of any respiratory virus. This may strengthen the case for H7N9 having been in the community for much longer than the pneumonia cases officially commencing back in Feb, suggest.
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