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Showing posts with label poultry. Show all posts
Showing posts with label poultry. Show all posts

H7N9 and human infections: not just a paltry matter

Jones and an all-star cast of colleagues from Hong Kong, Shenzen, Beijing and Tennessee have looked at songbirds and their susceptibility to a human isolate (infectious virus recovered from a human case of H7N9 influenza) H7N9 infection (1).

But before I note the good bits of their study, this paper is one of importance for adding a lot to our understanding of how H7N9 is jumping to people from poultry/live bird/wet markets. It's also a great reference if you want to better understand influenza and birds overall. 


We've read much about human cases of this avian virus having had contact with "poultry" and bird markets and  from that we assume that poultry are the pool in which H7N9 is swimming (reservoir); but where did the poultry get it from (source/natural host)? Its also interesting to note that: 
  1. Very few poultry test positive for the virus; may simply be because of a test-based problem including using a test that is insensitive or sampling from the wrong end of the bird (testing the cloaca instead of throat as was discussed ). 
  2. Looking at the sequences of the H7N9 gene segments suggested that wild birds (bramblings) played a part in the evolution of the virus currently infecting humans in south east China (4)
  3. Pigeons have tested H7N9-positive (2,3)
So it might be that at least some of the human exposures are not from poultry but from other birds.

The authors of this latest article note the songbirds are common pets and so are in close contact with their owners. In the wild, such birds are likely to interact with farm birds.

Some key findings of this new study are:
  • A/Anhui/1/2013 was the strain used for H7N9 studies; it was an isolate from a human but early on and similar to bird (6) strains. H5N1 (A/Vietnam/1203/05) and H3N8 (A/songbird/Hong Kong/SV102/2001) were also used for comparisons
  • Zebra finches (Taeniopygia guttata), society finches (Lonchura striata domestica), parakeets (Melopsittacus undulates) and wild-caught house sparrows (Passer domesticus) were kept isolated for 3-weeks prior to experiments to let any naturally acquired infections burn out; none of the birds had antibodies suggestive of previous infection by an H3, H5, H7 influenza A virus (is that low prevalence normal?)
  • Birds were inoculated with 105 50% egg infectious doses of virus via nose, eye and mouth (that should do it) and then put in the same cages, sharing water and food, with uninfected birds
  • Virus testing was by growth using eggs (3/sample collected)
  • All inoculated birds shed virus (only) from the oropharynx; finches shed most virus at 2-days post inoculation (dpi); parakeet viral shedding could be detected by culture for 2-days and from finches for 6-days
  • Communal water troughs yielded culturable virus; zebra finches shed most virus but water consumption and drinking frequency were not measured and may have differed among bird species
  • No virus could be detected at 8dpi
  • 1 sparrow showed signs of disease and died; 1 zebra finch died without signs of disease (some loss of appetite)
  • Birds in contact with infected birds did not often acquire infection but when they did, they also shed via the oropharynx
  • In finches that were killed for organ testing, virus was mostly found in the trachea; some was isolated from brain and eye tissues of 1 society finch and in the small and large intestine and a high titre form the lung of the other. H7N9 was grown from the brain, lung and intestines of zebra finch. H7N9 was not found in surviving sparrow organ tissues; in the dead sparrow, some H7N9 was found only in the lungs
  • Nearly all inoculated birds mounted a specific antibody response to H7N9 after inoculation. Among the contact birds, 3/3 zebra finches, 1/3 society finches (had highest amount of antibody), 2/3 sparrows and 0/2 parakeets mounted a response to virus indicating that they were infected but did not show signs of illness nor did they shed virus, at least at culture-detectable levels
So songbirds, can be infected by a human H7N9 isolate, they can shed the virus into the environment, they can die (presumably) due to H7N9 infection, 33-66% of songbirds in contact with an experimentally infected songbird acquire aninfection (even if it was rare to grow infectious virus from that contact which may be a sensitivity issue of the testing) and they mount an immune response to the infection. Given that H7N9 acquisition seems to be a numbers among humans, this degree of transmission among birds fits well.

It was also very interesting that water troughs often contained lots of shed H7N9 virus. This is not new in the world of influenza virus but its nice to cross the 't' for H7N9. The authors note that studies of transmission from songbirds to poultry via communal water sources are yet to be conducted. Seems like this would be a very important piece of the influenza puzzle and with broad application to future outbreaks and seasonality in birds via migration. 

Add to all of this that songbirds are present in many markets (thanks to @Crof, @Laurie_Garrett and @debmackenzie1 for supporting info via Twitter this morning; also see refs from Jones et al (1) and a related story from New Scientist (8)) and that older males are a key demographic for keeping songbirds as luck-enticing (and cute) pets. They are also over-represented among H7N9 cases (see adjacent chart). A good fit.

Another recent study (7) shows chickens and quail (a possible amplification host helping bridge the gap between wild birds and poultry) shed a lot of H7N9 after experimental inoculation via an intranasal route. Also, quail (but not pigeons) shed enough H7N9, for long enough, to pass it along to their contacts; less so ducks.

None of this may be very new to some of you, but it's nice to see data that confirm it all for H7N9. After all, as someone reminded me recently on Twitter, data is just how we roll.

It's not hard to see the circle of life for influenza viruses is there for the interpreting and that non-poultry birds may be important intermediate hosts of H7N9 and act as a source of other influenza A viruses. 

Just how many human cases of H7N9 are acquired by songbirds vs chickens/ducks/quail/geese remains unquantified....perhaps unquantifiable.

References...

  1. Possible Role of Songbirds and Parakeets in Transmission of Influenza A(H7N9) Virus to humans.
    http://wwwnc.cdc.gov/eid/article/20/3/pdfs/13-1271.pdf
  2. A summary of Influenza A(H7N9) virus findings in birds and humans
    http://newsmedicalnet.blogspot.com.au/2013/10/a-summary-of-influenza-ah7n9-virus.html
  3. Emergence of avian influenza A(H7N9) virus causing severe human illness - China, February-April 2013.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a6.htm
  4. Sunny summer or birds on the wing?
    http://newsmedicalnet.blogspot.com.au/2013/05/sunny-summer-or-birds-on-wing.html
  5. Origin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses
    http://press.thelancet.com/H7N9genetics.pdf
  6. Genetic analysis of novel avian A(H7N9) influenza viruses isolated from patients in China, February to April 2013http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20453
  7. Role of poultry in spread of novel H7N9 influenza virus in Chinahttp://jvi.asm.org/content/early/2014/02/20/JVI.03689-13.long
  8. Budgies may be behind latest spread of H7N9 bird flu
    http://www.newscientist.com/article/mg22129542.000-budgies-may-be-behind-latest-spread-of-h7n9-bird-flu.html#.Ux5CnvmSx8F

Guangzhou reopens live poultry markets: Good idea or too soon?

Curve of H7N9 human cases in the two most hard-hit
Provinces in China Zhejiang and Guangdong.
Hangzhou shut its poultry markets 24-Jan.  Guangzhou shut
its markets 15-Feb. Similar rate of cases in Wave 2 of H7N9.
The difference? Zhejiang's markets remain closed.
Well, that seemed like a very quick 2-weeks. But it is 2-weeks (see my earlier post when the markets shut) and a lot of financial hardship for the local poultry industry. They will breath a sigh of relief as the chickens start moving through the crowded markets once more.
With new H7N9 human case announcements reduced to zero for the past 2 nights (my time), we'll now get a look at what happens when a market gets restocked after the region it serviced has had a transmission interruption, and the weather moves towards Spring and its subtropical rainy season. Will the market be restocked from virus-positive farms? Is the weather still conducive to maximising H7N9's chances of being picked up by humans? Will surveillance methods have changed at the markets in Guangzhou? 
"..poultry traders are required to clean their stalls every day, carry out a thorough sterilization once a week and close business one day a month."                                                                                   Shanghai Daily.
It is like watching an experiment played out in real-time. Without the Aims. Or hypotheses. Or controls. Or stuff.

h/t to @Potrblog as my source for this article.

Related links...
  1. Zhejiang province leads the way in H7N9 cases and their decline 3-weeks after market closures...
    http://newsmedicalnet.blogspot.com.au/2014/02/zhejiang-province-leads-way-in-case.html
  2. Guangzhou reopens live poultry markets
  3. http://www.shanghaidaily.com/national/Guangzhou-reopens-live-poultry-markets/shdaily.shtml
  4. China.today Guangdong Province weather
  5. Shenzen shopper weather

Live bird market closures continue...

Changsha, capital of Hunan province has had its live poultry markets closed since 21-Feb (1).
H7N9 case map.

So that can be added to Shanghai, major markets in Hangzhou, Ningbo and Jinhua cities in Zhejiang (15), markets in Guangzhou, Guangdong ((3); plus a previous 2-week pause for disinfection in Shenzen (15) ), Hong Kong recently extended its ban (4) on live poultry imports from mainland China and Fujian provinces markets were closed fro disinfection back in 21-Jan. 

No word, that I can find anyway, on market closures in the Jiangsu province (11.8% of all H7N9 cases), other sites in Fujian province (5.5%) or Anhui province (2.5% but over-represented in cases recently).

And yet with no cases announced yesterday - the latest in a recent precipitous decline in total human cases per day - it's tempting to wonder whether market shutdowns in regions that have had the highest case activity (Zhejiang and Guangdong provinces) and which produce or trade a lot of the nation's chickens, have had enough of a flow-on effect to stem the tide in other regions supplied by these. 

Aside #1: Poultry eggs are mainly produced by >1-billion birds in Henan, Shandong, Hebei, Liaoning, Jiangsu, Sichuan, Hubei, Anhui, Heilongjiang and Jilin (7,8) whereas >4-billion broiler chickens (bred for meat) are more concetrated in Shandong, Jiangsu, Guangxi, Liaoning, Guangdong, Anhui, Sichuan and Henan provinces  (2,6,8,9,10,11,12,13).
Aside #2: An interesting to read (5,9) that the volume of chicken consumed per capita has risen by 9-fold or more in recent years - it has not always been the staple but is part of the tradition.

Sources...


  1. http://english.cri.cn/11354/2014/02/22/2702s814226.htm?utm_source=dlvr.it&utm_medium=twitter
  2. http://www.globaltimes.cn/content/843788.shtml#.Uwl4ovna6-1
  3. http://newsmedicalnet.blogspot.com.au/2014/01/zhejiang-live-bird-market-closures-and.html
  4. http://www.interaksyon.com/article/81029/hong-kong-extends-ban-on-live-poultry-imports-from-mainland-china
  5. http://www.iatp.org/documents/fair-or-fowl-industrialization-of-poultry-production-in-china
  6. http://www.forbes.com/sites/russellflannery/2013/04/13/by-the-numbers-chinas-poultry-industry/
  7. http://www.prweb.com/releases/chinas-egg-and-poultry/industry-research-2013/prweb11170628.htm
  8. http://www.ccagr.com/content/view/117/184/
  9. http://www.newschinamag.com/magazine/poisoned-plucked-processed
  10. http://www.tysonfoods.com/Around-the-World/International-Operations/Tyson-China/About-Tyson-China.aspx
  11. http://www.wantchinatimes.com/news-subclass-cnt.aspx?cid=1103&MainCatID=11&id=20140219000043
  12. http://articles.chicagotribune.com/2012-04-19/business/sns-rt-us-usa-china-food-factboxbre83j05v-20120419_1_hog-farm-province-hubei
  13. http://english.agri.gov.cn/hottopics/ah/201310/t20131028_20492.htm
  14. http://news.xinhuanet.com/english/photo/2014-01/22/c_133063832_2.htm
  15. http://news.xinhuanet.com/english/china/2014-01/31/c_133087279.htm

Humans unlikely to infect poultry with H7N9? Data please!

The United Nations Food and Agriculture Organization (FAO) has said that poultry is not at risk of being infected by humans carrying H7N9 virus.
In fact, we have no evidence that affected people could transmit the virus to other species, including birds. The highest risk of virus introduction is uncontrolled live poultry trade between affected and unaffected areas.
But absence of evidence is not evidence of absence.

We have seen studies, like this one, that use a human H7N9 virus and use it to successfully infect chickens. So the virus is capable of replicating even if it is inefficient at spreading to other chickens or even ferrets ( a human surrogate of influenza infection). But then we do know that humans get infected from exposure to something in poultry markets.

I agree (for what that's worth), that the risk of spreading virus is more in the area of moving infected birds around, as well as their own migration movements. But I think it is too early be early to issue strong denials that humans may infect poultry until we find some data to support them.

Sources...

Neither market nor farm poultry all that positive for H7N9; songbirds the culprit...?

Following on from yesterday's post, "If not poultry then what?", I thought it worth noting the impressive numbers from the Chinese Ministry of Agriculture.

From 2013:

  • 1,630,000 poultry and environmental samples tested
    • 88 POS; all from live bird markets
    • None from poultry farms
From 2014, to date:
  • 33,400 poultry and environmental samples
    • 8 H7N9 POS; all from live bird markets
    • None from poultry farms
The other alternative to answer the question in my heading; the testing methods are at fault. 

No detail of what approach has been used to obtain these numbers in the links below. Viral culture and serology with some PCR have been noted before. I'd wager culture yields chicken scratchings compared to PCR for detecting virus in he wild; but serology has successfully been a pillar upon which animal testing rests. So that's why the numbers above are such a quandary for the epidemiologist who reads about the high frequency of links between human disease and exposure to poultry.

It would be nice to see some technical papers on antibody test testing (development and validation) at some point. If only to reassure everyone that the testing methods are doing what testing methods should be doing.

See #3 below for influenza PCR discussion at WHO.

Sources..

If not poultry then what? [UPDATED]

Maybe China needs to look at other
animals, both within market 

environments and at the source farms 
(using sensitive molecular tools as they 
have been), to find the "smoking chicken" 
(shamelessly stolen from Mike Coston)...
which may not be a chicken at all.
Mike Coston has written a nice post about the Chinese MOA denying that there is any proof of direct transmission of H7N9 from poultry to humans. 

Technically, they are of course correct. 

We have yet to see a human put in a cage downwind, but separated from, a flock of infected chickens or duck or geese to see if the human acquires H7N9 infection and disease. Nor have we seen any card-playing lockdown transmission scenarios to investigate aerosol, droplet and direct transmission routes. 

Nonetheless - if you take a look at a snippet of my list of H7N9 cases compiled from various public sources, "poultry" contact is mentioned...a lot; 72% of those rows (if you exclude the 19 awaiting WHO notification data; see below for update). 

Of course it may be a "poultry" euphemism or a translation error (I'm asking @WHO) for contact with any feathery creatures, so song birds and wild birds may be the source in the markets....or another animal altogether of course but I think something non-feathery would have shown up as a pattern by now.

[UPDATE] Gregory H�rtl notes..
Only one way to tell what's happening now; get more samples and RT-PCR them. Serology is historically solid and well relied upon, particularly in the world of influenza surveillance. See expert comments on this in a recent CIDRAP article here. I'm just not convinced its providing enough sensitivity at a suitable speed to feed the needs of rapid response and control measures for an emerging virus like an influenza. A virus which is spilling into humans from somewhere not yet convincingly defined to everyone's satisfaction. 

But I'm new to flu and am coming at this from an endemic human virus detection and characterization angle. I may be waaay off point.

Things I did not know #125,326...H5N1 is enzootic (=endemic in animals) in some countries...

Makes perfect sense of course, I just hadn't seen that in print in my short time looking at flu.

Helen Branswell has a piece on CTVnews about the Canadian H5N1 cases, noting that the genome will be deduced and submitted to the GISAID database.

So officially, H5N1 is considered enzootic in poultry (endemic for animals) in at least 6 countries (circulating, or epizootic, in at least 9 others):
  1. Bangladesh
  2. China (since 2003) 
  3. Egypt
  4. India
  5. Indonesia
  6. Vietnam

Further reading and references...

  1. http://www.cdc.gov/flu/news/first-human-h5n1-americas.htm
  2. http://www.cdc.gov/flu/avianflu/h5n1-animals.htm

The H7N9 missing link: testing the wrong end?

Helen Branswell has an excellent piece detailing as yet unpublished work by the Southeast Poultry Research Laboratory in Georgia.

The researchers have found that influenza A(H7N9) virus can be detected from the nasal passages of chickens and quail - both animals implicated in transmission during the H7N9 outbreak in China. The "so what?" factor is that normally avian hosts shed influenza viruses from the gut reflecting that it is the primary site of influenza virus replication in birds.

As Helen writes, an implication is that if the thousands of birds that have been tested in China to date were only sampled at the cloaca and not from the upper respirator tract, H7N9 prevalence in these oft-blamed but seldom-positive hosts could have been grossly underestimated. However, Dr David Swayne, Director of SPRL notes that it is common practice to swab both ends of a bird when testing.

The research also plays down a major role in transmission for pigeons, ducks and geese.

The search for a definitive answer to what animal is the principal host for H7N9, goes on.

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