Wednesday, May 24, 2017

Shanxi Province Reports Their 2nd H7N9 Case

Credit Wikipedia


Seven days ago Shanxi province (not to be confused with neighboring Shaanxi Province which has announced their first 5 cases this month), reported their very first H7N9 case. In very short order, Shanxi has now reported a second infection, this time in a farmer from Xinzhou city.
Although this patient was hospitalized with fever, cough, and fatigue on May 7th, he wasn't diagnosed with H7N9 for more than 2 weeks.
The reasons behind this delay are not stated, although it seems likely that in the wake of last week's case, doctors in Shanxi are now more alert to the possibility of H7N9 infection.

We saw a similar (albeit shorter) delay in diagnosing neighboring Shaanxi Province's first case (link) earlier this month. Onset dates were not provided for Shanxi's first case reported last week.

Published: 2017-05-23 17:58:05 
Shanxi Province Health and Family Planning Commission briefing May 23, 2017, Taiyuan report one case of H7N9 confirmed cases imported. 

       A certain segment of patients, male, 57 years old, farmer, Xinzhou City, Shanxi Province pianguan County. May 7, 2017 with fever, cough, fatigue and other symptoms, immediately to the hospital for treatment. May 23, the provincial expert group of patients combined with epidemiological history, clinical manifestations and laboratory test results, diagnosis in this case as H7N9 confirmed cases. Fourth People's Hospital in Taiyuan is currently being treated in isolation. 

      Up to now, the province a total of two cases of H7N9 confirmed cases found. After the outbreak, the provincial government attach great importance to science departments at all levels and orderly conduct joint prevention and control, health planning department to treat the patient. By the medical observation, two close contacts of confirmed cases no clinical abnormalities occur.

Qatar MOH: Statement On Their 3rd MERS Case Of 2017



For the third time in just over 60 days (see earlier reports here, and here) Qatar's Ministry of Health has announced a new MERS case; their 21st since the virus emerged in 2012. Overnight @Crof at Crofsblog  picked up a Gulf Times media report on this case (see Qatar reports new MERS case, third this year).

Unlike the first two reported in 2017, which were without an obvious source of exposure, today's case had extensive contact with camels. 

The MOH is continuing to test close contacts of the patient and testing has been ordered on the livestock in order to identify the source.  Meanwhile the public is being reminded of the risks of contact with sick animals (particularly camels), the importance of good hygiene, and are being urged to consult a doctor at the first sign of fever, cough, and throat pain.

Ministry of Health announces the registration of new infection Corona

date of issue:  May 24, 2017

The Ministry of Public Health announced the registration of new cases of laboratory confirmed infection Corona causes syndrome Middle East respiratory resident at the age of 29 years, thus registering the third case this year, the total number of cases registered in Qatar since the beginning of the discovery of the virus to 21 cases including 7 deaths.

The patient , who works in the field of camel breeding has complained of the symptoms of fever, cough and pain in the body for several days , so he headed to Hamad General Hospital , where radiological examinations showed the presence of pneumonia acute that require further confirmatory tests in the reference laboratories of the Hamad Medical Corporation, which proved positive sample for the virus Koruna causes respiratory syndrome Middle East. Medical reports stated that the patient is in a stable condition and has been admitted to the hospital to receive proper medical care in line with the national protocol for dealing with cases of the new virus confirmed or suspected. Initial reports have reported that the patient does not suffer from any chronic illness and did not mix with people similar symptoms, and did not travel outside the country during the past two weeks.

Upon receipt of the communication of the case of the Rapid Response Team of the Department of Health Protection and Anti - Communicable Diseases at the Ministry of Public Health to conduct epidemiological investigation with the participation of the Department of Livestock at the Ministry of Municipal and Environment team in order to identify the potential source of infection and collect samples of camels , which was sponsored by the patient as well as follow - up of all potential contacts the patient to check if it matches them from the standard definition of a case of suspected according to the World Health Organization definition, is currently under way to conduct the necessary tests on them, which will continue to monitor them for two weeks to make sure You do not receive any symptoms on them to provide them with appropriate preventive advice.

And calls for the Ministry of Public Health all members of society, especially those at risk of developing complications of the disease such as those with chronic diseases or suffering from immune deficiency level of adherence to hygiene measures while avoiding contact with animals sick and to constantly wash your hands with soap and water and consult a doctor when feeling symptoms of fever, cough , and pain throat and in particular persons who deal closely with camels.

The rapid response team is working around the clock and receiving any complaints or concerns regarding the transition to digital disease hotline 66740948 or 66,740,951.

Tuesday, May 23, 2017

WHO H7N9 Update - May 23rd


The World Health Organization has published an update on 23 cases - including two clusters - reported to them 10 days ago by the Chinese government.  These cases were previously covered in this blog on May 12th (see HK CHP Notified Of 23 Additional H7N9 Cases On The Mainland).
What today's report adds is that among those cases were two clusters (of 2 cases each), which may signify human-to-human transmission.  H-2-H transmission isn't proven in these clusters, but is considered a possibility.

Most H7N9 cases report recent exposure to live birds - which are assumed to be the source of their infection - but suspected H-2-H cases are not unheard.  Today's report contains the 10th and 11th cluster reported by the WHO since the start of 2017. 
While occasional H-2-H transmission undoubtedly occurs, the H7N9 virus has not, as yet, demonstrated the ability to transmit easily or efficiently among humans. 
The virus, however, continues to evolve and our own CDC quite frankly states in last January's  Updated CDC Assessment On Avian H7N9:
. . . . of the influenza viruses rated by the Influenza Risk Assessment Tool (IRAT), H7N9 is ranked as having the greatest potential to cause a pandemic, as well as potentially posing the greatest risk to severely impact public health.

So we stay alert for even the smallest signs the virus may be better adapting to human hosts.

Human infection with avian influenza A(H7N9) virus – China
Disease outbreak news
23 May 2017

On 13 May 2017, the National Health and Family Planning Commission of China (NHFPC) notified WHO of 23 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China.

Details of the case patients

Onset dates ranged from 11 April to 6 May 2017. Of these 23 case patients, ten were female. The median age was 58 years (range 31 to 83 years). The case patients were reported from Beijing (2), Fujian (1), Gansu (1), Hebei (5), Henan (3), Hubei (1), Jiangsu (2), Shaanxi (3), Sichuan (3), Tianjin (1), and Zhejiang (1).

At the time of notification, there were seven deaths, 15 case patients were diagnosed as having either pneumonia (5) or severe pneumonia (10), and one case was mild. Nineteen case patients were reported to have had exposure to poultry or live poultry market, one case patient was reported to have visited a patient with avian influenza A(H7N9) in the hospital, one case patient was reported to have had both exposure to live poultry and a contact with a confirmed case, and two were reported to have had no known poultry exposure.

Two clusters were reported: 

A 63-year-old male from Xi’an, Shaanxi Province. He had symptom onset on 29 April 2017 and was admitted to hospital on 2 May. His symptoms were mild. He had visited a confirmed case in the hospital, a 62-year-old male from Shaanxi Province with symptom onset on 18 April 2017 and who was previously reported to WHO on 5 May.

A 37-year-old female from Chengde, Hebei Province. She had symptom onset on 2 May 2017 and was admitted to hospital on 3 May with pneumonia. She raised backyard poultry before her onset. She also had contact with a confirmed case, her mother, a 62-year-old with symptom onset on 16 April 2017 and who was previously reported to WHO on 5 May.

To date, a total of 1486 laboratory-confirmed human infections with avian influenza A(H7N9) virus have been reported through IHR notification since early 2013. 

Public health response

The Chinese governments at national and local levels are taking further measures, mainly including:

  • Convening a video conference with some key epidemic provinces to provide avian influenza A(H7N9) epidemic information and guidance on strengthening risk assessment and prevention and control measures.
  • Continuing to strengthen control measures with a focus on hygienic management of live poultry markets and cross-regional transportation.
  • Conducting detailed source investigations to inform effective prevention and control measures.
  • Continuing to detect and treat cases of human infection with avian influenza A(H7N9) early to reduce mortality.
  • Continuing to carry out risk communication and issue information notices to provide the public with guidance on self-protection.
  • Strengthening virology surveillance to better understand levels of virus contamination in the environment as well as mutations, in order to provide further guidance for prevention and control. 

WHO risk assessment

The number of human infections with avian influenza A(H7N9) and the geographical distribution in the fifth epidemic wave (i.e. onset since 1 October 2016) is greater than in earlier waves. This suggests that the virus is spreading, and emphasizes that further intensive surveillance and control measures in both the human and animal health sector are crucial.

Most case patients are exposed to avian influenza A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, and live poultry vending continues, further human infections can be expected.
Although small clusters of human infection with avian influenza A(H7N9) virus have been reported including those involving patients in the same ward, current epidemiological and virologic evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore the likelihood of further community level spread is considered low.

Close analysis of the epidemiological situation and further characterization of the most recent viruses are critical to assess associated risk and to adjust risk management measures in a timely manner.

        (Continue . . . . )

HK CHP Avian Flu Report Week 20

Credit HK CHP


Hong Kong's Centre For Health Protection has published their latest weekly avian influenza report which details 17 recent H7N9 cases on the mainland, 16 which were announced last Friday in an NHFPC report from Beijing.
For the third week in a row, Hebei leads the pack with 6 new cases (making 18 over the past 3 weeks), followed by 2 from Shandong and 1 each from Anhui, Beijing, Chongqing, Jiangsu, Zhejiang, Anhui, Hunan, Shaanxi and Sichuan. 
While we are seeing signs of a slowdown in cases, during the first four H7N9 epidemics the month of May has always produced fewer than a dozen cases. While some of these `May' cases had onsets in April, we've seen more than quadruple that number reported over the past 3 weeks.

Since only those sick enough to be hospitalized are typically tested for novel flu strains, the actual number of infections remains unknown. 
Since this 5th H7N9 epidemic season began last October, we've seen just over 700 cases reported globally (697 on the Mainland, 5 in Hong Kong, 2 in Macao, 1 in Taiwan).  More than double the previous 1 year record. 

Avian Influenza Report
Avian Influenza Report is a weekly report produced by the Respiratory Disease Office, Centre for Health Protection of the Department of Health. This report highlights global avian influenza activity in humans and birds.

Reporting period: May 14, 2017 – May 20, 2017 (Week 20)
(Published on May 23, 2017)


1. Since the previous issue of Avian Influenza Report (AIR), there were 17 new human cases of avian influenza A(H7N9) reported by the National Health and Family Planning Commission (NHFPC) from Hebei (6 cases), Shandong (2 cases), Anhui (1 case), Beijing (1 case), Chongqing (1 case), Hunan (1 case), Jiangsu (1 case), Shanxi (1 case), Shaanxi (1 case), Sichuan (1 case) and Zhejiang (1 case). Since March 2013 (as of May 20, 2017), there were a total of 1503 human cases of avian influenza A(H7N9) reported globally. Since October 2016 (as of May 20, 2017), 697 cases have been recorded in Mainland China.

2. Since the previous issue of AIR, there were no new human cases of avian influenza A(H5N6). Since 2014 (as of May 20, 2017), 16 human cases of avian influenza A(H5N6) were reported globally and all occurred in Mainland China. The latest case was reported on December 1, 2016.

3. Since the previous issue of AIR, there was one new human case of avian influenza A(H5N1) from Egypt reported by the World Health Organization (WHO). From 2011 to 2016, 10 to 145 confirmed human cases of avian influenza A(H5N1) were reported to the WHO annually (according to onset date). In 2017, there have been so far three cases in Egypt.*

Monday, May 22, 2017

Cell: Researchers Identify Broadly Protective Antibodies In Ebola Survivor


Although the two most common strains of Ebola known to cause outbreaks are Ebola Zaire (EBOV) and Ebola Sudan (SUDV), three other strains have previously been identified; Bundibugyo ebolavirus (BDBV), the rarely seen Taï Forest ebolavirus (TAFV), and a strain found in the Philippines - not known to cause illness in humans - called Ebola Reston (RESTV) (see I'm Not Dying, I'm Just Reston).

This diversity complicates the creation of effective vaccines and/or therapeutics, since we can never be sure what version of Ebola will spark the next major outbreak. 
Last week researchers from Albert Einstein College of Medicine announced the discovery (as part of a multi-institutional research study) of 2 human antibodies (ADI-15878 & ADI-15742)  - out of a field of 349 distinct mAbs harvested from a survivor of the 2013-16 Ebola epidemic - that potently neutralized all five known Ebola viruses in tissue culture.

While there's still a great deal of work ahead, this discovery is hoped could eventually lead to a viable pan-Ebola treatment.  First the abstract, then a link to and some excerpts from the Albert Einstein College press release.

Antibodies from a Human Survivor Define Sites of Vulnerability for Broad Protection against Ebolaviruses
Anna Z. Wec10, Andrew S. Herbert10, Charles D. Murin, Elisabeth K. Nyakatura, Dafna M. Abelson, J. Maximilian Fels, Shihua He, Rebekah M. James, Marc-Antoine de La Vega, Wenjun Zhu, Russell R. Bakken, Eileen Goodwin, Hannah L. Turner, Rohit K. Jangra, Larry Zeitlin, Xiangguo Qiu, Jonathan R. Lai, Laura M. Walker, Andrew B. Ward, John M. Dye11,'Correspondence information about the author John M. DyeEmail the author John M. Dye, Kartik Chandran11,12,'Correspondence information about the author Kartik Chandran Email the author Kartik Chandran , Zachary A. Bornholdt11,13,'Correspondence information about the author Zachary A. Bornholdt

    •The human humoral response to Ebola virus contains broadly neutralizing antibodies
    •Potent pan-ebolavirus neutralizing antibodies recognize the viral fusion loop
    •The antibodies target viral entry intermediate generated in endosomes
    •The antibodies protect against three ebolaviruses that cause outbreaks in humans


Experimental monoclonal antibody (mAb) therapies have shown promise for treatment of lethal Ebola virus (EBOV) infections, but their species-specific recognition of the viral glycoprotein (GP) has limited their use against other divergent ebolaviruses associated with human disease.
Here, we mined the human immune response to natural EBOV infection and identified mAbs with exceptionally potent pan-ebolavirus neutralizing activity and protective efficacy against three virulent ebolaviruses. These mAbs recognize an inter-protomer epitope in the GP fusion loop, a critical and conserved element of the viral membrane fusion machinery, and neutralize viral entry by targeting a proteolytically primed, fusion-competent GP intermediate (GPCL) generated in host cell endosomes.
Only a few somatic hypermutations are required for broad antiviral activity, and germline-approximating variants display enhanced GPCL recognition, suggesting that such antibodies could be elicited more efficiently with suitably optimized GP immunogens. Our findings inform the development of both broadly effective immunotherapeutics and vaccines against filoviruses.

Researchers Discover First Human Antibodies That Work Against All Ebolaviruses

May 18, 2017—(BRONX, NY)—After analyzing the blood of a survivor of the 2013-16 Ebola outbreak, a team of scientists from academia, industry and the government has discovered the first natural human antibodies that can neutralize and protect animals against all three major disease-causing ebolaviruses. The findings, published online today in the journal Cell, could lead to the first broadly effective ebolavirus therapies and vaccines.


Broadly Active Therapeutics and Vaccines Needed

Monoclonal antibodies, which bind to and neutralize specific pathogens and toxins, have emerged as one of the most promising treatments for Ebola patients. A critical problem, however, is that most antibody therapies target just one specific ebolavirus. For example, the most advanced therapy—ZMappTM, a cocktail of three monoclonal antibodies—is specific for Ebola virus (formerly known as “Ebola Zaire”), but doesn’t work against two related ebolaviruses (Sudan virus and Bundibugyo virus) that have also caused major outbreaks.

“Since it’s impossible to predict which of these agents will cause the next epidemic, it would be ideal to develop a single therapy that could treat or prevent infection caused by any known ebolavirus,” says study co-leader Zachary A. Bornholdt, Ph.D., director of antibody discovery at Mapp Biopharmaceutical, Inc. “Our discovery and characterization of broadly neutralizing human antibodies is an important step toward that goal,” adds study co-leader, Kartik Chandran, Ph.D., professor of microbiology & immunology at Albert Einstein College of Medicine.

The study was also co-led by John M. Dye, Ph.D., chief of viral immunology at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID).

(Continue . . . )

NIH VideoCast: Current Infectious Disease Challenges

Credit NIH


When it comes to putting the global threat of infectious diseases into perspective, you'd be hard pressed to find anyone better versed than Dr. David M. Morens of NIAID at the NIH.  Over the year's we've looked at his work - often collaborating with Jeffrey K. Taubenberger - on the history of pandemics. 

A few well worth revisiting include:
EID Journal: Morens & Taubenberger On The Evolution Of HPAI H5Nx
Morens & Taubenberger - Influenza Viruses: Breaking All the Rules

mBio: An H7N9 Perspective by Morens, Fauci & Taubenberger

Morens and Taubenberger: A New Look At The Panzootic Of 1872

Last week (May 16, 2017) NIAID Director Dr. Anthony Fauci was scheduled to give a talk on current infectious disease challenges in the NIH's Demystifying Medicine series of video casts, but was called away, and so Dr. Morens ably stepped in at the last minute to give the presentation. 
I think you'll find Dr. Moren's seminar both interesting and informative.   Be sure to download the slides.

Highly recommended. 

Demystifying Medicine 2017: Current Infectious Disease Challenges
Source:National Institutes of Health (NIH)
Date Published:05/16/2017

Format:Video or Multimedia

Annotation:This one-hour, 25-minute presentation discusses infectious disease challenges in 2017: established infectious diseases, newly emerging diseases, and re-emerging diseases. It provides examples of established infectious diseases of global health importance, and global examples of newly emerging and re-emerging infectious diseases, including chikungunya, dengue, and Middle East respiratory syndrome coronavirus (MERS-CoV). It includes a detailed discussion of the Zika virus, yellow fever, Ebola, and pandemic influenza. [less]


Authors:Morens, David
Type:Instructional/Training Material
Access Notes:Link to presentation slides: