AVIAN INFLUENZA, HUMAN (61): INDONESIA
Date: Wed 6 Aug 2008
Source: Canada.com, Agence France Presse (AFP) report [edited] <
http://www.canada.com/topics/news/story.html?id=4e94d76c-0b28-4b22-8011-69a6c32d99a5>
Three people have died, and 13 have been admitted to hospital with symptoms of bird flu in Indonesia, a nurse treating the patients said Wednesday [6 Aug 2008]. Officials and residents in Asahan district of North Sumatra province said villagers began showing symptoms of avian flu after a large number of chickens died suddenly last week. The nurse at Asahan district's Kisaran hospital said 3 people had died after suffering bird flu-like symptoms in Air Batu village.
"According to residents there, a number of chickens died suddenly last week followed by several pigeons. Days later, 3 people died with the same ailments," the nurse, told AFP.
Another 13 people had been admitted to the hospital with "high temperatures and respiratory problems," she said. Two of these -- a baby boy and a 7-year-old girl -- were transferred early Wednesday [6 Aug 2008] to a bird flu isolation unit at Adam Malik hospital in the provincial capital of Medan, officials said. Adam Malik hospital spokesman Sinar Ginting confirmed that blood samples from the 2 children were sent Wednesday [6 Aug 2008] to a health ministry laboratory in Jakarta for analysis. "We are now waiting for the result," he said.
The father of the baby boy said a lot of poultry had died in the village a week ago. His baby developed a high fever and respiratory problems shortly afterward. A spokeswoman for the health ministry could not be reached for comment. The ministry, which has stopped giving regular bird flu updates, announced earlier this week that the human toll from avian influenza in Indonesia had risen to 112 with the recent death of a 19-year-old man [The WHO Table of the Cumulative number of Confirmed human Cases of Avian Influenza A/(H5N1), which has not been updated since 19 Jun 2008, records the number of deaths in Indonesia as 110. - Mod.CP]. The man was from a town adjoining the capital Jakarta on Java island.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
******
[2]
Date: Wed 6 Aug 2008
Source: The Jakarta Post, National news online [edited] <
http://www.thejakartapost.com/news/2008/08/06/eleven-more-bird-flu-suspects-detected-north-sumatra.html>
Eleven people from Air Batu village, Air Batu subdistrict, Asahan regency in North Sumatra, were taken to Asahan's Abdul Manan hospital early Wednesday [6 Aug 2008] after showing symptoms of avian influenza, more commonly known as bird flu.
Two patients were later admitted to Medan's Adam Malik Hospital for further treatment, while the other 11 were still undergoing treatment at Abdul Manan hospital. "Two patients from Abdul Manan hospital, a 7-year-old girl and an 8-month-old baby boy, arrived here at 2 a.m.,"
Adam Malik Hospital spokesman Sinar Ginting told Kompas.com on Wednesday [6 Aug 2008]. Ginting said the 2 patients were in a "critical" condition, with a high fever, serious respiratory problems and a cough. The 2 patients, he said, had no history of direct contact with chickens, but a week earlier, chickens around their neighborhood had died suddenly. "Officials from the local health agency have examined the chickens and found they were positively infected with H5N1 virus," Ginting said.
Ginting said a team of doctors led by Dr Luhur Soeroso had provided all appropriate treatment to the patients, who are being held for further tests even though they are only suspected of having the disease.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[Taken together, these 2 reports indicate that 3 people have died and at least another 13 people (including 2 severely ill children) have been admitted to hospital with suspected avian influenza virus infection. The description of the signs and symptoms are not sufficiently specific to confirm a diagnosis of avian influenza. The evidence is circumstantial (contemporaneous outbreaks of poultry
deaths) rather than specific. Further information and the results of laboratory tests are awaited.
A map of the province of North Sumatra showing the location of Medan is available at:
<
http://www.indonesia-tourism.com/north-sumatra/map/index.html>.The HealthMap/ProMED-mail interactive map of Indonesia is available at:
<
http://healthmap.org/promed?v=-2.6,120.9,5>. - Mod.CP][see also:
Avian influenza, human (59): Indonesia 20080803.2372 Avian influenza, human (56): Indonesia, susp 20080719.2196 Avian influenza, human (55): Indonesia, WHO 20080620.1918 Avian influenza, human (54): Indonesia 20080619.1912 Avian influenza, human (51): Indonesia, new policy 20080606.1811] ....................................cp/msp/mpp
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ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the
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thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material.
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UNDIAGNOSED HEMORRHAGIC DISEASE - CHINA: (SHANDONG),
REQUEST FOR INFORMATION
****************************************************************************
Date: 27 Jul 2008
From: Stephen O. Cunnion
<scunnion@potomacinstitute.org>
I received the following email from Chuck Dolejs of the International Association of Emergency Managers regarding a Sound of Hope web page
(<
http://en.epochtimes.com/n2/china/strange-disease-kills-three-in-china-1742.html>)updated [26 Jul 2008]. Has this outbreak been verified by authorities?
"China reported that approximately 20 days ago, a man suddenly died from an unidentified disease in Wanjiakou Village, Xiaoguan Town, Wendeng City, Shandong Province. His entire body turned dark purple, and he bled from his mouth, nostrils, ears, and eyes just as he died.
Shortly after the man died, 2 other men who been in contact with him, died showing the same symptoms. Villagers who had left the village to work said "3 people died 10 days ago. 6 or 7 more are being treated in the Wendeng Central Hospital. People have been to the area to investigate, but they are unable to classify the disease." Most people outside of the village do not know about the illness. Their families do not want people who have left the village to return.
"Reporters from Sound of Hope Radio Network (SOH) interviewed local residents and staff from a health clinic. What follows are transcripts from the recorded interviews. A male villager verified that the disease broke out in the northern section of Wanjiakou Village, and spread rather quickly. The SOH reporter then phoned the Department of Health and Prevention of Contagious Diseases in Wendeng City and Yantai City, Shandong Province using numbers published on the official web sites. However, he was unable to talk with anyone, as the line was either filled with static or the call was routed to a wrong number announcement." [The actual details of the interviews are available at the URL link provided above - Mod.MPP]
--
Stephen O. Cunnion, MD, PhD, MPH
Medical Director, National Security Health Policy Center The Potomac Institute for Policy Studies
901 N. Stuart Street, Suite 200
Arlington, VA 22203
<scunnion@potomacinstitute.org>
[ProMED-mail would like to thank Dr. Stephen Cunnion for sending on this information. As a reminder, it was he who sent ProMED-mail the 1st report on an outbreak of "atypical pneumonia" in Guangdong, China, on 10 Feb 2003 that we posted and was the 1st public notification of the early outbreaks of what was later named Severe Acute Respiratory Sydrome (SARS) (see ProMED-mail posting Pneumonia - China
(Guangdong): RFI 20030210.0357 for this report).
Using the database of the Global Infectious Disease and Epidemiology Network (GIDEON <
http://gideononline.com>) to see possible etiologies for a hemorrhagic fever syndrome in China, the most likely diagnosis would be Old World hantavirus infection (57 percent probability), followed by _Streptococcus suis_ infection (40 percent), leptospirosis(1.8 percent) and Crimean-Congo hemorrhagic fever (CCHF -- less than one percent probability).
According to the GIDEON database, hantaviruses are endemic in 28 of the 32 provinces, with most cases occurring in the eastern and northeastern provinces (where Shandong is located). Hantaan virus is endemic to Hubei, Heilongjiang, Jiangxi, Jilin and Shanxi. (Fang LQ, Li CY, Yang H, Wu XM, Yang H, Chen HX, Li XW, Cao WC [Using geographic information system to study the association between epidemic areas and main animal hosts of hemorrhagic fever with renal syndrome in China.] Zhonghua Liu Xing Bing Xue Za Zhi 2004 Nov ;25(11):929-33.
- 52.2 percent of infections in Hubei are caused by Hantaan virus, and 31.5 percent by Seoul virus.
- Most infections in Shandong provin
ce are caused by Seoul virus. (Wang ZQ, Wang YL, Fu JH, Zhao L, Sun CY, Zhang XQ, Zhang YX, Fan SZ, Wang ND [Molecular analysis of hantavirus isolated from Shandong province]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2003 Jun ;17(2):121-3.)
- Seoul virus was identified in humans and rodents (_Rattus norvegicus_ and _Mus musculus_) in Beijing during 2003 to 2005. (Zuo SQ, Zhang PH, Jiang JF, Zhan L, Wu XM, Zhao WJ, Wang RM, Tang F, Dun Z, Cao WC. Seoul virus in patients and rodents from Beijing, China. Am J Trop Med Hyg 2008 May ;78(5):833-7.
A new Puumala virus subtype, most closely related to strains from Japan and South Korea, has been isolated from bank voles in Northeast China. (2007 publication) (Tang LH, Zhang QF, Xiu MH, Gu GW, Bo S, Yang XD, Liang MF, Li DX [Identification of a new Puumala hantavirus subtype in rodents from China] Bing Du Xue Bao 2007 Jul ;23(4):320-5.
The abstract does not give any information about human infection by it.
ProMED-mail has reported on hantavirus outbreaks in China earlier this year in Inner Mongolia (see Hantavirus infection - Taiwan ex China (Inner Mongolia) 20080119.0249), and in prior years (see references
below)
According to the GIDEON database, CCHF has been reported from the southwestern desert region in Xinjiang province and is referred to as Xinjiang fever. Hence it would be a significant geographic change were this outbreak to be due to CCHF. There is also mention that 10 to 20 percent of sheep, goats and cattle in Sichuan are seropositive
-- so movement of livestock from the southwest to other provinces may very well move the disease geographically.
One should not forget the earlier major outbreaks of _Streptococcus suis_ in China in 2005. A recurrence of the problem is possible.
It is noteworthy that according to the question and answer part of the referred media report, there is mention that the cases to date have been in predominantly in men, suggesting that exposure may well be occupational, which places both hantavirus infection and _Streptococcus suis_ as leading possibilities for the etiologic agent for this outbreak. The outbreak is occurring in a rural zone where there is a high likelihood of exposure of males to rodents and to the porcine population during usual occupational activities in an agricultural zone.
ProMED-mail would greatly appreciate more information from knowledgeable sources in the region on this as yet unsubstantiated report of a cluster of hemorrhagic-like illnesses with fatalities in Shandong Province.
For a map of China with geographic divisions see <
http://www.lib.utexas.edu/maps/middle_east_and_asia/china_pol01.jpg>.Of note, Shanjong province is contiguously north of Jiangsu province, where there was an outbreak of 'epidemic hemorrhagic fever' in 2007, which while the etiologic agent was not mentioned, was felt to most likely be due to an Old World hantavirus infection (see prior ProMED-mail postings Epidemic hemorrhagic fever - China
(Jiangsu) 20070113.0179 and Epidemic hemorrhagic fever - China
(Jiangsu) (02) 20070116.0206).
The interactive HealthMap/ProMED map of China can be accessed at <
http://healthmap.org/promed?v=36.5,103.9,4>This map provides links to other recent ProMED-mail postings on events occurring in China and neighboring countries. - Mod.MPP]
[Seoul virus occurs worldwide and is unlikely to be associated with a localized outbreak in China. Puumala virus is prevalent throughout northern Europe and middle Asia and is usually responsible for only mild forms of hemorragic fever with renal syndrome (HFRS). - Mod.CP]
[see also:
Hantavirus infection - Taiwan ex China (Inner Mongolia) 20080119.0249
2007
----
Streptococcus suis, human - China (Guangdong) 20070726.2411 Streptococcus suis - China (Hong Kong) 20070517.1573
Streptococcus suis - China (Hong Kong)(02) 20070527.1707
Epidemic hemorrhagic fever - China (Jiangsu) 20070113.0179 Epidemic hemorrhagic fever - China (Jiangsu) (02) 20070116.0206
2006
----
Streptococcus suis, porcine, human, 2005 - China (... 20060411.1082
2005
----
Hemorrhagic fever - China (Inner Mongolia) 20050701.1863
Streptococcus suis, human - China (Hong Kong) 20050728.2196 Streptococcus suis, porcine, human - China 20050730.2217 Streptococcus suis, porcine, human - China (20) 20051024.3099 Streptococcus suis, porcine, human - China (Sichuan) (02) 20050728.2194
Streptococcus suis, porcine, human - China (Sichuan) 20050727.2179
2000
----
Hantavirus infection - China (Chongqing) (02) 20001121.2020
Hantavirus infection - China (Chongqing): alert 20001117.2008
Hantavirus infection - China: background 20001118.2015
Hantavirus infection - China: background (02) 20001126.2056 Hantavirus infection - China: background (03) 20001206.2127
1999
----
Strep. suis, human infection - China (Hong Kong) 19991009.1810
1998
----
Hantavirus infection - China (Hong Kong) 19980412.0670 Hemorrhagic fever, epidemic warning - China 19980905.1782
1997
----
Hemorrhagic fever with renal syndrome - S.E. Asia 19970408.0743] ...............................mpp/ejp/jw
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at
<
http://www.isid.org/ProMEDMail_Premium.shtml>Hong Kong scales down avian flu response level to "alert"
---------------------------------------------------------
The Secretary for Food and Health of Hong Kong York Chow Wednesday [9 Jul 2008] announced the scale down of the response level for avian influenza from "serious" to "alert."
After the detection of H5N1 avian influenza in environmental samples collected from poultry stalls in Po On Road Market, Sham Shui Po, on
7 Jun 2008, the government had raised the response level to "serious."
With more environmental samples from 3 other retail markets found to have the virus on 11 Jun 2008, live chicken trading in Hong Kong was suspended for 21 days.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
******
[2]
Date: Thu 10 Jul 2008
Source: Cidrap News [edited]
<
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/jul1008avian-br.html>
Expert warns Hong Kong's avian flu vaccine is waning
-----------------------------------------------------
A poultry vaccine designed to protect chickens in Hong Kong from H5 avian influenza has lost effectiveness over the past 7 years of use, an expert told the Chinese media recently.
Yuen Kwok-yung, who heads the microbiology department at the University of Hong Kong, told the South China Morning Post newspaper that the virus is shifting away from the Fujian strain that it was developed for, according to a 8 Jul 2008 Deutsche Presse-Argentur (DPA) report.
He told city officials that they must ban all live chickens from markets before the vaccine becomes completely ineffective, the DPA report said. Tests on birds in 2005 suggested that the vaccine generated only a quarter of the antibody response it did in 2001.
"It takes time for the manufacturers to produce new vaccines. Hong Kong is taking its own risk if it still has live chickens in the market," Yuen said.
In early June [2008], animal health workers detected the virus in poultry feces at several market stalls. They did not say if the testing was done in response to sick or dead birds, and the source of the virus has not been determined.
Since then, officials have banned poultry from overnight stays in the market and have proposed a total ban on live poultry in Hong Kong markets. They have offered traders and farmers compensation packages in return for surrendering their sales licenses, but the offer has angered the poultry merchants, who have said the government's offer was too low, according to previous reports.
[Byline: Lisa Schnirring]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[Until February/March 2002, stamping-out policy was applied to control HPAI H5N1. With endemic presence of the virus in the region becoming apparent and in view of the large daily importation of poultry to Hong Kong, the Administration considered that further risk management measures, in addition to improved biosecurity and enhanced surveillance, were necessary to prevent outbreaks. The decision to add vaccination is analysed in the paper "Use of avian influenza vaccination in Hong Kong" by Ellis, Simms et al. from the Agriculture Fisheries and Conservation Department, Kowloon, Hong Kong SAR, published in Dev Biol (Basel). 2006;124:133-43. Its abstract includes the following data:
"Vaccination using a killed H5N2 vaccine was evaluated over a 12-month period in the district with the last HPAI cases in the early
2002 outbreak. The vaccination trial showed that farmer-administered killed H5N2 vaccine produced suitable flock antibody responses; vaccinated birds were protected against H5N1 HPAI virus challenge and excreted significantly less H5N1 virus; and vaccination was able to control virus excretion in flocks during field outbreaks. Universal vaccination of local chicken farms was introduced in June 2003 and by the end of 2003 all chickens entering the live poultry markets in Hong Kong were vaccinated by killed H5N2 vaccine. In addition to vaccination, an enhanced biosecurity programme on farms and in live poultry markets and a comprehensive surveillance programme in poultry, wild birds, recreation park birds and pet birds were in place. Vaccination use and performance is closely monitored. This programme was successful in protecting local farms and live poultry markets from H5N1 outbreaks during the regional H5N1 outbreaks in 2004."
Hong-Kong's policy and its meticulous applications have been regarded appropriate, even exemplary, for several years. As commented in the above paper, its performance is closely monitored, and rightly so.
The recent comments of Yuen Kwok-yung from the microbiology department at the University of Hong Kong deserve considerations by the evaluators. - Mod.AS]
[see also:
Avian influenza (80): China (Hong Kong, Guandong), UK 20080617.1900 Avian influenza (75): China (Hong Kong) 20080607.1814 Avian influenza (41): Viet Nam, China (Hong Kong) 20080308.0951 Avian influenza (34): China (Hong Kong), Laos 20080213.0574 Avian influenza (30): Turkey (Sakarya), Bangladesh, Hong Kong 20080206.0488
2007
----
Avian influenza (178): Hong Kong, Saudi Arabia, Myanmar, S.
Korea 20071126.3827
Avian influenza (94): Viet Nam, China (Hong Kong) 20070602.1786 Avian influenza (32): UK (England), China (Hong Kong), Turkey 20070212.0534 Avian influenza (30): China (Hong Kong), UK 20070209.0512 vian influenza (12): Hong Kong, Thailand, Japan, OIE 20070118.0237 Avian influenza (09): Viet Nam (Vinh Long), Hong-Kong 20070114.0190
2006
----
Avian influenza - Eurasia (42): EU, Hong Kong, prevention 20060203.0353 Avian influenza - Eurasia (40): Near East, Hong Kong 20060201.0332 Avian influenza, human - Eurasia (44): Hong Kong, alert 20060201.0330 Avian influenza - Eurasia (36): Hong Kong, wild birds, OIE 20060130.0291 vian influenza - Eurasia (35): Cyprus, Hong Kong, conf. 20060129.0283 Avian influenza, Eurasia (25): Hong Kong, China 20060120.0183
2004
----
Avian influenza - Eastern Asia (147): Hong Kong, OIE 20041220.3356 Avian influenza - Eastern Asia (146): Hong Kong 20041216.3322 Avian influenza - Eastern Asia (144): Hong Kong, conf. 20041214.3302 Avian influenza, falcon - China (Hong Kong)(02): OIE 20040127.0314 Avian influenza, falcon - China (Hong Kong) 20040121.0243
2003
----
Avian influenza - China (Hong Kong): OIE (02) 20030126.0236 Avian influenza - China (Hong Kong): OIE 20030120.0186 Avian influenza - China (Hong Kong) (02) 20030107.0054 Avian influenza - China (Hong Kong) 20030105.0036
2002
----
Avian influenza - China (Hong Kong) (14) 20021228.6144 Avian influenza - China (Hong Kong) (12) 20021219.6092 Avian influenza, H5N1/97-like viruses - China (Hong Kong) 20020622.4567 Avian influenza - China (Hong Kong) (08) 20020405.3890 Avian influenza - China (Hong Kong) (06) 20020224.3627 Avian influenza - China (Hong Kong) (05) 20020220.3593 Avian Influenza - China (Hong Kong) (03) 20020209.3516 Avian influenza - China (Hong Kong) (02) 20020206.3492
2001
----
Avian influenza, H5N1 - China (Hong Kong) (07) 20010710.1332 Avian influenza, H5N1 - China (Hong Kong) (06) 20010528.1038 ] ....................arn/ejp/dk
H5N1 fears on smuggled chickens
-------------------------------
Smuggled chickens may have been the cause of the latest outbreak of the bird flu virus. The suspicions arose after the farms that supplied the 3 stalls at the center of the H5N1 outbreak cleared preliminary checks.
Customs officials said yesterday [9 Jun 2008] they are treating reports of smuggling seriously. Officers also said they would be stepping up intelligence-gathering operations to prevent underground poultry shipments.
"We will collaborate with the Agriculture, Fisheries, and Conservation Department (AFCD) and the Food and Environmental Hygiene Department (FEHD) in investigating the reported problem of smuggling at both the wholesale and retail levels," said Tam Yiu-keung, acting assistant commissioner of intelligence and investigation at the Customs and Excise Department.
AFCD assistant director of inspection and quarantine Thomas Sit Hon-chung
added: "Invoices show the chickens that tested positive came from 3 local and 6 mainland registered farms. But checks at the 3 local farms showed no problems, and mainland inspection and quarantine authorities have also confirmed there are no problems with the 6 farms on their side." Sit said more than 70 samples taken from farms, wholesale, and retail markets all tested negative for H5N1. More tests will be conducted at local and mainland farms and the results will be out in a few days.
The FEHD has sent inspectors to mainland farms and processing plants.
Sales of around 4000 chickens left in the Cheung Sha Wan Temporary Wholesale Poultry Market resume today [10 Jun 2008] after samples tested negative.
Hong Kong Poultry Wholesalers' and Retailers' Association chairman Steven Wong Wai-chuen said he had heard that chilled chickens were being smuggled in by sea and land in air-conditioned carriers from Shenzhen. "The wholesale price of such chickens is about HKD 7-8 [USD 0.9-1.02] a catty [catty = about 1.3 lbs or 600g], while the usual price is about HKD 16 [USD 2.05] a catty," he said. All chickens were slaughtered and chilled in yesterday's [9 Jun 2008] citywide cleanup -- earlier than the bi-monthly routines on the 25th and 10th of every month. Wong expected the sector to lose HKD 100 million [about USD 12.8 million] in sales during the 21-day suspension of chicken imports.
Traders dropped a plan to free chickens at SAR [Hong Kong Special Administrative Region] government headquarters and Government House yesterday [9 Jun 2008] after meeting with officials on Sunday [8 Jun 2008].
That came after FEHD acting director of operations Chu Lan-ying said compensation is being considered, with HKD 30 000 [USD 3842] and a 3-month rent waiver planned for vendors in government markets and HKD 60 000 [USD 7684] for vendors in markets managed by The Link.
The scare erupted on Saturday [7 Jun 2008] after chickens at the Po On Road market in Sham Shui Po tested positive. All 2700 chickens in the market's 9 stalls were culled.
[byline: Carol Chung]
--
communicated by:
ProMED-mail rapporteur Mary Marshall
[This was rather to be expected considering the situation in mainland China. - Mod.MHJ
Hong Kong can be located on the HealthMap/ProMED-mail interactive map at <
http://healthmap.org/promed?v=36.5,103.9,4>. - CopyEd.MJ]
