China - H5N1 death in Alberta, Canada upon return from China trip - died from meningoencephalitis

[sharon sanders]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

There are several repetitive reports in the Chinese press that the patient did not have access to any poultry or markets while in Beijing. It should be interesting to see how the WHO handles this investigation. No onset date is mentioned in this article. The US CDC press release above says the patient died on the 4th while some Canadian reports state the 3rd. So there is lots to sort out.

Chinese embassies and consulates in Canada and one died of bird flu drew attention

At 9:52 on January 9, 2014Source: People's Daily
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　　People in Ottawa January 8 (Reporter Xuejiang) this afternoon, Health Canada held a press conference to announce the deaths due to H5N1 avian influenza together and concurrent cause of coronavirus. 　　Informed that a patient on January 1, 2014 due to influenza hospitalization in Alberta, died after January 3.

Informed that: before admission, the patient was December 27, 2013 multiplied by AC030 flights from Beijing arrived in Vancouver on the same day ride AC244 arrived in Edmonton, Alberta. 　　Conference emphasized that this case the Department of North America's first individual cases of H5N1 avian influenza infection, are isolated cases, does not spread from person to person. 　　After hearing the news, the Consulate General in Calgary my first time with the Canadian Ministry of Foreign Affairs and the Alberta Health Department made contact, requiring further informed of the situation to my library. 　　Recently, Cadogan ground, especially in Alberta and Ontario, H1N1 flu epidemic has led to more than a dozen people were killed, thousands hospitalized. Health Canada said that in the winter, the national low temperatures, and longer duration, thus aggravating the flu epidemic. The number of influenza infections this year over the same period last year, the number of flu patients more than 2-fold. Provinces health authorities urged residents to the hospital as soon as possible influenza vaccination. Chinese Consulate General in Calgary remind local Chinese compatriots on the mainland, Hong Kong, Macao and Taiwan compatriots, the official close attention to local information and tips about timely vaccinations, do preventive work. 　　Author: Xuejiang (Source: People's Daily Online - International Channel)

[alert]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

There are several repetitive reports in the Chinese press that the patient did not have access to any poultry or markets while in Beijing. It should be interesting to see how the WHO handles this investigation. No onset date is mentioned in this article. The US CDC press release above says the patient died on the 4th while some Canadian reports state the 3rd. So there is lots to sort out.

Chinese embassies and consulates in Canada and one died of bird flu drew attention

At 9:52 on January 9, 2014Source: People's Daily
Mobile client
Save to blog
　　People in Ottawa January 8 (Reporter Xuejiang) this afternoon, Health Canada held a press conference to announce the deaths due to H5N1 avian influenza together and concurrent cause of coronavirus. 　　Informed that a patient on January 1, 2014 due to influenza hospitalization in Alberta, died after January 3.

Informed that: before admission, the patient was December 27, 2013 multiplied by AC030 flights from Beijing arrived in Vancouver on the same day ride AC244 arrived in Edmonton, Alberta. 　　Conference emphasized that this case the Department of North America's first individual cases of H5N1 avian influenza infection, are isolated cases, does not spread from person to person. 　　After hearing the news, the Consulate General in Calgary my first time with the Canadian Ministry of Foreign Affairs and the Alberta Health Department made contact, requiring further informed of the situation to my library. 　　Recently, Cadogan ground, especially in Alberta and Ontario, H1N1 flu epidemic has led to more than a dozen people were killed, thousands hospitalized. Health Canada said that in the winter, the national low temperatures, and longer duration, thus aggravating the flu epidemic. The number of influenza infections this year over the same period last year, the number of flu patients more than 2-fold. Provinces health authorities urged residents to the hospital as soon as possible influenza vaccination. Chinese Consulate General in Calgary remind local Chinese compatriots on the mainland, Hong Kong, Macao and Taiwan compatriots, the official close attention to local information and tips about timely vaccinations, do preventive work. 　　Author: Xuejiang (Source: People's Daily Online - International Channel)

I thought the phrase "concurrent case of coronavirus" might be an artifact of machine translation, but it appears the patient may have also tested positive for a (human?) coronavirus:

http://ca.news.yahoo.com/canadian-press-newsalert-fatal-case-h5n1-bird-flu-205021777.html

[snip]

But a chest X-ray showed signs of pneumonia and the unidentified hospital ran a battery of tests. The influenza A test came back positive, as did one for a human coronavirus, one of the causes of common colds. The team wondered for a time if the severity of the illness was due to the co-infection with two viruses.

[snip]

[NS1]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

I also thought we were looking at a translation error or a dual report covering two separate cases. Thank you for validating the communique.

Either we are seeing an extremely low probability viral storm in one patient or something is amiss at the source of the communications cycle.

[NS1]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

I also thought we were looking at a translation error or a dual report covering two separate cases. Thank you for validating the communique.

Either we are seeing an extremely low probability viral storm in one patient or something is amiss at the source of the communications cycle.

Unless they are actually going to the trouble of reporting a common cold, rather than a beta CoV?

[alert]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

It is certainly possible that she picked up an OC43 or NL63 or such other human coronavirus co-infection either in China or in Canada; it is winter in the Northern Hemisphere after all. Technically, I believe MERS is thought to be an animal coronavirus, not a human one.

Neither China nor Canada has reported any MERS cases, so something would be seriously amiss if that were the coronavirus detected.

[alert]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

Here's another possible complication:

http://www.torontosun.com/2014/01/08/first-case-of-h5n1-avian-flu-confirmed-in-canada

[snip]

Officials would not confirm that the person who died was a woman who worked at a Red Deer, Alta., hospital.

[NS1]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

It is certainly possible that she picked up an OC43 or NL63 or such other human coronavirus co-infection either in China or in Canada; it is winter in the Northern Hemisphere after all. Technically, I believe MERS is thought to be an animal coronavirus, not a human one.

Neither China nor Canada has reported any MERS cases, so something would be seriously amiss if that were the coronavirus detected.

Precisely. SARS2 is unlikely as co-infection with H5N1 and unlikely in geography.

However, if they went to the trouble of reporting a HCoV, I would expect to see a complete sero panel, not just H5 and HCoV.

[Giuseppe]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

The situation is really disconcerting.

A rare infection - H5N1 is indeed a rare event in humans - detected in a remote world area in a passenger from China with meningo-encephalitis, with possibly dual infection with other pathogens, such as an human coronavirus.

Now, every day in the world millions of people travel to and from China and some of them will fall ill with a number of conditions, infectious and not.

As other Members pointed out, what is the likelihood to identify an H5N1 infection in a such massive amount of individuals?

Or in other words, how many H5N1 cases went missed in the last ten years at least?

If considers that only in Nepal there were this year hundreds of poultry H5N1 outbreaks - and that Nepal is a busy touristic location - one would expect that at least some of these travelers would have been ill with this virus.

Why now? Why not in 2003 (start of H5N1 panzootic), or 2005 (after the global dissemination through Qinghai Lake wild birds mass die-off), or in 2007 (remember the Pakistani cluster and the Long Island suspected cases)?

Several things must be clarified about this incident. GM

[sharon sanders]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

January 08, 2014

Thinking about the Canadian H5N1 case

When I remarked that this was a busy day, early in the morning, I had no idea how right I was. The announcement (which I picked up via Twitter) of the H5N1 death in Alberta knocked everything else off the table. And after a couple of hours of reflection I think I see some aspects of the case that might be worth discussion.

We know from the CBC that the person was younger than Alberta's 58-year-old medical officer of health, and it seems likely that the person was a woman. For the sake of simplicity I'll assume she was. We also know she did not leave Beijing during her visit to China, and she did not come into contact with poultry on a farm or in a market. She may have been in contact with live poultry in some restaurant.

What we don't know is immense: Was she a tourist or businessperson from Canada, or a recent immigrant home for a holiday? When exactly was she in China, and where in Beijing did she go? What was her prior medical history? If she was starting to feel ill as she left China on December 27, where had she been 3 or 4 days earlier where she might have been exposed to H5N1? And why didn't she show the usually symptoms of cough, fever, etc.?

In some ways, her case is more alarming for the Chinese than for us. It would have been extremely unlikely for her to infect anyone else. But H5N1 hasn't been reported in humans in China for almost a year. They reported a poultry outbreak in Guizhou, far from Beijing, a week ago. China's last human cases were reported to WHO almost a year ago. Both were dead by March 12. (I can't find specific WHO reports on these cases.)

Granted, the Chinese health authorities have been distracted by H7N9 since last spring, but their relative openness about that disease suggests they would have certainly reported any H5N1 cases as well.

One of the maddening aspects of H7N9 is that it doesn't bother the chickens; they carry it invisibly right up to the end of their lives, and only rarely does a poultry dealer or customer actually catch it. So we're the canaries in Chinese poultry's coal mine.

Is it possible that H5N1 has learned this trick from its cousin H7N9? That's a very unpleasant thought.

Or are asymptomatic H5N1 carriers roaming Beijing? That's unpleasant too. One objection to H5N1's seemingly awful case fatality rate is that many people may contract it without effect. If so, then the CFR would be far lower than it currently seems to be. But very few humans have been found with H5N1 antibodies. (Granted, the first case in Indonesia, back in 2005, was a healthy labourer who was found to be carrying such antibodies.)
The Chinese must also be worrying about their surveillance methods. When the little daughter of a Beijing poultry dealer came down with H7N9 last spring, her whole neighbourhood got tested (a little boy across the street appeared to be asymptomatic). But H5N1 in Beijing seems to have eluded them.

This is also, to the best of my knowledge, the first long-distance export of an H5N1 case—exactly the kind of case we've been fretting about for years, and also the kind of case that moved H1N1 around the world so quickly in the spring of 2009.

H5N1 has so far been a disease of poor farmers and working- or middle-class Asian urbanites. Such people don't travel far. If H5N1 is showing some social mobility up into the jet set, that lends a new terror to air travel (which already has too many terrors).

Taking exams is very educational, because exams teach us what we don't know. H5N1 has just run a snap quiz on us, and we've bombed it. Back to the books.

http://crofsblogs.typepad.com/h5n1/2014/01/thinking-about-the-canadian-h5n1-case.html

[sharon sanders]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

In 2012 a boy, 2, from Guangdong province was hospitalized in Hong Kong with an H5N1 infection. His main symptom was obstructive hydrocephalus.

Malik Peiris, a virology professor at the University of Hong Kong, was quoted in The Standard: in regard to this case "that hydrocephalus is an 'atypical' presentation of H5N1 infection. Patients with bird flu usually exhibit cough and fever."

Our thread on this case here.

[Giuseppe]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

We had a case in Indonesia with neurological symptoms (Karo Cluster)(2), for example.

It seems useful to remember the case of the Pakistani cluster(1) when a family clan was infected by H5N1 and one of these people traveled back to the US with suspicious symptoms. The subjects involved (even a relative) tested negative later.

H5N1 has not Always be a poors disease: several cases in China involved wealthy people and even a PLA soldier(4) in Beijing.

So far, H5N1 has been deadly for poultry (see for example the massive die-off in Nepal this year) and elsewhere continues to be endemic (Egypt, Indonesia, Vietnam) but fell out of radar after the emergence of H7N9 and MERS.

Wild birds demonstrated a variable susceptibility to this virus, according the species and viruses' clade.

In Austria(3) during 2013 smuggled and infected birds have been collected by border authorities.

It is clear that world must not be complacent with H5N1 even though for some reasons it seems a minor candidate for a pandemic (wrongly thought, I suspect), with respect other novel reassortant like H7N9, H9N2 and the recent H1pdm09.

gm

______

(1) Pakistan Cluster of H5N1 human Cases FT thread: http://www.flutrackers.com/forum/showthread.php?t=46327
(2) Indonesia Sumatra's Karo Cluster of Human H5N1 cases FT Thread: http://www.flutrackers.com/forum/showthread.php?t=5653
(3) Austria imported smuggled H5N1 infected birds FT thread: http://www.flutrackers.com/forum/sho...d.php?p=501437
(4) First 2003 H5N1 human case in China, a PLA soldier, on FT archive: http://www.flutrackers.com/forum/arc...p/t-24995.html

[sharon sanders]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

Because the onset of symptoms are reported to have occurred in December 2013, this case will be counted in the year 2013 H5N1 totals by the World Health Organization.

Reading my mind Al!

The WHO has started their investigation.

H5N1 death detective work by WHO begins in Alberta case

[alert]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

There is not a doubt in my mind that the identity of this young woman is going to be leaked eventually, probably through social media. I would assume she has friends who are very upset.

Here is a bit more information from a Chinese language Canadian source:

http://info.51.ca/news/canada/2014/01/09/323362.shtml

20-year-old Chinese girl returned dye H5N1 death: doctors advise

Federal Health Minister Rona Ambrose confirmed the first case of human infection in Canada appears H5N1 avian influenza cases, the deceased was a 20-year-old Alberta girl, she at December 27, 2013 from Beijing China flight back, she was already on the plane headache, fever and general weakness symptoms, January 1 hospitalized, seriously ill died two days later. But because the girl did not cough symptoms, so the chance of infecting others on the plane was very low, and the variant of H5N1 yet to easily from person to person, so the public need not panic.

[snip]

[Pathfinder]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

Translation Google

Beijing reported no cases of bird flu

January 10, 2014 Source: Beijing Times

Beijing Times (Reporter Li Qiumeng) for Health Canada announced the day before yesterday, "a Canadian citizen from Beijing to fly back because of the H5N1 strain of bird flu incidence of death" issue, the Beijing Municipal Health Bureau, said yesterday that as of last weekend, the city is no bird flu Case Report. Currently the city has entered the seasonal flu and other respiratory diseases high season, influenza activity continues to strengthen in the future, or centralized heating phenomenon will further increase.

Canada appears H5N1 deaths

Canadian Health Minister Rona Ambrose, the 8th confirmed that a resident of Alberta, Canada, died of H5N1 avian influenza on the 3rd death. This is the first case of H5N1 avian flu deaths in North America.

Ambrose said, the patient returned to Canada from Beijing China last year after the onset of December 27, died of his wounds. 7, released its autopsy report confirmed the H5N1 bird flu virus died. Canada, China and the World Health Organization has been notified. It is not known route of infection of the deceased.

This is North America's first case of the H5N1 bird flu deaths, but are isolated medical records, two with their close contacts have been under medical observation, there are no disease symptoms.

Beijing Not bird flu reports

Beijing Municipal Health Bureau, CDC has been established in the city of pneumonia of unknown causes at all levels of medical institutions to monitor, surveillance of influenza-like illness, the symptoms of influenza pathogen monitoring and surveillance of communicable diseases. Once suspected cases must be reported to the first time. As of last weekend, the city reported no cases of bird flu.

CDC said the city is currently flu virus was increasing, and has entered the peak season for seasonal influenza and other respiratory diseases, the recent collective center received several units and schools gathered febrile report. In the coming period, influenza activity levels will continue to enhance the city, leading to the possibility of centralized by the influenza virus fever epidemic in schools and other collective units will further increase occurred.

■ Glossary

H5N1 avian influenza

H5N1 avian influenza virus in poultry and wild birds easy to spread, but spread to humans more difficult. However, this virus is fatal, since 2003, the global total of 15 countries reported 648 individuals infected with the H5N1 strain of bird flu cases, including 384 cases of death.

■ Tips

CDC to remind the public to maintain good personal hygiene and indoor environmental health; strengthen wash their hands and other good health habits; patients with influenza and other respiratory diseases should wear masks at home or away, is not recommended to go to work sick to go to school, so infect others, resulting in the spread of disease: the population concentrated in the collective unit, the high school season in respiratory disease should pay attention to strengthening health monitoring, especially to enhance ventilation and indoor environmental disinfection work in confined spaces, in order to reduce the spread of infectious diseases.

zhttp://epaper.jinghua.cn/html/2014-01/10/content_55018.htm

[sharon sanders]

Re: Canada - H5N1 death in Alberta after travel from China - died from meningoencephalitis

The above story also reported in Sina, a major media outlet in China. Apparently the Beijing Municipal Health department says there are no H5N1 cases reported.

"...the Beijing Municipal Health Bureau, said yesterday that as of last weekend, the city is no bird flu Case Report..."

zhttp://news.sina.com.cn/c/2014-01-10/015929201823.shtml


I did not find anything on the Beijing health department web site.