Vietnam - H9N2 avian flu case hospitalized in Tien Giang province - April 6, 2024

[Michael Coston]

Vietnamese Media Reports: Severe A/H9 Case Reported in Tien Giang Province



Credit Wikipedia

#17,993


For the second time in just over 2 weeks Vietnamese state run media is reporting a severe human avian flu infection; this time it is A/(H9) - the first time a human case of this subtype has been reported in that country. While the full subtype has not been determined - unless it is a new reassortment - it is most likely H9N2.

After years of relative quiescence, in recent months we've seen a flurry of avian flu activity in Vietnam - including a fatal H5N1 case reported in late March - and just yesterday, a warning from the FAO on a new H5N1 reassortment in the Mekong Delta region.

Although roughly 130 cases have been reported (see FluTracker's list) over the past 25 years (see ECDC/EFSA graphic below), most have been mild, and the virus is usually detected in children. Nearly 90% of all known cases have been reported by China.



While I haven't found anything posted on the Vietnamese MOH or CDC websites (yet), state run media is widely reporting on the case. First, the following (translated) report from VOV.vn (Voice of Vietnam), after which I'll have a bit more.

Tien Giang conducts emergency treatment after detecting the first case of influenza A/H9

Saturday, 16:21, April 6, 2024


VOV.VN - Information from Pasteur Institute, City. Ho Chi Minh City, just discovered the first case of Influenza A/H9 in the country in Tien Giang province. The health sector, veterinary medicine and local authorities are taking urgent measures to prevent the spread of this disease.

That is patient Nguyen Van D., 37 years old, working as a construction worker, residing in Tan Quoi hamlet, Tan Ly Dong commune, Chau Thanh district (Tien Giang province), currently being treated at the Hospital of Tropical Diseases in Ho Chi Minh City.

Tien Giang Disease Control Center has coordinated with Chau Thanh District Health Center, Tan Ly Dong Commune People's Committee, Epidemiology Department of Region VI Veterinary Department, Livestock and Veterinary Department, Agricultural Service Center Chau Thanh district verified case information, investigated epidemiology and took measures to handle the outbreak in accordance with regulations.

On March 9, the patient had fever, cough with phlegm, abdominal distention, and loss of appetite to be examined at Military Hospital 120 with a diagnosis of liver fibrosis and cirrhosis. The hospital advised the patient to be hospitalized for treatment at the Hospital. City Hospital for Tropical Diseases. HCM and found positive for Influenza AH9. Through verification, this patient 4 weeks ago only lived at home with his wife and did not leave the place of residence; Sometimes I drink alcohol with 2 other people at home. Near the house there is a slaughterhouse and live poultry trading facility.

According to the instructions of the Pasteur Institute of Ho Chi Minh City, the local health sector is handling the epidemic according to the instructions for monitoring and preventing influenza A (H5N1) and influenza A (H7N9); Coordinate with veterinary agencies at all levels to share information about the epidemic situation and coordinate to investigate and handle outbreaks, and take samples for testing on poultry in areas near the patient's home; Perform surface disinfection with Chloramin B 2% in the patient's household and surrounding area; Make a list and monitor daily health of cases who have had close contact with the patient within 14 days from the last contact for adults and 21 days for children under 15 years old.

Instruct close contacts to monitor if they have symptoms such as fever, cough, difficulty breathing, etc. to immediately report to the Health Station. Assign Tan Ly Dong Commune Health Station to monitor and monitor the health of close contacts daily within 14 days from last contact for adults and 21 days for children under 15 years old. During the monitoring period, if there are suspicious symptoms, the Health Station will notify the Tien Giang Center for Disease Control to take samples.

As an LPAI (low path avian influenza) virus, H9N2 is not considered a `reportable' disease by WOAH (formerly the OIE), even though it is zoonotic. We've seen seroprevalence studies which suggest people with exposure to infected poultry often develop H9 antibodies, suggesting mild or asymptomatic infection.

Over the past 15 years we've watched as H9N2 has expanded its geographic range - spreading out of Asia into Europe, the Middle East and Africa. While it occasionally spills over into humans, H9N2's biggest threat may come from its unique ability to reassort with other, potentially more dangerous, avian viruses.



Its internal genes have often been found inside many HPAI viruses (including H5N1, H5N6, H7N9, and most recently zoonotic H3N8) - (see The Lancet's Poultry carrying H9N2 act as incubators for novel human avian influenza viruses).


Reassortment can also occur in humans, and with seasonal flu viruses. The possibility exists that someone could bhttps://afludiary.blogspot.com/2024/04/vietnamese-media-reports-severe-ah9.htmle co-infected with seasonal flu and H9N2, allowing a hybrid (reassortment) to emerge (see The `Other Mixing Vessel' For Pandemic Influenza).



Note quite a month ago, in Infectious Medicine: Rapid Adaptive Substitution of L226Q in HA protein Increases the Pathogenicity of H9N2 Viruses in Mice, we looked at mutations that can enhance the pathogenicity in mammals.

Given unusual severity of today's case, and the FAO Alert issued yesterday on the co-circulation of two clades of H5N1, and the emergence of a new H5N1 genotype in the Mekong Delta Region, we'll be interested to see what - if any - changes may have occurred in this virus.

While LPAI H9N2 ranks pretty far down our pandemic threats list - at least as a standalone virus - it's ability to reassort with potentially more dangerous avian, human, and swine flu viruses make any uptick in cases worthy of our attention.

https://afludiary.blogspot.com/2024/04/vietnamese-media-reports-severe-ah9.html

[Shiloh]

Source: https://en.sggp.org.vn/first-case-of...ost109206.html

First case of A/H9N2 influenza in Vietnam under treatment in HCMC
SGGPO
April 6, 2024 at 06:49:39
The patient, a 37-year-old male construction worker from Chau Thanh District, Tien Giang Province, was transferred from Military Hospital 120 in My Tho City, Tien Giang Province, to HCMC Hospital for Tropical Diseases for treatment on March 16.

On April 6, the HCMC Department of Health reported a confirmed case of A/H9N2 influenza undergoing isolation and treatment at HCMC Hospital for Tropical Diseases. The patient, a 37-year-old male construction worker from Chau Thanh District, Tien Giang Province, was transferred from Military Hospital 120 in My Tho City, Tien Giang Province, to HCMC Hospital for Tropical Diseases for treatment on March 16.

Before seeking medical attention and treatment, the patient resided and worked at his place of residence. He had not received vaccinations for influenza or Covid-19. Opposite the patient's house lives his sister and brother-in-law, who are directly involved in slaughtering and trading poultry (including chickens, ducks, and field mice). However, the patient did not have direct contact with poultry. The patient's household also raises two geese for egg-laying purposes for family consumption, with no eggs being supplied to the outside. As of now, the health condition of individuals in the patient's sister's and brother-in-law's households remains robust, and there have been no reports of poultry deaths or abnormal symptoms at these locations.

On March 10, the patient started experiencing symptoms of fever and occasionally self-medicated. By the morning of March 16, the patient complained of pain in both legs and abdominal swelling, prompting his relatives to take him to Military Hospital 120 for examination. There, doctors diagnosed the patient with liver fibrosis and advised him to seek further examination and treatment at HCMC Hospital for Tropical Diseases...

[sharon sanders]

Please see:

H9N2 Avian Flu: FluTrackers Global Cumulative Partial Case List 1998 - Current

H5N1 Avian Flu: FluTrackers 2016 - Current Global Case List

[Commonground]

Ho Chi Minh City Pasteur Institute reports on influenza A/H9N2 discovered for the first time in Vietnam
06/04/2024 20:09
Excerpt:

Dr. Nguyen Vu Thuong said that immediately after receiving information about a case of influenza A/H9N2 in a person being treated at the Hospital for Tropical Diseases in Ho Chi Minh City, the Institute closely coordinated with the Hospital for Tropical Diseases. Tropical Ho Chi Minh City and the health sector of Tien Giang province, where the patient lives, to localize epidemiological investigation and risk assessment.

Photo captions
The patient is being treated in isolation in the negative pressure room at Ho Chi Minh City Hospital for Tropical Diseases.
Through epidemiological investigation, this is a 37-year-old male patient with underlying diseases such as cirrhosis and diabetes. The patient was admitted to the hospital with symptoms of severe pneumonia and respiratory failure. The veterinary department of Tien Giang province investigated and found that there was an area selling and slaughtering poultry near the patient's house. People in close contact with the patient are still healthy at present.

According to a report from the Department of Health of Ho Chi Minh City, the patient was hospitalized at the Department of Emergency Medicine - Adult Intensive Care and Poison Control at Ho Chi Minh City Hospital for Tropical Diseases on the afternoon of March 16 with a diagnosis of bleeding monitoring. Digestion on the background of gastric ulcer, disease with alcoholic cirrhosis, monitoring for sepsis.

During treatment, the patient had pneumonia with images of diffuse alveolar and interstitial damage to both lung fields on X-ray, and was assigned to take a nasopharyngeal swab sample to do a PCR test for influenza A virus. B. Respiratory failure gradually worsened, the patient was intubated and mechanically ventilated.

On March 22, the patient's nasopharyngeal swab test results (1st time) were positive for influenza A, negative for influenza B, the strain could not be determined. On March 26, the patient had an X-ray to check the damage to the lung tissue on both sides, which showed no improvement; Nasal and throat swab samples were taken (second time) to do PCR testing for influenza A and B viruses and continued treatment. On April 1, the Ho Chi Minh City Hospital of Tropical Diseases Laboratory coordinated with the Oxford University Clinical Research Unit (OUCRU) to decode the gene sequence to identify patients with influenza A/H9N2 virus.

Currently, the patient continues to be treated in the negative pressure isolation room of the adult intensive care and toxicology department with a follow-up diagnosis of sepsis from pneumonia, influenza A, invasive fungal infection, complications of respiratory failure, pulmonary hemorrhage, stable abdominal bleeding, gastrointestinal bleeding, acute kidney injury, alcoholic cirrhosis, liver tumor monitoring.

Faced with the above situation, the Department of Health of Ho Chi Minh City has directed the Ho Chi Minh City Hospital for Tropical Diseases to effectively isolate, treat and care for patients in accordance with the Ministry of Health's regulations on avian influenza. The Infection Control Department monitors the health status of medical staff who have cared for patients (all staff who come into contact with patients from the moment of admission to the hospital wear protective equipment in accordance with regulations).

Continued: https://baotintuc.vn/y-te/vien-paste...6192000444.htm

[Pathfinder]

Translation Google

The first case of influenza A/H9 appeared in Vietnam, the Ministry of Health directed urgently

Lien Chau- lienchautn@gmail.com
April 6, 2024 12:18 GMT+7

After recording the first case of influenza A/H9 in Vietnam, a case in Tien Giang, this morning, April 6, the Department of Preventive Medicine (Ministry of Health) sent an urgent dispatch to the Department of Health of Tien Giang province and the Institute of Health. Pasteur Ho Chi Minh City proposed to strengthen the prevention and control of avian influenza from spreading to humans.

The patient received intensive treatment after 6 days of self-treatment

According to this morning's announcement on April 6 from the Ministry of Health(Department of Preventive Medicine), the case of avian influenza - influenza A/H9 is a male patient, 37 years old, residing in Tan Ly Dong commune, Chau Thanh district, Tien Giang Province.

On March 10, the patient developed symptoms of fever and self-medicated but did not use it regularly.

The patient came for examination and treatment at the Hospital for Tropical Diseases in Ho Chi Minh City on March 16 and was diagnosed with severe pneumonia suspected to be caused by a virus. Initial test results at the Ho Chi Minh City Tropical Diseases Hospital detected positive for influenza A and had gene segments similar to influenza A virus subtype H9. The patient sample was sent to the Pasteur Institute in Ho Chi Minh City for confirmation testing.
First case of influenza A/H9 recorded in Vietnam, Ministry of Health directs urgent measures to prevent bird flu spread

MOH

On April 1, Ho Chi Minh City Pasteur Institute discovered that the patient sample was positive for influenza A subtype H9 and is continuing to perform in-depth tests to determine the subgroup. The patient is being actively treated at the Ho Chi Minh City Tropical Diseases Hospital.

According to the results of the epidemiological investigation, the patient's place of residence is located in a poultry market, and there is a poultry market in front of the patient's house. There have been no reports of sick or dead poultry around the area where the patient's family lives.

Cases in close contact with patients are listed and their health monitored; Up to now, no symptoms of respiratory infection have been detected; No outbreak of respiratory infections has been recorded in the community where the patient lives.

This is the first case of influenza A/H9 in Vietnam ever. To prevent bird flu from spreading to humans, the Department of Preventive Medicine requested the Director of Tien Giang Department of Health to direct affiliated units to urgently investigate the source of infection and thoroughly handle the outbreak; Strengthen surveillance to detect new cases, be ready to collect, quarantine, and treat according to regulations of the Ministry of Health and direct the disease control center to promptly deploy epidemic prevention and control measures.
...
Potential risk of bird flu infection to humans

According to the Ministry of Health, from 2015 to present, in the Western Pacific region, there have been 98 cases of influenza A/H9N2, including 2 deaths , both of which were patients with the disease. background. Of these, 96 cases were recorded in China and 2 cases were recorded in Cambodia. There is currently no evidence that influenza A/H9N2 is transmitted from person to person.

Domestically, according to information from the Department of Animal Health (Ministry of Agriculture and Rural Development), influenza A/H9N2 virus was previously detected circulating in poultry. This is a low-virulence avian influenza virus, usually causing mild symptoms and not causing mass deaths of poultry. However, humans can still be infected and contract avian influenza A/H9N2 if they contact and use infected poultry and poultry products.

Currently, it is the changing season, and unusual weather changes are favorable conditions for pathogens to develop, increasing interactions between influenza virus strains along with the risk of infection to mammals. , the Ministry of Health said that in the coming time, there is still a potential risk of transmitting avian influenza virus strains to humans.

https://thanhnien.vn/xuat-hien-ca-benh-cum-a-h9-dau-tien-tai-viet-nam-bo-y-te-chi-dao-khan-185240406115848494.htm

---------------------------------------------------

The Department of Animal Health announced the results of testing for avian influenza virus A/H9N2 in Tien Giang

April 6, 2024 19:26 GMT+7

The Department of Animal Health (Ministry of Agriculture and Rural Development) directed the local veterinary agency to take samples to test for avian influenza virus A/H9N2, and closely monitor the poultry herd at Tan Quoi hamlet (Tan Ly Dong commune, District 1, Ho Chi Minh City). Chau Thanh, Tien Giang), where the first human case of avian influenza A/H9 infection was detected in Vietnam.

Talking to Thanh Nien on April 6, a leader of the Department of Animal Health informed about the results of testing for avian influenza virus A/H9N2 in Tien Giang, after this locality recorded a case of influenza A/H9 infection .

The Department of Animal Health requires strict monitoring of poultry flocks in Tan Ly Dong commune after someone infected with avian influenza A/H9 in this locality

Previously, on April 2, the Pasteur Institute of Ho Chi Minh City reported a case of avian influenza - influenza A/H9 in a 37-year-old male patient, residing in Tan Ly Dong commune (Chau Thanh district, Tien Giang).

Immediately after receiving this information, the Department of Animal Health directed the local veterinary agency to take 7 samples at 2 live poultry trading points in Tan Quoi hamlet (Tan Ly Dong commune). Through analysis, these 7 samples were all negative for influenza A/H9N2 virus.

The Department of Animal Health continues to require close monitoring of disease developments in poultry flocks in this locality; Strengthen propaganda to livestock farmers on measures to prevent and control epidemics.
...

https://thanhnien.vn/cuc-thu-y-thong-tin-ket-qua-xet-nghiem-virus-cum-gia-cam-a-h9n2-o-tien-giang-185240406180758905.htm

[Treyfish]

dude is pretty sick …….

Currently, the patient remains under treatment in the negative-pressure isolation ward of the Intensive Care and Toxicology Unit for Adults, diagnosed with septicemia secondary to pneumonia, influenza A, fungal infection, complications of respiratory failure, pulmonary hemorrhage, stable abdominal hemorrhage, gastrointestinal bleeding, acute kidney injury, alcoholic liver fibrosis, and under surveillance for hepatocellular carcinoma.… https://en.sggp.org.vn/first-case-of...ost109206.html

[Michael Coston]

Vietnam MOH Statements On A/H9 Case In Tien Giang Province






#17,994

Vietnam's Ministry of Health has published two statements on the A/H9 case reported in this blog yesterday that add a little bit to what we already knew, and illustrates how seriously they are taking this case.

Although the exact subtype has yet to be determined, this is most likely a spillover from LPAI H9N2.

As an LPAI (low path avian influenza) virus, H9N2 is not considered a `reportable' disease by WOAH (formerly the OIE), even though it is zoonotic. We've seen seroprevalence studies which suggest people with exposure to infected poultry often develop H9 antibodies, suggesting mild or asymptomatic infection

While most human infections have been mild, the CDC has designated 2 different lineages (A(H9N2) G1 and A(H9N2) Y280) for their short list of influenza viruses with zoonotic potential (see CDC IRAT SCORE), and several candidate vaccines have been developed.

First, the two reports from the MOH, after which we'll take a deeper look at the differences between LPAI and HPAI viruses.

Information about cases of Influenza A(H9) in Tien Giang

07/04/2024 Print article

The Department of Preventive Medicine announces a case of influenza A(H9) as follows:

Male patient, 37 years old, residing in Tan Ly Dong commune, Chau Thanh district, Tien Giang province. On March 10, 2024, the patient developed symptoms of fever and self-medicated but did not regularly. The patient came for examination and treatment at the City Hospital for Tropical Diseases. Ho Chi Minh City (BVBND) on March 16, 2024, was diagnosed with severe pneumonia suspected to be caused by a virus.

Initial test results at the National Hospital showed positive for influenza A and had gene segments similar to influenza A virus subtype H9. The specimen was sent to the Pasteur Institute in Ho Chi Minh City for confirmation testing. On April 1, 2024, the Pasteur Institute in Ho Chi Minh City discovered a patient sample positive for influenza A subtype H9. Currently, the Institute is continuing to perform in-depth tests to determine the subgroup. The patient is currently being actively treated at Ho Chi Minh City People's Hospital.

According to the results of the epidemiological investigation, the patient's place of residence is in a poultry market, and there is a poultry market in front of the patient's house; There have been no reports of sick or dead poultry around the area where the patient's family lives. Cases in close contact with patients are listed and their health monitored; Up to now, no symptoms of respiratory infection have been detected; No outbreak of respiratory infections has been recorded in the community where the patient lives.

This is the first case of influenza A(H9) in Vietnam ever. Previously, in March 2024, in Khanh Hoa, 01 case of death due to human influenza A(H5N1) was recorded. From 2015 until now, in the Western Pacific region, 98 cases of influenza A(H9N2) have been recorded, including 2 deaths, both of which were patients with underlying diseases. Of which 96 cases were recorded in China and 02 cases were suspected in Cambodia. There is currently no evidence that influenza A(H9N2) is transmitted from person to person.

In the world, from the end of 2023 until now, the situation of avian influenza in animals has become complicated, not only recording many outbreaks of influenza in poultry in all regions but also recording its transmission. for an increasing variety of mammals. In the US, scattered cases of influenza A(H5N1) infection transmitted from livestock have been recorded in many states. In Asia, outbreaks of influenza in poultry continue to be recorded caused by many strains of influenza A virus such as H5N1, H5N6, H5N8, H3N2, H9N2, H10N3... Some countries bordering Vietnam Nam continues to record cases of avian influenza in humans including H5N1 and H9N2.

Domestically, according to information from the Department of Animal Health - Ministry of Agriculture and Rural Development, influenza A(H9N2) virus was previously detected circulating in poultry flocks. This is a low-virulence avian influenza virus that usually causes mild symptoms and does not cause mass deaths of poultry. However, humans can still be infected and contract avian influenza A(H9N2) if they contact and use infected poultry and poultry products.

Currently, it is the changing season, and unusual weather changes are favorable conditions for pathogens to develop, increasing interactions between influenza virus strains along with the risk of infection to animals. mammals, the Ministry of Health said that in the near future there is still a potential risk of transmitting avian influenza virus strains to humans.

There is currently no specific treatment for avian influenza in humans and no vaccine to prevent the disease. To proactively prevent and control influenza transmitted from poultry to humans, people need to well implement the following measures:

1. Do not eat poultry or poultry products that are sick, dead or of unknown origin; Make sure to eat cooked food and drink boiled water; Wash hands with soap before eating.

2. Do not slaughter, transport, buy or sell poultry and poultry products of unknown origin; Limit contact, slaughter, and eating of wild animals, especially birds.

3. When discovering sick or dead poultry, absolutely do not slaughter and use it, but must immediately notify the local authorities and veterinary unit in the area.

4. Poultry farmers, traders, transporters and slaughterers absolutely comply with routine disease prevention measures;

5. Encourage wearing masks when entering live poultry markets or live poultry trading areas; Wash your hands with soap after contact with poultry or after going to the market.

6. When you have flu-like symptoms such as fever, cough, chest pain, difficulty breathing, go to a medical facility immediately for timely consultation, examination and treatment.

For detailed information, contact: Department of Preventive Medicine, Ministry of Health.

Strengthen the prevention and control of bird flu from spreading to humans

07/04/2024

On April 2, 2024, the Pasteur Institute in Ho Chi Minh City reported a case of influenza A(H9) in a 37-year-old male patient, residing in Tan Ly Dong commune, Chau Thanh district, Tien Giang province. This is the first human case of influenza A(H9) infection recorded in Vietnam to date. Previously, in March 2024, in Khanh Hoa, 01 case of death due to human influenza A(H5N1) was recorded. From 2015 until now, in the Western Pacific region, 98 cases of influenza A(H9N2) have been recorded, including 2 deaths, both of which were patients with underlying diseases. Of which 96 cases were recorded in China and 02 cases were suspected in Cambodia. There is currently no evidence that influenza A(H9N2) is transmitted from person to person.

According to information from the Department of Animal Health - Ministry of Agriculture and Rural Development, avian flu epidemics are still sporadically recorded in poultry flocks in many localities across the country. Besides, this is currently the season change period and the weather has many unusual changes that are favorable for the development of avian influenza virus. Therefore, there is always a potential risk of bird flu infection to humans.

To proactively prevent avian influenza from infecting humans, on April 6, 2024, the Department of Preventive Medicine sent an urgent dispatch to the Department of Health of Tien Giang province and the Pasteur Institute of Ho Chi Minh City requesting attention. direct some content as follows:

1. The Director of the Department of Health is interested in directing affiliated units to urgently implement the following key contents:

• Organize investigation of the source of infection and thoroughly handle the outbreak; Strengthen surveillance to detect new cases- Guide and support localities in confirmatory testing of specimens from suspected human cases and handle outbreaks according to regulations.
• Consider training to improve local capacity in monitoring, detecting, investigating and handling avian influenza outbreaks in humans as well as providing guidance on coordination with the veterinary sector.
• Guide and support localities in developing media messages and deploying communications on avian flu prevention and control.

Editorial board of the website of the Department of Preventive Medicine, be ready to collect, quarantine, and treat according to regulations of the Ministry of Health and direct the Center for Disease Control to promptly deploy epidemic prevention and control measures.

• Closely coordinate with the agricultural sector and local authorities in monitoring and early detection of influenza outbreaks in poultry, promptly sharing information and coordinating to thoroughly handle outbreaks.
• Strengthen propaganda on measures to prevent transmission of avian influenza to humans, especially in areas with sick and dead poultry and high-risk areas.
• Prepare drugs, supplies, chemicals, and means to promptly support localities in implementing measures to handle outbreaks.
• Implement coordination in the prevention and control of diseases transmitted from animals to humans according to the provisions of Joint Circular No. 16/2013/TTLT-BYT-BNN&PTNT dated May 27, 2013 of the Ministry of Health and the Ministry of Health. Agriculture and rural development; Report on infectious diseases according to Circular No. 54/2015/TT-BYT dated December 28, 2015 of the Minister of Health to the Department of Preventive Medicine, phone: 04.38456255, fax: 0437366241, email: baocaobtn@gmail. com.

2. Comrade Director of the Pasteur Institute of Ho Chi Minh City is interested in directing affiliated units to urgently implement the following key contents:

• Continue to investigate, monitor and track close contacts of cases, promptly detect new cases.
• Continue to perform in-depth tests to determine virus subtypes.
• Guide and support localities in confirmatory testing of specimens from suspected human cases and handle outbreaks according to regulations.
• Consider training to improve local capacity in monitoring, detecting, investigating and handling avian influenza outbreaks in humans as well as providing guidance on coordination with the veterinary sector.
• Guide and support localities in developing media messages and deploying communications on avian flu prevention and control.

Editorial board of the website of the Department of Preventive Medicine

Since we use acronyms like HPAI (Highly Pathogenic Avian Influenza) and LPAI (Low Pathogentic Avian Influenza) frequently - and they don't mean exactly what they sound like they mean - a long-time reader has asked for a deeper dive.

The terms HPAI and LPAI refer to a virus's pathogenicity in poultry as determined by specific laboratory tests. It has little to do with its impact on human health. HPAI viruses often produce severe disease in poultry in as little as 48 hours, while LPAI viruses typically cause few, if any, signs of illness.

Agriculture's big concern with LPAI H5 and H7 viruses is their known ability to spontaneously mutate into HPAI viruses after they have been introduced into a poultry flock (see graphic below). We've yet to see this occur with any other avian subtypes.



While it is true that up until a dozen years ago LPAI viruses were thought to pose less of a public health threat, the LPAI H7N9 outbreak in China (2013-2017) - with a CFR that approached 40% (among hospitalized cases) - changed that perception.


Since then, we've seen roughly 130 confirmed LPAI H9N2 cases around the world, and a smattering of other LPAI human infections, including A(H6), A(H7), A(H9), and A(H10) viruses. A partial list includes:

• In 2013 a 20-year-old college student on Taiwan as hospitalized with LPAI H6N1 pneumonia (see Taiwan CDC: Epidemiological Analysis Of Human H6N1 Infection).
  • The following year we learned that a number of dogs on the island tested positive as well (see EID Journal: Influenza A(H6N1) In Dogs, Taiwan)

• In addition to H7N9, we've seen a number of LPAI H7 spillovers around the world including;
  • NYC's 2016 dramatic H7N2 outbreak in cats, and spillover into animal shelter workers (see J Infect Dis: Serological Evidence Of H7N2 Infection Among Animal Shelter Workers, NYC 2016)
  • 3 mild cases of LPAI H7N7 in Italy in 2013 (see ECDC Update & Assessment: Human Infection By Avian H7N7 In Italy).
  • In 2006 1 person in the UK was confirmed to have contracted H7N3, and the following year, 4 people tested positive for H7N2 – both following local outbreaks in poultry.
  • The Fraser Valley H7N3 outbreak of 2004 resulted in at least two human infections, as reported in this EID Journal report: Human Illness from Avian Influenza H7N3, British Columbia.
  • And in 2003 a large outbreak of H7N7 (89 confirmed, 1 fatality) in the Netherlands – with nearly all reported cases having very mild (often just conjunctivitis) symptoms.

• We've also seen scattered LPAI H10 human infections in Egypt, Australia, and China, including:
  • Last JanuaryA Fatal Case of H3N2 and H10N5 Mixed Infection Discovered in Zhejiang Province
  • China has reported several LPAI H10N3 cases since 2021 (see The Lancet Microbe: Novel H10N3 Avian Influenza Viruses - a Potential Threat to Public Health).
  • A small number of LPAI H10N7 infections were was reported in Egypt in 2004 (see Avian Influenza Virus A (H10N7) Circulating among Humans in Egypt) and Australia in 2010 (see EID Journal: Human Infection With H10N7 Avian Influenza).
  • LPAI H10N8 has been reported in a small number of people with severe pneumonia with respiratory failure, including a few deaths, in China since 2013 (see EID Journal Human Infection with Influenza Virus A(H10N8) from Live Poultry Markets, China, 2014).

While we are understandably keeping a close watch on HPAI H5N1, LPAI viruses are quite capable of jumping to humans, and causing equally severe illness.

And since they tend to cause few symptoms in poultry or wild birds, and are often not considered legally `reportable' diseases, they have the potential to fly under our radar.

Even if most don't appear to be as deadly as H5N1, even a 2% CFR (Case Fatality Rate) pandemic would make COVID pale in comparison. And that is something the world remains poorly prepared to deal with.


https://afludiary.blogspot.com/2024/04/vietnam-moh-statements-on-ah9-case-in.html

[Pathfinder]

Translation Google

Updated: 07:52 - April 7, 2024 | Views: 160

Ho Chi Minh City: recorded the country's first human case of avian influenza A(H9N2).

Ho Chi Minh City has recorded the first case of influenza A(H9N2) in Vietnam. The patient is being isolated for treatment, the source of infection is currently unknown.

Male patient, 37 years old, working as a bricklayer, Tien Giang province, was transferred to Ho Chi Minh City for treatment with a diagnosis of gastrointestinal bleeding on a background of gastric ulcer, accompanied by alcoholic cirrhosis, and sepsis monitoring. During treatment, patients with pneumonia should have samples taken for testing.

The first test result was positive for influenza A. On April 1, 2024, the second test using gene sequencing method was conducted by the Hospital for Tropical Diseases in collaboration with the University Clinical Research Unit. Oxford (OUCRU) performed the results of the genome of influenza A(H9N2) virus.

According to preliminary investigation, the patient lives and works near home and has never been vaccinated against flu or COVID-19. Opposite the patient's house is the house of a relative who directly slaughters and sells poultry. The patient does not have direct contact with poultry. Currently, the health situation of everyone in the family is healthy, and there have been no reports of dead poultry or unusual symptoms in the area where the patient lives.

The Department of Health has directed the Hospital to isolate, treat and care for patients in accordance with the Ministry of Health's regulations on avian flu, and monitor the health status of medical staff who have cared for patients. It is known that all staff when coming into contact with patients wear protective equipment according to regulations.

The Department of Health directed the Center for Disease Control to report to the Pasteur Institute in Ho Chi Minh City and coordinate with the Center for Disease Control of Tien Giang province to continue investigating the epidemiology, especially the travel and contact history of the patient. Patients, as well as monitor and instruct relatives in close contact with the patient to self-monitor their health at home and implement cleaning and disinfection measures. At the same time, share information with the City Department of Animal Husbandry and Veterinary Medicine to report and monitor poultry and livestock herds.

According to the US Centers for Disease Control and Prevention (CDC), influenza virus is a large family of viruses including 4 types A, B, C and D. Of which groups A and B often cause seasonal flu epidemics in humans. , especially influenza A can cause influenza pandemics around the world. Meanwhile, influenza C only causes mild illness in humans and does not cause epidemics, while influenza D only causes disease in animals. Particularly for influenza A, up to now, science has discovered up to 18 H antigen groups (symbols from H1 to H18) and 11 N antigen groups (symbols from N1 to N11). These antigens combine with each other and form different types of influenza A virus. There have been more than 130 types of influenza A viruses identified in nature, mainly in wild birds. The types of influenza A currently circulating in humans are influenza A (H1N1) and influenza A (H3N2). Influenza A(H1N1) caused a pandemic in 2009 and then circulated until now. Some highly pathogenic influenza A types that cause disease in poultry such as H5N1 and H7N9 have also been transmitted to humans.

Influenza A (H9N2) is a low-virulence virus circulating in poultry flocks in Africa, Asia, the Middle East and Europe. Since the first human case of H9N2 was reported in the late 1990s, the virus has still been detected sporadically in humans, pigs and some other mammals and still needs attention for monitoring and prevention.

Influenza is an infectious disease that circulates every year around the world, including Vietnam. In the South, the disease occurs year-round, and can cause small outbreaks. Influenza viruses can be transmitted from person to person or from animal to person through droplets or through the air. The main preventive measure is still annual influenza vaccination to prevent infection with dominant influenza viruses; At the same time, each person needs to seriously implement personal hygiene measures such as washing hands regularly with water and soap before eating, after going to the toilet after contact with pets..., eating cooked food and drinking boiled food, not eating boiled food. using products from sick, dead or unknown poultry; For the elderly and people with underlying medical conditions, they need to closely monitor their health, stabilize the underlying medical condition, and improve their resistance to fight the disease. When detecting sick or unusually dead poultry, it is necessary to immediately notify the local veterinary agency for proper handling.

In the current context, there have been many consecutive cases of influenza A (H5N1) in humans appearing in neighboring Cambodia; At the same time, scientists are always concerned about the risk of another pandemic that can spread from animals to humans. To proactively control epidemics in the City, the Department of Health will strengthen coordination with the Department of Agriculture and Rural Development to improve the capacity to control diseases transmitted from animals to humans according to the approach. One Health.

https://hcdc.vn/tphcm-ghi-nhan-ca-mac-cum-gia-cam-ah9n2-tren-nguoi-dau-tien-cua-ca-nuoc-8EcfhD.html

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Translation Google

Tien Giang: Announcing the end of the human influenza A/H9N2 outbreak in Tan Ly Dong commune, Chau Thanh district

Date posted: April 10, 2024 - 15:04

Tien Giang:

Announcing the end of the A/H9N2 influenza outbreak in humans in Tan Ly Dong commune, Chau Thanh district

At 21:09 on April 1, 2024, the Tien Giang Center for Disease Control (CDC) received information about a case of Influenza A/H9 from the Pasteur Institute in Ho Chi Minh City, currently being treated at the Hospital for Heat Diseases. Ho Chi Minh City area. Tien Giang Disease Control Center coordinates with Chau Thanh District Medical Center, Tan Ly Dong Commune People's Committee, Tan Ly Dong Commune Health Center, Epidemiology Department of Region VI Veterinary Branch, Animal Husbandry and Veterinary Branch, Central The district Agricultural Service Center verifies case information, conducts epidemiological investigations and takes measures to handle outbreaks in accordance with regulations..

According to report No. 310/BC-KSBT dated April 10, 2024 of Tien Giang CDC, the outbreak has been controlled in the past 21 days, no new suspected cases have occurred and prevention measures have been implemented. epidemic according to regulations of the Ministry of Health, CDC announced the end of the Influenza A/H9N2 outbreak in humans in Tan Ly Dong commune, Chau Thanh district.

Doctor CKII. Vo Thanh Nhon, Acting Director of CDC of Tien Giang province, said: CDC has coordinated with relevant units to carry out steps to verify and investigate epidemiology and proactively implement measures to prevent, control and handle epidemics. outbreak according to regulations. Specifically, a list of 14 adults and 1 child who had close contact with the patient was made and their health monitored daily. As of April 9, 2024, 24 days since the patient was isolated and treated at the hospital, 15 people in close contact with the patient are currently in normal health.

According to regulations of the Ministry of Health, after close contact with a patient within 14 days from the last contact for adults and 21 days for children under 15 years old, if there is no spread of suspected cases. new suspicion and have implemented epidemic prevention and control measures according to regulations of the Ministry of Health, then declare the end of the outbreak.

Regarding the patient's health, as of April 9, the patient was still being treated at the Intensive Care Department - City Hospital for Tropical Diseases. In Ho Chi Minh City, the patient is being ventilated and screened for pneumonia - a hospital infection.

Regarding the next epidemic prevention and control plan, doctor CKII. Vo Thanh Nhon said that the health sector will strengthen communication activities and guide people to make and use clean poultry food and poultry of clear origin, ensuring food safety. Immediately notify health officials, veterinarians or Commune People's Committees in the area when detecting cases of mass poultry deaths of unknown causes.

Strengthen surveillance of severe cases of viral pneumonia at treatment facilities. Pay special attention to cases where patients are slaughterers, traders of poultry and live poultry products, and people with an epidemiological history of traveling/to/staying from areas with poultry flu epidemics/avian influenza epidemics. hold on person. Take samples, preserve and transport samples according to regulations and promptly send samples to the Pasteur Institute of Ho Chi Minh City. Ho Chi Minh tested to identify the causative agent of the disease.

Guide, support, and coordinate with the District Health Center in epidemiological investigation of severe viral pneumonia cases, monitoring of close contacts, and reporting according to regulations.

For the treatment system, prepare drugs, supplies, chemicals, vehicles, and equipment for collection, isolation, and treatment when there is a severe case of viral pneumonia; promptly notify the reserve unit to coordinate the implementation of epidemic prevention and control measures; Carry out consultations with higher-level hospitals when there are serious cases of illness, minimizing deaths.

Coordinate with the Department of Livestock and Veterinary Medicine in activities to prevent and control diseases transmitted from animals to humans; Grasp information about influenza outbreaks in poultry flocks, and information about areas with high rates of disease in poultry in the province. From there, identify risk areas to orient and organize risk factor control activities, health education and communication aimed at target groups, helping propaganda and prevention of influenza epidemics. more effective in controlling transmission to humans.

Organize training on surveillance and response in the prevention and control of avian influenza epidemics in humans; Advise the Department of Health to organize teams to inspect and supervise the prevention and control of avian influenza epidemics in humans at medical facilities. Guide, support, and coordinate with local health facilities in handling avian influenza outbreaks in humans and make reports according to regulations.

Thanh Hoang

http://trungtamkiemsoatbenhtattiengiang.gov.vn/tin-moi/tien-giang-cong-bo-ket-thuc-o-dich-cum-a-h9n2-tren-nguoi-tai.html

[Shiloh]

Source: https://en.sggp.org.vn/health-condit...ost109295.html

Health condition of A/H9N2 first infection bad because of cirrhosis, diabetes
SGGP
April 10, 2024 at 21:12:00
Director Hoang Minh Duc of the Department of Preventive Medicine revealed the health condition of the first infection of A/H9N2 is bad because of cirrhosis and diabetes.

He made the revelation at the Ministry of Health’s yesterday national online conference on strengthening disease prevention.

At the conference, to clarify the first case of influenza A/H9N2 in Vietnam, Director Hoang Minh Duc said that the first A/H9N2 was a 37 year old man in Tien Giang Province’s Chau Thanh District. Currently, the patient continues to be treated in the negative pressure room of the Ho Chi Minh City Hospital for Tropical Diseases’ Adult Intensive Care Department with follow-up care for sepsis from lung inflammation and influenza A.

Moreover, the man was diagnosed with invasive fungal infection, complications of respiratory failure, pulmonary hemorrhage, stable abdominal hemorrhage, gastrointestinal bleeding, acute kidney injury, and alcoholic cirrhosis. He must be under liver tumor monitoring. Since the man was detected to be infected with the A/H9N2 virus and isolated for treatment, his close contacts are in normal health.

Mr. Hoang Minh Duc also said that the first case of influenza A/H9N2 in the country had underlying diseases such as cirrhosis and diabetes, so the symptoms were more severe...

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Avian Influenza A(H9N2) - Viet Nam

19 April 2024

Situation at a Glance

The World Health Organization (WHO) was notified about a case of human infection with an influenza A(H9N2) virus in Viet Nam on 9 April 2024 by the International Health Regulations (IHR) National Focal Point (NFP). The patient, who had underlying conditions and was in severe condition was admitted to the intensive care on 21 March 2024. A respiratory sample was collected on 21 March and tested positive for influenza by Real-Time Polymerase Chain Reaction (PCR). Subsequently, virus subtyping confirmed avian influenza A(H9N2) on 8 April. Case investigation identified that the case lives near a poultry market, where poultry trade occurs daily in front of his house. As of 15 April, there have been no reports of new cases with respiratory symptoms among contacts of the case or outbreaks in the community where the case resides. This is the first human infection with an avian influenza A(H9N2) virus reported in Viet Nam. According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. Based on available information, WHO assesses the risk to the general population posed by this virus as low.

Description of the Situation


On 9 April 2024, the IHR NFP of Viet Nam notified WHO of one human infection with an avian influenza A(H9N2) virus.

The patient is a 37-year-old male from Tien Giang Province, Viet Nam, who had underlying conditions. The patient developed a fever on 10 March 2024 and was admitted to the hospital on 16 March. Following a diagnosis of severe pneumonia with bilateral pleural effusions, he was transferred to the intensive care unit (ICU) on 21 March and received treatment with oseltamivir and antibiotics. As of 15 April, the patient was still in severe condition and under intensive care.

The patient was detected through severe viral pneumonia surveillance (SVP). A nasopharyngeal swab was collected on 21 March, and the test result revealed positive avian influenza A with similar H9-strain gene segments on 22 March. On 1 April, Pasteur Institute in Ho Chi Minh City (PI HCMC) performed PCR testing, which confirmed the presence of avian influenza A(H9) virus. Subsequently, virus subtyping confirmed avian influenza A(H9N2) on 8 April.

Case investigation identified that the patient lives near a poultry market, where poultry trade occurs daily in front of his house. There have been no reports of dead or sick poultry near the patient’s residence or of consumption of sick, dead, or uncooked poultry products from his household or neighbouring households. However, influenza A(H9N2) is not highly pathogenic in poultry. On 2 April, seven poultry samples were collected from two live bird trading points within the same commune. One sample was positive A(H5N1); the remaining were negative for avian influenza A(H5N1), A(H5N6), A(H5N8), A(H7N9), and A(H9). On 4 April, samples were taken from two geese at the patient's house, which tested negative for A(H5) and A(H9).

Fifteen close contacts of the case have been requested to self-monitor their health at home. As of 15 April, there have been no reports of new cases with respiratory symptoms among contacts of the case or outbreaks in the community where the case resides.

This is the first human infection with avian influenza A(H9N2) reported in Viet Nam.

Epidemiology


Influenza viruses natural reservoir is wild water birds, but some influenza viruses may infect poultry and mammals, including humans. Infections in humans have primarily been acquired through direct contact with infected animals or contaminated environments. Avian influenza virus infections in humans may cause diseases ranging from mild upper respiratory tract infection to more severe diseases and can be fatal. Conjunctivitis, gastrointestinal symptoms, encephalitis and encephalopathy have also been reported.

Laboratory tests are required to diagnose human infection with influenza. WHO periodically updates technical guidance protocols for the detection of zoonotic influenza using molecular methods, e.g. RT-PCR. Evidence suggests that some antiviral drugs, notably neuraminidase inhibitors (oseltamivir, zanamivir), can reduce the duration of viral replication and improve prognosis in some cases.

To date, globally there have been 99 cases of human avian influenza A(H9N2) infections, including two deaths, reported to WHO since 2015. Public Health Response


The government of Viet Nam has taken the following public health response actions:

• PI HCMC and Ho Chi Minh City Center for Disease Control (HCDC), in cooperation with the Tien Giang Provincial CDC, have conducted investigations, contact tracing, and disinfection of the patient’s residence and suspected exposure areas.
• Local public health and animal health sectors cooperated for further investigation, contact tracing and testing for possible detection of potential additional cases and/or outbreaks of avian influenza A(H9N2) or other strains in humans and poultry.
• On 5 April, the Ministry of Health issued a press release containing detailed information about the case and provided public health messages on proactive disease prevention and control measures.

WHO Risk Assessment


Most human cases of infection with avian influenza A(H9N2) viruses are exposed to the virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness. Further human cases can be expected since the virus continues to be detected in poultry populations. No clusters of cases have been reported.

Currently available epidemiological and virological evidence suggests that this virus has not acquired the ability to be sustained in transmission among humans. Thus, the likelihood of human-to-human spread is low. Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community-level spread is considered unlikely as this virus has not acquired the ability to transmit easily among humans.

WHO Advice


This case does not change the current WHO recommendations on public health measures and influenza surveillance. A thorough investigation of every human infection is essential.

The public should avoid contact with high-risk environments such as live animal markets/farms and live poultry or surfaces that might be contaminated by poultry droppings. Hand hygiene, with frequent washing or the use of alcohol hand sanitizer, is recommended. WHO does not recommend any specific different measures for travelers.

All human infections caused by a new subtype of influenza virus are notifiable under the IHR (2005). State Parties to the IHR (2005) are required to immediately notify WHO of any laboratory-confirmed case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic.

WHO advises against applying any travel or trade restrictions based on the current information available on this event.

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https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON514