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H7N9 discussion thread: January 24, 2014 to Feb 5 2014 (closed)
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
We have no information to determine if gulls or pidgeons have been tested, or not, in this latest outbreak. Testing focus appears to be poultry. Without such information, its hard to draw any conclusions and rule any option in or out.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
if they had found gulls in LPMs or poultry farms or rivers with dead pigs,
they would probably have tested them. Gulls usually have different flu.
Pidgeons were tested last year, they were a candidate ...
For me it was pretty much settled with the large sampling by the HK-team
and lots of sequences, H7N7,H7N9,H9N2,...
This goes with H9N2 since almost 20 years. Just chickens.
The exact circulation from LPM to ever new chickens and how H7N9
survives disinfection of markets is still a bit mysterious to me, though.
We should interview some of the traders.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
Thinking about the age skew to older adults.
China is in the midst of a seasonal flu epidemic. What are the odds that any severe flu's in 20 - 50 year olds have been assumed to be H1N1 and treated as such with no further testing as this is the pH1N1 demographic?
Is there any data from china on the epidemiology of severe flu in the last six months with patient numbers and outcomes?
China is in the midst of a seasonal flu epidemic. What are the odds that any severe flu's in 20 - 50 year olds have been assumed to be H1N1 and treated as such with no further testing as this is the pH1N1 demographic?
Is there any data from china on the epidemiology of severe flu in the last six months with patient numbers and outcomes?
WARNING - PROPAGANDA ALERT
0 lab H7N9 lab confirmations for weeks 50,51,52 indicated on table 1 which is in conflict with MoH, Provincial, and WHO reports for that time period.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
Interesting, but no data on hospitalisations, mortality rates, ages of those affected. That is what we need to see to assess if something unusual is going on and where. Shame such data is not offered.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
Data also features with this interesting 'rider'.
Note: Analysis in this part was based on the test results of network laboratories. If it were not consistent with the results of CNIC confirmation, the results of CNIC confirmation were used.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
Also, no reports so far in 2014. Added to the 137 H7N9 cases in this flu wave, there is the exported H5N1 case too.
The government has no credibility. Today's fiasco is the Minister of Agriculture denying poultry as a source of H7N9 while all regional health authorities actively warn people against contact with live poultry.
Gregory Härtl @HaertlG 2h
.@WHO NB: these 21 #H7N9 cases include 7 cases not notified at the time. 6 cases were notified to WHO today, and 8 yesterday. @FluTrackers
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
I know I stand on the outside of accepted thought here but, I too am doubtful that chickens are the vector. If they are, I don't think they are the only vector. When seeing a doctor for their allotted 6 minutes, one of the questions asked is if they have been in contact with chickens. If they don't answer in the affirmative they don't have H7N9. Therefore, they have H1N1. I cannot help but wonder how many cases are missed? My guess is a lot are slipping through the cracks. Roughly 30% say they have not been in contact with live chickens. If they say they haven't been in contact and either die or sicken, to the point they cannot answer questions, the doctors later try to reconstruct their lives through family. The assumption is if the family says they don't know of any contact with chickens then they must be ignorant or mistaken. The person really must have come into contact because that is how you get H7N9. Entrenched thinking.
Please do not ask me for medical advice, I am not a medical doctor.
Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
Thank you,
Shannon Bennett
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
Shannon - you are not alone in your thinking. Given the weighting towards urban areas, i think we have another vector, possibly mammalian (vermin, cats, dogs) or gulls or pidgeons or a combination of all of the above. Dont forget the pigs either....
The genetic data (as I understand it) also points to multiple different introductions, which probably originated with chickens as the ultimate source. I am not sure we are ever going to pin this down, but if the wet market closures in Zheijang lead to a cessation of cases, then the center would appear to be the wet markets, whatever the vector. We will have to wait and see.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
no multiple different introductions. One source.
Well, subsequently it reassorts occasionally with H9N2.
(obviously in chickens - H9N2 is chickenish since the 90s)
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
I think chickens are a reluctant intermediary being infected from a reservoir in the un-sampled 'Other birds' group - of which chickens are a fairly isolated sub-group with both human and 'other bird' zoonotic edges. Once infected they provide the type of contact needed to cause human cases. The wild bird to poultry contact is good enough to get it into the chicken and then the unfortunate chicken does the rest. The key is to test everything that has the necessary level of contact with the chickens. H9N2 is so firmly entrenched, and well poultry-optimised, I doubt H7N9 is much of a threat to it in the short term. Until we know where the chickens are getting it from it is impossible to know how many - if any - of the human cases are getting it directly from the primary host(s).
The 'don't-ask-don't-tell' MO is absurd and we went through the same thing in the UK at the start of the H1N1(2009) outbreak. The UK was one of the first countries outside of the Americas to get cases but you could not get tested unless you answered yes to 'have you had contact with anyone recently returning from Mexico or the US' or were a close contact of one of the early cases. The WHO would not raise the Pandemic threat level until they saw infections in the community and the UK authorites would not test anyone who met this criteria - Catch 22.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
I do not think there is only 1 source. The chickens got it from somewhere. There are probably several species infected now, including man, and there is probably a reservoir animal too.
I think if we learned anything from H5N1 we learned that once an avian flu is endemic in the environment - many different species are infected - and some are carriers.
I just think that the MoA is ridiculous because, obviously, chickens are infected too.
Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+
Rapid Release Emergent H7N9
Centre for Health Protection Hong Kong
The sequences from Hong Kong in January demonstrate a virus on the move.
In a display of intellectual and logistical expertise, the Public Health Laboratory Services Branch, Centre for Health Protection in Kowloon, Hong Kong sampled material from a man on January 28, 2014, sequenced, annotated and published early on January 30, 2014, much less than 48 hours after the sample, autopsy to full genetic report in 2 days.
We are grateful for their demonstration of intellectual prowess because for this one, timeliness is extremely important.
Early January Hong Kong has homology at the HA to the circulating human strains with the gain of material from pH1N1. More recent Hong Kong data shows a variance at key aminos from the circulating human Emergent H7N9Hemagglutinin segments. The reservoir in China is under revision and is quite potentially now attractant to pH1N1 sub-segment input.
We'd like to see the clinicals on the latest case and additional passage strategies when available.
If a dominant input reservoir switch is at work from sH3N2 to pH1N1 for new genetic material, potential risk increases due to the established "give / take" relationship of H7 to pH1N1.
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