China: Health alert after pig farmers die

[Gert van der Hoek]

Health alert after pig farmers die

Caroline Kim

Friday, December 29, 2006

Health officials are probing the deaths of two local pig farmers who suffered from pneumonic symptoms over the past six months.

As of Thursday evening, the viruses or bacteria that triggered the symptoms had still not been identified despite laboratory tests on the two men.

"Further investigations are needed to ascertain the nature of a possible infectious illness and whether these were in anyway connected to the pigs," Centre for Health Protection consultant Thomas Tsang Ho-fai said Thursday.

"The CHP attaches great importance to the cases and is liaising closely with relevant parties, including the Hospital Authority, the Agriculture, Fisheries and Conservation Department and mainland health authorities."

The two men, a 44-year-old from Sheung Shui and a 62-year-old in Tsuen Wan, had suffered from pneumonic symptoms prior to their deaths on December 13 and June 4, respectively.

The more recent of the two cases was first detected on December 11 when the man was admitted to North District Hospital, only to die two days later.

Health officials were notified of the man's travel history. He went to Dongguan city in Guangdong province about 20 days prior to the onset of the symptoms.

"The CHP has been liaising with the mainland health authorities for exchange of information," Tsang said.

In the earlier case, Tsang said, the Tsuen Wan man suffered from an influenza-like illness before being admitted to Yan Chai Hospital in Tsuen Wan toward the end of May.

Investigations have shown so far that no family members of the Sheung Shui man had suffered from similar symptoms. Officials are still examining the family of the Tsuen Wan patient.

Authorities are also investigating friends, including a pig farmer, who had been visited by the Sheung Shui man early December. The friend has been in hospital with a lung disease and kidney problems.

"We have telephoned local pig farmers and issued them letters reminding them to report any disease outbreaks among the livestock to the AFCD for investigation," a spokesman for the Agriculture, Fisheries and Conservation Department said.

The AFCD also called on farmers to be more sensitive to bio-security measures, including observation of farm hygiene and inoculation of pigs.

The two deaths have sparked concern over a lack of reporting of animal- related diseases in Hong Kong.

"There are loopholes in the communication between the Hospital Authority and the Department of Health that need to be plugged," said Lo Wing-lok, a specialist in infectious diseases.

Lo, who insists any infection related to animals should be reported immediately, drew on previous cases involving diseases transmitted from animals to humans such as AIDS, avian flu and the Ebola and Nipah viruses.

"Most of these animal-related cases are highly infectious and highly fatal," Lo said, adding that close investigation of swine influenza and other possible infections among pigs is necessary to prevent outbreaks.

The time gap between the two cases does not make the risk any less significant, Lo said.

"The world witnessed the first case of avian influenza in April 1997, which then reappeared seven months later in November," he said.

Tsang of the CHP urged pig farmers suffering from pneumonia-like illnesses since June 1 to call a special hotline at 2125 1133 for health-care services.

A meeting between the Health, Welfare and Food Bureau, the Food and Environmental Hygiene Department and the Hospital Authority will be held today to review the cases and to determine what interdepartmental measures may be necessary.

http://www.thestandard.com.hk/news_...=35016&sid=11527970&con_type=1&d_str=20061229

credits Babcom

 

[Gert van der Hoek]

Re: China: Health alert after pig farmers die

Third case probed after pig farmer deaths

Donald Asprey

Saturday, December 30, 2006

Health officials are investigating a third case of pneumonia after the deaths of two local pig farmers.

A 61-year-old male worker at Sheung Shui slaughterhouse has contracted pneumonia but is in stable condition, North District Hospital said.

The latest case comes after the death of two pig farmers, a 44-year-old from Sheung Shui and a 62-year-old from Tsuen Wan, who suffered pneumonic symptoms before they died December 13 and June 4, respectively.

In addition, mainland officials confirmed Thursday the case of a Foshan farmer, 44, who died this month.

A government hotline, meanwhile, has received a call from a 42-year-old male safety supervisor at Sheung Shui slaughterhouse, who said he was hospitalized in North District Hospital for pneumonia in mid-September.

He responded to antibiotics and was discharged from hospital in early November. He apparently had no direct contact with pigs during his work.

Earlier, officials sought to allay the public's fears, stating the unknown illness was neither as contagious as SARS nor as lethal to animals as bird flu.

Centre for Health Prevention consultant Thomas Tsang Ho-fai said the Agriculture, Fisheries and Conservation Department is conducting tests on local pigs, the Hospital Authority enhancing surveillance on local cases of pneumonia and the center manning the hotline for farmers to report any cases of hospitalization.

However, Tsang said identifying the virus or bacteria that triggered the pneumonic symptoms would take at least a month or more, or not at all, adding the cause of 60 percent of pneumonia cases go undiagnosed.

"There is a difference from SARS. The families of the victims were not found to be infected, which suggests the infectious agent is not as contagious as SARS. Also, there have been no reports of pig deaths and in this respect it is unlike avian flu, which kills a large number of chickens," he said.

No connection between any of the farmers, other than they kept pigs, has been found.

"We will have to focus on pig farmers and conduct more investigations as that is the most striking similarity between the cases and the effect on them will be greatest," Tsang said.

http://www.thestandard.com.hk/news_detail.asp?pp_cat=11&art_id=35088&sid=11541267&con_type=1

 

[Gert van der Hoek]

Re: China: Health alert after pig farmers die

Archive Number 20061229.3649
Published Date 29-DEC-2006
Subject PRO/EDR> Undiagnosed respiratory disease, fatal - China (Hong Kong): RFI



UNDIAGNOSED DISEASE, FATAL - CHINA (HONG KONG): REQUEST FOR INFORMATION
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 29 Dec 2006
From: Dan Silver <dgsilver@yahoo.com>
Source: Health & Community, news gov hk online, Fri 29 Dec 2006 [edited]
<http://www.news.gov.hk/en/category/healthandcommunity/061229/html/061229en05004.htm>


Investigations have not found a link between the deaths of 2 local
pig farmers of a pneumonia-like illness in the past 6 months. Centre
for Health Protection consultant Dr Thomas Tsang said the men tested
negative for SARS.

An inter-departmental working group meeting was held today to look
into these 2 cases and a package of new measures were mapped out to
enhance investigation, surveillance and risk communication with the community.

Dr Tsang said the family members of the 2 deceased have no symptoms.
Evidence collected by the Agriculture, Fisheries & Conservation
Department found no unusual deaths among local pigs in Hong Kong.
However, he said the Government will continue investigations and
liaise with Mainland officials. The Centre and the Hospital Authority
will form a special arrangement that requires doctors report
pneumonia cases among hospitalised pig farmers and live pig handlers.

North District Hospital reported a pneumonia case today, involving a
61-year-old man who works in Sheung Shui Slaughterhouse. His
condition is stable.

A special hotline 2125 1133 has been launched for pig farmers to
report any pneumonia hospitalisation they may have had since 1 Jun
2006. It has received 7 calls so far. Six were for enquiries. One was
from a 42-year-old male safety supervisor of Sheung Shui
Slaughterhouse who had been hospitalised at North District Hospital
for pneumonia in mid-September 2006. His illness responded to
antibiotics and he has recovered. He had no direct contact with pigs at work.

******
[2]
Date: Thu 28 Dec 2006
From: Dan Silver <dgsilver@yahoo.com>
Source: Health & Community, news gov hk online, Thu 28 Dec 2006 [edited]
<http://www.news.gov.hk/en/category/healthandcommunity/061228/html/061228en05007.htm>


The Centre for Health Protection is investigating the death of 2
local pig farmers who succumbed to a pneumonic illness in the past 6
months. Laboratory tests have not identified a specific bacteria or
virus causing the pneumonia. Further investigations are needed to
ascertain the nature of a possible infectious illness and any
relation it may have with pigs.

A 44-year-old Sheung Shui man came down with fever and cough on 7 Dec
2006. He was admitted to North District Hospital on 11 Dec 2006 and
died of a pneumonia-like illness on 13 Dec 2006. He visited Dongguan
about 20 days before the onset of symptoms, but an association
between this travel and his illness cannot be established yet.

Another case involved a 62-year-old Tsuen Wan man who developed a
similar illness and was admitted to Yan Chai Hospital at the end of
May. He died on 4 Jun 2006. The Centre is following up on his travel history.

Five family members of the 44-year-old patient and a worker at his
farm have no symptoms. Family members of the 62-year-old patient will
be tested. The Centre has also followed up on a pig farmer
acquaintance of the 44-year-old whom he had visited in Queen
Elizabeth Hospital in early December. This acquaintance had a
pre-existing lung disease and kidney problems and had been
hospitalised since the end of October. His clinical presentation was
different from the victims.

The Centre's Consultant Dr Thomas Tsang appealed to pig farmers who
have suffered from pneumonia-like illnesses and required
hospitalisation since 1 Jun 2006 to call 2125 1133 for follow-up advice.

The Centre has been liaising with Mainland health authorities, and
the Agriculture, Fisheries & Conservation Department has reminded
local farmers to report any pig disease outbreak and abnormal pig
death. So far there has been no unusual increase in the mortality
rate of pigs in local farms. There have also been no unusual pig
diseases found.--

Dan Silver
<dgsilver@yahoo.com>

[The information provided is not sufficient to allow speculation as
to the nature of these undiagnosed cases of respiratory illness. They
are unlikely to be related to avian influenza virus or SARS virus
infection in view of the expertise available in Hong Kong in relation
to diagnosis of these virus infections. The absence of disease in
swine and probable antibiotic sensitivity discount any involvement of
Nipah virus or _Streptococcus suis_, which in any case do not cause
respiratory disease in man. Further information would be welcomed. -
Mods.CP/JW]

http://www.promedmail.org/pls/prome..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,35663

 

[kent nickell]

Re: China: Health alert after pig farmers die

It would seem that Nipah can cause acute respiratory illness... http://en.wikipedia.org/wiki/Henipavirus

Nipah virus was identified in 1999 when it caused an outbreak of neurological and respiratory disease on pig farms in peninsular Malaysia, resulting in 105 human deaths and the culling of one million pigs [5].

Symptoms of infection from the Malaysian outbreak were primarily encephalitic in humans and respiratory in pigs. Later outbreaks have caused respiratory illness in humans, increasing the likelihood of human-to-human transmission and indicating the existence of more dangerous strains of the virus.

Six more outbreaks of Nipah virus have occurred since 1998, one in India and five in Bangladesh

2004 19 February ? 16 April, Faridpur district, Bangladesh: 36 cases with 27 fatalities (75% mortality). Epidemiological evidence strongly suggests that this outbreak involved person-to-person transmission of Nipah virus, which had not previously been confirmed [10]. 92% of cases involved close contact with at least one other person infected with Nipah virus. Two cases involved a single short exposure to an ill patient, including a rickshaw driver who transported a patient to hospital. In addition, at least six cases involved acute respiratory distress syndrome which has not been reported previously for Nipah virus illness in humans. This symptom is likely to have assisted human-to-human transmission through large droplet dispersal.

http://www.icddrb.org/pub/publication.jsp?pubID=5144&classificationID=0&typeClassificationID=0

Nipah Encephalitis Outbreak Over Wide Area of Western Bangladesh, 2004

Clinical materials from this outbreak investigation have allowed the isolation and genetic characterization of the causative agent, a strain of Nipah virus closely related but distinguishable from the virus that had caused a large outbreak of encephalitis in Malaysia in 1998-1999 (2).

As in the previous Nipah virus outbreaks in Bangladesh, pigs did not appear to play a central role in maintenance and transmission of Nipah virus to man as occurred with the first outbreak of Nipah encephalitis in Malaysia and Singapore (6).

 

[Jonesie]

Re: China: Health alert after pig farmers die

FROM THE MERCK VETERINARY MANUAL:



Nipah Virus Infection: Introduction
(Porcine respiratory and neurologic syndrome, Barking pig syndrome)


Etiology and Epidemiology
Transmission and Pathogenesis
Clinical Findings
Diagnosis
Treatment
Control and Prevention
Zoonotic Risk


--------------------------------------------------------------------------------
Nipah virus disease is a newly discovered disease of swine and humans associated with infection with a new paramyxovirus given the name Nipah virus. This disease emerged in Malaysia in 1998 and 1999. It was linked to severe encephalitis among humans occupationally exposed to infected pigs in Malaysia and Singapore. The disease was eradicated from the national commercial swine population by control efforts. Fruit bats of the genus Pteropus appear to be reservoirs of the virus.

Etiology and Epidemiology:
The etiologic agent, Nipah virus (genus Henipavirus, family Paramyxoviridae), is an enveloped negative-sense, single-stranded RNA virus. The virus is closely related to Hendra virus ( Hendra Virus Infection: Introduction), the only other member of the genus. The human outbreak in Malaysia and Singapore followed contact with infected swine and resulted in encephalitis and ~40% case mortality. The virus is assumed to have been introduced into the swine population from 1 of the 2 species of Pteropus found with Nipah virus antibodies during investigation of the outbreak. The geographic range of Pteropus includes all of southeast and south Asia, and several species have been found with antibodies, suggesting that the virus or closely related viruses occur in other areas within the range of this genus of bats. In Malaysia, genetic analysis of virus from human and swine clinical materials strongly supported a single introduction of the virus with spread through the commercial swine population. There was evidence of infection among several other species of domestic animals including dogs, cats, and horses.

Transmission and Pathogenesis:
Infection in pigs is assumed to have been a transfer from the reservoir bat species to pigs. Once the virus was introduced into an intensive swine husbandry setting, infection of animals within premises was rapid, and serologic tests suggested that nearly all pigs on an infected premise were infected. Transmission between premises was thought to be by poor biosecurity procedures and movement of infected animals. Experimental infection of swine with Nipah virus in a high biosecurity facility in Geelong supported that transmission between swine in close contact occurred readily.

Clinical Findings:
Because of the danger of human infection and the emergency setting, clinical observations were not detailed in the field during the epidemic. Most pigs developed a febrile respiratory disease with a severe cough that led to the local names for the disease, ?barking pig syndrome? and ?one-mile cough.? Encephalitis was also noted, particularly in the sows and boars in affected facilities. The proportion of animals with each form of the disease is uncertain, although the respiratory form predominated. Overall mortality within affected facilities was also not well documented but it probably was not >5% among all age groups.

Diagnosis:
Laboratory diagnosis can be made by isolation of the virus, identification of the RNA by use of reverse transcriptase-PCR, detection of antigens in tissues by immunohistochemical staining with specific antibodies, or serologic tests such as indirect ELISA and virus neutralization tests. The virus is considered biosafety level 4 in the USA and Australia, and stringent laboratory containment at limited laboratories is a special consideration.

Treatment:
Treatment of affected swine was not attempted during the Malaysian emergency. Humans required intensive care with ventilation support to manage the encephalitis; no specific treatment is available. Ribavirin was administered to some patients and results of one study suggested that it may reduce mortality, but subsequent studies in laboratory animals suggest that it is ineffective.

Control and Prevention:
Control of the epidemic/epizootic in Malaysia was dependent on the initiation of strict quarantine procedures and the slaughter of all swine from affected facilities. Adherence to appropriate biosecurity and quarantine procedures within facilities, as with other contagious diseases, is of paramount importance in preventing spread of the infection. An active surveillance and slaughter program successfully eliminated the virus from the national commercial swine population and it has remained free of infection. Presence of the virus in reservoir species of bats in a wide geographic range emphasizes the importance of good disease surveillance and biosecurity practices to promote early detection and confine the disease to initial premises should reintroduction occur.

Zoonotic Risk:
Transmission of the virus from infected pigs to humans was largely in an occupational setting, and a study of risk factors associated with human infection suggests that close contact with live infected swine is the means of infection of nearly all human Nipah virus infections.

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/53900.htm

 

[Gert van der Hoek]

Re: China: Health alert after pig farmers die

Ill abattoir worker recovers

The 61-year-old male Sheung Shui Slaughterhouse worker hospitalised December 30 for pneumonia was discharged today. Preliminary microbiological tests on him found pneumococcus and the parainfluenza virus, common respiratory pathogens that can cause pneumonia.

Centre for Health Protection Community Medicine Consultant Dr Thomas Tsang said test results on the 44-year-old pig farmer, who died of a pneumonia-like illness last month, and 23 specimens from local pig farms will be available in the coming weeks.


Meanwhile, a meat delivery vehicle supervisor from the slaughterhouse was admitted to North District Hospital today. The 69-year-old man went to Zhuhai and Panyu and Guangzhou last month, and came down with cough. He is now in stable condition. His family contacts are asymptomatic.

Retrospective review

Dr Tsang said a retrospective review from May to December is being conducted on Hospital Authority records to identify pig farmers who had been hospitalised with pneumonia.

"With all the enhanced surveillance measures and record reviews, it is expected that some more cases of pneumonia among pig farmers may be uncovered in the process," he said.

There is an average of 4,000 pneumonia deaths in Hong Kong a year. The number of hospitalisations due to pneumonia every year is about 40,000.

The Centre for Health Protection's hotline 2125 1133 for pig farmers has so far received nine calls, with only one requiring follow-up action. A forum will be held at the centre tomorrow to update pig farmers and live pig handlers' on the situation and offer health advice.

http://www.news.gov.hk/en/category/healthandcommunity/070102/html/070102en05001.htm

 

[Gert van der Hoek]

Re: China: Health alert after pig farmers die

Skepticism over pneumonia connection to pigs

Carol Chung

Thursday, January 04, 2007

Pig farmers and abattoir workers have been briefed on a spate of pneumonia cases and deaths involving workers in their industry and advised to maintain high hygiene standards.

"Germs know no boundaries, " said Thomas Tsang Ho-fai, a community medicine consultant at the Centre of Health Protection, which organized Wednesday's forum.

Speaking after meeting with more than 20 pig farmers and abattoir workers, he was confident those attending got the message. But an abattoir worker surnamed Wong said he did not think the pneumonia cases were linked to pigs. Another participant, Asia Waste Management project manager Bruce Lee, agreed.

Tsang said there was a low possibility that pathogens causing the pneumonia cases found in the territory were related to pigs.

Laboratory reports show that the pneumococcus and parainfluenza pathogens found in one sick pig farmer had not jumped from pigs to humans, he said.

The two abattoir workers who came down with pneumonia also had no direct contact with live pigs, Tsang said.

He said consumption of meat from pigs carrying pneumonia- causing pathogens is safe because pneumonia can only be transmitted through droplets expelled during coughing.

An investigation into whether the trips made by two patients, a pig farmer who has since lost his battle with the illness and an abattoir worker, to Zhuhai and Guangzhou, could be a cause of the disease is ongoing.

The center, the Chinese University of Hong Kong and Hong Kong University are conducting tests on tissue samples taken from pigs and patients.

Agriculture, Fisheries and Conservation Department staff have collected 23 such samples from farms.

Samples have also been taken from the 44-year-old pig farmer who died last month.

Laboratory results and reports on efforts to track down the source of the infections will be ready in a month and will be shared with mainland counterparts and the World Health Organization.

But the tissue samples at this stage will not be shared with health departments in Guangdong.

The pneumonia scare arose after two pig farmers died in June and last month.

A 69-year-old male supervisor of meat delivery vehicles was also admitted to hospital with pneumonia symptoms.

A 61-year-old male worker was discharged Tuesday after recovering.

All the cases involved employees from the same slaughterhouse in Sheung Shui.

http://www.thestandard.com.hk/news_...=35372&sid=11581879&con_type=1&d_str=20070104

 

[wetDirt]

Re: China: Health alert after pig farmers die

Note that the common link here is the slaughterhouse/abbatoir. Many cases of facility-linked atypical pneumonias end up being Legionnaire's, due to problems in the air systems. Wouldn't surprise me.