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China: Man Dies; Infected Father "Improving"; More Suspects

Re: China: Man Dies; Infected Father "Improving"; More Suspects

Research Article Abstract - EDITORIAL to precedent
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EDITORIAL COMMENTARY
Human Genes and Influenza
Samira Mubareka1 and
Peter Palese1,2

1Department of Microbiology and 2Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Received 5 July 2007; accepted 5 July 2007; electronically published 11 December 2007.

Potential conflicts of interest: none reported.

Financial support: W. M. Keck Foundation (to P.P.); National Institutes of Health (grant P01 AI158113 to P.P.); Northeast Biodefense Center (grant U54 AI057158 to P.P.); Center for Investigating Viral Immunity and Antagonism (grants U19 AI62623 and U01 CI 000354 [R21 to P.P.]); Ruth L. Kirschstein Physician Scientist Research Training in Pathogenesis of Viral Diseases Award (to S.M.); Sunnybrook Health Sciences Centre, University of Toronto, Canada (salary support to S.M.).

(See the article by Albright et al., on pages XXX–XX.)

Reprints or correspondence: Dr. Samira Mubareka, Dept. of Microbiology, Mount Sinai School of Medicine, 1 Gustave Levy Pl., Box 1124, New York, NY 10029 (samira.mubareka@mssm.edu).
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http://www.journals.uchicago.edu/doi/full/10.1086/524067
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[EXCERPT - 1st Paragraph]
Why some individuals resist infection or recover quickly, whereas others experience severe disease associated with infection, is a fundamental question that medicine has struggled to answer. Pathogens and host immune factors have been extensively investigated for many infectious diseases, to address these questions. However, limited information is available concerning the influence of host genetics on the response to viral infections. Genetic determinants have the potential to play a role at numerous points during the course of viral infection, including viral attachment and entry, replication, disease progression and development of severity, and, finally, transmission. In this issue of the Journal, Albright et al. [1] propose that the severity of influenza illness may have a heritable component. To investigate this hypothesis, the authors used as a resource the Utah Population Data Base, which contains data from founding families and their descendants, comprised primarily of members of the Church of Jesus Christ of Latter‐Day Saints (i.e., Mormons), thus representing a relatively ethnically homogeneous population.

(....)
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Re: China: Man Dies; Infected Father "Improving"; More Suspects

ironorehopper said:
Research Article Abstract - EDITORIAL to precedent
-------
EDITORIAL COMMENTARY
Human Genes and Influenza
Samira Mubareka1 and
Peter Palese1,2

1Department of Microbiology and 2Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Received 5 July 2007; accepted 5 July 2007; electronically published 11 December 2007.

Potential conflicts of interest: none reported.

Financial support: W. M. Keck Foundation (to P.P.); National Institutes of Health (grant P01 AI158113 to P.P.); Northeast Biodefense Center (grant U54 AI057158 to P.P.); Center for Investigating Viral Immunity and Antagonism (grants U19 AI62623 and U01 CI 000354 [R21 to P.P.]); Ruth L. Kirschstein Physician Scientist Research Training in Pathogenesis of Viral Diseases Award (to S.M.); Sunnybrook Health Sciences Centre, University of Toronto, Canada (salary support to S.M.).

(See the article by Albright et al., on pages XXX–XX.)

Reprints or correspondence: Dr. Samira Mubareka, Dept. of Microbiology, Mount Sinai School of Medicine, 1 Gustave Levy Pl., Box 1124, New York, NY 10029 (samira.mubareka@mssm.edu).
-
http://www.journals.uchicago.edu/doi/full/10.1086/524067
-
[EXCERPT - 1st Paragraph]
Why some individuals resist infection or recover quickly, whereas others experience severe disease associated with infection, is a fundamental question that medicine has struggled to answer. Pathogens and host immune factors have been extensively investigated for many infectious diseases, to address these questions. However, limited information is available concerning the influence of host genetics on the response to viral infections. Genetic determinants have the potential to play a role at numerous points during the course of viral infection, including viral attachment and entry, replication, disease progression and development of severity, and, finally, transmission. In this issue of the Journal, Albright et al. [1] propose that the severity of influenza illness may have a heritable component. To investigate this hypothesis, the authors used as a resource the Utah Population Data Base, which contains data from founding families and their descendants, comprised primarily of members of the Church of Jesus Christ of Latter‐Day Saints (i.e., Mormons), thus representing a relatively ethnically homogeneous population.

(....)
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Click to expand...
The number of H5N1 cases is small and the original hypothesis was based on no examples of clusters involving individuals who were not blood relatives. The basis for the original hypothesis was false (and was largely based on the Karo cluster and a MATERNAL linkage).
 
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Re: China: Man Dies; Infected Father "Improving"; More Suspects

Here is a SusanC translation (hat-tip, Sue!) of this article from Takungpao...

http://www.takungpao.com/news/07/12/12/MW-835799.htm

Nanjing Military region: prevention of avian flu to be treated as seriously as SARS outbreak
Dec 12, 2007

Nanjing military authorities have asked all units to set up avian flu prevention teams, to be led by senior officers. They are asked to report daily on the health condition of personnel in the unit, especially when they have unusual symptoms such as fever. These have to be reported immediately. According to sources, the military is treating the avian flu prevention "as seriously as SARS" when it was happening.

In addition, all units are ordered to slaughter all poultry being kept by the families, and to remind officers and soldiers not to go to the neighborhood of the Confucius temple. There have been no reports of unusual symptoms in the military in Nanjing.

Patient gradually improving

According to sources, the second confirmed H5N1 patient in Jiangsu Lu Wei is now stable, and gradually improving. He is eating and sleeping normally, and is now able to read newspapers for a period of time every day, to get information from outside, and to overcome the monotony of being in hospital.

Experts have been holding daily meetings to analyze his condition and make adjustments to treatment; these meetings have now been changed to once every two days. He is still on antivirals and nutritional support, but dosages have been reduced. He is still under 24 hour observation by experienced doctors and nurses, who are not taking any chances. They are monitoring his temperature, pulse, respiration, and blood pressure.

Province needs comprehensive poultry industry regulations

In addition, the provincial government today placed large advertisements in higher-circulation newspapers in Nanjing, with information on how to prevent avian flu. The ads explicitly tell citizens not to buy life poultry to be slaughtered at home.

According to these articles, experts say that control of HPAI H5N1 involve different elements of the production, processing, marketing, transport, and storage of poultry. Inside the city itself, the major focus is on the operation of life poultry markets. In order to protect consumers, the agency for prevention of animal epidemics in Jiangsu issued a special notice recently, asking all regions to increase life poultry market surveillance, and banning the purchase of life poultry from farm markets to be slaughtered at home.

The province is asking all regions to establish comprehensive measures for regulating poultry and poultry product industries, including requirements for certification (probably of vaccination or testing), disinfection and safe disposal. All live poultry transactions in wholesale markets have to be registered per vehicle. Live poultry sold in retail markets must be slaughtered in the market. Consumers are banned from bringing live poultry home.

At the same time, all regions are told they must enforce disinfection of business premises, equipment, garbage and excreta in a rigorous manner. Any businesses not adhering to strict animal disease prevention regulations, or sell unvaccinated or infected live poultry and poultry products will be severely punished.

People told not to eat chicken if there

Provincial authorities also say the next step is to strengthen the surveillance, inspection, and regulation of live poultry and poultry product industries, and logistics, and to establish thorough live poultry inspection, certification, and fixed slaughtering locations.

The government is reminding people that it is safe to eat chicken if they only buy from licensed farm markets or supermarkets, and buy only chicken that have passed the certification process. They emphasized to the public not to eat any chicken if the origin is uncertain, if the meat is not fully cooked, especially if there is there is blood on the meat. Eggs have to be fully cooked.

People who were infected with SARS had a death rate of 10-20%, whereas those infected with avian flu has over 60% mortality. However, many doctors were infected by the SARS virus, but worldwide, up to now there has been no report of doctors being infected by avian flu. A history of contact with sick poultry is present in 60% of H5N1 patients.

http://www.newfluwiki2.com/showComment.do?commentId=76347
 
Re: China: Man Dies; Infected Father "Improving"; More Suspects

Here's another SusanC translation (hat-tip, Sue!) of another article from Takungpao...

http://www.takungpao.com/news/07/12/10/ZM-834826.htm

(Nanjing, 9th December) The patient Lu Wei's residence is under heavy guard. This building (address given but I can't be bothered to translate that!) is the location of the Nanjing military region communication and maintenance office. Both the offices and residences/barracks are located in the same compound. According to (unspecified) sources, this building/courtyard/compound has been sealed off for more than a week. There is no number at the front of the building, or any other identifying signs. The big metal gates that were open before are now closed. Only a small side gate is open for people to enter or exit. This door is guarded by two armed soldiers.

(As far as the reporter understands) all the residents of the building where LuWei lived are under quarantine and observation, with daily temperature taking, and various tests done.

The doctors and nurses who resuscitated Lu Wei's son at the Jiangsu People's hospital are all under medical observation and quarantine.

More than 60 healthcare workers at the Nanjiang neurology hospital who had contact with the deceased's mother are also under quarantine and observation.

http://www.newfluwiki2.com/showComment.do?commentId=76389
 
Re: China: Man Dies; Infected Father "Improving"; More Suspects

Chinese military-controlled region bans poultry purchases in wake of bird flu case


2007-12-13

BEIJING (AP) - A military command in eastern China has banned poultry purchases in the wake of a human bird flu case in the area, an official said Thursday.

The move by the Nanjing Military Region comes about a week after a 52-year-old man was confirmed to have been infected with the H5N1 virus days after his son died of the disease in Nanjing.

«We have already had a meeting for all staff including those who have retired to notify us of the human bird flu case,» said a man who answered the telephone at the region's administrative bureau. «We were also told not to purchase poultry products.

He refused to give his name or any other details, a standard practice among officials when dealing with sensitive issues, especially in the secretive military.

The Ta Kung Pao, a Hong Kong newspaper backed by China's communist authorities, said this week the father was a retired regiment commander of the Nanjing Military Region, a critical division that covers the provinces of Jiangsu, Zhejiang, Anhui, Fujian, and Jiangxi.

It also faces Taiwan, China's rival, and is the front-line launching point for an assault on the island.

The newspaper said the man, surnamed Lu, and his family are believed to have eaten a dish called «Beggar's Chicken,» which is traditionally made by wrapping the bird in lotus leaves and baking it.

Earlier this week, Chinese health officials said they were investigating the case of the 24-year-old son, the country's 17th fatality from bird flu.

He died Dec. 2 and his father started showing symptoms a day later and was confirmed to have the disease, health officials have said.

Investigators have said human-to-human transmission was possible, although both men could also have been infected by the same source or been infected separately from different sources. None of the possibilities have been ruled out, both Chinese and World Health Organization officials have said.

Hans Troedsson, the WHO's representative in China, said Monday the father was recovering after being treated with the antiviral medicine Tamiflu at the onset of symptoms.

Eighty-two other people who had contact with the father and son were being monitored for symptoms. China's Health Ministry on Thursday refused to answer questions over the telephone.

The Animal Husbandry and Veterinary Bureau in Jiangsu province, where Nanjing is located, said last week no bird flu epidemic had been discovered in the province.

Out of the 27 human cases reported in China so far, only one had been forewarned by a poultry outbreak in the vicinity, WHO has said, an indication the country needs to improve its surveillance systems.

Scientists have warned if outbreaks among poultry are not controlled, the virus may mutate into a form more easily passed between people, potentially resulting in millions of deaths.

http://www.pr-inside.com/chinese-military-controlled-region-bans-r346449.htm
 
Re: China: Man Dies; Infected Father "Improving"; More Suspects

niman said:
The number of H5N1 cases is small and the original hypothesis was based on no examples of clusters involving individuals who were not blood relatives. The basis for the original hypothesis was false (and was largely based on the Karo cluster and a MATERNAL linkage).
Click to expand...

How does this relate to the study posted by Ironorehopper to which you were responding (post #102)? :confused:
 
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Re: China: Man Dies; Infected Father "Improving"; More Suspects

Google-translated from Chinese:

Jiangsu bird flu patients conditions improve
2007-12-14

An Chen Min Nanjing 13 Mar: According to sources, Jiangsu who confirmed the second case of highly pathogenic avian flu patients Lu Wei, the current conditions in stabilizing the situation, the situation has noticeably improved. Lu Wei is no longer as recently as a day bed, with the condition improves, his obvious physical rehabilitation, is now able to get out of bed in the corridor, walking back and forth.

Mainland medical profession dedicated to the expert group he set up for him every two days a collective consultation, a detailed analysis of conditions and adjust drug treatment and never perfunctory. It is learned that Lu Wei inflammation of the lungs has been significantly improved, the temperature has been normal, cough symptoms have disappeared. His appetite is good, restaurants, had long ago by the liquid, semi-liquid food to normal meals.

It is understood that doctors still hanging daily Lu Wei lose fluid, continue to use anti-virus treatment and nutritional support, and other measures aimed at consolidating therapeutic effect.

Special Care Unit where nurses and doctors are still on the group's Lu Wei carry out 24-hour monitoring and close observation of body temperature, pulse, respiration and blood pressure and other vital signs and condition. His personal life is still conducted by the special nurses who care, meticulous care.

http://www.takungpao.com/news/07/12/14/ZM-836796.htm
 
Re: China: Man Dies; Infected Father "Improving"; More Suspects

A SusanC (partial) translation from Chinese (hat-tip, Sue!) -- note that this article is a couple of days old:
SusanC @ FW said:
Nanjing medical profession avoids talking about avian flu

Here is the article that I thought was worth reading but didn't have time to translate. This is just half of it, but the important half!

http://www.takungpao.com/news/07/12/10/ZM-834825.htm

(Nanjing 9th December) HCWs from many hospitals in Nanjing, in response to this reporter's questions about the condition of the recent bird flu patient, all said that "this is a highly sensitive" question. They are not allowed to talk casually to people, and they don't know anything about what is happening.

According to a family member, the ?intensive care HCWs who had participated in resuscitating the patient have not returned home, and there's been no communication with their families either.

According to one doctor at the hospital, except for Lu Wei who is still being "resuscitated" (NB. this article is several days old, plus the Chinese phrase for resuscitation covers a broader range of severity, and not necessarily just for the critically ill), there are 4 other close contact still under medical observation (it seems they use the phrase 'medical observation' to imply a higher degree of observation than the more casual contacts, like the 60+ contacts of the mother) and quarantine at the hospital. They are all in single infectious disease rooms, and even the staff (those talking to the press) know nothing about it.

Citizens calm

Whereas several days ago, most people did not know about this avian flu infection, now the difference is most people in Nanjing have learned about it in the past 2 days. When the Ministry of Health announced the confirmation of the second case, they also released the information that the patients were from Nanjing. As a result, local newspapers and TV stations reported on the cases.

When asked whether they were nervous, people said "not bad. Not as frightened as last time (during SARS 2003)." Many people also said, this should be an isolated case, but they will still pay more attention to personal hygiene. Winter is the season for flu outbreaks anyway (NB. Chinese people especially in colder regions do tend to take even seasonal flu more seriously than westerners), so they will be paying more attention anyway. Some people also said, even though the government said it was ok to eat chicken and ducks, they have decided not to buy them for a while.

http://www.newfluwiki2.com/showComment.do?commentId=76461
Click to expand...
 
Re: China: Man Dies; Infected Father "Improving"; More Suspects

Nanjing bird flu cases contained

<!--enpproperty <date>2007-12-14 11:28:39.0</date><author></author><title>Nanjing bird flu cases contained</title><keyword>bird flu</keyword><subtitle></subtitle><introtitle></introtitle><siteid>1</siteid><nodeid>158961</nodeid><nodename>Regional</nodename><nodesearchname>2@webnews</nodesearchname>/enpproperty--><!--enpcontent--> [FONT=Arial,Helvetica,sans-serif](Xinhua)
Updated: 2007-12-14 11:28[/FONT]

[FONT=Arial,Helvetica,sans-serif] BEIJING - Two cases of bird flu in humans involving family members in Nanjing, Jiangsu Province, have been effectively contained, China's Ministry of Health said, adding all close contacts involved have been released from medical observation.

"None of those in close contact showed unusual symptoms and they were all released from medical observation on December 12," the ministry said in a statement posted at its website (www.moh.gov.cn) on Thursday.

China announced on December 2 that a 24-year-old man surnamed Lu in the provincial capital Nanjing died of H5N1 infection. On December 7, the man's father was also confirmed to be infected with the virus.

About 80 people who had contact with either man were put under close medical observation.

"The father, who has been under intensive medical treatment, is in stable condition and showing signs of improvement," the ministry said in the statement.
So far, the means of transmission remained unknown and experts were still conducting an investigation.

The son was said to have no known contact with dead poultry. In addition, the Jiangsu Animal Husbandry and Veterinary Bureau said last week that no bird flu epidemic had been discovered in the province.

The ministry said that local health authorities had tightened monitoring on pneumonia cases and collected a large number of samples. "All samples tested (H5N1) negative and no suspicious or unusual cases were discovered," it said.

The latest cases bring the number of confirmed bird flu cases in humans in China to 27 since 2003. During that period, there have been 17 deaths.

http://www.chinadaily.com.cn/china/2007-12/14/content_6322161.htm




[/FONT]
 
China's father-son bird flu cases have not spread: official[

China's father-son bird flu cases have not spread: official[

China's father-son bird flu cases have not spread: official

The dead man, a 24-year-old surnamed Lu, died from avian flu on December 2. His 52-year-old father was confirmed a few days later to have also contracted the H5N1 strain of the virus.

The father was now in a stable condition and showing signs of improvement, according to a health ministry statement on its website.

The father-son case, in the eastern province of Jiangsu, raised concerns of possible human-to-human transmission, and the authorities' latest announcement seemed targeted at easing those fears.

The health ministry said Monday that there was no evidence the father had contracted the disease from his son and there was no reported outbreak of the disease among poultry.

However, exactly how the virus transmitted in their case remains unknown, because the son is not thought to have had any contact with dead poultry and authorities said there had been no bird flu epidemic locally.

This followed a familiar pattern in China where humans have contracted the disease in an area where there have been no reported outbreaks among poultry.

The father-son case has brought reports of human cases of bird flu in China to 27 since 2003. Seventeen of those people have died.
 
Re: China: Man Dies; Infected Father "Improving"; More Suspects

Below is an earlier rendition of the article posted by Niko above (post #109) by about 10 minutes. There are some subtle differences between the two news releases particularly in the quotes relating to H2H transmission.

Nanjing bird flu cases contained

2007-12-14 11:18:12

BEIJING, Dec. 14 (Xinhua) -- Two cases of bird flu in humans involving family members in Nanjing, Jiangsu Province, have been effectively contained, China's Ministry of Health announced. It added all close contacts involved had been released from medical observation.
"None of those in close contact showed unusual symptoms and they were all released from medical observation on Dec. 12," the ministry said in a statement posted at its Website (www.moh.gov.cn) on Thursday.
China announced on Dec. 2 that a 24-year-old man surnamed Lu in the provincial capital Nanjing died of H5N1 infection. On Dec. 7, the man's father was also confirmed to be infected with the virus.
Eighty-two people who had contact with either man were put under close medical observation.
"The father, who has been under intensive medical treatment, is in stable condition and showing signs of improvement," the ministry said in the statement.
Neither men was said to have known contact with sick or dead poultry and so far the source of the infection remained unknown.
Mao Qun'an, spokesman of the Health Ministry, said earlier that there were several possibilities for infection in the second case, including close contact between the father and the son. It was also possible that both men were either infected by the same source or separately by different sources.
Joanna Brent, a Beijing-based the WHO spokeswoman, told Xinhua that "there is no strong indication of human-to-human transmission. But because this possibility cannot be ruled out, the WHO is monitoring this case closely."
"If this (the second case) was proved to be a case of human-to-human transmission, it seems likely that the transmission is inefficient since, so far, there is just one confirmed case out of 83 close contacts and the two cases were directly related, with no second-generation transmission," she said.
She also said that at this stage a possible common source has not been identified and based on preliminary laboratory results of these two cases, the possibility of infection from two separate sources is least likely.
Brent said that like most H5N1 cases in China, these cases were not foreshadowed by a poultry outbreak reported to the Ministry of Agriculture. "This suggests that strategies for monitoring H5N1 in poultry need further strengthening," she said. China's Ministry of Health said that local health authorities had tightened monitoring of pneumonia cases over the past 10 days and collected a large number of samples. "All samples tested (H5N1) negative and no suspected or unusual cases were discovered," it said. The latest cases bring the number of confirmed bird flu cases in humans in China to 27 since 2003. During that period, there have been 17 deaths.

http://news.xinhuanet.com/english/2007-12/14/content_7248247.htm
 
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