H7N9 discussion thread: January 24, 2014 to Feb 5 2014 (closed)

[NS1]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Given the seemingly growing number of conditions that quality as underlying health issues that may compromise immune response, it seems that the majority of the population would fit into this category.

I'm sure obesity isn't nearly as much of a factor in China as it is in the US. I found it odd when one report on hospitalization pH1N1 cases in the US stated that 50% of the cases were considered obese. When you look at the criteria describing obesity, it's not what first comes to mind. Many reasonably healthy looking individuals meet the medical criteria for obesity. I'd be willing to bet that the percentage of hospitalized patients with flu in the US that are obese is similar to the percentage in the population at large.

Similarly, given the living conditions in many parts of China (air pollution, unsanitary or crowded conditions, etc.), it seems possible that a majority of people would have one or more underlying health conditions such that the government could claim that those who have died had compromised immune systems.

Exactly, Jim.

Most claims of pre-existing condition in Influenza deaths are not factually exclusionary of the general population, but are strictly in place to ameliorate the death count.

That being said, we must understand that most Americans are disposed to severe outcomes upon infection with particular genetic lines of pH1N1 due to their internal derangement of cell-to-cell signalling, either from obesity driving leptin ratio faults or from the usage of lifestyle pharmaceuticals that dysregulate hormonal and other immune signalling systems.

Carefully noting these causal factors with each case is a much better solution than the public health specialist just blaming the dead victim.

 

[gsgs]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

hypertension,ischemic heart disease,stroke,diabetes,obesity,...

are all conditions that have increased deaths in a seasonal wave.

It's sometimes subsumed as "metabolic syndrome".

How flu increases this is not well understood, afaik

Or why do these show seasonality at all, even without flu ?

 

[Giuseppe]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

I wonder whether in the most affected regions (ie Guangdong, Shenzhen, Zhejiang), in the towns' outskirts massive garbage landfills the number of wandering non-domesticated birds (seagulls for example) may transport the virus from organic matter abandoned in the dump from a site to another and along the coastal area.

 

[gsgs]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

how would the gulls find the virus there and keep it alive and transport it,
if the professional virus searchers don't find it ?

how would humans come into contact with those viruses ?

why does it mutate, if it resides extended time in the environment ?

why dont we find gull-segments, mutations - instead we can consistently
follow the evolution in chickens with occasional new introductions
from mallards

 

[Giuseppe]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

All right! But...

Landfills in China as in most of the developing (and often even in affluent) countries are full of 'organic' matter: ie discarded food (meat, vegetables, etc.), from city inhabitants daily production, AND agricultural business industrial acitivities (ie animals carcasses, pigs, chickens, litters...).

These wastes should be treated in advance before providing them to dump, through bio-reactor facilities (to digest all organic matter); it is use instead to provide them ''as-is'', making the dumps enormous reserves of percolate (to poison rivers, lakes and coastal waters, as well as pits for human use) and microbial agents (often resistant to drugs).

If non-domesticated birds and stray mammals have free access to these areas they can easily enter in contact with viruses of any species, flu included.

A lot of people work in these immense landfills to collect, select and recycle all things they can...

 

[Vibrant62]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[gsgs]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[gsgs]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

http://gmggranger.wordpress.com/201...mploymentzhejiang-age-pyramid-to-26-jan-2014/


many farmers. What do they farm ? chickens ? ducks ? pigs ?
corn,wheat,grass,
cats,dogs,

 

[Vibrant62]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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?

 

[gsgs]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

they do some random checking.
Remember last year, they tested
20000 human flu samples from the sentinal
surveillance and found 6 H7N9

http://wwwnc.cdc.gov/eid/article/19/8/13-0662_article.htm

 

[sharon sanders]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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?

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.


Week 52 is the last week I see on their flu site:

http://www.cnic.org.cn/eng/show.php?contentid=686

 

[Vibrant62]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[Vibrant62]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[sharon sanders]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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

http://www.flutrackers.com/forum/showthread.php?p=523279#post523279

 

[Shannon Bennett]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[Vibrant62]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[gsgs]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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)

 

[JJackson]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[sharon sanders]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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.

 

[NS1]

Re: H7N9 discussion thread: recent increase in cases, January 24, 2014+

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 H7N9 Hemagglutinin 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.