Thanks to Sari Setiogi for tweeting the link to this article in Kompas.com: Indonesia Facing Biggest Problems of Possible Bird Flu Resurgence. First an excerpt, then a comment:
The United Nations warned of a possible major resurgence of bird flu and said a mutant strain of the H5N1 virus was spreading in Asia and elsewhere.
The UN’s Food and Agriculture Organisation (FAO) on Monday urged increased surveillance and preparation for a potential outbreak of the virus, which it says has infected 565 people since it first appeared in 2003, killing 331 of them.
The virus was eliminated from most of the 63 countries infected at its peak in 2006 after mass poultry culling, but since 2008 it has been expanding geographically in both poultry and wild birds, partly due to migration patterns, the FAO said.
“The general departure from the progressive decline observed in 2004-2008 could mean that there will be a flare-up of H5N1 this fall and winter,” the FAO’s chief veterinary officer, Juan Lubroth, said in a statement. He said the appearance of a variant strain of the virus in China and Vietnam was a concern, because it appeared to be able to sidestep the defences of existing vaccines.
The circulation of the virus in Vietnam also poses a direct threat to Cambodia, Thailand and Malaysia as well as endangering the Korean peninsula and Japan, FAO said.
The latest human death occurred earlier this month in Cambodia, which has registered eight cases of human infection this year, all of them fatal, the agency added.
Countries that could face the biggest problems are Bangladesh, China, Egypt, Indonesia and Vietnam, where the FAO said the virus is still firmly entrenched. It said recently affected areas included Israel, the Palestinian Territories, Bulgaria, Romania, Nepal and Mongolia.
Meanwhile, a Flublogian of long standing Scott McPherson, is back blogging after too long away. He says this new mutant is actually our old pal the Fujian strain, which was thriving in China in 2008 and even earlier. (The Chinese were no more happy about the "Fujian" tag than the Indians are about New Delhi as the name for the NDM-1 superbug.)
Robert Roos at CIDRAP has an
excellent report on the FAO warning, in which he mentions the clade of this strain (2.3.2.1), but doesn't use the Fujian tag.
Here's
one of my posts from late 2007 about the controversy, and here's
another from early 2006. It's interesting that the controversy over "Fujian-like" H5N1 has been so forgotten.
This reminds me that
China hasn't reported a case of human H5N1 this year, and only two in 2010.
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FAO warns of possible H5N1 resurgence in birds
Robert Roos 
News Editor
Aug 29, 2011 (CIDRAP News) – The United Nations Food and Agriculture Organization (FAO) expressed renewed concern today about H5N1 avian influenza, warning of a "possible major resurgence" of bird outbreaks and saying that a vaccine-evading strain has emerged in Vietnam and China.
However, other influenza experts said the FAO statement was not surprising and did not offer new information that would suggest a significant increase in the threat posed by the virus, which has killed poultry in 63 countries since 2003 and caused 565 confirmed human illnesses with 331 deaths in that time.
After peaking in 2006, H5N1 outbreaks declined until mid 2008, but since then they have been increasing in number and expanding geographically, probably with help from migratory birds, the FAO said.
The number of outbreaks reached about 4,000 in 2006 before dropping off, the FAO said. It said about 302 outbreaks were reported in the first half of 2008. "But outbreaks have risen progressively since, with almost 800 cases recorded in 2010-2011," the statement said.
Also, 2008 marked the start of renewed geographic expansion of H5N1 in both poultry and wild birds, the agency said. In the past 2 years it has shown up in poultry or wild birds in countries that had been free of it for several years, including Israel and the Palestinian Territories, Bulgaria, Romania, Nepal, and Mongolia.
The long-distance movements of the virus seem to be associated with migratory birds, said FAO Chief Veterinary Officer Juan Lubroth. "Wild birds may introduce the virus, but people's actions in poultry production and marketing spread it," he said in the press release.
The agency also said a new H5N1 variant in Vietnam and China, called clade 2.3.2.1, is able to sidestep existing poultry vaccines. The strain has invaded most of northern and central Vietnam, and the country suspended its spring vaccination campaign this year as a result, the FAO said.
"Viet Nam's veterinary services are on high alert and reportedly considering a novel, targeted vaccination campaign this fall," the FAO stated. "Virus circulation in Viet Nam poses a direct threat to Cambodia, Thailand and Malaysia as well as endangering the Korean peninsula and Japan further afield. Wild bird migration can also spread the virus to other continents."
Lubroth said the recent increase in outbreaks could mean there will be a "flare-up" of H5N1 this fall in winter, with the virus popping up in unexpected places. The countries where the virus is endemic—Bangladesh, China, Egypt, India, Indonesia and Vietnam—are likely to face the biggest problems, but no country can consider itself safe, he said.
David A. Halvorson, DVM, an avian health expert at the University of Minnesota in St. Paul, said he didn't see anything surprising in the FAO statement.
"This appears to be a continuing situation where the Asian lineage HPAI [highly pathogenic avian influenza] H5N1 virus escapes from an endemic region and causes infection in another area," he commented. "That spread may come about by poultry movement or wild bird movement," he added, seconding Lubroth's comment on that point.
As for the new variant, he commented, "The appearance of mutant viruses that are able to bypass vaccinal immunity is not surprising; actually, with heavy vaccine use in the absence of other steps to completely control HPAI, the emergence of such viruses is to be expected."
Halvorson said it was reported earlier that Vietnam was suspending its vaccination campaign because officials didn't think it was working, which must have led to the identification of the new variant. "But everybody has said from the beginning that vaccination is not a primary [control] tool, it's secondary. And these countries that try to use it for a primary control method, it just won't work," he said.
He said his understanding is that Vietnam plans to make a new vaccine targeting the new variant.
Concerning the growing number of reported outbreaks, Halvorson cautioned that "incentives or disincentives" to report outbreaks can operate in any given country at any time, and therefore "it gets to where it's really difficult to know what's going on in any particular place."
Another expert, Michael T. Osterholm, PhD, MPH, voiced similar views about the FAO statement. He is director of the University of Minnesota's Center for Infectious Disease Research and Policy, which publishes CIDRAP News.
"I'm not sure what it means that the number of outbreaks is up this year. We don't know how good the surveillance is," he commented.
"We all know there's a risk of H5N1 changing and becoming much more lethal again in birds and humans. But there's no data that supports that's happening," Osterholm added.
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/aug2911h5n1.html
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FAO warns of spread of Fujian H5N1 mutation
Back in 2008, flublogia announced the origins of a new clade, or substrain, of bird flu. And I joined right in, proclaiming that the new clade -- nicknamed "Fujian," after the province where it was subtyped -- would eventually cause major problems. The best blog of mine that I could remember on the topic, from 2008, can be read here. You might also be entertained by my original blog on the Chinese H2H case involving Fujian H5N1, here. I know I was; I have forgotten half of this stuff!
Fujian H5N1 was the cause of the father-to-son (or was it son-to-father) Chinese H2H infection back in 2008. The arrival of simultaneous Fujian B2B and H2H bird flu was extremely troubling to all of us.
Well, it took awhile (just over three years), but Fujian H5N1 is on the lips of television announcers and copy editors the world over. The reason? The FAO (think WHO for animals) released a statement today, proclaiming great worry over this "new" mutant strain of bird flu, and imploring the world to monitor it carefully.
Now the timing of such stories is interesting. We have been monitoring Fujian for years, as I mentioned earlier. But with the release of the film "Contagion," we may be seeing where the world's public health authorities see an opportunity to raise awareness just when bird flu is about to become a household word again.
Make no mistake: I am all about awareness. Consider my own "pandemic fatigue" following the aftermath of the first wave of the swine flu/H1H1 pandemic of 2009-11. This story woke me up and caused me to go back and retrace my own experiences writing about Fujian 2.3.x H5N1. So let's review what has been happening in the months since I last blogged seriously about H5N1.
As of August 19th of this year, there were more confirmedhuman bird flu cases than in all of 2004, 2008 or 2010. Keep in mind that this includes an alarming increase in Egyptian human cases and accompanying deaths. But most distressing is the sudden re-emergence of Cambodia as a bird flu incubator. While Egypt has had 32 cases and 12 deaths to date, Cambodia has had 8 cases -- all fatal. Of course, we shrug our shoulders at Indonesia, which continues to befuddle Western experts with its distressing lack of transparency.
So 2011 already ranks as the fifth-worst year for human H5N1, and we have the beginnings of flu season in which to add to that total. It would take a huge, but not impossible, acceleration of human cases to move it past 2009's 73 totals. that is the good news. But the FAO apparently sees a cause-and-effect relationship between the initial discovery of a new clade, the distribution of that new clade, its ability to overtake the existing clade as the dominant substrain, and then extend its reach back into humanity. Now it is hard to calculate an accurate Case Fatality Rate (CFR) based on such low numbers, but it is safe to say that of all the documented H5N1 human cases, we are still at a reliable 50% figure, meaning that half of all human bird flu patients either die of the disease or its byproducts. In Egypt, that figure is currently 37%; in Cambodia and Indonesia, it is much, much higher.
The FAO is signaling that it fully expects bird flu cases in poultry and in humans to accelerate in 2011. The efforts to vaccinate poultry, while admirable, have failed to eradicate the disease (did we ever really expect this effort to be successful?). Pockets of H5N1 remained and pockets remain today. While migratory wildfowl (laden with virus) are the primary culprit, humans and their myriad and almost universally bad ways of moving poultry from area to area are also culpable. Perhaps even more so, when humans smuggle sick and dying poultry across borders, as happens hourly from the Bird Flu Ho Chi Minh Trail from Vietnam into China.
http://www.scottmcpherson.net/journal/2011/8/29/fao-warns-of-spread-of-fujian-h5n1-mutation.html
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