First Probable Person to Person Transmission of H7N9 Bird Flu Virus in China

The development was "worrying" and should be closely watched, the team wrote in the British online journal bmj.com, but stressed that the virus, believed to jump from birds to people, was still inadept at spreading among humans.

"People should not panic," epidemiologist Chang-jun Bao of the hard-hit Jiangsu province's Center for Disease Control and Prevention, told AFP of the report that he co-authored.

"The transmissibility of this novel virus... was not so effective."

Scientists have long feared the virus would mutate into a form that transmits easily from person to person.

In the new study, Bao and a team report on the case of a 60-year-old man who died in hospital after contracting the H7N9 virus, which he apparently transmitted to his daughter.

The 32-year-old woman, who had nursed her father for over a week, also died in hospital.

She had had no access to potentially infected poultry, leading investigators to conclude that the "most likely explanation" for her illness was direct virus transmission from her father, who had regularly visited live poultry markets.

"Aside from the exposure to her father's respiratory secretions during her bedside care, the daughter had no definite exposure to poultry or other suspect sources of infection," said Bao.

Genetic tests of virus samples from the two patients also revealed they were "almost identical".

Despite this apparent evidence of direct transmission, the virus's transmissibility remained "limited and non-sustainable," said the paper. None of 43 other people who had had close contact with the two patients, including hospital staff, contracted the virus.

"These findings suggest that potential genetic susceptibility might be one of the determinants and that avian influenza viruses... are more easily transmitted between individuals with genetic connection," said the paper.

The scientists noted they had been unable to interview the two critically ill patients and could not definitively rule out the possibility that the daughter picked up the virus somewhere else, although this seemed "less likely".

Official figures released last month said the H7N9 virus had made 132 people ill in mainland China since the first human cases were reported in March, of which 43 died. One case was recorded in Taiwan.

A study in June warned that a lull in new infections may lift in the autumn.

The results of a lab study published in the US journal Science in May showed the H7N9 strain can spread among mammals, specifically ferrets, and could do the same between humans under certain conditions.

H7 influenza viruses comprise a group that normally circulate among birds, of which H7N9 forms a subgroup that had never been found in humans until the Chinese outbreak.

Commenting on the paper in a BMJ editorial, researchers James Rudge and Richard Coker of the Communicable Diseases Policy Research Group in Thailand said it provided the "strongest evidence yet" of H7N9 transmission between humans.

"Does this imply that H7N9 has come one step closer towards adapting fully to humans? Probably not," they wrote.

Odd cases of human-to-human transmission had also been reported in other bird flu types like H5N1 and H7N7 -- none of which has mutated into an easily spreadable form, and so to see it in H7N9 was not surprising.

"While the paper... might not suggest that H7N9 is any closer to delivering the next pandemic, it does provide a timely reminder of the need to remain extremely vigilant: the threat posed by H7N9 has by no means passed," said Rudge and Coker.

Peter Horby, senior fellow at Oxford University's Clinical Research Unit in Hanoi, Vietnam, agreed that limited human-to-human transmission "does not necessarily represent the early stages of a trajectory towards full adaptation to humans".

Source-AFP

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MERS Virus Affects Three More in Saudi Arabia

One of the patients is a 67-year-old woman from Riyadh with underlying medical conditions, but who was not known to have come into contact with animals or another sufferer of the virus.

The other two patients diagnosed with Middle East Respiratory Syndrome were health care workers who had been exposed to other MERS patients.

According to the WHO, 46 of the 94 people confirmed to have been infected have died from MERS since September 2012.

Concerns about the virus have led Saudi Arabia to restrict visas for the hajj pilgrimage in October, during which millions of Muslims flock to the holy sites of Mecca and Medina.

Experts are struggling to understand MERS, which still lacks a vaccine and which has an extremely high fatality rate of more than 51 percent.

It is considered a cousin of the SARS virus that erupted in Asia in 2003 and infected 8,273 people, nine percent of whom died.

Like SARS, MERS is thought to have jumped from animals to humans, and shares the former's flu-like symptoms -- but differs by causing kidney failure.

Scientists studying the new virus have found older patients, men, and people with underlying medical conditions are those particularly at risk.

Source-AFP

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Human Immunity to H7N9 Flu Virus is too Low

The study used a new, high throughput method that allows blood samples to be analysed for antibodies to multiple human and animal influenza viruses at the same time and is easier to standardise than previous techniques. However, the assay is yet to be validated clinically for the H7N9 virus, and the researchers caution that the results must be interpreted with care.

Since the first case of H7N9 infection in humans was reported in February 2013, there have been 131 confirmed cases and 36 deaths, all in China apart from one case in Taiwan. All of the infections seem to have come from infected poultry and there is no evidence of sustained transmission between people. One of the first key pieces of information that officials need when considering how best to respond to the threat of a pandemic is how much, if any, immunity the human population has to this virus. This helps to predict where the virus is likely to affect first and how likely it is that the virus will spread further. Having this knowledge also helps to understand the risks of severe infection, as well as helping to target protective measures such as where to direct antiviral medication.

Researchers at the Wellcome Trust Oxford University Clinical Research Unit (OUCRU) in Vietnam tested 1723 blood samples collected in southern Vietnam for the presence of antibodies to five different bird flu viruses, including one from the H7 sub type. The presence of antibodies would be an indication of past exposure to these particular strains of flu. They used a new technique that was developed by their research collaborators at the National Institute of Public Health of The Netherlands that is faster and easier to use than previous methods.

The results reveal that although the level of antibodies to the H7 sub-type of flu virus are higher than any of the H5 sub-types tested, levels of antibodies to all five bird flu viruses are much lower than to human flu viruses. This suggests that people living in this particular area of Vietnam have had very little or no exposure to the H7 sub-type of virus, similar to other bird flu viruses. As this population of people would be expected to be among the first to be affected in the event of a pandemic, these findings have important implications for pandemic preparedness plans in this area.

Dr Maciej Boni, a Sir Henry Dale Fellow at the OUCRU and first author of the study, explains: "H7N9 is a virus that until now has only infected birds so it's not surprising that we don't find much evidence of humans having been exposed to it. It is reassuring that in Vietnam we don't see any evidence that the current outbreaks represent a tip-of-the iceberg observation of widespread H7N9 infection in people. On the other hand, the low antibody levels indicate that there is likely to be very little immunity to this virus."

Around half of the samples were taken from an urban environment, Ho Chi Minh City, and half from a rural area, the nearby Khanh Hoa province. The team found no difference in the level of immunity to bird flu viruses between these two populations, even though people living in rural areas are more likely to live in close proximity to poultry.

"It has been suggested that people who live in closer proximity to chickens and other birds will have higher levels of immunity to bird flu viruses simply because their exposure is likely to be greater. However we find no evidence for this. Our findings would suggest that both rural and urban populations should be treated the same when considering how best to respond to the threat of an outbreak," added Dr Boni.

Professor Jeremy Farrar, Director of the Wellcome Trust Major Overseas Programme in Vietnam and the Oxford University Clinical Research Unit Hospital for Tropical Diseases, explains: "This is the first study to give us information about the level of antibodies and potentially human immunity to this new bird flu virus, H7N9 in the region. But we need to interpret the findings cautiously, these assays are relatively new and we need to understand how they correspond to existing assays and how they reflect past infection and true human immunity.

"We know that antibodies are very important for immunity to other flu viruses but at this stage, we still don't know what level of antibody measured using this assay would provide protection against this novel strain. Further studies will be needed to understand the clinical relevance of these new assays, how they compare with classic techniques and what the apparent absence of antibodies to these viruses in the human population means. However these new techniques do allow for much higher throughput of samples, ease of use and once validated may allow much more rapid assessment of the spread of infection and levels of population immunity than do traditional assays."

The study, which was carried out in collaboration with scientists at the National Institute for Public Health and the Environment (RIVM) in the Netherlands, is published online this week in the Journal of Infectious Diseases.

Professor Marion Koopmans, who is Head of Virology at the RIVM and senior author of the study, said: "We developed this technique exactly to be used in the current situation: we wanted a standardised test that allowed us to rapidly compare antibodies to the new virus with those to influenza viruses that we already know are common in people. The level of immunity to a new virus is one of the important questions during any emerging disease outbreak. We need only one drop of blood, so that tests can also be run when only small sample volumes are available, for instance when testing children. For outbreak investigations, testing of animals may be needed, and we are currently working on that. To do the clinical validation studies, we need blood samples from patients (and animals) with confirmed H7N9, and we hope to be able to do that soon through collaborations with other groups working on H7N9."

Source-Eurekalert

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SEAS dead Virus Hits 33

"In the world, September 2012 to date, which has been informed of a total of 58 confirmed cases of infection by the seas - VOC, with 33 deaths," Chaib told journalists.

Until last month, the disease was known simply as a novel coronavirus, before being renamed Middle East Respiratory Syndrome Coronavirus, or seas - VOC, as launched in this region.

Have now been 44 confirmed cases in Saudi Arabia, 28 of them fatal, according to who figures.

THAT connects by countries in cases of infection, rather than death, and its Saudi toll includes a deceased in Britain.

A person has died in France after being infected in Dubai, and one patient died in Munich, Germany, that has been transferred there after the first treaty in Abu Dhabi.

There were also two cases in Jordan, two of them fatal. Qatar saw two, with these patients in Britain and Germany.

Two patients contracted the disease in Britain of a person who had been in the Middle East, which one died.

Tunisia saw two non-fatal cases and the Italy two - one of them caught the virus in Jordan and gave it to a contact in Italy.

France has recorded an infection, a man who is believed to have caught the disease while sharing a hospital room with the deceased patient, who had been in Dubai.

The virus is a member of the coronavirus family, which includes the pathogen that causes severe acute respiratory Syndrome (SARS).

SARS triggered a worldwide in 2003 after panic that it has jumped to humans, to animals in Asia and killed 800 people.

As SARS, seas appears to cause a lung infection, patients with a temperature, cough and struggling to breathe. But it differs in that it also causes rapid renal failure.

Health authorities were concerned about the high proportion of deaths compared to the case, warning that seas could trigger a new crisis if it were to mutate into a form that spreads more easily.

Source-AFP

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Saudi Arabia to Send Animal Samples to US in SARS-like Virus Probe

The ministry has "collected large samples from bats and other animals, including camels, sheep and cats," said Saudi Deputy Health Minister Ziad Memish.

So far, there have been 44 lab-confirmed cases worldwide of the virus, which until now has been known as the novel coronavirus, or nCoV-EMC, but was this week redubbed the Middle East Respiratory Syndrome Coronavirus, or MERS.

Saudi Arabia counts by far the most cases, with 30 confirmed infections and 17 fatalities, while cases have also been detected in Jordan, Qatar, Tunisia, the United Arab Emirates, Germany, Britain and France.

Memish told diplomats gathered in Geneva for the World Health Assembly, the decision-making body of the World Health Organization, that his country until now had not been able to send samples from animals besides bats to the United States.

"But now... we've got an approval to move these samples and they will be shipped for testing," he said.

The virus is a cousin of Severe Acute Respiratory Syndrome (SARS), which triggered a scare 10 years ago when it erupted in east Asia, leaping to humans from animal hosts and eventually killing some 800 people.

Scientists at the Erasmus medical centre in Rotterdam have determined that the virus appears to infect the body via a docking point in lung cells, suggesting bats may be a natural reservoir for it.

Bats were also pinpointed as a likely natural reservoir for SARS in a 2005 study, and are known carriers of the deadly haemorrhagic fever Ebola.

Source-AFP

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WHO Concerned Over Potential Spread of SARS-Like Virus Among Humans

by Kathy Jones on? May 25, 2013 at 8:28 PM General Health News The World Health Organization deputy chief has voiced deep concern over the potential spread of SARS-like virus that has so far killed 22 people in less than a year.
"We have a high level of concern over the potential... for this virus to have sustainable person-to-person spread," WHO deputy chief Keiji Fukuda told diplomats gathered in Geneva for the World Health Assembly, the UN agency's decision-making body.

There has already been evidence of limited transmission between humans, and last week the WHO said two Saudi health workers had contracted the deadly coronavirus from patients -- the first evidence of transmission in a hospital setting.

But Fukuda said the WHO was looking into "whether this has the potential to have a more extensive spread, more extensive transmission."

Given the high fatality rate relative to the number of cases, experts have highlighted the power of the virus and the frightening prospect of its mutating into a form that leaps easily from human to human.

Fukuda's comments came after Saudi Arabia on Wednesday said another person had died from the virus. With a total death toll of 17, it has been the hardest hit by the disease that first emerged last June.

So far, there have been 44 lab-confirmed cases worldwide, half of them fatal, with 30 infections in Saudi Arabia and the rest spread across Jordan, Qatar, Tunisia, the United Arab Emirates, Germany, Britain and France.

Most of the patients infected in Europe and Tunisia had links to or had travelled in the Middle East.

The WHO said Thursday the virus, which until now has been known as the novel coronavirus, or nCoV-EMC, had been redubbed the Middle East Respiratory Syndrome Coronavirus (MERS CoV).

The virus is a cousin of Severe Acute Respiratory Syndrome (SARS), which triggered a scare 10 years ago when it erupted in east Asia, leaping to humans from animal hosts and eventually killing some 800 people.

Like SARS, the new virus appears to cause an infection deep in the lungs, with patients suffering from a temperature, cough and breathing difficulty, but it differs from SARS in that it also causes rapid kidney failure.

Source-AFP

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