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report detection of a case of subtype H5N1 infection in a human in Bangladesh, which was ... to the Kamalapur clinic with a history of 7 days of fever,

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http://www.recombinomics.com/News/03161 ... uster.html

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Bangladesh, which is hosting the 2011 International Cricket Council (ICC) 10th Cricket World Cup, is troubled by the discovery of a third human case of avian influenza, but urges the public not to panic.


In the Bangladesh capital's crowded Kamlapur slum, not far from where the opening ceremony extravaganza of the World Cup was held, the third case, a 31-month-old boy, was discovered.

The government has assured the ICC organizers that the flu is under control, and no travel warning has been issued by international health agencies.

Two days early, a 13-month-old girl claimed the dubious title of the first human case of bird flu this year. Both the girl and the boy are stable and epidemiologists assured that they will recover.

Despite limited manpower, the Institute of Epidemiology Disease Control and Research (IEDCR) has begun an extensive mopping up the area where the flu strain was detected. The institute maintains virus surveillance at 28 spots, including 26 hospitals across Bangladesh, with the help of the US Center for Disease Control and Prevention.

Professor Mahmudur Rahman, director of IEDCR, told online news agency bdnews24.com that the institute has launched an extensive search operation for unreported cases in the community in an attempt to determine the source of the infection.

The first human infection in the country was detected in May 2008. Also in the capital, it was a 15-month-old boy who fully recovered after treatment at the IEDCR. It was reported that the child became infected after his mother slaughtered an infected chicken and cuddled the child with unwashed hands.

Rahman said maintaining bio-security in poultry farms and personal hygiene can keep the virus away. He said the virus could cause severe illness in humans and had the potential for a high rate of mortality.

He added that the strain of H5N1 influenza that circulates in Bangladesh, class 2.2, is less virulent, so it causes fewer infections in humans, adding it could change into another class, 2.1, that was highly infectious.

Dr. Mat Yamage, country chief of the avian influenza unit of the United Nations Food and Agriculture Organization (FAO), told bdnews24.com that people should be careful in this situation. "It's a public health concern."

He said the practice of marketing live birds might pose a considerable risk to the people in those areas currently experiencing avian influenza outbreaks.

Thousands of chickens and eggs are being destroyed in different places in the country.

The world's first outbreak of bird flu among humans occurred in Hong Kong in 1997. So far it killed 315 people out of 533 infected in 15 countries. Most of these cases have been linked to close contact with infected poultry or their secretions.




Read more: http://www.allheadlinenews.com/articles ... z1Gnb6lWQx

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Detail on 2008 case:

First human infection with Influenza A H5N1 confirmed in Bangladesh

The first human case of influenza A H5N1 recognized in Bangladesh and was notified to WHO by Bangladesh Government on 22 May, 2008. The case occurred in a 15 month old child from Dhaka. He developed fever and difficulty breathing, but recovered completely. His likely exposure was to a chicken that was slaughtered in his household. Physicians who see patients with serious respiratory illness should take a history of exposure to sick poultry and contact IEDCR if they suspect highly pathogenic avian influenza.
We report the first case of human infection with influenza A, H5N1 confirmed in Bangladesh. The case was identified as part of the population based surveillance in urban Dhaka. Upon laboratory confirmation of the case an investigation team re-evaluated the affected child and family and investigated potential sources for the infection.
The World Health Organization and the Food and Agriculture Organization monitor strains of influenza circulating globally to identify dangerous emerging strains with the hope that early recognition and intervention a high mortality pandemic can be avoided. Strains of Influenza A, H5N1, first identified in Hong Kong in 1997 have been circulating in Asia since 2001. These strains have caused high mortality outbreaks among poultry throughout Asia, and in many countries in Europe and Africa. The H5N1 virus is a adapted to birds, the natural host of influenza viruses. However, these strains occasionally infect humans. Among the 383 human cases of H5N1 recognized and reported to the World Health Organization by 28 May 2008, 241 (63%) had died. If the H5N1 virus develops the capacity to efficiently transmit from person to person, this could cause a deadly pandemic.
The government of Bangladesh confirmed the presence of influenza A, H5N1 virus in poultry in March 2007 and since then poultry outbreaks of H5N1 have been confirmed in 47 of the 64 districts in Bangladesh. ICDDR,B collaborates with the Government of Bangladesh on human surveillance for influenza under two broad activities, national hospital surveillance in 12 hospitals across the country and population based surveillance in a low income community in urban Dhaka.

Kamalapur is a densely populated, low-income community in Dhaka city. Since March 2004, approximately 5000 households with children under the age of 5 years are under active surveillance for respiratory illness. Each week a field worker visited participating households and referred children to the clinic who had signs of serious respiratory illness. Participating families were encouraged to bring their children to the clinic if they developed signs or symptoms of illness on days that the field worker did not come to visit them in the home. In the clinic physicians performed a standardized exam, and ordered additional studies based on specific findings. Every fifth child from the surveillance area who met the criteria for acute infectious respiratory illness had a nasopharyngeal wash specimen collected. An aliquot of the nasopharyngeal washes was placed on tissue culture in the Virology Laboratory of ICDDR,B, and incubated. If cytopathic effect was noted, the tissue culture supernatant was collected and a haemagglutination inhibition test conducted using the standard WHO influenza reagent kits for Influenza A (H1N1), Influenza A (H3N2), Influenza B Shanghai and Influenza B/Hong Kong.

A 15 month old Kamalapur resident developed cough and runny nose on 22 January 2008. By 27 January his breathing was labored. On 29 January his mother brought him to the ICDDR,B clinic in Kamalapur. On examination the child had a temperature of 38.1 °C, a respiratory rate of 40 breaths per minute, pulse of 124, weight for age was the 78th percentile and there were no abnormal sounds on chest auscultation. Because the child was part of the active surveillance system, a chest radiograph was obtained. The child was also selected as one of the one in every 5 children selected for nasopharyngeal wash and influenza culture.

The initial clinical impression was enteric fever. The child was treated with amoxicillin. The chest radiograph was later interpreted as showing an alveolar infiltrate. Because the child was in the surveillance system, a field worker visited him daily at his home. He was also seen in the clinic for follow-up on 31 January, 5 February, 10 February and 13 February. Although the mother reported the child had fever at home as late as 7 February, an elevated temperature was not identified after the initial clinic visit. The child completed a 13 day course of amoxicillin. On his last clinic visit on 13 February the child was clinically well. The final clinical diagnosis was upper respiratory tract infection. The child was re-evaluated on 22 May and remained clinically well.

The culture of the child’s nasopharyngeal wash specimen showed cytopathic effect typical of influenza virus, reacted against antibody to influenza A, but the specimen did not agglutinate with H1 or H3 antisera. The specimen was forwarded to the Centers for Disease Control in Atlanta, Georgia for further characterization. At the Centers for Disease Control the isolate was confirmed as a highly pathogenic Influenza A, H5N1, by anti-sera agglutination and real time PCR. The viral genome was sequenced. It was a clade 2.2 virus.

The infected child lived with his mother, sister, and father in a one room residence in the Kamalapur community. The child’s father bought a live broiler chicken from a poultry shop located 50 meters from the residence at 11:00 am at some time in January. He kept the chicken near the door of their one room house where the affected child was sleeping. At 12:00 pm, the child’s mother with the help of her next door neighbor slaughtered the chicken inside the bathroom near the tap. While they were slaughtering the chicken, the child was sleeping and immediately after the processing of the chicken, the child awoke. Neither the mother nor the neighbor washed their hands. The mother handed the child to the neighbor. The mother gathered all the entrails, organs and other wastes of the chicken in a polythene bag, tied a knot in that bag and kept it near the main entrance of the house. The waste bag remained there for about two hours.

The poultry shop where the father bought the chicken sold an average of 15 chickens per day. The owner purchased chickens from the Jatrabari whole sale market in Dhaka. One day during the first three weeks in January he recalled that three of the chickens that he purchased died on the same day. This was quite an unusual event. Poultry wholesalers at the Jatrabari whole sale poultry market report purchasing their poultry mostly from Savar, Gazipur, Norshingdi, Munshigonj, Brahmanbaria, and Commilla outside Dhaka. During January they recalled that deaths among poultry in cages occurred commonly averaging among 5 – 10% of chickens each day. Fifty outbreaks of H5N1 were confirmed in Bangladesh in January.

The mother also reported that the child ate a soft boiled egg each day in January. None of the child’s family members reported illness during the time that the index child was ill nor in the following two weeks.

Reported by:
Institute for Epidemiology Disease Control and Research (IEDCR), Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh

http://www.iedcr.org/Default.aspx?tabid=52

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More on 2008 case:

ICDDR,B and the Government of Bangladesh have worked hand-in-hand for many years to tackle disease and improve public health in Bangladesh. This long-standing collaboration allows us to assist in surveillance and outbreak response when necessary and now, as bird flu tops the list of concerns in Bangladesh, we have been able to work together to identify and test cases quickly.

On 22 May 2008 the Ministry of Health in Bangladesh announced the first case of human infection with H5N1 avian influenza in Bangladesh. Working together with ICDDR,B researchers, this case of H5N1 was identified in a 16 month-old boy in one of the largest urban slums in Dhaka, during seasonal surveillance activities. The results were later confirmed by the Centers for Disease Control and Prevention (CDC) in Atlanta. The boy has fully recovered from the infection.
To identify this case and other suspected cases of H5N1 in humans, ICDDR,B and the Government of Bangladesh respond quickly and work well together: government workers identify high-risk patients and alert ICDDR,B’s infectious disease team, who immediately ensure the patient is isolated and specimens are transferred to Dhaka. Finally, ICDDR,B’s virology laboratories test the samples and determine if they are negative or positive for influenza.
ICDDR,B and the Government of Bangladesh remain ready to work together to respond to potential outbreaks and to identify and manage bird flu cases in Bangladesh.

http://www.icddrb.org/page_view.cfm?ID=84

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Bangladesh reports another H5N1 infection

Lisa Schnirring Staff Writer
Mar 16, 2011 (CIDRAP News) – Health officials in Bangladesh have confirmed another H5N1 avian influenza infection, the second one in a week, bdnews24.com, a news service based in Dhaka, reported today.

The new case is in a 2-year-old boy who appeared at a surveillance site in Kamalapur with mild symptoms that included a fever and cough. Tests on the boy's respiratory and serum samples were conducted by the country's Institute of Epidemiology Disease Control and Research (IEDCR).

Dr Mahmudur Rahman, director of the IEDCR, told bdnews24 that the strain (clade 2.2) of the H5N1 virus that circulates in Bangladesh is less virulent than other strains.

The boy's illness was detected during surveillance related to the investigation of another recently reported case, in a 13-month-old girl whose infection was confirmed today by the World Health Organization (WHO). However, Rahman said the boy is not related to the girl.

The WHO said in its statement today that Bangladesh's health ministry has confirmed a 16-month-old girl's infection with the H5N1 influenza. Her illness was reported by the media on Mar 14.

In its statement, the WHO said the girl's infection was detected at an IEDCR surveillance center in Kamalapur in Dhaka state. She was brought to the center on Mar 8 with cough and fever and has since recovered.

An investigation into the source of her illness is being conducted by Bangladeshi and WHO officials.

Her illness, plus the boy's infection, raise Bangladesh's H5N1 case total to 3, none of which have been fatal. The other infection occurred in 2008, in a 16-month-old boy.

If the WHO confirms today's reported case, the global H5N1 case count would rise to 535, including 316 deaths.

http://www.cidrap.umn.edu/cidrap/conten ... angla.html

The Bangladesh cluster will be discussed tonight at 10 PM EDT

http://www.rense.com/about/guests.htm

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Thank you, Henry.

I suspect we will have more news about H5N1 in humans in Bangladesh.

If the news breaks prior to 10 PM, it will be discussed tonight.

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AVIAN INFLUENZA, HUMAN (27): BANGLADESH (DHAKA) WHO
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 16 Mar 2011
Source: WHO Global Alert and Response (GAR) [edited]
<http://www.who.int/csr/don/2011_03_16/en/index.html>


Avian influenza situation in Bangladesh
---------------------------------------
The Ministry of Health and Family Welfare, Government of the People's
Republic of Bangladesh, has confirmed a case of human infection with
avian influenza A (H5N1) virus. The case was detected through the
influenza sentinel surveillance centre run by the Institute of
Epidemiology Disease Control and Research (IEDCR) and the
International Centre for Diarrhoeal Disease Research, Bangladesh
(ICDDR,B).

The case is a 16-month-old female from Kamalapur, Dhaka. She
presented at a influenza sentinel surveillance on 8 Mar 2011 with a
history of cough and fever and subsequently recovered.

A detailed epidemiological investigation and contact follow-up is
being conducted by a team of epidemiologists from IEDCR, ICDDRB, and
WHO Bangladesh. The case was confirmed as being infected with A(H5N1)
by the Institute of Epidemiology Disease Control and Research
(IEDCR).

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[This is the WHO confirmation of the case reported in ProMED-mail
report: "Avian influenza, human (25): Bangladesh (DA) 20110315.0826".
This is only the 2nd human case of avian influenza (H5N1) in humans to
have been recorded in Bangladesh. The previous case was a 16-month-old
child from the same area in 2008. Both this infection and the previous
case involved young children and appear to have been mild, detected
during routine influenza surveillance.

According to the WHO Table of the Cumulative Number of Confirmed
Human Cases of Avian Influenza A/(H5N1) Reported to WHO, updated to 16
Mar 2011, the global total of cases is now 534, of whom 311 have been
fatal
(http://www.who.int/csr/disease/avian_in ... index.html>).
The number of cases recorded so far in 2011 is 18 (Bangladesh 1,
Cambodia 3, Egypt 11, Indonesia 3).

The HealthMap/ProMED-mail interactive map of Bangladesh can be
accessed at <http://healthmap.org/r/0AzS>. - Mod.CP]

[see also:
Avian influenza, human (25): Bangladesh (DA) 20110315.0826
2008
----
Avian influenza, human (50): Bangladesh, WHO 20080529.1740
Avian influenza, human (49): Bangladesh, WHO 20080525.1718
Avian influenza, human (48): Bangladesh 20080523.1704]
.................................................cp/mj/dk

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