H7N9

[dothedd]

A pandemic virus needs to win only once and it could be the end of humankind.

Bird Flu in China Spreads Hundreds of Miles From Outbreak Point

"Virus makes potentially dangerous leap by infecting a seven-year-old girl. This infection of the girl happened in Beijing. This is worth watching. This situation is not over...."

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China Bird-Flu Deaths Rise to 13 as H7N9 Virus Spreads
Apr 14, 2013 7:26 AM ET

Beijing confirmed that a 7-year-old girl has H7N9 avian influenza and Henan province reported its first two cases, opening a new front in the spread of the virus in the world’s most populous nation.

Shanghai said today two people infected with the strain of bird flu died, taking the country’s death toll to 13. The city also reported three fresh infections today while the eastern provinces of Jiangsu and Zhejiang also confirmed new cases, raising the national tally to 60 from 49 yesterday.

www.bloomberg.com/news/2013-04-13/beijing-confirms-child-s-h7n9-case-first-in-north-china.html

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"WHY IT WILL SPREAD FAST: TOURISM......................BIG TIME!

CHINA: ranks third in the world for inbound and outbound tourism.....human to human
transfer would be devastating....here is where tourists GO....and where they COME FROM.....note Shanghai and Hong Kong as top destinations.....
Top 20 China Destinations for Overseas Tourists:
1. Beijing 2. Shanghai 3. Xian 4. Guangzhou 5. Guilin
6.Shenzhen 7. Hangzhou 8. Chongqing 9. Chengdu 10. Kunming
11. Hong Kong 12. Yichang 13. Suzhou 14. Datong 15. Zhuhai
16. Luoyang 17. Huangshan 18. Lhasa 19. Haikou 20. Sanya

Top 20 Tourist Source Countries:
1. United States 2. Australia 3. Singapore 4. United Kingdom 5. Malaysia
6. Canada 7. India 8. Germany 9 Indonesia 10. France
11. Spain 12. Netherlands 13. Russia 14. Italy 15. Philippines
16. Israel 17. Poland 18. Brazil 19. Thailand 20. Mexico ..."

"Once the travelers are on the airplane for 15 hours everyone is susceptible..."

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Asymptomatic Beijing H7N9 Raises Pandemic Concerns
Recombinomics Commentary 21:13
April 14, 2013

active screening monitoring 4-year-old bamboo surname boys H7N9 avian influenza virus nucleic acid positive. The boy is currently no clinical symptoms

The above translation describes an asymptomatic contact (4M) of the index case (7F) in Beijing. The case was identified through screening of contacts of the earlier case. The detection of H7N9 is an asymptomatic contacts raises concerns that H7N9 is far more widespread than represented by the 61 confirmed cases (see map), which includes 13 fatalities.

The confirmed cases have a case fatality are of more than 92% (13 fatalities out of 14 outcomes). All of the other confirmed cases are hospitalized, including the above case who was hospitalized for observation.

Sequences from this case would be useful. There are 4 public sequences and all 4 have E627K. These sequences are from fatal cases. Avian isolates are lacking E627K, but have Q226L. Differences between severe / fatal cases and mild / asymptomatic cases remain to be determined.

However, the detection of H7N9 in an asymptomatic contact raises serious pandemic concerns.

Media Link

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H7N9 spreads to central China as asymptomatic case reported

Lisa Schnirring Staff Writer
Apr 14, 2013 (CIDRAP News) – In quickly evolving H7N9 influenza developments, the virus has spread to a new part of China—as two illnesses were reported today in Henan province—and Beijing officials have reported the outbreak's first asymptomatic case.

Meanwhile, the H7N9 hot spot in the eastern part of the country reported 9 more cases, spiking the case count to 61, according to official sources and media reports. Shanghai also reported 2 deaths of previously announced cases, which pushes the fatality total to 13.

The asymptomatic case is in a child who apparently tested positive during risk-group surveillance.

The cases from Henan were included in an update today from the World Health Organization (WHO), which did not include the 10 new cases outside of Henan. Confirmation of the virus for the first time in central China comes just 1 day after the first H7N9 case was detected outside of eastern China, in a 7-year-old daughter of Beijing poultry traders.

All of China's provinces are now able to test for the virus, according to earlier media reports.

Henan province is about 590 miles northwest of Shanghai and about 440 miles south and slightly west of Beijing.

Case total soars to 61 infections, 13 deaths
One of the Henan province patients is a 34-year-old man who got sick on Apr 6 and the other is a 65-year-old man who got sick on Apr 8, according to the WHO.

Xinhua, China's state news agency, had a few other details today about the two patients. It said the younger man works as a chef in Kaifeng and is in critical condition and the older man is a farmer from Zhoukou who had frequent contact with poultry in his home and is also in critical condition. The towns are about 60 miles apart.

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H7N9, Jiangsu: Three new birdflu cases

At 18:00 on 2013 04 16 Source: Jiangsu Health Department

Health Department of Jiangsu Province, April 16 Bulletin, Jiangsu newly confirmed three cases of human infection with the H7N9 avian influenza.

Fumou, male, 56 years old, now living Qinhuai District of Nanjing City. On April 16, the provincial expert group diagnosed cases of human infection of H7N9 avian influenza confirmed cases. A hospital in Nanjing, where serious condition. After investigation, the close contacts of the cases of a total of seven people, far showed no abnormality.

Humou, female, 21 years old, now living in Kunshan City. On April 16, the provincial expert group diagnosed cases of human infection of H7N9 avian influenza confirmed cases. Kunshan City in a hospital where he is currently in serious condition. After investigation, the close contacts of the case has a total of 12 people, far showed no abnormality.

Zhu, male, 72 years old, now living in Suzhou City, Suzhou District. On April 16, the provincial expert group diagnosed cases of human infection of H7N9 avian influenza confirmed cases. Where critical condition in a hospital in Suzhou. After investigation, the close contacts of the cases of a total of six people, far showed no abnormality.

Since human infection with the H7N9 avian influenza outbreak, the provincial government attaches great importance to the provincial leaders on many occasions given instructions, repeatedly listening to the reports, a number of thematic studies, the deployment of epidemic prevention and control work. Recently, the province's health system in accordance with the national and provincial deployment requirements, take comprehensive measures to effectively prevent and control human infection with the H7N9 avian flu.

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April 18, 2013
Bad week just got worse....

Chinese authorities suspect human-to-human transmission of H7N9 avian flu

A worrying development in China’s H7N9 outbreak: There is growing evidence that the virus may have the ability to be transmitted between humans, especially close family members, and the Chinese government has admitted for the first time it’s a possibility.

The Chinese National Health and Family Planning Commission said on Thursday it could not rule out human-to-human transmission in the case of a Shanghai family—two brothers, at least one of whom has the virus, and their 87-year-old father, who was the first confirmed H7N9 fatality. A husband and wife in Shanghai also both contracted H7N9.

“Further investigations are still under way to figure out whether the family cluster involved human-to-human transmission,” said Feng Zijian, director of the health emergency center of the Chinese Center for Disease Control and Prevention, according to the state-run China Daily. “Human-to-human transmission, in theory, is possible, but is highly sporadic.”

Some of the H7N9 patients have had no contact with poultry, making human-to-human transmission a real possibility, the World Health Organization said on Wednesday. There have been 82 cases of H7N9, with 17 fatalities.

There is a crucial difference between a virus capable of limited human-to-human transmission, during long periods of close contact between family members, and effective human-to-human transmission, as with seasonal flu that can spread with incidental contact.

The H1N1 avian flu, which caused several hundred thousand deaths in 2009 and 2010, was capable of limited human-to-human transmission. A strain of avian flu with a high mortality rate that is capable of effective human-to-human transmission, on the other hand, would have the makings of a disaster film.

news.yahoo.com/china-says-investigating-human-human-spread-bird-flu-044438853.html

[dothedd]

April 2013

H7N9 Tamiflu resistant

A mutation associated with resistance to neuraminidase inhibitors--like Roche's ($RHHBY) Tamiflu and GlaxoSmithKline's ($GSK) Relenza--was found in genetic sequence data from a H7N9 patient specimen. The mutation can be present in viruses sensitive to Tamiflu--and China reports this is the case in H7N9--but it warrants attention. "It's not a strong signal, but there's a possibility [of resistance]," Japanese state health institute director Masato Tashiro told Bloomberg.

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Apr 26, 2013

Responding to H7N9 Threat, FDA Issues Emergency Use Authorization for CDC RT-PCR Diagnostic


The U.S. Food and Drug Administration this week issued Emergency Use Authorization for the Centers for Disease Control and Prevention Human Influenza Virus Real-Time RT-PCR Diagnostic Panel-Influenza A/H7 Assay in response to what it called “significant potential for a public health emergency” based on the emergence of the influenza A(H7N9) virus that has led to 23 deaths in China and Taiwan.

Though the assay is intended for research purposes only, the federal agency said that “based on the totality of scientific evidence available to FDA, it is reasonable to believe that the CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel-Influenza A/H7 (Eurasian Lineage) Assay may be effective in diagnosing A(H7N9) influenza virus,” and that the known and potential benefits of using it for diagnostic purposes “outweigh the known and potential risks of such product.”

Life Technologies reports that its Applied Biosystems® 7500 Fast Dx Real-Time PCR instrument is the sole platform cleared for use under the CDC protocol created for emergency screenings of patients suspected of harboring H7N9. The company adds that its SuperScript III One-Step qRT-PCR reagent kit “is intended to be used with the CDC's human influenza virus assay to quickly monitor the spread of the pathogen and thwart a potential pandemic.”

The firm also says it is increasing reagent production to meet global need, adding that scientists are currently using its Ion PGM™ Sequencer to characterize the virus in order to determine whether it can be transmitted from human to human.

"We have learned through our past experiences that a strong surveillance program is crucial in times like these," Dan Didier, Life Tech public health director, said in a statement. "We are working continually with our partners around the globe on improving our capabilities, particularly when it comes to developing rapid detection kits."

FDA has issued such authorization for medical devices during past flu emergencies, including the 2009 H1N1 outbreak.

[dothedd]

NOTE: This article was from April 9, 2013

H7N9 – What Happens Next? Who Knows! The Good, The Bad And The Ugly!

What happens next? Who knows!!!! Really, anything is possible. Virus replication is a random act and anything could happen. This includes that it fizzles out, it stays in the background (like the current status of H5N1) or it becomes our next pandemic. No one knows. Max Fisher from the Washington Post, blogged this yesterday and he is spot on! The good, the bad and the ugly!

The Good

1. China is being unusually transparent so far. Ten years ago, as the deadly viral respiratory illness known as SARS first spread across China, the government did not respond well. It suppressed information about the outbreak, making it that much harder to contain and study the disease, ultimately costing lives. This time, though, Chinese authorities have been sharing information about the disease’s spread, and state media appear to be freely reporting on new cases. Chinese officials seem to take the disease seriously and want to combat its rise, even if it means overcoming more secretive instincts. All health care for H7N9 is now free in China, for example, to help encourage people to report cases.

2. The number of cases has largely flatlined in the last week. After weeks of rising cases, the number seems to have stayed stable at around 110 over the last week. Big caveats here that there might be cases we don’t know about, and the count could change at any moment.

3. Shanghai has found some success limiting new cases. A lot of the cases started around Shanghai, but the city was able to reduce the number of new infections after it closed poultry markets, according to Laurie Garrett, a senior fellow at the Council on Foreign Relations covering health-care policy. The Wall Street Journal found the same thing.

The Bad

1. It’s spreading. With cases recently reported in Shandong province and now in Taiwan, the virus seems to be moving outward.

2. No verified human-to-human transmissions, but it’s possible. Neither China nor the World Health Organization has documented human-to-human transmission, which would allow the virus to spread far more quickly and widely, but nor have they ruled it out. The Taiwanese case had no known exposure to poultry.

3. Tough to identify birds with the virus. World Health Organization officials say the virus is more difficult to detect in sick poultry than were previous strains because the birds do not show symptoms that are as clearly identifiable. This makes it tougher to keep sick birds off the market.

The Ugly

1. It’s very deadly, with 18 percent mortality so far. For comparison, tuberculosis has a mortality rate of about 4 or 5 percent in China. Still, the avian flu virus that had its first outbreaks in China in 2006, known as H5N1, has a mortality rate of 60 percent and has killed hundreds of people on multiple continents. It’s way too early to tell H7N9′s mortality rate, given that many infected patients have not yet fully recovered, but it’s so far killed about 18 percent of patients.

2. “This is definitely one of the most lethal influenza viruses that we have seen so far.” That’s according to Keiji Fukuda, the World Health Organization’s assistant director general for health, security and the environment, who added, “This is an unusually dangerous virus for humans.” Fukuda said the WHO is still struggling to understand the disease, but he certainly seems to be sounding the alarm.

3. More easily transmitted than the 2006 avian flu outbreak. That’s also according to the WHO’s Fukuda, who says this new strain is more easily contracted than the H5N1 virus.

www.extremehealthzone.com/h7n9-is-a-new-bird-flu-pandemic-imminent/

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How scared should we be of H7N9?

The most recent outbreak of avian flu, the strain H7N9, has killed 22 people and infected 108. The cases were thought to be contained within China until Wednesday, when a Taiwanese man was confirmed to be infected with the virus.

As more cases appear, the death toll rises and so does the fear. But are the fears founded?

GlobalPost talked to Dr. Neil Fishman, associate chief medical officer at the University of Pennsylvania Health System, about where to focus efforts to quell the outbreak, how the press is handling the news and just how likely it is that humans will one day transfer the virus to other humans.

GlobalPost: The current flu strain has been found in disparate areas of China. How does the wide spread of cases affect efforts to combat the virus?

Dr. Neil Fishman: There's two critical things that are promising. One is that the virus has not been isolated in migratory birds. It's only been found in chickens, ducks and pigeons in live poultry markets, so that makes it potentially easier to manage.

The other piece of promising news is that the closing of poultry markets appears to have led to a slowdown of the spread of disease. The focus needs to be on controlling the live poultry.

Scientists have said H7N9 is more readily transmissible to humans than previous strains. How bad is this outbreak compared to previous ones? Are we at a tipping point?

I wouldn't call it a tipping point. The prior bird flu outbreak, the H5N1 strain, has been smoldering for well over a decade. This is H7N9 and, on the optimistic side, there haven't been that many cases.

It does appear to transmit a little more efficiently from animals to humans. But there still hasn't been any evidence of human-to-human transmission. I don't think it's a tipping point yet, but I do think it is a situation that needs to be monitored very closely.

Scientists have acknowledged that human-to-human contact is possible. How likely do you think this is?

It appears unlikely at this time, but it is important to remain vigilant. However, I will not be surprised if we learn about limited human-to-human transmission in the coming months. This is to be expected and does not signal a pandemic. Widespread human-to-human transmission remains unlikely, particularly given the H5N1 experience.

What do you think of the media response to the outbreak?

I actually think it's been appropriate and well-informed. I always fear too much hype and I haven't seen that yet. I think if you go back to the early H5N1 days there was overreaction. Initial coverage of this outbreak appears more informed.

I wonder if China has been more transparent about this outbreak [as opposed to the early days of H5N1], so the info is more readily available, and that leads to less circumspection, less hypothesis.

There's still a lot to learn about this virus. I don't believe that there is a saturation effect, that people are getting used to these outbreaks. I prefer to think of it as more of an educated response. There have been more outbreaks, the public has learned, the press has learned ... we need to gather all of this information to see how an outbreak progresses.

How likely is the international spread of H7N9?

Right now, less likely, because the virus has not been found in migratory birds, and there has not been human-to-human transmission. I will get concerned if the virus mutates and develops the ability for human-to-human transmission. Again, that has never occurred in the 10-plus years of the H5N1 outbreak, but we just need to follow it closely right now.


April 26, 2013 3:1 PM

NOTE:
H7N9 Spread To Fujian Province
Recombinomics Commentary 13:00
April 26, 2013

Fujian Province confirmed case of human infection with H7N9 avian influenza. Patients Luomou, male, 65 years old, Yongding County, Longyan City, Fujian Beizhen. On April 18 patients no obvious incentive to repeated coughing, with active chest tightness, fever. At 14:50 on the 23rd "cough, sputum, fever, shortness of breath two days," the chief complaint of stay in Longyan City Hospital. The provinces and expert consultation diagnosis of severe pneumonia, human infection of H7N9 avian influenza be diagnosed. Given anti-viral treatment, non-invasive respiratory support and comprehensive treatment of Chinese medicine, the condition has improved.


Commentary

H7N9 Spread To Fujian Province
Recombinomics Commentary 13:00
April 26, 2013


Chinese Center for Disease Control at 11 o'clock on the April 26 review of test results for the H7N9 avian influenza virus nucleic acid positive.

The above translation describes the first confirmed H7N9 bird flu case in Fujian province. This case (65M) represents a significant geographic spread. This week cases were reported for the first time in Shandong and Jiangxi Provinces, which represented an incremental spread. Similarly, the detection of the case in Taiwan represented an infection that originated in Jiangsu, just north of Shanghai.

However, the confirmation of H7N0 represents a significant jump, and the upcoming May 1 travel will likely spread H7N9 throughout China and beyond.

Although the sequences from human cases are closely related to those found in birds in live markets, the human PB2 sequences contain mammalian adaptation changes (E627K or D701N) signaling human to human transmission.

The movement of such changes to Fujian Province raises serious pandemic concerns.


www.recombinomics.com/News/04261302/H7N9_Fujian.html

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U.S. Hospitals Told to Be on Lookout for H7N9 Bird Flu
Apr 19, 2013 11:29 AM ET
U.S. hospitals are being urged to head off a spread of the new H7N9 avian influenza by looking out for people exhibiting flu-like symptoms who have traveled to China or had contact with someone who has the illness.

The Centers for Disease Control and Prevention held a conference call with health-care professionals yesterday to review procedures for treating bird-flu patients and controlling infections, Erin Burns, an agency spokeswoman, said in an e- mail. The Atlanta-based agency today issued interim guidance on the use of antiviral agents to treat H7N9 infections.

Issuing the guidance and holding the clinician calls “would be considered routine preparedness measures for an outbreak with pandemic potential,” Burns said.

China has recorded 92 human infections of the H7N9 strain of bird flu, with 17 of the cases fatal, according to data compiled by Bloomberg from national and provincial governments and the World Health Organization. The source of the infection hasn’t been identified and there is no evidence of person-to- person transmission, with many of the cases involving human contact with poultry, according to the CDC’s website.

There haven’t been any cases reported in the U.S. and sustained person-to-person spread is needed for a pandemic to occur. The H7N9 virus is novel and has the potential to cause a pandemic if it were to change and spread through human-to-human contact, CDC said.

No Vaccine

H7N9 viruses have been detected in poultry in the same area in China where human infections have occurred, according to the CDC. A vaccine for the strain isn’t available.

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US Hospital Prepares for H7N9
April 25, 2013

New Flu Strain in Far East Adds Vigilance to Midwest Hospital
PR NewswirePress Release: The University of Kansas Hospital

KANSAS CITY, Kan., April 25, 2013 /PRNewswire/ -- The World Health Organization (WHO) is calling the new strain of H7H9 influenza virus "lethal" and The University of Kansas Hospital is preparing now for any potential cases. Although the H7N9 flu strain – or "bird flu" – has not resulted in any confirmed cases in the U.S., authorities want the public to be aware and vigilant about this new strain of flu that is spreading in China and now Taiwan that poses a pandemic threat. Lee Norman, MD, chief medical officer for The University of Kansas Hospital, was briefed on the virus during a recent regional Homeland Security committee meeting.

"This is a brand new strain of flu," said Dr. Lee Norman. "This is not the H5N1 bird flu that we've known about for 15 or 16 years, nor is it associated with the SARS epidemic. This is brand new, just recently genetically typed out for the first time and there's a whole lot we don't know about it."

Dr. Norman says it is most likely an airborne transmitted disease, but researchers don't fully yet know how it spreads. In a video interview, Dr. Norman answers several questions that will help the public understand the virus and be more vigilant, including:

Fatality Rates – currently fatality rates are at about 20 percent, which makes this a very dangerous virus

Most Impacted – fatalities are following the same general patterns as other flu virus outbreaks, which means that older and younger populations, as well as those with immune issues are more at risk.

Vaccines – while there are no vaccines at this time, the CDC is working on investigating this further. Vaccines for other flu strains do not seem to prevent this particular strain.
Medical Response – Staff at The University of Kansas Hospital has been briefed on the H7H9 symptoms

[dothedd]

April 24, 2013


Taiwan: 3 hospital staff show symptoms after H7N9 contact


Via Focus Taiwan, a CNA report: 3 hospital staff show symptoms after H7N9 contact. Excerpt:
Three hospital personnel have developed respiratory symptoms after coming into contact with Taiwan's first confirmed case of H7N9 avian flu, the Central Epidemic Command Center said Wednesday.

All three had taken proper protective measures when providing medical care for the patient, a 53-year-old man who fell ill three days after retuning from China's Jiangsu Province, one of the H7N9-affected areas, the center said.

A survey of the epidemic situation showed that 139 local people had come into contact with the man, a Taiwanese businessman based in Jiangsu's Suzhou area, the center said.

Three of them had close contact, 26 had contact more than seven days ago (putting them past the infectious period) and 110 are hospital personnel, the center said.

Four of the hospital personnel have also passed the infectious period and have not developed symptoms, the center said.

A further three of the hospital personnel did not take proper protective measures when treating or caring for the patient, but none of them have so far shown any symptoms, the center said, adding that they will be strictly monitored until April 27.

The epidemic control center said that all those who have had contact with the patient have been served notice urging them to engage in self-health management.

They will also be subject to close monitoring until their respective infectious periods expire, the center said, adding that public health officials will help people on the watch list to get medical treatment should they develop flu-like symptoms such as fever or coughing.

The quasi-official Straits Exchange Foundation said Wednesday it has posted information about the imported H7N9 case in Taiwan on its website and urged the Taiwanese trade association in Suzhou to help push Taiwanese residents in the region to step up epidemic prevention measures and provide them with news updates.

[dothedd]

Pharma & Healthcare|

4/30/2013 @ 8:35AM

We're Not Prepared For China's Deadly Bird Flu

In Asia, more than 120 people have been sickened, and 23 are dead, from a potent strain of bird flu that has the frightening markings of a potential pandemic strain.

We have grappled with deadly pockets of potent flu outbreaks before. But this one has characteristics that make it different.

There’s a greater risk that this strain could acquire the ability to spread more easily from person to person. If it does, it could have devastating consequences.

That’s because we may not be ready. We have the capacity to make a vaccine. But we may not have the time. What we need are oral drugs that can combat a wide range of different pandemic flu strains. For the most part, we don’t have these medicines.

The number of confirmed H7N9 bird flu cases in Mainland China increased by five on Sunday, the country’s official Xinhua news agency reported. Four provinces — Zhejiang, Shandong, Jiangxi and Fujian — reported illnesses.

Like other strains of bird flu, this H7N9 virus affects mostly poultry – and has spread mostly to people handling chickens.

The Chinese Government suspects that there have already been human-to-human cases – proof that the virus has developed the capacity to spread by people. Of the patients analyzed so far, half appear to have had no contact whatsoever with poultry. Officials from the World Health Organization have confirmed that this new strain transmits to humans more easily than previous bird flues. American health authorities have confirmed the human spread.

Moreover, a case has already been reported outside China — an equally worrisome development.

Another problem is the absence of visible illness in poultry infected with the new virus. This makes it harder to track the spread of the disease, and to eradicate its source by slaughtering stricken birds.

Right now, 18 percent of the cases in China have ended in death. This is less deadly than the previous avian flu outbreak in China six years ago (that H5N1 bird flu virus killed more than 300 people after spreading from China to other countries in 2006). But this new strain has characteristics that make it perhaps more problematic.

One flu expert, John Oxford from Queen Mary University in London, told Reuters this week that this new strain of bird flu is “very, very unsettling.” It’s, in fact, a mixture of three different types of bird flu variants and “seems to have been quietly spreading in chickens without anyone knowing about it,” he said.

As Reuter’s noted, recent pandemic viruses, including the H1N1 “swine flu” that spread through the United States in 2009 and 2010, have been mixtures of mammal and bird flu. These kinds of hybrids are more likely to be milder because mammalian flu tends to make people less severely ill than bird flu.

By contrast, pure bird flu strains, such as the new H7N9 virus that’s now spreading in China, are generally more deadly for people.

So are we ready to battle a pandemic strain of bird flu if this new virus picks up the capacity to more efficiently spread from person to person?

For the most part, our strategy for preparing for pandemic flu focuses on the development of vaccines. We’ve made a lot of strides in recent years developing the tools and infrastructure for rapidly developing just such vaccines.

Moreover, countries where these viruses often get their start (in Asia) have become much more aggressive and transparent at combating early outbreaks.

Our tools for surveillance and quarantine in the U.S. have also gotten a lot better.

But there’s good reason to believe this may not be enough.

What we really need are potent antiviral medicines with broad activity against many different strains of pandemic virus. These drugs could be used not only to treat infected patients, but as a prophylaxis in those who might be exposed to the bug.

In the event of a full-blown outbreak of pandemic flu, there may not be enough time or capacity to develop an effective vaccine and to deliver it.

Antiviral drugs can also be effective at containing early outbreaks, before they become a full-blown pandemic.

Moreover, we may not know that a strain has turned into a pandemic until its too late to scale up vaccine production, which can take six months or longer if we have trouble getting a viral seed stock to use in that process.

Finally, the government may be skittish at undertaking a costly, crash program to develop a vaccine until a pandemic is already manifested.

The Feds got a spate of criticism for their expensive effort to rapidly develop a vaccine to the H1N1 swine flu strain the rippled through the country in 2009 – a government effort that by most reasonable measures was not only prudent, but successful. Yet the political fallout from that episode could make public officials skittish next time, giving the virus a dangerous chance to get the jump on us.

The mix of programs that we have put in place over the last decade to combat a potential pandemic has generally underinvested in developing oral antiviral drugs. Yet there are a number of promising drugs already on the shelf, and with adequate investment, it seems likely more could be developed.

An adequate vaccine is an important tool. But it may not be enough — or come in time. We have given comparatively short shrift to developing an oral antiviral with broad applicability to a range of pandemic strains. Yet we need one on our shelf if we’re going to be ready for this bird flu outbreak, or a future one.

[dothedd]

Taiwan on H7N9 alert amid Chinese holiday travel surge

2013/04/30 11:54:26

Taipei, April 30 (CNA) Taiwan is tightening up disease control measures against the H7N9 bird flu virus during China's national holiday, when over 15,000 Chinese group tourists are expected to visit Taiwan from April 29-May 1, the Tourism Bureau said Tuesday.

Taiwan could see 15,170 group tourists over China's three-day Labor Day holiday, the bureau said, adding that up to 6,000 more independent tourists are likely to arrive under a travel program that allows Chinese nationals to travel to Taiwan without having to be part of a tour group.

Although the tourist influx could remain similar to the level during last year's holiday between May 1-3, the bureau said, it has asked travel agencies across the Taiwan Strait to take extra precautionary measures.

Public concerns have arouse on whether a holiday travel surge could threaten Taiwan's epidemic control against the H7N9 avian flu outbreak in China, which has reported 125 confirmed H7N9 cases as of April 29, according to Taiwan's Centers for Disease Control.

Nearly half of the group tourists come from the areas under Taiwan's level-2 travel advisory. Those areas have reported cases of bird flu. The advisory asks travelers to exercise extreme caution and take strong protective measures if they have to visit the Chinese provinces of Jiangsu, Henan, Zhejiang, Anhui, Shandong, Fujian, Jiangxi, and Hunan, or the cities of Shanghai and Beijing.

But Yang Yeong-sheng, director of the bureau's Hotel, Travel and Training Division, said there is no need for panic about Chinese tourists coming here.

"The rumors could do harm to the travel industry," he said, explaining that there is no proof that the virus can be transmitted among humans.

He stressed that the bureau has asked tour guides to keep high alert on the tourists' health condition, and asked hotels to provide free surgical masks upon requests.

As to individual travelers, Yang said the bureau has distributed leaflets with information on where to seek local medical treatment to some 100 Chinese travel agencies providing services to the travelers.

[dothedd]

WHO: H7N9 virus 'one of the most lethal so far'By Peter Shadbolt, CNN
April 26, 2013 -- Updated 1115 GMT (1915 HKT)

Hong Kong (CNN) -- On the same day yet another death was reported in China's bird flu outbreak, the World Health Organization warned the H7N9 virus was one of the most lethal that doctors and medical investigators had faced in recent years.

"This is an unusually dangerous virus for humans," Keiji Fukuda, WHO's assistant director-general for health, security and the environment told a news conference in Beijing Wednesday.

"We think this virus is more easily transmitted from poultry to humans than H5N1," he added, referring to the bird flu outbreak between 2004 and 2007 that claimed 332 lives.

READ: Researchers: Elderly more at H7N9 risk


Virologist: Bird flu 'cause for concern'
WHO: Bird flu outbreak especially lethal
Poultry markets closed over bird flu "This is definitely one of the most lethal influenza viruses that we have seen so far."

As investigations continue into the possible sources of infection, Fukuda warned that authorities were still struggling to understand the virus. The WHO said China must brace for continued infections.

Fukuda's warning came as Taiwanese health authorities said they've confirmed the first human case of H7N9 in Taiwan -- one they said was imported from China.

A 53-year-old Taiwanese man who worked in eastern China was confirmed to have H7N9 on Wednesday, the Taiwanese Centers for Disease Control said. His condition was described to be severe.

He had been traveling back and forth regularly between China's Jingsu province and Taiwan, health officials said.

"According to the case, he had not been exposed to birds and poultry during his stay in Suzhou (in Jingsu province) and had not consumed undercooked poultry or eggs," the Taiwanese CDC said.

Taiwanese health officials said they are screening travelers arriving from China for signs of H7N9.

Fukuda, meanwhile, said WHO officials "are at the beginning of our understanding of this virus."

"(The situation remains) complex, difficult and it is evolving," he said.

So far there is no evidence of sustained human-to-human transmission, the authorities say.

"We do want to note, however, that if limited person-to-person transmission is demonstrated in the future, this really will not be surprising," Fukuda warned, adding that it was critical to remain vigilant, monitoring the virus's spread and mutation.

READ: Bird flu eats up Yum profits in China

"We are not sure that the clusters were caused by common exposure to a source of the virus or were due to limited person-to-person transmission," he said. "Moreover we have not seen sustained person-to-person transmission."

While some elements of the outbreak have baffled investigators -- specifically why the virus tends to target an elderly demographic and the fact that it is asymptomatic or mild in some cases and lethal in others -- authorities have claimed some significant victories in the fight against a pandemic.

Anne Kelso, the director of a WHO-collaborating research center, said researchers had seen a "dramatic slowdown" in human cases in Shanghai after the city's live poultry market was shut on April 6. Describing the finding as "very encouraging," she said evidence suggests the closure of live poultry markets is an effective way to stop the spread of the virus.

The joint inspection team from China's National Health and Family Planning Commission and the World Health Organization also found that, so far, no migratory birds have tested positive for the virus, taking another worrying route of transmission out of the equation.

It said the H7N9 virus is only being found in chickens, ducks and pigeons at live poultry markets.

WHO officials said there are already efforts underway in other countries to develop a vaccine after Chinese officials admitted international help would be needed with this.

Meanwhile, the National Health and Family Planning Commission said in its daily update on H7N9 cases that a total of 109 H7N9 cases have been reported within mainland China, including 23 deaths. Most cases have been confined to Shanghai and neighboring provinces in eastern China.

[dothedd]

Hong Kong tightens bird flu defenses
April 29, 2013

Hong Kong (CNN) -- Officials wielding infrared thermometers are becoming more difficult to avoid at entry points from mainland China as Hong Kong strengthens its defenses against the H7N9 strain of bird flu.

Extra measures are being taken this week during an expected surge in visitors across the border for the three-day Labor Day break from Monday to Wednesday.

Up to 600 officials will be stationed at border crossings during the holiday, including more than 100 volunteers in addition to government staff, according to Hong Kong's food and health secretary, Ko Wing-man.

"There will also be promotion and education work done at the borders reminding visitors to stay home or visit a doctor if they are not feeling well," he added, in response to reporters' questions on Sunday.

READ: Bird flu: 5 things to know

Along with extra screening at entry points, tour operators are also being asked to keep an eye on travelers who may be showing symptoms of what the World Health Organization calls "one of the most lethal influenza viruses" it has ever seen.

As of Sunday, the number of bird flu infections had risen to 124, based on provincial Ministry of Health websites. The figure includes one case in Taiwan, which remains the only recorded infection beyond mainland China.

Within the country, the infection has spread to eight provinces and the city of Shanghai, as well as the capital Beijing. Twenty-three people have so far died from the infection.

According to the last figures released from the national Ministry of Health on April 24, 14 people have recovered after treatment. On that day, the ministry switched to weekly updates and the figure hasn't been updated since.

Health authorities are still investigating the possible sources of infection and how the virus is spread. As recently as Thursday, the WHO repeated that so far there had been no evidence of sustained human-to-human transmission.

Taiwanese health officials say the territory's first case was imported by a local businessman who regularly traveled between back and forth between China's Jiangsu province and Taiwan.

To date, 27 cases have been reported in Jiangsu, resulting in four deaths. That's only the second highest number of provincial cases behind Zhejiang, which has reported 46 cases of infection and six deaths.

Wearing a customary white lab coat during a tour of the China's Center for Disease Control and Prevention on Sunday, Premier Li Keqiang urged officials to be vigilant against bird flu.

"We cannot afford to take it easy or relax, as we are facing a new virus. We should be prepared for any possible development," he said in quotes carried by state-run news agency Xinhua.

On Saturday, a mass cull was ordered at a major wholesale poultry market in the city of Dongguan after random testing detected the presence of an H7 strain of bird flu. No birds were showing symptoms, according to a statement from the city's Bureau of Agriculture. Nor had been there been any cases of human infection, it added. Dongguan is a city in the central province on Guangdong.

Hong Kong has said it is prepared to halt the import of live poultry, meat and eggs if the H7N9 virus is found at a mainland poultry farm with export ties to Hong Kong, or if that farm is within 13 kilometers of another that supplies the city.

edition.cnn.com/2013/04/29/world/asia/china-hong-kong-bird-flu/index.html?iref=allsearch

[dothedd]

 WHO: H7N9 Candidate Vaccine Viruses
2 May 2013

Influenza vaccination is the most important intervention in reducing the impact of influenza, and a key component of the WHO response and preparedness efforts for influenza of pandemic potential, including avian influenza A(H5N1), A(H9N2) and A(H7N9).

Development of candidate vaccine viruses

The first step in the long cycle of vaccine development and production is vaccine virus selection and the development of high-growth reassortants (candidate vaccine viruses (CVVs)). This is a well-established process and has been in place since the 1970s. It was further strengthened during the response to A(H5N1) and pandemic A(H1N1) 2009, mainly through the WHO Global Influenza Surveillance and Response System (GISRS) which currently comprises 150 laboratories in 111 countries.

Since the detection of avian influenza A(H7N9) virus in China, GISRS has been on alert. Through the excellent work undertaken by the WHO Collaborating Centre (WHO CC) in Beijing, viruses have been isolated and shipped to other WHO CCs and Essential Regulatory Laboratories (ERLs) of GISRS for joint virus characterization, development of diagnostic tests, risk assessment and candidate vaccine virus development for pandemic preparedness purposes.

Using the two available technologies, classical reassortment and reverse genetics, the WHO CCs and ERLs are developing high-growth reassortants that are suitable for vaccine development and production. The status of development of CVVs will be updated routinely by WHO for influenza vaccine manufacturers, national/regional regulatory agencies and other interested parties.

[dothedd]

Scientists create hybrid flu that can go airborne
H5N1 virus with genes from H1N1 can spread through the air between mammals.
Ed Yong, Nature, 02 May 2013

As the world is transfixed by a new H7N9 bird flu virus spreading through China, a study reminds us that a different avian influenza — H5N1 — still poses a pandemic threat.

A team of scientists in China has created hybrid viruses by mixing genes from H5N1 and the H1N1 strain behind the 2009 swine flu pandemic, and showed that some of the hybrids can spread through the air between guinea pigs. The results are published in Science1.

Flu hybrids can arise naturally when two viral strains infect the same cell and exchange genes. This process, known as reassortment, produced the strains responsible for at least three past flu pandemics, including the one in 2009.

There is no evidence that H5N1 and H1N1 have reassorted naturally yet, but they have many opportunities to do so. The viruses overlap both in their geographical range and in the species they infect, and although H5N1 tends mostly to swap genes in its own lineage, the pandemic H1N1 strain seems to be particularly prone to reassortment.

“If these mammalian-transmissible H5N1 viruses are generated in nature, a pandemic will be highly likely,” says Hualan Chen, a virologist at the Harbin Veterinary Research Institute of the Chinese Academy of Sciences, who led the study.

[dothedd]

'Appalling irresponsibility': Scientists create bird flu virus that could kill millions

A REASEARCH laboratory in China has deliberately engineered a deadly new hybrid strain of the bird-flu virus and human influenza which could cause a global pandemic, outraging experts.

By: Charlotte MeredithPublished: Fri, May 3, 2013
Chinese scientists have been slammed for creating new deadly influenza strains

Senior scientists have denounced the “appalling irresponsibility” of the researchers, warning there is a danger that the new viral strain could escape from the laboratory.

Lord May of Oxford, former president of the UK’s Royal Society, slammed the study – published today in the journal Science.

“They claim they are doing this to help develop vaccines and such like.

"In fact the real reason is that they are driven by blind ambition with no common sense whatsoever,” Lord May told The Independent.

“The record of containment in labs like this is not reassuring.

"They are taking it upon themselves to create human-to-human transmission of very dangerous viruses. It’s appallingly irresponsible,” he said.

[dothedd]

Bird flu likely to appear in Europe, other places, expert says

Published May 02, 2013
Reuters

Human cases of a deadly new strain of bird flu that has killed 27 people in China are likely to crop up in Europe and around the world but that should not cause undue alarm, Europe's leading flu expert said on Thursday.

In his first media interview since returning from an international scientific mission to China last week, Professor Angus Nicoll said the H7N9 flu outbreak in humans was one that should be taken extremely seriously and watched closely.

"We are at the start of a very long haul with H7N9," Nicoll told Reuters in a telephone interview from the Stockholm-based European Centre for Disease Prevention and Control (ECDC), where he is head of the influenza and respiratory viruses program.

He said there were many scientific questions to be answered about the new flu strain, which was first detected in patients in China in March having been previously unknown in humans.

The flu has so far infected at least 127 people in China and killed 27 of them, according to latest data from Chinese health authorities and the World Health Organization.

Scientific studies of the virus have established it is being transmitted from birds - probably mostly chickens - to people, making it a so-called zoonotic disease that humans catch from animals rather than from other humans.

Nicoll, who visited Beijing and Shanghai last week with a team of international scientific experts, confirmed what the WHO has repeatedly said - that there is no evidence yet of the virus efficiently passing from person to person - a factor that would make H7N9 a serious pandemic flu threat if it were to evolve.

Nicoll said the "most pressing public health question" for now was to identify the source of the circulating virus - the so-called "reservoir" - that is leading to chickens contracting it and sporadically passing it on to humans. This is likely to take time, with any results unlikely for several months.

"IMPORTED CASES"

In the meantime, Nicoll said the ECDC, which monitors disease in the European Union, and health authorities around the world should expect that "imported cases" of H7N9 flu may well begin to crop up elsewhere.

Just as Taiwan reported its first case on April 24, other countries should expect that business travelers and tourists may occasionally return from China having picked up the infection, he said.

"I'm not sure when that will happen. But the case in Taiwan shows that it can. If that person had got on a different flight and ended up in Paris, then we would have had a scenario that we would expect people to be alarmed at," he said.

"But again we should stress that this thing doesn't seem to be transmissible from human to human, so if we get some sporadic cases appearing in Europe, that doesn't change anything."

Nicoll noted that genetic analysis studies of H7N9 samples taken from patients in China showed the virus had already acquired two genetic mutations that made it more likely to be able to become transmissible between people.

Flu experts speaking at a briefing in London on Wednesday said those mutations, together with evidence that H7N9 is still mutating rapidly and probably spreading almost invisibly among birds because it does not make them obviously sick, meant this new flu was a "serious threat" to world health.

"You can never predict anything about flu, but it is concerning to see those mutations there, Nicoll said. "That's why it's important Europe should take this very seriously."

Nicoll added that he thought the Chinese were doing an "impressive job" handling, reporting, investigating and seeking to contain the outbreak.


Read more: www.foxnews.com/health/2013/05/02/bird-flu-likely-to-appear-in-europe-other-places-expert-says/#ixzz2SIL0Ekus

[dothedd]

Global Alert and Response (GAR)

Human infection with avian influenza A(H7N9) virus – update

29 April 2013 - As of 29 April 2013 (16:30CET), the National Health and Family Planning Commission, China notified WHO of an additional 17 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

The patients include:
• a 38-year-old man from Zhejiang province who became ill on 18 April 2013;
• an 80-year-old man from Fujian province who became ill on 17 April 2013;
• an 80-year-old man from Jiangxi province who became ill on 21 April 2013;
• a 31-year-old woman from Jiangxi province who became ill on 23 April 2013;
• a four-year-old boy from Shandong province who became ill on 27 April 2013;
• a 54-year-old man from Hunan province who became ill on 15 April 2013;
• a 64- year-old woman from Hunan province who became ill on 14 April 2013;
• a 38-year-old man from Zhejiang province who became illness on 17 April 2013;
• a 49-year-old man from Jiangsu province who became ill on 17 April 2013;
• a 36-year-old man from Jiangsu province who became ill on 19 April 2013;
• a 60-year-old man from Jiangsu province who became ill on 8 March 2013;
• a 65-year-old man from Fujian province who became ill on 18 April 2013;
• a 69-year-old man from Jiangxi province who became ill on 17 April 2013;
• a 76- year- old woman from Jiangxi province who became ill on 19 April 2013;
• a 60-year- old woman from Zhejiang province who became ill on 17 April 2013;
• a 50-year-old woman from Zhejiang province who became ill on 18 April 2013; and
• a 56-year-old man from Henan province who became ill 17 April 2013.
Additionally, two patients earlier reported from Jiangsu province died.

To date, a total of 126 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus including 24 deaths have been reported to WHO. Contacts of the confirmed cases are being closely monitored.

The authorities in the affected locations continue to implement prevention and control measures.

Investigations into the possible sources of infection and reservoirs of the virus are ongoing. Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus.

So far, there is no evidence of sustained human-to-human transmission.
WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.

[dothedd]

May 10, 2013, 8:00 a.m. ET.  Novavax H7N9 VLP Influenza Vaccine Enters Animal Testing

Novavax H7N9 VLP Influenza Vaccine Enters Animal Testing

-- Novavax H7N9 VLP vaccine produced, purified and entered into preclinical
immunogenicity and efficacy studies in less than a month

-- Production of GMP H7N9 clinical trial materials underway ROCKVILLE, Md., May 10, 2013 (GLOBE NEWSWIRE) -- Novavax, Inc. (Nasdaq:NVAX) today announced that it has completed purification of a lot of A/Anhui/1/13 H7N9 virus-like particle (VLP) vaccine and initiated animal immunogenicity and efficacy studies, including studies intended to evaluate protection against wild-type viral challenges. Novavax began work on the strain in early April. Analysis and optimization of the gene sequences for the key viral hemagglutinin (HA) and neuraminidase proteins, synthesis of the genes, construction of a recombinant baculovirus vector, infection of insect cells, purification of the first batches of VLP vaccine, and administration to animals were all completed in 28 days.

In October 2012, the company reported top-line data from its two Phase I clinical trials of A/H5N1 vaccine conducted under the company's $179 million contract with the U.S. Department of Health and Human Services' Biomedical Advanced Research and Development Authority (BARDA). These trials showed that the VLP avian influenza vaccine was immunogenic at conventional doses without adjuvant and induced strong immunogenicity in all its adjuvanted dose groups including the lowest dose of 3.75ug. In addition to vaccine homologous antibody responses, cross clade immunity was also demonstrated. Such immunity could be important if a pandemic virus undergoes antigenic drift during a vaccine campaign.

"The Novavax team has demonstrated that recombinant vaccine technology can be used to rapidly move from identification of a lethal virus, to production of a vaccine," said Dr. Gregory Glenn, Novavax' Chief Medical Officer. "Based on our recent clinical trials with A/H5N1 vaccine that induced 100% seroprotection using low doses of an otherwise poorly immunogenic vaccine, we are optimistic that our A/H7N9 VLP may induce strong immune responses and perform well in animal efficacy testing."

"While our recent A/H5N1 clinical results help demonstrate the potential efficacy and immunogenicity of our pandemic VLP vaccines, we always believed the true test of our platform would be its ability to respond rapidly to an emerging pandemic threat," added Stanley C. Erck, President and Chief Executive Officer. "We have committed to this A/H7N9 campaign without outside funding."

About VLPs and Novavax' Vaccine Program

VLPs are self-assembling protein structures that resemble the external structure of viruses, elicit broad and strong antibody and cellular immune responses but lack the live genetic material that causes viral replication and infection. VLPs contain three of the major structural virus proteins that are important for fighting influenza: hemagglutinin and neuraminidase, both of which stimulate the body to produce antibodies that neutralize the influenza virus and prevent its spread through the cells in the respiratory tract, and matrix 1, which stimulates cytotoxic T lymphocytes to kill cells that may already be infected. VLPs can be designed quickly to match individual viral strains and be produced efficiently using portable recombinant cell-culture technology. Novavax' VLP-based vaccine candidates are produced more rapidly than egg-based vaccines because of our cell-culture technology platform combined with single-use bioprocessing technology employed strategically throughout the manufacturing process.

About Novavax

Novavax, Inc. (Nasdaq:NVAX) is a clinical-stage biopharmaceutical company creating vaccines to address a broad range of infectious diseases worldwide. Using innovative recombinant nanoparticle technology, as well as new and efficient manufacturing approaches, the company produces vaccine candidates to combat diseases, with the goal of allowing countries to better prepare for and more effectively respond to rapidly spreading infections. Novavax is committed to using its technology platform to create geographic-specific vaccine solutions and is therefore involved in several international partnerships, including collaborations with Cadila Pharmaceuticals of India, LG Life Sciences of Korea and PATH. Together, these organizations support Novavax' worldwide commercialization strategy and have the global reach to create real and lasting change in the biopharmaceutical field. Additional information about Novavax is available on the company's website, www.novavax.com

[dothedd]

Experts offer dim view of potential vaccine response to H7N9

Robert Roos * News Editor


Editor's note: This story deals with a commentary article written by CIDRAP scientists. CIDRAP News operates independently in relation to the center's research and policy programs.

May 10, 2013 (CIDRAP News) – If the H7N9 influenza virus now circulating in China evolves into a pandemic strain, the world is likely to have great difficulty providing adequate supplies of an effective vaccine in time to blunt its impact, according to a viewpoint article by three experts in the Journal of the American Medical Association (JAMA).

"Even with additional vaccine manufacturing capacity . . . the global public health community remains woefully underprepared for an effective vaccine response to a pandemic," says the commentary by Michael T. Osterholm, PhD, MPH, and colleagues with the University of Minnesota's Center for Infectious Disease Research and Policy, which publishes CIDRAP News.

The authors say an H7N9 vaccine may have limited effectiveness, given the performance of other H7 vaccines that have been tested. In addition, they say the vaccine might arrive too late to do very much good and that global vaccine production capacity may fall far short.

Two other experts who were not involved in writing the commentary agreed with it in some respects but were less pessimistic about the ultimate impact of an H7N9 vaccine, if one is needed.

The novel H7N9 virus was identified in China in late March and has sickened at least 131 people, killing 33 of them. The virus apparently is spreading to people from birds. It has shown some signs of adapting to humans, but no sustained human-to-human transmission has been seen so far. Most of the case-patients have been older, with a median age of 60, according to the JAMA authors.

The authors note that seasonal flu vaccine has moderate effectiveness—59% in working-age adults for the trivalent inactivated vaccine, or flu shot, according to a careful meta-analysis the same experts published as part of a report on flu vaccines last year. They found little evidence that existing flu vaccines provide good protection in elderly people. As for the 2009 pandemic vaccine, one study showed the effectiveness of the version used in the United States to be 56%.

"There is no reason to believe that a yet-to-be-developed pandemic A(H7N9) vaccine will perform any better than existing seasonal vaccines or the A(H1N1)pdm09 vaccines, particularly with regard to vaccine efficacy in persons older than 65 years," say Osterholm and colleagues.

They also observe that experimental vaccines for other H7 viruses, developed for pandemic preparedness, generated weak immune responses in early trials. In trials of two different inactivated vaccines that used larger-than-normal amounts of antigen, few or no volunteers had good antibody responses. A live attenuated vaccine for an H7N3 virus showed better results, however.

Another daunting problem is the timeline for producing a vaccine in quantity, the authors write. The Department of Health and Human Services (HHS) is developing H7N9 vaccine seed strains and planning to conduct phase 1 clinical trials, they explain, but large-scale production is unlikely to occur until a pandemic is considered imminent. They predict that once manufacturers receive vaccine orders, it will take them at least 4 months to produce vaccine lots for distribution.

Depending on when vaccines are ordered and other factors, including how fast the pandemic spreads, "it is possible that vaccines will arrive in limited quantities but after the critical point when they will significantly affect morbidity and mortality, as occurred in 1957, 1968, and 2009," the authors write.

The world's current production capacity for conventional flu vaccines (with the hemagglutinin [HA] head as the antigen) is about 4.54 billion 15-microgram (mcg) doses, they say. The amount of antigen needed for an H7N9 vaccine is unknown, but if it's 90 mcg, as was used in an H5N1 vaccine, global capacity would be only about 757 million doses of monovalent vaccine, or less than 15% of the global need, according to the analysis.

In an interview, Osterholm said he's worried about the public health community's credibility when it comes to flu vaccines.

"Public health has had a long history of overstating the effectiveness and our level of preparedness with influenza vaccine, and if we've learned no other lesson from the past, we need to be very careful how we state our level of preparedness," he said.

He added that the challenges in providing pandemic flu vaccines should cause the public health community to think much more seriously about non-vaccine-related interventions for fighting a pandemic.

Osterholm and colleagues have promoted the need for "game-changing" flu vaccines that would provide broader, more lasting protection than conventional vaccines using HA-head antigens.

"I'd give the US government a lot of credit for having tried to do what they can with existing technology to improve our response," he said. "But for preparedness, we have to have a game-changing improvement in vaccines."

John Treanor, MD, a veteran flu vaccine researcher at the University of Rochester, agreed about the difficulty of making a pandemic vaccine fast enough to have a great impact, but he was a little more optimistic on the question of vaccine effectiveness. He is a professor in the departments of medicine and of microbiology and immunology.

"I agree that the current technology for influenza vaccines inevitably means it would be very difficult to actually vaccinate the population ahead of a pandemic, because by the time a decision were made that a vaccine should be administered, it would already be too late," he said.

He said some advances over the past 20 years have sped the process somewhat, but "you're always left with the possibility that you won't be ready by the time the pandemic starts moving."

On the other hand, Treanor said, "I'm not as gloomy about the effectiveness of the vaccine as [Osterholm] is. Let's say it's 60% effective—it's not what we want, but that's not to say it doesn't work. It reduces the risk by more than half, so that's an effective intervention."

"I think the conclusion is that it'd be great if we had better vaccines," he added. "I don't think a single person would disagree with that."

Another flu expert, Arnold S. Monto, MD, an epidemiology professor at the University of Michigan, said he generally agrees with Osterholm and colleagues on a number of points, but he suggested that pandemic preparedness efforts in recent years have made a difference.

"Granted, this is going to be a difficult one," he said. "But we have to view it against the alternative of what else we have right now. Fortunately, the work on H5N1 has left us in a much better position to respond to this than if we had not done that work. It's pretty clear we're going to need an adjuvant, and there's been a lot of work on adjuvants." (Adjuvants are vaccine additives that boost the immune response, making it possible to vaccinate more people with a given amount of antigen.)

No adjuvanted flu vaccine has been licensed in the United States, but Monto said regulatory requirements should not be a big obstacle, because the Food and Drug Administration could issue an emergency use authorization.

Concerning flu vaccine effectiveness, he said, "We know it's lower than we'd like to see." But because no one has antibodies to H7 viruses, it will be important to provide a vaccine, even if its effectiveness is only modest, in his view.

If a vaccine could provide 70% effectiveness, which was the case with adjuvanted 2009 H1N1 vaccines in Europe, that would be "pretty great," Monto said. "And if as we believe—though we don't have as much evidence as we'd like—that [flu vaccines] do better against severe disease than against mild disease, we'd be preventing a lot of hospitalizations with this."

He also voiced confidence that recent advances in vaccine production technology, exemplified by Novartis's cell-culture vaccine facility in North Carolina, will make a difference in the ability to provide vaccine.

He declined to say whether he thinks it would now be possible to produce plenty of vaccine before the peak of a pandemic, but he said, "I don't think it's as gloomy with regard to the supply" as Osterholm and colleagues suggest.

[dothedd]

H7N9 Virus: Human-to-Human Transmission Possible – Study

May 24, 2013 11:21 AM EST

The bird flu strain H7N9, which had so far infected 131 and killed 36 in China, could be passed on between humans through the air and close contact.

Using ferrets that were injected with the new H7N9 strain, scientists at Shantou University, the University of Hong Kong as well as colleagues in the US and Canada observed and found that the virus could spread through the air, from one cage to another.

The H7N9 virus is seen to mutate over time, thus becoming more transmissible in humans as time goes by, Richard Webby, a virologist at St. Jude Children's Hospital in Memphis, Tenn. and a co-author of the paper, said.

Flu transmission in ferrets forecast likely patterns in humans, the authors said in the study published Thursday in the online edition of the journal Science.

"The emerging human H7N9 influenza is infectious and transmissible in mammals," the study said.

"Under appropriate conditions, human-to-human transmission of the H7N9 virus may be possible," it added.

Read: COVID-19 Alert: H7N9, H5N1 Strains Active, Tibet Outbreak Kills 1 Child

Dr Maria Zhu Huachen, a research assistant professor at HKU's School of Public Health, said they also observed that the virus can infect pigs, which was not previously known.

But the good news was that the pigs did not pass the virus to each other.

"If the study has shown that one pig had easily infected another pig, then I would be more concerned," Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases.

Read: As China Bird Flu Death Toll Now at 31, Infections Among Pigs Also Rising

"Under very experimental circumstances, one mammal can infect another one by direct contact," he told AFP.

"Saying that we are now in a greater danger of a pandemic is probably an exaggeration," he added. "It's obviously something we need to keep an eye on to make sure we understand the virus better."

Based from the organs of infected ferrets, researchers detected the H7N9 virus can infect the upper and lower respiratory tracts, and lymph nodes and potentially the brain.

"It seemed significant to me that that much virus is reaching the brain," Suresh Mittal, a bird flu expert and professor of comparative pathology at Purdue University, told AFP.

Mr Mittal said highly pathogenic viruses are not often seen in human flu pandemics, thus he urged more research into the subject.

"Physicians will be more careful looking at patients and seeing if patients develop signs of encephalitis or not," he said.

According to the latest update on human infections released by the World Health Organization, no new lab-confirmed cases of H7N9 in humans were reported between May 8 and May 17.

Read: Bird Flu Strain H7N9 Hitting China Not Yet a Pandemic, But..

au.ibtimes.com/articles/470789/20130524/china-transmission-h7n9-virus.htm

[dothedd]

China Society

H7N9 Bird Flu Spreads by Direct Contact in Mammals

By Cassie Ryan, Epoch Times | May 24, 2013
Last Updated: May 24, 2013 11:49 am

A health worker sprays disinfectant near the house of a 4-year-old boy infected with the H7N9 strain in Beijing on April 15, 2013. New research shows that the H7N9 bird flu virus spreads between ferrets in close contact with each other, suggesting human-to-human transmission is possible.

While the latest official news from China says that the H7N9 bird flu outbreak is now under control, a new international study urges continued caution.

According to official Chinese figures, the virus has claimed 36 lives among 131 cases, mostly in people with exposure to poultry, and there have been no further human cases since May 8. There were some instances of multiple cases in families, suggesting the possibility of transmission between humans.

Published in the journal Science on May 23, a new paper emphasizes that the virus is “infectious and transmissible in mammals,” adding that human-to-human transmission may be possible “under appropriate conditions.”

“This is a more infectious virus—it has a higher intrinsic transmissibility [among mammals]—than most of the avian viruses we’ve seen in the past,: study co-author Dr. Richard Webby at St. Jude Children’s Research Hospital in Memphis told NPR.

“On a scale from 1 to 10—from an avian virus with no potential to infect humans to a fully human-adapted strain—we don’t know exactly where this H7N9 is,” Webby added. “But I think we can safely say from these data that it might be closer to 10 than the avian viruses we’ve seen infecting humans in the last decade.”

Using ferrets and pigs as mammalian models, the research shows that the virus spreads easily when ferrets are in close contact, namely by touching, coughing, and exchange of body fluids.

“This study was designed to give us clues about the transmission of H7N9 which has affected some humans in China,” explained study co-author David Kelvin at the University of Toronto in a press release. “The animals used in the study had very mild clinical symptoms as a result of their exposure to the virus and it was clear that very close contact was required for transmission. It also appears that this virus in its present form does not transmit very well through the air.”

Kelvin added that, although the research was conducted on animals, “health care workers are at risk for transmission as they are in close contact with the individuals.”

The researchers also noted that both the ferrets and pigs were shedding the virus before they showed clinical signs of infection, showing that the disease could spread even when animals appear to be healthy.

“There’s a bit of a worry in my mind that the urgency to do something about this will drop,” Dr. Webby told NPR.

“We really need to get on top of this virus and get it out of animal populations. Otherwise it’s just not going to go away.”

[dothedd]

MIT Researchers warn: New ‘bird flu’ strains close to becoming pandemics
.

By Arturo Garcia: RAW STORY Saturday, June 8, 2013

Researchers at the Massachusetts Institute of Technology (MIT) found there isn’t much stopping the latest strains of the H5N1 and H7N9 flu viruses — also known as the “bird flu” — from being communicable from person to person.

MIT News reported on Thursday that new studies showed the viruses could become “pandemic flus” within just a few mutations — all it would take would be a change in one or two amino-acids.

“There are multiple different ways that this can happen,” lead author Ram Sasisekharan told the publication. Sasisekharan’s studies were published in the journal Cell on Thursday.

At least 132 people around the world have been infected by the H7N9 virus in 2013, most of them in China. Doctors in Shanghai reported that at least three patients encountered a strain that showed resistance to treatment via medication.

“The advent of H7N9 in early 2013 is of concern for a number of reasons,” Sasisekharan wrote in his team’s report, citing “its’ capability to infect humans, the lack of clarity in the etiology of infection, and because the human population does not have pre-existing immunity to the H7 subtype.”

[dothedd]

Bloomberg News:

New Bird Flu Found to Be Deadlier Than First Estimated

Jun 23, 2013 6:30 PM ET

The H7N9 strain of bird flu that has killed 38 people in China since March is less deadly than had been supposed, according to the most detailed analysis of the outbreak so far.

The risk of death for patients admitted to a hospital with H7N9 infection is about 36 percent, researchers at the Chinese Center for Disease Control and Prevention and the University of Hong Kong wrote in The Lancet medical journal today. While initial reports of severe illness among most patients suggested the virus may be highly lethal, as many as about 27,000 undetected mild cases may have occurred, lowering the risk, the study said.

Still, H7N9 is only about half as deadly as the H5N1 bird flu strain that has killed about 60 percent of the 630 people it’s infected since 2003, the researchers wrote. The new virus, which has subsided with the onset of warmer weather and the closure of live bird markets in China, may rebound this year if it follows a similar pattern to H5N1, they said in a separate study.

“This potential lull should be an opportunity for discussion of preventive public health measures,” the authors wrote.

The virus has sickened 131 people in China and killed 39 since it emerged in March, the official Xinhua news agency reported June 9, citing China’s National Health and Family Planning Commission. Most cases were among people with exposure to live poultry, and there’s no evidence the virus can be transmitted between people, according to the Geneva-based World Health Organization.

The outbreak caused airline stocks and soybean prices to fall, prompting Chinese authorities to halt trading in live poultry, close bird markets and slaughter fowl to curb transmission. Shanghai, the city with the most cases, lifted a ban on live poultry sales last week as concern about the outbreak eased, according to the Shanghai Daily newspaper.

“It is reassuring that head-to-head comparison of the fatality risk of admitted patients infected with avian influenza A H7N9 or H5N1 suggests a substantially milder disease course for H7N9,” Cecile Viboud from the U.S. National Institutes of Health and Lone Simonsen of George Washington University wrote in an editorial accompanying the two papers.

H7N9 is more dangerous than the H1N1 swine flu virus that sparked the 2009 flu pandemic and killed about 21 percent of those infected in China, the authors wrote.

The WHO estimated the fatality risk of H7N9 at about 25 percent in a report last month.

[dothedd]

New studies fine-tune H7N9 severity estimates
CIDRAP News
 
Jun 24, 2013
A lull in the number of H7N9 cases in China has given experts a chance to sift the data to fine-tune the clinical picture of the disease.


H7N9 surveillance cases trended younger, milder
CIDRAP News
 
Jun 25, 2013
A report on H7N9 cases that were found by routine surveillance reveals younger patients and milder infections.


Shanghai man dies from H7N9 infection
CIDRAP News
 
Jun 26, 2013
Shanghai health officials today reported another death from H7N9 flu, in a man whose wife was among the city's first H7N9 victims.