Sunday, June 25, 2017

Taiwan Seizes 210 Bottles of Illegal Chinese `Poultry Vaccine'

Seized `Vaccine' in Wine bottles - Credit BAPHIQ


Although a victim of sporadic avian flu outbreaks for many years, HPAI H5N8 arrived in the island nation of Taiwan in January of 2015, immediately spun off several reassorted HPAI H5 viruses - and together - would infect more than 1,000 farms over the next 12 months.
While the level of bird flu activity dropped in 2016, and is even further reduced this year, well over 100 outbreaks have been reported since January, including the first detection of H5N6 on the island.
In Taiwan, as in most of the world, culling and quarantine are the preferred methods of controlling avian flu. Unlike in neighboring China, and a few countries like Vietnam and Egypt, avian flu vaccines for poultry are not allowed.
For at least a dozen years the OIE has warned that vaccination of poultry cannot be considered a long-term solution to combating  avian flu. And that “Any decision to use vaccination must include an exit strategy, i.e. conditions to be met to stop vaccination. – OIE on H7N9 Poultry Vaccines.
Unfortunately, the handful of countries that currently allow use of poultry AI vaccines have shown little signs of having that `exit strategy'.  China, 12 years into their vaccination program, two weeks ago announced plans to test a New H7N9 Poultry Vaccine In Two Provinces starting late this month.
Faced with this reality, a couple of years ago the OIE - while still discouraging their use - softened the language in their recommendations to allow: 
`In short, vaccination should be implemented when culling policies cannot be applied either because the disease is endemic and therefore widely present, or the infection in affected animals is too difficult to detect.'

As we’ve discussed previously (see PLoS Bio: Imperfect Poultry Vaccines, Unintended Results & The HPAI Poultry Vaccine Dilemma), despite more than a decade of heavy use, poultry AI vaccines have proven to be less than a panacea for bird flu.
Countries that have gone the vaccine route (notably China, Egypt, Vietnam, and Indonesia) continue to battle the virus. One could argue (at least in Egypt & China), that their AI problems are worse now than when they started.
The problem is that as the avian viruses evolve, poultry vaccines become increasingly less effective; often only masking the symptoms of infection.
That can allow viruses to spread silently among flocks, to continue to reassort and evolve, and potentially lead to the emergence new subtypes of avian flu (see Subclinical Highly Pathogenic Avian Influenza Virus Infection among Vaccinated Chickens, China)
Twelve years ago, the world had only one HPAI H5 virus of concern; H5N1. Now we have at least a half dozen subtypes (H5N1, H5N2, H5N3, H5N6, H5N5, H5N8, H5N9), with literally dozens of genotypes between them.
The 2015 study Recombinant H5N2 Avian Influenza Virus Strains In Vaccinated Chickens found `These results are in agreement with previous work indicating that AIVs can continue genetic evolution under vaccination pressure'.

Which is why so few countries allow their use. In the fall of 2015, as desperate poultry farmers lobbied for vaccines, Taiwan's Council Of Agriculture strongly Warned Against the Importation & Use Of AI Vaccines.   
Beyond the illegalities, the HPAI H5 viruses in Taiwan originated from Korea, and were expected to be a poor match to the Chinese R5 vaccine.
While not completely ruling out use of an AI vaccine in the future, the COA reiterated that AI vaccines were prohibited in Taiwan, and there were currently no plans to introduce them. They then warned of severe penalties for the illicit manufacture, import, processing, trafficking and use of any illegal animal drugs.

Fast forward to today, and we learn - via the COA - that 18 boxes of  `poultry vaccine' were intercepted - bound for Taiwan - at the Kinmen airport in Fujian Province. While there is considerable doubt as to the authenticity of this `vaccine' (testing is underway), when arrested, the smuggler claimed that it was `duck vaccine'.
'Tis a sad day, indeed, when you can't trust the word of a drug smuggler.  But I digress. . . .
The purported `vaccine' was repackaged into more than 200 recycled Kaoliang (sorghum wine) bottles - and according to local media reports - was discovered after one of the bottles broke, and a custom's official realized it didn't smell like alcohol.

First the (translated) press release, then I'll return with a brief post script.
Seized the mainland smuggling suspected animal vaccines, called on the industry to try to defensively, so as not to spread the disease

(Hereinafter referred to as the Prevention and Control Bureau) on June 24, said the Golden Gate Aviation Police found that people to air cargo delivery 18 boxes (a total of 210 bottles) Golden Gate sorghum wine to Taiwan, one box after the break out There is no alcoholic liquid, so check and notify the Office of the Office of the Kaohsiung Branch Kinmen quarantine police station investigation, after the sea inspection center in the central area of ​​the inspection team Kinmen mobile investigation team preliminary investigation, the public said the bottle filled with liquid system from Continental smuggled ducks with vaccines (what kind of virus or bacteria are not clear). The inspection team on the same day the people transferred to the Kinmen and Quarantine Recruitment, the relevant samples have been sampled by the Golden Gate quarantine station, in this (24) sent someone to send animal health test animal animal inspection branch identification.

The anti-crime bureau states that, according to the Animal Drug Administration Act, animal drugs are not approved by the unauthorized importation of doping, manufacturing or import of animal doping, at 1 year to 7 years imprisonment, and NT $ 450 And shall also be sentenced to a fine of not less than 6 months but not more than five years and shall be fined not more than NT $ 5 million.

The anti-crime bureau states that smuggling or the use of illegal animal vaccines has not been tested and the quality is not guaranteed. It can not only prevent the epidemic, it is more likely to spread the epidemic. The council will continue to cooperate with the prosecution and prosecution agencies, check illegal, to prevent blocking animals into the domestic market with doping.

While this appears to be an amateurish attempt to smuggle a potentially dangerous vaccine into Taiwan, had a bottle not broken, it is very possible it would have been successful.  One can't help but wonder about how many other shipments, either real or counterfeit, have already gotten through.

Nature's laboratory is fully capable of creating the next pandemic virus.  We scarcely need to be lending it a helping hand.

Saturday, June 24, 2017

WHO Avian Flu Risk Assessment - June 2017

WHO H7N9 Epi Curve - June 12th


Just 12 months ago H7N9 was closing out its 4th, and least impressive, epidemic wave in its short tenure in China.  After making a big splash over 2013-2014, the virus appeared on the decline (see epi curve above), despite dozens of genotypes in circulation.
But the only real constant with influenza is that it is constantly changing.
And so we find ourselves a year later watching the biggest bird flu human epidemic on record winding down, two distinct new H7N9 variants (1 LPAI, 1 HPAI) taking hold, and the virus edging closer to escaping the confines of Mainland China.

The recent surge, and continuing evolution H7N9 in China, has scientists increasingly  concerned.  A few recent blogs include:
PLoS Pathogens: Three Mutations Switch H7N9 To Human-type Receptor Specificity

EID Journal: 2 Expedited HPAI H7N9 Studies

Eurosurveillance: Preliminary Epidemiology & Analysis Of Jiangsu's 5th H7N9 Wave

The saving grace to all of this, so far at least, is that the H7N9 virus still doesn't transmit efficiently between humans. Clusters remain rare, and very few human-to-human transmissions have been observed.

Roughly once a month the World Health Organization releases an updated Influenza at the human-animal interface report that details novel human flu infections reported since the last update and provides a risk assessment.
Today's report - covering the 30 days between May 17th and June 15th - adds 47 H7N9 cases. No other avian or novel flu infections were reported during this time period.
Some excerpts from the 5-page PDF report follow, after which I'll return with a bit more.
Influenza at the human-animal interface

Summary and assessment, 17 May 2017 to 15 June 2017
  • New infections1: Since the previous update, new human infections with influenza A(H7N9) viruses were reported.
  •  Risk assessment: The overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the likelihood of sustained human-to-human transmission of these viruses remains low. Further human infections with viruses of animal origin are expected.
  • IHR compliance: All human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005).2 This includes any animal and non-circulating seasonal influenza viruses. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.

Avian influenza A(H7N9) viruses

Current situation: During this reporting period, 47 laboratory-confirmed human cases of influenza A(H7N9) virus infection were reported to WHO from China. Among these cases, one cluster of cases were reported; both cases in the cluster had exposure to live poultry. Cases were reported from Shaanxi province for the first time and cases had likely exposure in Inner Mongolia for the first time as well.
1 For epidemiological and virological features of human infections with animal influenza viruses not reported in this assessment, see the yearly report on human cases of influenza at the human-animal interface published in the Weekly Epidemiological Record. Available at:
2 World Health Organization. Case definitions for the four diseases requiring notification in all
circumstances under the International Health Regulations (2005). Available at: 3 WHO Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO tables. Available at:

Case and cluster details are presented in the table in the Annex of this document. For additional details on these cases, public health interventions, and the highly pathogenic avian influenza (HPAI) A(H7N9) viruses, see the Disease Outbreak News.

As of 15 June 2017, a total of 1533 laboratory-confirmed cases of human infection with avian influenza A(H7N9) viruses, including at least 592 deaths4, have been reported to WHO (Figure 1). The number of human infections with avian influenza A(H7N9) viruses and the geographical distribution of human cases in the fifth epidemic wave (i.e. onset since 1 October 2016) is greater than in any earlier wave.
This suggests that the virus is spreading, and emphasizes that further intensive surveillance and control measures in both the human and animal health sectors are crucial. However, the number of reported confirmed cases has continued to decline over the past few weeks indicating that the peak of cases this wave was reached in mid-February 2017.

According to reports received by the Food and Agriculture Organization (FAO) on surveillance activities for avian influenza A(H7N9) viruses in China, positives among virological samples continue to be detected in poultry from live bird markets, commercial and backyard farms. The agricultural authorities in China have also announced plans to commence vaccination of domestic poultry in certain areas against infection with avian influenza A(H7) viruses beginning in July.5

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Although eerily quiet now, just a year or two ago the  WHO considered H5 viruses the most obvious pandemic threat, particularly after Egypt's record setting H5N1 outbreak in the spring of 2015 and the emergence and global spread of H5N8, the reports of a new virus - H5N6 - infecting people and poultry in China. 
Like H7N9, those viruses continue to spread and evolve, and while reported human infections have been few and far between over the past year, they could easily stage a comeback just as H7N9 has over the past 8 months. 
H7N9 is viewed, rightfully so, as having the greatest pandemic potential right now (see Updated CDC Assessment On Avian H7N9 and NPR: A Pessimistic Guan Yi On H7N9's Evolution).
But influenza posesses remarkable evolutionary speed - where generations are measured in minutes or hours, not years or decades - and abrupt changes can occur literally overnight via viral reassortment.
Which means that we could just as easily be blindsided by a different mutated bird flu subtype, one of the many H1, H2, or H3 swine flu viruses in ciruculation around the globe, or something else that isn't even on our radar right now.

Despite the strides that have been made in the identification and understanding of novel flu viruses, less than a month ago in World Bank: World Ill-Prepared For A Pandemic, that organization warned that far too many nations have let pandemic preparedness slide, and that the world remains ill-prepared to face even a moderately severe pandemic.

Friday, June 23, 2017

A Dearth Of Recent Reports From The Saudi MOH

Screen Shot of MOH Today - 9:45 am EST


The screenshot above - taken at 0945 EST today - shows that after reporting 50+ cases in the 1st 18 days of June - the Saudi MOH hasn't updated their MERS surveillance page in several days.  

For some reason, they posted 2 updates for the 19th - and while the links state no new cases, the first report for that date lists 1 asymptomatic case in Riyadh.  The last report, dated the 19th, appears to be from the 20th, and lists 2 recoveries.

Since then, we've seen no new updates.  
With this being the last week of Ramadan, it is possible the MOH is working short staffed.  Hopefully after tomorrow (the end of Ramadan), the MOH will catch us up, and resume regular daily reporting.

Belgium Reports Two More Outbreaks Of HPAI H5N8


Belgium, which was one of the least affected countries in Western Europe during this past winter's HPAI epizootic, reports their 10th and 11th outbreak of the month of June today.
Once again, the virus has turned up in hobby farms, this time in Tournai (very near the French Border) and Courcelles.
This (translated) press release from Belgium's AFSCA (Federal Agency For Food Safety).

Avian influenza: situation
two additional infections in Courcelles and Tournai
temporary buffer lifted in Wellin

Two additional cases were again with the highly pathogenic avian influenza virus Influenza A virus subtype H5N8 fixed hobby holders in Tournai and Courcelles. Since June 1, the virus that total found in 11 locations in Belgium. The AFSCA requires all poultry to poultry bought at a market recently to be vigilant.

The temporary buffer in Wellin is released today. Which was established three weeks ago when the Influenza A virus subtype H5N8 virus was identified. The specific measures for this zone are no longer in effect.

The Minister of Agriculture Willy Borsus explains: "The situation is still alarming and biosecurity remain of paramount importance in order to avoid an impact on professional holders. I repeat that, in the current health context, must continue to appeal to a vet if the poultry is sick or dies suddenly. "

Around two new cases in Tournai and Courcelles delineated a temporary buffer zone with a radius of 3 kilometers. Within that area, each movement of poultry, other birds and eggs prohibited. The animals must be fed and watered in. Residents, which have within these zones to poultry and other birds, will be prompted so as to inform about an inventory to the mayor within 48 hours, which will indicate how many and which animals are kept. This zone will be maintained for at least 3 weeks.

The AFSCA requires all poultry farmers also to be vigilant and immediately go to the vet if their animals fall ill.

Abnormal mortality of wild birds can still be reported to the toll free number 0800/99777 .
For the consumer there is no danger at all poultry meat and eggs is safe and can be eaten without problems.
 Belgium joins FinlandLuxembourg, and the UK in reporting HPAI during the month of June.

OIE Confirms HPAI H7N9 In Heilongjiang Province


On Monday I reported (see MOA: Large Poultry Die Off In Heilongjiang - H7N9 Confirmed (HPAI Suspected) on what appeared - based on reported avian mortality - to be the farthest north outbreak of HPAI H7N9 to date, on a breeder farm only a few miles from the Russian border.

Today the OIE has confirmed HPAI H7N9, in the following announcement:

Since it emerged in 2013, we've seen a good deal of speculation as to when H7N9 would finally follow its HPAI H5 cousins and break out of Mainland China and begin to spread internationally (see FAO Warns On H7N9 In China).
For most of that time, the assumption was that Southeast Asia - most likely Vietnam, which shares a porous border with China - would be the first to encounter the virus (see Vietnam Wary Of H7N9).
But with the emergence of HPAI H7N9 in January, and its steady northward push over the past 5 months, Russia now finds the virus confirmed within 100 miles of its territory, and that increases its chances of spreading even further via the Asian migratory bird flyways. 

While these flyways are predominately north-south corridors, their overlapping allows for a degree of lateral (east-west) movement of avian viruses as well – often via shared nesting areas and ponds. 
Which explains how HPAI H5N1, HPAI H5N8, and H5N6 have all managed to expand their geographic range both east (to Korea, Japan, and North America) and west (to Europe, the Middle East, and Africa) in recent years.
It remains to be seen whether H7N9 has adapted well enough to migratory birds to follow suit, but this abrupt geographic expansion warrants close attention.

HK CHP Notified Of 10 H7N9 Cases On The Mainland

FAO H7N9 Epidemic Waves - June 14th


After falling to only 5 cases announced in last week's report, today China's NHFPC has notified Hong Kong of 10 H7N9 infections (2 fatal) during the past week.  Since June 1st, China has announced 35 cases, already making this the most active H7N9 summer by far.
The 10 patients, all male, range in age from 31 to 79, and all had onsets on or after June 5th.  They span 8 provinces/regions; Beijing (2), Sichaun (2), Anhui (1), Guizhou (1), Hebei (1), Inner Mongolia (1), Jiangsu (1), Tianjian (1).
The pronounced skewing towards older males is once again evident in this week's report, and 9 of the 12 reportedly had recent contact with live poultry.  We should get more details in next week's HK Avian Flu Report.

In past years, the heat of summer has forced a nearly complete shutdown of H7N9 activity in China, and seeing more than a dozen cases reported over the June-July-August period was a rarity. Last year, that pattern changed very slightly, prompting speculation that the virus was becoming more `heat tolerant'.
Those concerns were echoed again last March in Eurosurveillance: Preliminary Epidemiology & Analysis Of Jiangsu's 5th H7N9 Wave, when researchers reported ` . . . .  increased detection rate of H7N9 in environmental samples suggests that the virus might become more resistant to high ambient temperature'
While the expansion of H7N9 into more northern provinces might account for some of this year's late season persistence, we continue to see activity in some of China's southern provinces (Sichuan, Guizhou) as well, and temperatures reported this month in China's north have been running at or above average for much of June (see Chart below).    

Beijing Weather - Credit Accuweather

Between the rapid expansion of a new LPAI H7N9 lineage (Yangtze River Delta) over this  past winter, the emergence and spread of a new HPAI H7N9 strain, and the continual evolution of dozens of genotypes in the wild - some changes in the virus's behavior over time are to be expected. 
So far, no significant mutations have been reported that would account for increased `heat tolerance' in the virus, and so much of this speculation remains based on anecdotal evidence. 
The level of viral activity (both in birds, and in humans) over the summer should shed more light on the matter.  Some excerpts from today's HK CHP announcement follow:

     The Centre for Health Protection (CHP) of the Department of Health today (June 23) is monitoring a notification from the National Health and Family Planning Commission that 10 additional human cases of avian influenza A(H7N9), including two deaths, were recorded from June 16 to 22, and strongly urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

     The 10 male patients, aged from 31 to 79, had onset from June 5 to 19. Two each are from Beijing and Sichuan, and one each from Anhui, Guizhou, Hebei, Inner Mongolia Autonomous Region, Jiangsu and Tianjian. Among them, nine were known to have exposure to poultry or poultry markets.

     Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.

     Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell a doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

     While local surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

     The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

     The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

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