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Reasonable Rascal
02-19-03, 16:22
INFLUENZA, H5N1 HUMAN CASE - CHINA (HONG KONG)
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A ProMED-mail post

[1]
Date: 19 Feb 2003
From: ProMED-mail <promed@promedmail.org>
Source: NY Times / AP 19 Feb 2003 9:59 AM
<http://www.nytimes.com/aponline/international/AP-Hong-Kong-Bird-Flu.html>


Hong Kong Boy, 9, Contracts Bird Flu
--------------------------------
HONG KONG (AP) -- A 9-year-old boy contracted bird flu after visiting southern China last month and his sister and father have died of unspecified illnesses, officials said Wednesday, raising fears of a recurrence of the deadly disease that first hit humans and killed six people in 1997.

Incidents of bird flu set off alarms in Hong Kong because of the deadly outbreak six years ago. Officials then killed all 1.4 million chickens in the territory to try to wipe out the virus.

The boy suffering from bird flu and his family visited relatives in China's Fujian province late last month.

The boy's 8-year-old sister developed pneumonia and died in a Fujian hospital on Jan. 28. Their 33-year-old father fell sick with pneumonia Feb. 7 and returned to Hong Kong for treatment before dying in Princess Margaret Hospital on Monday. The exact cause of both deaths was still being investigated, officials said.

The Health Department said the boy tested positive for the H5N1 strain of the avian flu, or bird flu. It is a different strain of the disease than the one that infected humans in 1997.

The boy was admitted to a hospital Feb. 12, three days after the start of a fever. He was in stable condition Wednesday, officials said.

The boy's 30-year-old mother, his sister and grandfather were also in Princess Margaret Hospital. The mother had an influenza virus infection but has since recovered. The hospital said all three were in good condition and it was not immediately clear why the three were in the hospital.

``The Department of Health has stepped up its surveillance system further by testing all severe pneumonia cases for H5. So far, we have no other positive results,'' Dr. Tse Lai-yin said in a statement.

The department is closely liaising with mainland authorities to monitor the situation and has reported the case to the World Health Organization, said Diana Kam, a health department spokeswoman.

Medical experts said the government needs to learn if the H5N1 virus originated in Hong Kong or on the mainland.

``We have to see whether the boy's family has also contracted the bird flu,'' lawmaker Dr. Lo Wing-lok, who represents the medical sector, told reporters. ``Is this an independent case or an outbreak?''

Meanwhile, Hong Kong agricultural officials reported new cases of bird flu at four poultry stalls in suburban Tai Po market where 12 chickens were found dead Wednesday morning.

After samples from the dead chickens tested positive for the H5 strain of avian flu, the poultry stall owners slaughtered all the birds in the stalls, authorities said.

Earlier this month, Hong Kong sent back almost 10,000 chickens from mainland China after tests indicated they may have been exposed to bird flu.

Date: 19 Feb 2003
From: ProMED-mail <promed@promedmail.org>
Source: WHO/ WER
<http://www.who.int/csr/don/2003_2_19/en/>


Influenza A(H5N1) in Hong Kong Special Administrative Region of China
---------------------
As of 19 February results from two laboratories have confirmed the presence of an avian influenza virus in a child in Hong Kong SAR. Tests conducted in two samples from this single patient have identified the virus as the strain of influenza A(H5N1). A similar virus caused an outbreak in Hong Kong SAR in 1997, with 18 cases detected and six deaths.

In the current outbreak, a 9-year-old boy who travelled to Fujian Province (China) in January with his mother and his two sisters became ill on February 9 and was admitted to a Hong Kong hospital on February 12. He has recovered and is in a stable condition. Other members of his family presented with a similar illness. The child's sister and father have died. The boy's mother was ill but has recovered.

It is not yet known whether the other family members were also infected with influenza A(H5N1). A medical and epidemiological investigation is ongoing in Hong Kong to determine the cause of those illnesses. Results should be available in the next few days. Investigations are ongoing to determine the source of the infection.

The World Health Organization is collaborating closely with health authorities in Hong Kong SAR and China in investigating the outbreak. The WHO Global Influenza Surveillance network has been alerted.

--
ProMED-mail
<promed@promedmail.org>

[As these articles mention, there was an outbreak of H5N1 influenza in Hong Kong in 1997/1998 (see ProMED-mail postings below covering this outbreak). In this current instance there is the suggestion that the location of infection may have been in Fujian Province (China) if the father also had H5N1 influenza. These articles also suggest that the current strain of H5N1 is different from the strain involved in the 1997
outbreak.

On a provocative note, checking the geography it is noteworthy that Guangdon Province is adjacent to Hong Kong and Fujian Province is the next northerly province on mainland China. A rather curious coincidence to have a major respiratory outbreak in a nearby province (see ProMED-mail postings on Pnuemonia - China (Guangdong) listed below). As a reminder there were approximately 350 cases of pneumonia with 5 deaths reported in Guangdong province. Checking population statistics, Guangdong province has a population of 70,510,000 with a population density of 1,027 per square mile -- a respiratory syndrome outbreak with approximately 350 cases in this environment would be classified as a small outbreak.

More information on this outbreak as it becomes available would be appreciated. - Mod. MPP]

Reasonable Rascal
02-26-03, 19:02
INFLUENZA, H5N1 HUMAN CASE - CHINA (HONG KONG) (03)
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A ProMED-mail post

Date: Mon 24 Feb 2003
From: ProMED-mail <promed@promedmail.org>
Source: Reuters News UK online, Mon 24 Feb 2003 [edited]
<http://www.reuters.co.uk/newsArticle.jhtml?type=scienceNews&storyID=2276440>

No Human Influenza Virus Genes in Avian H5N1 Virus from 2 Human Patients
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The avian influenza virus that infected 2 Hong Kong people this month contains no human genes [i.e., no human influenza A virus genes - Mod.CP], meaning that the risk of person-to-person transmission is low, a government official said on Mon 24 Feb 2003.

A 33-year-old Hong Kong man died last Monday [17 Feb 2003] of pneumonia and doctors confirmed he had contracted an H5N1-type avian influenza virus after visiting relatives who keep chickens in China's southern Fujian province. His 9-year-old son was also infected but recovered. They were the first cases of avian influenza passing to humans since an outbreak in the territory killed 6 people in 1997, triggering worldwide alarm.

"Results of the laboratory tests ... show that the virus genes were purely avian in origin," a spokesman for the Department of Health said in a statement. In the absence of human [influenza virus] genes in the avian virus, the risk of human-to-human transmission will be low." Earlier on Monday, government officials told legislators that the absence of human [influenza virus genes] meant it was unlikely there would be an epidemic. A leading microbiologist in Hong Kong has said the virus could only cause a pandemic if it got mixed up with human flu strains [i.e., if the avian virus had acquired human influenza virus genes, facilitating person-to-person transmission of the reassortant virus. - Mod.CP]

On Fri 21 Feb 2003, a government official said it had detected no unusual increase in flu activity or any other H5-type virus over the past few weeks. It said it was still investigating the source of the recent infection and conducting further laboratory tests on the victims' relatives to determine whether they had also contracted the virus.
--
ProMED-mail
<promed@promedmail.org>

[This is the second recorded occurrence of apparent direct transmission of an avian influenza virus to human hosts, unmodified by reassortment of viral genes or by adaptation to an intermediate mammalian host. Fortunately, this H5N1 avian influenza virus, although able to cause severe disease in the initial human host, probably because there is no pre-existing immunity to H5-type virus, has no ability to spread from person to person. There are many other avian influenza viruses, however, in wild and domestic bird populations in relatively close proximity to man, especially in the Far East, and it may only be a matter of time before an avian virus able to spread from person to person makes its appearance. Nonetheless, since generally avian influenza viruses multiply in the gut and are spread through water, the probability of such an event should remain low. Perhaps the most important matter to be resolved at this juncture is the manner in which the original infections occurred. - Mod.CP]

Reasonable Rascal
02-26-03, 19:08
INFLUENZA, H5N1 HUMAN CASE - CHINA (HONG KONG) (02)
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A ProMED-mail post

[1]
Date: 20 Feb 2003
From: ProMED-mail <promed@promedmail.org>
Source: WHO / Communicable Disease Surveillance & Response (CSR) [edited]
<http://www.who.int/csr/don/2003_02_20/en/>


Influenza A(H5N1) in Hong Kong Special Administrative Region of China - Update
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As of 20 February the Department of Health in Hong Kong SAR confirmed that a 33-year-old man, who died in hospital in Hong Kong on 17 Feb 2003, had been infected with a strain of the influenza A(H5N1) virus. ( see previous report ). A nasopharyngeal aspirate taken from the man tested positive for influenza A(H5N1) in the Hong Kong SAR Government Virus Unit.

The 33-year-old man is the second confirmed case of influenza A(H5N1) virus related to this outbreak in Hong Kong SAR. The man is known to have been the father of the 9-year-old boy reported as having tested positive for influenza A(H5N1) yesterday. Both cases had travelled to Fujian Province (China) in January 2003, and 2 other members of the family who accompanied the cases to Fujian in January have also been unwell. The mother of the family has now made a full recovery; the other affected member of the family (an 8-year-old girl) died on 4 Feb 2003 in Fujian Province. The health authorities in Hong Kong SAR are continuing laboratory and epidemiological investigations to determine the source of infection of this outbreak. Further laboratory tests, including gene sequencing, are being conducted. The Department of Health in Hong Kong has reported that no unusual increase in influenza activity has been detected over the past few weeks.

The World Health Organization is in close contact with the health authorities in Beijing, China and in Hong Kong, SAR. The WHO Global Influenza Surveillance Network has been alerted, and additional reagents for laboratory diagnosis are being made available to National Influenza Centres and other Members of the Global Influenza Surveillance Network.

******
[2]
Date: 20 Feb 2003
From: ProMED-mail <promed@promedmail.org>
Source: AP Online 20 Feb 2003 10:28 EST [edited]


Bird Flu Death Confirmed in Hong Kong
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A Hong Kong man who died earlier this week had contracted bird flu, health officials confirmed Thursday, in a case that disturbingly echoes a 1997 outbreak in which the disease first crossed over into humans and killed 6 people.

When bird flu hit Hong Kong's populace more than 5 years ago, officials killed all the territory's 1.4 million chickens in an attempt to wipe out the virus.

Health Department spokeswoman Eva Wong said the man, whom she did not identify, had been infected with the H5N1 bird flu virus. The hospital that treated him said he died of severe pneumonia.

The man's 9-year-old son remained hospitalized Thursday with the same strain of the bird flu. It is a different strain of the disease than the one that infected humans in 1997.

The man's family visited relatives in southeastern China's Fujian province in late January 2003. One of his daughters, an 8-year-old, contracted pneumonia and died 28 Jan 2003 in a Fujian hospital. Officials were investigating what caused her death.

The man, his son, wife, father and another daughter were hospitalized in Hong Kong after their return. The wife and father were released Thursday, but the other daughter, 10, remains in the hospital.

Wong said officials believed the disease did not originate in Hong Kong, but declined to say whether the family might have caught it in mainland China.

Mainland health authorities so far found that none of the family's relatives or medical staff caring for them in Fujian had shown similar symptoms.

The latest case coincided with reports that 12 chickens were found dead at market stalls in a Hong Kong suburb Wednesday -- one of numerous outbreaks of bird flu in recent months. It was, however, unclear whether the birds were infected with the same strain as the boy and his father, whose home is in a different area.

The cases have prompted speculation that the bird flu might have originated in mainland China. Hong Kong returned almost 10 000 chickens to the mainland in 2001 and 2002 after tests indicated they might have been exposed to the virus. A mainland Chinese official recently insisted the flu was endemic to Hong Kong.

--
ProMED-mail
<promed@promedmail.org>

[This newswire confirms a second case of human illness (and first death) associated with an H5N1 infection. In this article there is the additional suggestion that the geographic area of transmission of this infection may have been Fujian, as the entire family had been in Fujian in the immediate period preceding onset of illness. While it may be too late to obtain specimens from the family member who died while in Fujian, results of specific avian influenza testing from the area in Fujian where the family stayed will be of interest and may possibly shed further light on this. To date there has been confirmation of H5N1 activity among poultry in Hong Kong but not elsewhere in mainland China. Perhaps this current cluster of human H5N1 infections with associated mortality will lead to more widespread avian testing/monitoring in mainland provinces. We await further information on this outbreak as it becomes available. - Mod.MPP]
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RR's note:

Hong Kong used to maintain an on-line reporting site for influenza, but since the assumption of control by Peking the site is not regularly updated. Literally weeks or even months may transpire before updated information is uploaded. This is a sad affair for those who depend on timely reports as a matter of maintaining a public health watch for other countries eventually affected by new flu strains coming out of China.

Reasonable Rascal
03-01-03, 02:47
Date: Thu 27 Feb 2003
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: World Health Organisation (WHO) CSR, Disease Outbreak News, Thu 27
Feb 2003 [edited]
<http://www.who.int/csr/don/2003_02_27a/en/>


Influenza A Virus (H5N1) Outbreak in Hong Kong S.A.R. - WHO Update 2
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As of Thu 27 Feb 2003, no further cases of human influenza A(H5N1) have been reported in Hong Kong S.A.R. (see previous report: <http://www.who.int/csr/don/2003_02_20/en/>)


To date the current outbreak of influenza A(H5N1) in Hong Kong S.A.R. has been limited to 2 cases, one of whom has died. Both cases were members of the same family who returned to their home in Hong Kong S.A.R. on 8 Feb 2003 after travelling to Fujian province, China. The mother and children were in mainland China for 14 days; the father for 9 days.

The father of the family (a 33-year-old man) developed respiratory symptoms on 7 Feb 2003 whilst in Fujian Province, China. He was admitted to hospital in Hong Kong S.A.R. on 11 Feb 2003 with pneumonia but died on 17 Feb 2003. Influenza A virus (H5N1) was isolated from post-mortem specimens on 20 Feb 2003. The man's 9-year-old son also became unwell whilst in Fujian province. He was admitted to hospital in Hong Kong S.A.R on 12 Feb 2003 with pneumonia. Influenza A virus (H5N1) was isolated from 2 nasopharyngeal aspirates taken from the boy on 19 Feb 2003. The boy is in a stable condition. Additional family members have also had respiratory symptoms. The boy's 8-year-old sister died on 4 Feb 2003 whilst the family was in Fujian Province, China. The cause of her death is under investigation. The mother has now recovered from what was thought to have been a parainfluenza virus infection.

An outbreak of atypical pneumonia occurred between November 2002 and February 2003 in Guandong province, China. Health authorities in China investigated the outbreak and identified _Chlamydia pneumoniae_ as the causative agent. The Ministry of Health in Beijing has informed WHO that the outbreak in Guandong is over and that there is no evidence of a link between the outbreak in Guandong and the H5N1 cases in Hong Kong SAR.

The Department of Health in Hong Kong S.A.R has intensified its surveillance for influenza among patients with influenza-like symptoms or atypical pneumonia. No unusual increase in influenza activity has been detected over the past few weeks. WHO is continuing to work closely with health authorities in Beijing, China and Hong Kong S.A.R. Reagents for laboratory diagnosis of influenza A(H5N1) virus have been made available to the Ministry of Health in Beijing, the National Influenza Centres, and other members of the WHO Global Influenza Surveillance Network.

--
Marianne Hopp

Reasonable Rascal
03-01-03, 03:01
INFLUENZA, H5N1 HUMAN CASE - CHINA (HONG KONG) (05)
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A ProMED-mail post


Date: Thu 27 Feb 2003
From: George Robertson <RobertG3@wyeth.com>
Source: The Scientist online, Thu 27 Feb 2003 [abbreviated and edited by Mod.CP]


Genetic Characterization of the 2003 Human Isolate of H5N1 Influenza Virus
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The new avian influenza virus that has killed at least one person in South China is genetically different from the avian influenza virus strain that infected 18 people in Hong Kong and killed 6 of them in 1997. Like the 1997 virus, the new strain does not appear to contain sequences from human flu viruses that would speed its spread from person to person, lessening fears that a lethal pandemic flu may be imminent.

Malik Peiris, a microbiologist at the University of Hong Kong who is studying the new virus, told "The Scientist" that the avian influenza virus strain from the 9-year-old boy is completely sequenced. The 6 internal genes of the virus, as well as the neuraminidase gene, are derived from a different genetic lineage from that of the 1997 virus. Only the haemagglutinin derives from the same lineage as 1997. "In addition, we also can establish that the virus has not acquired any human influenza internal genes," said Pieris.

Although similar, this year's hemagglutinin gene "has undergone change, so that the 1997 and 2003 viruses, while related, can be distinguished serologically. In addition to being antigenically different the 2003 virus appears to be more pathogenic for ducks than its predecessor," Ian Gust told The Scientist. "The factors which control infectivity seem to lie on genes other than those coding for the H5 and N1 surface proteins." Gust, at the University of Melbourne in Australia, is collaborating with the WHO influenza research team.

Peiris says he is reassured by the fact that the bird virus has not reassorted with a human influenza virus, which probably hampers its ability to infect people. "However, it is not possible to say with certainty that this virus will not transmit human to human, purely from genetic data. The epidemiological data is important. The key will be to enhance surveillance in humans to ascertain whether there are further human cases. So far, there are none."

Although the Hong Kong death occurred less than 2 weeks ago, researchers were able to move quickly with genetic studies because they set up an early warning system after the 1997 outbreak and had already been studying the recent infections in Hong Kong birds. "The precursors of these viruses are all over Asia. It's not as though this thing came out of left field again. We've been waiting to see when it would happen," said Robert Webster, of St. Jude Children's Research Hospital in Memphis, Tennessee.

[Byline: Tabitha M Powledge]

--
George A. Robertson, PhD
Director of Quality Control Operations
WYETH VACCINES
Marietta, PA 17547-0304
<RobertG3@wyeth.com>