Scott McPherson's Web Presence

This afternoon, Nature's Declan Butler has one of the more fascinating -- and ominous -- dispatches since the H7N9 outbreak in China occurred. Nature bills itself as the international weekly journal of science.  It is one of the most respected publications of its kind in the world. 

And Declan Butler is not one to go around sounding alarms.  His articles are reasoned and insightful. SO it was with great concern that one of my IT people (shout-out Sean Nickerson) came into my office (my door is always open, insert Bob Newhart quip here).  He had just gotten an email with a link to the Nature story.

Here is a snippet:

There is still no evidence of any sustained human-to-human spread of the H7N9 virus. But the World Health Organisation confirmed on Saturday that Chinese authorities are investigating two suspicious clusters of human cases. Though these can arise by infection from a common source, they can also signal that limited human-to-human transmission has occurred.

"I think we need to be very, very concerned" about the latest developments, says Jeremy Farrar, director of the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam.

....The Beijing Municipal Health Bureau also announced today that a 4-year-old contact of a 7-year-old girl who had been hospitalized with the virus tested positive for the virus too, despite showing no symptoms. (bold mine) This is the first asymptomatic case. Along with several mild cases already reported, it suggests that the virus might be more widespread among humans than the numbers of reported cases suggest.

Perhaps counterintuitively, such mild cases are "very worrying", says Farrar. That is because reduced virulence can often point to further genetic adaptation of the virus to infection of human beings — and thus greater potential to spread.

 Marc Lipsitch is an epidemiologist at the Harvard School of Public Health in Boston, Massachusetts. Declan quotes him:

"It's too soon to say how big a threat H7N9 poses because we don't know how many animals of which species have it, how genetically diverse it is, or what the geographic extent is," says Lipsitch, "It looks as though it will be at least as challenging as H5N1."

I am pulling this directly from the proMED (Harvard) report.  No claim of authorship from this corner!

UNDIAGNOSED ILLNESS - GERMANY: (HAMBURG) RESPIRATORY, FATAL, REQUEST FOR INFORMATION

************************************************************************************

A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases <http://www.isid.org>

Date: Wed 10 Apr 2013

Source: Bild [in German, machine trans., edited] <http://www.bild.de/regional/hamburg/viren/toetet-polizisten-im-uke-29943928.bild.html>

A 49 year old policeman is dead, 5 other persons are ill and doctors are puzzled by this mysterious disease just outside of Hamburg.

Andreas Breitner, Minister of the Interior, confirmed to the "Schleswig Holstein newspaper" the death of the 49-year-old policeman at the University Medical Center Hamburg-Eppendorf (UKE) on Tuesday [9 Apr 2013], after multi-organ failure.

Another policeman, aged 38 years is in critical condition. He is suffering from similar flu symptoms, including severe pneumonia.

A teacher from the Schacht Audorf area near Rendsburg has also died of multi-organ failure in the UKE, and according to unconfirmed reports,

3 other persons from the same region are seriously ill.

All are suffering from flu-like symptoms but the doctors do not know what disease is affecting them. It could be a "degenerated virus"

[?mutated], the "Schleswig Holstein" newspaper reporter quotes" an official.

District spokesperson Martin Schmedtje said: "Both policemen showed the same clinical picture. However, we do not know yet whether there is a pathogen or whether a pathogen was actually the cause."

After investigation there are no known connections between both colleagues.

Police spokesperson Sonke Hinrichs said, "the 2 policemen did not work in the same agency, were not on duty together, do not live in the same place. There is no visible connection, but naturally we are working together to try to find out what has happened."

The hospital is also investigating a possible link. UKE spokesperson Christine Jaehn said, "At present no patients with unusual infectious diseases are being treated in the UKE intensive care unit. Moreover, no accumulation of patients exists in the Rendsburg area."

Public health authorities in Rendsburg-Eckernfoerde have been activated since Friday [5 Apr 2013].

But so far nobody knows what this deadly disease is. On Wednesday evening [10 Apr 2013] the Rendsburg-Eckernfoerde District Administrator announced, " Despite the efforts of the specialists involved we have not been able to identify a pathogen."

However, the danger has been estimated as low. District spokesman Martin Schmedtje said, "a recommendation from the health services to close public facilities as a precaution is not necessary. General hygiene measures taken in times of rampant influenza, are sufficient."

Communicated by:

ProMED-mail

<promed@promedmail.org>

[Given the heightened awareness of the public and public health community for severe acute respiratory illness (SARI) and the identification of 2 new novel organisms producing SARI -- the novel coronavirus (nCoV) identified in individuals with contact with Middle Eastern countries and the appearance of human cases of influenza H7N9, an avian influenza virus in Eastern China, a report such as the one above is potentially cause for concern. Other reports on this occurrence in Germany have been posted on FluTrackers

(<http://www.flutrackers.com>) where there is mention that the fatality referred to in the newswire above was found to be attributable to influenza, but a specific virus was not mentioned (?H1N1, H3N2).

As there is no history of travel outside of Germany, the likelihood of this being due to infection with either the nCoV or the avian influenza H7N9 is very low. More information on the results of laboratory studies and other investigations would be greatly appreciated.

Rendsburg-Eckernfoerde is a district in Schleswig-Holstein, Germany.

It is bordered by (from the east and clockwise) the city of Kiel, the district of Ploen, the city of Neumuenster, the districts of Segeberg, Steinburg, Dithmarschen, and Schleswig-Flensburg, and the Baltic Sea (see <http://en.wikipedia.org/wiki/Rendsburg-Eckernf%C3%B6rde> for a map and additional information on the District).

OK, now my biting, insightful commentary.

I called Mike Coston yesterday.  Mike is FLA_MEDIC and the founder of the well-known and respected Avian Flu Diary blog. He is a buddy and it is great talking with him again. Anyway, I asked him if I could interrupt his blogging for a few minutes.  He only wrote ten or so blogs yesterday (slacker!) and only writers and bloggers know how painful deadlines can truly be.

Anyway, Mike told me about this story, and I was very interested to see the proMED journal about it. Hamburg recently struggled with an outbreak of H5N3 in poultry, and it does rest on the Baltic. 

It is now five days later, and we still have no explanation as to what has infected these individuals.  I find that interesting, because if a simple explanation had been found, more than enough time has passed to tell everyone.  One has to assume the German press remains interested in this case.  Whether it is related to H7N9, NCoV, or even H5N1 is both unknown and wrong to speculate upon until answers come.