H5N1 returns with a vengeance in poultry -- and in people.

It didn't take long for H5N1 avian influenza to re-establish itself as the dominant disease in the global press. Just a few scant months ago, we were wondering (some silently, some aloud) if bird flu had gone away.

Now, with simultaneous events taking place over two continents and several thousand miles, we can say the answer is a resounding "no." Bird flu has not gone away. If anything, it has roared back with a terrible vengeance.

Look at the distribution of cases. Hong Kong slaughters 80,000 domestic fowl after several chickens turn up positive for high-path H5N1. China then finds H5N1 intwo different areas northwest of Shanghai in the province of Jiangsu, and orders the culling of more than 300,000 chickens.

Two Indonesians die and a third is treated. A 19-year old Cambodian tests positive for H5N1 for the first time in a year and a half, and culling ops ramp up in the affected province. In India, two entire provinces (Assam and West Bengal) are on alert after bird flu is found among poultry in both states, and humans in Assam are reporting "flu-like" symptoms, prompting quick medical response from field doctors. Some 300,000 Indian chickens will meet an inglorious fate at the hands of cullers.

Finally, in Egypt, a 16-year old teenage girl dies of H5N1. Her domestic poultry were infected, and she apparently caught the deadly disease from them. It is the first human case in Egypt since April.

All in all,it appears that H5N1 has begun its global march reinvigorated. Additionally, all these cases -- in humans and in poultry -- are happeningsimultaneously.

Of course, as we all know, Indonesia and Egypt have declared H5N1 to be endemic to fowl, and both nations have stopped reporting individual cases of H5N1 in poultry. Egypt continues to report human cases immediately; Indonesia only reports on a quarterly basis or if the situation is important enough to disclose it early.

Now Chinese scientific hero Guan Yi has theorized that the H5N1 virus has begun to mutate yet again, possibly explaining the simultaneousappearances in Egypt and China. here is the story, from China Daily and with bold highlights from me (and a tip o' the cap to Crof:):

Farms may not be using 'right vaccines' (China Daily)
Updated: 2008-12-17 07:45

HONG KONG - The re-emergence of bird flu in Asia and Egypt was partly because poultry farms were not using the right vaccines and that the virus is mutating, experts said on Tuesday.

Guan Yi, of the University of Hong Kong and an expert on H5N1 virus, warned that poultry farms in some parts of the world were using vaccines that did not provide full protection against the H5N1 and can't keep up with its mutation process.

"The vaccine (used in Hong Kong) was made to fight an American strain of the H5N2, and it is very different from the Guangdong strain of the H5N1 virus here," he said.

"When there were no outbreaks, we just assumed it was protective. Now that there is an outbreak (on a Hong Kong farm), we assume it is useless," he said.

Since late November, the virus has infected two children in Indonesia, killing one of them. Earlier this week, it killed a 16-year-old girl in Egypt, too. And a youth in Cambodia tested positive for the virus after eating chicken.

"The virus is definitely mutating," Guan said, warning that authorities in some areas were using batches of vaccine that may no longer be effective.

Since 1997, when H5N1 was identified in Hong Kong, scientists have discovered 10 strains of the virus, which shows the speed and extent at which it is mutating, though it has not mutated to pass from human to human.

The strain found in Indonesia, for example, is very different from the H5N1 strain in Europe, the Middle East and Africa.

"There is a theoretical possibility that the strain being used in the vaccine is too different from the one circulating," said Albert Osterhaus, a leading virologist with Erasmus Medical Center in Rotterdam, the Netherlands.

China Daily - Agencies

Now let's take a confirming look at the report coming from Jiangsu province, China:

Jiangsu suspects bird flu virus mutation

Shanghai. December 17. INTERFAX-CHINA - The H5N1 bird flu virus recently discovered in eastern China's Jiangsu Province may have mutated, local authorities announced on Dec. 17.

According to the Jiangsu Department of Agriculture and Forestry, bird flu-infected chickens in Jiangsu's Dongtai City and Hai'an county had been vaccinated against the virus although a new H5N1 virus strain has emerged and is unlike other strains previously discovered in southern China.

Jiangsu authorities reported the detection of the deadly H5N1 virus in poultry on Dec. 15 and have since ordered the culling of 377,000 poultry across the province. The Ministry of Agriculture announced on Dec. 15 that the outbreak in the two major poultry-rearing regions in Jiangsu may be attributed to migratory birds.

In the meantime, the National Bird Flu Reference Laboratory in Heilongjiang Province is running further tests on the virus, according to the Jiangsu Department of Agriculture and Forestry.

The MoA has also ordered chickens in the province to be vaccinated with a new vaccine in a bid to contain the outbreak.

Just last week, Hong Kong culled nearly 80,000 chickens after health authorities confirmed three chickens tested positive for the H5N1 virus. On Dec. 15, a 16-year-old girl died of bird flu in Egypt following contact with poultry.

To review:  A new, previously undiscovered strain of H5N1 has simultaneously appeared in both China and Egypt.  It may or may not have appeared in Cambodia.  It is once again lethal to humans, especially young humans.  It is believed to have mutated beyond the ability of a crude poultry vaccine to defeat it (so why should we believe an experimental human H5N1 vaccine should cause the virus to behave any different?). 

This poultry vaccine has produced a vaccine-resistant, mutant strain of bird flu.  Perhaps a new "clade" has been launched.  Just remember that each and every time this virus has a significant drift, it potentially places that virus one step closer in its evolutionary march toward pandemic status.  The death of the Egyptian teenager and the infection of the Cambodian young man clearly show that this virus has lost none of its lethality nor its proclivity toward infecting the young. 

So if we do, indeed, have a new strain of H5N1 emerging in two different continents simultaneously, we have a major cause for concern. 

As I mentioned in a blog a few weeks ago, Nature likes to kick Humanity when it is down.  With all the economic uncertainty, wars and upheaval, we need to be more on guard than ever against this viral foe.  As Michael Osterholm says:  Each day brings us closer toi the next pandemic, not further away from it.  I cannot help but feel that we are closer than ever.

We have a breaking report of a South African man who died earlier this week in Rio de Janeiro, Brazil, of a suspected arenavirus. Some 50 persons who either treated this patient or were exposed to him at a conference are actively being monitored very, very carefully.

This past October 13th, I blogged about a Zambian woman who died in South Africa of a new, previously unseen and as-yet-unnamed type of arenavirus. Not only did that woman die, but three other persons connected with the index case also died. And a nurse treating Patient Two, NOT Patient Zero -- almost died.

Last month it was reported that the woman, a Zambian who booked African safaris, had visited clinics several times before, and a diagnosis eluded both her and her doctors.

I am not the only person who has made the mental link between the deaths in South Africa and the death of the man in Rio. Reuters is reporting that Brazilian authorities are stating the dead man was actually a patient at the same hospital as the four arenavirus patients who died in the same South African hospital. If true, that would either mean the virus was endemic within the hospital, or it means the incubation perios is much longer than the new virus'incubation period of seven to thirteen days.

Arenaviruses, including lassa fever, are wicked nasty bugs that are hemorrhagic fevers, transmitted by the waste products of rats and other rodents.

This novel arenavirus has people in South Africa rightly stirred up. A man was recently declared negative for this new virus last month. Here is the proMED report on his illness and diagnosis:

A man presenting symptoms similar to viral haemorrhagic fever has been admitted to the Life Fourways hospital in Johannesburg. The 55 year old South African citizen, who lives in Malawi, arrived at the hospital on Thursday [6 Nov 2008] at 7 pm and was brought in to the trauma and emergency unit before being placed in an isolation unit as a precaution, said hospital spokeswoman Marietjie Shelly yesterday.

"He had high temperature, severe abdominal and kidney pain, and vomiting.

Initial blood tests gave no indication of internal bleeding," she said.

"Even though no diagnosis has as yet been made for the patient's condition, as is routine full infection control protocols were immediately implemented and he was placed in an isolation unit."

This was done as a precautionary measure to ensure the safety of hospital staff, patients and visitors. "He walked into the hospital, he wasn't flown in or brought in by ambulance," said Shelly.

The National Institute of Communicable Diseases had been informed about the latest admission, she said. A broad range of blood tests and screenings were currently in progress as these symptoms may also be indicative of other non-infectious conditions.

Just a month ago, American scientists identified a new type of arenavirus (bold mine) which caused the deaths of 4 people since September [2008]. A name was still being chosen for the virus. The 1st person known to have died from the virus was a woman who was flown from Zambia to South Africa in September for emergency treatment. 3 previous visits to health facilities had failed to determine what was wrong with her. (bold mine)Since then the paramedic who accompanied her, a nurse at the Morningside Medi Clinic, and a contract cleaner have died. Another nursing sister is currently receiving treatment at the Morningside Medi Clinic after presenting with symptoms. However, she had since been moved from the intensive care unit. "She's improved that much... however, she's is still in isolation," said hospital spokeswoman Melinda Pelser. Pelser said doctors indicated that the nursing sister was not infectious anymore. As a precautionary measure the woman would be kept in isolation for 3 more weeks.

A total of 39 people who had been in contact with her were still being monitored for signs of the virus.

Good, the man was negative.  But what if, as we suspect about H5N1, he sure looked like a candidate but tested negative?  So are there false negatives for this virus as we suspect are happening with H5N1?

Here is the WHO report on the initial outbreak as mentioned in the proMED report:

New virus from Arenaviridae family in South Africa and Zambia - Update

13 October 2008 -- The results of tests conducted at the Special Pathogens Unit, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service in Johannesburg, and at the Special Pathogens and Infectious Disease Pathology branches of the Centers for Disease Control in Atlanta, USA, provide preliminary evidence that the causative agent of the disease which has resulted in the recent deaths of 3 people from Zambia and South Africa, is a virus from the Arenaviridae family.

Analysis continues at the NICD and CDC in order to characterize this virus more fully. CDC and NICD are technical partners in the Global Outbreak Alert and Response Network (GOARN).

Meanwhile, a new case has been confirmed by PCR in South Africa. A nurse who had close contact with an earlier case has become ill, and has been admitted to hospital. Contacts have been identified and are being followed-up.

WHO and its GOARN partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts.

Most of your hemorrhagic fevers -- Marburg, Lassa Fever, and Ebola -- are not easily spread because the onset of symptoms is so quick. People usually cannot get out of their village due to the effects of the virus.

But this new arenavirus can apparently linger for a week or longer before taking down its host. the thought of a hemorrhagic fever being able to survive in its host for over a week before kicking in and the host kicking off is too frightening to imagine.

This incident also reminded me of a still-unsolved mystery aboard a Virgin jet from Johannesburg to London in 2006. Here is the original story from the UK Mirror:

KILLER BUG AIR SCARE

By Stephen Moyes 20/05/2006

A WOMAN who arrived in London on a flight from Africa yesterday is reported to have died from the deadly and contagious ebola virus.

Panic has spread among cabin crew and hospital staff after the death of the 38-year-old Briton.

The unnamed woman is understood to work at an embassy in the African kingdom of Lesotho.

Before boarding a Virgin Atlantic flight from Johannesburg to Heathrow she visited a doctor complaining of flu-like symptoms.

She was allowed to fly, but during Flight VS602 to the UK she suffered a violent fit which left her unconscious.

Virgin later released a statement saying the passenger did not die from Ebola. Of course, they never said what she did die of. Neither did the British authorities, as best as I can find on Google.

So let's wrap up. We have a South African man who dies after flying to Rio, who may or may not have been a patient at the SAME HOSPITAL as the three South Africans and one Zambian who died in Johannesburg on November. And a woman who took a flight in May 2006 from Johannesburg to London, who worked in an embassy in Lesotho, died of a mystery illness.

Let's hope somebody is taking the 2006 dead woman's fluids and looking for this new, mystery hemorrhagic fever.

I am very worried about this. I know, I know, it's only a handful of dead, but look at the potential. You talk about panic? It's one thing to talk about a flu pandemic killing people. Now imagine a killer virus that is like Ebola but as easy to catch as the flu, killing in a much more disgusting fashion.

Stay tuned.

A suspected bird flu cluster has been ruled out.

At one point, the seventeen villagers from Makassar, Indonesia, were held under guard, so they would not run away.

Now, apparently, they can go home of their own free will.  Bird flu has been officially ruled out as the source of their malaise, according to the always-reliable Health Ministry (can you see my tongue in my cheek?). 

What it WAS was not mentioned.  But we apparently know what it wasn't, and it wasn't H5N1.  Thank goodness.

Last year, an outbreak of what appeared to be a new form of the hemorrhagic fever Ebola surfaced in western Uganda. I blogged about this apparent new strain frequently.

Now, in the journal PLoS pathogens, the existence of a new form of Ebola is confirmed. Its name: Bundibugyo ebolavirus. From the proMED email:

The new virus is genetically distinct from all other known Ebola virus species, differing by more than 30 percent at the genetic level. More traditional ELISA (enzyme-linked immunosorbent assay)-based assays detected the new virus; however, the unique nature of this virus created initial challenges for traditional Ebola virus molecular diagnostic assays and genome sequencing approaches.

To determine the genetic signature of this new Ebola virus species, scientists used a recently developed random-primed pyrosequencing approach, quickly determining the genetic sequence of over 70 percent of the virus genome.

Knowledge of this sequence then allowed for the rapid development of a sensitive molecular detection assay, which was deployed to the field as part of the outbreak response. This draft sequence also allowed for easy completion of the whole genome sequence using a traditional primer walking approach and prompt confirmation that this virus represented a new Ebola virus species. Current worldwide efforts to design effective diagnostics, antivirals, and vaccines will need to take into account the distinct nature of this new member of the Ebola virus genus.

So we officially have a new strain of Ebola, some 30% different from previous strains.  I do not know if 30% is par for the course or way different, but it does mean that the Ebola virus continues to evolve while maintaining its ability to kill over 50% of the people it infects.

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