China reports 14 more H7N9 cases, 3 fatal

Lisa Schnirring | Staff Writer | CIDRAP News | Feb 03, 2014 Over the past 3 days, China reported 14 new H7N9 influenza infections, including 4 in children and 3 fatal cases.

Lunar New Year celebrations are winding down in China, and health officials are watching to see what impact that might have on the pace of human cases. Global health groups have warned that the surge of human cases could continue, fueled by increases in poultry trade and transport, as well as heavy volume of travel as families gather to observe the holiday season.

Southern provinces lead second-wave cases
Six of the latest cases are from Guangdong province, continuing a strong second-wave tilt toward the mainland’s southernmost areas. In the first wave, locations north of that area were driving most of the outbreak activity: Shanghai, Jiangsu province, and Zhejiang province. China’s steady stream of H7N9 cases has averaged about 5 to 7 a day over the past few weeks, and the latest reports puts the total close to the 300 case mark since the disease was first detected in people last spring. For comparison, it took H5N1 avian flu—another closely watched virus that can pass from poultry to people—4 years for the global total to reach 263 cases. China passed that mark for H7N9 last week after less than a year of outbreak activity.

Latest case announcements
News of the latest 14 cases appeared in provincial health ministry announcements translated and posted by Avian Flu Diary (AFD), an infectious disease blog, and five of the cases were also covered in the latest disease update today from the World Health Organization (WHO). Three more deaths were included in the reports: in a 63-year-old man and a 48-year-old man from Guangdong province, and in a 59-year-old man from Hunan province. The 48-year-old’s infection was first confirmed on Jan 15, according to the FluTrackers infectious disease news message board. Six of the latest case-patients are from Guangdong province, and three of them are children, a 2-year-old girl, a 5-year-old boy, and a 6-year old boy. Aside from the 63-year-old man who died from his infections, the other cases involve a 37-year-old man and a 76-year-old woman. The 6-year-old boy’s illness was detected on Jan 28 as he was traveling through a border point between Shenzhen and Hong Kong, according to the WHO report. He lives in Shenzhen and started having symptoms on Jan 27. His symptoms are described as mild, and he is in stable condition and is being treated and isolated at home. The investigation shows that he had been exposed to live poultry.

Meanwhile, the 5-year-old boy, from the city of Zhaoquing, got sick on Jan 29 and was hospitalized the same day. He is in stable condition. The WHO said he had been exposed to a live poultry market. The 2-year-old girl, whose illness was confirmed yesterday, is from Zhongshan City, where she is hospitalized in stable condition, according AFD’s translation of today’s health ministry report. The fourth child—an 8-year-old girl—is from Hunan province, which also reported two adult case-patients, a 38-year-old man and a 59-year-old man who died from his infection. Zhejiang province reported three new cases, all involving adult men, ages 80, 54, and 44. Fujian province also reported two more lab-confirmed cases, also in men, ages 27 and 35.

The 14 new cases boost the H7N9 outbreak’s total to 291, according to a running total compiled by FluTrackers. Of those, 155 have come in the second outbreak wave since October, compared with 136 in the first wave last spring. The three latest deaths lift the unofficial fatality total to 64.

WHO reports add to outbreak, case profiles
The WHO’s statement today also includes details on five case notifications it received from China on Jan 31. In addition, a separate statement from the agency on Feb 1 fleshes out new details on seven cases reported from China on Jan 30. Of the 16 patients reported in the two WHO statements, 11 had been exposed to live-poultry markets, three had been exposed to live poultry, and the source wasn’t known for two. Ages range from 5 years to 82 years. Twelve of the patients are male, and four are female. Eleven of the patients are in critical condition, one is serious, one is stable, and one has a mild infection. Two of the patients died from their illnesses. Illness-onset dates range from Jan 13 through Jan 29. The patients in the two WHO reports are from five different Chinese provinces, all in the southeastern part of the country. They include seven from Guangdong, 6 from Zhejiang, and 1 each from Guangxi, Hunan, and Jiangsu.

See also:
Feb 3 WHO statement

Feb 1 WHO statement

FluTrackers post on H7N9 death

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Chinese scientists sound warning over new H10N8 bird flu

France-Presse, Tuesday, February 4, 2014. Chinese scientists sounded the alarm Wednesday after a new bird flu virus, H10N8, killed an elderly woman in December and infected another individual last month. The fifth novel influenza strain to emerge in 17 years, the virus has a worrying genetic profile and should be closely monitored, they reported in The Lancet medical journal.

It appears to be able to infect tissue deep in the lung and may have features allowing it to spread efficiently among humans, they said. “The pandemic potential of this novel virus should not be underestimated,” said the team headed by Yuelong Shu from the Chinese Centre for Disease Control and Prevention (CDC) in Beijing. The warning stems from analysis of a virus sample taken from a 73-year-old woman who died in Nanchang, in southeastern Jiangxi province, on December 6 after being diagnosed with severe pneumonia and respiratory failure. The Chinese authorities announced her death from H10N8 on December 18.

The Lancet study disclosed that a second case of H10N8 was recorded in Nanchang, on January 26. It did not give further details. They are the first known human cases of H10N8, a virus that has been found only twice before in China — once in a water sample from a lake in Hunan in 2007, and the second time in live poultry in Guangdong province in 2012. But this particular strain is different from the ones found in those two samples, the study said.

Genetic profile of virus
The big contributors to its genome are reshuffled genes from the H9N2 virus, the authors said. This is a bird virus that erupted in Hong Kong in 1999 and has also contributed to the dangerous H5N1 and H7N9 flu viruses, the probe said. Avian flu viruses pass from infected birds to humans in close proximity but typically do not transmit easily between humans. The worry for health watchdogs is their potential to acquire an ability to jump easily from person to person. H7N9, which emerged last year, has led to 159 human infections in China, including 71 deaths, according to a combined toll of official figures and an AFP tally of reports by local authorities. H5N1, which first occurred among humans in Hong Kong in 1997, has caused 648 infections with 384 deaths since 2003, according to figures cited in The Lancet study. The genome of H10N8, it said, pointed to a mutation in its so-called PB2 protein that, previous research has found, suggests an ability to adapt to mammals.

The virus also has a mutation in its haemagglutinin protein — a spike on the virus surface that enables it to latch onto other cells — that suggests it can infect deep in the lung, like H5N1, rather than the upper respiratory tract, the trachea. Lab tests on the sample showed it could be attacked by Tamiflu, the frontline anti-viral drug. Many questions remain, including how the woman was infected. She had bought a live chicken at a poultry market several days before falling sick. But she may have become infected beforehand, the scientists said. She did not handle the bird and no virus traces were found in poultry at the market. In addition, the woman may have been an easy target for the virus because of poor health — she had coronary heart disease, high blood pressure and a muscle-weakening disease called myasthenia gravis. Tests on people who had been in close contact with her concluded that no one else had been infected. The second case of H10N8 “is of great concern”, said co-author Mingbin Liu of the Nanchang branch of China’s CDC. “It reveals that the H10N8 virus has continued to circulate and may cause more human infections in the future.”

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DG SANCO study on the various methods of stunning poultry

The purpose of the study (published December 2012) was to investigate the scale of the use of multiple-bird water bath stunners, the possible alternatives and their respective socio-economic and environmental impacts. Additionally, the study had to examine if phasing out the use of water bath stunning as recommended by EFSA is a feasible option and, if so, under which terms.

It is estimated that there are around 5,300 commercial slaughterhouses in the EU, the majority of which are found in France. Where available, data on slaughterhouse capacity suggest significant differences between Member States in terms of individual capacity. This is reflected by the concentration of slaughterhouse sectors within Member States with a highly concentrated sector in some Member States such as Germany, the Netherlands and Italy and a less concentrated sector in other Member States such as Spain, Poland and Hungary. EU slaughterhouses slaughtered around 5.81 billion broiler chickens and had an estimated economic output between €30.6 to €32.5 billion in 2011.

It was estimated that some 16,000 staff handle live birds across the EU at present. Approximately half of these work in Member States where formal training is required by national law. Just under half work in Member States where there are no formal training requirements, though it is probable that on the job training is provided in some of these Member States.
The majority of poultry in the EU is stunned using multiple bird waterbaths. More precisely:

• 81% of broilers are stunned using waterbaths; 9% using CAS
• 83% of end of lay hens are stunned using waterbaths; 7% using CAS
• 61% of parent stock using waterbaths, and 37% using CAS
• 76% of turkeys are stunned using waterbaths, and 24% using CAS.

The most important driver behind the choice of stunning system is installation and running cost, which is cheapest for waterbath systems. Product quality and revenue is also important with certain stunning systems providing quality advantages for specific end markets which often result in higher revenue, for example for breast fillets resulting from CAS stunning. Other drivers of system choice include access to capital and slaughterhouse size with CAS systems requiring higher investment costs and being most cost effective at higher throughputs.
The costs of stunning systems were compared through a cost model using a number of simplifying assumptions where necessary. The following factors were included in the cost model:

• Installation cost depreciated over a 10 year period
• Annual maintenance cost
• Labor for reception and hanging, and other labor used in the stunning process
• Water for stunning and cleaning
• Electricity for stunning; and, gas for stunning;
The main data sources used were:
o Aggregated estimates of equipment manufacturers (45% weighting)
o Results of the slaughterhouse survey (45% weighting)
o Data from literature and other sources (10% weighting)

Waterbath stunning was found to be the cheapest stunning method, and CAS the most expensive. The highest cost difference between waterbath and CAS is around 1.5 cents per bird. Slaughterhouses with low throughputs (3,000-6,000 birds per hour) present the largest costs difference compared to slaughterhouses with high throughput (12,000 birds per hour with a difference of around 1 cent).

The impact on revenue of different stunning systems is highly dependent on the end market. Three potential mechanisms for higher revenue were identified: access to higher value markets; higher revenue for better quality; and, reduction in losses through trimming and the cost of trimming.

There has been very limited investigation into the impact of different stunning methods on quality. Evidence generally suggests that damage to breast and leg meat is higher with waterbath stunning. In contrast, damage to wing tips and skin is generally lower with waterbath stunning.

In the case of the fresh breast fillet market, it was estimated that losses through trimming and downgrading of the breast could be between €0.011 and €0.052 per bird.

The feasibility of phasing out multiple bird waterbath stunners 

It is considered that, under the baseline, there will be a slight reduction in the use of waterbath systems and increase in the use of CAS systems in the short-to-medium term (two to five years). It is estimated that the proportion of broilers stunned using waterbaths will fall from 79% at present to around 65%, while the proportion of broilers stunned with CAS systems will increase from 21% to around 35%. There will be significant differences between Member States, with no changes in stunning system in some Member States, and significant changes in others.

A complete mandatory ban on waterbaths was considered difficult. There would be positive aspects of a ban; from a political perspective, it would bring the industry into line with the 2004 recommendation of EFSA, and in social terms there would be a positive impact on animal welfare.

However, there were considered to be significant potential negative impacts and problems. Mandatory phasing out would have strong economic impacts on operators, and these would be accentuated for smaller slaughterhouses due to the technological issue of the current lack of commercial alternatives to waterbath stunning systems. It may also be difficult to make changes to a regulatory framework, which was only recently modified. Furthermore, there may be some negative social impacts if consolidation in the sector were to accelerate as a result of such a mandatory phasing out.

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