Saturday, December 22, 2012

More evidence of nasty flu season ahead

There’s more evidence that this is shaping up to be a nasty flu season, with the number of states with high flu activity doubling in a week and reports of the achy, feverish illness spreading widely across the U.S.

Eight states are now reporting high levels of what’s known as influenza-like illness, according to the Centers for Disease Control. Eighteen states reported widespread flu activity for the week that ended Dec. 8, according to the agency’s FluView data.

"Today’s report confirms that the U.S. flu season is off to early start,” CDC Director Dr. Thomas Frieden said in a statement. “It’s too early to tell how severe our season might be. However, we know that thousands die and hundreds of thousands of people are hospitalized with flu each year. Vaccination is the single most important step we can take to protect ourselves and our families against infection. It's not too late to get vaccinated before the flu season peaks.”
The good news, though, is that this year’s vaccines are well-matched to the viruses, CDC officials said.
The eight states with high levels of flu activity include Alabama, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

  Full Article

Flu prevalence in Mississippi triple national average, continuing to increase

Not too late for shot, official says
7:26 AM, Dec 22, 2012 

When going in for holiday hugs, it may be wise to note flu has been twice as prevalent in Mississippi in recent weeks as this time last year and triple the current national average.
Nationwide last week, an average of 3.2 percent of nontrauma patient visits reported flu symptoms. That rate more than tripled to 10.4 percent in Mississippi, state Department of Health data show. And in the same week last year in Mississippi, only 4 percent of patients had flu symptoms.

South Dakota Cluster of Antibiotic-Resistant Infections Reported

 December 16, 2012
PIERRE, S.D. – The Department of Health and northeastern area health care providers are investigating a cluster of bacterial infections. CRE, or carbapenem-resistant Enterobacteriaceae, are difficult to treat because they are resistant to many antibiotics. 
To date this year, 26 potential cases of CRE from northeastern South Dakota have been reported to the department for evaluation. CRE cases have been reported in 42 states, including all of South Dakota’s neighboring states except Nebraska.
Enterobacteriaceae bacteria such as Klebsiella and E. coli are found in the human digestive system and can become resistant to carbapenem antibiotics. Patients on ventilators, urinary or intravenous catheters, or long courses of certain antibiotics are most at risk for CRE infections. Healthy people are not at risk.
The department has provided area healthcare and long term care facilities with guidelines from the Centers for Disease Control and Prevention (CDC) for the control of CRE and also published the information in the August issue of South Dakota Medicine. It is possible to care for patients and residents with CRE and any other organism while safely caring for other patients and residents in the same facility. Protocols have been established and are followed to ensure patient and staff safety.
The CDC guidelines focus on screening of high risk individuals, laboratory capacity for testing, appropriate use of antibiotics to prevent drug resistance, and proper infection control precautions. The complete guidance can be found at
More information about CRE is available on the CDC website, 

12 flu-related deaths reported so far in NC

Saturday, Dec. 22, 2012
RALEIGH, N.C. North Carolina health officials say it's the worst flu season in a decade, with 12 flu-related deaths reported so far.

State Health Director Laura Gerald says it's unusual to see so many deaths this early in the season. She strongly encourages anyone over six months old to get a flu vaccination.

Flu outbreaks are being reported in schools and long-term care facilities statewide. Officials say the flu is especially dangerous for pregnant women, people with chronic diseases, very young children and the elderly.
Nine of the 12 people who died were older than 64. The other three were between 24 and 64 years old.
It takes about two weeks for people to develop immunity after getting the vaccination.

Read more here:

Seasonal Flu: South Dakota: 3rd Death This Season

 Brown County reports flu death
23 hours ago

South Dakota had its third influenza-related death last week, but flu activity here remained less than it was in three surrounding states, according to the South Dakota Department of Health.
Influenza activity remained at "regional" levels in South Dakota, while Minnesota, Iowa and Wyoming, along with 26 other states, all reported widespread influenza activity.
One new death was reported in Brown County, bringing the total number of flu-related deaths this season to three. The 2012-13 flu season started earlier and harder than last year, with 279 lab-confirmed cases to date compared to five cases at this time in 2011.

Seasonal Flu: Dallas Texas: Vaccine Flying Off Pharmacy Shelves As Flu Cases Up

Dallas County Health officials say flu cases are up 40 percent since October.  The bump in cases has come earlier than usual in the flu season and has pharmacists working hard to keep flu antivirals in stock.
Dougherty’s Pharmacy in Dallas is busy with customers looking for relief from the flu.  But those suffering with the common symptoms of fever aches and the chills–may hit a snag.
“We had some Tamilflu on the shelf, but we immediately ran out,” said pharmacist Andy Komuves.
Tamiflu–the most recommended medicine to fight influenza–is in high demand.  So much so that many pharmacies are running out and are having to make additional orders.
Shipments of the Tamiflu capsules for adults and adolescents is easier to refill, but Dougherty’s says it is completely out of the the liquid form for babies and infants.

Dallas county health experts say it’s not to late to get vaccinated against the flu and say certain patient groups are more at risk than others.

This can be very deadly for our older population and our young children the concern should always be the fact if you don’t have the flu shot you’re not protected,” said Dallas County Health Director Zachary Thompson.

Full Article:

Four Flu Deaths Reported In Texas As Season Gets Early Start

Officials say a woman in her 60s with underlying health conditions recently passed away.
It was the fourth flu-related death in Texas.  The other three, including one in Tarrant County, have been children.
Flu season is off to an early start, and it could be a bad one.  “This year we are starting early and its climbing quickly,” says Dr. Donald Murphey, an Infectious Disease Pediatrician at Cook Children’s in Fort Worth “Last year this time we really didn’t have much flu. Last year in general was a mild season.”
At Cook Children’s, doctors normally see 300 patients a day.   But in the last few days that number has doubled.

Cook Children’s treated 270 flu cases last week alone.  The week before it was 150.
At Children’s Medical Center in Dallas it’s been one of their busiest months.  Doctors say if you have a mild case of the flu treat it at home.  “We don’t have capacity to take care of everybody in a surge like this where you have lots and lots of sick kids all at one time,” explains Dr. Murphey.

Full Article:

New coronavirus may have spread person to person in Jordan; milder cases likely

 Helen Branswell, The Canadian Press

The World Health Organization says the new coronavirus may have spread from person to person in a cluster of cases that occurred in Jordan in April.
In a statement issued Friday, the global health agency did not indicate how many people it considers as probable cases from the Jordanian outbreak, which centred on a hospital in Zarqa.
In April, before the existence of the new coronavirus was recognized, the Jordan Times reported that there was an outbreak of an unknown illness causing pneumonias at Zarqa Public Hospital.

The newspaper cited Abdul Latif Wreikat, Jordan’s minister of health, as saying there were 11 cases. Seven were nurses, one was a doctor and one was a brother of one of the nurses. The article did not indicate who the other two patients were.
Two people in this cluster of cases died of their infections. Once the existence of the new coronavirus became known, stored samples taken from the two patients who died were tested for the virus and they were confirmed as cases.
Full article:

MOH rules out #birdflu #H5N1 outbreak in Kuwait


KUWAIT: Seven cases have been diagnosed with bird flu in Kuwait recently, a local daily reported yesterday quoting a senior Ministry of Health official who reassured that there is no fear of an outbreak of the dreaded disease. Speaking to Al-Rai on Thursday, Al-Sabah Hospital’s Director Dr Abbas Ramadan indicated that three senior citizens diagnosed with the disease are in stable condition at the Infectious Diseases Hospital where they receive treatment, along with four children who already have been cured at the hospital, adding that one child has already been discharged. In another development, Dr Ramadan confirmed reports about resignations among the medical staff in the Sabah Hospital, but reassured that hiring is in place to prevent shortage in staff, reported Arabic daily Al Rai Separately, Al-Qabas reported yesterday that the Central Tenders Committee refused bids to reward tenders for construction projects at four different hospitals for high costs. — Al Qabas

Indonesia: Central Java Suspected Human Case MAK (15)

 [This case lived in East Java, but was in Central Java since 12/17/12]

For the second time, a resident in Central Java suspected bird flu virus and isolated in hospital. The second victim this time a big new kid (ABG) was 15 years old. The boy's initials MAK had to be treated in hospital isolation room doctor Soewondo Kendal regency, Central Java.

Doctors Hospital Soewondo Kendal PR, Endang Setyorini as confirmed Saturday (22/12) stated the patient came to the hospital on Friday (21/12). The patient complained of head dizziness, cough, runny nose and body high heat.

"His complaint was initially really like the common flu. However, the fact that the complaint appears to tell a lot of birds in the surrounding environment that died suddenly, the patient is immediately placed in isolation. Concerned if positive bird flu," he said.

According Muarifin (15) which is a relative of MAK, patients come from Pare district of Kediri Regency, East Java. Since Monday (17/12) and MAK are at home relatives Hamlet Dukuh Dodokan RT 2 RW 5 Desa Purwokerto Kecamatan Patebon Kendal  to attend a niece's wedding.

"But on Friday morning MAK suddenly complained of pain. Fact it had never been in direct contact with poultry but often see a duck coops adjacent chance. Before complaining hot, so amazing. Valid On Thursday even had time to play PS (playstation) together -together. MAK had brought health center, but was subsequently referred to the hospital, "said Muarifin.

Deputy Director of Field Services Kendal Soewondo Doctors Hospital, said in addition to the space Saekhu special diet patients also considered. Do not drop her condition.

"Currently, blood and saliva samples of patients being conducted laboratory tests in hospitals Dr. Kariadi Semarang. Samples have been sent. To mengetahi positive or not, wait for the results," said Saekhu.

Shaeku add MAK is the first patient in the hospital in 2012 Soewondo suspected suspect bird flu. But to anticipate the surge in patients suspect bird flu, it has set up some other isolation.

Previously, as reported, Kendal DVO poultry in six states there Kendal had tested positive for bird flu. Patebon addition, the District Weleri, Rowosari, Cepiring, South Kaliwungu and Brangsong.

With MAK suspectnya Kendal residents is isolated due to the AI ​​virus in Central Java had two patients undergoing treatment in the isolation room at the two hospitals. The alleged victim was the first suspect AI MK Bergas citizens, Semarang regency which is a poultry farmer. MK undergoing treatment in the isolation room Semarang Elizabeth Hospital on Thursday (20/12) for patients who suspect complains like AI virus.

Indonesia: Kediri Anticipates #Birdflu Transmission To Humans

[I read this article a few days ago, and now we have a suspected case.  I can't post everything I read, but I will post this now.]

December 19, 2012

After thousands of ducks in Kediri, East Java, known to be positive bird flu (Avian Influenza), the local government is currently undertaking precautions so as not to infect humans.Chief Medical Officer of Kediri Regency, Adi Laksono said it has formed a team of Health Department as well as community health centers, and this time they began working in the field.
"We have also coordinated with the Department of Animal Husbandry related dots case finding dead birds," said Adi Laksono, Tuesday (18/12/2012).
The team, said Adi Laksono, tasked with investigating epidemiology to detect the presence or absence of people who suffer from shortness of breath accompanied by flu, the symptoms of bird flu. These checks are done on people who live within 100 meters of the location of the discovery of bird flu infected poultry.

In addition to the people who were at the discovery of bird flu cases, the examination will also be carried out on people who interact directly with the ducks, such as farmers, herders, to poultry traders.Counseling is also done to meninimalisasi the panic caused by the case. While passive measures, with accommodating people who come to the clinic to check yourself.
"We happen to have handled cases of humans infected with bird flu, which in the year 2006," he concluded.
Previously reported, thousands of ducks in Kediri positive for H5N1 virus with a clade 2.3. As a result of this attack, 26 thousand ducks infected and 11 thousand of them, died.

Indonesia: Suspected Bird Flu, Kediri Resident


East Java:
December 22, 2012

One patient, initials MAK (15) had to be treated in hospital isolation room doctor Soewondo Kendal. Based on the complaints and the examination while the patient allegedly infected with deadly H5N1 virus (bird flu).
Doctors Hospital Soewondo Kendal PR, Setyorini Endang said patients come to the hospital on Friday (21/12). The patient complained of head dizziness, cough, runny nose and body high heat.
"Actually complaint as common flu, but because it tells a lot of birds in the surrounding environment that died suddenly, the patient is immediately placed in isolation. Concerned if positive bird flu," said Endang on Suara Merdeka on Saturday (22/12).
Based on information from relatives, Muarifin (15), patients come from Pare district of Kediri Regency, East Java. Since Monday (17/12) and he was in the Hamlet relatives Dodokan RT 2 RW 5 Navan Rural District Patebon Kendal to attend a niece's wedding. But on Friday morning, relatives suddenly complained of pain.
The patient has not had direct contact with poultry, but seirng see duck coops adjacent chance.
"Before you complain of the heat, so ordinary. Valid On Thursday even had time to play PS(playstation) together. clinic he had taken, but refer directly to the hospital, "said Muarifin.
Deputy Director of Field Services Kendal Soewondo Doctors Hospital, Dr. Saekhu say other than the special diet patients also considered. Do not drop her condition. While current blood and saliva samples of patients being conducted laboratory tests in hospitals Dr. Kariadi Semarang.
"Samples have been sent. To mengetahi positive or not, wait for the results," said Saekhu.
He added that a memorandum was the first patient in 2012. But to anticipate the surge of patients with suspected bird flu, it has set up some other isolation.
Previously, Kendal DVO poultry in six states there Kendal positive for bird flu. Patebon addition, the district Weleri, Rowosari, Cepiring, South Kaliwungu and Brangsong.

Friday, December 21, 2012

WHO issues human-animal influenza summary and assessment

by Jeffrey Bigongiari
The World Health Organization recently released a summary and assessment of its most recent data regarding influenza at the human-animal interface.

The summary and assessment shows that from 2003 to December 17, 2012, the WHO received 610 laboratory-confirmed reports of human cases of A(H5N1) avian influenza virus infection, including 360 deaths. Official reports of infections came from 15 countries.

The WHO reported that there have been 32 new cases of avian influenza confirmed since the beginning of 2012. Since the last summary and assessment was issued on November 5, there have been two new cases confirmed. One of the cases was located in Egypt and another in Indonesia. The case in Indonesia resulted in a fatality.


Indonesia: West Java Prepares for Human Cases of #H5N1 #Birdflu

 West Java (Jabar) defined alert status following the outbreak of bird flu H5N1 virus back in some areas in Java.
West Java Health Office has alerted hospitals in 10 districts / cities in West Java. Tenth hospital isolation room equipped to handle patients who indicated the bird flu disease.
"The ten hospitals that include RSHS, RS Rotinsulu, Subang RS, RS Slamet Garut, Sukabumi RS and RS Cirebon," he said. Jabar He appealed to all people to be alert to bird flu outbreaks.For poultry farmers, he asked that they always use protective equipment when working at home.
"Those who work at home should carry out vaccination to inhibit the proliferation of the virus, especially bird flu virus," he said. while for people who raise poultry are encouraged to change his attitude in treating pets. "Do not put in the house, if you can keep and vaccinated. Those who raise chickens or ducks better not removed first, dikandangin better," he said.

Avian influenza hits Dharke

DHARKE: Hundreds of fowls that died in a Dharke-based a chicken firm over the past one week are learnt to have died due to bird flu outbreak.

The confirmation of bird flu came from a test report conducted by Central Veterinary Lab in Kathmandu on samples collected from Laxmi Pokharel’s chicken firm. Though the lab had confirmed the outbreak on Wednesday, farmers had been reluctant to flash the news fearing possible impact on business.

Yesterday, a joint team of technicians’ from the lab and the Dhading-based district livestock office destroyed dead fowls. Today, veterinary doctor Arjun Aryal’s team from the Central Livestock Health Directory and the veterinary lab and Dhading based district livestock office declared Dharke a bird flu affected area and sprayed medicine at Pokharel’s firm.

Most chicken firms in the district are located in Dharke. It is said there are about 500,000 fowls in various chicken firms there.

According to Dr Aryal, though it is necessary to cull all the fowls within a two-km vicinity of the bird flu outbreak site, there has been no decision to cull from the central level. “Frequent bird flu cases might have to do with import of chicken from India and migrant birds,” he said.

China probes Yum Brands' KFC over safety of chicken products

[editing is mine]
Thu Dec 20, 2012

(Reuters) - Yum Brands Inc's fast-food chain KFC was supplied with chicken in China that contained excessive amounts of antibiotics, said food safety authorities investigating allegations of tainted KFC products.

The finding by the Shanghai Food and Drug Administration (SFDA) deals a blow to KFC's reputation in China, where it is facing fierce competition from the likes of Taiwanese-owned fried chicken chain Dico and Japanese-style noodle chain Ajisen (China) Holdings Ltd. Yum Brands has forecast a drop in same store China sales in the fourth quarter.

Eight of the 19 batches of chicken samples Yum Brands sent to a testing laboratory in 2010 and 2011 contained overly high levels of antibiotics, the SFDA said in a statement on its Website late on Thursday.


Thursday, December 20, 2012

Indonesia: First Bird Flu Patients Referred to Hospital

[This article describes the patient as having bought 7 chickens on the market that died. It does not describe him as a breeder] 12/21/12 Semarang-A resident Bergas, Semarang regency, M (52), suspected of contracting bird flu virus. Currently, he is in intensive care in the isolation room Room Vincent's Hospital (RS) Elisabeth Semarang. This case stems from seven chickens recently purchased by M on the market suddenly died. Shortly thereafter, he was suffering from flu. Because worry, M took the initiative to check into the hospital. M has been undergoing treatment since Monday (17/12) and at Elisabeth improved health conditions and be able to move. But until yesterday, he was still occupying the isolation room. "Treatment is the same as other flu sufferers. The early symptoms of time here at the person who has the flu, such as shortness of breath and a runny nose. Instead missed, better treated first intensive, "said Head of Public Relations Elisabeth, Probowatie Tjondronegoro, Thursday (20/12). 

Initially, the time to register to check on Elisabeth, he uses the address Sambiroto Village, District Tembalang, Semarang. Having tracked the original address, was living in Bergas M, Semarang regency. "M to be vigilant. He immediately register and provide information about the flu that happened, "said the Probo.  

By X-ray examination of the thorax was performed. Health Department is also memeriska throat swabs and mucus in the laboratory to determine whether or not exposure to M by the H5N1 virus. Conducted an intensive examination of the Department of Health as an agency that has a lab to determine exposure to the virus.  

Chief Medical Officer of Central Java, Anung Sugihantono, said it has to record and track the bird flu is unpredictable. Semarang District Health Office has also set up posts around the house M to anticipate. "on Saturday (22/12) estimated the lab results came out. This is the first case of bird flu suspect in Central Java this year, "said Anung. M suspected bird flu infected poultry due to direct contact with the H5N1 virus.  

Throughout this year, cases of bird flu in Central Java has never happened, either suspected (unexpected) and positive exposure to the H5N1 virus. Since November 2011, Central Java Health Office wary bird flu increased in the rainy season with socialization and advocacy in Sukoharjo, Pemalang, Pekalongan, Wonogiri, Holy, Grobogan, Klaten, and Banjarnegara. 

 "A total of 24 clinics have been prepared to anticipate the spread of bird flu in the district," he said. Formerly, Department of Animal Husbandry and Animal Health Central Java, Whitono, explains, until Wednesday (19/12), avian influenza (AI) which attacks poultry least have killed 64,285 ducks (0.78%) of the total population of 8,159,311 tailed ducks in 23 districts / municipalities in the province. 

 In order not to extend, Whitono urged traders do not trade in a sick duck. Moreover, the new AI is considered a zoonotic or can be transmitted to humans. District Six in Kendal, H5N1 AI virus or getting raged. Viruses are better known as bird flu has spread over six districts and caused tens of thousands of ducks died suddenly. Breeders also troubled by the health and damage suffered.Kendal Head of Animal Husbandry Department of Animal Husbandry, Eko Tri Jatmiko, said indications were known after the rapid test (rapid test) in some farms.  

Samples have been taken and based on testing, confirmed the death of ducks caused by H5N1 virus. Six districts are Weleri, Rowosari, Cepiring, South Kaliwungu, Brangsong and Patebon. "Penyemperotan routinely be done by the breeder. Livestock shall not be sold, "said Eko, Thursday (20/12). anticipation to be done by the breeder was using gear / clothing when closed and sterile poultry feed. They also have to keep the cage and yourself, especially after being in the cage should wash their hands.Besides isolating sick animals. Suddenly Chairman of Farmers Group Navan Rural, Purnomo, said due to the virus breeder ducks belong to the group are dead. Ducks died suddenly, whereas before seen sense. On average, every day there's 30 ducks died suddenly. He was surprised by the incident. Various treatment efforts have been made, but to no avail. "And once there are 1,500 individuals. Harm already hundreds of millions, "said Purnomo. 

Indonesia: Central Java Increased suspect case of H5N1

21 December 2012

SURABAYA-virus bird flu or Avian Influenza (IA) that attacked ducks in East Java (East Java) continues to expand.least 26,000 ducks existing six AI.Padahal infected area a few days ago the number of newly infected ducks around 8,200 birds. Six regions are indicated AI attack Tulungagung, Blitar, Probolinggo, Kediri, Jombang and Lamongan.To avoid the spread of AI virus to other areas, East Java Livestock Office closes traffic ducks out of the region for the oversight. Head of Animal Health Animal Husbandry Department Emylia East Java, said: "We prohibit the sale and purchase of poultry in a state hospital, including closing traffic poultry in the infected AI virus. This also menghindarivirus AImenyerang steps to humans, "he said. Chairman of the quick reaction team of bird flu in East Java Provincial Livestock Office, said the virus that attacks Iswahyudi ducks are H5N1.Namun type of this disease have differences with a virus that attacks chickens. "From the research we do, the type of virus that attacks the ducks clade 2.3. while attacking type chickens 2.1, "he said. Outside the region, the poultry farmers in Bojonegoro start worrying impact of bird flu. Moreover, this area is a transit birds from Central Java. "Currently, most poultry farmers choose to stop first breed free-range chicken," said Fuad Ardianto, 30 poultry farmers in the village of Banjarsari, KecamatanTrucuk, Bojonegoro. Governor of East Java, Soekarwo suspect in the death of thousands of duck duck transmitted Java imports from China and Australia. To overcome this, East Java provincial government has deployed 270 officers rapid reaction unit (URC) bird flu. "It's not a category Extraordinary Events (KLB)," said Governor Soekarwo on the sidelines of Memorial Day archipelago in Psychology. Patient Suspect AI Increase the meantime, the patient suspect bird flu in Central Java, increased by one person. After a man from Semarang, suspect AI, yesterday a breeder in Dodogan Hamlet, Navan Rural, District Patebon, Kendal initials Pn suspect bird flu by keeping thousands of ducks are dead.  Pn experiencing cough, runny nose, and fever big tinggi. Most of the ducks are dead ducks belong to farmers who have large amounts of ducks in great numbers. "within 1-2 days if not healed, it will be referred to a hospital isolation room Dr H Soewondo," said Kendal Istiqomah Tri health office staff.   lutfi yuhandi / andi setiawan / hendrati hapsari / muhammad roqib / solichan arief

Journal Atani Tokoyo: The identification of AI virus in ducks in Indonesia ckade 2.3.2

20 December 2012


The Eurasian lineage of H5N1 viruses continue to cause the highly pathogenic avian influenza (HPAI) in poultry in some countries in Asia and Africa. In Indonesia, H5N1 clade 2.1 viruses have been known to cause outbreaks of HPAI H5N1 in all roomates clade 2.1.3 viruses have predominantly Circulated in poultry in this country since 2005. Most H5N1 HPAI outbreak Occurs in chickens, whereas outbreaks in other avian species is rare Including ducks. However, between September and November 2012, several disease outbreaks were reported from duck farms in three provinces in Java (Central Java, Yogyakarta and East Java) with high morbidity and mortality seen in ducks. The majority of disease cases found in young ducks, but in some occasions, adult ducks were also affected. Neurological signs, whitish eye and death were the main clinical signs in young ducks, while reduced in egg production were frequently observed in affected laying ducks. Showed histopathology acute necrotic to chronic non-suppurative encephalitis and perivascular cuffing in dead or severe infected ducks. Immunohistochemistry result Showed H5N1 viral antigen detected mainly in brain. H5N1 virus was successfully isolated either from tissues, oropharyngeal and cloacal swabs or from feather samples. Avian influenza subtype H5 viral RNA was detected by real-time reverse transcription PCR. Phylogenetic analysis of hemagglutinin sequences of seven H5N1 virus isolates indicated that these isolates belong to clade 2.3.2, a sublineage that H5N1 has not been detected previously in Indonesia. Further analysis should be done to investigate Whether the Emergence of this virus in Indonesia is due to new H5N1 viral introduction or to mutation processes occurring in poultry. In addition, another study is Necessary to assess the pathogenecity of the virus in ducks and other poultry, Including chickens.


Disease highly pathogenic avian influenza (HPAI) caused by H5N1 subtype avian influenza virus was identified in poultry since 2003 (Dharmayanti et al ., 2004; Wiyono et al ., 2004). According to the classification of WHO / OIE / FAO, all H5N1 viruses isolated from poultry and humans in Indonesia, including the clade 2.1. The predominant H5N1 virus been found since 2005 to date comes from clade 2.1.3 (,, and Several studies have shown that infection with H5N1 virus-clade 2.1 in group chickens ( gallinaceous ) as layer chickens, broiler chicken, chicken is highly pathogenic, causing illness and death perakut high amounts, while ducks and other water fowl are relatively more resistant to infection these viruses ( Bingham et al. , 2009 ; Swayne, 2007 ; Wibawa et al. , 2012 ). The study results are consistent with the results of the investigation BBVet / BPPV and some sur-vei epidemiology and molecular epidemiology suggests that the rate of prevalence of H5N1 clade 2.1 in ducks and other water fowl in Indonesia is very low compared to the prevalence of the virus in chickens ( Henning et al. , 2010 ; Wibawa et al. , 2011 ; Loth et al. , 2011 ). In September-November 2012 reported the case of a fairly high mortality in ducks in Central Java, Yogyakarta and East Java DI. Center for Veterinary Wates (Wates BBVet) did invesitigasi in the field and conduct sampling in order to identify the causative agent of the death of the ducks. This paper aims to identify the causative agent of infectious diseases that are pathogenic to ducks. 


1. Disease Investigation Case

The investigation conducted by the activities of active disease in which the team BBVet Wates to respond actively, based on reports from farmers and agencies, to conduct on-site investigation of the case. In addition to servicing also active with passive submission service that evaluates agencies and individual samples (farmers), as well as the activities of semi-active / passive where samples were taken at Wates BBVet team doing vigorous activities on activity monitoring service or other animal disease surveillance. Investigation of cases of the disease in Central Java, Yogyakarta and East Java, conducted from September-November 2012 to follow up some duck deaths reported in several districts in the three provinces. Chronology of disease cases described in Table 1.
Description:     Mortality is calculated based on the number of deaths in the total population of ducks on a  farm, tc: there is no record as informal reports by farmers, td: not done.
Some information from the breeder also said that duck plague occurred in several districts in Central Java such Boyolali, Starch and Apex. Based on the results of investigations in the field and report deaths of ducks introductory sample data showed that the average mortality was 39.3% ducks with the lowest percentage of 8.3% and highest mortality reached 100.0%. 

2. Laboratory Testing

Laboratory testing conducted in BBVet Wates to know the main agent causing disease deaths in ducks. Some testing is done partly by surgical test carcasses, Rapid Test AI, histopathology, immunohistochemistry, virus isolation, conventionalpolymerase chain reaction (PCR) for the detection of ND virus, real-time reverse transcription PCR (RT-PCR) for the detection of influenza A virus ti-pe and subtype H5 viruses, bacterial culture and serologic testing (titer AI and ND).

 In addition to laboratory testing BBVet Wates, also tests DNA sequencing to determine the sequence of nucleotides (nucleic acids) that make up the gene hemagglutinin (HA) of influenza A virus from samples positive by the results of virus isolation and RT-PCR H5N1 subtype H5. From some of the positive samples, a total of 3-7 samples were sent to asequencing lab partner , the Center Veterinaria Farma (3 samples of duck), Central Veterinary Research Bogor (3 samples), Center for Veterinary Drug Testing and Certification Bogor (7 samples) and Hall Regional Veterinary Investigation II Bukittinggi (7 samples). Samples ducks 1-3, sent to all the sequencing lab partner, while No.. 4-7 sent to BBPMSOH and BPPV II Bukittinggi. Detailed penaamaan H5N1 virus isolates from ducks as below:
No. 1: A/duck/Sukoharjo/BBVW-1428-9/2012 
No. 2: A/duck/Bantul/BBVW-1443-9/2012 
No. 3: A/duck/Sleman/BBVW-1463-10/2012 
No. 4: A/duck/Wonogiri/BBVW-1730-11/2012 
No. 5: A/duck/Blitar/BBVW-1731-11/2012 
No. 6: A/duck/Tegal/BBVW-1727-11/2012 
No. 7: A / Muscovy duck/Tegal/BBVW-1732-11/2012

DNA sequencing was performed by the standard operation procedure (SOP) of the Australian Animal Health Laboratory(AAHL), Geelong Australia, using four pairs of specific primers were designed by the AAHL ( AAHL, 2008 ). Primers are designed to mensekuen whole HA gene fragment that da-pat obtained full open reading frame (ORF) of this gene ( AAHL, 2008 ).

3. Sequence analysis and phylogenetic

 DNASTAR Lasergene 8.0 software used for the assembly and editing HA gene sequences. Multiple alignment performed using the Clustal W in Bioedit software ( Hall, 1999 ). Construction of phylogenetic done in MEGA 4 software ( Tamura et al., 2007 ) with the method of Neighbour Joining (NJ) tree using 1000 bootstrap replication and Tamura-Nei93 (TN93) for models of nucleotide substitution. Analysis of nucleotides pair distances carried by p -distance replication Bootstrapping with 1000 models.


The results of laboratory testing

To find out the possible cause of duck plague inspection and testing has been carried out in the laboratory either by rapid test (Rapid Test) for AI, clinical examination, pathological anatomical, histopathological, immunohistochemical and serologic testing, bacteriology, virology and molecular biology with realtime RT- PCR using the primers and probes that identify specific AI subtypes H5. Test results virology and molecular biology in particular are presented in Table 2. 
On clinical examination of the diseased ducks, ducks seen that show clinical symptoms of nerve pain such as torticollis (Figure 1), tremors, difficulty standing, loss of balance when walking and in severe cases with death. Surgical outcomes carcasses not found specific changes except for a whitish cornea either unilateral or bilateral (Fig. 2), whitish streaks on the heart muscle that varies from mild to severe, and the congestion of the blood vessels and malasea (necrosis) of the brain with variations from mild to severe.
Histopathological examination showed infiltration of lymphocytes in high amounts in heart muscle. In multifocal acute brain inflammation and necrosis in the more chronic cases lymphocytes infiltrate the brain (Figure 3), followed by the inflammation of mild to severe perivascular cuffing. In immunohistochemical staining method using the antibody of H5N1 AI virus antigen is found in the cells of brain neurons (Fig. 4). 

Changes histopathologic and immunohistochemical results are similar to observations at the microscopic changes in experimental ducks were infected by H5N1 virus isolates from clade 1 or 2.1 ( Bingham et al. , 2009 ; Wibawa et al. , 2012 ).But the H5N1 viruses isolated from ducks cases recently seen having lesion severity higher than infections caused viruses from clade 2.1. Therefore, further research needs to be done to determine the extent pathogenesitas new isolates of different poultry species, especially chickens and ducks.

On examination of the bacterial culture of the eye, eye fluid, brain, heart and the hearts of all the results were negative fungal and bacterial pathogens. This suggests that the probability of death in ducks problem is not caused by bacteria and fungi infections. In serological tests, serum samples from 28 ducks found 8 samples tested (28.6%) AI H5 antibody positive and 12 samples (42.9%) positive antibody ND. With the antibody titers in both AI and ND duck serum, suggesting the possibility that ducks had been vaccinated or had the disease or ND AI field. From the test data found 1 virus isolation positive cases ND (samples from LDCC), AI 10 positive, 1 negative isolation and the remaining 5 cases are still in the process of virus isolation (Table 2). For ND virus isolates, the test was performed by injecting the corresponding virus isolates in ducks as intravenous way, however, after 3 weeks of ducks did not die and arise ND antibody with a high titer (HI titer 2 5 ). This result indicates that the ND virus isolates were found not to cause the death of duck plague. On examination by PCR, from 17 cases of ducks, 11 cases tested PCR and obtained the following data: 9 H5 viral RNA positive samples, 9 ND viral RNA negative, a negative sample either H5 or ND, and the rest are still in the process of testing (Table 2). This reinforces the results of molecular testing of suspected causes of death occurring outbreaks in ducks is AI virus subtypes H5.

Sequence and Phylogenetic Analysis of the hemagglutinin gene

The results showed that the DNA sequence of the ORF of the HA gene of the virus was 1707 base pairs ( base pairs ) and it encodes 569 amino acids of the HA protein. The seven isolates had high genetic similarity, which is 99% both at the level of genetic similarity nucleotides or amino acids. The results of the analysis of Basic Local Alignment Search Tools (BLAST) in Genbank and genetic distance using Mega 4 software ( Tamura et al. , 2007 ) showed that the seven isolates of H5N1 duck has a rate of 97-98% homology with H5N1 clade viruses Instead, based on, the level of homology with viruses from clade 2.1 low at around 91-93%. These results indicate that the H5N1 isolates from ducks is not derived from the Indonesian clade 2.1.

Sequence analysis showed that the HA protein isolates seven ducks have basic amino acid sequence motifs that recur tread area cuts protease enzyme ( proteolitic cleavage site ) were identical to viruses from clade, namely PQRERRRKR ( Li et al. , 2011 ) ( Figure 5). This indicates that the viruses isolated from ducks has Characteristic HPAI virus ( Perdue et al. , 1997 ; Senne et al. , 1996 ).

To view the classification of H5N1 isolates isolated from ducks, performed phylogenetic analyzes using the Neighbor-Joining (NJ) Tree with nekleotida TN93 substitution models using 1000 bootstrap replications. The results of the phylogenetic tree showed that the duck isolates included in clade 2.3.2 and is a branch of the phylogenetic clade (Figure 6). Next, to see whether this virus is still in one strain ( lineage ) with clade, the test was done to determine the genetic diversity within the average nucleotide pair duck isolates with viruses from clade WHO / OIE / FAO H5N1 Evolution Working Group ( WHO, 2008 ; WHO, 2012 ) has made ​​provision H5N1 clade classification as follows: 1) Classified a new clade if it has an average percentage range (diversity) nucleotide pair between species ( average pairwise distance ) of more than 1.5% of the clade that has been there and most previous definitions, 2) the results of phylogenetic analysis and the diversity of the HA sequence   shows sharing common ancestral node with bootstrap values> 60% of the nodes indicate phylogenetic clade (after 1000 neighbor-joining bootstrap replicates ).
Figure 6 . phylogenetic tree of H5N1 isolates isolated from ducks (3 isolates using that for analysis). Analysis using the NJ tree, with a nucleotide substitution model of Tamura-Nei (TN93) with 1000 boostrap replication. Phylogenetic tree dirootkan on A / goose / Guangdong/1/96 (H5N1). H5N1 isolates from ducks case is colored red.

Phylogenetic analysis and genetic diversity by using MEGA 4.0 software showed that the average distance between neighbor nucleotides pair of duck isolates was 0.3%, which means that the seven isolates of H5N1 from ducks case is still in the group, but the average distance of nucleotides pair with the group or other clusters within clade (group 1, group 2 and group 3) is more than 1.5% (2.3-4.6%) (Figure 6). Although the average distance between isolates nukletida pair of ducks is more than 1.5% of the other group in the clade, all virus isolates still share a common ancestral node of clade 2.3.2. These results indicate that there is a possibility isolates or ducks are derived from a group or cluster of new phylogenetic clade 2.3.2 (Fig. 6). To date it is known that only viruses derived clade of of 2.1 which attacks poultry and humans in Indonesia. With the invention of a new clade of H5N1 in Indonesia, particularly in the area of Yogyakarta, Central Java and East Java, suggesting the possibility of introduction of a new virus into Indonesia. But the initial introduction, the animal species involved, and the factors that cause the emergence of this virus which causes death in ducks in all three parts of Java is not yet known. To find it necessary to hold a retrospective study of both epidemiology and molecular epidemiology. More important is the need to be increased attention ( awareness ) and monitoring the possibility of expansion of the virus to other parts of Indonesia through the traffic of poultry or their products. To prevent the spread of cases, necessary control measures such depopuasi or culling of infected poultry ducks and restrictions and strict traffic control ducks and their products into and out of the three areas mentioned above.
  1. Based on the laboratory test results concluded that the suspected cause of duck plague that is currently happening in the province of Central Java, and East Java are DIYogyakarta AI subtype H5N1 disease.
  2. Seven isolates of H5N1 viruses have been sequenced allegedly not come from the lineage of clade 2.1 H5N1 virus has been endemic in poultry in Indonesia.
  3. Isolates of H5N1 viruses isolated from ducks have a higher degree of kinship to the viruses of clade (97-98% nucleic acid similarity) than kinship against viruses from clade 2.1 (91-93%).
  4. Based on phylogenetic analysis, isolates of H5N1 viruses isolated from ducks are included in clade 2.3.2.
  5. Based on the analysis of the genetic diversity of the nucleotide sequence of the HA gene, did not rule out if this virus isolates belong to a group ( sublineage ) new but still included in the clade 2.3.2. This should prove a more accurate analysis and involve more comprehensive virus isolates.
  6. The factors that led to the emergence of clade 2.3.2 into Indonesia needs to be further investigated, whether this is due to the introduction of a new virus into Indonesia.
  7. Need improved monitoring of poultry (chickens and waterfowl) on circulating viruses and the like clade 2.3.2 HPAI endemicity resulting.

The author would like to thank the Director of Animal Health, Head BBVet Wates, Chief Regional BPPV II Bukittingi, BBalitvet Chief, Head and Chief BBPMSOH Pusvetma for their input and support given in the writing of this article. Our thanks also go to the Australian Animal Health Laboratory (AAHL), Geelong, Australia and the FAO-OIE OFFLU Project, which has helped increase the capacity of the testing and development of AI and sequensing DNA diagnosis in laboratories in the technical services unit under the Directorate General of Livestock and Animal Health, Indonesia. We also would like to thank all parties, particularly the Department of Agriculture / Animal Husbandry and Animal Health at the district and also breeders who have helped in the investigation of disease.


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