EINet Alert ~ Aug 01, 2008

2008
Bangladesh / 1 (0)
China / 3 (3)
Egypt / 7 (3)
Indonesia / 18 (15)
Viet Nam / 5 (5)
Total / 34 (26)

***For data on human cases of avian influenza prior to 2008, go to: http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 385 (243).
(WHO 6.19.08 http://www.who.int/csr/disease/avian_influenza/en/index.html )

Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
(WHO/WPRO 6.19.08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 6.19.08): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 7.14.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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The decision, which affects less than two percent of the birds sold by the company, is one of a number of initiatives taken in response to the H5N1 outbreak that triggered widespread culling and damaged Bernard Matthews' sales and reputation. Mr. Hall, who recently gave a presentation on the subject to the food industry, warned that bird flu in animals could become an annual event in Europe. He called on policymakers to strengthen cross-border exchange of information. He said reduced purchases of imported meat could help cut the risk of infection, but argued there was evidence the virus spread through wild migratory birds. In spite of recent improvements, he said it could take two months before European Union countries identifying a bird flu outbreak provided the information to a central database available to industry. He argued that following infection reports elsewhere in Europe, the Department for Environment, Food and Rural Affairs (DEFRA) should be more willing than it is now to announce "housing orders," which allow poultry breeders to bring birds indoors for several weeks to keep them safe without losing the right to label them free range. Mr. Hall said DEFRA remained reluctant to make such orders unless there were infections in the UK, France or the Netherlands, and was skeptical it would unveil any change in policy ahead of Christmas. He said officials had refused to allow workers culling birds at Bernard Matthews' plant to wear full face masks, encouraging them to switch to less practical goggles in spite of written instructions to the contrary.
(ProMED 7.29.08)

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Many of the 10 states had little organized bureaucracy or infrastructure to tackle a pandemic, which could kill millions if it mutates into a more easily transmissible form, Krisnamurthi said. "Indonesia, Thailand, Vietnam, have experienced human cases. Others have not. That's the main difference between countries," the official, who heads Indonesia's bird flu committee, said after the meeting in Medan. "First we would like an assessment of ASEAN countries on pandemic preparedness. . .if pandemic influenza happened in one of the (ASEAN) countries, the reach and the impact would be on a regional scale," he said. Countries are expected to finish assessing their preparedness by January or February 2009, Krisnamurthi said. Health ministers from the 10 ASEAN states will also meet in the Philippines capital Manila in October 2008 to discuss preparedness and the need to develop a "common language" to deal with the threat, he said.
(AFP 7.23.08)

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South Korea (North Jeolla): Cat becomes country's first mammal to die of H5N1 avian influenza
The first bird flu infection of a mammal in Korea was confirmed on 28 Jul 2008. The Ministry for Food, Agriculture, Forestry and Fisheries announced that the National Veterinary Research and Quarantine Service (NVRQS) confirmed that the cause of death of a cat found dead in marshland along the Mangyeong River in Gimje, North Jeolla Province, in late April 2008 was a highly pathogenic strain of bird flu virus, H5N1.

The College of Veterinary Medicine at Chungnam National University asked the national quarantine service to verify the exact cause of death. The Ministry said unlike poultry, cats do not transfer the highly pathogenic strain to humans. The virus found in the cat was the same strain that killed thousands of poultry in April 2008. Joo Yi-Seok, head of the Department of Animal Disease Control at the NVRQS said, "Because cats do not have a strong enough system to reproduce the bird flu virus in their bodies, there is no risk of cats spreading the virus. There is no known case around the world of humans being infected with the virus by cats."
(ProMED 7.29.08)

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Thailand (Phichit): Four suspected cases of H5N1 avian influenza test negative
The Public Health Ministry said on 30 Jul 2008 that four people in Phichit province who were suspected of having contracted the bird flu virus have tested negative for the disease. Deputy permanent secretary Dr. Paijit Warachit said he ordered the mobile rapid disease investigation unit to collect blood samples from the four for testing against the H5N1 strain of the virus at Nakhon Sawan's provincial Science Centre. The laboratory results found that none of the four had the H5N1 virus, which can be lethal to humans. Three of them are suffering from seasonal influenza, while the fourth has no flu whatsoever.

The four people tested included a six-year-old child, a 10-year-old child, and two women aged 62 and 70. They all remain under observation in Phichit's Sam Ngam Hospital. The six-year-old does not have the flu. The four reported they had come into contact with dead chickens in their village before falling ill. Three days later, they had a high fever, and it was feared they had been infected with the H5N1 strain.

Paijit has asked healthcare volunteers in Sam Ngam district to monitor the symptoms of the relatives of the three patients with seasonal flu for the next 12 days. If any suspicious symptoms are found, they will also be sent to hospital immediately. He also urged villagers to avoid cooking food using chickens or ducks that have died suspiciously. Villagers should incinerate any such poultry in order to minimize the risk of the H5N1 virus spreading to other areas, he said.
(ProMED 7.30.08)

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Dr. Loeb will work with Hutterite communities in western Canada to examine the transmission of flu viruses from person to person and from pigs to humans. Dr. Loeb is an internationally-recognized expert in infectious disease epidemiology, and has studied SARS (as founding director of the Canadian SARS Research Network), West Nile Virus, and antibiotic use and resistance. His team's new research will detect influenza viruses in humans and pigs in Hutterite communities, and use computer modeling to analyze the transmission of the virus. "Hutterite communities are uniquely well-suited to this sort of research, because they are active swine farmers and because they live in isolation from mainstream society," says Loeb. "We hope to use this research grant to learn important lessons about how disease spreads and how to prevent it."

"The SARS outbreak taught us that there are no national boundaries when it comes to infectious diseases," said Dr. Bhagirath Singh, Scientific Director of the CIHR Institute of Infection and Immunity. "Through this partnership, Dr. Loeb and his team will receive the critical support needed to further advance knowledge in the area of pandemic preparedness and influenza outbreaks."
(Medical News Today 7.30.08)

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USA (Washington): Comic book to spread word on influenza to immigrants, youth
Public Health — Seattle & King County has come up with the novel idea of producing a comic book to teach immigrants and youth about pandemic flu. More than 500,000 copies of the 12-page comic "No Ordinary Flu" will soon be distributed across the state and nation. The comic, written in 12 different languages, will be free. In addition to describing the devastating events of 1918, the comic gives tips on how to prepare for a possible future pandemic. That includes storing enough food and medical supplies at home to last at least a week and planning ways to work and stay at home for an extended period, if needed.

The comic took six months to produce and cost $75,000 — which was paid for by the National Association of County & City Health Officials (NACCHO). The state Department of Health is hoping to distribute more than 300,000 copies of the comic at schools statewide. King County officials plan to hand out 78,000 additional copies, while NACCHO has ordered 160,000 copies for national distribution.

The concept and story were created by Meredith Li-Vollmer of Public Health – Seattle & King County and Matthew French, a public health graduate student at the University of Washington and research assistant with APEC EINet. The comic book was drawn by Seattle artist, David Lasky. Li-Vollmer said the idea of the comic is to reach low-literacy folks through an easily accessible medium. She said most experts believe it's not a case of "if" another outbreak strikes — but a matter of "when." "The main message is that it can potentially be catastrophic, and everyone needs to be prepared," Li-Vollmer said.
(Seattle Times 7.24.08)

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Abstract
This study examined consumer risk perceptions and knowledge of avian influenza and its linkage to behavioral changes in chicken consumption. A consumer survey was administered in 3 metropolitan areas in Taiwan in 2007. Multivariate analyses were utilized in this study to analyze data. Findings in this study indicated that respondents who were more knowledgeable of avian influenza with relatively high levels of risk perceptions would be likely to stay away from birds and the crowd. Respondents with relatively low levels of avian influenza knowledge were likely to prefer not eating chicken at all under a possible threat of avian influenza outbreaks. Respondents with low risk perception levels would be more likely to maintain usual chicken consumption than those with high risk perception levels if outbreaks of avian influenza occurred. Contributions of this study are to provide new insights into knowledge and risk perceptions of avian influenza and to reveal behavioral changes in chicken consumption in an area that a pandemic situation like avian influenza has not occurred but under a possible threat. Findings in this study would be beneficial to government administration and industry managers in designing effective information communication for educational purposes to ease possible effect on the industry as well as the consumer market if outbreaks had occurred in Taiwan.
(CIDRAP 7.31.08)

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Environmental Contamination during Influenza A Virus (H5N1) Outbreaks, Cambodia, 2006
Vong S, et al. Emerging Infectious Diseases [serial on the Internet]. 2008 Aug. http://www.cdc.gov/eid/content/14/8/1303.htm

Abstract
To determine potential risk for bird-to-human transmission during influenza A virus (H5N1) outbreaks among backyard poultry in rural Cambodia, we collected environmental specimens. Viral RNA was detected in 27 (35%) of 77 specimens of mud, pond water, water plants, and soil swabs. Our results underscore the need for regular disinfection of poultry areas.
(CIDRAP 7.30.08)

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Highly Pathogenic Avian Influenza Virus (H5N1) in Experimentally Infected Adult Mute Swans
Kalthoff D, et al. Emerging Infectious Diseases. [serial on the Internet]. 2008 Aug. http://www.cdc.gov/eid/content/14/8/1267.htm

Abstract
Adult, healthy mute swans were experimentally infected with highly pathogenic avian influenza virus A/Cygnus cygnus/Germany/R65/2006 subtype H5N1. Immunologically naive birds died, whereas animals with preexisting, naturally acquired avian influenza virus–specific antibodies became infected asymptomatically and shed virus. Adult mute swans are highly susceptible, excrete virus, and can be clinically protected by preexposure immunity.
(CIDRAP 7.30.08)

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Contact structures in the poultry industry in Great Britain: Exploring
transmission routes for a potential avian influenza virus epidemic Dent JE, et al. BMC Veterinary Research. 2008;4(27). http://www.biomedcentral.com/1746-6148/4/27/abstract

Background
The commercial poultry industry in United Kingdom (UK) is worth an estimated GBP3.4 billion at retail value, producing over 174 million birds for consumption per year. An epidemic of any poultry disease with high mortality or which is zoonotic, such as avian influenza virus (AIV), would result in the culling of significant numbers of birds, as seen in the Netherlands in 2003 and Italy in 2000. Such an epidemic would cost the UK government millions of pounds in compensation costs, with further economic losses through reduction of international and UK consumption of British poultry. In order to better inform policy advisers and makers on the potential for a large epidemic in Great Britain (GB), we investigate the role that interactions amongst premises within the British commercial poultry industry could play in promoting an AIV epidemic, given an introduction of the virus in a specific part of poultry industry in GB.

Results
Poultry premises using multiple slaughterhouses lead to a large number of premises being potentially connected, with the resultant potential for large and sometimes widespread epidemics. Catching companies can also potentially link a large proportion of the poultry population. Critical to this is the maximum distance traveled by catching companies between premises and whether or not between-species transmission could occur within individual premises. Premises closely linked by proximity may result in connections being formed between different species and or sectors within the industry.

Conclusion
Even quite well-contained epidemics have the potential for geographically widespread dissemination, potentially resulting in severe logistical problems for epidemic control, and with economic impact on a large part of the country. Premises sending birds to multiple slaughterhouses or housing multiple species may act as a bridge between otherwise separate sectors of the industry, resulting in the potential for large epidemics. Investment into further data collection and analyses on the importance of industry structure as a determinant for spread of AIV would enable us to use the results from this study to contribute to policy on disease control.

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Laboratory Investigation of the First Suspected Human Cases of Infection with Avian Influenza A(H5N1) Virus in Bulgaria
Hadzhiolova T, et al. Eurosurveillance. 2008;13(30):Article 4 http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18938

Abstract
Reports of human cases of infection with avian influenza A(H5N1) virus have received increased public attention because of the potential for the emergence of a pandemic strain. In the end of 2005 and the beginning of 2006, avian influenza A(H5N1) virus caused outbreaks among domestic poultry and was isolated from wild swans in many European countries, including Bulgaria. Between January and March 2006, samples were collected from 26 patients who had been in close contact with ill or dead birds and developed a subsequent respiratory illness. The testing took place at the National Laboratory of Influenza in Sofia. Specific А(H5N1) assays were applied for screening (Sacace RT-PCR and real-time kit). Avian flu А(H5N1) virus was not detected in any of the patients tested. In three patients, human subtype А(H1N1) influenza virus, identifiable by RT-PCR was isolated and further characterized by hemagglutination inhibition test (HIT). The reliability of the molecular assays used in this investigation was demonstrated in an International Quality Control for Human and Avian А(H5N1) Influenza performed later in 2006 by INSTAND (Society for Promotion of Quality Assurance in the Medical Laboratories), Germany.
(CIDRAP 7.30.08)

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Experimental infections of herring gulls (Larus argentatus) with H5N1 highly pathogenic avian influenza viruses by intranasal inoculation of virus and ingestion of virus-infected chicken meat
Brown JD, et al. Avian Pathology. 2008;37(4):393-397 http://www.informaworld.com/smpp/content~content=a794894283~db=all~order=page

Abstract
The present study investigated the susceptibility of herring gulls (Larus argentatus) exposed to two strains of Asian lineage H5N1 highly pathogenic avian influenza (HPAI) virus by evenly separating six gulls into two groups and inoculating them intranasally with 106 median embryo infectious doses of either A/whooper swan/Mongolia/244/05 (H5N1) or A/duck meat/Anyang/AVL-1/01 (H5N1). Two additional gulls were fed 5.0 g meat from a specific pathogen free chicken that died after experimental infection with A/whooper swan/Mongolia/244/05. Morbidity and mortality were observed in the gulls infected with A/whooper swan/Mongolia/244/05 by both routes of exposure. Gulls infected with A/duck meat/Anyang/AVL-1/01 exhibited high morbidity, but no mortality. The concentration and duration of viral shedding were similar between gulls infected with either strain of H5N1 HPAI virus by intranasal inoculation and gulls exposed to A/whooper swan/Mongolia/244/05 through ingestion of virus-infected chicken meat. The susceptibility of herring gulls in this study varied between the two strains of Asian lineage H5N1 HPAI virus. These results also provide preliminary data to support that ingestion of virus-infected raw or uncooked chicken meat is a viable route of exposure to some H5N1 HPAI viruses in herring gulls. Additional studies are necessary to further evaluate the efficiency of this route of exposure to a variety of H5N1 HPAI virus strains in herring gulls and other avian species in order to better understand the potential role of scavenging species in the epidemiology of H5N1 HPAI virus.
CIDRAP 7.28.08)

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Efficacy of disinfectants and hand sanitizers against avian respiratory viruses
Patnayak DP, et al. Avian Diseases. 2008;52(2):199-202. http://avdi.allenpress.com/avdionline/?request=get-toc&issn=0005-2086&volume=52&issue=2

Abstract
Disinfectants play a major role in the control of animal diseases by decontaminating the farm environment. We evaluated the virucidal efficacy of nine commonly used disinfectants on a nonporous surface contaminated experimentally with avian metapneumovirus (aMPV), avian influenza virus, or Newcastle disease virus (NDV). Phenolic compounds and glutaraldehyde were found to be the most effective against all three viruses. Quaternary ammonium compounds were effective against aMPV but not against the other two viruses. In addition, efficacy of commercially available hand sanitizers was evaluated on human fingers contaminated with aMPV and NDV. All three hand sanitizers tested were found to be effective against both viruses within 1 min of application on fingers.
(CIDRAP 7.27.08)

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Who should be first to receive scarce health-related resources in a severe pandemic? How should scarce resources like antivirals, masks, vaccines, and ventilators be rationed? How will you communicate a public health perspective to your community, supporting rationing strategies to further our common good? How will you educate them and enlist their support of a state-wide plan to ration these resources in ways intended to save the most lives, preserve public safety and order, and be fair?

Ethicists in Minnesota have worked with state and local public health agencies and a diverse community panel to develop an ethical framework to guide the Minnesota Department of Health's decisions in the midst of a severe pandemic, for the statewide rationing of a range of critical health-related resources for prevention, treatment and personal protection. In this session, they presented their ethical framework, consisting of principles, goals, and strategies. They engaged participants in the vexing ethical issues associated with deciding which groups should be prioritized to receive these vital resources when everyone is, in varying ways and to varying extents, at risk.

Click below for videos from 5 June 2008
Part one of the event (Pandemic Ethics Panel Presentation
Part two of the event (Exercises and Q&A)
(CIDRAP 7.29.08)

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No Ordinary Flu: Preparedness comic book in multiple languages
http://www.metrokc.gov/health/pandemicflu/comicbook.htm

To promote pandemic flu preparedness, Public Health - Seattle & King County has developed a 12-page comic book on pandemic flu. Targeting readers of all ages, this story tells the tale of a family’s experience of the 1918 influenza pandemic. It also explains the threat of pandemic flu today, illustrates what to expect during a pandemic (such as school closures), and offers tips to help households prepare. You can order copies (or download) all 12 language versions of the comic (PDF format) at the above link.
(CIDRAP 7.23.08)

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PHI2008--Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
http://www.gpphi.org/conferences

Dates: 18-19 September 2008
Location: Seattle, WA, USA
Venue: Bell Harbor International Conference Center

PHI2008 will be hosted by Global Partners in Public Health Informatics (GPPHI) at the Center for Public Health Informatics (CPHI) at the University of Washington, Seattle, WA, USA. The idea of creating a partnership of governmental and non-governmental organizations, academic institutions and companies to define and develop a vision for addressing health challenges in low-resource settings through information and communications technologies was first articulated at PHI2007: Building a Global Partnership in Public Health Informatics. PHI2007 brought together nearly 200 individuals from across the globe who created the impetus for the Global Partners in PHI.

The Rockefeller Foundation recently funded the UW Center for Public Health Informatics to begin the planning process for the Global Partners organization. That process will take place over the coming year through an invitational meeting on Public Health Informatics at the Rockefeller Foundation conference center in Bellagio, Italy as well as at the second annual GPPHI meeting -- PHI2008 -- to be held in September 18-19, 2008 at the Bell Harbor Conference Center, Seattle, Washington, USA. The theme for the PHI2008 meeting is "Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies."

Program:
- Keynote addresses by leading international experts
- Plenary presentations:
- National approaches from countries leading the development of integrated public health information systems
- Creative approaches to collecting and linking data and systems to improve public health practice
- Strategies for compiling and delivering contextually relevant information for decision support
- Poster sessions presenting research and applied methodologies and results from public health informatics interventions in low-resource settings throughout the world
- Panelist discussions of funding opportunities for research and applications development
- Information exchange and networking opportunities

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