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EINet Alert ~ Jun 23, 2006


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Hungary: Excerpts from the OIE report on avian influenza H5N1
- China (Guangdong): Close contacts of 19th human avian influenza case cleared
- China: Report of new avian influenza H5N1 outbreak
- Indonesia: Confirmation of 51st human case of avian influenza H5N1
- Indonesia: H5N1 mutation showed human transmission in family cluster
- Indonesia: Confirmed case of cat infected with avian influenza H5N1
- Canada: Further tests show no avian flu in Canadian flock
- USA: USDA trains foreign scientists on avian influenza testing

1. Updates
- Avian/Pandemic influenza updates

2. Articles
- CDC EID Journal, Volume 12, Number 7—Jul 2006
- Report: China had human H5N1 case in late 2003
- Migratory flyways in Asia, Eurasia and Africa and the spread of HP H5N1
- HPAI spread from western Siberia to eastern Mediterranean and beyond
- Remote sensing, ecological variables and bird migration
- Incursion of H5N1 Asian lineage virus into Europe: source of introduction?
- Mass bird vaccination may hinder H5N1 detection in humans
- Removing Barriers to Global Pandemic Influenza Vaccination


Global
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 11 (7)
Djibouti / 1 (0)
Egypt / 14 (6)
Indonesia / 34 (28)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 84 (54)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 228 (130).
(WHO 6/20/06 http://www.who.int/csr/disease/avianinfluenza/en/ )

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Europe/Near East
Hungary: Excerpts from the OIE report on avian influenza H5N1
Information received 9 Jun 2006 from Dr Miklos Suth, Chief Veterinary Officer, Ministry of Agriculture and Rural Development: Identification of agent: highly pathogenic avian influenza virus subtype H5. Date of start of event: 4 Jun 2006. Details of outbreak: The outbreak was on a farm in Bacs-Kiskun with 3107 birds, 1600 which were affected and 807 who died. Description of affected population: geese. Results from the Central Veterinary Institute in Budapest: virus isolation, RT-PCR, haemagglutination inhibition were all positive for H5. Source of outbreak or origin of infection: unknown or inconclusive. Pre-emptive culling of the remaining birds in the flock took place 7 Jun 2006, before the results of the test were known, and was followed by the cleaning and disinfection of the holding.

H5 virus was initially confirmed in Hungary in mute swans 15 Feb 2006, apparently in the vicinity of the current outbreak. Hungarian Agriculture Minister Jozsef Graf said the government had allocated 11 million euros to compensate farmers affected by the outbreak. Graf also said Hungary had asked the European Union for 32 million euros in compensation for losses due to avian flu. Elsewhere, the laboratory examinations performed at the Danish Institute for Food and Veterinary Research has proven that the LPAI virus found in a holding in Denmark (2 Jun 2006) is of the subtype H5N2.
(Promed 6/23/06, CIDRAP 6/19/06 http://www.cidrap.umn.edu/ )

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Asia
China (Guangdong): Close contacts of 19th human avian influenza case cleared
All 98 people who had close contact with a confirmed human case of avian influenza in South China have tested clear of the disease, the local health bureau stated 15 Jun 2006. The contacts included relatives of the 31-year-old male patient, medical workers in a local clinic and in Shenzhen People's Hospital, where the man had been treated, and the patients in the same ward. Tests on the 98 contacts all proved negative for the H5N1 strain of the bird flu virus, but doctors will continue observations of them. The man was still in critical condition and being treated in Donghu Hospital. A test sample from him had been sent to Beijing for verification by the Ministry of Health. He was admitted to the Shenzhen People's Hospital 9 Jun 2006. The patient was transferred to Donghu Hospital 13 Jun 2006 for advanced treatment. The male patient, a truck driver, had no contacts with birds before becoming ill. However, his wife bought a freshly slaughtered chicken from a local market 2 weeks ago and cooked it for dinner for 5 family members, including the man. None of the man's family showed similar symptoms.

Authorities in Hong Kong stepped up customs checks at the weekend to stamp out poultry smuggling, after the truck driver was found infected by the H5N1 bird flu virus across the border in mainland China. More officers were deployed at Hong Kong's 4 land border checkpoints, and the territory beefed up examination of suspicious cargoes and baggage at sea and air boundaries. "We confiscated 3 fresh chickens and 3 fresh ducks by Saturday [17 Jun 2006] night at Lowu," a government spokeswoman said. Lowu is 1 of the heaviest land border crossings in the world, handling up to 17 000 people an hour during peak periods. Hong Kong suspended imports of live poultry from mainland China 16 Jun 2006 after the truck driver was confirmed to be infected with the H5N1 virus.
(Promed 6/19/06)

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China: Report of new avian influenza H5N1 outbreak
China has announced a new bird flu outbreak at poultry farms in its northern province of Shanxi. Samples taken after the chickens died in Changzi county tested positive for the H5N1 strain, agriculture ministry reportedly said 19 Jun 2006. The local government has quarantined the area, and experts have started disinfection and culling. A campaign to teach residents how to protect themselves against the virus has been launched. China has recorded 35 outbreaks of bird flu since Oct 2005. The last was in the remote Xinjiang Autonomous Region early Jun 2006. A human case of bird flu was confirmed on 15 Jun 2006 in south China's Guangdong Province, bringing the country's total human infections to 19. China's chief veterinary officer Jia Youling warned that the virus was on the rise among migratory birds in 2006. A total of 1168 migratory birds had been found dead in Qinghai and Tibet by 1 Jun 2006. The disease was striking more species of birds than in 2005, Jia said, noting the Ministry of Agriculture would target migration paths for future supervision, especially in areas with a record of infection.
(Promed 6/19/06)

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Indonesia: Confirmation of 51st human case of avian influenza H5N1
A 13-year-old boy from south Jakarta who died Jun 14 represented Indonesia's 51st avian influenza case and was the 39th Indonesian to succumb. His death leaves Indonesia only 3 fatalities behind Vietnam, which has reported the most H5N1 deaths in the world but hasn't had a human case since late last year. The boy experienced symptoms Jun 9, 2006 and was hospitalized Jun 13. His symptoms began 1 week after he helped his grandfather slaughter chickens. The grandfather has shown no signs of flu, and WHO is tracing and monitoring contacts to ensure that no further cases arise.

Elsewhere, Malaysia declared itself free of the disease after 3 months with no outbreaks, but said it would remain vigilant. Malaysia had a rash of outbreaks starting Feb 2006 in chickens in villages near Kuala Lumpur. Since then, 5 other outbreaks have occurred in poultry in the northern states of Perak and Penang. Agriculture Minister Muhyiddin Yassin said the country must remain on alert because avian flu is still spreading in neighboring Indonesia. In new safety measures, he said slaughtering of chickens at "wet markets" must stop, and state governments have been asked to require farmers to breed birds in cages to keep them away from wild birds.
(CIDRAP 6/20/06, 6/22/06 http://www.cidrap.umn.edu/ )

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Indonesia: H5N1 mutation showed human transmission in family cluster
The family cluster of H5N1 avian influenza cases in North Sumatra in May 2006 marks the first time laboratory tests confirmed human-to-human transmission, WHO said. WHO officials said the virus mutated slightly when it infected a 10-year-old boy, and he passed the altered virus on to his father. The first 5 family members to fall ill had identical strains of H5N1, one that is common in animals in Indonesia. But the virus mutated slightly in the sixth victim, the 10-year-old boy, and he apparently passed the mutated virus to his father. The presence of that mutation allowed the lab to confirm the route of transmission. The cluster involved 7 confirmed cases, 6 of them fatal. It is believed to have started with a 37-year-old woman who died and was buried without being tested. Officials believe she caught the virus from poultry and passed it on to other family members.

The mutation did not make the virus more transmissible, and the boy's father, who died of the illness, did not pass it on to anyone else, WHO said. Human-to-human transmission has been suspected in previous family case clusters but has never been confirmed by lab tests. Previously, either there were no samples available to test, or the virus in the patients was the same as in local poultry. One of the mysteries about the case cluster is why only blood relatives, not spouses, became infected. WHO speculates that the family members had "a common genetic predisposition to infection with H5N1 virus with severe and fatal outcomes," but there is no evidence for that.

Reportedly, the first 5 family members who got sick had identical strains of H5N1, one that is common in animals in Indonesia. But the virus mutated slightly in the 10-year-old boy. WHO spokesman Dick Thompson described the virus as "slightly mutated, but in a way that viruses commonly mutate.” But that didn't make it more transmissible or cause more severe disease, he said. Health officials have described the case cluster as the first instance of a probable 3-person chain of transmission (two generations of transmission). Genetic analyses of viruses from the family cluster showed no evidence of reassortment, or combination of avian and human flu viruses. More than 3 weeks (twice the maximum H5N1 incubation period) have passed since the last infected family member died, and no new cases have been reported. WHO has been following 54 neighbors and family members who lived near the family for a month, and none has contracted the virus. The agency had conducted house-to-house monitoring throughout the family's village and in healthcare facilities where the patients were treated.

WHO discussed some of its findings concerning the cluster at a 3-day meeting in Jakarta, with experts from the UN FAO, the US CDC, the Indonesian ministries of health and agriculture, and other organizations. The consultation was held at the request of Indonesia and reviewed Indonesia's efforts to contain avian flu, provide an authoritative risk assessment for both animals and people, and give advice to improve the situation. Indonesia is reporting new H5N1 cases faster than any other country. Indonesia has been criticized for not doing enough to stem the tide of avian flu. H5N1 has been found in birds in the vast majority of the nation, but few mass culls have been carried out as recommended by experts. The public is still lacking basic knowledge of the risks to their poultry and themselves and therefore their understanding of control methods in poultry and how to protect themselves is minimal. Jeff Mariner, a Tufts University researcher, said avian flu is more pervasive in Indonesia's poultry than previously thought. Mariner is coordinating a UN FAO effort to train local avian flu surveillance teams. In 12 pilot districts on Java Island, the teams detected 78 poultry outbreaks Jan - May, with about 1 out of every 10 interviews revealing an outbreak. Because of a lack of personnel, the surveillance covered only about a third of each district, he said.

The focus should now be on implementing Indonesia's national strategy to contain bird flu. The Indonesian government has been saddled with a series of natural disasters, including the 2004 tsunami and an earthquake in May 2006. Indonesia needs $50 million from donors in the next 3 years to establish a system to help fight bird flu in poultry, according to Peter Roeder of FAO. Indonesia has said it needs $900 million over the next 3 years for its overall battle against the H5N1 virus but has only budgeted $59 million.
(Promed 6/23/06, 6/23/06; CIDRAP 6/20/06, 6/22/06, 6/23/06 http://www.cidrap.umn.edu/ )

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Indonesia: Confirmed case of cat infected with avian influenza H5N1
A case of cat infection by the H5N1 strain of bird flu has been detected in Indonesia, a WHO officer in Jakarta said. "We have evidence of 1 cat in Indonesia that has already been infected by this virus," said Steven Bjorge. Bjorge said he thinks the cat "was infected probably by eating contaminated birds. This is a very rare disease. It's extremely difficult for this virus to be passed on to humans," he said, downplaying concerns about cross-species transmission of the virus. There are no recorded cases of cat-to-human H5N1 infection. Trisatya Naipospos, the government's top adviser on H5N1 strategy, told the panel there have been unpublished studies of other cats in Indonesia being tested positive for the H5N1 strain of bird flu. And there have been a number of cases of feline infection by the dangerous H5N1 strain of avian flu outside of Indonesia, all of which appear to have been associated with outbreaks in domestic or wild birds and acquired through ingestion of raw meat from an infected bird. In Dec 2003, 2 tigers and 2 leopards that were fed with fresh chicken carcasses died of H5N1 infection at a zoo in Thailand. In Oct 2004, 147 of 441 captive tigers in another zoo in Thailand died or were euthanized as a result of infection after being fed fresh chicken carcasses. Civet cats have died of bird flu in Vietnam, while earlier in 2006 a domestic cat in Germany became the first case of a European Union mammal dying of bird flu.
(Promed 6/20/06)

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Americas
Canada: Further tests show no avian flu in Canadian flock
Further tests have revealed no sign of H5N1 or any other avian influenza virus in samples from a Prince Edward Island poultry flock where an H5 virus was detected last week, the Canadian Food Inspection Agency (CFIA) announced. "All birds tested negative on serological and virological tests," CFIA said. CFIA announced Jun 16, 2006 that a gosling, 1 of 4 dead birds in a backyard flock of about 40, had tested positive for an H5 virus at a laboratory. The finding prompted authorities to destroy the rest of the flock and raised concern about the threat of the H5N1 virus. "The fact that the H5 virus was not detected in testing at the Winnipeg lab, along with the absence of clinical signs of disease in the birds depopulated in the flock, indicates that only a very small amount of low pathogenicity virus may have been present in the index bird," CFIA said. The agency added that "incidental contamination" in the index bird would not be surprising because the bird spent time outdoors and other birds on the farm were known to have mingled with migratory birds. The lab will try to grow virus from samples from the index bird. Dr. Jim Clark, manager of the CFIA's avian influenza working group, suggested that the virus or the nucleic acid in the sample might have deteriorated during shipment to the Winnipeg lab to the point where it was no longer detectable. CFIA said a quarantine on the affected farm would be maintained until tests are completed. Birds from an adjoining farm were tested as a precaution, and all the results were negative, CFIA said.

Clark said any virus at the affected farm is unlikely to be a threat. "Whatever virus is there, we're reasonably certain it is so low in pathogenicity there's difficulty maintaining it and reproducing it," he said. H5 and H7 viruses in poultry can be either mild or deadly. Because mild strains can evolve into lethal ones, outbreaks of low-pathogenic strains often lead to culling of poultry. In Nov 2005, about 58,000 poultry were destroyed near Chilliwack, British Columbia, to stop an outbreak of a low-pathogenic H5 virus.
(CIDRAP 6/21/06 http://www.cidrap.umn.edu/ )

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USA: USDA trains foreign scientists on avian influenza testing
U.S. Department of Agriculture’s Animal and Plant Health Inspection Service Administrator Ron DeHaven today announced the training of 24 scientists from 19 countries on diagnostic testing for highly pathogenic Avian Influenza (HPAI). The workshop is scheduled for June 19-23 at USDA's National Veterinary Services Laboratories (NVSL) in Ames, Iowa. It is the third in a series of train-the-trainers workshops on HPAI testing and diagnostics. "The goal is to assist senior-level veterinarians and poultry disease experts from countries that either have discovered HPAI, or are at high risk for the disease. When they return to their countries, they are better equipped to train their colleagues in lab procedures and protocols," said DeHaven. The 24 participants come from countries that have requested USDA technical assistance in HPAI testing and diagnostics. Countries participating include Argentina, Brazil, Burkina Faso, Burma, Cote d'Ivoire, Democratic Republic of Congo, Dominican Republic, Indonesia, Lebanon, Libya, Mexico, Mozambique, Oman, Pakistan, Romania, Sudan, Taiwan, Uganda, and Uruguay. Similar to the previous workshops, training will include hands-on lab exercises and lectures from USDA experts. The workshops are a joint effort of Iowa State University and USDA's Agricultural Research Service, Animal and Plant Health Inspection Service and the Foreign Agricultural Service.
(6/20/06 http://www.pandemicflu.gov/ )

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1. Updates
Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html. Includes the updated document, “WHO pandemic influenza draft protocol for rapid response and containment.”
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Read the FAOAIDEnews, a situation update on avian influenza outbreaks throughout the world (as of 19 Jun 2006).
- OIE: http://www.oie.int/eng/en_index.htm. Read about the upcoming Asian European Conference on Avian Influenza 2006 (29-30 June 2006).
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and scholarly articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- American Veterinary Medical Association: http://www.avma.org/public_health/influenza/default.asp.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Very frequent news updates.
(WHO; FAO, OIE; CDC; CIDRAP; PAHO; AVMA; USGS)

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2. Articles
CDC EID Journal, Volume 12, Number 7—Jul 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 7—Jul 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Several influenza-related articles are available: 1) Influenzalike Illness Among Homeless Persons, S.J. Bucher et al. 2) H5N1 Influenza Virus, Domestic Birds, Western Siberia, Russia, A.M. Shestopalov et al. 3) Avian Influenza Risk Communication, Thailand, M.T. Takeuchi 4) Critical Issues in Responding to Pandemic Influenza, J.W. Buehler et al.

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Report: China had human H5N1 case in late 2003
A 24-year-old Beijing man died of H5N1 avian influenza Nov 2003, nearly 2 years before China reported any human H5N1 cases to WHO, according to Chinese scientists writing in New England Journal of Medicine. The letter has renewed speculation about how many H5N1 cases might have been missed or not reported in China, especially before late 2005. And in an unusual twist, the New England Journal said the authors asked that the letter be withdrawn, but the issue had already been published. The authors did not explain why they wanted to withdraw the letter.

In the letter, the scientist wrote, "Because the clinical manifestations were consistent with those of the severe acute respiratory syndrome (SARS) and occurred when sporadic cases of SARS were described in southern China," samples from the patient were tested for the SARS coronavirus. All the tests were negative. The authors cultured a virus from a sample of the patient's lung and identified it as an H5 avian flu virus. "The genomic sequence of the virus (A/Beijing/01/2003) was determined, and its 8 segments were genetically related most closely to corresponding sequences of influenza A (H5N1) viruses that had been isolated from chickens in various regions in China in 2004," the letter states. The segments were most closely related to corresponding segments of H5N1 viruses from Guangdong province, Jilin province, Hubei province, and Japan. "These findings," the scientists write, "suggest that influenza A/Beijing/01/2003 may be a mixed virus. . .The genetic distance between the isolate reported and the strain currently proposed for vaccine development (A/Vietnam/1203/2004) implies that viruses from different regions may need to be considered in the development of an effective vaccine against influenza A virus," they conclude. A similar conclusion was reached by the authors of a massive phylogenetic analysis of H5N1 strains from Hong Kong and mainland China, reported earlier this year.

During the early stages of pubic reports on the outbreak of respiratory syndrome in Guangdong (later on being named SARS), there were 2 cases of H5N1 (in a father and son) diagnosed in Hong Kong in Feb 2003 with history of travel to Fujian province. There was also a presumed third case (a daughter from the same family) that became ill and died in Fujian province, with no further diagnostic testing done. The mother of this family also had a severe respiratory illness but the final diagnosis on her was "thought to have been a parainfluenza infection".

Zhu Q-Y, Qin E-D, Wang W, et al. Fatal infection with influenza A (H5N1) virus in China (letter). N Engl J Med 2006 Jun 22;354(25):2731-2.
(CIDRAP 6/22/06 http://www.cidrap.umn.edu/ ; Promed 6/22/06)

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Migratory flyways in Asia, Eurasia and Africa and the spread of HP H5N1
W. Hagemeijer & T. Mundkur.
Abstract: “Many species of waterbirds connect the land masses of the northern and southern hemispheres through their annual migrations. . .Wetlands International, in partnership with EURING, undertook a preliminary assessment of ornithological data relevant to the spread of avian influenza for the European Union, including a process of ranking of species based on a number of ecological and habitat preference characteristics. Count, ringing and other ornithological data were mobilized for these species and analyzed. From the literature, 50 percent of the selected higher risk species were found to have been infected with HP H5N1 (against less than 10 percent for non-selected species), suggesting that this analysis has provided a valuable scientific basis for identification of higher risk species as a first step towards the development of an early warning system for HP H5N1. The need to undertake such analyses in the other flyways to inform risk assessments is an urgent priority. This requires long term and sizable investments to determine migratory routes of waterbird species and to identify and study higher risk species, work that will also require building human capacity in the different countries in these flyways.”
From the FAO & OIE International scientific conference: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/conference/abstracts_en.html.
(Promed 6/21/06)

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HPAI spread from western Siberia to eastern Mediterranean and beyond
Marius Gilbert et al.
Abstract: “Wild birds are considered as the natural reservoir of influenza viruses, and with highly pathogenic avian influenza (HPAI) infections by H5N1 reported in a wide diversity of bird families, it has been assumed that the intercontinental flyways of migratory birds delineate the areas at risk of spread of the ongoing epidemic. Previous works have shown that the natural history of low pathogenic avian influenza viruses is primarily linked to populations of Anatidae (Ducks, Geese and Swans) and more specifically Anatinae. By overlaying the known migratory population flyways of Anatidaespecies and by matching population-weighted flyway overlays against the traveling wave of frost, we discuss how the pattern of spread of HPAI H5N1 virus along the Western Palaearctic in the second half of 2005 may be consistent in space and time with the hypothesis that some Anatidaeseeded the virus over long distances along their migrations.”
From the FAO & OIE International scientific conference: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/conference/abstracts_en.html.
(Promed 6/21/06)

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Remote sensing, ecological variables and bird migration
Xiangming Xiao et al.
Abstract: “. . .Domestic free-ranging ducks play an important role in the persistence and spread of HPAI, as the ducks can remain relatively healthy whilst excreting sufficient amounts of H5N1 virus to sustain transmission. However, it is not clear what role wild birds and their migration play in the spatial spread and temporal dynamics of the HPAI epidemic over 2003-2006. Migration timing and flyways of wild birds are affected by a number of biological and environmental factors, including habitat, condition of breeding, molting, stop-over and wintering sites, and weather. Agricultural expansion has resulted in substantial losses of natural wetlands; however, agricultural intensification (double or triple cropping, irrigation), aquaculture (fish and shrimp ponds) and post-harvest management of paddy rice fields have generated complex farming landscapes that are now used by wild birds, in particular during the wintering period. In those closely interwoven farming and natural ecosystems landscapes, wild birds and domestic ducks are likely to mix and interact. . .Here, we present our effort in using satellite remote sensing (1) to quantify key ecological variables that affect migration timing and flyways of waterfowl and (2) to catalogue farming landscapes, ecosystems and interactions between these 2 forms of land cover. We present case studies in Asia to illustrate improved geospatial datasets of HPAI-relevant ecological factors, including agricultural systems (cropping intensity, crop calendar, and irrigation), seasonality of wetlands, and biophysical variables (e.g., land surface temperature, snow cover). These geospatial datasets can be used for better understanding the relationship between HPAI outbreaks and ecological variables and for identifying potentially hot-spots (location-varying risks) and hot-periods (time-varying risk) of HPAI, which could substantially help targeted surveillance of wild birds and domestic poultry, risk assessment and early warning and response strategies.”
From the FAO & OIE International scientific conference: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/conference/abstracts_en.html.
(Promed 6/21/06)

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Incursion of H5N1 Asian lineage virus into Europe: source of introduction?
I.H. Brown et al.
Abstract: “In October 2005, the first reported outbreak of H5N1 high pathogenic avian influenza of Asian lineage occurred in a turkey flock in Turkey. Although this outbreak, located in eastern Turkey, was dealt with swiftly using movement restrictions and depopulation, it heralded the detection of this virus in at least 25 European countries between October 2005 and May 2006 (at the time of writing). The majority of these reports involved the detection or isolation of virus from wild birds that were found dead. In addition, there were a number of incursions into poultry populations. Molecular epidemiology based on sequence analyses of the hemagglutinin gene revealed high homogeneity amongst all these viruses, which were also very closely related to the viruses present in eastern and central Asia (i.e. Siberia, Mongolia and Qinghai lake). One mechanism of virus spread to Europe was by migratory wild birds that were found positive in many countries, with no associated outbreaks in poultry. Some, but not all of these reports may relate to movement of birds due to adverse weather in eastern Europe. Further infection of wild birds through exposure to infected backyard poultry in eastern Europe appears probable. Conventional spread and introduction resulting from the movement, legal or illegal, of poultry and poultry products would also appear to be a key factor. An up to date analysis of the epidemic in Europe will be presented.”
From the FAO & OIE International scientific conference: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/conference/abstracts_en.html.
(Promed 6/21/06)

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Mass bird vaccination may hinder H5N1 detection in humans
Avian flu vaccination programs in poultry that are widely but imperfectly instituted, like those in China and Indonesia, may impede detection of human cases, according to a Eurosurveillance Weekly report. WHO has underscored the risk to human health of poorly implemented programs for avian flu vaccination and the use of poor-quality vaccines, said Roy Wadia, WHO spokesperson in Beijing. "If you don't see poultry dying when they are infected, then from a public health point of view, you can't be extra vigilant and warn people that they could be at risk," Wadia said. He noted that vaccination may "mask infection" in birds, i.e. vaccinated birds can carry and shed virus without being visibly ill. "Thus, poultry vaccination shouldn't be taken as a sign that human surveillance can be in some way eased," he said. Regarding China, the report says information about the avian flu situation is difficult to obtain, in part because of widespread poultry vaccination. Also, the report says that poultry immunization "is a challenging task, with billions of birds being needed to be immunized annually."

"Indonesia," the report says, "is failing to control outbreaks, due to a poorly implemented veterinary control strategy, including poorly implemented vaccination." The situation in China and Indonesia is contrasted in the report with that in Vietnam and Thailand. Both those countries seem to have controlled their avian flu outbreaks—Vietnam through vaccination and other measures, such as banning the sale of live birds, and Thailand via mass culls and other non-vaccination steps. In Africa, the reports says, surveillance "is especially weak, and there is evidence of widespread infection in domestic poultry in parts of north, west, and central Africa. . .Prospects of control are bleak here because of weaknesses in veterinary services, and a number of competing animal and human health problems. . ."

Influenza team. World avian influenza update: H5N1 could become endemic in Africa. Euro Surveill 2006 Jun 22;11(6):E060622.3. http://www.eurosurveillance.org/ew/2006/060622.asp#3
(CIDRAP 6/23/06 http://www.cidrap.umn.edu/ )

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Removing Barriers to Global Pandemic Influenza Vaccination
Gigi Kwik Gronvall and Luciana L. Borio. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. Jun 2006, Vol. 4, No. 2: 168-175. http://www.liebertonline.com/doi/abs/10.1089/bsp.2006.4.168
This article clarifies the regulatory issues surrounding influenza pandemic vaccine for the larger policy community and describes the need for regulatory harmonization. Vaccination would save lives in an influenza pandemic, but a lack of global manufacturing capacity will leave most of the world without access to vaccine. Capacity can be expanded if governments harmonize their regulatory policies. This article details the regulatory approaches taken by the United States, the European Union, and Japan for pandemic vaccine development, three regions that produce the majority of the world's seasonal influenza vaccine. They should quickly converge on regulatory requirements, intellectual property considerations, the use of recombinant DNA techniques for vaccine production, and technical issues about the composition of pandemic vaccine.
(CIDRAP http://www.cidrap.umn.edu/ )

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 apecein@u.washington.edu