|HomeAvian Influenza and EINetVirtual SymposiumHuman Avian Influenza CasesAbout APEC-EINetNewsbriefs> Browse• SearchAPEC EconomiesPeople DirectoryTeaching & LearningResearch ResourcesContact Us
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
- Avian/Pandemic influenza updates
- 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: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 228 (130).
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.
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.
China: Report of new avian influenza H5N1 outbreak
Indonesia: Confirmation of 51st human case of avian influenza H5N1
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.
Indonesia: H5N1 mutation showed human transmission in family cluster
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.
Indonesia: Confirmed case of cat infected with avian influenza H5N1
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.
USA: USDA trains foreign scientists on avian influenza testing
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)
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.
Report: China had human H5N1 case in late 2003
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.
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
"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
Removing Barriers to Global Pandemic Influenza Vaccination