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EINet Alert ~ Jul 07, 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)
- Global: Avian influenza patterns resemble 1918 pandemic, WHO study shows
- Russia (Omsk region): The Avian Influenza Situation in the Omsk Region
- Russia (Altai Krai): Quarantines lifted
- Russia (Novosibirsk region): Quarantines lifted
- Hungary: New outbreaks of Avian Influenza in Birds
- Indonesia: Avian Influenza Claims 40th Human Victim
- China: China's Agriculture Ministry confirms new outbreak of bird flu
- China: H5N1 in Poultry in Shanxi province
- Tibet: Wild Bird die-off in Biosphere Reserve
- USA: HHS has enough H5N1 vaccine for 4 million people
- USA: USDA, DOI and HHS expand screening for H5N1 avian influenza in migratory birds
- Nigeria: Bird flu spreads to new state

1. Updates
- Avian/Pandemic influenza updates

2. Articles
- WHO WER, Volume 81, Number 26—June 30, 2006
- Multiple introductions of H5N1 in Nigeria


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 / 35 (29)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 85 (55)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 229 (131).
(WHO 7/06/06 http://www.who.int/csr/disease/avian_influenza/en/index.html)

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Global: Avian influenza patterns resemble 1918 pandemic, WHO study shows
The World Health Organization (WHO) on Friday published its first epidemiologic analysis of all laboratory-confirmed cases of H5N1 avian influenza reported to the agency between Dec 1, 2003, and Apr 30, 2006. Over the time period studied, 205 cases were confirmed by polymerase chain reaction on respiratory tract specimens and/or microneutralization assay on serum specimens.

The number of new countries reporting human cases of H5N1 has increased greatly in recent months as outbreaks among avian populations have spread, the study showed. From late 2003 through mid-2005, four countries reported human cases of H5N1 infection. In the much shorter period from October 2005 through the end of April 2006, five new countries reported cases in humans.

About half the cases occurred in people under age 20 (102 of 202), and 90% in people younger than age 40 (180 of 202). The high proportion of cases occurring in younger people may reflect the young population of the countries where the cases occurred, for example in Egypt and Indonesia. The WHO noted that the incomplete nature of the data makes it difficult to make reliable links between age and exposure and that more studies are needed to assess whether younger people or other groups are at increased risk of contracting the disease.

The overall fatality rate was 56% (113 of 202), with the incidence of death highest in those aged 10 to 39 years. The WHO emphasized that the fatality-rate patterns are notable for two reasons. They differ from the pattern of seasonal influenza, in which mortality is highest in elderly people. Also the case-fatality patterns resemble those observed during previous influenza pandemics—particularly the one that occurred in 1918.

Human cases have occurred year-round, but the peaks have coincided with winter and spring in the northern hemisphere. "If this pattern continues, an upsurge in cases could be anticipated starting in late 2006 or early 2007," the researches state. The report highlights the gap in essential data needed to understand and refine treatment of patients with the disease. "Collecting more detailed information on antiviral treatments and outcomes, and particularly linking this information to sequential virological sampling, could inform future management decisions," the authors concluded.
(CIDRAP 7/03/06 http://www.cidrap.umn.edu)

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Europe/Near East
Russia (Omsk region): The Avian Influenza Situation in the Omsk Region
In connection with the uncovering of material from the avian influenza virus A/H5N1 in samples from dead birds by PCR-analysis on 16 Jun 2006, quarantine measures are implemented in the village of Aleksandrovka.

During analysis of pathological material from dead birds in the villages of Ust-Zaostravka and Istrysh with PCR on 21 Jun 2006, genetic material of the virus was not detected. Over the past 24 hours, mass die-off in birds has not been registered. Over the past 24 hours, 1123 persons have been examined and cases among humans have not been registered. In all the 5 settlements in Omsk regions, where mass die-off of birds caused by influenza virus A/H5N1 has been registered, the quarantene has been lifted; from Poltavka on 6 Jun 2006, from Maksimovka 9 Jun 2006, from Novobelozerovka 14 Jun 2006, from Bobrinka 18 Jun 2006 and from Karan-Goral on 19 Jun 2006.
(PROMED 7/02/06)

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Russia (Altai Krai): Quarantines lifted
Quarantine has been lifted in the villages of Troitsk and Plotava were mass die-offs were registered from 19 to 27 May 2006.
(PROMED 7/02/06)

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Russia (Novosibirsk region): Quarantines lifted
Quarantine has been lifted in the settlements of Resheti, Kochki, and Lyagushe were mass die-offs were registered from 3 to 17 May 2006.
(PROMED 7/02/06)

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Hungary: New outbreaks of Avian Influenza in Birds
New outbreaks occurred in 6 farms in Bacs-Kiskun province: 2 in Bodoglar (28 000 and 15 000 birds, respectively); 3 in Moricgat (110, 120, 126 birds) and one in Szank (19 000 birds). All affected flocks were subject to immediate stamping out based on suspicion. Cleaning and disinfection of the holdings as well as all measures according to European Commission Decisions 2006/415/EC and 2006/416/EC were implemented immediately.

On 16 Jun 2006, the OIE/FAO Reference Laboratory for avian influenza in Weybridge, United Kingdom, using RT-PCR confirmed the presence of highly pathogenic avian influenza virus subtype H5N1 in the affected goose flock notified on 9 Jun 2006.
(PROMED 7/05/06)

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Asia
Indonesia: Avian Influenza Claims 40th Human Victim
The Ministry of Health in Indonesia has confirmed the country's 52nd case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 5-year-old boy from Tulungagung district, East Java Province. The boy became ill on 8 Jun 2006, was hospitalized on 14 Jun 2005 and died 2 days later on 16 Jun 2006. An investigation found a history of chicken deaths in the boy's household 2 weeks before symptom onset. Laboratory testing of poultry in the sub-district confirmed the presence of H5N1 in chickens. Monitoring of close contacts has detected no further cases.
(PROMED 7/03/06, 7/03/06; CIDRAP 7/03/06 http://www.cidrap.umn.edu)

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China: China's Agriculture Ministry confirms new outbreak of bird flu
China's agriculture ministry has confirmed a new outbreak of avian influenza in the north western Ningxia Hui Autonomous Region, according to a government statement. The outbreak occurred in Zhongwei city in Ningxia, the ministry stated on its website [on 1 Jul]. The national avian influenza reference laboratory on 29 Jun 2006 confirmed the H5N1 strain of the virus in dead birds, it said. The statement did not say how many birds were involved or whether it was among farm-raised poultry or wild birds. Ministry officials have been sent to the region to begin quarantine and disinfection operations, it said.
(PROMED 7/02/06)

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China: H5N1 in Poultry in Shanxi province
H5N1 has been reported in new outbreaks in poultry in China. Poultry in four villages in the western province of Shanxi have been diagnosed as being infected with bird flu.
(USGS 7/06/06; http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp)

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Tibet: Wild Bird die-off in Biosphere Reserve
A die-off of wild birds in the biosphere reserve of Ubsu-nur has been recently reported. Dying fish and small rodents were reported before the bird die-off. On June 23, 2006, 169 wild birds were reported dead; this increased to 1,622 by June 25 and as of June 27, over 3,339 dead birds have been found. The reserve straddles the border between Russia and Mongolia, and mortality has been reported on both sides of the border. Some media sources have reported that H5N1 has been found, although a statement from the Emergency and Disaster Relief Ministry said only that “antibodies to the virus of bird influenza” were detected. Confirmation of H5N1 or other types of avian influenza is not available at this time. A local ornithologist, Vladimir Zabelin, has said that the deaths may have been caused by toxic chemicals being dumped into one of the rivers. The chemicals affected the fish first and subsequently the birds that ate the fish.
(USGS 7/06/06; http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp)

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Americas
USA: HHS has enough H5N1 vaccine for 4 million people
In an update on pandemic influenza preparedness efforts, the federal government said last week it had stockpiled enough vaccine against H5N1 avian influenza virus to inoculate about 4 million people and enough antiviral medication to treat about 6.3 million. Health and Human Services (HHS) Secretary Mike Leavitt said his department has stockpiled about 8 million doses of H5N1 vaccine. "Given a two-dose vaccination schedule, this would allow vaccination of 4 million people." The H5N1 vaccine being stockpiled now is based on a virus isolated from a Vietnamese patient in 2004 (a clade 1 virus). A second H5N1 vaccine under development is based on an H5N1 strain that was collected in Indonesia in 2005 (clade 2 virus) and has circulated in Europe, Africa, and parts of Asia.
(CIDRAP 7/05/06 http://www.cidrap.umn.edu)

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USA: USDA, DOI and HHS expand screening for H5N1 avian influenza in migratory birds
Secretary of Agriculture Mike Johanns, Secretary of the Interior Gale A. Norton and Secretary of Health and Human Services Michael Leavitt moved to further ensure the protection of people, domestic poultry and wild birds by unveiling an enhanced national framework for early detection of highly pathogenic avian influenza (HPAI) in wild migratory birds in the United States. This readiness plan and system builds on, significantly expands and unifies ongoing efforts among federal, state, regional and local wildlife agencies. Those agencies have been monitoring and testing for the presence of the highly pathogenic H5N1 virus in migratory birds for several years. The increased efforts come as the spring migration of migratory birds is underway and the spread of avian influenza continues across continents.
(USGS 7/06/06; http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp)

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Africa
Nigeria: Bird flu spreads to new state
H5N1 strain of bird flu has appeared in remote Taraba state in eastern Nigeria, but in most other parts of Africa's most populous country the spread of the virus is slow, officials said on Friday [30 Jun 2006]. Nigeria was the first African country to be hit by bird flu, but no human cases have been reported. However, experts warn surveillance may not be completely effective and cases may have gone undetected. The detection of the virus in Taraba means bird flu is now present in 14 of Nigeria's 36 states and in the Federal Capital Territory. New outbreaks are still occurring in a few places in Plateau and Kaduna while samples from other areas have been negative. Plateau and Kaduna, form a strip of north-central Nigeria, were among the first 4 states where H5N1 was detected in February. Taraba borders Plateau to the east.

In the first few weeks after the first cases were found, bird flu spread rapidly in poultry across the country despite measures to contain it such as culling and quarantine. Veterinary officials say it would not be safe to consider the disease contained, but recent evidence suggests measures to prevent its spread are working better than at the start.
(PROMED 7/02/06)

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1. Updates
Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. View a slideshow showing the funding requirements and donor funding situation for FAO’s avian influenza programme.
- OIE: http://www.oie.int/eng/en_index.htm. View an update of avian influenza in animals as of July 4, 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/. Read the second report on pandemic planning released by Health and Human Services
- 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
WHO WER, Volume 81, Number 26—June 30, 2006
WHO Weekly Epidemiological Record, volume 81, number 26 (page 249–260) is now available at: http://www.who.int/csr/disease/avian_influenza/guidelines/wer8126/en/index.html
This week's issue sets out results from the first analysis of epidemiological data on all 205 laboratory-confirmed H5N1 cases officially reported to WHO by onset date from December 2003 to 30 April 2006.

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Multiple introductions of H5N1 in Nigeria
Abstract: "As the avian influenza virus H5N1 swept from Asia across Russia to Europe, Nigeria was the first country in Africa to report the emergence of this highly pathogenic virus. Here we analyse H5N1 sequences in poultry from two different farms in Lagos state and find that three H5N1 lineages were independently introduced through routes that coincide with the flight paths of migratory birds, although independent trade imports cannot be excluded."
Ducatez MF, Olinger CM, Owoade AA, et al. Avian flu: multiple introductions of H5N1 in Nigeria (brief communication). Nature 2006 Jul 6;442:37
(CIDRAP 7/06/06 http://www.cidrap.umn.edu)

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 apecein@u.washington.edu