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EINet Alert ~ Jul 21, 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)
- Indonesia: 42nd Death from H5N1 Avian Influenza
- USA: Philadelphia Bird Market Closed After Positive Bird Flu Tests
- USA: Novartis to build US cell-based flu vaccine plant
- USA: States slow to sign up for Tamiflu subsidy
- USA: Broad health preparedness bill advances in Senate, includes pandemic influenza
- USA: National Governors Association Center for Best Practices Releases Pandemic Primer
- Thailand: Undiagnosed poultry deaths

1. Updates
- Influenza
- Avian/Pandemic influenza updates

2. Articles
- Phylogenetic analysis revealed genetic similarity of the H5N1 avian influenza viruses isolated from HPAI outbreaks in chickens in Maharashtra, India, with those isolated from swan in Italy and Iran in 2006.
- Planning for Avian Influenza.


Global
Global: Cumulative number of human cases of avian influenza A/(H5N1)
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 / 37 (31)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 87 (57)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 231 (133).
(WHO 7/20/06 http://www.who.int/csr/disease/avianinfluenza/en/ )

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Asia
Indonesia: 42nd Death from H5N1 Avian Influenza
Indonesia has recorded its 42nd human bird flu death, bringing the country level with Vietnam as the worst affected by the disease. Tests by the World Health Organization showed that a 44-year-old man who died last week had the H5N1 virus, Health Ministry officials said. Indonesia has registered more bird flu deaths so far in 2006 than any other nation. In contrast, the outbreak in Vietnam now seems to be under control, due to a large culling and [poultry] vaccination drive. No Vietnamese deaths have been recorded in 2006. Indonesia has been criticised for its reluctance to cull fowl in infected areas -- a measure that experts say is the best way to stem the spread of the disease. But the government says it does not have enough money to compensate farmers, and has asked for USD 900 million (GBP 495 million) over the next 3 years to tackle the virus. Indonesia's problems were highlighted in May [2006] when the country recorded a cluster of [7] deaths which the WHO believes were the result of human-to-human transmission. Experts say this particular incident did not signal a major change in the spread of the disease. But there is a fear that the bird flu virus could mutate to a form which could be easily passed from human to human, triggering a pandemic and potentially putting millions of lives at risk. Globally, more than 130 [currently 133] people have died of bird flu since late 2003. Most of the deaths have been in East Asia, but the virus has also spread to Europe, Africa and South and Central Asia. According to the Post report, the Indonesian government needs $980 million to finance its avian influenza programs from 2006 to 2008. The funds would go toward activities such as compensating farmers for culled chickens, purchasing vaccines, and planning for a pandemic.
(Promed 7/16/06 and 7/20/06, CIDRAP 7/17/06 7/20/06 http://www.cidrap.umn.edu/)

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Americas
USA: Philadelphia Bird Market Closed After Positive Bird Flu Tests
A live bird market in Philadelphia was temporarily closed Wednesday after birds there tested positive for a type of avian influenza, the Pennsylvania Department of Agriculture said in a press release. Stephanie Meyers, press secretary for the state agriculture department, told Dow Jones Newswires the signs point to a mild, or low-pathogenic, strain of avian influenza. There have been no bird deaths and no birds are sick, she said. The discovery of the avian influenza, commonly known as bird flu, was the result of routine surveillance, the release said. Meyers said while the exact strain of avian influenza isn't known yet, the department has sent samples to be tested and expects to have the results in three to five days. The closure of the bird market was simply a routine precaution, the department said.
(USGS http://www.nwhc.usgs.gov/disease_information/avian_influenza/avian_influenza_news.jsp)

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USA: Novartis to build US cell-based flu vaccine plant
Novartis, the Swiss-based drug manufacturer, today announced plans to build what it says will be the first US plant to make cell-culture-based influenza vaccines. The facility will be built in Holly Springs, N.C., at a total cost of about $600 million, the company said in a news release. It will be able to produce about 50 million doses of seasonal trivalent (three-strain) flu vaccine annually. "In the event of an influenza pandemic, the site is planned to have a capacity of up to 150 million monovalent doses annually within six months of a pandemic declaration," the company said. The US government awarded Novartis a $220 million contract in May for development of cell-based flu vaccines in the United States. That money will go toward the cost of the new facility, officials said. Depending on validation testing and approval, the plant could begin production as early as 2011 and be ready for full production as early as 2012, a Novartis spokesperson told CIDRAP News by e-mail. Novartis also announced today it has submitted a cell-based flu vaccine for approval by the European Union's Committee for Medicinal Products for Human Use. The company said it filed in June after successfully completing phase 3 clinical trials of the vaccine. Officials said this marks the first such submission in the EU. The company is currently conducting a phase 1 and 2 clinical trial of a cell-based flu vaccine in the United States. The company spokesperson said by e-mail, "Our phase I/phase II trial in the US is fully enrolled, and immunogenicity data are satisfactory. We are in ongoing dialog with the US Food and Drug Administration to evaluate the data received to date and achieve an optimal design for our phase III program."
(CIDRAP 7/18/06 http://www.cidrap.umn.edu/ )

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USA: States slow to sign up for Tamiflu subsidy
The federal government on Jun 30 announced a subsidy to help states buy the antiviral drug oseltamivir (Tamiflu) to build stockpiles in preparation for a potential influenza pandemic, but so far, few states have said they intend to use the program. The states have until Aug 1 to indicate they want to purchase the discounted Tamiflu, said Marc Wolfson, a spokesman for the HHS Office of Public Health Emergency Preparedness in Washington. Wolfson told CIDRAP News that so far, four states have notified HHS that they plan to order the medication. When HHS Secretary Mike Leavitt announced the program, he said the goal was to help states develop their own stockpiles, which would facilitate quicker distribution in a pandemic. HHS awarded a contract to Roche Laboratories, Inc, to sell oseltamivir to the states at a federally negotiated price, with the federal government paying 25% of the cost. The $149 million contract with Roche provides for the purchase of up to 31 million treatment courses of the drug, according to HHS. These will be in addition to 44 million doses that HHS is buying for future distribution to the states for free, the agency said. Each state and territory has been allocated a population-based amount of oseltamivir that HHS will provide at no cost and an additional amount under the subsidy program. For example, Colorado is due to receive 677,699 courses at no cost and can buy up to 477,470 courses at the subsidized price. Wolfson said he hopes more states take HHS up on the subsidy. He said the Aug 1 deadline only requires states to declare their intent to participate; it does not obligate them to follow through. They have until Dec 29 to tell HHS how much they want to buy. “We’re hopeful that everyone’s going to participate,” Wolfson said.
(CIDRAP 7/18/06 http://www.cidrap.umn.edu/ )

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USA: Broad health preparedness bill advances in Senate, includes pandemic influenza
A US Senate committee today approved a bill packed with a wide variety of provisions designed to improve the nation's ability to handle public health emergencies, including pandemic influenza. The bipartisan "Pandemic and All-Hazards Preparedness Act" was unanimously approved by the Senate Health, Education, Labor and Pensions Committee, according to Laura Caudell, a spokeswoman for Sen. Richard Burr, R-N.C., the bill's author. Burr's office cited five major objectives of the bill: 1) To "put someone in charge" by designating the HHS secretary as the lead official for responding to public health emergencies. Caudell said current law doesn't specifically assign that job to anyone. 2) To "speed up coordinated responses to medical emergencies" by improving training, logistics, and planning for healthcare providers and by promoting the use of "mobile medical assets and alternative federal facilities" for accommodating surges of patients. 3) To establish standards of preparedness for states. "The legislation requires individual states to meet performance standards developed by the Secretary of HHS to ensure all states have a basic level of preparedness for disasters," the release states. 4) To fund public health and medical preparedness. The bill authorizes $824 million for state and local preparedness and $474 million for hospital preparedness for fiscal year 2007, plus "such sums as may be necessary" for 2008 through 2011. 5) To create a system to promote, organize, train, and support healthcare volunteers for emergency response work. Concerning flu vaccine supplies, the legislation directs HHS "to track and facilitate the distribution" of vaccines so that supplies can go to high-priority groups. It does not suggest how this should be done. The information gathered by HHS for this purpose must remain confidential.
(CIDRAP 7/19/06 http://www.cidrap.umn.edu/ )

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USA: National Governors Association Center for Best Practices Releases Pandemic Primer
Recognizing that aggressive, comprehensive planning at the state level will be essential to effectively manage a pandemic influenza or other widespread disease outbreak, the National Governors Association Center for Best Practices (NGA Center) has released "Preparing for a Pandemic Influenza: A Primer for Governors and Senior State Officials." A pandemic outbreak, should it occur, is likely to affect hundreds or even thousands of communities across the country simultaneously and could come in a series of waves, each lasting weeks at a time. State and local governments therefore must be prepared to manage their responses independently, without relying on the outside assistance that would be available for natural disasters or other localized incidents. "Preparing for a Pandemic Influenza" stresses the need to look beyond the initial public health and medical response and develop strategies to ensure essential government and private sector services—such as police, fire, paramedic, food, water and electricity—remain available during periods when a pandemic outbreak is at its peak and absentee rates are highest. The primer also calls for comprehensive planning that involves government agencies, businesses and individuals, each of whom will have a role to play in responding to a pandemic outbreak. "Proper planning and training for a pandemic flu will produce wide-ranging benefits because the preparation involved is transferable to virtually any type of public health emergency," said Minnesota Gov. Tim Pawlenty, co-lead on Pandemic and Avian Flu. "Done well, pandemic flu planning will help the nation become better prepared for all types of hazards."
(U.S. Department of Health & Human Services Pandemic Influenza, website http://www.pandemicflu.gov/)

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Thailand: Undiagnosed poultry deaths
The Agriculture and Cooperatives Ministry yesterday denied vehemently it had been covering up fresh outbreaks of bird flu following reports of mass deaths of poultry over the past few weeks. It could not possibly conceal such outbreaks because its bird flu surveillance and diagnostic operations were monitored closely by various agencies such as the World Organisation for Animal Health, said Charal Trinvuthipong, assistant to the agriculture and cooperatives minister. Covering up bird flu outbreaks would also end up doing more harm than good to the country, he added. The Livestock Development Department reported on Sunday that fowl died in huge numbers in 430 tambons [subdistricts] in 50 provinces. The department's laboratory tests confirmed that 351 tambons were free of bird flu, while 79 tambons in 23 provinces were still awaiting test results. Meanwhile, more chicken deaths were reported yesterday, including about 1000 in Phichit and 300 in Phitsanulok provinces. The test results on the samples are due to be released next week.
(Promed 7/18/06)

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1. Updates
Influenza
Seasonal influenza activity in the APEC Economies
During weeks 23-26, with the exception of Hong Kong Special Administrative Region of China, overall influenza activity was low.
Hong Kong Special Administrative Region of China. During week 23 influenza A(H1N1) activity started to increase and was a high in week 26.
New Zealand. An increase in A(H3N2) activity has been observed since week 23. Influenza activity was reported as regional during week 26.
Other reports. During weeks 23-26, low influenza activity was reported in Canada (A and B), Chile (H1, H3 and B) and Japan (H1 and B), and Mexico (A and B).
(WHO 7/21/06 http://www.who.int/csr/disease/influenza/update/en/ )

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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 Read the ECTAD newsletter providing the latest figures on donor funding for FAO’s avian flu programme and reports on activities in the affected regions
- OIE: http://www.oie.int/eng/en_index.htm
- 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
Phylogenetic analysis revealed genetic similarity of the H5N1 avian influenza viruses isolated from HPAI outbreaks in chickens in Maharashtra, India, with those isolated from swan in Italy and Iran in 2006.
B. Pattnaik, et al. In the present investigation an attempt has been made to trace the origin of both the Indian H5N1 viruses by comparing their partial nucleotide sequences in the HA1 and HA2 regions of the HA gene with 30 other H5N1 viruses that were isolated in different countries of Asia, Europe and Africa during the years 1997 (02), 2003 (02) and 2004–2006 (26). Current Science, Vol. 91, No. 1 10 July 2006.
(US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp)

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Planning for Avian Influenza.
John G. Bartlett
Abstract: “Avian influenza, or influenza A (H5N1), has 3 of the 4 properties necessary to cause a serious pandemic: It can infect people, nearly all people are immunologically naive, and it is highly lethal. The Achilles heel of the virus is the lack of sustained human–human transmission. Fortunately, among the 124 cases reported through 30 May 2006, nearly all were acquired by direct contact with poultry. Unfortunately, the capability for efficient human–human transmission requires only a single mutation by a virus that is notoriously genetically unstable, hence the need for a new vaccine each year for seasonal influenza. Influenza A (H5N1) is being compared to another avian strain, the agent of the "Spanish flu" of 1918–1919, which traversed the world in 3 months and caused an estimated 50 million deaths. The question is if we are ready for this type of pandemic, and the answer is probably no. The main problems are the lack of an effective vaccine, very poor surge capacity, a health care system that could not accommodate even a modest pandemic, and erratic regional planning. It's time to get ready, and in the process be ready for bioterrorism, natural disasters, and epidemics of other infectious diseases.”
(CIDRAP 7/18/06 http://www.cidrap.umn.edu/ )

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