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EINet Alert ~ Aug 18, 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: Characteristics of candidate H5N1 vaccine viruses
- Netherlands: Owls in Rotterdam zoo die of H5N1 avian flu
- China: 14th bird flu fatality confirmed
- China: Delayed confirmation of 1st case due to communications problems
- Indonesia: Suspected human case of avian influenza
- Indonesia: 58th human case confirmed
- Indonesia: 57th human case confirmed
- Indonesia: 5.9 million birds culled in response to avian influenza outbreak
- Laos: Re-emergence of highly pathogenic avian influenza in poultry
- Thailand, Laos: Countries cooperate to response to possible spread of avian influenza
- Thailand: Only 2 human cases of avian flu confirmed in latest outbreak
- Thailand: suspected case to undergo post mortem
- Thailand: Strain of H5N1 genetically similar to strain from southern China
- Thailand: Unauthorised vaccination
- Cambodia: New outbreak of avian influenza
- Viet Nam: Additional ducks and geese infected with H5N1 flu
- USA (Michigan): Low pathogenicity avian influenza found in mute swans
- Avian/Pandemic influenza updates
- Control of Avian Influenza in Poultry
- Online certificate program Emerging Infections & Biopreparedness
- Epidemic Intelligence Service (EIS) Application Deadline September 15, 2006
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: 236 (138).
Global: Characteristics of candidate H5N1 vaccine viruses
The H5N1 viruses chosen for development of pre-pandemic candidate vaccine viruses are representative of antigenically and genetically distinct groups of viruses that have infected humans primarily through contact with ill or dead H5N1-infected birds. These representative candidate H5N1 vaccine viruses have been prepared by reverse genetics and safety tested prior to release for production of pilot vaccine lots that may be used for experimental studies and for stockpiling by governments in advance of a possible H5N1 pandemic, should such a national policy exist. Companies are recommended to consult individual national authorities on the H5N1 strains to be used. Decisions should be based on the epidemiology of the circulating H5N1 viruses that are described below.
Comparison of the previously developed (clade 1 rg A/Vietnam/1194/2004 and rg A/Vietnam 1203/2004)2 and new candidate H5N1 vaccine viruses and studies of cross-reactivity of these pre-pandemic vaccine viruses and their relationship to newly emerging H5N1 viruses are ongoing, and will be reported periodically by WHO.
A full report is available at http://www.who.int/csr/disease/avian_influenza/en/index.html
Netherlands: Owls in Rotterdam zoo die of H5N1 avian flu
Four young Northern Hawk Owls in the Rotterdam Zoo died or were culled due to infection with the H5N1 avian influenza virus.
The dead young owls from the Blijdorp Zoo in Rotterdam have been tested within the ongoing [avian influenza] surveillance undertaken by the Wild Life Health Centre (Erasmus MC Rotterdam/Utrecht University) and found infected with the H5N1 virus. Further investigations at the Lelystad Laboratory [The Central Institute for Animal Disease Control Lelystad, CIDC] confirmed the above suspicion. Further investigations are underway to obtain final confirmation of an HPAI infection. The young infected owls had not been vaccinated. Additional sampling and testing will be carried out in the zoo during the coming days.
Though most birds in the zoo are vaccinated, the birds should be kept, as far as possible, protected indoors.
Humans may be infected with H5N1 only by close contact with infected birds or their excrement. Therefore, the zoo will remain open for visitors, while specific protective measures are prescribed for personnel engaged in animal handling. However, to be on the safe side, the zoo will take measures to prevent contact between visitors and birds.
China: 14th bird flu fatality confirmed
The Chinese Ministry of Health on Monday [14 Aug 2006] confirmed a man had died from the H5N1 avian influenza virus in Xinjiang Uygur Autonomous Region. The victim, a 62-year-old farmer, became ill on 19 Jun 2006 and died on 12 Jul 2006. Epidemiological research showed the man did not have close contact with any human cases of bird flu and sick or dead poultry in the last month of his life.
The Regional Center for Disease Control (CDC) and Prevention tested his samples and got negative results 14 days after he fell ill, but the re-test by the national CDC on 16 Jul 2006 indicated he was H5N1-positive. On 2 Aug 2006, the national CDC tested the rest of his samples left from previous tests and again got positive results, said the Ministry. The Ministry confirmed it as a human case of bird flu by both Chinese and WHO standards and reported the new case to the World Health Organization. Local health authorities have tightened prevention and control measures and have found no abnormal symptoms of the people who had close contact with the farmer. This case brings China's total human cases of bird flu to 21 and the death toll from the disease to 14.
An outbreak of bird flu in poultry in Xinjiang's Aksu City was confirmed on 14 Jul 2006. A total of 3045 chickens were killed by the disease and another 356 976 were culled when the outbreak was confirmed, according to the Ministry of Agriculture. It announced on 10 Aug 2006 that the outbreak had been brought under control.
The information office of the Ministry of Health said they could not link the new human case with outbreaks among poultry in the region. The source of infection for the new case is still unclear, spokesman of the Ministry of Health Mao Qun'an told Xinhua.
China: Delayed confirmation of 1st case due to communications problems
Previously, the government had said the 1st case had occurred at the end of 2005, and the delay in reporting the earlier case has prompted the U.N.'s health agency to call for greater transparency.
"This issue has exposed problems in our scientific research organisations," Jiang Zuojun, Vice Minister of Health, said at a news conference. China now has confirmed 20 cases, 13 of which were fatal, including the 2003 case that was confirmed on Tuesday [8 Aug 2006], the WHO announced. The virus has killed 137 people worldwide since 2003.
China's Health Ministry had said military scientists first tested the soldier and found he had been infected with HN51 but did not tell the Health Ministry until much later. "Their communications with disease prevention organisations should be strengthened in future," Jiang said.
The case of the soldier had spurred questions on whether other human H5N1 infections in China had developed prior to its 1st reported human case, near the end of 2005. Jiang said there were no recorded cases of bird flu prior to the soldier because there were no data. He said the soldier's disease was initially a puzzle only confirmed as bird flu by lengthy tests. "At the time, we had incomplete standards for diagnosis... From the data we have at hand, which starts from 2003, that was the first case," he said.
The scientists' findings were one of the clearest indications yet that the virus might have been present in the vast country for much longer than had been reported. Experts in Hong Kong have long insisted that the virus has long been present in mainland China, but Chinese authorities have denied that.
Indonesia: Suspected human case of avian influenza
The woman was from Cikelet, a village 150 kilometers (90 miles) southeast of the capital Jakarta, where at least one person was killed by the disease and another sickened. Four other people died before tests could be taken to see if they had bird flu.
The H5N1 virus has killed at least 140 people worldwide since it began ravaging Asian poultry stocks in late 2003, 45 of them in Indonesia, the world's worst affected country, according to the World Health Organization.
Indonesia: 58th human case confirmed
Three hamlets within the village are currently under investigation. An additional case [the 57th confirmed case] from the village, but from another hamlet, was confirmed by the Ministry of Health on 14 Aug. This 17-year-old male developed symptoms on 26 Jul and is now recovering.
Another death from severe respiratory disease occurred on 5 Aug 2006 in a 20-year-old neighbour, who is also now known to be a cousin. As no samples were taken for testing, the cause of his illness remains uncertain. Based on epidemiological and clinical findings, however, infection with the H5N1 virus is strongly suspected. As both young men developed symptoms on the same day (26 Jul), epidemiologists assume that they acquired their infection from a shared environmental source. The currently recognized incubation period for H5N1 infection of 2 to 8 days makes human-human transmission between the 2 highly improbable.
Teams from local health authorities, the Ministry of Health, and WHO are currently in the 3 hamlets investigating these cases and assessing the overall situation. Team members include experts in animal health. Recent die-offs of poultry are known to have occurred in the village, and all 3 cases described above had documented exposure to diseased chickens.
Heightened awareness in the hamlets, supported by the presence of well-equipped teams, has led to the presentation of additional persons for medical evaluation. Specimens have been taken and tests are being conducted. Rumours of additional deaths from respiratory disease in the hamlets in late July and early August 2006 are also being investigated.
Although the village is remote and access by road is difficult, good communications from the field have been established with the Ministry of Health and WHO.
Of the 58 cases confirmed to date in Indonesia, 45 have been fatal.
The case is a 17-year-old male from a remote village in Garut district, West Java Province. He developed symptoms on 26 Jul 2006 and was referred to hospital on 9 Aug 2006. At the hospital, medical staff suspected H5N1 infection based on his respiratory symptoms and a history of exposure to dead poultry. Because of this suspicion, specimens were collected from the patient and sent for testing. Results received on 12 Aug 2006 were positive for H5N1 infection. The patient is presently recovering.
A thorough field investigation found that chicken and duck deaths occurred in the patient's household and neighborhood during the week prior to symptom onset. The case reportedly had direct contact with diseased chickens during the disposal of carcasses.
The investigation also obtained information about a 20-year-old male who lived in a neighboring household where chickens were also dying. The man developed symptoms on 26 Jul 2006 and sought care at the local health center on 5 Aug 2006. He died of respiratory disease on 6 Aug 2006 before arrangements could be made for transfer to hospital and before samples could be taken for testing. The cause of his illness and death remain undetermined.
Of the 57 cases confirmed to date in Indonesia, 44 have been fatal.
Indonesia: 5.9 million birds culled in response to avian influenza outbreak
"Besides that, the government has also provided free vaccines for 262 million birds," the minister said after a coordinating meeting on bird flu control at the office of the Coordinating Minister for People's Welfare here on Wednesday [9 Aug 2006].
He said that the government has been conducting routine surveillance over fowls in endemic places and cooperating with local universities to find 'hotspots' where the bird flu virus would most likely spread.
The minister said that at present there were about 30 million households which raised fowls so that it was quite difficult for the government to control all of them.
Laos: Re-emergence of highly pathogenic avian influenza in poultry
Thailand, Laos: Countries cooperate to response to possible spread of avian influenza
Thailand's Deputy Agriculture and Cooperatives Minister Adisorn Piengkes met with Lao officials earlier this week to reinforce cooperation between the health authorities of the 2 neighbouring countries to jointly combat the spread of bird flu.
Speaking to journalists upon his returning to Bangkok Friday, Mr. Adisorn said he attended a briefing on the deadly disease in Laos and conferred with the Lao Minister of Agriculture and Forestry and agreed to disclose the real situation of the disease to each other on a regular basis in future.
Such disclosures regarding the disease would benefit both countries as officials concerned with the potential spread of bird flu would be more able to efficiently curtail and control the disease, he said.
Mr. Adisorn said he had also proposed a meeting of the Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy grouping (ACMECS) to be held in Thailand to allow member countries to exchange ideas and ways to control the avian influenza.
ACMECS membership is comprised of the 3 Indochina countries -- Cambodia, Laos and Vietnam -- as well as Myanmar and Thailand.
Thailand: Only 2 human cases of avian flu confirmed in latest outbreak
Sansanee Nakpong, government deputy spokesperson, said the Minister of Public Health informed the cabinet meeting here on Tue 15 Aug that Thailand has officially recorded only 2 bird flu deaths since early this year. Ms. Sansanee said the Ministry of Public Health would take 2 patients thought of having suffered from the virus off the country's suspect list as results from their lab tests against bird flu were negative.
"Until now, only 2 people have been confirmed as bird flu deaths during the ongoing outbreak. One was in Phichit and the other was from Uthai Thani," she told reporters after the cabinet meeting. The Ministry has initiated surveillance to monitor for bird flu in chickens and in humans nationwide since the beginning of this year and has so far put over 3600 people under a health quarantine after the recent reemergence of the deadly H5N1 strain of bird flu virus in many provinces across the country.
According to Public Health Minister Pinij Jarusombat, a 66-year-old woman and a 24-year-old man were reportedly admitted to hospitals for flu-like symptoms, but doctors put them on suspect list for bird flu even though they did not have a contact with dead chickens before their illnesses.
He said laboratory tests and lung X-rays on the 2 patients showed they did not have bird flu, but other viral infections. He said doctors were convinced the woman was infected with human influenza virus type A, while further tests would be conducted on the male patient to determine what virus or bacteria sickened him.
The minister withdrew a team of epidemiologists and a rapid mobile lab unit from northeastern Nakhon Phanom province after the bird flu outbreak there was contained. The team would be stationed in Khon Kaen province, said the minister. "This year, we have had outbreaks of human [seasonal] flu, bird flu and dengue fever all at the same time. Our health officials have worked very hard," he said. Thailand has reported 24 000 dengue fever cases [so far in 2006], said the minister, about 1000 more than [in 2005]. "To diagnose these diseases correctly, health officials have to realise what viruses are around," he said.
Thailand: suspected case to undergo post mortem
The man fell ill and was admitted to a local hospital last week shortly after many of his backyard chickens died of unknown causes. Laboratory tests showed that he was infected with a bacterium, not the influenza virus. However, his condition continued to deteriorate until he died on Thursday [10 Aug 2006], said Vipon Ratchtapongtorn, Deputy Director of Nong Bua Lam Phu Hospital. Kamnuan Ungchusak, Director of the Epidemiology Bureau, said the case was "uncommon," as the man died from flu-like symptoms despite testing negative for influenza [viruses].
"A thorough disease investigation is urgently needed in this case," said Dr Kamnuan, adding that the bureau would send a team of experts to Nong Bua Lam Phu today to carry out the post-mortem. The doctors would also collect tissue samples from the victim.
According to the Livestock Development Department (LDD), there were reports of poultry dying en masse in 15 tambons in the province. Seven samples tested negative for H5N1, while results for the other 8 tambons were pending.
In Bangkok, the Bangkok Metropolitan Administration's (BMA) bird flu control and surveillance centre said another 2 villagers had been put on the city's bird flu surveillance list -- a 56-year-old woman from Bang Sue district and a 5-year-old girl from Nong Khaem district. The BMA also revealed that 6 fighting cocks in Phaya Thai district died of unknown causes on Thursday [10 Aug 2006], prompting officials to put the area under quarantine for 10 days and to send the carcasses for bird flu diagnosis at the LDD's National Institute of Animal Health. Director of the LDD's disease control bureau Nirundorn Aungtragoolsuk played down fears of a re-emergence of bird flu in the city, saying that the examination of chicken carcasses from Phaya Thai district showed they did not die from H5N1. The fighting cocks died from another disease because they did not suffer internal lung and kidney bleeding, which was a common symptom in bird flu-infected fowl, said Dr Nirundorn.
Thailand: Strain of H5N1 genetically similar to strain from southern China
The new strain, the same found in southern China, was confirmed in poultry outbreaks that occurred in July 2006 in the northeastern Thai province of Nakhon Phanom and the Laotian capital of Vientiane, the FAO in Bangkok said in a statement.
"We are aware that there is a lot of trade still going on, mainly smuggling, of course, of chicken and poultry products," said Diderik de Vleeschauwer, FAO spokesman in Bangkok. "The movement and trade of animals and poultry products is the main reason for the spreading of disease."
He added that migratory birds are not to blame because they are not on the move in Southeast Asia this time of year. The strain also is unique to southern China and had not previously been found elsewhere, de Vleeschauwer said.
The samples have been sent to an international reference laboratory in Australia for further analysis. FAO also warned countries in the region to step up awareness and surveillance as more outbreaks surface in other countries.
"Continuing outbreaks in China, recurrence in Cambodia, Laos and Thailand, and the steady march of the disease in Indonesia, underline the need for heightened vigilance in other Asian countries," He Changchui, FAO's regional representative for the Asia-Pacific, said in a statement.
There are 4 strains of the H5N1 virus in the region: the so-called Thai-Vietnamese strain, the Indonesian strain, and another 2 strains occurring in China. The Thai-Vietnamese strain has plagued Thailand since official confirmation of the 1st outbreak in early 2004.
Virologists say the impact of the new strain on human health was so far no different from that of the Thai-Vietnamese type. But warn officials to pay attention if they wanted to develop human vaccines which can tackle both types of the virus strain.
Bird flu re-emerged in Thailand in July for the 1st time in 2006, and Laos reported its 1st outbreak in more than 2 years. The virus killed 2 people in Thailand as the government raced to slaughter birds in the affected areas.
Thailand: Unauthorised vaccination
Vice Minister for Agriculture and Cooperatives Charal Trinvuthipong affirmed on Wednesday [9 Aug 2006] the ministry has been informed about the illegal use of bird flu vaccine in poultry, mostly in egg-producing hens and free-range ducks, but it is quite impossible to conduct blood tests to prove which fowl has been vaccinated.
He appealed to farmers not to smuggle the bird flu vaccine or clandestinely use it in poultry since it can't be officially proven that the vaccine is efficient and effective.
Dr. Charal explained that the current vaccine cannot be fully effective in preventing the H5N1 virus and the chemical substance remaining in vaccinated poultry can be released to the environment.
Even worse, he indicated, vaccination can lead to carelessness of farmers who might have contacted with dead poultry in the belief that their vaccinated dead fowls did not die from bird flu.
"Vaccination cannot kill the H5N1 virus; so the virus can continue spreading without being detected since the vaccinated fowls will not show any symptoms of bird flu," Dr. Charal added.
The ministry has ordered suppression to be stepped up against the vaccine and offenders will face harsh punishments, he said.
Meanwhile, the vice minister reiterated that there was no indication of any H5N1 virus mutations that could lead to an influenza pandemic among people in Thailand.
Cambodia: New outbreak of avian influenza
The H5N1 virus, which re-emerged in Asia in late 2003, has killed at least 138 people worldwide, including 6 in Cambodia.
The announcement came after the government ordered health officials to be on alert for possible human cases of bird flu. The alert followed recent outbreaks of the virus in poultry in neighboring countries and 2 recent human deaths from the disease in Thailand, a bird flu bulletin compiled by United Nations agencies said.
It said the Cambodian Ministry of Health has "called all provincial rapid response teams to put them on alert and ask them to follow up with hospitals and health centers" on suspected human cases of bird flu. The government has also enlisted Buddhist monks to help spread information on the virus. Workshops will be held this month for monks and other citizens at 2538 pagodas in 11 provinces, the U.N. said Wednesday.
Viet Nam: Additional ducks and geese infected with H5N1 flu
The Saigon Giai Phong (Liberation Saigon) newspaper quoted Dong Manh Hoa, head of the Ho Chi Minh City Regional Veterinary Centre, as saying tests of the waterfowl in Tien Giang, Long An and Ben Tre provinces revealed the H5 subtype virus. A Ben Tre official told Reuters on Thursday more than 50 healthy waterfowl had been killed in the province after tests showed they had the H5 subtype, but there had been no outbreaks.
It has not killed anyone in Vietnam this year, but recurrences in Thailand, Laos and China have alarmed Hanoi officials worried their country has become complacent.
In an urgent directive issued on Thursday, Prime Minister Nguyen Tan Dung told officials "to focus strongly on instructing and deploying forces to carry out synchronised, preventive measures". Officials say a failure to control waterfowl, which can be silent carriers of bird flu, made Vietnam vulnerable to new outbreaks and wild birds believed to carry H5N1 would migrate soon from the north, raising the risk of outbreaks.
Farmers in the Mekong Delta have been raising ducks in large numbers despite a ban on breeding waterfowl due to remain in place until February 2007. At this time of year, when a rice harvest is underway in the region, ducks usually roam from field to field feeding on spilled grain.
USA (Michigan): Low pathogenicity avian influenza found in mute swans
The U.S. Departments of Agriculture and Interior today announced that routine surveillance has indicated the presence of H5 and N1 avian influenza subtypes in samples from 2 wild mute swans in Michigan, but testing has ruled out the possibility of this being the highly pathogenic H5N1 strain that has spread through birds in Asia, Europe and Africa. Test results thus far indicate this is low pathogenicity avian influenza [LPAI], which poses no threat to human health.
The swans were sampled as part of the expanded avian influenza surveillance program. They were showing no signs of sickness, which suggests that this is indeed LPAI. Additionally, genetic analysis of the virus conducted at USDA's National Veterinary Services laboratories (NVSL) in Ames, Iowa, suggests that it is similar to a low pathogenicity strain that has been found in North America.
It is possible that these birds were not infected with an H5N1 strain, but instead with 2 separate avian influenza viruses, one containing H5 and the other containing N1. The confirmatory testing underway at NVSL will clarify whether one or more strains of the virus are present, the specific subtype, as well as pathogenicity. These results are expected within 2 weeks and will be made public when completed.
It should be noted that wild birds are known to harbor many influenza viruses, and the finding of one or more of these viruses during routine testing is not unusual.
LPAI commonly occurs in wild birds, where it typically causes only minor signs or no noticeable signs. These strains of the virus are not a human health concern. This includes LPAI H5N1, commonly referred to as the North American H5N1. This strain of low pathogenicity avian influenza is very different from the more severe high pathogenicity HPAI H5N1 circulating overseas, which is commonly referred to as the Asian H5N1.
Evidence of LPAI H5N1 has been found on 2 occasions in wild birds in the United States. In 1975 and 1986, it was detected in wild ducks. These detections occurred as part of routine sampling. LPAI H5N1 has also been detected in Canada, most recently in 2005.
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.
- 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/.
- 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)
Control of Avian Influenza in Poultry
Summary: Avian influenza, listed by the World Organization for Animal Health (OIE), has become a disease of great importance for animal and human health. Several aspects of the disease lack scientific information, which has hampered the management of some recent crises. Millions of animals have died, and concern is growing over the loss of human lives and management of the pandemic potential. On the basis of data generated in recent outbreaks and in light of new OIE regulations and maintenance of animal welfare, we review the available control methods for avian influenza infections in poultry, from stamping out to prevention through emergency and prophylactic vaccination.
(Emerging Infectious Diseases September 2006 / 12(9))
Online certificate program Emerging Infections & Biopreparedness
The University of Washington announces it will offer an online program focused on emerging infectious diseases and the challenges they pose to public health and health care systems across the globe. The Emerging Infections and Biopreparedness online certificate program has been designed by the University of Washington for public health officials and private corporate safety officers who have the responsibility for either developing a proactive bioresponse effort to infectious disease outbreak or managing the bioresponse effort.
Program Web Page:
Epidemic Intelligence Service (EIS) Application Deadline September 15, 2006