EINet Alert ~ Dec 01, 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)
- South Korea: Avian influenza H5N1 in poultry after 3-year lull
- South Korea: Excerpts from the OIE report on avian influenza H5N1
- South Korea: Avian influenza H5N1 hits second poultry farm
- Indonesia: 57th death from avian influenza H5N1 infection
- China: Consideration of ban on new live-poultry markets
- Australia: Provides AU$4 Million for APEC Infectious Diseases' Defenses
- Ivory Coast: Report of H5N1 virus in 2 dead turkeys

1. Updates
- Avian/Pandemic influenza updates

2. Articles
- WHO guidelines for investigation of human cases of avian influenza A(H5N1)
- FAO: Enhancing control of highly pathogenic avian influenza in developing countries through compensation: issues and good practice
- Evidence of influenza A virus RNA in Siberian lake ice
- What maintains parental support for vaccination when challenged by anti-vaccination messages? A qualitative study
- Surveillance of influenza immunisation uptake in people aged under 65 years with chronic disease

3. Notifications
- Fourth International Conference on Avian Influenza
- Vaccination: a tool for the control of avian influenza
- Flexible financing for FAO's avian influenza programme

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

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

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

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

Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 12 (8)
Djibouti / 1 (0)
Egypt / 15 (7)
Indonesia / 55 (45)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 111 (76)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 258 (154).
(WHO 11/29/06 http://www.who.int/csr/disease/avianinfluenza/en/ )

Avian influenza age & sex distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
(WHO/WPRO 11/13/06)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 28 Nov 2006): http://gamapserver.who.int/mapLibrary/


South Korea: Avian influenza H5N1 in poultry after 3-year lull
South Korea has reported its first outbreak of H5N1 avian influenza in nearly 3 years, on a poultry farm in North Jeolla province, about 100 miles from Seoul. The virus was detected in dead poultry on a farm in the city of Iksan that raises parent stock for broiler chickens. The outbreak caused 6,500 deaths among 13,000 susceptible birds. The source of the outbreak is unknown, though reportedly the farm lies on a bird migration route. The last poultry outbreak in South Korea occurred Dec 2003 and prompted the culling of 5 million birds and cost about 1.5 trillion won [USD 161 million] to prevent the disease spreading. No human cases of H5N1 illness have ever been reported in the country, but South Korea's Center for Disease Control and Prevention said Sep 2006 that 5 workers who helped cull poultry nearly 3 years ago showed evidence of past infection with H5N1 avian influenza, though they had not been ill.

Reportedly the South Korean agriculture ministry has begun culling 236,000 poultry on 6 Iksan poultry farms. About 6 million eggs will also be destroyed. A 3-kilometer quarantine zone was set up around the outbreak site, and a 10-kilometer surveillance zone covers 200 poultry farms. Authorities have also banned the sale and shipment of poultry, eggs, and related products from the area and have set up checkpoints to inspect trucks. Farms in the surveillance zone raise more than 50 million chickens and ducks. Reportedly health officials plan on culling cats, dogs, and other animals such as pigs in the area to control the spread of the disease. South Korea culled dogs and cats along with 5.3 million birds during its last outbreak in 2003.

However, Peter Roeder, an animal health expert with the UN Food and Agriculture Organization (FAO), questions the validity of culling cats and dogs. "It's highly unusual, and it's not a science-based decision," he said. Japan is temporarily suspending poultry imports from South Korea. The imports constituted 0.2 per cent of Japan's total in 2005, according to the Japanese ministry of agriculture.
(Promed 11/25/06; CIDRAP 11/27/06 http://www.cidrap.umn.edu/ )


South Korea: Excerpts from the OIE report on avian influenza H5N1
Highly pathogenic avian influenza in the Republic of Korea (diagnosis confirmation): Information received 26 Nov 2006 from Dr Chang-Seob Kim, Chief Veterinary Officer, Animal Health Division, Ministry of Agriculture and Forestry (MAF): Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of the event: 22 Nov 2006. Nature of diagnosis: clinical, post-mortem and laboratory. Location of the outbreak: Iksan city (Jeollabuk-do province). Number of animals in the outbreak: 6500 cases, 13 300 susceptible animals, 6500 deaths and 6800 animals destroyed. Description of affected population: a parent stock farm for broiler chickens (45 weeks old). Laboratory where diagnostic tests were performed: National Veterinary Research and Quarantine Service, Anyang, Kyonggi. Diagnostic tests used: PCR, haemagglutination inhibition test, sequence analysis: amino acid sequence at cleavage site reveals a HPAI profile, cytopathic effect on cell culture, neutralisation. Source of outbreak or origin of infection: unknown or inconclusive.

Control measures undertaken: control of wildlife reservoirs; stamping out (all poultry in the affected farm); quarantine (removal of feed, manure and egg plates out of the farms within a 3-km radius zone around the outbreak is prohibited); movement control inside the country (a 10-km radius zone around the infected holding); screening; zoning; burial of dead and destroyed poultry as well as of feed, manure and egg plates in the affected farm; disinfection and surveillance intensified in the poultry holdings. Control measure to be undertaken: stamping out (all poultry within a 0.5-km radius zone around the outbreak).
(Promed 11/28/06)


South Korea: Avian influenza H5N1 hits second poultry farm
H5N1 avian influenza has been confirmed at a second poultry farm near the site of a recent outbreak, South Korea’s agriculture ministry said. The farm is about 3 km from the first reported outbreak in Iksan in North Jeolla province, about 230 km south of Seoul. The owner of the second farm requested that his chickens be tested for H5N1 avian flu after 206 of 12,000 chickens died. The National Veterinary Research and Quarantine Service confirmed that the chickens were infected with the H5N1 virus. The outbreaks on the 2 farms are South Korea’s first in almost 3 years.

There have been no reports of infections associated with the current outbreak in local residents or quarantine workers. Health authorities have reportedly vaccinated 151 people living within 500 meters of the second outbreak (kind of vaccine used not reported). Reportedly quarantine authorities would cull all poultry within a 500 meter radius of the latest infected farm. The second outbreak has raised concern that the virus has spread outside the high-risk zone around the first affected farm. Expanding the quarantine zone beyond the site of the first outbreak could greatly increase the number of chickens, dogs, cats, and other animals that officials would kill. Reportedly more than 170,000 chickens at farms within 500 meters of the first outbreak have been killed in the past 2 days, along with a number of pigs and dogs.

The agriculture ministry confirmed 3 avian flu outbreaks in other districts but said they involved a mild strain. Since news of the first outbreak 22 Nov 2006, major retailers have been seeing chicken sales decline.
(Promed 11/28/06; CIDRAP 11/28/06 http://www.cidrap.umn.edu/ )


Indonesia: 57th death from avian influenza H5N1 infection
WHO confirmed that a 35-year-old Indonesian woman who died 29 Nov 2006 of H5N1 disease was the patient who was cited in a WHO update Nov 13, 2006. Based on Real Time-Polymerase Chain Reaction (RT-PCR) tests, carried out by the Health Ministry's Research and Development Agency and the Jakarta-based NAMRU-2 laboratory, she was confirmed as having bird flu 13 Nov 2006. She was the 57th Indonesian to die of the illness, out of 74 total cases. Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza Preparedness said the woman lived in Tangerang, Banten province, and fell ill Nov 7, 2006. She was initially hospitalized in Tangerang and was transferred to Sulianti Saroso Infectious Disease Hospital in Jakarta Nov 10. Although some reports said the woman had had contact with sick poultry, the committee said, "A history of contact with poultry has not been established." In addition to 74 confirmed H5N1 cases, Indonesia has had 12 probable cases, including 4 fatal ones, and 187 "suspect" cases, of which 50 were fatal, the committee said. The statement said lab tests have ruled out 539 suspected cases. 9 Indonesian provinces have had human cases, the committee said. West Java leads the list, with 25 cases and 20 deaths, followed by Jakarta, with 18 cases and 16 deaths, and Banten, with 9 cases and 8 deaths.
(Promed 11/27/06; CIDRAP 11/29/06 http://www.cidrap.umn.edu/ )


China: Consideration of ban on new live-poultry markets
China is reportedly considering phasing out live-poultry markets in an effort to prevent the spread of avian flu. A document released by China’s State Council suggests a ban on any new live-poultry markets and recommends that existing markets be moved out of densely populated urban areas. Poultry markets present an avian flu exposure risk because chickens are often slaughtered there in unsanitary conditions. The markets also serve as hubs for viral spread as birds are moved to farms or other markets. About 46,000 poultry have died in 10 outbreaks in 7 Chinese provinces this year. Another 2.94 million fowl were culled.
(CIDRAP 11/28/06 http://www.cidrap.umn.edu/ )


Australia: Provides AU$4 Million for APEC Infectious Diseases' Defenses
Australia has signed a Memorandum of Understanding with APEC to provide AU$4 million to help developing APEC economies bolster their defences against emerging and infectious diseases such as Avian Influenza. This contribution to the APEC Support Fund will be used for capacity building projects including preparedness planning, surveillance and reporting. These funds will strengthen coordination and response mechanisms, build effective and transparent regional communication systems, and develop business continuity and recovery plans. Australia has been proactive in providing support to regional neighbours to ensure the protection of the region against the threat of pandemics and other emerging infectious diseases. The contribution forms part of an AU$10 million commitment made by Australia at APEC 2005 to support APEC initiatives to combat Avian and Pandemic Influenza. Other elements were AU$4 million for simulations and to create a register of experts for rapid response; and AU$2 million to strengthen linkages between Australian institutions and their counterparts in developing APEC economies. In preparation for the APEC Ministerial Meeting on Avian and Influenza Pandemics in Viet Nam earlier this year, Australia hosted a high-level APEC meeting on avian influenza that brought together principal pandemic and disaster management coordinators from APEC economies along with health and quarantine experts. Australia also hosted a major simulation exercise in June designed to test communication in the event of a human influenza pandemic within the APEC region that involved the active participation of all APEC Member Economies. The APEC Support Fund was established in 2004 through an initial AU$3 million contribution from Australia to meet capacity building needs in high priority sectors relating to economic and social development. The Fund supports projects for developing member economies in the APEC region. (Promed 11/27/06 http://www.apec.org/apec/news___media/media_releases/271106_vn_ausmou.html )


Ivory Coast: Report of H5N1 virus in 2 dead turkeys
Avian influenza H5N1 virus was detected in 2 turkeys that died early Nov 2006 in Ivory Coast, according to an Agence France-Presse report. The turkeys came from a livestock camp at a village near Abidjan in the south. The country's last outbreak in poultry was May 2006. Health officials said that health and safety measures had been taken and that people who were exposed to the birds were under medical supervision.
(CIDRAP 11/27/06 http://www.cidrap.umn.edu/ )


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. Information and link to the International Conference on Avian Influenza.
- 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/.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html. Information on avian influenza: http://www.hc-sc.gc.ca/dc-ma/avia/index_e.html.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and journal 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. Updates on H5N1 in wild and domestic animals/birds (global).


2. Articles
WHO guidelines for investigation of human cases of avian influenza A(H5N1)
WHO released guidelines for investigating human cases of H5N1 avian influenza in an effort to shed more light on the virus and improve the chances of detecting changes that could turn it into a pandemic strain. The document calls for a thorough probe of each case, from interviewing the patient and searching for contacts through hunting for other cases nearby and sifting data for any signs of human-to-human transmission. It calls for investigating suspected cases before lab test results are available. The new guidance comes less than a month after the WHO issued a report on how much remains unknown about the H5N1 virus. The report said H5N1 illness is fundamentally different from ordinary flu in its severity and range of manifestations. The panel called for research to determine why children and young adults seem especially susceptible and whether genetic factors increase the risk of infection or transmission among blood relatives.

The introduction to the new guidance says, "The document reflects and incorporates the practical field experience gained by investigators working at international, national, and sub-national levels during investigations of A(H5N1)." The intention is that local health agencies will use the guidelines to build their own investigative plans and procedures. The purposes of case investigation include: Confirming the diagnosis of H5N1; Reducing illness and death by rapidly identifying cases and starting appropriate treatment and precautions; Reducing further spread by identifying possible sources of exposure and implementing prevention and control measures; Determining if human-to-human transmission is becoming more efficient; Identifying the key epidemiologic, clinical, and virologic characteristics of each case; Ensuring timely exchange of information among clinicians, health investigators, and government officials to facilitate appropriate responses.

In advice on searching for patients' contacts, WHO says investigators should assume that patients are infectious for 1 week before onset of illness and 2 weeks afterward, even though the infectious period for the virus has not been determined. Healthy contacts should be monitored and given preventive antiviral treatment, depending on their risk of exposure. Besides tracing contacts, investigators should search actively for other possible H5N1 cases by going from house to house and possibly conducting telephone surveys of healthcare facilities, practitioners, and labs, WHO advises.

The agency recommends against using rapid diagnostic tests for the H5N1 virus. "The diagnostic accuracy of commercially available rapid tests is unknown, and if the test result is positive, differentiation between influenza A subtypes is not possible and confirmatory tests must be done," WHO says. WHO has said a rapid, reliable diagnostic test for H5N1 infection is urgently needed. The guidance discusses potential clues to a change in the virus's human transmissibility and what to look for in evaluating clusters of cases. It also suggests doing complementary studies, such as seroprevalence surveys of people with possible occupational risk in affected areas and case-control studies to evaluate risk factors for infection.

Full report: http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_4/en/index.html
(CIDRAP 11/29/06 http://www.cidrap.umn.edu/ )


FAO: Enhancing control of highly pathogenic avian influenza in developing countries through compensation: issues and good practice
• Introduction: Objectives of the Report and of Compensation; Background and Rationale for Assessing Good Practices; Context in Which Compensation Occurs; Approach to Ascertaining Good Practice
• Deciding Who to Compensate: The Beneficiaries: Who Has Been Compensated in Control of Animal Diseases Other Than HPAI?; Who Is Involved in Poultry Production?; Ensuring That Eligible People Are Included
• Establishing Losses: Direct, Consequential, and Indirect Losses; Types of Losses That Compensation Schemes Typically Take into Account; Losses Covered by Private Insurance or Public-Private Partnership in Developed Countries
• Setting the Level and Timeliness of Compensation: Introduction; Approaches for Setting Compensation Rates; Who Defines the “Market” Price?; Choice of Price Baseline to Establish Compensation Rates; Establishing the Compensation Rate; Timeliness of the Payment
• Promoting Awareness, Communications, and Capacity Building: Background; Experience to Date; Preparing the Communication Plan; Preparing the Messages; Mechanisms and Channels of Communication on Compensation; Consistency of Message and Policy; Costs of the Awareness Campaign; Use of Nonpublic Sector Human Resources
• Organizing Payment and Accountability: Introduction; Insights from Economy Case Studies; Critical Success Factors; Who Pays?; Assessing Financial Needs; Payment Mechanisms and Timeliness; Certification; Use of Local Governments and Social Accountability; Core Components of Compensation; Good Practice Recommendations for Rapid Disbursements; Continuous Monitoring and Oversight
• Where Are We and Where Do We Go from Here?: Compensation as an International Public Good; Characteristics of Good Practice in Compensation Schemes Designed to Help Control Disease Spread in an Emergency; Changes in the Structural Context under Which Compensation Is Occurring; The Future of Compensation in the Context of the Future of the Poultry Sector
(FAO 11/27/06 http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html )


Evidence of influenza A virus RNA in Siberian lake ice
Zhang G et al. J Virol. 2006 Dec;80(24):12229-35. Epub 2006 Oct 11
Abstract: "Influenza A virus infects a large proportion of the human population annually, sometimes leading to the deaths of millions. The biotic cycles of infection are well characterized in the literature, including in studies of populations of humans, poultry, swine, and migratory waterfowl. However, there are few studies of abiotic reservoirs for this virus. Here, we report the preservation of influenza A virus genes in ice and water from high-latitude lakes that are visited by large numbers of migratory birds. The lakes are along the migratory flight paths of birds flying into Asia, North America, Europe, and Africa. The data suggest that influenza A virus, deposited as the birds begin their autumn migration, can be preserved in lake ice. As birds return in the spring, the ice melts, releasing the viruses. Therefore, temporal gene flow is facilitated between the viruses shed during the previous year and the viruses newly acquired by birds during winter months spent in the south. Above the Arctic Circle, the cycles of entrapment in the ice and release by melting can be variable in length, because some ice persists for several years, decades, or longer. This type of temporal gene flow might be a feature common to viruses that can survive entrapment in environmental ice and snow.”
(Promed 11/27/06)


What maintains parental support for vaccination when challenged by anti-vaccination messages? A qualitative study
Leask J, Chapman S, Hawe P, Burgess M. Vaccine. 2006 Nov 30;24(49-50):7238-7245. Epub 2006 May 23
Abstract: “This study sought to explore how parents respond to competing media messages about vaccine safety. Six focus groups with mothers of infants were shown television vignettes of typical pro- and anti-vaccination claims. Thematic analysis of transcripts was undertaken. Mothers expressed surprise and concern about alleged vaccine risks but quickly reinstated their support for vaccination by deference to authority figures; type-casting immunisation opponents; and notions of anticipatory regret, good parenting and social responsibility. We conclude that personal experiences, value systems and level of trust in health professionals are fundamental to parental decision making about vaccination. Vaccination advocacy should increase the focus on matters of process such as maintaining trust and public confidence, particularly in health professionals. Stories about people affected by vaccine-preventable diseases need to re-enter the public discourse.”
(CIDRAP http://www.cidrap.umn.edu/ )


Surveillance of influenza immunisation uptake in people aged under 65 years with chronic disease
Thomas DR et al. Vaccine. 2006 Nov 30;24(49-50):7027-9. Epub 2006 Jul 12 Abstract: “Historically, it has been difficult to obtain population based data on the uptake of influenza immunisation in people aged under 65 years who are at risk of serious illness or death from influenza and its complications. Data obtained electronically from 96% of all practices in Wales demonstrated that uptake in this group is low, with only a quarter of eligible patients immunised. Uptake varies considerably between patient groups and between geographical areas. This suggests an opportunity for significant health gain from targeted interventions to improve uptake.”
(CIDRAP http://www.cidrap.umn.edu/ )


3. Notifications
Fourth International Conference on Avian Influenza
6-8 Dec 2006, Bamako - the Fourth International Conference on Avian Influenza aims to: provide new insights into Avian Influenza disease development around the world and review progress recorded after the Beijing and Vienna Conferences; provide latest information on strategies and forms of compensation, vaccination, with reference to the major technical meetings' recommendations; and foster intergrated national strategies coordinated at regional and global levels.
(FAO http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html )


Vaccination: a tool for the control of avian influenza
OIE/FAO/IZSVe scientific conference, co-organised and supported by the EC 20 - 22 Mar 2007; Verona.
The objectives of the conference are to: Explain international standards, regulations and guidelines with regard to AI vaccination and trade implications; Review the current methods and recent experiences in the use of vaccination as one of the tools to control and prevent avian influenza; Assess the need of vaccination and its epidemiological and socio-economical consequences; Exchange scientific information on the efficacy and development of current vaccines and those under development in conjunction with other prevention and control methods; Discuss the decision-making process for the implementation of a vaccination strategy.


Flexible financing for FAO's avian influenza programme
The Special Fund for Emergency and Rehabilitation Activities (SFERA) is FAO's flexible financing facility for effective rapid emergency response. It allows FAO to channel funding to the geographical and thematic areas of greatest need, pool resources and allocate them more promptly, adapt flexibly to the changing priorities of a developing emergency situation, and focus corporate vision better, enabling a programmatic rather than piecemeal approach. First set up in response to the Indian Ocean tsunami and now being used for the avian influenza crisis, SFERA receives donations from the governments of China, France, Greece, Jordan, Norway, Saudi Arabia, Sweden and Switzerland donate to SFERA, and an agreement with the OPEC Fund is in the pipeline. This report takes stock of activities carried out under FAO's avian influenza programme with SFERA support as of September 2006.
(FAO http://www.fao.org/docs/eims/upload//217280/rep_hpai_sfera_en.pdf )