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EINet Alert ~ Jan 12, 2007
*****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 prevention puzzle: linking knowledge, action
- EU: Tighter regulations for importing live captive birds
- Indonesia: Additional confirmed and suspected cases of avian influenza H5N1 infection in humans
- China (Anhui): Human case of avian influenza H5N1 infection
- Viet Nam: Avian influenza H5N1 spreads to fifth province
- South Korea: Poultry worker was infected with avian influenza H5N1
- Hong Kong: Avian influenza H5N1-infected bird found
- Japan (Miyazaki): Farm may have avian influenza outbreak
- Bangladesh: Undiagnosed deaths in poultry
- Azerbaijan: Undiagnosed deaths in poultry
- USA: HHS awards $102 million for new influenza drug
- USA: FDA approves refrigerated form of FluMist
- USA (Iowa): Human case of swine influenza
- Nigeria: Avian influenza suspected in poultry
- Avian/Pandemic influenza updates
- Seasonal Influenza
- Pandemic Influenza School Closure Policies
- Influenza vaccination and risk of mortality among adults hospitalized with community-acquired pneumonia
- Avian Influenza Risk Perception, Europe and Asia
- Code-based Syndromic Surveillance for Influenzalike Illness by International Classification of Diseases, Ninth Revision
- Tropism of avian influenza A (H5N1) in the upper and lower respiratory tract
- Pandemic Preparedness Planning for US Businesses with Overseas Operations
- Pandemic Planning Tool Kit
- Flu Vaccine Effectiveness: Questions and Answers for Health Professionals
- Business preparedness for pandemic influenza Summit
- Paris Anti-Avian Influenza Conference
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: 265 (159).
Avian influenza age & sex distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 1/12/07): http://gamapserver.who.int/mapLibrary/
Global: Avian influenza prevention puzzle: linking knowledge, action
The gap between knowing what to do and doing it is spotlighted by a dispatch in the Jan edition of Emerging Infectious Diseases. The paper reports the results of a "knowledge, attitudes and practices" survey of 460 Cambodian villagers. 97 % of the 269 households where the villagers lived kept chickens. 81% of the households had learned about avian flu and flu prevention from announcements on television; 78% had heard similar messages on the radio. 72% of the participants understood that avian flu is a fatal disease that can be transmitted to humans, 67% thought it was unsafe to touch sick or dead poultry with their bare hands, and 70% knew it was not safe to eat wild birds. Poultry had indeed died in 62% of the households in the previous 6 months. Nevertheless, 75% acknowledged touching sick or dead poultry bare-handed; 45% ate poultry that had died from illness; 33% ate wild birds; and 8% collected and ate dead wild birds. In addition, though half of the participants agreed on the importance of reporting poultry deaths to authorities, many did not report—41% because they did not know how, 31% because they had not done so in the past, and 18% because they believed it would hurt sales of their surviving birds.
The divide between developing-world villagers' avian-flu beliefs and practices is familiar and frustrating territory to groups that work on flu control. Villagers who did not follow safe practices nevertheless had not gotten sick, leading others to conclude that eating sick and dead poultry was worth the risk. Equipment that could protect them during handling and slaughtering (rubber gloves, masks, soap, etc.) is hard to obtain. Some avian-flu prevention programs improve their success when they choose locally trusted sources to deliver flu-control messages. In addition, "We try to ask what the motivation is—why people will do this," Academy for Educational Development’s Silvio Waisbord said. "Technical messages may not work, but. . .'Protect your birds so you will have them for religious festivals,' those messages resonate with people's existing concerns." Economic incentives such as payments in exchange for preventively slaughtered birds can be a powerful persuader—the World Bank recently recommended that compensation be paid directly to farmers in cash within 24 hours of a cull.
Recently, staff at some nonprofit organizations that work on avian flu have been comparing efforts against the disease to campaigns against HIV/AIDS. Early on it became clear that blanket prohibitions on behaviors that transmit HIV would never conquer human nature, but campaigns that encouraged incremental protective steps had a chance of success. (One, the ABC campaign—from its slogan "Be Abstinent, Be faithful, use a Condom”) That risk-reduction model, advocates argue, may have a better chance of controlling avian flu than broad prohibitions that effectively order villagers to sacrifice important sources of protein and income. Whitney Pyles, avian influenza coordinator for CARE International, said the essential component is turning out to be community participation. Protective behaviors that are discussed and agreed to by a community have better adherence than solutions imposed from above by national health authorities.
EU: Tighter regulations for importing live captive birds
Indonesia: Additional confirmed and suspected cases of avian influenza H5N1 infection in humans
The husband and son of an Indonesian woman who was being treated for H5N1 avian influenza were hospitalized with possible cases of the same illness 11 Jan 2007, and the woman died shortly afterward. The 38-year-old woman from Tangerang, Banten Province died at Persahabatan Hospital in East Jakarta. The woman reportedly slaughtered a chicken she bought from a local market. Deaths among poultry in the neighbourhood have also recently been reported. The woman's case was first reported Jan 8, 2007. Reportedly, the woman's 42-year-old husband and their 18-year-old son were hospitalized 11 Jan 2007 with fever and signs of respiratory infection and were being tested for the H5N1 virus.
On 10 Jan 2007, a 14-year-old boy from Tangerang died of avian influenza H5N1 at the same hospital. He developed symptoms 31 Dec 2006 and was hospitalized 4 Jan 2007. Deaths among poultry in the neighbourhood have recently been reported, and he had reportedly been in contact with ducks but the source of exposure is currently still under investigation.
The Ministry of Health has also confirmed a new case of human infection with the H5N1 avian influenza virus. The 22 year old woman from Banten Province developed symptoms 3 Jan 2007 and remains in hospital. An initial investigation into the source of her exposure found reports of chicken deaths near her home in the days prior to symptom onset. Of the 77 cases confirmed to date in Indonesia, 59 have been fatal. Indonesia has the world's highest avian influenza H5N1 death toll.
China (Anhui): Human case of avian influenza H5N1 infection
Of the 22 cases confirmed to date in China, 14 have been fatal. China last reported a human case of bird flu Jul 2006, when a farmer died of H5N1 in Xinjiang. Investigation had found no history of exposure to dead or diseased birds. The man had no history of travel the month before he got sick, and no poultry outbreaks were reported near his home. The most recent reported poultry outbreaks were early Oct 2006 in Inner Mongolia and Ningxia. China has been criticized for a lack of transparency in its handling of health threats, but Bekedam said WHO was informed of the case as soon as he tested positive, and WHO praised the fact that he was tested a second time after his first tests turned up negative.
Viet Nam: Avian influenza H5N1 spreads to fifth province
Officials from WHO and the UN Food and Agriculture Organization (FAO) are in talks with the Vietnamese government about sending experts to investigate the source of the outbreaks. Viet Nam has had no human cases since Nov 2005, though it had 93 cases with 42 deaths before that. For an interactive map of HPAI visit: http://www.oie.int/wahidprod/public.php?page=disease_outbreak_map&disease_id=15. Clicking on Vietnam will allow zooming in and viewing the respective locations of the recent outbreaks.
South Korea: Poultry worker was infected with avian influenza H5N1
Hong Kong: Avian influenza H5N1-infected bird found
AFCD advised the public not to release birds. The statement said pet birds imported from mainland China must come from registered farms and be accompanied by a veterinary health certificate certifying that the birds have been quarantined and have tested negative for H5. Farms on the mainland that are allowed to export birds to Hong Kong are inspected by mainland authorities and occasionally by AFCD authorities and must have had no avian flu outbreaks in the past 180 days. AFCD has enhanced checks on farms and pet shops, and physicians will be informed of the latest situation. Precautionary measures and cleaning operations have been enhanced in all Leisure & Cultural Services Department venues where birds congregate. The aviaries in Hong Kong Park, the Zoological & Botanical Gardens and Kowloon Park have been temporarily closed. All the birds are healthy. The government said its records show that 38,000 munias were imported into Hong Kong from the mainland in 2006. The scaly-breasted Munia is a resident bird in Hong Kong and has been found all over the territory (although reportedly more common in rural areas).
Japan (Miyazaki): Farm may have avian influenza outbreak
Bangladesh: Undiagnosed deaths in poultry
Azerbaijan: Undiagnosed deaths in poultry
USA: HHS awards $102 million for new influenza drug
In an effort to expand the pool of antiviral drugs for influenza, the US government awarded a $102.6 million contract to BioCryst Pharmaceuticals Inc. to develop peramivir, a new neuraminidase inhibitor. Research under the contract will include tests involving the H5N1 virus and may include research on the possible preventive use of the drug. Licensed drugs in the neuraminidase inhibitor class are taken orally (oseltamivir) or by an inhaler (zanamivir). However, peramivir is under development as a parenterally administered drug, meaning it can be given through intramuscular and intravenous routes. The Department of Health and Human Services (HHS) said a parenteral neuraminidase inhibitor may be particularly useful in hospital emergency departments for treatment of patients who have life-threatening flu. Parenteral injection could permit rapid buildup of peramivir to high levels throughout the body and allow treatment of people too ill to take medications by mouth, the agency said.
BioCryst said its laboratory tests have shown that peramivir, an inhibitor of influenza A and B neuraminidases, is more potent than currently available drugs in its class and is active against antiviral-resistant flu strains. The company said high doses of injectable formulations have been safely administered to healthy people, and the drug has been found to promote survival in animals infected with the H5N1 virus. Both the intramuscular and intravenous formulations of peramivir will go through phase 2 and 3 clinical trials. The intramuscular formulation will be tested against a placebo in outpatients, and the intravenous trial will likely test peramivir against oseltamivir in hospitals. Enrollment of patients for the phase 2 trials will begin this flu season in the US, Canada, and Europe; the company has identified sites in the southern hemisphere that could be used to fill this year's phase 2 study groups or facilitate an early start on phase 3 studies. BioCryst is also identifying sites in Southeast Asia, where flu outbreaks occur year-round, that might be added to the study. The HHS contract to develop peramivir is subject to an emergency use authorization that would allow the department to stockpile the drug before approval by the Food and Drug Administration (FDA) if clinical data show it to be beneficial.
USA: FDA approves refrigerated form of FluMist
USA (Iowa): Human case of swine influenza
Nigeria: Avian influenza suspected in poultry
New cases of bird flu have been recorded on 2 farms in north-western Nigeria, officials say, a year after the disease was first found there. Reportedly local officials had culled 1070 chickens. Some of the infected birds were found in a backyard farm in Katsina town. There are fears that 2 other farms may be infected. "We've heard it, but we are not yet sure. . ." said Ayokanmi Osinlu, spokesman for Nigeria's health minister. There have been no human victims in Africa's most populous country since the H5N1 strain was first recorded early in 2006. The UN had expressed concerns about the Nigerian government response to the disease, as poultry are still being moved around by local farmers despite an official quarantine and promised compensation for infected birds.
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat; managed by UN System Influenza Coordination (UNSIC). Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- 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. Link to “Vaccination: a tool for the control of avian influenza”; various updates under “Highlights”.
- US CDC: http://www.cdc.gov/flu/avian/index.htm. Link to OPLAN
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. The public is also being asked to comment on vaccine prioritization.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html. Check out the highlights from the Canadian Pandemic Influenza Plan for the Health Sector.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and journal articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Global updates.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)
Pandemic Influenza School Closure Policies
Laura H. Kahn. EID Journal Home > Volume 13, Number 2–February 2007. (references removed)
To the Editor: “. . .The US Department of Health and Human Services' checklist regarding school closures gives conflicting messages. For example, it recommends that schools stay open during a pandemic and develop school-based surveillance systems for absenteeism of students and sick-leave policies for staff and students. It also recommends developing alternate procedures to ensure the continuity of instruction in the event of district-wide school closures. These vague recommendations may reflect the paucity of data to recommend school closure. To assess the current status of school closure decisions in the United States, I conducted an internet survey of all 50 state health commissioners during the spring of 2006. I asked the respondents 2 questions: "Who makes the school closure decisions in your state?" and "What absenteeism rate, if any, would prompt a school in your state to close during a typical influenza year and/or during a pandemic influenza year?" Of the 44 responding states, I found that school closure decisions were primarily a local-level responsibility in half. Of these 22 states, closure decisions would be made either on a school-by-school or a school district–by–school district basis. Only 6 states indicated that school closure decisions would be made at the state level, and 16 states would have decisions made jointly at the state and local levels. For a typical influenza season, only 6 states indicated that they close schools if a certain absenteeism rate due to illness were reached. For 5 of these states, the absenteeism rates ranged from 10% to 30%; the sixth state said its schools would close if the rates were anywhere from 7% to 31%. However, only 1 state reported a threshold absenteeism rate for closure during an influenza pandemic. Another state said that it was developing an absenteeism rate that would prompt closure for pandemic influenza. Forty-two states did not have threshold absenteeism rates that would prompt school closures during an influenza pandemic. . .I therefore think a national policy, or at least specific national guidelines, should be developed jointly by the Centers for Disease Control and Prevention and the Department of Education, so that states' school districts can develop rational, coherent, and coordinated closure plans to protect children and communities during an influenza pandemic.”
Influenza vaccination and risk of mortality among adults hospitalized with community-acquired pneumonia
Avian Influenza Risk Perception, Europe and Asia
Code-based Syndromic Surveillance for Influenzalike Illness by International Classification of Diseases, Ninth Revision
Tropism of avian influenza A (H5N1) in the upper and lower respiratory tract
Pandemic Preparedness Planning for US Businesses with Overseas Operations
In the event of pandemic influenza, businesses will play a key role in protecting employees’ health and safety as well as limiting the negative impact to the economy and society. The US Government has created a guide to help U.S. businesses with overseas operations prepare and implement pandemic business continuity. This is a list of suggestions and can serve as a starting point for developing a comprehensive plan. The checklist highlights actions applicable to businesses of all sizes, although each item does not necessarily apply to every overseas business. Checklist sections include:
• Plan for maintaining business continuity during and after a pandemic
• Plan for the impact of a pandemic on the lives and welfare of your employees
• Establish policies and guidelines to be implemented during a pandemic to avoid creating policies on demand” in the midst of a pandemic
• Determine resources required to fulfill actions in your pandemic plan
• Create an emergency communications system
• Work to coordinate with external organizations and your community
• Prepare for post-pandemic scenarios
Pandemic Planning Tool Kit
Flu Vaccine Effectiveness: Questions and Answers for Health Professionals
Business preparedness for pandemic influenza Summit
By attending the 2007 Summit, you will: 1) Discover risk-communication techniques to help combat “pandemic fatigue”; 2) Learn how to run meaningful business preparedness tabletop scenario exercises; 3) Gain access to the scientific and business facts necessary to gain "buy in" with internal and external constituents; 4) Benchmark your organization’s pandemic preparedness to discover how your budget allocations and major decisions stack up against others'.
Paris Anti-Avian Influenza Conference