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EINet Alert ~ Jan 26, 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: FAO says recent spread of avian influenza H5N1 doesn't match last year's
- Hungary: Report of avian influenza H5N1 infection in geese
- Indonesia (Jakarta): Government to ban backyard poultry
- Indonesia: New human cases of avian influenza H5N1 infection
- Thailand: Control policies against avian influenza H5N1
- Thailand (Nong Khai): Report of a new avian influenza H5N1 outbreak in poultry
- Viet Nam: Avian influenza H5N1 found in ducks in Can Tho City
- Viet Nam (Dong Thap): Ducks infected with avian influenza H5
- Japan (Miyazaki): Avian influenza H5N1 highly virulent; studies on origin
- Japan (Miyazaki): Suspected second outbreak of avian influenza H5N1 in poultry
- South Korea: Latest poultry outbreak caused by avian influenza H5N1 virus
- Hong Kong: Wild birds confirmed to have avian influenza H5N1 infection
- Australia: Launch of new surveillance project for wild birds
- Egypt: Eleventh human death from avian influenza H5N1 infection
- Nigeria (Kano): Outbreak of avian influenza H5N1
- Avian/Pandemic influenza updates
- Seasonal Influenza
- Impact of Rapid Diagnosis on Management of Adults Hospitalized With Influenza
- Antiviral Resistance and the Control of Pandemic Influenza
- Modeling the Worldwide Spread of Pandemic Influenza: Baseline Case and Containment Interventions
- No Evidence of Avian Influenza A (H5N1) among Returning US Travelers
- Compensation for Avian Influenza Cleanup
- Pandemic influenza preparedness: business continuity planning for the global healthcare industry
- Business preparedness for pandemic influenza
- CDC offers pandemic communication guidance
- Pandemic Influenza: Progress Made and Challenges Ahead
- IDSA urges requiring flu shots for healthcare workers in new 12 point plan
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: 269 (163).
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 1/25/07): http://gamapserver.who.int/mapLibrary/
Global: FAO says recent spread of avian influenza H5N1 doesn't match last year's
Lubroth warned that banning backyard poultry would lead to illegal poultry production. His warning came less than a week after the city government in Jakarta, Indonesia, announced that backyard poultry would be banned as of Feb 1 in an effort to control avian flu. Instead of banning production, he said, authorities should encourage farmers to participate in virus control and vaccination campaigns. Given the prevalence of avian flu in Indonesia, FAO has suggested vaccination of chicks before they leave hatcheries, plus mass vaccination in heavily infected areas. FAO also said that the private sector should be more closely involved in avian influenza control campaigns.
Hungary: Report of avian influenza H5N1 infection in geese
Hungary announced an H5N1 avian influenza outbreak at a goose farm, signaling the first appearance of the disease in Europe this winter. Hungarian authorities notified the European Union of an H5N1 avian flu outbreak in Csongrad County in southeastern Hungary. The EU said veterinarians tested some geese after several deaths were reported in a 3,000-bird flock; the remaining geese were culled. Reportedly, residents said a large flock of wild ducks had passed through the area last month. Hungarian officials said they will send samples to a UK lab to confirm results. Chief veterinarian Miklos Suth said a surveillance zone was set up around the farm (3-km protection zone and 10-km surveillance zone), which is in an isolated location, making spread of the disease unlikely. Croatia banned imports of poultry from Hungary 24 Jan 2007. Hungary's first H5N1 outbreaks involved a handful of mute swans in the south-central region Apr 2006. The following June, the disease was detected on several goose farms in the same area. 26 nations in Europe reported their first H5N1 outbreaks in wild birds or poultry late 2005 and early 2006. The last previous outbreak in Europe occurred in Germany Aug 2006.
(CIDRAP 1/23/07, 1/24/07 http://www.cidrap.umn.edu/ ; Promed 1/24/07)
Indonesia (Jakarta): Government to ban backyard poultry
Government authorities in Indonesia banned backyard poultry in the country's capital after 5 human cases were reported so far this month, all in Jakarta or its suburbs. In several instances, poultry deaths were reported in the patients' neighborhoods. Residents reportedly have until Jan 31 to surrender the banned fowl, including chickens, ducks, swans, quail, and pigeons. The government promised to pay USD1.40 for each bird surrendered for culling. A fully grown chicken costs about USD 4 in Jakarta. Indonesia has resisted widespread culling in the past, despite the high number of human illnesses. Backyard farmers are often reluctant to hand over their sick or at-risk birds. The country has about 350 million backyard chickens, many of which are in Jakarta and surrounding areas.
Health Minister Siti Fadilah Supari told residents culling is urgently needed. She said 18 Jan 2007 the ban in Jakarta would be extended to 8 other provinces that had reported human infections of the H5N1 bird flu virus. Starting Feb 1, government officials will go door-to-door confiscating banned birds, the governor of Jakarta said. Officials of Bogor, a town that neighbors Jakarta, branded the culling plan unrealistic and too expensive. A number of regencies said it was difficult to conduct mass culls due to the limited availability of funds to compensate owners and the absence of necessary regulations. West Java legislators and officials of the provincial livestock husbandry office are also questioning a decrease in the supply of bird flu vaccine from the central government at a time when the virus is spreading.
Indonesia: New human cases of avian influenza H5N1 infection
5 people in Indonesia’s South Sulawesi province are hospitalized with possible avian flu symptoms at Wahidin Sudirohusodo hospital in Makassar. The patients, 3 of whom are children, are reportedly improving. All come from the same area, Tamamaung village in Panakkukang district, Makassar, where chicken deaths had been reported. They were sent to the hospital after coming down with high fever and breathing problems. A quick test result reportedly found that one was infected with influenza virus type A. There are also reports of suspected avian flu cases from Bandung and Semarang, Central Java. Since the beginning of Jan 2007, 5 human cases of H5N1 avian influenza have been confirmed in Indonesia, 4 of whom have died. Human cases have been reported from 8 provinces (Banten, Jakarta, West Java, East Java, Lampung, West Sumatra, North Sumatra, South Sulawesi).
Thailand: Control policies against avian influenza H5N1
Thailand (Nong Khai): Report of a new avian influenza H5N1 outbreak in poultry
Also, 12 children and 1 man from Phichit and Ang Thong provinces are reportedly under watch after they became ill following suspicious chicken deaths in their areas. 8 of the children experienced high fevers after a chicken carcass was found in their schoolyard.
Viet Nam: Avian influenza H5N1 found in ducks in Can Tho City
Viet Nam (Dong Thap): Ducks infected with avian influenza H5
Japan (Miyazaki): Avian influenza H5N1 highly virulent; studies on origin
Also, the avian flu in Miyazaki was found to be almost identical to the one that sparked an epidemic in China that has been spreading since 2005. Experts said the highly virulent strain of the virus might have been carried by migratory birds from China to Japan. The National Institute of Animal Health has been analyzing the virus after obtaining samples from dead chickens at a poultry farm in Kiyotake, Miyazaki Prefecture, in mid-Jan 2007. The test results showed that the strain found on the Kiyotake farm was at least a 99-percent match in terms of DNA sequencing with the H5N1 strain confirmed in China May 2005. The strain at the Kiyotake farm is apparently genetically different from the other H5N1 strain of avian flu that has caused outbreaks in Southeast Asia. Several thousand migratory birds have been killed by avian flu at Qinghai Lake, in the western part of China. The Ministry of Agriculture, Forestry and Fisheries is trying to determine the route of the infection that ended up killing thousands of chickens at the Kiyotake farm. The same H5N1 strain is believed to have caused an epidemic in South Korea Nov 2006.
Japan (Miyazaki): Suspected second outbreak of avian influenza H5N1 in poultry
South Korea: Latest poultry outbreak caused by avian influenza H5N1 virus
Hong Kong: Wild birds confirmed to have avian influenza H5N1 infection
Also, Hong Kong should tighten imports of wild birds from China, which are released en masse at Buddhist religious rites, due to the risk they could spread bird flu to poultry, experts say. 6 scaly-breasted munias--a popular species of "prayer birds" used for release in Buddhist rituals to enhance a devotee's karma--were found dead on New Year's eve, including 1 which tested positive for the H5N1 virus. Prayer bird species range from munias, Japanese white-eye, white-rumped munia and tree sparrows costing as little as HK 4 (USD 0.50) each, to the more expensive azure-winged magpies and Mongolian larks. While the Hong Kong government tightly regulates poultry imports, laws for wild bird imports are much more lax, making it a potential crack in the city's bird flu defenses. The territory banned imports of poultry from Japan 15 Jan 2007 after a fresh outbreak of bird flu there. Richard Corlett, a professor of ecology at the University of Hong Kong, said the trade in wild birds was on a much larger scale than previously thought, with at least half a million birds freed by Buddhists in 2005. The European Union passed new laws last week banning imports of wild birds. The government has not said whether it would consider a ban on wild bird imports but has urged Buddhist organizations not to release such birds in the future.
Australia: Launch of new surveillance project for wild birds
Egypt: Eleventh human death from avian influenza H5N1 infection
As of 22 Jan 2007, Egypt announced a new human case of avian influenza A(H5N1) virus infection. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No.3 (NAMRU-3). The 27-year-old woman from Beni Sweif Governate developed symptoms 9 Jan 2007 and died in hospital 19 Jan 2007. Initial investigations indicate the presence of sick and dead poultry at her residence in the days prior to the onset of illness. Of the 19 cases confirmed to date in Egypt, 11 have been fatal. The other 8 have recovered.
(Promed 1/20/07, 1/23/07)
Nigeria (Kano): Outbreak of avian influenza H5N1
Also, officials are investigating 2 suspected human H5N1 cases. A mother and daughter from Lagos, Nigeria’s largest metropolitan area, died within 2 weeks of eating chicken bought from a live-chicken market. The father of the family said that after one of the chickens they bought died mysteriously, the family slaughtered the rest. Reportedly WHO was awaiting test results on the woman, her daughter, and a chicken.
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. 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.
- 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. 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)
Canada. Localized activity of influenza A was reported in parts of Canada during weeks 51–52, with an overall influenza-like illness (ILI) consultation rate below the expected range for the time of year.
USA. Influenza activity increased during weeks 51–52 and was widespread. The overall ILI consultation rate was above the national baseline, but the percentage of deaths due to pneumonia and influenza remained below the baseline level. During week 52, 82% of the influenza viruses detected were influenza A and 18% influenza B. Of the A viruses subtyped, 95% were influenza A(H1) and 5% A(H3) viruses.
Other Reports. During weeks 51–52, low influenza activity was reported in Hong Kong (H1, H3 and B), Japan, and Russia (H1, H3 and B). Mexico reported no influenza activity.
Impact of Rapid Diagnosis on Management of Adults Hospitalized With Influenza
Ann R. Falsey, Yoshihiko Murata, and Edward E. Walsh.
Arch Intern Med. 2007;167:(doi:10.1001/archinte.167.4.ioi60207).
Abstract: “Background: Rapid influenza testing decreases antibiotic and ancillary test use in febrile children, yet its effect on the care of hospitalized adults is unexplored. We compared the clinical management of patients with influenza whose rapid antigen test result was positive (Ag+) with the management of those whose rapid antigen test result was negative or the test was not performed (Ag0). Methods: Medical record review was performed on patients with influenza hospitalized during 4 winters (1999-2003). Hospital policy mandated influenza testing (antigen or culture) for all patients with acute cardiopulmonary diseases admitted from November 15 through April 15. A subset of patients participated in an epidemiological study and had reverse-transcriptase polymerase chain reaction or serologic testing performed. Clinical data from Ag+ and Ag0 patients were compared. Results: Of 166 patients with available records, 86 were Ag+ and 80 were Ag0. Antibiotic use (74 [86%] of 86 patients vs 79 [99%] of 80 patients; P = .002) was less and antibiotic discontinuance (12 [14%] of 86 patients vs 2 [2%] of 80 patients; P=.01) was greater in Ag+ compared with Ag0 patients. No significant differences in antibiotic days, length of hospital stay, or antibiotic complications were noted. Antiviral use (63 [73%] of 86 patients vs 6 [8%] of 80 patients; P<.001) was greater in Ag+ than Ag0 patients. Antigen status was independently associated with withholding or discontinuing antibiotics in multivariate analysis. Of 44 Ag+ patients deemed low risk for bacterial infection, 27 continued to receive antibiotics despite positive influenza test results. These patients more commonly had pulmonary disease and had significantly more abnormal lung examination results (P = .005) compared with those in whom antibiotics were withheld or discontinued. Conclusions: Rapid influenza testing leads to reductions in antibiotic use in hospitalized adults. Better tools to rule out concomitant bacterial infection are needed to optimize the impact of viral testing.”
Antiviral Resistance and the Control of Pandemic Influenza
Modeling the Worldwide Spread of Pandemic Influenza: Baseline Case and Containment Interventions
No Evidence of Avian Influenza A (H5N1) among Returning US Travelers
Compensation for Avian Influenza Cleanup
The response to the second question, extent of compensation, varies. In Nigeria, farmers are partially compensated for loss of poultry; however, in the United States, farmers who are part of the USDA program are fully compensated for loss of poultry and equipment. Setting the amount of compensation is difficult and can affect the outcome of culling efforts. In Thailand, to take advantage of the program in which compensation was perceived as high, some farmers reportedly moved infected poultry into previously uninfected areas. In Vietnam, where compensation was perceived as low, culling compliance was poor.
The last question, who should be compensated, seems straightforward for the United States, where only farmers who participate in the USDA program would be fully compensated. However, H5N1 does not affect only farmers who sign up for such a program. And not all poultry are raised in commercial operations, especially in developing countries. In Thailand, for example, >80% of infected poultry are reportedly raised in backyards. Reasonable assumptions are that those backyard farmers do not honestly report dying poultry or that they rush sick and dying poultry to market, causing the disease to spread. Additional questions revolve around potential compensation for those who are involved in the poultry industry but who do not own poultry (e.g., poultry processing plant operators and their staff). Because each country's needs and circumstances differ, building a coherent plan for tackling HPAI is difficult. However, each stakeholder should consider compensation as part of an overall package of prevention, preparedness, and response strategies toward controlling and preventing the spread of HPAI. Because H5N1 does not respect international boundaries, donors worldwide should step forward to support the most affected and vulnerable developing countries.”
Pandemic influenza preparedness: business continuity planning for the global healthcare industry
Report from the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), released Jan 22, 2007:
“Many organisations have business continuity plans in place to address the impact of a crisis on their continuing operations. While these plans are likely to cover a variety of scenarios, it is important that they are reviewed and updated to address the specific case of an influenza pandemic. Unlike other crises, an influenza pandemic could result in a peak employee absenteeism rate of 30% – 50% and last for an extended period of time. Therefore, pharmaceutical manufacturers’ continuity plans must focus on maintaining the manufacture and supply of essential medicines to patients and communities around the world during an influenza pandemic. This paper outlines the key areas that pandemic influenza business continuity plans should address. The IFPMA recommends that members develop detailed plans to address the issues covered in this paper, and publish a non-confidential overview on their websites to enhance confidence and demonstrate their preparedness to key stakeholders: employees, governments, suppliers, customers, health care professionals and local communities. . .”
Business preparedness for pandemic influenza
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'.
For more information: https://programs.regweb.com/metro/cidrap07/1/. Also, CIDRAP has an article 1/24/07 about the summit:
CDC offers pandemic communication guidance
Communicators need to show empathy within the first 30 seconds of a crisis message. "If not, they won't hear your message because they're so overwrought with their emotions," said Reynolds. During a pandemic, a public health communicator's job is to help people manage their emotions so that they can still function and not be "hopeless or helpless," Reynolds said. She outlined several mistakes to avoid, such as: Mixed or late messages: When it's critical to send a message quickly, "Don't worry about grammar or punctuation," she said. Paternalism: "It's not reasonable to tell people to not be afraid. Address that they are afraid, then give them information that may help alleviate that fear," Reynolds said. Ignoring rumors or myths: The longer rumors are allowed to circulate, the more likely they are to take hold. Power struggles between government agencies, which erode pubic confidence in crisis response.
Communities and businesses should be planning their communications strategies now for scenarios such as the first H5N1 avian flu outbreak in poultry on US soil, she said. Withholding information during a pandemic is risky, Reynolds said, because honesty and openness during a crisis help build the public's trust. She said news reporters are more likely to interpret events themselves when they have fewer facts and less background information. Public health communicators should also be careful not to unnecessarily or unconsciously link people or things to specific health threats.
Pandemic Influenza: Progress Made and Challenges Ahead
IDSA urges requiring flu shots for healthcare workers in new 12 point plan
The strongest language in the IDSA's proposals was aimed at boosting seasonal flu immunization rates among healthcare workers. The current rate for this group is about 40%, ISDA report says. IDSA recommends that healthcare workers be required to receive flu shots unless they decline, for religious or philosophical reasons or because of a medical contraindication. Other recommendations are aimed at supporting the development of new vaccines and improving the supply and selection of antiviral medications. The US should serve as a catalyst for a well-financed international effort to quickly develop pandemic influenza vaccines, the report says. IDSA envisions the effort as a large public-private partnership. IDSA supports using incentives for the pharmaceutical industry to develop flu vaccines and treatment. The group emphasizes that antibiotic innovations should also be a focus of pandemic flu planning, because patients who have severe influenza often develop lethal secondary bacterial infections. Planning for mass casualty events and updating plans for distributing vaccines and antivirals are other major themes of the IDSA's recommendations.
Among suggestions for protecting the healthcare workforce during a pandemic, IDSA proposes that Congress establish a compensation fund to help those who are injured by a pandemic influenza vaccine given during an emergency, as well as liability protection for healthcare workers following altered standards of care, consistent with local and national recommendations, during a public health emergency. Other recommendations include developing and testing community mitigation measures, improving flu surveillance, and strengthening leadership and communication.