EINet Alert ~ Feb 25, 2005

*****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:

1. Notifications
- Viet Nam: WHO official--bird flu control in Viet Nam improved
- Viet Nam: Second International meeting on avian influenza opens in Ho Chi Minh
- Viet Nam: Leading veterinary experts of 28 countries call for more vigorous bird flu control
- Southeast Asia: Fighting bird flu at its origin to prevent a human flu pandemic
- WHO: Bird flu pandemic is imminent, Governments must act swiftly to prevent outbreak
- OIE-FAO International Conference on Avian Influenza, Paris, France 7 - 8 April 2005
- "Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population"

1. Notifications
Viet Nam: WHO official--bird flu control in Viet Nam improved
Bird flu control has improved, and so have government measures against bird flu outbreaks, particularly in the health sector, said Dr Troesson Hans, resident representative of WHO in Viet Nam. He added, "other very positive signs are the commitment and awareness within the government, especially at the highest level." If long term measures are taken to control animal infections, Viet Nam will stand a good chance of preventing any further outbreaks, Hans said. "In the short term, Viet Nam should manage outbreaks through continued surveillance of poultry and humans, and contain animal infections. In the long term, it should help change behavior in at-risk populations through information, education and communication activities, increase the capacity to respond rapidly, build integrated animal and public health surveillance systems, improve laboratory capacities for analyzing and testing samples bio-safelyViet Nam and other Asian countries should make long-term investments to control infections in animals throughout the chain, from poultry raising to marketing and transportation right through to the household level, implications of which would be major changes in husbandry practices. We are providing technical and financial support [for] Viet Nam and other regional countries, and coordinating with the UN FAO to mobilize additional donor resources," Hans said. (Promed 2/23/05)


Viet Nam: Second International meeting on avian influenza opens in Ho Chi Minh
Viet Nam has taken comprehensive measures to prevent and fight bird flu, said Minister of Agriculture and Rural Development Cao Duc Phat. At the 2nd regional meeting on avian influenza control in animals which opened in Ho Chi Minh City 23 Feb 2005, Phat also said that the country's efforts had contributed to regional countries' success in controlling the disease. More than 150 delegates from 30 countries are attending the three day meeting, jointly organized by the FAO, the OIE and the WHO. They reviewed bird flu developments in the region and measures taken to deal with the disease over the past 12 months. They also made scientific presentations on achievements in discovering, inspecting, preventing and controlling the disease. Issues relating to economy, international cooperation and people's health were also mentioned at the meeting.

The meeting is an opportunity for regional countries to share experiences in bird flu control and in protecting humans from the disease. Apart from calling upon international organizations to support the fight against the disease, the meeting will provide up-to-date information to help countries strengthen their capacity for controlling avian influenza. The Agriculture and Rural Development Ministry's Veterinary Department reported that, by 21 Feb 2005, no new outbreaks have been found in 12 out of 35 bird flu-affected provinces and cities in Viet Nam in the past 21days. The provinces and cities free from the outbreak include Kien Giang, Ninh Binh, Ha Nam, Binh Phuoc, Ninh Thuan, Lam Dong, Quang Binh, Thai Nguyen, Nghe An, Dong Nai and Tien Giang provinces, and Ho Chi Minh City. (Promed 2/23/05)


Viet Nam: Leading veterinary experts of 28 countries call for more vigorous bird flu control
An international conference on avian influenza has expressed major concern about the bird flu situation in the region. Chief Veterinary Officers from 28 countries called upon governments in the region and the international community to make the fight against the lethal virus a top priority and to commit more financial resources to national and regional anti-bird flu campaigns. Animal and human health experts agreed that one year after the bird flu crisis, progress has been made in the early detection of and rapid response to the disease. There are fewer outbreaks in the region today than were recorded one year ago. However, the virus is still circulating among poultry, ducks and wildlife in the region and continues to pose a serious threat to human health and animals. More funds and more vigorous bird flu control campaigns in affected countries could help to control the disease in birds and thus avoid the risk of a global avian influenza pandemic in humans. Countries hit by the virus should take a more proactive approach to combat the disease at its origin. Funding for this approach is considered essential.

The virus circulation in poultry-producing rural and urban areas and marketplaces requires more attention, according to conference participants. As long as the virus continues to circulate among animals, it will remain a threat to humans. Massive public awareness campaigns should sensitize poultry producers and consumers throughout the food chain about bird flu related risks. Farmers and veterinarians should become the main allies in detecting the virus at the earliest stage possible to trigger immediate control interventions.

The conference also recognized the link between farming systems and the spread of the virus, especially the proximity between farmed chickens and ducks in many backyard farms contributing to the circulation of the disease. In addition, the movement and marketing of live animals, not controlled by veterinarians, are a major cause of the spread of the disease. The conference recommended several strategies to minimize the risk of virus transmission between species and to therefore protect humans. These include segregation in farm settings of chickens, ducks, and other animals such as pigs and a reduction in contact between these animals and humans.

Delegates called upon the global community to help with the financing of these costly but vital changes. More than $100 million would be needed to urgently strengthen animal health services and laboratories to improve virus detection and its ultimate eradication. Several hundred million dollars would be required to finance the restocking of infected poultry flocks and to restructure the whole sector.

Bird flu control campaigns (virus detection, culling, biosecurity and vaccination) should respect social, economic and cultural conditions in each affected country. The meeting agreed that vaccines can be a strong weapon in the fight against the disease in poultry. The possibility of vaccinating ducks should be explored. However, the conference acknowledged the need to further study conditions in which vaccines can be delivered with minimum risk to human health.

The bird flu virus does not respect borders and needs a strong regional response. Existing regional cooperation networks recently established by FAO should be extended. Without proper funding, these networks will cease their activities within the next six months. Countries are urged to report occurrences of the disease to the OIE in a timely and transparent manner. They should also share information on disease outbreaks and campaigns with neighbouring countries. There are between 25 and 40 million village backyard poultry farmers in Cambodia, Indonesia, the Lao People's Democratic Republic, Thailand and Viet Nam. The majority of poor farmers keep poultry for income and food security. (FAO 2/25/05 http://www.fao.org/newsroom/en/news/2005/90041/index.html)


Southeast Asia: Fighting bird flu at its origin to prevent a human flu pandemic
Containing the bird flu virus to the greatest extent possible and reducing the risk of infection in poultry and farmed free-range ducks will help to prevent a global human influenza pandemic, FAO said. "It is in the interest of both developed and developing countries to invest in the control and containment of avian influenza. Our objective is to protect human health - locally and internationally - and to promote food security - and our strategy is to control the disease at source," said Samuel Jutzi, Director of FAO's Animal Production and Health Division. "This means addressing the transmission of the virus where the disease occurs, in poultry, specifically free-range chickens and wetland dwelling ducks, and thus curbing the virus in the region before it spreads to other parts of the world," Jutzi told the Regional Meeting on Avian Influenza. "The disease could, in the worst case, lead to a new global human influenza pandemic," Jutzi said. "There is an increasing risk of avian influenza spread that no poultry keeping country can afford to ignore."

Bird flu will probably persist for many years in some of the countries that recently had disease outbreaks, Jutzi said. Wild birds, particularly ducks, are considered as natural hosts of the bird flu virus and it will therefore be very difficult to completely eliminate the disease. "However, current evidence suggests that trade in live poultry, mixing of avian species on farms and at live bird markets, and poor biosecurity in poultry production contribute much more to disease spread than wild bird movements," Jutzi said. "FAO advises against the destruction of wild birds and their habitats as such practice is unlikely to contribute significantly to disease control and is inappropriate from a wildlife conservation viewpoint," he added.

Strict biosecurity measures need to be applied throughout the poultry production chain, from farms and small producers to distribution channels, markets and retailers. Public awareness of disease risks must be raised and some traditional practices such as drinking raw blood of ducks need to be changed to prevent further cases of human infection. Many of the countries affected by bird flu have limited capacity to control the virus. They lack effective diagnostic tools and surveillance systems that are essential for early warning and timely response. "Affected countries need more help to search for infection and conduct analysis. Veterinary services also need access to better tools for diagnosis and disease control, including vaccines that are efficient, cost-effective and safe," Jutzi said.

He called upon the international community to respond to the urgent requirements of the Asian countries for support in their efforts "to get on top of this current serious situation." Countries need help to strengthen central animal health and veterinary public health services; to implement stamping out, vaccination and biosecurity programmes; to develop better diagnostic methods and vaccines; to support regional networks for information sharing, early warning and control strategies.

FAO said that in addition to the human suffering, recent avian influenza outbreaks have devastated many local economies. The major impact of the epidemic has been on the livelihoods of rural communities depending on poultry for their subsistence. Close to 140 million birds have died or been destroyed in the Asian epidemic to date, and loss of their flocks has left many farmers in deep debt. Total poultry farm losses in Asia in 2004 are estimated at more than $10 billion, according to Oxford Economic Forecasting. (FAO 2/23/05 http://www.fao.org/newsroom/en/news/2005/89912/index.html)


WHO: Bird flu pandemic is imminent, Governments must act swiftly to prevent outbreak
World Health Organization officials urged governments 23 Feb 2005 to act swiftly to control the spread of bird flu, warning that the world is in grave danger of a deadly pandemic triggered by the virus.The illness has killed 45 people in Asia over the past year, in cases largely traced to contact with sick birds, and experts have warned the H5N1 virus could become far deadlier if it mutates into a form that can be easily transmitted among humans. A global pandemic could kill millions, they say. "We at WHO believe that the world is now in the gravest possible danger of a pandemic," Dr. Shigeru Omi, the WHO's Western Pacific regional director, said. He said the world is "now overdue" for an influenza pandemic, since mass epidemics have occurred every 20 to 30 years. It has been nearly 40 years since the last one.

Speaking at the opening of a three-day bird flu conference in Vietnam's Ho Chi Minh City, Omi said it is critical that the international community better coordinate its fight against the virus. As bird flu experts met to devise plans to combat the H5N1 virus, scientists said they lacked knowledge about whether the strain that has led to the slaughter of tens of millions of birds has the pandemic potential of the 1918 Spanish flu that killed between 20 million and 40 million people. They cautioned that more evidence is needed about how infectious the virus is in humans. To become a pandemic strain, H5N1 would have to adapt sufficiently on its own, or mix its genetic material with a human virus to become highly infectious in humans who have no protection against it.

"We don't know whether the virus that is currently circulating among poultry in southeast Asia, the H5N1, will eventually be able to reassert its genetic material with a human influenza virus. That is the key question," Professor Albert Osterhaus, a leading European virologist at Erasmus University Hospital in Rotterdam, told Reuters in an interview. So far the H5N1 strain has shown no evidence that it has become highly infectious in humans. Scientists also do not know how many people may have been exposed to it. But Laurence Tiley, a molecular virologist at Cambridge University in England, said the H5N1 strain is lethal. "It is the most likely candidate for adapting and becoming a pandemic strain because we are not going to be able to get rid of it easily," he said.

The U.S. CDC is taking the threat of a possible pandemic "very seriously" and is working closely with the global health community to quickly detect any emergence of the new strain, CDC spokesperson Tom Skinner said. The mortality rate among identified patients who contract the disease from chickens and ducks is about 72 percent, said Dr. Julie Gerberding, head of the of the CDC. However, on 22 Feb 2005 she downplayed an earlier report about a possible avian flu pandemic. "We are ... not on the brink of an avian flu epidemic," she said at a National Press Club luncheon.

But officials with the WHO appeared far more concerned about the possibility of a bird flu epidemic. In comparing the deadly virus to severe acute respiratory syndrome, or SARS, which killed nearly 800 people in 2003, Omi said, "If the virus becomes highly contagious among humans, the health impact in terms of deaths and sickness will be enormous, and certainly much greater than SARS." The challenge for many countries is the lack of diagnostic tools and surveillance systems needed for early warnings, said Omi. "This is why we are urging all governments to work now on a pandemic preparedness plan - so that even in an emergency such as this they will be able to provide basic public services such as transport, sanitation and power," he said. The disease, which devastated the region's poultry industry last year, has killed 32 Vietnamese, 12 Thais and one Cambodian over the past year. Bird flu's reemergence in Vietnam has shown the virus is now endemic in parts of the region. The virus has proven to be "very versatile and very resilient," and has even been found in animals such as tigers and cats that weren't believed to be susceptible to influenza, he added. (MSNBC 2/23/05 http://msnbc.msn.com/ID/6861065/)


OIE-FAO International Conference on Avian Influenza, Paris, France 7 - 8 April 2005
Joint OIE-FAO statement: "During the past few years we have witnessed the global emergence and re-emergence of several infectious animal diseases that have had a major impact on both animal and human health and evoked strong reactions from policy-makers and the media at the world-wide level. Avian influenza is one of the animal re-emergent diseases with potential zoonotic impact for which the control is complicated by the predominant role of the wild birds in the dissemination of the virus over the world.

A particularly severe outbreak has hit South East Asia since the end of 2003. Since then the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO), have been very active in coordinating the global control of the disease and supporting the infected countries in their efforts to eradicate it in the infected animal populations.

The Second FAO/OIE Regional Meeting on Avian Influenza Control in Animals in Asia will be held in Ho Chi Minh City on 23-25 February 2005. It will review recommendations of the first HPAI Emergency Regional Meeting held in Bangkok in February 2004 and discuss the evolution of the disease in the region. In order to update the current scientific knowledge and to address the different aspects of the disease control based on this knowledge, OIE and FAO, in collaboration with WHO, also decided to jointly organize the "International Conference on Avian Influenza".

The Conference will take place at the OIE Headquarters in Paris (12, rue de Prony 75017 Paris - France) from 7 - 8 April 2005. Invited speakers will be selected by both a Steering and a Scientific Committee on the basis of their world wide scientific recognition. It will be an opportunity to update and exchange the latest scientific information at a global level in order to improve, through these new basis, international standards and guidelines for a better global prevention and control of avian influenza, while ensuring the safety of consumers and the global trade of animals and their products. The resulting standards and guidelines will be implemented by the 167 Member Countries of the OIE.

More information about the Conference is available on the OIE website (www.oie.int), under "Events". Information about the procedures for participation in the conference may be requested by e-mail to the Conference Secretariat s.suarez@oie.int." (OIE 2/21/05 http://www.oie.int/eng/press/en_050221.htm)


"Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population"
A Statement by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH): "A study published this week in the Archives of Internal Medicine reports that vaccination of the elderly population against influenza may be less effective in preventing death among the elderly than previously assumed. This study's findings have caused some confusion about whether people 65 years old and older should receive an influenza vaccination.

CDC and NIH continue to support the Advisory Committee on Immunization Practices (ACIP) recommendation that people aged 65 and older get vaccinated against influenza each year. People aged 65 and older are at highest risk for complications, hospitalizations, and deaths from influenza. Vaccination remains the best protection from influenza available for people 65 and older and their loved ones.

Numerous studies have shown that influenza vaccination works-including to help protect the elderly from serious illness and hospitalizations-but the degree to which it works varies from year to year and can be difficult to measure. For example, influenza seasons differ each year in length and severity, and the health status of individuals also matters.

In the current study by Simonsen et al, the authors in no way imply that the elderly should not receive influenza vaccine. Rather, the study concludes that the vaccine may prevent fewer deaths among the elderly than previous studies would have suggested. Therefore, the authors note that there is room for improvement in influenza prevention efforts, including research into developing more effective vaccines for the elderly and the increased use of medicines to treat flu.

In addition, recently published studies raise the possibility that it may be beneficial to vaccinate larger numbers of healthy persons, including children, to prevent transmission of influenza viruses to high-risk persons such as the elderly.

Expansion of groups for whom influenza vaccination is recommended is under discussion by the ACIP and CDC, and is partly contingent on adequate vaccine supply in the future.

The CDC and ACIP continually review their influenza vaccine recommendations as well as studies and published research in order to develop the best recommendations for protecting all Americans from influenza. This study is a reminder that there is room for improvement in how we protect the elderly from influenza, and CDC and NIH encourage research that strengthens our ability to do so." (CDC, Promed 2/24/05)