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EINet Alert ~ Feb 23, 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: WHO reports progress on avian influenza H5N1 vaccines
- Global: WHO picks one new strain for 2007-08 flu vaccine
- Russia (Moscow, Kaluga, Krasnodor): Outbreaks of avian influenza H5N1 among poultry, wild fowl
- United Kingdom (England): Official report on contaminated poultry
- United Kingdom/Hungary: Submission of genetic sequences from Hungarian and UK H5N1 viruses
- Afghanistan (Nangarhar, Kunar): Avian influenza H5N1 found in poultry
- Turkey (Batman, Diyarbakir): Poultry outbreaks of avian influenza H5N1 continue
- Hong Kong: Avian influenza H5N1 found in wild bird of prey
- Indonesia (Papau): Suspected human cases of avian influenza H5N1 infection, birds culled
- Indonesia: To resume sharing H5N1 samples with WHO
- Japan (Miyazaki, Okayama): Rats implicated in spread of avian influenza H5N1
- Laos (Vientiane): Avian influenza H5N1 reported in ducks
- Pakistan (Islamabad): Outbreak of avian influenza H5N1 among household and zoo fowl
- Egypt (Sharkia): 22nd case of avian influenza H5N1 infection
- Nigeria: FAO urges Nigeria to increase bird flu control measures
- Africa: OIE provides African countries with 18 million doses of poultry vaccine

1. Updates
- Avian/Pandemic influenza updates
- Seasonal Influenza

2. Articles
- Matrix Protein 2 Vaccination and Protection against Influenza Viruses, Including Subtype H5N1
- Surveillance of Influenza A Virus in Migratory Waterfowl in Northern Europe
- Rationing of influenza vaccine during a pandemic: Ethical analyses
- What is the root cause of the outbreak?
- New Strain of Influenza A Virus (H5N1), Thailand

3. Notifications
- APHA Influenza Policy Summary
- Flu Radar Website and Newsletter Launched
- 2000 Influenza Virus Genomes Now Completed and Publicly Accessible


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

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 56 (46)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 116 (80)

2007
Egypt / 4 (3)
Indonesia / 6 (5)
Nigeria / 1(1)
Total / 11 (9)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 274 (167).
(WHO 2/19/07 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 2/6/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 2/22/07): http://gamapserver.who.int/mapLibrary/

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Global: WHO reports progress on avian influenza H5N1 vaccines
WHO reported "encouraging progress" on development of H5N1 avian influenza vaccines, while cautioning that global capacity to make the vaccines remains very limited. Following a 2-day meeting of vaccine experts in Geneva, WHO said Feb 16, 2007 that new vaccines aimed at various strains of H5N1 look promising. 16 companies from 10 countries are developing prototype pandemic flu vaccines against H5N1, WHO said. 5 of those companies also are developing vaccines against other avian flu strains, including H9N2, H5N2, and H5N3. More than 40 clinical trials have been completed or are under way, most of them involving healthy adults. But some companies have begun clinical trials in children and the elderly.

The statement does not give an estimate of how many doses of H5N1 vaccines have been made so far, and further information was not immediately available. In 2006 WHO launched its global pandemic influenza action plan, a program expected to cost $10 billion over 10 years. One goal of the plan is to enable developing countries to build their own flu vaccine production facilities. In launching the program last Oct, WHO called for an urgent effort to boost vaccine production capacity and develop better vaccines, while cautioning that it would take 3 to 5 years for the effort to bear fruit.
(CIDRAP 2/16/07 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb1607vaccines.html)

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Global: WHO picks one new strain for 2007-08 flu vaccine
Because of changes in the influenza viruses now in circulation, WHO has recommended changing one of the three viral strains to be used in flu vaccines in the Northern Hemisphere next fall and winter. WHO is recommending changing the influenza A/H1N1 strain in the vaccine for the first time since the 2000-01 season. The agency recommends a Solomon Islands strain of H1N1, replacing a New Caledonia strain. The New Caledonia strain of H1N1 had been recommended for the previous 7 years. The other 2 recommended strains remain the same as last year. They are a Wisconsin strain of influenza A/H3N2 and a Malaysia strain of influenza B. WHO had changed the H3N2 strain the past 3 years and changed the B strain last year.

WHO recommended strains http://www.who.int/csr/disease/influenza/recommendations2007north/en/index.html

Full WHO report on strain selection http://www.who.int/csr/disease/influenza/20078anorthreport.pdf

WHO page with list of past vaccine strains http://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/index.html
(CIDRAP 2/20/07, http://cidrap.umn.edu)

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Europe/Near East
Russia (Moscow, Kaluga, Krasnodor): Outbreaks of avian influenza H5N1 among poultry, wild fowl
As of Feb 22, 2007, the H5N1 virus had been officially confirmed in birds in Moscow's pet market, 7 districts in the Moscow region, and in Adygeya district. It has yet to be confirmed in the Dmitrov district or in the region of Kaluga. Officials reported avian flu as the cause of chicken and turkey deaths in a number of regions, including a minimum of 3 private farmsteads near Moscow this week. Russia recorded its first cases of bird flu Aug 2005, but until now, outbreaks have occurred only in southern provinces and in Siberia. Incidents of bird flu were also reported in the Borovskoi district in the Kaluga region. Officials have traced all outbreaks in the Moscow region to birds bought in the last 2 weeks at the Sadovod market.

Moscow authorities stated that there is no danger for people. Quarantine was imposed in settlements, and measures implemented include the disinfection of all vehicles going out of the region and a ban on deliveries of any poultry products and fodder from the region. Poultry and eggs produced at farms near Moscow are safe to eat, Russia's animal and plant health watchdog said. Health officials are monitoring 5,453 residents near the outbreak areas, including 20 who had contact with the infected birds, Gennady Onischchenko, Russia’s chief epidemiologist, said. No human H5N1 cases have been reported in Russia.

Vaccination against avian flu of domestic birds kept in small farms began in the Moscow region Feb 19. More than a million vaccines were brought for a massive vaccination campaign in the region. As many as 95 000 chickens, ducks, geese, and turkeys have been inoculated out of a total of 800 000. Vaccination has been completed at private aviaries in 16 municipalities of the territory. The early vaccination campaign was spurred by a warm winter, the possibility of an earlier return of migrating birds from their wintering places, and the cases of bird flu in China, South Korea, and Japan. The emergencies ministry said Feb 22 that since Feb 9, 1500 birds have been culled to prevent the spread of the virus, and 355 have died.

One of many measures to minimize the risk of outbreaks has been a ban for people working at poultry farms to keep birds at home. Furthermore, all pavilions that sell birds at Moscow's market have been closed since Feb 16, and veterinary inspectors are now looking for any traces of the virus there. A telephone hotline has been opened for residents of the Moscow Region who bought any birds on the market after Feb 1, 2007.

In a separate development, Russia's Emergency Situations Ministry reported wild fowl deaths in the southern region of Krasnodar. It said between 100 and 1000 dead ducks had been found in coastal areas, but that preliminary tests had detected no bird flu virus in the birds. About 3000 wild ducks have been destroyed near the Black Sea city of Anapa after a number were found dead.
(ProMED 2/17/07, 2/18/07, 2/20/07, 2/21/07 http://promedmail.org, CIDRAP 2/19/07, http://www.cidrap.umn.edu)

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United Kingdom (England): Official report on contaminated poultry
The UK’s DEFRA (Department for Environment, Food, and Rural Affairs) published a report on potentially contaminated poultry products in the country. The full report can be found at http://www.defra.gov.uk/animalh/diseases/notifiable/disease/ai/pdf/vra-recallpoultrymeat.pdf

Key findings, excerpted by ProMED: In conclusion, the available evidence does not demonstrate conclusively that infected poultry meat may have entered the UK from Hungary. Hungarian authorities have confirmed that turkeys were not sourced from their restricted areas. However, if it did, then only a single batch is likely to have been affected. The specific tissues imported are likely to contain low levels of virus. Risk management measures as explained are already in place to deal with the background level of risk that foodstuffs may contain low, undetected levels of virus liable to cause animal disease. There is a low likelihood that infected poultry meat is present in the UK. There are already measures in place to mitigate this level of animal health risk so it would be disproportionate and unnecessary to trace and dispose of Hungarian meat.
(ProMed 2/16/07,http://www.promedmail.org)

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United Kingdom/Hungary: Submission of genetic sequences from Hungarian and UK H5N1 viruses
Ian Brown, Director of the International Reference Laboratory for Avian Influenza, at Veterinary Laboratories Agency (VLA), UK, reports that VLA Weybridge has submitted full genome sequences for the following H5N1 avian influenza viruses:
A/Turkey/England/250/07,
A/Goose/Hungary/2823/07,
A/Goose/Hungary/3413/07.
These sequences are currently being processed by GenBank, and, as soon as accession numbers are allocated, they will be made them available.
(ProMED 2/21/07, http://promedmail.org)

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Afghanistan (Nangarhar, Kunar): Avian influenza H5N1 found in poultry
Afghan authorities culled poultry after an outbreak of the H5N1 strain of bird flu in chickens in an eastern Afghan city, a U.N. official said Feb 21, 2007. Bird flu was reported in the eastern provinces of Nangarhar and Kunar, said Serge Verniau, the country representative of the U.N.'s Food and Agriculture Organization in Afghanistan. Samples from chickens in the Nangarhar provincial capital of Jalalabad were found to have the H5N1 strain, while the exact type of the outbreak in Kunar has yet to be confirmed. Afghanistan reported its first outbreaks of H5N1 Mar and Apr 2006 in Kabul, and the provinces of Kapisa, Logar and Nangarhar. There have been no reported infections of humans.
(ProMED 2/21/07, http://promedmail.org)

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Turkey (Batman, Diyarbakir): Poultry outbreaks of avian influenza H5N1 continue
Officials in Turkey announced H5N1 outbreaks in 2 more villages, one in Batman province, where the first outbreak of the 2007 season was reported, and several in Diyarbakir province. All are in southeast Turkey, about 460 miles from Ankara. Turkish officials suspect that the disease has spread to poultry in two more villages in Diyarbakir but are awaiting test results. The two villages were quarantined, and 340 birds were destroyed. There have been no WHO-confirmed human cases in Turkey in 2007.
(CIDRAP 2/16/07, http://www.cidrap.umn.edu/, ProMED 2/17/07, http://promedmail.org)

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Asia
Hong Kong: Avian influenza H5N1 found in wild bird of prey
A common kestrel found earlier at Pak Tin Estate in Sham Shui Po has been confirmed to be H5N1 positive, the Agriculture, Fisheries & Conservation Department says. The bird's carcass was collected by a Housing Department subcontractor and sent to the Agriculture, Fisheries & Conservation Department Feb 17, 2007. The common kestrel (Falco tinnunculus) is a relatively small bird of prey belonging to the falcon family Falconidae (order Falconiformes). This species is widespread in Europe, Asia and Africa.
(ProMED 2/22/07, http://www.promedmail.org)

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Indonesia (Papau): Suspected human cases of avian influenza H5N1 infection, birds culled
In Jambi, a suspected bird flu patient was admitted to hospital, the 6th such patient to be treated at the same hospital this week (Feb 11-18, 2007). A hospital employee said the 5-year-old patient had bird flu-like symptoms such as difficulty breathing, a high fever and coughing. Meanwhile, residents of the Dok IX area in Jayapura voluntarily culled 56 fowls and 1 bird Feb 15, after 7 chickens believed to be infected with bird flu died suddenly. If the presence of the virus were confirmed, it would make Jayapura the third city in Papua and West Papua to be hit by bird flu, along with Manokwari and Timika. It is not yet known how the virus might have gotten there. The nearby livestock husbandry office suspected an outbreak after local residents reported the deaths of the chickens. Officers sent to the area took blood samples from the dead chickens for laboratory testing.
(ProMED, 2/17/07, http://promedmail.org)

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Indonesia: To resume sharing H5N1 samples with WHO
Indonesia and WHO agreed Feb 16, 2007 that Indonesia will resume sharing its H5N1 avian influenza virus samples while the WHO will work to ensure that developing countries have access to pandemic vaccines based on viruses they supply. The country vowed to share the samples only with groups that agreed to use them for noncommercial purposes. Indonesia's prior rationale for withholding its H5N1 samples was that it is unfair for foreign countries to use the samples to develop vaccines that poorer nations can't afford. Indonesia has been among the nations hit hardest by avian influenza and has had the most human deaths from the disease.
(CIDRAP 2/16/07 http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb1607indonesia.html)

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Japan (Miyazaki, Okayama): Rats implicated in spread of avian influenza H5N1
Scientists suspect rats spread the recent outbreaks of avian flu at 4 farms in Miyazaki and Okayama prefectures after the H5N1 virus strain was brought over by migratory birds from China. The experts agree that the migratory birds triggered the infections at the 4 poultry farms over the past month [Jan-Feb 2007]. But they said that the way the disease spread indicates that other factors were involved. Inspectors found that nets and coverings were in place to prevent large migratory birds from coming into contact with the poultry. In addition, dead chickens at 3 of the farms were found in areas farthest from the entrance of the coops, so the wild birds were not likely the direct source of the infection. "It's possible that small rodents, such as rats, carried the virus into the chicken coops," said Toshihiro Ito, a professor of veterinary microbiology at Tottori University, who chairs the team of specialists. He said the rats were likely infected by the wild birds from China. The task force said the H5N1 strain at the 4 farms was identical to the one that killed thousands of wild birds at Qinghai Lake in western China starting in 2005. The strain was also similar to one found in duck droppings in South Korea Jan 2007.
(ProMed 2/16/07,http://www.promedmail.org)

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Laos (Vientiane): Avian influenza H5N1 reported in ducks
On Feb 13 2007, the Department of Livestock and Fisheries of the Ministry of Agriculture and Forestry reported the detection of H5N1 among ducks on a private farm in Phonpapao-thong village, and in a private backyard in Dongsavath village in Sisattanak district, Vientiane. The report specified that 7 of the 1100 ducks on the farm had died, while more than 100 were sick, and that 12 of the 600 ducks in the private backyard had died. The movement of poultry in and out of the detected areas was restricted, and more than 83 000 people living in the 50 villages near the area were surveyed for suspect symptoms for several days. Authorities were also checking inhabitants in 20 villages between Xaysettha and Sisattanak districts, and plan to cull all ducks on the 2 affected properties. Laos' last outbreak of H5N1 started Jul 2006.
(ProMED 2/17/07, http://www.promedmail.org)

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Pakistan (Islamabad): Outbreak of avian influenza H5N1 among household and zoo fowl
In Pakistan, H5N1 infection was recently detected among household poultry, birds and peacocks in the Islamabad, Rawalpindi and Mansehra areas. Migratory birds were believed to have been the source of this infection. According to another newswire, the Islamabad outbreak was detected in the zoo, in its peacocks and geese. An official notification Feb 21 reported that lab results had confirmed that the H5N1 strain of bird flu killed 24 birds at the Marghazar Zoo from Feb 12 to 19, 2007. Zoo officers have reportedly started screening, disinfection and isolation of birds, and no deaths have taken place since Feb 20.
(ProMED 2/21/06, 2/22/07 http://promedmail.org)

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Africa
Egypt (Sharkia): 22nd case of avian influenza H5N1 infection
An Egyptian woman died of bird flu in a Cairo hospital and a boy, 5, from Sharkia Governorate, became the 22nd Egyptian to test positive for the disease, officials reported Feb 16, 2007. The Egyptian Ministry of Health and Population confirmed the country's 13th death from H5N1 avian influenza, a 37-year-old female whose infection was announced 15 Feb. Meanwhile, the 5-year-old boy was in stable condition and being treated with Tamiflu. He was reportedly exposed to sick birds 1 week prior to the onset of symptoms. Contacts of the boy remain healthy and have been placed under close observation. The case was confirmed by the Egyptian Central Public Health Laboratory and by the US Naval Medical Research Unit No. 3 (NAMRU-3). Egypt has the highest known cluster of human bird flu cases outside Asia, with 22 known human cases since the virus first surfaced in Egyptian poultry in 2006. John Jabbour, a WHO official in Cairo, said a delay in reporting symptoms was making bird flu more deadly in Egypt, where many people keep birds at home but are often reluctant to disclose that to health officials for fear of sanctions. The case fatality from bird flu this winter is significantly higher than it was between Mar and May 2006, before the country witnessed a 5-month warm-weather lull in human cases. Since the disease reappeared in humans in Egypt Oct 2006, 8 Egyptians have contracted bird flu. 7 have died, including 3 who had contracted infection with a virus with a mutation that made the disease "moderately" resistant to Tamiflu.
(CIDRAP 2/16/07, http://www.cidrap.umn.edu/, ProMED 2/16/07, 2/19/07 http://www.promedmail.org, WHO 2/19/07)

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Nigeria: FAO urges Nigeria to increase bird flu control measures
FAO has urged Nigeria to increase control measures on poultry farms and markets to prevent the spread of avian influenza and reduce the risk of further human cases. A statement issued after a mission to Nigeria said that the virus is still circulating in poultry flocks in the country with outbreaks reported in at least 10 states over the past few months. The virus probably spreads along major trade routes within Nigeria, placing neighboring countries at risk by birds moved informally across borders. Increased surveillance could ensure that countries detect an incursion of disease without delay.

FAO is supporting the government to increase active disease search to better understand the spread and incidence of the disease to identify high-risk areas. Understanding how the virus circulates is essential for good control plans. FAO stressed the need to reduce the risk of infections in humans through control measures in markets, such as veterinary inspections, improved hygiene and the discouraging of home slaughter. Home slaughtering is very common in Nigeria as in many other African countries.

FAO is increasing its technical support to the country in expert advice, supplies and equipment to help bring the disease under control, which will not be an easy task. The agency has also launched an active disease surveillance programme funded by the European Union. Nigeria produced around 150 million live chickens in 2005. 60 percent of the chickens are kept in backyard flocks. The commercial sector accounts for 25 percent of production and the semi-commercial sector for 15 percent. Approximately 300 000 poultry have died due to H5N1 and another 400 000 have been culled as part of control measures. Affected species include chickens, ostrich, ducks, pigeons, turkeys, and geese.
(FAO 2/20/07 http://www.fao.org/newsroom/en/news/2007/1000499/index.html )

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Africa: OIE provides African countries with 18 million doses of poultry vaccine
During the last 3 months, OIE provided African countries with a total of 18,000,000 doses of AI vaccines protecting adult poultry against H5N1 Avian influenza strain, in conformity with its quality standards on vaccines. Vaccine was delivered to Egypt (14 million doses), Mali (1 million), Mauritania (2 million) and Senegal (1 million). This vaccine delivery comes as a result of the OIE partnership with African Union and the financial support of the European Commission. The OIE established a virtual vaccine bank for African countries to rapidly assist infected countries which would have to vaccinate poultry populations at risk and also countries not yet infected wishing to count with a strategic stock to protect themselves.
(OIE 2/20/2007, http://oie.int)

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1. Updates
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. Read latest reports from Africa.
- 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 upcoming avian influenza conferences.
- 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.
- 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)

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Seasonal Influenza
USA
Around the US, at least 9 children have died of flu, and 6 other child deaths have been tentatively linked to flu since Feb 3, 2007 said Curtis Allen, a spokesman for the CDC. Midway through the month when influenza typically peaks, health officials were monitoring 4 hospitalized Nebraska children, while 3 North Carolina schools remained closed over widespread symptoms of the illness. And in Oklahoma, 1 school district reported 350 students out sick Friday, though no schools were closed. Still, a federal health official called this season relatively mild so far. Last year, 47 children under age 18 died from influenza. In 2003-2004, the worst recent flu season, 153 children died. About 36,000 people die from the flu each year in the US, according to the CDC.
(Associated Press, 2/21/07, Available at http://fluradar.com)

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2. Articles
Matrix Protein 2 Vaccination and Protection against Influenza Viruses, Including Subtype H5N1
Tompkins SM et al. Matrix protein 2 vaccination and protection against influenza viruses, including subtype H5N1. Emerg Infect Dis [serial on the Internet]. 2007 Mar [2/23/07]. http://www.cdc.gov/EID/content/13/3/426.htm
Abstract: “Changes in influenza viruses require regular reformulation of strain-specific influenza vaccines. Vaccines based on conserved antigens provide broader protection. Influenza matrix protein 2 (M2) is highly conserved across influenza A subtypes. To evaluate its efficacy as a vaccine candidate, we vaccinated mice with M2 peptide of a widely shared consensus sequence. This vaccination induced antibodies that cross-reacted with divergent M2 peptide from an H5N1 subtype. A DNA vaccine expressing full-length consensus-sequence M2 (M2-DNA) induced M2-specific antibody responses and protected against challenge with lethal influenza. Mice primed with M2-DNA and then boosted with recombinant adenovirus expressing M2 (M2-Ad) had enhanced antibody responses that cross-reacted with human and avian M2 sequences and produced T-cell responses. This M2 prime-boost vaccination conferred broad protection against challenge with lethal influenza A, including an H5N1 strain. Vaccination with M2, with key sequences represented, may provide broad protection against influenza A.”

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Surveillance of Influenza A Virus in Migratory Waterfowl in Northern Europe
Wallensten AA et al. Surveillance of influenza A virus in migratory waterfowl in northern Europe. Emerg Infect Dis [serial on the Internet]. 2007 Mar [2/23/07]. http://www.cdc.gov/EID/content/13/3/404.htm
Abstract: “We conducted large-scale, systematic sampling of influenza type A virus in migratory waterfowl (mostly mallards [Anas platyrhynchos]) at Ottenby Bird Observatory, southeast Sweden. As with previous studies, we found a higher prevalence in fall than spring, and among juveniles compared with adults. However, in contrast to other studies, we found that prevalence in spring was sometimes high (mean 4.0%, highest 9.5%). This finding raises the possibility that ducks are capable of perpetuating influenza A virus of different subtypes and subtype combinations throughout the year and from 1 year to the next. Isolation of the H5 and H7 subtypes was common, which suggests risk for transmission to sensitive domestic animals such as poultry. We argue that wild bird screening can function as a sentinel system, and we give an example of how it could have been used to forecast a remote and deadly outbreak of influenza A in poultry.”

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Rationing of influenza vaccine during a pandemic: Ethical analyses
Zimmerman RK. Vaccine. 2007 Mar 1;25(11):2019-2026. Epub 2006 Nov 30.
Abstract: “Rationing of scarce vaccine supplies will likely be required when the next pandemic occurs, raising the questions about how to ration and upon what principles. Because influenza pandemics have differing mortality patterns, such as the 1918 pandemic's "W" shaped curve that effected healthy young adults, the particular pattern should inform rationing. Competing ethical principles for vaccine rationing are utilitarianism and egalitarianism. Vaccine manufacturers and essential healthcare workers can be justified with either principle. Utilitarian principles of choosing based on social worth or those in whom vaccination is most likely to medically succeed raise substantial justice issues. Egalitarian principles of medical neediness and random chance avoid justice concerns and are proposed. A framework that uses multiple principles to address influenza vaccine rationing in light of a shortage is recommended.”

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What is the root cause of the outbreak?
Rebecca Coombes. BMJ 2007;334:342-343 (17 February), doi:10.1136/bmj.39126.577488.59.
http://www.bmj.com/cgi/content/extract/334/7589/342
“Although the infected processing plant reopened last week, government investigators are still trying to root out the cause of H5N1 virus outbreak in Suffolk, which led to the culling of 160 000 birds earlier this month. Initially, the finger of blame had pointed to the infected droppings of migrating wild birds. There had been an outbreak of H5N1 among captive geese in the Csongrád region of Hungary in January, but there was no obvious link to the outbreak at the Holton farm, which is owned by UK poultry tycoon Bernard Matthews. By the eighth day of the outbreak, genetic tests confirmed that the Suffolk virus was the same pathogenic Asian strain found in Hungary. That in itself didn't prove that there was a direct link; the infection still may have come from a third country. But it had also become clear that Matthews not only had a processing plant in. . .”

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New Strain of Influenza A Virus (H5N1), Thailand
Chutinimitkul S, et al. New strain of influenza A virus (H5N1), Thailand [letter]. Emerg Infect Dis [serial on the Internet]. 2007 Mar [2/23/07]. http://www.cdc.gov/EID/content/13/3/506.htm
Excerpt: “. . .The latest wave of the outbreaks in Thailand was caused by viruses closely related to those that caused outbreaks in Thailand in 2004–2005 and to viruses recently circulating in southeast People's Republic of China and other Southeast Asian countries. This finding raises concern for development of new candidate influenza (H5N1) vaccine strains. Geographic spreading, epidemiology, and genetic properties of recently circulating influenza (H5N1) viruses should be considered when developing candidate H5N1 strains of influenza vaccine.”

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3. Notifications
APHA Influenza Policy Summary
In November 2006, the American Public Health Association (APHA) adopted a new policy that supports comprehensive national planning for an influenza pandemic and recommends key changes to the current preparedness and response strategy. APH believes that current federal plans and strategies—the National Strategy for Pandemic Influenza, the US Department of Health and Human Services Pandemic Influenza Plan, and the Implementation Plan for the National Strategy for Pandemic Influenza—are blueprints that can be used as the nation moves forward to prepare for pandemic flu. However, they can be strengthened, especially in the following subject areas, to ensure that all individuals, families, and communities are able to prepare for and respond to a flu pandemic, especially in the care for vulnerable populations.

Contents in this Summary include:
Who Will Respond: Public Health Workforce Issues
Slowing the Spread of Pandemic Flu: The Role of Non-Pharmaceutical Interventions Medical Countermeasures
Ensuring Access to Care
Pandemic Flu on the Job: Business and Occupational Health Considerations
Incorporating Mental Health into Pandemic Flu Preparedness and Response
Ensuring Public Health Leadership.

The full report can be found at: http://www.apha.org/advocacy/policy/APHA+Prescription+for+Pandemic+Flu.htm.
CIDRAP’s article on this summary can be found at: http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb2307apha.html
(CIDRAP 2/23/07 http://www.cidrap.umn.edu/ )

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Flu Radar Website and Newsletter Launched
A website and e-newsletter service, supported by the 4th International Bird Flu Summit, was launched to provide news and information about upcoming events and opportunities related to bird flu. “We have designed Flu Radar primarily to serve students, faculty, public health executives, and the larger business community; though anyone interested in learning more about Bird Flu will find it helpful.” The newsletter will go out once every day, Monday to Friday.
http://fluradar.com

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2000 Influenza Virus Genomes Now Completed and Publicly Accessible
The Influenza Genome Sequencing Project, funded by the National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health (NIH), announced that it has decoded the entire genetic blueprints of more than 2,000 human and avian influenza viruses taken from samples around the world and the sequence data has been made available in a public database. The Influenza Genome Sequencing Project, initiated in 2004, has been carried out at the NIAID-funded Microbial Sequencing Center managed by The Institute for Genomic Research (TIGR) of Rockville, Maryland. More information about the Influenza Genome Sequencing Project and access to the influenza virus sequence data is available at NIAID’s Influenza Genome Sequencing Project:
http://www.niaid.nih.gov/dmid/genomes/mscs/influenza.htm
(NIH, NIAID, 2/21/07, http://pandemicflu.gov)

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 apecein@u.washington.edu