Login   

EINet Alert ~ Apr 06, 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 Reports fewer bird flu outbreaks this year
- Kuwait (Wafra): Five more avian influenza H5N1 cases confirmed in chickens
- Kuwait (Wafra): Suspected cases of avian influenza among cullers test negative
- Pakistan (Northwest Frontier Province): Scare over avian influenza in Abbottabad
- Saudi Arabia (Al-Gamma): Highly pathogenic avian influenza in birds
- Bangladesh: Avian influenza H5N1 spreads to more farms
- Cambodia (Kampong Cham): Seventh fatal case of avian influenza H5N1 infection
- Hong Kong: Map of avian influenza cases/outbreaks published
- Indonesia (Jakarta): Two new suspected cases of avian influenza infection fatal
- Indonesia: Avian influenza sample sharing debate continues
- Indonesia: Autopsies considered for avian influenza H5N1 victims
- Myanmar (Rangoon): Avian influenza outbreak in chickens, report of failed cleanup
- Philippines: Rapid-containment exercise will test plans to avert an influenza pandemic
- Viet Nam (Ca Mau Province): Avian influenza H5N1 outbreak in ducks
- USA: Novel Influenza A infection added as notifiable disease
- USA: Firm seeks license for seasonal flu vaccine
- USA: Expanded Capability for Influenza Research and Surveillance
- USA (West Virginia): Low-pathogenic avian influenza found in Turkeys
- Egypt (Qena, Qalubiea, Sohag, Minya): 4 avian influenza H5N1 cases in children

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

2. Articles
- Public health interventions and epidemic intensity during the 1918 influenza pandemic.
- The effect of public health measures on the 1918 influenza pandemic in US cities
- Ethics in a Pandemic: A Survey of the State Pandemic Influenza Plans
- Disrupting the Transmission of Influenza A: Face Masks and Ultraviolet Light as Control Measures.
- Genome analysis linking recent European and African influenza (H5N1) viruses
- Nucleic acid-based antiviral drugs against seasonal and avian influenza viruses.
- Avian and pandemic influenza: An overview.
- Antiviral Therapy and Prophylaxis for Influenza in Children
- Emergence of Influenza B Viruses With Reduced Sensitivity to Neuraminidase Inhibitors
- Changing perspective on immunization against influenza.

3. Notifications
- CDC Publishes Travel Industry Checklist for Pandemic
- International conference in Verona reviews poultry vaccination methods


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
China / 2 (1)
Egypt / 14 (3)
Indonesia / 6 (5)
Laos / 2 (2)
Nigeria / 1 (1)
Total / 25 (12)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 288 (170).
(WHO 4/2/07 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 3/20/07)

WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 4/2/07):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 4/2/07):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

^top

Global: FAO Reports fewer bird flu outbreaks this year
Despite substantial progress in global efforts to bring H5N1 avian influenza virus under control, the disease continues to spread to new countries and to new areas in some countries where containment has not been successful, FAO said Apr 2, 2007. The virus continues to threaten the lives of people living and working around poultry, while hurting farm incomes and reducing the availability of nutritious food. However, according to FAO’s Chief Veterinary Officer, worldwide “there have been fewer cases of the disease this year than last year at the same time, indicating that there is a reduction in overall viral load. The presence of H5N1 in wild birds is less than it was last year when we saw a surge in the virus, particularly in Europe. Also there is more transparency, better surveillance and improved and timelier reporting of outbreaks”. Bird flu outbreaks have occurred in 56 countries in Africa, Asia and Europe since 2003. In 2006, 53 countries reported HPAI outbreaks; this year, so far, 17 countries have been affected.
(FAO 4/2/07, http://fao.org, CIDRAP 4/2/07, http://cidrap.umn.edu )

^top


Europe/Near East
Kuwait (Wafra): Five more avian influenza H5N1 cases confirmed in chickens
Kuwait confirmed 5 more H5N1 cases April 1, bringing to 101 the total number of infected birds in the Gulf Arab country this year. The new cases were chickens from a 4th farm in the southern region of Wafra, where most of the bird flu infections have been found. Reportedly no human infections were found after more than 500 people who had been in contact with the birds had been tested. Kuwaiti authorities have culled some 1.5 million birds, out of which 1.1 million were at 3 farms in Wafra near the Saudi border, representing almost 60 percent of the country's egg hens. The measures are hitting Kuwait's egg production, since the culled 1.1 million hens account for 88 percent of local egg needs. The country has closed down the zoo and poultry shops in residentialareas and banned the import of live birds.
(ProMED 4/1/07, http://promedmail.org, CIDRAP 4/2/07, http://cidrap.umn.edu)

^top

Kuwait (Wafra): Suspected cases of avian influenza among cullers test negative
Preliminary tests for bird flu infection were positive, but later confirmatory tests were negative for H5N1 on 4 Bangladeshi workers who had been culling infected chickens in Kuwait. There have thus far been no cases of bird flu affecting humans in Arab nations of the Gulf. The 4 workers were admitted to Kuwait's infectious diseases hospital with flu-like symptoms Apr 3. The men were isolated in a special ward and remain hospitalized. The patients will remain under medical supervision and treatment for 10 more days, according to health officials. Since the outbreak of bird flu in poultry in Kuwait, 22 people have been admitted to hospital on suspicion of being infected but later discharged after confirming they were healthy. The Bangladeshis were part of official teams culling and burying hundreds of thousands of chickens in Wafra, south of Kuwait City on the Saudi border. For unknown reasons, very few H5N1 cases have occurred in poultry cullers and certain other presumably high-risk groups, such as veterinarians and workers in live-bird markets, WHO has reported.
(ProMED 4/4/07, http://promedmail.org, CIDRAP 4/4/07, 4/6/07 http://cidrap.umn.edu)

^top

Pakistan (Northwest Frontier Province): Scare over avian influenza in Abbottabad
The Abbottabad Cantonment Board has directed poultry shop owners to close down their businesses after traces of bird flu were found in the district. It also directed people to cull birds in their houses and bury them if they found traces of the disease in them. Sources said a large number of chickens and other birds were found dead in different poultry farms a few days ago and after confirmation of reports from the health department, the cantonment board issued the above directives. It also directed chicken sellers to close their shops and advised people not to buy poultry products until precautionary measures were adopted.
(ProMED 4/1/07, http://promedmail.org,)

^top

Saudi Arabia (Al-Gamma): Highly pathogenic avian influenza in birds
Saudi Arabia reported to OIE Mar 31, 2007 an outbreak of avian influenza among a flock of birds of unknown species. 106 of the birds died from the virus; the remainder of the flock has been culled. The source of the outbreak is suspected to be contact with wild birds.
(ProMED 4/3/07, http://promedmail.org)

^top


Asia
Bangladesh: Avian influenza H5N1 spreads to more farms
Bird flu has spread to 5 more farms in central and northern districts, Bangladesh said Mar 30, 2007. "The avian flu has now spread to 16 farms in 5 districts so far. But no humans have been confirmed infected," an official of the fisheries and livestock ministry said. The newly affected farms included some near the capital, Dhaka, where the virus first surfaced, and some in the north. Bangladesh has culled about 60 000 birds since confirming the outbreak of the H5N1 flu virus simultaneously on 6 farms near the capital, Dhaka, on 22 March 2007. All the culled birds belonged to the 16 affected farms. So far, 30 workers in the 5 newly affected farms were being monitored. In addition, a health official said that nearly 500 farm workers have been given a local version of oseltamivir (Tamiflu) as a precaution. Movement of chickens has been banned outside a 10 sq km area around the affected farms. Livestock officials said after the outbreak they had inspected about 10 000 farms containing nearly 1.1 million birds.
(ProMED 3/31/07, http://promedmail.org, OIE 3/30/07, http://oie.int, CIDRAP 4/2/07 http://cidrap.umn.edu)

^top

Cambodia (Kampong Cham): Seventh fatal case of avian influenza H5N1 infection
A 13-year-old Cambodian girl has died of bird flu in Kampong Cham province, a Ministry of Health source reported Apr 6, 2007. This is the 7th victim of avian influenza H5N1 in the country. All 7 confirmed human cases of avian influenza in Cambodia have been fatal. The girl died 5 Apr 2007, and her blood samples tested positive for the disease, according to a joint statement issued by the Ministry and WHO. The girl was from Ponhea Kreak district in Kampong Cham province, which borders Vietnam. She became ill April 2 with a fever and diarrhea and was hospitalized the next day. Her case was confirmed by the Pasteur Institute of Cambodia. It is not known yet how the girl contracted the disease.
(ProMED 4/6/07, http://promedmail.org, CIDRAP 4/6/07, http://cidrap.umn.edu)

^top

Hong Kong: Map of avian influenza cases/outbreaks published
Hong Kong's Agriculture, Fisheries, and Conservation Department said that of 3430 wild birds found dead and tested for H5N1 this year, 15 had tested positive, all for the "Fujian" strain of the virus. It is the same strain identified in a scientific paper published Oct 2006 by University of Hong Kong virologists Guan Yi and Malik Peiris, and US flu expert Robert Webster, of St Jude's Children's Hospital. The researchers called it a new strain of the H5N1, and said it emerged Oct 2005. The strain had been found in almost all poultry outbreaks and in some human cases in southern China, and had been detected in Hong Kong, Laos, and Thailand. In 2006, 15 wild birds and 2 hens tested positive to the strain in the area. Some scientists suspect that China has not been transparent about its mapping of the virus. The Chinese Agriculture Minister defined the research data as "false" and the viral strain "non-existent". Yet in Dec 2006, WHO acting assistant director-general, David Heymann, said the strain had been circulating since 2005 and that the mainland had provided information and sequencing data about the strain. Hong Kong sources confirm that diseased migratory birds died in large numbers in periods when China did not report any infections in the area. They fear that the virus is far more widespread than official Chinese data claims. Hong Kong has halted imports of live poultry and poultry meat from 13 provinces, where infection has been confirmed.

This site: http://www.chinacdc.net.cn/n272442/n272530/n273736/n273781/n305111/n3138373/10517.html includes a map—in Chinese—titled "China avian influenza: disease distribution map (number of human cases confirmed by the Chinese Ministry of Health)". Since the map, updated on 30 Mar 2007, is not available online in English, ProMED-mail provided a translation (by Dan Silver).
(ProMED 4/5/07, http://promedmail.org)

^top

Indonesia (Jakarta): Two new suspected cases of avian influenza infection fatal
Initial laboratory tests showed a 23-year old Indonesian woman died of bird flu, Indonesian Health Ministry said Apr 2, 2007. Health officials await the result of a second laboratory test for confirmation that she was positive for the avian influenza virus. The woman from Central Jakarta died April 1, at Persahabatan hospital in East Jakarta. The woman, a Jakarta housemaid, had looked after a pet eagle. Authorities had yet to determine whether the eagle had the virus, although a number of fowl in the area had suddenly died. Meanwhile, an Indonesian teenager died of bird flu in Jakarta, a Health Ministry official and doctor said April 6. The 15-year-old girl was admitted to the Sulianti Saroso Hospital for Infectious Diseases April 2 and died April 5. Health Ministry officials confirmed that the girl's lab tests showed she had contracted the H5N1 virus, apparently after coming into contact with infected pet birds at her home in central Jakarta. As of April 2, 2007, WHO has confirmed 81 human cases of H5N1 avian influenza in Indonesia, 63 of whom have died as a result of the infection. The Indonesian press, however, reports these 2 suspected cases as the 72nd and 73rd fatal cases of the 92 total cases of H5N1 in the country.
(ProMED 4/3/07, 4/4/07, 4/6/07 http://promedmail.org, CIDRAP 4/4/07, 4/6/07 http://cidrap.umn.edu)

^top

Indonesia: Avian influenza sample sharing debate continues
Indonesian officials said they would not resume sharing H5N1 virus samples unless vaccine manufacturers promise to provide the country with free pandemic flu vaccines. On April 5, Bloomberg News reported that Indonesian Health Minister Siti Fadilah Supari said the country would resume sharing samples "only after the WHO helps Indonesia negotiate free supplies of pandemic-flu shots and money to build vaccine plants." The requirement would be a first. Indonesia is demanding compensation from drug manufacturers GlaxoSmithKline (GSK) and Novartis in particular. A GSK spokeswoman told said the company's chief executive, Jean-Pierre Garnier, would meet with WHO Director-General Margaret Chan today to discuss the dispute. After a conference with the WHO and other Southeast Asian countries Mar 26 and 27, Indonesia promised to resume sharing samples immediately, while the WHO vowed to develop new guidelines for the sharing of virus samples. The rules were to be debated at the World Health Assembly in May, officials said.
(CIDRAP, 4/6/07, http://cidrap.umn.edu)

^top

Indonesia: Autopsies considered for avian influenza H5N1 victims
Indonesia's national avian influenza commission has recommended that the health ministry conduct an autopsy on each person who dies of H5N1 avian flu to learn more about how the disease affects the body. Though experts say multiple organ failure plays a role in avian flu deaths, there are no data on humans, Bayu Krisnamurthi, chairman of the National Commission for Avian Influenza and Pandemic Preparedness, said. Postmortem examination has confirmed the role of multiple organ failure in chickens, and autopsies are needed to determine if the disease also spreads beyond the lungs in humans.
(CIDRAP 4/3/07, http://cidrap.umn.edu)

^top

Myanmar (Rangoon): Avian influenza outbreak in chickens, report of failed cleanup
An unidentified Burmese veterinarian told Democratic Voice of Burma that the latest bird flu outbreak in Rangoon was caused by not properly 'clearing up' chicken and duck farms around the affected area during the previous outbreak. “At Nyaung Hnapin, there are 3 farms; Kaung Thukkha, a duck farm and another farm nearby. As Kaung Thukkha was affected, they didn't clear the nearby farms and when it was certain that the farms were affected the number (of chickens) were reduced as they just sold the birds off in advance," explained the vet. He added that had the authorities compensated the farm owners at half the price of the going rate, they would not have sold the chickens illegally. The comment came after the state-run newspaper reported April 2 a new outbreak of bird flu in Rangoon's Htaukkyant township, where more than 900 chickens were suspected to have died from the H5N1 virus on 28 and 30 Mar 2007.
(ProMED 4/6/07 http://promedmail.org, CIDRAP 4/6/07, http://cidrap.umn.edu)

^top

Philippines: Rapid-containment exercise will test plans to avert an influenza pandemic
The Association of Southeast Asian Nations (ASEAN), the Japanese Government, and WHO took part in an exercise designed to test their ability to head off the first signs of a human influenza pandemic. The exercise, known as Panstop 2007, involved a mock scenario in which Tamiflu and personal protective equipment such as goggles and masks were dispatched from an ASEAN-supported stockpile in Singapore to Cambodia, where there are signs of a pandemic strain of influenza emerging. No drugs or other materials were actually moved in the drill, which served to test rapid containment, involving risk assessment, communications, and decision-making between the partners. The two-day drill was facilitated from the WHO Regional Office for the Western Pacific in Manila, Philippines, on 2 and 3 April 2007. Panstop should yield practical information about the efficiency of procedures, discover gaps in planning, build on strengths, and identify opportunities for improvement of rapid response and containment planning.
(WHO Western Pacific, 4/1/07, http://www.wpro.who.int/)

^top

Viet Nam (Ca Mau Province): Avian influenza H5N1 outbreak in ducks
Ca Mau province, Vietnam's southernmost, has reported an outbreak of bird flu, the first since declaring it was free of the disease before the Lunar New Year in mid-February. More than 100 ducks had died of the disease in Khanh Binh Dong commune in Tran Van Thoi district, authorities said. The ducks, 20 days old and unvaccinated, began dying Mar 22. The new outbreaks came a few days after the government said the country had gone 21 days with no new outbreaks. The virus resurfaced in the country's poultry this past winter after about a year with no outbreaks. Most of the recent outbreaks have been in southern Vietnam's Mekong Delta region. The source of this latest outbreak remains unknown. All poultry in the infected area have been culled, and the administration has asked authorities to step up surveillance to prevent the disease from recurring. There have been no confirmed human cases of H5N1 avian influenza in Viet Nam since Nov 2005, when Viet Nam led the world with a total of 42 deaths attributable to H5N1 influenza.
(ProMED 3/31/07, http://promedmail.org, OIE 3/23/07, http://oie.int, CIDRAP 4/2/07, http://cidrap.umn.edu)

^top


Americas
USA: Novel Influenza A infection added as notifiable disease
The Executive Committee of the Council of State and Territorial Epidemiologists approved an interim position statement adding novel influnza A virus infections to the National Notifiable Diseases Surveillance System (NNDSS). The CDC’s Morbidity and Mortality Weekly Report for the week of April 5 adds novel influenza A virus infection to Table I (Provisional cases of infrequently reported notifiable diseases).
(MMWR 50:13, http://www.cdc.gov/mmwr)

^top

USA: Firm seeks license for seasonal flu vaccine
CSL Biotherapies, the US branch of an Australian vaccine producer, announced this week it has applied for Food and Drug Administration (FDA) approval to market a seasonal influenza vaccine in the United States. The company has requested an expedited review from the FDA, with the intention of having the vaccine ready for distribution for the 2007-08 flu season. The number of doses to be made available is yet to be determined and will depend on the FDA approval and antigen yields from various virus strains. A clinical trial sponsored by the National Institutes of Health (NIH) and involving 1,359 adults at nine sites began last June to test the vaccine's safety and immunogenicity. Results of the phase 3 study have not yet been published. The company already supplies the vaccine in 16 other countries. The vaccine will be manufactured in Melbourne, Australia. It will then be finished in Marburg, Germany and distributed out of Kankakee, Ill. With FDA approval, CSL Biotherapies would become the fifth provider of seasonal flu vaccines in the United States, joining Sanofi Pasteur, GlaxoSmithKline, Novartis, and MedImmune. The four companies distributed more than 100 million doses of vaccine for the 2006-07 season, according to the Centers for Disease Control and Prevention.
(CIDRAP 4/5/07 http://cidrap.umn.edu)

^top

USA: Expanded Capability for Influenza Research and Surveillance
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), announced it is awarding $23 million per year for seven years to establish six Centers of Excellence for Influenza Research and Surveillance. Collectively, the centers will expand NIAID’s influenza surveillance program internationally and in the United States, and will bolster influenza research in key areas, including understanding how the virus causes disease and how the human immune system responds to infection with the virus. The goal of the newly created centers is to provide the federal government with important information to inform public health strategies for controlling and lessening the impact of seasonal influenza as well as an influenza pandemic.
(CIDRAP 4/4/07 http://cidrap.umn.gov, CDC 4/4/07 http://cdc.gov)

^top

USA (West Virginia): Low-pathogenic avian influenza found in Turkeys
Turkeys at a farm in West Virginia (WV) have tested positive for what government officials believe is a low-pathogenic strain of the bird flu virus, the U.S. Department of Agriculture (USDA) said April 1. Preliminary tests indicated the turkeys had a low pathogenic H5N2 avian influenza virus. USDA officials said they can say "for certain" it's not the highly pathogenic H5N1 virus (HPAI). Spokesmen would not identify the farm but said it was located in Pendleton County in the east-central part of the state. The samples were collected by an industry group as part of a routine examination before slaughter. The birds showed no sign of illness or mortality. The samples were collected from a flock of about 25 000 birds. The USDA's National Veterinary Services Laboratory will conduct sequencing and pathogenicity tests to further identify the virus. The USDA's policy is to cull birds that have H5 or H7 influenza viruses, because they can mutate into highly pathogenic strains. The poultry's owner participates in the National Poultry Improvement Plan and therefore will be compensated for the loss. Control measures implemented include quarantine, stamping out, movement controls and increased surveillance in surrounding flocks (within a 10 km radius). Vaccination is not permitted. All H5 and H7 avian influenza (low and highly pathogenic forms) is reportable. A low-pathogenic strain, which produces less disease and mortality in birds than does a high-pathogenic version, poses no threat to humans.
(ProMED 4/2/07, 4/3/07 http://promedmail.org, OIE 4/3/07, 4/4/07 http://oie.int, CIDRAP 4/2/07 http://cidrap.umn.edu)

^top


Africa
Egypt (Qena, Qalubiea, Sohag, Minya): 4 avian influenza H5N1 cases in children
Four Egyptian children have tested positive for H5N1 avian influenza virus, bringing the total number of human cases in Egypt to 32. The Health Ministry identified the children as a 4-year-old boy of Qena province, around 670 km south of Cairo, who is the brother of the 6-year-old girl whose infection was reported Mar 2007; a 4-year-old girl from Qalubiea Governorate; a 7-year-old boy of Sohag province, around 467 km south of Cairo; and a 2-year-old girl from Minya governorate, south of Cairo. WHO officials confirmed the 3 new cases. The children were admitted to hospital suffering from fevers after exposure to poultry, and have been treated with the antiviral Tamiflu. All 4 remain in stable condition and have been transferred to hospital in Cairo. Investigations into the sources of exposure indicate a history of contact with dead birds in each case. Egyptian health authorities have excluded the possibility of human-to-human transmission in the case of the brother and sister, WHO said Apr 2. Both of the children had been exposed to poultry infected with the H5N1 virus. 10 of the Egyptians diagnosed so far this year have been children. Thirteen of the country's 32 cases have been fatal.
(ProMED 3/31/07, 4/2/07, 4/3/07 http://promedmail.org, WHO 4/2/07 http://who.int/en, CIDRAP 4/2/07 http://cidrap.umn.edu)

^top


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 some recent reports regarding Nigeria.
- 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/. Pandemic Flu Public Service Announcement has been released.
- 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)

^top

Seasonal Influenza
During week 12 (March 18 – March 24, 2007), influenza activity continued to decrease in the United States. Data from the U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories indicated a decline in activity for the sixth consecutive week; 15.1% of specimens tested positive for influenza this week. ILI data decreased during week 12 and was at the national baseline for the first time since early January. Twelve states reported widespread influenza activity; 17 states reported regional influenza activity; 11 states, and New York City reported local influenza activity; the District of Columbia and nine states reported sporadic influenza activity; and one state did not report. The reporting of widespread or regional influenza activity decreased from 37 for week 11 to 29 for week 12. The percent of deaths due to pneumonia and influenza remained below baseline level.
(CDC http://www.cdc.gov/flu/weekly/ )

^top


2. Articles
Public health interventions and epidemic intensity during the 1918 influenza pandemic.
R Hatchett et al. PNAS DOI: 10.1073/pnas.0610941104 (2007)
Abstract: Nonpharmaceutical interventions (NPIs) intended to reduce infectious contacts between persons form an integral part of plans to mitigate the impact of the next influenza pandemic. Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined. We obtained data on the timing of 19 classes of NPI in 17 U.S. cities during the 1918 pandemic and tested the hypothesis that early implementation of multiple interventions was associated with reduced disease transmission. Consistent with this hypothesis, cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates {approx}50% lower than those that did not and had less-steep epidemic curves. Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller ({approx}20%) and less statistically significant than that for peak death rates. This finding was not unexpected, given that few cities maintained NPIs longer than 6 weeks in 1918. Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic. These findings support the hypothesis that rapid implementation of multiple NPIs can significantly reduce influenza transmission, but that viral spread will be renewed upon relaxation of such measures.
(http://www.pnas.org/cgi/content/abstract/0610941104v1)

^top

The effect of public health measures on the 1918 influenza pandemic in US cities
M Bootsma and N Ferguson. PNAS DOI: 10.1073/pnas.0611071104 (2007)
Abstract: During the 1918 influenza pandemic, the U.S., unlike Europe, put considerable effort into public health interventions. There was also more geographic variation in the autumn wave of the pandemic in the U.S. compared with Europe, with some cities seeing only a single large peak in mortality and others seeing double-peaked epidemics. Here we examine whether differences in the public health measures adopted by different cities can explain the variation in epidemic patterns and overall mortality observed. We show that city-specific per-capita excess mortality in 1918 was significantly correlated with 1917 per-capita mortality, indicating some intrinsic variation in overall mortality, perhaps related to sociodemographic factors. In the subset of 23 cities for which we had partial data on the timing of interventions, an even stronger correlation was found between excess mortality and how early in the epidemic interventions were introduced. We then fitted an epidemic model to weekly mortality in 16 cities with nearly complete intervention-timing data and estimated the impact of interventions. The model reproduced the observed epidemic patterns well. In line with theoretical arguments, we found the time-limited interventions used reduced total mortality only moderately (perhaps 10-30%), and that the impact was often very limited because of interventions being introduced too late and lifted too early. San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30-50%. Our analysis also suggests that individuals reactively reduced their contact rates in response to high levels of mortality during the pandemic.
(http://www.pnas.org/cgi/content/abstract/0611071104v1)

^top

Ethics in a Pandemic: A Survey of the State Pandemic Influenza Plans
Thomas JC, Dasgupta N, et al. American Journal of Public Health. E-Published April 5, 2007. 10.2105/AJPH.2006.093443
Abstract: A pandemic of highly pathogenic influenza would threaten the lives of hundreds of thousands in the United States and confront governments and organizations, with ethical issues having wide-ranging implications. The Department of Health and Human Services and all states have published pandemic influenza plans. We analyzed the federal and state plans, available on the Internet, for evidence of ethical guidance as judged by the presence of ethical terms. The most striking finding was an absence of ethical language. Although some states acknowledged the need for ethical decisionmaking, very few prescribed how it should happen. If faced by a pandemic in the near future, we stand the risk of making many unjust and regrettable decisions.
(http://www.ajph.org/cgi/content/abstract/AJPH.2006.093443v1)

^top

Disrupting the Transmission of Influenza A: Face Masks and Ultraviolet Light as Control Measures.
Weiss, et al. American Journal of Public Health. E-Published April 5, 2007. 10.2105/AJPH.2006.096214
Abstract: In the event of an influenza pandemic, where effective vaccine and antiviral drugs may be lacking, disrupting environmental transmission of the influenza virus will be the only viable strategy to protect the public. We discuss 2 such modalities, respirators (face masks) and ultraviolet (UV) light. Largely overlooked, the potential utility of each is underappreciated. The effectiveness of disposable face masks may be increased by sealing the edges of the mask to the face. Reusable masks should be stockpiled, because the supply of disposable masks will likely prove inadequate. UV light, directed overhead, may be beneficial in hospitals and nursing homes.
(http://www.ajph.org/cgi/content/abstract/AJPH.2006.096214v1)

^top

Genome analysis linking recent European and African influenza (H5N1) viruses
Salzberg SL et al. Emerg Infect Dis [serial on the Internet]. 2007 May.
Abstract: To better understand the ecology and epidemiology of the highly pathogenic avian influenza virus in its transcontinental spread, we sequenced and analyzed the complete genomes of 36 recent influenza A (H5N1) viruses collected from birds in Europe, northern Africa, and southeastern Asia. These sequences, among the first complete genomes of influenza (H5N1) viruses outside Asia, clearly depict the lineages now infecting wild and domestic birds in Europe and Africa and show the relationships among these isolates and other strains affecting both birds and humans. The isolates fall into 3 distinct lineages, 1 of which contains all known non-Asian isolates. This new Euro-African lineage, which was the cause of several recent (2006) fatal human infections in Egypt and Iraq, has been introduced at least 3 times into the European-African region and has split into 3 distinct, independently evolving sublineages. One isolate provides evidence that 2 of these sublineages have recently reassorted.
(http://www.cdc.gov/EID/content/13/5/713.htm)

^top

Nucleic acid-based antiviral drugs against seasonal and avian influenza viruses.
Wong JP, et al. Vaccine. 2007 Apr 20;25(16):3175-8. Epub 2007 Jan 19.
Abstract: Influenza viruses are etiological agents of deadly flu that continue to pose global health threats, and have caused global pandemics that killed millions of people worldwide. The availability of neuraminidase inhibitors and attenuated vaccines improves our ability to defend against influenza, but their benefits can be significantly limited by drug-resistance and virus mutations. Nucleic acid-based drugs may represent a promising class of antiviral agents that could play a role in the prevention and treatment of influenza. Efficacy studies in animals have shown that ds RNA, such as poly ICLC can provide effective and broad-spectrum prophylaxis against lethal challenges against various strains of influenza A virus. Furthermore, similar level of antiviral protection in mice can be provided by using short fragments of oligonucleotides that induce antiviral immunity. Finally, influenza virus expression can also be specifically inhibited or suppressed using antisense oligonucleotides that bind to viral mRNA encoding key viral proteins. The versatility and potency of nucleic acid-based drugs make them potential drug candidates for used in seasonal or pandemic influenza situations.

^top

Avian and pandemic influenza: An overview.
Poland GA, Jacobson RM, Targonski PV. Vaccine. 2007 Apr 20;25(16):3057-3061. Epub 2007 Jan 18.
Abstract: Influenza A/H5N1 (avian influenza) has now caused 258 human infections (as of November 13, 2006), with an approximate 50% mortality rate. Because the virus is novel in terms of antigenic type and causes infection and illness, and because humans have no pre-existing immunity, the conditions for a possible pandemic exist. Additionally, wild migratory birds appear to be spreading the virus across ever larger geographic areas, and newer clade 2 influenza A/H5N1 viruses have begun to emerge. The US Congressional Budget Office has formally modeled the likely consequences of pandemic influenza and estimates that up to 2 million of the US population might die, with up to 40% of all workers ill for as long as 3 or more weeks. This brief overview will review basic virologic, immunologic and epidemiologic information relevant to understanding and preparing for this threat. In particular, the role of avian influenza vaccines will be reviewed.

^top

Antiviral Therapy and Prophylaxis for Influenza in Children
Committee on Infectious Diseases. PEDIATRICS Vol. 119 No. 4 April 2007, pp. 852-860 (doi:10.1542/peds.2007-0224)
Clinical Report: Antiviral agents are available that are safe and effective for the treatment and prophylaxis of influenza virus infections in children. The neuraminidase inhibitors (oseltamivir [Tamiflu] and zanamivir [Relenza]) are preferred agents because of current widespread resistance to the adamantanes (amantadine [Symmetrel] and rimantadine [Flumadine]). Therapy should be provided to children with influenza infection who are at high risk of severe infection and to children with moderate-to-severe influenza infection who may benefit from a decrease in the duration of symptoms. Prophylaxis should be provided (1) to high-risk children who have not yet received immunization and during the 2 weeks after immunization, (2) to unimmunized family members and health care professionals with close contact with high-risk unimmunized children or infants who are younger than 6 months, and (3) for control of influenza outbreaks in unimmunized staff and children in an institutional setting. Testing of current H5N1 avian influenza virus isolates, the potential agents of pandemic influenza, suggests susceptibility to oseltamivir and zanamivir. Because no prospective data exist on the efficacy of these agents in humans for H5N1 strains, the dosage and duration of therapy in adults and children may differ from those documented to be effective for epidemic influenza strains.
(http://pediatrics.aappublications.org/cgi/content/abstract/119/4/852)

^top

Emergence of Influenza B Viruses With Reduced Sensitivity to Neuraminidase Inhibitors
Shuji Hatakeyama et al. JAMA. 2007;297:1435-1442.
Abstract: Context: Very little is known about the frequency of generation and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors. Furthermore, transmission of resistant virus, whether influenza A or B, has not been recognized to date. Objective: To assess the prevalence and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors. Design, Setting, and Patients: Investigation of the neuraminidase inhibitor sensitivity of influenza B isolates from 74 children before and after oseltamivir therapy and from 348 untreated patients with influenza (including 66 adults) seen at 4 community hospitals in Japan during the 2004-2005 influenza season. Four hundred twenty-two viruses from untreated patients and 74 samples from patients after oseltamivir therapy were analyzed. Main Outcome Measure: Sialidase inhibition assay was used to test the drug sensitivities of influenza B viruses. The neuraminidase and hemagglutinin genes of viruses showing reduced sensitivity to neuraminidase inhibitors were sequenced to identify mutations that have the potential to confer reduced sensitivity to these drugs. Results: In 1 (1.4%) of the 74 children who had received oseltamivir, we identified a variant with reduced drug sensitivity possessing a Gly402Ser neuraminidase substitution. We also identified variants with reduced sensitivity carrying an Asp198Asn, Ile222Thr, or Ser250Gly mutation in 7 (1.7%) of the 422 viruses from untreated patients. Review of the clinical and viral genetic information available on these 7 patients indicated that 4 were likely infected in a community setting, while the remaining 3 were probably infected through contact with siblings shedding the mutant viruses. Conclusions: In this population, influenza B viruses with reduced sensitivity to neuraminidase inhibitors do not arise as frequently as resistant influenza A viruses. However, they appear to be transmitted within communities and families, requiring continued close monitoring.
(http://jama.ama-assn.org/cgi/content/abstract/297/13/1435)

^top

Changing perspective on immunization against influenza.
Johansson BE, Brett IC. Vaccine. 2007 Apr 20;25(16):3062-5. Epub 2007 Jan 19.
Abstract: Current vaccination strategies against influenza rely on decades old technology of strain selection and prolonged labor-intensive, embryonated chicken-egg based production methods. Although, containing both major surface glycoproteins, hemagglutinin (HA) and neuraminidase (NA), the immunity engendered by these vaccines is dominated by the anti-HA response. Consequently, current vaccines are susceptible to failure resulting from significant antigenic drift or shift in the time elapsing from the selection of the vaccine candidate strain and wild-type virus exposure. Therefore, immunity may be of short duration. There must be a change in vaccine strategy to include immunization with both HA and NA to broaden the immune response against influenza. Inclusion of the more slowly evolving NA in a vaccine against influenza will reduce the vulnerability to antigenic changes in a potential emerging influenza virus. Alternative production technologies such as recombinant baculovirus and yeast should be explored to decrease vaccine production times.

^top


3. Notifications
CDC Publishes Travel Industry Checklist for Pandemic
Businesses in the travel industry—including travel agencies and air, rail, bus, and cruise lines—will play a key role in protecting the health and safety of their personnel and travelers in the event of a pandemic. Planning and coordinating with public health and emergency management agencies at the local, state, national, and international levels are critical. To help with this, the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed a checklist. It identifies important steps that businesses in the travel industry can take now to prepare for an influenza pandemic. This checklist provides a general framework for developing a pandemic influenza plan. Individual businesses will need to adapt this checklist to meet their unique needs and circumstances. Many of these activities will also help travel-related businesses prepare for other kinds of emergencies. The key planning activities in this checklist are meant to complement and enhance existing all-hazards emergency/business contingency plans.
(http://pandemicflu.gov/plan/workplaceplanning/travelchecklist.html)

^top

International conference in Verona reviews poultry vaccination methods
Vaccinating poultry is an important tool in the worldwide battle against the H5N1 virus combined with several other control instruments, according to an international scientific conference. Around 400 experts reviewed the recent experiences and achievements of vaccination programs carried out in many countries worldwide. The conference was jointly organized by the World Organisation for Animal Health (OIE), the UN Food and Agriculture Organization (FAO) and the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), with the support of the European Commission. The meeting stressed that since the beginning of the avian influenza crisis in late 2003 disease reporting and control policies have substantially improved. Fighting the disease in poultry is essential to decrease the amount of virus in the environment and thus reduce the risk of human infection and the threat of a possible human influenza pandemic. The conference recommended that poultry should be vaccinated against avian influenza particularly in endemic countries and when other control measures such as stamping out, movement controls of poultry and biosecurity cannot stop the spread of the virus.

A successful vaccination campaign depends mainly on the use of high quality vaccines complying with OIE standards, appropriate infrastructure to ensure the rapid and safe delivery of vaccines (cold chain), monitoring of vaccinated flocks, movement control of poultry, and adequate financial resources. Efficient veterinary services complying with OIE standards on quality and evaluation is also very important for the suspension of the use of vaccination. Any vaccination policy should include an exit strategy so that countries do not rely on costly long-term vaccination campaigns. The tools differentiating infected from vaccinated animals such as DIVA strategy or the use of sentinel birds are recommended in the field when possible. There are no elements indicating human health implications related to the vaccination of poultry and to the consumption of poultry products from vaccinated animals. The conference called upon the commercial poultry industry to reinforce its engagement in the control of avian influenza under the supervision of national veterinary authorities. A call to international donors for the funding of vaccination in endemic countries, with particular focus on backyard poultry, was also made.

The conference urged the development and funding of more research in the following fields: Development of new and improved vaccines; Development of new vaccines that combine protection against H5N1 with the control of other poultry diseases particularly Newcastle disease; Design of cost-effective delivery systems particularly for small-holders and backyard farmers; Development of a vaccination decision support model; Data sharing of vaccination programs conducted under field conditions; Impact of vaccination on production, consumption and trade; Impact of mass culling programs on valuable poultry genetic material. Participants of the Verona conference also proposed to develop communication strategies to improve the vaccination coverage, to avoid possible market shocks and to apply basic biosecurity measures.
(OIE http://www.oie.int/eng/press/en_070322.htm )

^top

 apecein@u.washington.edu