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EINet Alert ~ May 04, 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) - Bangladesh: Avian influenza detected in poultry - Indonesia: Request of written guarantee from WHO on sample sharing - Malaysia: Warnings of smuggled chicken - USA: CDC offers advice on citizen use of masks, respirators - USA: GAO says financial markets not ready for a pandemic - USA: New York group offers plan for rationing ventilators in pandemic - Ghana: Reports of first avian influenza H5N1 outbreak - Ghana: Excerpts from the OIE report on avian influenza in birds 1. Updates - Avian/Pandemic influenza updates - Seasonal Influenza 2. Articles - Hospital Personnel Response during a Hypothetical Influenza Pandemic: Will they come to Work? - A Simple Triage Scoring System Predicting Death and Need for Critical Resources for Use During Epidemics - Recombinant Modified Vaccinia Virus Ankara–Based Vaccine Induces Protective Immunity in Mice against Infection with Influenza Virus H5N1 - Prevaccine Determination of the Expression of Costimulatory B7 Molecules in Activated Monocytes Predicts Influenza Vaccine Responses in Young and Older Adults - Controlling Pandemic Flu: The Value of International Air Travel Restrictions - Can Influenza Epidemics Be Prevented by Voluntary Vaccination? - Detection of H5 Avian Influenza Viruses by Antigen-Capture Enzyme-Linked Immunosorbent Assay Using H5-Specific Monoclonal Antibody 3. Notifications - Panel supports EU approval of cell-based influenza vaccine Global Global: Cumulative number of human cases of avian influenza A/(H5N1) Economy / Cases (Deaths)
2003
2004
2005
2006
2007
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 291 (172).
Avian influenza age & sex distribution data from WHO/WPRO:
WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 4/16/07):
WHO’s timeline of important H5N1-related events (last updated 4/20/07):
FAO map showing outbreaks among poultry (last updated 3/26/2007): Asia Bangladesh: Avian influenza detected in poultry Some 8500 chickens have been culled in Bangladesh following the spread of bird flu in the country. "We have culled 8500 chickens in a one-sq-km area. It (the virus) was first identified at a government-run farm and then in 3 nearby farms," a government livestock official said 2 May 2007. Samples from other farms in the southwestern district of Jessore, where the outbreak occurred, had also been taken for analysis, he said. The cull took the total number of birds killed so far in Bangladesh to more than 70 000. Officials said Apr 2007 that around 66 000 birds at 22 farms had been destroyed after the disease spread in other parts of the country, including to the north. The disease was first identified in Bangladesh Mar 2007, after samples from a farm near the capital, Dhaka, tested positive for the H5N1 strain of bird flu. So far, there has been no report of any human infection in the impoverished nation. Bangladesh is home to hundreds of thousands of poultry farms employing more than a million people. It had already banned imports of live birds from more than 50 countries, including neighboring India and Myanmar, after outbreaks were detected there. (Promed 5/3/07) Indonesia: Request of written guarantee from WHO on sample sharing
Malaysia: Warnings of smuggled chicken
Americas USA: CDC offers advice on citizen use of masks, respirators Though there is little scientific evidence to go on, wearing a surgical face mask may make sense for people who have to go into crowded public places during an influenza pandemic, federal health officials said. Furthermore, people who care for a pandemic flu patient at home or have other close contact with sick people in a pandemic should consider wearing an N-95 respirator, a more elaborate type of mask designed to stop virus-sized particles, CDC advised. CDC officials said avoiding crowded conditions and infected people are the most important precautions in a pandemic, but masks and respirators may provide additional protection. Standard precautions such as hand hygiene and social distancing should also be used. "If people are not able to avoid crowded places, [or] large gatherings or are caring for people who are ill, using a facemask or a respirator correctly and consistently could help protect people and reduce the spread of pandemic influenza," CDC Director Dr. Julie Gerberding said. For example, people might choose to wear a face mask when going to a grocery store or a religious service, and they might want to use a respirator when visiting a sick neighbor to deliver food or medicine. Surgical face masks are simple masks designed to fit across the nose and mouth and catch large respiratory droplets produced by the wearer, but they also offer some protection from others' secretions. They are inexpensive and typically fit fairly loosely. N-95 respirators are thicker masks that are designed to fit tightly to the face and block at least 95% of small airborne particles. They must be specially fitted for the wearer. CDC said people should consider wearing a face mask during a flu pandemic if: They have the flu and think they might come in close contact with others; They live with someone who has flu symptoms (resulting in possible exposure) and they need to be in a crowded public place; They are well and don't expect to have close contact with a sick person, but they need to be in a crowded place. People should consider wearing an N-95 respirator if they are well and expect to be in close contact with someone who is known or believed to have the flu, and particularly when caring for a sick person at home, the agency said. Gerberding said the CDC is not recommending that people stockpile masks or respirators now. CDC is stockpiling masks and respirators for use by healthcare workers in a pandemic, mainly because the supply depends heavily on imports. "We have almost 52 million regular surgical masks, and of N-95 respirators we have almost 100 million in the stockpile, with several million more on order," Gerberding said. If N-95 respirators run short during a pandemic, face masks can be used instead—and should be used when close contact with sick people is expected, the CDC guidance says. Gerberding added that a respirator can lead to a "false sense of security," because if it fits poorly so that air can leak around it, it provides less protection. . . . "If you're going to choose a mask right now, it's probably best to think about a simple face mask that prevents your respiratory secretions from infecting someone else" and that also offers some protection from incoming droplets, she said.
May 3 CDC news release: http://www.cdc.gov/od/oc/media/pressrel/2007/r070503.htm USA: GAO says financial markets not ready for a pandemic
Though the financial markets have made good strides since the Sep 11 terrorist attacks to spread their operations to dispersed back-up sites, the GAO warns that the industry shouldn't depend on the more dispersed operating centers to help them through a pandemic. "With global airline travel available, any disease outbreak could occur quickly and be widely spread within a short period of time," the report says. The GAO says that while federal regulators are discussing their pandemic planning expectations with the financial industry, they haven't told industry groups to include a severe pandemic scenario in their planning or to set dates for completing pandemic plans.
Both regulators and the financial markets have become concerned about how strong telecommunications systems will be during a pandemic, because most business continuity plans involve telecommuting, the report says. A modeling study from the National Communication System suggested there was enough bandwidth to handle the traffic, but problems could crop up in individual residential or commercial areas. USA: New York group offers plan for rationing ventilators in pandemic
The task force, called the New York State Workgroup on Ventilator Allocation in an Influenza Pandemic, has invited public comments on the proposed guidelines and plans to revise them in coming months. Once the guidelines are finished, the expectation is that New York hospitals could use them as an acceptable standard of care if ventilators ran short in a pandemic, said Guthrie S. Birkhead, MD, the other co-chair of the task force and director of the NYSDOH Center for Community Health. Given that status, the guidelines might offer hospitals some protection against legal liability for ventilator allocation, he said. The plan is based on a set of ethical principles, including (1) healthcare workers' fundamental duty to care for patients, (2) the duty to steward scarce resources wisely, (3) the duty to plan in advance how to allocate ventilators, (4) statewide application of the allocation guidelines, so that the same rules apply in different hospitals and communities, and (5) transparency in proposing and refining the guidelines. The proposal depicts rationing as a last resort. Hospitals would need to limit the need for ventilators by canceling or postponing elective medical procedures and would be expected to acquire as many ventilators as possible from their own suppliers or networks and the state and federal stockpiles. Unlike some other proposals for allocating ventilators, the New York group decided not to list either specific diseases, such as AIDS, or age as exclusion criteria. "We tried to focus more on functionality—we just want to know how sick you are and what your probability of survival is," said Powell. Patients who do get a ventilator will be reassessed after 48 hours and again after 120 hours to see if they still need and can benefit from the treatment, the proposal says. In an effort to protect primary treating physicians from the heavy burden of deciding whether their own patients will get or keep a ventilator, the guidelines assign the rationing decisions to the supervising clinician in charge of intensive care patients. Some issues were more controversial than others. One was "whether there would be priority access for healthcare workers and other first responders," said Powell. "The group has proposed that there not be prioritized access for healthcare workers. Once you're a critically ill patient, it doesn't matter what you do for a living." Powell said another controversial issue was how to deal with patients in chronic care facilities, including those who are chronic ventilator users. "We proposed that people in chronic care facilities be offered a different standard," she said. "To be in a chronic care facility, by definition, you're stable, you're not acutely ill. . .We thought it was important to offer a haven for some of our most vulnerable chronically ill patients." Acknowledging that ventilator rationing would be likely to trigger lawsuits, the proposal says that guidelines issued by the NYSDOH "would provide strong evidence for an acceptable standard of care during the dire circumstances of a pandemic." However, it adds, there is no guarantee that a court would accept this view. Only legislation would provide certain protection. To see the NYSDOH website on the plan: http://www.health.state.ny.us/diseases/communicable/influenza/pandemic/ventilators/ (CIDRAP 4/30/07 www.cidrap.umn.edu ) Africa Ghana: Reports of first avian influenza H5N1 outbreak News services reported the confirmation of H5N1 avian influenza on a chicken farm in Ghana, apparently making it the ninth African country to be hit by the virus. Agriculture Minister Ernest Debrah said the outbreak was discovered Apr 24 on a farm near the port city of Tema, east of the capital, Accra. Dr. Harry Opata, a WHO disease prevention officer, said the outbreak was confirmed by a veterinary lab in Accra and by the US Navy lab in Cairo, Egypt. He said about 100 chickens had died each day for the past 3 or 4 days. Debrah said about 1,700 birds have been destroyed to stop the outbreak. The farm was relatively isolated, and the surrounding area had been put under veterinary surveillance to prevent any spread. Ghana will join 8 other African countries that are facing or have faced H5N1 outbreaks in birds: Burkina Faso, Cameroon, Cote d'Ivoire, Djibouti, Egypt, Niger, Nigeria, and Sudan. Human cases have occurred in Egypt (34), Djibouti (1), and Nigeria (1). Nigeria reported sub-Saharan Africa's only confirmed human death from H5N1 early in 2007. (CIDRAP 5/2/07 www.cidrap.umn.edu ; Promed 5/2/07 ) Ghana: Excerpts from the OIE report on avian influenza in birds
Samples have been sent to the OIE Reference Laboratory in Italy 2 May 2007. Results are pending. Accra veterinary laboratory (National laboratory): Test hemagglutination (HA) test: Positive. Test hemagglutination inhibition test (HIT): Positive. Rapid tests: Positive. Noguchi Memorial Institute for Medical Research (National laboratory): Test reverse transcription - polymerase chain reaction (RT-PCR): Positive. (Promed 5/3/07) 1. Updates Avian/Pandemic influenza updates - UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat; new news from Central Asia. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community; update on the Ghana situation. - 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 the avian influenza web portal: http://www.oie.int/eng/info_ev/en_avianinfluenza.htm - US CDC: http://www.cdc.gov/flu/avian/index.htm. - The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Information on the Community/Non-Occupational Mask Guidance plan. - 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. Updates from Brazil and the US. (UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS) Seasonal Influenza
2. Articles Hospital Personnel Response during a Hypothetical Influenza Pandemic: Will they come to Work? Charlene Irvin et al. Acad Emerg Med Volume 14, 5 Supplement 1 13 http://www.aemj.org/cgi/content/full/14/5_Supplement_1/S13-a Abstract: “A recent public health survey found half not likely to report to duty during an influenza pandemic. The CDC pandemic preparedness plans address ill workers, but there is no discussion of a potentially decreased workforce (from fears of contracting illness). Assessing the likelihood that hospital personnel would report to work, and issues that may affect this decision are important in the preparedness for any pandemic. Objectives To determine the willingness of hospital personnel to report to work in the hypothetical event of avian influenza pandemic (the avian influenza virus became person to person transmissible). Methods A voluntary, confidential, IRB approved survey was administered to 178 hospital personnel regarding their willingness to report to work, and what issues would be important in this decision, should an avian influenza pandemic occur. Results Of 178 surveys, 169 completed (95% response rate), with 34% doctors (Docs), 33% nurses, 33% clerical and other (OTHER) (average age = 38 years, Male 32%). When asked: In the event of an avian influenza pandemic, and patients were being treated at this hospital, would you report for work as usual: 50% yes, 42% maybe, and 8% no. Docs were more likely than Nurses or OTHER to respond Yes: Docs 73% (42/57), Nurses 44% (24/55), OTHER 33% (19/57); No: Docs 2% (1/57), Nurses 15% (8/55), OTHER 7% (4/57), p < 0.001. Males were more likely to respond Yes: 66% (34/51), Female 42% (45/108) p < 0.01. For the Maybe responders, the factor making the biggest difference (83%) was: How confident I am that the hospital can protect me. In 18% (30/169), financial incentives would not make a difference for them to report to work, even up to triple pay. Conclusions Personnel absenteeism during a pandemic due to fear of contracting an illness may result in significant personnel shortage and this issue should be addressed in pandemic disaster plans. Ensuring worker confidence in adequate personal protection may be more important than financial incentives.” A Simple Triage Scoring System Predicting Death and Need for Critical Resources for Use During Epidemics
Recombinant Modified Vaccinia Virus Ankara–Based Vaccine Induces Protective Immunity in Mice against Infection with Influenza Virus H5N1
Prevaccine Determination of the Expression of Costimulatory B7 Molecules in Activated Monocytes Predicts Influenza Vaccine Responses in Young and Older Adults
Controlling Pandemic Flu: The Value of International Air Travel Restrictions
Can Influenza Epidemics Be Prevented by Voluntary Vaccination?
Detection of H5 Avian Influenza Viruses by Antigen-Capture Enzyme-Linked Immunosorbent Assay Using H5-Specific Monoclonal Antibody
3. Notifications Panel supports EU approval of cell-based influenza vaccine A committee that reviews medical product applications for the European Union (EU) recommended approval of a cell-based seasonal influenza vaccine made by Novartis, improving the company's chance of becoming the first to market a flu vaccine grown in cell culture instead of in eggs. The Committee for Medicinal Products for Human Use (CHMP), which reviews applications for 27 EU countries, found that Novartis's Optaflu vaccine, given to more than 3,400 people during clinical studies, met the CHMP's immunogenicity criteria. The CHMP said it concluded there is "a favourable benefit to risk ratio" for Optaflu and therefore recommended its authorization. The vaccine is intended for adults. If the European Commission approves Optaflu, it may become the first seasonal flu vaccine made with cell-culture production techniques to go on the market. The Optaflu vaccine is grown in canine kidney cells. Cell-culture production is seen as slightly faster and considerably more flexible than traditional egg-based methods. Novartis said products made with cell-culture methods are safe for people who are allergic to eggs because they are not created with egg proteins. The new technology also offers the possibility of developing vaccine seed strains that more closely match the original "wild" virus. Cell-culture methods eliminate passage of the virus through eggs, where it may need to adapt before it can replicate. Novartis has said that Optaflu is a subunit vaccine, meaning it contains individual viral proteins rather than whole virus particles.
Novartis said it anticipates applying for US licensing of its cell-based flu vaccine in 2008. The company has conducted phase 1 and 2 clinical trials of the vaccine in the US and in Jul 2006 announced it would build a $600 million plant to make cell-culture flu vaccines. In May 2006 the US Department of Health and Human Services awarded Novartis a $220 million contract to develop cell-based flu vaccines, and Novartis has said the money would go toward the cost of the new facility. Depending on when its vaccine is approved by the Food and Drug Administration, the plant could begin production as early as 2011 and be ready for full production as early as 2012, with an annual output of 50 million doses of a trivalent vaccine. In the event of a flu pandemic, the facility is designed to have the capacity to make up to 150 million monovalent (single strain) doses each year within 6 months of a pandemic declaration, Novartis said.
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