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EINet Alert ~ Jun 15, 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: Glaxo to give 50 million doses of H5N1 vaccine to WHO
- UK (England): Low Pathogenic avian influenza H7N2 found at smallholding
- Europe: EU safety agency approves avian influenza vaccination
- Europe: EU approves Novartis's cell-based influenza vaccine
- Asia: Leaders vow to share avian influenza H5N1 samples
- Indonesia (Riau): New human case of avian influenza H5N1 infection
- Indonesia: Few Indonesians see avian influenza as threat based on survey
- Indonesia: Concerns that avian influenza H5N1 infections becoming less symptomatic in birds
- Malaysia: Suspected human cases of avian influenza H5N1 infection; outbreaks in poultry
- Myanmar: Report of new avian influenza H5N1 outbreak in farm north of Yangon
- Viet Nam: Report of 2 new avian influenza H5N1 cases; risks from free range ducks
- Viet Nam: Northern Vietnam reports new avian influenza H5N1 infections in ducks
- USA: Many Americans confused about avian influenza and food safety
- USA: HHS hears community leaders' ideas on pandemic influenza readiness
- USA: Firm wins grant for fast way to make DNA vaccines
- Egypt (Qena): More human cases of avian influenza H5N1 infection
- Avian/Pandemic influenza updates
- Inefficient Transmission of H5N1 Influenza Viruses in a Ferret Contact Model
- Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary
- Tamiflu and neuropsychiatric disturbance in adolescents
- National Pandemic Influenza Exercise, Exercise Cumpston 06 Report
- APEC Avian/Pandemic influenza Documents
- Pandemic preparedness Webinar recordings
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 313 (191).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm. (WHO/WPRO 6/4/07)
WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 6/13/07): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 6/4/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.
Global: Glaxo to give 50 million doses of H5N1 vaccine to WHO
The idea of a global stockpile emerged after complaints by Indonesia and other developing countries about lack of access to commercial H5N1 vaccines. Indonesia, the country hit hardest by H5N1, withheld samples of the virus from the WHO from Dec 2006 until May 2007 on grounds that drug companies use the samples to make vaccines priced out of Indonesia's reach. WHO said it needs to do "detailed operational planning for the stockpile, including how and under which conditions it will be deployed, as well as regulatory aspects of the vaccine." WHO members had passed a resolution calling for the creation of a stockpile of vaccines for H5N1 and other viruses of pandemic potential. The resolution also called on WHO to set up mechanisms for the "fair and equitable distribution" of pandemic flu vaccines at "affordable prices."
GSK's vaccine includes a proprietary adjuvant (immune-stimulating chemical) and in clinical trials has induced a strong immune response at low doses. In Jul 2006 the company said 80% of volunteers showed a good immune response after receiving two 3.8-microgram doses. A typical dose of seasonal flu vaccine contains 15 micrograms of antigen for each of three flu strains. In Mar GSK said its vaccine might protect people against more than 1 strain of H5N1. The vaccine is based on a 2004 strain from Vietnam, but in a clinical trial it elicited an immune response (neutralizing antibodies) to an H5N1 strain from Indonesia.
WHO noted that 3 other vaccine producers—Baxter, Sanofi Pasteur, and Omnivest of Hungary—also have expressed a willingness to provide some doses of H5N1 vaccine to the global stockpile. Baxter's said the company intends to provide a "multiyear donation" of its candidate pandemic flu vaccine to WHO. Sanofi Pasteur, meanwhile, said it was ready to give a "significant number of doses" of H5N1 vaccine. GSK promised that, in addition to its donation, it would provide some of its H5N1 vaccine to WHO at "preferential" prices for use by countries eligible for assistance from GAVI (the Global Alliance for Vaccines and Immunization), a public-private program that provides vaccines for children in poor countries.
The company noted that a precisely matched vaccine won't become available until 4 to 6 months after a pandemic strain emerges. Experts hope that if the next pandemic strain is an H5N1 variant, existing H5N1 vaccines will provide some protection, though supplies are likely to be very short.
UK (England): Low Pathogenic avian influenza H7N2 found at smallholding
A restriction zone has been placed around a non-commercial smallholding near St Helens, Lancashire, England, following the positive tests for low pathogenic avian influenza. Some of the infected chickens had been bought from a market 7 May 2007 held in Chelford that was associated with a recent H7N2 low pathogenic bird flu outbreak in north Wales. All the farm's birds, including peacocks, have been culled. Low pathogenic avian influenza typically causes little or no clinical symptoms in infected birds. The birds included 20 chickens, 3 ducks, 3 peacocks, and some peacock chicks. A restricted zone extends 1 km from the holding, which is thought to be in Rainhill, near St Helens. People are forbidden from moving poultry or any sort of live birds or eggs through this zone. The 2 people who live on the smallholding have been testing for the disease after exhibiting flu-like symptoms but results came back negative. The animal health department is tracing movements and contacts. DEFRA is working closely with the Health Protection Agency on all potential human health aspects.
(Promed 6/8/07 www.promedmail.org/ )
Europe: EU safety agency approves avian influenza vaccination
The EU authorised vaccines for poultry such as chickens and ducks meet relevant quality standards. However more study is needed before an opinion could be made about the use of vaccination for other poultry, European Food Safety Agency (EFSA) stated. According to the EFSA, monitoring strategies, combined with the use of sentinel birds in order to detect possible transmission after vaccination, must be employed to allow the detection of a possibly circulating field strain. Last year the European Centre for Disease Prevention and Control (CDPC) warned that vaccination programmes that are widely but imperfectly instituted in poultry may impede detection of human cases. Mass vaccination can also serve to disguise the presence of any H5N1 that manages to survive in innoculated flocks, and thus pose a great danger, others have argued. So far, the European Commisson and member countries have resisted calls for mass vaccination of the domestic poultry stock.
At least 3 countries -- China, Indonesia and Viet Nam -- are undertaking large-scale poultry vaccination programmes against H5N1, alongside with the mass culling of millions of birds. "If poultry immunisation is efficient and well monitored it could reduce the population burden of H5N1 in poultry and hence the risk for humans," the CDPC stated. "Equally however if it leads to the silent circulation of H5N1 in poultry it could actually increase the threat to humans in those countries and the risk of co-infection with other influenzas. Falling numbers of reported human cases in countries practicing large scale poultry immunisation may therefore be misleading." Cases of avian influenza H5N1 have occurred in wild birds in 13 member states of the EU to date: Greece, Italy, Slovenia, Hungary, Austria, Germany, France, Slovakia, Sweden, Poland, Denmark, Czech Republic and, more recently, the UK.
Europe: EU approves Novartis's cell-based influenza vaccine
Asia: Leaders vow to share avian influenza H5N1 samples
In a statement released at the end of the 2-day APEC health ministers' conference, the ministers pledged to continue supporting WHO influenza surveillance with the timely sharing of virus samples. APEC's 21 members include many of the countries that have been hardest hit by avian flu, including Indonesia, China, and Vietnam. Their statement acknowledges the concerns that Indonesia and other developing countries have about equitable access to pandemic vaccines. "We aim to ensure and promote the transparent, fair, and equitable sharing of benefits arising from the generation of information, diagnostics, medicines, vaccines, and other technologies associated with the sharing of virus samples," the ministers said.
At the World Health Assembly in May 2007, WHO adopted a resolution calling for an international H5N1 vaccine stockpile, a system for fairly distributing the vaccines, and a group to draw up "terms of reference" for virus sharing. Also at the APEC meeting, a senior WHO official warned that the H5N1 virus is mutating rapidly and unpredictably. Shigeru Omi, WHO regional director for the Western Pacific, said, "The virus is already entrenched, embedded in this part of the world, and it has been very, very unstable and changeable."
Omi said the virus has evolved from 2 distinct groups into 4 subgroups, adding, "And I would not be surprised to if we end up with more subclasses in the years to come," he said. Though the current mutations have not clearly increased the likelihood of human-to-human transmission, they do show that the virus is "risky", Omi said. To read more about the APEC Health Ministers meeting: http://www.apec.org/.
Indonesia (Riau): New human case of avian influenza H5N1 infection
Indonesia: Few Indonesians see avian influenza as threat based on survey
Indonesia: Concerns that avian influenza H5N1 infections becoming less symptomatic in birds
Scientists are conducting surveys of poultry to gauge the frequency of asymptomatic H5N1 infections, their cause and risks to people. 4 of every 5 human H5N1 cases have been fatal in Indonesia. Of 15 cases confirmed there May 2007, doctors weren't able to identify the cause of infection in 8 of them. "If there's virus circulation and the animals appear clinically healthy, then it can be a human health risk because people keep on handling those animals" without being aware of the risks, said Christianne Bruschke, a veterinarian leading an avian influenza project for the World Organisation for Animal Health [OIE]. Indonesia's vaccination program aimed at controlling poultry outbreaks may be obscuring infections, said Bruschke. The Indonesian government allocated 60 million doses of vaccine for poultry this year , enough to protect about 1/5 of the 285 million chickens raised in backyards across the country.
Malaysia: Suspected human cases of avian influenza H5N1 infection; outbreaks in poultry
Excerpts from OIE report
Source of infection: unknown or inconclusive.
Test: real-time reverse transcriptase/polymerase chain reaction (RRT-PCR), positive.
Myanmar: Report of new avian influenza H5N1 outbreak in farm north of Yangon
Excerpts from the OIE report:
Outbreak 1: Hanthawaddy ward, Bago, Bago, BAGO.
Affected population: layer poultry (battery cage).
Tests and results: polymerase chain reaction (PCR), 05 Jun 2007, Positive; rapid tests, 04 Jun 2007, Negative; virus isolation, 07 Jun 2007, Positive.
Viet Nam: Report of 2 new avian influenza H5N1 cases; risks from free range ducks
Reportedly, the patient from Tranh Hoa got sick after eating meat from an infected duck and was released from a hospital after recovering from pneumonia-like symptoms. Reportedly, the woman from Ha Nam province was in critical condition at the Hospital for Tropical Diseases in Hanoi. Officials were trying to learn how she was exposed to the virus. If WHO confirms the 2 cases and 2 others reported by Vietnam over the past few weeks, the country's H5N1 case count will rise to 97.
In other news, Vietnam's first H5N1 case-patient in a year and a half, a 30-year-old man, left the hospital May 15, 2006. He became infected after he helped slaughter chickens for a friend's wedding. Doctors at the Bach Mai hospital said they treated him with the antiviral drug oseltamivir for 10 days instead of the standard 7 days. Doctors also said the virus was found in the man's saliva, stomach, and feces. A number of studies have reported gastrointestinal symptoms in H5N1 patients, and WHO has said that H5N1 infection is more likely to involve diarrhea than ordinary flu is.
Since early May 2007, Vietnam has battled H5N1 outbreaks in 15 provinces. The UN Food and Agriculture Organization (FAO) and Vietnamese agriculture officials recently conducted a joint investigation of outbreaks in Nam Dinh province, one of the affected areas. In a report released 2 days ago, the FAO said this year's outbreaks are occurring later in the year than expected. Historically, January and February have been the worst months for the spread of H5N1, because of high consumer demand for poultry products during Lunar New Year (Tet) celebrations and because cooler temperature have been thought to favor the virus's survival in the environment, FAO said. Investigators believe an increase in the numbers of ducks, many of which are unvaccinated, released to graze on newly harvested rice paddies are the reason for the later-than-usual spike in bird outbreaks this year. Investigators found that unvaccinated young ducks, whose breeding cycles may not have corresponded with local vaccination campaigns, were released onto the rice paddies.
"Free range duck production is an excellent system for farming, but there are risks and challenges involved," said Andrew Speedy, FAO's Vietnam representative. The agency recommends that officials ensure that all ducks are vaccinated, require hatcheries to meet basic biosecurity standards, and discourage small hatcheries. FAO said current poultry vaccines are still effective and that it was assisting the government with the study of the H5N1 virus circulating in poultry. Jeffrey Gilbert, chief technical advisor of the FAO's avian influenza program in Vietnam, said, "So far, genetic sequencing of recent viral isolates has shown no significant changes in the antigenicity of the virus."
Viet Nam: Northern Vietnam reports new avian influenza H5N1 infections in ducks
USA: Many Americans confused about avian influenza and food safety
A nationwide survey indicates that many Americans have misconceptions about food safety issues related to avian influenza, researchers from Rutgers University said. Researchers from the Food Policy Institute at Rutgers New Jersey Agricultural Experimental Station conducted the survey to gauge the public's knowledge about H5N1 avian influenza and determine how Americans would respond if the virus were found in US poultry. The research team interviewed 1,200 adults by telephone between May 3 and Jun 5, 2006. Investigators used random-digit dialing to select survey participants from all 50 states. They first asked a series of questions to gauge respondents' overall awareness of avian flu and how the disease spreads and is prevented. Then they asked what respondents would do if the threat of avian influenza increased, particularly regarding poultry buying and consumption.
Though Americans seem to be aware of avian influenza, they are uncertain of food-related transmission risks. While more than two-thirds of the survey respondents believed that the avian flu virus is present in the uncooked meat of infected poultry, less than half understood that proper cooking kills the virus. Further, when asked what they would do if the H5N1 virus turned up in US chickens, 40% of respondents said they would stop eating chicken products, rather than limiting their risk by using proper cooking and food handling procedures. The researchers said this result is consistent with findings among European consumers.
Among other misconceptions, many Americans believe it's easy to identify H5N1-contaminated raw meat. Respondents said they would turn away from chicken products if a wild bird with the H5N1 virus was found in the US or if poultry outbreaks were reported in Canada or Mexico. Though consumers' actual behavior often differs from what they predict it will be, the research group concluded that domestic poultry consumption would drop dramatically if avian flu emerged in the US. Targeted messages to consumers should include information on the safety of the US poultry supply, food handling techniques to avoid cross-contamination, and properly cooking chicken to at least 165ºF, the researchers said.
USA: HHS hears community leaders' ideas on pandemic influenza readiness
HHS Secretary Mike Leavitt said the goal was to share ideas on how local leaders can promote the importance of personal preparedness. Personal preparedness "is a message that needs to surround everyone. They need to hear it from their pastors, from their employers, from their physicians, and from everyone in a position of responsibility," Leavitt said. Despite uncertainty about when a pandemic will strike, Leavitt said, "Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate." He said, "We need to reach out to everyone with words that inform, but not inflame. We need to encourage everyone to prepare, but not panic.” Stephanie Marshall, director of pandemic communications for HHS, said the agency would launch 2 more personal-preparedness promotion efforts. Later this summer officials will release tool kits, tailored to 4 different sector (business, healthcare, faith, and civic), that leaders can use to teach people more about pandemic flu and what they can do to prepare.
HHS officials urged participants to communicate to their communities that it is critical for everyone to prepare for possible pandemic flu. Participants were urged to encourage people to (1) store extra food and other daily supplies to make it easier to stay home for a prolonged period of time, (2) learn and practice proper hand washing, (3) use safe cough and sneeze techniques to limit the spread of illnesses, and (4) stay home and avoid others during illness.
USA: Firm wins grant for fast way to make DNA vaccines
DNA vaccines contain small pieces of the target pathogen's genetic material instead of a killed or weakened form of the virus. In a separate project, Vical is developing an H5N1 avian flu vaccine that is produced in cell culture, but the RapidResponse process represents a step beyond that, the company said. "The new RapidResponse platform does not use any type of cell-based process. It's a chemical synthesis enzyme reaction," Alan Engbring, Vical's executive director of investor relations, said. In initial research, a single 2-microgram dose of the PCR-produced vaccine protected mice from a lethal dose of H3N2 flu virus, a common human subtype. The company said the RapidResponse process could potentially be scaled up without adding to production time, "conceivably allowing production of hundreds of millions of doses of DNA vaccine during the earliest stages of an outbreak." For the H5N1 vaccine, Escherichia coli is used to produce a plasmid, or loop of DNA, containing genetic material from the target virus. Production time is "measured in weeks"—faster than with egg-based production, but slower than what the RapidResponse system promises to make possible.
Egypt (Qena): More human cases of avian influenza H5N1 infection
A 4-year-old Egyptian girl was reported to have H5N1 avian influenza, as WHO confirmed that a 10-year-old girl from the same area died of the illness 2 days ago. The Egyptian health ministry said the 4-year-old girl (36th case of avian influenza infection in Egypt), from Qena governorate in southern Egypt, was hospitalized with fever and breathing difficulty 10 Jun 2007. Officials said she had been exposed to birds sick with suspected flu. The 10-year-old girl, also from Qena, was listed in critical condition when her illness was reported Jun 8, 2007. WHO said she fell ill Jun 1 and was hospitalized on the Jun 6. There was evidence that she had been exposed to dead birds. The 2 latest cases were the first in Egypt in about 2 months. The country had 16 cases earlier this year. Egypt is the worst hit nation outside East Asia. Most Egyptian cases have occurred in the northern part of the country, but 10 of the past 12 cases have been in the hotter south. Many of the victims have come into contact with infected dead birds, which occurs mostly near their homes. Around 5 million households in Egypt depend on poultry as a main source of food and income and the government has said this makes it unlikely the disease can be eradicated. The government still finds it hard to enforce restrictions on the movement and sale of live poultry.
(CIDRAP 6/11/07, 6/13/07 www.cidrap.umn.edu ; Promed 6/9/07, 6/13/07 www.promedmail.org/ )
Avian/Pandemic influenza updates
- UN: http://influenza.un.org/. UN response to avian influenza and the pandemic threat. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza in order to help the humanitarian community.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Read the article on ducks and avian influenza.
- OIE: http://www.oie.int/eng/en_index.htm. Link to upcoming Paris Anti-avian influenza conference.
- US CDC: http://www.cdc.gov/flu/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Read about the Pandemic Flu Leadership Forum and Blog.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html.
- CIDRAP: http://www.cidrap.umn.edu/. Pandemic preparedness Webinar recordings available for purchase.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm. The website has been updated, with link to National Influenza Centers in PAHO Member States.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp. Updates for Hong Kong, Bangladesh, and Indonesia, 15 Jun 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)
Inefficient Transmission of H5N1 Influenza Viruses in a Ferret Contact Model
Hui-Ling Yen et al. Journal of Virology, July 2007, p. 6890-6898, Vol. 81, No. 13. http://jvi.asm.org/cgi/content/abstract/81/13/6890
Abstract: “The abilities to infect and transmit efficiently among humans are essential for a novel influenza A virus to cause a pandemic. To evaluate the pandemic potential of widely disseminated H5N1 influenza viruses, a ferret contact model using experimental groups comprised of one inoculated ferret and two contact ferrets was used to study the transmissibility of four human H5N1 viruses isolated from 2003 to 2006. The effects of viral pathogenicity and receptor binding specificity (affinity to synthetic sialosaccharides with 2,3 or 2,6 linkages) on transmissibility were assessed. A/Vietnam/1203/04 and A/Vietnam/JP36-2/05 viruses, which possess "avian-like" 2,3-linked sialic acid (SA) receptor specificity, caused neurological symptoms and death in ferrets inoculated with 103 50% tissue culture infectious doses. A/Hong Kong/213/03 and A/Turkey/65-596/06 viruses, which show binding affinity for "human-like" 2,6-linked SA receptors in addition to their affinity for 2,3-linked SA receptors, caused mild clinical symptoms and were not lethal to the ferrets. No transmission of A/Vietnam/1203/04 or A/Turkey/65-596/06 virus was detected. One contact ferret developed neutralizing antibodies to A/Hong Kong/213/03 but did not exhibit any clinical signs or detectable virus shedding. In two groups, one of two naïve contact ferrets had detectable virus after 6 to 8 days when housed together with the A/Vietnam/JP36-2/05 virus-inoculated ferrets. Infected contact ferrets showed severe clinical signs, although little or no virus was detected in nasal washes. This limited virus shedding explained the absence of secondary transmission from the infected contact ferret to the other naïve ferret that were housed together. Our results suggest that despite their receptor binding affinity, circulating H5N1 viruses retain molecular determinants that restrict their spread among mammalian species.”
Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary
Tamiflu and neuropsychiatric disturbance in adolescents
National Pandemic Influenza Exercise, Exercise Cumpston 06 Report
Exercise Cumpston 06 was the first major event of its kind conducted by the Department of Health and Ageing. The aim was to exercise the capacity and capability of the Australian health system to prevent, detect and respond to an influenza pandemic. This document provides an evaluation report on the exercise. Released by the Australian Department of Health and Ageing report released Jun 7, 2007: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/ohp-cumpston-report.htm
APEC Avian/Pandemic influenza Documents
- Opening comments and keynote address from the Chair of the APEC Health Ministers' Meeting and Australia's Minister for Health, Tony Abbott
Also available is information on the upcoming Workshop on Sharing Experiences with the Management of the Avian Influenza H5N1 Threat in Bangkok, Thailand, Jun 18-20, 2007.
Pandemic preparedness Webinar recordings
September 2006: Planning for Pandemic Influenza: Will Your Organization Be Prepared?