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EINet Alert ~ Jul 13, 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) - Czech Republic: Confirmation of avian influenza H5N1 at 2 more farms - Germany (Thuringia): Domestic goose test positive for avian influenza H5N1 - Australia: 3 Children die from influenza after bacterial infection in Perth - Indonesia: Report of 81st human death from avian influenza H5N1 infection - Viet Nam (Dien Bien, Ca Mau): New avian influenza H5N1 outbreaks in poultry - USA: Poll shows waning concern about avian influenza in public - USA: HHS to give states $430 million for hospital preparedness - USA (Virginia): Turkeys may have been exposed to mild avian influenza H5N1 1. Updates - Avian/Pandemic influenza updates 2. Articles - Highly pathogenic avian influenza A/H5N1 in birds within the EU - Implications for Public Health - Addressing the Need for Integration between Health and Agriculture in the Preparedness Plans in Latin America - Avian and pandemic influenza: Progress and problems with global health governance - Duration of Influenza A Virus Shedding in Hospitalized Patients and Implications for Infection Control 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: 318 (192).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm. WHO's maps showing world's areas reporting confirmed cases of H5N1 avian influenza in humans, poultry and wild birds (last updated 7/12/07): http://gamapserver.who.int/mapLibrary/ WHO’s timeline of important H5N1-related events (last updated 7/3/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html. Europe/Near East Czech Republic: Confirmation of avian influenza H5N1 at 2 more farms Tests confirmed the H5N1 type of the bird flu virus in poultry at 2 farms in the eastern Czech Republic, the State Veterinary Authority (SVS) said 12 Jul 2007. The virus was found at the 2 farms with 71 000 poultry, bringing the number of outbreaks in Czech farms to 4. Vets were preparing to cull all 71,000 birds on the farms 12 Jul 2007, spokesman Josef Duben said. The Czechs identified their first H5N1 bird flu case at a turkey farm in the eastern part of the country Jun 2007 (wild swans in the country had tested positive for H5N1 in the spring of 2006). The 2 farms where disease was reported 11 Jul 2007 are within a 3-km protective zone around another farm where H5N1 had been found. Vets have extended the standard 3-km protection zone and 10-km surveillance zone to include the 2 farms. (Promed 7/12/07; CIDRAP 7/12/07) Germany (Thuringia): Domestic goose test positive for avian influenza H5N1
Thueringen had re-introduced a lock-up order for farm poultry, which must be kept indoors in areas of high-risk contact with wild birds, such as in farms near lakes and rivers. 4 German states have recently reported finding the H5N1 virus in swans and other wild birds. The number of infected birds in Germany has risen to 43, plus the pet goose. Saxony said 2 more wild swans had tested positive for H5N1 bird flu. Japan said it was banning imports of day-old chicks from Germany following the bird flu case in the pet goose. Asia Australia: 3 Children die from influenza after bacterial infection in Perth Health officials in Perth, Australia, last week advised parents to seek medical care quickly for young children with respiratory symptoms, after 3 children under age 5 died of pneumonia as a complication of "mild" influenza A (H3) infections. Paul Van Buynder, director of communicable disease control for Western Australia's health department, said Jul 6 that officials were surprised by how quickly the illness developed in the children. "While we do not want to create unnecessary panic, it is important for parents to be aware that the disease can cause serious illness within 24 hours," he said. The children who died had a streptococcal pneumonia infection, but officials have not announced what type. The cases started out as "mild influenza A infection," Van Buynder said. He said the health department found no links between the children's cases. Australia is at the peak of its flu season, and the report said hospitals in the Perth area were inundated by anxious parents bringing children with flu symptoms. The Australian report also is a reminder of recent worries US health officials have had about rising numbers of young flu patients who have suffered coinfections with the sometimes-fatal Staphylococcus aureus pneumonia, in some cases involving drug-resistant strains. S aureus can cause a severe, necrotizing pneumonia that has a relatively high case-fatality rate—33% during the 1968-69 flu pandemic, US CDC said in an Apr 13 Morbidity and Mortality Weekly Report article. Evidence points to a synergistic relationship between S aureus and influenza, according to an article in the June 2006 issue of Emerging Infectious Diseases. Flu viruses appear to increase S aureus adhesion in the respiratory tract, and S aureus-specific enzymes (proteases) appear to increase flu virus replication. Also, influenza A virus strains appear to decrease destruction of S aureus by immune cells called phagocytes, making patients more susceptible to bacterial coinfection.
In May CDC issued an alert after noticing an increase in the number of S aureus infections in children with flu. CDC said that from Oct 2006 through May, 55 influenza deaths in children had been reported. 20 of the children (out of 51 for whom relevant data were available) had bacterial infections, and 16 of these were infected with S aureus. Though the number of pediatric flu deaths this past flu season was similar to the 2 previous years, CDC said the 16 deaths from S aureus pneumonia or bacteremia recorded so far reflected a sharp increase over those years. Further, of the 16 children who had S aureus infections, 11 had methicillin-resistant (MRSA) strains that are typically associated with MRSA skin infection outbreaks. CDC also noted that the children who had S aureus infections had been in good health before they got sick, but progressed rapidly to serious illness. Indonesia: Report of 81st human death from avian influenza H5N1 infection
Also, on 11 Jul 2007, the national committee overseeing Indonesia's bird flu fight along with UNICEF were to begin distributing 7000 protective kits to villages in Banten province, where at least 10 bird flu deaths have occurred. The kits contain gloves, masks, soap, an informational VCD (video compact disk), a banner, and booklet. About 100 000 kits were distributed in high-risk areas in May 2007. Indonesia stepped up its campaign in 2007 to battle bird flu, barring Jakarta residents from the popular practice of keeping poultry in their backyards. Avian influenza-positive cases by Indonesian province (Province / Cases / Deaths):
West Java / 29 / 23 Viet Nam (Dien Bien, Ca Mau): New avian influenza H5N1 outbreaks in poultry
Americas USA: Poll shows waning concern about avian influenza in public Only 27% of Americans describe themselves as concerned about avian influenza, down from 35% last year, according to a national survey. In an Associated Press–Ipsos Public Affairs poll released Jul 2, 2007, 41% of respondents said they were not concerned about avian flu, an increase from 31% last year. Another 34%—the same as last year—said they were moderately concerned. Only 15% of respondents said they were concerned that they or someone in their household would get sick, as compared with 24% last year. The survey questions used the terms "bird flu" and "avian flu," but not "pandemic flu." Ipsos said the apparent drop in Americans' concern over avian flu coincides with reports from WHO that the number of human H5N1 flu cases appears to have stabilized over the past year. Through mid June, WHO had confirmed 50 human cases in 2007, compared with 115 for all of 2006. Recall of news coverage about avian flu has also declined. The number of Americans who say they have read, heard, or seen at least some coverage of bird flu is 56%, down from 74% in 2006. 62% thought US government leaders were giving enough attention to avian flu, up from 45% 2006. Only 32% thought the government should be directing more attention to the problem, down from 42% last year. One number that seems to have changed little is the share of Americans who say news about avian flu is influencing their eating habits: about 9 in 10 respondents reported there has been no change in their consumption of chicken, turkey, or eggs. The survey interviews were conducted from Jun 7-17. The poll, which included 1,438 adults, had a margin of sampling error of plus or minus 3.1 percentage points.
The apparent decline in concern about avian flu also comes at a time when the US Department of Health and Human Services (HHS) is ramping up efforts to urge Americans to prepare for a pandemic. HHS recently sponsored a summit and blog series for pandemic planning leaders and announced that it would soon provide preparedness tool kits for various groups and conduct personal preparedness communication campaigns in 5 to 10 diverse communities. USA: HHS to give states $430 million for hospital preparedness
HHS said this year's funds are to be used to develop or improve 4 activities: interoperable communications, systems to track available hospital beds, advance registration of volunteer health professionals, and planning for "fatality management and hospital evacuation." The grants will go to territories and 4 major metropolitan areas—Chicago, Washington, Los Angeles County, and New York—as well as the states. For the states, amounts range from $1.15 million for Wyoming to $34.1 million for California. Each state is allotted a base grant of $500,000 plus an additional amount based on population, according to Marc Wolfson, spokesman for the HHS Office of the Assistant Secretary for Preparedness and Response. HHS said this year's funding includes $15 million for the new Healthcare Facilities Partnership Program, which is designed to foster regional partnerships to enhance community and hospital preparedness. The agency will use a competitive process to award between 6 and 30 cooperative agreement awards ranging from $500,000 to $2.5 million. "The goal of the new program is to develop innovative and creative projects that can be replicated across the country," said Rear Adm. Craig Vanderwagen, MD, HHS assistant secretary for preparedness and response. "These partnerships will require close coordination among health officials from state, local and private sectors."
"The guidance for this year's program includes new performance measures, one of which requires the submission of timely and complete data from grantees," he commented. In addition, Wolfson said, "There is an ambitious evaluation plan for this year that includes a number of studies and reports." One of these will be a book of state preparedness profiles, including data on hospital preparedness and other dimensions, such as hazards and vulnerability. USA (Virginia): Turkeys may have been exposed to mild avian influenza H5N1
So far, tests suggest that the antibodies detected correspond to the low-pathogenic North American strain of H5N1, which usually causes only minor illness or no noticeable signs in birds. Several thousand poultry samples collected from other poultry operations near the affected Shenandoah Valley turkey farm have all tested negative for avian influenza, which further suggests that the antibodies found in the turkeys involve a common avian flu virus that poses no threat to humans, Clifford said. When the USDA expanded its avian flu testing program for wild birds beyond Alaska in 2006, several birds, such as a green-winged teal in Delaware and mallard ducks in Illinois and Michigan, tested positive or were presumed positive for the mild North American H5N1 strain. In a fact sheet on the low-pathogenic H5N1, the USDA said the strain was detected in apparently healthy wild birds as long ago as 1975. In 2002, antibodies to the same strain were found in samples from Michigan turkeys, but the virus could not be isolated. After Virginia officials announced the antibody findings, Richard Wilkes, the state veterinarian, banned all bird sales and exhibitions until Jul 30, 2007 and restricted the application of poultry litter on fields in 17 counties. 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. - 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 about the International Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection. - OIE: http://www.oie.int/eng/en_index.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/. 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/. - 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. Updated 5 Jul 2007. (UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS) 2. Articles Highly pathogenic avian influenza A/H5N1 in birds within the EU - Implications for Public Health Influenza Team, European Centre for Disease Prevention and Control. Eurosurveillance weekly releases, Vol 12, Issue 7. 5 Jul 2007. http://www.eurosurveillance.org/ew/2007/070705.asp#0 (References removed) "Since the later part of June 2007, three European Union (EU) Member States (Czech Republic, Germany, and France) have recorded cases of highly pathogenic avian influenza (HPAI) of the subtype A/H5N1 in bird populations. On 21 June, authorities in the Czech Republic confirmed an outbreak of HPAI A/H5N1 in a domestic poultry flock in the Pardubicky region in the centre of the country. A few days later a second infected flock, located 4km from the first, was identified through the enhanced surveillance of flocks in the area that was introduced after discovery of the first infected premise. Subsequently, virus was isolated from a wild bird (swan) found dead on 28 June in the Jihomoravsky region in south of the country, near the border to Austria. At almost the same time, on 26 and 28 June, German authorities reported that HPAI A/H5N1 had been identified in wild birds in two locations in Germany; six wild birds (five swans and one Canada goose) in Bavaria in southern Germany, and three wild swans in Saxony in eastern Germany. On 5 July, France also confirmed the first occurrence this year of three wild swans infected with influenza A/H5N1. They were found in the Mosel region in the north-east of France. Samples from the infected birds from all three countries were identified as part of the EU supported active surveillance programme for avian influenza in wild birds, which requires all EU Member States to test wild birds for avian influenza viruses in order to provide an early warning of the presence of the virus in the EU. . ." Addressing the Need for Integration between Health and Agriculture in the Preparedness Plans in Latin America
". . .The objective of this document is to review if this integration exists in countries of the Americas, and in particular if and how it is reflected in the preparedness plans against avian and human pandemic influenza. For that purpose, we present a quick review of the link between animal and human health, and characteristics of the latest threat, Avian Influenza. We then define intersectoral action and its importance in this context, with specific public health measures at the interface between animal and human health that are most important for the prevention and control of zoonoses. These measures are reflected in the subsequent analysis, by subregion, of the intersectoral integration. Our diagnosis then leads us to a series of recommendations on how to improve intersectoral action in the context of Avian Influenza, but with a broader impact on the prevention and control of all zoonotic diseases. . ." Avian and pandemic influenza: Progress and problems with global health governance
Duration of Influenza A Virus Shedding in Hospitalized Patients and Implications for Infection Control
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