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EINet Alert ~ Jul 27, 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)
- India (Manipur): Avian influenza H5N1 outbreak in poultry after 1-year hiatus
- Viet Nam (Dong Thap, Dien Bien, Quang Binh): New outbreak of avian influenza in poultry
- Egypt: New human case of avian influenza H5N1 infection
- Avian/Pandemic influenza updates
- Control of a highly pathogenic H5N1 avian influenza outbreak in the GB poultry flock
- Detecting emerging human transmissibility of avian influenza virus in human households
- Bird flu: if or when? Planning for the next pandemic
- A sensitive retroviral pseudotype assay for influenza H5N1-neutralizing antibodies
- Preparation of genetically engineered A/H5N1 and A/H7N1 pandemic vaccine viruses by reverse genetics in a mixture of Vero and chicken embryo cells
- Researchers warn H5N1 reassortment can occur beyond winter months
- Medical groups announce agenda for improving disaster response
- People likely to alter lifestyles to cut risk in a pandemic
- Meeting for Asia and the Pacific for the Progressive Control of Transboundary Animal Diseases
- Public Health Informatics Conference: Creating a Global Partnership in Public Health Informatics
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: 319 (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 7/26/07): 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.
India (Manipur): Avian influenza H5N1 outbreak in poultry after 1-year hiatus
Animal health officials in India announced that samples from chickens at a poultry farm in the remote northeastern Manipur state were positive for the H5N1 avian flu virus, signaling the country's first outbreak in more than a year. The farm where the chickens with the H5N1 virus were found is near India's border with Myanmar, a country that reported outbreaks earlier this year, Bimal Singh, a senior official in the Manipur chief minister's office, said. Health officials were sent to the area and began slaughtering chickens and other poultry in a 5-km radius around Chenngmeirong village, where dead chickens were found earlier this month. They plan to slaughter some 150 000 poultry in a 5-km radius around the affected farm. 132 chickens died over 6 days in early Jul 2007. More than 20 people who handled infected poultry before the birds died have been quarantined. The handlers and 6 veterinary workers have been given oseltamivir (Tamiflu), but none have shown any respiratory symptoms. India's last confirmed H5N1 outbreak occurred in April 2006 in domestic poultry, according to a report from the United Nations' Food and Agriculture Organization (FAO). The country has reported no human H5N1 cases. Neighboring Bangladesh, Myanmar and Pakistan have also witnessed outbreaks of the H5N1 bird flu in 2007.
Excerpts from OIE report
Apparent morbidity rate/Apparent mortality rate/Apparent case fatality rate/Proportion susceptible removed
Source of infection: Unknown or inconclusive
Control measures applied: Movement control inside the country; Disinfection of infected premises/establishment(s); Stamping out; Zoning; Vaccination permitted; No treatment of affected animals
hemagglutination (HA) test: Positive
Viet Nam (Dong Thap, Dien Bien, Quang Binh): New outbreak of avian influenza in poultry
Another commune in the northern province of Dien Bien also reported a new outbreak of bird flu 16 Jul 2007, despite the fact that the area was not considered a high-risk region. Bird flu was responsible for the deaths of 120 ducks in Noong Het Commune, located in Dien Bien District. The remaining ducks were slaughtered and the farm was sprayed to prevent the virus' return, said officials. Animal health officials also recently reported poultry outbreaks in Quang Binh in the central part of the country. The outbreak in Quang Binh involved more than 200 ducks that were found dead on a farm. Local veterinarians culled about 3,000 remaining ducks and disinfected the area.
The Food and Agriculture Organisation (FAO) recommended that poultry farmers comply with department regulations on vaccinating their flocks and closely monitor the illegal trafficking of waterfowl. The organisation commended the Government for its recent orders to close egg hatcheries and slaughterhouses that fail to meet food safety and sanitation standards.
Egypt: New human case of avian influenza H5N1 infection
As of 25 Jul 2007, the Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is a 25-year-old female from Damietta Governorate in northern Egypt. Her infection has been confirmed by the Egyptian Central Public Health Laboratory and by the WHO H5 Reference Laboratory, US Naval Medical Research Unit No. 3 (NAMRU-3). She developed symptoms (fever) 20 Jul 2007 and was hospitalized the following day. She is receiving treatment (oseltamivir) and is in a stable condition. Investigations into the source of her infection indicate exposure to sick and dead poultry in the week prior to onset of symptoms. Of the 38 cases confirmed to date in Egypt, 15 have been fatal. The most recent previous case in Egypt was reported on 25 Jun 2007. Egyptian officials had projected that H5N1 activity would wane during the hot summer months, as it did during 2006 when there were no human cases between May and October. However, the country continues to report sporadic cases
(Promed www.promedmail.org 7/25/07; CIDRAP http://www.cidrap.umn.edu/ 7/23/07)
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. News on federal updates.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/.
- Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html.
- CIDRAP: http://www.cidrap.umn.edu/.
- 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. Updated 27 Jul 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)
Control of a highly pathogenic H5N1 avian influenza outbreak in the GB poultry flock
James Truscott et al. Proc R Soc B, published online Jul 20, 2007. 10.1098/rspb.2007.0542. http://www.journals.royalsoc.ac.uk/content/5jr2p6341418376m
Abstract: The identification of H5N1 in domestic poultry in Europe has increased the risk of infection reaching most industrialized poultry populations. Here, using detailed data on the poultry population in Great Britain (GB), we show that currently planned interventions based on movement restrictions can be expected to control the majority of outbreaks. The probability that controls fail to keep an outbreak small only rises to significant levels if most transmission occurs via mechanisms which are both untraceable and largely independent of the local density of premises. We show that a predictor of the need to intensify control efforts in GB is whether an outbreak exceeds 20 infected premises. In such a scenario neither localized reactive vaccination nor localized culling are likely to have a substantial impact. The most effective of these contingent interventions are large radius (10km) localized culling and national vaccination. However, the modest impact of these approaches must be balanced against their substantial inconvenience and cost.
Detecting emerging human transmissibility of avian influenza virus in human households
Bird flu: if or when? Planning for the next pandemic
A sensitive retroviral pseudotype assay for influenza H5N1-neutralizing antibodies
Preparation of genetically engineered A/H5N1 and A/H7N1 pandemic vaccine viruses by reverse genetics in a mixture of Vero and chicken embryo cells
Researchers warn H5N1 reassortment can occur beyond winter months
Surveillance data from the Pacific basin from 1954 to 1988 show a marked variation in human influenza A activity. The authors found that while consistent seasonality of viral activity between Dec and Mar occurs in Japan, patterns were not uniform across the rest of the region. "Periods of moderate to high activity typically last longer in tropical and subtropical regions than in temperate regions, and they occur more frequently than once a year," they write. "It is not prudent to assume there is a short period of risk of reassortment."
The existence of new host populations in which the H5N1 virus is endemic raises the pandemic flu risk to humans, especially when there is close contact between people and the infected animals, the researchers point out. They say the greatest concerns are (1) the frequency with which the virus is found in domestic ducks, because the ducks have close contact with people, and (2) isolation of the virus from pigs in China and Indonesia, because receptors in their respiratory tracts make coinfection with human and avian strains and thus generation of reassortant strains possible. Though a review of the H5N1 viral circulation data suggest some seasonal factors, outbreak patterns also appear to be affected by interventions such as culling, the authors report. Migration and movement of birds are also thought to play a role. Poultry culls have successfully contained the spread of the disease, but if the virus is endemic in some species, culling might not be practical and officials may need to focus on vaccination and intensive surveillance to contain the virus, they say. Awareness of the seasonal risk of both human disease and viral reassortment can help officials design control measures to help prevent an emerging pandemic strain, the authors conclude.
Park AW, Glass K. Dynamic patterns of avian and human influenza in east and southeast Asia. Lancet Infect Dis 2007 Aug;7(8):543-8
Medical groups announce agenda for improving disaster response
Steady, dedicated funding is needed to ensure the emergency and critical infrastructure and capacity to respond to disasters, because the health system is already pressed beyond capacity, the groups wrote. Governments and health systems must develop processes that enable local health systems to return to readiness as soon as possible after a disaster, and funding for economic recovery from disasters must make reestablishing public health and healthcare systems a priority. The groups requested that the Institute of Medicine (IOM) be funded to perform a comprehensive study of healthcare surge capacity and develop recommendations to help health systems improve disaster response and recovery.
Governments, health systems, and professional organizations should continue progress toward nationwide integration of emergency and trauma care services with emergency and disaster preparedness and healthcare systems. The IOM has already recommended that a lead agency should be established to oversee emergency and trauma care, and the federal government has issued a mandate that fosters interagency collaboration among emergency and trauma care services. All aspects of governmental and health system emergency and disaster preparedness efforts should directly involve public health and healthcare professionals, the report said. Integration goals also require that health disaster communication and information networks be technologically interoperable with all government levels and health systems, the report said.
Educational institutions can help ensure that public health and healthcare professionals receive adequately training in incorporating competency-based disaster preparedness and response coursework into undergraduate, graduate, postgraduate, and continuing educational programs. Governments, health systems, and professional groups must develop and distribute competencies for managing adult and pediatric patients in emergency and catastrophic settings. Educational accreditation agencies should then incorporate the competencies into educational materials and formal continuing education programs.
National and state legislation is needed to create adequate legal protection so that health and mental health practitioners can provide care in emergency and disaster settings outside of the location where they are licensed or accredited, they state. Policies must also address medical liability, standards and altered standards of care, and license reciprocity to make it easier for volunteer health professionals to assist with disaster response, the report said.
AMA-APHA report on improving health system preparedness:
People likely to alter lifestyles to cut risk in a pandemic
In late 2005, European researchers did telephone surveys in 5 European countries (Denmark, Spain, Great Britain, the Netherlands, and Poland) and 3 Asian regions (Singapore, Hong Kong, and Guangdong, China). They chose the Asian locales specifically because they had experienced SARS in 2003, which may have influenced citizens' perception of what might be high-risk activities during a pandemic. A total of 3,436 people answered the survey, which represented 42% of those called (ranging from 21% in Great Britain to 81% in Poland).
In 6 of the 8 countries, public transportation was seen as the riskiest place in a pandemic, followed by places of entertainment. In China and Singapore, those selections were reversed. As far as precautionary behaviors, 79% of Europeans and 74% of Asians would avoid public transportation; the same percentage of Europeans but only 33% of Asians would avoid public entertainment settings. Other measures ranked lower: limiting shopping (69% in Europe, 59% in Asia), staying home from work (35% and 52%), keeping children from school (59% and 39%), limiting contact with family and friends (45% and 52%), avoiding physicians (22% and 34%), and staying indoors (24% and 35%). Asians were far less prone than Europeans to avoid entertainment venues, in spite of rating such places as riskier during a pandemic than did their European counterparts (52% to 43%). Younger respondents were less likely to avoid places of entertainment and less likely to show up for work. Compared with those not employed full time (eg, retirees, homemakers, and students), fewer employed respondents reported being likely to avoid places of mass transit, entertainment, and work, or to stay at home. Respondents with higher education levels were more likely than their less educated counterparts to avoid entertainment and shopping establishments.
This survey of the general public found about the same percentage tending toward not reporting to work in a pandemic—about half—as a study among US healthcare workers published last year in BMC Public Health. The higher percentage of Asians expressing reluctance to visit a physician during a pandemic "may have been related to their increased awareness of SARS, which was often acquired in a healthcare setting," the authors write. Respondents' perception of risk was not associated with precautionary actions, except in the case of avoiding public transportation. They write, "because of the hypothetical nature of the questionnaire, concluding that persons actually would respond in the way that they have indicated here is not possible." They point out, though, that their findings coincide with unpublished data from a study conducted among the Chinese community in the Netherlands just after the SARS epidemic. In that study, many had avoided travel to SARS-affected areas and avoided large gatherings.
"Knowledge of what persons are likely to do," the authors say, "can be used to estimate the health and economic effects of various pandemic influenza scenarios. We describe what proportion will take precautionary actions as well as the socioeconomic background of these persons, which would be useful for improving communication efforts by public health official and clinicians in response to an outbreak." The authors conclude: ". . .A new influenza pandemic would most likely result in persons' limiting their use of public transportation, entertainment, and shopping for nonessentials."
Sadique MZ, Edmunds WJ, Smith RD, et al. Precautionary behavior in response to perceived threat of pandemic influenza. Emerg Infect Dis 2007 Sep (published online Jul 20)
Meeting for Asia and the Pacific for the Progressive Control of Transboundary Animal Diseases
The Second Regional Steering Committee Meeting for Asia and the Pacific of the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADS), a joint FAO/OIE initiative, was held in Bangkok, Thailand 18 and 19 Jul 2007. The meeting was opened by Professor Dr Thira Sutabutra, Honourable Minister of Agriculture and Cooperatives of Thailand and attended by various personalities including the OIE Director General, Dr Bernard Vallat and the Chief Veterinary Officer of the FAO, Dr Joseph Domenech. The Honourable Minister emphasised the economic importance of controlling animal diseases particularly foot and mouth disease and highly pathogenic avian influenza and commended the roles played by the OIE and FAO. Dr Vallat underlined the role played by the OIE in the international control of animal diseases pointing out that the combined strengths of the OIE, FAO and Sub-Regional Organisations such as ASEAN, SAARC and SPC under the GF-TADs, provided a unique mechanism to control transboundary animal diseases in the world including the Asian region. He warned that “although certain diseases are apparently on the decline, others are emerging and re-emerging in various parts of the world”. He stated that highly pathogenic avian influenza is reoccurring in countries where it was thought to have been eradicated and other diseases are making their appearance where they were least expected.
Dr Domenech explained the need to establish regional lead teams in diagnosis and epidemiology. He stressed that "these regional networks will push and pull national laboratories and epidemiological units and provide a basis for training and improvement of capacity building”. He also insisted on the need to continue the fight against avian influenza and further the investments in endemic countries such as Indonesia . He provided assurances that FAO will pursue its efforts to prevent and control avian influenza and other transboundary animal diseases in the region. Dr Vallat informed that the negotiations between the OIE and the Government of Thailand for the establishment of an OIE Sub-Regional Representation in Bangkok had reached an advanced stage and that the Sub-Representation would soon be functional. He also announced the full participation of the People's Republic of China and Chinese Taipei in the activities of the OIE.
Public Health Informatics Conference: Creating a Global Partnership in Public Health Informatics
Sessions (and invited papers) will be presented in the following areas, with a particular focus on under-resourced countries and environments: 1) Global syndromic surveillance and epidemiology issues including ehealth records (open medical records system) and technology for data gathering and sharing in inner-city, rural and remote settings 2) Knowledge management issues and challenges for health practitioners and researchers including semantic interoperability, ontologies for knowledge modeling and mapping; sociocultural aspects of knowledge management and information needs assessment 3) Multi-national drug and vaccine effectiveness and safety studies and roll-out of programs, including standards for data sharing; post-approval surveillance issues and strategies.
Specific objectives include: 1) Identification of critical opportunities and challenges in global public health informatics. Examples of challenges likely to be identified include: standards for data exchange; cultural, social and political impediments to data sharing; metrics for evaluation of public health information systems; semantic interoperability; and training public health informatics researchers and practitioners. 2) Develop a Framework for Action in public health informatics. The Framework for Action would grow out of the identified opportunities and challenges and would include examples of successful projects as well as relevant research findings 3) Identify 2-3 multi-national pilot projects to address key challenges and potential funding sources for those projects. 4) Develop agenda and identify Steering Committee for the PHI2008 meeting.
Keynote speakers will include international leaders in public health informatics, global public health metrics and health information systems. Invitees will include international global health experts with an interest in improving health outcomes through public health informatics. There is some travel support available, but interested individuals should have a background and ongoing responsibilities in the area of informatics to benefit and contribute to this conference. For more information email: firstname.lastname@example.org For conference details: https://phi2007.cphi.washington.edu/.