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EINet Alert ~ Aug 24, 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)
- Italy (Lugo): Low pathogenic avian influenza H5N2 detected in poultry
- Indonesia (Bali): New human case of avian influenza H5N1
- Pakistan: Avian influenza H5N1 strikes poultry again
- Avian/Pandemic influenza updates
- Journal of Wildlife diseases – Supplement on avian influenza
- Ecologic immunology of avian influenza (H5N1) in migratory birds.
- Antigen sparing and cross-reactive immunity with an adjuvanted rH5N1 prototype pandemic influenza vaccine: a randomised controlled trial.
- Neuraminidase inhibitor resistance in influenza viruses.
- How much would closing schools reduce transmission during an influenza pandemic?
- Pandemic Flu Preparedness: A Manufacturing Perspective
- Influenza Survey Uncovers Key Differences Between Bird Flu And Human Flu
- North American pandemic plan takes shape
- WHO Clinical management of human infection with avian influenza A (H5N1) virus
- Roche Joins the Fifth International Bird Flu Summit as a Sponsor
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: 322 (195).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm. (WHO/WPRO 8/16/07)
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 8/24/07): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 7/30/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.
Italy (Lugo): Low pathogenic avian influenza H5N2 detected in poultry
An outbreak of low pathogenic avian influenza (LPAI), type H5N2, has been diagnosed on a poultry farm in Lugo, Italy. This has been notified by the Ministry of Agriculture. The farm included 7000 adult ducks, 3000 geese and 150 chickens. The infection was detected within the framework of the annual, routine sero-surveillance activities. No clinical symptoms were seen. Some of the birds reportedly also had antibodies to an H7 avian flu virus. The holding was confined, and the animals will be culled. A restriction zone of 1km radius has been imposed around the site. Last week, an infected hobby-holding was found. In late Jul 2007, LPAI H7N3 was found in a holding with ornamental birds in the region of Veneto; the same strain was found earlier, in May 2007.
(Promed 8/20/07; CIDRAP 8/21/07)
Indonesia (Bali): New human case of avian influenza H5N1
As of 23 Aug 2007, the Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 28-year-old female from Tabanan District, in Bali Province developed symptoms 14 Aug 2007, was hospitalized 18 Aug 2007, and died in hospital 21 Aug 2007. The case was a poultry trader. The case investigation found that she collected poultry from villages where outbreaks of avian influenza in poultry had occurred and were later confirmed by rapid testing. She is the second fatal case in Bali this month. Of the 105 cases confirmed to date in Indonesia, 84 have been fatal.
US CDC confirmed that it has received from Indonesia a sample from the woman who had the first reported H5N1 infection on Bali, a 29-year-old who died of the disease Aug 12, 2007. The CDC is a WHO collaborating center. Results of tests by the CDC would be announced by the Indonesian government. In an Aug 20 statement, Indonesia's avian flu committee said it had sent the CDC samples from the 29-year-old Bali woman and a 2-year-old girl, also from Bali, who had a suspected case but had tested negative for H5N1. The statement said the CDC had already confirmed the findings from the Indonesian labs regarding the two patients. Previous reports mentioned a 2-year-old girl with suspected avian flu who was a neighbor of the 29-year-old woman. The woman also had a 5-year-old daughter who died of pneumonia on Aug 3, but she was not tested for H5N1 (reportedly she was cremated before samples were taken), according to previous reports. The bird flu issue is sensitive in Bali, where the tourism industry is only just recovering from the 2002 and 2005 terrorist bombings. None of the recent bird flu cases, or suspected cases, was from areas close to Bali's tourist precincts.
Elsewhere, local officials on Sulawesi island said they were struggling to contain H5N1 outbreaks on farms near Palu, the capital of Central Sulawesi. Tests conducted after several chickens in Palu died confirmed the disease in 29 chickens. Infected birds have been found in 3 of 4 subdistricts in Palu, and 2 chickens in neighboring Donggala district died of the disease recently.
Pakistan: Avian influenza H5N1 strikes poultry again
Avian/Pandemic influenza updates
- UN: http://www.un-influenza.org/ : the website has been moved and updated. Also, http://www.irinnews.org/Birdflu.asp provides information on avian influenza.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Link to supplement to Journal of Wildlife Diseases on avian influenza.
- 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/. Link to North American Plan for Avian and Pandemic Influenza.
- 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. 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 17 Aug 2007.
Journal of Wildlife diseases – Supplement on avian influenza
The Wildlife Disease Association (WDA) and the Food and Agriculture Organization of the United Nations (FAO) have worked together to publish a supplement to the Journal of Wildlife Diseases on avian influenza. The supplement is comprised of 14 papers presented at an FAO/OIE international conference on avian influenza in Rome in May 2006. Articles can be viewed at: http://www.jwildlifedis.org/content/vol43/3_Supplement/index.dtl
Ecologic immunology of avian influenza (H5N1) in migratory birds.
Antigen sparing and cross-reactive immunity with an adjuvanted rH5N1 prototype pandemic influenza vaccine: a randomised controlled trial.
Neuraminidase inhibitor resistance in influenza viruses.
How much would closing schools reduce transmission during an influenza pandemic?
Pandemic Flu Preparedness: A Manufacturing Perspective
Influenza Survey Uncovers Key Differences Between Bird Flu And Human Flu
The researchers also found that various strains of the H5N1 that have infected humans are more likely to contain human markers than are H5N1 strains that have not infected humans. Only occasionally have H5N1 samples obtained from human patients shown any of these markers, and no H5N1 strain has permanently acquired any of them. The investigators cautioned that there is no proof yet that the human markers in H5N1 and other avian influenza viruses directly contribute to the ability of these viruses to cause pandemics among humans; and H5N1 is not any more adapted to humans today than in the past. However, the fact that the bird viruses accumulate and retain these markers after infecting humans suggests that these changes are important. Therefore, scientists should monitor avian influenza viruses to see if they are acquiring human markers.
The St. Jude team identified 32 specific locations in proteins where a gene mutation caused the existing amino acid to be substituted with a different amino acid. What made these 32 changes special was that influenza from birds differed from the influenza that was in humans. After the avian influenza infected humans, the amino acid changes are stable in the proteins and remain stable over time. Therefore, these markers can be used to distinguish influenza viruses that infect birds from those that infect humans. The researchers identified 32 persistent markers that exist in 5 bird and human virus proteins: PA, NP, M1, NS1 and PB2. These markers stand out as obvious differences between bird and human viruses, and many appear in regions where host protein and viral replication occur. The researchers did not determine what functional role the markers play in the life of the viruses.
For example, 26 of the 32 markers discovered are found in NP, PB2 and PA, which help to form a complex of proteins critical for the replication of virus genes. The other 6 persistent host markers are in M1 and NS1 proteins. M1 is known to bind to a protein in cells that enhances the replication of viruses; and NS1 plays a role in suppressing the host immune response. Therefore, the markers in M1 and NS1 might represent key mutations needed to improve the ability of the virus to suppress the immune system and enhance viral replication.
The St. Jude team also studied markers in influenza viruses that caused pandemics in 1918, 1957 and 1968 -- outbreaks thought to have been caused by avian influenza viruses that adapted to humans. The study focused on the viruses isolated from humans early in each pandemic in order to determine which markers the viruses had recently acquired just before they sparked the outbreak. The researchers showed that 13 of the 32 markers identified by their survey had remained stable in these viruses, and, like the other viruses, these markers were distributed among PB2, PA, NP and M1 -- the proteins linked to virus replication. "This suggests that these 13 sites are required for pandemic influenza to fully function," Finkelstein said.
The researchers also showed that the H1N1 virus that caused the 1918 pandemic already contained 13 of the 32 markers early in the outbreak; and acquired the other 19 markers within 10 to 20 years, acquiring the preferred human influenza amino acids in stages. Eventually, descendents of the pandemic virus became the seasonal flu outbreaks rather than deadly pandemics. "While we can't directly estimate how long it would take an avian virus such as H5N1 to acquire these traits, we can use these markers to roughly measure the distance between an avian influenza and a pandemic," said Clayton Naeve, St. Jude Hartwell Center director and the paper's senior author.
Persistent Host Markers in Pandemic and H5N1 Influenza Viruses. Finkelstein DB, Mukatira S, Mehta PK, Obenauer JC, Su X, Webster RG, Naeve CW. J Virol. 2007 Jul 25; [Epub ahead of print] http://jvi.asm.org/cgi/content/abstract/JVI.00921-07v1
North American pandemic plan takes shape
"Although influenza will not physically damage critical infrastructure, systems may be weakened by the absence of essential personnel in the workplace or the diversion of resources," the 44-page report states. "The Plan, therefore, extends beyond health and medical sectors to include provisions in relation to critical infrastructure and the movement of goods and services across our borders." Kim Elliott, deputy director of Trust for America's Health (TFAH), a nonprofit public health advocacy group, said TFAH welcomes the release of the pandemic flu plan. A pandemic plan is meaningless unless it stipulates that participants hold exercises to test it, Elliott said. The North American plan includes provisions for bilateral and trilateral pandemic response exercises, with a target date of Dec 2008. Among the challenges North American pandemic planners will face, Elliott said, is vastly different healthcare systems—particularly Canada with its more centralized approach, and the US with a more privatized healthcare model. "So it's good to test operations and different strategies," she said.
The plan spells out the triggers that would prompt one of the 3 countries to request assistance from its neighbors: when human or material resources are scarce, when a pandemic event in one country threatens the others, and when an outbreak requires robust coordination of responses by all 3 countries. In several areas, the plan calls on the countries to address obstacles that could hamper outbreak containment. For example, authorities should ensure rapid cross-border movement of diagnostic materials and reagents, as well as specimens, isolates, and vaccines. Also, the document specifies that countries should ease the way for veterinary and medical personnel to respond to emergencies in other countries.
Sharing information and best practices is another theme of the plan. For example, it says countries should share information about how they plan to use nonpharmaceutical interventions and communicate public health messages to their citizens. Regarding stockpiling of vaccines and drugs, planners acknowledge that though the countries have different goals, it is useful for them to share their strategies for shelf-life extension, vaccine and antiviral allocation, and mass distribution. Though border restrictions are not a centerpiece of the plan, the document does address international arrivals. The 3 countries will share and coordinate triggers, criteria, and protocols for screening international travelers. The plan advises countries to adopt a layered passenger-screening approach consisting of predeparture, en route, and arrival checks. Because the infrastructures of the 3 countries are highly interrelated, the plan suggests that infrastructure sectors in each country, such as agriculture, transportation, and utilities, join with their counterparts in the other countries to assess their risks and share their resiliency strategies. The US has already identified how it would protect critical infrastructure and key resource sectors, and Canada and Mexico are both finalizing similar plans.
North American plan for avian and pandemic influenza: http://www.state.gov/g/avianflu/91242.htm
WHO Clinical management of human infection with avian influenza A (H5N1) virus
This document replaces the WHO interim guidelines on clinical management of humans infected by influenza A(H5N1) published Mar 2004. The present advice is applicable for the current situation with sporadic A(H5N1) virus human infection. As more data become available or if the disease patterns change, this advice will be modified as appropriate. At the below URL you can also find: WHO H5N1 Clinical Case Summary Form and Supplementary WHO H5N1 Clinical Case Data.
(WHO 8/15/07 http://www.who.int/csr/disease/avian_influenza/guidelines/clinicalmanage07/en/index.html )
Roche Joins the Fifth International Bird Flu Summit as a Sponsor