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EINet Alert ~ Sep 07, 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: WHO confirms 5 Vietnam avian influenza H5N1 cases, lists lab test criteria - Indonesia (Sumatra): Man's death raises Indonesia's avian influenza H5N1 toll to 85 - Russia (Krasnodar): Avian influenza H5N1 hits poultry farm - Egypt: Migrant birds test positive for the H7 strain of avian influenza 1. Updates - Avian/Pandemic influenza updates 2. Articles - CDC EID Journal, Volume 13, Number 9—Sep 2007 - Prioritization strategies for pandemic influenza vaccine in 27 countries of the European Union and the Global Health Security Action Group: a review - Childhood Influenza: Number Needed to Vaccinate to Prevent 1 Hospitalization or Outpatient Visit - Testing of Diagnostic Methods for Detection of Influenza Virus for Optimal Performance in the Context of an Influenza Surveillance Network - Host Single-Nucleotide Polymorphisms and Altered Responses to Inactivated Influenza Vaccine - Vesicular stomatitis virus vectors expressing avian influenza H5 HA induce cross-neutralizing antibodies and long-term protection - Enhanced growth of seed viruses for H5N1 influenza vaccines 3. Notifications - Asian officials discuss avian influenza surveillance at FAO conference Global Global: Cumulative number of human cases of avian influenza A/(H5N1) Economy / Cases (Deaths)
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2004
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Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 327 (199).
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 affected by H5N1 avian influenza (last updated 9/5/07): http://gamapserver.who.int/mapLibrary/ WHO’s timeline of important H5N1-related events (last updated 8/27/07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html. Global: WHO confirms 5 Vietnam avian influenza H5N1 cases, lists lab test criteria
WHO said it will now accept positive polymerase chain reaction (PCR) results from national reference laboratories that (1) have participated successfully in the WHO's new External Quality Assessment (EQA) project and (2) have accurately identified H5 flu viruses in at least 3 previous cases. Tiffany Domingo, a technical officer in WHO's outbreak and pandemic communications department, said WHO will now confirm positive H5N1 results from Vietnamese labs—as it did for the latest 5 H5N1 case patients—so long as the labs meet the new testing criteria. Most countries that have had human H5N1 cases have had to send specimens to WHO reference labs elsewhere for confirmation. However, WHO has accepted positive H5N1 results from a few countries, such as China and, in recent months, Indonesia. Established in July, the EQA project is conducted by the WHO Global Influenza Programme and the WHO reference laboratory at the National Influenza Centre in Hong Kong. The program is designed to build the capacity of labs to use PCR to diagnose both seasonal and avian influenza and to support good laboratory practices. To participate in the EQA project, laboratories must test a simulated panel of RNA specimens twice a year and fill out a "Good Laboratory Practice" questionnaire. The RNA specimens include H1, H3, and H5 virus subtypes. WHO analyzes the test results and reports on the performance of each laboratory. WHO spelled out the 2 main requirements for accepting positive H5 test results from national laboratories: 1) The lab must participate in the EQA project and must have correctly detected all H5 viruses in the most recent set of samples, without reporting any false-positive H5 findings; 2) Since 2004, the lab must have tested for human H5 infections and must have made at least 3 positive diagnoses that were later confirmed by a WHO H5 reference lab. Countries that don't have a national influenza reference lab, or have a national lab that has not met the WHO criteria, must have their positive H5 test results confirmed by a WHO reference lab or by another WHO-approved national reference lab.
Recommendations and laboratory procedures for detection of avian influenza A(H5N1) virus in specimens from suspected human cases (Revised August 2007): http://www.who.int/csr/disease/avian_influenza/guidelines/labtests/en/index.html Asia Indonesia (Sumatra): Man's death raises Indonesia's avian influenza H5N1 toll to 85 Indonesian officials reported a fatal H5N1 avian influenza infection in a 33-year-old man from Sumatra. Joko Suyono, an official at the health ministry's avian flu center, said the man was from Riau province and had contact with chickens before becoming ill Aug 25. "He processed chicken that he bought from a nearby market," Suyono said. Reportedly 2 laboratory tests came back positive. The man, a plantation worker, was hospitalized 10 days ago with a high fever, a cough, and breathing difficulties, Arman Zubair, another health ministry official, said. He said the man previously seemed to be recovering, but his infection worsened suddenly and he died. If the case is confirmed by WHO, it will go down as Indonesia's 85th avian flu fatality and 106th case. Indonesia has the world's highest toll of H5N1 cases and deaths. Animal-health experts believe the H5N1 virus has become endemic in poultry in some parts of Indonesia. (CIDRAP 9/6/07; Promed 9/7/07) Russia (Krasnodar): Avian influenza H5N1 hits poultry farm
Africa Egypt: Migrant birds test positive for the H7 strain of avian influenza The H7 strain of the bird flu virus has been detected in Egypt for the first time. A total of 9 migrant birds, all of them ducks, tested positive for the virus when 6432 samples were taken from the approximately 1 million birds that annually migrate over Al-Manzalah Lake in the Sharqiya governorate from central and eastern Europe. The recently identified H7 strain is thought to pose little risk, compared to the virulent H5N1 strain. The H7 strain samples are now being tested at both the Ministry of Health and Population (MOHP) and Naval Medical Research Unit (NAMRU) laboratories in order to determine the N subtype. Avian influenza has 16 H & 9 N subtypes. Only viruses of the H5 and H7 subtypes comprise the pathogenic form of the disease, though not all H5 and H7 subtypes cause severe disease in poultry.
Abdel-Rahman Shahin, spokesman at the MOHP, explains that the H5 and H7 viruses are usually introduced to poultry in a low pathogenic form. It is only after several months that they mutate into highly pathogenic strains. The appearance of the H7 strain is therefore a cause for concern. The virus has been known to infect humans but is less virulent than the H5N1 strain. Since the H5N1 virus was first detected in poultry in Egypt Feb 2006, 38 cases of human infection have been reported, of which 15 resulted in fatalities. The most recent case was a 25-year-old from Damietta governorate, who tested positive for the H5N1 virus late Jul 2007. Veterinary experts, though, warn that the presence of both the H7 and H5N1 viruses in Egypt could facilitate further genetic mutations, which can be caused by the combination of the 2 types of avian influenza virus which are currently present in Egypt. Meanwhile, Minister of Agriculture and Land Reclamation Amin Abaza issued a press release saying that 38 percent of poultry in Egypt had been vaccinated against the H5N1 bird flu virus. Abaza notes that while the ministry has managed to contain the virus, the fact that an estimated 5 million people continue to raise poultry at home, especially in the rural areas, constitutes an ongoing threat. 1. Updates 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. - 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. Link to supplement to Journal of Wildlife Diseases on avian influenza. - 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/. 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 7 Sep 2007. (UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS) 2. Articles CDC EID Journal, Volume 13, Number 9—Sep 2007 CDC Emerging Infectious Diseases Journal Sep 2007 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Expedited articles can be viewed at: http://www.cdc.gov/ncidod/eid/upcoming.htm. Prioritization strategies for pandemic influenza vaccine in 27 countries of the European Union and the Global Health Security Action Group: a review
Childhood Influenza: Number Needed to Vaccinate to Prevent 1 Hospitalization or Outpatient Visit
Testing of Diagnostic Methods for Detection of Influenza Virus for Optimal Performance in the Context of an Influenza Surveillance Network
Host Single-Nucleotide Polymorphisms and Altered Responses to Inactivated Influenza Vaccine
Vesicular stomatitis virus vectors expressing avian influenza H5 HA induce cross-neutralizing antibodies and long-term protection
Enhanced growth of seed viruses for H5N1 influenza vaccines
3. Notifications Asian officials discuss avian influenza surveillance at FAO conference Animal-health experts from a dozen countries are meeting in Bangkok at a conference sponsored by the UN Food and Agriculture Organization (FAO) to hear reports from Asian countries on their H5N1 wildlife surveillance efforts and discuss how countries can better coordinate their activities. Scott Newman, international wildlife coordinator for the FAO, said the virus hasn't been found in any of 300,000 to 350,000 healthy wild birds that have been sampled in global surveillance activities in the past 2 years. "We know now that we haven't found a species that even suggests that it would be a reservoir for this disease," he said. Experts said some countries test healthy wild birds, while others test for H5N1 only in sick or dead birds. So far the virus has been found in 90 species of birds. Scarce H5N1 findings in wild birds don't mean surveillance efforts should stop, Newman said. Instead, countries should fine-tune monitoring activities by, for example, improving testing at sites where domestic and wild birds mingle. Officials attending the meeting, which includes 70 experts, said the only way to get an accurate view of H5N1 in wild birds is to establish a uniform and comprehensive surveillance system. Last year, FAO officials expressed concern that migratory birds would spread the H5N1 virus from Asia and Europe to Africa. However, William Karesh, program director of the Wildlife Conservation Society's field veterinary program, said surveillance has found very few instances of the virus in Africa's wild birds. He said the illegal trade in wildlife in Africa and elsewhere makes tracking the virus particularly challenging. (CIDRAP 9/4/07)
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