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EINet Alert ~ Nov 09, 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 influenze A/(H5N1)
- Indonesia (Jakarta): 30-year-old woman dies of suspected avian influenza H5N1 infection
- Bangladesh: Avian influenza H5N1 detected in northern poultry farms
- Pakistan (North-West Frontier Province): Thousands of avian influenza-infected chickens culled
- Viet Nam: Economy-wide outbreaks of avian influenza H5N1 in fowl
- Viet Nam (Can Tho city): Suspected human death from avian influenza H5N1
- USA, Canada, and Mexico: US, Canada, and Mexico agree to coordinate infectious disease efforts
- USA: GAO urges more effort to gird US infrastructure for pandemic

1. Updates
- Avian/Pandemic influenza updates

2. Articles
- Travellers need immediate access to Tamiflu when entering areas at risk from avian or seasonal influenza
- Susceptibility of Canada Geese (Branta canadensis) to Highly Pathogenic Avian Influenza Virus (H5N1)
- DAS181, A Novel Sialidase Fusion Protein, Protects Mice from Lethal Avian
- Development and Evaluation of an Influenza Virus Subtype H7N2 Vaccine Candidate for Pandemic Preparedness
- Comparing Flu Vaccines
- Detecting human-to-human transmission of avian influenza A (H5N1)
- Role of Terrestrial Wild Birds in Ecology of Influenza A Virus (H5N1)
- Avian Flu: Pandemic Preparedness

3. Notifications
- Meeting Report: Expert consultation on diagnosis of H5N1 avian influenza
- The pandemic vaccine puzzle
- New and old ways to make flu vaccines


Global
Global: Cumulative number of human cases of avian influenze A/(H5N1)
Global: Cumulative number of human cases of avian influenza A/(H5N1) Economy / Cases (Deaths)

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2006
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 56 (46)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 116 (80)

2007
Cambodia/ 1 (1)
China / 3 (2)
Egypt / 20 (5)
Indonesia / 37 (32)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 7 (4)
Total / 70 (46)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 334 (205).
(WHO 11/5/07 http://www.who.int/csr/disease/avian_influenza/en/index.html)

Avian influenza age distribution data from WHO/WPRO:
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
(WHO/WPRO 10/25/07)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 10/23/07):
http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 11/5/07):
>http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.

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Asia
Indonesia (Jakarta): 30-year-old woman dies of suspected avian influenza H5N1 infection
A 30-year-old Indonesian woman died of suspected bird flu 3 Nov 2007, the country's Health Ministry said. The woman from Tanggerang town on the outskirts of Jakarta died on Saturday in a designated bird flu hospital of Persahabatan in east Jakarta, said Harris Subiantro, an official of the anti-bird flu center of the Ministry. One of two laboratories' tests, which are needed for confirmation, indicated that she was positive for avian influenza, said the official. "One of laboratory tests has showed positive," he said. The woman had history of contact with some of hundreds chickens that suddenly died last month [October 2007] in her residence, he said. "She had contact with dead chickens belonging to her neighbors," said Subiantoro. If the woman's case is confirmed, it will [raise] the death toll to 90 out of 112 cases in the bird flu hardest-hit country, he said. Her child and niece who were suspected of having the disease, were not under suspicion, said the official. The woman began to [exhibit signs of avian influenza virus infection] 23 Oct 2007 and went to clinics 5 days later in the town. She was admitted to a hospital in Tanggerang town 30 Oct 2007 and was shifted to Persahabatan hospital in East Jakarta one day later, said Subiantoro.

[The huge extent of the country], the traditional way of raising chickens in back yards, and lack of obedience to provincial administration in implementing the Jakarta decision to stop the virus spread are among the obstacles to fighting bird flu in this country. There have been 2 human cases of H5N1 avian influenza confirmed in the Tangerang district of Banten province in recent days: a 3-year-old boy who has since recovered, and a 5-year-old girl who died. An earlier suspected adult case in Tangerang has not been confirmed.
(ProMED 11/3/07)

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Bangladesh: Avian influenza H5N1 detected in northern poultry farms
In Bangladesh, an official from the government's livestock department said the H5N1 virus was detected at 3 farms in the northern part of the country. Workers culled about 6000 chickens, which were buried over the last 2 days, the report said. The country's last reported H5N1 outbreak occurred in May [2007], according to an Office International des Epizooties (OIE; World Organization for Animal Health) report.
(ProMED 11/3/07)

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Pakistan (North-West Frontier Province): Thousands of avian influenza-infected chickens culled
More than 45,000 chicks were burnt and buried by Buttle Ehtsham Breeder Farm after it was confirmed that they were suffering from bird flu. Reportedly, on 26 Oct 2007, the Ehtsham poultry farm got a report about the spread of bird flu, the livestock director Mansehra Ali Akbar Khan sent the samples to Islamabad for testing. Later after receiving positive reports, more than 45,000 chicks were burnt and buried so that the virus might not affect other poultry farms. The farm manager informed the media about the loss and said that if the poultry farms owners do not take proper measures, the virus can cause huge losses.
(ProMED 11/3/07)

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Viet Nam: Economy-wide outbreaks of avian influenza H5N1 in fowl
Veterinary officials in Viet Nam reported 2 more H5N1 outbreaks in ducks. An outbreak that began 29 Oct 2007 in southern Viet Nam's Tra Vinh province struck a flock of 2-month-old ducks, killing 400 and sickening 500. On 28 Oct 2007, an H5N1 outbreak killed 210 of 400 ducks at a household in northern Viet Nam's Nam Dinh province. According to OIE reports, Viet Nam had 6 H5N1 outbreaks Oct 2007, all involving unvaccinated ducks. Besides Tra Vinh and Nam Dinh, affected provinces included Cao Bang in the north and Quang Tri in central Viet Nam. Before October, Viet Nam's last reported outbreaks occurred in August 2007.

In the northern province of Ha Nam, Bird flu has killed 590 ducks. The 2-month-old ducks started dying 5 Nov 2007, and tests confirmed 7 Nov 2007 the presence of the H5N1bird flu virus, the Animal Health Department said. Further tests also found the H5N1 virus in samples taken from 2 dead chickens dumped in a river in Ha Nam province, 60 km south of Hanoi. The case in Ha Nam brought to 5 the number of provinces that have confirmed bird flu in poultry since early Oct 2007. 3 of the provinces are in the north, one is in the southern Mekong delta, while the fifth is in the central province of Quang Tri. Floods that affected Quang Tri in the past 2 weeks could help spread the virus to nearby areas, an Agriculture Ministry official said. No human infections have been reported in Viet Nam since the virus killed a teenager in early Aug 2007, 1 of 4 deaths among 7 Vietnamese known to have been infected this year.
(ProMED 11/3/07, 11/8/07)

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Viet Nam (Can Tho city): Suspected human death from avian influenza H5N1
A South Korean man died of pneumonia in Can Tho city [5 Nov 2007], local doctors, who suspect he had contracted bird flu, said. The man was taken to the city General Hospital 5 Nov 2007 with high fever and breathing problems. The doctors have sent his blood samples to Pasteur Institute in HoChi Minh City to test for the H5N1 strain of bird flu virus, which has caused 100 infections and 46 deaths in Viet Nam in the last few years. The man's family said his father in Korea too was suffering from pneumonia-like symptoms. [It is not clear from this report how long the Korean man had been in Viet Nam, in order to get some idea if he, in fact, had avian influenza and, if so, whether he was infected in Korea or in Viet Nam].
(ProMED 11/8/07)

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Americas
USA, Canada, and Mexico: US, Canada, and Mexico agree to coordinate infectious disease efforts
The United States, Canada, and Mexico vowed to help each other during public health emergencies and outlined the types of aid they could provide and accept from each other in the event of a pandemic or other infectious disease outbreak. A memorandum of understanding was signed by health leaders from the three countries: Mike Leavitt, secretary of the United States Department of Health and Human Services (HHS), Jose Angel Cordova Villalobos, Mexico's secretary of health, and Tony Clement, Canada's minister of health, according to an HHS press release from yesterday.

The health ministers were meeting in Washington, D.C, with health representatives from the G7 countries, Mexico, and the European Union at the Global Health Security Initiative's eighth ministerial forum, according to Health Canada. Discussion topics included pandemic influenza and biological, chemical, and radionuclear terrorism threats. "As North American neighbors, we owe it to our citizens to work together whenever possible to minimize the spread and impact of an infectious disease outbreak or other public health emergency that may affect our nations," Leavitt said. The memorandum stipulates that all three countries agree to improve their public health emergency preparedness and response as they relate to border health, laboratory testing, diagnosis and treatment, epidemiological investigation, and infectious disease control. The countries also agree to share laboratory information before and during an emergency, collaborate on the review and sharing of assay methods, reagents, and laboratory results, and participate in trilateral or bilateral exercises to test emergency response.

In August, leaders from the three nations who met at a security summit in Quebec unveiled a North American pandemic influenza plan designed to share expertise, coordinate public health messages, and overcome anticipated obstacles at national borders.

The memorandum of understanding the health leaders signed directs the three countries to implement protocols to share:
• Healthcare and public health personnel
• Regulated medical products from national stockpiles
• Unregulated medical supplies from national stockpiles
• Specimens and reagents from each country's national reference laboratories
(CIDRAP 11/2/07)

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USA: GAO urges more effort to gird US infrastructure for pandemic
The federal government should step up efforts to prepare the nation's key infrastructure industries, such as energy and transportation, for an influenza pandemic, Congress's investigative agency said in a report this week. The report by the Government Accountability Office (GAO), released Oct 31, recommends that the secretary of the Department of Homeland Security (DHS) take the lead in encouraging the "coordinating councils" for the infrastructure sectors to prepare for the challenges the sectors will face during a pandemic.

The coordinating councils are advisory groups set up by DHS to foster collaboration within and between government and the private sector to protect the nation's "critical infrastructure." A government coordinating council and a sector coordinating council were set up for each of 17 industrial sectors, ranging from information technology and telecommunications to water and electric power. More than 85% of the nation's critical infrastructure is owned and operated by the private sector, the report notes. It says that public-private partnerships are vital to ensure that essential services will continue during a pandemic or other national emergency.

The GAO reviewed preparedness efforts in the five sectors (other than public health and healthcare) that it deems most essential to maintaining society and the economy during a pandemic: transportation, food and agriculture, water, electric power, and telecommunications. The agency interviewed officials from the federal agencies responsible for infrastructure protection related to the five sectors and also reviewed infrastructure protection plans, regulations, and guidance. The federal government and private sector have already taken some steps to prepare the nation's infrastructure for a pandemic, such as developing general preparedness guidance and determining the number of workers necessary to maintain operations, the GAO says. In some cases the federal and private sectors are using the coordinating councils to cooperate on infrastructure protection, but those efforts so far focus mainly on hazards in general rather than a pandemic in particular, the report says. Yet some specific pandemic preparations are under way. For example, the Communications Sector Coordinating Council has set up a working group to address telecommuting issues.

Government and private-sector officials who were interviewed by the GAO reported a number of challenges they face in working together on pandemic preparedness:
• Maintaining a focus on pandemic planning, given the unpredictable timing of a pandemic and the existence of more immediate problems, such as foodborne disease outbreaks
• Uncertainty about federal and state roles in areas such as state border closures and pandemic flu vaccine distribution
• Potentially confusing and conflicting messages from the many government agencies responsible for providing information on the pandemic issue
• Developing strategies to address "the crucial cross-sector interdependencies" in the nation's infrastructure, "such as the electricity and telecommunications capabilities that are necessary to support all the other sectors"
• A need for more funds for training and infrastructure and dealing with potential legal and regulatory issues

"While some discussion has occurred, there are opportunities to further address these issues through the increased federal and private sector use of the sector-specific and cross-sector coordinating councils," the report states. DHS is in a good position to lead this endeavor, because it is responsible for coordinating infrastructure protection and is the lead agency for more than half of the critical industrial sectors, the GAO says. Accordingly, the agency recommends that the DHS secretary, working with other sector-specific agencies, "lead efforts to encourage the government and private sector members of the councils to consider and help address the challenges that will require coordination between the federal and private sectors involved with critical infrastructure and within the various sectors" before and during a pandemic.

A letter from a DHS official, included in the report, says DHS concurs with the GAO recommendation.

House Homeland Security Chairman Bennie Thompson, D-Miss., said the GAO report confirmed his view that DHS should make better use of the infrastructure coordinating councils, according to a Nov 1 report by CQ Homeland Security, published by Congressional Quarterly Inc.
(CIDRAP 11/2/07)

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1. Updates
Avian/Pandemic influenza updates
- UN: http://www.un-influenza.org/ : latest news on avian influenza. 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 15-17 Nov 2007 event in Beijing, China: 1st Meeting of the Asia-Pacific Working Group on Migratory Waterbirds and Avian Influenza
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.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/ Public Comments Sought on Draft of Flu Vaccine Allocation Plan.
- Health Canada: information on pandemic influenza:
http://www.influenza.gc.ca/index_e.html Updates on Saskatchewan avian influenza outbreak
- CIDRAP: http://www.cidrap.umn.edu/ : Read the series, “The Pandemic Vaccine Puzzle”.
- 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 2 Nov 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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2. Articles
Travellers need immediate access to Tamiflu when entering areas at risk from avian or seasonal influenza
Smith JR, Wood SC. Travel Medicine and Infectious Disease 2007;5(6):411 http://www.travelmedicinejournal.com/article/PIIS1477893907001202/abstract
Abstract: The protection of global travelers against influenza is an increasing concern in travel medicine.Travelers need immediate access to Tamiflu when entering areas at risk from avian or seasonal influenza.

Since January 2006, the range of H5N1 viruses has greatly extended from being mostly confined to East and South East Asia to outbreaks spreading into Europe, the Middle East and Africa meaning that travelers will be increasingly likely to enter into an affected region. Travelers need reassurance that they can be protected from developing this life-threatening disease if exposed.

Seasonal influenza is responsible for significant morbidity and loss of productivity in corporate employees and travelers each year. While vaccines are normally the mainstay of preventing influenza infection, movement between the northern and southern hemispheres will not only take travelers into an influenza season and potential epidemic situation, but also expose them to virus strains not circulating in their countries, and potentially not covered in their local vaccines.

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Susceptibility of Canada Geese (Branta canadensis) to Highly Pathogenic Avian Influenza Virus (H5N1)
Pasick J, et al. Emerg Infect Dis. 2007 Dec; [Epub ahead of print] http://www.cdc.gov/eid/content/13/12/pdfs/07-0502.pdf
Abstract: Migratory birds have been implicated in the long-range spread of highly pathogenic avian influenza (HPAI) A virus (H5N1) from Asia to Europe and Africa. Although sampling of healthy wild birds representing a large number of species has not identified possible carriers of influenza virus (H5N1) into Europe, surveillance of dead and sick birds has demonstrated mute (Cygnus olor) and whooper (C. cygnus) swans as potential sentinels. Because of concerns that migratory birds could spread H5N1 subtype to the Western Hemisphere and lead to its establishment within free-living avian populations, experimental studies have addressed the susceptibility of several indigenous North American duck and gull species. We examined the susceptibility of Canada geese (Branta canadensis) to HPAI virus (H5N1). Large populations of this species can be found in periagricultural and periurban settings and thus may be of potential epidemiologic importance if H5N1 subtype were to establish itself in North American wild bird populations.
(CIDRAP 11/5/07)

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DAS181, A Novel Sialidase Fusion Protein, Protects Mice from Lethal Avian
Belser JA, et al. The Journal of Infectious Diseases 2007;196:1493-1499 http://www.journals.uchicago.edu/JID/journal/issues/v196n10/38762/brief/38762.abstract.html
Abstract: Increasing resistance to currently available influenza antivirals highlights the need to develop alternate approaches for the prevention and/or treatment of influenza. DAS181 (Fludase), a novel sialidase fusion protein that enzymatically removes sialic acids on respiratory epithelium, exhibits potent antiviral activity against influenza A and B viruses. Here, we use a mouse model to evaluate the efficacy of DAS181 treatment against a highly pathogenic avian influenza H5N1 virus. When used to treat mice daily beginning 1 day before infection with A/Vietnam/1203/2004(H5N1) virus, DAS181 treatment at 1 mg/kg/day protected 100% of mice from fatal disease, prevented viral dissemination to the brain, and effectively blocked infection in 70% of mice. DAS181 at 1 mg/kg/day was also effective therapeutically, conferring enhanced survival of H5N1 virus–challenged mice when treatment was begun 72 h after infection. This notable antiviral activity underscores the potential utility of DAS181 as a new class of drug that is effective against influenza viruses with pandemic potential.
(CIDRAP 11/5/07)

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Development and Evaluation of an Influenza Virus Subtype H7N2 Vaccine Candidate for Pandemic Preparedness
Pappas C, Matsuoka Y,1 Swayne D, Donis O. Clinical and Vaccine Immunology, November 2007, p. 1425-1432, Vol. 14, No. 11 [doi:10.1128/CVI.00174-07] http://cvi.asm.org/cgi/content/abstract/14/11/1425
Abstract: Influenza virus of the H7N2 subtype has been introduced into noncommercial poultry in the United States, and this probably resulted in incidents of transmission of H7N2 virus to humans, documented in 2002 and 2003. This virus could be considered a potential threat to public health if it acquired person-to-person transmissibility. A favored approach for global pandemic preparedness includes development of pre-pandemic vaccines for any potential pandemic virus. To this end, we created a high-growth reassortant virus (H7N2-PR8) containing the genes for the hemagglutinin and the neuraminidase from a low-pathogenicity (H7N2) virus strain and the remaining six genes from a human vaccine strain (H1N1). The reassortant strain was evaluated to assess its antigenicity, safety, and protective efficacy using a mouse model. Antigenicity studies using ferret antibodies raised against H7N2-PR8 indicated that this virus confers broad cross-reactivity with divergent H7 viruses of different years and lineages. Mice and chickens inoculated with high doses of H7N2-PR8 supported virus replication but survived, indicating that this virus is comparable to other avian viruses of low pathogenicity. To assess the protective efficacy of H7N2-PR8, mice were immunized with two doses of formalin-inactivated H7N2-PR8, alone or with alum. Vaccinated mice subsequently challenged with highly pathogenic viruses from homologous and heterologous lineages A/Canada/444/04 (H7N3) and A/Netherlands/219/03 (H7N7) showed pronounced reduction of wild-type virus replication. These studies indicate that H7N2-PR8 is immunogenic, safe, and protective in animal models; these are the essential attributes to qualify for phase I human clinical trials as a prepandemic vaccine.
(CIDRAP 11/5/07)

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Comparing Flu Vaccines
NPR.org, November 7, 2007 http://www.npr.org/templates/story/story.php?storyId=16105360
Flu vaccines provide protection against the influenza virus by presenting the human body with something that looks like the flu virus but that does not cause disease. Our immune systems recognize this material and produce antibodies to it. If we are exposed to an actual flu virus, those antibodies will neutralize the virus and protect us. Below, a look at the pros and cons of various vaccine production methods, either being used today or in development:

Standard Vaccine
Pros: Millions of Americans receive this vaccine every year. It's safe and well tolerated. Its production begins in hens' eggs — a tried and true technology for 50 years.
Cons: The production method requires a great deal of planning. Eggs must be ordered many months in advance, and millions of doses require millions of eggs. Also, egg-based production could be problematic for a pandemic strain of flu that develops from a bird virus. That bird virus could be deadly to the chickens needed to make eggs.

Live-attenuated Vaccine
Pros: This newer method of production results in a vaccine that has a flu virus that is crippled, so it can't cause disease. But the virus is not killed, as is the case in the standard vaccine. The vaccine also can be given as a nasal spray (FluMist is the brand name).
Cons: More expensive than standard vaccine, and also produced in eggs. Not approved for young children or older people.

Cell-based Vaccine
Pros: This vaccine can be produced in giant vats of living cells. Such a production method means it can be scaled up much faster than egg-based vaccines, making it more useful in a pandemic. Several versions have been tested successfully in people. Earlier this year, the European Union approved a seasonal flu vaccine grown in cell culture. It's called Optaflu and is manufactured by Novartis, which is building a manufacturing facility in North Carolina that will produce cell-based flu vaccines.
Cons: Won't be widely available for a few years. Clinical trials are under way, but no flu vaccine made this way is currently approved by the Food and Drug Administration.

DNA Vaccine
Pros: Instead of injecting flu virus proteins into people, this concept involves injecting just the DNA from a flu virus. Human cells then "read" this DNA and create proteins that act as a vaccine. Manufacture of DNA could be much faster than that of conventional vaccines.
Cons: The method is being tested in human clinical trials, but development could still take years, and it may not prove to be safe and effective.

Universal Vaccine
Pros: Scientists would like to develop a flu vaccine that can be given just once and last for life, as is the case for some childhood vaccines. Current vaccines have to be tailored to protect against specific strains of flu viruses. This one, ideally, would protect against them all.
Cons: This is currently more a concept than an actual product, though scientists do have some strategies that could ultimately lead to a universal vaccine.

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Detecting human-to-human transmission of avian influenza A (H5N1)
Yang Y, Halloran ME, Sugimoto JD, Longini IM. Emerg Infect Dis. 2007;13:1348–53. http://www.cdc.gov/eid/content/13/9/1348.htm
Abstract: Highly pathogenic avian influenza A (HPAI) subtype H5N1 has caused family case clusters, mostly in Southeast Asia, that could be due to human-to-human transmission. Should this virus, or another zoonotic influenza virus, gain the ability of sustained human-to-human transmission, an influenza pandemic could result. We used statistical methods to test whether observed clusters of HPAI (H5N1) illnesses in families in northern Sumatra, Indonesia, and eastern Turkey were due to human-to-human transmission. Given that human-to-human transmission occurs, we estimate the infection secondary attack rates (SARs) and the local basic reproductive number, R0. We find statistical evidence of human-to-human transmission (p = 0.009) in Sumatra but not in Turkey (p = 0.114). For Sumatra, the estimated household SAR was 29% (95% confidence interval [CI] 15%–51%). The estimated lower limit on the local R0 was 1.14 (95% CI 0.61–2.14). Effective HPAI (H5N1) surveillance, containment response, and field evaluation are essential to monitor and contain potential pandemic strains.

Response to the above article:
Uyeki TM, Bresee JS. Emerg Infect Dis. 2007 Dec; [Epub ahead of print]
To the Editor: This letter is in response to a recently published article about statistical modeling to assess human-to-human transmission of avian influenza A (H5N1) viruses in 2 case clusters. Sporadic cases and clusters of human infection with highly pathogenic avian influenza A (H5N1) viruses have occurred after direct contact with diseased or dead poultry. Limited, nonsustained human-to-human transmission of avian influenza (H5N1) viruses is believed to have occurred in some clusters. Every human infection with a novel influenza A virus should be investigated, and suspected clusters should be investigated immediately to assess exposures and transmission patterns. (More at: http://www.cdc.gov/eid/content/13/12/pdfs/07-1153.pdf )

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Role of Terrestrial Wild Birds in Ecology of Influenza A Virus (H5N1)
Boon ACM, Sandbulte MR, Seiler P, Webby RJ, Songserm T, Guan Y, et al. Emerg Infect Dis [serial on the Internet]. 2007 Nov [date cited]. Available from http://www.cdc.gov/EID/content/13/11/1720.htm
Abstract: House sparrows, European starlings, and Carneux pigeons were inoculated with 4 influenza A (H5N1) viruses isolated from different avian species. We monitored viral replication, death after infection, and transmission to uninfected contact birds of the same species. Sparrows were susceptible to severe infection; 66%–100% of birds died within 4–7 days. High levels of virus were detected from oropharyngeal and cloacal swabs and in organs of deceased sparrows. Inoculation of starlings caused no deaths, despite high levels of virus shedding evident in oropharyngeal swabs. Least susceptible were pigeons, which had no deaths and very low levels of virus in oropharyngeal and cloacal swabs. Transmission to contact birds did not occur frequently: only A/common magpie/Hong Kong/645/2006 virus was shown to transmit to 1 starling. In summary, recent influenza (H5N1) viruses are pathogenic for small terrestrial bird species but the rate of intraspecies transmission in these hosts is very low.

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Avian Flu: Pandemic Preparedness
Jan K. Home Healthcare Nurse. Volume 25(10), November/December 2007, p 637–642
Abstract: Pandemic influenza is unpredictable, and the risk of an avian flu outbreak is unclear. It is critical that home health providers, who may become overburdened quickly in the event of a pandemic outbreak, be prepared to ensure a sustainable healthcare response. This article offers information on strategies that may be used by home health providers to prepare for, prevent, and manage pandemic influenza.

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3. Notifications
Meeting Report: Expert consultation on diagnosis of H5N1 avian influenza
The Global Influenza Programme (WHO, 2007) Influenza and Other Respiratory Viruses 1 (4), 131–138. [doi:10.1111/j.1750-2659.2007.00028.x]

The current epizootic of H5N1 highly pathogenic avian influenza (HPAI) in poultry is unprecedented in its virulence, extent and longevity, raising global concern that the virus could mutate into a form easily transmitted between humans and initiate an influenza pandemic. The ability to rapidly and accurately diagnose infections with novel influenza subtypes is crucial to minimizing morbidity and mortality in humans and reducing the potential for a pandemic. However, questions remain about how to ensure validity of the currently available diagnostics, optimize their availability and the potential offered by new technologies.

To address these questions, during 19–20 February 2007, more than 40 scientists, clinicians, researchers and industry representatives from around the world came together for the first World Health Organization (WHO) Consultation on Diagnosis of H5N1 Avian Influenza Infections in Humans (summary available at http://www.who.int/csr/disease/avian_influenza/guidelines/diagnosis_consultation /en/index.html).

The meeting was co-organized by the WHO Global Influenza Programme (GIP), the International Society for Influenza and other Respiratory Viruses (ISIRV) and the Foundation for Innovative New Diagnostics (FIND). This marked the first time public and private sectors met at length to discuss this important issue. An ‘open forum’ meeting style was adopted, and substantial time was allotted for discussion.

Overall, the consultation addressed:
• The ‘state of the art’ for H5N1 diagnostics in humans.
• Considerations and gaps related to H5N1 diagnostic capacity.
• Collaborative ways forward and the roles of WHO, private industry and other stakeholders.
(CIDRAP 11/8/07)

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The pandemic vaccine puzzle
This is a seven-part series investigating the prospects for development of vaccines to head off the threat of an influenza pandemic posed by the H5N1 avian influenza virus. The series puts promising advances in vaccine technology in perspective by illuminating the formidable barriers to producing large amounts of an effective and widely usable vaccine in a short time frame. Part 1 described how flu research has been a relatively low priority until very recently, which has left many important scientific questions unanswered. Part 2 discussed the huge gap between current global vaccine production capacity and the likely demand for vaccine in the event of a pandemic. Part 3 discussed the immunologic challenges posed by the H5N1 virus, including its poor immunogenicity when incorporated in vaccines and the difficulty of assessing immune responses to the vaccines. Part 4 examined the possibility of using adjuvants to stretch the supply of pandemic vaccines and the regulatory barriers to that strategy. Part 5 looked at the idea of vaccinating people before a pandemic with a best-guess vaccine and following up later with a vaccine matched to the emergent pandemic strain. Part 6 explored the potential of novel vaccine technologies such as using whole flu viruses or growing vaccines in cell cultures instead of in eggs.

Part 1: Flu research: a legacy of neglect
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct2507panvax1.html

Part 2: Vaccine production capacity falls far short
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct2607panvax2.html

Part 3: H5N1 poses major immunologic challenges
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct2907panvax3.html

Part 4: The promise and problems of adjuvants
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct3007panvax4.html

Part 5: What role for prepandemic vaccination?
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/oct3107panvax5.html

Part 6: Looking to novel vaccine technologies
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov0107panvax6.html

Part 7: Reinforcing the research agenda
>http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov0207panvax7.html

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New and old ways to make flu vaccines
by Nell Greenfieldboyce

Chances are the vaccine for annual flu shots was made in the small Pennsylvania town of Swiftwater. It is home to the biggest flu vaccine plant in the country [USA]. Listen at: http://www.npr.org/templates/story/story.php?storyId=16105360

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