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EINet Alert ~ Dec 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:

1. Influenza News
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- UN report says avian influenza H5N1 responses improving, but threat persists
- Poland (Mazowsze): Avian influenza H5N1 infection found at two poultry farms
- Poland (Pomorze): Turkey meat has been found to contain avian influenza
- Saudi Arabia (Riyadh): 60,000 birds killed in the latest discovery of avian influenza H5N1
- Bangladesh (Pabna): Thousands of chickens must be destroyed due to avian influenza H5N1 infection
- China (Jiangsu): Avian influenza H5N1 death confirmed
- Canada: Minister of Agriculture revokes order declaring Saskatchewan a Control Area
- USA: Experts urge clinicians to extend flu-shot season
- USA: FDA panel seeks stronger label warnings for two influenza drugs

2. Updates
- * Avian/Pandemic influenza updates*
- Global
- UK

3. Articles
- Influenza activity in Europe during eight seasons (1999-2007): an evaluation of the indicators used to measure activity and an assessment of the timing, length and course of peak activity (spread) across Europe
- H5N1 in wild and domestic birds in Europe – remaining vigilant in response to an ongoing public health threat
- Applying the scientific method when assessing the influence of migratory birds on the dispersal of H5N1
- Response to Avian Influenza and State of Pandemic Readiness: Third Global Progress Report

4. Notifications
- The New Delhi Road Map for 2008
- Non-Pharmaceutical Interventions for Use During a Human Influenza Pandemic
- Vaccine Allocation: Join the Discussion
- APEC Center for Technology Foresight: Technology Roadmapping Workshop


1. Influenza News

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

2007
Cambodia/ 1 (1)
China / 4 (3)
Egypt / 20 (5)
Indonesia / 38 (33)
Laos / 2 (2)
Nigeria / 1 (1)
Viet Nam 7 (4)
Total / 73 (49)

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)

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

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

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

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 336 (207).
(WHO 12.4.07 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 11.12.07)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 12.6.07):
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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UN report says avian influenza H5N1 responses improving, but threat persists
Many countries have improved their responses to H5N1 avian influenza outbreaks in poultry in the past year, but the disease remains entrenched in six countries, according to a new report from the United Nations and the World Bank.

Amid the persisting threat that the H5N1 virus will spark a human flu pandemic, governments need to do more to coordinate their pandemic planning efforts, according to a UN news release about the report.

"The pandemic threat has led most governments to improve services to detect, contain and lessen the impact of dangerous pathogens," the UN statement says. "Many national pandemic plans, however, are not sufficiently operational and the coordination of pandemic planning between countries needs greater attention."

Dr. David Nabarro, the UN's senior influenza coordinator, commented in the statement, "The most urgent need, now, is for the governments of different countries to work together. First, they must contain avian influenza and other animal diseases that might affect humans. Second, they must prepare for influenza and other possible pandemics."

The report was released in advance of a global conference on avian and pandemic flu, scheduled for 4-6 Dec 2007 in New Delhi. The document comes a week after a World Health Organization (WHO) conference in Geneva made little headway toward solving a dispute over the international sharing of H5N1 virus samples and in the wake of poultry outbreaks in Romania, the United Kingdom, Saudi Arabia, Vietnam, Bangladesh and Pakistan.

The report says H5N1 avian flu has been reported in 60 countries since 2003. The UN statement does not list the six countries in which the virus remains well established, but a Reuters story quotes the report as saying the virus "is currently entrenched in Indonesia, Egypt and Nigeria, and possibly in some locations in China and Bangladesh." Reuters quoted the report as saying, "Outbreaks are being detected more rapidly and the response is more effective. However, animal health services are still substandard in most countries Ethey lack necessary regulatory frameworks, budgets, laboratory capacity and implementation of biosecurity measures."

The UN said nations that initially treated avian flu as an emergency are now developing "longer-term sustainable strategies for the healthy rearing and management of waterfowl, and investing in animal health, including better-run veterinary services." The document also calls on countries to share H5N1 virus samples.

Indonesia, the country hit hardest by avian flu, has shared very few samples over the past year, contending that the long-standing international system for flu surveillance is unfair because rich countries use virus samples from poor countries to develop vaccines that the poor countries can't afford.

A story (29 Nov 2007) from the UN News Service says the report calls for the urgent creation of a 3- to 5-year road map to drive intergovernmental action to control avian flu and improve global readiness for other health crises. The UN report is based on data provided by 143 countries, the UN said. Ninety-five percent of the countries said they are planning for a pandemic. Some of these have taken steps to ensure continuity of vital infrastructure in a pandemic, and some have tested their plans in simulation exercises.
(CIDRAP 11.30.07)

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Europe/Near East
Poland (Mazowsze): Avian influenza H5N1 infection found at two poultry farms
Two poultry farms northwest of Warsaw were cordoned off after the deadly H5N1 strain of bird flu was found in turkeys, Polish officials said on 1 Dec 2007.

Earlier reports had said three farms were affected, but the governor of Mazowsze province, where the outbreak occurred, later revised the count.

"A third farm had initially been suspected, but that suspicion was not confirmed," Governor Jacek Kozlowski told a news conference in Plock.

There are plans to cull 4,000 birds at farms around the village of Brudzen near the city of Plock, Poland's chief veterinary officer Ewa Lech said. She said the virus was most likely brought to Poland by migrating ducks, geese or swans, adding that an area within a 3-km (1.8 miles) radius of the outbreak had been cordoned off.

"Areas of contamination and danger have been marked off and are being constantly monitored by veterinary officials and police," said Plock crisis-management official Hilary Januszczyk.

Poland's efforts to contain the spread of the virus won the approval of the European Commission. "The Polish authorities notified us in the middle of the night about a strong suspicion of bird flu," European Commission spokeswoman Barbara Helfferich told Reuters. "We have been in contact with them since then; they are now taking the appropriate measures."

This includes disinfection mats over which pedestrians and vehicles entering and leaving the affected areas must pass, Polish officials said.

Bird flu was discovered in wild swans near the north Poland city of Torun in early 2006. "There is no cause for alarm," Polish Prime Minister Donald Tusk said on television. "I am in touch with the interior and health ministers as well as veterinary officials in charge. This is not the kind of threat we had several years ago."
(ProMED 12.2.07)

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Poland (Pomorze): Turkey meat has been found to contain avian influenza
In the Pomorze region, 480 kg of turkey meat has been found to contain the bird flu virus. Ongoing research is being carried out in infected areas in farms around the town of Plock.

Vehicles passing through the area are also being disinfected. Anna Obuchowska, spokeswoman for the Sanitary Inspectorate in the Pomorze region, has stated that the meat came from two warehouses, in Zukow and Sierakowice. The Zukow plant supplied meat to shops in Gdansk and Gdynia, with the Sierakowice source providing shops in Czluchow, Chojnice, Koscierzyna and Kartuzy. Obuchowska has said that there is a search for remaining meat in the shops, but it is unlikely that any remains, as the turkey meat was delivered to the shops at the beginning of the previous week. Shop employees are under surveillance by the Sanitary Inspectorate for their own safety.

Avian flu has the same effects as normal flu, and can be treated with the same anti-viral treatment, including Tamiflu. Specialists have stated that meat preparation at temperatures above 70 C should kill any viruses that were present in the meat before its preparation, rendering it safe to eat.
(ProMED 12.2.07)

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Saudi Arabia (Riyadh): 60,000 birds killed in the latest discovery of avian influenza H5N1
Saudi Arabia killed close to 60,000 birds on 3 Dec 2007 in the latest discovery of the deadly disease in the kingdom, bringing the total number birds culled to around 4 million.

The discovery at another table-egg farm in the Al-Kharj region south of the capital Riyadh is the 15th in the area, as fears that the disease may spread to other parts of the kingdom continue to grow.

The ministry last week said that farms surrounding the port city of Jeddah, the gateway for pilgrims to Mecca and Medina, are still safe from the bird flu. Concerns over the spread of the H5N1 strain have grown steadily in recent weeks as Saudi Arabia prepares for the Hajj, with around 3 million pilgrims expected to gather in the holy cities of Mecca and Median.

As a precaution, the Agriculture Ministry on 3 Dec 2007 banned the shipment of live birds from the Riyadh area to Mecca for the next month. All cases of bird flu in the kingdom so far have come from the Riyadh province.
(ProMED 12.6.07)

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Asia
Bangladesh (Pabna): Thousands of chickens must be destroyed due to avian influenza H5N1 infection
Bird flu has spread to another district in northwestern Bangladesh, forcing health and veterinary workers to cull some 6,000 chickens and destroy over 2,500 eggs, officials said on 1 Dec 2007.

The latest case was reported in a village in Pabna district, 160 km from the capital Dhaka, a senior official of the fisheries and livestock ministry said. Bird flu was first detected near the capital in March 2007 and has since spread mostly to northern districts. There have been no cases of human infection.

Including Pabna, 20 of Bangladesh's 64 districts have been affected by the virus, which has forced authorities to kill 256,000 chickens and destroy nearly three million eggs since its outbreak. About four million Bangladeshis are directly or indirectly associated with poultry farming.
(ProMED 12.2.07)

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China (Jiangsu): Avian influenza H5N1 death confirmed
A man in east China's Jiangsu province died of bird flu on 2 Dec 2007, the provincial health department reported.

The 24-year-old man developed fever, chills and other symptoms on 24 Nov 2007 and was hospitalized on 27 Nov 2007 after being diagnosed with "lower left pneumonia." His illness worsened in the hospital, and he died on 2 Dec 2007.

A respiratory tract sample examination by Jiangsu Provincial Disease Control and Prevention Center on Saturday 1 Dec 2007 showed the man's avian flu virus nucleic acid was H5 positive and N1 positive. However, the man had no contact with dead poultry, the health department said. A test done by the China Disease Control and Prevention Center on 2 Dec 2007 also indicated that the man was H5N1 positive, and the Chinese Ministry of Health has confirmed he was infected with bird flu.

The local government has adopted relative prevention and control measures. All of the 69 people who had close contact with the patient have been put under strict medical observation. So far, they have shown no signs of symptoms. The Ministry of Health has reported the case to the World Health Organization and some countries and regions. The Jiangsu Animal Husbandry and Veterinary Bureau said no bird flu epidemic has been found in the province so far.

But virologist Julian Tang Wei-tze was skeptical about the assessment that the victim has had no contact with birds or poultry. "It's about the accuracy of their contact history. With an incompatible history it's hard to exclude any contact with infected birds, their droppings or people." A Hong Kong-based microbiologist said it was too early to assume any sort of mutation and that the explanation lay in the definition of contact with sick or dead poultry. "If you look back to Hong Kong in 1997 and take the definition of sick or dead poultry, hardly any of the 18 human cases had evidence of contact with sick or dead poultry. Hong Kong has very few poultry farmers and in all likelihood, the cases were exposed at markets."

Contact with infected birds is the most common form of transmission of the virus to humans. A similar case occurred in July 2007 when a six-year-old Indonesian boy was infected, with no apparent contact with poultry. The Indonesian medical community was puzzled, unable to find infected poultry within 300 meters [984 feet].

This is the 26th human case of avian influenza and the 17th fatality in China. It is the first new case to be reported in China since 30 May 2007.
(ProMED 12.2.07 & 12.5.07)

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Americas
Canada: Minister of Agriculture revokes order declaring Saskatchewan a Control Area
On 30 Oct 2007, The Honorable Gerry Ritz, Minister of Agriculture and Agri-Food Canada revoked the Ministerial Order that declared the Province of Saskatchewan to be a Control Area for the purposes of establishing movement controls and responding to a finding of H7N3 highly pathogenic notifiable avian influenza (HPNAI).

The virus was not found on any other premises, although intensive surveillance was carried out, as described below. Although the virus was an H7N3 subtype of influenza A, it did not have a close phylogenetic relationship to the HPNAI H7N3 subtype found in British Columbia in 2004.

A paper describing the homology with other H7N3 viruses is currently being prepared for publication. A detailed report describing the circumstances and actions taken by Canadian Food Inspection Agency (CFIA) will be available on the CFIA website."

Information about the 2007 HPNAI outbreak in Saskatchewan can be found
in English at:
http://www.inspection.gc.ca/english/anima/heasan/disemala/avflu/2007sask/saske.shtml
in French at:
http://www.inspection.gc.ca/francais/anima/heasan/disemala/avflu/2007sask/saskf.shtml
(ProMED 12.5.07)

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USA: Experts urge clinicians to extend flu-shot season
Experts from the US Centers for Disease Control and Prevention (CDC) and the National Influenza Vaccine Summit (NIVS) in a teleconference urged clinicians to consider extending their seasonal flu vaccination efforts through March and shared strategies for immunizing more patients during office visits.

The CDC and NIVS efforts are aimed at utilizing the record number of seasonal flu vaccine doses that will be available this year. In November the CDC predicted producers would ship 132 million doses of vaccine by the end of the flu season Emore than 10 million more than ever produced before in the United States.

At today's teleconference, Andrew Kroger, MD, medical officer and trainer with the CDC's immunization services division, said 109.3 million doses have already been distributed. Kroger said the influenza season is just beginning and emphasized the importance of encouraging patients to be vaccinated, even well after December.

"It's a fallacy that the vaccination season is over in December. The job is not done yet," he said.

The number of confirmed influenza cases is normal for this point in the season, Kroger said. It's too early to tell if this season's vaccine is a good match for the circulating flu strains, he said. "Lab surveillance began in October, so we don't really have a sense of that yet."

In November, John Bresee, MD, chief of epidemiology and prevention for the CDC's immunization services division, said the agency was concerned about reports from last season and the summer of possible drift in the influenza A subtype H3N2.
(CIDRAP 12.6.07)

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USA: FDA panel seeks stronger label warnings for two influenza drugs
The US Food and Drug Administration's (FDA's) Pediatric Advisory Committee voted today to recommend stronger label warnings for two antiviral influenza medications Eoseltamivir and zanamivir Ethat have been linked to reports of neuropsychiatric problems in children and teens, mainly in Japan.

Oseltamivir already carries a warning, but zanamivir currently carries no warning about reported neuropsychiatric effects. The FDA typically follows through on the recommendations of its advisory committees, though it is not required to do so.

In briefing materials posted on the FDA's Web site in advance of today's meeting, the committee said it is unclear if the two drugs play a role in reported neuropsychiatric events, but because reports of adverse effects are still occurring, labeling changes are needed for both drugs to urge health-care providers to monitor children closely when they begin taking the medications.

Since 2005, US regulators have been concerned about reports of self-injury and delirium linked to oseltamivir in children and adolescents from Japan, where use of the drug is much more prevalent than in the United States.

In November 2006, the advisory committee said it still found no evidence that the oseltamivir contributed to the neuropsychiatric events, but it recommended a labeling change to reflect the increasing number of reports, which included a small number of patients from the United States. Roche, the maker of oseltamivir, revised the drug's packaging insert.

Meanwhile, GlaxoSmithKline, the company that produces zanamivir, said in its briefing report to the FDA that the company received 145 reports of neuropsychiatric events associated with zanamivir during the 2007 flu season, all from Japan. Nearly all (99%) were reported in children and adolescents aged 6 to 14 who had flu or flu-like illness. None were fatal.

The increased reports of neuropsychiatric events in young people who took zanamivir coincided with a warning issued by Japan's health ministry about abnormal behaviors in Japanese youth who took oseltamivir, Glaxo wrote in its report to the FDA committee. Japan also had a fivefold increase in zanamivir use over the past two years, the company added.

Both Roche and Glaxo said in their reports that they don't believe the evidence warrants labeling changes. However, Roche spokesman Terry Hurley said the company would be open to considering a labeling change if the FDA thinks more details should be added.
(CIDRAP 11.27.07)

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2. 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
- 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/
- 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/
- 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 16 Nov 2007.
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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Global
The upsurge in the incidence and spread of avian influenza, observed since the beginning of fall 2007, seems to continue. The following 27 countries in Asia, Europe and Africa have reported H5N1 in wild birds or poultry during 2007 so far:

Afghanistan, Bangladesh, Cambodia, China, Czech Republic, France, Germany, Ghana, Hong Kong (SARPRC), Hungary, India, Japan, Kuwait, Laos, Malaysia, Myanmar, Pakistan, Republic of Korea, Poland, Romania, Russia, Saudi Arabia, Thailand, Togo, Turkey, United Kingdom, Viet Nam.
(ProMED 12.2.07)

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UK
1. Following a report of suspected avian notifiable disease in turkeys in Suffolk on 11 Nov 2007, highly pathogenic (HP) H5N1 avian influenza (AI) infection was confirmed on 12 Nov 2007.

2. The infected premises (IP) comprised 5,000 growing turkeys, kept in five groups of a thousand each, 1,118 ducks and 410 geese maintained under a free-range system. Samples collected at slaughter for laboratory examination revealed that two groups of turkeys had a significant prevalence of infection (more than 50 percent), a further group had a maximum prevalence of five percent. No evidence of infection was found in the geese, but infection was detected in the ducks for which the maximum prevalence was two percent. The findings suggest that there had been an initial focal introduction of virus into one of the groups of turkeys, rather than a widespread exposure of all poultry on the site.

3. Epidemiological investigations of the IP resulted in the identification of five dangerous contact (DC) premises as a result of them being tended by the same stockmen who employed poor biosecurity measures. Only turkeys were kept on four of these DC premises; ducks, geese and turkeys were kept on the other DC premises. Samples were taken for laboratory examination from the birds culled at the DC premises. Infection was detected in one group of turkeys on one of these premises, which became designated as IP2. The maximum prevalence of infection in this group was 10 percent. This was consistent with infection having been transmitted from IP1.

4. Genetic analyses of the virus isolates from the turkeys on the two IPs and the ducks on IP1 indicated that the birds were infected from a single source. The current isolate has the closest genetic identity to an isolate from wild birds in the Czech Republic detected in mid-2007. The current isolate is phylogenetically distinct from the previous isolate of H5N1 in 2007 obtained from the Holton outbreak.

5. The poultry on the premises which supplied the birds to IP1 and IP2 were sampled and tested with negative results. All of the birds were hatched in Great Britain.

6. The surveillance of poultry in the PZ and SZ has not revealed any further infected flocks indicating that infection has been confined to the two IPs.

7. The results of the epidemiological investigations to date provide no evidence that infection was introduced via imported poultry or poultry products or any activities associated with such importations.

8. IP1 was located in an area where wild birds were relatively common and was notably near to an ornamental lake which supports some 1,000 waterfowl. H5N1 infection has not been detected in wild birds nor have any incidents of high mortality been observed in the area. An enhanced surveillance program has been initiated. At the present time, wild birds, most likely migratory species from central Europe, cannot be ruled out as the source of infection. Epidemiological investigations are continuing, and the results will be provided in further reports.

9. Two important and epidemiologically significant findings are evident from the investigations to date. These are:

  • The poor biosecurity measures employed by the stockmen, which in this case were peripatetic and therefore cared for more than one unit of poultry, which resulted in the transmission of infection in the area
  • The siting of a free-range poultry unit (IP1), which is likely to attract wild birds because of feed availability, in an area already unavoidably occupied by populations of wild bird species, notably migratory waterfowl, but also "bridge" species (such as gulls), which are capable of becoming infected by HP H5N1 and transmitting the virus from primarily infected wild birds to commercial poultry.
    (ProMED 12.2.07)

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    3. Articles
    Influenza activity in Europe during eight seasons (1999-2007): an evaluation of the indicators used to measure activity and an assessment of the timing, length and course of peak activity (spread) across Europe
    Paget J. BMC Infectious Diseases 2007, 7:141 doi:10.1186/1471-2334-7-141 http://www.biomedcentral.com/content/pdf/1471-2334-7-141.pdf

    Background: The European Influenza Surveillance Scheme (EISS) has collected clinical and virological data on influenza since 1996 in an increasing number of countries. The EISS dataset was used to characterize important epidemiological features of influenza activity in Europe during eight winters (1999-2007). The following questions were addressed: 1) Are the sentinel clinical reports a good measure of influenza activity? 2) How long is a typical influenza season in Europe? 3) Is there a west–east and/or south-north course of peak activity (spread) of influenza in Europe?

    Conclusions: We found that: 1) The clinical data reported by sentinel physicians is a valid indicator of influenza activity; 2) The length of influenza activity across the whole of Europe was surprisingly long, ranging from 12-19 weeks; 3) In four out of the eight seasons, there was a west-east spread of influenza, in three seasons a south-north spread; not associated with type of dominant virus in those seasons.

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    H5N1 in wild and domestic birds in Europe – remaining vigilant in response to an ongoing public health threat
    Needham H. Eurosurveillance weekly releases. 2007;12(12) http://www.eurosurveillance.org/ew/2007/071206.asp#1

    Background: Since the emergence of A/H5N1 in the winter of 2005-2006 at the border of the European Union (EU), including human cases in Turkey, the European Centre for Disease Prevention and Control (ECDC) has developed assessments on the public health risks from A/H5N1, and guidance on how to protect those that may be exposed to the virus. Over the last three years, the EU has also made strenuous efforts to improve the protection of EU domestic poultry from A/H5N1 infection, including enhancing biosecurity around domestic flocks and increasing veterinary surveillance activities in bird populations (wild and domestic) in order to provide an essential early warning of the presence of the virus.

    Direct comparison of surveillance activity between the two periods is difficult, but the data available to date suggest a lower surveillance activity in wild birds in 2007 compared to 2006. There also remains large heterogeneity in the number of wild birds tested in all the Member States. However, the reported incidence data in 2007 are consistent with a relatively low level of A/H5N1 virus circulation within EU bird populations: infected wild birds have only been identified in four EU Member States, all within a short time-frame and a limited geographical area in central Europe. The apparent lower level of virus circulation in wild birds during 2007 has not been reflected in the reported number of domestic poultry outbreaks in the EU. As of 3 December 2007, 14 outbreaks in domestic poultry have been reported in six Member States. Although three countries (Hungary, Germany and the Czech Republic) have also reported cases in wild birds, the timing and location of cases in domestic poultry offer no obvious epidemiological link to wild bird infection in the majority of cases. This is in contrast to 2006, when most of the 33 domestic poultry outbreaks reported in the five affected Member States (Hungary (29), Sweden (1), German (1), Denmark (1) and France (1)) were preceded by the positive identification of virus in wild birds in the vicinity of the index case, giving a strong epidemiological link to the source of infection. It seems, therefore, that unlike 2006, where proactive surveillance in wild birds established the presence of virus in several locations prior to the virus being identified in poultry, epidemiological data from 2007 did not detect infection in local wild birds before infection in domestic flocks. This is open to various interpretations, one being that EU wild bird surveillance, although extensive, has not been sufficient to trace infection in wild birds. However, in those areas where domestic flocks have been affected, even increased retroactive wild bird surveillance around cases in domestic poultry has, in most cases, failed to identify A/H5N1 infection in wild bird populations. This points to the possibility of other routes of entry into domestic poultry, such as through trade in poultry products, or via formites. The latter has been suggested in the linked outbreaks in Hungary and the United Kingdom (UK) in 2007.

    Conclusion: Irrespective of the cause, the infrequent but indiscriminate challenge from A/H5N1 may be the new reality that all owners of poultry in the EU, both commercial and hobby flocks, must now adapt to, at least in the short term. This also has important implications for public health: the apparently increasingly sporadic outbreaks of infection in domestic poultry, although uncommon, highlight the need for all owners of poultry to remain vigilant for the presence of infection in flocks. ECDC’s risk assessment is that those most at risk are people with small domestic and hobby flocks, rather than those working on large industrial farms, although it is important that the prevention messages reach both. The truth of this was shown earlier this year, when an outbreak with another less pathogenic avian influenza infection (avian influenza A/H7N2) in poultry infected some owners, put a few people into hospital with illness and required many more to take prophylaxis.

    Although there have been no human H5N1 cases in the EU, there is more than a theoretical possibility that cases will be seen in the future and that they will come from people with small backyards or hobby flocks. In order to minimize this risk, it is important to encourage good hygiene practices in all who have contact with poultry, including in particular avoiding handling sick or dead birds and regular hand-washing following any contact with birds. This is especially the case given the apparent uncoupling between cases detected in wild birds and domestic poultry; wild bird sentinels may not highlight the presence of infection before it appears in domestic flocks. Of course, there are a number of other zoonoses that are considerably more likely to be transferred from birds to their owners in the EU, but the same precautions recommended to protect against A/H5N1 will also protect against the other infections.

    Overall, although the epidemiological interaction of H5N1 virus between wild birds and domestic poultry may have changed somewhat during 2007 in comparison to previous years, there is nothing in the international data to suggest that the virus has altered its characteristics in such a way as to increase the likelihood of transmission to humans. The ECDC has therefore not altered its standing risk assessment on the direct human health implications of the A/H5N1 viruses, which is that they are, at present, a group of influenza viruses of birds, poorly adapted to humans, whom they find hard to infect except at high doses. They are dangerous as they are highly pathogenic in those few humans that do become infected, but then they generally do not transmit on to other humans.

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    Applying the scientific method when assessing the influence of migratory birds on the dispersal of H5N1
    Flint PL. Virology Journal 2007, 4:132doi:10.1186/1743-422X-4-132 http://www.virologyj.com/content/4/1/132/abstract

    Background: The role of wild birds in the dispersal of highly pathogenic avian influenza virus H5N1 continues to be the subject of considerable debate. However, some researchers functionally examining the same question are applying opposing null hypotheses when examining this issue.

    Discussion: I describe the correct method for establishing a null hypothesis under the scientific method. I suggest that the correct null hypothesis is that migratory birds can disperse this virus during migration and encourage researchers to design studies to falsify this null. Finally, I provide several examples where statements made during this debate, while strictly true, are not generally informative or are speculative.

    Summary: By adhering to the scientific method, definitive answers regarding the role of wild birds in the dispersal of highly pathogenic viruses will be reached more effectively.

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    Response to Avian Influenza and State of Pandemic Readiness: Third Global Progress Report
    UN System Influenza Coordinator and World Bank. December 2007 http://interaction.org/files.cgi/6077_Responses_to_Avian_Influenza_and_State_of_Global_Readiness_Dec_2007.pdf

    Executive Summary
    The risk of a world-wide influenza pandemic is as great in late 2007 as it was in mid-2005. The World Health Report 2007 states that “There will be an influenza pandemic, sooner or later” with the potential to result in millions of deaths and severe social, economic and humanitarian consequences. We have a unique opportunity to prepare for the pandemic now and to significantly mitigate its potential impact.

    The current epizootic of Highly Pathogenic Avian Influenza (HPAI) is caused by type A virus H5N1 which has the capacity to infect humans (though, at the time of writing, less than 350 cases of sporadic human infection have been confirmed). There is concern that the genetic material in the avian virus could mutate or re-assort in a way that makes the virus capable of sustained transmission between humans. So far, this sustained human-to-human transmission has not been observed.

    However, HPAI continues to spread among poultry and other birds. The virus has been found in an additional five new countries so far during 2007: a total of 60 countries and territories have now reported H5N1 outbreaks either in poultry or wild birds or both. Continuous transmission of HPAI H5N1 occurs in some settings: the virus is considered to be entrenched (or enzootic) in parts of Indonesia, Egypt, Nigeria and (possibly) part of Bangladesh and China. Given the potential for wild birds to carry the virus over long distances, continued transmission of HPAI among poultry in any one country represents a threat to the world.

    This is the third in a series of reports to document global progress with control of HPAI and preparedness for the next influenza pandemic. Once again it has been jointly produced by the United Nations System Influenza Coordinator (UNSIC) and World Bank. The description of progress in this report is based primarily on the data provided by national governments.

    Information was collected from 146 countries in response to a survey circulated by UNSIC during July 2007. This data gathering was complemented with case studies, key informant interviews and the analyzes of experts from specialized UN system agencies, the World Bank and the OIE. The information on pledges, commitments and disbursements in support of avian and human influenza control and pandemic preparedness has been collected by the World Bank from donor countries.

    The report covers developments over the past two years, with a specific focus on the last six months (January – June 2007). It provides (a) an analysis of efforts made and financial assistance provided to date, and (b) an assessment of progress in the capacity of nations to respond to HPAI and their preparations for the next influenza pandemic.

    The report considers the implications of progress to date for future national and international investments in animal and human health security. The results presented in the report indicate that substantial progress has been made in the initial – emergency – phase of the global response to HPAI and threats to public health. Data from countries suggest that capacity to respond to Highly Pathogenic Influenza (HPAI) infection in poultry has improved. Outbreaks are being detected more rapidly and the response is more effective. However, animal health services are still substandard in most countries – they lack necessary regulatory frameworks, budgets, laboratory capacity and implementation of biosecurity measures.

    Economy data also suggests that there has been an improvement in human influenza virus diagnostic and surveillance capacity globally. However, capacity varies significantly and is considered to be insufficient in a number of countries (particularly in Africa).

    Whilst there has been an increase in the number of countries reporting that they are planning for pandemic influenza, the preparations pay insufficient attention both to operational readiness at the local level and to cooperation on pandemic preparedness between neighboring countries. Only a small proportion of preparedness plans focuses on sectors other than health. Analysis of the ways in which pledged international assistance has been used reveals that virtually all grant funds have been committed and more than three quarters disbursed.

    The following challenges are identified:

    1. The need to expand from emergency, short-term responses to sustained medium- and longer-term strategies with an increased focus on biosecurity in both family and commercial poultry production systems;
    2. The importance of intensive responses in locations where there is continued transmission of HPAI H5N1 among poultry and where the virus is entrenched;
    3. The requirement for sufficient capacity at country level for compliance with the International Health Regulations (2005);
    4. The need for increased involvement of different economic and social sectors, as well as humanitarian organizations, in pandemic planning in order to mitigate social, economic and humanitarian impacts; and
    5. The need for convergence in capacities for animal and human health, environmental health, food safety and crisis management to better prepare for threats to human security.

    Many national authorities, especially in countries where HPAI is entrenched, will seek international technical and financial assistance as they respond to these challenges: additional grant finance will be required to ensure that the necessary assistance can be provided as and when needed, in a sustained manner.

    In order to ensure proper control of avian influenza (and other zoonoses) and readiness for future health crises, an appropriate national, regional and international three to five year response to these challenges (and others identified in the forthcoming New Delhi International Conference on Avian and Pandemic Influenza) should be mapped out and agreed by governments. The resulting road map would serve as a valuable guide for policies, actions and outcomes, and as a measure against which future progress could usefully be assessed.

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    4. Notifications
    The New Delhi Road Map for 2008
    http://pib.nic.in/release/release.asp?relid=33862

    A Road Map that sets out the actions that a nation intends to implement could help with the establishment of achievable benchmarks to be pursued by all concerned government entities, and other stakeholders. It would encourage focused action and counter uncertainty, fatigue and confusion. The New Delhi Road Map for 2008 is designed as a template to be adapted by National Authorities and used to enable the nation to be as ready as possible (by the end of 2008) both to control HPAI and to contain and mitigate an influenza pandemic. It identifies simple milestones on the road to the vision – milestones that each country should seek to reach during 2008.

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    Non-Pharmaceutical Interventions for Use During a Human Influenza Pandemic
    http://www.pandemicflu.gov/nonpharminterv.html

    Overview
    Response to a human influenza pandemic should include a wide spectrum of medical and non-medical interventions at local, national and international levels to reduce morbidity and mortality and to mitigate the socio-economic consequences. However, there is uncertainty about the potential effectiveness of pre-pandemic vaccines against the future specific influenza strain causing the pandemic. There is also concern about the amount of time that will be needed to develop, manufacture and distribute a vaccine that would be specific to the pandemic strain.

    To help prepare the nations of the world for a possible global influenza pandemic, the US Government is promoting the consideration of non-pharmaceutical interventions for use during an influenza pandemic, both domestically and internationally. We offer this condensed and adapted version of our national “community-mitigation guidance” – developed by the US Centers for Disease Control and Prevention (CDC) within the US Department of Health and Human Services (HHS),1 in accordance with recommendations of the Secretariat of the World Health Organization (WHO)2 – which provides information on key non-drug, non-vaccination measures that can mitigate the effects of disease during an influenza pandemic. We believe the core principles of community mitigation highlighted in this document are adaptable for use outside the United States – particularly in developing countries, which could suffer significant morbidity and mortality in the case of a human influenza pandemic. In addition, this document intends to articulate the principles in language the WHO can use to guide national and local governments as they create their own community-mitigation policies for a human influenza pandemic.

    By design, this document does not include specific suggestions for adapting the guidance to reflect different cultural and social realities across the world. Each country and its partners can do this only by developing a plan that reflects each country’s unique needs, resources and perspectives. Key contexts for adaptation of this guidance include consideration of diverse scenarios and settings such as: urban vs. rural environments, housing structure, sources of employment and income, safety and availability of local food and water, the roles of schools, the efficacy of health care delivery systems, the status of sanitation and hygiene, primary forms of transportation, legal authorities, enforcement and ethical constructs and political/governmental frameworks. Countries and communities need to factor in these variables, as well as cultural issues, when planning to implement non-pharmaceutical interventions to mitigate a pandemic, as well as the special needs of vulnerable populations such as persons with disabilities, elderly citizens or low-income individuals.

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    Vaccine Allocation: Join the Discussion
    Who gets vaccinated first in a flu pandemic? Doctors? Paramedics? Kids? The elderly? It’s the central question posed in a series of public forums seeking input on a draft plan that spells out how vaccines will be allocated in the early days of a flu pandemic. In recent months public meetings were held in communities across the United States to gather feedback. Meanwhile, the draft plan was posted in the Federal Register asking the public to review it and submit comments.

    To further the discussion, we are sponsoring a Web dialog to let experts, federal officials and the public learn from one another by sharing information, ideas and perspectives. This is an excellent opportunity for interested participants to post their views and concerns and propose constructive solutions related to pandemic flu vaccinations.

    Join the discussion at:
    http://www.webdialogues.net/cs/panflu-engage-home/view/di/104?x-t=home

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    APEC Center for Technology Foresight: Technology Roadmapping Workshop
    The APEC second technology roadmapping workshop on "Converging Technologies to Combat Emerging Infectious Diseases" in Chinese Taipei (as a part of APEC-wide project) was recently completed with success.

    The final stage of this project are now being planned. The final symposium, which aims to discuss longer term perspective to enhance the region’s capacity in development and utilization converging technologies that contribute to the successful prevention and management of emerging infectious diseases. The details can be found in the following links:

    http://www.apecforesight.org/apec_wide/EID/eid_main.cfm

    http://www.apecforesight.org/apec_wide/EID/docs/SymposiumBkkDraft051107.pdf

    Ponpiboon Satangput, Ph.D., Policy Researcher, APEC Center for Technology Foresight www.apecforesight.org ; E-mail: ponpiboon@nstda.or.th

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 apecein@u.washington.edu