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EINet Alert ~ Jan 04, 2008
*****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)
- China (Xinjiang): H5N1 avian influenza reported in far west
- Bangladesh: H5N1 avian influenza strikes northern villages
- Myanmar (Shan): New case of H5N1 avian influenza following unusual death of domestic chickens
- Pakistan (Peshwar): WHO confirms human-to-human transmission of H5N1 avian influenza
- Vietnam: Influenza hits two more southern poultry farms
- Vietnam: Infection in four-year-old confirmed
- Israel (Binyamina): H5N1 avian influenza found in kindergarten chicken coop
- Egypt: Four people die of H5N1 avian influenza
- Egypt: Officials take measures to contain H5N1 outbreak
- Avian/Pandemic influenza updates
- Active influenza surveillance at the local level: a model for local health agencies
- Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers
- Influenza vaccination among registered nurses: Information receipt, knowledge, and decision-making at an institution with a multifaceted educational Program
- House staff attitudes about influenza vaccination after participation in a clinical trial to improve vaccination of hospital patients
- Experimental infection and natural contact exposure of dogs with avian influenza virus (H5N1)
- Cross-protection against lethal H5N1 challenge in ferrets with an adjuvanted pandemic influenza vaccine
- A novel approach to the development of effective H5N1 influenza A virus vaccines: the use of M2 cytoplasmic tail mutants
- Lao PDR tests its pandemic preparedness
- Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Cambodia/ 1 (1)
China / 5 (3)
Egypt / 25 (9)
Indonesia / 41 (36)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 1 (1)
Viet Nam 8 (5)
Total / 85 (58)
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)
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)
Viet Nam / 3 (3)
Total / 3 (3)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 348 (216).
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 12.10.07): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 1.2.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
China (Xinjiang): H5N1 avian influenza reported in far west
China has reported an outbreak in poultry of the H5N1 strain of bird flu in its far west Xinjiang region, Xinhua news agency said. The first bird flu outbreak in the country since September came about a month after the virus killed a 24-year-old man in the eastern province of Jiangsu. A total of 4,850 poultry have died of the disease in Turpan city in the Xinjiang Uighur Autonomous Region since 29 Dec 2007, prompting authorities there to cull another 29,383 birds. The National Avian Influenza Reference Laboratory confirmed the virus as a subtype of the H5N1 strain, without specifying which kinds of poultry were infected. "At present, the epidemic has been brought under effective control," Xinhua said.
With the world's largest poultry population and hundreds of millions of farmers raising birds in their backyards, China is seen as crucial in the global fight against bird flu. The Agriculture Ministry has warned of a "very high" possibility of bird flu outbreaks in the country over winter and spring, when the virus is at its most contagious.
Bangladesh: H5N1 avian influenza strikes northern villages
Nearly 2,000 chickens have been culled in a village in northern Bangladesh after the H5N1 bird flu virus was detected at a poultry farm, officials said on 28 Dec 2007.
The infection was detected in Dinajpur district, 420 km from the capital Dhaka, a senior official of Fisheries and Livestock Ministry said. In another, more recent, outbreak, 2,500 chickens were culled after the virus infected more farms in the northern part of the country. This infection was detected in two villages in Gaibandha district, about 350 km from the capital Dhaka.
Bird flu was first detected near the capital in March 2007 and has since spread mainly to northern districts and forced authorities to cull around 278,000 chickens. About four million Bangladeshis are directly or indirectly associated with poultry farming, but so far there have been no cases of human infection, government and health officials say.
(ProMED 12.29.07, 1.2.08)
Myanmar (Shan): New case of H5N1 avian influenza following unusual death of domestic chickens
A fresh bird flu case was detected in Myanmar's eastern Shan state and confirmed on 27 Dec 2007 following an unusual death of domestic chickens in Yankham village in the state's Mongphyat township last weekend, according to a statement of the Livestock Breeding and Veterinary Department. The unusual death of chickens started on 23 Dec 2007 and after laboratory tests, H5N1 was detected and further confirmed on 27 Dec 2007. The authorities assessed that the H5N1 was spread to the area from the same state's Kengtung township where bird flu broke out on 18 Nov 2007, infecting a seven-year-old girl. Preventive measures are being taken under the bird flu control program which include setting up restricted zones and control zones, culling poultry in these zones, disinfecting, banning of the marketing of chickens in the township and enhancing of bio-security.
Human infection of bird flu in Myanmar was first officially reported on 15 Dec 2007 to the public after a bird-flu-infected girl had been discharged from a local hospital in Kengtung on 12 Dec 2007 after treatment.
H5N1 virus was detected in some chickens and ducks of local species which died at the village farm in Kengtung on 18 Nov 2007. In its prevention and control measures, the local authorities culled 14,889 chickens, ducks, geese and Muscovy ducks within a week after such unusual deaths were found on the fowls traded in the area.
Pakistan (Peshwar): WHO confirms human-to-human transmission of H5N1 avian influenza
The WHO confirmed on 27 Dec 2007 a single case of human-to-human transmission of the H5N1 bird flu virus in a family in Pakistan but said there was no apparent risk of it spreading wider.
A statement from the UN agency said tests in its special laboratories in Cairo and London had established the "human infection" through presence of the virus "collected from one case in an affected family." But it said a WHO team invited to Pakistan to look into an outbreak involving up to nine people, from late October to 6 Dec 2007 had found no evidence of sustained or community human-to-human transmission.
No identified close contacts of the people infected, including health workers and other members of the affected family, had shown any symptoms and they had all been removed from medical observation, the WHO added. The outbreak followed a culling of infected chickens in the Peshawar region, in which a veterinary doctor was involved. Subsequently he and three of his brothers developed proven or suspected pneumonia. The brothers cared for one another and had close personal contact both at home and in the hospital, a WHO spokesman said. One of them, who was not involved in the culling, died on 23 Nov 2007. His was the human-to-human transmission case confirmed by the WHO. The others all recovered.
"All the evidence suggests that the outbreak within this family does not pose a broader risk," the WHO spokesman said. "But there is already heightened surveillance and there is a need for ongoing vigilance." It was the first human-to-human case of H5N1 transmission in Pakistan, while others have been confirmed in Indonesia and Thailand in similar circumstances of what the WHO calls close contacts in a very circumscribed area.
Vietnam: Influenza hits two more southern poultry farms
Bird flu has hit two more poultry farms in southern Vietnam, forcing the slaughter of hundreds of geese last week, animal health officials said 2 Jan 2008. More than 600 birds were culled after the virus killed several geese in two flocks in Da Loc commune of Tra Vinh province, where an outbreak was also reported earlier in December 2007, the Animal Health Department said.
Vietnam's government has warned of a higher risk of avian influenza, as the northern winter months favor the spread of flu viruses and ahead of February's Tet Lunar New Year, when travel and poultry consumption rise.
Vietnam: Infection in four-year-old confirmed
The Ministry of Health in Vietnam has confirmed a new case of human infection of H5N1 avian influenza. The case, a four-year-old male from Son La Province, has been confirmed by the National Institute of Hygiene and Epidemiology (NIHE). He developed symptoms 7 Dec 2007, was hospitalized 11 Dec 2007, and died 16 Dec 2007.
Control measures have been implemented and close contacts have been identified. All remain healthy and will continue to be monitored. The source of exposure is currently under investigation. The child might have been infected with bird flu virus strain H5N1 from wild birds. All specimens from poultry in the province have tested negative for H5N1, so the child might have contracted the virus from infected wild birds hunted and brought home by his family members.
(ProMED 12.28.07, 1.3.08)
Israel (Binyamina): H5N1 avian influenza found in kindergarten chicken coop
Health Ministry made positive identification of H5N1 bird flu virus in Binyamina kindergarten. Agriculture Ministry quarantines all chicken coops, hatcheries within six-mile radius pending further testing.
The Haifa District Physician, Prof. Shmuel Rishpon, confirmed on 3 Jan 2008 that a deadly strain of the bird flu virus has infected chickens at a petting zoo in a Binyamina kindergarten. In the backyard of the one-story building, there is an area where 12 chickens, eight ducks and six pigeons were kept as pets. Ten of the chickens and one duck died, found infected by HPAI H5N1; all the remaining birds, namely seven ducks, two chickens and six pigeons have been destroyed.
A protective zone of three km and surveillance zone of 10 km have been applied. Epidemiological investigation is being carried out; the mesh, while keeping the birds enclosed, does not prevent their possible exposure to droppings of wild birds and to birds which land on the cage or come close to it.
Israel's previous outbreak of HPAI H5N1 occurred in March 2006. It affected mainly farms adjacent to the Gaza strip; there was also one single outbreak in the Jordan Valley. Mass destruction was applied, to be analyzed later. Israel has culled more than 1.2 million turkeys and chickens after detecting the H5N1 virus. There have been no human cases.
Egypt: Four people die of H5N1 avian influenza
On 31 Dec 20007, two Egyptian women died of bird flu, bringing to four the number of fatalities from the virus in the most populous Arab country in less than a week.
All four deaths involved women and were believed to have resulted from exposure to sick or dead backyard birds. One of the victims, from Menoufia province in the Nile Delta region north of Cairo, was taken to hospital on 29 Dec 2007 and died early on 31 Dec 2007, Egypt's Health Ministry said in a statement.
"She suffered from a high fever and difficulty breathing and had a pulmonary infection after coming into contact with birds suspected of being infected with avian flu," the statement said. "She was placed on a respirator but died at dawn on 31 Dec 2007."
Later, John Jabbour, an Egypt-based World Health Organisation official, said a second woman (from Damietta, also in the Nile Delta) had died of bird flu in northern Egypt. On 30 Dec 2007, a 25-year-old Egyptian woman died of bird flu in the Nile Delta city of Mansoura while another woman died of bird flu on 26 Dec 2007 in Beni Suef province south of Cairo, the first case of this winter season.
The deaths broke a five-month pause in human cases in Egypt and brought to 19 the number of Egyptians who have died of the H5N1 bird flu virus since it emerged in Egypt in early 2006. It is also the third winter that the virus has struck after lying low during Egypt's hot summers, when it is much less likely to spread from one carrier to another.
Jabbour said the high fatality rate in the recent cases was likely due to a delay in diagnosis after patients and their family members denied exposure to infected birds. Patients are most likely to survive if they start treatment with Tamiflu early after symptoms occur.
Around five million households in Egypt depend on poultry as a main source of food and income, and the government has said this makes it unlikely the disease can be eradicated despite a large-scale poultry vaccination program. WHO officials have said the bird flu virus was now considered endemic in Egypt.
[The four cases reported in Egypt during the past week included a woman in the Beni Suef governorate (the 41st case and the 16th death), a woman in Mansoura city who died 30 Dec 2007 (the 42nd case and the 17th death), a woman in Menoufia governorate who died 31 Dec 2007 (the 43rd case and the 18th death), and the woman Dumiyadh governorate who also died 31 Dec 2007 (the 44th case and the 19th death). None of these four cases appear to be connected in any way. The 100 percent mortality rate for the four cases reported during the past week, in contrast to the more favorable outcomes achieved by the Egyptian Health Ministry previously, is being attributed to delayed diagnosis (in part due to reluctance of patients to come forward for treatment) and consequent late initiation of Tamiflu treatment, rather than to any increased virulence of the H5N1 virus.]
A map showing the locations of the governorates and cities of the Nile Delta region and of the governorates south of Cairo is available at:
Egypt: Officials take measures to contain H5N1 outbreak
The Egyptian government has been exerting more effort to prevent further spread of the bird flu virus since the fatal disease caused four human deaths in less than a week in late December 2007.
Egypt has culled 1,599 domestic poultry suspected of contracting bird flu in its latest efforts to prevent further spread of the fatal disease in the populous country, the official MENA news agency reported 1 Jan 2008. The culling of birds was carried out in four governorates, namely Cairo, Qalyubiya, Minufiya and Gharbiya, chairman of the General Authority for Veterinary Services Hamid Samaha was quoted as saying. Under the supervision of a committee, the dead poultry was buried deep between two layers of white lime, said Samaha.
The preventive medicine department has launched a campaign to vaccinate live poultry against the H5N1 strain of bird flu in the country, with the participation of 3,000 veterinarians, assistants and drivers. Some 85 million doses of anti-bird flu vaccines were secured.
During a meeting discussing means of preventing more cases, el-Gabali urged chest and fever hospitals in the country to intensify protective measures. The minister also ordered speeding up a media campaign to keep the citizens aware of the symptoms and dangers of the disease and, more importantly, how to deal with it.
Giza Governorate has decided to launch campaigns to control homebred poultry and close illegal living birds stores. Work teams have been set up in Minufiya Governorate to execute poultry infected with bird flu using safe methods. Minufiya governor Hassan Hemaida has issued directives to intensify regular inspection patrols at some 4,882 poultry farms in the governorate.
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/avianflu/en/index.html. Read about the 4-6 Dec 2007 International Ministerial Conference on Avian and Pandemic Influenza.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm .
- US CDC: http://www.cdc.gov/flu/avian/index.htm. Updated news from December 2007.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Use the toolkit to prepare your community for a possible flu pandemic.
- 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 the avian influenza portal.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp .
(UN; WHO; FAO; OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)
Active influenza surveillance at the local level: a model for local health agencies
Ghosh TS, Vogt RL. AJPH First Look, published online ahead of print Jan 2, 2008
Abstract: Laboratory-supported, community-based local surveillance systems for influenza can act as early warning systems in identifying the initial entry points of different influenza strains into the community. Unfortunately, local health departments often have limited resources to implement this type of surveillance. We developed and evaluated an active, local influenza surveillance system in three metropolitan Denver, Co., counties that enabled timely case ascertainment and strain identification at little cost. When compared with Colorado’s surveillance system, our system detected cases seven to eight weeks earlier than the state’s electronic disease reporting system.
Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers
Kuntz JL, Polgreen PM, et al. Infect Control Hosp Epidemiol 2008;29:000–000
Objective: To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs).
Conclusions: The University of Iowa Hospitals and Clinics (UIHC) dramatically increased the influenza vaccination rate among HCWs by conducting a pandemic influenza preparedness drill. Additionally, the drill allowed us to conduct a bioemergency drill in a realistic scenario, use innovative methods for vaccine delivery, and secure administrative support for future influenza vaccination campaigns. Our study demonstrates how a drill can be used to improve vaccination rates significantly.
Influenza vaccination among registered nurses: Information receipt, knowledge, and decision-making at an institution with a multifaceted educational Program
Objective: To evaluate the receipt of information and knowledge about influenza and vaccination, as well as influenza vaccination status and reasons for declining vaccination, among registered nurses.
Conclusions: RNs exposed to a longstanding, multifaceted educational program had received information about influenza vaccination, but misconceptions were common and only 331 (64.5%) intended to receive vaccination. Strategies other than educational interventions are needed to increase influenza vaccination rates and thereby to ensure healthcare worker and patient safety.
House staff attitudes about influenza vaccination after participation in a clinical trial to improve vaccination of hospital patients
Cabello J, Charles-Damte M, et al. Infect Control Hosp Epidemiol 2008;29:000–000
Abstract: We surveyed house staff who had participated in a trial that compared influenza vaccination strategies for inpatients. House staff who were exposed to computer–generated vaccination orders were more likely to report that they recommended vaccination to their inpatients and outpatients, compared with house staff who were not exposed to a vaccination intervention. Also, house staff did not recognize pregnant women as a high–priority population for influenza vaccination.
Experimental infection and natural contact exposure of dogs with avian influenza virus (H5N1)
Giese M, Harder TC, Teifke JP et al. Emerg Infect Dis. 2008 Feb; [Epub ahead of print]
Abstract: Contact exposure experiments of influenza virus (H5N1)–infected cats with susceptible dogs, and infected dogs with susceptible dogs and cats, did not result in intraspecies or interspecies transmission. Infected dogs showed increased body temperatures, viral RNA in pharyngeal swabs, and seroconversion but not fatal disease.
Cross-protection against lethal H5N1 challenge in ferrets with an adjuvanted pandemic influenza vaccine
Baras B, Stittelaar KJ, Simon JH, Thoolen RJMM, Mossman SP, et al. PLoS ONE 2008;3(1): e1401. doi:10.1371/journal.pone.0001401
Background: Unprecedented spread between birds and mammals of highly pathogenic avian influenza viruses (HPAI) of the H5N1 subtype has resulted in hundreds of human infections with a high fatality rate. This has highlighted the urgent need for the development of H5N1 vaccines that can be produced rapidly and in sufficient quantities. Potential pandemic inactivated vaccines will ideally induce substantial intra-subtypic cross-protection in humans to warrant the option of use, either prior to or just after the start of a pandemic outbreak. In the present study, we evaluated a split H5N1 A/H5N1/Vietnam/1194/04, clade 1 candidate vaccine, adjuvanted with a proprietary oil-in-water emulsion based Adjuvant System proven to be well-tolerated and highly immunogenic in the human (Leroux-Roels et al. (2007) The Lancet 370:580–589), for its ability to induce intra-subtypic cross-protection against clade 2 H5N1/A/Indonesia/5/05 challenge in ferrets.
Methodology and Principal Findings: All ferrets in control groups receiving non-adjuvanted vaccine or adjuvant alone failed to develop specific or cross-reactive neutralizing antibodies and all died or had to be euthanized within four days of virus challenge. Two doses of adjuvanted split H5N1 vaccine containing ≥1.7 µg HA induced neutralizing antibodies in the majority of ferrets to both clade 1 (17/23 (74%) responders) and clade 2 viruses (14/23 (61%) responders), and 96% (22/23) of vaccinees survived the lethal challenge. Furthermore lung virus loads and viral shedding in the upper respiratory tract were reduced in vaccinated animals relative to controls suggesting that vaccination might also confer a reduced risk of viral transmission.
Conclusions: These protection data in a stringent challenge model in association with an excellent clinical profile highlight the potential of this adjuvanted H5N1 candidate vaccine as an effective tool in pandemic preparedness.
A novel approach to the development of effective H5N1 influenza A virus vaccines: the use of M2 cytoplasmic tail mutants
Watanabe T, Kawaoka Y, et al. Journal of Virology. published online ahead of print on 26 December 2007
Abstract: Outbreaks of highly pathogenic H5N1 influenza viruses in avian species began in Asia and have since spread to other continents. Concern regarding the pandemic potential of these viruses in humans is clearly warranted, as is the need to develop effective vaccines against them. Previously, we and others demonstrated that deletions of the M2 cytoplasmic tail caused a growth defect in A/WSN/33 (H1N1) influenza A virus in vitro (Iwatsuki-Horimoto et al., J. Virol. 80: 5233-5240, 2006; McCown and Pekosz, J. Virol. 79: 3595-3605, 2005 and J. Virol. 80: 8178-8189, 2006). We, therefore, tested the feasibility of using M2 tail mutants as live attenuated vaccines against H5N1 virus. First, we generated a series of highly pathogenic H5N1 [A/Vietnam/1203/04 (VN1203)] M2 cytoplasmic tail deletion mutants and examined their growth properties in vitro and in vivo. We found that one mutant, which contains an 11-amino-acid deletion from the C-terminus (M2del11 virus), grew as well as the wild-type virus, but replicated in mice less efficiently. We then generated a recombinant VN1203 M2del11 virus whose HA gene was modified by replacing sequences at the cleavage site with those of an avirulent type of HA (M2del11-HAavir virus). This M2del11-HAavir virus protected mice against challenge with a lethal dose of homologous [VN1203 (clade 1)] and antigenically distinct heterologous [A/Indonesia/7/2005 (clade 2)] H5N1 viruses. Our results suggest that M2 cytoplasmic tail mutants have potential as live attenuated influenza vaccines against H5N1 viruses.
Lao PDR tests its pandemic preparedness
The Ministry of Health of Lao PDR and the World Health Organization (WHO) organized a simulation exercise to assess the country’s readiness to respond to a potential human influenza pandemic. The exercise, known as “PanStop II”, consisted of table-top exercises where participants tested rapid response and containment mechanisms based on a scenario of sustained human-to-human transmission of a novel human influenza virus in the Lao PDR. “This PanStop II exercise will be very useful for the government and partners in testing the country’s operational preparedness and coordination among all parties. It will enable us to identify what is working and what needs further improvement ahead of time to ensure optimal planning and response during an actual outbreak,” says Dr. Bounlay Phommasack, director for the National Avian and Human Influenza Coordination Office (NAHICO). “The exercise will also help in assessing the effectiveness of the country’s rapid containment strategy, including mobilization of in-country resources and medicine stockpiles.” Although no medicine was transported during the exercise, a regional ASEAN stockpile of antivirals has been established in Singapore with support from the Government of Japan.
WHO has been one of the lead agencies in consultations with various international organizations in pandemic preparedness. The PanStop II in Lao PDR is a part of a series of exercises WHO is undertaking with regional member states to help develop their capacity while testing operational preparedness in key areas such as planning, coordination, management and communication for Rapid Containment. The first Panstop exercise was based in WHO’s Western Region offices in Manila, the Philippines, earlier this year and involved a mock outbreak in Cambodia.
(Full article at:
Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
Date: 23-25 January 2008
Location: The Dusit Thani, Bangkok, Thailand
The Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control is organized by the National Center for Genetic Engineering and Biotechnology (BIOTEC), the National Science and Technology Development Agency (NSTDA) and many allied organizations in Thailand, aiming to provide a forum that world scientific experts and scientists working in affected areas can share knowledge, experiences and expertise. The forum will provide ample opportunities for knowledge, particularly those learned during the last three years, to find their ways to applications and controls. It will also facilitate international understanding and collaboration, which is obviously essential for handling this global threat. To facilitate this NSTDA will provide a number of travel funds for students and scientists in developing, especially the affected countries. Because of this many of world leading scientists already committed to participate.