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EINet Alert ~ Jan 18, 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: OIE's resopnse to criticism of Vallat
- Global: OIE chief's downplaying of pandemic risk draws fire
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- UK (Dorset): Fourth dead swan tests positive for H5N1 avian infuenza
- Iran (Mazandaran): Avian influenza resurfaces in domestic birds
- Indonesia (Tangerang): 32-year-old woman succumbs to H5N1 avian influenza infection
- Indonesia (West Java): 16-year-old female dies due to H5N1 avain influenza infection
- India (West Bengal): Initial reports confirm avian influenza in poultry
- Egypt: 15 new suspected human cases of H5N1 avian influenza
- Egypt: Public resists efforts to prevent the spread of avian influenza

2. Updates
- Avian/Pandemic influenza updates

3. Articles
- A vaccine prepared from a non-pathogenic H5N1 avian influenza virus strain confers protective immunity against highly pathogenic avian influenza virus infection in cynomolgus macaques.
- Promising Practices For Pandemic Planning: Health workers in Texas prepare national border for pandemic flu
- Emergency Response Following Suspicion of an Avian Influenza Outbreak
- Prevalence and diversity of avian influenza viruses in environmental reservoirs
- Using physical barriers to reduce the spread of respiratory viruses
- Pandemic Preparedness: The Need for a Public Health — Not a Law Enforcement/National Security — Approach
- New Perspectives in Avian Influenza Diagnosis
- Ecology, Epidemiology and Human Health Implications of Avian Influenza Viruses: Why do We Need to Share Genetic Data?

4. Notifications
- Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
- Proceedings of the EU Network of Excellence EPIZONE Workshop on ‘Avian Influenza in the EU: Legislation, Outbreak Management and Decision Making’
- Promising Practices: Pandemic Preparedness Tools
- APEC EINet Pandemic Influenza Preparedness Videoconference: Partnerships and Continuity Planning for Critical Systems.


1. Influenza News

Global
Global: OIE's resopnse to criticism of Vallat
At an informal meeting with the press on 10 Jan 2008 , the Director General of the OIE, Dr Bernard Vallat presented an overview on current and future activities of the organisation while addressing the need for global animal health strategies to control emerging and re-emerging infectious animal diseases worldwide. In this context, the issue of highly pathogenic avian influenza and the current situation with H5N1 was raised by some of the reporters.

Dr. Vallat said, as he has said in the past, that although the H5N1 virus is extremely virulent, it has shown to be quite stable over the last few years and its epidemiological behavior remained the same from the beginning of the crisis in 2003. He added that this observed stable behaviour of the H5N1 strain of the virus does not allow ruling out the risk of a mutation into a new dangerous form for humans, thus becoming a potential candidate for an avian influenza pandemic. Dr. Vallat also said that while no one can predict when and how a human influenza pandemic will occur, this may not originate from the highly pathogenic avian influenza H5N1 South East Asian strain which is only one of many other influenza virus strains that can eventually be responsible for a pandemic.

“Bird flu will always remain a risk, be it H5N1 or another and for that reason pandemic preparedness as well as permanent control of the pathogen at the animal source are important”, he said.

In line with the organisation’s position and that of its international partners, Dr. Vallat reinforced the need to strengthen the infrastructure capable of early detection and rapid response for any emerging disease at animal level, especially those with a zoonotic potential. He regretted that such capacities were not in place at the very beginning of the H5N1 avian influenza crisis, which delayed the reaction of countries, especially the poorest ones, first hit in South East Asia . He welcomed today’s much better preparedness of countries to detect and control the disease. Dr. Vallat repeated the need to strengthen the governance of veterinary services and to improve the collaboration between disciplines, as well as between private and public sectors.
(OIE 1.16.08)

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Global: OIE chief's downplaying of pandemic risk draws fire
Disease experts and preparedness advocates reacted negatively today to comments by the head of the World Organization for Animal Health (OIE) suggesting that the risk of an influenza pandemic posed by the H5N1 avian flu virus is minimal.

In news reports yesterday, Dr. Bernard Vallat, director-general of the Paris-based OIE, was quoted as saying that the H5N1 virus is "extremely stable," implying that it is unlikely to evolve into a human pandemic strain. In interviews on 11 Jan 2008, experts such as Dr. Kathy Neuzil, MD, chair of the Infectious Diseases Society of America's (IDSA's) Pandemic Influenza Task Force, countered that the virus has been known to mutate many times already and that both science and history suggest it still represents a very real threat.

Accounts from the Associated Press (AP), Agence France-Presse (AFP), and Reuters offered somewhat different versions of Vallat's comments, with the AP making him sound the most reassuring — or complacent.

According to the AP, Vallat said, "The risk (of a pandemic) was over-estimated." Concern a few years ago about a possibly imminent pandemic represented "just nonscientific supposition," he said.

An AFP account focused on Vallat's statements about the stability of the H5N1 virus. "We have never seen a virus which has been so stable for so long," Vallat was quoted as saying. "Compared to other viruses, it is extremely stable, which minimizes the risk of mutation" into a pandemic strain. He also said the virus is endemic in Indonesia, Egypt, and to a lesser extent Nigeria, according to AFP.

"If we could eradicate the virus in those countries, the problem of a pandemic from Asian H5N1 would be resolved," he asserted. But the Reuters report depicted Vallat as more cautious. "We notice that the virus is now extremely stable but there is no base to say that the H5N1 will not mutate," he said. "Bird flu will always remain a risk, be it H5N1 or another."

Despite the somewhat conflicting accounts, the other experts asserted that Vallat was sending the wrong signal. "The main message that should be out there is that the threat is real," said Neuzil, senior clinical advisor with the nonprofit organization PATH in Seattle. She and others pointed to the recent history of pandemics.

"The 1918 pandemic occurred from a mutation of a bird virus, to the best of our knowledge," she said. "The 1957 and 1968 pandemics occurred through viral reassortment, sudden events where human and animal viruses combined genes and came out with a new virus. So a pandemic can occur either way. You can have a very stable virus that reassorts with another virus."

[Full Text: http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/jan1108vallat.html ]
(CIDRAP 1.11.08)

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

2008
Indonesia / 1 (1)
2007
Cambodia / 1 (1)
China / 5 (3)
Egypt / 25 (9)
Indonesia / 42 (36)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 1 (1)
Viet Nam 8 (5)
Total / 86 (58)

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: 350 (217).
(WHO 1.15.07 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 11.11.08)


WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 1.15.08): 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 .

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Europe/Near East
UK (Dorset): Fourth dead swan tests positive for H5N1 avian infuenza
A fourth swan has tested positive for the deadly H5N1 strain of bird flu in Dorset, the Department for Environment, Food and Rural Affairs (Defra) said on 16 Jan 2008. Officials revealed on 9 Jan 2008 that three birds had tested positive for the virus at the Abbotsbury swannery during routine surveillance.

A three km (two mi) control zone and a 10 km (six mi) monitoring area were set up around the swannery to try to stop the strain spreading. Fred Landeg, the government's acting chief veterinary officer, last week warned bird keepers to be vigilant. He said there was a "constant low-level risk" of avian influenza being introduced into the UK.

Government vets plan to test 800 swans. The outbreak poses little risk to humans but staff were being monitored for symptoms and were handed Tamiflu tablets as a precaution. Farmers and bird keepers have been ordered to isolate flocks from wild birds near the swannery. As yet, no disease has been found in domestic birds. Defra said last week that there were no plans to cull wild flocks because it might disperse birds. The latest outbreak came less than a month after restrictions on poultry movement were lifted in Norfolk and Suffolk. The restrictions were imposed after an outbreak of H5N1 on a free-range turkey farm in November 2007. Wild birds are the likely source of infection, but Andre Farrar, of the RSPB (Royal Society for the Protection of Birds), said it was "slightly odd" that the outbreak happened outside a migration period. One possibility was that the virus had been brought to the region some time ago but only recently infected the birds.
(ProMED 1.16.08)

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Iran (Mazandaran): Avian influenza resurfaces in domestic birds
Officials in Iran have confirmed their country's first H5N1 avian influenza outbreak in domestic birds. A report that Iran filed with the World Organization for Animal Health (OIE) says the outbreak occurred in Mazandaran, a northern province that fronts on the Caspian Sea. Authorities destroyed a flock of 475 surviving free-range chickens after 14 chickens died in an outbreak that began Dec 10, the report says. The outbreak was detected through Iran's passive surveillance program for avian flu. Samples from the birds first tested positive in the Iran Veterinary Organization's central laboratory in December, and an OIE reference lab in Padova, Italy, confirmed the findings on 8 Jan 2008. The source of the outbreak is under investigation, the report says. Iran's only previous reported outbreak of H5N1 in birds occurred in February 2006 and killed 153 wild swans in Gilan province, which borders Mazandaran on the west. The country has reported no human cases.
CIDRAP 1.16.08)

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Asia
Indonesia (Tangerang): 32-year-old woman succumbs to H5N1 avian influenza infection
The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 32-year-old female from Tangerang District, Banten Province, developed symptoms on Thu 3 Jan 2008, was hospitalized on Wed 9 Jan 2008, and died on Thu 10 Jan 2008. Investigations indicate the patient had a history of close contact with birds and poultry in the week prior to her onset of symptoms.
(ProMED 1.15.08)

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Indonesia (West Java): 16-year-old female dies due to H5N1 avain influenza infection
A 16-year-old female from West Java Province developed symptoms on 30 Dec 2007, was hospitalized on 4 Jan 2008, and died on 8 Jan 2008. Investigations found a history of chicken deaths in the case's neighborhood in the two weeks preceding her onset of symptoms.
(ProMED 1.11.08 & 1.16.08)

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India (West Bengal): Initial reports confirm avian influenza in poultry
Reports of bird flu among the poultry population in West Bengal's Birbhum district galvanised the top district administration into holding a series of meetings through 14 Jan 2008, even as villagers remained unaware of the causes and feasted on chicken curry to make the best of a huge loss.

"Samples have been tested positive," a government official said. The samples of the dead birds had been sent to High Security Animal Disease Laboratory (HSADL) in Bhopal to find out whether the death of poultry was due to Avian Influenza. With around 15,000 birds estimated to have died since 29 Dec 2007, when the first reports of unusual deaths surfaced here, dead birds lie all over the landscape and no steps were visible to contain the spread of the virus. The organized poultry sector has not been affected so far, since there are no major hatcheries there. The H5NI avian influenza virus has hit the population of free-range birds reared in almost every household in the area of Birbhum district bordering Murshidabad. Villagers, most of them farmers, rear livestock as well as the free-range 'desi' murgi, with their distinctive bright feathers, for sale in the local haat or for their eggs.

An alert has also been sounded in neighbouring Bihar and Assam. "We have asked the West Bengal government to take corrective action in every city and village," Agriculture Minister Sharad Pawar told reporters in Delhi. The minister claimed that there was no major impact on the market.

The Health Ministry asked the state to adopt quarantine measures to prevent transport of people, animals and birds from the bird-flu-hit areas of Birbhum and south Dinajpur. The fallout was felt in neighbouring Bhutan, which banned import of poultry and poultry products from India for an indefinite period. The ban came into effect on 16 Jan 2008. Bangladesh has been identified as the source of the outbreak of bird flu in south Dinajpur, one of the two affected districts in West Bengal, a senior Animal Husbandry official said. The BSF guarding the Indo-Bangla border in the district has been alerted to ensure that no poultry products could enter from Bangladesh, Inspector General of Police (North Bengal) R J S Nalwa said. The administration of Siliguri subdivision of Darjeeling district has decided to immediately stop import of chickens, chicks and eggs to Siliguri from outside and continue checks for sick birds, SDO Smita Pandey said.

Culling operations continue for the second day on 17 Jan 2008 in Bengal. Close to 9,000 birds were culled on 16 Jan 2008 by the Rapid Response Teams in the core districts of Birbhum and Dinajpur. The impact of the bird flu scare has spread far beyond the state capital Kolkata. They have a target of culling 350,000 birds in 10 days. The capital is on guard, with the government doing whatever it can to make sure there is no spread of infection, but Chief Minister Sheila Dikshit has said there is no need to panic. The government claims to be taking all precautionary steps to prevent the virus from entering Delhi and that they are being supported by traders and shopkeepers who suffered severe losses two years back when the bird flu scare hit the capital.
(ProMED 1.15.08 & 1.16.08)

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Africa
Egypt: 15 new suspected human cases of H5N1 avian influenza
Fifteen new suspected cases of the deadly H5N1 strain of the avian flu virus were reported last week in five governorates in Egypt, as government measures to strengthen national pandemic preparedness provoked mixed reactions in Cairo's streets.

According to local media, the latest cases were detected in Qena, Al-Buheira, Al-Gharbia, Al-Minya and Al-Sohag. The patients were admitted to hospital for treatment and surveillance after suffering high temperatures and breathing problems. In response, the government's Supreme National Committee for Combating Bird Flu met last week to discuss the current outbreak and to implement measures to combat the spread of bird flu.

Amr Kandeel, an official in the Ministry of Health's communicable diseases department, told IRIN that the bird flu committee is focusing on five measures to curb the spread of the virus: active surveillance; public awareness campaigns; support of public health teams in hospitals; stockpiling of the flu treatment drug Tamiflu, antiviral medications and vaccination equipment; and the setting up of a telephone hotline to answer public enquiries. In addition, Kandeel said the Ministry of Agriculture had banned the sale of live birds in Cairo's markets. "Poultry sellers who do not abide by the protection measures will face forced closure of their shops," he said.

While empty bird cages in many of Cairo's poultry shops reflect the efficiency of the government crackdown, many in the poultry business said they would ignore the ban as they felt the government was over-reacting. One poultry seller in Old Cairo's Khan El-Khalili market, who refused to reveal his name fearing arrest, said he would continue to sell live chicken covertly. Another poultry seller, was critical of the government's anti-bird flu initiatives.

"I have heard about bird flu, it's famous nowadays," he said. "But there is nothing here; this disease comes from outside the country. I am not scared because our chicken is good and healthy, but the government wants to scare us. Chicken is the cornerstone of our economy; it's cheap and nourishes our families."

Poultry is the main source of food and income for about five million households across Egypt.
(ProMED 1.13.08)

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Egypt: Public resists efforts to prevent the spread of avian influenza
In a dark and muddy alley in the Nile Delta town of Damietta, where Egypt's latest fatal bird flu victim lived, inhabitants fear the authorities more than the virus.

"It was the will of God that she died. The chickens had nothing to do with it," says Husseini Ahmed Amine, 54, a furniture maker who employs a son of the dead woman, who was aged 50. Most of the inhabitants of the Ezbet el-Lahm district pay scant attention to the government's campaign against the H5N1 virus, which, after a summer respite, killed four people, all women, in the space of a week over New Year.

Health Minister Hatem al-Gabali warned in December 2007 against "slackness in the preventive measures taken to fight bird flu, especially as winter approaches." But distrust of the government is widespread. A national campaign to slaughter possibly infected birds is more often than not seen as just another threat from authorities in which people have no faith.

"Listen to me: all these chickens, they don't kill them, they sell them off or eat them," says Hanane Essayyed Farhat, 42, a mother of four selling her poultry a few dozen metres (yards) from the latest victim's home. "The state and businessmen profit from bird flu. It's all just about trying to get people to buy frozen chickens. That way they'll make money off our back," she adds.

The authorities recommend eating factory farmed chicken, whose origins can be traced. Almost two years since H5N1 appeared in Egypt, the north African country has become one of the most affected countries in the world. But despite a government ban on raising poultry on rooftops — an age-old tradition in Egypt — chicken, ducks and geese continue to squawk and quack from cages on most of this district's rooftops, alongside a multitude of pigeon coops. It is a challenge to get people to stop raising and eating poultry in a country where meat is a luxury for most, and birds can be fed cheaply on food leftovers.
(ProMED 1.13.08)

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2. Updates
Avian/Pandemic influenza updates
* Avian/Pandemic influenza updates*

(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)

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3. Articles
A vaccine prepared from a non-pathogenic H5N1 avian influenza virus strain confers protective immunity against highly pathogenic avian influenza virus infection in cynomolgus macaques.
Itoh Y, et al. Vaccine. 2008 Jan 24;26(4):562-72. Epub 2007 Dec 3

In order to prepare for the emergence of pandemic influenza viruses, we have established an influenza virus library that contains non-pathogenic influenza A virus strains with 135 combinations of 15 hemagglutinin and 9 neuraminidase subtypes. In this study, we developed a vaccine against H5N1 highly pathogenic avian influenza (HPAI) virus infection in humans using a virus strain selected from the library. We examined its immunogenic potency using cynomolgus macaques as a primate model. Virus antigen-specific antibodies were elicited by intranasal or subcutaneous administration of inactivated whole virus particle vaccines. After challenge with an H5N1 HPAI virus isolate obtained from a Vietnamese patient, the virus was detected only on the next day following inoculation in the nasal and/or tracheal swabs of vaccinated macaques that were asymptomatic. On the other hand, the viruses were isolated from nasal and tracheal swabs from non-vaccinated macaques until day 5 and day 7 after inoculation of the H5N1 HPAI virus, respectively. Although six non-vaccinated macaques developed a high body temperature, and two of them lost their appetite after HPAI virus infection, they recovered by the end of the 12-day observation period and did not show the severe symptoms that have been reported in human H5N1 virus infection cases. This demonstrates that the vaccine prepared with the non-pathogenic H5N1 virus from our influenza virus library conferred protective immunity against H5N1 HPAI virus infection to macaques.
(CIDRAP 1.12.08)

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Promising Practices For Pandemic Planning: Health workers in Texas prepare national border for pandemic flu

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/jan1408borderpp.html
By Natalie C. Vestin

Planners in Texas are preparing the US/Mexico border for an influenza pandemic by drawing on a unique workforce: bilingual community health workers called promotores. El Paso County agencies use promotores to provide outreach for numerous public health programs in border communities. (El Paso County sits across the Rio Grande from Ciudad Juarez, Mexico.) District training programs are beginning to offer innovative coursework on pandemic influenza to further promotores' roles in protecting their communities. Planners also hope that the use of promotores will surmount several of the economic, political, and linguistic challenges to preparedness in the region.

Serving a unique bilingual region
Seventy-seven percent of El Paso County's residents are Hispanic/Latino, and most residents speak Spanish at home. Conditions are difficult: El Paso is one of the poorest counties in the United States. Approximately 80,000 people live in more than 200 colonias in the county. The Texas Secretary of State's office defines a colonia as "a residential area along the Texas-Mexico border that may lack some of the most basic living necessities, such as potable water and sewer systems, electricity, paved roads, and safe and sanitary housing." Political issues are another barrier to health information access in the colonias. "People who come from Latin American countries are reluctant to seek government services," said Joanne Bates, MPA, MPH, health education instructor for the Emergency Preparedness Program at El Paso City-County Health and Environmental District. Mistrust can be due either to experience with systemic corruption in a country of origin or to fear of reprisal based on residency status in the United States, Bates said. Promotores usually live in the neighborhoods or colonias they serve. "Promotores are a link to the community, a gateway to the community, a link between bureaucracy and the people," said Bates, a certified health education specialist. The district partners with promotores trained by El Paso Community College in El Paso and Texas A&M University in College Station. Most promotores in El Paso are students, and they can usually use their training for continuing education credit. Although many promotores volunteer their time, The Center for Housing and Urban Development at Texas A&M pays its promotores through an AmeriCorps VISTA program. Several promotores from the community college are international students from Latin America with previous training as doctors and nurses, Bates said. Promotores forged relationships with El Paso residents in 2006 when a massive flood forced evacuations and caused home destruction in El Paso and Juarez. "In one area, they said that we were the first people they'd seen come and check on them. They were grateful to know that there are people who care about them," she added.

When preparedness runs up against poverty
The flood underscored the importance of family preparedness, a challenge for a county with 25% of households living in poverty. "How do you teach a family to stockpile bottled water when they're living paycheck to paycheck? You can't stockpile a disaster kit like that," Bates said. The district uses a shopping list that allows families to stockpile specific items over 5 months. Promotores also are establishing relationships with faith-based organizations that may alleviate some of the economic burden of preparedness. El Paso's proximity to the Mexican border adds the 1.7 million residents of Ciudad Juarez to promotores' Spanish-speaking audience in El Paso. "Our community's so unique—there really isn't a border," Bates said, referring to the movement of workers and schoolchildren. "When you talk about [Strategic National Stockpile] planning, we can't discount the population of Juarez. It benefits us to be planning for them." Pandemic preparedness education for El Paso promotores uses a train-the-trainer format. Promotores educate other community members to provide preparedness services and are strengthening peer networks between El Paso and Juarez. Promotores from El Paso recently partnered with Paso del Norte Health Foundation to distribute information on pandemic preparedness to Mexican promotores.

Forming, and informing, promotores
The USA Center for Rural Public Health Preparedness at Texas A&M conducts much of the pandemic-related training for promotores in McAllen, Laredo, and El Paso. Recruitment of promotores began in September 2005, and their training centered on basic infection control tips. The course served as an entree with several groups of promotores in the region. "We find that speaking in Spanish and going to talk to them face-to-face is very helpful. The culture is one where getting to know you is important," said Kay Carpender, assistant director of the USA Center for Rural Public Health Preparedness. In the summer of 2007, the center held courses for promotores on communicating pandemic flu risk to the public. Speakers delivered the trainings in Spanish, but they occasionally used English to familiarize promotores with clinical terms. Facilitators used a workshop format to allow promotores to develop uniquely tailored risk communication messages in groups. Promotores also received a bilingual handbook with bold, colorful pictures to use as a resource in the field. "Emergency preparedness to a promotora is probably not as important as diabetes, tuberculosis, and sanitary conditions," Carpender said. The center has found, however, that promotores embrace the concept of preparedness when staff members listen closely to their training needs. For instance, promotores recently requested training on mental health during an influenza pandemic, because they wanted to bring that information back to their communities, said Annie Graham, project coordinator for the USA Center for Rural Public Health Preparedness. "Promotores really help people get the services they need," Bates added.
(CIDRAP 1.14.08)

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Emergency Response Following Suspicion of an Avian Influenza Outbreak
Pozza M, et al. Zoonoses and Public Health. Volume 55 Issue 1 Page 50-53, February 2008
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1863-2378.2007.01083.x

Abstract
The management of a suspected index case of highly pathogenic avian influenza (AI) is crucial to the subsequent actions aimed at limiting the spread of infection and ultimately in prompt eradication of the virus. In this study, the legislative basis, basic concepts and actions behind a successful disease management program are reviewed. These include actions at local veterinary headquarters and at farm level that must be coordinated centrally to ensure the flow of information essential to decision making. The success of any emergency intervention strategy is dependent upon the level of preparedness, including action plans to source manpower, equipment and on the degree of communication between relevant parties. Availability of information on the successes and failures in field outbreak management, will inevitably result in improved AI control worldwide.
(CIDRAP 1.13.08)

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Prevalence and diversity of avian influenza viruses in environmental reservoirs
Lang AS, Kelly A, et al. J Gen Virol 89 (2008), 509-519; DOI 10.1099/vir.0.83369-0 http://vir.sgmjournals.org/cgi/content/abstract/89/2/509

Abstract
Little is known about the ecology and evolution of avian influenza in the natural environment, despite how these affect the potential for transmission. Most work has focused on characterizing viruses isolated from hosts such as waterfowl, and there have also been several instances of isolation and detection from abiotic sources such as water and ice. We used RT-PCR to amplify and characterize the influenza virus sequences present in sediments of ponds that are used heavily by waterfowl. The detection rate of influenza virus was high (>50 %). Characterization of the viruses present by sequencing part of the haemagglutinin (HA) gene showed that there is a diverse collection of viruses in these sediments. We sequenced 117 partial HA gene clones from 11 samples and detected four different HA subtypes (H3, H8, H11 and H12), with approximately 65 % of clone sequences being unique. This culture-independent approach was also able to detect a virus subtype that was not found by sampling of birds in the same geographical region in the same year. Viruses were detected readily in the winter when the ponds were frozen, indicating that these sediments could be a year-to-year reservoir of viruses to infect birds using the ponds, although we have not shown that these viruses are viable. We demonstrate that this approach is a feasible and valuable way to assess the prevalence and diversity of viruses present in the environment, and can be a valuable complement to more difficult viral culturing in attempting to understand the ecology of influenza viruses.
(CIDRAP 1.15.07)

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Using physical barriers to reduce the spread of respiratory viruses
Dawes M. BMJ 2008;336:55-56 (12 January), doi:10.1136/bmj.39406.511817.BE http://www.bmj.com/cgi/content/extract/336/7635/55

Introduction
Preparing health professionals and the public for a flu pandemic has been the subject of much research worldwide, and governments and public health departments have published various recommendations over the past five years. One aspect of the clinical management of respiratory viruses — namely barrier methods to reduce transmission — is assessed in the accompanying systematic review by Jefferson and colleagues.* This review found that handwashing and wearing masks, gloves and gowns were effective individually in preventing the spread of severe acute respiratory syndrome, and even more effective when combined (odds ratio 0.09, 95 percent confidence interval 0.02 to 0.35, number needed to treat (NNT)=3, 2.66 to 4.97). The incremental effect of adding virucidals or antiseptics to normal handwashing to reduce respiratory disease was uncertain.

Because pandemic flu is such a potentially catastrophic event, governments worldwide should have commissioned such a review many years ago and not have left it to the academic community to take the lead. The academic community needs to educate governments that expert advice is not necessarily the best advice. Guidelines should be based on rigorous systematic reviews and need to be continuously updated.

*Jefferson T, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2008;336:77-80. Full Text:
http://www.bmj.com/cgi/content/full/336/7635/77
(CIDRAP 1.12.08)

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Pandemic Preparedness: The Need for a Public Health — Not a Law Enforcement/National Security — Approach
Prepared for the ACLU by: Annas GJ, et al. January 2008.
http://www.aclu.org/pdfs/privacy/pemic_report.pdf

Summary
The spread of a new, deadly strain of avian influenza has raised fears of a potential human pandemic. While the virus is not easily transmissible to humans, were it to mutate to be more highly contagious to or between humans — a possiblity whose probability is unknown — an influenza pandemic could occur. Government agencies have an essential role to play in helping to prevent and mitigate epidemics. Unfortunately, in recent years, our government’s approach to preparing the nation for a possible influenza pandemic has been highly misguided. Too often, policymakers are resorting to law enforcement and national security-oriented measures that not only suppress individual rights unnecessarily, but have proven to be ineffective in stopping the spread of disease and saving lives. The following report examines the relationship between civil liberties and public health in contemporary U.S. pandemic planning and makes a series of recommendations for developing a more effective, civil liberties-friendly approach.
(CIDRAP 1.15.08)

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New Perspectives in Avian Influenza Diagnosis
Cattoli G, Terregino C. Zoonoses and Public Health. Volume 55 Issue 1 Page 24-28, February 2008
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1863-2378.2007.01085.x

Abstract
Recent outbreaks of avian influenza (AI) occurring in Europe, in the Americas, in Asia and in Africa have provided field evidence of how challenging the control of this infection can be, particularly in densely populated poultry areas or in areas where free-range rural village poultry and backyard flocks are present. In these areas, laboratory testing is mainly applied to trace viral circulation in a given area or in a susceptible population to implement an early warning system, rather than to diagnose the presence of the virus in a diseased flock or animal. This implies the use of rapid, sensitive and possibly cost-effective laboratory tests adaptable to very high throughputs. As a consequence, new diagnostic approaches and technologies have been increasingly developed and applied. Molecular biology and biotechnology are providing important and precious contributions to the field of AI diagnosis, making extremely rapid, specific and sensitive techniques available. However, the use of some of these technologies is still limited, due to their costs and to the requirement of advanced technical and scientific expertise. Therefore, more conventional and well-established techniques, should not be abandoned but rather reconsidered and improved or modified.
(CIDRAP1.13.08)

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Ecology, Epidemiology and Human Health Implications of Avian Influenza Viruses: Why do We Need to Share Genetic Data?
Capua D, Alexander DJ. Zoonoses and Public Health. Volume 55 Issue 1 Page 2-15, February 2008
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1863-2378.2007.01081.x

Abstract
Avian influenza (AI) is a listed disease of the World Organisation for Animal Health (OIE) that has become a disease of great importance both for animal and human health. Until recent times, AI was considered a disease of birds with zoonotic implications of limited significance. The emergence and spread of the Asian lineage highly pathogenic AI H5N1 virus has dramatically changed this perspective; not only has it been responsible of the death or culling of millions of birds, but this virus has also been able to infect a variety of non-avian hosts including human beings. The implications of such a panzootic reflect themselves in animal health issues, notably in the reduction of a protein source for developing countries and in the management of the pandemic potential. Retrospective studies have shown that avian progenitors play an important role in the generation of pandemic viruses for humans, and therefore these infections in the avian reservoir should be subjected to control measures aiming at eradication of the Asian H5N1 virus from all sectors rather than just eliminating or reducing the impact of the disease in poultry. Collection and analysis of information in a transparent environment and close collaboration between the medical and veterinary scientific community are crucial to support the global AI crisis.
(CIDRAP 1.13.08)

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4. Notifications
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 the students and scientists in developing, especially the affected countries, Thailand. Because of this many of world leading scientists already committed to participate, as you can find in the details of this announcement. On behalf of the Scientific and Organizing Committees, it is our pleasure to invite you to participate in this meeting, which will certainly be fruitful to your important roles in our defense against this frightening disease.

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Proceedings of the EU Network of Excellence EPIZONE Workshop on ‘Avian Influenza in the EU: Legislation, Outbreak Management and Decision Making’
http://www.blackwell-synergy.com/toc/jvb/55/1
By Ilaria Capua

The workshop ‘Avian Influenza in the EU: Legislation, Outbreak Management and Decision Making’ was held at the Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy 3-5 June 2007. It was undertaken as part of the activities foreseen in the framework of the Network of Excellence for Epizootic Disease Diagnosis and Control (EPIZONE). This network, funded by the European Commission began in June 2006 and will last for five years, comprises 18 institutes from 12 countries in addition to the United Nations Food and Agricultural Organization (FAO). The primary goal of EPIZONE is to improve research on preparedness, prevention, detection and control of epizootic diseases, including Avian influenza (AI), by the improvement of excellence through integration and collaboration while taking into account the public health concerns of consumers and other stakeholders. The course aimed at providing participants with updated information on AI outbreak management, contingency planning, application of EU policy related to the importation of poultry into Europe and novel methods for the diagnosis of AI.
(CIDRAP 1.13.08)

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Promising Practices: Pandemic Preparedness Tools
http://www.pandemicpractices.org/practices/article.do?page=home

This project aims to enhance public health preparedness for an influenza pandemic and conserve resources by sharing promising practices. CIDRAP and the Pew Center on the States (PCS) launched this initiative to collect and peer-review practices that can be adapted or adopted by public health stakeholders. The project was conceived and funded by The Pew Charitable Trusts. This collection of more than 130 practices represents a year-long effort. Our Advisory Committee, composed of state and local public health experts in pandemic influenza preparedness nationwide, selected the categories and topics. Pandemic planners and others submitted materials, chiefly via surveys. The practices in this project come from 22 US states and 33 counties. If your agency is not included you can still submit practices. Practices are chosen through a peer-review process. More than 25 US experts reviewed the materials (on the Web site). Portions of reviewers' comments have been incorporated into a project description to provide greater context for each practice.

An interactive map allows the user to search for practices by state.
(CIDRAP 1.15.08)

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APEC EINet Pandemic Influenza Preparedness Videoconference: Partnerships and Continuity Planning for Critical Systems.
APEC EINet is pleased to host a special videoconference on pandemic influenza preparedness. This videoconference is a follow-up to our first “virtual symposium”, which was conducted in January 2006 with great success (participating economies were Australia, Canada, China, Korea, Philippines, Singapore, Chinese Taipei, Thailand, USA and Vietnam). You can view a five-minute videoclip of our previous virtual symposium at: http://depts.washington.edu/einet/symposium.html.

Our upcoming videoconference will be held in late May 2008. It will take place during the evening hours of 29 May in the Americas and in the morning hours of 30 May in Asia, for approximately 3.5 hours. Our objective is to describe how private and public sectors in the APEC region can cooperate and work effectively to prepare for and respond to an influenza pandemic.

Through this videoconference, we hope to promote regional information sharing and collaboration to enhance pandemic preparedness. In order to improve preparedness regionally, it is vital to understand how each economy in the region is undertaking this task. In this process, EINet will:

  1. Bring together economies in a dynamic, real-time discussion on preparedness through the collaboration of the health and the business/trade sectors, with a focus on critical systems continuity.
  2. Share specific examples of current practices — e.g. scenario exercises, communication drills and policy evaluation.
  3. Use innovative technologies (e.g. Access Grid) for real-time, virtual interchange, enhancing their utility for future collaboration and response in the event of a pandemic.
Videoconferencing offers an alternative to in-person conferencing. It cuts down on the time and cost of traditional conferences requiring long-distance travel. Simultaneous communication with multiple sites is possible, with numerous visualization options. Real-time Web-based information exchange is also possible, and, during an actual pandemic, the virtual medium would be a safe way to communicate when international travel is limited or prohibited.

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 apecein@u.washington.edu