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EINet Alert ~ Feb 01, 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)
- Global: Seasonal influenza vaccine may help in fight against H5N1 avian influenza
- Global: Researchers report that engineered antibodies protect mice from H5N1 avian influenza
- Saudi Arabia (Al-Kharj): New outbreak of H5N1 avian influenza leads to mass culling of poultry
- Turkey (Zonguldak): Officials point to wild ducks as cause of H5N1 avian influenza
- Bangladesh: Experts dub deaths amongst crows and ducks "alarming"
- Cambodia: H5N1 avian influenza infection may go undetected in children
- China (Tibet): China confirms new H5N1 avian influenza cases in Tibet
- India (West Bengal): Outbreak of H5N1 avian influenza spreads to over half the state
- Indonesia: New H5N1 avian influenza infections and deaths
- Indonesia: Experts probe high H5N1 avian influenza mortality rate in Indonesia
- Indonesia: Economy launches a new three-year plan to combat H5N1 avian influenza
- Thailand (Phichit): H5N1 avian influenza infection confirmed in Phichit poultry
- AVIAN/PANDEMIC INFLUENZA
- Transmissibility of the Influenza Virus in the 1918 Pandemic
- Emerging Infectious Diseases – Volume 14, Number 2 – January 2008
- Cross-Clade Protective Immune Responses to Influenza Viruses with H5N1 HA and NA Elicited by an Influenza Virus-Like Particle
- Avian influenza: genetic evolution under vaccination pressure
- Emergence of seasonal influenza viruses type A/H1N1 with oseltamivir resistance in some European Countries at the start of the 2007-8 influenza season
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- The FBIIC/FSSCC Pandemic Flu Exercise of 2007: After Action Report
- Highlights from the Bangkok International Conference on Avian Influenza 2008: Integration from Knowledge to Control
- WHO Influenza Virus Tracking System (interim)
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 357 (224). (WHO 1.30.07 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 1.21.08)
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 1.22.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 1.30.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html.
Global: Seasonal influenza vaccine may help in fight against H5N1 avian influenza
Many doctors believe that seasonal flu vaccines offer little or no protection against the H5N1 virus, which experts say may unleash a pandemic that could kill millions of people. But a study by biotechnology firm MedImmune Inc, which produces influenza vaccine, found that ferrets that had been vaccinated against seasonal flu appeared to be more responsive when they were later administered the H5N1 vaccine.
"If you have previously received normal seasonal flu vaccine, you may have better response to the H5N1 vaccine," MedImmune's scientist Hong Jin told a bird flu conference in Bangkok.
In the MedImmune study, a group of ferrets was given seasonal flu vaccine, while a control group of ferrets were given nothing. After 40 days had elapsed, both groups were given H5N1 vaccines designed using seed virus taken from outbreaks of the disease in Hong Kong in 2003 and Viet Nam in 2004. They were then monitored for the production of H5N1 antibodies.
"We found much more response in ferrets that received (seasonal flu) vaccine, before, whereas in control ferrets, you don't see the response," Hong said. Huge volumes of antibody producing cells were seen in the ferrets that had both vaccines on day 45, but there was no antibody response in the control group, MedImmune said.
Global: Researchers report that engineered antibodies protect mice from H5N1 avian influenza
Crucell created the human antibodies by mixing antibody fragments taken from nine blood donors with antigens from two H5N1 strains found in Viet Nam and Indonesia. Mark Throsby, project director for antibody discovery at Crucell, told the conference that in vitro studies showed that one line of the engineered antibodies neutralized several strains of the H5N1 virus, including strains isolated in Hong Kong in 1997, Indonesia in 2005 and Viet Nam in 2003. In the animal studies, he said, researchers injected the engineered antibodies into mice that had been given normally lethal doses of H5N1 virus three days earlier.
"We were able to protect all the animals," Throsby was quoted as saying. "It reduced their disease and they became well again."
Saudi Arabia (Al-Kharj): New outbreak of H5N1 avian influenza leads to mass culling of poultry
The Saudi agriculture ministry ordered a cull of 158,000 chickens on 29 Jan 2008 following the confirmation of a new outbreak of the H5N1 strain of bird flu. The outbreak was detected on a poultry farm in the Al-Kharj region [Riyadh Province], 80 km (50 mi) south of Riyadh, said a ministry statement. Since the latest outbreak of bird flu was discovered on 15 Nov 2007, some four million birds have been culled on at least 15 separate infected farms. There have been no reports of the disease spreading to humans.
Turkey (Zonguldak): Officials point to wild ducks as cause of H5N1 avian influenza
Officials from the Ministry of Agriculture and Rural Affairs stated on 21 Jan 2008 that several dead chickens found in Zonguldak's Saz village during a routine inspection conducted on 19 Jan 2008 tested positive for the bird flu virus. The village was immediately put under quarantine, and teams from the local government started culling poultry in the village. "Some 600 chickens, ducks and turkeys have been culled so far. Members of the family who consumed the wild duck in question are currently receiving medical care. Everything is under control; thus, there is nothing to fear," stated Erkmen.
ProMED moderator MHJ states, "I suspect that the domestic poultry were not given the leftovers from the cooked wild duck but that the feathers, feet and unused raw viscera were tossed out into the yard, from which their domestic chickens acquired the virus, if that were the route. An observant reader will note however that no ducks have been tested. Only dead domestic chickens have been tested and the Ministerial presumption then made that it had all started from this culinary duck. There are no reports of sick or dead wild ducks."
Bangladesh: Experts dub deaths amongst crows and ducks "alarming"
Avian influenza is spreading across Bangladesh. From 25-29 Jan 2008, over 1,000 crows died in Barisal, Patuakhali and Dinajpur districts, with laboratory tests confirming they were infected with the H5N1 virus.
Initial reports suggest the crows had eaten bird flu-infected dead chickens thrown away by farmers. Despite government efforts to burn or buy the dead birds, in many places the carcasses of dead chickens and crows can be seen rotting in the open. Habibur Rahman and ASM Alamgir, leading bird flu experts, now describe the situation as "alarming."
On 27 Jan 2008, bird flu was reported at a poultry farm in Peelkhana in Dhaka, nearly a quarter of whose 12 million people live in overcrowded shanties with minimum health and hygiene facilities. Special assistant to the country's chief adviser Manik Lal Samaddar conceded at a press conference that the government was unable to address the situation alone. He called on poultry farmers to help tackle the problem. Every vehicle at 11 border crossings with neighboring India, which is now battling its own outbreak of the virus, is to be sprayed with anti-viral disinfectant. Spraying is also taking place at other key points. Security forces were closely checking for any illegal poultry and egg imports from India. A 16-member government health team was also working at district level to detect and observe the disease, Samaddar said. In addition, 150 volunteers had been appointed under the Directorate of Livestock to prevent the spread of the disease, while's the UN's Food and Agriculture Organization (FAO) was supporting the government in its effort to bring the disease under control.
Moreover, a bird flu ward had been set up in the National Institute of Diseases of the Chest and Hospital in Dhaka, while a laboratory had been established to diagnose infected persons. "The government is well prepared to face any situation," Alamgir said. "Rapid Response Teams (RRT), with 11 trained members in each team, has been put in place in all 64 districts. Personal protective equipment has been provided to five trained RRT members in each of 471 sub-districts. Enough antiviral drugs have been stored at district hospitals for the use of those who cull sick birds," he said. More than 225,000 volunteers had been trained at more than 4,400 unions (elected local government unit at community level) across Bangladesh. "Volunteers are visiting rural households and educating people to report dead or sick birds, safe disposal of solid poultry waste, safe disposal of dead birds, proper hand washing, and other safe health practices," Alamgir explained. Since August 2007, the government of Bangladesh has been implementing a project — with financial assistance of USD 22.3 million from the World Bank — for training livestock officials on bird flu surveillance.
Cambodia: H5N1 avian influenza infection may go undetected in children
China (Tibet): China confirms new H5N1 avian influenza cases in Tibet
India (West Bengal): Outbreak of H5N1 avian influenza spreads to over half the state
Expert teams were accompanied by police force at many places in culling operations in view of resentment among many villagers fearing loss of livelihood. The culling process has been hindered in most of the affected districts of West Bengal due to incessant rain. However, the district officials have geared up to control the bird flu by distributing Tamiflu drugs among poultry owners. Isolation camps have been set up in the government hospitals for treating the individuals who show clinical symptoms of contracting bird flu.
On 25 Jan 2008, the High Security Animal Disease Laboratory in Bhopal confirmed avian influenza (H5) in samples from Sankrail block of Howrah district and Santuri block of Purulia district.
The virus has now spread to more than half of the state's 19 districts. The 11 districts affected by bird flu are Birbhum, South Dinajpur, Murshidabad, Nadia, Burdwan, Bankura, Malda, Coochbehar, Hooghly, Purulia and Howrah. The samples from Mayureswar-II and Khoyrasole blocks of Birbhum district and Kandi block of Murshidabad district have also tested positive for avian influenza. Official sources in Kolkata said at least 10 lakh [one million] chicken have been culled in the nine affected districts while 1.46 lakh [146,000] eggs have been destroyed as of 24 Jan 2008. At least 901 rapid response teams were deployed today in the state for carrying out culling and surveillance operations.
Indonesia: New H5N1 avian influenza infections and deaths
The first case, a 31-year-old woman from East Jakarta, Jakarta Province, developed symptoms on 18 Jan 2008, was hospitalized on 22 Jan 2008, and is currently in hospital. The investigation indicated that she visited a wet market where live poultry are sold, three days prior to her onset of symptoms.
The second case, a nine-year-old boy from Depok Municipality, West Java, developed symptoms on 16 Jan 2008, was hospitalized on 23 Jan 2008, and died on 27 Jan 2008. Investigations into the source of his infection indicate that the case lived next door to a wet market where live poultry are sold.
The third case, a 32-year-old man from Tangerang Municipality, Banten Province, developed symptoms on 17 Jan 2008, was hospitalized on 24 Jan 2008, and died on 29 Jan 2008. Investigations into the source of his infection are ongoing.
The fourth case, a 23-year-old woman from East Jakarta, Jakarta Province, developed symptoms on 19 Jan 2008, was hospitalized on 24 Jan 2008, and died on 27 Jan 2008. Investigations into the source of her infection are ongoing.
Of the 124 cases confirmed to date in Indonesia, 101 have been fatal.
Indonesia: Experts probe high H5N1 avian influenza mortality rate in Indonesia
"It could be they are treated later, or the virus is different, more virulent. There are many maybes, including differences in susceptibility," Menno de Jong, a doctor who has treated bird flu victims in Viet Nam, said at the bird flu conference in Bangkok.
He said a major concern was the H5N1 variant in Indonesia appeared to be less susceptible to oseltamivir, the antiviral used to combat the disease. "It's not a drug resistant virus, it's just that a bit more drug may be needed to inhibit these (H5N1) clade 2 viruses," he said, referring to the sub-category that Indonesia's H5N1 virus has been classified under. Studies are being conducted in Thailand, Viet Nam and Indonesia to see if H5N1 patients need to be given higher dosages of oseltamivir.
Indonesia: Economy launches a new three-year plan to combat H5N1 avian influenza
Kandun said Indonesia would need to meet with EU and WHO officials on a "routine basis" in order for the plan to work. WHO's Indonesia representative Subhash Salunke said the strategy would focus on preventing new infections, better monitoring of the spread of the virus and continued scientific research. "Prevention of new cases remains an urgent priority, while improving survival [rates] of those infected is another major priority," he said. The prevention campaign would include ramped up efforts to improve hygiene in the country's wet markets and public awareness initiatives. "The persistence of H5N1 in Indonesia has serious (global) consequences for health, economies and food security," Salunke said. "Out of 33 provinces, in 31 provinces this is an endemic virus ... because it is present in such a vast area, the opportunity for virus and human being contact is immense," Salunke said.
Thailand (Phichit): H5N1 avian influenza infection confirmed in Phichit poultry
Meanwhile, Agriculture and Cooperatives Minister Thira Sutabutra said the authorities had mounted regular surveillance operations to prevent H5N1 outbreaks in the country. Hence, there was unlikely to be an impact on poultry consumption at Chinese New Year, he said. Consumers could buy avian flu-free poultry products at outlets guaranteed by the Livestock Department or labeled ''Q-Mark'' by the ministry. Thira added that poultry exports might not feel the pinch from the re-emergence of bird flu because authorities had managed to keep outbreaks under control immediately.
Transmissibility of the Influenza Virus in the 1918 Pandemic
White LF, Pagano M. PLoS ONE. 2008;3(1): e1498.
Emerging Infectious Diseases – Volume 14, Number 2 – January 2008
Cost-effectiveness of Antiviral Stockpiling and Near-Patient Testing for Potential Influenza Pandemic
Cross-Clade Protective Immune Responses to Influenza Viruses with H5N1 HA and NA Elicited by an Influenza Virus-Like Particle
Avian influenza: genetic evolution under vaccination pressure
Emergence of seasonal influenza viruses type A/H1N1 with oseltamivir resistance in some European Countries at the start of the 2007-8 influenza season
APEC EINet Pandemic Influenza Preparedness Virtual Symposium: 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 Viet Nam). 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:
The FBIIC/FSSCC Pandemic Flu Exercise of 2007: After Action Report
Beginning September 24, 2007, more than 2,700 U.S. financial services organizations participated in a three-week exercise simulating a severe global pandemic flu. The scenario for this exercise posed a realistic picture of the possible systemic risks to the sector and its dependencies on other critical infrastructures. Based on the findings of this exercise, it appears that while there will be significant impacts to the financial services sector, the sector overall will continue to operate and cope with these impacts. This free and voluntary exercise provided organizations from the banking, insurance and markets (securities and derivatives) industries, as well as financial utilities, trade associations and regulators, an opportunity to assess their pandemic plans against a rigorous and detailed scenario. The scenario was developed by a team of technical experts from diverse disciplines that few organizations have the ability to tap on their own.
The exercise was designed to use progressive absenteeism rates — reaching as high as 49 percent — to stress the contingency plans of participating organizations. Critical infrastructures that the financial services sector relies on were also stressed during the exercise to simulate likely degradation in available services. Through this approach, the sector was able to gauge how their individual organizations and markets might be expected to cope with different levels of a pandemic.
The Bangkok meeting drew about 500 experts from 40 countries to discuss research and ideas on a wide range of topics. Some other topics discussed included the idea that some human cases of H5N1 avian influenza escape detection due to mild or absent symptoms, stockpiling vaccine adjuvants to prepare for a pandemic, the use of engineered human antibodies as a defense against the H5N1 virus, and the high H5N1 case-fatality rate in Indonesia.
More cases of mild disease might suggest that the virus is improving its ability to spread among humans, while becoming less virulent. Based on the current global count of 353 cases with 221 deaths, the case-fatality rate is almost 63 percent. The Cambodian researchers, led by Sirenda Vong of the Pasteur Institute of Cambodia in Phnom Penh, conducted their study in early 2006. The researchers asked villagers about their exposure to poultry and tested their blood for antibodies to H5N1. The median age of the seven people who had antibodies was 12 years, compared with 27 years for those who had no antibodies. Vong and colleagues had conducted a similar study of 351 Cambodian villagers in 2005 and found that none had antibodies to the virus. The study was published in Emerging Infectious Diseases in 2006.
Malik Peiris, a microbiology professor at the University of Hong Kong, said, "Most of the children diagnosed in Hong Kong in 1997 had a very mild course of infection; they basically had a mild flu-like illness and they recovered… I don't think there is any evidence to say the situation has changed."
Stockpiling of adjuvants
Albert Osterhaus, a virologist at Erasmus Medical Center in the Netherlands who spoke at the conference on Jan 23 2008, said stockpiling adjuvants would be useful if the pandemic strain turned out to be a subtype other than H5N1. "There's a lot of discussion to vaccinate people against H5N1 with adjuvanted vaccines," Osterhaus said. "We might do that, but it's very expensive and it might well be that the pandemic outbreak may not be caused by H5N1 but by H7, H9 or H2 [viruses]." Osterhaus said adjuvants should be stockpiled separately from antigens. "Adjuvants can be stockpiled and H5 antigen as well," he said. "So if the pandemic is going to be H5N1, you just mix them and you get a vaccine. If not, you rapidly produce the antigen and add it together with the adjuvant."
Currently, the United States has no licensed influenza vaccines that contain adjuvants. However, a few studies of influenza vaccines with alum-based adjuvants have shown acceptable protection levels. In August 2007, researchers working on a GlaxoSmithKline vaccine reported positive results for a split-virus vaccine combined with a proprietary oil-and-water adjuvant. A month later, Sanofi Pasteur reported promising results for its inactivated vaccine paired with its own adjuvant.
Using engineered antibodies
Drug resistance in Indonesia?
WHO is developing an electronic system to track influenza A (H5) viruses that have been shared by Member States with WHO through the Global Influenza Surveillance Network (GISN). The tracking system, currently available in an interim version, indicates which H5N1 viruses/specimens have been shared with WHO, where they are located, analyses that have subsequently been conducted, further development into H5N1 vaccine viruses and recipients of the vaccine viruses and other viruses. Improvement of the interim system is ongoing and it is anticipated that this system will be upgraded in the future. The interim system contains data for the majority of viruses and clinical specimens that have been shared with WHO from 24 November 2007 onwards, as well as all H5N1 viruses that have been developed into vaccine viruses.
Data entry of the remaining viruses and clinical specimens (from 24 November 2007 onwards) is ongoing.
Currently the data entry is conducted by WHO Collaborating Centers, WHO H5 Reference Laboratories, and regulatory laboratories which are involved in the WHO H5N1 vaccine virus selection and development process.