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EINet Alert ~ Feb 16, 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: CDC says influenza B strain doesn't match vaccine
- Ukraine (Crimea): Economy sees second outbreak of 2008
- Hong Kong: H5N1 avian influenza found in market & amusement park
- India (New Delhi): Government accepts US help in combating H5N1 avian influenza outbreak
- Indonesia (Jakarta): 15-year-old girl hospitalized with H5N1 avian influenza infection
- Laos (Luang Namtha): H5N1 avian influenza resurfaces in poultry
- Viet Nam: Officials report two new H5N1 avian influenza cases, one fatal
- Canada (Alberta): Study recommends monitoring pig farm workers for swine influenza
- USA: Report urges USDA to tighten oversight of pandemic planning
- USA: USDA increases spending to protect food, cuts avian influenza budget
- Global: The BioChek Avian Influenza Antibody diagnostic kit gets OIE recommendation
- AVIAN PANDEMIC INFLUENZA
- Experimental Infection and Natural Contact Exposure of Dogs with Avian Influenza Virus (H5N1)
- H5N1 avian influenza re-emergence of Lake Qinghai: phylogenetic and antigenic analyses of the newly isolated viruses and roles of migratory birds in virus circulation
- Novel Approach to the Development of Effective H5N1 Influenza A Virus Vaccines: Use of M2 Cytoplasmic Tail Mutants
- Vaccination of Macaques with Adjuvanted Formalin-Inactivated Influenza A Virus (H5N1) Vaccines: Protection against H5N1 Challenge without Disease Enhancement
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- Promising Practices for Pandemic Planning: CIDRAP toolkit promotes preparedness for non-profit, faith-based groups
- iJet announces publication of its 2007 Year in Review: Avian Influenza and Pandemic Planning
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: 360 (226).
Avian influenza age distribution data from WHO/WPRO:
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 2.7.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 1.30.07):
Global: CDC says influenza B strain doesn't match vaccine
Joe Bresee, MD, chief of epidemiology and prevention in the CDC's Influenza Division, told reporters that 93 percent of the circulating influenza B viruses analyzed so far belong to the Yamagata lineage, which doesn't match the influenza B component of this year's vaccine. The B component is a B/Malaysia/2506/2004-like virus, which belongs to the Victoria lineage. Because the Yamagata and Victoria lineages are distinct, the vaccine provides little cross-protection for influenza B, he said.
The news of the mismatch between the influenza B strains closely follows recent indications that a circulating influenza A/H3N2 subtype, A/Brisbane/10/2007-like, doesn't match the vaccine. However, the CDC said the Brisbane strain is a recent antigenic variant of the A/Wisconsin/67/2005-like virus, a component of this year's flu vaccine. Consequently, CDC director Julie Gerberding said this year's vaccine should provide some cross-protection against the Brisbane strain. "Even when there is less than an ideal match, there is still some cross-protection," Bresee said. "This is especially true for high-risk populations. Getting a flu vaccine may reduce the risk of death or hospitalization from the disease."
Bresee said it's difficult for global health officials to predict what strains will be prevalent in the next influenza season, because the selection must allow enough time for vaccine production. At the upcoming World Health Organization (WHO) meeting, officials will advise what three components should be included in the northern hemisphere's 2008-09 seasonal flu vaccine. Despite the difficulties, he said the seasonal flu vaccine has been well matched to the circulating strains in 16 of the last 19 seasons.
The news about the influenza B mismatch is the latest in a string of unusual findings about circulating flu viruses. In late January 2008, the European Centre for Disease Prevention and Control sounded a warning that some H1N1 influenza viruses in Europe were showing signs of oseltamivir (Tamiflu) resistance. On 7 Feb 2008 the WHO reported that resistance has been found in 14 countries, 10 of them in Europe. According to a WHO table updated on 7 Feb 2008, 8.4 percent (15 of 179) of the H1N1 viruses analyzed in the United States so far had the resistance mutation, and 6.3 percent (8 of 128) Canadian isolates showed signs of oseltamivir resistance. Bresee said the CDC is watching the oseltamivir-resistant viruses very closely and that investigators still don't know what caused the mutation.
Ukraine (Crimea): Economy sees second outbreak of 2008
The highly pathogenic virus of bird flu has been found again in Crimea. Two hens and a rooster were found dead in a private yard in the village Kirovskoe of the Chernmorskoe region. Specimens, taken from dead birds and from additional two hens and two ducks, have reacted positive for DNA of influenza A, serotype H5 on 6 Feb 2008. Additional samples have been sent to the State Research Institute for Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kiev (national laboratory), for reconfirmation.
In the previous outbreak, the bird-flu virus was found on 18 Jan 2008 in a bird farm of the village Rovnoe, Krasnogvargeyskoe region, Crimea. The virus was eventually confirmed to be H5N1.
Hong Kong: H5N1 avian influenza found in market & amusement park
Authorities are stepping up health measures at Cheung Sha Wan Wholesale Food Market after an oriental magpie robin found there tested positive for the H5 avian flu virus. A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said on 12 Feb 2008 that the bird, a common species in Hong Kong, was found on 8 Feb 2008. "In view of the tentative finding, we will conduct a thorough cleansing and disinfection operation in both the Wholesale Food Market and the Temporary Wholesale Poultry Market in Cheung Sha Wan tomorrow," the spokesman said. "We will also step up inspections and surveillance of the wholesale poultry market." The AFCD will step up farm inspections and phone farmers to remind them to strengthen precautionary measures. Letters will be issued to owners of businesses involving live birds reminding them that proper precautions must be taken. A black-crowned night heron found at Ocean Park also tested positive for H5N1 on 28 Jan 2008.
India (New Delhi): Government accepts US help in combating H5N1 avian influenza outbreak
Animal husbandry secretary Pradeep Kumar confirmed India's plans. He said, "We will write to MEA soon to ask US to provide us with superior tools to carry out culling, containment and disinfection operations. At present, birds are culled by breaking their neck. India wants US to supply fumigation chambers to cull birds." Also, disinfecting areas won't be easy, especially with backyard poultry. "We want improved technological tools to carry out meticulous disinfection of infected districts," Kumar added.
The US is the global leader in funding efforts to combat avian and pandemic influenza. In the recently concluded International Ministerial Conference on Avian and Pandemic Influenza in New Delhi, the US raised its pledge to $629 million for bird flu related operations. US special representative on avian and pandemic influenza John E Lange said, "US is engaged in efforts to prevent the spread of bird flu in poultry and avert the possibility of a human pandemic. We are facing a deadly virus and the world must confront it united — the alternative could be catastrophic."
Indonesia (Jakarta): 15-year-old girl hospitalized with H5N1 avian influenza infection
Laos (Luang Namtha): H5N1 avian influenza resurfaces in poultry
Viet Nam: Officials report two new H5N1 avian influenza cases, one fatal
Meanwhile, samples from a 27-year-old man from Ninh Binh province tested positive for the H5N1 virus. If the man's illness is confirmed by the WHO, he will be listed as Vietnam's 104th case. The man was admitted to a Hanoi hospital on 12 Feb 2008, where he remains in critical condition. The health ministry said he had slaughtered two sick chickens on 31 Jan 2008. The two cases are Vietnam's second and third reported to be infected with the H5N1 virus in 2008.
Canada (Alberta): Study recommends monitoring pig farm workers for swine influenza
A University of Alberta study recommends that workers on pig farms be monitored as part of influenza pandemic preparedness, after a child on a communal farm in Canada was diagnosed with swine flu in 2006.
Though the seven-month-old boy made a full recovery, health researchers were concerned because of evidence that the virus spread to other members of the multi-family community, who, fortunately, all demonstrated mild or no apparent illness. It has been known for a long time that avian and swine strains of flu can spread to humans, with avian strains appearing to be more dangerous than swine strains. Of the 90 people on the farm tested by the University of Alberta and a team of other researchers with provincial and federal health agencies, 54 were tested for positivity to the flu strain, thought to be of swine origin. Besides the baby boy, four of seven other household members and four of 46 other people living on the farm tested positive. The strain of flu was also detected in one of 10 young pigs on the farm. The child apparently had no direct contact with the swine.
"The concern is that swine viral strains could adapt into a form that results in efficient human-to-human transmission," said Dr. Joan L. Robinson, a professor at the University of Alberta in Edmonton, Canada, a pediatrician at the Stollery Children's Hospital, and lead author of the study, which was published recently in the journal Emerging Infectious Diseases. Swine flu in humans is "under-recognized in Canada, but it has the capacity to become a problem," she added. "Early recognition that swine strains are becoming more virulent might expedite both implementation of ideal infection control precautions for symptomatic cases and vaccine development." Rather than workers on livestock farms being responsible for recognizing their own flu symptoms, there should be a public health program in place that leads to specific measures if an unexpected number or level of severity of flu-like illnesses occur in swine workers. No health program targeting swine workers currently exists, Robinson notes.
USA: Report urges USDA to tighten oversight of pandemic planning
The agency has made significant progress on initiatives such as developing an interagency outbreak-response playbook, implementing a bird biosecurity program, and creating scripted risk messages, inspectors determined. But inadequate management controls in some areas — such as lack of testing for new or revised procedures — undermine confidence that the agency is ready to respond to an H5N1 threat to US birds and poultry, the report says. The report faults the agency for inaccurately reporting its progress on two initiatives to the president's Homeland Security Council (HSC), the White House group that authored the federal government's two pandemic planning strategy and implementation plan documents. One initiative involved the Animal and Plant Health Inspection Services' (APHIS's) ability to identify high-risk bird importers and withdraw their federal live-bird import permits. In the other instance, the inspector general found that APHIS erroneously reported the status of its personal protective equipment stockpiles. The inspector general's office also found that the USDA had not followed through on two of the recommendations from its previous audit report, which was issued in June 2006. One was that the agency needed to include live-bird markets and other "off-farm" sites in its response plan, and the other was to establish a procedure for notifying animal owners about impending outbreak risks.
In a response letter from the USDA that accompanied the audit, Cindy Smith, administrator of APHIS, wrote that the agency recognizes that planning and preparedness "is an ongoing continual improvement process." She said the agency agreed with a number of the recommendations in the report. While Smith agreed that testing of procedures is important, she pointed out that recent events, such as a 2007 low-pathogenic avian influenza outbreak in West Virginia, provided useful tests of several of the USDA's response capabilities. She also wrote that several tasks that the auditors recommended for testing, such as communications messaging and distribution of avian flu information to states and local agencies, are tested daily through the USDA's normal operations.
USA: USDA increases spending to protect food, cuts avian influenza budget
The budget proposal says USDA is spending an estimated $51 million on highly pathogenic avian flu and $16 million on low-pathogenic avian flu this year, for a total of $67 million. The plan calls for combining the two efforts in 2009 and providing $60 million for them. Rachel Iadicicco, an APHIS spokeswoman in Riverdale, Md., said the reduced request reflects expected savings from combining the activities and also from the completion of several one-time expenditures this year. The latter included costs for disease modeling, staff recruiting, and purchase of supplies for the National Veterinary Stockpile, she said. "We're working to eliminate duplication of efforts," Iadicicco said. For example, "Instead of testing one bird for low-pathogenic and another for highly pathogenic, we'll test for both" in the same bird, she said. Iadicicco said there are no plans to reduce testing or surveillance for avian flu in poultry and wild birds or to cut back on staff.
Global: The BioChek Avian Influenza Antibody diagnostic kit gets OIE recommendation
AVIAN PANDEMIC INFLUENZA
Experimental Infection and Natural Contact Exposure of Dogs with Avian Influenza Virus (H5N1)
Giese M, et al. Emerg Infect Dis [serial on the Internet]. 2008 Feb
H5N1 avian influenza re-emergence of Lake Qinghai: phylogenetic and antigenic analyses of the newly isolated viruses and roles of migratory birds in virus circulation
In May 2006, another outbreak struck Lake Qinghai and six novel strains were isolated. To elucidate these QH06 viruses, the six isolates were subjected to whole-genome sequencing. Phylogenetic analyses show that QH06 viruses are derived from the lineages of Lake Qinghai, 2005. Five of the six novel isolates are adjacent to the strain A/Cygnus olor/Croatia/1/05, and the last one is related to the strain A/duck/Novosibirsk/02/05, an isolate of the flyway. Antigenic analyses suggest that QH06 and QH05 viruses are similar to each other.
These findings implicate that QH06 viruses of Lake Qinghai may travel back via migratory birds, though not ruling out the possibility of local circulation of viruses of Lake Qinghai.
Novel Approach to the Development of Effective H5N1 Influenza A Virus Vaccines: Use of M2 Cytoplasmic Tail Mutants
Vaccination of Macaques with Adjuvanted Formalin-Inactivated Influenza A Virus (H5N1) Vaccines: Protection against H5N1 Challenge without Disease Enhancement
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 video clip 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:
Promising Practices for Pandemic Planning: CIDRAP toolkit promotes preparedness for non-profit, faith-based groups
[CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools (www.pandemicpractices.org) online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a biweekly series exploring the development of these practices.]
Strong relationships emerged between public health planners and community organizations during an innovative pandemic influenza education campaign in Ramsey County, Minn. Planners developed a toolkit to provide community and faith-based organizations with comprehensive pandemic awareness and training. Although the toolkit addresses basic information, local groups proactively solicited and used its guidance to meet their unique needs, said Emily Brennan, health educator for the Saint Paul–Ramsey County Department of Public Health. The sought-after training sessions held to educate community groups about the toolkit also allowed planners to cultivate a growing desire for organizational emergency preparedness.
"It's a way to get the community involved in the work we do — in the planning, in the disaster response. It's a tool. It's a way to create a relationship," Brennan said.
Evolution of the toolkit
"I wanted to put everything in one place," Brennan said of the toolkit. "It's a resource for them, to get their arms around something that feels overwhelming. It's a way to put parameters around it."
Planners selected information from numerous sources on pandemic influenza and hired a consulting firm to distill the data into user-friendly slideshows and activities. In 2006, a community review board reviewed the toolkit and approved it for a general audience.
Engaging community organizations
Protecting vulnerable populations A pandemic may threaten the core missions of community and faith-based organizations, many of which provide services to some of the most vulnerable community members. Basic education on pandemic preparedness has allowed community organizations to conduct continuity of operations planning, Brennan said. "It's more of a service issue for vulnerable populations. The fact that the women's shelter has started planning will allow them to serve their clients," even during a pandemic, she said.
Building fruitful relationships
"It's an entree into a relationship. They see us as a credible source, and we see them as people we can go to. If we have a question about vulnerable children, we can go to them," she said. Relationships with community organizations are particularly important as the county seeks to include community representatives on a pandemic influenza planning committee this year.
"I now have established, through this toolkit, relationships with participating organizations, and now look to them as a planning resource," Brennan said.
iJet announces publication of its 2007 Year in Review: Avian Influenza and Pandemic Planning
iJET Intelligent Risk Systems, a leading provider of global intelligence and business resiliency services, today announced the publication of 2007 Year in Review: Avian Influenza and Pandemic Planning. Created by iJET's health intelligence team, the report provides analysis of worldwide incidences of the avian flu virus (H5N1) and summarizes global pandemic response and preparedness, delivering a comprehensive point of reference to aid organizations in the development and continuation of effective pandemic planning.