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EINet Alert ~ Feb 29, 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 (Guangxi): 41-year-old male succumbs to H5N1 avian influenza infection, country's 19th death
- Egypt (Cairo): Four-year-old girl tests positive for H5N1 avian influenza, county's 44th case
- China (Guangdong): 44-year-old woman sick with H5N1 avian influenza dies, country's 20th fatality
- China (Guizhou): Outbreaks of H5N1 avian influenza in poultry trigger mass culling
- India: FAO praises country's control of H5N1 avian influenza outbreak, warns of possible recurrence
- Indonesia: Economy to share virus samples with the CDC, health minister pens controversial book
- Japan: Officials report country's first cases of Tamiflu-resistant/Relenza-sensitive influenza virus
- Pakistan: Officials report two new outbreaks in the Karachi area
- Viet Nam (Phu Tho): 23-year-old woman is country's 51st death due to H5N1 avian influenza
- AVIAN PANDEMIC INFLUENZA
- MIT explains spread of 1918 flu pandemic
- Pandemic influenza, reopening schools, and returning to work [commentary]
- Resource allocation during an influenza pandemic
- Highly pathogenic avian influenza virus (H5N1) in domestic poultry and relationship with migratory birds, South Korea
- Low frequency of infection with avian influenza virus (H5N1) among poultry farmers, Thailand, 2004
- Influenza A H5N1 immigration is filtered out at some international borders
- Broad clade 2 cross-reactive immunity induced by an adjuvanted clade 1 rH5N1 pandemic influenza vaccine
- New Health Risks and Sociocultural Contexts: Bird Flu Impacts on Consumers and Poultry Businesses in Lao PDR
- Use of Vaccination in Avian Influenza Control and Eradication
- A potential treatment for pandemic influenza using siRNAs targeting conserved regions of influenza A
- Emerging Infectious Diseases – Volume 14, Number 3 – March 2008
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- Eleventh Annual Conference on Vaccine Research
- National Institute for Occupational Safety (NIOSH): Protecting Poultry Workers from Avian Influenza (Bird Flu)
- 2008 International Conference on Biocontainment Facilities (in cooperation with the American Biological Safety Association)
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: 369 (234). (WHO 2.28.07 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's maps showing world's areas affected by H5N1 avian influenza (last updated 2.25.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 2.11.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
China (Guangxi): 41-year-old male succumbs to H5N1 avian influenza infection, country's 19th death
The Ministry of Health in China has reported a new case of human infection with the H5N1 avian influenza virus.
The case is a 41-year-old male from Xixiangtang District of Nanning City of Guangxi Autonomous Region. He developed symptoms on 12 Feb 2008 and died on 20 Feb 2008. The case was confirmed by the national laboratory on 21 Feb 2008. According to investigations, the patient bought three live chickens on 4 Feb 2008 from a chicken vending stall. That night, one chicken died of unknown causes (this chicken was thrown in a garbage dump by the patient, unconsumed). After the other two chickens became sick, the patient slaughtered and ate them. Later, the patient developed symptoms of avian influenza infection. All the patient's contacts have been placed under medical observation. All remain healthy to date.
In response to this fatal case of avian influenza, and to protect the health and safety of the masses and preserve social stability, the Nanning Municipal Administration of Industry & Commerce immediately adopted emergency measures and actively undertook avian influenza prevention and control work to guarantee that avian influenza does not extend and does not spread.
Egypt (Cairo): Four-year-old girl tests positive for H5N1 avian influenza, county's 44th case
A four-year-old Egyptian girl tested positive for bird flu on 25 Feb 2008, the 44th confirmed human case in the Arab world's most populous country. Ministry of Health spokesman Abdel Rahman Shaheen said the girl had been treated with the antiviral drug Tamiflu (oseltamivir) and had been transferred from Minya province to a hospital in Cairo. The girl is suffering from a high fever and is having trouble breathing because she has inflammation of one of her lungs. Four Egyptian women died from bird flu in December 2007. Their 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
China (Guangdong): 44-year-old woman sick with H5N1 avian influenza dies, country's 20th fatality
The patient, a woman from Sichuan Province, was a migrant laborer in Haifeng County of Shanwei City. She became ill on 16 Feb2008. On the morning of 22 Feb 2008 she was transferred to Haifeng County Pengpai Memorial Hospital and was diagnosed as a "case of pneumonia of unknown origin" after group consultation by Shanwei City Health Bureau. Investigations found that the patient had a history of contact with diseased, dead birds before the onset of illness.
Those who had close contact with the patient and with diseased, dead birds were placed under strict medical observation. The Guangdong Center for Disease Control ran tests on samples from the patient that were positive for avian influenza (H5N1).
None of the patient's close contacts have since developed similar symptoms. The 44-year-old mother of two was a native of Nanchong City in Sichuan Province. Sources say the deceased and her husband leased a brick factory in Haifeng County five years ago and invited other families to jointly run the enterprise. The seven families raised 35 chickens next to their residences. Half a month ago, chickens raised by the brick factory workers suddenly became ill.
On the evening of 24 Feb 2008 Haifeng County police sealed the brick factory where the deceased had worked, preventing workers inside from leaving. As of 26 Feb 2008, 20 people inside the factory are isolated, the youngest is only one year of age, and the deceased's husband is in isolation at the hospital. Haifeng County's government has held two days of emergency meetings and ordered all poultry within a three km radius of the brick factory culled. Personnel from epidemic prevention agencies arrived at the brick factory on 25 Feb 2008 to conduct disinfection work.
China (Guizhou): Outbreaks of H5N1 avian influenza in poultry trigger mass culling
China has reported four outbreaks of the disease in poultry since December 2007, when average temperatures across the country hit their lowest in decades (bird flu tends to be more active in the cold). 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 the disease. China has struggled to combat the virus with mass inoculations for poultry and an education campaign for those who handle them.
India: FAO praises country's control of H5N1 avian influenza outbreak, warns of possible recurrence
Mohinder Oberoi, an FAO veterinary expert, recently traveled to the affected areas in West Bengal to observe how state and local officials responded to the outbreaks. "Intensive culling in the predominantly backyard poultry sector appears to have stopped the disease in its tracks," he said.
The poultry outbreaks in West Bengal were first reported in mid January in the village of Margram. The virus spread quickly to other villages, striking in 13 of the state's 19 districts. However, no outbreaks were reported in Calcutta, West Bengal's capital. Oberoi said no new outbreaks have been detected in West Bengal since 2 Feb 2008. No human infections were reported, though some individuals, including some veterinary workers, were placed in isolation because of suspicious symptoms.
Key factors that helped curb the West Bengal outbreaks included political and financial commitments from the federal and state governments, public awareness campaigns, a strong chain of command between districts and villages, compensation payments, and collaboration between animal and human health departments, Oberoi said. Joseph Domenech, the FAO's chief veterinary officer, warned that the possibility of new outbreaks is high and urged India to maintain intensive surveillance. "The virus could still be present in the environment, despite heavy slaughtering and extensive disinfection of affected areas, or it could be reintroduced from other countries," he said.
More than 3.9 million chickens and ducks were culled to prevent the spread of the virus, a burden that fell heaviest on mainly poor backyard farmers, the FAO said. It said the socioeconomic impact of the culling should be urgently assessed to help guide efforts to mitigate the negative impact on poor farmers. The outbreaks in India and Bangladesh show that close collaboration is needed among countries in the region, according to the FAO. The agency said it and the World Organization for Animal Health (OIE) have invited the two countries plus Nepal, Bhutan, and Myanmar to a regional meeting to be hosted by Nepal in Kathmandu.
Indonesia: Economy to share virus samples with the CDC, health minister pens controversial book
Cox said Indonesia's health ministry shipped 15 clinical samples to the CDC on Feb 22 2008. She said the samples are from two patients whose infections were confirmed by the WHO on Feb 5 2008 and Feb 12 2008. The two patients were a 27-year-old woman from a Jakarta suburb who died on Feb 2 2008 and a 15-year-old girl from another Jakarta suburb who was hospitalized with an H5N1 infection after her mother died of the disease.
"Based on past experience, the samples should arrive over the weekend or early next week," Cox said. "We expect to obtain results over the next two weeks."
In December 2006, Indonesia, the nation hardest hit by the H5N1 virus, stopped sending samples to WHO collaborating centers to protest pharmaceutical companies' use of the samples to develop vaccines that Indonesia said would be too expensive for developing nations to buy. A WHO group that has been meeting to resolve the virus-sharing issue failed to forge an agreement the last time it met in November. Indonesia has shared only a few samples since the end of 2006. Last May it sent three to the WHO in advance of the World Health Assembly, but WHO officials later said the specimens contained no viable viruses. Indonesia also sent a sample to the CDC lab in August to show that an outbreak of human cases on the island of Bali did not involve a mutated strain. Siti Fadilah Supari, Indonesia's health minister, said that the samples it sent are meant only for risk assessment.
"If they want to develop them into a seed virus they must notify us. If they make them into a vaccine our rights over (the vaccine) will be recognized," she said.
Supari's announcement came at the end of a tumultuous week regarding the country's stance on sharing its H5N1 samples. Earlier this week, media outlets reported that Supari published a book alleging that the United States intended to produce a biological weapon with the H5N1 virus and the WHO was conspiring to profit from H5N1 vaccines. Details about the book, titled Time for the World to Change: God is Behind the Avian Influenza Virus, were given in a 8 Feb 2008 press release from Indonesia's health ministry. However, the release did not list a publisher for the 182-page book.
Officials from the US State Department and WHO denied the claims Supari apparently made in her book and Indonesian President Susilo Bambang Yudhoyono reportedly ordered Supari to recall all copies, though he had authored its introduction. At a meeting with health ministry officials on 20 Feb 2008, Yudhoyono said he supported Supari's demand for fair international virus-sharing policies.
"We certainly need to form a partnership with WHO and friendly nations. We can only proceed if we agree on building and implementing a fair cooperation framework," he said.
Japan: Officials report country's first cases of Tamiflu-resistant/Relenza-sensitive influenza virus
Five patients between 8 and 13 years of age all resided in the same ward. A cluster of three children attended the same elementary school, and two were treated in the same hospital. They had received no Tamiflu treatment prior to testing. All showed positive results for Relenza sensitivity (Relenza is the trade name for the neuraminidase inhibiter zanamivir).
This is the first report of Tamiflu-resistant/Relenza-sensitive influenza virus from Japan. Such viruses have been reported widely throughout Europe and North America during the 2007-2008 influenza season. It is presumed that the resistant virus isolated in Japan is the A/H1N1 serotype, as observed elsewhere in the current influenza season. So far, there has been no obvious explanation for the simultaneous appearance of Tamiflu-resistant influenza virus across the Northern Hemisphere.
Pakistan: Officials report two new outbreaks in the Karachi area
Viet Nam (Phu Tho): 23-year-old woman is country's 51st death due to H5N1 avian influenza
The case is a 23-year-old female from Cam Khe district, Phu Tho province. She developed symptoms on 14 Feb 2008, was hospitalized on 19 Feb 2008, and died on 25 Feb 2008. The case had contact with sick and dead poultry prior to her illness. Of the 105 cases confirmed to date in Viet Nam, 51 have been fatal.
AVIAN PANDEMIC INFLUENZA
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)
MIT explains spread of 1918 flu pandemic
Anne Trafton, February 18, 2008
In this issue of Emerging Infectious Diseases, Victoria Davey and Robert Glass present a paper (Davey VJ, Glass RI. Rescinding community mitigation strategies in an influenza pandemic. Emerg Infect Dis. 2008;14:365–72) in which they consider the question of when to "switch off" community-based interventions designed to reduce the spread of pandemic influenza. These authors attempt to answers questions such as when it would be optimal to reopen schools that have been closed as part of a nonpharmaceutical, community-wide influenza mitigation strategy. The authors use a mathematical model [described in Davey and Glass (2008)] to simulate the spread of pandemic influenza throughout a community that represents the US population…
Are such models useful? Yes, so long as readers accept that the results are illustrative and are not absolutely accurate. The models clearly illustrate the complexities of estimating influenza transmission and the potential success of interventions (i.e., such models require a very large set of variables, many with uncertain values). Perhaps the most useful role of such models is the debate that is stimulated regarding the most appropriate, and most feasible (i.e., most likely to work), set of interventions.
[Full text available at: http://www.cdc.gov/eid/content/14/3/509.htm ]
Planning for pandemic influenza is accepted as an essential health-care service and has included creation of national and international antiviral drug stockpiles and novel approaches to emergency vaccine development. The effectiveness of these strategies in a pandemic may be substantial but is unknown. More certain is that effective management of severe and complicated influenza will reduce deaths and that demand will exceed available treatment resources. Appropriate allocation of treatment resources is therefore essential, perhaps more important than any specific treatment such as administering antiviral medication to symptomatic patients. Resource allocation requires the following: 1) making clear societal decisions on the goals for healthcare resources; 2) conducting operational research to develop an evidence base to support the achievement of these goals; and 3) developing systems to capture and learn from new information in a pandemic to facilitate modification of the response as the characteristics of the pandemic emerge.
[Full text available at: http://www.cdc.gov/eid/content/14/3/520.htm]
Highly pathogenic avian influenza virus (H5N1) in domestic poultry and relationship with migratory birds, South Korea
Low frequency of infection with avian influenza virus (H5N1) among poultry farmers, Thailand, 2004
Influenza A H5N1 immigration is filtered out at some international borders
Methodology and Principal Findings
Broad clade 2 cross-reactive immunity induced by an adjuvanted clade 1 rH5N1 pandemic influenza vaccine
Methods and Findings
New Health Risks and Sociocultural Contexts: Bird Flu Impacts on Consumers and Poultry Businesses in Lao PDR
Use of Vaccination in Avian Influenza Control and Eradication
Emerging Infectious Diseases – Volume 14, Number 3 – March 2008
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:
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.
The remarkable pace of biotechnology discovery is continuing unabated. New cytokines are identified, immune regulatory pathways unraveled, promising adjuvants reported, and investigational products revealed to have high degrees of protection for humans against viral diseases not yet vaccine preventable. The tools of vaccination are also being applied therapeutically for various cancers and chronic conditions. The Annual Conference on Vaccine Research provides high-quality current reports of scientific progress featured in both invited presentations and submitted abstracts. The disparate fields covered in both human and veterinary vaccinology encourage valuable cross-fertilization of ideas and approaches among researchers otherwise focused on specific diseases or methods. The Conference has become the largest scientific meeting devoted exclusively to research on vaccines and associated technologies for disease prevention and treatment through immunization. The Eleventh Annual Conference promises to maintain this tradition as the premier venue for cutting edge topics and issues. International experts will lead seminars and panel discussions on topical areas of basic immunology, product development, clinical testing, regulation, and other aspects of vaccine research. Opportunities for networking and scientific collaboration critical to advancing vaccine science and development will be available through audience discussions, poster presentations, meet the expert breakfast sessions, sponsored exhibits, and evening ceremonies and receptions.
The National Institute for Occupational Safety and Health (NIOSH) requests help in protecting poultry workers from infection with viruses that cause avian influenza (also known as bird flu). Although human infection with avian influenza viruses is rare, workers infected with certain types of these viruses may become ill or die. This site contains information on how to prevent an outbreak and what to do during an outbreak.
Location: Washington, DC Venue: JW Marriott Hotel, Washington DC Dates: 21-22 Apr 2008