EINet Alert ~ Mar 14, 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: Numerous outbreaks of H5N1 point to a complicated epidemic control situation
- Hong Kong: Oriental magpie robin tests positive for H5N1 avian influenza
- India (West Bengal): H5N1 avian influenza resurfaces
- Laos (Luang Namtha): Total ban on poultry sales following four outbreaks of H5N1 avian influenza
- Viet Nam: Incomplete vaccination poses high risk of transmission in poultry flocks
- Viet Nam: Palm civets in Cuc Phong national park die from H5N1 avian influenza
- Viet Nam (Hanoi): Farm culls thousands of poultry after H5N1 avian influenza outbreak
- USA: Hectic season exposes gaps in seasonal influenza preparedness
- Egypt (Fayum): Eight-year-old boy with H5N1 avian influenza infection in stable condition
- Egypt: H5N1 avian influenza shocks the poultry market
- USA (California): Outbreak of seasonal influenza shuts down prison
- Bangladesh: Despite massive culling, H5N1 avian influenza spreads to another district
- Hong Kong: Officials close schools due to seasonal influenza

2. Updates

3. Articles
- Federal Guidance to Assist States in Improving State-Level Pandemic Influenza Operating Plans
- Modeling targeted layered containment of an influenza pandemic in the United States
- Avian influenza A (H5N1) infection in a patient in China, 2006
- Protective efficacy of several vaccines against highly pathogenic H5N1 avian influenza virus under experimental conditions
- Avian influenza knowledge among medical students, Iran [letter]
- Determination of oseltamivir quality by colorimetric and liquid chromatographic methods
- Cross-neutralisation of antibodies elicited by an inactivated split-virion influenza A/Vietnam/1194/2004 (H5N1) vaccine in healthy adults against H5N1 clade 2 strains

4. Notifications
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- 13th International Congress on Infectious Diseases (ICID)
- Questions and Answers with William Raub

1. Influenza News

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

China / 3 (3)
Egypt / 4 (1)
Indonesia / 12 (10)
Viet Nam / 4 (4)
Total / 22 (18)

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)

Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 56 (46)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 116 (80)

Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

Viet Nam / 3 (3)
Total / 3 (3)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 372(235).
(WHO 3.11.07 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 3.5.08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 3.11.08): http://gamapserver.who.int/mapLibrary/

WHO’s timeline of important H5N1-related events (last updated 3.11.07): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html


China: Numerous outbreaks of H5N1 point to a complicated epidemic control situation
The Ministry of Agriculture said on 10 Mar 2008 it has received the reports of 12 bird flu cases in 2008, warning of a more "complicated" epidemic control situation.

Of the 12 cases three have been confirmed—two in Tibet Autonomous Region and one in Guizhou Province. He said three factors shall be blamed for the outbreak of bird flu cases: 1) south China was hit by unprecedented snowstorm and cold snap from the beginning of 2008, which made bird flu virus active; 2) snowstorms and cold snaps affected regular immunization work, as it was conducted usually in February and March; and 3) snow and ice disasters harmed the living conditions of livestock, bringing risks of epidemic spread.

The official said currently relevant government departments across the country are actively launching spring epidemic control and immunization work. The ministry has prepared five billion milliliters of vaccine for immunization efforts. Epidemic surveillance has also been strengthened.
(ProMED 3.11.08)


Hong Kong: Oriental magpie robin tests positive for H5N1 avian influenza
An oriental magpie robin found dead earlier in Hong Kong has tested positive for the H5N1 strain of the bird flu virus, the Agriculture, Fisheries and Conservation Department of Hong Kong Special Administrative Region said 7 Mar 2008.

The dead bird was collected on 29 Feb 2008 near a management center in Tai Po Kau Nature Reserve.

Hong Kong has reported nine cases of bird infections of the H5N1 virus since November 2007. Authorities in Hong Kong have been on alert against the virus, with contingency plans and education programs aimed at informing the public about bird flu. More than 300 people from government departments, the Hong Kong International Airport and airline held an exercise in Hong Kong on 7 Mar 2008, simulating a suspected case of H5N1 avian influenza on a plane at the Hong Kong International Airport.
(ProMED 3.8.08)


India (West Bengal): H5N1 avian influenza resurfaces
Smuggling of poultry for trade, from bird-flu free districts of West Bengal into the affected districts, may have caused the highly pathogenic H5N1 virus to resurface in West Bengal.

According to the avian influenza control and containment protocol, no "repopulation" of poultry is allowed in an infected district at least three months from the time culling teams complete disinfection operations. However, reports officially sent to the center almost two weeks ago by teams traveling across West Bengal had clearly documented how poultry was being sold in local villages of Birbhum and Murshidabad, which were the first two districts to be infected by the virus in January 2008.

The reports were then forwarded to state government officials, who were asked to immediately curb such practices until the virus was completely destroyed. But on 7 Mar 2008, the Center's worst fears were confirmed—the virus had returned to haunt West Bengal. Animal husbandry secretary Pradeep Kumar said, "Central teams had confirmed incidents of villagers selling poultry within infected districts even when repopulation of poultry within three months from completion of containment and cleaning up operations is strictly prohibited."

The virus has reappeared in Raghunathganj-II and Jiaganj blocks of Murshidabad. Kumar confirmed, "two samples from these blocks sent to HSADL [High Security Animal Disease Laboratory], Bhopal, on 6 Mar 2008, tested positive.

Animal Husbandry Commissioner Dr. S K Bandhopadhyay said, "We don't know whether this is a fresh outbreak or whether the virus was being carried there all along by ducks. However, surveillance teams had informed the state government that repopulation and trade was occurring in districts like Birbhum, Murshidabad, and Burdwan."

Meanwhile, the state government started fresh culling operations in a radius of 5 km (3 mi) around the two new areas of infection. While 22,440 birds are to be culled in Raghunathganj-II, the culling target in Jiaganj is 27,000. Twenty rapid response teams (RRTs) have been deployed in each of the two blocks. Since the outbreak of bird flu in Bengal was detected on 15 Jan 2008, over four million birds have been culled and 1.4 million eggs destroyed.
(ProMED 3.11.08)


Laos (Luang Namtha): Total ban on poultry sales following four outbreaks of H5N1 avian influenza
The Luang Namtha provincial governor has announced a total ban on the sale of poultry in the province, as well as prohibiting the purchase of poultry from neighboring countries for the next 30-45 days, following four separate outbreaks of bird flu.

"If the provincial authorities do not detect the H5N1 virus during this period they will lift the ban," the deputy head of the provincial Livestock and Fisheries Office, Ms Bouathong Inthongsay, said.

She said that each section of the provincial Committee for Bird Flu Control had allocated staff to monitor the situation and take extra precautions in outbreak areas. They would set up checkpoints between villages to make sure there was no trade or movement of poultry either within the province or with other provinces.

Following the outbreaks in three districts, the neighboring provinces of Oudomxay, Phongsaly, and Bokeo are now vulnerable to infection. Luang Namtha's highest risk district is considered to be Viengphoukha, as this surrounds the only road leading from the outbreak areas to the provincial capital and other provinces, she said. The committee has organized staff to disinfect all vehicles using this road.

No humans have yet to contract the virus because most local residents understand the dangers and have cooperated with the authorities, said a departmental official, Aae Mithda. He said that two people had reported flu-like symptoms in Namlue village, the site of the fourth outbreak. They were undergoing tests but the results were not yet known.
(ProMED 3.11.08)


Viet Nam: Incomplete vaccination poses high risk of transmission in poultry flocks
Viet Nam is now facing high risks of bird flu spreading nationwide because of low immunity rate on poultry and the absence of followed-up vaccination on poultry, an official from the Ministry of Agriculture and Rural Development said.

Bui Ba Bong, deputy minister of agriculture and rural development, said that the rate of immunity on poultry was low as the vaccination program had not been refreshed after a long time, which will make bird flu epidemic spread widely. "Aside from that, the poor quality of propaganda against the epidemic at grassroots level will make it difficult to contain bird-flu outbreaks nationwide," he added.

Nguyen Huy Nga, head of the Preventive Medicine Department under the Ministry of Health, said that bird flu would become complicated due to uncontrolled transportation of poultry across border gates. Since the beginning of 2008, market monitors have reported booming illicit trade in poultry across the border. Market watchdogs under the Ministry of Industry and Trade said they had confiscated and destroyed more than 7,000 fowl of unclear origins within the past two months.
(ProMED 3.14.08)


Viet Nam: Palm civets in Cuc Phong national park die from H5N1 avian influenza
Five Owston's palm civets are reported dead because of bird flu in the Cuc Phuong National Park.

From 2 Feb to 2 Mar 2008, five Owston's palm civets (Chrotogale owstoni), two common palm civets, five peewit hoopie birds, two langurs, and one loris have died. Independent tests performed by the HCM (Ho Chi Minh) City Tropical Hospital and the Central Veterinary Diagnosis Centre show that the five Owston's palm civets died because of H5N1 virus, said Nguyen Van Cam, director of the Central Veterinary Diagnosis Centre.

The park's animal preservation area currently has eight Owston's palm civets and a black civet. Cam said wild birds and mice could enter the cages of these civets and transmitted H5N1 virus to them. The sources of food for civet are worms, fresh beef, and poultry meat bought from outside which could also bear the virus.

In June-July 2005, at least three Owston's palm civets in the Cuc Phuong national park were reported dead because of H5N1. At that time, the case was considered mysterious because the dead civets lived in the same cage with 20 other healthy civets. Moreover, they ate pork, worms, and fruits, not chicken.
(ProMED 3.12.08)


Viet Nam (Hanoi): Farm culls thousands of poultry after H5N1 avian influenza outbreak
Some 3,700 birds were culled at a poultry farm in Soc Son District after a bird flu outbreak infected much of the farm's livestock, the Hanoi Animal Health Department reported on 6 Mar 2008.

The northern province of Tuyen Quang also reported an outbreak in Son Duong District. Northern Viet Nam is seeing a massive spread of bird flu epidemic as eight out of the 12 areas hit by the epidemic nationwide are in the north, including Hai Duong, Quang Ninh, Ninh Binh, Phu Tho, Nam Dinh, Ha Nam, Tuyen Quang and Hanoi.

Central provinces include Quang Nam and Quang Binh. The southern provinces of Tra Vinh and Vinh Long are also hit. The southern animal health departments are strengthening control over slaughtering and trading of poultry. They also require farmers to have their poultry vaccinated.
(ProMED 3.8.08)


USA: Hectic season exposes gaps in seasonal influenza preparedness
The announcement by the Centers for Disease Control and Prevention (CDC) that influenza appears to be slowing down has left medical personnel relieved for the imminent end of a harsh flu season. But it has also left them worried over weaknesses that the season exposed in public health's ability to anticipate flu's behavior, and over doubts raised among their patients by the flu vaccine's diminished effectiveness. Many are concerned as well for what the bad season demonstrates about the healthcare system's lack of surge capacity, and for the lack of nimbleness in the vaccine-production system that forced distribution of a suboptimal vaccine.

The CDC has not floated any adjectives to describe the 2007-2008 flu season, though the agency said on 7 Mar 2008 that 47 out of 51 jurisdictions (the states plus Washington, DC) are experiencing "widespread" flu—two fewer than the week before. But to the dozen family and emergency physicians who spoke to CIDRAP last week, "widespread" does not begin to capture their flu season experience. "Severe" and "slammed" are more like it. "In four weeks, we went from a ho-hum flu season to ridiculous overcrowding," said Dr. Maurice Ramirez, an emergency physician who works in several institutions in north Florida. "We have had so many people that we have them, not in beds in the hallway, but in chairs with a number taped to the wall over their heads." The doctors experiencing the influx of flu patients all said they were impressed by how sick patients have been, recounting very high fevers, frequent pneumonias, and uncommon symptoms such as stridor, a high, whistling breath sound that indicates a partially obstructed airway and is an emergency in children.

Troublingly, many of the flu patients coming to the healthcare system received flu shots. Their illnesses represent a mismatch between the strains that were chosen for the vaccine a year ago and the strains that actually caused illness this season, a development the CDC acknowledged in early February 2008. The mismatch has been significant: CDC has said that the rates of match between the current flu vaccine and flu isolates analyzed so far this winter were 77 percent, 14 percent, and 7 percent for the three flu strains.

In the meantime, however, clinicians are concerned about the impression that the vaccine mismatch and the resulting flu cases will leave. Several times over the past decade, flu-vaccine problems—manufacturing problems, late vaccine delivery, an early-arriving season—have dented flu-vaccine uptake the following year. "We will need to really clearly and plainly explain that each year, the experts make their best educated guess . . . and some years are spot-on and some years are a mismatch," said Dr. David Kimberlin, professor of pediatrics at the University of Alabama at Birmingham. "The burden is on the medical community to say that, if we do not have a complete match, you are still getting some protection, and it is better to have partial protection than none."

Some say the 2007-2008 flu season has more lessons to teach. In Florida, emergency physician Ramirez—also a disaster-readiness consultant—ticked off the components: a significant flu-virus drift, a vaccine-manufacturing system that could not keep up, seriously ill patients, and an overwhelmed healthcare system. "These are exactly the things we ought to be prepared for in an influenza pandemic, and we were not prepared," he said. "We ought to consider this flu season as a warning to healthcare and industry. This is a gunshot across our bow."
(CIDRAP 3.10.08)


Egypt (Fayum): Eight-year-old boy with H5N1 avian influenza infection in stable condition
The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A(H5N1) virus infection. The case is an 8-year-old boy from Etsa District, Fayum Governorate. He was admitted to hospital with symptoms on 3 Mar 2008. He is receiving treatment and is in a stable condition. Investigations into the source of his infection indicate a history of contact with sick and dead poultry. Of the 47 cases confirmed to date in Egypt, 20 have been fatal.
(ProMED 3.13.08)


Egypt: H5N1 avian influenza shocks the poultry market
After the first outbreak of HPAI H5N1 in Egypt in Feb 2006, the government adopted several mechanisms to limit the spread and control the disease as well as the risk of human infections. In the control process, an estimated 30 million birds were culled and, more recently, there has been widespread free vaccination of private sector commercial flocks and backyard poultry. The rapid spread of the disease in Egypt has been related to the development of poultry product supply chains that move millions of birds per day with low levels of biosecurity. More recent outbreaks would appear to be related to the mixture of ducks and chickens in the rooftop and backyard systems and their close proximity to industrial poultry units. Ducks play a critical role in the maintenance of HPAI H5N1, and current strengthening of surveillance systems and epidemiological analysis should allow the development of improved containment strategies.

The importance of poultry within Egyptian households is unique. Addressing the impacts avian influenza has had on these households, in particular the poor and vulnerable families, with actions to support the affected households is a challenge not just for poultry health specialists and development specialists but also for national and local government institutions that need to assess these actions in light of efforts to reach the Millennium Development Goals. Significant market shocks to commercial and backyard poultry operations in Egypt have followed the same sequential pattern in other countries dealing with HPAI: during and immediately after an outbreak, demand falters, prices drop, supplies decline as producers reduce output (birds are culled, mortality rates increase, or producers respond to reduced consumption and lower prices), and industry returns decline; and markets subsequently recover but the ability of producers to re-enter the market in a timely fashion may be compromised by various factors with implications for the long-term structure of the sector.

The food management chains of the industrial chicken sub-sector (broilers and layers with associated breeding stock which account for 80 percent of the chicken population) have weak contractual arrangements, poor infrastructure investment, and limited investment in food processing, marketing, and retailing. It is possible that this is hampering Egypt's ability to control HPAI and also to compete in international markets, but this requires further study and analysis to reach definitive conclusions.
(ProMED 3.11.08)


USA (California): Outbreak of seasonal influenza shuts down prison
An influenza outbreak at a state prison sickened more than 500 prisoners since 23 February 2008, forcing the facility to bar new inmates and visitors, officials said on 7 Mar 2008. Inmates at Chuckawalla Valley State Prison began experiencing flu-like symptoms on 23 Feb 2008, said Lt. Debbie Asuncion, prison administrative assistant. The symptoms include fever, cough and body aches. Asuncion said 546 inmates have become ill, and 10 of them were hospitalized. Two inmates died, and those deaths were being investigated to determine if they were related to influenza, Asuncion said. Eight remained hospitalized, and the rest were being treated at the prison. The prison was closed to all visitors, including attorneys and volunteers, to keep the public from being exposed. The prison also was not receiving or transferring inmates and was restricting inmate movement within the prison, Asuncion said. Chuckawalla Valley State prison is a low-to-medium-security prison that currently houses 3,147 inmates.

The high attack rate in this outbreak (546 persons among 3,147 inmates) since 23 Feb 2008 is probably a reflection of population density. It also suggests that availability and/or uptake of the current seasonal influenza vaccine has been unsatisfactory.
(ProMED 3.9.08)


Bangladesh: Despite massive culling, H5N1 avian influenza spreads to another district
Bird flu has spread to another district in Bangladesh despite massive culling by authorities to control the outbreak, officials said on 9 Mar 2008, bringing the number of affected districts to 47 out of 64. The new case of the avian influenza was found in Brahmanbaria, in the east of the capital Dhaka, livestock officials said. They added that the spread of bird flu had slowed in the previously affected areas in recent weeks.

Nearly 1.25 million birds have been culled since the virus was first detected in March 2007, threatening the impoverished country's growing poultry sector.

Industry officials said bird flu had caused losses of about 45 billion taka (USD 650 million) to the poultry sector, which accounts for 1.6 percent of gross domestic product. Around five million of the country's more than 140 million people are directly or indirectly involved in poultry farming. Officials estimate that more than 1.5 million have now become jobless. No human bird flu cases have been reported in Bangladesh, a densely populated nation where poultry is commonly kept by households.
(ProMED 3.11.08)


Hong Kong: Officials close schools due to seasonal influenza
Hong Kong school officials made an abrupt decision on 12 Mar 2008 to close all primary schools for two weeks in an effort to block a rising wave of seasonal influenza.

The move, described as Hong Kong's first school closure since the SARS (severe acute respiratory syndrome) epidemic of 2003, came after authorities reported outbreaks involving 184 people at 23 schools and kindergarten/child-care centers. Fifty more reports of outbreaks involving 305 people at 27 schools were reported on 13 Mar 2008.

The closure affects nearly 560,000 children at 1,745 primary schools and kindergarten/child-care centers. News agencies said three or four children have died of flu-like illnesses in the city in weeks prior to the school closure. A World Health Organization (WHO) official said one child tested negative for flu, while two others had flu along with other illnesses.
(CIDRAP 3.13.08)


2. Updates
  • UN: http://www.un-influenza.org/ : UNDP recently launched a new Web site for information on fund management and administrative services and includes the website of the Central Fund for Influenza Action. This site also includes a list of useful links to governments, international agencies, NGOs, and scientific organizations.
  • WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html Read the WHO/ECDC frequently asked questions for Oseltamivir Resistance at: http://www.who.int/csr/disease/influenza/oseltamivir_faqs/en/index.html .
  • UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. View updated maps showing the H5N1 avian influenza situation in poultry and wild birds .
  • OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm. Link to the Communication Portal gives latest facts, updates, timeline, and more.
  • US CDC: http://www.cdc.gov/flu/avian/index.htm. Read about ways to prevent transmission.
  • The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Use the toolkit to prepare your community for a possible flu pandemic.
  • Health Canada: information on pandemic influenza: http://www.influenza.gc.ca/index_e.html .
  • CIDRAP: http://www.cidrap.umn.edu/ See Pandemic preparedness tools: Find more than 130 peer-reviewed practices from 22 states and 33 counties aimed at furthering pandemic preparedness.
  • PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm Link to National Influenza Centers in PAHO Member States.
  • US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp Read about the latest news on H5N1 in wild birds.


    3. Articles
    Federal Guidance to Assist States in Improving State-Level Pandemic Influenza Operating Plans
    U.S. Government. March 11.2008

    Effective state, local, and community functioning during and following an influenza pandemic requires focused planning and practicing in advance of the pandemic to ensure that states can maintain their critical functions. The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States—Early, Targeted, Layered Use of Nonpharmaceutical Interventions (February 2007) was developed to provide guidance for pandemic planning and response. For community mitigation strategies to be effective, state governments need to incorporate them into their operating plans and assist local communities, businesses, non-governmental organizations, and the public in doing the same. State governments must have robust operating plans that have been sufficiently tested and improved by staff who understand and perform proficiently their supporting activities. Community partners must also perform proficiently their roles and responsibilities and understand accurately what the State government will and won’t do and how it will communicate with both them and the public.

    This document provides a strategic framework to help the 50 States, the District of Columbia (DC), and the five U.S. Territories improve and maintain their operating plans for responding to and sustaining functionality during an influenza pandemic. Hereinafter within this document, the terms “States” and “State-level” refer to all 56 governmental entities.

    At the heart of the strategic framework are the supporting activities that State-level operating plans should address. Representatives of several United States Government (USG) Departments (see Annex) developed this document with input from State representatives.
    (CIDRAP 3.11.08)


    Modeling targeted layered containment of an influenza pandemic in the United States
    Halloran ME, Ferguson NM, et al. PNAS USA. Published online: March 10, 2008

    Planning a response to an outbreak of a pandemic strain of influenza is a high public health priority. Three research groups using different individual-based, stochastic simulation models have examined the consequences of intervention strategies chosen in consultation with U.S. public health workers. The first goal is to simulate the effectiveness of a set of potentially feasible intervention strategies. Combinations called targeted layered containment (TLC) of influenza antiviral treatment and prophylaxis and nonpharmaceutical interventions of quarantine, isolation, school closure, community social distancing, and workplace social distancing are considered. The second goal is to examine the robustness of the results to model assumptions. The comparisons focus on a pandemic outbreak in a population similar to that of Chicago, with 8.6 million people. The simulations suggest that at the expected transmissibility of a pandemic strain, timely implementation of a combination of targeted household antiviral prophylaxis, and social distancing measures could substantially lower the illness attack rate before a highly efficacious vaccine could become available. Timely initiation of measures and school closure play important roles. Because of the current lack of data on which to base such models, further field research is recommended to learn more about the sources of transmission and the effectiveness of social distancing measures in reducing influenza transmission.
    (CIDRAP 3.10.08)


    Avian influenza A (H5N1) infection in a patient in China, 2006
    Influenza and Other Respiratory Viruses 2007;1(5-6) :207–213

    Highly pathogenic avian influenza H5N1 virus has caused increasing human infection in Eurasia since 2004. So far, H5N1 human infection has been associated with over 50% mortality that is partly because of delay of diagnosis and treatment.

    Objectives and Methods
    Here, we report that an H5N1 influenza virus infected a 31-year-old patient in Shenzhen in June 2006. To identify the possible source of the infection, the human isolate and other H5N1 influenza viruses obtained from poultry and wild birds in southern China during the same period of time were characterized.

    Genetic and antigenic analyses revealed that the human H5N1 influenza virus, Shenzhen/406H/06, is of purely avian origin and is most closely related to viruses detected in poultry and wild birds in Hong Kong in early 2006.

    The findings of the present study suggest that the continued endemicity of H5N1 influenza virus in the poultry in southern China increases the chance for introduction of the virus to humans. This highlights the importance of continued surveillance of poultry and wild birds for determining the source for human H5N1 infection.
    (CIDRAP 3.11.08)


    Protective efficacy of several vaccines against highly pathogenic H5N1 avian influenza virus under experimental conditions
    Veits J, Mettenleiter TC, et al. Vaccine. 2008;26(13):1688-1696

    Although several vaccines have been developed to protect against highly pathogenic avian influenza of subtype H5N1 'Asia' their efficiency has primarily been assessed individually. Thus, a direct comparison of their performance is still lacking. The following study was conducted to compare the protective efficacy of three commercially available inactivated vaccines based on influenza virus strains of subtypes H5N2 (vaccine A), H5N9 (vaccine B), and H5N3 (vaccine C), as well as two hemagglutinin expressing experimental vector vaccines (modified vaccinia virus Ankara-H5 and Newcastle disease virus-H5) against a lethal dose of highly pathogenic H5N1 avian influenza virus in chickens. To assess their potential as emergency vaccines, a single immunization was performed for all vaccines, despite the recommendation of a double-vaccination schedule for commercial vaccines B and C. Overall, all vaccines induced clinical protection against challenge infection 3 weeks after immunization. No mortality was observed in chickens immunized with vaccine A and viral shedding could not be detected. Immunization with NDV-H5, vaccine C and MVA-H5 conferred also protection against lethal challenge. However, viral RNA was detected by real-time RT-PCR in swabs of 10%, 20% and 50% of animals, and 0%, 10% and 30% of animals, respectively, shed infectious virus. Immunization with vaccine B was less protective since 50% of the vaccinated animals shed infectious virus after challenge and 20% of the chickens succumbed to disease. These results indicate that the NDV-H5 vectored vaccine is similarly effective as the best inactivated vaccine. Considering the advantage of live NDV which can be administered via spray or drinking water as well as the potential use of this H5 expressing vector vaccine for an easy DIVA (differentiating infected from vaccinated animals) strategy, NDV-H5 could represent an alternative for extensive vaccination against avian influenza in chickens.
    (CIDRAP 3.10.2008)


    Avian influenza knowledge among medical students, Iran [letter]
    Ghabili K, Shoja MM, Kamran P. Emerg Infect Dis. 2008 Apr; [Epub ahead of print]

    During a pandemic, public health agencies and medical students will play critical roles in controlling the spread of disease. Therefore, medical school curricula should include specific courses in the epidemiology of avian influenza to ensure that all medical students and health care professionals will have the knowledge needed to confront a potential pandemic. . .Medical students study virology during the second year of medical school. Thereafter, no additional coursework in virology is offered. Because several cases of avian influenza have been found in adjacent countries such as Turkey and Iraq, we anticipate that the virus will spread to Iran. Therefore, we designed a study to assess the knowledge of a group of Iranian medical students regarding avian influenza and to delineate the potential source of their knowledge.
    (CIDRAP 3.10.08)


    Determination of oseltamivir quality by colorimetric and liquid chromatographic methods
    Green MD, Nettey H, Wirtz RA. Emerg Infect Dis. 2008 Apr; [Epub ahead of print]

    We developed a colorimetric and chromatographic assay for oseltamivir to assess the authenticity of Tamiflu (F. Hoffmann-La Roche Ltd., Basel, Switzerland) because of a growing concern about counterfeit oseltamivir. The colorimetric assay is quantitative and relies on an extractable colored ion-pair complex of oseltamivir with Congo red or bromochlorophenol blue. The reverse-phase chromatographic assay uses an alkaline mobile phase with UV detection. Both methods were evaluated for variability and selectivity and subsequently applied to batches of oseltamivir products acquired through the Internet. The Congo red test showed greater assay sensitivity, linearity, and accuracy. Colorimetric and chromatographic analysis showed all batches of oseltamivir product were within ±15% of the stated amount of active ingredient.
    (CIDRAP 3.10.08)


    Cross-neutralisation of antibodies elicited by an inactivated split-virion influenza A/Vietnam/1194/2004 (H5N1) vaccine in healthy adults against H5N1 clade 2 strains
    Höschler K, Gopal R, et al. Influenza and Other Respiratory Viruses 2007;1(5-6):199–206

    Highly pathogenic avian influenza A H5N1 viruses are widespread in different parts of the world and have evolved into clade 1 and 2 lineages. Their continuing circulation represents serious pandemic threat, spurring human vaccine development efforts. Initial clinical trials tested vaccines prepared from clade 1 strains circulating in 2004.

    Post-vaccination sera from a phase I trial of an inactivated split-virion vaccine based on A/Vietnam/1194/2004/NIBRG14 (H5N1) were analyzed in vitro for cross-reactivity against highly pathogenic, wild-type clade 2 H5N1 strains isolated from human cases, and their corresponding reverse genetics derived vaccine candidate strains.

    Neutralization of clade 1 and 2 wild-type and reverse-genetics viruses was seen, with highest titers observed for viruses most closely related to the vaccine strain. There was no consistent relationship between vaccine dose given, or presence of aluminum adjuvant and cross-neutralizing antibody titer, possibly because of small sample size. Use of wild-type highly pathogenic strains compared with antigenically equivalent reverse-genetics viruses suggests presence of a higher level of cross-neutralizing antibody.

    Vaccination with a clade 1 H5N1 virus elicited antibodies capable of neutralizing diverse clade 2 H5N1 strains. This data underlines that while a close match between vaccine virus and circulating virus is important to achieve maximum protection, population priming with a ‘pre-pandemic’ vaccine may be beneficial for the protection of a naïve population. The data suggests that use of reverse-genetic viruses in neutralization assays may underestimate the extent of cross-protective antibody present following H5N1 vaccination.
    (CIDRAP 3.10.08)


    4. Notifications
    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:

    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.


    13th International Congress on Infectious Diseases (ICID)

    Date: June 19-22 Location: Kuala Lumpur, Malaysia Venue: Kuala Lumpur Convention Center

    Our meeting in Kuala Lumpur hosted by the Ministry of Health, Malaysia will again welcome delegates from over 100 countries. The program will include plenary talks by world-renowned experts in the science of infectious diseases and important topics critically presented by international luminaries in our field. Moreover, there will be great opportunities to spend time with leaders in the field, exchange ideas and develop collaborations with scientists from distinguished Medical Centers around the globe. All who are committed to the prevention and control of infections worldwide will find this a compelling meeting that should not be missed.


    Questions and Answers with William Raub
    Tue Feb 19, 2008 at 07:24:12 AM EST

    HHS Secretary Mike Leavitt's science advisor, Dr. William Raub has kindly agreed to an email/blog interview with the Flu Wiki community. Dr. Raub answers questions about responsibility for preparedness efforts, vaccine allocation, new vaccine and antiviral technologies, and much more. See the full text at: