EINet Alert ~ Mar 28, 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: STMicroelectronics introduces influenza detection laboratory on a chip
- Switzerland: Officials report H5N1 avian influenza in wild duck
- India (West Bengal): H5N1 avian influenza reported in Jalpaiguri district
- Viet Nam: H5N1 avian influenza outbreaks reported at farms participating in vaccination program
- Viet Nam (Lang Son): Illegal chickens in northern area test positive for H5N1 avian influenza
- USA: CDC says pandemic drills hone decision-making tools
- US: Officials launch regional stockpile to fight H5N1 avian influenza in Asia
- Egypt: Backyard poultry declining, production transitioning to large commercial farms
- Nigeria: International Organization for Migration advocates fight against pandemic influenza

2. Updates

3. Articles
- Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia
- Wild ducks as long-distance vectors of highly pathogenic avian influenza virus (H5N1)
- Reassortant avian influenza virus (H5N1) in poultry, Nigeria, 2007
- Multiple sublineages of influenza A virus (H5N1), Viet Nam, 2005-2007
- Oseltamivir prophylactic regimens prevent H5N1 influenza morbidity and mortality in a ferret model
- Molecular detection and typing of influenza viruses: Are we ready for an influenza pandemic?

4. Notifications
- Emerging Infectious Diseases – Volume 14, Number 4 – April 2008
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- BirdFlu 2008: Avian Influenza and Human Health
- 13th International Congress on Infectious Diseases (ICID)

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 / 5 (5)
Total / 24 (19)

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: 373(236). (WHO 3.18.07 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 3.18.08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 3.18.08): 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


Global: STMicroelectronics introduces influenza detection laboratory on a chip
The top European maker of semiconductors, STMicroelectronics, on 24 Mar 2008 introduced a portable chip to detect influenza viruses, including avian flu, in humans.

The device, which functions as a mini-laboratory on a chip, can screen and identify — in a single diagnostic and in two hours — multiple classes of pathogens and genes. Other tests, already on the market, can detect only one strain at a time and require days or weeks to obtain results. The new chip can differentiate human strains of the Influenza A and B viruses, drug-resistant strains and mutated variants, including the H5N1 strain known as avian flu.

"ST sees new high-growth opportunities in the health care market, especially in areas like patient care," said François Guibert, Asia-Pacific chief of the company, at a briefing in Singapore on 24 Mar 2008 to announce the commercial introduction of the product.

The device, marketed under the name VereFlu Chip, was developed by the French-Italian chip maker together with the privately held Veredus Laboratories, of Singapore, after more than a year of research. The application underwent extensive evaluation trials at National University Hospital in Singapore last year.

With the chip, patient samples of blood, serum or respiratory swabs can be analyzed on a single disposable microchip the size of a thumb nail. Guibert said revenue from its biomedical chip business would remain "negligible" for at least three to five years.
(International Herald Tribune 3.25.08)


Europe/Near East
Switzerland: Officials report H5N1 avian influenza in wild duck
Animal health officials in Switzerland on 27 Mar 2008 said samples from an asymptomatic duck were positive for H5N1 avian influenza. Switzerland's Federal Veterinary Office said the virus was found in a duck on Sempachersee Lake, northwest of Lucerne in the central part of the country. Switzerland hasn't reported any infected birds in nearly two years, according to past reports from the World Organization for Animal Health (OIE). Animal health officials said the wild duck was a European pochard. Authorities said an analysis of the H5N1 virus showed that it resembled strains found in other European birds in 2007.

The infected duck brings the number of H5N1 findings in Swiss birds to 33, the veterinary office statement said. The other 32 birds were found on Lake Geneva and Lake Constance.
(CIDRAP 3.27.08)


India (West Bengal): H5N1 avian influenza reported in Jalpaiguri district
District officials in India announced on 27 Mar 2008 that the H5N1 virus was responsible for an outbreak in poultry in West Bengal state's Jalpaiguri district. The findings in Jalpaiguri push the number of West Bengal districts affected by a second round of H5N1 outbreaks to three. The virus struck 112 backyard poultry. Samples from the birds tested positive at the High Security Animal Diseases Laboratory in Bhopal, said Banamali Roy, a Jalpaiguri official.
(CIDRAP 3.27.08)


Viet Nam: H5N1 avian influenza outbreaks reported at farms participating in vaccination program
Agriculture officials in Viet Nam said on 27 Mar 2008 they would examine vaccinated poultry in Hanoi and some of the country's provinces in the wake of reports of H5N1 outbreaks at farms that have participated in vaccination programs. On 17 and 18 Mar 2008, animal health officials reported two H5N1 outbreaks in two districts in Quang Nam province in central Viet Nam. One third of the birds in one of the districts, Ni Thanh, had been vaccinated on 12 Mar 2008, but veterinary officials said they could have had H5N1 before the vaccine generated antibodies to the virus. Nguyen Thanh Sol, deputy chief of Viet Nam's Department of Agriculture and Rural Development, said that though many provinces have taken part in vaccination and other programs, carelessness — especially among farmers — was responsible for avian flu outbreaks.
(CIDRAP 3.27.08)


Viet Nam (Lang Son): Illegal chickens in northern area test positive for H5N1 avian influenza
Out of 104 samples of illegally imported chickens confiscated since February 2008, 24 have tested positive for the H5N1 virus, Lang Son Animal Health Department reported on 21 Mar 2008. Most of the chickens were seized mainly in northern Lang Son Province's Trang Dinh and Loc Binh districts and in Lang Son City. Provincial veterinarians took samples of the trafficked chickens for testing before killing them.

The province has seized and destroyed over 60 tons of non-quarantined chickens since the beginning of 2008. But authorities said it was too little compared to the illegally imported chickens that had been successfully transported and consumed through the province. Although no bird flu outbreaks have been reported in the province, the local Animal Health Department immediately vaccinated poultry in its bordering communes, Lang Son City and in districts where National Highway 1A passes through.

Elsewhere in the country, Southern Ca Mau Province on 21 Mar 2008 also declared bird flu outbreaks after the H5N1 virus killed 30 muscovy ducks on a farm in Hiep Tung Commune, Nam Can District, listing it as the eighth province on Viet Nam's current bird flu-hit list. One day earlier, on 20 Mar 2008, central Quang Nam Province had reported fresh outbreaks on duck farms in Tam Ky and Nui Thanh districts, said the Viet Nam Animal Health Department. Other bird flu-stricken areas include Tuyen Quang, Lao Cai, and Ha Noi in the north, Quang Binh, and Quang Tri in the center and Soc Trang in the south.
(ProMED 3.25.08)


USA: CDC says pandemic drills hone decision-making tools
Recent pandemic influenza response exercises have helped the Centers for Disease Control and Prevention (CDC) improve its tools for making policy decisions quickly, according to senior CDC officials.

Before a large-scale exercise conducted earlier this month, the agency set up a "planning cell" of leaders who were insulated from the need to respond immediately to events so they could think carefully about policy issues raised by the emergency, officials said.

In the exercise, on 11 and 12 Mar 2008, the new group made a noticeable impact on the CDC's ability to make decisions, according to Dr. Richard Besser, director of the CDC's Coordinating Office for Terrorism Preparedness and Emergency Response. "One thing I was struck by was that we did a much better job of reaching decisions quickly, and it's critical that in a crisis we do that," Besser said in a recent interview about the results of the exercise.

CDC spokesman Von Roebuck said the idea for the new planning group stemmed from previous pandemic exercises. In some of them the CDC designated a special team to assist staff members actively engaged in the response, which proved to be very helpful, he explained. "This idea helped spawn and make the planning group a more formal entity for pandemic response," he added. <> Dr. Daniel Jernigan, deputy director of the CDC's Influenza Division, said the aim in setting up the planning cell was to free leaders from some of the immediate pressures of the situation so they could think more deliberately about policies.

The "plans unit" consists of 12 to 15 planning experts and subject-matter experts, who can call on other specialists when needed, Jernigan said. They unit includes specialists in influenza, quarantine, healthcare quality, communications, logistics, and legal issues. Their assignment is to deal with issues that require a more thoughtful approach, such as steps that "are costly, require multiple partners for implementation, or could lead to a strategic change in direction," he said. The CDC is training specialists in other areas so that the planning-cell approach can be used in responding to other kinds of emergencies, such as bioterrorist attacks, not just a flu pandemic, Jernigan added.

Besides demonstrating the value of the approach, the latest pandemic exercise yielded some lessons about information flow and about tracking of containment efforts, according to Besser and Jernigan. Besser said the exercise marked the first time a state health department — Georgia's — participated with the CDC in a pandemic drill. A resulting observation was that "we have work to do regarding information flow," he said. "It's critical that we all have a common operating picture, that we're viewing the same set of information and the same facts. We made a lot of progress in terms of the operating picture at the CDC, but we need to work on systems for sharing information at the state and local level."

The exercise also showed that the CDC needs to pay more attention to the fact that a flu pandemic will unfold in different ways and at varying rates in different parts of the country, according to Besser. "What you see with a pandemic is that states aren't affected in a uniform fashion, and not all areas within a state are affected the same," he said. Jernigan said the agency is working on a way to characterize the different "intervals" or phases of a pandemic. The plan is to include that information in guidance for state and local health officials, in the hope that it will help them with decisions such as when to begin community mitigation steps.

The CDC plans to conduct another large-scale pandemic exercise in September 2008 to extend the scenario used in the previous four. "In the September exercise we're going to be shooting to have more states playing with us in real time," said Besser. He said the agency intends to run a pandemic exercise that will simulate a sizable share of CDC employees being out sick with the flu, but it remains to be decided whether that challenge will be included in the September 2008 event. "It's critical to decide what functions we won't be doing as an agency and how critical functions are covered," he said.
(CIDRAP 3.25.08)


US: Officials launch regional stockpile to fight H5N1 avian influenza in Asia
The first of three US-funded supply stockpiles aimed at helping authorities in Asia stamp out avian influenza outbreaks opened near Bangkok on 25 Mar 2008. Eric John, the US ambassador to Thailand, spoke at a ceremony to open a Regional Distribution Center (RDC) in Chachoengsao province, in eastern Thailand.

"The RDC will help ensure that countries in Asia will be able to take fast action to counter avian influenza without endangering the lives of rapid-response teams," he said. The stockpile, funded by the US Agency for International Development (USAID), initially contains 45,000 protective suits, 400 decontamination suits, 10 laboratory specimen kits, and other equipment totaling $548,300. USAID officials said the supplies, stored in a warehouse near Bangkok's international airport, could be airlifted to affected areas within 24 hours.

John MacArthur, USAID's infectious disease adviser for the Asian region, said at the opening ceremony that continuing outbreaks in the region raise the risk of the H5N1 virus mutating into a form that could be transmitted among humans. On 18 Mar 2008, officials from the United Nations Food and Agriculture Organization (FAO) said they were deeply concerned that high viral loads circulating among birds in Indonesia are creating fertile grounds for H5N1 virus mutation.
(CIDRAP 3.25.08)


Egypt: Backyard poultry declining, production transitioning to large commercial farms
In Egypt, people who raise poultry in their backyards now seem to be heeding safety warnings about H5N1, such as advice to keep the birds in coops away from living areas.

Poultry have nearly vanished from the streets of the country's villages. Egypt has had 47 human H5N1 cases and 20 deaths, the third highest toll after Indonesia and Vietnam, and the disease has struck women and children hardest, because they have traditionally been the primary caretakers of poultry.

"In the beginning, the people were just afraid for their chickens. Now they are afraid for themselves," said Abeer Hussein Moussa, a resident of Tawfiqiya in Fayoum governorate.

As more Egyptians stop raising birds at home, chicken production has transitioned mainly to large commercial farms. However, not all commercial farms conduct rigorous vaccination programs, and the government has shuttered 18 farms after finding birds infected with the H5N1 virus.
(CIDRAP 3.27.08)


Nigeria: International Organization for Migration advocates fight against pandemic influenza
The International Organization for Migration (IOM), an inter-governmental organization working on migration, has called for the fight against the spread of Avian and Human Influenza (AHI) pandemic within the Federal Capital Territory.

Speaking on the deadly pandemic at the Garki model market, popularly called Monday market, the senior program coordinator of IOM, Abuja, Mrs. Queen Chinwe Okaro, said the program was aimed at addressing the health needs of migrants and mobile populations in Nigeria. Mrs. Queen added that IOM, since 2007 with the support of the Japanese government, has been experimenting on AHI pandemic preparedness project, which creates awareness amongst key government institutions and other stakeholders.

According to her "amongst the migrants and mobile populations in Nigeria and fowl sellers who hire vehicles to transport their poultry products, nomads were identified as a target group for the IOM interventions". The coordinator also disclosed that the sensitization campaign is aimed at sensitizing the identified groups, urging them to adopt healthy behavioral practices so as to avert a pandemic.
(Allafrica.com 3.27.08)


2. Updates


3. Articles
Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia
Gilbert M, Xiao X, et al. PNAS. 2008;105(12):4769-4774 http://www.pnas.org/cgi/content/full/105/12/4769

The highly pathogenic avian influenza (HPAI) H5N1 virus that emerged in southern China in the mid-1990s has in recent years evolved into the first HPAI panzootic. In many countries where the virus was detected, the virus was successfully controlled, whereas other countries face periodic reoccurrence despite significant control efforts. A central question is to understand the factors favoring the continuing reoccurrence of the virus. The abundance of domestic ducks, in particular free-grazing ducks feeding in intensive rice cropping areas, has been identified as one such risk factor based on separate studies carried out in Thailand and Viet Nam. In addition, recent extensive progress was made in the spatial prediction of rice cropping intensity obtained through satellite imagery processing. This article analyses the statistical association between the recorded HPAI H5N1 virus presence and a set of five key environmental variables comprising elevation, human population, chicken numbers, duck numbers, and rice cropping intensity for three synchronous epidemic waves in Thailand and Viet Nam. A consistent pattern emerges suggesting risk to be associated with duck abundance, human population, and rice cropping intensity in contrast to a relatively low association with chicken numbers. A statistical risk model based on the second epidemic wave data in Thailand is found to maintain its predictive power when extrapolated to Viet Nam, which supports its application to other countries with similar agro-ecological conditions such as Laos or Cambodia. The model's potential application to mapping HPAI H5N1 disease risk in Indonesia is discussed.
(CIDRAP 3.24.08)


Wild ducks as long-distance vectors of highly pathogenic avian influenza virus (H5N1)
Keawcharoen J, van Riel D, et al. Emerg Infect Dis [serial on the Internet]. 2008 Apr http://www.cdc.gov/eid/content/14/4/600.htm


Wild birds have been implicated in the expansion of highly pathogenic avian influenza virus (H5N1) outbreaks across Asia, the Middle East, Europe, and Africa (in addition to traditional transmission by infected poultry, contaminated equipment, and people). Such a role would require wild birds to excrete virus in the absence of debilitating disease. By experimentally infecting wild ducks, we found that tufted ducks, Eurasian pochards, and mallards excreted significantly more virus than common teals, Eurasian wigeons, and gadwalls; yet only tufted ducks and, to a lesser degree, pochards became ill or died. These findings suggest that some wild duck species, particularly mallards, can potentially be long-distance vectors of highly pathogenic avian influenza virus (H5N1) and that others, particularly tufted ducks, are more likely to act as sentinels.
(CIDRAP 3.21.08)


Reassortant avian influenza virus (H5N1) in poultry, Nigeria, 2007
Monne I, Joannis TM, Fusaro A, et al. Emerg Infect Dis [serial on the Internet]. 2008 Apr http://www.cdc.gov/EID/content/14/4/637.htm

Genetic characterization of a selection of influenza virus (H5N1) samples, circulating in eight Nigerian states over a 39-day period in early 2007, indicates that a new reassortant strain is present in seven of the eight states. Our study reports an entirely different influenza virus (H5N1) reassortant becoming predominant and widespread in poultry.
(CIDRAP 3.21.08)


Multiple sublineages of influenza A virus (H5N1), Viet Nam, 2005-2007
Nguyen TD, Nguyen TV, et al. Emerg Infect Dis [serial on the Internet]. 2008 Apr http://www.cdc.gov/EID/content/14/4/632.htm

Phylogenetic analysis of influenza subtype H5N1 viruses isolated from Viet Nam during 2005–2007 shows that multiple sublineages are present in Vietnam. Clade 2.3.4 viruses have replaced clade 1 viruses in northern Vietnam, and clade 1 viruses have been detected in southern Viet Nam. Reassortment between these 2 sublineages has also occurred.
(CIDRAP 3.21.08)


Oseltamivir prophylactic regimens prevent H5N1 influenza morbidity and mortality in a ferret model
Boltz DA, Rehg JE, et al. The Journal of Infectious Diseases. 2008;197:000–000 DOI: 10.1086/586711 http://www.journals.uchicago.edu/doi/abs/10.1086/586711

Current oseltamivir prophylactic regimens may not be as effective against highly pathogenic H5N1 influenza viruses as they are against less pathogenic strains. An optimal regimen is urgently needed.

Ferrets were given the neuraminidase inhibitor oseltamivir orally for 10 days (5 or 10 mg/kg once daily or 2.5 or 5 mg/kg twice daily). Prophylaxis was initiated 1 day before infection, and oseltamivir was given 4 h before the ferrets were inoculated with a lethal dose of A/Viet Nam/1203/04 (H5N1) influenza virus.

At a dose of 5 mg/kg once daily, oseltamivir prevented death but not clinical signs of infection in ferrets; severe pathology was observed in the lungs, brain, and liver. At 10 mg/kg once daily, oseltamivir reduced clinical symptoms and systemic virus replication, but pathology was observed in the internal organs. The best results were obtained at a dose of 2.5 or 5 mg/kg given twice daily. Both regimens resulted in 100 percent survival and the absence of clinical symptoms, systemic virus spread, and organ pathology. Serum antibody titers were comparable across regimens and were sufficient to protect against rechallenge.

An increased dose of oseltamivir or twice-daily administration effectively protects ferrets against morbidity and mortality caused by H5N1 infection and does not interfere with the development of protective antibodies against subsequent H5N1 infection.
(CIDRAP 3.21.08)


Molecular detection and typing of influenza viruses: Are we ready for an influenza pandemic?
Mackay WG, van Loon AM, et al. J Clin Virol. 2008 Mar 21 [Epub ahead of print]

We cannot predict when an influenza pandemic will occur or which variant of the virus will cause it. Little information is currently available on the ability of laboratories to detect and subtype influenza viruses including the avian influenza viruses.

To assess the ability of laboratories to detect and subtype influenza viruses.

Study Design
In 2006 QCMD distributed an External Quality Assessment panel for the molecular detection and haemagglutinin subtyping of influenza viruses to 87 laboratories in 34 countries worldwide, which were given six weeks to return results. These data were analysed to assess laboratory performance.

Influenza virus positive panel samples were correctly identified by 35-98 percent of laboratories. The correct haemagglutinin subtype was reported by 32-87 percent of laboratories that detected the virus: incorrect subtyping results included the reporting of avian influenza viruses as human strains and vice versa. Twelve laboratories reported false positives with some avian influenza viruses reported.

These data suggest that improvements are needed in the molecular detection of influenza viruses and influenza virus A haemagglutinin subtyping. Only rapid and accurate identification of circulating pandemic influenza virus will ensure that the maximum time is available for intervention.
(CIDRAP 3.27.08)


4. Notifications
Emerging Infectious Diseases – Volume 14, Number 4 – April 2008
This issue includes articles on the multiple lineages of H5N1 in Viet Nam in 2005-2007, wild ducks as vectors of H5N1, and many other infectious disease topics. New issue online at: http://www.cdc.gov/ncidod/eid/


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:

  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.


BirdFlu 2008: Avian Influenza and Human Health

Date: 10-11 September 2008
Location: Oxford, UK
Venue: St. Hilda's College

The 1st annual Oxford avian influenza conference, BirdFlu2008, will address most aspects of basic and applied research on avian influenza viruses and their potential health and socio-economic impact on humans. The conference is aimed at bringing together leading experts in the field from both academia and industry, veterinarians, postdoctoral researchers, graduate research students, physicians and doctors, research managers and policy makers. Thus this event will provide an international forum to discover the latest research directions and thinking in this field in academic and commercial settings, to exchange data and ideas and to develop new collaborative links.


13th International Congress on Infectious Diseases (ICID)

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

The 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.