EINet Alert ~ Apr 11, 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: Officials report human-to-human transmission of H5N1 avian influenza virus
- India (Tripura): Authorities begin culling chickens in area hit by H5N1 avian influenza
- South Korea (Jeongeup): Officials confirm new outbreak of H5N1 avian influenza in poultry
- Viet Nam (Quang Nam): H5N1 avian influenza ravages central Viet Nam province
- USA (Florida): Researchers report that influenza vaccination still a challenge for hospitals
- Egypt (Behra): WHO confirms country's 48th case of H5N1 avian influenza, 21st death
- USA: Innovative Biosensors, ATCC partner to create avian influenza test
- Indonesia: 16-year-old girl dies of suspected H5N1 avian influenza infection

2. Updates

3. Articles
- Estimating the impact of school closure on influenza transmission from Sentinel data
- Pandemic Influenza, Worker Absenteeism and Impacts on Freight Transportation
- Panalysis: A New Spreadsheet-Based Tool for Pandemic Planning
- Pandemic planning in China: Applying lessons from severe acute respiratory syndrome
- Pandemic planning: Non-pharmaceutical interventions
- Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China
- Global epidemiology of human infections with highly pathogenic avian influenza A (H5N1) viruses
- Update on Influenza Vaccines
- Update on influenza anti-virals

4. Notifications
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- Eleventh Annual Conference on Vaccine Research

1. Influenza News

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

China / 3 (3)
Egypt / 5 (2)
Indonesia / 15 (12)
Viet Nam / 5 (5)
Total / 27 (21)

Cambodia / 1 (1)
China / 5 (3)
Egypt / 25 (9)
Indonesia / 42 (37)
Laos / 2 (2)
Myanmar / 1 (0)
Nigeria / 1 (1)
Pakistan / 3 (1)
Viet Nam 8 (5)
Total / 88 (59)

Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 13 (8)
Djibouti / 1 (0)
Egypt / 18 (10)
Indonesia / 55(45)
Iraq / 3 (2)
Thailand / 3 (3)
Turkey / 12 (4)
Total / 115 (79)

Cambodia / 4 (4)
China / 8 (5)
Indonesia / 20 (13)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 98 (43)

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: 379(239).
(WHO 4.8.08 http://www.who.int/csr/disease/avian_influenza/en/index.html )

Avian influenza age distribution data from WHO/WPRO:
(WHO/WPRO 4.3.08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 4.8.08):

WHO’s timeline of important H5N1-related events (last updated 3.25.08):


China: Officials report human-to-human transmission of H5N1 avian influenza virus
A 24-year-old Chinese man who died of bird flu in December 2007 passed the virus directly to his father in a rare case of human-to-human transmission of the virus, doctors reported on 7 Apr 2008.

Chinese officials had already said they believed the younger man infected his 52-year-old father, who survived; and genetic sequencing and other checks confirmed this was likely, the researchers said.

"In this family cluster of confirmed cases of infection with highly pathogenic avian influenza A (H5N1) virus in mainland China, we believe that the index case transmitted H5N1 virus to his father while his father cared for him in the hospital," they wrote in the Lancet medical journal.

Yu Wang of the Chinese Center for Disease Control and Prevention in Beijing and colleagues investigated the cases of the man and his son, who were diagnosed within a week of each other in December 2007 in Jiangsu Province. They also tested 91 people the two men had come into close contact with. None of these people became infected.

The young man had a high fever, cough and watery diarrhea and his father nursed him intensively in the hospital. The younger man died but his father got the flu drugs Tamiflu and rimantadine as well as serum from a woman inoculated with an experimental H5N1 vaccine and recovered.

"With the exception of occasional infection in health workers, all published incidents of possible or probable person-to-person transmission report transmission between genetically related individuals," Nguyen Tran Hien of Vietnam's National Institute of Hygiene and Epidemiology, and colleagues wrote in a commentary. "Although this finding could be related to the intensity and intimacy of contact between family members, host genetic factors might also play a part in susceptibility to H5N1." Anyone in close, prolonged contact with an H5N1 victim should get flu drugs just in case, they said.

Most victims of bird flu have been directly infected by sick birds, but in a few rare cases, there appears to have been human-to-human transmission. These have been documented in Indonesia and, in March 2008, between two brothers in Pakistan. Most have been among people who are genetically related and this also appears to be the case with the two Chinese men, the researchers said. Some experts believe there may be a genetic susceptibility to H5N1 infection.

(Perhaps the most significant and novel feature of this report, apart from the confirmation of the probability of transmission of infection from son to father, is that the surviving patient was treated with serum from a woman inoculated with an experimental H5N1 vaccine.)

Read the original article, “Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China” in the Articles section.


India (Tripura): Authorities begin culling chickens in area hit by H5N1 avian influenza
India began culling thousands of chickens on 8 Apr 2008 and checking people for fever in remote northeastern villages on the border with Bangladesh after tests on dead poultry confirmed bird flu infections.

Around 100 health workers wearing protective suits and masks began collecting chickens and ducks from eight villages in Dhalai district in Tripura state, where 3,000 birds died in the week after the outbreak started.

"The state government is fully prepared to tackle the situation. There is no shortage of medicines or trained veterinary and medical staff in the affected area," said Aghore Debbarma, Tripura's Animal Resources Development Department minister.

He said at least 21 rapid-action teams were formed to carry out culling of around 20,000 birds in the affected area to prevent further spread of the H5N1 avian flu virus.

Tripura borders Bangladesh, where more than half the country's districts have been affected by the virus. In India, the virus surfaced in West Bengal earlier in 2008 and appeared to have been contained by culling nearly four million birds. But the virus has intermittently flared up.

India's egg trade suffered losses of millions of rupees following the outbreak of bird flu after Sri Lanka, Bangladesh, and other countries banned egg imports. Chicken sales have been largely affected in only those areas where the flu occurred, but there has been little national impact on demand. India, home to tens of millions of farmers who keep poultry in their yards, has seen three major outbreaks of bird flu in poultry since 2006, all of which were brought under control. No human cases have been reported in India.
(ProMED 4.8.08)


South Korea (Jeongeup): Officials confirm new outbreak of H5N1 avian influenza in poultry
Highly pathogenic avian influenza is confirmed to have broken out in the southwestern city of Jeongeup, the second after one on a chicken farm in Gimje, North Jeolla Province.

The Food, Agriculture, Forestry and Fisheries Ministry announced on 7 Apr 2008 that the H5N1 strain of the bird flu virus killed ducks on a farm in the town of Yeongwon near Jeongeup as reported on 3 Apr 2008. The number of poultry farms with or suspected of having bird flu has increased to four after the first outbreak was confirmed in a chicken farm in the town of Yeongji last week.

Quarantine authorities of North Jeolla Province examined a duck farm in the town of Gobu, where 700 of the birds died on 5 Apr 2008. They suspect the possibility of a H5N1 outbreak. The farm is only 4.5 km (3 mi) away from where the virus was first detected. Bird flu symptoms such as bleeding in the kidney were found among ducks in the first autopsy. Health authorities prohibited 18,000 ducks from the Gobu farm from being carried out and are considering culling them.

Fine Korea, a duck butchery in Naju, South Jeolla Province, has culled 6,520 ducks from Yeongwon. The company has been ordered to bury 30,000 out of 90,000 animals slaughtered over the past two to five days, including the ducks it culled. 60,000 of the dead ducks are being collected as they are already on the market.

Kim Chang-seop, the ministry's director for animal disease prevention, said, "Though ducks on the market are not directly related to avian influenza, we are collecting them because they might have been contaminated by the butchery machine. Even if they were contaminated, their meat is safe."
(ProMED 4.8.08)


Viet Nam (Quang Nam): H5N1 avian influenza ravages central Viet Nam province
An outbreak of bird flu is sweeping through the central province of Quang Nam, felling fowls and forcing authorities to cull a further 26,660 birds. They destroyed 7,000 eggs and 1,250 ducks on 31 Mar 2008 after finding signs of the H5N1 virus that causes the disease. Seven communes in four districts — Nui Thanh, Thang Binh, Dai Loc, and Tien Phuoc — have been affected. Nguyen Ngoc Quang, vice chairman of the Quang Nam People's Committee, instructed local authorities to focus on disinfecting affected areas and containing the spread of the disease.
(ProMED 4.6.08)


USA (Florida): Researchers report that influenza vaccination still a challenge for hospitals
Healthcare institutions still face significant hurdles in getting their staff members vaccinated against seasonal influenza, and fear of flu infection and caring for sick family will keep many staff home during an influenza pandemic, according to researchers.

Four teams of researchers reported at the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, held in Orlando, Fla., that large proportions of hospital staff believe that flu vaccine causes influenza or triggers other side effects. Others believe that previous bouts of flu have made them immune to contracting the flu again. On average, only 40 percent of healthcare workers receive flu shots each year, according to the Centers for Disease Control and Prevention.

At Emory University School of Medicine and Emory Healthcare of Atlanta, intensive campaigns have raised flu vaccination coverage from 43 percent to 67 percent of the staff, but pockets of resistance remain, according to a report by Sarah E. Smithson and colleagues.

An anonymous online survey of the academic medical center's 9,700 employees, which garnered responses from 1,994 workers or 21 percent of the staff, found that 50 percent of those who did not take the flu shot believe vaccination is a "personal decision," 31 percent did not take it for fear of side effects, and 20 percent had confidence in their own "natural immunity." Concern about vaccine side effects was also common at Our Lady of Mercy Medical Center in New York, as well as in hospitals at the University of California–Irvine and the University of South Alabama in Mobile.

Staff in the hospital at the University of South Alabama also said they would have difficulty coming to work in a flu pandemic, said the report by William K. Green, MD. Only 13.7 percent of employees expected to report as usual. Among those who said they would not come to work, 13.9 percent said they were afraid of becoming sick, 30 percent said they could not come to work if someone else in their household were sick, and 48.1 percent said they would not be able to report if schools and daycare centers were closed as a protective measure. Despite educational efforts by the hospital, 15.7 percent of the staff said they did not know what pandemic influenza was.
(CIDRAP 4.9.08)


Egypt (Behra): WHO confirms country's 48th case of H5N1 avian influenza, 21st death
The Ministry of Health and Population of Egypt has announced a new human case of avian influenza A (H5N1) virus infection.

The patient is a 19-year-old male from Kafr El-Dawar District, Behera governorate. He developed symptoms on 30 Mar 2008, was hospitalized on 31 Mar 2008, and died on 4 Apr 2008. The patient was confirmed as being infected with A (H5N1) by the Central Public Health Laboratories and by Cairo-based US Naval Medical Research Unit 3 (NAMRU-3). Investigations into the source of his infection indicate a history of contact with sick and dead poultry. The teenager was the 48th reported case of human bird flu in the country and the 21st death.

Egypt's location on major bird migration routes and the widespread practice of keeping domestic fowl near living quarters have led to it being the hardest-hit country outside Asia. The government says it is conducting a vigorous campaign to combat the spread of the virus through vaccinations and raising awareness, but experts and officials have warned against people dropping their guard.

Earlier this year [2008], Health Minister Hatem al-Gabali warned against slackness in the preventative measures taken to fight bird flu. Health ministry spokesman Abdel Rahman Shahin has repeatedly urged the public to remain vigilant. Officials have called for the banning of raising fowl in towns and transporting them between provinces without authorization. They have also warned sick people that failure to report contact with contaminated domestic fowl makes it more difficult to detect and treat the virus. Women and children have borne the brunt of the virus because of their role in taking care of domestic fowl.
(ProMED 4.6.08 & 4.8.08)


USA: Innovative Biosensors, ATCC partner to create avian influenza test
Two local companies are working together to produce a new test to detect the avian flu within minutes.

Rockville-based Innovative Biosensors Inc. and Manassas-based ATCC have signed a research and development partnership to use the former company's detection technology and latter company's proteins to build the test. Once it's developed, Innovative Biosensors' new Environmental Group will be responsible for selling and distributing the portable detector.
(Washington Business Journal 4.9.08)


Indonesia: 16-year-old girl dies of suspected H5N1 avian influenza infection
A 16-year-old Indonesian girl has died of suspected bird flu, a doctor said on 6 Apr 2008. The girl died on Saturday, three days after being admitted for treatment at the Sulianti Saroso bird flu referral hospital in the Indonesian capital, hospital spokesman Ilham Patu said.

"She showed all the symptoms of bird flu infection such as high fever, coughing and low blood cell count," Patu said. "But we have not yet received the results of tests of samples taken from her. She remains a suspected bird flu case," Patu said.

Health minister spokesperson Lili Sulistiawati confirmed officials were still awaiting the results before confirming the case as a bird flu death. Two positive results are needed before Indonesian authorities confirm a human infection of bird flu. The girl's father said that officials conducted a check of poultry in their neighborhood in Sawangan, southeast of Jakarta, and found some were positive for the virus. The girl fell sick on 31 Mar 2008 and was taken to a private hospital two days later, before being referred to Sulianti Saroso on 3 Apr 2008.
(ProMED 4.6.08)


2. Updates


3. Articles
Estimating the impact of school closure on influenza transmission from Sentinel data
Cauchemez S, et al. Nature. 2008;452:750-754

The threat posed by the highly pathogenic H5N1 influenza virus requires public health authorities to prepare for a human pandemic. Although pre-pandemic vaccines and antiviral drugs might significantly reduce illness rates, their stockpiling is too expensive to be practical for many countries. Consequently, alternative control strategies, based on non-pharmaceutical interventions, are a potentially attractive policy option. School closure is the measure most often considered. The high social and economic costs of closing schools for months make it an expensive and therefore controversial policy, and the current absence of quantitative data on the role of schools during influenza epidemics means there is little consensus on the probable effectiveness of school closure in reducing the impact of a pandemic. Here, from the joint analysis of surveillance data and holiday timing in France, we quantify the role of schools in influenza epidemics and predict the effect of school closure during a pandemic. We show that holidays lead to a 20–29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. Holidays prevent 16–18% of seasonal influenza cases (18–21% in children). By extrapolation, we find that prolonged school closure during a pandemic might reduce the cumulative number of cases by 13–17% (18–23% in children) and peak attack rates by up to 39–45% (47–52% in children). The impact of school closure would be reduced if it proved difficult to maintain low contact rates among children for a prolonged period.
(CIDRAP 4.9.08)


Pandemic Influenza, Worker Absenteeism and Impacts on Freight Transportation
Jones DA, et al. Proceedings of the 41st Hawaii International Conference on System Sciences – 2008

A pandemic influenza outbreak could cause serious disruption to operations of several critical infrastructures and concern about the effects of such disruptions is a matter of public concern. This paper focuses on freight transportation services, particularly rail and port operations. It develops models to assess the likely impacts of varying levels of worker absenteeism on the performance of these critical systems. Using current data on performance of specific rail and port facilities, we reach some conclusions about the likelihood of severe operational disruption under varying assumptions about the absentee rate and draw out implications that would be of government concern.
(CIDRAP 4.9.08)


Panalysis: A New Spreadsheet-Based Tool for Pandemic Planning
Abromovich MN, et al. Biosecurity and Bioterrorism. 2008;6(1)

Publicly available influenza modeling tools are of limited use to hospitals and local communities in planning for a severe pandemic. We developed Panalysis, a new tool to estimate the likely healthcare consequences of a pandemic and to aid hospitals in the development of mitigation and response strategies. By way of example, we demonstrate how Panalysis can be used to plan for a 1918-like flu pandemic. We discuss potential future applications of this tool.
(CIDRAP 4.7.08)


Pandemic planning in China: Applying lessons from severe acute respiratory syndrome
Zhong NS, Zeng GQ. Respirology 2008; 13: S33–S35

There were three events of severe acute respiratory syndrome (SARS) in China from 2003 to 2004. Starting from 2002, we are also aware of the increasing alert of an avian flu pandemic. Epidemics of SARS and avian flu have posed huge threats to social stability, economic prosperity and human health in this country. What we have experienced during SARS outbreaks has great implications for the protection of people against a resurgence of SARS and potential attacks of high-pathogenic avian flu viruses. To that end, China has been preparing to contain future pandemics by applying lessons learnt from SARS.
(CIDRAP 4.6.08)


Pandemic planning: Non-pharmaceutical interventions
Low DE. Respirology 2008; 13: S44–S48

Ongoing concerns about the emergence of an influenza pandemic continue as the number of avian and human infections with the H5N1 virus mount. Adequate amounts of vaccine or anti-virals are unlikely to be available early on in a pandemic, and the latter could become ineffective because of resistance. These factors have focused attention on the use of non-pharmaceutical public health interventions to inhibit human-to-human transmission.
(CIDRAP 4.6.08)


Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China
Wang H. The Lancet. Early online publication, 8 April 2008

In December, 2007, a family cluster of two individuals infected with highly pathogenic avian influenza A (H5N1) virus was identified in Jiangsu Province, China. Field and laboratory investigations were implemented immediately by public-health authorities.

Epidemiological, clinical, and virological data were collected and analyzed. Respiratory specimens from the patients were tested by reverse transcriptase (RT) PCR and by viral culture for the presence of H5N1 virus. Contacts of cases were monitored for symptoms of illness for 10 days. Any contacts who became ill had respiratory specimens collected for H5N1 testing by RT PCR. Sera were obtained from contacts for H5N1 serological testing by microneutralization and horse red-blood-cell haemagglutinin inhibition assays.

The 24-year-old index case died, and the second case, his 52-year-old father, survived after receiving early antiviral treatment and post-vaccination plasma from a participant in an H5N1 vaccine trial. The index case's only plausible exposure to H5N1 virus was a poultry market visit 6 days before the onset of illness. The second case had substantial unprotected close exposure to his ill son. 91 contacts with close exposure to one or both cases without adequate protective equipment provided consent for serological investigation. Of these individuals, 78 (86%) received oseltamivir chemoprophylaxis and two had mild illness. Both ill contacts tested negative for H5N1 by RT PCR. All 91 close contacts tested negative for H5N1 antibodies. H5N1 viruses isolated from the two cases were genetically identical except for one non-synonymous nucleotide substitution.

Limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster.
(CIDRAP 4.8.08)


Global epidemiology of human infections with highly pathogenic avian influenza A (H5N1) viruses
Uyeki TM. Respirology 2008; 13: S2–S9

From 1997 through 2007, human infections with highly pathogenic avian influenza A (H5N1) viruses resulted in rare, sporadic, severe and fatal cases among persons in 14 countries in Asia, the Middle East, Eastern Europe and Africa. Of 369 reported human H5N1 cases that occurred from 1997 through 2007, overall mortality was 60%. Ten antigenically and genetically distinct clades of H5N1 viruses have been identified to date, and strains from four clades have infected humans. Surveillance has focused upon hospitalized cases of febrile acute lower respiratory tract disease among persons with exposure to sick or dead poultry, or to a human H5N1 case. Detection of H5N1 virus infection is based primarily upon collection of respiratory tract specimens from suspected cases for RT-PCR testing. Most human H5N1 cases were previously healthy children or young adults who developed severe acute pulmonary or multi-organ disease following direct or close contact with sick or dead H5N1 virus–infected poultry. Occasional clusters of H5N1 cases have occurred, predominantly among blood-related family members. Limited human-to-human H5N1 virus transmission has been reported or could not be excluded in some clusters. The frequency of asymptomatic or clinically mild H5N1 virus infection is unknown, but limited investigations suggest that such infections have been rare since 2003. There is no evidence of sustained human-to-human H5N1 virus spread. However, H5N1 viruses continue to circulate and evolve among poultry in many countries, and there are many unanswered questions about human infection with H5N1 viruses. Thus, the pandemic influenza threat presented by H5N1 viruses persists.
(CIDRAP 4.6.08)


Update on Influenza Vaccines
Tambyah PA. Respirology. 2008;13: S41–S43

Vaccination has been the most effective means for control of viral infections for centuries. While seasonal vaccines have been highly effective in the management of influenza, there are a number of obstacles to the development of safe and effective pandemic influenza vaccines. The good news is that there has been a lot of investment into novel approaches including reverse genetics and whole cell vaccines that hold promise for successful pandemic control if they can be rolled out in time.
(CIDRAP 4.6.08)


Update on influenza anti-virals
Tambyah PA. Respirology 2008;13:S19–S21

While the mainstay of prevention and control of any viral infection has historically been the use of vaccines, it is recognized that the pace of a global pandemic is likely to be such that it is unlikely that an effective vaccine will be ready for the first wave of an influenza pandemic. As such, in addition to non-pharmacological public health and infection control measures, the first line of action will be the use of antivirals.
(CIDRAP 4.6.08)


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 videoclip of our previous virtual symposium at:

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 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.


Eleventh Annual Conference on Vaccine Research
Date: May 5 - May 7, 2008
Location: Baltimore, Maryland
Venue: Baltimore Marriott Waterfront Hotel

Conference Overview
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.