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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
- AVIAN PANDEMIC INFLUENZA
- 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
- 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)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 379(239).
Avian influenza age distribution data from WHO/WPRO:
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
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.
South Korea (Jeongeup): Officials confirm new outbreak of H5N1 avian influenza in poultry
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."
Viet Nam (Quang Nam): H5N1 avian influenza ravages central Viet Nam province
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.
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 , 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.
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.
Indonesia: 16-year-old girl dies of suspected H5N1 avian influenza infection
"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.
AVIAN PANDEMIC INFLUENZA
Estimating the impact of school closure on influenza transmission from Sentinel data
Cauchemez S, et al. Nature. 2008;452:750-754
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
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: