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EINet Alert ~ Apr 25, 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)
- India (Tripura): H5N1 avian influenza resurfaces in the northeast
- India (Guwahati): Officials blame outbreak on Bangladesh, many experts disagree
- India (Kolkata): Response to H5N1 avian influenza outbreaks threatens country chicken
- Indonesia (Jakarta): Government wants access to vaccines, not money
- Japan: Pre-pandemic vaccine trial approved
- South Korea (North Jeolla): Economy confirms fresh H5N1 avian influenza outbreak in poultry
- USA: Report on HHS Secretary Mike Leavitt's trip to Southeast Asia
- Egypt (Sharkea): WHO confirms country's 50th case of H5N1 avian influenza
- AVIAN PANDEMIC INFLUENZA
- Human infection with highly pathogenic H5N1 influenza virus
- Children, avian influenza H5N1 and preparing for the next pandemic
- Identification of oxidative stress and toll-like receptor 4 signaling as a key pathway of acute lung injury
- Hydrophobic inactivation of influenza viruses confers preservation of viral structure with enhanced immunogenicity
- Comparative efficacy of neutralizing antibodies elicited by recombinant hemagglutinin proteins from avian H5N1 influenza virus
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- Pandemic Planning for Academic Institutions (Webcast)
- AI.COMMuniqué: Preparedness for Influenza Pandemic
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 381(240).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm.
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 4.17.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 4.11.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
India (Tripura): H5N1 avian influenza resurfaces in the northeast
Authorities in a remote northeastern state of India prepared to cull thousands of chickens after a fresh outbreak of bird flu in poultry was detected on 22 Apr 2008, officials said. More than 25,000 chickens and ducks have already been slaughtered in Tripura state in April 2008 after eight villages were hit by the H5N1 strain. On 22 Apr 2008, officials said bird flu had spread to a new area.
"Bird flu has been confirmed for the second time in Tripura," Kartick Debbarma, a senior animal resources official said in Agartala, Tripura's capital. "It is the H5N1 strain."
The remote northeastern state borders Bangladesh, where the virus has affected more than half the country’s districts. In India, the virus resurfaced in the eastern state of West Bengal in January 2008, forcing authorities to cull more than four million birds. Since then the virus has flared up intermittently, hitting poultry sales in the region. Many states banned poultry products, pulling down prices sharply and prompting farmers to cut production. The World Health Organization (WHO) described the January 2008 outbreak in West Bengal as the worst ever in India. Officials in Tripura said they were holding meetings and drawing up their strategy to contain the disease, which has hit Mohanpur, a town just 20 km (12 miles) west of Agartala.
India (Guwahati): Officials blame outbreak on Bangladesh, many experts disagree
"Our main problem in controlling the situation is because of close proximity with Bangladesh," Venkatateswarlu added.
But many people disagreed. For days, while hundreds of birds mysteriously died in remote villages, state authorities largely ignored complaints, some officials and animal experts said.
"It is foolish on their part to blame Bangladesh for their own doing," N.G. Jayasimha of the People for the Ethical Treatment of Animals (PETA), an animal rights group said. "We had warned the Tripura government about bird flu, and we told them the reason for the spread of bird flu is because of bad farm practices. They sat on our report and did nothing."
Local politicians also voiced concern over the government's slow reaction in dealing with bird flu.
"The government is going too slow and blaming Bangladesh will not solve this problem as it is time we should take strong action," said Ratan Lal Nath, a lawmaker from Mohanpur town, worst-hit by the recent outbreak.
Authorities said they would cull at least 15,000 more birds to control the virus in two new areas. Most people had also stopped buying chickens in markets and traders said they were staring at huge losses. When the virus resurfaced in West Bengal in January this year, many states banned poultry products, pulling down prices sharply. Farmers cut production as sales went down by more than 70 percent.
India (Kolkata): Response to H5N1 avian influenza outbreaks threatens country chicken
The killing of chickens threatens to destroy their gene bank in India, experts said.
"There are 17 varieties of country chickens in India. From them, thousands of new breeds can be developed that would be better than broiler chickens. The way they are being culled, we run the risk of wiping out a few varieties. Even if that doesn’t happen immediately, it is a possibility since birds are being culled due to flu outbreaks almost every year," said Barun Roy of West Bengal University of Animal and Fisheries Sciences, a member of the expert team that supervised culling in Rampurhat.
Experts also pointed out that the culling has affected rearing chicken in the backyard — the only source of country chickens. Farmers have started backing away fearing losses. While the sale of chickens dropped by 30 percent following the flu scare in 2007, this time they have plummeted by over 60 percent. Every day, the poultry industry in Bengal is losing the equivalent of 70 million rupees.
"While the organized farms are in a better position to recover, the country chicken farmers have to just give up the trade. So, every time flu strikes, country chickens are pushed a step towards extinction," explained Roy.
Broiler chickens sold by the farms have been the beneficiaries. But in taste and nutrition, they are still way behind the indigenous varieties, said experts.
"Broiler strains were imported from United States, United Kingdom, Canada, and other countries. They grow faster and are easier to rear. But we need to develop our own gene bank since the strain import has been stopped," said a scientist.
Gene sequencing of the H5N1 virus could have prevented the culling.
"Flu outbreaks have become regular during the last eight years. The authorities could have done the sequencing earlier to find out if the gene is likely to affect humans," said Roy. Farms admitted that country chickens face a bleak future. "Very few make it to Kolkata. Another flu outbreak might see them disappear altogether," said Abhijit Kanjilal, manager, Shanti Fortune Hatcheries.
Indonesia (Jakarta): Government wants access to vaccines, not money
Instead, Indonesia wants governments and pharmaceutical companies to come up with a mechanism that will ensure future pandemic vaccines are accessible to developing nations, said Widjaja Lukito, an adviser to Health Minister Siti Fadilah Supari. That could include creating a multilateral trust that would enable price tiering or bulk purchasing of lifesaving vaccines, Lukito said.
The adviser was responding to comments made by Health and Human Services Secretary Mike Leavitt, who accused Indonesia of withholding virus samples from the World Health Organization since early 2007 because it wanted royalties or other monetary benefits.
"This is not a line we want to cross," Leavitt said at the end of a quick stopover in Indonesia last week. "Because it means the next unique virus we come across, wherever it is, we'll end up with people who say there is a price to pay for the virus." He repeated the allegation on his blog, saying Supari's bottom line appeared to be "share samples, get paid."
Indonesia — seen as a potential hotspot for a pandemic because of its high density of chickens and humans — denied that was the case. Lukito said he thought there might have been poor communication on both sides.
"There are many types of benefit programs that can be discussed," he said, noting that the United States and Indonesia agreed during Leavitt's visit to set up an expert panel on the issue. "One could be a kind of revolving fund developed by pharmaceutical companies."
Another, Lukito said, could be to create a multilateral trust — funded by contributions from governments, influenza vaccine manufacturers and individuals — to make sure vaccines are produced and distributed in a fair and equitable manner. Suggestions at a WHO meeting in 2007 included tiered pricing of vaccines, bulk purchasing and other procurement mechanisms that take into consideration how much governments could afford for vaccines, he said.
Under the existing virus-sharing system, poor countries are obliged to send samples to WHO, which then makes them available to a handful of pharmaceutical companies to use in vaccine production. Wealthy nations have stockpiled tons of bird flu vaccines, while Indonesia and other developing countries have limited supplies. U.S. Ambassador to Indonesia Cameron R. Hume, meanwhile, appeared to downplay claims by Leavitt that Indonesia was trying to put a price tag on its H5N1 virus samples.
"Frankly, I think Indonesia's basic concern is that you have a very high mortality rate from avian influenza here," with nearly 80 percent of all humans infected dying, he said. "They are concerned about trying to be sure ... Indonesians don't face this totally unacceptable risk of death."
Many international health experts said Supari had a point when she bucked WHO's decades-old virus sharing system. But by withholding bird flu samples, health experts note, she is impeding the global body's ability to monitor whether the virus is morphing into a more dangerous form. Leavitt vowed in his blog on 15 Apr 2008 to give Indonesia another two months to work toward a solution.
"The cost of Indonesia's refusal to share influenza samples is incrementally small. However, the damage done by accepting Indonesia's view is profound, and simply unacceptable," Leavitt wrote.
Japan: Pre-pandemic vaccine trial approved
South Korea (North Jeolla): Economy confirms fresh H5N1 avian influenza outbreak in poultry
USA: Report on HHS Secretary Mike Leavitt's trip to Southeast Asia
A US Department of Health and Human Services (HHS) official on 22 Apr 2008 shared wrap-up perspectives on HHS Secretary Mike Leavitt's recent trip to Southeast Asia, which included discussions on virus-sharing and restrictions on the US Navy laboratory in Indonesia, updates on avian influenza collaborations, and talks on import safety. The tour included stops in Indonesia, Vietnam, and Singapore. In Indonesia, Leavitt met with government officials to address virus-sharing issues and Indonesia's recent move to restrict the work of US Naval Medical Research Unit 2 (NAMRU-2) in Jakarta. Bill Steiger, special assistant for international affairs at HHS, said that highlights of the trip also included an update on the United States' joint venture with a regional emerging disease center in Singapore and meetings in Vietnam to gauge how United States support is assisting the country's progress on its own human H5N1 influenza vaccine.
Steiger, who accompanied Leavitt on the tour, said the NAMRU-2 lab has functioned in Indonesia for several years. Like other Department of Defense labs in foreign nations, NAMRU-2 originally focused on investigating diseases affecting US troops stationed abroad but has grown into a larger mission, he said.
"Over time, the labs have evolved into collaborative public health assets, often in consultation with the World Health Organization (WHO) and host governments," he said.
The NAMRU-2 lab is situated near other government buildings in Jakarta and has been integrated into the country's health system, Steiger added. The lab has connections to several private and public hospitals in Indonesia and has played a key role in tracking pathogens in the country. However, Indonesia's health minister recently prohibited all tissue samples — not just those containing H5N1 influenza viruses — from being sent to NAMRU-2, he said.
Leavitt asked Steiger and Ambassador John Lange, the State Department's special representative for avian and pandemic influenza, to spend the next two months working on a solution to the virus-sharing issue. He said a small contingent of the WHO's virus-sharing working group met in early April 2008 and that the larger group's next formal meeting is in November.
In Singapore, Leavitt visited the health ministry and spent time at the Regional Emerging Diseases Intervention (REDI) Center, a joint venture of the United States and Singapore that opened in 2004 to serve as an early warning and research center for infectious diseases in Asia. Steiger said the REDI Center shares a building with other research institutes, which fosters collaboration. For example, he said a trilateral project between Singapore, Indonesia, and the United States is focusing on the H5N1 outbreaks in Tangerang, a suburb of Jakarta that has been a hot spot for human cases.
"This is very much a regional effort that leverages Singapore's technical expertise with avian influenza," he said.
In Vietnam, Leavitt had similar talks with health and agriculture officials, Steiger said. One of the topics was US support of Vietnam's human H5N1 vaccine programs. These include a project at the National Institute of Hygiene and Epidemiology in Hanoi that is currently in phase one clinical trials and a smaller vaccine research project based in Nha Trang in southern Vietnam.
Egypt (Sharkea): WHO confirms country's 50th case of H5N1 avian influenza
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 two-year-old male from Al-Honsanya, Sharkea Governorate. He developed symptoms on 13 Apr 2008 and was hospitalized on 14 Apr 2008 and is currently in hospital. 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. Of the 50 cases confirmed to date in Egypt, 22 have been fatal.
AVIAN PANDEMIC INFLUENZA
Human infection with highly pathogenic H5N1 influenza virus
Gambotto A. The Lancet 2008; 371:1464-1475
Children, avian influenza H5N1 and preparing for the next pandemic
Identification of oxidative stress and toll-like receptor 4 signaling as a key pathway of acute lung injury
Hydrophobic inactivation of influenza viruses confers preservation of viral structure with enhanced immunogenicity
Comparative efficacy of neutralizing antibodies elicited by recombinant hemagglutinin proteins from avian H5N1 influenza virus
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 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:
This program is co-sponsored by the Upper Midwest Center for Public Health Preparedness, and features Elizabeth Hosmanek, who currently serves as facilitator for the University of Iowa Pandemic Influenza Task Force and also played an instrumental role in the ASPH/CDC Pandemic Influenza Collaborative Group, which developed the forthcoming "Pandemic Influenza Preparedness Resource Kit for Academic Institutions." She will share information and resources available to academic institutions to support their pandemic influenza preparedness efforts, and lessons learned during the development and execution of the April 2007 tabletop exercise designed to prompt rapid decision-making and test the current Pandemic Plan at the University of Iowa.
AI.COMMuniqué: Preparedness for Influenza Pandemic
Please see The Communication Initiative's Avian Influenza Theme Site at: http://www.comminit.com/avianinfluenza.html for a full display of avian influenza communication knowledge in support of your work. Also see the Academy for Educational Development's Avian Influenza website at http://www.avianflu.aed.org.
AI.COMMuniqué is very interested in your knowledge and experience in avian influenza communication - your projects and programs, strategic thinking, support materials, and any other relevant documentation. Please contact firstname.lastname@example.org with any input.