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EINet Alert ~ May 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: WHO meets to revise pandemic preparedness guidelines
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Denmark (Stenstrup): Officials report low pathogenic H7 avian influenza outbreak in poultry
- Japan (Hokkaido): Two more dead swans infected with H5N1 avian influenza
- Indonesia: Officials discuss virus sharing and NAMRU-2
- India (West Bengal): H5N1 avian influenza resurfaces in backyard poultry
- South Korea (Kyonggi): H5N1 avian influenza spreads to Seoul
- AVIAN/PANDEMIC INFLUENZA
- Summary of Suggestions From the Task Force for Mass Critical Care Summit, January 26–27, 2007
- Preparedness for the Spread of Influenza: Prohibition of Traffic, School Closure, and Vaccination of Children in the Commuter Towns of Tokyo
- Development and Validation of a One-Step Real-Time PCR Assay for Simultaneous Detection of Subtype H5, H7, and H9 Avian Influenza Viruses
- Simultaneous Genotyping of All Hemagglutinin and Neuraminidase Subtypes of Avian Influenza Viruses by Use of Padlock Probes
- H2N5 influenza virus isolates from terns in Australia: genetic reassortants between those of the Eurasian and American lineages
- PROMISING PRACTICES FOR PANDEMIC PLANNING: North Carolina fosters preparedness with the touch of a finger
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
1. Influenza News
Global: WHO meets to revise pandemic preparedness guidelines
World Health Organization (WHO) officials on 6 May 2008 kicked off a four day meeting to begin revising pandemic preparedness guidance for countries, amid warnings that the risk of an influenza pandemic has not waned since the last update. The new guidance will reflect important advances since the last guidance was issued in 2005, WHO said recently. For example, several companies are working on or have developed H5N1 vaccines, clinicians have more experience treating patients who are infected with the virus, and the new International Health Regulations specify how member nations and the WHO should respond to pandemic influenza threats.
Keiji Fukuda, coordinator for the WHO's global influenza program, in an address to about 150 expert participants, said the pandemic threat remains substantial. "We can't delude ourselves. The threat of a pandemic influenza has not diminished," he told the group. Fukuda told the group that more than 150 countries have preparedness plans, but their levels of detail vary, with some amounting only to brief statements acknowledging the risk. Fukuda said the WHO's global stockpile of the antiviral medication oseltamivir (Tamiflu) contains five million treatment courses, and the organization is developing a vaccine stockpile that will initially contain 150 million doses.
The WHO statement said working groups at the meeting will focus on topics such as disease control, surveillance, nonpharmaceutical interventions, and pandemic communications. New draft guidelines from the meeting will circulate for comments. The WHO said it expects to publish the new pandemic planning guidance by the end of the year.
Supamit Chunsuttiwat, an infectious disease expert with Thailand's health ministry who is chairing the meeting, said the pandemic influenza risk is probably expanding, and that the H5N1 virus persists on three continents and has infected humans in Indonesia, Egypt, and China this year (2008). "We are concerned that the spread through migratory birds hasn't stopped. Once the virus is established in birds it is difficult to get rid of the virus, and the risk (to humans) remains unless countries develop good control of transmission in birds," he said.
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 382(241).
Avian influenza age distribution data from WHO/WPRO:
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 5.6.08):
WHO’s timeline of important H5N1-related events (last updated 4.24.08):
Denmark (Stenstrup): Officials report low pathogenic H7 avian influenza outbreak in poultry
Veterinary officials in Denmark on 29 Apr 2008 reported a low-pathogenic avian influenza outbreak at a farm in the southern part of the country, according to a report to the World Organization for Animal Health (OIE). The outbreak site is a poultry farm in Stenstrup that housed 2,050 birds, mostly mallards but also including a few hundred other ducks and geese. All of the birds were culled. Preliminary testing revealed an H7 virus. The outbreak was identified through routine surveillance in poultry. Denmark's Veterinary and Food Administration established a restricted zone around the farm and disinfected the site. Denmark's last avian influenza outbreak occurred in July 2006 and involved a low-pathogenic H5N3 subtype.
Japan (Hokkaido): Two more dead swans infected with H5N1 avian influenza
Environmental officials in Japan said on 5 May 2008 that two more dead swans from two different sites have tested positive for the H5N1 virus.
One of the infected swans was found on 24 Apr 2008 on the Notsuke Peninsula in eastern Japan's Hokkaido prefecture. The other, which was positive for H5N1 in preliminary tests, was found near Lake Saroma, also in Hokkaido prefecture. Prefecture officials said they inspected five chicken farms within a 30-kilometer radius around the Lake Saroma site.
In late April 2008, animal health officials conducting heightened surveillance spurred by South Korea's H5N1 outbreaks found three dead wild swans and one sick one on the shores of Lake Towada in Akita prefecture. Samples from all four of the birds were positive for the virus.
Indonesia: Officials discuss virus sharing and NAMRU-2
Officials in Indonesia, the country with the highest number of human bird flu victims, have said they want to ensure equal access to any vaccines that are made against bird flu. But U.S. Health Secretary Michael Leavitt said after visiting Jakarta that Indonesia also wanted payments. Supari likened Indonesia's gripe over virus sharing to someone giving a ripe banana to someone so it could be fried to raise its value and then not giving any benefit to the person providing the banana.
"Well that's our culture, but Western culture cannot understand. Western people are used to buying the thing and after that don't feel any attachment," said Supari, who is known for being outspoken on the bird flu issue. She said that virus samples were not being sent to the WHO until a new fairer global mechanism for sharing was in place that ensured that samples sent from countries benefited them. "If the virus is from Indonesia they (WHO) must share with Indonesia, if the virus came from Vietnam they must share with Vietnam, and that also goes for Thailand."
The future of the U.S. naval lab in Jakarta would be discussed by the health, defense and foreign ministries, and the intelligence agency, Supari said. The minister said the U.S. lab had been receiving virus samples from across Indonesia, but that had been stopped. "We don't know what happened to the viruses that we sent," she said, adding the U.S. lab had also received samples from Indonesian soldiers deployed in Papua. A memorandum of understanding allowing the lab to operate in Jakarta expired two years ago and a new one is being discussed but sticking points include the number of U.S. staff that can have diplomatic immunity and an agreement over virus transfers. Supari said that the U.S. Naval Medical Research Unit No. 2, or NAMRU-2 for short, had provided Indonesia benefits for example during a dengue outbreak but not by as much as expected.
"For example, up to now malaria is still a problem, until now tuberculosis is still a problem and we don't have tools to diagnose. . .and we don't have vaccine or special treatment," she said, adding that NAMRU had also not provided research results. U.S. officials have dismissed accusations that the lab with about 170 staff it not transparent and said the facility, which has been in Indonesia since 1970 and is one of five in the world, is based in the Southeast Asian country to further studies into tropical diseases that benefits both nations.
India (West Bengal): H5N1 avian influenza resurfaces in backyard poultry
On 9 May 2008, officials said the virus had spread to the tea-growing Darjeeling district, the 15th to be hit by bird flu in 2008. "Tests in a central laboratory confirmed the recent poultry deaths from the H5N1 strain of the virus in Darjeeling district," Rajesh Pande, a senior government official said.
Around 300 birds mysteriously died in Sukna area in the foothills of the Himalayas near the bustling town of Siliguri, he said. "The deaths are all in backyard poultry and not in any farm," Pande added. After a massive culling operation, authorities in West Bengal said in February 2008 that bird flu was under control. The World Health Organization (WHO) has described the situation in West Bengal as India's worst bird flu outbreak in poultry. India's first outbreak of H5N1 was reported in 2006. Officials in West Bengal said they were looking for people with flu-like symptoms. India has so far not reported any human infections.
South Korea (Kyonggi): H5N1 avian influenza spreads to Seoul
The agriculture ministry said a case was reported at a small aviary run by Gwangjin district officials in eastern Seoul. "This was the first outbreak in Seoul. We believe it has been caused by infected pheasants that district officials purchased at an open market in the city of Seongnam south of Seoul," a ministry official said.
All 53 chickens, turkeys, and pheasants at the aviary were slaughtered, he said. "Initial blood tests showed pheasants and chickens were infected with bird flu, although the type of the virus is not yet known," he said. "Health officials are conducting blood tests to determine whether it was caused by the virulent H5N1 strain." Quarantine officials slaughtered poultry in a nearby public park and also plan to decontaminate aviaries and poultry farms in other parts of Seoul. A major theme park in southern Seoul culled 221 ducks, wild chickens and geese in its aviary. More than six million chickens and ducks have been slaughtered since the country's latest outbreak was reported on 1 April 2008, the ministry said.
The Korea Center for Disease Control and Prevention said it asked all hospitals in Seoul to keep a close eye on their patients and immediately report any suspected cases of human bird flu. The public health clinic in Gwangjin said on 7 May 2008 it had been swamped with inquiry calls or visits by residents, some with a high fever and headache, for medical checks. No bird flu infections were reported.
"They all turned out to be completely irrelevant to bird flu," Mo Hyun-Hee, head of the clinic, said. South Korea has not recorded any human cases of bird flu. A soldier taken to hospital last month was found not to have the disease. The agriculture ministry said quarantine authorities were continuing to decontaminate all aviaries and poultry farms in the city. Public access has been limited to those areas. It was also trying to trace poultry dealers and farms which had sold birds to a market at Seongnam south of Seoul, which was the suspected supplier of infected pheasants to the Gwangjin aviary.
Agriculture officials in South Korea said H5N1 avian influenza outbreaks have been reported in six of the country's nine provinces. South Korean officials said the three provinces that have not reported outbreaks are Gangweon in the northeast, North Chungcheong in the central part of the country, and Jeju, an island off the southern coast, according to a report on 3 May 2008. The H5N1 virus returned in South Korea in early April 2008 after about a year with no reported outbreaks. The virus first hit an egg producer in Gimje in North Jeolla province and quickly spread to several more farms, mostly in the southwest, before striking sites in southern and eastern areas.
In related events, North Korea announced on 5 May 2008 that it vaccinated poultry to prevent the spread of the virus from South Korea. Ri Kyong Gun, a North Korean quarantine official, said that poultry in provinces bordering South Korea received emergency vaccinations and that 1,600 observation posts had been established on the east and west coasts to monitor the movement of migratory birds.
Summary of Suggestions From the Task Force for Mass Critical Care Summit, January 26–27, 2007
Devereaux A, et al. Chest. 2008;133:1S-7
Mass casualty events occur frequently worldwide. Fortunately, the vast majority of these do not generate overwhelming numbers of critically ill victims. Attention to mass critical care, however, has been stimulated by the severe acute respiratory syndrome epidemic of 2002–2003, recent natural disasters, concern for intentional catastrophes, and the looming threat of a serious influenza pandemic. To guide preparedness for such events, the Task Force for Mass Critical Care (hereafter referred to as the Task Force) was convened. It comprised 37 experts from fields including bioethics, critical care, disaster preparedness and response, emergency medical services, emergency medicine, infectious diseases, hospital medicine, law, military medicine, nursing, pharmacy, respiratory care, and local, state, and federal government planning and response. Several members of the Critical Care Collaborative initiated the project and assembled a steering committee for project development and administration. Members of this steering committee included representatives from the organizational members of the Critical Care Collaborative as well as several unaffiliated North American disaster experts. This steering committee then selected members of the broader Task Force on the basis of their expertise and experience.
Preparedness for the Spread of Influenza: Prohibition of Traffic, School Closure, and Vaccination of Children in the Commuter Towns of Tokyo
Development and Validation of a One-Step Real-Time PCR Assay for Simultaneous Detection of Subtype H5, H7, and H9 Avian Influenza Viruses
Simultaneous Genotyping of All Hemagglutinin and Neuraminidase Subtypes of Avian Influenza Viruses by Use of Padlock Probes
CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools (www.pandemicpractices.org) online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a series exploring the development of these practices
Prodding citizens to prepare for pandemics and other disasters is a constant challenge, but public health officials in North Carolina have a creative approach that didn't require thinking outside the box, but rather inside of it—in the form of touch-screen computer kiosks.
In North Carolina, natural disaster isn't just an abstract concept to the state's residents, said Bill Furney, communication coordinator of North Carolina's office of Public Health Preparedness and Response (PHPR), which resides in the state's division of public health and is funded by the US Centers for Disease Control and Prevention.
"North Carolina is an equal-opportunity state for disasters. We have everything—tornados, landslides, flooding, and hurricanes," he said. PHPR developed the "Be Ready!" disaster preparedness kiosks in 2006 as a way to help the state's seven Public Health Regional Surveillance Teams spread the message about emergency preparedness, said Furney.
The seven surveillance teams were created after the 11 Sept 2008 terrorist attacks to respond to terrorism activities, infectious disease outbreaks, and natural disasters. He said PHPR needed a way to stir more interest in emergency preparedness brochures. "We could have printed a bazillion materials, but what is it that makes people want to read?" he said, adding that offering a kiosk component could grab the public's attention and lure them to look at the collateral materials.
According to PHPR, kiosks are a useful educational tool because they:
PHPR has eight kiosks, one for the main office and one for each of the seven regional surveillance teams. The kiosks are available to county and city public health departments, which use them at health fairs, county fairs, conferences, clinics, and other events. The devices are especially popular during the fall county fair season and during spring observances for public health month and week.
"This gives us the ability to provide a service to counties, which wouldn't necessarily be able to afford or coordinate this on their own," Furney said. He said it's rewarding watching people use the kiosks.
"The kids love it, and their parents will follow up on what they're doing," Furney said. "It really is a 'gee whiz' kind of technology that people will gravitate toward, but it's also functional." The kiosk devices allow public health officials the opportunity to cost-effectively offer interactive presentations on other topics, and Furney said that PHPR has recently installed a pandemic-specific module on the machines. So far, the biggest obstacle to using the kiosks in the field is keeping all of the devices maintained and repaired, Furney said. North Carolina's PHPR was recognized for its "Be Ready!" kiosks when the National Public Health Coalition awarded the group its 2006 silver excellence award in the new media (outsourced) category.
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 five 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: