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EINet Alert ~ Jun 06, 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)
- UK (Oxfordshire): High-pathogenic H7N7 avian influenza confirmed
- Indonesia: Government stops notifying global health authorities of H5N1 avian influenza cases
- USA: Researchers find North America still free of H5N1 avian influenza
- USA: HHS announces preparedness grants for public health, hospitals
- USA: Routine surveillance finds low-pathogenic H7N3 avian influenza in US poultry
- AVIAN/PANDEMIC INFLUENZA
- Impact of Emerging Antiviral Drug Resistance on Influenza Containment and Spread: Influence of Subclinical Infection and Strategic Use of a Stockpile Containing One or Two Drugs
- Healthcare workers' attitudes towards working during pandemic influenza: A multimethod study
- Plasmid DNA-Based Vaccines Protect Mice and Ferrets against Lethal Challenge with A/Vietnam/1203/04 (H5N1) Influenza Virus
- Thermal Inactivation of Avian Influenza and Newcastle Disease Viruses in Chicken Meat
- World Vaccine Congress Asia 2008
- International Meeting On Emerging Diseases and Surveillance (IMED 2009)
- HHS offers pandemic guidance on masks, antivirals
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: 383 (241).
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 5.28.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 5.20.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
UK (Oxfordshire): High-pathogenic H7N7 avian influenza confirmed
The avian influenza virus that struck chickens on a farm in England this week has been identified as highly pathogenic H7N7 and is probably related to viruses that have sometimes surfaced in other European countries, British officials said on 5 June 2008. "Preliminary analysis . . . indicates that this H7N7 strain is likely to be related to viruses which have occasionally been detected in domestic poultry and wild birds elsewhere in Europe," the United Kingdom Department for Environment, Food, and Rural Affairs (DEFRA) said. DEFRA said further laboratory tests were under way. The statement did not suggest how closely related the virus may be to the H7N7 strain that caused a series of major poultry outbreaks and forced the destruction of millions of birds in the Netherlands in 2003. That virus also infected at least 89 people, causing mild conjunctivitis in most cases but killing a veterinarian.
First reported on 3 June 2008, the latest outbreak occurred on a farm near Banbury, Oxfordshire, about 80 miles northwest of London. A flock of 25,000 chickens is being culled. "The Health Protection Agency has advised that H7N7 avian flu remains largely a disease of birds and the risk to human health is low," a DEFRA statement said. The agency set up protection and surveillance zones around the outbreak site and said a full epidemiologic investigation was under way. Richard Court, the owner of the farm, said the source of the outbreak was unknown.
Indonesia: Government stops notifying global health authorities of H5N1 avian influenza cases
Indonesia's health minister said today the government has stopped the practice of promptly notifying global health officials each time it confirms a human H5N1 avian influenza case or death, a move some say will likely hamper efforts to monitor the world's pandemic risk level.
Health Minister Siti Fadilah Supari on 5 June 2008 confirmed that a 15-year-old girl from Jakarta tested positive for H5N1 avian influenza on May 13 2008 and died the next day. Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza had previously listed the case as confirmed on its Web site, but the information is apparently no longer listed. The WHO, which typically confirms cases when it receives notifications from health ministries or test results from its collaborating laboratories, has not yet confirmed Indonesia's most recent case and has not commented on Supari's decision to stop sending out H5N1 case notifications. The WHO last confirmed an Indonesian H5N1 case in a three-year old boy who died on Apr 23.
Supari said that the health ministry would not send out H5N1 case confirmations until after they have been reported in the media. However, Reuters reported that the ministry will announce the death toll from the H5N1 virus only every six months. "How does it help us to announce these deaths?" Supari said. "We want to focus now on positive steps and achievements made by the government in fighting bird flu." She said that announcements of H5N1 deaths are sometimes misunderstood. "It's OK not to announce it. Sometimes they only give hurtful comments instead of helping," she said without further explanation.
Sharon Sanders, editor-in-chief of FluTrackers, a well-known Web message board that focuses on avian flu developments, said that Indonesia's decision to delay H5N1 notifications will obscure what is happening there, which negatively affects the world's ability to prepare for a pandemic. She said Indonesia's news blackout would likely have the opposite effect from what the government apparently intends. "Now, there will be intense speculation and generation of rumors surrounding suspicious deaths that have similar symptoms to H5N1 infections," Sanders said. "False rumors of an H5N1 outbreak have the potential to be even more economically devastating than a government-confirmed outbreak."
USA: Researchers find North America still free of H5N1 avian influenza
The feared H5N1 avian influenza has yet to make it to North America in the bodies of migrating birds, researchers said on 5 June 2008. Testing of more than 16,000 migratory birds between May 2006 and March 2007 showed no evidence of the H5N1 bird flu virus, which has become entrenched in many parts of Asia and which regularly pops up in flocks in Europe, the Middle East and Africa.
The birds are infected with virtually every other known strain of influenza, said Hon Ip of the U.S. Geological Survey, National Wildlife Health Center in Madison, Wisconsin. But not the highly pathogenic H5N1 virus. "Maybe the Pacific Ocean is a nice, big biological barrier, for which I am forever grateful," Ip said. "The general avian influenza infection rate is not really different in Alaska or North America than pretty much anywhere else. In spite of H5N1's spread through most of Asia and into Africa and Europe, that spread has not come into North America," Ip added.
About 1.7 percent of the birds were infected, but all with low-pathogenic strains of influenza viruses, which typically do not cause disease, Ip's team reported in the Virology Journal. However, U.S. government officials have said it is inevitable that migratory birds will carry H5N1 to the Americas at some time. An estimated that 1.5 million to 2.3 million birds migrate from Asia to Alaska each year. But Ip, who worked with teams at the U.S. Department of Agriculture, the Fish and Wildlife Service and the Alaska Department of Fish and Game, says it has not happened yet. The researchers are sampling birds that ornithologists say are the most likely to have migrated recently from Asia. "Some of these viruses contain a mix of genes from both North American and Asian viruses," Ip said. "We have direct evidence that the birds are carrying back at least a relative or descendant of viruses from Asia," he added. "This confirms we are sampling from those birds that are most likely to bring H5N1 back if H5N1 was to be brought back from Asia." It also confirms that the viruses swap genes inside the birds -- a process that scientists believe gives rise to new and sometimes more dangerous strains.
The researchers have been testing birds since 2005 for H5N1, concentrating on Alaska but looking in all regions. The birds most likely to be infected with any kind of flu virus are the dabbling ducks -- species such as mallards, Ip said. This reinforces the theory that the virus spreads as birds feed in the same water in which they are defecating.
USA: HHS announces preparedness grants for public health, hospitals
HHS earmarked $1.1 billion for two related cooperative agreement programs: Public Health Emergency Preparedness (PHEP), administered by the Centers for Disease Control and Prevention (CDC), and the Hospital Preparedness Program (HPP), managed by the HHS Assistant Secretary for Preparedness and Response (ASPR). HHS said it allocated $704.8 million in PHEP funds to states, territories, and certain metropolitan areas, which is down from $896 million the agency granted in 2007. However, last year's amount included $175 million for pandemic influenza preparedness. Focus areas for this year's funds include:
In February 2008, TFAH issued an analysis of the Bush administration's budget proposals for 2009 in which it raised concerns over shrinking funding levels for public health preparedness and hospital readiness programs. Over the past five years, the funding level has been reduced by one-third, according to a TFAH press release that accompanied the analysis. At about the same time, a report from the National Association of County and City Health Officials (NACCHO) said that the cuts have impaired local preparedness efforts.
USA: Routine surveillance finds low-pathogenic H7N3 avian influenza in US poultry
While the findings are no threat to humans, shares of US chicken companies dropped as investors worried foreign buyers may ban US chicken. The United States exports about 16 percent of its chicken, and a loss of key overseas markets could create a glut of chicken here. There have been previous cases of mild bird flu in the United States. In 2007, government investigators found cases in 13 states. Because of the Arkansas findings the US Agriculture Department (USDA) already has suspended shipments of chicken from that state to Russia, the top overseas market for US chicken. One concern is Russia may implement a broader ban. "The Russians might say nothing or they may ban all sales from us. There is no predicting what they will do," said Paul Aho, economist with the consulting firm Poultry Perspective.
In addition to Tyson's shares, shares of top chicken producer Pilgrim's Pride Corp and smaller rival Sanderson Farms Inc also were lower on 3 Jun 2008. "By itself, the ban of exports from Arkansas doesn't necessarily change the momentum of the export business," Jonathan Feeney, Wachovia food industry analyst, said in a note to clients. He said chicken can just be exported from other states. While the stock market may be justified "to give some pause to the news," Feeney said the drop in chicken company shares seems overdone. "Honestly, it's a non-event. So far, it's not something that's reportable to any international monitoring agency like the World Organization for Animal Health (OIE)," said Toby Moore, spokesman for the USA Poultry and Egg Export Council, an industry trade group.
The Arkansas chickens were not sick and the antibodies were discovered as part of routine surveillance by the company, Tyson said. Shares of Tyson Foods fell more than nine percent on New York Stock Exchange trading on 3 Jun 2008, but by early afternoon were down about eight percent, or USD 1.44, at USD 17.01. While tests showed the birds had antibodies for the mild bird flu strain, "there was no indication the birds currently have the virus," the company said.
Impact of Emerging Antiviral Drug Resistance on Influenza Containment and Spread: Influence of Subclinical Infection and Strategic Use of a Stockpile Containing One or Two Drugs
McCaw JM, et al. PLoS ONE 3(6): e2362.
Methods and Findings
Healthcare workers' attitudes towards working during pandemic influenza: A multimethod study
Methods This study is designed as a two-phase multi-method study, incorporating focus groups and a questionnaire survey. In phase one, qualitative methods will be used to collect the views of a purposive sample of HCWs, to determine the range of factors associated with their responses to the prospect of working through pandemic influenza. In phase two, the findings from the focus groups, combined with the available literature, will be used to inform the design of a survey to determine the generalisability of these factors, enabling the estimation of the likely proportion of HCWs affected by each factor, and how likely it is that they would be willing and/or able to continue to work during an influenza pandemic.
Plasmid DNA-Based Vaccines Protect Mice and Ferrets against Lethal Challenge with A/Vietnam/1203/04 (H5N1) Influenza Virus
Thermal Inactivation of Avian Influenza and Newcastle Disease Viruses in Chicken Meat
Thomas C, et al. Journal of Food Protection. 2008;71(6):1214-1222.
Dates: 2-5 June 2008
World Vaccine Congress Asia 2008 is an annual meeting place where vaccine buyers and sellers, health authorities, financing institutions, regulators, big and small vaccine producers and manufacturers, technology providers and other stakeholders come together to discuss industry trend, market and partnership opportunities, new vaccines and new technology innovations across Asia.
Meet vaccine experts from NGOs (e.g. Bill & Melinda Gates, PATH, WHO, IVI) and top vaccine companies such as Green Cross, 9Bio, Novartis, Intercell, Dynavax, Sanofi Pasteur, CNBG, AdImmune, NasVax, Vaxine, Serum Institute of India, IVAC, Shantha Biotechnics, Panacea Biotec and more.
Dates: 13-16 Feb 2009
Emerging infectious diseases are at the center of the world’s attention. The threats of pandemic influenza and bioterrorism, and the realization that new infectious diseases may be recognized at any time, in any place, have dramatically raised our awareness. What are the most important emerging disease threats? How can we quickly detect their occurrences in order to respond in a timely and appropriate way?
ProMED, the Program for Monitoring Emerging Diseases, is pleased to invite you to the International Meeting on Emerging Diseases and Surveillance 2009. Along with our co- sponsors, the European Centers for Disease Control, the World Organization for Animal Health, the European Commission, and the Wildlife Conservation Society, we are developing a conference that will bring together the public health community, scientists, health care workers and other leaders in the field of emerging infectious diseases. The meeting will embrace the ‘One Medicine, One Health’ concept recognizing that, just as diseases reach across national boundaries, so do they transcend species barriers. We therefore welcome the full participation of both the human and animal health communities.
IMED 2009 will be organized by the International Society for Infectious Diseases, which has over 20 years experience in planning and implementing international biomedical meetings. Because of the enthusiastic response to the inaugural meeting, IMED 2007, which attracted over 600 participants from 65 countries, IMED 2009 will expand to 3 full days of sessions and include more opportunities for oral presentations of submitted abstracts.
Abstract Submission: The deadline for abstract submission is December 1, 2008.
Target Audience: ProMED-mail participants, physicians, veterinarians and other health care workers, public health workers, scientists, pharmaceutical and biotechnology industry, journalists, other interested persons.
Proposed pandemic preparedness guidance released by the federal government recommends that people wear face masks if they have to go into crowds during an influenza pandemic and says critical infrastructure businesses should consider stockpiling antiviral drugs, among various other suggestions. The guidance from the US Department of Health and Human Services (HHS) also spells out a role for preventive use of antiviral drugs in a pandemic but says that antivirals used preventively will have to come mainly from private stockpiles, because government stockpiles will be used mostly for treating the sick. HHS released three draft guidance documents, covering the use of face masks and respirators by individuals and families, antiviral use during a pandemic, and considerations on antiviral drug stockpiling by employers. The agency is inviting public comments on all of them and says none as yet represents established policy.
Masks and respirators
The proposed recommendations on use of antiviral drugs replace advice that was developed in 2005 as part of the HHS pandemic preparedness and response plan. The recommendations were prepared by an interagency group that included state, local, and tribal public health agencies as well as HHS. The proposed guidance recommends prophylactic antivirals for several groups, but it says the supplies used for that purpose "will depend largely on private sector organizations and businesses purchasing and stockpiling antiviral drugs for their employees." The document recommends that government antiviral supplies "be prioritized for treatment of all persons who may benefit from therapy," without attempting to put certain groups ahead of others. Further, it states, "Treatment is preferred to prophylaxis in settings of limited antiviral drug supply; targeting some antiviral drug supply for prophylaxis and prioritizing treatment for certain groups would raise significant ethical and logistical challenges." The working group recommends that antivirals be used for:
Employer stockpiling of antivirals