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EINet Alert ~ Jun 20, 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: Pandemic preparedness pays off, but threat remains
- Global: Sanofi to give WHO 60 million doses of H5N1 avian influenza vaccine
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- UK (Oxfordshire): H5N1 avian influenza outbreak was restricted, say officials
- Australia: Authorities approve CSL’s H5N1 avian influenza vaccine
- China (Guangdong): Officials report outbreak of H5N1 avian influenza near Hong Kong border
- Hong Kong: Authorities battle outbreak of H5N1 avian influenza in poultry, first in five years
- North Korea (South Hamgyong): Suspected outbreak of H5N1 avian influenza
- Indonesia: Health Ministry reports two deaths from H5N1 avian influenza

2. Updates
- AVIAN/PANDEMIC INFLUENZA
- Global H5N1 Avian Influenza Update (OIE)

3. Articles
- Optimal allocation of pandemic influenza vaccine depends on age, risk, and timing
- Ability of regional hospitals to meet projected avian flu pandemic surge capacity requirements
- A hospital-based strategy for setting priorities for antiviral prophylaxis during an influenza pandemic
- Prioritization of Influenza Pandemic Vaccination to Minimize Years of Life Lost
- Protecting global health security through the International Health Regulations: requirements and challenges
- A legislative failure of epidemic proportions
- A clinical trial of a whole-virus H5N1 vaccine derived from cell culture

4. Notifications
- PHI2008 — Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
- Animal health and welfare aspects of avian influenza and the risk of its introduction into the EU poultry holdings — Scientific opinion of the Panel on Animal Health and Welfare


1. Influenza News

Global
Global: Pandemic preparedness pays off, but threat remains
David Nabarro, influenza coordinator for the UN, said during a press conference on 17 Jun 2008 that the world is better prepared to respond to an influenza pandemic, but he added that continuing outbreaks in some countries are a reminder that a major threat remains.

“The situation is really improving. It doesn’t mean that we can say the situation is completely under control — we have the situation in countries where it is still quite entrenched — but it does mean that in the rest of the world there is a great deal of vigilance and action under way,” said Nabarro.

He praised South Korea and the United Kingdom for how quickly they brought recent H5N1 outbreaks under control, and credited Australia and the United States with conducting pandemic exercises aimed at testing the resiliency of their financial sectors. Nabarro pointed out that the financial sector exercises show that it’s not necessarily expensive to prepare for a pandemic and such strategies could help countries prepare for other types of threats.

Nabarro also said many governments have aggressively invested in improving poultry biosecurity and have focused efforts on the link between animal and human diseases. Other notable achievements include the work that the World Tourism Organization has done to spearhead preparedness in travel and tourism industries and updates that the World Health Organization has made to its international health regulations and pandemic preparedness guidance, Nabarro said. However, he said that the UN was very concerned that the virus is still entrenched in nations such as Vietnam, Bangladesh, India, Egypt, and Indonesia, and, to some extent, Nigeria.

“We remain very concerned about Indonesia, where the disease seems to be concentrated among poultry, particularly in Western Java, and we’re also seeing the largest numbers of human cases,” Nabarro said.

National governments have pledged $2.7 billion to the UN over the past three or four years, he said, adding that countries have not earmarked their donations toward particular sectors, which helps the agency allocate the money toward animal and human health initiatives, as needed.

Preparations are under way for a global conference on the H5N1 virus and pandemic preparedness, Nabarro told reporters. The meeting will be held in October in Egypt. Representatives from UN agencies, the World Bank, and the Egyptian government will meet in July in Cairo to flesh out plans for the meeting. A likely outcome of the meeting will be a review of each country’s response to and preparation for avian influenza events and a better understanding of the private sector’s role as a partner in planning, he said.
(CIDRAP 6.18.08

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Global: Sanofi to give WHO 60 million doses of H5N1 avian influenza vaccine
Sanofi Pasteur pledged today to give 60 million doses of H5N1 influenza vaccine over three years to the World Health Organization (WHO) for a planned stockpile to help poor countries in the event of an influenza pandemic. Sanofi Pasteur, the vaccines division of French-based Sanofi-Aventis, is the second company to make a specific pledge for the WHO stockpile. A year ago, the United Kingdom’s GlaxoSmithKline (GSK) promised to provide 50 million doses of H5N1 vaccine. At two doses per person, the combined total of 110 million doses would be enough to vaccinate 55 million people.

“The H5N1 virus is currently circulating in some of the poorest regions of the world and an outbreak of pandemic influenza would most likely hit populations living in areas with limited access to vaccines,” said Wayne Pisano, Sanofi Pasteur’s president and chief executive officer. “This donation of H5N1 vaccine aims to address the needs of those most vulnerable populations.”

Sanofi Pasteur makes an H5N1 vaccine that is being stockpiled by the US government. It became the world’s first licensed H5N1 vaccine when the US Food and Drug Administration approved it in April 2007. The European Union approved an H5N1 vaccine made by GSK in May 2008. Sanofi did not say when it would turn over the first doses to the WHO. In May 2008, the WHO reported that work on the stockpile was under way, but no doses had been acquired yet. In that report, the WHO said the contemplated uses of the stockpile were to help contain the initial, localized emergence of a potential H5N1 pandemic and to provide vaccine to countries that would have little access to it.

Besides Sanofi and GSK, Omnivest of Hungary and US-based Baxter have expressed a willingness to contribute to the stockpile. WHO member countries called for the establishment of a global H5N1 vaccine stockpile when they met for the World Health Assembly in May 2007. The idea of a global stockpile emerged after complaints by Indonesia and other developing countries about lack of access to commercial H5N1 vaccines. In its news release, Sanofi said it is “committed to producing as many doses as possible of its most advanced vaccine in the shortest possible time frame should a pandemic be declared by WHO. Under such circumstances, Sanofi Pasteur’s seasonal influenza vaccine facilities would globally be able to switch to pandemic vaccine manufacturing.”
(CIDRAP 6.16.08)

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

2008
Bangladesh / 1 (0)
China / 3 (3)
Egypt / 7 (3)
Indonesia / 18 (15)
Viet Nam / 5 (5)
Total / 31 (24)

2007
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)

2006
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)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 20 (13)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 98 (43)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2003
China / 1 (1)
Viet Nam / 3 (3)
Total / 4 (4)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 385 (243).
(WHO 6.19.08 http://www.who.int/csr/disease/avian_influenza/en/index.html )

Avian influenza age distribution data from WHO/WPRO:
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm .
(WHO/WPRO 5.28.08)

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 6.2.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html .

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Europe/Near East
UK (Oxfordshire): H5N1 avian influenza outbreak was restricted, say officials
An outbreak of bird flu in Oxfordshire was confined to a single premise, a Department for Environment, Food and Rural Affairs (DEFRA) report has concluded. More than 25,000 chickens were culled after birds tested positive for the H7 strain of the disease on Eastwood Farm, near Banbury on 3 Jun 2008. DEFRA’s epidemiology report, published on 17 Jun 2008 says there was no evidence of infection in the protection zone.

However, investigations continue and the source is still being examined. The report suggests the possibility that the highly pathogenic H7N7 avian influenza came from a low pathogenic strain already present on the farm. Nigel Gibbens, chief veterinary officer, said: “The UK is at a constant but low level of risk of the introduction of avian influenza and the report highlights the need for flock owners and poultry vets to remain vigilant for signs of disease. I would encourage all keepers to maintain good quality records and practice high standards of biosecurity.” The 3km (1.8-mile) protection and 10km (6.2-mile) surveillance zones remain in place. Further surveillance, testing and epidemiological work on the outbreak are continuing.
(ProMED 6.17.08)

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Asia
Australia: Authorities approve CSL’s H5N1 avian influenza vaccine
Australian authorities have approved an H5N1 avian influenza vaccine made by the Australian-based pharmaceutical company CSL Limited, giving the country a home-grown defensive tool if the virus evolves into a pandemic strain. Meanwhile, Swiss-based Novartis has withdrawn its application for a European license for its own H5N1 vaccine, saying it couldn’t meet a deadline to supply additional clinical data requested by regulators, the European Medicines Agency (EMEA) announced on 18 Jun 2008.

CSL announced on 19 Jun 2008 the approval of its vaccine, Panvax, by Australia’s Therapeutic Goods Administration. The Australian government had provided more than $7 million to help develop the vaccine. Panvax can be used only when the Australian government officially declares that an influenza pandemic is under way, CSL said.

“In the event of a pandemic, CSL will rapidly gear up to manufacturing levels that will ensure all Australians have access to safe, effective coverage against avian flu,” said Mary Sontrop, general manager of CSL Biotherapies.

CSL said the immunogenicity and safety of Panvax have been tested in three clinical trials, involving adults aged 18 to 64 and adults older than 64. The vaccine, given in two doses, was found to be safe and well tolerated. The CSL statement listed no details about the composition of the vaccine. But a chart of clinical trials on the Web site of the International Federation of Pharmaceutical Manufacturers and Associations says it is a split-virus vaccine that is produced in eggs and is used with an adjuvant. Experts say that with egg-based production, it will take four to six months after the identification of a pandemic flu strain to develop and launch mass production of a precisely matched vaccine. Roxon said Australia already has 1.2 million doses of a foreign-made vaccine on hand.
(CIDRAP 6.19.08)

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China (Guangdong): Officials report outbreak of H5N1 avian influenza near Hong Kong border
China on 17 Jun 2008 reported a bird flu outbreak in ducks in the southern province of Guangdong, close to Hong Kong where poultry at all commercial markets was culled recently. The Guangdong outbreak, in a village administered by Jiangmen city, was first detected on 13 Jun 2008. The National Avian Influenza Reference Laboratory confirmed on 17 Jun 2008 that the virus the birds contracted was a subtype of the H5N1 strain. A total of 3,873 ducks died of the disease and a further 17,127 were culled as part of a contingency plan aimed at containing the outbreak.

Large parts of densely populated Guangdong province, which provides much of Hong Kong’s poultry, have also been battling floods triggered by downpours in the past week. Hong Kong banned poultry imports from the Chinese mainland for 21 days since the first instance of the virus was discovered there in early June 2008. China reported its last bird flu outbreak in April 2008 in Tibet. It also recorded an outbreak in March in Guangzhou, Guangdong’s provincial capital. With the world’s biggest poultry population and hundreds of millions of farmers raising birds in their backyards, China is seen as crucial in the global fight against bird flu. (
ProMED 6.17.08)

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Hong Kong: Authorities battle outbreak of H5N1 avian influenza in poultry, first in five years
An outbreak of the deadly H5N1 bird flu virus in poultry in Hong Kong food markets has led to the culling of live poultry across the city. According to government officials the bird flu virus was detected at a poultry stall in one of Hong Kong’s numerous wet markets and as a result 2,700 birds were culled. But the virus has now spread among the island’s poultry population and mass cullings have been conducted as a precaution to try to control the spread of the virus. Officials say that all wet market stores and fresh food stores selling live poultry are now infected areas and all poultry will be culled, but poultry on local farms is not said to be affected. Officials say mass the cullings are a necessary precaution but no people have been infected and they are trying to trace the source of the outbreak.

The outbreak of the virus, the first in Hong Kong wet markets in five years, has prompted Hong Kong authorities to suspend live poultry imports from mainland China. This year there have been a number of outbreaks of bird flu among migrating birds in the territory, which are the suspected culprits in spreading the disease worldwide and it was in Hong Kong that the world’s first reported major bird flu outbreak among humans occurred in 1997, which killed six people.
(ProMED 6.17.08)

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North Korea (South Hamgyong): Suspected outbreak of H5N1 avian influenza
Bird flu has broken out near a North Korean military base in the first reported case of the disease in the country since 2005, a South Korean aid group said on 11 Jun 2008. The outbreak occurred during the week of 1-7 Jun 2008 near an air force base in Jongpyong county in South Hamgyong province, north east of the capital Pyongyang, according to the Seoul-based private aid group Good Friends. The case was first reported 3 Jun 2008, when several birds were found dead in a small mountain area near the military base, said the aid agency. There were no details on whether it was the H5N1 virus, which can be deadly to humans. South Korea’s Unification Ministry said it could not immediately confirm the report.

Separately, dozens of magpies were found dead inside a political prison camp in Hwasong in North Hamgyong province, said Good Friends. A prison camp official’s five-year-old child subsequently suffered a high fever and died, the group said. There was no way to confirm if the child caught a virus from the birds or to know what killed the child. The Buddhist-affiliated group that sends food and other aid to the North also said two prisoners showed similar symptoms and three others were subsequently diagnosed with an unidentified virus. Good Friends has previously provided information on the North that has proven correct but does not provide information on its sources, out of fear they could face retribution.

The case prompted the authorities to quarantine people inside the prison camp and launched preventive measures, but they failed to identify the disease, said the aid agency. It had no details of measures taken. The North’s outbreak came after South Korea slaughtered 8.46 million chickens, ducks and other poultry in recent months to stem the spread of bird flu. Bird flu was last known to have hit North Korea in 2005, leading to the killing of about 210,000 birds.
(ProMED 6.14.08)

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Indonesia: Health Ministry reports two deaths from H5N1 avian influenza
The Indonesian health ministry has reported two deaths from bird flu in recent weeks, easing concerns about whether Jakarta would share information about the disease, the World Health Organization (WHO) said on 19 Jun 2008. The latest infections are the first since Health Minister Siti Fadillah Supari said two weeks ago that Jakarta had changed its policy on reporting human cases and would only announce the death toll every six months. The WHO, a UN agency, has been seeking clarification on her remarks, which appeared to run counter to international health regulations requiring the WHO’s 193 member states to report human cases of bird flu within 24 hours.

“We’ve had reassurances they are going to comply with the international health regulations,” WHO spokesman in Geneva John Rainford told Reuters on 19 Jun 2008.

The WHO, in a statement reporting information from the Indonesian health ministry, said that a 16-year-old girl from South Jakarta died on 14 May 2008 and a 34-year-old woman from Banten province died on 3 Jun 2008. Investigation into the girl’s death indicates she was exposed to sick and dead poultry, which carry the H5N1 virus, while investigations into the source of the second woman’s infection are continuing, according to the WHO statement.

Indonesia has maintained its decision not to share bird flu samples with WHO laboratories, saying it wants guarantees from richer nations and drug makers that poor countries would get access to affordable vaccines developed from their samples. International health experts say it is vital to have access to samples of the constantly-mutating virus, which they fear could change into a form spreading more easily among humans and sweep the world in months, killing millions of people.

“There is a strong working relationship between the WHO country office and the government. Even if there is a conflict on issues like virus-sharing, it hasn’t eroded the ability to carry out joint investigations,” Rainford said.
(ProMED 6.20.08)

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2. Updates
AVIAN/PANDEMIC INFLUENZA
  • UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDP recently launched a new web site for information on fund management and administrative services and includes the website of the Central Fund for Influenza Action. This site also includes a list of useful links to governments, international agencies, NGOs, and scientific organizations.
  • WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html . The Influenza Virus Tracking System is now live and can be accessed by the public at: www.who.int/fluvirus_tracker .
  • UN FAO: http://www.fao.org/avianflu/documents/key_ai/key_book_preface.htm . Read the first installment of a major new and wide-ranging overview of avian influenza that has just been released by FAO.
  • OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm. Link to the Communication Portal gives latest facts, updates, timeline, and more.
  • US CDC: http://www.cdc.gov/flu/avian/index.htm . View weekly US Flu Activity Report at: http://www.cdc.gov/flu/whatsnew.htm .
  • The US government’s Web site for pandemic/avian flu: http://www.pandemicflu.gov/ . View the factsheet “Control of Pandemic Flu Virus on Environmental Surfaces in Homes and Public Places” at: http://www.pandemicflu.gov/plan/individual/panfacts.html .
  • CIDRAP: http://www.cidrap.umn.edu/ See Pandemic preparedness tools: Find more than 130 peer- reviewed practices from 22 states and 33 counties aimed at furthering pandemic preparedness.
  • PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm Link to National Influenza Centers in PAHO Member States.
  • US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp Read about the latest news on H5N1 in wild birds and poultry. (UN; WHO; FAO, OIE; CDC; CIDRAP; PAHO; USGS)

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    Global H5N1 Avian Influenza Update (OIE)
    Between 2003 and early 2008, a total of 61 countries/territories reported the occurrence of highly pathogenic avian influenza (HPAI) virus subtype H5N1.

    Some historical background information on this disease: in late 2003 and in 2004 the disease was restricted to Southeast Asia and in 2005 spread to Central Asia, Russia, and Eastern Europe. In 2006, it reached the African continent and the Middle East for the first time and spread to Western Europe, where mainly wild birds were infected. In 2006, a total of 47 countries/territories notified the OIE of the presence of the disease. In 2008 (up to the end of May), 12 countries/territories had notified the reoccurrence of HPAI H5N1 following its previous eradication, thus indicating that the virus is continuing to circulate. These are the Republic of Korea, Hong Kong (SARPRC), India, Iran, Israel, Japan, Laos, Switzerland, Thailand, Turkey, Ukraine, and the United Kingdom (wild birds).

    In 2007, 29 countries (four in Africa, 14 in Asia, three in the Middle East, and eight in Europe) reported HPAI subtype H5N1 in poultry, in wild birds, or in both poultry and wild birds. For Bangladesh, Benin, Ghana, Kuwait, Saudi Arabia, and Togo these were the first ever reports of the disease. In 2007, the number of countries that reported outbreaks was smaller (29 countries) than in 2006, when 47 countries were affected. Starting in 2007, the trend has been for a decline in both the number of affected countries and the number of notified outbreaks. Benin, Germany, Israel, Myanmar, Nigeria, Poland, Romania, Saudi Arabia, Togo, and the United Kingdom submitted a final report indicating the resolution of the outbreaks of HPAI H5N1 and the absence of any new outbreaks. Germany, Israel, Myanmar, Poland, Romania, and Saudi Arabia declared themselves free from HPAI in poultry.

    In March 2008, Viet Nam notified the presence of this disease in a new host species. The affected animals were six Owston’s palm civets (Chrotagale owstoni) in the Cuc Phuong National Park. The disease had been identified in civets in 2005 but the OIE was not notified at that time.

    Regarding the evolution of the disease, 18 affected countries succeeded in eradicating the disease in 2007 and 11 countries did so early in 2008. However, four of the 18 countries where HPAI had been eradicated in 2007 notified the reoccurrence of the disease at the beginning of 2008. In other countries, such as Indonesia, Egypt, and possibly certain parts of Vietnam, Bangladesh and the People’s Republic of China, the disease is not under control, despite the vaccination strategy (excluding Bangladesh) put in place. Nine out of 18 countries that submitted a final report in 2007 declared themselves free from HPAI H5N1.

    This epizootic of HPAI subtype H5N1 is unprecedented since there are no records of an epizootic having lasted so long a time and having covered such a wide geographical area in such a short period of time. While it is important to combat the disease at source, additional efforts are needed in order to monitor on a more regular basis the efficiency of the vaccines currently in use, to increase vaccination coverage and to decrease the interval between vaccinations in countries where the disease is endemic. It will not be possible to attain these objectives without a very real international and national commitment to apply effective vaccination, so as to achieve better control of the disease and ultimately its eradication once vaccination is no longer used.
    (ProMED 6.14.08)

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    3. Articles
    Optimal allocation of pandemic influenza vaccine depends on age, risk, and timing
    Mylius SD, et al. Vaccine. 7 May 2008 [Epub ahead of print].

    Abstract
    The limited production capacity for vaccines raises the question what the best strategy is for allocating the vaccine to mitigate an influenza pandemic. We developed an age-structured model for spread of an influenza pandemic and validated it against observations from the Asian flu pandemic. Two strategies were evaluated: vaccination can be implemented at the start of the influenza pandemic, or vaccination will be implemented near the peak of it. Our results suggest prioritizing individuals with a high-risk of complications if a vaccine becomes available during a pandemic. If available at the start, vaccinating school children might be considered since this results in slightly lower expected number of deaths.
    (CIDRAP 6.19.08)

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    Ability of regional hospitals to meet projected avian flu pandemic surge capacity requirements
    Ten Eyck RP. Prehospital and disaster medicine. 2008;23(2):103-12.

    Introduction
    Hospital surge capacity is a crucial part of community disaster preparedness planning, which focuses on the requirements for additional beds, equipment, personnel, and special capabilities. The scope and urgency of these requirements must be balanced with a practical approach addressing cost and space concerns. Renewed concerns for infectious disease threats, particularly from a potential avian flu pandemic perspective, have emphasized the need to be prepared for a prolonged surge that could last six to eight weeks.
    (CIDRAP 6.18.08)

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    A hospital-based strategy for setting priorities for antiviral prophylaxis during an influenza pandemic
    Hsu EB, Millin MG. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 2008;6(2):171-178.
    http://www.liebertonline.com/doi/abs/10.1089/bsp.2007.0057

    Summary
    In the event of an influenza pandemic, it is likely that there will be a shortage of antiviral medications to treat flu patients. How will hospitals decide who will receive the available medications? Based on the recommendations of an expert panel, the authors suggest some ways for hospitals to set priorities.
    (CIDRAP 6.17.08)

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    Prioritization of Influenza Pandemic Vaccination to Minimize Years of Life Lost
    Miller MA, et al. The Journal of Infectious Diseases 2008;198:000–000
    http://www.journals.uchicago.edu/doi/abs/10.1086/589716

    Background
    How to allocate limited vaccine supplies in the event of an influenza pandemic is currently under debate. Conventional vaccination strategies focus on those at highest risk for severe outcomes, including seniors, but do not consider (1) the signature pandemic pattern in which mortality risk is shifted to younger ages, (2) likely reduced vaccine response in seniors, and (3) differences in remaining years of life with age.

    Methods
    We integrated these factors to project the age-specific years of life lost (YLL) and saved in a future pandemic, on the basis of mortality patterns from thre historical pandemics, age-specific vaccine efficacy, and the 2000 US population structure.

    Results
    For a 1918-like scenario, the absolute mortality risk is highest in people <45 years old; in contrast, seniors (those 65 years old) have the highest mortality risk in the 1957 and 1968 scenarios. The greatest YLL savings would be achieved by targeting different age groups in each scenario; people <45 years old in the 1918 scenario, people 45-64 years old in the 1968 scenario, and people >45 years old in the 1957 scenario.

    Conclusions
    Our findings shift the focus of pandemic vaccination strategies onto younger populations and illustrate the need for real-time surveillance of mortality patterns in a future pandemic. Flexible setting of vaccination priority is essential to minimize mortality.
    (CIDRAP 6.17.08)

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    Protecting global health security through the International Health Regulations: requirements and challenges
    Wilson K, von Tigerstrom B, et al. Early release, published on 12 June 2008
    http://www.cmaj.ca/cgi/rapidpdf/cmaj.080516

    Introduction
    The International Health Regulations, the principle document governing the response to public health emergencies that pose an international threat, were revised in 2005 and became binding international law on June 15, 2007. These new regulations, unanimously approved by the World Health Assembly, differ in important ways from previous versions and represent a major step forward in protecting global public health security. Despite their importance, countries will face several challenges to implementing the regulations. Many developing countries lack the capacity to detect and respond to public health emergencies, and developed countries may choose to act unilaterally. Decentralized states such as Canada will also face specific challenges to implementation. In May 2008, the Auditor General of Canada issued a report highlighting areas in which Canada has had difficulty complying with the new regulations. In this article, we describe how the regulations provide new guidance to member states on preparing for and responding to public health emergencies, some of the challenges to compliance with the regulations, and Canada’s role in helping to ensure their successful implementation.
    (CIDRAP 6.14.08)

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    A legislative failure of epidemic proportions
    Attaran A. CMAJ. Early release on 12 June 2008
    http://www.cmaj.ca/cgi/rapidpdf/cmaj.080818

    Introduction
    Thrice in a decade — in 1999, 2002 and now in 2008 — the Auditor General of Canada has slammed Ottawa and the provinces for doing an indolent job of protecting Canadians from epidemic emergencies. And thrice in a decade, she has been ignored. Today, there is not a politician in the country who has not heard of SARS or avian influenza, and who is not aware that a massive epidemic or pandemic could kill tens or hundreds of thousands of Canadians within weeks or months. Yet the federal and provincial governments cannot agree on how they will share epidemiologic information in a disease outbreak.
    (CIDRAP 6.14.08)

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    A clinical trial of a whole-virus H5N1 vaccine derived from cell culture
    Ehrlich HJ, Muller M, et al. New England Journal of Medicine. 2008;358(24):2573-2584
    http://content.nejm.org/cgi/content/full/358/24/2573

    Background
    Widespread infections of avian species with avian influenza H5N1 virus and its limited spread to humans suggest that the virus has the potential to cause a human influenza pandemic. An urgent need exists for an H5N1 vaccine that is effective against divergent strains of H5N1 virus.

    Methods
    In a randomized, dose-escalation, phase 1 and 2 study involving six subgroups, we investigated the safety of an H5N1 whole-virus vaccine produced on Vero cell cultures and determined its ability to induce antibodies capable of neutralizing various H5N1 strains. In two visits 21 days apart, 275 volunteers between the ages of 18 and 45 years received two doses of vaccine that each contained 3.75 µg, 7.5 µg, 15 µg, or 30 µg of hemagglutinin antigen with alum adjuvant or 7.5 µg or 15 µg of hemagglutinin antigen without adjuvant. Serologic analysis was performed at baseline and on days 21 and 42.

    Results
    The vaccine induced a neutralizing immune response not only against the clade 1 (A/Vietnam/1203/2004) virus strain but also against the clade 2 and 3 strains. The use of adjuvants did not improve the antibody response. Maximum responses to the vaccine strain were obtained with formulations containing 7.5 µg and 15 µg of hemagglutinin antigen without adjuvant. Mild pain at the injection site (in 9 to 27% of subjects) and headache (in 6 to 31% of subjects) were the most common adverse events identified for all vaccine formulations.

    Conclusions
    A two-dose vaccine regimen of either 7.5 µg or 15 µg of hemagglutinin antigen without adjuvant induced neutralizing antibodies against diverse H5N1 virus strains in a high percentage of subjects, suggesting that this may be a useful H5N1 vaccine.
    (CIDRAP 6.12.08)

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    4. Notifications
    PHI2008 — Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
    http://www.gpphi.org/conferences

    Dates: 18-19 September 2008
    Location: Seattle, WA, USA
    Venue: Bell Harbor International Conference Center

    PHI2008 will be hosted by Global Partners in Public Health Informatics (GPPHI) at the Center for Public Health Informatics (CPHI) at the University of Washington, Seattle, WA, United States. The idea of creating a partnership of governmental and non-governmental organizations, academic institutions, and companies to define and develop a vision for addressing health challenges in low-resource settings through information and communications technologies was first articulated at PHI2007: Building a Global Partnership in Public Health Informatics. PHI2007 brought together nearly 200 individuals from across the globe who created the impetus for the Global Partners in PHI.

    The Rockefeller Foundation recently funded the UW Center for Public Health Informatics to begin the planning process for the Global Partners organization. That process will take place over the coming year through an invitational meeting on Public Health Informatics at the Rockefeller Foundation conference center in Bellagio, Italy as well as at the second annual GPPHI meeting — PHI2008 — to be held in September 18-19, 2008 at the Bell Harbor Conference Center, Seattle, Washington, United States. The theme for the PHI2008 meeting is “Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies.”

    Program:

    • Keynote addresses by leading international experts
    • Plenary presentations:
      • National approaches from countries leading the development of integrated public health information systems
      • Creative approaches to collecting and linking data and systems to improve public health practice
      • Strategies for compiling and delivering contextually relevant information for decision support
    • Poster sessions presenting research and applied methodologies and results from public health informatics interventions in low-resource settings throughout the world
    • Panelist discussions of funding opportunities for research and applications development
    • Information exchange and networking opportunities

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    Animal health and welfare aspects of avian influenza and the risk of its introduction into the EU poultry holdings — Scientific opinion of the Panel on Animal Health and Welfare
    http://www.efsa.europa.eu/EFSA/efsa_locale-1178620753812_1178713016506.htm

    Following a request from the European Commission, the Animal Health and Welfare (AHAW) panel was asked to deliver a scientific opinion on the animal health and welfare aspects of avian influenza and the risk of its introduction into the European Union poultry holdings. More in particular, the Commission was asked to update, consolidate, and summarize the main conclusions and recommendations from previous EFSA opinions influenza in the light of new scientific evidence available. Further, the AHAW panel was asked to provide scientific advice and assess risk factors for the introduction and spread of avian influenza to support a possible fine-tuning of current prevention and biosecurity measures taken by the member states. This article includes opinions on topics such as epidemiology and surveillance, intervention strategies, impacts on biodiversity, transmission, and many more.
    (ProMED 6.12.08)

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