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EINet Alert ~ Aug 29, 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)
- Global: Researchers say oseltamivir resistance becoming more prevalent
- India (West Bengal): Officials suspect smuggled poultry in 2008 H5N1 avian influenza outbreak
- Japan: Sharp Corp's air purifier could be valuable weapon in the fight against H5N1 avian influenza
- Viet Nam: Unusual strain of H5N1 avian influenza virus starting to appear in smuggled poultry
- USA: Novavax one step closer to licensing pandemic vaccine production system
- Benin (Lokossa): H5N1 avian influenza detected at live poultry market
- USA: University of Pittsburg receives $3.6 million for avian influenza vaccine research
- AVIAN/PANDEMIC INFLUENZA
- Protein structure discovery could help in the fight against influenza epidemics
- Influenza A virus infections in land birds, People’s Republic of China
- Evidence of Infection by H5N2 Highly Pathogenic Avian Influenza Viruses in Healthy Wild Waterfowl
- Genotypic diversity of H5N1 highly pathogenic avian influenza viruses
- Clinical Characteristics of 26 Human Cases of Highly Pathogenic Avian Influenza A (H5N1) Virus Infection in China
- Evolutionary and Transmission Dynamics of Reassortant H5N1 Influenza Virus in Indonesia
- PHI2008--Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
- The 7th International Bird Flu Summit
- No Ordinary Flu: Preparedness comic book in multiple languages
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
***For data on human cases of avian influenza prior to 2008, go to: http://depts.washington.edu/einet/humanh5n1.html
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 385 (243).
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 8.18.08): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 8.14.08): http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html
Global: Researchers say oseltamivir resistance becoming more prevalent
Until bird flu vaccines are developed for the specific pandemic influenza virus once it evolves and starts spreading, work likely to take three months or more, Tamiflu and another retroviral treatment, Relenza, are the main medical weapons to battle pandemic flu. Tamiflu is being stockpiled by WHO and governments around the world for use in the event of a pandemic, and to treat the H5N1 avian flu strain that has infected humans in 15 of the 60 countries to which it has spread.
In 2007, Swedish researchers warned that sewage systems do not break down Tamiflu, and that the drug was being discharged in rivers and streams used by the waterfowl thought to be the main carriers of avian flu. They urged doctors not to over-prescribe Tamiflu to avoid creating resistance in avian flu carried by ducks. If those viruses combined with other viruses that made humans sick they could mutate into strains resistant to Tamiflu, they said early in 2007.
India (West Bengal): Officials suspect smuggled poultry in 2008 H5N1 avian influenza outbreak
The bird flu virus, which caused India's Avian Influenza (AI) outbreak in 2008, has been found to be very similar to the one that created havoc in Bangladesh. This has been confirmed by Indian scientists after it studied the genetic make-up of Bangladesh's H5N1 virus strain. India's eastern neighbour, after much persuasion, finally shared the genetic sequencing data of its virus with India in August 2008. The sequencing was completed in the OIE Reference Laboratory for Avian Influenza in Weybridge, UK.
The H5N1 outbreak that broke out in West Bengal in January 2008 spread to nearly 13 of the state's 19 districts. An animal husbandry department source stated: "Both India and Bangladesh finally exchanged genetic information of its H5N1 strains. We have found that both the strains are related. However, we can't say that Bangladesh was the cause of the outbreak in West Bengal because we don't have documented proof to show that infected poultry was smuggled into India." He added: "We now know that both the viruses were of clade 2.2 variety which is a sub-lineage of the highly pathogenic Qinghai strain. The strain, however, is different to the one that caused the Manipur and Maharashtra outbreaks."
India was almost certain that the virus came from Bangladesh through illegal poultry trade. Even agriculture minister Sharad Pawar had openly said so. The animal husbandry department then made a formal request to the Bangladesh government through the ministry of external affairs to share the genetic history of its virus.
The H5N1 virus was first detected in Bangladesh in March 2007. Since then, over 47 of the country's 64 districts had been affected by bird flu.
Japan: Sharp Corp's air purifier could be valuable weapon in the fight against H5N1 avian influenza
But influenza is a hard virus to beat and will need several lines of defense, said John Oxford, a University of London professor who heads Retroscreen Virology, a British research institute involved in the project. "This kind of new technology will add something to (our) ammunition box," he said. Plasmacluster ions have also proved effective against 26 other kinds of harmful airborne substances, including bacteria and allergens, Sharp said. During the tests, the H5N1 virus was sprayed in a one-cubic meter box with a concentration of 50,000 ions per cubic centimeter. Samples were then taken 10 minutes later and injected into cell cultures.
Plasmacluster technology can be installed in air conditioners, dehumidifiers and air purifiers for home and industrial use, although Sharp gave no indication of when the latest technology might be used commercially.
Sanyo Electric Co. has also developed a similar technology that proved 99 percent efficient in removing the bird flu virus using electrolyzed tap water.
Viet Nam: Unusual strain of H5N1 avian influenza virus starting to appear in smuggled poultry
USA: Novavax one step closer to licensing pandemic vaccine production system
Novavax said on 26 Aug 2008 that its bird flu vaccine elicited a robust immune response in humans, moving the biotech a step closer to licensing its pandemic vaccine production system. In the trial, 160 patients received two vaccine injections, of 15 to 90 micrograms, one month apart. Of the patients who received the highest dosage, 94 percent produced antibodies to neutralize H5N1, an Indonesian strain of bird flu that emerged in 2005 and has been linked to 110 deaths. "These results are strong and very competitive," said Rahul Singhvi, Novavax's chief executive. Novavax has had a demo of the vaccine manufacturing process set up at its Rockville headquarters since 1 May 2008 but does not have a buyer.
Many large multinational biotechs -- GlaxoSmithKline, Sanofi-Aventis, Novartis -- are working on bird flu vaccines in the United States and Western Europe under government contract, said Ken Trbovich, an analyst with RBC Capital Markets. Novavax has partnered with GE Healthcare to reach the rest of the world by providing other countries a system to quickly mass-produce vaccines. "If you truly believe a pandemic outbreak is likely, there is reason to believe foreign governments and the U.S. will clamp down and control the supply," Trbovich said. He added, "Other places in the world may have a lot of money, but no amount of money will get you vaccines in the case of a pandemic."
Traditionally, to create flu vaccines, drugmakers grow live virus strains in chicken eggs, which act as incubators. The virus is later killed and bottled into a vaccine. But eggs are a volatile medium, and a scarce supply essentially stops production. Novavax's bird flu vaccine uses particles that mimic the size and shape of the virus, which trigger an immune response but lack the genetic material to replicate. Because the particles are produced in more stable insect-cell cultures, yields are seven to 10 times higher than egg-based manufacturing, Novavax said. The vaccine can also be created within 10 to 12 weeks of identifying a pandemic strain -- half the time it takes to make egg-based vaccines.
GE is developing the production equipment, which is cheap to set up and run in case of a pandemic. In December 2007, Novavax studied low doses of its bird flu vaccine in a much smaller patient population. After tweaking the production process, the biotech was able to elicit a stronger immune response in this recent trial. Novavax is seeking a governmental or pharmaceutical partner to finance the next set of human trials. "We see no reason to invest additional money of our own into the pandemic vaccine when we can wait for a foreign government that needs this vaccine to put money in," Singhvi said. Meanwhile, Novavax will begin human tests of its seasonal influenza vaccine, using virus-like particles, in the fall. Currently all U.S. flu vaccines are egg-based. "The pandemic area is difficult to monetize even if you successfully generate a contract," Trbovich said. "There are no reoccurring revenues. Moving a seasonal flu vaccine into clinical trials is their first real commercial opportunity."
Benin (Lokossa): H5N1 avian influenza detected at live poultry market
Agriculture officials in Benin recently reported that two chickens at a live poultry market tested positive for the H5N1 avian influenza virus, the country's first outbreak since the virus was detected there at the end of 2007. Authorities found the virus during routine surveillance at a market in Lokossa, the capital of Mono department, located in the southern part of the country near the coast, according to a 25 Aug 2008 report from the World Organization for Animal Health (OIE). Testing performed at Benin's national laboratory revealed H5 highly pathogenic avian influenza, according to the report. The surveillance activity at the Lokossa market was also a training exercise for the lab's managers and officials, the OIE report said. Animal health officials have not determined the source of the outbreak. Authorities disinfected market stalls and have restricted the movement of poultry within the country. Outbreaks in 2007 affected two farms, also located near Benin's southern coastal area. Several countries surrounding Benin have reported poultry outbreaks over the past few years, including Nigeria, Togo, Niger, and Burkina Faso.
USA: University of Pittsburg receives $3.6 million for avian influenza vaccine research
Ted Ross, principal investigator in the vaccine development project and assistant professor at Pitt, said the grant will allow the team to test the vaccine on monkeys in the center's 20,000-square-foot Regional Biocontainment Laboratory. It marks the first time monkeys will be used in vaccine development. If the vaccine proves effective in the monkeys, it could be ready for human trials within three years. "Our goal is to move it into human studies," Dr. Ross said. "What's nice about our work, in looking at H5N1, there are numerous subtypes it could cause. We could quickly respond and quickly make vaccines."
Pitt is using a relatively new approach in developing its avian-flu vaccine. Typically vaccines are produced with live viruses, but the center is using a virus-like particle that the immune system still perceives to be the real virus. The viral decoy is safer because it does not include its genome or "bad parts of the virus," Dr. Ross said. That speeds up the manufacturing process and reduces costs. Gardasil, the vaccine against viruses that cause cervical cancer, was the first to use virus-like particles to be approved by the U.S. Food and Drug Administration. Given the evolving nature of H5N1, the new vaccine also is being engineered to encode genes for many influenza viral proteins, which will enhance protection against possible new strains of avian flu. "If there's a different strain, we quickly can make a vaccine," Dr. Ross said.
- 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/en/maps.html. View the latest cumulative highly pathogenic avian influenza outbreak maps.
- 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. Visit "Pandemic Influenza Preparedness Tools for Professionals" at: http://www.cdc.gov/flu/pandemic/preparednesstools.htm. This site contains resources to help hospital administrators and state and local health officials prepare for the next influenza pandemic.
- The US government’s website 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 information on the upcoming “Big 7 Pandemic-Planning Mistakes” Webinar (October 9, 2008)
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm Link to the Avian Influenza Portal at: http://influenza.bvsalud.org/php/level.php?lang=en&component=19&item=1. The Portal is a developing project for the operation of product networks and information services, for specialists, authorities and the general public.
- 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)
Protein structure discovery could help in the fight against influenza epidemics
Researchers at Rutgers University and The University of Texas at Austin have reported a discovery that could help scientists develop drugs to fight the much-feared bird flu and other virulent strains of influenza. The researchers have determined the three-dimensional structure of a site on an influenza A virus protein that binds to one of its human protein targets, thereby suppressing a person's natural defenses to the infection and paving the way for the virus to replicate efficiently. This so-called NS1 virus protein is shared by all influenza A viruses isolated from humans – including avian influenza, or bird flu, and the 1918 pandemic influenza virus. A paper detailing this breakthrough discovery appears in the PNAS (Proceedings of the National Academy of Sciences) Early Edition and will be published soon in the PNAS print edition.
About 10 years ago, Professor Robert M. Krug at The University of Texas at Austin discovered that the NS1 protein binds a human protein known as CPSF30, which is important for protecting human cells from flu infection. Once bound to NS1, the human protein can no longer generate molecules needed to suppress flu virus replication. Now, researchers led by Rutgers Professor Gaetano T. Montelione and Krug identified the novel NS1 binding pocket that grasps the human CPSF30 protein. "Our work uncovers an Achilles heel of influenza A viruses that cause human epidemics and high mortality pandemics," said Montelione, professor of molecular biology and biochemistry. "We have identified the structure of a key target site for drugs that could be developed to effectively combat this disease." X-ray crystallography, which was carried out by Kalyan Das, Eddy Arnold, LiChung Ma and Montelione, identified the three-dimensional structure of the NS1 binding pocket. "The X-ray crystal structure gives us unique insights into how the NS1 and human protein bind at the atomic level, and how that suppresses a crucial antiviral response," said Das, research professor at Rutgers.
Rei-Lin Kuo, Jesper Marklund, Karen Twu and Krug at The University of Texas at Austin verified the key role of this binding pocket in flu replication by genetically engineering a change to a single amino acid in the NS1 protein's binding pocket, which in turn eliminated the protein's ability to grasp the human protein that is needed to generate antiviral molecules. These investigators then produced a flu virus with an NS1 pocket mutation and showed that this mutated virus does not block host defenses, and as a consequence has a greatly reduced ability to infect human cells. "These experiments validate the NS1 pocket as a target for antiviral drug discovery," said Krug, professor and chair of molecular genetics and microbiology. "Because this NS1 pocket is highly conserved in all influenza A viruses isolated from humans, a drug targeted to the pocket would be effective against all human influenza A strains, including the bird flu."
Influenza A virus infections in land birds, People’s Republic of China
Evidence of Infection by H5N2 Highly Pathogenic Avian Influenza Viruses in Healthy Wild Waterfowl
Genotypic diversity of H5N1 highly pathogenic avian influenza viruses
Clinical Characteristics of 26 Human Cases of Highly Pathogenic Avian Influenza A (H5N1) Virus Infection in China
Evolutionary and Transmission Dynamics of Reassortant H5N1 Influenza Virus in Indonesia
PHI2008--Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies
Dates: 18-19 September 2008
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, USA. 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, USA. The theme for the PHI2008 meeting is "Envisioning Options for Integrated Public Health Information Systems for Low Resource Settings: Components, Connections, Partners, Strategies."
- Plenary presentations:
- Panelist discussions of funding opportunities for research and applications development
- Information exchange and networking opportunities
The 7th International Bird Flu Summit
November 13-14, 2008 in Las Vegas, Nevada. The two-day event will draw on first-hand best practices to create solid business continuity plans that companies and organizations need to prepare for, respond to, and survive a pandemic. Public Health Officials, Top leaders and key decision-makers of major companies representing a broad range of industries will meet with distinguished scientists, law enforcers, first responders, and other experts to discuss pandemic prevention, preparedness, response and recovery at the two day summit.
No Ordinary Flu: Preparedness comic book in multiple languages