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EINet Alert ~ Sep 26, 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)
- WHO recommends composition for 2009 southern hemisphere influenza vaccine
- Indonesia: Reports Avian Influenza H5N1 decline in poultry flocks
- Iraq: Discovers H9 avian influenza strain in 50,000 chicks
- Kyrgyzstan: Avian influenza prevention program STOP AI launched
- Mexico: Outbreak of avian flu affects backyard poultry
- United States: CDC awards funds for new pandemic planning approaches
- United States: HHS web seminar touts personal pandemic preparedness
- Gambia: Workshop builds regional avian influenza prevention capacity
- United States: CDC expects plentiful, on-target influenza vaccine
- AVIAN/PANDEMIC INFLUENZA
- Pandemic Influenza and Excess Intensive-Care Workload
- Emerging Infectious Diseases
- State-Specific Influenza Coverage Among Adults—United States, 2006-07 Influenza Season
- Influenza Activity—United States and Worldwide, May 18-Sep 19, 2008
- Cross-Protection between Successive Waves of the 1918–1919 Influenza Pandemic:
- Stockpiling pandemic influenza vaccines; a new cornerstone of pandemic preparedness plans
- The 7th International Bird Flu Summit
- FAO-OIE-WHO Joint Technical Consultation on Avian Influenza at the Human-Animal Interface
- National Vaccine Summit newsletter
- Web seminar: Avoiding the big seven preparedness planning mistakes
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: 387 (245).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm (WHO/WPRO 6.19.08)
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 9.24.08): 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
WHO recommends composition for 2009 southern hemisphere influenza vaccine
. *A/South Dakota/6/2007 (an A/Brisbane/59/2007-like virus) is a current vaccine virus used in live attenuated vaccines. **A/Brisbane/10/2007 and A/Uruguay/716/2007 (an A/Brisbane/10/2007-like virus) are current vaccine viruses. ***B/Florida/4/2006 and B/Brisbane/3/2007 (a B/Florida/4/2006-like virus) are current vaccine viruses.
Twice annually, the WHO Global Influenza Program analyzes the global data on circulating influenza strains and issues recommendations for the formulation of the influenza vaccine for the following influenza season. These recommendations are used by the national drug licensing agencies and the pharmaceutical companies to update the content of the influenza vaccines they produce. An annual adjustment of the vaccine content is necessary to match the vaccine with the ever changing antigenic and genetic characteristics of circulating influenza viruses.
In August 2008, the United States Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee recommended the vaccines to be used in the 2008-2009 influenza season. The influenza vaccine composition to be used in the 2008-2009 influenza season in the U.S. is identical to that recommended by the WHO for the Northern Hemisphere's 2008-2009.
In summary, perhaps unusually, the compositions of the influenza vaccines for use in the northern and southern hemispheres in 2009 are identical. Since 1999, when the WHO began making recommendations for a Southern Hemisphere vaccine, the Southern Hemisphere vaccine was the same as the previous Northern Hemisphere season's vaccine in five out of the eleven years: 1999, 2002, 2003, 2007, and 2009. Furthermore, the northern hemisphere vaccine has never differed from the previous southern hemisphere vaccine by more than one component and the southern hemisphere vaccine has never differed from the previous northern hemisphere vaccine by more than two components.
Overall there has been little divergence between the vaccines recommended for
use in the northern and southern hemispheres, reflecting only a slow drift in
the antigenic properties of the seasonal influenza viruses affecting the human
populations of the northern and southern hemispheres.
Indonesia: Reports Avian Influenza H5N1 decline in poultry flocks
An agriculture ministry official in Indonesia who spoke at a pandemic planning conference for businesses said that the number of poultry outbreaks caused by the H5N1 avian influenza virus is declining. Muhammad Azhar, the agriculture ministry's avian influenza control coordinator, said only two of Indonesia's 31 provinces have not been hit by the virus, but pointed out that nine provinces have gone six months without reporting any new outbreaks. "Areas still at risk are those on Java Island, because it is the main producer of both pedigree and nonpedigree chickens," he said.
In March, a representative from the United Nations Food and Agriculture Organization (FAO) warned that H5N1 virus levels in Indonesia's poultry are so high that conditions might be ripe for viral mutation that could start an influenza pandemic. The FAO has said that the disease is endemic in Java, Sumatra, and southern Sulawesi islands.
A health minister said the number of human H5N1 cases has also declined this
year, the Post reported. Erna Tresnaningsih, the health ministry's director for
animal-vector diseases, said Indonesia has recorded 20 H5N1 cases and 17
fatalities from the disease so far in 2008. She said the numbers appear to trail
the numbers seen in 2006 (55 cases and 45 deaths) and 2007 (42 cases and 37
Iraq: Discovers H9 avian influenza strain in 50,000 chicks
Kyrgyzstan: Avian influenza prevention program STOP AI launched
USAID's STOP AI program provides export assistance and resources for planning,
surveillance, control, and disease prevention. It also focuses on economic
recovery after an outbreak and safety measures for animal health workers and
other response personnel. The project included a five-day training session for
25 veterinary and health workers from five central Asian countries. Topics
included procedures for avian influenza diagnosis and decontamination and the
collection, storage, and transportation of virus samples. USAID said its goal is
to enable the participants to train their colleagues upon return to their home
Mexico: Outbreak of avian flu affects backyard poultry
An outbreak of bird flu was recorded in the northern area of the state of Veracruz. The outbreak affected 78 animals that have been slaughtered. Efrain Acosta Martinez, chief of the animal health program of SAGARPA (Secretariat of Agriculture, Livestock, Rural Development, Fishing, and Food) indicated that surveillance continues, and an epidemiological barrier is already in place to stop the disease from spreading. Acosta Martinez added: "We have some outbreaks of avian influenza in backyards in the north, but we are already working hard [to control the situation]. We have evacuated the premises where the disease was detected, and we can say that we have it under control."
The federal official also stated that the 78 cases were not detected in poultry farms, but in animals raised in backyards. After the slaughter of the birds and epidemiological surveillance of the area, Veracruz retains its "free of avian flu" status. He explained that whenever a focus is detected, reaction has to be quick in order for the state to maintain its free-of-disease status; producers are compensated, [infected] animals are slaughtered, and long-term surveillance of the zone is implemented.
This is stated to be a low pathogenic strain, although the strain type is not
provided. In 2006, there was an outbreak of low pathogenic H5N2 in Chiapas state
in southern Mexico.
United States: CDC awards funds for new pandemic planning approaches
The recipients' pandemic preparedness projects focus on seven main areas:
Statewide totals for the awards range from $144,000 for projects in Ohio that address one of the focus areas to more than $2 million for Minnesota efforts that address five of the areas.
The CDC said the $24 million is part of $600 million in PHEP supplemental funding that was distributed in three phases beginning in 2006. The agency said the funding focus has been "practical, community-based procedures that could prevent or delay the spread of an influenza pandemic." Rich Hamburg, director of governmental relations for Trust for America's Health (TFAH), a nonprofit health advocacy group, said that the projects are appealing because they're geared toward sharing ideas with a quick research turnaround.
However, Hamburg said the $24 million in grants represents the final installment of pandemic planning support to states and localities from the fiscal year 2006 PHEP funding. "The last of the money is going out the door for state and local pandemic planning. The well has dried up," he said. Compounding TFAH's ongoing concern about federal support for pandemic planning is that all-hazards preparedness funding has been shrinking over the past few years, Hamburg added.
Of the $7 billion in total pandemic preparedness funding over the past three
years, about $870 million remains for measures such as vaccine research and
development, he said. "But whatever advocacy we do—and vaccines and antivirals
are important—we need to talk about other things, too. We need more resources,"
United States: HHS web seminar touts personal pandemic preparedness
Admiral Joxel Garcia, assistant secretary of health for HHS, and Richard Benjamin, MD, chief medical officer for the American Red Cross, warned that a pandemic is unlike any other disaster, because the disease strikes many locations simultaneously. "It's like 50 hurricane Katrinas happening at the same time," Benjamin said.
Benjamin urged those who haven't begun their personal pandemic preparations to start by thinking through four scenarios: if schools closed, if a family member was ill, if wage earners couldn't work, or if people were urged to stay in their homes. He said government and nonprofit groups have useful resources that cover personal pandemic preparation; for example, the Red Cross has a guide for caring for sick family members.
The Red Cross's role now is to increase awareness, but during a pandemic the organization plans to help distribute food and supplies to the homebound and ensure an adequate blood supply, Benjamin said. A pandemic will diminish the blood supply, and he said the Red Cross will continue to rely on donors. "You can help by getting used to giving blood now," he added.
Two members of PandemicPrep.org, a nonprofit group, told viewers that grassroots pandemic preparedness organizing doesn't need to take a lot of time or expense, but it can yield benefits beyond just pandemic preparedness. Tim Woerther, the group's co-chair and mayor of Wildwood, Mo., said, "This brings together people who don't normally talk," such as people from faith-based organizations, education, government, and businesses.
Near the end of the webcast, the speakers fielded questions submitted by online
viewers. One viewer asked why different groups recommend different stockpiling
amounts; some recommend two weeks’ worth of food, water, and supplies, while
some advise up to six months. Benjamin said the Red Cross advises at least two
weeks, "but if you could do more, that would be a wonderful thing," he said.
Coming up with a stockpiling recommendation is difficult, he said. "Six to 12
months would be wonderful, but that's probably not practical for most people,"
Gambia: Workshop builds regional avian influenza prevention capacity
The U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) recently co-hosted an avian influenza workshop in Gambia for veterinarians in African countries including Ghana, Liberia, Sierra Leone, and Senegal. Kekoi Kuyateh, a Gambian agriculture secretary, said the USDA has helped Gambia and other countries build avian influenza prevention capacity by providing personal protective equipment, sampling supplies, and diagnostic kids. Ten African countries have reported H5N1 outbreaks, including Togo, who reported outbreaks in early September.
United States: CDC expects plentiful, on-target influenza vaccine
Two of the three components in last year's vaccine—A/H3N2 and B—didn't match well with the circulating flu strains. A preliminary study from Wisconsin showed that the H3N2 component provided 58% protection against circulating H3N2 viruses, but the B component offered no protection.
In the spring of 2008, the CDC recommended for the first time that school-age children, from five through 18 years, should receive flu immunizations, which added about 30 million children to the groups included in vaccination recommendations. (Children from six months through four years old were included in earlier recommendations.) In all, 261 million Americans are targeted in the CDC recommendations.
The reason for immunizing school-age children is that they have higher flu rates than most groups and the virus spreads easily in schools, said Dr. Renee Jenkins, president of the American Academy of Pediatrics. "And reducing the rate in children reduces the rate in the community at large," she added. Officials said 86 children died of flu in the 2007-08 season.
A recent NFID consumer survey of 2,029 adults pointed up the need for healthcare providers to promote flu vaccination. Seventy percent said they would be very likely to get vaccinated if their provider recommended it. But nearly four in ten respondents overall, and nearly one in five elderly people, reported they had never discussed flu vaccination with their providers. Of those who had talked about the subject, half said they had raised it themselves. Schaffner also indicated that African-Americans and Hispanics do not vaccinate themselves as often as Caucasians do.
Coverage in health care workers
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDP’s 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.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html The Influenza Virus Tracking System can be accessed at: www.who.int/fluvirus_tracker.
- UN FAO: http://www.fao.org/avianflu/en/index.html. View the latest avian influenza outbreak maps, upcoming events, and key documents on avian influenza.
- 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: 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 archived Webcasts on influenza pandemic planning.
- CIDRAP: http://www.cidrap.umn.edu/ See information on the upcoming “Avoiding the 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 National Wildlife Health Center: 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)
Pandemic Influenza and Excess Intensive-Care Workload
Nap, Raoul E. et al. Emerg Infect Dis. Oct 2008 [early online release]. 14(10). Available at http://www.cdc.gov/EID/content/14/10/1518.htm.
Emerging Infectious Diseases
State-Specific Influenza Coverage Among Adults—United States, 2006-07 Influenza Season
Data from the 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) surveys indicate that influenza vaccination coverage among adults for the 2006-07 season increased significantly compared with the 2005-06 season. However, vaccination coverage remained well below Healthy People 2010 targets of 90% among all persons aged >65 years and 60% among persons aged 18–64 years who have one or more high-risk conditions.
Influenza Activity—United States and Worldwide, May 18-Sep 19, 2008
During May 18--September 19, 2008, influenza A (H1), influenza A (H3), and influenza B viruses were detected worldwide and were identified sporadically in the United States. This report summarizes influenza activity in the United States and worldwide since the last update and rev qiews the new influenza vaccine recommendations for the upcoming season. Influenza viruses circulating this summer appear antigenically similar to the strains included in the 2008--09 influenza vaccine. Recent antiviral resistance data are limited, but oseltamivir resistance among influenza A (H1N1) viruses might persist during the 2008--09 influenza season.
Cross-Protection between Successive Waves of the 1918–1919 Influenza Pandemic:
Background. The current worst-case scenario for pandemic influenza planning is based on the catastrophic 1918–1919 pandemic. In this article, we examine the strength of cross-protection between successive waves of the 1918–1919 pandemic, which has remained a long-standing issue of debate. Method. We studied monthly hospitalization and mortality rates for respiratory illness in 37 army camps, as well as the rates of repeated episodes of influenza infection during January-December 1918 in 8 military and civilian settings in the United States and Britain. Results. A first wave of respiratory illness occurred in US Army camps during March-May 1918 and in Britain during May-June, followed by a lethal second wave in the fall. The first wave was characterized by high morbidity but had a lower fatality rate than the second wave (1.1% vs. 4.7% among hospitalized soldiers; p<.001). Based on repeated illness data, the first wave provided 35%–94% protection against clinical illness during the second wave and 56%–89% protection against death (p<.001). Conclusion. Exposure to influenza in the spring and summer of 1918 provided mortality and morbidity protection during the fall pandemic wave. The intensity of the first wave may have differed across US cities and countries and may partly explain geographical variation in pandemic mortality rates in the fall. Pandemic preparedness plans should consider that immune protection could be naturally acquired during a first wave of mild influenza illnesses.
Stockpiling pandemic influenza vaccines; a new cornerstone of pandemic preparedness plans
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.
Discussions topics: Surveillance and Data Management; Preparing Communities Strategies; Local Partnership and Participation; Delivery of Vaccine and Antiviral Medication; National Pandemic Influenza Medical Countermeasure; Socio Economic Impact on Poultry Industry; Benefit-risk Assessment: Public Health, Industry and Regulatory Perspectives; Prevention Education Efforts and Risk Communication; Command, Control and Management; Emergency Response Management; Business-Based Planning; School-Based Planning; Community-Based Planning and more.
New Fields http://www.new-fields.com/birdflu7/
The animal and public health sectors have generated data and expertise in their respective areas, but there is room for closer cooperation between the two sectors and the promotion of shared use of the accumulated data. This joint technical consultation will be a milestone towards better global understanding of avian influenza risks at the human-animal interface. It will offer a forum for sharing the benefits of research and surveillance efforts in both fields, and will provide a valuable opportunity to discuss how tools and systems might be developed and further adapted for broader application at this interface.
- identify critical virological characteristics for the emergence of zoonotic
and pandemic viruses
National Vaccine Summit newsletter
Web seminar: Avoiding the big seven preparedness planning mistakes