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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

2. Updates
- AVIAN/PANDEMIC INFLUENZA

3. Articles
- 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

4. Notifications
- 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
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 / 20 (17)
Viet Nam / 5 (5)
Total / 36 (28)

***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).
(WHO 9.10.08 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 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

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WHO recommends composition for 2009 southern hemisphere influenza vaccine
The World Health Organization (WHO) recommends that vaccines for use in the 2009 influenza season (southern hemisphere winter) contain the following: 1) an A/Brisbane/59/2007 (H1N1)-like virus;* 2) an A/Brisbane/10/2007 (H3N2)-like virus;** 3) a B/Florida/4/2006-like virus.***

. *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.
(ProMED 9/22/08 and 9/23/08)

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Asia
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 deaths).
(CIDRAP 9/24/08)

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Iraq: Discovers H9 avian influenza strain in 50,000 chicks
The Duhok veterinary office has culled 50,000 chicks from two hatcheries following the discovery of the H9 strain of avian influenza. Luqman Tayeb Omer, the general director of the Duhok Veterinary Office, said that the virus likely came from Mosul as the districts of Al-Hamdaniya, Shalalat and Talkef are known to be infected. While the strain is not H5N1, discovery of the H9 strain shows Iraq's continued surveillance of the disease.
(National Wildlife Health Center 9/25/08)

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Kyrgyzstan: Avian influenza prevention program STOP AI launched
On 2008 Sep 15, U.S. officials in Kyrgyzstan launched a new avian influenza prevention program called STOP AI for the central Asian countries of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. William Frej, USAID's regional mission director for central Asia, said at the opening ceremony in Bishkek, Kyrgyzstan, "This project will help central Asia's governments and poultry producers protect their citizens and economies from the serious consequences that can result from even a limited outbreak of highly pathogenic avian influenza." Countries in central Asia import large quantities of poultry from countries that have reported outbreaks, including China, Iran, Russia, Pakistan, and Afghanistan. In March 2006, Kazakhstan and Azerbaijan reported H5N1 outbreaks.

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 countries.
(CIDRAP 9/24/08)

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Americas
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.
(ProMED 9/25/08)

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United States: CDC awards funds for new pandemic planning approaches
The US Centers for Disease Control and Prevention (CDC) announced the awarding of $24 million to fund state and local projects aimed at innovative approaches to boost the nation's readiness for an influenza pandemic. The 1-year grants will fund 55 projects in 29 state and local health departments. The $24 million award pool is part of $600 million in Public Health Emergency Preparedness (PHEP) Cooperative Agreement funding approved by Congress in 2006. The 55 projects were selected from 184 funding application. Eligibility was limited to 62 state, local, and territorial public health departments that receive funding through PHEP cooperative agreements. Recipients have one year from 2008 Sep 30 to complete the projects.

The recipients' pandemic preparedness projects focus on seven main areas:
• Public engagement during public health decision-making
• Electronic exchange of laboratory data to improve influenza pandemic monitoring
• Integration of state immunization information systems to track countermeasure distribution
• Development of statewide electronic death reporting systems that are compatible with the Public Health Information Network
• Coordination among healthcare providers to deliver essential services
• Interventions to promote preparedness among vulnerable populations
• Distribution of antiviral drugs to people who stay in their homes as a social distancing measure

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," Hamburg said.
(CIDRAP 9/25/08)

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United States: HHS web seminar touts personal pandemic preparedness
The US Department of Health and Human Services (HHS) hosted a live webcast to teach laypeople and community groups how to prepare their homes and families for a pandemic. The HHS program was the sixth in a series that began in March 2008 with sessions aimed at state pandemic planners. Other webcasts have addressed topics such as school closures and implications for home healthcare organizations.

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," Benjamin said.
(CIDRAP 9/25/08)

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Africa
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.
(CIDRAP 9/24/08)

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United States: CDC expects plentiful, on-target influenza vaccine
Public health and medical leaders predicted that this year's influenza vaccine will match up well with circulating flu viruses—unlike last year's vaccine—and that plenty of doses will be available. "We are optimistic that this year's vaccine will be on target in protecting against the flu," said Dr. Daniel B. Jernigan of the Centers for Disease Control and Prevention (CDC). "Last year at this time we had an indication that the vaccine might not be as effective," Jernigan said at a press conference to promote flu immunization as flu season approaches. "There is no such indication this time."

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.

Vaccine abundance
Officials from the CDC and several medical societies also predicted that plenty of vaccine will be available this season. "Vaccine is out there in abundance," said William Schaffner, president-elect of the National Foundation for Infectious Diseases (NFID). "We should continue to vaccinate through the fall and into winter and into the early part of next year [2009]."

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.

Under-immunized groups
Immunization coverage varies widely among the different flu-shot target groups, officials said. The NFID said immunization rates in 2007 were 66.7% for people 65 years and older—well below federal targets—and 36.2% for those between 50 and 64 years. CDC data show that only 21.3% of children aged 6 through 23 months were fully vaccinated in the 2006-07 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
Only 42% of health care workers were vaccinated in 2006. Officials encouraged health care facilities to measure their vaccination coverage and report it. In addition, patients are encourages to ask their providers about their coverage. When asked if any health care facilities are requiring employees to be vaccinated, Schaffner said, "There are individual facilities that are moving in that direction. We're hoping that they will document their activities and publish that so we can all benefit from those things."
(CIDRAP 9/24/08)

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2. Updates
AVIAN/PANDEMIC INFLUENZA
- 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)

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3. Articles
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.

Abstract:
In the Netherlands a major part of preparedness planning for an epidemic or pandemic consists of maintaining essential public services, e.g., by the police, fire departments, army personnel, and healthcare workers. We provide estimates for peak demand for healthcare workers, factoring in healthcare worker absenteeism and using estimates from published epidemiologic models on the expected evolution of pandemic influenza in relation to the impact on peak surge capacity of healthcare facilities and intensive care units (ICUs). Using various published scenarios, we estimate their effect in increasing the availability of healthcare workers for duty during a pandemic. We show that even during the peak of the pandemic, all patients requiring hospital and ICU admission can be served, including those who have non–influenza-related conditions. For this rigorous task differentiation, clear hierarchical management, unambiguous communication, and discipline are essential and we recommend informing and training non-ICU healthcare workers for duties in the ICU.

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Emerging Infectious Diseases
U.S. Center for Disease Control. Oct 2008 [early online release]. 14(10). Available at http://www.cdc.gov/ncidod/eid/index.htm.

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State-Specific Influenza Coverage Among Adults—United States, 2006-07 Influenza Season
Morbidity and Mortality Weekly Review. 57(38); 1033-1039. Available at http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5738a1.htm.

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.

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Influenza Activity—United States and Worldwide, May 18-Sep 19, 2008
Morbidity and Mortality Weekly Review. 57(38); 1046-1049) Available at http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5738a4.htm.

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.

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Cross-Protection between Successive Waves of the 1918–1919 Influenza Pandemic:
Barry, John M. et al. J Infect Dis. 2008; 198 [released online 9/18/08]. Available at http://www.journals.uchicago.edu/doi/abs/10.1086/592454.

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.

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Stockpiling pandemic influenza vaccines; a new cornerstone of pandemic preparedness plans
Jennings, Lance C et al. Lancet Infect Dis. Oct 2008. 8(10). Available at http://www.thelancet.com/journals/laninf/article/PIIS1473309908702329/abstract.

Summary
The history of pandemic influenza, along with the evolving epizootic of the highly pathogenic avian influenza A (H5N1) virus and the severity of associated human infections, serve as a warning to the world of the threat of another influenza pandemic. Conservative estimates suggest that up to 350 million people could die and many more would be affected, causing disruption to health care systems, society, and the world’s economy. WHO has encouraged countries to prepare in advance by developing influenza pandemic preparedness plans that involve public-health and pharmaceutical interventions. Vaccination is a cornerstone of these plans; however, a pandemic vaccine cannot be manufactured in advance because the next pandemic virus cannot be predicted. The concepts of vaccine stockpiling and prepandemic vaccination have thus become attractive. Human H5N1 vaccines are currently available and can induce heterotypic immunity. WHO and governments should give urgent consideration to the use of these vaccines for the priming of individuals or communities who would be at greatest risk of infection if an H5N1 influenza pandemic were to emerge.

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4. Notifications
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/
1001 Pennsylvania Avenue, NW 6th Floor South
Washington, DC 20004
Tel: (202) 536-5000; Fax: 202.280.1239; email: sharon.villalon@new-fields.com

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FAO-OIE-WHO Joint Technical Consultation on Avian Influenza at the Human-Animal Interface
7-9 Oct 2008; Verona, Italy.

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.

OBJECTIVES
The Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO), with support from the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe) and the EC-funded project FLUTRAIN, have called this technical consultation to:

- identify critical virological characteristics for the emergence of zoonotic and pandemic viruses
- evaluate external factors affecting the evolution and emergence of a pandemic strain, and identify monitoring mechanisms for pandemic strain emergence
- identify likely modes of transmission and exposure sources for zoonotic infection with avian influenza viruses
- maximise outcome of ongoing research and preparedness efforts and identify gaps in knowledge
- identify next steps for further integrated data collection, analysis and research
(FAO http://www.fao.org/avianflu/documents/Announcement_Verona.pdf )

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National Vaccine Summit newsletter
The 2008 Sep 19 National Vaccine Summit newsletter can be accessed at http://www.preventinfluenza.org/summit_news_91908.pdf

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Web seminar: Avoiding the big seven preparedness planning mistakes
9 Oct 2008
The Webinar features presenters Michael T. Osterholm, PhD, MPH, and Peter M. Sandman, PhD, who will discuss such pitfalls as bundling pandemic preparedness into an all-hazards approach and avoiding invoking fear in risk communications. Additional information and registration at http://online.krm.com/iebms/coe/coe_p2_details.aspx?oc=10&cc=00279763&eventid=13 937.

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 apecein@u.washington.edu