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EINet Alert ~ Nov 21, 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
- Cumulative number of human cases of avian influenza A/(H5N1)
- Global: Research on vaccine that is effective for any type of influenza
- India: Government is in proactive mode to tackle avian influenza H5N1
- Indonesia: Claims no avian influenza H5N1 cases in suspicious cluster
- Pakistan: Avian influenza H5N1 outbreaks cannot be attributed to migratory birds
- Qatar: Government increases stock of avian influenza H5N1 vaccine
- USA: Experts weigh advisability of school-based influenza shots
- USA: Report says pandemic will threaten coal and power supplies
- AVIAN/PANDEMIC INFLUENZA
- Biosecurity for Highly Pathogenic Avian Influenza
- Videoconferencing in the Field: A Heuristic Processing Model
- Personal protective equipment in an influenza pandemic: a UK simulation exercise
- Detecting influenza epidemics using search engine query data
- More Detailed Plans Needed for the Centers for Disease Control and Prevention’s Redesigned BioSense Program
- Influenza Virus (H5N1) in Live Bird Markets and Food Markets, Thailand
- ASEAN Plus 3 EID Programme launches new website
1. Influenza News
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:
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 10/6/08):
WHO’s timeline of important H5N1-related events (last updated 8/14/08):
Global: Research on vaccine that is effective for any type of influenza
A collaborative effort is under way involving researchers from Britain, France, the US, and Ireland, and such a vaccine could possibly be ready for use within three years, explains Dr Anne Moore, who heads the Irish research team. The great advantage of the approach being used is that human trials can begin immediately, even as she studies how the vaccine works, she says.
Moore heads the immunology group within UCC’s school of pharmacy. Her role is to explain the biochemistry behind the idea. It is based on giving an initial vaccine to sensitize the patient against influenza, followed by a second, very different flu vaccine that produces a strong immune response against all types of the virus. A high level of safety is assured, given that the first jab involves the adenovirus, a well-understood organism responsible for the common cold, and the second involves the poxvirus, long used in vaccines against diseases such as smallpox, she says.
The two-step approach was informed by earlier collaborative work by an international team including UCC, which reported progress towards a promising malaria vaccine in the journal Nature Medicine. The new malaria vaccine used this one-two combination and the idea was then carried across to a project including the University of Oxford funded by the UK's Medical Research Council and the Wellcome Trust and UCC, which is funded by the Health Research Board.
Oxford is overseeing the human trials, which could begin next summer, Moore says. These patients would then be challenged with live flu within the following year.
Meanwhile, her team is studying the complex biochemistry behind the two-step approach. "For reasons we don't understand, some of these viral platforms are very good at boosting the immune response while others work on building immune memory," she says. "We are working on the mechanism of protection and trying to understand it."
If invaded by a virus our immune system produces antibodies to clear the virus and also imprints a memory of the organism in special central memory "T-cells" located mainly in the lymph nodes, Moore explains. You need a strong immune memory to produce the "effector" cells that release fresh antibodies should the invader ever return. The adenovirus is particularly good at producing a powerful immune memory and this can be targeted against flu by building a harmless piece from the surface of the flu virus into the adenovirus, she says.
Flu is notorious for changing its surface proteins, however, which is why every year we need a new kind of vaccine. The researchers got around this in the malaria vaccine and now with flu by using the poxvirus. It is engineered to carry harmless but essential pieces from inside the flu virus, parts of the virus that never change. They found in the case of malaria that once the immune memory was in place the second vaccine strongly boosted the immune response. This should also work with flu, and because the poxvirus vaccine includes essential bits found in every type of influenza, it means the person should be vaccinated against any kind of flu including the dangerous H5N1 bird flu, Moore says. "This means you can stockpile just one vaccine instead of trying to hold seasonal vaccines," she says.
They are continuing to study these processes, but the trials can go ahead independently because all parts of the vaccine are known to be safe for humans.
India: Government is in proactive mode to tackle avian influenza H5N1
Bird flu is being met head-on by the Indian state animal husbandry department. The department has undertaken an exhaustive drive to train veterinarian, para-veterinarian and the staff of other associated departments on the technical know-how of the disease and how to best combat it.
In the next stage, this know-how will be passed on to the farmers and the rearers of the birds. The two-month training which ended on 15 November 2008, consisted of 1,263 veterinarians, 7,689 para-veterinarians and 7,000 employees of the other departments of the state receiving training in the technical know-how about the disease under a World Bank-funded scheme.
Under the training, the staff was told how to detect the symptoms of the disease and how to collect the samples and send them to the testing laboratories in Bhopal and Pune, while ensuring that the cold chain did not get disrupted. Says Qidwai "the farmers cannot be expected to do differential diagnosis as in many cases the birds may be having symptoms which are akin to the flu but is not actually flu.”
Training was also given to the staff of the public works, forest, health, and revenue departments. At the time of any outbreak birds in large numbers may have to be destroyed and compensation paid to the farmers. Training was given to the staff of these departments so that each should know the specifics of their job in the event of an outbreak. Adds Qidwai "many a times it has been found that birds do not suffer from the flu but a scare is generated which results in a marked fall in the consumption of backyard, commercial and layer birds. The issue, therefore, had to be taken up scientifically and a general awareness created about the same". Poultry farming is now being looked upon as a lucrative business and is considered to have a lot of potential to generate employment.
Indonesia: Claims no avian influenza H5N1 cases in suspicious cluster
Chandra Yoga Adhitama, the health ministry's acting director of communicable disease control, said in an update on 14 Nov 2008 that the patients were hospitalized as a precaution after chickens died in the area. He also states that the patients' conditions were generally good and that their samples would be sent to Jakarta for testing at the health ministry's laboratory.
Then on 15 Nov 2008, Halik Saleh, a spokesman for the hospital's avian flu team, said the university tests also indicated the patients had the H5N1 virus but that the hospital decided not to use either institution's test results and would instead wait for results from the health ministry. Lily Sulistyowati, a health ministry spokeswoman, stated on 20 Nov 2008 that the patients' tests were negative for H5N1.
Reports of potential H5N1 case clusters raise concern because, if confirmed, they suggest the possibility of human-to-human transmission, which would increase the risk of a pandemic. News about human H5N1 infections in Indonesia has been questionable since June 2008, when the health ministry said it would no longer promptly report H5N1 cases and instead give only periodic updates. Some officials have said the lack of timely reporting will hamper efforts to monitor the world's pandemic risk level.
On 13 Nov 2008, the country's health minister denied media reports that a 15-year-old girl who died in central Java had avian influenza. News services had earlier cited one of the girl's doctors and a local official as saying tests from two laboratories indicated she did have an H5N1 infection. Experts say that the lack of transparency about the current H5N1 status in Indonesia is troublesome because the disease is endemic and current human H5N1 clinical samples are not being shared internationally.
Pakistan: Avian influenza H5N1 outbreaks cannot be attributed to migratory birds
The United Nations Food and Agriculture Organisation (FAO) collected samples from 300,000 to 350,000 wild birds across the world. None of these were found H5N1 positive. After a comprehensive review of the recent literature it has been concluded that poultry trade, rather bird migration, is the main mechanism of global dispersal of the virus. Wildlife expert and coordinator Natural Resources Management Rabnawaz stated on 16 Nov 2008 that such migratory birds (more than 150 bird species) come from Russia and Africa during November and December, and return in February and March.
"After the last outbreak of the H5N1 strain of avian influenza and the subsequent allegations that migratory birds are responsible for the spread of the disease to local poultry farms, World Wildlife Fund (WWF) Pakistan showed its concerns that such statements could have serious repercussions against wild bird populations and their habitats. Such statements may prompt mass culling of wild birds and seriously endanger the efforts of conservation organizations and relevant government departments. Since the last outbreak in Sindh, WWF Pakistan has been in close contact with Bird Life International, the world's authority on birds, which has already carried out significant research and literature review on the role of wild birds, including migratory species in the spread of HPAI [highly pathogenic avian influenza] H5N1. . . I would like to highlight some of the scientific facts that though there is some evidence to back the case that migratory wild birds can spread the H5N1 virus, they are not the main source of the virus spread. Sampling of 5000 water birds after the outbreak in Nigeria during 2006 found no traces of the virus. Mapping of the outbreaks across the world have shown that they follow trade routes of poultry rather than migratory flyway of wild birds. After a critical review of recent scientific literature it has been concluded that poultry trade, rather than bird migration, is the main mechanism of global dispersal of the virus," he added.
Rabnawaz said that the widespread illegal trade of cage birds had transported H5N1 infected birds over large distances. The most likely source of infection in cage birds is at animal 'wet' markets in Asia, where domestic and wild-caught birds were kept in close proximity, posing a high-risk of cross-contamination. There was a healthy bird trade in the cities of Pakistan and yet there had been no study to determine whether this was a factor in the spread of the disease or not. "Avian influenza viruses are readily transmitted from farm to farm by the movement of live birds, people (especially when shoes and other clothing are contaminated), and contaminated vehicles, equipment, feed, and cages. Highly pathogenic viruses can survive for long periods in the environment, especially when temperatures are low. For example, the highly pathogenic H5N1 virus can survive in bird feces for at least 35 days at low temperature (4 deg C/39.2 deg F). At a much higher temperature (37 deg C/98.6 deg F), H5N1 viruses [have been shown to] survive, in fecal samples for 6 days."
Media should play a responsible role in the dissemination of information based on facts and scientific research, especially pertaining to the role of wild migratory birds in spreading the H5N1 disease. The disease spreads through the faces, tears, nasal [secretions], saliva, or droppings of sick birds or chickens and their contaminated features, he urged.
Qatar: Government increases stock of avian influenza H5N1 vaccine
The quantity of the vaccine and the antiviral drugs against the H5N1 virus that causes the disease has to be determined after considering various factors. “We would procure enough quantity to cover the entire population of the country, in keeping with the international standards or even more,” stated Dr Sheikh Mohamed al-Thani, who is also National Health Authority’s medical adviser. Qatar had earlier purchased stocks of two antiviral drugs, Oseltamivir (Tamiflu) and Zanamivir (Relenza), in capsule and powder form, respectively, as a precautionary measure.
USA: Experts weigh advisability of school-based influenza shots
Early in 2008 the US Centers for Disease Control and Prevention (CDC) broadened its flu vaccine recommendation to include all school-age children, prompting some health officials to eye school-based immunization programs as an efficient way to improve vaccination rates in young people. Federal health officials have said children bear a significant burden of seasonal flu and that reducing flu transmission among children may limit virus spread among household contacts and in the community. Also, they point out that vaccinating school-age children could reduce the need for medical care and curb school absenteeism.
The new recommendation, which includes children from ages 5 through 18 years, adds 30 million children to the CDC's target group, poses a big challenge for the health care system because the vaccine season is limited and many young people don’t regularly visit doctor's offices, where many people typically get their yearly flu shots. Some experts question whether school-based flu vaccination programs lower health care costs. Though research findings have been mixed, a recent multistate trial that factored in household protection benefits suggested that such programs were cost-effective.
A snapshot of school-based efforts
In early November 2008, the East Baton Rouge (Louisiana) Parish school district launched its first influenza vaccine program, a state pilot program that hopes to vaccinate close to 40% of the student population. Vaccines will be administered by a contractor that provides medical care at the schools as well as volunteers from Southeastern Louisiana University's school of nursing. The cost of immunizations for qualifying students is covered through the CDC's Vaccines for Children (VFC) program, with the remainder covered by a donation from a local hospital foundation.
One district's experience
In 2005, Knox County's pilot program included 81 public schools with a goal of immunizing 54,000 children over a 4-week period. "We were their (MedImmune's) largest project, and our vaccination rate was 46%," he said, adding that the company challenged the county to exceed that number in 2006. In 2007, the county continued the school-based immunizations on its own by cobbling together some vaccine from the VFC program, funding for staffing and vaccine purchase from the county, and assistance from school nurses. However, the vaccination rates were difficult to sustain because of the extra burden on schools and their nurses. "It's a challenge trying to find a sustainable model," he said.
Despite the difficulties, Lott says he has seen other benefits for schools beyond just improved vaccination rates. Over the past four years, Knox County hasn't had to close any of its schools, even though closures have occurred in surrounding areas. Financial support for schools is often based on daily attendance, he said, so healthy students can have bottom-line benefits for their schools.
Lott said he and his colleagues have learned useful lessons from their experiences with school-based immunization. For example, he said it's easier to exceed 60% vaccination rates in K-5 elementary schools because the paperwork channels for items such as vaccine consent forms are more reliable with this age-group. Rates drop to about 45% in middle schools, then fall off to about 25% to 30% in high schools. With limited resources for school-based vaccination drives, healthcare officials have to make tough decisions about what age-groups to target.
Realistic expectations for schools
USA: Report says pandemic will threaten coal and power supplies
The authors recommend that power plants stockpile coal to last much longer than the average 30-day supply they have now and that the nation prepare now for disruptions in the coal-supply chain and electrical service. They also urge that coal industry workers be put in the highest priority group for pandemic vaccines and antivirals.
The report can be accessed at:
- 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 (interim) 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/ Find more than 150 peer-reviewed practices from 25 US states and 37 cities and counties aimed at furthering pandemic preparedness in public health and allied fields.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm Link to the Avian Influenza Portal at: http://influenza.bvsalud.org/php/index.php?lang=en. The Virtual Health Library’s Portal is a developing project for the operation of product networks and information services related to avian influenza.
- 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)
Biosecurity for Highly Pathogenic Avian Influenza
Food and Agriculture Organization of the United Nations report. Nov 2008. Available at ftp://ftp.fao.org/docrep/fao/011/i0359e/i0359e00.pdf.
This paper moves forward from the discussion presented in the FAO/OIE/World Bank position paper on The importance of biosecurity in reducing HPAI risk on farms and in markets. It draws on what we already know about biosecurity, particularly for countries endemically infected with HPAI or at high risk of introduction, identifies problems, proposes solutions and outlines a future course of action.
Among others, it looks at the basic principles of biosecurity within the overall framework of disease control, discusses species- and sector-specific issues, stresses the importance of situating biosecurity in appropriate economic and cultural settings, and makes the case for the role of communication.
Videoconferencing in the Field: A Heuristic Processing Model
This research uses dual-process cognitive theory to describe how people process information differently when it is delivered via videoconference rather than when it is delivered face-to-face. According to this theory, relative to face-to-face communication, people in videoconferences tend to be more influenced by heuristic cues—such as how likeable they perceive the speaker to be—than by the quality of the arguments presented by the speaker. This is due to the higher cognitive demands that videoconferencing places on participants. We report on a field study of medical professionals in which we found differences in information processing as predicted: participants attending a seminar via videoconference were more influenced by the likeability of the speaker than by the quality of the arguments presented, whereas the opposite pattern was true for participants attending in-person. We also found that differences in cognitive load explain these effects. The discussion on the theoretical model and associated findings explains why prior videoconference studies have not consistently found main effects for media. The findings also show that videoconferencing is not like face-to-face communication, despite apparent similarities.
Detecting influenza epidemics using search engine query data
More Detailed Plans Needed for the Centers for Disease Control and Prevention’s Redesigned BioSense Program
Why GAO did this study?
Influenza Virus (H5N1) in Live Bird Markets and Food Markets, Thailand
ASEAN Plus 3 EID Programme launches new website
The ASEAN Plus Three Emerging Infectious Diseases (EID) Programme aims to enhance regional preparedness and capacity through integrated approaches to prevention, surveillance and timely response to emerging infectious diseases, including SARS, avian and pandemic influenza. The website provides updates on EID in the ASEAN plus 3 countries through sharing country bulletins and surveillance reports. It contains notification of upcoming events and workshops conducted in the network countries. In addition, it provides a forum for information sharing of regional best practices.
The website can be accessed at http://www.aseanplus3-eid.info/index.php