EINet Alert ~ Dec 05, 2008

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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 9/11/08)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 11/17/08):
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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Global: Study finds migratory ducks unlikely to spread LPAI over long distances   PRINT THIS EMAIL THIS
Avian flu viruses make mallard ducks thinner than other ducks, a finding that implies they do not spread the germs over long distances, researchers reported on 2 Dec 2008. Their tests of thousands of ducks migrating through Sweden showed the viruses do affect the birds, contrary to conventional wisdom that the pathogens have no effect on them. And, to their surprise, they found the birds only "shed" virus for a few days, the researchers reported in the Proceedings of the Royal Society B: Biological Sciences. "Mallard ducks are a main reservoir for low-pathogenic avian influenza [LPAI] virus in nature, yet surprisingly little is known about how infection affects these birds," Jonas Waldenstrom of Sweden's Kalmar University, Albert Osterhaus of Erasmus Medical Center in Rotterdam and colleagues wrote.

A reservoir is a species that hosts a virus without becoming ill, and thus serves to spread it. Avian flu viruses have most often been found in migratory waterfowl, especially mallard ducks. "We analyzed 10,000 samples from migratory mallards in Sweden for presence of influenza virus and were able to demonstrate that infected birds were leaner than uninfected birds, and that weight loss was related to the amount of virus shed in their feces," Waldenstrom's team added. "Although many mallard populations are migratory, the short virus shedding times (often less than a week) imply that individual birds are not long-distance dispersers of the virus on a continental scale."

There are hundreds of kinds of bird flu, and evidence suggests that human forms of influenza originate in birds. Low-pathogenic avian influenza strains generally have little effect, although the highly pathogenic forms can wipe out flocks in a matter of days. Highly pathogenic H5N1 avian influenza [HPAI] is currently affecting flocks in Asia, parts of Europe, and Africa and experts fear it may mutate into a form that humans can catch and transmit easily. If it does, it could kill millions. Even in its current hard-to-catch form, H5N1 has infected 387 people and killed 245 since 2003. Researchers do not know precisely how it spreads, although migrating birds are suspects, as is the poultry trade.

Waldenstrom's team found that infection did not affect how fast or far the birds migrated. On average, the ducks were infected for eight days and spread the virus for just three of them in their droppings. "The short virus shedding time suggests that individual mallards are less likely to spread the virus at continental or intercontinental scales," they wrote. But they may stay longer in one place when they are infected -- something that needs to be studied, they added.
(ProMED 12/2/08)

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China (Jiangsu): Suspected avian influenza outbreak among poultry   PRINT THIS EMAIL THIS
Sources say that over the last few weeks, there has been an outbreak of possible avian influenza near Jiangsu's Haian and Dongtai counties. Local chicken deaths have been relatively serious. Egg production has dropped sharply due to the outbreak. But because the outbreak has not yet been confirmed by authorities, it is still uncertain whether it is actually avian influenza. Demand for poultry feed in the area has dropped under the impact of chicken deaths and declining egg production.
(ProMED 12/4/08)

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India (Assam): Avian influenza H5N1 outbreak in poultry confirmed and spreading   PRINT THIS EMAIL THIS
Government officials in India recently confirmed an H5N1 avian influenza outbreak in the northeastern state of Assam, according to a 28 Nov 2008 report from the World Organization for Animal Health (OIE). The virus struck backyard poultry in a small village, killing 324 of 391 birds. Testing on samples from the birds was conducted at the High Security Animal Disease Laboratory in Bhopal, which reported the positive H5N1 findings on 27 Nov 2008.

India's last H5N1 outbreak occurred in May 2008, when the virus struck backyard poultry in West Bengal state. That outbreak signaled the end of a five-month battle against the virus at several sites in West Bengal and Tripura states, both of which adjoin Bangladesh. On 4 Nov 2008, India filed a final report on the 42 outbreaks in those two northeastern states.

In Assam, officials ordered the culling of all domestic poultry within a 5 km radius of the outbreak site and said owners would be compensated for their birds. The OIE report said authorities have closed poultry markets and curbed the sale and transport of birds in the zone near the outbreak.

Manoranjan Choudhury, deputy director of Assam's veterinary department, said that as of 1Dec 2008, animal health workers have culled 40,000 of 60,000 poultry that were slated for culling. He said chickens and ducks are affected by the slaughtering activities, which will involve 48 villages. Twenty-two rapid response teams are expected to complete the operations within the next two or three days.

On 3 Dec 2008, animal health officials in India reported that the virus turned up in new areas and that authorities were set to start culling birds in the area, located in northeastern India. The new outbreak areas include about 20 villages, some of which are close to Guwahati, Assam's capital. He said precautionary measures throughout the state include a ban on the sale and movement of poultry in and out of Guwahati.

Despite several poultry outbreaks, India has never reported a human H5N1 case. Indian Health Officials have attributed the outbreak to migratory birds. While that is possible for this case, experts maintain that there is as yet very little evidence for them playing a meaningful part in the epidemiology of the disease. In fact, commercial movements of poultry and such have been found to be the consistent cause.
(ProMED 11/30/08, CIDRAP 12/1/08, 12/4/08)

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Myanmar: Calls for precaution against cross-border avian influenza H5N1   PRINT THIS EMAIL THIS
On 5 Dec 2008, the Myanmar Livestock Breeding and Veterinary Department (LBVD) called on the country's people to take preventive measures against cross-border bird flu, saying that avian influenza was found occurring intermittently in neighboring countries in both Thailand to the east and India to the northwest since November 2008.

The statement of LBVD attributed the phenomena to have been caused by migratory wild birds, carriers of H5N1 virus from one place to another and urged poultry traders to step up bio-security measures against the probability. Migratory birds from different regions across the world fly over Myanmar territory during the winter season period between November and February, especially during December, according to experts.

The authorities have also called for maintaining awareness about the modes of infection of avian influenza and intensifying precautionary and educational measures to prevent any occurrence in humans and birds. Meanwhile, Myanmar is cooperating with the Food and Agriculture Organization (FAO) and the United States Agency for International Development (USAID) in prevention efforts against avian influenza.

In April 2008, the World Animal Health Organization (OIE) declared Myanmar a bird-flu-free country three months after the country proved that there was no residual bird flu virus remaining after outbreaks prior to January 2008. From February 2006 through December 2007, there were numerous outbreaks of avian influenza in Myanmar covering 25 townships of six states and divisions. All of the occurrences were attributed to poultry coming into the country from abroad, especially by migratory birds from the cold regions in the world infecting local birds, according to the LBVD.

Myanmar reported outbreaks of avian influenza in the country for the first time in some poultry farms in Mandalay and Sagaing divisions in early 2006, followed by those in Yangon division in early 2007. Outbreaks were reported in Mon state's Thanbyuzayat and western Bago division' s Letpadan in July 2007 and in eastern Bago division's Thanatpin and in Yangon division's Hmawby in October the same year.

Despite the declaration as a bird-flu-free country, the Myanmar livestock authorities continued to call on the country's people to exercise a long-term precaution against avian influenza H5N1.
(The Hindu 12/5/08)

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Philippines: Avian influenza test facility opens in Zamboanga City   PRINT THIS EMAIL THIS
An avian influenza test facility has opened in Zamboanga City. Oscar O. Parawan, regional director the Department of Agriculture, said the Regional Avian Influenza Diagnostic Laboratory is the third in the country and second in Mindanao. Other similar facilities are in the cities of Cebu and Cagayan de Oro.

He said the laboratory was set up here since the city, along with key areas in the Zamboanga Peninsula, is a migratory bird path and transit point of smuggled birds from countries that have been affected by the virus. The Philippines has maintained its bird flu-free status.

Located in Tumaga village, Mr. Parawan said the facility will boost Mindanao’s positioning as a supplier of halal poultry products within the Brunei-Indonesia- Malaysia-Philippines-East ASEAN Growth Area (BIMP-EAGA). Halal is a Muslim manufacturing process, while BIMP-EAGA is an economic subgroup of 10 members of the Association of Southeast Asian Nations (ASEAN).

Dr. Davinio P. Catbagan, director of the Bureau of Animal Industry, said the laboratory, a joint project with the Japanese government, "can detect accurately, precisely and quickly the presence of avian influenza in the country." Mr. Parawan said there will be at least three experts who will man the laboratory.

Zamboanga Peninsula is among the top 20 priority areas being monitored by the National Avian Influenza Task Force. The region was described as a "vulnerable spot" because of its proximity to Malaysia and Indonesia, which has had confirmed bird flu cases. The region’s Veterinary Quarantine Office has also beefed up its measures in checking poultry passing through every seaport and airport in the region. The Philippines is part of the so called migratory fly way where thousands of shore birds, mostly from Australia, China, Siberia, and Mongolia, pass by.
(Business World Online 12/5/08)

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Viet Nam: Two provinces report new outbreaks in avian influenza H5N1 among poultry   PRINT THIS EMAIL THIS
Medical officials in Vietnam acknowledged fresh outbreaks in two provinces on 3 Dec 2008. Media reports coming out of Vietnam quoted health ministry officials as saying the virus has reappeared in Ca Mau province, in the south, and Nghe An province, in the central part of the country.

Nguyen Huy Nga, head of the department for preventive medicine and the environment, said on 3 Dec 2008 that though no new human cases have been reported, weather conditions and unpredictable circulation of the virus in poultry present a high risk of the disease to humans.

According to reports from the World Organization for Animal Health (OIE), Vietnam has notified the agency about several H5N1 outbreaks this year. The most recent report, dated 27 Nov 2008, described two outbreaks in Nghe An province, the site of one of the country's new outbreaks. Those two outbreaks involved duck flocks; one occurred in unvaccinated village ducks, and the other—considered to be ongoing—was reportedly caused by the introduction of unvaccinated ducklings into an existing flock.
(CIDRAP 12/4/08)

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In a letter accompanying the draft, Joxel Garcia, assistant secretary for health at HHS, wrote that the next step involves extensive input on the plan from the public, the vaccine industry, and other stakeholders. He added that HHS's goal is to finalize the plan by late 2009. "This input will also enable us to develop an implementation plan with discrete activities and measurable milestones," wrote Garcia, who is also director of the HHS's National Vaccine Program.

Though the efforts across several federal departments mostly or fully achieved all of the 1994 vaccine plan goals, many of the same challenges remain, the report said. For example, vaccine shortages still crop up, and immunization rates for high-risk groups fall below their ideal levels. "Additionally, emerging and pandemic infections and bioterrorist threats pose new challenges for vaccine development and regulation, manufacturing, vaccine delivery, and access in the US and abroad," the report notes. It also states a need to pursue a cross-protective vaccine for influenza.

The draft plan was coordinated by the National Vaccine Program Office and reflects the input of several federal agencies. The plan addresses five broad goals:
• Develop new and better vaccines
• Enhance vaccine and immunization safety
• Assist the public, providers, and policy makers with vaccine decisions
• Ensure vaccine supply and uptake of existing vaccines
• Boost global efforts to curb vaccine-preventable disease and deaths

The report acknowledged that specifics about pandemic vaccines and countermeasures for biological attacks are included in other federal plans. However, the draft plan spells out the need to organize, practice, and evaluate mass vaccination activities for disease outbreaks, biological attacks, and pandemic-related scenarios for the workforce and members of the public. It also includes efforts to ensure vaccine supplies and look for health problems related to vaccines.
(CIDRAP 12/4/08)

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USA (Minnesota): Training for addressing psychological needs in a disaster response   PRINT THIS EMAIL THIS
A training program under way through the Minnesota Department of Health (MDH) aims to reduce the psychological impact of emergencies and disasters in a process that has similarities to delivering physical first aid. Since September 11, 2001, there has been a growing understanding of the psychological impact of terrorism and disasters. Thus more professional and lay responders have learned a range of ways to address the psychological needs of people affected by terrorism and disasters. One type of training, called psychological first aid (PFA), is increasingly used as a first step in assisting people caught in disasters.

Nancy Carlson, the behavioral health preparedness coordinator at the MDH, began teaching PFA in Minnesota more than four years ago. The training program offers basic courses for disaster behavioral health responders and addresses the needs of specific local audiences.

Short, efficient training
"Although the federal government recommended psychological first aid shortly after September 11, 2001," Carlson said, "there was no training for first responders or healthcare providers." One of the only PFA courses available at that time was taught by the International Red Cross in Africa. It was designed for communities that were short of mental health professionals.

The length of the course—for example, 40 hours from the International Red Cross—was another barrier. "No one here could take that kind of time off to do the training," Carlson said. So she and her colleagues brought in mental health professionals and experienced agencies and then created their own Minnesota model, a two- to four-hour training class for emergency responders.

They identified several priorities for improving disaster mental health response, including communicating with people about their spiritual needs, helping people to feel safe in uncertain circumstances and surroundings, and providing people a safe environment to allow them to talk openly.

User-friendly information
Although PFA responders are not necessarily licensed behavioral health professionals, they do provide important interventions following a disaster. PFA responders listen with compassion, provide any needed referrals, and encourage healthy coping strategies, such as eating healthfully and getting rest and exercise. It is a role that anybody can play provided they have received PFA training. "In addition, people are trained to identify the situation that is too serious and pressing for them," Carlson said. "They also need to know how to help people to get access to the professional mental health services."

In Minnesota, trainees receive a PFA card with the information on:
• Promoting safety
• Fostering calm and comfort
• Promoting connectedness
• Encouraging self empowerment
• Offering prevention strategies
• Teaching self-care

New goals, new challenges
According to the statistics from the MDH's Nancy Carlson, more than 20,000 people from all over Minnesota have been trained in PFA. And the training is ongoing throughout the state. Not solely designed for disasters, PFA training can be used anywhere, such as during seasonal flu and even pandemic influenza.

"A few years ago, when we had a shortage of flu vaccine, there were a lot of people calling in, and they were upset," Carlson said. The big difference during a flu pandemic would be that the responders could not have individual, face-to-face conversations, she said, "But it would be the same skills. We are still able to use the PFA via phones such as hotlines, and [in] training family members and community groups."

Public awareness of the availability and usefulness of PFA training continues to lag, especially when there is no sign of disaster, and this lack of awareness concerns Carlson. "But we can hit our target audience by going through different community groups. And our next goal is developing a program for kids to train the youth on how to help each other deal with their emotions, through which we can promote the training program further," Carlson said.
(CIDRAP 12/1/08)

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Objective To assess influenza vaccine effectiveness against influenzalike illness (ILI) and ILI impact on health care use and school performance among college and university students.

Design Pooled analysis of 4 consecutive cohorts for the 2002-2003 through 2005-2006 seasons.

Setting Twin Cities campus of the University of Minnesota (2002-2003 through 2005-2006 seasons) and St. Olaf College in Northfield, Minnesota (2005-2006 season).

Participants Full-time students received e-mail invitations to participate in single-season cohorts. Internet-based surveys collected baseline (October) and follow-up (November-April) data.

Main Exposure Influenza vaccination.

Main Outcome Measure Proportion of students with ILI. Multivariable regression models assessed the effectiveness of vaccination for reducing ILI during months when influenza was circulating while controlling for confounders and after pooling data across the 4 cohorts.

Results There were 2804, 2783, 3534, and 3674 participants in the 2002-2003, 2003-2004, 2004-2005, and 2005-2006 cohorts respectively, and overall, 30.2% were vaccinated. In the pooled analysis, 24.1% of students experienced at least 1 ILI during influenza seasons. Vaccination was associated with a significant reduction in the likelihood of ILI during influenza seasons (adjusted odds ratio, 0.70; 95% confidence interval, 0.56-0.89) but not during noninfluenza periods (adjusted odds ratio, 0.98; 95% confidence interval, 0.73-1.30). Vaccination was also associated with significant reductions in ILI-associated provider visits, antibiotic use, impaired school performance, and numbers of days of missed class, missed work, and illness during the influenza seasons.

Conclusions Influenza vaccination was associated with substantial reductions in ILI and ILI-associated health care use and impairment of school performance. College and university students can experience substantial benefits from influenza vaccinations.

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Human Infection with Highly Pathogenic Avian Influenza Virus (H5N1) in Northern Vietnam, 2004-2005   PRINT THIS EMAIL THIS
Hien ND, et al. Emerg Infect Dis. Jan 2008, early online pub. Available at http://www.cdc.gov/eid/content/15/1/pdfs/08-0073.pdf.

Abstract
We performed a retrospective case-series study of patients with influenza A (H5N1) admitted to the National Institute of Infectious and Tropical Diseases in Hanoi, Vietnam, from January 2004 through July 2005 with symptoms of acute respiratory tract infection; a history of high-risk exposure or chest radiographic findings such as pneumonia; and positive findings for A/H5 viral RNA by reverse transcription—PCR. We investigated data from 29 patients (mean age 35.1 years) of whom 7 (24.1%) had died. Mortality rates were 20% (5/25) and 50% (2/4) among patients treated with or without oseltamivir (p=0.24), respectively, and were 33.3% (5/15) and 14.2% (2/14) among patients with and without methylprednisolone (p=0.39), respectively. After exact logistic regression analysis was adjusted for variations in severity, no significant effectiveness for survival was observed among patients treated with oseltamivir or methylprednisolone.

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Knowledge about Avian Influenza, European Region   PRINT THIS EMAIL THIS
Mossialos E & Rudisill C. Emerg Inf Dis. Dec 2008: 14(12). Available at http://www.cdc.gov/eid/content/14/12/1956.htm.

To the Editor: Since the first identifications of avian influenza (H5N1) in Europe in late 2005 and early 2006, Eurobarometer survey data obtained during April–May 2006 have provided a unique opportunity to examine the knowledge of respondents across the European Union, Croatia, and Turkey about the risks and transmission of avian influenza. The H5N1 strain of avian influenza virus has caused >240 human deaths in central and Southeast Asia, the Middle East, and Africa. Four of these deaths occurred in Turkey in 2006. Understanding gaps in the public's knowledge about avian influenza risks and transmission provides guidance on which issues future public health information campaigns may wish to focus. From a public health perspective, a more informed general public will be less likely to unnecessarily alter their travel and food consumption behavior and more likely to take appropriate preventive actions.

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The deadline for abstract submission for the conference is 12 Dec 2008. This will allow the most timely and up-to-date abstracts to be presented at IMED. Accepted abstracts may be presented as posters during two dedicated poster sessions, and selected abstracts will be presented in three platform sessions.

Topics for abstracts at IMED 2009 include:
• Animal reservoirs for emerging pathogens
• Emerging zoonoses
• Emerging vectorborne diseases in humans and animals
• Models of disease surveillance, detection and reporting
• Outbreak control
• Surveillance using informal sources
• Syndromic surveillance
• Regional disease surveillance
• Laboratory surveillance
• New pathogen discovery
• Avian influenza
• Agents of bioterrorism
• Antibiotic resistance
• Climate change
• Vaccines against emerging diseases

This meeting is being co-sponsored by ProMED, the OIE, the European Commission, the Wildlife Conservation Society, and the European CDC. This meeting follows the highly successful IMED 2007, which drew over 600 participants from more than 60 countries and at which more than 300 abstracts were presented. For additional information: http://imed.isid.org/.

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FSIS Seeks Comments On Draft Risk Assessment For The Public Health Impact Of Highly Pathogenic Avian Influenza Virus In Poultry, Shell Eggs, And Egg Products   PRINT THIS EMAIL THIS
The U.S. Department of Agriculture's (USDA) Food Safety and Inspection Service (FSIS) is seeking public comments on a draft quantitative food safety risk assessment for highly pathogenic avian influenza (HPAI) virus from consumption of poultry products, shell eggs and egg products. The risk assessment was done in collaboration with the Department of Health and Human Services' Food and Drug Administration (FDA), and USDA's Animal and Plant Health Inspection Service (APHIS).

The risk assessment is available at:
http://www.fsis.usda.gov/Science/Risk_Assessments/index.asp.

Comments must be received by 31 Jan 2009. They can be sent to Docket Clerk, U.S. Department of Agriculture, Food Safety and Inspection Service, Room 2534 South Agriculture Building, 1400 Independence Avenue, SW., Washington, D.C. 20250; e-mailed to fsis.regulationscomments@fsis.usda.gov or submitted through the Federal eRulemaking Portal at www.regulations.gov. All submissions received by mail or electronic mail must reference the Food Safety and Inspection Service and include the docket number FSIS-2007-0001.

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Grand Challenges in Global Health Initiative request for proposals   PRINT THIS EMAIL THIS
The McLaughlin-Rotman Centre for Global Health (MRC) and its Ethical, Social and Cultural Program (ESC) for the Grand Challenges in Global Health (GCGH) Initiative are pleased to invite individuals, institutions, organizations and companies from the developing world to submit proposals to carry out projects that will facilitate the implementation and use of technologies in the developing world that arise from the GCGH projects.

The goal of this Request for Proposals (RFP) is to select and commission research on strategies that will facilitate the implementation and appropriate use in the developing world of technologies that arise from the GCGH projects related to diagnostics, modified insect vectors, nutritionally enhanced foods, and vaccine delivery. Visit www.mrcglobal.org/rfp for further information. The deadline to submit proposals is January 16, 2009.

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