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Vol. XI, No. 26 ~ EINet News Briefs ~ Dec 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
- Cumulative number of human cases of avian influenza A/(H5N1)
- Global: EU panel supports innovative pandemic and seasonal influenza vaccines
- Belgium: Low pathogenic H5 avian influenza detected on poultry farms
- Denmark: Avian influenza suspected on farm with free-range chickens
- England: Surging influenza cases may herald tough season
- Germany: Low pathogenic avian influenza outbreak continues in Cloppenburg County
- Bangladesh: Reports fifth outbreak of avian influenza H5N1 among poultry since October 2008
- China: Government efforts reduced the incidence of avian influenza in 2008
- China (Jiangsu): FAO announces that it will monitor avian influenza H5N1 outbreak
- Chinese Taipei: Report confirms October 2008 outbreak as avian influenza H5N2
- USA: CDC Advisory on Tamiflu resistant influenza virus
- Cambodia: Young man survives avian influenza H5N1 virus infection
2. Infectious Disease News
- Indonesia: Update on response to suspected rabies outbreak in Bali
- Indonesia: Health emergency declared due to spread of chikungunya outbreak
- Malaysia: Battle against chikungunya epidemic continues
- Russia (Novosibirkaya Oblast): Rabies vaccination efforts continue
- USA: FDA approves shortened anthrax-vaccine course
- AVIAN/PANDEMIC INFLUENZA
- WEST NILE VIRUS
- Weekly Epidemiological Record Bulletin
- Experimental Infection of Dogs with Avian-Origin Canine Influenza A Virus (H3N2)
- Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak
- School Closure to Reduce Influenza Transmission
- Personal Protective Equipment and Risk for Avian Influenza (H7N3)
- Videoconference video and materials now available on APEC EINet website
- Nobel Prize winner D Carleton Gajdusek dies at age 85
- 2009 International Conference on Biocontainment Facilities
- Grand Challenges in Global Health Initiative request for proposals
- XI International Symposium on Respiratory Viral Infections
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:
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 391 (247).
Avian influenza age distribution data from WHO/WPRO:
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 12/24/08):
WHO’s timeline of important H5N1-related events (last updated 12/8/08):
Global: EU panel supports innovative pandemic and seasonal influenza vaccines
Most flu vaccines, including the two H5N1 prepandemic vaccines now licensed, are grown in chicken eggs, a process that takes about 4 to 6 months. Baxter's H5N1 vaccine, called Celvapan, is grown in Vero (monkey kidney) cells. Cell culture production is regarded as somewhat faster and much more flexible than the egg-based method.
CHMP also recommended EMEA approval of a Sanofi Pasteur seasonal flu vaccine that is injected intradermally (ID)—just beneath the skin surface—instead of into muscle. "This represents the first key step toward recognition of the ID route as a promising option for vaccine administration," the company said.
Baxter vaccine called mock-up
"Once a pandemic strain is declared, this licensure allows for a fast track approval of the vaccine containing the actual pandemic strain," the company said. Health officials hope that vaccines based on existing H5N1 viruses will provide some protection if H5N1 evolves into a pandemic strain.
In May 2007 the EMEA approved a mock-up flu vaccine made by Novartis, called Focetria, to permit a faster start on production in case of a pandemic. The company said that vaccine would not be manufactured until a pandemic is declared.
Baxter said the antigen composition and structure of Celvapan "are identical to the actual virus circulating in nature," which eliminates the need to use adjuvants (immune-boosting chemicals) and the resulting potential for side effects.
Intradermal vaccine supported
The BD product consists of a prefilled syringe with a needle and a shield that allows the needle to penetrate only 1.5 millimeters into the skin. Previously, ID injections were done with the Mantoux technique, developed for tuberculosis skin tests. It said the Mantoux technique is not commonly used for vaccination, because it is hard to apply reliably and efficiently. The US flu vaccine shortage in the 2004-05 flu season stimulated interest in using ID vaccination as a way to stretch the vaccine supply.
Belgium: Low pathogenic H5 avian influenza detected on poultry farms
Emergency measures have been taken after an outbreak of bird flu was detected in two farms in northern Belgium. Control tests showed on 19 Dec 2008 that some ducks and geese in a farm in Bocholt, which borders the Netherlands, were infected with the H5 bird flu virus. The same virus was also detected in a farm in Buggenhout in the province of East Flanders.
The H5 virus is not dangerous to human beings and is different from the H5N1 variant, which has killed more than 200 people since it resurfaced in 2003.
The Belgian Federal Food Agency, which supervises the safety of the food chain, has ordered emergency measures to be taken in the two farms and surrounding areas. Some 5000 animals had to be slaughtered as a precautionary measure and all poultry within a radius of one km of the farms must be kept indoors. Transport of poultry is forbidden for 21 days.
Denmark: Avian influenza suspected on farm with free-range chickens
England: Surging influenza cases may herald tough season
British public health officials define a flu epidemic as an ILI rate of 200 per 100,000. The last time that happened in England was in 1989-90. "That one caught everyone a bit off guard but there's been a big push on flu vaccination since then," virologist John Oxford of Queen Mary's School of Medicine and Dentistry stated.
Germany: Low pathogenic avian influenza outbreak continues in Cloppenburg County
Since the outbreak in Friesoythe-Schwaneburg has been officially confirmed, a 1000 meters radius zone has been declared as an exclusion zone around the farm. No additional poultry farms are located within the said zone, leading to a limited impact of the declaration.
A new suspected case was reported on 20 Dec 2008 from the municipality Bosel, where 17,500 turkeys have been killed as a precaution, according to the district. The official investigation's results are not yet available. So far, approximately 300,000 birds have been culled and destroyed.
Bangladesh: Reports fifth outbreak of avian influenza H5N1 among poultry since October 2008
Agriculture officials in Bangladesh stated on 23 Dec 2008 that they have detected another H5N1 avian influenza outbreak on a farm, the country's fifth one since the virus reemerged in poultry flocks in October 2008. Salahuddin Kahn, livestock department spokesman, said the outbreak occurred on a farm in Kurigram in the northern part of the country and that 100 birds were culled to control it. He said that Kurigram is the fifth district to be hit by the virus since October 2008. Two states in western India that share borders with Bangladesh, Assam and West Bengal, have also battled recent H5N1 outbreaks.
China: Government efforts reduced the incidence of avian influenza in 2008
The number of birds infected with avian flu dropped by 60 percent, with 9000 birds falling prey to the virus, said Li Jinxiang, director of the ministry's veterinary bureau. "We've paid greater attention to animal epidemic control this year , enforcing effective vaccination programs and surveillance,"
Li said. A general nationwide survey shows the free inoculation program for poultry and livestock covered 95 percent of the country's villages and towns, Li said.
China (Jiangsu): FAO announces that it will monitor avian influenza H5N1 outbreak
"We are going to see how it evolves. If for some reason there were more outbreaks and it was spreading, then I would say I am concerned, but today not at all," said Vincent Martin, senior technical adviser for the UN Food and Agriculture Organisation (FOA) in China. "Today we are just monitoring the situation. Having a few outbreaks in the winter time in this place is not a real concern."
The H5N1 strain of bird flu was found on a chicken farm in Dongtai city and in another farm in Haian County, China's Agriculture Ministry said. The discovery prompted local agricultural authorities to step up vaccinations, while culling 377,000 chickens in the area around the farms. The virus has not been detected in any other locations. Martin said the FAO had been notified by Chinese authorities on 16 Dec 2008 about the outbreak, which could have been triggered by migratory birds.
China has had several bird flu outbreaks in 2008, leading to the deaths of three humans. "The situation in China has been improving for the past four years, and during the last year, we had less outbreaks of avian flu," Martin said. "The Chinese government is doing quite a lot of surveillance, and they are also implementing a massive vaccination campaign."
Chinese Taipei: Report confirms October 2008 outbreak as avian influenza H5N2
An inspection report released on 20 Dec 2008 showed that the chickens had contracted the H5N2 strain of avian influenza, a less virulent strain than H5N1, which can be transmitted to humans. However, the findings of the report came too late for the 18,000 chickens on the farm that were slaughtered on 14 Nov 2008. The origin of the outbreak remains unclear.
Since the outbreak, 76 chicken farms within three km of the epicenter have been monitored to ensure the disease does not spread, he added. Taipei has suspended its poultry exports, but will be allowed to resume them if no fresh outbreak of H5N2 is reported within the next three months, officials said.
USA: CDC Advisory on Tamiflu resistant influenza virus
The U.S. Centers for Disease Control and Prevention (CDC) warned in an official health advisory to doctors that the most common influenza virus that is spreading in the US is resistant to the flu drug Tamiflu [oseltamiver]. The Tamiflu-resistant virus is the flu virus most commonly seen so far in 2008 and has been detected in 12 states so far, mostly in Hawaii and Texas. The strain is not more or less dangerous than other flu strains. Medical experts say Tamiflu resistance was not unexpected though the speed of Tamiflu resistance was surprising. Last year 11 percent of type A H1N1 flu bugs were resistant while this year, 49 out of 50 H1N1 viruses have been resistant.
CDC Director Julie Gerberding, said, "There is no crystal ball here. We can't predict if this strain will end up being the most important one this year. It could fizzle out. . .We're giving a 'heads-up' to the clinicians, but we are not making drastic changes in our treatment and prevention recommendations." There is no way of knowing this early in the flu season if Tamiflu resistant flu virus will be this year's predominant cause of the flu. In humans, three different flu bugs are in circulation with type A H3N2 strain, one type B strain and the resistant bug is the type A H1N1 strain. Gerberding said the current flu vaccine protects against all three of the viruses and is an excellent match for the drug resistant bug.
Tamiflu which costs about USD 100 a box, has been the most attractive treatment because it is taken in pill form and can be given to children as young as one year old. There are alternatives for the flu such as Relenza, which the Tamiflu-resistant flu bug is still sensitive to as well as older drugs such as the adamantanes Flumadine and Symmetrel, although resistance to these drugs has been steadily increasing among type A flu viruses.
Relenza comes in an inhaler and cannot be used for children younger than seven years for treatment, and those younger than five years cannot use it for prevention. Moreover, Relenza sometimes causes lung spasms, so it cannot be used by people with lung problems.
Joseph S. Bresee, chief of the epidemiology and prevention branch of the CDC's flu division said, "Even among hospital patients with the flu, more than half do not receive antiviral therapy. Tamiflu and Relenza are relatively underused at this point. He said that the current warning may actually see an increase in the use of flu drugs by increasing awareness in doctors on how to use them.
The complete text of the CDC advisory regarding the use of antiviral medications for influenza can be accessed at http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00279.
Cambodia: Young man survives avian influenza H5N1 virus infection
Cambodia began culling poultry near its capital last week, and ordered a three-month ban on poultry being moved from the province of Kandal, 50 kilometres south of Phnom Penh, after tests confirmed it had been hit by the virus.
The young man, the eighth person in Cambodia to have contracted bird flu since its first case in 2005, fell ill on 28 Nov 2008 but was only confirmed as having bird flu on 11 Dec 2008. All seven of Cambodia's previous human cases have died.
2. Infectious Disease News
Indonesia: Update on response to suspected rabies outbreak in Bali
In response to what is feared to be a rabies outbreak in Bali, several authorities and health organizations expressed their readiness on 8 Dec 2008 to carry out several measures designed to curb the spread of the disease. Their willingness was declared at a meeting held at the Bali Health Agency chaired by Tjandra Yoga Aditama, the director general of disease control and environmental health at the Health Ministry. The meeting was attended by officials from regency animal husbandry agencies, the Bali Health Agency, police, tourism offices, community health centers, state-run Sanglah Hospital, and others.
The Bali provincial administration has declared a condition of extraordinary occurrence following the confirmation that a brain sample from a dog in Kedonganan, South Kuta, tested positive to rabies. "This is an extraordinary occurrence or an emergency situation. We have to quickly work to restore Bali as a rabies-free area," said Dewa Ketut Oka, head of the Bali Health Agency.
However, only one brain sample of one dog tested positive, Oka said. The results of laboratory tests on the four people who died in Ungasan village, Uluwatu, recently after being bitten by stray dogs were not available yet. "But from the clinical symptoms of a victim, there is a strong indication they were infected by rabies," Oka said, referring to one of the four victims.
At the meeting a number of steps to curb the spread of rabies were taken, including culling stray dogs and vaccinating domesticated dogs in areas 10 km from Ungasan and Kedonganan villages. At least 20,000 doses of rabies vaccine for dogs have been sent from Jakarta. Dog owners are encouraged to fence their dogs so they are not infected by any other sick animals.
"Seventy-five stray dogs in Ungasan and Kedonganan have been put down by lethal injection in cooperation with the Yudhistira Swarga foundation for wild dog welfare," IB Ketut Alit, head of the Bali Livestock Husbandry Agency, said. "A similar program could be conducted throughout other regencies in Bali as the program to curb the population of stray dogs has been [conducted] on a routine basis," Katut Alit said.
Bali Tourism Agency chairman Gde Nurjaya said it was important to protect Bali's image as an international tourist destination. "The health of both humans and animals is very important here."
Indonesia: Health emergency declared due to spread of chikungunya outbreak
The number of residents who have been attacked by the illness has reached over 100 people. In the Argosari Village and Jintung, the number of sufferers of chikungunya virus infection that have been detected reached 62 people. In the Kalibangkang Village and Watukelir, around 50 people are suspected of being infected by the virus.
Health officials are following up by carrying out various steps, including wide-spread mass medical treatment, fumigation (fogging) and counseling of local villagers as well as a demonstration of abate [application of larvacide] that was carried out symbolically by the Regent. An entomological investigation was carried out. Results of that surveillance found mosquito breeding sites in the affected locations.
The Head of the Health Service doctor, HA Dwi Budi Satrio MKes said, "After the blood samples were sent to the Hall of the Health Laboratory in Yogyakarta, positive results for chikungunya were received. This was done to be able to confirm that a chikungunya outbreak had occurred in Argosari Village," said Budi Satrio.
The head of the Field Control for Health Problems, Kusbiyantoro SKM MKes, added, "This is just the first time that an outbreak of chikungunya has occurred in Kebumen. There has not been a report of cases of chikungunya before."
As for the risk factor, most residents have created pools when the rainy season arrived, which provided a place for expansion of mosquito breeding sites," said Kusbiyantoro. Regent Kebumen KH Nashirudin Am made a plea to the residents to continue to actively eradicate mosquito breeding sites.
The emerging chikungunya illnesses have been detected since 30 Nov 2008. The number of cases continues to increase and spread.
Malaysia: Battle against chikungunya epidemic continues
All 32 patients have been transferred to Sungai Petani Hospital near the Kuala Muda District Health Department in Sungai Petani. "The transfer of the patients to the old hospital will enable our medical staff to continue to monitor and conduct checks on the victims. I would like to stress that all patients are in a stable condition," Ismail said.
After affecting 32 residents from Kampung Baru Sungkap Para, the chikungunya outbreak spread to another village. In Kampung Batu Lima, two villagers were admitted to Yan Hospital, in Yan, after they developed symptoms of chikungunya.
The Health Ministry has detected about 4000 suspected chikungunya cases nationwide in 2008, Minister Datuk Liow Tiong Lai said on 17 Dec 2008. "So far, the chikungunya disease is still under control nationwide," he stated. He again called for public diligence in taking preventive measures since there is currently no specific medicine to treat the chikungunya fever disease spread by Aedes mosquito.
To contain the spread of the disease the ministry has taken several measures including intensifying the campaign to eliminate the Aedes mosquito and holding lectures on the outbreak. He said the disease was first detected to have spread to Malaysia from Africa in 1997.
Meanwhile, he said 63 health projects costing RM 458 million (USD 131,230,211) had been approved for implementation in Terengganu under the Ninth Malaysia Plan with some projects already underway.
Russia (Novosibirkaya Oblast): Rabies vaccination efforts continue
USA: FDA approves shortened anthrax-vaccine course
The US Food and Drug Administration (FDA) recently approved a new version of BioThrax—the nation's only licensed anthrax vaccine—that requires fewer doses and changes the injection route. Emergent BioSolutions, maker of BioThrax, that the FDA's approval of the company's supplemental biologics license application for its anthrax vaccine adsorbed (AVA) allows a new schedule for the vaccine: five intramuscular (IM) doses compared with the previous regimen of six subcutaneous doses.
The vaccine is required for US military members who are deployed to the Middle East, but some have objected to the vaccine because of side effects. The FDA's approval is based on early findings from a large multicenter trial that was initiated by the US Centers for Disease Control and Prevention (CDC) in 2002. The goal of the study is to evaluate if as few as three doses of the vaccine administered over 6 months with booster doses up to 3 years apart will offer sufficient protection.
- 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 their new report: Pandemic Influenza, Electricity, and the Coal Supply Chain.
- 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)
Worse hit suburbs for the mosquito-borne disease are North Cairns, Parramatta Park and Whitfield. Dr. Jeffrey Hannah from the Tropical Population Health Service is urging those who become sick to see their doctor. Some northern beaches suburbs are also affected, and it is suspected that the outbreak is spreading to other suburbs. Authorities are monitoring several more suburbs close to the infected zones or where properties are conducive to breeding dengue mosquitoes.
The public in all suburbs is being warned to clear stagnant water in potted plants, car tires, palm fronds and any other containers; to use insect repellent, to wear personal repellent during the day, and re-apply it according to the label, and to use plug-in mosquito zappers; and also to use cockroach surface spray under tables, chairs and beds in the home.
This decline, if it is correct and continues until the end of 2008, will be the first drop after five consecutive years of rises in the number of cases. Overall, Indonesia has been experiencing an almost consistently rising trend in dengue fever infections since they were first recorded in 1968, when the case fatality ratio was as high as 40 percent.
With the number of cases usually reaching its peak between January and March, it is likely the 2008 figure for dengue fever cases will indeed end up being lower than the number in 2007. The government claims that the drop in dengue fever cases is a consequence of its anticipative measures, which include improving epidemiological surveillance, improving the quality of dengue services management, intensifying vector control and providing quick responses to "extraordinary occurrence" cases.
But other experts have said the drop was very probably due to the cycle in the population growth of Aedes aegypti, the mosquito that is the species vector of dengue fever virus. During the past 40 years, in about every decade showing a rising trend in cases, there has always been one year with a significant drop. If this drop is indeed part of this cycle, then in 2009 Indonesia will likely see another rise in infections.
As well as the disease's cyclic pattern, the threat of global warming could also boost the number of dengue fever cases in the future, as vector mosquitoes will be able to expand their territory to the highlands, which were once too cool for them to survive but are now growing warmer.
The Health Ministry's disease control director, Datuk Dr Hassan Abdul Rahman, said that this brings the number of cases due to dengue fever reported so far in 2008 to 44,494, including 98 deaths. He said the recent increase in dengue cases was due to, among others things, the rainy weather and the public's lackadaisical attitude in keeping their premises and surroundings free of Aedes mosquito breeding grounds.
He said that of the 969 premises inspected by health officials, 81 percent of them were found to contain breeding grounds for Aedes mosquitoes, adding that a total of 45 compound notices, involving fines of RM 12,650 (USD 3329), and 78 notices to clean up had been issued.
Because West Nile virus (WNV) has become endemic in North America and cases can be expected to occur throughout the virus transmission season, APEC EINet will be reporting only newly detected virus and human cases in the US states and Canadian provinces for the current reporting period. Those wishing to see the complete summary for virus detection in birds, mosquitoes, sentinel animals, and equines, as well as a breakdown of human disease cases for 2008, can access that information on the following websites:
Weekly Epidemiological Record Bulletin
WHO. 19 Dec 2008, 83(51/52): 461-464. Available at http://www.who.int/wer.
Contents of this issue:1) Note to travelers: prevention of falciparum malaria 2) Index of countries/areas 3) Index, Volume 83, 2008, Nos. 1-52.
Experimental Infection of Dogs with Avian-Origin Canine Influenza A Virus (H3N2)
Enhanced Hygiene Measures and Norovirus Transmission during an Outbreak
School Closure to Reduce Influenza Transmission
Letter to the editor
Personal Protective Equipment and Risk for Avian Influenza (H7N3)
Videoconference video and materials now available on APEC EINet website
On 29 May 2008 in the Americas and 30 May 2008 in Asia, APEC EINet hosted its second regional videoconference on preparedness entitled "Pandemic Influenza Preparedness: Partnerships and Continuity Planning for Critical Systems". With the support of the University of Washington Technology group, 16 APEC economies were brought together in a real-time interactive videoconference using videoconference technology. Economies shared best practices in public-private partnerships in local and national pandemic influenza preparedness planning. This "Virtual Symposium" showed that it is possible to partner public health, business, and technology communities to discuss best practices in preparedness in an efficient and effective manner.
For additional information please visit http://depts.washington.edu/einet/symposium.html. Presentations by each participating economy and a six minute video can be viewed at this website.
Nobel Prize winner D Carleton Gajdusek dies at age 85
Full obituary can be accessed at http://www.the-scientist.com/templates/trackable/display/blog.jsp?type=blog&o_url=blog/display/55284&id=55284. (Free registration required.)
Who should attend?
Additional information on registration and the conference agenda is available at http://www.TradelineInc.com/BIO2009.
Grand Challenges in Global Health Initiative request for proposals
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.
World opinion leaders will address key topics including epidemiology, pathogenesis, clinical, vaccinology and prevention, antivirals and therapeutics, as well as a minisymposium on avian influenza H5N1 animal-human interface.
Additional information available at www.themacraegroup.com.