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EINet Alert ~ Mar 13, 2009


*****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: Human vaccine against avian influenza within reach with new discovery
- Germany: European Unionís first avian influenza H5N1 outbreak in wild birds in 2009
- Bangladesh: Avian influenza H5N1 spreading among poultry farms in various regions
- Hong Kong: Wild birds likely caused avian influenza H5N1 outbreak in 2008
- Hong Kong: Dead chicken tests positive for avian influenza H5N1
- Japan: Avian influenza discovered in Aichi identified as H7N6 strain
- Nepal: Poultry destroyed in eastern district due to avian influenza H5N1
- Viet Nam: Another avian influenza H5N1 outbreak in Dien Bien
- USA: Spending bill includes pandemic influenza money
- Egypt: Official denies two avian influenza H5N1 cases in Cairo
- Egypt: Two more cases of avian influenza H5N1 in children prompts concern at WHO

2. Updates
- AVIAN/PANDEMIC INFLUENZA

3. Articles
- Influenza Pandemic: Sustaining Focus on the Nationís Planning and Preparedness Efforts
- The role of law in pandemic influenza preparedness in Europe
- Pandemic Influenza: Imminent Threat, Preparedness and the Divided Globe

4. Notifications
- Request for information for Mekong regional directory
- Influenza in the Asia-Pacific


1. Influenza News

Global
Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2009
China/ 7 (4)
Egypt/ 7 (0)
Viet Nam/ 2 (2)
Total/ 16 (6)

***For data on human cases of avian influenza prior to 2009, go to:
http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 411 (256).
(WHO 3/11/09 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 2/2/09)

WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 3/5/09): http://gamapserver.who.int/mapLibrary/

WHOís timeline of important H5N1-related events (last updated 2/23/09):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Human vaccine against avian influenza within reach with new discovery
A vaccine to protect humans from a bird flu pandemic is within reach after a new discovery by researchers at the University of Melbourne, Australia. The discovery, published in the Proceedings of the National Academy of Sciences, reveals how boosting T cell immunity could better protect humans from a bird flu pandemic.

The continued spread of the highly virulent "bird flu" virus has experts worried that we are facing a new potential influenza pandemic which could transfer between humans. Furthermore, given the bird flu is new, there is no pre-existing immunity in the population and current vaccine formulations would be useless.

"The 'Killer T cell' is the hit-man of the immune system. It is able to locate and destroy virus-infected cells in our body helping rid us of infection," said Prof Stephen Turner, from the Department of Microbiology and Immunology at the University of Melbourne who is a lead author on the paper. "Unfortunately, current influenza vaccines are poor at inducing killer T cell immunity. Therefore, we wanted to see if we could improve the current vaccine formulation to induce killer T cells after vaccination," he said.

"We added a compound, known to increase immunity, to the flu vaccine in an animal model. The addition of this compound promoted significant generation of potent killer T cell immunity and provided protection from infection. "The significance of these findings is that rather than having to design a new vaccine altogether, we can improve current flu vaccines by adding this potent immune modulator. With appropriate clinical testing, we could see improvements to current vaccines within the next five years."
(Science News 3/11/09)

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Europe/Near East
Germany: European Unionís first avian influenza H5N1 outbreak in wild birds in 2009
Germany has informed the European Commission of an outbreak of H5N1 bird flu, the European Union's first case of the lethal strain of the contagious disease in poultry in 2009.

The outbreak "was found in a wild duck shot during a hunt near the town of Starnberg in the German state of Bavaria," the European Union's executive arm said. The district office in Starnberg, just southwest of Munich, said that the duck was shot on 10 Jan 2009 and tested as part of an EU-wide monitoring program. None of the 39 birds shot on the hunt showed signs of illness.

Experts said the positive test was not surprising as wild birds are a natural 'virus reservoir', the Starnberg district office added. "Individual positive findings in the framework of the monitoring of wild birds are, furthermore, to be expected," the office said.

"There are no indications that during the last eight weeks a highly pathogenic virus has, directly or indirectly via a wild bird, been introduced into a poultry stock, or carried on from there," the district office added.

"There are so far no indications of the virus spreading in the wild bird population," the office said. The Starnberg authorities had not made any area off-limits or set up a monitoring area following the positive test. "On basis of the favorable result of a risk assessment, Germany may refrain from the establishment of a control area and a surrounding monitoring area around a positive finding," the European Commission said.

The last wild-bird case of bird flu in the 27-nation bloc was found in a Canadian goose in Britain in February 2008, while the last outbreak in poultry of H5N1 in the EU was detected in October 2008 in the German state of Saxony.
(ProMED 3/11/09)

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Asia
Bangladesh: Avian influenza H5N1 spreading among poultry farms in various regions
Avian influenza has started spreading in different poultry farms across the country again, as the department of fisheries and livestock detected the bird flu virus and culled birds at different places. Up to 3 Mar 2009, a total of 1,663,702 chickens were culled since 2007 when bird flu was first detected in the country.

On 6 Mar 2009, authorities culled 2095 chickens and destroyed 205 eggs following detection of bird flu in Netrakona and Gaibandha. Earlier, on 28 Feb 2009, 188 chickens were culled and 60 eggs destroyed, according to the Ministry of Fisheries and Livestock.

Reports from Netrakona stated that a total of 1595 chickens and 205 eggs were destroyed at a poultry farm at Kendua upazila in Netrakona. Officials at Netrakona District Livestock office said they detected bird flu virus at a poultry farm at Rampur village under Kendua upazila on 5 Mar 2009.

"The virus was found when dead chickens of the farm were examined at the district livestock laboratory by rapid antigen detection test (RADT)," said an official. The laboratory test was conducted after they received information that over a dozen chickens died on the farm over three days, officials said.

"The government has been alert enough this season to monitor bird flu cases. Wherever any bird flu virus is detected, authorities are taking measures to check its outbreak," said Dr Giasuddin, chief scientific officer at Bangladesh Livestock Research Institute. The government, with assistance from the UN Food and Agriculture Organisation (FAO), has employed field volunteers since October 2008 to strengthen surveillance of bird flu in rural areas, he said.

According to the official website, the government found the presence of the H5N1 virus at 308 farms in 47 districts and culled chickens of 568 farms up to 3 Mar 2009. Outbreaks of the virus generally occur after the end of the rains in October and continue until early June when the rains return.
(ProMED 3/7/09)

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Hong Kong: Wild birds likely caused avian influenza H5N1 outbreak in 2008
An outbreak of H5N1 avian influenza virus at a Hong Kong farm in 2008, which led to the slaughter of 90,000 chickens, was likely spread by wild birds, the government announced on 5 Mar 2009.

The December 2008 outbreak was the first to be discovered at a Hong Kong poultry farm in six years, and raised fears about the city's biosecurity measures or whether the H5N1 virus had mutated. Thomas Sit, the head of the government's investigation team, said they could not be totally sure what had caused the outbreak. "As with many epidemiological studies of this nature, it is difficult to determine the exact cause of the outbreak," Sit stated. But he said the virus was "most likely to have been introduced to the farm by wild birds."

The dust and dirt near the entrance of one of the two affected chicken sheds could have been contaminated by the droppings from infected wild birds, and then blown into the shed area by wind, Sit said. Sit said the farmer, who ran one of the city's major poultry farms, had been warned to improve biosecurity measures, but would not face any further action.
(ProMED 3/8/09)

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Hong Kong: Dead chicken tests positive for avian influenza H5N1
Hong Kong authorities said on 6 Mar 2009 that a dead chicken found in the southern Chinese territory had tested positive for H5N1 strain of the bird flu virus. The government said laboratory tests had confirmed that the chicken found floating in the sea off Hong Kong on 2 Mar 2009 carried the strain. The statement said there were no poultry farms within 3 km of where the dead bird was found, but warned farmers to be on their guard against the disease.
(ProMED 3/7/09)

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Japan: Avian influenza discovered in Aichi identified as H7N6 strain
The avian flu found in quails in Aichi has been identified as the H7N6 strain, the first outbreak of the strain in Japan, local authorities said. The National Institute of Animal Health in Tsukuba, Ibaraki Prefecture, identified the virus found in two quails at a farm in Toyohashi, Aichi Prefecture, as the H7N6 strain. The institute will conduct investigations on the samples, officials said.

According to the Ministry of Agriculture, Forestry and Fisheries, the first H7N6 infection was reported in 1981 in Australia in chickens, then in migratory ducks in Mongolia between 2004 and 2007, and in waterfowl in Slovakia in 2006. However, no human infections have been reported to date.

The quail farm in Toyohashi is culling about 259,000 quails and had put to death roughly 61,200 of them as of 1 Mar 2009.
(ProMED 3/6/09)

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Nepal: Poultry destroyed in eastern district due to avian influenza H5N1
At least 232 chickens, one duck, 26 pigeons, and 41 eggs were destroyed in Pathamari village of Jhapa district in eastern Nepal after the detection of bird flu in the locality, the National News Agency RSS reported on 11 Mar 2009. Chief of bird flu control room, Jhapa, Indrakant Jha said a team led by chief of district livestock services office Dilip Sapkota destroyed the birds and poultry products on 10 Mar 2009.

According to the RSS, tests conducted after the sudden death of chickens in the locality had confirmed bird flu in the area on 6 Mar 2009, 240 km east of Kathmandu. Bird flu was detected for the first time in Nepal in Kakarbhitta in the district in Jan 2009.

After the first outbreak of the disease in the country on 16 Jan 2009, the government declared an emergency in affected area of Sarnamati village in Jhapa district in eastern Nepal.
(Xinhua 3/11/09)

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Viet Nam: Another avian influenza H5N1 outbreak in Dien Bien
Bird flu has hit Thanh Yen Commune, Dien Bien district, in the mountainous northern province of Dien Bien, said Do Hoa Luong, head of the provincial veterinary department on 11 Mar 2009. This is the third bird flu outbreak confirmed in Dien Bien since early Feb 2009.

Samples taken from the poultry of some local households all tested positive for the H5N1 virus. The local veterinary agency has destroyed nearly 300 infected fowl and taken measures to contain the epidemic. The province has set up three checkpoints and a mobile inspection team on main roads to prevent the slaughter and transport of birds from the affected areas.

The veterinary department is conducting a vaccination campaign against the disease and spraying chemicals to sterilize affected areas. The two previous bird flu outbreaks discovered in Nong Luong and Thanh Hung communes have led to the culling of nearly 12,000 infected birds.
(Viet Nam Net Bridge 3/12/09)

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Americas
USA: Spending bill includes pandemic influenza money
In passing a huge spending bill this week to cover the next six months, Congress approved pandemic preparedness funds that had been proposed by former President Bush and increased appropriations for food safety, according to a health advocacy group.

The $410 billion bill was passed by the Senate on 10 Feb 2009, following earlier House approval, and signed by President Barack Obama on 11 Mar 2009. It funds numerous government agencies for the rest of fiscal year 2009, which ends 30 Sep 2009. The measure includes more than $700 million in pandemic spending that Bush had sought for the Department of Health and Human Services (HHS), but none of that is for state and local public health agencies, according to Richard Hamburg, government affairs director for the nonprofit group Trust for America's Health.

The bill also includes $648.7 million for food safety efforts at the Food and Drug Administration (FDA), which represents a $141 million increase from the 2008 level, Hamburg reported. In addition, Congress approved $971.5 million for the US Department of Agriculture's Food Safety and Inspection Service (FSIS), an increase of $41 million over the 2008 amount, he said.

The HHS pandemic funding includes $425 million for vaccine production capacity, $42 million for production of egg-based vaccines, and $40 million for medical countermeasures for HHS staff members and contractors, according to Hamburg. Also included is $156 million for ongoing pandemic-related activities at the US Centers for Disease Control and Prevention (CDC), which is $1.4 million more than the agency received in 2008, he said. In addition, the office of the HHS secretary is to receive $78 million for pandemic activities, up from $75 million in 2008.

Hamburg said he hadn't seen the breakdown of amounts for other agencies, but he expects that the FDA and the National Institutes of Health will get about the same amounts of pandemic-related funding as in 2008ó$38 million and $34 million, respectively.

Also included in the legislation is $3 million for research by the National Institute of Occupational Safety and Health (NIOSH) on flu transmission and respiratory protection from flu viruses, Hamburg reported. The bill calls for NIOSH to evaluate filtering facepiece respirators and other types of personal protective equipment (PPE) for healthcare workers and to work on designing the next generation of PPE, he said. He noted that the allocation follows an Institute of Medicine report in 2008 that cited a critical need for more information on airborne transmission of flu. He didn't think the money was part of the Bush administration's 2009 budget proposal.

On the food safety front, the $141 million increase for the FDA goes mainly to the agency's Center for Food Safety and Applied Nutrition (CFSAN), according to Hamburg. Overall, the FDA is getting a $325 million budget increase from 2008, which raises its total funding for 2009 to nearly $2 billion, he said. A CFSAN spokesman said he had no information yet on how the increased funding for food safety will be spent.

As for the proposed 2010 budget, the Obama administration has released only a general outline so far; said Hamburg: "We expect to see more detailed information on pandemic [funding] in early April." Pandemic preparedness advocates had hoped Congress would include pandemic funds for state and local health departments in the economic stimulus bill passed in February. The House approved $900 million for that purpose, but it was stripped from the final bill.
(CIDRAP 3/12/09)

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Africa
Egypt: Official denies two avian influenza H5N1 cases in Cairo
Egyptian Chief of Health Affairs department in Cairo Dr. Naibal Abdul-Qader denied on 6 Mar 2009 reports of emergence of two cases of bird flu in the Egyptian capital, excluding one case of a child who tested positive in Faiyum province. Abdul-Qadir said that all suspected cases of the disease were in two hospitals, adding that laboratory results proved that the two cases were negative, contradicting rumors that the samples of those two cases were positive.

The only exception was of a two-year old child from Faiyum province, who was under treatment in hospital.
(ProMED 3/6/09)

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Egypt: Two more cases of avian influenza H5N1 in children prompts concern at WHO
An 18-month-old Egyptian girl has contracted bird flu and is in stable condition, the Egyptian Health Ministry said on 10 Mar 2009. The Middle East News Agency (MENA) reported that the child is from the Menoufia province in northern Egypt and showed symptoms after coming into contact with dead birds. She was given the antiviral drug Tamiflu at an Egyptian hospital, MENA said.

Meanwhile, a two and a half year old male from Amaria District, Alexandria Governorate began exhibiting symptoms on 3 Mar 2009. He was hospitalized at Alexandria Fever Hospital where he remains in a stable condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 4 Mar 2009. Investigations into the source of infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

The rapid growth rate of bird flu infections in children is worrying, said John Jabbour, senior epidemiologist with WHO, which is asking the Health Ministry to investigate why so many children aged 2-3 years are being infected. Jabbour speculated that the reason for the increased number of cases in this age group was that families were no longer as alert as immediately after the last awareness campaign.

He warned that families with poultry must be on their guard at all times, given UN Food and Agriculture Organization (FAO) warnings that the H5N1 strain was endemic in poultry. "This is a problem that will not go away in poultry; hence people who deal with birds cannot afford to relax. Those who come in contact with birds must make caution part of their daily routine," he said.

Jabbour said social behaviour and attitudes also played a vital role in tackling bird flu. "We are not just fighting bird flu only; we are also trying to change the mentality which says reporting a case of bird flu infection in poultry will destroy income," he said.

Assistant Health Minister Sayyed said poultry keepers were often reluctant to report suspected cases for fear that health officials would cull not only their birds but those of neighbouring families.

Egypt does not run a compensation scheme for farmers who lose poultry in a cull.
(ProMED 3/11/09, IRIN 3/12/09)

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2. Updates
AVIAN/PANDEMIC INFLUENZA
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDPís 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. Epidemiological updates on the avian influenza outbreak in Hong Kong available at http://www.oie.int/wahis/public.php?page=single_report&pop=1&reportid=7609 and the outbreak in India at http://www.oie.int/wahis/public.php?page=single_report&pop=1&reportid=7606.
- 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 governmentís 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 Libraryís 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)

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3. Articles
Influenza Pandemic: Sustaining Focus on the Nationís Planning and Preparedness Efforts
US Government Accountability Office. February 2009. Available at http://www.gao.gov/new.items/d09334.pdf.

Why GAO Did This Study
The US Government Accountability Office (GAO) has conducted a body of work over the past several years to help the nation better prepare for, respond to, and recover from a possible influenza pandemic, which could result from a novel strain of influenza virus for which there is little resistance and which therefore is highly transmissible among humans. GAOís work has pointed out that while the previous administration had taken a number of actions to plan for a pandemic, including developing a national strategy and implementation plan, much more needs to be done. However, national priorities are shifting as a pandemic has yet to occur, and other national issues have become more immediate and pressing. Nevertheless, an influenza pandemic remains a real threat to our nation and the world.

This report does not make new recommendations. However, the report discusses the status of GAOís prior recommendations on the nationís planning and preparedness for a pandemic.

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The role of law in pandemic influenza preparedness in Europe
Martin R. Public Health. 4 Mar 2009.

Summary
The European Union (EU) is composed of 27 states with widely varying histories, economies, cultures, legal systems, medical systems and approaches to the balance between public good and private right. The individual nation states within Europe are signatories to the International Health Regulations 2005, but the capacity of states to undertake measures to control communicable disease is constrained by their obligations to comply with EU law. Some but not all states are signatories to the Schengen Agreement that provides further constraints on disease control measures. The porous nature of borders between EU states, and of their borders with other non-EU states, limits the extent to which states are able to protect their populations in a disease pandemic. This paper considers the role that public health laws can play in the control of pandemic disease in Europe.

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Pandemic Influenza: Imminent Threat, Preparedness and the Divided Globe
Chaturvedi S. Indian Pediatrics. 17 Feb 2009; 46:115-122. Available at http://www.indianpediatrics.net/feb2009/115.pdf.

With generic consensus on certainty of an impending influenza pandemic, concerns are mounting about its devastating global impact. Preparedness and preventive approaches adopted by the nation states are polarized between resource rich and resource challenged countries. India has, rightly, taken a middle path. It seems that the non-pharmaceutical interventions would be the only preventive modality available in large parts of world. Production of any pandemic vaccine would take a minimum of 6 months after isolation of novel virus, and antivirals may not be available where they are required most. Efforts to create a universal pool of resources and stockpiles of antivirals, antibiotics and vaccines for use in first affected countries need to be strengthened with urgency.

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4. Notifications
Request for information for Mekong regional directory
The Second Edition of the Directory of Professionals involved in Communicable Diseases Surveillance and Response in the Greater Mekong Sub-Region is underway. If interested you can submit your updated information at http://www.gms-cdc.org/resource/cdc-directory-of-professionals-.html.

Deadline for submission is 27 March 2009.

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Influenza in the Asia-Pacific
The Lancet Conferences
Date: August 21-23, 2009
Location: Qingdao, China

The Lancet and The Lancet Infectious Diseases have joined forces to develop a conference that will enable leaders in their fields to present and discuss management of influenza with key health administrators, experts from the medical and scientific communities, and industry representatives. We hope the meeting will provide valuable insight into fundamental public health and operation strategies to bring about change within the Asia-Pacific.

Register now and take advantage of the early bird discount until May 31, 2009. To register, go to http://mail.elsevier-alerts.com/go.asp?/bELA001/qUQEAS8/x8BATS8

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 apecein@u.washington.edu