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EINet Alert ~ Jun 05, 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 influenza A/(H1N1) - Cumulative number of human cases of avian influenza A/H5N1 - Global: WHO moves closer to declaring influenza pandemic; Chan urges governments not to overreact - Australia: Reports community spread of influenza A/H1N1 in Victoria - India (West Bengal): New outbreak of avian influenza H5N1 in backyard poultry - Japan: Seasonal flu vaccine for 2008/2009 has no protective effect on novel influenza A (H1N1) virus - Canada: PHA update on influenza A/H1N1 - Mexico: Update on outbreak of influenza A/H1N1 virus infection in Mexico - USA: CDC update on influenza A/H1N1 - USA: Analysis of influenza A/H1N1 flu response shows progress, problems - USA (New York): Asthma leads risk factors in influenza A/H1N1 hospitalizations - Egypt: Economy's 77th and 78th human avian influenza H5N1 cases in children 2. Updates - INFLUENZA A/H1N1 - AVIAN INFLUENZA 3. Articles - Satellite-marked waterfowl reveal migratory connection between H5N1 outbreak areas in China and Mongolia - Managing and Reducing Uncertainty in an Emerging Influenza Pandemic - Pig infection studies with influenza A (H1N1) associated with global epidemic in humans - Update: Novel Influenza A (H1N1) Virus Infection--Mexico, March--May, 2009 4. Notifications - Weekly Epidemiological Record Bulletin - Characteristics of the emergent influenza A (H1N1) viruses and recommendations for vaccine development - General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers - Influenza Pandemic--Continued Focus on the Nation’s Planning and Preparedness Efforts Remains Essential - Influenza in the Asia-Pacific 1. Influenza News Global Cumulative number of human cases of influenza A/(H1N1)  PRINT THIS
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69 countries have officially reported 21,940 of influenza A/H1N1 infection, including 125 deaths. Economy / Cases (Deaths)
2009 (WHO 6/5/09)
Additionally, first cases have been confirmed in Ukraine, Venezuala, French Polynesia and the Cayman Islands. Cases have been reported in Sudan as well.
APEC economy updates: Chile reports first novel H1N1 death in South America. Viet Nam recorded its first case of influenza A/H1N1; case is a student who reported travel to the US. China reported its first locally acquired case of H1N1. Patient had contact with travelers to the US. Cumulative number of human cases of avian influenza A/H5N1
2009
***For data on human cases of avian influenza prior to 2009, go to:
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 433 (262).
Avian influenza age distribution data from WHO/WPRO: WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 5/10/09): http://gamapserver.who.int/mapLibrary/
WHO’s timeline of important H5N1-related events (last updated 3/23/09): Global: WHO moves closer to declaring influenza pandemic; Chan urges governments not to overreact
Most pandemic plans were crafted for the H5N1 bird flu virus, deadly in three out of five cases. Swine flu, the new bug racing across the world, so far causes little more than a fever and a cough in most patients. Governments must resist the temptation to restrict travel, close borders and adopt other measures that aren’t justified, according to Chan. Asia Australia: Reports community spread of influenza A/H1N1 in Victoria PRINT THIS
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Australian health officials acknowledged 3 June 2009 that the novel H1N1 influenza virus has achieved sustained community transmission in the state of Victoria, where 521 cases were reported that same day, an increase of 126 since the previous day. The Australia Department of Health and Ageing said the pandemic response for Victoria has been raised from "contain" to "sustain." The resulting measures "will enable Victoria to more appropriately respond to the relatively higher number of cases and the sustained community transmission of the infection in Victoria," said the agency. Australia's overall novel H1N1 case count reached 633 as of 3 June 2009, with all eight states and territories reporting cases. In addition to Victoria's cases, New South Wales has reported 70, and Queensland has reported 26. For the remaining states and the two territories, case numbers are in the single digits. The spread of the virus in Victoria suggests that the World Health Organization's (WHO's) formal criterion for a full-fledged pandemic (pandemic alert phase 6)—sustained community transmission in more than one global region—has probably been met. The WHO has been holding off on a pandemic declaration because of concern that it may trigger undue alarm, given that the illness is mild in most cases. The agency said it would come up with a way to rate the disease's severity and provide related guidance in an effort to reduce undue alarm from a pandemic declaration. Victoria's health minister, Daniel Andrews, said that the state's move to a modified sustain phase of its influenza plan is being done to focus on protecting vulnerable people from the virus rather than containing the virus. Vulnerable groups include seniors, students at special development schools, hospital patients, and those who have chronic illnesses. The state will provide antiviral treatment only to those who have novel flu infections and their household contacts, require people with confirmed cases to isolate themselves for three days after starting treatment, conduct intensive surveillance in high-risk settings such as nursing homes, and enhance community surveillance for illnesses and changes in the circulating influenza strains. Schools will no longer automatically close if a student has a flu-like illness, though large numbers of confirmed cases in a school might warrant closure. Raina MacIntyre, professor of infectious diseases and epidemiology at the University of New South Wales in Sydney, said that Victoria is the only state where sustained community transmission appears to be occurring. More than 75% of cases have occurred in children aged 5 to 18, she said. The normal influenza season in Australia and the rest of the southern hemisphere is just getting under way, and global health officials worry that the novel flu virus could change when it circulates alongside the seasonal strains. Though weekly reports on Australia's flu season haven't yet begun, MacIntyre said so far labs are reporting that both seasonal and flu viruses are circulating. Meanwhile, an Australian cruise ship was been turned away from New Caledonia amid fears of influenza H1N1. The Dawn Princess cruise liner was prevented from stopping after up to five people on board started showing flu-like symptoms. Swabs have been taken from the sick passengers and sent to Sydney for testing. Dr Jeremy McAnulty from New South Wales Health says the ship has not been to any novel H1N1 infected countries, but they are still being cautious. "We've learnt a lot from cruise ships and transmission of diseases over the last few years, but also particularly in the past week or so," he said. "We're working to identify people who may have had infections on board to help determine whether it was swine flu or something else." The ship is now heading back to Sydney and will arrive on 5 Jun 2009. Cruise ships have been in the spotlight since late May 2009, when about 3000 passengers and crew on board the Dawn Princess were not allowed to leave the ship on its return to Sydney because four passengers displayed mild flu symptoms. The passengers and crew were then allowed to disembark but told to remain in home isolation until the all clear was given.
Then cases of novel H1N1 appeared on the P&O cruise ship Pacific Dawn, which docked in Sydney on 1 Jun 2009. The 1800 passengers on the ship were cleared of the virus and were allowed to disembark, although three crew members were confirmed to have the virus. Passengers on the ship's previous cruise were found to have H1N1. On 1 Jun 2009, the chief executive of Carnival Cruises, which runs P&O, said passengers might be screened before they boarded the ship for its next cruise to the South Pacific. India (West Bengal): New outbreak of avian influenza H5N1 in backyard poultry
It was confirmed that the birds died of avian influenza A/H5N1 on 25 May 2009. The animal husbandry department formally notified the World Organisation of Animal Health (OIE) of the outbreak of bird flu in the area on 28 May 2009. It also told OIE that measures such as curbs on the movement of poultry products and screening and culling of domestic poultry in a 3 km radius around the outbreak spots have already been taken. No vaccination or treatment of the affected birds has been performed, as part of the government's strategy to tackle bird flu. The places of infection would be disinfected. This outbreak of bird flu occured about six months after the last outbreak of this disease in Hajo, Rajabazar, and Kamrup areas of Assam. About 325 birds died of H5N1 infection at that time. The first outbreak of bird flu in India occurred in Navapur and Uchchal around the Maharashtra and Madhya Pradesh border in February 2006. Since then, there have been several outbreaks in different parts of the country, causing huge economic losses to the poultry industry. The organized poultry industry is currently believed to be worth over Rs 30,000 crores (approx. USD 6.4 billion).
Following successful containment of the disease in the epicentres of infection between 2006 and 2008, India formally declared itself bird flu-free country on 4 Nov 2008. But this status did not last long. Barely three weeks later, the disease resurfaced in the Kamrup (rural) district of Assam. Japan: Seasonal flu vaccine for 2008/2009 has no protective effect on novel influenza A (H1N1) virus
They investigated 43 RT-PCR confirmed cases reported from Kobe City. Their median age was 17 years which ranged from 5 to 44 years. Among them, 42 reported the status of pre-seasonal vaccination for 2008/2009 season and the coverage was 52.4 percent. According to MHLW's estimation, the coverage of influenza vaccine among Japanese population was 53.7 percent for those aged less than 13 years, 23.1 percent for those aged 13 to 64 years, and 58.8 per cent for those aged over 64 years during the 2008/2009 season [3]. Taking account of the population age structure, 27.9 per cent of Japanese people aged 5 to 44 years are estimated to have been vaccinated for seasonal influenza virus. This indicates that vaccine coverage among confirmed cases is no less than that of the population average. It is too early to reach a conclusion about a possible negative effect, yet it is already obvious that pre-seasonal vaccine for 2008/2009 season has no protective effect on disease from the novel influenza A (H1N1) strain among the Japanese population. This finding should be valuable information for public health policy makers preparing for coming winter season.
References:
Submitted by Dr. Motoi Suzuki Americas Canada: PHA update on influenza A/H1N1 PRINT THIS
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PHA has confirmed 1795 human cases of influenza A (H1N1) in 12 provinces/territories, including two deaths in Ontario and death in Alberta. Provinces most heavily burdened are Onterio (894) and Quebec (346). The only territory that has not reported cases is Newfoundland. (PHA 6/3/09) Mexico: Update on outbreak of influenza A/H1N1 virus infection in Mexico
President of Mexico, Felipe Calderon has lifted the sanitary contingency. Nevertheless, preventive sanitary measures will remain constant. One of the most affected sectors is tourism. As a result, on 25 May 2009 the Mexican Government launched the promotion campaign “Vive México” in order to boost the Mexican economy and regain the confidence of national and international visitors. As part of this campaign, several companies will launch special offers and discounts to attract tourists from abroad, while Mexico’s destinations and sites will be promoted within the country and around the world by Mexican figures from entertainment, sports and culture. This program will be granted with an investment of 1,200 million pesos. On 25 May 2009, the government of Japan donated 25 thermal cameras to be installed at bus terminals as part of the control measures. Furthermore, Japan stopped requesting visas for Mexican travelers. For further information visit:
www.prevencioninfluenza.gob.mx/ (Mexico MOE 6/3/09) USA: CDC update on influenza A/H1N1
USA: Analysis of influenza A/H1N1 flu response shows progress, problems
The good news: The experience has shown that years of pandemic preparation have paid dividends, particularly with regard to coordination, communication, antiviral drugs, and vaccine development. The bad news: The outbreak has pointed up the serious limitations of the financially strapped public health sector, suggesting that it would be overwhelmed in a more severe and widespread epidemic. The report was produced by Trust for America's Health (TFAH), a nonprofit, nonpartisan advocacy group in Washington, DC, in collaboration with the Center for Biosecurity at the University of Pittsburgh Medical Center and the Robert Wood Johnson Foundation. "It was clear in our report that all the pandemic planning and preparedness efforts over the past several years have improved our ability to respond to an outbreak, but it was also clear that the situation didn't test the limits of our response," said Jeff Levi, PhD, executive director of TFAH. Positives and negatives are sprinkled through the 10 lessons presented in the report, titled "Pandemic Flu Preparedness: Lessons from the Frontlines." Many of them repeat TFAH messages about the need to restore and strengthen the nation's public health infrastructure.
Investments prove wise At the press briefing, David Fleming, MD, director of Seattle and King County Public Health, strongly endorsed that conclusion. He said Seattle officials had thought through many of the issues and stockpiled medications. In particular, "Telling citizens we had sufficient supplies of Tamiflu [oseltamivir] went a long way" to help the situation, said Fleming, a peer reviewer for the report. He said that by the time the outbreak began, private antiviral supplies were "essentially zero," because it was the end of the regular flu season. "We dipped into our local reserve [of antivirals] and made those available to people through our public health clinics," which resulted in moderate but not overwhelming use, he added. Nationally, only modest amounts of stockpiled antivirals have been used, since relatively few people have been infected, said Thomas V. Inglesby, MD, deputy director of the Center for Biosecurity and a co-author of the report. But he said the stockpiles gave people confidence in their ability to help the sickest patients, adding, "I think the investment is widely seen to have been wise."
Lack of resources exposed Fleming said the national surveillance picture was 1 to 2 weeks behind what was happening on the ground. In Seattle, some schools that had possible cases were closed and then reopened before the CDC confirmed and reported a single local case of the novel flu, he said. He also said a key part of Seattle's response to the novel flu was using public health nurses to educate school and daycare authorities about the outbreak. Ironically, many of the nurses were due to receive layoff notices two weeks after the start of the flu outbreak. A third finding was that, though the outbreak was mild, healthcare systems in some areas were "overwhelmed." In many hospitals, emergency departments were flooded by the "worried well," and some outpatient clinics had inadequate personal protective equipment and "a limited understanding of infection control measures."
Need for flexibility, good communication
Other lessons
Full text of report available at http://healthyamericans.org/assets/files/pandemic-flu-lesson.pdf. USA (New York): Asthma leads risk factors in influenza A/H1N1 hospitalizations
Africa Egypt: Economy's 77th and 78th human avian influenza H5N1 cases in children PRINT THIS
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The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza A (H5N1) on 1 Jun 2009. The case is a 4-year old female child from the Kafr el-Sheikh District of Kafr el-Sheikh Governorate. Her symptoms started on 30 May 2009 with fever, cough, and sore throat. She was admitted to Kafr el-Sheikh Fever Hospital on 31 May 2009. The patient received oseltamivir [Tamiflu] and is in a stable condition. Investigations into the source of infection indicated that she had close contact with dead and sick poultry. The case was confirmed by the Egyptian Central Public Health Laboratories. A spokesperson for Egypt’s health ministry indicated that 39 people have been hospitalized with suspected infections. Previously, the ministry confirmed on 30 May 2009, the 77th infection with H5N1 virus. A baby girl, aged 14 months, contracted the highly pathogenic avian A (H5N1) influenza virus; she was in contact with domestic birds in a village located in Daqahliya, north Cairo, the ministry's spokesman Dr Abdulrahman Shahin said. The baby was hospitalized on 26 May 2009 suffering from bird-flu-like symptoms including high temperature, running nose, and respiratory disorder. She was diagnosed as H5N1-positive and has been treated with the antiviral drug Tamiflu (oseltamivir), Dr Shahin said. The patient is being relocated to Manshiyat Al-Bakri Hospital, Cairo for further medication, he added.
Egypt's national tally of the disease is 78, with the death toll amounting to 27 since the outbreak of the highly contagious virus in February 2006. The National Higher Commission against Bird Flu has adopted a new preventive methodology to control the spread of H5N1. The methodology involves the medical and municipal authorities as well as the mass media. 2. Updates INFLUENZA A/H1N1 PRINT THIS
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The following websites provide the most current information and advice.
- WHO
- North America
- Other useful sources AVIAN INFLUENZA
3. Articles Satellite-marked waterfowl reveal migratory connection between H5N1 outbreak areas in China and Mongolia PRINT THIS
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Prosser DJ et al. International Journal of Avian Science. 18 May 2009. Available at http://www3.interscience.wiley.com/journal/122389147/abstract?CRETRY=1&SRETRY=0.
ABSTRACT Managing and Reducing Uncertainty in an Emerging Influenza Pandemic
Perspective Pig infection studies with influenza A (H1N1) associated with global epidemic in humans
Preliminary summary Update: Novel Influenza A (H1N1) Virus Infection--Mexico, March--May, 2009
On April 12, 2009, Mexico responded to a request for verification by the World Health Organization (WHO) of an outbreak of acute respiratory illness in the small community of La Gloria, Veracruz. During April 15--17, the Mexico Ministry of Health received informal notification of clusters of rapidly progressive severe pneumonia occurring mostly in Distrito Federal (metropolitan Mexico City) and San Luis Potosi. In response, on April 17, Mexico intensified national surveillance for acute respiratory illness and pneumonia. During April 22--24, novel influenza A (H1N1) virus infection, previously identified in two children in the United States, was confirmed in several patients. This report updates a previous report on the outbreak in Mexico and summarizes public health actions taken to date by Mexico to monitor and control the outbreak. During March 1--May 29, national surveillance identified 41,998 persons with acute respiratory illness; specimens from 25,127 (59.8%) patients were tested, of which 5,337 (21.2%) were positive for novel influenza A (H1N1) virus infection by real-time reverse transcription--polymerase chain reaction (rRT-PCR). As of May 29, 97 patients with laboratory-confirmed infection had died. Epidemiologic evidence to date suggests that the outbreak likely peaked nationally in late April, although localized cases continue to be identified. (Excerpt with references removed.) 4. Notifications Weekly Epidemiological Record Bulletin PRINT THIS
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WHO. 5 June 2009; 84(23): 213-236. Available at http://www.who.int/wer.
Includes: Characteristics of the emergent influenza A (H1N1) viruses and recommendations for vaccine development
General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers
This guidance is to help employers with employees in OSHA's Lower Risk (Caution) Zone: those employees who have minimal occupational contact with the general public and other coworkers (for example, office employees). Influenza Pandemic--Continued Focus on the Nation’s Planning and Preparedness Efforts Remains Essential
Why GAO Did This Study Influenza in the Asia-Pacific
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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