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EINet Alert ~ Nov 25, 2005
*****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:
- Global: Global bird migration data system
- Global/Japan/USA: Tamiflu investigation and monitoring
- Global: APEC conference and avian/pandemic influenza
- Romania: H5N1 virus in dead poultry confirmed
- Kuwait: Flamingo, avian influenza suspected
- East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- China: Additional confirmed human case of H5N1 infection; new avian influenza outbreaks
- China: Stringent rules to control animal epidemics
- China: Avian influenza preparedness updates
- China: Sharing of viral isolates with the international community
- Indonesia: Further investigation into H5N1-positive human cases; another avian flu outbreak
- Viet Nam: Additional human case of H5N1 infection; more avian influenza outbreaks
- Thailand: Cockfighting can resume on New Year's Day 2006
- Taiwan: H7N3 detected in migratory bird droppings; discussions with UK
- Russia: Reports 250 wild swans died of H5 avian influenza virus infection
- Hong Kong: Steps up measures against avian influenza threat
- Japan (Ibaraki): OIE avian influenza H5N2 follow-up report
- Canada (Manitoba, British Columbia): Low path avian influenza in migratory birds, farm duck
- CDC EID Journal, Volume 11, Number 12-December 2005
- The Origins of Pandemic Influenza — Lessons from the 1918 Virus
Global: Global bird migration data system
The UN is to set up a bird flu early warning system to alert countries of incoming migratory birds which could be carrying avian influenza virus, said Robert Hepworth, a UN official who heads the Convention on Migratory Species (CMS). The system, which will take 1-2 years to become operational, will provide details of the types of wild birds, arrival times and destinations -- giving countries enough time to prepare. Hepworth said scientists, governments and experts across the world had information about migratory birds, but it was inaccessible and not shared. He said all the information would be collected and centralized in a global computerized system which would constantly update and monitor bird migration patterns, warning countries of any potential threat. The project will gather a team of experts to collect information, maps and charts from national governments, conservation and wildlife bodies. Hepworth said the main beneficiaries of the system would be developing countries, many of which do not have enough resources to take countrywide preventative action. "The problem we have in Africa and other developing countries is that the kind of measures that may be appropriate in Europe such as locking up poultry and separating them from wild birds are not practical in these countries," he said. "The early warning system will actually pinpoint where the higher risk areas might be, so developing country officials can target those specific areas," he said, adding this would be more cost-effective than a more general countrywide approach. Special maps will be drawn up to show potential bird flu hot spots, both in countries where birds have been nesting and those to which they are migrating. There are important gaps in our scientific knowledge about 'fly-ways' and migratory routes for some species," said Klaus Toepfer, executive director of the UN Environment Programme. The cost of setting up the bird flu early warning system is expected to range between USD 200 000-300 000, which officials say is a small amount compared to the budgets being spent on containing the virus. They add that the challenge is not in the financial resources required but in the commitment from stakeholders to devote the time and energy in providing the information. (Promed 11/18/05, 11/22/05)
Global/Japan/USA: Tamiflu investigation and monitoring
The safety review identified neurologic and psychiatric problems such as delirium, hallucinations, abnormal behavior, convulsions, and encephalitis, nearly all of them (and all 12 deaths) in Japanese children. "In many of these cases, a relationship to Tamiflu was difficult to assess because of the use of other medications, presence of other medical conditions, and/or lack of adequate detail in the reports," the FDA said. The agency said that since the mid-1990s there have been many reports of flu-associated encephalitis or encephalopathy in children: "These reports originated primarily from Japan where pediatricians described a pattern of rapid onset of fever, accompanied by convulsions and altered level of consciousness, progressing to coma within a few days of the onset of flu symptoms. This syndrome frequently resulted in death or significant neurologic sequelae."
Roche said that studies in the US and Canada had shown that the death incidence rate of influenza patients who took Tamiflu was far below those who did not. Japan's Health Ministry warned recently that Tamiflu may induce "strange behavior" after reporting that 2 teenage boys died shortly after taking the medicine. Roche has carefully reviewed these events and has concluded that a causal link cannot be established. However, the Japanese distributor of the Roche-patented drug said it could not rule out a link between Tamiflu and the deaths. Roche said the high number of deaths and adverse neuropsychiatric events in Japan were also due to the fact that 2 of 3 people taking Tamiflu are in Japan. The 12 deaths represented a rate of about 1 death per million Japanese children treated. "The scientific evidence is that neuro-psychiatric events are no more common among people on Tamiflu than those not being treated," said David Reddy, head of Roche Holding AG's virology unit. Tamiflu is one of the few drugs believed effective in treating bird flu, which officials fear could spark a pandemic should it mutate into a form easily passed from human to human.
The Japanese Health, Labor and Welfare Ministry does not plan to warn medical institutions of the danger of using Tamiflu. An official of the ministry's Safety Division said: "We can't deny the link [between the deaths and the side effects of Tamiflu]. But a large volume of Tamiflu has been available here, so the number of deaths isn't high even if they died from the side effect." The Ministry has confirmed 13 children aged 16 or under died after taking Tamiflu. In 8 cases, the causal relation between the deaths and taking the medicine has been ruled out. Chief Cabinet Secretary Shinzo Abe, citing experts, said Tamiflu does not cause safety problems if it is prescribed "appropriately."
***Additional information is available from the official US FDA website: http://www.fda.gov/cder/drug/infopage/tamiflu/QA20051117.htm. (Promed 11/18/05, 11/19/05, 11/22/05)
Global: APEC conference and avian/pandemic influenza
Chinese President Hu Jintao said 19 Nov 2005 that China stands ready to cooperate closely with APEC in the prevention and control of avian influenza. Hu said China will host the APEC Symposium on Emerging Infectious Disease in Beijing April 2006. He urged APEC members to make joint efforts to cooperate to meet such a challenge. Hu said China welcomes APEC members to attend the APEC Symposium on Emerging Infectious Disease to strengthen regional cooperation in the area. China attaches importance to the prevention and control of avian influenza and has adopted a series of effective measures including intensive vaccination, monitoring and quarantine, he said. Hu said China attaches importance to international cooperation in natural disaster reduction. The APEC Economic Leaders' Meeting concluded with the adoption of the Busan Declaration, the Statement on Doha Development Agenda Negotiations, and the Statement on Preparing for and Mitigating an Influenza Pandemic. (Promed 11/18/05, 11/19/05)
Romania: H5N1 virus in dead poultry confirmed
Kuwait: Flamingo, avian influenza suspected
The current Kuwaiti case is regarded as "suspected" until further details and confirmation from a reference laboratory are available. In view of the concerns related to the current HPAI panzootic and its zoonotic impacts, there is a clear need to encourage and increase the interdisciplinary cooperation between virologists, epidemiologists, ornithologists, ecologists, physicians, and veterinarians. (Promed 11/18/05, 11/20/05)
East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
***As CIDRAP has terminated reporting of unofficial cases, EINet will from hereon report only official (WHO-confirmed) cases.
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:
Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 132 (68)
China: Additional confirmed human case of H5N1 infection; new avian influenza outbreaks
The Chinese Ministry of Agriculture confirmed 20 Nov 2005 bird flu outbreaks in Inner Mongolia Autonomous Region and Hubei Province. It noted that a total of 176 chickens, ducks and geese died 15 Nov 2005 in the banner [county] of Morin Dawa in Inner Mongolia before they were confirmed by a state avian flu lab as being H5N1 subtype highly pathogenic bird flu cases. In addition, the same kind of bird flu killed 3500 geese 16 Nov 2005 in Shishou City of Hubei Province. Reportedly, the Ministry of Agriculture has sent a team of experts to help contain the disease, and local veterinary departments have culled poultry near the affected area. China has reported 24 bird flu outbreaks in 2005 and has culled millions of poultry. China has recently vowed to vaccinate all its 14 billion poultry.
***The official OIE follow up report on highly pathogenic avian influenza in China is available at: http://www.oie.int/eng/info/hebdo/a_current.htm#Sec4. This report includes the recent avian influenza outbreaks reported from Anhui, Hubei, and Xinjiang provinces. Weekly reports on China's influenza situation, with interactive maps: <http://www.flu.org.cn/map/>. It shows provinces with current outbreaks in avians and cases in humans. For daily updates: http://www.flu.org.cn/.
China: Stringent rules to control animal epidemics
In addition, Xianghai National Nature Reserve, a major habitat of migratory birds in Jilin Province, has closed its scenic spots. "It's necessary to close the nature reserve in order to reduce contact between humans and birds," Bao Jun, deputy director of Xianghai National Nature Reserve Administration, said. Jilin, adjacent to bird-flu-hit Liaoning Province and the Inner Mongolia Autonomous Region, has strengthened inspection and quarantine. Xianghai is on the flight route of migratory birds, which increases the province's risk of bird flu outbreaks. The birds living in the reserve [wild birds, or domestic birds maintained within the reserve?] have been injected with anti-bird flu vaccines, said Bao, adding that 10 observation stations and a 60 person surveillance team have been set up. (Promed 11/18/05, 11/21/05)
China: Avian influenza preparedness updates
China: Sharing of viral isolates with the international community
Dr Lubroth says China's slowness to share viruses reflects a concern there that the country's researchers do not receive adequate credit for their scientific contribution. Another concern has been voiced by several countries affected by H5N1 outbreaks. They know part of the reason developed countries want access to virus samples is to ensure that the seed strain for H5N1 vaccine is up-to-date enough that the vaccine would be protective. That rankles because these countries further understand that should H5N1 spark a pandemic, their people stand little chance of getting access to limited global supplies of vaccine. In addition, it is perhaps unfair to criticize the Chinese for not releasing virus samples when there is counter-pressure to limit the distribution of infectious virus to only a few approved laboratories with adequate containment facilities. (Promed 11/19/05)
Indonesia: Further investigation into H5N1-positive human cases; another avian flu outbreak
Also, Indonesia has detected the first outbreak of bird flu in tsunami-ravaged Aceh province, where hundreds of chickens have died from the disease, the Agriculture Ministry said 24 Nov 2005. Bird flu has now been found in 23 of Indonesia's 30 provinces, said Sjamsul Bahri, the Agriculture Ministry's director of animal health. The emergence of the virus in Aceh -- where tens of thousands of people still live in crowded refugee camps following the Dec 2005 tsunami -- is especially worrisome. Bahri said chickens have been infected with the H5N1 strain of the virus in at least 3 districts of the province. Some died of the virus while other sick birds were destroyed to prevent the virus from spreading, he said. (Promed 11/19/05, 11/24/05)
Viet Nam: Additional human case of H5N1 infection; more avian influenza outbreaks
Also, 30 cormorants in a bird sanctuary in Vietnam's southern Dong Thap province have suddenly died recently, prompting the authorities to close all wild bird eco-tourism sites, media reported 15 Nov 2005. Reportedly, the black cormorants died in Gao Giong, a famous eco-tourism site in the Mekong Delta, and specimens from the birds are being tested for bird flu viruses. Recently, Hanoi and Ho Chi Minh City ordered residents of their inner areas not to raise ornamental birds as of 15 Nov 2005 and 30 Nov 2005, respectively. Early in Nov 2005, the Vietnamese government decided to cease import of all kinds of poultry, including ornamental birds and related products that have not undergone temperature or chemical treatment, from bird flu-hit countries. (Promed 11/18/05, 11/19/05; WHO 11/25/05)
Thailand: Cockfighting can resume on New Year's Day 2006
Taiwan: H7N3 detected in migratory bird droppings; discussions with UK
In addition, the government assigned veterinary epidemiologists to Britain to sort out government skepticism of a British report that the virulent H5N1 strain was found in Taiwan-exported silver-eared mesias. Liao Tung-chou, deputy director-general of the foreign ministry's Department of International Organizations, said it is necessary for both sides to discuss the case. The proposal has been accepted by Britain. According to the report released 15 Nov 2005 by the British Department for Environment, Food and Rural Affairs, 53 of a shipment of 101 mesias imported from Taiwan had died. But it was not clear how many of them died of avian flu. Tests showed that the H5N1 strain was present only within a group of mesias imported from Taiwan. Officials at the COA challenged the credibility of the report, claiming that no bird in Taiwan has so far tested positive for H5N1. Taiwan has not experienced a major outbreak of H5N1. In October 2005, the island found its second case of the strain since 2003 in birds smuggled in a container ship from China. Out of 1037 birds smuggled from China to Taiwan aboard a ship in mid-October 2005, random testing found 8 of the 276 dead birds to be infected with H5N1. (Promed 11/18/05)
Russia: Reports 250 wild swans died of H5 avian influenza virus infection
Hong Kong: Steps up measures against avian influenza threat
Hong Kong Hospital Authority launched 8 Nov 2005 its first ever drill on the Special Administrative Region's preparedness for a possible avian influenza pandemic. The drill, code-named "Exercise Flamingo," was aimed at testing the response of the public hospital's disease control and the procedures for the treatment of the patients. Chief Executive Donald Tsang said after seeing the drill that Hong Kong had made enormous headway since the outbreak of SARS--resource acquisition, deployment of resources, communication between various units, and the equipment and facilities within the hospitals have all been improved. A second drill code-named "Exercise Poplar" will be staged 24 Nov 2005 for testing Hong Kong's capacity in tracing the source of avian influenza patients. So far, the government has invested over 3 billion HK dollars [USD 386 million] to enhance the city's preparedness against emerging infectious diseases, including an avian influenza-induced influenza pandemic. As the presence of live poultry in "wet markets" is a potential threat for an outbreak of avian influenza, the government is considering setting up a regional slaughtering hub in Hong Kong. (Promed 11/21/05)
Japan (Ibaraki): OIE avian influenza H5N2 follow-up report
Information received 11 Nov 2005 from Dr. Hirofumi Kugita, Chief Veterinary Officer, Ministry of Agriculture, Forestry and Fisheries, Tokyo. Precise identification of agent: low pathogenic avian influenza virus subtype H5N2. First administrative division (Prefecture): Ibaraki; Type of epidemiological unit: farm; Date of start of the outbreak: 7 Nov 2005. Number of animals in the outbreak: 950 000 susceptible chickens. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: quarantine; movement control on farms within a radius of 5 km of the infected farms; screening; zoning; disinfection of infected premises/establishments. Control measures to be undertaken: all chickens in farms where the infection has been confirmed, except for those kept in premises with strict biosecurity facilities, are to be destroyed. (Promed 11/21/05)
Canada (Manitoba, British Columbia): Low path avian influenza in migratory birds, farm duck
Avian influenza A low-pathogenic strain of the H5N1 avian influenza virus has been discovered in wild migratory birds in Manitoba province, Canadian officials announced 19-20 Nov 2005. Brian Evans of the Canadian Food Inspection Agency said, "Canadians can rest assured that we have not detected the Asian strain of avian influenza of animal or human health concern.” Tests revealed low pathogenic strains of H5N9 in 2 birds and H5N2 in 5 birds in the western province of British Columbia, H5N1 in 2 birds from the central province of Manitoba and H5N3 in 2 birds from the eastern Quebec province. All of the viruses analyzed were "low pathogenic types," "very mild" and "non-virulent" and would produce "only mild disease if any at all if introduced into domestic birds," Evans said. The samples were gathered by the Canadian Wildlife Services as part of a cross-country testing of viruses carried by wild waterfowl, coordinated through the Canadian Cooperative Wildlife Health Centre. Evans said Canadian public health and food inspection agencies would expand their survey of wild birds, implement national testing of domestic birds at slaughter facilities, and remind bird owners to follow strict bio-security measures to restrict exposure of their flocks to wild birds. These results should not prompt other countries to restrict the import of Canadian fowl or eggs, Evans added.
In addition, tests have confirmed a farm duck in British Columbia has a low pathogenic, North American strain of avian influenza H5, but health officials will still cull about 60 000 poultry as a preventive measure, the Canadian Food Inspection Agency (CFIA) said 20 Nov 2005. The farm where the duck was raised had allowed its birds to be outside of barns, which meant the animal might have come in contact with wild waterfowl that are known to carry the disease. Initial tests found an H5-type strain in the duck during routine tests. Health officials immediately quarantined the farm, located in the Fraser Valley. In addition, the CFIA has also quarantined 4 other "high risk" farms. (Promed 11/20/05, 11/21/05)
Seasonal influenza activity for the Asia Pacific and APEC Economies
During week 44, low influenza activity was detected in Canada (H3, A and B), Hong Kong Special (H3, A and B), Mexico (H1, H3 and A), and USA (H3, A and B). (WHO 11/23/05 http://www.who.int/csr/disease/influenza/update/en/ )
Avian/Pandemic influenza updates
- The CDC website on pandemic influenza: http://www.cdc.gov/flu/pandemic.htm has been updated; for avian influenza (available in Chinese, Korea, Vietnamese, and Japanese):
CDC EID Journal, Volume 11, Number 12-December 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 12-December 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles on influenza are available online: Economics of Neuraminidase Inhibitor Stockpiling for Pandemic Influenza, Singapore, V.J. Lee et al.; Estimating Influenza Hospitalization among Children, C.G. Grijalva et al.
The Origins of Pandemic Influenza — Lessons from the 1918 Virus