EINet Alert ~ Nov 25, 2005

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Global/Japan/USA: Tamiflu investigation and monitoring
US federal health advisers looked into the deaths of 12 Japanese children who took Tamiflu. The FDA's Pediatrics Advisory Committee unanimously agreed that the drug's label does not need a warning related to the children's deaths. However, the panel did say that information about serious skin reactions should be added to the label. Many countries are stockpiling the medication in case H5N1 avian flu triggers a flu pandemic. There are also reports of 32 "neuropsychiatric events" associated with Tamiflu, all but one experienced by Japanese patients. FDA said the children's deaths appear to be part of a wave of influenza-related encephalitis and encephalopathy cases in Japanese children that began in the mid-1990s, before oseltamivir was approved. There have been no reports of deaths in the US or Europe associated with Tamiflu. "Based on the information available to us, we cannot conclude that there is a causal relationship between Tamiflu and the reported pediatric deaths," the statement said.

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)

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Global: APEC conference and avian/pandemic influenza
Leaders of 21 Pacific Rim nations, holding their annual summit in Pusan, South Korea, put discussion of ways to contain the disease and prevent a human pandemic high on their agenda. Australian Prime Minister John Howard told business leaders meeting alongside the Asia-Pacific Economic Cooperation (APEC) summit that he would announce "a very significant initiative" on the disease. "Appropriate responses to the potential pandemic will be high on the agenda" at the APEC summit, Howard said, emphasizing "the importance of putting aside any sense of national pride or self-consciousness about any outbreak in individual countries. The last thing that any nation can afford to do, not only in its own interests but in the interests of the fellow members of the world community, is to hide or cover up in any way." Also, the leading medical journal The Lancet called on governments to communicate honestly and openly with the public. Governments "must admit to uncertainty, act transparently, issue guidance on disease protection and make sure information is disseminated to the public as quickly as possible" to avoid panic even before a pandemic emerges, it said. Separately, North Korea, which announced July 2005 that it had stamped out an outbreak of bird flu after destroying 200 000 chickens, said it had now worked out regulations, emergency action plans and prevention strategy in case of a new outbreak.

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)

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Romania: H5N1 virus in dead poultry confirmed
Romania's agriculture ministry said 21 Nov 2005 that laboratory tests confirmed the H5N1 virus in dead poultry in a Danube delta village. "Regarding the samples in Caraorman, the laboratory in London confirmed it was the highly pathogenic H5N1 virus," the ministry said. Romania said 14 Nov 2005 that 4 new cases of avian flu in domestic birds had been discovered in Caraorman. It said the village, which has no road access, would be quarantined and 2000 domestic birds would be slaughtered. The Balkan state in October 2005 became the first country in mainland Europe to detect H5N1 virus in poultry in 2 villages in the Danube delta, Europe's largest wetlands near the Black Sea. (Promed 11/24/05)

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Kuwait: Flamingo, avian influenza suspected
Recent posts dealt with the reported detection of an H5N1-positive flamingo in Kuwait. Here is information from the official OIE report: Information received 10 Nov 2005 from Dr. Mohammed Wael Al-Muhanna, Acting Deputy Director General for Animal Health, The Public Authority for Agriculture Affairs and Fish Resources (PAAF), Safat: Precise identification of agent: avian influenza virus subtype H5N1. Date of first confirmation of the event: 9 Nov 2005. During routine surveillance for avian influenza, 1 of 2 flamingos in a private property close to the beach was found to be positive for antibodies against avian influenza virus subtype H5N1. Results: One out of 2 samples was positive for H5N1 antibodies. No antigen could be detected from fecal samples from both flamingos. Source of outbreak or origin of infection: may be due to migratory birds' droppings. Control measures: both birds were killed and incinerated immediately, and the entire farm and the area were disinfected. Serum and fecal samples collected from the neighboring enclosures and the neighboring farms were found to be negative for both antibodies and antigen detection.

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)

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Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:
Economy / Cases (Deaths)
Indonesia / 11 (7)
Cambodia / 4 (4)
Thailand / 4 (1)
Viet Nam / 66 (22)
China / 3 (2)
Total / 88 (36)

Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 132 (68)
(WHO 11/25/05 http://www.who.int/csr/disease/avian_influenza/country/en/index.html )

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China: Additional confirmed human case of H5N1 infection; new avian influenza outbreaks
As of 24 Nov 2005, the Ministry of Health in China has confirmed a further case of human infection with H5N1 avian influenza virus. The fatal case occurred in a 35-year-old woman who worked as a farmer in Anhui province. She developed symptoms 11 Nov 2005, was hospitalized 15 Nov 2005 and died 22 Nov 2005. This is the third laboratory-confirmed case in China and the second from Anhui. Of these cases, 2 have been fatal. Also in Anhui, 22 farmers who had close contact with the 24 year old fatal case "were all OK", Wu Fuqing, an Anhui official, reportedly said. In addition, blood tests on a Chinese schoolteacher who fell ill in an area that suffered a bird flu outbreak showed that he doesn't have the virus. The teacher lived in the same county in Hunan province as a 9-year-old boy who was confirmed to be one of China's first human cases. The boy's sister, who died, was a suspected case. "Based on an extensive range of blood tests, [the schoolteacher] has been excluded as a case of H5N1," said Dr. Julie Hall, an infectious diseases specialist for the WHO's Beijing office. The 36-year-old teacher apparently fell ill after chopping raw chicken. Also in Hunan, "no abnormal signs" were detected in 152 villagers who came in contact with the 9 year old boy or his sister. The Chinese Ministry of Health has invited WHO to participate in a joint mission to Anhui Province. The mission will review laboratory findings and investigate the exposure histories of the 2 cases reported there.

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/.
(Promed 11/18/05, 11/19/05, 11/21/05, 11/23/05, 11/24/05)

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China: Stringent rules to control animal epidemics
Provincial governments should report major animal epidemic cases to the State Council, China's highest governing body, within 4 hours after having learned of them, according to a new State Council regulation. The regulation, which was released 20 Nov 2005, also requires county or city governments to report such cases to provincial authorities within a matter of just 2 hours. It was issued when China reported an increasing number of avian flu outbreaks. The regulation is aimed at "controlling and stamping out major animal epidemic cases as soon as possible, ensuring the safety of breeding industry, protecting people's health and lives and safeguarding the normal social order." The animal epidemic includes avian flu and other animal diseases with a high incidence or fatality. Local government officials who neglect the performance of their duties will be removed from their posts and be prosecuted. It lists detailed preparations and emergency measures to cope with animal epidemics. Army and police should support the efforts made by local governments to control animal epidemics, the State Council regulation said.

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)

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China: Avian influenza preparedness updates
Reportedly, China's south western province of Yunnan stated that it would cooperate with Laos to prevent the spread of bird flu at border areas. No cases of bird flu have been reported in Laos or Yunnan, which also borders Myanmar and Viet Nam. About 14 million poultry have been vaccinated in Yunnan and 25 markets selling live birds have been closed. In Anhui, officials have been asked to sign a contract of responsibility that includes compulsory poultry vaccination and proper handling of dead poultry. Provincial health authorities have also stockpiled 60 million units of bird flu vaccine for poultry, 10 tons of disinfectant and 2000 sets of protective suits in case of an outbreak. In Beijing, schools were required to report any students who have a fever. Anyone who has had contact with a confirmed human case of bird flu and subsequently develops a fever or shows other symptoms of the disease is required to undergo at least a week of medical observation. 2 infectious diseases hospitals have been set aside to treat human cases. Meanwhile, 2 people have been detained for producing and selling fake poultry vaccines in the northern province of Liaoning, where 4 outbreaks have been reported. Authorities discovered the counterfeits earlier in November 2005 and have already detained 4 other people, it said. (Promed 11/18/05)

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China: Sharing of viral isolates with the international community
With confirmation of human cases of H5N1 virus infection in China, the need to look at a range of viral samples or isolates from that country has taken on a heightened sense of urgency. "The new outbreaks are coming hot and heavy now and we just don't know what's out there. We don't know if it's the same virus or different viruses. And we need to get that information," says Michael Perdue, a scientist with the WHO’s global influenza program. The international agencies involved in trying to contain the spread of H5N1 have made a number of entreaties to China for virus samples and have received assurances from authorities there that viruses will be shared. China has posted the genetic sequences of a large number of H5N1 avian influenza viruses isolated from birds in open-access databases; a step for which the agencies and outside researchers are grateful. But only so much can be learned from analyzing the genetic sequences of viruses. In order to determine whether the lethality of the virus is changing and whether the current prototype H5N1 vaccine would still be a good match, scientists have to be able to study live viruses. Dr Juan Lubroth, head of the emergency prevention system of the UN's Food and Agriculture Organization, said, "To be able to study this virus through its genes is great. But what does it do biologically? What does it do in the host? That is also very, very important." Sequence variation has to be correlated with biological experiments to make predictions about the imminence of changes in transmissibility and virus virulence.

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)

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Indonesia: Further investigation into H5N1-positive human cases; another avian flu outbreak
2 Indonesian women who died from avian influenza earlier in November 2005 apparently had no known contact with avian influenza virus-infected birds. "It remains unclear how these 2 people contracted the disease," said Ilham Patu, 47, a medical officer with Sulianti Saroso, one of 2 hospitals in Jakarta designated to treat avian influenza cases. A government investigation found that no fowl or other birds were infected with the avian influenza virus near their homes, Patu said. The WHO laboratory confirmed 16 Nov 2005 that the 2 Indonesian women died of H5N1 virus infection, taking the number of confirmed cases in Indonesia to 11 [7 of which were fatal]. In about 80 per cent of human cases, the infection was probably caused by direct contact with sick or dying birds, Georg Petersen, WHO's representative in Jakarta, said 14 Nov 2005. "Then we are left with a group of people where we don't know exactly how they got infected," Petersen said. Human-to-human transmission of the H5N1 avian flu virus is "not proven and not disproved," Petersen said. "There is only one case published from Thailand where human-to-human transmission is implicated," he said. 2 teenagers who had developed symptoms are currently undergoing tests. Neither had been exposed to H5N1 infected chickens at their homes, Patu said.

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)

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Viet Nam: Additional human case of H5N1 infection; more avian influenza outbreaks
The Ministry of Health in Viet Nam has confirmed a further case of human infection with H5N1 avian influenza. The case is a 15-year-old boy from Hai Phong Province. He developed symptoms 14 Nov 2005 and was hospitalized 16 Nov 2005. He has been discharged from hospital and is recovering. In addition, the northern province of Phu Tho declared 18 Nov 2005 a bird flu outbreak after finding 100 ducks dead at a farm in Yen Lap district. The new outbreaks brought the total number of provinces and cities hit by the epidemic to 17, said the Ministry of Agriculture and Rural Development 18 Nov 2005. Thai Binh province discovered the death of 49 chickens at a farm in Hung Ha district, 13 Nov 2005. The dead birds tested positive for the H5N1 strain of the avian flu virus. So far almost 900 000 poultry across the country have been culled in the fight against bird flu. Vietnam has detected 65 human cases of bird flu infections, including 22 fatalities, in 25 cities and provinces since Dec 2004. The government has decided to allocate additional 1 trillion 306 billion Vietnamese dong (VND) (over 82.6 million US dollars) for combating bird flu outbreaks in humans this year. The Vietnamese Ministry of Finance said 10 Nov 2005 it ensured a budget of 4 trillion 915 billion VND (311 million dollars) to realize an urgent plan to cope with bird flu in humans, including more than 1 trillion VND (63 million US dollars) to be used from now to the end of 2005 for the prevention.

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)

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Thailand: Cockfighting can resume on New Year's Day 2006
Cockfighting is expected to resume from New Year's Day 2006 if owners register their roosters and have their health checked before placing them in competitive matches, Agriculture and Cooperatives Minister Khun Ying Sudarat Keyuraphan said 18 Nov 2005. Cockfighting is a popular sport in many areas of rural Thailand. Khun Ying Sudarat said officials would meet with breeders to agree on government guidelines so that the fighting cocks could compete again in fighting arenas beginning from the upcoming New Year. However, she warned that Livestock Development Department statistics show that only some 40 000 out of a million fighting cocks have been registered. Explaining the government's vaccination policy regarding bird flu, Khun Ying Sudarat said research conducted both in and outside Thailand had shown that the vaccine could not prevent the fatal virus from spreading. She said vaccinated chickens contracting the virus would not develop symptoms and could transmit the virus without the owners' awareness. For this reason, the government has decided to impose a ban on vaccination and apply a 3-year plan of action, endorsed by international agencies, to control the disease instead. Khun Ying Sudarat stressed that her ministry plans to control the outbreak of avian influenza within 3 years. (Promed 11/21/05)

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Taiwan: H7N3 detected in migratory bird droppings; discussions with UK
Animal health officials ruled out infection by bird flu virus after testing migratory bird droppings in the wetland areas of Tainan, 17 Nov 2005. Officials said the tests showed a strain of avian flu, H7N3, discovered in the droppings in Tainan was low-pathogenic. The animal health inspection division of the Council of Agriculture (COA) said the strain was unlikely to cause illness in birds or humans. But the COA and the local county government have erected warning signs in the marsh where the droppings were discovered. Officials said there are no poultry farms nearby. But they have also alerted the chicken and duck raisers to carry out thorough anti-flu measures like quarantine and disinfection. According to the WHO, H5 and H7 viruses are the only avian influenza subtypes implicated in outbreaks of the highly pathogenic diseases. It was the second time the H7N3 strain had been detected in Taiwan. The first case was discovered in Taipei in April 2005.

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)

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Russia: Reports 250 wild swans died of H5 avian influenza virus infection
Reportedly, about 250 wild swans died of an H5 avian flu virus infection on the Volga River delta in southern Russia. Tests to determine if the strain was H5N1 had not been completed. As a result of the swan die-off, a quarantine was being enforced in an area near the city of Astrakhan. H5N1 viruses have been found in birds in 8 Russian provinces, and hundreds of thousands of birds have been culled to stop the outbreaks. (CIDRAP 11/23/05)

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Hong Kong: Steps up measures against avian influenza threat
With the theme "Raise hygiene awareness, guard against influenza," cleaning events will run from 20 Nov 2005 until early next year in Hong Kong. Activities include cleaning operations, inspection of back lanes, roving exhibitions, bus parades, health talks and distribution of publicity materials. As more and more avian flu cases were reported in mainland China, Hong Kong has stepped up measures to keep the disease outside its territories. Temperature screening at Lo Wu and Lok Ma Chau border crossings have already been reactivated. Any wild bird feeders in common areas at public rental housing estates and markets will be served a 1500 HK dollars [USD 194] fixed-penalty notice when caught, and no prior warning will be given, Hong Kong's housing department said. The government also has updated its website on avian flu with a Really Simple Syndication application to allow subscribers to receive automatically the latest news updates on avian flu via their personal computers, smart phones or personal digital devices. Additionally, the government has widely distributed a number of leaflets with different themes and in different languages to ensure a proper understanding of the differences between seasonal flu, avian flu and flu pandemic, as well as give health tips to guard against the diseases.

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)

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Japan (Ibaraki): OIE avian influenza H5N2 follow-up report
For full report: http://www.oie.int/eng/info/hebdo/a_current.htm#Sec2

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)

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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)

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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):
http://www.cdc.gov/flu/avian/ (Key Facts and Q&A updated 25 Nov 2005). - The US government’s official Web site for pandemic flu: http://www.pandemicflu.gov/.
- Latest FAO updates on avian influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes maps documenting the latest avian flu outbreaks and an interactive map displaying the timeline of the outbreaks. Documents from the avian influenza meeting (7-9 Nov 2005) are now available.
- Latest OIE updates on avian influenza: http://www.oie.int/eng/en_index.htm. Includes documents from the avian influenza 7-9 Nov 2005 meeting. A press release on the 24th Conference of the OIE Regional Commission for Asia, the Far East and Oceania - Seoul (Republic of Korea) 15-18 November 2005 is also available.
- WHO “Influenza pandemic threat: current situation”: http://www.who.int/csr/disease/avian_influenza/pandemic/en/index.html. Comprehensive information on the avian influenza 7-9 Nov 2005 meeting, including presentations, are available at: http://www.who.int/mediacentre/events/2005/avian_influenza/en/index.html WHO recommendations relating to travelers coming from and going to countries experiencing outbreaks of highly pathogenic H5N1 avian influenza: http://www.who.int/csr/disease/avian_influenza/travel2005_11_3/en/index.html. ***WHO does not recommend any restrictions on travel to any areas affected by H5N1 avian influenza; WHO does not recommend screening of travelers coming from H5N1 affected areas; WHO advises travelers to avoid contact with high-risk environments in affected countries
- WHO/WPRO (Regional office for the Western Pacific) website on avian influenza: http://www.wpro.who.int/health_topics/avian_influenza/overview.htm
- Influenza information from the US Food and Drug Administration: http://www.fda.gov/oc/opacom/hottopics/flu.html
- PAHO’s latest updates on avian influenza: http://www.paho.org/ Includes press release on the Summit of the Americas.
- American Public Health Association (APHA) information on Influenza (http://www.apha.org/preparedness/influenza.htm) and Avian Influenza (http://www.apha.org/preparedness/avian.htm ).
- The American Veterinary Medical Association information on avian influenza: http://www.avma.org/public_health/influenza/default.asp
(CDC; WHO; FAO, OIE; FDA; PAHO; APHA; Washington Dept of Health)

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The Origins of Pandemic Influenza — Lessons from the 1918 Virus
By Robert B. Belshe, M.D.
Excerpts: “The completion of the genetic sequencing of the 1918 influenza A virus by Taubenberger et al. and the subsequent recovery of the virus by Tumpey et al. using reverse genetic techniques are spectacular achievements of contemporary molecular biology and provide important insights into the origin of pandemic influenza. The three pandemic viruses that emerged in the 20th century — the 1918 ("Spanish influenza") H1N1 virus, the 1957 ("Asian influenza") H2N2 virus, and the 1968 ("Hong Kong influenza") H3N2 virus — all spread rapidly around the world, but only the 1918 virus was associated with mortality measured in the thousands per 100,000 population. . . The characterization of the recovered 1918 virus in tissue culture and mice reveals at least two unique qualities. This virus is able to replicate and form plaques on tissue-culture monolayers in the absence of the protease trypsin. Normally, a protease such as trypsin is required to activate the hemagglutinin in order to initiate the infection of tissue culture, but the 1918 virus can activate its own hemagglutinin through the action of neuraminidase, either directly or indirectly (possibly by neuraminidase's binding of a host protease). . .In addition, the 1918 virus is 100 times as lethal in mice as any other human influenza virus; the median lethal dose (LD50, or 103.5 to 3.75 median egg infectious doses [EID50]) is low, and the virus replicates rapidly so that high titers (>107 EID50 per milliliter) are found in the lungs of infected mice. . .” (CIDRAP; N Engl J Med. 2005 Nov 24;353(21):2209-2211. http://content.nejm.org/cgi/content/full/353/21/2209 )

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