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EINet Alert ~ Dec 09, 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:
- Romania (Tulcea): New suspect cases of avian influenza in birds
- Ukraine (Crimea): Birds culled after confirmation of H5 virus
- Ukraine (Crimea): State of Emergency to avian influenza endorsed
- Zimbabwe: Outbreak of avian influenza H5N2 in ostrich farms
- East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
- Indonesia: Plans for an early avian influenza warning system
- Indonesia: Reports additional confirmed and suspected human cases of avian influenza
- Viet Nam (Cao Bang): Bird flu outbreaks in area near China
- Thailand: Additional human case of avian influenza confirmed
- Thailand: Discussion on human-to-human transmission of avian influenza
- China: Fifth human case of avian influenza confirmed
- Russia: Avian influenza quarantine lifted in provinces
- USA: States support HHS plan for flu preparedness summits
- USA: HHS hopes pandemic preparations will ease flu vaccine supply kinks
- USA: HHS urges business to plan for pandemic as economic impacts assessed
- USA (North Carolina): Low pathogenic avian influenza reported
- Adverse Events Reported Following Live, Cold-Adapted, Intranasal Influenza Vaccine
- Quantification of the effect of vaccination on transmission of avian influenza (H7N7) in chickens
- FAO/WHO: No bird flu risk for consumers from properly cooked poultry and eggs
Romania (Tulcea): New suspect cases of avian influenza in birds
Romania has discovered new suspect cases of avian flu in birds in 2 villages in the Danube delta, the area where the H5N1 strain of the virus was first detected, the Agriculture Ministry said 5 Dec 2005. All the outbreaks occurred in villages close to lakes where migratory birds often rest. Avian flu has been found in about a dozen villages in Romania since Oct 2005, including several places outside the delta. 3 outbreaks have been confirmed as the highly pathogenic H5N1 strain avian influenza. Samples from other outbreaks are being sent to Britain for testing. "A few samples from the villages Agighiol and Crisan from Tulcea County came out positive in the quick diagnosis test," the ministry said. "The actual virus hasn't been isolated yet." Agriculture Minister Gheorghe Flutur said the 2 villages had been quarantined and domestic birds would be culled. Also, samples from a virus detected in 4 outbreaks in Braila County outside the delta will be subject to further tests in Britain. However, officials said 4 Dec 2005 the birds had likely contracted the H5N1 strain. Disinfection checkpoints were installed on all roads leading out of Braila. Around 5000 birds in Ciocile, where bird flu was discovered 3 Dec 2005, have already been culled. Officials have told people to keep domestic birds isolated so they do not come into contact with wild birds. The Danube delta, near the Black Sea, is Europe's largest wetlands and lies on the migratory route of millions of wild birds towards warmer winter climes in North Africa. Romania has not reported any cases of bird flu in humans so far. (Promed 12/4/05, 12/5/05)
Ukraine (Crimea): Birds culled after confirmation of H5 virus
In an alert message to the OIE on 5 Dec 2005, the Ukrainian authorities reported the confirmation of H5 infection in chickens and geese in 5 villages, situated in 3 separate districts (Dzhankoyskiy, Nizhnegorskiy and Sovetskiy districts) within the Autonomous Republic of Crimea. According to the message, the outbreaks started 25 Nov 2005 and were confirmed 2 Dec 2005. The Crimean peninsula and Azov Sea are situated on a main flyway of migratory birds on their route to the Balkans and the Near East. The urgent need for intensification of the epidemiological surveillance in wild birds was among the recommendations of the global avian influenza meeting, 8-10 Nov 2005. (Promed 12/2/05, 12/4/05, 12/5/05)
Ukraine (Crimea): State of Emergency to avian influenza endorsed
On 6 Dec 2005, Petro Verbytsky, the Head Veterinary Surgeon of Ukraine, announced his resignation. The bird flu outbreak in Ukraine was reportedly provoked by a lack of preventive measures. Reportedly, the first cases of bird deaths were registered 2 months ago, but the government and the local authorities did not respond. Yushchenko reportedly said, "What happened in these villages is clearly a professional error of the veterinary service, and it must accept responsibility." (Promed 12/5/05, 12/7/05)
Zimbabwe: Outbreak of avian influenza H5N2 in ostrich farms
H5N2 is not as virulent as the H5N1 strain. According to the reports by the WHO, the OIE, and the South African Institute for Communicable Diseases, the H5N2-virus poses almost no risk to humans, who have no receptors for the virus in their respiratory tract. South Africa in 2004 had an outbreak of H5N2 among ostriches that led to around 26 000 of the birds being culled. It declared itself bird flu-free Sep 2005, and the EU in Nov 2005 lifted a ban on the import of South African ostriches and their meat. H5N1 has not yet been detected in Africa, but experts say uncovering it in the region's rural areas will be difficult because of poor surveillance and already high mortality rates among the continent's backyard chickens.
OIE avian influenza report
East Asia: Cumulative number of human cases of avian influenza A/(H5N1)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:
Economy / Cases (Deaths)
Indonesia / 13 (8)
Cambodia / 4 (4)
Thailand / 5 (2)
Viet Nam / 61 (19)
China / 5 (2)
Total / 88 (35)
Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 137 (70)
Indonesia: Plans for an early avian influenza warning system
But putting in place an extensive, test-responding, monitoring system has been a huge challenge for the cash-strapped government as well as U.N. agencies, which have been calling for more foreign aid. The FAO welcomed the plan but said it required a national strategy and called on local officials not to cover up bird flu outbreaks. Peter Roeder, an animal health officer heading an emergency team from the FAO, said it was important that district leaders be aware of their responsibility and obligations and used their resources to make sure they [were] part of the reporting system. The FAO says it has launched its own grass-roots scheme covering Java island since Nov 2005. "[They are] very similar activities, and I hope we could build that into one unified system. I'm sure we can, but we haven't discussed this before with the minister," said Roeder referring to Agriculture Minister Anton Apriyantono. Indonesia, a country experiencing human cases, has not reported cases in avians to the OIE since 27 Jun 2005. (Promed 12/2/05)
Indonesia: Reports additional confirmed and suspected human cases of avian influenza
Also, an 8-month-old baby is the latest patient to test positive for avian influenza in Indonesia. Reportedly, doctors believe the baby may have caught the disease from an infected pigeon. A spokesman at the Sulianti Soroso hospital says preliminary tests, yet to be confirmed by the WHO lab, show that the child is suffering from the H5N1 strain. The infant was reportedly put into an isolation ward at the designated avian influenza centre 4 Dec 2005, 5 days after contracting a high fever at his home in North Jakarta. 6 other patients are undergoing tests at the hospital. (Promed 12/6/05)
Viet Nam (Cao Bang): Bird flu outbreaks in area near China
Thailand: Additional human case of avian influenza confirmed
Thailand: Discussion on human-to-human transmission of avian influenza
Only severe cases of human bird flu have previously been detected in Thailand simply because patients went to hospital for treatment. But doctors believe that there have been many cases with mild symptoms of the disease. Signs of possible human-to-human transmission were closely observed in Vietnam, where 10 clusters of probable human transmissions were detected in which the victims had no contact with infected poultry, Charoen said. Thailand and Indonesia had one official cluster, he said, but the Indonesian cluster showed clear-cut evidence because a child contracted H5N1 without going to an infected area, as her father had. From an analysis of a cluster of 3 cases in the same family in 2004, it was concluded previously that person-to-person transmission may have occurred in Thailand at an earlier phase of the outbreak. 2 family members appeared to have contracted infection from a critically ill index patient, but onward transmission was not observed.
The situation emphasizes the need for comprehensive serological surveys of the general population in East Asian countries. (Promed 12/2/05)
China: Fifth human case of avian influenza confirmed
The Ministry of Health in China has confirmed a further case of human infection with the H5N1 avian influenza virus. The case is a 31-year-old female farmer from the Heishan county, Liaoning province. She developed symptoms 30 Oct 2005 and subsequently underwent extensive hospital care for severe pneumonia and acute respiratory distress. She recovered and was discharged from hospital 29 Nov 2005. Initial tests on this case produced negative results for infection with the H5 virus subtype. Diagnostic confirmation was made following antibody testing using a microneutralization test. Using this test, a positive diagnosis is made when antibody levels in a blood sample taken late in illness are at least four times higher than those found in a sample taken early in illness. Diagnostic confirmation using antibody tests, though reliable, is thus slower than that achieved using direct tests for virus RNA.
The "China Daily" reported that there have been at least 30 avian outbreaks of bird flu in 11 provinces and regions so far in 2005. Beginning in late October, Chinese authorities have reported several outbreaks of highly pathogenic H5N1 avian influenza in poultry in Liaoning Province. Investigation of this case has linked the woman’s infection to direct exposure to diseased poultry. Agricultural authorities have detected the H5N1 virus in samples taken from poultry in the province. As a precaution, local authorities placed contacts of the woman under medical observation pending definitive laboratory results. No signs of influenza-like illness were detected, and all contacts have now been released from observation. This is China’s fifth laboratory-confirmed case. Of these cases, two were fatal. The cases have been reported from Anhui, Hunan, Guangxi, and Liaoning provinces.
OIE avian influenza report
Russia: Avian influenza quarantine lifted in provinces
USA: States support HHS plan for flu preparedness summits
State and local health officials from around the nation voiced support for a federal government plan to hold a "summit" meeting on pandemic influenza preparedness in every state over the next few months. Health and Human Services Secretary Michael Leavitt described the plan for a "50-state summit" as part of his quest to achieve an unprecedented level of public health preparedness for the pandemic threat posed by the H5N1 avian flu virus. State and local health officials generally expressed support for the summit meetings and preparedness efforts, though they had some reservations about costs and about what will happen if the pandemic doesn't materialize. They spoke of "fatigue" from having to prepare for a succession of public health threats in recent years and said the smallpox vaccination program in 2003 damaged their credibility.
Leavitt said two things convince him that pandemic preparations are essential. One is that history shows that "ultimately this is going to happen." Second, a pandemic differs fundamentally from other disasters in that it happens everywhere at the same time. He said that states should follow up on their summit meetings by regularly assessing the progress of preparations. Leavitt said the meetings are part of his strategy to drive pandemic planning "deep" into state and local governments, business, and other sectors of society. Heads of state now understand the significance of the pandemic threat, but local politicians, business leaders, and school officials generally don't, he said. "We're looking to create a rallying event to help you engage, inform, and motivate people who are critical to your capacity to implement a local strategy," he explained. HHS officials envision the meetings as lasting about 4 to 6 hours and involving a simple tabletop exercise that could be customized to fit local conditions, Leavitt said.
HHS has a goal of obtaining 81 million courses of antiviral treatment, of which 6 million are to be reserved for emergency use to stop a budding pandemic. Leavitt explained that under the plan, HHS will pay for 50 million courses to be allocated to the states. The remaining 25 million treatment courses would also be available to the states, but the federal government would pay only 25% of the cost, with the states bearing the rest. Even if Congress "didn't appropriate a dime" for pandemic preparedness, "It would still be our constitutional and moral responsibility to do everything that is possible for us to be prepared," Leavitt said. He added that the federal plan to pay for 50 million doses fulfills the government's obligation to ensure that everyone has access to antivirals. (CIDRAP 12/5/05 http://www.cidrap.umn.edu/ )
USA: HHS hopes pandemic preparations will ease flu vaccine supply kinks
President Bush had proposed spending $2.8 billion to improve cell-culture technology for flu vaccine production. The administration also wants to expand existing egg-based vaccine production and develop adjuvant, or dose-sparing, technology. To clear the way, the administration wants Congress to pass laws protecting vaccine makers from lawsuits over vaccine-related injuries. But health officials also said that expanding US production capacity depends on having a dependable market for the vaccine, the demand for which has been unpredictable. "We've got to build the demand for the annual flu vaccine," said Leavitt. "So the annual flu vaccine is a very important part of the strategy to have pandemic preparedness." CDC Director Julie Gerberding said that having a "reliable large supply" of annual vaccine will help iron out kinks in distribution, but a steady demand is necessary to drive production.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the government will have about 6.5 million doses of the experimental "prepandemic" vaccine for the H5N1 avian flu virus by January. Leavitt raised the question of what will happen if no flu pandemic erupts anytime soon. "My guess is that people will in fact say, 'They overreacted, they cried wolf,'" he said. "The truth is that a pandemic influenza of some sort will ultimately be our lot to handle. But what I believe to be an opportunity is that we can become the first society in history to do something about it." (CIDRAP 12/6/05 http://www.cidrap.umn.edu/ )
USA: HHS urges business to plan for pandemic as economic impacts assessed
HHS's "Business Pandemic Influenza Planning Checklist" is intended for large businesses, but it doesn't spell out how large. It was prepared by CDC. The list offers 35 suggestions grouped in 6 categories. Sample suggestions from a few of the categories:
- Plan for the impact of a pandemic on your business: Identify a pandemic coordinator and/or team with defined roles and responsibilities for preparedness and response planning; Identify essential employees and other critical inputs required to maintain business operations; Determine the potential impact of a pandemic on company financial results under multiple possible scenarios; Establish an emergency communications plan.
The Congressional Budget Office (CBO) estimated that a severe pandemic like that of 1918 would cut gross domestic product (GDP) in the ensuing year by about 5%. By comparison, the typical business recession in the US since World War II cut GDP by 4.7%, the report says. The estimate is based on a pandemic scenario involving 90 million illness cases and 2 million deaths. In a milder pandemic, like that of 1957 or 1968, GDP would be reduced by about 1.5%, according to the CBO. This second scenario assumes 75 million cases with about 100,000 deaths.
The CBO report was criticized by Dr. Michael Osterholm, a leading pandemic preparedness proponent and director of CIDRAP. He called the report "overly simplistic" because the CBO assessed only lost work days and reduced sales due to restricted social interaction. "The inability to transport products would result in a much greater impact" than the CBO estimated. He predicted that a severe pandemic would bring "an abrupt halt" to global, regional, and national economies. "Foreign trade and travel will be reduced or even ended in an attempt to stop the virus from entering new countries—even though such efforts will probably fail given the infectiousness of the virus and the volume of illegal crossings at most borders," he said. He predicted that curtailment of international trade will trigger shortages of critical products, such as those needed to maintain water, power, and communication systems and meet health needs unrelated to flu prevention and treatment. As an example of an area demanding "critical product continuity" planning, Osterholm said the US pharmaceutical industry obtains more than 80% of its raw materials from foreign sources. He added that the common business practice of maintaining very limited inventories of raw materials and products will likely exacerbate the problems. (CIDRAP 12/9/05 http://www.cidrap.umn.edu/ )
USA (North Carolina): Low pathogenic avian influenza reported
Seasonal influenza activity for the Asia Pacific and APEC Economies
Influenza activity remained low during weeks 46-47.
Canada. Localized activity of influenza B virus was reported from Alberta during week 46. Activity remained low in the rest of the country.
Others. During weeks 46–47, low influenza activity was detected in Australia (B), Hong Kong (H1, H3, A and B), Japan (H1 and H3), Mexico (H1, H3 and A), Russia (H1, H3 and B), and USA (H3, A and B). Philippines reported no influenza activity. (WHO 12/8/05 http://www.who.int/csr/disease/influenza/update/en/ )
Avian/Pandemic influenza updates
Adverse Events Reported Following Live, Cold-Adapted, Intranasal Influenza Vaccine
Hector S. Izurieta, et al. JAMA. 2005;294:2720-2725.
Abstract: “Context: In June 2003, the US Food and Drug Administration licensed a trivalent live, attenuated influenza vaccine (LAIV-T) for intranasal administration to healthy persons 5 to 49 years of age. Although prelicensure testing involved 20 228 vaccinees, clinical trials were not of sufficient size to detect rare adverse events reliably. Objective: To identify adverse events reported following LAIV-T administration after licensure. Design, Setting, and Participants: All adverse events reported to the US Vaccine Adverse Event Reporting System (VAERS) during the 2003-2004 and the 2004-2005 influenza seasons. Main Outcome Measures: Numbers and proportions of reported adverse events and reporting rates of adverse events per 100 000 vaccinees. Results: Approximately 2 500 000 persons received LAIV-T during the first 2 postlicensure seasons. As of August 16, 2005, VAERS received 460 adverse event reports for vaccinations received from August 2003 through July 2005. No fatalities were reported. There were 7 reports of possible anaphylaxis, 2 reports of Guillain-Barré syndrome, 1 report of Bell palsy, and 8 reports of asthma exacerbation among individuals with a prior asthma history. Events in individuals for whom the vaccine was not indicated accounted for 73 reports (16%). Conclusions: Reports to VAERS in the first 2 seasons of LAIV-T use did not identify any unexpected serious risks with this vaccine when used according to approved indications. Like many vaccines and other medical products, LAIV-T may rarely cause anaphylaxis. Secondary transmission of the vaccine virus merits further investigation. Reports of asthma exacerbations in vaccinees with prior asthma history highlight the risks of vaccine use inconsistent with approved labeling.”
(CIDRAP http://www.cidrap.umn.edu/ )
Quantification of the effect of vaccination on transmission of avian influenza (H7N7) in chickens
FAO/WHO: No bird flu risk for consumers from properly cooked poultry and eggs
Chicken and other poultry are safe to eat if cooked properly, according to a joint statement by FAO and the WHO issued to national food safety authorities. However, no birds from flocks with disease should enter the food chain. FAO/WHO made the statement to clarify food safety issues in relation to the current bird flu crisis. The statement has been issued through the International Food Safety Authorities Network (INFOSAN) and is available in 6 languages. In areas where there is no bird flu outbreak in poultry, there is no risk that consumers will be exposed to the virus via the handling or consumption of poultry and poultry products. Cooking of poultry at or above 70C throughout the product, so that absolutely no meat remains raw and red, is a safe measure to kill the H5N1 virus in areas with outbreaks in poultry. Eggs from areas with outbreaks in poultry should not be consumed raw or partially cooked. To date, there is no epidemiological evidence that people have become infected after eating eggs, egg products, or contaminated poultry meat that has been properly cooked.
In the process of killing and preparing a live bird for food, slaughtering poses the greatest risk of passing the virus from infected or diseased birds to humans. When a diseased bird is slaughtered, defeathered and eviscerated, virus from that bird can transfer to humans through direct contact. Infected poultry excrete virus in their secretions and faeces. Exposure might also occur when the virus is inhaled through dust and possibly through contact with surfaces contaminated with the virus. In areas where marketing of live birds is common, the practices of home slaughtering, defeathering, and eviscerating increase the exposure to potentially contaminated parts of a chicken. These practices therefore result in a significant risk of infection in areas with outbreaks in poultry. It is not always possible to differentiate infected and non-infected birds in outbreak areas. Some avian species, such as domestic ducks, may harbour the virus without displaying symptoms. Therefore, people need to be fully informed about preventive measures, including the use of protective equipment. The practice of slaughtering and eating of infected birds, whether diseased or already dead, must be stopped. These birds should also not be used for animal feed. (FAO 12/5/05 http://www.fao.org/newsroom/en/news/2005/1000172/index.html )