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Vol. IX, No. 1 ~ EINet News Briefs ~ Jan 13, 2006
*****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:
- Pan-Asia: Japan-WHO joint meeting on early response to potential influenza pandemic
- OIE's participation at the International Pledging Conference on Avian and Human Pandemic
- Turkey: 2 Additional human cases of avian influenza infection
- Turkey: Analyses of viruses from the first two fatal human cases from Turkey
- Turkey: Official expert agencies express concern about avian influenza situation
- Turkey: Possible influence of Tamiflu and weather on avian influenza; Unique epidemiology
- Romania: New suspected avian influenza cases in poultry; Regional preparedness
- Ukraine (Crimea): Avian influenza outbreak in 3 poultry farms
- Eurasia: Cumulative number of human cases of avian influenza A/(H5N1)
- China: Eighth human H5N1 avian influenza case
- China (Sichuan, Guizhou): New avian influenza outbreaks; economic impacts
- Japan (Saitama and Ibaraki): World’s first confirmed human cases of H5N2 infection
- Indonesia: New suspected human cases of avian influenza infection
- Russia: Update on avian influenza situation and preparedness
- New Zealand (Christchurch): Hepatitis A outbreak
- Russia (St. Petersburg): Typhoid fever outbreak
- Hong Kong: Additional cases of Typhoid fever
- Indonesia: Update on polio outbreak
- USA: States to share $100 million for pandemic planning
- USA: USDA experts part of U.S. avian influenza team to Turkey
- Mexcio (Chiapas): Avian influenza H5N2 outbreak controlled
- Peru (Amazonas): Outbreak of Yellow Fever
- USA (Oklahoma): At least 45 begin rabies treatments
- USA (Nebraska): 2 Cases of tularemia prompt health warning
- Viet Nam: Human cases of avian influenza may be more common and less lethal
- Bioterrorism — Preparing to Fight the Next War
- Business Planning for Pandemic Influenza: A National Summit
- Public Health Preparedness Database
- Recommended Childhood and Adolescent Immunization Schedule--United States, 2006
- Toxoplasma & Food Safety Meeting, 8-10 May 2006
- CDC’s Global Communications Center opens
- APEC Support Fund Receives Contribution from Chinese Taipei
4. APEC EINet activities
- APEC EINet pandemic influenza videoconference
5. To Receive EINet Newsbriefs
- APEC EINet email list
Pan-Asia: Japan-WHO joint meeting on early response to potential influenza pandemic
Anti-bird-flu drugs should be stockpiled at the disease's frontline in Asia, ready to be shipped to threatened populations in the critical first 2 weeks of an outbreak, WHO said. Asia was "still the epicentre of the threat to global health posed by this virus", said the regional director of WHO, Shigeru Omi, at a 2-day meeting of Asian countries and international organisations on bird flu in Tokyo. 21 countries and organizations are holding talks there to discuss what measures to take should the virus mutate into a form that could be transmitted from human to human. Stockpiles are only now being built up but are in Europe and the US. 1 or 2 stockpiles should be located in Asia, where they could be drawn on in an emergency, Omi said. All countries need a rapid reaction plan or the only feasible approach to the disease, containment, would fail, according to a WHO official, who said a global influenza taskforce would be set up within weeks. But the logistics of managing an outbreak in Asia remain complex. Laos said it had neither the pathology laboratories to quickly confirm an outbreak nor the trucks to deliver medicine.
Doctors need to speed up testing for bird flu and governments must jointly stockpile supplies to prevent the virus from taking a greater toll. Hitoshi Oshitani, a doctor on the WHO's bird flu task force, said it takes nearly 17 days on average for suspected bird flu cases to be confirmed locally and by WHO. "It would be too late for containment," Oshitani said. He called for a streamlining of procedures to verify bird flu cases, but acknowledged that a lack of lab space and specialists was an impediment. "One of the essential requirements in rapid response and containment, I think, is participation of all countries," said another WHO medical expert, Keiji Fukuda. "As this kind of rapid movement requires a great deal of resources and expertise, we see that training, working on the development and building stockpiles both at the regional and international level is necessary," he said. Narongsakdi Aungkasuvapala, deputy permanent secretary at Thailand's ministry of public health, said that "improving measures to detect bird flu is the most important issue" facing his country. "A large part of the population raises chickens in their households, so it is essential for us," he said. Rapid diagnosis is and has always been an important veterinary need. Speed in diagnosis has a massive impact on the efficiency of stopping any epidemic. But vaccination depends on the national budget and veterinary services efficiency in the field. Too often it is invoked after things have got out of hand. And with avian influenza it merely stops the birds demonstrating clinical signs. The risk of disease spread is only decreased, not eliminated.
WHO’s rationale for the meeting:
OIE's participation at the International Pledging Conference on Avian and Human Pandemic
It will cost international donors about UDS 1.4 billion to finance the next phase of the global campaign against the virus, including gearing up veterinary services and preparing expert teams for quick deployment to outbreaks, a senior UN expert said. Dr. David Nabarro, U.N. senior coordinator for avian influenza, said he was confident delegates to the Beijing conference would pledge the needed amount. The EU announced its intention to grant up to 80 million euros (about $100 million) to help developing countries fight avian flu. The pledge is to be formally announced in Beijing. The Turkish agriculture minister said his country would receive $35 million under a World Bank Program to improve its "technical capacity" for fighting avian flu. (Promed 1/11/06; OIE 1/13/06 http://www.oie.int/eng/press/en_060113.htm ; CIDRAP 1/13/06 http://www.cidrap.umn.edu/ )
Turkey: 2 Additional human cases of avian influenza infection
Laboratory tests completed in 12 Jan 2006 in Turkey have detected the H5 virus subtype in post-mortem specimens taken from a 12-year-old girl, from Agri Province, who died 7 Jan 2006. The child was the sibling of 2 other patients who died earlier. Their infection with the H5N1 virus was subsequently confirmed by a WHO collaborating lab in the UK. The Ministry of Health is now reporting 18 laboratory-confirmed cases, of which 3, all from the same family, have been fatal. Arrangements have been made to send specimens from several patients to the UK collaborating lab for further analysis. The head of the collaborating lab is now in Ankara to support diagnostic work at the country's national influenza centre. Ways are being sought to expedite the testing of patient samples. High awareness of the disease in the Turkish population, combined with almost daily reports of poultry outbreaks in new areas, has resulted in a large number of people concerned about exposure and seeking reassurance.
The Turkish government has launched an intensive public awareness campaign. Better public understanding of the disease, supported by more complete data on disease activity in birds, could help to reduce the risk of additional human cases, pending control of the disease in birds. As the majority of confirmed cases and persons under investigation are children, it is particularly important that messages about high-risk behaviours reach children. Some 100 000 treatment courses of oseltamivir (Tamiflu) arrived in Turkey 6 Jan 2006. This supply is being used for both the treatment of patients and prophylaxis of persons at risk. WHO has organized additional support for laboratory diagnostic work. "All of the cases confirmed by the laboratory are people who had close contact with infected, sick or dead poultry. The major point now is to control the outbreak in poultry as it is the source of infection in humans," Guenael Rodier, a senior specialist for communicable diseases with WHO, said.
The rapid assessment of patients with a possible exposure history is providing a unique opportunity to learn more about the disease in humans. It is also generating data that can be used to assess the efficacy of antiviral drugs, as most people with an exposure history or respiratory symptoms are receiving oseltamivir either prophylactically or very early after the onset of symptoms. International teams are working with local experts to plan relevant studies. These studies should deepen understanding of the epidemiology of the disease, including the possibility that any human-to-human transmission may have occurred, the vulnerability to infection of health care workers and other occupationally-exposed groups, and the possibility that milder forms of the disease might be occurring in the general population. All available evidence indicates that no sustained human-to-human transmission has occurred. As in Asia, contact with infected birds is the principal source of infection. The risk of infection for travellers to Turkey is negligible provided direct contact with dead or diseased domestic and wild birds is avoided.
An interactive map of the officially reported Avian Influenza outbreaks in Turkey can be seen at http://poultrymed.com/files/index.html (go to "maps"). Map of avian flu outbreaks, along with human cases, in Turkey is also available from the European Commission Joint Research Centre: http://disasters.jrc.it/AvianFlu/Turkey/. (Promed 1/8/06, 1/9/06, 1/10/06, 1/12/06)
Turkey: Analyses of viruses from the first two fatal human cases from Turkey
Virus from one of the patients shows mutations at the receptor-binding site. One of the mutations has been seen previously in viruses isolated from a small outbreak in Hong Kong in 2003 and from the 2005 outbreak in Viet Nam. Research has indicated that the Hong Kong 2003 viruses bind preferentially to human cell receptors more so than to avian cell receptors. Researchers at the current UK laboratory anticipate that the Turkish virus will also have this characteristic. Interpretation of the significance of this finding for human health will depend on clinical and epidemiological data now being gathered in Turkey. The present WHO level of pandemic alert remains at phase 3: human infections with a new virus subtype are occurring, but the vast majority of these infections are acquired directly from animals. (Promed 1/12/06)
Turkey: Official expert agencies express concern about avian influenza situation
Turkey should consider poultry vaccination in addition to culling to control its bird flu outbreak if the number of cases in animals continues to rise, the head of the world animal health body (OIE) said 11 Jan 2006. "They must act quickly as soon as new cases emerge to stamp out the virus. The problem now is that there are cases throughout the country," OIE Director General Bernard Vallat said. "If cases continue to come to light, the second option is to use vaccination in the area around detected outbreaks. Of course, sick animals must still be culled," he added. "The idea is that you create a protective area around an outbreak through vaccination. This could involve an entire province," Vallat said. The international community should provide logistical support and vaccine stocks if Turkey took this option. The OIE is concerned about the very bad weather conditions in eastern Turkey that make any technical intervention very difficult and that also favor a longer survival of the animal virus in the environment.
"The highly pathogenic avian influenza virus H5N1 could become endemic in Turkey," FAO said. Juan Lubroth, senior FAO animal health officer, said the virus may be spreading despite the measures already taken to combat it. Turkey needed to apply "a centrally coordinated and countrywide control campaign based on efficient local actions carried out in a transparent manner." FAO urged neighboring countries such as Armenia, Azerbaijan, Georgia, Iraq, Iran and Syria to be on high alert, apply surveillance and control measures and ensure that the public is fully informed about the bird flu risk. Experts also warned the public to be cautious during the 4-day Eid al-Adha, the Muslim Feast of Sacrifice that began 10 Jan 2006 and sees the faithful sacrifice sheep and cows often brought from rural areas to cities for sale. Although sheep and cattle are not affected by avian influenza, doctors say animals that have lived in close proximity with infected poultry could carry the virus on their skin or hooves. (Promed 1/11/06)
Turkey: Possible influence of Tamiflu and weather on avian influenza; Unique epidemiology
The avian influenza outbreaks and infections in this country have perplexed international scientists on many fronts. Turkey is the first country outside eastern Asia to have human cases, and the first one anywhere to have so many separate animal outbreaks simultaneously. In one week, Turkey announced 15 confirmed human cases of A(H5N1); Asia has seen only about 140 in the space of 5 years. In that same week, Turkish agriculture authorities announced bird outbreaks in 16 cities, from Aydin on the West coast to Van in the far east; in Asia, outbreaks have occurred more sporadically. (Promed comment: A provisional assessment of these observations might be that, in Turkey, exposure to H5N1 avian influenza virus infection may be more widespread than previously supposed and that the virus may be less virulent in humans than inferred from the East Asian experience. Perhaps the heightened awareness of the population in Turkey, combined with a heightened awareness of the health sector, and the capacity of the health sector to conduct more extensive laboratory testing is leading to the identification of much milder expressions of human disease related to H5N1 infection.) (Promed 1/10/06, 1/11/06, 1/12/06)
Romania: New suspected avian influenza cases in poultry; Regional preparedness
Also, authorities in the Bulgarian capital Sofia banned the sale of livestock as a precaution against bird flu. The city would close its 4 livestock markets. Following reports of unwillingness to report outbreaks in poultry in other countries, Bulgaria said it would pay farmers twice the market value of their domestic birds in the event they had to be culled. The virus had not yet been detected in Bulgaria. Georgia has tightened controls on goods crossing the border and Iran has decided to cull poultry within 15 km of the Turkish frontier. Iran has also imposed tight controls on its border with Turkey, banning one-day trips to Turkey from its Bazargan border area. It has also joined the rest of Turkey's neighbours in banning its poultry imports. Ukraine, which has reported outbreaks among poultry in the Crimea region, said it had stepped up monitoring at its Black Sea ports. The EU has banned imports of live birds and risky poultry products such as fresh meat and untreated feathers from affected areas. Moscow raised the prospect of economic damage to Turkey's vital tourist industry, warning Russians against traveling to Turkey. (Promed 1/10/06, 1/11/06, 1/12/06)
Ukraine (Crimea): Avian influenza outbreak in 3 poultry farms
Eurasia: Cumulative number of human cases of avian influenza A/(H5N1)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 2005:
Economy / Cases (Deaths)
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 16 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 94 (41)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 2006:
Total number of confirmed human cases of avian influenza A/(H5N1), 26 Dec 2003 to present: 147 (78)
China: Eighth human H5N1 avian influenza case
China (Sichuan, Guizhou): New avian influenza outbreaks; economic impacts
China also reported a new outbreak of avian influenza in quails in the southern province of Guizhou, according to the Ministry of Agriculture's website, 10 Jan 2005. About 16 000 quail died between 1 and 6 Jan 2006 at a farm in Guiyang city's Wudang area. The infection was confirmed by China's National Avian Influenza Reference Laboratory 10 Jan 2005 as having been caused by the H5N1 strain of bird flu. The local government's veterinarian department culled 42 000 quail at the infection site 6 Jan 2006. The outbreak is reportedly "under control". China, the world's second-biggest poultry meat producer, is vaccinating all 14.2 billion farm poultry in the country to prevent fresh outbreaks of avian influenza from increasing the risk of avian flu spreading to humans and potentially mutating into a pandemic influenza.
The Agriculture Ministry has warned that the risk of the virus spreading could be higher during the Chinese Lunar New Year (late Jan 2006), as meat consumption and the transport of live poultry increases. China's poultry industry, which state media says lost 60 billion yuan (USD 7.44 billion) alone in the fourth quarter of 2005, is gearing up for more losses, according to one senior official. "Prices of chicks have fallen 80 percent, and the price of chicken in the markets is down 20 percent," Deng Fujiang, vice chairman of the China Meat Association, said. Less severe poultry outbreaks in 2004 cost the industry an estimated 30 billion yuan (USD 4 billion), and the final figure for 2005 was likely to be far higher, he said. China has been strictly controlling the movement of poultry around the country since Autumn 2005, even going as far as to set up special quarantine stations outside major cities to ensure no live birds get in. It has done little to boost consumer confidence. "In our surveys, 40 percent of people said they are either eating less poultry, or have stopped altogether," Deng said. (Promed 1/7/06, 1/11/06)
Japan (Saitama and Ibaraki): World’s first confirmed human cases of H5N2 infection
The Japanese government said that 77 farm workers had been infected with H5N2, after tests on 350 workers and their families at affected chicken farms. The workers are the world's first to test positive for the mild strain. Chickens at some 40 farms in Ibaraki Prefecture have been infected with H5N2 since June 2005. The human infections probably took place before the infections were detected in chickens in the areas. The people were probably exposed to the virus while dealing with chickens and their excrement without taking proper preventive measures. The Health Ministry said it asked the Agriculture, Forestry and Fisheries Ministry and local governments to adopt preventive measures such as advising workers at chicken farms to put on masks at work even if no abnormalities have been found in chickens.
According to WHO, an H5N2 epidemic in birds in 1983-1984 in the USA originally caused little death, but within 6 months reached a mortality rate of 90 percent. Japan, which has stockpiled Tamiflu in case of an avian influenza pandemic, designates all H5 [serotype] strains as avian influenza, requiring the killing of the infected chicken. "If a patient with conventional human influenza is infected by mild bird flu, it could create a new type of human influenza strain for which no vaccine or medicine are prepared," the institute's scientist said. "Because it is winter, and it is the season for influenza, the authorities should keep their eyes on even the milder avian influenza viruses," he said. Japan's Health and Welfare Ministry instructed poultry workers to take preventive measures, such as wearing masks and washing their hands frequently. "Workers who were infected with human influenza should avoid working in poultry farms," the Ministry said. But no one has been found to fall ill from the mild strain. Japan is the only country to treat H5N2 as an infectious disease, the researcher said. "I hope these cases provide a warning whistle to countries worldwide," he said. "Scientists only found in 1997 that avian influenza is infectious for human beings, and now we know that a milder [form] of the avian virus, which is hard to detect because it doesn't [produce] any physical symptoms, can infect human beings," he said.
“Interim Report on a Serological Survey for [Human] Antibodies to the Highly Pathogenic Avian Influenza Virus in Ibaraki and Saitama Prefectures” (10 Jan 2006) is available at the Ministry of Health, Labour and Welfare website: http://www.mhlw.go.jp/houdou/2006/01/h0110-4.html (in Japanese). (Promed 1/8/06, 1/10/06, 1/11/06, 1/12/06)
Indonesia: New suspected human cases of avian influenza infection
Russia: Update on avian influenza situation and preparedness
New Zealand (Christchurch): Hepatitis A outbreak
Hepatitis A is a viral disease that affects the liver. It is spread either by contamination of food or directly from person to person because of poor hygiene, particularly failure of hand washing. Early symptoms include generally feeling unwell, abdominal discomfort, nausea and fever. Jaundice develops in the later stages of the disease. General practitioners (GPs) have been advised of the outbreak and requested to consider the diagnosis in patients with suggestive symptoms. "The Canterbury DHB (District Health Board) views this outbreak as a serious public health issue and cannot stress enough the importance of hand washing after going to the toilet and before handling food", said Dr Brieseman. (Promed 1/10/06)
Russia (St. Petersburg): Typhoid fever outbreak
Hong Kong: Additional cases of Typhoid fever
Indonesia: Update on polio outbreak
USA: States to share $100 million for pandemic planning
The federal government announced the release of $100 million appropriated by Congress recently to help states prepare for a potential influenza pandemic. The money is the first installment of $350 million included in the $3.8 billion emergency appropriation for pandemic preparedness that Congress passed in late Dec 2005, said Health and Human Services Secretary Mike Leavitt. "Pandemics happen globally but must be managed at the state and local level, and these funds will help communities meet that responsibility," he said. The $100 million will be divided among the 50 states, the District of Columbia, New York City, Chicago, Los Angeles County, and the 7 US territories. Each state will get $500,000 plus an additional amount based on population. "The remaining $250 million from the appropriation will be awarded later this year in accord with guidance that will require progress and performance," HHS said. The agency said states and cities will use the money to step up their planning and to conduct drills to test the plans. "The focus is on practical, community-based procedures that could prevent or delay the spread of pandemic influenza, and help to reduce the burden of illness communities would contend with during an outbreak," the statement said. The recent appropriation came in response to President Bush's request on Nov 1, 2005 for $7.1 billion for pandemic preparedness. That included $100 million for state and local preparedness, an amount that some public health organizations criticized as too small. The pandemic planning money is in addition to federal funds to help state and local governments prepare for bioterrorism and other public health emergencies. For fiscal year 2006, Congress recently appropriated about $824 million for that purpose, according to the Council of State and Territorial Epidemiologists. (CIDRAP http://www.cidrap.umn.edu/ 1/12/06)
USA: USDA experts part of U.S. avian influenza team to Turkey
Mexcio (Chiapas): Avian influenza H5N2 outbreak controlled
Peru (Amazonas): Outbreak of Yellow Fever
The existence of this outbreak was first reported in a radio call to a national radio network 26 Dec 2005. A health team reached the village 28 Dec 2005. The health team remains in the area providing care to the people of Alto Tuntus. The Minister of Health, Pilar Mazzetti Soler, confirmed 30 Dec 2005 that the disease affecting the population of the community of Alto Tuntus is yellow fever, according to testing done by National Institute of Health. As soon as the confirmation was made, a team of 24 professionals (physicians, epidemiologists, nurses and health technicians) were flown in by helicopter carrying 2000 doses of yellow fever vaccine to the area to conduct a vaccination campaign in an epidemiologic circle. (Promed 1/1/06)
USA (Oklahoma): At least 45 begin rabies treatments
One cow in the dairy's herd died from rabies, the state Health Department and CDC both confirmed 20 Dec 2005. The infected cow's milk was mixed with the milk of up to 70 other healthy cows, therefore diluting any infected milk that could have been present. Additional tests are being run to determine whether there was any of the virus in the milk. The milk that may have been infected was not pasteurized. Pasteurization, a heating-and-cooling treatment that kills organisms in the milk, would have killed the rabies virus, Garner said. Milk sold at commercial stores and restaurants must be pasteurized. Before this incident the owner did not vaccinate his herd for rabies, but he will start doing so this week. Officials suspect the cow was infected when it was bitten by a rabid skunk, and additional laboratory tests will confirm what type of animal infected the dairy cow.
Rabies, a Lyssavirus, normally affects the neurological tissue. However, the virus is most often transmitted through saliva or contact with oral or gastric mucosa. Additionally, rabies virus also has been detected in the kidney, prostate, pancreas, and other tissues and body fluids. In naturally occurring cases, the proven vehicle for transmission is saliva and neural tissue. Anecdotal reports exist of rabies transmission by ingestion of milk by a nursing lamb from its mother. However, in all of these reports, a bite or mucous membrane exposure could not be ruled out. Transmission of rabies virus in un-pasteurized milk is a theoretical possibility. Another source of exposure have included neural tissues, such as a transplanted corneas, and laboratory aerosols. Recently, the first U.S. instance of human rabies transmission via solid organ transplantation was documented in 3 recipients of a donor unsuspected of having rabies; transmission via organ transplantation has also been documented in other countries. The development of rabies generally takes 10 to 90 days when the virus is transmitted through a bite. (Promed 1/1/06)
USA (Nebraska): 2 Cases of tularemia prompt health warning
Seasonal influenza activity for the Asia Pacific and APEC Economies
WHO’s surveillance information has not been updated since the 22 Dec 2005 report. Please see EINet’s 23 Dec 2005 Alert for further details.
USA. During week 1 (Jan 1 – Jan 7, 2006), influenza activity continued approximately at the same level as recent weeks in the US. 203 (9.1%) specimens tested by U.S. WHO and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) was above the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. 7 states reported widespread influenza activity; 11 states reported regional influenza activity; 9 states reported local influenza activity; 21 states, New York City, the District of Columbia, and Puerto Rico reported sporadic influenza activity; and 2 states reported no influenza activity.
A comprehensive update on influenza activity in the USA (“Update: Influenza Activity--United States, December 18--24, 2005”) is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451a3.htm. (MMWR January 6, 2006 / 54(51&52);1305-1307) (CDC 1/13/06 http://www.cdc.gov/flu/weekly/ )
Avian/Pandemic influenza updates
- Latest FAO updates on avian influenza, including news from Turkey: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html.
- OIE updates and documents on avian influenza: http://www.oie.int/eng/en_index.htm.
- CDC website on pandemic influenza: http://www.cdc.gov/flu/pandemic.htm (“Highlights” have been updated Jan 2006). For avian influenza: http://www.cdc.gov/flu/avian/. “Key facts” have been updated 10 Jan 2006.
- The US government’s web site for pandemic flu: http://www.pandemicflu.gov/. New State Summit summaries have been uploaded; On 12 Jan 2006, HHS announced $100 million to accelerate State and Local Pandemic Influenza Preparedness Efforts.
- Influenza information from the US Food and Drug Administration: http://www.fda.gov/oc/opacom/hottopics/flu.html.
- Latest CIDRAP updates on avian/pandemic influenza: http://www.cidrap.umn.edu/index.html. A comprehensive overview on avian influenza, updated Dec 20, 2005, is available. The article, “H5N1 avian flu viruses: What's in a name?”, clarifies common questions and confusion arising from the nomenclature.
- PAHO’s updates on avian influenza: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- The American Veterinary Medical Association information on avian influenza: http://www.avma.org/public_health/influenza/default.asp
Viet Nam: Human cases of avian influenza may be more common and less lethal
Human cases of avian influenza may be both more common and less lethal than has been reported, Swedish and Vietnamese researchers reported 9 Jan 2006. A survey of Vietnamese residents shows that people who handled or cared for sick chickens were more likely to report some sort of flu-like illness in 2004. While the study cannot prove these people were infected with avian influenza, it suggests that infections may be going undetected, said Dr. Anna Thorson of the Karolinska Institute in Stockholm. "The verified human cases of highly pathogenic avian influenza in Viet Nam may represent only a selection of the most severely ill patients," Thorson's team wrote in their report. Half of all respiratory deaths are never diagnosed in developed countries, and the numbers are even lower in developing nations.
Thorson's team sent trained interviewers to a rural Vietnamese region with confirmed outbreaks of H5N1 avian influenza among poultry. "We included 45 478 randomly selected inhabitants," they wrote. They found that 8149 people, or close to 18 percent, reported having some sort of flu-like illness and that about 25 percent of all those surveyed lived in households reporting sick or dead poultry. Other exposures to poultry -- such as using bird feces as manure -- were common. "The flu-like illness attributed to direct contact with sick or dead poultry was estimated to be 650 to 750 cases," the researchers said. "Our epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required," they concluded. "Having poultry in the household was in itself not a risk factor for flu-like illness, but contact with sick or dead poultry was," they added.
They said someone should follow up with blood tests to see if people who reported flu-like illness had antibodies to H5N1, which would indicate they had been infected with the virus at some point. If the virus is circulating more widely among people than believed, this could be dangerous, because it would give the virus more opportunities to evolve into a form that more easily infects humans, the researchers said. (In the absence of supporting serological data, it is premature to conclude that all or any of the symptomatic flu-like illnesses recorded are associated with H5N1 avian influenza virus. There are a diverse range of human respiratory viruses that could account for these findings.)
The reference for this study is: Thorson A et al. “Is Exposure to Sick or Dead Poultry Associated With Flulike Illness? A Population-Based Study From a Rural Area in Vietnam with Outbreaks of Highly Pathogenic Avian Influenza.” Arch Intern Med. 2006;166: 119-123. http://archinte.ama-assn.org/cgi/content/abstract/166/1/119 (As stated in the CIDRAP article, 10 Jan 2006, recall bias may be a limitation in this study). (Promed 1/10/06; CIDRAP http://www.cidrap.umn.edu/ )
Bioterrorism — Preparing to Fight the Next War
Business Planning for Pandemic Influenza: A National Summit
February 14-15, Minneapolis, Minnesota
The Summit will join leaders in business and government and health experts in a timely and practical discussion of how to effectively and efficiently prepare business for pandemic influenza. Business leaders, government officials, and business-related organization officials should consider attending the Summit. Hosted by the Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, U.S. Chamber of Commerce, and Minnesota Chamber of Commerce (CIDRAP https://programs.regweb.com/metro/cidrap/1/ )
Public Health Preparedness Database
Recommended Childhood and Adolescent Immunization Schedule--United States, 2006
Also, “QuickStats: Number of Vaccine Doses Provided or Prescribed for Patients Aged <18 Years, by Vaccine and Setting--United States, 2002—2003”, is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451a4.htm. (MMWR January 6, 2006 / 54(51&52);1308)
Toxoplasma & Food Safety Meeting, 8-10 May 2006
Location: Palermo, Sicily, Italy
CDC’s Global Communications Center opens
APEC Support Fund Receives Contribution from Chinese Taipei
4. APEC EINet activities
APEC EINet pandemic influenza videoconference
As EINet celebrates its 10th anniversary of service to the Asia Pacific, we are pleased to host the first APEC Virtual Symposium on Pandemic Preparedness, Friday 20 Jan 2006, 02:00 – 07:00 UTC. A strong alliance of government and academic partners with experts in pandemic preparedness and technology is bringing this innovative effort in real time communications into the fight against regional pandemics. Using state of the art advanced networking we will host economies online to discuss lessons learned with preparedness planning, exercises, stockpiling and other strategic issues. This is an experiment bringing state of the art high speed communications tools into the regional mission of public health. For more information please visit: http://depts.washington.edu/einet/symposium.html.
5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact email@example.com. Further information about APEC EINet is available at http://depts.washington.edu/einet/.