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Vol. IX, No. 2 ~ EINet News Briefs ~ Jan 27, 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:
- Global: WHO updated factsheet on avian influenza
- Turkey: Update on human cases of avian influenza infection
- Near East: Regional avian influenza updates
- North Cyprus: Suspected avian cases of avian influenza
- Ukraine (Crimea): Sevastopol declared potential danger zone due to avian influenza
- Croatia: Official OIE update report on avian influenza
- Global: WHO calls for an immediate halt to provision of single-drug artemisinin malaria pills
- Eurasia: Cumulative number of human cases of avian influenza A/(H5N1)
- Indonesia: 2 additional fatal cases of avian influenza; additional suspected case
- China: Tenth confirmed human case of avian influenza
- North Korea, Japan: Group says North Korean infected with avian influenza
- China: New HIV data show growing AIDS epidemic
- New Zealand (Christchurch): Source of hepatitis A outbreak linked to childcare center
- Australia (New South Wales, South Australia): Increase in cases of Ross River virus
- Viet Nam (Ho Chi Minh): Nearly 260 children suffer from food poisoning
- Canada (Alberta): BSE Detected
- USA/Japan: Japan reimposes US beef ban
- USA/Taiwan: Taiwan reopens market to US beef
- USA: Limits on US distribution of Tamiflu lifted
- USA (Arizona, North Dakota): Human cases of Hantavirus pulmonary syndrome
- USA (Washington, Oregon): E. coli O157:H7 infections from unpasteurized milk
- USA: Recall of Vapotherm 2000i and 2000h respiratory gas humidifier
- Cholera, diarrhea & dysentery
- CDC EID Journal, Volume 12, Number 2-February 2006
- Orf virus infection in humans--New York, Illinois, California, and Tennessee, 2004--2005
- Surveillance for early detection of disease outbreaks at an outdoor mass gathering--Virginia, 2005
- Antivirals for influenza in healthy adults: systematic review
- Management of potential human cases of influenza A/H5N1: lessons from Belgium
- Large-Scale Sequence Analysis of Avian Influenza Isolates
- Third International Conference on Current Research in Avian Zoonoses
- 2006 Annual conference on antimicrobial resistance, June 26--28, 2006
4. APEC EINet activities
- APEC EINet pandemic influenza videoconference
5. To Receive EINet Newsbriefs
- APEC EINet email list
Global: WHO updated factsheet on avian influenza
The updated WHO factsheet on avian influenza incorporates the most recent findings on the H5N1 avian influenza virus, which WHO says is causing by far the worst outbreak among both birds and people ever recorded. Bird droppings may be a significant source of its spread to both people and birds, WHO said. For example, the highly pathogenic H5N1 virus can survive in bird feces for at least 35 days at low temperature (4C). At 37C, H5N1 viruses have been shown to survive, in fecal samples, for 6 days. Poultry, especially those kept in small backyard flocks, are the main source of the virus. These birds usually roam freely as they scavenge for food and often mingle with wild birds or share water sources with them. Such situations create abundant opportunities for human exposure to the virus, especially when birds enter households or are brought into households during adverse weather, or when they share areas where children play or sleep, WHO states.
H5N1 has different qualities from seasonal flu. The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for H5N1 infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. Initial symptoms include a high fever, usually with a temperature higher than 38C, and influenza-like symptoms. Diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. And with H5N1 infection, all patients have developed pneumonia, and usually very early on the illness, WHO states. On present evidence, difficulty in breathing develops around 5 days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. There is bloody sputum. Another common feature is multiorgan dysfunction, notably involving the kidney and heart. WHO recommends using Tamiflu (oseltamivir), as soon as possible to treat bird flu. WHO stresses that H5N1 remains mostly a disease of birds, with tens of millions infected in 2 years. For unknown reasons, most cases have occurred in rural and periurban households where small flocks of poultry are kept. Very few cases have been detected in presumed high-risk groups, such as commercial poultry workers, workers at live poultry markets, cullers, veterinarians, and health staff caring for patients without adequate protective equipment. Also lacking is an explanation for the puzzling concentration of cases in previously healthy children and young adults.
The full factsheet as of 20 Jan 2006 is available at: http://www.who.int/csr/disease/avian_influenza/avianinfluenza_factsheetJan2006/en/index.html. Sections include: “The disease in birds: impact and control measures”, “A constantly mutating virus: 2 consequences”, “Human infection with avian influenza viruses: a timeline”, “Why H5N1 is of particular concern”, “Influenza pandemics: can they be averted”, “Clinical course and treatment of human cases of H5N1 avian influenza”. (Promed 1/21/06)
Turkey: Update on human cases of avian influenza infection
As of 25 Jan 2006, there is a continuing discrepancy between the number of confirmed human cases of H5N1 infection in Turkey cited by WHO and those reported by the Turkish authorities. According to WHO, the cumulative number of human cases of H5N1 virus infection in Turkey remains at 4 with 2 deaths, figures very different from the 21 cases with 4 deaths reported by the Turkish Ministry of Health. A map of the H5N1 situation in Turkey is available at http://disasters.jrc.it/AvianFlu/Turkey/. (Promed 1/23/06, 1/25/06)
Near East: Regional avian influenza updates
Syria has asked the UN to help it guard against bird flu and plans to tighten surveillance along its border with Turkey, Lubroth said 21 Jan 2006. Lubroth said FAO had received unconfirmed reports within the past week of poultry deaths in Syria. Syria has culled birds near its 483 km border with Turkey as a precaution, but said the birds had showed no sign of illness. Damascus, which has launched domestic awareness campaigns on bird flu and has prepared medical teams to monitor and deal with the eventuality that it spills over from Turkey, rarely asks foreign organizations for help. "They are going to increase their surveillance and maybe do some depopulation, some culling along the northern border with Turkey. That's what I have heard," he said. Beyond technical assistance from the FAO, Syria has also requested diagnostic technology, laboratory equipment and protective gear.
Cases of bird deaths are registered in a number of Armenian villages. Local authorities and high ranking officials assure the public that the dead birds were examined in labs and bird flu was not found. "We would like to closely cooperate with Armenian authorities [and] help them make sure the virus is absent," Lubroth remarked. FAO will send its specialists to Armenia, Georgia and Ukraine to check on whether their laboratories are able to provide accurate diagnostics, he said.
An Iranian animal health department official, Dr Kamyar Dahim, said 30 000 birds along a 10 km border and in Western Azerbaijan have been killed so far and their goal is to raise the number to 150 000 in 1 week. The Bird Flu Control committee has been receiving phone calls from villagers having fowls with the disease, and a significant drop in chicken and egg sales has been reported in Iran.
Noting that Azerbaijan has the shortest border with Turkey, the Deputy Chairman of the State Veterinary Service at the Azerbaijani Agriculture Ministry, Emin Shahbazov, stressed that 7 searches for bird flu have been held in the country so far, and no virus has been found: "The poultry farms and private farms are monitored now." Shahbazov added that US experts will arrive in Azerbaijan 23 Jan 2006 to study the bird flu situation in the country. According to him, WHO suggested that Azerbaijan would benefit from the assistance of Turkish experts to implement better precautions. Azerbaijan has accepted the offer.
Georgian and Russian scientists will cooperate in the fight against avian flu. The resolution was passed at a meeting between Vladimder Chipashvili, Health Care Minister of Georgia, and Oleg Kiselev, director of the Scientific-Research Flu Institute of the Russian Academy of Medical Sciences. "We are sure that Georgia will find a way out independently, but scientific cooperation is better," Kiselev declared.
WHO has installed a team in Van, Turkey, and a team of US experts arrived 21 Jan 2006 as part of a tour to Turkey's flu-stricken areas and 3 neighboring countries. "The cooperation among the ministries involved, and with international agencies on the ground here, and the 24-hour nature of the operations that allow rapid response are very important," Anne Derse, a State Department communications expert with the US team, said 22 Jan 2006. No cases of bird flu have been reported in the countries that the team will visit -- Azerbaijan, Armenia and Georgia -- but they all border the worst-hit regions of eastern Turkey. (Promed 1/21/06, 1/23/06)
North Cyprus: Suspected avian cases of avian influenza
Ukraine (Crimea): Sevastopol declared potential danger zone due to avian influenza
Croatia: Official OIE update report on avian influenza
Global: WHO calls for an immediate halt to provision of single-drug artemisinin malaria pills
“So far, no treatment failures due to artemisinin drug resistance have been documented, but we are watching the situation very attentively,” said Dr Arata Kochi, the newly appointed director of WHO's malaria department. “We are concerned about decreased sensitivity to the drug in South-East Asia which is the region that has traditionally been the birthplace of anti-malarial drug resistance.” In Thailand, sulfadoxine-pyrimethanime (SP) was initially almost 100% effective in curing malaria when introduced in 1977, but within 5 years was curing only 10% of cases due to drug resistance. The once-popular chloroquine has lost its effectiveness in almost every part of the world. Resistance to atovaquone developed within 1 year of introduction in 1997. In order to contain the circulation and use of counterfeit antimalarial medicines, WHO plans to strengthen its collaboration with international and national health and regulatory authorities. It is estimated that up to 25% of medicines consumed in developing countries are counterfeit or sub-standard. Additionally, to anticipate and prevent the onset and spread of drug resistance in the long term, WHO urges the global malaria research community and the pharmaceutical industry to rapidly invest in the design of the next generation of antimalarial drugs. By creating ACTs with multiple-drug combinations and transmission blocking components, resistance can be prevented. “Our biggest concern right now is to treat patients with safe and effective medication and to avoid the emergence of drug resistance. If we lose ACTs, we’ll no longer have a cure for malaria,” said Dr Arata Kochi, “and it will probably be at least 10 years before a new one can be discovered.” (WHO 1/19/06 http://www.who.int/mediacentre/news/releases/2006/pr02/en/index.html )
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: 152 (83)
Indonesia: 2 additional fatal cases of avian influenza; additional suspected case
Also, an Indonesian chicken seller whom local tests showed had been infected with H5N1 avian influenza virus has died, a hospital official said 26 Jan 2006. The victim’s blood samples had been sent to a Hong Kong laboratory recognized by the WHO for confirmation. If confirmed, the case would take total known deaths in Indonesia from avian flu to 15. "The 22-year-old man died. . .26 Jan 2006. He was the vendor from a traditional market and the only positive case that we were treating today," said Ilham Patu, a spokesman of the Jakarta hospital designated to deal with bird flu patients. This latest death comes as WHO drew attention to the threat posed by Indonesia's traditional markets and urged that hygiene and sanitation standards be improved. WHO has called for preventive measures included limiting contact between humans and poultry in markets, as well as better access to water and improved waste management. Indonesia is also still awaiting official confirmation of local tests that showed a 39 year old man died of bird flu earlier this month. The highly pathogenic strain of bird flu has affected birds in 2/3 of the provinces in Indonesia. The country has millions of poultry, many in the yards of rural or urban homes, raising the risk of more humans becoming infected with the virus. (Promed 1/21/06, 1/23/06, 1/25/06, 1/26/06)
China: Tenth confirmed human case of avian influenza
North Korea, Japan: Group says North Korean infected with avian influenza
An bird flu outbreak that infected humans could be devastating in North Korea, where poultry is an important source of meat for its people. North Korea's official media reported outbreaks among poultry last year and in 2004. Pyongyang informed South Korea last year that it had culled thousands of chickens infected with the H7 strain of the virus. South Korea's unification ministry said it was unaware of any human cases in the North. Pyongyang's Korean Central News Agency reported 21 Dec 2005 that North Korean scientists had "found out the basis to rapidly and correctly identify any types of bird flu viruses." It said scientists had confirmed bird flu within 10 days when it broke out in spring 2005. (Promed 1/25/06, 1/26/06)
China: New HIV data show growing AIDS epidemic
The majority of all estimated HIV infections (approximately 80 percent) are related to injecting drug use and commercial sex. The epidemic is equally or more serious than previously thought in all parts of China, except in central China where HIV transmission in connection with the sale of blood and blood plasma may have been overestimated in the past. The report released presents the new estimates of people living with HIV and AIDS in China. It also provides background and context to the new estimates, including a brief update on the response to the epidemic as well as the challenges for the future. (WHO 1/25/06 http://www.who.int/mediacentre/news/releases/2006/china_hiv_aids/en/index.html )
New Zealand (Christchurch): Source of hepatitis A outbreak linked to childcare center
Hepatitis A is an enterically transmitted viral disease of the liver. Following exposure, an incubation period of 15 to 45 days precedes the development of clinical symptoms. Symptoms include general malaise, fever, nausea and jaundice. It is usually transmitted through contact with the faeces of infected people, or by environmental contamination. Unlike hepatitis B and C, it does not cause chronic liver disease. Most patients recover completely within 6-10 weeks. Close contacts of sufferers may be offered an injection of antibodies for temporary protection. Immunisation may also be offered for long-term protection. Day care centers have been identified as significant "players" in the epidemiology of hepatitis A outbreaks. The pre-school age children often have non-icteric (no jaundice) non-specific viral syndrome symptoms so that hepatitis A is not considered as an etiology until their parents and/or caretakers present with jaundice and other more typical symptoms associated with hepatitis A. (Promed 1/13/06)
Australia (New South Wales, South Australia): Increase in cases of Ross River virus
Also, more than 20 Meningie residents have been infected with Ross River Virus in just 6 weeks, including children. Meningie now accounts for nearly half of all cases reported across South Australia since the start of Dec 2005, prompting Health Department calls for people to cover up against mosquitoes. For the same period last year, just 7 cases were reported in South Australia. Warm and wet weather conditions in 2005 provided a perfect breeding ground for virus-carrying mosquitoes, and in some areas, including Meningie, they have reached uncontrollable proportions. Because of this, Meningie general practitioner Dr Michael Kerrigan said the number of cases was not unexpected. However he said it was a wake-up call for local residents who had become complacent about the threat of infection from mosquitoes. While locals were likely to have the disease diagnosed quickly, Dr Kerrigan said he was concerned tourists from Adelaide would contract the disease and go undiagnosed by metropolitan doctors.
Ross River virus (RRV) fever, or epidemic benign polyarthritis, is a viral infection. Ross River virus infection can be transmitted to humans by the bite of an infected mosquito. It generally results in a self-limiting flu-like non-fatal illness, but it can cause long-term joint pain and fatigue. Symptoms disappear eventually and leave few or no after-effects. Most people who have been exposed to RRV are immune for life. There is no vaccine and no specific treatment for Ross River virus infection, but treatment of symptoms can reduce discomfort. Medical treatment is aimed at easing joint pains and swelling, and minimizing fatigue and lethargy. A variety of mosquito species can transmit RRV, biting day and/or night. RRV fever is found in all States and Territories of Australia, but occurs more often in the northern States and in coastal areas. Infection can occur year-round, but is more common from late Nov to the end of Apr, during the wet season when mosquito activity increases. RRV is also found in Papua, New Guinea, areas of Indonesia and the Western Pacific islands. (Promed 1/14/06)
Viet Nam (Ho Chi Minh): Nearly 260 children suffer from food poisoning
Canada (Alberta): BSE Detected
The Canadian Food Inspection Agency (CFIA) confirmed 23 Jan 2006 that bovine spongiform encephalopathy (BSE) in an approximately 6-year-old cross-bred cow born and raised in Alberta. No part of the animal entered the human food or animal feed systems. This finding is not unexpected and was identified through Canada's national surveillance program, which targets cattle at highest risk of being infected with BSE. The program has tested more than 87 000 animals since Canada's first BSE case in 2003. The geographic location and age of this animal are consistent with the 3 domestic cases previously detected through the national BSE surveillance program and the current understanding of BSE in Canada. The clustering of these cases is examined in the epidemiological report "Canada's Assessment of the North American BSE Cases Diagnosed from 2003 to 2005 (Part II)," which is available at: http://www.inspection.gc.ca/english/anima/heasan/disemala/bseesb/eval2005/evale.shtml. Food safety remains protected through the removal of specified risk material (SRM) from all cattle slaughtered for human food in Canada. SRM are tissues that, in infected cattle, contain the BSE agent.
CFIA, working with the producer and the Province of Alberta, has launched an investigation into the feeding regime and storage practices employed on the farm as well as the production and source of feeds delivered to the farm. CFIA will identify cattle born on the farm within 12 months before and after the affected animal as well as offspring of the affected animal born during the last 2 years. Any live animals found from these groups will be segregated and tested. Definitive conclusions regarding the source of infectivity cannot be made until the investigation is complete; however, it is probable that the source is contaminated feed. This detection is consistent with a low level of disease and does not indicate an increased risk of BSE in Canada. This finding should not affect Canada's ability to export live animals, beef and beef products. Canada has notified its key trading partners. Since May 2003, Canada has clearly stated the possibility of finding a small number of additional BSE cases. This international dialogue will continue as Canadian officials work closely with their international counterparts to ensure the facts and supporting science of this case are shared in an open and timely manner. (Promed 1/23/06)
USA/Japan: Japan reimposes US beef ban
The US agriculture secretary Mike Johanns stated: “The processing plant that exported this product has been de-listed and therefore can no longer export beef to Japan. . .I am dispatching a team of USDA inspectors to Japan to work with Japanese inspectors to reexamine every shipment currently awaiting approval, to confirm compliance with the requirements of our export agreement with Japan. I have directed that additional USDA inspectors be sent to every plant that is approved to export beef to review procedures and ensure compliance with our export agreements, and I am requiring that 2 USDA inspectors review every shipment of US beef for export to confirm that compliance. I have also ordered unannounced inspections at every plant approved for beef export. These additional inspection requirements in the US will be applied to all processing plants approved for beef export and all beef shipments designated for export from the U.S. I am also requiring that all USDA beef inspectors undergo additional training to make certain they are fully aware of all export agreement requirements. And, I have directed my staff to coordinate a meeting of representatives from all US processing plants that export beef to review those requirements. While this is not a food safety issue, this is an unacceptable failure on our part to meet the requirements of our agreement with Japan. We take this matter seriously, recognizing the importance of our beef export market, and we are acting swiftly and firmly."
To view the transcript of remarks by the Agriculture Secretary, see: http://www.usda.gov/wps/portal/usdahome. (Promed 1/22/06; USDA 1/24/06)
USA/Taiwan: Taiwan reopens market to US beef
USA: Limits on US distribution of Tamiflu lifted
USA (Arizona, North Dakota): Human cases of Hantavirus pulmonary syndrome
HPS is a disease transmitted by infected rodents through urine, droppings, or saliva. Humans can contract the disease when they breathe in aerosolized virus. Hantavirus infection causes flu-like symptoms as fever, shortness of breath, chills, nausea, headache, diarrhea, and abdominal pain. HPS was first recognized in 1993 and has since been identified throughout the US. Although rare, HPS is potentially deadly. Rodent control in and around the home remains the primary strategy for preventing Hantavirus infection. As of 6 Jul 2005 there had been a total of 396 cases of HPS in the US. As of 6 Jul 2005, New Mexico topped the list with 64 cases, and North Dakota now ranks as 11th in frequency of disease. For more information on HPS: http://www.cdc.gov/ncidod/diseases/hanta/hps/index.htm. (Promed 1/20/06, 1/21/06)
USA (Washington, Oregon): E. coli O157:H7 infections from unpasteurized milk
Raw milk can contain a variety of bacteria, including E. coli O157:H7, which are destroyed by the heat of pasteurization, Beundel said. Milk contains minor amounts of vitamin C and thiamine, which also are removed by pasteurization, but they can be replaced through supplements, he said. Among the improvements the state wants at Dee Creek are a concrete floor in the milking parlor, replacing a muddy rubber mat; running water in the milking area for hand washing; and an improved area for filtering and chilling the milk, now done in the family kitchen. Denny said E. coli can grow "even in a healthy cow, and can be intermittently shed" via milk or feces. (Promed 1/21/06)
USA: Recall of Vapotherm 2000i and 2000h respiratory gas humidifier
Seasonal influenza activity for the Asia Pacific and APEC Economies
WHO’s surveillance information has not been updated since the 18 Jan 2006 report. Please see EINet’s 20 Jan 2006 Alert for further details.
USA.During week 3 (Jan 15 – Jan 21, 2006), influenza activity continued approximately at the same level as recent weeks in the US. 247 specimens (10.8%) 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. 5 states reported widespread influenza activity; 23 states and New York City reported regional influenza activity; 9 states and the District of Columbia reported local influenza activity; and 13 states reported sporadic influenza activity. (CDC 1/27/06 http://www.cdc.gov/flu/weekly/ )
For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity --- United States, January 8--14, 2006”): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5503a4.htm. (MMWR January 27, 2006 / 55(03);74-76)
Avian/Pandemic influenza updates
- Latest FAO updates on avian influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes animation timeline of avian influenza outbreaks in Turkey.
- OIE updates and documents on avian influenza: http://www.oie.int/eng/en_index.htm. Includes the major veterinary proposals by OIE.
- The US government’s web site for pandemic flu: http://www.pandemicflu.gov/. New State Summit summaries have been uploaded.
- 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.
- PAHO’s updates on avian influenza: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- The American Veterinary Medical Association information on animal influenzas: http://www.avma.org/public_health/influenza/default.asp
- US Geological Survey, National Wildlife Health Center: http://www.nwhc.usgs.gov. NWHC Avian Influenza Information (with bulletins, maps, and news reports): http://www.nwhc.usgs.gov/research/avian_influenza/avian_influenza.html.
Cholera, diarrhea & dysentery
CDC EID Journal, Volume 12, Number 2-February 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 2-February 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles are available online: Clostridium difficile Infection in Patients Discharged from US Short-Stay Hospitals, 1996–2003, L.C. McDonald et al., and West Nile Virus Infections Projected from Blood Donor Screening Data, United States, 2003, M.P. Busch et al.
Orf virus infection in humans--New York, Illinois, California, and Tennessee, 2004--2005
Surveillance for early detection of disease outbreaks at an outdoor mass gathering--Virginia, 2005
Antivirals for influenza in healthy adults: systematic review
Roche, the maker of oseltamivir, said, "Roche fundamentally disagrees with the conclusions reached by the authors that oseltamivir should not be used for the treatment or prevention of seasonal influenza. The conclusion is at odds with the opinion of experts and regulatory authorities around the world." WHO and many countries are stockpiling the NIs, mainly oseltamivir, in the hope that they will be useful if H5N1 avian flu leads to a pandemic. "After carefully reviewing this analysis, WHO will not be changing its stockpiling recommendations," WHO spokesman Dick Thompson said. Roche did not directly challenge the authors' conclusion about the effectiveness of oseltamivir against avian flu strains in humans, but the company reported that the drug performed well in a recent animal study, as well as previous ones.
The researchers analyzed 19 randomized controlled trials of oseltamivir and zanamivir along with 34 trials of amantadine and rimantadine. They examined the drugs' record in preventing and treating lab-confirmed influenza and influenza-like illness in patients aged 16 to 65. For treatment of symptomatic flu, oseltamivir had 61% to 73% efficacy, depending on the dosage, and zanamivir had 62% efficacy. The NIs were found to have no significant effect when used to prevent flu-like illness. But for preventing flu after exposure to the virus (postexposure prophylaxis), oseltamivir was 58.5% efficacious in households and 68% to 89% efficacious in contacts of index cases, the analysis showed. The researchers also found evidence that the NIs shortened the duration of symptoms and reduced the viral load in nasal secretions, but the drugs did not eliminate viral shedding. Oseltamivir, 150 mg daily, reduced the incidence of bronchitis and pneumonia in flu cases but not in flu-like illness cases. "We do not see a role for the use of neuraminidase inhibitors in seasonal inflenza, since the evidence shows that they are ineffective against influenza-like illness," they write. But they add that in the context of a known flu epidemic, flu-like illness is more likely to be actual influenza and the NIs are more likely to be helpful.
In responding to the article, Roche officials said, "The statement by the author that neuraminidase inhibitors should not be used in seasonal influenza control is inappropriate and inconsistent with data. Roche strongly disagrees with this article; surveillance activities and the appropriate use of antivirals are critical to combat influenza." Roche took issue with using oseltamivir's reported lack of effectiveness against flu-like illness as a reason not to use it for seasonal flu: "Once influenza is circulating and with clearly defined symptoms identified[,] influenza is easy to diagnose. Roche has never advocated the use of Tamiflu for control of influenza-like symptoms."
The researchers also examined reports on the effects of oseltamivir in human H5N1 flu patients in Southeast Asia. There, oseltamivir treatment had no clear effect on mortality, although this could have been a result of starting treatment late in patients who already had a high viral load, the report says. In H5N1 cases, the viral load can be 10 times greater than in seasonal flu, a WHO study showed. Resistance to oseltamivir was seen in 7 of 43 children and in 2 of 8 Vietnamese children and adults, the report says. The scientists also found no clear benefits from the use of oseltamivir in people exposed to H7N7 avian flu in the Netherlands in 2003 and H7N3 avian flu in Canada in 2004. "As viral load and virulence of pandemic viruses are considerably higher than those of seasonal influenza viruses, the use of neuraminidase inhibitors in a serious epidemic or pandemic should not be considered without concomitant measures, such as barriers, distance, and personal hygiene." They add that overestimating the ability of NIs to prevent illness could cause those treated to be less careful, leading to increased spread. (CIDRAP 1/20/06 http://www.cidrap.umn.edu/index.html )
Management of potential human cases of influenza A/H5N1: lessons from Belgium
Large-Scale Sequence Analysis of Avian Influenza Isolates
Third International Conference on Current Research in Avian Zoonoses
Kalmar, Sweden; 3-5 May 2006. http://www.mikrobiologi.net/avian.
From Dr. Ingvar Eliasson (firstname.lastname@example.org): “I would like to announce the third international conference on current research in zoonotic ecology and epidemiology, organized by the Society for Zoonotic Ecology and Epidemiology (SocZEE). The theme of the upcoming meeting is zoonotic diseases associated with birds: avian zoonoses. The purpose of the meeting is to bring together both basic and clinical scientists active in the field of zoonotic infections and zoonotic infectious agents in order to increase networking and interdisciplinary collaboration between human and veterinary medicine, microbiology, epidemiology, ecology, biology, and other related biosciences. This time, we have added interaction with authorities and journalists in a special seminar entitled Risk Communication. By doing this, we hope to assist the participants in their preparedness to meet the media and to inform the public about their research in a professional way. The conference will be followed by a 2 day optional tour to Ottenby Bird Observatory. The participants will be introduced to the different methods used to monitor migrating birds for viral and bacterial pathogens. . .” (Promed 1/22/06)
2006 Annual conference on antimicrobial resistance, June 26--28, 2006
4. APEC EINet activities
APEC EINet pandemic influenza videoconference
EINet celebrated its 10th anniversary of service to the Asia Pacific by hosting the APEC EINet Virtual Symposium on Pandemic Influenza Preparedness, Friday 20 Jan 2006, 02:00 – 07:00 UTC. Participants in the videoconference included the economies of: Australia, Canada, People’s Republic of China, Republic of Korea, Philippines, Singapore, Chinese Taipei, Thailand, USA, and Viet Nam. Each economy presented briefly their state of pandemic influenza preparedness, followed by moderated questions and answers. Overall, the collaborative event was very successful, and the economies were able to share a rich level of information and engage in productive discussions. Evaluation of the videoconference and a formal report are currently pending. 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/.