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EINet Alert ~ Mar 03, 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:
- Eurasia: Cumulative number of confirmed human cases of avian influenza A/(H5N1)
- Global: Import bans are overreaction to avian influenza; wild birds are not the key to control
- Global: WHO sets meeting on flu pandemic containment
- Ethiopia: Reports avian influenza H5N1 infection in poultry
- Niger: Confirmation of avian influenza H5N1 infection in domestic poultry
- Nigeria: Avian influenza H5N1 spreads to more states
- Azerbaijan: Avian influenza situation update; economic losses
- Bosnia and Herzegovina: Avian influenza H5N1 infection confirmed in swans
- Bulgaria: 4 swans so far test positive for avian influenza H5N1
- Croatia: Avian influenza H5N1 infection in swans
- France: Avian influenza H5N1 confirmed in domestic turkeys
- Georgia: Dead swans suspected of avian influenza H5N1 infection
- Germany (Reugen): Avian influenza H5N1 infection in dead cat
- Germany: Fifth German state detects avian influenza H5N1 infection in birds
- Greece: Reports nineteenth avian case of avian influenza H5N1 infection
- Hungary: Confirmation of additional bird cases of avian influenza H5N1 infection
- Italy: 18 of 40 dead wild birds so far test positive for avian influenza H5N1
- Romania: Confirmation of new case of avian influenza H5N1 in poultry
- Slovakia: Avian infection H5N1 infection confirmed in wild birds
- Sweden: Highly pathogenic avian influenza H5N1 found in tufted ducks
- Switzerland: Second H5 avian influenza case in dead swan
- Ukraine: Avian influenza H5 infection in dead zoo birds
- Iraq: Additional suspected human cases of avian influenza H5N1 infection
- Cambodia: Reports avian influenza H5N1 infection in birds
- China: 2 additional confirmed cases of human infection with H5N1 avian influenza
- Hong Kong: Thirteenth bird confirmed with avian influenza H5N1 infection
- Japan (Ibaraki): Veterinarians held over avian influenza H5N2 cover up
- India (Gujarat): H5N1 strain confirmed at poultry farm; no confirmed human cases
- Indonesia: Confirmed and suspected human cases of avian influenza H5N1 infection
- Malaysia: 5 suspected human cases of avian influenza infection quarantined
- Pakistan: Suspected human case of avian influenza infection
- Russia: Avian influenza H5N1 in poultry farms and wild birds
- South Korea: Asymptomatic human infection of avian influenza H5N1
- Viet Nam: Firsts round of poultry vaccination completed
- USA: 2 new strains to be used in 2006-07 flu vaccine
- USA: HHS orders drugs to treat 14 million in flu pandemic
- USA: Home Health Care Services Pandemic Influenza Planning Checklist
- USA: FDA Initiative Helps Expedite Development of Seasonal and Pandemic Flu Vaccines

1. Updates
- Influenza


Global
Eurasia: Cumulative number of confirmed human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)

2003
Viet Nam / 3 (3)
Total / 3 (3)

2004
Thailand / 17 (12)
Viet Nam / 29 (20)
Total / 46 (32)

2005
Cambodia / 4 (4)
China / 8 (5)
Indonesia / 17 (11)
Thailand / 5 (2)
Viet Nam / 61 (19)
Total / 95 (41)

2006
China / 6 (3)
Indonesia / 10 (9)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 30 (18)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 174 (94)
(WHO 3/1/06 http://www.who.int/csr/disease/avian_influenza/en/ )

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Global: Import bans are overreaction to avian influenza; wild birds are not the key to control
Countries that are banning imports of poultry from bird flu-affected areas are overreacting, because the meat is safe to eat, an international animal health group said 27 Feb 2006. And while wild birds may play a role in spreading the virus, they are not the key to controlling its spread, said Alex Thiermann, president of the standard-setting committee for the World Animal Health Organization. Thiermann said sensible precautions, such as quickly culling birds in affected areas, can work to control outbreaks of H5N1 avian influenza. "Countries have far exceeded what is science-based, and they have further complicated the losses to the industry," Thiermann told the New-Fields' Bird Flu Summit, a meeting of avian influenza experts. French trade minister Christine Lagarde said 20 countries had imposed curbs on imports of French poultry after an outbreak of H5N1 at a turkey farm in France. WHO stressed again 27 Feb 2006 that properly cooked poultry does not spread bird flu. No one seems to have become infected merely through handling chicken meat, WHO added. But poultry sales have plunged, and many countries have moved to block imports as the virus spreads among flocks. "A lot has to do with the trust level between the public and government," Thiermann said. He said countries were now beginning to respond in the proper manner, doing the right surveillance to watch the virus as soon as it begins to infect birds, culling poultry right away and sealing off the movement of poultry within affected areas.

Watching wild birds for signs of the virus is important, but it would be impossible to try to control the spreading virus in wildfowl, Thiermann said. "Once the disease gets into a country, it really doesn't matter whether it is carried by wildlife, because it is going to get into the poultry," he said. Mute swans have been the latest sentinels in Europe, he said, and there is some evidence that wild mallards may be carrying the virus. But control has to take place in poultry. Developing countries are more at risk than richer nations, because they lack a good veterinary system, Thiermann said. "We can look at Croatia, Romania, Japan, Malaysia and South Korea as good examples," he added. "We can look at Nigeria, at Indonesia and other places where we see existing problems, in my opinion, having to do with lack of veterinary infrastructure." (Promed 2/28/06)

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Global: WHO sets meeting on flu pandemic containment
Public health experts will meet in Geneva next week to continue developing the WHO's draft plan for quick action to head off a potential influenza pandemic. WHO released a draft rapid-response plan at a Tokyo meeting Jan 2006. More than 30 experts in epidemiology, virology, public health, laboratory issues, and other disciplines will meet Mar 6 through 8 in Geneva to continue work on the plan, the WHO announced. Officials said the meeting would focus on 3 areas: operations (logistics), surveillance and epidemiology, and public health measures, such as quarantines, antiviral treatment, and social distancing, the agency said. WHO spokeswoman Fadela Chaib said the purpose of the meeting is "to decide who—the WHO, its members nations and its partners—would do what in the event of a pandemic," according to an Agence France-Presse report. Many experts are skeptical that stopping an emerging pandemic is possible, and the WHO has acknowledged that it will be very difficult at best. "Even if the pandemic cannot be stopped, public health interventions might buy time to allow countries to further strengthen their response systems, as well as accelerating the production of pandemic vaccine," the agency said. The WHO draft plan released in Jan called for completion of the strategy in time to allow training of rapid-response teams to begin in May. (CIDRAP 3/3/06 http://www.cidrap.umn.edu/ )

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Ethiopia: Reports avian influenza H5N1 infection in poultry
Ethiopia confirmed 28 Feb 2006 that bird flu caused the deaths of thousands of chickens. Since 16 Feb 2006, more than 6000 chickens have died at a government-owned farm in the Endibir area of the Southern Nation and Nationality People's (SNNP) state. "According to our laboratory, it is avian flu, but there are many sorts of avian flu. To determine the specific type of avian flu, we have to send the samples to another laboratory in Italy," agriculture and rural development ministry spokesman Mulugeta Debalkew said. Samples from the dead birds will be tested for the H5N1 strain. Earlier, officials said local tests had confirmed the presence of a "bird flu-like" disease in 49 chickens in the farm, 175 km south west of the capital. Debalkew said measures were being taken to prevent the disease from spreading, including a ban on the sale of the poultry and poultry products within a 60 km radius of Gubere. Some 9000 chickens in the affected Gubere Poultry Center would be killed starting 28 Feb 2006. Ethiopia, along with other east African Rift Valley nations, are considered at high risk for the virus, as millions of migratory birds flock there during the European winter. (Promed 3/1/06)

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Niger: Confirmation of avian influenza H5N1 infection in domestic poultry
During Feb 2006, significant mortality of chickens and ducks was observed in 5 outbreaks in 2 administrative districts near the border with Nigeria. Tests on domestic ducks from Magaria, a town in southern Niger, showed positive results for H5N1, the World Animal Health Organization (OIE) said. No human cases are presently under investigation for possible H5N1 infection. Niger has appealed for international help to cull poultry, saying it lacked the necessary means to carry out the cull. Niger is the second sub-Saharan African nation after neighboring Nigeria to confirm the presence of H5N1. The government in Niger, one of the poorest nations on earth, has ordered the systematic culling of poultry in affected zones but said it needed equipment such as protective suits and chemicals before it could begin. Drought and a locust plague left an estimated 3.6 million people short of food in 2005 with malnutrition rates among children particularly high in the border region with Nigeria where bird flu has hit. The head of the environmental protection brigade in the zone around Magaria said measures had been tightened. "There is no movement of poultry in the region. The sole avian farm in the town remains isolated and under permanent surveillance," Commander Adamou Djibrila said. The government said poultry would be killed in a 3 km radius around infected sites, while all transport would be checked within a 10 km security perimeter. The 20 avian farms around the country would be placed under surveillance. Niger had already banned poultry imports and the transport of poultry between regions. It proposes to compensate farmers and householders 1000 CFA francs (USD 1.81) per domestic bird destroyed in culls.

Experts fear weak detection systems in Africa--which has an estimated 1.1 billion chickens, many in backyard farms--combined with the easy movement of birds across borders and limited awareness about the disease, could help its spread. Throughout most of Africa, rapid detection and investigation are hampered by the absence of an early warning system for avian influenza in animals or humans, inadequate diagnostic capacity, and difficulties in shipping specimens, both internally and abroad, for diagnostic confirmation. (Promed 2/28/06, 3/2/06)

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Nigeria: Avian influenza H5N1 spreads to more states
Nigeria said that bird flu had been detected in 2 more of its states, confirming fears the outbreak was widening in Africa's most populous country. Several of the affected areas lie on or near the border with Niger. Experience in all affected countries has shown how easily and rapidly the virus can become established in birds when detection is late and the introduction of control measures is delayed. The Government initially imposed restrictions on the movement of live poultry from a disease-suspected state to other states and also within the suspected state. This movement ban has now been extended to all 36 states. Under the emergency preparedness plan, the Government has organised 70 investigative and diagnostic teams. An awareness campaign to sensitize villagers on biosecurity has been implemented, including information dissemination by polio vaccination teams of the health sector and animal health personnel of the Veterinary Services Department. In the northern province of Kano, some 51 farms are now known to have been affected. 4 persons have been investigated to date for possible H5N1 infection. Local tests have ruled out infection in 3 of these cases, including 1 which was fatal. The outbreak has prompted an import ban on Nigerian poultry and poultry products by neighbouring countries: Cameroon, Central African Republic, Ghana, Niger, Angola, Cote d'Ivoire, Mali, Equatorial Giunea, Guinea-Bissau, Gabon and Sao Tome.

Excerpts from the official OIE report:
Information received on (and up to) 15 Feb 2006 from Dr Junaidu A Maina, acting director, Department of Livestock and Pest Control Services, Federal Ministry of Agriculture and Rural Development: Precise identification of agent: highly pathogenic avian influenza virus type A. Date of first confirmation of event: 7 Feb 2006. Date of start of event: 10 Jan 2006. Description of affected populations: All the affected farms are commercial poultry production units, mostly layers of over 40 weeks of age. Source of outbreaks or origin of infection: unknown or inconclusive. Control measures: undertaken: stamping out; quarantine; disinfection of infected premises/establishment. To be undertaken: control of wildlife reservoirs; movement control inside the country. Vaccination prohibited. The presence of the disease is now confirmed, and an emergency plan has been activated. Further investigations are being carried out all over the country to determine the source of the infection and prevent its spread. (Promed 2/24/06, 2/27/06, 2/28/06, 3/2/06)

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Azerbaijan: Avian influenza situation update; economic losses
Samples taken from a wild swan from Absheron Peninsula, Caspian Sea coast tested positive for H5N1 10 Feb 2006. Authorities urged the population to keep their domestic birds indoors, not allow them to be in contact with wild birds, and to immediately contact the local veterinary services in case of any suspicion. A few days later, 15 more wild birds were found dead in the Ceyranbatan reservoir. Further reports of dead birds started coming in from the Khachmaz, Samukh, and Fizuli districts. Also, Kilyazin farm outside capital Baku has been reportedly put under quarantine after avian flu virus was found in samples taken 22 Feb 2006. However, the government did not specify whether it was the H5N1 strain of virus. To curb the spread of bird flu, President Ilham Aliev set up a state commission headed by Deputy Prime Minister Abbas Abbasov. So far, the state commission's activities have been limited to collecting samples from dead birds and sending them off to laboratories. Health Minister Oktay Siraliev has denied that anyone is infected with the bird flu virus, although he did say that 3 hospitals in the capital have made provision for a possible epidemic. As demand has fallen away, the poultry trade has been hard hit, and the price of beef and lamb have almost doubled. Government run poultry farms and private farmers have incurred colossal losses. In the southern Massali district, farmers who slaughtered their chickens after H5N1 was found in the region say the government is now ignoring them. Deputy Prime Minister Abbasov admitted that the Azerbaijani government had not yet considered the issue of compensation. On 14 Feb 2006, Russia imposed restrictions on imports of live birds, incubatory eggs, poultry flesh and other products from Azerbaijan. (Promed 2/28/06, 3/1/06)

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Bosnia and Herzegovina: Avian influenza H5N1 infection confirmed in swans
Samples from 2 dead swans found on Plivsko lake near Jajce tested positive for avian influenza H5. The UK reference laboratory confirmed 25 Feb 2006 the highly pathogenic avian influenza H5N1 subtype in the swan samples. The swans were reported to have shown strange behaviour. A total of 4420 poultry within 3 km of the lake have been culled. Another suspected swan case has been discovered in Tuzla. (Promed 2/24/06, 2/26/06)

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Bulgaria: 4 swans so far test positive for avian influenza H5N1
1 of 3 dead mute swans (Cygnus olor) found in the Danube River near the town of Vidin (near the border with Romania) 30 Jan 2006 and 3 samples from wild swans found in Lake Shabla in the wetlands near Varna Town and Kraymorie near Bourgas 5 Feb 2006 tested positive for H5N1. A 3-km radius protective zone and surveillance zone of 10-km radius has been established around the dam. Police have been requested to assist with control measures. Access to and hunting in the area has been prohibited. (Promed 2/24/06)

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Croatia: Avian influenza H5N1 infection in swans
Croatia said 25 Feb 2006 that it had found its second case this week of avian flu in swans. The H5 virus was isolated from a swan found dead near the coastal town of Trogir in the southern Adriatic near the sparsely populated island of Ciovo, where the H5N1 strain of the virus was reported in a dead swan earlier the same week. Final typing is anticipated. Croatia reported its first bird flu case Oct 2005, when H5N1 was found in 6 wild swans on a fish pond in eastern Croatia. Since 8 Feb 2006, some 35 swans were found dead in the capital, near Karlovac, at Lake Jarun, and near Sisak. (Promed 2/24/06, 2/26/06)

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France: Avian influenza H5N1 confirmed in domestic turkeys
France on 25 Feb 2006 confirmed the presence of the H5N1 strain of bird flu at a farm in the east of the country. The outbreak was discovered at the farm with 11 000 turkeys in the Ain department, not far from the Swiss border, where H5N1 had already been confirmed in wild ducks. Laboratory tests by Afssa, France's national agency for nutritional safety, showed that the virus found at the turkey farm was 99 per cent homologous with that found in one of the ducks, the Agriculture Ministry said. An investigation was under way to establish how the farm became contaminated with the virus. "What worries us, and this is why we have reacted immediately, is that the farm is within the protection zone that we set up for the first duck," farm minister Dominique Bussereau said. French Prime Minister Dominique de Villepin said, “Depending on what we find, we may have to strengthen our security recommendations.” Local sources said about 80 per cent of the turkeys at the French farm, in a region famous for the quality of its chickens, had died. The remaining birds were culled. A security zone of 3 km and a surveillance zone of 7 km had been set up around the farm as is usual under EU emergency measures. The owners of the turkey farm and their children and workers, have been placed under quarantine at home and a surveillance zone has been set up covering 1/3 of the departement of Ain. This is the first outbreak in a poultry farm in Europe. Officials explained that poultry was safe to eat and there was no immediate reason to fear an outbreak of the disease among humans.

France is the largest producer and exporter of poultry in Europe. It is worth 6 billion euros (USD 7 billion) a year. Poultry sales in France are already down by about 30 per cent. Tokyo imposed a temporary ban on imports of French poultry products after bird flu was found at the farm. An embassy spokesman said the ban was temporary and would take effect immediately. Villepin announced an aid package for the sector worth 52 million euros. In Lyon, authorities held a simulation exercise focused on the potential arrival of infected people on a plane from a bird flu-hit region. France has permission from the EU for a limited vaccination programme in geese and ducks in 3 departments in the west of the country. Bussereau said 2 of the departments had decided to opt for the confinement of fowl rather than vaccination. Bernard Vallat, France's former chief vet--now director general of the World Organisation for Animal Health (OIE)--criticised the European Union for accepting French and Dutch demands that poultry farmers should be allowed to vaccinate their birds, which might mask the presence of the disease and make it harder to control. Vallat warned that the H5N1 virus was now so endemic in migratory wildfowl that is was certain to spread to almost every country in the world. The only possible exceptions, he said, were Australia and New Zealand.

Excerpts from the official OIE report:
Translation of information received on (and dated) 25 Feb 2006 from Dr Monique Eloit, deputy director general, General Directorate for Food (DGAL), Ministry of Agriculture, Food, Fisheries and Rural Affairs: An outbreak of avian influenza due to highly pathogenic avian influenza virus subtype H5N1 was reported in a commercial turkey farm in Versailleux district, Ain department. Date of first confirmation of event: 25 Feb 2006. Date of start of event: 23 Feb 2006. Number of susceptible animals in outbreak: 11 700 (56-day old turkeys). Number of cases: 10 500. Number of deaths: 400. Number of animals destroyed: 11 300. Source of outbreak or origin of infection: unknown or inconclusive. Control measures undertaken: control of wildlife reservoirs; stamping out (total culling of farm poultry was applied 23 Feb 2006); quarantine; movement control inside the country; screening; zoning (protection and surveillance zones were delineated around the farm beginning from the suspicion period, that is on 23 Feb 2006); disinfection of infected premises (in progress); dipping/spraying. Vaccination prohibited. (Promed 2/24/06, 2/25/06, 2/27/06)

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Georgia: Dead swans suspected of avian influenza H5N1 infection
The first case of H5N1 bird flu virus has reportedly been detected in the southern Caucasus republic of Georgia, Prime Minister Zurab Nogaideli said 24 Feb 2006. Dead swans were tested in the capital Tbilisi, and "the presence of the H5N1 virus was confirmed by a laboratory", Nogaideli said. Samples had reportedly been sent to the UK laboratory for further testing. The dead swans were found in the village of Adliya, in the Black Sea coastal region of Adjara. Operations have been ongoing in the Adjara region to prevent the bird flu from spreading. Preventive measures have also been taken along the border area with Azerbaijan and Turkey, Nogaideli said. The discovery of the virus in Georgia follows discoveries in neighboring Russia, Azerbaijan, Iran and Turkey. Experts from the WHO have gone to Georgia, Armenia and Azerbaijan to advise local organizations and people on how to fight and control the disease. (Promed 2/24/06)

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Germany (Reugen): Avian influenza H5N1 infection in dead cat
The World Organisation for Animal Health (OIE) has been informed that a cat infected with the H5N1 virus has been found in the island of Ruegen. According to the Friedrich-Loeffler Institut (FLI), an OIE reference laboratory for avian influenza, a dead cat tested positive for the H5N1 virus. Further investigations are underway in order to assess if the isolated strain is similar to the one isolated from the wild swans on the island. This is not the first time that felines have been naturally infected with the H5N1 virus. An episode occurred in 2004 in a zoo in Thailand where more than 40 tigers died and many others were culled due to the infection. Investigations showed that the tigers were fed entire carcasses of chickens most likely infected with H5N1. The tigers may have been infected by either inhalation of large amounts of virus that could have been present on the surface/feathers of the poultry carcasses (faecal contamination) or via ingestion of the entire carcasses, including intestines and faeces. Also other "natural" fatal cases of H5N1 have been reported in domestic cats in Asia. Cats are known to be susceptible to the H5N1 virus. Under experimental conditions cat-to-cat transmission of H5N1 virus has also been demonstrated. FLI president Thomas Mettenleiter recommended that cat owners in areas with bird flu not let their cats run around freely outside.

The OIE stresses that all the natural cases in feline have not led to any change in the epidemiology of the disease, which has fundamentally remained a bird disease nor have they led to any recognized virus change in epidemiology or mutation leading to an increased virulence of the virus for felines or other mammals. There is no present evidence that domestic cats play a role in the transmission cycle of H5N1 viruses. To date, no human case has been linked to exposure to a diseased cat. The detection of the H5N1 virus in cat in Germany shows the high degree of alertness and the very effective surveillance system in place in Europe. This report comes one day after the conclusion of the two days OIE meeting of chief veterinary officers of the European region, where the importance of the early detection of the H5N1 virus in the control of the disease has once again been underlined. (Promed 3/1/06)

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Germany: Fifth German state detects avian influenza H5N1 infection in birds
2 samples from dead wild birds have tested positive for H5N1 virus in Bavaria. As reported 28 Feb 2006 in Munich by the minister for consumer protection, Werner Schnappauf, the avian flu virus was detected in a mute swan (Cygnus olor) from the town of Schwabstadl in the district Landsberg am Lech, and in a wild mallard duck (Anas platyrhynchos) from the town of Sachsenkam in the district Bad Tolz Wolfratshausen. "Countermeasures as required by the regulations for wild bird-avian influenza have been completely implemented by those responsible for epidemic control in those districts," stated Mr Schnappauf. "Bavaria has been ready for this event, ever since the movement of the avian flu infection made it clear that it was only a matter of time before Bavaria itself would have its first case." Even if avian flu does not present an immediate danger to humans, it presents one for poultry farmers through severe economic damage. The EU reference laboratory has yet to confirm whether this represents the highly pathogenic type of Asian virus. Bavaria is the fifth of Germany's 16 states in which bird flu has been detected, after the northern regions of Mecklenburg-Western Pomerania, Schleswig-Holstein, and Brandenburg and the southern state of Baden-Wurttemberg. Avian influenza was first detected on Ruegen 14 Feb 2006, leading to the immediate imposition of preventive measures. Since mid-Feb 2006, more than 100 wild birds have died in Ruegen, and tests have confirmed H5N1 infection in several. Most of the affected wild birds so far have been swans and ducks. It hasn't spread to poultry in Germany yet.

The districts have erected around the points of discovery a restricted area within a 3-km radius and an observation area within a 10-km radius. Fresh poultry meat, ground poultry meat, meat parts or products, as well as prepared poultry meat or bird meat, cannot be brought in or out of a poultry farm. By-products cannot be brought into or out of the poultry farms as well. All the poultry farmers in the affected 3 districts have been identified and are being informed. The discovery points have been sealed off. The 2 animals were isolated finds; larger numbers of dead birds have not been discovered. During 16-25 Feb 2006, there have been 733 samples from wild birds sent to Office for Health and Food Safety. 595 samples have been tested. (Promed 3/1/06)

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Greece: Reports nineteenth avian case of avian influenza H5N1 infection
Greece confirmed 3 more cases of the H5N1 strain of bird flu in migratory birds, bringing the number to 19 since the disease was first reported in the country Feb 2006. The 3 swans were found in the north, the same area where all other cases of bird flu have been reported. Greece is awaiting the results of tests on 7 other wild birds suspected of infection, but has had no suspect domestic poultry cases. Since the first case of bird flu was discovered Feb 2006, Greece has implemented a series of precautionary measures to stop the spread of the disease. These include a 10 km quarantine around the areas where the infected fowl were found. The Agriculture Ministry said no further precautionary measures were needed. According to wildlife experts, an unusually large number of migratory birds have arrived in Greece this winter, forced south from their usual wintering grounds by severe weather conditions in northern Europe. (Promed 3/2/06)

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Hungary: Confirmation of additional bird cases of avian influenza H5N1 infection
Hungary has confirmed new cases of bird flu in a dead mallard and a gull found in 2 different places near Budapest, and in 2 dead swans in southern Hungary. The announcement comes after the government had just confirmed Hungary's eighth case of the H5N1 virus, detected in a swan just outside Budapest. 1 of the dead swans reported was found 100 km south of Budapest in Dunaszentbenedek, while the other was found in Nagybaracska, where last week other dead swans had already tested positive for the H5N1 strain of avian influenza. Final confirmation from the UK laboratory is expected soon. The H5N1 virus has not been detected in domestic poultry in Hungary. (Promed 3/2/06)

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Italy: 18 of 40 dead wild birds so far test positive for avian influenza H5N1
Authorities carried out investigations on wetlands, from Sicily in the south to near Venice in the north. Of the 40 wild birds found dead, 18 tested positive for H5N1 in Calabria, Puglia, Sicilia, and Umbria Regions. Most of them are mute swans (Cygnus olor). (Promed 2/24/06)

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Romania: Confirmation of new case of avian influenza H5N1 in poultry
Romania confirmed the H5N1 bird flu virus in domestic birds in the village of Topalu, in the south east, and detected new suspected cases, authorities said 28 Feb 2006. Avian flu has been detected in 35 villages and a small Black Sea resort across the country since the virus was first found in the Danube Delta Oct 2005. Birds have been culled swiftly, and Romania has not reported any cases in humans. "The national laboratory isolated the H5N1 virus in the village of Topalu, where all the birds will be culled today [28 Feb 2006]," the agriculture ministry said. It said all the 15 000 domestic birds in Topalu will be culled. Gabriel Predoi, an official from the animal health agency ANSV said that new suspected cases of bird flu were found in poultry in 4 villages in the southeast of the country. Domestic birds in another village where bird flu was first discovered Dec 2005 tested positive again, but the virus has not been isolated yet, he added. WHO and local experts warned earlier Feb 2006 that Romania could see human cases of bird flu, because its rural areas, where around 45 per cent of the 22 million population live, lack proper water and sewerage systems.

Excerpts from the official OIE report:
Information received 16 and 22 Feb 2006 (up to 22 Feb 2006) from Dr Gabriel Predoi, director general, National Sanitary Veterinary and Food Safety Authority: Precise identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 7 Oct 2005. Date of start of event: October 2005. Description of affected populations: Outbreak in Vlahii: backyard premises with 69 hens and 7 geese; samples have been collected from 5 hens. Outbreak in Ostrov: backyard premises with 27 hens; samples have been collected from 10 hens. Outbreak in Mereni: a wild pigeon found dead near an irrigation canal at a distance of 2 km from Mereni village. Diagnosis: RT-PCR test for the detection of HPAI specific viral genome / 15-21 Feb 2006 / positive virus isolation on embryonated SPF eggs / 15-21 Feb 2006 / positive for subtype H5N1. Source of outbreaks: contact with infected animal(s) at grazing / watering; contact with wild animals. Control measures undertaken: stamping out; quarantine; movement control inside the country; screening; zoning; disinfection of infected premises/establishments. Control measures to be undertaken: control of wildlife reservoirs. Treatment of affected animals: no. Vaccination prohibited. (Promed 2/26/06, 2/27/06, 3/1/06)

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Slovakia: Avian infection H5N1 infection confirmed in wild birds
H5N1 virus was detected from 2 wild birds found dead 20 Feb 2006 in Bratislava and in Gabcikovo Town. The UK avian influenza reference laboratory confirmed 25 Feb 2006 the highly pathogenic avian influenza H5N1 subtype (reportedly from a dead wild falcon and grebe). (Promed 2/24/06, 2/26/06)

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Sweden: Highly pathogenic avian influenza H5N1 found in tufted ducks
Diagnostic investigations of carcasses of tufted ducks (Aythya fuligula) found in close proximity to the south eastern port of Oskarshamn revealed positive results in 2 of 4 samples at the National Veterinary Institute, Uppsala 27 Feb 2006 by avian influenza virus specific real time RT PCR. Subsequent positive results obtained with RT PCR and sequencing showed a pattern indicative of highly pathogenic properties. Comparison of the amplified fragment with published sequences revealed 100 per cent identity (on nucleotide level) with isolates from Russia (Novosibirsk H5N1) and China (Jiangxi H5N1), and only 1 nt difference from an H5N1 isolate from Nigeria. Samples from the infected birds were sent to the UK Reference Laboratory for further analysis 28 Feb 2006. Protection and surveillance zones have been implemented according to EU legislation. (Promed 3/1/06)

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Switzerland: Second H5 avian influenza case in dead swan
Switzerland has found its second case of H5 bird flu in a dead swan close to the German border, but said 1 Mar 2006 it would be another week before it is known whether it is the H5N1 strain. The swan was found close to the town of Kreuzlingen at the northwestern corner of Lake Constance--also known as Bodensee--where 2 wild ducks have tested positive on the German side. The Swiss cantons Schaffhausen and Thurgau, located near the affected German sites, have enacted controls to restrict the movement of poultry and other birds and boost testing. On 26 Feb 2006, Switzerland confirmed its first case of H5 bird flu in a duck found in the heart of Geneva. Reportedly, the duck was a "gansesager", namely the common merganser (goosander in Europe), Mergus merganser, a large sea duck. Final test results from the UK laboratory are still awaited. Officials have enacted a surveillance zone around the site of its bird flu finding, although there are few poultry farms in the immediate area, which is principally urban. The country has been on high alert for bird flu since the virus emerged in neighbors France, Germany, Austria and Italy. Switzerland has ordered all poultry be kept indoors for an indefinite period to lessen the risk from the fast-spreading H5N1 virus. (Promed 2/26/06, 3/1/06)

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Ukraine: Avian influenza H5 infection in dead zoo birds
Parrots and pheasants have died of bird flu at a zoo in southern Ukraine, prompting officials to quarantine the facility's bird enclosures. Veterinary officials reportedly said the strain of flu detected was the H5 type. The H5N1 virus has been detected in about 24 villages in Crimea since the outbreak was discovered late 2005. Around 140 wild birds were found dead due to avian influenza in town of Aloushta, and the presence of the virus was also confirmed in flocks in the village of Tsvetochnoe. "We have recorded deaths of birds--3 or 4 pheasants and several parrots in 2 of the enclosures at Odessa zoo," a spokesman for the zoo in the Black Sea port said. "A quarantine has been set up in all enclosures. The zoo has been declared a zone of heightened risk." The official said there had been no contact with humans, as the zoo had been closed for the past week due to cold weather. He said a plastic screen had been drawn around the aviaries to guard against any spread of the virus. The country's top veterinarian has said Ukraine had begun testing several types of vaccine for H5N1, but would take no decision on mass vaccination of poultry pending the results. Officials predict more outbreaks once migratory birds return to Ukraine in spring on their northward flight paths.

Excerpts from the official OIE report:
Information received 16 and 22 Feb 2006 (up to 22 Feb 2006) from Dr Ivan Yuriyovych Bisyuk, head, State Department for Veterinary Medicine, Ministry of Agricultural Policy: Identification of agent: highly pathogenic avian influenza (HPAI) virus subtype H5N1. Date of first confirmation of event: 2 Dec 2005. Date of start of event: 25 Nov 2005. The State Veterinary Services of the Autonomous Republic of Crimea, in collaboration with local authorities, have formed 179 groups to perform clinical examination of backyard poultry throughout the territory of the Autonomous Republic of Crimea. (Promed 2/24/06, 2/27/06, 2/28/06)

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Iraq: Additional suspected human cases of avian influenza H5N1 infection
A woman has died of suspected H5N1 avian influenza virus infection in the province around the town of Nassiriya in southern Iraq, the Iraqi government said 2 Mar 2006. Further tests were being carried out in Baghdad and Cairo. Dr Ibtisam Aziz, a spokeswoman for the Higher Committee on Bird Flu in Iraq, said that suspected cases in the Shula area of Baghdad are still under medical care, with laboratory results yet to be received. Other cases of infection from samples taken from 2 villages in Kefry, in Dayala province, north east of Baghdad, have prompted the killing of infected poultry and the sterilization of villages, Aziz said. One other suspected patient in Dayala province was sent to the health centre in Said Jabir village. WHO has said it is concerned about the suspected human case of H5N1 virus in Diyala. "This case is [has symptoms very similar to those] of the 2 people killed by bird flu in northern Iraq last month, and we need to urgently check this sample also because it's in an area far from the others reported so far," said Naeema al-Gasser, WHO representative for Iraq. Meanwhile, samples tested from 50 suspected patients in the northern city of Sulaimaniyah and Missan governorate in the south were confirmed negative, according to al-Gasser. 2 fatal cases of human bird flu were previously confirmed in the province of Sulaimaniya, close to the border with Turkey. Those 2 deaths were both due to contact with sick animals carrying the H5N1 virus.

The WHO official urged the government to compensate farmers for losses incurred due to culling of poultry. Since 15 Jan 2006, nearly 1.6 million birds have been killed by officials in Sulaimaniyah and Missan, with farmers expressing increasing discontent. The northern Kurdish authorities quickly responded to the call for compensation, recently adding another USD 3 million to the USD 5 million initially allocated last week to reparations and preventive measures in northern areas. Each farmer will receive a financial package based on the value of birds lost. "We have to spend from our local public funds because we haven't yet received a response from the central government about the budget, and we can't stop our programmes in Kurdistan," said Tahseen Nameek, deputy minister of agriculture in the regional government. However, no such initiative has been announced for farmers in the south. The government in Baghdad responded by saying that the allocation of funds was still under discussion. (Promed 3/1/06, 3/2/06)

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Asia
Cambodia: Reports avian influenza H5N1 infection in birds
Since Jan 2006, National Animal Health and Production Investigation Center (NAHPIC) introduced 30 sentinel ducks in 3 flocks in Kampong Cham Province around Boeung Thom Lake to detect H5N1 virus circulation in the zone, by collecting blood and swab samples every 2 weeks. On 6 Feb 2006, 5 sera in 1 flock were tested positive, and H5N1 was confirmed in 1 swab sample by PCR. The Ministry of Agriculture, Forestry and Fisheries decided to implement culling of the infected flock, disinfection of all duck flocks' premises and surroundings in the Lake zone. The flock of more than 200 ducks were culled and the government banned the movement of 10 000 ducks being raised near the 12 square km lake. Samples were collected before culling. In addition, investigation and sampling has been conducted to assess virus circulation in 3 villages in the Lake zone to clarify H5N1 epidemiology in free-ranging duck flocks.

The H5N1 virus has killed 4 people in Cambodia since it first arrived late 2003 and its reappearance was the first in months in the region. There had been no reports of new human infections since 3 ducks were found dead 2 weeks ago in the Kampong Seim district of Kampong Cham. The government was trying to persuade other duck raisers in the area to kill their birds but could not afford to pay them to do it. Experts worry about Cambodia as its veterinary service is rudimentary and its people poor, many of them dependent on poultry. Cambodia's last reported outbreak dates back to 24 Mar 2005. (Promed 2/24/06, 2/25/06)

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China: 2 additional confirmed cases of human infection with H5N1 avian influenza
The Ministry of Health has reported 2 additional laboratory confirmed cases of human infection with the H5N1 avian influenza virus. Both patients are in critical condition. The first patient is a 9 year old girl from the Zhejiang province. She developed symptoms 10 Feb 2006. Symptom onset followed visits to relatives in the adjacent province of Anhui. Reportedly, during her visits, chickens raised at her relatives' homes got sick and some died. The exact source of her infection is under further investigation, said the ministry. No animal outbreaks have been reported in Zhejiang Province since 2004. She is the first human case to be reported from Zhejiang. The second patient is a 26 year old female farmer from Yingshang County, Anhui Province. She developed symptoms 11 Feb 2006, following contact with diseased poultry. The local agricultural department has isolated H5N1 virus strain from samples of dead chickens in Yingshang County, said the ministry. The local government has culled more than 200 fowls in the area and intensified prevention measures, according to the Ministry of Agriculture, which noted that the epidemic is now under control. To date, China has reported 14 laboratory confirmed cases. Of these, 8 have been fatal. The H5N1 virus is now considered to be endemic in birds in large parts of China. WHO is working with national authorities to increase public awareness of the disease, encourage populations to report outbreaks, and warn people to avoid contact with dead or ill birds.

China has reported more than 30 outbreaks of the H5N1 strain of bird flu in both poultry and wild birds in a dozen provinces in the past year. Agriculture minister Du Qinglin said China culled 23 million fowl in 2005 as it sought to halt the spread of the disease. Du said his ministry would stick to consistent epidemic monitoring, diagnosing and reporting, and strengthen poultry vaccination and virus testing. China will expand a training program aimed at helping health officials detect highly pathogenic avian influenza rapidly. Chinese farmers raised about 15 billion poultry in 2005, or 21 per cent of the world's total, Du said. (Promed 2/24/06, 2/26/06, 2/27/06)

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Hong Kong: Thirteenth bird confirmed with avian influenza H5N1 infection
Health authorities in Hong Kong confirmed that 3 more birds had died from the H5N1 strain of bird flu and said tests were under way on another suspected case. The latest birds confirmed with H5N1 were a dead large-billed crow [Corvus macrorhynchos] found in Kowloon, a munia and a white-backed munia [Lonchura striata], discovered separately on Hong Kong. This brings to 13 the number of birds in the southern Chinese territory known to have caught the bird flu strain since late 2003. Preliminary tests on a 14th bird, a house crow found 23 Feb 2006 in Shek Kip Mei in the Kowloon area, indicated a suspected case of H5 avian influenza, a spokesman from the Agriculture, Fisheries and Conservation Department said. A law banning chickens and ducks as pets came into force in Hong Kong 13 Feb 2006. Agriculture department staff have been searching homes in villages throughout the territory's rural areas in what was expected to be a 6-week programme to clear Hong Kong of an estimated 9000 chickens and 3500 ducks kept in homes. Authorities also ordered the closure of all bird parks in Hong Kong and the Mi Pu Park of Natural Reserve 1 Feb 2006. (Promed 2/24/06, 2/25/06)

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Japan (Ibaraki): Veterinarians held over avian influenza H5N2 cover up
Police arrested 4 people 27 Feb 2006 related to a poultry farm operator in Ibaraki Prefecture in connection with a suspected cover up of an avian flu [H5N2] outbreak 2005. Police suspect that 3 veterinarians at IKN Egg Farms Co, and an IKN employee violated the Domestic Animal Infectious Diseases Control Law, which requires reporting any suspected contagious diseases in poultry. They also suspect an antibody test conducted at the National Institute of Animal Health in Tsukuba, Ibaraki Prefecture by a veterinarian at the request of the IKN vets was positive, the sources said. The Tsukuba veterinarian is an acquaintance of the IKN vets. The 4 IKN employees allegedly failed to report a case of suspected avian flu infection to the Ibaraki government Aug 2005. Polices searched IKN Egg Farms and the Tsukuba research institute Dec 2005 and questioned the vets. The vets at IKN Egg Farm are also suspected of obstructing an avian flu test at 3 farms conducted by Ibaraki Prefecture Aug 2005 by submitting samples taken from other poultry farms, the sources said. The prefecture has alleged that IKN Egg Farms committed similar misdeeds at 2 other poultry farms it operates in Ibaraki, officials said. Avian flu infections have been found at 40 farms in Ibaraki Prefecture since Jun 2005, and about 5.8 million chickens have had to be killed. (Promed 3/1/06)

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India (Gujarat): H5N1 strain confirmed at poultry farm; no confirmed human cases
At least 2 chickens found dead at a poultry farm in Gujarat state were infected with the H5N1 strain of bird flu, officials said 25 Feb 2006. The birds were discovered at the National Poultry Farm in the Utchal area, the region's administrator, Vatsala Vasudev, said. She said officials were meeting to discuss the next steps, including the possibility of culling and sealing off the area. The head of Gujarat's Department of Animal Husbandry, DK Rao, said the bird flu infections had been confirmed by tests in a federal laboratory. Rao is on the state government's 4-member panel formed to prevent bird flu cases in Gujarat. Gujarat is located next to north west of Maharashtra, where an outbreak of bird flu last week prompted the culling of over 200 000 chickens and domestic birds. Also, on 24 Feb 2006, the Health Ministry said tests on 9 people suspected of having bird flu in Maharashtra's Navapur region showed no signs of the disease. (Promed 2/24/06, 2/26/06)

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Indonesia: Confirmed and suspected human cases of avian influenza H5N1 infection
The Ministry of Health confirmed an additional case of human infection with the H5N1 avian influenza virus (tests were conducted by the US CDC). The case, which was fatal, occurred in a 27 year old woman from West Java Province. She developed symptoms 13 Feb 2006 and died 20 Feb 2006. Investigations carried out found reports of chicken deaths in the woman's neighborhood 4 days prior to her onset of symptoms. The newly confirmed case brings the total in Indonesia to 27. Of these, 20 were fatal.

2 more people have been admitted to hospital on suspicion of having contracted avian influenza virus. "A 20 year old and a 12 month old were admitted separately 1 Mar 2006, both after the hospitals where they were being treated suspected avian influenza," Sardikin Giriputro, the deputy chief of Sulianti Saroso hospital, said. This hospital is the country's main center for the treatment of avian influenza, which has killed 20 Indonesians. Sardikin said 7 other patients were also being treated as suspected cases at the hospital, after local tests cleared 2 more patients who were to be discharged. Results of tests for the remainder were not yet in, he said. If local tests return positive results for the H5N1 virus, the samples will be sent to a WHO-affiliated laboratory for confirmation. 6 of Indonesia's 33 provinces where the virus has hit the most severely have begun door-to-door checks on birds. Indonesia is offering farmers up to 10 000 rupiah (1 USD) for each bird culled, but the sum has been criticized for being too low, as the cheapest fresh chicken sold on the market fetches around 15 000 rupiah. Although most of Indonesia's human bird flu victims have come from Jakarta and its surroundings, infected birds have been found in 26 provinces. (Promed 2/26/06, 2/27/06, 3/2/06)

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Malaysia: 5 suspected human cases of avian influenza infection quarantined
On 21 Feb 2006, Malaysia confirmed its first outbreak of avian influenza H5N1 in more than a year after 40 free range chickens died in 4 villages near Kuala Lumpur. An initial group of 10 people from the affected villages who were hospitalised complaining of flu symptoms and respiratory problems have all tested negative for the virus. However, 5 people were quarantined with suspected avian influenza, officials said 25 Feb 2006. Ramlee Rahmat, director of the health ministry's disease control division, said 5 people with high temperature and respiratory infection were admitted to hospital for observation 24 Feb 2006. Ramlee said the 5 -- 3 children and 2 adults -- were aged between 4 and 44 years. "They live some 300m from 1 of the outbreak areas," he said. Officials have combed through 505 houses, screening more than 2000 residents. Mustapa Abdul Jalil, acting chief of veterinary services, said surveillance tasks would be extended to a 10-km zone. 2451 chickens, ducks and other birds have been killed and 516 eggs destroyed. No new cases of H5N1 have emerged since 19 Feb 2006, with clinical tests on swab samples from 329 birds so far turning out to be negative, Mustapa added.

Lee Chong Meng, adviser to the Selangor and Federal Territory Poultry Traders Association, said that chicken dealers said sales had plunged 30 per cent in West Malaysia. Lee said commercial farms in West Malaysia produce some 35 million chickens a month for domestic demand and the usual daily consumption is 1.2 million chickens. Lee said the fall in demand was a concern to the country's poultry industry which employs thousands of workers. (Promed 2/24/06, 2/26/06)

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Pakistan: Suspected human case of avian influenza infection
The first suspected avian influenza death in Pakistan has occurred at the Doctor's Hospital, Johar Town, hospital sources said 28 Feb 2006. The victim, his mother, and younger brother also allegedly died in a span of 15 days, sources said, adding however that doctors at the hospital concerned had not confirmed the patient's cause of death. The victim (a 27 year old man) had been attending his younger brother, said the victim's family. He was brought from Gujranwala in serious condition 3 days ago and was admitted to the Doctor's Hospital. He was put in a private room, but transferred to the Medical Intensive Care Unit (MICU) by Dr Kamran Cheema and Dr Sobia Qazi. He was kept in a separate room in the MICU and all doctors and nurses concerned were handling the patient with gloves. Nobody was allowed to meet the patient. (Promed 3/2/06)

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Russia: Avian influenza H5N1 in poultry farms and wild birds
Outbreaks of bird flu have been registered in Russia's Stavropol territory, Dagestan, Krasnodar territory, and the republics of Kalmykia and Adygeya, the Federal Consumer Rights Oversight Service (Rospotrebnadzor) said. The disease has killed more than 2000 hens at a private farm in the village of Nadezhda in Stavropol territory. All infected birds were destroyed. 42 Nadezhda residents have been inoculated against bird flu and another 43 have undergone medical examinations. No bird flu cases among humans have been reported in the village. A total of 561 987 domestic birds have died of avian flu in Dagestan. Officials of the local Rospotrebnadzor branch and the Interior Ministry are inspecting shops and markets where poultry products are sold. In addition, bird flu has killed over 102 000 birds at the Tbilisskaya poultry farm in Krasnodar territory and 96 at private farms in Bolshoi Gok, Kalmykia. Quarantine has been imposed at the Komsomolets poultry farm in Kalmykia, which has 900 birds. Tests of blood samples taken from dead birds in Krasnodar confirmed the A/H5 bird flu strain (According to additional information 27 Feb 2006, a commercial poultry farm in the village Lavlinskaya, Krasnodar region, where 39 000 hens died, was found to be infected with Newcastle disease by the regional laboratory. Samples have been sent for confirmation to the Russian reference laboratory). In Adygeya, H5 was identified in an affected village. Samples were sent to the reference laboratory. All chickens at this village were destroyed.

Also, the Russian Agricultural Ministry said bird flu virus had been detected in wild birds, including migratory birds (reportedly storks, wild ducks, and others), in 6 Russian regions in southern Russia -- the Republics of Kabardino-Balkaria, Dagestan, Chechnya, and Kalmykia, and the Krasnodar and Stavropol Territories. The Russian president has ordered to establish special headquarters to prevent the spread of the bird flu, a news agency reported 27 Feb 2006. (Promed 2/24/06, 2/28/06)

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South Korea: Asymptomatic human infection of avian influenza H5N1
4 South Koreans were infected with the H5N1 strain of bird flu in late 2003 and early 2004, but none of them developed any serious illness, an official said 24 Feb 2006. These 4 are the first people in the country confirmed to have been infected with the H5N1 strain, Oh Dae-kyu, the head of the Korea CDC, said. South Korea now becomes the eighth country to report a human infection of the H5N1 strain since 2003. About 400 000 poultry at South Korean farms were infected by bird flu between Dec 2003 and Mar 2004, but no human cases were reported at that time. About 5 million poultry were slaughtered. Oh said the discovery did not pose a threat to people's health. He said blood tests showed the 4 poultry workers had developed antibodies for the H5N1 strain of the virus. The ministry had sent blood samples from 318 poultry industry workers to the US CDC for tests and received confirmation of the antibodies in the blood of the four 23 Feb 2006. The blood was drawn at the time of the outbreak and tests were first conducted in South Korea. Those blood samples were also sent to the US CDC Nov 2005 for more accurate testing, Oh said. South Korea plans to ask the CDC in the coming months to test samples drawn at the time of the outbreak of 1600 other people who were involved in culling of fowl in South Korea.

The 4 did not develop major illnesses when South Korea had its bird flu outbreak in poultry and are all healthy now. 3 have been contacted by the ministry, while the other person is in Japan and was reported to be healthy. There have been no cases of bird flu in South Korea since the 2003-2004 outbreak. North Korea had an outbreak of bird flu about a year ago at poultry farms in Pyongyang, and it reported there were no human infections. The virus responsible for the outbreaks in South Korea and Japan belongs to the V genotype of H5N1 avian influenza virus, whereas the predominant virus in East Asia belongs to the Z genotype. However, this is unlikely to be a relevant factor in human susceptibility to infection, since these genotypes are reassortants which differ only in the origin of their NA genome subunit. (Promed 2/24/06)

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Viet Nam: Firsts round of poultry vaccination completed
The first round of chicken and duck vaccination has been completed in all provinces and cities nationwide; 246 million doses of vaccines have been used. Post-vaccination surveillance has been implemented, and 10 102 serum samples have been tested so far with protection rate over 80 percent. For antigen detection, 1500 swab samples have been collected; the results were all negative. (Promed 2/24/06)

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Americas
USA: 2 new strains to be used in 2006-07 flu vaccine
Global and US health authorities have recommended 2 new influenza virus strains for use in the flu vaccine for the 2006-07 season. Last week the US Advisory Committee on Immunization Practices (ACIP) selected a "Wisconsin" strain of influenza A(H3N2) and a "Malaysia" strain of influenza B for next season. They will replace a "California" strain of H3N2 and a "Shanghai" strain of influenza B used in the current vaccine. The "New Caledonia" strain of influenza A(H1N1) virus used in this year's vaccine should be used again next season as the third component of the trivalent vaccine, the ACIP said. (The strain's full name is A/New Caledonia/20/99[H1N1].) The ACIP, which advises the CDC, followed recommendations from the WHO and the Food and Drug Administration (FDA) in picking the strains. The CDC routinely follows the ACIP recommendations on flu vaccines. Each February the WHO assesses the flu virus strains in circulation before picking the strains for the next Northern Hemisphere flu season. In a Feb 14 report on its recommendation concerning the H3N2 strain to be used, the WHO said, "Many recent isolates were antigenically similar to the current reference virus, A/California/7/2004, but an increasing proportion of recent viruses was more closely related to A/Wisconsin/67/2005." Likewise, the WHO said the majority of recent influenza B isolates were similar to the strain B/Malaysia/2506/2004, rather than to the B/Shanghai/361/2002 strain used in this year's vaccine. The Malaysia strain is antigenically equivalent to B/Ohio/1/2005, according to the CDC.

A year ago, health authorities picked only 1 new strain for the 2005-06 flu vaccine, keeping the other 2 the same. Reportedly, a spokesman for a leading vaccine manufacturer said changing 2 of the strains in next season's vaccine may make production less predictable. "It does put more uncertainty into the total number of doses you're producing at any one time," said Albert Thomas, director of vaccine manufacturing for Sanofi Pasteur. His company has been the biggest supplier for the US market in recent years. The strains to include in each season's vaccine must be chosen early in the year because it takes roughly 6 months to produce the vaccine. The viruses used in vaccines are grown in chicken eggs. WHO said global flu activity from Oct 2005 through Jan 2006 was low compared with recent years. Several countries had outbreaks of H3N2 influenza, but H1N1 and B viruses caused only scattered cases in most countries, the agency said. (CIDRAP 3/1/06 http://www.cidrap.umn.edu/ )

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USA: HHS orders drugs to treat 14 million in flu pandemic
US health officials announced they have ordered more than 14 million treatment courses of 2 antiviral drugs to add to the 5.5 million courses already bought in preparation for a possible influenza pandemic. The Department of Health and Human Services (HHS) has ordered 12.4 million courses of oseltamivir (Tamiflu) from Roche and 1.75 million courses of zanamivir (Relenza) from GlaxoSmithKline, according to HHS. The HHS pandemic plan calls for buying enough doses of antivirals to treat 25% of the US population. The department didn't say how soon it expects to receive the doses just ordered. (CIDRAP 3/1/06 http://www.cidrap.umn.edu/ )

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USA: Home Health Care Services Pandemic Influenza Planning Checklist
Planning for pandemic influenza is critical. The Department of Health and Human Services (HHS) and the CDC have developed the following checklist to help public and private organizations that provide home health care services assess and improve their preparedness for responding to pandemic influenza. Home health agencies will likely be called upon to provide care for patients who do not require hospitalization for pandemic influenza, or for whom hospitalization is not an option because hospitals have reached their capacity to admit patients. These agencies may become overburdened very quickly and shortages of personnel and supplies for providing home health care may occur. This checklist is modeled after the one included in the HHS Pandemic Influenza Plan (www.hhs.gov/pandemicflu/plan/sup3.html#app2). The list is comprehensive but not complete; each home care agency will have unique and unanticipated issues that will need to be addressed as part of a pandemic planning exercise. Also, some items on the checklist may not be applicable to a given agency. Collaboration with hospitals, local pandemic planning committees and public health agencies will be essential to ensure that the affected population receives needed health care services. Further information can be found at www.pandemicflu.gov. (Pandemicflu.gov 3/2//06 http://www.pandemicflu.gov/plan/healthcare.html )

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USA: FDA Initiative Helps Expedite Development of Seasonal and Pandemic Flu Vaccines
The Food and Drug Administration issued recommendations to aid manufacturers in developing influenza vaccines. FDA's goal is to expedite the development and availability of safe and effective vaccines needed to protect against influenza. In 2 guidance documents released today, one for seasonal, and the other for pandemic influenza vaccines, the FDA provides manufacturers with guidance on developing and submitting clinical data to show safety and effectiveness for new vaccines. Consistent with the aims of FDA's Critical Path Initiative to get products to market more quickly and to advance the development and use of new technologies, these documents outline specific approaches that vaccine developers may follow. For licensed vaccines, they describe the process for changing rapidly from the currently-licensed seasonal vaccine to a new pandemic vaccine by supplementing the existing license. For new vaccines, they describe defined pathways for both traditional and accelerated approval approaches. Accelerated approval allows for evaluation based on biological indicators likely to demonstrate effectiveness.

Because these guidances will assist manufacturers in the development and evaluation of seasonal and pandemic influenza, the direction that they provide to new manufacturers, in turn, helps address the increased demand for influenza vaccine. The guidance also helps support and defines steps needed for development and evaluation of vaccines using new technologies (such as cell culture and recombinant manufacturing) and potential approaches to stretching limited pandemic vaccine supplies (such as with the use of ingredients added to a vaccine to improve the immune response it produces, known as adjuvants and different vaccine delivery methods). The accelerated approval pathway was critical in allowing last year's rapid approval of a new influenza vaccine, Fluarix, and broke new ground in that it was the first vaccine approved using that approval process. In issuing this advice, FDA aims to facilitate manufacturers in increasing the number of doses. Having additional diversity in our vaccine supply helps enhance the capacity to produce more doses of influenza vaccine and contributes to the nation's pandemic preparedness. The release of these guidances is part of the effort that FDA is undertaking to work with manufacturers to facilitate the development of vaccines. (Pandemicflu.gov 3/2//06 http://www.pandemicflu.gov/plan/healthcare.html )

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies
WHO’s surveillance information has not been updated since the 13 Feb 2006 report. Please see EINet’s 17 Feb 2006 Alert for further details.

USA. During week 8 (Feb 19 – Feb 25, 2006), influenza activity increased in the US. 439 specimens (21.2%) tested by US 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. 21 states and New York City reported widespread influenza activity; 14 states reported regional influenza activity; 10 states and the District of Columbia reported local influenza activity; and 5 states and Puerto Rico reported sporadic influenza activity.

For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity--United States, February 12--18, 2006”): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5508a6.htm (CDC 3/3/06 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates
- WHO’s comprehensive information on avian influenza: http://www.who.int/csr/disease/avian_influenza/en/index.html. WPRO website on avian influenza: http://www.wpro.who.int/health_topics/avian_influenza/overview.htm
- FAO updates on avian influenza: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes the article: “Escalating bird flu crisis jeopardizes global poultry trade prospects”
- OIE updates and documents on avian influenza: http://www.oie.int/eng/en_index.htm. Includes information on the meeting on highly pathogenic influenza in Europe, 27-28 February 2006
- CDC website on pandemic influenza: http://www.cdc.gov/flu/pandemic.htm. For avian influenza: http://www.cdc.gov/flu/avian/.
- The US government’s web site for pandemic flu: http://www.pandemicflu.gov/. Latest update on U.S. government’s preparedness activities.
- 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/.
- 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/disease_information/avian_influenza/index.jsp.
(WHO; FAO, OIE; CDC; US FDA; CIDRAP; PAHO; APHA; AVMA; USGS)

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 apecein@u.washington.edu