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EINet Alert ~ Apr 14, 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: Cumulative number of human cases of avian influenza A/(H5N1)
- Global: Susceptibility of animal species to the H5N1 Asian strain
- Global: Illegal international trade in poultry products
- Afghanistan (Ghor): No evidence of avian influenza in poultry
- Azerbaijan (Salyan): Additional retrospective human case of avian influenza H5N1 infection
- Croatia (Zagreb): Dead swan tests positive for avian influenza H5
- Czech Republic: 2 more swans killed by avian influenza H5 infection
- Denmark: Excerpts from the OIE report on avian influenza H5N1
- Denmark: Update on avian influenza H5N1 infection in wild birds
- France: Excerpts from the OIE report on avian influenza H5N1
- Germany: Excerpts from the OIE report on avian influenza H5N1
- Germany (Bavaria): Avian influenza H5N1 update in animals
- Israel: Excerpts from the OIE report on avian influenza H5N1; compensations
- Poland: Excerpts from the OIE report on avian influenza H5N1
- Russia (Volgograd): Avian influenza H5N1 infection in poultry; vaccinations
- UK (Scotland): Avian influenza situation update
- Slovenia: Excerpts from the OIE report on avian influenza H5N1
- Switzerland: Excerpts from the OIE report on avian influenza H5N1
- Cambodia: Excerpts from the OIE report on avian influenza H5N1
- India: Economic and societal consequences of avian influenza epidemic in poultry
- Indonesia: 31st case of human infection with avian influenza H5N1
- Indonesia: Poultry vaccination shortage hampers fight against avian influenza
- Myanmar: Increase in number of avian influenza outbreaks in poultry
- Thailand: Excerpts from the OIE report on avian influenza H5N1
- Vietnam (Cao Bang): Avian influenza H5 infection in poultry
- USA: FDA gives advice on rules for new bird flu tests
- Egypt: 12th case of human infection with avian influenza H5N1 infection
- Nigeria: Excerpts from the OIE report on avian influenza H5N1

1. Updates
- Influenza

2. Articles
- H5N1 infections in cats – public health implications
- Public Health Strategies for Pandemic Influenza: Ethics and the Law


Global
Global: Cumulative number of 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
Azerbaijan / 8 (5)
Cambodia / 2 (2)
China / 8 (6)
Egypt / 4 (2)
Indonesia / 14 (12)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 50 (33)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 194 (109)

Notable features (not shown above): the predominance of deaths in younger age groups; and the absence of unequivocal evidence of direct person-to-person transmission of infection. An interactive map illustrating the spread of avian outbreaks and human cases of HPAI A/H5N1 virus infection can be accessed at:
http://news.bbc.co.uk/1/shared/spl/hi/world/05/bird_flu_map/html/1.stm.
(WHO 4/12/06 http://www.who.int/csr/disease/avian_influenza/en/ ; Promed 4/12/06)

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Global: Susceptibility of animal species to the H5N1 Asian strain
The World Organisation for Animal Health (OIE) and the UN Food and Agriculture Organization (FAO) confirm that the animal species playing a role in the transmission and spread of highly pathogenic H5N1 avian influenza virus are essentially domestic and wild birds. Although some 50 non-domestic bird species have proved susceptible to infection with the virus, it would appear from the epidemiological data that, among the wild birds implicated in the transboundary spread of the virus, aquatic birds play a major role. Epidemiological findings and experimental studies have demonstrated that some mammal species, particularly cats may be susceptible to the virus. However, from the data that have accumulated since the start of the current avian influenza crisis (end of 2003), cats do not appear to play any discernable role in the transmission of the virus. The OIE and the FAO can thus confirm the statement issued by WHO 28 Feb 2006 that "there is no present evidence that domestic cats can play a role in the transmission cycle of H5N1 viruses". Nevertheless, in view of the susceptibility of certain individuals of this species, it is recommended that cats in infected zones and surveillance zones set up around avian influenza outbreaks be kept indoors.
(OIE 4/13/06 http://www.oie.int/eng/press/en_060413.htm )

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Global: Illegal international trade in poultry products
There is increasing evidence, experts say, that a thriving international trade in smuggled poultry products--including birds, chicks, eggs, meat, feathers and other products--is making a contribution to the spread of the H5N1 bird flu virus. Poultry smuggling turned out to be a huge and previously largely overlooked business, perhaps second only to narcotics in international contraband. Raids at a warehouse in Italy have yielded millions of packages of chicken meat smuggled from China, even though such imports have been banned in the EU since 2002. H5N1 virus can survive in frozen meat, feathers, bones and on used cages--although it dies with cooking. Illegal trade seriously undermines the bans on poultry products from bird flu-infected countries. No one has any precise sense of the extent of the trade--or the importance of its role in spreading bird flu--because until recently, poultry smuggling was regarded mostly as an economic nuisance. Experts say the trade is hard to control because massive amounts cross borders in trucks, carts, planes and boats.

Although many countries attribute the spread of H5N1 to migratory fowl, many ornithologists say the evidence often points to smuggling. "We believe it is spread by both bird migration and trade, but that trade--particularly illegal trade--is more important," said Wade Hagemeijer, a bird flu expert at the Netherlands-based Wetlands International. The effect of smuggling can sometimes be direct, when sick birds are smuggled onto farms. The H5N1 virus strain found on the farms involved in Nigeria's first outbreak closely matched those found on Chinese farms, Hagemeijer said. Although bird flu has now been detected on many farms in several African nations, there have been only a handful of reports in wild birds on the continent, supporting the notion that trade is most important there. The main concern is China, a country with a serious avian influenza problem and also formerly a major exporter of poultry products. There is extensive illegal trade between China and Africa. "The government policies created the illegal trade," said an official at the US Embassy in Lagos, adding that some products certainly came from Asia. "The industry was growing at 8 percent annually and it needed imports, from parent stock to hatching eggs. Everything comes in illegally." (Promed 4/14/06)

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Europe/Near East
Afghanistan (Ghor): No evidence of avian influenza in poultry
As of 11 Apr 2006, no evidence of avian flu was found in birds in a remote village in Afghanistan where 3 children recently died, Reuters reported 10 Apr 2006. However, 20 other samples from 7 provinces have tested positive for an H5 avian flu, although the neuraminidase has not yet been determined. The deaths of the children, all from the same family in the province of Ghor, prompted fears of avian flu. Samples were reportedly not taken from the children before their burial. The lack of samples left investigators to rely on bird samples. Officials reportedly found no evidence of disease among 1000 chickens in the village. (Promed 4/12/06)

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Azerbaijan (Salyan): Additional retrospective human case of avian influenza H5N1 infection
As of 11 Apr 2006, tests conducted at a WHO collaborating laboratory in the UK have retrospectively identified an additional human case of H5N1 infection. The case is a 17-year-old girl who developed symptoms 11 Mar 2006. She was seriously ill with bilateral pneumonia but has since fully recovered and been discharged from hospital. Early in her course of illness, a diagnosis of H5N1 infection was presumed based on her clinical symptoms and preliminary laboratory results, and she was treated accordingly. Her 15-year-old cousin, previously confirmed by WHO, developed symptoms on the same day and was hospitalized in critical condition. She has also fully recovered and been discharged from hospital. Both girls, who are neighbours, reside in the small Daikyand settlement in Salyan rayon, where 7 of the 8 cases in Azerbaijan occurred. Active house-to-house surveillance in the settlement has failed to detect any further cases. Retrospective confirmation of this case brings the total in Azerbaijan to 8, 5 of which were fatal. (Promed 4/12/06)

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Croatia (Zagreb): Dead swan tests positive for avian influenza H5
Croatia confirmed 7 Apr 2006 the first bird flu case in the capital, Zagreb, after a dead swan found there tested positive for the H5 strain of bird flu virus. The swan was found on the shores of the Sava River in southeast Zagreb, said Mladen Pavic, spokesman for the Croatian Agriculture, Forestry and Water Management Ministry. Tests findings as to whether it was the H5N1 strain would reportedly be released later. Quarantine officers found no other birds after combing the area within a radius of 3 km of the locale, Pavic said, adding that they would continue to monitor the situation closely. Croatia, which lies under one of the main flight paths for migratory birds, reported its first bird flu case Oct 2005 when H5N1 was found in 6 wild swans in the eastern part of the country. In late Feb 2006, the disease struck the country's southern coastal region, where 2 dead swans were tested positive for H5N1. Croatian authorities immediately adopted a series of precautionary measures to curb the spread of the disease, including ordering farmers to keep their poultry indoors to try to prevent them from contracting the virus from wild birds. (Promed 4/8/06)

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Czech Republic: 2 more swans killed by avian influenza H5 infection
Another 2 swans killed by bird flu have been found in the Czech Republic, both in Bavorovice near the south Bohemian center Ceske Budejovice, State Veterinary Authority spokesman Josef Duben said 8 Apr 2006. All the previous cases of bird flu have been detected in South Bohemia, and they all involved swans. The first positive bird (a dead mute swan, Cygnus olor) was detected 20 Mar 2006. The latest 2 swans have been found on the bank of the Vltava river, almost on the same spot where the fifth swan victim was found a week ago. Tests showed they died of the highly infectious H5 virus. "Since they have been found on the spot of the previous find, the declared protective measures will remain unchanged," Duben said. Extraordinary measures have been in effect in the affected areas in south Bohemia since last week. Local breeders must not keep poultry in open-air enclosures. A ban has been imposed on the transfer of poultry, eggs and further related material, and people's access to poultry farms has been limited. Steps have been taken to secure disinfection of people and cars in contact with the farms. The measures are to last for 21 days at least. (Promed 4/10/06)

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Denmark: Excerpts from the OIE report on avian influenza H5N1
Information received 5 Apr 2006 from Dr Preben Willeberg, Chief Veterinary Officer, Danish Veterinary and Food Administration: End of this report period: 5 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 12 Mar 2006. Description of affected population: Outbreak in Bornholm: a mute swan (Cygnus olor) near Vang. Outbreak in Fredriksborg: a rough-legged buzzard (Buteo lagopus) near Skibby. Outbreaks in Funen: 6 tufted ducks (Aythya fuligula) in Aeroskobing, a peregrine falcon (Falco peregrinus) on the island Drejo, a greyleg goose (Anser anser) near Svendborg, 2 mute swans (Cygnus olor), a tufted duck (Aythya fuligula) and a common buzzard (Buteo buteo) near Fåborg. Outbreaks in Southern Jutland: a common buzzard (Buteo buteo) near Sønderborg, a tufted duck (Aythya fuligula) on Kegnæs. Outbreaks in Storstroem: a tufted duck (Aythya fuligula) in Guldborgsund, a common buzzard (Buteo buteo) near Nysted, a tufted duck (Aythya fuligula) near Stubbekøbing, a tufted duck (Aythya fuligula) near Bandholm. Outbreak in Western Zealand: a tufted duck (Aythya fuligula) near Skælskør. Diagnostic tests results: RT-PCR positive for H5; virus isolation positive for H5N1; amino acid sequence at cleavage site reveals an HPAI profile.

The protection and surveillance zones have been established in accordance with European Union legislation. All poultry within the zones must be kept inside and all poultry holdings must be registered. The Danish Veterinary and Food Administration will inspect all poultry holdings in the protection zones in order to look for possible further spread of avian influenza. Restrictions on movement of eggs and poultry have been imposed within the zones. All hunting within the zones is also prohibited. (Promed 4/11/06)

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Denmark: Update on avian influenza H5N1 infection in wild birds
During the period 15 Feb 2006 to 14 Mar 2006, 225 wild birds have been tested for avian influenza with negative results. Since 14 Mar 2006, when the first H5N1-positive case was detected in Denmark, a total of 39 positive cases have been confirmed. They included the following species: Tufted ducks (Aythya fuligula): 23; Common buzzard (Buteo buteo): 6; Whooper swan (Cygnus cygnus): 2; Peregrine falcon (Falco peregrinus) 1; Greylag goose (Anser anser): 1; Mute swans (Cygnus olor): 3; Rough-legged buzzard (Buteo lagopus): 1; Swan (unspecified) (Cygnus sp.): 2.

No case in domestic poultry has been recorded in Denmark, which is officially free of HPAI. The meticulous surveillance in Denmark and the transparency expressed in the maintenance of a user-friendly, mapped web-site which is updated on nearly a real-time basis is exemplary. All cases detected so far are described in detail: http://www.uk.foedevarestyrelsen.dk/AnimalHealth/Avian_influenza/Latest_news/forside.htm. (Promed 4/8/06, 4/12/06)

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France: Excerpts from the OIE report on avian influenza H5N1
Information received 29 Mar 2006 from Dr Monique Eloit, Deputy Director General, General Directorate for Food (DGAL), Ministry of Agriculture, Food, Fisheries and Rural Affairs: End of this report period: 28 Mar 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 13 Feb 2006. New outbreaks: In Ain, there have been 25 cases reported. Affected population: Outbreaks in Marlieux, Birieux, Villars les Dombes, Versailleux and Lapeyrouse: wild swans (Cygnus cygnus) and mute swans (Cygnus olor). Outbreak in Chanoz Chatenay: a common pochard. Outbreak in Divonne les Bains: a great crested grebe. Diagnostic tests results: amino acid sequence at cleavage site reveals an HPAI profile. Typing indicates the virus is very similar to virus A/Chicken/Tula/10/2005(H5N1), A/Bar Headed Goose/Qinghai/65/05 (H5N1), and also to A/common pochard/France/0667/2006(H5N1), the virus typed in the first case in wildlife (wild duck) in France, detected at Joyeux, Ain department. (Promed 4/11/06)

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Germany: Excerpts from the OIE report on avian influenza H5N1
Information received 6 Apr 2006 from Prof. Dr. Werner Zwingmann, Chief Veterinary Officer, Ministry of Consumer Protection, Food and Agriculture: Report date: 6 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 5 Apr 2006. Location of outbreak: Mutzschen, Muldentalkreis, Sachen land. Number of animals in the outbreak: susceptible: 14 300; cases: 801; deaths: 800; destroyed: 13 500. Description of affected population: turkeys (Meleagris gallopavo). Diagnostic tests used: PCR (M, H5, N1 genes). Control measures undertaken: control of wildlife reservoirs; stamping out; movement control inside the country; screening; zoning. Just as in France, this outbreak occurred in a commercial turkey population.

Information received 29 and 31 Mar 2006 from Prof. Dr. Werner Zwingmann, Chief Veterinary Officer, Ministry of Consumer Protection, Food and Agriculture: End of this report period: 31 Mar 2006. Identification of agent: avian influenza virus subtype H5N1. Date of start of event: 8 Feb 2006. New outbreaks: Brandenburg: 2 cases (Anserini and Fulica atra); Baden Wuerttemberg: 1 case (Anatinae Bavaria), 18 cases (Cygnini, Anatinae and Falconiformes); Mecklenburg-Western Pomerania: 15 cases (Falconiformes, Anatinae, Grey heron, Cygnini and Laridae); Schleswig-Holstein: 5 cases (Anatinae, Falconiformes and Cygnini). Diagnostic test results: PCR (M, H5, H7, N1 genes) positive for H5N1. Avian influenza in wild birds in Germany as of 31 Mar 2006: 229 outbreaks. (Promed 4/7/06, 4/11/06)

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Germany (Bavaria): Avian influenza H5N1 update in animals
So far in 2006, 5334 wild birds have been handed over to the Bavarian Agency for Health and Food Safety; 4655 of them have by 7 Apr 2006 been tested for influenza A, and the 71 samples that were influenza A positive have been sent to the Friedrich Loffler Institute (FLI) for further testing. The FLI has confirmed 54 samples as H5N1 positive, 7 as H5N1 negative, and 10 have yet to be determined. During 31 Mar 2006 until 7 Apr 2006, 16 new cases were confirmed in Schwabia (tufted duck, duck, swan, mallard duck), Upper Bavaria (duck, merganser), Lower Bavaria (duck, tufted duck), and Middle Franconia (swan). In addition, 238 carnivores (martens, foxes, cats) have been sent to the LGL; 224 have been tested for influenza A virus. 1 influenza A positive sample has been forwarded to the FLI, where it was found H5N1 negative. HPAI has been confirmed in wild birds in 6 other German States, as follows (in brackets, number of H5N1 positive samples since 15 Feb 2006, updated 7 Apr 2006): Baden-Wurttemberg (18), Berlin (1), Brandenburg (17), Mecklenburg-Vorpommern (200, including 165 from the island of Rugen), Lower Saxony (2), Schleswig-Holstein (13). The entire 7 Apr 2006 update for Germany (in German), is available at http://bfav.hnm.de/fileadmin/user_upload/Dokumente/News/av_Influ/LB_Influenza.pdf. (Promed 4/12/06)

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Israel: Excerpts from the OIE report on avian influenza H5N1; compensations
Information received 4 Apr 2006 from Dr Moshe Chaimovitz, Director of Veterinary and Animal Health Services, Ministry of Agriculture and Rural Development: End of this report period: 2 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 16 Mar 2006. New outbreaks: 2 in Jerusalem (30 000 birds) and HaDarom (20 000 birds). Description of affected population: heavy breeders and turkeys. Diagnostic tests results: PCR (H5N1) positive; virus isolation and haemagglutination inhibition test pending. Vaccination prohibited: yes, except for birds of species listed in Appendix I of the Convention on International Trade in Endangered Species of Wild Fauna and Flora living in zoos, which are vaccinated with inactivated H5N2 vaccine (Nobilis, Intervet, Holland), and a flock of 14 000 ostriches in the south of Israel, which is the only commercial flock being vaccinated.

Also, Israel's Agriculture Ministry has begun paying farmers for losses due to bird flu exposure, which resulted in more than 1 million culled animals. Reportedly the ministry has given more than USD 4.7 million to poultry farmers in 25 kibbutzim and moshavim in Israel and plans to make payments to more agriculture settlements. The ministry paid USD 17 for a turkey, USD 3 per chicken and 44 cents per chick. Egg hatcheries will be compensated later. A committee in Israel will also decide how to compensate for other damages from the bird flu. Israeli policy is to compensate farmers for losses from epidemic diseases. (Promed 4/11/06, 4/13/06)

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Poland: Excerpts from the OIE report on avian influenza H5N1
Information received 31 Mar and 4 Apr 2006 from Dr Krzysztof Jazdzewski, Chief Veterinary Officer, General Veterinary Inspectorate: End of this report period: 31 Mar 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 2 Mar 2006. New outbreaks: Bydgoski and Grudziadz in wild swans. Diagnostic test results: RT-PCR(H5) and RT-PCR (N1) positive. (Promed 4/11/06)

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Russia (Volgograd): Avian influenza H5N1 infection in poultry; vaccinations
Bird flu has been confirmed as the cause of the deaths of poultry in the village of Kolobrodovo in the Frolovo district of the Volgograd region. 25 birds died 11 Apr 2006. "A local veterinary laboratory confirmed that the blood of the dead birds contained the H5N1 virus and sent samples to Vladimir where the type of virus is to be identified," the district administration said. This is the second registered case of bird flu in Volgograd. In late Mar 2006 bird deaths were registered in a village in Koteknikovo district, Volgograd.

A criminal investigation has been launched into the activities of 2 villagers from Russia's Saratov region, who decided to make money by playing on the fear of a bird flu pandemic. They reportedly used milk instead of vaccine to inoculate birds, earning USD 1.70 per injection. They visited private houses, introduced themselves as vets and, if people agreed, performed the "vaccination". They are currently facing charges of fraud. Russia is one of the countries applying vaccination against HPAI H5N1 (other countries vaccinating are: China, Indonesia and Vietnam; in addition, limited vaccination, in selected holdings/sections, in France and the Netherlands). (Promed 4/13/06)

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UK (Scotland): Avian influenza situation update
New bird flu restrictions may have to be imposed across large parts of Britain after scientists discovered they had wrongly identified the type of swan found dead in Fife, the Scottish Executive admitted 11 Apr 2006. DNA tests on the bird showed that, rather than being a resident mute swan, as officials first believed, it was a migratory whooper swan, which may have carried the disease around the UK. The mistake was blamed on the creature's state of decomposition. Once tests confirmed it had the highly pathogenic H5N1 strain, samples were sent for DNA testing, which revealed it was a whooper swan. There are believed to be more than 8000 whooper swans scattered around Britain over-wintering after flying in from Iceland, Russia and Scandinavia. The problem facing the government is that it does not know whether the Cellardyke swan made it to the UK and came into contact with other birds or died offshore and drifted to land. On 11 Apr 2006, Scotland's chief vet, Charles Milne, said the fact that the swan was not a native bird was not good news. After confirmation that the swan had succumbed to the H5N1 strain of bird flu, authorities set up a 1.8-mile protection zone around Cellardyke in which birds were to be tested, a 6-mile surveillance zone in which the movement of poultry was restricted and a 1000-square-mile-wild-bird risk area in which bird owners were told to keep flocks indoors. More than 3300 birds found dead in Britain have been tested for bird flu since Christmas 2005, and only 1 has been identified with the H5N1 strain.

Supermarkets said 8 Apr 2006 they weren't too worried about an effect on the sales of eggs and poultry. And the tourism industry seems to be unaffected by the bird flu scare so far. Department for Environment, Food and Rural Affairs (Defra) is telling the public to call only if one spots dead swans, ducks, or geese or clusters of garden birds. The public is being told not to call Defra if they find just 1 dead garden bird. Timely and detailed publication of AI cases identified in wild birds might help in maintaining consumers' confidence. Some countries use the internet to publish their wildlife surveillance results (e.g. Denmark, Germany). A useful map of the European AI situation is available at the European Commission's Disasters website at <http://disasters.jrc.it/AvianFlu/index.asp?europe=true>.

The Royal Institution of Chartered Surveyors in Scotland has called for calm in the debate surrounding the discovery of the H5N1 virus in Scotland. The poultry industry has been proactive in drawing up its own contingency measures. The likely impact on wild birds and shooting industries is more difficult to predict. However, those involved in this area have been seeking advice from their advisers in advance of any outbreak. It is estimated that shooting contributes BP 650 million [USD 1130 million] to the UK rural economy each year. A flexible yet speedy response will be required in these circumstances, supported by good bio-security measures. Angus McNicol, Head of the RICS Scotland Rural faculty, said: "All of those involved in the rural sector. . .have been drawing up their own contingency plans in line with official guidance. Our members have been advising their clients and staff on Health and Safety measures and bio-security. . .Many lessons have been learned from the way that BSE and foot and mouth were handled. It is vital that we use all of the information available to take an appropriate response as the situation evolves."

Defra stood by its policy that there was no need to require that all UK poultry be kept indoors as a precaution against the disease. "We are urgently considering whether there is a need for any regional measures in addition to those that have already been put in place in the protection and surveillance zones," according to a joint statement from the chief veterinary officers in the UK and Scotland. Earlier, Bjorn Olsen, who conducts Europe's largest bird monitoring survey, was quoted as warning that UK regulators may have missed many flu cases because of the way that samples are handled. Defra said the UK's Veterinary Laboratories Agency (VLA) is using the most up-to-date testing technologies. (Promed 4/10/06, 4/12/06, 4/13/06)

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Slovenia: Excerpts from the OIE report on avian influenza H5N1
Information received 3 Apr 2006 from Dr Simona Salamon, Deputy Director General, Veterinary Administration of the Republic of Slovenia (VARS): End of this report period: 3 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 11 Feb 2006. New outbreaks: 2 new outbreaks in Maribor are reported. Affected population: a northern pintail (Anas acuta) and a mute swan (Cygnus olor). Diagnostic tests results: RT-PCR positive for H5N1; amino acid sequence at cleavage site reveals an HPAI profile; RT-PCR H530 positive. (Promed 4/11/06)

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Switzerland: Excerpts from the OIE report on avian influenza H5N1
Information received 3 Apr 2006 from Dr Hans Wyss, Director of the Federal Veterinary Office: End of this report period: 3 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 26 Feb 2006. New outbreak: A case is reported in Thurgau. Description of affected population: 1 common pochard (Aythya ferina). Diagnostic test results: RT-PCR (gene H5) positive for H5; RT-PCR (genes M, H5 and N1) positive for H5N1; amino acid sequence at cleavage site indicates a highly pathogenic avian influenza profile. The case was detected as part of a national monitoring programme for avian influenza in wild birds. Since the beginning of the event, a total of 4 wild birds (1 tufted duck [Aythya fuligula], 1 common coot [Fulica atra], 1 goosander [Mergus merganser] and 1 common pochard [Aythya ferina]) have been identified H5N1 positive. There are currently 28 more cases (wild birds) positive for H5. (Promed 4/11/06)

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Asia
Cambodia: Excerpts from the OIE report on avian influenza H5N1
Information received 13 Apr 2006 from Dr Sen Sovann, Deputy Director, Department of Animal Health and Production: Report date: 13 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 23 Mar 2006. Date of start of event: 20 Mar 2006. 2 outbreaks of highly pathogenic avian influenza have been reported in: (1) Tuol Prich village, Moha Russei commune, Kong Pisey district, Kompong Speu province. Number of animals in outbreak: susceptible: 700; cases: 402; deaths: 402; destroyed: 200. Affected population: backyard chickens. (2) Kamakor village, Samlanh commune, Angkor Chey district, Kompot province. Number of animals in outbreak: susceptible: 247; cases: 76; deaths: 76; destroyed: 171. Affected population: backyard ducks and free-ranging ducks. Diagnostic tests used: RT-PCR. Control measures undertaken: modified stamping out; disinfection of infected premises/establishment(s); movement control in affected areas; surveillance around the outbreaks. (Promed 4/13/06)

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India: Economic and societal consequences of avian influenza epidemic in poultry
In India, 7 poultry farmers apparently committed suicide because the H5N1 virus destroyed their livelihood, according to an Agence France Presse (AFP) report. The H5N1 infections and subsequent culling that have swept India have cost the industry USD 1.8 billion in 6 weeks, the National Egg Coordination Committee said 12 Apr 2006. The 7 suicides are not an unheard-of response to the stresses of farming in India. The AFP story noted that nearly 9000 people in 4 Indian states are thought to have killed themselves in connection with rising costs, debt, and repeated crop failures in the past 5 years. (Promed 4/12/06)

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Indonesia: 31st case of human infection with avian influenza H5N1
As of 12 Apr 2006, the Ministry of Health in Indonesia has confirmed the country's 31st case of human infection with the H5N1 avian influenza virus. The case occurred in a 23-year-old man employed as a poultry worker in West Java. He developed symptoms 20 Mar 2006 and has since fully recovered. Poultry deaths occurred in the 2 weeks preceding his visit to a farm. Of the 31 laboratory-confirmed cases in Indonesia, 23 have been fatal. Indonesia has had the most human bird flu deaths of any country so far in 2006, killing at least 12 people. (Promed 4/12/06)

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Indonesia: Poultry vaccination shortage hampers fight against avian influenza
A shortage of vaccines has hampered the government's plan to carry out a nationwide poultry vaccination drive against bird flu next month, a senior government official said 10 Apr 2006. "We planned to hold 2 rounds of a massive vaccination campaign in May and June, but because we are short of vaccines, we have to reconsider the plan," Agriculture Ministry head of bird flu emergency response Delima Hasri Azahari said. The vaccination effort would target mostly backyard and small-farm poultry. She explained that to carry out the drive, the government needed about 600 million doses of the vaccine for some 300 million birds across the country. Each would receive 2 shots. "However, the 2006 state budget could only afford enough money to purchase 120 million doses. So we are facing a gap of 480 million doses," Delima said. She could not specify how much money was needed to cover the shortage. "We could still carry out the vaccination drive according to schedule, but we could only focus on high-priority regions where bird flu is pandemic. Such measures wouldn't be effective, however, because to contain the spread of the virus we should vaccinate all poultry at the same time," she said.

High numbers of bird flu fatalities among humans and poultry have been recorded in 9 provinces across Indonesia -- Jambi, Lampung, Jakarta, Banten, Central Java, West Java, East Java, Yogyakarta and South Sulawesi. "Recently, a team of World Bank experts did a preliminary assessment of bird flu in the country. So we expect they will understand our needs," she said. "However, we also encourage the private sector to support the campaign," Delima said. An advisor to Aburizal on bird flu issues, Emil Agustiono, said the private sector should do more to help the government. He said that to date, of the Rp 9 trillion [USD 1 billion] needed to fight bird flu from 2006 to 2008, the private sector had donated only Rp 200 million [USD 22 300]. Secretary-General of the Indonesian Employers Association Djimanto said businesses were actually eager to help fight bird flu, since a pandemic could cost companies billions of rupiah in losses. (Promed 4/12/06)

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Myanmar: Increase in number of avian influenza outbreaks in poultry
Bird flu is spreading fast in secretive, military-ruled Myanmar, which is now battling more than 100 outbreaks in poultry since the virus was first reported a month ago, UN officials said 10 Apr 2006. After visits by 2 teams from the UN Food and Agriculture Organization (FAO), the situation appeared to be "more serious than what we imagined," said He Changchui, the Asia-Pacific representative. "Up to now, there are over 100 outbreaks, mainly in 2 districts, Mandalay and Sagaing," He said. "The issue there is that awareness is rather poor. The information is not that comprehensive," He said. Myanmar reported its first outbreak of H5N1 bird flu 13 Mar 2006, and within a week, the number of outbreaks had climbed to 5. Even then, FAO experts said the authorities were struggling to cope. David Nabarro, the U.N.'s bird flu coordinator said, "We're going to be focusing on Myanmar a lot in the next few days and weeks, trying to make sure that the authorities and civil society in that country are able to cope better.” Alongside FAO efforts to boost culling and provide vaccines and protective gear for agricultural workers, WHO is to send a team to Yangon to assess human defenses against the H5N1 virus. The Asian Development Bank said Mar 2006 that it would be eligible for funds from a USD 38 million program to help poor countries plug gaps in their health defenses. There have been no reported human cases in Myanmar of H5N1. (Promed 4/10/06)

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Thailand: Excerpts from the OIE report on avian influenza H5N1
Information received 31 Mar 2006 from Dr Yukol Limlamthong, Director General, Department of Livestock Development, Ministry of Agriculture and Cooperatives: End of this report period: 31 Mar 2006. 140 days have elapsed since the last case of highly pathogenic avian influenza in Thailand (on 9 Nov 2005), where stamping-out with compensation was employed. In Feb 2006, the Department of Livestock Development conducted the first biannual HPAI active surveillance. During the month, 57 461 cloacal swab samples were collected for virus isolation. To date, no new positive case has been reported in Thailand. (Promed 4/11/06)

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Vietnam (Cao Bang): Avian influenza H5 infection in poultry
Vietnam has detected bird flu on 3 farms near the Chinese border, the second such finding in the past few days, an official said 8 Apr 2006. Health workers slaughtered 157 chickens and ducks after farmers said 30 birds died 19 Mar 2006 on 3 farms in Cao Bang province, said Dang Quang Binh, head of the provincial Animal Health Department. Samples were sent for testing and on 25 Mar 2006 the results showed the H5 subtype was found in poultry samples from the 3 farms. No further tests will likely be done to confirm if the strain was H5N1. Vietnam usually tests for the N component of the strain when a sample comes from a suspected human case. With poultry, the finding of H5 is enough to carry out preventive measures such as slaughter and disinfection of birds. The H5N1 strain has killed or led to the culling of millions of poultry in Vietnam but there have not been any human cases since Nov 2005.

On Thursday, officials said the H5 subtype virus was found in samples from chickens smuggled from China and seized in Lang Son province, next to Cao Bang, marking the first published finding of bird flu in poultry in Vietnam since Dec 2005. Binh said the latest infection was in Trung Khanh district, an area afflicted by bird flu in 2005. Cao Bang province would vaccinate poultry against bird flu later this month, he said. Vietnam vaccinated 240 million poultry in 2005 as part of a series of measures to fight bird flu. This week Vietnam stepped up border-control measures to prevent a resurgence of bird flu, but officials said the efforts did not always succeed because northern Vietnamese were involved in the lucrative illegal trade of smuggling chickens from China. (Promed 4/8/06)

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Americas
USA: FDA gives advice on rules for new bird flu tests
The Food and Drug Administration (FDA) issued a regulatory guidance document this week to help spur the development of diagnostic tests for avian influenza in humans. The document, issued Apr 10, is intended to help medical technology companies meet FDA requirements when developing new tests for influenza A viruses, the FDA said. The agency said the move was prompted by the public health concern over the human cases of H5N1 avian flu and the associated threat of a human flu pandemic. "FDA is making this guidance document immediately available because prior public participation is not feasible given the national and global public health threat of pandemic influenza," the notice says. The document gives information on labeling requirements and outlines the "premarket regulatory path" for new tests to detect either influenza A viruses in general or specific influenza A virus subtypes. Flu tests already approved by the FDA are designed to detect influenza A in general—not specific subtypes—and were developed when only H3 and H1 viruses were circulating, the FDA said. There is no evidence that the existing tests "would reliably detect novel influenza A viruses" from human samples, the notice said. The guidance is effective immediately, but the FDA is accepting comments on it. (CIDRAP 4/13/06 http://www.cidrap.umn.edu/ )

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Africa
Egypt: 12th case of human infection with avian influenza H5N1 infection
The Ministry of Health in Egypt has informed WHO of the country's 12th case of human infection with the H5N1 avian influenza virus. The patient is an 18-year-old girl from the northern governorate of Minufiyah. She developed symptoms 5 Apr 2006 and was hospitalized 11 April. She remains hospitalized in stable condition. As with all other cases in Egypt, her infection has been linked to direct contact with diseased birds. Samples from the patient tested positive for H5N1 infection in the country's Central Public Health Laboratory and the Cairo-based US Naval Medical Research Unit 3. Of the 12 cases in Egypt, 3 have died and 4 remain hospitalized. 5 patients have fully recovered and been discharged from hospital. (Promed 4/13/06)

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Nigeria: Excerpts from the OIE report on avian influenza H5N1
Information received 2 April 2006 from Dr Junaidu A. Maina, Acting Director, Department of Livestock and Pest Control Services, Federal Ministry of Agriculture and Rural Development: End of this report period: 31 Mar 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 10 Jan 2006. Details of new outbreaks: Reported across wide areas of the North of Nigeria, 9 outbreaks, mainly in commercial poultry: 3 are from Bauchi, 3 from Kaduna and 3 from Jos in Plateau State. Description of affected populations: All the farms are commercial backyard layer production units, except for a farm at Bauchi which is non-commercial and had a mixture of 38 susceptible ornamental birds (10 ostriches, 18 emus, 1 turkey, 2 guineafowl, 2 Chinese geese and 5 black-crowned cranes). Laboratory where diagnostic tests were performed: National Veterinary Research Institute, Vom, Nigeria. Results: haemagglutination test; agar gel immunodiffusion test; virus isolation; RT-PCR were all positive.

Also, a 10 Apr 2006 Reuters report indicated that a WHO official, Honore Meda, said in Nairobi that human cases of H5N1 may be occurring undetected in Africans. "So far, there is no confirmed human case of avian flu virus infection in West Africa, but this is not a reason to say there is no human case," Meda said. WHO in Feb 2006 tested samples from 4 Nigerians, including a woman who died. The samples did not yield a clear result. 4 West African countries have experienced or are experiencing avian flu outbreaks in poultry. (Promed Promed 4/11/06, 4/12/06)

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1. Updates
Influenza
Seasonal influenza activity for the APEC Economies, weeks 12-13, 2006
Except a few eastern European countries, where influenza activity increased and was reported as widespread during weeks 12–13, overall influenza activity remained moderate to low with an observation of slight decline in most parts of the northern hemisphere.
Canada. During weeks 12–13, influenza activity remained similar to previous weeks. The overall influenza-like illness consultation rate was within the expected range with influenza A and B viruses co-circulating.
Hong Kong. A slight increase in influenza activity continued to be observed since week 1, with influenza A(H1N1) virus predominating, whereas overall activity has remained moderate.
Russia. Influenza activity continued to increase and was reported as widespread for weeks 12–13, with influenza A(H3N2) and B viruses co-circulating.
Other reports. During weeks 12–13, low influenza activity was reported in Japan (H1, H3 and B) and Mexico (A and B). Chile reported no activity of influenza.
USA. During week 14 (Apr 2 – Apr 8, 2006), influenza activity continued to decrease in the US. 300 specimens (15.7%) tested by US WHO and National Respiratory and Enteric Virus Surveillance System collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like illness was below the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. 10 states reported widespread influenza activity; 10 states reported regional influenza activity; 15 states, New York City, and the District of Columbia reported local influenza activity; 14 states and Puerto Rico reported sporadic activity; and 1 state reported no activity.

For the comprehensive update on recent influenza activity in the USA (“Update: Influenza Activity--United States, March 26--April 1, 2006”): http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5514a7.htm
(WHO 4/12/06 http://www.who.int/csr/disease/influenza/update/en/ ; CDC 4/14/06 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html. Includes: “Pandemic influenza preparedness and mitigation in refugee and displaced populations: WHO guidelines for humanitarian agencies”.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Includes links to FAO/OIE International Scientific Conference on Avian Influenza and Wild Birds.
- OIE: http://www.oie.int/eng/en_index.htm. Includes information on the Asian European Conference on Avian Influenza 2006.
- US CDC: http://www.cdc.gov/flu/pandemic.htm. Now available: “Instructions to Estimate Impact of Next Pandemic”. For avian influenza: http://www.cdc.gov/flu/avian/.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Latest updates on U.S. State Summits are available.
- US FDA: http://www.fda.gov/oc/opacom/hottopics/flu.html.
- CIDRAP: http://www.cidrap.umn.edu/.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- American Veterinary Medical Association: 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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2. Articles
H5N1 infections in cats – public health implications
Eurosurveillance weekly release, vol 13,no 4, 13 Apr 2006
<http://www.eurosurveillance.org/ew/2006/060413.asp#4>
Influenza team (influenza@ecdc.eu.int), European Centre for Disease Prevention and Control
“The natural reservoir of influenza viruses is generally considered to be wild waterbirds. In this animal group, many types of influenza viruses circulate without seeming to cause much disease, and are therefore known as ‘low pathogenic’ avian influenza viruses. As well as waterbirds, a number of other animals (including humans) are occasionally infected with influenza viruses. However, a distinction needs to be made between species which can occasionally be infected by a particular influenza but who rarely transmit on – so called ‘dead end hosts’ and those species where it seems that the viruses are better adapted and are transmitted – ‘propagating hosts’. Cats are among the species which can, and have been, infected with influenza type H5N1. The first time that this happened, and was reported, was in December 2003 when a few large cats (leopards and tigers) died in a zoo in Thailand after being fed with infected poultry. The second natural event was a much larger H5N1 outbreak in zoo tigers, also in Thailand, which had been fed chicken carcasses. Over 140 tigers died, or were euthanised, and there was convincing evidence of tiger to tiger transmission. . .” (Promed 4/13/06)

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Public Health Strategies for Pandemic Influenza: Ethics and the Law
Lawrence Gostin. JAMA. 2006 Apr 12;295(14):1700-4.
http://jama.ama-assn.org/cgi/content/extract/295/14/1700
“Highly pathogenic influenza A(H5N1) is endemic in avian populations in Southeast Asia, with serious outbreaks now in Africa, Europe, and the Middle East. Human cases, although rare, continue to increase, with high reported case-fatality rates. Industrialized countries place great emphasis on scientific solutions. The White House strategic plan and congressional appropriation both devote more than 90% of pandemic influenza spending to vaccines and antiviral medications. Yet, medical countermeasures, discussed in a previous JAMA Commentary, will not impede pandemic spread: experimental H5N1 vaccines may not be effective against a novel human subtype, neuraminidase inhibitors may become resistant, and medical countermeasures will be extremely scarce. This Commentary focuses on traditional public health interventions, drawing lessons from past influenza pandemics and the outbreaks of severe acute respiratory syndrome (SARS). . .”
(CIDRAP http://www.cidrap.umn.edu/ )

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 apecein@u.washington.edu