Login   

EINet Alert ~ Apr 28, 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: Surveillance of migratory birds for avian influenza H5N1
- Afghanistan (Kapisa): Test confirms avian influenza H5N1 in fourth Afghan province
- France: More swans test positive for avian influenza H5N1 infection
- Germany (Bavaria): Avian influenza H5N1 update in animals
- Germany (Brandenburg and Saxony): New cases of avian influenza H5N1 in wild birds
- Jordan: Excerpts from the OIE report on avian influenza H5N1
- The Netherlands: Policies regarding vaccination of poultry
- Turkey: Excerpts from the OIE report on avian influenza H5N1
- UK (Scotland): Some restrictions lifted in Fife
- UK (Norfolk): Avian influenza H7 suspected in poultry
- Cambodia: Excerpts from the OIE report on avian influenza H5N1
- China: 18th human case of avian influenza H5N1 infection
- India (Maharashtra): No confirmation of human cases of avian influenza H5N1 infection
- Indonesia (Bali): Ducks positive for avian influenza, hundreds culled
- Pakistan: Over 40 000 birds culled following avian influenza outbreaks; no human cases
- Cote d'Ivoire: Excerpts from the OIE report on avian influenza H5N1
- Sudan: Excerpts from the OIE report on avian influenza H5N1

1. Updates
- Influenza

2. Articles
- CDC EID Journal, Volume 12, Number 5—May 2006
- Special Science issue on avian influenza
- Study cites gaps in Europe's influenza pandemic plans


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 / 10 (7)
Egypt / 12 (4)
Indonesia / 15 (13)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 61 (37)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 205 (113)

An updated interactive H5N1 map of Europe is available at: http://disasters.jrc.it/AvianFlu/index.asp?europe=true. The following world maps on H5N1 are available at the WHO web-site: http://gamapserver.who.int/mapLibrary/app/searchResults.aspx.
(Promed 4/22/06; WHO 4/27/06 http://www.who.int/csr/disease/avian_influenza/en/ )

^top

Global: Surveillance of migratory birds for avian influenza H5N1
Ducks have a flu season just like people do--and they're more likely to be sick in the fall than in the spring. So authorities must keep their guard up even if the government's mass testing of migrating birds, beginning now in Alaska, doesn't spot the H5N1 bird-flu strain right away. That's a key warning from a new review of what scientists know--and don't know--about how waterfowl constantly incubate influenza, and how much of a role wild birds play as this new flu strain spreads around the globe. And it's one that federal wildlife officials are taking into account as they determine how many birds to test now, as ducks and other migratory species start flying into Alaska's breeding grounds from Asia, and how many to test later in the year. "If results in the spring are entirely negative, we still have that opportunity in the late summer and the fall when many species of birds come into closer contact with one another. . .all using the same wetlands at the same time rather than using more [discrete] breeding areas," said Grace McLaughlin, who is helping to lead that testing at the U.S. Geological Survey's National Wildlife Health Center.

For birds, H5N1 already is an epidemic in much of the world, and authorities fear it could finally reach birds in North America sometime in 2006. H5N1 is most lethal to poultry, and outbreaks originated from chickens in China, not from wild birds, said Ron A.M. Fouchier, a virologist at the Netherlands' Erasmus Medical Center who led the scientific review published recently in Science. [Global Patterns of Influenza A Virus in Wild Birds, http://www.sciencemag.org/cgi/content/full/sci;312/5772/384 Science 21 Apr 2006: Vol. 312. no. 5772, pp. 384-388]. The question is what role wild birds now play as the virus hops across continents. There's growing suspicion that international smuggling of contaminated live poultry or poultry products, such as fertilizer, may be playing a bigger role. But wild birds do play some role, Fouchier said, pointing to dead swans found in parts of Europe where no chickens were sick. What isn't clear is whether the swans were sentinel species, the victims that died after infection from a still unknown source, or were actual flu spreaders. In Europe during fall 2005, scientists spent 3 months testing 30 000 live wild birds and couldn't find the virulent H5N1 strain--but they did find it in 500 of 2000 dead birds tested, Fouchier said in calling for better global surveillance to quantify and understand flu strains in birds.

The US-based Wildlife Conservation Society is about to launch a global bird-testing network to help do that, said William Karesh, chief of the nonprofit group's field veterinary program. Meanwhile, as the U.S. steps up its effort to detect H5N1's arrival, Fouchier's review does provide some reassurance, McLaughlin noted: Over the years, there hasn't been much mixing of Eurasian and North American strains of bird flu. Nor do very many species fly from Asia into Alaska. Fouchier and colleagues in Sweden detailed global patterns of flu infections among wild birds, an analysis that suggests that climate and migratory patterns coincide to spur spread. Flu viruses like cold weather and cold water--ducks and other birds typically trade influenza through feces in ponds or lakes. Flu viruses can live more than 30 days in near-freezing water but for no more than 4 days in warm water. Migrating ducks in turn tend to have the most flu infection when young, immune-naive birds are congregating in early fall, to prepare for winter flight to warmer climates. (Promed 4/22/06)

^top


Europe/Near East
Afghanistan (Kapisa): Test confirms avian influenza H5N1 in fourth Afghan province
The H5N1 bird flu virus has been found in poultry in a fourth Afghan province, a UN agency said 25 Apr 2006. Results of tests on 103 samples sent to Italy early Apr 2006 showed that Kapisa province to the north east of the capital is also affected by the disease. The virus had been found already in samples from birds in Kabul, Logar and Nangarhar provinces. No human cases have been found. "According to the results, H5N1 highly pathogenic avian influenza (HPAI) cases have been definitely confirmed in 4 provinces: Kabul, Logar, Nangarhar and Kapisa," the UN Food and Agriculture Organization (FAO) stated. There are also strong suspicions that 2 other provinces--Laghman and Parwan--are affected, but further analysis is needed, it said. Afghanistan has 34 provinces. "Based on the currently available data, it seems that the disease is slowly spreading," FAO said. FAO was backing efforts to strengthen surveillance systems. Poultry has been culled and quarantine measures introduced in affected areas, but the spread of the virus among poultry is a concern in a country where many farmers and traders are illiterate and have little knowledge of the disease. (Promed 4/26/06)

^top

France: More swans test positive for avian influenza H5N1 infection
2 more swans have tested positive for the H5N1 strain of bird flu in France. The swans were found this week in Saint-Paul-de-Varax in the Ain region of southeast France, some 45 km from Lyon. A national laboratory confirmed they were infected with H5N1, the Ain region's prefecture said. Anti-bird flu protection and surveillance zones were put in place for 10 km around the spot where the 2 dead swans were found. The measures will be in place for a month. The Ain is the epicentre of French efforts to combat bird flu, recording 65 of the 66 cases of H5N1 found so far in 2006 in tests on more than 14 000 dead wild birds in France. The other case was in the Bouches-du-Rhone region further south. (Promed 4/22/06)

^top

Germany (Bavaria): Avian influenza H5N1 update in animals
For the year 2006 in Bavaria, 63 cases of avian influenza in wild birds have been confirmed by the Friedrich Loeffler Institute (FLI). During the week of 13 Apr 2006 - 21 Apr 2006, new cases were confirmed in Upper Bavaria (Gadwell duck, owl); Lower Bavaria (falcon) and; Schwabia (owl). So far in 2006, 6452 wild birds have been handed over to the Bavarian Agency for Health and Food Safety; 5698 of them have already [by 21Apr 2006] been tested for influenza A, and the 81 samples that were influenza A positive have been sent to FLI for further testing. FLI has confirmed 63 samples as H5N1 positive, 17 as H5N1 negative, and 1 has yet to be determined. In addition to avians, 277 carnivores (martens, foxes, cats) have been sent to the LGL; 269 have been tested for influenza virus. 1 influenza A positive sample has been forwarded to the FLI, where it was found H5N1 negative. (Promed 4/22/06)

^top

Germany (Brandenburg and Saxony): New cases of avian influenza H5N1 in wild birds
A white stork with avian influenza virus H5N1 was found in the administrative district of Maerkisch-Oderland. It is the first white stork discovered to have the virus. The carcass was found near Letschin. The particular strain of the virus is being investigated at the Friedrich Loeffler Institute (FLI). The number of avian influenza cases (within Brandenburg) has now risen to 19. Officials established a 3 km radius restricted area around the point of discovery. In addition, a 10 km radius observation area has been declared. This is the second discovery of an infected bird in Maerkisch-Oderland. The first case in Brandenburg arose late Feb 2006. The latest case prior to this stork occurred 11 Apr 2006 in the Dahme-Spreewald area (a dead wild goose). This carried the Asian variant of the H5N1 avian influenza virus.

Also, the first suspected case of avian influenza in a wild bird has been detected in the Free State of Saxony. The case involves a tufted duck (Aythya fuligula) from Bautzen. A sample was sent 25 Apr 2006 to the FLI and the test result revealed H5N1. Investigation is continuing to confirm whether it is the highly pathogenic form of the avian influenza virus. The necessary measures were taken in accordance with ordinances for a suspected case of wild bird avian influenza: a 3 km radius restricted area (21 day transport ban for poultry, birds and their products) has been established around the discovery point in area about the Bautzen dam and; a 10 km radius observation area (30 day transport ban for poultry and birds) has been declared around the discovery site. In both restricted areas, dog leashing is prescribed, and cats are required to stay indoors. (Promed 4/27/06)

^top

Jordan: Excerpts from the OIE report on avian influenza H5N1
Information received 16 Apr 2006 from Dr Fares Bakhit Naser, Director of Veterinary Department, Ministry of Agriculture: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of first confirmation of event: 23 Mar 2006. Since the last detection of highly pathogenic avian influenza virus subtype H5N1 in a turkey in a backyard flock at Kofranja in Ajloun governorate, 3 weeks have now passed. Control measures have been completed involving a stamping out policy with compensation for the destroyed poultry in a 3-km-radius zone around the infected backyard holding. Surveillance and control procedures have been undertaken in the 10-km-radius surrounding zone and no more cases have been detected. It is believed that the virus was introduced through migratory birds. An ongoing national surveillance programme for wild birds and domestic poultry has not detected any further infections. (Promed 4/21/06)

^top

The Netherlands: Policies regarding vaccination of poultry
Keepers of hobby poultry and free-range chickens may have their birds vaccinated against avian influenza. The vaccination plan applies from Mar to Jun 2006 for hobby poultry and from Mar 2006 to Jun 2007 for organic layers and free-range hens. On the first visit to the veterinarian, a blood sample will be taken, and the bird will be vaccinated and registered. On the second visit, 3 to 4 weeks later, a second vaccination will be given. On the third visit, the veterinarian will once again take a blood sample for testing. 3 weeks after the second vaccination, the birds may again go outdoors. Vaccination is voluntary and provides protection for a maximum of 1 year. The costs of vaccination are to be borne by the poultry keeper. The costs for the blood tests will be borne by the Ministry of Agriculture, Nature and Food Quality. Vaccination will take place at the location where the birds are housed. All birds must be older than 7 weeks, as they are then fully grown. Commercial poultry farmers may only have their free-range laying hens vaccinated. Hobby poultry keepers may only vaccinate chickens, turkeys, ducks and geese.

Vaccination is an alternative to keeping the birds indoors or under cover and is one of the ways of controlling the risk of infection and spread of avian influenza. Poultry farmers who do not wish to have their flock vaccinated must continue to keep their birds indoors or under cover until the ban is lifted. Vaccination does not guarantee that birds will not be culled if an outbreak occurs. But culling will only take place if absolutely necessary, in order to prevent further spread of the disease. The Ministry of Agriculture, Nature and Food Quality has ensured that vaccine is approved and available: 4 million doses of Gallimune Flu H5N9 from supplier Merial. The holdings with vaccinated birds and holdings with non-vaccinated birds must be separated. No poultry, day-old chicks and hatching eggs originating from holdings where vaccinated birds are kept may be moved without authorization. Eggs, other than hatching eggs, and poultry meat from vaccinated holdings may be traded freely in the Netherlands. Their transport to other Member States is subject to certain conditions. Manure from vaccinated holdings may not be moved abroad. In principle, no vaccinated hobby poultry, day-old chicks and hatching eggs may be moved.

It is important to carry out intensive monitoring where preventive vaccination is carried out, as it is very difficult to detect infection with the AI virus in vaccinated birds. The European Commission considers the Dutch vaccination plan as a pilot, as little practical experience has so far been gained with preventive vaccination of poultry against H5N1. The Netherlands is to submit an evaluation on the implementation and effectiveness of the vaccination by the end of June 2006. Reportedly, during about 3 weeks since the start of the vaccination scheme, 1530 hobby-bird holdings and 2 commercial farms registered for vaccination, and 1007 vets in 321 practices sent their registration forms to carry out vaccinations. (Promed 4/23/06)

^top

Turkey: Excerpts from the OIE report on avian influenza H5N1
Information received 14 Apr 2006 from Dr Huseyin Sungur, Director General, General Directorate of Protection and Control, Ministry of Agriculture and Rural Affairs: Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 15 Dec 2005. New outbreaks: 2 villages in Kars (90 cases and deaths) and Yozgat (4 cases and deaths) provinces report outbreaks in backyard poultry flocks. Source of new outbreaks: contact with infected animal(s) at grazing/watering and contact with wild animals. Between 15 Dec 2005 and 14 Apr 2006, a total of 2 503 516 poultry within the outbreaks and around the outbreaks were culled. Between 6 and 14 Apr 2006, 20 outbreaks in 5 provinces were eradicated. Kars--RT-PCR positive for H5N1 in a goose; Yozgat--RT-PCR positive for H5N1 in a chicken and goose. (Promed 4/21/06)

^top

UK (Scotland): Some restrictions lifted in Fife
Some bird flu restrictions, imposed after a dead whooper swan in Fife tested positive for H5N1 virus, have been lifted. The measures, limiting the movement of poultry and eggs in parts of eastern Scotland, were introduced 5 Apr 2006. Tests since then have established that no further cases have been found. The immediate 3-km protection zone will lapse, but a 10-km control zone on the movement of poultry and captive birds will not be removed until 1 May 2006. The final restrictions will only be lifted if there are no further positive tests for the virus. So far tests for the virus on all dead birds across Scotland have proved negative. Vets now believe the swan which had the virus died before it could spread the disease. Restrictions followed and local farms were warned not to transport poultry or eggs in or out of the area. ***Correction: The reference to routine use of prophylactic vaccination in poultry was inaccurate. Vaccination is prohibited (reported previously in Promed and EINet’s 21 Apr 2006 Newsbrief). (Promed 4/21/06, 4/22/06)

^top

UK (Norfolk): Avian influenza H7 suspected in poultry
Chickens found dead on a farm near Dereham, Norfolk in east England were infected with bird flu, the government has said. The flu "is likely to be the H7 strain of avian influenza, and not H5N1," the Department for Environment Food and Rural Affairs said. The farm is in Hockering, 13 miles west of Norwich. Norfolk is one of the main centres of Britain's poultry industry, with around 300 farms in the county. The farm has been quarantined and its remaining birds are being slaughtered. Debby Reynolds, the UK's chief veterinary officer, said the source of the flu strain was not yet known and she expected more test results over the next 24 hours. "Those results will allow us to decide whether it's the highly pathogenic dangerous form to birds, which kills a lot of birds, or the low pathogenic which is a much less serious infection," Reynolds said. The slaughter of as many as 35 000 chickens on the affected farm was a "highly precautionary" measure to avoid a spread of the disease, Reynolds said. Britain last saw an infection of H7 avian flu in 1987. Although the strain is not considered to be as dangerous as H5N1, it is still considered a risk. A 2003 epidemic in the Netherlands resulted in 89 human infections and 1 related death. (Promed 4/27/06)

^top


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 (DAHP): Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 20 Mar 2006. Details of outbreaks: An outbreak in Kompong Speu (Tuol Prich) killed 402 backyard chickens and another outbreak in Kompot (Kamakor) 76 backyard ducks and free-ranging ducks. (Kompong Speu is a large province which is home to the capital, Phnom Pnen and Kompot is to the south, bordering the gulf of Thailand.) Diagnostic tests: RT-PCR. Results positive for H5N1. (Promed 4/21/06)

^top

China: 18th human case of avian influenza H5N1 infection
As of 27 Apr 2006, the Ministry of Health reported the country's 18th case of human infection with the H5N1 avian influenza virus. The patient is an 8 year old girl from the south western province of Sichuan. She developed symptoms of fever and pneumonia 16 Apr 2006. She remains in hospital. According to the Ministry of Health, an initial investigation determined that poultry deaths recently occurred near the child's home. Of the 18 laboratory-confirmed cases in China, 12 have been fatal. Human cases of H5N1 avian influenza virus infection have now been recorded in 10 of the administrative units: Anhui, Guangxi, Liaoning, Jiangxi, Fujian, Hunan, Sichuan, Guangdong, Shanghai, and Hubei. There have been more than 30 outbreaks in poultry in a dozen provinces over the past year in China, making it one of the countries worst-hit by a virus that has spread with surprising speed this year. (Promed 4/27/06)

^top

India (Maharashtra): No confirmation of human cases of avian influenza H5N1 infection
The state government of Maharashtra said 24 Apr 2006 the Akola-based veterinary surgeon involved in culling operations in Jalgaon in Maharashtra had died of jaundice and not bird flu as reported by the press. The victim was apparently suffering from high fever for some time. State animal husbandry department commissioner Bijay Kumar assured that there was no reason for anybody to believe that the deceased doctor died after getting infected with the H5N1 virus. "Since he was involved in the culling process, people are relating his death with bird flu. There is still no case of bird flu infection in human beings in the country," he said. According to the animal husbandry commissioner, the 3 samples from the deceased sent to National Institute of Virology, Pune, have been declared negative. (Promed 4/26/06, 4/27/06)

^top

Indonesia (Bali): Ducks positive for avian influenza, hundreds culled
Hundreds of ducks have been culled on Indonesia's Bali island, after samples tested positive for the H5N1 bird flu virus, a senior veterinarian said 26 Apr 2006. The birds were culled in Gianyar regency on the popular tourist island and came from a farm and its surrounding areas. "We burned 432 ducks yesterday; 392 of them came from that farm while the rest were owned by surrounding residents," Dewa Nyoman Raka Jaya, head of Gianyar's animal husbandry office, said. "We assumed that all of them had the bird flu virus because all of the samples were positive." In another newswire, 25 Apr 2006, it was said that the birds had been smuggled to Bali from neighboring Java island and that initial tests showed that 16 of almost 400 ducks seized at a house on Bali had the bird flu virus. In Indonesia, the H5N1 virus has been reported in birds in most of the country's 33 provinces, and there have been previous cullings in Bali. No human cases have been reported on the island. WHO has confirmed 24 human deaths in Indonesia from the virus from a total 32 confirmed cases, the majority in and around the capital Jakarta.

Regarding an earlier news report from Lampung of a suspected cluster of human avian influenza cases (8 members of 1 family), an investigation has ruled out H5 as a cause in this cluster. "The Ministry of Health may report more fully, but in brief, the full investigation has ruled out H5 as a cause of illness in this cluster in Lampung," Graham Tallis, a WHO medical epidemiologist in Indonesia, said. (Promed 4/21/06, 4/26/06; CIDRAP 4/21/06 http://www.cidrap.umn.edu/)

^top

Pakistan: Over 40 000 birds culled following avian influenza outbreaks; no human cases
Authorities in Pakistan have culled over 40 000 birds following outbreaks of H5N1 avian influenza strains at about 13 poultry farms on the outskirts of the capital city. Official sources said 23 Apr 2006 that blood samples tested at the National Reference Laboratory (NRL) have confirmed the presence of bird flu at about 13 poultry farms in Tarlai and Alipur Farash areas. This brings the total number of affected farms in Tarlai and Alipur Farash to 13. Reportedly, over 40 000 birds have been culled and the culling is still continuing. 5 more farms with suspected H5N1 strains have been reportedly quarantined and samples have been sent to the NRL for confirmation. The Health Ministry and Livestock commissioner confirmed H5N1 strains at only 6 farms and mild strains of H5 at 12 poultry farms in the 2 areas. Pakistan reported its first outbreak of H5N1 in North-West Frontier Province Feb 2006. There were also reports of suspected human cases, but an official statement said 23 Apr 2006 that 49 samples collected from suspected human cases tested negative. (Promed 4/23/06)

^top


Africa
Cote d'Ivoire: Excerpts from the OIE report on avian influenza H5N1
Information received 25 Apr 2006 from Dr Denis Kouakou, director of veterinary services and quality, Ministry of Animal Production and Fish Resources. Identification of agent: highly pathogenic avian influenza virus subtype H5N1. Date of start of event: 30 Mar 2006. 2 outbreaks of highly pathogenic avian influenza have been reported in Abidjan district (Marcory Anoumabo and Treichville communes), in Lagunes region. The animals affected are traditional backyard free-ranging chickens (7 cases) and ducks (9 cases) and 1 sparrowhawk. The diagnosis has been established by the Central Veterinary Laboratory of the LANADA (National Laboratory for Agricultural Development Support) at Bingerville and by Pasteur Institut of Cote d'Ivoire. The confirmation of the OIE reference laboratory in Italy is expected. In addition to other measures, there has been an implementation of an infected zone around the outbreak in Marcory Anoumabo and a surveillance zone in the district of Abidjan.

H5N1 avian influenza has now been reported from Nigeria, Niger, Cameroon, Burkina Faso, and now Cote d'Ivoire from West Africa. Birds of prey (like the sparrowhawk) have been reported several times for H5N1, including recently in Germany, and there was a report of H5N2 in a hawk in Kuwait in 2005. (Promed 4/27/06)

^top

Sudan: Excerpts from the OIE report on avian influenza H5N1
Information received 19 Apr 2006 from Dr Ahmed Mustafa Hassan, Undersecretary, Federal Ministry of Animal Resources: Report date: 18 Apr 2006. Identification of agent: highly pathogenic avian influenza virus subtype H5. Highly pathogenic avian influenza has never been reported before in Sudan. Date of start of event: 25 Mar 2006. Details of outbreaks: 2 outbreaks in Khartoum resulted in 27 000 and 35 000 poultry cases and deaths. A smaller outbreak in Gezira province resulted in 1400 cases and deaths in poultry in both closed and backyard systems. Khartoum and Gezira States are the most highly populated States in Sudan. Both States are situated at the centre of the country. As they are highly populated areas there are many poultry farms. Most of the farms are small units with capacities ranging from 1000-50 000 birds. In addition there are 6 intensive system farms with a capacity of around 250 000 birds. The backyard system is practiced in rural areas all over the country. The poultry industry in urban areas in Sudan is highly dependent on importation of hatching eggs and day-old live poultry from various sources. Since the start of the current reports of avian influenza in many countries in Asia, Europe and the Middle East, Sudan has implemented a harmonized action plan involving all stakeholders (veterinary authorities, public health authorities and poultry producers). Diagnostic test results: rapid test positive for H5. (Promed 4/21/06)

^top


1. Updates
Influenza
Seasonal influenza activity for the APEC Economies
WHO’s surveillance information has not been updated since the 12 Apr 2006 report. Please see EINet’s 14 Apr 2006 Alert for further details.

USA. During week 16 (Apr 16 – 22, 2006), influenza activity continued to decrease in the US. 193 specimens (11.0%) tested by U.S. WHO and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) was below the national baseline. The proportion of deaths attributed to pneumonia and influenza was below the baseline level. 6 states reported regional influenza activity; 11 states and the District of Columbia reported local influenza activity; 31 states and New York City reported sporadic influenza activity; and 2 states reported no activity. (CDC 4/28/06 http://www.cdc.gov/flu/weekly/ )

Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html. Includes document: “Infection control recommendations for avian influenza in health-care facilities”.
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. A new table provides information on influenza vaccine manufacturers and suppliers.
- 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/avian/index.htm.
- The US government’s web site for pandemic/avian flu: http://www.pandemicflu.gov/. Latest updates on U.S. State Summits are available. Read the article, “HHS Assistant Secretary Simonson Travels to Bangladesh and India to Enhance Planning for a Potential Influenza Pandemic.”
- 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. Contains recently updated “Avian influenza backgrounder:”
- US Geological Survey, National Wildlife Health Center 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; AVMA; USGS)

^top


2. Articles
CDC EID Journal, Volume 12, Number 5—May 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 5—May 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. An expedited influenza article is available online: H5N1 Influenza A Virus and Infected Human Plasma, S. Chutinimitkul.

^top

Special Science issue on avian influenza
The 21 Apr 2006 (Vol 312) special issue of the journal Science is dedicated to Influenza (http://www.sciencemag.org/cgi/content/short/312/5772/379 ). In a review titled "Global Patterns of Influenza A Virus in Wild Birds", Bjorn Olsen et al. discuss available data and identify important gaps in the current knowledge regarding H5N1 in wild birds. Other articles in this issue include:

- Research Articles: “Structure and Receptor Specificity of the Hemagglutinin from an H5N1 Influenza Virus”
- Reports: “Synchrony, Waves, and Spatial Hierarchies in the Spread of Influenza”
- Brevia: “H5N1 Virus Attachment to Lower Respiratory Tract”
- Editorial: “Early Diagnosis of Avian Influenza”
- News: “A One-Size-Fits-All Flu Vaccine?”
- News: “Oseltamivir Becomes Plentiful--But Still Not Cheap”
- Perspective: “Emergence of Drug-Resistant Influenza Virus: Population Dynamical Considerations”
- Perspective: “Predictability and Preparedness in Influenza Control”
- Perspective: “Host Species Barriers to Influenza Virus Infections”

Another comprehensive source of current information on avian influenza and human disease is available at the CIRAP web-site under the heading "Avian Influenza (Bird Flu): Implications for Human Disease". This document can be accessed at: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/biofacts/avflu_human.html.
(Promed 4/22/06)

^top

Study cites gaps in Europe's influenza pandemic plans
European countries' plans for coping with an influenza pandemic are generally good but have a number of gaps, including a lack of detail on distribution of drugs and supplies, according to an analysis published last by The Lancet. The analysis of plans prepared by 21 countries gave them average scores of 54% for completeness and 58% for quality. The report was prepared by Sandra Mounier-Jack, MSc, and Richard J. Coker, MD, of the Department of Public Health and Policy at the London School of Hygiene and Tropical Medicine. "Governmental commitment in most European countries is strong, and levels of preparedness are broadly good," the authors wrote. "However, gaps in preparedness planning remain, and substantial variations exist between countries, with important implications for the region and nation states. Improved cooperation between countries may be needed to share experience, and to ensure coherence of approaches."

The researchers checked the plans of 25 EU members, plus those of Norway, Switzerland, Bulgaria and Romania. Only the 21 plans published between Jan 2002 and Nov 2005 were included in the analysis. In their analysis, the authors used 47 essential criteria and looked at 7 thematic areas: planning and coordination, surveillance, public health interventions, health system response, maintenance of essential services, communication, and "putting plans into action." They found the plans generally good in the areas of surveillance, planning and coordination, and communication. But the plans were "probably inadequate" when it came to maintenance of services, putting plans into action, and public health interventions. Some specific problems found:

• Details on the distribution of antiviral drugs, vaccines, masks, and other medical supplies were missing from the plans, and none included estimates of quantities needed.
• Except in Eastern Europe, most plans didn't mention the need for collaboration with neighboring countries.
• Few countries specified which institutions would handle triage.
• 7 plans didn't address the need to prepare for maintaining essential services during a pandemic.
• Most countries did not discuss the potential role of the media.
• Aside from an EU-wide exercise in 2005, only 3 countries have tested their plans in national simulation exercises.
• 18 plans recommend that people exposed to the pandemic virus receive preventive antiviral treatment, and 13 plans offered guidance on who should have priority for that. But none of the plans spell out how members of priority groups will be identified.
• While most of the plans discussed public health interventions such as closing schools and restricting public gatherings, many of them were unclear about when, in terms of WHO’s pandemic phases, such interventions would be used.

All but Portugal's plan had a strategy for use of a vaccine, and 14 of the 21 plans call for immunizing the entire population if vaccine is available. Most plans called for vaccinating healthcare workers first, essential service workers second, and people at risk for serious flu complications third. The article says WHO has suggested that travel restrictions are unlikely to help much and are mostly impracticable, yet 15 of the 21 plans included some kind of travel restriction. The scores for completeness ranged from 24% to 80%, while quality scores ranged from 27% to 86%. Countries with the most complete plans, the report says, were France, Germany, Ireland, the Netherlands, Sweden, Switzerland, and Britain. In the middle range were Austria, Denmark, Estonia, Greece, Norway, Slovakia, and Spain. Those with the least complete plans were Czech Republic, Italy, Latvia, Lithuania, Romania, Poland, and Portugal. The authors cautioned, "The completeness of plans could show simply the attention paid to drafting rather than preparedness. Countries may be prepared in areas that are not mentioned in their plans.”

Mounier-Jack S, Coker RJ. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet 2006 (early online publication Apr 20)
(CIDRAP 4/24/06 http://www.cidrap.umn.edu/ )

^top

 apecein@u.washington.edu