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EINet Alert ~ May 12, 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)
- Pan-Europe: Migratory birds return to Europe without avian influenza virus
- Denmark: Excerpts from the OIE report on avian influenza H5N1; restrictions removed
- France: Excerpts from the OIE report on avian influenza H5N1
- Germany: Avian influenza H5N1 update in animals
- Switzerland: Excerpts from the OIE report on avian influenza H5N1
- UK: Avian Influenza H7N3 in poultry (excerpts from the OIE report)
- China (Qinghai): 17 wild birds reportedly infected with avian influenza H5N1
- Indonesia : 33rd case of human infection with avian influenza H5N1
- Pakistan: 2 more poultry farms hit by avian influenza H5N1
- Russia (Novosibirsk): Poultry reportedly killed by avian influenza H5N1
- Cote d'Ivoire: Suspected human case of avian influenza H5N1 infection
- Djibouti: Confirmation of human infection with avian influenza H5N1
- Nigeria: Spread of avian influenza H5N1 appears to be declining
- Viet Nam: Possible avian influenza transmission via the gastrointestinal tract
- H5N1 Influenza A Virus and Infected Human Plasma
- Study suggests older antivirals could help fight H5N1
- Sanofi reports results for H5N1 vaccine with adjuvant
- Delaying the International Spread of Pandemic Influenza
- FAO/OIE International Conference on Avian Influenza & Wild Birds
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 208 (115)
Pan-Europe: Migratory birds return to Europe without avian influenza virus
Migratory birds that flew south to Africa last autumn and then back over Europe in recent weeks did not carry the H5N1 flu virus or spread it during their annual journey, scientists concluded. Health officials had feared that the disease was likely to spread to Africa during the winter migration and return to Europe with a vengeance during the reverse migration this spring. That has not happened - a significant finding for Europe. In Europe, there have been only a handful of cases detected in wild birds since Apr 1, 2006, at the height of the northward migration. The number of cases in Europe has decreased so dramatically compared to Feb 2006, when dozens of new cases were found daily, that experts believe the northward spring migration played no role. Agriculture officials in many European countries have this month lifted restrictions designed to protect valuable domestic poultry from infected wild birds. In early May 2006, both the Netherlands and Switzerland rescinded mandates that poultry be kept indoors. Austria has loosened similar regulation and France is considering doing so. [However, the EU has also decided to extend strict safety measures to guard against the spread of the bird flu virus, acknowledging that the danger has not yet passed. EU experts endorsed a plan to prolong surveillance of poultry farms and restriction on the movement and sale of poultry in high-risk areas until late Jul 2006. France received permission to continue vaccinating birds.] The February cases in Europe were attributed to infected wild birds that traveled west to avoid severe cold in Russia and Central Asia but apparently never carried the virus on to Africa.
Juan Lubroth, a senior veterinary official at the UN Food and Agriculture Organization, said, "Perhaps it is because it was not as bad as we feared, or perhaps it is because people took the right measures.” Specialists from Wetlands International, who were deputized by the UN FAO, sampled 7,500 African wild birds last winter. They found no H5N1, Ward Hagemeijer, an avian influenza specialist with Wetlands International, said, so it is not surprising that H5N1 did not return to Europe with the spring migration. Mr. Hagemeijer thinks that the virus's strength among wild birds may have weakened as the southward migration season progressed. That probably limited its spread to Africa, he said. Many avian influenza viruses are picked up by migratory birds in their nesting places in northern lakes during the summer and autumn breeding season. As the months pass, the viruses show a decreasing pattern of spread and contamination. "So it tends to be mostly a north-to-south spread, and then it wanes," he said. Still, this means that the cycle could well start again this summer, if the H5N1 virus has persisted in those breeding areas. (Promed 5/6/06, 5/10/06)
Denmark: Excerpts from the OIE report on avian influenza H5N1; restrictions removed
On 8 May 2006, the protection and surveillance zones in Funen County were removed. There are no more protection and surveillance zones in Funen County. On 5 May 2006, the protection and surveillance zones in Storstrom County were removed. There are no more zones in Storstrom County. On 4 May 2006, the following zones were removed: Protection and surveillance zones in Frederiksborg County. There are no more zones in Frederiksborg County; Protection and surveillance zones surrounding Sonderborg and Kegnaes in South Jutland County were also removed. On 2 May 2006, the Danish Veterinary and Food Research Institute detected high pathogenic avian influenza (H5) in a great crested grebe (Podiceps cristatus), which was found in South Jutland County. Between 14 Mar 2006 -- when the first HPAI H5-infected wild bird (a Common buzzard) was confirmed in Denmark -- and 2 May 2006 -- when the (so far) last case was confirmed (a great crested goose) – the Danes identified a total of 43 infected wild birds. 716 dead wild birds were tested for the presence of avian influenza at the Danish Veterinary and Food Research Institute during the first 3 months of 2006. The latest news about avian influenza detected in wild birds in Denmark can be accessed on the Danish Veterinary and Food Administration's website: <http://www.uk.foedevarestyrelsen.dk/AnimalHealth/Avian_influenza/Latest_news/forside.htm> (Promed 5/6/06, 5/10/06)
France: Excerpts from the OIE report on avian influenza H5N1
Germany: Avian influenza H5N1 update in animals
Municipality / Administrative or City District / State / Species
Switzerland: Excerpts from the OIE report on avian influenza H5N1
UK: Avian Influenza H7N3 in poultry (excerpts from the OIE report)
Also, information received (and up to) 2 May 2006 from Dr Debby Reynolds: Date of start of event: 30 Mar 2006. Following the completion of a programme of veterinary inspections on all premises with poultry in the "wild bird surveillance zone" and taking account of epidemiological advice, restrictions were lifted 1 May 2006. The restrictions in the associated "wild bird risk area" were lifted simultaneously. All restrictions have therefore been lifted and the incident is now considered closed. (Promed 5/5/06, 5/6/06)
China (Qinghai): 17 wild birds reportedly infected with avian influenza H5N1
The Ministrty of Agriculture confirmed 5 May 2006 another case of bird flu outbreak among wild birds in a remote area of Qinghai Province. 17 bar-headed geese were found dead on a wetland in Yushu County 23 Apr 2006 (the area is reportedly said to be uninhabited with no domestic birds). The number of dead wild birds had risen to 125 by 4 May 2006, of which 123 were bar-headed geese, the ministry said. The national bird flu laboratory confirmed that the dead birds had tested positive for the H5N1 strain. The province's veterinary departments has sterilized the area and is keeping a close eye on any new cases. Nearby livestock have been transferred to summer pastures far from the outbreak location. Local authorities have demanded local herdsmen keep a distance from the dead birds to prevent the virus from infecting human beings. The outbreak is the second case found in the province in a month after a dead bar-headed goose in Gangcha County was found carrying the virus 29 Apr 2006. Reportedly, the mainland and Hong Kong will host a joint exercise to test their ability to cope with the flu pandemic.
Qinghai has become a major focus for studying the H5N1 virus. A year ago, scientists believe a mutated form of the virus killed thousands of wild birds at Qinghai Lake, a major stop-off point for migratory birds. Soon after the mass die-off of birds in Apr and May 2005, the virus spread West to Europe and then to the Middle East and Africa, underscoring the importance of monitoring what's happening at the lake, and elsewhere in China. WHO says the Qinghai Lake form of the H5N1 virus is almost identical to the strain found in recent outbreaks in Nigeria, Iraq and Turkey. Prior to the Qinghai Lake event, H5N1 was known to cause occasional sporadic deaths in migratory waterfowl, but not to kill them in large numbers or be carried by them over long a distance, WHO has said. China has reported almost 40 outbreaks of bird flu in poultry across a dozen provinces over the past year. Health experts see the country as being particularly at risk because of its huge human population and many poor, remote areas. As in many other parts of Asia, poultry often live near humans in China, increasing the risk of transmission from poultry to people.
"Animal surveillance remains extremely important and there is probably even greater need for enhanced surveillance now because although reports of animal outbreaks are on the decrease, we are still seeing human cases," Julie Hall, WHO's China bird flu coordinator, said. China was being a lot more open with sharing information and samples, she added, even if there remained areas of concern. In Mar 2006, WHO said that China had agreed to share virus samples from outbreaks in poultry to meet a request the country go beyond sending samples collected from people and help global efforts to limit the spread of the disease. "The Ministry of Agriculture is in the process of catching up in terms of what has not been shared for a year to 18 months. We hope that this is a sign that in the future there will be more timely and easier sharing of information and viruses," Hall said.
Indonesia : 33rd case of human infection with avian influenza H5N1
Elsewhere, in Myanmar, British and Australian avian flu experts plan to spend 2 months increasing public awareness and combating the spread of the disease, according to another AFP report. Their visit to the central Myanmar farmlands comes after the region experienced more than 100 outbreaks in March.
Pakistan: 2 more poultry farms hit by avian influenza H5N1
Russia (Novosibirsk): Poultry reportedly killed by avian influenza H5N1
Cote d'Ivoire: Suspected human case of avian influenza H5N1 infection
Health and government officials in Cote d'Ivoire have announced a range of measures to stamp out bird flu after the discovery of at least 3 outbreaks in Abidjan. Minister of animal production and fish resources, Alphonse Douaty, said veterinarians are to cull all poultry in markets through the city as the government prepares a system for reimbursement. The ministry was also planning to inspect industrial poultry farms and issue a stamp of approval to reassure costumers. The city's 4 million people will be able to call a free hotline. Douaty said the government needed at least 6 billion CFA, or 11 million US dollars, to compensate poultry farmers. The first cases of bird flu were reported 26 Apr 2006 by the World Organization for Animal Health (OIE), but the Ivorian government only this week issued official confirmation. The latest of the 3 outbreaks was found in domestically kept chickens in the populous suburb of Yopougon. Reportedly, several people in the area were being monitored for potential human infections of the H5N1 avian virus. (Promed 5/7/06)
Djibouti: Confirmation of human infection with avian influenza H5N1
Also, Sudan reported to the OIE 8 May 2006 as follows: "A new outbreak has been identified at Atbara, in River Nile State, 250 km to the north of Khartoum. New outbreaks have also been reported in Gezira State in 4 poultry farms located 40-50 km to the south of Khartoum town.
Nigeria: Spread of avian influenza H5N1 appears to be declining
USA. Influenza activity in the US peaked in early March and continued at low levels during week 18 (April 30 – May 6, 2006). 93 specimens (8.9%) 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 threshold level. 5 states reported local influenza activity; 38 states, the District of Columbia, New York City, and Puerto Rico reported sporadic influenza activity; and 7 states reported no activity.
(CDC 5/12/06 http://www.cdc.gov/flu/weekly/ )
Avian/Pandemic influenza updates
Viet Nam: Possible avian influenza transmission via the gastrointestinal tract
Avian influenza may be capable of invading people through the gut, not just the respiratory system, and diarrhea is sometimes the first symptom, said virologist Menno de Jong, whose team observed 18 cases in Viet Nam. Particles of the H5N1 virus contained in the meat and blood of infected poultry may have been ingested by some patients, possibly causing their infection, said De Jong, who is head of the Virology Department at the Oxford University Clinical Research Unit in Ho Chi Minh City. "In a number of patients the only exposure risk has been drinking raw duck blood," De Jong said. "That could imply that the gastrointestinal tract is also a route of transmission or a route of first infection, and there are experiments in animals" that suggest this. If live virus particles are carried outside the lungs and surrounding tissues to other parts of the body, some antiviral treatments such as inhaled zanamivir, marketed by GlaxoSmithKline Plc as Relenza, may not be effective treatments, De Jong said. GlaxoSmithKline, Europe's biggest drugmaker, is developing an intravenous form of Relenza, Nancy Pekarek, a U.S. spokeswoman for the company, said. Scientists are still formulating the compound, and testing in people hasn't started, she said.
In uncomplicated cases of seasonal influenza, disease is limited to infection in the nose, throat and lungs. In contrast, H5N1 was observed to have caused encephalitis, or swelling of the brain, in 1 patient in Viet Nam, De Jong said. Virus particles collected from numerous sites could be cultured, including from the throat, rectum, blood and cerebralspinal fluid, he said. De Jong said it is possible H5N1 may be replicating in the gastrointestinal tract after the virus was cultured from a rectal swab in a patient who had diarrhea. For some patients, the gastrointestinal tract may have been the initial site of infection, possibly after the consumption of raw chicken or raw duck products, he said. Some scientists said survival of flu particles in the gut would be difficult because of enzymes and bile that break down fats in the process of food digestion. Flu particles are enveloped by a layer of lipids or fats. (Promed 5/9/06)
H5N1 Influenza A Virus and Infected Human Plasma
Virologist Menno de Jong and colleagues, at Oxford University's Clinical Research Unit at the Hospital for Tropical Medicine in Ho Chi Minh City, said his group has found viral RNA in the blood of about half of the H5N1 patients in which they've looked for it. "It was really surprising for influenza, because the case reports of human influenza and viremia are so rare," he said. "It's probably quite common in H5N1 infected patients." That poses challenges for treating patients infected with H5N1, because if the virus is spreading through the blood, so too must drugs that aim to combat the infection. Currently there are only 4 flu antivirals on the market and one, zanamivir (sold as Relenza) is administered to the respiratory tract by inhalation. The drug would need to be formulated in an injectable form to be useful for systemic infection, Dr. de Jong said. It also raises concerns about infection control for health-care workers and laboratory scientists coming in contact with the blood of H5N1 patients.
The findings also raise questions about whether blood transfusions could be a source of infection if H5N1 became a pandemic strain. Canadian Blood Services and the American Red Cross have been studying the issue, but currently it is believed that the risk is low, because flu’s incubation period is so short. Once people develop symptoms they would be unlikely to want to give blood and would probably be turned away if they showed up to a blood-donor clinic. "From the blood-donor and blood-supply point of view, the issue would be whether there's virus in the blood before the patient becomes ill," said Dr. Jeffrey McCullough. (Promed 5/5/06)
Study suggests older antivirals could help fight H5N1
The study was done by scientists from the University of Hong Kong; Shantou University in China; St. Jude Children's Research Hospital in USA; and the Center for Indonesian Veterinary Studies in Jakarta. Chung Lam-Cheung and colleagues analyzed the genetic sequences of the M2 ion channel protein of 638 H5N1 viruses, including 599 from birds and 39 from humans. Most of the isolates came from Hong Kong, China, Vietnam, Thailand, and Indonesia, with a few from Cambodia, Malaysia, Japan, and Korea. The sequences were screened for 4 mutations predicted to confer amantadine resistance. Data in the report show that 92.6% (162 of 175) of the Vietnam isolates had resistance mutations, as did all the isolates from Thailand (58 of 58), Cambodia (9 of 9), and Malaysia (2 of 2). In contrast, only 13% (16 of 123) of the isolates from China and 6.3% (2 of 32) of those from Indonesia had such mutations. None of the 8 isolates from Japan and Korea, collected from poultry in late 2003, showed resistance.
"Although amantadine-resistant H5N1 viruses are present in Asia, their distribution appears to be largely limited to Thailand, Vietnam, and Cambodia," the report states. "That most H5N1 isolates from China and Indonesia are sensitive to amantadine is striking and perhaps surprising, in view of the reportedly widespread administration of amantadine to farmed poultry in some countries." Amantadine and rimantadine have been used in treating human flu for more than a decade. However, flu viruses can quickly become resistant to the drugs, because just 1 point mutation is required. Last January, US CDC advised physicians to stop prescribing the drugs for the rest of the flu season because the predominant strain of influenza A had turned highly resistant to them.
Sanofi reports results for H5N1 vaccine with adjuvant
Each patient received the vaccine on the first day of the study and 21 days later. All patients were assessed on day 21 and day 42 for immune response. On day 42, of those receiving 30-mcg doses with adjuvant, 67% were seropositive (95% confidence interval, 52% to 79%), compared with 52% of the 30-mcg group without adjuvant. Percentages for both 15-mcg groups were 44%, and those for the 7.5-mcg groups were 43% and 28% without and with an adjuvant, respectively. In the US study published Mar 2006, 451 adults received 2 doses of 7.5, 15, 45, or 90 mcg of another H5N1 vaccine made by Sanofi, all without an adjuvant. Of the 99 volunteers who received two 90-mcg doses, 54% developed H5N1 antibodies. This compared with 43% in the 45-mcg group, 22% in the 15-mcg group, and 9% in the 7.5-mcg group. The vaccine was based on a different human isolate of H5N1 than the one used in the French study.
In the new study, some seroconversion was evident in each of the groups at day 21, after only 1 dose of the vaccine was administered. The patients had no serious adverse events, few severe reactions, and no oral temperatures higher than 38°C. In an accompanying commentary, however, Suryaparkash Sambhara from CDC and Gregory A. Poland of the Mayo Clinic write that the study results, though more promising than in the earlier US study, leave much to be desired. "The results of these two early clinical trials,” they write, “clearly indicate that we still do not have a highly immunogenic vaccine to use against H5N1 influenza.” They cite the following factors: It is unknown whether the antibodies induced by the vaccine would sufficiently protect people from a pandemic virus. No published reports indicate how this "clade 1" vaccine will cross-react with other H5N1 subtypes. The regimen of two 30-mcg doses is still high and would limit the number of doses available at current manufacturing capacity. No data exist on the vaccine’s effect on immunocompromised people. According to the study’s authors, “In a pandemic situation, the aim will be to immunize a maximum number of people to protect them against mortality and severe disease. The level of postvaccination antibodies needed to achieve this protection is not known. Limited manufacturing capacity implies the need to adapt dose-sparing strategies. The challenge, therefore, is to find the appropriate compromise between individual protection and protection from a population perspective.”
Delaying the International Spread of Pandemic Influenza
FAO/OIE International Conference on Avian Influenza & Wild Birds
The Food and Agriculture Organization of the UN (FAO) and the World Organisation for Animal Health (OIE) are organizing the FAO/OIE International Scientific Conference on Avian Influenza (AI) and Wild Birds to be held in Rome, Italy 30-31 May 2006. The venue of the Conference is FAO Headquarters. For more information: http://www.fao.org/ag/AI-Conference. For practical reasons, FAO/OIE are unable to make open invitations, but if you are interested in participating, please contact us before 11 May 2006, 1200 hours local time at
For more information, contact: Willem Schoustra, Avian Influenza Consultant