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EINet Alert ~ Jun 09, 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: Global avian influenza pledge money slow to arrive
- Global: SOM meeting on avian influenza and human pandemic preparedness
- Pan-Europe: Revised ECDC Risk Assessment
- Denmark: Excerpts from the OIE report on low pathogenic avian influenza H5
- Greece: Update on avian influenza surveillance findings
- Romania: Poultry culled after report of another avian influenza outbreak
- Pan-Asia: APEC Pandemic Response Exercise 2006
- China: Dead poultry attributed to avian influenza H5N1; transparency concerns
- Indonesia: 4 suspected human cases of H5N1 infection test negative
- Indonesia: 49th human case of avian influenza H5N1 infection
- USA: CDC updates advice on avian influenza testing, lab work
- USA: Vical Inc. gets funds for work on avian influenza DNA vaccine
- Egypt: Update on avian influenza H5N1 situation; import of avian influenza vaccines
- Djibouti: Excerpts from the OIE report on avian influenza H5N1
- Niger: New avian influenza outbreak near Nigeria
- Avian/Pandemic influenza updates
- CDC EID Journal, Volume 12, Number 6—Jun 2006
- Science and Technology Adviser to the Secretary of State to address Second Bird Flu Summit
4. APEC EINet activities
- APEC EINet team to participate in Pacific Health Summit
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: 225 (128).
Global: Global avian influenza pledge money slow to arrive
Global: SOM meeting on avian influenza and human pandemic preparedness
The ongoing spread of the animal virus in South East Asia and particularly in Indonesia has also been addressed as a matter of concern. The Indonesian delegation mentioned that besides all efforts undertaken in the control and the management of the disease, a lot of action was still to be done and appealed for further international assistance. Decentralization of Veterinary Services remains one of the main obstacles to be overcome in order to address the situation in this country. The conference agreed that even though there was still an important need for political commitment, a real progress had occurred in the control of the animal disease in several countries which accepted to follow the recommendations of intergovernmental organizations such as OIE and FAO and in the elaboration by countries of national human pandemic preparedness plans. Dr Bernard Vallat of the OIE stated that resources pledged in Beijing had to be transferred very soon. “The evaluation of the financial needs presented by the OIE in Beijing to control avian influenza at its animal source worldwide are still the same, except for Africa” he said. “As of today, the OIE only received 32% of the total needs. Other intergovernmental organizations are in a similar situation. The political commitment worldwide is crucial if we really want to achieve our goals”.
Pan-Europe: Revised ECDC Risk Assessment
The European Centre for Disease Prevention and Control (ECDC) Technical Report, entitled ECDC Risk Assessment, has been recently revised and can be accessed at http://www.ecdc.eu.int. The ECDC risk Assessment provides a balanced and detailed account of current understanding of the HPAI avian influenza outbreak in animals and humans. It highlights the need for governments to intensify preparations against a possible influenza pandemic. While the assessment concludes that "bird flu," in its present form, presents only a low risk to humans, it expresses concern about the spread of H5N1 among birds in Asia and Africa. Developments in recent months mean that more humans than ever are being exposed to the virus, increasing the possibilities for the virus to adapt or mutate into a human pandemic virus.
ECDC's new risk assessment points out that, because of its occasional presence in wild birds, Europeans may have to adapt to the fact that H5N1 will remain one of the zoonoses present on the continent. It finds no evidence that H5N1 has become any better adapted to humans than it was in 1997, when the virus first emerged. The few humans who become infected do so only when exposed to high doses of the virus. People who keep poultry near where they live need to be aware of the risk from H5N1 and how to protect themselves. In addition, some precautions need to be taken to protect people such as vets and poultry farm workers. However, the overall level of risk to the public in Europe from "bird flu" in its current form is lower than for many other infections that can pass from animals to humans. As of yet, there have been no human cases of H5N1 in the European Union. The major cause for concern about H5N1 "bird flu" is its potential to mutate or adapt into a human pandemic virus. There is no way of knowing whether or when this might happen. However, the increased exposure of humans to H5N1 resulting from its spread across Africa and Asia multiplies the opportunities for it to adapt or mutate, if it has that capability. This increased exposure raises the importance of preparing for a pandemic. Even if a pandemic caused by "bird flu" never occurs, the same preparations will protect against other pandemics. 3 influenza pandemics occurred in the 20th century. It is highly likely that another pandemic will occur at some point in the coming years.
Denmark: Excerpts from the OIE report on low pathogenic avian influenza H5
Greece: Update on avian influenza surveillance findings
Romania: Poultry culled after report of another avian influenza outbreak
Pan-Asia: APEC Pandemic Response Exercise 2006
Asia-Pacific Economic Cooperation announced it will conduct an exercise Jun 7 to test the economies’ response to an avian flu pandemic. The desk-top simulation exercise is called "APEC Pandemic Response Exercise 2006”. All 21 member economies will take part to test and strengthen regional communication networks in the event of an influenza pandemic. 8 APEC member economies have elected to be ‘primary’ participants – Chile, China, Indonesia, Japan, Korea, Malaysia, Chinese Taipei and Viet Nam. The others members will participate as secondary players. The exercise, to be coordinated by Australian officials (with Singapore as co-facilitator), will involve a hypothetical scenario in which the H5N1 virus is spreading easily between people. The focus of the exercise is regional, and not domestic. It will not involve domestic decision-making on the detail of disease control such as vaccine distribution, deployment of experts and repatriation of citizens from other countries, as these are matters which can be best tested through internal domestic exercises.
The APEC Pandemic Response Exercise was endorsed at the annual Leaders’ Meeting in Busan Nov 2005 as part of the APEC Initiative on Preparing for and Mitigating an Influenza Pandemic. The initiative committed APEC economies to maintaining effective surveillance, transparency and openness, as well as close coordination and collaboration. The exercise scenario envisages human-to-human transmission of an influenza virus that has mutated from avian influenza, escalating to pandemic level. The main objectives of the exercise are to test emergency responses and communication channels among APEC member economies, in particular their effectiveness in sharing information and providing regional assistance and advice to bordering economies and other regional partners. At the end of the exercise, detailed debriefs and evaluations will be conducted covering lessons learned, recommendations for improvement and possible next steps. A number of international organisations, including WHO, the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE) will observe the exercise and participate in a debriefing session in August.
China: Dead poultry attributed to avian influenza H5N1; transparency concerns
After covering up the severe acute respiratory syndrome (SARS) epidemic in early 2003, the central government of China now is said to be taking a more positive, open attitude in dealing with avian influenza. But that hasn't filtered down to the provinces. As the market economy has taken root in China, the country has become increasingly decentralized. Because of this, Beijing's tough orders regarding the prevention of a bird-flu outbreak may not necessarily be carried out at all levels. Overwhelmingly concerned with economic growth, some local officials still tend to cover up any outbreak of bird flu, defying Beijing's order to report new cases immediately. Beijing has punished some local officials for their incompetence in dealing with bird-flu outbreaks. But during an investigative reporting trip to Yangzhou, Chuzhou and Chenzhou, Asia Times Online found that in rural areas, local officials and residents really don't like any action that might expose a possible bird-flu outbreak, fearing the damage it would do to the economy.
Indonesia: 4 suspected human cases of H5N1 infection test negative
The 2 additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. 1 of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness 1 Jun 2006. Test results received were negative for H5N1 infection. The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all 4 nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.
Indonesia: 49th human case of avian influenza H5N1 infection
USA: CDC updates advice on avian influenza testing, lab work
CDC released updated guidelines that provide more details on when to test a patient for the H5N1 avian influenza virus, as well as substantially more specifics on laboratory testing. In the revised guidelines, CDC also recommends that H5N1 avian flu surveillance in the US remain the same, saying the epidemiology of human cases has not changed significantly since the agency issued recommendations on surveillance Feb 2004. The guidelines are titled "Updated Interim Guidance for Laboratory Testing of Persons with Suspected Infection with Avian Influenza A (H5N1) Virus in the United States" (http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00246 ). The new guidelines recommend lab testing for a patient whose illness is associated with all of the following: (1) hospitalization or death; (2) a fever of 100.4F or higher; (3) radiographically confirmed pneumonia, acute respiratory distress syndrome, or other severe respiratory illness; and (4) potential exposure within 10 days of symptom onset. CDC lists potential exposure as any of the following: 1) History of travel to a country with documented H5N1 in poultry, wild birds, or people and, during travel, at least one potential exposure (e.g., contact with sick or dead domestic poultry, consumption of incompletely cooked poultry, or close contact with a person who was hospitalized with a severe, unexplained respiratory illness); 2) Close contact (within about 3 feet) of a sick person who was confirmed or suspected to have H5N1 or; 3) Working with live influenza H5N1 in a laboratory.
In addition, the new guidelines recommend considering testing for a patient with: (1) mild or atypical disease (e.g., respiratory illness and fever that does not require hospitalization, or significant neurologic or gastrointestinal symptoms in the absence of respiratory disease) and one of the exposures in the list above, or (2) severe or fatal respiratory disease whose epidemiologic information is uncertain, unavailable, or otherwise suspicious. The new guidelines expand substantially on previous CDC guidelines, which called for testing for patients who have the radiographically confirmed severe respiratory illnesses listed above as well as a history of travel to a country where H5N1 infection has been documented. The CDC update also provides greatly expanded recommendations for specimen collection and testing. The update reiterates that the public need not avoid travel to countries affected by H5N1. However, its advice remains that travelers to these countries should avoid poultry farms, bird markets, and other places where poultry is kept.
USA: Vical Inc. gets funds for work on avian influenza DNA vaccine
DNA vaccines use small pieces of the target pathogen's genetic material instead of a killed or weakened form of the whole pathogen. Vical says it makes DNA vaccines with simple bacterial fermentation methods that may allow rapid production of large amounts. David C. Klaslow, MD, Vical's chief scientific officer, said the company's DNA flu vaccines "have performed remarkably well in animal challenge studies, and this accelerated access to funding allows us to move forward ahead of our original schedule, which is quite important given the imminent threat posed by pandemic influenza." The company has been collaborating with St. Jude Children's Research Hospital in Memphis. In reporting the results of animal experiments, the company said its 3-component vaccine fully protected mice and ferrets against death and weight loss after exposure to an H5N1 virus, whereas animals that received a control vaccine all died. The 3-component vaccine targeted one of the virus's variable surface proteins and two conserved core proteins, the company said. The company also said it tested DNA vaccines targeting only the two conserved viral proteins. In that study, 14 of 16 mice in each of two vaccine groups survived with moderate weight loss. "The study is the first to provide evidence that a vaccine targeting conserved influenza virus proteins without matched surface proteins can provide protection against such a highly virulent H5N1 flu strain," the company said. The firm also said the same vaccine formulation protected animals against two strains of human influenza in a previous study. "A vaccine that provides cross-protection against more than one strain of flu is important for addressing a pandemic flu threat because it is likely that the H5N1 virus could mutate before it becomes transmissible from human to human," said Richard Webby, PhD, of St Jude Children's Research Hospital.
Egypt: Update on avian influenza H5N1 situation; import of avian influenza vaccines
The Egyptian Ministry of Health maintains a special avian influenza web-site (http://birdflu.sis.gov.eg ), which has been updated almost on daily basis since the beginning of the H5N1 outbreak in Egypt, Feb 2006. On 2 Jun 2006, the ministerial committee has been continuously monitoring and reviewing developments as follows: First: 16 samples of humans from Meniya, Beheira and Sohag, who had been in contact with dead birds, employed at farms where infections had been detected or showed symptoms similar to that of avian flu, were tested; all samples tested negative. Second: Daily report on the spread out of bird flu among birds: Sohag: 1 positive case was detected in a farm in the districts of (El Manshaa), an area that had previously reported infections. All fowls at the site were culled and all persons involved were tested. No cases among the birds has tested positive to H5N1 in the rest of the governorates so far.
On 25 May 2006, some 7 tonnes of bird flu vaccine reportedly arrived at Cairo International Airport for bird inoculation. The veterinary quarantine authorities at the airport tested the Mexican vaccines, coming via Paris, and handed them over to an international company on vet trade cooperation for transferring it to a number of Egyptian governorates. Reportedly, according to Cairo airport quarantine sources, the shipment contains H5N1 and H5N2 vaccines.
Djibouti: Excerpts from the OIE report on avian influenza H5N1
Niger: New avian influenza outbreak near Nigeria
Avian/Pandemic influenza updates
- WHO: http://www.who.int/csr/disease/avian_influenza/en/index.html. Includes the updated document, “WHO pandemic influenza draft protocol for rapid response and containment.”
- UN FAO: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html. Now available: FAO statement and presentation illustrating the funding requirements and donor funding situation for FAO’s avian influenza programme (presented to the Vienna Donors Meeting, 6-7 June 2006).
- OIE: http://www.oie.int/eng/en_index.htm. Read about the upcoming Asian European Conference on Avian Influenza 2006 (29-30 June 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/. Secretary Mike Leavitt, Department of Health and Human Services, recently addressed Central American Health Ministers on pandemic preparedness and held a tele-news conference on U.S. preparations for avian influenza with Secretary Johanns (USDA) and Special Assistant to the President, Dr. Rajeev Venkayya.
- CIDRAP: http://www.cidrap.umn.edu/. Frequently updated news and scholarly articles.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm. Read the article, “Americas Make Progress on Pandemic Preparedness”.
- American Veterinary Medical Association: http://www.avma.org/public_health/influenza/default.asp.
- US Geological Survey, National Wildlife Health Center Avian Influenza Information: http://www.nwhc.usgs.gov/diseaseinformation/avianinfluenza/index.jsp. Very frequent news updates.
(WHO; FAO, OIE; CDC; CIDRAP; PAHO; AVMA; USGS)
CDC EID Journal, Volume 12, Number 6—Jun 2006
CDC Emerging Infectious Diseases Journal, Volume 12, Number 6—Jun 2006 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. Several influenza-related articles are available: 1) “Host Range Restriction and Pathogenicity in the Context of Influenza Pandemic”, G. Neumann and Y. Kawaoka. 2) “Preventing Zoonotic Influenza Virus Infection”, A. Ramirez et al. 3) “H5N1 Influenza A Virus and Infected Human Plasma”, S. Chutinimitkul.
Science and Technology Adviser to the Secretary of State to address Second Bird Flu Summit
New Fields Exhibitions announced that the Science and Technology Adviser to the Secretary of State, Dr. George Atkinson, will deliver a key presentation at the Second Bird Flu Summit in Washington, DC, June 28-29, 2006. Joining the Department of State in 2001, Dr. Atkinson continues efforts to strengthen the Department of State’s scientific capacity by increasing the number of scientists in the Department, introducing new anticipatory, proactive programs and developing key domestic and international science and technology relationships. New-Fields also announced that Dr. Sardikin Giriputro, Hospital Deputy Head, Sulianto Saroso Hospital for Infectious Diseases, and Dr. Hariadi Wibisono, Director of Vector-Borne Diseases Control Program Division of Indonesia will be providing up-to-date presentations on the status of the current human cases of Avian Influenza. In addition, the Summit will be featuring other lead speakers such as the Department of Homeland Security’s Special Assistant to the Under Secretary for Preparedness, Robert Zitz. The summit will also be featuring speakers from overseas, including country reports from Egypt, Turkey, and Russia. The first conference was received with featuring lead experts: Dr. David Nabarro - U.N. System Senior Coordinator for Avian Influenza; and Koos Van der Velden - Chairman, European Influenza Surveillance Scheme. Topics for discussion in the second summit include: Economy Report and Situation Updates, Surveillance and Data Management, Preparing Communities Strategies, Local Partnership and Participation, Vaccine Delivery, Emergency Response and Hospital/Health Care Coordination, and more. To obtain further information, call 202.536.5000 or visit http://www.new-fields.com. New Fields Exhibitions, Inc. is a leading emerging markets and business information provider, producing trade shows that produce results for companies worldwide.
(New Fields Exhibitions 6/5/06, 6/7/06)
4. APEC EINet activities
APEC EINet team to participate in Pacific Health Summit
The APEC EINet team will be participating in the Pacific Health Summit, in the Emerging Infections/Pandemics Workgroup (publication now available online). The Summit will be held in Seattle, USA, 20-22 Jun 2006. The APEC EINet team had also participated in the Health Information Technology and Policy (HIT) Workgroup, in April 2006 in Tokyo, Japan. For more information, visit: http://pacifichealthsummit.org/