EINet Alert ~ Jun 09, 2006

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)
Djibouti / 1 (0)
Egypt / 14 (6)
Indonesia / 32 (26)
Iraq / 2 (2)
Turkey / 12 (4)
Total / 81 (52)

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 225 (128).
(WHO 6/6/06 http://www.who.int/csr/disease/avianinfluenza/en/ )

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Global: Global avian influenza pledge money slow to arrive
Key global organizations that are fighting the battle against avian influenza may have to cut some programs, because only $286 million of the $1.9 billion pledged by 34 countries in Jan 2006 has been delivered. Only Japan ($158 million), Switzerland ($4.7 million), Finland ($3.4 million), and the Czech Republic ($200,000) have contributed all the funds that they had pledged during donor conference in Beijing in January. The US has delivered on $71 million of its $334 million pledge. All the figures are from a World Bank donor survey and draft report that was written for the Influenza Partners' Senior Officials Meeting (see following article). The slow response in fulfilling pledges to fight avian flu may mean that key organizations receiving the funding—such as the UN Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and WHO—may need to cut back on their efforts. "The WHO, and, to a lesser extent, the FAO, are so strapped for cash that it's going to be very difficult for them to maintain the current level of response to urgent calls for help from countries trying to control H5N1," said UN senior coordinator for avian and pandemic influenza, David Nabarro. WHO has received about $20 million of $77 million pledged. Speaking of the WHO's recent responses to human H5N1 outbreaks in Azerbaijan, Egypt, Iraq, Djibouti, and Indonesia, WHO senior adviser Paul Gully said, "The ability to maintain that level of response with that sophistication with that number of experts is going to be a challenge." And without adequate funding, OIE will be forced to pare back its activities, such as training government officials. Reportedly, the nations due to receive the largest amounts of promised funds, according to the World Bank, are Vietnam ($66 million), Indonesia ($55 million), Nigeria ($51 million), Turkey ($46 million), and Cambodia ($23 million).
(CIDRAP 6/5/06 http://www.cidrap.umn.edu/ )

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Global: SOM meeting on avian influenza and human pandemic preparedness
The Senior Official Meeting on Avian Influenza and Human Pandemic Preparedness ended in Vienna after 2 days of work. Co-organized by the European Commission, USA, the People's Republic of China and the Austrian EU Presidency, the principal aim of the meeting was to confirm the financial resources already pledged at the Beijing conference earlier this year. The OIE, together with FAO and WHO presented an up-date on the needs and financial gaps that are still to be filled in order to be able to control the disease. The OIE together with the FAO and the AU-IBAR (Inter-African Bureau for Animal Resources of the African Union) particularly stressed the need for the international community to take rapid action in the control of the evolving animal situation in Africa. Supported by the World Bank, together with key donors, the OIE/FAO/AU-IBAR and all African institutions involved in the control of animal diseases, the ALive Platform has been identified as an optimal coordination mechanism by all participants in the prevention and control of avian influenza in Africa. The AU and the OIE also called for the next pledging conference to be held in Africa in autumn. ALive experts calculated that at least further 700 million US dollars would be needed mainly to focus on the short and medium term control of the situation in Africa.

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”.
(OIE 6/7/06 http://www.oie.int/eng/press/en_060607.htm )

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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.
(Promed 6/5/06)

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Denmark: Excerpts from the OIE report on low pathogenic avian influenza H5
Information received 2 Jun 2006 from Dr Preben Willeberg, Chief Veterinary Officer, Danish Veterinary and Food Administration: Identification of agent: low pathogenic avian influenza virus subtype H5. Date of start of event: 1 Jun 2006. An outbreak of low pathogenic avian influenza virus subtype H5 has been reported in a hatchery for farmed game birds (mallards), ducks and geese at Tommerup in Funen county. There were approximately 19 750 mallards (day-old to 5-weeks-old), 1200 [other] ducks (day-old to 2-weeks-old) and 1600 geese (day-old to 5-weeks-old). There were also 6 adult geese and 14 adult ducks. The diagnosis was made using PCR test and sequence analysis. The holding is located within the already existing "area B" (covering Funen county), which has been in place since 18 May 2006. The Danish Veterinary and Food Administration is setting up a 1 km-radius restricted zone around the holding and implementing the necessary measures in accordance with European Union.
(Promed 6/6/06)

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Greece: Update on avian influenza surveillance findings
Almost 5000 birds in Greece were checked for bird flu between Sep 2005 and May 2006, but none tested positive for the disease, which can be fatal for humans, scientists said 3 Jun 2006. The animals included wild birds and poultry bred for food. The samples tested at the Institute for Infectious Diseases in Thessaloniki were taken from live as well as dead birds. 3 dead swans from northern Greece had tested positive for the H5N1 strain disease Feb 2006, the first discovery of the virus in Greece. This was followed by tens of other positive tests, but no humans have been affected in Greece so far. The outbreak of the disease, however, had a damaging effect on the country's poultry industry. "All the positive tests were in migrating wetland fowl," the head of the Greek Veterinary Society, Spyridon Kyriakis, said. (The "tens of other positive tests" refers to the additional records of swans and red-breasted geese reported from various areas in Greece subsequent to initial detection of 3 swans in Thermaikos.)
(Promed 6/6/06)

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Romania: Poultry culled after report of another avian influenza outbreak
The latest site with the H5N1 bird flu in Romania was confirmed to be just 40 km away from the northern Bulgarian border, in Gurgevo province. The site with detected infection is near the village of Balbukata, and Romanian authorities are affirming it has been disinfected. Reportedly, the settlement is under quarantine and some 800 birds were culled.
(Promed 6/8/06)

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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.
(APEC http://apec.org/ ; CIDRAP 6/6/06 http://www.cidrap.umn.edu/ )

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China: Dead poultry attributed to avian influenza H5N1; transparency concerns
China has discovered a new H5N1 bird flu case in poultry in the western Xinjiang Uygur Autonomous Region, the Ministry of Agriculture (MOA) said 7 Jun 2006. The case was identified after domestic poultry at a farm in Xinjiang's Hetian County died of an unclear illness. The dead poultry were confirmed to have been infected with the bird flu virus after testing at the national bird flu laboratory. The MOA has sent expert teams to Hetian to control any possible outbreak. An emergency mechanism has been launched and the local veterinary departments have set up examination stations to disinfect people and vehicles into and out of the affected area.

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.
(Promed 6/8/06)

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Indonesia: 4 suspected human cases of H5N1 infection test negative
As of 6 Jun 2006, for the past 4 days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in 4 nurses who were involved in the care of confirmed H5N1 patients. Test results have now convincingly ruled out H5N1 infection in all 4 nurses. 2 of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. 1 nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

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.
(Promed 6/6/06)

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Indonesia: 49th human case of avian influenza H5N1 infection
As of 6 Jun 2006, the Ministry of Health in Indonesia has confirmed the country's 49th case of human infection with the H5N1 avian influenza virus. The case occurred in a 15-year-old boy from Tasikmalaya District, West Java Province. He developed symptoms 24 May 2006, was hospitalized 26 May, and died 30 May. An investigation conducted by provincial health authorities found a history of contact with sick and dying chickens in the boy's household in the week before the onset of his symptoms. Monitoring of family members and close contacts has detected no cases of influenza-like illness. Of the 49 cases confirmed to date in Indonesia, 37 have been fatal. The H5N1 virus is considered firmly entrenched in poultry throughout much of Indonesia. Unless this situation is urgently and comprehensively addressed, sporadic human cases will continue to occur. The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviours that should be avoided.
(Promed 6/6/06)

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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.
(CIDRAP 6/8/06 http://www.cidrap.umn.edu/ )

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USA: Vical Inc. gets funds for work on avian influenza DNA vaccine
Vical Inc. announced it would receive early access to $2.6 million in government funds to help it complete preclinical development of a DNA vaccine for avian influenza. Last September the National Institute of Allergy and Infectious Diseases (NIAID) awarded the company a $2.9 million challenge grant to develop the vaccine. In May the company reported the vaccine had protected mice and ferrets against a highly virulent strain of H5N1 avian flu virus and had protected mice against multiple human flu strains. On the basis of those results, the National Institutes of Health notified Vical that it had achieved the second milestone required under the challenge grant. The new funds will be used to finish preclinical work on the vaccine and apply to the US Food and Drug Administration for permission to launch a phase 1 clinical trial, the company reported. The firm is seeking additional funds to support the phase 1 trial.

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.
(CIDRAP 6/7/06 http://www.cidrap.umn.edu/ )

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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.
(Promed 6/4/06)

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Djibouti: Excerpts from the OIE report on avian influenza H5N1
Highly pathogenic avian influenza has never been reported before in Djibouti. Information received 27 May 2006 from Dr. Moussa Ibrahim Cheick, Director of Agriculture, Livestock and Veterinary Services, Ministry of Agriculture, Livestock and Sea: Identification of agent: avian influenza virus subtype H5N1 (the virus pathogenicity index has not been provided). Date of start of event: 6 Apr 2006. Details of outbreak: a farm in the commune of Boulaos had 4 cases -- all of which died -- out of 22 birds. The remaining birds were slaughtered. Description of affected population: local poultry in an industrial zone of Boulaos. Laboratory where diagnostic tests were performed: NAMRU-3 (Naval American Medical Research Unit), Cairo, Egypt. Source of outbreak or origin of infection: unknown or inconclusive. Details of the specific type of test or tests upon which a diagnosis of disease was based was not included in this official report.
(Promed 6/4/06)

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Niger: New avian influenza outbreak near Nigeria
Scientists have confirmed a new outbreak of H5N1 bird flu in southern Niger, near the border with Africa's most populous country, Nigeria, a senior local government official said 2 Jun 2006. Tests carried out in Europe confirmed the presence of H5N1 in samples taken from the village of Boko Mai Gao, around 10 km from the border with Nigeria's Kano state. The discovery comes 3 days after Niger, landlocked and among the poorest countries on earth, described its epidemiological situation as "calm." The H5N1 strain of bird flu was first confirmed in Niger late Feb 2006, but it took until Apr 2006 to start culling poultry in the affected areas. Scientists worry that poor health and veterinary systems in Africa could allow the virus to spread undetected among millions of domestic fowl living in houses and back yards. Several countries in West Africa, including Nigeria and Burkina Faso, have confirmed outbreaks of the H5N1 bird flu, but so far no cases have been detected among humans there.
(Promed 6/5/06)

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